​Summary: This publication represents the 20th anniversary of the State of Health Insurance in California (SHIC) report series. It is the 10th installment of the UCLA Center for Health Policy Research’s ongoing, in-depth study of the overall outlook for health insurance coverage in our state. Longtime readers of this report series will find similar chapters as in the past — a demographic overview, private coverage, public coverage, and access to care impacts — and will recognize the focus on adults under age 65 and children, since seniors are almost universally covered through Medicare. However, authors are now providing the data in a more streamlined and broadly accessible chartpack, allowing readers to draw their own conclusions based on the comprehensive data provided.

The data are from the 2019 and 2020 California Health Interview Surveys (CHIS), representing the decade following the enactment of the Patient Protection and Affordable Care Act of 2010, also known as the ACA or “Obamacare.” Most of the health insurance expansions took full effect in 2014. Since then, ACA expansion has continued in California, including the growth of subsidies and coverage, notwithstanding rollbacks and roadblocks posed by the federal government from 2017 to 2020.

Findings: Despite these advances, this chartpack shows that significant coverage gaps remain in California. Racial and ethnic disparities persist (Chapter 1); many small businesses struggle to even offer health insurance to employees (Chapter 2); more than half a million low-income people who could be eligible for Medi-Cal remain uninsured (Chapter 3); and being uninsured remains a significant barrier to accessing health care (Chapter 4).