Increasing access to care for the uninsured: considering the options in California counties

We interviewed California county health agency staff and administered a 58-county survey in 2002 and 2004 to inventory programs designed to improve access to care for the uninsured, and to assess county ability to meet the needs of California's uninsured during slow economic periods. Most counties have established means to connect people to existing public insurance programs and services have been expanded. Growth in new health care insurance programs for children and modest growth for adults are apparent. Counties pursue funding opportunities by a variety of strategies (e.g., leveraging of existing funding to secure new funds such as federal Healthy Community Access Program (HCAP) grants). While counties vary in their resources, political will, and barriers to care, they share a strong commitment to access to care. The implications of local efforts for state and federal policymaking are significant. In the absence of federal or state reform, county initiatives, particularly children's coverage expansions, may coalesce into state-level reform. Second, the state may move closer to access to health care for all as it recognizes the complementarity of county programs.