THE UNINSURED ARE ‘US’: Cliff Sarkin,  policy director for the Insure the Uninsured Project (ITUP), writes about how CHIS data can help us all understand who the uninsured are — overwhelmingly employed citizens — as we move forward to implement health reform in California.

It has been quite an exciting time for health policy in America! With passage of landmark health reform legislation last March, we sit on the precipice of our country’s single largest expansion of coverage, the greatest simplification of our health care and delivery systems, and the potential to radically improve public health.

However, to reach those potentials and ensure robust implementation of reform, it will be imperative that members of the public – especially those who will gain coverage through these policies – are knowledgeable about the law and how it will affect them.
Typical media coverage of health reform is not proportionate to the public’s knowledge of the details, which is admittedly difficult considering the length and density of the bill. Beginning last year, many federal regulations were  instituted, hundreds of state-level bills were passed, and large funds were allocated, all with the goal of implementing these measures. This web of action only makes it more difficult for everyone – the uninsured, under-insured, and already insured – to comprehend how this legislation will affect them personally.

In our experience at ITUP arguably the best way to increase this knowledge is through the use and dissemination of public health data. Since our founding in 1996, we have relied on research by the UCLA Center for Health Policy Research in our public awareness and education efforts. In particular, since its launch in 2001, we have continually looked to the Center’s California Health Interview Survey (CHIS) for the most accurate and reliable information on the state of Californian’s health, insurance coverage and access to care.

For 15 years, ITUP has been compiling and synthesizing CHIS data at the county and state levels on various aspects of reform and the California population, including:

• Demographics
• Poverty levels
• Current health coverage
• County funding
• Community clinic and emergency department utilization rates
• How much funding each county could potentially receive for each year until 2019 (full implementation)
• How individuals could benefit from the Health Benefits Exchange
• How small businesses can make use of tax credits and how Medicaid expansion will affect individuals and families between 100 and 133% FPL

From our perspective, the single biggest obstacle for both the media and public is knowledge of who the uninsured are. There are two typical, but very dangerous, assumptions aboutthe uninsured that the general public tends to make. First, that the uninsured are non-workers. And, second, that most of the uninsured are here illegally. Both are grave misconceptions.

Demographic data reveal a very different truth. It turns out that the vast majority – in fact, 85% – of the uninsured in Californians are workers. And 80% are U.S. citizens or legal permanent residents. These myths – that health reform only helps non-workers and the undocumented – hurt the cause of successfully implementation reform because they perpetuate the belief that it’s  for “them” and not “us.” Wide dissemination of such reliable, understandable data helps us make sure the public knows health reform is all about “us.”  We believe that distribution of these data, togehter with the understanding that help reform will help everyone, is part of the reason we are seeing a significant uptick in popular support of the reform law.

Data also enable policymakers to know how many are uninsured in the communities they represent. CHIS offers those local data. And when we arm elected officials with detailed, neighborhood-level data, they are better able to attack problems with appropriate policy solutions.

Access to such information isn’t available only to policy wonks or public officials. The data belong to everyone. In fact, the UCLA Health DATA Program’s AskCHIS Community Workshops go from region to region around the state helping community leaders, clergy, local board members and city citizens by offering tutorials on how to access the information CHIS containts.

Having the ability to attain, understand and distribute information is vital in political decision-making. Accurate data, such as that CHIS and UCLA provide, will help California policymakers and stakeholders move quickly to implement important health reform policies and draw down as much federal matching funds as possible, ultimately maximizing the benefits to public health in their communities.

Suggested Resources:
Insure the Uninsured Project
California Health Interview Survey