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Using data to deepen the statehouse policy conversation on California’s uninsured

Topics in Health: Lessons From The Field

Using data to deepen the statehouse policy conversation on California’s uninsured

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Kate Green is a 30-year-old who’d rather roll the dice without insurance than face steep out-of-pocket costs. (Photo by Autumn P
Kate Green is a 30-year-old who’d rather roll the dice without insurance than face steep out-of-pocket costs.
(Photo by Autumn Payne/courtesy)

After Gov. Gavin Newsom took office he quickly assumed the unofficial role of California’s “health care governor,” which meant a flurry of progressive proposals aimed at expanding health insurance to millions more in the state.

Out the gate, Newsom wanted to extend Medi-Cal, California’s version of the state-federal Medicaid program, to more undocumented immigrants, increase subsidies for middle-income residents and penalize those who forgo buying insurance.

What we didn’t know was how these initiatives could shape the lives of working residents already strained by a high cost of living and rising housing prices. As members of the USC Center for Health Journalism’s News Collaborative participating in its “Uncovered California” project on the state’s uninsured, we had an opportunity to help answer these questions. We turned to data — on at least a few occasions — for the answer.

California has cut its uninsured rate dramatically since the federal Affordable Care Act was passed. More than nine out of every 10 people in the state have some form of insurance, according to the U.S. Census Bureau. But the estimate leaves out the many undocumented people who reside in the state. A ballpark figure provided by UCLA and UC Berkeley suggests the real number is closer to 3.5 million people.

We directed our attention first to California’s proposed tax penalty. The controversial federal version of the tax was scrapped in 2017 by GOP lawmakers and President Donald Trump’s administration.

It was supposed to be an incentive for people to buy insurance. Without it, many feared Covered California, the state-run insurance marketplace, would go into freefall.

It turns out the Internal Revenue Service has been keeping detailed data on the types of people who have paid the penalty since 2014; how much money they make and even the ZIP code where they lived. The data could be useful for other reporters if their state decides to follow California and Massachusetts and reinstate their own penalty for going without insurance. 

In 2016, nearly 600,000 Californians paid a penalty, the most recent year for which data is available. Nearly three in four of those people earned less than $50,000 in gross income, our analysis of IRS data showed.

Our work didn’t stop there. We talked to key lawmakers and rounded out the story with an anecdote from a 30-year-old who’d rather roll the dice without insurance than face steep out-of-pocket costs. 

It represented a gamble many seemed willing to take. The data added a new dimension to the conversation about inequality in California. Newson ultimately signed the bill —  along with many others —  into law and the state’s penalty begins next year. There are exemptions for some, but it will be interesting to see if it continues to disproportionately impact lower-income residents.

We encountered a different problem when reporting on the state’s existing laws. Measuring the effect of the benefits already extended to undocumented children under 18 could offer a window into the effect of expanding such benefits to older immigrants. But finding public data proved difficult.

The state has not been tracking the impact of the 2016 law that extended Medi-Cal to all eligible children under age 18, regardless of their legal status. Even so, lawmakers still were working to expand the policy to undocumented young adults. Our story also relied on a state audit of the Medi-Cal program, which found that many kids, regardless of immigration status, were enrolled but not actually accessing health services.

Interviews with key health policy experts, lawmakers and community health organizations helped fill in the gaps. In stories about Medi-Cal’s expansion and the role of school-based health centers, we were able to better understand how expanded eligibility was playing out on the ground. 

These stories only scratched the surface and there’s plenty more that could be done. Reporters looking to follow up on the state’s legislative efforts would do well to check for new data as the portrait of California’s uninsured keeps changing.

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