Covering Californians

California has been a big beneficiary of the Affordable Care Act. The state Legislature didn’t hesitate to expand Medi-Cal for low-income Californians, and millions more were able to get coverage through Covered California, our well-run, state-based insurance exchange.

But now that the Affordable Care Act is under attack in Washington, California has a lot to lose.

A new report by the UC Berkeley Labor Center and the UCLA Center for Health Policy Research projects a substantial increase in the statewide uninsured rate by 2020 and an even larger increase by 2023.

Specifically, the researchers are projecting that 11.7 percent of Californians under 65 will lack insurance by 2020 — about 4.02 million people — and about 12.9 percent will lack it in 2023 — about 4.4 million people.

That’s terrible for the uninsured, but even Californians who are fortunate enough to have health insurance will be affected.

The projections are based on the assumption that, with the end of the federal health care mandate penalty, a number of healthier Californians will choose to drop coverage. That will leave a smaller, sicker group of people in the state-based exchange, who will face immediate higher prices.

But even those Californians who receive their coverage through an employer will be affected. Providing care to uninsured people in emergency rooms is the most expensive, least efficient medical care a society can provide. It’s a warped cost that impacts everyone’s rates and access to care.

The obvious answer to this problem would be for Congress to reinstate the individual mandate.

Earlier this year, the Commonwealth Fund found that the uninsured rate is rising across the nation due to Washington’s unwillingness to support the Affordable Care Act.

Unfortunately, that’s unlikely to happen as long as President Trump and the Republican-dominated U.S. Senate remain ideologically opposed to the Affordable Care Act.

So California must consider taking matters into its own hands.

The state has a variety of options. One proposal that’s been suggested by state legislators in the past would be an expansion of Medical to all low-income residents in California, regardless of their immigration status.

But doing so would be expensive and politically challenging. Two options that are more viable include increasing Covered California’s outreach efforts or passing a statewide individual mandate.

California has to act fast. The Legislature needs to give health care a top spot on its agenda, or the result will be more suffering and higher prices.