Friday, August 29, 2014

qotd: Pulling the safety net from under 4 million Californians

The Greenlining Institute
August 2014
Voices from the Front Lines: California's Remaining Uninsured and the
Safety Net

The Affordable Care Act (ACA) has made purchasing private health
insurance easier and more affordable for millions of Americans, but in
California, an estimated four million will remain uninsured in 2019. The
remaining uninsured population is very diverse, though often incorrectly
made synonymous with undocumented immigrants. In reality, these four
million Californians include citizens, undocumented immigrants and
documented immigrants who will continue to rely on the health care
safety net for their medical care.

Even with full ACA implementation, millions of people will remain
uninsured for a variety of reasons: a lack of an affordable offer of
health insurance, an exemption from the individual mandate due to
immigration status, unforeseen life events that may lead to temporary
periods of being without coverage, a knowing choice not to purchase
health insurance, or the reality that Medi-Cal participation rates will
not be 100 percent. A majority of these Californians will continue to
access their health care through safety net providers, whose critical
funding is rapidly diminishing in the broader context of ACA implementation.

In the 2013-14 state budget, Governor Jerry Brown moved forward with
Medi-Cal expansion in California — opening up access to health insurance
for millions of low-income Californians who were previously ineligible,
a majority of whom are people of color. As of the end of March, 1.9
million additional Californians have been determined eligible for Medi-Cal.

This initial success in Medi-Cal enrollment, made possible by the ACA,
does not come without a cost. Based on the assumption that expanded
coverage through Medi-Cal and Covered California would mean fewer
Californians relying on the safety net, the 2013-14 budget included the
requirement that counties had to relinquish significant funding
previously used to provide care for the remaining uninsured. As noted by
others, this carving out of local safety net dollars will leave millions
of remaining uninsured and underinsured Californians falling through the

People of color disproportionately lack access to health care; prior to
the ACA, they made up 74 percent of California's uninsured and likely
will continue to be a majority of the uninsured moving forward.


Comment by Don McCanne

After all of the health care reform measures have been fully
implemented, over four million Californians will still be uninsured. Yet
funding of the health care safety net has been sharply reduced.

Four million people! The entire population of each of the following
states is less than four million: Oregon, Oklahoma, Connecticut, Iowa,
Mississippi, Arkansas, Utah, Kansas, Nevada, New Mexico, Nebraska, West
Virginia, Idaho, Hawaii, Maine, New Hampshire, Rhode Island, Montana,
Delaware, South Dakota, Alaska, North Dakota, Vermont, and Wyoming.
Suppose nobody in any of those states had any insurance, and the funding
of their health care safety nets were significantly reduced. Although
the states are not comparable, it does give a perspective of the
magnitude of the problem that California faces, not to mention the
difficulties for the other states with large numbers of uninsured and an
inadequate safety net infrastructure.

So do we stop now that the Affordable Care Act has been enacted and
largely implemented? No? How do we expand on the ACA model? More
Medicaid? California is already fully expanding their Medi-Cal program.
Greater buy-in of the exchange plans? Where does the money come from?
Most of the uninsured certainly do not have it, and there are
insurmountable political barriers to further expanding government
contributions to these plans. Do we spend more on the safety net? ACA
was supposed to eliminate the need for a safety net by covering
everyone. More funds for federally qualified health centers could help,
but that would still fall far short of the needs.

No. Patching the ACA model is the most expensive approach to reform yet
it can never meet our needs. Each nail in each patch springs more leaks.
We do not need to perpetuate the inequities and inadequacies of our
highly flawed health care financing system. What can we do? (Trumpets
please.) Enact a single payer national health program - an improved
Medicare that covers everyone.

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