CORVALLIS - A new study by Oregon State University researchers suggests that language barriers, immigration status, and a lack of knowledge about how "the system works" prevents many uninsured Oregonians from gaining access to the Oregon Health Plan.
As a result, says OSU anthropologist Sunil Khanna, ethnic minority populations may be adversely affected.
"Many Hispanic groups in particular are perpetually uninsured," he said. "They don't learn about the Oregon Health Plan by reading the formal literature, or visiting the web site. They may not be able to read, or they may not have access to a computer. So they learn about the health plan informally, through friends and family, and that word-of-mouth information tends to be colored by experiences that aren't necessarily positive."
Khanna, an associate professor of anthropology, serves on the Governor's Racial and Ethnic Health Task Force, which advises Gov. John Kitzhaber on issues relating to health access among minority groups in Oregon.
Last year, the Office for Oregon Health Policy and Research received a grant from the federal Health Resources and Services Administration to explore different options for universal health coverage in Oregon, and for expanding the Oregon Health Plan.
Though methodology and margin of error makes it difficult to know exactly how many Oregonians have full insurance coverage, the state estimates that 12.3 percent of Oregonians are completely without insurance - a figure Khanna feels is on the conservative side. In addition, he says, a large number of Oregonians are under-insured or only temporarily insured.
An expert in health care access by minorities, Khanna was asked by the Office for Oregon Health Policy & Research to conduct a series of focus groups around the state to explore options for universal health coverage among three interest groups - uninsured individuals, small business owners, and health care providers/administrators.
The OSU study, he said, added an important experiential component to the numerical data the state also has collected.
"Numbers are an important part of research, but listening to people's experiences adds layers of depth and perspective that help provide context for the real life issues," Khanna said. "The experiential component cannot replace numerical data, but it can effectively complement it."
"There is kind of an unwritten feeling among many of those working in the health care arena that people who are uninsured are that way because either they don't care about their health, or they are ignorant about how the system works. Instead, what we found, was that this group is very, very concerned about health - not just for themselves, but for their families."
Khanna and a group of OSU students conducted a series of interviews throughout the state, visiting urban areas including Multnomah County, fishing communities in Newport and Waldport, the rural Willamette Valley, and sparsely populated Sherman and Wasco counties of eastern Oregon.
What they discovered was that many uninsured Oregonians didn't know they qualified for the Oregon Health Plan, others couldn't understand the enrollment procedures, and others were turned down because no doctor would be willing to accept them as Oregon Health Plan patients.
"Some were turned down by physicians because the state reimburses doctors at a low level - significantly less than the reimbursement for Medicare patients," Khanna said. "It is simply a losing proposition for the physicians. Other uninsured Oregonians had a different kind of access problem; they were too far away from a provider and had no transportation."
Khanna also discovered that many low-income Oregonians didn't know they qualified for the plan until they were forced to go to the emergency room for some kind of treatment. "At that point," Khanna said, "they learn they are qualified and the state reimburses them once they sign up for the Oregon Health Plan. So they don't go in for care again until something goes wrong, knowing they can go through the process again to requalify. The Oregon Health Plan is designed for preventive health care, but most of the people we talked to who used it did so for acute care only."
Many Oregonians are on the borderline for qualifying for the plan, Khanna said. If they get a pay raise, or a better job, they risk losing Oregon Health Plan benefits because of their higher salary. And yet they still won't make enough to purchase adequate health insurance.
"That is one of the many disincentives we heard," he said.
The problems of uninsured and underinsured Oregonians are found throughout the state, Khanna said. Rural areas may have a higher number of uninsured people, in part because of the migrant worker influence, higher rates of unemployment, season jobs and fewer providers who will accept Oregon Health Plan patients.
Urban areas are more likely to have safety-net clinics and there are more providers from which to choose.
Other options for coverage do exist outside the realm of the Oregon Health Plan, Khanna said, but most are too expensive for low-income Oregonians. There has been some interest by employers owning small- to medium-sized businesses in combining to offer an insurance package for their employees, especially if their "purchasing alliance" receives some tax benefits.
"Many of these employers would really like to help, but they are struggling to meet expenses and can't always provide coverage, or even share costs with employees," Khanna said.
Not all of the uninsured Oregonians are ethnic minorities, Khanna emphasized, but those populations where English is a second language, or where education levels are low, are more adversely affected.
"The bottom line is that many of these people would dearly love to have insurance," Khanna said. "They either can't afford it, they don't qualify for the Oregon Health Plan, they don't understand the enrollment procedure, or they are turned off by past negative experiences."