Although California came close to enacting near universal healthcare coverage, the state’s efforts at reform were ultimately voted down in the state’s Senate in early 2008. Three new papers published in a Health Affairs web exclusive examine how California’s health care reform attempt can inform the current federal debate on expanding coverage for the uninsured. Successful reform, say the authors, must come from a federal plan and financing, since individual states’ economies are too volatile and precarious to achieve sustainable universal coverage.
One of the biggest challenges for California was in setting affordable levels of coverage and out-of-pocket expenses for a diverse population. The authors propose that a federal plan could allow low-income workers or dependents to receive subsidized coverage and require employers to pay a defined fee, or offer sliding-scale credits for workers who opt for coverage from their employers. Other lessons from California that could be applied to a federal plan are the use of a publicly financed “backstop reinsurance” to curtail high costs associated with insuring an unknown population and a careful design of choice of plans to avoid adverse selection and extreme cost shifting.
Read the papers.
