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.
Area of Expertise
Miranda Dietz (she/her) is a research and policy associate at the Labor Center and project director of the California Simulation of Insurance Markets microsimulation model (CalSIM). CalSIM, developed jointly with the UCLA Center for Health Policy Research, models the impacts of various policies on health insurance coverage in California. Miranda’s research has focused on development of the model, estimates of the uninsured, and churn in and out of insurance coverage. Miranda has also written on local enforcement of labor standards, low-wage airport workers, and temporary workers in California. She is co-editor with Michael Reich and Ken Jacobs of When Mandates Work: Raising Labor Standards at the Local Level. Miranda received a Master of Public Policy degree from UC Berkeley in 2012, and a bachelor’s degree in government from Harvard University.
Comments on Rule Proposed by the Internal Revenue Service on Affordability of Employer Coverage for Family Members of Employees
Comment submitted to the Internal Revenue Service on proposed regulation that would address the ACA “Family Glitch.”
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.
The Medi-Cal redetermination process has been paused during the COVID public health emergency. As a result, many more individuals have newly enrolled in Medi-Cal than disenrolled, increasing Medi-Cal enrollment by almost 2 million since the beginning of the pandemic. This blog post summarizes (1) the available estimates of the potential reduction in Medi-Cal enrollment once the PHE is unwound and redeterminations have been completed, and (2) the likely eligibility for and enrollment in private coverage among those losing Medi-Cal.
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.
“It makes it so it’s very disheartening to take away these extra subsidies that have been really crucial in improving affordability for folks,” Miranda Dietz said.
Miranda Dietz, a research and policy associate at UC Berkeley Labor Center, said the significant increase in the number of Californians with health insurance over the last two years would be in jeopardy without the federal subsidies.
“Folks who are under age 26 who are low-income and undocumented can get full scope medical coverage through the state and this expands that to be 50 and above,” Dietz explained. “But, as you can imagine that still leaves a significant number of Californians ages 26 to 49 who are low-income and documented who are without insurance coverage.”
According to the UC Berkeley Labor Center, one in 10 low-income workers experiences wage theft in California. Violations range from getting paid below minimum wage to working off the clock or without overtime pay, resulting in thousands of dollars in lost compensation per worker.
A recent joint publication by the UC Berkeley Labor Center and UCLA Center for Health Policy Research projected the subsidies passed in the American Rescue Plan (ARP) will help over 1.6 million Californians. This number includes 151,000 individual market enrollees who will qualify for subsidies for the first time and 135,000 uninsured people who will become insured.