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The CHCF Blog

When It Comes to Seeing a Doctor in California, the Uninsured Still Fare Worst

Janet Coffman, Associate Professor, UCSF School of Medicine, Institute for Health Policy Studies
Janet Coffman
Janet Coffman

With repeal of the Affordable Care Act (ACA) on the horizon, and no replacement plan in sight, millions of Californians are at risk of losing their coverage. Approximately 5 million Californians are currently covered under the ACA. The state's uninsured rate, which hit a historic low under the ACA, could start to rise again depending on what happens in Washington in the coming weeks and months.

It's worth remembering the multiple barriers that people without insurance face in our health care system. I am reminded of some key findings from a 2015 survey of California physicians that the University of California, San Francisco, released last fall with support from the California Health Care Foundation.

The survey asked, among other questions, if physicians were accepting new patients who had various types of insurance (private, Medicare, or Medi-Cal) or who were uninsured. The survey also asked physicians if any of their existing patients were uninsured.

As the slides below show, the uninsured face the hardest time getting accepted into a physician's practice. Only 38% of all California physicians said they accepted new uninsured patients in 2015; only 55% said they had any uninsured patients. The sample of physicians includes emergency department (ED) doctors who are legally required to see all persons who come to an ED, regardless of whether they have insurance.

California Physicians Accepting New Patients by Payer, 2015

California Physicians with Any Patients by Payer, 2015

These slides and the full survey results also show how Californians on Medi-Cal faced disparities in access compared to those with private insurance or Medicare. We also highlighted steps that could be taken to improve physician participation in Medi-Cal.

But make no mistake: The data show that when it comes to the likelihood of being seen by a doctor in California, people on Medi-Cal still fare far better than the uninsured. These are just two data points that provide a reality check about what it means to be uninsured in California.

We also know that the uninsured are more likely than the insured to experience a medical bankruptcy, to go without necessary care, and to suffer from poorer health outcomes (PDF) for acute and chronic conditions.

In the event they lose coverage, these challenges will become a reality for many Californians.

About Janet

Janet Coffman, a health services researcher and associate professor at the UCSF School of Medicine's Institute for Health Policy Studies, strives to build bridges between academia and policymakers. She has co-authored articles and reports on health workforce shortages, geographic maldistribution, and lack of racial and ethnic diversity among health professionals. Janet has published in a wide range of journals, including Health Affairs, Health Services Research, the Milbank Quarterly, and Pediatrics. Janet received a doctoral degree in health services and policy analysis as well as a master's degree in public policy from the University of California, Berkeley. She previously worked for the US Senate Committee on Veterans Affairs, the San Francisco Department of Public Health, and the UCSF Center for the Health Professions.
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