Health care access problems in New Orleans

As the second anniversary of Hurricane Katrina's landfall approaches, new analysis by the Kaiser Family Foundation of its household survey of people in the New Orleans area shows that more than four in 10 (43 percent) adults reported at least one health care access problem in the aftermath of Hurricane Katrina.

Underscoring the racial disparities documented generally in the Kaiser household survey, 70 percent of the one in four adults without health insurance in Orleans Parish were African Americans. In Orleans Parish, the survey found that 33 percent of African American adults were uninsured versus 12 percent of white adults.

The newly released, Health Challenges for the People of New Orleans, is a follow-up to the May 2007 report, Giving Voice to the People of New Orleans: The Kaiser Post-Katrina Baseline Survey. The new 65-page report examines the health care status of the adult population of Greater New Orleans based on a Fall 2006 household interview survey of residents of the parishes of Orleans, Jefferson, Plaquemines and St. Bernard and details their health coverage and access to health care services after the disaster.

Some of the most frequently reported health access problems included deterioration in the ability to have health needs met now compared to before Katrina (22 percent), having a harder time getting to their place of medical care now (18 percent), and having a different medical provider after Katrina (16 percent).

"Many of the health access problems highlighted in our survey are common in other low-income urban areas across the country. What makes New Orleans unique is the lack of a health care system able to respond post-Katrina. The findings help explain why residents ranked getting medical facilities up and running as such a top priority only behind repairing levees and controlling crime," said Kaiser Family Foundation President and CEO Drew E. Altman, Ph.D.

The survey found that among all New Orleans area adults, one in five reported being uninsured, substantially higher than the national average of 15 percent for this group. But by comparison, the survey shows that in the Greater New Orleans area, less than one in 10 (9 percent) of households with children reported a child lacked health insurance. And most notably, in an area characterized by racial disparities documented throughout the survey, the percentage without health insurance was comparable for both African American and white households with children.

"Louisiana is among the state leaders in covering low-income children, but ranks at the very bottom of coverage of their low-income adult population, with Medicaid eligibility levels at 20 percent of the Federal Poverty Level or $4,130 per year for an adult in a working family of four," said Foundation Executive Vice President Diane Rowland, Sc.D. "Although Louisiana is poised to potentially narrow the racial disparity gap in coverage of children even further with a new state law expanding their State Children's Health Insurance Program to children up to 300 percent of the Federal Poverty Level, addressing coverage for the one in five uninsured adults remains a real challenge," she added.

The uninsured rates among a variety of vulnerable subgroups are also of note. Fifty-six percent of previous users of the Charity Hospital System-an integral part of the New Orleans health care delivery system prior to Hurricane Katrina, predominantly served the uninsured-reported being without coverage.

As policymakers at the federal, state, and local level grapple with the challenges presented by Hurricane Katrina, the Kaiser Family Foundation will continue to give voice to the people of New Orleans and supply policymakers with a source of information about who is returning to the area and how they are faring. Future Kaiser household surveys planned for the next two years will monitor progress and changes.

The full survey analysis, Health Challenges for the People of New Orleans, along with a link to the broader May 2007 analysis is available online at http://www.kff.org/kaiserpolls/7659.cfm. Additionally, Diane Rowland will testify on August 1 to the U.S. House of Representatives, Committee on Energy and Commerce's Subcommittee on Oversight and Investigations about the key health findings from the household survey. The Subcommittee is holding the hearing, "Post-Katrina Health Care in the New Orleans Region: Progress and Continuing Concerns Part II."

The Kaiser Post-Katrina Baseline Survey of the New Orleans Area was designed and analyzed by researchers at the Kaiser Family Foundation. This in-person survey was conducted door-to-door from September 12 to November 13, 2006. Interviews were completed in English and Spanish among 1,504 randomly selected adults ages 18 and older residing in Orleans, Jefferson, Plaquemines, and St. Bernard parishes. These four neighboring parishes make up Region 1 as defined by Louisiana's Department of Health and Hospitals, an administrative region used for recovery planning. The sample design was a stratified area probability sample, with 456 sampling points distributed proportionate to expected population size in each of the four parishes, and in each of fourteen Census tract defined neighborhoods in Orleans Parish. An oversample was drawn in Orleans to allow for more detailed analysis of this area; final results have been weighted so that each parish reflects its estimated share of the area's population. The margin of sampling error for the full sample is plus or minus 4 percentage points; for results based on Orleans Parish or Jefferson Parish it is plus or minus 5 percentage points. For results based on other subsets of respondents the margin of sampling error may be larger. ICR/International Communications Research collaborated with Kaiser researchers on sample design and weighting, and supervised the fieldwork.