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By many measures, the rambunctious campaign for a single-payer health-care system in California appears to be struggling.

A bill that would replace the existing health-care system with a new one run by a single payer—specifically, the state government—paid for with taxpayer money remains parked in the Assembly, with no sign of moving ahead. An effort by activists to recall Assembly Speaker Anthony Rendon for shelving the bill has gone dormant. And an initiative that would lay the financial groundwork for a future single-payer system has little funding, undercutting its chances to qualify for the ballot. 

But even if single-payer is a lost cause in the short term, advocates are playing a long game. For now, it may well be less a realistic policy blueprint than an organizing tool.

And by that metric, advocates are making gains.

Riding a wave of enthusiasm from progressive Democrats, supporters of single-payer have effectively made it a front-and-center issue in California’s 2018 elections. It’s been discussed in virtually every forum with the candidates running for governor, emerged as a point of contention in some legislative races, and will likely be a rallying cry at the upcoming California Democratic Party convention.

“This issue is not going away,” said Garry South, a Democratic political consultant who has worked with the California Nurses Association, which sponsored the stalled single-payer bill. “The progressive elements who are supportive of the single-payer concept know that it’s not going to happen now; it’s not going to happen tomorrow. It’s a long-term process, and Jerry Brown is gone as of January 2019.”

The governor has not needed to stake a position on the bill, because it skidded to a stop in the Assembly last summer without reaching his desk. But state Sen. Toni Atkins, a San Diego Democrat who co-authored Senate Bill 562, said Brown was not receptive. Analyses peg the cost of a statewide single-payer system at between $330 billion and $400 billion—far exceeding the state’s entire budget. That made it an anathema to Brown’s record of prioritizing fiscal stability for state government.

“When the governor saw that we introduced that bill… all he could look at me and do is shake his head and say, ‘$400 billion dollars.’ And I kept trying to say, ‘Can we back up and talk about what you've got to do to get (there)?’" Atkins said in an interview.

“He wasn’t letting it go.”

Atkins, who will take over as Senate leader next month, said she’s not giving up on the goal of single-payer, but does not expect it to happen this year. “People are polarized on this issue in a way that’s not good for coming together to get it done,” she said.

Led by the nurses association—a labor union that embraces firebrand activism—supporters of single-payer have targeted Rendon after he shelved the bill last summer, saying it lacked critical information on how to pay for a massive overhaul of the healthcare system. They peppered social media with images that not only portrayed the bill fight as a boxing match between Rendon and the nurses, but also depicted a knife labeled “Rendon” back-stabbing the bear symbol of California.

The nurses were not involved in the campaign to recall Rendon, said recall organizer Stephen Elzie, who has since dropped the effort and is now helping Democrat Maria Estrada challenge Rendon’s re-election bid. But the nurses union leapt into the governor’s race as one of the first labor unions to endorse Lt. Gov. Gavin Newsom. Single-payer has emerged as one of few issues on which the Democratic candidates disagree.

Newsom and Delaine Eastin, the former state superintendent of schools, have both said they support the nurses’ single-payer bill. Fellow Democrats Antonio Villaraigosa, former mayor of Los Angeles, and John Chiang, the state treasurer, say they want to expand health care so that everyone is covered, but not necessarily with the single-payer model that would abolish private health insurers and replace them with a government-run system.

A coalition of medical groups is lobbying against the single-payer bill, arguing that it makes more sense to protect and expand the federal Affordable Care Act, which has increased the number of Californians who have health insurance. Some members of the coalition have a history of spending big money to sway California elections. One of them, the doctors’ association, donated to Newsom before he voiced support for single-payer; it’s not yet clear if they will shift support to another candidate. 

Almost two-thirds of Californians like the idea of a statewide single-payer health-care system, although enthusiasm drops significantly if it would require raising taxes, according to polling last year by the Public Policy Institute of California. Still, Californians didn’t cite health care as a top priority when asked last month what the Legislature and governor should focus on in 2018.

The Assembly just wrapped up a series of hearings on what it would take to create a health-care system that covers all Californians. It exposed many obstacles—in both federal and state law—to swiftly enacting single-payer. For one, the state would need permission from the federal government—and perhaps an act of Congress—to shift billions of dollars from Medi-Cal and Medicare into a state-run single-payer plan. For another, if lawmakers raised taxes to fund single-payer, voters would likely need to approve changes to the California Constitution to allow the money to go to health care instead of schools. (That’s the only single-payer initiative that someone is trying to get qualified for the ballot; while a Silicon Valley tech consultant is gathering signatures for it, he doesn’t have support from the nurses’ union or any other well-financed group.)

Assemblyman Jim Wood, a Healdsburg Democrat who chaired the panel, called the single-payer bill “aspirational” and said he’s instead considering legislation that could help more Californians get health care without requiring permission from the federal government. One idea: extending subsidized health plans to adults who are undocumented immigrants.

“I believe we can actually get to single-payer, once we go through a lot of study and a lot of work,” Wood said. “But this feels, at times, more like a litmus test.”

CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

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California’s Democratic legislators want to extend health benefits to undocumented young adults, the continuation of an effort that ushered children without legal status into the state’s publicly funded health care system last year.

It is unclear when the program would start or how much the state would spend if the proposal, which could cost up to $85 million a year, is approved by Gov. Jerry Brown. Lawmakers are working out details ahead of their June 15 deadline for passing a new budget.

The plan would provide full-scope coverage for 19-to-26-year-olds who qualify for Medi-Cal, the state’s name for Medicaid. Currently, the federally funded program covers only emergency visits and prenatal care for undocumented residents. Under the proposal, revenue from taxes on tobacco products would absorb expenses for all other coverage.

Democratic Sen. Ricardo Lara of Bell Gardens has been one of the strongest voices for expanded care. In 2015, he pushed for coverage for all adults. That proposal was changed to admit only undocumented children; it took effect last year. This year, he said in a recent video message to supporters, “We are going to make the final push to ensure we capture our young adults.”

Supporters’ ultimate goal is to include all undocumented adults, said Anthony Wright, executive director of Health Access California, a health care consumer group backing the proposal.

“We believe without coverage, people are sicker, die younger and are one emergency away from financial ruin. It has consequences for their families and their communities—both health and financial consequences,” he said.

The plan would mean that undocumented children currently in the program would not age out at 19, putting low-income undocumented immigrants on par with those allowed to stay on their parents’ insurance under the Affordable Care Act (often called Obamacare) until they are 26.

Republican Sen. John Moorlach of Costa Mesa opposes an extension of benefits. One reason is financial: California doesn’t have “a balance sheet we can brag about,” he said, citing the state’s debt load, among other reasons.

Secondly, he disapproves of illegal immigration. Moorlach migrated to the U.S. legally as a child with his family from the Netherlands.

“I’m kind of offended that we feel an obligation to pay for expenses for those who did not come through the front door,” he said. “I certainly have compassion and want to help people in need, but I’m having difficulty, as a legal immigrant, because we are already in such bad fiscal shape.”

Advocates argue that undocumented immigrants help propel California’s economy with their labor and the taxes they pay, and that they cost the state money when they don’t work because of illness or when they end up in the emergency room.

“Health care is a right,” said Ronald Coleman, director of government affairs for the California Immigrant Policy Center, an advocacy organization and supporter of the proposal. “These are folks we are investing in through the California Dream Act and through other programs our state offers, and it makes sense to invest in our future, which our young adults will be.”

Estimates vary for how many people this expansion of Medi-Cal would serve and what the costs would be. Each house of the Legislature has passed its own version of the proposal, with differing figures attached.

The Assembly allocated $54 million a year to cover an unspecified number of additional enrollees, with a July 2017 start date. The Senate proposed $63.1 million in the first year, beginning in 2018, and $85 million annually thereafter, also without specific population numbers.

Coleman’s center, which is working closely with lawmakers on the issue, estimates about 80,000 new people would be eligible, and the cost would be around $54 million a year. That assumes the federal Deferred Action for Childhood Arrivals program continues, because it provides access to Medi-Cal. If DACA were eliminated, the figures would increase to about 100,000 eligible people and about $84 million in annual costs, Coleman said.

The governor’s proposed budget does not include the proposed expansion or any money for it.

Kevin, a 19-year-old Angeleno who asked that only his first name be used, because he lives in California illegally, wants the proposal to succeed. He has been working for more than a year to distribute information about Medi-Cal children’s coverage to immigrant families.

He meets all but one of the requirements for DACA: He was not in the country before June 15, 2007. He arrived in the U.S. in 2011 at age 14 from Guatemala, on a visa that later expired. He graduated high school, has no criminal record and is now majoring in business administration at California State University, Los Angeles.

“There’s this misunderstanding that young people are healthy,” said Kevin, who suffers from eczema. He worries about the chronic condition flaring up. “When it gets worse, it doesn’t let me do anything with my hands.”

He is enrolled in a county health insurance program for low-income residents, but he can’t afford a dermatologist. He can barely pay for the prescription lotion he uses for the eczema, and sometimes goes without it.

“We are trying to have a better economic standard, and we are like the building blocks of this society,” he said. “Having health insurance will allow us to focus more on school and do our regular day-to-day activities. A healthier society works better for everyone.”

If lawmakers can now agree on details, a consensus proposal will go to the full Legislature for approval. The deadline for that is June 12.

CALmatters.org is a nonprofit journalism venture dedicated to exploring state policies and politics.

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Editor's Note: While the Independent has a policy against running press releases, we've agreed to run this piece from Covered California, as it contains important information about the availability of health insurance—which can be a life-changing situation. 

Despite the best-laid plans, life can sometimes throw you a curveball.

So it is with health care.

After months of planning, promotion and outreach, Covered California successfully completed its first open enrollment period of the historic Patient Protection and Affordable Care Act—helping more than a million consumers gain health insurance coverage.

Some people, however, may have had a change in life circumstances since open enrollment ended on March 31, and suddenly, they have a new need for coverage. If so, the door is not closed. They can still gain coverage through Covered California’s special-enrollment option.

“We continue to remind people that we still are open for business,” said Covered California executive director Peter V. Lee.

Through Nov. 15, 2014, consumers can sign up for health insurance as long as they do so within 60 days of a qualifying life event. The following circumstances are among the more common reasons that make someone eligible:

• They lose their health care coverage because they’ve lost or changed jobs.

• They lose their Medi-Cal coverage.

• They get married or enter a domestic partnership.

• They have a baby, adopt a child, or place a child in adoption or in a foster home.

• They move and gain access to new Covered California health insurance plans that were not available where they previously lived.

• They become a citizen, national or lawfully present individual.

For other examples that may qualify you for coverage through special enrollment, visit www.CoveredCA.com/coverage-basics/special-enrollment.

You must report changes and select a plan within 60 days of the qualifying life event to purchase a Covered California health insurance plan outside of open enrollment. Medi-Cal is available all year, however, and no qualifying life event is required to enroll in Medi-Cal.

If you have additional questions about whether you qualify for a special-enrollment period, you can call the Covered California Service Center at (800) 300-1506.

How do I avoid gaps in coverage?

You will need to plan ahead to avoid gaps in health coverage. It helps to know that in general, the start date for coverage depends on the date you enroll. If you enroll by the 15th day of the month, your coverage will start on the first day of the next month. If you enroll after the 15th day of the month, your coverage will start on the first day of the second month. For example, if you enroll on Aug. 13, your coverage will start Sept. 1. If you enroll on Aug. 16, your coverage will start Oct. 1. You can use this rule as a guideline to help plan your new coverage and avoid gaps.

(Note: If you go without coverage for three consecutive months during the year, and you don’t fall under an exemption permitting you to do so, you will be subject to a tax penalty.)

For most qualifying life events, the start date for coverage depends on the date you enroll, as described above, but there are a few exceptions:

• If you lose your Medi-Cal coverage, job-based coverage or other coverage, and you use a special-enrollment period, your coverage would start on the first day of the next month following your plan selection, regardless of when during the month you make your plan selection.

• If you get married and use a special-enrollment period, your coverage will start on the first day of the next month following your plan selection, regardless of when during the month you make your plan selection.

• If you have a child, adopt a child or place a child in adoption or foster care, and you use a special-enrollment period, your coverage starts on the date of the birth, the adoption or the placement for adoption or foster care.

• On a case-by-case basis, Covered California may start your coverage earlier.

Larry Hicks is the public information officer for Covered California.

Published in Community Voices

Michelle Brodeur makes regular trips to Mexico for her eyeglasses and contacts.

At 50, the self-employed graphic artist and writer is in good health. That’s a good thing, too, because Brodeur hasn’t had health insurance in nearly a decade—and her uninsured status isn’t about to change any time soon, despite the roll-out of the Affordable Care Act.

Brodeur, who earned about $23,000 last year, said she makes too much to qualify for free or reduced-cost Medicare or Medi-Cal, expanded under President Barack Obama’s signature health-care reform effort, dubbed “ObamaCare.” With insurance plans that she considers decent starting at roughly $175 per month for her, Brodeur said her premium would be too big of a financial bite.

So, Brodeur said she’s opting out.

“If it was $95 or $100 a month, I’d be able to manage,” said Brodeur, who lives in Palm Springs, where the median per-capita income is $36,627. “It’s a conundrum. I’ve not had insurance since I lost my job nine years ago.”

Early efforts to get people to sign up for insurance under the controversial law got off to a rocky start with lagging enrollment numbers, after much-publicized glitches at healthcare.gov. (California’s signup site, Covered California, at www.coveredca.com, worked much better, though it did suffer through some glitches.)

The fine for opting out this year is relatively small—$95, or 1 percent of a person’s income, whichever is greater. But the fine incrementally increases to $695 by 2016, or 2.5 percent of a person’s income. After 2016, the penalty is indexed to inflation.

Brodeur’s far from alone when it comes to opting out.

The UC Berkeley Labor Center estimated in a 2013 report that nearly 4 million Californians under the age of 65 this year will be eligible for health insurance, but will not get coverage. The reasons vary.

“Any time coverage has expanded in the past, it’s taken at least a few years for enrollment to scale,” said Laurel Lucia, a policy analyst at the University of California at Berkeley Center for Labor Research and Education. “As people figure out the system and the system improves, more people will get coverage.”

Some opt out simply because they do not qualify for Medi-Cal or the exchange subsidies. Others find the enrollment process confusing and cumbersome. About a million will be ineligible because of their immigration status. And roughly 400,000 Californians will find the exchanges, as Selena Solis has, unaffordable.

The 19-year-old Columbia College Hollywood student said she hasn’t decided whether she’ll get insurance or pay the fine.

“I’m still debating whether or not I should,” said Solis, who graduated from Palm Springs High School in 2012. “I work two jobs. I just can’t fit another bill into my budget.”

The Obama administration has struggled to sign up young invincibles like Solis. She’s a prized demographic, among the people age 18 to 34 who are relatively healthy and inexpensive to care for—and who are necessary for the pool to subsidize older enrollees.

“I understand that it’s for my own benefit, but what if it’s something I really just do not need at the moment?” Solis said.

Experts say about 40 percent of enrollees need to be young and healthy for Obama’s signature program to succeed.

In three months since the October roll-out, 23,417 Riverside County residents enrolled in the health-care exchanges, according to Covered California, which released a report in January. That number is 58 percent of the 40,377 the agency expects to enroll during open enrollment, which began Oct. 1 and ends March 31. Of the counties highlighted in the January report, only Fresno and San Bernardino counties had a smaller percentage of the uninsured enrolling compared to projections, with 47 percent and 45 percent, respectively.

“We are focusing in a regional campaign to increase those numbers in those counties,” said Edith Lara-Trad, a Covered California spokeswoman. “The good news is that we have (more time) to work on this.

“We are very confident that we are going to reach those numbers.”

Latinos, African Americans and the young are being targeted for the agency’s outreach and education efforts, Lara-Trad said.

In the first three months of the enrollment period, more than 500,000 people statewide—86 percent of the six-month projection—had enrolled in plans through Dec. 31, the agency reported. 

Covered California is the state’s health-care marketplace, created under the Affordable Care Act to offer coverage to the uninsured.

The Congressional Budget Office estimates 6 million Americans will pay the opting-out penalty in 2016. It is unclear how many will elect to pay the fine this year.

An estimated 48 million Americans—or nearly 16 percent of the nation—were uninsured in 2012, according to the U.S. Census Bureau.

In California, an estimated 7.3 million people—or roughly 19 percent of Californians—were uninsured, according to a 2012 report by the California HealthCare Foundation.

Signed into law by Obama in 2010, the Affordable Care Act was enacted to insure more Americans and lower skyrocketing health-care costs. It represents a significant overhaul of the U.S. health-care system, the first since 1965 with the passage of Medicare and Medicaid.

“It’s a shitty system. I understand what they’re trying to do. I just wish it had been a single-payer (system),” said Brodeur, referring to a health-care system paid for by the government rather than private insurers.

“They did it wrong, in the spirit of compromise.”


About the penalty

For the Affordable Care Act to work, it requires everyone who can afford health insurance to purchase health insurance. Those who don’t will face a penalty.

In the first year, the penalty is $95 per adult and $47.50 per child, or 1 percent of the yearly household income, whichever is greater.

That fine jumps incrementally over the next two years, to 2 percent, or $325 per person in 2015; and 2.5 percent, or $695 per person, in 2016. After 2016, the penalty is adjusted for inflation.

If you happen to be uninsured for part of the year, one-twelfth of the penalty applies to each month you’re not covered.

After open enrollment ends March 31, no one will be able to get health coverage through the marketplace until the next annual enrollment period, absent a qualifying life event such as moving to a new state, getting married or divorced, or having a child.

Source: healthcare.gov


By the Numbers

The Affordable Care Act was an ambitious and historic piece of legislation signed into law in 2010 to extend health insurance to uninsured Americans in 2014. In California, officials estimate the new law, which requires individuals to purchase or otherwise acquire health insurance, will lead 4.6 million people to enroll.

Here’s a look at the uninsured and enrollment in California:

  • About 7 million Californians were uninsured in 2013.
  • 6.4 million Californians received Medi-Cal insurance in 2013.
  • More than 1.6 million Californians have signed up for coverage via Covered California, Medi-Cal or Medicare through Jan. 31.
  • Young invincibles are enrolling at a rate of about 26 percent. Healthy 18 to 34 year olds represent about 25 percent of the state’s population.
  • Latino enrollment statewide is about 28 percent. Even still, two-thirds of Latinos are estimated to remain uninsured, although they will comprise roughly 45 percent of the state’s population in 2020. Latinos remain a key demographic because people of color are more likely to be without health insurance.

Source: Covered California, UC Berkeley Labor Center, Kaiser Family Foundation.

Editor's note and correction: A previous version of this story said that plans for Michelle Brodeur started out at $175; actually, basic plans for Brodeur would start out at around $75. Brodeur researched a variety of health care plans with differing salary ranges through Covered California, looking for the best deal. The $175 monthly premium she found was the amount she most readily recalled, not the cheapest plan. Having recently again gone over her options, Brodeur said she will still opt out of purchasing a health care plan through the exchanges in 2014.

Published in Local Issues

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