Eliminating Healthcare Disparities: The Role of Insurance Coverage Marsha Lillie-Blanton, Dr.P.H. Vice President in Health Policy The Henry J. Kaiser Family Foundation Making Public Programs Work for Communities of Color Families USA Washington, DC January 25, 2006

Why the Concern about Insurance Coverage

Potential Sources of Disparities in Care Patient-Level Provider-Level Healthcare Systems-Level SOURCE: IOM, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Figure 1

Uninsured Rates Among the Nonelderly Population: Poverty Status, Race, and Selected States, 2003 SOURCE: KCMU and Urban Institute estimates based on March 2004 Current Population Survey. Uninsured Rates Poor (<100% Poverty level) % of Poverty 400%+ of Poverty Children (<Age 19) Poor Children Adults (Age 19-64) Poor Adults White Black Hispanic National Florida Texas California New Hampshire Minnesota Figure 2

Nonelderly Uninsured by Race/Ethnicity, 2003 SOURCE: KCMU and Urban Institute estimates based on March 2004 Current Population Survey. Total = 45 Million Uninsured American Indian/ Alaska Native 1% White (non-Latino) 48% 2 or More Races 1% Latinos 29% African American (non-Latino) 15% Asian/Pacific Islanders 5% White (non-Latino) African American (non-Latino) Latino Asian/Pacific Islander American Indian/ Alaska Native 13% 21% 34% 20% 28% 17%Two or More Races National Average 18% Uninsured Rates Figure 3 Distribution by Race/EthnicityRisk of Being Uninsured

What is the link between insurance coverage and health care access?

The Consequences of Being Uninsured Research demonstrates that the uninsured: use fewer preventive and screening services; are sicker when diagnosed; receive fewer therapeutic services; have poorer health outcomes (higher mortality and disability rates); and have lower annual earnings because of poorer health. SOURCE: Hadley, Jack. Sicker and Poorer – The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income, Medical Care Research and Review (60:2), June Figure 4

Disparities in Cardiac Care for Chronic Renal Disease Patients by Race and Gender: Uninsured vs. Medicare Insured, Odds ratio < 1.0 indicates group is less likely to undergo procedure compared to white men *Difference is statistically significant after adjustment. NOTE: Odds ratios are adjusted for age, sex, insurance, socioeconomic status, health status, and disease severity. SOURCE: Daumit and Powe, Seminars in Nephrology, Vol. 21, No. 4 (July), Equally likely as white men Figure 5

Review of four studies; 8 comparisons (4 of Hispanic-White disparities and 4 of African American-White disparities Seven of 8 comparisons show insurance coverage as the single largest factor explaining racial disparities in having a regular source of medical care Role of Health Coverage in Racial/Ethnic Disparities in Access to Medical Care Figure 6 SOURCE: Lillie-Blanton and Hoffman. Health Affairs, March/April 2005.

Role of Health Coverage in Racial/Ethnic Disparities in Access to Medical Care Figure 7 Hispanic-White* African American-White *Researchers did not separate income from other personal socio-economic factors. **Local area demographics and health care system. SOURCE: Zuvekas & Taliaferro, 2003 EX: Percent of gap in having regular source of care Health InsuranceIncomeUnexplained Health InsuranceIncomeOther**Unexplained Disparity

Promising Strategies for Reducing HealthCare Disparities Increasing awareness of the problem Assuring adequate and meaningful health insurance coverage Improving healthcare quality through government regulatory and purchasing mechanisms Figure 8

What Can Be Done To Improve Insurance Coverage Create a more uniform system of coverage that guarantees a defined benefit Expand the reach of the current mix of private and public coverage, while maintaining the scope of benefits Figure 9

What Can Be Done To Improve Coverage & Reduce Disparities Nearly three-quarters of the 23 million uninsured persons of color have family incomes below 200% of poverty Many, therefore, would qualify for Medicaid or S-CHIP Policy Options - expand outreach and enrollment efforts to ensure that all eligible children are enrolled in Medicaid and S-CHIP -expand coverage to parents of enrolled children -expand coverage to low-income adults without dependent children Figure 10

Challenges and Opportunities Perceptions on the scope and nature of the problem vary Health costs continuing to rise Public resources limited (federal deficits, state budget crises) Lack of political will to implement best evidence Figure 11