Where are California's Uninsured Now? Wave 2 of the Kaiser Family Foundation California Longitudinal Panel Survey
Executive Summary
The baseline survey included only those adult Californians ages 19-64 who reported being without coverage for at least two months. Because this panel survey focuses on a specific group who were uninsured prior to open enrollment, it does not estimate the overall change in the number of uninsured Californians. The approximate number of newly insured adult Californians is calculated with the estimate of 5.9 million uninsured nonelderly adults based on a Kaiser Family Foundation analysis of 2013 ASEC Supplement to the Current Population Survey, available at https://www.kff.org/other/state-indicator/adults-19-64/.
For the purposes of this report, undocumented immigrants are defined as those that reported in the baseline survey that a) they were not born in the United States, and b) they came to this country without a green card, and c) they have not received a green card or become permanent residents since arriving. See the “About The Terms In This Report” Section for more details.
Among ‘eligible’ previously uninsured Californians earning 138% FPL or less, 61 percent report gaining coverage and 39 percent say they remain uninsured. For those ‘eligible’ between 139% and 400% FPL, 66 percent report now being covered and 34 percent say they remain uninsured. For the purposes of this report, the previously uninsured who are ‘eligible’ are defined as California residents ages 19-64 who have been uninsured for at least two months and would be eligible for participation in the ACA coverage expansion based on their self-reported status as a citizen, permanent resident, or lawfully present immigrant.
Introduction
For more information on Wave 1, see “California’s Uninsured on the Eve of ACA Open Enrollment: The Kaiser Family Foundation Baseline Survey,” Kaiser Family Foundation, September 2013, https://www.kff.org/health-reform/report/californias-uninsured-on-the-eve-of-aca-open-enrollment/.
DHHS Centers for Medicare & Medicaid Services, “Medicaid & CHIP: May 2014 Monthly Applications, Eligibility Determinations and Enrollment Report,” July 11, 2014 http://medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/May-2014-Enrollment-Report.pdf. DHHS Office of the Assistant Secretary for Planning and Evaluation Issue Brief, “Health Insurance Marketplace: Summary Enrollment Report For The Initial Annual Open Enrollment Period,” May 1, 2014 http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollment.pdf. The California Department of Health Care Services estimates 1.9 million people have enrolled in Medi-Cal since open enrollment started, http://news.coveredca.com/2014/04/covered-californias-historic-first-open.html.
For more information on the experiences of insured and uninsured Californians prior to open enrollment, see, “The Uninsured At The Starting Line In California,” Kaiser Family Foundation, February 2014, https://www.kff.org/uninsured/report/the-uninsured-at-the-starting-line-in-california-california-findings-from-the-2013-kaiser-survey-of-low-income-americans-and-the-aca/
Section 1: Who Got Covered?
For the purposes of this report, undocumented immigrants are defined as those that reported in the baseline survey that a) they were not born in the United States, and b) they came to this country without a green card, and c) they have not received a green card or become permanent residents since arriving. See the “About The Terms In This Report” Section for more details.
In the baseline survey, 13 percent of California’s uninsured population reported having a disability, handicap or chronic disease that keeps them from participating fully in work, school, housework, or other activities. Most of those reporting such an ailment also report being in fair or poor health, but the measure of health status is more general with about a third reporting being in fair or poor health (32 percent for Wave 2 and 38 percent for Wave 1). The fact that the group reporting a debilitating chronic condition is a small but specific group may help explain why 77 percent of them report getting health insurance compared to 53 percent of those reporting being in fair or poor health.
Regression results are available on request.
Section 2: The Newly Insured
This share is lower than what has been reported by Covered California. According to Covered California, 88 percent of those covered through the Marketplace (including those who were previously insured and those who were not) have subsidized coverage. This may indicate that some of the newly insured are unaware of the assistance they’re receiving and may not know the real cost of their plan. Multiple factors may be contributing to this apparent under-reporting on the survey, but it is likely that at least some individuals receiving government financial help may be unaware that the government is paying a portion of their premium. Insurance concepts are complicated and many people have trouble reporting detailed information about their plans. During the enrollment process, some people may have been focused on the bottom line question of “What do I pay?” and less focused on whether that amount was subsidized or not. For the numbers from Covered California, see http://news.coveredca.com/2014/04/covered-californias-historic-first-open.html
Los Angeles Times, “Website glitch slows Obamacare enrollment in California,” March 11, 2014. http://articles.latimes.com/2014/mar/11/business/la-fi-mo-covered-california-obamacare-enrollment-20140311
The Covered California Marketplace reports the distribution of enrollment across metal types for all Covered California enrollees, not just the previously uninsured, as follows: 26% bronze, 62% silver, 6% gold, 5% platinum, 1% catastrophic. For more information, see http://news.coveredca.com/search?updated-max=2014-05-07T08:46:00-07:00&max-results=7&start=7&by-date=false This survey only includes those who were previously uninsured prior to the open enrollment period, but after excluding the 24 percent who said they didn’t know the metal level of their plan, the distribution is similar to what Covered California reported for all of its enrollees: 23% Bronze, 65% Silver, 2% Gold, 5% Platinum, 0% catastrophic.
Section 3: The Remaining Uninsured
For the purposes of this report, the ‘eligible remaining uninsured’ are California residents who said they had been uninsured for at least two months in the baseline survey and would be eligible for participation in the ACA coverage expansion based on their self-reported status as a citizen, permanent resident, or lawfully present immigrant. See the “About The Terms In This Report” Section for more details.
Kaiser Health News, “Mountainous Backlog Stalls Medi-Cal Expansion in California,” July 02, 2014. http://www.kffhealthnews.org/stories/2014/july/02/mountainous-backlog-stalls-medical-expansion-in-california.aspx
U.S. Immigration and Customs Enforcement. Clarification of Existing Practices Related to Certain Health Care Information, October 25, 2013. http://www.ice.gov/doclib/ero-outreach/pdf/ice-aca-memo.pdf
Methodology
Those who had been uninsured for less than two months were excluded from the survey since they may be experiencing a short period of uninsurance (i.e. someone who is between jobs), and the goal of the survey was to capture the experiences and views of those who have been without insurance for a longer period of time and are poised to experience the new coverage provisions of the ACA.
M. Brodie, “Sensitization Effects in a Study of the Impact of a Nationally Broadcast Special on Health Care Reform,” in Doctoral Thesis: Political Institutions, Participation, and Media Evaluations— Influences on Health Care Policy (Boston, Mass.: Harvard University, 1995).