August 4, 2021

California models universal coverage goals

California shows how innovative policy and appropriate investments can significantly reduce the number of uninsured people in the country.

By John Garcia, Vice President, Government Relations

California shows how innovative policy and appropriate investments can significantly reduce the number of uninsured people around in the country.

In 2007, then California Gov. Arnold Schwarzenegger and legislative Democrats debated health care reform proposals to achieve universal coverage through strategies like purchasing pools, an individual mandate, and subsidies to help people pay premiums. Sound familiar?

Three years later, Congress passed, and President Barack Obama signed, the Affordable Care Act. Since then, the ACA has survived 3 Supreme Court challenges, the most recent decided by a 7-2 majority in June 2021. The legislation also escaped a concerted repeal effort in Congress by 1 vote, thanks to late Republican Sen. John McCain of Arizona. Throughout these ordeals, the objectives of the ACA have remained the same as those advanced by California policymakers almost 15 years ago: to ensure everyone has access to high-quality health coverage and care, and to make health care more affordable for all.

With a head start on this policy work, California’s health plans, providers, and government leaders put the ACA to work with rapid results. California’s efforts, as outlined here, serve as an example to illustrate that through innovative policy and appropriate investments, we can make great strides toward reducing the number of uninsured people in our country. Our challenge is how to make coverage more affordable while protecting access to the high-quality care most Americans have come to expect from their health plans.

Reducing the number of uninsured Californians

Since 2014, the state’s uninsured population dropped by 3.7 million people, from over 17% to under 8%.

In 2019, California also led the way in providing subsidies to help lower the cost of health care premiums for families in need whose income exceeded limits set by the ACA.

This action made health care insurance more affordable for tens of thousands of Californians.

Under Govs. Jerry Brown and Gavin Newsom, enrollment in the state’s ACA health care exchange, Covered California, has reached a high of 1.6 million, second only to Florida. Covered California offers a robust health care coverage marketplace in which premiums are negotiated by a powerful state purchaser, and individuals can conveniently shop for high-quality coverage among health plans that must compete on cost and quality.

Protecting consumers and expanding access

California also stepped up to protect consumers by prohibiting short-term insurance and other types of “junk insurance plans” that don’t cover preexisting conditions, exclude important benefits, and charge higher premiums for people who are sick.

Covered California was essential to stabilizing access to coverage for many Californians during the COVID-19 pandemic. Approximately 246,000 individuals enrolled in the first 6 months of 2021 alone. And this spring, Congress and President Joe Biden included premium subsidies in the American Rescue Plan to provide additional support to 139,000 Californians.

California continues to make progress on its goal to provide health care coverage to everyone through smart public policies supported by Kaiser Permanente. Nearly 200,000 undocumented residents under the age of 26 have enrolled in comprehensive Medi-Cal coverage since California began extending coverage to this population in 2016. In 2019, Gov. Newsom and the legislature implemented a state individual mandate after Congress eliminated the federal penalty for going without coverage.

The governor and legislature recently agreed to extend Medi-Cal coverage to another 235,000 undocumented individuals over the age of 50. With undocumented residents accounting for 65% of the 3.2 million Californians expected to remain uninsured in 2022, continued progress on making coverage available for this population will be important.

Building on success to achieve universal coverage

Kaiser Permanente believes that America needs to redesign how health care is delivered and make it more affordable. That’s work we’ve been doing for 76 years, by focusing on combining coordinated care and coverage into an integrated health care organization that is efficient and delivers care that is among the highest quality in the nation.

Building on the success of California’s approach, policymakers should remain focused on closing the existing coverage gaps, not removing tens of millions of people from their employer-sponsored coverage and placing them into something new and unproven. Our leaders must focus on consolidating the gains we have made over the past decade that have enabled millions more people to access health care and coverage.

Kaiser Permanente strongly supports and has always supported achieving universal coverage. In California, and each of the 8 states and the District of Columbia in which we serve, Kaiser Permanente is as committed as ever to building on recent successes of providing health coverage to more people, while also addressing the urgent issues of affordability and health equity.

Reaching these goals will require sustained action at the state and federal levels. But as California continues to demonstrate, it may not require anything more radical than a continued commitment to collaboration and innovation.