Many Americans Still Without Health Insurance, Especially in San Fernando Valley
Published in partnership with the USC Price Center for Social Innovation in support of the Neighborhood Data for Social Change platform (NDSC): The platform is a free, publicly available online data resource that provides reliable, aggregated data at the city, neighborhood, and census tract level. The mission of the USC Price Center for Social Innovation is to develop ideas and illuminate strategies to improve the quality of life for people in low-income urban communities.
As of the end of 2016, 28 million Americans were still without health insurance despite the historic gains in insurance coverage following the implementation of the Affordable Care Act (ACA) in 2014. Many Americans are still without health insurance for a variety of reasons. For some who live in states that didn’t expand Medicaid eligibility, who don’t have internet access at home, or who are not legal citizens of the U.S., there are barriers in the enrollment process. For others, even the subsidized healthcare provided by the Affordable Care Act remains unaffordable. It is critical that insurance companies, lawmakers, and healthcare institutions solve these access and affordability issues, because there are wide-ranging costs of going uninsured.
Flip between 2013 and 2015 on the map below to see how the uninsured population changed before and after the implementation of the Affordable Care Act for large metro areas in L.A. County.
The Costs of Being Uninsured
According to a 2012 study by Families USA, people without health insurance pay more for their medical care than the insured, and 60% of uninsured adults are in medical debt. They are also five times less likely to have a usual source of medical care outside of the emergency room than insured people. Additionally, the uninsured are more likely to go without screenings or preventative care and are 25% more likely to die prematurely than adults with health insurance.
A literature review conducted by researchers at the USC Schaeffer Center for Health Policy & Economics also found that access to insurance affects other areas of life beyond health. The Center reports that insurance access leads to increased labor force participation in single mothers and decreased labor force participation for pregnant women. The review also found that insurance access is linked to improved educational outcomes for children and improved mental health status for low-income adults.
Lack of insurance can also have spillover effects in their communities. According to the National Academies of Sciences Engineering and Medicine, hospitals in communities with large numbers of uninsured people often have less inpatient care capacity and offer fewer services in trauma and burn care. There is also a higher risk of the spread of communicable diseases in communities where many people cannot afford to see a doctor for preventative care.
Uninsured Rates in Los Angeles County
Although the ACA reduced California’s uninsured population by half, a report by UCLA projected that between 2.7 and 3.4 million Californians will remain uninsured in 2019 and one third of the uninsured population will reside in Los Angeles County. According to 2015 American Community Survey estimates, 18.4% of people in Los Angeles County were uninsured, higher than the national average of 13%. However, there are large discrepancies in coverage within L.A. County, with small pockets of the county facing particularly high rates of uninsured people.
In a cluster of neighborhoods in the San Fernando Valley including Van Nuys, Panorama City, Valley Glen, North Hollywood, Sun Valley, North Hills, Pacoima, and Arleta, one quarter of the population is uninsured. Despite the fact that the area has slightly better air quality than the county average (learn more about the air quality measure here), the cluster of neighborhoods has a 28% higher rate of asthma-related ER visits, a phenomenon that is often caused in part by poor air quality. One possible explanation for this trend might be that the high number of uninsured people in this area are unable to get preventative asthma care and are turning to the emergency room as their only source of medical care for the disease.
The chart below highlights characteristics for each neighborhood in the cluster as well as the cluster averages.
A Collaboration between Community Clinics and Emergency Rooms
Local community health clinics in the Valley have taken steps to help remedy the problems faced by many of their patients without health insurance. Valley Community Healthcare and Northeast Valley Health Corporation, two heavily used health clinics in the area, offer no cost or low cost programs and a sliding fee scale based on family income for those who don’t have insurance. They also provide enrollment assistance that includes translating services to help reduce barriers in the insurance enrollment process.
Larger hospitals in the Valley are also working with health clinics to expand care for people without insurance. Valley Presbyterian Hospital and two Providence hospitals are closing the gaps in communication between their large hospital networks and community health clinics by tracking and sharing when community clinic patients visit the emergency room. This improved communication allows clinics serving as primary care providers to follow up with their patients after they are released from the emergency room. The hospital networks are also referring uninsured emergency room users to the community health clinics for more regularly managed care. While this isn’t a comprehensive solution to the San Fernando Valley’s health insurance problems, it’s a good start to providing alternatives to emergency rooms as a main source of care for the uninsured.
Living without health insurance has grave health and financial consequences. In recent years, entities starting with the federal government and ranging from large hospital networks to small community clinics have stepped up to solve these challenges collaboratively. Thanks to the ACA and innovations from healthcare networks, rates of uninsurance are continuing to drop around the country. Despite this progress, we must continue to focus on this problem and potential solutions from a wide-ranging group of participants, as the consequences for affected populations can be the difference between life and death.
Families USA. "Dying for Coverage: The Deadly Consequences of Being Uninsured." (2012).
Gaudette, Etienne, Gwyn C. Paley and Julie M. Zissimopoulos. "Lifetime Consequences of Early-Life and Midlife Access to Health Insurance: A Review." Medical Care Research and Review. (2017).
Henry J Kaiser Family Foundation. "Key Facts about the Uninsured Population." (2017).
Institute of Medicine. "A Shared Destiny: Effects of Uninsurance on Individuals, Families and Communities." (2003).
Lucia, Laurel, et. al. "Which Californians will Lack Health Insurance under the Affordable Care Act?" UCLA Center for Health Policy and Research. (2015).
National Immigration Law Center. "The Consequences of Being Uninsured." (2014).