Report: 4M Calif. Residents Will Still Rely on Safety-Net Care in 2019

Many of the approximately four million Californians who will remain uninsured by 2019 could have trouble accessing health care as funding for safety-net providers increasingly drops, according to an issue brief by the Greenlining Institute, the Sacramento Business Journal reports (Robertson, Sacramento Business Journal, 8/19).

Background

According to the brief, the uninsured population in California by 2019 is expected to be "very diverse" but not entirely made up of undocumented immigrants. The brief notes that residents could lack coverage because of:

Affordable Care Act exemptions based on immigration status;

• Lack of affordable coverage;
• Unforeseen life circumstances; and
• Other reasons.

The brief states, "A majority of these Californians will continue to access their health care through safety-net providers, whose critical funding is rapidly diminishing in the broader context of ACA implementation." For example, the fiscal year 2013-2014 state budget included provision requiring counties to "relinquish significant funding" for safety-net care under the assumption that many Californians would gain health coverage through the ACA's expansion of Medi-Cal, California's Medicaid program.

Details of Brief

During the summer of 2013, researchers conducted and transcribed interviews about safety-net care in California with:

• A policy-focused not-for-profit organization;
• Staff from two foundations; and
• Two safety-net providers.

During the interviews, researchers identified six themes that were most referenced by interviewees:

• Funding, which was referenced the most;
• Citizenship;
• Coverage;
• County;
• Politics; and
• Advocate.

The report states, "Everyone we spoke to made it clear in their own way that public policies that will improve health insurance coverage and health care access for California's remaining uninsured cannot be disentangled from immigration reform."

In addition, the safety net providers said that changes in state and federal funding have affected health care access for some communities.

According to the report, "In 2014 and beyond, the remaining uninsured will still primarily depend on the safety net, until comprehensive legislation ... is passed" (Greenlining Institute brief, August 2014).

Recommendations

To strengthen the safety net in California, the report recommends that the state Legislature and Gov. Jerry Brown (D) advance a measure (SB 1005) that would:

• Expand Medi-Cal eligibility to all California residents with incomes below 138% of the federal poverty line; and
• Establish a mirror health insurance exchange that would allow undocumented immigrants to purchase coverage similar to that offered on Covered California (Sacramento Business Journal, 8/19).

The brief also recommends that:

• Brown re-evaluate funding for safety-net care midway through fiscal year 2014-2015;
• Policyholders and stakeholders promote the California Endowment's campaign advocating health care access for all residents, including undocumented immigrants;
• The state Department of Health Care Services outreach to uninsured communities and encourage collaboration among safety-net providers and stakeholders; and
• Foundations encourage collaboration as part of their grant-making process (Greenlining Institute brief, August 2014).