As Californians continue to live through the COVID-19 pandemic, access to health care is top of mind for many. Below is a reminder of the Affordable Care Act’s role in providing health care coverage to Californians, which is especially important during the pandemic. Explore the table below to see how many people in your local area are covered and protected under the ACA. (A printable PDF of the text and data on this page is available under Document Downloads, along with the raw data in an Excel file.)

What Has Been the Impact of the Affordable Care Act in California?

The Affordable Care Act (ACA), which was fully implemented in 2014, increased Californians’ access to health coverage. Under the ACA, California established Covered California, a health insurance marketplace where those who don’t get coverage through their jobs and don’t qualify for public health insurance can purchase coverage. Eighty five percent of Covered California consumers receive a federal subsidy to help them afford coverage.¹ The ACA allowed California to expand its Medicaid program, called Medi-Cal, to more adults with low incomes. The ACA also included vital protections for all consumers, including barring health insurers from denying coverage based on preexisting conditions. As a result:

• California’s uninsured rate has fallen from 17% to 7.1%. The number of uninsured Californians has dropped by 3.7 million.²
• 1.5 million Californians get their coverage through Covered California.³
• 12.5 million Californians are covered by Medi-Cal, including 3.7 million adults through the ACA expansion.⁴
• As the uninsured rate has fallen across all groups, racial disparities in coverage have declined.⁵
• 16.8 million nonelderly Californians who have preexisting conditions are protected from being rejected by a health insurer.⁶

California has built on the ACA to further expand access to health coverage, implementing additional subsidies to help more people afford coverage on Covered California. The state has also further expanded Medi-Cal to all children and young adults with low incomes regardless of immigration status.

ACA Coverage During the COVID-19 Pandemic

As the state confronts the COVID-19 pandemic, and the ensuing economic recession, the ACA is providing a vital safety net. Many Californians losing their jobs and job-based health insurance can turn to either Covered California or Medi-Cal to stay covered, options that would not have been there before the ACA.

In addition, it is estimated that Medi-Cal is covering close to a million of the workers Californians are relying on so heavily during the pandemic.⁷ This includes Californians with jobs like home health aides, grocery store workers, farm workers, warehouse workers, and more.  Many low-income workers in these jobs are not offered job-based coverage or can’t afford the premiums for it.

The ACA Is Still Under Threat

The Trump Administration continues, even during the COVID-19 pandemic, to pursue a federal lawsuit to invalidate the entire ACA. If successful, the lawsuit could end all consumer protections and all forms of health care coverage currently provided under the law. It is estimated that 20 million Americans could lose health coverage, including 3.8 million Californians.⁸

How Many Are Covered by the ACA in Your Area?

Below see how many in your local congressional district get their coverage through Medi-Cal or Covered California, or benefit from the ACA’s protections for those with preexisting conditions.

1. Active Member Profiles (March 2020), Covered California, June 8, 2020.
2. SHADAC analysis of the American Community Survey (ACS) Public Use Microdata Sample (PUMS) files, SHADAC, accessed August 27, 2020. This drop in the uninsured rate occurred between 2013 and 2018, the latest data available at the time of publication.
3. Active Member Profiles (March 2020), Covered California, June 8, 2020.
4. Medi-Cal Certified Eligibles Data Table by County and Aid Code Group: June 2020 (Dates Represented: March 2020) (PDF), California Dept. of Health Care Services, July 2020.
5. Tara Becker and Ninez A. Ponce, Californians Maintain Health Insurance Coverage Despite National Trends, UCLA Center for Health Policy Research, October 2019. (Report examines 2018 data from the California Health Interview Survey.)
6. Emily Gee, “Number of Americans with Preexisting Conditions by District for the 116th Congress,” Center for American Progress, October 2, 2019. (Data derived from 2017 American Community Survey.)
7. Matt Broaddus, “5 Million Essential and Front-Line Workers Get Health Coverage Through Medicaid,” Center on Budget and Policy Priorities, August 4, 2020.
8. Jessica Banthin et al., Implications of the Fifth Circuit Court Decision in Texas v. United States: Losses of Coverage, Federal Health Spending, and Provider Revenue (PDF), Urban Institute, December 2019.