Medi-Cal’s expansion has reduced the financial barriers to the healthcare that is needed

The COVID-19 pandemic has increased the importance of healthcare — and underscored its unpredictable and potentially financially devastating costs, even for middle-class households. Half of Californians are delayed with health care for cost reasons in the past 12 months, according to the California Health Care Foundation. For the uninsured online fundraising Covering healthcare costs has become all too common. In recent years, California has taken a number of steps to increase access to affordable health care. In particular, the expanded eligibility for public health insurance through the Affordable Care Act (ACA) has significantly reduced the financial hurdles for the necessary care. Following Governor Newsom’s proposal Expand access to health care to all CaliforniansLet’s look at some longer-term implications of the 2014 Medi-Cal expansion in the state, with a focus on financial barriers to supply.

The ACA extended Medicaid (known as Medi-Cal in California) to most low-income adults in participating states. Numerous studies of the Medi-Cal expansion have shown that it has reduced health care costs, financial worries and even debt collections and bankruptcies. But the program also lowers financial hurdles for the necessary health care.

In those California counties with high uninsured rates in 2013—places that benefited most from Medi-Cal’s expansion—families were less likely to delay needed care because of cost concerns compared to families in other areas. Between 2014 and 2018, this represented an average reduction of around 25% in delays in needed care. Moreover, this effect has increased over time.

Despite Medi-Cal’s effectiveness in reducing financial burdens and improving access to healthcare, enrollment has been lower than expected during the pandemic: data continues Medi-Cal applications during the COVID-19 period tend to have fewer new applications than in 2019. Nevertheless, Medi-Cal registration has grown steadilyprobably because the state Logout paused during the public health emergency.

Figure - Medi-Cal registration has increased during the pandemic

The state is taking several additional steps to improve healthcare for low-income Californians. For example, Medi-Cal coverage has been expanded to low-income children and young adults up to the age of 26regardless of immigration status and low-income Adults over 50 Persons without satisfactory immigration status are eligible from May 1st.

The state is also starting its newly approved, ambitious CalAIM plan Integrate Medi-Cal with social services to improve care for the most vulnerable, low-income individuals. In addition, the recently established Office of Health Care Affordability aims to improve healthcare cost transparency – and ultimately reduce the cost of quality healthcare.

At the federal level new safeguards against surprise medical bills will alleviate some of the financial uncertainty associated with seeking medical care. All of these initiatives have the potential to build on the success of ACA expansion by reducing financial barriers to care.

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Disclaimer: The findings and conclusions in this post are those of the author and do not necessarily represent the views of the Research Data Center, the National Center for Health Statistics, or the Centers for Disease Control and Prevention.

ERB Approval: Data collection for the National Health Interview Survey was approved by the NCHS Research Ethics Review Board. The analysis of anonymized data from the survey is exempt from the federal regulations for the protection of people involved in human beings. Analysis of restricted data by the NCHS Research Data Center is also approved by the NCHS ERB.

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