JOB-BASED COVERAGE: L.A. Lowest in Nation on Health Insurance
A booming economy has failed to bring up the rate of employer- provided health insurance in California -- especially Los Angeles -- as the area's high rate of small businesses and high concentration of immigrants conspire to limit access to the most common form of health coverage. The Los Angeles Times, drawing from an analysis by the University of California-Los Angeles' Center for Health Policy Research, reports that 59% of Los Angeles County workers, and 66% of workers in California, have job-based coverage, compared to 74% of all U.S. workers. Los Angeles' employer-based rate is the lowest among major U.S. metropolitan areas. Thirty-percent of employers do not offer health coverage in Los Angeles County -- twice the national rate. Small businesses, which employ 72% of the county's workforce -- up from less than 70% in 1990 -- are far less likely to offer health insurance, the Times reports. The trend is hardest on Hispanics, only 42% of whom are covered on the job, compared to 75% of whites, 73% of blacks and 58% of Asians. The Venice Family Clinic's Dr. Susan Fleischman said, "If you work, you get insurance. That was the basic assumption. That model is no longer true." With 2.8 million, or 31%, of the non-elderly Los Angeles population uninsured, the county is spending an increasing amount on emergency care: $80 million in 1997, the most recent yearly data available, up from $64 million in 1992 (Lee, 7/4).
The Times also examines the cultural barriers that prevent many businesses -- especially those owned and operated by first-generation immigrants -- from providing health insurance to their workers. Linda Wong of Community Technologies Development, an inner-city development group, said, "The challenges are really significant. Many of these small employers are isolated. They're not affiliated with chambers or trade groups. They have very high failure rates." In the textile and garment industries, most workers are "from east or southern Asia, where people are more likely to go without insurance or look to government, not employers, to take care of their health needs." Also, especially in apparel manufacturing, "employer-employee relations are fairly adversarial," with "employers grumbling that they wouldn't give health benefits because their workers don't appreciate them. Turnover is high, loyalty low, and if they were to provide medical insurance ... will workers demand to get other benefits like sick pay?" Norbert Chung, vice president of Arthur J. Gallagher & Co. insurance brokers, said, "Immigrant workers are not as demanding at that wage level, and this particular industry has historically taken advantage of immigrant labor." Roy Hong, head of Korean Immigrant Workers Advocates, added, "The employers see it as a cost item that they don't have to have" (Lee, 7/4).