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Medibear for All!

With the Trump administration still trying to drown Obamacare in a Supreme Court-shaped bathtub, the state of California is busily passing a ton of bills to improve healthcare coverage for its residents, because Cali is just contrary that way. Let's take a look at some of the dozen or so healthcare bills California's lege has passed so far, which will improve both the state's Obamacare exchanges -- "Covered California" -- and its Medicaid, "Medi-Cal."

For starters, the legislature voted this week to expand Medi-Cal coverage to include a large portion of the state's undocumented population. In 2016, California extended Medi-Cal coverage to undocumented kids, meaning that about 250,000 children now have healthcare. This year, coverage for undocumented adults will be expanded, with Medi-Cal covering young adults aged 19 to 25, and all seniors over 65, regardless of immigration status. Because federal Medicaid funds are only allowed to go to citizens and permanent residents, California will have to pick up the cost of the coverage expansion, but that's a cost they're willing to cover, because 1) hospitals cover emergency Medicaid care at higher costs, so why not cover more people with basic care for less money, and B) damn it, healthcare is a human right. The state Assembly's version of the bill originally called for covering all undocumented adults, but Gov. Gavin Newsom wouldn't support the $3.4 billion price tag, so instead the Senate's more limited coverage was passed. Still room for improvement, but that's what future sessions are for. And not only will Californians be healthier, it'll piss off Fox News. We approve.


The other big healthcare bills are an assortment of measures aimed at improving bits and bobs of the healthcare system. There are two biggies: The first is a state version of the individual mandate (SB 175/AB 414), to make up for the national mandate getting killed off in the 2017 Big Fat Tax Cuts for Rich Fuckwads. That means a return of tax penalties for people who don't sign up for health insurance (you gotta have everybody in the risk pool). Newsom wants the anticipated $500 million in annual revenue from those penalties to pay for subsidies for enrollees in Covered California. So far, the new mandate has passed the Assembly but hasn't yet made it through the Senate.

The other big legislation, which passed both houses last week, is related to the mandate: AB 174/SB 65 would expand subsidies for people buying insurance on the state exchange, Covered California. We'll let the Sacramento Bee do the 'splaining:

Assembly Bill 174 would establish a tax credit beginning in 2020 for individuals who currently earn between 400 and 600 percent of the federal poverty level, or more than $48,000 a year for an individual and more than $100,000 a year for a family of four. These families are not currently eligible for Affordable Care Act tax credits. The Senate bill would require Covered California to implement premium contribution limits, while also reducing copayments and deductibles for people with incomes between 200 and 400 percent of the federal poverty level.

That, kids, is huge, and addresses one of the big shortcomings of the ACA by helping out people who made too much to qualify for premium subsidies but still had trouble paying for insurance. While we're working on getting Medicare for All nationally (which would have to include reining in prices of healthcare overall), this would be a good idea for Congress to crib from.

Beyond those big deal bills, there are a whole bunch of smaller improvements to the system, designed to cover more people and improve transparency. One, AB 715, irons out a coverage gap that caused some seniors on Medi-Cal to have to pay out-of-pocket fees every month; the bill raises the income eligibility for those folks, restoring full benefits to about 20,000 seniors. Another bill, AB 1088, likewise keeps seniors from getting bumped from Medi-Cal if the state covers their Medicare Part B premiums, so this bill makes sure that Medicare help won't be counted as "income."

Nothing all that earth-shaking here, but fixing small bugs in the program will make healthcare a lot more seamless and worry-free for a lot of people. We love the idea that government might actually solve problems like that, instead of seizing on a problem and then saying it's why we need to abolish all social services, which seems to be the Republican model.

Other fixes are aimed at simply making healthcare less of a hassle. AB 526 makes it easier for kiddos and pregnant women receiving federal WIC benefits to also sign up for Medi-Cal. SB 260 is aimed at preventing coverage gaps when people lose their insurance; health plans would be required to notify people when they lose their coverage and inform them how to sign up for Covered California or Medi-Cal. Just to make sure, the insurers would also have to provide Covered California with lists of people who've lost coverage, so the exchange can reach out to them and make coverage available. Both measures passed their respective houses last week, and will now go to the other house for consideration.

We're also glad to see SB 464 passed in the state Senate last week; it's aimed at addressing racial disparities in infant and maternal mortality. Black women die four times as often as whites during pregnancy, a horrific problem in American healthcare that's finally getting attention. SB 464 is part of California's effort to start addressing the crisis.

The state's health department is currently required to maintain a maternal and child health program, and the Office of Health Equity must track ethnic and racial health statistics on infant and maternal mortality, among other issues. This bill would require hospitals, birth centers and clinics that provide perinatal care to implement an implicit bias program for all providers, in an effort to reduce racial disparities. The providers would have to complete training at the outset, and a refresher course every two years. The bill would also change the way deaths of pregnant women are recorded on certificates.

SB 464 passed the Senate unanimously last week and is headed to the House.

Among the bills that haven't yet passed, we really hope there's further action on AB 1611, which would limit what hospitals can charge for out-of-network emergency care. Vox did an excellent series on "surprise billing," including an insane story about a San Francisco woman hit with a $20,000 ER bill after a minor bike accident. Here's more on AB 1611, which sponsor David Chiu says was a direct response to Vox's reporting. Heck, if we someday have a functioning national government again, there's even a bipartisan US House bill designed to address the issue.

So hooray for California! We hope other states will be inspired to take their own actions to improve healthcare like these, instead of deciding that poor people need to jump through more hoops. But let's also remember: Even in progressive states, the insurance and medical industries are so worried about their bottom line that they'll happily sabotage reform. See for instance Connecticut, where the prospect of the state's creating a public option on the state healthcare exchange reportedly led Cigna to threaten to pull out of the state altogether. Cigna insists it didn't threaten any such thing; it just lobbied vigorously. Either way, the public option proposal is dead for now, and wouldn't it be a shame if your state's insurance biz burned down?

Just a little reminder that money and influence by the medical-industrial complex will need to be tackled if Medicare for All is ever going to work. Just shifting who's paying the bills from the private sector to the public isn't enough.

[ACASignups blog / Kaiser Health News / Sacramento Bee / ACASignups / Vox / Hartford Courant]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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