Pathways to Universal Coverage in California CHRIS HOENE, EXECUTIVE DIRECTOR PRINCETON CONFERENCE: NAVIGATING UNCERTAINTY IN THE U.S. HEALTH CARE SYSTEM PRINCETON, NEW JERSEY, MAY 24, 2018 calbudgetcenter.org
Key Issues • Progress made in California to date under the ACA • Challenges that still need to be addressed • The politics of single-payer health care in California • Challenges to achieving single-payer in California • Pathways to universal coverage | 2
The Share of Californians Without Health Care Coverage Continued to Decline Into 2017 California Fully Implemented Federal Health Care Reform in January 2014 18.6% 17.0% 7.2% 6.8% * January to June. Note: Estimates are based on survey respondents’ health care coverage status at the time of the interview. Source: National Center for Health Statistics, National Health Interview Survey | 3
Medi-Cal Enrollment Exceeds 13 Million, More Than Twice the 2006-07 Level Enrollment Gains Have Been Due to Full Implementation of Health Care Reform Note: Data for 2012-13 through 2017-18 are state estimates and 2018-19 is projected. Figures reflect average monthly enrollment. | 4 Source: Department of Health Care Services
Federal Funds Account for More Than One-Third of California’s State Budget Total Proposed 2018-19 Expenditures = $296.2 Billion F edera l F unds 35.7% S ta te G enera l F und 44.5% S ta te B ond F unds 0.8% S ta te S pec ia l F unds 19.0% | 5 Source: Department of Finance
More Than 7 in 10 Federal Dollars Spent Through the State Budget Support Health and Human Services Federal Funds Estimated to Be Spent Through the State Budget in 2018-19 = $105.9 Billion H ea lth a nd 74.0% Huma n S ervic es K -12 E duc a tion 7.1% L a bor a nd W orkforc e 6.3% D evelopment T ra ns porta tion 5.4% 4.9% Higher E duc a tion O ther* 2.3% $0 $10 $20 $30 $40 $50 $60 $70 $80 * Includes Environmental Protection; Legislative, Judicial, and Executive; Corrections and Rehabilitation; and other state budget categories that account for relatively small shares of federal funds. Source: Department of Finance | 6
Three principles for pursuing universal coverage in California • A comprehensive transition plan and realistic revenue plan should be created before state lawmakers or voters are asked to approve a proposal. • These transition and financing plans should assume a gradual phase-in of a new system, in light of the many uncertainties associated with transforming a sector that comprises one-seventh of the state’s economy. • Let the voters weigh in in order to ensure that the system holds up to constitutional requirements and legal scrutiny. | 7
1107 9th Street, Suite 310 Sacramento, California 95814 916.444.0500 choene@calbudgetcenter.org @CalBudgetCenter @CWHoene calbudgetcenter.org
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