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UCLA Report Provides Strategies for Making Covered California More Affordable Public Policy's Wes Yin helps develop policy options to keep insurance costs down

By Mary Braswell

With California taking steps to revamp its health care system, research by the UCLA Luskin School of Public Affairs is guiding the conversation.

The report, published Feb. 1, details strategies to improve the affordability of Covered California, the state’s health insurance marketplace. It was co-authored by economist Wes Yin, associate professor of public policy at UCLA Luskin.

Affordability is “the top challenge for individuals who are insured as well as those who remain uninsured,” according to the report (PDF), which lays out a wide array of proposals to meet that challenge, including:

  • capping out-of-pocket premiums for all eligible Californians;
  • offering expanded cost-sharing benefits, which would lower deductibles and the cost of office visits; and
  • creating a California-only penalty for those who opt out of coverage, to replace the penalty that was phased out by the federal government.

“This will help push the conversation forward, now with policy options that we know will improve affordability and market stability,” said Yin, who wrote the report with economist Nicholas Tilipman of the University of Illinois, Chicago, and Covered California’s policy and research division.

Commissioned under a state law, the report was presented to the governor’s office and state Legislature. It was developed amid a shifting landscape for health care in California.

On Jan. 30, Covered California reported mixed figures for 2019 enrollment. Although the number of Californians held steady from 2018 to 2019, the number of new enrollees dropped by 23.7 percent. In addition, on the first day of his term, Gov. Gavin Newsom unveiled his own far-reaching health care plan, calling for increased premium subsidies and Medicaid coverage for undocumented youths up to age 26, among other reforms.

“Our analysis gives policymakers a sense for how different approaches benefit Californians and at what cost,” Yin said. “So this report bolsters the governor’s effort to improve health care access.”

The dialogue, he said, will include a debate over the state’s funding priorities.

“From a wider lens, it’s helpful to think about how we can best spend that next public dollar,” Yin said. “It could be health care, it could be pre-K programs, it could be public education or parental leave benefits. These are all important. And there is a strong argument for improving the affordability of health care coverage and reducing cost-sharing burdens. Coverage improves health — especially mental health — it improves chronic disease management and it drastically reduces the risk of catastrophic spending and debt incurred by consumers.”

The report includes proposals to address the divisive issue of penalties for Californians who choose not to buy health insurance. Covered California attributes the decline in new enrollments to removal of the federal individual mandate penalty beginning this year. A statewide penalty would create a fresh incentive to opt in.

“The penalty appears to be quite impactful,” Yin said. “What we’re seeing in Covered California the past year shows that, and our modeling also shows that. Zeroing out the penalty has directly caused premiums to increase and enrollment to drop. Including a penalty while making plans more affordable can be both an effective and fair way of expanding coverage and lowering premiums.”

The report also notes that premium costs can vary widely for consumers based on their age and geographic location. “For consumers nearing retirement age living in high-cost regions, premium costs can exceed 30 percent of income for the most common benefit package,” it said.

To make health insurance more affordable for those consumers, California could use subsidies to cap all premium payments at 15 percent of annual income. Currently, subsidies are offered only to people who earn up to 400 percent of the federal poverty level, or $103,000 for a family of four. Consumers who earn just over the 400 percent threshold would not qualify for federal premium subsidies, Yin said. A 15 percent cap would also eliminate this so-called tax-credit cliff.

The report’s policy options are based on a model developed by Yin and Tilipman that shows the potential effects that various policy proposals would have on health care enrollment, consumer health spending and public spending.

As elected officials and consumers debate competing visions of health care reform — from repealing the federal Affordable Care Act to moving to a state-run single-payer system — Yin said the proposals are aimed at expanding coverage and increasing affordability as much as possible.

“Let’s find ways to build on the successes of the Affordable Care Act and make it work better,” Yin said. “These are models for improvement.”

LPPI Co-Hosts Conference of Latino Elected Officials From Across the U.S.

Elected officials from over a dozen different states, including state legislators, municipal and school district officials, gathered Aug. 3-5 at UCLA Luskin for a landmark conference co-hosted by the Latino Policy and Politics Initiative (LPPI). More than 60 elected officials were expected to participate in the first-ever National Association of Latino Elected and Appointed Officials (NALEO) National Education Leadership and Public Policy Academy to learn about effective public policies that support Latino families and communities. NALEO Educational Fund and LPPI designed an innovative public policy curriculum to strengthen the governance capacity of Latino policymakers in the critical policy areas of education, economic development, criminal justice and immigration. “UCLA is ecstatic to partner with NALEO Educational Fund to empower Latino elected officials with the data and strategy necessary to address today’s most critical policy challenges and improve the well-being of Latinos from Connecticut to California,” said Sonja Diaz, LPPI’s executive director. The invitation-only intensive training featured modules created by LPPI faculty, with a cadre of national policy experts and practitioners from across the U.S. advancing evidence-based policymaking. Conference speakers included Diaz and her LPPI co-founders — UCLA Luskin Dean Gary Segura and Matt Barreto, professor of political science and Chicano/a Studies at UCLA — as well as LPPI-affiliated faculty such as Amada Armenta, who recently joined the faculty of UCLA Luskin Urban Planning. NALEO Educational Fund Executive Director Arturo Vargas also participated.

Carnesale Joins Board of California Council on Science and Technology

The California Council on Science and Technology (CCST) has added Albert Carnesale, UCLA chancellor emeritus and professor emeritus of public policy and mechanical and aerospace engineering to its Board of Directors. Also joining the board, which provides strategic vision and direction for CCST, is Alexandra Navrotsky of UC Davis. “Dr. Navrotsky and Dr. Carnesale have made exceptional contributions to their respective scientific fields and applications on the global stage,” said CCST Board Chair Charles F. Kennel in a news release. “Their deep insights and experiences into the societal importance of science and technology will greatly inform CCST’s mission and service to state leaders in California.” Carnesale joined UCLA in 1997 and was chancellor through 2006. He is the author or co-author of six books and more than 100 articles on a wide range of subjects, including national security strategy, arms control and nuclear proliferation. CCST is a nonpartisan, nonprofit organization that engages experts in science and technology to advise state policymakers.

Maps Show Gentrification, Displacement Policies

The Center for Neighborhood Knowledge (CNK) at UCLA Luskin has updated its website to offer two important online resources: an inventory and map of anti-displacement policies in Los Angeles County, and a map of neighborhood change and gentrification in Southern California. The map of anti-displacement policies utilizes data collected between February and May of 2018, and it reflects CNK’s first step to highlight and better understand the policies that can promote affordability or mitigate displacement of vulnerable populations in gentrifying neighborhoods. Among the findings is the fact that despite a wide range of anti-displacement policies and strategies in Los Angeles County, their coverage is fragmented and implementation is not equitably distributed across jurisdictions. CNK’s urban displacement map reflects an update to a resource first provided in 2016. It focuses on understanding where neighborhood transformations are occurring and helps identify areas that are vulnerable to gentrification and displacement in both transit and non-transit neighborhoods. One of the key findings in this update is that the number of gentrified neighborhoods (based on census tracts) rose by 16 percent in Los Angeles County between 1990 and 2015.

 

Gridlock Rage: Manville Offers Possible Traffic Solutions for Los Angeles

UCLA Luskin’s Michael Manville recently did an on-camera interview for Fox 11 News about possible solutions to traffic gridlock in Los Angeles. The piece by reporter Phil Shuman is also available for viewing with a short text summary on the station’s website.


 

Lens Is Interviewed About Expo Line Upzoning

In an on-air interview for the “Take Two” program on KPCC, UCLA Luskin’s Michael Lens talked about L.A.’s Planning and Land Use Management Committee (PLUM), which has recommended that the City Council adopt a proposal to re-zone property along the Expo Line. “Upzoning” the transportation corridor could mean taller, more dense housing units. Although upzoning isn’t always popular, it can lower the cost of housing through supply and demand economics. To listen to Lens’ interview, scrub forward to the 12:45-minute mark of the show.


 

Parking Is Sexy Now. Thank Donald Shoup

A CITYLAB profile of Donald Shoup, distinguished research professor emeritus of urban planning, highlights his career studying parking in the U.S. and his most recent book on the subject, “Parking and the City,” published this year. “It’s been 13 years since my first book, and I think people are surprised by how many cities have been persuaded to follow the recommendations,” said Shoup, referring to his “revolutionary” 2005 book, “The High Cost of Free Parking.” “I’m very happy people are beginning to see the huge benefits of getting parking right.” Shoup also spoke about his new book in a recent KPCC “Take Two” radio segment.


 

In Wake of Recent Celebrity Suicides, Kaplan Appears on Radio Panel

Professor of Social Welfare Mark S. Kaplan joined other experts in a recent KPCC broadcast following recent high-profile suicides that included celebrity chef Anthony Bourdain and designer Kate Spade. “Suicide is a remarkable public health issue because it is to some extent a hidden problem and in some cases almost a hidden epidemic. … And it is a remarkable problem because it is also associated with firearms,” said Kaplan, who studies suicide risk among vulnerable populations. Kaplan noted that of the approximately 45,000 yearly suicide deaths, half involve the use of firearms.


 

Curbed L.A. Seeks Out Monkkonen for Comment on Development Near Expo Line

A new Expo Line plan to allow higher density residential development around five Westside stations may provide an important example of how to approach the city’s housing crisis, according to Paavo Monkkonen, associate professor of urban planning. “Look at how often a single-family home sells on a block. You’ll have a gradual change, not some crazy transition overnight,” Monkkonen said about the Exposition Corridor Transit Neighborhood Plan. “But we need some proof-of-concept model because it has never happened, really.”


 

Shoup Writes About How to Fix New York’s Parking Problems 

Donald Shoup has a smart fix for New York City’s traffic woes: Sell market-priced parking permits for heavily trafficked parts of the city, then plow that money back into nearby neighborhoods. In a New York Times opinion article, Shoup, UCLA Luskin professor of urban planning and author of “Parking and the City,” writes, “Diverse interests across the political spectrum can find things to like in a parking benefit district.” He argues, “Cities can fairly and efficiently manage their curb space as valuable public real estate. … They can stop subsidizing cars, congestion and carbon emissions, and instead provide better public services.”