California is one of two dozen states preparing to dramatically expand Medicaid (called Medi-Cal in California), the federal-state insurance program for the poor.
But the survey found only half of newly eligible low-income Californians assume they will qualify. The nonpartisan Kaiser Family Foundation surveyed some 2,000 uninsured Californians from mid-July until the end of August, a summertime lull before a burst of planned advertising and outreach efforts.
"There is a lot of confusion about the messaging in the news and at the federal level," said Sonya Vasquez, policy director for Community Health Councils, a Los Angeles-based group that is part of a statewide enrollment effort getting underway. "With the enrollment program, that is going to shift."
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The cost of health coverage will likely be a key factor in the law's adoption: The survey found 57 percent of California's uninsured say they have little financial security, and 64 percent report forgoing needed medical care because of cost, including skipping recommended treatments and leaving prescriptions unfilled.
"Having health insurance is important, but economically it was not possible," said survey respondent Lissette Melgar, 46, who has been uninsured since her divorce five years ago. "I began to have a pain in my back, and I need health insurance for this." Melgar, who lives in Tracy (San Joaquin County), will likely qualify for Medi-Cal given her low income. She said, in Spanish, that she understands the health care system is changing, "but (I) don't know how."
The state's health insurance marketplace, Covered California, began airing television advertisements in several small markets earlier this month, and expects to be on the airwaves in major markets, such as Los Angeles, in October. Anxiety over the cost of coverage "reminds us that we have to push forward on the message that the plans are affordable," Vasquez said, "and some people may not have to pay hardly anything, if at all" if they qualify for subsidies.
Health policy experts were buoyed by the uninsured's strong desire for coverage: Eight in 10 of those eligible under the Affordable Care Act’s coverage expansion feel they need health insurance and 57 percent believe health insurance is worth the money. "That tells me that people do value health coverage and will take action to get themselves covered if it's affordable," said Michael Cousineau, a professor at the University of Southern California's school of medicine. "I just don't think it's going to happen overnight."
Undocumented immigrants have misplaced expectations of the Affordable Care Act, according to the survey. The law specifically forbids illegal immigrants from buying insurance in the state exchanges, and they are already barred from enrolling in Medi-Cal. Yet the survey found 49 percent believe they may qualify for Medi-Cal and 43 percent expect to shop for coverage on the exchange.
Sindi Duarte, an undocumented immigrant from Antioch, has not seen any ads about the coverage expansion. "I don't know much about it," said Duarte, 19, who was born in Guatemala and entered the United States with her parents when she was 2. She recently received a permit to remain in the U.S. under an immigration policy adopted last June by President Barack Obama, and in April was diagnosed with multiple sclerosis. She is receiving some care for her condition, but has no health insurance. She is uncertain if the law will help her. "I thought I was (eligible for insurance), but I’m not completely sure."
The survey is unusual in that the foundation expects to track the same pool of people, who are entering the open enrollment period uninsured, for as long as two years to assess the effectiveness of the Medi-Cal expansion and Covered California, the new insurance marketplace meant to ease the burden of buying health coverage.
"Only through a poll like this can we see what Obamacare means for real people," said Mollyann Brodie, director of public opinion and survey research at the foundation. "Is it impacting their lives? Is it helping or not? What's working and not working about the law?"
Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the Kaiser Family Foundation.
