Does state healthcare spending create jobs or just shift costs?
Core argument: California's uninsured rate fell to 5.9% in 2024 vs. higher national levels, driven by Medi-Cal expansion to undocumented populations and.
California’s population is not especially old or feeble. Only 16.5% of its population is 65 or older, making it the sixth-youngest state on this measure. Californians also report fewer chronic health conditions than almost anywhere else. So why is its healthcare sector so mighty? One plausible partial explanation is that state policies are driving the outcome — in other words, that government subsidies are allowing more people to access more healthcare and social support, stoking demand. Enrollment in Medi-Cal, the state’s medicaid program, has increased significantly over the past decade as the state has continuously expanded coverage, including in recent years to undocumented populations. As a result, only 5.9% of Californians went without health insurance in 2024, a record low. The extensive margin (new enrollment) isn’t the only one at work; the intensive margin (use of healthcare services) is too. The state legislature has noted that Medi-Cal spending per enrollee is increasing even faster than the number of enrolled. Both greater utilization and greater coverage are driving demand and creating jobs in the process.

