Some of the costliest care in the nation goes to the nine million people who are enrolled in both Medicaid and Medicare. Dubbed dual-eligibles, these low-income seniors and younger people with disabilities qualify for the insurance program for seniors (Medicare) and the insurance program for the poor (Medicaid, called Medi-Cal in California). Dual-eligibles often have complicated illnesses. But that’s not the only reason why their care is so expensive, with yearly spending for their care exceeding $300 billion.
Author: Callie Shanafelt
Elizabeth Luciano sits in her small office looking compassionately at the young mother complaining of stomach pain. She was undocumented and had no health insurance. They met at a community event a week before and the woman cautiously approached Luciano to see if she knew of anyone who could help with her Medi-Cal application. Luciano, a former hospital nutritionist in her home country of Columbia, told her it was safe to come to her office at the Pittsburg Health Center.
As Obamacare outreach efforts ramp up around the country, the question on everyone’s mind is ‘who will enroll?’ But those who are especially in the know wonder if ‘hard-to reach’ people will even understand that there are programs that they can enroll in.
The expansion of Medi-Cal (California’s Medicaid program), a signature part of Obama’s landmark health care reform plan, has gone largely unnoticed in a county that already had a health care plan for low-income people.
The Supreme Court decision that kept Obamacare intact made one major change to the legislation: the Medicaid expansion became optional. But California, one of the states leading on reforms, started the expansion of the state Medicaid program—known as Medi-Cal— three years ago. The early expansion in California and other states was intended to show the benefits and pitfalls of reforms before they were rolled out nationwide and to provide models for success.
Right now, young people are generally benefitting from protective changes ushered in by Obama care. But many advocates and experts wonder if the Affordable Care Act will actually make care more affordable for young people – or if the young will simply end up paying the price of lowering costs for everyone else.
State prison reforms are supposed to reduce dangerously overcrowded prison populations and help to alleviate the state’s fiscal crisis. But trial courts in San Mateo are feeling the squeeze of the fiscal crisis and the reforms on the county.
Advocates for Native American survivors of intimate violence cheered when they won the right to prosecute non-Indian assailants in tribal court. That change came with a provision in the Violence Against Women Act earlier this year. On at least one slice of California sovereign tribal land, the change also means defendants will have to engage with a very different criminal justice system – one that is based on restorative justice.
Native American women are physically abused, raped and stalked more than women of any other racial group in the nation. A new provision in the Violence Against Women Act, passed in February, allows Native American courts to prosecute non-Native offenders for the first time since the 1970s. While most expect the provision to help address violence against Native women, particularly in Western states, it also poses challenges for California’s tribal courts, which work with far fewer resources than county courts.
Provisions in the Affordable Care Act may not be enough to ensure that small businesses can provide health to their employees — and some provisions may actually discourage employers from providing insurance.