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Left Behind

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MILLIONS OF CALIFORNIANS have gained health insurance coverage under the Patient Protection and Affordable Care Act (ACA), reducing the state’s uninsured rate to a historic low. Implementation of the ACA has led to significant increases in coverage for all racial/ ethnic groups in California, according to the FSPH-based UCLA Center for Health Policy Research (CHPR), which reported the findings in October 2018 using data from the 2017 California Health Interview Survey (CHIS).

But despite these important gains, the state’s large Latino population continues to lag behind other racial/ethnic groups in coverage and access to health care. A subsequent CHPR study, released in August 2019, found that Latinos are less likely to have health insurance than other racial/ethnic groups, due to lower rates of coverage through employers as well as barriers such as citizenship restrictions on access. This lack of coverage means less access to health care services, ultimately resulting in poorer health outcomes, the study authors note.

Using 2015 and 2016 data from CHIS — the nation’s largest state health survey, based in CHPR — the researchers found that 13.7% of California’s nonelderly Latinos remain uninsured, compared with 6.4% of African Americans and 5.3% of non-Latino whites. Although Latinos have one of the highest rates of enrollment in Medi-Cal, the state’s Medicaid program (44.9%), more than one-fifth of uninsured nonelderly Latinos are also eligible for the program but not currently enrolled.

The study also found that more than three-fourths of the state’s Latino children are eligible for Medi-Cal but not currently enrolled. In 2016, California extended Medi-Cal eligibility to all undocumented residents under the age of 19. In July 2019, California became the first state to extend Medicaid coverage to undocumented young adults by making all low-income residents ages 19-25 eligible for Medi-Cal, regardless of immigration status. Medi-Cal eligibility is particularly important for California’s Latinos given that they have the lowest job-based coverage rates among all racial/ethnic groups, with just 31.6% reporting being insured through an employer, the study authors note.

California legislation allows the state to fund health care through Medi-Cal for residents regardless of citizenship status, but the state needs to obtain a federal waiver to implement the program, which allows only some Latino adults to enroll. Not all noncitizens and nonpermanent residents would qualify for Medi-Cal if eligibility California’s uninsured rate is at a historic low, but an FSPH study finds that the state’s Latino population isn’t enjoying the same benefits as other racial/ethnic groups. was expanded to these groups, because some would have incomes above the qualifying threshold for the program.

“These findings show that expanding Medi-Cal access to noncitizens would substantially reduce, but not eliminate, the gap in uninsured rates between Latinos and other Californians,” says Tara Becker, the study’s lead researcher and senior public administration analyst at CHPR. “Despite high employment rates, many California Latinos lack access to affordable coverage through an employer and must purchase more expensive individual coverage on the private market. Eliminating the gap in coverage will require reducing health care costs and expanding access to subsidies to purchase coverage.”

Robert Ross, president and CEO of The California Endowment, which supported the research, said upon the release of the findings: “We hope the data from the study can be used to inform health care policies that expand and promote access to care for such an important segment of California’s population.”