News Analysis: Latinos Feel Brunt of Job-Based Insurance Drop By HILARY ABRAMSON Pacific News Service
If every working California adult is “headed over the cliff” for lack of affordable health insurance, as the co-author of a new statewide study contends, then Latinos will be the first to go.
California has no racial/ethnic majority, but according to the report by the UCLA Center for Health Policy Research, the burden from “crumbling” employer-based insurance is shared unevenly. Non-Hispanic whites continue to have the highest—and Latinos the lowest—rates of job-based health insurance coverage.
“If the Latino population weren’t so damned healthy, the cliff would have collapsed by now,” says Dr. David Hayes-Bautista, professor of medicine and director of the UCLA Center for the Study of Latino Health, which was not involved in the study.
More than 6.5 million Californians under the age of 65—more than one in five—lack health insurance, according to the study that covers 2001-2003. The figure includes nearly one million children. E. Richard Brown, the study’s co-author and director of the health policy center, reports that the cost of job-based family health insurance coverage escalated nearly 80 percent in the past few years.
Contrary to stereotype, nearly two-thirds of the state’s uninsured children have parents with full-time jobs. But many employers have passed on the escalating costs by cutting benefits for spouses and children. Those seeking private health insurance may find lower premiums, but usually have higher deductibles and, according to Brown, “skimpy” coverage.
“I think that the trends we’re seeing are a clear indication that we are all headed over the cliff in not being able to afford health insurance coverage for ourselves and our families,” Brown concludes.
According to this latest analysis of insurance in California, dependents cut from employer rolls and unable to afford private insurance have turned to state, federal and expanded county programs. The study, which was funded by the California Endowment and the California Wellness Foundation, does not estimate additional costs to government for use of its programs.
Nowhere does the study’s message hit harder than in California’s racial and ethnic communities. Non-elderly Latinos and American Indian/Alaska Natives report the highest rates of non-insurance. While 66.6 percent of non-Hispanic white workers report having employment-based health coverage, only 34 percent of Latino workers were similarly insured—the lowest rate among all groups. In 2003, Latinos had the highest rates of non-insurance, with one in three uninsured for some or all of the year. One in four of American Indians/Alaska Natives was uninsured during some or all of 2003; most of them do not have access to Indian Health Service medical clinics or hospitals, which are available only on tribal lands.
Shana Alex Lavarredo, the other author of the study, says the disparity in job-based health insurance is due to issues of citizenship, education, and lower-paying service, retail and restaurant jobs—all of which work against California’s Latino population. Just 37 percent of non-citizens with green cards are covered by employer-offered insurance, according to the report.
“There is something peculiar about California that wasn’t a part of our research,” Lavarredo says. “If you’re a non-citizen Latino here, you’re less likely to have employers offer health insurance than you might from employers for the same job in another part of the country.”
Anthony Wright, executive director of the consumer health organization Health Access, thinks he knows why. “In California, there is a strong correlation with immigrant status and employers thinking they might get away without providing benefits. Regional culture matters. Look at Minnesota, which has one of the highest rates of employer-based insurance in the nation. It’s a combination of factors—unionization and employers having the expectation that they will offer health care.”
Even small business Latino owners who employ Latinos are caught in a bind of rising health insurance rates, according to Dr. Hayes-Bautista.
“Small business owners are classically contracting out for things like janitorial services,” he says. “Did you know that when Social Security was set up, some jobs held by poor blacks in domestic service and poor whites in agriculture were exempted? Now, Latinos are filling these. One has to wonder if California is ahead of the country in the race to the bottom....”
Minnesota doesn’t get caught up in the California conversation over immigration and its impact on health coverage, adds the doctor.
“There’s this absolutely ludicrous notion in the West that we have 10 million undocumented immigrants clawing at the emergency rooms. What people don’t know is that Latino immigrants have better behaviors than U.S.-born Latinos. Immigrants smoke and drink less and are more likely to be married and have fewer sexually transmitted diseases. There are tremendous pressures in the United States to change these good behaviors.
“Right now, Latinos see doctors and stay in hospitals far less and have less expensive procedures than other groups. And they still live five years longer than non-Hispanic whites. But how long can that last?”
In Beverly Hills, there are 2,022 physicians for every 100,000 people, according to Hayes-Bautista.
“In Bell—a mainly Latino community about 20 miles away—there are 19 physicians for every 100,000 people. Even if Latinos had insurance, where will they go? Getting insurance is only part of the solution for them.”
Hilary Abramson is a Pacific News Service contributing editor and the recent recipient of a grant from the Fund for Investigative Reporting for health reporting.