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In Praise of the Affordable Care Act – The Uninsured

There have been widely reported, continuous attacks on the Affordable Care Act (ACA), but relatively little review of its important progress. This series will summarize some of that progress here in California. 

The Uninsured

  • LIHP’s (Low Income Health Programs). The ACA provides a federal match to states who cover low-income adults through Medicaid beginning in April 2010. California received a waiver to cover low-income adults through an upgrading of its county health systems. All but two of California’s 58 counties have agreed to this expansion. Over 360,000 low-income adults are already covered from 47 counties – a number that is expected to grow to 500,000 in 2013.[1] Early reports of the waiver implementation indicate that it is increasing primary care and prevention, reducing avoidable emergency room visits, lowering hypertensive patients’ blood pressure, reducing diabetic patients’ blood sugars, and decreasing per capita spending for the enrollees.[2]
  • Medically uninsurable.  The ACA provides federal funding for high risk pools to cover individuals with pre-existing conditions. Over 10,000 medically uninsurable Californians are now enrolled in PCIP (Pre-existing Condition Insurance Program) and nearly 6,000 in MRMIP (Managed Risk Insurance Program).[3]
  •  Young adults.  The ACA permits young adults up to age 26 to enroll in their parents’ plan up to age 26. Over 900,000 young uninsured Californians are now covered.[4]


[1] California has two Section 1115 waivers to cover the low income uninsured. The first was approved in 2005 and was limited to $180 million annually for three years. The second was approved in November 2011; it allows California to access a federal 50/50 match with county contributions matching the ACA; it eliminates the cap of the first waiver and will expire at the end of 2013 when ACA coverage begins with 100% federal matching funds. The March, 2012 enrollment is 363,871 and can be found at  http://www.dhcs.ca.gov/provgovpart/Pages/ProgramReports.aspx

[2] See summaries for Kern, San Diego and Orange counties at http://www.dhcs.ca.gov/provgovpart/Pages/SacMeetings.aspx.

[3] California has two programs for individuals with pre-existing conditions who are medically uninsurable. PCIP is funded by the ACA while MRMIP is funded by Prop 99 funds an increase in the state’s tobacco tax, approved by voters in the late 1980’s.

As of April 2012, current subscriber total was 10,075 for PCIP (http://www.mrmib.ca.gov/mrmib/Agenda_Minutes_052312/Agenda_Item_8.a_PCIP_Enrollment_Report_for_April_2012.pdf), with an additional 5,997 enrolled in MRMIP (http://www.mrmib.ca.gov/mrmib/Agenda_Minutes_052312/Agenda_Item_9.a_MRMIP_Board_Report_Summary_for_April_2012.pdf)

[4] Collins et al, Young Uninsured and In Debt: Why Young Americans lack Health Insurance and How the Affordable Care Act is Helping (Commonwealth Fund, June 2012) http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/Jun/Young-Adults-2012.aspx. We multiplied the national figure of 6.6 million by 14%, California’s share of the nation’s uninsured.

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