Amidst uncertainty about the future of the Affordable Care Act, the Los Angeles County Board of Supervisors moved Tuesday to position the county as a leader in the effort to figure out how California can maintain the gains of Obamacare in case the state loses federal health care dollars.
The supervisors unanimously approved a motion directing county staff to "develop options of how health insurance coverage could be maintained and/or extended" within the county and the state in case Congress repeals the health law.
While the supervisors did not discuss specific ideas, Dr. Mitchell Katz, director of the county's Department of Health Services, mentioned a couple of possibilities in an interview with KPCC and in testimony before the board. For example, he told KPCC that California could pass a law saying that if Congress eliminates the federal mandate that everyone have health insurance, the state will institute its own mandate.
The federal individual mandate has been the most controversial aspect of the Affordable Care Act. It requires most Americans to have insurance or pay a tax penalty, and is designed to compel healthy people to sign up for insurance, which helps keep insurers' costs and consumers' premiums down.
Republicans in Congress generally want to repeal the mandate, arguing that there are other ways to have a broad pool of insurance customers.
Katz told the supervisors on Tuesday that he believes it's worth taking another look at "the public option," a government-run health insurance agency that would compete with private insurers. The original Affordable Care Act legislation included a public option, but it was dropped from the final bill.
"I think a focus should be to eliminate the administrative costs as much as possible and that’s why I think looking at the public option ... is worthwhile," he said.
Katz also expressed support for the idea of expanding health insurance to everyone in the U.S. illegally. California law currently allows children 19 and under to get coverage, regardless of their immigration status.
On another front, Katz said "providing assisted living for elderly people instead of nursing homes would be a huge potential savings." He told the supervisors that about 30 percent of the people in more expensive nursing homes "would be happier and better served in assisted living were it available and paid for as a Medicaid service."
L.A. County is well-positioned to be a leader in the effort to protect expanded health insurance, Katz said, due to the size of its population and its role as a major provider of care. The county operates four hospitals: Harbor-UCLA Medical Center, LAC+USC Medical Center, Olive View-UCLA Medical Center and Rancho Los Amigos National Rehabilitation Center.
The county, he said, "is both the policy arm and we're a provider ourselves. We know what works and what doesn't work. If we can come up with something that would work in Los Angeles, it would work in the other counties as well."
Any plan to maintain and/or expand health insurance will need broad consensus, said Katz. If the county could help develop an approach that had the support of "patient advocates, physician groups, nursing groups and other professional associations, along with insurers, pharmaceutical companies and hospitals … there would be broad support in Sacramento for supporting it," he said.
During Tuesday's debate, Supervisor Janice Hahn agreed with Supervisor Sheila Kuehl that supporters of the Affordable Care Act shouldn't show all of their cards now, since that could give Congress another reason to repeal the law. "We don’t really want to prove that we do have an alternative way of delivering health care to our residents if the [health law] is repealed," said Hahn.
At the same time, it's important that the county is "very clear that repealing this law is a bad idea," she said.
Katz acknowledged concerns about developing a plan before knowing how Congress will change the Affordable Care Act. But he said uncertainty about the law is already destabilizing the insurance markets, so California should be armed with plans to fill in the gaps.
While she voted for the motion, Supervisor Kathryn Barger said, "I don’t think repeal is the appropriate way to go." She said she hoped "to look at where the system has failed and how we can offer dialogue with the federal government."
The supervisors' motion comes days after State Sens. Ricardo Lara (D-Bell Gardens) and Toni G. Atkins (D-San Diego) introduced a bill that would establish a comprehensive universal single-payer health system in California. The legislature passed similar measures, sponsored by Kuehl, in 2006 and 2008, but then-Gov. Arnold Schwarzenegger vetoed them.