The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has issued proposed regulations to implement Section 1557 of the Affordable Care Act (ACA). Section 1557 prohibits discrimination on the basis of race, color, national origin (including immigration status and language), sex (including sex stereotyping and gender identity), age, or disability in health programs. These protections apply to consumers in all federally funded state health programs, including Covered California and Medi-Cal.
The proposed regulations are a good first step, but the rule could be made stronger to better protect people at risk of discrimination in health coverage or care, including communities of color, Limited English Proficient, women, LGBTQ populations, and persons with disabilities.
Public comments are needed to strengthen these proposed regulations. While comments submitted by organizations are important, it also is very important for individual members of the public to submit personalized comments.
As Covered California’s third open enrollment period fast approaches, a new report sheds some light on the state’s remaining uninsured and finds that roughly half are eligible for either Medi-Cal or subsidized coverage through Covered California. Earlier this week, the Kaiser Family Foundation released New Estimates of Eligibility for ACA Coverage among the Uninsured, which looks at the over 32 million remaining uninsured across the country after the first two years of the Affordable Care Act (ACA) coverage expansions.
Nationally, the report shows the devastating impact of many states’ refusals to expand Medicaid. Roughly one-tenth of the remaining uninsured in the U.S. – over 3 million individuals – would fall into the coverage gap and could have been covered had their states decided to expand Medicaid as stipulated in the ACA.
But the report also looks at the remaining uninsured at a state-by-state level, and with this analysis we see that over half (53%) of California’s more than 3.8 million uninsured are eligible for either Medi-Cal (37%) or for subsidized coverage in Covered California (16%). These numbers show that while we have cut our state’s uninsured population nearly in half over the past three years, we still have an opportunity to continue this dramatic improvement. With another open enrollment period on the horizon, it is imperative that there are sufficient outreach and enrollment efforts, particularly in low-income areas, communities of color, and Limited English Proficient populations to maximize participation by the eligible population.
Over the past two years, California’s implementation of the Affordable Care Act’s (ACA) coverage expansions has resulted in the biggest increase in access to affordable health care in a generation. Today, thanks to a new Field Poll sponsored by the California Wellness Foundation, we know that a large majority of voters in the state see the ACA as a success. Further, there is significant support for expanding access to coverage to undocumented immigrants, who are currently left out of the ACA.
Health care advocates credited the implementation of the Affordable Care Act as contributing to the shift in sensibilities.
“Californians acknowledge that the Affordable Care Act and the expansion of services is working,” said Sarah de Guia... “People understand what it’s like to be uninsured (and then get coverage). Now there’s this growing movement of ‘We need to finish the job.’”
Earlier today, the California Wellness Foundation hosted a hearing in Sacramento to discuss the results of the survey. The event featured a presentation by Field Poll director Mark DiCamillo followed by a panel including de Guia, Health and Human Services Agency Secretary Diana Dooley, Covered California Director Peter Lee, and Juan Esparza Loera, editor of Vida en el Valle.
DiCamillo gave a detailed overview of the results of the poll, with accompanying charts. The panel after his presentation went into more detail about the findings. Some highlights included:
Editor's note: This report from Texas Health Institute features a great analysis of outreach and enrollment in Covered California and how it compares to other states.
Health insurance marketplaces have enrolled over 14 million individuals in health insurance since the first open enrollment began in 2013 -- an unprecedented achievement that together with Medicaid expansion in many states has lowered the national uninsured rate to its lowest in over 15 years. Despite this momentum, and notwithstanding gains across virtually all racial and ethnic groups, uninsured rates are still much higher for groups such as Latinos and African Americans as compared to Whites.
CPEHN Executive Director Sarah de Guia appeared on National Public Radio (via Bay Area affiliate KQED) to discuss the report and the impact the ACA has had in our state:
"This is really great news for California," said Sarah de Guia, executive director of the California Pan-Ethnic Health Network, an advocacy group. She spoke of people being lifted from the fear of paying for care. "There's this sense of relief, that they're not one accident or incident away from bankruptcy. ... They can keep their costs contained."
Over 100 advocates from across the state gathered at the Sierra Health Foundation in Sacramento earlier today for CPEHN’s sixth Focus on Equity: Communities of Color in a Post-ACA California convening. The event, co-hosted by OnTrack Program Resources, highlighted a number of topics that impact health in California’s communities of color, including health care quality, behavioral health integration, and access to health care for the remaining uninsured, particularly undocumented immigrants.
After the popularity of our events in Oakland, Fresno, Los Angeles, San Diego, and Riverside, we were invited by OnTrack to continue the discussion in the state capital. The event began with a presentation by CPEHN Executive Director Sarah de Guia that touched on each of the event’s topics.
She focused on how communities of color, who represent a majority of the state’s population, have the most to gain from successful implementation of the Affordable Care Act (ACA). She also pointed to the increased enrollment of Latinos and African Americans during Covered California’s second open enrollment period as a sign that the law’s programs are starting to have their intended impact.
A new issue of our Health Equity Forum newsletter was released today and it starts off July with a lot of great articles and resources highlighting efforts to improve health and equity in California.
CPEHN’s Executive Director, Sarah de Guia, opens the newsletter with an article about the emotional last few weeks for social justice advocates. She celebrates last week’s Supreme Court decisions regarding the Affordable Care Act and same-sex marriage. However, she also takes time to remember the lives lost in the tragic hate crime in Charleston.
Our Ethnic Partner Spotlight features an article from Xavier Morales, Executive Director of the Latino Coalition for a Healthy California. He focuses on the importance of addressing the diabetes health crisis in communities of color and what policy steps can be taken.
The American Lung Association in California has an interesting piece on their terrific new report, State of the Air 2015. The report looks at how California’s cities rank nationally in terms of air quality and what trends have become evident over the last decade. And the RYSE Center in Richmond has a compelling story on the challenges facing those returning from the juvenile justice system.
The report focused on California’s experiences during the first full year after implementation of the Affordable Care Act’s coverage expansion. Focusing on those who have gained coverage either through Covered California or an expanded Medi-Cal program, the report examined the state’s health care system after roughly 4.4 million people have enrolled in coverage in the two programs. Using results from a comprehensive survey, the report found that those with insurance were more likely to use it, but the newly insured had more trouble than the previously insured navigating how to use their coverage. Additionally, almost half (47%) of those newly enrolled in Covered California reported having difficulty affording their monthly premiums, compared to 27% of those who were previously ensured prior to 2014. The report also found that community clinics and health centers are increasingly relied upon by the uninsured and newly insured.
Continuing an effort to explore Affordable Care Act (ACA) implementation in the states, the Kaiser Family Foundation and the Blue Shield of California Foundation are examining ACA implementation in California at abriefing and panel discussion in Sacramento on May 28th. A state official, experts, and advocates will discuss issues and challenges related to the implementation of the law and the practical impact of providing coverage to roughly 4.5 million Californians who have coverage via the state marketplace or the Medi-Cal expansion.
The event will feature the release of the report Coverage Expansions and the Remaining Uninsured: A Look at California During Year One of ACA Implementation, based on the latest round of The Henry J. Kaiser Family Foundation’s Survey of Low-Income Americans and the ACA. The report, funded by the Blue Shield of California Foundation, provides a California snapshot of who gained coverage or remained uninsured in 2014. It also provides information on how the newly insured view their coverage and any problems they have encountered in using their coverage; how the remaining uninsured and newly insured fare with respect to access to medical care and financial burden; and why people in California continue to lack coverage.
On Wednesday March 11th, the Senate and Assembly Health Committees held a Joint Hearing on Health Disparities in California. Co-chaired by Senator Ed Hernandez (D-West Covina) and Assemblymember Rob Bonta (D-Oakland), the hearing featured panel presentations by advocates and researchers discussing the status of California’s communities of color and recommendations for addressing persistent health disparities. In addition, staff from the Department of Health Care Services (DHCS), Office of Health Equity, Covered California, Safety Net Institute, and Partnership Health Plan discussed initiatives to improve data collection and analysis to better align health care services to address health disparities.
Defining Disparities in California
CPEHN’s Executive Director Sarah de Guia framed the discussion by emphasizing the need to incorporate an equity lens into our post-ACA health care delivery system. She noted that the key to reducing health disparities is to ensure standardized data collection and analysis of demographic data for disparities reduction initiatives and incorporating primary prevention into our delivery system to address the root causes of disparities.