* It downgraded coverage for many who have public coverage now.
* It placed too much financial burden on low-income populations.
* It placed a mandate without condition or exemption even on low-income people who weren’t eligible for public programs or subsidies.
* For those uninsured from 250-400 percent (up to 80K for a family of four), many are more likely to get a employer contribution toward their health care. But even if they don’t, they get a subsidy so that a mid-level (“tier 3”–undefined so far) product is no more than 5.5 percent of income. This means that folks can use whatever subsidy they get to buy a comprehensive plan for more than 5.5 percent (maybe 8 or 9 percent), or buy a cheaper plan (for 2 or 3 percent) that has a higher deductible. This gives them a bunch of help they don’t have now: guaranteed issue, a subsidy/tax credit they didn’t have before, maybe an employer contribution they didn’t have before, and a purchasing pool they didn’t have before to negotiate on their behalf. And they have a choice of paying a little and getting catastrophic coverage, or getting a comprehensive top-tier plan that is still a reasonable percent of income.
* For the uninsured over 400 percent of FPL (less than 1%-350,000), very few of the uninsured are over 400 percent for more thana few months. They get guaranteed issue, a Section 125 ability to pay premiums with pre-tax dollars (which is this income range is probably a 30 percent or more discount), etc. They are the most likely to get a contribution from an employer. There’s also some money booked for subsidy for early retirees, who are the ones most likely to continue to have an issue, given the higher premiums for those over 50. Finally, there is an exemption process if needed, so that people can say that they want temporary or long-term exemptions, based on affordability or hardship.
* Those left uninsured, such as the undocumented, visitors to the states, and others, would get better funded community clinics and public hospitals as a safety-net.
FOR THE INSURED:
* Medi-Cal recipients (6.8 million low-income children, parents, seniors, and people with disabilities) get better access to doctors, hospitals and other providers, due to increased Medi-Cal remibursement rates; they also get better security to keep their coverage, with the removal of the “asset test” that now prohibits their ability to save.
* The many Californians who now buy coverage in the individual market (2.1 million) could get help in a couple of ways. Some will find that their employer will now provide coverage. Those still in the individual market–working but without an employer contribution–will still get the benefit of a Section 125 plan to use pre-tax dollars to pay for premiums. Some may also get, on top of that, a subsidy for those under 400% (or early retirees above 400%). These folks also get the benefit of buying coverage through a purchasing pool. In addition, these folks will have greater security that their premiums can’t be jacked up because of their health status, so people don’t have to fear that they would “use it or lose it.”
* Those who get employer-based coverage now (19 million Californians) would have additional security that their employer won’t be able to completely drop coverage altogether, and the likelihood that they can get coverage even after a job change or other life event, such as divorse, loss of income, etc. Those with lower-incomes might get a subsidy or improved coverage through the public program expansion. Finally, the cost containment may help them in the long term deal with potential rising costs.