The Kaiser Family Foundation has been conducting a longitudinal panel survey on the uninsured in California. The organization focused on that state because California has had such a large portion of the nation’s uninsured, and its experience has national implications. As does the finding that, thanks to California’s success with Obamacare, there are 3.4 million fewer uninsured people now.
Of those Californians who were uninsured prior to open enrollment, 58 percent now report having health insurance, which translates to about 3.4 million previously uninsured adult Californians who have gained coverage, and 42 percent say they remain uninsured.1 The most common source of coverage was Medi-Cal with 25 percent of previously uninsured Californians reporting they are now covered by Medi-Cal. An additional 9 percent of California’s previously uninsured say they enrolled in a plan through Covered California, resulting in about a third reporting new coverage from the two sources most directly tied to the ACA.
Twelve percent say they obtained coverage through an employer and 5 percent report enrolling in non-group plans outside of the Covered California Marketplace; some enrollment in these types of coverage may have been motivated by the ACA’s requirement to purchase insurance and some may be the result of normal movement within the marketplace.
[…]Overall, after controlling for a number of demographic factors, the remaining uninsured are more likely to be male, undocumented immigrants, or people who have never had insurance, while those who are newly insured are more likely to be married, have been uninsured for less than two years, have a debilitating chronic condition or report being contacted about signing up for coverage.
That degree of success was completely unforeseen, says Gerald Kominski, director of the UCLA Center for Health Policy Research. “If the numbers are accurate and borne out by larger studies … I think it is an indication that the law is working even better than many of us anticipated.”
However, California will continue to have high rates of uninsurance because the state has a large population of undocumented immigrants who aren’t eligible for coverage under the law. But the groups getting coverage were the primary targets for sign-ups. Among the previously uninsured, 58 percent of people aged 18-34 now have coverage, 54 percent of the group eligible for expanded Medicaid are enrolled and 61 percent who qualified for subsidies got them, as well as 53 percent of the group reporting fair or poor health who were likely shut out of insurance previously.
Those still lacking insurance in California are going to be a challenge to reach, says Kaiser. About 62 percent are Hispanic, “70 percent of whom prefer to communicate in Spanish.” Almost 4 in 10 of the remaining uninsured have never had insurance, so require a lot of education along with signup information, and 45 percent have had insurance before, but not in at least two years. And a third of these people say that cost still remains a barrier to signing up. Nearly two-thirds of this group still “don’t feel like they have enough information to understand how the ACA will impact them and their families.”
The first enrollment period sort of got the low-hanging fruit of the uninsured—the people most informed and most motivated to sign up. As in California, reaching the rest of the uninsured is going to be the major challenge for the administration this fall.