Becerra, running for governor of California, faces a health insurance problem

Xavier Becerra campaigns to be governor of California in Los Angeles' Little Tokyo on August 18. He faces Republican Steve Hilton in the race to succeed two-term Gov. Gavin Newsom. Justin Sullivan/Getty Images hide caption

By the time Democrat Xavier Becerra left Washington, D.C., more Americans than ever had health insurance, owing partly to his work over the years to pass, defend, and expand the Affordable Care Act.

It's an achievement the former congressman and U.S. secretary of Health and Human Services often touts as he campaigns for California governor against Republican Steve Hilton, a former Fox News commentator.

But should Becerra cruise to victory in November, as polling suggests , he will face what may be the steepest decline in health insurance coverage in a generation, one that will land especially hard in his home state.

By 2030, the number of uninsured Californians under 65 is expected to nearly double from 2.4 million to 4.6 million as recently enacted state and federal cuts to Medicaid and ACA marketplaces begin to roll back historic gains in health coverage, according to a May analysis by the University of California, Berkeley Labor Center. The anticipated rise in the uninsured population could have broad implications for hospital systems, insurers, and the economy.

In February, Miranda Dietz, the labor center's healthcare program director, told legislators the changes could end up costing California about 200,000 jobs , mostly in the healthcare industry.

Hospital executives have begun reporting more unpaid medical bills , and experts warn health plans will raise premiums further as they're left with enrollees who are, on average, sicker and more expensive to cover.

"It's triage," said Jessica Altman , executive director of Covered California, the nation's largest state-run health insurance marketplace. "That's what the next governor is walking into."