Medi-Cal Changes, Healthy Families Expansion Required to Increase Insurance Coverage in California
In an effort to "pressure" California's congressional delegation to help the uninsured, researchers from the UCLA Center for Health Policy Research presented demographic information at a Capitol Hill briefing yesterday that outlines the demographics and trends of the uninsured in each of California's 52 congressional districts. Researchers said that the number of uninsured in California "dipped" to 6.8 million in 1999, down from 7.3 million in 1998. However, between 1994 and 1999, insurance rates for people of color did not improve. The rate of uninsurance for Asian-Americans/Pacific Islanders rose 1% in that time frame. The rate for African Americans increased 2%. The rate for Latinos -- the highest of any group -- held steady at 36%. Job-based coverage increased for all groups between 1994 and 1999, but Medi-Cal/Healthy Families coverage "plummeted" for people of color, researchers said. While the number of non-Latino whites enrolled in Medi-Cal/Healthy Families dipped 1% in that time frame, Latinos dropped from 22% in 1994 to 17% in 1999. Asian-Americans/Pacific Islanders dropped from 18% to 7% and African Americans dropped from 24% to 15%. While immigrant status accounted for some disparity in coverage between whites and Latinos, the researchers found that because Latinos are less likely to have employer-based coverage, uninsurance rates are higher for Latinos in each citizen group. However, immigration status "dramatically" affects children's coverage, as 41% of noncitizen children in the state do not have insurance.
One of researchers' main areas of focus was the affordability of employer-based insurance. Researchers said that 85% of the uninsured in the state are from working families and that the number of firms that do not offer benefits is 5% higher in California than in other states. More than two million Californians work at firms that do not offer coverage. Even if employees have access to insurance, researchers said that coverage is often still unaffordable. For example, 66% of uninsured Latino families would need to pay 5% or more of their income to enroll in employer sponsored coverage. Researchers warned that rising health care costs will continue to "threate[n]" coverage as it becomes more unaffordable for workers.
Richard Brown, the UCLA center's director, said the research was meant to "put pressure on the state of California to do things they aren't currently doing" to increase the number of covered Californians. Because researchers concluded that job-based coverage by itself would not reduce uninsurance, researchers recommended that the state offer tax credits to employers who cover more of their workers' share of insurance premiums. Researchers also noted that employers are "less efficient and less effective" at expanding coverage than public programs, and therefore lawmakers should also work to expand Medi-Cal and Healthy Families and eliminate barriers to enrollment. Currently, about two million children and adults are eligible for either Medi-Cal or Healthy Families but are not enrolled. Brown said that this number would drop if Healthy Families coverage was expanded to adults earning up to 250% of the federal poverty level and if the Medi-Cal assets test was eliminated. "These are people who are highly unlikely to have any assets. [Applicants] must document their income in a stigmatizing and onerous process. This is the most irrational policy," Brown said. On a federal level, Brown said that Congress can also help to decrease the rate of uninsurance in the state by restoring Medi-Cal and CHIP benefits to legal immigrants and by expanding CHIP to cover low-income adults (Darryl Drevna, California Healthline, 6/28). The briefing material is available online at www.healthpolicy.ucla.edu.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.