California Health Insurance Stable in 2021, but Many Will Need to Switch Coverage Once COVID-19 Pandemic Protections End – California Health Care Foundation

Throughout 2021, the second calendar yr of the COVID-19 pandemic, California’s medical health insurance panorama remained comparatively steady. This text focuses solely on Californians underneath age 65, which is the brink for age-based Medicare protection, and the protection charges highlighted beneath embrace kids besides the place in any other case specified (i.e., “nonelderly adults”). Primarily based on the 2021 California Well being Interview Survey (CHIS), the proportion of Californians underneath age 65 with out medical health insurance, 7.4% in 2021, was not considerably completely different from the prior yr. There additionally have been no statistically vital adjustments throughout demographic teams, together with revenue, age, geography, and race and ethnicity.

Additionally, the speed of Californians with particular person market protection, 5.9% in 2021, was statistically unchanged from 2020. Whereas the speed of Californians with Medi-Cal protection (California’s Medicaid program), 26.4% in 2021, seems larger than the 24.8% of 2020, the distinction will not be statistically vital. That discovering contrasts with information from the California Division of Well being Care Providers, which reported that Medi-Cal enrollment elevated by 7.3% (893,552 enrollees) in 2021 for individuals underneath age 65, rising from 12,244,085 in December 2020 to 13,137,637 in December 2021.

There are a number of potential explanations why survey knowledge on Medi-Cal enrollment could differ from Medi-Cal’s information. Analysis reveals that surveys are likely to undercount individuals enrolled in state Medicaid applications, partly because of individuals’s confusion over program names and whether or not they’re nonetheless enrolled in Medicaid. This second problem, of individuals being unaware they’re nonetheless enrolled, could have been exacerbated through the pandemic. A short lived coverage, termed “steady protection,” prevented enrollees from being disenrolled from Medicaid through the public well being emergency, as well being protection has been important to preserving entry to well being care. This coverage could have resulted in some Californians retaining Medi-Cal protection they assumed had expired.

On the similar time, the speed of Californians with employer-sponsored insurance coverage (ESI) declined considerably, from 60.1% in 2020 to 57.8% in 2021. The losses in ESI seem to have been offset by will increase in Medi-Cal protection for some key teams. As an example, whereas ESI charges declined considerably for nonelderly adults (age 18–64), individuals with reasonable incomes (139%–400% of federal poverty degree) and Latinx individuals skilled statistically vital will increase in Medi-Cal protection charges.

Though the proportion of Californians with out medical health insurance at a given time was unchanged in 2021, the speed of Californians experiencing long-term uninsurance (for a yr or extra) rose from 4.8% in 2020 to five.7% in 2021, a statistically vital enhance.

Conclusions and Dialogue

Total, the steadiness of the state’s medical health insurance price may be seen as constructive, significantly through the upheaval of the COVID-19 pandemic. Regardless of huge job losses in 2020, California’s uninsurance price declined to a historic low within the first yr of the pandemic, virtually actually because of federal and state efforts to keep up or enhance entry to medical health insurance. The power for California to carry that low price of uninsurance right into a second risky yr of the pandemic is notable.

There have been different measures, nonetheless, that point out California’s protection panorama shifted barely since 2020. As an example, the state’s price of ESI protection declined considerably in 2021, which might be regarding if it developed right into a pattern. Nonetheless, you will need to acknowledge that in 2020 the portion of Californians with ESI was a high-water mark since full implementation of the Inexpensive Care Act in 2014, so it could possibly be that the pattern of elevated ESI in recent times is just moderating.

One other doubtlessly regarding indicator was the rise in California’s price of long-term uninsurance from 2020 to 2021. However on this case, pattern knowledge present that the 2020 long-term uninsurance price of 4.8% could merely have been an outlier — presumably to because of the pandemic — with the 2021 price of 5.7% falling again consistent with the slim vary of charges between 5.3% and 5.8% for different years since 2016.

Altogether, knowledge from the 2021 CHIS illustrate a surprisingly steady panorama of medical health insurance protection. The COVID-19 pandemic — which started in 2020 and continued into 2021 and past — had the potential to trigger huge losses of medical health insurance protection, primarily by declining ESI brought on by sharp job losses. However uninsurance charges didn’t spike, and ESI protection has not proven dramatic erosion in comparison with the prepandemic pattern.

Even because the pandemic endured into 2022, lots of the authorities helps that helped individuals keep protection through the disaster have already ended or are anticipated to sundown quickly. For instance, the expansion of Medi-Cal protection for key subpopulations through the pandemic is due largely to the continual protection provision related to the general public well being emergency, anticipated to finish someday in 2023. Whereas researchers venture that almost all Californians dropping Medi-Cal will likely be eligible for different forms of protection, as CHCF has written elsewhere, it is going to be important to take motion to maintain enrolled those that proceed to be eligible for Medi-Cal, and to attach those that grow to be ineligible to different sources of protection. This — in addition to different challenges, akin to inflation — could make holding onto California’s protection beneficial properties troublesome. To totally perceive whether or not and what sorts of impacts the pandemic triggered in California’s well being protection panorama, it is going to be important to proceed monitoring knowledge from 2022 and future years.