California Stands To Gain From Health Care Reform Provisions
Given California's mounting coverage gap and rising health care costs, the state could benefit significantly from the health care reform legislation approved by the U.S. House yesterday, the San Francisco Chronicle reports.
However, even with the legislation, California's uninsured population is expected to remain high because of the number of Californians who will not qualify for health insurance under the reform bill, such as undocumented immigrants (Colliver, San Francisco Chronicle, 3/22).
Beginning in 2014, the legislation would:
- Require nearly all residents to have insurance;
- Provide insurance subsidies to help individuals buy coverage through new health insurance exchanges; and
- Expand Medicaid, including Medi-Cal, California's Medicaid program (Bazar, Modesto Bee, 3/22).
California HealthCare Foundation Senior Program Officer Marian Mulkey said that once reform is fully implemented after 2014, about two-thirds of the state's uninsured will get coverage and access to affordable care (San Francisco Chronicle, 3/22). CHCF publishes California Healthline.
More immediately, the bill calls for the creation within 90 days of a high-risk insurance pool to offer subsidized premiums to those who have been uninsured for at least six months and have pre-existing medical conditions.
According to Insure the Uninsured Project Executive Director Lucien Wulsin, at least 200,000 Californians do not have insurance because of pre-existing conditions.
California has a high-risk pool, but it caps enrollment at 7,100 and insurance benefits at $75,000 per year because of limited funding. The federal high-risk pool under the billÂ calls forÂ subsidized premiums and no annual caps on benefits.
About 1.9 million California Medicare beneficiaries are expected to benefit from a provision that would close the Medicare Part D prescription drug "doughnut hole." Under Medicare Part D,Â beneficiaries pay 100% of their drug costs once they hit a $2,830 threshold up until their out-of-pocket expenses exceed $4,550 (Modesto Bee, 3/22).
Meanwhile, cuts to Medicare Advantage plans are likely to impact California more than other states because a greater percentage of the state's Medicare beneficiaries enroll in such plans -- 34% comparedÂ with the national average of 22%, according to the Kaiser Family Foundation.
The legislation would increase Medi-Cal payments to physicians and cover the costs for newly eligible Medi-Cal beneficiaries until 2016 (San Francisco Chronicle, 3/22).
California likely will wait until 2014 to expand Medi-Cal to adults under age 65 earning up to 133% of the federal poverty level and to childless adults. The California Department of Health Care Services estimates 1.6 million more people will join Medi-Cal (Modesto Bee, 3/21).Â
A last-minute change added to the bill would require tax-exempt insurers, such as Kaiser Permanente, to pay a new fee levied on all insurers on half of their premiums. Earlier versions of health care reform exempted such insurers from the fee (Fram, AP/San Jose Mercury News, 3/21).
Many health care advocacy organizations in California applauded the Houseâs approval of the health care reform legislation.
Anthony Wright, executive director of Health Access California, said, "California would disproportionately benefit from these reforms" (Lin, AP/Monterey County Herald, 3/21).Â Â
Meanwhile, California hospital officials had mixed reactions, with some saying that hospitals in the state would be unfairly burdened by reform and others noting how much local hospitals stand to gain (Kimitch, Whittier Daily News, 3/21).
Other California health organizations cautioned that the next steps toward executing the reforms will be difficult.
Patrick Johnston, president of the California Association of Health Plans, said that his organization is "ready to work with state and federal officials to implement the complexities of what will become the new law." He warned that health care cost containment still needs to be addressed (Calvan, Sacramento Bee, 3/22).
Candidate Promises Repeal
Former U.S. Rep. Tom Campbell, a Republican running for a California Senate seat against Sen. Barbara Boxer (D), on Sunday said that if elected, he would seek to repeal the health care reform legislation (Noguchi, San Jose Mercury News, 3/22).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.