UCLA Center for Health Policy Research

The Affordable Care Act (ACA) will significantly expand access to affordable health coverage in California starting in 2014. Californians with the lowest incomes will have access to coverage under the expansion of Medi-Cal, while millions of low- and middle-income families will be eligible for subsidies through the California Health Benefit Exchange (the Exchange). Demand for health insurance in the state will also increase as a result of the minimum coverage requirement.

The level of enrollment in the new and expanded programs and the resulting share of Californians who gain coverage under the ACA will depend on a range of factors, including the ease of enrollment and retention, outreach strategies, and language accessibility. 

We used the California Simulation of Insurance Markets (CalSIM) model, version 1.7, to predict changes in health coverage in California under the ACA using two  scenarios: one based on typical responses by individuals and employers to expanded coverage offerings (the “base” scenario) and another based on a more robust enrollment and retention strategy planned by state coverage programs (the “enhanced” scenario). 

Based on the results of our CalSIM model, we estimate that in 2019, after the ACA is fully implemented:

Between 89 and 92 percent of Californians under the age of 65 will have health coverage, compared to 84 percent without the law.

Between 1.8 and 2.1 million Californians will enroll in subsidized coverage in the California Health Benefit Exchange.

Between 1.2 and 1.6 million individuals will be newly enrolled in Medi-Cal.

Between 3 and just under 4 million Californians will remain uninsured,1 million of whom will not be eligible for coverage due to immigration status.

Under our enhanced scenario, we assume that greater enrollment in Medi-Cal and the California Health Benefit Exchange could be achieved through many factors,including:

Simplified enrollment and redetermination processes and systems; Robust outreach and education; Culturally competent and linguistically appropriate outreach and enrollment assistance; Pre-enrollment from existing health and human service programs; and Use of institutional connections to reach individuals in life transitions to maximize seamless coverage.