California and Texas are home to more than 20 percent of the U.S. population, so their experiences in implementing the Affordable Care Act (ACA) aka Obamacare have a huge impact on its success or failure. While the two states bear little in common politically, the demographics of the people who were uninsured before and ACA and are still uninsured are similar, according to new research. With insurance companies and insurance exchanges gearing up for this fall’s enrollment period for 2016 coverage, the third for ACA metal plans, it is a good time to look at results so far.
Both California and Texas have experienced dramatic declines in their uninsured populations in the past two years. The newly insured have also found out that having coverage is not a panacea or ensure they can find a health care provider in their area that accepts that coverage. One other common experience in both states is that Hispanics are disproportionately the remaining uninsured population.
The Kaiser Family Foundation recently published a detailed look at the experience in California, a state in which the government wholeheartedly supported enactment of the ACA. The Foundation followed up with a pool of people who were uninsured before the implementation of the act. Over the last two years, they determined that 68 percent of the previously uninsured adults in California got health insurance coverage.
In California, there were marked decreases in people who had difficulty paying for their coverage. This was largely due to the expansion of the state’s Medicaid program, Medi-Cal. It was where 34 percent of those who had been uninsured prior to the ACA implementation got coverage.
California was one of the 30 states that expanded the eligibility requirements for their Medicaid programs (Medicaid offers medical care coverage at no or little charge to eligible recipients, which typically are the poorest populations or children of a parent with employer –paid coverage who cannot afford adding the child to his or her insurance).
Another 14 percent of California’s previously uninsured obtained coverage through an employer, which may or may not reflect the expanded number of small businesses offering coverage to employees. Lastly, Kaiser reports that 12 percent told them they got coverage though Covered California, the state-run insurance marketplace. Covered California has reportedly put more than 1 million people into insurance plans sold by private insurance companies.
In the golden state, only 17 percent of the remaining people without health insurance are white, according to the research. Almost 30 percent are Hispanics who are eligible for coverage through Covered California or Medi-Cal but remain uninsured. Another 41 percent are believed to be undocumented immigrants and ineligible.
Unlike California, Texas’ government was hostile to implementing ACA. They refused to expand their Medicaid program (which is largely funded by the federal government). They also refused to set up a state insurance marketplace. In spite of that lack of support for Obamacare, more than 1.2 million people in Texas enrolled in the metal plans through the federal government’s HealthCare.gov site, according to a report from the Rice University Baker Institute for Public Policy along with the Episcopal Health Foundation.
The report determined that the percentage of people without health insurance in Texas has fallen from 24.6 percent to 16.9 percent in the last two year. That is a decrease of almost one-third.
In Texas, too, there are persistently high rates of uninsured among the poor and Hispanics. Nearly 70 percent of the uninsured in Texas have household incomes less than 138 percent of the federal poverty level and would clearly qualify for tax subsidies to help fund their insurance, if they applied. If they were in a state that expanded Medicaid, they would qualify for it. The report also found that more than 57 percent of the remaining uninsured in Texas are Hispanic. In that state, about 17 percent of the uninsured actually indicated that they do not want health insurance when asked why they had not gotten coverage.
The experiences and results from California and Texas show issues, particularly the lower Hispanic enrollment rate, that impact the ACA (Obamacare) success. Maybe they will attempt to address that uninsured population during Open Enrollment for 2016 ACA coverage, which will start Nov. 1, 2015.
Written and edited by Dyanne Weiss
CNBC: Big states see big Obamacare gains, still face challenges
Baker Institute: Health Reform Monitoring Survey – Texas
Kaiser Family Foundation: California’s Previously Uninsured After The ACA’s Second Open Enrollment Period
NPR: More Previously Uninsured Californians Got Coverage Under Obamacare
Orange County Register: Obamacare checkup: millions of previously uninsured Californians now have health coverage, but cost and access worries persist
Photo from the National Cancer Institute (public domain)