ACA: “The most sweeping legislation of our lifetime”

AlexBriscoe colorA new level of health care will be available to Alameda County residents expected to be insured under The Affordable Care Act (ACA) according to the LWVBAE Annual Meeting keynote address, “Health Reform in Alameda County: The ACA and Beyond.” Speaking to League membership in Berkeley’s Northbrae Community Church September 25, Alameda County Health Care Services Agency Director Alex Briscoe said, “This is the most sweeping legislation of our lifetime.”

Articulate and enthusiastic about the new mandates, Briscoe quipped of the complex legislation, “Humans have the most complicating descriptions for things they don’t understand.”

The Patient Protection and Affordable Care Act (P.L. 111-148) is the most sweeping federal health care reform legislation since Medicare was created in 1965. The bill creates an individual mandate to carry health insurance coverage while also requiring most employers to offer coverage. The new law will add 16 million Americans to the Medicaid roles and cost approximately $940 billion over the next 10 years, Briscoe said.

Most provisions of the federal bill begin in 1914, with full implementation and financing operational by 2018 when the legislation is projected to provide California with an additional $6.8 billion federal match, he said.

In California, nearly 4 million uninsured Californians will be eligible for coverage expansion programs (i.e., MediCal) while another 960 thousand will be ineligible for financial assistance but still required to purchase insurance and able to use the California Health Benefit Exchange to do so. It’s projected that $11 billion in federal subsidies will come to Californians through The Exchange. Small businesses also would be eligible for subsidies to provide coverage for their workers, with a projected benefit of over $600 million annually for the 638,000 small businesses with less than 20 employees in California. UCLA predicts a 25% increase in the current MediCal program while doubling MediCal managed care enrollment.

Of the 1.45 million residents in Alameda County, nearly 18 percent were uninsured in 2006 with the number rising during recession, Briscoe said, swelling to well over 200,000, nearly 90 percent of them adults. After full implementation of reform in 2018, 56,200 Alameda residents will be eligible for subsidies to purchase private, individual insurance through The Exchange, with a countywide allocation totaling $370.5 million in federal subsidies. Assuming full enrollment, 95 percent of Alameda County residents will be insured. However, some 60 thousand county residents won’t be insured, even under the most optimistic scenario, he said. Those who remain uninsured would be comprised of the undocumented and people with exemptions due to religious beliefs or financial hardship. “Oakland, Hayward and Ashland are below the national average in the percent of residents who are uninsured,” he noted.

“Eligibility doesn’t mean enrollment; enrollment doesn’t mean access, access doesn’t mean better health outcomes,” Briscoe explained. “In order to attract providers we must raise rates. To raise rates we need to get those eligible enrolled; viability of managed care approach to medical depends on the effective eligibility and enrollment models,” he said.

Alameda County’s HealthPAC is a Low-Income Health Program (LIHP), California’s effort to take advantage of the opportunity to expand MediCal eligibility before 2014 using county funds as the non-federal match. Alameda is one of a few counties to take advantage of this opportunity, Briscoe said, providing up to 40 million in new federal funds annually. To be eligible for LIHP an enrollee must be between 19 to 64 years old; have a family income between 0 and 200% FPL (Federal Poverty Line); be a U.S. citizen or legal permanent resident for at least 5 years; and not be eligible for MediCal.  Briscoe said there are currently 90,000 people in HealthPAC and that the County’s LIHP has about 45,000 enrollees. “Alameda County far exceeds any other county in terms of percentage of LIHP enrollees compared to estimated ACA eligible populations,” he said.

Briscoe emphasized the need for such legislation because of health inequities that are greatly determined by race, ethnicity, income and location. “Place matters,” he said. Compared to a white child in the affluent Oakland hills, an African American infant born in West Oakland is 7 times more likely to be born into poverty; a child 2.5 times more likely behind in vaccinations; an adult 5 times more likely to be hospitalized for diabetes and twice as likely to die of heart disease, with a cumulative impact of a 15-year difference in life expectancy. “It’s life expectancy by zip code,” Briscoe said.

Until now, Briscoe said healthcare coverage has been unaffordable for more than 200,000 Alameda County residents; medical debt that can lead to financial ruin accounts for 1 in 4 bankruptcies in Alameda County; health services have been fragmented; there’s been Supply and Demand disconnect on preventive and primary care; a lack of racial and language diversity among providers; and lack of support for patients and families to manage their own care.

“Before you were just risking it if you were uninsured,” he observed. “We have to find a way to (help people) look at health care as something they deserve as a basic human right.”

The LWVUS also sees health care as a human right, reflected in our position supporting single-payer financing as the best solution for access to good, affordable, and portable healthcare for all.  The LWVBAE is working with other Leagues around the state to champion continuing work in support of that position.

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