Almost 4.7 million nonelderly adults and children of the seven million Californians who were uninsured for all or part of 2009 will be eligible for insurance as a result of last year’s health care reform legislation, according to new data from the 2009 California Health Interview Survey (CHIS 2009). Eligible Californians will obtain coverage either through Medi-Cal or through subsidies to purchase private health insurance in the new California Health Benefit Exchange (CHBE) starting in 2014. The CHBE will also be open to 1.2 million uninsured persons who do not qualify for subsidized premiums due to their income exceeding eligibility levels, but who will benefit from the new marketplace created through the Patient Protection and Affordable Care Act (PPACA). Just over one million uninsured persons do not qualify to participate in either the CHBE or in the Medi-Cal expansion due to their citizenship status. With seven million uninsured residents of California in 2009, the new insurance options made available by the PPACA could face challenges in enrolling these uninsured individuals.

Between 2001 and 2003, both children and adults lost employment-based health insurance coverage. For children, increased enrollment in Medi-Cal and Healthy Families resulted in a lower uninsured rate. For adults, however, the decline in employment-based insurance coverage from 2001 to 2003 resulted in a slight increase in the uninsured rate. Using data from the 2003 California Health Interview Survey, this policy brief provides a profile of nonelderly Californians' health insurance coverage and describes how these rates have changed since 2001. In 2003, 6.6 million nonelderly Californians were uninsured at some time during the year -- the majority of whom were uninsured for at least the entire year. In fact, one in four nonelderly adults and one in ten children under age 18 experienced a lack of coverage for all or part of the year. In addition, this study found that three-fourths of uninsured nonelderly Californians are in working families. Over 80% of uninsured employees have no access to employment-based insurance coverage because they either worked for an employer that did not offer health insurance, or they were not eligible for benefits from their employer. While more than half of uninsured children in California were eligible for enrollment in Medi-Cal or Healthy Families, only 6% of uninsured nonelderly adults, ages 18-64, were eligible for these public programs. Overall, rapidly rising health insurance costs and a still-slack labor market have reduced employment-based insurance in California since 2001. However, Medi-Cal and Healthy Families have proven their effectiveness in covering children, underscoring their potential for offsetting at least some of the loss in job-based insurance.

The success of health care reform implementation in 2014 partly depends on more efficient delivery of care to the millions of California residents eligible to gain insurance. Emerging evidence supports the effectiveness of the patient-centered medical home (PCMH) as a potential model of care delivery, which improves health outcomes and reduces costs. Among other principles, PCMH entails receipt of care from a personal doctor, who coordinates the patient’s care and develops an individualized treatment plan for the patient. These principles are particularly essential in delivery of care to those with chronic conditions who require more intensive care management.

Using the 2009 California Health Interview Survey (CHIS 2009), this policy brief indicates that patients who reported meeting these fundamental PCMH principles were more likely to have visited the doctor and to have received flu shots, and they also had better communication with providers than those who did not report meeting these PCMH principles. The data also showed that uninsured individuals, Medi-Cal beneficiaries, those at or below 133 percent of the federal poverty level, Latinos, and Asian-Americans were less likely to report meeting all three PCMH principles. These findings highlight the population groups that would most benefit from the PMCH care delivery model, particularly Medi-Cal beneficiaries and those eligible for Covered California, the California health benefits exchange.

The Patient Protection and Affordable Care Act of 2010 (ACA) restricts its health insurance expansions in ways that exclude many uninsured children in California who are immigrants or have immigrant parents. These exclusions directly limit coverage options for noncitizen children. And immigrant parents, potentially misinterpreting eligibility requirements for these new programs, may not enroll their citizen children. Using the 2007 California Health Interview Survey (CHIS 2007), this policy brief estimates that of the 1.08 million children in California who were uninsured all or part of the year, between 180,000 to 220,000 will be excluded from the health care reform expansions due to the combined direct and potential indirect effects of these exclusions. This "left-out" group comprises between 17% and 20% of all uninsured children in California. In light of these exclusions, California’s community clinics and public hospitals could continue to serve a significant number of uninsured immigrant children even after full implementation of ACA.

As California’s system of job-based health insurance continues to erode, low- and moderate-income workers are increasingly being left out, according to this policy brief from the UCLA Center for Health Policy Research. While a majority of Californians continue to get health insurance through their employer or that of a family member, researchers noted that job-based insurance is particularly declining among those living at or below the poverty level. This policy brief examines changes in employment-based insurance of working Californians, ages 19-64.

This report examines health insurance coverage in California based on the 2001 California Health Interview Survey (CHIS 2001) data. CHIS 2001 provides new time frames and a rich source of data with which to better understand health insurance coverage and the lack of coverage for California’s diverse population. Using CHIS 2001 data, an estimated 4,519,000 Californians lacked health insurance at the time they were interviewed in 2001. An additional 1,753,000 persons were insured when interviewed, but were uninsured during at least some of the preceding 12 months. Thus, a total of 6.3 million Californians (21%) experienced lack of coverage during at least some part of a year. For those covered by some form of health insurance at the time of interview, employment-based health insurance remains critically important, covering nearly two-thirds of all nonelderly adults and children in California (18.7 million). Medi-Cal and Healthy Families combined cover 16% of Californian children and adults under 65 — a total of 4.65 million people. Despite the important role these sources of coverage play, together with privately purchased insurance and some additional public programs, 15.2% of nonelderly Californians were uninsured at the time they were interviewed. More than 1.85 million workers (14.5%) are uninsured, comprising over half (51.1%) of all uninsured adults. Los Angeles County remains the epicenter of uninsurance in California and the nation, where one in five nonelderly residents of the county is uninsured — more than 300,000 children and nearly 1.4 million adults. On the whole, CHIS 2001 data show wide differences in coverage across California’s diverse population groups

This fact sheet presents county-by-county estimates of the number of California residents who have lost health insurance during the economic downturn. The authors find that the number of Californians without health insurance grew in all counties and that 37 counties — from Imperial to Kern to Shasta — had uninsured rates above the statewide average of 24.3%.

Loss of health insurance was concentrated in Southern California (Imperial, Riverside, San Bernardino counties), the San Joaquin Valley (all counties), and the Northern/ Sierra areas (all but Sutter and Humbolt), all of which had 2009 uninsured rates that were above the statewide average (24%).

The losses were due to sharp increases in local unemployment and corresponding drops in both household income and job-based coverage.