California leads the way

As Americans await a Supreme Court ruling on health-care-reform legislation, millions of Californians already are reaping benefits from the Patient Protection and Affordable Care Act (PPACA).

According to a study by Health Access California, a consumer advocacy coalition of around 200 organizations, state legislators and governmental agencies have moved forward with notable speed since the PPACA became law in 2010. California has passed new laws, established new programs and secured more than $340 million in federal funding.

“California has been a leading state in implementing and improving upon the federal Affordable Care Act in the last two years,” Anthony Wright, executive director of Health Access California, writes in a recent essay announcing the research.

The study (titled “The Affordable Care Act in California: After Two Years—Big Benefits, More Work to Do”) quantifies the beneficiaries as follows:

• More than 8,600 adults, plus tens of thousands of children, with pre-existing conditions have gained access to private insurance coverage.

• Hundreds of thousands receive rebates, surpassing $100 million, on their private insurance policies.

• More than 319,000 seniors have saved a total of $170 million on their prescriptions.

• More than 355,000 young adults (under age 26) get coverage through their parents’ policies.

• More than 370,000 Californians now have coverage through Low-Income Health Programs (in 2014, 2 million more will be eligible for Medi-Cal).

• More than 6.1 million have preventative care as part of their coverage.

• More than 12 million no longer have a lifetime limit on their health insurance plan.

In addition, myriad small businesses qualify for tax credits to help defray the cost of private insurance coverage, and more than 100 large employers and trusts have received assistance with covering early retirees.

“The two-year status report identifies California as a leader in taking advantage of opportunities of the law, from enacting over a dozen laws … to applying for federal grant funds to negotiating a new Medicaid ‘waiver’ with the federal government,” Wright writes, referring to the White House-approved expansion of public health coverage in the state.

“Millions more Californians will benefit and qualify for direct financial assistance in the next year and beyond, but only if the implementation continues at both the federal and state level. In addition to preventing efforts to repeal or defund the law, California can take additional steps to maximize the benefits.”

Toward that end, the Legislature is slated to consider dozens of bills that either implement or expand upon elements in the PPACA. They include:

• AB 714: Would pre-enroll eligible Californians in subsidized coverage programs ahead of 2014.

• AB 792: Known as automatic enrollment, it would ease the process for receiving subsidized coverage after key life events (e.g. divorce, adoption, unemployment).

• AB 43 and SB 677: Would change eligibility requirements for Medi-Cal to match the PPACA.

• SB 703: Also in sync with the PPACA, would create a “basic health plan” for Californians between 133 percent and 200 percent of the poverty level.

• AB 1869: Would require the Office of the Patient Advocate to expand its services to include military veterans.

• AB 52: Would authorize the Department of Managed Health Care and the Department of Insurance to approve or deny increases in premiums, copayments or deductibles.

• AB 1453 and SB 951: Would require insurers to cover a set of “minimum essential health benefits.”

• AB 1461 and SB 961: Would prohibit insurers from denying coverage for pre-existing conditions (akin to the PPACA).

• AB 1083: Would prevent insurers from raising the rates on small businesses based on the health of their employees.

• SB 1313: Would prevent deceptive marketing practices.

• AB 1766: The so-called “Walmart list” bill would create and publicize a list of employers who push employees to public health coverage rather than provide coverage themselves.

• AB 441: Would require community transportation plans to incorporate health concerns.

• AB 727: Would create nutrition standards for all state agencies, as well as setting sustainable policies for purchasing from local farmers and vendors.

“California is moving forward full steam ahead to implement the [PP]ACA,” Bill Monning (D-Carmel), chairman of the Assembly Health Committee, told Health Access California. “We recognize this unprecedented opportunity to improve and promote the health and wellness of Californians, and we are taking full advantage of it.”

Changes in California are progressing in conjunction with federal reform, but also independent of it. Thus, it is unclear how the Supreme Court’s pending ruling on the PPACA would affect state policy. (For more about the court case, see the March 22 Healthlines story, “Uncertainty the only sure thing.”)

The Supreme Court decision will be significant because the fiscal balance of the PPACA depends on more people paying for private insurance—the so-called “individual mandate.”

Yes, insurance companies need to cut their administrative expenses or provide rebates to consumers, both of which they’ve done (the latter to the tune of $1.3 billion, according to a study released last week). The PPACA also contains price controls, such as those embodied in California legislation. But without new customers, particularly healthy young ones to help dilute the “risk pool” that includes patients with pre-existing conditions, the math won’t work.

In that case, look for new legislation from both sides of the aisle, as well as a renewed push for single-payer insurance in California.