September 30, 2013; Fox News Latino


Will the Affordable Care Act work? The Kaiser Family Foundation plans to cut through the “all’s good” and “the sky is falling” arguments of both sides and do what should be done: conduct a longitudinal analysis of the behaviors of 2,000 Californians who, after having lacked insurance for at least two months, find their way through the state’s health insurance exchange (called “Covered California). Tracking the respondents will allow Kaiser to determine if consumers think, over time, that the ACA met their needs and expectations or fell short.

The Kaiser webpage has the first results from the survey of the 2,000 consumers, data collected in July and August. The report divides the population covered by the survey into four groups:

  • Those in the “Medi-Cal” target group (incomes at 138% of the federal poverty level (FPL) or less), which could qualify them for coverage under California’s Medicaid program
  • Those in the “exchange subsidy” target group (incomes between 138% and 400% FPL, inclusive), who would then have access to subsidies for purchasing insurance through “Covered California,” the state’s new health insurance marketplace
  • Those able to shop on the exchange, but ineligible for tax credits based on their relatively higher incomes (greater than 400 percent FPL)
  • Those uninsured who, due to their immigration status, will not be able to access health insurance via either option.

The first three groups together comprise the “eligible uninsured.”

These results then serve as the baseline for measuring changes as a result of the planned startup of the exchanges or other factors, beginning October 1st. Some of the key findings from the first phase interviews are as follows, along with the questions they raise:

  • Eighty percent of all eligible uninsured Californians, and, moreover, more than 70% of uninsured Californians between 19 and 25, acknowledge that they need health insurance. Will the “young invincibles” whose participation is necessary to make the ACA a success actually sign up?
  • Two-thirds of the respondents have been without health insurance for two years or more. One-fifth have never had health insurance at all, with cost as the primary reason. More than half of respondents say that health insurance isn’t worth the money. Will the subsidies available to lower income persons and the idea that competition among the insurers lead to insurance that is more affordable?
  • Forty percent of the uninsured say that the ACA will help them with their ability to get healthcare, but 20% say it will make things worse. After three months, six months, or a year of the exchanges, whose opinion will carry the day?
  • Seven out of ten say that they have heard little about the expansion of Medi-Cal that would enable persons with incomes up to 138% of the poverty level to get healthcare coverage. Many who should be eligible don’t think they are. What makes low-income people think they won’t be eligible for the program that is designed for them?
  • Six out of ten say that they have gone without needed healthcare due to cost, and four in ten say that they have had trouble paying medical bills. Will the availability of healthcare insurance mean people’s access to doctors and health outcomes will improve?
  • The exchanges are online, but about a quarter of the respondents do not have Internet access in their homes, a third don’t have bank accounts or checking accounts, and a majority of respondents don’t have credit cards. Without these appurtenances of modern life, will California’s uninsured find themselves able to navigate through the exchanges?
  • Twenty percent of the state’s uninsured are undocumented immigrants, who are technically not eligible for medical insurance under the ACA. Over 40 percent of them, however, believe that they will be able to get insurance through the exchanges. What will happen when undocumented immigrants discover that the ACA enables the uninsured to shop for insurance on the exchanges, but not them?

The Nonprofit Quarterly will check in on the Kaiser Family Foundation research results on a regular basis. This is data that policy makers would be looking for—if they weren’t growling at each other from opposite corners of the ring.—Rick Cohen