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Covering the Difference

News1 CoveredCalifornia1Will Covered California equalize the county’s health insurance disparities?

Healthcare has been a fixture in the headlines for several years now—from the passage of President Barack Obama’s flagship Affordable Care Act (ACA) in 2010 and the House Republicans’ constant attempts to repeal it, to the recent rollout of the online insurance marketplace and the glitches that characterized its launch.

The take-home message has been that healthcare will become more accessible for all Americans, who will need to attain some form of health insurance under the new law by the end of March 2014 to avoid a penalty.

Obamacare, as it’s called, is expected to affect approximately 30,000 uninsured or underinsured Santa Cruz County residents, according to county officials. However, until then, a recent report has shown that our county remains characterized by stark disparity when it comes to healthcare coverage.

According to the 2013 Santa Cruz County Community Assessment Project (CAP) report, there are drastic differences in healthcare coverage between North and South County residents, as well as between local Whites and Latinos.

The report, which is conducted annually by Applied Survey Research (see this week’s cover story for a deeper look), includes aggregated data as well as primary data collected through a countywide telephone survey. In this year’s survey, only 58.6 percent of Latino respondents reported that they were covered by some form of health insurance in 2013. This was an increase from a record low of 51 percent in 2011, but still much lower than the 92.1 percent of White respondents who stated that they had health insurance coverage in 2013 (the highest figure in more than a decade).

The CAP report, using statistics from the Central California Alliance for Health (CCAH), also showed that 56 percent of those in the county covered by Medi-Cal, the Medicaid program in California that provides low-income individuals and families with free or low-cost medical coverage, were located in South County—a 12 percent increase since 2007. Forty-one percent of people covered by Medi-Cal hailed from North County, representing a 14 percent decrease since 2007.

“There is an income qualification for Medi-Cal, and unfortunately our Latino population is disproportionately making an income that would qualify them for this publicly funded program,” says Raquel Ramirez Ruiz, director of programs at the Pajaro Valley Community Health Trust. “It is not surprising that there is such a disparity in this category.”

With a variety of factors involved in the imbalance of health insurance coverage and participation in Medi-Cal within the demographics and regions of Santa Cruz County, some experts on the subject are hesitant to identify specific causes of the trend.

“There could be so many different reasons why that could be that I wouldn’t even want to hazard a definitive statement as to ‘this is the reason why,’” says Jan Wolf, member services director at CCAH, which facilitates Medi-Cal benefits in Santa Cruz County. “Medi-Cal is a program for low-income individuals. It depends on whether or not, for example, individuals have the same access to employment opportunities, or educational opportunities, or whether it is a matter of the economy.”

Wolf points to the fact that unemployment rates are significantly higher in South County—17.8 percent in the City of Watsonville in 2013, for example, and 6.8 percent in the City of Santa Cruz. “So those areas may have more individuals qualifying for Medi-Cal on the basis of income than others,” she explains.

Issues of economic hardships caused by the 2008 recession may be to blame for the disparities in health insurance coverage. According to the CAP report’s findings, 78 percent of Latinos surveyed in 2007 responded that they had health insurance. In 2009 the figure decreased to 52.6 percent, which could be attributed to the effects of the recession. The number of White respondents who said they had health insurance was 91.8 percent in 2007 and 88.9 percent in 2009, a significantly smaller decrease, reflecting a potentially disproportionate effect felt by the recession.

Ramirez, with the Pajaro Valley Community Health Trust, says the issue will need broader community support to be properly addressed.

“This is a larger issue than one organization can take on,” she says. “We need to work together to improve the quality of life for everyone in our county and create more lucrative jobs to assist with this issue.” 

With the October rollout of Covered California, the state’s health insurance marketplace for Obamacare, the county’s disparities in insurance coverage may be resolved in the coming months and years.

Gary McNeil, senior analyst at the county’s Human Services Department, states that approximately 8,000 to 10,000 county residents will be newly eligible for the Medi-Cal program, which has been modified and expanded to include a wider range of low-to-moderate income individuals and households.

“Medi-Cal expansion just opens the door to all of these people who weren’t eligible before because they weren’t disabled [for example], or didn’t have children,” says McNeil. “A lot of adults and couples and households who didn’t have access to Medi-Cal now will.”

A number of outreach programs for Medi-Cal and Covered California have been implemented in the county at large, with three specifically centered in South County through the Pajaro Valley Unified School District’s Healthy Start Program, Salud Para la Gente, and the United Way of Santa Cruz County. All have bilingual capabilities.

A recent press release from Covered California shows that within California’s Region 9, which includes Santa Cruz County, enrollment in Covered California insurance plans and Medi-Cal is gradually increasing, but as time passes, McNeil hopes that more of the uninsured in South County will take advantage of these new programs.

“I do believe they will close that gap,” says McNeil.

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