The state Legislature is considering a bill to create a Basic Health Program in California. If adopted, SB 703 by Ed Hernandez (D-West Covina) would create low-cost health care insurance for as many as one million low-income Californians.
One of the options offered states in the Affordable Care Act, the Basic Health Program shares some goals with the Health Benefit Exchange, though the cost of insurance is expected to be significantly lower under the BHP.
That prospect would seem to be a slam-dunk proposition for patient advocates, but it's not as simple as that.
Experts and policy leaders gathered Friday in the Capitol to discuss the issue in a legislative briefing organized by the California HealthCare Foundation, which publishes California Healthline.
Experts and policy leaders gathered Friday to discuss the issue at a legislative briefing in Sacramento organized by the California HealthCare Foundation, which publishes California Healthline.
"When I first thought of BHP, I saw it as a clear choice, but now I see more to it," said Lucien Wulsin, executive director of the Insure the Uninsured Project, who was a panelist at the briefing.
"With Insure the Uninsured, our goal is to cover all of the uninsured in California. But … I feel that a strong exchange is vital. … And splitting them up into two [entities] could be negative."
The BHP is an alternative to the exchange's coverage for two sets of Californians -- adults with income between 133% and 200% of the federal poverty level, and for legal immigrants with income below 133% of the poverty level.
Wulsin said there are many good reasons to establish a lower-cost BHP; for instance, enrollment might be expanded because lower-income people may be more likely to sign up if the cost was reduced. But he is leery of shifting such a large pool of enrollees away from the exchange, since it is the primary vehicle for expanding enrollment in California. One possible alternative, Wulsin said, is to house the BHP within the exchange, rather than having it run by the Managed Risk Medical Insurance Board, as proposed in SB 703.
Nancy Wise, vice president for planning and strategy at HTMS, a health care consulting firm, painted a detailed picture of policy experts' and stakeholders' concerns and hopes for BHP.
Wise said the potential impact on the volume of the exchange's business is a big point of contention. She said some physicians are wary of a lower reimbursement rate under BHP. And, she said, the addition of a new federal program in the state -- along with Medicare, Medi-Cal and the exchange -- carries its own baggage.
"It's a program that could offer coverage of many people, but it would need significant coordination with other programs," Wise said.
Gerald Kominski, director of the UCLA Center for Health Policy Research, said the number of Californians eligible for BHP is theoretically about 3.1 million, "but in reality about 984,000 Californians would be eligible" for BHP, Kominski said.
"One concern is whether they present higher or lower levels of health risk," Kominski said. "BHP skews somewhat more likely to present poor health status, but when compared to potential exchange eligibles, we don't find much difference."
SB 703 was introduced last legislative session, and is currently in the Assembly Committee on Appropriations.
According to Wise, who called the BHP debate "a murky landscape," most experts and stakeholders don't hold a strong position one way or another about the program. She said most people see the strengths of it and have some concerns, as well.
"Few people were unilaterally for or against the BHP," Wise said, "but they had more of a considering tone."