Health Care Advocacy Efforts Towards Universal Coverage in California

1. Care4All California
Los Angeles Convening
Fighting to Protect and Win Care for All California
December 10, 2018
www.health-access.org

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Welcome and Introductions
Thank you to our hosts:
SEIU California State Council
SEIU Local 721.
PLEASE SHARE YOUR:
• Name and Organization
• Why are you here today and what are
you
hoping to get out of this convening?

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Organizations Present Today
Alliance of Californians for Community
Empowerment (ACCE)
California Health Professional Student
Alliance (CaHPSA)
Los Angeles LGBT Center
AltaMed California Physicians Alliance (CaPA) Maternal and Child Health Access
Alzheimer's Los Angeles ChapCare
Mixteco Indígena Community Organizing
Project (MICOP)
American Cancer Society
Cancer Action Network
Clinica Monseñor ÓscarRomero National Health Law Program
American Heart Association
Community Clinic Association of
Los Angeles County
National Multiple Sclerosis Society
American Lung Association Community Health Councils Planned Parenthood Los Angeles
AIDS Project Los Angeles (APLA Health) Disability Rights Legal Center SEIU Local 721
Asian Americans Advancing Justice L.A. GEM Project SEIU California State Council
Blue Shield of California Health Access SEIU Local 2015
Breast Cancer Partner Health Net Social Security W orks
California Alliance for Retired
Americans (CARA)
Health Outreach Program-Los Angeles
County Office of Education
UCR School of Medicine
California Association of Health Facilities Kaiser Permanente United Farmworkers Foundation
California Food Policy Advocates Korean Resource Center Visión y Compromiso
California Immigrant Policy Center LGBT Center of Orange County W orksite W ellness LA
California Latinas for Reproductive Justice LGBTQ HHS Network Young Invincibles

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Your Packet Contents:
Left Side
• Agenda
• Health Access 2018
Legislative Scorecard
• Media Advisory/Press Release
 #Health4All Bill Introduced in CA Legislature
• Health Access/CIPC Factsheet: Health4All
• Politico Article: Democrat to Introduce Bill Extending Health
Care to Undocumented Immigrants
• Care4All California 2018 Legislative Priorities
• Care4All California Campaign Membership Form
• Health Access Factsheet: California’s Efforts to Shield
Consumers from Trump Sabotage
• Health Access Factsheet: California Bills to Improve
Affordability, Moving State Closer to Universal Coverage
• Health Access Annual Membership Form
Right Side

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Who We Are
• For more than 30 years, Health Access California has
been the lead consumer advocacy coalition in
California, advocating for quality, affordable health
care for all Californians.
• Our core mission:
• Preserving access to care
• Protecting consumers
• Expanding coverage and winning comprehensive
health reform

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Presenters:
ANTHONY WRIGHT
Executive Director
Health Access
awright@health-access.org
@AEWright
DENZEL TONGUE
Health & Public Benefits Campaign Coordinator
California Immigrant Policy Center
dtongue@caimmigrant.org
@DenzelTongue
ERIN REYNOSO
Organizing Director
Health Access
ereynoso@health-access.org
AMY WIWUGA
Southern CA Consumer Advocate/Community
Organizer
awiwuga@health-access.org
NANCY M. GOMEZ
Senior Consumer
Advocate/Organizer
Health Access
ngomez@health-access.org

7. CALIFORNIA UNDER THE ACA
Millions with new consumer protections; financial assistance
4+ million Californians with new coverage already
Biggest drop in uninsured rate of all 50 states
CA IMPLEMENTED AND IMPROVED:
• Covered CA negotiating on behalf of consumers
• Shop & compare health plans & benefits
• Medi-Cal express lane enrollment options
• Oversight over health plan rates & networks
• State coverage expansions: immigrant kids,
newly qualified immigrants
If we can prevent ACA repeal,
stop Medicaid cuts, and resist attacks
how can California drive forward?

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Care4All California Campaign Background

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Legislative Priorities
Aspirational and Achievable Without Federal
Approval:
I. PROTECT PATIENTS FROM FEDERAL SABOTAGE OF OUR
HEALTH SYSTEM
II. COVER ALL CALIFORNIANS, INCREASING UNIVERSALITY AND
AFFORDABILITY
III. REDUCE HEALTH CARE PRICES, IMPROVING QUALITY &
EQUITY THROUGH ACCOUNTABILITY

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ELECTION RESPONSE
(Opportunities and Challenges)
• Role of Health Care in the
Campaigns
• Federal and State Implications

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Review of Health4All and Care4AllCA
Campaign and Policy Discussion
• Recap of Past Legislative Session
• Affordability
• Senior Penalty
• Cost Containment
• Health4All
• Quality and Equity in Medi-Cal

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Holding Californians Harmless From Administrative Attacks

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Holding Californians Harmless From Federal
Administrative Attacks
BILLS SIGNED:
• “Junk” Substandard Insurance:
SB 910 (Hernandez) to ban so-called “short term” insurance
SB 1375 (Hernandez) to limit Association Health Plans
• Medical Loss Ratio
AB 2499 (Arambula) to ensure 80% of premium dollars
go to patient care, not administration and profit.
• Medi-Cal Waivers & Work Requirements
SB 1108 (Hernandez) on preventing Medicaid waivers
from including eligibility barriers, like work requirements

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Covering the Remaining Uninsured
Take-Up and Affordability Matter:
MEDI-CAL:
• Enrollment today: 13.8 million
• 322,000 eligible but not enrolled
• Less than 3% eligible not enrolled
COVERED CALIFORNIA:
• Enrollment today: 1.2 million
• 401,000 eligible but not enrolled
• Around 1/4 of those eligible for
Covered California subsidies are
not
enrolled
California Projected Uninsured Ages 0-64, 2017
Not eligible
due to
Immigration
status
1,787,00
58%
Chart Source: Dietz M, Graham-Squire D, Becker T, Chen X, Lucia L, and Jacobs K, Preliminary
CalSIM v. 2.0 Regional Remaining Uninsured Projections, UC Berkeley Labor Center and UCLA
Center for Health Policy Research, August 2016.

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Who Needs More Help--
To Enroll in or Afford Coverage?
28%
31%
41%
Uninsured citizens ages 0-64 with household income at or
above 139% FPL, California, 2016
401%+ FPL
$47,500+ single
Source: California Health Interview Survey 2016
139-250% Federal Poverty Level (FPL)
$16,500 - $29,700 single
251-400% FPL
$29,700 - $47,500 single
2018 Proposals to
Increase Affordability
in Covered California:
SB1255 (Hernandez)
AB2459 (Friedman)
AB2565 (Chiu)
AB3148 (Arambula)
Another Issue: “Family Glitch”
of unsubsidized spouses/children
of worker with job-based coverage
but not family coverage.

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No Investments in 2018:
But a Path for a New Governor
WHAT DIDN’T GET DONE IN 2018:
Steps to Universal Coverage
• Bills on #Health4All; Covered California Additional Assistance; Medi-Cal
“Senior Penalty”
• Assembly $1 Billion Budget Package; Senate had some similar
components.
Steps to Health Care Cost Containment “It’s the Prices, Stupid”:
• Health Care Cost, Quality & Equity Commission: Insurers, Hospitals,
Doctors, etc. (AB 3087, Kalra)
• Unfair & Anti-Competitive Hospital Contract Provisions (SB 538,
But a new Governor has a ready-made first-year agenda to take big steps to
a Universal, Accountable and Affordable Health System

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2018 Bills ENACTED on Cost/Quality/Equity
PASSED BY THE LEGISLATURE AND SIGNED BY GOV. BROWN:
More Work on Prescription Drug Prices
• Regulate Pharmacy Benefit Managers (AB 315, Wood)
• Maintain co-pay caps, (SB 1021, Wiener)
Health Plan Consolidation and its Impact on Costs
• Health plan merger oversight (AB 595, Wood)
Public Option Feasibility Study
• Conducted by Health Care Delivery System Council (AB 2472, Wood)
VETOED: Medi-Cal Managed Care--Accountability for Quality & Equity
• (AB 2275, Arambula)

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• Employer-sponsored health care
went up 234% from 2002-16.
• 83% of 2017-18 large group
increases is price inflation—only
16% utilization.
• 75% of premium dollars to doctors
and hospitals (+another 16% on
drugs)
• Average in-patient procedures 79%
higher in NorCal’s concentrated
market; Hospital prices 70% higher;
Physician prices 25-65% higher.
Why Health Costs Are So High

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State Administrative Authority & Actions
• Governor Signed AB 595 (Wood) to Increase DMHC Authority over Health
Plan Mergers
• Explicit Ability to Approve, Reject, or Impose Conditions
• Requires Hearing, Health System Impact Analysis for Major Mergers
• Attorney General Becerra Sued Sutter Health For Anti-Competitive Practices
• Related bill on unfair contract provisions, SB 538 (Monning), stalled.

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Broad Support for Government Action
Total
Agree
Total
Disagree
Don’t
Know
The government should act as a check on health
care providers to get costs under control
72 25 3
The government needs to step in and put limits
on what health care providers can charge
67 30 3
Health costs are lower when everyone has
coverage, so we should make sure everyone has
coverage they can afford
63 32 5

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Potential Other Ideas for 2019
AS A REGULATOR:
• Plan & Provider Price-Gouging
o Hospitals, Doctors, Medical Groups; Learning from MD, MA, MT
• Overseeing Out-of-Network ER Prices As a Driver of Health Costs
• Enhanced Insurance Rate Review
• Delivery System Reform—And Capturing the Savings for Consumers
AS A PURCHASER
• Continued Medi-Cal Managed Care Accountability
• Further Use of CoveredCA Purchasing Power— for value, for cost, quality, and equity,
and for simplification. (Model contract, Attachment 7)

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24. California’s Undocumented Residents
● 2.9 Million Californians
● Parents of 1 in 6 kids
● 1 in 10 workers
● $180 billion per year to state economy
● Over 50% have lived here for at least a decade

25. Current Medicaid Eligibility
● Medi-Cal is a federal program, but states can set their own
eligibility guidelines.
● SB 75 (Lara): Expanded Medi-Cal coverage to
undocumented kids (under 18 years old) in 2015
● Many immigrants remain excluded except for
emergencies & pregnancies

26. Immigrant Health Equity
● ACA
○ Helped reduce CA’s uninsured rate from 17% in 2013 to 7% in
2017.
○ Medicaid expansion to childless adults, households with incomes
below 138% of FPL
● Current
○ Multiple efforts to get to universal coverage.
○ Undocumented immigrants remain a large portion of CA’s
uninsured population

27. Health4All 2018
● SB 974 (Lara): elders 65+
● AB 2965 (Arambula): adults 19-25
● Both bills passed floor votes out of both houses of origin and out of
policy committees in second house
● Both Senate and Assembly allocated funds in their budget proposals
● Ultimately, Governor Brown DID NOT make any new ongoing health
care investments

28. Health4All 2019 Priorities
● Building New Champions
○ Asm. Arambula (Fresno) and Senator Lara- continuing champions. Both
will introduce bills at the start of session. Lara will have a co-author in
senate who will champion the issue.
○ Ensure that Assembly & Senate make Health4All top budget priority
○ Uplifting immigrant health disparities in rural and border regions
● Fall Visits with doubters
○ Sen. Stern (Thousand Oaks/Malibu)
○ Sen Glazer (Contra Costa)
○ Sen. Dodd (Solano/Yolo)
○ Sen. Roth (Inland Empire)
○ Sen. Allen (Santa Monica/Redondo Beach/Westwood area)

29. Health4All Bills Introduced on Dec. 3, 2018
SB 29 Health4All (By Senators Ricardo Lara and Maria Elena Durazo)
Full-Scope Medi-Cal for Income-Qualified Undocumented Adults
AB 4 Health4All (By Assembly Members Joaquin Arambula, Rob Bonta, and David Chiu)
Full-Scope Medi-Cal for Income-Qualified Undocumented Adults

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California’s Steps to #Health4All
PROGRESS WON:
•Counties are setting up more inclusive and smarter safety-net
programs. Sacramento, Contra Costa, Monterey and CMSP all
created new limited-benefit pilot programs that newly cover the
undocumented. Others like LA and Santa Clara are improving
existing programs. Ventura, Kern, and others are looking at new
programs.
County Safety-Net Reforms and Expansions
•Now covering an estimated 200,000 more children.
#Health4AllKids: Medi-Cal For All Children Under 266% FPL
•DACA eligibility for state-funded Medi-Cal is reaffirmed under
PRUCOL (Permanently Residing Under Color of Law)—even if DACA
is rescinded.
Continuing California’s Coverage of “Deferred Action” Immigrants
In 2018, legislative #Health4All
efforts SB 974(Lara)/AB 2965
(Arambula) originally sought to
expand Medi-Cal to all income-
eligible adults, regardless of
immigration status. In the budget,
the Assembly focused on young
adults up to 26, the Senate on
over 65 elders. Neither passed.
Stalled (for now): §1332 waiver
(withdrawn) to allow
undocumented adults to buy
unsubsidized Covered CA plans
(SB 10, Lara)

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Your Ideas and Questions

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Medicare for All
Single Payer
Universal Coverage

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Renewed Focus on Universal Coverage and
Medicare for All
For 30+ years, Health Access has been a strong supporter of multiple vehicles
to get universal health care and quality, affordable health care to all
Californians—including a Medicare for all single-payer system, with bills
introduced by:
• Senator Sheila Kuehl (SB 971, SB 810)
• Senator Mark Leno (SB 840)
• Senator Nicholas Petris (SB 2868)
• Proposition 186 (in 1994)
SB562 (Lara/Atkins) renewed this effort.
Now, a Council on Health Delivery Systems is funded to develop a plan,
including how to deal with issues like financing, transition, constitutional
barriers, and federal approval.

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What Are We Fighting for?
When we work for single-payer we are fighting for:
• a universal system,
• a publicly and progressively financed system,
• a cost-effective system,
• a comprehensive coverage system
• a simpler and more efficient system,
• a system focused on prevention not profits.

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Goals and Strategies of Care4All California
a) Timeline
b) New Legislative Session/New Governor/New
Members
c) Governor’s Swearing in and Budget Release
(January 10th)
d) Bill Introduction Deadline (February 22nd)
e) Re-Launch of the Care4All Campaign

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COALITION BUILDING
DISCUSSION
Inclusivity and Outreach
to Multi-Issue
Organizations and
Non- Traditional Allies

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LGBTQ Health and Human Services Network

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Our Network
The CA LGBTQ Health and Human Services Network is a coalition of over
60 non-profit organizations, direct service providers, researchers, and
community members working towards LGBTQ Health Equity.
We directly engage in advocacy efforts for LGBTQ-inclusive health policy
at the local, state, and federal levels – and we provide LGBTQ cultural
competency trainings for non-profit organizations and direct service
providers!

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1) The #Out4MentalHealth Project
The Project consists of five regional task forces located across California that are working to
address LGBTQ Mental Health Disparities in their local communities.
• We are currently seeking members for the San Fernando Valley Task Force to
develop a mental health equity agenda for the Los Angeles region and work
towards addressing these disparities.
2) The Reducing Tobacco Disparities Project
The Project supports creating tobacco-free LGBTQ communities.
• We work with four (4) regional partners committed to reducing LGBTQ tobacco-related health
disparities
• In Southern California, we are working in Los Angeles, San Bernardino County, Imperial
as well as Orange County and San Diego.
• We are seeking members to join our coalitions in these areas. These coalitions will work to
educate, advocate, and change local laws and policies towards tobacco-free communities.
The LGBTQ Network is Currently
Working on Two Statewide Projects:

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FOR MORE INFORMATION
CONTACT:
Dannie Ceseña
Program Coordinator –
CA LGBTQ HHS Network -
Los Angeles
dcesena@health-
access.org

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How You Can Contribute
• Become and Official Member of the Care4AllCA
Campaign
• Attend Follow-Up Meetings and Calls
• Attend In-District Legislative Visits
• Participate in Public Events and Press Conferences
• Gather Personal Patient Impact Stories
• Get or Renew your Health Access Membership

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For More Information
Website: http://www.health-access.org
Blog: http://blog.health-access.org
Facebook: www.facebook.com/healthaccess
Twitter: www.twitter.com/healthaccess
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