health care reform – 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.

Video: PPIC Statewide Survey Briefing

As discussions continue in Sacramento about drought relief, funding for higher education and transportation projects, and an extension of Proposition 30 tax increases, PPIC surveyed public opinion on these and many other topics. At a briefing last week in the capital, PPIC researcher Jui Shrestha provided the survey findings. Among the key points:

Two-thirds of Californians say the regional water supply is a big problem, and two-thirds say people in their part of the state are not doing enough to respond to the drought.
While most adults say that spending money on the maintenance of California roads, highways, and bridges is very important, there is little support for increasing the gasoline tax or vehicle registration fees to do so.
Half of Californians favor extending the Proposition 30 tax increases, and about a third favor making them permanent.

Health Care Reform in California: An Update

Beginning tomorrow, many Californians will be able to enroll in or switch health insurance plans through the state’s insurance exchange, Covered California. In its first six months, Covered California enrolled 1.1 million people in private insurance plans and 2.2 million in Medi-Cal. This year the goal is to further expand enrollment and reduce the number of uninsured in the state. The open enrollment period will last for three months, although people will have to enroll in private plans by December 15 for coverage to kick in on January 1, 2015, and those who are eligible for Medi-Cal can enroll year-round.

What has happened so far?

California was one of the first states to implement the Affordable Care Act and set up its own exchange. Although there were some bumps along the way, the rollout was relatively smooth, and enrollment numbers were strong.

Of the 1.1 million people who enrolled in private insurance plans, approximately 88% were eligible for federal subsidies to offset their out-of-pocket costs.

What’s different this year?

In 2015, insurers and policymakers are hoping to enroll a large number of the estimated 3-5 million California residents with no insurance. A recent survey estimated that 30% of the remaining uninsured are undocumented immigrants, who are ineligible for ACA coverage.

Covered California is trying to make enrollment easier by increasing staffing and hiring more workers who speak more than one language.

Covered California monthly premiums will increase modestly—by around 4.2 percent, on average. Some premiums may increase by more than that, and some plans may become less expensive.

The tax penalty for uninsured individuals will be considerably higher:
- In 2014, the penalty was 1.0% of household income or $95 per adult and $47.50 per child, whichever is greater.
- In 2015, it will be 2.0% of household income or $325 per adult and $162.50 per child, whichever is greater.

Small businesses (with fewer than 50 employees) will be able to offer plans in two tiers through the Small Business Health Options Program (SHOP); they can also offer separate adult dental plans.

The tax penalty for firms with 50 to 100 employees that do not offer insurance coverage has been delayed until 2016.

What to look for in the months ahead?

Covered California is expecting to enroll around 500,000 people of all ages in private plans over the next few months. Policymakers are eager to enroll young adults (under 35) in insurance plans, because they are likely to be healthy, which will help keep premiums low and encourage insurers to enter the marketplace. Covered California has also allocated more than $100 million for Latino outreach.

There is currently a backlog of Medi-Cal applications waiting for approval from the Department of Health Care Services. A big influx of new enrollees could create longer wait times. Department officials are working to improve the system that processes applications; to clear the backlog, it will begin granting temporary approval to applicants younger than 19 to speed up their enrollment.

The U.S. Supreme Court will hear a challenge to the Affordable Care Act’s federal subsidy provisions next year. Because California does not participate in the federal insurance marketplace, it will not be directly affected by the court’s decision. But there could be significant implications for the program as a whole.

The Kaiser Family Foundation is a reliable source of information about enrollment specifics.

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.

Expanding Health Insurance—to Jail Inmates

The federal Affordable Care Act provides an opportunity for local governments to enroll jail inmates in health insurance programs that could lower costs and improve health conditions. Moreover, California has recently passed legislation that facilitates the use of jails as sites of health care enrollment.

PPIC researchers Mia Bird and Shannon McConville address this topic in a recent report titled Health Care for California’s Jail Population. The report, presented at a public event this week in Sacramento, finds that nearly 2.3 million health care visits were recorded in county jails statewide in 2012. Inmates have disproportionately high health needs and typically have had little access to health care prior to incarceration. Connecting inmates to health coverage before they are released from custody may help to reduce county costs, lower recidivism, and improve public health.

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.