Even after the federal health care overhaul is in place, 2 million Californians could still be left uninsured, and the budget-strapped state may find it difficult to absorb millions of others who will suddenly have coverage, experts told lawmakers Wednesday.

California has the nation's largest population of the uninsured — 7 million people.

Many of the people without health coverage will choose not to buy it — despite penalties — or are in the state illegally and will not be eligible for subsidies and other government assistance, said Marian Mulkey, a senior program officer with the California HealthCare Foundation, during testimony before a joint session of the state Senate and Assembly health committees.

In addition to the 2 million people Mulkey estimated would continue to lack coverage, another 2 million poor Californians would likely receive it under an expansion of Medi-Cal eligibility.

While the federal government will pick up the tab for the 2 million additional enrollees, the state will nevertheless find itself financially stressed to pay for its share of existing enrollees, Mulkey said.

"We face ongoing challenges of maintaining the public programs that we have under the difficult budget challenges that we have," Mulkey said in an interview.

Medi-Cal has been much maligned by health care providers and consumer advocates who say the program is inadequately funded.

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