Survey: Two-thirds of uninsured work
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By NANCY HICKS / Lincoln Journal Star
Almost two-thirds of Nebraska's uninsured are working, or are children with parents who work, according to a recent health insurance coverage survey. Some work at businesses that don't offer health insurance, often small businesses with fewer than 10 employees. Some own their own business. Some of the uninsured have decided they don't need insurance because they are young or seldom sick. But many simply can't afford the cost of health insurance.
"My employer offers insurance, but it is ridiculous. There's no way you can afford it, unless you have somebody else working in your household. It's almost half a paycheck (every two weeks)." Low-income, white female
In fact, 65 percent of those without private insurance say they can't afford it, and 27 percent of working Nebraskans said they couldn't afford employer-sponsored insurance.
The statewide survey is part of a new report that mixes survey statistics and comments from focus groups. It shows both the human face of the uninsured in the state and the numbers behind those faces.
The Health and Human Services System will use the report for strategic planning. A federal grant will help develop a plan on how to increase access to health insurance and to health care.
Much of the report's information comes from a telephone survey of 3,750 Nebraska households and 13 focus groups conducted last year. Information on Nebraska businesses came through a Department of Labor mail survey.
Nebraska's status hasn't changed much in the more than 12 years between statewide surveys its 10 percent uninsured rate is less than the 15 percent national average.
About 145,000 Nebraskans under the age of 65 have no health care protection, either through insurance or the state-federal Medicaid program that covers some low-income adults and children, based on the survey. Almost all older Nebraskans, 65 and above, are covered by the federal Medicare program.
"
times have changed, because every place I ever worked had insurance until my last two jobs.
The place that I work at full time did have insurance until five years ago, but they can't afford it anymore. So it's not just the employees that are uninsured, it's the bosses that are uninsured, too. It's gotten so expensive." Low-income, white female
Who are the uninsured?
"Probably half of the ranchers and small business owners in this area (Panhandle) don't have insurance. Not having insurance is a crisis in rural communities. The problem is fluctuations in your net income each year coupled with the continual 20 percent increase in premiums each year." Rural small employer
Nebraska has a lower percentage of people who get their insurance through their employer than nationally, and a higher percentage who purchase private insurance, said Keith Mueller, director of the Nebraska Center for Rural Health Research at the University of Nebraska Medical Center. His agency conducted the telephone survey and focus groups for the Health and Human Services System.
"We got fairly expected results," said Dave Palm about the survey. "Most of those without insurance have low incomes, below 200 percent of poverty, or about $38,000 for a family of four. And most people work," he said.
Young adults are the most likely to not have health insurance. About 16 percent of Nebraskans 19 to 34 reported not having insurance. But 9 percent of adults 35 to 54 and almost 8 percent of those 55 to 64 don't have health insurance.
Children are the most likely to have insurance, likely because the Medicaid program covers children in moderate-income families through the Kids Connection program, according to Mueller.
There has been some increase in the percent of middle-aged uninsured (55 to 64 age group) over the past decade, Mueller said. Though the study itself doesn't provide any explanations, Mueller said these people may be having more difficulty getting back into the work force after losing jobs.
"I'm working part time and my job don't offer insurance to part-timers. I'm not qualified for Medicaid because I'm employed. So I'm stuck." Native American female
Health care for the uninsured
"Last year I was pregnant and I lost my twin babies. But I went to the (private) clinic and they asked me if I had insurance and because I didn't have it they couldn't take care of me. They said I had to wait until it was an emergency. I waited for 2 days, holding in the pain. When I went to Kearney (for care), it was too late. I had already lost my babies. If I had had medical assistance when I needed it, I would not have lost my babies." Rural Hispanic female
The study also found that people with no health-care protection from the high costs of doctors, drugs and hospitals don't have the same level of care as those with insurance or Medicaid coverage.
Occasionally people are turned away because they have no health insurance. But it's more likely that they don't even go to a doctor, according to the survey data.
"Often people say, I'm not going to even try (to go see a doctor)'," Mueller said. People in the focus groups said those without insurance are the last in the waiting room to be seen and sometimes still get a bill, and then a letter from a collection agency, he said.
One experience like that is enough. People don't chance it a second time, he said.
More than 40 percent of the uninsured reported not seeing a doctor in the past year, while just 14 percent of those with insurance didn't visit a doctor's office. And 14 percent of the uninsured said there was a time in the last 12 months when they needed care but could not get it, compared with 3 percent of the insured.
Fifty percent of the unemployed reported using a public clinic for health care.
But public clinics aren't available in some rural areas, and clinics sometimes have to turn away clients because they don't have enough money or space, Mueller noted.
There is a common assumption in Nebraska that everyone has access to health care, Mueller said. That is not true.
In fact, private clinics or doctors may refer someone without insurance to a public clinic not understanding that they may not get an appointment for weeks, he said.
In February the One World Community Health Center in Omaha had about 1,000 appointments they couldn't make because they didn't have the capacity both money and space, said Andrea Skolkin, executive director.
"We have a friend who had an aneurysm.
Now they are in the situation where what they owe is worth more than their ranch." Rural employer
New immigrants
"The majority of the people who come from our countries
they are not used to having health insurance where you have to pay weekly. They think that you will never need it and that it's just stealing money from your salary." Rural Hispanic male
Survey leaders also discovered different barriers for new immigrants, where lack of information about how health insurance works or how to get health insurance keeps them from using employer health insurance even when they can afford it.
People think that if they have paid the premium that they don't have to pay for anything else. So they cancel when they have to pay a co-pay or a deductible because they think it doesn't work, said Mueller about information from the study's focus groups.
They're not used to a system that says, Go get a health-care plan before you go get a doctor'," Mueller said.
"If I was legal, I would be paid a fair wage, and then I would be able to afford health insurance." Urban Hispanic male
Reach Nancy Hicks at 473-7250 or nhicks@journalstar.com.
Who are the uninsured?
A study of health insurance coverage in Nebraska gathered information from a telephone survey, focus groups and a mail survey. What the study revealed about the uninsured:
* Almost half 46 percent had incomes of less than 200 percent of the poverty level ($38,700 for a family of four).
* Almost two-thirds, or 63 percent, live in households where the head of the household is employed.
* About 21 percent are children. The rest are working adults.
* Sixteen percent of young adults, ages 19 to 34, are uninsured, the highest percentage by age breakdown.
* Almost one-third are middle-age Nebraskans, ages 35 to 54.
* Hispanics were nearly three times more likely to be uninsured (26.9 percent uninsured) than white or black Nebraskans.
* About two-thirds of the uninsured under age 65 without access to employment-based insurance don't buy private insurance because it is too expensive.
* About one-fourth of Nebraskans working for companies with health-care insurance didn't buy the insurance because it was too expensive. More than 50 percent who didn't enroll in the company plans were not eligible.
The study is available online (click on "Nebraska State Planning Grant on the Uninsured")
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