Reducing the Number of Uninsured in California - Term Paper Example

? Decision Maker Reducing the Number of Uninsured in California Background of the Problem In the history of every deep-rooted and difficult problem, there comes a time when the consequences of the predicament seems to be overwhelming enough that a solution turns out to be not simply appealing, but vital. And the issue of growing populations of uninsured Americans has been existent for hundreds of years. Only President Johnson realized a certain level of success, through Medicaid and Medicare. And yet, the problem continues and even worsens. This paper tries to recommend several steps to reduce the number of uninsured in California. California, for past two decades, has witnessed an escalation in the number of uninsured individuals, as the percentage with employer health insurance coverage has thinned. The section of the non-elderly population insured through an employer kept on dropping from 65 percent to 52 percent between 1987 and 2009.i Albeit growth in Medicaid coverage somewhat counteract the drop, there remains at least 20 percent uninsured Californians.ii California has a greater percentage of uninsured and a lower proportion of people with employer-sponsored insurance than all the other states in the country.iii *table taken from California Health Care Almanac (2010a): http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20CaliforniaUninsured2010.pdf Between 2007 and 2009, the population of uninsured children and adults in California grew by 28%. The growth in the number of uninsured transpired in every age group, yet employed adults were the most affected.iv The number of people out of work in California grew from 5.4% to 12.3% between 2007 and 2009. Non-White individuals are also more prone to be uninsured. Young people are also more prone to be uninsured, or roughly 63 percent are at most 34 years old.v Being insured, besides enhancing access to healthcare, can increase annual income by 10-30 percent, cut down mortality rate by 5-15 percent, and improve the educational achievement of children.vi Employer health insurance coverage is the primary source of insurance for Californians and in the United States. According to California Health Care Almanac (CHCF) in 2010, benefit plan and premiums have evolved over time.vii Important findings are: Since 2002, premiums have increased 134.4%, more than five times the 24.5% rise in California’s overall inflation rate.viii Twenty-eight percent of California firms either reduced benefits or increased cost sharing for employees in 2010 as a result of the economic downturn, up considerably from the 15% who did so in 2009.ix *graph taken from California Health Care Almanac (2010b): http://www.chcf.org/publications/2010/12/california-employer-health-benefits-survey Medicaid in California, or Medi-Cal, covers the health insurance of 7.7 million individuals. California witnessed major achievements in trimming down the number of children with no insurance by 12 percent from 2003 to 2007.x The Affordable Care Act broadens Medicaid to cover ‘133 percent of federal poverty level’.xi This significant expansion will aid vast numbers of poor Americans who cannot afford to get insured. Annually, Medicaid and the Children’s Health Insurance Program (CHIP) have served a major function in reducing the impact of the economic downturn for employed families. The federal government will totally subsidize the expansion of Medicaid for all new enrollees from 2014 to 2016. Medicaid is still collaboration between the states and the federal government, which maintain considerable flexibility in the way they plan the different parts of their Medicaid initiatives.xii The Affordable Care Act offers new alternatives to states to enhance care and regulate expenditure increase through medical home demonstration initiatives, payment adjustments, and a focus on offering long-term assistances and services in community- and home-based locations rather than in hospitals or other institutions, when necessary. Discussion and Analysis of Options According to the findings of the CHCF, the Children’s Health Insurance Program (CHIP) in California has been fairly successful in reducing the numbers of uninsured children in the state. Nevertheless, in numerous ways, the evident achievement of this initiative has obscured the mounting problem of a growing population of uninsured adults. As it seems that universal coverage is not a solution that will deliver, states have employed numerous strategies. The three options proposed in this paper are consistent with the role of state Medicaid and CHIP programs after January 2014 when the ACA policies are implemented. The first option is developing a clear contribution managed care approach. California will offer a set premium to managed care agencies for all plan enrollees, instead of refunding providers for a definite benefit package, just like before. This alternative is accessible mostly to adults, and does not include individuals with developmental impairments and children with chronic health conditions. This essential reform requires a transition from ‘definite benefits’ to ‘definite contribution’. Within the conventional model of defined benefits, employers, or other institutional buyers, decide the scope of the coverage, then develops a plan or design that will give those services for a suitable rate.xiii On the contrary, within defined contribution, the institutional buyer decides on the spot the sum it will invest for healthcare, and then usually presents a range of alternatives from which recipients can select. However, under this system, the employee bears most of the risk inherent in a health insurance plan, and contributes solely to the plan except if matching of contribution is provided by his/her employer. The second option implies that California should exert effort in enhancing the experience of the patient and physician in coping with the Medicaid plan. Strategies should consider removing some administrative obstacles, and fostering more effective communication and appropriate pay requirements between healthcare providers and payers. Subsidy should be given to Medicaid-involved healthcare providers to buy and use health information technology. In order to attain a more efficient dealing of medical documents between payers and physicians, state and federal governments should speed up construction and completion of a health information technology system. Nevertheless, the financial support given for health information technology efforts today is perhaps insufficient. The third option states that Medi-Cal should be responsible for implementing regulations and carrying out programs that enhance the quality of care and condition of health care, such as mitigating ethnic and racial gaps and efficiently managing mental health and chronic illness. This paper firmly argues for reforming the delivery system of Medi-Cal to put emphasis on patient-oriented care, particularly by constructing patient-oriented medical facilities for Medi-Cal recipients. The importance of this option is attested by the diagram below: *diagram taken from Alliance for Health Reform (2004), p. 438 The three proposed options should place importance on consolidated primary care, should focus on quality, and should offer recipients with more alternatives to cater to their long-term care requirements. Primary healthcare providers will take on a very important function in giving care to Medi-Cal recipients, but the reforms should perform more to make sure that healthcare providers can give care, that information can be disseminated throughout the healthcare system, and that organizational barriers are removed to encourage Californians to apply for health insurance. Conclusion The most important of the three proposals discussed is the third one, reducing ethnic and racial gaps. Medicaid is especially imperative for ethnic and racial groups, giving an important guarantee for disabled and poor Californians. Ethnic and racial groups usually have special healthcare demands and requirements and usually have greater rates of chronic illness than White people.xiv Moreover, people with low income are frequently in poorer health conditions than people in higher socioeconomic status, possibly because of increased exposure to harmful environmental factors and restricted access to quality and inexpensive healthcare. *figure taken from Alliance for Health Reform (2004), p. 437 Affordable Health Care Act states that all individuals, irrespective of nationality, race, cultural background, or socioeconomic status ought to receive quality healthcare. Removing ethic and racial gaps is a financial and moral necessity: gaps between White and non-White Medicaid recipients lead to billions of dollars unnecessary Medicaid expenditures.xv Ethnic and racial gaps in access to quality healthcare continue in spite of significant developments in expanding Medicaid and enhancing the overall quality of care. Expanding Medicaid will be an overwhelming mission as the initiative is projected to become one of the biggest payers of medical services. Nevertheless, this overwhelming mission presents an opportunity to modify the initiative to stress primary care; guarantee the involvement of healthcare providers; reform the system of care provision to reinforce patient-oriented, evidence-based care; make changes to the system of long-term care to permit individuals to reside in their communities and homes; and break down organizational hindrances by developing a system of health information technology. Read More