The Sacramento Bee, June 24, 2012
Just as it's beginning to look like parts of the federal health care law may be struck down, new research shows exactly how many people in the Sacramento region may be affected by two prominent pieces of the vast legislation.
At the high end, with vigorous outreach, up to 330,000 people in the four-county region would be enrolled in expanded Medi-Cal, California's version of Medicaid. The expansion extends assistance to people earning up to $14,856 a year, or 138 percent of the federal poverty level.
Another 100,000 in the region are predicted to be enrolled in the tax-subsidy program for people buying insurance in the state exchange established to help implement the health care reform law. Again, this assumes ambitious outreach to the segment of the affected population, people making up to 400 percent of the poverty level — or an individual earning $44,680 annually.
Conducted by UC Berkeley and UCLA researchers, the study offers the first glimpse at how many people are expected to be enrolled by 2019 in Sacramento, Yolo, Placer and El Dorado counties.
But the figures come as the U.S. Supreme Court is poised this week to release its ruling on the constitutionality of the federal law.
The numbers assume that California will move forward with these two critical parts of the Affordable Care Act, launching a rigorous effort to identify and sign up eligible participants by 2019.
"This is the range of what we expect to happen under the health care reform act if California does a good job of reaching eligible enrollees," said Ken Jacobs, chairman of the UC Berkeley Center for Labor Research and Education, which conducted the study along with the UCLA Center for Health Policy Research.
On the flip side, the research predicts that up to 150,000 low-income people in the Sacramento region may fall through the cracks, remaining uninsured, if enrollment outreach programs are mediocre, Jacobs said.
Already, the Sacramento region has seen an infusion of funds to expand public health clinics, reimburse seniors an average of $585 each so far this year for prescription costs and help launch conversions to electronic medical records, among other things.
About 20,000 people in the region are believed to be ineligible for expanded health care under the federal law because they are illegal immigrants, Jacobs said.
One stopgap program called the Low Income Health Program has attracted federal dollars to help set up new care networks in the four-county region.
About 400,000 people are enrolled in this program statewide. Locally, it's too early to say how many will be enrolled in the program since counties, for the large part, are still pulling together their programs.
Currently, Sacramento County's Low Income Health Program is being delayed from a scheduled August debut because two hospital systems need to join the county effort — and so far only one has stepped forward.
Placer County's clinic was expected to begin operating in August and Yolo County's clinic has been shooting for a July startup date. El Dorado County joined more than 30 other rural counties to start enrolling low-income residents in the program, considered a precursor to the Medi-Cal expansion envisioned for 2014.
The footrace for funds has left Sacramento and Placer counties on the tail end of a wave of California counties reaching out for the matching Low Income Health Program dollars.
"The places that started early had robust safety net systems with public hospitals, and with large urban counties that were very keen on the Low Income Health Program," said Anthony Wright, executive director of the non-profit Health Access California.
By contrast, Sacramento County's safety net has been frayed by persistent budget cuts to the point where, currently, only one county public health clinic remains in operation. Still, the county envisions enrolling up to 10,000 in its Low Income Health Program once it's up and running.
Another crucial part of federal health care reform — providing coverage to those with pre-existing conditions — is set in state law, so California now operates its own, independent plan.
The Pre-Exisiting Condition Insurance Plan enrolls 523 patients in the Sacramento region — with 314 in the county of Sacramento, 115 in Placer County, 52 in El Dorado County and 42 in Yolo County.
It's believed that, no matter which way the U.S. Supreme Court rules, the pre-existing condition program is here to stay because the Legislature passed laws setting it up. However, funding for this and other programs may be up in the air after the high court's ruling.
"We will be waiting with bated breath," Wright said. "There's perhaps no state that has a greater stake than California just by its sheer size."