California made huge strides in care for the uninsured since ACA implementation in 2014.  California decreased the number of uninsured from 6.5 million in 2013 to only 3.3 million by 2015.  It may surprise you to learn that the largest drops in lack of insurance occurred with low income adults, part time workers and Latinos.  Most of these people have jobs, they just don’t make enough money to buy health insurance. They are the working poor. The fact is that so many Medi-Cal expansion adults are working is not well known. In fact, 47% are currently employed and 12% are actively looking for work.

California offered Medi-Cal coverage to legal residents ages 19 to 64 with incomes below 138% of the federal poverty level (FPL).  This is really not much income since 138% of the FPL is only $16,400 for an individual and only $33,500 for a family of four in 2016.  It would be hard enough to have food and a place to live without the additional cost of health insurance.

Medi-Cal expansion numbers:

Expansion adults 3.67 million
Adult male 1.79 m 51%
19 to 39 1.87 m 51%
40 to 54 0.99 m 27%
55 to 64 0.81 m 22%
Hispanic 1.37 m 42%
White 0.95 m 29%
Asian/Pacific Islander 0.63 m 19%
African American 0.28 m 9%
English speaking 2.59 m 71%
Spanish speaking 0.81 m 22%

In some of PHC’s counties, the Medi-Cal expansion adults make up a significant part of the population.  Humboldt, Lake and Mendocino counties each had over 13% of the general population covered as Medi-Cal expansion adults.  The total enrollment for Medi-Cal in those counties in 2016 was 39.7% (Humboldt), 48.8% (Lake) and 47.0% (Mendocino).

Repeal of the ACA could immediately cost 3.7 million Californians their health care coverage under Medi-Cal expansion.  This would result in 7 to 14% of the total populations of PHC counties again becoming uninsured.  This does not even take into account those members who enrolled in Covered California through insurance subsidies.  Losing subsidies would add an addition 3 to 5% increase in the uninsured in PHC counties.

The ACA has done so much to reduce disparities in health coverage among people of color in California.  It has also offered health insurance to a large number of the working poor. It will be very hard to accept a loss of the ACA’s benefits to people of California.  We could double the number of uninsured overnight.

For more information: ACA Repeal in California: Who Stands to Lose. Dietz, et all, UC Berkeley Center for Labor Research and Education/UCLA Center for Health Policy Research, December 2016

James Cotter, MD

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