Quietly, while the drought and immigration grab the headlines, California has done something remarkable. It has cut the number of residents without health insurance in half since last summer, from 22 percent to 11 percent of the population.
And, despite the myriad problems with the system, the percentage of uninsured Americans has dropped from 18 to 13.4 percent in the same time. It would have dropped even more if all the states were taking advantage of the Affordable Care Act's health exchange programs.
Even better, health care analysts are nearly unanimous in expecting the trend to continue, especially after the employer mandate kicks in.
The United States still has a huge amount of work to do if it wants to catch up to other countries on health care. The Commonwealth Fund reported last month that the U.S. ranked last among 11 major, industrialized countries in 2011 on measures of health system quality, efficiency, access to care, equity and healthy lives.
This country spends about $8,500 per person on health care -- none of the other countries in the survey, including Germany, France, and the United Kingdom, spends more than $5,700 -- but stands at or near the bottom in most measures of health outcomes. It's the U.S. inability to achieve universal access to coverage that is at the heart of its low rankings; however, it's making real progress.
The increase in the number of insured residents isn't coming at the expense of health insurance companies. They recorded record profits in 2013 and expect the same in 2014, despite the new regulation calling for a cap on profits of 15 percent for larger insurance firms.
Some of that profit is due to unfair rate hikes, which will take center stage in this fall's election in California. Proposition 45 on the November ballot will ask voters whether the state insurance commissioner should have the authority to reject excessive health insurance rate increases. The commissioner can do this for car and homeowner insurance, but not health. It's an overdue change in California, but we're not yet sure whether this particular initiative is the right approach.
The complication is the short negotiating window for Covered California. Proposed rates are due from insurance companies in July, and if any were rejected, there would be just a few months to complete negotiations between the companies and the commissioner before Covered California's open enrollment period begins.
We mention this as one more example of how difficult it is to achieve health care reform. But we continue to believe we're on the right track. California and the nation have made real progress toward making health care available to all Americans.