2014: Tomorrow is Here

January 2, 2014

We hope you had wonderful holidays and New Year celebrations.

The rollout of the Affordable Care Act in California has gone well, with enrollment for the first three months, reported to top one and a half million in California. California has had the advantages of a three-year head start in Medicaid enrollment, supportive Governors and legislature and some mix of good luck and terrific management at Covered California and the Department of Health Care Services.

ITUP has been working extensively on the ground with local organizations that can help use the Affordable Care Act’s improvements in primary care, mental health and substance abuse treatments to help their clients turn their lives around. We think these primary care and behavioral health investments will have huge payoffs in the lives of individuals, their families and the communities they live in. We hope you will share these stories widely as they are immensely important to advance the public’s understanding of these positive steps.

ITUP’s staff spent many months teaching and training on the ACA before the rollout of the coverage expansions. The big surprises from our training were the level of misinformation even among well-informed members of the public and the incredible complexity of people’s questions. I certainly thought we knew the ACA reasonably well, but the questions kept sending us back to the federal rules to figure out the right answers. I have far greater empathy for the confusion surrounding the federal roll out and the terrific work that community organizations, clinics, counties, providers and brokers did here in California. The interfaces of the ACA’s new coverage with traditional Medicaid, with employer-sponsored insurance, with immigration policy, with all the tax implications and with the mixture of relationships that comprise the modern California family are just really complex.

Most of the negative commentary we heard was from people with insurance who wanted the ACA to go further than it does in making their own coverage more affordable. They wanted to get some help paying their premiums even though they had coverage through their employers or they wanted help paying individual insurance premiums even though their incomes were too high to qualify for premium assistance under ObamaCare.

The ACA will need improvements to help particular groups of individuals and families — people with larger families whose premiums are three times those of an individual, individuals with incomes just above the federal subsidy level (about $46,000 for an individual or $95,000 for a family of four) who must pay full freight, or individuals in their 60’s whose premiums are three times as high as for younger folk of comparable income. This is going to require some bi-partisanship in DC, which may be a while in coming.

My sense is that those states which were on the fence are now seeing that the ACA is here to stay and beginning to seek some accommodation with the federal government to expand Medicaid with a twist to adjust the programs to their particular state’s political and economic framework. Ohio, Iowa and Arkansas are among the leaders. While it may not happen in Texas or Oklahoma any time soon, I expect Medicaid expansions will start to go forward in states from Maine, and New Hampshire, to Missouri, Virginia or Pennsylvania depending on their assessments of the success in the neighboring states. Your stories of what is happening here in California will be important to the citizens of other states throughout the country.

With much appreciation for all of you, for everything you do, and best wishes for the New Year. Let’s keep building affordable coverage for every Californian.