In 2007, nearly 14 percent of Californians reported they were unable to see a doctor when necessary due to cost. Between 2003 and 2009, health insurance premiums for California families increased by 39 percent. Individuals saw an even greater increase with premiums rising 41 percent, according to the Common Wealth Fund.
Who are the uninsured in California?
Of the Californians who have health insurance, 45 percent are covered through their employer, six percent purchase individual private policies, and 30 percent rely on public programs such as Medicaid and Medicare for their health insurance. This leaves approximately 20 percent of the population, 7.3 million people, uninsured in California. 
California’s children are uninsured at a rate of 11 percent; among adults younger than 65, 26 percent lack health insurance. The rate of uninsured rises for households with incomes less than 139 percent of the Federal Poverty Level. Children in these homes are uninsured at a rate of 18 percent, and 46 percent of non-elderly adults in these lower income households have no health insurance. Among the Hispanic population, 30 percent lack health insurance. The uninsured rate for Black Americans is 18 percent, and 14 percent for the White population. 
How does the Affordable Care Act affect Californians?
The Affordable Care Act (ACA) requires states provide access to an online marketplace where individuals and small businesses may compare, select and purchase private health insurance policies that offer a minimum level of coverage. States have the option of establishing their own exchange, operating an exchange in cooperation with the federal government, or turning all administration of the health care marketplace over to the federal government.
In September 2010, Governor Arnold Schwarzenegger signed legislation that made California the first state in the nation to create its own health care exchange. The state received conditional approval for its plan from the Department of Health and Human Services in January 2013.
Under the ACA, all new policies, and in-force policies upon renewal, must cover a core of essential health benefits, including hospitalization, emergency services, and mental health treatments. Annual wellness check-ups and other preventative screenings must be covered with no co-payments or deductibles. Residents may not be denied health insurance for pre-existing health conditions, and insurers may not place a lifetime cap on benefits. Households with incomes at or below 400 percent of the Federal Poverty Level may be eligible for tax credits to offset premium costs.
The ACA Shared Responsibility provision requires all citizens, with few exceptions, have health insurance. The penalty for non-compliance in 2014 is one percent of annual income up to $95. The penalty increases in subsequent years.
California’s health insurance exchange
The California exchange, called Covered California, is the portal through which California’s residents and small businesses may purchase health insurance policies. Covered California operates as an independent government agency and selects insurance policies for inclusion in the exchange as active purchasers, meaning the exchange will select policies that meet quality and cost standards. This is in contrast to a clearinghouse model, which allows all qualified plans to compete in a state’s exchange.
Covered California has selected 13 health insurance companies to offer individual plans in the exchange: 
- Alameda Alliance for Health
- Anthem Blue Cross of California
- Blue Shield of California
- Chinese Community Health Plan
- Contra Costa Health Plan
- Health Net
- Kaiser Permanente
- L.A. Care Health Plan
- Molina Healthcare
- Sharp Health Plan
- Valley Health Plan
- Ventura County Health Care Plan
- Western Health Advantage
As required under the ACA, policies will be assigned to one of four levels, which determine the percent of health care costs covered under the plan. At the bronze level, insurers are responsible for 60 percent of costs, the silver level covers 70 percent, gold level covers 80 percent and platinum covers 90 percent. Policies with lower levels of coverage will have lower premiums.
California requires all insurers participating in Covered California offer at least one policy in each of the four-coverage levels and catastrophic coverage for adults younger than 30.  The California exchange also offers stand-alone pediatric dental and vision policies.
Only legal residents of California who do not have access to affordable health insurance through an employer or a government program will be allowed to purchase insurance through the Covered California exchange. The California exchange is open for enrollments from October 1 offering health insurance policies effective January 1, 2014.
Small Business Health Options Program (SHOP)
Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.
Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.
For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. California small business owners may access SHOP through California’s health insurance exchange.
Free or low-cost health care
Medi-Cal, California’s Medicaid health program, provides free medical services for low-income adults and children. Beginning January 1, 2014, the state’s program expands to include households that may have been ineligible in the past. Under the expanded program, individuals with annual incomes less than $15,856, and families of four with household incomes less than $32,499, will be eligible. Applications for Medi-Cal may be completed online at E-Benefits of California or in-person at a county Department of Social Services. For more information about Medi-Cal, contact the California Department of Health Care Services (DHCS) at (916) 445-4171.
Where to get enrollment assistance in California
California has initiated an Assisters Program to train and certify individuals and organizations to provide culturally and linguistically appropriate in-person enrollment assistance. Assistants will work with a community outreach network of health care centers, faith-based organizations, labor groups, employers, pharmacies and advocacy organization.
- To request enrollment assistance: visit Assistance request.
- For plan pricing purposes, California is divided into 19 regions. For information about health plans and rates by region, visit Cover California Health Plans.
- To estimate your health insurance costs and eligibility for tax credits, visit Health Insurance Cost Calculator.
External resources for California residents
- Covered California
- California Department of Insurance
- California Healthcare Foundation
- Centers for Medicare & Medicaid Services
- Cover USA.org
- The Kaiser Family Foundation
- State Refor(u)m
Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.