Coverage During a Crisis: Insured Rate for Californians Hits Historic High in First Year of COVID-19 Pandemic

Lacey Hartman, Senior Research Fellow, State Health Access Data Assistance Center


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Despite widespread concern that economic fallout from the pandemic could slow California’s progress toward covering the uninsured, more Californians had health insurance coverage than ever before in 2020, according to results from the latest California Health Interview Survey (CHIS). A combination of prepandemic state and federal policies that expanded health insurance coverage, along with quick action by policymakers in 2020 to bolster those policies with additional crisis stopgaps, helped protect coverage for many Californians during the pandemic.

Key Findings

  • The uninsured rate among the nonelderly California population declined significantly, from 8.4% in 2019 to 7.0% in 2020.
  • Rates of uninsured dropped across several population subgroups from 2019 to 2020.
    • Californians with incomes up to 138% of the federal poverty guidelines (FPG), dropping from 12.1% to 9.6%. (These are people whose income would make them eligible for Medi-Cal, many through the Affordable Care Act expansion of the program.)
    • Californians who identify as Latinx, from 12.9% in 2019 to 10.5%.
    • Those residing in rural areas of the state, from 9.6% to 6.4%.
    • Adults age 18 to 64, from 10.8% to 9.1%.
  • Employer and individual coverage held steady statewide, and increased for some groups.
    • The overall statewide rate of employer coverage among the nonelderly was statistically unchanged from 58.8% in 2019 to 60.1% in 2020.
    • Employer coverage increased significantly from 59.2% to 60.9% among nonelderly adults, from 62.6% to 64.9% among citizens, and from 20.5% to 24.0% among those with incomes up to 138% FPG.
  • Medi-Cal coverage held steady statewide, but declined significantly among Black Californians.
    • Medi-Cal coverage held steady between 2019 and 2020, covering roughly one quarter of the nonelderly population.
    • Changes by subpopulation were also limited, with the notable exception that the share of Black Californians with Medi-Cal declined from 34.5% in 2019 to 24.0% in 2020, a difference that was statistically significant, and is a continuation of recent trends.
  • Despite measurable progress, critical disparities in coverage persist.
    • The uninsured rate among Latinx Californians remains almost three times as high as that of their White counterparts (10.5% compared to 3.8%).
    • Noncitizen adults are uninsured at more than three times the rate of their citizen counterparts (18.4% compared to 5.6%).
    • Californians with lower incomes are more likely to be uninsured than those with incomes above 400% FPG.

Looking Ahead

The state’s robust implementation of the Affordable Care Act and additional state policies over the years, in combination with recent state and federal policies designed to protect against coverage losses during the pandemic, has enabled the rate of coverage among Californians to rise to historic levels, even during a massive public health and economic crisis. However, there is potential for coverage expansion to slow or even reverse as policies that provided robust protection during the pandemic unwind or scale back.