The Debate Continues on the County Safety-Net and the Remaining Uninsured

Wednesday, May 22, 2013


* As part of California Budget debate, next few weeks will determine implementation of the Affordable Care Act, and California’s commitment to the remaining uninsured.
* As U.S. Senate Judiciary Committee passes immigration reform bill, questions about whether California will provide safety-net care and coverage for those on a “path to citizenship.”
* Governor Brown wants state to cut $300 million-$1.3 billion from the current $1.4 billion fund that now goes to county safety net for public health, public hospitals, clinics, etc.
* Recent Health Access Concept Paper argues for preserving funding for the public hospital safety net, and extending county Low-Income Health Programs for the Remaining Uninsured
* WEBINAR TODAY at 1PM on Safety-Net Care for Immigrants and the Remaining Uninsured

Following the Governor’s May Revision of the State Budget, California legislators are moving quickly to resolve outstanding questions on the implementation of health reform, including the expansion of Medi-Cal, and particularly the issue of funding the county safety-net for the remaining uninsured.
At stake are the funds that support public hospitals, clinics, county low-income health programs, and public health efforts–about $1.4 billion from vehicle license fees that goes from the state earmarked for county health programs.
Governor Jerry Brown has conditioned his support of the Affordable Care Act’s Medi-Cal expansion on a state-county realignment of these funds, wanting the state to get any savings that may come from the ACA reducing the number of uninsured.
Advocates and counties want to ensure the survival of the state’s safety-net of public hospitals and community clinics that are there when we need it, from trauma and burn centers to basic care services for those who have no other option.
The historic Affordable Care Act is estimated to reduce the number of uninsured by one-half to two-thirds, but that would still potentially leave 3-4 million remaining uninsured in California. A majority would be citizens or legal residents, and a significant portion of these will be from communities of color. These communities stand to benefit most from the expansion of health care services but may be hardest to reach and the least informed about health care choices.
Around one million of the remaining uninsured would be immigrants for whom a new immigration process could offer a roadmap to citizenship. The U.S. Senate Judiciary Committee yesterday passed a comprehensive immigration bill, but one that would bar those on a path to citizenship from federally-funded health care for many years.
Numerous community, labor, faith and consumer organizations have recently backed a set of recommendations detailed in a Health Access concept paper entitled, “Continuing California’s Commitment to the Remaining Uninsured.
The paper makes the case for protecting county safety-net dollars, and extending county Low-Income Health Programs to the remaining uninsured. Rather than allowing them to expire at the end of the year when their current enrollees are shifted to the expanded Medi-Cal program, these LIHPs can continue their work to provide more efficient and effective primary and preventative care to the remaining uninsured–not just emergency and episodic care.

The concept has gotten significant support in the legislature, among stakeholder organizations (in this joint statement), and in editorial boards, including:


WEBINAR TODAY: The California Endowment today is hosting an informational webinar featuring community advocates from Health Access and other key organizations to brief partners on the Governor’s proposed May Revise budget and its implications for the safety net. Special consideration will be given to a proposal for the remaining uninsured involving the state’s Low Income Health Programs. Also, updates will be provided on Comprehensive Immigration Reform legislation and its implications on health.

Presenters include: Marielena Hincapie, Executive Director of the National Immigration Law Center (NILC) and Angelica Salas, Director of the Coalition for Humane Immigrant Rights of Los Angeles (CHIRLA), to present on developments on Comprehensive Immigration reform.
On the issue of these county safety-net funds and extending Low-Income Health Programs, presenters include Anthony Wright, Executive Director of Health Access; Vanessa Cajina, Policy Advocate at the Western Center on Law and Poverty; Ronald Coleman, Government Affairs Manager of the California Immigrant Policy Center (CIPC); and Chad Silva, Policy Director of the Latino Coalition for a Health California (LCHC).

Topic: Immigration Reform and Remaining Uninsured proposal briefing
Date and Time: Wednesday, May 22, 2013 1:00 pm, Pacific Daylight Time
Event number: 661 636 580
Event address:
Call-in toll-free number (US/Canada): 1-855-244-8681
Access code: 661 636 580

MORE ON LIHPs AND THE REMAINING UNINSURED: A success story, LIHPs in 53 counties now cover over 550,000 otherwise uninsured Californians, virtually all of whom will become eligible for full Medi-Cal on January 1, 2014. While not full coverage, LIHPs offer more than episodic and emergency room care for the uninsured, providing a medical home with primary and preventative care services. Instead of letting the LIHPs expire, California should extend the LIHPs to the remaining uninsured—both continuing our commitment to all Californians, and using our dollars in the most effective and efficient way. This unique opportunity represents a viable way to fulfill the goal of providing access to care and coverage to Californians regardless of income or immigration status.

1. Confirming that California is undertaking a statewide Medi-Cal expansion, under the Affordable Care Act, along with an aggressive effort to enroll as many Californians as possible.
2. Preserving the state realignment dollars for the first three years, in which the federal government is funding the expansion at 100%, would allow for capacity building to meet the needs of the newly insured as well as the remaining uninsured during this peak.
3. Keeping those state dollars should be contingent on a maintenance of effort requirement to assure counties continue to spend at least what they are spending now, including their own county dollars, on the remaining uninsured, public health and related health needs.
4. Encouraging counties to redirect existing Low Income Health Programs to serve the remaining uninsured; Counties would be encouraged to maintain their LIHP-like or Healthy San Francisco-type programs using these state realignment dollars.
5. Ensuring, after three years, half of state realignment funds continue to go to counties to perform public health functions, as envisioned in the original 1991 realignment, as well as base 17000 safety-net responsibilities.
6. Linking the remaining portion of this funding stream to LIHP enrollment, so counties are funded in line with the demand and their commitment. The first three years provide time when counties have the opportunity to build their enrollment back up, but then the state can yield savings as the ACA is implemented and overall demand goes down.
7. Allocating some state savings to support safety-net institutions through a state funding stream.
8. Instituting accountability and transparency into the state-county relationship going forward.
The broad coalition supporting this proposal includes the AARP, AFSCME, California Immigrant Policy Center, California Labor Federation, California Pan Ethnic Health Network, Latino Coalition for a Healthy California, Health Access California, PICO California, SEIU California, and the Western Center on Law and Poverty.
Their campaign to provide safety-net coverage for the remaining uninsured includes grassroots efforts, media, and is using the hashtag #Health4All on Twitter.
Health Access California promotes quality, affordable health care for all Californians.