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As enrollment opens, advocates for uninsured plot endgame

As enrollment opens, advocates for uninsured plot endgame

Picture of Judy  Silber

California’s state health exchange, Covered California, opened for its second enrollment season on Nov. 15 with a few glitches, but likely recorded more enrollees than this same time last year.

The Sacramento Business Journal reported that on the first day, a hotline set up for small employers and insurance agents was not working. However, by day’s end, state health officials reported more people had signed up – via the Internet and hundreds of in-person sites – than had on the first day of open enrollment last year.

The Affordable Care Act (ACA) has already sliced California’s uninsured population in half, from about 7.1 million down to about 3.5 million. The state is determined to make further dents this year with outreach efforts that include a nine-day bus tour across the state and targeted campaigns aimed at Latinos, who are under-enrolled in both state and federal programs.

The momentum is there. Last year’s Covered California’s 1.2 million sign-ups exceeded expectations. In addition, loosened restrictions for Medi-Cal, California’s Medicaid program cut the ranks of the state’s uninsured by another 2.3 million.

Those numbers are a vote of affirmation for the ACA, and there’s still more good news: Many of the 3.5 million who remain uninsured in California are still eligible for state and federal programs.   

By the end of 2019, California’s uninsured population could drop to about 6 percent, according to data compiled by the UCLA Center for Health Policy Research and the UC Berkeley Center for Labor Research and Education. Taking into account population growth, the UCLA/UCB study suggests the remaining uninsured will shrink to about 2.5 million people out of a projected 40 million total residents in the state.

Much work remains, but for those who have worked hard on California’s uninsured problem, the progress counts as a satisfying denouement to decades of hard work.

“From our perspective, we want to get every Californian enrolled,” said Lucien Wulsin, executive director of the Insure the Uninsured Project. “We would want to see coverage not only for the folks who are eligible for help, but also folks who are not eligible for help.”

Wulsin says it will take more creativity to cover that last 6 percent. The UCLA/UCB study predicts that about half of the remaining uninsured will be made up of undocumented residents. The rest will be divided among people who do not realize they qualify for Medi-Cal or Covered California subsidies; those who are eligible for some subsidies but cannot afford to pay the remaining monthly premium rates; and those do not qualify at all. 

Multiple approaches may be needed to fill in the gaps, Wulsin said. For example, Alameda and San Francisco counties are taking steps to provide coverage for undocumented residents through their public hospitals. But not all counties have robust safety net systems. So in other parts of the state such as the Central Valley, where undocumented workers contribute to the local economy, it may make more sense for employers to help fund coverage for workers.

Beyond the undocumented, Wulsin said California should consider expanding qualifying income levels so that more people can get help. Right now, subsidies are available for people who make less than 400 percent of the federal poverty level, or about $95,400 for a family of four.

Raising the qualifying levels would help, but if that doesn’t happen, Wulsin said that large employers, who provide insurance to the majority of California’s residents, may be asked to do a little more. Many employ flex, part-time, seasonal and contract workers, but do not pay for their insurance.

In the past, with premiums rising by double digits annually, employers have resisted efforts that would force them to pay for coverage for these workers. However, if the new insurance market can help contain premium increases, employers may be more likely to step in and pay health insurance premiums for employees who aren’t covered under the ACA.

Photo by Dafne Cholet via Flickr.

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