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TWO STATES, Rhode Island and Indiana, have been able to make major changes to the traditional Medicaid programs, which allowed them to curb costs and enhance their recipients’ quality of care. Patient satisfaction went up sharply. In 2009 Rhode Island sought and won an unprecedented waiver from Washington. . . As Alexander noted, “These reforms, in turn, gave patients greater independence and better outcomes, and their satisfaction soared. . . . The imaginative remedies we implemented were so responsive and customized to our patients’ needs that their experiences and health improved even as we spent less.” . . . Indiana instituted even better Medicaid reform. The Hoosier State has long pushed the idea of health savings accounts (HSAs) coupled with high-deductible health insurance that covers catastrophic medical expenses. As the state has observed: “About 96% of [the state’s] employees have voluntarily elected to enroll in a consumer-driven health plan option. In its first four years of offering [such options] to state employees, the state saved 10.7% annually, as employees used hospital emergency departments at lower rates, had fewer physician office visits, lower prescription costs and a higher generic-medication dispensing rate.” . . .Now the Hoosier State is expanding this state-employees concept and applying it to its Medicaid recipients.

Assembly Speaker Anthony Rendon put the brakes on a sweeping plan to overhaul the health care market in California Friday, calling the bill “woefully incomplete.” Rendon announced plans to park the bill to create a government-run universal health care system in Assembly Rules Committee “until further notice” and give senators time to fill in holes that the bill does not currently address. “Even senators who voted for Senate Bill 562 noted there are potentially fatal flaws in the bill, including the fact it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump administration and voters to make SB 562 a genuine piece of legislation,” Rendon said.

There will be two sources of financing for Healthy California. The first is the same public health care revenue sources that are presently providing about 71 percent of all health care funding in the state. These include Medicare and MediCal, which together provide nearly 50 percent of all health care funding in California at present. It also includes tax subsidies for health care expenditures by individuals and households in the state, which provide about 9 percent of the state’s total health care funding. The Healthy California bill is explicit in stating that the State will work to obtain waivers in all of the present areas of public health funding, so that these present funding sources will continue to finance Healthy California. Assum ing the state is successful in obtaining these waivers, these funds will provide $225 billion in funding for the state’s single -payer program. That means that the remaining $106 billion to fund Healthy California will need to be provided by new revenue sources in the state.

It wouldn’t be the first time that a high price tag torpedoed a government takeover of health care. In 2014, Vermont’s attempt at single-payer ended abruptly when Gov. Peter Shumlin rejected the 11.5% payroll tax hike and 9.5% individual tax hike required to fund the program. Yet the financial costs of single-payer are practically negligible compared with the human costs.

Consider the Department of Veterans Affairs’ scandal-plagued single-payer health program. Last month, the agency’s inspector general found that more than 100 veterans died while waiting for care at a Los Angeles VA facility between October 2014 and August 2015. 

California’s uninsured rate has declined dramatically in the past few years. Much of the increase in health coverage has been the result of the state’s decision to expand Medi-Cal, its Medicaid program, under the Affordable Care Act. While the federal government has funded a large share of program growth, state costs have also risen. This cost growth, combined with major policy shifts still conceivable at the federal level, has created additional uncertainty about the future of Medi-Cal financing. As state lawmakers and other stakeholders plan for the future of the program, it is important to understand how Medi-Cal is currently financed and how it fits into California’s overall budget.

The top 1 percent of health-care spenders use more resources, collectively, than the bottom 75 percent, according to a new study based on national surveys. Slice the data a different way, and the bottom half of spenders all together rack up only about 3 percent of overall health care spending — a pattern that hasn’t budged for decades. This creates a fundamental inequality in the country’s health spending that is the crux of the challenge policymakers face: They need a system that works for people who are ill, but is attractive to those who are healthy and spend little on health care.

An ambitious proposal to create a single statewide insurance plan for every Californian — including undocumented residents, seniors on Medicare and people who now get their health coverage through work — began to take shape on Thursday when two legislators released details about what services would be covered and who would run the giant program. Still missing, however, are the details that have bedeviled universal health care advocates for decades: how much it would cost taxpayers. And the plan will be difficult, if not impossible, to execute without permission from Washington to steer billions of federal Medicare and Medicaid dollars into a trust fund that covers everyone.

UnitedHealthcare’s pullback from government-run health insurance exchanges includes vacating the online marketplace for California, state regulators announced Tuesday.

The Affordable Care Act suffered another jolt late last week with the news that UnitedHealth Group, the nation’s largest health insurer, was making good on its threat to pull out of Obamacare, beginning with its operations in Georgia and Arkansas.

Both regulators responsible for reviewing insurance mergers in California have now approved Centene Corp.’s $6.8 billion acquisition of Health Net, allowing the controversial deal to move forward.

The Brown administration this week formally asked the U.S. government to sign off on a revamped tax on health plans that has the primary goal of continuing to pull in more than $1 billion in federal money.

Blue Shield of California, one of the state’s biggest health plans, has eliminated up to 460 jobs, including about 300 in Sacramento and the Central Valley, more than 70 in Southern California, and close to 80 in its San Francisco headquarters office and other Bay Area outposts.

California lawmakers approved a health plan tax package Monday designed to continue pulling in more than a billion dollars in matching federal money, while committing several hundred million dollars to services for the developmentally disabled, debt relief and other programs.

Even though the state could reap a huge windfall if the four health plans lose the case, Gov. Brown’s administration has sided with the plans, arguing that the 1968 case is being misapplied and that the state Legislature long ago determined these plans should be separately taxed and regulated. The lawsuit, the state’s attorneys warn, could disrupt California’s health care delivery system and cause consumers’ premiums to soar.

Men and women are more or less equally likely to have private health insurance, most often through their jobs. But young women are more likely to receive government health care, specifically Medicaid. Poor single mothers are especially likely to be eligible for Medicaid. But not so for men. More than a quarter of young men lack insurance at some ages, even as the overall share of uninsured has dropped to around 10%.