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The CHCF Blog

The California Health Care Foundation draws on experts from within and outside CHCF to share their health policy insights on this blog. We encourage readers to join the conversation by using the comments feature at the bottom of each article.

  1. ACA Repeal Bill Is Cruel Medicine

    Sandra R. Hernández, President & Chief Executive Officer
    Sandra Hernandez
    Sandra R. Hernández

    Last week, the House bill to repeal and replace the Affordable Care Act (ACA) emerged from the shadows into the glare of public scrutiny, and it wasn't a pretty sight. The American Health Care Act (AHCA) is a deeply disturbing plan that would shift hundreds of billions of dollars to the rich and the healthy at the expense of the poor, the sick, and the elderly.

    Four years after the ACA enabled millions of Californians to gain health coverage from California's Medicaid program (Medi-Cal) and the Covered California marketplace, House Speaker Paul Ryan, with support from President Donald Trump, wants to revoke coverage and care for our most vulnerable people. In the process, he wants to dismantle the carefully constructed broad base of revenues that finance that care. The Congressional Budget Office (CBO) estimates that the Ryan bill would reduce the number of Americans with health insurance by 14 million next year, rising to 24 million in 2026.

  2. How California Can Meet the Challenge of Accurately Diagnosing Autism

    Peter Currie, Senior Vice President, Program Strategy and Innovation
    Peter Currie
    Peter Currie

    A few months ago, I went back to the community where I lived for more than 30 years to attend a big party. The venue looked like a garden-variety medical office, but every one of us at the party knew it was so much more than that. We were there to celebrate the realization of a shared dream — raising the standard of care for a population of vulnerable children. Overcoming professional and institutional barriers, we were able to establish a first-of-its-kind center to ensure that low-income children with autism and related disorders would benefit from more accurate evaluation — at a point in their lives when the interventions would do the most good. The creation of the center ensures that parents and providers get a comprehensive diagnostic assessment and detailed treatment recommendations, and that their health plans can confidently authorize the treatment resources needed to make sure these children get the help they need.

  3. 'The ACA Allowed Me to Pursue My American Dream'

    Anne Sunderland, Senior Communications Officer, Improving Access
    Anne Sunderland
    Anne Sunderland

    Three Californians. Three Stories of How the Affordable Care Act Affected Their Lives.

    On Monday night, legislation to repeal and replace parts of the Affordable Care Act (ACA) was introduced in Congress.

    More than 5 million Californians are now covered under provisions of the ACA. Here are just three. While their stories are different, each shares one thing in common — before the ACA, they all would have likely fallen into the ranks of the uninsured.

  4. Rural Pregnant Women with Opioid Addiction Find a Doctor, Not a Judge

    Zachary Siegel, Independent Journalist (@ZachWritesStuff)

    Eleven years ago, something snapped inside Dr. Candy Stockton.

    She was a busy family medicine physician treating middle class, well-insured patients in Southern California, but she felt unfulfilled. Then a patient who was dissatisfied with his relationships, his job, and his whole life committed suicide.

    "I remember thinking his story wasn't that different than mine," Stockton said. "I couldn't imagine killing myself, but it was really a wake-up call."

  5. Community Paramedicine Delivers Better Care at Lower Cost

    Janet Coffman, Associate Professor, UCSF School of Medicine, Institute for Health Policy Studies
    Janet Coffman
    Janet Coffman

    In a closely watched pilot program, a cadre of specially trained California paramedics is demonstrating how innovative responses to gaps in access to care are improving patient outcomes and reducing costs. Known as community paramedicine (CP) or mobile integrated health, this approach offers policymakers the ability to increase access to medical care and community resources by training existing personnel to perform expanded roles.

    I lead the team that is performing an independent evaluation of the community paramedicine pilot program. Our team, based at the Philip R. Lee Institute for Health Policy Studies and the Healthforce Center at the University of California, San Francisco, recently released data on the first year of pilot project operations, and the results are very promising.

  6. The Perils of Partial Health Reform

    Amy Adams, Senior Program Officer, Improving Access
    Amy Adams
    Amy Adams

    When it comes to the Affordable Care Act (ACA), many are trying to predict the future. At the California Health Care Foundation, we're also looking to the past, examining how lessons from prior health reform efforts can help guide us through a time of great uncertainty. A new report from PricewaterhouseCoopers (PwC) examining state efforts to reform individual and small group health insurance markets before the ACA is particularly relevant to the ongoing debate.

    The PwC report primarily looks at the experiences of four states: Kentucky, Massachusetts, New York, and Washington. (California is also included but is not a main focus because California's pre-ACA reforms were limited to the small group market.) In general, the states shared common goals: Improve access to coverage for those who do not have health insurance through an employer or a public program, reduce the number of uninsured residents, improve the viability and stability of the individual market to provide consumers with a choice of plans, and keep premiums under control.

  7. Uncompensated Hospital Care Costs Sink to Record Low in California

    Jen Joynt, Independent Health Care Consultant
    Jen Joynt
    Jen Joynt

    As California's uninsured rate plummeted during the first two years of the implementation of the Affordable Care Act (ACA), uncompensated care costs for California's hospitals followed suit, declining 52% from $3.1 billion in 2013 to $1.5 billion in 2015, according to data from the California Office of Statewide Health Planning and Development (OSHPD) now available on ACA 411. This progress may be in peril, however, if efforts to repeal and replace the ACA are successful and the uninsured population increases.

    To continue reading this article, go to the ACA 411 uncompensated hospital care costs page.

  8. Bringing Moneyball to Medicine

    Andy Bindman, Professor of Medicine, Health Policy, Epidemiology, and Biostatistics, UCSF
    Andy Bindman
    Andy Bindman

    For most of the last year I had the privilege of serving as director of the US Agency for Healthcare Research and Quality (AHRQ), the lead federal agency charged with improving the safety and quality of America's health care system. AHRQ is not a payer or regulator. It develops the knowledge, tools, and data needed to improve the health care system and help Americans, health care professionals, and policymakers make informed health decisions.

    Change is a reality of our political process. When the new administration took over last month, I reluctantly departed to return to my work as a primary care physician and a health services researcher at the University of California, San Francisco (UCSF). The completion of my work at AHRQ did nothing to dampen my excitement about AHRQ's future and its readiness to support transformation to an improved health care system.

  9. What I Learned from My 20-Year Fight for Children's Health Coverage

    Bob Brownstein, Director of Policy and Research, Working Partnerships USA
    Bob Brownstein
    Bob Brownstein

    This article is adapted from remarks delivered at a David and Lucille Packard Foundation event celebrating California's commitment to universal coverage for children.

    I'm the public policy and research director at Working Partnerships USA (WPUSA), a San Jose-based community organization that drives the movement for a just economy by bringing together public-policy innovation and the power of grassroots organizing. It's the same job I held 16 years ago, when my organization and People Acting in Community Together (PACT) boldly announced that Santa Clara County would be the first in the nation to provide health insurance for every child.

  10. Travel Ban Highlights Importance of Immigrant Physicians to California Health Care

    Avram Goldstein, Senior Engagement Officer
    Avram Goldstein
    Avram Goldstein

    One week after taking office, President Donald Trump delivered on a high-profile campaign promise and issued an antiterrorism order that has reverberated around the world. The president banned nationals of seven Muslim-majority countries (Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen) from traveling to the US for the next three months, suspended admission of all refugees for four months, and indefinitely blocked admission of Syrian refugees to the US. Up to 100,000 people were affected, with many detained, some deported, and thousands overseas forced to change their travel plans to the US.

    Some physicians employed in the United States were caught up in the executive order. The episode has not only provoked a showdown over the federal courts' authority to block the president's order, it has alerted health care organizations that they may be unable to keep their staffing at full strength. In California, hundreds — possibly thousands — of doctors could be affected by immigration bans.

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