Doing without insurance coverage is not a problem limited to low-income families or families headed by people who do not work.  Over half of the uninsured Nevadans are working families.  Less than one-third of uninsured children in our state live below the federal poverty level.   Without a doubt, Nevada’s uninsured rate will continue to climb if serious action steps are not taken in the near future. We have the tools in our hands to make a difference, we just need to make sure we are using those tools to build a lasting and effective plan that will keep our people healthy.

Number of Uninsured Nevadans

The study of uninsured Nevadans, conducted by the Great Basin Primary Care Association, has been updated through July 1, 2004.

An Executive Summary and comprehensive Trend Analysis reflecting the economic impacts of recent events in Nevada and the nation and their affect on the uninsured population of our state is now published and will be included Great Basin Primary Care Association's Primary Care Handbook - The State of Nevada's Safety Net Providers.

Click to open site of Nevada's Uninsured Study

 

Highlights of Trends in Nevada

Overall, Nevada is 44^th in the nation for insured residents (U.S. Census, 2005), as the number of Nevadans without insurance has continued to rise slightly. This last study found a roughly 1% increase in uninsured, leading to around 400,000 people living in Nevada without insurance. While this increase might seem small, the upward trend remains the same. This means that there are about 16% to 17% of Nevadans who did not have health insurance for the entire year, and about 22% to 23% of Nevadans did not have health insurance for at least part of the year.  

Both Washoe and Clark County’s percent of uninsured rose from 2003 to 2004. Almost 17% of Clark County residents and around 16% of Washoe County residents do not have health insurance. While Washoe County’s rate was slightly lower, Clark County represents about 70% of Nevada’s total population while Washoe County only represents about 16%. This means that what happens in Clark County will drive the states uninsured rate.  

We also found that some sub-populations are more at risk for living without insurance than others. For example, the working poor, who are defined as 200% to 100% of the Federal Poverty Level, are the fastest growing uninsured group, making up 127,000 of the almost 400,000 Nevadans without insurance.

The uninsured rate for people below 100% of the Poverty Level compared to the percent uninsured for people between 100% to 199% of the Poverty Level, you see that the higher income group is actually more likely to be insured. We can safely assume that this large number is largely contributed by families falling into the “grey area,” where they are no longer eligible for Medicaid because they found a higher paying job but then their new job does not offer health insurance and does not pay enough for them to purchase it on their own. These are often single moms who get a job and then lose Medicaid eligibility, so while their children are still able to enroll in Nevada Check-Up, the parents are left without insurance. It is important to keep in mind that these families are paying taxes, working, and trying to take care of their families but they just don’t have the ability to acquire health insurance.  

Another high-risk sub-population is Hispanics, whose population rate has more than doubled since 1990.  Hispanics are three times less likely to have health insurance coverage, which is higher than any other race or ethnic group (US Census, 2004). This means that as the Hispanic population in Nevada continues to rise, they are less likely to have health coverage. The Hispanic population is expected to continue to grow because of higher birth rates and continuing immigration – and Nevada (along with other western states) will continue to gain a disproportionate share.  

Gender differences also play a role in a persons insured status. We see that while there are more uninsured men than women, uninsured women are a faster growing group than men. This takes special consideration, since Nevada has the highest pregnancy rate in the country (Health Care State Rankings, 2005). Pregnant women need prenatal care to ensure they and their babies remain healthy, but without insurance, most are not getting the care they need. And, where do these uninsured women go when it’s time to deliver their baby? They go to the ER because they don’t have anywhere else to go, resulting in mom, the hospital, and the tax payers paying much more than they would have to pay if she had insurance.  

One thing that our uninsured study did not look at but that needs to be examined is the effect on dental care when people do not have insurance. People without insurance who are not going to the doctor almost definitely are not going to a dentist. According to the Health Care State Rankings published in 2005, Nevada is 45^th in the nation for the percent of adults who have been to a dentist in the previous year. This is for all adults, regardless of insurance, so it’s safe to assume that if insured people aren’t going to the dentist, then uninsured people certainly are not. Add this to the fact that Nevada is 50^th in the nation for the rate of dentists per 100,000 people – that is - Nevada has only 37 dentists per 100,000 people, and the national average is 59 dentists (Health Care State Rankings, 2005).

Why?

There are a number of reasons for Nevada’s high uninsured rate, one of which centers on a two-prong Medicaid problem. The first-prong is that Nevada is 51^st in the nation for per capita expenditures over the last decade on Medicaid (Health Care State Rankings). We spend less on Medicaid than any other state in the country, yet we have one of the highest uninsured rates. It just doesn’t make sense. The second-prong is that fewer people than the national average are participating in Medicaid and Nevada Check-Up, which has been an ongoing problem in Nevada. Some people who could have enrolled in these programs have not.  

Business also plays a role in Nevada’s uninsured rate as small businesses struggle to provide insurance to their employees. According to the report of County Business Patterns by the U.S. Census Bureau, these businesses with fewer than 50 employees make up about 95% of Nevada businesses and employ 50% of Nevada’s workers. Employees in these small firms are less likely to have health insurance benefits than people employed by larger firms because health premiums have risen exponentially and smaller businesses just can’t afford it (BLS, 2000).  This leads to fewer firms offering insurance, and when they do, few employees take it because the premiums and co-payments are too high. Moreover, the U.S. Department of Agriculture reports that part-time and seasonal workers are less likely to be offered employer-sponsored health insurance and this is a special population that persists in Nevada’s rural counties. Additionally, physician services for rural areas are poor due to the small numbers of clients, the distances the providers must travel, and the sustainability of a full-time practice in these areas.  

Poverty is probably the most obvious contributor in the struggle to obtain health insurance, as the majority of people living in poverty are also without insurance. If you will turn to page 28, you will see that poverty and minority status go hand-in-hand, as African-Americans and Hispanics have a significantly higher poverty rate than their Caucasian counter-parts.  Poverty is still rising in Nevada and nationwide and until the economic recovery reaches the working poor, we will most likely see continued high rates of uninsured.

A Few Solutions

Clearly, without intervention, the issues related to our uninsured population will remain a persistent problem in the future.

Outreach is crucial. We now know that there are many people who are eligible for Medicaid and Nevada Check-Up, yet they are not enrolled. We need to continue to educate and inform the community about all available programs and help them access those resources. This includes making the application process easier and more available, including offering online inter-active applications as has Arizona, California and many other states. Improving the applications through electronic means will fast-track the process and allow applicants to receive their benefits sooner.   It also reduces the amount of paperwork needed by both the applicant and the administrators, thus making the process much more efficient. Expanding the income caps for Medicaid and Nevada Check-Up to allow more families to participate will obviously have a positive effect on our uninsured rate, as well.   

Supporting models that already work is a relatively easy way to address some of our uninsured problem. One proven model is a specialty care network like the AccessHealth Program in Clark County.  This is a model that works. It ensures patient responsibility and results in a self-sufficient network of specialty care providers who see uninsured patients.  The Access to Health Care Network in Washoe County has now started building a similar model.   

Our Community Health Center network is another important model with demonstrated successes. Our Community Health Centers and Tribal Clinics are serving people who have no where else to go. They are located in the heart of the communities that need them most, are culturally framed for the populations they are serving, and treat all people, regardless of their ability to pay. Financial partnerships should be developed between the State of Nevada and local communities to create and sustain additional community health centers and other access points to serve low-income and uninsured patients. With federal funding constantly on the chopping block, it is time to diversify and supplement their funding.  

Additionally, incentives are needed to encourage small businesses to provide health insurance to their employees. This includes supporting national efforts to develop an insurance program that allows small business owners and employees to partner on paying health insurance premiums for themselves and their families.  Health insurance costs are rising rapidly, which means fewer and fewer businesses have the ability to offer it. Nevada is known as being a business state, so we need to step up and start supporting our small businesses.