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January 22, 2008 - We analyzed certain fiscal issues related to the health care reform (HCR) plan currently under consideration by the Legislature. We estimated the fiscal impact of HCR using two different assumptions of premiums: $250 per month per person and $300 per month per person. Under the $250 premium scenario there are sufficient revenues to support the program in the first year of operation (2010-11). However, by the fifth year of the program, annual costs exceed revenues by $300 million. Despite annual costs exceeding revenues in the fifth year, the program still has a positive cumulative fund balance because the collection of tobacco tax and employer fees start before program costs are incurred. Under the $300 premium assumption, costs exceed revenues by $122 million in the first year of operation and this shortfall increases to $1.5 billion by the fifth year of the program. In addition, the fund balance shows a deficit of almost $4 billion by the end of that period, even with the early collection of the tobacco tax and employer fees. In addition to the premium level, we have identified a number of other fiscal risks and uncertainties which could negatively affect the fiscal solvency of the plan by more than an additional $1.5 billion annually.
October 31, 2007 - Presented to Assembly Health Committee, Mervyn M. Dymally, Chair
April 23, 2007 - Presented to: Assembly Budget subcommittee No. 1 on Health and Human Services
February 21, 2007 - The Governor proposes to extend health care coverage to California’s uninsured population and to implement specific reforms. The Governor’s proposal would impose an individual mandate requiring all Californians to maintain a minimum level of health insurance, attempt to contain health care costs so that individuals could afford to purchase coverage, and promote various measures meant to improve the overall health of Californians. We conclude that the Governor has presented a comprehensive framework to expand coverage for the uninsured. In addition, the administration has made a serious effort to estimate the programmatic and fiscal impacts of its proposal. We identify a number of legal obstacles and policy issues and conclude that the plan creates fiscal risks to the state potentially reaching several billions of dollars annually.
February 21, 2007 - The budget plan implements Chapter 241, Statutes of 2006 (SB 162, Ortiz) that creates a new Department of Public Health (DPH) and Department of Health Care Services (DHCS) from the existing Department of Health Services. We recommend the Legislature require the administration provide additional information to ensure cost neutrality as required under Chapter 241.
February 21, 2007 - We estimate a shift of veterans from Medi-Cal to the federal Veterans Administration (V.A.) health system could save the state up to $250 million annually, while providing those veterans with quality health care services. We recommend that California join 42 other states participating in a federal data matching process that would facilitate achieving these goals.
February 21, 2007 - We review the proposal for a net reduction of $25 million for Proposition 36 programs, discuss why this reduction might eventually result in increased prison costs, and recommend redirecting funds in order to support Proposition 36 programs at their current level.
February 15, 2007 - Presented to the Senate Health Committee, Hon. Sheila Kuehl, Chair
February 12, 2007 - Persistent increases in health care spending and deficiencies in health care quality are attributable in part to the continued reliance by many health care providers on archaic, paper-based methods of storing and communicating health information. Health information technology (HIT) offers the potential to improve health care delivery and quality, but adoption of these tools by health care providers has been slow. Our review assesses the potential for HIT tools such as electronic health records (EHRs) and regional health information organizations (RHIOs) to meet these challenges, and provides an overview of HIT development efforts in government and the private sector. We conclude that the state should take steps to promote widespread adoption of HIT, and we outline several strategies to achieve that goal.
October 3, 2006 - Presented to a joint hearing of Assembly and Senate Revenue and Taxation, Assembly Governmental Organization, and Assembly and Senate Health committees.
February 23, 2006 - The Governor proposes to freeze future state participation in county administrative costs for health and social services programs at the 2005-06 level, adjusted for caseload, but not inflation. We recommend rejecting the Governor’s proposal because it would restrict legislative flexibility to adjust funding and services levels.
February 23, 2006 - The budget plan includes a package of proposals to encourage the enrollment of uninsured children in state health coverage. Some of the proposals are reasonable, but we recommend others be rejected or modified because they are overbudgeted or are likely to be ineffective.
February 23, 2006 - The administration is proposing changes to the way the state conducts licensing and certification of providers of certain health and social services. We concur in some proposals, recommend others be reduced to correct overbudgeted staffing and funding, and propose further changes to improve the way these functions are carried out.
February 23, 2006 - Proposition 36 provided annual appropriations from the General Fund through 2005-06 to implement a voter-approved initiative requiring drug treatment instead of incarceration in prison or jail for certain nonviolent drug possession offenders. The guaranteed appropriations for Proposition 36 are expiring, giving the Legislature discretion now to determine the level of funding for this measure. We comment on how the funding level should be set and proposals for making policy changes in the Proposition 36 law.