Shana Charles

​Summary: This publication represents the 20th anniversary of the State of Health Insurance in California (SHIC) report series. It is the 10th installment of the UCLA Center for Health Policy Research’s ongoing, in-depth study of the overall outlook for health insurance coverage in our state. Longtime readers of this report series will find similar chapters as in the past — a demographic overview, private coverage, public coverage, and access to care impacts — and will recognize the focus on adults under age 65 and children, since seniors are almost universally covered through Medicare. However, authors are now providing the data in a more streamlined and broadly accessible chartpack, allowing readers to draw their own conclusions based on the comprehensive data provided.

The data are from the 2019 and 2020 California Health Interview Surveys (CHIS), representing the decade following the enactment of the Patient Protection and Affordable Care Act of 2010, also known as the ACA or “Obamacare.” Most of the health insurance expansions took full effect in 2014. Since then, ACA expansion has continued in California, including the growth of subsidies and coverage, notwithstanding rollbacks and roadblocks posed by the federal government from 2017 to 2020.

Findings: Despite these advances, this chartpack shows that significant coverage gaps remain in California. Racial and ethnic disparities persist (Chapter 1); many small businesses struggle to even offer health insurance to employees (Chapter 2); more than half a million low-income people who could be eligible for Medi-Cal remain uninsured (Chapter 3); and being uninsured remains a significant barrier to accessing health care (Chapter 4).

Read the Publications:

• Report: The State of Health Insurance in California: Findings From the 2019 and 2020 California Health Interview Surveys
• Infographic
• Press Release

​In 2019, 2.75 million California adults reported that they never vote in elections, and an additional 7.7 million reported that they only “sometimes” vote. The combined number of "never" and "sometimes" voters is even higher for local elections, in which 6 million California adults reported that they “never” vote, and an additional 7.4 million reported that they only “sometimes” vote. In addition, the proportion who reported infrequently voting in local elections (52%) is twice as high as for presidential elections (26%). Voter participation rates vary widely by race/ethnicity and these differences can have an important impact in local elections where greater participation by underrepresented groups could influence the results. 

Read the Publication:

• Fact Sheet: Voter Participation in California Varies Widely by Type of Election and by Voter Race and Ethnicity
• Infographic
• Related Policy Brief: Better Health, Greater Social Cohesion Linked to Voter Participation

Summary: This policy brief describes voter registration and participation among California adults using data from the 2017–2018 California Health Interview Survey (CHIS). 

Findings: Better health status, lower levels of psychological distress, and better access to health care were related to higher levels of voter participation. Higher levels of voter registration and participation were reported among those living in neighborhoods perceived as safe and as having high social cohesion. 

Among citizens, Asians and those with limited English proficiency were more likely to report that they were not registered to vote because they did not know how or where to register. Individuals who lacked a high school degree, whose incomes were below the poverty level, who were Latino/a, or who were non–native English speakers but spoke English very well or well were more likely to report a lack of eligibility as the main reason for not being registered to vote.

Strategies to increase voter engagement could help ensure that the voters better represent the diverse residents
of California and could also promote policies that better meet the health needs of these populations.

Read the Publications:

• Policy Brief: Better Health, Greater Social Cohesion Linked to Voter Participation
• Appendix
• Infographic
• Related Fact Sheet: Voter Participation in California Varies Widely by Type of Election and by Voter Race and Ethnicity

California led the way in implementing ACA reforms, and national data comparisons of all 50 states clearly show the state has been one of the most successful states in enrolling eligible people in new coverage from the ACA’s full launch in 2014 until today. But California still must contend with and operate under federal rules and guidelines, and when the federal administration changed in 2017 to a president hostile to the ACA, even California felt the pinch and saw uninsured rates begin to creep up again.

This report, which presents 2015-2016 California Health Interview Survey data, is a snapshot in time. The data are from just before the current administration took power, just before the mantra of a Republican-led Congress was that it was going to “repeal and replace Obamacare” in 2017. That did not happen, and the House became controlled by ACA supporters in the next election. This report shows the peak of the ACA, before federal regulators began to backpedal on expansions. Additionally, a new focus on Medicare data is added to this year’s report. With the ACA under attack since 2017, much of the policy conversation around expanding health insurance coverage has turned to building instead on the one widely admired public program, Medicare. While proposals can differ on just how to expand Medicare, they all should be based on solid initial data on what Medicare does for its current enrollees and on how the program compares with other public and private coverage. Authors note that while the ACA’s impact is now slowly declining, even at its height in 2016, millions of Californians still did not have any health insurance coverage.  

Publication Authors:

• Shana Charles, PhD, MPP
• Tara Becker, PhD
• Ian Perry
• Ken Jacobs
• Nadereh Pourat, PhD
• Maria Ditter, Dr.med., M.P.H.
• Maria Mekhaiel
• Gerald F. Kominski, Ph.D.