This year, taxpayers will cover about 70 percent of what is spent on health care in California, according to released Wednesday by the UCLA Center for Health Policy Research.
Many people assume that the U.S. health care system is primarily supported by private dollars, such as insurance premiums from employer-based coverage, said Gerald Kominski, director of the UCLA Center for Health Policy Research and the study鈥檚 lead author.
But that鈥檚 no longer the case, at least in California 鈥斅爉ostly because of its massive expansion of Medi-Cal, the state鈥檚 version of Medicaid, he said.
鈥淭here鈥檚 this myth that we have a mostly privately funded health care system, but we鈥檙e approaching a point in which almost three quarters of this system is funded by public money,鈥 Kominski said. 鈥淣ow a question to ask ourselves is: when do we reach the tipping point and say 鈥榯his is essentially a public system?鈥欌
Of $367 billion estimated to be spent on health care in the state in 2016, $260 billion will be from taxpayer money, according to the research.
Nationwide, public funds paid for about 45 percent of the country鈥檚 $3 trillion in health care expenditures in 2014 through public insurance programs such as Medicaid, Medicare and programs for low-income children, according to federal data. But that estimate may be too low 鈥斅爄t鈥檚 probably closer to 65 percent as suggested in a , according to Kominski.
In California, Medicare and Medi-Cal alone account for roughly 47 percent of health care expenditures.
鈥淚n California we鈥檝e had a much larger Medi-Cal expansion than anyone expected,鈥 he said, noting that almost one-third of the state鈥檚 population is covered by the health program for low-income people.
Researchers were surprised, however, to see how big a role was played by county health programs that often serve indigent populations 鈥斅$10 billion, or nearly 3聽percent of the state鈥檚 total health care spending.
The UCLA researchers counted a 鈥渉idden鈥 public expenditure that other federal studies do not: tax subsidies for employer-based health insurance, Kominski added. That makes up another 12 percent of the state鈥檚 health care spending, the data shows.
Before the Affordable Care Act took effect, it was true that the health care system in California was mostly private, Kominski said.
Maribeth Shannon, a director at the California Health Care Foundation, agreed that the ACA greatly accelerated the shift. (California Healthline is an editorially independent publication of the California Health Care Foundation.)
It used to be that most Americans were covered by their employer. Today, far fewer are, Shannon said.
鈥淚t鈥檚 a combination of things,鈥 she said. 鈥淎fter the ACA you now have more generous eligibility guidelines for public programs. You also have the factor of an aging population.鈥
A growing national population of people over 65 will mean higher health care costs.
People 65 and older are generally covered by Medicare.
Because of this new dominance of public spending in health care, the researchers concluded that a single-payer health care system is more feasible than previously believed.
鈥淔or a majority of Californians, a public-run system is already the reality,鈥 said Andrea Sorensen, a graduate student at the UCLA Fielding School of Public Health, who co-authored the study.
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