Earlier this month, Governor Arnold Schwarzenegger submitted legislative language to the Senate and Assembly to continue the conversation in earnest and get health care reform resolved. We continue to strive for health insurance for all California families.
We need to find a solution this year — a solution that achieves the Governor’s goals of: coverage for all; affordability and cost containment; and, prevention, health promotion and wellness. The language the Governor submitted makes a number of changes but leaves intact the basic premise of the plan he introduced this past January.
As in January, Governor Schwarzenegger is committed to coverage for all. To achieve this goal, the Governor’s plan requires all individuals to have a minimum level of health coverage. We believe this is the most effective strategy for ensuring all Californians are insured and fixing our broken health care system.
We also recognize that an individual mandate must be paired with a requirement that insurers offer health insurance. Market rules will be reformed so that health plans cannot deny coverage due to age, health status or pre-existing conditions. And, to ensure maximum value, insurers will be required to dedicate no less than 85 percent of premiums on patient care. To help keep costs down and make health care affordable, Governor Schwarzenegger’s plan would address the issue of the hidden tax that individuals and employers pay for the uncompensated care of the uninsured. While uninsured individuals can access health care services, far too often and for far too many, that care is provided in the most expensive, least appropriate setting possible – the emergency room.
Emergency rooms throughout the state are struggling with the financial burden associated with the uninsured. It is morally right to treat people in their time of need, but when their bills go unpaid, the cost is shifted to those who have health insurance, something akin to a hidden tax. The hidden tax insured Californians pay in the form of higher premiums to subsidize care for the uninsured is estimated at $1,186 per year for families and $455 per year for individuals.
It is morally right to treat people in their time of need, but when their bills go unpaid, the cost is shifted to those who have health insurance, something akin to a hidden tax.
This hidden tax is even higher when underpayments from government programs such as Medi-Cal are added in. Taken together, it is estimated that families pay as much as 17 percent more in premiums due to the cost of uncompensated care for the uninsured and Medi-Cal underpayments. That’s why the Governor’s plan calls for $4 billion in additional Medi-Cal payments to ensure adequate compensation and to address the hidden tax.
A final essential element of the Governor’s health reform plan includes strategies to keep Californians healthy and keep them from having to use expensive medical services.
Chronic illnesses, like diabetes, and poor health choices, such as smoking and inadequate exercise and nutrition, drive up the cost of care. The Governor’s proposal outlines a comprehensive prevention policy that encourages and rewards healthy behaviors, supports diabetes prevention and management and continues nation-leading innovative strategies to reverse obesity trends and reduce the smoking rate.
The proposal also includes measures to reduce medical errors by the use of electronic prescribing and the implementation of new health care safety measures and reporting requirements to keep Californians from expensive preventable procedures due to medical errors.
All Californians are hurt by our broken health care system and all Californians will benefit from comprehensive reform based on coverage for all, shared responsibility and balanced financing. Working together, we can achieve affordable health care, coverage for all and a healthier California.
Kim Belshé is the Secretary of the California Health and Human Services Agency.
