Medicaid Expansion


Memo to Washington: Lessons Learned From California’s Obamacare Rollout

Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College. (David McNew/Getty Images)

Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College. (David McNew/Getty Images)

At the same time that California was releasing its latest enrollment numbers 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.

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.

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. Continue reading

Immigration Reform, Maybe; But Long Wait for Health Access by the Undocumented

By John M. Gonzales, CHCF Center for Health Reporting

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)

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)

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.

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.

But first — the immigration reform piece: a bandwagon of endorsements last week 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.

Would California’s estimated 2.5 million undocumented immigrants become eligible for health benefits? How would an already burdened health care system absorb them? Continue reading

In Fresno, the Road to Health Reform Is Bumpy

(Charles Nadeau/Flickr)

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.

Peter Cunningham, with the Center for Studying Health Systems Change, first outlined findings from a regional study. 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.

In addition to this geographic challenge, the region also faces:

  • 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
  • Severe, chronic physician shortages
  • Structural or bureaucratic barriers to reform, specifically a 30-year contract between one hospital and Fresno County to provide care for the poor
“There is no health care policy in Fresno County. We’re in a position of haphazardly approaching this.”

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.


Continue reading

State vs. County Showdown Over Funding the Medi-Cal Expansion?

(Justin Sullivan/Getty Images)

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)

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 two ways to handle that expansion.

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.

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.

But don’t get too excited, counties.

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.

“There’s an assumption we’ve been fully funded. That is simply not accurate.”

“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.

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.” Continue reading

The 4 Health Care Overhaul Questions Before the Supreme Court

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.

(Courtesy: U.S. Supreme Court)

(Courtesy: U.S. Supreme Court)

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.

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.

Here’s my take on them: Continue reading