Nearly 60% of Californians without health insurance before Obamacare sign-ups began last year now have a medical plan, but the remaining uninsured will present a challenge in the second round of enrollments beginning this fall, according to a new study.
A Kaiser Family Foundation survey examining the state’s progress under the federal medical care overhaul said more than 80% of those still uninsured hadn’t had coverage in two or more years, including 37% who reported never having coverage before.
Foundation Chief Executive and President Drew Altman said though large numbers of Californians gained insurance during the first open enrollment period, “expanding coverage gets harder from here.”
The biggest reported barrier to signing up was cost, even though nearly two-thirds of those who remained without coverage were eligible for either Medi-Cal or subsidies through the state-sponsored marketplace, the survey found.
Mollyann Brodie, the foundation’s senior vice president, said researchers are observing a disconnect between what people expect insurance will cost and the price of plans actually available.
She said that in the next enrollment period, which begins Nov. 15, outreach needs to be “even more targeted and more intense to convince this group of Californians that they can actually get health insurance.”
The federal Affordable Care Act required nearly everyone to have health insurance starting in 2014. In California, people with qualifying incomes can receive subsidies to get discounted plan rates through the state’s health insurance exchange, Covered California. The state’s low-income health plan, MediCal, has also been expanded to include more people.
Erika Malady, 33, looked into signing up for health insurance last year but decided against it.
A single mother living in Santa Fe Springs, Malady said that when she browsed through the available plans offered through Covered California, the monthly premiums were about $120 a month. She said she couldn’t afford that on her annual salary of about $35,000 a year.
“It’s too expensive,” she said.
The study found that 42% of those who were uninsured before Obamacare sign-ups remained without insurance after. Twenty-four percent of those were eligible for subsidies through the exchange, and 39% were eligible for Medi-Cal, the survey found.
More than 70% of those who remained uninsured said health coverage was something they felt they needed.
Malady said she wants health insurance and now worries about having to pay a penalty and not having a safety net if she becomes ill. She says she’ll try to find an affordable plan when open enrollment opens again later this year.
“I’m not going to hold my breath,” she said.
Many survey respondents who signed up for insurance said it made them feel more financially secure. But 46% of the newly insured also said paying their monthly bill was at least somewhat difficult.
Total enrollment in Covered California private health plans is approximately 1.2 million. The exchange estimates that number will reach 1.7 million by the end of the next enrollment period.
A large share of those still uninsured -- approximately 30% -- are undocumented immigrants, who aren’t eligible to sign up for insurance through the state exchange or Medi-Cal, the survey found.
Nearly 20% of the remaining uninsured said they didn’t sign up because they’ve either been too busy or don’t know how. Brodie said that points to a continuing need for trained people who can help explain the process.
“It’s hard, it’s complicated, it’s serious, it’s scary,” she said. “This is not the same as just going to buy your groceries.”
Brodie said despite the attention given to the state exchange websites, many enrollees needed more personalized assistance.
Though open enrollment for Covered California won’t begin again until November, qualifying patients with special circumstances, such as losing employer-provided insurance or moving, can apply now for coverage. Signups for Medi-Cal coverage for lower-income residents continues year-round.
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