Access To Care: Latinos & The U.S.

Economy
Kevin C. Moriarty, President & CEO
Methodist Healthcare Ministries

Health Insurance Yesterday & Today

Europe
Since 1911 all major European countries have had national health insurance.

United States
Employer 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

Total health care spending per capita
$7,000

United States
$6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 $0 $100 $200 $300 $400 $500 $600 $700 $800 $900

France Netherlands

Canada Germany a OECD Median New Zealand Japan a

Australiab

Out-of-pocket spending per capita

a2003

b2003

Total Health Care Spending, 2002 OOP Spending

Source: The Commonwealth Fund, calculated from OECD Health Data 2006.

Health Care Expenditure per Capita by Source of Funding in 2004

$7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0
United States
a2003 b2002

$6,102

Private Spending Out-of-Pocket Spending

$2,572

Public Spending

$803

$3,165 $3,158 $3,038 $3,005 $2,876

$483 $444 $472 $239 $906 $238 $342 $313 $354 $582

$2,546 $2,461 $2,249

$370 $148 $396 $28 $389

$2,083
$113 $359

$2727

$2,210

$2,475

$1,894

$2,350

$1,940

$2,176

$1,917

$1,832

$1,611

Canada

France

Netherlands Germany

Australia

ab

United

OECD Median

Japan

New Zealand

Kingdom
(Out-of-Pocket)

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

40%

23% 19% 14%

White

Hispanic

African American

Asian and Pacific Islander

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

Dominican 25.3 28.4 37.1 9.2

Cuban

22.1 7.3

46.5

24.1

Puerto Rican

17.6

22

46.4

14

Mexican

35.6

18.7

36.9

8.8

Uninsured

Medicaid/CHIP

ESI

Other

Twelve Year Trends in Health Insurance among Latinos, Subgroup and Immigration Status, Health Affairs. *2004 March CPS Supplement (data in %)

Insurance Coverage by Immigration Status

27.2 44.6 47.5
10.3

23.1

6.9

56.6 21.8 Native US 24.9

Naturalized
Uninsured Medicaid/CHIP

Non Citizen
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

Health Insurance Coverage of the Nonelderly Population by Race/Ethnicity

100%
13% 19%

12%
6%

34% 10%
7%

21%

Uninsured
28%

23%
3% 3% 69% 63%

Medicaid and Other Public Individual Employer

40%

48%

0%
White Asian and (Non-Hispanic) Pacific Islander Hispanic African American
(Non-Hispanic)

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.

Three-Quarters of Low-Income Hispanics Are Uninsured During the Year

Percent of adults ages 1964

Insured now, time uninsured in past year 100 75

53

Uninsured now
76

12
46 44 40

50 25 0

14 39

14 32
White

13 30
African American

64

16

7 9
Hispanic Total

12

23

16 23
Hispanic

5 7
White

12 10
African American

Total

Under 200% poverty

200% poverty or more

Source: The Commonwealth Fund Biennial Health Insurance Survey (2005).

Employed, Low Income Hispanics Are Less Likely to Have Insurance

Percent uninsured by employment of head of household among low-income adults (1964), 19961999
Any time uninsured 88 75 49 76 54 71 47 32 25 0
White African American Hispanic White African American Hispanic

Uninsured more than one year

100 75 50

73 55 57

26

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 (%)

100 workers or more

62 84

1 to 99 workers

42 59

Access

Participation

Source: DOL National Compensation Survey, March 2007

Mean deductible for single coverage (PPO, in-network)

$900 $750 $600 $450 $300 $150 $0 Total Small firms, 3199 employees 187 210 461 667

Deductibles Rise Sharply, Especially in Small Firms, Over 20002007

2000 2007

382 157

Large firms, 200+ employees

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.

Health Care Benefits by Industry (by %)

Production Construction & Maintenance Sales & Office Management & Professional All Workers

50 78 61 76 28 46 67 85 52 71
Access Participation

Source: DOL National Compensation Survey, March 2007

Native Born Hispanic Workforce By Top Five Employment Industries

Hospital Services, 785 Manufacturing (Durable Goods), 493

Construction, 691 Communication, 250

Wholesale & Retail Trade, 1,438

Top Five Employment Industries of Native Born Hispanics
(2006 & in thousands)

Wh l

l &

Latino Labor Report, 2006 Source Hispanic Pew Center (in thousands)

Foreign Born Hispanic Workforce By Top Five Employment Industries

Wholesale & Retail Sale, 1,275 Construction, 2,323

Ag, Forestry, Fishing, Mining, 457 Educational Services, 352 Professional & Other Business, 1,250
Top Five Employment Industries of Foreign Born Hispanics
(2006 & in thousands)

Wh l

l &

Latino Labor Report, 2006 Source Hispanic Pew Center

Latino Business Owners

Source: US Census, Survey of Business Owners, 2002

The State & National Landscape

Distribution of U.S. Population by Race 2000, 2006, 2050*

3.8% 2.5%

12.7%

4.4%

2.7%

5.3% 8%

12.0%

12.6%

14.7%

14.6%

24.4% 69.4% 66.2% 50.1%

2000
White Alone Hispanic

2006
African American Asian

2050
Other

Source: U.S. Census Data , American Fact FInder

Ten Largest States in United States by Population Size in 2000 Ranked by Population Size in 2006
State California Texas New York Florida Illinois Pennsylvania Ohio Michigan Georgia North Carolina * 2000 Population* 33,871,648 20,851,820 18,976,457 15,982,378 12,419,293 12,281,054 11,353,140 9,938,444 8,186,453 8,049,313 2006 Population* 36,457,549 23,507,783 19,306,183 18,089,888 12,831,970 12,440,621 11,478,006 10,095,643 9,363,941 8,856,505 Numerical Change 2000-2006 2,585,901 2,655,963 329,726 2,107,510 412,677 159,567 124,866 157,199 1,177,488 807,192 Percent Change 2000-2006 7.6 12.7 1.7 13.2 3.3 1.3 1.1 1.6 14.4 10.0

Population values are decennial census counts for April 1 for 2000 and estimates for July 1 for 2006. Derived from U.S. Bureau of the Census Estimates for dates indicated by the Texas State Data Center, University of Texas at San Antonio.

Source:

Uninsured: 47 Million in the US 15.3 Million Hispanics

Hispanic Population in 2005

Snapshot: Texas: 3.7 Million Hispanics: 1.4 Million (38%)

p Hispanic Population
1-9,600 9601 - 29700 29701 - 74800 74801 - 285290 285291 - 1.12 Million

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%

Uninsured in Texas
Snapshot: Texas: 24% (5.5 M) Hispanics: 55% of Uninsured National Average: 15%

Uninsured Population (%)

14-18% 19-21% 22-25% 26-35%

Source: Texas State Data Center, 2005 Uninsured Rates by County

Texas Population Growth: Hispanics

2000

2040
(2000-2004 Scenario)

Percent Hispanic Population

Le ss Than 50% Hispanic Popula tion 50 % o r G reater Hispani c Popu latio n

Projections, Texas State Data Center, c and Socioeconomic Research, at San Antonio

Texas Counties with 50 Percent or More of Their Total Population That is Hispanic in 2000 and Projected for 2040 Under Alternative Projection

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

Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2006

(*BMI 30, or about 30 lbs. overweight for 54 person) 1990 1998

2006

No Data

<10%

10%14%

15%19%

20%24%

25%29%

30%

Growth in National Health Expenditures PCI 19802011*

10,000 8,000 6,000

9,216

5,400 4,177

4,000 2,000 0 1980 1998 2003 2011*

Source: Levit et al. Health Affairs 2002;21:172181. *Projection from Heffler et al. Health Affairs 2002;21:207218.

1,067

How it Impacts You

The Business Owner

Premiums 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 coverage Salary 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 old Has 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 high Uninsured.

Immigrant
Working as a day laborer. Only speaks Spanish Sends earnings to his family in Mexico. Is trying to find another job. Does not qualify for any benefits.

Child
Has 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