California, the New Massachusetts?

Seven million of California’s nearly thirty-eight million people don’t have health insurance, the largest total in the nation. With the Affordable Care Act (AFC) – so-called Obamacare – marching forward, California is only one of 14 states/jurisdictions (Washington, D.C. is included) that is actively in the process of creating a healthcare exchange (the California Health Benefit Exchange), a state-sponsored insurance-pooling effort that will allow the uninsured to seek the cost and coverage benefits of group coverage. These exchanges are focused on providing benefits in at least ten essential categories at affordable coverage rates.

The provisions in the AFC of banning denial of coverage based on preexisting conditions, cutting off coverage under lifetime benefit caps or terminating heavy users of healthcare don’t kick in nationally until January of 2014. That’s also the date that Americans able to afford healthcare either have to have the requisite coverage or pay a fine, but without such implemented exchanges, many will not be able to find the mandated affordable coverage. Under then-Governor Mitt Romney, Massachusetts led the country in creating a viable government healthcare program, since disavowed by that same governor who signed it into law, which embraced a whole pile of people previously unable to afford health insurance. Today, that leadership role seems to be in the process of being passed to California.

Many governors are simply ignoring the need to create such health exchanges, since it is an expensive structure to mount (California is paying $327 million to just one consultant, Accenture, as the primary implementing consultant) under a statute that candidate Mitt Romney has vowed to repeal if elected. The United States is the only developed country in the world that is still without universal healthcare and remains the costliest per capita in this per capita on earth.

But there are also a few Republican governors – even ultra-conservative Arizona Republican Jan Brewer – “working to have a framework ready by Nov. 16, the deadline for states to commit to running an exchange or leave it to the federal government to run it for them. That is just 10 days after Election Day, which is likely to decide the future of the law.” New York Times, September 23^rd. You won’t read about these preparations in the headlines, because these Republican leaders – want the law to die – believe that either their revised lawsuits (after the U.S. Supreme Court upheld most of the AFC) will prevail or a new Republican administration will just do away with virtually all of the law. “Given that the health care overhaul remains a lightning rod — [mid-September], Oklahoma revised a lawsuit against it — even the most tentative discussions about carrying it out in Republican states tend to take place behind closed doors or ‘underground,’ as the leader of a health care advocacy group in the South put it.” NY Times. The process of actively setting up a functioning exchange, however, is taking place in more liberal states.

Budget-impaired California faces yet a 16 billion deficit that will decimate that state’s ability to provide basic services if voters reject the tax increases posited for the November election. The costs of the program have been estimated at $2 billion a year, and still, California voters favor the AFC by a whopping 54% vs. 37% against margin according to an August 20^th Fields poll. “Support was strongest among blacks (88 percent) and Hispanics (67 percent), who together make up more than 44 percent of the state’s population. Voters of Vietnamese and Korean descent also firmly supported the law, but white and Chinese voters were more divided. The poll of 1,579 voters, conducted in July, has a sampling error of plus or minus 3 percentage points.

“Only 17 percent of respondents said they had seen, heard or read anything about the insurance exchange though. Still, 75 percent of those who are not insured through their employer or Medicare said they would be interested in using the exchange to shop for health insurance.” New York Times, September 14^th. What it is fascinating is the resistance shown by so many people to the AFC when clearly the majority of those resisting will, sooner rather than later, without the AFC lose the ability to afford health insurance that is still escalating at a cost multiple several times greater than the general cost of living, and most certainly above any semblance of increases in pay for average working Americans.

Still, with such burning economic issues, California healthcare exchange officials have a more immediate issue to deal with: what to name the program to get people to pay attention. I think that’s a problem they want to solve, although one of the more popular possible names, Avocado, seems a strange (but, like a totally California) approach.

I’m Peter Dekom, and if given a choice between upgrading an F-22 Raptor and getting life-saving medical care, I wonder what those opposed to the AFC would really pick when pressed?