Health care reform has passed. For all the uncertainty about reform— only time will tell if it succeeds at containing costs and improving quality— it is justified by the direness of the country’s challenges in health care. Perhaps no state has as much to gain as California whose woes are a particularly astonishing depiction of all that has gone awry in American health care.
It all begins with the unassailable access to health care that the reform plan will provide to millions of Californians. The access problem is considerably more pronounced here with a recent UCLA study showing that a staggering 8.2 million of the state’s residents— in total 24 percent of Californians under the age of 65— are uninsured.
The importance of this can’t be overstated; there is no substitute for consistent access to physicians who serve as patient advocates and provide basic preventive care. Our health care system has seen too many people not receive care until it’s too late and financially destabilizing.
The coverage gap in California is dramatic even in comparison to the nearly one-sixth uninsured nationally which is in its own respect unprecedented for an industrialized nation. Providing universal coverage is a leap forward. Doing so affirms that health care is if not a basic human right at least a moral responsibility of an industrialized nation like the United States.
It also represents a commitment to providing our citizens peace of mind. The alarming jump in uninsured Californians noted in the UCLA study— from 6.4 million adults in 2007 to 8.2 million in 2009— is largely due to the recession with many losing their jobs and others deciding they can no longer afford health insurance.
Reform will assuage fears of medical-related financial ruin. Medical bills are the leading cause of bankruptcy in the United States forcing nearly 1 million Americans into bankruptcy annually.
In California two-thirds of those who fall into medical debt are actually insured often seeing no option but to delay or altogether forgo needed care. When insurance no longer provides security the abjectness of the present situation in health care is made particularly clear.
Few are exempt from having health care suddenly taken away or priced beyond their means whether by unemployment or the misfortune of illness the latter leading to so-called “pre-existing condition exclusion” by insurers whose incentive is to preferentially insure the healthy before the sick.
Universal coverage combined with a ban on such discrimination based on medical history provides assurance. It guarantees that all Americans whether or not they currently stand to benefit will always have access to health care regardless of life’s unforeseen turns. In recent weeks California has been increasingly referenced as a compelling example of the need for comprehensive reform. The spectacle of skyrocketing premiums in the state is what the insurance industry would call a recessionary death spiral— take the recent controversial rate increases (by up to 39 percent) of Anthem Blue Cross California’s largest insurer.
In tough economic times unemployment and falling income prompt healthy people to relinquish their insurance. What’s left is a sicker and hence more expensive risk pool pushing premiums upward and forcing yet more people out of the market.
The end result is that people are forced to deliberate about the cost-effectiveness of health insurance— a decision no one should ever have to make. The legislation is devoted as much as anything to reforming the health insurance system.
While virtually everyone in Congress supported the ban on pre-existing condition exclusion an issue of contention was the individual mandate. In reality this is a requisite feature. The only way to make insurance affordable is to spread the risk which means bringing both the healthy and the newly insured sick into the market.
Under the plan subsidies are provided for those who cannot afford to buy insurance under the mandate. The legislation also expands eligibility for the poor under the federal Medicaid program (known as Medi-Cal in California) providing access to a quarter of uninsured nonelderly Californians.
A centerpiece of the plan is the establishment of insurance exchanges— marketplaces that have a wide array of transparently competing insurers and plans all operating under required standards of comprehensiveness and cost-effectiveness. In effect insurance exchanges capitalize on group purchasing power to offer individual consumers a much better chance in the insurance market.
Perhaps the most intriguing characteristic of health reform is that it will promote health equality in our state. Our large minority populations disproportionately shoulder the burden of health disparities.
A troubling number of Hispanics and blacks in particular are uninsured. There are 2 million uninsured adults and children in Los Angeles alone. In this respect ensuring access to health care for nearly all of them will truly be a momentous event.
Reform will also energize the fight against health disparities by establishing community health centers in the areas that exhibit the greatest need providing primary care— the Achilles’ heel of our health care system— to our most vulnerable populations.
No one can predict exactly how health care reform will fare. To be sure the bill has its flaws and uncertainties. But for the millions of Americans who had no other option before who were forced to choose between their livelihood and their health insurance who feared the day they might lose their health insurance who have long suffered from inequality in health care— this is a commendable and wholly worthwhile step in the right direction.