Four Sacramento area counties prepare for early test of Obama’s health care overhaul The Sacramento Bee
March 6, 2012
One slice of President Barack Obama’s health care overhaul is
coming early to the Sacramento region, providing a first glimpse
at what the massive, complex law will look like.
All four Sacramento-area counties are joining a program that will
insure tens of thousands of residents who have been without
coverage, more than a year before federal health care changes
For county governments and health care providers, the Low-Income
Health Program is a chance to get a head start and work out some
of the kinks in a new and complicated system – one that must
emerge by Jan.1, 2014, but remains largely unformed.
For new patients, the plan could mean the difference between
getting sporadic care in unfamiliar clinics (or simply staying
sick), and having something that resembles full-fledged health
insurance, paid for in county and federal dollars.
“It’s a very important jump start on health care reform,” said
Gerald Kominski, director of UCLA’s Center for Health Policy
Research. He said it will give early signs of how ready
California is to absorb the “huge expansion of coverage in 2014
that doesn’t exist today.”
The 2010 federal law creates several new avenues for the
uninsured to get coverage, starting in 2014. It requires states
to build competitive marketplaces, called exchanges, for low- to
middle-income people to buy insurance using federal tax credits.
For an estimated 16 million of the nation’s very poor – those
with annual incomes up to about $15,000 for a single person – the
law will make public insurance (Medicaid) available for the first
That Medicaid expansion is the piece that’s starting early in
California – where the program is called Medi-Cal – and several
other states, including Washington, Connecticut, Minnesota and
“California is definitely ahead of the pack in a lot of ways in
terms of trying to prepare people for reform,” said Laurie
Felland, director of qualitative research at the Center for
Studying Health System Change, a national research firm based in
Sacramento, Yolo, Placer and nine other California counties are
working to join the early-start program as soon as they can. More
than 40, including El Dorado, have already started.
The plan will serve poor, childless adults under age 65 – a group
that has slipped through the cracks of the health care system.
Illegal immigrants are excluded.
A Public Policy Institute of California study found that most
residents who will qualify are under age 40 and single. Until
now, they weren’t eligible for Medicaid – which serves the
disabled, pregnant women, and families with children – and
couldn’t afford private coverage.
For some people, “this is the first time that they’re getting
access to a real health care system, as opposed to just jumping
in when they’re sick and then jumping out,” said Carmella
Gutierrez, president of the patient-advocacy group Californians
for Patient Care.
Program to be short-lived
The Congressional Budget Office expects the Medicaid change to
cost the federal government $430 billion over 10 years. Between
now and 2014, counties and the federal government will split the
cost of the early-start programs. After that, almost all the new
coverage will come on the federal dime.
In California, Kominski estimates that 2.5 million residents will
qualify for the public insurance program by 2014. But he expects
the Low-Income Health Program to enroll just 500,000 Californians
ahead of time.
Come 2014, the Low-Income Health Program is designed to
evaporate, as the people in it automatically switch into
Short-lived as it may be, the program will help counties ramp up
their systems of care.
By New Year’s Day 2014, the federal law says, most adults with
very low incomes must be eligible for Medi-Cal. But they can’t
get started overnight.
Counties first need to vastly expand their corps of doctors’
offices that accept Medi-Cal, establish standards and payment
systems, enroll patients, and educate them on how to use the new
“You can’t flip a switch like that. That’s impossible,” said
Sandy Damiano, deputy director of the Sacramento County
Department of Health and Human Services.
Health officials hope the program will also answer some important
questions: Who exactly are the uninsured? What are the barriers
to getting them enrolled? And could connecting them with regular,
preventive care – a key goal of the federal law – cut down on
costly, unnecessary trips to the emergency room?
No more ‘episodic care’
The new patients’ primary care will come through “medical homes”
– regular, one-stop doctor’s offices where patients and providers
develop relationships, where the staff knows the patients’ names
and medical histories.
For people who are used to having comprehensive coverage, that’s
not a new concept. The uninsured normally “hop,” said Gutierrez.
“It’s episodic care, and they go from clinic to clinic.”
Each county determines how much it can spend on the program and
therefore how many patients it can serve. Sacramento County says
it can afford to serve only those making up to 67 percent of the
federal poverty level – or about $600 a month for a single
Sacramento anticipates enrolling about 10,000 county residents
between August and the end of 2013. That will cost approximately
$40 million a year, half of it federal dollars.
Many challenges remain. Sacramento County’s contract with the
state to join the Low-Income Health Program is not finalized.
So Molina Healthcare, the company that the county has tapped to
run the program, is trying to recruit doctors to the new network
on a promise of new patients and payments.
Counties continue to discover new expenses as the state
Department of Health Care Services clarifies the program
Some people fear that the newly insured in 2014 will have so many
unaddressed needs that they’ll overwhelm the health system and
squeeze out other patients. Yet Kominski said a similar program
tested in 10 California counties several years ago showed that
the spike in demand levels out quickly.
The pieces are in place. There are financial resources available.
The technology exists,” he said.
“But it is nevertheless a tremendous expansion,” Kominski added,
“and it’s not something we have done in California or nationally
since the implementation of the Medicare and Medicaid program in
the 1960s. That’s well beyond the experience of most of us who
are alive and well today.”