Helping hand of employers offering access to health care pulls back to its own pocket
Helping hand of employers offering access to health care pulls back to its own pocket
While there are many reasons Americans often go about their lives without health insurance, a recent study places the majority of the blame on companies that do not offer employer-based health care coverage.
Couple the lack of employer-based coverage with high proportions of immigrants in metropolitan areas of the United States and the results are high levels of uninsured people, according to the study, which was conducted by the University of California, Los Angeles Center for Health Policy Research, with a grant from The Commonwealth Fund. The study was launched to examine health insurance coverage and access to health care among moderate- and low-income, nonelderly residents.
"There are incentives for employers to cut back on their coverage," Cathy Schoen, vice president of research and evaluation at The Commonwealth Fund, tells State Health Watch. "But it is good labor policy to offer decent wages and benefits. Those employees have fewer sick days and more loyalty."
The study looked at 85 metropolitan areas and found that health coverage rates vary widely, with only 7% of the population uninsured in Akron, OH, and Harrisburg, PA, and rising to a high of 37% in El Paso, TX. The variation among areas with employer-based coverage is also high. In Milwaukee, 84% of employers offer coverage, while in El Paso, it was only 49%.
Uninsured and Job-based Coverage Rates | |||
The urban areas with the highest and lowest uninsured rates and rates of job-based coverage among all income levels, ages 0 to 64 |
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Highest uninsured rates: | |||
1. | El Paso, TX | 37% | |
2. | Jersey City, NJ | 36% | |
3. | Los Angeles | 31% | |
4. | Houston | 30% | |
5. | West Palm Beach, FL | 29% | |
6. | Miami | 27% | |
New York City | 27% | ||
7. | Fort Lauderdale, FL | 26% | |
Phoenix-Mesa, AZ | 26% |
Highest rates of job-based coverage: | ||
1. | Milwaukee | 84% |
2. | Harrisburg, PA | 83% |
3. | Cincinnati | 82% |
4. | Akron, OH | 81% |
5. | Ann Arbor, MI | 80% |
6. | Albany, NY | 78% |
Greenville, SC | 78% | |
Minneapolis | 78% | |
7. | Charlotte, NC | 77% |
Indianapolis | 77% | |
Middlesex, NJ | 77% | |
Omaha, NE | 77% |
Lowest uninsured rates: | ||
1. | Akron, OH | 7% |
Harrisburg, PA | 7% | |
2. | Honolulu | 8% |
Milwaukee | 8% | |
3. | Ann Arbor, MI | 9% |
4. | Minneapolis | 10% |
Omaha, NE | 10% | |
5. | Allentown, PA | 11% |
Norfolk, VA | 11% | |
Pittsburgh | 11% | |
Youngstown, OH | 11% |
Lowest rates of job-based coverage: | ||
1. | El Paso, TX | 49% |
2. | Los Angeles | 50% |
New York City | 50% | |
3. | Bakersfield, CA | 51% |
Jersey City, NJ | 51% | |
Miami | 51% | |
4. | Tucson, AZ | 55% |
5. | Fresno, CA | 56% |
6. | Riverside- | |
San Bernardino, CA | 57% | |
Tampa, FL | 57% | |
Source: UCLA Center for Health Policy Research. Current Population Survey. Los Angeles; 1998. |
"High uninsured rates in urban areas correspond directly to low rates of employment-based health insurance," asserts E. Richard Brown, director of the center at UCLA School of Public Health, and the report’s lead writer. "No matter where they live, people with moderate and low incomes are much less likely than more-affluent people to have job-based coverage. The disparity is greater, however, among the less advantaged living in low-coverage areas, particularly Latinos and noncitizens."
The state’s role in softening the burden of those without health insurance is crucial to the mix, according to Mr. Brown. "Given similar economic conditions, a particular community is likely to have a lower uninsured rate if the state has more generous eligibility requirements for Medicaid and other public health insurance programs."
Ms. Schoen agrees, adding that cities and counties have a limited ability to cover the uninsured and that most urban areas cannot afford to help out like the state does. Those metropolitan areas with the highest rates are also less likely to take advantage of all the available options under Medicaid and CHIP, she says.
Helping stem the erosion of employer-based coverage among the populations that were studied, adds Ms. Schoen, are households that now have two workers. "Everyone in the household working full time has helped stem what would have been a drop in employer-based coverage," she says, adding that rising health insurance premiums have also been a burden on people’s decision to add insurance coverage for their families.
The study also found:
• Among residents with incomes below 250% of the poverty level (less than $32,000 for a family of three), uninsured rates vary from 11% in Honolulu to 50% in El Paso.
• The uninsured are much less likely to have a regular source of health care or to have seen a physician in the last year. They also are much more likely to delay seeking care.
• Residents of cities with high uninsured rates generally have a harder time getting the health care they need than those living in cities with relatively low uninsured rates. The negative impact of high uninsured rates affects individuals with moderate incomes well above the poverty level.
According to the study, the average uninsured rate for the 85 metropolitan areas is 19%. Twelve of the 85 areas had higher than average rates, including New York City at 27%, Los Angeles at 31%, and Houston with 30%. An almost equal number had uninsured rates that the study labeled as "substantial," including Milwaukee at 8%, Minneapolis at 10%, and Norfolk, VA, at 11%.
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