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The model  is designed to estimate the impacts of various elements of the ACA on employer decisions to offer insurance coverage and individual decisions to obtain coverage in California.

In 2019, state lawmakers took steps to protect California’s coverage gains and increase affordability of coverage by instituting a state individual mandate penalty, providing additional subsidies for Covered California’s individual market enrollees, and expanding Medi-Cal to low-income undocumented young adults. California is the first state to include undocumented adults in full Medicaid benefits and the first to provide subsidies to middle-class consumers not eligible under the ACA.

This paper discusses the methodology behind the UC Berkeley UCLA California Simulation of Insurance Markets (CalSIM) micro-simulation model, version 2.

Many California policymakers have expressed a desire and commitment to resist federal sabotage of the ACA, control health care costs, and achieve universal health care coverage. As the state explores ways to fundamentally redesign our health care delivery system—including by adopting a single payer or other unified public financing approach—state policymakers are also considering near-term policies that do not require federal approval but address the immediate challenges of improving affordability and expanding coverage.

We project that between 150,000 and 450,000 more Californians will be uninsured in 2020, growing to between 490,000 and 790,000 more uninsured in 2023, compared to the projected number if the ACA penalty had been maintained.

This study (Note 1) investigates potential differences in language use between genders, by applying a modified model of thought representation. Our hypothesis is that women use more direct forms of thought representation than men in modern spoken British English. Women are said to favour "private speech" that creates intimacy and nearness through discourse, which involves direct forms of speech, and thought, representation. Men are said to prefer a more distancing "public speech" style, in order to maintain independence and to hold and negotiate status, which often involves the display of skill and knowledge. In order to investigate this hypothesis, we examine a slightly modified form of the Lancaster SW & TP Spoken corpus, which has been tagged for the full spectrum of the primary categories of thought representation. The results of this study prove our thesis to be correct, there are statistically highly significant differences between the genders' use of direct forms of thought representation. British women use the direct forms more than their male counterparts. This greater use of direct thought categories in their daily discourse depicts a lucidity and consciousness, supposedly faithfully repeating the actual thoughts of the speaker, and it often occurs in a moment of heightened emotional or cognitive state. Therefore, because women seem to be able to express their emotions more lucidly then men, and are more inclined to express their thoughts in more detail, they tend to use more direct forms of thought representation than men in daily discourse.

This paper (Note 1) examines the form sort of in British men and women's speech, and investigates whether there is a gender difference in the use of this form. We do so through corpus analysis of the British National Corpus (BNC). We contend there is no quantitative difference in the use of sort of in men and women's speech. Contrary to general belief, we claim women do not use hedges more than men. However, there is a functional difference. Men and women use the item sort of for slightly different functions: in particular, women use these forms as politeness devices more often than men. The results of this study do not present any evidence to support the widespread claim that women use the forms sort of more than men do. There is no significant gender difference in the frequency of sort of. In the light of these results, women's allegedly greater usage of these forms could be regarded as persistent folklore. Furthermore, sort of has been treated mainly as a sign of powerlessness and uncertainty. Yet, this study indicates that it is a useful interpersonal resource, which both men and women seem to appreciate. When examining the affective function in greater detail, some marked gender differences emerge. The main finding is that positive affect is more common in women's speech, whereas negative affect is clearly more frequent in men's speech. In much of the research on gender differentiated conversational strategies, women's language is presented as co-operative and men's language as competitive. The results of this study show that, with respect to sort of, such a distinction cannot be drawn. Even if negative affect is more common in men's than in women's speech, by far the most instances of interpersonal function occur in essentially co-operative behaviour not only in women's but also in men's speech. This notion does not fit the description of men's speech style being competitive and prone to conflict. Hence, the results of this study suggest that men use the marker sort of more co-operatively than many researchers allow for.

BackgroundMonitoring of immune function, measured by CD4 cell count, is an essential service for people with Human Immunodeficiency Virus (HIV). Prescription of antiretroviral (ARV) medications is contingent on CD4 cell count; patients without regular CD4 monitoring are unlikely to receive ARVs when indicated. This study assesses disparities in CD4 monitoring among HIV-positive Medicaid beneficiaries.MethodsIn this retrospective observational study, we examined 24 months of administrative data on 2,250 HIV-positive, continuously-enrolled fee-for-service Medicaid beneficiaries with at least two outpatient healthcare encounters. We used logistic regression to evaluate the association of patient demographics (age, gender, race/ethnicity, and language) with receipt of at least one CD4 test per year, controlling for other potentially confounding variables.ResultsHaving a history of ARV therapy was positively associated with receipt of CD4 tests. We found racial/ethnic, gender, and age disparities in CD4 testing. Among individuals with a history of ARV use, all racial/ethnic groups were significantly less likely to have CD4 tests than White non-Latinos (African Americans, OR = 0.35, p

The California legislature is considering a proposal (Senate Bill 1005, the Health for All Act) that would expand Medi-Cal coverage to include primary and preventive care, prescription drugs, mental health care, dental care, and other routine health services for all low-income California residents regardless of immigration status. This brief finds that the proposed Medi-Cal expansion would involve new state spending, but the cost is modest in comparison to the impact on health and coverage, and the policy also produces savings.

In early 2013, the California Legislature will consider bills implementing a key provision of the Affordable Care Act (ACA) which required states to expand Medicaid eligibility to low-income adults under age 65, including those without children living at home. This Expansion was  effectively made optional for states by a 2012 Supreme Court decision and has not yet been formally enacted in California. In this report, the authors find that the Medi-Cal Expansion offers California the opportunity to significantly increase health insurance coverage at minimal cost to the state budget.Using the California Simulation of Insurance Markets (CalSIM) model, the authors predict that more than 1.4 million low-income adults will be newly eligible for Medi-Cal under the Expansion beginning in 2014. Other mandatory provisions of the ACA will lead to increased enrollment among Californians who are already eligible for Medi-Cal but not enrolled. This increase in coverage will have far-reaching benefits for Californians’ health outcomes and the California economy.The report also estimates that the federal government will pay for at least 85 percent of new Medi-Cal spending in 2014 through 2019. In the initial years of implementation, most new state Medi-Cal spending will result from required Medicaid changes and will occur whether or not the Expansion is implemented. We find that the new state spending on Californians newly eligible for Medi-Cal will be largely offset by increased state tax revenues and potential savings in other areas of the budget.This is a joint report from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research and funded by The California Endowment.

The Affordable Care Act (ACA) will significantly expand access to affordable health coverage in California starting in 2014. Californians with the lowest incomes will have access to coverage under the expansion of Medi-Cal, while millions of low- and middle-income families will be eligible for subsidies through the California Health Benefit Exchange (the Exchange). Demand for health insurance in the state will also increase as a result of the minimum coverage requirement.The level of enrollment in the new and expanded programs and the resulting share of Californians who gain coverage under the ACA will depend on a range of factors, including the ease of enrollment and retention, outreach strategies, and language accessibility. We used the California Simulation of Insurance Markets (CalSIM) model, version 1.7, to predict changes in health coverage in California under the ACA using two  scenarios: one based on typical responses by individuals and employers to expanded coverage offerings (the “base” scenario) and another based on a more robust enrollment and retention strategy planned by state coverage programs (the “enhanced” scenario). Based on the results of our CalSIM model, we estimate that in 2019, after the ACA is fully implemented:Between 89 and 92 percent of Californians under the age of 65 will have health coverage, compared to 84 percent without the law.Between 1.8 and 2.1 million Californians will enroll in subsidized coverage in the California Health Benefit Exchange.Between 1.2 and 1.6 million individuals will be newly enrolled in Medi-Cal.Between 3 and just under 4 million Californians will remain uninsured,1 million of whom will not be eligible for coverage due to immigration status.Under our enhanced scenario, we assume that greater enrollment in Medi-Cal and the California Health Benefit Exchange could be achieved through many factors,including:Simplified enrollment and redetermination processes and systems; Robust outreach and education; Culturally competent and linguistically appropriate outreach and enrollment assistance; Pre-enrollment from existing health and human service programs; and Use of institutional connections to reach individuals in life transitions to maximize seamless coverage.

Between 1.2 and 1.6 million more Californians are predicted to be enrolled in Medi-Cal in 2019 than otherwise would have been under current law

The California Simulation of Insurance Markets (CalSIM) model is designed to estimate the impact of various elements of the ACA on employer decisions to offer insurance coverage and individual decisions to obtain coverage in California.

The Affordable Care Act (ACA) will significantly expand access to affordable health coverage in California, increasing the share of insured non-elderly Californians to nearly 90 percent. An estimated 3 to 4 million Californians are predicted to remain uninsured in 2019, depending on the extent of outreach and enrollment activities and ease of enrollment and retention.

As we draw closer to 2014 and the full implementation of the Patient Protection and Affordable Care Act (ACA), we continue to increase our understanding of its full potential and its implications. In California, about 6.7 million nonelderly adults will be eligible for coverage under the law, through either Medi-Cal or tax credits to purchase insurance through California’s new Health Benefit Exchange.This policy brief, developed with support from the California Pan-Ethnic Health Network (CPEHN), highlights findings from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research’s California Simulation of Insurance Markets (CalSIM) model. The CalSIM model estimates the effects of specific provisions of the ACA on family and employer decisions about insurance coverage in California. People of color and those who speak English less than very well (Limited English Proficient, or LEP) could benefit greatly from implementation of the ACA. However, although the LEP population represents a considerable portion of those eligible, without effective multilingual outreach and enrollment efforts, language barriers may result in a difference of 110,000 fewer LEP individuals enrolled in the Exchange. To fully realize the potential of the ACA and California’s Health Benefit Exchange, resources need to be allocated for culturally and linguistically appropriate outreach and education to facilitate enrollment in coverage among all those who are eligible.

The Affordable Care Act (ACA) requirement that almost all Americans purchase some type of health insurance coverage has been controversial. This policy note examines the potential implications of eliminating the minimum coverage requirement (MCR), or "individual mandate." Based on analyses using the California Simulation of  Insurance Markets (CalSIM) model, the authors find that the ACA will reduce California’s eligible uninsured population from 4.63 to 2.72 million by 2019; a reduction of 1.91 million or 41% of the eligible uninsured. In contrast, without the MCR, the ACA will reduce the state’s eligible uninsured population from 4.63 to 3.76 million; a reduction of only 870,000 or 19% of the  eligible uninsured. Comparing the number of newly insured with and without the MCR shows that the number of newly insured will be 1.04 million lower in 2019 without the MCR. In addition, eliminating the MCR is likely to accelerate premium growth due to adverse selection. If this occurs, the ACA will reduce the state’s eligible uninsured from 4.63 to 4.02 million by 2019; a reduction of only 610,000 or 13% of the eligible uninsured. The number of newly  insured will be 1.30 million lower in 2019 without the MCR and with higher premiums due to adverse selection. Eliminating the MCR from the ACA would therefore substantially lower  the number of newly insured Californians by 2019 and undermine the goal of the law to substantially increase health insurance coverage for the uninsured.

This policy note examines the potential implications of eliminating the minimum coverage requirement (MCR), or “individual mandate.” Based on analyses using the California Simulation of Insurance Markets (CalSIM) model, the authors find that the ACA will reduce California’s eligible uninsured population from 4.63 to 2.72 million by 2019; a reduction of 1.91 million or 41% of the eligible uninsured.