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Resistance State: California in the Age of Trump

Between Sacramento and Washington D.C. sits the rest of the country, and a chasm. On immigration and taxes, guns and healthcare, cannabis and climate change, California is the federal government’s equal and opposite reaction. One year into President Trump’s first term, the push and pull continues—playing out under the Capitol dome, in the courts and on Twitter.

Ready for another year? Follow along here.

Resistance State: California in the Age of Trump


April 9, 2018 1:41 pm

Work to get Medi-Cal? California bill says no

Contributing Writer

Since the Trump administration said in January that states could require Medicaid recipients to work if they want to continue receiving the benefit, three states have signed on: Kentucky, Indiana and Arkansas. Many others are considering it.

California, of course, is walking a different path. State Sen. Ed Hernandez (D-West Covina) is floating a bill to ban work requirements for Medi-Cal recipients. Medicaid is the national health care program for the poor; the California version of it is Medi-Cal.

Hernandez called the federal work-requirement idea “backwards” when introducing his bill. “Now is the time to focus all efforts on covering more people,” he said, “not less.”

Proponents of the work requirement say it can save money and make recipients accountable for receiving benefits. The whole point of requiring work for non-disabled adults, according to federal guidance, is to promote recipients’ well-being and increase their self-sufficiency.

Critics argue it won’t reach any of those goals and, in fact, might actually cost states money. Erecting a work wall, they say, also would discourage people from getting Medicaid and drop many people who need it.  

 “I’m not sure why adding a work requirement would promote well-being,” said Nadereh Pourat, director of research at the UCLA Center for Health Policy Research. “The reality is, the great majority of Medicaid recipients are children or seniors—or they’re part of working families. We can’t assume people who get Medicaid are just sitting on their hands.”

In California, most of the working-age poor on Medi-Cal already do have jobs. According to a California HealthCare Foundation report based on 2016 data, children and seniors make up the vast majority of Medi-Cal recipients. Only about a third are working-age, non-disabled adults.

The majority of those adults, 62% of them, work. Among those not working, almost all (82%) were ill, caring for an ailing family member or going to school.

Costs and taxes remain potential obstacles to a single-payer plan.

Who’s left? The report said 324,000 Californians who didn’t work and were eligible to work were receiving Medi-Cal benefits. That’s about 2.4% of the 13.5 million on Medi-Cal.

If a work requirement would lift those people out of poverty and off Medi-Cal, that would save the state money, right?

That’s a pipe dream, according to Anthony Wright, executive director of the Sacramento-based Health Access, a nonprofit health advocacy group. Wright said a work requirement won’t make jobs appear.

The real way the work-for-Medicaid plan saves money is by cutting back on the number of people who receive benefits, he said. Imposing a lot more paperwork and eligibility requirements would do the trick, he said.

“This will have an impact because of the paperwork and administrative barriers being put up to get coverage. People will fall off coverage as a result,” Wright said. “That’s the hidden agenda.

“Those [work-for-Medicaid] rules would marginalize Medi-Cal as a welfare program, rather than see it as a safety net for all of us,” he said.

The Hernandez bill doesn’t defy federal guidance the same way California’s cannabis and sanctuary laws do—adoption of a Medicaid work requirement is a choice. But it sends a message.

Hernandez has said he’s hoping other states might follow California’s lead. And resistance did crop up in Minnesota, where one legislator sent a message similar to California’s:

Democratic Sen. Tony Lourey recently proposed an amendment to a Republican-backed work-for-Medicaid measure in Minnesota, one that the GOP-controlled Legislature there quickly voted down. It would have required that lawmakers lose their state-funded health care benefits unless they work with some of the people affected by the legislation.

That is, the amendment said legislators must put in some time at, say, the county human services agency when the Legislature was not in session, or they’d lose their state health coverage.

The California bill already has passed the Senate Health committee, which Hernandez chairs, and has been given priority status by the influential Latino caucus. It has no organized opposition and is expected to sail through the Legislature.

Want to submit a reader reaction? You can find our submission guidelines here. Please contact Dan Morain with any questions, dmorain@calmatters.org, (916) 201.6281.

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California Attorney General Xavier Becerra filed a federal records request today for information about the impact of the Trump administration’s “zero tolerance” policy on immigrant children’s mental and physical wellbeing.

The Freedom of Information Act request seeks all records related to the creation of the policy and the federal government’s determination of its ability to care for the influx of children detained as a result of the policy.

The request follows a hearing last week in which federal health official Jonathan White said he warned the Trump administration of potential negative effects children could suffer if they were parted from their undocumented immigrant parents. “Separation of children from their parents entails significant harm to children,” said White. “There’s no question that separation of children from parents entails significant potential for traumatic psychological injury to the child.”

Last week’s Congressional hearing shows that this President and his Administration received warnings about the impacts of the family separation policy and still acted,” said Becerra in a press release. “We must have answers and accountability. We all deserve to know what went into the federal government’s inconceivable decision to separate thousands of children from their families.”

Becerra’s request targeted the Justice, Homeland Security and Health and Human Services departments, and included disclosure of senior staff communications—including memorandums, emails, and notes of meetings or calls regarding the “zero tolerance” policy. He specifically is pursuing internal communications from Attorney General Jeff Sessions, Homeland Security Secretary Kirstjen Nielsen and the current and former secretaries of Health and Human Services.

President Trump has defended the policy as necessary to stem what he has characterized as a host of societal ills resulting from illegal immigration. “It’s about keeping families together, while at the same time, being sure that we have a very powerful, very strong border,” he said in a statement.

Becerra co-leads a coalition of 18 attorneys general that sued President Trump in June over the “zero tolerance” policy. He has sued the Trump administration 39 times times since March 2017.

Note: This post has been revised to correct the number of lawsuits Becerra has filed against the Trump administration.

Want to submit a reader reaction? You can find our submission guidelines here. Please contact Dan Morain with any questions, dmorain@calmatters.org, (916) 201.6281.

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Aug. 5, 2018 6:00 pm

California lawmakers move against ‘junk’ health insurance

Contributing Writer
Image via Pixabay
Image via Pixabay

Legislators in California appear ready to counter a new Trump administration move, this time on health insurance.

Last week, federal officials announced they would expand health insurers’ ability to sell so-called skinny insurance plans, short-term policies that offer only bare-bones benefits. Those plans also are called “junk” plans because of the dearth of conditions and ailments they cover—for instance, most don’t cover maternity care or cancer treatment, and some have high deductibles or exclude pre-existing conditions.

Less expensive because of the “skinny” coverage, the plans were launched under the Obama administration as a bridge to Affordable Care Act plans. They were limited to three months and could not be renewed.

The new federal rules allow low-benefit plans that don’t comply with ACA standards to last a year and be renewed for up to three years.

A proposal making its way through California’s Legislature, which returns from summer recess tomorrow, would ban such insurance in California.

SB 910, by Democratic Sen. Ed Hernandez of Azusa, would outlaw issuance or renewal of any health plan shorter than 12 months in duration. ACA standards require longer-term insurance, bar denial of coverage based on pre-existing conditions and mandate 10 essential health benefits.

The short-term, low-benefit plans are fine as long as you stay well, Hernandez said. But people with those plans who get sick often discover they have to pay for treatment and medication themselves. Basically, he said, that’s not health care coverage.

“California needs to ban junk health insurance policies in our state, not only because they are an affront to the basic principles of the Affordable Care Act, but also because they are dangerous and deceiving,” Hernandez said by email Friday.

Dozens of Republican legislators have either voted No on his bill or abstained, but did not articulate that opposition in hearings. Attempts to contact several of them were unsuccessful Friday.

One health care expert said he had hoped the idea of limited-benefit plans had been put to rest, after the years of policy discussion before and during setup of the Affordable Care Act.

“There are significant costs to having skinny plans,” said Micah Weinberg, president of the Bay Area Council’s Economic Institute, a San Francisco-based business think tank. “People still get medical care, even if it’s not covered, so the hospitals or the state end up holding the bag.”

That means taxpayers are basically subsidizing people on limited-benefit plans, he said.

“It isn’t actually insurance,” Weinberg said. “It provides a sense that you’re insured, but if you need it, you don’t really have it.”

Want to submit a reader reaction? You can find our submission guidelines here. Please contact Dan Morain with any questions, dmorain@calmatters.org, (916) 201.6281.

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Aug. 1, 2018 2:53 pm

Trump can’t withhold federal money from ‘sanctuary’ cities, court rules

Editorial Intern
Marchers in Sacramento protest Trump administration immigration policies. Photo by Trevor Eischen for CALmatters
Marchers in Sacramento protest Trump administration immigration policies. Photo by Trevor Eischen for CALmatters

A federal appeals court ruled today that President Trump does not have the authority to withhold federal funding from so-called sanctuary cities and counties.

Upholding a lower court decision, the U.S. 9th Circuit Court of Appeals said the power to allocate federal funding belongs to Congress: “The Executive Branch may not refuse to disperse the federal grants in question without congressional authorization.”

Last year, U.S. District Judge William H. Orrick III in San Francisco issued a national injunction against an executive order that Trump issued five days into his presidency. The president’s order directed that federal monies be withheld from “sanctuary” jurisdictions such as San Francisco.

San Francisco and the County of Santa Clara, which have declared themselves sanctuary jurisdictions, limiting cooperation with federal immigration authorities, sued the Trump administration.

Orrick said Trump’s order was unconstitutional, violating the Separation of Powers doctrine and the Fifth and Tenth amendments.

Today, the 9th Circuit panel of judges agreed but removed his injunction, except in California, citing a lack of evidence to keep it in place elsewhere and returning it for reconsideration. The judges said California, specifically San Francisco and Santa Clara counties, are “likely targets” of Trump’s order and retained it for the state.

The federal Justice Department denounced the decision on funding as “a victory for criminal aliens in California.” The state “will protect them from federal immigration officers whose job it is to hold them accountable and remove them from the country,” spokesman Devin O’Malley said in a written statement.

California laws limiting cooperation with federal immigration agents went into effect this year. Dozens of local governments have dissented, suing the state, joining a federal lawsuit against the policy or taking other actions.

Want to submit a reader reaction? You can find our submission guidelines here. Please contact Dan Morain with any questions, dmorain@calmatters.org, (916) 201.6281.

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