Who Can Participate in the California Health Benefit Exchange?: A Profile of Subsidy-Eligible Uninsured and Individually Insured

Examines the size of the population that will be eligible for subsidies in the state health insurance exchange and their demographic and other characteristics, including health status and healthcare utilization. Considers implications

Californians Newly Eligible for Medi-Cal Under Health Care Reform

Examines the size of the population that will be newly eligible for Medi-Cal under the 2010 healthcare reform and their demographic and other characteristics, including health status and access to health care. Considers implications

Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study.

OBJECTIVE:To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). DESIGN:Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. SETTING:United States. PARTICIPANTS:A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. MAIN OUTCOMES AND MEASURES:Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. RESULTS:37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change -28.0% (95% confidence interval -38.4% to -15.8%); adjusted absolute change -122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (-29.0% (-40.5% to -15.3%); -442; adjusted P&lt;0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change -4.7 (-7.9 to -1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. CONCLUSION:Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act's implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults

Proposed Regulations Could Limit Access to Affordable Health Coverage for Workers' Children and Family Members

Outlines implications of how the health reform law's premium subsidies apply if employer-sponsored self-only coverage is affordable but family coverage is not. Suggests basing family members' eligibility and affordability on additional cost to employee

Public Funds Account for Over 70 Percent of Health Care Spending in California

This policy brief examines public versus private health care expenditures in California.  The authors find that personal health care expenditures are estimated to total more than $367 billion in 2016 and that approximately 71 percent of these expenditures will be paid for with public funds (i.e., taxpayer dollars). This estimated contribution of public funds to health care expenditures is much higher than estimates that include only major health insurance programs such as Medicare and Medicaid. Several additional public funding sources also contribute to health care expenditures in the state, including government spending for public employee health benefits, tax subsidies for employer-sponsored insurance and the Affordable Care Act (ACA) insurance exchange, and county health care expenditures. As health care reform continues to take effect, it will be important to monitor the public versus private contributions to state health care expenditures to ensure that funds are being distributed both efficiently and equitably

Health Coverage Expansion in California: What Can Consumers Afford to Spend?

Analyzes Californians' current spending on insurance premiums and out-of-pocket expenditures to assess whether proposals to make obtaining health insurance mandatory include sufficient measures to make it affordable for low- and middle-income families

The State of Health Insurance in California: Findings From the 2009 California Health Interview Survey

Analyzes sources of coverage and uninsurance rates by county, effects of declines in income and employer-sponsored insurance, disparities, access to and affordability of care, role of public insurance, and projected impact of federal healthcare reform

What Does It Take for a Family to Afford to Pay for Health Care?

Addresses how much Californians can afford to pay for health care based on their current insurance premiums and out-of-pocket expenses as well as other basic necessities, such as housing, child care, transportation, food, and taxes

Newly Insured Californians Would Fall by More than 1 Million Under the Affordable Care Act Without the Requirement to Purchase Insurance

Compares the estimated number and percentage of currently uninsured Californians who will be insured by 2019 under the Affordable Care Act with the individual mandate and without. Highlights the need for the mandate to ensure affordable coverage

Towards universal health coverage: lessons from 10 years of healthcare reform in China.

Universal health coverage (UHC) is driving the global health agenda. Many countries have embarked on national policy reforms towards this goal, including China. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. The year of 2019 marks the 10th anniversary of China's most recent healthcare reform. Sharing China's experience is especially timely for other countries pursuing reforms to achieve UHC. This study describes the social, economic and health context in China, and then reviews the overall progress of healthcare reform (1949 to present), with a focus on the most recent (2009) round of healthcare reform. The study comprehensively analyses key reform initiatives and major achievements according to four aspects: health insurance system, drug supply and security system, medical service system and public health service system. Lessons learnt from China may have important implications for other nations, including continued political support, increased health financing and a strong primary healthcare system as basis