Self-employed workers and small business employees in California have seen expanded health insurance coverage under the Affordable Care Act (ACA), according to a recent report from the UC Berkeley Center for Labor Research and Education (CLRE). The brief draws on data from the California Health Interview Survey (CHIS).

"Analysis of CHIS data shows substantial coverage gains between 2013 and 2015 among self-employed Californians and those working for small businesses (defined as having 50 or fewer employees)," according to CLRE health policy analyst Laurel Lucia, a report co-author, along with Rachel Siemons and Ken Jacobs. "Among both groups, approximately 1 in 5 workers lacked insurance in 2015, compared to 1 in 3 in 2013."

Meanwhile, Congressional Republicans seek to repeal provisions of the ACA and replace it with the American Health Care Act (AHCA), which President Donald Trump supports. The AHCA passed the GOP-majority House of Representatives on a party-line vote.

"The drop in uninsured among entrepreneurs and small businesses through the ACA is a massive number," said Mark Herbert, California director of Small Business Majority, a national advocacy group, on a CLRE media teleconference.

The Congressional Budget Office's score of the House's version of the AHCA estimates that the bill would result in 23 million Americans losing health insurance coverage by 2026, while cutting the federal deficit by $119 billion during the same time. The AHCA is now in the GOP-controlled Senate.

Most working-age Californians have health insurance coverage through their employers, according to the CLRE. However, self-employed Californians comprised 2.7 million members (15 percent) of the state's 17.9 million labor force in 2015, while 5.1 million state residents (28 percent) worked for small businesses (restaurants, small retailers and family farms) with no more than 50 employees.

Image: UC Berkeley Center for Labor Research and Education (CLRE)

In Lynwood, California, Kateri Gutierrez, 24, co-launched Collective Avenue Coffee in October 2015.

"Without the Affordable Care Act, I would not have insurance today, and I would not be in business for myself," Gutierrez said on the CLRE call.

The health insurance coverage growth proceeded on two tracks in the Golden State. One is via Medicaid (Medi-Cal in California), and the other is subsidies through Covered California, a health-insurance marketplace, or exchange.

The CLRE's key findings on health insurance coverage flesh out the 2010 ACA's impacts on the labor force in California — the largest state economy in the U.S. and the sixth-biggest worldwide.

  • Small business employees had a higher rate of enrollment in the Medi-Cal expansion put in place by the ACA than other workers: 15.2 percent of employees at businesses with 50 or fewer workers, or 778,000 workers, compared to 9.5 percent of employees at larger businesses.
  • 246,000 small business employees (4.8 percent) enrolled in Covered California and were eligible for subsidies — more than double the rate for workers at large businesses (1.9 percent).
  • 214,000 self-employed Californians (8.1 percent) enrolled in Covered California through the individual market and were estimated to be eligible for premium subsidies based on income — a much larger proportion than that of all other workers (2.9 percent).
  • An additional 353,000 self-employed Californians enrolled in the Medi-Cal expansion.

Blue Shield of California Foundation and The California Endowment funded the CLRE's ACA data brief.