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.
Dylan H. Roby
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.
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.
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%).
A Little Investment Goes a Long Way: Modest Cost to Expand Preventive and Routine Health Services to All Low-Income Californians
The California legislature is considering a proposal (Senate Bill 1005, the Health for All Act) that would expand Medi-Cal coverage to include primary and preventive care, prescription drugs, mental health care, dental care, and other routine health services for all low-income California residents regardless of immigration status. This brief finds that the proposed Medi-Cal expansion would involve new state spending, but the cost is modest in comparison to the impact on health and coverage, and the policy also produces savings.