Timeline: Health Insurance in California Before the ACA

Katherine Wilson, Wilson Analytics


CHCF offers a brief look at the health insurance market prior to passage of the Affordable Care Act (ACA). The infographics provide a breakdown of enrollment in commercial plans and public programs, as well as a visual guide to the consolidation of health plans since 1985. Also, a timeline marks key milestones in the history of health insurance in California, from the opening of the first prepaid group practice of physicians in Los Angeles, to the historic passage of national health reform in 2010.

“Insurance Plan and Public Program Enrollment, 2009” outlines enrollment in large commercial plans (more than one million members), such as Kaiser Permanente and Aetna, broken out by for-profit and nonprofit status. Detail on Medi-Cal, Medicare, and Healthy Families enrollment in the commercial plans is also provided. In addition, enrollment estimates are given for Medi-Cal and Medicare, with detail on enrollment in managed care.

“Consolidation of Health Plans, 1985 to 2011” offers a visual representation of how the key players in the health plan market have changed over time and illustrates how for-profit plans dominate the market in 2011.

“History of Health Insurance in California” is a timeline of milestones in the evolution of the market from 1929 to 2010. Use the interactive version of the timeline below to learn more about each event.

A PDF containing all three graphics is provided as a Document Download; it should be printed on 11″ x 17″ paper for maximum legibility.

Sources: 2009 Profile and Annual Report, California Association of Health Plans; California Health Plans and Insurers, California Health Care Foundation, October 2010; Peter Long and Jonathan Gruber, “Projecting the Impact of the Affordable Care Act on California,” Health Affairs 30, no. 1 (2011): 63-70; S. A. Lavarreda and L. Cabezas, Two-Thirds of California’s Seven Million Uninsured May Obtain Coverage Under Health Care Reform, UCLA Center for Health Policy Research, 2011; G. A. Melnick and J. Zwanziger et al., “Competition and Cost Containment in California: 1980-1987,” Health Affairs 8, no. 2 (1989): 129-136; Thomas Rice et al., “The State of PPOs: Results from a National Survey,” Health Affairs 4 (1985): 425-40; Debra L. Roth and Deborah R. Kelch, Making Sense of Managed Care Regulation in California, California Health Care Foundation, December 2001; “Table HIA-4: Health Insurance Coverage Status and Type of Coverage by State, All People: 1999 to 2009” in Annual Social and Economic Supplement of the Current Population Survey, US Census Bureau.