The analysis by the UCLA Center for Health Policy Research looked at California data on the uninsured between 2007 and 2009 and found that of the approximately 700,000 Californians to lose health insurance during this time, the greatest increase was among residents between the ages of 45 and 64.
"Whether because mid-career workers are viewed as too expensive or because there is a deeper bias against older workers, the data suggests the axe is first to fall on the baby boom generation," said Shana Alex Lavarreda, lead author of the study and the center's director of health insurance studies. "This might open the door for policymakers to question the fairness of hiring and firing in the next economic cycle."
The findings are part of a larger study that looks at the staggering job losses during the "Great Recession" and their impact on individual California counties.
Between 2007 and 2009, the number of people in the state without health insurance surged by more than 10 percent, to 7.1 million, the researchers found. During that same period, the jobless rate in the state more than doubled, from 5.5 percent to 12.3 percent, causing a steep drop in the number of people receiving health insurance through their employer.
Using data from the California Health Interview Survey (CHIS), the study's authors examined economic variations by county, creating a "recession index" that takes into account increases in unemployment and decreases in household income. They then divided the state's 58 counties into four categories that gauge the impact of the recession: low, moderate, medium and high.
This index found at least one silver lining in the economic clouds: The "high impact" counties, such as Imperial, Merced and San Joaquin, saw a modest 1 percent decline in the number of uninsured people (ages 0-64), from 22.5 percent in 2007 to 21.5 percent in 2009. This was attributed in large part to the safety net provided by public programs such as Medi-Cal and Healthy Families.
"The safety net did its job during the Great Recession," Lavarreda noted. "Programs such as Medi-Cal and Healthy Families kept the problem from getting worse and demonstrated once again the importance of public programs during economic downturns."
Paradoxically, wealthier counties that were less impacted by the recession, such as Marin and San Francisco, saw a 1.7 percent increase in the number of uninsured, from 19.1 to 20.8 percent.
But the hardest hit were the "medium impact" counties, which saw a significant 5.4 percent increase in the number of uninsured people, from 20.8 percent in 2007 to 26.2 percent in 2009. These counties include Monterey, San Bernardino and Tulare, among others.
These "medium" counties were likely "not poor enough to tap into public programs yet not wealthy enough to survive the economic storm," Lavarreda noted.
Statewide, the uninsured population became older on average following the start of the recession, with significant growth in the number of uninsured individuals between the ages of 45 and 64 in three of the four county groups examined.
The state's uninsured population also grew poorer, on average. Much of the growth in the uninsured was the result of job loss and a subsequent decline in job-based coverage. Between 2007 and 2009, the percentage of Californians who were uninsured, unemployed and looking for work more than doubled in all counties. For example, in the "medium impact" group, this category grew from 6.6 percent in 2007 to 21.9 percent in 2009.
The authors say that the Affordable Care Act (ACA) and Medi-Cal expansion may help a larger number of people than was initially anticipated. Many post-recession workers make minimum wage, making them eligible for Medi-Cal under health care reform legislation. Enrollment in public health insurance programs will likely grow even as jobs return and California climbs out of recession.
The study used data from the 2007 and 2009 California Health Interview Survey, as well data from the California Employment Development Department.
Development of the study was supported by The California Endowment and the California Wellness Foundation.
Read the policy brief: "The Effects of the Great Recession on Health Insurance: Changes in the Uninsured Population from 2007 to 2009."
The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians.
The California Wellness Foundation's mission is to improve the health of the people of California by making grants for health promotion, wellness education and disease prevention.
The California Health Interview Survey (CHIS) is the nation's largest state health survey and one of the largest health surveys in the United States.
The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health-related information on Californians.
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