California’s Uninsured: Progress Toward Universal Coverage

Paul Fronstin, Employee Benefit Research Institute

Since the implementation of the Affordable Care Act (ACA) in 2014, the uninsured rate in California dropped by nearly half, from 16% in 2013 to an all-time low of 9% in 2016. However, 2.9 million Californians remained uninsured.

California’s Uninsured: Progress Toward Universal Coverage takes a look at who was uninsured in 2016, three years after full implementation of the ACA. The health care reform law was enacted in 2010 and allowed individuals to purchase insurance through ACA exchanges and also expanded Medi-Cal. Even with these gains, the future of health insurance coverage remains uncertain. There have been many efforts to roll back portions of the ACA, including the elimination of the tax penalty for not obtaining health coverage beginning in 2019. Analysts predict that this policy change will increase the uninsured rate in California and nationally starting that year.

Key findings include:

  • The drop in the uninsured rate was mainly due to a five percentage point increase in individually purchased insurance coupled with a four percentage point increase in Medi-Cal enrollment.
  • One in three of California’s uninsured had annual incomes of less than $25,000. At this income level, people are potentially eligible for Medi-Cal, unless they do not qualify due to citizenship status.
  • Of the 1.7 million uninsured workers in California, 47% worked for private companies with fewer than 50 workers.
  • Of California’s uninsured, one in four were age 25 to 34, nearly one in three were noncitizens, and over half were Latino.
  • A smaller percentage of Californians cited affordability as the reason for not having health insurance in 2016 compared to 2014.

Uninsured rates are tracked by various sources including the US Census Bureau’s Current Population Survey (CPS), the American Community Survey, and the California Health Interview Survey. Due to differences in survey methodology, sources may publish different rates. The author of this publication used CPS data to calculate uninsured rates.

The full report, a quick reference guide, and all of the charts found in the report are available under Related Materials. Also available are the data files and previous years’ reports. These materials are part of CHCF’s California Health Care Almanac, an online clearinghouse for key data and analyses describing the state’s health care landscape.