Two-thirds of California's 7 million uninsured will gain coverage under health reform

Number represents two-thirds of California's 7 million uninsured

Up to two-thirds of California's 7 million uninsured residents will become eligible for health insurance coverage when health care reform is implemented in 2014, according to a new policy brief from the UCLA Center for Health Policy Research.

The study draws on the latest data from the California Health Interview Survey (CHIS), which will be released shortly.

The policy brief, "Two-thirds of California's 7 Million Uninsured May Obtain Coverage Under Health Care Reform," finds that 4.7 million Californians, including both adults and children, will likely be eligible in 2014 for new coverage options, either the health insurance exchange or Medi-Cal expansion.

The brief presents county-by-county estimates of the number of Californians who had job-based, public or private insurance in 2009, as well as those who were uninsured for all or part of that year.

"This expansion will have a huge impact on the number of people without insurance," said Shana Alex Lavarreda, lead author of the brief. "It will provide relief in the short term to millions of Californians who currently have no insurance options. And it will provide long-term relief to all residents by shifting the taxpayer emphasis from high-cost emergency room services to lower-cost preventative care."

Poor to benefit most

Based on the CHIS 2009 data, center researchers estimate in the brief that 3 million uninsured Californians will gain coverage through health reform's Medi-Cal expansion and 1.7 million will be eligible for subsidies through the state's health insurance exchange. Additionally, 1.2 million will become eligible to purchase non-subsidized coverage through the exchange.

The remaining 1 million non-citizen Californians who lack health insurance are not eligible for benefits under health reform, largely due to citizenship or residency status.

Reform may particularly help those struggling in the economic downturn by expanding the definition of those who are eligible for Medi-Cal to include adults without dependent children who earn up to 133 percent of the federal poverty level ($10,956 for one person in 2009). With this newly eligible population added to those who are uninsured but eligible for Medi-Cal under existing regulations, approximately 3 million of the lowest-income nonelderly adults and children will be eligible for coverage through Medi-Cal.

"Health care reform lifts a tremendous burden off the shoulders of all Californians," said E. Richard Brown, the center's director. "And it will be an enormous relief to anyone who's struggling to pay both the rent and a medical bill."

California, with its 7 million uninsured, has the largest total number of uninsured residents in the nation, a situation exacerbated by the economic downturn and rising unemployment. That number might have been even higher, the authors note, without a federal subsidy offered around the time the 2009 CHIS data was collected that may have enabled laid-off Californians to retain their employer-provided health insurance through COBRA. That subsidy has since expired.

Larger increases in public program participation, as well as a decline in California's overall population (largely due to undocumented residents leaving the state), also may have kept the total uninsured rate from rising.

"Health reform offers a significant opportunity to greatly extend access to health care to low-income and other underserved residents in California," said Gary L. Yates, president and CEO of the California Wellness Foundation, which co-funded this study with The California Endowment. "To take full advantage of this opportunity we must strengthen the health care safety net and increase the health care work force and its diversity."

"The sheer number of Californians without health insurance underscores the importance of implementing the health care law successfully," said Robert K. Ross, M.D., president and CEO of The California Endowment. "As the first state to enact a health benefit exchange under the new law, California is providing a model to the country of effective implementation and laying the foundation for a healthier state."

The California Wellness Foundation's mission is to improve the health of the people of California by making grants for health promotion, wellness education and disease prevention.