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After Millions of Californians Gain Health Coverage Under the Affordable Care Act, Who Will Remain Uninsured?

September 13, 2012

Research Report

Authors: Laurel Lucia, MPP, Ken Jacobs, Miranda Dietz, Dave Graham-Squire, Nadereh Pourat, PhD, Dylan H. Roby, PhD

The implementation of the Affordable Care Act (ACA) is predicted to expand coverage to millions of Californians by 2019. This increase in coverage will primarily result from the expansion of Medi-Cal and the availability of subsidized coverage in the California Health Benefit Exchange (Exchange). However, three to four million Californians could remain uninsured even after the law is fully implemented.

The study used the California Simulation of Insurance Markets (CalSIM) model, version 1.8, to estimate the size and characteristics of the remaining uninsured under age 65 in California under two scenarios. In a base scenario the authors assume that take up of Medi-Cal follows current trends and that take up in the Exchange reflects typical individual behavior patterns from the health economics literature. In their enhanced scenario, the authors assume that eligibility determination will be simplified, outreach and enrollment efforts will be escalated in a culturally sensitive and language appropriate manner, and that the majority of individuals currently enrolled in existing categorical public programs that provide services but not full coverage will transition to Medi-Cal and the Exchange.


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