Up to 3.7 million insured in California’s Medicaid expansion and a further 1.2 million Californians receiving subsidies to buy affordable health insurance in Covered California are at risk if current Republican plans to repeal the Affordable Care Act are enacted, according to a set of new studies and county fact sheets from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.
Millions of Californians stand to lose from ACA repeal in some way -- either through lost access to affordable coverage or to jobs created by health insurance expansion.
In particular, low-income earners, young adults, part-time workers, and people of color in California gained the most between 2013 and 2015. Now, with the impending repeal and replacement of the ACA, people in these and other groups have the most to lose and risk sliding back into the ranks of the uninsured, according to "ACA Repeal in California: Who Stands to Lose?," one of the two policy briefs. And according to brief's authors, these could be underestimates.
"Fallout from Republican changes to the health care system could be even more harmful if the administration changes the way Medi-Cal benefits are calculated or if coverage features are reduced," said Miranda Dietz, researcher at the UC Berkeley Labor Center and lead author of the study.
Under the ACA, California cut the number of its uninsured residents in half, from 6.5 million in 2013 to 3.3 million in 2015 - the largest decline in the uninsured rate of any state. Statewide, 9.4 percent of the population enrolled in the expanded Medi-Cal, and 3.1 percent enrolled in Covered California, with subsidies.
Medi-Cal accounts for most of the drop in uninsured population
Medi-Cal expansion drove much of the drop in uninsurance rates, enabling 3.7 million adults to become newly eligible for coverage. If this aspect of the ACA were repealed, these Californians would immediately lose their insurance or face significantly higher costs to purchase coverage. People of color made up 71 percent of this expansion group, with 42 percent identifying as Latinos.
The 1.2 million subsidized enrollees received an average of $309 per month in federal premium subsidies, and many (60% of subsidized enrollees) received additional funds to reduce their out-of-pocket costs. For some, these subsidies kept them from being uninsured; others may have had coverage before 2014, but the coverage that became available to them under the ACA was more comprehensive and/or more affordable, the study reports.
More than half of this group had incomes below 200 percent above the federal poverty level - the group that had the highest uninsurance rates prior to ACA enactment.
State-wide reach of repeal of Medi-Cal expansion
Repeal of the ACA should put all counties on alert, especially those with high enrollment under Medi-Cal expansion, the study reports. As of July 2016, counties that had the highest share of adults who joined Medi-Cal during ACA expansion were in the northern and central regions of the state, including Humboldt, Mendocino (both 13.9 percent), Trinity (13.6 percent), Fresno (12 percent), and Stanislaus (11.6 percent) counties.
Sister paper on economic effects of the repeal
A related paper from UC Berkeley reports the economic impacts of repeal of the ACA would result in an estimated $20.5 billion annual loss in funding for Medi-Cal expansion and federal subsidies, $1.5 billion lost in state and local tax revenue, and 209,000 lost jobs, primarily in the healthcare industry.
The study reports counties that could face the biggest job losses already have high rates of unemployment: Fresno, Kern, Los Angeles, San Bernardino, San Joaquin, Stanislaus and Tulare.
Data sheets for selected counties outline the potential number of people who would lose insurance coverage and potential number of jobs that would be lost under ACA repeal. In sheer numbers, Los Angeles could see 970,000 people lose their health insurance and 63,000 losing jobs.
"Californians benefited significantly from the economic stimulus of health care jobs and other job related to implementation of the ACA," said Laurel Lucia, a manager of the health program at the UC Berkeley Labor Center and lead author of the second study. "Ultimately, we could face a complete reversal for the state if the ACA is repealed."
Read the report: ACA Repeal in California: Who Stands to Lose?
Read the related data brief: California's Projected Economic Losses under ACA Repeal
Read fact sheets for selected counties on the potential number of job losses and estimated number of people who could go back to being uninsured.
About the UCLA Center for Health Policy Research
The UCLA Center for Health Policy Research (CHPR) is one of the nation’s leading health policy research centers and the premier source of health policy information for California. UCLA CHPR improves the public’s health through high quality, objective, and evidence-based research and data that informs effective policymaking. UCLA CHPR is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit healthpolicy.ucla.edu.