Access to Care for the Insured and Remaining Uninsured: A Look at California During Year One of ACA Implementation

Under the ACA, millions of individuals have gained coverage through new provisions (which went into effect in January 2014) to expand Medicaid and provide premium tax credits for coverage purchased through Health Insurance Marketplaces. California is a bellwether state for understanding the impact of the ACA. The state’s sheer size and its high rate of uninsured prior to ACA implementation means that its experience in implementing the ACA has implications for national coverage goals. California was also an early and enthusiastic adopter of the ACA; the state implemented an early Medicaid expansion through its Low-Income Health Program (LIHP) and was the first to create a state-based Marketplace. In addition, coverage gains were substantial in the state, with 2.7 million people gaining Medi-Cal coverage and nearly 1.7 million people determined eligible for enrollment through Covered California between October 2013 and September 2014.¹

While much attention has been paid to enrollment in new coverage options and changes in the uninsured over the past year, less is known about how this coverage has affected people’s ability to access the medical services they need. This report, based on findings from the California sample of the 2014 Kaiser Survey of Low-Income Americans and the ACA, funded by the Blue Shield of California Foundation, aims to understand the impact that gaining coverage has had on access to care for the “newly insured” adult population, with comparisons to the remaining uninsured as well as those who have had coverage since before 2014. The survey findings reinforce a large body of literature documenting that people with insurance are more likely to be linked to regular care, are less likely to postpone care when they need it, and have an easier time accessing services. The findings also provide insight into patterns of care among the newly insured and remaining uninsured. Additional detail on the survey method is available online.