RELEASE: For California’s self-employed and small business employees, ACA repeal would be a huge setback

UC Berkeley Labor Center

For Immediate Release

CONTACT: Jacqueline Sullivan, (510) 642-0052 (office), (510) 604-2289 (cell)

May 18, 2017

Berkeley – Legislation passed by the U.S. House of Representatives earlier this month to repeal and replace significant portions of the Affordable Care Act, or ACA, threatens the health coverage of the self-employed in California and workers in small businesses such as restaurants, small retailers, and family farms.

According to a new data brief from UC Berkeley’s Center for Labor Research and Education, more than one million small business employees and over half a million self-employed Californians benefitted from the health insurance options made available under the ACA. Uninsurance among these groups fell sharply from one in five lacking insurance in 2013 to less than one in three in 2015.

While most Californians have health insurance through their employer, the self-employed do not have that option, and small business employees are much less likely to be offered affordable employer sponsored insurance. These workers had much greater health coverage gains than other workers under the ACA, through the expansion of Medi-Cal, California’s Medicaid program, and subsidies through Covered California.

The new data brief, “California’s Self-Employed and Small Business Employees Experienced Large Health Coverage Gains under ACA,” analyzes California Health Interview Survey data, finding a dramatic decrease in the numbers of uninsured among these workers with less access to employer sponsored insurance.

“Republican leaders in Congress are proposing to roll back federal funding for the expansion of Medicaid under the ACA, making it very difficult for states like California to continue the program,” according to Laurel Lucia, co-author of the brief.

For those individually purchasing private insurance, the Republicans’ proposal would “provide subsidies that are less generous for many low and middle-income Californians, especially those who are older or who live in high-premium areas,” Lucia said.

Key findings:

  • The uninsurance rate among California’s self-employed declined sharply under the ACA from 33.8% in 2013 to 17.9% in 2015. Among California’s small business employees, the uninsurance rate also plummeted from 31.0% in 2013 to 18.8% in 2015.
  • One in five small business employees and self-employed Californians relied on ACA coverage in 2015.
    • Small business employees had a higher rate of enrollment in the Medi-Cal expansion put in place by the ACA than other workers: 15.2% of employees at businesses with 50 or fewer workers, or 778,000 workers, compared to 9.5% of employees at larger businesses.
    • 246,000 small business employees, or 4.8%, enrolled in Covered California and were eligible for subsidies – more than double the rate for workers at large businesses (1.9%).
    • 214,000 self-employed Californians, or 8.1%, were enrolled in Covered California through the individual market and were estimated to be eligible for premium subsidies based on income – a much larger proportion than that of all other workers (2.9%).
    • An additional 353,000 self-employed Californians enrolled in the Medi-Cal expansion.

“The ACA has been a lifeline for California’s small businesses employees and the self-employed. Dismantling the ACA’s premium subsidies, standard of comprehensive coverage, and federal funding for the Medicaid expansion would be a big step back,” said Ken Jacobs, Chair of the Center for Labor Research and Education and co-author of the brief.

Laurel Lucia, Director, Health Care Program, Center for Labor Research and Education at UC Berkeley,, (510) 642-1851 (office), (510) 432-2565 (cell) 

Ken Jacobs, Chair, Center for Labor Research and Education at UC Berkeley,, (510) 643-2621 (office), (415) 516-3135 (cell)