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Under California Gov. Jerry Brown’s revised budget, counties stand to lose crucial health care funding that would leave millions of people without access to care.
An estimated 3 to 4 million, or 10 percent of the state’s population, the majority from ethnic communities, will remain uninsured in 2014, according to a study by UCLA and UC Berkeley. Some of them – an estimated 1 million -- will be excluded from public health programs by federal law because they are undocumented. Some will not be eligible for Medi-Cal, the federal-state funded health care program for low-income people. Others who may qualify to buy coverage on the health insurance marketplace could miss the open enrollment period or simply not be able to afford it.
And of course there are those who decide to take a gamble and not buy health insurance because they are healthy and young or, as Shannon McConville, a research associate with the Public Policy Institute of California, puts it, “who are just not familiar with health insurance.”
Whatever the reason for remaining uninsured, the burden of their care will fall to the state’s traditional safety nets: public hospitals, emergency rooms, county health centers or community clinics.
For many low-income Californians, “counties are providers of last resort,” notes McConville.
Gov. Brown’s revised budget has proposed changes to how the state allocates about $1.4 billion in funds to its 58 counties to care for their low-income residents. Brown believes that over time, the state should be able to reduce that money, as more of the state’s uninsured get insurance coverage under Obamacare.
The state estimates that the first-year savings to the counties would be about $300 million, about $900 million the next year and about $1.3 billion in the third year. Those savings would be shifted away from county health programs, the Brown administration says, a suggestion that isn’t sitting well with county officials who argue that counties that run their own hospitals and clinics could be seriously affected.
Health advocates say that for the many who fall through the cracks even after the full implementation of Obamacare, there should be a safety net similar to the Low-Income Health Program (LIHP). LIHP is the “bridge” program set up in 2010 to help low-income people get health coverage. Some 623,000 people have benefited from the program, people who would otherwise have remained uninsured. LIHP programs will be expiring on Dec. 31, 2013. LIHP offers more than episodic and emergency room care for the uninsured. It offers a “viable way to fulfill the goal of providing access to care and coverage to Californians regardless of income or immigration status,” according to Anthony Wright, executive director of Health Access.
LIHP is only one county-run program, but to make a significant dent in the number of uninsured Californians, it is “important to maintain access to [other] health care safety net services,” asserted McConville of PPIC.
Letting the counties keep the money they save when Obamacare is fully implemented is one way of doing that.
This column was made possible by a grant from The California Endowment and is part of New America Media's series on the Affordable Care Act.
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