California Journal of Politics and Policy

We examined the impact of the Affordable Care Act (ACA) on healthcare coverage, access, health status, and affordability, as well as disparities in these outcomes by race/ethnicity among low-income Californians. We used nationally representative survey data from the Behavioral Risk Factor Surveillance Survey 2011-2019 and a difference-in-differences approach that compared California with nonexpansion states. We examined the impact of Medicaid expansion on health insurance coverage, having a usual source of care, self-reported health status, frequent (≥14) unhealthy days in the past month (physical, mental, and both), and foregone care due to cost. The sample population included low-income Californians (<100% of the federal poverty guidelines) aged 19-64 and low-income childless adults. Low-income adults, childless adults, and white childless adults in California saw post-ACA gains in six of seven outcomes, including a 7.7 percentage point increase in having a usual source of care for all low-income adults (CI: 0.051 to 0.104). Childless adult people of color (POC) reported significant improvements in three measures, with a 6.6 percentage point increase in having a usual source of care (CI: 0.013 to 0.120). All of the groups we examined had coverage gains, ranging from 3.9 percentage points for all low-income adults (CI: 0.013 0.066) to 8.4 percentage points for white childless adults (CI: 0.025 to 0.143). Additionally, all groups reported improved mental health, including an 8.2 percentage point decrease in frequent mental distress for childless adults (CI: -0.120 to -0.044). These findings indicate that the ACA coverage expansion benefitted the targeted population of low-income Californians. Additionally, the disparity between white and non-white Californians decreased for the unadjusted mean rate of having a usual source of care. However, unadjusted means showed that white low-income adults remained more likely to have health insurance coverage and a usual source of care compared with POC in both California and nonexpansion states.

The decennial U.S. Census is intended to generate an accurate count of the population for use in allocating seats in the House of Representatives and distributing federal funds. However, individuals are less likely to complete the Census if they have privacy and confidentiality concerns. Previous research conducted on behalf of the U.S. government found that reassurances of confidentiality increased participation but not for items asking for sensitive information. In March 2018, the Trump administration announced its intention to add a citizenship question to the 2020 Census, raising concerns that the citizenship question might reduce participation among members of mixed-status households. In October and November 2018, while a legal challenge to the question was pending, we worked with three partner organizations within a faith-based non-profit community network to explore how best to encourage participation in the 2020 Census in hard-to-count populations in Southern California. Using a randomized field experiment with messages delivered using face-to-face canvassers, we find limited evidence that reassurances from the community organization about the confidentiality of information provided to the Census Bureau increased intent to participate in communities.

The COVID-19 pandemic is an unprecedented and ongoing calamity, laying bare the vulnerabilities of California’s public health and emergency response systems. Although youth confined in juvenile detention facilities are among those at highest risk of suffering from the effects of the virus, the plight of these young people has been largely invisible to the public and overlooked by the state. This article describes the unique dangers posed by the coronavirus to youth incarcerated in county-run detention facilities in California. It summarizes the policies and procedures necessary to protect the health and well-being of detained youth based on the recommendations of public health officials and youth justice stakeholders nationally. It then describes the county and state agencies whose coordinated action is essential to respond to COVID-19, the efforts of the authors and other California advocates to urge these government stakeholders to implement essential health and safety protocols, and the obstacles and challenges encountered. Those efforts met with a range of responses ranging from lack of certainty about authority to act to non-responsiveness.  As a result, California failed to provide systematic guidelines for releasing youth from custody, proactively oversee conditions in detention facilities, report data in meaningful ways, or respond to concerns and complaints from youth and families. The article, finally, draws on the experiences of the past year and a half to offer recommendations for the systemic changes necessary to prepare for the next pandemic or similar public health emergency.