California is one of the most generous states in terms of funding for getting the uninsured, particularly children, enrolled in health programs. But Healthy Families, which is supposed to help fill in the gap between Medical (California's Medicaid program) and those who can afford insurance, has had a fairly low adoption rate.
Take this stat from the LA Times article:
About two-thirds of the uninsured children in California could, if only they'd apply, qualify for Medi-Cal or Healthy Families, according to the UCLA Center for Health Policy Research.
italics mine. But that's exactly the problem. Take a look at this chart with the income guidelines for Healthy Families eligibility. They sure as hell don't make sense to me, let alone your average low-income worker (assuming they found this website period). We haven't made it particularly easy for people to sign up, and in the place of an immediate punishment for not doing so, low adoption of programs is what you get.
This Health Affairs article is a great place to start if you want to learn more about the insane and illogical income requirements for Medicaid enrollment. Authors Etheredge and Moore found that Medicaid defines twenty-eight different categories of people and allows states to cover up to twenty-one optional eligibility groups. And keep in mind that your average American has no conception of how Medicaid actually works -- the majority think that if you're poor and unemployed, you can go sign up. Sure, if you're poor, pregnant, work x hours per week, have x children...
While a Medicaid overhaul is necessary and would make a huge difference in terms of getting people into health insurance, it's not politically favorable. A call to remake our nations health system for the poor, with no mention of the plight everyone else faces with rising premiums, would not be greeted well.
That's why I've always felt one of the key ways to proceed needs to be an insurance mandate. Until people are fiscally punished for not enrolling in insurance, they will have a million reasons to remain uninsured. Now, any mandate must be accompanied by a floor of care opened to everyone, whether that's an extension of FEBHP or a "Medicare for the rest" kind of arrangement; we have to offer a lower-cost option than many families have now. But in the absence of a mandate that every citizen be enrolled in health insurance, we'll continue to see less than desirable enrollment rates in programs like Healthy Families. Simplification of enrollment procedures would help, but there will always be a portion of families who won't enroll without more immediate disincentives.