How great is California’s Obamacare success?

So you think Obamacare is a disaster? Here's how California is proving you wrong

By Noam N. Levey
Los Angeles Times, October 7, 2016

Even as turmoil in insurance markets nationwide fuels renewed election-year attacks on the Affordable Care Act, California is emerging as a clear illustration of what the law can achieve.

The state has recorded some of the nation’s most dramatic gains in health coverage since 2013 while building a competitive insurance marketplace that offers consumers enhanced protections from high medical bills.

California and its Obamacare marketplace, Covered California, still face challenges, including rising costs. Like consumers elsewhere, some Californians, particularly those who make too much money to qualify for government subsidies, are seeing substantial premium increases and narrowing networks.

But while health coverage has faltered in other states where politicians worked to undermine the law, California highlights what can be accomplished if government officials and industry leaders work together to expand insurance, control costs and protect consumers.

More than three-quarters of newly insured Californians said their health needs are now being met, a recent survey by the nonprofit Kaiser Family Foundation found.

At the same time, Californians who gained coverage reported fewer worries about paying for not just healthcare, but also housing, transportation, even food.

Much of the insurance expansion in California has been fueled by the state’s decision to take advantage of federal funding in the health law to expand Medicaid eligibility to poor, childless adults, a population traditionally excluded from most states’ safety nets.

But Covered California has also played a critical role, with about 1.3 million direct customers and nearly 1 million more who get health plans that must meet Covered California standards even though consumers don’t use the marketplace to purchase them.

In 2017, Covered California rates are increasing an average of 13.2%, driven in part by rising medical costs and the end of a federal program that helped hold down rates.

Premiums for several insurers, including Blue Shield of California and Anthem Inc., are increasing even more dramatically.

Preventing large rate hikes in the future will require adjustments to the marketplaces in California and elsewhere, many experts say.



By Don McCanne, M.D.

California’s aggressive implementation of the Affordable Care Act has made it one of the more successful states in expanding the numbers of individuals with insurance coverage while reducing, for the previously uninsured, the financial burden of health care. As the title of this article indicates, California has proved that Obamacare is not a disaster. But what if California had had a better designed health care financing system with which to work? Say, a single payer system.

* The 3.8 million California residents who remain uninsured would be covered.

* Patients would not be faced with unaffordable deductibles.

* Exchange enrollees would not be facing an average of 13.2% increase in premiums.

* Patients would not be locked into narrow networks, limiting their choice of providers.

* Patients’ health would not be negatively impacted by constant churning of health plans and programs.

* The need to shop premium prices, which increases churning, would go away.

* Patient dollars would no longer be wasted on our profound administrative excesses.

* Employers would be relieved of the burden of administering employee health benefit  programs.

* Since lifetime, comprehensive, public coverage would be initiated at birth automatically, health insurance plans and their exchanges would go away.

California is to be commended for accomplishing what they have within the limitations of our multi-payer system as modified by the Affordable Care Act. But is this the best we could have done?

California bears responsibility for not leading the nation in demanding enactment of a single payer national health program - an improved Medicare for all. All that work for a comparatively small gain, when we could have had a much simpler, more equitable, more effective, more efficient and more affordable health care financing system.

The disaster is that we didn’t move forward with single payer. In this case, disaster relief is only a matter of political will.