IMPROVING ACCESS TO HEALTH CARE AND SERVICES, ESPECIALLY
FOR THE INDIGENT AND WORKING POOR, TO ENSURE DETECTION AND TREATMENT OF ILLNESS
AND INJURY AT THE EARLIEST POSSIBLE TIME
Health care coverage is critical to providing access to health care services,
therefore those who have no insurance have problems obtaining health care (Wyn,
Teleki, & Brown, September 12, 2000). Texas has the largest population of uninsured
in the nation, with 24 percent of people without insurance in 1998. Nationally,
16.3 percent of Americans lacked health insurance in the same year (Texas Health
and Human Services Commission, September 2000, Demographic profile of the Texas
population without health insurance during the 1996-1998 period).
Using data from 1996 to 1998, 42 percent of young Texan adults ages 18-24
were uninsured, the highest rate of any age group (Texas Health and Human Services
Commission, September 2000, Demographic profile of the Texas population without
health insurance during the 1996-1998 period). This trend is similar to what
is being seen on the national level; people 18 to 24 years old were more likely
than other age groups to lack coverage - 30 percent were without coverage in
1998 (United States Census Bureau, September 12, 2000). The rate of uninsurance
among young Texas adults ages 25 - 34 is 32 percent and is also substantially
higher than the 24 percent average across all age groups (Texas Health and
Human Services Commission, September 2000, Demographic profile of the Texas
population without health insurance during the 1996-1998 period).
The following table illustrates the estimated number of persons without health
insurance by each county in the MSA. In Travis County, the percent of children
ages 0 - 18 without insurance is 23.6 percent. Nationally, the number of uninsured
children under 18 years of age in 1998 was 11.1 million, or 15.4 percent of
all children.
Compared to other urban areas, the Austin-San Marcos MSA has the lowest percentage
of uninsured residents (Wyn, Teleki, & Brown, September 12, 2000).
According to a study done by the Center for Health Policy Research at UCLA,
having at least one physician visit in the past year is a broad measure of
access to the health care system for both acute and chronic conditions as well
as preventative checkups. Their study reports that 30 percent of the Austin
population ages 0 - 64 did not visit a MD from 1995 - 1996 and that 27 percent
had no usual source of care in the same time period (Wyn, Teleki, & Brown,
September 12, 2000). As the following table demonstrates, the moderate- and
low-income population (below 250% of the federal poverty level) that is uninsured
is less likely to have a usual source of care and usually less likely to have
seen a physician within the past year than the moderate- and low-income population
with coverage.
Employment remains the leading source of health insurance coverage (70.2 percent
of those insured). Of all workers in the US in 1998, 53.3 percent had employment-based
health insurance policies in their own name. The proportion varied widely by
size of employer, with workers employed by companies with fewer than 25 employees
being the least likely to be covered. The government also provided health care
coverage (24.3 percent of those insured) which includes Medicare, Medicaid,
and military health care. Because of Medicare, only 1.1 percent of the US elderly
population lacked coverage. While the Medicaid program insured 14 million people
in 1998, 11.2 million poor people still had no health insurance (United States
Census Bureau, September 12, 2000).
Race and ethnicity are also factors that influence a person's chances of having
health care coverage. In 1998, Hispanics had the highest chance of not having
health insurance. The uninsured rate among Hispanics was higher than that of
non-Hispanic Whites - 35.3 percent compared with 11.9 percent (United States
Census Bureau, September 12, 2000).
Income is also a significant factor when looking at those who are uninsured.
Persons who lack health insurance coverage have traditionally been those at
or below the poverty level. Of those poor people between the ages of 18 and
24, 46.7 percent were uninsured in 1998. A growing number of individuals and
families without health insurance are the working poor whose incomes are used
to meet basic necessities of food, shelter, and clothing, leaving little for
health coverage. About one-half, or 47.5 percent, of poor, full-time workers
were uninsured in 1998. The uninsured poor comprised 25.2 percent of all uninsured
people (United States Census Bureau, September 12, 2000). In Texas, about 64
percent of those without insurance come from families and households with incomes
below 200 percent of the federal poverty income level (Texas Health and Human
Services Commission, September 2000, Demographic profile of the Texas population
without health insurance during the 1996-1998 period).
The growth in the number of uninsured residents has strained the local health
care safety net, resulting in a rising number of residents who delay care or
seek non-urgent care in hospital emergency rooms. Health care providers and
related human service agencies in the region have participated in cooperative
efforts to improve the delivery of services to low income and uninsured populations.
Numerous Travis County safety net providers came together to form the Indigent
Care Collaboration (ICC) to develop joint projects to increase access, improve
quality, and lower the cost of providing care to the area's uninsured population.
Only through the combined efforts of public and private resources in cities,
counties, and the state, can the issue of health care coverage be adequately
addressed.
Cities and counties have limited ability to provide health
insurance coverage to uninsured residents. But states have been given expanded
support to cover uninsured children and their families. The federal Children's
Health Insurance Program (CHIP) gives states additional opportunities and
funding to extend coverage to children in moderate- and low-income working
families. Recent policy changes in Medicaid also give states considerable
flexibility in setting income eligibility for Medicaid coverage for moderate-
and low-income working families, an option that only 11 states are using
to any extent.
While the states and federal government have the ability
to extend health insurance coverage, cities and counties are in a position
to provide direct support to safety net health care services. Public and
community-sponsored clinics are important providers of care to the uninsured,
as well as to moderate- and low-income community residents in general (Wyn,
Teleki, & Brown, September 12, 2000).
The implementation of the Texas Children's Health Insurance Program (CHIP)
will certainly affect the number of children under age 18 who have health care
coverage and services.
With the implementation of the main part of the Texas Children's
Health Insurance Program (CHIP), which started in 2000, almost 3 out of
every 4 uninsured Texas children (those from families with incomes of 200
percent of poverty income or less) are likely to have access to health
insurance coverage under either Medicaid or CHIP. If all income eligible
children were to enroll in either one of these two programs, the rate of
uninsurance among Texas children under 18 could drop to a little more than
five percent (Texas Health and Human Services Commission, September 2000,
Demographic profile of the Texas population without health insurance during
the 1996-1998 period).
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