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California’s Health Coverage Gains to Erode Without Further State Action

November 27, 2018

Research Report

Authors: Miranda Dietz, Laurel Lucia, MPP, Dylan H. Roby, PhD, Ken Jacobs, Petra Rasmussen, MPH, Dave Graham-Squire, Xiao Chen, PhD, Gregory Watson, MS, Ian Perry, Gerald F. Kominski, Ph.D.

​In 2016, 10.4 percent of non-elderly Californians lacked insurance, compared to 16.6 percent in 2012, according to the California Health Interview Survey (CHIS). Without state action to protect and build upon these coverage gains, authors project that the uninsurance rate could grow to 11.7 percent in 2020, or approximately 4.0 million people, and to 12.9 percent in 2023, or 4.4 million people. These uninsured rates are based on a definition of insurance that excludes restricted-scope Medi-Cal for undocumented Californians.

The federal law zeroing out the ACA individual mandate penalty beginning in 2019 will result in lower individual market and Medi-Cal enrollment, but there is significant uncertainty about how much enrollment will decline in California. Using the California Simulation of Insurance Markets (CalSIM) microsimulation model and a range of assumptions about the extent to which the penalty influences enrollment decisions, the authors project that between 150,000 and 400,000 more Californians will be uninsured in 2020, growing to between 490,000 and 790,000 more uninsured in 2023, compared to if the ACA penalty had been maintained. The most substantial enrollment changes will occur in the individual market, where the authors project enrollment will decline by 10.1 percent in 2020 and 14.4 percent in 2023.

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