What counts as covered?

One more thing about the Governor’s insistence for universal coverage without actually putting forward a plan that gets there.

Let me be clear, AB8(Nunez) isn’t universal either. Again, only SB840(Kuehl) offers full universality.

But AB8 still makes major reforms that makes coverage more available, affordable, and automatic for many. So is the Governor’s plan *more* universal?

The earlier modeling by Jonathan Gruber at MIT shows that both AB8 and the Governor’s plan both would cover the vast majority of the uninsured, although leave some uninsured. The Governor’s plan is credited for covering more–on the scale of 700,000 Californians.

It seems that here are two components.

* While both plans expand public program subsidies to children and parents up to 250% of the federal poverty level (AB8 actually goes to 300%), the Governor’s plan also requests a federal waiver to also expand coverage to adults without children at home.

This is a group neglected now–right now, a childless adults even under the poverty level has no ability to get Medi-Cal. The challenge here is to raise the money, which might trigger a 2/3 vote issue, and the ability to get federal permission, which requires the ability to show savings in Medi-Cal.

* The other reason for the difference is the individual mandate, requiring people in the individual market to take up coverage, even if they don’t get coverage at work or through a public program. There’s a question in the modeling about whether the individual mandate would actually bring in the 95% estimated compliance–or how aggressive the enforcement would have to be to get that. Right now, the requirement for car insurance leaves 15% of drivers uncovered.

Regardless, many of the folks impacting by the individual mandate I would *not* classify as “covered,” such as those that can only afford to get the $5,000 high-deductible minimum plan. As the Its Our Healthcare ads say, “it’s not health care if you can’t afford to use it.”

Even Massachusetts made the decision to exempt people from the mandate, rather than make them pay for coverage that was both unaffordable to get and to use. Call this group the “overcharged and underinsured.” If you can’t raise the money to provide adequate subsidies, then politically and morally, the Governor’s plan would have to at least provide Massachusetts-like exemptions. That would make the difference between his plan and AB8 even narrower.

Short version: When we describe which plans will cover more people, if matters what we count as coverage.

Health Access California promotes quality, affordable health care for all Californians.

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