access to care: latinos & the u.s. economy
TRANSCRIPT
Access To Care: Latinos & The U.S. Economy
Kevin C. Moriarty, President & CEOMethodist Healthcare Ministries
Health Insurance Yesterday & TodayEurope
Since 1911 all major European countries have had national health insurance.
United StatesEmployer Based expanded due to War World II labor market issues. Today, the U.S. is the only industrialized nation with employer based health insurance.
Health Care Costs
Americans Spend More Out-of-Pocket on Health Care Expenses, 2004
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$0 $100 $200 $300 $400 $500 $600 $700 $800 $900
a2003b2003 Total Health Care Spending, 2002 OOP Spending
ba
United States
OECD Median
New Zealand
Netherlands
Japan
GermanyFrance Canada Australia
a
Source: The Commonwealth Fund, calculated from OECD Health Data 2006.
Total health care spending per capita
Out-of-pocket spending per capita
Health Care Expenditure per Capita by Source of Funding in 2004
$803
$472 $313$582 $396 $389
$359
$2,572
$483 $342 $354
$1,611$1,832$1,917$2,176$1,940$2,350
$1,894$2,475$2,210
$2727
$238
$239$370 $28
$113
$444
$906 $148
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
UnitedStates
Canada France Netherlands Germany Australia UnitedKingdom
OECDMedian
Japan NewZealand
Private Spending
Out-of-Pocket Spending
Public Spending
a b
a2003b2002 (Out-of-Pocket)
aa
$6,102
$3,165 $3,158 $3,038 $3,005 $2,876$2,546 $2,461 $2,249
$2,083
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
Health care economic links
Health Coverage & Ethnicity
Uninsured Rates Among Workers by Race/Ethnicity, 2005
14%
40%
23%19%
White Hispanic African American Asian and PacificIslander
NOTE: Workers includes all workers ages 18 to 64.DATA: March 2005 Current Population Survey.SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
Coverage Trends among Latinos
Twelve Year Trends in Health Insurance among Latinos, Subgroup and Immigration Status, Health Affairs. *2004 March CPS Supplement (data in %)
35.6
17.6
22.1
25.3
18.7
22
7.3
28.4
36.9
46.4
46.5
37.1
8.8
14
24.1
9.2
Mexican
Puerto Rican
Cuban
Dominican
Uninsured Medicaid/CHIP ESI Other
Insurance Coverage by Immigration Status
21.8 24.9
56.623.1 6.9
10.344.6
47.5
27.2
Native US Naturalized Non CitizenUninsured Medicaid/CHIP ESI
Twelve Year Trends in Health Insurance among Latinos, Subgroup and Immigration Status, Health Affairs. *2004 March CPS Supplement (data in %)
Factors related to Insurance Coverage
63%
7%
3%3%
13% 19% 21%
69%
6%
0%
100%
Health Insurance Coverage of the Nonelderly Population by Race/Ethnicity
White(Non-Hispanic)
AfricanAmerican
(Non-Hispanic)
HispanicAsian and Pacific
Islander
NOTE: Nonelderly includes individuals up to age 65. “Other Public” includes Medicare and military-related coverage; SCHIP is included in Medicaid.DATA: March 2005 Current Population Survey.SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
Uninsured
Medicaid and Other Public
Individual
Employer
40% 48%
34%10%
28%23%
12%
Three-Quarters of Low-Income Hispanics Are Uninsured During the Year
39 32 30
64
9 7 1023
1414 13
12
7 512
16
0
25
50
75
100
Total White AfricanAmerican
Hispanic Total White AfricanAmerican
Hispanic
Insured now, time uninsured in past yearUninsured now
200% poverty or more
Percent of adults ages 19–64
Under 200% poverty
5346 44
76
16 12
40
23
Source: The Commonwealth Fund Biennial Health Insurance Survey (2005).
73
5547
88
7675
57
2632
71
5449
0
25
50
75
100
White AfricanAmerican
Hispanic White AfricanAmerican
Hispanic
Any time uninsured Uninsured more than one year
Employed, Low Income Hispanics Are Less Likely to Have InsurancePercent uninsured by employment of head of household among low-income adults (19–64), 1996–1999
Less than full-time employment over 48 months
Full-time employment over 48 months
*Low-income defined as less than 200% of the federal poverty level.Source: M. M. Doty and A. L. Holmgren, Unequal Access: Insurance Instability Among Low-Income Workers and Minorities, The Commonwealth Fund, April 2004.
Health Benefits by Business Size (%)
59
84
42
62
1 to 99 workers
100 workers ormore
Access Participation
Source: DOL National Compensation Survey, March 2007
Deductibles Rise Sharply, Especially in Small Firms, Over 2000–2007
PPO = preferred provider organization. PPOs covered 57 percent of workers enrolled in an employer-sponsored health insurance plan in 2007.Source: The Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits, 2000 and 2007 Annual Surveys.
187 210157
461
667
382
$0
$150
$300
$450
$600
$750
$900
Total Small firms, 3–199employees
Large firms, 200+employees
2000 2007Mean deductible for single coverage (PPO, in-network)
Health Care Benefits by Industry (by %)
71
85
46
76
78
52
67
28
61
50
All Workers
Management &Professional
Sales & Office
Construction &Maintenance
Production
Access Participation
Source: DOL National Compensation Survey, March 2007
Manufacturing (Durable Goods),
493
Wholesale & Retail Trade,
1,438Communication, 250
Construction, 691
Hospital Services, 785
Native Born Hispanic Workforce By Top Five Employment Industries
Latino Labor Report, 2006 Source Hispanic Pew Center (in thousands)
Top Five Employment Industries of Native Born Hispanics
(2006 & in thousands)
Wh l l &
Educational Services, 352
Ag, Forestry, Fishing, Mining, 457
Wholesale & Retail Sale, 1,275
Professional & Other Business,
1,250
Construction, 2,323
Top Five Employment Industries of Foreign Born Hispanics
(2006 & in thousands)
Wh l l &
Latino Labor Report, 2006 Source Hispanic Pew Center
Foreign Born Hispanic Workforce By Top Five Employment Industries
Latino Business Owners
Source: US Census, Survey of Business Owners, 2002
The State & National Landscape
69.4% 66.2%50.1%
12.6% 14.7%24.4%
12.7% 12.0%14.6%
8%4.4%3.8% 5.3%2.7%2.5%
2000 2006 2050
White Alone Hispanic African American Asian Other
Distribution of U.S. Population by Race 2000, 2006, 2050*
Source: U.S. Census Data , American Fact FInder
Numerical Percent2000 2006 Change Change
State Population* Population* 2000-2006 2000-2006
California 33,871,648 36,457,549 2,585,901 7.6 Texas 20,851,820 23,507,783 2,655,963 12.7New York 18,976,457 19,306,183 329,726 1.7Florida 15,982,378 18,089,888 2,107,510 13.2Illinois 12,419,293 12,831,970 412,677 3.3Pennsylvania 12,281,054 12,440,621 159,567 1.3Ohio 11,353,140 11,478,006 124,866 1.1Michigan 9,938,444 10,095,643 157,199 1.6Georgia 8,186,453 9,363,941 1,177,488 14.4North Carolina 8,049,313 8,856,505 807,192 10.0
* Population values are decennial census counts for April 1 for 2000 andestimates for July 1 for 2006.
Source: Derived from U.S. Bureau of the Census Estimates for dates indicated by the Texas State Data Center, University of Texas at San Antonio.
Ten Largest States in United States by Population Size in 2000 Ranked by Population Size in 2006
Uninsured:47 Million in the US15.3 Million Hispanics
Hispanic Population in 2005Snapshot:Texas: 3.7 MillionHispanics: 1.4 Million (38%)
p p1-9,600
9601 - 29700
29701 - 74800
74801 - 285290
285291 - 1.12 Million
Hispanic Population
Poverty In Texas
Snapshot:Texas: 16.9% of Individuals National Average: 13.3%
Poverty Rates (%)0-11%
12-15%
16-20%
21-29%
30-50%
Snapshot:Texas: 24% (5.5 M)Hispanics: 55% of Uninsured National Average: 15%
Uninsured in Texas
Uninsured Population (%)14-18%
19-21%
22-25%
26-35%
Source: Texas State Data Center, 2005 Uninsured Rates by County
Texas Counties with 50 Percent or More of Their Total PopulationThat is Hispanic in 2000 and Projected for 2040 Under Alternative Projection
Projections, Texas State Data Center,c and Socioeconomic Research,at San Antonio
2040(2000-2004 Scenario)
2000
Percent Hispanic PopulationLess Than 50% Hispanic Population
50% or Greater Hispanic Population
Texas Population Growth: Hispanics
Total Uninsured in Texas (2000)
Total Uninsured in Texas (2040)
U.S. Health Insurance Coverage (2005)
Percentage of Adults Who Visited the Dentist or Dental Clinic within the Past Year, 2004
Source: Kaiser State Facts
Percentage of Hispanic Adults Reporting Poor Mental Health by Race/Ethnicity, 2004
Source: Kaiser State Facts
1998
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2006
(*BMI ≥30, or about 30 lbs. overweight for 5’4” person)
2006
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Growth in National Health Expenditures PCI 1980–2011*
Source: Levit et al. Health Affairs 2002;21:172–181.*Projection from Heffler et al. Health Affairs 2002;21:207–218.
1,067
4,177
5,400
9,216
0
2,000
4,000
6,000
8,000
10,000
1980 1998 2003 2011*
How it Impacts You
The Business OwnerPremiums continue to increase and impact their bottom line and employee benefits.Less than 50% of small business employees have health insurance.Contributes $7-$8K to employee health plan.Cut benefits and shift cost to employees
Skilled Worker(teacher aid and hospitality)
Hourly wages.Has benefit package but is too expensive and does not accept employer coverage and does not qualify for State benefits.Has a child on CHIP and a wife on Maternal Medicaid.Contributes to American economy but does not benefit.
The Professional Pays $2,247 on average a month for family coverageSalary has increased by 2-3% yet premium will double that.Is about to switch jobs and will not have coverage for 6 months.Pays $1,000 more in premiums to cover the uninsured.
Low Income Adult(under 200% of poverty)
Under 65 years oldHas not worked consistently for the past 2 years. Has gone to the ER two times in the past year for colds.Was denied Medicaid benefits because income was too highUninsured.
Immigrant
Working as a day laborer.Only speaks SpanishSends earnings to his family in Mexico.Is trying to find another job. Does not qualify for any benefits.
ChildHas asthma.Has been on the CHIP program for a year. Makes good grades at school.Hispanic children make up one-fifth (20.5%) of all U.S. children, but two-fifths (38%) of uninsured children.
Conclusion