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California health insurance

CA exchange enrolls 1.4 million; aims to do better in 2015

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Do you wonder how you and your neighbors in California are doing healthwise? Looking for information on how political viewpoints have impacted the rollout of the Affordable Care Act in California? If so, this brief summary will help you get a handle on the public health indicators and medical insurance coverage in your state.

California health ratings

In a comparison of the 50 states and the District of Columbia, California is ranked 26th by the Scorecard on State Health System Performance 2014. California ranked 29th in the 2009 analysis. The comparison is based on an overall health score, which rolls up health indicators in four categories. See California’s Scorecard for the details.

America’s Health Rankings, compiled by the United Health Foundation, places California at 21st in its most recent rankings, which were completed in 2013. California scores well for low smoking and physical activity rates as well as low infant mortality, cancer deaths and premature death rates. California’s public health challenges include air pollution levels, a high uninsured rate, and low immunization rates. Note that California’s uninsured rate dropped significantly following the initial open enrollment period of the ACA, so the state’s ranking in that category will likely rise.

The 2014 edition of Trust for America’s Health also evaluates a variety of public health indicators. Visit the site for Key Health Data About California.

Given California’s size and diversity, a statewide view might not provide the level of information you want. Get county-by-county health rankings for California, which were developed by the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

California and the Affordable Care Act

The Affordable Care Act was signed into law in March 2010. California’s Congressional delegation voted along party lines. Both Democratic senators voted yes as did 34 Democratic representatives. Nineteen Republican representatives voted “No.”

At the state level, legislators moved quickly to pass bills in support of a state-based marketplace – making California the first state to do so. Former Gov. Arnold Schwarzenegger, Republican, signed both the Assembly and Senate bills into law on Sept. 30, 2010. Current Gov. Jerry Brown, a Democrat, called a special session in late 2012, enabling additional legislation to implement the ACA in California.

How did the ACA help California?

As noted above, California’s uninsured rate showed a significant decline following the 2014 ACA open enrollment period. A study by The Commonwealth Fund showed California’s uninsured rate dropping from 22 percent in July-September 2013 to 11 percent in April-June 2014. The Commonwealth Fund, along with a Gallup-Healthways poll and the Urban Institute’s Health Reform Monitoring Survey all show the national uninsured rate dropping to the 13-to-15 percent range.

Californians’ enrollment in QHPs

A Kaiser Family Foundation estimate from November 2013 put California’s potential market for its health insurance exchange at 3,291,000 people. Kaiser further estimated that 1,903,000 of those people would qualify for premium subsidies to help them purchase policies from qualified health plans (QHPs).

Actual enrollment data from the U.S. Department of Health and Human Services (HHS) shows that 1,405,102 Californians enrolled in QHPs – that’s 42.7 percent of the eligible market. Eighty-nine percent (or about 1,250,400) of those enrolling in a QHP qualified for financial assistance.

Covered California, the state-run marketplace, has announced that 10 insurers will sell marketplace policies for 2015:

  • Anthem Blue Cross of California
  • Blue Shield of California
  • Chinese Community Health Plan
  • Health Net
  • Kaiser Permanente
  • L.A. Care Health Plan
  • Molina Healthcare
  • Sharp Health Plan
  • Valley Health Plan
  • Western Health Advantage

Medicaid in California

California embraced Medicaid expansion in addition to implementing a state-run marketplace. Expanding Medicaid eligibility – to include nearly all nonelderly adults with incomes at or below 138% of poverty – is one of the ACA’s main strategies to reduce uninsured rates.

Between October 2013 and March 2014, about 1.7 million Californians were deemed eligible for Medicaid. Enrollment and disenrollment for these programs continues throughout the year, so the total number of enrollees fluctuates monthly.

Learn about California’s Medicaid program, which is called Medi-Cal. Note: California’s Children’s Health Insurance Program (CHIP) was previously known as Healthy Families. In 2013, California transitioned Health Families enrollees to Medi-Cal.

Does California have a high-risk pool?

Prior to the ACA’s reforms in the individual health insurance market, medical history was a factor in eligibility for private plans in nearly every state, including California.  Applicants with pre-existing conditions were often unable to buy individual plans in the private market, or if coverage was available it came with a higher premium or with exclusions on pre-existing conditions.

The California Major Risk Medical Insurance Board (MRMIB) was created in 1991 to provide a coverage option for people who were ineligible for coverage under a private plan because of medical history.

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This change largely eliminated the need for high risk pools, since pre-existing conditions are no longer a barrier to obtaining coverage.

The California Budget Act of 2014 included a provision for MRMIB to cease operations as of July 1, 2014. Most of the MRMIB insureds had already been able to obtain coverage through the exchange or expanded Medicaid, but remaining members were transitioned to the California Department of Health Care Services on July 1.

Health reform legislation in California

Here’s a summary of legislative action regarding healthcare reform at the state level in California: