(Getty Images)

If you don’t have a child with autism, you might not know about Applied Behavioral Analysis. ABA is widely regarded as a necessary and effective treatment.

Now many poor children will lose access to this therapy under deals reached in Sacramento last week. Meanwhile, other kids — including those who become insured under the state’s new Obamacare marketplace — may well continue to have access to this therapy.

Here’s the background: under the Affordable Care Act, states can expand Medicaid, called Medi-Cal in California. People with incomes up to 138 percent of poverty will be eligible. Last week, as the legislature and the administration were wrapping up the state’s budget, the legislature was simultaneously moving forward on final bills to implement the Medi-Cal expansion.

Last Friday, after months of debate, legislators sent two final bills to the governor’s desk to approve the expansion. But for supporters of the expansion, this victory came at the cost — ABA therapy for kids on Medi-Cal was axed. Children’s advocates are frustrated.

“With ABA services not covered in Medi-Cal, it essentially means that low-income children are not provided the same comprehensive level of mental health benefits that we’ve mandated private plans cover,” said Mike Odeh, senior health policy associate at Children Now, an advocacy group based in Oakland.

Private insurers are currently required to cover ABA therapy under a law signed in 2011. But that law is scheduled to sunset in 2014. In an odd turn of fate, as legislators nixed ABA coverage for Medi-Cal last week they simultaneously moved a bill forward that would extend the mandate for private plans to continue to cover ABA therapy.

In short, if your children are on Medi-Cal, they will lose access to ABA while children receiving private insurance will apparently retain it — until 2019, if the proposed bill passes.

Families who had been receiving insurance through Healthy Families, California’s low-cost insurance specifically for children and pregnant women, have been fighting hard to keep access to ABA. Last fall, the state passed an emergency measure to provide ABA to children enrolled in the insurance program. When the state began moving Healthy Families children to Medi-Cal earlier this year, families were promised that benefits would be the same. Yet, some 500 children have lost or will soon lose their ABA benefits.

The emergency legislation “specifically documented that these children would likely face irreparable harm if they did not receive this treatment,” said Kristin Jacobson, President and Co-Founder of Autism Deserves Equal Coverage.

Families and advocates have been pushing the state to continue to cover this intensive therapy, which they say is necessary for many autistic children to build important developmental and social skills.

Without ABA “not only are you condemning [children] to a life where they are unable to function in society, you’re also burdening society with their care for their lifetime,” said Jacobson. She said the legislators’ move to take ABA coverage out of last week’s bills was “completely perplexing” and “inexplicable.”

Parents like Rachel Harris feel betrayed. Harris was told that her son’s treatments would continue despite the switch from Healthy Families to Medi-Cal. Harris’s 4-year-old son, Daniel, had just started receiving ABA for autism that he was diagnosed with at age 3.

In the short time Daniel had been receiving the therapy, he was already making big gains: making eye contact with people, asking questions, and he ran off less.

But when Daniel was moved to Medi-Cal on April 1, his ABA treatments ended. Harris said Daniel has begun to go backwards, biting his brother, climbing on top of the refrigerator and running off into a parking lot.

“I am trying to tend to my son and help him cope day to day,” Harris said in a press release. “It is nearly impossible without the ABA therapy on which we depended. We are devastated that the State has broken its promises to our son and our family.”

Half of the children enrolled in Healthy Families have already been switched over to Medi-Cal with the rest moving over in the coming months. With larger numbers of families expected to sign up for Medi-Cal later this year, more children with autism will not be able to access the care that they need.

Advocates are hoping to work with the legislature to get the therapy covered.

“There’s some urgency to it,” said Mike Odeh. “Some children that have already transitioned to Medi-Cal have lost those services but there’s still more transitions to come.”

At the state capital, Sen. Darrell Steinberg, (D-Sacramento), who has been pushing for autism coverage in both private insurance and Medi-Cal, said he will keep trying.

“Unfortunately, this year, there simply wasn’t enough room in the budget to fund ABA therapy in Medi-Cal for kids with autism spectrum disorder. I will not give up the fight, however,” Steinberg told California Healthline. “It’s at the top of my list to get done next year.”

(William West/AFP/Getty Images)

In a unanimous decision, the U.S. Supreme Court ruled Thursday morning that human genes are not patentable.

The case centered around Myriad Genetics, the holder of patents on two genes, BRCA1 and BRCA2. Some mutations of these genes are associated with an increased risk of breast and ovarian cancer. For women with a strong family history of these cancers, the only place they could be tested was Myriad Genetics, which sometimes charged more than $3,000 for the test.

Breast Cancer Action, an advocacy group based in San Francisco, was a plaintiff in the case, and executive director Karuna Jaggar sounded jubilant in a phone call Thursday morning.

“From our perspective, these patents never should have been granted in the first place,” Jaggar said. “There’s no question that DNA is a product of nature, and so it’s very affirming to see the court rule in our favor.”

BRCA1 and 2 mutations became international news when actress Angelina Jolie revealed that she’d had a preventive double mastectomy after testing showed that she had a specific mutation that put her at very high risk of developing breast cancer.

Breast Cancer Action has long argued against the high cost of the test, and said that the patent gave an unfair monopoly to Myriad Genetics, which is located in Salt Lake City. With the court’s ruling, Jaggar believes that more companies will be able to offer a test to women.

“They’ll have access to new tests at lower costs and will have access to second opinions,” Jaggar said. “Currently Myriad offers the one and only test. It has not been peer reviewed; it has not been scientifically validated. New labs will now be able to offer new tests using new methodologies.”

In a statement Myriad Genetics played down the magnitude of the decision, pointing to its 500 other valid patent claims as well as the BRCA test. The court upheld patent claims on what’s known as synthetic DNA or “cDNA.” Synthetic DNA is man-made, not a “product of nature,” and is still patentable.

“We believe the Court appropriately upheld our claims on cDNA,” Myriad’s CEO Peter Meldrum said in a release, “ensuring strong intellectual property protection for our BRACAnalysis test moving forward.”

But Breast Cancer Action insists the Supreme Court’s decision opens the door to new options for women who worry about inherited risk of breast cancer. “Laboratories can conduct genetic testing without using cDNA and this means that Myriad no longer holds a monopoly on the BRCA genes,” Jaggar said in a release this morning.

Roughly 5 to 10 percent of women carry a BRCA1 or 2 mutation, according to the National Cancer Institute. Not all mutations are harmful, but some can be devastating. Angelina Jolie said that she had a mutation that put her at an 87 percent risk of breast cancer.

Learn More:

Read the decision: Association for Molecular Pathology v. Myriad Genetics, Inc.

A proposed law seeks to close the so-called “Walmart Loophole.” (Justin Sullivan/Getty Images)

For many businesses Obamacare is downright intimidating. The requirement to provide coverage to full-time employees or potentially face thousands of dollars in fines is what’s really worrying some large companies.

Most employees at large businesses already receive health insurance through their employer. But there are still some exceptions.

Barbara Andridge is a sales associate at a Walmart near Sacramento. She’s not sure if she’s eligible for the company’s health insurance program because her hours are all over the map — from eight hours one week up to 36 hours the next.

To qualify for company benefits she says she’d have to be working at least 30 hours per week.

“I really had to sit down and think about my hours and if I’m going to have enough hours to qualify to have health care all year,” Andridge says.

With no guarantee of hours Andridge decided to enroll her six-year-old son in Medi-Cal, the government health insurance program for low-income Californians. Andridge plans to apply for herself soon as well.

Some health care advocates are concerned there will be even more employees like Andridge applying for Medi-Cal once Obamacare kicks in next year. They fear companies will limit hours for workers just to avoid having to pay for their health insurance.

“Employers should not be able to skirt their responsibility simply by exploiting a vulnerability in the law,” says Steve Smith with the California Labor Federation.

Assemblyman Jimmy Gomez (D-Los Angeles) introduced, and the California Labor Federation is co-sponsoring Assembly Bill 880. It’s designed to address what Smith calls a limitation of federal health reform. Under the Affordable Care Act employers aren’t required to cover part-time employees or those working fewer than 30 hours a week.

Smith says AB 880 is aimed at preventing low-wage workers who lose hours — and their health care coverage — from turning to Medi-Cal.

The fines would vary under the measure, but on average businesses with more than 500 employees would face a $5,500 penalty for each worker who enrolls in Medi-Cal. Smith says the state would collect the fees and use them to offset repeated budget cuts to the Medi-Cal program.

“We don’t support big companies that can afford health care costs for their employees simply pushing those costs onto taxpayers,” he says.

No one knows for sure how many employees will apply for and ultimately receive Medi-Cal, but researchers have developed a simulation model to come up with some estimates.

Ken Jacobs of the UC Berkeley Center for Labor Research and Education says 250,000 employees from large companies are already on Medi-Cal. Jacobs predicts that number could grow by an additional 100,000 people within the first year after the Affordable Care Act takes full effect.

However, Jacobs points out that most of those workers will not end up on Medi-Cal because a company cuts their hours.

“Cutting to part-time would entail much greater costs than the penalty on employers,” he says. “They’ve got greater hiring costs, more turnover, more supervision costs, more unemployment insurance costs. It’s not worth it.”

While Jacobs believes that some workers’ hours will be cut, he says the main reason employees will go on to Medi-Cal is that under Obamacare, more people will be eligible. The program is being expanded to all people making up to 138 percent of poverty, a higher income threshold than is in place today. In California alone more than one million additional people will qualify for the program.

Whether it’s because of reduced hours or new eligibility that workers end up on Medi-Cal, thousands of California businesses oppose paying a penalty if they do.

Law could lead to lay-offs

Some of the loudest protests are coming from those with seasonal and part-time workers. Obamacare doesn’t affect them, but the proposed California law will.

Rick Fowler, CEO of the nonprofit Community College Foundation, says AB 880 would do more harm than good. He employs more than 500 students to work as part-time tutors helping disadvantaged kids get to college. Fowler says those students will suffer the unintended consequences of the legislation.

“I have no choice but to lay off people and increase the rolls of the unemployed and reduce the services that we’re providing to at-risk youth,” Fowler says.

He believes an ongoing and epic battle between labor unions and non-unionized business giants is driving this legislation.

“The sad part is that this nonprofit and perhaps many other good organizations are going to die in the crossfire between those heavyweight players,” he says.

The bill requires a two-thirds majority vote and with Republicans generally opposed it faces a tough hurdle: every Democrat will need to vote yes. Then Governor Brown would have until the end of September to sign or veto the measure.

This story was produced in collaboration with the California HealthCare Foundation Center for Health Reporting, a nonprofit news organization that focuses on California health issues. Based at the USC Annenberg School for Communication and Journalism, the center is funded by the nonpartisan California HealthCare Foundation.

Desert Mobile Home Park, near Thermal, CA, in the heart of eastern Coachella Valley. (Lisa Morehouse/KQED)

About 40 miles from the Southern California resort town of Palm Springs is an abundant agricultural region, the Eastern Coachella Valley. It’s in the middle of a desert, but because of irrigation, the land there is rich.

Most of the people who live there are not.

The economy depends on the labor of the region’s farmworkers, many of whom struggle financially. For years, this desert valley has also been known as another kind of desert:  a data desert. Though many here know the area is rife with environmental hazards and social vulnerabilities like poverty and limited English-proficiency, there hasn’t been plentiful information about environmental risks, air quality, or residents’ social capital and resources. Without data identifying problems, it’s difficult to make a case for improvements.

But a new report released Wednesday documents the overlap of environmental and social access problems in the Eastern Coachella Valley. Revealing the Invisible Coachella Valley analyzes public data tracking environmental issues (including pollution, air quality, and water quality) and overlays that information with data on residents’ social and economic resources (such as poverty rates, education levels, unemployment, and health).

The California Endowment tapped a team from U.C. Davis to collaborate with Eastern Coachella Valley community advocates to develop this report. Jonathan London, directs the U.C. Davis Center for Regional Change and led this study. He says his team met with community members who were struggling to find the best ways to gather data and to collaborate to drive change in the region. “We had the methods we’d developed doing a similar project in the San Joaquin Valley,” London said, “so it was natural extension for us,” The study provides these community leaders with a shared playbook, “a common analysis of what the key issues are that would benefit from collective action,” which they can use in their advocacy with public agencies.

In rural, poor and marginalized areas, collecting data is challenging, London asserts. “Some of the publicly available data, like U.S. Census, is notoriously bad in rural communities,” often under-counting undocumented immigrants and migrant workers.  “There’s also a lack of good air quality data because there aren’t enough air quality monitors in the region,” he adds.

Even when accurate data is collected by a public agency, London says, it’s not always analyzed, or broken down in a way the public can understand and use. This study includes maps which clearly delineate environmental and social problems across the valley. “We really try to show where environmental hazards are concentrated … and where those clusters are affecting the populations with the fewest economic, political and social resources,” says London. His goal is that the information can be used to change policy. “We were able to put them in a form that community advocates can use. They can point out, ‘Here are areas of greatest concern.’”

It’s already happening, says community organizer Karen Borja with Inland Congregations United for Change. She says residents in the historically isolated community of North Shore suspected that lack of public transportation was a major barrier to health, income and education. They asked researchers to collect information. The numbers told a compelling story about the need for public transportation and the ability of the community to pay for it.

“Data showed people traveled 20 miles each way to work every day, and were paying neighbors or family members up to $285 a week to get to work, the grocer, the doctor,” Borja says. “Some college students said they couldn’t get to their institutions of higher learning because they didn’t have reliable transportation.”

Borja says Inland Congregations United for Change was able to leverage this information in meetings with the Riverside County Transportation Department, which secured a grant for bus service to and from the North Shore community. The service will start in September. “We weren’t just putting a face on the issue,” Borja says. “We were also providing numbers, and we know numbers talk. Now there will be a health benefit, a recreational benefit, an educational benefit, an economic benefit for a community that’s largely been ignored.”

Bringing together research science with community-based knowledge “is really powerful,” London says, adding that the under-served often feel fundamentally outside the democratic process. “That calls into question the basic legitimacy of democracy. We have to get them involved in an integral way.”

These are complex issues, he says, and the best available science can’t really articulate that complexity unless it’s able to make use of the local knowledge. He draws the example of a mother living in a mobile home park. “She can tell you about the education system because she’s getting her kids through it. She can tell you about the water system because she has to drive 30 miles to buy expensive water. She knows she’s living in a food desert. She sees water contamination from sewage in her driveway. She knows the labor market, the transportation network.” A researcher could try to capture that complexity using a variety of different methods, he says, “but that woman’s knowledge is so deep. There’s no alternative to getting in there and listening to people talk about their lives and struggles.”

This new report is an element of what London calls the “data democracy movement, making information available to people who really need it — when government agencies can’t or won’t make the data available.  “By controlling the data,” he says, “you control the story.”

Learn More:

Coachelle Farmworkers Struggle for Quality Housing

(seliaymiwell/flickr)

After years of devastating cuts to the health and human services budget, this year’s small surplus brought restoration of some programs.

Mental health programs will get a one-time boost of $140 million. The adult dental program, Denti-Cal, cut back in 2009 and leaving tooth extraction as just about the only service being covered, has been restored, albeit partially. Benefits won’t start until next May.

But lost in the deal was a proposal to provide some therapies to 500 children with autism. Those children had lost some services when the state moved them from Healthy Families and to Medi-Cal.

Then there’s the issue of funding to county health programs. Counties bear the cost for providing health care to the uninsured. Gov. Brown has been arguing since he introduced his budget in January that counties will gain federal money in January under the full implementation of the Affordable Care Act and so the state could reduce its own health funding to counties. But counties have fought that idea, saying that there would still be plenty of uninsured people after Jan. 1 — and that now is not the time to cut the safety net.

While we’re still waiting for final language, the legislature seems to have agreed with the governor’s numbers, and it appears $300 million in county health funding cuts are coming.

Alex Briscoe, Director of Alameda County’s Health Care Services Agency, called it a “money grab” that will “threaten the stability of local safety nets.”

Briscoe says the cuts presume that safety net providers are adequately funded right now, a presumption he called “offensive.”

“The state has overestimated savings it will achieve, underestimated the burden of the residually uninsured and put forward a proposal that is divorced form the reality of local safety nets,” he said.

The budget deal also leaves in place a 10 percent cut in Medi-Cal provider rates — cuts that were approved by the legislature in 2011 and then held up in a long court challenge. The appeals process was exhausted last month, and the cuts will likely move forward this summer.

California has some of the lowest Medicaid reimbursement rates in the nation, advocates say.

Mike Jackson has diabetes and high blood pressure. His eye was damaged after he cut back on insulin because he couldn’t afford it. (Bryan Terry/NPR)

For many years, high medical bills have been a leading cause of financial distress and bankruptcy in America. That pressure may be easing ever so slightly, according to a survey released earlier this month by the Centers for Disease Control and Prevention.

But 1 in 5 Americans still face hardships due to medical costs — and African-Americans continue to be the hardest hit.

A poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health found that 24 percent of African-American families say they’ve had problems paying for needed prescription drugs. The poll is part of NPR’s ongoing series, The View From Black America.

Mike Jackson is one of those people. Jackson, 52, lives in Oklahoma City and works for a major insurance company. He has high blood pressure and hypertension, and has been diabetic for 15 years.

Treating these chronic health problems isn’t cheap. Jackson’s medical bills add up to nearly $500 a month. “Diabetes alone — just the two medications alone for diabetes would have run $325 a month,” he says.

That’s “would have,” because Jackson couldn’t pay. This time last year, he was laid off, got divorced and lost his health benefits.

He worried that he wouldn’t be able to afford the insulin he needs to control his diabetes, so he started cutting back.

“Instead of taking 60 units twice a day, I was taking 30 units twice a day,” Jackson says. “The idea behind that was if I watched what I would eat and then stay with the 30 units — I would keep my blood sugar down enough that hopefully it would not be much of a problem.”

But cutting back on insulin for eight months did cause problems. Jackson developed numbness in his foot and toes, and nerve damage in his eye — all complications of uncontrolled diabetes. “My left eye actually shut; wouldn’t open,” Jackson says. “The muscle for my eyelid won’t open.”

An ophthalmologist gave Jackson a discount, but Jackson is still struggling to make payments.

In response to an NPR Facebook callout, 30-year-old Ashley Liggins of Fort Worth, Texas, wrote that she’ll never forget being without health insurance and having to decide between medication for high blood pressure, gas for her car, or food for the week.

Like Jackson, Liggins also tried to stretch out the medication she had by reducing the dose and even borrowing pills from her mother. “I was really worried,” says Liggins, who now works in the financial services industry. “High blood pressure runs in my family.”

A single mother of two wrote to us about being sued for unpaid medical bills totaling nearly $5,000. She has no idea how she’ll pay. She, too, has high blood pressure, a common worry among African-Americans in our poll.

One in 3 African-Americans surveyed said they, too, had serious problems paying bills from doctors or hospitals in the past year.

“We specifically asked African-American families what were the top concerns they had for health in their own families,” says Robert Blendon, a professor of health policy at the Harvard School of Public Health, who partnered with NPR for this survey. “And we ended up with high blood pressure, stroke and diabetes as being the top.”

That’s in contrast with other national surveys, where cancer and other types of illnesses are often raised as the biggest concerns.

And even though most of the people in this poll did have health insurance, nearly half still worried that if they suffered a major illness in the future, they wouldn’t be able to pay for medical care.

“We found general economic insecurity among families who generally were doing well,” says Blendon, “and this fear of paying a larger medical bill was just one of the top problems they had.”

For Mike Jackson, covering the cost of caring for a chronic health problem became impossible. He’s now working, but it’s a temporary job that doesn’t offer health benefits. And Jackson worries every day about the future.

“It’s one of those things where, if something happens to my car or to me healthwise, I’m in trouble. If anything goes wrong, I’m one step away from disaster.”

While not included in the video, the president also answered two questions about the government’s controversial surveillance program. The president defended the program.

Here’s the transcript of his remarks:

OBAMA: These leaders from California’s government, the California Endowment, and major Spanish-language media outlets have joined together to help implement the Affordable Care Act here in California and to educate folks about how to sign up and shop for quality affordable plans. And their efforts have already shown some excellent results in the biggest insurance market in the country.

There are two main things that Americans need to know when it comes to the Affordable Care Act and what it means for you. First of all, if you’re one of the nearly 85 percent of Americans who already have insurance, either through Medicare or Medicaid or your employer, you don’t have to do a thing. You’ve just got a wide array of new benefits, better protections, and stronger cost controls that you didn’t have before, and that will over time improve the quality of the insurance that you’ve got, benefits like free preventive care, checkups, flu shots, mammograms, and contraception.

You are now going to be able to get those things through your insurance where they previously were not — didn’t have to be provided, protections like allowing people up to the age of 26 to stay on their parents’ health care plans, which has already helped 6 million Americans, including 6 million young Latino Americans.

Cost controls like requiring insurance companies to spend at least 80 percent of the money that you pay in premiums in your actual health care costs, as opposed to administrative costs or CEO pay, not overhead, but that money has to be spent on you. And if they don’t meet that target, they actually have to reimburse you. So in California, we’re already getting reports that insurers are giving rebates to consumers and small-business owners to the tune of $45 million this year.

So already we’re seeing millions of dollars of rebates sent back to consumers by insurance companies as a consequence of this law. All of that is happening because of the Affordable Care Act. All of this is in place right now already for 85 percent of Americans who have health insurance.

By the way, all of this is what the Republican Party has now voted 37 times to repeal, at least in the House of Representatives. And my suggestion to them has been, let’s stop re-fighting the old battles and start working with people like the leaders who are on stage here today to make this law work the way it’s supposed to.

We’re focused on moving forward and making sure that this law works for middle-class families, and that brings me to the second thing that people need to know about the Affordable Care Act. If you’re one of nearly 6 million Californians or 10 million — tens of millions of Americans who don’t currently have health insurance, you’ll soon be able to buy quality, affordable care just like everybody else. And here’s how.

States like California are setting up new online marketplaces, where beginning on October 1st of this year, you can comparison shop an array of private health insurance plans side-by-side, just like you were going online to compare cars or airline tickets, and that means insurance companies will actually have to compete with each other for your business. And that means new choices.

See, right now, most states don’t have a lot of competition. In nearly every state, more than half of all consumers are covered by only two insurers, so there’s no incentive to provide you a lot of choices or to keep costs down. The Affordable Care Act changes that.

Beginning next year, once these marketplaces are open, most states will offer new private insurance choices that don’t exist today. And based on early reports, about 9 in 10 Americans expected to enroll in these marketplaces live in states where they’ll be able to choose between five or more different insurers.

So, for example, here in California, 33 insurers applied to join the marketplace. Covered California then selected 13 based on access, quality and affordability, four of which are brand new to your individual market. So what’s happening is, through the Affordable Care Act, we’re creating these marketplaces with more competition, more choice. And so the question is, what happens to cost?

Now, a lot of the opponents of the Affordable Care Act said — you know, they had all kinds of “sky is falling,” doom-and-gloom predictions that not only would the law fail, but what we’d also see is costs would skyrocket for everybody. Well, it turns out we’re actually seeing that — in the states that have committed themselves to implementing this law correctly, we’re seeing some good news. Competition and choice are pushing down costs in the individual market, just like the law was designed to do.

The 13 insurance companies that were chosen by Covered California have unveiled premiums that were lower than anybody expected. And those who can’t afford to buy private insurance will get help reducing their out-of-pocket premiums even further with the largest health care tax cut for working families and small businesses in our history. So about 2.6 million Californians — nearly half of whom are Latinos — will qualify for tax credits that will in some cases lower their premiums a significant amount.

Now, none of this is a surprise. This is the way that the law was designed to work. But since everybody’s been saying how it’s not going to happen, I think it’s important for us to recognize and acknowledge, this is working the way it’s supposed to.

We’ve seen similar good news, by the way, not just here in California, but in Oregon and Washington. In states that are working hard to implement this law properly, we’re seeing it work for people, for middle-class families, for consumers.

Now, that’s not to say that everything’s going to go perfectly right away. When you’re implementing a program this large, there will be some glitches. There are going to be some hiccups. But no matter what, every single consumer will be covered by the new benefits and protections under this law permanently.

So the bottom line is, you know, you can listen to a bunch of political talk out there, negative ads and fear-mongering geared towards the next election, or alternatively you can actually look what’s happening in states like California right now. And the fact of the matter is, through these exchanges, not only are the 85 percent of people who already have health insurance getting better protections and receiving rebates and being able to keep their kids on their health insurance until they’re 26, and getting free preventive care, but if you don’t have health insurance, and you’re trying to get it through the individual market, and it’s too expensive or it’s too restricted, you now have these marketplaces where they’re going to offer you a better deal because of choice and competition.

And if even at those lower rates and better insurance that you’re getting through these marketplaces you still can’t afford it, you’re going to be getting tax cuts and tax credits through the Affordable Care Act that will help you afford it. And that’s how we’re going to make sure that millions of people who don’t currently have health insurance or are getting a really bad deal on their health insurance are finally going to get it.

But — and here’s my final point. To take advantage of these marketplaces, folks are going to need to sign up. So you can find out how to sign up at healthcare.gov, healthcare.gov. Or here in California, you can sign up at coveredca.com, coveredca.com.

Because quality care is not something that should be a privilege. It should be a right. In the greatest country on Earth, we’ve got to make sure that every single person that needs health care can get it. And we’ve got to make sure that we do it in the most efficient way possible.

One last point I’m going to make on this, because there are a lot of people who currently get health insurance through their employers, the 85 percent who are already out there, and they may be saying, well, if — if this law’s so great, why is it that my premiums still went up?

Well, part of what’s happening across the country is in some cases, for example, employers may be shifting more costs through higher premiums or higher deductibles or higher co-pays, and so there may still be folks who are out there feeling increased costs not because of the Affordable Care Act, but because those costs are being passed on to workers. Or insurance companies, in some cases, even with these laws in place are still jacking up prices unnecessarily.

So this doesn’t solve the whole problem, but it moves us in the right direction. It’s also the reason why we have to keep on implementing changes in how our health care system works to continually drive better efficiency, higher quality, lower cost. We’re starting to see that. Health care cost inflation has gone up at the lowest rate over the last three years that we’ve seen in many, many years. So we’re making progress in actually reducing overall health care costs while improving quality, but we’re going to have to continue to push on that front, as well. That’s also part of what we’re doing in the Affordable Care Act. All right?

But the main message I want for Californians and people all across the country, starting on October 1st, if you’re in the individual market, you can get a better deal. If you’re a small business that’s providing health insurance to your employees, you can get a better deal through these exchanges. You’ve got to sign up, healthcare.gov, or here in California, coveredca.com. All right? So, thank you very much.

President Obama at a White House ceremony in February. (Win McNamee/Getty Images)

President Obama is expected to deliver remarks about the ongoing implementation of his signature health law, the Affordable Care Act, Friday morning in San Jose.

Last month the state’s health insurance marketplace, Covered California, released preliminary plans and premiums they expect to offer. Average premiums for these plans were lower than had been anticipated. Senior administration officials say they are “encouraged by what we see in California” in terms of “competitive choices.”

Starting Jan. 1, most Americans will be required to have health insurance or pay a fine. Under the health law, many Americans will be eligible for subsidies to help them buy health insurance.

Administration officials say the goal is to enroll 7 million people nationwide and that “it’s important that we get 2.6 to 2.7 million young, healthy people.” These younger, healthier people are necessary in a large pool of enrollees to spread risk and avoid the possibility that insurance rates will spike in the future. One in three of these young people are in just three states: California, Texas and Florida.

In California, 6 million people overall are eligible for the new insurance marketplace. More than 2 million of them will be eligible for subsidies, and half of those eligible are Latinos. A White House official told reporters that the president will “highlight efforts to ensure that Latinos are enrolled in California.” Administration officials said that Spanish language media — Univision, Telemundo, ImpreMedia — will play a role in reaching this population. “We looked at messages and messengers that would be best for reaching that audience,” administration officials said. A statewide health care foundation, The California Endowment, is also heavily involved in outreach efforts.

Immigrants living in the U.S. illegally are not eligible for any benefits under the health law, including subsidies.

The president is also expected to discuss education and outreach plans about the health law in general. Covered California recently awarded $37 million in grants for community education and also expects to launch a public education campaign this summer.

In California, 13 plans will be offered in the state’s insurance marketplace, pending approval by state regulators. Open enrollment will start Oct. 1, and insurance will take effect Jan. 1, 2014.

The president’s remarks will come a day after a Wall Street Journal/NBC News poll showed that many Americans remain displeased with the law: 41 percent said the law is a “bad idea” versus 35 percent who said it’s a “good idea,” NBC reported.

Learn more about the health law:

Obamacare Explained: A Guide for Californians (KQED)