Uninsured Project Buoyed by State’s Success in Expanding Medi-Cal

The annual conference for the uninsured this week in Sacramento aired many concerns and plans for the future but it also celebrated something unusual — this year the accomplishment of some of its goals.

“We’re actually underway now, for everyone outside of undocumented people to have health care available for all of California,” said Lucien Wulsin, executive director of the Insure the Uninsured Project, which hosted Tuesday’s conference in Sacramento. “That’s quite something.”

California HHS Secretary Diana Dooley in addressing the conference mentioned a button popularized by her predecessor at HHS, Kim Belshé: “Tomorrow is today,” the button said, referring to the planning that needed to be done to implement the Affordable Care Act.

“Well, today is today,” Dooley said.

She cited successes in Medi-Cal expansion, in establishment of the exchange, in moving millions of Californians into managed care systems, in starting to change the fragmented and often dysfunctional medical system in California.

“Over time, systems build up around the people in need,” Dooley said. “But now we are in a different world, and we have to think differently about the programs we helped develop. How can we develop these systems in a more integrated way?”

She applauded the hundreds of people attending the conference for their hard work over many years: “This is hard work,” she said, “and it has to get done. This is not just about expansion of coverage, we also need a system that’s simpler and easier to navigate, and we need to have cost and quality transparency.”

Toby Douglas, director of the Department of Health Care Services, received multiple ovations when he listed some of the state and county accomplishments.

“So far, through the [Low Income Health Program], 650,000 Californians have been transitioned into Medi-Cal,” Douglas said. “That was a tremendous achievement.”

Thousands more have enrolled in Medi-Cal because of contact with the health benefit exchange, and Douglas said that in the first week of the CalFRESH Express Lane program, about 10,000 people have enrolled.

One of the biggest remaining questions in California’s health care reform effort is making sure the additional one million to two million Californians who get some kind of new insurance coverage are able to get care from providers.

“The elephant in the room is access,” Douglas said. “How can we add one to two million more people and make sure they have access to services? Many people say it’s rates — we need to raise [Medi-Cal provider reimbursement] rates, we’re 50th in the nation. But it’s a lot more than that.”

The answer lies in payment reform, he said. “How we set rates provides protections around access,” Douglas said. “Rates are not the only thing. We have to look at how we pay differently — bundled payments, group visits, incentives to delegate risk — all of those need to be incorporated, to make sure we preserve access for the one to two million new people on Medi-Cal.”

The one group left out of ACA coverage is the undocumented, but that issue has to be on the back burner for awhile, Dooley said.

“Our attention right now is on making this work and that’s a big challenge,” Dooley said. “At this point, the undocumented have not been addressed in the ACA, or in national immigration reform, so it’s a subject we’ll continue to explore. But what we have on our plate is huge, and we need to do that right now.”

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