Findings from a recent Kaiser Family Foundation survey of low and moderate income California residents, released yesterday, suggest the state is generally on the right track in ACA implementation, specifically in its choice to build a robust “active purchaser” exchange and to target communities with the largest coverage gaps. Those and other priorities of Covered California are paying off—starting with dramatic reductions in the state uninsured rate, the fact that enrollment of communities of color are very close to academic estimates, and in the slower rate of growth in premium costs.
Survey findings further suggest the need to build on the state’s reform efforts through legislation and targeted appropriations that consumer advocates are seeking. Though it may be purely coincidental, it’s fitting for the findings to come out the same day as the “suspense” hearings which decide whether certain bills continue in the legislative process or not. Most of the bills sponsored by consumers got the green light, also yesterday, which means the state is on the path to addressing the challenges consumers still face on access and cost issues.
Key Findings, With Health Access Comment on Legislation Designed to Address Issue At Hand
- Coverage obtained through Covered California has been an effective gateway to care, even if access and cost issues remain.
One issue cited was whether the newly insured understood what providers they had access to. Through SB137 (Accurate Provider Directories) we and our coalition partners are taking a targeted approach to consumers’ access issues, beginning with a baseline of accurate provider directories and working from the timely access standards set forth in last year’s successful SB964 (Hernández).
- The remaining uninsured are more likely to be Hispanic, male, and undocumented.
No surprises there, and this is why SB4 #Health4All (Lara) continues to be a top priority for Health Access and so many of our allies and partners. The Kaiser survey provides a timely reminder that undocumented immigrants are an inseparable part of the fabric of the California community. For California, more than for any other state, the health care system simply will not work as well as it should unless we find a robust coverage solution regardless of immigration status. Many will recall what brought health reform to the top of the nation’s priority list: studies like the Institute of Medicine’s Coverage Matters series documenting the hidden costs or cost shifting that results from having so many uninsured. In California, where we have more immigrants than the number of residents in four entire states, these issues persist.This is what makes yesterday’s passage of SB4 in Appropriations so gratifying. With yesterday’s amendments, SB4 would expand Medi-Cal eligibility regardless of immigration status to kids (0-19) as an entitlement; expand coverage for adults regardless of immigration status as budget allocations will allow (enrollment would be capped if funding runs out). By way of a Section 1332 waiver (a formal request to the federal government), SB4 would also allow people to purchase coverage through Covered California using their own money. It’s a decent start on a goal that many of us share: that California’s reforms should finish the job started by the ACA, and that, given who lives and works in our community, our reforms should be truly universal.
- The newly insured need help understanding their benefits.
With this finding, advocates will have more evidence to urge Covered California Board to do more to support navigators and enrollment counselors to focus more on helping consumers understand their benefits and use them effectively to manage their health.
- The newly insured were less likely to prioritize provider networks or scope of coverage in their plan selections.
What they were looking for, more than anything else, was the financial security that coverage provides. Their sensitivity to premium prices further underscores the need to create more affordable plan choices and to make benefits themselves more affordable to use. Both are issues addressed by Health Access-sponsored bills AB339 (Prescription Drug Cost Sharing), which keeps cost sharing within affordable limits for those who take specialty drugs to manage their chronic conditions; and AB533 (Surprise Bills), which protects patients from “surprise” bills from out-of-network doctors when they did the right thing by going to an in-network hospital or imaging center or other facility. The bill would ensure that the consumer only has to pay in-network cost sharing.
Important survey findings not specifically addressed by proposed legislation include:
The #1 reason why people remain uninsured, even though eligible, is cost. Given the high cost of living in certain parts of California, like the Bay Area and Los Angeles, it makes sense that counties would take matters into their own hands and find a way, for example through San Francisco’s employer assessment, to further subsidize premiums.
The message from consumers is coming through loud and clear—and now even from the Kaiser survey—that premiums need to be more affordable if we want to cover more of the uninsured. Cost sharing, too, needs to be more manageable if the goal is for people to use their coverage to get care. Having coverage has made a huge difference for folks’ ability to afford care—but there is still work to do to make sure that coverage serves, as it should, as a key to better health and health care.