CalSIM: More Californians Covered Sooner

June 9, 2014

The UCLA Center for Health Policy Research and the UC Berkeley Labor Center recently released an updated version of the California Simulation of Insurance Markets (CalSIM) estimates of insurance coverage from 2015 to 2019. Compared to estimates from March 2013, CalSIM version 1.9 predicts that more Californians will enroll in insurance coverage, and at a faster rate.

The previous version of CalSIM estimated that 7.3 million individuals would be enrolled in Medi-Cal (compared to the Governor’s estimate of 11.5 million) and 2.91 million would be enrolled in Covered California or off-Exchange individual plans by 2015, however the new base estimates expect 7.43 individuals in Medi-Cal and 3.21 million in private individual plans. Through the next few years, Medi-Cal enrollment is expected to stay relatively flat, while Covered California/individual market enrollment is expected to increase from 3.21 million in 2015 to 3.99 million in 2017 to 4.26 million in 2019 (all base estimates significantly higher than the previous estimates). See below for the enhanced estimates.

Screenshot 2014-06-05 16.13.51

The Covered California take up rates for the subsidy eligible in 2015 are 48% for base projections and 56% for the enhanced scenario. Take up rates are highest for individuals with incomes between 139-200% FPL, children, women, and Caucasians. Interestingly, the take-up rate for Asians is the lowest of the ethnic groups, at 29%, despite the high enrollment numbers of Asians in 2013.

Other estimates that have changed include the number of uninsured, both those eligible for coverage and those ineligible due to immigration status. Far fewer individuals who are eligible for coverage are expected to be uninsured while more people without legal immigration status will be uninsured.

Screenshot 2014-06-05 16.16.14

More interesting estimates:

  • A majority (70%) of individuals who were previously eligible for Medi-Cal but not enrolled are children – and only 8-9% will take up coverage, even by 2019, under the base scenario (16% under enhanced scenario)
  • In 2015, 290,000 to 350,000 individuals with incomes below 138% FPL will take up unsubsidized private coverage despite likely Medi-Cal eligibility
  • In 2015, 250,000 to 310,000 individuals will take up unsubsidized private coverage despite incomes between 139-250% FPL. Some of these individuals may be ineligible for subsidies due to the ‘kid glitch’ or offers of employer-sponsored coverage.
  • 73% of enrollees in Covered California and outside the Exchange will have no chronic conditions
  • 54% of those newly eligible for Medi-Cal are Latino
  • Those newly eligible for Medi-Cal are equally dived between incomes of 0-100% FPL and 101-138% FPL
  • 62-72% of Californians who remain uninsured will be exempt from the individual mandate’s penalty
  • Only 45-50% of individuals under 400% FPL who are ineligible for subsidies because the prices of Covered California plans are lower than the ACA’s premium caps will enroll in 2015, but this increases over time to 60%