Who's Left Out of the ACA? Reporting On the Remaining Uninsured

We’ve heard the prediction: as the Affordable Care Act rolls out, millions of previously uninsured Californians are expected to gain health coverage.  We’ve heard stories, especially from other parts of the country, of people frustrated with enrollment processes, and heard that in California, over 500,000 people signed up for insurance using Covered California.  What I haven’t heard as much about, though, are the people who are left out, and the institutions working to help them.  When the ACA is fully implemented in 2019, as many as four million people in California may remain uninsured, and these Californians are more likely to be undocumented, Latino, poor, or some combination of the above. 

Read about the projects of other 2014 California Health Journalism Fellows.

I’m really curious about the stories behind this last prediction, who are the people most impacted.  Public radio’s a great medium for contextualizing policy through individuals’ stories.  So, for my fellowship, I’ll be producing three audio pieces featuring Californians excluded from the ACA, those who otherwise don’t have access, and the people who staff institutions which serve them. 

Undocumented people are the one group explicitly excluded from federally-funded health coverage under the ACA; in five years there may be as many as one million undocumented Californians without insurance.  I’ll profile one or two undocumented Californians, exploring their health care needs, and addresses how they’ve been served before the ACA and what care they’re receiving now.  State Senator Ricardo Lara has introduced the Health for All Act, legislation which would allow undocumented Californians to qualify for coverage, so I’ll be following the progress of that bill.

When I first began looking into the issue of the remaining uninsured, I was surprised to learn that as many as three million other Californians who have citizenship or legal immigration status are also predicted to lack insurance in five years.  Most of these are people who are eligible but who haven’t enrolled because they lack access or awareness or because, even with subsidies, they can’t afford coverage.  I’ll be working to profile people with compelling stories who fit into one or more of these categories.

Finally, I’m interested to learn how clinics with a large clientele likely to remain uninsured are working with the new system (and new ways of financing).  I’ll head out to a network of clinics to learn about budget changes, relationships with the county, and populations clinics continue to serve.  I also plan on exploring differences in care between California counties, and efforts by some law-makers and advocates to generate funds for community health clinics and hospitals which serve the remaining uninsured.