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The Affordable Care Act & California: What's New, What's Next, & What Do We Need to Do?

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Health Access California presents a review of the Affordable Care Act, California's efforts to implement and improve upon it, and the new agenda for 2015 and beyond. January 2015.

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The Affordable Care Act & California: What's New, What's Next, & What Do We Need to Do?

  1. 1. January 2015January 2015 The Affordable Care Act &The Affordable Care Act & California:California: What’s New, What’s Next,What’s New, What’s Next, and What Do We Need to Do?and What Do We Need to Do? www.health-access.org www.facebook.com/healthaccess www.twitter.com/healthaccess
  2. 2. BFDBFD Biggest Congressional Action for Consumer Protections; Coverage Expansion; Cost Containment
  3. 3. The Biggest Reforms of OurThe Biggest Reforms of Our EraEraThe health reform law doesn’t do all that is needed,The health reform law doesn’t do all that is needed, but it is historic Congressional action in three areas of focus:but it is historic Congressional action in three areas of focus: 1)1) Provides new consumer protectionsProvides new consumer protections to prevent the worstto prevent the worst insurance industry abusesinsurance industry abuses • Biggest reform of insurance practices ever: no denials for pre-existingBiggest reform of insurance practices ever: no denials for pre-existing conditions; no rescissions; no lifetime/annual caps on coverage; etcconditions; no rescissions; no lifetime/annual caps on coverage; etc 2) Ensures security2) Ensures security for those with coverage, andfor those with coverage, and new andnew and affordable optionsaffordable options for those without coveragefor those without coverage • Biggest expansion of coverage in almost 50 years; To bring US from 85%Biggest expansion of coverage in almost 50 years; To bring US from 85% to 95% coverage.to 95% coverage. • Expansion of Medicaid and a new exchange, with affordability tax creditsExpansion of Medicaid and a new exchange, with affordability tax credits so premiums are tied to income, not how sick we are.so premiums are tied to income, not how sick we are. 3) Begins to control health care costs3) Begins to control health care costs , for our families and our, for our families and our government.government. • Multiple efforts to ensure quality & reduce costMultiple efforts to ensure quality & reduce cost • Biggest deficit reduction measure in a generation.Biggest deficit reduction measure in a generation. • Big investments in prevention, with unbooked savingsBig investments in prevention, with unbooked savings
  4. 4. Ensuring Affordable CoverageEnsuring Affordable Coverage & Essential Benefits& Essential BenefitsIn each of the ways people get coverage today, throughIn each of the ways people get coverage today, through 1)1) an employer (over a half)an employer (over a half) 2)2) a public program (around a third), ora public program (around a third), or 3)3) buying it as an individual (5%)buying it as an individual (5%) new protections now ensure that coverage includes:new protections now ensure that coverage includes:  AffordabilityAffordability – Premiums not to exceed a percentage of income—sliding scale up to 9.5% of income.Premiums not to exceed a percentage of income—sliding scale up to 9.5% of income. – No lifetime limits, no annual limitsNo lifetime limits, no annual limits – Cap on out-of-pocket costs (co-pays, deductibles) of $6,350 individual/$12,500 familyCap on out-of-pocket costs (co-pays, deductibles) of $6,350 individual/$12,500 family (2014 dollars)(2014 dollars) – No co-pays for preventive services like mammograms and prostate cancer screening.No co-pays for preventive services like mammograms and prostate cancer screening.  Basic BenefitsBasic Benefits – Covers doctors, hospitals, prescription drugs, mental health parity.Covers doctors, hospitals, prescription drugs, mental health parity. – Comparable to most large employers now. (Knox/Keene+Rx)Comparable to most large employers now. (Knox/Keene+Rx)  Purchasing Power of Group CoveragePurchasing Power of Group Coverage  Consumer ProtectionsConsumer Protections – Example: Medical Loss Ratio: 80/85 cents of premiums must be spent on careExample: Medical Loss Ratio: 80/85 cents of premiums must be spent on care
  5. 5. Securing On-the-JobSecuring On-the-Job Coverage:Coverage: Subsidies and StandardsSubsidies and Standards Around half of all Californians (18 million) already haveAround half of all Californians (18 million) already have coverage through their employer, andcoverage through their employer, and reform will makereform will make on-the-job coverage more secure and reliableon-the-job coverage more secure and reliable  Many small employers of low-wage workers willMany small employers of low-wage workers will receive significant subsidiesreceive significant subsidies (tax credits up to 35% of(tax credits up to 35% of premiums) to help pay for coverage.premiums) to help pay for coverage.  Larger employers (over 50 FTEs) will either cover theirLarger employers (over 50 FTEs) will either cover their workers, or may have to contribute to their care—setting aworkers, or may have to contribute to their care—setting a standard much like the minimum wage does for pay:standard much like the minimum wage does for pay: – Provide Health Benefits for Full-Time, Non-Seasonal workers ORProvide Health Benefits for Full-Time, Non-Seasonal workers OR – Pay a penalty for Full-Time, Non-Seasonal worker in exchangePay a penalty for Full-Time, Non-Seasonal worker in exchange ($2,000/$3,000 depending on coverage offer)($2,000/$3,000 depending on coverage offer) – Full-Time and Non-Seasonal Defined:Full-Time and Non-Seasonal Defined:  Full-Time=Average 30 hours per week in monthFull-Time=Average 30 hours per week in month  Non-Seasonal=120 days for one employer in a yearNon-Seasonal=120 days for one employer in a year
  6. 6. Improving Public Programs:Improving Public Programs: MedicareMedicare  Nearly a third of Californians (10 million+) getNearly a third of Californians (10 million+) get coverage thru Medicare, Medicaid, SCHIP, etc.coverage thru Medicare, Medicaid, SCHIP, etc.  For seniors,For seniors, MedicareMedicare will remain intact and bewill remain intact and be strengthened so it is more stablestrengthened so it is more stable – No reductions in Medicare benefit package; someNo reductions in Medicare benefit package; some improvements:improvements: – Closes “donut hole” gap in prescription drug coverageCloses “donut hole” gap in prescription drug coverage  Right now, coverage runs out at around $2,830/year; doesn’t kickRight now, coverage runs out at around $2,830/year; doesn’t kick back in until over $4,550.back in until over $4,550.  In 2010, impacted seniors will get $250 rebateIn 2010, impacted seniors will get $250 rebate  Annual improvements until drug coverage becomes completeAnnual improvements until drug coverage becomes complete – No cost-sharing for preventative screenings & careNo cost-sharing for preventative screenings & care – Roots out waste, fraud, and abuse, especially overpayments toRoots out waste, fraud, and abuse, especially overpayments to insurance companies in Medicare Advantage.insurance companies in Medicare Advantage. – Extends solvency of Medicare for nearly a decadeExtends solvency of Medicare for nearly a decade
  7. 7. Improving Public Programs:Improving Public Programs: MedicaidMedicaid  Medi-CalMedi-Cal (Medicaid) has been expanded to(Medicaid) has been expanded to cover lowest-income families, including adultscover lowest-income families, including adults without dependent childrenwithout dependent children – Expands Medicaid for all under 138% of the federal povertyExpands Medicaid for all under 138% of the federal poverty level (excluding undocumented immigrants)level (excluding undocumented immigrants) – Before reform, adults without kids at home excludedBefore reform, adults without kids at home excluded – Two million additional Californians on Medi-Cal nowTwo million additional Californians on Medi-Cal now – For newly-eligible population, federal government will payFor newly-eligible population, federal government will pay 100% of costs for 2014-2016; By 2020, will pay up to 90%100% of costs for 2014-2016; By 2020, will pay up to 90% of costof cost – Reduces paperwork and eligibility barriersReduces paperwork and eligibility barriers  Example: Removes complicated “asset test” that is barrier toExample: Removes complicated “asset test” that is barrier to enrollment, and that prevents poor families from savingenrollment, and that prevents poor families from saving – SCHIP (formerly Healthy Families in CA) intactSCHIP (formerly Healthy Families in CA) intact
  8. 8. Covered California: A NewCovered California: A New Insurance Market & ChoicesInsurance Market & Choices  New market rules/consumer protections prevents denials orNew market rules/consumer protections prevents denials or surcharges for pre-existing conditions; new standards againstsurcharges for pre-existing conditions; new standards against “junk” insurance: minimum essential benefits; minimum“junk” insurance: minimum essential benefits; minimum actuarial value; medical-loss ratio; out-of-pocket cap; etc.actuarial value; medical-loss ratio; out-of-pocket cap; etc.  Covered CaliforniaCovered California offers new affordable coverageoffers new affordable coverage options.options. – Affordability creditsAffordability credits will be provided for coveragewill be provided for coverage purchased in the Exchange for families earning up to 400%purchased in the Exchange for families earning up to 400% FPL (~$92K for family of 4).FPL (~$92K for family of 4). – The Exchange can use itsThe Exchange can use its bargaining power tobargaining power to provide the “group rate”provide the “group rate” for individuals and smallfor individuals and small businesses, to get the best possible price.businesses, to get the best possible price. – TheThe Marketplace will make itMarketplace will make it easier to understandeasier to understand andand get a quality, affordable health plan, offering a range ofget a quality, affordable health plan, offering a range of
  9. 9. Sliding Scale SubsidiesSliding Scale Subsidies
  10. 10. Health Reform and YouHealth Reform and You  IF YOU ARE INSUREDIF YOU ARE INSURED, you continue to get your, you continue to get your coverage in the same way, but in a more secure andcoverage in the same way, but in a more secure and stable fashion:stable fashion: – Makes it more likely your employer continues to offerMakes it more likely your employer continues to offer coverage, set minimum standards for such coverage.coverage, set minimum standards for such coverage. – Improves Medicare and expands Medicaid.Improves Medicare and expands Medicaid. – Fixes the “individual market” of coverage in multiple ways.Fixes the “individual market” of coverage in multiple ways. – Ensures that even if your life situation changes (job change,Ensures that even if your life situation changes (job change, divorce, graduation), you have access to affordabledivorce, graduation), you have access to affordable coverage.coverage. – Provides the foundation to bring down the overall costs ofProvides the foundation to bring down the overall costs of health carehealth care
  11. 11. Health Reform and YouHealth Reform and You  IF YOU ARE UNINSUREDIF YOU ARE UNINSURED ,, you need to get coverage, butyou need to get coverage, but there will be new help and new options to ensure coverage is:there will be new help and new options to ensure coverage is: – AVAILABLE:AVAILABLE: No denials or different rates for pre-existingNo denials or different rates for pre-existing conditions.conditions. – AFFORDABLE:AFFORDABLE: Subsidies/affordability credits for low & midSubsidies/affordability credits for low & mid income families to limit out of pocket costs to a certain percentageincome families to limit out of pocket costs to a certain percentage of income, plus other efforts to bring down costs.of income, plus other efforts to bring down costs. – ADEQUATEADEQUATE: Minimum benefit standards and a cap on out-of-: Minimum benefit standards and a cap on out-of- pocket costs, so no one goes into significant debt or bankruptcy.pocket costs, so no one goes into significant debt or bankruptcy. – ADMINISTRATIVELY SIMPLE:ADMINISTRATIVELY SIMPLE: The Exchange providesThe Exchange provides choice and convenience, making it easier to compare and sign up.choice and convenience, making it easier to compare and sign up. – Note that the individual mandate includesNote that the individual mandate includes exemptionsexemptions forfor affordability (more than 8% of income) and hardship.affordability (more than 8% of income) and hardship. – Health insurance isn’t cheap or easy—reforms help make itHealth insurance isn’t cheap or easy—reforms help make it cheaper and easier.cheaper and easier.
  12. 12. Up To States To:Up To States To:
  13. 13. ““Because of the money and resources, California is frequently touted asBecause of the money and resources, California is frequently touted as the state that is implementing the Affordable Care Act most actively andthe state that is implementing the Affordable Care Act most actively and aggressively.aggressively. The stakes couldn’t be higher.”The stakes couldn’t be higher.” – POLITICO– POLITICO ““California is a particularly important test for Obamacare.California is a particularly important test for Obamacare. It’sIt’s not just the largest state in the nation. It’s also one of the states mostnot just the largest state in the nation. It’s also one of the states most committed to implementing Obamacare effectively. ...committed to implementing Obamacare effectively. ... If California can’tIf California can’t make the law work, perhaps no one can. But if California canmake the law work, perhaps no one can. But if California can make the law work, it shows that others can, too.”make the law work, it shows that others can, too.” –Ezra Klein,–Ezra Klein, Washington PostWashington Post ““The ACA can’t succeed if California fails,”The ACA can’t succeed if California fails,” –Drew Altman,–Drew Altman, president of the Kaiser Family Foundation.president of the Kaiser Family Foundation. "If this works in California, eventually America will follow your lead… If it comes off the rails here, it will give aid and comfort to everyone who really just wants to say, 'I told you so.‘” –President Bill Clinton.
  14. 14. California LeadingCalifornia Leading on Health Reformon Health Reform  States need to maximize the benefit—our healthStates need to maximize the benefit—our health system needs all the help we can get.system needs all the help we can get.  California is showing the way, especially amongCalifornia is showing the way, especially among states with significant diverse & uninsuredstates with significant diverse & uninsured populations…populations…
  15. 15. New Numbers!New Numbers! FROM OUR 4-YEAR ACA REPORT/After 1FROM OUR 4-YEAR ACA REPORT/After 1 stst Enrollment PeriodEnrollment Period ““Mission Advanced, But Not Accomplished”:Mission Advanced, But Not Accomplished”: Over 1.4 million Californians picked plans in Covered California (goal wasOver 1.4 million Californians picked plans in Covered California (goal was 700K by March; 1 million by end of 2014 and 2700K by March; 1 million by end of 2014 and 2ndnd enrollment period);enrollment period); Over 2 million Californians determined eligible for Medi-Cal;Over 2 million Californians determined eligible for Medi-Cal; Over 430,000 young adults on parents coverage; others getting guaranteedOver 430,000 young adults on parents coverage; others getting guaranteed issue individual coverage; small business tax credits; etc.issue individual coverage; small business tax credits; etc. Over half of the uninsured now covered; 3.5 million CaliforniansOver half of the uninsured now covered; 3.5 million Californians in new ACA coverage optionsin new ACA coverage options Big demand despite problems:Big demand despite problems: website glitches; call center wait timeswebsite glitches; call center wait times for 30-50 minutes; inadequate number of community enrollment counselors;for 30-50 minutes; inadequate number of community enrollment counselors; provider search function not working; negative press..provider search function not working; negative press.. Millions of other Californians with new consumer protections andMillions of other Californians with new consumer protections and financial assistance.financial assistance. No-cost preventive care; not lifetime/annual limits; etc.No-cost preventive care; not lifetime/annual limits; etc. Rate rebates, roll backs, and retractions from Rate Review & MLRRate rebates, roll backs, and retractions from Rate Review & MLR Over 300,000 on Medicare saved $183 million in prescription drug costsOver 300,000 on Medicare saved $183 million in prescription drug costs
  16. 16. CALIFORNIA IMPLEMENTS Millions with new consumer protections; financial assistance 3.5+ million Californians with new coverage already Uninsured cut in half; Average rate hike 4.2% CALIFORNIA IMPROVES EARLY: Low-Income Health Programs Children with pre-existing conditions Maternity coverage BETTER: Exchange that negotiates & standardizes Medi-Cal express lane enrollment options Coverage of legal & DACA immigrants LGBT inclusion
  17. 17. Fulfilling the Promise:Fulfilling the Promise: Making Enrollment EasierMaking Enrollment Easier  Outreach & education, eligibility and mass enrollment is aOutreach & education, eligibility and mass enrollment is a moral, public health, and financial imperativemoral, public health, and financial imperative  Need continued improvements toNeed continued improvements to make it easier to get on and staymake it easier to get on and stay on coverage:on coverage: – Streamlined and simplified enrollment in Medicaid, CoveredStreamlined and simplified enrollment in Medicaid, Covered California; no wrong doors; need to improve consumer experienceCalifornia; no wrong doors; need to improve consumer experience – Expand integrated and better-trained system of enrollmentExpand integrated and better-trained system of enrollment assistance and “navigation”: Call center employees, county workers,assistance and “navigation”: Call center employees, county workers, brokers/agents, community enrollment counselors, etc.brokers/agents, community enrollment counselors, etc. – More to do: Increased capacity; Smoother enrollment systems,More to do: Increased capacity; Smoother enrollment systems, online and otherwise; more trained enrollment counselors on-the-online and otherwise; more trained enrollment counselors on-the- ground; More targeted outreach, in CA’s diverse communities, inground; More targeted outreach, in CA’s diverse communities, in multiple languages; Improved selection tools; focus on retentionmultiple languages; Improved selection tools; focus on retention – If successful, we can ultimately cover 2/3 of California’s 7 millionIf successful, we can ultimately cover 2/3 of California’s 7 million uninsured.uninsured.
  18. 18. Health Reform 2.0Health Reform 2.0 1) Unfinished Business1) Unfinished Business –Medi-CalMedi-Cal: benefits, provider rates, etc.: benefits, provider rates, etc. –Covered CaliforniaCovered California : quality ratings; improving: quality ratings; improving health plan standards; options for the unbanked;health plan standards; options for the unbanked; pediatric dental coverage; other triaged & delayedpediatric dental coverage; other triaged & delayed decisionsdecisions –Consumer protections once coveredConsumer protections once covered :: network adequacy/timely access, cost-sharing, etc.network adequacy/timely access, cost-sharing, etc. –Getting insurers to compete not on avoiding sickGetting insurers to compete not on avoiding sick people, but on cost, quality, customer service, andpeople, but on cost, quality, customer service, and prevention and wellnessprevention and wellness –Cost containment and quality improvementCost containment and quality improvement 2) Next Steps: Fulfill Promise of Reform2) Next Steps: Fulfill Promise of Reform 3) A Platform for More3) A Platform for More
  19. 19. “What I would do if I were a Democrat running four years from now, I’d say, you know what, dental care will be included in Obamacare.” “GIFTS” * Medi-Cal: Adult Dental Restored May 2014 * Covered California: • Pediatric Dental in Stand-Alone Plans in 2014 • Pediatric Dental Embedded in 2015 • Family Dental Offered as Additional Option
  20. 20. California Has About 3 MillionCalifornia Has About 3 Million Remaining UninsuredRemaining Uninsured
  21. 21. 2323
  22. 22. WhichWhich CountyCounty Safety-NetsSafety-Nets ServeServe Patients NotPatients Not LegallyLegally Present?Present? AlamedaAlameda Contra Costa (only children)Contra Costa (only children) Fresno (<67% FPL)Fresno (<67% FPL) KernKern Los Angeles (<133% FPL)Los Angeles (<133% FPL) RiversideRiverside San FranciscoSan Francisco San MateoSan Mateo Santa ClaraSanta Clara Santa Cruz (<100%FPL)Santa Cruz (<100%FPL) (Most to 200% FPL or more)(Most to 200% FPL or more)
  23. 23. County & Statewide SolutionsCounty & Statewide Solutions Undocumented explicitly excluded from federal help;Undocumented explicitly excluded from federal help; even undereven under immigration reform, many aspiring citizens will be on a “path toimmigration reform, many aspiring citizens will be on a “path to citizenship” of over a decade, restricted from federal help with healthcitizenship” of over a decade, restricted from federal help with health care. So even with immigration reform,care. So even with immigration reform, this issue remains for localthis issue remains for local policymakers, states, counties, and private providers.policymakers, states, counties, and private providers.  MAXIMIZE ENROLLMENT:MAXIMIZE ENROLLMENT: Continue efforts to maximize enrollment of those who are eligible but not enrolled.  EMPLOYER-BASED COVERAGE:EMPLOYER-BASED COVERAGE: Most undocumented residentsMost undocumented residents are working, and some are covered through on-the-job benefits. Theare working, and some are covered through on-the-job benefits. The more we promote employer-based coverage, the more we cover. (i.e.more we promote employer-based coverage, the more we cover. (i.e. AB880)AB880)  SAFETY-NET FUNDING:SAFETY-NET FUNDING: From the county safety-net and publicFrom the county safety-net and public hospital dollars to funding for community clinics (like restoring EAPC).hospital dollars to funding for community clinics (like restoring EAPC).  COUNTY COVERAGE OPTIONS:COUNTY COVERAGE OPTIONS: Some counties are movingSome counties are moving forward with extending coverage-like medical homes with primary andforward with extending coverage-like medical homes with primary and preventive care.preventive care.  STATE-ONLY/MIRROR PROGRAMS:STATE-ONLY/MIRROR PROGRAMS: Philosophically, allPhilosophically, all Californians should be eligible for the level of benefits offered by theCalifornians should be eligible for the level of benefits offered by the
  24. 24.                                                                                                                                  RICH PEDRONCELLI, ASSOCIATED PRESS The chairman of the California Legislative Latino Caucus plans to propose a new law that would expand access to health insurance for all Californians, including those living in the country illegally. State Sen. Ricardo Lara, D-Bell Gardens, is working with a broad coalition of organizations to map out the details of a bill that would cover undocumented immigrants, who are excluded from insurance coverage under the national Affordable Care Act, or ACA. “Immigration status shouldn’t bar individuals from health coverage, especially since their taxes contribute to the growth of our economy,” Lara said in a news release. NEWS State senator wants health care for all immigrants By ROXANA KOPETMAN / ORANGE COUNTY REGISTER Published: Jan. 10, 2014 Updated: 6:04 p.m. LEGISLATIVE CAMPAIGNLEGISLATIVE CAMPAIGN BEGINSBEGINS
  25. 25. Who Needs More Help?Who Needs More Help? ACA has millions of “winners,” who have new coverage, newACA has millions of “winners,” who have new coverage, new access, and/or new financial help to afford coverage.access, and/or new financial help to afford coverage. •And everyone wins with a health system more humane,And everyone wins with a health system more humane, more rational, more transparent, with a stronger safety-net,more rational, more transparent, with a stronger safety-net, new consumer protections and incentives aligned fornew consumer protections and incentives aligned for improved quality and reduced cost.improved quality and reduced cost. ButBut on affordability, some folks will need more helpon affordability, some folks will need more help :: •Uninsured undocumented immigrantsUninsured undocumented immigrants •Those in “family glitch”: family members for workers withThose in “family glitch”: family members for workers with employer based coverage affordable for just themselvesemployer based coverage affordable for just themselves •Some over 400% federal poverty level (typically older, inSome over 400% federal poverty level (typically older, in high-cost areas) who don’t have affordability guarantee.high-cost areas) who don’t have affordability guarantee. •Those in Exchange who find monthly premiums/costThose in Exchange who find monthly premiums/cost sharing still a burden, and may/may not decline coverage.sharing still a burden, and may/may not decline coverage.
  26. 26. Cost ContainmentCost Containment  PreventionPrevention: Major investments in prevention and public health; Change: Major investments in prevention and public health; Change delivery system to promote primary and preventative care; no cost-sharing fordelivery system to promote primary and preventative care; no cost-sharing for preventative care to encourage use; other efforts like menu labeling.preventative care to encourage use; other efforts like menu labeling.  Bulk PurchasingBulk Purchasing through group coverage, and a new exchange, to bargainthrough group coverage, and a new exchange, to bargain for better rates.for better rates.  Abolishing UnderwritingAbolishing Underwriting and its expense and incentives, getting insurersand its expense and incentives, getting insurers to compete on cost & quality rather than risk selection.to compete on cost & quality rather than risk selection.  Information TechnologyInformation Technology to foster electronic records, reduce bureaucracy,to foster electronic records, reduce bureaucracy, get better data on cost & qualityget better data on cost & quality  Better Research from Transparency EffortsBetter Research from Transparency Efforts on prices and healthon prices and health outcomes; and onoutcomes; and on comparative effectivenesscomparative effectiveness of key treatments.of key treatments.  Patient SafetyPatient Safety measures to reduce hospital-acquired infections, reducemeasures to reduce hospital-acquired infections, reduce hospital re-admissions, etc.hospital re-admissions, etc.  Payment ReformsPayment Reforms to reward quality & better health outcomes, includingto reward quality & better health outcomes, including better care coordination and disease management;better care coordination and disease management;  Coverage for allCoverage for all both directly (prevention, reduces cost-shift) reducesboth directly (prevention, reduces cost-shift) reduces costs and helps provides policy tools for further efforts.costs and helps provides policy tools for further efforts.
  27. 27. Next Steps: Fulfilling the FullNext Steps: Fulfilling the Full Promise of Health ReformPromise of Health Reform ““What we are getting here is not a mansion but a starter home. It’s got aWhat we are getting here is not a mansion but a starter home. It’s got a good foundation: 30 million Americans are covered. It’s got a good roof: Agood foundation: 30 million Americans are covered. It’s got a good roof: A lot of protections from abuses by insurance companies. It’s got a lot of nicelot of protections from abuses by insurance companies. It’s got a lot of nice stuff in there for prevention and wellness. But, we can build additions asstuff in there for prevention and wellness. But, we can build additions as we go along in the future” –Senator Tom Harkinwe go along in the future” –Senator Tom Harkin Including the Excluded/Covering the UndocumentedIncluding the Excluded/Covering the Undocumented Fixing Flaws in the Law/Closing GapsFixing Flaws in the Law/Closing Gaps – Employer-Based Coverage [AB880(Gomez)]Employer-Based Coverage [AB880(Gomez)] More on Affordability & Cost ContainmentMore on Affordability & Cost Containment – Prop 45 On the Ballot: Health Insurance Rate RegulationProp 45 On the Ballot: Health Insurance Rate Regulation Public Option/Single-Payer/Etc.Public Option/Single-Payer/Etc. A Platform OnA Platform On Other IssuesOther Issues
  28. 28. SB35(Padilla)
  29. 29. “The federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago...” – David Leonhardt, The New York Times, 323/2010 Beyond Preventing Medical Bankruptcy: Progressive Revenue & Distribution * Income Support Affordability * Health Jobs * On-The-Job Benefits Economic and Community Development
  30. 30. Changes to coverage,Changes to coverage, mental health, and substancemental health, and substance abuse treatment can andabuse treatment can and should have ripple effectsshould have ripple effects throughout criminal justice,throughout criminal justice, policing, county services, andpolicing, county services, and corrections…corrections…
  31. 31. PreventionPrevention  Outside the health systemOutside the health system – Beyond no cost-sharing for preventative care, andBeyond no cost-sharing for preventative care, and other delivery system reformsother delivery system reforms  Health In All PoliciesHealth In All Policies – Housing, Zoning, Education, Environmental,Housing, Zoning, Education, Environmental, Transportation, Food Security, Public Safety, and otherTransportation, Food Security, Public Safety, and other services all vital.services all vital. – Place matters: Major opportunity for county-basedPlace matters: Major opportunity for county-based policy interventionspolicy interventions  Major Investments in Public HealthMajor Investments in Public Health  Community Transformation GrantsCommunity Transformation Grants  Other PoliciesOther Policies – Menu labeling, etc.Menu labeling, etc.
  32. 32. A Political Realignment forA Political Realignment for Prevention and More?Prevention and More? “Big Food vs. Big Insurance” --Pollan, 9/9/09“Big Food vs. Big Insurance” --Pollan, 9/9/09
  33. 33. What it Means to Repeal inWhat it Means to Repeal in CACALEAVE CONSUMERS AT THE MERCY OF INSURER ABUSES.LEAVE CONSUMERS AT THE MERCY OF INSURER ABUSES. allowing insurers to:allowing insurers to:  deny almost 400,000 Californiansdeny almost 400,000 Californians for “pre-existing conditions”;for “pre-existing conditions”;  impose arbitrary annual and lifetime capsimpose arbitrary annual and lifetime caps on coverage, leavingon coverage, leaving insuredinsured patients at risk ofpatients at risk of medical debt and bankruptcy; andmedical debt and bankruptcy; and  sell “junk” coveragesell “junk” coverage that does not provide basic benefits.that does not provide basic benefits. DENY MILLIONS HELP WITH HEALTH CAREDENY MILLIONS HELP WITH HEALTH CARE  DenyDeny 2 million2 million uninsured Californians access to coverage through Medicaid;uninsured Californians access to coverage through Medicaid;  DenyDeny 3.8 million3.8 million uninsured Californians access to new coverage through individual healthuninsured Californians access to new coverage through individual health insurance and prevent improvements to coverage forinsurance and prevent improvements to coverage for 21 million21 million Californians with employer orCalifornians with employer or individual plans.individual plans.  CondemnCondemn 66,00066,000 more California families a year to bankruptcy due to health care costs.more California families a year to bankruptcy due to health care costs.  PreventPrevent 3.2 million3.2 million young adults in California (under age 26) to obtain coverage on theiryoung adults in California (under age 26) to obtain coverage on their parents’ insurance plans.parents’ insurance plans.  Deny allDeny all 4.5 million4.5 million California seniors free preventive servicesCalifornia seniors free preventive services REJECT RESOURCES AND FEDERAL FUNDS FORREJECT RESOURCES AND FEDERAL FUNDS FOR CALIFORNIANSCALIFORNIANS  Deny Californians access toDeny Californians access to $106 billion$106 billion in tax credits would meanin tax credits would mean increased healthincreased health insurance premium costs for millions of California familiesinsurance premium costs for millions of California families  Increase taxes on up to 392,000 California small businesses by $4.3 billion,Increase taxes on up to 392,000 California small businesses by $4.3 billion, byby stopping small business tax credit.stopping small business tax credit.  Increase prescription drug costs for 794,000 California seniors by $9.3 billion,Increase prescription drug costs for 794,000 California seniors by $9.3 billion, byby leaving the Medicare Donut Hole unfilled.leaving the Medicare Donut Hole unfilled.  Eliminate $1.4 billion in new funding to California community health centersEliminate $1.4 billion in new funding to California community health centers ..
  34. 34. For more informationFor more information Website: http://www.health-access.orgWebsite: http://www.health-access.org Blog: http://blog.health-access.orgBlog: http://blog.health-access.org Facebook: www.facebook.com/healthaccessFacebook: www.facebook.com/healthaccess Twitter: www.twitter.com/healthaccessTwitter: www.twitter.com/healthaccess Health Access CaliforniaHealth Access California 1127 111127 11thth Street, Suite 234,Street, Suite 234, SacramentoSacramento, CA 95814, CA 95814 916-497-0923916-497-0923 414 13414 13thth Street, Suite 450,Street, Suite 450, OaklandOakland, CA 95612, CA 95612 510-873-8787510-873-8787 1930 Wilshire Blvd., Suite 916,1930 Wilshire Blvd., Suite 916, Los AngelesLos Angeles, CA 90057, CA 90057 213-413-3587213-413-3587

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