Health Insurance Coverage of California’s Working Latinos Howard Greenwald Suzanne O'Keefe Mark DiCamillo University of Southern California California State University, Sacramento The Field Institute Research supported by the California HealthCare Foundation

Facts About Health Insurance Among Latinos According to the National Center for Health Statistics, 34% of non-elderly Latinos nationwide do not have health insurance, twice the national average. In California, 41% of Latino adults under age 65 do not have health insurance Most California Latinos without insurance are employed, or live in households headed by someone employed. The purpose of this survey is to understand specific causes of this lack of health insurance among the employed Latino population.

About the Survey Statewide survey of 1,000 employed California Latinos conducted by The Field Institute. Interviewing completed January 27–February 17, 2001 by telephone in English and Spanish. Sampling carried out using a random digit dial methodology, screening for Latino adults who are employed full or part-time. About half of the interviews were conducted in English and half in Spanish.

Differences Between Employed California Latinos and the Overall California Labor Force Industry Type: About half (47%) are employed in retail trade, manufacturing or construction, almost twice the statewide average. Tenure: About half (47%) have worked for their current employer for two years or less, compared to 39% among the overall CA labor force. Company Size: About h alf (49%) work for small businesses employing fewer than 50 employees, compared to 37% among all employed Californians. Educational Attainment: One in three (33%) do not have a high school degree, more than twice the proportion found in the overall CA labor force.

Source of Health Insurance Among Employed California Latinos and Their Children Employed CA Latinos with Children under age 18 (n = 566) 24% Uninsured 26% Medi-Cal/ Healthy Families 47% Employed- based 4% Other Employed CA Latinos (n = 1,000) 31% Uninsured Medi-Cal 8% 56% Employed- based 5% Other

Reasons Offered by Employed CA Latinos for Not Having Health Insurance Costs too much Not offered by employer Deductibles/ co-payments too high Healthy and don’t need it Prefer to pay for health care directly Trouble understanding plans, completing forms Have access to free, inexpensive care Benefits with former employer ran out (n for each = 299 employed Latinos without health insurance)

Reasons Given By Employed CA Latinos with Children for Not Having Health Insurance for Their Kids Too expensive Trouble understanding plans, completing forms Employer doesn’t provide insurance Don’t know where to get insurance for kids Prefer paying for health care directly Child not eligible for any coverages (n for each = 133 employed Latinos with uninsured children) Don’t need insurance Afraid to apply because it might affect immigration status

Previous Health Insurance Among Employed CA Latinos Currently Without Health Coverage Employed CA Latinos without Insurance (n = 299) 23% More than 3 years ago 12% Within past year 44% Never insured 18% 1-3 years ago 3% Not reported

Access to Employer-based Health Insurance Among Employed CA Latinos Without Health Coverage Employed CA Latinos without Insurance (n = 299) 67% No insurance offered 28% Employer offers coverage for job type Not reported 5%

Reasons Given by Employed CA Latinos Without Insurance Whose Income is <200% of FPL and Who Have Not Applied for Government-Sponsored Health Insurance Don’t know where to apply It costs too much Don’t need insurance Don’t think I’m eligible Don’t understand plans/ have trouble with forms Don’t have the time Don’t want to give out personal info to government (n for each = 117 employed CA Latinos without insurance whose income is < 200% of FPL and who haven’t applied for government health insurance)

Percent Insured: Stratified by Income and Years in the United States

Percent Insured: Stratified by Education and Years in the United States

Percent Insured: Stratified by Ethnicity and Years in the U.S. (March CPS)

Percent of Latinos Insured In Each Sector

Who is Most Likely to Have Insurance? People who work for larger firms Older Latinos Latinos with higher family income Citizens, and those who have been in the United States longer Managers * Results based on probit regressions of age, marital status, number of children, education, income, size of firm, citizenship status or time in the US, type of employment, and other characteristics on the probability of being insured. Relationships highlighted here are significant at the 5% level.

How Much More Likely Are They Insured? Probability of insurance is 15 percentage points higher for people who work for firms with more than 500 employees. Probability of insurance rises 3 percentage points if age increases by 10 years. Probability of insurance rises 10 percentage points if income rises by $10,000. Probability of insurance is 13 percentage points higher for citizens, and 15 percentage points higher for those who have been in the United States more than 20 years. Probability of insurance is 12 percentage points higher for managers

Characteristics of Those Who Choose Not to Enroll in Employer’s Plan

Children of Employed Latinos 76% of employed Latinos with children have insurance for their children. 33% of these families insure their children through Medi-Cal or Healthy Families.

Share of Families With Children Covered Through Medi-Cal or Healthy Families

Share of Families With Uninsured Children Who Don’t Know Where to Get Insurance

Conclusions Many working Latinos cannot afford health insurance. Latino workers often hold jobs that do not offer health insurance. Cultural differences, language skills, and recent immigration to the United States all contribute to low levels of insurance. Length of time in the United States is a strong predictor of insurance status, implying that acculturation may lead to higher levels of insurance.

Innovative Policy Due to the unique nature of this large population in California, innovative policy solutions are needed to meet the health care needs of employed Latinos. Solutions must address cost and access, but this is not sufficient. Cultural barriers limit use of insurance even if it is affordable, so cultural friendliness of health care organizations should be addressed. Improving access to information about insurance programs and simplifying the application process is also necessary.