From 2010 to the first quarter of 2015, the nation’s uninsurance rates fell from 22.3% to 13.0%. The percentage rates of uninsured children fell from 13.9% in 1997 to 4.6% in 2015 due to CHIP and then the ACA. The uninsured rates for adults declined from 22.3% in 2010 to 13.0% in 2015 due to the ACA. Most of the declines for adults happened in only 15 months.
In this blog post I review Republican Presumptive Presidential nominee Donald Trump’s health care reform proposals to make America great again. Mr. Trump has seven key points: 1) completely repeal ObamaCare, 2) permit interstate sale of health insurance, 3) deductibility of individual insurance premiums, 4) broader Health Savings Accounts, 5) price transparency, 6) Medicaid block grant and 7) reduce barriers to market entry for pharmaceuticals. Some are good ideas, some are bad, and two are atrociously bad ideas.
The starting points: Medicare covers seniors and the disabled, is paid for by the federal government and covers very little long term care, no dental or vision care. Medicare comprises four parts: Part A for hospital care, Part B for doctors, Part D for prescription drugs and Part C that combines them all through private insurers (HMOs and PPOs). Just over 5.6 million Californians are enrolled.
Medi-Cal covers the poor; it is paid for by the federal and state governments; it covers a full range of long term care, most dental care and vision care only for children. Almost all subscribers are enrolled in local managed care plans (HMOs). Over 13 million Californians are enrolled.
Employment-based coverage covers about ½ of all Californians; it is paid for by employers and employees assisted by a very large tax subsidy (pre-tax purchasing). Most enrollees are in HMOs; the rest in PPOs. Large and medium sized employers are required to offer coverage to their full time employees, small employers are not so required.
Covered California (Exchanges) cover the uninsured and private individually insured above Medi-Cal levels; individuals pay a share of premiums based on their incomes and the federal government pays a very large share of the premiums, copays and deductibles for those who cannot afford the full cost. Individuals pick their plan, their doctor and their level of coverage. Individuals not otherwise covered by Medicare, Medi-Cal, their employers or the VA are required to enroll in coverage, if affordable. About 1.5 million are enrolled.
The undocumented uninsured (about 1.5 million Californians) are only eligible for emergency care and prenatal care through Medi-Cal if they are low income, but are otherwise ineligible for federally financed coverage. California has just begun to offer full scope Medi-Cal for low income undocumented children (about 170,000 may be eligible). This will be through local HMOs.
The latest count is that 47,000 Los Angelenos are homeless. The growth in the city was 11%; the growth in the county was 5.7%. Meanwhile homeless veterans in Los Angeles declined by a third in the past year due to the recent concerted efforts of the federal Veteran’s Administration.
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.