Three Years In, ACA Gains Hold Steady in California

New data from the 2016 California Health Interview Survey (CHIS) show that the uninsured rate in California remains at historic lows three years after implementation of the Affordable Care Act (ACA). When comparing 2013, the year before ACA implementation, to 2016 there are dramatic and statistically significant declines in the uninsured rate among Californians, across income levels, race/ethnicity, and geography.

There were no statistically significant changes in uninsured rates among any of these groups between 2015 and 2016. This reflects that after millions obtained and retained ACA coverage during the law’s first years, the remaining uninsured population increasingly includes hard-to-reach groups and adults who are ineligible for ACA coverage due to immigration status.

In addition, there was a steep decline between 2013 and 2016 in the percentage of uninsured Californians citing cost as the reason for lacking insurance.

Click on the images below to explore the data.

Key Findings: Coverage

The uninsured rate dropped by seven percentage points, from 15.5% in 2013 to 8.5% in 2016. Medi-Cal continues to be a driving force behind this drop. The percentage of Californians covered by the program grew from 20.1% in 2013 to 33.0% in 2016.

Uninsured Rate Among Californians Under Age 65, 2013-2016

Coverage gains remain across income groups. The largest gains in coverage continue to be among those earning less than 138% of the federal poverty level (FPL), or a little over $16,000 a year for an individual, the income eligibility threshold for Medi-Cal. The uninsured rate in this group was cut by more than half, from 22.6% in 2013 to 11.1% in 2016.

Rate of Uninsured Californians, by Income Level, 2013-2016

Coverage gains persisted across almost all California regions. The biggest improvement was seen in the San Joaquin Valley, where the uninsured rate dropped from 18.1% in 2013 to 7.6% in 2016.

Uninsured Rate Among Californians Under Age 65, by Counties, 2013-2016

The uninsured rate dropped in both rural and urban California. However, improvements were more pronounced in rural areas, where the overall uninsured rate was cut roughly in half, from 16.4% in 2013 to 7.8% in 2016.

Uninsured Rate Among Californians Under Age 65, Rural vs. Urban, 2013-2016

Key Findings: Affordability

Californians continue to be less likely to report cost as the reason for being uninsured than before the ACA. This figure was slashed nearly in half between 2013 and 2016, from 52.6% to 31.3%. The slight uptick between 2015 and 2016 was not statistically significant. This suggests that expanded access to Medi-Cal and subsidized coverage through Covered California continue to have an important impact on many Californians’ ability to afford health insurance.

Californians Citing "Can

Looking Ahead

These data reflect the state of health care coverage in California before the 2016 presidential election. It’s possible that federal efforts to repeal and replace the ACA in 2017 have sowed confusion and uncertainty among Covered California consumers, and that may affect enrollment. In addition, federal immigration policy and rhetoric may be having a chilling effect on families enrolling their undocumented children in Medi-Cal.

It will be important to closely track how health care coverage rates are affected in 2017 and beyond.

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