Having a job is not necessarily a passport to health insurance in New York City. One million New Yorkers - some 17% of the adult population - lacked coverage in 2005, according to a new Health Department report, and 700,000 of them were employed. The complete report, Health Care Access among Adults in New York City, is available online here.

The report suggests that the lack of coverage is especially severe among young adults, Hispanics, and men:

* More than one quarter (27%) of 18- to 24-year-olds lack health insurance, compared to 19% of adults ages 25 and older.

* One in four Hispanics lacks insurance, as do one in five Asians, one in six blacks, and one in 10 whites.

* One in five men lacks health insurance, compared to one in eight women.

Fortunately, some of those lacking insurance have not exhausted all their options. The report estimates that up to a quarter of the city's uninsured may be eligible for benefits they are not claiming. But expanding enrollment is only one of the challenges the report highlights. Having a both regular doctor and health insurance increases the likelihood of receiving critical preventive services and getting the best care. The report finds that one in five New Yorkers - including 600,000 people with health insurance - lacked a regular doctor in 2005. As expected, many of those without regular doctors missed out on essential screenings or immunizations.

NYC Adults and Preventive Care Services

Insurance & Regular Care Provider Neither
Colonoscopy (50+) 58% 21%
Cholesterol Test 86% 51%
Pap Test (Women) 83% 60%
Mammography (Women 40+) 78% 41%
Flu Shot (65+) 57% 14%
Pneumonia (65+) 51% 6%
HIV Test (2+partners) 37% 17%

"If you don't have a regular doctor, chances are you're not getting the care you need," said Dr. Thomas R. Frieden, New York City Health Commissioner. "This report tells us that hundreds of thousands of New Yorkers are missing out on routine screenings that could prevent illness and save lives. All of this adds up to people landing in emergency rooms with costly, devastating health problems that could have been prevented or treated."

Missing Out on Preventive Care

The report details several ways that expanding routine primary care could improve New Yorkers' health. Among the findings:

* Adults 65 and older are four times more likely to receive a flu shot - and eight times more likely to get immunized against pneumonia - if they have insurance and a regular provider.
* Women with insurance and a regular provider are about twice as likely to report having received a recent mammogram.
* Among adults 50 and older, those with insurance and a regular provider are three times more likely to receive a colonoscopy.

New Yorkers with a regular health care provider also say they have better relationships with their providers, rating them higher in terms of listening, explaining, and spending enough time during appointments. This suggests that having a regular doctor improves the quality of care.

Skipping Care Because of Cost

Some New Yorkers without health insurance forgo doctor visits and medications because they cannot afford them. The report found that:

* Uninsured adults are four times more likely than insured adults to skip medical care due to cost (41% vs. 11%)

* About 900,000 New Yorkers did not fill a prescription because of cost in 2003. Those who were uninsured were twice as likely to not fill a prescription (24 vs. 14%)

Addressing the Gaps in Access

The City conducts numerous programs to reduce the number of uninsured New Yorkers:

* The Human Resources Administration (HRA) provides enrollment assistance at its 19 Community Medicaid Office and processes Medicaid applications through organizations trained in facilitating enrollment.
* Through HealthStat, a mayoral initiative that seeks to enroll more eligible New Yorkers in public insurance, 14 City agencies facilitate enrollment at schools, at places of worships, and at community events. In 2006, more than 98,000 New Yorkers gained access to public health insurance programs through HealthStat.
* To simplify the enrollment process, HRA is exploring electronic submission of public health insurance applications.
* HRA promotes affordable private options through seminars for insurance providers and outreach to business organizations. Since 2006, almost 20,000 New Yorkers have obtained health insurance coverage through these efforts.
* In June 2007, the City reached an agreement with insurers to provide domestic partner coverage for purchase by small businesses.
* In 2006, the Health Department:

o Raised to 76,000 the number of blind, disabled or elderly (65 and over) New Yorkers enrolled in Medicaid Managed Care - a 50% increase over 2005.
o Screened more than 15,000 children for insurance eligibility, and completed applications for the nearly 25% who qualified for Medicaid or Child Health Plus.
o Expanded an initiative to enroll eligible inmates in Medicaid upon discharge from city jails, and to help connect them to primary care providers or substance abuse treatment programs.

All New Yorkers should have access to the care they need to stay healthy or get well. Here are some steps that any New Yorker can take to get better care:

* Find Out If You Qualify For Insurance
If you do not have insurance, call 311 for health insurance information. New Yorkers can also learn whether they qualify for public and subsidized health insurance through AccessNYC at www.nyc.gov/accessnyc or by visiting www.nyc.gov/healthstat.
* Track Your Own Health
Even without insurance, the Take Care New York Passport can help you track your health and get the treatments you need. The Passport can be found at: www.nyc.gov/health/tcny.
* Visit City Health Clinics
If you do not have a regular doctor and need immunizations, STD treatment or tuberculosis screening and care, check to see if a Health Department clinic can help you. Information on Health Department immunization, STD, and TB clinics is available by calling 311.

New Yorkers can also access comprehensive, affordable healthcare at any NYC Health and Hospital Corporation hospital or community based health center. Through HHC Options, financial assistance is available to help patients apply for public health insurance or receive reduced fee services based on income and family size -- with doctor visits for as low $15. For more info, visit www.nyc.gov/hhc.