Population – Page 16 – Public Policy Institute of California

Video: PPIC Survey Examines Election Landscape

As California heads into an election year, the PPIC Statewide Survey looks at residents’ views on a broad range of issues that are already flashpoints in the presidential primary races and will likely surface in statewide campaigns next year.

PPIC research associate Lunna Lopes presented the survey’s key findings at a Sacramento briefing last week. She was joined by Mark Baldassare, PPIC president and CEO, for a question and answer session afterward. He noted a link between Californians’ “modestly optimistic view of the economy,” their belief that there is income inequality in the state, and their attitudes about which ballot issues are important. Twice as many residents say that increasing the state minimum wage is very important than say legalizing marijuana is very important.

“In California, the belief that this state is divided into the haves and have-nots—and the feeling among many Californians that they are among the have-nots—are going to be driving forces in the election,” he said. The survey briefing was held just after the mass shooting in San Bernardino, and the briefing touched on Californians’ views about gun laws. PPIC research associate David Kordus provided findings from the September survey on this issue: Compared to adults nationwide, Californians are more likely to favor stricter laws than we have now. Most also say that controlling gun ownership is more important than protecting the right of Americans to own guns.

Immigrants and Health Insurance

California has made major strides in reducing the number of state residents without health insurance coverage. With the state’s Medicaid expansion and the creation of Covered California under the Affordable Care Act (ACA), the percentage of Californians without insurance dropped nearly 5 percentage points in 2014—the first year of ACA implementation. Declines occurred across all racial and ethnic groups, with Latinos registering the largest drop at 9 percentage points. Nevertheless, Latinos continue to experience the highest uninsured rate, in part because the ACA coverage expansions exclude California’s estimated 2.7 million undocumented immigrants.

But there is more to the story of insurance coverage and California’s immigrants: we also observe large declines in the uninsured rate among all noncitizens, a group that includes an estimated 2.6 million people who are legally residing in the state (with green cards, temporary visas, work visas, etc.), as well as those who are undocumented. When we look at uninsured rates across different citizenship categories, we see the drop was larger among noncitizens than among US-born and naturalized citizens—noncitizens had nearly a nine percentage point decline in their uninsured rate.

Noncitizens who legally reside in the state have access to ACA coverage expansions either through the Medi-Cal program—if their household income is below 138 percent of the federal poverty level, about $33,500 for a family of four—or through Covered California, with financial assistance available to help pay for coverage. Still, about 35% of California’s more than five million noncitizen residents currently lack comprehensive health insurance coverage—most are likely to be undocumented, with limited sources for affordable insurance coverage.

Undocumented residents sometimes have private health insurance, most often through their employers. National estimates suggest between 30–40% of undocumented immigrants have coverage. This number could grow if federal immigration reforms are implemented, by providing undocumented immigrants who qualify (between 1.1 and 1.3 million in California) with work permits and better job opportunities that could offer increased access to employment-based insurance.

Along with pending federal action on immigration reform, state legislative proposals are also focusing on expanding affordable insurance coverage options to the undocumented. In our new report, we discuss these potential options and provide new regional estimates of the undocumented population in California by income thresholds to assist policymakers in planning for potential coverage expansions to this group.

Video: Health Coverage & Undocumented Immigrants

Legislative efforts, executive decisions, and public opinion all suggest interest in expanding health coverage to California’s undocumented immigrants. The state’s decision to provide Medi-Cal benefits to undocumented children reflects that support. But the vast majority of undocumented residents in California are adults, and they make up a sizable share of residents without health insurance.

A new PPIC report finds that half of California’s undocumented immigrants—about 1.4 million—have incomes low enough to qualify for full Medi-Cal benefits should legislative proposals to offer coverage be enacted.

This week at a briefing in Sacramento, PPIC research associates Shannon McConville and Iwunze Ugo presented their report, which includes estimates of the number of undocumented immigrants across family income levels and the Covered California insurance regions. These estimates can help policymakers plan for the increase in Medi-Cal participants if coverage is expanded—which will depend on the legislature, governor, and federal courts.

Californians and Congress

The recent announcement of Speaker Boehner’s resignation comes at a time when national approval ratings of the US Congress are in the teens (14% in September Gallup Poll). With the early talk of majority leader Kevin McCarthy stepping into the Speaker position, what are Californians saying about the powerful federal institution that the congressman from Bakersfield is well-positioned to lead?

In the latest PPIC Statewide Survey, we asked Californians to rate eight state and federal elected leaders and legislative bodies—interviewing was completed just before Pope Francis’ speech to Congress and Speaker Boehner’s surprise announcement. California likely voters give their lowest approval by far to the US Congress. Just 17 percent say they approve of the way the US Congress is handling its job.

Surprisingly, there is overwhelming consensus about Congress even in this era of hyper-partisanship. In the recent PPIC Statewide Survey, California likely voters of different political stripes are united in their low approval of Congress. By contrast, other political figures in Washington elicit highly partisan responses—including President Obama, Senator Boxer, and Senator Feinstein. Remarkably, approval among Republican likely voters of President Obama (13%) and Senator Boxer (15%)—both Democrats—is about the same as approval of Congress (17%), while Republican approval of Senator Feinstein (27%) and Governor Brown (29%) is higher than approval of Congress. It’s also noteworthy that Republicans (36%) are less likely than Democrats (62%) and independents (50%) to approve of their own House representatives—this may be related to their low approval of a Congress controlled by their party.

The 53 members of the California House delegation may take some solace in the fact that Californians are much more approving of their own representatives to the US House than of the Congress as a whole. And California’s US senators have approval ratings around 50 percent. Still, the California State Legislature has recovered from several years of low approval ratings while the US Congress has not. Moreover, the members of the California congressional delegation are working in an institution that is mostly seen as not doing its job. This raises doubts about their political futures, especially given the top-two primary—which takes away the certainty that candidates from both major parties will appear on the November ballot—and more competitive elections through independent legislative redistricting.

Low approval ratings of the US Congress have been a consistent feature in PPIC Statewide Surveys throughout this decade. Approval ratings of Congress among California’s likely voters have been in the mid-teens each September since the Republicans (and Speaker Boehner) took control of the House in January 2011. Under Democratic control (and Speaker Nancy Pelosi’s leadership, beginning in January 2007), approval ratings were somewhat higher. This could be partly because the California electorate leans Democratic, but it is worth noting that approval ratings of Congress under Republican leadership 10 years ago were higher than they are today.

Clearly, low approval of Congress is a national phenomenon tied to intense media focus on legislative gridlock and government shutdowns. But Californians do have fundamental policy disagreements with the current Congress that also affect their views of its job performance. Specifically, the recent PPIC Statewide Survey finds that Californians are more likely than people nationwide to express support for immigration reform, abortion rights, and stricter gun laws. The actions of Congress in recent years are at odds with California public opinion in all three of these controversial policy domains.

In the California context, immigration reform stands out as a special case. Sixty-nine percent of California likely voters—compared to 60 percent of adults in a national ABC News/Washington Post Poll in July—say that undocumented immigrants currently living in the United States should be allowed to live and work here legally if they pay a fine and meet other requirements. Moreover, majorities of likely voters across party groups (83% Democrats, 66% independents, 51% Republicans) support a way for undocumented immigrants to stay in the US legally. Importantly, 68 percent of those likely voters disapprove of Congress want there to be a way for undocumented immigrants to stay in the US legally. And among likely voters who support a way for undocumented immigrants to state in the US legally, 77 percent disapprove of Congress.

The next Speaker will face the major challenge—critical to the nation’s future—of restoring public trust and confidence in Congress. Our poll sheds light on the need for Congress to show leadership in addressing the complex problem of immigration, which is surfacing early and often as the defining issue for the Republican presidential candidates. The view from California is that the path to higher approval of Congress runs through immigration reform. It won’t be easy, but there is a way forward for a new leader who seeks to improve perceptions of the way that the Congress handles its job.

Poverty and Well-being in California

California is one of 12 states in which poverty declined last year, according to newly released US Census statistics. The state’s official poverty rate is down by 0.6 percentage points to 16.4%, from 17.0% in 2012. But poverty in the state remains high relative to the early 2000s. In 2007, the year the Great Recession began, California’s official poverty rate was 12.4%.

Official poverty statistics are intended to capture cash resources at hand. In other research we have analyzed the role of social safety net programs in augmenting cash resources and helping families to avoid dire economic need.

It’s important to note that jobs are still the biggest source of income for Californians overall, even among those living in poverty. And good news out last week shows the economy is continuing to improve—the unemployment rate in California is now 6.1%, less than half of what it was during the worst of the economic crisis.

At the same time we are all aware that well-being is complex, so it is instructive to look at multiple measures. Food insecurity—defined as ranging from worrying about being able to afford enough food to actually cutting back on meals—is also down from a recent high of 16.2% in California (across 2009–2011) and is estimated to be 13.5% for 2012–2014. In addition, the number of homeless in California—often not well-represented in indicators of need—is estimated to have declined by 13% between 2012 and 2014. The share of all California children with a validated report of maltreatment (most commonly for reasons of neglect) has also dropped, although this appears to be a longer term trend that predates the recession.

Broadly speaking, then, trends in well-being appear to be positive, even though we have a ways to go before poverty and other indicators decline to the levels experienced before the recession.

Big Declines in Number of Uninsured Californians

Nearly 2 million more Californians had health insurance coverage in 2014 than in 2013, according to newly released US Census data. Still, about 4.7 million Californians reported they were uninsured in 2014.

The percentage of Californians without health insurance coverage dropped nearly 5 points in the first year the Affordable Care Act (ACA) was implemented—from 17.2% to 12.4%. Declines were even more dramatic among adults age 18 to 64, who benefited the most from the ACA coverage expansions. Among this group, uninsurance rates declined nearly 7 percentage points—from about 24% in 2013 to about 17.3% in 2014.

Declines in uninsurance rates occurred across all racial/ethnic groups, with the largest drops among Latinos (6.5% overall and 9.2% adults age 18 to 64), followed by African Americans (5.7% overall and 8.1% adults age 18 to 64) and Asian Americans (4.9% overall and 6.7% adults age 18 to 64). Despite coverage gains, Latinos continue to have the highest proportion of residents without health insurance, with about 28% of adults age 18 to 64 reporting no coverage.

Changes in uninsurance rates also varied across California counties. The largest declines were in parts of the Central Valley and Monterey County, where the percentage of residents without insurance dropped by more than 6%. The counties that experienced the largest declines include Stanislaus (8.5%), Monterey (6.7%), and Merced (6.4%). Los Angeles County, home to the largest number of residents without health insurance in the state, had more than half a million fewer residents reporting they were uninsured in 2014 than in 2013. Generally, counties with higher shares of uninsured residents in 2013 experienced the largest declines.

California experienced one of the largest declines in the proportion of residents without health insurance coverage across the nation. But the percentage of Californians who remain uninsured is still above the national average – and continues to be higher than in several states that have not expanded their Medicaid programs.

Chart Source (TOP): American Community Survey, One Year Files for 2014 and 2015 accessed at American Factfinder.

Chart Notes (TOP): Individuals are considered to be uninsured if they do not have coverage at the time of the survey. The uninsurance rates presented do not account for the margin of error associated with the estimates. For the state estimates by race the margin of errors range from about 0.1% – 0.5%. The margins of error are larger for the county-level estimates and are larger for counties with smaller populations.

Video: California’s Aging Population

California is on the verge enormous change. In 2030—when the youngest baby boomers have reached retirement age—the state’s senior population will be nearly twice as big as it is today. It will be more ethnically and racially diverse. And many more seniors are likely to be living alone.

These changes have already begun, and their policy implications are wide-reaching. The state’s growing and changing senior population will require more support services and health care professionals. How is California coping with the challenge? That was the question posed to a panel of experts at a PPIC event in Sacramento last week.

“We could be doing better,” said Assemblymember Cheryl Brown, chair of the Assembly Committee on Aging and Long-Term Care. She said information that can help caregivers is fragmented and not easily accessible.

Her assessment was shared by fellow panelists Karen Keeslar, executive director of the California Association of Public Authorities for In-Home Supportive Services, and Barbara O’Connor, a boardmember of AARP.

But Brown sounded a hopeful note. She predicted that as many more Californians—including legislators—begin care for aging loved ones the issue would become prominent. In fact, Brown and her fellow panelists are or have been caregivers for members of their own families. Keeslar noted the sheer number of Californians who are using in-home support services today—507,000, compared to 90,000 in 1980.

O’Connor advocated new models for senior living to help more Californians live as independently as possible—and not necessarily alone at home. Small senior communities are thriving as alternatives to nursing homes in other states, she said.

“It’s not just nursing home versus staying home,” she said.

Before the presentation, PPIC research fellow Laurel Beck provided an overview of a new report, Planning for California’s Growing Senior Population, which she coauthored.

Testimony: Measuring Poverty

The Assembly Human Services Committee held a hearing on Tuesday, July 14, to consider a joint resolution regarding official poverty measurement tools. PPIC research fellow Sarah Bohn provided background on official poverty statistics and explained how different measurement tools affect our understanding of poverty in California. Here are her prepared remarks.

My name is Sarah Bohn, I am a research fellow at the Public Policy Institute of California. PPIC is a nonpartisan, independent research institute and as such does not take positions on bills before the legislature. I am here today to inform the committee on facts related to Assembly Joint Resolution 22 (AJR 22). As some of you know, PPIC, in collaboration with the Stanford Center on Poverty and Inequality, has been deeply involved in research on alternative poverty measurement for the past three years. I will provide background on the shortcomings of official poverty statistics and offer an updated view of poverty measurement—and poverty in California.

According to official statistics, poverty is significantly higher (50% higher) than it was 50 years ago, when the War on Poverty began. As we shall see, this finding should be taken with a big grain of salt. Poverty status, as you know, is based on how family income compares to the “federal poverty line.” This was developed in the early 1960s as the first working definition of poverty in the U.S. It is based on family budgets of that time, when a typical family spent one-third of its income on food. So the threshold was (to simplify a bit) three times the cost of food a family would need to meet basic needs. While this was a novel use of the facts and information available then and was hugely important in creating a standard metric to inform policy, it’s hard to apply the same metric to modern families and derive a clear understanding of how families—and policy—are doing. There are two main reasons for this: (1) the cost of living and family budgets have shifted considerably, with families spending more on housing, work expenses (like commuting and child care), and medical care and less on food overall (2) several government programs have changed and expanded, but are not counted in family income data in the official poverty measure. For these reasons, official poverty statistics are hard to interpret; they essentially compare a part of family resources to an outdated benchmark.

Two current measures—the Census Bureau’s “Supplemental Poverty Measure” and the PPIC-Stanford “California Poverty Measure” (which uses a similar methodology)—update and realign the basic poverty concept that is now more than 50 years old. There is quite a lot of momentum and agreement around the benefits of these “supplemental” measures. In summary, the methodology aims to improve on official poverty measurement in the following ways. First, both measures use detailed data on what families actually spend to meet basic needs, rather than relying on a 1960s-era approximation. Second, these metrics allow for the cost of living to vary (conservatively), depending on where one lives. Third, they make use of a comprehensive estimate of resources families have on hand, which includes cash income, program benefits, taxes paid or credited, net of medical and work expenses.

The Supplemental and California Poverty Measures provide new insights to poverty. I’ll highlight a couple that are especially related to the impact of policy. First, I’ll return to the effects of the War on Poverty. Using supplemental measures, researchers find a clear downward trend in poverty—specifically, that government programs reduced poverty by 15 percentage points since the mid-1960s. These are facts that cannot be uncovered by official poverty data, which, you may recall, suggests that poverty rates rose 50 percent despite policy efforts. Second, poverty in California today would be much higher were it not for the safety net. Without major programs like CalWORKs, CalFresh, the federal Earned Income Tax Credit, and housing subsidies (among others) nearly 40 percent of children in California would be poor—or 30 percent of state residents overall.

It’s possible that the safety net in California could have an even longer reach than it already does. For one, increasing program participation among eligible families could reduce poverty. Also, because many poverty programs are not scaled to cost of living, their ability to materially affect families in poverty varies substantially across the state. In high-cost areas, safety net benefits reduce poverty by about 30 percent, but they reduce it by 50 percent in the Central Valley and far north. Poor families in coastal (and the most populous) parts of the state face costs $7,000 to $12,000 higher than the federal poverty line accounts for. Although we find that poor families in high cost areas are more likely to be working—and earning more—than their counterparts elsewhere, their earnings are not enough to boost them above the more realistic cost-adjusted supplemental poverty threshold. But their slightly higher earnings (which are still low by California standards) make them less likely to qualify for some safety net programs.

These examples scratch the surface of what is possible using the tools of improved measures like the Supplemental and California Poverty Measure. We also hope to use our research to assess how proposed changes to programs could move families out of poverty. But beyond these efforts, I would argue that simply tracking poverty in and across California and the U.S.—using truly comprehensive and accurate metrics—should be a regular contribution to the policymaking process. For those of us at PPIC and for other researchers involved in poverty research across the country, including those at the Census Bureau, alternative measures of poverty are still in their early phases, and, as such, rely on policymaker awareness and on funding to continue to produce. Thank you for your interest in the topic and your time today.

High Poverty Rate Persists

Although the state’s economy has rebounded, the latest poverty statistics suggest there’s been little improvement in the share of Californians struggling to make ends meet.

More than 1 in 5 Californians—or 8.1 million people—were living in poverty in 2012, the most recent year for which we have data. This is according to the California Poverty Measure, a comprehensive metric developed by PPIC and the Stanford Center on Poverty and Inequality. This share is about the same as it was in 2011. Rates were highest among children, with about 1 in 4, or 2.3 million, living in poverty—virtually unchanged from 2011.

Why? Although California’s overall economy is growing, not all have shared equally in the recovery. The reasons for this are both specific to this economic recovery and true more generally of economic upturns. The unemployment rate remains higher than it has been since 2004 and a high share of workers—by historical standards—have given up looking for work or are underemployed (working part time when they would prefer full time, for example). As is typical of past patterns of recession and recovery, high-income families tend to rebound most quickly, followed by middle-income and finally low- income families. This means that improvements in poverty metrics tend to lag behind other indicators of how the economy is faring.

The good news is that the social safety net—programs like CalFresh and the federal Earned Income Tax Credit—helped many families through the recession and still plays an important role in keeping families out of poverty. Without it, more families—including 1.3 million children—would be poor. We estimated that without these and other safety net programs, poverty would be roughly a third higher in the state as a whole. This cushioning effect of the safety net decreases swings in poverty, meaning that a slowly changing poverty rate is partly an indication that the safety net is working.

Health Insurance for the Undocumented

California continues to have at least 3 million uninsured residents, even after the coverage gains from the Affordable Care Act (ACA). Estimates suggest that between 1 million and 1.5 million of them are undocumented immigrants who are not eligible for federally subsidized coverage.

But there may be two opportunities for California’s undocumented population to gain access to coverage – depending on the legislature, governor, and courts. We estimate that as many as half of the state’s undocumented immigrants have incomes that are low enough to qualify for Medi-Cal coverage—with some variation across regions. To qualify for Medi-Cal, household income must be below 138% of the federal poverty level (about $16,000 for a single person or about $28,000 for a family of 3). Those with higher incomes may gain access to insurance through a state exchange.

First, the governor’s recently released proposal for the state budget includes funding to provide full Medi-Cal coverage to low-income undocumented immigrants who register for the federal Deferred Action for Parental Accountability (DAPA) program, which offers protected status to undocumented immigrants who have resided continuously in the U.S. for the past five years and are parents of children who are either U.S. citizens or legal permanent residents. This proposal is dependent on DAPA surviving current legal challenges.

Second, the Senate Appropriations Committee has approved state legislation that proposes to expand insurance coverage options to undocumented immigrants not eligible for DAPA. The bill (SB 4) would extend Medi-Cal to low-income undocumented immigrants under age 19. The number of adults who are eligible would depend on the state budget. The bill also includes provisions to allow those with higher incomes to purchase coverage through a state-based insurance exchange.

How many undocumented immigrants might be affected by these actions? Estimating the number is not straightforward. To help in the policy and planning process, we have recently updated our county estimates of undocumented immigrants for 2013 using zip code level tax records (filed with Individual Taxpayer Identification Numbers, or ITINs) and the analytic methods we have used in past work. We extend our earlier analysis to estimate how many undocumented immigrants might be eligible for insurance coverage based on family income for the pricing regions used by Covered California. To do this, we rely on information available from tax filings—we estimate income levels from adjusted gross income groupings and family size from tax filing status and the use of the federal child tax credit. PPIC expects to publish more results based on these analyses in the near future.

Statewide, our preliminary estimates indicate that just over half of undocumented immigrants (51%) are likely to be under the 138% poverty threshold used for Medi-Cal income eligibility. This share varies widely across regions. Nearly 60% in Los Angeles County and the Central Valley have incomes below the 138% threshold. Most Bay Area counties have lower shares below this threshold—from 36% in Santa Clara County to 44% in Contra Costa County. These findings are generally consistent with other work that uses different methods to profile California’s undocumented immigrants (MPI (2014), Marcelli and Pastor (2014), Warren (2015)).

We also estimate shares, by region, of undocumented immigrants that fall between 138% and 400% of the federal poverty level, the income range used by Covered California for its current enrollees to receive premium subsidies. Across most regions, between 40% and 60% of the undocumented population falls within this range, potentially making them eligible to purchase coverage through a state insurance marketplace.

Finally, about 85,000 undocumented have incomes above 400% of the federal poverty level – with most residing either in Bay Area counties or the coastal Southern California counties of Orange and San Diego.

Regional differences in health plans, provider capacity, and insurance costs make information on the size and distribution of the state’s undocumented population by income level crucial to planning effectively for coverage expansions. We expect to contribute regularly to the discussion as these planning efforts unfold.

Table source: Author’s analysis of tax data.
Table note: Counts are rounded to the nearest 500 and may not add to the statewide total as a result. Regions correspond to the insurance pricing regions used by Covered California, with one exception. Region 15 in the table includes all of Los Angeles County.