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Medicaid Recipients Are Not Invisible

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California reached a historic milestone this week with the announcement that 1.2 million people are enrolled in the state's health care exchange.

California's success is a credit to Peter V. Lee, Covered California's Executive Director, who announced the news at a U.S. House of Representatives Oversight and Government Reform Committee hearing: "I sit before you today proud of what we have accomplished as a state and as a nation ... for the first time in our history, health care is now a right and not a privilege."

But those numbers tell only a third of the story. In addition to enrollment in the marketplace plans, California also enrolled nearly 2 million residents in Medi-Cal, our state's Medicaid program, with an additional 800,000 applications in the pipeline and more rolling in every day.

What is extraordinary is that many of these new Medi-Cal recipients are insured for the first time. That's because the Affordable Care Act allowed states to expand their Medicaid programs to cover single adults and childless couples.

Oddly, many members of Congress at the hearing didn't seem concerned that new Medicaid enrollees were left out of the total ACA enrollment count. Fortunately, Dr. Joshua Sharfstein from Maryland's exchange spoke up for these folks and said, "I don't consider the Medicaid individuals to be invisible."

Dr. Sharfstein's comment spoke volumes. In the last few years, the media and many policymakers have failed to address the critical role that Medicaid plays in the health care law's mission to expand access to affordable, quality health coverage. That's a shame, since its expansion was meant to assist people who, in many ways, need health coverage the most: lower-income families and individuals, seniors, the disabled and others who cannot afford coverage on their own.

Medi-Cal managed care offers 22 health plans, many of which are also offered through Covered California. Often, individuals who meet income requirements can enroll in Medi-Cal with no premiums, no co-payments and no out-of-pocket cost. Like marketplace plans, Medi-Cal offers people comprehensive preventive care and access to essential benefits like vaccinations, annual check-ups, blood pressure and cholesterol tests, and more.

All in all, in states that expanded Medicaid, consumers who qualify have access to the same comprehensive care as marketplace plans at little or no cost. And for individuals and families in states where their leaders chose not to expand Medicaid programs, millions are losing out.

And here's the best part: For all the attention the media and pundits have put on the March 31 deadline, they've neglected to report to the public that they can still apply for health coverage through the Medicaid program in their state. Medi-Cal enrollment is open year-round and applications will continue to be submitted.

Here in California, there is more work to be done to build on the initial success of the ACA rollout.

First, California's leaders need to create a renewal system that simplifies the process for people to stay on Medi-Cal. Currently, recipients have to undergo a painful, bureaucratic process to remain in the program. We need to advocate for a commonsense system that allows those who need coverage and have coverage to keep their coverage and not lose it over bureaucratic confusion.

Second, we have to advocate for those who are left out of both Medi-Cal and marketplace plans. More than a million undocumented Californians remain without access to affordable, quality coverage. Most of them would pay for coverage if it were affordable, but under current law, they aren't even eligible to buy a plan on the exchanges if they pay for the entire premium cost. Until all Californians have access to affordable coverage and care, our work is not over.

Finally, we have to make sure that the very Californians who are enrolled and enrolling in health care through state and national exchanges can exercise their right to help determine the future of these programs. The Affordable Care Act was meant to include California's most underserved communities -- and these communities often have the lowest voter participation rates in the state.

We must make it easier for the underserved to also participate civically by registering and empowering them to vote. This means providing a pre-populated voter registration form when they fill out their Covered California application. As politicians endlessly debate the program's future, it's important that the voices of those who have gained health coverage through the law have their voices heard too.

Let's celebrate together that the direst predictions about the Affordable Care Act have been proven wrong again, and millions have gained coverage through both the exchanges and Medi-Cal. The time for arguing about what's done is over; now is the time to work together to fulfill the promise of the new law for the health and future of our state.