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California’s Steps to Expand Health Coverage and Improve Affordability: Who Gains and Who Will Be Uninsured?

November 19, 2019

Policy Research Report

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

California’s success in implementing the ACA resulted in the number of uninsured falling from 6.5 million in 2013 to 3.5 million in 2017. At the end of 2017, Congress voted to eliminate the individual mandate penalty starting with the 2019 tax year, a change projected to increase the uninsured by more than half a million Californians.

In 2019, California lawmakers took steps to protect California’s coverage gains and increase affordability of coverage by instituting a state individual mandate penalty, providing additional subsidies for individual market enrollees, and expanding Medi-Cal to low-income undocumented young adults. California is the first state to include undocumented adults in full Medicaid benefits and the first to provide subsidies to middle-class consumers not eligible under the ACA.

Authors model these policies using CalSIM, the UCLA CHPR/UC Berkeley Labor Center micro-simulation model of insurance take up in California, which uses California Health Interview Survey (CHIS) data from 2011-2012, 2014 data on Medi-Cal, other public coverage, and insurance coverage by citizenship. Authors project that in the absence of these policies prices in the individual market would be higher and that the number of uninsured in California would climb to 4.3 million by 2022. However, with these policies in place, authors project the number of uninsured would remain stable at 3.5 million. They estimate that by 2022, these policies will have prevented 770,000 Californians from becoming uninsured  and reduced premiums for 1.55 million Californians, benefitting a total of 2.2 million Californians.


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