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Many children of state’s ‘working poor’ families still lack health-care coverage

| 02 February 2005

A significant number of children in California’s “working poor” families remain without health insurance, even though a 1998 program has reduced that number substantially over the past decade, according to a new study by Berkeley researchers associated with the School of Public Health.

The study found that these children were far more likely to be uninsured and less likely to have a usual source of health care than were children from “nonworking poor” and “nonpoor” families. In addition, a larger proportion of children older than age 2 from working poor families either had never seen a dentist or had not received dental care in the previous two years of the survey.

The working poor are defined as households of four earning less than $35,300 per year and that do not rely upon Temporary Assistance for Needy Families (TANF) or Welfare to Work aid as their primary sources of income.

“This survey highlights the health-access disparities that still exist in California,” said lead author Sylvia Guendelman, professor of health policy and management at the School of Public Health. “These are kids who are falling through the cracks in health coverage. They are from families whose incomes are too high to qualify for Medi-Cal, yet too low to enable them to afford their own health insurance, and who do not have employer-sponsored health care.”

According to the 2001 federal poverty guidelines used by the researchers, the annual income level for a family of four at the poverty level is $17,650. The threshold income of $35,300 used to define a family as “working poor” is twice that amount.

Although the study found that health-access disparities still exist, it also found reason to be optimistic. The study showed that fewer kids from working poor families are uninsured since California implemented the Healthy Families program in 1998, a state-supported, low-cost insurance plan for children and teens who do not have other insurance or who qualify for Medi-Cal. According to state figures from 1994, as many as 32 percent of children from working poor families were without health insurance, compared with 20 percent in the current study.

"California's budget crisis eliminated funding for Healthy Families education, outreach, and application assistance in the last couple of years," said Guendelman. "As a result, new enrollment in the program has leveled off and there is a higher rate of disenrollment. I am encouraged that under Gov. Schwarzenegger's budget for 2005-06 several reforms are proposed that support the enrollment and retention of uninsured children eligible for Medi-Cal or Healthy Families."

In the study, published in the January 2005 issue of the monthly journal Medical Care, children from working-poor families were compared with those from nonworking-poor families (those earning less than 200 percent of the federal poverty level who also relied upon TANF as the primary source of income) and the nonpoor group (families earning at least 200 percent of the federal poverty level and who did not receive TANF benefits).

The study found that 20.4 percent of children in working-poor families were uninsured compared with 7.9 percent from poor and 3.8 percent from nonpoor families. In addition, 10.9 percent of children in working poor families did not have a usual source of healthcare, such as a regular doctor or community clinic, compared with 3.9 percent of children in non-working-poor families.

The researchers found that children in working poor families were more likely to be Latino, undocumented, and living in rural areas. They noted that families in California are particularly vulnerable to being uninsured because of the state’s high cost of living.

“The consequences of curtailing efforts to ensure all children in California are significant,” said Guendelman. “Without insurance, children are less likely to receive preventive care and more likely to delay health care until problems become more acute.”