The Inflation Reduction Act (IRA) currently being considered by Congress would improve health care affordability for many Californians by addressing high and rising drug prices and by extending the improved premium affordability assistance to Covered California enrollees that began in 2021. The extension of federal premium assistance would also unlock additional state-financed affordability help to reduce how much Covered California enrollees pay out-of-pocket when they access care.
Laurel Lucia is director of the Health Care program at the UC Berkeley Labor Center, where she has worked since 2009. Her research focuses on health coverage and cost trends in California, and policies to improve access to and affordability of health care for California workers and their families. Recent publications have examined the impact of rising health care costs for workers in California, policies to improve access to health insurance for California immigrants, shifts in health coverage during COVID-19, and the health coverage and economic impacts in California of the possible repeal of the Affordable Care Act.
She provides technical assistance to policymakers and stakeholders, and her work has been covered in the Los Angeles Times, the Atlantic, and National Public Radio. Previously, Laurel worked on issues affecting long term care workers during her time as a researcher/policy analyst for the Service Employees International Union (SEIU). She has served as an elected officer for two unions. Laurel received a Master of Public Policy degree from UC Berkeley and a bachelor’s degree in public policy from Stanford University.
Comments on Rule Proposed by the Internal Revenue Service on Affordability of Employer Coverage for Family Members of Employees
Comment submitted to the Internal Revenue Service on proposed regulation that would address the ACA “Family Glitch.”
The Medi-Cal redetermination process has been paused during the COVID public health emergency. As a result, many more individuals have newly enrolled in Medi-Cal than disenrolled, increasing Medi-Cal enrollment by almost 2 million since the beginning of the pandemic. This blog post summarizes (1) the available estimates of the potential reduction in Medi-Cal enrollment once the PHE is unwound and redeterminations have been completed, and (2) the likely eligibility for and enrollment in private coverage among those losing Medi-Cal.
California has the opportunity to expand Medi-Cal to all low-income Californians, regardless of immigration status or age. This policy would result in a massive increase in coverage, bringing close to 700,000 undocumented Californians into coverage and reducing the uninsured rate for residents under 65 to just 7.1%, the biggest single improvement since implementation of the ACA.
The Threat to Coverage and Affordability Gains in Covered California if Congress Fails to Renew Subsidy Enhancements
In response to the COVID-19 pandemic, Congress enacted the American Rescue Plan of 2021 to provide additional temporary financial help for buying health insurance through the ACA Marketplaces. If these enhanced subsidies are not extended for 2023 and beyond, we project 220,000 fewer Californians would have individual market insurance in 2023 than if enhanced subsidies are extended, and premiums would be less affordable for more than two million individual market enrollees.
The state of California is ready with $304 million to help lower- and middle-income consumers pay for health insurance if federal subsidies end. But the fund will cover only a fraction of what would be lost. “We’re fortunate the state has the program, but it’s not enough,” said Laurel Lucia.
Much of the cost for increasing premiums has been swallowed by employers, but it gets passed down to employees anyway. When health costs increase, wages stagnate, said Laurel Lucia, director of health care at the UC Berkeley Labor Center.
If the state pours more money into part-time faculty health plans, “unions and the districts may negotiate to improve the benefits currently offered,” said Laurel Lucia. Colleges that already offer health plans to part-time faculty “might reduce the premium amount that the worker is required to pay or they might reduce the amount that people have to pay out of pocket to access care.”
Two women’s stories suggest why California’s expansion of Medicaid to undocumented older adults is a big deal
Gov. Newsom’s proposed budget has proposed providing the final missing piece and the largest group remaining: all low-income adults ages 26 to 49, regardless of immigration status. That move would represent the state’s biggest coverage expansion since the Affordable Care Act’s implementation, and comprises about 670,000 people, Lucia said.
“Our health insurance system, which is primarily tied to employment, is not financed in a way that’s progressive,” said Laurel Lucia. “Low-wage workers who get coverage through their jobs pay a much higher percentage of their income than middle- and higher-income workers.”
Lack of access because of immigration status is just one piece of the remaining uninsured. Many other Californians forgo coverage despite being eligible, likely because of the cost. According to the UC Berkeley and UCLA study, 2 million uninsured people qualify for Medi-Cal, employer coverage or Covered California.
“Unfortunately, employers use this threat to discourage workers from going on strike or to push workers to end a strike before an adequate contract agreement has been reached,” says Laurel Lucia.
“We do have a challenge with staffing problems [in healthcare],” said Laurel Lucia, director of the healthcare program at the UC Berkeley Labor Center. “I don’t see how this is the solution. Removing labor protections and benefits for healthcare workers will be bad for both workers and patients.”
Laurel Lucia, director of the Health Care Program at UC Berkeley Labor Center, said she is also somewhat surprised that a health care company would move toward a two-tier wage system at this particular moment when workforce shortages make worker happiness and satisfaction especially important.