Opinion, Berkeley Blogs

A good day for America

By Ken Jacobs

The Supreme Court has upheld the Affordable Care Act. We are fortunate to live in a state that has been working overtime to implement those parts of the law that have already gone into effect and to prepare for implementation of the remaining elements of the law in January 2014.

The law has already had an important impact on coverage in California.  An estimated 350,000 young adults who would have aged off their parents' plans were able to retain coverage under the ACA, which allows dependents to stay on a parent's plan until the age of 26. Nearly 400,000 Californians have enrolled in County Low Income Health Programs which were created through a Medicaid waiver as a bridge to health reform; a half million are expected to do so by 2013.  An additional 10,000 Californians who could not otherwise purchase coverage due to pre-existing conditions have enrolled in the State's Pre-Existing Condition Insurance Program that was established through the ACA.

Working with the UCLA Center for Health Policy Research, we developed a micro-simulation model to understand how health coverage would change in California under the ACA.  The research briefs can be found here. We found that when the law is fully implemented, nine out of ten Californians under the age of 65 will be enrolled in health coverage.  The ACA expands eligibility for Medicaid to families with incomes under 133% of the Federal Poverty Level ($15,415 for an individual and $31,810 for a family of four). We estimate that between 1.2 and 1.6 million Californians will be newly covered through Medi-Cal (California's version of Medicaid) by 2016. (This research was funded by The California Endowment and the California Health Benefit Exchange).

The ACA also provides subsidies to purchase health coverage to families with incomes between 138 and 400 percent of the federal poverty level ($92,200 for a family of four). We estimate that in 2019 between 1.8 and 2.1 million Californians will have subsidized coverage through the Exchange. You can find out how much of a subsidy your family may be eligible for using our new calculator here.

While most Californians will remain in job-based coverage, the law will affect us all. In any given 10-year period, an estimated half of all Americans are uninsured at some point in time. People lose coverage when they lose their job, age-off a parent's plan or get divorced. The ACA will provide a critical health care safety net that goes well beyond coverage for those who are now uninsured.

However you look at it, this is a significant expansion of health care coverage in California. The ACA will not, however, cover every Californian. We estimate that in 2019, 3 to 4 million Californians will remain uninsured. One million of them will be ineligible for coverage due to their immigration status, as undocumented immigrants are not eligible for coverage under the law. Another 1 million will be eligible for Medi-Cal, but will not have enrolled. Others will be exempt from the individual mandate because they do not have an affordable option of coverage. Some individuals will simply choose not to enroll and pay the tax penalty.

Much work remains to be done to implement the ACA.  Even as the Supreme Court upheld the law, the outcome of the upcoming election will have a significant impact on what happens next.