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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. 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 51% 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.

  2. 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.

  3. 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.

  4. 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.

  5. In California Health Policy, What's Past Is Prologue

    Marian MulkeyIt's hard to know where you're going if you don't know where you've been. To understand how California policies expanding coverage and access to health care developed before passage of the Affordable Care Act (ACA), independent consultant Marian Mulkey created a helpful timeline that traces the progression. The chronology describes California's policy debates and implementation experiences, connects readers to resources that go into greater detail, and gives context to inform the state's responses to potential ACA repeal. Check out the timeline.

  6. In California, What's Driving the Variation in Total Cost of Care — Volume or Price?

    Jeffrey Rideout, President and CEO, Integrated Healthcare Association
    Jeffrey Rideout
    Jeffrey Rideout

    As the "repeal and replace" debate continues in Washington over the future of the Affordable Care Act, policymakers considering new legislation should not lose sight of the key concept of the ACA — affordability. High and rising costs are among the most intractable health care issues facing consumers across California and the nation, and any discussion must keep underlying cost drivers at the forefront.

    But where should the focus be? At the most elementary level, total health care spending boils down to two main factors: how much care we use (volume, or utilization) and what we pay for that care (price). Teasing out how each factor — utilization or price — contributes to costs is important because cost-control solutions vary depending on the answer.

  7. In Extremis: The Stark Reality of Life and Death in the ICU

    Steven Birenbaum, Senior Communications Officer
    Steven Birenbaum
    Steven Birenbaum

    The first time intensive care unit physician Jessica Zitter encountered the "family support team" — a precursor to the palliative care services now routinely found in hospitals — it didn't go well. Zitter felt threatened. She thought, "Who are these people getting in the middle of my relationship with my patients and telling me I'm not doing it well or not asking enough questions?"

    Like many doctors early in their careers, Zitter was convinced her role was to save patients "from the jaws of death." Over the years, however, she came to realize she was often causing more suffering, particularly for those who were dying or frail. But that was the paradigm in which she had been trained. "The way I had been taught," she said, "was when this organ starts to fail, insert this catheter. And when that cardiac function isn't working, use this medication. And when the person stops being able to breathe, insert a breathing tube."

  8. Making Room in the Maternity Ward for Normal Childbirth

    Chitra P. Akileswaran, Obstetrician-Gynecologist at Highland Hospital and Lecturer at Beth Israel Deaconess Medical Center
    Margaret S. Hutchison, Certified Nurse-Midwife at Zuckerberg San Francisco General Hospital and Clinical Professor of Obstetrics, Gynecology, and Reproductive Sciences at UCSF
    Chitra Akileswaran
    Chitra P. Akileswaran
    Margaret Hutchinson
    Margaret S. Hutchison

    Between 1935 and 1985, the number of American women who died from complications of childbirth dropped by 99%. Our health care system achieved this success by orienting around safeguards to protect women against the worst possible outcomes — an approach that continues to this day to define the delivery of hospital-based US maternity care.

    Recently, conversations among care providers, policymakers, and patients have begun to challenge this assumption. Have we created a system so focused on vigilance to protect mothers and newborns at birth that we interfere with the normal processes of childbearing? And if so, at what cost?

  9. New Reports Highlight the Potential Economic Impacts of ACA Repeal

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

    The proposed repeal of the Affordable Care Act (ACA) without a simultaneous comparable replacement will put health coverage for millions of Californians in jeopardy. According to two recent reports, it will also put a lot of jobs in jeopardy. California stands to lose more than any other state because it has the largest population and because it fully embraced opportunities to expand coverage through the ACA.

    Recent research from George Washington University, supported by the Commonwealth Fund, projects that the US would lose 2.6 million jobs in 2019, the year repeal is assumed to take effect. California is projected to lose 334,000 jobs — 225,000 more than the next most-affected state, Florida. The report also details declines in state and local taxes, gross state product, and other economic indicators across the country and by state if no replacement plan is in place between 2019 and 2023.

  10. How CHCF Is Responding to the Changing Landscape

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

    The inauguration of Donald Trump as our next president seems likely to bring significant change to the health care system. While we at the California Health Care Foundation (CHCF) can only guess how the story will play out, the intense debate highlights to us that the foundation's core mission — improving the health and care of all Californians, especially the underserved — is more important than ever.

    We are proud of California's gains from the Affordable Care Act (ACA). Five million more Californians are now covered, the uninsured rate has been cut in half, financial stability has increased for families and health care institutions, and thousands of jobs have been created.