Federal health law has cut uninsured in California by 72%

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More than 70 percent of California residents who were uninsured before the Affordable Care Act went into effect now have coverage, even though some worries about costs and access to medical care persist, according to a study released Thursday.

The study, the fourth in a series of surveys of Californians who did not have health insurance in 2013, found that 72 percent have since obtained coverage, either through their employer, the state exchange created by the federal health law or through Medi-Cal, the state’s Medicaid program for the poor. This number is slightly higher than the 68 percent reported last year, a gain that represents hundreds of thousands of newly insured Californians. The state had the largest number of uninsured in the country, with about 6 million residents lacking coverage in 2013.

“People are largely getting their coverage, and they are keeping their coverage,” said Bianca DiJulio, associate director of public opinion and survey research for the Kaiser Family Foundation, a nonprofit health policy research organization in Menlo Park.

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The foundation has been following more than 1,000 Californians who lacked health insurance in September 2013, before the exchange and the major reforms in the health care act went into effect, through the past three open enrollment periods, the latest of which ended Jan. 31.

The survey found that the largest share of the previously uninsured study participants — about a third — received coverage through Medi-Cal, which was expanded to include more people under the federal law. About 21 percent obtained coverage through an employer and 11 percent bought coverage through the state exchange, called Covered California, which has about 1.6 million members.

While those recently insured Californians were more likely to say their health needs are being met and that they are less worried about paying their medical bills, more than half reported that they still worry about paying bills in the event of a medical crisis. One in 5 respondents said they did not get medical care at some point during the past year because of the cost.

The pain of high costs is only expected to get worse next year with sharp increases in premiums projected for plans sold through the Affordable Care Act for coverage starting in 2017.

Covered California’s premiums are expected to rise by an average of more than 13 percent, a jump that follows two years of modest 4 percent increases. That rise is largely due to projected hikes averaging 17.2 percent for Anthem, which sells Blue Cross plans in the state, and 19.9 percent for Blue Shield of California. Other insurers are planning more modest increases.

The two largest plans sold through California’s exchange have blamed higher-than-expected use of medical services by members and rising drug costs for forcing them to bump their rates. Similar claims have sparked disruption in plans offered in the exchanges nationwide and prompted even higher premium increases — as high as 40 to 60 percent — by some plans in other states.

Aetna, which never participated in Covered California, announced earlier this week it would drop out of selling coverage in the exchanges in all but four states because it was losing money on that part of the business. This follows decisions by other plans, including UnitedHealthcare and Humana, to scale back their offerings in the exchanges.

While that’s clearly not good news for the central health policy reform of the Obama administration, the Kaiser Family Foundation’s DiJulio noted that Covered California accounts for about 1 in 10 newly insured residents.

“While they’re a very important piece, the exchanges are really only one piece of the insurance picture,” she said. “At least in California, the Covered California piece is a relatively small share of those who are new to coverage.”

Under the Affordable Care Act, employers with more than 50 full-time employees have to offer health benefits or pay a tax penalty. On top of that, since the passage of the act, California’s unemployment rate declined from 8.5 percent to 5.4 percent.

San Francisco resident Liza Brown, who has participated in the Kaiser Family Foundation survey for the past four years, was relieved to finally obtain employer-backed coverage this spring when she got a new full-time job.

Brown, 54, had been uninsured, but said she was able to get medical care through the San Francisco Free Clinic, where she described the services, which included screenings and some preventive care, as “top notch.”

While she was self-employed, Brown opted not to buy insurance through Covered California and acknowledges that she was taking a risk. Still, she said, she supports the expanded options made possible by the federal health law. “People I know who wouldn’t have gotten covered were able to get coverage,” she said. “I would have been one of them if I didn’t have that great free clinic nearby.”

Once people get coverage, they are likely to keep it, the survey found. Among the 70 percent of previously uninsured Californians who had gone without coverage for at least two years prior to 2013, two-thirds had coverage for at least a year and nearly half of that group kept it longer.

Still, about 27 percent of those in the survey remained uninsured, a figure that includes about 10 percent of participants whom researchers believe are probably not residing in the state legally. They are ineligible for standard Med-Cal and are barred from buying insurance in the exchange.

That leaves about 17 percent who are potentially eligible for some form of coverage. When asked why they remain uninsured, 47 percent of the uninsured said insurance is too expensive and 19 percent cited “eligibility concerns.”

The latest and final round of interviews for the survey, which has been supported by a grant from the California Endowment, was conducted between Feb. 10 and June 20 with about half the participants in the original 2013 survey. The survey’s margin of error of plus or minus five percentage points for the newly insured raises to nine points for those who remain uninsured.

Victoria Colliver is a San Francisco Chronicle staff writer. Email: vcolliver@sfchronicle.com Twitter: @vcolliver