By Trish Violett
In the years since implementation of the Affordable Care Act (ACA) California made steady progress in reducing the number of uninsured in the state. According to newly released projections from the California Simulation of Insurance Markets (CalSIM), a micro-simulation model developed by UC Berkeley and UCLA health policy researchers to estimate the impact of various elements of the ACA, this pattern is unlikely to continue without state policy intervention.
Newly released projections from the model estimate that the uninsured rate among non-elderly Californians will increase from 10.4 percent in 2016 to approximately 11.7 percent in 2020 and 12.9 percent in 2023, primarily attributed to the elimination of the federal individual mandate tax penalty beginning in 2019 and ongoing affordability concerns. The updated estimates are based on a definition of uninsured that includes undocumented adults who are only eligible for restricted scope Medi-Cal, which is limited to emergency and pregnancy-related services but does not provide comprehensive, ongoing coverage.
Characteristics of the Projected Uninsured
As of 2020, CalSIM projects an uninsured population of approximately 4 million individuals in California. Specifically, the uninsured are expected to be:
- Undocumented adults. More than one in three (1.5 million, or 37 percent) of the uninsured are expected to be undocumented, most between the ages of 30-49 (62 percent), and the majority with low incomes (65 percent with annual income under 138% of the Federal Poverty Level (FPL), or $16,754 for an individual).
- Eligible for Medi-Cal but not enrolled. Nearly 1 million individuals (900,000, or 22 percent of the uninsured) are expected to be eligible for Medi-Cal but not enrolled in the program. The unenrolled Medi-Cal-eligible population is expected to be primarily Latino (58 percent).
- Eligible for subsidized coverage. Around 530,000 (13 percent) of the uninsured will be eligible for but not enrolled in subsidized coverage through Covered California, and of those individuals, 70 percent will have incomes between 200-400 percent FPL ($24,120-$48,240 annual income for an individual), and 73 percent will be between the ages of 19-49.
- Varied throughout the state. Los Angeles County, which accounts for 26 percent of the state’s population, will comprise 36 percent of the undocumented uninsured and 35 percent of the uninsured eligible for subsidized coverage through Covered California. The San Francisco Bay Area, which accounts for 19 percent of the state’s population, will comprise 26 percent of the uninsured with incomes over 400 percent FPL (more than $48,240 annual income for an individual).
State Actions to Continue Reducing the Uninsured
In today’s release of the new CalSIM estimates, the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research list several policies the state could pursue to continue increasing coverage, including expanding Medi-Cal eligibility to additional low-income adults, state-funded subsidies to improve affordability, and continued investment in outreach and enrollment assistance. For additional information on potential state policies to expand coverage and improve affordability, see the updated ITUP Issue Brief, California Strategies: Covering California’s Remaining Uninsured and Improving Affordability.