Health4All & Further Expansions

Quality, Affordable Health Care for ALL Californians

Affordability of coverage and care remains a challenge for too many Californians. Some remain uninsured because coverage is unaffordable or the premium they can afford does not facilitate access to care. Others will face high costs for coverage or care while living in some of the highest cost regions in the country. Estimates of California’s remaining uninsured could be as high as 3 million—even after several years of enrollment experience.

While the ACA provided significant subsidies to millions of consumers, four populations need help:

    • Health4All: Undocumented immigrants are explicitly excluded from financial help for coverage through the ACA, and even from using a state marketplace like Covered California to purchase health coverage using their own money. And while many of the most populous California counties serve the undocumented in their safety-net, too many counties still do not. Yet undocumented Californians are a key part of our community and economy and should be included in our health system as well.
      • Health Access will actively work to get county systems to refocus their indigent care programs to cover the remaining uninsured, including the undocumented, and state funding formulas and waiver negotiations should take that goal into account. We will also seek a smarter safety-net that is focused on providing a medical home and primary and preventive care to the remaining uninsured.
      • Health Access seeks a statewide solution to enroll undocumented Californians in coverage, through a state-only Medicaid expansion and allowing all Californians the ability to buy-in to Covered California.
    • “Family glitch:” The ACA allows workers whose out-of-pocket premium costs are more than 8% of income to obtain subsidies in the marketplace. But an IRS interpretation of the federal law states that if worker coverage costs less than 8% of income, but family coverage costs more than 8% of income, then the family members are not eligible for subsidies. This leaves some spouses and children without an affordable option for coverage. This “family glitch” should be remedied at the federal level. Until then, California should explore providing help as well.

Improved affordability:

Health Access, along with many other organizations, fought for better affordability in the ACA; but for many Californians below 400% of poverty, affordability of premiums and cost sharing remains a real problem. Even with financial assistance, some families are simply not able to afford the premium or the cost-sharing through Covered California. While technically they are not subject to the individual mandate, this offers little solace if they are left with no coverage. Massachusetts and Vermont have supplemented the federal subsidies and we will urge counties to followSan Francisco’s lead in pursuing similar strategies.

  • Under the ACA, all who would spend more than 8% of their income on coverage are exempt from the requirement to have coverage; moreover, for most people the ACA provides protection that no one should have to pay more than 9.5% of income for a basic “silver” plan. But subsidies for coverage are only available up to 400% of the poverty level.  There are consumers, mostly in the 50-64 age range with household income somewhat above the 400% premium subsidy threshold, who, simply because they live in high-cost health care areas, are having to pay premiums higher than 9.5% of their incomes. Especially for a high cost-of-living state like California, providing relief for those having to spend more than 10% or 12% of income, regardless of their level of income, would make the ACA’s affordability guarantee more universal and sustainable.

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 Health Access Analysis & Advocacy