As the Supreme Court nears a decision on health care reform, more than 360,000 Californians are already receiving medical coverage under a state-administered precursor to the landmark legislation.
But they could find their coverage fleeting if the so-called Affordable Care Act has no future.
The effort, dubbed "The Bridge to Reform," is part of a sweeping Medicaid expansion unfolding in California. It exists to usher patients to health care reform's planned implementation in 2014.
Bridge to Reform patients are receiving care in 47 participating California counties, from tiny Del Norte near the Oregon border to sprawling Los Angeles County.
Ventura County has 10,059 patients receiving care through the program, according to state enrollment records. County officials said they would work to keep the system, also known as Access Coverage Enrollment, or ACE, and believe they would succeed even if federal health care reform is overturned.
"We would fight to keep this program. We believe in it," said Dr. Robert Gonzalez, director of the Ventura County Health Care Agency.
California Department of Health Care Services spokesman Norman Williams said even if the Supreme Court renders the Bridge to Reform a bridge to nowhere, just building it has been of value to the state's health care apparatus.
"Health care delivery infrastructure at the local level is being improved as a result," he said.
But Williams offered no promises if the U.S. Supreme Court strikes down health care reform in opinions expected this week. The justices could invalidate all or parts of the law, and the Medicaid expansion is among the pieces in jeopardy.
The state department of health care services "does not anticipate seeking other funding" if the Medicaid expansion is cut down, Williams said.
For now, the Bridge to Reform forms the building blocks of health care reform's core mission — a vast expansion of health care coverage across the country. California health officials project that as many as 1.9 million patients will qualify for the Medicaid expansion alone statewide. National estimates run as high as 17 million.
All told, the controversial health reform legislation was projected to provide health coverage to more than 30 million Americans.
California's bridge program is implemented by county health agencies, which enroll patients under the same qualifying rules that would be in place under health care reform. For every budgetary dollar counties invest in the program, they receive a 50-cent match from the federal government, which has reserved $8 billion for the effort.
Ventura County's ACE program predates federal reform. It was launched in 2007, part of a pilot program designed to cover the uninsured and funded in part by the U.S. Centers for Medicare & Medicaid Services. ACE and handful of similar programs across the state were later folded into the Bridge to Reform project.
Gonzalez said that pedigree and a track record that shows ACE saves health care dollars fuel his expectation that the program would be saved regardless of the Supreme Court's ruling.
"We know this program has decreased emergency room services, has decreased hospitalizations and provided medical care and preventive care to a large number of people in Ventura County," he said.
" We expect this program to exist. If there's any challenge to it, we would definitely advocate for this."
In Bridge to Reform programs across the state, participants have income levels beyond the traditional ceilings for Medicaid, which is called Medi-Cal in California
They reach as high as $46,100 for a family of four in some counties and are never lower than $30,667 for a family of four in others. In another major change, adults without children now qualify.
Undocumented immigrants do not qualify.
Not all California counties are embracing the program. Fresno and San Luis Obispo counties have formally withdrawn from participation, not because of the Supreme Court uncertainty, but because they feared their health care systems could not accommodate the new patient load.
Still, participating health officials say the effort is showing significant promise by offering patients access to a "medical home" primary-care facility and quick referrals to medical specialists.
"In a very short period of time we were able to establish a very effective program with an extensive provider network," Mark Refowitz, director of the Orange County Health Care Agency, said in an email.
A program summary provided by the county health agency supports his claim. The agency says participants are receiving better care while simultaneously cutting costs — including a 50 percent reduction in expensive emergency room visits, and all hospital visits in general.
The number of patients regularly visiting a primary-care doctor has more than doubled, according to the agency.
Debbie Binning, a nurse practitioner who treats Bridge to Reform patients at an AltaMed clinic in Huntington Beach, said the program reaches a population traditionally excluded from the safety net, but one that needs help in the economic downturn.
A large portion of her Bridge to Reform patients "are white, middle class and unemployed," she said.
In addition to significantly raising income ceilings, the new program throws out other disqualifying factors, such as owning a home or a car.
That leads to enrollees like Jack Jordan, 64, a Bridge to Reform patient who six years ago lost his job in toxic materials remediation and has not been able to find full-time employment with health insurance.
Jordan, of Seal Beach, drives a commuter van part time for a local substance abuse recovery center. He would have been summarily disqualified under the previous version of Medi-Cal on two grounds: He has no children and earns too much money with his part-time job.
Under the old version of Medi-Cal, an adult with one child could be disqualified from full coverage with an income as low as $13,200 a year.
"No one actually comes out and says it. But I'm just a higher health risk than younger people, so I don't meet the employers' profile," said Jordan, who suffers from diabetes and high blood pressure while he looks for a better job.
"The old system would have discouraged me from any type of self-sufficiency," Jordan said. "This program is helping me through a rough time."
Staff writer Tom Kisken contributed to this report. John M. Gonzales is a senior writer at the California HealthCare Foundation Center for Health Reporting. Attached to the USC Annenberg School for Communication & Journalism, the center produces in-depth reporting on California health policy. It is funded by the nonpartisan California HealthCare Foundation.
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Comments » 37
Nosmo_King writes:
Info-mercials are ubiquitous
VenturaMusician writes:
THe states can still enact their own laws, in fact this is where such laws should reside. Get ready though, most of the key points that liberals love about the new law are the ones the court is going to overturn.
JCInVC writes:
I'm confused. Didn't the state want to cut payments to providers by 10% because they couldn't afford the costs? How's that going to change when you add another 1.9 million Medi-Cal people to it?
Honestcop writes:
Re: "Undocumented immigrants do not qualify." They don't need to; they get free (well, on our taxpayer dollars) medical care at VCMC and at the clinicas branches.
JCInVC writes:
Pardon my ignorance, but not having ever been on Medi-Cal, do they even check the documents? It's not like these people are "undocumented". They've got plenty of fake/stolen ID's...
rebel123 writes:
You mean like the part that allows 3 million young people to stay on their parent's policies until they are 26? Or the part that prohibits companies from denying coverage to those with per-existing conditions? Or the part that prevents insurers from charging women substantially more than men for coverage? Or the part that gives seniors 50% discount on their expensive brand name meds? Or the part that provides tax credits to small businesses who provide insurance for their employees? Or the part that removes life time limits on the dollar value of claims and prevents insurers from dumping insurers when they are sick? Or the part that allows 30 million middle class Americans to get lower premiums and for middle class families to be eligible for refundable and advanceable premium credits and cost-sharing subsidies to ensure that the coverage they have is affordable?
Yes, let's just dump the whole thing and let the individual states pass laws and let insurance companies regulate themselves... that has worked so well so far, right?
rebel123 writes:
The fee for my daughter's recent surgery was $37,000. That's just for the surgery, not for the three day hospital stay. That fee was over ten grand. So the better part of fifty grand in fees. Any idea how someone is supposed to pay for that out of pocket without draining their entire bank account if they are lucky enough to have that kind of money saved?
Pierpont writes:
She'll be coming round the mountain when she comes....
VintageRacer writes:
She didn't say it was! She was explaining her situation. But, you, of course, had to come back with another one of your less-than-useful replies!
Typical!
socallvr writes:
Some users consider this comment inappropriate. Reveal this comment.
Tomcat, you're so predictable... You either write about "kool aid" or of course how you'e so "intelligent!" But actually you're nothing but a liberal hypocrite! And you're comment, "few conservatives have major health problems" is one of the most ignorant mean spirited comments I have ever read in these blogs! You're an extremely disturded person!
foggydoggy writes:
Getaway, and what happens with your pay as you go service when the cost for heart surgery exceeds nine hundred thousand dollars?
VintageRacer writes:
"Nothing I post could possibly be sillier then Obamacare."
OMG, I'm laughing and can't stop! I can't take this comic relief!!
"Actually,those that understand Obamacare know in their bones just how silly Obamacare is."
Try reading up on it and "enlighten" yourself.
http://www.timesnews.net/article/9048...
No one said it was a cure for our broken healthcare system, but at least it's step at addressing the problem. Right-wingers would just let people die instead of lending a helping hand. In fact, you said just that in an earlier comment.
VintageRacer writes:
Romney's plan
"Mitt will begin by returning states to their proper place in charge of regulating local insurance markets and caring for the poor, uninsured, and chronically ill. States will have both the incentive and the flexibility to experiment, learn from one another, and craft the approaches best suited to their own citizens.
-Block grant Medicaid and other payments to states
-Limit federal standards and requirements on both private insurance and Medicaid coverage
-Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies
-Ensure flexibility to help the chronically ill, including high-risk pools, reinsurance, and risk adjustment
-Offer innovation grants to explore non-litigation alternatives to dispute resolution
Promote Free Markets and Fair Competition
Competition drives improvements in efficiency and effectiveness, offering consumers higher quality goods and services at lower cost. It can have the same effect in the health care system, if given the chance to work.
-Cap non-economic damages in medical malpractice lawsuits
-Empower individuals and small businesses to form purchasing pools
-Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage
-Facilitate IT interoperability
Empower Consumer Choice
For markets to work, consumers must have the information and the power to make decisions about their own care. Placing the patient at the center of the process will drive quality up and cost down while ensuring that services are designed to provide what Americans actually want.
-End tax discrimination against the individual purchase of insurance
-Allow consumers to purchase insurance across state lines
-Unshackle HSAs by allowing funds to be used for insurance premiums
-Promote "co-insurance" products
-Promote alternatives to "fee for service"
-Encourage "Consumer Reports"-type ratings of alternative insurance plans"
http://www.mittromney.com/issues/heal...
While on paper it sounds like a good plan, there are likely a lot of areas that are unworkable. And what will be the costs to the individual?
VintageRacer writes:
Actually, that is not true
"Researchers have found that immigrants tend to use the health care system less than legal residents. Illegal immigrants, in particular, tend to avoid using the health care system until they have to, favoring home remedies first or making cash payments to providers when they need care. "
http://www.timesnews.net/article/9048...
VintageRacer writes:
Personally, I like the idea of shifting the responsibility to the states. Beyond that, I don't know. But I would never say if someone can't afford healthcare to just let them die as you suggested.
VintageRacer writes:
So tell us what YOUR grand plan is beyond letting people die!! I am all ears!
DrivebyObserver writes:
(This comment was removed by the site staff.)
VintageRacer writes:
Did I indicate it was a Romney/Strickland plan? No! My comment simply states Romney plan.
BCChick writes:
(This comment was removed by the site staff.)
VintageRacer writes:
A general plan without any sound thinking. Yep, that's you!
rebel123 writes:
Never said it was. Just an illustration of why your previous, simplistic solution of fee based service (get the service, pay the fee I believe is what you said) is unworkable. Your second comment that there are many HMO's out there, just pick one and pay the premiums is also simplistic. Not a single HMO would touch her. As it turns out, my daughter has a pre-existing condition (totally unrelated to her surgery) that prevents her from finding affordable coverage. Under Obamacare, they wouldn't be able to do this. The cheapest policy she could find which had a ten grand deductible was $780 a month. As a young person starting out (with student loan payments as well) that is not affordable. So you see, there are situations where mandates to cover people at affordable rates are necessary and your simplistic panacea doesn't work. Your "not my problem" attitude, however, explains a lot.
rebel123 writes:
Which is pretty much a single payer system. Some might even call it Socialized Medicine. I would be very much in favor of that for my daughter. Gee... to bad the Republicans don't think that's a good idea!
VintageRacer writes:
You seem to have promoted several plans
"My Plan? It is so very very simple I am surprised you haven't posted it. We have the government sponsored agencies,Medicare. Medical and Medicaid,right. Just sign every one that can't afford medical insurance up."
Or this one
"My solution is,when you use a medical service,regardless what it is. When you receive the bill. simply send the bill to 1600 Pennsylvania ave. c/o B Obama medical program. Problem solved.."
Or this one
"There are many good HMO's a person can choose from. Just simply pay the monthly premiums and co pay."
This one is a zinger
"You DIE and take the burden off everyone."
And since you suggested Medicare, Medicaid, and Medical, do you remember your thought on these agencies?
"Interesting that Medicare,Medicaid and Medical are all government supported enterprises and all are undefunded,under staffed and wrought with bureaucratic rules and regulations and marginally seem to perform their function."
Who knows WHAT your plan is since you waffle around and don't provide anything that makes any sense. Why am I not surprised?
VintageRacer writes:
Exploring venues? Deep thinker? Constructive thought? HAHAHAHAHA!! More comic relief!!
"That's the difference when people are deep thinkers like what I post and those that simply criticizes others without any sign of constructive thought of their own"
You plagiarize so often who knows what thought is yours or what has been plagiarized
TK421 (Inactive) writes:
But why should this bill be laid on the states and federal government? Which in turn is really the taxpayers!!! All the money in the world can't pay for what is slowing being expected the government to provide for what soon will be 500 million people...
Everybody talks about the single payer system which was what we had before, for-profit health insurance companies. That means, YOU are that single payer. Or do you expect the doctors to fork out 250k+ for medical school and then work for free?
VintageRacer writes:
pwned!!
socallvr writes:
My Health Insurance rate went up 24% AFTER Obama Care was passed. I called the Cal PERS Health Insurance Agent to inquire why. She told me it was becasuse of Obama Care. The Agent told me with all of the mandates that are in Obama Care, that Insurance companies have no choice but to dramatically raise rates in order to pay for the mandates. In other words, people that work have to pay MORE for those that don't! I pray that the Supreme Court declares it unconditional!
Lazlo_Toth writes:
Going through all these remarks you see the depth of thought...or not..that folks have. Whatever side you take, the other ranges the gamut of seriousness from high to low.
One remark to me, really does stand out, for its shallow cruelty. You may have missed it, since it seems to have been taken out by the Star moderators for violating..well, some standard that i don't understand since the Star permits most any foolish statement.
I am referring to the remark made by "gateway" who in response to the question of what should be done when the cost of care rises too high (a clearly variable standard) writes:
"You DIE and take the burden off everyone."
Well, i surely hope that "gateway" never has that question come and knock on their personal door. I would never wish "gateway" to see someone they love pass....in that manner.
I also surely hope that "gateway" is better loved than that by his/her OWN loved ones, and if not, that would i think, be the just rewards for so callous and thoughtless a belief as that.
rebel123 writes:
Did you hear me say the government should pick it up? I didn't. Because of a pre-existing condition unrelated to this surgery, she is unable to get insurance. That should be illegal and would be under Obama's plan. She should be able to buy affordable insurance which she would be able to do under Obama's plan. The small company she works for could afford to cover their employees if they got tax incentives for having a group plan for their workers, as they would under Obama's plan. There are fundamentally some things that should not be profit driven. Our health is one of them. My kid's medical debt will take years to pay off and guess what? The hospital wants their money NOW. All of it. They are unwilling to let her pay it off over time, which is all she can reasonably afford to do. When did we have a single payer plan other than Medicare? Why is it ok that this country has the most expensive medical care in the world yet we are well down the rankings for quality of care and outcomes? Why is it ok that when someone gets cancer and doesn't have insurance (or gets dumped by their insurance company), they will lose everything trying to save their life? There are plenty of solutions to the current crisis in our health care system that don't include doctors working for free or the government paying my daughter's medical bill. It is not an either/or situation where we are saddled with a lifetime of medical debt or we make doctors work for free! Opening your mind to solutions is a start.
TK421 (Inactive) writes:
Rebel123
"There are plenty of solutions to the current crisis in our health care system that don't include doctors working for free or the government paying my daughter's medical bill."
Okay, what are they?
I think it was your post to Gateway, the gist I got was the cost was so high for your daughter's surgery, somebody else should be covering it because it was too much of an burden for just her. What were you getting at? Who do you think will be covering it?
"When did we have a single payer plan other than Medicare?"
Pre-1960's.. My mother (now 68 yrs) said when she was growing up, if you wanted to see a doctor, YOU paid him at time of service (Single payer system). You need medication, YOU went and saw the pharmacist and told him what was wrong. He deiced what meds you got. And YOU paid him for it...
Maybe that's why life expectancy was much lower then? Do we really need to keep unnaturally extending life on and on at extraordinary costs to the rest of us? I say no.
I'm curious what your solution is? Because under Ovomit-care, regular citizens (weather it be through insane insurance premiums, governmental fines, or just higher taxes )get to pay more weather they choose to or not regardless if they are regular users of healthcare. That is completely un American and I will be happy to see that slammed by the Supreme Court.
My solution is creatively simple, albeit a bit harsh for some.... Physical fitness tests! You fail a physical and can't run a mile in 10 minutes, are disgustingly obese, a chain smoker, a heavy drinker, a drug user? Then you get no assistance and have to pay everything out of your own pocket.
Eventually that group of heavy healthcare users will naturally dwindle down and mostly the healthy people will be left. This in turn will drive costs down for everybody as the healthy, physically fit people don't see the doctor as nearly as much as the ones I listed above!!!! See, it's not hard, it just about tough choices. :)
ceeyh805 writes:
I know lots of Doctors, fee's have risen 10% a year or more for decades on end. The entire medical profession is overpriced in relationship to the actual cost of service delivery, the profession the industry of medicine is greedy. My father was a mortician, doctors are greedy lier's they're not Gods. At best a doctor can extend your natural life for a short time but at what cost?, there were no $200 pills 30 years ago. No matter the doctors promises you will die no matter what.
Why not a Federal mandate for burial insurance..? After all as Ben Franklin rightly said "only two sure things in life are death and taxes".
rebel123 writes:
You have misinterpreted my post entirely. I do not expect anyone to pay my daughter's medical bills. I do believe that it is highly unfair that she was denied insurance coverage due to a chronic medical condition that is completely unrelated to this surgery, has no cure and is well managed through diet and life style choices (which she has made) and has minimal medical cost to manage. She is not a smoker, she is not overweight and I am betting she could out swim you doing laps by double. Yet she is now facing a monstrous bill because for profit insurance companies have decided that she is too high a risk to bet on. I never implied someone else should pay her bill. The insurance companies who have refused to cover her would have paid a much lower amount for the same surgery too. Your definition of a single payer system is incorrect. A single payer system is one that removes for profit insurance companies from the mix and replaces them with a single entity to whom all pay their premiums and from whom all claims are paid. Estimates are that a single payer plan would shrink the overhead administrative costs now needed to deal with processing multitudinous forms, coding and paperwork for dozens of different insurance companies by as much as 27% which would provide significant cost savings that could be passed on the the consumer/customer... which is us. The uninsured now drive the cost of insurance and medical care up for the rest of us. When they can't pay for outrageous costs of care, doctors and hospitals recover those charges by charging those with insurance more and insurance companies raise their premiums accordingly. Single payer systems are successfully being used in almost all other industrialized nations. A single payer system would work, it would insure that nobody could be denied coverage or treatment due to pre-existing conditions and could not have their insurance pulled out from under them in the event of a serious illness.
Your suggestion of covering only the healthy is flawed. Some people will continue to have bad habits and require care. Are you suggesting that we turn them away at the doctor's office or at the ER/hospital doors?
THE UNINSURED DRIVE COSTS UP FOR ALL OF US! Thus your plan would simply drive the cost of care and premiums up. Removing the profit motive from insurance would bring costs down dramatically and a single payer plan would insure coverage for everyone. It works. It is working well in other countries.
TK421 (Inactive) writes:
"Your suggestion of covering only the healthy is flawed. Some people will continue to have bad habits and require care. Are you suggesting that we turn them away at the doctor's office or at the ER/hospital doors?"
If they don't have their own money to pay for themselves, YES!
TK421 (Inactive) writes:
The main problem Rebel with your version of a single payer system is that it will be government run. Can you honestly (and I remember you saying you were an aerospace engineer so I know you dealt with the government) say the government does anything that is efficient and works for the benefit of taxpayers? Why then does everything end up costing ten times as much as the original "estimate (wink)." Remember the $120 million each for the F22 what with the "fixes" that drove the cost up to over $450 million each? I have worked with different governmental agencies as well, and I can say first had, those people don't give two s--t's about wasting other people's money.
And where does it stop? It's apparent that many in this country do not believe in our own sovereignty. So we're to believe this take care of everybody who steps foot on our soil is a good idea? But why stop their, why does't the US just provide healthcare for the world? And if single payer government controlled healthcare is so wonderful, why is everybody trying to get into the US and not Canada or all the other industrialized nations as proponents of this are always touting?
rebel123 writes:
I don't agree that a government run system has to be fraught with bloat and red tape. Yes, I was in aerospace and the program I was on for eight years for three launches came in ahead of schedule and under budget. We have the means to do it right and can do it right.
As to the European healthcare systems, I have many friends, Canadian, French, Swedish, and Czech and none all of the say their systems at home are far better than what we have here. It is a fallacy that people are flocking to this country for medical care.
rebel123 writes:
So they'll just have to die of otherwise treatable illnesses. By your logic, I'd have to let a burst appendix kill me since I have no coverage and have no job and am rapidly running out of money. Gee, such an advanced view of modern society. Third world conditions don't just happen, they are created. When we start letting people without means, along with their children die from common diseases we become a third world country. I suppose you don't want to pay for standard vaccinations that keep the entire population safer either, right? I would not want to live in the society you would create, my friend.
TheCrusader writes:
If ObamaCare is overturned by the Koch Brothers Hand Puppets on the Supreme Court send all the medical bills for your kids in college to the RNC and demand they pay it!
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