Californians without health insurance could double, state analyst warns

The number of Californians without health insurance could double from 2 million today to 4 million by 2030, according to a report from the state Legislative Analyst's Office. It’s the state budget office’s preliminary attempt to quantify how federal legislation known as the “One Big Beautiful Bill” will reshape healthcare access statewide.

The One Big Beautiful Bill is driving nearly 90% of the projected coverage loss, according to the LAO report. It's mostly Medi-Cal enrollees who are expected to be dropped when new work requirements take effect in 2027. The remaining 10% are largely people leaving the state's health insurance marketplace, Covered California, after enhanced federal premium subsidies expired last year.

What's the impact to coverage?

L.A. County officials estimate that recent Medi-Cal changes could put coverage at risk for hundreds of thousands of residents and cost the health departments about $800 million a year. A UC Berkeley Labor Center analysis projected more than 1 million Medi-Cal enrollees could lose coverage by 2028.

The LAO report also warns that county indigent health programs for uninsured residents will soon face a surge in demand they’re not prepared to meet. Those county programs had enrolled about 850,000 people statewide before the federal government expanded Medicaid coverage in 2014. Total enrollment is currently 10,000 statewide, but the trend is going to reverse, according to the report.

What's the impact to health-care providers?

More uninsured people means hospitals and clinics provide more services without getting paid. The LAO projects that uncompensated care costs at hospitals could grow by several billion dollars statewide by 2030. Clinics face steeper losses because they run on smaller budgets and depend more heavily on Medi-Cal revenue.

The LAO also projects premiums on the individual health insurance market will rise as healthier people drop coverage.

What are proposals to help?

The LAO itself doesn’t recommend new spending and instead urges lawmakers to track what happens to hospitals, clinics and county programs before taking action. But both L.A. County and state officials are pushing tax efforts to combat federal cuts.

L.A. County voters will decide June 2 on Measure ER, a half-cent sales tax that would generate about $1 billion a year for hospitals and clinics. ANovember statewide ballot initiative would impose a one-time 5% tax on Californians worth over $1 billion and direct 90% of proceeds to Medi-Cal.