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Text-message survey: Insured Californians like their care, while others struggle to gain coverage

Text-message survey: Insured Californians like their care, while others struggle to gain coverage

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The new survey was conducted via text messages.
The new survey was conducted via text messages.

A new survey indicates that most Californians with health insurance are satisfied with their coverage and the care provided. 

The survey, a collaboration between the nonprofit Citizen Insights and Stanford University, shows that across the board, Californians hold favorable views of their insurance plans. That includes residents who gained access to care through Covered California, the state’s two-year-old health exchange program; Medi-Cal, the state’s program for low-income residents; and employer-based coverage. Overall, the survey bolsters the notion that Obamacare rates well among those who receive coverage and care through its channels.

“One of the big fears is that people wouldn’t be able to get appointments, and they weren’t going to use [their insurance] or like their doctors,” said Alana Conner, executive director of Stanford SPARQ, a research center in the Stanford University Department of Psychology whose acronym stands for Social Psychological Answers to Real-world Questions. “If you get health insurance, it seems to be working. It’s not a huge policy failure.”

The survey researchers focused their efforts on low-income Californians in urban areas. Only 15 percent of respondents had finished a college degree. The researchers posted Craigslist ads and passed out flyers near welfare offices in Oakland, San Jose and Los Angeles. The survey itself was conducted through a text-message service that asked from seven to 12 questions, depending on the responses. 

More than half of participants were people of color, with about 30 percent African American, 11 percent Latino, 5 percent Asian, and 6 percent of multi-ethnic origins. The vast majority of respondents chose to take the survey in English, suggesting that immigrants who only speak Spanish weren’t well represented.

The majority of those surveyed already had insurance. Of 824 participants, 324 reported that they still had not gained health coverage. Those numbers are likely due to the Affordable Care Act’s expansion of coverage. In the wake of the Affordable Care Act (ACA), the state set up the Covered California health exchange, which offers subsides to people who earn up to 400 percent of the federal poverty level, or $83,060 for a family of three. The ACA also allowed California to expand eligibility requirements for Medi-Cal so that more of the state’s poorest residents could gain health coverage.   

The survey found that among those insured, 77 percent of respondents said their insurance is affordable; 86 percent said it was easy to get an appointment; 84 percent said they like their doctor; and 93 percent said their co-pay was affordable.

“Generally, people seemed to be using their health insurance and having positive experiences with it,” Stanford’s Conner said.

Of those insured through Covered California, 69 percent had visited a doctor, while 84 percent of those with Medi-Cal had seen a physician.

Since full rollout of the ACA in 2014, Medi-Cal enrollments have increased from about 8 million in 2012 to about 12 million in 2015, while another 1.9 million people have signed up for Covered California.  The surge in enrollments has greatly reduced the number of uninsured in California; before the ACA, the state faced one of the highest uninsured rates in the country with more than 7 million people –about 20 percent of the population – lacking health care coverage, 

A January study by the UCLA Center for Health Policy Research and the UC Berkeley Center for Labor Research and Education projected that the state will soon have more than halved its the numbers of uninsured. But the researchers also noted that by 2019, an estimated 2.7 million to 3.4 million people will remain uninsured, many of them undocumented Latinos who are currently ineligible for state or federally funded programs (California is currently considering legislation that would extend coverage to undocumented residents).

Even for people who are eligible for health coverage, hurdles remain. The text-message survey suggested that the biggest hurdle for many is the sign-up process. Results indicate that 57 percent of uninsured respondents had tried to sign up for Covered California or Medicaid but failed. Another 28 percent were still waiting to hear back on their applications.

“There are still uninsured people who want insurance and are struggling to enroll,” said Perla Ni of Citizen Insights. “That’s a great opportunity to refine and improve the enrollment process.”

[Photo by 世書 名付 via Flickr.]


The Center for Health Journalism’s 2023 National Fellowship will provide $2,000 to $10,000 reporting grants, five months of mentoring from a veteran journalist, and a week of intensive training at USC Annenberg in Los Angeles from July 16-20. Click here for more information and the application form, due May 5.

The Center for Health Journalism’s 2023 Symposium on Domestic Violence provides reporters with a roadmap for covering this public health epidemic with nuance and sensitivity. The next session will be offered virtually on Friday, March 31. Journalists attending the symposium will be eligible to apply for a reporting grant of $2,000 to $10,000 from our Domestic Violence Impact Reporting Fund. Find more info here!


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