Providing Health Care to the Residually Uninsured in a Post-Reform World (Updated)

September 18, 2013

This updated version of ITUP’s 2012 report incorporates the latest research and data in regard to the Residually Uninsured.

On March 23, 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law, laying the groundwork for many health reforms, including the expansion of Medicaid, increasing coverage of preexisting conditions through guaranteed issue, and the establishment of statewide and/or regional health insurance exchanges. Although these reforms will provide coverage to previously uninsured millions, a sizeable population will remain uninsured, estimated at 3.1 million individuals in California in 2016. Previously insured individuals may lose job-based health insurance due to employers dropping coverage or increasing employees’ contribution. Documented individuals not subject to the individual mandate and those subject to the mandate may choose not to seek coverage. In Los Angeles County, 1 in 5 of the currently uninsured will be excluded from the ACA coverage expansions due to citizenship status. As a result, the residually uninsured will continue to rely on local health care safety net systems, while financing streams that presently support services will be severely reduced when ACA implementation commences fully in 2014.

This report provides an overview of the residually uninsured, as well as four models to provide services post-reform.

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