SMALL AREA ESTIMATES OF HEALTH INSURANCE COVERAGE:
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1 SMALL AREA ESTIMATES OF HEALTH INSURANCE COVERAGE: A LOCAL HEALTH DEPARTMENT PERSPECTIVE Sanaa Abedin, MPH sanaa.abedin@sdcounty.ca.gov Epidemiologist, Public Health Services Community Health Statistics Unit
2 Jun-2006 Jan-2007 Aug-2007 Mar-2008 Oct-2008 May-2009 Dec-2009 Jul-2010 Feb-2011 Sep-2011 Apr-2012 Nov-2012 Jun-2013 Jan-2014 Aug-2014 Mar-2015 Oct-2015 May-2016 Recipients WHAT WILL THIS PRESENTATION COVER OVERVIEW San Diego County Demographics Uninsured at Point in Time Insurance Coverage Distribution Sociodemographic Factors and the Uninsured 800, , , , , , , ,000 0 Medi-Cal Recipients in San Diego County, /06, 256,255 ACA Enacted Medi-Cal Expansion 08/16, 742,077 Changes in the rate of health insurance coverage reflect^: Economic trends Demographic shifts Policy changes, such as the Affordable Care Act (ACA) ^
3 THE VISION Building Better Health Living Safely Thriving 3
4 DATA SOURCES Regional and Subregional Trends American Community Survey 5-Year Data on Health Insurance Coverage San Diego County Trends American Community Survey 1-Year Data on Health Insurance Coverage San Diego County, California and US Trends U.S. Census Bureau, Small Area Health Insurance Estimates American Community Survey 1-Year Data on Health Insurance Coverage Health Access California Health Interview Survey Table S2701 ACS Table Contents/Data HEALTH INSURANCE COVERAGE STATUS: Age Group Sex Race/Ethnicity Nativity/Citizenship Educational Attainment Employment Status Work Experience Household Income Federal Poverty Level Health Coverage Type
5 San Diego County 2 nd most populous county in California and 5th most populous in the United States San Diego has: Close to 3.2 million residents. Majority minority population. Busiest land border crossing in the world 1 of every 13 people who enter US come through San Ysidro. 70 miles of Coastline. 16 naval and military installations. 18 federally recognized Indian reservations. A total area of 4,526 square miles, larger than Rhode Island and Delaware combined.
6 White Black Hispanic API Other Citizen Non-Citizen % 6% 4% 4% 10% 13% 14% 13% 11% 13% 23% 24% 17% 20% 11% 14% 19% 20% 47% 39% 33% 39% 52% 47% 63% 63% 89% 87% DEMOGRAPHICS SELECTED DEMOGRAPHIC CHARACTERISTICS OF THE SAN DIEGO COUNTY POPULATION, COMPARED TO CALIFORNIA OVERALL, 2015 San Diego County California Note: Data may not add to 100% due to rounding and data restrictions Asian & Pacific Islander Source: UCLA Center for Health Policy Research. California Health Interview Survey (CHIS), Prepared by: County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit, 2016
7 HEALTH INSURANCE IN SAN DIEGO COUNTY
8 Percent Uninsured (%) Percent Uninsured US, STATE & COUNTY TRENDS IN THE UNINSURED Since 2010: San Diego County: percentage points California: percentage points US: percentage points Uninsured Among Civilian Noninstitutionalized Population by Age, to 64 years - California 18 to 64 years - San Diego County, CA Under 19 years - California Under 19 years - San Diego County, CA Under 65 years - California Under 65 years - San Diego County, CA 17.3 Uninsured Among Civilian Noninstitutionalized Population, % 30% 25% 20% 15% 10% 5% 0% United States 15.1% 15.5% 15.1% 14.8% 14.5% 11.7% 9.4% California 18.0% 18.5% 18.1% 17.9% 17.2% 12.4% 8.6% San Diego County 17.0% 17.6% 17.4% 17.0% 16.3% 12.3% 8.8% Since 2010: Generally, all age groups experienced a decline in the percent uninsured for both the county and state. The year age group experienced the greatest decline in number of people uninsured under the ACA.
9 ** Please Note: 2012 and 2015 San Diego County percentage of uninsured come from ACS 1-Year estimates; whereas, 2012 and 2015 San Diego County HHSA Region and Subregional estimates come from ACS 5-Year estimates. The sub-county estimates are underestimates of the actual percentage of uninsured for UNINSURED IN SAN DIEGO COUNTY 100% 80% 60% 40% 20% 0% Comparison of ACS 1-Year and 5-Year Estimates of San Diego County's Uninsured Population, % 16.8% 15.9% 14.1% 17.0% 16.3% 12.3% 8.8% County of San Diego 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% (ACS 5-Year) (ACS 5-Year) (ACS 5-Year) (ACS 5-Year) 2012 (ACS 1-Year) 2013 (ACS 1-Year) 2014 (ACS 1-Year) 2015 (ACS 1-Year) 0.0% Uninsured San Diego County Residents by Health & Human Services Agency Region, (5-Year Est.) % 20.6% 15.8% 12.9% 11.1% 9.5% 16.2% 15.5% 12.7% 13.4% 20.7% 16.9% 2012 SDC % Uninsured 2015 SDC % Uninsured Central East North Central North Coastal North Inland South
10 Percentage (%) SOCIODEMOGRAPHICS BY HHSA REGION Poverty Among San Diego County Residents by HHSA Region, 2014 & 2015 (Pooled) 0-99% FPL % FPL % FPL 300% FPL and above North Coastal North Central Central South East North Inland San Diego County
11 SOCIODEMOGRAPHICS BY HHSA REGION % Type of Usual Source of Care by HHSA Region in San Diego County, (Pooled) 63.9% Doctor's office/hmo/kaiser Community clinic/government clinic/community hospital Emergency room/urgent care, Some other place/no one place No usual source of care 70.6% 50.3% 50.6% 61.4% 60.7% % 20.2% North Coastal 12.9% 11.9% North Central 28.2% 20.4% 29.6% 18.1% 17.4% 9.6% 25.0% Central South East North Inland 11.5% 23.3% 2.1% 13.9% San Diego County
12 Percentage (%) SOCIODEMOGRAPHICS BY HHSA REGION Delay in Care Experienced by San Diego County Residents by HHSA Region, (Pooled) Healthcare system/provider issues and barriers or Personal reasons Cost, lack of insurance, or other insurance-related reasons North Coastal North Central Central South East North Inland San Diego County
13 ** Please Note: 2012 and 2015 US, CA and San Diego County percentage of uninsured come from ACS 1-Year estimates; whereas, 2012 and 2015 San Diego County HHSA Region and Subregional estimates come from ACS 5-Year estimates. The sub-county estimates are underestimates of the actual percentage of uninsured for UNINSURED IN SAN DIEGO COUNTY US: 9.4% CA: 8.6% 2015: SAN DIEGO COUNTY: 8.8%
14 HEALTH CARE COVERAGE TYPE
15 UNINSURED UNINSURED BY CITIZENSHIP/NATIVITY
16 Percent Uninsured Percent Uninsured Percent Uninsured Percent Uninsured UNINSURED AMONG NATIVE BORN AND FOREIGN BORN Uninsured Among Native Born, Uninsured Among Foreign Born, % 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% United States 12.5% 12.7% 12.4% 12.1% 11.9% 9.4% 7.4% California 12.8% 13.1% 12.9% 12.9% 12.4% 8.6% 5.5% San Diego County 13.0% 13.4% 12.9% 12.9% 12.2% 9.0% 5.9% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% United States 33.6% 34.3% 33.6% 32.8% 32.1% 26.5% 22.2% California 32.0% 32.9% 32.0% 31.3% 30.1% 22.6% 16.7% San Diego County 30.4% 31.0% 31.8% 30.3% 29.0% 22.9% 17.5% Uninsured Among Foreign Born Naturalized Citizens, Uninsured Among Foreign Born Non-citizens, % 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% United States 15.7% 16.4% 16.6% 16.2% 16.1% 11.4% 8.4% California 16.1% 16.9% 16.5% 16.2% 15.5% 9.6% 5.8% San Diego County 14.4% 16.4% 15.3% 14.9% 14.4% 10.3% 6.7% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% United States 47.4% 48.3% 47.4% 46.7% 46.0% 40.0% 34.9% California 45.4% 46.4% 45.7% 45.1% 43.9% 35.2% 27.4% San Diego County 44.2% 43.1% 46.3% 44.6% 42.4% 35.2% 29.0%
17 UNINSURED BY CITIZENSHIP/NATIVITY
18 UNINSURED BY CITIZENSHIP/NATIVITY
19 SUMMARY OF ADDITIONAL SOCIODEMOGRAPHIC FACTORS Uninsured status was highest among adults (25 years and older) with less than high school education; however, this group saw the largest drop in uninsured status overall between (- 16.5% points) Particularly high among communities in Northern San Diego (Anza-Borrego Springs and San Marcos; 55.1% and 54.0% respectively) in Adults working part-time had a higher percentage of uninsured, when compared to full-time or adults who did not work, at 15.2% in Highest in Palomar-Julian (46.0%) and National City (43.8%) in Unemployed adults(18+ years) had the largest percentage of uninsured adults at 21.3% in 2015 compared to employed adults and those not in the labor force. Valley Center and National City had the highest percentage (54.4% and 54.8% respectively) in Households with incomes between $25,000 and under $50,000 had the largest percentage of uninsured at 14.0% in Especially high in National City and Central San Diego; 33.3% and 31.0%, respectively in
20 SUMMARY: IMPACTS OF THE ACA IN SAN DIEGO COUNTY Who Were More Likely to Remain Uninsured in San Diego County? Foreign born non-citizens (29%) Adults < HS Graduation (23.6%) Unemployed (21.3%) Groups with the largest decreases in the uninsured in 2015 were: Unemployed (- 24.8%) Adults with less than high school graduation (- 16.5%) Hispanics (- 14.7%) Foreign born non-citizens (- 14.1%) Households making <$25K (-12.9%) Adults ages years (- 11.3%) Individuals below 138% of FPL(16%) Adults year olds (15.4%) American Indian/Alaska Native (21.7%) and Hispanics (15.3%) Part-time workers (15.2%) Household making $25K-$49.9k (14%)
21 QUESTIONS? Soon to be Released Report from Community Health Statistics Unit: Sanaa Abedin, MPH Epidemiologist County of San Diego, Health & Human Services Agency, Public Health Services For more information, including data, resources and reports, from Public Health Services:
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