Health Insurance: Notes & Sources
Affordable Care Act: The primary goals of the 2010 federal Patient Protection and Affordable Care Act (PPACA) are to decrease the number of uninsured Americans and to reduce the costs of healthcare. Some of the mechanisms for achieving these goals include expanding Medicaid eligibility, offering subsidies for low-income individuals and families, requiring insurers to price and issue policies regardless of gender or (most) medical conditions, and requiring that individuals not covered by employer-sponsored or public health insurance plans either purchase private coverage or pay a penalty.
Confidence interval (also called "error bar") is the range of values that includes the true value 90% of the time (for the American Community Survey). If the confidence intervals of two groups do not overlap, the difference between groups is statistically significant (meaning that chance or random variation is unlikely to explain the difference).
Federal Poverty Guidelines are issued by the Department of Health and Human Services and are used to determine financial eligibility for various federal, state, and local assistance programs. The guidelines are based on the Census Department’s federal poverty thresholds. For a family of 4, the federal poverty guideline was $23,550 in 2013; the 2014 guideline is $23,850.
The Federal Poverty Threshold was adopted in 1964 as an “absolute measure” by which progress in the War on Poverty could be assessed. It is updated annually by the Census Bureau, and is used to calculate official population statistics on the number of Americans in poverty. Its usefulness has diminished over the past half century, as it almost certainly underestimates poverty in the United States. Specific shortcomings include:
- Lack of adjustment for regional costs
- Calculation based totally on the cost of food, ignoring significant contributions from housing, transportation, utilities, health care, and child care
- Reliance on pre-tax earnings, excluding the effects of tax adjustments, food stamps, housing benefits, and other transfers.
Poverty: “Fundamentally, poverty is a denial of choices and opportunities, a violation of human dignity. It means lack of basic capacity to participate effectively in society. It means not having enough to feed and clothe a family, not having a school or clinic to go to, not having the land on which to grow one’s food or a job to earn one’s living, not having access to credit. It means insecurity, powerlessness and exclusion of individuals, households and communities. It means susceptibility to violence, and it often implies living in marginal or fragile environments, without access to clean water or sanitation.” United Nations Statement, June 1998, signed by the heads of all UN agencies. http://www.un.org/esa/socdev/unyin/documents/ydiDavidGordon_poverty.pdf
Race/Ethnicity: Federal standards mandate that race and ethnicity (Hispanic origin) are distinct concepts requiring 2 separate questions when collecting data from an individual. "Hispanic origin" is meant to capture the heritage, nationality group, lineage, or country of birth of an individual (or his/her parents) before arriving in the United States. Persons of Hispanic ethnicity can be of any race. Communities Count's terms for racial/ethnic groups are derived from those used by the U.S Census Bureau in 2010.
- Communities Count terms: Hispanic, Non-Hispanic, White Non-Hispanic, Black, American Indian/Alaska Native (AIAN), Asian, Native Hawaiian/Pacific Islander (NHPI), White, and Multiple Race (Multiple). Persons of Hispanic ethnicity can be of any race and are included in other racial categories. Racial/ethnic groups are sometimes combined when sample sizes are too small for valid statistical comparisons of more discrete groups.
- 2010 Census terms: Hispanic or Latino, Not Hispanic or Latino, White alone (Not Hispanic or Latino), Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, White, Some Other Race, and Two or More Races.
Washington Healthplanfinder is the new online marketplace where individuals, families, and small businesses in Washington can compare and enroll in health plans that differ in levels of coverage and cost-sharing. They can also gain access to income-based tax credits and public programs such as Medicaid. For more information, go to http://wahbexchange.org/.
Some data have been averaged over 3 years (as noted) to enable comparisons across groups that would otherwise be too small for detection of statistically significant results.
Medicare coverage is almost universal for adults 65 and older, therefore, this indicator focuses on the remaining adult population and children. With Medicaid expansion for adults in 2014, lawfully present immigrants are not eligible if they have lived in the US for less than 5 years, and undocumented immigrants are ineligible.
Children are eligible for public health insurance through the age of 18. However, data are available only for those younger than age 18.
Through Washington State’s Apple Health for Kids Program, children younger than age 19 …
- … qualify for free health insurance if they live in households with income below 200% of the federal poverty guidelines.
- … qualify for low-cost health insurance if they live in households with income below 300% of the poverty guidelines (low-cost = $98 monthly premium per child with no family paying more than $196 monthly). http://www.kingcounty.gov/healthservices/health/personal/insurance/children.aspx
- NOTE: Although children who are 18 years old can qualify for public childrens' health insurance, data are only available for those who are younger than 18.
Trends: Long-term trend data are not available because the American Communities Survey has only collected data on health insurance since 2008.
Statistical Significance: Unless otherwise noted, any difference mentioned in the text is statistically significant (unlikely to have occurred by chance).
Data on health insurance coverage are from the US Census Bureau’s American Community Survey (ACS) (see www.census.gov/acs). In 2008, the ACS began to ask about health insurance coverage. To see the question as it appears in the questionnaire, go to http://www.census.gov/acs/www/Downloads/QbyQfact/health_insurance.pdf
Affordable Care Act definition: http://en.wikipedia.org/wiki/Affordable_Care_Act, retrieved 03/20/13.
Health Insurance Coverage of Workers Ages 18 to 64, by Work Experience: 2008 and 2010.” American Communities Survey brief. http://www.census.gov/prod/2011pubs/acsbr10-11.pdf
Impact of the Affordable Care Act on Uninsured Adults in King County: This February 2013 Public Health Fact Sheet offers geographic and demographic snapshots of uninsured adults in King County, explains who will be affected by expanded eligibility for public insurance and insurance subsidies, and describes those who will remain without health insurance. http://www.kingcounty.gov/healthservices/health/data/datawatch.aspx, accessed 3/18/14.
Mothers' ages in King County (2012): Table A9 - Mother's Age Group by Place of Residence at http://www.doh.wa. gov/DataandStatisticalReports/VitalStatisticsData/BirthData/BirthTablesbyTopic.aspx, acessed 12/11/13
Numbers and percentages of adults age 18-64 without health insurance in King County cities and Census-designated places.
Uninsured Adults in King County - Cities & Census Designated Places, 2010-2012
|Total Uninsured Adults aged 18-64||Potentially Eligible for Medicaid Expansion (<138% FP)||Potentially Eligible for Maretplace Subsidies (138-399% FP)||Not Eligible for Medicaid or Susidies (≥400% FP)||Population ages 18-64|
|Cottage Lake CDP||828||5.78%||110||0.7%||382||2.8%||336||2.1%||14,402|
* = Census Designated Places FP = Federal Poverty Guidelines
Public Health-Health Care Reform Planning Team website- resources and data http://www.kingcounty.gov/healthservices/health/partnerships/HealthReform.aspx
Washington State Health Care Authority Medicaid Program. Overview: Medical Assistance Eligibility (July, 2012), HCA 22-315 (6/12). http://hrsa.dshs.wa.gov/publications/documents/22_315.pdf, accessed 3/18/2013.
2.5 Million Young Adults Gain Health Insurance Due to the Affordable Care Act (December 2011). http://aspe.hhs.gov/health/reports/2011/YoungAdultsACA/ib.shtml
Health Insurance Coverage of Young Adults Aged 19 to 25: 2008, 2009, and 2011 (September 2012). http://www.census.gov/prod/2012pubs/acsbr11-11.pdf
Additional Census Data available on US Census American Factfinder website: www.census.gov/acs
Quotes: Communities Count interviewed 32 King County parents or guardians raising at least one child younger than 6 years of age. We reached out to communities of color, recent immigrants, and residents with limited English proficiency to achieve a broad range of racial, cultural, and socioeconomic diversity. We interviewed both families with very low household income and those who earned up to median income (about $68,000 for a family of four in 2010). Family structures included single-parent households, couples living in consensual unions, married couples, and extended families.