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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