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Predicted Exchange Enrollment with Subsidies under the Affordable Care Act: Regional and County Estimates

UC Berkeley Center for Labor Research and Education
UCLA Center for Health Policy Research

The Affordable Care Act (ACA) will expand access to health coverage across California. Tax subsidies to purchase coverage will be available through the California Health Benefit Exchange (the Exchange) for eligible families with incomes up to 400 percent of the Federal Poverty Level ($44,680 for an individual and $92,200 for a family of four in 2012). Between 1.8 and 2.1 million Californians are expected to have subsidized coverage through the Exchange in 2019. (See Nine Out of Ten Non-Elderly Californians Will Be Insured When the Affordable Care Act is Fully Implemented).

Los Angeles will account for nearly one-third (31 percent) of the new subsidy eligible Exchange enrollees, with 550,000 to 670,000 participants depending on the level of enrollment. While Angelenos make up 27 percent of the state’s population, they accounted for 32 percent of the uninsured in 2009. In contrast, the Greater Bay Area, which starts with a disproportionately smaller share of the uninsured (13 percent compared to 19 percent of the state’s population), is expected to make up 16 percent of the subsidized Exchange participants. The remaining Southern California counties will account for 28 percent of the subsidized Exchange enrollees.

Data Sources and Methodology

We used the California Simulation of Insurance Markets (CalSIM) model, version 1.7, to predict changes in health coverage in California under  the ACA. The model  is designed to estimate the impacts of various elements of the ACA on employer decisions to offer insurance coverage and individual decisions to obtain coverage in California. For further information on the CalSIM methodology, please visit http://healthpolicy.ucla.edu/publications/Documents/PDF/calsim1.7methods.pdf.
Exhibit 1: Predicted Exchange Enrollment with Subsidies, Californians under AGe 65, by REgion and County, 2019

About the Authors

Ken Jacobs is the chair of the University of California, Berkeley, Center for Labor Research and Education. Dave Graham-Squire is a research associate at the University of California, Berkeley, Center for Labor Research and Education. Gerald F. Kominski is the director of the UCLA Center for Health Policy Research and a professor at the UCLA Fielding School of Public Health. Dylan H. Roby is the director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research and an assistant professor at the UCLA Fielding School of Public Health. Nadereh Pourat is the director of research at the UCLA Center for Health Policy Research and a professor at the UCLA Fielding School of Public Health. Christina M. Kinane is a research associate/project manager at the UCLA Center for Health Policy Research. Greg Watson is a data analyst at the UCLA Center for Health Policy Research. Daphna Gans is a research scientist at the UCLA Center for Health Policy Research. Jack Needleman is a professor at the UCLA Fielding School of Public Health.

Acknowledgements

We would like to thank Peter Lee, Katie Marcellus, and Laurel Lucia for their helpful comments. Funding for this research was provided by the California Health Benefit Exchange. The California Simulation of Insurance Markets (CalSIM) model was developed with the generous support of The California Endowment.