In Health Insurance Debate, Who’s Covered?

By Michelle Chen Sep 25, 2009

The media has circulating a haunting figure in recent days:45,000 deaths due to lack of health insurance—a grim marker of the depth of the country’s health care crisis. The statistic, from a new study by Harvard School of Medicine researchers, reflects projections based on government data on more than 9,000 individuals tracked over a number of years. Basically, we live in a country where about 46 million people don’t have health coverage, and drawing from government medical and census data, researchers calculate that this trend was tied to “approximately 44789 deaths among Americans aged 18 to 64 years in 2005.” The link between insurance and death held steady even after controlling for various socioeconomic, racial and health factors.” (A handy chart tells you how many of those dead folks are from your home state.) But when you factor those other characteristics in, a different sort of picture emerges. In the study sample, the Black uninsured rate, 23 percent, was nearly double that of whites. Nearly half of Mexican Americans were uninsured. Interestingly, the death rate for Blacks was significantly higher compared to Whites, but not for Mexican Americans. Clearly, other issues determine health and death risk besides insurance coverage or race alone. But what are they? The researchers raise the question in its discussion of the findings, comparing the study with an earlier analysis that connected uninsurance and mortality:

It is less clear how the differences in the racial and ethnic make-up of our study population would affect our ability to detect difference in risk of death. In fact, the increased likelihood of uninsurance among Mexican Americans who were nonetheless no more likely to die than non-Hispanic Whites might also be expected to reduce our power compared with the earlier study.

Obviously, the notion that Mexicans Americans are statistically less likely to perish than Blacks or whites wouldn’t, or shouldn’t, detract from the main point that the insurance crisis is leading to unnecessary deaths. And it doesn’t mean necessarily that Mexican immigrants and their families are inordinately healthy. Other research indicates major disparities in disease rates between Latinos and whites, and unequal access to medical services. Racial justice groups ought to parse studies like this to broaden our understanding of who is impacted by health insurance or lack thereof, and how communities should respond. How do uninsured Mexican Americans, for example, compare with uninsured Blacks and whites with similar socioeconomic backgrounds? And does it make a difference whether people rely on Medicaid, employer-sponsored insurance, or community clinics for care? A study published earlier this year on Mexican American women found that they are in some respects especially vulnerable to breast cancer. A summary of the findings on explains:

Mexican American women diagnosed with an aggressive type of breast cancer are more likely than African American women diagnosed with the same type of breast cancer to have a family history of breast cancer. The association between the aggressive breast cancer and family history suggests that abnormal breast cancer genes may be more common in Mexican American women.

In addition, Mexican American women faced unique barriers in getting diagnosis and treatment, according to Medpage:

The most common method of discovery was breast self-examination (68%). But after noticing a change in their breasts, almost half of the women said they waited at least a month before seeking medical attention. They cited having no insurance or not being able to afford medical care (31%) and not feeling it was important (33%) as the reason for the delay. Other explanations were fear and no earlier appointments available.

An analysis from the Medical College of Wisconsin found Latino youth are much more likely to lack insurance compared to white or Black peers, and that:

Uninsured Latino children are significantly more likely than insured Latino children to have no regular physician, and to not get needed medical care due to expense, lack of health insurance, difficulty making appointments, and cultural barriers.

Were these women and children captured in the Harvard study? The consequences of uninsurance are not just life-or-death: insurance coverage influences health conditions that permeate the way people live, work, and interact in their communities. And likewise, economic security and community cohesion could shape the way people interface with the health care system. The Urban Institute has analyzed the economic costs of racial disparities in preventable diseases.

We estimate that in 2009, disparities among African Americans, Hispanics, and non-Hispanic whites will cost the health care system $23.9 billion dollars. Medicare alone will spend an extra $15.6 billion while private insurers will incur $5.1 billion in additional costs due to elevated rates of chronic illness among African Americans and Hispanics…. Taken together… the two largest public sector health insurers, Medicare and Medicaid, do experience excess costs for both African Americans—more than $12 billion annually in combined costs—and Hispanics—nearly $5 billion—as a result of the health disparities studied here.

In other words, inequality is costly for everyone. And the private insurance industry, free to ration care by dictating costs and blocking access, bears less of the burden than do increasingly unstable public health programs. Among the many complaints about health care reform spewed by rancorous mobs in recent weeks, a timeless favorite is the canard of Americans being taxed to death to pay for everyone else’s abortions, colonoscopies and junk food habits. For all the paranoia about a socialist takeover, opponents of reform seem to be going out of their way to ignore the biggest tax of all–the toll of injustice. Those who aren’t paying now will pay later. Image: Remote Area Medical Foundation clinic, August 2009 (Genaro Molina / Los Angeles Times)