Job-based Health Insurance Failing Hispanic Workers
By Lisa Duchon, PhD - Deputy Director, Research and Evaluation, The Commonwealth Fund

The US Hispanic community is facing a health care crisis. Nearly 40 percent of Hispanics under age 65 do not have insurance. Despite the contributions of Hispanics to the nation’s economic prosperity, they are more than twice as likely to lack health insurance as the U.S. population overall. Of the 44 million uninsured in the United States, one-quarter are Hispanic.

By 2025, the Hispanic population is expected to increase from 31 to 59 million, or from 11 percent of the population to 18 percent.1 With Hispanics constituting an increasingly significant portion of the nation’s workforce, their importance to the nation’s economy will only grow as the baby boom generation begins to retire in 2010.

The Commonwealth Fund, an independent health research philanthropy in New York City created the Task Force on the Future of Health Insurance, to help address health insurance problems facing the nation’s working families. A recent report released by the Task Force found that Hispanics lack health insurance primarily because they work for employers that do not offer coverage or are in jobs not covered by their firm’s health plan.2 In a health system dominated by employer-based coverage, only 43 percent of Hispanic adults and children are insured through employers&emdash;a rate well below the national average of 64 percent. Florida mirrors national statistics, with only 46 percent of its Hispanic residents under age 65 having employer-based coverage. Hispanic workers are more likely than white and black workers to have low wage jobs and work for small firms&emdash;conditions that increase their risk for being uninsured. In Florida, 85 percent of uninsured Hispanics are part of a family with at least one worker.

The Commonwealth Fund also sponsored 8 focus groups, conducted last spring by Lake Snell Perry & Associates, with low-income Hispanic adult workers in New York, Los Angeles, San Antonio and Chicago to explore their views about and experiences with health insurance.3 The focus groups revealed that Hispanic workers desire comprehensive, affordable health insurance for themselves and their families, but employers either offer no coverage, make them ineligible for the firm’s plan, or the premiums are unaffordable for them to still meet other living expenses.

Lack of coverage limits Hispanics’ access to needed health care and leads many to forgo care altogether. A number of uninsured Hispanic focus group participants told of how they delay getting care as long as possible, relying on home remedies and, in some cases, returning to their native country to get inexpensive or free medical treatment. Others described the difficulties they have had trying to pay off large medical debt. A 1999 Commonwealth Fund national survey found that two-thirds of uninsured Hispanic adults could not pay their medical bills or were contacted by a collection agency in the last year.

Sustaining the nation’s economic momentum will depend, in part, on maintaining a healthy and productive workforce, a goal that demands adequate access to dependable, high-quality, affordable health care&emdash;for all working families.

1 U.S. Bureau of the Census, Statistical Abstract of the United States, 1999 edition, p. 14.
2 Kevin Quinn, Working Without Benefits: The Health Insurance Crisis Confronting Hispanic Americans, The Commonwealth Fund, March 2000.
3 Michael Perry, Susan Kannel, Enrique Castillo, Barriers to Health Coverage for Hispanic Workers: Focus Group Findings, The Commonwealth Fund, September 2000.