Health Insurance Problems and Issues 1

Health Insurance Problems and Issues Within San Diego County Arises because of the New

Health Care Plan

Tracy Nguyen

California State University of Long Beach

Author Note

Tracy Nguyen, College of Health and Human Services, Health Care Administration

Major, California State University of Long Beach.

This research is assigned by the Health Care System Class.

Correspondence concerning this paper should be addressed to Tracy Nguyen, College of

Health and Human Services, Health Care Administration Major, California State University of

Long Beach, 6405 Saipan St., Cypress, CA 90630. Contact: Tracy.Nguyen01@student.csulb.edu

Health Insurance Problems and Issues 2

Abstract

This paper will discuss the running issues presented by the new changes of the health care plan

created by the new President and the Republican Party. Mainly focused on San Diego County,

issues such as, who will be covered and how much funding does San Diego County receive, will

be analyzed with potential recommendations and solutions. The paper will go into detail about San

Diegans who are being affected by the new health care plan and what plans the San Diegans are

creating to continue their health insurance coverage. San Diego County will be compared to

California about the health insurance issue and smaller facts such as, demographics, number of

hospitals, number of physicians, number of people in poverty, etc. Comparison will also include

the differences and similarities the county and the state have when the new health care plan is

passed. Potential funding plans will be shown and the impacts of each funding plan affecting the

San Diegans and Californians.

Key Terms: Insurance, Affordable Care Act, New health plan

Health Insurance Problems and Issues 3

Health Insurance Problems and Issues Within San Diego County Arises because of the New

Health Care Plan

San Diego County is one of the largest county in California with a total of 3,317,749

people. One of the biggest issues today within the country is the new health coverage plan the new

President and Republican Party is trying to create and pass. This will affect all states. Many

problems arise from this issue such as, will the new plan fully cover and replace the Affordable

Care Act, how many people will go back to being uninsured, will there be a discrimination among

health insurance plans with people who have pre-existing conditions. In the article; Without

Obamacare or a replacement, 370,000 in San Diego County could lose insurance; by Cheryl Clark

and Joe Yerardi; the authors discuss how San Diegans are being affected by the potential new

health plan and how San Diego County will be affected financially. Confusion will arise from

anywhere in the country once the new plan is enacted. When the Affordable Care Act was just

enacted, many people were unaware of how to enroll in the ACA and Covered California. Officials

had to go out and publicly educate and enroll people into the program. In the article, San Diego

Gearing up for Health Insurance Exchange Enrollment, by Megan Burks, the author described how

the San Diegans were first enrolled into the ACA plan. Actions within the article could be used

again when the new health plan is passed. The new health plan will not only affect San Diegans

but also Californians. The article; California’s Uninsured: As Coverage Grows, Millions Go

Without; by Paul Fronstin, discusses how many people are already uninsured and with the new

health plan, Fronstin estimates more people will become uninsured. It is unsure of the exact

outcome from this new health plan but officials are already scrambling to find funding for their

county. Only negativity has been expressed about this plan and people are accepting the fact that

they will not be covered again.

Health Insurance Problems and Issues 4

In San Diego County, 9.5% of people under 65 years of age are not covered by health

insurance. This percentage will easily grow if the new health plan will not fully cover what the

Affordable Care Act and Covered California covered. The ACA was able to cover people of ages

19 to 64 whose incomes were between 100 percent and 138 percent of the federal poverty level in

California. These people might lose insurance coverage if the new health plan decides to eliminate

federal tax subsidies that most expansion enrollees receive. According to Clark and Yerardi, “about

one in six San Diego County residents between 18 and 64 rely on one of the programs for

coverage.” The new health plan will repeal the individual mandate, which requires all American

citizens to purchase health insurance, and will replace it with a block grant. This will give each

state the decision of where to use that money. The block grant will also destroy any deals made

with health insurances in accordance to the Affordable Care Act, giving insurance companies the

ability to discriminate against people with pre-existing conditions again. Clark and Yerardi

interviewed Darrell Issa, San Diego County member of Congress who is a Republican, who

compared health insurance to car insurance. People will have to face the consequences of not

buying health insurance if an event does occur. Many people are against this idea because buying

health insurance or not is not a yes or no decision to people, it is a decision of whether they can

afford health insurance or not. In cases where people have pre-existing conditions, they will not

have an option to purchase insurance because the insurance companies have already denied them

coverage. Clark and Yerardi also interviewed Dr. Jim Dunford, an emergency medicine physician.

Dr. Dunford states that the less amount of people who are uninsured, the greater amount of money

the county or state will eventually have to pool out of funds. Because people are not covered

anymore, they will less likely purchase medication to keep them physically stable, leading to more

people vising the emergency rooms or urgent cares. (Clark, 2017).

Health Insurance Problems and Issues 5

Having more people in emergency rooms or urgent cares is not ideal. According to the

Office of Statewide Health Planning and Development, within San Diego County, there is a total

of 35 hospitals with 8 different types, most of them overlapping in types. There is a total of 20 ER

hospitals, 6 trauma center hospitals, 8 disproportionate share hospitals, 1 primary care HPSA

hospital, 1 mental health HPSA hospital, 5 primary car shortage area hospitals, 35 registered nurse

shortage area hospitals, and 7 medically underserved area hospitals. With an increase of patients

because of the lack of insurance coverage, waiting times will be longer and number of beds and

physicians will not be enough to care for the patients. According to the California Health Care

Almanac, in 2010, there was a ratio of 2.1 beds per 1,000 population in San Diego County and a

ratio of 1.9 beds per 1,000 population in California. In San Diego County, there is a ratio of 51.40

primary care physicians per 100,000 population with a total of 1,696 primary care physicians and

116 specialty care physicians per 100,000 population with a total of 3,828 specialty care

physicians. The ratio of beds per population will grow since this data was taken when the

Affordable Care Act was still enacted. It is already alarming that the ratio to beds per population

is large but now, there is an estimate that there will be more patients, it seems like hospitals are

not ready for this despite all the warnings. The same will be said to the ratio of primary care

physicians to population but not specialty care physicians to populations. Since more people will

be uninsured, the ratio of specialty care physicians to San Diego’s population will decrease.

Though it might seem futile, community clinics may be able to help some San Diegans.

Community clinics are an integral part of California’s primary care and safety-net system,

especially for uninsured, underinsured, and low-income people. According to the Office of

Statewide Health Planning and Development, there is a total of 109 primary care clinics, 28 chronic

dialysis clinics, 3 surgical clinics, 1 psychology clinic, 1 rehabilitation clinic, and 1 alternative
Health Insurance Problems and Issues 6

birthing clinic. There is a total of 150,00 patients who are served by San Diego County’s

community clinics and 6.2 million Californians who are served by community clinics. Both

numbers are expected to grow once the new health plan is passed.

Within the 3,317,749 people of San Diego, 75.9% are White, 5.5% are Black, 12.2% are

Asian, 33.5% are Hispanic/Latino, and 1.3% are Native American. There are 49.7% females in the

population leaving 50.3% to be males. Twenty-two percent of the population is under the age of

18 and 13.4% are 65 years and older. Unfortunately, 13.9% of San Diego County is in poverty

including 17.8% that are children. In comparison, California has a population total of 39,250,017

people with 75.9% being White, 6.5% being Black, 14.8% being Asian, 38.9% being

Hispanic/Latino, and 1.7% being Native American. There are 50.3% are females and 49.7% are

males within the population. Twenty-three point two percent are under age 18 and 13.6% are 65

years and older. Fifteen point four percent of the people are in poverty, which includes 21.2% that

are children. Looking at the numbers, it gives reason why so many people within the health

profession and without are so worried about what is to come following the new health care plan.

By taking away the mandate of purchasing health care, people in poverty will not be motivated to

buy health insurance if they are not able to afford it. As stated before, counties and eventually

states will have to pay more money if an event occurs and someone who is not covered enters into

an emergency room. These percentages were taken in 2015 when the ACA was still enacted, these

percentages will continue to grow once the new health care plan is passed and because the middle

class is now growing smaller making the higher class grow and unfortunately the lower class

growing as well. (USDA, 2015).

Though the concern over health insurance coverage in San Diego County is a big issue,

health insurance will not be needed if there is a shortage of the health workforce and a growing
Health Insurance Problems and Issues 7

number of designations that are medically underserved. Data collected in 2013 shows there are

approximately 5,900 designated primary care health professional shortage areas (HPSAs) within

San Diego. As listed above, the ratio between primary care physicians to patients is significantly

large and will continue to grow due to the shortage of the health workforce. In addition to primary

care, there is approximately 4,600 dental HPSAs and 3,800 mental health HPSAs. It is quite

alarming the amount of health professions that are in need of health workers. One of the health

careers that are in high demand are registered nurses. The shortage of nurses not only affects San

Diego County but California as well. According to the HealthCare Shortage Atlas, “the number of

nurses per 100,00 in the state is significantly below the national number of nurses per 100,00

population.” The California Health Care Workforce Policy Commission looks at the county

boundaries, the Board of Registered Nursing licensee data and, the patient day or census data from

all long term care facilities and general acute care hospitals to see if a region is considered to have

a shortage of nurses. San Diego county is one of the twenty-seven counties that is listed as a

registered nurse shortage area. The San Diego Service Area within San Diego County is considered

a medically underserved area. It was considered a medically underserved area since 1994. (Health

Care Almanac, 2013).

Though San Diego County may seem like the county needs a better healthcare system, it

is ranked 12 out of 57 counties for health outcomes. Health outcomes is the length of life and 4

different types of health factors which consists of health behaviors, clinical care, social and

economic factors, and physical environment. There is a total of 4,700 premature deaths per

100,000 population in San Diego County. Of the health behaviors, 11% of the population are adult

smokers, 19% are adults with obesity, and 20% are excessive drinkers. Of the clinical cares, 13%

of the population under 65 years are uninsured, 83% are diabetic Medicare enrollees, and 56%
Health Insurance Problems and Issues 8

receive mammography screening under Medicare. Of the social and economic factors, 5.2% of the

population are unemployed, 349 per 100,000 are associated with violent crimes, and 49 per

100,000 deaths are due to injuries. Of the physical environment, there are drinking water

violations, 26% of the population have severe housing problems, and 76% drive alone to work.

(County Health Rankings, 2017).

Despite the issues and problems that could potentially arise once the new health plan is

enacted, San Diego County does have a Medi-Cal managed care that can potentially help those on

Medi-Cal once the new health plan is in full swing. According to the San Diego County website,

the “state law requires most people on Medi-Cal to join a health plan.” This will ensure those who

have Medi-Cal to enroll in a plan that is most beneficial to their health needs. San Diego County

has 8 health insurance plans within Medi-Cal. The 8 plans people are able to choose from are Care

1st Partner Plan, LLC; Community Health Group Partnership Plan; health Net Community

Solution, Inc.; Kaiser Permanente; Molina Healthcare of California Partner Plan, Inc.;

UnitedHealthcare Community Plan; Specialty Health Plan; and St. Paul’s PACE. All these health

insurance plans are all tied under San Diego’s Medi-Cal managed care which is called Healthy

San Diego. The Healthy San Diego program consists of consumer and community stakeholders

who work on local managed care issues. According to the San Diego County website, the

program’s main purpose is to “inform persons on Medi-Cal about their health care choices.” The

program will reach out each month to those who are enrolled or renewed their benefits.

Whether the new health care plan will be enacted or not, officials must always be prepared

for any outcome. When the Affordable Care Act was first enacted, to have many people enroll

under it, officials of San Diego County set up outreach events where they were able to set stations

for people to easily sign up. Megan Burks explains how iPad-clad workers from SAY, a local
Health Insurance Problems and Issues 9

nonprofit organization, helped San Diego residents sign up for the Affordable Care Act. The

organization set up events more towards the Latino population because the Latino population was

comparatively young. With many young, healthy people signing up for health insurance, it will

offset the insurance costs overall to everyone within the health insurance pool. This idea can be

used again once the new health plan is enacted. For example, San Diego County’s officials can set

up outreach events to educate communities as to why it is important to purchase health insurance.

Once people realize the importance of health insurance, more people will be more willing to

purchase health insurance which will reduce the amount of money the county has to spend on those

who do not have health insurance. Officials can also partner up with health care providers to set

up outreach events to educate residents what each health care provider offers and which one will

best fit to each person. Paul Fronstin estimates more than 3 million Californians will become

uninsured once the new health plan takes action. Because of this, it is very important for officials

in San Diego County and California to educate the people. The county and state will not be able

to afford everyone’s medical bill and having insurance will benefit both the consumer, county, and

state. (Fronstin, 2017).

It is clear more than ever that health care is vital within any area of America. Health care

workers are needed, health supplies are needed, and health insurance is needed. It does not matter

which health plan will be enacted for the next years to come, changes need to be done. Many

Americans are relying on the government to provide for the needs and to solve all problems that

ever arises. Unfortunately, not many Americans are aware of the exact issue is. By educating the

population on what is happening and what needs to be done to help society as a whole, people will

become more aware and be more willing to make the changes. Educating the population of San

Diego County to purchase health insurance will provide many benefits and opportunities for the
Health Insurance Problems and Issues 10

consumer and the county. If enough people are reached and purchase their health insurance, the

funding problem will slowly decrease. Most likely than not, having enough funding will always

be the main issue but, taking small steps at a time can help reduce the issue into a smaller one.
Health Insurance Problems and Issues 11

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