Three Ways that Access to Health Care in California Improves This Year, Despite Federal Attacks

Despite epic threats to our health care system from federal proposals to repeal the Affordable Care Act and massively cut and cap Medicaid, California policymakers successfully worked to both hold consumers harmless from administration attacks on our health care, and significant progress in 2017 to not just protect the progress the state made in reducing the uninsured rate to a historic low but to also improve our care and coverage.

While consumers will see some premium increases and other impacts from the Trump Administration’s attacks on the ACA in 2018, Californians can be proud that we mobilized against catastrophic Congressional proposals that did not pass at the federal level, while putting in place state policies to shield patients from the federal sabotage. Not content to just hold consumers harmless, California made surprisingly significant strides to improve our health system, by enacting new patient protections such as continuity of care, setting new national policy to prevent unjustified prescription drug price hikes, and restoring dental and vision benefits and improving provider rates in Medi-Cal.

Today, on January 1, many Californians will actually start to see some improvements in their health care:

  • Millions in our Medi-Cal program will finally have dental coverage fully restored, nine year after it was eliminated during the Great Recession. The restoration of Denti-Cal is a reason to smile–not just for improved oral health and financial security for those adults on Medi-Cal and their families, but for strengthening our whole health system. Folks should not need to go a emergency room for dental pain if they have comprehensive coverage to deal with oral health issues.
  • Patients who had their insurer, like Anthem, abandon their area will have had to change insurers, but will now have the ability to complete their course of treatment, such as pregnancy, chemotherapy, or scheduled surgery, with their provider. This important patient protection has been in place for those with group coverage, but now those with individual insurance can be assured of continuity of care.
  • Prescription drug prices will now no longer be able to be spiked by double-digits without notice and justification, under the new law starting January 1. This new prescription drug price transparency law may not be immediately obvious to a patient at the pharmacy, but the advance notice and new information will allow insurers, employers, union trusts, and public programs to better bargain and prevent the big and unexplained price hikes.

THE FEDERAL #FIGHT4OURHEALTH AND CALIFORNIA’S EFFORT TO SHIELD CONSUMERS FROM THE SABOTAGE: Even with the substantial improvements California has made, the biggest news of 2017 is what didn’t change—we didn’t have Californians losing coverage or consumer protections, or have to deal with the massive multi-billion cuts and caps to Medi-Cal as was threatened. California took extraordinary steps to hold consumers harmless from the Trump Administration’s assault on our health system, from Covered California’s creative workarounds to last-minute legislation to put in new patient protections.

While the Trump Administration cut in half the time available for consumers to sign up for a health plan, Covered California will continue to hold a full three-month open enrollment period, this year and into the future under AB 156 (Wood). With the signing of SB 133 (Hernandez), Californians who must switch to a new health plan due to an insurer abandoning the market can stay with the doctor through a course of treatment, such as pregnancy, chemotherapy, or a scheduled surgery. Patient advocates have long sought to extend continuity of care protections, which have been in place for years in group coverage–into the individual market. The departure of Anthem and Cigna from most of California’s individual market created an urgent situation and we are grateful the Legislature and Governor responded.

A full fact sheet on the more than half-dozen administrative attacks on the ACA, and how California has responded, is available on our website. More may need to be done in 2017, to respond to the repeal of the individual mandate and efforts to promote substandard “junk” coverage like association health plans and short-term insurance.

PRESCRIPTION PRICES AND OTHER HEALTH CARE COSTS: In addition to protecting patients from losses, California took a proactive step on controlling health care costs, under SB 17 (Hernandez). With the passage and signing of SB 17 and AB 265, and other bills pending for next year, California is confronting the question of why our needed medications cost so much, and rise so much. We look forward to continuing to confront health care costs, with more oversight on prescription drug prices, health insurance mergers, hospital contracts, or other cost drivers.

MEDI-CAL RESTORATIONS AND IMPROVEMENTS: While Congress considered catastrophic cuts and caps to Medi-Cal, California was looking for ways to invest in and improve this program, which covers one-third of our state, half of our children, and two-thirds of nursing home residents. California voters extended and even raised taxes for the explicit purpose of supporting Medicaid. Tobacco tax dollars allowed California to make some key improvements in provider reimbursements to increase access to doctors, dentists, and family planning services in Medi-Cal. We were particularly pleased to see the coming full restoration of dental and vision services in Medi-Cal, which was cut nine years ago during the Great Recession.

NEXT STEPS TO #HEALTH4ALL: There’s more work to do. We are proud of the steps California has already taken, implementing and improving upon the ACA, to get comprehensive health coverage for 93% of Californians. We had the largest drop in the uninsured rate of all 50 states. If we keep the progress made under the ACA intact, we can take further steps to the goal of health for all Californians. We were heartened that there was so much legislative support to expand Medi-Cal to all income-eligible children, regardless of immigration status, and to take another step to cover undocumented young adults up to age 26 as well. This, and other steps, could get us even closer to universal coverage in California. The Medicare for All efforts this year restarted a welcome conversation about how to get to a more universal, simpler, more efficient, and less profit-focused health system. We hope to pursue an aspirational agenda next year, including steps to universal coverage that are achievable without federal approval. As California showed this year, we can’t wait three years for the potential of a better federal partner to both safeguard our health system and make the improvement we can.