Financial Impact

A repeal of the Medi-Cal expansion could result in California’s public health care systems losing $2.2 billion in revenue every year.

The State of California estimates that the most recent per capita cap proposal would cost the state $8.7 billion in annual revenue by 2027, and continue to grow thereafter.

A dramatic increase in the number of uninsured, coupled with a loss of funding, could destabilize the state’s health care delivery system.


What happens to California if coverage expansion is repealed?

More Uninsured: California’s uninsured rate is expected to double, to over 17%.

Economic Impact: The state estimates a $16 billion loss in federal revenue with a repeal of the Medicaid expansion and another $5 billion with the elimination of tax subsidies for enrollees in Covered California.

Job Loss: An estimated 200,000 Californians could lose their jobs.

The expansion of Medicaid in California

Coverage expansion through the Affordable Care Act (ACA) has helped transform how public health care systems provide care in California’s communities, by providing a stable coverage landscape which enables a shift in focus from costly acute care to more cost-effective primary and preventive care.

The ACA offered an unprecedented expansion of insurance coverage to low-income Californians, with Medicaid (Medi-Cal) enrollment increasing from 8.6 million prior to the ACA to over 13 million in 2016.

California’s efforts around coverage expansion began in 2010, with federal support for the ACA expansion population prior through the Low-Income Health Program.  Those who enrolled in this early expansion effort were seamlessly transitioned into Medi-Cal when the ACA rolled out in 2014.

The impact of coverage expansion

Fewer Uninsured Patients: Across California, the uninsured rate has been cut in half, dropping from 17.2% to 8.6%.

California’s public health care systems serve as the primary care provider to more than 560,000 people who have gained coverage through Medi-Cal since 2014.

Higher Value Care: The expansion of Medi-Cal has created a more stable coverage landscape, which has enabled California’s public health care systems to focus investments on better care coordination, increased access, and improved health outcomes for patients through an emphasis on primary and preventive care. These efforts lead to care that is more effective and efficient, providing higher value to the patient at a lower cost to the system.

Since the outset of expansion efforts, California’s public health care systems have given around 700,000 patients newly-assigned primary care teams, and have added more than one million patients to disease management registries that help track and manage chronic conditions.

As an example of these efforts, Calfornia’s public health care systems have decreased the rate of diabetes patients being hospitalized for short-term complications by more than 20% and the rate of patients with a diagnosis of “uncontrolled diabetes” dropped from 1% to 0.18% – more than five times smaller than what it had been.

Through a combination of coverage expansion and delivery system improvements, California’s public health care systems are now able to provide tens of thousands more preventive screenings than before.