Resource Page: Expanding Coverage to All Californians
May 9, 2018
Under California’s implementation and improvement of the Affordable Care Act (ACA), the percentage of insured Californians has risen to 93%. The goal of covering every Californian is within reach. California is currently in the midst of a critical discussion about how to expand coverage to the three million Californians who remain without health insurance.
This page will be updated regularly. If you have suggested additions, please email Anne Sunderland.
Current Sources of Health Coverage in California
The following presentations were all given before the Assembly Select Committee in October 2017 and provide a broad overview of how Californians are currently covered and how the state’s health insurance markets function.
California’s Uninsured: As Coverage Grows, Millions Go Without
Relies on the March 2016 supplement to the Current Population Survey as well as 2015 California Health Interview Survey data to describe California’s uninsured, put the declining uninsured rate in the context of other trends in California’s health insurance market, and describe the experience of the uninsured accessing care. (California Health Care Foundation, November 14, 2017)
Health Coverage Gaps in California This presentation to the Assembly Select Committee uses a variety of data sources to describe California’s remaining uninsured, as well as the main factors behind lacking insurance — namely, immigration status and affordability. (UC Berkeley Center for Labor Research and Education, October 23, 2017)
Preliminary Regional Remaining Uninsured 2017 Data Book, California Simulation of Insurance Markets (CalSIM) version 2.0
This publication models the number of uninsured per large county (such as Fresno, Los Angeles, and others), and breaks that number out by those (1) not eligible due to immigration status, (2) eligible for Medi-Cal but not enrolled, (3) eligible for subsidies through Covered California, and (4) non-subsidy-eligible citizens and lawfully present immigrants. In areas where individual county populations were too small to obtain an adequate sample size, the analysis is done by Covered California rating region, which group together multiple counties. (UC Berkeley Center for Labor Research and Education, August 11, 2016). See this CHCF page for a summary of the data.
Immigration Status as a Barrier to Health Coverage
Undocumented adults remain ineligible for both Medi-Cal and coverage through Covered California. For this reason, immigration status is the most prevalent reason for lacking coverage among California’s uninsured. These resources provide a deeper overview of undocumented Californians and describe the challenges they experience accessing health care. As undocumented Californians have continued to be excluded from traditional forms of coverage, some counties have stepped up to provide them with safety-net health services.
Affordability on the Individual Market as a Barrier to Coverage
While the ACA made coverage for many in the individual market much more affordable, challenges remain. The lack of affordability in the individual market is second only to immigration status as the biggest driver of the state’s uninsured rate. The following reports dive deeper into these affordability challenges, which are exacerbated by California’s high cost of living.
Balancing the Books: How Affordable Is Health Insurance Through Covered California When Local Cost of Living Is Taken Into Account?
California’s high cost of living can make it even more difficult for families to afford health insurance. This analysis identifies the minimum amount a typical household would need to earn to cover its basic needs (housing, food, etc.) and Covered California premiums and out-of-pocket costs after federal subsidies. An interactive map shows how this amount varies widely by California county, mostly due to the cost of living. In every California county, there are families and individuals who fall into an affordability gap: They earn too much for Medi-Cal but not enough to afford health insurance through Covered California, even with subsidies. (California Health Care Foundation, June 8, 2016)
Policy Options to Expand Coverage
The resources below highlight bills currently active in the 2017–18 session of the California legislature in addition to broader policy proposals articulated by groups such as advocates and unions.
2017–18 Legislative Session Bills in California
On this page, ITUP will track and update numerous bills related to health care coverage in the California legislature. These bills are grouped into categories including “expanding coverage, improving affordability, and containing costs,” “preserving ACA advances,” and more. (ITUP, updated regularly)
Care4All California Policy Agenda
In March 2017 a coalition was launched consisting of consumer, community, labor, progressive, and health care organizations. Their policy proposals includes expanding Medi-Cal to the undocumented, making ACA coverage more affordable, and addressing the biggest drivers of health care costs.