California’s Future: Health Care
California’s embrace of the Affordable Care Act (ACA) has resulted in historic declines in the number of uninsured residents. Since 2014, the state’s uninsured rate among residents under age 65 has decreased from nearly 20 percent to 8.5 percent. Medi-Cal, the state’s Medicaid program, is responsible for much of the coverage gain, while Covered California, the state’s insurance marketplace, has maintained steady enrollment. Still, nearly 3 million Californians lacked health insurance coverage in both 2016 and 2017—which suggests that coverage gains may have plateaued.
Federal policy shifts—including the repeal of the requirement that nearly all Americans have health insurance or face a tax penalty—could further erode California’s coverage gains under the ACA. In response, state policymakers have been exploring options for maintaining current coverage levels and expanding health insurance to all Californians. An advisory council tasked with developing options to expand coverage within an efficient health care financing system was established under the current year’s budget. The new governor has signaled support for such a plan. Still, major components of a state-based system are as yet unknown—including how it would be financed. Californians seem supportive, although there are differences across age groups.
This publication is part of a briefing kit that highlights our state’s most pressing long-term policy challenges in 11 key areas: