Inauguration Day!

Inauguration day in Sacramento always brings the possibility and excitement of the new–even if it is when key political leaders get re-elected. Both Governor Jerry Brown and Insurance Commissioner Dave Jones invoked health care and the Affordable Care Act, and their comments are worthy of mentioning.

Governor Jerry Brown began his historic fourth term with an inaugural address that cited the progress made in the last four years in a range of areas, from the economy and the budget to education and health care. On health reform, he stated: 

“Two years ago California embraced the Affordable Care Act, dramatically increasing its health insurance coverage under the Medi-Cal program. The state will enroll 12.2 million people during this new budget year, a more than 50 percent increase. Providing the security of health coverage to so many Californians who need it is the right thing to do. But it isn’t free. Although the federal government will temporarily foot much of the bill, new state costs – now and more so in the future – will run into the billions.”

The Governor is correct that expanding coverage under the Affordable Care Act was the right thing to do–in a state that took full advantage of the new opportunities under the Affordable Care Act, over 3.5 million Californians got newly covered under the new options and benefits in just the first year. Not only did California cut its uninsured rate in half in 2014—a dramatic reduction for a problem that some had considered insolvable, but we made major improvements and instituted new protections in the health care system for all Californians, not just the newly insured.

However, the Governor overstated the state costs of expanding coverage, which are minor in context and given the benefit. In fact, the federal government will pick up much of the bill permanently, not just temporarily. All subsidies in Covered California are financed through the federal Affordable Care Act, with no state participation. In Medi-Cal, the federal government is covering 100% of the cost of the newly eligible for the next two years–but even in 2020 and beyond, that share will be go down to 90% permanently. While there is a cost, the benefits are big: the Affordable Care Act is a boon, not a burden, to the state’s health system, economy, and budget.

We appreciate the Governor’s partnership in making the Affordable Care Act work, and the work that has been done and is left to do in health reform will be as big a part of his legacy as his visionary focus on infrastructure and climate change. The work ahead must include making it easier to sign up for coverage, and ensuring consumer protections that patients have access to the care they need when they need it. Finally, California can and should continue and extend its history and policy of covering immigrants excluded from federal health programs. The Governor cited key steps he has already taken to include immigrants into the fabric of California life, recognizing that immigrants are essential parts of our economy and society–we need to take the next step, to include immigrants in our health system as well.

Insurance Commissioner Dave Jones started his speech after being sworn in with some humor about the many television ads against Prop 45, joking that his travel schedule was going around the state looking over doctor’s shoulders interfering with their medical decisions. He then outlined some broad goals out of his immediate jurisdiction but of interest: education, income inequality, and climate change.

In his role as Insurance Commissioner, her cited his four goals as: 1) earthquake preparation; 2) consumer protection; 3) fostering a vibrant insurance market, and 4) implementing the Affordable Care Act. On that fourth one, he highlighted the work to date, stating he worked with Covered California and other state departments (including DMHC which regulates much more of the health insurance market), but he promised to be an “independent regulator,” not afraid to disagree with other leaders on health reform if he felt it was right.

Four years ago, he started his term by signing emergency regulations on health reform, and this time was no different–he announced new regulations on provider directors and network adequacy, which we will comment on in a separate post. But he clearly wanted to project that he would continue to be active in this arena.