Policy in California
The Patient Protection and Affordable Care Act, better known as Obamacare, enacted back in 2010 in honor of the President of the United States who approved the reform, was designed to make medical care for Americans more affordable and accessible. It is worth recognizing that despite the scale of the program, the California State Administration has demonstrated the best policy applicability in everyday health care practice (Colliver, 2019). In particular, it is known that the reform, which became the main merit of Barack Obama’s presidency, was aimed at increasing the share of insurance policies in the population while reducing the cost of health services (Pant et al., 2017). The law has not gone smoothly in all states, but the California authorities have ensured that low-income citizens can qualify for health services.
The state’s significant achievement is that the Obamacare system has been transformed into a structure called Covered California, divided into levels. Metal levels of coverage for patient financial costs vary according to the number of services provided, but the government states that the quality of care, in any case, remains unchanged (“The Affordable Care Act for California,” 2017). Levels start in bronze when the patient pays 40% of the service, and end in platinum when the cost of treatment is only 10% of the total. Regardless of the cost, health care insurance services include outpatient treatment, emergency care, prescription work, preventive therapy, and psychological counseling, as well as pediatric care.
Adoption of the bill
The United States has been characterized by a situation where the cost of medical care has increased unduly while maintaining its quality. As a result of such a health care crisis, there was a problem of policy rejection due to unreasonably high costs (Peterson, 2018). As a result, health system stakeholders, including patients, medical staff, pharmacists, drug manufacturers, entrepreneurs, and policymakers, were deliberately at a loss. Among other things, it is worth understanding that these circumstances caused not so much economic collapse as the real problem of providing quality health care to the population. The situation in California began to change in September 2010, when then-Governor Arnold Schwarzenegger signed Assembly Bill 1602 and Senate Bill 900. In the early years, the program began to expand actively, implementing a system of metal levels and registering customers. Schwarzenegger’s successor governor, Jerry Brown, and later Gavin Newsome, took bold steps beyond Obamacare to allow the Covered California program to scale. So, as a result of the activity of a state administration, according to Sunderland (2020), for years of existence of a policy, the number of uninsured Californians has fallen on 3.7 million people that is the most significant indicator among all states (figure 1). At the same time, treatment spending fell sharply by $1.7 billion between 2013 and 2017 (Sunderland, 2020). These figures show the effectiveness of the reform in the daily lives of citizens.
Search for compromises
Given the multidimensional nature of the adopted reform, it would be wrong to assume that the only object of influence in Covered California is patients. There are more stakeholders, and each one is affected by an improved health care system. Thus, for patients, Covered California means reducing the cost of health care and guaranteeing care, including psychological care. The law also made medical platforms more accessible, which could increase public interest in medical sciences. Figure 2 shows the upward trend in funding for Covered California entities, so it is safe to say that the reform is proving useful for health organizations to hire higher-quality staff (Ghaly et al., 2019). Within a clinical organization, health care reform has led institutions to focus on patient health by focusing on evidence-based medicine (Drake, 2019). Among other issues, this phenomenon may have increased the demand for medicines, as more patients were under medical and nursing care. As a result, the number of legal costs due to inappropriate treatment may have decreased. Given the importance of the nation’s health care, Californians’ increased insurance coverage demonstrated a positive effect for policymakers and authorized individuals by attracting additional funding from the federal government.
Role of public perception
While focused on public health, reform must take into account public perceptions of the program, taking into account both Covered California’s strengths and its apparent weaknesses. The latter include the bureaucratic difficulties encountered in applying for membership: quite often, due to fluctuating income levels, patient benefits can decline (Bazar, 2017). It is the public perception that allows assessing how well the Covered California program is being implemented, so the state administration should increase public awareness of its benefits.
It must be recognized that there is a system of linkages between the degree of community involvement in health processes and the quality and quantity of services provided. In particular, if citizens show a low level of interest in reforms such as Covered California, fewer health care referrals, as well as lower economic outcomes for facilities, municipalities, and the state. In a more optimistic scenario, when the population shows interest in reforms, there is a situation where all stakeholders understand the benefits of cooperation, which makes the healthcare system better. It should be noted that for California, active advocacy works more effectively than the American average: in the reporting period 2017-2018 alone, the administration planned to spend more than $111.5 million on marketing promotion of the insurance program, including banners, posters, radio, and television information (Ibarra & Rodriguez, 2017). These steps allow us to highlight another stakeholder of Covered California, namely the advertising agencies that win tenders for marketing campaigns.
Balance for stakeholders
Considering the already mentioned economic benefits from the technical implementation of the law for advertising agencies, it should be noted that the improvement of the health care system will impact other stakeholders. For example, increased funding for clinical organizations will lead to an increase in the number of employees, which in turn will have an impact on reducing waiting times for emergency care for patients (Mclaughlin & McLaughlin, 2015). By contrast, an assessment of public perceptions, along with a survey of health care workers about their satisfaction with changing working conditions, allows California managers to analyze the program’s effectiveness and take appropriate steps to improve it. However, it is essential to understand that such an extensive regional program involves risks, so their accounting and control allow for a scenario where each interested participant is assured of their benefit. One such risk has been the Coronavirus COVID-19 pandemic, exposing the shortcomings of public health systems to a large extent. However, this challenge became a decisive one for Covered California, as the virus allowed the program to increase its spread to the low-mobility and poor populations. This, in turn, demonstrates the law’s effectiveness for patients, health care providers, and state administration.
References
The Affordable Care Act for California (ACA). (2017). Health for California. Web.
Bazar, E. (2017). How to cope with Covered California glitches. The Sacramento Bee. Web.
Colliver, V. (2019). California goes even bigger on Obamacare. Politico.
Drake, C. (2019). What are consumers willing to pay for a broad network health plan? Evidence from covered California. Journal of Health Economics, 65, 63-77.
Ghaly, M., Fearer, P., Fleming, J., Hernández, S., Torres, A. (2019). Covered California Annual Report [PDF document].
Ibarra, A. & Rodriguez, C. (2017). California is outspending the U.S. government to market Obamacare. CNN Business. Web.
Mclaughlin, C. & McLaughlin, C. D. (2015). Health policy analysis: An interdisciplinary approach, 2nd ed. Jones & Bartlett Learning
Pant, S., Burgan, R., Battistini, K., Cibotto, C., & Guemara, R. (2017). Obamacare: A view from the outside. Hawai’i Journal of Medicine & Public Health, 76(3 Suppl 1), 42-44.
Peterson, M. A. (2018). Reversing course on Obamacare: Why not another Medicare catastrophic? Journal of Health Politics, Policy and Law, 43(4), 605-650. Web.
Sunderland, A. (2020). Ten years after: The ACA’s success in five charts. California Health Care Foundation. Web.