This year San Mateo County was ranked the healthiest county in the state (County Health Rankings). Ranking criteria consist of a wide range of factors, many of which are a reflection of the county’s affluence and an impressive public health system that resulted from thoughtful long-term planning. Notwithstanding the county’s healthcare system accomplishments, the high cost of living impacts health outcomes for many residents who lack funds or ability to take time away from work to arrange care for themselves or their families.
- Hunger impacts health and 42% of low-wage households in San Mateo County were food insecure in 2015, compared with 38% for the state.
- Learn more about food insecurity from our 2016 report on the local food system.
Cost of Healthcare
An increasing number of residents have health insurance, but costly co-pays, premiums, deductibles, and non-covered services are a financial burden for many households.
- The majority of residents receive health insurance through their employer. However, a report by the Kaiser Foundation found that between 2006 and 2016, employees paid an increasing share of insurance premiums, and over the past five years the average deductible paid by employees has increased by 50%.
- According to the California Regional Health Care Costs & Quality Atlas, per-enrollee total average annual cost of commercial insurance is $5,200 in San Mateo County. This is the same cost as Santa Clara County, but lower than San Francisco, which is the highest in northern CA at $5,400.
- In 2015, 14.3% of San Mateo County’s population was over the age of 65. These residents (and those with certain disabilities) qualify for health insurance through Medicare. Unfortunately, these benefits do not include total healthcare costs, which often require supplemental healthcare, such as dental care or assisted living facilities.
- Medicaid is a national program that serves low-income residents. California’s Medicaid expansion in 2014 improved access to healthcare coverage for residents who earn 138% of the Federal Poverty Level ($16,642 for individuals and $33,948 for a family of four). However, Medicaid does not cover dental procedures.
- According to the 2013 Community Health Needs Assessment: Health & Quality of Life in San Mateo County: “employed adults in San Mateo County missed an average of 6.0 workdays in the past year due to personal illness. Workdays missed are highest among residents aged 40 to 64 (8.9 workdays missed in the past year), those living below the 200% poverty threshold (13.4), Whites and Hispanics (both 7.9 days), and residents of the North County area (7.4)“.
Affordable Care Act and Covered California
The Affordable Care Act created a marketplace for healthcare and guaranteed access for citizens with pre-existing conditions. However, there are no limits on the cost of healthcare within this system. For those with low incomes, the cost of premiums are mitigated through subsidies based on the FPL, which does not account for the high cost of living in San Mateo County. Enrollees that earn over 400% of the FPL do not qualify for a subsidy.
Recent studies show that many health outcomes are determined at the neighborhood level, which is often an indicator of socioeconomic conditions, proximity to healthcare, and exposure to pollution. The Health Disadvantage Index maps neighborhoods and measures factors that influence health.
- Within San Mateo County, areas with a high ranking on the Health Disadvantage Index are: Redwood City, North Fair Oaks, East Palo Alto, and Daly City.
- Common disadvantages in these areas are poverty, high housing costs, renter occupied housing, single parent households, age-eligible children not enrolled in preschool, less than HS educational attainment, no park access, and linguistic isolation.
- Renter occupied housing is a disadvantage compared to homeownership because rent increases or eviction may destabilize household budgets. Furthermore, household income spent on rent does not contribute to long-term wealth accumulation.
Economic Impacts on Mental Health
In 2015, the UCLA Center for Health Policy Research recorded an increase in respondents that reported serious psychological distress during the past month in San Mateo County. Previous spikes were record in 2012 when there was an increase in poverty and continuing drop in wages, and in 2007 at the beginning of the recession. Those who earned between 100-200% of the FPL ($24,300-$48,600 for a family of four) reported the highest rate of psychological distress at 6.6%. The second highest rate was reported by those who earned over 400% of the FPL ($97,200 and above for a family of four), this group’s rate increased to 1.9%.
Financial constraints that affect economic mobility can cause stress. Stress leads to a variety of health problems, including drug and alcohol abuse.
- Puente de la Costa Sur collaborates with the county, other agencies, and nonprofits to ensure access to health services for coastal residents, including assistance with enrollment in safety net services, a coastal clinic, field nurse, fitness classes, and counseling.
- The San Mateo County healthcare districts were originally established to create hospitals and are now providing financial support for safety net service providers:
- Center for Dental Health and mobile dental outreach program organized by the Peninsula Health Care District provides dental care for residents who are unable to secure commercial dental care.
- Sequoia Healthcare District’s School Wellness Projects fund programs in the eight school districts in its boundaries.
- Samaritan House has expanded support to the missing middle, those who earn a middle income and struggle to afford medical and housing expenses.
- Caminar for Mental Health operates a variety of programs for people with mental health disabilities.
- StarVista is a nonprofit counseling provider specializing in crisis intervention, substance abuse treatment, and suicide prevention.
- Children’s Health Council and Jewish Family and Children Services support programs that bring mental health services into local schools.
Kate Bundorf, Assistant Professor, Stanford University
Cheryl Fama, CEO, Peninsula Health Care District
Lee Michelson, CEO, Sequoia Healthcare District
Bringing Healthcare Within Reach. Covered California: The California Health Benefits Exchange. 2017. Retrieved from: http://hbex.coveredca.com/data-research/
California Regional Health Care Costs & Quality Atlas. 2016. Retrieved from: http://www.iha.org/sites/default/files/resources/issue-brief-cost-atlas-2016.pdf
County Health Rankings. 2017. Retrieved from: http://www.countyhealthrankings.org/app/california/2017/
Covered California Open Enrollment Profile. Covered California: The California Health Benefits Exchange. 2016. Retrieved from: http://hbex.coveredca.com/data-research/
Kaiser Foundation. 2017. Retrieved from: https://www.kff.org/health-costs/report/2017-employer-health-benefits-survey/
2013 Community Health Needs Assessment: Health & Quality of Life in San Mateo County. The Healthy Community Collaborative of San Mateo County. Retrieved from: http://www.smchealth.org/sites/main/files/file-attachments/2013fullreportlow.pdf