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We present tomographic measurements of structure growth using cross-correlations of Atacama Cosmology Telescope (ACT) DR6 and Planck cosmic microwave background (CMB) lensing maps with the unWISE Blue and Green galaxy samples, which span the redshift ranges 0.2 ≲ z ≲ 1.1 and 0.3 ≲ z ≲ 1.8, respectively. We improve on prior unWISE cross-correlations not just by making use of the new, high-precision ACT DR6 lensing maps, but also by including additional spectroscopic data for redshift calibration and by analyzing our measurements with a more flexible theoretical model. We determine the amplitude of matter fluctuations at low redshifts (z ≃ 0.2-1.6), finding S 8 ≡ σ 8 ( Ω m / 0.3 ) 0.5 = 0.813 ± 0.021 using the ACT cross-correlation alone and S 8 = 0.810 ± 0.015 with a combination of Planck and ACT cross-correlations; these measurements are fully consistent with the predictions from primary CMB measurements assuming standard structure growth. The addition of baryon acoustic oscillation data breaks the degeneracy between σ 8 and Ωm , allowing us to measure σ 8 = 0.813 ± 0.020 from the cross-correlation of unWISE with ACT and σ 8 = 0.813 ± 0.015 from the combination of cross-correlations with ACT and Planck. These results also agree with the expectations from primary CMB extrapolations in ΛCDM cosmology; the consistency of σ 8 derived from our two redshift samples at z ∼ 0.6 and 1.1 provides a further check of our cosmological model. Our results suggest that structure formation on linear scales is well described by ΛCDM even down to low redshifts z ≲ 1.

The Protein Phosphatase type 1 catalytic subunit (PP1c) (PF3D7_1414400) operates in combination with various regulatory proteins to specifically direct and control its phosphatase activity. However, there is little information about this phosphatase and its regulators in the human malaria parasite, Plasmodium falciparum. To address this knowledge gap, we conducted a comprehensive investigation into the structural and functional characteristics of a conserved Plasmodium-specific regulator called Gametocyte EXported Protein 15, GEXP15 (PF3D7_1031600). Through in silico analysis, we identified three significant regions of interest in GEXP15: an N-terminal region housing a PP1-interacting RVxF motif, a conserved domain whose function is unknown, and a GYF-like domain that potentially facilitates specific protein-protein interactions. To further elucidate the role of GEXP15, we conducted in vitro interaction studies that demonstrated a direct interaction between GEXP15 and PP1 via the RVxF-binding motif. This interaction was found to enhance the phosphatase activity of PP1. Additionally, utilizing a transgenic GEXP15-tagged line and live microscopy, we observed high expression of GEXP15 in late asexual stages of the parasite, with localization predominantly in the nucleus. Immunoprecipitation assays followed by mass spectrometry analyses revealed the interaction of GEXP15 with ribosomal- and RNA-binding proteins. Furthermore, through pull-down analyses of recombinant functional domains of His-tagged GEXP15, we confirmed its binding to the ribosomal complex via the GYF domain. Collectively, our study sheds light on the PfGEXP15-PP1-ribosome interaction, which plays a crucial role in protein translation. These findings suggest that PfGEXP15 could serve as a potential target for the development of malaria drugs.

During the first hours after stroke onset, neurological deficits can be highly unstable: some patients rapidly improve, while others deteriorate. This early neurological instability has a major impact on long-term outcome. Here, we aimed to determine the genetic architecture of early neurological instability measured by the difference between the National Institutes of Health Stroke Scale (NIHSS) within 6 h of stroke onset and NIHSS at 24 h. A total of 5876 individuals from seven countries (Spain, Finland, Poland, USA, Costa Rica, Mexico and Korea) were studied using a multi-ancestry meta-analyses. We found that 8.7% of NIHSS at 24 h of variance was explained by common genetic variations, and also that early neurological instability has a different genetic architecture from that of stroke risk. Eight loci (1p21.1, 1q42.2, 2p25.1, 2q31.2, 2q33.3, 5q33.2, 7p21.2 and 13q31.1) were genome-wide significant and explained 1.8% of the variability suggesting that additional variants influence early change in neurological deficits. We used functional genomics and bioinformatic annotation to identify the genes driving the association from each locus. Expression quantitative trait loci mapping and summary data-based Mendelian randomization indicate that ADAM23 (log Bayes factor = 5.41) was driving the association for 2q33.3. Gene-based analyses suggested that GRIA1 (log Bayes factor = 5.19), which is predominantly expressed in the brain, is the gene driving the association for the 5q33.2 locus. These analyses also nominated GNPAT (log Bayes factor = 7.64) ABCB5 (log Bayes factor = 5.97) for the 1p21.1 and 7p21.1 loci. Human brain single-nuclei RNA-sequencing indicates that the gene expression of ADAM23 and GRIA1 is enriched in neurons. ADAM23, a presynaptic protein and GRIA1, a protein subunit of the AMPA receptor, are part of a synaptic protein complex that modulates neuronal excitability. These data provide the first genetic evidence in humans that excitotoxicity may contribute to early neurological instability after acute ischaemic stroke.

Reproductive interference is widespread, despite the theoretical expectation that it should be eliminated by reproductive character displacement (RCD). A possible explanation is that females of sympatric species are too similar phenotypically for males to distinguish between them, resulting in a type of evolutionary dilemma or catch-22 in which reproductive interference persists because male mate recognition (MR) cannot evolve until female phenotypes diverge further, and vice versa. Here we illustrate and test this hypothesis with data on rubyspot damselflies (Hetaerina spp.). First, reproductive isolation owing to male MR breaks down with increasing interspecific similarity in female phenotypes. Second, comparing allopatric and sympatric populations yielded no evidence for RCD, suggesting that parallel divergence in female coloration and male MR in allopatry determines the level of reproductive isolation on secondary contact. Whenever reproductive isolation depends on male MR and females of sympatric species are phenotypically similar, the evolutionary catch-22 hypothesis offers an explanation for the persistence of reproductive interference.

Reproductive interference is widespread, despite the theoretical expectation that it should be eliminated by reproductive character displacement (RCD). A possible explanation is that females of sympatric species are too similar phenotypically for males to distinguish between them, resulting in a type of evolutionary dilemma or catch-22 in which reproductive interference persists because male mate recognition (MR) cannot evolve until female phenotypes diverge further, and vice versa. Here we illustrate and test this hypothesis with data on rubyspot damselflies (Hetaerina spp.). First, reproductive isolation owing to male MR breaks down with increasing interspecific similarity in female phenotypes. Second, comparing allopatric and sympatric populations yielded no evidence for RCD, suggesting that parallel divergence in female coloration and male MR in allopatry determines the level of reproductive isolation on secondary contact. Whenever reproductive isolation depends on male MR and females of sympatric species are phenotypically similar, the evolutionary catch-22 hypothesis offers an explanation for the persistence of reproductive interference.

Background: Oral health studies to address dental needs of children have been conducted in Nairobi, Kenya. However, limited data is available for the rural areas of Kenya. The aim of this study was to gather baseline oral health data on primary school children in the rural Kithoka community of Meru, Kenya. Methods: A cross sectional dental examination and oral health survey of 583 children, aged 3-18 years, were performed. Decayed, missing, and filled primary/permanent teeth (dmft/DMFT) values were recorded. Gingival recession ranking, a gingival inflammation index, and a fluorosis index were also employed. Children were surveyed regarding dental visits, toothbrush ownership, and oral pain. Results: The average dmft/DMFT score was 1.2, fluorosis prevalence was 29%, gingival disease prevalence was 75.1%, oral pain prevalence was 29%, and 72% of children had never been to a dentist. Conclusions: DMFT scores for Kenyan children were almost exclusively comprised of decayed teeth. This finding probably reflects the low dentist-to-population ratio and the scarcity of dentists practicing in Kenyan rural areas. Gingival disease and pain prevalence in these children were high, exceeding those reported in developed countries. The findings reflect the oral health preventive and treatment needs for children in this Kenyan region.

Background: Oral health studies to address dental needs of children have been conducted in Nairobi, Kenya. However, limited data is available for the rural areas of Kenya. The aim of this study was to gather baseline oral health data on primary school children in the rural Kithoka community of Meru, Kenya. Methods: A cross sectional dental examination and oral health survey of 583 children, aged 3-18 years, were performed. Decayed, missing, and filled primary/permanent teeth (dmft/DMFT) values were recorded. Gingival recession ranking, a gingival inflammation index, and a fluorosis index were also employed. Children were surveyed regarding dental visits, toothbrush ownership, and oral pain. Results: The average dmft/DMFT score was 1.2, fluorosis prevalence was 29%, gingival disease prevalence was 75.1%, oral pain prevalence was 29%, and 72% of children had never been to a dentist. Conclusions: DMFT scores for Kenyan children were almost exclusively comprised of decayed teeth. This finding probably reflects the low dentist-to-population ratio and the scarcity of dentists practicing in Kenyan rural areas. Gingival disease and pain prevalence in these children were high, exceeding those reported in developed countries. The findings reflect the oral health preventive and treatment needs for children in this Kenyan region.

Theoretical advances in the science of consciousness have proposed that it is concomitant with balanced cortical integration and differentiation, enabled by efficient networks of information transfer across multiple scales. Here, we apply graph theory to compare key signatures of such networks in high-density electroencephalographic data from 32 patients with chronic disorders of consciousness, against normative data from healthy controls. Based on connectivity within canonical frequency bands, we found that patient networks had reduced local and global efficiency, and fewer hubs in the alpha band. We devised a novel topographical metric, termed modular span, which showed that the alpha network modules in patients were also spatially circumscribed, lacking the structured long-distance interactions commonly observed in the healthy controls. Importantly however, these differences between graph-theoretic metrics were partially reversed in delta and theta band networks, which were also significantly more similar to each other in patients than controls. Going further, we found that metrics of alpha network efficiency also correlated with the degree of behavioural awareness. Intriguingly, some patients in behaviourally unresponsive vegetative states who demonstrated evidence of covert awareness with functional neuroimaging stood out from this trend: they had alpha networks that were remarkably well preserved and similar to those observed in the controls. Taken together, our findings inform current understanding of disorders of consciousness by highlighting the distinctive brain networks that characterise them. In the significant minority of vegetative patients who follow commands in neuroimaging tests, they point to putative network mechanisms that could support cognitive function and consciousness despite profound behavioural impairment.

Background and Objective Clinicians have difficulty assessing and monitoring early occlusal caries. Traditional clinical exam and radiographs are unable to detect the subtle alterations in enamel indicative of de- or re-mineralization, particularly under dental sealants. Although clinicians have used laser fluorescence (LF) to address this gap, this modality has demonstrated weak correlation with histology. The International Caries Detection and Assessment System (ICDAS-II) has demonstrated high sensitivity and specificity for caries detection, but since it is based on visual assessment, it is of no use in areas beneath the most commonly used dental sealants which are opaque. Optical coherence tomography (OCT) is an emergent assessment tool which has demonstrated great promise in detecting and quantifying caries, including areas beneath commonly used dental sealants and composites. However, OCT has not yet been widely integrated into clinical dental practice, perhaps because OCT imaging does not provide an easily accessible diagnostic outcome for clinicians. The objective of this ex vivo study was to use OCT-images of sound and carious occlusal surfaces in combination with a simple algorithm to compare the caries detection ability of OCT with tools clinicians may be more familiar with (LF and radiography), and with an established valid and reliable clinical assessment tool (ICDAS-II). Study Design/Materials and Methods One hundred twenty extracted teeth with sound or naturally carious occlusal surfaces were imaged with OCT, LF, radiography, and examined clinically with the ICDAS-II. Teeth were randomized to one of two dental sealants recommended for use with LF. A novel simple algorithm was used to interpret OCT-based images. The accuracy of caries severity assessments of the OCT-based diagnosis, LF, ICDAS-II, and digital radiography were compared to the 4-point histological analysis gold standard. Results OCT and ICDAS-II caries severity assessments demonstrated high sensitivity (94.0%; 92.3%) and specificity (85.0%; 83.3%), LF demonstrated low sensitivity (65.2%) but high specificity (97.6%), and digital radiography demonstrated low sensitivity (67.1%) with moderate specificity (79.5%) on unsealed occlusal surfaces. OCT-based caries severity assessments of sealed teeth demonstrated high specificity (97.6%), sensitivity (89.9%), excellent positive predictive value (98.6%), and negative predictive value (83.3%). Despite our use of LF recommended dental sealants, in the presence of sealants, LF assessment of caries severity demonstrated high sensitivity (95.1%), but extremely low specificity (10.3%), positive predictive value (68.8%), and negative predictive value (50.0%). Conclusion This study found that OCT-based imaging combined with a simple diagnostic algorithm accurately assessed the severity of natural early caries on occlusal surfaces in extracted teeth both in the absence and presence of dental sealant. The findings of this study support the clinical use of OCT imaging for assessment and monitoring progression of early non-cavitated caries lesions on occlusal surfaces including areas under dental sealants. © 2014 Wiley Periodicals, Inc.

Theoretical advances in the science of consciousness have proposed that it is concomitant with balanced cortical integration and differentiation, enabled by efficient networks of information transfer across multiple scales. Here, we apply graph theory to compare key signatures of such networks in high-density electroencephalographic data from 32 patients with chronic disorders of consciousness, against normative data from healthy controls. Based on connectivity within canonical frequency bands, we found that patient networks had reduced local and global efficiency, and fewer hubs in the alpha band. We devised a novel topographical metric, termed modular span, which showed that the alpha network modules in patients were also spatially circumscribed, lacking the structured long-distance interactions commonly observed in the healthy controls. Importantly however, these differences between graph-theoretic metrics were partially reversed in delta and theta band networks, which were also significantly more similar to each other in patients than controls. Going further, we found that metrics of alpha network efficiency also correlated with the degree of behavioural awareness. Intriguingly, some patients in behaviourally unresponsive vegetative states who demonstrated evidence of covert awareness with functional neuroimaging stood out from this trend: they had alpha networks that were remarkably well preserved and similar to those observed in the controls. Taken together, our findings inform current understanding of disorders of consciousness by highlighting the distinctive brain networks that characterise them. In the significant minority of vegetative patients who follow commands in neuroimaging tests, they point to putative network mechanisms that could support cognitive function and consciousness despite profound behavioural impairment.

Background and Objective Clinicians have difficulty assessing and monitoring early occlusal caries. Traditional clinical exam and radiographs are unable to detect the subtle alterations in enamel indicative of de- or re-mineralization, particularly under dental sealants. Although clinicians have used laser fluorescence (LF) to address this gap, this modality has demonstrated weak correlation with histology. The International Caries Detection and Assessment System (ICDAS-II) has demonstrated high sensitivity and specificity for caries detection, but since it is based on visual assessment, it is of no use in areas beneath the most commonly used dental sealants which are opaque. Optical coherence tomography (OCT) is an emergent assessment tool which has demonstrated great promise in detecting and quantifying caries, including areas beneath commonly used dental sealants and composites. However, OCT has not yet been widely integrated into clinical dental practice, perhaps because OCT imaging does not provide an easily accessible diagnostic outcome for clinicians. The objective of this ex vivo study was to use OCT-images of sound and carious occlusal surfaces in combination with a simple algorithm to compare the caries detection ability of OCT with tools clinicians may be more familiar with (LF and radiography), and with an established valid and reliable clinical assessment tool (ICDAS-II). Study Design/Materials and Methods One hundred twenty extracted teeth with sound or naturally carious occlusal surfaces were imaged with OCT, LF, radiography, and examined clinically with the ICDAS-II. Teeth were randomized to one of two dental sealants recommended for use with LF. A novel simple algorithm was used to interpret OCT-based images. The accuracy of caries severity assessments of the OCT-based diagnosis, LF, ICDAS-II, and digital radiography were compared to the 4-point histological analysis gold standard. Results OCT and ICDAS-II caries severity assessments demonstrated high sensitivity (94.0%; 92.3%) and specificity (85.0%; 83.3%), LF demonstrated low sensitivity (65.2%) but high specificity (97.6%), and digital radiography demonstrated low sensitivity (67.1%) with moderate specificity (79.5%) on unsealed occlusal surfaces. OCT-based caries severity assessments of sealed teeth demonstrated high specificity (97.6%), sensitivity (89.9%), excellent positive predictive value (98.6%), and negative predictive value (83.3%). Despite our use of LF recommended dental sealants, in the presence of sealants, LF assessment of caries severity demonstrated high sensitivity (95.1%), but extremely low specificity (10.3%), positive predictive value (68.8%), and negative predictive value (50.0%). Conclusion This study found that OCT-based imaging combined with a simple diagnostic algorithm accurately assessed the severity of natural early caries on occlusal surfaces in extracted teeth both in the absence and presence of dental sealant. The findings of this study support the clinical use of OCT imaging for assessment and monitoring progression of early non-cavitated caries lesions on occlusal surfaces including areas under dental sealants. © 2014 Wiley Periodicals, Inc.

In 2014, over 500,000 California residents will transition from the Low Income Health Program (LIHP) to new health coverage provided by Medi-Cal or subsidized health plans offered in Covered California. This Policy Note focuses on the transition of more than 470,000 lower-income LIHP enrollees into a state-operated Medi-Cal program. If a county-based approach is adopted, expanding the existing local LIHPs, adjustments to the plan will be needed. The LIHPs continue to grow; one-third of those potentially eligible for the Affordable Care Act’s optional Medi-Cal expansion have already been enrolled in the LIHP. The Department of Health Care Services has made considerable efforts to involve stakeholders in the planning process for the transition. Including providers, consumer advocates, and other stakeholder groups will enhance the transition to Medi-Cal, regardless of the implementation approach. Further recommendations include: engaging in automatic Medi-Cal eligibility determination methods, establishing procedures for data transfer that will provide adequate time for Medi-Cal enrollment, creating an extensive communication and outreach plan and evaluating the need for special transition plans for populations in need of additional assistance.

In 2014, over 500,000 California residents will transition from the Low Income Health Program to health coverage provided by Medi-Cal or subsidized health plans offered in Covered California. This policy note focuses on the transition plans for the 27,000 higher income enrollees that will be eligible for sizeable federal subsidies in the state-based health insurance exchange, Covered California. A successful transition with high rates of participation relies on collaboration between the Department of Health Care Services, the local Low Income Health Programs (LIHPs) and Covered California. Enrollees will be moving into a complex system of premium payment, plan choice, subsidies and cost-sharing reductions and their engagement in the transition is necessary to result in enrollment in health plans by January 1, 2014. Recommendations to promote success include: applying administrative LIHP and DHCS data to ease the enrollment process in Covered California, collaborating in communication with LIHPs and other county programs, and targeted outreach with personal assistance for potential enrollees.

In 2014, over 500,000 California residents will transition from the Low Income Health Program to health coverage provided by Medi-Cal or subsidized health plans offered in Covered California. This policy note focuses on the transition plans for the 27,000 higher income enrollees that will be eligible for sizeable federal subsidies in the state-based health insurance exchange, Covered California. A successful transition with high rates of participation relies on collaboration between the Department of Health Care Services, the local Low Income Health Programs (LIHPs) and Covered California. Enrollees will be moving into a complex system of premium payment, plan choice, subsidies and cost-sharing reductions and their engagement in the transition is necessary to result in enrollment in health plans by January 1, 2014. Recommendations to promote success include: applying administrative LIHP and DHCS data to ease the enrollment process in Covered California, collaborating in communication with LIHPs and other county programs, and targeted outreach with personal assistance for potential enrollees.

This policy note explores disparities in access to pediatric subspecialty care in California by insurance coverage, geographic location, race/ethnicity, and language. Using the available literature and interviews with stakeholders, it identifies barriers to access, which include a potential shortage of trained pediatric subspecialists, gaps in care delivery, low reimbursement rates and payment levels, and lack of care integration. Innovative care delivery models for improving the capacity of pediatric subspecialty care, including expanded use of technology, team models of care, and standard care processes, are also examined.Among the recommendations proposed to ensure adequate access to pediatric subspecialty care: increase the number of pediatricians specializing in pediatric subspecialties; address payment and reimbursement issues that impede the access of children with special health care needs (CSHCN) to pediatric subspecialty care; increase the capacity of pediatric subspecialists by better utilizing physician extenders and general pediatricians; improve access to telehealth services for pediatric subspecialty providers; improve the availability of pediatric subspecialty services to underserved populations; improve communication between general pediatricians and providers; develop benchmarks and collect accurate data on workforce supply; and assess the standards of care available to CSHCN in California.

This policy note focuses on the transition plans for the 27,000 higher income enrollees that will be eligible for sizeable federal subsidies in the state-based health insurance exchange, Covered California.

This Policy Note focuses on the transition of more than 470,000 lower-income LIHP enrollees into a state-operated Medi-Cal program.

This Policy Note focuses on the transition of more than 470,000 lower-income LIHP enrollees into a state-operated Medi-Cal program.

More than 400,000 Californians had ever enrolled in California’s Low Income Health Program (LIHP) as of March 2012. These LIHP enrollees, who would otherwise be underinsured or uninsured, now have access to services through their county’s safety net facilities and contracted providers. This policy note highlights innovative and successful strategies for outreach, enrollment, and redetermination and retention, as well as the challenges faced by LIHPs.

Multiple sclerosis (MS) is a demyelinating disease that causes major neurological disability in young adults. A definitive diagnosis at the time of the first episode is still lacking, but since early treatment leads to better prognosis, the search for early biomarkers is needed. Here we characterized the transcriptome of the choroid plexus (CP), which is part of the blood-brain barriers (BBBs) and the major site of cerebrospinal fluid production, in the experimental autoimmune encephalomyelitis (EAE) mouse model of MS. In addition, cerebrospinal fluid samples from two cohorts of patients with MS and with optic neuritis (ON) were analyzed to confirm the clinical relevance of the findings. Genes encoding for adhesion molecules, chemokines and cytokines displayed the most altered expression, supporting the role of CP as a site of immune-brain interaction in MS. The gene encoding for lipocalin 2 was the most up-regulated; notably, the cerebrospinal fluid lipocalin 2 levels coincided with the active phases of the disease. Immunostaining revealed that neutrophils infiltrating the CP were the source of the increased lipocalin 2 expression in this structure. However, within the brain, lipocalin 2 was also detected in astrocytes, particularly in regions typically affected in patients with MS. The increase of lipocalin 2 in the cerebrospinal fluid and in astrocytes was reverted by natalizumab treatment. Most importantly, the results obtained in the murine model were translatable into humans since patients from two different cohorts presented increased cerebrospinal fluid lipocalin 2 levels. The findings support lipocalin 2 as a valuable molecule for the diagnostic/monitoring panel of MS.

Multiple sclerosis (MS) is a demyelinating disease that causes major neurological disability in young adults. A definitive diagnosis at the time of the first episode is still lacking, but since early treatment leads to better prognosis, the search for early biomarkers is needed. Here we characterized the transcriptome of the choroid plexus (CP), which is part of the blood-brain barriers (BBBs) and the major site of cerebrospinal fluid production, in the experimental autoimmune encephalomyelitis (EAE) mouse model of MS. In addition, cerebrospinal fluid samples from two cohorts of patients with MS and with optic neuritis (ON) were analyzed to confirm the clinical relevance of the findings. Genes encoding for adhesion molecules, chemokines and cytokines displayed the most altered expression, supporting the role of CP as a site of immune-brain interaction in MS. The gene encoding for lipocalin 2 was the most up-regulated; notably, the cerebrospinal fluid lipocalin 2 levels coincided with the active phases of the disease. Immunostaining revealed that neutrophils infiltrating the CP were the source of the increased lipocalin 2 expression in this structure. However, within the brain, lipocalin 2 was also detected in astrocytes, particularly in regions typically affected in patients with MS. The increase of lipocalin 2 in the cerebrospinal fluid and in astrocytes was reverted by natalizumab treatment. Most importantly, the results obtained in the murine model were translatable into humans since patients from two different cohorts presented increased cerebrospinal fluid lipocalin 2 levels. The findings support lipocalin 2 as a valuable molecule for the diagnostic/monitoring panel of MS.

The Patient Protection and Affordable Care Act of 2010 (ACA) restricts its health insurance expansions in ways that exclude many uninsured children in California who are immigrants or have immigrant parents. These exclusions directly limit coverage options for noncitizen children. And immigrant parents, potentially misinterpreting eligibility requirements for these new programs, may not enroll their citizen children. Using the 2007 California Health Interview Survey (CHIS 2007), this policy brief estimates that of the 1.08 million children in California who were uninsured all or part of the year, between 180,000 to 220,000 will be excluded from the health care reform expansions due to the combined direct and potential indirect effects of these exclusions. This "left-out" group comprises between 17% and 20% of all uninsured children in California. In light of these exclusions, California’s community clinics and public hospitals could continue to serve a significant number of uninsured immigrant children even after full implementation of ACA.

Almost 4.7 million nonelderly adults and children of the seven million Californians who were uninsured for all or part of 2009 will be eligible for insurance as a result of last year’s health care reform legislation, according to new data from the 2009 California Health Interview Survey (CHIS 2009). Eligible Californians will obtain coverage either through Medi-Cal or through subsidies to purchase private health insurance in the new California Health Benefit Exchange (CHBE) starting in 2014. The CHBE will also be open to 1.2 million uninsured persons who do not qualify for subsidized premiums due to their income exceeding eligibility levels, but who will benefit from the new marketplace created through the Patient Protection and Affordable Care Act (PPACA). Just over one million uninsured persons do not qualify to participate in either the CHBE or in the Medi-Cal expansion due to their citizenship status. With seven million uninsured residents of California in 2009, the new insurance options made available by the PPACA could face challenges in enrolling these uninsured individuals.

This fact sheet presents county-by-county estimates of the number of California residents who have lost health insurance during the economic downturn. The authors find that the number of Californians without health insurance grew in all counties and that 37 counties — from Imperial to Kern to Shasta — had uninsured rates above the statewide average of 24.3%.Loss of health insurance was concentrated in Southern California (Imperial, Riverside, San Bernardino counties), the San Joaquin Valley (all counties), and the Northern/ Sierra areas (all but Sutter and Humbolt), all of which had 2009 uninsured rates that were above the statewide average (24%).The losses were due to sharp increases in local unemployment and corresponding drops in both household income and job-based coverage.

Nearly two million Californians lost their health insurance during 2008 and 2009 – years characterized by a deep recession and mass layoffs – bringing the total number of uninsured in the state to more than 8 million, according to this policy brief that draws upon both 2009 and adjusted 2007 data.The number of uninsured represents a 28 percent increase since 2007, when 6.4 million Californians lacked insurance, according to the authors, who also estimate that nearly one-quarter of all adult Californians currently lack health insurance.The estimates are based upon 2009 enrollee data from health insurance companies and the public health insurance programs offered by the state of California. Those counts were then used to update 2007 California Health Interview Survey health insurance rates, adjusting for 2009 population growth and changes in insurance status.