Provisions of Health Care Reform Bills Get Mixed Response in Calif.
California might have to chip in more than other states to cover the costs of a proposed Medicaid expansion included in national health care reform legislation, the San Jose Mercury News reports.
Currently, California receives a dollar-for-dolllar match from the federal government for Medi-Cal, the state's Medicaid program. The program currently covers about seven million Californians, but that number could swell by up to two million if a health care overhaul passes.
The health care reform proposals would expand Medi-Cal by raising income eligibility levels. The federal government would cover the entire cost of the expansion for its first three years and would cover at least 80% of the expansion thereafter.
However, the federal assistance would apply only to Medi-Cal beneficiaries who became eligible under the new rules. The state would need to continue paying the 50% match to cover any new enrollees who previously qualified for the program.
California currently has hundreds of thousands of eligible residents who have not signed up for Medi-Cal but who might enroll if health care reform legislation requires all residents to have health coverage.
California also would have less to gain from a subsidized national Medicaid expansion because the state already has expanded Medi-Cal to cover residents with higher income levels. Under the current health care reform proposals, a greater federal subsidy would go toward states that currently offer the lowest levels of Medicaid benefits.
State officials say federal regulations would make it nearly impossible for California to scale back its Medicaid benefits to take greater advantage of the federal subsidies.
Gov. Arnold Schwarzenegger's (R) administration also has been lobbying for a reimbursement formula change that would require the federal government to cover a larger share of Medi-Cal costs (Zapler, San Jose Mercury News, 1/16).
Hindering Access to Care?
Last week, members of the California Medical Association traveled to Washington, D.C., to express their concerns that a national health care overhaul could make it more difficult for Medi-Cal beneficiaries to obtain access to primary care.
About one-third of the state's 60,000 physicians currently accept Medi-Cal beneficiaries, partly because the state offers relatively low reimbursement rates.
If the state's Medi-Cal reimbursements remain unchanged, more physicians might drop out of the program. At the same time, a national health care overhaul could spur more Californians to sign up for Medi-Cal, thus adding further strain to the program.
CMA officials say Medi-Cal beneficiaries who cannot access primary care physicians are more likely to seek higher-cost care at hospital emergency departments (Hotakainen, Sacramento Bee, 1/16).
Hard Hit From Health Plan Tax?
Other observers are expressing concern that California could shoulder a disproportionate burden under a provision of health care reform legislation that would tax "fully insured" health insurance plans.
The proposal would tax health insurers that cover the costs of members' medical claims. It would not affect self-funded plans offered by employers that pay their workers' claims.
Observers say the tax would hit California particularly hard because the state has a relatively large proportion of its population enrolled in HMOs, which typically are fully funded. About 77% of California residents are enrolled in a fully insured plan, compared with about 48% of U.S. residents nationwide.
Critics say the proposal could drive up member premiums if it compels state insurance plans to pay significantly higher taxes (Colliver, San Francisco Chronicle, 1/18).
Editorial, Opinion Pieces
- Los Angeles Times : The concession that Democratic leaders offered when they exempted unionized workers from the tax on high-cost "Cadillac" health insurance plans "isn't fair, but in the long run the deal preserves an important piece of the bill's approach to controlling health care costs," a Times editorial states. The editorial continues by describing the trade-offs of a tax on high-cost health plans (Los Angeles Times, 1/16).
- Sonal Ambegaokar, New America Media: National health care reform proposals "threaten to shut out millions of immigrants" by requiring documented immigrants to remain in the country for five years until they can apply for Medicaid, Ambegaokar writes in a New America Media opinion piece. Ambegaokar continues that such provisions could "jeopardize the nation's economy and the health of all of us" (Ambegaokar, New America Media, 1/16).
- Debra Saunders, San Francisco Chronicle: Democratic Congress members negotiating the national health care reform legislation "do not understand that, with each maneuver, voters find confirmation in their suspicions that if Beltway biggies have to bribe their co-believers to pass the bill, they should do a rewrite," columnist Saunders writes in a Chronicle opinion piece. Saunders continues by comparing Congress' deal-making to previous legislative efforts in California (Saunders, San Francisco Chronicle, 1/19).