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

BERKELEY, Nov. 28, 2018 – A new study by researchers at UC Berkeley and UCLA projects how changes to federal law that remove the Affordable Care Act (ACA) individual mandate penalty in 2019 could significantly impact California’s record-breaking health coverage gains.

“Unless the state takes action, we could see 500,000 to 800,000 more Californians become uninsured as a result of the individual mandate penalty going away,” said lead report author Miranda Dietz, a UC Berkeley Labor Center research and policy associate. “Policies supporting broader enrollment matter even more now.”

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Entitled California’s Health Coverage Gains to Erode without Further State Action, the report uses the California Simulation of Insurance Markets (CalSIM) microsimulation model developed by the UC Berkeley Labor Center and UCLA Center for Health Policy Research. It includes a range of assumptions to detail how many Californians will be uninsured in 2020
and 2023.

Thanks to California’s effective implementation of the ACA, the state uninsurance rate among non-elderly Californians fell from 17.6% in 2012 to 10.4% in 2016 after new enrollment in the Medi-Cal expansion and subsidized insurance through Covered California leveled off. Today, 10.4%, or 3.55 million Californians under the age of 65, lack insurance.

Without state action to protect and build upon these coverage gains, the report projects that the uninsurance rate could grow to 11.7% in 2020, or to approximately 4.0 million people, and to 12.9% in 2023, or 4.4 million people under age 65. These estimates include undocumented Californians who only have restricted-scope Medi-Cal.

The report projects most substantial enrollment changes will occur in the individual market. It also details which populations are projected to remain uninsured, such as undocumented Californians, who make up the largest group, and others who struggle to afford insurance.

To protect the progress made under the ACA in expanding health coverage and to reduce the remaining coverage gaps, report authors note that the state could implement policies that:

  • Expand Medi-Cal to all low-income residents regardless of immigration status
  • Provide state subsidies to improve affordability of individual market premiums and out-of-pocket costs
  • Implement a state individual mandate, and
  • Continue to support and strengthen outreach and enrollment efforts.

“Federal decisions threaten to reverse health coverage gains around the country,” said Gerald Kominski, senior fellow at the UCLA center and co-author of the policy brief. “These policies would help to ensure that California continues to build on its successes and drive toward its goal of achieving universal health coverage.”

The UC Berkeley Center for Labor Research and Education (Labor Center) is a public service project of the Institute for Research on Labor and Employment (IRLE) at UC Berkeley. IRLE connects world-class research with policy to improve workers’ lives, communities, and society.

The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center is the home of the California Health Interview Survey (CHIS) and is affiliated with the UCLA Fielding School of Public Health.