Editorial support for safety-net coverage for the remaining uninsured…

As we await Governor Brown’s May Revise budget, the main health question is: Will California maximize the benefit for Californians when implementing the Affordable Care Act? And will the Governor continue California’s commitment to the remaining uninsured?

On the Health Access website front page is our solution to that second question, with a one-page Joint Statement on Extending LIHPs to Provide a Medical Home for the Remaining Uninsured.

Our full paper, Continuing California’s Commitment to the Remaining UninsuredExtending County Low-Income Health Programs (LIHPs) to Provide Safety-Net Coverage for the Remaining Uninsured in California, is also on our website. 
We are gratified for the recent strong editorial support, including from the Sacramento Bee and the Los Angeles Times. Here are excerpts below:


The state estimates that half of the uninsured will sign up for insurance in the exchange or through Medi-Cal. But some 3 million to 4 million will remain uninsured – 3 million citizens, plus 1 million noncitizens who are not eligible for coverage.

What to do about the remaining uninsured? Counties historically have taken care of the medically indigent, and receive some money from the state for that – about $700 million this year. Since about half would become insured, Brown indicated in his January budget that he wanted to “capture” the county savings to pay the state’s costs for Medi-Cal expansion.

The counties point out, rightly, that the federal government covers 100 percent of the cost of the Medi-Cal expansion for 2014, 2015 and 2016.

They argue that during this three-year transition period, they will continue to cover the remaining uninsured and need to ramp up to enroll those eligible for Medi-Cal and the exchange.

Brown should heed their concern. But he should not issue the counties a blank check. Dollars should be distributed by actual numbers of the remaining uninsured cared for by the county safety net. And that care should provide a “medical home,” with preventive and primary care – as counties have built up with the existing Low- Income Health Program – to avoid expensive crisis care.

The Los Angeles Times:
Last week a group of nonprofits offered a sensible compromise, proposing that counties keep the funds if they spend them on a more efficient way to deliver care to the needy…
The proposal by Health Access and other nonprofit advocacy groups would let counties keep the money from sales taxes and vehicle fees for three years, while the feds cover the full cost of the Medi-Cal expansion. After that, counties would receive a set amount per indigent person they enroll in an HMO-style healthcare network, with any leftover dollars reverting to the state. This would make counties much more accountable for the money they receive, while giving the uninsured preventive and coordinated care that’s far more cost-efficient than what they receive at clinics and emergency rooms.
The bottom line is that federal law requires counties to provide emergency care to anyone who needs it, regardless of ability to pay or immigration status. But that’s the most expensive form of care. The Health Access proposal offers a better approach to public health, while leaving counties free to decide who should be eligible for the benefits. The state should embrace it.

Health Access California promotes quality, affordable health care for all Californians.
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