In a region where more than half of the population is on Medi-Cal, the state’s health insurance program for low-income people, there remain more than 308,000 people in the San Joaquin Valley who have no insurance coverage whatsoever – no Medi-Cal, no Medicare for seniors, no VA benefits for military veterans.
Who are they? That’s tough to quantify exactly. But KFF, a nonprofit health policy, research, polling and news organization, estimates that most of the 23.5 million uninsured in the U.S. are adults in low-income, working families, and are people of color. Almost three out of four uninsured people had at least one person in their family working full-time.
Estimates from the U.S. Census Bureau for 2023 indicate in each of the eight Valley counties, from San Joaquin County in the north to Kern County in the south, more than half of the people who were uninsured were employed in the labor force:
- Fresno County: 60%.
- Kern County: 59.6%.
- Kings County: 51.8%.
- Madera County: 62.7%.
- Merced County: 61.1%.
- San Joaquin County: 60.5%.
- Stanislaus County: 60.8%.
- Tulare County: 62.4%.
At United Health Centers of the San Joaquin Valley, a Fresno-based nonprofit that operates almost 40 clinics in Fresno, Kings and Tulare counties, about 15% to 20% of the organization’s 180,000 patients are uninsured, CEO Justin Preas told CVJC. Another 60% are covered by Medi-Cal..
United Health Centers, like other organizations known as federally qualified health centers across the Valley and the state, receives federal grant funds specifically to take care of uninsured people.
“That money we receive really is not even enough to take care of all of our uninsured patients,” Preas said. “But we stretch it to make it work, like all of the other FQHCs here in the Valley and in the nation.”
In each Valley county, the percentage of men who are without health insurance of any sort outweighs women by an average margin of more than 17%.
And while Latinos represent an average of about 56% of the population of Valley counties, the share who are without insurance ranges between 70% and 80%.
“Lack of access to affordable health coverage is the main reason many people say they are uninsured,” KFF reported in December. And while most working-age adults get their health insurance through their employer, some who hold jobs still cannot afford their share of the insurance premiums. And some workplaces don’t offer medical benefits.
As a result, nearly two-thirds of the uninsured indicated they could not afford coverage, and as a result often forgo seeking medical care.
When they do go, it is to medical providers that generally represent a last resort in a community’s safety net of care – hospital emergency departments, community clinics or health centers whose charge is to provide care regardless of ability to pay.
“We provide care for people that don’t have any other options in many cases,” said Amy Collier Carroll, vice president of Merced-based Golden Valley Health Care Centers, which operates about 50 health clinic sites in Merced, Stanislaus and San Joaquin counties – among the largest networks of federally qualified health centers in the Valley.
“We do see people who have other insurances, and we have a sliding fee scale for people who want to pay by cash,” Collier Carroll said. “But we are committed to providing access to all, and that means everyone.”
Hospital emergency departments are required to at least provide a medical screening to anyone who shows up at their door, according to the federal Centers for Medicare & Medicaid Services, and to provide treatment to stabilize the patient if they are deemed to have an emergency condition. Under the Emergency Medical Treatment and Labor Act, “the hospital must treat the patient … regardless of health insurance or ability to pay,” but may still bill patients for care.
A 2021 report, also by KFF, estimated that the costs for providers to care for uninsured nationwide averaged more than $42.4 billion per year. Of that, providers received a total of about $33.6 billion in public funds to make up some of their losses. About $21.7 billion came from the federal government.
That’s on top of the costs of public insurance – Medi-Cal, Medicare, and VA benefits – to cover those who are eligible and enrolled.
Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org.