To Ensure The Doctor Is Always In, New Panel Tackles Health Worker Shortage

August 31, 2017 by · Leave a Comment 

Health and education leaders across California have joined forces with business and labor leaders to address workforce shortages in health care. The new group aims to create a blueprint for policymakers.

The California Future Health Workforce Commission, unveiled Wednesday, includes two dozen representatives from businesses, organized labor, schools and hospitals. It will meet throughout the year to discuss the state’s current and future health staffing needs and suggest ways to meet them. Its members hope their findings will lead to new policies and greater investment in training health care professionals. They also hope their recommendations will help other states grappling with similar problems.

To Ensure the Doctor Is Available CA Healthline doctor-shortage

Health and education leaders across California have joined forces with business and labor leaders to address workforce shortages in health care. The new group aims to create a blueprint for policymakers.

The California Future Health Workforce Commission, unveiled Wednesday, includes two dozen representatives from businesses, organized labor, schools and hospitals. It will meet throughout the year to discuss the state’s current and future health staffing needs and suggest ways to meet them. Its members hope their findings will lead to new policies and greater investment in training health care professionals. They also hope their recommendations will help other states grappling with similar problems.

Ensuring adequate health care staffing is increasingly important because more Californians are insured and schools cannot produce physicians, nurses and other providers fast enough to serve them, said Jeff Oxendine, a dean at the University of California-Berkeley’s School of Public Health and co-director of the commission.

A lack of qualified professionals can also drive health care costs higher by heightening the demand for their services.

The commission plans to focus on three areas: primary care, mental health and the aging population.

“We have a greater demand for health services now,” Oxendine said. “With the aging, increased diversity and the growth of the population, that is only going to put more strain on the system.”

California’s health care staffing shortages are well documented and projected to widen as the population grows and physicians retire. The state will lack about 4,700 primary care doctors by 2025, according to a recent report by the Healthforce Center at University of California-San Francisco. The Central Valley, Central Coast and southern border areas will be hardest hit, according to the report.

To ease the shortage of primary care physicians, for example, medical schools could accelerate training so students could graduate faster. To help seniors age in their communities rather than in nursing homes, the state could ensure that home care workers earn more than the current average of about $11 an hour.

“Those who provide this kind of care are for the most part paid a wage that doesn’t particularly command long-term job loyalty,” said Kevin Barnett, senior investigator at the Public Health Institute and co-director of the commission. “Looking at the demographics, we have to come to terms very quickly with that.”

Barnett also cited a growing need for more people to work outside the clinical setting, helping patients with housing, food, transportation and other services that can affect their health.

Many areas, particularly in rural parts of the state, also do not have enough psychiatrists and other behavioral health providers to serve their communities. That creates a burden for patients who may have to travel long distances for mental health care or substance abuse treatment.

“We still have a ways to go to ensure timely access to quality [behavioral health] services, particularly for our Medicaid populations,” Barnett said.

In addition, the commission plans to address the lack of diversity among health workers. Latinos make up nearly 40 percent of the population but only 7 percent of doctors and 8 percent of nurses are Latino, according to the Medical Board of California.

Informing young people from underserved areas about health careers and providing opportunities to pursue them could help with recruitment and retention of a more diverse workforce, Oxendine said.

Health employers consider workforce sufficiency to be a “business imperative,” Oxendine said. Increased competition for a shrinking pool of medical professionals drives up costs, he said.

One of the commissioners, physician Hector Flores, said one of his priorities is to examine whether health care workers can provide services that are better, faster and cheaper. One way to do that could be to have more community health workers and medical assistants working alongside doctors and nurse practitioners, he said.

“Team-based care is not only better and friendlier for patients, but it also reduces costs overall,” said Flores, chairman of the family practice department at White Memorial Medical Center in Los Angeles.

University of California president Janet Napolitano and Dignity Health president Lloyd Dean will co-chair the commission, which is scheduled to hold its first meeting next month and plans to issue research and recommendations throughout the year for state legislators, schools, health care employers and others.

Four organizations are funding the project: The California Endowment, California Health Care Foundation, The California Wellness Foundation and The Blue Shield of California Foundation. (Kaiser Health News, which produces California Healthline, has received support from each of these organizations.)

Ensuring adequate health care staffing is increasingly important because more Californians are insured and schools cannot produce physicians, nurses and other providers fast enough to serve them, said Jeff Oxendine, a dean at the University of California-Berkeley’s School of Public Health and co-director of the commission.

A lack of qualified professionals can also drive health care costs higher by heightening the demand for their services.

The commission plans to focus on three areas: primary care, mental health and the aging population.

“We have a greater demand for health services now,” Oxendine said. “With the aging, increased diversity and the growth of the population, that is only going to put more strain on the system.”

California’s health care staffing shortages are well documented and projected to widen as the population grows and physicians retire. The state will lack about 4,700 primary care doctors by 2025, according to a recent report by the Healthforce Center at University of California-San Francisco. The Central Valley, Central Coast and southern border areas will be hardest hit, according to the report.

To ease the shortage of primary care physicians, for example, medical schools could accelerate training so students could graduate faster. To help seniors age in their communities rather than in nursing homes, the state could ensure that home care workers earn more than the current average of about $11 an hour.

“Those who provide this kind of care are for the most part paid a wage that doesn’t particularly command long-term job loyalty,” said Kevin Barnett, senior investigator at the Public Health Institute and co-director of the commission. “Looking at the demographics, we have to come to terms very quickly with that.”

Barnett also cited a growing need for more people to work outside the clinical setting, helping patients with housing, food, transportation and other services that can affect their health.

Many areas, particularly in rural parts of the state, also do not have enough psychiatrists and other behavioral health providers to serve their communities. That creates a burden for patients who may have to travel long distances for mental health care or substance abuse treatment.

“We still have a ways to go to ensure timely access to quality [behavioral health] services, particularly for our Medicaid populations,” Barnett said.

Health and education leaders across California have joined forces with business and labor leaders to address workforce shortages in health care. The new group aims to create a blueprint for policymakers.

The California Future Health Workforce Commission, unveiled Wednesday, includes two dozen representatives from businesses, organized labor, schools and hospitals. It will meet throughout the year to discuss the state’s current and future health staffing needs and suggest ways to meet them. Its members hope their findings will lead to new policies and greater investment in training health care professionals. They also hope their recommendations will help other states grappling with similar problems.

Ensuring adequate health care staffing is increasingly important because more Californians are insured and schools cannot produce physicians, nurses and other providers fast enough to serve them, said Jeff Oxendine, a dean at the University of California-Berkeley’s School of Public Health and co-director of the commission.

A lack of qualified professionals can also drive health care costs higher by heightening the demand for their services.

The commission plans to focus on three areas: primary care, mental health and the aging population.

“We have a greater demand for health services now,” Oxendine said. “With the aging, increased diversity and the growth of the population, that is only going to put more strain on the system.”

California’s health care staffing shortages are well documented and projected to widen as the population grows and physicians retire. The state will lack about 4,700 primary care doctors by 2025, according to a recent report by the Healthforce Center at University of California-San Francisco. The Central Valley, Central Coast and southern border areas will be hardest hit, according to the report.

To ease the shortage of primary care physicians, for example, medical schools could accelerate training so students could graduate faster. To help seniors age in their communities rather than in nursing homes, the state could ensure that home care workers earn more than the current average of about $11 an hour.

“Those who provide this kind of care are for the most part paid a wage that doesn’t particularly command long-term job loyalty,” said Kevin Barnett, senior investigator at the Public Health Institute and co-director of the commission. “Looking at the demographics, we have to come to terms very quickly with that.”

Barnett also cited a growing need for more people to work outside the clinical setting, helping patients with housing, food, transportation and other services that can affect their health.

Many areas, particularly in rural parts of the state, also do not have enough psychiatrists and other behavioral health providers to serve their communities. That creates a burden for patients who may have to travel long distances for mental health care or substance abuse treatment.

“We still have a ways to go to ensure timely access to quality [behavioral health] services, particularly for our Medicaid populations,” Barnett said.

In addition, the commission plans to address the lack of diversity among health workers. Latinos make up nearly 40 percent of the population but only 7 percent of doctors and 8 percent of nurses are Latino, according to the Medical Board of California.

Informing young people from underserved areas about health careers and providing opportunities to pursue them could help with recruitment and retention of a more diverse workforce, Oxendine said.

Health employers consider workforce sufficiency to be a “business imperative,” Oxendine said. Increased competition for a shrinking pool of medical professionals drives up costs, he said.

One of the commissioners, physician Hector Flores, said one of his priorities is to examine whether health care workers can provide services that are better, faster and cheaper. One way to do that could be to have more community health workers and medical assistants working alongside doctors and nurse practitioners, he said.

“Team-based care is not only better and friendlier for patients, but it also reduces costs overall,” said Flores, chairman of the family practice department at White Memorial Medical Center in Los Angeles.

University of California president Janet Napolitano and Dignity Health president Lloyd Dean will co-chair the commission, which is scheduled to hold its first meeting next month and plans to issue research and recommendations throughout the year for state legislators, schools, health care employers and others.

Four organizations are funding the project: The California Endowment, California Health Care Foundation, The California Wellness Foundation and The Blue Shield of California Foundation. (Kaiser Health News, which produces California Healthline, has received support from each of these organizations.)

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

As GOP Deliberates In Washington, Californians Fear For Their Health Coverage

June 22, 2017 by · Leave a Comment 

More than half of Californians fear they or their loved ones will lose health coverage if the Affordable Care Act is repealed and replaced, a new statewide poll shows.

A poll by the Institute of Governmental Studies at the University of California-Berkeley, released Tuesday, unmasks a deep sense of insecurity across the Golden State, especially among low-income residents and people enrolled in Medi-Cal, the state’s version of the federal Medicaid program for low-income people.

The poll found that 56 percent of Californians worry that they or someone in their family will lose health insurance if the federal health care law, also known as Obamacare, is terminated.

The level of concern jumps dramatically among Californians whose household income is less than $20,000 per year and people enrolled in Medi-Cal.

About 4 in 5 people in those categories fret over the potential loss of coverage.

Medi-Cal covers 13.5 million Californians, about one-third of the state’s population, and nearly 4 million of those enrollees joined as a result of the program’s expansion under Obamacare.

“We all have friends or relatives who are or have been on this program,” said Jennifer Kent, director of the state Department of Health Care Services, which administers Medi-Cal.

“The state has literally bent over backwards to make the ACA work,” Kent said. “This poll is basically now showing that people are appreciating what has been built and are worried that it’s going to be taken back down again.”

A GOP bill passed by the House in early May would not only eliminate the major planks of Obamacare but also cap the flow of federal dollars going to Medicaid. The nonpartisan Congressional Budget Office estimated that the proposal would leave 23 million more people uninsured by 2026 than under Obamacare and reduce federal spending on Medicaid by $834 billion over 10 years.

The House sent its measure to the U.S. Senate, whose leaders now are secretly drafting their own version of a health bill and aiming for a vote before July 4.

With the ACA facing a major existential risk, its popularity in California has never been higher. The poll found that roughly two-thirds of state residents support the law.

That represents a record level of public support, said poll director Mark DiCamillo.

“Health care is important. It’s kind of a family issue for a lot of people,” he said. “There’s just a lot of concern about the cuts, or the potential for cuts, and the changes that may be made to the Affordable Care Act. It’s really having an impact in California.”

Pollsters, who conducted the survey on behalf of the California Health Care Foundation, interviewed 1,845 Californians through most of May.

Medi-Cal was a major focus of the poll, and more than two-thirds of respondents said it is important to them and their families.

Diana Mullis of Sacramento said it would be “scary” if her husband and 4-year-old daughter lost their Medi-Cal coverage.

Her daughter is healthy, and she mostly sees doctors for routine shots and check-ups. But Mullis, 33, knows that Medi-Cal will protect her family from massive medical bills and bankruptcy should her daughter or husband ever land the hospital.

“That’s not going to be the case if things roll back,” said Mullis, who has employer-sponsored insurance.

Lanhee Chen, a fellow at Stanford University’s Hoover Institution, supports the repeal and replacement of the ACA. He believes fearful Californians are being influenced by media coverage.

“Are they getting the full picture of what an effort to repeal and replace Obamacare would look like? I would suggest they’re not getting a full picture,” he said.

He pointed to the majority of Californians who have employer-based coverage and said they wouldn’t be dramatically impacted by an Obamacare repeal.

“The vast majority of Californians, if the ACA goes away, probably won’t see an effect one way or the other,” he said.

And those on Medi-Cal may not lose their coverage, especially if California takes its own steps to keep residents insured, he added.

“California could make the decision to raise taxes,” he said.

But Kent, director of the state’s health care department, counts herself among the worried Californians. She said she has been losing sleep over the future of the ACA and Medi-Cal.

“Any change at the federal level that happens in Medicaid has the potential to have both serious and/or catastrophic effects in the state,” she said.

 

California Healthline reporter Pauline Bartolone contributed to this report. California Healthline is produced by Kaiser Health News, delivering expanded coverage of health policy news in California and original reporting that highlights the state’s outsized influence on the nation’s health care system.

 

Tab For Single-Payer Proposal In California Could Run $400 Billion

May 25, 2017 by · Leave a Comment 

A proposed single-payer health system in California would cost about $400 billion annually, with up to half of that money coming from a new payroll tax on workers and employers, according to a state analysis.

The report by the state Senate Appropriations Committee, issued Monday, put a price tag for the first time on legislation that would make the state responsible for providing health coverage to all 39 million Californians. The state-run system would supplant existing employer health insurance in California, as well as coverage through public programs such as Medicaid and Medicare.

One of the chief obstacles to the legislation, Senate Bill 562, is the prospect of higher taxes. It also has exposed deep divisions among Democrats over whether now is the time to pursue single-payer — just as the Affordable Care Act comes under attack from Republicans in Washington. At a hearing Monday, one Democratic legislator questioned whether the state can effectively manage a universal health care system.

The legislative analysis estimates a total annual cost of $400 billion to enact the Healthy California program for all residents, regardless of their immigration status.

To put that in perspective, about $367 billion was spent on health care last year statewide, including public and private spending by employers and consumers, according to the UCLA Center for Health Policy Research.

Legislative analysts said federal, state and local taxpayer funding of about $200 billion a year for existing programs could be available to offset the overall tab of $400 billion for universal coverage. But additional tax revenue would be needed to foot the other half of the cost, according to the report, which raised the possibility of a 15 percent payroll tax on earned income.

Of course, the shift to a single-payer system should reduce current spending on health insurance by employers and workers, so those savings could offset some of the new taxes, the analysts said. The report estimated that employers and employees in California spend $100 billion to $150 billion a year now on health insurance and medical care.

“Total new spending required under the bill would be between $50 billion and $100 billion per year,” the report said.

The Senate analysis noted that all of its projections were “subject to enormous uncertainty” because the bill would mark “unprecedented change in a large health care market.”

A single-payer system likely “would be more efficient in delivering health care,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. (California Healthline is produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.)

But the proposal expands coverage to all and eliminates premiums, copayments and deductibles for enrollees, and that would cost more money, Levitt said. “You can bet that opponents will highlight the 15 percent tax, even though there are also big premium savings for employers and individuals,” he added.

State Sen. Ricardo Lara (D-Bell Gardens), a chief sponsor of the legislation, said the present system is unsustainable because health spending continues to grow faster than the overall economy, making coverage unaffordable for too many people.

Lara touted the potential savings from creating a public plan with greater bargaining power and cutting out the administrative overhead and profits of private health insurers acting as middlemen.

Overall, many of the details behind California’s single-payer proposal remain in flux. Under questioning from fellow lawmakers, Lara said the 15 percent payroll tax is “hypothetical” and “we don’t have a financing mechanism yet for this bill.”

Lara said he has sought a review from researchers at the University of Massachusetts-Amherst into potential funding sources for the measure.

Lara also said there’s no guarantee the Trump administration would grant the federal waivers necessary for California to shift Medicare and Medicaid funding into a single pot for universal health care.

With so many unknowns, the Senate Appropriations Committee didn’t vote on the measure Monday. Backers of the legislation are hopeful for a vote in the full Senate next month and then lawmakers could continue to work on the financial aspects during the summer.

At Monday’s hearing, many consumers pointed to Medicare as a model for how single-payer works now and urged lawmakers to make California the proving ground for how it can succeed at the state level.

Business groups and health insurers spoke out in opposition, saying it would lead to massive disruption and escalating costs. Even if it passes the legislature, California Gov. Jerry Brown hasn’t endorsed the idea and new taxes may require a statewide ballot measure, which are always hard-fought campaigns.

The California Chamber of Commerce said the costs would likely be far higher than what was projected and the taxes imposed on employers would trigger major job losses.

State Sen. Jim Nielsen (R-Tehama), a member of the Appropriations panel, expressed similar concerns. “The impact on employers will be astounding,” Nielsen said. “How can you say this will be fiscally prudent for the state? The state has never gotten anything right in health care.”

State Sen. Steven Bradford (D-Gardena) also preached caution, questioning whether state agencies are up to the task. “I don’t want California to move toward a program that is not sustainable and one that we can’t manage,” Bradford said.

Other states have taken a close look at single-payer and balked. Colorado voters rejected a ballot measure last year that would have used payroll taxes to fund a near-universal coverage system.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

House Leaders Came Up Short In Effort To Kill Obamacare

March 30, 2017 by · Leave a Comment 

Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders last Friday failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act.

House Speaker Paul Ryan pulled the bill from consideration after he rushed to the White House to tell President Donald Trump that there weren’t the 216 votes necessary for passage.

“We came really close today, but we came up short,” he told reporters at a hastily called news conference.

When pressed about what happens to the federal health law, he added, “Obamacare is the law of the land. … We’re going to be living with Obamacare for the foreseeable future.”

Trump laid the blame at the feet of Democrats, complaining that not one was willing to help Republicans on the measure and he warned again that the Obamacare insurance markets are in serious danger. “Bad things are going to happen to Obamacare,” he told reporters at the White House. “There’s not much you can do to help it. I’ve been saying that for a year and a half. I said, look, eventually it’s not sustainable. The insurance companies are leaving.”

But he said the collapse of the bill might allow Republicans and Democrats to work on a replacement. “I honestly believe the Democrats will come to us and say, look, let’s get together and get a great health care bill or plan that’s really great for the people of our country,” he said.

Ryan originally had hoped to hold a floor vote on the measure Thursday — timed to coincide with the seventh anniversary of the ACA — but decided to delay that effort because GOP leaders didn’t have enough “yes” votes. The House was in session Friday before his announcement while members debated the bill.

House Democratic leader Nancy Pelosi (Calif.) said the speaker’s decision to pull the bill “is pretty exciting for us … a victory for the Affordable Care Act, more importantly for the American people.”

The legislation was damaged by a variety of issues raised by competing factions of the party. Many members were nervous about the Congressional Budget Officeshowing that the bill would lead eventually to 24 million people losing insurance, while some moderate Republicans worried that ending the ACA’s Medicaid expansion would hurt low-income Americans.

At the same time, conservatives, especially the hard-right House Freedom Caucus that often has needled party leaders, complained that the bill kept too much of the ACA structure in place. They wanted a straight repeal of Obamacare, but party leaders said that couldn’t pass the Senate, where Republicans don’t have enough votes to stop a filibuster. They were hoping to use a complicated legislative strategy called budget reconciliation that would allow them to repeal only parts of the ACA that affect federal spending.

The decision came after a chaotic week of negotiations, as party leaders sought to woo more conservatives. Trump personally lobbied 120 members through personal meetings or phone calls, according to a count provided Friday by his spokesman, Sean Spicer. “The president and the team here have left everything on the field,” Spicer said.

On Thursday evening, Trump dispatched Office of Management and Development Budget Mick Mulvaney to tell his former House GOP colleagues that the president wanted a vote on Friday. It was time to move on to other priorities, including tax reform, he told House Republicans.

“He said the president needs this, the president has said he wants a vote tomorrow, up or down. If for any reason it goes down, we’re just going to move forward with additional parts of his agenda. This is our moment in time,” Rep. Chris Collins (R-N.Y.), a loyal Trump ally, told reporters late Thursday. “If it doesn’t pass, we’re moving beyond health care. … We are done negotiating.”

Trump’s edict clearly irked some lawmakers, including the Freedom Caucus chairman, Rep. Mark Meadows (R-N.C), whose group of more than two dozen members represented the strongest bloc against the measure.

“Anytime you don’t have 216 votes, negotiations are not totally over,” he told reporters who had surrounded him in a Capitol basement hallway as he headed in to the party’s caucus meeting.

Trump, Ryan and other GOP lawmakers tweaked their initial package in a variety of ways to win over both conservatives and moderates. But every time one change was made to win votes in one camp, it repelled support in another.

The White House on Thursday accepted conservatives’ demands that the legislation strip federal guarantees of essential health benefits in insurance policies. But that was another problem for moderates, and Democrats suggested the provision would not survive in the Senate.

Republican moderates in the House — as well as the Senate — objected to the bill’s provisions that would shift Medicaid from an open-ended entitlement to a set amount of funding for states that would also give governors and state lawmakers more flexibility over the program. Moderates also were concerned that the package’s tax credits would not be generous enough to help older Americans — who could be charged five times more for coverage than their younger counterparts — afford coverage.

The House package also lost the support of key GOP allies, including the Club for Growth and Heritage Action. Physician, patient and hospital groups also opposed it.

But Ryan’s comments made clear how difficult this decision was. “This is a disappointing day for us,” he said. “Doing big things is hard. All of us. All of us — myself included — we will need time to reflect on how we got to this moment, what we could have done to do it better.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

[Update]: Apr. 4, 2017 to correct spelling of author Mary Agnes Carey’s name.

 

SB10 is it worth it? What is an exemption?

June 16, 2016 by · Leave a Comment 

Nidia Torres says paying a penalty for not having health insurance is unfair if you can’t qualify for an affordable plan. It’s not easy to find health care coverage when you don’t even know where to start looking, she says.

Torres, 34, has Deferred Action for Childhood Arrivals (DACA) status, making her eligible for a reprieve from deportation and a work permit, but not for health insurance through the Affordable Care Act (ACA) —also known as Obamacare—due to her quasi-legal status.

Lea este artículo en Español: Soñadores en Busca de Cuidado de Salud Asequible

Senate Bill 10 – the #Health4All Waiver – signed by Gov. Jerry Brown Friday, however, could open the door to coverage for her and other DACA recipients and people who are undocumented now excluded from ACA coverage because they are not considered lawfully present in the country.

While many cheer the legislation as a positive step toward inclusion for immigrants, its impact may be more symbolic than practical since it does not give them access to the subsidies that are often what makes coverage affordable.

 

#Health4All Waiver

SB 10, authored by Sen. Ricardo Lara (D-Bell Gardens), allows California to seek a federal waiver to allow undocumented immigrants and DACA recipients to use their own money to buy health insurance through Covered California, the state’s online marketplace. Under ACA, states can apply for a waiver to modify provisions of the law based on guidelines set by the U.S. Department of Health and Human Services.

“This bill presents an historic opportunity for California to become the first state in the nation to request a federal waiver,” said Sen. Lara Friday in a statement.

If approved, California’s waiver will have no financial impact on the federal government because SB10 does not allow DACA recipients or the undocumented to receive the government subsidies that lower the cost of monthly premiums.

Nevertheless, proponents see it as an important step forward, and Covered California estimates as many as 50,000 more people — who make too much money to qualify for Medi-Cal — may buy coverage through the marketplace if the waiver is approved.

Nidia Torres, mother of one, is a DACA recipient with no health coverage. (Courtesy of Nidia Torres)

Nidia Torres, mother of one, is a DACA recipient with no health coverage. (Courtesy of Nidia Torres)

Torres, a single mother of one, makes about $23,000 a year, which she told EGP is too high to qualify for Medi-Cal but not high enough to purchase insurance on her own.

“I have been wanting to go to the doctor for a physical exam but I was told it is about $100” since I don’t have insurance, she told EGP, explaining she opted to pay for a one-time visit at a community clinic rather than struggle to pay monthly for insurance. “It’s not that I don’t want to buy the coverage, but I can’t afford it,” she told EGP. SB10 will not give her access to a plan she can afford.

Lara’s spokesperson Jesse Melgar told EGP that even though subsidies are not provided under SB 10, it does fight for health care for all.

There are about 390,000 undocumented immigrants who earn too much to qualify for Medi-Cal, said Melgar. “Of those, an estimated 10% earn over 400% of FPL meaning they would not be eligible for any subsidies regardless of immigration status.”

We recognize that SB10 would make a modest change but “we think the change is still important, beyond the symbolism of inclusion and of an explicitly exclusionary policy in the ACA,” Anthony Wright, executive director of Health Access California told EGP.

With over 70% of undocumented Californians in mixed-status families, it means many will get subsidies, said Wright, citing examples of two situations where people will benefit from access to Covered California. The first involves a family of three, with the child receiving free Medi-Cal, one spouse getting subsidized coverage for about a $50 a month, and the other spouse paying about $250 a month for unsubsidized coverage.

“As a family, on their income, $300 might be a stretch, but it might be doable depending on how they prioritize it,” he explained.

Access to California’s health exchange would also benefit people who have the means to pay for coverage, like contract workers in the Silicon Valley who do not have employer sponsored health coverage, Wright said.

#Health4All campaign informs the immigrant community about their options for health care services. (EGP photo by Jacqueline Garcia)

#Health4All campaign informs the immigrant community about their options for health care services. (EGP photo by Jacqueline Garcia)

Covered California spokesperson Dana Howard told EGP undocumented immigrants can currently buy private health insurance, but approval of the SB 10 waiver would benefit families in mixed status making it “easier for them to purchase their service in one place.”

In an interview with California Healthline, however, insurance agent Alex Hernandez said people are not rushing to buy health care plans because of the high-cost. Hernandez calculated that a woman in her mid-20s, making about $45,000 a year, would pay $304 per month for a standard Anthem-Blue Cross plan through the exchange. If she buys that same plan directly from Anthem, it would cost $303.30, he told California Healthline.

Giving all Californians access to Covered California makes the health care system more inclusive and efficient, contends Maricela Rodriguez, a program manager with The California Endowment.
“Not all undocumented individuals will be able to afford health care through Covered California and will remain ineligible for Medi-Cal,” she told EGP in an email, acknowledging that the measure is not a total solution.

“Without the assistance of subsidies, affordability will continue to be a barrier for many. Which is why this is only a first step and why we, along with advocates and policy leaders, will continue to fight for health justice for everyone,” she said.

The federal government has 225 days to grant or deny permission.

 

Excluded from Obamacare? No Penalty for Not Having Insurance

In the meantime, DACA recipients and undocumented immigrants, like Torres, who were excluded from Obamacare but penalized for not having health insurance can seek a refund and exemption from future penalties.

When Torres filed her 2015 taxes through H&R Block she was penalized about $200 for not having health insurance in 2014. “I didn’t know I was exempted,” she said.

The Covered California website states that DACA recipients and undocumented immigrants are eligible for an exemption to the tax penalty for being uninsured.

Not every tax preparer is aware of the exemption, however, and many will just have their clients pay the penalty. It’s important for DACA recipients to explain their status to their tax preparer before they file, says Elba Schildcrout, Community Wealth Dept. director and tax preparer at East LA Community Corporation (ELACC).

ELACC partners with Volunteer Income Tax Assistance (VITA)—an Internal Revenue Service program to help low- and moderate-income taxpayers file returns at no cost.

Once DACA recipients have disclosed their status, tax preparers must file Form 8965 Health Coverage Exemptions along with their 1040 tax return.

DACA recipients who previously paid the penalty can file an amendment to get their money back, said Schildcrout.

The process is doable, she said, but added that tax preparers usually charge to file the amendment.

It’s sad to see clients pay for an amendment to a tax return that was done wrong, she told EGP.

According to Schildcrout, the VITA program can help DACA recipients who were charged a penalty for not having health insurance to file the amendment at no cost.

The three-part series was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.

To read Part 1: DACA and Obamacare: Who Qualifies?

To read Part 2: The Health Challenge In Mixed-Status Homes

—-

Twitter @jackiereporter

jgarcia@egpnews.com

 

 

Dreamers In Search of Affordable Health Care

June 2, 2016 by · Leave a Comment 

June 15, 2012 was a historic day for thousands of young immigrants who under President Obama’s executive action became eligible for temporary relief from deportation.

“These are young people who study in our schools … they pledge allegiance to our flag. They are Americans in their heart, in their minds, in every single way but one: on paper,” said Obama when he introduced Deferred Action for Childhood Arrivals (DACA), a program making nearly 1.5 million youth brought to the country illegally as children eligible for a reprieve from deportation and a work permit, both renewable every two years.

Lea este artículo en Español: Soñadores en Busca de Cuidado de Salud Asequible

Over 853,000 immigrants between the ages of 16 and 31, often referred to as “dreamers,” have applied for DACA status since the president’s announcement. For many, with the ability to work legally came the hope of higher wages and perhaps benefits.

Getting health insurance, however, has not been easy for some. For others, it’s not a priority.

The Affordable Care Act (ACA) enacted in 2014—commonly known as Obamacare— excluded DACA recipients from coverage because they are not permanent legal U.S. residents or citizens.

In this three-part series, EGP looks at some of the challenges this group of dreamers face in their search for affordable health care and the options they have to access services.

 

DACA and Obamacare: Who Qualifies?
Los Angeles resident Nidia Torres was brought illegally to the U.S. when she was six years old. She lived in the shadows for over two decades, hoping not to be discovered or deported back to Mexico, a country she does not call home.

In 2013, everything changed. Torres was granted DACA status and excitedly started planning for the future. The opportunities a work permit, driver’s license and social security number would bring to her life were endless, including providing a better future for her U.S. born daughter, Torres told EGP.

“No more shame for being undocumented,” she recalls thinking when her work permit arrived in the mail.

Nidia Torres, 34 with her four-year old daughter said DACA has provided her great opportunities, in this country, which she consider home. She just needs to find an option for medical insurance. (Courtesy of Nidia Torres)

Nidia Torres, 34 with her four-year old daughter said DACA has provided her great opportunities, in this country, which she considers home. She just needs to find an option for medical insurance. (Courtesy of Nidia Torres)

Torres soon landed a job waitressing at a national restaurant chain where she was paid minimum wage plus tips, but did not offer health insurance.

“I can work legally, my daughter has Medi-Cal, so I think I’m OK,” she told EGP, explaining that after years of low-paying jobs and long hours that left her little time for her daughter, the new job was a big step forward.

“I just wanted a job,” she told EGP. “Plus I don’t really get sick,” so health insurance was not a big deal, she said, adding she had no idea where to get coverage on her own.

Torres, who speaks both English and Spanish and has some college education has since been promoted to manager and is earning more money, but still has no health benefits.

The goal of the Affordable Care Act was to increase “the quality, availability, and affordability” of private and public health insurance to the then over 44 million uninsured Americans, providing they are legal permanent residents or U.S. citizens. To keep costs down, large numbers of young, healthy individuals — the same group targeted by DACA — would have to be enrolled, yet undocumented immigrants and DACA recipients are ineligible to buy health coverage through government sponsored health exchanges or receive premium tax credits or other savings on marketplace plans, even though they pay into the tax system.

Gabrielle Lessard, a health policy attorney with the National Immigration Law Center, calls the policy unjust. DACA recipients are working and paying taxes for a service that they can’t apply for, she told EGP.

“The exclusion of DACA recipients probably increases the price of insurance for all other people,” Lessard said.

In California, however, some low-income undocumented immigrants and DACA recipients may qualify for Medi-Cal, a state funded health insurance program for low-income families, people with disabilities, pregnant women, children in foster care and low-income adults who meet certain requirements.

(DHHS)

(CDHCS)

Torres is not one of them. According to the California Department of Health Care Services and federal eligibility requirements, Torres’ $23,000 a year income puts her just slightly above the $22,108 maximum Federal Poverty Level (FLP) for a family of two, making her ineligible for Medi-Cal.

Like many other DACA recipients with incomes “too high” for health insurance subsidies, Torres’ options for health coverage are limited, and the process for finding affordable coverage can be complex, according to the UC Berkley study, “Realizing the Dream for Californians Eligible for Deferred Action for Childhood Arrivals: Health Needs and Access to Health Care.”

Many DACA recipients don’t even know they have options, the study found. The lack of information reflects “the complexity” of the network of programs available and the process to access them, researchers stated.

Getting health care doesn’t have to be a problem, says Irene Holguin, director of community relations with Arroyo Vista Family Center, a network of five clinics serving the east and northeast side of Los Angeles.

During a free family health fair Friday at Arroyo Vista’s clinic in Lincoln Heights, Holguin told EGP there are options for everyone, regardless of immigration status or income.

When people arrive at one of our clinics for the first time they undergo a financial screening to determine what types of programs they are eligible for, she said. “We don’t turn anyone away,” she added. She explained that the clinic offers discount programs and fees to those who not qualify for state or federal funded program.

For example, if a patient can only pay $10, Arroyo Vista will help them set up an affordable payment plan for the balance, Holguin said.
The Arroyo Vista clinics provide primary health care in communities where approximately 98% of families are Latino and many of them low-income, explained Holguin.

“There’s a lot [more] that needs to be done in regard to informing the community and encouraging people to be proactive and seek preventive health services,” she said, “because a lot of people have illnesses that they don’t even know they have.”

As for Torres, she told EGP she would be open to going to a clinic like Arroyo Vista to look into her what her options are. “Better safe than sorry,” she said.

 

The three-part series was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.

 

To read Part 2: The Health Challenge In Mixed-Status Homes

To read Part 3: SB10 is it worth it? What is an exemption?

—-

Twitter @jackiereporter

jgarcia@egpnews.com

CA Sen. Lara Urges Undocumented Parents to Sign Kids Up For Health Care

May 19, 2016 by · Leave a Comment 

New America Media – Kicking off his statewide tour to promote California’s Health for All Kids program, the new law’s author, State Sen. Ricardo Lara, D-Bell Gardens, said undocumented parents should set their fears aside and enroll their children in the program. The legislation would expand the state’s health insurance program for low-income people.

“There’s a misconception among immigrants,” Lara said, that asking for government help could land them in trouble. He made this observation during a May 12 media presentation at San Francisco’s Mission Neighborhood Health Center.

Mindful of this, the Health for All Kids program – which launched on Tuesday — was designed so children who currently have limited access to health care through the Emergency Medi-Cal, Healthy San Francisco or Healthy Kids programs would “seamlessly transition” into full-scope Medi-Cal (California’s version of Medicaid), said Lara. He was flanked on the podium by State Sen. Mark Leno, D-San Francisco, and Democrat Assemblymembers Phil Tang and David Chiu.

Representatives of such health advocacy groups as Children Now, Health Access, California Pan-Ethnic Health Network, Asians Advancing Justice and California Immigrant Policy Center also spoke at the media briefing.

 California State Sen. Lara at a press conference promoting the California Health for All Kids program. Photo courtesy Jesse Melgar)

California State Sen. Lara at a press conference promoting the California Health for All Kids program. Photo courtesy Jesse Melgar)

170,000 California Children Eligible
An estimated 170,000 undocumented children are eligible to enroll in the state-funded program, expected to cost $40 million in the first year of its operation, and $137 million annually “in perpetuity,” Lara said.

Lara drew on his experience growing up in the United States as the child of poor undocumented immigrants from Mexico to emphasize why it’s important to have children enrolled in health insurance.

“Children shouldn’t have to worry about how their parents are going to pay for a broken arm or for a dentist,” the lawmaker said.
Leno, who chairs the Senate Budget Committee, said the importance of the Health For All Kids program can not be overemphasized because illnesses make no distinction between documented and undocumented people.

“Our bodies, viruses, bacteria don’t know what our immigration status is,” Leno said. He noted that dental problems alone results in around 500,000 children in California missing school each year.

He also observed, “Without a high school diploma, a child is more likely to find his way into the criminal justice system.”

‘Get a Clue, Donald Trump’
Leno’s elicited laughter when he quipped, “Get a clue, Donald Trump.” He was referring to the Republican presidential presumptive GOP nominee’s vow to upend the Affordable Care Act (ACA) should he become president.

Undocumented Bay Area resident Teresa Lopez, a mother of four children, said she would be relieved to see her Mexico-born daughter, Litzy, age 15, enroll in the full-scope Medi-Cal program and enjoy accessing health care the way her two U.S.-born children currently do.
“Having to make copayments for every visit, and for medications is taking a toll on my family,” said Lopez, speaking in Spanish, through an interpreter. “It will be nice when all my children have the same kind of health care benefits.”

Lara noted earlier this week that the California Department of Health Care Services, which operates Medi-Cal, has said it is ready for the influx of thousands of children when the Health For All Kids program begins next week.

Lara is hopeful that Gov. Jerry Brown will sign his second bill, SB 10, which is currently making its way through the Legislature. It would allow the state’s undocumented adults to buy unsubsidized health insurance on Covered California, the online marketplace set up under ACA, with their own money. More than 2 million people currently have no access to health care, Lara said.

California has sought a federal waiver to allow its undocumented population to purchase health insurance on the marketplace.

“We hope we get the waiver before the administration in Washington changes,” Lara said, suggesting that the next U.S. president might either dismantle ACA or make drastic changes to it.

Teresa Lopez with her U.S.-born child, said she hopes to enroll her Mexico-born daughter, age 15, into the new Health For All Kids Program.  (Photo courtesy Jesse Melgar)

Teresa Lopez with her U.S.-born child, said she hopes to enroll her Mexico-born daughter, age 15, into the new Health For All Kids Program. (Photo courtesy Jesse Melgar)

Medi-Cal Provider Shortage
In the wake of the new Health For All Kids program, Lara was asked how the state could cope with the large influx of new Medi-Cal enrollees when there is already a shortage of doctors and dentists in the Medi-Cal network.

He said that said he hopes lawmakers would make the program more attractive to health care providers by increasing reimbursement rates, currently among the lowest in the nation.

“We are going to keep pushing for this,” Lara said.

County Home Health-Care Workers to Get Pay Bump

June 18, 2015 by · Leave a Comment 

The Los Angeles County Board of Supervisors agreed Tuesday to boost the wages of more than 140,000 home health-care workers.

The board voted 4-1 to approve a motion by Supervisors Mark Ridley-Thomas and Hilda Solis instructing county administrators to allocate $11.9 million in the 2015-16 Department of Public Social Services budget to raise wages of home health-care workers from their existing $9.65-an-hour salaries to $11 effective Jan. 1, 2016.

Salaries of the In-Home Supportive Service workers will increase to $11.18 on Feb. 1, 2017.

“IHSS providers care for and support the county’s most vulnerable residents so that they can remain safe and independent in their homes and communities, thereby avoiding higher-cost institutional settings,” according to the motion. “Despite the critical services these low-wage workers perform for the county, they are among the lowest-paid workers among the low-wage

workforce, earning a ‘poverty wage’ of $9.65 an hour, excluding health benefits, or $20,072 per year.

“At this wage level, many home care workers are forced to rely on public assistance programs to make ends meet.”

Supervisor Don Knabe, who was the lone vote against the wage increase, introduced an alternative proposal that would also increase home-care worker salaries, but at a slower pace.

“We have a lot of things coming up as it relates to the minimum wage and other economic kinds of things that we’ve done on a slow but sure basis,” Knabe said, noting that the board is expected to consider a proposal next week to increase the county’s minimum wage.

But Ridley-Thomas said any delay would be a slap in the face to the workers.

“It is a question of the level of tolerance for income inequality that’s at stake here,” he said. “This is the maximum that can be allowed by the state without exposing the county to risk from a fiscal point of view and at the same time it gives a clear indication to these 140,000 workers that they matter and that they deserve the dignity of a decent compensation commitment with what they do to help people we love and care for. That’s what’s at stake here.”

Paid through a state program, the home care workers would not benefit from an increase in the city or county’s minimum wage.

Home care workers have been pushing the county to boost their salaries to $15 an hour. Earlier this month, dozens of the workers represented by the Service Employees International Union-United Long-Term Care Workers rallied at a Board of Supervisors meeting to state their case. Dozens more showed up Tuesday.

Workers told the board about the work they do caring for the elderly and disabled, some of whom are members of their own families, and how hard it is to make ends meet on $9.65 an hour.

Union research shows that 81 percent of the in-home care providers live in poverty, 33 percent rely on public assistance and 18 percent depend on food stamps to feed their families.

A study released by union leaders concluded that a raise to $15 an hour would generate $768 million in local economic activity and support the creation of 6,000 new full-time jobs.

“Today is a victorious day for L.A. County IHSS providers as we celebrate the greatest wage increase we’ve ever won,” Laphonza Butler, president of SEIU-ULTCW, said.

Historic Vote Takes California’s Undocumented a Step Closer to Health Care

June 4, 2015 by · Leave a Comment 

New America Media – A sweeping bill that will expand health care coverage to California’s undocumented population sailed through the State Senate Wednesday on a 28 to 11 vote.

All 26 Democrats on the Senate, plus two Republicans – Assemblymembers Anthony Cannella (R-Ceres) and Andy Vidak (R-Hanford) — gave the bill their nod.

“Today’s vote is a transformational and decisive step forward on the path to achieving health for all,” said the bill’s author Sen. Ricardo Lara, (D-Bell Gardens), in a statement. “Over the past year, I’ve worked to draft a bill that is realistic, balanced and fiscally prudent, while arriving at our goal of expanding access to health care for some of our most vulnerable communities.”

The bill, if passed by the Assembly and signed by Gov. Jerry Brown, would allow undocumented Californians to buy health insurance with their own money through the online exchange, Covered California, pending permission from the federal government.

Senate Bill (SB) 4 gives all adults, regardless of their immigration status, access to health care, but it would not be an entitlement. It would only cover those enrolled up to a capped budget level each year in Medi-Cal (California’s name for Medicaid), the health insurance program for low-income people.

However, another provision of SB 4 that would allow all children, 19 and under, to enroll in Medi-Cal, would entitle all who qualify to received health benefits, no mater how limited the program’s budget is.

In May, the Senate Budget Sub-Committee set aside $40 million to begin covering children who are among the state’s nearly 2.5 million residents remaining uninsured because they don’t qualify for full-scope Medi-Cal because of their immigration status or their income level. The committee made the $40 million allocation after the Senate Appropriations Committee scaled back the cost of SB 4, pegged earlier as $740 million. A stalled version of the bill last year came with a $1.4 billion price tag.

Although legislative analysts have not yet estimated the total cost of the scaled back plan, providing Medi-Cal to the state’s 200,000 or so undocumented children could run anywhere between $7 million and $135 million. But president Obama’s executive action on immigration could greatly reduce those amounts.

“Once Obama’s executive action moves forward, the cost could drop to between $4 million and $83 million,” asserted Ronald Coleman, government policy analyst with the California Immigrant Policy Center.

The executive action, announced by the President last November, would grant a three-year renewable deportation reprieve to 5.6 million undocumented people nationwide by expanding the Deferred Action for Childhood Arrivals (DACA) program, as well as by launching the Deferred Action for Parents of Americans (DAPA) program. An estimated 1 million California residents could benefit from the programs, which are now suspended pending decisions on federal court lawsuits.

Immigrant and health care advocates in California hailed the passage of SB 4 in the Senate.

Marielena Hincapie, executive director of the National Immigration Law Center, said, “Senator Lara’s bill is urgently needed, not just for immigrant communities, but for all Californians. Our communities and economy are stronger if everyone has access to quality, affordable health care.”

Anthony Wright, executive director of Health Access California, a statewide consumer advocacy network, called the bill “transformational” and a “first of its kind by a state legislative chamber.”

Reshma Shamasunder, executive director of the California Immigrant Policy Center, urged Governor Brown to “invest real dollars in measures like SB 4.”

If the Assembly Health Committee, where the bill is now headed, approves SB 4, the Assembly Appropriations Committee has to come up with its own price tag for the bill. Both chambers would then have to reconcile the funding amount before the bill reaches the governor’s desk.

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