25% in the Valley lack health insurance

Region's plight worse than nationwide total of 15%.

Published online on Saturday, Oct. 03, 2009

Covering the uninsured is a key part of the national health-care debate, and few places have more at stake than the central San Joaquin Valley.

As many as 25% of the people in this region lack health insurance, compared to 15% nationally. And those who are insured are far more likely than people nationwide to depend on public insurance such as Medi-Cal.

Children fare somewhat better, but the only people with near-universal coverage are 65 and older -- because of Medicare.

Those findings come from the U.S. Census Bureau, which asked about health-insurance coverage for the first time last year in its ongoing American Community Survey.

The data attach solid numbers to the uninsured population, regardless of citizenship or immigration status, at a time when their fate dominates Washington politics. For the San Joaquin Valley and other areas with high poverty and immigration, the news is not good.

"This is not shocking ... for those of us who have been working in the health and social services world," said Steve Schilling, chief executive officer of Clinica Sierra Vista, which operates two dozen clinics for mostly low-income patients.

Charlene Bellchambers, 52, has been a Clinica Sierra Vista patient since moving to Fresno to live with her brother's family five months ago. Before that, she was homeless in San Bernardino County.

With multiple medical problems and no job, she relies on the clinic as well as a county program for medical services to the indigent -- and worries about what will happen if her eligibility runs out.

"I'm between a rock and a hard place," she said. "Too old to get something from work, and too young for Medicare."

In Tulare County, an estimated 69% of working-age adults were insured last year, either through work or other private insurance, or though public programs like Medi-Cal and Medicare, or both. It was the lowest rate of any major county in the state, which had an overall rate of 82%.

Better coverage rates were found among children and teenagers, of whom 80% were covered, and people older than 65, of whom 97% were covered. Both groups are far more likely than working-age adults to have public insurance.

Combining public and private forms of coverage, Tulare County's overall insured rate stood at 75%. Because the survey covered only a sample rather than the entire population, the percentages are estimates that may differ from reality by few points in either direction.

Poverty and large numbers of recent immigrants don't explain all of the Valley's high rates of uninsured. Workers whose jobs don't provide insurance also account for a big share, said Harry Foster, president and chief executive officer of Family HealthCare Network, which operates clinics in Tulare and Kings counties.

"They're working in fast food. They're working in ag. They're working in various occupations where the employer is not providing health insurance," Foster said.

Other counties in the region rated slightly better than Tulare but still fell below state and national averages. The survey found that 80% in Fresno County are insured, 79% in Merced and Madera counties and 78% in Kings County.

The survey also showed that San Joaquin Valley residents who are insured are more likely to have public health insurance, such as Medi-Cal or Medicare, and less likely to have employer-based or other private health insurance.

An estimated 70% of U.S. residents and 65% of Californians have private insurance, the survey said. But in the five central San Joaquin Valley counties, the proportion ranged from 49% to 54%.

For public insurance, the numbers were 26% nationally, 25% in California, but 31% to 52% in the Valley. Some people are counted twice because they have both public and private insurance.

Nationally, low rates of health-insurance coverage are concentrated in a few geographical areas, the survey said.

Of 123 U.S. counties with more than 500,000 people, Fresno County ranked 20th from the bottom in the percentage of people with health insurance.

Only three California counties of that size ranked lower -- Los Angeles, Riverside and San Bernardino. So did counties in six other states -- Texas, Florida, Georgia, Colorado, Nevada and Oklahoma. Ranking last was Hidalgo County, Texas, on the Mexico border.

Foster said his clinics estimate that 25% of their patients lack insurance and must pay cash, scaled to their income and family size. Slightly more than half have Medi-Cal, the state-federal insurance for the poor, and most of the rest have private insurance.

Clinica Sierra Vista's uninsured share is even higher, almost 35% of patients, Schilling said. Much of the cost is made up by government grants. But Schilling said the burden has been growing as people in the Valley lose their insurance in the recession.

"All of us in the community health center world have seen a spike in the last couple of years as the economy has turned for the worse," he said.