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Further information: Health care in the United States

This article summarizes healthcare in California.

California State Department of Health Care Services

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Main article: California Department of Health Care Services

The California Department of Health manages state government projects in California.

Health insurance

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As of 2018, most insured Californians were in plans regulated by the California Department of Managed Health Care (DMHC) with about 60% regulated by either DMHC or the California Department of Insurance (CDI).[1] This dual regulation arose due for historical reasons, and when the DMHC was created in 2000,[2] the California legislature requested a report[2] on merging the health insurer responsibilities with the CDI.[3] Dual regulation has also raised questions around the applicability of premium tax to the DHMC-regulated entities, which have historically not paid premium taxes while CDI-regulated entities have.[4] Value-based pay for performance managed care plans where providers take on risk have arisen, and in 2019 the DHMC announced plans to regulate these "risk-bearing entities".[5]

Medi-Cal

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Medi-Cal is California's version of Medicaid. Medicaid was enacted in 1965 by the United States federal government to provide a public insurance program for low-income patients. The funding for Medi-Cal is provided by the federal government.[6]

Additionally, under the Affordable Care Act, low-income coverage could be expanded to nearly all low-income patients depending on how states chose to use the funding provided by the ACA. After the passage of the ACA, 32 states used the funding of the ACA to expand their state's low-income insurance programs, such as Medi-Cal, and 19 states opted out. The 19 states, as of 2014, had a 15% higher poverty rate than the 32 states that chose to expand their services. California was one of the states to expand its Medicaid program. [6]

As of 2018, about one-third of California was covered by Medi-Cal. It is administered by the California Department of Health Care Services, which operates it in accordance with California's Medicaid State Plan and Title XIX of the Social Security Act.[7]

California relies on Affordable Care Act (ACA) funding to support the Covered California program. In 2014, a collaborative effort between UCLA and UC Berkeley produced a model aimed at estimating the impact of the ACA on insurance coverage in the state. This model compares real-time data sets of insurance coverage in 2014 to a baseline scenario without ACA coverage. By doing so, the model can project future enrollment numbers in California health programs. According to this model, at some point in time, an estimated 1.1 to 1.3 million Californians will be enrolled in Covered California. Simultaneously, Medi-Cal enrollment is anticipated to reach an unprecedented high, ranging from 7.4 to 7.8 million individuals.[8]

Notably, the model refrains from providing specific projected years or dates. This cautious approach stems from its reliance on 2014 data, preventing precise predictions of the evolving landscape of health insurance programs in subsequent years. Nevertheless, the model serves as a tool for policymakers and researchers, facilitating an understanding of how diverse segments of the population are likely to be covered under various health insurance plans.[8]

Private markets

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As of 2015, about 14.1 million people were insured privately, including in self-funded plans; 1.3 million were in plans regulated by the CDI and 12.7 million were in plans regulated by the DHMC.[9] Kaiser Permanente had about 50% of the market, followed by Blue Shield of California, Anthem Blue Cross, and Health Net (a subsidiary of Centene).[9]

L.A. Care was among the top six in 2015, and the largest county-based insurer.[9] As of 2017, UnitedHealthcare was sixth-largest.[10]

Marketplace

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Covered California is the health insurance marketplace.

Kaiser Permanente and Blue Shield of California had about two-thirds of the market share as of 2018.[11] In 2017 Anthem stopped selling on the exchange.[12]

Healthcare by region

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Los Angeles

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See also: My Health LA

Los Angeles offers all available health care services. Notable health systems or hospitals in the region include Los Angeles County Department of Health Services, Kaiser Permanente, UCLA Health, Cedars-Sinai, Verity Health, Providence Health, UCI Medical Center, and Keck Hospital of USC.

San Francisco Bay Area

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See also: Healthy San Francisco

San Francisco offers all available health care services. Large health systems in Northern California include Sutter Health, Kaiser Permanente, UCSF Health, Dignity Health, and Stanford Medical.[13]

In 2018, a lawsuit was filed against Sutter Health for alleged antitrust.[14]

San Diego

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San Diego offers all available health care services. Notable health systems or hospitals in the region include Scripps Health, Kaiser Permanente, Naval Medical Center San Diego, UC San Diego Health, Tri-City Medical Center, Palomar Health, and Sharp HealthCare.

Infrastructure

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See also: List of hospitals in California

Proposed single-payer healthcare

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A single-payer health care system for California has been suggested multiple times. Two bills in the California State Legislature that would have implemented universal health coverage were vetoed by Governor Arnold Schwarzenegger in 2006 and 2008, respectively.[15][16][17] A 2021 proposal for single-payer healthcare, AB 1400, also known as CalCare, was presented in the State Assembly, and renewed discussion about unilateral state-wide universal healthcare.[18] On January 31, 2022 the bill was shelved and not voted on by the assembly.[19] SB770 passed, allowing Medicare and Medicaid funds to be used in a potential single-payer system.[20] A single-payer system is set to be proposed again in early 2024.[21]

Outbreaks, plagues, and epidemics

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See also

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References

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  1. ^ "Issue Brief: Estimates of Sources of Health Insurance in California for 2019" (PDF). California Health Benefits Review Program.
  2. ^ a b "Making Sense of Managed Care Regulation in California" (PDF). California HealthCare Foundation. 2001.
  3. ^ Kelso, J. Clark (2001). "Regulatory Jurisdiction Over Health Insurance Products: The Department of Managed Health Care & The Department of Insurance" (PDF). Archived (PDF) from the original on 2015-09-09. Retrieved 2019-10-12.
  4. ^ "New California Court of Appeal Decision May Impose Premium Taxes on California Health Plans". C&M Health Law. 2015-10-12. Retrieved 2019-11-29.
  5. ^ Oppenheim, Charles B.; Gross, Stephanie (16 May 2019). "Changes Ahead for California's Managed Care Regulatory Scheme". Archived from the original on 18 December 2019. Retrieved 29 November 2019.
  6. ^ a b Davenport, Lisa (2018). "Barriers to health care access for low income families: a review of literature". Journal of Community Health Nursing. 35 (1): 28–37. doi:10.1080/07370016.2018.1404832. PMID 29323941. S2CID 24374244.
  7. ^ "California's Medicaid State Plan (Title XIX)". California Department of Health Care Services.
  8. ^ a b Roby, Dylan; Jacobs, Ken; Watson, Greg; Bronshteyn, Alla; Graham-Squire, Dave; Keller, Michelle (July 2014). "Health care reform in the US: an analysis of implementation of the Affordable Care Act in California". BMC Health Services Research. 14 (S2): P103. doi:10.1186/1472-6963-14-S2-P103. ISSN 1472-6963. PMC 4122896.
  9. ^ a b c "The Private Insurance Market in California, 2015". California Health Care Foundation. Retrieved 2019-06-13.
  10. ^ "2019 Edition — California Health Insurers". California Health Care Foundation. Retrieved 2019-10-14.
  11. ^ "Evolving Market Share Of Health Plans In Covered California". IMK. 2018-10-09. Retrieved 2019-06-13.
  12. ^ Bartolone, Pauline; Gorman, Anna; Terhune, Chad. "Anthem's retreat leaves Californians with fewer choices, more worries". The Sacramento Bee.
  13. ^ "Hospital consolidation in California linked to higher health prices". SFChronicle. 5 September 2018.
  14. ^ "Suit against Sutter spawns fight with Bay Area hospitals over trade secrets". SFChronicle. 15 October 2018.
  15. ^ Korcok, Milan (October 10, 2006). "Schwarzenegger vetoes single-payer bill". Canadian Medical Association Journal. 175 (8): 860. doi:10.1503/cmaj.061200. PMC 1586096. PMID 17030932.
  16. ^ "Bill Status - SB-840 Single‑payer health care coverage". leginfo.legislature.ca.gov.
  17. ^ Rojas, Aurelio (September 30, 2008). "Gov. Schwarzenegger again vetoes single payer bill". Physicians for a National Health Program. Retrieved 2021-04-09.
  18. ^ "Letter: Health care for all California". Davis Enterprise. April 7, 2021. Retrieved 2021-04-09.
  19. ^ "Single-payer healthcare proposal fizzles in California Assembly". Los Angeles Times. February 1, 2022.
  20. ^ "New California law takes a step toward single-payer healthcare". Los Angeles Times. 2023-10-08. Retrieved 2023-10-24.
  21. ^ "California Will Again Weigh Single-Payer Health Care in 2024". Bloomberg.com. 2023-10-10. Retrieved 2023-10-24.
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