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"content": "\u003cp>After shelving a plan to provide full government health benefits to all undocumented, low-income adults in the state, California lawmakers are trying to extend coverage to seniors and the disabled in that population.\u003c/p>\n\u003cp>An estimated 1.8 million adult immigrants live in California without authorization, and roughly 1.2 million of them are poor enough to qualify for Medi-Cal, the state’s version of Medicaid. They can get care in emergency rooms, but a proposed new law would have provided them with full Medi-Cal benefits, including preventive care. \u003c/p>\n\u003cp>That idea, contained in bills by Democratic Sens. Ricardo \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB974\" rel=\"noopener\" target=\"_blank\">Lara\u003c/a> of Bell Gardens and Joaquin \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB2965\" rel=\"noopener\" target=\"_blank\">Arambula\u003c/a> of Fresno, took a major hit this week when the measures were placed in the dreaded “suspense file,” where bills sit in limbo and often die. Instead, Democratic lawmakers have included a vastly scaled-back version in the ongoing budget negotiations, which will conclude in mid-June.\u003c/p>\n\u003cp>The original plan was estimated to cost California $3 billion a year, and Gov. Jerry Brown has signaled extreme reluctance to spend such a large portion of the state’s nearly $9 billion surplus. And billions in taxpayer funds for undocumented residents may be an especially hard sell in this election year, when state Republicans are using illegal immigration as a wedge issue, hoping to drive GOP voters to the polls to support their candidates and causes.\u003c/p>\n\u003cp>Democratic lawmakers are now pushing for $250 million in the next budget to cover roughly 114,000 low-income seniors and disabled residents who are undocumented. \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In 2016, the state extended Medi-Cal benefits to undocumented children, and nearly 250,000 have enrolled since then, at a cost to the state of about $280 million. Adults’ health care is more expensive overall than children’s. \u003c/p>\n\u003cp>Opponents have said it’s a mistake for the state to pay for full-scope health care benefits to any portion of the undocumented population—whether it’s adults, children or seniors—not just because of the cost but also on principle, because many people without documentation are here illegally.\u003c/p>\n\u003cp>John Baackes is CEO of LA Care Health Plan, the largest publicly operated health plan in the nation. Baackes said the undocumented adult population is the largest segment of people in the state without health insurance, and getting them coverage is a huge cost-saver in the long run. \u003c/p>\n\u003cp>“Their care right now is episodic and inefficient—and expensive,” he said. California is already paying to care for them in emergency rooms and other urgent-care facilities, so the choice is whether or not to do that in a low-cost way, he said. \u003c/p>\n\u003cp>Including the low-income undocumented population in Medi-Cal potentially could save federal dollars, because it would ease the financial burden of free care received at federally qualified health centers. \u003c/p>\n\u003cp>Lara has argued that providing full care would save the state money, both in the expense of care and in increased worker productivity, because working adults wouldn’t wait till they’re really sick and rush to get expensive emergency room care. \u003c/p>\n\u003cp>He and others said the Trump administration’s crackdown on illegal immigration is deterring some residents from seeking needed care. Immigration and health care advocates have speculated that’s why enrollment of undocumented children in California’s public health services has been slower than expected. Many immigrants fear that using those services could lead immigration officials to deport them or family members. \u003c/p>\n\u003cp>“The fear-mongering is higher now,” Lara said. But he said California needs to blaze its own path, to look at its long-term future: “Fear in the immigrant community was there before Trump, and it will be there after Trump.”\u003c/p>\n\u003cp>In the end,Sacramento policy shifts almost always come down to cost, said Micah Weinberg, president of the Bay Area Council Economic Institute, a nonprofit think tank based in San Francisco.\u003c/p>\n\u003cp>Multiple studies have shown, he said, that immigrants are a benefit to communities where they live. The real problem, Weinberg said, is that health care costs too much, so adding undocumented adults becomes a pricier proposition than it should be. \u003c/p>\n\u003cp>“More health care for more people costs more money,” Weinberg said. “There’s no way around that.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org\" rel=\"noopener\" target=\"_blank\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In 2016, the state extended Medi-Cal benefits to undocumented children, and nearly 250,000 have enrolled since then, at a cost to the state of about $280 million. Adults’ health care is more expensive overall than children’s. \u003c/p>\n\u003cp>Opponents have said it’s a mistake for the state to pay for full-scope health care benefits to any portion of the undocumented population—whether it’s adults, children or seniors—not just because of the cost but also on principle, because many people without documentation are here illegally.\u003c/p>\n\u003cp>John Baackes is CEO of LA Care Health Plan, the largest publicly operated health plan in the nation. Baackes said the undocumented adult population is the largest segment of people in the state without health insurance, and getting them coverage is a huge cost-saver in the long run. \u003c/p>\n\u003cp>“Their care right now is episodic and inefficient—and expensive,” he said. California is already paying to care for them in emergency rooms and other urgent-care facilities, so the choice is whether or not to do that in a low-cost way, he said. \u003c/p>\n\u003cp>Including the low-income undocumented population in Medi-Cal potentially could save federal dollars, because it would ease the financial burden of free care received at federally qualified health centers. \u003c/p>\n\u003cp>Lara has argued that providing full care would save the state money, both in the expense of care and in increased worker productivity, because working adults wouldn’t wait till they’re really sick and rush to get expensive emergency room care. \u003c/p>\n\u003cp>He and others said the Trump administration’s crackdown on illegal immigration is deterring some residents from seeking needed care. Immigration and health care advocates have speculated that’s why enrollment of undocumented children in California’s public health services has been slower than expected. Many immigrants fear that using those services could lead immigration officials to deport them or family members. \u003c/p>\n\u003cp>“The fear-mongering is higher now,” Lara said. But he said California needs to blaze its own path, to look at its long-term future: “Fear in the immigrant community was there before Trump, and it will be there after Trump.”\u003c/p>\n\u003cp>In the end,Sacramento policy shifts almost always come down to cost, said Micah Weinberg, president of the Bay Area Council Economic Institute, a nonprofit think tank based in San Francisco.\u003c/p>\n\u003cp>Multiple studies have shown, he said, that immigrants are a benefit to communities where they live. The real problem, Weinberg said, is that health care costs too much, so adding undocumented adults becomes a pricier proposition than it should be. \u003c/p>\n\u003cp>“More health care for more people costs more money,” Weinberg said. “There’s no way around that.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org\" rel=\"noopener\" target=\"_blank\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why Millions of Californians Eligible for Food Stamps Don't Get Them",
"title": "Why Millions of Californians Eligible for Food Stamps Don't Get Them",
"headTitle": "The California Report | KQED News",
"content": "\u003cp>Millions of low-income Californians eligible for food stamps are not receiving the benefit, earning the state one of the lowest rankings in the nation for its participation in the program.\u003c/p>\n\u003cp>Just three states — Utah, North Dakota and Wyoming — have lower rates of participation, according to the latest available \u003ca href=\"https://www.fns.usda.gov/snap/reaching-those-need-estimates-state-supplemental-nutrition-assistance-program-participation-2\">federal data\u003c/a> released this year. Meanwhile, California is among the leaders on enrollment in Medi-Cal, the state's version of Medicaid, which also serves people living in low-income households.\u003c/p>\n\u003cp>The reasons for California's low food stamp participation rate remain a \"persistent puzzle,\" says Kim McCoy Wade, chief of the \u003ca href=\"http://www.cdss.ca.gov/inforesources/CalFresh\">CalFresh\u003c/a> branch of the state's Department of Social Services. But she and others suggest historically poor customer service and a bulky bureaucracy have something to do with it.\u003c/p>\n\u003cp data-pym-loader data-child-src=\"https://apps.npr.org/dailygraphics/graphics/snap-participation-20180427/child.html\" id=\"responsive-embed-snap-participation-20180427\">Loading...\u003c/p>\n\u003cp>\u003cscript type=\"text/javascript\" src=\"https://pym.nprapps.org/npr-pym-loader.v2.min.js\">\u003c/script>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>About 4.1 million Californians, or 70 percent of those eligible, are enrolled in the food assistance program known as CalFresh. That leaves about 2 million people out, according to 2015 \u003ca href=\"https://fns-prod.azureedge.net/sites/default/files/ops/Reaching2015.pdf\">federal data cited in a January report\u003c/a>. The national average is 83 percent enrolled.\u003c/p>\n\u003cp>Yet only about 322,000 people who qualify for Medi-Cal aren't signed up, according to a \u003ca href=\"http://laborcenter.berkeley.edu/pdf/2016/Preliminary-CalSIM-20-Regional-Remaining-Uninsured-2017.pdf\">2016 report\u003c/a> by University of California-Berkeley researchers. The researchers estimate that more than \u003ca href=\"http://laborcenter.berkeley.edu/taking-stock-californians-insurance-take-up-under-the-affordable-care-act/\">90 percent\u003c/a> of those eligible for Medi-Cal who don't have another source of insurance are enrolled. Medi-Cal now serves more than 13.5 million people, a number boosted significantly by Medicaid's recent expansion under the Affordable Care Act.\u003c/p>\n\u003cp>To address this gap between food assistance and medical assistance, California has begun leveraging its vast pool of new Medi-Cal beneficiaries to boost enrollment in CalFresh. Officials are building upon relationships between county welfare departments and new Medi-Cal enrollees, using electronic records on Medicaid recipients to identify food stamp candidates and then are guiding them through the enrollment process.\u003c/p>\n\u003cp>\"We are taking the successes from the Affordable Care Act and are turning to our next-biggest program and trying to apply those lessons,\" says McCoy Wade. \"The Medi-Cal/CalFresh connection is something where we think there is a lot of room to grow.\"\u003c/p>\n\u003cp>The push comes as both Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, are under threat from Washington, D.C. Just this month, Republicans in Congress unveiled a farm bill that would mandate \u003ca href=\"https://www.npr.org/sections/thesalt/2018/04/12/601900588/republican-farm-bill-calls-on-some-snap-recipients-to-work-or-go-to-school\">stricter work requirements\u003c/a> for SNAP beneficiaries. Several times over the past few years, President Donald Trump and congressional Republicans have proposed overhauling the Medicaid program to rein in costs.\u003c/p>\n\u003cp>One of California's challenges with the food stamp program is that it is administered at the county level — and there are 58 counties. Only 10 states run their programs that way. \u003c/p>\n\u003cp>\"Because we are decentralized ... it takes us longer to move the whole ship,\" McCoy Wade says.\u003c/p>\n\u003cp>However, Medicaid, too, is run by counties, and has been more successful in signing people up.\u003c/p>\n\u003cp>\"Doing things to help integrate the programs can be mutually beneficial, both for saving on administrative costs and being able to enroll more families,\" says \u003ca href=\"https://www.urban.org/author/michael-katz\">Michael Katz\u003c/a>, a research associate at the Urban Institute.\u003c/p>\n\u003cp>Still, SNAP and Medicaid have different eligibility rules. \u003c/p>\n\u003cp>\"It's not a perfect overlap, but it is a pretty close Venn diagram,\" says \u003ca href=\"https://cfpa.net/our-staff/\">Jared Call\u003c/a>, managing nutrition policy advocate at California Food Policy Advocates, which works to help low-income families access healthy food.\u003c/p>\n\u003cp>Several California counties have tried to be proactive in enrolling food stamp candidates from among Medi-Cal beneficiaries. San Francisco County placed a CalFresh eligibility worker at a public hospital and a community clinic. Los Angeles County mailed over 1 million flyers to Medi-Cal recipients who potentially qualified for food stamps.\u003c/p>\n\u003cp>San Bernardino County has self-service kiosks and staff members at the entrances of county offices who help people enroll in CalFresh if they are interested. \"It's a one-stop shop,\" said Nancy Hillsdale, who manages a county government office in Colton.\u003c/p>\n\u003cp>In San Diego County, officials printed CalFresh materials for health fairs and sent texts to everyone who applied for Medi-Cal with a link to apply for the food benefits, says Rick Wanne, director of eligibility operations for the county.\u003c/p>\n\u003cp>But there are other challenges. There's a perceived stigma around food stamps. Residents can be reluctant to apply. Some immigrants living in the country legally fear that signing up for food stamps may affect their chances of becoming citizens later. (Undocumented immigrants don't \u003ca href=\"https://www.fns.usda.gov/snap/snap-policy-non-citizen-eligibility\">qualify\u003c/a>, but family members who are citizens do.)\u003c/p>\n\u003cp>Wanne points out that enrolling people in CalFresh is a lot tougher than enrolling them in Medicaid. \"There is a laundry list of long-standing ... rules and regulations that make it difficult to get on the program,\" he says.\u003c/p>\n\u003cp>For example, applicants for CalFresh must be re-interviewed every year and update their information every six months. Medicaid, by contrast, does annual renewals without requiring interviews.\u003c/p>\n\u003cp>McCoy Wade says CalFresh eliminated some of the most burdensome requirements, including providing fingerprints, and it's starting to make a difference. The state increased its participation rate from 67 percent in 2014 to 70 percent in 2015, according to the January report. That occurred as the economy improved and fewer needed the help. \"We are closing the gap,\" she says.\u003c/p>\n\u003cp>Still, participation can be hampered by other challenges. Lack of transportation, long lines at county offices and lack of flexibility in setting appointment times may also contribute to low participation, county officials said.\u003c/p>\n\u003cp>And paperwork often gets mailed to residences, making it harder for homeless people or those who move frequently to stay enrolled. That's what happened to 25-year-old Crystle Conant, who lives only part time at her father's house in San Bernardino County.\u003c/p>\n\u003cp>\"When I swipe my card at the store and it gets declined, then I know,\" she said. \"I haven't renewed in time.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.\u003c/em> \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Millions+Of+Californians+Eligible+For+Food+Stamps+Don%27t+Get+Them&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "The state ranks near the bottom in enrolling people for food assistance. To change that, it's taking lessons from its robust Medi-Cal health insurance program, which targets much the same population.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Millions of low-income Californians eligible for food stamps are not receiving the benefit, earning the state one of the lowest rankings in the nation for its participation in the program.\u003c/p>\n\u003cp>Just three states — Utah, North Dakota and Wyoming — have lower rates of participation, according to the latest available \u003ca href=\"https://www.fns.usda.gov/snap/reaching-those-need-estimates-state-supplemental-nutrition-assistance-program-participation-2\">federal data\u003c/a> released this year. Meanwhile, California is among the leaders on enrollment in Medi-Cal, the state's version of Medicaid, which also serves people living in low-income households.\u003c/p>\n\u003cp>The reasons for California's low food stamp participation rate remain a \"persistent puzzle,\" says Kim McCoy Wade, chief of the \u003ca href=\"http://www.cdss.ca.gov/inforesources/CalFresh\">CalFresh\u003c/a> branch of the state's Department of Social Services. But she and others suggest historically poor customer service and a bulky bureaucracy have something to do with it.\u003c/p>\n\u003cp data-pym-loader data-child-src=\"https://apps.npr.org/dailygraphics/graphics/snap-participation-20180427/child.html\" id=\"responsive-embed-snap-participation-20180427\">Loading...\u003c/p>\n\u003cp>\u003cscript type=\"text/javascript\" src=\"https://pym.nprapps.org/npr-pym-loader.v2.min.js\">\u003c/script>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>About 4.1 million Californians, or 70 percent of those eligible, are enrolled in the food assistance program known as CalFresh. That leaves about 2 million people out, according to 2015 \u003ca href=\"https://fns-prod.azureedge.net/sites/default/files/ops/Reaching2015.pdf\">federal data cited in a January report\u003c/a>. The national average is 83 percent enrolled.\u003c/p>\n\u003cp>Yet only about 322,000 people who qualify for Medi-Cal aren't signed up, according to a \u003ca href=\"http://laborcenter.berkeley.edu/pdf/2016/Preliminary-CalSIM-20-Regional-Remaining-Uninsured-2017.pdf\">2016 report\u003c/a> by University of California-Berkeley researchers. The researchers estimate that more than \u003ca href=\"http://laborcenter.berkeley.edu/taking-stock-californians-insurance-take-up-under-the-affordable-care-act/\">90 percent\u003c/a> of those eligible for Medi-Cal who don't have another source of insurance are enrolled. Medi-Cal now serves more than 13.5 million people, a number boosted significantly by Medicaid's recent expansion under the Affordable Care Act.\u003c/p>\n\u003cp>To address this gap between food assistance and medical assistance, California has begun leveraging its vast pool of new Medi-Cal beneficiaries to boost enrollment in CalFresh. Officials are building upon relationships between county welfare departments and new Medi-Cal enrollees, using electronic records on Medicaid recipients to identify food stamp candidates and then are guiding them through the enrollment process.\u003c/p>\n\u003cp>\"We are taking the successes from the Affordable Care Act and are turning to our next-biggest program and trying to apply those lessons,\" says McCoy Wade. \"The Medi-Cal/CalFresh connection is something where we think there is a lot of room to grow.\"\u003c/p>\n\u003cp>The push comes as both Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, are under threat from Washington, D.C. Just this month, Republicans in Congress unveiled a farm bill that would mandate \u003ca href=\"https://www.npr.org/sections/thesalt/2018/04/12/601900588/republican-farm-bill-calls-on-some-snap-recipients-to-work-or-go-to-school\">stricter work requirements\u003c/a> for SNAP beneficiaries. Several times over the past few years, President Donald Trump and congressional Republicans have proposed overhauling the Medicaid program to rein in costs.\u003c/p>\n\u003cp>One of California's challenges with the food stamp program is that it is administered at the county level — and there are 58 counties. Only 10 states run their programs that way. \u003c/p>\n\u003cp>\"Because we are decentralized ... it takes us longer to move the whole ship,\" McCoy Wade says.\u003c/p>\n\u003cp>However, Medicaid, too, is run by counties, and has been more successful in signing people up.\u003c/p>\n\u003cp>\"Doing things to help integrate the programs can be mutually beneficial, both for saving on administrative costs and being able to enroll more families,\" says \u003ca href=\"https://www.urban.org/author/michael-katz\">Michael Katz\u003c/a>, a research associate at the Urban Institute.\u003c/p>\n\u003cp>Still, SNAP and Medicaid have different eligibility rules. \u003c/p>\n\u003cp>\"It's not a perfect overlap, but it is a pretty close Venn diagram,\" says \u003ca href=\"https://cfpa.net/our-staff/\">Jared Call\u003c/a>, managing nutrition policy advocate at California Food Policy Advocates, which works to help low-income families access healthy food.\u003c/p>\n\u003cp>Several California counties have tried to be proactive in enrolling food stamp candidates from among Medi-Cal beneficiaries. San Francisco County placed a CalFresh eligibility worker at a public hospital and a community clinic. Los Angeles County mailed over 1 million flyers to Medi-Cal recipients who potentially qualified for food stamps.\u003c/p>\n\u003cp>San Bernardino County has self-service kiosks and staff members at the entrances of county offices who help people enroll in CalFresh if they are interested. \"It's a one-stop shop,\" said Nancy Hillsdale, who manages a county government office in Colton.\u003c/p>\n\u003cp>In San Diego County, officials printed CalFresh materials for health fairs and sent texts to everyone who applied for Medi-Cal with a link to apply for the food benefits, says Rick Wanne, director of eligibility operations for the county.\u003c/p>\n\u003cp>But there are other challenges. There's a perceived stigma around food stamps. Residents can be reluctant to apply. Some immigrants living in the country legally fear that signing up for food stamps may affect their chances of becoming citizens later. (Undocumented immigrants don't \u003ca href=\"https://www.fns.usda.gov/snap/snap-policy-non-citizen-eligibility\">qualify\u003c/a>, but family members who are citizens do.)\u003c/p>\n\u003cp>Wanne points out that enrolling people in CalFresh is a lot tougher than enrolling them in Medicaid. \"There is a laundry list of long-standing ... rules and regulations that make it difficult to get on the program,\" he says.\u003c/p>\n\u003cp>For example, applicants for CalFresh must be re-interviewed every year and update their information every six months. Medicaid, by contrast, does annual renewals without requiring interviews.\u003c/p>\n\u003cp>McCoy Wade says CalFresh eliminated some of the most burdensome requirements, including providing fingerprints, and it's starting to make a difference. The state increased its participation rate from 67 percent in 2014 to 70 percent in 2015, according to the January report. That occurred as the economy improved and fewer needed the help. \"We are closing the gap,\" she says.\u003c/p>\n\u003cp>Still, participation can be hampered by other challenges. Lack of transportation, long lines at county offices and lack of flexibility in setting appointment times may also contribute to low participation, county officials said.\u003c/p>\n\u003cp>And paperwork often gets mailed to residences, making it harder for homeless people or those who move frequently to stay enrolled. That's what happened to 25-year-old Crystle Conant, who lives only part time at her father's house in San Bernardino County.\u003c/p>\n\u003cp>\"When I swipe my card at the store and it gets declined, then I know,\" she said. \"I haven't renewed in time.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.\u003c/em> \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Millions+Of+Californians+Eligible+For+Food+Stamps+Don%27t+Get+Them&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Is Sitting on a Surplus -- But Don't Expect a Refund",
"title": "California Is Sitting on a Surplus -- But Don't Expect a Refund",
"headTitle": "The California Report | KQED News",
"content": "\u003cp>It should be said that California’s resistance began before there was a resistance.\u003c/p>\n\u003cp>When Gov. Jerry Brown \u003ca href=\"https://ww2.kqed.org/news/2018/01/10/gov-browns-190-billion-state-budget/\" rel=\"noopener\" target=\"_blank\">unveiled his last budget Wednesday\u003c/a>, it will bookended eight years of a progressive march to reduce greenhouse gases, expand health care, grant more rights to undocumented immigrants and raise the minimum wage to $15 an hour. Along the way, blue state voters have assented by passing temporary taxes on the rich—not once, but \u003ca href=\"http://www.latimes.com/nation/politics/trailguide/la-na-election-day-2016-proposition-55-income-tax-1478277671-htmlstory.html\">twice\u003c/a>. The top marginal income tax rate is now 13.3 percent, the \u003ca href=\"http://www.politifact.com/california/statements/2017/jul/11/travis-allen/mostly-true-californias-taxes-among-highest-nation/\">highest\u003c/a> state income tax rate in the country.\u003c/p>\n\u003cp>In short, policies that are now labeled acts of resistance to President Donald Trump were alive and ascendant in California long before he won the White House. But the contrasts have become much more stark.\u003c/p>\n\u003cp>Instead of cutting taxes, the Democratic governor and his party’s legislative leaders have passed a gas tax to help pay for aging infrastructure. Instead of trying to shift government out of the healthcare marketplace, California is looking for a way to fund single-payer health care, including coverage for undocumented immigrants. Instead of criminalizing pot, the state is looking forward to collecting taxes on \u003ca href=\"https://calmatters.org/articles/pot-legal-california-will-get-thought-voted/\">marijuana\u003c/a> sales.\u003c/p>\n\u003cp>[contextly_sidebar id=\"N5345J6Czkq4yxEQjYyk1yZAxppZyYHc\"]\u003c/p>\n\u003cp>In the months between now and the June deadline for a final budget, the governor and the Legislature will hammer out details. The focus this year: what to do with an expected surplus of $6.1 billion. Republicans say return it to California’s 40 million residents as a nice tax refund. The governor's priority is to fill up the state’s rainy day fund. Democratic legislators mostly want to spend it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We have a very different approach,” said Assemblyman Phil Ting, D-San Francisco, who chairs the Assembly Budget Committee. “Our focus, the people who we think need tax relief, are the working Californians who are making less than $25,000. That’s where we want to spend our money, making sure they have money to pay rent, to pay for food.”\u003c/p>\n\u003cp>Rather than giving out “huge corporate tax breaks and a huge tax break for the wealthiest in this country,” Ting has a long list of how he would like to spend that extra money, including:\u003c/p>\n\u003cul>\n\u003cli>Increase the state’s Earned Income Tax Credit, which puts money into the hands of the working poor\u003c/li>\n\u003cli>Expand Medi-Cal health care for poorer Californians to cover all remaining uninsured residents, mostly undocumented immigrants\u003c/li>\n\u003cli>Expand early education for 4-year-olds through preschool and transitional kindergarten programs\u003c/li>\n\u003cli>Increase college aid\u003c/li>\n\u003cli>Expand mental and social services to reduce the number of criminals who go on to re-offend\u003c/li>\n\u003c/ul>\n\u003cp>As supportive as Brown might be of these Democratic aspirations, his administration is urging legislative leaders to proceed with caution. \u003c/p>\n\u003cp>The state’s tax structure is more vulnerable than ever to the stock market gains and losses of its wealthiest citizens, and the governor said California must prepare for the next economic downturn because a mild recession could wipe away at least $20 billion a year in revenues.\u003c/p>\n\u003cp>\u003cimg src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/01/BudgetBreakdown-800x2629.jpg\" alt=\"\" width=\"800\" height=\"2629\" class=\"aligncenter size-medium wp-image-11641531\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-800x2629.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-160x526.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-1020x3352.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-1180x3877.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-960x3155.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-240x789.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-375x1232.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-520x1709.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Gov. Brown also warns of uncertainty from Washington.\u003c/p>\n\u003cp>“There are certain policies that are radical departures from the norm, and California will fight those, whether it’s immigration or offshore drilling,” Brown said. “We don’t know what will happen. I wouldn’t want to portray a California-Washington battle, although there are some key differences and we’ll espouse our values.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"QCFefAktUaMCZgjPoS28R9iZWtXzSfDL\"]\u003c/p>\n\u003cp>Since Brown was elected to a second stint as governor in November 2010, the state has climbed out of the recession and enjoyed economic prosperity. \u003c/p>\n\u003cp>The unemployment rate, which topped 12 percent, now stands at \u003ca href=\"http://www.edd.ca.gov/About_EDD/pdf/urate201712.pdf\">4.6 percent\u003c/a>. Since his return, California has added \u003ca href=\"http://www.labormarketinfo.edd.ca.gov/data/Top-Statistics.html\">2.4 million\u003c/a> jobs and hourly wages are up \u003ca href=\"http://www.labormarketinfo.edd.ca.gov/data/Top-Statistics.html\">$4.76 an hour\u003c/a>. The state, which carried a $25 billion deficit in his first year back, has enjoyed billion-dollar surpluses in recent years and the state now has a rainy day fund.\u003c/p>\n\u003cp>The governor’s proposed \u003ca href=\"http://www.ebudget.ca.gov/budget/2018-19/#/Home\">$190 billion\u003c/a> budget is dominated by education (29 percent) and health care (32 percent) \u003ca href=\"https://calmatters.org/articles/california-state-budget-best-visualization-tool/\">spending\u003c/a>. Health care spending has been growing particularly fast since the state embraced the Affordable Care Act, best known as Obamacare.\u003c/p>\n\u003cp>The act not only grew the marketplace for private health plans but allowed states to expand their Medicaid health insurance programs for the poor. Because California is among 30 states that expanded Medicaid, the federal government is paying at least 90 percent of the cost for newly eligible enrollees.\u003c/p>\n\u003cp>That has allowed California to draw billions in extra funding from the federal government to bolster Medi-Cal, the state’s version of the national Medicaid program. As a result, the number of people without health coverage in the state has dropped to a historic low: from \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CaliforniaUninsuredDec2016.pdf\">17.6 percent in the 1980s\u003c/a> to \u003ca href=\"https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201611.pdf\">7.6 percent in 2016\u003c/a>. Today, \u003ca href=\"http://www.chcf.org/publications/2013/05/medical-facts-figures\">one in three\u003c/a> Californians are covered by Medi-Cal.\u003c/p>\n\u003cp>Public schools too have greatly benefited since the recession, with much of the extra spending on schools going to improve teachers’ \u003ca href=\"https://www.ed-data.org/\">salaries\u003c/a>.\u003c/p>\n\u003cp>However, if the federal government doesn’t \u003ca href=\"https://calmatters.org/articles/tens-thousands-california-kids-lose-health-care/\">reauthorize\u003c/a> the Children’s Health Insurance Program for 1.3 million children, that could add more than $850 million in costs to the state over two years.\u003c/p>\n\u003cp>[contextly_sidebar id=\"6V0gO63cMEeSjKQhw0mxdejihSZ86928\"]\u003c/p>\n\u003cp>Worse, if Republicans in Washington slash Medicaid funding in 2018, the state could lose between $25 billion and $50 billion, said Chris Hoene, executive director of the California Budget & Policy Center, a progressive think tank in Sacramento.\u003c/p>\n\u003cp>“The reality is California could not afford the scale of the cuts the GOP has been proposing,” Hoene said. “That’s going to put state leaders in a position of deciding who gets state services and how do they fund that.”\u003c/p>\n\u003cp>Other factors are straining the budget.\u003c/p>\n\u003cp>For example, pension costs for public workers continue to be one of the fastest-growing liabilities—driven by lower investment rate assumptions, higher health care costs and longer life spans.\u003c/p>\n\u003cp>Voters, too, could turn on Brown and lawmakers. Early \u003ca href=\"https://www.igs.berkeley.edu/sites/default/files/2017-21_gas_tax_repeal.pdf\">polling\u003c/a> suggests Republicans have a decent shot at repealing a gas tax hike that went into effect late last year. Brown said at a press conference Wednesday that he believes a repeal initiative could be defeated.\u003c/p>\n\u003cp>The Legislature’s nonpartisan budget analyst is urging lawmakers not to commit to too many new spending programs.\u003c/p>\n\u003cp>“As it crafts the 2018-19 budget and future budgets, we encourage the Legislature to consider all of the uncertainty faced by the budget in future years and continue its recent practice of building its reserve levels,” the analyst \u003ca href=\"http://lao.ca.gov/reports/2017/3718/fiscal-outlook-111517.pdf\">wrote\u003c/a>.\u003c/p>\n\u003cp>On the flipside, Republicans are calling for a tax refund, if not an outright repeal of state income taxes. They argue that California’s high taxes chase residents out of state.\u003c/p>\n\u003cp>“This surplus is a direct result of Capitol Democrats overtaxing hard-working Californians,” \u003ca href=\"https://twitter.com/AsmHarper/status/948969552100057088\">said\u003c/a> Assemblyman Matthew Harper, R-Huntington Beach. “Rather than expanding an ever-growing list of government programs, our leaders should figure out a way to return that money to the people who earned it in the first place.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/f2acd022-56d6-48db-bc60-e21c12a1d261?src=embed\" title=\"California Tax Increases\" width=\"800\" height=\"700\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Assemblyman Vince Fong, R-Bakersfield, said he plans to introduce tax cuts aimed at helping families and small businesses stay in California.\u003c/p>\n\u003cp>“As we see all too often now, we are losing families and small businesses to neighboring states that have tax burdens much lower than California’s high-priced tax code,” Fong \u003ca href=\"https://twitter.com/vfong/status/948994635845611525\">said\u003c/a> on Twitter. “We have an opportunity to change that.”\u003c/p>\n\u003cp>Brown dismissed the refund idea, saying it would only prompt service cuts to public schools and universities later. “If you want to budget responsibly, you need big surpluses in years that are good,” he said.\u003c/p>\n\u003cp>Still, there’s a growing sentiment that California may have to respond to recent changes in the federal tax plan, specifically to a $10,000 cap on state and local deductions that will hit millions of households.\u003c/p>\n\u003cp>[contextly_sidebar id=\"aePxEpQv8dWe5MbzcOOVpb8RJVDTcrwL\"]\u003c/p>\n\u003cp>According to the state \u003ca href=\"https://calmatters.org/wp-content/uploads/Letter-to-conferees-121117.pdf?x74105\">Finance Department\u003c/a>, the average deduction for state and local income taxes alone is nearly $16,000 per return, while state and local property taxes average less than $6,000 per return. Because a portion of those taxes will no longer be deductible, it acts as double taxation for California taxpayers.\u003c/p>\n\u003cp>Senate President Pro Tem Kevin de León, who is running for U.S. Senate, introduced legislation Thursday to shield Californians from bearing the costs of the tax overhaul. The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB227\">bill\u003c/a>, dubbed Protect California Taxpayers Act, would allow taxpayers to make charitable deductions to the state and receive a dollar-for-dollar tax credit on the full amount of their contribution. By having residents donate to the state government as a charitable contribution, the contribution remains deductible on federal taxes.\u003c/p>\n\u003cp>“The Republican tax plan gives corporations and hedge-fund managers a trillion-dollar tax cut and expects California taxpayers to foot the bill,” de León said in announcing his legislation. “We won’t allow California residents to be the casualty of this disastrous tax scheme.”\u003c/p>\n\u003cp>Brown was particularly vocal against the GOP tax proposal, calling it a “\u003ca href=\"https://calmatters.org/articles/trump_california/jerry-brown-urges-no-vote-tax-monstrosity/\">tax monstrosity\u003c/a>,” but the governor expressed reservations about whether the state could sidestep federal law.\u003c/p>\n\u003cp>“It looks interesting,” Brown said. “But two questions: Can it work? If it does work, can the Internal Revenue Service issue a regulation and completely subvert it?”\u003c/p>\n\u003cp>De León responded that he was confident it would work because similar charitable deductions have already been given out for education-based contributions.\u003c/p>\n\u003cp>For now, state Democrats are in agreement about a common threat.\u003c/p>\n\u003cp>Whether it’s federal tax changes or entitlement cuts, the leader of the Assembly, Anthony Rendon, D-Paramount, said he’s most concerned Republicans in Congress and the Trump administration will take another swipe at liberal California in 2018. “We’re worried about the next shoe to drop.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CALmatters is a nonpartisan, nonprofit media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\n",
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"excerpt": "The state’s tax structure is more vulnerable than ever to the stock market gains and losses of its wealthiest citizens, and Gov. Brown said California must prepare for the next economic downturn.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It should be said that California’s resistance began before there was a resistance.\u003c/p>\n\u003cp>When Gov. Jerry Brown \u003ca href=\"https://ww2.kqed.org/news/2018/01/10/gov-browns-190-billion-state-budget/\" rel=\"noopener\" target=\"_blank\">unveiled his last budget Wednesday\u003c/a>, it will bookended eight years of a progressive march to reduce greenhouse gases, expand health care, grant more rights to undocumented immigrants and raise the minimum wage to $15 an hour. Along the way, blue state voters have assented by passing temporary taxes on the rich—not once, but \u003ca href=\"http://www.latimes.com/nation/politics/trailguide/la-na-election-day-2016-proposition-55-income-tax-1478277671-htmlstory.html\">twice\u003c/a>. The top marginal income tax rate is now 13.3 percent, the \u003ca href=\"http://www.politifact.com/california/statements/2017/jul/11/travis-allen/mostly-true-californias-taxes-among-highest-nation/\">highest\u003c/a> state income tax rate in the country.\u003c/p>\n\u003cp>In short, policies that are now labeled acts of resistance to President Donald Trump were alive and ascendant in California long before he won the White House. But the contrasts have become much more stark.\u003c/p>\n\u003cp>Instead of cutting taxes, the Democratic governor and his party’s legislative leaders have passed a gas tax to help pay for aging infrastructure. Instead of trying to shift government out of the healthcare marketplace, California is looking for a way to fund single-payer health care, including coverage for undocumented immigrants. Instead of criminalizing pot, the state is looking forward to collecting taxes on \u003ca href=\"https://calmatters.org/articles/pot-legal-california-will-get-thought-voted/\">marijuana\u003c/a> sales.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In the months between now and the June deadline for a final budget, the governor and the Legislature will hammer out details. The focus this year: what to do with an expected surplus of $6.1 billion. Republicans say return it to California’s 40 million residents as a nice tax refund. The governor's priority is to fill up the state’s rainy day fund. Democratic legislators mostly want to spend it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We have a very different approach,” said Assemblyman Phil Ting, D-San Francisco, who chairs the Assembly Budget Committee. “Our focus, the people who we think need tax relief, are the working Californians who are making less than $25,000. That’s where we want to spend our money, making sure they have money to pay rent, to pay for food.”\u003c/p>\n\u003cp>Rather than giving out “huge corporate tax breaks and a huge tax break for the wealthiest in this country,” Ting has a long list of how he would like to spend that extra money, including:\u003c/p>\n\u003cul>\n\u003cli>Increase the state’s Earned Income Tax Credit, which puts money into the hands of the working poor\u003c/li>\n\u003cli>Expand Medi-Cal health care for poorer Californians to cover all remaining uninsured residents, mostly undocumented immigrants\u003c/li>\n\u003cli>Expand early education for 4-year-olds through preschool and transitional kindergarten programs\u003c/li>\n\u003cli>Increase college aid\u003c/li>\n\u003cli>Expand mental and social services to reduce the number of criminals who go on to re-offend\u003c/li>\n\u003c/ul>\n\u003cp>As supportive as Brown might be of these Democratic aspirations, his administration is urging legislative leaders to proceed with caution. \u003c/p>\n\u003cp>The state’s tax structure is more vulnerable than ever to the stock market gains and losses of its wealthiest citizens, and the governor said California must prepare for the next economic downturn because a mild recession could wipe away at least $20 billion a year in revenues.\u003c/p>\n\u003cp>\u003cimg src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/01/BudgetBreakdown-800x2629.jpg\" alt=\"\" width=\"800\" height=\"2629\" class=\"aligncenter size-medium wp-image-11641531\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-800x2629.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-160x526.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-1020x3352.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-1180x3877.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-960x3155.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-240x789.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-375x1232.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2018/01/BudgetBreakdown-520x1709.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Gov. Brown also warns of uncertainty from Washington.\u003c/p>\n\u003cp>“There are certain policies that are radical departures from the norm, and California will fight those, whether it’s immigration or offshore drilling,” Brown said. “We don’t know what will happen. I wouldn’t want to portray a California-Washington battle, although there are some key differences and we’ll espouse our values.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Since Brown was elected to a second stint as governor in November 2010, the state has climbed out of the recession and enjoyed economic prosperity. \u003c/p>\n\u003cp>The unemployment rate, which topped 12 percent, now stands at \u003ca href=\"http://www.edd.ca.gov/About_EDD/pdf/urate201712.pdf\">4.6 percent\u003c/a>. Since his return, California has added \u003ca href=\"http://www.labormarketinfo.edd.ca.gov/data/Top-Statistics.html\">2.4 million\u003c/a> jobs and hourly wages are up \u003ca href=\"http://www.labormarketinfo.edd.ca.gov/data/Top-Statistics.html\">$4.76 an hour\u003c/a>. The state, which carried a $25 billion deficit in his first year back, has enjoyed billion-dollar surpluses in recent years and the state now has a rainy day fund.\u003c/p>\n\u003cp>The governor’s proposed \u003ca href=\"http://www.ebudget.ca.gov/budget/2018-19/#/Home\">$190 billion\u003c/a> budget is dominated by education (29 percent) and health care (32 percent) \u003ca href=\"https://calmatters.org/articles/california-state-budget-best-visualization-tool/\">spending\u003c/a>. Health care spending has been growing particularly fast since the state embraced the Affordable Care Act, best known as Obamacare.\u003c/p>\n\u003cp>The act not only grew the marketplace for private health plans but allowed states to expand their Medicaid health insurance programs for the poor. Because California is among 30 states that expanded Medicaid, the federal government is paying at least 90 percent of the cost for newly eligible enrollees.\u003c/p>\n\u003cp>That has allowed California to draw billions in extra funding from the federal government to bolster Medi-Cal, the state’s version of the national Medicaid program. As a result, the number of people without health coverage in the state has dropped to a historic low: from \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CaliforniaUninsuredDec2016.pdf\">17.6 percent in the 1980s\u003c/a> to \u003ca href=\"https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201611.pdf\">7.6 percent in 2016\u003c/a>. Today, \u003ca href=\"http://www.chcf.org/publications/2013/05/medical-facts-figures\">one in three\u003c/a> Californians are covered by Medi-Cal.\u003c/p>\n\u003cp>Public schools too have greatly benefited since the recession, with much of the extra spending on schools going to improve teachers’ \u003ca href=\"https://www.ed-data.org/\">salaries\u003c/a>.\u003c/p>\n\u003cp>However, if the federal government doesn’t \u003ca href=\"https://calmatters.org/articles/tens-thousands-california-kids-lose-health-care/\">reauthorize\u003c/a> the Children’s Health Insurance Program for 1.3 million children, that could add more than $850 million in costs to the state over two years.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Worse, if Republicans in Washington slash Medicaid funding in 2018, the state could lose between $25 billion and $50 billion, said Chris Hoene, executive director of the California Budget & Policy Center, a progressive think tank in Sacramento.\u003c/p>\n\u003cp>“The reality is California could not afford the scale of the cuts the GOP has been proposing,” Hoene said. “That’s going to put state leaders in a position of deciding who gets state services and how do they fund that.”\u003c/p>\n\u003cp>Other factors are straining the budget.\u003c/p>\n\u003cp>For example, pension costs for public workers continue to be one of the fastest-growing liabilities—driven by lower investment rate assumptions, higher health care costs and longer life spans.\u003c/p>\n\u003cp>Voters, too, could turn on Brown and lawmakers. Early \u003ca href=\"https://www.igs.berkeley.edu/sites/default/files/2017-21_gas_tax_repeal.pdf\">polling\u003c/a> suggests Republicans have a decent shot at repealing a gas tax hike that went into effect late last year. Brown said at a press conference Wednesday that he believes a repeal initiative could be defeated.\u003c/p>\n\u003cp>The Legislature’s nonpartisan budget analyst is urging lawmakers not to commit to too many new spending programs.\u003c/p>\n\u003cp>“As it crafts the 2018-19 budget and future budgets, we encourage the Legislature to consider all of the uncertainty faced by the budget in future years and continue its recent practice of building its reserve levels,” the analyst \u003ca href=\"http://lao.ca.gov/reports/2017/3718/fiscal-outlook-111517.pdf\">wrote\u003c/a>.\u003c/p>\n\u003cp>On the flipside, Republicans are calling for a tax refund, if not an outright repeal of state income taxes. They argue that California’s high taxes chase residents out of state.\u003c/p>\n\u003cp>“This surplus is a direct result of Capitol Democrats overtaxing hard-working Californians,” \u003ca href=\"https://twitter.com/AsmHarper/status/948969552100057088\">said\u003c/a> Assemblyman Matthew Harper, R-Huntington Beach. “Rather than expanding an ever-growing list of government programs, our leaders should figure out a way to return that money to the people who earned it in the first place.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/f2acd022-56d6-48db-bc60-e21c12a1d261?src=embed\" title=\"California Tax Increases\" width=\"800\" height=\"700\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Assemblyman Vince Fong, R-Bakersfield, said he plans to introduce tax cuts aimed at helping families and small businesses stay in California.\u003c/p>\n\u003cp>“As we see all too often now, we are losing families and small businesses to neighboring states that have tax burdens much lower than California’s high-priced tax code,” Fong \u003ca href=\"https://twitter.com/vfong/status/948994635845611525\">said\u003c/a> on Twitter. “We have an opportunity to change that.”\u003c/p>\n\u003cp>Brown dismissed the refund idea, saying it would only prompt service cuts to public schools and universities later. “If you want to budget responsibly, you need big surpluses in years that are good,” he said.\u003c/p>\n\u003cp>Still, there’s a growing sentiment that California may have to respond to recent changes in the federal tax plan, specifically to a $10,000 cap on state and local deductions that will hit millions of households.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>According to the state \u003ca href=\"https://calmatters.org/wp-content/uploads/Letter-to-conferees-121117.pdf?x74105\">Finance Department\u003c/a>, the average deduction for state and local income taxes alone is nearly $16,000 per return, while state and local property taxes average less than $6,000 per return. Because a portion of those taxes will no longer be deductible, it acts as double taxation for California taxpayers.\u003c/p>\n\u003cp>Senate President Pro Tem Kevin de León, who is running for U.S. Senate, introduced legislation Thursday to shield Californians from bearing the costs of the tax overhaul. The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB227\">bill\u003c/a>, dubbed Protect California Taxpayers Act, would allow taxpayers to make charitable deductions to the state and receive a dollar-for-dollar tax credit on the full amount of their contribution. By having residents donate to the state government as a charitable contribution, the contribution remains deductible on federal taxes.\u003c/p>\n\u003cp>“The Republican tax plan gives corporations and hedge-fund managers a trillion-dollar tax cut and expects California taxpayers to foot the bill,” de León said in announcing his legislation. “We won’t allow California residents to be the casualty of this disastrous tax scheme.”\u003c/p>\n\u003cp>Brown was particularly vocal against the GOP tax proposal, calling it a “\u003ca href=\"https://calmatters.org/articles/trump_california/jerry-brown-urges-no-vote-tax-monstrosity/\">tax monstrosity\u003c/a>,” but the governor expressed reservations about whether the state could sidestep federal law.\u003c/p>\n\u003cp>“It looks interesting,” Brown said. “But two questions: Can it work? If it does work, can the Internal Revenue Service issue a regulation and completely subvert it?”\u003c/p>\n\u003cp>De León responded that he was confident it would work because similar charitable deductions have already been given out for education-based contributions.\u003c/p>\n\u003cp>For now, state Democrats are in agreement about a common threat.\u003c/p>\n\u003cp>Whether it’s federal tax changes or entitlement cuts, the leader of the Assembly, Anthony Rendon, D-Paramount, said he’s most concerned Republicans in Congress and the Trump administration will take another swipe at liberal California in 2018. “We’re worried about the next shoe to drop.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures",
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"content": "\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mrVakER0R6f0AToNbkAK83dprja2VTaO\"]\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Senate Republicans Reveal Long-Awaited Affordable Care Act Repeal Bill",
"title": "Senate Republicans Reveal Long-Awaited Affordable Care Act Repeal Bill",
"headTitle": "The California Report | KQED News",
"content": "\u003cp>\u003cem>Updated at 2:32 p.m. ET Thursday\u003c/em>\u003c/p>\n\u003cp>Senate Republicans unveiled \u003ca href=\"https://www.documentcloud.org/documents/3872487-SenateHCBill.html\" target=\"_blank\" rel=\"noopener noreferrer\">their long-awaited health care overhaul proposal\u003c/a> on Thursday. The Senate bill, called the \"Better Care Reconciliation Act,\" would repeal major parts of the Affordable Care Act, also known as Obamacare. The broad outlines of it look a lot like the House bill, the American Health Care Act, which was passed in May.\u003c/p>\n\u003cp>In a lot of ways, the Senate's bill looks like the House bill: It rolls back the ACA's Medicaid expansion — making for deep spending cuts to that program, compared to current law. The Senate bill also proposes eliminating many ACA taxes, and the employer penalties associated with the employer and individual mandates would be repealed retroactively, dating back to the start of 2016. And like the House bill, young adults up to the age of 26 could stay on their parents' health care plans.\u003c/p>\n\u003cp>Larry Levitt, a health policy expert at the Kaiser Family Foundation, \u003ca href=\"https://twitter.com/larry_levitt/status/877910700315729920\" target=\"_blank\" rel=\"noopener noreferrer\">summed up his thoughts on the bill\u003c/a> on Twitter on Thursday: \"In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal heath spending, big increase in the uninsured.\"\u003c/p>\n\u003cp>As with the House bill, the Senate proposal also allows insurance companies to charge older people five times more than younger people — under the ACA, that ratio is 3 to 1. That's just one provision that could hit older Americans hard.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A small group of Republican senators has written the bill in secret in recent weeks, with many Americans and even some fellow Republicans eagerly awaiting details about what's in the bill. After the bill was released on Thursday, protesters gathered outside Senate Majority Leader Mitch McConnell's office. \u003ca href=\"https://twitter.com/NBCNightlyNews/status/877915310526939136\" target=\"_blank\" rel=\"noopener noreferrer\">Video from NBC\u003c/a> showed police removing some of those protesters from the hallway.\u003c/p>\n\u003cp>https://twitter.com/NBCNightlyNews/status/877915310526939136\u003c/p>\n\u003ch3>Big Changes to Medicaid\u003c/h3>\n\u003cp>Some of the biggest changes this bill makes are to Medicaid, the entitlement program that provides health care to low-income Americans. In that sense, it looks like the House bill, which the CBO said would cut Medicaid by $834 billion over a decade (relative to current law), with a loss of 14 million beneficiaries.\u003c/p>\n\u003cp>Both bills roll back a Medicaid expansion undertaken under the Affordable Care Act. That law extended the program to some low-income Americans above the poverty level. The Senate proposal would roll back that expansion, though it would do so more slowly than the House bill proposes.\u003c/p>\n\u003cp>As with the House, the Senate also proposes giving states either a per capita cap on Medicaid spending or a block grant of funds. That's a fundamental change; currently the program is \"\u003ca href=\"http://www.commonwealthfund.org/publications/newsletters/headlines-in-health-policy/2017/jan/january-23-2017/medicaid\" target=\"_blank\" rel=\"noopener noreferrer\">open-ended\u003c/a>,\" meaning funding increases as need increases.\u003c/p>\n\u003cp>But there's another change on top of that. Those caps would vary based on the rate of inflation, and the inflation rate the Senate would attach to those caps is one that is lower than the inflation rate the House attached.\u003c/p>\n\u003cp>That might sound like a minor wonky change, but it's not, says one former Medicaid administrator.\u003c/p>\n\u003cp>\"That's a big deal. It's a big shift,\" said John Corlett, president of the Center for Community Solutions who also served as a director of Ohio's Medicaid program. \"It means billions of dollars less in federal aid to states for their Medicaid programs.\"\u003c/p>\n\u003ch3>Tax Cuts for Richer Americans\u003c/h3>\n\u003cp>The Senate bill is also much like the House bill in that it would repeal most of the taxes associated with Obamacare. (It would bump out the implementation of the so-called \"Cadillac Tax\" on expensive, employer-sponsored health care plans, from 2025 to 2026.)\u003c/p>\n\u003cp>Repealing those taxes, as the \u003ca href=\"http://www.taxpolicycenter.org/taxvox/new-cbo-ahca-score-confirms-what-we-already-knew\" target=\"_blank\" rel=\"noopener noreferrer\">Tax Policy Center reported\u003c/a> in May (regarding the AHCA), would overwhelmingly benefit higher-income Americans. The taxes in Obamacare were largely progressive, as Kyle Pomerleau of the right-leaning Tax Foundation told NPR.\u003c/p>\n\u003cp>To one health policy expert, those tax cuts, combined with the cuts to Medicaid, mean the bill isn't a health care overhaul.\u003c/p>\n\u003cp>\"It is a tax cut bill, and they had to find a way to finance it, and Medicaid beneficiaries are going to be the ones who hurt,\" said Nicholas Bagley, a University of Michigan Law School professor who specializes in health law.\u003c/p>\n\u003cp>There are a few other ways the Senate bill mirrors the House bill. It bans the use of any federal funds for any health care plan that covers abortion, except in the cases of rape, incest or where the pregnancy puts the mother's life in danger.\u003c/p>\n\u003cp>As of 2020, the bill also eliminates cost-sharing subsidies that help low-income Americans pay for their insurance.\u003c/p>\n\u003cp>But it also has some key differences from the House bill. For example, it cuts the upper-income limit that determines who gets premium tax credits. Currently, that upper limit is at 400 percent of the poverty level. This bill would limit that to 350 percent.\u003c/p>\n\u003cp>The Senate's proposal allows states substantial freedom in determining their own health care programs — even more freedom than the House bill allows for. Under the Affordable Care Act, states can apply for \"innovation waivers\" exempting them from parts of the law and allowing them to determine their own health care systems, to an extent.\u003c/p>\n\u003cp>However, there are strict rules in place stating that states getting those waivers must provide coverage that is \"at least as comprehensive\" as they would be otherwise, as the \u003ca href=\"https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Section_1332_State_Innovation_Waivers-.html\" target=\"_blank\" rel=\"noopener noreferrer\">Centers for Medicare and Medicaid Services\u003c/a> explains.\u003c/p>\n\u003cp>The Senate proposal greatly widens that loophole, saying that states can get those waivers, provided their alternate plans simply don't grow the deficit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[documentcloud url=\"https://www.documentcloud.org/documents/3872487-SenateHCBill\" notes=\"true\" text=\"true\" search=\"true\" sidebar=\"true\" pdf=\"true\" responsive=\"true\" page=\"1\"]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Senate+Republicans+Reveal+Long-Awaited+Affordable+Care+Act+Repeal+Bill&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated at 2:32 p.m. ET Thursday\u003c/em>\u003c/p>\n\u003cp>Senate Republicans unveiled \u003ca href=\"https://www.documentcloud.org/documents/3872487-SenateHCBill.html\" target=\"_blank\" rel=\"noopener noreferrer\">their long-awaited health care overhaul proposal\u003c/a> on Thursday. The Senate bill, called the \"Better Care Reconciliation Act,\" would repeal major parts of the Affordable Care Act, also known as Obamacare. The broad outlines of it look a lot like the House bill, the American Health Care Act, which was passed in May.\u003c/p>\n\u003cp>In a lot of ways, the Senate's bill looks like the House bill: It rolls back the ACA's Medicaid expansion — making for deep spending cuts to that program, compared to current law. The Senate bill also proposes eliminating many ACA taxes, and the employer penalties associated with the employer and individual mandates would be repealed retroactively, dating back to the start of 2016. And like the House bill, young adults up to the age of 26 could stay on their parents' health care plans.\u003c/p>\n\u003cp>Larry Levitt, a health policy expert at the Kaiser Family Foundation, \u003ca href=\"https://twitter.com/larry_levitt/status/877910700315729920\" target=\"_blank\" rel=\"noopener noreferrer\">summed up his thoughts on the bill\u003c/a> on Twitter on Thursday: \"In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal heath spending, big increase in the uninsured.\"\u003c/p>\n\u003cp>As with the House bill, the Senate proposal also allows insurance companies to charge older people five times more than younger people — under the ACA, that ratio is 3 to 1. That's just one provision that could hit older Americans hard.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A small group of Republican senators has written the bill in secret in recent weeks, with many Americans and even some fellow Republicans eagerly awaiting details about what's in the bill. After the bill was released on Thursday, protesters gathered outside Senate Majority Leader Mitch McConnell's office. \u003ca href=\"https://twitter.com/NBCNightlyNews/status/877915310526939136\" target=\"_blank\" rel=\"noopener noreferrer\">Video from NBC\u003c/a> showed police removing some of those protesters from the hallway.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003ch3>Big Changes to Medicaid\u003c/h3>\n\u003cp>Some of the biggest changes this bill makes are to Medicaid, the entitlement program that provides health care to low-income Americans. In that sense, it looks like the House bill, which the CBO said would cut Medicaid by $834 billion over a decade (relative to current law), with a loss of 14 million beneficiaries.\u003c/p>\n\u003cp>Both bills roll back a Medicaid expansion undertaken under the Affordable Care Act. That law extended the program to some low-income Americans above the poverty level. The Senate proposal would roll back that expansion, though it would do so more slowly than the House bill proposes.\u003c/p>\n\u003cp>As with the House, the Senate also proposes giving states either a per capita cap on Medicaid spending or a block grant of funds. That's a fundamental change; currently the program is \"\u003ca href=\"http://www.commonwealthfund.org/publications/newsletters/headlines-in-health-policy/2017/jan/january-23-2017/medicaid\" target=\"_blank\" rel=\"noopener noreferrer\">open-ended\u003c/a>,\" meaning funding increases as need increases.\u003c/p>\n\u003cp>But there's another change on top of that. Those caps would vary based on the rate of inflation, and the inflation rate the Senate would attach to those caps is one that is lower than the inflation rate the House attached.\u003c/p>\n\u003cp>That might sound like a minor wonky change, but it's not, says one former Medicaid administrator.\u003c/p>\n\u003cp>\"That's a big deal. It's a big shift,\" said John Corlett, president of the Center for Community Solutions who also served as a director of Ohio's Medicaid program. \"It means billions of dollars less in federal aid to states for their Medicaid programs.\"\u003c/p>\n\u003ch3>Tax Cuts for Richer Americans\u003c/h3>\n\u003cp>The Senate bill is also much like the House bill in that it would repeal most of the taxes associated with Obamacare. (It would bump out the implementation of the so-called \"Cadillac Tax\" on expensive, employer-sponsored health care plans, from 2025 to 2026.)\u003c/p>\n\u003cp>Repealing those taxes, as the \u003ca href=\"http://www.taxpolicycenter.org/taxvox/new-cbo-ahca-score-confirms-what-we-already-knew\" target=\"_blank\" rel=\"noopener noreferrer\">Tax Policy Center reported\u003c/a> in May (regarding the AHCA), would overwhelmingly benefit higher-income Americans. The taxes in Obamacare were largely progressive, as Kyle Pomerleau of the right-leaning Tax Foundation told NPR.\u003c/p>\n\u003cp>To one health policy expert, those tax cuts, combined with the cuts to Medicaid, mean the bill isn't a health care overhaul.\u003c/p>\n\u003cp>\"It is a tax cut bill, and they had to find a way to finance it, and Medicaid beneficiaries are going to be the ones who hurt,\" said Nicholas Bagley, a University of Michigan Law School professor who specializes in health law.\u003c/p>\n\u003cp>There are a few other ways the Senate bill mirrors the House bill. It bans the use of any federal funds for any health care plan that covers abortion, except in the cases of rape, incest or where the pregnancy puts the mother's life in danger.\u003c/p>\n\u003cp>As of 2020, the bill also eliminates cost-sharing subsidies that help low-income Americans pay for their insurance.\u003c/p>\n\u003cp>But it also has some key differences from the House bill. For example, it cuts the upper-income limit that determines who gets premium tax credits. Currently, that upper limit is at 400 percent of the poverty level. This bill would limit that to 350 percent.\u003c/p>\n\u003cp>The Senate's proposal allows states substantial freedom in determining their own health care programs — even more freedom than the House bill allows for. Under the Affordable Care Act, states can apply for \"innovation waivers\" exempting them from parts of the law and allowing them to determine their own health care systems, to an extent.\u003c/p>\n\u003cp>However, there are strict rules in place stating that states getting those waivers must provide coverage that is \"at least as comprehensive\" as they would be otherwise, as the \u003ca href=\"https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Section_1332_State_Innovation_Waivers-.html\" target=\"_blank\" rel=\"noopener noreferrer\">Centers for Medicare and Medicaid Services\u003c/a> explains.\u003c/p>\n\u003cp>The Senate proposal greatly widens that loophole, saying that states can get those waivers, provided their alternate plans simply don't grow the deficit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
"title": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "What Happens to Elder Care With Proposed Caps to Medi-Cal?",
"title": "What Happens to Elder Care With Proposed Caps to Medi-Cal?",
"headTitle": "The California Report | KQED News",
"content": "\u003cp>It’s a Sunday evening at the home of Marc and Charlotte Altieri of Long Beach, and that means bath time for the couple’s children -- 2-year-old Gino and 5-month-old Jessie.\u003c/p>\n\u003cp>And for this moment at least, Charlotte, 39, is able to focus on her children rather than worrying about her mother, 71-year-old Carmencita Misa. Three years ago, a debilitating stroke stole Misa’s short-term memory, her sight and her mobility.\u003c/p>\n\u003cp>“Before my mom had a stroke, she always made sure that she danced,” Charlotte says. “She would work regularly, like 60 hours or so a week, but no matter what, she would make (sure) that (there was) at least one night a week where she could go dancing. That was her thing.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/03/20170314gtcr.mp3\" program=\"The California Report\" image=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/RS24616_Brian-McGee-Carmencita-Misa-and-Charlotte-Altieri.jpeg\"]\u003c/p>\n\u003cp>But since the spring of 2014, Misa has required 24-hour care, which she now gets at a nearby nursing home. Charlotte says she wishes she could provide it herself -- but she can’t.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s not just physically having the logistics of two kids and their energies, and if they're hungry and if they’re sleepy,” Charlotte says. “It’s me trying to get my brain and heart together to go visit my mom, who’s not my mom. She’s just laying there.”\u003c/p>\n\u003cp>Initially, it was \u003ca href=\"https://www.medicare.gov/\" target=\"_blank\">Medicare\u003c/a>, the federal insurance program for those 65 and older, that paid for Misa’s nursing home care. But unbeknown to many, that program limits care to only 100 days. When Charlotte learned of the Medicare cutoff, she scrambled to figure out how to pay her mom’s monthly nursing home bill.\u003c/p>\n\u003cp>“The $5,000 -- we were wondering where it was going to come from,” she says.\u003c/p>\n\u003cp>For Misa, and for the tens of thousands of low-income Californians who need ongoing long-term services and support, there is one source of aid: the joint federal-state Medicaid program, known here in the Golden State as \u003ca href=\"https://www.medi-cal.ca.gov/\" target=\"_blank\">Medi-Cal\u003c/a>. Medicaid covers nursing home care if seniors can't pay for it themselves.\u003c/p>\n\u003cp>“Most people, when they think about Medicaid, they think of it as sort of a low-income, working population welfare health care program,” says Matt Salo, executive director of the National Association of Medicaid Directors. “But what really comes as a big surprise to almost everybody is that that’s not where Medicaid spends most of its dollars.”\u003c/p>\n\u003cp>Salo says Medicaid spends about two-thirds of its annual budget on the elderly and those with disabilities. And that’s why patient advocates say they’re worried about the Medicaid provision contained in the newly released \u003ca href=\"https://www.cbo.gov/publication/52486\" target=\"_blank\">GOP plan \u003c/a>to replace and repeal Obamacare.\u003c/p>\n\u003cp>That \u003ca href=\"http://www.foxnews.com/politics/interactive/2017/03/06/text-american-health-care-act/\" target=\"_blank\">legislation\u003c/a> would impose per-person limits on federal Medicaid spending, known as \"per capita caps.\" Those fixed spending limits would replace the existing funding approach in which the federal government provides matching funds of $1 to $3 for every $1 the state spends.\u003c/p>\n\u003cp>Eric Carlson is an attorney for the nonprofit advocacy group \u003ca href=\"http://www.justiceinaging.org/\" target=\"_blank\">Justice in Aging\u003c/a>. He’s also co-author of a new \u003ca href=\"http://www.justiceinaging.org/wp-content/uploads/2017/02/Medicaid-Funding-Caps-Would-Harm-Older-Americans.pdf\" target=\"_blank\">report\u003c/a> by the group , which says the proposed spending caps are certain to hurt older Americans who rely on Medicaid.\u003c/p>\n\u003cp>“It’s really a form of rationing where you have the care based on the money that’s budgeted rather than on the needs of the people,” Carlson says. “And that’s entirely backwards.”\u003c/p>\n\u003cp>But Oren Cass, a senior fellow with the \u003ca href=\"https://www.manhattan-institute.org/\" target=\"_blank\">Manhattan Institute, \u003c/a>disagrees.\u003c/p>\n\u003cp>“It just forces states to work within the budget constraints of a fixed amount of federal money, which, by the way, is how every other part of our federal government already works,” Cass says.\u003c/p>\n\u003cp>He says the GOP plan would also remove some federal rules now imposed on states and give them more flexibility in how they spend their Medicaid dollars. He and other supporters of that approach say it will allow states to better serve their Medicaid enrollees — while patient advocates argue it would harm them.\u003c/p>\n\u003cp>“Every time I see the words ‘program flexibility’ or ‘state flexibility,’ it makes us cringe,” says Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/\" target=\"_blank\">California Advocates for Nursing Home Reform\u003c/a>. “Because there are so many federal protections under the current Medicaid system, and I think most of those would be gone.”\u003c/p>\n\u003cp>As Congress continues hammering out the details of the GOP plan to revamp Obamacare and Medicaid, Charlotte Altieri hopes her mother's long-term care coverage will be spared any cuts.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“My mom is getting the most basic of basic [care],” she says. “If they cut it, I don’t know what I’d do.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It’s a Sunday evening at the home of Marc and Charlotte Altieri of Long Beach, and that means bath time for the couple’s children -- 2-year-old Gino and 5-month-old Jessie.\u003c/p>\n\u003cp>And for this moment at least, Charlotte, 39, is able to focus on her children rather than worrying about her mother, 71-year-old Carmencita Misa. Three years ago, a debilitating stroke stole Misa’s short-term memory, her sight and her mobility.\u003c/p>\n\u003cp>“Before my mom had a stroke, she always made sure that she danced,” Charlotte says. “She would work regularly, like 60 hours or so a week, but no matter what, she would make (sure) that (there was) at least one night a week where she could go dancing. That was her thing.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But since the spring of 2014, Misa has required 24-hour care, which she now gets at a nearby nursing home. Charlotte says she wishes she could provide it herself -- but she can’t.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s not just physically having the logistics of two kids and their energies, and if they're hungry and if they’re sleepy,” Charlotte says. “It’s me trying to get my brain and heart together to go visit my mom, who’s not my mom. She’s just laying there.”\u003c/p>\n\u003cp>Initially, it was \u003ca href=\"https://www.medicare.gov/\" target=\"_blank\">Medicare\u003c/a>, the federal insurance program for those 65 and older, that paid for Misa’s nursing home care. But unbeknown to many, that program limits care to only 100 days. When Charlotte learned of the Medicare cutoff, she scrambled to figure out how to pay her mom’s monthly nursing home bill.\u003c/p>\n\u003cp>“The $5,000 -- we were wondering where it was going to come from,” she says.\u003c/p>\n\u003cp>For Misa, and for the tens of thousands of low-income Californians who need ongoing long-term services and support, there is one source of aid: the joint federal-state Medicaid program, known here in the Golden State as \u003ca href=\"https://www.medi-cal.ca.gov/\" target=\"_blank\">Medi-Cal\u003c/a>. Medicaid covers nursing home care if seniors can't pay for it themselves.\u003c/p>\n\u003cp>“Most people, when they think about Medicaid, they think of it as sort of a low-income, working population welfare health care program,” says Matt Salo, executive director of the National Association of Medicaid Directors. “But what really comes as a big surprise to almost everybody is that that’s not where Medicaid spends most of its dollars.”\u003c/p>\n\u003cp>Salo says Medicaid spends about two-thirds of its annual budget on the elderly and those with disabilities. And that’s why patient advocates say they’re worried about the Medicaid provision contained in the newly released \u003ca href=\"https://www.cbo.gov/publication/52486\" target=\"_blank\">GOP plan \u003c/a>to replace and repeal Obamacare.\u003c/p>\n\u003cp>That \u003ca href=\"http://www.foxnews.com/politics/interactive/2017/03/06/text-american-health-care-act/\" target=\"_blank\">legislation\u003c/a> would impose per-person limits on federal Medicaid spending, known as \"per capita caps.\" Those fixed spending limits would replace the existing funding approach in which the federal government provides matching funds of $1 to $3 for every $1 the state spends.\u003c/p>\n\u003cp>Eric Carlson is an attorney for the nonprofit advocacy group \u003ca href=\"http://www.justiceinaging.org/\" target=\"_blank\">Justice in Aging\u003c/a>. He’s also co-author of a new \u003ca href=\"http://www.justiceinaging.org/wp-content/uploads/2017/02/Medicaid-Funding-Caps-Would-Harm-Older-Americans.pdf\" target=\"_blank\">report\u003c/a> by the group , which says the proposed spending caps are certain to hurt older Americans who rely on Medicaid.\u003c/p>\n\u003cp>“It’s really a form of rationing where you have the care based on the money that’s budgeted rather than on the needs of the people,” Carlson says. “And that’s entirely backwards.”\u003c/p>\n\u003cp>But Oren Cass, a senior fellow with the \u003ca href=\"https://www.manhattan-institute.org/\" target=\"_blank\">Manhattan Institute, \u003c/a>disagrees.\u003c/p>\n\u003cp>“It just forces states to work within the budget constraints of a fixed amount of federal money, which, by the way, is how every other part of our federal government already works,” Cass says.\u003c/p>\n\u003cp>He says the GOP plan would also remove some federal rules now imposed on states and give them more flexibility in how they spend their Medicaid dollars. He and other supporters of that approach say it will allow states to better serve their Medicaid enrollees — while patient advocates argue it would harm them.\u003c/p>\n\u003cp>“Every time I see the words ‘program flexibility’ or ‘state flexibility,’ it makes us cringe,” says Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/\" target=\"_blank\">California Advocates for Nursing Home Reform\u003c/a>. “Because there are so many federal protections under the current Medicaid system, and I think most of those would be gone.”\u003c/p>\n\u003cp>As Congress continues hammering out the details of the GOP plan to revamp Obamacare and Medicaid, Charlotte Altieri hopes her mother's long-term care coverage will be spared any cuts.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“My mom is getting the most basic of basic [care],” she says. “If they cut it, I don’t know what I’d do.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>House Republicans are debating a plan to replace the Affordable Care Act that would give consumers tax credits to buy insurance, cut back on Medicaid and allow people to save their own money to pay for health care costs.\u003c/p>\n\u003cp>The outline plan is likely to take away some of the financial help low-income families get through Obamacare subsidies, and also result in fewer people being covered under the Medicaid health care program for the poor.\u003c/p>\n\u003cp>\"In general this is going to result in fewer people covered nationwide,\" says \u003ca href=\"http://avalere.com/team#!/CarolineF-Pearson\">Caroline Pearson\u003c/a>, a senior vice president at Avalere, a health care consulting group.\u003c/p>\n\u003cp>Republican leaders distributed the skeleton proposal at a meeting of the House Republican Conference in the Capitol on Thursday. Lawmakers now have an outline to bring with them to their districts for the Presidents Day holiday weekend, where they may face constituents with questions about what is going to happen to their health care. The plan is based on \u003ca href=\"http://www.npr.org/sections/health-shots/2016/11/21/502612264/if-republicans-repeal-obamacare-ryan-has-replacement-blueprint\">one outlined last summer \u003c/a>by House Speaker Paul Ryan.\u003c/p>\n\u003cp>Rep. \u003ca href=\"https://huizenga.house.gov/\">Bill Huizenga\u003c/a>, R-Mich., called the 18-page outline \"guideposts and a road map.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We know the direction we want to go and sort of the destination,\" Huizenga said outside the meeting.\u003c/p>\n\u003cp>[contextly_sidebar id=\"sRJxQM0P8BvLJlS9QdKFt49Wzeme9VV0\"]\u003c/p>\n\u003cp>Lawmakers who attended the meeting said the plan is to repeal the Affordable Care Act with a bill similar to one that passed in 2015 but was vetoed by then-President Barack Obama. That proposal would have repealed all the taxes and subsidies associated with the health care law and would have killed the mandate for individuals to buy health insurance by getting rid of the tax penalty used to enforce it.\u003c/p>\n\u003cp>This Congress could either first pass a repeal bill and then a replacement bill, or include replacement elements in the repeal.\u003c/p>\n\u003cp>The meeting Thursday centered on \"principles and goals on where we're going in patient-centered care,\" said House Ways and Means Committee Chairman Kevin Brady, R-La., after the meeting.\u003c/p>\n\u003cp>\"We're talking about repealing, replacing and starting to return control of health care and restoring the free market,\" he said.\u003c/p>\n\u003cp>Most of the plan is silent on how much money lawmakers want to put behind their proposals, so it's impossible to know exactly how generous the plan is and how many people it would cover.\u003c/p>\n\u003cp>The elements of the plan include replacing the subsidies that help people buy insurance through Obamacare exchanges with fixed tax credits to buy coverage on the open market.\u003c/p>\n\u003cp>The major difference between the two is that the Obamacare subsidies increase as premiums rise so that consumers are responsible for the same premium amount, which is tied to their income. The tax credits proposed by Ryan are not tied to income but rise as a person ages and insurance rates increase.\u003c/p>\n\u003cp>\"The important thing on the tax credits is that they're not income adjusted and we don't know how big they are,\" Pearson says.\u003c/p>\n\u003cp>She says it's unlikely they'll be as generous as the Obamacare subsidies.\u003c/p>\n\u003cp>\"This likely means that low-income people will have difficulty affording individual insurance,\" she says.\u003c/p>\n\u003cp>The outline distributed by Republicans repeatedly mentions that people will be able to buy so-called catastrophic coverage, which has limited day-to-day benefits but protects people when they have a serious illness or accident that requires a lot of health care.\u003c/p>\n\u003cp>The plan also calls for expanding health savings accounts, which allow people to save their own money tax-free to pay for health care costs. It calls for the limits on HSA savings to rise from $6,750 per family to $13,100.\u003c/p>\n\u003cp>HSAs are a favorite among conservatives because they encourage people to save and plan for their health spending and to shop around for price.\u003c/p>\n\u003cp>Democrats have criticized the focus on HSAs because they help only people who have extra money to put away and give a bigger tax cut to people with higher incomes.\u003c/p>\n\u003cp>The Republicans' plan also calls for a major restructuring of the Medicaid health care program for the poor. It would repeal the Medicaid expansion that most states adopted under the Affordable Care Act, which allowed able-bodied people with incomes just above the poverty line to become eligible for Medicaid coverage.\u003c/p>\n\u003cp>And it would cap how much the federal government spends per person per year. Right now, Medicaid pays all health care costs for those who are eligible.\u003c/p>\n\u003cp>\"This is a potentially significant incentive for states to get serious about efficiency,\" says \u003ca href=\"https://www.manhattan-institute.org/expert/paul-howard\">Paul Howard\u003c/a>, director of health policy at the Manhattan Institute, a conservative think tank.\u003c/p>\n\u003cp>Howard says states currently have an incentive to increase their spending on Medicaid, because it boosts the amount of federal money they get.\u003c/p>\n\u003cp>Ryan's plan would make Medicaid either a block grant program, where states receive a fixed amount of money, or it would be a per capita benefit, where the federal government would give the states a set amount for each beneficiary.\u003c/p>\n\u003cp>States could still offer Medicaid to those who became eligible under expansion, but the states' share of the costs would be higher than it is under the Affordable Care Act, likely making it too expensive for many states to do so.\u003c/p>\n\u003cp>Finally, the Republican plan would offer states pools of cash to come up with ways to expand insurance access to more people.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\">NPR.org\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>House Republicans are debating a plan to replace the Affordable Care Act that would give consumers tax credits to buy insurance, cut back on Medicaid and allow people to save their own money to pay for health care costs.\u003c/p>\n\u003cp>The outline plan is likely to take away some of the financial help low-income families get through Obamacare subsidies, and also result in fewer people being covered under the Medicaid health care program for the poor.\u003c/p>\n\u003cp>\"In general this is going to result in fewer people covered nationwide,\" says \u003ca href=\"http://avalere.com/team#!/CarolineF-Pearson\">Caroline Pearson\u003c/a>, a senior vice president at Avalere, a health care consulting group.\u003c/p>\n\u003cp>Republican leaders distributed the skeleton proposal at a meeting of the House Republican Conference in the Capitol on Thursday. Lawmakers now have an outline to bring with them to their districts for the Presidents Day holiday weekend, where they may face constituents with questions about what is going to happen to their health care. The plan is based on \u003ca href=\"http://www.npr.org/sections/health-shots/2016/11/21/502612264/if-republicans-repeal-obamacare-ryan-has-replacement-blueprint\">one outlined last summer \u003c/a>by House Speaker Paul Ryan.\u003c/p>\n\u003cp>Rep. \u003ca href=\"https://huizenga.house.gov/\">Bill Huizenga\u003c/a>, R-Mich., called the 18-page outline \"guideposts and a road map.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We know the direction we want to go and sort of the destination,\" Huizenga said outside the meeting.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Lawmakers who attended the meeting said the plan is to repeal the Affordable Care Act with a bill similar to one that passed in 2015 but was vetoed by then-President Barack Obama. That proposal would have repealed all the taxes and subsidies associated with the health care law and would have killed the mandate for individuals to buy health insurance by getting rid of the tax penalty used to enforce it.\u003c/p>\n\u003cp>This Congress could either first pass a repeal bill and then a replacement bill, or include replacement elements in the repeal.\u003c/p>\n\u003cp>The meeting Thursday centered on \"principles and goals on where we're going in patient-centered care,\" said House Ways and Means Committee Chairman Kevin Brady, R-La., after the meeting.\u003c/p>\n\u003cp>\"We're talking about repealing, replacing and starting to return control of health care and restoring the free market,\" he said.\u003c/p>\n\u003cp>Most of the plan is silent on how much money lawmakers want to put behind their proposals, so it's impossible to know exactly how generous the plan is and how many people it would cover.\u003c/p>\n\u003cp>The elements of the plan include replacing the subsidies that help people buy insurance through Obamacare exchanges with fixed tax credits to buy coverage on the open market.\u003c/p>\n\u003cp>The major difference between the two is that the Obamacare subsidies increase as premiums rise so that consumers are responsible for the same premium amount, which is tied to their income. The tax credits proposed by Ryan are not tied to income but rise as a person ages and insurance rates increase.\u003c/p>\n\u003cp>\"The important thing on the tax credits is that they're not income adjusted and we don't know how big they are,\" Pearson says.\u003c/p>\n\u003cp>She says it's unlikely they'll be as generous as the Obamacare subsidies.\u003c/p>\n\u003cp>\"This likely means that low-income people will have difficulty affording individual insurance,\" she says.\u003c/p>\n\u003cp>The outline distributed by Republicans repeatedly mentions that people will be able to buy so-called catastrophic coverage, which has limited day-to-day benefits but protects people when they have a serious illness or accident that requires a lot of health care.\u003c/p>\n\u003cp>The plan also calls for expanding health savings accounts, which allow people to save their own money tax-free to pay for health care costs. It calls for the limits on HSA savings to rise from $6,750 per family to $13,100.\u003c/p>\n\u003cp>HSAs are a favorite among conservatives because they encourage people to save and plan for their health spending and to shop around for price.\u003c/p>\n\u003cp>Democrats have criticized the focus on HSAs because they help only people who have extra money to put away and give a bigger tax cut to people with higher incomes.\u003c/p>\n\u003cp>The Republicans' plan also calls for a major restructuring of the Medicaid health care program for the poor. It would repeal the Medicaid expansion that most states adopted under the Affordable Care Act, which allowed able-bodied people with incomes just above the poverty line to become eligible for Medicaid coverage.\u003c/p>\n\u003cp>And it would cap how much the federal government spends per person per year. Right now, Medicaid pays all health care costs for those who are eligible.\u003c/p>\n\u003cp>\"This is a potentially significant incentive for states to get serious about efficiency,\" says \u003ca href=\"https://www.manhattan-institute.org/expert/paul-howard\">Paul Howard\u003c/a>, director of health policy at the Manhattan Institute, a conservative think tank.\u003c/p>\n\u003cp>Howard says states currently have an incentive to increase their spending on Medicaid, because it boosts the amount of federal money they get.\u003c/p>\n\u003cp>Ryan's plan would make Medicaid either a block grant program, where states receive a fixed amount of money, or it would be a per capita benefit, where the federal government would give the states a set amount for each beneficiary.\u003c/p>\n\u003cp>States could still offer Medicaid to those who became eligible under expansion, but the states' share of the costs would be higher than it is under the Affordable Care Act, likely making it too expensive for many states to do so.\u003c/p>\n\u003cp>Finally, the Republican plan would offer states pools of cash to come up with ways to expand insurance access to more people.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\">NPR.org\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California’s Undocumented Kids—Why They Could be First to Lose Medical Care Under Trump",
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"content": "\u003cp>On a recent rainy morning in Los Angeles, Maria Bernal’s stove clicks to life with a bright blue flame to toast bread on a griddle for her 9-year-old son Edwin to smear with peanut butter. As she scoops papaya chunks into the blender for a smoothie, she recalls her worry during all the years when she couldn’t afford health care and he suffered painful ear infections.\u003c/p>\n\u003cp>The waiting six months to get an appointment for Edwin at a county facility. The nights trying to calm him as he cried in constant pain. The months-long wait for each of three surgeries to insert tubes into his ears. The fear when the medical bills arrived.\u003c/p>\n\u003cp>At the time, she couldn’t afford health care, and he wasn't eligible for regular government-funded Medi-Cal coverage because she had brought Edwin to the United States illegally from Mexico when he was 1. He qualified for a local program and emergency Medi-Cal, but that didn’t provide all the care he needed. Then last year, she heard on TV that California was \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_EE_Plan_032116_Final.PDF\" target=\"_blank\">creating a new program\u003c/a> under Medi-Cal to fully cover poor undocumented children. Relieved, she rushed to sign Edwin up. As a result, she says, “I can take him in whenever he needs to go.”\u003c/p>\n\u003cp>Now, however, the ability of Edwin and some 164,000 poor undocumented California children to see a doctor for regular medical care hangs in the balance—with several experts predicting they could be among the first to lose health coverage if the Trump administration carries out its promise to end much of Obamacare, leaving California to try to make up the difference.\u003c/p>\n\u003cp>To be clear, the federal government does pay \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014b.aspx\" target=\"_blank\">limited medical costs\u003c/a> for kids in the country illegally under the restricted-scope Medi-Cal program, which is available to anyone regardless of immigration status for emergency and prenatal services only. Last May, however, California became one of a handful of states to provide \u003ca href=\"http://www.scpr.org/programs/take-two/2016/04/21/48148/medi-cal-for-immigrant-kids-in-us-illegally-starts/\" target=\"_blank\">state-funded full-scope Medi-Cal\u003c/a>, California’s Medicaid program. About 71 percent of the program is funded by the state, according to the state \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SB-75.aspx\" target=\"_blank\">Department of Health Care Services\u003c/a>, with 29 percent paid for out of \u003ca href=\"https://www.medicaid.gov/medicaid/outreach-and-enrollment/downloads/overview-of-eligibility-for-non-citizens-in-medicaid-and-chip.pdf\" target=\"_blank\">federal funds\u003c/a> for emergency coverage. Also of note: Because the federal government funds emergency services, the state shares enrollee information with federal health officials.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In his most recent \u003ca href=\"http://www.ebudget.ca.gov/2017-18/pdf/BudgetSummary/FullBudgetSummary.pdf\" target=\"_blank\">budget proposal\u003c/a>, Gov. Jerry Brown allocated $279.5 million to cover approximately 185,000 kids in the coming year in what the state has dubbed its Health for All Kids program—double what the program was estimated to cost when it was approved.\u003c/p>\n\u003cp>With the election of Donald Trump, who took office last week, some health policy experts and advocates say the fledgling program is in danger. Assuming the new administration carries out plans to change how Medicaid is funded, California could stand to lose $17 billion the federal government currently provides for the Medi-Cal expansion that California adopted under the Affordable Care Act.\u003c/p>\n\u003cp>Such a cut would leave state leaders unable to fully make up the funding difference—and could force them to revisit a decades-old debate over whether the state has an obligation to care for sick children regardless of their immigration status, or should focus limited resources on citizens and legal residents.\u003c/p>\n\u003cp>It’s impossible to precisely predict the ripple effects. But, said Nancy Gomez, organizing director of the health advocacy organization \u003ca href=\"http://Health%20Access%20California\" target=\"_blank\">Health Access California\u003c/a>: “The first things that are going to go are these optional programs. They are not optional to us. But Health for All Kids are discretionary funds and they may be the first to go.”\u003c/p>\n\u003cp>Trying to make up the gap will be nearly impossible, experts say.\u003c/p>\n\u003cp>“These federal cuts to the broader Medi-Cal program would force California policymakers to make some difficult decisions—raise revenue by unprecedented amounts to maintain the current program, cut benefits, reduce eligibility, or make other cuts to the program,” said Laurel Lucia, manager of the Health Care Program at the UC Berkeley \u003ca href=\"http://laborcenter.berkeley.edu/\" target=\"_blank\">Center for Labor Research and Education\u003c/a>. But, she acknowledged, “if the Legislature decides to take a 'last in, first out' approach to making eligibility cuts in response to federal cuts, state-funded Medi-Cal for undocumented kids would especially be at risk because the expansion started less than one year ago.”\u003c/p>\n\u003cp>That’s as is should be, according to those who insist that anyone in the country illegally should not receive state resources—especially if funding is cut short.\u003c/p>\n\u003cp>“Sacramento should be focused on helping American citizens,” said Robin Hvidston, executive director of \u003ca href=\"https://wethepeoplerising.wordpress.com/\" target=\"_blank\">We The People Rising\u003c/a>, a Claremont-based organization that fights against legislation that it says promotes illegal immigration. The group opposed the expansion, which she contends is merely an open invitation for illegal immigration.\u003c/p>\n\u003cp>“It’s a program our state cannot afford,” she said. “We have a burgeoning homeless crisis in this state, we have disabled people in this state that need help. This energy and our tax dollars should be going to help our suffering American citizens in this state and not those here illegally.”\u003c/p>\n\u003cp>Nonetheless, the lawmaker who \u003ca href=\"https://calmatters.org/articles/californias-undocumented-kidswhy-they-could-be-first-to-lose-medical-care-under-trump/\" target=\"_blank\">authored\u003c/a> the expansion to cover undocumented children, Democratic Sen. Ricardo Lara of Los Angeles, has vowed to protect them.\u003c/p>\n\u003cp>“I will fight to ensure that they remain a priority population in terms of receiving adequate healthcare and meeting their health needs,” Lara said. “It makes economic sense, it’s the moral thing to do.”\u003c/p>\n\u003cp>But in an unmistakable sign that the Democratic-controlled state is changing tactics in response to a less receptive White House, California recently \u003ca href=\"http://khn.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\" target=\"_blank\">retracted\u003c/a> its request for a federal waiver that it had hoped would allow undocumented immigrants of all ages to buy unsubsidized health care via California’s Affordable Care Act exchange. Lara labeled it the “first California casualty of the Trump presidency.”\u003c/p>\n\u003cp>He said the state could always renew its quest for such a waiver, but won’t until it first ensures that the state can protect the data immigrants would be sharing with the federal government by using the health exchange.\u003c/p>\n\u003cp>“It’s very clear and apparent that we are dealing with a hostile administration toward our immigration community,” Lara said. “Given the fact that we are working currently on legislation to protect the privacy of the immigrant communities, we felt that it was appropriate to pull the waiver and focus on the fights ahead with the incoming administration.”\u003c/p>\n\u003cp>President Trump and the Republican-controlled Congress favor establishing caps on Medicaid and changing funding to a block grant formula that sets limits on total spending per state regardless of how many people are in the program. Currently it is funded as an entitlement for all enrollees who qualify.\u003c/p>\n\u003cp>Medicaid is the largest insurer in the country, with 73 million people enrolled, mostly low-income or disabled. In California, 13.5 million people are on Medi-Cal, or roughly one in three Californians. The program grew by 3.6 million people when it was expanded under the Affordable Care Act.\u003c/p>\n\u003cp>A study by the Center on Budget and Policy Priorities found that the proposals to reorganize Medicaid funding would decrease funding by one-third to one-half within a decade.\u003c/p>\n\u003cp>Such federal cuts would trigger a cascade of effects, said Senate President Pro Tem Kevin de Leon (D-Los Angeles).\u003c/p>\n\u003cp>“If the Trump administration decides to remove and take away access to quality healthcare that could possibly drive a budget deficit—and if you drive a budget deficit that means cuts would have to be made,” he said at a health care rally in Los Angeles after the November election. “If cuts have to be made that means other people could be hurt.”\u003c/p>\n\u003cp>But others aren’t ready to concede that outcome, and say there are likely alternatives the state can employ to keep as many people covered as possible.\u003c/p>\n\u003cp>“The reality is if Congress has enough votes to change the Medicaid program into a block grant program, California will struggle to maintain its commitment to the 13.5 million people currently covered,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “I suspect the governor and Legislature will give higher priority to cutting covered services rather than cutting the number of beneficiaries.”\u003c/p>\n\u003cp>Sen. Lara said he hopes the state resists choosing one group over another—adding that he plans to suggest cutting coverage, as the state has done during lean times, or increasing eligibility thresholds in his fight to keep health care for the neediest across all groups, including undocumented children.\u003c/p>\n\u003cp>As for 9-year-old Edwin Bernal, he says going to the doctor more often is good for him because of his hearing challenges and ear tubes.\u003c/p>\n\u003cfigure id=\"attachment_287952\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg\" alt=\"Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger.\" width=\"800\" height=\"533\" class=\"size-medium wp-image-287952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger. \u003ccite>(Maria J. Avila/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“My friends talk to me and I’m like ‘what, what,’ because I can’t hear them that good,” he said. “Same with my mom, she tells me something and I don’t really hear her and I don’t do the stuff she tells me because I can’t hear. So it’s better, I can hear her and I’m not getting in more trouble.”\u003c/p>\n\u003cp>If kids like Edwin lose Medi-Cal overage, their health care will depend largely on where they live. \u003c/p>\n\u003cp>In Los Angeles, the county offers a basic low-cost program to everyone regardless of immigration status and emergency Medi-Cal is expected to still be available. Private insurer Kaiser Permanente also offers a community benefit program for kids without legal status who live near their facilities.\u003c/p>\n\u003cp>“It’s going to be a challenge for us and the patients,” said Chona de Leon, senior vice president and chief operating officer at Eisner Pediatric & Family Center, in downtown Los Angeles, where Edwin has received care since he was a baby. \u003c/p>\n\u003cp>Clinics like Eisner would lose the increased funding that has come from previously uninsured patients getting access through the Affordable Care Act. de Leon says they would continue to serve uninsured patients as they always have, although they would have to work hard to find outside funding and donations.\u003c/p>\n\u003cp>But in 11 California counties, including Orange and San Diego, there are no programs for undocumented families to find care for their children outside of charitable clinics and hospital emergency rooms.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://CALmatters.org\" target=\"_blank\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California’s policies and politics.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"excerpt": "A medical plan covering some 164,000 poor undocumented California children hangs in the balance. Both experts and families fear a cut-off if the Trump administration carries out its promise to end much of Obamacare. ",
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"nprByline": "\u003ca href=\"https://calmatters.org/about/staff/elizabeth-aguilera/\">\u003cstrong>Elizabeth Aguilera\u003c/a>\u003c/strong>\u003cbr/>\u003ca href=\"https://calmatters.org/\">CALmatters\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On a recent rainy morning in Los Angeles, Maria Bernal’s stove clicks to life with a bright blue flame to toast bread on a griddle for her 9-year-old son Edwin to smear with peanut butter. As she scoops papaya chunks into the blender for a smoothie, she recalls her worry during all the years when she couldn’t afford health care and he suffered painful ear infections.\u003c/p>\n\u003cp>The waiting six months to get an appointment for Edwin at a county facility. The nights trying to calm him as he cried in constant pain. The months-long wait for each of three surgeries to insert tubes into his ears. The fear when the medical bills arrived.\u003c/p>\n\u003cp>At the time, she couldn’t afford health care, and he wasn't eligible for regular government-funded Medi-Cal coverage because she had brought Edwin to the United States illegally from Mexico when he was 1. He qualified for a local program and emergency Medi-Cal, but that didn’t provide all the care he needed. Then last year, she heard on TV that California was \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_EE_Plan_032116_Final.PDF\" target=\"_blank\">creating a new program\u003c/a> under Medi-Cal to fully cover poor undocumented children. Relieved, she rushed to sign Edwin up. As a result, she says, “I can take him in whenever he needs to go.”\u003c/p>\n\u003cp>Now, however, the ability of Edwin and some 164,000 poor undocumented California children to see a doctor for regular medical care hangs in the balance—with several experts predicting they could be among the first to lose health coverage if the Trump administration carries out its promise to end much of Obamacare, leaving California to try to make up the difference.\u003c/p>\n\u003cp>To be clear, the federal government does pay \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014b.aspx\" target=\"_blank\">limited medical costs\u003c/a> for kids in the country illegally under the restricted-scope Medi-Cal program, which is available to anyone regardless of immigration status for emergency and prenatal services only. Last May, however, California became one of a handful of states to provide \u003ca href=\"http://www.scpr.org/programs/take-two/2016/04/21/48148/medi-cal-for-immigrant-kids-in-us-illegally-starts/\" target=\"_blank\">state-funded full-scope Medi-Cal\u003c/a>, California’s Medicaid program. About 71 percent of the program is funded by the state, according to the state \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SB-75.aspx\" target=\"_blank\">Department of Health Care Services\u003c/a>, with 29 percent paid for out of \u003ca href=\"https://www.medicaid.gov/medicaid/outreach-and-enrollment/downloads/overview-of-eligibility-for-non-citizens-in-medicaid-and-chip.pdf\" target=\"_blank\">federal funds\u003c/a> for emergency coverage. Also of note: Because the federal government funds emergency services, the state shares enrollee information with federal health officials.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In his most recent \u003ca href=\"http://www.ebudget.ca.gov/2017-18/pdf/BudgetSummary/FullBudgetSummary.pdf\" target=\"_blank\">budget proposal\u003c/a>, Gov. Jerry Brown allocated $279.5 million to cover approximately 185,000 kids in the coming year in what the state has dubbed its Health for All Kids program—double what the program was estimated to cost when it was approved.\u003c/p>\n\u003cp>With the election of Donald Trump, who took office last week, some health policy experts and advocates say the fledgling program is in danger. Assuming the new administration carries out plans to change how Medicaid is funded, California could stand to lose $17 billion the federal government currently provides for the Medi-Cal expansion that California adopted under the Affordable Care Act.\u003c/p>\n\u003cp>Such a cut would leave state leaders unable to fully make up the funding difference—and could force them to revisit a decades-old debate over whether the state has an obligation to care for sick children regardless of their immigration status, or should focus limited resources on citizens and legal residents.\u003c/p>\n\u003cp>It’s impossible to precisely predict the ripple effects. But, said Nancy Gomez, organizing director of the health advocacy organization \u003ca href=\"http://Health%20Access%20California\" target=\"_blank\">Health Access California\u003c/a>: “The first things that are going to go are these optional programs. They are not optional to us. But Health for All Kids are discretionary funds and they may be the first to go.”\u003c/p>\n\u003cp>Trying to make up the gap will be nearly impossible, experts say.\u003c/p>\n\u003cp>“These federal cuts to the broader Medi-Cal program would force California policymakers to make some difficult decisions—raise revenue by unprecedented amounts to maintain the current program, cut benefits, reduce eligibility, or make other cuts to the program,” said Laurel Lucia, manager of the Health Care Program at the UC Berkeley \u003ca href=\"http://laborcenter.berkeley.edu/\" target=\"_blank\">Center for Labor Research and Education\u003c/a>. But, she acknowledged, “if the Legislature decides to take a 'last in, first out' approach to making eligibility cuts in response to federal cuts, state-funded Medi-Cal for undocumented kids would especially be at risk because the expansion started less than one year ago.”\u003c/p>\n\u003cp>That’s as is should be, according to those who insist that anyone in the country illegally should not receive state resources—especially if funding is cut short.\u003c/p>\n\u003cp>“Sacramento should be focused on helping American citizens,” said Robin Hvidston, executive director of \u003ca href=\"https://wethepeoplerising.wordpress.com/\" target=\"_blank\">We The People Rising\u003c/a>, a Claremont-based organization that fights against legislation that it says promotes illegal immigration. The group opposed the expansion, which she contends is merely an open invitation for illegal immigration.\u003c/p>\n\u003cp>“It’s a program our state cannot afford,” she said. “We have a burgeoning homeless crisis in this state, we have disabled people in this state that need help. This energy and our tax dollars should be going to help our suffering American citizens in this state and not those here illegally.”\u003c/p>\n\u003cp>Nonetheless, the lawmaker who \u003ca href=\"https://calmatters.org/articles/californias-undocumented-kidswhy-they-could-be-first-to-lose-medical-care-under-trump/\" target=\"_blank\">authored\u003c/a> the expansion to cover undocumented children, Democratic Sen. Ricardo Lara of Los Angeles, has vowed to protect them.\u003c/p>\n\u003cp>“I will fight to ensure that they remain a priority population in terms of receiving adequate healthcare and meeting their health needs,” Lara said. “It makes economic sense, it’s the moral thing to do.”\u003c/p>\n\u003cp>But in an unmistakable sign that the Democratic-controlled state is changing tactics in response to a less receptive White House, California recently \u003ca href=\"http://khn.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\" target=\"_blank\">retracted\u003c/a> its request for a federal waiver that it had hoped would allow undocumented immigrants of all ages to buy unsubsidized health care via California’s Affordable Care Act exchange. Lara labeled it the “first California casualty of the Trump presidency.”\u003c/p>\n\u003cp>He said the state could always renew its quest for such a waiver, but won’t until it first ensures that the state can protect the data immigrants would be sharing with the federal government by using the health exchange.\u003c/p>\n\u003cp>“It’s very clear and apparent that we are dealing with a hostile administration toward our immigration community,” Lara said. “Given the fact that we are working currently on legislation to protect the privacy of the immigrant communities, we felt that it was appropriate to pull the waiver and focus on the fights ahead with the incoming administration.”\u003c/p>\n\u003cp>President Trump and the Republican-controlled Congress favor establishing caps on Medicaid and changing funding to a block grant formula that sets limits on total spending per state regardless of how many people are in the program. Currently it is funded as an entitlement for all enrollees who qualify.\u003c/p>\n\u003cp>Medicaid is the largest insurer in the country, with 73 million people enrolled, mostly low-income or disabled. In California, 13.5 million people are on Medi-Cal, or roughly one in three Californians. The program grew by 3.6 million people when it was expanded under the Affordable Care Act.\u003c/p>\n\u003cp>A study by the Center on Budget and Policy Priorities found that the proposals to reorganize Medicaid funding would decrease funding by one-third to one-half within a decade.\u003c/p>\n\u003cp>Such federal cuts would trigger a cascade of effects, said Senate President Pro Tem Kevin de Leon (D-Los Angeles).\u003c/p>\n\u003cp>“If the Trump administration decides to remove and take away access to quality healthcare that could possibly drive a budget deficit—and if you drive a budget deficit that means cuts would have to be made,” he said at a health care rally in Los Angeles after the November election. “If cuts have to be made that means other people could be hurt.”\u003c/p>\n\u003cp>But others aren’t ready to concede that outcome, and say there are likely alternatives the state can employ to keep as many people covered as possible.\u003c/p>\n\u003cp>“The reality is if Congress has enough votes to change the Medicaid program into a block grant program, California will struggle to maintain its commitment to the 13.5 million people currently covered,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “I suspect the governor and Legislature will give higher priority to cutting covered services rather than cutting the number of beneficiaries.”\u003c/p>\n\u003cp>Sen. Lara said he hopes the state resists choosing one group over another—adding that he plans to suggest cutting coverage, as the state has done during lean times, or increasing eligibility thresholds in his fight to keep health care for the neediest across all groups, including undocumented children.\u003c/p>\n\u003cp>As for 9-year-old Edwin Bernal, he says going to the doctor more often is good for him because of his hearing challenges and ear tubes.\u003c/p>\n\u003cfigure id=\"attachment_287952\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg\" alt=\"Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger.\" width=\"800\" height=\"533\" class=\"size-medium wp-image-287952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger. \u003ccite>(Maria J. Avila/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“My friends talk to me and I’m like ‘what, what,’ because I can’t hear them that good,” he said. “Same with my mom, she tells me something and I don’t really hear her and I don’t do the stuff she tells me because I can’t hear. So it’s better, I can hear her and I’m not getting in more trouble.”\u003c/p>\n\u003cp>If kids like Edwin lose Medi-Cal overage, their health care will depend largely on where they live. \u003c/p>\n\u003cp>In Los Angeles, the county offers a basic low-cost program to everyone regardless of immigration status and emergency Medi-Cal is expected to still be available. Private insurer Kaiser Permanente also offers a community benefit program for kids without legal status who live near their facilities.\u003c/p>\n\u003cp>“It’s going to be a challenge for us and the patients,” said Chona de Leon, senior vice president and chief operating officer at Eisner Pediatric & Family Center, in downtown Los Angeles, where Edwin has received care since he was a baby. \u003c/p>\n\u003cp>Clinics like Eisner would lose the increased funding that has come from previously uninsured patients getting access through the Affordable Care Act. de Leon says they would continue to serve uninsured patients as they always have, although they would have to work hard to find outside funding and donations.\u003c/p>\n\u003cp>But in 11 California counties, including Orange and San Diego, there are no programs for undocumented families to find care for their children outside of charitable clinics and hospital emergency rooms.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Obamacare Repeal Could Punch $15 Billion Hole in State Budget",
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"content": "\u003cp>When Gov. Jerry Brown unveils his 2017-18 budget Tuesday, there will be one huge question mark hanging over the proposal: What will it cost California when congressional Republicans follow through on their promise to dismantle Obamacare?\u003c/p>\n\u003cp>GOP lawmakers, along with President-elect Donald Trump, have \u003ca href=\"https://ww2.kqed.org/news/2017/01/03/republicans-take-the-first-step-to-repeal-obamacare/\">vowed to repeal the landmark health care law\u003c/a> and replace it with something. But what that something will be is still unknown -- and since California wholeheartedly embraced the Affordable Care Act and insured millions of poor residents through its Medicaid program, Medi-Cal, any rollback is likely to punch a huge hole in the state budget.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/301686124\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Since 2014, Medi-Cal rolls have swelled from about 8 million Californians to about 14 million. One reason: the Affordable Care Act greatly expanded Medicaid eligibility for childless, low-income adults -- more than 3 million new Medi-Cal enrollees have qualified because of that change since 2014. Along with the expanded eligibility came expanded federal funding for Medi-Cal, to the tune of more than $15 billion this fiscal year alone.\u003c/p>\n\u003cp>Now, there are huge questions for both state leaders, who have depended on that federal funding, and the millions of Californians who have benefitted from the expansion of Medi-Cal.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"(I'm) really worried,\" said UC Berkeley graduate student Rebecca Fritton, who enrolled in Medi-Cal last summer when she turned 26 and could no longer get coverage from her mother's insurance plan.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If they got rid of that funding, you would have 3 million people on the streets without health insurance, and we would be dead in the water.'\u003ccite>State Sen. Ed Hernandez\u003c/cite>\u003c/aside>\n\u003cp>Fritton wouldn't have been eligible to join Medi-Cal before Obamacare. But after the health care law? Fritton said enrolling was a breeze -- she was even able to keep her primary care doctor at UCSF when she made the switch.\u003c/p>\n\u003cp>\"This has proven to be such a helpful resource for me ... so it’s just a little scary that it could be taken away.\"\u003c/p>\n\u003cp>But Fritton considers herself lucky -- she has another option.\u003c/p>\n\u003cp>\"We get offered health insurance through Berkeley, but it’s pretty expensive and I already have lots of student loans out,\" she said.\u003c/p>\n\u003cp>That's not the case for many other Medi-Cal recipients, said state Sen. Ed Hernandez, who is an optometrist and chairs the Senate's Health Committee. He said there's no way California could keep those millions of new people insured if federal funding disappeared.\u003c/p>\n\u003cp>\"If they got rid of that funding, you would have 3 million people on the streets without health insurance, and we would be dead in the water. That is my biggest concern,\" he said. \"I mean, we don't have the additional dollars, so if that money is not available, patients won't get access to health care. That's the bottom line.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"UgPaWX92hhGiw9hvTFk5GdsgL7J6tRrH\"]\u003c/p>\n\u003cp>The governor is well aware that funding could disappear, said H.D. Palmer, a spokesman for the Department of Finance. But since the Republican plan is still unclear, California can only budget based on current law, he said.\u003c/p>\n\u003cp>\"We don't know yet what changes are in the works specifically for the Affordable Care Act -- but we know there is a very high likelihood that they will happen, so we recognize it as a broad fiscal pressure on state government,\" Palmer said. \"Until and unless there is a change, however, the ACA constitutes the rules of the road -- those are the governing statutes that we budget by and abide by.\"\u003c/p>\n\u003cp>He said the governor's annual budget revision in May will offer the state an opportunity to tweak Brown's proposal if Republicans have made any concrete decisions by then. In general, he said, Brown's administration is trying to keep costs down because of a number of unknown factors, including potential Obamacare changes and whether California's economy will remain strong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"One of the things that we are doing is make sure the state doesn't overcommit itself to ongoing levels of spending that may not be sustainable,\" he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Gov. Jerry Brown unveils his 2017-18 budget Tuesday, there will be one huge question mark hanging over the proposal: What will it cost California when congressional Republicans follow through on their promise to dismantle Obamacare?\u003c/p>\n\u003cp>GOP lawmakers, along with President-elect Donald Trump, have \u003ca href=\"https://ww2.kqed.org/news/2017/01/03/republicans-take-the-first-step-to-repeal-obamacare/\">vowed to repeal the landmark health care law\u003c/a> and replace it with something. But what that something will be is still unknown -- and since California wholeheartedly embraced the Affordable Care Act and insured millions of poor residents through its Medicaid program, Medi-Cal, any rollback is likely to punch a huge hole in the state budget.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/301686124&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/301686124'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Since 2014, Medi-Cal rolls have swelled from about 8 million Californians to about 14 million. One reason: the Affordable Care Act greatly expanded Medicaid eligibility for childless, low-income adults -- more than 3 million new Medi-Cal enrollees have qualified because of that change since 2014. Along with the expanded eligibility came expanded federal funding for Medi-Cal, to the tune of more than $15 billion this fiscal year alone.\u003c/p>\n\u003cp>Now, there are huge questions for both state leaders, who have depended on that federal funding, and the millions of Californians who have benefitted from the expansion of Medi-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"(I'm) really worried,\" said UC Berkeley graduate student Rebecca Fritton, who enrolled in Medi-Cal last summer when she turned 26 and could no longer get coverage from her mother's insurance plan.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If they got rid of that funding, you would have 3 million people on the streets without health insurance, and we would be dead in the water.'\u003ccite>State Sen. Ed Hernandez\u003c/cite>\u003c/aside>\n\u003cp>Fritton wouldn't have been eligible to join Medi-Cal before Obamacare. But after the health care law? Fritton said enrolling was a breeze -- she was even able to keep her primary care doctor at UCSF when she made the switch.\u003c/p>\n\u003cp>\"This has proven to be such a helpful resource for me ... so it’s just a little scary that it could be taken away.\"\u003c/p>\n\u003cp>But Fritton considers herself lucky -- she has another option.\u003c/p>\n\u003cp>\"We get offered health insurance through Berkeley, but it’s pretty expensive and I already have lots of student loans out,\" she said.\u003c/p>\n\u003cp>That's not the case for many other Medi-Cal recipients, said state Sen. Ed Hernandez, who is an optometrist and chairs the Senate's Health Committee. He said there's no way California could keep those millions of new people insured if federal funding disappeared.\u003c/p>\n\u003cp>\"If they got rid of that funding, you would have 3 million people on the streets without health insurance, and we would be dead in the water. That is my biggest concern,\" he said. \"I mean, we don't have the additional dollars, so if that money is not available, patients won't get access to health care. That's the bottom line.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The governor is well aware that funding could disappear, said H.D. Palmer, a spokesman for the Department of Finance. But since the Republican plan is still unclear, California can only budget based on current law, he said.\u003c/p>\n\u003cp>\"We don't know yet what changes are in the works specifically for the Affordable Care Act -- but we know there is a very high likelihood that they will happen, so we recognize it as a broad fiscal pressure on state government,\" Palmer said. \"Until and unless there is a change, however, the ACA constitutes the rules of the road -- those are the governing statutes that we budget by and abide by.\"\u003c/p>\n\u003cp>He said the governor's annual budget revision in May will offer the state an opportunity to tweak Brown's proposal if Republicans have made any concrete decisions by then. In general, he said, Brown's administration is trying to keep costs down because of a number of unknown factors, including potential Obamacare changes and whether California's economy will remain strong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"One of the things that we are doing is make sure the state doesn't overcommit itself to ongoing levels of spending that may not be sustainable,\" he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "what-happens-to-medi-cal-under-a-trump-administration",
"title": "What Happens to Medi-Cal Under a Trump Administration?",
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"content": "\u003cp>President-elect Donald Trump has vowed that he will repeal Obamacare and replace it with something “better.” Specifics are scarce, but one plan Trump has outlined is to change how the federal government funds Medicaid, health coverage for low-income people.\u003c/p>\n\u003cp>Under the Affordable Care Act, 32 states expanded Medicaid, so that more people would qualify for the benefits. Health policy experts say states that embraced it the most could feel the changes the worst.\u003c/p>\n\u003cp>“Winding back the clock would create all kinds of turbulence and disruption,” says Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/292468414″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>Twenty million Americans now have health coverage because of Obamacare. A full quarter of them are in California. And most of them are covered by Medi-Cal, California’s Medicaid program.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Right now, the federal government shares the cost of Medicaid with the states, no matter how many people are enrolled. But Trump wants to cap that funding, and just give states one fixed grant.\u003c/p>\n\u003cp>“A block grant would give California greater flexibility in running the Medi-Cal program, but it would also give the state less money,” Levitt says.\u003c/p>\n\u003cp>In California, 62 percent of new Medi-Cal enrollees are Latino, African-American or Asian-American.\u003c/p>\n\u003cp>“The effect is magnified in California in part because the state has been so successful in getting people signed up for coverage,” Levitt says.\u003c/p>\n\u003cp>Some states could pay doctors and hospitals less to save money. But in California, payment rates are already the second lowest in the country.\u003c/p>\n\u003cp>“California can’t really pay much less than it does to providers,” says Gerald Kominski, UCLA health policy professor. “These are going to be very, very difficult choices.”\u003c/p>\n\u003cp>Under one Republican plan, the amount of block grants would be based on Medi-Cal enrollment levels before the Affordable Care Act was implemented. Kominski says, in that scenario, the only choice California really would have is to reduce services or reduce the number of people who get Medi-Cal.\u003c/p>\n\u003cp>“That would have a devastating consequence on the Medicaid expansion population in California, and would basically put everyone who’s been newly enrolled in the program back off the program,” he says.\u003c/p>\n\u003cp>It’s unclear how soon a Trump administration would change Medicaid funding, so health advocates are encouraging people to continue signing up for Medicaid and other coverage during the current Obamacare open enrollment season.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“California is not an island,” says Anthony Wright, executive director of Health Access, adding that the state “must engage fully in the coming national debate on the future of health reform — especially as an example of what has been achieved, and what we can’t give up.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>President-elect Donald Trump has vowed that he will repeal Obamacare and replace it with something “better.” Specifics are scarce, but one plan Trump has outlined is to change how the federal government funds Medicaid, health coverage for low-income people.\u003c/p>\n\u003cp>Under the Affordable Care Act, 32 states expanded Medicaid, so that more people would qualify for the benefits. Health policy experts say states that embraced it the most could feel the changes the worst.\u003c/p>\n\u003cp>“Winding back the clock would create all kinds of turbulence and disruption,” says Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/292468414″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/292468414″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Twenty million Americans now have health coverage because of Obamacare. A full quarter of them are in California. And most of them are covered by Medi-Cal, California’s Medicaid program.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Right now, the federal government shares the cost of Medicaid with the states, no matter how many people are enrolled. But Trump wants to cap that funding, and just give states one fixed grant.\u003c/p>\n\u003cp>“A block grant would give California greater flexibility in running the Medi-Cal program, but it would also give the state less money,” Levitt says.\u003c/p>\n\u003cp>In California, 62 percent of new Medi-Cal enrollees are Latino, African-American or Asian-American.\u003c/p>\n\u003cp>“The effect is magnified in California in part because the state has been so successful in getting people signed up for coverage,” Levitt says.\u003c/p>\n\u003cp>Some states could pay doctors and hospitals less to save money. But in California, payment rates are already the second lowest in the country.\u003c/p>\n\u003cp>“California can’t really pay much less than it does to providers,” says Gerald Kominski, UCLA health policy professor. “These are going to be very, very difficult choices.”\u003c/p>\n\u003cp>Under one Republican plan, the amount of block grants would be based on Medi-Cal enrollment levels before the Affordable Care Act was implemented. Kominski says, in that scenario, the only choice California really would have is to reduce services or reduce the number of people who get Medi-Cal.\u003c/p>\n\u003cp>“That would have a devastating consequence on the Medicaid expansion population in California, and would basically put everyone who’s been newly enrolled in the program back off the program,” he says.\u003c/p>\n\u003cp>It’s unclear how soon a Trump administration would change Medicaid funding, so health advocates are encouraging people to continue signing up for Medicaid and other coverage during the current Obamacare open enrollment season.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“California is not an island,” says Anthony Wright, executive director of Health Access, adding that the state “must engage fully in the coming national debate on the future of health reform — especially as an example of what has been achieved, and what we can’t give up.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>This post has been updated with the final vote count.\u003c/em>\u003c/p>\n\u003cp>California voters have approved Proposition 52, a ballot measure that makes permanent a fee on hospitals that helps fund Medi-Cal, the state’s health insurance plan for low-income Californians.\u003c/p>\n\u003cp>The measure was proposed by hospitals, who spent more than $60 million to promote it. Dignity Health alone spent $8,478,390 to promote the proposition. With all precincts reporting, the measure passed 70-30 percent in unofficial results.\u003c/p>\n\u003cp>The fee currently draws $3.5 billion a year in federal matching funds. Hospitals say the fee system provides a major source of funding for Medi-Cal patients.\u003c/p>\n\u003cp>The fee system is routinely renewed by the Legislature but requires support from a two-thirds super-majority of lawmakers. Hospitals say permanently extending it ensures the funding source is protected from politics.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A union representing health care workers opposed the measure, saying it benefits wealthy hospital executives.\u003c/p>\n\n",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
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