In 2019, California lawmakers took steps to build upon the ACA by providing additional state subsidies for coverage in the individual market, including first-in-the-nation subsidies for middle income families above the federal subsidy cliff. California will also expand Medi-Cal coverage to low-income undocumented young adults, and institute a state individual mandate to replace the federal penalty that Congress eliminated.

Using CalSIM, a micro-simulation model that can be used to estimate the impact of various policies on health insurance coverage in California, the authors project that in the absence of these new policies, prices in the individual market would be higher and the number of uninsured in California would have climbed to 4.3 million by 2022. However, with these policies in place, they project that the number of uninsured would remain stable at 3.5 million. In addition to the 770,000 who would gain or retain coverage as a result of California’s policies, they project 750,000 would pay lower premiums as a result of a healthier mix of enrollees in the individual market and another 800,000 would receive state subsidies. Among them, 120,000 are projected to be middle income Californians not eligible for federal subsidies. 

Among the 3.5 million who are projected to remain uninsured, undocumented Californians remain the largest group. Low-income undocumented adults age 26 and older continue to be ineligible for full-scope Medi-Cal coverage. Affordability remains a major concern for the nearly  one million citizens or lawfully present immigrants projected to be eligible for Covered California but remain uninsured, most of whom have incomes in the subsidy eligible range. Californians who are low-income, Latino, or adults under 50 years of age are projected to be more likely to be uninsured.

“California’s lawmakers have taken important steps to build on the ACA, and we project 2.2 million Californians will benefit from these policies,” said Miranda Dietz, CalSIM project director at the UC Berkeley Labor Center and lead author of the report.

“Though millions of Californians will benefit from more affordable coverage thanks to these policies, 3.5 million will still be uninsured and many insured Californians will still struggle to afford coverage and care. Policy makers, including the new Healthy California for All Commission, have more work to do to make health coverage universal and affordable for all Californians,” said Gerald Kominski, senior fellow at the UCLA Center for Health Policy Research and co-author of the report.

The Center for Labor Research and Education (Labor Center) is a public service project of the Institute for Research on Labor and Employment (IRLE) at UC Berkeley. IRLE connects world-class research with policy to improve workers’ lives, communities, and society.

The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center is the home of the California Health Interview Survey (CHIS) and is affiliated with the UCLA Fielding School of Public Health.