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