DOCSLIB.ORG

HEALTH SAVINGS ACCOUNTS (Hsas) and CONSUMER DRIVEN HEALTH CARE: COST CONTAINMENT OR COST SHIFT?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
HEALTH SAVINGS ACCOUNTS (Hsas) and CONSUMER DRIVEN HEALTH CARE: COST CONTAINMENT OR COST SHIFT? HEALTH SAVINGS ACCOUNTS (HSAs) AND CONSUMER DRIVEN HEALTH CARE: COST CONTAINMENT OR COST SHIFT? HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON WAYS AND MEANS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED TENTH CONGRESS SECOND SESSION MAY 14, 2008 Serial No. 110–84 Printed for the use of the Committee on Ways and Means ( U.S. GOVERNMENT PRINTING OFFICE 50–037 WASHINGTON : 2009 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Nov 24 2008 01:30 Jul 15, 2009 Jkt 050037 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 E:\HR\OC\50037.XXX 50037 tjames on DSK5CLS3C1PROD with HEARING COMMITTEE ON WAYS AND MEANS CHARLES B. RANGEL, New York, Chairman FORTNEY PETE STARK, California JIM MCCRERY, Louisiana SANDER M. LEVIN, Michigan WALLY HERGER, California JIM MCDERMOTT, Washington DAVE CAMP, Michigan JOHN LEWIS, Georgia JIM RAMSTAD, Minnesota RICHARD E. NEAL, Massachusetts SAM JOHNSON, Texas MICHAEL R. MCNULTY, New York PHIL ENGLISH, Pennsylvania JOHN S. TANNER, Tennessee JERRY WELLER, Illinois XAVIER BECERRA, California KENNY HULSHOF, Missouri LLOYD DOGGETT, Texas RON LEWIS, Kentucky EARL POMEROY, North Dakota KEVIN BRADY, Texas STEPHANIE TUBBS JONES, Ohio THOMAS M. REYNOLDS, New York MIKE THOMPSON, California PAUL RYAN, Wisconsin JOHN B. LARSON, Connecticut ERIC CANTOR, Virginia RAHM EMANUEL, Illinois JOHN LINDER, Georgia EARL BLUMENAUER, Oregon DEVIN NUNES, California RON KIND, Wisconsin PAT TIBERI, Ohio BILL PASCRELL, JR., New Jersey JON PORTER, Nevada SHELLEY BERKLEY, Nevada JOSEPH CROWLEY, New York CHRIS VAN HOLLEN, Maryland KENDRICK MEEK, Florida ALLYSON Y. SCHWARTZ, Pennsylvania ARTUR DAVIS, Alabama JANICE MAYS, Chief Counsel and Staff Director JON TRAUB, Minority Staff Director SUBCOMMITTEE ON HEALTH FORTNEY PETE STARK, California, Chairman LLOYD DOGGETT, Texas DAVE CAMP, Michigan MIKE THOMPSON, California SAM JOHNSON, Texas RAHM EMANUEL, Illinois JIM RAMSTAD, Minnesota XAVIER BECERRA, California PHIL ENGLISH, Pennsylvania EARL POMEROY, North Dakota KENNY HULSHOF, Missouri STEPHANIE TUBBS JONES, Ohio RON KIND, Wisconsin Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Ways and Means are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occur- rences are inherent in the current publication process and should diminish as the process is further refined. ii VerDate Nov 24 2008 05:58 Jul 15, 2009 Jkt 050037 PO 00000 Frm 00002 Fmt 0486 Sfmt 0486 E:\HR\OC\50037.XXX 50037 tjames on DSK5CLS3C1PROD with HEARING C O N T E N T S Page Advisory of May 7, 2008, announcing the hearing ............................................... 2 WITNESSES John E. Dicken, Director, Health Care, U.S. Government Accountability Office (GAO) .................................................................................................................... 9 Michael E. Chernew, Ph.D., Professor of Health Care Policy, Harvard Medical School, Boston, Massachusetts ............................................................................ 26 Linda J. Blumberg, Ph.D., Principal Research Associate, The Urban Institute 32 Judy Waxman, Vice President and Director of Health and Reproductive Rights, National Women’s Law Center .............................................................. 39 Wayne Sensor, CEO, Alegent Health, Omaha, Nebraska .................................... 47 SUBMISSIONS FOR THE RECORD America’s Health Insurance Plans (AHIP), statement ......................................... 81 American Benefits Council, statement ................................................................... 87 Consumers for Health Care Choices at the Heartland Institute, statement ...... 93 Consumers Union, statement ................................................................................. 94 Energy Manufacturing Company, Inc., statement ................................................ 96 Henderson Brothers, Inc., statement ..................................................................... 97 Melodee S. Webb, statement ................................................................................... 97 National Business Group on Health, statement ................................................... 99 Ross Schriftman, statement .................................................................................... 103 Terri Buck, statement ............................................................................................. 105 The Council for Affordable Health Insurance (CAHI), statement ....................... 106 iii VerDate Nov 24 2008 01:30 Jul 15, 2009 Jkt 050037 PO 00000 Frm 00003 Fmt 0486 Sfmt 0486 E:\HR\OC\50037.XXX 50037 tjames on DSK5CLS3C1PROD with HEARING VerDate Nov 24 2008 01:30 Jul 15, 2009 Jkt 050037 PO 00000 Frm 00004 Fmt 0486 Sfmt 0486 E:\HR\OC\50037.XXX 50037 tjames on DSK5CLS3C1PROD with HEARING HEALTH SAVINGS ACCOUNTS (HSAs) AND CONSUMER DRIVEN HEALTH CARE: COST CONTAINMENT OR COST SHIFT? WEDNESDAY, MAY 14, 2008 U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON WAYS AND MEANS, SUBCOMMITTEE ON HEALTH, Washington, DC. The Subcommittee met, pursuant to notice, at 10:30 a.m., in Room 1100, Longworth House Office Building, Hon. Fortney Pete Stark (Chairman of the Subcommittee), presiding. [The advisory announcing the hearing follows:] (1) VerDate Nov 24 2008 01:30 Jul 15, 2009 Jkt 050037 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 E:\HR\OC\50037.XXX 50037 tjames on DSK5CLS3C1PROD with HEARING 2 ADVISORY FROM THE COMMITTEE ON WAYS AND MEANS SUBCOMMITTEE ON HEALTH FOR IMMEDIATE RELEASE CONTACT: (202) 225–3943 May 07, 2008 HL–25 Stark Announces Hearing on Health Savings Accounts (HSAs) and Consumer Driven Health Care: Cost Containment or Cost Shift? House Ways and Means Health Subcommittee Chairman Pete Stark (D–CA) an- nounced today that the Subcommittee on Health will hold a hearing on Health Sav- ings Accounts (HSAs) and so-called Consumer Driven Health Care (CDHC) or high- deductible health plans (HDHPs). The hearing will take place at 10:30 a.m. on Wednesday, May 14, 2008, in Room 1100, Longworth House Office Building. In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consider- ation by the Committee and for inclusion in the printed record of the hearing. BACKGROUND: The Medicare Modernization Act of 2003 (MMA) (P.L. 108–173) created new tax- preferred Health Savings Accounts (HSAs) to encourage adoption of high-deductible health plans (HDHPs). These accounts allow individuals and/or their employers to make tax-preferred contributions toward qualified medical expenses, provided they have HDHPs with deductibles of at least $1,100 for individuals and $2,200 for fami- lies for 2008. HSA holders can contribute more to the savings account (up to a speci- fied limit) than would be required to fulfill their annual deductible, and any unused portions of the account accrue tax-free and can be withdrawn tax-free so long as the funds are used only for qualified medical expenses. However, unlike employer-pro- vided Flexible Spending Accounts (FSAs), individuals are not required to prove or otherwise substantiate that their HSA withdrawals are being used for health care purposes. As employers attempt to limit their health costs, some are turning to HDHPs— often called ‘‘consumer driven’’ health care plans—which have high-deductibles, often in exchange for lower premiums. While HDHPs have grown in recent years, only a fraction of those with these plans have active HSAs. These plans shift the cost of health care away from insurers and employers and toward individuals. These plans are predicated on the assumption that consumers will make more rational health care choices if they have a significant financial stake in the cost of their care. Proponents of these plans argue that they will help control overall health spending. But these plans may discourage consumers from seeking treatment and obtaining preventive care, and total health spending could even increase if people defer or delay needed preventive care or initial treatment. These plans result in significant out-of-pocket costs for those with serious medical conditions. A June 2007 Kaiser Family Foundation study found that pregnant women could face high out-of-pocket costs under these plans, particularly when complications arise. Furthermore, an April 2008 GAO study found that the average HSA enrollees had incomes nearly three times the average income of other tax filers and that HSA contributions were almost twice that of withdrawals. Simply stated, these policies are designed to help those who can afford to put money away to do so, but only serve to put health care further out of reach for those with high medical costs and/or modest incomes. VerDate Nov 24 2008 01:30 Jul 15, 2009 Jkt 050037 PO 00000 Frm 00006 Fmt 6633 Sfmt 6621 E:\HR\OC\50037.XXX 50037 tjames on DSK5CLS3C1PROD with HEARING 3 In announcing the hearing, Chairman Stark said, ‘‘HSAs and high deductible plans are a flawed policy approach to making health
Load more

Recommended publications
  • Board of Governors Meeting
    BOARD OF GOVERNORS MEETING April 2, 2020 ● 2:00 PM L.A. Care Health Plan, Conference Room 100 1055 W. 7th Street, Los Angeles, CA 90017 1 About L.A. Care Health Plan Statement L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Overview Committed to the promotion of accessible, affordable and high quality health care, L.A. Care Health Plan (Local Initiative Health Authority of Los Angeles County) is an independent local public agency created by the State of California to provide health coverage to low-income Los Angeles County residents. Serving more than two million members in five product lines, L.A. Care is the nation’s largest publicly operated health plan. L.A. Care Health Plan is governed by 13 board members representing specific stakeholder groups, including consumer members, physicians, federally qualified health centers, children’s health care providers, local hospitals and the Los Angeles County Department of Health Services. L.A. Care advances individual and community health through a variety of targeted activities including a Community Health Investment Fund and sponsorships program that have awarded more than $180 million throughout the years to support the health care safety net and expand health coverage. The patient-centered health plan has a robust system of consumer advisory groups, including 11 Regional Community Advisory Committees (governed by an Executive Community Advisory Committee), 35 health promoters and six Family Resource Centers and one Community Resource Center that offer free health education and exercise classes to the community, and has made significant investments in Health Information Technology for the benefit of the more than 10,000 doctors and other health care professionals who serve L.A.
    [Show full text]
  • Strategies by Federally-Funded Health Centers to Facilitate Patient Access to Specialty Care
    FINAL REPORT Strategies by Federally-Funded Health Centers to Facilitate Patient Access to Specialty Care September 27, 2017 Ha Tu Claire Postman Submitted to: Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation 200 Independence Avenue, SW Washington, D.C. 20201 Contracting Officer’s Representative: Amy Nevel Contract Number: HHSP233201500035I/HHSP23337015T Submitted by: Mathematica Policy Research 1100 1st Street, NE 12th Floor Washington, DC 20002-4221 Telephone: (202) 484-9220 Facsimile: (202) 863-1763 Project Director: Alyssa Crawford Reference Number: 50295.11.21P This page has been left blank for double-sided copying. HEALTH CENTER SPECIALTY ACCESS STRATEGIES MATHEMATICA POLICY RESEARCH CONTENTS INTRODUCTION ...........................................................................................................................1 DATA AND METHODS ................................................................................................................1 Selection of health centers ...................................................................................................1 Phone discussions with health centers .................................................................................2 Limitations ...........................................................................................................................3 HIGHLIGHTS OF KEY FINDINGS ..............................................................................................4
    [Show full text]
  • MEDICAL COVERAGE, GATEWAY to BETTER HEALTHCARE for Transition-Aged Youth with Special Healthcare Needs HANDOUT
    MEDICAL COVERAGE, GATEWAY TO BETTER HEALTHCARE For Transition-Aged Youth with Special Healthcare Needs HANDOUT Age 17 PREPARE – Turning 18 will affect all health plan types Might have to start researching for a New PCP* at 17 years of age because: o At 18 you will need to switch from a Pediatrician* to one of the following types of doctors: Internal Medicine*, Family Medicine (FM*) or General Practice (GP*) Good News: if you are already assigned to an FM or GP there is no need for a PCP change All HMO* insurance types will encourage you to make the switch, this includes: Covered CA*, Private Commercial Insurance (through work), Medi-Cal (HMO)*, and Medicare Advantage* (if applicable) \ PPO* & EPO* Plans o Will also need to start researching for a New PCP before 18 o From a Pediatrician to Internal Medicine, Family Medicine, General Medicine Transition between Ages 17 and 18 The possible consequences of having a Pediatrician as the PCP after turning 18 are: Cancellation or rescheduling of an appointment that may have taken many months to setup Wasted time from work and/or school Postponement of healthcare services or referrals to certain specialists Age 18 Parents no longer have authority over their children’s healthcare decisions. Two primary types of young patients with special healthcare needs are: Patients with Complex Disabilities (who continue to need their parents to advocate and be their voice), you may want to consider… o Conservatorship* – In the area of Healthcare o Affidavit of Health – Known as an Authorizations for PHI* Patients with Special Needs (that live independent lives) o Are able to manage health on their own .
    [Show full text]
  • Los Angeles: Vast and Varied Health Care Market Inches Toward Consolidation, 2020
    CALIFORNIA Health Care Almanac REGIONAL MARKETS SERIES JANUARY 2021 Los Angeles: Vast and Varied Health Care Market Inches Toward Consolidation Summary of Findings The Los Angeles health care market — as varied as it is The region has experienced a number of changes since vast — juggles the needs of more than 10 million people the prior study in 2015–16 (see page 24 for more informa- across a geographically diverse landscape. More than 80 tion about the Regional Markets Study). Key developments general acute care hospitals are scattered throughout Los include: Angeles County, an area twice the size of Delaware with 10 ▶ Medi-Cal coverage expansion continues to fuel times the population. The county includes 88 cities, and the growth of L.A. Care Health Plan, the local public historically fragmented health care sector tends to serve dis- plan. The 2014 Medi-Cal expansion under the federal tinct geographic areas where residents live and work. Only Affordable Care Act (ACA) has helped push L.A. Care two health systems operate on a countywide scale: Kaiser enrollment to more than two million people, about Permanente, an integrated delivery system with a health two-thirds of Medi-Cal managed care enrollment in the plan, owned hospitals, and tightly aligned employed physi- county. However, many residents are ineligible for Medi- cians serving primarily commercial and Medicare patients Cal and remain uninsured — primarily those who are across the market; and the Los Angeles County Department undocumented. To help fill this access gap, the county of Health Services (LACDHS), which operates the county- operates My Health LA, a program providing care — not wide safety-net system.
    [Show full text]
  • Health Access Presentation
    Health Reform Next Steps: Implementing & Improving… Anthony Wright Executive Director Health Access California @AEWright @HealthAccess October 2015 www.health-access.org www.facebook.com/healthaccess www.twitter.com/healthaccess BFD Biggest Congressional Action for Consumer Protections; Coverage Expansion; Cost Containment Up To States (& Us) To: “Because of the money and resources, California is frequently touted as the state that is implementing the Affordable Care Act most actively and aggressively. The stakes couldn’t be higher.” – POLITICO “California is a particularly important test for Obamacare. It’s not just the largest state in the nation. It’s also one of the states most committed to implementing Obamacare effectively. ... If California can’t make the law work, perhaps no one can. But if California can make the law work, it shows that others can, too.” –Ezra Klein, Washington Post “The ACA can’t succeed if California fails,” –Drew Altman, president of the Kaiser Family Foundation. "If this works in California, eventually America will follow your lead… If it comes off the rails here, it will give aid and comfort to everyone who really just wants to say, 'I told you so.‘” –President Bill Clinton. California: Leading from Behind States need to maximize the benefit—our health system needs all the help we can get. California shows the way, especially for states with high diversity & uninsured… CALIFORNIA IMPLEMENTS Millions with new consumer protections; financial assistance 4+ million Californians with new coverage already Uninsured
    [Show full text]
  • Today's Discussion A. SAMSHA Leading Change 2.0-Strategic Plan
    7/26/2016 Behavioral Health Financing, Medicaid and Collaboration In Challenging Times Mitchell Berger, MPH Office of Policy, Planning, and Innovation, SAMHSA Today’s Discussion • A. SAMHSA and Leading Change • B. Health Coverage, Medicaid/CHIP and Behavioral Health • C. SAMHSA Block Grants • D. SAMHSA Response to Public Health Crises: Medication-Assisted Treatment (MAT) and Opioids • E. Enhancing Partnerships and Collaboration Slide 2 A. SAMSHA Leading Change 2.0-Strategic Plan Slide 3 1 7/26/2016 A. Leading Change 2.0 • Six Strategic Initiative areas: Health Care and Health Systems Integration (HCHSI); Prevention; Trauma and Justice; Recovery Support; Health Information Technology; Workforce Development • For HCHSI Goals include fostering integration, providing support to states on Medicare and Medicaid and financing mechanisms, supporting parity, increasing “coverage and access for those in need” Slide 4 B. Health Coverage: Reasons for Not Receiving Mental Health Services in the Past Year among Adults Aged 18 or Older with a Perceived Unmet Need for Mental Health Care Who Did Not Receive Mental Health Services, by Mental Illness Status: Percentages, 2014 AMI-any mental illness SMI-serious mental illness Slide 5 B. Health Coverage: Reasons for Not Receiving Illicit Drug Use Treatment or Alcohol Use Treatment among People Aged 12 or Older Who Felt They Needed Treatment: Percentages, 2011-2014 Combined Slide 6 2 7/26/2016 B. Background: Health Coverage • Total coverage: 49% employer-based; 19% Medicaid, 13% Medicare, 10% uninsured; 6% non-group (e.g., Marketplace); 2% other public. About 32.3 million non-elderly (ages 18-64) Americans total lack health insurance. Total US Population: 316 million • Up to 15.9 million of 32.3 million non-elderly uninsured eligible for Medicaid and the Marketplaces.
    [Show full text]
  • Undocumented Immigrants and Access to Health Care in New York City Identifying Fair, Effective, and Sustainable Local Policy Solutions
    April 2015 Undocumented Immigrants and Access to Health Care in New York City Identifying Fair, Effective, and Sustainable Local Policy Solutions Report and Recommendations to The Office of the Mayor of New York City Nancy Berlinger The Hastings Center Claudia Calhoon New York Immigration Coalition Michael K. Gusmano The Hastings Center Jackie Vimo New York Immigration Coalition About this report This independent report is based on a meeting convened by the New York Immigration Coali- tion and the Undocumented Patients Project of The Hastings Center, which was hosted by the Vera Institute of Justice in New York City on December 11-12, 2014. The goals of this meeting were to sharpen local stakeholders’ understanding of gaps in access to health care for popula- tions left out of the Patient Protection and Affordable Care Act of 2010 (ACA)—in particular, New York City residents who are both undocumented and uninsured—and to identify proven or promising local solutions to closing these gaps in other cities, counties, and states. Although this report and its recommendations focus on challenges and solutions in New York City, it may also be useful to other New York State municipalities, and to other cities and counties in the United States. This document describes New York City’s undocumented uninsured population, the City’s safety-net health care system, and the specific gaps in coverage and financing that impede ac- cess to health care for this population. It also describes special opportunities and challenges for health care system improvement in the City and compares models that are proven or promising as sustainable ways to improve access to health care for undocumented immigrants and other uninsured populations.
    [Show full text]
  • HEALTH CARE SAFETY-NET PROGRAMS AFTER the AFFORDABLE CARE ACT Innovative Approaches and Opportunities for States Mark A
    October 2019 October HEALTH CARE SAFETY-NET PROGRAMS AFTER THE AFFORDABLE CARE ACT Innovative Approaches and Opportunities for States Mark A. Hall, JD and Janet Weiner, PhD, MPH Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care forover 44 million uninsured people.1 While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources.2,3 The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable populations. THE HEALTH CARE SAFETY-NET LANDSCAPE ACA designated many of these programs as “Essential Community Providers” (ECPs), and requires plans on the ACA marketplaces to The health care “safety net” is a patchwork of health care institutions, include a sufficient number and geographic distribution of ECPs in financing mechanisms, and programs that serve uninsured, low- their provider networks.6 income, and other vulnerable populations. By legal mandate or mission, these programs serve patients regardless of their ability to Health care reform has altered the landscape of safety-net programs. 4 pay, and often, regardless of immigration status. Safety-net providers Their constituency has changed in size and composition, especially in typically include public hospital systems; federal, state, and local the 37 states (including DC) that have expanded Medicaid income community health centers and free clinics; rural health clinics; local limits to 138 percent of the federal poverty level (FPL).7 From 2013- patient referral programs; and local health departments.
    [Show full text]
  • Providing Health Care to Undocumented Residents Program Details and Lessons Learned from Three California County Health Programs Speakers
    PROVIDING HEALTH CARE TO UNDOCUMENTED RESIDENTS PROGRAM DETAILS AND LESSONS LEARNED FROM THREE CALIFORNIA COUNTY HEALTH PROGRAMS SPEAKERS Denisse Rojas, medical student at Icahn School of Medicine at Mount Sinai and author of the report Tangerine Brigham, Director, Office of Managed Care, Los Angeles County Reginauld Jackson, Program Officer, Office of Managed Care, San Francisco Dept. of Public Health Lee D. Kemper, Policy & Planning Consultant, CMSP Governing Board NEXT STEPS The report will be posted at: http://laborcenter.berkeley.edu/providing- health-care-to-undocumented-residents/ The recording of this webinar will be posted on nilc.org Providing Health Care to Undocumented Residents: Program details and lessons learned from three California health programs UC BERKELEY CENTER FOR LABOR RESEARCH AND EDUCATION DENISSE ROJAS, HEALTH CARE TEAM, SUMMER 2016 Background Undocumented Immigrants & Access to Health Care . Excluded from many health coverage options under ACA . In CA, 1.8 million uninsured due to their immigration status oLeads to delayed care, treatment at inappropriate settings, or lack of treatment in a health care setting entirely oNo evidence that undocumented immigrants are flooding emergency rooms . 1993 - California Welfare and Institutions Code Section 17000 oCounties must make available a safety net with no other resources of for their health care needs o47/58 counties provide care beyond emergency services to undocumented immigrants Background California’s Safety Net Programs . Creation of coordinated health care services to eligible residents with no other resources to cover their health care needs. How does it work? o Streamline enrollment, eligibility, costs, types of services offered under a network of providers Providers: Federally Qualified Health Centers (FQHCs), Public Hospitals, Private Hospitals, Clinics, Community Health Centers, other facilities.
    [Show full text]
  • Providing Health Care to Undocumented Residents: Program Details and Lessons Learned from Three California County Health Programs
    Providing Health Care to Undocumented Residents: Program details and lessons learned from three California county health programs By Denisse Rojas and Miranda Dietz University of California, Berkeley Center for Labor Research and Education October 4, 2016 1 INTRODUCTION While the number of people without health insurance has declined dramatically since the Affordable Care Act went into effect, undocumented immigrants continue to be exclud- ed from many health coverage options under this law. In California, approximately 1.8 million individuals are projected to remain uninsured due to their immigration status.1 Without resources to pay for costly health care, w undocumented immigrants may delay care and eventually seek treatment in the emergency room In California, 1.8 million 2 or go untreated entirely. individuals are projected to Undocumented adults in California are generally remain uninsured due to their eligible for only emergency and pregnancy-related services through Medi-Cal, the state’s Medicaid immigration status. program, though undocumented children and those granted deferred action may be eligible for full-scope Medi-Cal. Many of California’s counties provide primary and preventive health care services to low-income undocumented residents through safety-net programs.3 These programs are of interest to advocates and policymakers in other states who are looking for local solutions to offer non-emergency health services to undocumented immigrants. This report profiles three county programs that offer health care services to undocumented res- idents and aims to serve as a resource for designing and implementing similar programs elsewhere across the nation. It is based on interviews with county program staff, statewide informants, provider organizations, consumer advocacy groups, and published reports and documents gathered in June and July of 2016.
    [Show full text]
  • Access to Healthcare in Los Angeles County and Boyle Heights
    A RESEARCH SERIES OF THE PAT BROWN INSTITUTE AT CAL STATE LA IN FOCUS: BOYLE HEIGHTS Access to Healthcare in Los Angeles County and Boyle Heights xiaohan zhang PhD n melina monroy IN FOCUS IN FOCUS is a research series of the Pat Brown Institute for Public Affairs at Cal State LA, covering in depth timely issues of concern to neighborhoods and communities throughout the greater Los Angeles region. ABOUT THE PAT BROWN INSTITUTE ABOUT BUILDING HEALTHY COMMUNITIES The Pat Brown Institute for Public Affairs, a presiden- Building Healthy Communities is The California Endow- tially-chartered institute at California State University, ment’s ten-year, $1 billion comprehensive community Los Angeles, is dedicated to the quest for social justice initiative that is creating a revolution in the way Cali- and equality of opportunity, enlightened civic engage- fornians think about and support health in their com- ment, and an enhanced quality of life for all Californians. munities. In 14 places across California, residents are The Institute is a non-partisan public policy center proving that they have the power to make health happen committed to sustaining the vision and legacy of former in their neighborhoods, schools, and with preven- California Governor Edmund G. “Pat” Brown through tion—and in doing so, they’re creating a brighter fu- convening public policy forums, engaging multi-sector ture for their children and for our state. stakeholders and diverse communities, and conducting Building Healthy Communities has a simple strategy: timely policy research and community-driven initiatives. work on a local scale to create broad, statewide impact.
    [Show full text]
  • Health Insurance Reform and Intimations of Citizenship
    HUNTER REVISED FINAL.DOCX (DO NOT DELETE) 6/11/2011 7:35 PM ARTICLE HEALTH INSURANCE REFORM AND INTIMATIONS OF CITIZENSHIP † NAN D. HUNTER INTRODUCTION .................................................................................... 1956 I. SOCIAL INSURANCE AND THE EPISTEMOLOGY OF CITIZENSHIP .... 1960 A. The Obligations of Citizenship .......................................... 1962 B. Participation Rights and Citizen Consumers ....................... 1966 C. Social Security ................................................................ 1970 II. THE INDIVIDUAL MANDATE AS LINCHPIN AND SIGNIFIER ............. 1973 A. Economic Necessity .......................................................... 1973 B. A Signification Contest Between Economic Liberty and the Social Compact .................................................... 1977 III. CITIZENSHIP PRACTICES AND THE AFFORDABLE CARE ACT .......... 1982 A. The Concept of “Citizenship Practices” ............................... 1982 B. The Design of Exchanges Under PPACA ............................. 1983 1. Regulation ............................................................. 1986 2. Public or Private Forms......................................... 1988 3. Information Requirements and Consumer Participation ....................................... 1990 a. Providing Consumer Information .................. 1991 b. Seeking Consumer Input .............................. 1993 4. Summary ................................................................ 1995 C. Social Meanings of PPACA .............................................
    [Show full text]