Health Care for the Poor in California

California has acted as a health-care reform leader since the 1930s, when the first employer-funded plans appeared. Medi-Cal is presently the largest program for low-income residents. However, many local governments have pushed to provide services for the poor, while reimbursing hospitals who care for the uninsured. In 2010, California secured additional Medicaid funding, which it hoped would expand coverage--especially for childless adults, a group long left out of many coverage proposals.

History

• Employer-funded health insurance took hold in California during the 1930s as companies sought new ways to compete for labor. In 1945, state legislators defeated a single-payer health-care proposal by a 39-38 vote--four years before President Harry Truman failed to do likewise at the federal level. In 1971, the legislature created Medi-Cal, which remains the Golden State's primary avenue for people who lack health-insurance coverage.

Size

• According to the California Health Care Almanac, about 6.8 million Californians, or one in six residents, rely on Medi-Cal to some degree. This includes most AIDS patients, as well as one in three children, and more than one in 10 adults under 65. As the nation's largest Medicaid program, Medi-Cal accounts for about $47 billion in spending. On the flip side, Medi-Cal brings $27 billion of federal funds to Californian providers, amounting to virtually two-thirds of net patient revenue for public hospitals.

Effects

• Medi-Cal is not the sole option for poor Californians. Since the 1970s, many counties have dedicated property tax revenues--and some federal money--to cover services for the poor, and reimburse hospitals for providing the uninsured with care. In 2005, a federal Medicaid waiver allowed 10 of the state's 58 counties to provide acute care and health maintenance for low-income adults, according to the Central Vally Business Times.

Significance

• An expanded Medicaid waiver is at the heart of California's latest health-care experiment. In November 2010, the Obama administration agreed to give the state an additional $10 billion to help cover 500,000 uninsured residents, the "Central Valley Business Times" reported. In return, the state agreed to cut $2 billion per year from its Medicaid budget by revamping care for its costliest recipients--including adults with disabilities, seniors and severely ill children.

Potential

• Health officials voiced excitement at the chance to move ahead of the 2014 headline for states to begin expanding Medicaid programs--the centerpiece of President Barack Obama's health-care overhaul. By giving local governments the chance to widen preventive care and prescription drug coverage, officials hoped to reduce low-income adults' dependence on emergency room care for chronic conditions. Public hospitals, in turn, hoped to collect reimbursements for basic prevention efforts they had not been able to recoup in the past.