Uninsured Minorities

Higher premiums for family coverage mean more salary deductions and a shrinking paycheck. People from all walks of life must then contemplate whether to continue to pay for coverage or to just live without it.

Who Are the Uninsured?
The minority and immigrant populations are most affected by the increase in health insurance costs. Together, minorities comprised 46 percent of the uninsured, although these groups represent only 24 percent of the U.S. population. In a recent study of urban areas, researchers of the UCLA Center for Health Policy Research found that the American cities with the highest uninsured rates also had the largest minority and immigrant populations.

One of the reasons for these statistics is a higher unemployment rate -- in some cases three to four times what it is for the non-minority population. Minority and immigrant population groups are more likely to have low wage jobs that do not offer health insurance. They are usually positioned in non-traditional, part-time or temporary jobs.

The National Coalition on Health Care published some revealing research on this subject in 1999. According to the study, in 1997, 7.4 million African Americans (21.5 percent), 10.5 million Hispanics (34 percent) and 2.2 million Asian and Pacific Islanders (20.7 percent) had no health insurance. By comparison, only 15 percent of white Americans had no health insurance.

Allyson Hall and Karen Scott-Collins of the Commonwealth Fund and Sherry Glied of Columbia University conducted another study that was published in 1999. They found that minority workers were likely to be uninsured even when they could afford it.

In 1997, among workers with employment-based coverage in their own name, 69 percent of white Americans had coverage compared to 52 percent of African Americans and 44 percent of Hispanics. In addition, 70 percent of Hispanics in executive positions had employment-based coverage compared to 83 percent of whites. The authors aggregately concluded that Blacks and Hispanics are 21 percent less likely than whites to have coverage through their employers. The authors suggest that the following factors play a role in the declining of coverage:

Why Some Minorities Avoid Health care
Low income and poverty are barriers to minority access to health care. Another reason within some minority groups is the historical lack of trust in receiving quality care.

The Commonwealth Minority Health Survey revealed racial and ethnic differences in the use of medical care services. The most well-documented racial differences in medical care utilization have to do with coronary procedures.

African-American patients are less likely than white patients to undergo diagnostic, invasive and therapeutic coronary procedures after a myocardial infraction. African-Americans also undergo fewer cardiac catheterizations, angioplasties, coronary angiographies and bypass graft surgeries. Racial differences have also been reported in amputations, renal transplantations, surgical treatments for breast cancer, discretionary surgeries, orchiectomies and many other major diagnostic and therapeutic procedures. In addition, once a patient is discriminated against, he or she may delay or chose to forgo much needed care.

Medicaid and Medicare: Health Insurance Refuge for Most Minorities
Minority patients who have Medicaid or Medicare regularly visit health care facilities that accept this coverage. Most minorities have one of these two health care plans, which were legislated in the 1960s.

Medicaid was devised for the poor and the disabled. Medicare provides health insurance to people age 65 and over, those who have permanent kidney failure and certain peoples with disabilities.

Approximately 14 percent of the total white population in 1990 were 65 and over. This compares to 8 percent of the black population, 6 percent of Asian/Pacific Islanders, 6 percent of Native Americans and 5 percent of those of Hispanic origin.

So-called safety net providers such as public hospitals, community health centers and health departments play a significant role in caring for the ethnically diverse and the uninsured.

Medicare Pays Less, Patients Pay More
Medicare has an outpatient rule where the patient pays 20 percent of the hospital's charge for treatment. The problem is that hospitals are inflating the cost of the treatment. The patient now has to outlay more from his pocket and Medicare reimburses the hospital at less than 20 percent.

There is a well-documented example in the case of Gerald Ralph from the HealthCare Financing Administration. Ralph is a retiree of Tennessee that had outpatient cataract surgery at Columbia/HCA's Summit Medical Center in Hermitage.

The cost for his surgery was $9,000 and he was expected to co-pay $1,800. However, Medicare only approved reimbursing the medical center $3,200 -- including the patient co-payment. Medicare ended up only covering one third of the billed price. If Ralph paid 20 percent of the real cost, he would have only paid $640 instead of $1,800. It is nearly impossible for patients to figure out the formula for what Medicare covers for their treatment. The final paperwork is confusing to most people. As a result, they do not realize they overpay in most cases.

In Conclusion
There are a great number of minorities that are always without health insurance. Some minorities avoid health care as long as possible because of poor quality treatment. Even when members of this group can afford health insurance, they often decline employment-based coverage.

Rising health care costs result in rising health insurance costs. As a result, the patient pays more and health insurance continues to pay less. Solving the problem of health insurance costs, its access and the quality of health care is not going to happen overnight. But the process must start somewhere in order to fix the system and remedy these institutional discrepancies.

Notes
Findley, S., Miller, J. "Down A Dangerous Path: The Erosion of Health Insurance Coverage in the United States," The National Coalition on Health Care (May 5, 1999), www.americashealth.org.
Hall, A, Collins, K.S., and Glied, S. "Employer-Sponsored Health Insurance: Implications for Minority Workers," The Commonwealth Fund (February 1999), www.cmwf.org.
Hogue, C., Hargraves, M. and K. Collins, Commonwealth Fund, Minority Health In America: Findings and Policy Implications From the Commonwealth Fund Minority Health Survey (Johns Hopkins University Press, 2000), pp 194-95 and 278-279.
U.S. Bureau of the Census, Health Insurance Coverage: 1997 (September 1998), Data from the March 1998 Current Population Survey.
Wissner, S., "Medicare Allows Patient Overcharges: Expensive Road to Treatment," The Detroit News (September 21, 1997), www.detnews.com.