California Jumps Ahead on Expansion of Health Coverage

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As the Supreme Court nears a decision on health reform, more than 360,000 Californians are already receiving medical coverage under a state-administered precursor to the landmark legislation.

But they could find their coverage fleeting if the so-called Affordable Care Act has no future.

The effort, dubbed “The Bridge to Reform,” is part of a sweeping Medicaid expansion unfolding in California. It exists to usher patients to health reform’s planned implementation in 2014.

Bridge to Reform patients are receiving care in 47 participating California counties, from tiny Del Norte near the Oregon border to Orange County, which has 34,544 patients receiving care through the program, according to state enrollment records.

Norman Williams, spokesman for the state Department of Health Care Services, said even if the Supreme Court renders the Bridge to Reform a bridge to nowhere, just building it has been of value to the state’s health care apparatus.

“Health care delivery infrastructure at the local level is being improved as a result,” he said.

But Williams offered no promises if the U.S. Supreme Court strikes down health reform in opinions expected next week. The justices could invalidate all or parts of the law, and the Medicaid expansion is among the pieces in jeopardy.

The state department of health care services “does not anticipate seeking other funding” if the Medicaid expansion is cut down, Williams said.

For now, the Bridge to Reform forms the building blocks of health reform’s core mission — a vast expansion of health care coverage across the country. California health officials project that as many as 1.9 million patients will qualify for the Medicaid expansion alone statewide. National estimates run as high as 17 million.

All told, the controversial health reform legislation was projected to provide health coverage to more than 30 million Americans.

California’s bridge program is implemented by county health agencies, which enroll patients under the same qualifying rules that would be in place under health reform. For every budgetary dollar counties invest in the program, they receive a 50-cent match from the federal government, which has reserved $8 billion for the effort.

Participants have income levels beyond the traditional ceilings for Medicaid, which is called Medi-Cal in California.

They reach as high as $46,100 for a family of four in some counties and are never lower than $30,667 for a family of four in others. In another major change, adults without children now qualify. Undocumented immigrants do not qualify.

Not all California counties are embracing the program. Fresno and San Luis Obispo counties have formally withdrawn from participation, not because of the Supreme Court uncertainty but because they feared their health systems could not accommodate the new patient load.

Still, participating health officials say the effort is showing significant promise by offering patients access to a “medical home” primary care facility and quick referrals to medical specialists.

“In a very short period of time we were able to establish a very effective program with an extensive provider network,” Mark Refowitz, director of the Orange County Health Care Agency, declared in an email.

A program summary provided by the county health agency supports his claim. The agency says participants are receiving better care while simultaneously cutting costs, including a 50 percent reduction in expensive emergency room visits and all hospital visits in general.

The number of patients regularly visiting a primary care doctor has more than doubled, according to the agency.

Debbie Binning, a nurse practitioner who treats Bridge to Reform patients at an AltaMed clinic in Huntington Beach, said the program reaches a population traditionally excluded from the safety net but one that needs help in the economic downturn.

A large portion of her Bridge to Reform patients “are white, middle-class and unemployed,” she said. In addition to significantly raising income ceilings, the new program throws out other disqualifying factors, such as owning a home or a car.

That leads to enrollees like Jack Jordan, 64, a Bridge to Reform patient, who six years ago lost his job in toxic materials remediation and has not been able to find full-time employment with health insurance since.

Jordan of Seal Beach drives a commuter van part time for a local substance abuse recovery center. He would have been summarily disqualified under the previous version of Medi-Cal on two grounds: He has no children and earns too much money with his part-time job.

Under the old version of Medi-Cal, an adult with one child could be disqualified from full coverage with an income as low as $13,200 a year.

“No one actually comes out and says it, but I’m just a higher health risk than younger people, so I don’t meet the employers’ profile,” said Jordan, who suffers from diabetes and high blood pressure.

“The old system would have discouraged me from any type of self-sufficiency,” said Jordan. “This program is helping me through a rough time.”

John M. Gonzales is a senior writer at the California HealthCare Foundation Center for Health Reporting. Attached to the USC Annenberg School for Communication & Journalism, the center produces in-depth reporting on California health policy. It is funded by the nonpartisan California HealthCare Foundation.

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