By the time President Obama signed his health care reform bill into law, the national conversation about it had been played out six ways to Sunday. The debate had gotten so rancorous, so weighted down with talking points, both real (the sacrificial public option) and imagined (death panels), that even supporters had grown disillusioned with the whole bloody mess. It's a bit surprising, in retrospect, that any actual reform measures survived the process.
Three months later, health care professionals and policy experts have begun examining the effects of the reform measures that have already been enacted, and they're preparing for a slew of new policies that are due to roll out later this year.
What's most significant for Humboldt County? According to Nancy Starck, legislative analyst for the county Health and Human Services department, it's the salvation of Medi-Cal and Healthy Families, two state programs designed to aid low-income families, both of which had been targeted for cuts by Governor Arnold Schwarzenegger. The new federal legislation rescued these programs, Starck said, by prohibiting eligibility reductions. "We have nearly 3,500 children enrolled in Healthy Families in Humboldt County," Starck said. The state program, enacted nearly five years ago and operating locally under the nickname Healthy Kids Humboldt, offers insurance to children of low-income working families. Starck said this federal measure alone is a significant benefit of the new legislation. "Any measure that reduces the number of uninsured is good for community health," she said.
By that same yardstick, a report released Monday delivered bad news, not just for local residents but for the whole country: Insurance companies are raising their rates by an average of 20 percent for adults who buy their own policies, according to the nonprofit Kaiser Family Foundation. Those hikes are causing many of the 14 million such U.S. residents to either downgrade their coverage or switch insurers, the study found. Here in California, the state's four largest insurers, which together control 90 percent of the market for individual health policies, are having their proposed rate increases independently reviewed to "keep them in line with legal limits on profit," according to the Associated Press. Insurance Commissioner Steve Poizner said Wednesday that Anthem-Blue Cross already attempted to raise rates 50 percent more than the law allows. (The proposal has since been withdrawn.)
Nevertheless, a panel of health care professionals and experts sounded cautiously optimistic about the law's potential when they spoke Monday during a teleconference presented by The California Endowment, a private, nonprofit health foundation. Media, including the Journal, were invited to listen in and ask questions. During the hour-long conversation, there emerged a consensus that the state is at a key turning point: Either employers and the health care system at large position themselves to take advantage of the tens of billions of dollars beginning to flow in as a result of the law's passage, or we'll miss a rare opportunity to improve the health of our citizens. "This is really a moment that will determine how well or poorly we do in the future," California Endowment Director of Health and Human Services Robert Philips declared.
Among the measures already enacted: Employers can get temporary reimbursement for paying early retiree benefits; qualifying seniors can get $250 checks for prescriptions if they fall into Medicare's "donut hole" coverage gap; and small businesses (those with fewer than 25 full-timers) have been granted tax credits covering up to 35 percent of the premium costs of employee policies. Those credits will jump to 50 percent starting in 2014, and UC Berkeley's Center for Labor Research and Education estimates they'll be worth $4.4 billion to California over the next decade, according to Dr. Ken Jacobs, the center's chair.
Later this year, the first set of insurance regulations will go into effect. Among other things, these regulations will prevent insurers from dropping coverage when policy-holders get sick, ban them from denying coverage to children based on preexisting conditions and prohibit them from charging for preventive services like cardiovascular screenings, mammograms and diabetes screenings for individuals with high blood pressure.
"This focus on prevention is welcome news for those of us who work in the primary care environment," said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association, which represents more than 800 community health clinics statewide. Such clinics, including local ones like the Eureka Community Health Center and the Humboldt Open Door Clinic in Arcata, are the big winners in the initial round of funding, according to Connie Stewart, executive director of the California Center for Rural Policy at Humboldt State University. Reached by phone Tuesday, Stewart said the bill leaves a lot to be desired, but there's no doubt that it will help people. "It's better than nuthin', that's for sure," she said.
Teleconference participant and past-president of the California Medical Association Dr. Dev GnanaDev phrased it in grander terms. While he agreed that the law falls short of what's needed, he sees its passage as historic. "I look at this as [being] similar to previous landmark laws, whether it was civil rights or equal employment. None of them started with exactly what we needed, but eventually we will get there." And where's "there"? It's a place, he said, where "we can finally look like a civilized country, where we can provide all the citizens with some type of health care coverage." He added that we have a long way to go.
The North Coast is certainly no exception. According to data gathered by the Insure the Uninsured Project, nearly one in every four residents of Humboldt and Del Norte counties is uninsured.