How to Deal With Remaining Millions Uninsured

Health care experts gathered in Sacramento this week to take on the thorny issue of what to do about the estimated 3.1 million to 4 million Californians who will remain uninsured after five years of implementation of the Affordable Care Act.

The symposium, held on Monday and sponsored by the Insure the Uninsured Project, focused on what to do about the new estimate of uninsured in California.

Last month, the UC-Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research issued a joint report, “After Millions of Californians Gain Health Coverage under the Affordable Care Act, Who Will Remain Uninsured?”

The report predicted the number of uninsured in California will be reduced significantly by the ACA — with between 1.8 million and 2.7 million people who are currently uninsured getting coverage by 2019.

However, it said, that still leaves 3.1 million to 4 million Californians without insurance. Approximately three-fourths of those people are likely to be U.S. citizens or lawfully present immigrants, the report said.

About half of the remaining uninsured will be eligible for Medi-Cal, the report predicted, and that’s what Monday’s workgroup focused on. A presentation by LA Health Action outlined four different ways to approach the problem: strengthening the safety net in California, mostly by protecting existing revenue streams and creating others; integration of care, which includes an effort to coordinate emergency Medi-Cal funding; trying to expand employer-based insurance for uninsured workers; and a hybrid approach which combines public and private providers and financing.

Lucien Wulsin, executive director at ITUP, said a Basic Health Plan could address some of that remaining uninsured population.

“Conceptually, a Basic Health Plan would look more like the Healthy Families

program for children than like commercial private insurance,” Wulsin said. “This means lower out-of-pocket … but tighter utilization controls on the use of medical services.”

The idea of the BHP was floated in the Legislature through SB 703 by Sen. Ed Hernandez (D-West Covina), but it failed to get out of committee. It could be revived in the next legislative session, however.

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