Published On: April 25, 2019

​​Berkeley ― California made historic gains in health insurance coverage under the Affordable Care Act (ACA), but several million Californians remain uninsured and many struggle to afford individual market insurance.
A new brief from the Labor Center at University of California, Berkeley and Center for Health Policy Research at UCLA is the first to evaluate  the combined effects of near-term policies proposed by California state policymakers that do not require federal approval but address the immediate challenges of improving affordability and expanding coverage. “Taking bold action by implementing these improvements would benefit 3.6 million Californians,” said Labor Center research associate Miranda Dietz.  That projection includes 1.7 million Californians who would be enrolled in coverage instead of being uninsured in 2023. In addition, it would lower health insurance costs for 2.3 million people enrolled in the individual market. They would either receive state assistance with health care costs or experience lower premiums. Near-term policy options currently being considered in the Legislature include:

  • Expanding Medi-Cal to all low-income California adults regardless of immigration status (Senate Bill 29, Assembly Bill 4);
  • Providing robust help with individual market premium and out-of-pocket costs for those already eligible for ACA subsidies and eliminating the ACA eligibility cliff at four times the federal poverty level (similar to AB174); and
  • Implementing a state individual mandate penalty that mirrors the federal ACA penalty that was eliminated starting in 2019 (SB175, AB 414).

If the state takes no action, the number of Californians uninsured is projected to increase to 4.4 million in 2023. This is due to the elimination of the individual mandate penalty as well as other trends such as premium growth, population growth, and changes in eligibility due to minimum wage increases.  Taking bold action would not only protect our progress under the ACA, but also further reduce the uninsured,” said Gerald Kominski, senior fellow at the UCLA center and co-author of the policy brief. These projections are based on version 2.4 of the UCLA-UC Berkeley California Simulation of Insurance Markets (CalSIM) model.

About the UCLA Center for Health Policy Research
The UCLA Center for Health Policy Research (CHPR) is one of the nation’s leading health policy research centers and the premier source of health policy information for California. UCLA CHPR improves the public’s health through high quality, objective, and evidence-based research and data that informs effective policymaking. UCLA CHPR is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit