Californians who were historically unable to afford health insurance — those with low incomes and people of color — benefited significantly from health coverage expansion policies under the Patient Protection and Affordable Care Act, according to new 2015 California Health Interview Survey data released today.
The new CHIS data, which are accompanied by a fact sheet on insurance trends, show the overall rate of uninsured Californians fell to a new low in 2015: 9.5 percent — the first time the rate has dropped to less than 10 percent since data have been collected.
And declines in rates of those who are uninsured were most pronounced among the state’s poorest residents ages 0 to 64, dropping by nearly 10 percentage points between 2013 and 2015, to 12.8 percent. Declines were also more pronounced for most racial and ethnic groups, with rates of those who are uninsured falling nearly 7 percentage points among Asian-Americans and African-Americans, and 6.5 percentage points among Latinos.
“The evidence shows that the Affordable Care Act has opened the doors to groups who have been historically shut out from health insurance coverage,” said Ninez Ponce, associate director of the UCLA Center for Health Policy Research and principal investigator at CHIS. “It is likely that the ACA’s expansion of Medi-Cal and income subsidies for Covered California have been instrumental in expanding the safety net for poor and traditionally disadvantaged groups.”
CHIS, the nation’s largest state health survey, surveyed 21,444 households in 2015, including 21,034 adults, 754 teens and 2,157 children.
Medi-Cal expansion drives coverage
The related fact sheet published in conjunction with the 2015 CHIS data release reports that the number of Californians ages 0 to 64 with Medi-Cal health coverage climbed to 32.2 percent of people in 2015 — an increase of 11 percentage points since 2013. Medi-Cal is the state’s version of Medicaid.
However, progress made in expanding health care coverage in the state may be in danger, said Shana Alex Charles, faculty associate at the center and author of the fact sheet.
“Both our data and national data show Americans have clearly benefited from Medicaid’s expansion under the Affordable Care Act, and this is the benchmark against which any future policies will be measured,” Charles said. “We can’t go back to 2013, when millions more Californians were uninsured.”
The share of Californians with individual insurance remained fairly constant at 7 percent, or 1.2 million people, according to the fact sheet.
The new data reveal large declines across all income levels of those who said they are currently uninsured because they “can’t afford” health care, from a 26 percentage point drop for the lowest income earners to a 20 percentage point decline for highest.
Fewer Californians cited cost as a reason to go without needed medical care in 2015. With the exception of African-Americans, all other racial and ethnic groups reported 6 to nearly 14 percentage point drops in cost being a reason to forgo care.
Despite the gains, American Indian/Alaska Native and Latino residents have the highest rates of not being insured, 17.5 percent and 15 percent, respectively. And there was a 3.3 percentage point increase from 2013 to 2015 in African-Americans citing cost as a barrier to care.
New topics and updated variables
In addition to updated insurance estimates, respondents answered questions on hundreds of new and updated health topics ranging from discrimination in getting medical care to chronic disease management, to resiliency among teens.
Some findings from 2015:
Other new and updated topics in CHIS 2015 include estimates of delays in dental care and emergency room dental care among children, breast feeding and bottle feeding and mammography screenings.
“We’re excited about the latest data on the broad set of topics included in the CHIS, and how they can help researchers, policymakers, and local organizations address emerging health needs,” said Todd Hughes, director of the California Health Interview Survey. “But the insurance data is significant — it gives us a measure of how the ACA improved access and affordability of health care for millions of people who had gone without.”
Related: Noon seminar on “CHIS 2015: What’s new in the nation’s largest health survey.”
The California Health Interview Survey is conducted by the UCLA Center for Health Policy Research in collaboration with the California Department of Public Health and the California Department of Health Care Services and is supported by several public and private funders committed to improving the health of Californians.