Where are California's Uninsured Now? Wave 2 of the Kaiser Family Foundation California Longitudinal Panel Survey
The California Longitudinal Panel Survey is a series of surveys that tracks the experiences and perceptions of a representative, random sample of 2,001 nonelderly Californian adults who were uninsured prior to the initial open enrollment period created by the Affordable Care Act (ACA). The first survey in the series was conducted prior to the open enrollment period1 and the second, presented here, took place at its conclusion. This longitudinal panel is a unique opportunity to follow the same group of Californians to find out whether they gained coverage or remained uninsured, how they feel about and interact with the new coverage options and what barriers to getting insurance remain. Additional surveys in this series will continue to track these individuals to keep the pulse on how their experience with and views towards coverage are evolving, how coverage impacts their feelings of financial security, and will illuminate how key groups of previously uninsured Californians are faring, such as Hispanics, new Medi-Cal or Covered California enrollees, or people reporting poor health.
California was an early adopter of the ACA and has been a leader in enrolling eligible residents in coverage through the two main avenues for expanding coverage under the law. Medi-Cal, the state Medicaid program is estimated to have enrolled about 1.6 million people and Covered California, the new state marketplace where people can shop for insurance and access government subsidies to help pay for coverage, is estimated to have enrolled about 1.4 million people.2 Because of California’s size and early embrace of the ACA, the experiences of those who were uninsured prior to the coverage expansions within the state can help inform future enrollment efforts both locally and across the country.
This longitudinal panel study allows us to follow a large group of randomly selected uninsured Californians and assess how their insurance status changes over time to learn more about why or why not those changes occurred, and what gaining health insurance means for their daily lives without having to rely on respondents ability to report and recall details from months or years ago. By tracking a scientifically representative panel, we can quantify how widespread or limited certain problems or changes that may have been reported anecdotally actually were. Statistically representative narratives and stories from individual’s actual experiences can then be drawn from the sample to illuminate more accurately how the uninsured fare as the law is implemented in California.
And, while the ACA makes it easier for some people to get and keep coverage, there will inevitably continue to be people who move in and out of coverage as their job status changes, as shifts in their income change their eligibility for public assistance, or as they miss deadlines for enrollment. And, just as people have moved from being uninsured to having insurance since last summer (reported on in this study), others likely moved in the opposite direction and were covered then, but are uninsured now.3 This survey does not capture those experiences, and hence, does not estimate the overall change in the number of uninsured Californians since the start of open enrollment, but instead estimates the share of previously uninsured who got coverage.
Looking back to the results from the baseline survey to see where California’s uninsured started from prior to the open enrollment period, most (80 percent) had expressed a need for health insurance but many said they were without it because they didn’t think they could afford coverage (42 percent). In fact, California’s uninsured were a group struggling to stay financially afloat with nearly 90 percent reporting family incomes under 400% of the federal poverty level (FPL) (about 94,000 a year for a family of four in 2013), including more than half who reported their family income as 138% or less of the FPL (roughly $32,000 a year for a family of four). Sizeable shares reported that it is at least somewhat difficult for them to afford basic needs such as health care (83 percent), rent (65 percent), gas or other transportation costs (63 percent), or monthly utilities (61 percent). Health insurance is something that many of California’s uninsured had gone without for quite a while – about 7 in 10 (69 percent) reported they had not had coverage for two or more years. While many reported being employed (58 percent), most said they did not have access to a plan through an employer. In terms of the potential role the ACA may play in their lives, most had heard little about the upcoming coverage expansion opportunities and were unsure about how the law would impact them personally. Now, at the conclusion of the enrollment period we find that many more say they have enough information to understand the law’s impacts and are aware of some of the law’s key provisions, such as the requirement to have insurance and the coverage expansions through Medi-Cal and Covered California.