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What's at stake: A million California adults gained insurance in Year One of the Affordable Care Act

Report on ACA impact is benchmark against which ACA repeal can be measured

January 31, 2017

    The number of uninsured Californians ages 64 and under fell from 5.32 million in 2012 to 4.46 million in 2014 ― a decline of 16 percent, according to The State of Health Insurance in California: Findings from the 2014 California Health Interview Survey, a new report from the UCLA Center for Health Policy Research.

    Since that time, the number of uninsured has fallen further ― effectively halving the number of uninsured in the state since the inception of the Patient Protection and Affordable Care Act (ACA).

    Findings from the Center's report ― which uses data after full implementation of the Patient Protection and Affordable Care Act (ACA) ― show how even one year into ACA implementation the law had made significant impact on access to health insurance and to health care services across multiple vulnerable population groups.
     

    "The drop in the uninsured population shows the ACA was a success," said Shana Alex Charles, Center faculty associate and lead author of the report. "But it is bittersweet, given that the current administration is focused on repealing the law."

    The State of Health Insurance in California is the Center's signature publication, released every two years following analysis of comprehensive data from the California Health Interview Survey (CHIS), the nation's largest state health survey.
     

    "This report will be the benchmark against which Republican plans to repeal the ACA will be measured," said Gerald Kominski, a co-author of the report and the director of the UCLA Center for Health Policy Research.  "If the current administration is not able to maintain or exceed the ACA's track record, they will be judged ― and judged harshly."

    Many Gains Overall, but Disparities Persist
    The report shows the expansion of health care under the ACA played a significant role reducing the population of uninsured Californians due to two main factors: Expansion of Medi-Cal to previously excluded groups and provision of federal subsidies that helped people afford to buy private insurance on Covered California. The uninsured population for those 64 and under dropped from 21 percent in 2012 to 17 percent in 2014.

    Other statewide 'before and after reform' findings:

    Employer-based insurance unaffected: The ACA had a relatively negligible effect on overall employment-based insurance (EBI) coverage in the state, despite ACA critics' speculating that employers would cut back on insurance benefits if Californians were able to access coverage elsewhere. EBI rates declined slightly from 54.9 percent in 2012 to 53.4 percent in 2014. However, findings showed only 44.7 percent of Latino workers have health coverage through an employer, compared to nearly 75 percent of white workers.

    More individually purchased health plans: With the elimination of pre-existing conditions as a factor for denying coverage and the provision of federal subsidies under the ACA, the number of people 64 and under who bought individual health plans increased from 1.9 million in 2012 to 2.4 million in 2014. Self-employed Californians saw a nearly 9 percentage point reduction in uninsurance.

    "This group, those who were self-employed or wanted the flexibility to leave an employer and start their own business, was a focus of health reform," said Kominski.

    Insurance gender gap: More women than men gained coverage through Medi-Cal expansion. Uninsurance rates for women ages 19-64 dropped from 19 percent to 13 percent, while the rate for men in the same age category declined slightly from 23 percent to 22 percent.

    Increased access to care: Ability to see a doctor increased for nonelderly adults with employer-provided insurance, but declined among those with public health coverage. Delayed or foregone care was lowest among children and the elderly and highest among Medi-Cal adults 64 and under. The latter group saw an increase in delays in care, from 11 percent in 2012 to 32 percent in 2014. Racial and ethnic disparities in access to care persist.

    Policy recommendations include outreach efforts by the state and/or private foundations in counties with high populations of uninsured ― the result of factors such as limited education and citizenship status ― and monitoring Medi-Cal patients' access to care and ensure they know how to use their coverage.

    "Although the report’s findings show the state has significantly cut the number of its uninsured population, we now face challenges on two fronts," said Robert K. Ross, MD, president and CEO of The California Endowment, which supported the report. "We must work hard to protect the gains made in health reform, while we continue to reach out to Californians who remain uninsured."

    Read the report: The State of Health Insurance in California: Findings from the 2014 California Health Interview Survey

    The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health policy information for California. The Center improves the public's health through high-quality, objective and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.

    The California Health Interview Survey (CHIS) is the nation's largest state-based health survey and one of the largest health surveys in the United States.

    The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians.