Meanwhile, California has emerged as perhaps the
most aggressive state in the nation in implementing
the health care overhaul. Enormous obstacles
remain, not least the state's nagging budget
shortfalls.
But former Republican Gov. Arnold Schwarzenegger,
who once voiced grave concerns about the billions
of dollars he said the law would cost California,
became an active supporter of the federal measure
in the months before he left office.
Schwarzenegger signed legislation to authorize a
new health care exchange -- a state-run
marketplace where millions of unemployed
Californians will eventually purchase insurance --
making California the first state in the nation to do
so since the
law's passage (Massachusetts and Utah had
exchanges previously).
He also appointed two staunch reform law backers
to a five-member panel running the exchange who,
combined with other members appointed by
Democrats, all but assure that California will remain
at the vanguard of turning the reform act into
reality.
"In California, people are focused on finding ways to
make it work," said Peter Harbage, an independent
health care consultant who backs the reform law and
has done extensive work in California. "In
Washington, it's just the same old noise, repeating
the arguments of the past."
In some cases, California has gone beyond
requirements of the reform measure that have
already taken effect (most elements don't start until
2014). The law, for example, forbids insurers from
denying insurance to children with pre-existing
conditions. After some insurers responded by
refusing to sell child-only plans altogether,
California shot back with a law that made them
quickly reverse course. It said that insurance firms
that decline to sell policies for kids would be barred
from selling any individual health insurance plans
in the state for a period of five years.
In another move that solidified California's
reputation as a reform leader, state officials in
November hatched an agreement with the federal
government that will send $10 billion in health care
money to California over five years. The money will
allow counties to enroll more uninsured people in
Medi-Cal, the state's version of Medicaid, and to
shift more Medi-Cal beneficiaries into managed care
plans in a bid to control costs. The program
currently covers about 7.7 million Californians and
is expected to add another 1.5 million to 2 million,
making it a main vehicle to reduce the ranks of
uninsured.
Still, thorny issues loom on the horizon. In
Washington, Republicans are expected to try to
undermine the law by withholding money for
provisions that depend on federal aid. Lawsuits are
pending in multiple states that challenge the so-
called individual mandate requiring all Americans to
obtain health insurance or pay a fine.
"This is just the opening round, the overture to the
symphony," said Ed Haislmaier, a health care expert
at the conservative Heritage Foundation.
Haislmaier said the biggest obstacle to the law's
implementation may not be what Congress or the
courts do but rather the difficulties that state
legislatures -- many not nearly as hospitable as
California's -- will inevitably face in enacting the
law. Unless their financial fortunes improve
dramatically over the next few years, California and
other states could be on the hook for significant
new costs spawned by the health care measure. In
California, Schwarzenegger estimated last spring
that the health care overhaul could impose $2
billion or more a year in new costs on the state once
it fully takes effect.
Medi-Cal is already buckling under the stress of
recurring budget cuts and a reimbursement rate for
doctors that is among the lowest in the country -- a
problem that has prompted many physicians to
refuse to treat Medi-Cal patients. Gov. Jerry Brown
last week proposed $1.7 billion in Medi-Cal cuts,
including slashing the doctor reimbursement rate
by 10 percent.
Real questions loom about whether Medi-Cal will be
able to accommodate the huge influx of new
patients -- up to 2 million people -- expected to
enroll once the mandate to obtain coverage takes
effect in 2014.
"That's one of the big challenges: We don't want to
decimate the Medi-Cal program at a time when we
need to expand it and make it better," said Anthony
Wright, executive director of the consumer group
Health Access.
Still, health reform advocates in California remain
optimistic. The current and former heads of the state
Health and Human Services Agency -- Diana Dooley
and Kim Belshé -- said in interviews that they expect
California to continue to lead the way in enacting
health care reform, fiscal woes notwithstanding.
Both were recently appointed to the state health care
exchange.
"Something a little different is going on in
California," Belshé said. "I'm confident we'll continue
to be at the forefront of reform."
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Should US states control healthcare?
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Originally Posted by Lord Mov
