The Leapfrog Group annually ranks the nation’s hospitals. Its most recent Spring 2016 rankings point to wide disparities in the quality of care among the nation’s hospitals. The quality indicators measured included hospital acquired infection rates, surgical mistakes, the adoption of safety measures, and patient communications. For example, how often did patients have bed sores or falls, how often did the hospital infect the patient, leave a foreign object in the patient during surgery, cause an air or gas bubble leading to a stroke, did the hospital, its nurses and doctors explain to the patient what to do for follow up care after discharge.

Last Sunday morning, Katie announced that we were going to a brunch to meet Henry Stern who is running for the state Senate in District 27. I wondered why we were not going for our traditional Sunday morning hike in the mountains. She explained this was to save the mountains, so I said ok.

On May 1, California children can be eligible for Medi-Cal regardless of their immigration status. The income threshold is 266% of the federal poverty level ($53,626 for a family of three or $75,650 for a family of five). California joins four other states and Washington DC. We are nearly at universal coverage for every California child. The projections are that 175,000 of the estimated 250,000 eligible children will enroll.

This is ITUP’s 20th and my 70th birthday, and its now time for me to step away for a dynamic new leader (Deborah Kelch, Deborah@itup.org ) to help with building the next steps of health reform for every Californian. We still need coverage for undocumented adults and a financing plan to help them pay for basic coverage. But we need to turn our vision to better health outcomes for those with new insurance. In California over the next year we will have 1.5 million with Covered California and 13.5 million with Medi-Cal coverage according to Governor Brown’s recently proposed budget. We need to begin to reimburse for better outcomes, assure an adequate workforce and delivery system in underserved rural communities and knit our programs together to provide whole person care to those suffering with debilitating mental illness or severe substance addictions. We need to assure that premium increases stay low and out of pocket becomes more affordable.

In California, we are scheduled to begin Medi-Cal coverage for undocumented uninsured children on May 1, 2016 – this is huuuugely important progress culminating over a decade and a half of sustained state, local and philanthropic efforts.

What should California do to finance care and coverage for those who are uninsured adults and ineligible for full scope coverage due to their immigration status?

Welcome to Lucien’s blog; we have much to celebrate in California’s implementation of the Affordable Care Act and a great deal to discuss and develop.

I’m retired from ITUP (www.itup.org) now and wanted to start a blog with my own perspectives on what lies ahead. I hope you find the ideas useful and will let me know your experiences.

As we all know, the national atmosphere for forward progress is incredibly toxic at the moment. Important opportunities for further progress lie ahead at the state of California level, at the plan and provider levels, and at the county and regional government levels.

I believe we have seven key challenges in front of us. Some of the first postings of this blog will address these challenges and the opportunities to resolve them here.