07/17/2010 07:52 pm ET Updated May 25, 2011

What Does Health Care Reform Mean For Californians?

Health care reform is coming to a city near you, and it might not be pretty. There's a lot of confusion right now about how the new laws will affect citizens, both as consumers and as taxpayers, as well as the state of California. To address the issue, Zocalo Public Square convened a forum of experts last night at NPR West Studios in Culver City. LA Times health reporter Duke Helfand moderated a panel with California HealthCare Foundation's Marian Mulkey (the foundation sponsored the event), Jan Spencley of San Diegans for Healthcare Coverage, Small Business Majority CEO John Arensmeyer, and Lucien Wulsin of the Insure the Uninsured Project.

What follows is a short summary of the evening's questions and answers. To watch the full video of the event, visit Zocalo Public Forum. Photo courtesy of Aaron Salcido.

Health Care Reform Goal: expand health insurance coverage.
Challenges: Implentation, implementation, implementation. Lucien Wuslin notes, "the opportunities to mess this up are legion."
Current Status: In 2009, due to layoffs and a rise in premiums, there are over 8 million uninsured Californians - that's one in four people in the state.

Questions and Answers

1. I have a pre-existing condition. What are my options?

California will receive $760 million to create a high-risk pool in September for people who have been blocked from health insurance due to a pre-existing condition. The Managed Risk Medical Insurance Board of California is accepting applicants right now at There are over 200,000 people in California that fit this description, but the program is likely to cover only 30,000. Get in line early. The premiums are likely to be expensive, but at least those who can afford them can finally get coverage. ( via Lucien Wulsin of the Insure the Uninsured Project)

2. I run a small-business. How will I be able to afford coverage for my employees?

Health insurance exchanges are being debated right now that could allow small businesses to band together for the leverage of a big business in order to negotiate health insurance costs. Lucien Wulsin likens the exchanges to a cross between "William Shatner negotiating prices on [Priceline] and Travelocity, displaying what those prices are." Self-employed people can also participate in these exchanges.

Additionally, tax credits for small businesses are available immediately. These small businesses need to have less than 25 employees, and the average salary is less than $50,000 a year. It's estimated that 80% of California's small businesses will be able to benefit. Businesses with over fifty employees will be mandated to cover their employees or face a fee. (via Small Business Majority CEO John Arensmeyer)

3. I make too much money to participate in the 2014 MediCal/Medicaid expansion. Does the government help pay for my mandated insurance?

Refundable tax credits can help pay for premiums. To qualify for this, an individual can make up to $14,000 a year. Families can be making up to 400% of the poverty level ($88,000 for a family of four) to qualify. Mandates don't go into effect until 2014.

4. Is it true that my Medicare is being cut?

Medicare Advantages plans, or Medicare HMOs, will be forced to compete on the open market instead of enjoying protected status. Marian Mulkey reminds us that California has lots of people enrolled in these Medicare Advantage plans and that right now, they are enjoying more generous benefits or paying less than they will when the changes happen. "People will feel some pain," Mulkey emphasized. "It's going to be a little ugly for the next few years.. there's no way they could pass something that was going to magically fix everything immediately," Arensmeyer added. Consider yourself warned!

5. California's budget is in crisis right now. How will this affect our state's bottom line?

Most of the funding for health insurance will be federal, so it won't burden California as a state. In fact, some of California's programs will no longer be needed because new federal programs will make them redundant, easing our load even more. Lucien Wulsin estimates California may be able to save $1.8-$2 billion. Jan Spencley of San Diegans for Healthcare Coverage reminds us that in the interim, Gov. Schwarzenegger has already begun cutting the budget for health coverage for poor women and children in anticipation of the federal funds.

However, as an audience member noted, California will be facing new costs such as the administrative needs of the Exchange, the financial incentives for doctors to enter primary care, more people who require medical services, and the costs of more preventative care.

6. How does the health care reform affect the undocumented in California?

The panel gave a strong, brief, and unified answer: absolutely no change in status for undocumented immigrants. They cannot benefit from any subsidies or tax credits or buy into any of the exchanges, even if they could afford it. In fact, as the reforms roll out over the next few years, it is anticipated that the state will decrease funding to the community and county clinics that service many undocumented immigrants, as it will be assumed that more people are getting health insurance coverage. (via Jan Spencley of San Diegans for Healthcare Coverage)

7. Bottom line: are premiums going up or down?

Preventative care and abolishing lifetime caps will drive premiums up, but measures like the health insurance exchange and more efficient administration mandates will drive premiums down. Mandates will also keep costs down. The CBO scored premium changes as slightly decreasing for big businesses, both slight increases or decreases for small businesses, and big decreases for individuals on the market. On the other hand, individuals may find that their dollars go so much further with the new insurance policies that they may be motivated to buy more coverage, automatically increasing their premiums. John Arensmeyer emphasized, however, that the growth of costs (cost containment) is not going to go down until everybody is in the system, which may take five to ten years.