Implementing National Health Reform in California: Opportunities for Improved Access to Care

Authors:  Melinda J. Dutton | Alice J. Lam

Marking the one-year anniversary of the enactment of the federal health reform legislation this month, Manatt Health Solutions and the California HealthCare Foundation have partnered to complete a second report in a series designed to highlight the wide-ranging health care implications for the state of California. The report "Implementing National Health Reform in California: Opportunities for Improved Access to Care," examines provisions of the Affordable Care Act (ACA) that invest in the health care delivery workforce and infrastructure and those that realign resources to enhance access to care.

The ACA provides the opportunity to increase health insurance coverage for Californians through the expansion of Medi-Cal and the establishment of health insurance exchanges. After the law is fully implemented in 2014, it is estimated that 92 percent of Californians will be insured. Broader coverage will increase demand for health care services, as the newly insured seek care, often with greater unmet needs requiring more intense interventions. With this in mind, the ACA includes provisions to enhance the capacity of the delivery system to meet this heightened demand, so that increased coverage translates into access to high quality, culturally competent care. This is crucial in California, where health care is unevenly distributed across the state’s vast geography, shortages exist among many providers and Medi-Cal participation among providers is already inadequate.

Significant investments are made under the ACA to ensure the availability of primary, community-based care, including enhanced Medi-Cal payments for primary care, demonstration funds for institutions for mental diseases (IMDs), and resources to double community clinic capacity nationally.  New initiatives also are established to support healthcare workforce planning and analysis, as well as training and education for a variety of health professionals.  At the same time, however, the ACA reduces funding for uncompensated care provided by certain safety-net providers.  Whether the level and timing of coverage gains will reduce hospital uncompensated care costs sufficiently to fully offset these reductions remains to be seen.

The report is structured to help state policymakers and stakeholders navigate the legislation and the challenges ahead, providing a summary of each of the key ACA access provisions along with the effective date; the entities responsible for implementation; the decisions, tasks and considerations facing California as implementation progresses; and “the bottom line.”  As a further resource, the report includes charts outlining California’s health coverage and service programs and opportunities to support health care workforce development under the ACA.  Please click here for the full report and accompanying charts available on the CHCF website.  

This report is the second in a series of reports on which Manatt Health Solutions and the California HealthCare Foundation have collaborated.  The initial report, published in June 2010, addresses health insurance coverage and the ACA provisions that aim to expand the availability of health insurance and to restructure the insurance market.  Click here to read the June 2010 report.

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