Promises Made. Promises Kept?

Every health care reform plans being considered in Sacramento is basically a promise. Several proposals, for example, call for expanding existing public health care coverage programs and creating premium subsidies to help low income Californians ineligible for public programs to better afford private coverage.

Making promises is easy. Keeping them is a lot harder. Sometimes because conditions change after the commitment is made, sometimes even the best and most sincere of efforts fail.  Sometimes it’s all about execution, or more precisely, a lack of execution.

Unfortunately, when it comes to delivering on health care coverage promises, the state’s track record is less than reassuring. Consider: according to UCLA’s authoritative California Health Interview Survey, over 630,000 Californians were eligible for, but failed to enroll, in state programs like MediCal and Healthy Families in 2005.  This represents approximately 13 percent of the 4.9 million uninsured identified in this CHIS study (other CHIS studies estimate there are 6.5 million uninsured Californians). For these these 630,000 people, the promise has not been kept.  

You’d think health care reform proposals by the Governor and legislative leaders would address this sad reality. Yet, as far as I’m aware, only CAHU’s Healthy Solutions  plan addresses this issue.

Healthy Solutions calls on the state to increase participation in Healthy Families and MediCal to at least 85 percent before expanding them. CAHU’s position is not “anti-expansion.” It’s pro-keeping promises, as evidenced by the suggestions it offers to increase participation by those currently eligible for the programs.

Healthy Solutions calls on the state to take a business-like approach to current outreach efforts. This means reviewing existing outreach efforts and requiring them to prove their effectiveness. And it calls on the state to consider new approaches to outreach, including:

  • Identifying and enrolling eligible participants when they access the health care system at community clinics, emergency rooms and the like;
  • Identifying and enrolling eligible participants when they enroll for school, whether K-12, community colleges or adult education programs;
  • Simplifying the enrollment process by modifying qualification requirements to tie into other programs aimed at helping low income families, such as Section 8 Housing and food stamps;
  • Commencing inter-agency discussions aimed at combining and simplifying enrollment processes for these programs; and
  • Increasing participation by the working poor by enabling employers and health plans to create a single point of entry to private and public health care coverage programs.

Health care reform is one of the most important promises the state will make to its people in the coming months. It’s similar to Bruce Springsteen’s line in The River: “Is a dream a lie if it don’t come true, or is it something worse?” Enacting legislation with hollow promises is worse than a lie. Promises matter. And so does delivering on them.