CHA News Article

Report Examines Coverage Expansions, Remaining Uninsured in California

The Kaiser Family Foundation has released a report that examines the first year of Affordable Care Act (ACA) implementation in California. Titled Coverage Expansions and the Remaining Uninsured: A Look at California During Year One of ACA Implementation, the report uses the California sample of the 2014 Kaiser Survey of Low-Income Americans and the ACA to examine California adults who gained coverage and those who remained uninsured in 2014. It also provides information on how the newly insured view their coverage and problems they have encountered in using it; how the remaining uninsured and newly insured fare with respect to access to medical care and financial burden; and why people in California continue to lack coverage, as well as their plans for obtaining coverage in 2015.

Key report findings reveal:

  • The newly insured and remaining uninsured populations resemble each other with respect to income, age, and health status and have different characteristics from the previously insured.
  • However, the insured and uninsured populations in California differ on some important factors, such as race/ethnicity, work status, gender and immigration status.
  • Medi-Cal and Covered California enrollees are more likely to be racially diverse and are made up primarily of working adults without dependent children.
  • Though the adult Medi-Cal population is younger than that of other coverage groups, enrollees have poorer health status.
  • Newly insured adults were more likely to change where they usually go for care than their previously insured counterparts, but clinics remain an important source of care for newly insured adults.
  • Adults with insurance coverage were more likely than the uninsured to have used medical services or received preventive care.
  • Though most adults did not report problems getting appointments, adults with Covered California or Medi-Cal coverage were more likely than those with other private coverage to say a provider would not see them due to coverage.
  • Newly insured adults were less likely to prioritize scope of coverage or provider networks in choosing their plan than previously insured adults.
  • Across coverage groups, most insured adults did not report having difficulty with the plan selection process or other specific problems with their health plan.
  • Newly insured adults were less likely than previously insured to understand the details of their plan and to give their health plan high ratings.
  • Many Covered California enrollees report difficulty paying their monthly premium. However, coverage provides financial protection from medical bills and eases concern over affording medical care.
  • Many newly insured adults still face financial insecurity in areas outside of health care costs.
  • Most adults who were uninsured in fall 2014 had not tried to get ACA coverage, and perceptions of cost and eligibility were a common reason for not obtaining coverage.
  • Few adults who were uninsured at the end of 2014 had plans to obtain ACA coverage in 2015.

Policy implications outlined in the report include:

  • Cost continues to prevent many uninsured adults from seeking coverage.
  • Given the high share of remaining uninsured who are Hispanic, targeted outreach to this group is appropriate.
  • Community outreach may help engage many remaining uninsured.
  • Clinics and health centers remain core providers for the uninsured and will require ongoing support to serve this population.
  • While some uninsured are able to navigate the system when they need care, most are not and face serious consequences as a result.
  • While most adults with coverage have positive views and experience with their health plan across coverage type, consumer education about health insurance and health care may be needed.
  • While coverage eases the financial strain of health care, many newly insured adults are in precarious financial situations and still report affordability problems.
  • Continued attention is needed to ensure those who have coverage are able to access care.

To view the full report, visit the KFF website.