California’s health coverage gains will erode without new action by the state

UCLA-UC Berkeley report finds up to 4.4 million Californians could be uninsured in 2023 because of changes in federal law
Uninsured in California
Recent figures and projections for California uninsured rates.

A new study by UCLA and UC Berkeley researchers projects that hundreds of thousands more Californians could become uninsured because of forthcoming changes in federal health insurance law. Beginning in January 2019, new policy will remove the Affordable Care Act’s individual mandate penalty, the fee assessed to people who do not have health insurance.

The report uses the California Simulation of Insurance Markets model, which was developed by the UCLA Center for Health Policy Research and the UC Berkeley Labor Center, to forecast how many Californians will be uninsured in 2020 and 2023.

The authors suggest policies that could help California protect the progress the state made under the ACA in expanding health coverage, and to reduce the remaining gaps in coverage, including:

  • Expand Medi-Cal to all low-income residents regardless of their immigration status;
  • Provide state subsidies to individual market premiums and out-of-pocket costs more affordable;
  • 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, a 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.”

Thanks to California’s effective implementation of the ACA, the percentage of uninsured non-elderly Californians fell to 10.4 percent in 2016 (representing 3.55 million Californians under the age of 65), from 17.6 percent in 2012.

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

“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 Miranda Dietz, the report’s lead report author and a research and policy associate at the UC Berkeley Labor Center. “Policies supporting broader enrollment matter even more now.”

The report forecasts that the most substantial enrollment changes will occur in the individual market. It also details which populations are projected to remain uninsured — such as undocumented Californians — and which will struggle to afford insurance.

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