kate nordahl assistant commissioner division of health care finance and policy
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Health Insurance Coverage and Access to Care for Communities of Color
Presentation for the Health Disparities Council
Kate NordahlAssistant Commissioner
Division of Health Care Finance and Policy
2
Presentation Overview
• Who are the uninsured?
• Uninsurance rates by race/ethnicity and age
• Type of insurance coverage by race/ethnicity and age
• Access to and use of care– Usual source of care– Doctors visit in past 12 months– ER visit in past 12 months
• Barriers to care due to cost
3
Source: Urban Institute tabulations on the 2008 Massachusetts HIS
Massachusetts Division of Health Care Finance and Policy
Uninsurance was low among Massachusetts residents, with less than 3% (167,300 people) uninsured at the time of the survey (summer 2008).
Uninsurance Ratefor All Massachusetts Residents
Uninsurance
4
Who are the Uninsured?
• More likely to be:– Male (57% of the uninsured are male vs. 48.2% in general population)– Young adult - 19 to 25 years of age (32.1% vs. 15.2%)– Hispanic (18.8% vs. 6.8%)– Non-citizen (14.5% vs. 4.6%)– Low-income
• <150% FPL (45.1% vs. 20.2%)• 151-299% FPL (33.9% vs. 18.7%)
– With less formal education• Less than high school (12.0% vs. 3.9%)• High school graduate or GED (55.6% vs. 40.0%)
– Non-working or working only part-time• If work, work for a small sized firm (<51 employees) and for a firm
that doesn’t offer employer-sponsored insurance (ESI)
5
Hispanic residents were most likely to go without coverage in Massachusetts, with an uninsurance rate more than twice as high as other non-Hispanic groups (7.2% versus less than 3%).
Massachusetts Division of Health Care Finance and Policy
Uninsurance Rates by Race/Ethnicity, All Ages
Uninsurance
Source: Urban Institute tabulations on the 2008 Massachusetts HIS
2.6 2.23.2
1.0
4.2
7.2
0%
2%
4%
6%
8%
10%
12%
14%
TotalPopulation
White,Non-
Hispanic
Black, non-Hispanic
Asian,non-
Hispanic
Other race,non-
Hispanic
Hispanic
6
Uninsurance was highest among non-elderly Hispanic adults in Massachusetts, with an uninsurance rate roughly three times that of other, non-Hispanic groups.
Massachusetts Division of Health Care Finance and Policy
Uninsurance Rates of Non-Elderly Adults (ages 19-64) by Race/Ethnicity
Uninsurance
Source: Urban Institute tabulations on the 2008 Massachusetts HIS
3.73.0
5.9
1.6
7.7
12.6
0%
2%
4%
6%
8%
10%
12%
14%
TotalPopulation
White,Non-
Hispanic
Black, non-Hispanic
Asian,non-
Hispanic
Other race,non-
Hispanic
Hispanic
7
Uninsurance was highest among Hispanic children in Massachusetts, with 2.6% uninsured.
Note: there was not large enough sample size to report Black, non-Hispanic and Asian, non-Hispanic separately
Massachusetts Division of Health Care Finance and Policy
Uninsurance Rates of Children (<18) by Race/Ethnicity
Uninsurance
Source: Urban Institute tabulations on the 2008 Massachusetts HIS
1.2 1.3
0.0
2.6
0%
2%
4%
6%
8%
10%
12%
14%
Total Population White, Non-Hispanic
Other Race, Non-Hispanic
Hispanic
8
Employer-sponsored insurance was more common among white, non-Hispanic residents of Massachusetts (71%) than among other race, non-Hispanic or Hispanic residents (63% and 45%, respectively).
Type of Health Insurance Coverage* by Race/Ethnicity, All Ages
Massachusetts Division of Health Care Finance and Policy
*Insurance coverage is based on the hierarchy: Medicare, employer-sponsored insurance, public or other coverage. Public and other coverage are combined because of the survey respondents’ difficulties in reporting type of coverage. For lower-income residents, public or other coverage is mostly MassHealth or Commonwealth Care, while for higher-income residents it is non-group coverage and, to a lesser extent, Commonwealth Choice.Source: Urban Institute tabulations on the 2008 Massachusetts HIS
Type of Coverage
15 16 12 11
68 71
63
45
17 1326
44
0%
20%
40%
60%
80%
100%
Total InsuredPopulation
White, Non-Hispanic
Other Race,Non-Hispanic
Hispanic
Medicare Employer-Sponsored Insurance Public or Other Coverage
9
Employer-sponsored coverage was most common among white, non-Hispanic adults (83%), compared to other race, non-Hispanic adults (73%) and Hispanic adults (54%).
Type of Health Insurance Coverage* of Non-Elderly Adults by Race/Ethnicity
Type of Coverage
Massachusetts Division of Health Care Finance and Policy
*Insurance coverage is based on the hierarchy: Medicare, employer-sponsored insurance, public or other coverage. Public and other coverage are combined because of the survey respondents’ difficulties in reporting type of coverage. For lower-income residents, public or other coverage is mostly MassHealth or Commonwealth Care, while for higher-income residents it is non-group coverage and, to a lesser extent, Commonwealth Choice.Source: Urban Institute tabulations on the 2008 Massachusetts HIS
5 4 8 11
81 83 7354
15 13 1935
0%
20%
40%
60%
80%
100%
Total InsuredPopulation
White, Non-Hispanic
Other Race,Non-Hispanic
Hispanic
Medicare Employer-Sponsored Insurance Public or Other Coverage
10
Type of Health Insurance Coverage* of Children by Race/Ethnicity
Massachusetts Division of Health Care Finance and Policy
Type of Coverage
*Insurance coverage is based on the hierarchy: Medicare, employer-sponsored insurance, public or other coverage. Public and other coverage are combined because of the survey respondents’ difficulties in reporting type of coverage. For lower-income residents, public or other coverage is mostly MassHealth or Commonwealth Care, while for higher-income residents it is non-group coverage and, to a lesser extent, Commonwealth Choice.Source: Urban Institute tabulations on the 2008 Massachusetts HIS
Employer-sponsored coverage was most common among non-Hispanic, white children (79%), compared to other race, non-Hispanic children (56%) and Hispanic children (42%).
2 1 3 4
7079
5642
2920
4155
0%
20%
40%
60%
80%
100%
Total InsuredPopulation
White, Non-Hispanic
Other Race,Non-Hispanic
Hispanic
Medicare Employer-Sponsored Insurance Public or Other Coverage
11Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults with a Usual Source of Care by Race/Ethnicity
Other, non-Hispanic adults were less likely to have a usual source of care than white adults and adults reporting other race/ethnicities.
Non-Elderly Adults
Source: 2008 Massachusetts Health Insurance Survey
89% 90% 93%85% 86%
0%
20%
40%
60%
80%
100%
TotalPopulation
White,non-
Hispanic
Black,non-
Hispanic
Other,non-
Hispanic
Hispanic
12Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults with a Usual Source of Care by Insurance Status
Compared with the insured, uninsured non-elderly adults were much less likely to have a usual source of care (42% versus 91%).
Non-Elderly Adults
Source: 2008 Massachusetts Health Insurance Survey
89% 91%
42%
0%
20%
40%
60%
80%
100%
Total Population Insured Uninsured
13Massachusetts Division of Health Care Finance and Policy
Children with a Usual Source of Care by Race/Ethnicity
Hispanic children were least likely to have a usual source of care, compared to other race/ethnicity groups.
Children
Source: 2008 Massachusetts Health Insurance Survey
97% 98% 98%93%
0%
20%
40%
60%
80%
100%
TotalPopulation
White, non-Hispanic
Other, non-Hispanic
Hispanic
14Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults with a Doctor Visit in Past 12 Months by Race/Ethnicity
Among non-elderly adults, those who reported other, non-Hispanic race/ethni-cities were less likely than white, non-Hispanic or Hispanic adults to have had any doctor visits or a preventive care visit.
Non-Elderly Adults
Source: 2008 Massachusetts Health Insurance Survey
85% 86% 84%76%
87%
72% 73% 73%68%
73%
0%
20%
40%
60%
80%
100%
TotalPopulation
White,non-
Hispanic
Black,non-
Hispanic
Other,non-
Hispanic
Hispanic
Any doctor visit Visit for preventive care
15Massachusetts Division of Health Care Finance and Policy
Children with a Doctor Visit in Past 12 Months by Race/Ethnicity
Hispanic and other, non-Hispanic children were less likely than white, non-Hispanic children to have had any doctor visit or a preventive care visit in the past 12 months.
Children
Source: 2008 Massachusetts Health Insurance Survey
94% 95%91% 92%89% 90%
86% 86%
0%
20%
40%
60%
80%
100%
TotalPopulation
White, non-Hispanic
Other, non-Hispanic
Hispanic
Any doctor visit Visit for preventive care
16Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults with an ER Visit in the Past 12 Months by Race/Ethnicity
Among non-elderly adults, Hispanics were much more likely to have had an ER visit overall and an ER visit for a non-emergency than other race/ethnicity groups.
Non-Elderly Adults
*A non-emergency ER visit is one that the respondent says could have been treated by a regular doctor if one had been available.Source: 2008 Massachusetts Health Insurance Survey
23% 22%25%
20%
45%
7% 7% 7% 8%
18%
0%
10%
20%
30%
40%
50%
TotalPopulation
White,non-
Hispanic
Black, non-Hispanic
Other, non-Hispanic
Hispanic
Any ER visit Most recent ER visit was a non-emergency ER visit*
17Massachusetts Division of Health Care Finance and Policy
Children with an ER Visit in the Past 12 Months by Race/Ethnicity
Hispanic children were much more likely than non-Hispanic children to have had an emergency or non-emergency ER visit.
Children
*A non-emergency ER visit is one that the respondent says could have been treated by a regular doctor if one had been available.Source: 2008 Massachusetts Health Insurance Survey
32% 31%28%
44%
13%11% 12%
24%
0%
10%
20%
30%
40%
50%
TotalPopulation
White, non-Hispanic
Other, non-Hispanic
Hispanic
Any ER visit Most recent ER visit was a non-emergency ER visit*
18Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Race/Ethnicity Among non-elderly
adults, one-quarter of white, non-Hispanic adults skipped needed health care due to cost, compared with 29% of other, non-Hispanic adults and 35% of Hispanic adults.
Non-Elderly Adults
Source: 2008 Massachusetts Health Insurance Survey
26% 25%
31%29%
35%
0%
10%
20%
30%
40%
50%
TotalPopulation
White,non-
Hispanic
Black, non-Hispanic
Other, non-Hispanic
Hispanic
19Massachusetts Division of Health Care Finance and Policy
Children Not Getting Needed Care Due to Cost in Past 12 Months by Race/Ethnicity Unmet need for health
care due to cost was highest for Hispanic children, at 22%.
Children
Source: 2008 Massachusetts Health Insurance Survey
12%10% 11%
22%
0%
10%
20%
30%
40%
TotalPopulation
White, non-Hispanic
Other, non-Hispanic
Hispanic
20Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Race/Ethnicity Among non-elderly
adults, black, non-Hispanics were more likely to report problems paying medical bills than were white, non-Hispanic adults.
Non-Elderly Adults
Source: 2008 Massachusetts Health Insurance Survey
17% 16%
25%
20% 20%
0%
10%
20%
30%
40%
TotalPopulation
White,non-
Hispanic
Black, non-Hispanic
Other, non-Hispanic
Hispanic
21Massachusetts Division of Health Care Finance and Policy
Children in Families with Problems Paying Medical Bills in Past 12 Months by Race/Ethnicity Other, non-Hispanic
and Hispanic children were most likely to live in families that had trouble paying medical bills (22%).
Children
Source: 2008 Massachusetts Health Insurance Survey
17%15%
22% 22%
0%
10%
20%
30%
40%
TotalPopulation
White, non-Hispanic
Other, non-Hispanic
Hispanic
22
Summary
• While Massachusetts has made great strides to reduce uninsurance and improve access to care the Hispanic population is more likely to:– be uninsured– use the emergency department in the past 12 months – have sought care in the ER for a non-emergency– have not sought needed care due to cost
• The Hispanic, non-elderly adult population is less likely to have a usual source of care
• In addition, Black, non-Hispanic non-elderly adults were more likely to:– have not sought needed care due to cost– have problems paying medical bills
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