to person i've just been chased around the last couple this to get some folks come on the show and she's just been just real patient and understanding or thank her and officer kind of understanding today about the affordable healthcare act oh you've talked about there for care but not the what we're going to talk about it i wanted to bring some folks in particularly to talk about the national scope for health care act as relates to local issues and we've got two excellent guess to talk about th nationally but statewide and certainly locally and particularly you know we'll be talking about its impact on alameda county so again i want to thank you for have on the show so i'm cox i'm the agency county i'm actually excited to be here you are right not a lot of people are actually talking about the implications of the cia and what that really means and how to actually make it real for them what does it mean to commonly known as health care reform actually was passed in march two thousand and ten and some of the provisions under that act included for example extending the age limit between nineteen and twenty six years old for young people to still continue to be on their parents health care plans as as one example so there were some provisions that were implemented you know during  once it was passed in two thousand and ten another one of those provisions had to do with preexisting you know health care issues so you know those you any health care provider could not deny health care coverage and health care service to an individual who had a preexisting illness such as possibly cancer diabetes so those were some of the provisions that were passed you know once the legislation which is a historic piece of federal legislation that was and acted i think that that we need to underscore that it's it's an effort in which to create universal health care in the united states which obviously has never been enacted here before it's intended to try to provide you know access to health insurance for everyone to be able to hold health providers accountable and also to be able to create health care coverage where again irrespective of what kind what's most important is to realize that it does expand coverage within alameda county so you know we often talk in terms of poverty level so the affordable care act now allows folks who are zero percent to two hundred percent of poverty of the of the one point five they are in alameda county it's not a very large number with the affordable care act and with the expansion of coverage we're going to add on an additional fifty six thousand to medicare and an additional one hundred thirteen thousand to west considered find is that oftentimes they're eligible but not enrolled ok and so one of the things that has been challenging i think for many residents is that even once you get on medicare you have to do a redetermination every year and that redetermination process quite frankly is is laborious and humberside was the word i was going to years and it's cumbersome and i think it discourages a lot of folks and what happens is they fall off and then something happens they need to go to in the emergency room they get sick and so they legally or illegally which gets me into a discussion of undocumented but my discussion is different on the economy because it's one of the few columns that really take all comers and that's a really exciting so i want to talk about that too were you think we're going to record because well there are a couple of things that you raised that i thought were actually key to pick up on the first the first is that in the state we have the best low income health program within the state our health care department has done a phenomenal job in ensuring that people who are undocumented or otherwise uninsured have access to health care coverage it's a model and it's something certainly that we will continue to build upon as we move into full health care coverage for all so that peace will continue we are still going to have a problem with folks who are undocumented they will continue to receive indigent care but the reality is that doesn't quite cover that aspect of coverage we will see an increase obviously in the number of people who are eligible but getting a word out of people understanding what eligibility means what they're entitled to and then working through what right now is a very cumbersome process but the affordable care act talks about a simplified application process it talks about creating a nexus between other programs that people may be eligible for so you know the example i use is in my agency there are quite a few people in the county that are eligible for food stamps or cal fresh they are now coming in under medicare if we can somehow streamline the application process so that they're getting all of their benefits that is something that we continue to struggle with and move towards the other piece is the paperwork you know there's a lot of documents that are required to accompany an application the way that we're able to do that really is going to be a partnership with our community organizations our health care clinics their cue agencies and others to help folks pull those those documents together so that they can get the coverage that they need and then lastly of course retention how do you keep people from falling off those are all the discussions that are underway priorities that supervisor carson has always had is is he understands that in order to be effective at the local level you have to be engaged at the state level and the national level too because those conversations and the decision making process es that are happening there without a doubt connect directly to local decision making so as an example he serves on the executive committee for c sac which is the california state association of counties there's fifty eight counties in the state of california we have out of the entire united states we have the most counties in california and as lori's just stated our low income health program known as health pac in alameda county is definitely a model and it's due to both supervisor carson along with his colleagues the rest of the board of supervisors who who took that stance and adopted you know actually implementing a program that would provide the type of care that's necessary to all the indigent population undocumented individuals and not all local measures is kind of the local communities way of looking at or attempting to implement prevention health care prevention which is what essentially the affordable health care act is trying to do nationally in order for us locally to be effective in working with our population here as i mentioned before we also have to work with the state level and the a c a basically gives individual states the autonomy to decide if they want to do a medical expansion and right off the top governor brown said i make a commitment to go ahead and absolutely have california do the medicaid expansion in his budget proposal that he put forth in january he had primarily two options in that budget proposal one is whether there would be a state based option or a county based option and that's what's currently being discussed right now and will continue to be over the next few months for example the state based option would would have the state of california continue to maintain its medical administration and expand that whereas the county based option would primarily be in an expansion of the low income health program and would have let state let's take alameda county as an example but this would apply to all counties to have them incur the networks so many other responsibilities that currently the county is not dealing with the other aspect that the counties are right now attempting to try to work with the governor's office and the state legislature so there's all these conversations taking place right now is the one thousand nine hundred one realignment dollars if the state were to take take on that responsibility then they're looking at this point counties wouldn't would be responsible for indigent health care ok so those are the dollars and and and you're supposing that maybe there was already enough funds to begin with to take on that responsibility which in essence is not necessarily the case that's why as an example counties have had to supplement that and as we stated earlier county has done a great job of doing that but not every county has been in that fiscal position in which to do what alameda county has and i think laurie can expand on that well what i would just do is clarify so you have one thousand nine hundred one realignment which during a speaking to within the realignment is broken up into two pieces that's a b one hundred nine which is the reforms around the criminal justice system and then there is health and human services which is i believe a b one hundred which is focused on both the behavioral health care mental health programs and social state based option are ongoing and different proposals are being put forward and of course all counties are looking at what's going to be in our best interest how do we deliver the best possible model under the circumstances that we have and continue to have the appropriate funding to be able to so importantly and i would say it's around the administration of the program so quite frankly to come up with the county option really does require that individual counties create their own relationships with healthcare providers and quite frankly that's an administration that i think most of us would like to say at the state level i think it's important to note head of the folks that are eligible that will become eligible under the ac it will still have about sixty thousand residents that are not going to be eligible or they'll they'll be eligible for you know specialized services they're pregnant things like that we still have to be able to administer a program for them and again you know we can't say enough about the program that we currently have but even then revenues getting folks to kind of sing the same to getting to me i think more of a cultural change about exactly how you're going to change your behavior toward folks that at tyson you see some compare the ability or there's going to be a mix of the cars a model world a health pack or how do you see that makes you know we're still in that discussion also i would say that some of that is still under discussion but you made a point that i kind of want to go back to that's around systems change what you're talking about are large organizations my organization is i mean i have a six hundred and fifty million dollars budget and twenty two hundred employees and they have operated the same way for y what we're talking about is how do we serve clients differently how do we serve them better how do we open our doors and think about what our role is in the community and how we partner better with the community that we're not just this bureaucracy that people come to us and we dole out dollars or we dole out you know the blue cards as you call them but that we really are trying to make sure that holistically we're looking at the clients that we serve people who are undergoing trauma people who are really struggling with life in general there they are  struggling poor and our response to them has to be different but with a huge bureaucracy the way you change that in the way those wheels move it takes a lot of due diligence what i will tell you is that in our county alone i think we have you know really among all of the department has strong partnerships my staff the health care staff which is a different agency where in weekly conversations we have weekly steering committees and meetings between the state and the counties there  weekly phone calls and then even at the state level they're ongoing meetings and discussions because all of our systems are having to change and how we change in concert with each other is no easy feat  i do think that it requires of course the commitment of our of our board of all the board but certainly you know supervisor carson who make sure that people like me come and talk about this who is consistently asking questions you know what are you doing and what support do you need in order to make these changes a reality all of that becomes very important and yes it is amid a lot of change every day we learn something a little differently technology plays a role in this  ways that our residents are going to be able to access health care they're there's a variety of ways they can currently they can just come to my office i have eleven offices throughout the county but now they'll be able to call an eight hundred number they'll be able to go online and apply on their own and submit their documents all over versus the homeless folks and then we make provisions for everyone i mean we're looking at how can we set up kiosks in some of our key community agencies  again how do you make that experience of coming in and applying for a benefit that folks are now entitled to i mean that's the big piece they are entitled to this and it is our responsibility to ensure that they get it well as we go about three earlier in those conversations at the state level and supervisor carson explicitly want staff to to be attending some of these weekly hearings that are taking place in the capital both by the senate and the assembly and i do want to say that last week for example i attended a a senate health committee hearing and i can tell you and i know sometimes there's perspectives from people and that could even be myself even though i'm i'm working directly in a in a governmental entity where sometimes you wonder are folks really understanding what our needs are and i have to tell you i was highly impressed with there's probably about fifteen members of the senate health committee that were listening to many individuals that were there testifying and asking extremely thoughtful questions wanting to ensure that they are getting the right information from  hospital representative behavioral health specialist doctor you know individuals that are providing a variety of different services on the health care level in terms of which option are we going to five seconds if our final work i just want to thank you again for having us on and being able to give this important nation information out to your viewers it's called i would say that you know i i want people to enroll you know health care coverage is