The Star-Ledger

Where Do New Jerseyans Without Health Insurance Live?

The Star-Ledger — Thursday, March 27, 2014

By Kathleen O'Brien / The Star-Ledger

Diego Arias, a health policy advocate for NJ Citizen Action, answers questions about Obamacare in November in Elizabeth. Photo by Ed Murray / The Star-Ledger
Diego Arias, a health policy advocate for NJ Citizen Action, answers questions about Obamacare in November in Elizabeth. Photo by Ed Murray / The Star-Ledger

As the days dwindle until Monday's deadline for Americans to buy health insurance, just what do we know about the estimated 1.3 million uninsured New Jersey residents?

Are they without insurance simply because they can't afford it? Or is there something more going on?

"The uninsured are everywhere among us. They're in every neighborhood, with very few exceptions, and they're as diverse as the entire population," said Joel Cantor, director of Rutgers University's Center for State Health Policy.

Under the Affordable Care Act, those who continue to be without insurance on April 1 will face a penalty when they file their 2014 taxes a year from now. The fine isn't much in the first year — $95 or 1 percent of income, whichever is greater — but it will rise in subsequent years.

(The Obama administration said Tuesday that anyone willing to attest that technological problems hampered their attempt to meet the deadline can ask for an extension.)

The U.S. Census, through the five-year American Community Survey, provides estimates of the uninsured population in several geographies, including by town. The data, the most recent available, covers a period from 2008 to 2012 and does not include information on residents who received insurance through Obamacare.

That data reveals that in some towns — Palisades Park, Fairview, West New York and East Newark — a third or more of their residents are without insurance, while other municipalities — such as Monmouth Beach, Roseland and Cape May Point — have less than 1 percent uninsured.

In sheer numbers, that survey shows the highest concentration of the uninsured live in the state's most populous counties — no surprise there. The center says 60 percent of the state's uninsured live in the six northeastern counties: Passaic, Bergen, Essex, Hudson, Union and Middlesex.

However, a swath of rural southern Jersey includes towns with the largest percentage of uninsured. In other words, while a certain town might not have that many residents, a large percentage of them are without health insurance.

But besides their place of residency, what else do we know about the uninsured as a group?

Collectively, they are more likely to be young, male, Hispanic, employed less than full time, and with less than a high school education, according to a 2013 study by the center at Rutgers.

"Cost is certainly a barrier for them, but there are certainly other reasons for not having insurance," said Jeff Brown of the New Jersey Health Care Quality Institute, a nonprofit group seeking quality, accountability and cost containment in health care.

In general, men are less likely to get insurance. Young men have lower medical bills than women the same age, according to insurance data — a situation that flips the other way with time.

Taking a chance

Psychologically, the uninsured are more likely see themselves as risk-takers in all walks of life, according to a survey by the Center for State Health Policy. Nearly half (48 percent) agree with the statement, "I am a lot more likely to take risks than the average person." (Only 28 percent of the insured say that about themselves.)

"It's an uphill battle to get these folks insured," said Brown.

The uninsured tend to be content with the care they get at various free clinics and don't feel they need anything more, the study indicated. The uninsured were more than twice as likely (40 percent) as the insured (18 percent) to agree with the statement, "Having my medical needs taken care of at a public or free clinic is just fine with me."

"There's a warning though: Those clinics won't pay for your hospitalization, and provide limited to no specialty care," Cantor said.

They are more willing to go without insurance even if they have health problems, with only 72 percent viewing insurance as a necessity for those who aren't healthy. That contrasts with a 91 percent of the insured.

Of New Jersey's 1.3 million uninsured, an estimated 300,000 are unauthorized immigrants. They cannot buy insurance through the federal marketplace website.

But that doesn't mean all unauthorized immigrants have no health insurance, said Cantor. Just as immigrants here illegally can buy clothing, gas, real estate or restaurant meals, so too can they buy health insurance for themselves.

Family connections

Even immigrants who are here legally may be intimidated by the task of purchasing insurance.

The American system of health insurance is incredibly convoluted compared with those of other countries. With different companies offering a large menu of choices with mystifying terms like "out-of-network," "co-pay" and "family deductible," it quickly becomes complicated. "So even if you're a new immigrant who's eligible, it's mind-boggling," Cantor said.

Many immigrants live in "mixed households," where some family members may be here legally, but other relatives are not. That leads to a general wariness about signing up for any Obamacare policy, for the federal website asks for information about household size. Cantor said regulations prohibit the website from sharing information with immigration enforcement officials, but for some immigrants, the possibility of getting a family member into trouble is too great to risk.

One-sixth of the uninsured would not qualify for any federal subsidy, meaning they can, in theory, afford to be insured, said Brown. (The definition of affordable is a cost equal to about 10 percent of income.)

Yet for whatever reason, they have decided to forgo insurance. "There are a whole range of attitudes about health care out there," said Cantor.

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