Transcript Local Advocacy for State and Federal Health Reform

2012 Election Results:
Impacts and Next Steps
in CA Health Policy:
What’s New, What’s Next?
November 2012
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Obamacare Wins!
Implementation Steams Ahead
With the Supreme Court decision and the President’s re-election, the
Affordable Care Act is assured of implementation. While there’s
more to do, “Obamacare” is the biggest Congressional action to:
1) Provide new consumer protections to prevent the worst
insurance industry abuses
• Biggest reform of insurance practices ever: no denials for pre-existing
conditions; no rescissions; no lifetime/annual caps on coverage; etc
2) Ensure security for those with coverage, and new and
affordable options for those without coverage
• Biggest expansion of coverage in 45 years; Would bring US from 85% to
95% coverage.
• Expansion of Medicaid and a new exchange, with affordability tax credits
so premiums are tied to income, not how sick we are.
3) Begin to control health care costs, for our families & our govt.
• Multiple efforts to ensure quality & reduce cost
• Biggest deficit reduction measure in a generation.
• Big investments in prevention, with unbooked savings
More Election Results
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No supporter of the Affordable Care Act lost to
an opponent of “ObamaCare”
– U.S. Senate: Democrats increased margins, including in
tough states like Missouri and Montana where candidates
defended the ACA.
– California House: Democratic gains includes likely defeat of 3
incumbents and ACA opponents: Bilbray; Bono Mack;
Lungren. (Last two defeated by doctors with safety-net
experience: Dr. Raul Ruiz and Dr. Ami Bera)
– California Legislature: Democrats increased margins to 2/3
supermajorities.
Prop 30!
Prevents “trigger cuts” to education & public safety, by
raising $6 billion/year in revenue to the state budget,
through temporary increases in upper-income tax rates,
and a slight quarter-cent hike in sales tax (which would
still be less than last year).
Stabilizes budget after years of tough cuts
 Health and human services 2nd biggest budget item after
education; 1/3 of the state budget.
 $15 billion in cuts to health & human services in the last
three years, such as:
– Elimination of Denti-Cal and 9 other Medi-Cal benefits
– Elimination/transition of Adults Day Health Centers
– Elimination/transition of Healthy Families
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No restorations triggered—but helps prevent
further cuts to health
Creates a firmer fiscal foundation for reform
HEALTH REFORM:
Next Steps &
The Special Session
California Leading
on Health Reform
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California needs to maximize the benefit—our
health system needs all the help we can get
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California leads, and can show the way among
states with significant uninsured populations…
Fulfilling the Promise:
California 2010 Legislation
– Created an Exchange that is transparent, consumerfriendly, easy-to-use, fairly governed, and that negotiates
with the insurers to provide the best value to consumers:
AB1602 (Perez) & SB900 (Alquist/Steinberg)
– Ensured availability of child-only plans, prohibited
children with pre-existing conditions to be denied
coverage, and limited higher rates: AB2244 (Feuer)
– Made rate hikes (& justifications) public: SB1163
(Leno)
– Conformed state law to many new federal consumer
protections, including rescissions, dependent coverage up to
age 26, no cost-sharing for preventative care, etc.
The Exchange in CA
California’s first-in-the-nation legislation to establish an
Exchange post-reform:
Provides for “selective contracting,” so it can
negotiate for individuals and small businesses, who
otherwise are left all alone at the mercy of the insurers.
Can serve as the HR department for CA, getting a
better deal, vetting products, providing neutral and
credible information, standardizing benefits, and fixing
issues that come up.
 Five board members appointed: HHS Secretary Diana Dooley
(Gov. Brown); Kim Belshe and Susan Kennedy (Gov.
Schwarzenegger); Paul Fearer (Speaker Perez) ; Dr. Bob
Ross (Senate President Steinberg).
 Initial work: Hired an Executive Director, Peter Lee, and
staff; created business plan; Sought and got $39 million in
federal funds through 2012; Start work on eligibility and
enrollment systems; IT systems; navigation; stakeholder
process; public education and outreach; etc.
Fulfilling the Promise:
California 2011 Legislation
– Reformed key systems to help consumers get
coverage and care, to be ready ramping up to 2014:
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Eligibility and Enrollment: AB1296(Bonilla) outlines a “no
wrong door” philosophy for signing up Californians for coverage.
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Consumer Assistance: AB922(Monning) enhances & expands
the Office of Patient Advocates as a triage center for questions
and complaints about coverage and care.
– Instituted new consumer protections and insurance
oversight, to align with federal law:
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Medical Loss Ratio: SB51(Alquist) would allow state regulators
to enforce new federal standards to ensuring premiums dollars
go to patient care, not administration and profit.
Maternity Care: AB210(Hernandez)/SB222(Evans) mandates
maternity services as a basic benefit by July 2012.
Fulfilling the Promise:
California 2012 Legislation
– Instituted new consumer protections and insurance
oversight, to align with federal law:
ESSENTIAL HEALTH BENEFITS: AB1453 (Monning) / SB951
(Hernandez)—set a minimum standard for health plans
(equivalent to a Kaiser small group HMO), so consumers have
more confidence that their coverage is comprehensive.
 SMALL GROUP MARKET REFORM: AB1083 (Monning) prevents
small businesses from seeing spikes in insurance premiums if
their workers get sick.
Also:
 NOTICE OF COVERAGE OPTION DURING LIFE CHANGES:
AB792(Bonilla) requires that consumers are informed of their
coverage options in the new Exchange when losing coverage-such as during a job change, divorce, adoption, and other
circumstances.
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Fulfilling the Promise: (LIHP)
Low Income Health Program
A win for the county, the uninsured, and the health system:
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County gets new federal matching funds, for dollars they
already largely already spend on indigent care, helping their
health system and their local economy.
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Now 550,000 uninsured get coverage prior to 2014; a
medical home providing primary and preventative care, not just
care at the emergency room.
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Since this coverage is grounded in county-based systems of care,
these new dollars go to shore up safety-net institutions,
including public hospitals, community clinics, and other providers.
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This serves as a bridge to health reform, ensuring these
patients are getting treated and in systems of care before 2014,
and ready to get full Medi-Cal (or exchange-based) coverage on
day one, maximizing enrollment and federal funds for California.
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This isn’t a long-term obligation: In fact, the more people are
enrolled in these programs, and thus quickly shifted to Medi-Cal in
2014 with 100% funding by the federal government, the more
county resources can be refocused to better serve the
medically indigent who remain uninsured after 2014.
Reform is Real
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Californians are feeling the benefits already.
– 14,667 “uninsurable” Californians are enrolled in the Pre-Existing
Condition Insurance Program for those denied coverage due to pre-existing
conditions.
– 552,000 Californians are enrolled in coverage through the Low Income
Health Program (LIHP) in 51 counties, which serves as bridge coverage for the
low-income uninsured who will qualify for Medi-Cal in 2014.
– 355,927 young adults in California have coverage who might otherwise
have become uninsured, since they are covered by their parents’ insurance.
– 8,978,000 insured Californians gained new consumer protections,
including Medical Loss Ratio requirements that require insurance companies to
spend more premium dollars on medical health care. 1.9 million California
residents received $74 million in rebates from insurance companies who
did not meet these minimums.
– California consumers saved over $100 million dollars in savings from
rate hikes that were retracted, reduced, or withdrawn due to rate review.
– 319,429 California seniors in Medicare saved $171,983,735 in
prescription drug costs, an average of over $500 a patient facing the “drug donut
hole.”
– Over 12 million Californians no longer have a lifetime limit on their health
insurance plan.
– Health plans in California must all cover maternity care.
2013 Special Session Agenda:
Consumer Protections & Insurer Oversight
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Watchdog the federal and state government to ensure that new
consumer protections are implemented and enforced.
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Focus at the Department of Managed Health Care (DMHC) and
the Department of Insurance (DOI)
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Continued focus on rate review has generated hundreds of million
in savings through scaled-back and withdrawn rate hikes.
Ensure Californians know about their new rights and options.
Start to transition from the “Wild Wild West” insurance market:
phasing in benefits, standards, and options to be ready for 2014. (Bill
numbers from previous session)
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INDIVIDUAL MARKET REFORM: AB1462 (Monning) / SB961
(Hernandez)
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COST SHARING LIMITS: AB1800 (Ma)
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Maybe: RATE REGULATION: AB52(Feuer) / Scheduled for 2014
ballot measure
Fight efforts to weaken, defund, undermine, and repeal these
consumer protections and the rest of reform.
2013 Special Session Agenda:
Ensuring Californians Get Coverage:
The Day One Challenge
Eligibility and enrollment (bill numbers from prior session):
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2014 MEDI-CAL EXPANSION: AB43 (Monning) / SB 677 (Hernandez)
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Medicaid Benchmark Benefits
Eligibility and Enrollment Rules
Continuation of current State Programs: FamilyPACT, PRUCOL, etc.
PRE-ENROLLMENT: AB715 (Atkins)
Work to implement and improve:
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Streamline enrollment in Medicaid, Healthy Families, the Exchange
and elsewhere; no wrong doors;
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Get ready so millions of Californians get covered on Day
One—January 1, 2014—and California maximizes federal money.
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Create integrated system of “navigation”—right now, patchwork of
county workers, brokers/agents, community groups, etc.
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Work at the Legislature and at the Exchange, DHCS, etc.
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Enrollment starts October 2013—ten short months away.
Fulfilling the Promise:
What a Community Can Do
Educate the Community about Their New Rights, Options, Benefits,
and Consumer Protections
Engage Communities and Consumers Every Step of the Way
Maximize Federal Dollars for County and Community
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Grant opportunities
Matching Dollars for Medi-Cal, Healthy Families, LIHP, etc.
Aggressively Implement the Low-Income Health Program
Be Ready So Community Residents Get Coverage on Day One
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Set a Goal and Date; Work backwards to Meet That Goal
Systems in place for easy enrollment through no wrong door
Transform the Safety-Net to Survive and Thrive
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A Business Plan for Safety-net institutions
An Assessment and Augmentation of County-wide Capacity
Use the New Tools in the Law
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To focus on delivery system reform for cost, quality, safety & equity
To build health in all policies, with place-based policy interventions
So Much More To Do:
What Can You Do?
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Thank your member of Congress/Tell them not to
repeal it: Call, write, or visit your Congressional
Representative and thank them for their yes vote – or
attend a public event to thank them!
Share your story personal stories help others learn how
they can benefit from reform – and they are a compelling
advocacy tool!
Support state efforts to implement and improve
reform let your local representatives know that you
support robust implementation and improvement of reform.
Write a letter to the editor in support of reform and all
its benefits.
Join our mailing list to keep up to date on legislative
development and get important action alerts!
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For more information
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