Health Care
Health policy
Uninsured
Miranda Dietz (she/her) is director of the Health Care Program at the UC Berkeley Labor Center, where she has worked since 2012. Her research focuses on health care affordability and coverage in California, with a particular emphasis on policy impacts for low-income and immigrant working families and communities of color.
As project director for the California Simulation of Insurance Markets microsimulation model (CalSIM), developed jointly with the UCLA Center for Health Policy Research, Miranda has modeled and analyzed the impacts of various policies on health insurance coverage in California. She serves as vice chair of the Data Release Committee for the state’s Health Payments Database. Her work includes analysis of consumer affordability trends, the impact of the Affordable Care Act and Medi-Cal expansion, and estimates of the uninsured population in California.
Miranda’s research has informed policy decisions at the state and local levels. She has contributed analysis that has been used in legislative efforts to expand coverage and by Covered California, the Department of Health Care Services (California’s state Medicaid agency), the Department of Managed Health Care, and the Office of Health Care Affordability. Her research extends beyond health care to include 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 (University of California Press, 2014).
Miranda received a Master of Public Policy degree from UC Berkeley in 2012 and a bachelor’s degree in government from Harvard University.
This blog post examines the extraordinary growth in job-based health care costs, how this impacts California workers, and what the state can do to mitigate the problem. We focus on costs for family coverage, though a similar story could be told about the cost of single coverage.
California’s historic expansion of coverage to undocumented individuals has not only brought the state closer to universal coverage, but has also reduced racial disparities in health coverage. However, this progress is at risk due to a new state budget proposal that would curtail Medi-Cal benefits for certain immigrants, ahead of additional severe federal cuts to Medicaid being considered.
The onerous documentation needed with Medi-Cal work requirements would increase administrative costs and reduce enrollment and access to care, including for people who are already working or otherwise should be exempt.
This page provides the number and percentage of children and teens enrolled in Medi-Cal by county, congressional district, assembly district, and senate district, as of July 2024. These estimates reflect the district boundaries after the 2024 election
This page provides estimates of the number of individuals and percentage of population enrolled in Medi-Cal by county, congressional district, assembly district, and senate district, as of June 2024.
Along with rising premiums, more California employees also face increasing out-of-pocket costs. Workers bear indirect costs, too, Dietz said. As businesses spend more on health plans, they spend less on wages and other benefits, she said.
Because Congress failed to act to extend federal health insurance subsidies, everyone who buys insurance on California’s individual market will pay more, including roughly 740,000 Californians who receive no subsidies at all. Miranda Dietz explains.
By covering low-wage workers, the program helps millions remain healthy, productive contributors to the economy. A 2025 study by the UC Berkeley Labor Center found that nearly one in five California workers is enrolled in Medicaid, underscoring how deeply the program is tied to the state’s labor force.
“It doesn’t mean necessarily that 200,000 people are going to lose their job,” said Miranda Dietz, interim director of the Health Care Program at the Labor Center. “Some people will lose their job, and in some cases, the job growth won’t be as fast as anticipated.”
“The whole concept of Medi-Cal is that it’s a safety net program,” said Dietz. “Freezing people out and preventing new enrollment means that it can’t serve that function. And if people can’t navigate the bureaucratic hurdles of redetermination, they won’t be able to get back in.”
Nearly 40% percent of Californians rely on Medi-Cal for health coverage, and now millions are expected to fall off the rolls.
If cuts proposed by Republicans in Washington become law, millions of Californians could lose health care provided by Medi-Cal, according to an analysis by the UC Berkeley Labor Center. A cascade of economic damage would follow, touching every part of the state.
“Insurance premiums have been going up faster than wages over the last 20 years,” said Miranda Dietz. Rising hospital prices are largely to blame.
Temporary workers earn 18% less than non-temporary workers and are twice as likely to live in poverty and rely on social safety nets, according to Miranda Dietz, a researcher at the Center for Labor Research and Education at the University of California, Berkeley.
The Biden-era policies contributed to the lowest rate of uninsured U.S. residents in history. If they are allowed to expire next year, experts such as Miranda Dietz said they worry that health insurance costs and the rate of uninsured Americans will increase significantly.
