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State moves ‘full steam’ ahead with health reform Is ‘Jerrycare’ in California’s future?

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By Chris Levister

California Governor Jerry Brown will push for universal health care in the Golden State, even if the U.S. Supreme Court declares Obamacare to be unconstitutional.

If the Supreme Court strikes down the individual insurance mandate in the Affordable Care Act, (ACA) the California government wants to make ‘Jerrycare’ a requirement statewide. One day after the Supreme Court wrapped up arguments on constitutionality questions, California Health and Human Services Agency Secretary Diana Dooley weighed in telling a Sacramento radio station, "I believe that the law will be upheld. But I'm also working very hard to assure that we have as much benefit for California as possible, even if we don't have the full promise of the Act." She said, "I think that we should be committed to making this system more rational than it is today, and improving the health of the people of California," adding, "If we ask the insurance plans to take everybody and insure everybody with no screens for pre-existing conditions, then we have to have everybody buying some level of health insurance to meet their responsibility to the system." The Supreme Court case centers on whether the federal government can require residents to purchase insurance and whether federal lawmakers have the power to pressure states to expand insurance coverage through Medicaid.

California was the first state in America with legislation to create a public health insurance market to accommodate the federal Affordable Care Act. Health care and state leaders discussed the changes still to come and believe the state can get there, putting California at the forefront. "Millions of Californians who have been uninsured will be able to have the security of knowing when they get ill or injured, they will have somewhere to go and they will not go to bankruptcy as a result of it," Dooley said.

The Kaiser Family Foundation has estimated that California could receive an additional $45 billion to $55 billion in federal funds between 2014 and 2019 if the health reform law is upheld. As called for under the health reform law, California is using federal funding to build a health insurance exchange.

Dooley said, "My agenda is to use as much of that funding as possible, as quickly as possible, to be sure California has a marketplace even if we don't have the full promise of the ACA" "We're all on pins and needles on the Supreme Court stuff," said Robert Ross, CEO of the California Endowment. "We still have 7 million uninsured in the state, and we still have out-of-control health care costs."

Dooley said that without financial support from the federal government, "it will be very hard for us to move forward to expand health coverage." She said the state would have to balance its budget "and get California on a strong footing to do any of this work." Assembly member Tim Donnelly, R-Twin Peaks, who introduced a bill to nullify the federal healthcare reform, says state leaders should wait until the court rules on the Constitutionality. "They're a little Pinto driving in front of the snow plow; they're on dangerous road, and they have no business being there," Donnelly said.

Dooley said, "The Supreme Court will define how California will move forward and how quickly California will move forward" with health reform. She added, "If we have to do it without our federal partners, we will find a way to do it. But it will be a much better transition to better health if we can do it with the benefits of the Affordable Care Act"

While most of the federal changes don't begin until 2014, California has been at the forefront, doing as much as it can now and gearing up for full implementation, despite the legal challenge. According to estimates a Supreme Court decision striking down President Obama's entire health care law would have a major impact on African Americans. An estimated seven million of the 30 million who would eventually get health insurance under the law are black.

While much attention has been focused on the law's requirement that people purchase insurance, its expansions of Medicaid (the insurance program for low-income Americans), is perhaps just as important, according to the Joint Center for Political and Economic Studies, a Washington think-tank. This provision is critical because about half of working-age blacks don't get health insurance through jobs. Under the law, because of expansions of federal funding for Medicaid, an estimated 16 million low-income Americans, many of them black, would get coverage. (Under the new law, Medicaid would cover most families whose income is below $29,000 per year.)

Gutting the law would also affect another provision that disproportionately helps African-Americans. The Affordable Care Act, requires insurance companies to cover and offer reasonable prices to people who don't get insurance through their employers, even if they have chronic illnesses. The court is expected to make a decision by the end of June.

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