State of Progress


As California continues to counter the national trend by seeking new ways to expand health insurance coverage and benefits, the Fielding School serves as an invaluable resource.

State of Progress

THE PERCENTAGE OF PEOPLE IN THE UNITED STATES without health insurance rose from 7.9 in 2017 to 8.5 in 2018 — the first year-to-year increase since 2009, just before the Patient Protection and Affordable Care Act (ACA) became law. But at a time when the ACA has been weakened federally, California has bucked the national trend. Between 2013 and 2018, the uninsured rate for Californians under age 65 was nearly halved, according to a recent analysis by FSPH’s UCLA Center for Health Policy Research (CHPR), which noted that despite the national increase in 2018, the state’s uninsured rate remained at a historic low.

That’s thanks to bold steps taken by California lawmakers. Among other things, the most recent state budget included funding to increase the subsidies in Covered California (the health insurance exchange established by the ACA), making health insurance more affordable for a wider swath of the population. California also became the first state to extend Medicaid coverage to undocumented young adults, building on legislation from 2016 that made undocumented immigrant children Medicaid-eligible. “These are significant initiatives to stabilize the ACA and expand coverage in the absence of federal support,” says Gerald Kominski, FSPH professor of health policy and management and a senior fellow at CHPR.

In these and other efforts by the state to expand health insurance coverage and benefits, the Fielding School has been a vital resource.

During the run-up to ACA implementation, Kominski worked with colleagues at UC Berkeley to create the California Simulation of Insurance Markets (CalSIM) program, a micro-simulation model to estimate eligibility and enrollment under the law, along with the impacts of proposed policy changes on coverage. Covered California, which helped to fund CalSIM, relied heavily on the model at a time of great uncertainty about the volume of people who would enroll when the state exchange opened for business in October 2013. CalSIM proved highly accurate in projecting that 1.2 million would sign up in the initial enrollment period — the final number was 1.22 million subsidized enrollees.

Kominski, who continues to serve as CalSIM’s principal investigator, says that the model’s role in guiding Covered California has evolved. “It’s one thing to estimate the potential eligibility of the population, but Covered California wants to know who are the remaining eligible uninsured and who is most likely to sign up, demographically and geographically, so that they can target their advertising and outreach,” Kominski says. In the last year, he adds, the CalSIM group has been among those asked to model the potential effects of ACA expansions that were considered and ultimately enacted by the state.

CapitolBoth CalSIM and the CHPR-administered California Health Interview Survey have been critical sources of information fueling the work of another key player in the state’s ongoing efforts to expand health insurance benefits. The California Health Benefits Review Program (CHBRP) responds to requests from the state Legislature to provide independent, nonpartisan analyses of the medical effectiveness, cost, and public health impacts of proposed health insurance benefit mandates and repeals. CHBRP draws from experts throughout the University of California system, who work with actuarial consultants to complete each analysis during a 60-day period. Nadereh Pourat, FSPH professor of health policy and management and CHPR associate director, oversees the cost group as vice chair, a position previously held by Kominski.

“Frequently, policymakers have to rely on back-of-the-envelope calculations and anecdotal evidence to make policy decisions,” says Pourat, whose group focuses on the impact of proposed benefit expansions on premiums, out-of-pocket costs, and overall insurance coverage. “CHBRP has been tremendously important in providing the California governor and Legislature with a rigorous analysis of the potential impacts of proposals based on existing evidence, as well as any unintended consequences, so that there can be an informed debate leading to the best possible determinations.”

Originally authorized in 2002, CHBRP carries a sunset date but has been reauthorized each time it has come up for renewal — a testament to how highly it is valued by the state’s lawmakers and health plans alike, Pourat says.

Assemblymember Jim Wood, chair of the California Legislature’s Assembly Health Committee, praised the work of Pourat’s team and CHBRP in general. “The California Health Benefits Review Program is an invaluable resource for legislators like me,” Wood said in a statement. “When we need the independent actuarial talents and expertise of its analytic staff to assess the impact of proposed legislation on health insurance benefit mandates and repeals, we accept their analysis with a high level of confidence.”

Faculty Referenced by this Article

Gerald Kominski
Gerald Kominski
Health Policy and Management
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Nadereh Pourat
Nadereh Pourat
Health Policy and Management
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Thomas Priselac
Health Policy and Management
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Ty Robbins
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Emily Abel
Health Policy and Management
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Samuel Sessions
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Jody Heymann
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Robert Brook
Health Policy and Management
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Yvonne Flores
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Isomi Miake-Lye
Isomi Miake-Lye
Health Policy and Management
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Laura Erskine
Laura Erskine
Health Policy and Management
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Kadiyala, Srikanth
Srikanth Kadiyala
Health Policy and Management
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Michael Ong
Michael Ong
Health Policy and Management
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Freund, Deborah
Deborah Anne Freund
Health Policy and Management
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Dr. Risha Gidwani
Risha Gidwani
Health Policy and Management
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Dr. Naomi Zewde
Naomi Zewde
Health Policy and Management
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Burt Cowgill
Burt Cowgill
Health Policy and Management
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Paul Fu, Jr.
Health Policy and Management
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Jeanne Miranda
Jeanne Miranda
Health Policy and Management
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Roshan Bastani
Health Policy and Management
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Frederick Zimmerman
Health Policy and Management
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Arturo Vargas Bustamante
Health Policy and Management
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Beth Glenn
Health Policy and Management
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Aria Fallah
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Jose J. Escarce
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Neal Halfon
Health Policy and Management
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William Comanor
Health Policy and Management
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Corrina Moucheraud
Health Policy and Management
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Arlene Fink
Health Policy and Management
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Barbara Berman
Health Policy and Management
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Jonathan Fielding
Health Policy and Management
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David Hayes-Bautista
Health Policy and Management
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Vickie Mays
Vickie Mays
Health Policy and Management
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Yusuke Tsugawa
Yusuke Tsugawa
Health Policy and Management
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Dr. Daniel Eisenberg
Daniel Eisenberg
Health Policy and Management
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Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

Health Policy and Management
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Diana Hilberman
Health Policy and Management
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Alice Kuo
Health Policy and Management
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Mark Litwin
Health Policy and Management
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Aronberg, Sandra
Sandra Aronberg
Health Policy and Management
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Lillian Gelberg
Health Policy and Management
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Dr. William McCarthy
William J. McCarthy
Health Policy and Management
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Jean Balgrosky
Health Policy and Management
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Z. John Lu
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Annette Maxwell
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Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
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Emmeline Chuang
Health Policy and Management
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Olivia Jung
Olivia Jung
Health Policy and Management
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Patricia Ganz
Patricia Ganz
Health Policy and Management
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Linda Rosenstock
Environmental Health Sciences Health Policy and Management
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Thomas Rice
Health Policy and Management
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Anthony Hunter Schiff
Health Policy and Management
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Dr. Joann Elmore
Joann G. Elmore
Health Policy and Management
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Avram Kaplan
Avram Kaplan
Health Policy and Management
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James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
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Michael Galper
Health Policy and Management
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Ninez Ponce
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Clifford Ko
Health Policy and Management
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Thomas D. Gordon
Health Policy and Management
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Steven Teutsch
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Moira Inkelas
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Robert Kaplan
Health Policy and Management
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Dylan Roby
Health Policy and Management
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Julie A. Elginer

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Health Policy and Management
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Jack Needleman
Jack Needleman
Health Policy and Management
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Dr. Kenneth Wells
Kenneth Wells
Health Policy and Management
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Dr. Xi Zhu
Xi Zhu
Health Policy and Management
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Paul Chung
Paul Chung
Health Policy and Management
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Warren Scott Comulada
Health Policy and Management
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Alan Tomines
Health Policy and Management
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Susan Ettner
Health Policy and Management
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Lori Pelliccioni
Health Policy and Management
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Pamela Davidson
Health Policy and Management
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Elizabeth (Becky) Yano
Health Policy and Management
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Brennan Spiegel
Health Policy and Management
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Kristen Choi
Health Policy and Management
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Felicia Hodge
Health Policy and Management
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Ron D. Hays
Ron D. Hays

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Health Policy and Management
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Sangeeta Ahluwalia
Sangeeta Ahluwalia
Health Policy and Management
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Mangione, C
Carol Mangione
Health Policy and Management
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Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

Health Policy and Management
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Leah Vriesman
Leah Vriesman
Health Policy and Management
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Jennifer Wortham
Health Policy and Management
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