1. Coverage gaps in California and health care cost trends
Laurel Lucia
Director, Health Care Program
UC Berkeley Labor Center
May 17, 2018
CSAC HHS Policy Committee Meeting

2. Coverage gaps

3. Historic drop in uninsurance in California
Source: Centers for Disease Control and Prevention (CDC), National Health Interview Survey

4. At least 3 million Californians remain uninsured
Source: Dietz M, Graham-Squire D, Becker T, Chen X, Lucia L, and Jacobs K, Preliminary CalSIM v. 2.0 Regional Remaining Uninsured Projections, UC Berkeley Labor Center and UCLA Center for Health Policy Research, August 2016.

5. Undocumented Californians
More than 200,000 undocumented low-income children are enrolled in full-scope Medi-Cal under state expansion that began in 2016
An estimated 1.2 – 1.3 million undocumented adults have income at or below 138% of the Federal Poverty Level, including nearly 1 million enrolled in restricted scope Medi-Cal which covers emergency- and pregnancy-related services only

6. Affordability concerns are the second most important cause of uninsurance
Our recent report outlines five state policy options that could:
Move the state closer to universal coverage
Reduce financial difficulties related to health costs
Improve access to care
Counteract individual market enrollment reduction & premium increase expected to occur with elimination of ACA individual mandate penalty in 2019
Source:

7. Affordability gaps by county
In all 58 counties, some individuals face an affordability gap --- they earn too much to qualify for Medi-Cal but not enough to afford Covered California insurance even with subsidies --- based on a household budget analysis.
See affordability thresholds by county:

8. California’s high cost of living adds to affordability challenges
Income limit for ACA premium assistance is
4 times the federal poverty level ($48,240 for an individual or
$98,400 for a family of four)
& does not take into account
cost of living
Factoring in local costs, that is equivalent to
5 times the federal poverty level in CA &
6 times in San Francisco
Map from Wikimedia Commons
Source: UC Berkeley Labor Center analysis using California Poverty Measure developed by Public Policy Institute of California and Stanford Center on Poverty and Inequality.

9. Some Californians who earn too much for ACA subsidies struggle to pay premiums
Among Californians who earn too much for ACA premium subsidies:
Some face premiums equal to more than 20% of income for a Bronze plan with a $6,300 deductible
Especially likely to face high premiums relative to income:
Individuals age 50 and older
Individuals with income between 400% and 600% FPL ($48,240-$72,360 for a single individual)
Source: UC Berkeley Labor Center analysis using Covered California rate data.

10. Few subsidy-eligible households have assets sufficient to cover $6,300 Bronze deductible
Assets exceed family Bronze deductible
Assets exceed single Bronze deductible
Source: Rae M, Claxton G, & Levitt L (Kaiser Family Foundation), Do Health Plan Enrollees Have Enough Money to Pay Cost Sharing? November 2017.

11. Health Care costs

12. The U.S. spends more than twice as much on health care per capita

13. Health Care System Performance Compared to Spending
Higher health system performance
Eleven-country average
Lower health system performance
Lower health care spending
Higher health care spending
Note: Health care spending as a percent of GDP.
Source: Spending data are from OECD for the year 2014, and exclude spending on capital formation of health care providers.

14. Prices are a bigger driver of high spending than utilization
Source: Health Care Cost Institute, 2016 Health Care Cost and Utilization Report.

15. Provider consolidation is a big driver of high prices
44 out of 58 California counties have highly concentrated hospital markets
Hospital procedure prices are 79% higher in moderately/ highly-concentrated markets
Source: Nicholas C. Petris Center on Health Care Markets and Consumer Welfare, UC Berkeley School of Public Health, Consolidation in California’s Health Care Market : Impact on Prices and ACA Premiums, March 26, 2018.

16. Contact
Laurel Lucia