Study Shows Covered California Customers Have the Access to Doctors They Need and Are Getting the Life-Changing Care They Deserve
SACRAMENTO, Calif. — Today, the Henry J. Kaiser Family Foundation released a study titled “Coverage Expansions and the Remaining Uninsured: A Look at California During Year One of ACA Implementation.” This rigorous, independent survey underscores the success of Covered California’s outreach to communities of color and provides hard evidence that Covered California consumers are getting the care they need, when they need it.
“We are heartened by this independent study that validates that what we have been doing for two years is working,” said Covered California Executive Director Peter V. Lee. “To have a stand-alone, independent view that says our enrollees are getting the care they need allows us to move beyond the anecdotes and mythologies, which are often politically motivated, to focus on what’s next for the future of health care in California and across the country.”
This large-scale study included surveys of those insured by Covered California, Medi-Cal and the private market, as well as the uninsured. The survey went through the fall of 2014 and provides early indicators in areas that are critical to Covered California’s mission. The following are highlights from the study, which is online at http://files.kff.org/attachment/report-coverage-expansions-and-the-remaining-uninsured-a-look-at-california-during-year-one-of-aca-implementation, that will help inform the exchange’s work going forward.
The findings affirm that Covered California outreach is reaching California’s diverse population and an appropriate mix of ages.
- The newly insured were much more likely to be Latino than the previously insured (page 13 in the study); Latinos made up 37 percent of enrollees in Covered California, which mirrors the exchange’s own estimates (Figure 7 in the study).
- The study shows that 50 percent of the newly insured are between the ages of 19 and 34, compared with 31 percent of the previously insured and 48 percent of the uninsured (Figure 5).
The findings show Covered California is dramatically improving health care access for many Californians and highlights some areas for improvement.
- 91 percent of Covered California enrollees reported it was “very” or “somewhat easy” to travel to their usual source of care, which matches the findings for what the study calls the “Other Private” market (Figure 19 in the study).
- 59 percent of Covered California enrollees had a checkup or preventive care visit by the fall of 2014, which is nearly twice the rate for preventive care visits among the uninsured (Figure 20). This is not significantly statistically different from the data for the “Other Private” category, and, if extrapolated out over time, this means more than 800,000 preventive care visits have been provided through Covered California plans since January 2014.
- While 69 percent of Covered California enrollees have a usual source of care, this is lower than the 81 percent in the “Other Private” category (Figure 13). This highlights the need to educate Covered California enrollees, many of whom are newly insured, about the importance of having a primary care physician.
Cost and Affordability Findings
The findings validate the fact that health care costs are still a challenge for many Covered California consumers — as they are for many with private coverage through their employer. This reaffirms that the underlying reasons for health care being expensive in this country still need to be changed.
- 26 percent of Covered California enrollees faced costs that were higher than they expected, which compares with 29 percent in the “Other Private” category (Figure 32 in the study).
- 44 percent of Covered California enrollees reported it is “somewhat difficult” or “very difficult” to pay their premium, compared with 25 percent of those in the “Other Private” category (Figure 36).
“As an active purchaser, one of the ways Covered California is working to keep costs down is by negotiating with health carriers for the very best rates possible,” Lee said. “The study also showed that 84 percent of Covered California enrollees did not face a problem paying their medical bills, which is again comparable to the private market [Figure 38].”
Covered California recently made improvements to its standard benefit design to help consumers get access to care without being subject to a deductible. The changes, which will go into effect for the 2016 coverage year, include adding a specialist visit that will not be subject to a deductible for those in the Bronze plan and removing the application of a deductible for other needed services, such as lab tests, rehabilitation and others. Covered California’s Silver plan will also be simplified by combining copay and coinsurance into a single product. Every doctor visit, lab test and prescription will not be subject to a deductible in this single product.
Consumer Literacy Findings
The study shows more work is needed to educate consumers, especially those who are newly insured, about their health care policies and benefits.
- While a majority of Covered California consumers understand their benefits, 24 percent do not understand cost-sharing, compared with 14 percent of consumers with employer-based coverage (Figure 34 in the study). This highlights a continued need to educate consumers on how to navigate their health insurance.
Covered California Board Member Genoveva Islas participated in a briefing and panel discussion regarding the study.
“I was proud to take part in this discussion, to talk about how Covered California, Medi-Cal and the Affordable Care Act are changing lives in our state,” Islas said. “This is the best current data, with good demographics on actual coverage. This is an independent validation that Covered California is working.”
About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.
Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information about Covered California, please visit.