“This is one of the drawbacks of having a healthcare system that is tied to employment,” said Laurel Lucia, healthcare program director at the UC Berkeley Labor Center. “We saw during the pandemic, when there were furloughs or layoffs, people lost job-based coverage when they needed it most.”

“These dialysis initiatives have really been about regulating an industry that has a duopoly, high profit rates and well-documented patient safety concerns,” said Laurel Lucia, director of the Health Care program at the UC Berkeley Labor Center.

The state of California is ready with $304 million to help lower- and middle-income consumers pay for health insurance if federal subsidies end. But the fund will cover only a fraction of what would be lost. “We’re fortunate the state has the program, but it’s not enough,” said Laurel Lucia.

Much of the cost for increasing premiums has been swallowed by employers, but it gets passed down to employees anyway. When health costs increase, wages stagnate, said Laurel Lucia, director of health care at the UC Berkeley Labor Center.

If the state pours more money into part-time faculty health plans, “unions and the districts may negotiate to improve the benefits currently offered,” said Laurel Lucia. Colleges that already offer health plans to part-time faculty “might reduce the premium amount that the worker is required to pay or they might reduce the amount that people have to pay out of pocket to access care.”

Gov. Newsom’s proposed budget has proposed providing the final missing piece and the largest group remaining: all low-income adults ages 26 to 49, regardless of immigration status. That move would represent the state’s biggest coverage expansion since the Affordable Care Act’s implementation, and comprises about 670,000 people, Lucia said.

“Our health insurance system, which is primarily tied to employment, is not financed in a way that’s progressive,” said Laurel Lucia. “Low-wage workers who get coverage through their jobs pay a much higher percentage of their income than middle- and higher-income workers.”

Lack of access because of immigration status is just one piece of the remaining uninsured. Many other Californians forgo coverage despite being eligible, likely because of the cost. According to the UC Berkeley and UCLA study, 2 million uninsured people qualify for Medi-Cal, employer coverage or Covered California.

Medicaid, Affordable Care Act plans and special employer subsidies helped many who lost coverage, but “the pandemic has showed the risks of having health insurance tied to employment,” said Laurel Lucia.

“Unfortunately, employers use this threat to discourage workers from going on strike or to push workers to end a strike before an adequate contract agreement has been reached,” says Laurel Lucia.