Who Can Participate in the California

About 1.71 million nonelderly Californians were uninsured for all or part of 2009 and are estimated to be eligible to participate and receive subsidies in the new California Health Benefit Exchange marketplace under the Patient Protection and Affordable Care Act (ACA) of 2010. Another 737,000 are currently insured with individual policies and will also be eligible for participation in the Exchange based on their employment, income and citizenship status. This policy brief examines the characteristics of these Exchange-eligible with subsidies groups, based on 2009 California Health Interview Survey data. Among the findings, these Exchange-eligible populations alifornia has established the California Health Benefit Exchange in compliance with the Patient Protection and Affordable Care Act (ACA) of 2010. Premium and cost-sharing subsidies are offered to eligible individuals under 65 who earn between 133% and 400% of the federal poverty level (FPL) and those with lower incomes who do not qualify for Medi- Cal.1,2 The ACA also restricts the ability to purchase insurance through the Exchange to citizens and legal permanent residents who are not incarcerated. An estimated 1.71 million Californians were uninsured for all or part of 2009 and are estimated to be eligible to participate in the Exchange with subsidies. Another 737,000 legal California residents insured through privately-purchased individual policies in the past year will also be eligible to participate in the Exchange with subsidies. Subsidies are tax credits, vary by income level, and can be used towards premiums or cost-sharing. It is not possible to accurately predict how many Californians will participate in the Exchange as implementation details are currently in development and market dynamics are anticipated to change by 2014.3,4 This brief does not predict who will participate in the Exchange, but uses the latest available estimates from the 2009 California Health Interview Survey (CHIS 2009) to estimate the size and characteristics of the uninsured and individually-insured populations who are eligible and can participate in the Exchange. are often single, young working-age adults, and are employed in small firms. Most are healthy and the prevalence rates of most chronic conditions are similar to those with employmentbased insurance. However, several indicators show poorer access to care for those who are uninsured. The characteristics of the Exchangeeligible with subsidies are likely to change by 2014 when the major provisions of the ACA are implemented. Nevertheless, these data indicate that the California Health Benefit Exchange is likely to improve access to care for the uninsured, and has the potential to improve coverage and access to care of those with individual policies