Commissioner Initiates First-Ever Study on Fiscal Impacts of Health Coverage for Undocumented Californians

News: 2025 Press Release

LOS ANGELES — Insurance Commissioner Ricardo Lara has commissioned the School of Public Health at San Diego State University (SDSU) to conduct a comprehensive fiscal and economic impact study on California’s Medi-Cal coverage and Covered California expansions for undocumented Californians.

The study will quantify and analyze the financial impacts of these expansions by:

• Evaluating how increased access to healthcare affects utilization, spending, financing, and labor market outcomes in California.
• Providing policymakers with essential insights into the net fiscal impacts—whether cost-saving, cost-neutral, or more costly in both the short and long term—for individuals, employers, and the state as a whole.
• Informing future healthcare policy discussions.

"In an era of constant misinformation, it is imperative to provide data rooted in rigorous, independent analysis rather than politics or partisanship," said Commissioner Lara. "By partnering with one of our leading public research universities, this independent study will be vital for fiscal decision-making in Sacramento, especially as vulnerable communities often face cuts during budget crises. Rather than avoiding this issue, I want to confront it directly with real answers, not rhetoric, to guide policymakers and the next governor with factual data for informed decision-making."

The Department of Insurance chose SDSU’s School of Public Health within the College of Health and Human Services to lead this study due to its nationally recognized expertise in public health, healthcare policy, and advanced economic modeling. The school has a proven track record of translating research findings into actionable recommendations benefiting communities in California and beyond.

“This study offers an important opportunity to understand how California’s expanded access to care has shaped the lives of residents and the state’s health system,” said Wilton Choi, assistant professor of health economics at SDSU and principal investigator of the commissioned study. “Our goal is to provide a clear, evidence-based picture that can help inform future decisions and policy discussions at the legislative level.”

The SDSU research team will employ advanced modeling tools and data integration techniques—including tax simulation models and economic impact models—that are typically unavailable within legislative or state budget offices. These methods will enable the study to extend beyond basic cost estimates, providing a comprehensive view of how expanded healthcare coverage impacts state and local economies, healthcare spending, and household finances.

This study represents the first thorough evaluation of California’s Medi-Cal expansions to include all income-qualified residents, regardless of immigration status. It will provide the first empirical assessment of the effects of these policies since their implementation at the state level, examining changes in health insurance coverage, costs, healthcare service utilization, financing and payments, as well as labor market participation and employment since the phased expansion began in 2016.

The results will establish a neutral, evidence-based foundation for understanding the costs and impacts of these expansions, informing future decisions regarding healthcare access and financing in California.

Work on the study will commence this year, with completion anticipated in 2027.

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