UCLA Center for Health Policy Research
By E. Richard Brown, PhD, Ninez Ponce, PhD, Thomas Rice, PhD, & Shana Alex Lavarreda, MPP
June 2002
Exhibit 27: Self-Reported Health Status by Insurance Type, Ages 18-64, California, 2001
Percentage Reporting Fair or Poor Health, by Insurance Type:
25.9% – Uninsured 38.3% – MediCal/Healthy Families (Medicaid/CHIP) 10.5% – Job-Based Insurance 7.7% – Privately Purchased Insurance 20.5% – Other Public Coverage
Comment: Dr. Brown and his colleagues have provided an excellent analysis of the state of health insurance in California, also addressing the consequences of not having health insurance, and public policies that would expand coverage. This report is an important addition to the health policy literature.
Although the numbers reported in the isolated finding above are almost shocking, self-reporting of health status can be influenced by many variables. The Medicaid and CHIP programs are designed for low-income populations that happen to have greater health care needs and include individuals with significant chronic disabilities. Low-income uninsured individuals with major health care needs are more likely to enroll in these programs, if eligible. Nevertheless, it is impressive to note that those enrolled in MediCal and Healthy Families report a significantly higher incidence of fair or poor health than do the uninsured. MediCal alone has not improved the self-reported health status to a level better than that of the uninsured.
MediCal is a program that is chronically under-funded, resulting in reduced provider participation and consequent impaired access to care. The most important first step that could be taken to improve the health outcomes of those in the MediCal program would be to replace this “welfare” program with a universal, comprehensive health insurance program. That won’t resolve all of their health care problems, but it would certainly improve access to care. Obviously, the uninsured would benefit greatly as well.
In their report, Dr. Brown and colleagues call for continuing “the policy dialogue of the state Health Care Options Project established by SB 480 by examining alternative ways to insure all Californians.” We couldn’t agree more. In fact, every state and the federal legislators need to carefully examine the results of the Health Care Options Project.