Assuntos
Asiático/estatística & dados numéricos , Assistência Odontológica , Disparidades em Assistência à Saúde , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Saúde Bucal , Adulto , Assistência Odontológica/economia , Assistência Odontológica/estatística & dados numéricos , Cárie Dentária/epidemiologia , Acessibilidade aos Serviços de Saúde , Humanos , Área Carente de Assistência Médica , Saúde Bucal/economia , Saúde Bucal/estatística & dados numéricos , Periodontite/epidemiologiaRESUMO
This paper examines federal and state restrictions on immigrants and the negative impact of these restrictions on local efforts to serve the uninsured. It examines a health coverage program offered to low-income residents in Alameda County, California from 2000 to 2005, illustrating local efforts to expand health coverage to both adults and children, regardless of immigration status. After five years of operating the pilot program, leaders of Alameda County's health care safety net conclude that local health coverage programs are unsustainable over a long period of time without significant federal and state support. The financial resources that federal, state, and local governments are patching together for health coverage could be used more efficiently if consolidated. Stabilizing the federal tax base and recognizing the phenomenal amount of federal, state, and local funding that is already spent on medical care for the uninsured are the first steps towards achieving meaningful health care reform.
Assuntos
Serviços de Saúde Comunitária/economia , Emigração e Imigração , Saúde da Família/etnologia , Acessibilidade aos Serviços de Saúde/economia , Cobertura do Seguro , Pessoas sem Cobertura de Seguro de Saúde/etnologia , Pobreza/etnologia , Assistência Pública , Planos Governamentais de Saúde , Populações Vulneráveis/etnologia , California , Centers for Medicare and Medicaid Services, U.S. , Planejamento em Saúde Comunitária , Humanos , Desenvolvimento de Programas , Estados UnidosRESUMO
We inform a county's efforts to provide health insurance to uninsured working immigrants-a group left out of national and state strategies that aim to expand coverage. We analyzed a population-based survey data administered in English, Spanish, Cantonese, Mandarin, Korean, Vietnamese, and Dari on 5,540 nonelderly adult workers in Alameda County, California. The study models the likelihood of employment-based coverage, estimates the eligibility for public programs, and evaluates the affordability of average employee share of premiums by citizenship status and years lived in the United States (tenure). Immigrant workers in Alameda County are disproportionately uninsured. They constitute 29% of the employee labor force but 54% of uninsured employees. Employment-based coverage increased with citizenship and length of stay (tenure) in the United States. Noncitizens with less than 5 years residency in the United States faced the greatest disadvantage in securing employment-based coverage, an effect that is greater than disadvantages associated with race/ethnicity. A citizenship-tenure divide existed in obtaining employment-based coverage, suggesting that policies focusing on noncitizen and new immigrant workers would greatly relieve the disparate uninsured rates among workers. The expansion of nonemployment-based coverage programs would cover more than 30% of Alameda County's uninsured immigrant workers; but subsidies will also be needed for the lowest-income workers who are not eligible for these programs.
