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Impact of Health Care Reform Initiatives in California

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McDonough (2011) Poor-quality health-care services are one of the major concerns for most Americans, according to the report. According to studies, America is becoming a sick nation. Obesity, diabetes, cancer, and heart disease have all seen rapid increases in their prevalence in recent years. According to a recent CDC report, at least 33 million Americans have diabetes (McDonough, 2011). Millions more are afflicted with chronic illnesses that necessitate proper health-care management. Every state in the country is dealing with an alarming health-care situation. Unfortunately, a large number of Americans cannot afford to pay for the rising cost of health care in recent years. Although the Medicare and Medicaid health-care systems have helped to ensure that all Americans have access to high-quality healthcare, they are not completely universal. This is true because the majority of Americans do not have health insurance. Although the Obamacare Act aimed to improve the quality of health care for the general public, a report by the California Health Care Foundation (2014) found that the system is discriminatory because it is selective and benefits only a few groups. California has one of the highest percentages of residents without health insurance of any state. Unfortunately, the majority of the poor are low-income earners who are unable to cover their medical expenses when they become ill. As a result, there has been an increased need for health care reforms to ensure universal coverage for all California residents in order to improve the quality of life of the people of California. The various health-care reform initiatives that have been implemented in California in the last three years will be discussed in this document.

Impact of Health Care Reform Initiatives in California

The state of California is one of the most populous in the United States. California, on the other hand, has one of the highest rates of people without health insurance. As a result, millions of Californians have been unable to access the high-quality healthcare they require. Despite the state spending large amounts of money per person on health care, according to a report by the California Hospital Association (2014), the majority of California residents are not receiving the care they require. According to reports, California, like the majority of other states in the country, has underutilized preventive care, resulting in high treatment costs. According to a CDC report, the state has not prioritized providing quality health care services to its residents who suffer from chronic illnesses such as cancer, diabetes, hypertension, and heart disease. There is no evidence that the state has provided these patients with the necessary treatments, such as self-management services and therapies, to help them cope with their health condition. This is true for all Californians, including those who are insured, underinsured, and uninsured.

Although the majority of Californian patients often fail to receive the necessary medical care, some receive unnecessary care. The poor health care delivery system in California has been an issue of concern to the state officials and the public at large (McDonough, 2011). Therefore, to help improve the quality of healthcare delivery in California, there has been an increased need to reform the state healthcare system. So far, quite a number of health care reforms have been introduced to help improve the quality of health care delivery to Californians. Though some have been passed by state legislatures, other reform initiatives have been shot down by the state legislatures. 

 Health Care Reform Initiatives Already Implemented In California

Although politics has hindered to passing of certain bills that aim to reform the Californian health care system, the state has managed to introduce certain health care reforms successfully to improve the state’s health care delivery system. One such reform that has come as a lease of life to Californians is the implementation of The Patient Protection and Affordable Care Act (ACA). The recent move by the state officials to implement ACA has opened a great opportunity for state residents to enjoy increased access to care. For a long time now, Californians have not been able to receive quality care due to loss of coverage, whenever one turns 18, divorces or loses a job (Kempa, 2013). However, such is a thing of the past now since the passage and eventual implementation of ACA, which has introduced new eligibility terms for Californians and Americans at large. The ACA act has expanded the health care coverage to at least 47 million Americans and about 2.3 million Californians who initially lacked access to affordable healthcare services due to eligibility issues, which resulted in a lack of insurance coverage.

Following the implementation of the ACA, all American citizens and Californian residents, in particular are now eligible for some form of coverage. Californian state officials cite that many Californian residents have for a long time remained uncovered because of the strict eligibility requirements under the previous framework (California Hospital Association, 2014). The previous framework was highly discriminatory in nature because it provided coverage only to low-income individuals. However, determining whether someone was receiving low income to qualify for coverage followed cumbersome rules that denied millions of Californians the opportunity to get health care coverage. According to the previous framework, an individual’s income threshold was determined after conducting a thorough analysis of a person’s assets, disability status and income. However, these cumbersome rules for eligibility have been scrapped under the new ACA health care reform being implemented by Californian state officials.

Two major changes have been made in the ACA health care reform to increase coverage to Americans and Californian residents. The first major change is that all citizens and residents of California will now be covered through certain programs, which are yet to be identified. Secondly, the income threshold, which has been a hindrance to most Californian residents in receiving coverage, will now be determined through Adjusted Gross Income derived from tax form (McDonough, 2011). However, the implementation of ACA does not imply that Californian residents will lose their employer-based coverage; rather, all residents under enjoying employer-based coverage will retain their private employer-based coverage. Additionally, the elderly aged 65 years and above are still expected to continue enjoying Medicare coverage. Although most of the previous coverage infrastructures have been retained, the new ACA offers significant changes to the coverage. For instance, the new ACA health care reform will significantly subsidize health care cost to the poor and residents suffering from health conditions that make it hard for them to purchase affordable coverage. 

 Impact of the ACA on the Residents Covered

The residents of California have begun to feel the benefits of ACA health reform being implemented by the state officials. The first major impact of ACA on the Californian health care system is that it has ensured that all Californian residents are eligible for at least some form of coverage (California Health Care Foundation, 2014). This is unlike in the previous years when only the poor and the disabled were eligible for government health insurance coverage. In fact, Californians officials projects that the number of non-elderly Californians under health insurance coverage will increase to 92% for those with ACA by 2019. Children are also expected to benefit a great deal from the full implementation of ACA health reform. It is estimated that the full implementation of ACA will help reduce the number of children who are uninsured by about 40 percent. National estimates indicate that the implementation of ACA will result in a reduction of uninsured parents by about 50 percent (Ferguson, 2013). Certainly, the continued implementation of ACA has increased accessibility of affordable care to Californian residents. The increased coverage health coverage brought by ACA reform is expected to reduce the spread of health problems and death rates that have been high because of lack of access to affordable care by the majority of the Californian residents, particularly the poor. 

 Medi-Cal

Medi-Cal is a health care reform introduced recently in California, an expansion to the Medicaid (Kempa, 2013). The reform seeks to expand the provision of care services to the poor and the vulnerable in California. Although Medicaid has improved accessibility to care to millions of the poor, Medicaid has been discriminatory. As such, a large percentage of Californians who are eligible for Medicaid have often been left out due to the cumbersome Medicaid eligibility requirements. Therefore, to increase accessibility to health care services to Californians, Governor Jerry Brown signed the Medi-Cal bill into law as part of a federal reform, notes O’Neill (2013).

The reform has been well received by the Californians, particularly the childless adults who are projected to benefit a great deal from the Medi-Cal reform. According to the provisions of the Medi-Cal health reform, adult Californians without children but earning up to 138% of federal poverty level will be eligible for Medi-Cal, unlike under the Medicaid framework where such individuals are not covered under the Medicaid health insurance scheme. However, the only shortcoming is that such childless Californians adults will receive slightly less coverage compared to those presently covered by the Medicaid health insurance scheme. The full implementation of the reform that began in January 1, 2014 is expected to increase the number of Californian adult poor who are eligible for health care programs to about 1.5 million (O’Neill, 2013). This will be a great relief to the state that is currently grappling with high poverty levels and a large number of uninsured. Accordingly, an increase in the number of poor Californian adults having health coverage is expected to increase access to quality health care services. This is likely to reduce the health problems that plague the state. Additionally, the increased health coverage enhanced by Medi-Cal is expected to improve quality of life and eventual reduction in the deaths that occurred due to the inability of the majority of Californians to receive quality care on time. So far, about 550,000 Californian adults have already enrolled to Medi-Cal program since January 1, 2014, with the number of enrollees increased every day due to the relaxed eligibility rules, according to Kempa (2013).

Regarding eligibility, it is noted that Medi-Cal health reform was introduced to expand the health care coverage to the poor who cannot afford to pay health coverage from their pockets (California Health Care Foundation, 2014). Accordingly, Californian adults who are currently eligible for the Medi-Cal program include the disabled, the elderly, pregnant mothers, the blind, childless adults, children and other vulnerable people living in California. Patients suffering from terminal illnesses, such as cancer, diabetes and heart problems are also eligible for the program. 

 Covered California

Covered California is another important health care reform introduced recently to improve Californians accessibility to quality care. Covered California is a health insurance marketplace where Californians residents can find out whether they are eligible for help and purchase health insurance. For a long time now, most residents have not been able to know whether they are eligible for help or not. This is because of the cumbersome rules of the Affordable Care Act, Medicaid and Medicare (California Health Care Foundation, 2014). As a result, the most Californians, including those who are eligible for help, have not been able to seek help due to ignorance. However, this is no longer the case following the introduction and implementation of Covered California, which provides residents of California with a market place where they can seek help in regards to health insurance. Those who find that they are eligible can proceed to enroll and purchase health insurance at a much-subsidized fee. Covered California just celebrated its first anniversary since the reform was signed into law and already 1.3 million eligible California residents have enrolled to the program (Ferguson, 2013). This is the highest rate so far experienced in the entire country.

Regarding eligibility issues, any Californian resident who earns less than 400 percent of the federal poverty level is eligible to receive government assistance to cater for the cost of health insurance through Covered California. This translates to approximately $95,000 for a household consisting of four people. Additionally, Covered California health plan provides that any resident of the state not covered under employer-based health insurance scheme is eligible to buy health insurance through Covered California.

Covered California has been well received by Californian residents since it has increased the number of people who benefit from health insurance coverage (Ferguson, 2013). Those covered through Covered California have nothing to worry about the cost of treatment in case family members who is already legible for Covered California falls sick. This is because, once an individual has enrolled for the program, all the medical cost insured are paid for by the government. The main advantage of enrolling to the program is that it has numerous benefits attached to it. For instance, the plan offers tax credits and subsidies, which significantly reduces an individual’s out-of-pocket payment for the health care expenses that a person or his family has to pay in case of sickness. This makes this health care reform one of the best reforms ever created in the United States. 

 Breastfeeding & Health Care Reform

Breast milk is very critical for a baby’s healthy growth and development. Breast milk contains antibodies that help protect a child from pathogens that might cause diseases. Evidence has shown that children who are breastfed for the first six months and longer grow up healthier than those who are not breastfed. In the light of this finding, the California state officials have recognized the need to promote breastfeeding among mothers in the state. Therefore, in compliance with the requirements of the Affordable Care provisions, the state have began implementing the breastfeeding health reforms to ensure that mothers breastfeed their babies at least the first six months (California WIC Association, 2013). This is to ensure that Californian babies grow up healthily free of infections and diseases. It is estimated that those mothers who are enrolled to the program will benefit significantly from breast pumps, nutrition, and lactation and weight control programs provided to the consumers enrolled to the program. The benefit of the reform is that it ensures that consumers receive these benefits without co-paying. Already thousands of Californian residents have enrolled to the program with thousands of others expected to follow suit. 

 Conclusion

The U.S. is the largest economy in the world. As such, anyone would expect the country to have the best health care system in the world, which is not the case. Evidences across all states show that the country’s health care system is rotten and is in dire need of reform to improve accessibility of quality care to patients. Although all Americans complain of lack of accessibility to quality care due to the high cost of health care services, the most affected are the poor, the disabled, the uninsured and the under-insured in the country. Surprisingly, this situation is witnessed in the country at a time when a large part of the federal budget is channeled to finance health care in the country. California happens to be one of the states where the quality of health care delivery is very poor because of the rotten healthcare system.

A recent report indicated that at least 7.1 million Californians below 65 years in age have not been able to access quality health care since they are uninsured. The majority of these Californians residents have not been able to get insurance coverage because they are poor and cannot pay for the costly health insurance programs that have been available in the state. However, things are destined to change following the proactive measures that have been taken by Governor Jerry Brown and state officials to reform the state’s health care system. So far, the state has implemented various health reformed, which has significantly improved accessibility and health care delivery to Californian residents. Among the notable health reforms implemented over the past three years include ACA, Medi-Cal, Covered California and Breastfeeding & Health Program. The implementation of these health reforms has resulted in a significant rise in the number of residents covered under a health program. Additionally, the reforms have also improved the quality of health care service delivery for the benefit of Californian residents. However, Governor Brown, together with his state officials and health care stakeholders, should consider introducing more health reforms to ensure that all residents of California have access to Universal health care like the one practiced in Canada.

References;
  • California Hospital Association. (2014). Health care reform. Retrieved from http://www.calhospital.org/health-care-reform
  • California Health Care Foundation (2014). Health reform & public programs initiative. Retrieved from http://www.chcf.org/programs/healthreform/program-goal
  • California WIC Association. (2013). Breastfeeding & health care reform. Retrieved from http://www.calwic.org/focus-areas/breastfeeding/health-care-reform
  • Ferguson, E. W. (2013). American healthcare reform: Fixing the real problems. Los Angeles, CA: AuthorHouse.
  • Kempa, D. (2013). Medi-Cal, health-care reform and the ER collide. News Review, News Review.
  • McDonough, J. E. (2011). Inside national health reform. Los Angeles, CA: University of California Press.
  • O’Neill, S. (2013). Governor Brown commits to full Medi-Cal expansion under federal health reform. Retrieved from http://www.scpr.org/news/2013/01/10/35587/governor-brown-commits-full-medical-expansion-unde/

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