Coverage Expansions and the Remaining Uninsured: a Look at California During Year One of ACA Implementation (Kaiser Family Foundation, May 2015) is an excellent overview of the impacts of the Medicaid (Medi-Cal) and Covered California expansions. This is the report on Year 1.
The highlights are as follows:
- The newly insured and the remaining uninsured resemble each other in age, income and health status. They differ primarily on the basis of their immigration status.
- The Medi-Cal and Covered California enrolled populations are far more ethnically diverse than those with private insurance.
- Covered California provides a significant source of coverage for working families not offered coverage at the workplace – 75% are workers and families.
- One fifth of the newly insured reported changing their source of care, primarily for convenience – closer to home or work.
- The newly insured are now far more likely to have a regular source of care than the uninsured, but still less so than the previously insured.
- Both Medi-Cal and Covered California enrollees use clinics as a source of care, but far higher percentages (44%) of Coverage California enrollees use private doctors. Fifty-seven percent of those with Medi-Cal use clinics; 32% of those with Covered California use clinics, and 15% of those with other private insurance.
- For the uninsured, the principal reason for choosing their source of care was affordability; for the newly insured it was convenience, and for the previously insured it was pre-existing relationship with their doctor.
- Providers were more likely to refuse to treat Covered California enrollees (13%) than either Medi-Cal (8%) or other privately insured (3%) patients.
- Price was the most important determinant (37%) for Covered California enrollees in selecting a plan.
- Thirty-five percent of the newly insured had a hard time understanding their plan’s coverage as compared to 20% of the already insured.
- Forty-four percent of newly insured Covered California enrollees reported difficulty paying their premiums as opposed to 1/4th of adults with other coverage (i.e. employers), but they reported far lower rates of difficulty paying their medical bills and less worry about their ability to access and pay for their medical care than did the uninsured.
- Most (64%) of the remaining uninsured did not try to apply for coverage because they believed it would be too expensive. A third did apply but were told they were ineligible (38%) or decided it was too expensive (21%).
- Forty-four percent of the remaining uninsured identified cost as the reason they were uninsured; 3% said it was because they opposed the ACA or preferred to pay the penalty.
- Half of the remaining uninsured indicated that they planned to get coverage in 2015, — through work (7%), through Covered California (3%) or Medi-Cal (8%), but most (28%) simply weren’t sure.
- The remaining uninsured are less likely to report they have an ongoing condition, less likely to be taking medication, but more likely to report that they are in fair to poor health than the newly insured or already insured.