Under the Affordable Care Act (ACA) the percentage of Californians with health insurance has risen to 93%. The state is closer than ever to covering every Californian and is now considering various policies to cover the state’s remaining three million uninsured.

According to estimates from the UC Berkeley Center on Labor Research and Education and the UCLA Center for Health Policy Research (PDF), the remaining uninsured fall into four main groups:

• 1.8 million (59%) are ineligible due to immigration status. Many, although not all, would otherwise qualify for Medi-Cal based on their income.
• 550,000 (18%) are eligible to purchase coverage on Covered California, though they don’t qualify for federal ACA subsidies to bring down the cost of their premiums. Cost is the biggest barrier cited by this group to obtaining coverage. The high cost of living in California likely contributes to many in this group not being able to fit health coverage into their budgets.
• 401,000 (13%) are eligible to purchase coverage on Covered California and their incomes are low enough to qualify them for federal ACA subsidies. This group also cites cost as the main barrier to becoming insured and California’s high cost of living is also likely a factor. Many who receive subsides are still not able to meet deductibles or afford their premium payments.
• 322,000 (11%) are eligible for Medi-Cal but not enrolled. This can be due to multiple factors, including people not knowing they are eligible, fear of enrolling in a government program, or difficulty with enrollment processes and procedures.

The California legislature is currently considering a range of proposals to address the unique barriers that uninsured Californians face. For example, one proposal would expand Medi-Cal eligibility to all adults with low incomes regardless of immigration status. Others would seek to make coverage on Covered California more affordable by using state funds to supplement or extend federal subsidies. Another would streamline Medi-Cal enrollment for uninsured children and pregnant women who are enrolling in the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Explore the data by region to understand how many in your area face these different barriers to coverage. In every part of the state, the largest percentage of people who lack insurance are ineligible due to immigration status, although the specific percentage varies widely by area. Other examples of variation exist. For example, the Sacramento Valley and Northern Counties have a much higher percentage of uninsured who are currently eligible for Covered California (both with and without federal ACA subsidies) compared to the state average. The data are available for download under Related Materials.

A Note on Methodology

These preliminary CalSIM 2.0 estimates were published in 2016, incorporating the survey and administrative data available at that time. Researchers anticipate updating these estimates before the end of 2018.

The data are organized by Covered California rating region. In a few instances, noted below, researchers combined two rating regions due to their geographic proximity and/or to obtain an adequate sample size.

• Alameda: Alameda County
• Central Coast (rating regions 9 and 12): Monterey, San Benito, and Santa Cruz; San Luis Obispo, Santa Barbara, and Ventura Counties
• Central Valley (rating regions 10 and 11): Merced, Mariposa, San Joaquin, Stanislaus, and Tulare; Fresno, Kings and Madera Counties
• Contra Costa: Contra Costa County
• Eastern Counties: Imperial, Inyo, and Mono Counties
• Inland Empire: Riverside and San Bernardino Counties
• Kern: Kern County
• Los Angeles (rating regions 15 and 16): Los Angeles County
• North Bay Counties: Marin, Napa, Solano, and Sonoma Counties
• Northern Counties: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, and Yuba Counties
• Orange: Orange County
• Sacramento Valley: Sacramento, Placer, El Dorado, and Yolo Counties
• San Diego: San Diego County
• San Francisco and San Mateo (rating regions 4 and 8): San Francisco and San Mateo Counties
• Santa Clara: Santa Clara County

In addition, you will see “<5,000” in some cells in the data table. This indicates that there wasn’t sufficient sample size to produce a reliable estimate smaller than 5,000 for that specific subcategory of uninsured. For more information on the methodology, see the full analysis (PDF).