Monthly Archives: June 2012

Henry Cisneros on Policies to Help California Seniors Age in Place

California's aging baby-boomer population has policymakers and developers thinking about how to let them age at home. (Justin Sullivan/Getty Images)

California may be the sixth youngest state right now. But it has an outsized population of Baby Boomers.

“They are turning 65 soon,” says Adele Hayutin, a Senior Research Scholar at the Stanford Center on Longevity.

“We’ll have a doubling of our older population over the next 20 years,” Hayutin says. “That makes us aging faster than the United States, which I think is a bit of a surprise to people.”

In a recent paper, Hayutin wrote that projections show in 2040 California’s population will be slightly older than the nation’s as a whole. That has implications for policy makers, developers, and residents — everyone who lives here will feel the effect.

And the sooner the planning starts the better, says Henry Cisneros.

Cisneros is the former Secretary of the U.S. Department of Housing and Urban Development under President Clinton. He just co-edited a book with two scholars at Stanford – Jane Hickie and Margaret Dyer-Chamberlain – called “Independent for Life: Homes and Neighborhoods for an Aging America.

“When we listen to older Americans themselves,” Cisneros says, “when they describe the things they fear about aging in place … it’s things like isolation, being left alone and not being able to negotiate neighborhood streets. Not being able to get to the doctor or grocery store.” Continue reading

California Faces Headwinds in Easing Doctor Shortages

By David Westphal, CHCF Center for Health Reporting

The Supreme Court’s validation of President Obama’s landmark health law sets off a scramble across California to find enough primary care doctors and other professionals to serve an estimated 3 million newly insured patients by 2014.

California already rates below average in the number of doctors per capita.  But the state – rural counties in particular – will face additional headwinds as health reform slashes the ranks of its 7 million uninsured.

California has an unusually large number of doctors heading into their retirement years.  It expects a much higher-than-average rise in the health-intensive 65-and-older population.  And it has one of the lowest reimbursement rates in the country for Medi-Cal, the state’s primary program offering health coverage for the poor.

Especially for communities that are already struggling with doctor shortages, the court’s somewhat unexpected endorsement of the Affordable Care Act suddenly presents a steep challenge.

“What good is it in 2014,” when millions of uninsured Californians will gain coverage “when they don’t have access to providers?”

“The Affordable Care Act will add hundreds of thousands of people to the rolls of the insured.  That’s good,” said Dr. G. Richard Olds, founding dean of the UC Riverside School of Medicine.  “But where are the primary care physicians going to come from to serve that population?”

According to a 2009 study by the California HealthCare Foundation, only 16 of 58 California counties had sufficient primary care doctors as measured against standards set by the American Medical Association.  The Association of American Medical Colleges has warned the nation could reach a shortfall of nearly 100,000 doctors by 2020. Continue reading

New Phone-Based Program May Help Lower Diabetes Risk

By Alvin Tran

The study relied on health educators to help participants make healthy choices. (Jerry Bunkers/Flickr)

Get active. Eat Smart. Eat your colors. And eat breakfast.

These were the four themes guiding participants in “Live Well, Be Well,” a diabetes prevention program in the San Francisco Bay Area for underserved communities.

Live Well, Be Well was also a new study led by researchers at UCSF and implemented by the City of Berkeley’s Division of Public Health. 

The researchers recruited over 230 adults at risk for diabetes from Berkeley, Oakland, and Richmond. They were randomized, and half received a series of phone-based, lifestyle counseling sessions. The other half, the control group, was offered counseling after one year. 

Participants chose from the four themes to guide their sessions, says UCSF Associate Professor of Medicine and lead author of the study, Dr. Alka Kanaya, M.D.

“We wanted to basically see which [theme participants felt] most interested in and the one they felt were most feasible for them to make a change. We really did want to pound home the message about healthy diet, eating correct portion sizes, [and] making smart choices when you’re eating food.”

Trained health educators from Berkeley’s Division of Public Health guided these phone-based sessions and helped participants create goals for diet and exercise. After six months, the counseling sessions stopped. Continue reading

Will Employers Start Dropping Employees From Health Plans? Discuss.

Will employers stop covering employees and push them to the exchanges once they are set up in the 50 states? (STAN HONDA/AFP/GettyImages)

Now that the future of the Affordable Care Act has been decided – to some degree – the debates over what it means have begun.

Does the act potentially impose a tax on Americans or a penalty? Will the health care system become uniformly robust, or will it put a huge burden on physicians in private practice?

And another biggie that you’ll be hearing about:

The Chronicle has a piece this morning, with a link to a report in McKinsey & Company, which suggests: YES, given the opportunity, employers will stop offering coverage. But in Massachusetts, which has a similar law already in place, that hasn’t been the case.

Who is right? Probably this report from the Commonwealth Fund that sorts through a number of studies and concludes it will be hard to know how it will shake out until large employers are eligible for the health exchanges in 2017.

Studies and surveys on the subject aren’t hard to find, but they are hard to reconcile. Just since June 2010, there have been at least seven surveys on the subject.1 So, will 2.7 percent of employers drop coverage as this survey suggests? Or will 18.8 percent drop coverage, as this survey, conducted one month later, suggests? Or were researchers at RAND correct when then calculated in late 2010 that employers would offer coverage to an additional 13.6 million workers once the exchanges, penalties, and various subsidies are all up and running?2

Let the debates begin.

Supreme Court Upholds Health Care Act

The Supreme Court has ruled on the Affordable Care Act. (afagen/Flickr)

Update 6:42 PM Interview with Nancy Pelosi on Health Care: It was always in the bag

KQED’s Jon Brooks posted a full transcript, audio and some commentary (always fun) about Scott Shafer’s interview with Nancy Pelosi. It’s a great overview of the drama surrounding the Act over the years.

Update 1:47 PM Supreme Court Ruling Could Be Good for the State’s Budget

The LA Times is reporting that “California stands to receive as much as $15 billion a year to extend coverage to millions of the poor and uninsured starting in 2014.” Welcome news after last night which saw Governor Jerry Brown whittling almost $200 million more from the budget before finally approving it.

Update 12:24 PM Open Browser, Insert Foot

KQED’s News Fix blog has a great post up about all the tweets flying around after the decision. Some ill advised ones from public officials. And a slew from disgruntled Americans who don’t like the health care plan announcing they’re “moving to Canada.” Hmmmm.

Update 11:43 AM “The Horse Is Out Of the Barn”

The head of California’s Health Benefit Exchange, Peter Lee, just spoke. He’s been leading California’s efforts to create an online market for health insurance. He long contended it would move ahead regardless, but the mandate for all to have insurance definitely ups its relevance. Lee said his goal was to make an online system that would make buying health insurance as simple as buying a book from Amazon (or almost as simple). He also detailed what this decision means for Californians pocketbooks (or purses as we say in California). Lee also said “the horse is out of the barn,” and unlike what some commentators are saying he believes the Affordable Care Act is here to stay. Continue reading

Local Republican Leader Weighs In: The Discussion is About Taxes Now

Duf Sundheim was the chair of the California Republican Party from 2003-2007 and remains active in the party. He lives in Los Altos Hills, CA. KQED’s Stephanie Martin spoke to him today about his reaction to the Supreme Court decision.

MARTIN How do you feel that Chief Justice Roberts, a fellow conservative, voted to uphold the law?

SUNDHEIM Well I think he really had a lot of things he was trying to address. One was the specific issue of the mandate and the commerce clause. That’s why I think so many people thought the legislation would be overturned. And the fact he was able to make a bridge to find that it was a tax, not a mandate.  I think was very interesting.

I thought the reasoning was a little tortured but I think he was really concerned about the future of the court, the public perception of the court.

So I understand what he was trying to do. Again it’s not a situation where they’re making a decision that ties the hands of the other branches of government. It really transfers to the decision to those two branches. And it’s now up to those two branches to make a decision that’s in the best interest of the people. Continue reading

Health Decision Will Have Big Impact on California’s Ethnic Communities

A sign from a recent health care rally (seiuhealthcare775nw/Flickr)

Health disparities in the state are stark.

“Diabetes affects 13 percent of Native Americans in the state, 11 percent of Latinos, 10 percent of African Americans,” says Ellen Wu, the executive director of the California Pan-Ethnic Health Network (CPEHN). “That’s compared to five percent of the white population.”

Wu says there’s a gap in access to care too. That’s why the Supreme Court decision upholding the Affordable Care Act is such a watershed moment for her.

She says of the three million Californians who will now be eligible for coverage through the state’s health benefit exchange in 2014, two-thirds come from communities of color.

“For example with diabetes … they’ll be able to get screened earlier and prevent it. And when they do have onset they’ll be able to manage their care better and stay healthier,” said Wu.

The same goes for asthma, she said. “We know that for communities of color, they can show up in the emergency room for an asthma attack at higher rates than whites so the free preventive care under the Affordable Care Act (ACA) is really, really critical to keeping our communities healthy.”

Continue reading

OK California, What The Health Exchange Means for YOU

There are the politics and the spinning. There’s the talk of improved health outcomes … and then there is the bottom line. What does this mean for the state’s consumers?

The California Health Benefit Exchangeis the most tangible institution that Californians will interact with as a result of the law. Those newly in the market to buy insurance because of ACA, this is your go to shop.  Officials estimate that’s around 3 million Californians.

“We look forward to making the purchase of insurance through California’s exchange as easy as buying a book on Amazon or shoes on Zappos,” says Peter Lee, who has been working to set up this online marketplace. Continue reading

California Politicians Weigh in on Surprising Decision

A word bubble displays the most prevalent words in Democratic reactions to the Supreme Court's ruling on the Affordable Care Act.

Responses from California Politicians are starting to roll in.

Here at State of Health we made wordles out of the statements from the Democrats and the Republicans. Can you match the word cloud to the party?

A word bubble demonstrating the most used words used by Republicans in response to the Supreme Court ruling.



A hint: reading through the statements, themes from the Democrats: “great day,” “reaffirms what is right,” “benefits millions.” Themes from the Republicans: “great harm,” “repeal,” “take back the White House.” The Sacramento Bee has a wide round up. Here’s a sampling: Continue reading