California's success still leaves over 1 million eligible uninsured

Older Californians Struggle to Afford Lowest-Cost Plans on Covered California

California Health Care Foundation, May 14, 2018

Under the Affordable Care Act (ACA) California has now covered 93% of our adult population — a record high. Federal ACA subsidies through Covered California have made coverage more affordable for hundreds of thousands of Californians. The ACA further protected consumers’ finances by requiring insurers to pay a minimum level of medical expenses and by outlawing annual and lifetime caps on what insurers pay for care. However, 1.2 million Californians are eligible to purchase coverage on Covered California but remain uninsured, mainly because of cost.

Older Californians who aren’t covered by an employer or by Medi-Cal or Medicare, and who earn just above the maximum income to qualify for federal ACA subsidies (400% of the federal poverty level [FPL] — approximately $48,000 for an individual, $65,000 for a couple), may find it especially challenging to find affordable plans. For example, to purchase the lowest-cost bronze plan on Covered California:

* A 55-year-old single consumer earning $48,361 (401% FPL) would spend between 10% and 15% of her income on premiums, depending on where she lived.

* A 55-year-old married couple earning $65, 122 (401% FPL for a family of two) would pay between 15% and 22% of their income on premiums.

As consumers age, premiums increase:

* A 64-year-old earning $48,361 would pay between 13% and 20% of his income on premiums.

* A 64-year-old married couple earning $65,122 would pay between 20% and 30% of their income on premiums.

In addition, bronze plans come with a $6,300 deductible for individual policies and a $12,600 deductible for family policies.



By Don McCanne, M.D.

California has done a phenomenal job in implementing the Affordable Care Act and has gone beyond the federal requirements in an effort to further expand coverage. Yet 1.2 million Californians who are eligible to purchase coverage on Covered California remain uninsured, mainly because of cost.

Look at the numbers above. Not only are the premiums unaffordable for many of those who earn too much to qualify for subsidies - requiring up to 30 percent of income - but those premiums purchase only low actuarial bronze plans (60% AV) which require additional payments of an average of 40 percent of the costs of care received.

It is not California's fault nor the fault of any other state that is trying to make the system work. It is the fault of Congress and the administration for refusing to enact a health financing infrastructure that would work well for everyone, not just in California but in the entire nation. But sadly, not only is there inertia on reform that would work, the President and many members of Congress would actually pare back further the inadequate coverage we do have, leaving even more uninsured or underinsured.

We could provide everyone with all essential health care services with no cost sharing barriers without increasing our national health expenditures above their current level merely by enacting a well designed, single payer improved Medicare for all. We are already paying for it; we should have it. But to get there we will have to replace Congress and the administration with competent, caring public stewards.

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