One year later, law’s implementation continues, despite challenges…

Wednesday, December 29, 2010


* New status report of CA implementation after 9 months (1 year since Senate passage)
* Legal and political challenges will get headlines, but work continues
* Californians seeing new protections and options now; January 1 brings new benefits
* Much more work to do in 2011, for California to take full advantage of the law’s promise

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One year after the U.S. Senate first passed the Patient Protection and Affordable Care Act, and nine months since President Obama signed it (with some improvements that followed), Californians are seeing the new options and benefits, and the state is moving forward to fully implement and improve upon the new law.

Last week, Health Access California released a nine-month status report on California’s implementation of the federal health law. Yesterday, California’s efforts got a national spotlight with an extended segment on the PBS NewsHour, which featured HHS Secretary Kim Belshe, Representative Jim Costa, and others including Health Access California.

Challenges persist, including legal and political obstacles at the federal level, and a looming budget crisis at the state level. Here are some highlights from the Health Access blog in December that provide new updates on health policy in California, and put both the victories and challenges in perspective.


* Many wonder what the Republican takeover of the U.S. House of Representatives or the various legal challenges and court rulings will mean for the federal health law passed earlier this year. Some of these attacks are untrue, and/or won’t be a factor, while other threats are in fact, threatening. But others have little chance of ever coming to pass. And it’s important for people to know that the new consumer protections, benefits and options that many families have been anxiously awaiting or have already begun to rely upon will continue.

* While a federal judge in Virginia ruled that one provision of the Affordable Care Act around “individual responsibility” was unconstitutional, he rejected the request to strike down the entire law. It’s important to note that several other legal challenges to the new federal health reform had been dismissed earlier this year, and other judges have upheld the constitutionality of both the requirement for individuals to have coverage, and the new federal law as a whole. So the Virginia case (and a similar Florida case, now being considered) will go to high appeals courts over the next months and year, and likely to the Supreme Court.

* At the state level, the biggest concern for health care and everything else is the state budget crisis. Governor-elect Jerry Brown held budget forums in Sacramento and Los Angeles to explain the depth of the problem, and it’s daunting. It’s important to note that the federal health law has been a benefit, not a burden, to the state’s budget woes.


* New rate review regulations came out from the U.S. Health and Human Services Department requiring insurers to publicly justify their rates. These new regulations, with the new California law SB1163 (Leno) that goes into effect on January 1, will force insurers to give consumers more notice with regard to rate hikes, and to provide the supporting documentation for those increases. As Secretary Sebelius points out in a “White House White Board” video, Anthem Blue Cross’ 39% increases last year had to be retracted because the insurer’s justifications didn’t add up. This is a step for better transparency while health advocates continue to work for rate regulation.

* New estimates presented to the MRMIB Board of Directors suggest the enrollment capacity for the Pre-Existing Condition Insurance Plan to be approximately 24,300. Depending on a number of variables (like how quickly people enroll in PCIP), the federal funding for the program could support as few as 15,400 and as many as 40,400 individuals. The program just started a few months ago, and has over 900 Californians enrolled, so there’s more work to do to let people know about this new option.

* CALPERS reports that their members are seeing the benefits of the new reform, including 27,000 young adults being able to stay on their parents’ health coverage.

* More small businesses are starting to provide coverage to their workers, according to an LA Times report, because of the tax credits in the new federal law.

* It’s good news that California insurers are returning to the market to sell child-only policies, because of a Health Access California-sponsored law, AB2244(Feuer), that goes into effect January 1. One of the most important gifts an uninsured child can receive this holiday season is the gift of health care. Nearly 7 out of 10 uninsured children in California are eligible for a health coverage program but not enrolled, so help us spread the word to parents that coverage for their children is available. The President also advanced the cause of children’s health by signing into law the bipartisan-supported Healthy, Hunger-Free Kids Act.


* The issue of “junk insurance” got more attention with a U.S. Senate hearing on the issues, which featured California Senator Barbara Boxer. There’s more to do to phase-out these plans by 2014, when more of the federal health reform takes effect.

* California has been long remiss in not requiring maternity coverage as a basic benefit, and this has allowed major coverage gaps in our states, especially for those who buy coverage as individuals. As reported in an LA Times article by Duke Helfand, Governor Schwarzenegger has vetoed several bills to mandate maternity coverage—but perhaps a new Governor will be more inclined.

* While California is being spotlighted for its aggressive implementation of federal health reform, it is passing on a competitive funding opportunity for states to design information technology infrastructure for operating health insurance exchanges. With or without this “Early Innovator” grant, there’s a lot more for California to do to simplify and streamline our eligibility and enrollment systems to be ready in 2014.

* For our ongoing work we have excellent new and returning chairs of key health and budget committees, in both the state Senate and the Assembly. It was also good that Governor Brown also made his first two appointments in the areas of health and the budget, showing the urgency of both issues. And there’s a new director at the Managed Risk Medical Insurance Board, which runs the high-risk pools for those denied for pre-existing conditions, Healthy Families, and Access for Infants and Mothers.

* The National Association of Insurance Commissioners (NAIC) has just reappointed Elizabeth Abbott, our director of administrative advocacy at Health Access California, as a designated consumer representative. She will be one of 27 consumer liaison representatives for 2011. Former Consumer Representative, Wendell Potter has been making his way through California on a book tour, promoting his book, Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans.

There’s a lot more work to do. Please consider Health Access in your year-end giving, and may you have a happy and healthy new year. As always, more information on the budget and health reform is available on our website at

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