California workers, especially those employed by small companies and in low-wage jobs, are increasingly unable to get health insurance through their jobs and millions of them are unable to obtain any other coverage, say health care and insurance experts.
About 5.7 million adults and children - including 752,000 in nine Bay Area counties including Sonoma - in families with at least one worker had no access to job-based coverage in 2007, according to a report by the UCLA Center for Health Policy Research.
While many of the children gained coverage from public insurance programs such as Medi-Cal, 62 percent of the adults were uninsured for all or part of the year, the report said.
"These are the people who fell through the cracks," said Shana Alex Lavarreda, co-author of the study.
About one-third of the adults with no access to job-based insurance worked for companies with fewer than 10 employees, and nearly half earned less than the minimum wage, which was $7.50 an hour in 2007, the report said.
All of the statistics exclude adults 65 and older, who are eligible for Medicare coverage.
Dr. Mary Maddux-Gonzalez, Sonoma County public health officer, said the report "confirms a lot of what we already know," which is that a majority of the uninsured are "hardworking individuals and families."
The uninsured workers are those whose jobs do not offer health benefits, cannot afford to buy their own private insurance and make too much money to qualify for Medi-Cal, Lavarreda said.
Thirty-eight percent of the adults without access to job-based insurance either purchased private insurance, went on Medi-Cal or were covered by a relative, such as young adults on their parents' insurance.
Employers are caught between a stagnant economy and double-digit increases in health insurance premiums in each of the past three years, said David Hodges, a Santa Rosa health insurance broker.
"There's no question that employers are looking for ways to provide less coverage or no coverage at all," he said. "Just paying salaries is a big deal for a lot of these guys."
A dozen of his clients, all with fewer than 50 employees and most in the construction industry, have dropped their group insurance plans in the past 18 months, Hodges said.
Most of the others have pared the benefits by boosting deductibles, out-of-pocket maximum payments and co-pays, he said.
Job-based plans remain the leading source of insurance for Californians, covering 56 percent of residents under age 65 in 2008, according to the California HealthCare Foundation.
But the number of non-elderly residents covered by employer plans fell 9 percent from 1987 to 2008, while those covered by public programs rose 4 percent and the ranks of uninsured Californians increased by 3 percent, the foundation said.
It also found that almost one-third of the uninsured have family incomes of more than $50,000, and that 60 percent of uninsured children are in families headed by someone with a year-round, full-time job.
The prevalence of working people among the uninsured is "a further example of how the health care system in California is broken," said Dr. Robert Ross, CEO of the California Endowment, which funded the UCLA study along with the California Wellness Foundation.
The federal health care law, which expands Medi-Cal coverage next year and creates state insurance exchanges in 2014, should enable more people to become insured, Lavarreda said.
Another part of the law - a tax credit for small businesses that offer health insurance to their employees - probably accounted for a 9 percent increase in that type of coverage this year, she said.
In Sonoma County, about 60,000 people are uninsured, Maddux-Gonzalez said, calling that a "conservative estimate."
Under the health care law, 15,000 people will be covered by the Medi-Cal expansion, 30,000 will buy insurance from the state exchange and 15,000 will remain uninsured, most of them undocumented immigrants, she said.
You can reach Staff Writer Guy Kovner at 521-5457 or guy.kovner@pressdemocrat.com.
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