The Affordable Care Act (ACA), in its first year of implementation in California, has expanded health insurance to people who have been historically underserved by the health-care system, especially Latinos and low-income people.
A new report from the Kaiser Family Foundation took a detailed look at how the first year of fully expanded health coverage in California has impacted the lives of newly insured low- and moderate-income people, and what barriers many still face to either getting new coverage or making use of the coverage they have.
“California is a bellwether state for understanding the impact of the ACA,” the report’s authors note. “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 had the largest number of uninsured residents of any state in the country before ACA implementation—6.8 million uninsured people, which was 18.5 percent of the state’s population and 14 percent of the entire uninsured population nationwide.
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California was an early and enthusiastic adopter of the ACA, which helped a much larger number of people than expected to gain insurance coverage between October 2013 and September 2014. Medi-Cal, the state’s Medicaid program, covered 2.7 million new people, and 1.7 million gained coverage through Covered California, the state insurance exchange.
The report found that the ACA coverage expansion disproportionately benefited low-income people (those making less than 138 percent of the federal poverty level), Latinos, young people, and people who don’t work full-time—all of whom tend to lack insurance more often than other groups.
As might be expected, people who already had insurance before the ACA took effect were richer, whiter, and more likely to have full-time employment than both the newly insured and the uninsured. It was much harder to get affordable health insurance before the ACA without a full-time job, and people of color and low-income people faced other barriers.
At 41 percent of the newly insured, Latinos were by far the largest racial or ethnic group to gain insurance coverage in California after ACA implementation. Latinos also currently make up more than half, 54 percent, of the uninsured population in the state.
Unauthorized immigrants are not entitled to any subsidies under the ACA, leaving many of them without affordable health-care options.
Despite active outreach efforts in California, the report says, reaching Latinos was a challenge for the Department of Health and Human Services partly due to linguistic issues and insufficient staff resources.
Other challenges in implementation included Medi-Cal backlogs that delayed applications, technological issues, and a shortage of people to assist applicants in person.
Newly insured people had more regular care than uninsured people, but they were still more likely to go to a clinic or a health center than a regular doctor in an office, often due to cost concerns.
Newly insured people were also just as likely as uninsured people to postpone or go without care at some point. That could be due to problems finding a provider or navigating the health system, failing to understand their benefits, or being worried about out-of-pocket costs, according to the report.
Those out-of-pocket costs are still a problem for low-income people; almost half of the newly insured reported difficulty paying their premiums. But they still benefited from lower medical bills and less anxiety about being able to afford care.