Universal Health Coverage in California: Progress and Key Policy Actions

Affordable health care is essential for everyone to be healthy and thrive. Having health insurance coverage helps lower out-of-pocket expenses and ensures access to preventive care, which in turn supports workforce participation and education. While California has made great strides in lowering the uninsured rate and expanding health care access, policymakers can take further action to protect progress and achieve universal health care coverage.

1. Medi-Cal Covers Over a Third of the State’s Population

Medi-Cal, California’s Medicaid program, provides free or low-cost health care to over one-third of the state’s population. The program covers a wide range of services to Californians with modest incomes, and many children, seniors, people with disabilities, and pregnant individuals rely on it. Medi-Cal plays a crucial role in promoting health equity, with about half of its beneficiaries being Latinx Californians, who often face low-wage employment and limited access to employer-sponsored health plans. For those who earn too much to qualify for Medi-Cal, Covered California — the state’s health insurance marketplace established through the Affordable Care Act — serves as a vital resource, helping individuals and families find affordable health coverage. Nearly 1.8 million Californians purchase their insurance through this state marketplace.

2. California’s Uninsured Rate Reached a Historic Low in 2023

California has made substantial progress in expanding access to health coverage over the past decade. Key drivers of this success include the federal Affordable Care Act and more recent state initiatives, such as expanding full-scope Medi-Cal to income-eligible Californians who are undocumented. As a result, the uninsured rate dropped to 6.4% in 2023, matching the record low of 6.4% in 2022. These gains reflect a major shift from a decade ago when over 17% of Californians lacked health coverage, underscoring the state's commitment to improving health care access for all.

3. American Indian or Alaska Native Californians Have the Highest Uninsured Rate

Despite California’s overall progress in expanding health coverage, significant racial disparities persist. American Indian or Alaska Native Californians face the highest uninsured rate among all racial and ethnic groups in the state. The racial disparities in health coverage highlight the profound and enduring impact of racism, which blocks Californians of color from equal access to health care. Addressing the racial disparities in health coverage requires targeted outreach and education efforts along with other antiracist policy actions to improve health and well-being for Californians of color.

4. Too Many Californians Lost Medi-Cal Coverage Due to Paperwork Challenges

When California resumed Medi-Cal renewals in 2023, after pausing them during the pandemic, many Californians were disenrolled from Medi-Cal. This process, known as the "unwinding period," marked the end of the federal policy that temporarily paused routine renewals.¹A provision in the federal Families First Coronavirus Response Act passed in March 2020 required states to provide continuous coverage for Medicaid beneficiaries in exchange for enhanced federal funding during the federally declared Public Health Emergency (PHE). The Consolidated Appropriations Act of 2023, which federal policymakers passed in December 2022, delinked the continuous coverage provision from the PHE, thereby ending this provision on March 31, 2023. Over 1.8 million Californians lost Medi-Cal coverage from June 2023 to July 2024.²The California Department of Health Care Services publishes interactive dashboards detailing statewide and county-level demographic data on Medi-Cal application processing, enrollments, redeterminations, and renewal outcomes. The majority of disenrollments (85.2%) were due to challenges with the renewal paperwork. Completing the renewal process often involves complex paperwork and documentation requirements, which can be challenging to navigate. Additionally, many Californians have experienced extended call wait times when attempting to contact county Medi-Cal workers regarding their application. The high disenrollment rate underscores the need to further streamline the renewal process as well as permanently enact policies that build upon lessons learned during the pandemic.

5. Many Californians Could Lose Health Coverage if Premium Tax Credits Expire

Enhanced premium tax credits from recent federal policy actions have significantly improved health care affordability for many Covered California enrollees. However, these credits are set to expire at the end of 2025, which would lead to steep increases in monthly premiums. About 2.4 million Californians in the individual market would face higher health insurance premiums if Congress does not extend the expanded federal subsidies, according to the UC Berkeley Labor Center. The loss of these tax credits means that average premiums could rise by 63% for Covered California enrollees, and communities of color will be disproportionately impacted. Premiums will increase by 76% for Latinx enrollees, 67% for Black enrollees, and 71% for Asian enrollees, compared to a 57% increase for white enrollees. Overall, without these federal subsidies, an estimated 138,000 to 183,000 Covered California enrollees would disenroll.

Looking Ahead, Policymakers Can Take Action to Strengthen Health Coverage

While California has made substantial progress, challenges remain in ensuring health coverage for everyone. By addressing gaps in coverage, particularly for historically underserved communities, state leaders can continue leading the nation in advancing health equity and improving well-being for all Californians.

Key policy recommendations include: