预计到2030年，将有200多万加州人缺乏医疗保险

Over two million moreCalifornians projected to lack CalSIM By Miranda Dietz, Srikanth Kadiyala, Annie Rak, Sun-Yin Ho,Dylan H. Roby, and Laurel Lucia CaliforniaSimulationofInsurance As a result of federal and state policy decisions made in 2025, weproject that 4.6 million Californians under age 65 will be uninsuredby 2030—an increase of 2.2 million—and the uninsured rate willnearly double to 14.7%. This will erode much of the progressCalifornia has made since the Affordable Care Act and subsequentstate actions to move closer to universal coverage. It will also widen The California Simulation ofInsurance Markets (CalSIM)model is designed to estimatethe impacts of variousfederal and state policies onindividual decisions to obtain Significant policy changes are coming A series of federal and state policies will impact health insurancecoverage for Californians ages 0-64 over the coming years.1 We model policies that will have a substantial direct impact onenrollment in Medi-Cal (California’s Medicaid program) and CoveredCalifornia (the state’s marketplace for individual market coverage).To conduct this analysis we use the California Simulation of InsuranceMarkets (CalSIM) microsimulation model, developed to measure theimpact of policy changes on health insurance coverage; data from The policies we model will be implemented in California over the course of several years,as summarized below. Medi-Cal changes modeled: •January 2026:Enrollment freezefor undocumented Medi-Cal enrollees age 19+under state policy •October 2026:*Elimination of federal full-scope Medicaidfor refugees, asylees, andcertain other humanitarian immigrants under H.R. 1, the federal tax and budget •January 2027:Work requirementsfor ACA expansion enrollees (childless adults andparents with incomes 109-138% FPL) applied to federally funded enrollees under H.R.1, and applied to immigrant populations in state-only Medi-Cal by state policy3 •January 2027:More frequent redeterminations(every six months instead of yearly)applied to federally funded enrollees under H.R. 1, and applied to immigrant •July 2027:$30* monthly premiumfor enrollees ages 19-59 with “unsatisfactory * The 2026-27 California budget May revision proposes delaying the elimination of full-scope Medicaid for some immigrants to July 1, 2027, and increasing premiums to $50 per Covered California changes modeled:• January 2026:Elimination of federal subsidiesfor those with income over 400% FPL,and elimination of enhanced federal subsidies for those with incomes under 400% •January 2026:California provision of enhanced subsidiesfor those with incomes •January 2027:Elimination of federal marketplace subsidiesfor refugees, asylees, and ** The 2026-27 California budget May revision proposes enhanced state subsidies for thosewith incomes up to 200% FPL. The modeling does not reflect this recent proposal. The uninsured rate is projected to climb to 14.7% We project that, with the 2025 federal and state policy changes and the expiration of thefederal Covered California subsidies, by 2030 there will be 4.6 million Californians underage 65 who are uninsured and the uninsured rate will be 14.7%. Our analysis also foundthat,withoutthese policy changes and with thecontinuanceof the enhanced federal The overall uninsured rate is projected to climb to 14.7%, increasing among every racialand ethnic group, but with bigger percentage point increases among populationscurrently experiencing higher-than-average uninsured rates, exacerbating inequitiesalready present in California’s health insurance landscape. The uninsured rate amongLatino Californians under age 65 will increase almost 10 percentage points to 20.6% by2030. The uninsured rate among Black and Asian non-Latino Californians will more than rate increase from roughly one in ten (9.4%) to almost one in four (23.8%). Severalpolicies narrow Medi-Cal eligibility for immigrant Californians, especially undocumentedresidents. As a result, the uninsured rate for undocumented Californians, already high at Uninsured rate projected to be especially high in SouthernCalifornia There is also considerable geographic variation in policy impacts. Two main factorsaccount for this. First, several policies reduce Medi-Cal and Covered California enrollmentamong California immigrants, who are more concentrated in certain regions than others.Second, the Department of Health Care Services has expressed its intent to utilize federalexemptions to work requirements for those living in counties with high unemploymentrates. We model this exemption assuming counties with high unemployment rates todaywill continue to meet the threshold.5The work requirements are the biggest driver in the These policies will result in both more uninsured and lessaffordable coverage As a result of these federal and state policies, we project 2.2 million Californians willbecome uninsured due to loss of Medi-Cal or subsidized coverage through CoveredCalifornia.6In ad