Tag: Covered California

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.

Half a Million New Enrollees in Covered California

The 2015 enrollment period for Covered California is wrapping up, and the state appears to have exceeded its forecast of 500,000 new enrollees. According to the most recent available data, more than 495,000 people signed up for private plans through the exchange during open enrollment, and another 93,000 signed up during a special enrollment period from February to April 30. Among those who enrolled before February 22, approximately 88 percent were eligible for federal subsidies to help pay for premiums. In addition, more than 780,000 people enrolled in Medi-Cal, bringing total Medi-Cal enrollment to slightly more than 12 million.

In addition to working to increase total enrollment, the state prioritized outreach to the Latino and under-35 populations during the second open enrollment period. Among subsidized enrollees, the share that are Latino rose from 31 percent to 37 percent, and the share that are under 35 rose from 29 percent to 34 percent.

Peter Lee, Covered California’s executive director, had announced the special enrollment period for uninsured Californians who were surprised to learn that there’s a tax penalty for remaining uninsured. Residents who didn’t have health coverage in 2014 owed $95, or 1 percent of their income (whichever is higher). Those who are uninsured in 2015 face a higher penalty: $325, or 2 percent of income.

The special enrollment period resulted from a discussion about the misalignment of the Covered California enrollment period and the April 15 deadline for filing taxes. Many Californians were unaware of the tax penalty for being uninsured in 2014 until after the February open enrollment deadline. This year’s special enrollment period allowed people who were still unaware of the tax penalty to avoid paying it in 2015—more than 33,000 of those who signed up during this period indicated that they were unaware of the tax penalty.

Even though the 2015 open enrollment period is over, there are pathways for some individuals to obtain healthcare through Covered California or Medi-Cal. For example, individuals may sign up for or change private plans within 60 days of a “life-changing event” such as getting married or having a baby. And Californians who are eligible for Medi-Cal can enroll year-round.

Looking forward, the state will continue to face the challenge of ensuring access to providers for Medi-Cal recipients. California’s reimbursement rate for providers is among the lowest in the nation, leading many doctors to turn away Medi-Cal patients. Several bills have been proposed in the state assembly and senate to raise these rates. AB 366, which would prohibit the application of existing reductions to reimbursement rates, has moved into appropriations after unanimously passing the health committee. We’ll be tracking its progress throughout the term.

Californians’ Views of Health Care Reform Shift—a Bit

Open enrollment for health insurance through Covered California or HealthCare.gov is set to begin in less than a month, and Californians have had one year of experience obtaining coverage. The Affordable Care Act has divided the state as well as the nation. Have those views shifted? Yes and no.

Before the health insurance marketplace opened, PPIC asked Californians about the law’s potential impact. There was no consensus. About a quarter of respondents in our September 2013 survey said they thought they and their family would be better off (26%) and another quarter thought they would be worse off (24%). More thought the health reform law would not make much difference (43%). Adults nationwide were slightly more negative (24% better off, 32% worse off, 37% no difference), according to a Kaiser Family Foundation poll taken the same month.

Californians were divided along party lines in their opinions of the law’s impact, with half of Democrats (51%) saying the law would not make a difference to them and six in 10 Republicans (61%) saying they would be worse off. Californians without insurance were much more likely than those with insurance to say they would be better off (36% to 23%). Looking more broadly, pluralities across regions and demographic groups said that they expected the health reform law would make no difference to them or their families.

A year later, Californians’ opinions of the health reform law’s impact have shifted. In our latest survey, we asked respondents if it had directly helped them and their family, directly hurt them and their family, or had no direct impact. Most Californians (58%) say the health reform law has had no direct impact. Similar proportions say either it directly helped (20%) or it directly hurt (19%). Adults nationwide are slightly more likely to say the law hurt them (56% no direct impact, 14% helped, 27% hurt), the latest Kaiser Family Foundation poll shows.

Looking across political groups, we see more change. Majorities across parties (55% Democrats, 56% Republicans, 63% independents) say the health reform law has not had a direct impact on them or their family. Similarly, among the insured and the uninsured, 58 percent say the law has not affected them. In fact, majorities across regions and all demographic groups say the law has had no impact.

Although most Californians say they have not felt the law’s effects, they still remain sharply divided along party lines in their general opinion of the law. Six in 10 Democrats have a favorable opinion of the health care law, while eight in 10 Republicans have an unfavorable opinion of the law–almost identical findings to those last December.

Of course, the story of health care reform is far from over. At PPIC, we will continue to monitor Californians’ views of this issue and its impact on their lives.

May Survey Looks at Views on Budget, Drought

The May edition of the PPIC Statewide Survey, Californians and their Government, explores attitudes toward the governor’s latest proposed budget and gauges preferences in the gubernatorial primary. It also examines opinions on health care reform, the drought, poverty, and climate change.

PPIC research associate Dean Bonner presented the results of this wide-ranging survey at a lunch briefing in Sacramento last week.