{"id":1832,"date":"2019-01-29T00:00:11","date_gmt":"2019-01-29T00:00:11","guid":{"rendered":"http:\/\/surfshields.com\/index.php\/2019\/01\/29\/california-moves-toward-healthcare-for-more-not-yet-healthcare-for-all\/"},"modified":"2019-01-29T00:00:11","modified_gmt":"2019-01-29T00:00:11","slug":"california-moves-toward-healthcare-for-more-not-yet-healthcare-for-all","status":"publish","type":"post","link":"https:\/\/surfshields.com\/index.php\/2019\/01\/29\/california-moves-toward-healthcare-for-more-not-yet-healthcare-for-all\/","title":{"rendered":"California moves toward healthcare for more, not yet healthcare for all"},"content":{"rendered":"
\n
\n
\n

\n\t\t\t\t\t\t\tElizabeth Aguilera<\/span>
\n\t\t\t\t\t\tContributor<\/span>\n\t\t<\/p>\n<\/div>\n

\n

Elizabeth Aguilera<\/a> is an award-winning multi-media journalist who will cover health and social services for CALmatters. She joins CALmatters from Southern California Public Radio\/KPCC 89.3, where she produced stories about community health.\n<\/div>\n<\/div>\n

It was way easier for candidate Gavin Newsom <\/span><\/a> to endorse\u00a0single-payer healthcare<\/span>\u00a0coverage for everyone than it is now for Gov. Newsom to deliver it.<\/p>\n

Yet hardcore advocates say they\u2019re pleased with the moves he\u2019s made thus far \u2014 even if it may take years to come to fruition.<\/p>\n

\u201cThis is a governor that is operating from a compass of action,\u201d said Stephanie Roberson, government relations director for the politically powerful California Nurses Association, which hasn\u2019t exactly been\u00a0known for its patience\u00a0<\/span>on the issue.<\/p>\n

Newsom has taken two tacks. He\u2019s asking the Trump administration to let the state create its own single-payer system offering coverage to all Californians \u2014 a move almost everyone regards as a very longshot. And he\u2019s also pushing specific ideas to expand healthcare coverage to hundreds of thousands of still-uninsured Californians \u2014 a move that seems much more do-able.<\/p>\n

During his campaign, Newsom\u00a0promised<\/span>\u00a0the nurses he would make it happen. But the state can\u2019t do it alone. That\u2019s why he sent a letter to the federal government right out of the gate, asking the administration and Congress to set up an \u201cinnovation waiver\u201d to allow California to create its own single-payer system.<\/p>\n

Experts say there is little chance the Trump administration will give the state the go-ahead on this.<\/p>\n

\u201cHe\u2019s making a statement and sometimes making statements is important \u2014 even if there\u2019s little chance of making progress in the immediate future,\u201d said Gerald Kominski, senior fellow at the\u00a0UCLA Center for Health Policy Research<\/span>. \u201cIt\u2019s a way of drawing a line in the sand.\u201d<\/p>\n

It\u2019s also a way to stave off criticism from advocates, said Jesus Ramirez-Valles, director of the\u00a0Health Equity Institute<\/span>\u00a0at San Francisco State University. \u201cHe can say \u2018I tried it\u2019 and there is no risk on him. If he doesn\u2019t do what he promised, then he is risking opposition.\u201d<\/p>\n

Federal permission would also require Congress to support a new waiver system \u2014 one that would allow the state to redirect funds that usually go to the federal government, such as Medicare income taxes, to a state funding authority that would manage and pay for a single-payer healthcare system, Kominski said. Current waiver systems do not allow for this type of financial management by the state. Other states have used existing waiver programs for permission to set prices or to implement additional requirements, but not to collect federal money.<\/p>\n

\"\"<\/p>\n

\u201cYou have to ask for the money,\u201d said Roberson of the nurses union. \u201cWe are not going to sit on our hands and hope something is going to happen. This strengthens the governor\u2019s commitment to Medicare for all.\u201d<\/p>\n

Meantime, Newsom is tackling the block of 3 million uninsured California residents by chipping away at the edges \u2014 proposing spending to help struggling middle-income families buy health insurance, and providing state coverage to some undocumented young adults.<\/p>\n

He\u2019ll need approval from the Legislature, now a supermajority of Democrats, many of whom have supported similar ideas in recent years.<\/p>\n

Two intertwined\u00a0proposals\u00a0<\/span>in his budget would offer hundreds of thousands of middle-income families additional state subsidies to buy health insurance, and require every Californian to obtain health coverage or pay a tax penalty.<\/p>\n

This \u201cstate mandate\u201d would replace the controversial federal mandate \u2014 a central component of the Affordable Care Act, or Obamacare \u2014 that the Trump administration recently canceled. A few other blue states were quicker to create a replacement state mandate, but California\u2019s progressive lawmakers\u00a0were wary of penalizing people who failed to buy health insurance<\/span>\u00a0unless the state also cushioned the blow by offering people more subsidies to lower the costs.<\/p>\n

Newsom also proposes to use $260 million in state funds to extend Medi-Cal, the government health program for people who can\u2019t afford insurance, to low-income undocumented immigrants ages 18 to 26.<\/p>\n

It\u2019s a classic \u201cResistance State\u201d action for Newsom, as California tries to counteract the Trump administration\u2019s federal moves to undermine Obamacare. Last year a joint UCLA and UC Berkeley\u00a0study<\/span>\u00a0found that the uninsured rate in California would rise to nearly 13 percent by 2023 if nothing is done at the state level to prevent it.<\/p>\n

\"\"<\/p>\n

Since the Affordable Care Act, known as Obamacare, was enacted, California\u2019s uninsured rate has dropped from about 17 percent to roughly 7 percent. Roughly half of those 3 million remaining uninsured are undocumented immigrant adults who don\u2019t qualify for assistance.<\/p>\n

If Newsom\u2019s plan is approved, California would offer additional subsidies to families that earn between 250 and 400 percent of the federal poverty level and already receive some federal help. The state would also start offering state-sponsored subsidies to households that earn between 400 and 600 percent of the federal poverty level, up to $150,600 for a family of four, who currently do not qualify for any assistance. Families that earn above 400 percent of the federal poverty level make up 23 percent of the state\u2019s uninsured, according to data from the UCLA\u00a0AskCHIS<\/span>program.<\/p>\n

The\u00a0federal poverty level<\/span>\u00a0for 2019 is set at earnings of $12,140 for one person and $25,100 for a family of four.<\/p>\n

The budget does not include cost estimates for the additional subsidies, but Newsom intends to pay for the expansion by having the state collect penalties from Californians who forego insurance. His budget proposal estimates that the mandate penalty could raise about $500 million a year, similar to what about 600,000 Californians\u00a0paid<\/span>\u00a0to the federal government when it had a mandate and collected its own penalties.<\/p>\n

Peter Lee, who directs the state health insurance exchange\u00a0Covered California<\/span>, praised Newsom\u2019s proposals during a recent\u00a0board meeting<\/span>.<\/p>\n

\u201cNot only does his initiative propose an individual penalty show courage,\u201d he said, \u201cit shows some thoughtfulness about the challenges that middle-class Americans face.\u201d<\/p>\n

Enrollment for Covered California, which recently ended, was down 15 percent over last year. Lee said the elimination of the federal penalty is partly to blame.<\/p>\n

\"\"<\/p>\n

A draft affordability\u00a0report<\/span>\u00a0Covered California is preparing for the Legislature concludes that if Newsom\u2019s two proposals \u2014 expanded subsidies and a mandate \u2014 are adopted, enrollment could rise by nearly 650,000 people.<\/p>\n

Funding the subsidies with penalties is, of course, a bit of a Catch 22: The more successful California is in getting people to obtain healthcare, the smaller the penalty fund to pay for the subsidies that help fund that care.<\/p>\n

\u201cYou\u2019re accomplishing your goal, but you\u2019re taking away revenue,\u201d Kominski said. \u201cThis is the kind of problem we should be happy to have.\u201d<\/p>\n

The conundrum is reminiscent of the state\u2019s tobacco tax, which was intended to deter people from smoking. Success has meant a drop in the amount of money the tax brings in.<\/p>\n

Despite what many see as dismal prospects for single-payer in California so long as the Trump administration can quash the state\u2019s waiver request, the California Nurses Association is undaunted. They\u2019re working on a soon-to-be-introduced single-payer bill, more detailed than the version that\u00a0died<\/span>\u00a0in 2017. That one carried a $400 billion\u00a0price tag<\/span>, more than three times the state\u2019s annual budget, but lacked support from then-Gov. Jerry Brown and was scant on details. The new version, nurses union rep Roberson said, will be specific about how single-payer would work and how it would be paid for.<\/p>\n

\u201cWe\u2019re not eradicating providers, we are not seeking to dismantle hospitals,\u201d she said. \u201cThe fundamental structure of healthcare delivery will stay in place; what we are changing is how healthcare is financed.\u201d<\/p>\n

And if the Trump administration rejects the waiver request? Roberson sees other paths to a state single-payer system, including petitioning the Centers for Medicare and Medicaid, or trying to set up a system under Affordable Care Act provisions.<\/p>\n

If the nurses union and other single-payer advocates end up pursuing those other avenues, the question becomes whether Newsom will as well.<\/p>\n

CALmatters.org<\/i><\/span>\u00a0is a nonprofit, nonpartisan media venture explaining California policies and politics.<\/i><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

https:\/\/techcrunch.com\/2019\/01\/28\/california-moves-toward-healthcare-for-more-not-yet-healthcare-for-all\/<\/p>\n","protected":false},"author":0,"featured_media":1833,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/surfshields.com\/index.php\/wp-json\/wp\/v2\/posts\/1832"}],"collection":[{"href":"https:\/\/surfshields.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/surfshields.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/surfshields.com\/index.php\/wp-json\/wp\/v2\/comments?post=1832"}],"version-history":[{"count":0,"href":"https:\/\/surfshields.com\/index.php\/wp-json\/wp\/v2\/posts\/1832\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/surfshields.com\/index.php\/wp-json\/wp\/v2\/media\/1833"}],"wp:attachment":[{"href":"https:\/\/surfshields.com\/index.php\/wp-json\/wp\/v2\/media?parent=1832"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/surfshields.com\/index.php\/wp-json\/wp\/v2\/categories?post=1832"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/surfshields.com\/index.php\/wp-json\/wp\/v2\/tags?post=1832"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}