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Contact: Ken Jacobs
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Labor Center Reports on Health Care

New Federal Health Care Law Resources »
Health Law Guides, Summaries and Tools »

 

Report

A Little Investment Goes a Long Way: Modest Cost to Expand Preventive and Routine Health Services to All Low-Income Californians

May 2014, by Laurel Lucia, Ken Jacobs, Dave Graham-Squire, Greg Watson, Dylan H. Roby, Nadereh Pourat, and Gerald F. Kominski


» Press Release
» Press Coverage

More than 1.4 million undocumented Californians are predicted to remain uninsured because they are ineligible for Affordable Care Act coverage options due to their immigration status. State policymakers are considering a proposal to expand comprehensive Medi-Cal coverage to all low-income Californians. The authors predict the increase in Medi-Cal enrollment and net state spending under the proposal, primarily using the California Simulation of Insurance Markets (CalSIM) model. Predicted budget offsets are also estimated. The analysis finds that an investment equivalent to 2 percent of state Medi-Cal spending would expand preventive and routine health services to more than 690,000 undocumented Californians in 2015.


Report

The Impact of the Affordable Care Act on New Jobs

April 2014, by Joanne Spetz, Bianca K. Frogner, Laurel Lucia, and Ken Jacobs for the UCSF Philip R. Lee Institute for Health Policy Studies and Center for the Health Professions, the George Washington University School of Public Health and Health Services, and the UC Berkeley Center for Labor Research and Education

» Brief PDF
» Report PDF

This report explores entry-level and low-skill job opportunities that will expand due to Affordable Care Act (ACA) implementation. The analyses draw from estimates of future health worker demand published by the U.S. Bureau of Labor Statistics and a unique analysis of the effect of the ACA on job growth developed from a microsimulation model. The report also presents case studies that highlight effective education programs that prepare workers for new and changing jobs under the ACA.


Report

The Ongoing Importance of Enrollment: Churn in Covered California and Medi-Cal

April 2014, by Miranda Dietz, Dave Graham-Squire, and Ken Jacobs


» Press Coverage

Using the California Simulation of Insurance Markets (CalSIM) model and the Survey of Income and Program Participation (SIPP), the authors predict that large numbers of Californians will continue to enter and leave Covered California and Medi-Cal throughout the year during Special Enrollment Periods due to life-changing "triggering" events such as divorce and job change.


Report

Realizing the Dream for Californians Eligible for Deferred Action for Childhood Arrivals (DACA): Health Needs and Access to Health Care

March 2014, by Claire D. Brindis, Max W. Hadler, Ken Jacobs, Laurel Lucia, Nadereh Pourat, Marissa Raymond-Flesch, Rachel Siemons and Efrain Talamantes for the UC Berkeley Center for Labor Research and Education, the UCLA Center for Health Policy Research, and the UCSF Philip R. Lee Institute for Health Policy Studies

» Press Coverage

This report describes the common sources of care, barriers to care, and health needs of the estimated 300,000 young California immigrants who are eligible for Deferred Action for Childhood Arrivals (DACA). The authors find that DACA-eligible teens and young adults use less medical care than their U.S.-born peers in spite of being more likely to report poor health. The report also presents potential solutions for health care providers, community-based organizations, and private and public funders to improve health and access to care for this population.


Report

Realizing the Dream for Californians Eligible for Deferred Action for Childhood Arrivals (DACA): Demographics and Health Coverage

February 2014, by Claire D. Brindis, Max W. Hadler, Ken Jacobs, Laurel Lucia, Nadereh Pourat, Marissa Raymond-Flesch, Rachel Siemons and Efrain Talamantes for the UC Berkeley Center for Labor Research and Education, the UCLA Center for Health Policy Research, and the UCSF Philip R. Lee Institute for Health Policy Studies

» Press Release
» Press Coverage

This report describes the demographics and health care coverage of the estimated 300,000 young California immigrants who are eligible for Deferred Action for Childhood Arrivals (DACA). While these teens and young adults are excluded from federal Affordable Care Act health insurance options, the authors find that up to 125,000 may be eligible for Medi-Cal under state policy, based on an analysis of California Health Interview Survey data. In this report, we also present an overview of the health programs available, discuss the impact the DACA program has had on coverage, and present potential policy solutions that would expand coverage for these Californians.


Under the "Forty Hours is Full Time Act" more Americans would lose job-based health coverage and work hours, while federal costs would increase

Health CareDecember 2013, by Ken Jacobs and Dave Graham-Squire

» Report PDF
» Press Coverage

The Affordable Care Act requires larger employers to provide health coverage to employees working 30 hours a week or more, or pay a penalty. The proposed " Forty Hours is Full Time Act" would raise the threshold to 40 hours a week. This brief finds that if passed the act would result in reductions in work hours for significant numbers of American workers, fewer workers obtaining job-based coverage, and an increase in the federal deficit of more than $140 billion over a ten-year budget window.


Large Repayments Of Premium Subsidies May Be Owed To The IRS If Family Income Changes Are Not Promptly Reported

by Ken Jacobs, Dave Graham-Squire, Elise Gould, and Dylan Roby
Health Affairs, September 2013 vol. 32 no. 9 1538-1545

This study analyzes predicted repayments and refunds for people receiving subsidies for health insurance premiums under the Affordable Care Act, using California as a case study.

Full access to this article requires a subscription, but the authors have posted a blog entry that reviews the study results and implications.


New Research Further Strengthens Evidence of the Benefits of the Health Care Safety Net

Brief CoverMay 2013, by William H. Dow, Dylan R. Roby, Gerald F. Kominski, and Ken Jacobs

» Issue Brief PDF

This brief summarizes the evidence on the health benefits of expanded access to health care, with particular attention to the newest studies from recent coverage expansions in Massachusetts, Oregon, and parts of California.


Predicted Medi-Cal Enrollment among Californians Working for Large Firms

Fact Sheet CoverApril 2013, by Dave Graham-Squire, Ken Jacobs, and Laurel Lucia

» Fact Sheet PDF
» Press Coverage

Using the California Simulation of Insurance Markets (CalSIM) model, the authors found that more than 310,000 Californians working for large firms are predicted to be enrolled in Medi-Cal in 2014 under the Affordable Care Act. The estimates in this fact sheet reflect the number of workers for whom employers would be subject to penalties under proposed California Assembly Bill 880.


Smooth Transitions into Medi-Cal: Ensuring Continuity of Coverage for Low Income Health Program Enrollees

Data Brief CoverApril 2013, by Elizabeth C. Lytle, Dylan H. Roby, Laurel Lucia, Ken Jacobs, Livier Cabezas, Nadereh Pourat for the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research

» Policy Note PDF

California plans to transition over 500,000 individuals enrolled in the Low Income Health Program (LIHP) into Medi-Cal on January 1, 2014. This policy note provides background on the LIHP and offers an overview of the Initial Transition Plan submitted by the state to the federal government. Further, it provides recommendations to enhance a smooth transition: continuing to include providers, consumer advocates, and other stakeholder groups in transition planning and activities; engaging in automatic Medi-Cal eligibility determination methods; establishing procedures for data transfer that will provide adequate time for Medi-Cal enrollment; creating an extensive communication and outreach plan; and evaluating the need for special transition plans for populations in need of additional assistance.


Promoting Enrollment of Low Income Health Program Participants in Covered California

Data Brief CoverApril 2013, by Elizabeth C. Lytle, Dylan H. Roby, Laurel Lucia, Ken Jacobs, Livier Cabezas, Nadereh Pourat for the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research

» Policy Note PDF

 This policy note focuses on California's transition plans for the 27,000 Low Income Health Program (LIHP) enrollees who will be eligible for sizable subsidies in the state-based health insurance exchange, Covered California, beginning in January 2014. A successful transition with high rates of participation relies on collaboration between the California Department of Health Care Services, the local LIHPs and Covered California; the active engagement of enrollees; the use of already-available data to ease the enrollment process in Covered California; collaboration in communication with LIHPs and other county programs; and targeted outreach with personal assistance for the potentially eligible.


Which workers are most at risk of reduced work hours under the Affordable Care Act?

Report Cover February 2013, by Dave Graham-Squire and Ken Jacobs

» Data Brief PDF
» Press Coverage

The Affordable Care Act (ACA) requires employers to provide coverage or pay a penalty based on the number of employees working 30 or more hours per week. This data brief looks at which industries have a high percentage of employees working fewer than or slightly above 30 hours, placing them at risk for reduced hours by an employer wishing to avoid penalties.


Medi-Cal Expansion under the Affordable Care Act: Significant Increase in Coverage with Minimal Cost to the State

Report CoverJanuary 2013, by Laurel Lucia, Ken Jacobs, Greg Watson, Miranda Dietz, and Dylan H. Roby for the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research

» Report PDF
» Press Release
» Press Coverage

The Medi-Cal Expansion under the Affordable Care Act will expand eligibility to more than 1.4 million low-income adults in California beginning in 2014, if enacted by the state. Other mandatory provisions of the ACA will lead to increased enrollment among Californians who are already eligible for Medi-Cal but not enrolled. The authors predict the increase in Medi-Cal enrollment under the ACA using the California Simulation of Insurance Markets (CalSIM) model and estimate the associated new federal and state spending. The study finds that the new state spending on Californians newly eligible for Medi-Cal will be largely offset by increased state tax revenues and potential savings in other areas of the budget.


Envisioning Enhanced Roles for In-Home Supportive Services Workers in Care Coordination for Consumers with Chronic Conditions: A Concept Paper

Report

September 2012, by Janet M. Coffman, MA, MPP, PhD and
Susan A. Chapman, PhD, MPH, RN
A joint report from the Philip R. Lee Institute for Health Policy Studies and the Center for Personal Assistance Services, UCSF, and the Center for Labor Research and Education, UC Berkeley

» Report PDF

To bend the cost curve, the United States will need to improve the manner in which care is delivered to persons with chronic conditions. This concept paper explores the feasibility of creating opportunities for In-Home Supportive Services (IHSS) workers to provide enhanced care to the consumers they serve and earn higher wages. The authors provide an overview of the IHSS program, describe how expanding the role of IHSS workers in care coordination could benefit IHSS consumers with chronic conditions, and identify barriers and facilitators to implementing an expanded role for IHSS workers.


After Millions of Californians Gain Health Coverage under the Affordable Care Act, who will Remain Uninsured?

Report

September 2012, by Laurel Lucia, Ken Jacobs, Miranda Dietz, Dave Graham-Squire, Nadereh Pourat, and Dylan H. Roby for the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research

» Report PDF
» Press Coverage

The implementation of the Affordable Care Act will greatly expand Californians’ access to affordable health insurance, primarily due to the expansion of Medi-Cal and the availability of subsidized coverage in the California Health Benefit Exchange. However, three to four million Californians could remain uninsured even after the law is fully implemented. Using the California Simulation of Insurance Markets (CalSIM) model, the authors estimate the demographics, geographic distribution, eligibility for coverage and applicability of the minimum coverage requirements of Californians under age 65 who are predicted to remain uninsured.


Estimating the Change in Coverage in California with a Basic Health Program

Report

August 2012, by the UC Berkeley Center for Labor Research and Education
and the UCLA Center for Health Policy Research

» Research Brief PDF
» Press Coverage

This brief examines the impact of a Basic Health Program (BHP) on health coverage in California. Results are provided for two scenarios: a “base” scenario that assumes typical responses by individuals and employers to expanded coverage offerings, and an “enhanced” scenario that is based on a more robust enrollment and retention strategy by state coverage programs.


Nine Out of Ten Non-Elderly Californians Will Be Insured When the Affordable Care Act is Fully Implemented

coverJune 2012, by Ken Jacobs, Greg Watson, Gerald F. Kominski, Dylan H. Roby, Dave Graham-Squire, Christina M. Kinane, Daphna Gans, and Jack Needleman for the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research

The Affordable Care Act will significantly expand access to affordable health coverage in California through Medi-Cal and the Health Benefit Exchange. Using the California Simulation of Insurance Markets (CalSIM) model, the authors found that an estimated 2.9 to 3.7 million Californians will be newly covered through Medi-Cal or receive subsidized coverage in the Exchange. Others will gain access to coverage through new prohibitions on insurers denying coverage based on pre-existing conditions. As a result, nine out of ten Californians under age 65 will have coverage when the ACA is fully implemented.

CHART PACK
Health Insurance Coverage in California under the Affordable Care Act: Revision of the March 22, 2012 Presentation to the California Health Benefit Exchange Board PDF

» Press Coverage


Predicted Exchange Enrollment with Subsidies under the Affordable Care Act: Regional and County Estimates

Fact Sheet

June 2012, Ken Jacobs, Dave Graham-Squire, Gerald F. Kominski, Dylan H. Roby, Nadereh Pourat, Christina M. Kinane, Greg Watson, Daphna Gans, and Jack Needleman for the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research

» Fact Sheet PDF

Using the California Simulation of Insurance Markets (CalSIM) model, the authors found that between 1.8 and 2.1 million Californians will have subsidized health coverage in 2019 due to the Affordable Care Act. The authors break this down for seven California regions and selected counties.


Predicted Increase in Medi-Cal Enrollment under the Affordable Care Act: Regional and County Estimates

Fact Sheet

June 2012, Ken Jacobs, Dave Graham-Squire, Gerald F. Kominski, Dylan H. Roby, Nadereh Pourat, Christina M. Kinane, Greg Watson, Daphna Gans, and Jack Needleman for the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research

» Fact Sheet PDF

Using the California Simulation of Insurance Markets (CalSIM) model, the authors found that between 1.2 and 1.6 million more Californians will have coverage through Medi-Cal in 2019 due to the Affordable Care Act. The authors break this down for seven California regions and selected counties.


Remaining Uninsured in California under the Affordable Care Act: Regional and County Estimates

Fact Sheet

June 2012, by Ken Jacobs, Dave Graham-Squire, Gerald F. Kominski, Dylan H. Roby, Nadereh Pourat, Christina M. Kinane, Greg Watson, Daphna Gans, and Jack Needleman for the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research

» Fact Sheet PDF

Once the Affordable Care Act is fully implemented in 2019, nearly 90 percent of Californians under age 65 will have access to affordable health coverage. An estimated 3 to 4 million Californians are predicted to remain uninsured in 2019, depending on the extent of outreach and enrollment activities and ease of enrollment and retention. The authors break this down for seven California regions and selected counties.


Laying the Foundation for Health Care Reform: Local Initiatives to Integrate the Health Care Safety Net

ReportMay 2012, by Annette Gardner, PhD, MPH. A report of the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, and the Center for Labor Research and Education, University of California, Berkeley.


The Patient Protection and Affordable Care Act (ACA) provides an opportunity to coordinate care among health care providers and transform local safety nets into seamless systems of care. Dr. Gardner’s study of safety net integration activities in five California counties—Contra Costa, Humboldt, San Diego, San Joaquin, and San Mateo—confirmed that these counties had already made a great deal of progress. Each county is focusing on systems-wide integration, cross-provider integration, and patient-level integration. In addition, there is evidence that many of these integration initiatives have increased coordination of care and strengthened partnerships between providers and county agencies, thereby facilitating implementation of health care reform. Though there are differences in capacity and in the resources counties bring to bear, the study nonetheless identified specific strategies and models that can be adopted by other counties, particularly in the areas of specialty care access, mental health and primary care integration, patient care coordination, and outreach and enrollment. This report describes the factors that affect the ability of a local safety net system to develop integrated delivery systems. It also discusses lessons learned from the implementation of 30 safety net integration "best practices" that can be applied to other counties.


Health Insurance Reforms: How Will They Affect Employment-Based Coverage in California?

Policy Research April 2012, by Jon Gabel, Ryan Lore, Roland McDevitt, and Jeremy Pickreign

» Issue Brief PDF
» Abstract

The objectives of this issue brief are: (1) to examine how insurance reforms required by the Affordable Care Act will affect benefit packages currently offered by California employers and (2) to estimate out-of-pocket expenses and actuarial values for households with employment-based health plans in California in 2010.


The State of Health Insurance in California: Findings from the 2009 California Health Interview Survey

Policy Research February 2012, UCLA Center on Health Policy Research

» Research Findings PDF

This survey, published every two years with grant funding from The California Endowment and The California Wellness Foundation, uses the latest data from the California Health Interview Survey (CHIS) to paint a comprehensive picture of health insurance trends, access, and coverage status for California's more than 37 million residents. Labor Center chair Ken Jacobs authored the chapter “Job-Based Coverage and the Individual Market.”


Achieving Equity by Building a Bridge from Eligible to Enrolled

Achieving Equity by Building a Bridge from Eligible to Enrolled February 2012, by Daphna Gans, Christina Kinane, Greg Watson, Dylan H. Roby, Jack Needleman, Dave Graham-Squire, Gerald F. Kominski, Ken Jacobs, David Dexter, Ellen Wu
» Policy Brief PDF
» Press Coverage

This joint publication with  the UCLA Center for Health Policy Research and the California Pan-Ethnic Health Network finds that language barriers could deter more than 100,000 Californians from enrolling in the state's Health Benefit Exchange. The study recommendations include investing in linguistically and culturally appropriate marketing and outreach as well as investing in primary care and workforce diversity in underserved areas, among other actions.


Newly Insured Californians Would Fall by More than 1 Million under the Affordable Care Act without the Requirement to Purchase Insurance

Newly Insured Californians Would Fall by More than 1 Million under the Affordable Care Act without the Requirement to Purchase Insurance January 2012, by Gerald F. Kominski, Dylan H. Roby, Ken Jacobs, Greg Watson, Dave Graham-Squire, Christina M. Kinane, Daphna Gans, and Jack Needleman
» Policy Note PDF
» Amicus Brief from The California Endowment citing the Policy Note PDF
» Press Release from California Endowment

The Affordable Care Act (ACA) requirement that almost all Americans purchase some type of health insurance coverage has been controversial. This policy note examines the potential implications of eliminating the minimum coverage requirement (MCR), or "individual mandate."


Proposed Regulations Could Limit Access to Affordable Health Coverage for Workers’ Children and Family Members

Affordable Care ActDecember 2011, by Ken Jacobs, Dave Graham-Squire, Dylan H. Roby, Gerald F. Kominski, Christina M. Kinane, Jack Needleman, Greg Watson, and Daphna Gans
» Policy Brief PDF
» Press Release
» Members of Congress cite our report PDF
» Press Coverage

Our latest report analyzes the proposed regulations defining affordable job-based coverage under the Affordable Care Act. We find that the proposed regulations would result in 144,000 fewer Californians having access to subsidized coverage in the health insurance exchange than would be the case under an alternative interpretation of affordability.


Promise of the Affordable Care ActThe Promise of the Affordable Care Act, the Practical Realities of Implementation:
Maintaining Health Coverage During Life Transitions

October 2011, By Ann O’Leary, Beth Capell, Ken Jacobs, and Laurel Lucia
» Policy Brief PDF

Achieving the promise of the Affordable Care Act will require attention in federal regulations and actions by the new health insurance exchanges to ensure seamless coverage for those who rely on private insurance, including job-based coverage. This paper makes several policy recommendations to ensure that all Americans can maintain health coverage under the ACA—even during complicated life transitions.


Eligibility for Medi-Cal and the Health Insurance Exchange in California under the Affordable Care ActMaximizing Health Care Enrollment through Seamless Coverage for Families in Transition: Current Trends and Policy Implications
March 2011, By Ken Jacobs, Laurel Lucia, Ann O’Leary and Ann Marie Marciarille
» Policy Brief PDF

This policy brief reviews the literature on the prevalence of uninsurance caused by work or life transitions, including loss of or change in a job, a reduction in work hours, divorce or legal separation, loss of dependent status, a disability or the death of a family member.  The brief also provides initial recommendations for state and federal policymakers on how best to ensure seamless health coverage under the Affordable Care Act for individuals and families who lose health insurance because of a work or life transition.


Eligibility for Medi-Cal and the Health Insurance Exchange in California under the Affordable Care Act Eligibility for Medi-Cal and the Health Insurance Exchange in California under the Affordable Care Act
August 2010, By Ken Jacobs, Laurel Lucia and Dave Graham-Squire
» Issue Brief PDF

This issue brief analyzes the impact that the federal health reform law will have on California. More than 4 million Californians who are without health insurance, covered in the individual market or enrolled in unaffordable job-based coverage, will be eligible for Medicaid or subsidized coverage under the law. A significant segment of the private insurance market, between 3 and 8 million Californians, will be eligible to purchase subsidized or unsubsidized coverage in the exchange.


Federal Health Reform: Impact on California Small Businesses, Their Employees and the Self-Employed Federal Health Reform: Impact on California Small Businesses, Their Employees and the Self-Employed
June 2010, By Laurel Lucia, Ken Jacobs and Dave Graham-Squire
» Issue Brief PDF

This issue brief examines the impact that the health reform law will have on California small businesses, their employees and the self-employed. The law will make it more affordable for California small businesses to offer coverage by reducing administrative costs for small group health plans and offering $4.4 billion in health insurance tax credits over ten years. More than 1.6 million small business employees and self-employed Californians who lack affordable employer-based coverage will be eligible to enroll in Medicaid or purchase subsidized insurance in the non-group market. Small businesses with fewer than 50 full-time equivalent employees will be exempt from the proposed employer responsibilities and most California small businesses offering coverage will be minimally affected by the proposed health plan standards as they already offer qualifying health plans.


The President's Health Reform Proposal: Impact on Access and Affordability in California

The President's Health Reform Proposal: Impact on Access and Affordability in California
February 2010, By Ken Jacobs, Laurel Tan, Dave Graham-Squire, Jon Gabel and Roland McDevitt

» Data Brief PDF
» Press Release

This data brief, released jointly with the National Opinion Research Center (NORC) at the University of Chicago and Towers Watson, analyzes the impact that the Presidentís health reform proposal would have on California. Nearly 4 million Californians who are without health insurance, covered in the individual market or enrolled in unaffordable job-based coverage, would be eligible for Medicaid or subsidized coverage under the proposal. The proposal would also result in significant premium and out-of-pocket savings for low- and moderate-income families purchasing coverage in the exchange compared to costs in the current individual market.


Who Benefits from the Proposed Amendment to the Senate Excise Tax on Employer Health Premiums?

Who Benefits from the Proposed Amendment to the Senate Excise Tax on Employer Health Premiums?
February 2010, By Ken Jacobs, William H. Dow, Dave Graham-Squire and Laurel Tan

» Issue Brief PDF
» Press Release
» Article in Washington Post

This report examines the impact that the proposed Senate excise tax on high-cost employer health plans would have on union and non-union workers. The report finds that the vast majority of workers that would be affected by a tax on health benefits that cost more than a certain threshold are not covered by a union contract. Non-union workers would receive a much larger share of the savings from the reduced excise tax that was negotiated between the White House and labor leaders in January.


How would the Senate health bill affect U.S. workers employed at or near part-time? How would the Senate health bill affect U.S. workers employed at or near part-time?
January 2010, by Dave Graham-Squire
» Data Brief PDF

Under current language of the Senate's health bill, firms are not required to provide coverage for part-time employees (defined as those working fewer than 30 hours a week). This may put workers who work just over 30 hours a week at risk for reduced hours by employers wishing to avoid penalties. In all, 28 percent of U.S. workers are employed at or near "part-time." This brief also looks at the distribution of hours worked by industry and the prevalence of job-based coverage for full- and part-time employees.
National Health Reform Requirements and California Employers National Health Reform Requirements and California Employers
December 2009, by Jon Gabel, Ken Jacobs, Laurel Tan, Roland McDevitt, Jeremy Pickreign, and Shova KC
» Issue Brief PDF

This issue brief, released jointly with the National Opinion Research Center (NORC) at the University of Chicago and Watson Wyatt Worldwide, analyzes the impact that the House and Senate health reform proposals would have on the 18.4 million Californians who are enrolled in employer-based insurance. While the vast majority of employees work for firms that currently comply with most of the new requirements for employer-based insurance included in the bills, reform legislation, if passed, would increase protection for many insured workers and their families in California.
How Would Health Care Reforms Change the Spending of California Families Without an Employer Plan? How Would Health Care Reforms Change the Spending of California Families Without an Employer Plan?
December 2009, by Ken Jacobs, Laurel Tan, Roland McDevitt, Jon Gabel and Ryan Lore
» Research Brief PDF

This paper examines health care spending for the estimated two million Californians who would qualify for subsidies under the proposed insurance exchanges in the House and Senate health reform bills. Accounting for premiums and average out of pocket costs, both bills would result in significant savings for low- and moderate-income families compared to costs in the current individual market. The House bill would result in lower spending than the Senate bill for the lowest-income individuals and families, especially those with high health care use.
Californians' Access to Coverage under the Health Reform Proposals Californians' Access to Coverage under the Health Reform Proposals
December 2009, by Ken Jacobs and Dave Graham-Squire
» Data Brief PDF

This data brief finds that nearly 4 million Californians who are without health insurance, covered in the individual market or enrolled in unaffordable job-based coverage, would be eligible for Medicaid or subsidized coverage under the national health reform proposals. The brief analyzes both the House and Senate legislation to compare how they differ in their impacts on Californians.
Addressing California's Health Coverage Gaps: The Impact of National Health Care Reform Addressing California's Health Coverage Gaps: The Impact of National Health Care Reform
November 2009, by Annette Gardner, Melissa Rodgers, and Ken Jacobs
» Policy Brief PDF

This report, released jointly with the UC Berkeley Center for Health Economic and Family Security, discusses the gaps in health coverage in California, how well the House and the Senate proposals would succeed in filling those gaps, and effects on California's safety net system.


Comparing the Employer Requirements in the Congressional Health Proposals Comparing the Employer Requirements in the Congressional Health Proposals
October 2009, by Ken Jacobs
» Report PDF




The Impact of San Francisco's Employer Health Spending Requirement: Initial Findings from the Labor and Product Markets The Impact of San Francisco's Employer Health Spending Requirement: Initial Findings from the Labor and Product Markets
August 2009, by Arindrajit Dube, William H. Dow, and Carrie Hoverman Colla
» Report PDF


How to Structure a 'Play-or-Pay' Requirement on Employers: Lessons from California for National Health Reform How to Structure a "Play-or-Pay" Requirement on Employers: Lessons from California for National Health Reform
June 2009, by Ken Jacobs and Jacob Hacker
» Report PDF
» Press Coverage

This report analyzes three notable California health-care reform proposals and uses lessons learned in California to detail how "play-or-pay" requirements on employers could be structured in a national health-care reform plan. The report was jointly written with the Berkeley Center on Health, Economic & Family Security (Berkeley CHEFS).


No Recovery in Sight: Health Coverage for Working-Age Adults in the United States and California No Recovery in Sight: Health Coverage for Working-Age Adults in the United States and California
April 2009, by Ken Jacobs and David Graham-Squire
» Report PDF
» Press Release
» Press Coverage

This policy brief predicts the change in health-coverage rates and sources of coverage by the end of President Obamaís first term in office. It also analyses health-care trends from 2000 to 2007, and looks at the impact that increasing unemployment during the current economic recession has had on health-coverage rates.


First Dollar Coverage for Chronic Disease Care: Can it Save Money and Improve Patient Outcomes? First Dollar Coverage for Chronic Disease Care: Can it Save Money and Improve Patient Outcomes?
September 2008, by Korey Capozza
» Full Report PDF

This policy brief analyzes the potential impact of reducing or eliminating patient cost-sharing for chronic disease medications as a means to improve patient outcomes and reign in health care costs.


Labor Day 2008: Recession or not, a downturn for working families. Labor Day 2008: Recession or not, a downturn for working families.
A briefing on jobs, wages and healthcare

August 2008, by Sylvia Allegretto, Arindrajit Dube, Dave Graham-Squire and Ken Jacobs
» Report PDF
» Press Coverage

The Labor Center's annual briefing on California and national wage, employment and union trends.


A Health Impact Assessment of the California Healthy Families, Healthy Workplaces Act of 2008 A Health Impact Assessment of the California Healthy Families, Healthy Workplaces Act of 2008
July 2008, by Human Impact Partners and researchers at the San Francisco Department of Health (UC Berkeley Center for Labor Research and Education contributed)
» Report Summary PDF
» Full Report PDF

A research report showing that the proposed California paid sick days legislation will have significant positive public health impacts.


The Public Health Impacts of AB 2716 The Public Health Impacts of AB 2716
May 2008, by Korey Capozza
» Full Report PDF

This study analyzes the potential public health impact of AB 2716, a bill that would extend paid sick days to all workers in California. It finds that AB 2716 will likely have a positive impact on public health, potentially reducing the transmission of illnesses such as seasonal influenza and norovirus.


Secure and Affordable Health Care Act of 2008Secure and Affordable Health Care Act of 2008: Impact on Payroll Costs in California
January 2008, by Ken Jacobs and Dave Graham-Squire
» Data Brief PDF

This report analyzes what California employers' health care contributions would be under the proposed Secure and Affordable Health Care Act of 2008.


Modeling Employer Participation in Adult Healthcare Coverage Expansion in San Mateo CountyModeling Employer Participation in Adult Healthcare Coverage Expansion in San Mateo County
October 2007, by Ken Jacobs and Lucas Ronconi, for the San Mateo County Blue Ribbon Task Force on Adult Health Coverage Expansion.
» Report PDF
» Powerpoint Presentation

Report for the San Mateo County Blue Ribbon Task Force on Adult Health Coverage Expansion; assesses options for employer participation in a new county health care access expansion program and analyzes the potential for generating revenue for the program.


Health Coverage Expansion in CaliforniaHealth Coverage Expansion in California: What Can Consumers Afford to Spend?
September 2007, by Ken Jacobs, Korey Capozza, Dylan H. Roby, Gerald F. Kominski and E. Richard Brown
» Research Brief PDF
» Appendix: Methodology PDF
» Press Coverage

Report analyzes what families are currently spending on health care in California, and finds that health care represents a significant expense for families with incomes less than 300% of the federal poverty line. The authors recommend that any health care reform policy adopted in California include adequate affordability protections for those families.


Impact of Health Benefit Reductions in the Unionized Grocery Sector in CaliforniaImpact of Health Benefit Reductions in the Unionized Grocery Sector in California
August 2007, by Arindrajit Dube and Ken Jacobs
» Preliminary Findings PDF
» Powerpoint Presentation PDF
» Press Coverage

Analyzes the impact of changes in grocery worker labor contracts on healthcare coverage and utilization.


Small Raise ReportSmall Raise: Jobs, Wages and Healthcare in 2007
August 2007, by Arindrajit Dube, Ken Jacobs and Dave Graham-Squire
» Powerpoint Presentation PDF
» Press Coverage

The Labor Center's annual briefing on California and national wage, employment and union trends.


Health Coverage Proposals in California: Impact on BusinessesHealth Coverage Proposals in California: Impact on Businesses
July 2007, by Ken Jacobs, Lucas Ronconi and Dave Graham-Squire
» Research Brief PDF
» Press Release PDF
» Press Coverage

This study analyzes the potential economic impact of two of the main health care reform proposals under consideration in California, Governor Schwarzenegger’s health care reform proposal and Assembly Bill 8. Both proposals include provisions requiring employers to spend a minimum percentage of their payroll on employee health care or pay an en lieu fee to the state. The study finds that neither the Governor’s plan nor AB 8 will result in job losses in California, which has been a key argument of CA health care reform opponents. It forecasts that most firms will experience little or no net change in business operating costs after a short adjustment period.


Testimony for the Governor's Public Employee Post-Employment Benefits Commission
May 2007, by Ken Jacobs
» Testimony

Testimony about cost trends in retiree health benefits, how private sector employers are responding to those trends, and the implications for the public. Includes a discussion of steps that could be taken in the current health policy reform debates to control health premium inflation.


California Healthcare: Firm Spending and Worker CoverageCalifornia Healthcare: Firm Spending and Worker Coverage
March 2007, by Dave Graham-Squire, Ken Jacobs and Arindrajit Dube
» Research Brief
» Waiting Periods for Employer Sponsored Insurance PDF
» Offer, Eligibility and Coverage by Industry PDF

Research Brief discusses implications of the major new health reform proposals in California, which include fees for employers who spend less than a specified amount of total payroll on healthcare. In order to understand the impacts of these policies, it is important to look at the current patterns of healthcare spending as a percent of payroll in California. Of particular interest are those workers without any health coverage and the healthcare spending patterns of their employers. The data describe the amount California employers spend on healthcare as a percent of total employee payroll.


Declining Health Coverage in the Southern California Grocery IndustryDeclining Health Coverage in the Southern California Grocery Industry
January 2007, by Ken Jacobs, Arindrajit Dube and Felix Su
» Summary Findings
» Powerpoint Presentation
» Press Coverage

These summary findings assess the effects of a new contract for grocery workers in Southern California in March 2004 that significantly restructured health insurance coverage. The research draws on United Food and Commercial Workers (UFCW) actuarial and membership data and union survey responses to document the impact of benefits changes on health coverage and utilization in both Southern and Northern California. It concludes that the contract changes have dramatically reduced health coverage in the grocery industry in the Southern half of the state, diminished the rate of health care utilization, and exacerbated the annual turnover rate for grocery workers in Los Angeles.


Establishing a San Francisco Taxi Driver Health Care Coverage Plan Establishing a San Francisco Taxi Driver Health Care Coverage Plan
March 2006, by Rhonda Evans, Jabril Bensedrine, Ken Jacobs and Carol Zabin (for the City & County of San Francisco, Department of Public Health)
» Report PDF

This report was written for the San Francisco Department of Public Health and explores options for expanding health care coverage to the city’s taxi drivers. It lays out different options for stakeholders’ participation in funding and implementing a health care program, and compares the pros and cons of several alternative plans.


Declining Job-Based Health Coverage in the United States and California: A Crisis for Working FamiliesDeclining Job-Based Health Coverage in the United States and California: A Crisis for Working Families
January 2006, by Arindrajit Dube, Ken Jacobs, Sarah Muller, Bob Brownstein and Phaedra Ellis-Lamkins
» Report PDF

Due in large part to skyrocketing premiums, job-based health coverage—a cornerstone of our health care system—has eroded over the past five years. For every 10% increase in premiums costs, 1.4 million fewer working family members receive job-based insurance. Most adults losing such coverage become uninsured, while most children move to public coverage. This report both documents and forecasts trends in job-based health care coverage that will be of interest to policy makers, health care analysts, and concerned citizens in California and nationally.


Internal Wal-Mart Memo Validates Findings of UC Berkeley Study
October 2005, by Arindrajit Dube, Ken Jacobs and Steve Wertheim
» Research Brief PDF

The Labor Center’s report, The Hidden Cost of Wal-Mart Jobs, found that Wal-Mart workers disproportionately rely on taxpayer funded public health programs in California compared to workers in large retail as a whole. An internal Wal-Mart memo reported on in The New York Times provides data from Wal-Mart validates the basic findings of that UC Berkeley report. This research note highlights this confirming evidence, focusing on workers’ and dependent children’s health coverage.


Kids at Risk: Declining Employer-Based Health Coverage in California and the United States Kids at Risk: Declining Employer-Based Health Coverage in California and the United States
August 2005, by Arindrajit Dube, Ken Jacobs, Sarah Muller, Bob Brownstein and Phaedra Ellis-Lamkins
» Policy Brief PDF
» Press Coverage

This report focuses on children’s healthcare coverage status, scrutinizing recent trends and modeling future patterns. The authors determine the indirect effects of skyrocketing premiums on children’s coverage status, breaking apart the results by income levels. The study then simulates trends through 2010, finding an increase in the number of uninsured children in both California and nationally. The authors close with the policy implications of their findings.


Falling Apart: Declining Job-Based Health Coverage for Working Families in California and the United States Falling Apart: Declining Job-Based Health Coverage for Working Families in California and the United States
June 2005, by Arindrajit Dube, Ken Jacobs, Sarah Muller, Bob Brownstein and Phaedra Ellis-Lamkins
» Policy Brief PDF
» Appendix: Methodology
» Powerpoint Presentation: Summary
» Powerpoint Presentation: National Trends & Projections
» Press Release
» Press Coverage

This policy brief focuses on state and national patterns in healthcare coverage of non-elderly working adults. The authors model the effects of increasing premium costs on health coverage status, and forecast a significant decrease in job-based coverage along with a sizeable increase in the number of uninsured working adults state and nationwide.


Hidden Cost of Wal-Mart Jobs: Use of Safety Net Programs by Wal-Mart Workers in California Hidden Cost of Wal-Mart Jobs: Use of Safety Net Programs by Wal-Mart Workers in California
August 2004, by Arindrajit Dube and Ken Jacobs
» Briefing Paper
» Authors' Response to Wal-Mart's Statements
» Press Coverage

This widely publicized report finds Wal-Mart’s wage and health benefits packages for its California workers to be below average as compared to the overall retail sector in California. The authors also find a greater reliance upon public assistance programs among Wal-Mart workers as compared to other California retail workers. Finally, the authors estimate the additional costs to taxpayers of “Wal-Martization”—the adoption of Wal-Mart’s wage and health benefits standards by retailers throughout California.


Wage and Health Benefit Restructuring in California's Grocery Industry: Public Costs and Policy Implications
July 2004, by Arindarjit Dube and Alex Lantsberg
» Report
» Summary

This study analyzes the 2004 labor agreement between southern California grocers and employees, and examines the implications for grocery workers statewide as well. The authors predict that the agreement will result in the loss of employer-sponsored health insurance for one-third to one-half of the sector’s employees. The ensuing shift to public health care plans and emergency room care will translate to greatly increased costs to taxpayers, effectively transferring the burden from employers to the public. The authors conclude with policy solutions to this looming problem.


Workforce Needs in California’s Homecare System Workforce Needs in California’s Homecare System
May 2004, by Eileen Boris, Gawon Chung, Linda Delp, Ruth Matthias and Carol Zabin
» Briefing Paper PDF

This briefing paper summarizes the substantial advantages of California’s In-Home Supportive Services (IHSS) program, and argues for the continuation of the program in the face of potential budget cuts. The authors document the higher costs to the state of nursing home care compared to home care, and outline the positive effects of workers’ higher wages and benefits on worker recruitment/labor supply, worker turnover, the quality of care, and lowered public costs.


The Hidden Public Costs of Low-Wage Jobs in California The Hidden Public Costs of Low-Wage Jobs in California
November 2004, by Carol Zabin, Arindrajit Dube and Ken Jacobs, The State of California Labor 2004, University of California Institute for Labor and Employment.
» Report
» Report Summary
» Press Coverage

This report highlights the considerable number of working families in California’s public assistance programs, providing demographic and employment profiles of the families. The authors simulate various policy changes—including wage floors and universal employer-sponsored health insurance—and calculate the reductions in public assistance program costs flowing from the decreased reliance upon the programs. Finally, the authors survey policies and economic development strategies designed to alleviate the problem of low-wage employment.


2003 California Establishment Survey: Preliminary Results on Employer Based Healthcare Reform
September 2003, by Arindrajit Dube and Michael Reich
» Research Brief PDF

Early findings from a survey of California firms’ opinions on then-proposed Senate Bill 2, which would have created employer-sponsored health insurance for all state firms with more than twenty employees. The survey results demonstrate that a majority of firms were in favor of the bill, and the authors calculate the number of businesses covered by the proposed law. The authors then calculate the cost of SB 2 to the average covered firm.


Impact of SB2 on Health Coverage Impact of SB2 on Health Coverage
September 2003, by Arindrajit Dube
» Research Brief PDF

An examination of the effects of the 2003 Senate Bill 2, which, had it been enacted, would have required employers in California to either provide health coverage to their workers or pay a fee to the state for that purpose. This brief forecast possible impacts, including the number of uninsured Californians to gain health coverage under the law and how variously-sized businesses would have been affected.


Productivity Impact of Health Care Reform in California Productivity Impact of Health Care Reform in California
August 2003, by Arindrajit Dube
» Research Brief PDF
» Executive Summary PDF

This study examines the impact that providing health care insurance to currently uninsured California working-age adults would have for the state economy as a whole. The author quantifies productivity gains yielded from the elimination of “job lock” – a phenomenon whereby workers stay at jobs only because of the health benefits. The study also estimates the economic impact of labor force participation for individuals who are currently too unhealthy to work, but would be enabled to do so if they had health care coverage.


Working Family Members on Medi-Cal: Enrollment and Cost by Industry and Size of Employers Working Family Members on Medi-Cal: Enrollment and Cost by Industry and Size of Employers
August 2003, by Arindrajit Dube
» Research Brief PDF

This research brief calculates the number of people enrolled in Medi-Cal who are also members of working families. The report also calculates the costs to the state of working-family member enrollment in Medi-Cal, and identifies the industries whose employees are disproportionately represented in the Medi-Cal system.


Paid Family Leave in California: An Analysis of Costs and Benefits
June 2002, by Arindrajit Dube and Ethan Kaplan
» Report PDF

A cost-benefit analysis of 2002’s Senate Bill 1661, which extended California’s paid leave laws to include care for family members. The report begins with a survey of existing research on paid family leave legislation, and then provides an estimation of the costs of SB 1661 implementation, both for employers and employees. The authors conclude with an analysis of the benefits, including intangible health benefits, and the potential cost savings to employers and state government.


The California Healthcare Crisis: Impact on California Economy and BudgetThe California Healthcare Crisis: Impact on California Economy and Budget
2002, by Arindrajit Dube
» Powerpoint Presentation

A slide-show presentation of facts documenting the negative fiscal impacts to the State of California of the current state healthcare system.
 
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