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Towards Universal Health Coverage: California Policy Options for Improving Individual Market Affordability and Enrollment

March 5, 2018

California has made historic progress under the Affordable Care Act (ACA) by cutting the uninsurance rate by more than half, resulting in approximately 93% of Californians now having health insurance. Health coverage affordability has improved for many, especially for those who became newly eligible for Medi-Cal or subsidized coverage through Covered California. For those who purchase coverage individually, the ACA has not only provided financial assistance to help eligible low- and middle-income individuals afford premiums and out-of-pocket costs, but has also provided crucial protections to individual market enrollees of all income levels. These protections include requiring insurers to offer insurance to all without charging higher premiums for those with pre-existing conditions, setting a floor for the share of costs that insurers cover, and establishing a ceiling on enrollees' out-of-pocket costs. However, many Californians continue to face difficulties in affording premium and out-of-pocket costs. Affordability challenges can deter enrollment in and retention of coverage, cause financial difficulties for those struggling to pay premiums or medical bills, and decrease access to care. In this report, we focus specifically on the affordability challenges for the 2.3 million Californians who purchase private insurance individually and for many of the 1.2 million Californians who are eligible to purchase insurance through Covered California but remain uninsured. We also explore state policy options for improving affordability of individual market premiums and out-of-pocket costs, and consequently helping move the state closer to universal coverage. This set of policy options was developed based on analysis of the available evidence on affordability concerns in California's individual market, as well as on a review of policies used by other states and localities to improve affordability.

Providing Health Care to Undocumented Residents: Program Details and Lessons Learned from Three California County Health Programs

October 4, 2016

While the number of people without health insurance has declined dramatically since the Affordable Care Act went into effect, undocumented immigrants continue to be excluded from many health coverage options under this law. In California, approximately 1.8 million individuals are projected to remain uninsured due to their immigration status. Without resources to pay for costly health care, undocumented immigrants may delay care and eventually seek treatment in the emergency room or go untreated entirely. Undocumented adults in California are generally eligible for only emergency and pregnancy-related services through Medi-Cal, the state's Medicaid program, though undocumented children and those granted deferred action may be eligible for full-scope Medi-Cal. Many of California's counties provide primary and preventive health care services to low-income undocumented residents through safety-net programs. These programs are of interest to advocates and policymakers in other states who are looking for local solutions to offer non-emergency health services to undocumented immigrants. This report profiles three county programs that offer health care services to undocumented residents and aims to serve as a resource for designing and implementing similar programs elsewhere across the nation. It is based on interviews with county program staff, statewide informants, provider organizations, consumer advocacy groups, and published reports and documents gathered in June and July of 2016. This report will present a brief history, basic enrollment and eligibility information, and available cost and revenue data for each of the highlighted county health care programs, and then describe lessons learned about building provider networks, engaging in outreach and enrollment, and evaluating the program.

Preliminary Regional Remaining Uninsured 2017 Data Book, California Simulation of Insurance Markets (CalSIM) version 2.0

August 11, 2016

This data book provides estimates of the remaining uninsured in California in 2017 by Covered California rating region and for large counties using a preliminary version of the California Simulation of Insurance Markets (CalSIM) model v 2.0.

The Public Cost of Low Wages in New York

January 25, 2016

This report outlines the public cost of New York's Minimum wage. Over the next several years New York State will raise the minimum wage for fast-food workers to $15 per hour; Gov. Andrew Cuomo is now pushing for legislation to extend this to New York workers in all industries. The governor also recently committed to pay all state government workers $15 an hour.The Labor Center's report on the public cost of jobs paying less than $15 per hour in New York echoes the findings of earlier Labor Center research examining the fiscal impacts of low-wage work in the fast-food and retail sectors, including bank tellers and Wal-Mart employees, and in individual states. Report highlights for the study include:Of all New York workers paid less than $15 an hour, 52 percent received public assistance or had a family member enrolled in a safety net program.Of all New York workers, 32 percent earned less than $15 an hour.Eighteen percent of workers in New York earned less than $15 an hour and had at least one family member, including themselves, receiving public assistance such as food stamps, the Earned Income Tax Credit, Medicaid, or cash assistance programs.Approximately 26 percent of state and local assistance funds in New York went to help low-wage workers.

Health Coverage Expansion in California: What Can Consumers Afford to Spend?

September 1, 2007

Analyzes Californians' current spending on insurance premiums and out-of-pocket expenditures to assess whether proposals to make obtaining health insurance mandatory include sufficient measures to make it affordable for low- and middle-income families.