Amid Recession's Dark Clouds, Good and Bad Health Insurance News for Californians
There was some unexpected good news in our new California Health Interview Survey (CHIS) 2011 data – the number and percentage of people who were without health insurance in California actually remained stable. Just under 7 million nonelderly people lacked health insurance for all or part of 2011 (21.1% of the population), a slight dip from the 7.1 million in 2009.
But this silver lining is connected to some very troubling dark clouds, and it would be a mistake to look at this data and assume that the situation in California was improving overall.
The truth is that more than one million people lost their job-based coverage from 2009 to 2011, so that for the first time since CHIS began collecting data, less than 50% of the nonelderly population had health insurance through their own or a family member’s job. And this was during a period when the unemployment rate slightly declined. Unlike the precipitous 4.4 percentage point drop in job-based insurance from 2007 to 2009, this new 2.4 percentage point decline couldn’t be attributed to the unemployment rate more than doubling in a two year period.
Instead, from 2009 to 2011, the further crumbling of job-based insurance seems to be from a lack of access to coverage for employees. In increasing numbers, they either can’t afford the coverage offered to them, or they aren’t eligible due to part-time hours or a probationary period, or their employer doesn’t offer coverage to anyone.
So, why didn’t the number of uninsured skyrocket, as it did from 2007 to 2009? Because for the first time, Medi-Cal (California’s Medicaid program) enrollment surged from about 16% of the nonelderly population to over 19%, as more adults qualified for public coverage. This means about one in five nonelderly adults and children in California have their health insurance through Medi-Cal.
Keep in mind that this is 2011 data. In 2011, for parents to be eligible for Medi-Cal, their household incomes had to fall below the federal poverty level (about $15,000 per year for a single parent and one child, or $22,000 per year for a family of four).
So as more and more families fell into poverty, their household incomes declining over the course of this prolonged recession, enrollment in Medi-Cal surged. While it’s wonderful that more people were able to obtain health insurance, it’s heartbreaking to think of how they got it.
And this is our new health insurance landscape, heading into the full implementation of the Affordable Care Act (ACA, or Obamacare) expansions in 2014. With the re-election of President Obama, and even Speaker Boehner now publicly stating that the ACA is the law of the land, the health insurance expansions will most certainly take effect as scheduled. Eligibility for Medi-Cal will reach everyone, even childless adults, living with incomes near poverty, and the new Exchange (called Covered California) will help middle-income families obtain heavily subsidized, comprehensive health insurance. Once these are fully implemented, researchers estimate that about 94% of Californians will be insured.
There are some who will blame Obamacare for the declines in job-based coverage and will be outraged at the increases in public coverage that will occur in 2014 and beyond. But it’s important to know that the job-based system was already steadily crumbling, family incomes were already dropping, and that public health insurance has been the silver lining amidst the recession’s dark clouds for millions of Californians.
Please visit www.healthpolicy.ucla.edu to download Dr. Shana Alex Lavarreda’s new publication, Job-Based Coverage Insures Less Than Half of Nonelderly Californians in 2011.
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Photo credit: Ricardo Liberato via Flickr