Policy Spotlight
Covering California's Uninsured
After decades of debate, false starts and failed legislation, 2007 may be the year California lawmakers agree on an approach to expand health coverage among the state's estimated 6.6 million uninsured. As the costs associated with health care continue to rise, placing burdens on the public, employers, medical care facilities and insurers, there is general agreement that something needs to be done. No where is this more evident than with the state’s leading public officials who have highlighted health care reform at the top of their political agendas.
Proposals are now on the table from the governor and three of the four political caucuses within the California Legislature -- each with a different approach to reforming the current health care system and reducing the number of uninsured. The movement has spread outside of Sacramento to other major healthcare players in the state. From insurers to employee unions to hospitals, leading business and health care organizations are allocating significant resources to expand health care coverage and access. Leaders of Kaiser Health Plans and the Permanente Medical Groups (Kaiser's physician organization) published a proposal of their own in the policy journal, Health Affairs. And several policy groups, led by the California Health Care Foundation, have contributed data, analyses and alternative approaches to solving the state's medical cost and coverage crisis.
CHI will participate in this important debate, working to ensure that whatever design lawmakers pursue does not damage incentives to private-sector investment in medical innovation. Along the way, we will provide current information on proposals and legislation, as they are made public.
Governor Outlines Prevention, Wellness and Personal Responsibility Reforms (02-06-07)
Gov. Schwarzenegger released a document that highlights the prevention, wellness and personal responsibility cornerstones of his comprehensive health care proposal.
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"Comparison of Núñez, Perata, Schwarzenegger and Senate Republican Health Care Reform Proposals," (01-31-07)
The California Senate Office of Research prepared a side-by-side comparison based on analysis of the health care reform plans proposed by leading state policy makers.
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Senate Republican Caucus Releases Healthcare Proposal (01-30-07)
Led by Minority Leader Dick Ackerman (R-Irvine), the Senate Republican Caucus released a healthcare proposal to provide Californians greater access to health care.
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Gov. Schwarzenegger Releases Plan for Healthcare Programs (01-08-07)
Gov. Arnold Schwarzenegger released a plan that would dramatically re-shape the way health care is delivered and purchased in California by requiring increased contributions from employers, individuals, insurers, and health-care providers.
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Assemblymember Nunez Announces Healthcare Proposal (12-22-06)
Assembly Speaker Fabian Nuñez (D-Los Angeles) unveiled a healthcare proposal to ensure that California's working adults and their families have access to affordable health insurance.
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"Getting Healthcare Insurance for All: A Paradoxical Problem," California Health Care Foundation (12-13-06)
Analyzes a recent Public Policy Institute report on illegal immigrants and coverage.
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Sen. Perata Announces Healthcare Proposal (12-12-06)
Senate President pro Tem Don Perata (D-Oakland) unveiled a healthcare proposal to ensure that California's working adults and their families have access to affordable health insurance.
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"A Proposal to Cover the Uninsured in California,"Health Affairs (12-12-06)
The Kaiser proposal, whether one agrees or disagrees with its approach, presents a model that is likely to be part of future health policy debate. Two pivotal elements, sure to be controversial, are (a) an individual health coverage mandate, with compliance enforced through state income tax filings, and (b) a health care sales tax and in-lieu employer payroll tax. Such new taxes would encounter strong resistance from business and the health care provider community. As the authors note, Prop 98 (passed in 1988) requires a constitutional amendment for any new revenue source to cover the uninsured, so a plan like this would have to begin with a ballot initiative.
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"Insuring Californians: A Proposal that Matters,"Health Affairs (12-12-06)
A critique and analysis of the Kaiser proposal with suggestions for improvement.
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"The Uninsured and the Affordability of Health Coverage,"Health Affairs (11-30-06)
Examining subgroups of uninsured Americans uncovers certain patterns of coverage gaps, but affordability remains a key concern.
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"Pay-or-Play Health Insurance Mandates: Lessons from California," Public Policy Institute of California (October, 2006)
In 2003, Sacramento enacted one of the first "pay or play" laws, mandating that employers either provide health insurance to California workers or pay a fee. Although the law was never implemented, the pay or play idea has since caught the attention of many other states' legislatures. This article examines the probable outcomes of California's version of pay or play and concludes that it was seriously flawed: Employment and wages would have stagnated as employers passed on their increased costs, and many in the population would have remained uninsured.
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"Snapshot: California's Uninsured 2006," California Health Care Foundation (October, 2006)
Useful overview and survey data on the state's uninsured population.
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California Health Care Foundation Coverage Expansion Project (2006)
The Coverage Expansion Resource Center was created to help focus the complex and heated debate over how to cover the uninsured on core issues-the attributes of coverage expansion proposals and the trade-offs inherent in alternative approaches to reform.
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