In California, Health Reform ‘Nearly Impossible to Be Undone’

In California, Health Reform ‘Nearly Impossible to Be Undone’

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LOS ANGELES – As the U.S. Supreme Court prepares to review the constitutionality of the Affordable Care Act (ACA), California health experts are confident that the state will continue to lead the way on health reform.

The Supreme Court announced this week that it will examine various elements of the legislation, including the legality of the individual mandate to buy coverage, whether the federal government can legally require states to expand Medicaid, and whether it is too early to rule on this because the law won’t be implemented fully until 2014.

Obama’s health care reform law has been the largest action to expand and improve the delivery of health care in the United States, a move that many health care advocates believe might not come again. It builds on the existing state-based system of private insurance; and because states are in various phases of working toward the 2014 deadline, the Supreme Court’s decision in March could be a setback for health care reform.

Still, many health care advocates are hopeful that the Supreme Court will uphold the law.

Dr. Felix Aguilar, chief medical officer of the South Central
Family Health Center in Los Angeles, is excited about this next phase of the “game,” he says, likening the Supreme Court to a referee who is going to clarify the rules of the game. If the game is over at the federal level, he said, health care reform advocates need to pick it up at the state level. While he is optimistic that the mandate will be upheld, he says, “If it doesn’t pass, then I’ll be calling the governor the next day, to not lose momentum.”

Opponents of the health care reform law argue that it is an overreach of federal power to require that nearly all Americans have health insurance.

Dr. Aguilar understands the critics, saying their view “is rooted in the American spirit of individualism, of (picking yourself up by your) bootstraps.” But, he says, this isn’t the whole picture of what it means to be American. “We are also rooted in the spirit of cooperation and taking care of each other,” he said.

California has the highest number of uninsured persons of any state. Through the work of health and consumer advocates, the state has focused on building the infrastructure for future coverage expansion and implementing as many of the changes as fast as it can.

“In California, regardless of whatever happens in the Supreme Court, health reform will continue,” said Peter Harbage, a policy expert and president of Harbage Consulting in Sacramento. “It already has made a positive impact and it will continue to make a positive impact,” said Harbage, who worked as assistant secretary for health at the California Health and Human Services Agency under Gov. Gray Davis, and as special assistant to the administrator of the federal health under the Clinton administration.

One of the most popular features of the Affordable Care Act that has already gone into effect allows parents who are insured to cover their adult children up to age 26, even if their child is married.

Those who have been turned away from their insurance company because of a preexisting condition now have alternatives for coverage, and children with preexisting conditions can no longer be denied coverage.

Richard Figueroa, director of health and human services for The California Endowment, said he was “pleased that the Supreme Court took up the challenge.” The California Endowment was among the organizations that filed a brief asking the Supreme Court to take up the challenge and, Figueroa said, “We are confident it is going to be found constitutional.”

The California Endowment, which was set up to expand access to affordable, quality health care for underserved Californians, is now focused on the implementation of the Affordable Care Act.

Dr. Robert Ross, the foundation’s president and CEO, said in a press release, “We know that the Affordable Care Act will positively impact the health of communities in our state and its implementation is core to our mission of ensuring all Californians have access to health care services.”

“We have to rely on California’s strong history of covering people, of taking on health care challenges including trying to implement health reform on our own; and rely on policy makers, who - if parts were struck down - would still seek to maximize coverage opportunities of the federal law,” he said.

Depending on what the Supreme Court decides, state governments may have to reassess whether and how they plan to move forward with health care reform. But in California, says Harbager, the changes that have already taken place would be “nearly impossible to be undone.”