Health Reform Gives Some Immediate Benefits for Californians

Health care reform changes are vast and include many changes that will affect Americans now and in the future. While we’ve focused several articles on the changes affecting Medicare and Medicare beneficiaries, this article below, focuses on those affecting Californians old and young. Excerpted from the Passages HICAP Recap July-August 2010 newsletter (PDF), this article lists some of these changes and explains some of the immediate benefits impacting Californians.

Small business tax credits

503,000 small businesses in California could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable. Small businesses pay, on average, 18% more than large businesses for the same coverage, and health insurance premiums have gone up three 3 faster than wages in the past 10 years. This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole

Last year, roughly 382,000 Medicare beneficiaries in California hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs. Medicare beneficiaries in California who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks began being sent to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. (See our past blog article, Are You Eligible for the Part D Rebate: Q & A for more info.)

Support for health coverage for early retirees

An estimated 430,000 people from California retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time. On June 1, 2010, a $5 billion temporary early retiree reinsurance program started to help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010

  • Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 19 million California residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.
  • Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 2.7 million individuals who purchase insurance in the individual market from dishonest insurance practices.
  • Insurance companies will not be able to exclude children from coverage because of a preexisting condition, giving parents across California peace of mind.
  • Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 16.2 million residents of California with health insurance from their employer, along with anyone who signs up with a new insurance plan in California.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim. Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extended coverage to young adults

Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 196,000 individuals in California who could now have quality affordable coverage through their parents. Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with preexisting conditions

$761 million federal dollars are available to California starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014, when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers

Beginning on October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen over the next 5 years. The funding could not only help the 1,049 Community Health Centers in California but also support the construction of the new centers.


More doctors where people need them

Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over 5 years) for scholarships to help the 1,049 Community Health Centers in California but also support the construction of new centers and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 9% of California’s population who live in an underserved area.

New Medicaid options for states

For the first time, California has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. For more information on health care reform issues visit:

Also see our article, What Does Health Care Reform Mean for Beneficiaries? Summary of Key Provisions.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.