Sacramento Bee (CA)
March 15--Obamacare is unraveling. California can't create
its own replacement, at least not yet.
So health care advocates and lawmakers are working on a
piecemeal approach. They want to offer a public insurance option to compete
with private companies. They want to increase subsidies for those buying
insurance through Obamacare. They want to cover most undocumented immigrants.
They want to lower prescription drug costs.
A new coalition of California labor and health advocacy
groups -- including Health Access California and the Service Employees
International Union -- will unveil the latest legislative push Thursday,
outlining Democratic-led efforts supporters say will improve the state's health
care financing and delivery system.
Legislation is still being crafted, but any major overhaul
will face steep political and financial challenges. Rough estimates indicate
the costs for measures to expand access, improve quality and lower consumer
costs could be as much as $10 billion -- an amount lawmakers acknowledged is
not available in this year's budget.
Key players on health care in Sacramento, including the
California Hospital Association and the California Medical Association, are not
involved in early discussions and its chances in an election year are unclear.
But advocates are trying.
"We think this is a path that gets us to universal
care and coverage," said Anthony Wright, executive director for Health
Access. "We don't see this in any way as competing with the broader reform
efforts. In fact, this gets us closer to a 'Medicare-for-all' type system, and
if the window of opportunity opens at the federal level, that means we'll be
this much closer to take the leap when it's possible."
These are proposals under discussion in the state
Legislature:
Creating a California public insurance option
Under this approach, the government could compete with
private insurers in the health care marketplace and offer more coverage choices
in regions with few current options or high-priced plans.
The idea is attractive to policymakers like Assemblyman
Jim Wood, D-Healdsburg, who represents a large swath of the North Coast,
extending from Santa Rosa north to the Oregon border.
"As someone who represents a very rural district,
there is appeal to this for me personally," he said. "We have less
competition in the health care plans that are available out there, so why not
have this as an option? For people (who) simply don't have a lot of choices,
this could be an amazingly positive opportunity for them."
One idea would add a government-run public option to the
current plans offered through Covered California. Another approach would build
on Medi-Cal, expanding it to create a competitive alternative to existing
plans.
Expanding state financial assistance to purchase insurance
State Sen. Ed Hernandez, D-Azusa, has introduced Senate
Bill 1255 to expand existing federal subsidies with state money to help
consumers purchase insurance on Covered California.
A report released this week to the Assembly's special
health committee, charged with identifying a path to universal coverage in
California, also recommended lawmakers make Obamacare more affordable by
boosting financial assistance with state dollars.
Hernandez is eying $900 million that was set aside for the
Children's Health Insurance Program if the federal government had de-funded it.
But that never happened.
"I'm hoping that money can help reduce the cost of
health insurance through Covered California," Hernandez said.
California Department of Finance spokesman H.D. Palmer
warned, however, that the state could be on the hook for future cost increases
for new programs, such as the idea Hernandez is suggesting. Federal funding for
the children's health program is expected to decline in future budget years
"which means, by definition, the state share would have to increase over
time."
Covering undocumented immigrants
At present, the vast majority of Californians -- 93
percent -- have some type of coverage. There are roughly 3 million remaining
uninsured residents. Nearly 2 million of them are undocumented immigrants, who
are not covered by Obamacare. Many have incomes that would enable them to
qualify for Medi-Cal.
State Sen. Ricardo Lara, D-Bell Gardens, previously led
the state's efforts to expand Medi-Cal to kids. Now he wants to do the same for
undocumented immigrants ages 19 and older who don't currently qualify for the
program.
He's tried it before -- four times -- unsuccessfully. This
year he's proposing it again with Senate Bill 974, which could go far in
reducing the ranks of California's uninsured. Gov. Jerry Brown has not been
receptive.
"The governor never had animosity toward the
population we're trying to serve...it was trying to get to the real cost,"
Lara said. "I think this is a perfect year for us to make this
happen."
Imposing a California individual mandate
President Donald Trump, backed by Republicans in
Washington, has formally ended the individual mandate under Obamacare that
requires citizens to have health coverage or pay a federal tax penalty. That
requirement expires in 2019.
As a result, health insurers and policy experts are
concerned healthy, young people will drop their health insurance, destabilizing
markets and making coverage even more expensive.
No lawmaker has formally endorsed an individual mandate
bill, but some are considering it. The California Association of Health Plans
backs the idea.
"We are greatly concerned about the impact the
federal repeal will have on premiums for people purchasing their own coverage,
combined with the hundreds of thousands of Californians who wold choose not to
purchase coverage without a mandate in place," said Charles Bacchi,
president and CEO for the California Association of Health Plans.
"We are talking to policy makers about the need to
introduce legislation this year that would establish a state-based individual
mandate...as a way to stabilize California's health care market and protect
Californians from facing even higher health care premiums."
Controlling rising health care costs
Former Vermont Gov. Peter Shumlin has recommended
California lawmakers control rising health care costs by changing the way
providers are paid, from a system based on volume of services to one that
rewards better health outcomes.
Rising health care costs are being driven largely by
unregulated prices in the commercial market, where most Californians get their
health care, but also by hospital consolidations. As chains have grown bigger,
health insurers and and plans have also consolidated, arming them with more
purchasing power to negotiate lower prices.
But patients aren't always on the winning end of that.
"They may get lower prices, but they don't
necessarily pass those on to consumers," said Larry Levitt, a health
economist and co-executive director for the Program for the Study of Health
Reform and Private Insurance at the Kaiser Family Foundation.
Wood wants to bring some regulatory oversight to health
plan mergers, which could help drive down prices. He has proposed Assembly Bill
595, which would give state health insurance regulators the chance to deny
mergers and allow the public to weigh in.
Other efforts are under way to control costs by lowering
prescription drug prices, capping payment rates to medical providers and
requiring health plans to limit the amount of revenue spent on profits,
marketing and administrative costs, requiring them instead to spend that money
on patient care.
One bill would seek to ban Medi-Cal work requirements
being spearheaded by the Trump administration. Another would prevent insurance
companies in California from selling bare-bones plans or charging higher
premiums for people with pre-existing conditions.
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