Calif. Becomes Laboratory For Affordable Care Act

SACRAMENTO (AP) — A national health policy nonprofit on Thursday announced it is making California the focal point of a long-term research project to examine whether the Affordable Care Act lives up to expectations for the uninsured.

The Kaiser Family Foundation released the initial results of interviews with 2,000 randomly selected Californians who had lacked health insurance for at least two months.

The study will follow the respondents for two years, as they examine their options under the federal health care law. The act reaches its most notable public milestone Tuesday when the exchanges that act as marketplaces for insurance shopping open for business.

The initial study, conducted from mid-July to the end of August, found a relatively favorable response regarding expectations, with about 40 percent of those who are uninsured believing the Affordable Care Act will improve their ability to get affordable health insurance. Yet it also found a huge communication gap between the law's boosters and those who could benefit from it: About seven in 10 uninsured Californians told researchers they did not have enough information to understand how the law will affect their families.

California is home to roughly 15 percent of the nation's uninsured residents. About 7 million people in the state were without health insurance at some point in 2012, including about 6 million adults.

Of that number, 5.5 million are expected to be able to participate in the health insurance exchange in California based on their income and immigration status, according to data contained in the Kaiser report from the federal Centers for Medicare and Medicaid Services.

High costs and loss of a job were the most frequented reasons cited for going without health insurance.

California represents a credible laboratory to study the effects of the federal law because of its sheer size and diversity, and because the state has embraced the Affordable Care Act, said Mollyann Brodie, director of survey research at Kaiser Family Foundation headquarters in Menlo Park. The state's health benefits exchange, called Covered California, is seen as a bellwether for the rollout of open enrollment nationwide.

While the uninsured and self-insured can begin enrolling Tuesday, actual coverage starts Jan. 1.

Brodie said the nonprofit developed the study as a way to create an independent and objective picture of the law's consequences, rather than having its effects seen through the lens of just a few individuals. The idea was to track "what's really happening" through a representative group of uninsured.

"We feel like it's the only way really to assess the impact of the law on real people's lives — to talk to them and let them have a voice in telling us how it's working for them or not working for them," she said.

Kaiser's initial survey found widespread confusion about the law. Nearly three-quarters of uninsured Californians who would be eligible for government subsidies to buy insurance did not know they were eligible or believed they would be ineligible. The subsidies, which can greatly lower the cost of insurance for lower-income people, will be available on a sliding scale to individuals making up to $45,960 a year or a family of four with an annual income $94,200.

Nearly half of those whose incomes were low enough to qualify for Medicaid coverage didn't know it or thought they were not eligible. Medicaid will cover individuals whose incomes top out at $15,400 a year, or a family of four with an annual income of about $31,000.

More than 40 percent of the uninsured were unaware that the law includes a penalty for those who do not obtain health insurance, starting out at a minimum of $95 a year but rising to at least $695 by 2016.

Even when informed of the penalty, four of every 10 uninsured Californians said they still would not get coverage or that their decision would depend on the cost.

Anthony Wright, director of the nonprofit Health Access California, said those initial results weren't surprising given the level of attacks by opponents of the Affordable Care Act. He expects that to change once people begin shopping for insurance on the exchanges and can see what the law means for them.

"The political question is, 'What side are you on?' It's a very different question to say, 'How do I benefit and what are my new health care options now?'" he said. "That can change the dynamics."