Vulnerable populations in health care reform: Examples from California

The Affordable Care Act will expand health insurance coverage in California, which has the highest number of uninsured of any state in the nation. Beginning in 2014, millions of low- and middle-income Californians will gain access to coverage under the expansion of Medi-Cal and through premium and cost-sharing subsidies offered through the California Health Benefit Exchange. However, as many as four million Californians could remain uninsured or face access barriers.

This panel examines populations that will be left out and highlights policy recommendations to increase enrollment numbers. The panel's moderator will provide a brief overview of reform implementation efforts, innovations and analysis. The first study presents data from the California Simulation of Insurance Markets (CalSIM), which is designed to predict uptake and disparities in health insurance coverage. Based on CalSIM, almost three-quarters of the remaining uninsured in California will be U.S. citizens or legal immigrants. Two-thirds of Californians remaining uninsured will be Latino even though Latinos make up only 45 percent of the non-elderly population. The second study focuses on child health, specifically the fate of an estimated 150,000 ineligible, non-citizen children. The third study uses CalSIM to examine access issues, specifically on the nearly 250,000 Californians with limited English proficiency who could remain uninsured due to language barriers. Policy recommendations from the studies include increasing multi-lingual outreach to raise awareness about the Medi-Cal expansion and the Exchange and ways to make subsidized coverage more affordable.