small area estimates of health insurance coverage · ** please note: 2012 and 2015 us, ca and san...

SMALL AREA ESTIMATES OF HEALTH INSURANCE

COVERAGE:A LOCAL HEALTH DEPARTMENT

PERSPECTIVE

Sanaa Abedin, [email protected]

Epidemiologist, Public Health Services

Community Health Statistics Unit

WHAT WILL THIS PRESENTATION COVER

OVERVIEW

San Diego County Demographics

Uninsured at Point in Time

Insurance Coverage Distribution

Sociodemographic Factors and

the Uninsured

Changes in the rate of health insurance coverage reflect^:

Economic trends

Demographic shifts

Policy changes, such as the Affordable Care Act (ACA)

^http://www.shadac.org/sites/default/files/publications/SHADAC%20ACS-CPS-Webinar_2016_FINAL_Sept21.pdf#overlay-

context=publications/new-data-acs-cps-annual-conversation-census-bureau-experts-webinar

08/16, 742,077

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

Jun-2

006

Jan-2

007

Aug-2

007

Ma

r-2

008

Oct-

2008

Ma

y-2

009

De

c-2

009

Jul-2

010

Feb

-2011

Sep-2

011

Apr-

2012

No

v-2

012

Jun-2

013

Jan-2

014

Aug-2

014

Ma

r-2

015

Oct-

2015

Ma

y-2

016

Recip

ien

ts

Medi-Cal Recipients in San Diego County, 2006-2016

Medi-Cal Expansion

ACA Enacted06/06,

256,255

Building

Better

Health

Living

SafelyThriving

3

THE VISION

DATA SOURCES

Regional and Subregional Trends

American Community Survey 5-Year Data on

Health Insurance Coverage

San Diego County Trends



San Diego County, California and US Trends

U.S. Census Bureau, Small Area Health

Insurance Estimates



Health Access

California Health Interview Survey

TableACS Table

Contents/Data

S2701

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

2nd most populous county in California and 5th most populous in the

United States

San Diego County

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.

DEMOGRAPHICS

SELECTED DEMOGRAPHIC CHARACTERISTICS

OF THE SAN DIEGO COUNTY POPULATION,

COMPARED TO CALIFORNIA OVERALL, 2015

47%

5%

33%

10%

4%

23%

63%

14%

89%

11

% 17%

19%

11

%

52%

39%

6%

39%

13%

4%

24

%

63%

13%

87%

13% 20%

20

%

14%

47%

Wh

ite

Bla

ck

His

pa

nic

AP

I §

Oth

er

0-1

7

18

-64

65+

Citiz

en

No

n-C

itiz

en

0-9

9

10

0-1

99

20

0-2

99

300+

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), 2014.

Prepared by: County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit, 2016

HEALTH INSURANCE

IN SAN DIEGO COUNTY

US, STATE & COUNTY TRENDS IN THE UNINSURED

2009 2010 2011 2012 2013 2014 2015

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%

0%

5%

10%

15%

20%

25%

30%

35%

Perc

en

t U

nin

su

red

Uninsured Among Civilian Noninstitutionalized Population, 2009-15Since 2010:

San Diego County: - 8.8 percentage points

California: - 9.9 percentage points

US: - 6.1 percentage points

Since 2010:

Generally, all age groups experienced

a decline in the percent uninsured for

both the county and state.

The 18-64 year age group experienced

the greatest decline in number of

people uninsured under the ACA.

24.425.3 24.9 24.7 23.9

17.3

12.1

22.1 22.9 2322 21.5

16

11.6

10 9.58.6 8.4 7.9

5.83.6

10.89.6

8.6 8.9 8.36.6

3.6

20.1 20.7 20.2 20 19.4

14.1

9.7

18.8 19.1 19 18.4 17.9

13.4

9.5

0

5

10

15

20

25

30

2009 2010 2011 2012 2013 2014 2015

Perc

en

t U

nin

su

red

(%

)

Uninsured Among Civilian Noninstitutionalized Population by Age, 2009-2015

18 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

UNINSURED IN SAN DIEGO COUNTY

** 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 2015.

17.1% 16.8% 15.9% 14.1%

17.0% 16.3% 12.3% 8.8%0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

0%

20%

40%

60%

80%

100%

County of San Diego

Comparison of ACS 1-Year and 5-Year Estimates of San Diego County's Uninsured Population, 2012-2015

2008-12 (ACS 5-Year) 2009-13 (ACS 5-Year) 2008-14 (ACS 5-Year) 2011-15 (ACS 5-Year)

2012 (ACS 1-Year) 2013 (ACS 1-Year) 2014 (ACS 1-Year) 2015 (ACS 1-Year)

25.1%

15.8%11.1%

16.2% 15.5%20.7%20.6%

12.9%9.5%

12.7% 13.4%16.9%

Central East North Central North Coastal North Inland South

Uninsured San Diego County Residents by Health & Human Services Agency Region, 2012-2015 (5-Year Est.)

2008-12 2009-13 2010-14 2011-15

2012 SDC %

Uninsured

2015 SDC %

Uninsured

12.37.6

23.829

16 16.7 17.1

15.5

14.8

27.2

25.9

22.216.3

19.9

15

13.5

7.4

9.9

19.4

15.313.5

57.264.2

41.735.2

42.4

51.7 49.6

NorthCoastal

NorthCentral

Central South East NorthInland

San DiegoCounty

Poverty Among San Diego County Residents by HHSA Region, 2014 & 2015 (Pooled)

0-99% FPL 100-199% FPL 200-299% FPL 300% FPL and above

Perc

enta

ge (

%)

SOCIODEMOGRAPHICS BY HHSA REGION

66.0%63.9%

50.3% 50.6%

70.6%

61.4% 60.7%

19.9% 20.2%

28.2% 29.6%

17.4%

25.0%23.3%

2.1%

12.9% 11.9%

20.4%18.1%

9.6%11.5%

13.9%

0

0

0

0

0

1

1

1

1

NorthCoastal

NorthCentral


San DiegoCounty

Type of Usual Source of Care by HHSA Region in San Diego County, 2014-15 (Pooled)

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


§ § § § §§

52.9 49.9

62.5 62.2

52.357.7

47.1 50.1

37.5 37.8

47.742.3

NorthCoastal

NorthCentral


San DiegoCounty

Delay in Care Experienced by San Diego County Residents by HHSA Region, 2013-15 (Pooled)

Healthcare system/provider issues and barriers or Personal reasons

Cost, lack of insurance, or other insurance-related reasons

Perc

en

tag

e (

%)


§

UNINSURED IN SAN DIEGO COUNTY

2015:

US: 9.4%

CA: 8.6%

SAN DIEGO

COUNTY: 8.8%

** 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 2015.

HEALTH CARE COVERAGE TYPE

UNINSURED

UNINSURED

BY CITIZENSHIP/NATIVITY

2009 2010 2011 2012 2013 2014 2015

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%

0%5%

10%15%20%25%30%35%40%45%50%

Perc

en

t U

nin

su

red

Uninsured Among Foreign Born Non-citizens, 2009-15

2009 2010 2011 2012 2013 2014 2015

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%

0%5%

10%15%20%25%30%35%40%45%50%

Perc

en

t U

nin

su

red

Uninsured Among Foreign Born Naturalized Citizens, 2009-15

UNINSURED AMONG NATIVE BORN AND FOREIGN BORN

2009 2010 2011 2012 2013 2014 2015

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%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Perc

en

t U

nin

su

red

Uninsured Among Native Born, 2009-15

2009 2010 2011 2012 2013 2014 2015

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%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Perc

en

t U

nin

su

red

Uninsured Among Foreign Born, 2009-15

UNINSURED BY CITIZENSHIP/NATIVITY

SUMMARY OF ADDITIONAL SOCIODEMOGRAPHIC FACTORS

Households with incomes between

$25,000 and under $50,000 had

the largest percentage of uninsured

at 14.0% in 2015.

Especially high in National

City and Central San Diego;

33.3% and 31.0%,

respectively in 2011-15

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 2011-

2015

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 2012-2015 (-

16.5% points)

Particularly high among communities in

Northern San Diego (Anza-Borrego Springs

and San Marcos; 55.1% and 54.0%

respectively) in 2011-15

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 2015.

Highest in Palomar-Julian

(46.0%) and National City

(43.8%) in 2011-15

SUMMARY: IMPACTS OF THE ACA IN SAN DIEGO COUNTY

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 18-64 years (- 11.3%)

Who Were More Likely to Remain

Uninsured in San Diego County?

Foreign born non-citizens (29%)

Adults < HS Graduation (23.6%)

Unemployed (21.3%)

Individuals below 138% of FPL(16%)

Adults 25-34 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%)

Soon to be Released Report

from Community Health

Statistics Unit:

For more information, including

data, resources and reports,

from Public Health Services:

www.SDHealthStatistics.com

QUESTIONS?

Sanaa Abedin, MPHEpidemiologist

[email protected]

County of San Diego, Health & Human Services Agency, Public Health Services

small area estimates of health insurance coverage · ** please note: 2012 and 2015 us, ca and san...

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