Starting Up All Over Again

Starting Up All Over Again


I’ve had an utterly lovely six months off since leaving ITUP. It’s now time for me to get back to work. The Office of Lucien Wulsin is now open for business. I’ll be affiliating with organizations where our interests and skills align, and you’ll be hearing more about this soon I hope.

I’ll be available for consulting on health policy and law. I’m most interested in the next step efforts to improve care and effectiveness and outcomes for the millions of Californians who are newly insured.

California has made huge progress under the Affordable Care Act, and we need to build upon it. We have covered about 5 million through Medi-Cal and 1.5 million through Covered California. Our state’s remaining uninsured are now in the single digits, whereas in the past we were approaching and exceeding 20% uninsured Californians.

Our next step challenges are local implementation, and the challenges and solutions vary quite widely from place to place. In some regions, there are not enough doctors, and we need to make better use of telemedicine and nurse practitioners and physician assistants. In other regions, the care is not well coordinated between physical and behavioral health services as well as social services; program silos persist and block effective care. Substance abuse treatment services are underdeveloped in some communities, and substance abuse plagues some important rural communities. Safety nets need to be reimbursed in new forms that promote greater efficiency and rewards their effective treatment. They need to become competitive participants in all markets. Some doctors and some hospitals need to become more willing and able to see publicly funded patients.

We need to build ever-greater reliance on plans and integrated delivery systems that will make their products available to and manage care effectively for all Californians.  The time for cherry-picking the most profitable patients and lines of business has to come to an end, and the need is for plans and delivery systems with effective prevention programs for the healthy that can also effectively manage care for the sick.

We are not yet paying enough attention to the interfaces between employment-based coverage and public programs, and we need to build better bridges and improved affordability between them. The family with one spouse covered by a small employer plan, the other spouse in Covered California and the children in Medi-Cal may be facing serious difficulties in coordinating their family’s health care in these different plans and their networks. We need program simplification that begins locally and extends statewide. 

You can reach me at my cell 310-367-8477; follow me at or on Facebook Please let me know whether there are projects you’d like us to work on together. All the very best, and thanks so very much for all your support and friendship over the years.



Center for Medicare and Medicaid Services, Medicaid & CHIP: June 2016 Monthly Applications, Eligibility Determinations and Enrollment Report

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