Blog & News
Two Years after ACA Implementation in California: Coverage Gains Continued and Fewer Affordability Concerns Cited (Cross-Post)
January 03, 2017:The following content is cross-posted from California Healthcare Foundation. It was first published on December 15, 2016.
Author: Amy Adams, California HealthCare Foundation, Senior Program Officer
The uninsured rate in California reached historic lows two years after the implementation of the Affordable Care Act (ACA), according to new data from the 2015 California Health Interview Survey, now available on ACA 411. Consumers also reported fewer affordability problems.
(Click on the images to explore the data.)
Specific findings include:
- The uninsured rate dropped by six percentage points, from 15.5% in 2013 to 9.5% in 2015, a historic low in California. The enrollment surge in Medi-Cal was a driving force behind this drop. The percentage of Californians covered by the program grew from 20.1% in 2013 to 30.9% in 2015.
- All demographic groups experienced coverage gains. Uninsured rates declined significantly across most racial/ethnic and income groups. Among income groups, the biggest coverage gains were experienced by those earning less than 138% of the federal poverty level (FPL), the income threshold to qualify for Medi-Cal. This group experienced a nearly 10 percentage point drop in their uninsured rate, from 22.6% in 2013 to 12.8% in 2015. The uninsured rates among whites, African Americans, and Asians were all roughly cut in half. While the uninsured rate among Latinos also dropped, from 21.4% in 2013 to 15% in 2015, this rate is more than twice that of Asians and African Americans, and three times that of whites.
- Californians were less likely to say that cost was the main reason for being uninsured — this figure dropped dramatically between 2013 and 2015, from 52.6% to 28.8%. A decline was seen across all income levels. This finding suggests that expanded access to Medi-Cal and subsidized coverage through Covered California have had an important impact on many Californians' ability to afford health insurance.
- Cost was also less likely to be the reason people went without needed health care. While cost remains a barrier to health care access, some important progress was made in 2015: Among those who reported foregoing necessary care, the share who reported that they did so because of cost declined from 55.4% to 49.1% between 2013 and 2015.
These new data show that the early gains in coverage and affordability reported a year ago have continued to grow over time. Future blog posts will explore the impacts of the ACA on other important issues, such as access to care and private insurance.
Blog & News
Data Alert: New ACS 5-Year Estimates, Data Center Updates
December 12, 2017:The new American Community Survey (ACS) 5-year state and county uninsurance estimates for 2011 to 2015 are now available via a SHADAC clickable map. Users can click a state to access a table of uninsurance estimates for the state and all counties.
Background: The 5-year ACS is created by pooling together five years of ACS data to produce estimates for areas and subgroups with smaller populations, so estimates are available even for counties with a population below 65,000.
SHADAC's State Profiles have been updated to include these 5-year estimates.
In other data news, the SHADAC Data Center has been updated with 2015 estimates from the ACS, the Current Population Survey (CPS); the Behavior Risk Factor Surveillance System (BRFSS); and the Medical Expenditure Panel Survey (MEPS). Explore the new estimates.
Publication
State and County Coverage Estimates, 2011-2015 ACS
Use this clickable map to see state and county health insurance coverage estimates for the pooled years 2011-2015.
Counties are searchable by bookmark in each state file.
2011-2015 American Community Survey (ACS) 5-Year Estimates:
Percent Uninsured, Total Civilian Noninstitutionalized Population by County
Click here to view estimates for Puerto Rico by municipio.
Click here to view a 50-state table of estimates.
These estimates come from the 5-year American Community Survey (ACS) via the U.S. Census Bureau’s American FactFinder (AFF) tool. The 5-year ACS is created by pooling together five years of ACS data to produce estimates for areas and subgroups with smaller populations.
About the ACS
The ACS is a household survey that began in 2005 and produces annually updated data on a variety of population characteristics, including health insurance coverage. In total, the ACS surveys approximately three million US households each year. An important feature of the ACS is that it includes a large enough sample for state‐level and sub‐state estimates.
The Census Bureau publishes 1-year estimates for areas with populations of 65,000 or more and 5-year estimates (covering 60 months) for all statistical, legal, and administrative entities.
The ACS began asking survey respondents about health insurance coverage during the 2008 calendar year. Specifically, the survey asks respondents about current coverage for each person in the respondent’s household. A person is categorized as “insured” if he or she has coverage at the point in time at which the survey is administered.
How Are these Estimates Different from the Estimates that SHADAC Publishes Using Census Bureau Micro-Data Files?
Two definitions used by the Census Bureau to generate the tabulations above differ from those that SHADAC uses to generate tabulations for the SHADAC Data Center and the RWJF Data Hub. The definitional differences are as follows:
Family
- The Census Bureau defines a family as all related people in a household.
- SHADAC defines a family using a measure called the “Health Insurance Unit” (HIU), which includes all individuals who would likely be considered a family unit in determining eligibility for either private or public coverage.
- To learn more about the HIU, see SHADAC Brief #27, “Defining Family for Studies of Health Insurance Coverage.”
Family Income
- The Census Bureau determines family income as a percentage of the Federal Poverty Level (FPL), which is a definition of poverty used primarily for statistical purposes. For example, FPL is used to estimate the number of Americans living in poverty each year.
- SHADAC determines family income as a percentage of the U.S. Department of Health and Human Services’ Federal Poverty Guidelines (FPG), which is a measure used for administrative purposes. For example, FPG is used to determine eligibility for federal programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
- To learn more about the difference between FPL and FPG, click here.