New UCLA/CHIS Data Shows Declines in Racial/Ethnic Disparities in Health Coverage
Additional Data on Mental and Oral Health, Marijuana Use, Voter and Civic Engagement, Highlights Disparities as well as Opportunities for Action
The UCLA Center for Health Policy Research released new data from the 2017 California Health Interview Survey (CHIS) findings. The largest single-state health survey in the United States, the 2017 survey includes responses from children, teens and adults in nearly 21,300 households on wide-ranging topics including health care coverage, mental health, marijuana use, adult dental coverage, voter registration and civic engagement.
CPEHN reviewed the findings and found important implications for the health and wellbeing of communities of color in California. Below are some highlights from the survey as well as recommendations from CPEHN for what local and state advocates should do to address remaining disparities for California’s communities of color.
Health Coverage:
Finding #1: The ACA has significantly reduced the uninsured rate in California by half, from an average of 14.8% in 2013 to just 7.4% in 2017, and has produced historic declines in racial disparities in health coverage rates (see table below). However, despite these gains, Latinos still have the highest uninsured rates in the state (12%) compared to all other racial/ethnic groups (4.4% – 7.3%). These findings are consistent with CPEHN’s analysis of newly released U.S. Census Bureau statistics.
While this is positive news, the impact of federal policies on enrollment and uninsured rates for communities of color in 2017 and beyond may tell a different story. The Trump Administration’s lack of enforcement of the individual mandate coupled with harsher immigration policies (including proposed changes to “public charge” rules regarding the use of public benefits) is predicted to further dampen enrollment rates in public programs, particularly for California’s communities of color.
Finding # 2: Medi-Cal enrollment between 2016 and 2017 dropped significantly from (33% to 29%) while employer sponsored insurance and private insurance both saw increases during that same time. The increase in private coverage offset the drop in Medi-Cal enrollment reflecting a growing economy and improvements in household income across the state.
Finding # 3: Although there were declines in the uninsured rate across all California’s regions, San Joaquin Valley region, which had the highest uninsured rate in 2013, saw the steepest declines (18.1% – 7.6%), while the Central Coast region had the highest uninsured rate (11.6%) in the state.
Opportunity for Action: California should continue to fight for the expansion of health care coverage among low-income racial and ethnic groups, particularly among the Latino population and work to address disparities in access to health coverage across California’s regions with a particular focus on those with the highest uninsured rates.
Mental Health
Finding # 1: More adults (18+) shared they likely had psychological distress in the last year, needed help for emotional/mental or alcohol/drug problem in the last year, and ever seriously thought of committing suicide between 2016 and 2017.
Finding # 2: Although young adults were more likely to share challenges with their mental health and wellbeing, young adults were also more likely to seek help from a healthcare provider for emotional/mental or alcohol/drug problem between 2016 and 2017.
Finding # 3: Young adults (18-24) experienced worsening of their mental health and wellbeing between 2016 and 2017. More young adults shared they had likely had psychological distress in the last year, needed help for emotional/mental or alcohol/drug problem in the last year and ever seriously thought of committing suicide between 2016 and 2017.
Opportunity for Action: California is currently experiencing a statewide public mental health crisis. California should rapidly expand local and state investments in the public mental health system with a special focus on the young adult (18-24) population.
Marijuana Use
This is the first time the UCLA Center for Health Policy Research’s California Health Interview Survey has gathered data on marijuana use likely due to the recent state legalization of adult marijuana use. Proposition 64 reduces criminal penalties for various marijuana-related offenses for adults and imposes local regulation and taxation. California plans to invest a portion of Proposition 64 tax revenue in local substance use drug education, treatment and prevention efforts.
Finding # 1: Adults ages 25-34 are the highest percentage of adults who have ever tried Marijuana.
Findings # 2: By region, adults in Northern and Sierra counties show the highest rates of those who have ever tried Marijuana, while adults in San Joaquin Valley and Los Angeles County show the lowest rates of those adults who have ever tried Marijuana.
Finding # 3: There are differences across all racial and ethnic adults who have ever tried Marijuana.
Opportunity for Action: California should monitor, implement, and evaluate the impact of Proposition 64. California should ensure Proposition 64’s drug education, treatment and prevention efforts are equitably distributed and target disparities in communities of color.
Adult Dental Coverage Status
Finding # 1: Although the statewide dental coverage rate is 65.1%, Latinos had the lowest dental coverage rate at 55.8%, while African-Americans and Asian-Americans have the highest rates of dental coverage at 74.7% and 73.7%.
Opportunity for Action: The restoration of the adult dental benefit in Medi-Cal represents an opportunity to address existing dental coverage disparities. The state should ensure their investments in oral health outreach and education increase adults’ awareness and access to the newly restored benefits. Given the lower rate of coverage overall among Latinos, continued efforts to cover the uninsured and expand Medi-Cal to cover all adults regardless of immigration status may also make a difference. California should continue to fight for the expansion of health care coverage among low-income racial and ethnic groups, particularly among the Latino population.
Voter Registration and Engagement Measures
Importantly, the 2017 CHIS debuted voter registration and voter engagement measures for the first time in the survey’s history. These measures were included in an effort to begin collecting data on the social factors that can impact health.
Finding # 1: The observed statewide registration rate is 75.3%. According to the CA Secretary of State the 2017 voter registration count was 77.92% as of February 2017. Whites had the highest registration rate, at 89.7%, with only 3.2% ineligible to register to vote due to immigration status. They made up the largest group of registered voters.
Finding # 2: Although Latinos are the second largest bloc of registered voters, with 6,126,000 registered to vote, they are underrepresented in the electorate; 32.7% of Latinos are ineligible to vote due to their immigration status.
Finding # 3: 71.6% of Asians are registered to vote, with 18.7% ineligible to register to vote, the second highest rate after Latinos.
Finding # 4: Despite being the second largest bloc of voters, Latinos were the second lowest-engaged group, with only 41.8% reporting that they were either always engaged or frequently engaged in voting. Asians were the least engaged voters, with only 39.5% respectively reporting that they were either always engaged or frequently engaged.
Finding #5: Whites and African Americans were the most engaged voters, with 65.8% and 59.2% of registered voters respectively reporting that they were either always engaged or frequently engaged.
Opportunity for Action: As the state’s demographics shift and communities of color become an increasingly large portion of the electorate, multilingual voter engagement efforts are critical to ensure voters are aware of their voting rights and can understand the issues they are being asked to vote on. The state should ensure polling facilities are adequately prepared to serve a diverse electorate by providing language assistance and other accommodations to guarantee all may exercise their right to vote.
Challenges with Small Populations
Surveys like CHIS depend on sampling a large enough quantity of individuals in order to accurately estimate population-wide measures. Because the 2017 CHIS sampled a small number of American Indian/Alaska Native (AIAN) and Native Hawaiian/Pacific Islander (NHPI) individuals, nearly all of its measures for these populations were deemed “statistically unstable,” meaning the estimates could differ significantly from the true rate. According to its own website: “CHIS generally recommends against reporting or relying on estimates that are this statistically unstable.“
The lack of statistically stable indicators for these populations represents a data gap for several historically underserved communities of color. This poses a challenge for data-informed policymaking.
Opportunity for Action: In order to support informed policy making, more resources and better data is needed to understand key health indicators and factors affecting these groups. Policymakers should provide adequate funding for CHIS and other surveys so they may oversample these populations to ensure enough data is collected to accurately measure these groups.