California is heading toward a sharp rise in residents without health insurance, and the head of the state's marketplace is describing the moment in blunt terms. "It's triage," Covered California Executive Director Jessica Altman told KFF Health News in a report published this week.
The number of uninsured Californians under 65 is projected to nearly double, from 2.4 million to 4.6 million by 2030, according to a May analysis by the UC Berkeley Labor Center. The projection reflects federal and state changes to Medicaid and the Affordable Care Act marketplaces that are now taking effect.
Coverage losses do not stay contained to the people who lose insurance. Hospital executives have begun reporting more unpaid bills, and experts warn that premiums rise when healthier customers leave the risk pool, KFF Health News reported. For a household buying its own coverage, the next few months bring higher prices and harder choices.
Four Policy Changes Driving the Projection
The first is the expiration of enhanced federal premium tax credits at the end of 2025. Congress did not extend them, which raised premium payments for many middle-income enrollees and contributed to a national marketplace enrollment decline of nearly 3 million this year, according to KFF.
The second is the One Big Beautiful Bill Act, the 2025 federal tax and spending law expected to reduce federal Medicaid spending by more than $900 billion over a decade. It includes work requirements for certain adults, which begin in 2027.
The third is a tighter federal approach to Medicaid waivers. California's waiver, which the state has used to expand coverage of services such as food and housing supports, expires Dec. 31 and faces new federal budget neutrality rules that take effect in January, KFF Health News reported. State officials said they are still working with federal regulators to renew it.
The fourth is state budget retrenchment. Federal funds account for more than 60% of Medi-Cal spending. California has frozen new Medi-Cal enrollment for some undocumented adults, added monthly premiums for some enrollees, and delayed some cuts until July 2027, leaving the next governor and Legislature to decide what happens next.
Covered California's 2027 Prices and New State Help
Covered California announced a preliminary weighted average rate increase of 9.9% for 2027, following a 10.3% increase for 2026. The agency said California's figure is below the preliminary national median increase of 14%, and it attributed the rise to health care and pharmacy costs along with the loss of enhanced federal tax credits.
The state is trying to soften the impact. Lawmakers raised state subsidy funding to $300 million from $190 million, extending help to people with incomes up to 200% of the federal poverty level, or $31,920 for an individual. More than 500,000 Californians, about 30% of enrollees, are projected to receive a state subsidy in 2027, and nearly 200,000 can choose from two Silver plans with a $0 premium, the agency said.
Actual rates vary by plan and region, and final rates remain subject to state review before they take effect Jan. 1, 2027. Covered California enrolled about 1.9 million people for 2026, while Medi-Cal covers roughly 14.5 million low-income residents, so even small percentage changes affect large numbers of households.
Young Adults, Immigrants and Low-Wage Workers Face the Steepest Losses
The people most exposed are those whose costs rise faster than their paychecks. One 28-year-old told KFF Health News that an $800 monthly Covered California premium would amount to "another car note," so he goes without coverage and avoids activities that might cause injury. Health economists say losing young, healthy enrollees like him pushes average costs higher for everyone who remains.
Immigrants face specific changes. Immigrants with DACA status can no longer buy coverage on the exchange, and some documented immigrants will lose eligibility in 2027, according to the Public Policy Institute of California. PPIC also notes that when pandemic-era Medi-Cal renewals resumed, about 2 million people were disenrolled, roughly two-thirds for procedural reasons rather than ineligibility, a warning sign as work reporting requirements approach.
Many uninsured Californians are already eligible for help. Heading into 2026, nearly 1.2 million uninsured residents qualified for subsidized Covered California plans or low-cost or no-cost Medi-Cal, according to state modeling cited by Covered California.
Counties, which are legally required to provide care to uninsured residents too poor to afford it, are lobbying lawmakers for more funding, KFF Health News reported.
Options for Enrollees Before Open Enrollment
Current enrollees can take several steps this fall. Compare plans rather than letting coverage renew automatically, because the lowest-cost option in a region often changes. Update income estimates, since state subsidies now reach higher incomes. Respond quickly to any Medi-Cal renewal notice, and keep copies of documents submitted.
Enrollees who lose a job, move, or change household size during the year may qualify for a special enrollment period and should report the change promptly. Certified enrollment counselors offer free help with both Covered California and Medi-Cal applications.
People who lose coverage can seek care at community health centers that charge sliding-scale fees, ask hospitals about financial assistance, and check county programs for uninsured residents. Anyone with chest pain, trouble breathing, or signs of stroke should go to an emergency room regardless of insurance status.
The projection is a model, not a certainty. It depends on federal waiver decisions, state budget choices, and how many people successfully complete new paperwork. California stands to lose as much as $30 billion in federal funding annually, according to a state budget analysis cited by KFF Health News, and the next governor will inherit decisions about how much of that gap to fill.
The bottom line: coverage is getting more expensive and harder to keep in California, but new state subsidies and existing Medi-Cal eligibility still protect many families who act before deadlines.
Key Questions Answered
How many Californians could become uninsured? The UC Berkeley Labor Center projects that uninsured Californians under 65 could rise from 2.4 million to 4.6 million by 2030.
What is driving the increase? Expired enhanced federal premium tax credits, federal Medicaid cuts and work requirements, tighter rules on Medicaid waivers, and state budget cutbacks.
How much will Covered California premiums rise in 2027? The preliminary weighted average increase is 9.9%, compared with a 14% preliminary national median.
Who qualifies for California's state subsidy? People with incomes up to 200% of the federal poverty level, or $31,920 for an individual, in 2027.
When do Medicaid work requirements start? Federal work requirements for certain adults begin in 2027.
Can uninsured Californians still get care? Yes. Community health centers, hospital financial assistance programs, and county programs for uninsured residents remain options.
What should current enrollees do now? Compare plans instead of auto-renewing, update income estimates, and respond promptly to any Medi-Cal renewal notices.
