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Tomorrow is Now: Thoughts on California’s Implementation of the Affordable Care Act

The United States has nearly 50 million uninsured. Over the course of the year, over 7 million Californians are uninsured ranging from a few months to the entire year. Most are working individuals and their family members. No other developed nation has such a broken system.

Presidents, starting with Teddy Roosevelt, Harry Truman, Richard Nixon, and Bill Clinton have been trying to cover all Americans for over 100 years. In 2010, President Barack Obama signed the Affordable Care Act (ACA) to offer coverage for every American. It was modeled on a Massachusetts law, developed by recent Presidential candidate, Mitt Romney, pursuant to which 98% of Massachusetts residents now have coverage.

The ACA/Affordable Care Act/ObamaCare offers our nation the greatest opportunity in the last 40 years to cover America’s nearly 50 million uninsured citizens and legal permanent residents. There is much anticipation, fear, hope, and concern about what it will do for the American health system. Those aspects of it already in place, such as coverage through their parents for young adults up to age 26, guaranteed issue for children, high risk pool funding for those with pre-existing medical conditions, and a California Bridge Plan that already covers nearly 600,000 low income working poor, have been quite successful and widely appreciated by those newly covered and their families.

Under the ACA, for virtually all Americans with employment based health insurance, for seniors with Medicare, and the very poor with Medicaid there is very little change, other than some upgrades such as the closing of the donut hole for seniors’ prescription drug benefits and better behavioral health coverage. Over the next year, many Americans with private individual coverage will experience upgrades in covered benefits and greater reliability in staying covered. Americans with secure job based coverage today will have access to coverage through the Affordable Care Act when they change jobs, get laid off, have a family, go back to school, take early retirement, or found a new company. Students who lack coverage through their families will find affordable coverage through the ACA. Families working two to three part time jobs that don’t offer coverage or those working temp jobs with no coverage will now have access to coverage.

On October 1, enrollment opens for Covered California, and coverage will begin on January 1. The Exchanges (Covered California) will offer a marketplace where consumers can shop for the level of coverage they prefer with financial help that depends on their incomes on a sliding fee basis. In the Exchange, a private individually insured or uninsured family of four with incomes up to nearly $95,000 can qualify for help paying their premiums. In the Exchange, a private individually insured or uninsured family of four with incomes up to $58,000 can qualify for help paying their co-pays and deductibles. Premiums negotiated by Covered California with the participating health plans have been a pleasant surprise to many – 25% to 30% below comparable small business coverage in the Los Angeles region. All the big California health plans and many strong local and regional plans are participating.

For those uninsured with lower incomes (up to nearly $16,000 for an individual), Medi-Cal will for the first time in thirty years, offer coverage for individuals and working parents. An individual working a full time minimum wage job with no benefits will now have access to coverage, so will working parents in a family of four with incomes up to $32,000. California got a jump start on this expansion, county Bridge Plans, available in many but not all California counties, have already enrolled and covered 600,000 individuals and working parents. The early results are reduced hospitalizations and emergency room visits as uninsured persons gain access to outpatient and preventive care in community clinics, private doctor’s offices, and needed specialty care.

As the Covered California (Exchange) and Medicaid (Medi-Cal) expansion components of the Affordable Care Act roll out tomorrow, California is among the states better positioned to succeed due to strong leadership from many stakeholders and policy makers, from the state’s legislature and the Governor. Many eyes and much scrutiny will be upon us. While we should be prepared for a certain amount of confusion as is typical with most new start-up programs, the important thing to keep in mind is that this is an excellent starting point that offers an opportunity for up to six million uninsured California citizens and legal permanent residents and two million Californians with private individually purchased coverage to get more affordable, reliable, and ultimately more effective health care. We are fortunate to be on the precipice of history for our nation’s health, and the future is in our hands.

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