Health Policy Brief December 2019 Persistent Gap: Gender Disparities in Health Insurance and Access to Care in California Tara Becker and Susan H. Babey SUMMARY: Historically, men have been more likely to be enrolled in public health more likely than women to be uninsured, as insurance coverage, while men were more likely well as less likely than women to enroll in public to have coverage through an employer. The coverage. This policy brief examines gender gains in coverage changed the composition of differences in health insurance coverage and the uninsured and Medi-Cal populations. The access to care using data from the 2012-2016 socioeconomic status of Medi-Cal enrollees and waves of the California Health Interview Survey. of men who remained uninsured improved. Men By the end of 2016, following three years of were less likely than women to have contact full health insurance expansion due to the with the health care system, but they were also Patient Protection and Affordable Care Act less likely to report experiencing delays in care. (which went into effect on January 1, 2014), Though part of this difference could be due to just over 10% of both men and women had the greater difficulty Medi-Cal enrollees face gained coverage, leaving the gender gap in in accessing care, these gender disparities are uninsured rates intact. These gains in coverage also present by health insurance coverage type, were predominantly the result of increased suggesting that they cannot be eliminated enrollment in Medi-Cal. Women remained solely by expanding health insurance coverage. P rior to the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, nonelderly adult women of children under age 18, low-income pregnant women, extreme poverty, and disability. Because women face a gender gap in employment and (ages 18-64) in California were more likely income and are more likely to have custody of than similarly aged men to have health young children, they are more likely to meet insurance coverage. Women were more the eligibility requirements for Medi-Cal. likely than men to qualify for and enroll in The ACA expanded Medi-Cal coverage to all public health insurance programs, such as low-income adults, regardless of parental or Medicaid.1 This gender gap in insurance disability status, and extended subsidies for coverage increased during the first year in purchasing private health insurance coverage to which the ACA’s coverage expansion was fully those with incomes below 400% of the federal implemented, as women were more likely poverty level (FPL).3 These changes provided an to gain coverage, predominantly through opportunity to reduce the gender gap in health higher enrollment in Medi-Cal, California’s insurance coverage by removing the child-based Medicaid program.2 and health restrictions for Medi-Cal and making private health insurance more affordable. Before the ACA’s coverage expansion, adults Support for this policy brief Barriers to accessing health care for those who was provided by a grant from were eligible for Medi-Cal under a limited are uninsured are well documented.4 Those The California Endowment. number of circumstances: low-income parents 2 UCLA CENTER FOR HEALTH POLICY RESEARCH Exhibit 1 Comparison of Insurance Coverage by Gender, Adults Ages 18-64, California, 2012-2016 100% 13.6% 12.9% 8.7% 90% 23.3% 18.8% 21.5% 80% 34.4% 70% 31.0% 43.6% 32.8% 60% 42.9% 44.2% 50% 13.1% 20.9% 40% 7.8% 8.5% 20.5% 30% 11.1% 7.5% 8.6% 11.4% 7.3% 20% 7.7% 31.4% 6.1% 23.2% 15.2% 23.3% 10% 10.0% 14.1% 5.1% 2.7% 4.3% 5.5% 3.3% 3.9% 0% 2012 2014 2016 2012 2014 2016 Men Women Uninsured ESI: Own Name ESI: Dependent Private Purchase Medi-Cal Other Public Source: 2012, 2014, and 2016 California Health Interview Survey Note: ESI refers to employer-sponsored insurance. enrolled in public health insurance programs, experience larger coverage gains than men after such as Medi-Cal, also face greater difficulty the ACA expansion went into effect. Next, we accessing health care than those with private compare socioeconomic characteristics of men coverage.5 Because women are more likely than and women by type of health insurance coverage men to be enrolled in public coverage, they may to examine gender differences in composition experience greater difficulties accessing care, within insurance type, and to determine even though men are less likely to have health whether such compositional differences changed insurance coverage. However, the ACA changes after the ACA’s coverage expansion went into in Medi-Cal eligibility requirements could have effect. Finally, we assess gender differences changed the socioeconomic composition of both in access to care and examine whether these the uninsured and those who enrolled in Medi- differences changed over time. Cal. This could have led to improvements in Men and women experienced similar access among the Medi-Cal population that are decreases in uninsured rates under the due to changes in the socioeconomic status (SES) ACA’s coverage expansion. of that population rather than to improvements Though women were more likely to gain health in delivery systems.6 Similarly, by providing insurance in the first year of the ACA’s coverage access to health insurance for those with incomes expansion (2014), two years later, men’s gains below 400% FPL, the ACA could also have had caught up (Exhibit 1). In 2012, prior to changed the composition of the uninsured implementation of the ACA, the uninsured rate population by reducing the percentage of the was about five percentage points higher among uninsured who have lower SES. men (23.3%) than among women (18.8%). This policy brief extends previous analyses of Between 2012 and 2014, the uninsured rate gender differences in health insurance coverage among men did not change significantly, though among nonelderly adults in California by it dropped by nearly a third among women, examining whether women continued to UCLA CENTER FOR HEALTH POLICY RESEARCH 3 Socioeconomic Characteristics Within Insurance Type, by Gender, Adults Ages 18-64, Exhibit 2 California, 2012 and 2016 Uninsured Medi-Cal ESI: Any Source 2012 2016 2012 2016 2012 2016 Men Women Men Women Men Women Men Women Men Women Men Women Education <High School 28.6% 27.5% 30.1% 36.8% 32.5% 35.4% 29.0% 28.0% a 7.7% 7.7% 9.3% 5.1%* a High School 34.3% 24.4%* 30.1% 23.6% 33.2% 30.0% 30.2% 26.4% 22.2% 16.2%* 19.0% 15.7% Some College 22.7% 29.0%* 18.4% 18.8% a 24.2% 27.8% 25.2% 29.3% 22.7% 27.4%* 23.2% 21.6% a College Degree 14.4% 19.1%* 21.3% 20.8% b 10.1% 6.8% 15.6% 16.4% a 47.4% 48.7% 48.5% 57.7%* a Employment Status Full-Time (21+ hrs/wk) 60.9% 44.1%* 68.0% 47.0%* 45.8% 29.2%* 57.3% 41.3%* ab 82.8% 65.5%* 83.9% 69.1%* Part-Time/Other 10.5% 13.3% 10.6% 15.7% 8.7% 13.3% 11.3% 13.7% 5.4% 10.4%* 6.0% 10.4%* Unemployed 18.2% 15.5% 13.0% 8.2% a 19.3% 14.9% 10.5% 10.6% b 4.7% 4.8% 2.9% 2.5% ab Not in Labor Force 10.4% 27.2%* 8.3% 29.2%* 26.3% 42.6%* 21.0% 34.4%* a 7.1% 19.3%* 7.2% 18.0%* Income as Percentage of FPL Under 100% FPL 30.9% 30.8% 25.9% 31.0% 42.2% 57.2%* 37.9% 47.3%* a 3.8% 7.0%* 3.6% 3.2% a 100-199% FPL 32.5% 36.0% 23.4% 29.2% b 30.2% 28.0% 30.1% 29.9% 11.3% 12.2% 9.6% 9.2% a 200-299% FPL 16.0% 13.4% 23.1% 12.6% 16.2% 9.2%* 14.0% 9.9% 13.6% 12.4% 12.2% 13.3% 300-399% FPL 7.3% 8.3% 10.2% 6.6% 5.3% 2.7% 5.7% 6.5% a 13.5% 12.3% 12.1% 13.0% 400%+ FPL 13.3% 11.6% 17.4% 20.6% 6.1% 2.8% 12.2% 6.5%* b 57.9% 56.2% 62.6% 61.3% a Owns Home 33.9% 40.4%* 29.9% 43.4% 33.8% 22.8%* 30.8% 29.1% 68.4% 71.5% 62.9% 69.1%* b * The difference between men and women is significant at p<0.05. Note: FPL refers to the federal poverty level, and ESI refers to a For women, the change between 2012 and 2016 is significant employer-sponsored insurance. at p<0.05. Source: 2012 and 2016 California Health Interview Survey b For men, the change between 2012 and 2016 is significant at p<0.05. from 18.8% to 12.9%. By 2016, however, employer decreased over this period, but trends the uninsured rate had dropped significantly differ by source (own vs. dependent coverage). among men, to 13.6% — nearly 10 percentage Coverage received through one’s own employer points lower than it had been in 2012. Among remained steady over the period. The drop in women, the uninsured rate also dropped about employer-sponsored coverage (ESI) was driven 10 percentage points from 2012, to 8.7%. The primarily by a decline in dependent coverage. uninsured rate for men in 2016 remained about The percentage with ESI dependent coverage 5 percentage points higher than that for women. decreased from 11.4% to 7.8% among men and from 20.5% to 13.1% among women. This Decreases in uninsured rates were driven decline in dependent ESI coverage for women by higher enrollment in Medi-Cal among was more than compensated for by the increase both men and women. in coverage through Medi-Cal. Though the ACA provides subsidies to purchase health insurance on the private insurance Socioeconomic Characteristics of Men and market, the gains in coverage for both men and Women by Insurance Type women between 2012 and 2016 were driven Most of the change in insurance coverage by increased Medi-Cal coverage. Between between 2012 and 2016 was due to changes 2012 and 2016, the percentage enrolled in in the uninsured and enrollment in Medi-Cal Medi-Cal increased by nearly 16 percentage and ESI; therefore, in this section our focus is points among women (from 15.2% to 31.4%) on the SES characteristics of these insurance and by 13 percentage points among men types (Exhibit 2). Characteristics of those with (from 10.0% to 23.2%). Coverage through an private purchase coverage, ESI coverage in 4 UCLA CENTER FOR HEALTH POLICY RESEARCH their own name, and dependent ESI coverage Decline in ESI coverage post-ACA can be found in the online Appendix (https:// accompanied by increased SES among healthpolicy.ucla.edu/publications/search/pages/detail. women with ESI aspx?PubID=1916). In 2012, nonelderly adult men and women Socioeconomic status of uninsured men with insurance coverage through their employer improved after ACA expansion had similar SES levels. Among those with ESI, the proportions of men and women who In 2012, before the health insurance expansion had a college degree, whose income was above went into effect, uninsured men generally had 400% FPL, and who owned their homes were a lower SES than uninsured women. Uninsured similar. However, men with ESI were more men were less likely than uninsured women to likely than women to be employed for 20 or have attended or graduated from college (37.1% more hours per week (82.8% vs. 65.5%), and vs. 48.1%) and to own their home (33.9% vs. women were more likely to have household 40.4%). By 2016, the SES characteristics of incomes below the poverty line. After the uninsured men had improved, while those of ACA’s health insurance expansion went women remained mostly unchanged. Uninsured into effect, ESI declined due to a reduction men were as likely as uninsured women to have in dependent coverage, particularly among attended or graduated from college (39.7% women. Consistent with this, we saw significant vs. 39.6%). The proportion of uninsured men increases in SES between 2012 and 2016 among with income below 200% FPL decreased from women with ESI coverage. In 2016, among 63.4% to 49.3%. those with ESI, women were more likely than SES higher for both men and women men to have a college degree (57.7% vs. 48.5%) enrolled in Medi-Cal after ACA expansion, and to own their own home (69.1% vs. 62.9%). but still lower for women than men By 2016, household income had increased Among adults enrolled in Medi-Cal in 2012, among women with ESI coverage, erasing the women had lower SES than men. Women gender gap that had been present in 2012. enrolled in Medi-Cal were more likely than Taken together, the increases in socioeconomic men to be out of the labor force (42.6% vs. status among those with ESI are consistent 26.3%) and to be living in poverty (57.2% with the hypothesis that the decline in ESI vs. 42.2%). They were less likely to own their coverage was driven by the increase in available own home (22.8% vs. 33.8%). In 2016, after alternatives to dependent coverage for those the Medi-Cal expansion, both men and women with incomes below 400% FPL after the ACA enrolled in Medi-Cal had higher SES than in was fully implemented. 2012; education, employment, and income all increased among both men and women. This increase in socioeconomic status among men and women left the 2012 gender differences within this population intact. UCLA CENTER FOR HEALTH POLICY RESEARCH 5 Gender Differences in Access to Care, Adults Ages 18-64, California, 2012 and 2016 Exhibit 3 2012 2016 19.3% Women ED Visit in Past Year 23.0% 16.5% Men 20.8% 15.4% No Doctor Women Past Year 15.7% Visit in 30.3% Men 26.7% 15.1% Women No Usual 14.5% of Care Source Men 25.0% 25.9% 0% 5% 10% 15% 20% 25% 30% 35% Source: 2012 and 2016 California Health Interview Survey Gender Differences in Access to Care increased significantly between 2012 and 2016. The growth in health insurance coverage did However, there was no change among men not always lead to improvements in access to overall, because many uninsured men gained care, nor to decreases in gender disparities in coverage through Medi-Cal during this period, access (Exhibit 3). Men reported weaker ties and the percentage of Medi-Cal enrollees who and fewer contacts with the medical system lacked a usual source of care was lower than than women, both overall and within health the percentage of uninsured men who lacked a insurance coverage type. This was true in both usual source of care. 2012 and in 2016, after the health insurance Men More Likely Than Women to Report expansion had taken hold. No Doctor Visit in the Past Year Men More Likely Than Women to Have No Men were more likely than women to report Usual Source of Care that they hadn’t visited a doctor in the past Men were less likely than women to have a year. The gender gap narrowed slightly between usual source of care, and this did not change 2012 and 2016, from 14.9 percentage points to between 2012 and 2016. About one-fourth of 11.0 percentage points, because the percentage the men (approximately 25%) reported they of men with no doctor visits in the past year did not have a usual source of care at both significantly decreased — from 30.3% to time points, compared to roughly 15% of 26.7% — while the percentage of women women. The gender gap was largest among the remained at about 15.5%. A gender gap was uninsured, who were the least likely to have a apparent within each insurance type in both usual source of care at both time points, and years, but the largest gender gap occurred smallest among those with ESI, who were the among the uninsured, who also were the least most likely to have a usual care source at both likely to have visited a doctor in the past year. time points (data by insurance type are not The overall decline among men was due in part shown but are available in the online Appendix: to declines in the uninsured rate, which shifted https://healthpolicy.ucla.edu/publications/search/pages/ more uninsured men into Medi-Cal, where they detail.aspx?PubID=1916). The percentage of were more likely to have had at least one doctor men with ESI who had no usual source of care visit in the past year. 6 UCLA CENTER FOR HEALTH POLICY RESEARCH Exhibit 4 Gender Differences in Delays in Care, Adults Ages 18-64, California, 2012 and 2016 2012 2016 Prescription Medical Care 17.1% Women Receiving Delayed 15.2% 14.0% Men 10.7% 14.2% Women Delayed Filling a 12.2% 10.0% Men 8.4% Prescription Medical Care 10.2% Due to Cost Due to Cost Women Delaayed 6.8% Men 8.7% 4.7% Women 7.2% Delaayed 6.2% Men 5.1% 3.6% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% Source: 2012 and 2016 California Health Interview Survey ED Visits Higher in 2016 Than 2012 both 2012 and 2016. Although delays in care Among Both Men and Women declined somewhat among both women and Overall, both men and women were more men, men generally experienced slightly greater likely to have visited the ED in 2016 than in improvements. 2012. Among men, the percentage who visited Women More Likely to Report Delaying the ED in the past year increased from 16.5% Care, Despite Declines in Delays of Care to 20.8%; among women, the percentage Between 2012 and 2016 increased from 19.3% to 23.0%. Women were Women were significantly more likely than more likely than men to report visiting the ED men to report that they had delayed needed in 2012, but not in 2016. Men and women medical care in the past year (15.2% vs. who were enrolled in Medi-Cal were more 10.7% in 2016). The gender gap remained likely to have visited the ED in the past year relatively stable between 2012 and 2016. Both than those who were either uninsured or had men and women experienced a decline over ESI throughout the period. The overall increase this period, but only the decline among men between 2012 and 2016 was most likely due to was statistically significant. The uninsured the increased enrollment in Medi-Cal in 2016. were less likely to report delaying medical care Gender Differences in Delays in Care in 2016 than they were in 2012, regardless of Though men have fewer ties to the health gender (data by insurance type are not shown care system and are less likely to be insured, but are available in the online Appendix: women are more likely to report experiencing https://healthpolicy.ucla.edu/publications/search/pages/ delays in care (Exhibit 4). This was true in detail.aspx?PubID=1916). Because of this, by UCLA CENTER FOR HEALTH POLICY RESEARCH 7 2016, Medi-Cal enrollees had become the most Discussion likely group to have delayed medical care. When fully implemented in 2014, the Women More Likely to Report Delays in Affordable Care Act opened new health Filling a Prescription insurance options to many Californians. As a result, millions of uninsured Californians Women were significantly more likely than signed up for Medi-Cal or private purchase men to report that they had delayed filling health insurance coverage through California’s a prescription in the past year at both time private health insurance exchange, Covered points. The proportion of women who delayed California. Many Californians who had filling a prescription was approximately 4 previously received employer-sponsored percentage points higher than the proportion dependent coverage through a parent or spouse of men in both 2012 and 2016. Among those shifted to less expensive coverage through with either Medi-Cal or ESI, women were Medi-Cal or the private purchase market. significantly more likely to have delayed filling Both men and women benefited from these a prescription in 2012. coverage expansions in similar ways. Because Both Women and Men Experienced Declines of this, the gender gap in coverage observed in Delaying Medical Care Due to Cost prior to implementation of the ACA remained There was no difference between men and in 2016. Men continued to be more likely to women in the percentage who delayed medical be uninsured, and women continued to be care due to cost. Between 2012 and 2016, more likely to enroll in public health insurance both men and women experienced a significant coverage programs, such as Medi-Cal. Among decrease in cost-based delays in medical care, Californians who remained uninsured in with a decline from 8.7% to 4.7% for men and 2016, men were less likely to meet eligibility 10.2% to 6.8% for women. The percentage of requirements for Medi-Cal,7 suggesting that the uninsured who delayed medical care due further efforts to increase enrollment in that to cost decreased by 11.1 percentage points program under current eligibility rules will among both men and women. The percentage not eliminate the gender gap in coverage. of Medi-Cal enrollees who experienced a cost- Instead, it appears that reducing the gender based delay in medical care declined by 6.0 gap will require expanding access to affordable percentage points. coverage either through the private market or through the expansion of eligibility Women Were More Likely to Experience a requirements for public programs. Delay in Filling Prescriptions Due to Cost in Both 2012 and 2016 The increases in health insurance coverage did not substantially alter gender differences Women were more likely than men to in most measures of health care access and experience delays in filling a prescription due utilization. Both before and after the coverage to cost at both time points. The percentage expansion, women were more likely than men of men who experienced a delay in filling to have a usual source of care and to have visited a prescription due to cost in the past year the doctor in the past year. However, the gender significantly decreased, while there was no gap for visiting a doctor in the past year became change among women overall. Among women narrower: A decline in the percentage of men enrolled in Medi-Cal, the percentage reporting who were uninsured led to a decrease in the they had delayed filling a prescription due to percentage of men who had not visited a doctor cost significantly decreased from 7.2% in 2012 in the past year. The largest gains in access to 6.2% in 2016. came from decreases over time in delays seeking care, particularly delays due to cost or lack of insurance. Though both men and women experienced fewer delays in general and fewer 8 UCLA CENTER FOR HEALTH POLICY RESEARCH delays due to cost or lack of insurance, men to health insurance coverage are diminished. tended to see slightly greater improvements, Instead, these disparities might reflect gender- so gender differences in access to care remained based differences in overall health, health stable or grew over the period. care utilization, and socioeconomic status — differences that are more entrenched and The stability of the gender gap in access to resistant to change. health care could reflect the fact that the ACA’s coverage expansion led to similar declines in Data Source and Methods the uninsured rates of both men and women This policy brief presents data from the 2012, 2014, in California. Moreover, there were few gender and 2016 years of the California Health Interview differences in the type of coverage gained: Both Survey (CHIS), conducted by the UCLA Center for Health Policy Research (CHPR). Health insurance men and women primarily gained coverage coverage was measured at a point in time (at the time through the expansion of Medicaid, minimizing of responding to the survey). As a result, estimates the impact that this expansion had on gender presented here may differ from other sources that disparities in access to care. Though these report coverage over the past year. CHIS is a telephone disparities in access are long-standing8 — due survey that uses a dual-frame, random-digit-dial in part to a lack of medical providers who accept (RDD) technique. Through the use of traditional landline RDD and cell-phone RDD sampling frames, the lower reimbursement rates paid by Medi- the survey is representative of the state’s population. Cal compared to private health insurance — the Survey items for the adult modules are self-reported, rapid growth in enrollment in Medi-Cal after with data collected by trained interviewers. the ACA’s expansion of eligibility may have exacerbated these issues. CHIS data are collected continuously throughout the year, and each full cycle is comprised of two years. The expansion of eligibility also affected the Each year, CHIS completes interviews with adults, socioeconomic composition of the uninsured, adolescents, and parents of children in more than Medi-Cal, and ESI populations, which could 20,000 households, drawn from every county in the state. Interviews are conducted in English, Spanish, have contributed to changes over time within Chinese (both Mandarin and Cantonese), Vietnamese, these insurance types. However, many of the Tagalog, and Korean. Interviews cover a diverse array gender disparities within insurance type did of health-related topics, including health insurance not change in ways that were consistent with coverage, health status and behaviors, and access to these compositional changes. For example, health care. CHIS employs a complex survey design uninsured women experienced reductions that requires analysts to use complex survey weights to provide accurate variance estimates and statistical similar to those of uninsured men in delays testing. All analyses presented in this policy brief in receiving medical care due to cost, though incorporate replicate weights to provide corrected only uninsured men had higher SES in 2016 confidence interval estimates and statistical tests. than 2012. Therefore, it seems less likely that these compositional changes explain the Author Information changes in access by insurance type over time. Tara Becker, PhD, is a senior public administration Though gender disparities might be reduced analyst at the UCLA Center for Health Policy This publication contains by expanding coverage, they will not be Research. Susan H. Babey, PhD, is a senior research data from the California scientist at the UCLA Center for Health Policy Health Interview Survey totally eliminated even if disparities in access Research. (CHIS), the nation’s largest state health survey. Conducted by the UCLA Center for Health Policy Research, CHIS data give a detailed picture of the health and health care needs of California’s large and diverse population. Learn more at: chis.ucla.edu UCLA CENTER FOR HEALTH POLICY RESEARCH 10960 Wilshire Blvd., Suite 1550 Los Angeles, California 90024 Acknowledgments Endnotes The authors would like to thank Venetia Lai, 1 Source: 2009 California Health Interview Survey, accessed using AskCHIS at Ask.CHIS.ucla.edu. Elaiza Torralba, and Celeste Maglan Peralta for 2 Charles SA, Becker T, Jacobs K, Pourat N, Ebrahim their assistance. The authors are grateful to the R, Kominski GF. 2017. The State of Health Insurance The UCLA Center for Health Policy Research following reviewers for their helpful feedback: in California: Findings from the 2014 California Health Interview Survey. Los Angeles, CA: UCLA Center is part of the UCLA Fielding School of Public Health. Claire Brindis, DrPH, who holds the following for Health Policy Research. Available at: http:// positions at the University of California, San healthpolicy.ucla.edu/publications/Documents/PDF/2017/ shicreport-jan2017.pdf Francisco: Caldwell B. Esselystyn Chair in 3 The federal poverty level, used to establish eligibility Health Policy; director, Philip R. Lee Institute for public programs, is published annually by the for Health Policy Studies; distinguished U.S. Department of Health and Human Services as the federal poverty guidelines. These guidelines vary professor of pediatrics in the Division of by family size. In 2016, 400% FPL for a family of Adolescent and Young Adult Health and four was $97,200. Department of Obstetrics, Gynecology, and 4 For example, see: Garfield R, Orgera K, Damico A. The analyses, interpretations, conclusions, Reproductive Health Sciences; and founding 2019. The Uninsured and the ACA: A Primer. Kaiser and views expressed in this policy brief are Family Foundation Report #7451-14. director and senior scholar, Bixby Center for those of the authors and do not necessarily 5 Becker T, Charles SA, Scheitler AJ, Ponce N. represent the UCLA Center for Health Policy Global Reproductive Health 2015. Medi-Cal Versus Employer-Based Coverage: Research, the Regents of the University Comparing Access to Care. Report for the California of California, or collaborating Usha Ranji, MS, associate director, Women’s Health Care Foundation. Available at: https:// organizations or funders. Health Policy, Kaiser Family Foundation www.chcf.org/wp-content/uploads/2017/12/PDF- MediCalAccessComparedUCLA.pdf PB2019-9 Joelle Wolstein, PhD, MPP, research scientist, 6 For example, see: Adler NE, Newman K. 2002. Copyright © 2019 by the Regents of the University of California. All Rights Reserved. UCLA Center for Health Policy Research Health Affairs 21 (2): 60-76. 7 Author calculation using estimates from AskCHIS Editor-in-Chief: Ninez Ponce, PhD Roberta Wyn, PhD, associate, Pacific Institute (ask.chis.ucla.edu) that compare Medi-Cal eligibility for Women’s Health and UCLA Center for among the uninsured by gender, ages 18-64, in 2016. Health Policy Research 8 Becker T, Charles SA, Scheitler AJ, and Ponce N. Phone: 310-794-0909 2015. Medi-Cal Versus Employer-Based Coverage: Suggested Citation Fax: 310-794-2686 Comparing Access to Care. Report prepared Email: chpr@ucla.edu Becker T, Babey SH. 2019. Persistent Gap: Gender for the California Health Care Foundation healthpolicy.ucla.edu Disparities in Health Insurance and Access to Care in (July 2015). Available for download at: http:// garnerhealth.com/wp-content/uploads/2014/02/PDF- California. Los Angeles, Calif.: UCLA Center for MediCalAccessComparedUCLA.pdf Health Policy Research.