Affordability & Structures

California has been unable to come to agreement on big picture reforms. It has however enacted a series of incremental reforms which are significant building blocks for expansion of coverage to the uninsured. This chart analyzes what can or is being proposed and tried around California.

Target Group of Uninsured	Problems	Solutions	Actors
Adults; 250% of poverty and up	Lack of employer coverage Affordability of transitional coverage Lack of structure for flex workforce coverage Underwriting barriers in the individual and mid sized markets	Purchasing pools Targeted tax credits for uninsuring employers and uninsured employees Increased tax deductibility for self employed and individuals Affordability of portability	State legislature Congress Local employer groups and union organizing
Children; 250% of poverty and up	Structures	Purchasing pools Targeted tax credits for uninsuring employers and uninsured employees   Local Initiative efforts to cover uninsured children	State legislature Congress  Local Initiatives in Bay Area & elsewhere
Target Group of Uninsured	Problems	Solutions	Actors
Adults; 200% to 250% of poverty	Lack of employer coverage Affordability of transitional coverage Lack of structure for "flex workforce" coverage Eligibility for public programs limited to most costly care and conditions	Targeted tax credits Purchasing pools with limited but targeted subsidies Affordability of portability Development of coverage models for flex workforce  Healthy Families expanding to parents 200-250% FPL	Working Partnerships Community Health Group and Sharp Health Plan in San Diego State Legislature Congress
Children; 200% to 250% of poverty	Lack of employer coverage	Healthy Families, purchasing pools  and purchasing credits	MRMIB
Target Group of Uninsured	Problems	Solutions	Actors
Adults; 100% to 250% of poverty	Intermittent MediCal and county health coverage for some Lack of employer coverage Affordability of transitional coverage Lack of structure for flex workforce coverage	Healthy Families waiver for parents Purchasing pools for working adults without minor children with subsidies 1115 Waiver for non-categorically linked adults	State Legislature  County Health Departments Some Local Initiatives, COHS Commercial plans Union organizing Health Care Financing Administration
Children; 100% to 200% of poverty	Large numbers of eligible but unenrolled children Intermittent and fragmented eligibility shifting between Healthy Families, MediCal, CHDP, CCS, etc.	Healthy Families and MediCal at state, health plan and county levels Local Initiative efforts to cover uninsured children	MRMIB Department of Health Services Local Initiatives
Target Group of Uninsured	Problems	Solutions	Actors
Adults below 100% of poverty; no categorical linkage to MediCal	No eligibility for MediCal Access to care in county systems	§1115 waiver Transformation of county systems	County Health Departments Local Initiatives State Legislature Congress
Adults below 100% of poverty with categorical linkage to MediCal	Cumbersome and complex MediCal eligibility process	Outreach, and simplification of eligibility	State Legislature Department of Health Services County Welfare Departments
Children below 100% of poverty	Cumbersome and complex MediCal eligibility process	Outreach, and simplification of eligibility	Department of Health Services  County Welfare Departments Local Initiatives Efforts to cover all children