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High concentrations of Latinos HispanicVista.com LOS ANGELES — A new UCLA study of 85 metropolitan areas reveals that health coverage rates vary widely among cities, ranging from
a low of 7 percent uninsured in Akron, Ohio, and Harrisburg, Pa., to a high of 37 percent uninsured in El Paso, Texas. High proportions of immigrants and low rates of employer-based coverage correlate strongly with high
rates of uninsured in an urban population. The study, conducted by the UCLA Center for Health Policy Research found that low- and moderate-income urban residents who lack insurance are two to three times more likely
than their insured counterparts to lack access to health care. Overall, the study finds less access in cities with high uninsured rates. While the average uninsured rate for the 85 metropolitan areas is 19 percent, 12
areas had much higher rates, including New York (27 percent), Los Angeles (31 percent) and Houston (30 percent). Eleven areas had substantially lower rates, including Milwaukee (8 percent), Minneapolis (10 percent) and
Norfolk, Va. (11 percent). The average job-based coverage rate for all 85 urban areas is 67 percent, ranging from a low of 49 percent in El Paso to 84 percent in Milwaukee. The study found notable access problems in
cities such as Los Angeles, where 61 percent of uninsured residents with incomes below 250 percent of the poverty level had no regular source of care, compared with 8 percent of the insured. In Detroit the rates were 40
percent and 6 percent respectively, and in Washington, D.C., 40 percent and 12 percent. Closing the Health Insurance Gap "High uninsured rates in urban areas correspond directly to low rates of
employment-based health insurance," said Dr. E. Richard Brown, director of the center at UCLA's School of Public Health and lead author of the report. "No matter where they live, people with moderate and low
incomes are much less likely than more-affluent people to have job-based coverage. The disparity is greater, however, among the less advantaged living in low-coverage areas — particularly Latinos and noncitizens."
In addition to socioeconomic factors, public policy has a significant impact on a metropolitan area's uninsured rate, researchers said. "Given similar economic conditions, a particular community is likely to have
a lower uninsured rate if the state has more generous eligibility requirements for Medicaid and other public health insurance programs," Brown said. Cathy Schoen, vice president of research and evaluation at The
Commonwealth Fund, noted that cities and counties have limited ability to provide health insurance coverage to uninsured residents, but states have been given expanded federal support to cover uninsured children and
their families. "Without that assistance, cities and counties will bear responsibility for reducing barriers to care faced by their moderate- and low-income residents," Schoen said, "a task that most
urban areas cannot afford." A new policy brief published by the UCLA Center uses the same data to examine whether lack of insurance affects access to health care. An analysis of low- and moderate-income residents
of 29 cities revealed that — contrary to the common belief that urban "safety net" health care providers are available for the poor — the uninsured in these urban areas are two to eight times as likely as
their insured counterparts to lack a regular provider or place to seek care. The full study examined job-based insurance rates among the 85 metropolitan statistical areas (MSAs) with nonelderly populations of more
than 500,000, as estimated by the 1998 March Current Population Survey. The study also examines access to health care across MSAs using data from the 1995 and 1996 National Health Interview Surveys.
Other study findings include the following -- Among residents with incomes below 250 percent of the poverty level, uninsured rates vary from 11 percent in Honolulu to 50 percent in El Paso. -- The uninsured are much
less likely to have a regular source of health care or to have seen a physician in the last year. They also are much more likely to delay seeking care. -- Residents of cities with high uninsured rates generally have a
harder time getting the health care they need than those living in cities with relatively low uninsured rates. The negative impact of high uninsured rates affects individuals with moderate incomes well above the poverty
level. UNINSURED AND JOB-BASED COVERAGE RATES The urban areas with the highest and lowest uninsured rates and rates of job-based coverage among all income levels, ages 0-64 Highest uninsured rates
1. El Paso, Texas, 37% 2. Jersey City, N.J., 36% 3. Los Angeles, Calif., 31% 4. Houston, Texas, 30% 5. West Palm Beach, Fla., 29% 6. Miami, Fla., 27% New York City, 27% 8. Fort Lauderdale, Fla., 26%
Phoenix-Mesa, Ariz., 26% Tucson, Ariz., 26% Lowest uninsured rates 1. Akron, Ohio, 7% Harrisburg, Pa., 7% 3. Honolulu, Hawaii, 8% Milwaukee, Wis., 8% 5. Ann Arbor, Mich., 9% 6. Allentown, Pa., 10%
Minneapolis, Minn., 10% Omaha, Neb., 10% 8. Norfolk, Va., 11% Pittsburgh, Pa., 11% Youngstown, Ohio, 11% Highest rates of job-based coverage 1. Milwaukee, Wis., 84% 2. Harrisburg, Pa., 83%
3. Cincinnati, Ohio, 82% 4. Akron, Ohio, 81% 5. Ann Arbor, Mich., 80% 6. Albany, N.Y., 78% Greenville, S.C., 78% Minneapolis, Minn., 78% 9. Charlotte, N.C., 77% Indianapolis, Ind., 77%
Middlesex, N.J., 77% Omaha, Neb., 77% Lowest rates of job-based coverage 1. El Paso, Texas, 49% 2. Los Angeles, Calif., 50% New York, N.Y., 50% 4. Bakersfield, Calif., 51% Jersey City, N.J., 51%
Miami, Fla., 51% 7. Tucson, Ariz., 55% 8. Fresno, Calif., 56% 9. Riverside-San Bernardino, Calif., 57% Tampa, Fla., 57% Source UCLA Center for Health Policy Research, 1998 Current Population Survey
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