The proportion of Americans who went without health insurance significantly declined after full implementation of the Patient Protection and Affordable Care Act (ACA) in 2014.
However, the new federal administration in 2017 and 2018 made policy changes to the health law, and the national uninsurance rate rose in 2018. In contrast, California’s uninsurance rate remained low (8.1%) in 2018, associated with a stronger economy and state efforts to mitigate policy changes affecting the private purchase market. Racial and ethnic groups in 2018 maintained uninsurance rates that had already been cut in half since 2013, although Latino Californians still had rates twice as high as those of other racial and ethnic groups. Uninsured rates were also cut in half between 2013 and 2018 for low- and middle-income households. Higher-income households (400% of the federal poverty guideline and above) experienced smaller declines, though this group already had the lowest rates. State and local policies that target the cost of insurance coverage for those who are ineligible for public health insurance programs may help to further reduce this gap in the future.