Gov. Jerry Brown's administration wants health care change, with or without federal law

CAL/AAEM News Service - BP calaaem.news.service at gmail.com
Sun Apr 1 21:35:26 PDT 2012


Description: Description: Description: Description: Description: CAL/AAEM:
California Chapter of the American Academy of Emergency Medicine

 

March 30, 2012

 

Gov. Jerry Brown's administration wants health care change, with or without
federal law 

 

Sacramento Bee
<http://www.sacbee.com/2012/03/30/4377563/gov-jerry-browns-administration.ht
ml#mi_rss=Top%20Stories> 

 

 

By David Siders and Kevin Yamamura

 

 

If the court does rule the federal law unconstitutional, state Health and
Human Services Secretary Diana Dooley said California should at least
consider enacting its own universal health care legislation, including
requiring every Californian to buy insurance.

 

"I think that we should be committed to making this system more rational
than it is today, and improving the health of the people of California,"
Dooley said in an interview. "If we ask the insurance plans to take
everybody and insure everybody with no screens or pre-existing conditions,
then we have to have everybody buying some level of health insurance to meet
their responsibility to the system." 

 

She said whether the administration sponsors such legislation would depend
on "where we are and what the conditions are at that particular time."

 

Dooley's remarks came a day after the Supreme Court finished three days of
oral arguments over President Barack Obama's signature health care law.

 

At issue is whether Congress can require people to buy insurance and,
separately, whether lawmakers overstepped in pressuring states to expand
Medicaid coverage.

 

In 2010, California, amid urging from the White House, became the first
state in the nation to enact legislation establishing a public health
insurance marketplace to implement the Affordable Care Act.

 

The insurance exchange is expected to serve more than 2 million Californians
beginning in 2014, many of them now uninsured residents who do not qualify
for existing public health care or cannot afford coverage on the open
market.

 

Through Medi-Cal, the state's version of Medicaid, California provides
coverage for nearly 8 million low-income residents, including children and
their parents, disabled individuals and the elderly. A separate program,
Healthy Families, serves 878,000 children up to age 19 whose families earn
too much to qualify for Medi-Cal.

 

Under the federal health care overhaul, the federal government would cover
most costs for new enrollees such as single adults and parents who cannot
qualify for Medi-Cal. From 2014 to 2019, California could receive $45
billion to $55 billion from the federal government, while the state would
contribute an additional $3 billion to $6.5 billion, according to the Kaiser
Commission on Medicaid and the Uninsured.

 

"Just from her (Dooley's) point of view, from the agency she manages, it's
an infusion of literally billions of dollars into our health care system and
our economy that is pending here," said Anthony Wright, executive director
of Health Access California, an advocacy group.

 

Wright said an insurance exchange without federal subsidies "could still
provide an easy, consumer-friendly marketplace that doesn't exist now in a
very complex and confusing world."

 

But compared to the promise of the federal health care law, he said, "it
won't be the same thing."

 

He said "there are some portions of the reforms that we can go forward with"
but that "the key thing is money."

 

The California health exchange would bring together private insurers to
serve new health care enrollees, subsidized by those federal and state
dollars.

 

But it is difficult to know how any part of the program will fare until the
Supreme Court reaches a decision, expected by the end of June.

 

If the high court strikes down the mandate that everyone carry health
insurance, it is unknown how successfully the exchange can operate. Insurers
were counting on the mandate to ensure they could afford to cover high-risk
individuals who have health conditions and deliver health care at an
affordable price.

 

"We're all on pins and needles on the Supreme Court stuff," said Robert
Ross, a health exchange board member and president and CEO of the California
Endowment, a health care foundation. "We still have 7 million uninsured in
the state, and we still have out-of-control health care costs."

 

Ross said federal funding is "the wild card in all of this."

 

The idea of creating a universal health care system in California has
percolated for decades. In 2003, Gov. Gray Davis, a Democrat, signed
legislation that would have required employers of more than 50 people to
provide their workers with health insurance or pay a fee. The following
year, voters repealed the measure in a referendum.

 

More recently, legislation to create a universal health care system stalled
in the state Senate earlier this year. Opponents objected to the cost and to
the bureaucracy such a system would require.

 

Following oral arguments this week, many court observers have concluded
justices could strike down all or part of the current federal law.

 

If the law is unraveled, it is unclear whether the state could maintain some
provisions already in effect, including not allowing most insurers to deny
coverage to children because of pre-existing conditions and allowing people
up to age 26 to remain on their parents' policies.

 

Dooley said she thinks there is a "very good chance" the Supreme Court will
rule in the government's favor. If not, she said, it may leave certain
federal subsidies in place. 

 

 

 

 

 

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service



 

 

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