In health care, California is far from golden

New statistics this week from the Census Bureau indicated that California jumped to having the fourth-worst uninsured rate in the nation, with more than 21 percent of our non-senior population without coverage. This comes before the expected increase of at least a half-million more uninsured as a result of the current economic downturn, and the impacts of the budget cuts that are expected to double the number of uninsured children.

Californians are more likely to be uninsured than residents of all but three states; those who have coverage are unsure it will be there for them when they need it: will the health plan cover the treatments prescribed? Will coverage be rescinded or revoked? Will they be able to afford future increases in premiums and co-pays? Will the next job even offer coverage? Will I be denied for “pre-existing conditions?”

Over the last several years, California has wrestled with these issues in legislation big and small, and some bills are pending, like AB786(Jones) on reforming the individual market or AB2(De La Torre) on rescissions.

Thankfully, President Obama has made federal health reform his major priority. Last Friday, the U.S. House of Representatives passed a major health reform bill out of the third and final committee, and it will be ready for a floor vote when Congress reconvenes in September.

H.R. 3200, America’s Affordable Health Choices Act of 2009, would dramatically secure and expand health coverage:
•     Making it more likely that people get and keep their on-the-job health benefits;

•     Improving and expanding public health coverage programs like Medicaid, especially for those near or below poverty who currently get no help currently;

•     Providing significant subsidies for low- and moderate-income families (up to 400% of the federal poverty level) to be able to afford health coverage;

•     Placing new rules and oversight over insurers to protect health consumers, from prohibiting denial for pre-existing conditions, to limiting out-of-pocket costs; to ensuring a minimum benefit package; to limiting the amount of premium that goes for administration and profit rather than patient care; to providing a public health insurance option to compete with the private insurers.

Intertwined in the overall package are a range of efforts to contain rising health care costs, from prevention and public health initiatives to better use of information technology and bulk purchasing. The plan depends on “shared responsibility,” with requirements for individuals and employers to contribute to health coverage (but with subsidies for both groups who need it), savings generated from within the health sector, and taxes needed to make the investments that can result in long-term savings.

It’s an exciting notion that health consumers won’t have to pay more than a certain percentage of their income in premiums for health coverage; that they won’t be ever again denied for “pre-existing conditions;” and that when covered they won’t have unlimited liability, but instead a cap on the out-of-pocket costs they may incur.

Especially as this bill gets negotiated with what might come out of the Senate, there will be specific issues to watch:

•    Will the affordability subsidies be enough for both low- and moderate-income families, especially in a high cost-of-living state like California?

•    What will be the final mix to finance health reform, which now includes setting a standard for employer-based coverage to a surcharge on millionaires?

•    Will all Californians be able to get the help with health coverage that is needed?

•    Will consumers have a meaningful choice of a strong and viable public health insurance option?

But moving the bill is crucial to attain those goals, and the House bill, H.R.3200, is a comprehensive vehicle that is supported by dozens of leading consumer, labor, community, patient, and provider organizations, including Health Access California.

California consumers are uniquely suited to have their voice heard in this debate. In the House of Representatives, California is well represented in this debate, from Speaker Nancy Pelosi, to key members of leadership like Rep. Xavier Becerra, on down.

Each of the three committees of jurisdiction for health reform has a senior Californian in a top leadership position: Rep. Henry Waxman chairs the Energy & Commerce Committee; Rep. George Miller chairs the Education & Labor Committee, Rep. Pete Stark is the second senior member of the House Ways & Means Committee, and the chairman of the health subcommittee. Given this leadership and authorship, H.R.3200 can be seen as “made in California.”

Also, California has the largest contingent of both “Blue Dog” and “Progressive” Democrats, who were critical in the back-and-forth negotiations that led to Friday’s passage of the bill through the key Energy and Commerce Committee. The leadership of Progressive Caucus Chair Lynn Woolsey, Black Caucus Chair Barbara Lee, and Asian Pacific American Caucus Mike Honda, and others worked to maintain both affordability subsidies and the public health insurance option.

These leaders, and the other members who voted for H.R. 3200 in committee, should be thanked and encouraged to continue working for health reform. Other members may still need to be convinced, and urged to support reform. Given our grim statistics that are getting grimmer by the day, California looks to disproportionally benefit from national health reform.

This August, members of Congress are back in their districts, and it’s critical they hear the widespread support and urgency for health reform, especially here in California.

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