Fiscal Fitness: How States Cope

California group creates insurance products and expands access for low-income citizens

Working with an initial grant from the Robert Wood Johnson Foundation, the Alameda County (CA) Health Care Services Agency has been working to improve coverage and access to care for a number of targeted populations. Agency director David Kears tells State Health Watch the agency has succeeded by collaborating with other public and private groups in an effort that is both business-driven and value-driven. “We’ve been very successful doing things to create access,” he says.

The agency serves some 1.5 million people in a highly diverse community with many ethnic populations, including 22% Asian, 20% Hispanic, and 15% African American.

With receipt of the Robert Wood Johnson Foundation grant of $700,000 in 2001, the Alameda Health Consortium (Alameda County Health Care Services Agency, Alameda County Medical Center, Alameda Alliance for Health, and the Kellogg Foundation-funded Community Voices Project) committed $8.1 million to subsidize Family Care, an insurance product for uninsured families under 300% of the federal poverty level. As part of the total effort, the county supervisors allocated another $2 million per year of its share of the tobacco settlement funds to expand health care coverage; and the Alliance received a $300,000 grant from The California Endowment to provide coverage for undocumented immigrant children who are not eligible for Medi-Cal or Healthy Families, California’s SCHIP program.

As of August 2002, there were 7,400 members enrolled in Family Care, well above the original estimate of 2,000 members after five years. Officials said the membership numbers highlight their extreme success in enrolling members and the value people in the community place on affordable coverage.

Mr. Kears says the effort has hit some bumps in the road. A plan to expand coverage to parents of covered children was “too ambitious [and] far too costly.”

He points out there are programs to help kids with special needs, but not for adults who have high health care costs.

“We’ve all learned that we’re really not successful by ourselves,” Mr. Kears says, reflecting on why broad-scale collaboration works. “That’s the hard reality.” He says that many health and human services people who have been working in the systems for 15 to 20 years see the limitations in a hierarchical structure. “If you look at the outcomes you want, you need to work with others. The culture to work with others evolves over time. The hard part is integrating government into the mix.”

Mr. Kears says it is important to learn to measure success differently, not looking only at what each group can control. “The question is whether our citizens are better served,” he says. “Is there a diversity of providers and a diversity of locations?”

As the groups have achieved successes, that has led to additional efforts and even more successes. They have learned, he says, the value of ownership of problems and the commitment to find answers together. They’ve also learned that pooled resources go further since foundations prefer not to give money directly to governmental entities.

None of the stakeholders who were approached declined to participate, according to Mr. Kears, because they didn’t want to be left out when everyone else was moving forward.

Looking to the future, Mr. Kears says the problems being addressed and the products being developed may change over the next several years, but he doesn’t expect to see any movement away from the model. “That doesn’t mean that we all have to agree, but communications and openness are the key.”

[Contact Mr. Kears at (510) 618-3453.]