California Journal of Politics and Policy

Campaign Contributions Are a Growing Threat California’s Courts

Maricela Gutierrez — Mon, 12 Dec 2011 15:58:00 PST

The Promise of Affordable Care: Maintaining Coverage During Life Transitions

Ann O'Leary et al. — Thu, 10 Nov 2011 16:09:03 PST

Americans’ health insurance coverage is not static; people cycle in and out of coverageand between sources of coverage during life transitions like losing a job, changing jobs, moving, or divorce. The Affordable Care Act creates an unprecedented opportunity to address the gaps in health coverage caused by life transitions. Achieving the promise of the Affordable Care Act will require attention in federal regulations and actions by the new health insurance exchanges to ensure seamless coverage for those who rely on private insurance, including job-based coverage. This paper analyzes the population experiencing life transitions that lead to a loss of health coverage and makes several policy recommendations to ensure that all Americans can maintain health coverage under the ACA—even during complicatedlife transitions.

Is California Different? State-Specific Risk Adjustment Needs under Health Reform

Brent D. Fulton et al. — Thu, 10 Nov 2011 16:09:00 PST

The Affordable Care Act (ACA) allows state variation in implementing health reform. Critical to a stable health insurance market under reform is the use of risk adjustment to share risks across insurance plans. The ACA requires states to implement risk adjustment, but a California-specific risk adjustment scheme would require expertise beyond existing abilities of state agencies. California could rely on a default federal risk adjustment scheme, but it is unclear California’s health care market is sufficiently different from the national market to render the federal scheme inadequate. We compare the distribution of risk-adjusted health care expenditures in California versus the United States. We find California expenditures highly similar to the United States and conclude that California could rely on a federal risk adjustment scheme that pays special attention to high risks and differential patterns for HMO vs PPO plans.

The California Challenge: Ensuring Primary Care Access for Medi-Cal Recipients under the Affordable Care Act

Donald A. Barr — Thu, 10 Nov 2011 16:08:57 PST

This paper describes options for expanding access to care for California’s Medi-Cal population. Recent federal policy initiatives and an expanding set of research reports have begun to focus considerable attention on developing new models for the organization of primary care services. Initial results suggest that these innovative delivery models can both decrease the overall cost of care while improving the quality of care. This conclusion is especially relevant for those who provide care to Medi-Cal recipients with chronic medical conditions—the population that contributes by far the most to the cost of Medi-Cal. The exigencies of containing both federal and state health care expenditures for all covered populations make consideration of alternative modes of health care delivery an essential part of any analysis of the potential impacts of ACA, both in California and throughout the country.

Access to Job-Based Insurance for California’s Workers and their Families: The Effect of the Great Recession and Double-Digit Unemployment in California

Shana Alex Lavarreda et al. — Thu, 10 Nov 2011 16:08:52 PST

Lack of health insurance affects workers and families who depend on job-based coverage for health care. In 2007, the unemployment rate in California was 5.5%. By the end of 2009, it had more than doubled to 12.3%. This study uses data from the 2007 and 2009 California Health Interview Survey to assess changes in access to job-based health insurance among California workers and their dependents. We find that although increased unemployment dramatically reduced the number of employees, the proportion of employees with no access to job-based coverage through either their own or a spouse’s work remained constant. Among adults with no family access to job-based insurance, the most significant determinants of being uninsured were income and citizenship. Due to more generous public health insurance options, children with the lowest household incomes were not significantly more likely to be uninsured than children with higher household incomes. The results highlight the importance of public health insurance for children and confirm the need for the Affordable Care Act’s insurance expansion provisions.

Medicaid Expansion and the Patient Protection and Affordable Care Act: Lessons and Hopes for Implementation of Healthcare Reform

Autumn Kieber-Emmons et al. — Thu, 10 Nov 2011 16:08:48 PST

This study was designed to examine the perspectives and concerns of California healthcare policymakers and stakeholders about the upcoming expansion of Medicaid. Key California stakeholders show general support for the expansion of Medicaid, with concerns about the cost to implement expansion, hopes for increased use of managed care delivery system reform to produce cost savings, worries about provider access and physician payment rates, and support for the recent California Section 1115 Medicaid Waiver “bridge to reform” as a timely measure for the transition to Medicaid expansion. This state-level perspective from California can help to inform state and national preparations for the 2014 implementation of Medicaid expansion.

The Politicization of Evidence-Based Medicine: The Limits of Pragmatic Problem Solving in an Era of Polarization

Alan S. Gerber et al. — Thu, 10 Nov 2011 16:08:44 PST

A key test of a political system is its capacity to solve important societal problems. Few policy areas in the U.S. are more problem-ridden than health care. Medical care is expensive and wasteful, and the quality often falls short of best practice. One idea to improve health care is to eliminate gaps in the medical evidence base through “comparative effectiveness research” (CER). By identifying what treatments, tests, and technologies work best, CER could help doctors, patients, and payers make better decisions and help reduce wasteful spending. CER was a technocratic, third-tier issue familiar mainly to policy experts based in universities, foundations, and think tanks, but hardly anyone else. This paper traces how this obscure policy initiative got caught up in the wider ideological struggle over national health reform.

Public Opinion on the Affordable Care Act at One Year: Continuities and Contradictions

Claudia Deane et al. — Thu, 10 Nov 2011 16:08:40 PST

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. The law, which includes provisions to rein in the cost of health care and improve the health delivery system, will be phased in over several years. In the interim, this signature accomplishment remains mired in intensely partisan debate, reflective of the fact that it passed the U.S. House and Senate on party line votes, and candidates for the Republican presidential nomination continue to express an interest in repealing it wholesale. In this paper, we rely on a monthly survey series conducted by the Kaiser Family Foundation to assess public reaction to the ACA across the first year of its existence, noting both the continuities of opinion and the inherent contradictions in people’s views.

Is the Patient Protection and Affordable Care Act Constitutional?

Laurence H. Tribe et al. — Thu, 10 Nov 2011 16:08:37 PST

This is an edited transcript of a debate sponsored by the Commonwealth Club of California and the Institute of Governmental Studies, University of California, Berkeley. The speakers were Laurence H. Tribe, the Carl M. Loeb Professor and Professor of Constitutional Law at Harvard Law School, and Roger Pilon, Vice President for Legal Affairs and Director of the Center of Constitutional Studies at the Cato Institute. The debate was moderated by Jesse Choper, Earl Warren Professor of Law at the University of California, Berkeley Law School.

Implementing Health Reform in California

Congresswoman Doris O. Matsui — Thu, 10 Nov 2011 16:08:33 PST

The Impact of Health Insurance Policy Changes on Californians with Severe Chronic Disease

Arleen A. Leibowitz et al. — Wed, 05 Oct 2011 12:09:23 PDT

Two recent changes in health policy will likely negatively impact state budgets and the health of low-income Californians with chronic disease. The new cost-sharing for medical visits, pharmaceuticals, and inpatient stays in California’s Medcaid program (Medi-Cal) and the exclusion of the undocumented and individuals who have been legal residents for less than five years from the insurance expansions that The Patient Protection and Affordable Care Act of 2010 provides will reduce medical care utilization and may raise, rather than lower, state costs. Based on historical Medi-Cal utilization patterns, people living with HIV (PLWH) would average $514 in cost-sharing fees annually. The undocumented may lose coverage entirely and face even higher costs. The charges are high relative to the low incomes of both Medi-Cal recipients and the undocumented and are likely to discourage relatively inexpensive, but productive, medical care. Increasing patient costs harms patient health, harms public health, and increases state spending on medical care.

Comparative Advantage and Job Formation in California and Texas

Jerry Nickelsburg — Fri, 23 Sep 2011 10:19:15 PDT

By most measures the economy of the state of Texas is doing better than that of California. Texas has an unemployment rate 4% below California, it is considered to have a more conducive business climate than California and its attractiveness has caused immigration rates to Texas to be the highest in the nation. In this article we examine the “Texas Miracle” in the context of comparative advantage. By framing the analysis through the lens of the economic theory of specialization, we find that Texas is indeed doing better, but only in as much as it would be expected to do so even in the absence of lower taxes and better business climate. This then suggests that the policy discussion with regard to California job formation should be centered on how California can enhance its comparative advantage and facilitate job formation rather than how California can mimic other states or prevent the relocation of business to other states.

Judging the Redistricting Commission

Tony Quinn — Tue, 20 Sep 2011 10:15:22 PDT

What Hath the Redistricting Commission Wrought?

Darry Sragow — Tue, 20 Sep 2011 10:15:20 PDT

Open and Transparent: The Citizens Redistricting Commission

Chris Carson et al. — Tue, 20 Sep 2011 10:15:18 PDT

Redistricting from a Community Perspective

Deanna Kitamura — Tue, 20 Sep 2011 10:15:16 PDT

Redistricting 2011: California Latinos Face New Opportunities and Old Challenges

Arturo Vargas — Tue, 20 Sep 2011 10:15:15 PDT

Redistricting Reform Revisited

Matthew Jarvis — Tue, 20 Sep 2011 10:15:13 PDT

The Aftermath of Redistricting Reform in California

Justin Buchler — Tue, 20 Sep 2011 10:15:11 PDT

In 2009, Matthew Jarvis and I offered differing opinions in this journal about the potential effects of redistricting reform on California’s budgetary process. Jarvis suggested redistricting reform could help the process by either reducing legislative polarization, or giving Democrats the supermajority necessary to pass their budget without partisan gridlock. I argued the best approach would be to eliminate supermajority requirements for fiscal policy. Now that the new district lines have been released under the process created by Proposition 11, we revisit our arguments. I expect California’s legislature to remain polarized. While a two-thirds Democratic supermajority is possible, it is not probable, and legislative dysfunction will likely remain.

Failed State: Political Corruption and the Collapse of Democracy in Bell, California

Tom Hogen-Esch — Fri, 16 Sep 2011 14:09:36 PDT

This article seeks to explain recent patterns of corruption in the city of Bell, California. After reviewing the literature on municipal corruption and reform and political participation in immigrant communities, the article examines the Bell case study. It argues that the city’s primary democratic institutions, voter participation, watchdog media, and community organization engagement collapsed prior to the scandal. In addition, elements of the council-manager form of government contributed to community disengagement from city politics. In this “failed state,” local officials exploited governmental power for personal gain. Implications for political reform and local state-building in high immigration cities are discussed.