A report by the UCLA Center for Health Policy Research showing “where we were” with health insurance coverage before health care reform could help advocates and lawmakers evaluate the effects of the Affordable Care Act on California’s insurance market.
The report — “The State of Health Insurance in California” — was funded by the California Endowment and the California Wellness Foundation and based on data from the 2011-2012 California Health Interview Survey.
It outlines trends in employer-based health coverage, uninsured rates and other elements of the state’s insurance market. A release notes that the data were collected before the ACA went into effect, so the report’s findings “will serve as a baseline to gauge the effects” of the health reform law.
Trends in Job-Based Coverage
Overall, the report found that nearly 50% of Californians under age 65 had work-based health coverage throughout 2012, either through their own job or a family member’s plan. However, those rates varied significantly by county — San Mateo County had the highest rate of residents with year-round work-based coverage, at 70.7%. Lake County had the lowest rate at 26.9%.
While job-based insurance remained the leading source of health coverage for Californians, the rate of full-time workers who had such coverage fell from 66.5% in 2009 to 63.6% in 2012. Part-time workers experienced a similar drop, from 41.8% in 2009 to 39.6% in 2012.
According to the report, the rate of adults ages 40 to 54 who had work-based insurance “plummeted” from 2009 to 2012, falling from 49% to 45.4%.
Meanwhile, about 5% of full-time workers and 9.5% of part-time workers statewide had health plans purchased on the individual market in 2012.
The report found that Latinos lagged behind other populations in the state when it came to having health coverage.
Latinos had the lowest rate of employer-sponsored health insurance with 33.9%, compared with 63.3% of white Californians. Even among those who did have work-based coverage, 17.2% did not see a doctor between 2011 and 2012.
In addition, 28.4% of Latinos were uninsured — the highest rate of any population in the state. In comparison, one-third of low-income Californians overall were uninsured in 2012, according to the report.
A large proportion of Latinos also relied on public health insurance programs. Nearly one-third of low-income Latinos were enrolled in Medi-Cal. In addition, about 70% of children enrolled in Medi-Cal in 2012 were Latino.
Meanwhile, the report noted, “As the near-elderly population ages and demographic shifts occur throughout the next decade, it is likely that Latinos will become a larger part of the Medicare population.”
ACA Changes Already Underway
California Endowment President and CEO Robert Ross said, “California was poised and ready for the implementation of the Affordable Care Act,” given the decrease in job-based coverage and high rates of Latinos who lacked health insurance.
According to the report, analysts expect ACA implementation to have “a modest impact” on the rate of Californians who have work-based health coverage. Instead, the report notes, “Coverage sources are expected to change most for lower-income workers, who will have access to significant subsidies through the new” insurance exchanges.
However, the health reform law already has affected the rate of young adults who have health coverage. According to the report, “[A]dults ages 19 to 26 were the only age group that gained health coverage from 2009 to 2012.” Rates of work-based coverage for that age group increased from 23.2% in 2009 to 27.1% in 2012 — an increase of about 254,000 individuals. Meanwhile, the uninsured rate among that age group fell from 28.9% to 26% in the same time period.
The report concluded that “the data also show the clear early impact of the ACA,” noting, “A single provision allowing young adults (through age 25) to either remain on a parent’s coverage after graduation or to re-enroll as a dependent enabled hundreds of thousands of Californians to gain or keep health insurance. This group had the largest reduction in uninsurance compared to all other nonelderly age groups, and the change is directly attributable to the ACA.”
In addition, researchers concluded that ACA reforms could address the growing decline in job-based coverage across the state.
Shana Alex Charles, director of the Center for Health Policy Research’s health insurance program and lead author of the report, said, “Sadly health insurance is no longer a guarantee provided by many employers,” adding, “Health care reform (has) filled a huge and growing gap in job-based insurance.”
California Still Has Work To Do
Report co-author Gerald Kominski, director of the Center for Health Policy Research, said, “This report shows us where we were, and it wasn’t a good place. From here on out we can accurately measure how California’s health improves under reform.”
The report notes that the findings can be used as a tool to help health care advocates and policy analysts “measure the extent to which ACA reforms changed health access and health outcomes among the state’s residents in 2014.”
Charles said, “While the clear early success of the ACA in enrolling young adults in private coverage is promising, our data show that even the insured have delays in care, problems affording deductibles, and other access barriers that we hope will be addressed.”