Transcript Immigrant Health Presentation for TCE

Health Care Reform in
California
Steven P. Wallace, Ph.D.
UCLA Center for Health Policy Research & UCLA School of Public Health
UCLA Extension Beyond the Headlines Series
January 29, 2008
http://swallace.bol.ucla.edu
The Problem
2006 Health Care Spending in the US
– $2.1 trillion
– 16% of GDP
– $7,026 per person
Yet millions have no coverage
46.6 million Americans (15.9%) are
uninsured
– Both adults and children
– Led by declines in employer insurance
http://www.cbpp.org/8-29-06health.htm
CA rates worse than national
average
Uninsured, 2006
Ages 0-17
U.S.
TX
FL
MS
NV
NM
AZ
LA
UT
CO
MT
NC
NJ
OR
ID
CA
11.7%
21.2%
18.9%
18.9%
18.8%
17.9%
17.0%
15.9%
15.0%
14.6%
14.5%
14.0%
13.3%
13.1%
13.0%
12.8%
Ages 18-64
U.S.
TX
NM
LA
FL
AR
AZ
OK
MS
CA
NV
OR
NC
GA
AL
MT
20.2%
30.0%
29.6%
28.7%
27.2%
26.4%
25.9%
25.6%
24.9%
23.9%
23.5%
23.0%
22.6%
21.8%
21.2%
21.0%
Source: U.S. Census, Current Population Survey 2007
California also losing work-based
insurance
Source: California Health Interview Survey
http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=226
Why insurance matters, kids
time since last MD visit
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
69.1%
84.9%
89.5%
89.7%
9.7%
5.4%
7.4%
3.1%
7.2%
3.1%
uninsured all uninsured part
year
year
Medi-Cal
Employmentbased all year
>2 years
<1 year
17.4%
13.5%
1-2 years
Source: California Health Interview Survey
http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=226
Why insurance matters, adults
no usual source of care
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
21.6%
40.0%
44.4%
30.2%
76.4%
29.4%
44.1%
48.2%
30.6%
18.9%
4.8%
11.5%
uninsured all uninsured part
year
year
no usual source of care
Medi-Cal
gvnt/community clinic
Source: California Health Interview Survey
http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=226
Employmentbased all year
doctor's office/HMO
U.S. vs. other health care systems
Ellen Nolte and C. Martin McKee, Measuring The Health Of Nations: Updating An Earlier
Analysis, Health Affairs, Vol 27, Issue 1, 58-71
U.S. vs. other health care systems
Ellen Nolte and C. Martin McKee, Measuring The Health Of Nations: Updating An Earlier
Analysis, Health Affairs, Vol 27, Issue 1, 58-71
Copyright ©2008 by Project HOPE, all rights reserved.
What is to be done?
Last comprehensive national proposal by
Clinton in 2003
– Too complicated, well-financed groups against
Last major health care expansion = State
Children’s Health Insurance Program,
1997
– Low income kids only
– Expansion vetoed by President Bush, 2007
States as policy innovators
California SB2, 2003
– Legislature passed law requiring most
employers to provide health insurance
– Overturned in 2004 referendum w/Davis recall
(51% - 49%)
Outspent $18 million against, $15 million for
Against: Restaurant Assoc, Walmart, McDonalds
For: SEIU, CA Teachers Assoc, United Food
Workers
Most recent effort ABX1 1
Governor + legislative leaders
Attempt to cover most (70%) of uninsured
Californians = 3.6 million
Mixture of employer incentives, individual
mandates, and subsidies
Some new taxes to pay for subsidies
Planned to start 2010
Headline?
Key Features- employers
Employer “pay or play”
– Offer health insurance to workers or pay 1%6.5% of payroll into pool to cover employees;
based on size of firm
Key Features – public insurance
Expands public coverage
– Healthy Families increase coverage from
250% poverty to 300% poverty
– New Medi-Cal coverage for childless adults
up to 250% poverty
– These programs are paid 50% by state and
50% by federal government
Key Features - individuals
Individual mandate (affordable)
– All persons without insurance are required to
buy it (like car insurance)
– Special private plans for those whose cost of
coverage is greater than 5% of income (for
those <250% poverty or)
– Tax subsidy to help those with incomes 250%
- 400% of poverty
Key Features – insurance co’s
Insurance companies can not refuse to
sell policies (guaranteed issue)
Simplified insurance policy options (5, ala
Medicare)
Requires companies to spend 85% of
premiums on services (“loss ratio”)
Key Feature - revenues
New revenues in addition to employer $$
4% hospital tax
$1.75/pack additional cigarette tax
County tax contributions
All of the above require voter approval;
planned for November 2008 ballot
Contending Solution
Senator Kuehl – Single Payer Coverage
Similar to “Medicare for All”
Eliminates all marketing expenses
New worker (3-4%) and employer (8%)
tax, in lieu of health insurance premiums
Everybody would be treated the same,
100% coverage, uniform benefits
Governor vetoed in 2006
Politics (vs. Policy)
Republican governor w/no party support in
legislature but large public appeal
Democratic legislature w/o enough votes
to pass taxes alone or override governor
Business with low wage employees
oppose; some unions support
Economic downturn spooked everyone
Kuehl withdraws support for Gov’s plan
The next headline?
Nothing in California until the next
governor and legislature, at a minimum
National initiatives depend on who wins
the White House and the composition of
Congress
Until then, look for more headlines about
the uninsured and the U.S. lagging other
countries in health care performance.
Useful web sites
UCLA Center for Health Policy Research
http://www.healthpolicy.ucla.edu
California Legislative Analyst’s Office
http://www.lao.ca.gov/2008/hlth/health_reform/health_reform_012208.aspx
Health Access
http://www.health-access.org/advocating/2007_healthdebate.html
California Health Care Foundation
http://www.calhealthreform.org/
California Speaks
http://www.californiaspeaks.org/