The poor and people of color benefited most from Affordable Care Act, new data show

Californians who were historically unable to afford health insurance—those with low incomes and people of color—benefited significantly from health coverage expansion policies under the Patient Protection and Affordable Care Act, according to new 2015 California Health Interview Survey data released today.

The new CHIS data, which are accompanied by a fact sheet on insurance trends, show the overall rate of uninsured Californians fell to a new low in 2015: 9.5 percent—the first time the rate has dropped to less than 10 percent since data have been collected.

And declines in rates of those who are uninsured were most pronounced among the state's poorest residents ages 0 to 64, dropping by nearly 10 percentage points between 2013 and 2015, to 12.8 percent. Declines were also more pronounced for most racial and ethnic groups, with rates of those who are uninsured falling nearly 7 percentage points among Asian-Americans and African-Americans, and 6.5 percentage points among Latinos.

"The evidence shows that the Affordable Care Act has opened the doors to groups who have been historically shut out from health insurance coverage," said Ninez Ponce, associate director of the UCLA Center for Health Policy Research and principal investigator at CHIS. "It is likely that the ACA's expansion of Medi-Cal and income subsidies for Covered California have been instrumental in expanding the safety net for poor and traditionally disadvantaged groups."

CHIS, the nation's largest state health survey, surveyed 21,444 households in 2015, including 21,034 adults, 754 teens and 2,157 children.

Medi-Cal expansion drives coverage

The related fact sheet published in conjunction with the 2015 CHIS data release reports that the number of Californians ages 0 to 64 with Medi-Cal health coverage climbed to 32.2 percent of people in 2015—an increase of 11 percentage points since 2013. Medi-Cal is the state's version of Medicaid.

However, progress made in expanding health care coverage in the state may be in danger, said Shana Alex Charles, faculty associate at the center and author of the fact sheet.

"Both our data and national data show Americans have clearly benefited from Medicaid's expansion under the Affordable Care Act, and this is the benchmark against which any future policies will be measured," Charles said. "We can't go back to 2013, when millions more Californians were uninsured."

The share of Californians with individual insurance remained fairly constant at 7 percent, or 1.2 million people, according to the fact sheet.

Rising affordability

The new data reveal large declines across all income levels of those who said they are currently uninsured because they "can't afford" health care, from a 26 percentage point drop for the lowest income earners to a 20 percentage point decline for highest.

Fewer Californians cited cost as a reason to go without needed medical care in 2015. With the exception of African-Americans, all other racial and ethnic groups reported 6 to nearly 14 percentage point drops in cost being a reason to forgo care.

Despite the gains, American Indian/Alaska Native and Latino residents have the highest rates of not being insured, 17.5 percent and 15 percent, respectively. And there was a 3.3 percentage point increase from 2013 to 2015 in African-Americans citing cost as a barrier to care.

New topics and updated variables

In addition to updated insurance estimates, respondents answered questions on hundreds of new and updated health topics ranging from discrimination in getting medical care to chronic disease management, to resiliency among teens.

Some findings from 2015:

• Gender identity measurement: For the first time, CHIS, in partnership with the Williams Institute at UCLA School of Law, measured the size of the transgender and gender-nonconforming population in California, making it one of the few state-level health surveys featuring this population. In 2015, about 64,000 adults ages 18 to 70 (0.25 percent of the population) were estimated to be transgender or gender non-conforming, and about 133,000 Californian youth ages 12 to 17 (about 4.5 percent of the youth population) were estimated to express their gender in a "non-conforming" way (e.g., boys who act or dress mostly or very feminine, and girls who act or dress mostly or very masculine). Researchers can request more detailed data on both adults and teens through the Data Access Center.
• More adult Californians had routine primary care checkups in 2015: The proportion of those with coverage who had a primary care checkup rose nearly 4 percentage points between 2013 and 2015 to 73 percent.
• Discrimination in a health care setting: Another new question showed 15 percent of African-Americans and the same percentage of a group that includes multi-racial and small groups of single-race adults said they felt they had sometimes or often been treated unfairly while getting medical care. In comparison, 14 percent of Latinos, 10 percent of whites and 7 percent of Asian-Americans said they felt discriminated against. In a related question, nearly 14 percent of African-Americans said they felt they would have received better care if they were a different race or ethnicity, compared to 2 percent of whites.
• "Teledoctor" makes house calls: A new survey question on telemedicine revealed nearly 10 percent of adult Californians received health care from their provider by video or phone.
• Prediabetes rate: More than 12 percent of adult respondents said they were identified as having prediabetes, which can develop into type 2 diabetes, a jump of nearly 3.5 percentage points.

Other new and updated topics in CHIS 2015 include estimates of delays in dental care and emergency room dental care among children, breast feeding and bottle feeding and mammography screenings.

"We're excited about the latest data on the broad set of topics included in the CHIS, and how they can help researchers, policymakers, and local organizations address emerging health needs," said Todd Hughes, director of the California Health Interview Survey. "But the insurance data is significant—it gives us a measure of how the ACA improved access and affordability of health care for millions of people who had gone without."