california Health Care Almanac California s Uninsured

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1 california Health Care Almanac december 2011

2 Introduction Over the past two decades, California has seen an increase in the percentage of people who are uninsured. California now has the largest number of people without health insurance 6.9 million of any state in the nation. The percentage of Californians who obtain their insurance through their job has also continued to fall. The segment of the non-elderly population covered by employer-based insurance declined from 65% in 1987 to 53% in Although Medicaid coverage partially offset the loss, more than 20% of Californians remain uninsured. This annual publication provides an overview of California s uninsured. This year s findings include: Nearly one in four workers is uninsured. Employees in businesses of all sizes are more likely to be uninsured in California than in the United States. Nearly one third of the uninsured in California and the nation have family incomes of $50,000 or more. Fifty-three percent of California s uninsured children are in families where the head of household worked full-time during calendar year 2010, down from 61% in About 60% of the uninsured population are Latino. While the ranks of the uninsured may grow in the short run if more individuals lose their employer-based coverage, changes proposed under the Affordable Care Act, if permitted to take effect as scheduled in 2014, would allow more Californians to gain coverage. Overview contents State Comparison of the Uninsured...3 Health Insurance Sources...4 Insurance Coverage Source Trends Employer-based and Uninsured...6 Private and Public...7 Comparison by Employer Size and Type Likelihood of Workers Being Uninsured Uninsured Workers vs. Total Workers...9 Comparison by Family Income Likelihood of Being Uninsured California vs. U.S...11 Insurance Coverage Source Trends, Under $25, $25,000 to $49, $50,000 to $74, $75, Comparison by Age Group Eligibility for Public Health Programs Likelihood of Being Uninsured Uninsured vs. Total Population Uninsured Children, by Work Status of Family Head...19 Comparison by Race/Ethnicity Likelihood of Being Uninsured Uninsured vs. Total Population Highest Uninsured Noncitizen Rates, by State...22 About the Author, About the Data California HealthCare Foundation 2

3 State Comparison of the Uninsured, 3-Year Average, 2008 to 2010* total Population Uninsured residents in millions in millions share of total United States % Highest Proportion States Texas % New Mexico % Florida % Nevada % Compared to Other States California has the eighth largest proportion of uninsured in the nation and the largest total number of uninsured. Only three states (Massachusetts, Hawaii, and Minnesota) have uninsured rates under 10%. Mississippi % Arizona % Arkansas % California % Source: Employee Benefit Research Institute estimates of the Current Population Survey, March Supplements California HealthCare Foundation 3

4 Health Insurance Sources, California Residents, 2000 and 2010* Sources and Trends Over the past ten years, Employer-based Medicaid Individual 13.3% 19.3% 7.3% 7.6% 53.0% % Medicaid coverage has partially offset declining employer-sponsored insurance, but not enough to prevent continued growth in California s uninsured population. In Medicare 1.5% 2.4% 2010, one in five Californians was uninsured. Tricare/CHAMPVA 2.4% 2.1% Uninsured 19.3% 21.5% Estimate for 2010 is statistically different from estimate for 2000 at p <= 0.05 level. Medi-Cal and Healthy Families. Note: Details may not add to totals because individuals may receive coverage from more than one source. Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2001 and 2011 Supplements California HealthCare Foundation 4

5 Insurance Coverage Source Trends and Unemployment, California Residents, 1988 to 2010* Sources and Trends Although slightly more 80% Employer-based Uninsured Public Programs Individual Unemployment than half of Californians still receive health insurance 70% 62.5% through employers, coverage from that source 60% has declined substantially 50% 53.0% over the last two decades. 40% 30% 20% 18.8% 22.3% 21.5% 10% 0% % 6.3% 5.3% % 7.6% Medi-Cal, Healthy Families, Medicare, and Tricare/CHAMPVA. Notes: Details may not add to totals because individuals may receive coverage from more than one source. Unemployment rates are annual averages without seasonal adjustment is not directly comparable with data because of a methodological change in the way individuals with coverage were counted. Sources: Employee Benefit Research Institute estimates of the March Current Population Survey, Supplements, Labor Market Info, California HealthCare Foundation 5

6 Employer-based Coverage and Uninsured Trends, California vs. US Residents, 1988 to 2010* Sources and Trends California has a higher 80% 70% Employer-based Coverage 69.8% proportion of uninsured residents and lower rates of employer-based coverage than the nation as a whole. 60% 50% 62.5% 58.7% 53.0% US California 40% 30% Uninsured Population 20% 10% 18.8% 14.4% 21.5% 18.5% California US 0% Notes: Details may not add to totals because individuals may receive coverage from more than one source. Data for 1988 to 1998 is not directly comparable with 1999 to 2010 data because of a methodological change in the way individuals with coverage were counted. Source: Employee Benefit Research Institute estimates of the March Current Population Survey, Supplements California HealthCare Foundation 6

7 Private and Public Coverage Trends, California vs. US Residents, 1988 to 2010* Sources and Trends While the rate of public 80% Private Coverage 76.4% coverage for California and the nation is comparable, 70% 60% 68.8% 65.3% 59.1% US California California lags the nation in the rate of private coverage. 50% 40% 30% 20% Public Coverage 16.5% 22.3% 21.6% California US 10% 13.4% 0% Notes: Details may not add to totals because individuals may receive coverage from more than one source. Data for 1988 to 1998 is not directly comparable with 1999 to 2010 data because of a methodological change in the way individuals with coverage were counted. Source: Employee Benefit Research Institute estimates of the March Current Population Survey, Supplements California HealthCare Foundation 7

8 Likelihood of Workers Being Uninsured, by Employer Size and Type, California vs. US Residents, 2010* by Employer Size and Type Employees in businesses of TOTAL 23.7% 19.6% California United States all sizes are more likely to be uninsured in California than in the United States. In Self-employed Public Sector 8.6% 7.3% 30.2% 28.3% businesses with fewer than ten employees, more than 40% of workers are likely to Private Sector: less than % 42.7% have no insurance. 10 to % 34.5% 50 to % 26.7% 100 to % 22.1% 500 or more 14.5% 14.2% Note: Details may not add to totals because individuals may receive coverage from more than one source. Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2011 Supplement California HealthCare Foundation 8

9 Uninsured Workers vs. Total Workers, by Employer Size and Type, California Residents, Ages 18 to 64, 2010* by Employer Size and Type Nearly 30% of California s uninsured work for UNINSURED WORKERS n = 4.0 million Public Sector TOTAL WORKERS n = 16.9 million employers with 100 or more workers. Nearly one in four workers in California Self-employed 500 or more 14% 19% 5% 100 to 499 9% Private Sector (by number of employees) 50 to 99 8% 10 to 49 21% Less than 10 24% Selfemployed 11% 500 or more 30% Public Sector 14% Private Sector (by number of employees) 100 to % 50 to 99 7% 10 to 49 15% Less than 10 13% is uninsured. Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2011 Supplement California HealthCare Foundation 9

10 Likelihood of Being Uninsured, by Family Income, California vs. US Residents, 2010* by Family Income Californians with family % 34.3% California United States incomes below $25,000 are most likely to be uninsured. The likelihood of being uninsured is greater in California than % 28.6% 23.8% the United States for all income levels % 18.3% 14.4% 5 9.2% 6.9% 0 TOTAL Under $25,000 $25,000 to $49,999 $50,000 to $74,999 $75,000 or more Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2011 Supplement California HealthCare Foundation 10

11 Family Income of the Uninsured, California vs. US Residents, 2010* by Family Income Nearly one third of the CALIFORNIA UNITED STATES uninsured, in California and the US, have family incomes of $50,000 or more. $75,000 or more 15% $75,000 or more 15% $50,000 to $74,999 15% Under $25,000 41% $50,000 to $74,999 15% Under $25,000 40% $25,000 to $49,999 29% $25,000 to $49,999 30% Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2011 Supplement California HealthCare Foundation 11

12 Insurance Coverage Source Trends, by Family Income, Under $25,000, California Residents, 1994 to 2010* by Family Income Among Californians with family incomes less than 50% 40% 38.3% 44.5% Public $25,000, more are likely to be covered by public programs and less are likely 37.7% 35.1% Uninsured to be covered by private 30% insurance than were in % 24.3% Private 20% 10% 0% Medi-Cal, Healthy Families, Medicare, and Tricare/CHAMPVA. Notes: Details may not add to totals because individuals may receive coverage from more than one source. Data for 1994 to 1998 is not directly comparable with 1999 to 2010 data because of a methodological change in the way individuals with coverage were counted. Source: Employee Benefit Research Institute estimates of the Current Population Survey, Supplements California HealthCare Foundation 12

13 Insurance Coverage Source Trends, by Family Income, $25,000 to $49,999, California Residents, 1994 to 2010* by Family Income Among Californians with family incomes between 80% 70% 70.0% $25,000 and $49,999, the portion covered by public 60% programs more than doubled from 1994 to % 47.3% Private This group has seen a steep 40% 30% 22.1% 28.6% 28.5% Uninsured Public erosion in private coverage during this period. 20% 13.5% 10% 0% Medi-Cal, Healthy Families, Medicare, and Tricare/CHAMPVA. Notes: Details may not add to totals because individuals may receive coverage from more than one source. Data for 1994 to 1998 is not directly comparable with 1999 to 2010 data because of a methodological change in the way individuals with coverage were counted. Source: Employee Benefit Research Institute estimates of the Current Population Survey, Supplements California HealthCare Foundation 13

14 Insurance Coverage Source Trends, by Family Income, $50,000 to $74,999, California Residents, 1994 to 2010* by Family Income Nearly 14% of Californians 100% 85.1% with family incomes between $50,000 and $74,999 rely on public 80% 72.8% Private insurance. 60% 40% 20% 12.2% 18.3% 13.8% Uninsured Public 0% 6.3% Medi-Cal, Healthy Families, Medicare, and Tricare/CHAMPVA. Notes: Details may not add to totals because individuals may receive coverage from more than one source. Data for 1994 to 1998 is not directly comparable with 1999 to 2010 data because of a methodological change in the way individuals with coverage were counted. Source: Employee Benefit Research Institute estimates of the Current Population Survey, Supplements California HealthCare Foundation 14

15 Insurance Coverage Source Trends, by Family Income, $75,000 and Over, California Residents, 1994 to 2010* by Family Income The majority of Californians with family incomes above 100% 89.7% 87.7% Private $75,000 are covered by private insurance. However, 80% nearly 10% are uninsured. 60% 40% 20% 0% 8.2% 7.2% % 7.0% Uninsured Public Medi-Cal, Healthy Families, Medicare, and Tricare/CHAMPVA. Notes: Details may not add to totals because individuals may receive coverage from more than one source. Data for 1994 to 1998 is not directly comparable with 1999 to 2010 data because of a methodological change in the way individuals with coverage were counted. Source: Employee Benefit Research Institute estimates of the Current Population Survey, Supplements California HealthCare Foundation 15

16 Eligibility for Public Health Insurance Programs, Uninsured California Residents, 2010 Adults (ages 19 to 64) without adjustment for time in united states* with adjustment for time in united states number share of total number share of total Total Uninsured 5,927, % 5,927, % Eligible for Medi-Cal 359,584 6% 720,386 12% Not Eligible 5,567,919 94% 5,207,117 88% by Age Group Up to 76% of California s uninsured children are eligible for Medi-Cal and Healthy Families, but only 12% or less of adults are eligible. Children (age 18 and under) Total Uninsured 1,121, % 1,121, % Eligible for Medi-Cal 374,601 33% 408,894 36% Eligible for Healthy Families 407,621 36% 444,544 40% Not Eligible 338,871 30% 267,655 24% *Excludes all non-citizens from eligibility. Excludes non-citizens from eligibility if in United States less than 5 years. CPS collects data on citizenship but not immigration status. The lower number without adjustment underestimates eligible residents because it is restricted to citizens; the higher number with adjustment overestimates eligible residents because it includes all non-citizens who have resided in the US for at least 5 years (regardless of immigration status). Notes: The uninsured may be eligible for other public programs. For more information, see The Crucial Role of Counties in the Health of Californians: An Overview at May not add to 100% due to rounding. Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2011 Supplement California HealthCare Foundation 16

17 Likelihood of Being Uninsured, by Age Group, California Residents, 2000 and 2010* TOTAL Under to to to34 35 to to to % 10.7% 15.5% 19.3% 21.5% 18.0% 19.0% 18.9% 22.3% 28.1% 26.0% 26.5% 25.0% 32.7% 34.3% 31.9% by Age Group The likelihood of being uninsured rose from 2000 to 2010 for adults, with the likelihood highest for the 21 to 24 age group. In contrast, those younger than 21 were less likely to be uninsured during this period Estimate for 2010 is statistically different from estimate for 2000 at p <= 0.05 level. Note: Details may not add to totals because individuals may receive coverage from more than one source. Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2001 and 2011 Supplements California HealthCare Foundation 17

18 Age Group of the Uninsured vs. Total Population, California Residents, 2010* by Age Group Fourteen percent of UNINSURED TOTAL POPULATION California s uninsured are children, but children make up almost 30% of the population. Nearly one 45 to 54 16% 55 to 64 11% Under 18 14% 18 to 20 6% 21 to 24 11% 45 to 54 16% 55 to 64 12% Under 18 29% in four of the uninsured is between the ages of 25 and to 44 18% 25 to 34 24% 35 to 44 15% 25 to 34 16% 18 to 20 5% 21 to 24 7% Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2011 Supplement California HealthCare Foundation 18

19 Uninsured Children,* by Work Status of Family Head, California Residents, 2008 vs Part-time, Partial Year by Age Group Fifty-three percent of California s uninsured children are in families where the head of household worked full-time during calendar 3% Nonworker 14% Nonworker 20% year 2010, down from 61 percent in Full-time, Partial Year 14% Part-time, All Year 8% Full-time, All Year 61% Part-time, Partial Year 7% Full-time, Partial Year 13% Parttime, All Year 7% Full-time, All Year 53% *Under age 18. Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2011 Supplement California HealthCare Foundation 19

20 Likelihood of Being Uninsured, by Race/Ethnicity, California Residents, 2000 and 2010* TOTAL Latino 19.3% 21.5% 31.8% 30.3% by Race/Ethnicity Latinos are much more likely to be uninsured than other ethnic groups, and more than twice as likely as whites. Nearly one in three are uninsured. Asian African American White Other 16.9% 18.0% 16.2% 16.5% 10.6% 14.2% 20.9% 17.5% Estimate for 2010 is statistically different from estimate for 2000 at p <= 0.05 level. Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2001 and 2011 Supplements California HealthCare Foundation 20

21 Race/Ethnicity of the Uninsured vs. Total Population, California Residents, 2010* by Race/Ethnicity In California, Latinos UNINSURED TOTAL POPULATION represent 41% of the population but account for African American Other African American Other nearly 60% of the uninsured. 4% 2% 6% 3% Asian 10% Asian 12% White 26% Latino 58% Latino 41% White 38% Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2011 Supplement California HealthCare Foundation 21

22 Highest Uninsured Noncitizen Rates, by State, 2010* by Citizenship Although California has total Population Percentage Uninsured in millions Noncitizens Citizens Noncitizens United States % 16.1% 47.1% Texas % 22.4% 61.8% Florida % 21.4% 53.9% Nevada % 20.8% 50.9% the largest percentage of noncitizens in the nation, a smaller percentage are uninsured than in some other states with large noncitizen populations. New Jersey % 13.0% 49.5% California % 17.0% 46.8% New York % 14.0% 40.3% Includes only states with at least 10% of the population as noncitizens, among states with at least 75,000 noncitizens. Source: Employee Benefit Research Institute estimates of the Current Population Survey, March 2011 Supplement California HealthCare Foundation 22

23 About the Author Data Analyst: Paul Fronstin, Employee Benefit Research Institute About the Data In September 2011, the Census Bureau announced a revision to the CPS that affects the historical time series. The calendar year coverage estimates for 1999 to 2009 were revised as a result of enhancements to the editing process. As a result of the change, the number of persons with employment-based coverage as a dependent increased by 1.4 million, and the likelihood of having employment-based coverage increased by 0.5%. There was a corresponding decline in the uninsured estimates. The data in this report from 2000 to 2010 are based on the corrected historical data and may not match data published in previous versions. Data prior to 2000 have not been revised. for more information California HealthCare Foundation 1438 Webster Street, Suite 400 Oakland, CA Data tables for the presentation are available at: California HealthCare Foundation 23

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