PubMed2000
This Special Report examines why the uninsured rate is so much higher in California than it is in the rest of the United States; it focuses on labor market and demographic characteristics that may explain the differential in health insurance coverage. California has the third-highest rate of uninsured for the nonelderly population in the United States, accounting for 16.6 percent of the total U.S. uninsured population. In 1998, 24.4 percent of the nonelderly population in California (both workers and nonworkers under age 65) was uninsured, compared with 18.4 percent uninsured in the United States as a whole. Only Arizona (with 27.2 percent) and Texas (with 27.0 percent) had higher uninsured rates than California. Among California workers ages 18-64, nearly 24 percent (or 3.8 million workers) were uninsured in 1998. Eleven years earlier, in 1987, 19.3 percent (or 2.7 million workers) were uninsured. During the decade 1987-1997, the percentage of California workers with employment-based health insurance declined from 68.5 percent to 64.2 percent. But more recently, between 1997 and 1998, the percentage of workers with employment-based coverage increased slightly from 64.2 percent to 65.5 percent. Fifty-three percent of California workers employed in the agriculture sector were uninsured in 1998. Overall, agriculture accounts for 4 percent of the jobs in California; however, agricultural workers accounted for 8 percent of the uninsured. Demographics are a key factor affecting California's rate of uninsured. Twenty-seven percent of California workers are Hispanic, more than three times the proportion in the rest of the United States. Compared with the rest of the country, California has fewer workers who are white (54 percent vs. 76 percent) or black (6 percent vs. 12 percent), and more workers who are Asian (12 percent vs. 3 percent). More than 43 percent of Hispanic workers in California were uninsured in 1998, compared with 14 percent of white workers, 24 percent of black workers, and 21 percent of Asian workers. California workers--and Hispanic workers in particular--are more likely to be employed by small firms, which are significantly less likely to offer health benefits than large firms. Forty-four percent of the California work force was employed by firms with fewer than 100 employees, or was self-employed, compared with 40 percent of the work force in the rest of the United States. Sixteen percent of all workers in California did not graduate from high school. Among Hispanic workers, 44 percent did not graduate from high school; among white workers, 13 percent did not graduate. In comparison, 18 percent of Asian workers and 7 percent of black workers did not graduate from high school. In California, 60 percent of Hispanics earning less than $7 per hour were uninsured in 1998. In contrast, 26 percent of whites, 46 percent of blacks, and 41 percent of Asians earning less than $7 per hour were uninsured.