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.
Laurel Lucia is director of the Health Care Program at the Labor Center, where she has worked since 2009 analyzing health care policy. Recent papers have examined the impact of rising health care costs for workers in California, shifts in health coverage during COVID-19, health coverage and economic impacts of Affordable Care Act repeal on California, California’s Medicaid expansion, health insurance for California immigrants, and the remaining uninsured in California. She also analyzes the economic impact of public policy changes. Her work has been covered in the Los Angeles Times, the Atlantic, and National Public Radio. Previously, Laurel worked on issues affecting health care workers as a researcher/policy analyst for the Service Employees International Union (SEIU). She has served as an elected officer for two unions. Laurel has a Master of Public Policy degree from UC Berkeley and a bachelor’s degree in public policy from Stanford University.
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%).
Modified Adjusted Gross Income under the Affordable Care Act – UPDATED WITH INFORMATION FOR COVID-19 POLICIES
Under the Affordable Care Act, eligibility for income-based Medicaid and subsidized health insurance through the Marketplaces is calculated using a household’s Modified Adjusted Gross Income (MAGI). The Affordable Care Act definition of MAGI under the Internal Revenue Code and federal Medicaid regulations is shown below.
The ACA covered millions of people and reduced the racial and ethnic disparities in health coverage in California; to take away these coverage options especially during a global pandemic and recession would exacerbate racial and ethnic inequality in California.
The ACA expanded coverage options available to low-income Californians and unemployed workers; to take away those options during a global pandemic and recession would compound the hardships faced by low-income households.
Still, the subsidies may be coming late in the game for many people, said Laurel Lucia, director of the Health Care Program at the University of California Berkeley’s Center for Labor Research and Education. “Some workers who lost job-based coverage earlier in the pandemic and already enrolled in Medicaid or marketplace coverage may prefer to stay in that coverage to avoid further coverage transitions,” Lucia said.
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“It’s a uniquely American problem that so many people have to rely on crowdsourcing to pay for their health care,” said Laurel Lucia, director of the health care program at UC Berkeley’s Labor Center. “It shows how many people are left out of our system and how unaffordable care has become.”
“If the ACA is overturned, policymakers would be facing a lot of hard decisions about how to respond,” Lucia said. “Over $28 billion in federal funding would be very difficult for the state to replace.”
The fate of the Affordable Care Act will be decided by the Supreme Court in November, plus Trump’s nominee
Interview with Laurel Lucia on “What Losing the Affordable Care Act Could Mean for Californians.”
Enrollment could also be lagging because the service industry has been hit hard, and many low-income workers in restaurants, bars or salons were already enrolled in Medi-Cal. “About a quarter who were at risk of losing jobs were already enrolled when the crisis started,” said Laurel Lucia.
Laurel Lucia, director of the health care program at the UC Berkeley Center for Labor Research and Education, says some people will still face a fine. “I think it’s worth exploring whether a temporary exemption is needed for Californians who have lost coverage due to COVID-related hardship, but are not eligible for one of the existing exemptions,” she said.