Many Uninsured Eligible For Coverage
Two out of three Californians who went without health insurance in 2014 were actually eligible for coverage, but they did without primarily because they could not afford its cost, according to a new study by researchers at UCLA and UC Berkeley.
The study placed the uninsured into four groups: Those who were undocumented (32%), those eligible for Medi-Cal (28%); those eligible to buy subsidized coverage through the state health insurance exchange (31%), and those eligible for coverage but not qualifying for subsidies (9%). Slightly more than a quarter of all of those without coverage had one or more chronic health conditions.
As a whole, the group was predominantly male: 59% of those legally present in California, and 54% of undocumented immigrants. Among those eligible for subsidized coverage in the Covered California exchange, 65% were male. Among those eligible for Medi-Cal, 52% were male.
The majority of those who lacked insurance also had full-time employment. A total of 53% of legal citizens and residents had employment of 30 hours or more a week, along with 52% of undocumented immigrants.
The biggest reason for not having insurance was affordability. Of those legally in the U.S., 46% said insurance was too expensive for them to obtain. Among undocumented immigrants, 29% said they couldn't afford it (although more than half of this group said they believed they were ineligible for coverage).
“We’re a relatively high cost-of-living state,” said Miranda Dietz, a Berkeley researcher and the lead author of the study. “It’s no wonder some Californians, who may be unaware they qualify for health subsidies and other programs, still find the cost of health insurance out of reach. For people who are already stretched paying their rent, filling the car to get to work and feeding the kids, figuring out how to come up with more money for healthcare on top of that is a lot to handle.”
Indeed, many legally residing Californians who were eligible for coverage thought they were not: 19% perceived themselves as ineligible for programs like Medi-Cal or subsidies to purchase insurance on the exchange. Only 6% said they went without insurance due to personal beliefs.
The study made several proposals to try and reduce the number of uninsured. They included campaigns to raise awareness about the financial help available as part of the Affordable Care Act; obtaining a federal waiver for those households excluded from subsidies because an employer offers coverage that may not be affordable; or implement local programs to provide financial assistance to purchase assistance, as is the case with the Bridge to Coverage program in San Francisco.
The report did note that the state had already made some policy changes to help expand coverage, include a recently enacted provision that allows undocumented children to enroll in the Medi-Cal program.
A pending piece of legislation, Senate Bill 10, would expand Medi-Cal eligibility to undocumented adults and also allow them to purchase unsubsidized coverage in the exchange.
However, the report also noted that little was being done to enroll those in Medi-Cal who qualify through the federal Deferred Action for Childhood Arrivals (DACA) exception created by the Obama administration. To date, only 11,000 Californians eligible under DACA had been enrolled in Medi-Cal as of mid-2014.
“Hundreds of thousands of men, women and children, not to mention the workers that power California’s economy, are one health emergency away from potential financial ruin because they lack insurance,” said Nadereh Pourat, a co-author of the study and the director of research for the UCLA Center for Health Policy Research. “From an economic perspective, it’s bad business to rely on workers and then not offer them equal health protection. And from a humanitarian perspective, it’s just wrong.”
