FAIRFIELD — County officials expect the federal health care reform provisions taking effect in January 2014 to have some type of impact on county coffers.
The question is how big and whether for good or bad. The Board of Supervisors on Tuesday began to grapple with the issue, with no clear answers yet to emerge.
Counties are front and center of the discussion because Gov. Jerry Brown’s administration wants them to share the risks associated with a planned MediCal expansion, according to a California State Association of Counties report.
The Federal Patient Protection and Affordable Care Act is perhaps best known for the legal battle over whether the federal government can force individuals to purchase health care or pay a penalty. The U.S. Supreme Court last year settled that argument in favor of the Obama administration, allowing the requirement.
Now, as county and CSAC officials made clear, the effects of the Affordable Care Act are about to hit home.
California has an estimated 7.1 million uninsured residents, county Health and Social Services Director Patrick Duterte wrote to the board. The goal of the Affordable Care Act is to get more people insured.
Because of the Affordable Care Act, California is establishing a health insurance exchange. Called “Covered California,” it is to offer health care insurance at the gold, silver and platinum levels and will begin enrollment in October. About 2 million people will be eligible, Farrah McDaid Ting of CSAC told the board.
California is also expanding MediCal to make another 1.4 million people eligible and perhaps enroll the 1.3 million people who are already eligible but not enrolled, Ting said. MediCal is the state’s public health insurance program for the poor and the state’s version of Medicaid. Ting called this expansion the “heart and soul” of the Affordable Care Act.
Solano County, like all state counties, provides health care for the needy and uninsured. What role the state and its counties will have after January 2014 remains to be seen.
“It’s an issue that’s still evolving even as we speak in the Legislature and in some cases at the federal level,” Ting told the board.
Risks to counties include whether revenues will match the new responsibilities and what will happen with future state and federal legislation, the CSAC report said.
A big part of the uncertainty for Solano County and other counties has to do with the MediCal expansion. Ting said Brown has proposed two options, one a statewide MediCal expansion and the other that has the counties in charge of the MediCal expansion.
MediCal is to start insuring adults who meet income eligibility requirements, but who didn’t previously qualify because they don’t fall under the categories of being disabled or elderly or having children. These adults are called “medically indigent adults.”
The federal government is supposed to pay 100 percent of the costs for the MediCal expansion for three years and 90 percent by 2019, Ting said. But Brown has concerns this will actually happen, given the federal budget deficit arguments going on in Congress, she said.
No matter what happens, Solano County and other counties will still have to provide health care for the needy who remain uninsured after January 2014, as well as continue to administer various other public health and mental health programs, a county report said.
Brown in his proposed state budget wrote that some money presently spent by counties on health care for the needy should be redirected to the state to help pay the state’s Affordable Care Act costs. But the state needs to consider that counties will still have to provide medical care for those who remain uninsured, he wrote.
Solano County gets $36.8 million in so-called “1991 realignment” money from the state for various health and social services programs. How much of that money will get redirected is a question mark.
As it turns out, the issue proved too big for the Board of Supervisors to tackle during a single presentation. It will take up the topic again in March.
“We’ll look forward to Part Two,” Board of Supervisors Chairwoman Linda Seifert said at the end of Tuesday’s presentation.
Reach Barry Eberling at 427-6929 or firstname.lastname@example.org. Follow him on Twitter at www.twitter.com/beberlingdr.