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

May 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.

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

February 2012, UCLA Center on Health Policy Research

» Research Findings

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

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
» 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

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
» Amicus Brief from The California Endowment citing the Policy Note
» 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

December 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
» Press Release
» Members of Congress cite our report

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.

The 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

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.

Maximizing 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

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.

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
» 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 President’s 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?
February 2010, By Ken Jacobs, William H. Dow, Dave Graham-Squire and Laurel Tan

» Issue Brief
» 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.

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.