During health care reform's 2014 implementation, up to two-thirds of California's 7 million uninsured population will become eligible for health insurance coverage, according to a new policy brief from the UCLA Center for Health Policy Research.

The policy brief, Two-thirds of California's 7 Million Uninsured May Obtain Coverage Under Health Care Reform, estimates 4.7 million Californians will likely be eligible for either the health insurance exchange or Medi-Cal expansion, which is based on county-by-county estimates of the number of Californians with job-based, public or private insurance in 2009 along with those who were uninsured for all or part of that year.

"This expansion will have a huge impact on the number of people without insurance," says Shana Alex Lavarreda, the lead author of the brief. "It will provide relief in the short term to millions of Californians who currently have no insurance options. And it will provide long-term relief to all residents by shifting the taxpayer emphasis from high-cost emergency room services to lower-cost preventative care."

Poor gains most benefits

According to the CHIS 2009 data, center researchers believe 3 million uninsured Californians will gain coverage through health reform's Medi-Cal expansion while 1.7 million will be eligible for subsidies provided by the state's health insurance exchange. An additional 1.2 million will also become eligible to buy nonsubsidized coverage via the exchange.

The rest of the 1 million noncitizen Californians without health insurance are not eligible for health care reform benefits, mostly because of citizenship or residency status.

Health care reform also expands the definition of those who are eligible for Medi-Cal to include adults without dependent children earning up to 133 percent of the federal poverty level, which was $10,956 for one person in 2009. Under this new population, approximately 3 million of the lowest-income nonelderly adults and children will be eligible for Medi-Cal coverage.

"Health care reform lifts a tremendous burden off the shoulders of all Californians," says E. Richard Brown, the center's director. "And it will be an enormous relief to anyone who's struggling to pay both the rent and a medical bill."

California's uninsured population is the largest in the nation, which has worsened because of the down economy and rising unemployment. Still, the 7 million figure might have been higher had the 2009 federal subsidy via COBRA not been offered, the authors wrote. That subsidy is now expired.

"The sheer number of Californians without health insurance underscores the importance of implementing the health care law successfully," says Robert K. Ross, M.D., president and CEO of The California Endowment. "As the first state to enact a health benefit exchange under the new law, California is providing a model to the country of effective implementation and laying the foundation for a healthier state."

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Study estimates 4.7 Million Californians to gain health care coverage

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