Many recent health care reform proposals have included some form of “individual mandate” — a legal requirement that every citizen obtain adequate health insurance coverage. People who don’t receive coverage through their employer or some other group would be required to purchase their own individual coverage; failure to do so would result in fines or other penalties. This background report from the California Research Bureau looks at the pros and cons of the individual mandate — how many uninsured people would likely be covered, the costs of implementation, administration, and enforcement, and likelihood of compliance, based on similar policies in other areas (auto insurance, child support payments, immunizations).
As the Obama administration continues its push for health-care reform, many have voiced concern over the economic cost of enacting health-care reform during a time of economic crisis. Looking at the issue from another angle, the UC Berkeley Center for Labor Research and Education examines health coverage trends to calculate the costs of not acting on reform proposals. By 2012, they predict a possible increase of 4.2 million uninsured working-age adults in the United States and 600,000 uninsured working-age adults in California over pre-recession 2007 levels.
The federal stimulus package includes roughly $36 billion in outlays over six years for health information technology. The California HealthCare Foundation has a number of recommendations for how California can compete for and use the state’s fair share.
While 2007 saw small gains in the number of Californians with health insurance, data suggests that the recession of 2008 will reverse that trend. The safety net that Medi-Cal and Healthy Families have provided for many children and some adults will be in greater demand if the recession deepens and persists, as is expected.
The Dartmouth Atlas Project prepared this report for the California HealthCare Foundation, graphically demonstrating that “it’s not just who you are that matters in health care, it’s also where you live.”
Several new reports mine data from the California Health Interview Survey and other sources to provide a perspective on the health of California’s children. The bottom line: children in California are not as healthy as they could be. In particular, low-income and Latino children face multiple obstacles and consequently bear a disproportionate burden of health problems. According to a related report, Mexican-origin children and youth have less access to public health programs in comparison with immigrants from other regions and the white U.S.-born population.
Just in time for the November 4 election, the Reason Foundation has released a slew of reports on California ballot measures. The bond measures Prop. 1A High Speed Rail, Prop. 3 Children’s Hospitals, Prop. 10 Alternative Fuel Vehicles, and Prop. 12 Veterans’ Bonds, are treated in a single report. Prop 1A, Prop. 5 on Nonviolent Offenders, and Prop. 11 on Redistricting are covered more thoroughly in separate studies. For another perspective on the redistricting initiative, see the report from the Center for Governmental Studies. If after reading these you’re still undecided, check out the abundant resources on the ballot measures compiled by the Institute of Governmental Studies Library at Election 2008 Hot Topics.
Governor Arnold Schwarzenegger and Assembly Speaker Fábian Núñez filed with the state attorney general’s office their health care reform initiative today. Titled the Secure and Affordable Health Care Act of 2008, the measure will appear on the November 2008 ballot, assuming that it clears two major hurdles: getting 700,000 signatures required to appear on the ballot, and clearing the State Senate. The measure could also face legal challenges because its mandate for employer contributions may conflict with federal law.
The health care reforms in the measure would be financed in part by increasing the state cigarette tax from 87 cents to $1.75. At least one major tobacco company, Philip Morris USA, has already indicated that it will oppose the measure. Opposition is also expected to come from major insurance companies, pharmaceutical corporations, and state business groups.
Update: A US District judge ruled on December 26 that a key component of the Healthy San Francisco program — the provision mandating employer contributions — conflicted with the Employee Retirement Security Act of 1974 (ERISA). The San Francisco City Attorney has requested a stay on the ruling. A December 28 Orange County Register editorial calls this ruling “an indirect, but potentially debilitating blow” against the state health care reform initiative.
According to a recent Field Poll, Californians back the health reform package supported by Governor Schwarzenegger and Assembly Speaker Núñez (known as AB1X 1) by a margin of 64-23%. A somewhat narrower majority (63-33%) supports the idea of a 2% cigarette tax to pay for the reforms. As the director of the Field Poll, Mark DiCamillo, was quoted as saying in a San Francisco Chronicle article, “This is very significant support. There’s a lot of combinations of ideas that would not be palatable with the public — but this is one that the public is cheering on.”Media reports have noted that significant questions remain about the financing of the reform package and its legality under federal law, since a major component of the package involves mandatory employer contributions.
The Assembly approved the health reform package on Monday (without approving the approximately $14.4 billion that it will take to finance the reforms if they are fully implemented). However, State Senator Don Perata (D-Oakland) has issued a statement indicating that he will not be in favor of the Senate taking up consideration of AB1X 1 until the Legislative Analyst’s Office completes a fiscal analysis of the proposal’s possible impact on the state budget.
See our summary of the main points of AB1X 1 and other recent health care reform proposals here.
Update: The Governor and the Assembly Speaker on December 24 formally filed the health care reform package as an initiative for the November 2008 ballot. See details here.
Retail clinics — small walk-in facilities typically based in drugstores and supermarkets, staffed by nurse practitioners, and offering a menu of limited and routine-care health services — are on the rise across the country. There were only 62 retail clinics open nationwide at the start of 2006. There are predicted to be over 1500 open by the end of 2008.
According to a report from the California HealthCare Foundation, retail clinics help fill a health care gap for the uninsured and the underinsured that it otherwise falls almost exclusively to emergency rooms to cover. The report notes that retail clinics offer low-cost services to people without health insuarnce and provide substantial savings. For instance, diagnosis of strep throat or a urinary tract infection at a retail clinic could represent a savings of $240 or more over an emergency room visit. One big obstacle in the way of retail clinic success is finding money to stay open long enough to turn a profit. Wellness Express, a Sacramento-based firm which got a substantial amount of news media attention when it started opening clinics in 2005 and 2006, had to shut down in November 2006 because of a lack of funds.
According to the report, most retail care clinics are currently in the Midwest, East Coast, and South, with only about 20 retail clinics open statewide in California at present. But that number is expected to rise.