Trends in Health Insurance Coverage in California, 1989-1993

Abstract

California's uninsurance rate of 22.7 percent is higher than the national average. The state's rate of employment-based insurance coverage-below the national average-is declining because of rising health insurance premiums, falling family incomes, and the changing structure of the economy and the labor market. Growing Medicaid coverage, fostered by expanded eligibility and falling incomes, has prevented rapid growth in the state's uninsured population. Anticipated cutbacks in federal Medicaid funding, however, would increase California's uninsurance rate. Continuing cut- backs in health services for the uninsured would reduce their access to health care and increase stress on many private health services. C alifornia's uninsurance rate has persistently exceeded the national average. Compared with the nation as a whole, a relatively smaller and declining proportion of California's population is covered by employment-based health insurance. Expansion of Medicaid eligibility has offset declining employment-based health insurance, slowing growth of the state's uninsured population and improving access to care for pregnant women and young children. Cutbacks in Medi-Cal (California Medicaid), however, together with changes in the health care market, are likely to increase California's already high uninsurance rate. Increases in the number of uninsured persons, coupled with cutbacks in state and local health services for the medically indigent, are likely to reduce access to health services for this population and strain resources, even for persons with insurance. This DataWatch examines changes in health insurance coverage in California between 1989 and 1993, focusing especially on lack of insurance, employment-based health insurance, and Medi-Cal in relation to family work status. The analyses describe changes over time within California and in comparison with the United States as a whole. Study methods. The March 1990 and March 1994 Current Population Surveys (CPS) were used to develop estimates for California and the United States. The U.S. Census Bureau, which conducts the CPS, inter- views a rotating sample of approximately 60,000 households nationwide,