Holding her newborn son, Johnny Ceja, Lina Coria talks with Dr. Betsy Meux Friday at CommuniCare Health Center in Davis.
The waiting room at CommuniCare Health Center in Davis hums with the trills of children and the chattering of adults.
With a sliding economy, the buzz is louder at the clinic, one of five in Yolo County that provide care to the uninsured.
Paula Hutchison of Woodland was there last week because she’s gone without insurance since she started her Paula Pooh Housecleaning service. She’s been lucky, she said, but there have been close calls.
Like last year, when she knocked against an iron railing. Her shoulder turned red, then a yellowish blue and purple. She bought a sling and continued working. It still looks bruised.
Hutchison is among the uninsured in Yolo County, a proportion of the total county population among the highest in California.
Yolo is separated from Placer by a strip of Sutter County. But it’s a world away statistically.
Placer’s combination of demographics makes it one of the best for insurance coverage: wealthier, older residents employed by large companies.
In contrast, Yolo County residents are diverse in occupation and age.
Disparities in coverage, created by the nation’s reliance on employment-based health insurance, are at the heart of the debate about overhauling health care. Those disparities are most evident, locally, in Placer and Yolo counties.
According to new census data, Placer County in 2006 had the lowest rate of uninsured people under age 65 in California: 13.7 percent. Yolo County’s rate was 22 percent.
The uninsured present an immense fiscal and public health challenge: 18,000 Americans die each year because they aren’t covered, according to the Institute of Medicine, a nonprofit research organization. This is because having insurance is closely tied to health outcomes: The uninsured won’t see a doctor regularly, and if they seek care it is likely to be inadequate or too late.
Moreover, the uninsured are a cost for society: One economist recently estimated the tab at $56 billion per year, 75 percent of which is paid by governments. In cash-strapped California, that cost is critical: 6.6 million residents went uninsured in 2007, more than in any other state, according to the California HealthCare Foundation.
Today, the majority of the insured are covered through work, a tradition born of the Great Depression and World War II. During the war, the government limited wage increases, but provided incentives for private companies to add benefits.
But when it comes to insurance, not all employers are equal.
Placer and Yolo counties have had similar unemployment rates in recent years, yet a gap in insurance coverage persists.
What makes employers more, or less, likely to offer insurance is size and industry. Yolo County relies heavily on agriculture, a business with low rates of insurance benefits, said Catherine McLaughlin, a health economist who studies the uninsured at Mathematica Policy Research in Princeton, N.J. Additionally, a significant portion of workers in Yolo are in service and food industries, where coverage is less likely.
At the other end, white-collar workers are most likely to have employer-based insurance, according to the Center on Policy Initiatives, a social policy advocacy group.
In Placer, the financial industry employs 12.4 percent of workers, and professional and business services employ 16.3 percent, according to the Sacramento Regional Research Institute. In Yolo, the financial industry employs 4.9 percent, according to census statistics.
Placer County also counts high-tech companies such as Hewlett-Packard and Oracle among its major employers. High-tech firms are more likely to offer solid health insurance, McLaughlin said.
Yolo County is teeming with small businesses, which often do not offer health benefits, said Pat Billingsley, Yolo’s deputy director of medical services. Smaller businesses face higher overhead costs in purchasing insurance and lack leverage to negotiate with insurers, he said.
In California, businesses with fewer than 10 workers offer insurance 63.6 percent of the time, while businesses with more than 50 workers offer coverage 96.2 percent of the time, according to the California HealthCare Foundation. Census statistics show Placer County has 487 businesses with more than 50 employees; Yolo County has 242.
Income matters as well. The number of lower-middle class households in an area is the biggest predictor of health-insurance coverage rates, said Shana Alex Lavarreda, director of health insurance studies at the UCLA Center for Health Policy Research. The very poor are usually covered by public programs; the middle to upper classes are usually covered through employers.
“They tend not to have employment-based coverage,” said Lavarreda, referring to people earning between $20,000 and $60,000 a year for a family of four. “They can’t afford private insurance. They are not eligible for public assistance.”
In Placer County, about one in four residents falls into that lower-middle class group – 20 percent lower than the statewide average, census figures show. Yolo County is also below the state average for that income group, but just barely.
Additionally, people in similar occupations make less money in Yolo than in Placer. In management and professional-related occupations, the median in Placer is almost $14,000 more than Yolo, according to Corinne Wilson, an analyst from the Center on Policy Initiative in San Diego.
Ethnic diversity is also different in Placer and Yolo. Just 11 percent of Placer County’s population is Latino, way below California’s rate of 36 percent, census figures show. About 28 percent of Yolo County’s residents are Latino.
Latinos are more than twice as likely to be uninsured as whites, and nearly 60 percent of the uninsured in California are Latino, according to the California HealthCare Foundation.
McLaughlin said Latinos are more likely to work at jobs that don’t offer insurance, and undocumented residents are more likely to be Latino. Undocumented immigrants aren’t eligible for public health benefits, except emergency care, she said.
Another factor is age: Young adults between 20 and 34 are the most likely age group to lack health insurance, state figures show. Yolo County has those in droves; Placer County has an older population.
“We call them the ‘young invincibles,’ ” McLaughlin said of young adults in Yolo County. “They are more likely to have temporary jobs and be moving around. And if they have a choice between higher income and insurance, they’ll choose higher income.”
Yolo’s uninsured numbers would be higher if UC Davis students were not required to prove they have health insurance, said Lucien Wulsin, executive director of Insure the Uninsured. Many students stay in the area after college, though, and often go without coverage.
John Hoang, who graduated last year from UC Davis, is an uninsured part-time substitute teacher. “I don’t plan on dying and I just can’t afford it right now,” said Hoang, 23. Besides, even if he had the money, he said, there’s a long list of items – rent, phones, computers – higher on the priority list.
Meanwhile, things just keep getting busier in California’s community health clinics, the last safety net for the uninsured.
The uninsured population has grown by about 10 percent since the start of the current recession, Wulsin said, including Placer County’s.
In April, the Gathering Inn, a homeless shelter in Roseville, opened a weekly Saturday clinic to serve the increasing number of uninsured.
“I don’t think there’s been accessible health care in Placer,” said Suzi deFosset, shelter executive director. “The existing community clinics are getting overwhelmed.”
DeFosset said she has seen a 35 percent increase in people at the homeless shelter in recent months.
State budget cuts have slashed funding to community clinics, and several in California have closed.
Robin Affrime, chief executive officer of CommuniCare, said she’s feeling the squeeze. She must keep up with a robust stream of new patients and reduced funding.
“Really, most of these people are working,” she said. “Some are working at jobs that have never had benefits. Now we’re seeing a new shift in that employers can’t afford to maintain health care benefits for their employees anymore. It’s a real problem.”
Johnny Ceja, whose parents don’t have medical insurance, gets examined at the CommuniCare Health Clinic in Davis.
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