Published Date: April 13, 2021

Summary: The COVID-19 pandemic has further highlighted the importance of ensuring that all Californians have health coverage. As the state explores options for the unified financing of health care, policymakers are simultaneously working toward universal coverage under the current system.

The American Rescue Plan is projected to increase the number of people insured through Covered California in 2022, but to cement those coverage gains Congress would need to make the additional federal premium subsidies permanent. To continue to improve premium and out-of-pocket affordability for those enrolled in the individual market and the 800,000 who are projected to continue to remain uninsured further action is needed from federal or state policymakers.

The biggest step the state could take to move California closer to universal coverage is expanding Medi-Cal regardless of immigration status. Since 2014, California policymakers have considered proposals to expand Medi-Cal eligibility to all low-income Californians regardless of immigration status and have taken important steps to expand coverage to children and young adults up to age 26. This policy is well-targeted to moving the state closer to universal coverage because 89% of low-income undocumented California adults lack insurance, and a majority of low-income undocumented adults (61%) have income in the Medi-Cal eligibility range, according to UCLA research. Furthermore, the vast majority of undocumented adults are already enrolled in restricted-scope Medi-Cal that covers emergency and pregnancy-related services and could be automatically transitioned to full benefits on the first day the policy is effective. If Medi-Cal were expanded to low-income adults of all ages, nearly 950,000 Californians would be projected to enroll, reducing the number of uninsured Californians by more than one-quarter. 

This study uses California Simulation of Insurance Markets (CalSIM), a micro-simulation model that has been used since 2012 to estimate the impact of various elements of the Affordable Care Act. CalSIM uses a wide range of official data sources, including the California Health Interview Survey (CHIS).

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