California nearly achieved universal health care. Now, millions are losing coverage.

Two years ago, California hit a milestone decades in the making: Nearly every person in the state qualified for health insurance, regardless of immigration status and income, pushing the state's insured rate to a record 95 percent. Now, that progress is unraveling.

Facing budget shortfalls and new federal restrictions, state leaders have begun rolling back the system they built. Analysis at the UC Berkeley Labor Center and UCLA Center for Health Policy Research project California's uninsured rate could nearly double, to almost 15 percent, by 2030.

"I knew it was going to be bad, but seeing that doubling was shocking to me," says Miranda Dietz, director of the labor center's health care program.

An estimated 2.2 million people could lose insurance over the next four years from combined state and federal cuts. The losses will fall hardest on undocumented immigrants and low-income Californians, with the uninsured rate more than doubling among Black and Asian Californians.

"I knew it was going to be bad, but that was shocking."

When the Affordable Care Act passed in 2010, California quickly expanded Medi-Cal. More than 5 million Californians gained coverage. An additional 1.7 million middle-income Californians bought insurance through the commercial Affordable Care Act marketplace known as Covered California.

"That's a huge policy change," said Rachel Linn Gish, spokesperson for Health Access California, a consumer advocacy group. "Millions and millions and millions of Californians covered in 10 years. No other state can say that."

Gov. Gavin Newsom campaigned on a promise to bring single-payer health care to the state. He pivoted to expanding access within the existing system – transforming Medi-Cal with new benefits and a focus on high-quality primary care.

His administration also launched the state's second-largest coverage expansion, phasing in Medi-Cal eligibility for low-income undocumented immigrants. "We're making sure universal access to health care becomes a reality here in California," he said in 2022.

At its peak, the state-funded expansion covered 1.4 million adults and 217,000 children and cost more than $10 billion a year.

Republican lawmakers have sharply criticized that price tag, and increasingly, so have moderate Democrats. Medi-Cal spending has more than doubled since Newsom took office in 2019, growing from about $96 billion to $217 billion this year. The Legislative Analyst's Office attributes most of that growth to higher spending per recipient rather than enrollment alone. People are seeing doctors more, and each visit is more expensive.

The state froze enrollment for undocumented adults starting in January; roughly 86,000 fewer undocumented immigrants are now covered.

Many Democrats blame President Donald Trump, whose One Big Beautiful Bill rewrote Medi-Cal rules. State officials estimate Medi-Cal could lose more than $30 billion annually once federal changes fully take effect in 2027.

KRISTEN HWANG is a health reporter for CalMatters, where this story first appeared.