Spotlight on County Efforts to Win #Health4All


Thursday, April 9th, 2015



* SB4(Lara) included in key immigrant rights package endorsed by CA legislative leadership, including Senate President Pro Tem De Leon and Assembly Speaker Atkins, as well as by Latino Legislative Caucus. Bill, to be heard as early as next Wednesday, April 15th, in Senate Health Committee, would expand Medi-Cal to income-eligible Californians regardless of immigration status, and also get federal waiver to allow all to buy coverage with their own money in Covered California.

* FRESNO County Board of Supervisors voted Tuesday, 3-2, to continue a revamped county indigent care program for undocumented residents, allocating $5 million for specialty care, as per a bill last year to provide such flexibility.

* Other counties moving forward as well (as shown in a recent Health Access report on county indigent care programs): Sacramento County considering restoring programs cut in 2009, weighing options in a recent workshop by Board of Supervisors. 

* WEBINAR TODAY APRIL 9TH at 11AM ON COUNTY INDIGENT HEALTH CARE: Register for this overview of Health Access’ recent report on “Reorienting the Safety-Net for the Remaining Uninsured: County Indigent Care Programs After the ACA.”

* NEW COUNTY PROFILE RELEASED TODAY on lessons from Alameda County’s Measure AA campaign last year, which extended a 1/2-cent sales tax to fund the county health care safety-net.

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This past week provided new momentum to the effort to ensure care for all Californians regardless of immigration status, at both the state and county level.

CALIFORNIA: On Tuesday, key California legislative leaders, including Senate President Pro Tem Kevin De Leon and Assembly Speaker Toni Atkins, announced their support for a package of ten immigrant rights bills, including the #Health4All measure SB4 (Lara).

The bill, which came out with new amendments earlier this week, would expand Medi-Cal coverage for income-eligibility Californians regardless of coverage, and seek a federal waiver to allow all Californians to purchase in Covered California. the state’s marketplace or exchange under the Affordable Care Act. The bill would cost a fraction of last year’s similar SB1005 proposal, both because it focuses financial help on lower-income folks eligible for Medi-Cal (while allowing those with higher incomes to buy into Covered California with their own money, unsubsidized), and because part of this population is expected to get covered when the President’s executive order on immigration is upheld in the courts.

Citing the significant contribute of immigrants to the state’s history, California legislators urged federal lawmakers to undertake immigration reform, but in the absence of such movement, they vowed to continue state efforts to integrate and include undocumented immigrants into California life. They made the point that California’s health system is stronger when everyone, regardless of immigration status, has access to affordable care. They said that just as roads are safer if all drivers can be licensed and insured, similarly our health system is stronger if everyone has access to primary and preventive care, and not subject to the financial insecurity of being uninsured.

In addition to this package of immigration bills that have legislative leader backing, SB4(Lara) also is included on the priority bill list for the 22-member California Latino Legislative Caucus, which was announced on Wednesday. This gives further momentum for this proposal, which may be heard as early as next week on April 15th in Senate Health Committee.

FRESNO COUNTY: Also this Tuesday, the Fresno County Board of Supervisors voted 3-2 to continue a revamped county indigent care program, by allocating $5.6 million to provide specialty care for the remaining uninsured otherwise excluded from Medi-Cal and other programs.

Fresno Supervisors Brian Pacheco, Buddy Mendes and Henry R. Perea voted in favor of the staff recommendation. Supervisors Debbie Poochigian and Andreas Borgeas voted in opposition. This was the culmination of nearly two years of debate and discussion, which almost led to Fresno being the only county in the state to roll back eligibility in health coverage since the Affordable Care Act was passed: the county had successfully sued to get out from a legal injunction to provide care to the undocumented, and even voted in late 2014 to dramatically reduce its indigent care program, pending further negotiations. However, at the end of this sometimes contentious debate, Fresno voted Tuesday to continue to provide at least some basic health care to all their indigent residents.

Filling in between the primary care provided by some community clinics, and the hospital emergency room services already offered, the County is allocating $5 million made available through a recent law, AB2731(Perea), to provide the County some budget flexibility. If spent on needed indigent health care, the existing state safety-net funding stream, even under the AB85 reallocation, should reimburse that amount into the future. Advocates saw Fresno’s action as not just a lifeline for Fresno families directly impacted, but is an important indicator for inclusion that crosses county lines. The fact that Fresno is continuing their decades-long commitment to provide indigent care—even in a different way—helps build momentum for a statewide solution.

Fresno County thus continues to be one of 10 counties that provides non-emergency care to the undocumented, as shown in a recent Health Access report.

SACRAMENTO COUNTY: As the report indicates, while about ten counties report serving undocumented Californians (although in different ways), more are looking at their options. Three counties that used to provides services to undocumented Californians but stopped during the recession in 2009–Contra Costs, Sacramento, and Yolo–are all considering restoring such services.

Most recently, the Sacramento Board of Supervisors held a workshop weighing different options for providing such care, and over 500 community leaders and members came to show their support for #Health4All. While no decisions were made, at the end of the workshop, Board of Supervisors Chair Phil Serna and newly elected Supervisor Patrick Kennedy both indicated their strong support for providing health care services for the remaining uninsured including the undocumented. Recognizing the “improved situation of the county from 2009 but continued budget demands, Supervisor Don Nottoli also indicated that “we should craft something to help fill the gap.” The Board directed staff to further work up proposals over the next months.

Both Sacramento and other counties are weighing these decisions this spring, in time for new policies to be adopted along with their county budgets that start July 1, 2015.

NEW PAPER TODAY ON ALAMEDA’S MEASURE AA CAMPAIGN: With all the interest in county-based health coverage, Health Access is releasing the first in a series of “profiles in county coverage” today. This first paper, “Winning Revenues for the Remaining Uninsured” focuses on lessons learned from the Measure AA campaign in Alameda County, which passed by 75% of the vote last June to extend a 1/2-cent sales tax to support the county safety-net there.

WEBINAR TODAY ON COUNTY INDIGENT CARE PROGRAMS: Health Access and allied organziations reported on all these developments in Fresno, Sacramento, Los Angeles, Contra Costa, Alameda and other counties on a California Endowment webinar this past Thursday, to present on Health Access’ recent report, “Reorienting the Safety-Net for the Remaining Uninsured: Findings from a Follow-Up Survey of County Indigent Health Programs After the Affordable Care Act.”. The webinar slideshow is online, as is a recording of the presentation.