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(David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College. (David McNew/Getty Images) \u003ccite>(David McNew/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the same time that California was \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/19/california-exceeds-its-target-for-enrollment-in-obamacare-plans/\" target=\"_blank\">releasing its latest enrollment numbers\u003c/a> under Obamacare on Wednesday morning, advocates, experts and government officials at all levels gathered in Washington, D.C. to talk about … the Affordable Care Act in California.\u003c/p>\n\u003cp>Certainly, the rollout of Obamacare in the state has not been without its challenges and yet -- California has 12 percent of the nation's population and nearly 25 percent of all sign-ups nationwide. In addition to the more than 800,000 people currently enrolled in California, another 877,000 Californians are likely to be eligible for Medi-Cal. That's on top of another 652,000 people who transitioned to Medi-Cal from the Low Income Health Program (more on that in a minute). That's well over 2 million people total.\u003c/p>\n\u003cp>Diana Dooley, secretary of California's Health and Human Services Agency, wasn't about to gloat. \"California is certainly not ready to put up a mission-accomplished banner,\" she noted. But there was a lot of respect for California -- and a desire to learn -- from those in the room at the briefing.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Low Income Health Program Was Key \u003c/strong>\u003c/p>\n\u003cp>While it's been quite \u003ca href=\"http://www.californiahealthline.org/road-to-reform/2014/this-program-was-bigger-than-covered-california-why-did-we-ignore-it\" target=\"_blank\">underreported\u003c/a>, the Low Income Health Program (LIHP) is one pillar of the ACA's success in California. Toby Douglas, director of California's Department of Health Care Services, said they \"thought it was a stretch goal\" to enroll 500,000 people in 2010 when the state began implementation of the program.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Despite concerns that the transition from LIHP to Medi-Cal would be bumpy, it \"really was a smooth transition,\" said Dr. Mitch Katz, director of the Los Angeles County Department of Health Services. Katz said that adding people into LIHP over several years, instead of all at once into Medi-Cal on Jan. 1, made for a much smoother expansion of Medi-Cal.\u003c/p>\n\u003cp>Linked to the Medi-Cal expansion is the importance of changes to the delivery system. \"Insurance is not health care,\" Katz said. \"We still want to leave people feeling cared for. That's a huge change for Los Angeles, which traditionally has had an episodic, emergency room-driven\" system of providing health care.\u003c/p>\n\u003cp>Several speakers talked about moving people into primary-care medical homes -- as happened to enrollees in the Low Income Health Program, Douglas said -- to better coordinate their care.\u003c/p>\n\u003cp>\u003cstrong>Challenges Remain\u003c/strong>\u003c/p>\n\u003cp>While acknowledging the state's successes, Anthony Wright of Health Access pointed to what he thinks are the challenges that remain: undocumented immigrants who are not eligible for ACA benefits; people earning more than 400 percent of poverty and not eligible for subsidies, but above 10 percent of income to pay for health insurance; and the \"kid glitch\" -- those with employer-based health insurance who are exempt from subsidies to cover their children but can't afford insurance for dependents.\u003c/p>\n\u003cp>\"I wish the conversation would change to trying to make the system work for everybody,\" Wright said.\u003c/p>\n\u003cp>Rachel Garfield, senior researcher with the Kaiser Family Foundation, presented findings about \u003ca href=\"http://kff.org/uninsured/report/the-uninsured-at-the-starting-line-in-california-california-findings-from-the-2013-kaiser-survey-of-low-income-americans-and-the-aca/\" target=\"_blank\">California's uninsured\u003c/a>. More than 2,500 adults were interviewed in the weeks leading up to the opening of the Covered California marketplace on Oct. 1, 2013 -- and the foundation plans to follow the people they surveyed to assess how the ACA changes how people use the health care system and to track what happens to people who remain uninsured, despite the ACA.\u003c/p>\n\u003cp>Of adults under 65 who are uninsured:\u003c/p>\n\u003cul>\n\u003cli>52 percent have income less than 138 percent of the federal poverty level (the cutoff for the Medicaid expansion)\u003c/li>\n\u003cli>52 percent are Hispanic\u003c/li>\n\u003cli>64 percent are U.S. citizens and another 17 percent are legal immigrants\u003c/li>\n\u003c/ul>\n\u003cp>In addition, 67 percent had no preventive care visit in the past year -- yet 30 percent have an \"ongoing health condition\" or take a medication on a regular basis.\u003c/p>\n\u003cp>Presumably at least some of those uninsured have since enrolled in coverage, either Medi-Cal or Covered California, but still, Garfield noted, they need help to \"navigate the health care system.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"UJBW8MPkrKEePWZWaMmAS7WhIusRsTlr\"]\u003c/p>\n\n","blocks":[],"excerpt":"Certainly, the rollout of Obamacare in the state has not been without its challenges, and yet -- California has 12 percent of the nation's population and nearly 25 percent of all sign-ups nationwide. In addition to the more than 800,000 people currently enrolled in California, another 877,000 Californians are likely to be eligible for Medi-Cal. That's on top of another 652,000 people who transitioned to Medi-Cal from the Low Income Health Program (more on that in a minute). That's well over 2 million people total.","status":"publish","parent":0,"modified":1393280251,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":701},"headData":{"title":"Memo to Washington: Lessons Learned From California's Obamacare Rollout | KQED","description":"Certainly, the rollout of Obamacare in the state has not been without its challenges, and yet -- California has 12 percent of the nation's population and nearly 25 percent of all sign-ups nationwide. In addition to the more than 800,000 people currently enrolled in California, another 877,000 Californians are likely to be eligible for Medi-Cal. That's on top of another 652,000 people who transitioned to Medi-Cal from the Low Income Health Program (more on that in a minute). That's well over 2 million people total.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Memo to Washington: Lessons Learned From California's Obamacare Rollout","datePublished":"2014-02-20T00:30:34.000Z","dateModified":"2014-02-24T22:17:31.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"17793 http://blogs.kqed.org/stateofhealth/?p=17793","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/02/19/memo-to-washington-lessons-learned-from-californias-obamacare-rollout/","disqusTitle":"Memo to Washington: Lessons Learned From California's Obamacare Rollout","path":"/stateofhealth/17793/memo-to-washington-lessons-learned-from-californias-obamacare-rollout","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16531\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/450630139-e1386185604738.jpg\">\u003cimg class=\"size-large wp-image-16531\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/450630139-640x426.jpg\" alt=\"Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College. (David McNew/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College. (David McNew/Getty Images) \u003ccite>(David McNew/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the same time that California was \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/19/california-exceeds-its-target-for-enrollment-in-obamacare-plans/\" target=\"_blank\">releasing its latest enrollment numbers\u003c/a> under Obamacare on Wednesday morning, advocates, experts and government officials at all levels gathered in Washington, D.C. to talk about … the Affordable Care Act in California.\u003c/p>\n\u003cp>Certainly, the rollout of Obamacare in the state has not been without its challenges and yet -- California has 12 percent of the nation's population and nearly 25 percent of all sign-ups nationwide. In addition to the more than 800,000 people currently enrolled in California, another 877,000 Californians are likely to be eligible for Medi-Cal. That's on top of another 652,000 people who transitioned to Medi-Cal from the Low Income Health Program (more on that in a minute). That's well over 2 million people total.\u003c/p>\n\u003cp>Diana Dooley, secretary of California's Health and Human Services Agency, wasn't about to gloat. \"California is certainly not ready to put up a mission-accomplished banner,\" she noted. But there was a lot of respect for California -- and a desire to learn -- from those in the room at the briefing.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>Low Income Health Program Was Key \u003c/strong>\u003c/p>\n\u003cp>While it's been quite \u003ca href=\"http://www.californiahealthline.org/road-to-reform/2014/this-program-was-bigger-than-covered-california-why-did-we-ignore-it\" target=\"_blank\">underreported\u003c/a>, the Low Income Health Program (LIHP) is one pillar of the ACA's success in California. Toby Douglas, director of California's Department of Health Care Services, said they \"thought it was a stretch goal\" to enroll 500,000 people in 2010 when the state began implementation of the program.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Despite concerns that the transition from LIHP to Medi-Cal would be bumpy, it \"really was a smooth transition,\" said Dr. Mitch Katz, director of the Los Angeles County Department of Health Services. Katz said that adding people into LIHP over several years, instead of all at once into Medi-Cal on Jan. 1, made for a much smoother expansion of Medi-Cal.\u003c/p>\n\u003cp>Linked to the Medi-Cal expansion is the importance of changes to the delivery system. \"Insurance is not health care,\" Katz said. \"We still want to leave people feeling cared for. That's a huge change for Los Angeles, which traditionally has had an episodic, emergency room-driven\" system of providing health care.\u003c/p>\n\u003cp>Several speakers talked about moving people into primary-care medical homes -- as happened to enrollees in the Low Income Health Program, Douglas said -- to better coordinate their care.\u003c/p>\n\u003cp>\u003cstrong>Challenges Remain\u003c/strong>\u003c/p>\n\u003cp>While acknowledging the state's successes, Anthony Wright of Health Access pointed to what he thinks are the challenges that remain: undocumented immigrants who are not eligible for ACA benefits; people earning more than 400 percent of poverty and not eligible for subsidies, but above 10 percent of income to pay for health insurance; and the \"kid glitch\" -- those with employer-based health insurance who are exempt from subsidies to cover their children but can't afford insurance for dependents.\u003c/p>\n\u003cp>\"I wish the conversation would change to trying to make the system work for everybody,\" Wright said.\u003c/p>\n\u003cp>Rachel Garfield, senior researcher with the Kaiser Family Foundation, presented findings about \u003ca href=\"http://kff.org/uninsured/report/the-uninsured-at-the-starting-line-in-california-california-findings-from-the-2013-kaiser-survey-of-low-income-americans-and-the-aca/\" target=\"_blank\">California's uninsured\u003c/a>. More than 2,500 adults were interviewed in the weeks leading up to the opening of the Covered California marketplace on Oct. 1, 2013 -- and the foundation plans to follow the people they surveyed to assess how the ACA changes how people use the health care system and to track what happens to people who remain uninsured, despite the ACA.\u003c/p>\n\u003cp>Of adults under 65 who are uninsured:\u003c/p>\n\u003cul>\n\u003cli>52 percent have income less than 138 percent of the federal poverty level (the cutoff for the Medicaid expansion)\u003c/li>\n\u003cli>52 percent are Hispanic\u003c/li>\n\u003cli>64 percent are U.S. citizens and another 17 percent are legal immigrants\u003c/li>\n\u003c/ul>\n\u003cp>In addition, 67 percent had no preventive care visit in the past year -- yet 30 percent have an \"ongoing health condition\" or take a medication on a regular basis.\u003c/p>\n\u003cp>Presumably at least some of those uninsured have since enrolled in coverage, either Medi-Cal or Covered California, but still, Garfield noted, they need help to \"navigate the health care system.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"UJBW8MPkrKEePWZWaMmAS7WhIusRsTlr\"]\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/17793/memo-to-washington-lessons-learned-from-californias-obamacare-rollout","authors":["240"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_368","stateofhealth_402","stateofhealth_79"],"featImg":"stateofhealth_16531","label":"stateofhealth"},"stateofhealth_11630":{"type":"posts","id":"stateofhealth_11630","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"11630","score":null,"sort":[1364126404000]},"guestAuthors":[],"slug":"immigration-reform-maybe-but-long-wait-for-health-access-by-the-undocumented","title":"Immigration Reform, Maybe; But Long Wait for Health Access by the Undocumented","publishDate":1364126404,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>By John M. Gonzales, \u003ca href=\"http://centerforhealthreporting.org\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11636\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/24/immigration-reform-maybe-but-long-wait-for-health-access-by-the-undocumented/fred-bauermeister_laurenwhaley_chcfctrforhealthrptg_032013/\" rel=\"attachment wp-att-11636\">\u003cimg class=\"size-medium wp-image-11636\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Fred-Bauermeister_LaurenWhaley_CHCFctrforHealthRptg_032013-300x198.jpg\" alt=\"Fred Bauermeister is executive director of the Free Clinic of Simi Valley, which has been providing health care to undocumented immigrants for years. (Lauren Whaley/CHCF Center for Health Reporting)\" width=\"300\" height=\"198\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Fred Bauermeister is executive director of the Free Clinic of Simi Valley, a health care provider to undocumented immigrants for years. (Lauren Whaley/CHCF Center for Health Reporting) \u003ccite>(Lauren Whaley/CHCF Center for Health Reporting)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Clinic director Fred Bauermeister has watched them pass through his doors for decades: chronically ill, uninsured men, women and children, who have delayed medical care because they are in the country illegally.\u003c/p>\n\u003cp>Now, immigration reform may bring health benefits to millions of formerly undocumented people -- although there may still be a years-long wait after they attain legal residency.\u003c/p>\n\u003cp>But first -- the immigration reform piece: a bandwagon of \u003ca href=\"http://politicalticker.blogs.cnn.com/2013/03/19/rubio-praises-paul-on-immigration/\">endorsements last week\u003c/a> by Congressional Republicans have aligned with vows by President Obama and Senate Democrats to establish comprehensive immigration reform. A road to citizenship for people who entered the country illegally seems more assured by the day, but what is less clear is how the health care landscape of California, and the nation, would also change.\u003c/p>\n\u003cp>Would California’s estimated 2.5 million undocumented immigrants become eligible for health benefits? How would an already burdened health care system absorb them?\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We’re very interested -- and very concerned – with how this is all going to work out,” said Bauermeister, executive director of the Free Clinic of Simi Valley, a California provider that seeks to keep immigrants out of expensive modes of care like the emergency room.\u003c/p>\n\u003cp>Obama’s commitment to move an estimated 11 million undocumented immigrants nationally “out of the shadows” would not end there. Under current law, it would also slowly open the door for them to qualify for public programs, including the health care overhaul’s massive coverage expansions.\u003c/p>\n\u003cp>Obama’s plan would have immigrants wait at least eight years before they qualify for health benefits. A Congressional plan spearheaded by Republican senators Marco Rubio and John McCain pushes the wait to at least 10 years.\u003c/p>\n\u003cp>Some experts believe both scenarios would create an interim period in which even wider gaps will develop between the haves and have-nots of health care.\u003c/p>\n\u003cp>If health reform works as intended, there will not only be a boost in the number of new people covered, but a steady improvement in their health. Meanwhile, undocumented immigrants sit on the sidelines for, give or take, at least a decade.\u003c/p>\n\u003cp>“We’re going to create a two-tiered system of health, as well as perpetuate disparities in health,” said Ignatious Bau, a San Francisco-based health policy consultant whose clients include insurance giant Kaiser Permanente.\u003c/p>\n\u003cp>“People who are in the system are going to get better quality and efficiency,” said Bau. “But [undocumented] people who aren’t in the system are going to go to the ER.”\u003c/p>\n\u003cp>The haves, incidentally, will continue to be stuck with the bill for the health care have-nots, Bau said.\u003c/p>\n\u003cp>There is a push by several groups, \u003ca href=\"http://www.youtube.com/watch?v=sK6IG67IuLI\">including the California Endowment\u003c/a>, to win immediate health reform benefits for undocumented immigrants.\u003c/p>\n\u003cp>But so far neither President Obama, nor Congress, has shown any interest.\u003c/p>\n\u003cp>Some health providers believe that the gradual approach proposed by Washington is the only way to accommodate the undocumented population, particularly in immigrant-heavy states like California.\u003c/p>\n\u003cp>Health reform, which comes fully online in 2014, consists of two enormous coverage methods.\u003c/p>\n\u003cp>One is the Medicaid safety net, called Medi-Cal in California, from which undocumented immigrants are generally excluded.\u003c/p>\n\u003cp>The other is the government-subsidized insurance marketplace,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/13/aca-updates-covered-california-benefit-plans-and-calculate-your-subsidy-online/\" target=\"_blank\"> Covered California\u003c/a>, designed to help consumers find affordable health plans of their own choosing. Undocumented immigrants cannot participate in Covered California either.\u003c/p>\n\u003cp>The exclusions frustrate many health experts. They say that including currently ineligible immigrants in reform would slash the ranks of the uninsured.\u003c/p>\n\u003cp>According \u003ca href=\"http://healthpolicy.ucla.edu/publications/Documents/PDF/Two-Thirds%20of%20California%E2%80%99s%20Seven%20Million%20Uninsured%20May%20Obtain%20Coverage%20Under%20Health%20Care%20Reform.pdf\">to a 2011 study\u003c/a> by the UCLA Center for Health Policy Research, 84 percent of California’s 7 million uninsured will qualify for health reform coverage as it currently stands.\u003c/p>\n\u003cp>If undocumented immigrants were added to the health reform mix, 100 percent of the state’s uninsured would then be eligible for some form of coverage. Still, experts say, because of language barriers and personal choice, it is unlikely every qualified immigrant would apply.\u003c/p>\n\u003cp>Nationally, the Congressional Budget Office reported in 2010 that more than 90 percent of U.S. residents could eventually be insured with the boost provided by health reform, leaving about 23 million uncovered. If undocumented immigrants were granted coverage, the uninsured would be slashed by an additional third.\u003c/p>\n\u003cp>Health experts rarely dispute the long-term fiscal benefits of covering more people.\u003c/p>\n\u003cp>Studies like \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=185561\">Health Care Reform in Transition,\u003c/a> in the Journal of the American Medical Association, find the larger the population in an insurance pool, the more stable the premiums.\u003c/p>\n\u003cp>“The healthy subsidize the sick,” the 2010 study found.\u003c/p>\n\u003cp>Scholars also cite studies showing that immigrants are generally younger, and healthier, than the U.S.-born population when they first arrive. As they stay in the United States longer, their health begins to decline and look like that of their U.S.-born counterparts, studies find.\u003c/p>\n\u003cp>Nevertheless, Obama cites the Personal Responsibility and Work Opportunity Act of 1996, which bans green card holders from public benefits for five years, and his own ideas, as the timetable for immigrant access to health reform.\u003c/p>\n\u003cp>According to a leaked copy of the President’s proposal, undocumented immigrants must get in the “back of the line” and petition to become a “Lawful Prospective Immigrant.” They must hold that newly created status for at least eight years.\u003c/p>\n\u003cp>From there, they can be declared a “Legal Permanent Resident” with a green card. But they must hold the green card for at least five years to qualify for public health benefits including the expanded version of Medicaid created by reform.\u003c/p>\n\u003cp>“If everybody else is covered,” Bauermeister said, “then the ones who aren’t are going to be our patients.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Learn more about \u003c/em>\u003ca href=\"http://centerforhealthreporting.org/about\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>, \u003cem>an independent news organization reporting on health care issues.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Clinic director Fred Bauermeister has watched them pass through his doors for decades: chronically ill, uninsured men, women and children, who have delayed medical care because they are in the country illegally.\r\n\r\nNow, though, the prospect of a political deal over immigration reform may, after many years, bring health benefits to millions of undocumented people.","status":"publish","parent":0,"modified":1364250327,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":34,"wordCount":1033},"headData":{"title":"Immigration Reform, Maybe; But Long Wait for Health Access by the Undocumented | KQED","description":"Clinic director Fred Bauermeister has watched them pass through his doors for decades: chronically ill, uninsured men, women and children, who have delayed medical care because they are in the country illegally.\r\n\r\nNow, though, the prospect of a political deal over immigration reform may, after many years, bring health benefits to millions of undocumented people.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Immigration Reform, Maybe; But Long Wait for Health Access by the Undocumented","datePublished":"2013-03-24T12:00:04.000Z","dateModified":"2013-03-25T22:25:27.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"11630 http://blogs.kqed.org/stateofhealth/?p=11630","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/03/24/immigration-reform-maybe-but-long-wait-for-health-access-by-the-undocumented/","disqusTitle":"Immigration Reform, Maybe; But Long Wait for Health Access by the Undocumented","path":"/stateofhealth/11630/immigration-reform-maybe-but-long-wait-for-health-access-by-the-undocumented","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>By John M. Gonzales, \u003ca href=\"http://centerforhealthreporting.org\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_11636\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/24/immigration-reform-maybe-but-long-wait-for-health-access-by-the-undocumented/fred-bauermeister_laurenwhaley_chcfctrforhealthrptg_032013/\" rel=\"attachment wp-att-11636\">\u003cimg class=\"size-medium wp-image-11636\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/Fred-Bauermeister_LaurenWhaley_CHCFctrforHealthRptg_032013-300x198.jpg\" alt=\"Fred Bauermeister is executive director of the Free Clinic of Simi Valley, which has been providing health care to undocumented immigrants for years. (Lauren Whaley/CHCF Center for Health Reporting)\" width=\"300\" height=\"198\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Fred Bauermeister is executive director of the Free Clinic of Simi Valley, a health care provider to undocumented immigrants for years. (Lauren Whaley/CHCF Center for Health Reporting) \u003ccite>(Lauren Whaley/CHCF Center for Health Reporting)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Clinic director Fred Bauermeister has watched them pass through his doors for decades: chronically ill, uninsured men, women and children, who have delayed medical care because they are in the country illegally.\u003c/p>\n\u003cp>Now, immigration reform may bring health benefits to millions of formerly undocumented people -- although there may still be a years-long wait after they attain legal residency.\u003c/p>\n\u003cp>But first -- the immigration reform piece: a bandwagon of \u003ca href=\"http://politicalticker.blogs.cnn.com/2013/03/19/rubio-praises-paul-on-immigration/\">endorsements last week\u003c/a> by Congressional Republicans have aligned with vows by President Obama and Senate Democrats to establish comprehensive immigration reform. A road to citizenship for people who entered the country illegally seems more assured by the day, but what is less clear is how the health care landscape of California, and the nation, would also change.\u003c/p>\n\u003cp>Would California’s estimated 2.5 million undocumented immigrants become eligible for health benefits? How would an already burdened health care system absorb them?\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We’re very interested -- and very concerned – with how this is all going to work out,” said Bauermeister, executive director of the Free Clinic of Simi Valley, a California provider that seeks to keep immigrants out of expensive modes of care like the emergency room.\u003c/p>\n\u003cp>Obama’s commitment to move an estimated 11 million undocumented immigrants nationally “out of the shadows” would not end there. Under current law, it would also slowly open the door for them to qualify for public programs, including the health care overhaul’s massive coverage expansions.\u003c/p>\n\u003cp>Obama’s plan would have immigrants wait at least eight years before they qualify for health benefits. A Congressional plan spearheaded by Republican senators Marco Rubio and John McCain pushes the wait to at least 10 years.\u003c/p>\n\u003cp>Some experts believe both scenarios would create an interim period in which even wider gaps will develop between the haves and have-nots of health care.\u003c/p>\n\u003cp>If health reform works as intended, there will not only be a boost in the number of new people covered, but a steady improvement in their health. Meanwhile, undocumented immigrants sit on the sidelines for, give or take, at least a decade.\u003c/p>\n\u003cp>“We’re going to create a two-tiered system of health, as well as perpetuate disparities in health,” said Ignatious Bau, a San Francisco-based health policy consultant whose clients include insurance giant Kaiser Permanente.\u003c/p>\n\u003cp>“People who are in the system are going to get better quality and efficiency,” said Bau. “But [undocumented] people who aren’t in the system are going to go to the ER.”\u003c/p>\n\u003cp>The haves, incidentally, will continue to be stuck with the bill for the health care have-nots, Bau said.\u003c/p>\n\u003cp>There is a push by several groups, \u003ca href=\"http://www.youtube.com/watch?v=sK6IG67IuLI\">including the California Endowment\u003c/a>, to win immediate health reform benefits for undocumented immigrants.\u003c/p>\n\u003cp>But so far neither President Obama, nor Congress, has shown any interest.\u003c/p>\n\u003cp>Some health providers believe that the gradual approach proposed by Washington is the only way to accommodate the undocumented population, particularly in immigrant-heavy states like California.\u003c/p>\n\u003cp>Health reform, which comes fully online in 2014, consists of two enormous coverage methods.\u003c/p>\n\u003cp>One is the Medicaid safety net, called Medi-Cal in California, from which undocumented immigrants are generally excluded.\u003c/p>\n\u003cp>The other is the government-subsidized insurance marketplace,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/02/13/aca-updates-covered-california-benefit-plans-and-calculate-your-subsidy-online/\" target=\"_blank\"> Covered California\u003c/a>, designed to help consumers find affordable health plans of their own choosing. Undocumented immigrants cannot participate in Covered California either.\u003c/p>\n\u003cp>The exclusions frustrate many health experts. They say that including currently ineligible immigrants in reform would slash the ranks of the uninsured.\u003c/p>\n\u003cp>According \u003ca href=\"http://healthpolicy.ucla.edu/publications/Documents/PDF/Two-Thirds%20of%20California%E2%80%99s%20Seven%20Million%20Uninsured%20May%20Obtain%20Coverage%20Under%20Health%20Care%20Reform.pdf\">to a 2011 study\u003c/a> by the UCLA Center for Health Policy Research, 84 percent of California’s 7 million uninsured will qualify for health reform coverage as it currently stands.\u003c/p>\n\u003cp>If undocumented immigrants were added to the health reform mix, 100 percent of the state’s uninsured would then be eligible for some form of coverage. Still, experts say, because of language barriers and personal choice, it is unlikely every qualified immigrant would apply.\u003c/p>\n\u003cp>Nationally, the Congressional Budget Office reported in 2010 that more than 90 percent of U.S. residents could eventually be insured with the boost provided by health reform, leaving about 23 million uncovered. If undocumented immigrants were granted coverage, the uninsured would be slashed by an additional third.\u003c/p>\n\u003cp>Health experts rarely dispute the long-term fiscal benefits of covering more people.\u003c/p>\n\u003cp>Studies like \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=185561\">Health Care Reform in Transition,\u003c/a> in the Journal of the American Medical Association, find the larger the population in an insurance pool, the more stable the premiums.\u003c/p>\n\u003cp>“The healthy subsidize the sick,” the 2010 study found.\u003c/p>\n\u003cp>Scholars also cite studies showing that immigrants are generally younger, and healthier, than the U.S.-born population when they first arrive. As they stay in the United States longer, their health begins to decline and look like that of their U.S.-born counterparts, studies find.\u003c/p>\n\u003cp>Nevertheless, Obama cites the Personal Responsibility and Work Opportunity Act of 1996, which bans green card holders from public benefits for five years, and his own ideas, as the timetable for immigrant access to health reform.\u003c/p>\n\u003cp>According to a leaked copy of the President’s proposal, undocumented immigrants must get in the “back of the line” and petition to become a “Lawful Prospective Immigrant.” They must hold that newly created status for at least eight years.\u003c/p>\n\u003cp>From there, they can be declared a “Legal Permanent Resident” with a green card. But they must hold the green card for at least five years to qualify for public health benefits including the expanded version of Medicaid created by reform.\u003c/p>\n\u003cp>“If everybody else is covered,” Bauermeister said, “then the ones who aren’t are going to be our patients.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Learn more about \u003c/em>\u003ca href=\"http://centerforhealthreporting.org/about\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>, \u003cem>an independent news organization reporting on health care issues.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/11630/immigration-reform-maybe-but-long-wait-for-health-access-by-the-undocumented","authors":["240"],"categories":["stateofhealth_15"],"tags":["stateofhealth_402"],"featImg":"stateofhealth_11638","label":"stateofhealth"},"stateofhealth_10043":{"type":"posts","id":"stateofhealth_10043","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"10043","score":null,"sort":[1358469887000]},"guestAuthors":[],"slug":"in-fresno-the-road-to-health-reform-is-bumpy","title":"In Fresno, the Road to Health Reform Is Bumpy","publishDate":1358469887,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_10049\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/FresnoSign_CharlesNadeau_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-10049\" title=\"Fresno Sign (Charles Nadeau/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/FresnoSign_CharlesNadeau_Flickr-300x198.jpg\" alt=\"\" width=\"300\" height=\"198\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Charles Nadeau/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The greater Fresno area may be the most challenging region in California to implement the health care overhaul. Earlier this week a panel of experts gathered at Fresno State to review the issues and consider a path forward. Funding is always a problem, and Fresno is no exception. But in Fresno, collaboration seems to be an even bigger stumbling block.\u003c/p>\n\u003cp>Peter Cunningham, with the Center for Studying Health Systems Change, first outlined findings from a \u003ca href=\"http://www.chcf.org/publications/2012/12/regional-market-fresno\" target=\"_blank\">regional study\u003c/a>. For starters, the region encompasses a huge geographic area: five counties (Fresno, Tulare, Kings, Madera and Mariposa) stretch across 16,000 square miles and comprise both urban and very remote rural areas.\u003c/p>\n\u003cp>In addition to this geographic challenge, the region also faces:\u003c/p>\n\u003cul>\n\u003cli>High poverty and high uninsurance rates -- as well as a high number of undocumented residents -- people who are excluded from the benefits of Affordable Care Act, but will still need health care\u003c/li>\n\u003cli>Severe, chronic physician shortages\u003c/li>\n\u003cli>Structural or bureaucratic barriers to reform, specifically a 30-year contract between one hospital and Fresno County to provide care for the poor\u003c/li>\n\u003c/ul>\n\u003caside class=\"pullquote alignright\">\"There is no health care policy in Fresno County. We're in a position of haphazardly approaching this.\"\u003c/aside>\n\u003cp>After Cunningham's presentation, the discussion started off on a note everyone could agree on: more doctors are urgently needed. The region has 118 doctors per 100,000 people, about one-third below the state average of 174.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\"We need to recruit in the triple digits,\" said Stacy Vaillancourt, with St. Agnes Medical Center. \"People turn to the ER. They don't have primary care. There is a huge access problem.\"\u003c/p>\n\u003cp>To get to triple-digit recruiting, you need to start somewhere. One emphasis is recruiting graduating medical students for residency training in Fresno, because physicians often stay in the communities where they complete their residencies. The Fresno Health Community Access Partners (FHCAP) has received federal approval to start a program to train family practice residents.\u003c/p>\n\u003cp>The group is approved to recruit four doctors for each of the next three years. That sounds like a start -- 12 doctors coming to Fresno in the near future. Yet the program is only funded for three years while a medical residency typically runs three or four years.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We can tell these kids today that they'll get their full three years,\" said Stephen Schilling, CEO of Clinica Sierra Vista. \"I don't know what we'll them them next year.\"\u003c/p>\n\u003cdiv>\n\u003cp>Then in a line that got a laugh from the audience, Schilling added, \"We'll be coming after you -- all you hospitals, all you practices, we'll be coming to you to help pony up for to help fund this for the long haul.\"\u003c/p>\n\u003cp>But once the physician supply discussion was dispensed with, tension started to build. Fresno is one of just three counties in California to decline to set up a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/11/05/sacramento-county-expands-medi-cal-but-only-the-poorest-will-benefit/\" target=\"_blank\">Low Income Health Program\u003c/a>. The LIHP program gives counties access to federal funds ahead of the Medicaid expansion coming with the Affordable Care Act next January 1.\u003c/p>\n\u003cp>But even with the federal funds, money is needed at the county level. Dr. Edward Moreno, director of the Fresno County Department of Public Health, said that the county passed on the LIHP because it could allocate $20 million, and it \"wasn't enough to cover costs.\"\u003c/p>\n\u003cp>On this point, Norma Forbes of Fresno Health Community Access Partners promptly disagreed with Moreno. \"There is no health care policy in Fresno County,\" Forbes pointedly said. \"We're in a position of haphazardly approaching this. It's not an organized, not a collaborative approach.\"\u003c/p>\n\u003cp>One of the most obvious places where collaboration has been a challenge is the 30-year contract between Community Medical Centers (CMC) and Fresno County to provide indigent care. That contract still has more than a decade remaining on it. Cunningham's report identified a \"stalemate\" between CMC and Fresno County over modifying the contract which \"stymied\" LIHP development.\u003c/p>\n\u003cp>\"Each side has a position on the 30-year contract,\" Schilling said. \"It's just unfortunate that the parties that needed to ... couldn't come up with an agreement.\"\u003c/p>\n\u003cp>And that lack of collaboration is hampering overall efforts to plan for reform, as noted in Cunningham's report, which was prepared for the California HealthCare Foundation, one of the sponsors of the Fresno event:\u003c/p>\n\u003cblockquote>\u003cp>County governments and providers were doing little coordinated community-wide planning for health reform despite the importance of coverage expansions for this region and the large number of undocumented immigrants who will be ineligible to transition into Medi-Cal in 2014.\u003c/p>\u003c/blockquote>\n\u003cp>As the discussion wrapped up, Cunningham pointed out that even with the expansion of Medi-Cal, California's version of Medicaid, the Fresno area will still have a lot of uninsured, and he estimates one-third to one-half of those uninsured will be undocumented immigrants.\u003c/p>\n\u003cp>\"The county is still going to have that responsibility of caring for the indigent who do not qualify for the ACA expansions,\" Cunningham said. \"The challenge will be trying to fold them in within the changes that are happening in the Medi-Cal expansion.\"\u003c/p>\n\u003cp>Schilling, who is from Kern County, encouraged Fresno to \"get moving down the highway, so you're not left behind the 8-ball come next year.\"\u003c/p>\n\u003c/div>\n\n","blocks":[],"excerpt":"The greater Fresno area may be the most challenging region in California to implement the health care overhaul. Earlier this week a panel of experts gathered at Fresno State to review the issues and consider a path forward. Funding is always a problem, and Fresno is no exception. But in Fresno, collaboration seems to be an even bigger stumbling block.","status":"publish","parent":0,"modified":1358534768,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":883},"headData":{"title":"In Fresno, the Road to Health Reform Is Bumpy | KQED","description":"The greater Fresno area may be the most challenging region in California to implement the health care overhaul. Earlier this week a panel of experts gathered at Fresno State to review the issues and consider a path forward. Funding is always a problem, and Fresno is no exception. But in Fresno, collaboration seems to be an even bigger stumbling block.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"In Fresno, the Road to Health Reform Is Bumpy","datePublished":"2013-01-18T00:44:47.000Z","dateModified":"2013-01-18T18:46:08.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"10043 http://blogs.kqed.org/stateofhealth/?p=10043","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/01/17/in-fresno-the-road-to-health-reform-is-bumpy/","disqusTitle":"In Fresno, the Road to Health Reform Is Bumpy","path":"/stateofhealth/10043/in-fresno-the-road-to-health-reform-is-bumpy","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_10049\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/FresnoSign_CharlesNadeau_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-10049\" title=\"Fresno Sign (Charles Nadeau/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/FresnoSign_CharlesNadeau_Flickr-300x198.jpg\" alt=\"\" width=\"300\" height=\"198\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Charles Nadeau/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The greater Fresno area may be the most challenging region in California to implement the health care overhaul. Earlier this week a panel of experts gathered at Fresno State to review the issues and consider a path forward. Funding is always a problem, and Fresno is no exception. But in Fresno, collaboration seems to be an even bigger stumbling block.\u003c/p>\n\u003cp>Peter Cunningham, with the Center for Studying Health Systems Change, first outlined findings from a \u003ca href=\"http://www.chcf.org/publications/2012/12/regional-market-fresno\" target=\"_blank\">regional study\u003c/a>. For starters, the region encompasses a huge geographic area: five counties (Fresno, Tulare, Kings, Madera and Mariposa) stretch across 16,000 square miles and comprise both urban and very remote rural areas.\u003c/p>\n\u003cp>In addition to this geographic challenge, the region also faces:\u003c/p>\n\u003cul>\n\u003cli>High poverty and high uninsurance rates -- as well as a high number of undocumented residents -- people who are excluded from the benefits of Affordable Care Act, but will still need health care\u003c/li>\n\u003cli>Severe, chronic physician shortages\u003c/li>\n\u003cli>Structural or bureaucratic barriers to reform, specifically a 30-year contract between one hospital and Fresno County to provide care for the poor\u003c/li>\n\u003c/ul>\n\u003caside class=\"pullquote alignright\">\"There is no health care policy in Fresno County. We're in a position of haphazardly approaching this.\"\u003c/aside>\n\u003cp>After Cunningham's presentation, the discussion started off on a note everyone could agree on: more doctors are urgently needed. The region has 118 doctors per 100,000 people, about one-third below the state average of 174.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\"We need to recruit in the triple digits,\" said Stacy Vaillancourt, with St. Agnes Medical Center. \"People turn to the ER. They don't have primary care. There is a huge access problem.\"\u003c/p>\n\u003cp>To get to triple-digit recruiting, you need to start somewhere. One emphasis is recruiting graduating medical students for residency training in Fresno, because physicians often stay in the communities where they complete their residencies. The Fresno Health Community Access Partners (FHCAP) has received federal approval to start a program to train family practice residents.\u003c/p>\n\u003cp>The group is approved to recruit four doctors for each of the next three years. That sounds like a start -- 12 doctors coming to Fresno in the near future. Yet the program is only funded for three years while a medical residency typically runs three or four years.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We can tell these kids today that they'll get their full three years,\" said Stephen Schilling, CEO of Clinica Sierra Vista. \"I don't know what we'll them them next year.\"\u003c/p>\n\u003cdiv>\n\u003cp>Then in a line that got a laugh from the audience, Schilling added, \"We'll be coming after you -- all you hospitals, all you practices, we'll be coming to you to help pony up for to help fund this for the long haul.\"\u003c/p>\n\u003cp>But once the physician supply discussion was dispensed with, tension started to build. Fresno is one of just three counties in California to decline to set up a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/11/05/sacramento-county-expands-medi-cal-but-only-the-poorest-will-benefit/\" target=\"_blank\">Low Income Health Program\u003c/a>. The LIHP program gives counties access to federal funds ahead of the Medicaid expansion coming with the Affordable Care Act next January 1.\u003c/p>\n\u003cp>But even with the federal funds, money is needed at the county level. Dr. Edward Moreno, director of the Fresno County Department of Public Health, said that the county passed on the LIHP because it could allocate $20 million, and it \"wasn't enough to cover costs.\"\u003c/p>\n\u003cp>On this point, Norma Forbes of Fresno Health Community Access Partners promptly disagreed with Moreno. \"There is no health care policy in Fresno County,\" Forbes pointedly said. \"We're in a position of haphazardly approaching this. It's not an organized, not a collaborative approach.\"\u003c/p>\n\u003cp>One of the most obvious places where collaboration has been a challenge is the 30-year contract between Community Medical Centers (CMC) and Fresno County to provide indigent care. That contract still has more than a decade remaining on it. Cunningham's report identified a \"stalemate\" between CMC and Fresno County over modifying the contract which \"stymied\" LIHP development.\u003c/p>\n\u003cp>\"Each side has a position on the 30-year contract,\" Schilling said. \"It's just unfortunate that the parties that needed to ... couldn't come up with an agreement.\"\u003c/p>\n\u003cp>And that lack of collaboration is hampering overall efforts to plan for reform, as noted in Cunningham's report, which was prepared for the California HealthCare Foundation, one of the sponsors of the Fresno event:\u003c/p>\n\u003cblockquote>\u003cp>County governments and providers were doing little coordinated community-wide planning for health reform despite the importance of coverage expansions for this region and the large number of undocumented immigrants who will be ineligible to transition into Medi-Cal in 2014.\u003c/p>\u003c/blockquote>\n\u003cp>As the discussion wrapped up, Cunningham pointed out that even with the expansion of Medi-Cal, California's version of Medicaid, the Fresno area will still have a lot of uninsured, and he estimates one-third to one-half of those uninsured will be undocumented immigrants.\u003c/p>\n\u003cp>\"The county is still going to have that responsibility of caring for the indigent who do not qualify for the ACA expansions,\" Cunningham said. \"The challenge will be trying to fold them in within the changes that are happening in the Medi-Cal expansion.\"\u003c/p>\n\u003cp>Schilling, who is from Kern County, encouraged Fresno to \"get moving down the highway, so you're not left behind the 8-ball come next year.\"\u003c/p>\n\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/10043/in-fresno-the-road-to-health-reform-is-bumpy","authors":["240"],"categories":["stateofhealth_11","stateofhealth_15"],"tags":["stateofhealth_38","stateofhealth_402"],"featImg":"stateofhealth_10049","label":"stateofhealth"},"stateofhealth_9891":{"type":"posts","id":"stateofhealth_9891","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"9891","score":null,"sort":[1357939801000]},"guestAuthors":[],"slug":"state-vs-county-showdown-over-funding-the-medi-cal-expansion","title":"State vs. County Showdown Over Funding the Medi-Cal Expansion?","publishDate":1357939801,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_9899\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/brown20130110.jpg\">\u003cimg class=\"size-medium wp-image-9899\" title=\"(Justin Sullivan/Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/brown20130110-300x214.jpg\" alt=\"(Justin Sullivan/Getty Images)\" width=\"300\" height=\"214\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gov. Brown is proposing California's counties relinquish some of their state health funding once the Affordable Care Act is in place. (Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>We're now 354 days from the rollout of the Affordable Care Act next Jan. 1. While the governor declared the state's participation in the Medicaid expansion at his budget unveiling yesterday, he also proposed \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/10/governors-proposals-for-medicaid-expansion/\" target=\"_blank\">two ways\u003c/a> to handle that expansion.\u003c/p>\n\u003cp>Under one scenario, the state will continue to administer the program. Under the other, each of California's 58 counties will oversee running Medi-Cal, California's version of Medicaid, for its own residents.\u003c/p>\n\u003cp>The Affordable Care Act dictates that the federal government will pay 100 percent of the cost for those people newly eligible for Medicaid, and in both proposals, the state's position is that California counties will get some fiscal relief once those federal dollars start flowing.\u003c/p>\n\u003cp>But don't get too excited, counties.\u003c/p>\n\u003cp>California Secretary of Health and Human Services Diana Dooley yesterday referred to a \"conversation\" around \"appropriate sharing\" that needs to happen between the state and its counties around financial responsibilities.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"There's an assumption we've been fully funded. That is simply not accurate.\"\u003c/aside>\n\u003cp>\"Conversation\" might prove to be a euphemism for what could become a vocal debate between the state and the counties. And maybe between counties themselves.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Alex Briscoe, Director of Alameda County's Health Care Services Agency, told me this morning that \"sharing\" presumes that current state funding is sufficient to meet the needs of the indigent poor, an idea he called \"simply preposterous.\"\u003c!--more-->\u003c/p>\n\u003cp>\"There's an assumption we've been fully funded,\" he said. \"That is simply not accurate.\"\u003c/p>\n\u003cp>Counties bear the responsibility for caring for poor uninsured adults, and Alameda is one of 55 California counties that has moved forward with implementing a Low Income Health Plan (LIHP), a bridge to the 2014 Medi-Cal expansion. About a half-million Californians are currently enrolled.\u003c/p>\n\u003cp>Bill Walker, Contra Costa County's Health Director, says he would support having county-level responsibility for overseeing the Medi-Cal expansion. \"The devil is alwyas in the details win terms of agreements between the state and the county,\" he told KQED's Mina Kim yesterday. \"And obviously at the end of the day, the question is what are the rates, what is the cost sharing, and how do the dollars flow?\"\u003c/p>\n\u003cp>But whether the state or counties handle the Medi-Cal expansion, there will still be at least two million people who lack insurance, as Sarah Varney explained at \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2013/01/is-california-headed-for-state-vs-counties-health-budget-battle/\" target=\"_blank\">Kaiser Health News\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Those residents, many of whom are undocumented and barred from buying their own insurance coverage through “Covered California,” the state’s online marketplace, and are ineligible for any public insurance programs, will continue to rely on county-run facilities and safety-net clinics.\u003c/p>\n\u003cp>If the state drains the counties of health care funding, says Anthony Wright, executive director of Health Access, an advocacy group, “You run the risk of losing public hospitals and clinics at exactly the moment we need all the capacity we can get.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>Later this month, the governor is expected to call for a special legislative session on health care issues.\u003c/p>\n\n","blocks":[],"excerpt":"We're now 354 days until the Affordable Care Act rolls out next January 1st. While the governor committed in his budget unveiling yesterday that the state will participate in the Medicaid expansion -- health insurance for the poor and disabled -- he also proposed two ways to handle that expansion.\r\n\r\nUnder one scenario, the state will continue to administer the program. Under the other idea, each of California's 58 counties will oversee running Medi-Cal for its own residents.","status":"publish","parent":0,"modified":1357948400,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":540},"headData":{"title":"State vs. County Showdown Over Funding the Medi-Cal Expansion? | KQED","description":"We're now 354 days until the Affordable Care Act rolls out next January 1st. While the governor committed in his budget unveiling yesterday that the state will participate in the Medicaid expansion -- health insurance for the poor and disabled -- he also proposed two ways to handle that expansion.\r\n\r\nUnder one scenario, the state will continue to administer the program. Under the other idea, each of California's 58 counties will oversee running Medi-Cal for its own residents.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"State vs. County Showdown Over Funding the Medi-Cal Expansion?","datePublished":"2013-01-11T21:30:01.000Z","dateModified":"2013-01-11T23:53:20.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"9891 http://blogs.kqed.org/stateofhealth/?p=9891","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/01/11/state-vs-county-showdown-over-funding-the-medi-cal-expansion/","disqusTitle":"State vs. County Showdown Over Funding the Medi-Cal Expansion?","path":"/stateofhealth/9891/state-vs-county-showdown-over-funding-the-medi-cal-expansion","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9899\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/brown20130110.jpg\">\u003cimg class=\"size-medium wp-image-9899\" title=\"(Justin Sullivan/Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/brown20130110-300x214.jpg\" alt=\"(Justin Sullivan/Getty Images)\" width=\"300\" height=\"214\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gov. Brown is proposing California's counties relinquish some of their state health funding once the Affordable Care Act is in place. (Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>We're now 354 days from the rollout of the Affordable Care Act next Jan. 1. While the governor declared the state's participation in the Medicaid expansion at his budget unveiling yesterday, he also proposed \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/10/governors-proposals-for-medicaid-expansion/\" target=\"_blank\">two ways\u003c/a> to handle that expansion.\u003c/p>\n\u003cp>Under one scenario, the state will continue to administer the program. Under the other, each of California's 58 counties will oversee running Medi-Cal, California's version of Medicaid, for its own residents.\u003c/p>\n\u003cp>The Affordable Care Act dictates that the federal government will pay 100 percent of the cost for those people newly eligible for Medicaid, and in both proposals, the state's position is that California counties will get some fiscal relief once those federal dollars start flowing.\u003c/p>\n\u003cp>But don't get too excited, counties.\u003c/p>\n\u003cp>California Secretary of Health and Human Services Diana Dooley yesterday referred to a \"conversation\" around \"appropriate sharing\" that needs to happen between the state and its counties around financial responsibilities.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"There's an assumption we've been fully funded. That is simply not accurate.\"\u003c/aside>\n\u003cp>\"Conversation\" might prove to be a euphemism for what could become a vocal debate between the state and the counties. And maybe between counties themselves.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Alex Briscoe, Director of Alameda County's Health Care Services Agency, told me this morning that \"sharing\" presumes that current state funding is sufficient to meet the needs of the indigent poor, an idea he called \"simply preposterous.\"\u003c!--more-->\u003c/p>\n\u003cp>\"There's an assumption we've been fully funded,\" he said. \"That is simply not accurate.\"\u003c/p>\n\u003cp>Counties bear the responsibility for caring for poor uninsured adults, and Alameda is one of 55 California counties that has moved forward with implementing a Low Income Health Plan (LIHP), a bridge to the 2014 Medi-Cal expansion. About a half-million Californians are currently enrolled.\u003c/p>\n\u003cp>Bill Walker, Contra Costa County's Health Director, says he would support having county-level responsibility for overseeing the Medi-Cal expansion. \"The devil is alwyas in the details win terms of agreements between the state and the county,\" he told KQED's Mina Kim yesterday. \"And obviously at the end of the day, the question is what are the rates, what is the cost sharing, and how do the dollars flow?\"\u003c/p>\n\u003cp>But whether the state or counties handle the Medi-Cal expansion, there will still be at least two million people who lack insurance, as Sarah Varney explained at \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2013/01/is-california-headed-for-state-vs-counties-health-budget-battle/\" target=\"_blank\">Kaiser Health News\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Those residents, many of whom are undocumented and barred from buying their own insurance coverage through “Covered California,” the state’s online marketplace, and are ineligible for any public insurance programs, will continue to rely on county-run facilities and safety-net clinics.\u003c/p>\n\u003cp>If the state drains the counties of health care funding, says Anthony Wright, executive director of Health Access, an advocacy group, “You run the risk of losing public hospitals and clinics at exactly the moment we need all the capacity we can get.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>Later this month, the governor is expected to call for a special legislative session on health care issues.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/9891/state-vs-county-showdown-over-funding-the-medi-cal-expansion","authors":["240"],"categories":["stateofhealth_15","stateofhealth_13"],"tags":["stateofhealth_38","stateofhealth_263","stateofhealth_99","stateofhealth_402"],"featImg":"stateofhealth_9899","label":"stateofhealth"},"stateofhealth_3826":{"type":"posts","id":"stateofhealth_3826","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"3826","score":null,"sort":[1332194150000]},"guestAuthors":[],"slug":"the-supreme-courts-4-health-care-reform-questions","title":"The 4 Health Care Overhaul Questions Before the Supreme Court","publishDate":1332194150,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>\u003cem>The Supreme Court issued its decisions on the Affordable Care Act on June 28, 2012. This post has been updated to reflect the court’s rulings.\u003c/em>\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_4289\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/SupremeCourtJustices_2012_032620121.jpg\">\u003cimg class=\"size-medium wp-image-4289\" title=\"(Courtesy: U.S. Supreme Court)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/SupremeCourtJustices_2012_032620121-300x240.jpg\" alt=\"(Courtesy: U.S. Supreme Court)\" width=\"300\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: U.S. Supreme Court)\u003c/figcaption>\u003c/figure>\n\u003cp>Next Monday, the Supreme Court begins considering the Constitutionality of the \u003ca title=\"http://www.healthcare.gov/law/index.html\" href=\"http://www.healthcare.gov/law/index.html\" target=\"_blank\">Affordable Care Act\u003c/a>, or ACA. Three days, six hours of oral arguments. But it's not just one long slog about health care reform. The Supreme Court is considering four different questions over those three days.\u003c/p>\n\u003cp>Legal scholars, pundits and those suitably opinionated have been pontificating about all kinds of legal issues. But the average American might want to know, in straightforward language, what those Four Questions actually mean.\u003c/p>\n\u003cp>Here's my take on them:\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>1. Can the Supreme Court Consider the ACA Now, Anyway?\u003c/strong>\u003cbr>\nOral arguments Monday, March 26, 7-8:30am PT\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This is a question only lawyers can love. Feel free to skip to Question #2 if you like. If you're still with me, start by going 140 years back in time to the \u003ca title=\"http://www.law.cornell.edu/uscode/text/26/7421\" href=\"http://www.law.cornell.edu/uscode/text/26/7421\" target=\"_blank\">1867 Tax Anti-Junction Act\u003c/a>. No, I'm not making this up--it's the crux of this first question before the Supreme Court. Here's the deal: the ACA requires that people purchase health insurance or pay a penalty. Many people say this \"penalty\" is a tax in disguise. The Tax Anti-Injunction Act bars people from suing over a tax \u003cem>until they actually pay the tax.\u003c/em> Since the ACA goes into full effect in 2014, no penalties will be paid until 2015. And so, 2015 would be the soonest someone who paid the tax could challenge the constitutionality of the ACA. Will the Supreme Court punt and say, \"Come back in 2015\"? Court-watchers say that's unlikely. \u003cstrong>SPECIAL NOTE: \u003c/strong>If you can only pay attention to two of the three days of hearings, this is your day to skip.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Update: The Supreme Court determined it had the authority to rule.\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>2. Is the Individual Mandate Constitutional?\u003c/strong>\u003cbr>\nOral arguments Tuesday, March 27, 7-9am PT\u003c/p>\n\u003cp>Of the four questions the Supreme Court is considering, this is the big one. As you learned in Question #1, the ACA requires all Americans to purchase health insurance or pay a penalty/tax. If your annual income is below a certain level--about $92,000 for a family of four-- the government will provide subsidies or tax credits to help you. But the mandate is unpopular. Just \u003ca title=\"http://www.kff.org/kaiserpolls/upload/8285-F.pdf\" href=\"http://www.kff.org/kaiserpolls/upload/8285-F.pdf\" target=\"_blank\">over half of Americans\u003c/a> think the Supreme Court should declare the mandate unconstitutional, while 28 percent think it should stay. The primary legal question is this: does Congress have the authority under the \u003ca title=\"http://www.law.cornell.edu/wex/commerce_clause\" href=\"http://www.law.cornell.edu/wex/commerce_clause\" target=\"_blank\">Commerce Clause\u003c/a> of the U.S. Constitution to require Americans to purchase a product, in this case health insurance? Those in favor say yes--Congress can both regulate interstate commerce and legislate taxes. Those opposed say this is the first time Congress has required Americans to purchase a product and it's unconstitutional. \u003cstrong>SPECIAL NOTE:\u003c/strong> if your employer provides health insurance or if you are a Medicare recipient, nothing about your personal situation will change. On January 1, 2014, you would continue to receive the same employer-based coverage or Medicare.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Update: In a 5-4 ruling, the Supreme Court determined that the individual mandate is constitutional.\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>3. If the Individual Mandate is Unconstitutional, Can the Rest of the ACA Go Forward?\u003c/strong>\u003cbr>\nOral arguments Wednesday, March 28, 7-8:30am PT\u003c/p>\n\u003cp>Severability. This word will be all over the news next Wednesday. Why? Suppose the Supreme Court decides the individual mandate is unconstitutional. Can the mandate be \"severed\" from the ACA, allowing the ACA to stand? This question has a bit of unusual background: normally when Congress writes a law, it includes a \"severability\" clause, so that if one part of a law is struck down, the rest of the law can still stand. Back in the last days of drafting the ACA, the House version indeed had a severability clause. The Senate side expected to add it in a conference committee. But things got so hectic at the end, there was never a conference committee and the severability clause was not part of the final law. \u003cstrong>SPECIAL NOTE:\u003c/strong> many experts think severability is implied. They say if the individual mandate is struck down, the rest of the law can stand. Only the Supreme Court will say for sure.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Update: The question of “severability” became irrelevant since the Supreme Court determined that the individual mandate is constitutional. \u003c/em>\u003c/strong>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>4. Is the Medicaid Expansion Constitutional?\u003c/strong>\u003c/em>\u003cbr>\nOral arguments Wednesday, March 28, 10-11am PT\u003c/p>\n\u003cp>\u003ca title=\"http://www.medicaid.gov/\" href=\"http://www.medicaid.gov/\" target=\"_blank\">Medicaid\u003c/a> is the health care plan for the poor and disabled that is run by individual states with both state and federal dollars. The Affordable Care Act expands those eligible for Medicaid to adults earning 133 percent of the federal poverty level. But in order for states to continue receiving \u003cem>any\u003c/em> federal money for Medicaid, the ACA requires them to comply with this expansion. Twenty-six states who have challenged this requirement say withholding all monies for Medicaid is coercive and therefore unconstitutional. Those states which support the expansion--including California--say that Congress can constitutionally attach such conditions under what's known as the \"Spending Clause.\" \u003cstrong>SPECIAL NOTE:\u003c/strong> Congress has expanded Medicaid many times in the past and never had an expansion struck down.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Update: The Supreme Court ruled 5-4 that Congress may not take away all funds for Medicaid if a state decides not to expand the program. As of January 2013, many states have determined to go forward with the expansion; the federal government will pay 100 percent of the costs of any newly eligible enrollees for the first three years and not less than 90 percent of the cost thereafter. Other states have said they will not expand the program; Congress must continue to fund a state's existing Medicaid program at the existing level.\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Some final thoughts:\u003c/strong>\u003c/p>\n\u003cp>The Supreme Court's decisions are expected in late June, possibly early July.\u003cbr>\n\u003cem>Update: as noted, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/28/supreme-court-health-care-decision/\" target=\"_blank\">the decisions\u003c/a> came down June 28, 2012.\u003c/em>\u003c/p>\n\u003cp>The Court will make audio recordings available following the end of arguments each day, but turned down requests for live TV or radio broadcasts.\u003cbr>\n\u003cem>Update:\u003c/em> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/28/audiotranscripts-of-wednesdays-supreme-court-hearings-on-the-fate-of-the-health-law/\" target=\"_blank\">Oral arguments and transcripts on the Medicaid expansion and individual mandate. \u003c/a>\u003c/p>\n\u003cp>While some elements of the Affordable Care Act have already gone into effect, the major components of the legislation take effect on January 1, 2014.\u003c/p>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cp>Background on the Individual Mandate: \u003ca title=\"http://news.yahoo.com/court-weighs-making-health-coverage-fact-life-133951595.html\" href=\"http://news.yahoo.com/court-weighs-making-health-coverage-fact-life-133951595.html\" target=\"_blank\">Court Weighs Making Health Coverage a Fact of Life\u003c/a> (AP)\u003c/p>\n\u003cp>\u003ca title=\"http://www.kff.org/healthreform/upload/8270-2.pdf\" href=\"http://www.kff.org/healthreform/upload/8270-2.pdf\" target=\"_blank\">A Guide to the Supreme Court’s Review of the 2010 Health Care Reform Law\u003c/a> [PDF] (Kaiser Family Foundation)\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And for you wonks out there, you can find content galore here:\u003cbr>\n\u003ca title=\"http://www.kaiserhealthnews.org/Supreme-Court-Decides-Health-Law.aspx\" href=\"http://www.kaiserhealthnews.org/Supreme-Court-Decides-Health-Law.aspx\" target=\"_blank\">The Supreme Court Decides: Health Care at the High Court\u003c/a> (Kaiser Health News)\u003c/p>\n\n","blocks":[],"excerpt":"Next Monday, the Supreme Court begins considering the Constitutionality of the Affordable Care Act, or ACA. Three days, six hours of oral arguments. But it's not just one long slog about health care reform. The Supreme Court is considering four different questions over those three days.\r\n\r\nLegal scholars, pundits and those suitably opinionated have been pontificating about all kinds of legal issues. But the average American might want to know, in straightforward language, what those Four Questions actually mean.\r\n\r\nHere's my take on them:","status":"publish","parent":0,"modified":1377635096,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":1145},"headData":{"title":"The 4 Health Care Overhaul Questions Before the Supreme Court | KQED","description":"Next Monday, the Supreme Court begins considering the Constitutionality of the Affordable Care Act, or ACA. Three days, six hours of oral arguments. But it's not just one long slog about health care reform. The Supreme Court is considering four different questions over those three days.\r\n\r\nLegal scholars, pundits and those suitably opinionated have been pontificating about all kinds of legal issues. But the average American might want to know, in straightforward language, what those Four Questions actually mean.\r\n\r\nHere's my take on them:","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"The 4 Health Care Overhaul Questions Before the Supreme Court","datePublished":"2012-03-19T21:55:50.000Z","dateModified":"2013-08-27T20:24:56.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"3826 http://blogs.kqed.org/stateofhealth/?p=3826","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/03/19/the-supreme-courts-4-health-care-reform-questions/","disqusTitle":"The 4 Health Care Overhaul Questions Before the Supreme Court","path":"/stateofhealth/3826/the-supreme-courts-4-health-care-reform-questions","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>\u003cem>The Supreme Court issued its decisions on the Affordable Care Act on June 28, 2012. This post has been updated to reflect the court’s rulings.\u003c/em>\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_4289\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/SupremeCourtJustices_2012_032620121.jpg\">\u003cimg class=\"size-medium wp-image-4289\" title=\"(Courtesy: U.S. Supreme Court)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/SupremeCourtJustices_2012_032620121-300x240.jpg\" alt=\"(Courtesy: U.S. Supreme Court)\" width=\"300\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Courtesy: U.S. Supreme Court)\u003c/figcaption>\u003c/figure>\n\u003cp>Next Monday, the Supreme Court begins considering the Constitutionality of the \u003ca title=\"http://www.healthcare.gov/law/index.html\" href=\"http://www.healthcare.gov/law/index.html\" target=\"_blank\">Affordable Care Act\u003c/a>, or ACA. Three days, six hours of oral arguments. But it's not just one long slog about health care reform. The Supreme Court is considering four different questions over those three days.\u003c/p>\n\u003cp>Legal scholars, pundits and those suitably opinionated have been pontificating about all kinds of legal issues. But the average American might want to know, in straightforward language, what those Four Questions actually mean.\u003c/p>\n\u003cp>Here's my take on them:\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>1. Can the Supreme Court Consider the ACA Now, Anyway?\u003c/strong>\u003cbr>\nOral arguments Monday, March 26, 7-8:30am PT\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This is a question only lawyers can love. Feel free to skip to Question #2 if you like. If you're still with me, start by going 140 years back in time to the \u003ca title=\"http://www.law.cornell.edu/uscode/text/26/7421\" href=\"http://www.law.cornell.edu/uscode/text/26/7421\" target=\"_blank\">1867 Tax Anti-Junction Act\u003c/a>. No, I'm not making this up--it's the crux of this first question before the Supreme Court. Here's the deal: the ACA requires that people purchase health insurance or pay a penalty. Many people say this \"penalty\" is a tax in disguise. The Tax Anti-Injunction Act bars people from suing over a tax \u003cem>until they actually pay the tax.\u003c/em> Since the ACA goes into full effect in 2014, no penalties will be paid until 2015. And so, 2015 would be the soonest someone who paid the tax could challenge the constitutionality of the ACA. Will the Supreme Court punt and say, \"Come back in 2015\"? Court-watchers say that's unlikely. \u003cstrong>SPECIAL NOTE: \u003c/strong>If you can only pay attention to two of the three days of hearings, this is your day to skip.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Update: The Supreme Court determined it had the authority to rule.\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>2. Is the Individual Mandate Constitutional?\u003c/strong>\u003cbr>\nOral arguments Tuesday, March 27, 7-9am PT\u003c/p>\n\u003cp>Of the four questions the Supreme Court is considering, this is the big one. As you learned in Question #1, the ACA requires all Americans to purchase health insurance or pay a penalty/tax. If your annual income is below a certain level--about $92,000 for a family of four-- the government will provide subsidies or tax credits to help you. But the mandate is unpopular. Just \u003ca title=\"http://www.kff.org/kaiserpolls/upload/8285-F.pdf\" href=\"http://www.kff.org/kaiserpolls/upload/8285-F.pdf\" target=\"_blank\">over half of Americans\u003c/a> think the Supreme Court should declare the mandate unconstitutional, while 28 percent think it should stay. The primary legal question is this: does Congress have the authority under the \u003ca title=\"http://www.law.cornell.edu/wex/commerce_clause\" href=\"http://www.law.cornell.edu/wex/commerce_clause\" target=\"_blank\">Commerce Clause\u003c/a> of the U.S. Constitution to require Americans to purchase a product, in this case health insurance? Those in favor say yes--Congress can both regulate interstate commerce and legislate taxes. Those opposed say this is the first time Congress has required Americans to purchase a product and it's unconstitutional. \u003cstrong>SPECIAL NOTE:\u003c/strong> if your employer provides health insurance or if you are a Medicare recipient, nothing about your personal situation will change. On January 1, 2014, you would continue to receive the same employer-based coverage or Medicare.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Update: In a 5-4 ruling, the Supreme Court determined that the individual mandate is constitutional.\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>3. If the Individual Mandate is Unconstitutional, Can the Rest of the ACA Go Forward?\u003c/strong>\u003cbr>\nOral arguments Wednesday, March 28, 7-8:30am PT\u003c/p>\n\u003cp>Severability. This word will be all over the news next Wednesday. Why? Suppose the Supreme Court decides the individual mandate is unconstitutional. Can the mandate be \"severed\" from the ACA, allowing the ACA to stand? This question has a bit of unusual background: normally when Congress writes a law, it includes a \"severability\" clause, so that if one part of a law is struck down, the rest of the law can still stand. Back in the last days of drafting the ACA, the House version indeed had a severability clause. The Senate side expected to add it in a conference committee. But things got so hectic at the end, there was never a conference committee and the severability clause was not part of the final law. \u003cstrong>SPECIAL NOTE:\u003c/strong> many experts think severability is implied. They say if the individual mandate is struck down, the rest of the law can stand. Only the Supreme Court will say for sure.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Update: The question of “severability” became irrelevant since the Supreme Court determined that the individual mandate is constitutional. \u003c/em>\u003c/strong>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>4. Is the Medicaid Expansion Constitutional?\u003c/strong>\u003c/em>\u003cbr>\nOral arguments Wednesday, March 28, 10-11am PT\u003c/p>\n\u003cp>\u003ca title=\"http://www.medicaid.gov/\" href=\"http://www.medicaid.gov/\" target=\"_blank\">Medicaid\u003c/a> is the health care plan for the poor and disabled that is run by individual states with both state and federal dollars. The Affordable Care Act expands those eligible for Medicaid to adults earning 133 percent of the federal poverty level. But in order for states to continue receiving \u003cem>any\u003c/em> federal money for Medicaid, the ACA requires them to comply with this expansion. Twenty-six states who have challenged this requirement say withholding all monies for Medicaid is coercive and therefore unconstitutional. Those states which support the expansion--including California--say that Congress can constitutionally attach such conditions under what's known as the \"Spending Clause.\" \u003cstrong>SPECIAL NOTE:\u003c/strong> Congress has expanded Medicaid many times in the past and never had an expansion struck down.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Update: The Supreme Court ruled 5-4 that Congress may not take away all funds for Medicaid if a state decides not to expand the program. As of January 2013, many states have determined to go forward with the expansion; the federal government will pay 100 percent of the costs of any newly eligible enrollees for the first three years and not less than 90 percent of the cost thereafter. Other states have said they will not expand the program; Congress must continue to fund a state's existing Medicaid program at the existing level.\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Some final thoughts:\u003c/strong>\u003c/p>\n\u003cp>The Supreme Court's decisions are expected in late June, possibly early July.\u003cbr>\n\u003cem>Update: as noted, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/28/supreme-court-health-care-decision/\" target=\"_blank\">the decisions\u003c/a> came down June 28, 2012.\u003c/em>\u003c/p>\n\u003cp>The Court will make audio recordings available following the end of arguments each day, but turned down requests for live TV or radio broadcasts.\u003cbr>\n\u003cem>Update:\u003c/em> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/28/audiotranscripts-of-wednesdays-supreme-court-hearings-on-the-fate-of-the-health-law/\" target=\"_blank\">Oral arguments and transcripts on the Medicaid expansion and individual mandate. \u003c/a>\u003c/p>\n\u003cp>While some elements of the Affordable Care Act have already gone into effect, the major components of the legislation take effect on January 1, 2014.\u003c/p>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cp>Background on the Individual Mandate: \u003ca title=\"http://news.yahoo.com/court-weighs-making-health-coverage-fact-life-133951595.html\" href=\"http://news.yahoo.com/court-weighs-making-health-coverage-fact-life-133951595.html\" target=\"_blank\">Court Weighs Making Health Coverage a Fact of Life\u003c/a> (AP)\u003c/p>\n\u003cp>\u003ca title=\"http://www.kff.org/healthreform/upload/8270-2.pdf\" href=\"http://www.kff.org/healthreform/upload/8270-2.pdf\" target=\"_blank\">A Guide to the Supreme Court’s Review of the 2010 Health Care Reform Law\u003c/a> [PDF] (Kaiser Family Foundation)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And for you wonks out there, you can find content galore here:\u003cbr>\n\u003ca title=\"http://www.kaiserhealthnews.org/Supreme-Court-Decides-Health-Law.aspx\" href=\"http://www.kaiserhealthnews.org/Supreme-Court-Decides-Health-Law.aspx\" target=\"_blank\">The Supreme Court Decides: Health Care at the High Court\u003c/a> (Kaiser Health News)\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/3826/the-supreme-courts-4-health-care-reform-questions","authors":["240"],"categories":["stateofhealth_15"],"tags":["stateofhealth_38","stateofhealth_222","stateofhealth_41","stateofhealth_119","stateofhealth_402"],"featImg":"stateofhealth_4289","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png","officialWebsiteLink":"http://freakonomics.com/","airtime":"SUN 1am-2am, SAT 3pm-4pm","meta":{"site":"radio","source":"WNYC"},"link":"/radio/program/freakonomics-radio","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519","tuneIn":"https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/","rss":"https://feeds.feedburner.com/freakonomicsradio"}},"fresh-air":{"id":"fresh-air","title":"Fresh Air","info":"Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. 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How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png","officialWebsiteLink":"https://www.npr.org/podcasts/510313/how-i-built-this","airtime":"SUN 7:30pm-8pm","meta":{"site":"news","source":"npr"},"link":"/radio/program/how-i-built-this","subscribe":{"npr":"https://rpb3r.app.goo.gl/3zxy","apple":"https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2","tuneIn":"https://tunein.com/podcasts/Arts--Culture-Podcasts/How-I-Built-This-p910896/","rss":"https://feeds.npr.org/510313/podcast.xml"}},"inside-europe":{"id":"inside-europe","title":"Inside Europe","info":"Inside Europe, a one-hour weekly news magazine hosted by Helen Seeney and Keith Walker, explores the topical issues shaping the continent. No other part of the globe has experienced such dynamic political and social change in recent years.","airtime":"SAT 3am-4am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Inside-Europe-Podcast-Tile-300x300-1.jpg","meta":{"site":"news","source":"Deutsche Welle"},"link":"/radio/program/inside-europe","subscribe":{"apple":"https://itunes.apple.com/us/podcast/inside-europe/id80106806?mt=2","tuneIn":"https://tunein.com/radio/Inside-Europe-p731/","rss":"https://partner.dw.com/xml/podcast_inside-europe"}},"latino-usa":{"id":"latino-usa","title":"Latino USA","airtime":"MON 1am-2am, SUN 6pm-7pm","info":"Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg","officialWebsiteLink":"http://latinousa.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/latino-usa","subscribe":{"npr":"https://rpb3r.app.goo.gl/xtTd","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Latino-USA-p621/","rss":"https://feeds.npr.org/510016/podcast.xml"}},"live-from-here-highlights":{"id":"live-from-here-highlights","title":"Live from Here Highlights","info":"Chris Thile steps to the mic as the host of Live from Here (formerly A Prairie Home Companion), a live public radio variety show. 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Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. 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