As of 2020, more than 2.5 million Californians age 64 and under had no health insurance coverage, according to a study by the UCLA Center for Health Policy Research.

The report is based on an analysis of the center’s California Health Interview Survey from 2019 and 2020.

The researchers analyzed insurance rates in California. They found that adults aged 19 to 25 had the lowest rates of employment-based insurance (51.7%, compared to 61% to 66% for other age groups), even though they can remain on their parents’ health coverage.

In addition, just 43.1% of Latino women and 55.6% of Black women aged 19 to 64 had employer-based coverage — significantly lower rates than white women (72.0%). The disparities by race and ethnicity among adult men were similar, although men had slightly higher rates of employer-based coverage across the board than women did.

California has long been a bellwether in the national health-care-for-all debate. Without a national overhaul of health coverage on the horizon, the state has recently revived attempts to achieve universal health coverage, including through a bill currently under debate in the state legislature and an alternate proposal by Gov. Gavin Newsom to expand Medi-Cal eligibility.

“Even incremental expansion to health insurance eligibility would help California meet our remaining challenges, although the proposed comprehensive overhaul of our insurance system could also improve access to care for everyone,” said Shana Charles, a faculty associate at the center and the study’s lead author. “The question remains whether there is both the political will and the public financing needed for any of these steps forward.”

Among other findings:

  • 89.1% of Californians without insurance reported that health care costs or their lack of insurance was the main reason they had delayed receiving needed medical care — more than double the percentages for those with Medi-Cal (42.0%) or employment-based insurance (31.2%).
  • Among employees at companies with 50 or fewer workers, just 68.0% report that their employers offer health insurance to any employees; due to eligibility requirements and affordability of coverage, less than half of workers at small companies (48.3%) have health coverage through their employers. By comparison, 94.8% of employees at larger firms report that their companies offer health insurance to their workers.
  • 16.6% of uninsured children experienced a delay in needed medical care, compared with just 5.0% of children who were covered by employer-based insurance.
  • 77.5% of uninsured adults who may be eligible for Medi-Cal because of their low household incomes are of Latino descent.

“While previous expansions in health coverage were good for California residents, the state can do more to reduce persistent racial and ethnic disparities, reduce or eliminate lack of health insurance and remove barriers to accessing health care,” said Susan Babey, senior research scientist at the center and co-author of the report.

The report is the Center for Health Policy Research’s 10th in-depth analysis of health insurance in California since 2001. The new study examines insurance rates across demographic groups, the state’s private health insurance markets, Medi-Cal coverage rates, and access to health care. It does not focus on coverage for Californians 65 and older, who are almost universally covered by Medicare.

The researchers note some limitations in the data, including that estimated numbers of Medi-Cal enrollees based on self-reported data do not match Medi-Cal’s data on the numbers of enrollees, and that surveys for the new report were conducted primarily online, while previous studies in the series were administered by phone.