CalSIM

The UC Berkeley Labor Center and UCLA Center for Health Policy Research created the California Simulation of Insurance Markets model to help California policymakers, advocates, and stakeholders project the impacts of the Affordable Care Act (ACA) on insurance coverage in California, particularly eligibility and enrollment in Medi-Cal, insurance through Covered California, and employer-based coverage, and who remains uninsured. Recently the model has been used to estimate the impact of state-based reforms to expand subsidies, reinstate the “individual mandate,” and expand eligibility for Medi-Cal coverage for undocumented young adults. CalSIM uses a wide range of official data sources, including the California Health Interview Survey.

Research & Publications
Miranda Dietz, Tynan Challenorand Srikanth Kadiyala

Fact Sheet: Fixing the Family Glitch in California — Projections from the California Simulation of Insurance Markets

Proposed federal regulations would fix the family glitch by extending subsidies to spouses and children offered unaffordable family coverage through an employer. The employee would still be excluded from subsidies if their cost for single coverage through their employer was affordable. We use the California Simulations of Insurance Markets (CalSIM) model to project for 2023 how many people would fall into the family glitch in California, how many would be newly eligible for a positive dollar subsidy, and how many would enroll in Covered California with subsidies under the family glitch fix.

Miranda Dietzand Laurel Lucia

What’s at Stake for California Health Care Affordability in the Inflation Reduction Act?

The Inflation Reduction Act (IRA) currently being considered by Congress would improve health care affordability for many Californians by addressing high and rising drug prices and by extending the improved premium affordability assistance to Covered California enrollees that began in 2021. The extension of federal premium assistance would also unlock additional state-financed affordability help to reduce how much Covered California enrollees pay out-of-pocket when they access care.

Miranda Dietz, Laurel Lucia, Srikanth Kadiyala, Tynan Challenor, Annie Rak, Dylan H. Robyand Gerald F. Kominski

California’s biggest coverage expansion since the ACA: Extending Medi-Cal to all low-income adults

California has the opportunity to expand Medi-Cal to all low-income Californians, regardless of immigration status or age. This policy would result in a massive increase in coverage, bringing close to 700,000 undocumented Californians into coverage and reducing the uninsured rate for residents under 65 to just 7.1%, the biggest single improvement since implementation of the ACA.

Srikanth Kadiyala, Tynan Challenor, Annie Rak, Laurel Lucia, Dylan H. Roby, Gerald F. Kominskiand Miranda Dietz

The Threat to Coverage and Affordability Gains in Covered California if Congress Fails to Renew Subsidy Enhancements

In response to the COVID-19 pandemic, Congress enacted the American Rescue Plan of 2021 to provide additional temporary financial help for buying health insurance through the ACA Marketplaces. If these enhanced subsidies are not extended for 2023 and beyond, we project 220,000 fewer Californians would have individual market insurance in 2023 than if enhanced subsidies are extended, and premiums would be less affordable for more than two million individual market enrollees.

Miranda Dietz, Srikanth Kadiyala, Tynan Challenor, Annie Rak, Dylan H. Roby, Laurel Luciaand Gerald F. Kominski

American Rescue Plan Improvements to Covered California Affordability: Who Gains?

The American Rescue Plan substantially increases premium subsidies for coverage purchased through health insurance exchanges like Covered California. We project that these subsidies will help over 1.6 million Californians, including 151,000 individual market enrollees who will qualify for subsidies for the first time and 135,000 uninsured people who will become insured.

Miranda Dietz, Laurel Lucia, Srikanth Kadiyala, Tynan Challenor, Annie Rak, Dylan H. Robyand Gerald F. Kominski

Undocumented Californians Projected to Remain the Largest Group of Uninsured in the State in 2022

Even after the American Rescue Plan (ARP) substantially increases premium subsidies for health insurance coverage purchased through Covered California, large inequities remain in who has access to affordable coverage. Nearly 3.2 million Californians will remain uninsured in 2022, or about 9.5% of the population age 0-64, according to our projections. The highest uninsured rates will be among undocumented Californians (65%) and those eligible only for insurance through Covered California (28%).

Laurel Lucia, Xiao Chen, Dave Graham-Squire, Hanqing Yao, Petra W. Rasmussen, Greg Watson, Dylan H. Roby, Ken Jacobs, Srikanth Kadiyala, Gerald F. Kominskiand Miranda Dietz

California’s Steps to Expand Health Coverage and Improve Affordability: Who Gains and Who Will Be Uninsured?

In 2019, state lawmakers took steps to protect California’s coverage gains and increase affordability of coverage by instituting a state individual mandate penalty, providing additional subsidies for Covered California’s individual market enrollees, and expanding Medi-Cal to low-income undocumented young adults. California is the first state to include undocumented adults in full Medicaid benefits and the first to provide subsidies to middle-class consumers not eligible under the ACA.

Laurel Luciaand Ian Eve Perry

Comments on the Consumer Inflation Measures Produced by Federal Statistical Agencies

We urge you to not change the cost of living adjustment method for the OPM to Chained CPI-U, any other the other measures mentioned in the request for comment, or any other index that shows lower growth than the current CPI-U. Additionally, we urge you to include other issues apart from cost of living adjustments when considering any changes to the OPM.

Miranda Dietz, Laurel Lucia, Srikanth Kadiyala, Petra W. Rasmussen, Ken Jacobs, Dylan H. Roby, Dave Graham-Squire, Jason Zhang, Greg Watson, Xiao Chenand Gerald F. Kominski

3.6 Million Californians Would Benefit if California Takes Bold Action to Expand Coverage and Improve Affordability

Many California policymakers have expressed a desire and commitment to resist federal sabotage of the ACA, control health care costs, and achieve universal health care coverage. As the state explores ways to fundamentally redesign our health care delivery system—including by adopting a single payer or other unified public financing approach—state policymakers are also considering near-term policies that do not require federal approval but address the immediate challenges of improving affordability and expanding coverage.