THE UNINSURED: Better Outreach Needed to Improve Medi-Cal, Healthy Families Enrollment
"[L]agging" enrollment in California's private sector insurance programs might be explained by the fact that low-income families "often struggle with the cost of unsubsidized health care coverage, to the point where many choose not to obtain coverage," an issue brief from the UCLA Center for Health Policy Research states. Through its Kaiser Permanente Cares for Kids initiative, Kaiser Permenente commissioned a study of Latino and non-Latino white parents living in Los Angeles with incomes between 200% and 275% of the federal poverty level to determine the population's "beliefs and values regarding children's health care coverage." Forty-four Latino and 23 white adults participated in the focus groups, which took place in May 1999. According to the policy brief, families in the focus groups "viewed the cost of health insurance as unaffordable," even if it was offered through their jobs. Furthermore, many of the families thought they could save money by staying uninsured and paying health expenses out-of-pocket. But families did say that they would pay "an amount they considered affordable" to obtain coverage for their children. The Latino participants estimated that they would pay $50 per month for a "good" health plan for their children, while the white participants agreed that they could pay "some amount" to cover their children and "focused on the need for national health care coverage." Both groups also saw advantages of having health insurance, despite its high costs. For Latinos, health insurance lowers costs and gives families financial and health protection, while it also means that they would not have to delay their children's treatment because of financial barriers. For whites, some of whom experienced discrimination when seeking care for their children because they lacked insurance, believed avoiding that discrimination was a "major benefit of coverage."
The focus groups also strategized ways to increase access to health coverage. Both Latinos and whites maintained that they "would like their employers to pay a portion of health insurance coverage for their children." In addition, cost is the No. 1 factor in buying insurance for Latinos, but they also cited a need for more information about insurance options, including how to compare one plan to another and how to apply. The focus groups also discussed outreach strategies for publicizing health coverage programs, with both Latinos and whites agreeing that advertising "should be truthful, sincere and credible." Latinos also suggested that information be disseminated through door-to-door distribution, churches, health fairs and in magazines. Whites suggested discussing health insurance on talk shows, infomercials or events in parks. From these focus groups' suggestions, the brief surmises that programs aimed at low-income families, including California's Medi-Cal and Healthy Families programs, should "adopt outreach efforts tailored to specific populations they are trying to reach," as "it is important to recognize that current outreach efforts are not always connecting with the intended audience." The brief concludes, "Better coordination among these programs would be helpful, as would messages more specifically aimed at the groups that are currently not being reached" (Satter/Brown, "Focus Groups Suggest New Strategies Are Needed to Reach Uninsured Children in Low-Income Families," September 2000). The brief is available at http://www.healthpolicy.ucla.edu/FocusGroupsPolicyBrief.pdf