![]() ![]() The federal Affordable Care Act (ACA) has resulted in massive expansions of publicly funded health coverage over the past decade. Health insurance does not necessarily guarantee access to health care, but it does make care more affordable and, importantly, provides at least some measure of financial protection in the event of a major health crisis. Health care is widely recognized as a basic need-as evidenced by large public investments in health care systems and insurance coverage for broad swaths of the population. Monitoring the extent to which people become uninsured if they lose Medi-Cal coverage during the redetermination process should be a high priority. ![]() A more immediate-and larger-concern is how the resumption of Medi-Cal eligibility determinations starting in April 2023 could impact poverty.The expiration of pandemic-era federal subsidy enhancements in 2025 could slightly increase poverty. Without these subsidies, poverty would be a percentage point higher overall, and nearly 2 percentage points higher for older adults (ages 45–64) and Asian Americans-groups that are more likely to purchase individual coverage. Covered California reduces poverty by providing premium subsidies that lower costs for low- and middle-income Californians.When the state expands Medi-Cal coverage to all income-eligible Californians in 2024, we estimate that poverty could drop by 2.9 percentage points for non-citizens this should have a large impact on undocumented immigrants and families with mixed immigration statuses. Poverty rates are highest among demographic groups that are more likely to lack health care coverage-in particular, non-citizens (27%).For adults age 45 to 64, poverty could increase from 13.1 percent to 19.3 percent. In the absence of Medi-Cal, poverty among young children could increase from 7 percent to 16.9 percent. The Medi-Cal program plays a critical role in helping families achieve a basic level of resources.As a result, poverty rates are substantially higher for Californians without health insurance: nearly four in ten are living in poverty (38.4%), compared to 18.5 percent of those covered by Medi-Cal and only 4.2 percent of those with employer-based coverage. Including health insurance in our measure increases the resources required to remain out of poverty by nearly 60 percent.To more accurately assess the impact of health coverage (or lack thereof) on poverty across California, we developed a health-inclusive California Poverty Measure that integrates health insurance coverage as a basic need, along with food and shelter. Insurance does not guarantee access to health care, but it does make care more affordable and should shield families from large financial shocks generated by medical crises. Over the past decade, expansions of Medi-Cal (federally known as Medicaid) and federal subsidies under the Affordable Care Act (ACA) have improved access to health insurance for millions of lower-income Californians. ![]()
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