Executive Summary

In March 2017, California Assembly Speaker Anthony Rendon appointed a Select Committee on Health Care Delivery Systems and Universal Coverage to identify the best and quickest path to universal coverage for California and to explore strategies for improving our health care system. This summary and the accompanying report document and synthesize Select Committee hearings held between October 2017 and February 2018.

Health coverage and care in California today

Under the Affordable Care Act (ACA), the number of Californians without health insurance fell dramatically from nearly 7 million in 2013 to about 3 million today. The majority of the remaining uninsured population, about 1.8 million, is not eligible for public coverage programs due to immigration status. Various factors including affordability and awareness contribute to others remaining uninsured.

Health care spending across California from all sources totals about $400 billion. Of this total, more than half comes from public sources of which the largest are Medi-Cal (more than $100 billion) and Medicare ($75 billion). Employer-sponsored coverage remains the dominant source of coverage in the state and accounts for the largest share of private health care spending (between $100 and $150 billion). In addition to the portion of the  $100 billion to $150 billion in employer-sponsored insurance premiums that is paid by employees, consumers pay $10 billion for premiums for individual insurance and $25 billion to $35 billion in out-of-pocket spending.

The health insurance market in California is relatively competitive and includes multiple national, state-based and local health plans. Health plans are responsible for health care provider contracting and payment and, to varying extents, plan contracts establish rules and incentives for providers to meet quality standards and achieve positive health outcomes. California has a long history of managed care arrangements within both private and public health plans. The settings in which Californians receive health care vary depending on their source of coverage (employer-sponsored, Covered California or remaining individual market, Medi-Cal or Medicare).