California's ranks of uninsured residents could nearly double in the next four years - to nearly 4.6 million people - because of deep federal cuts to Medicaid and dramatic changes in federal and state policy, according to a new report from the UC Berkeley Labor Center.
In effect, the report says, the policies contained in the Trump Administration's "One Big Beautiful Bill" would slash federal funding for the state's Medi-Cal program, impose new work requirements and make it more difficult or impossible for tens of thousands of Californians to enroll in the state's Covered California insurance programs.
Courtesy of UC Berkeley Labor Center
As a result, a huge proportion of Californians would have less access to health care, said Miranda Dietz, director of the center's Health Care Program. Covered California premiums will be more expensive. Those who have no insurance will more often have to live with untreated illness, Dietz said, and more are likely to die at younger ages.
"We've really made progress as a state in getting closer to universal access to coverage for our residents," she said in an interview. "We're not going back to the levels of the uninsured where we were before, but within the space of a few years, we'll be losing a lot of the progress we've made."
A critical turning point in California's health care system came in 2010, with the passage of the Affordable Care Act, often called Obamacare after its influential advocate, then-President Barack Obama. Under the name Covered California, the state's program made affordable health care insurance available to millions of residents and expanded Medi-Cal coverage for low-income residents.
In 2012, the state's uninsured rate among those under age 65 was 17.6%; by 2024, that had dropped to 7.7%. But the passage last July of H.R. 1 - the "One Big Beautiful Bill Act" - began a sharp reversal.
Funding for Medicaid, the federal program that funds California's Medi-Cal program for low-income residents, was slashed. Federal Medicaid support and Covered California subsidies were eliminated for legal refugees, immigrants with asylum and some immigrants given residency for humanitarian reasons.
Stricter education and work requirements were imposed for some Medi-Cal recipients, and new documentation requirements led many analysts to warn that bureaucratic red tape would squeeze people out of the program.
In a May 2025 report, before H.R. 1 became law, Dietz and her colleagues warned of potentially devastating impacts.
The new report offers specific projections of how the federal and state policy changes and the end of federal subsidies for Covered California will affect state residents:
- 4.6 million Californians under age 65 will be uninsured by 2030 - an increase of 2.2 million. That would push the uninsured rate to 14.7%, nearly double the current rate.
- Low-income residents, defined as those with income less than double the federal poverty line, would be especially hard-hit because they often rely on Medi-Cal. The new report projects that their uninsured rates will rise from 9.4% to 23.8%, or nearly one in four low-income residents.
- The uninsured rate is projected to rise among every racial and ethnic group, but groups that already endure higher rates will be most vulnerable. For Latinx Californians under 65, the rate is projected to rise to 20.6%, up almost 10 percentage points. For Black residents, the rate would rise to a projected 14%, and to 13.1% among Asian and Pacific Islander residents.
- For undocumented state residents, the uninsured rate would rise from 25% in 2024 to 50.4% by 2030.
If federal and state policies had not changed, the researchers projected, the uninsured rate would have held steady at 7.7% by 2030.
The new policy brief is derived from analysis using the California Simulation of Insurance Markets model, which estimates the impacts of various federal and state policies on individual decisions to obtain insurance coverage and employer decisions to offer coverage. The model was developed by the Labor Center and the UCLA Center for Health Policy Research.
'Live sicker, die younger'
When people are uninsured, Dietz said, they are often reluctant to get health care even when they suspect they have a health issue.
"So they'll live sicker and they'll die younger," she said. "And if they get very sick, they might be just one emergency room visit away from bankruptcy."
The massive federal policy changes imposed last year presented a range of challenges for state policymakers, and resulted in state-imposed cuts to insurance and health care. The answer, or at least a partial answer, could come through new state policy, Dietz explained.
With millions of Californians potentially facing dire health consequences, she said, discussions are underway in Sacramento that could repair some of the damage and ease some of the risk.
For example, some state lawmakers have proposed a "fair share contribution" aimed at an estimated 1-2% of California corporations - including such giants as Amazon and Walmart - that do not provide health insurance for their low-wage employees. Those workers often end up on Medi-Cal, a cost that drains billions from the state budget. That cost is then borne by taxpayers, but the proposal would tax the corporations to help close the Medi-Cal funding gap.
"California policymakers can still limit the impacts of H.R. 1, maintain full-scope Medi-Cal regardless of immigration status, and raise the revenues needed to do so," the Labor Center's policy brief concludes. "The progress the state has made in getting closer to universal coverage and improving health equity was a choice; protecting it is also a choice."
