California\'s \"Day One\" Challenge

By Anthony Wright

Californians support the Affordable Care Act. That's the consistent finding of three years' of Field Polls, which also showed majority sentiment that this historic law is merely a first step toward future reforms. Policymakers should seize on that mandate as they implement and improve the law in California.

California should set a “Day One” challenge – getting millions covered on Jan. 1, 2014. Patients deserve to get the care they need and want and to which they are entitled. More than that, every day Californians go with healthcare coverage means millions of dollars go unclaimed in Washington, D.C. We need those resources to flow into California's health system and our economy as soon as possible.

In the next two weeks, the Legislature is considering bills to put key ACA protections into state law, so they can be better enforced. Two bills set an essential health benefit standard that all plans have to meet, so patients don't have to fear that what they may eventually need is not covered. Other bills implement key consumer protections – including preventing denials or discriiniation for pre-existing conditions – for those who buy coverage as individuals, and small businesses. 

A special session is also being scheduled to deal with any unfinished business starting in December, but we need to do as much as possible in the current session, given the limited time to get ready.

One area of agreement among all health care stakeholders – patients, payers, and providers – should be the effort to maximize Medi-Cal and health exchange enrollment as soon as possible. We can't let this be like previous expansions of Healthy Families or other programs – which took years to get tens of thousands, or even hundreds of thousands of lives in the door.

Finally, the Exchange needs to have a big and broad enrollment base to work, rather than smaller and sicker. Yet we know that those who are the quickest to sign up will be the sickest. The law will work best when the most people are enrolled – the costs of care can be spread out and ultimately lowered.

So for our health, our economy, and the very success of reform, early and aggressive enrollment is not just important – it is imperative. Part of the job is to make sure the infrastructure is in place. Our agencies are busy setting up streamlined enrollment, information technology and consumer assistance systems to be ready next year, from the call-in service centers to the army of in-person navgiators.

As part of this effort, we should spend the next year seeking to identify and pre-enroll Californians from existing programs, and better inform people of their new rights and options. We have a great head-start with the Low-Income Health Programs (LIHPs) operated by now 50 counties, providing over 420,000 Californians with an early expansion of Medi-Cal. We hope counties take advantage of the opportunity to ramp up much further as we approach January 2014 – when all enrolled should automatically be shifted into Medi-Cal, 100% funded by the federal government. Counties should also take the opportunity to find ways of finding and enrollment other medically indigent adults that qualify as well.

The more we can find systematic ways to get people informed and enrolled, and to close some of the gaps in our health system, the better. 

The Affordable Care Act, however historic it is, only provides tools and resources to states. It's up to California and our health system--including payers, providers, and patients, working together--to make reform real on the ground, to improve the health and financial security for all Californians

Anthony Wright is the executive director of Health Access California.