Many Republicans in congress favor repealing the Affordable Care Act (ACA.) The ACA allowed states like California to extend Medi-Cal health insurance coverage to adults with low incomes. If the ACA is repealed, 5 million adults could lose their Medi-Cal. These are our friends, neighbors, and family members.

Medi-Cal Expansion Under Threat
The UC Berkely Labor Center compiled a list of California congressional districts and the corresponding Medi-Cal and Covered California enrollments. The congressional districts 1, 3, 5, all held by elected Republicans, represent a Medi-Cal enrollment of 735,839 in June of 2024. Individuals enrolled in subsidized health insurance through Covered California totaled 100,780. Combined these three Northern California congressional districts include 836,619 individuals receiving federal assistance to either cover the cost of health care or help with paying the health insurance premiums.

Republican Congressional Representatives Have Large Medi-Cal Enrollments
In congressional district 1, Doug LaMalfa (R), 42 percent of the population is enrolled in some form of Medi-Cal. Another 4 percent of the population receives assistance through Covered California to pay health insurance premiums. Fully 46 percent of the population of congressional district 1 is receiving help with health care costs. This does not account for individuals and families who have opted out of either Medi-Cal or any health insurance plan.

Republicans Kiley (CA-3) and McClintock (CA-5) each represent districts where over 1/3 of the residents are either enrolled in Medi-Cal or Covered California.
For an adult to be eligible for MAGI Medi-Cal in 2024, a single individual need to earn less than $1,732 per month, or $20,783 annually. For a couple, two adults, if their income was less than $2,352 per month, $28,208 annually, they qualified for MAGI Medi-Cal. While these income numbers (138% of the federal poverty level) might be sufficient in other states, this is California were the cost of living (rent) is much higher than other parts of the country.


A quick look at Siskiyou County shows that 18,953 individuals, 43 percent of the population, is enrolled in some form of Medi-Cal. A further look at the demographics for April 2024 shows 56 percent of adults, ages 19 to 64, in Siskiyou County were on Medi-Cal. This large adult population is a direct result of the expanded low-income adult MAGI Medi-Cal from the ACA.


Statewide, 14.8 million people in 2024, 37 percent of the California population, were enrolled in some Medi-Cal program. Over half the children in the state, 5 million, were enrolled in the Children’s Health Insurance Program through Medi-Cal. There were 2.2 million seniors (Medicare) and people with disabilities in Medi-Cal programs. Over 3.4 million working adults were covered by Medi-Cal, most under the expanded MAGI Medi-Cal program.
5 Million Working Adults Could Lose Medi-Cal Coverage
In September 2024, Medi-Cal reported 5 million adults enrolled in expanded Medi-Cal. A substantial number of these adults attended colleges and trade schools that did not offer any health insurance. While the data classifies children separate from adults, if the children’s caretaker lose their Medi-Cal coverage or Covered California insurance because the ACA is repealed, the whole household suffers.
There are many counties where the number of residents enrolled in a Medi-Cal program exceeds 50 percent of the population.
- Lake County 52%
- Merced County 54%
- Madera County 53%
- Fresno County 54%
- Tulare County 63%
- Kern County 53%
- Imperial County 56%
If California congressional Republicans vote to repeal the Affordable Care Act and with its expanded adult Medi-Cal access, they will be irrevocably injuring thousands of their own constituents. Not all Medi-Cal programs that provide assistance to Medicare beneficiaries, children, and their caretakers are intertwined with the ACA. However, we all know that an accident or illness that befalls a household’s primary wage earner can lead to cascading effects for the whole family. Medi-Cal helps people bounce back after an accident or illness to support the whole family.
We see People with Medi-Cal Every Day
When you walk down the street, go into a store, or attend a neighborhood gathering, there is a good chance some of the people you encounter are on Medi-Cal. Some people may not be on Medi-Cal, but their children are. Perhaps the seniors or people with disabilities are getting extra help to pay their health care costs. All of this medical and insurance assistance helps people remain in the communities they call home.
Resources
Enrollment data compiled by Laurel Lucia and Miranda Dietz, “Medi-Cal Enrollment by District and County 2024,” UC Berkeley Labor Center, December 2, 2024 (reflects DHCS Medi-Cal enrollment data by zip code rolled up to district-level estimates). https://laborcenter.berkeley.edu/medi-cal-enrollment-by-district-and-county-2024/
Regional population from the US Census Bureau, 2020 Census Demographic and Housing Characteristics File.
Map of congressional districts https://www.govtrack.us/congress/members/CA#map
Medi-Cal eligibility and statistics dashboard Medi-Cal Eligibility Statistics
