A Final Look: California's Previously Uninsured after the ACA's Third Open Enrollment Period

The Kaiser Family Foundation California Longitudinal Panel Survey provides unique insights into the experiences and views of a representative, randomly selected sample of Californians who were uninsured prior to the major coverage expansions under the Affordable Care Act (ACA). The initial baseline survey was conducted with a representative sample of 2,001 nonelderly uninsured Californian adults in summer 2013, prior to the ACA’s initial open enrollment period. Because the same group of previously uninsured people has been followed over time, the survey is able to explore the dynamics of health insurance and track how many people have moved in to or back out of coverage since the baseline survey in 2013.

After three rounds of open enrollment under the Affordable Care Act, nearly three-fourths (72 percent) of Californians who were uninsured prior to the first open enrollment period now report that they have health insurance. This share is similar to the 68 percent who said they were insured after the second open enrollment period in the spring of 2015, and is an increase from 58 percent after the first open enrollment period in the spring of 2014. This indicates that the percent of Californians with health insurance may have reached a relatively steady rate, with less fluctuation in the market as individuals gain and keep coverage.

Most of California’s previously uninsured who reported having coverage after the first open enrollment period continued to report having coverage, but some have since become uninsured, while some others who reported being uninsured after the first open enrollment period or the second enrollment period now report having coverage. These dynamics indicate the potential challenges of getting and keeping coverage for the previously uninsured as well as potential opportunities for new enrollment gains among those who have potentially missed chances to enroll in the past. Future gains in coverage may be moderate, however, with the remaining shares of California’s previously uninsured consisting largely of harder-to-reach groups: those who are undocumented immigrants and therefore ineligible for coverage through the ACA and those who reported as of the baseline survey that they had been without coverage for two or more years or had never had health insurance. There is some lack of knowledge of the assistance that is currently available, which indicates that there is potential for outreach to make a difference.

Among the recently insured, there have been considerable gains in access and affordability compared to what they said in the baseline survey, but concerns about health care costs remain. The final fourth wave of the Kaiser Family Foundation California Longitudinal Panel Survey illustrates that while more individuals are gaining access to health insurance coverage, challenges still exist for both the remaining uninsured and those who now have health insurance coverage.