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California’s Low Income Health Program: A Public-Private Partnership That Worked


February 14th, 2014

Amidst all of the criticism surrounding early implementation of the Affordable Care Act (ACA), there was, in fact, a bright spot. As soon as the ACA was signed into law, California developed a landmark initiative known as the Low Income Health Program (LIHP). The program would go on to provide more than 660,000 low-income residents […]

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An ACA Navigator Massive Open Online Course: Using The Emerging U.S. Health Care System


August 30th, 2013

Many observers claim that we do not have a true “healthcare system” in the United States. Instead we have fragmentation across multiple dimensions resulting in unsustainable cost increases, compromised quality, and growing inequity. Streams of public, private, and individual funding for health care – each with their own rules, requirements, and information needs – are further complicated by unsynchronized provider organizations in hundreds of cities and thousands of communities across the country. This byzantine approach has also created a cottage industry of specialists whose sole job is to navigate these requirements and make sure that patients know their health insurance options, can enroll in coverage, and get access to the services that they are entitled to.

The Affordable Care Act (ACA) addresses this complexity in a number of important ways. For example, the expansion of Medicaid to all individuals with incomes under 138 percent of the federal poverty level greatly simplifies the enrollment criteria for low-income individuals. The ACA also provides clarity on the calculation of income, penalties, types and sources of required documentation, and clearly outlines the reconciliation process for eligibility and subsidies.

While enrollment has not yet been reduced to a single mouse click or finger swipe, there is considerable uniformity across the country. Under the ACA, a family of four living in the Coachella Valley of California will follow a largely similar enrollment process to a family of four in Cambridge, Maryland. Though their choices on plans and providers will differ, the process of calculating their eligibility and enrolling in Medicaid or a health plan through an Exchange should be similar.

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The Patient Is In: Listening To Low-Income Californians


February 11th, 2013

The dramatic expansions in health insurance coverage included in the Patient Protection and Affordable Care Act (ACA) will give millions of low-income Americans greater choice in where and how they receive their health care. Until now, most of the discussion around our changing healthcare landscape has focused on the goals of payers and providers, rather than the needs and desires of patients. Although policymakers have emphasized the importance — and necessity — of engaging patients differently under reform, there have been few data to inform these discussions.

Against this backdrop, Blue Shield of California Foundation commissioned a series of representative, random-sample surveys of Californians aged 19 to 64 with household incomes less than 200 percent of the federal poverty level. The ultimate goal of these surveys is to bring the voices of low-income Californians into the conversation about how best to deliver care in the ACA-shaped future in order to inform policy choices and help providers prepare for a reformed healthcare system.

Resetting Expectations

The first report, On the Cusp of Change: The Healthcare Preferences of Low-Income Californians, based on a spring 2011 survey, revealed that fewer than half of low-income residents feel satisfied with their current health care and six in ten report being interested in switching to a new facility if they had the insurance to cover it. With full implementation of the ACA rapidly approaching in 2014, providers serving low-income Californians will have to change the way that they practice in order to retain their current patients, and attract those who are newly eligible for coverage.

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Reconsidering Primary Care: A View from a Foundation President


January 30th, 2013

The author is the president and CEO of the Blue Shield of California Foundation, a statewide funder located in San Francisco. Since the passage of the Affordable Care Act , there has been a persistent, urgent call to produce more primary care physicians. With many provisions of the health reform law to be implemented less […]

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