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Reflections on the 6th Anniversary of the Affordable Care Act

Today we mark six years since passage of the landmark federal Affordable Care Act (ACA). This is an important opportunity to take time and acknowledge our collective efforts to embrace and fully implement the ACA and its coverage expansions.

ACA implementation has essentially cut in half the number of uninsured Californians. More than 13 million Californians are enrolled in Medi-Cal, up from just 7.9 million in the 2012-13 fiscal year. Another 1.6 million Californians have comprehensive coverage through Covered California, the state’s newly formed ACA marketplace. The state continues to move toward health care for all. This year, all eligible children regardless of immigration status will have access to full scope Medi-Cal with medical and dental coverage. Proposals are under consideration to reach and extend coverage to adults left out of the expansions to date.

Still, the ACA is more than just getting people covered and is also about reforming the health insurance market. Individuals are eligible for private coverage regardless of health status or pre-existing conditions. California adopted comprehensive benefits as the standard for individual and small employer coverage, eliminating low benefit plans which often resulted in delayed care and consumer debt. The state, counties, health plans and providers are implementing expanded mental health and substance abuse treatment benefits. California’s ACA marketplace, Covered California, is financially sustainable, increases competition among health plans inside and outside the exchange, and leads the nation in standardizing benefit designs to facilitate consumer comparison. Covered California is working with its health plans and stakeholders to measure and improve the quality of the care delivered. California’s Section 1115 federal Medi-Cal waiver offers unprecedented opportunities to improve and enhance coordination of care and services for Medi-Cal beneficiaries. Counties, health plans, providers and community-based organizations are conceiving and implementing innovative approaches to engage consumers in securing coverage and accessing needed health care. New partnerships are emerging aimed at improving collaboration and integration across the silos of care.

At the same time, we recognize that there is still a lot to do before we realize the vision of all Californians having access to affordable, quality health care. More than 3 million California residents remain uninsured. Many of our neighbors struggle to afford health care premiums or to pay out-of-pocket costs when they seek health care services. Many communities lack sufficient numbers of primary and specialty providers, with some regions missing entire categories of providers and services. Individuals with health coverage, including many newly covered persons, experience an array of barriers to accessing care including financial, language, literacy, geographic distance, physical accessibility and cultural challenges. Health care costs, pricing and utilization vary widely across regions of the state with no connection to quality. Health plans, providers, counties and affiliated agencies may yet have inadequate capacity to effectively monitor quality and make the adjustments necessary to improve care delivery and reduce costs.

We also understand that health is about more than access to health care services. Diverse stakeholders around the state are actively working in communities to ensure residents of the state have safe and healthy environments in which to flourish and grow.

Going forward, ITUP will continue to speak out on behalf of those left out and left behind. ITUP will engage state and regional partners, highlighting and promoting strategies and innovations to improve health and health care across the state. The dramatic successes to date give us the confidence to continue making progress toward our shared goals.

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