While California outperformed every state in reducing the number of uninsured residents during the first Affordable Care Act enrollment period, the last push to get the remaining uninsured signed up won’t be as easy. 

“As we go forward, it will actually be harder to enroll people,” said James Scullary, information officer at Covered California. “It will actually take more money and effort, and in a shorter amount of time.”

A Commonwealth Fund survey released last week found that California had reduced the number of uninsured residents by half — from 22% to 11% during the first open enrollment period.

Of the 3.75 million total Californians who signed up for coverage during the push, 1.4 million purchased plans through Covered California, the survey found, with 88% percent of those plans purchased with a subsidy.

About 1.9 million additional people signed up for Medi-Cal through the end of June, according to state officials. That large number of new Medi-Cal enrollees — almost two million — cannot be called low-hanging fruit, but reaching the remaining uninsured will be tougher, said Beth Capell, policy advocate for Health Access California.

“Signing up that last 11% will be a challenge,” Capell said. “Of this group, we have some who don’t speak English, people who are young and healthy and don’t think they need insurance, or people who still don’t think they can afford it.”

The exchange board will assess which enrollment and outreach strategies have been most successful and over the next few months Covered California and consumer advocates will take pains to tailor their efforts to minorities, hard-to-reach rural communities and young people who are not eligible for Medi-Cal.

Capell said the exchange has a brief window of time to reach that population.