Health Insurance, Health Care Use, and Health Status in Los Angeles County

Research publications reflect the views of the authors and do not necessarily reflect the views of the staff, officers, or Board of Directors of the Public Policy Institute of California. Short sections of text, not to exceed three paragraphs, may be quoted without written permission provided that full attribution is given to the source and the above copyright notice is included. PPIC does not take or support positions on any ballot measure or on any local, state, or federal legislation, nor does it endorse, support, or oppose any political parties or candidates for public office. iii Foreword Many Americans are without health insurance. Others have insurance but are vulnerable to the cost of catastrophic events, some lack coverage because they are unemployed, and still others are uncovered even though they hold full-time jobs—sometimes more than one. These simple facts have challenged decisionmakers in Washington and Sacramento for well over 30 years. With the nation now approaching 12 million illegal immigrants, the issue of un-or underinsured Americans has reached critical proportions. Meanwhile, Californians have an interest in health insurance not only because so many regions of the state have low-wage workers but also because the cost of providing care to the uninsured inevitably rests with the county governments and taxpayers of the state. Marianne Bitler and Weiyi Shi have analyzed detailed data on health insurance coverage, individual health status, and the use of the health care system in Los Angeles County. They investigate three questions: Who has health insurance? How does health care use differ among residents in Los Angeles County? And how does health status differ across population groups in the county? Their findings will be of immediate benefit to decisionmakers wishing to address the rising cost of care in both the public and private sectors. The answer to the first question is not unexpected—Hispanic adults are much more likely to be uninsured, after accounting for gender and age, than white, black, and Asian adults. Once immigration status is taken into account, however, the difference in coverage rates is greatly reduced—suggesting that immigration is indeed a factor that will be central to the resolution of this debate at the national level. In fact, both documented and undocumented immigrants were much more likely than U.S.-born residents to be uninsured. Perhaps the most surprising finding regarding the use of care is that hospital and emergency room (ER) visits did not differ much …