Berkeley, California - Two-thirds of Californians without health insurance in 2014 were eligible for coverage, but most said they did not enroll because of the cost, according to a new study by the University of California, Berkeley’s Center for Labor Research and Education and the UCLA Center for Health Policy Research.

The researchers found that the remaining third of uninsured Californians were ineligible for coverage under the Affordable Care Act due to their immigration status.

Using California Health Interview Survey (CHIS) data, the study on “Affordability and Eligibility Barriers Remain for California’s Uninsured” reports that California residents without health insurance fall into four groups:

Researchers at UC Berkeley and UCLA say that many previously uninsured Californians have enrolled in coverage, but fully covering those still uninsured will require changes in policy to improve affordability and expand eligibility. (Image from Creative Commons.)

• Undocumented residents: 32 percent. Residents who do not qualify for health coverage under the Affordable Care Act are predominantly low-income, Latino and have limited English language proficiency.
• Those eligible for Medi-Cal: 28 percent. Adult citizens and lawfully present immigrants with incomes at or below 138 percent of the federal poverty level, and children at 266 percent of the poverty level.
• Those eligible to buy health coverage on the state exchange, Covered California, with a federal subsidy to help offset costs: 31 percent. Citizens and lawfully present immigrants with incomes from 139 percent to 400 percent of the poverty level.
• Those eligible to buy health coverage on Covered California, but not eligible for federal subsidy: 9 percent. Citizens and lawfully present immigrants with incomes above 400 percent of the poverty level, which disqualifies them from federal subsidies.

An expensive place to live

Among reasons for not having insurance, the largest percentage of citizens and lawfully present immigrants (46 percent) cited cost as the main reason.

“We’re a relatively high cost-of-living state,” said Miranda Dietz, a researcher at UC Berkeley and the study’s lead author. “It’s no wonder some Californians, who may be unaware they qualify for health subsidies and other programs, still find the cost of health insurance out of reach. For people who are already stretched paying their rent, filling the car to get to work and feeding the kids, figuring out how to come up with more money for health care on top of that is a lot to handle.”

California has more than 1 million undocumented, uninsured residents who do not benefit from the Affordable Care Act because of their immigration status.

“Hundreds of thousands of men, women and children, not to mention the workers who power California’s economy, are one health emergency away from potential financial ruin because they lack insurance,” said Nadereh Pourat, a co-author of the study and the director of research for the UCLA center.

“From an economic perspective,” she said, “it’s bad business to rely on workers and then not offer them equal health protection. And from a humanitarian perspective, it’s just wrong.”

Young adults, men most likely to be left out

UCLA and UC Berkeley also collaborated on a related study, “Who Had Medi-Cal and Who Remained Uninsured in the First Year of Expansion?” to examine CHIS data on low-income adults under age 65 who were eligible for Medi-Cal in 2014. The researchers found that eligible but uninsured adults were more likely to be under the age of 30 and male, compared to those who enrolled, and concluded that health advocacy outreach should especially target men in that age bracket.

Reasons Californians gave for not being enrolled in Medi-Cal varied. About one-third of those who were eligible said they thought they were ineligible or didn’t know if they were eligible. Another 20 percent said they were getting insurance, reflecting a major backlog during the first year of processing applications that has largely been resolved since then.

Both studies were funded by the Blue Shield of California Foundation.

The Affordable Care Act was implemented in 2014, a time of major changes to the state’s healthcare system. The study notes that many previously uninsured Californians have enrolled for coverage, but fully covering those still uninsured will require changes in policy to improve affordability and expand eligibility.