Anthony WrightAnthony WrightApril 2015April 2015

Next Steps in Health Next Steps in Health Reform:Reform:

From #Obamacare to From #Obamacare to #Health4All #Health4All and Beyondand Beyond

www.health-access.org

www.facebook.com/healthaccess

www.twitter.com/healthaccess

BFDBFD

Biggest Congressional Action for Consumer Protections; Coverage Expansion; Cost Containment

The Biggest Reforms of Our The Biggest Reforms of Our EraEra

The 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 protections Provides new consumer protections to prevent the to prevent the worst insurance industry abusesworst insurance industry abuses• Biggest reform of insurance practices ever: no denials for pre-Biggest reform of insurance practices ever: no denials for pre-

existing conditions; no rescissions; no lifetime/annual caps on existing conditions; no rescissions; no lifetime/annual caps on coverage; etccoverage; etc

2) Ensures security 2) Ensures security for those with coverage, andfor those with coverage, and new and new and affordable options affordable options for those without coveragefor those without coverage• Biggest expansion of coverage in almost 50 years; To bring US Biggest expansion of coverage in almost 50 years; To bring US

from 85% to 95% coverage.from 85% to 95% coverage.• Expansion of Medicaid and a new exchange, with affordability Expansion of Medicaid and a new exchange, with affordability

tax credits so premiums are tied to income, not how sick we tax credits so premiums are tied to income, not how sick we are.are.

3) Begins to control health care costs3) Begins to control health care costs, for our families and , for our families and our government.our 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

Ensuring Affordable Ensuring Affordable Coverage Coverage

& Essential Benefits& Essential BenefitsIn each of the ways people get coverage, throughIn each of the ways people get coverage, through

1)1) an employer (over a half)an employer (over a half)2)2) a public program (a third), ora public program (a third), or3)3) buying it as an individual (10%)buying it as an individual (10%)

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 Premiums not to exceed a percentage of income—sliding scale up to 9.5% of

income.income.– No lifetime limits, no annual limitsNo lifetime limits, no annual limits– Cap on out-of-pocket costs (co-pays, deductibles) of $6,350 Cap on out-of-pocket costs (co-pays, deductibles) of $6,350

individual/$12,500 family (2014 dollars)individual/$12,500 family (2014 dollars)– No co-pays for preventive services like mammograms and prostate cancer No co-pays for preventive services like mammograms and prostate cancer

screening.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 Example: Medical Loss Ratio: 80/85 cents of premiums must be spent on carecare

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 coverage in the same way, but in a more secure and stable fashion:and stable fashion:

– Makes it more likely your employer continues to offer Makes 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 Fixes the “individual market” of coverage in multiple ways.ways.

– Ensures that even if your life situation changes (job Ensures that even if your life situation changes (job change, divorce, graduation), you have access to change, divorce, graduation), you have access to affordable coverage.affordable coverage.

– Provides the foundation to bring down the overall costs Provides the foundation to bring down the overall costs of health careof health care

Health Reform and YouHealth Reform and You IF YOU ARE UNINSUREDIF YOU ARE UNINSURED, , you need to get coverage, but you 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-existing No denials or different rates for pre-existing conditions.conditions.

– AFFORDABLE:AFFORDABLE: Subsidies/affordability credits for low & mid Subsidies/affordability credits for low & mid income families to limit out of pocket costs to a certain income families to limit out of pocket costs to a certain percentage of income, plus other efforts to bring down costs.percentage 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 provides choice The Exchange provides choice and convenience, making it easier to compare and sign up.and convenience, making it easier to compare and sign up.

– Note that the individual mandate includes Note that the individual mandate includes exemptionsexemptions for for 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 it Health insurance isn’t cheap or easy—reforms help make it cheaper and easier.cheaper and easier.

Up To States To:Up To States To:

““Because of the money and resources, California is frequently Because of the money and resources, California is frequently touted as the state that is implementing the Affordable Care Act touted as the state that is implementing the Affordable Care Act most actively and aggressively. most actively and aggressively. The stakes couldn’t be The stakes couldn’t be higher.”higher.” – POLITICO– POLITICO

““California is a particularly important test for California is a particularly important test for Obamacare. Obamacare. It’s not just the largest state in the nation. It’s It’s not just the largest state in the nation. It’s also one of the states most committed to implementing also one of the states most committed to implementing Obamacare effectively. ... Obamacare effectively. ... If California can’t make the law If California can’t make the law work, perhaps no one can. But if California can make the work, perhaps no one can. But if California can make the law work, it shows that others can, too.” 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 everyonewho really just wants to say, 'I told you so.‘”–President Bill Clinton.

California LeadingCalifornia Leadingon Health Reformon Health Reform

States need to maximize the benefit—our States need to maximize the benefit—our health system needs all the help we can get.health system needs all the help we can get.

California is showing the way, especially California is showing the way, especially among states with significant diverse & among states with significant diverse & uninsured populations…uninsured populations…

CALIFORNIA IMPLEMENTSMillions with new consumer protections; financial assistance4+ million Californians with new coverage alreadyUninsured cut in half; Average rate hike 4.2%

CALIFORNIA IMPROVESEARLY:Low-Income Health ProgramsChildren with pre-existing conditionsMaternity coverageBETTER:Exchange that negotiates & standardizesMedi-Cal express lane enrollment optionsCoverage of legal & DACA immigrantsLGBT inclusion

Health Reform 2.0Health Reform 2.01) Making Enrollment & Eligibility Easier1) Making Enrollment & Eligibility Easier2) Unfinished Business2) 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 & delayed pediatric dental coverage; other triaged & delayed decisionsdecisions–Consumer protections once coveredConsumer protections once covered: access: : access: network adequacy/timely access, cost-sharing, etc.network adequacy/timely access, cost-sharing, etc.–Getting insurers to compete not on avoiding sick Getting insurers to compete not on avoiding sick people, but on cost, quality, customer service, and people, but on cost, quality, customer service, and prevention and wellnessprevention and wellness–Cost containment and quality improvementCost containment and quality improvement

3) Next Steps: Fulfill Full Promise of Reform3) Next Steps: Fulfill Full Promise of Reform4) A Platform for More4) A Platform for More

Who Needs More Help?Who Needs More Help?ACA has millions of “winners,” who have new coverage, ACA has millions of “winners,” who have new coverage, new access, and/or new financial help to afford coverage. new 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-more rational, more transparent, with a stronger safety-net, new consumer protections and incentives aligned for net, new consumer protections and incentives aligned for improved quality and reduced cost.improved quality and reduced cost.

But But on affordability, some folks will need more on affordability, some folks will need more helphelp::•Uninsured Uninsured undocumented immigrantsundocumented immigrants•Those in Those in “family glitch”:“family glitch”: family members for workers family members for workers with job-based coverage affordable for just themselveswith job-based coverage affordable for just themselves•Some Some over 400%over 400% federal poverty level (typically older, federal poverty level (typically older, in high-cost areas) who have no affordability guarantee.in high-cost areas) who have no affordability guarantee.•Those Those under 400%under 400% who find monthly premiums/cost who find monthly premiums/cost sharing still a burden, and may/may not decline sharing still a burden, and may/may not decline coverage.coverage.

California May Have 3 California May Have 3 Million Remaining Million Remaining

UninsuredUninsured

Our Current Safety-NetOur Current Safety-Net Uninsured live sicker, die younger, one Uninsured live sicker, die younger, one

emergency from the financial ruin.emergency from the financial ruin. Emergency Rooms: But only to stabilize Emergency Rooms: But only to stabilize

emergencies; Bill and debt afterwards emergencies; Bill and debt afterwards – 2006 Fair Hospital Pricing Law 2006 Fair Hospital Pricing Law

www.hospitalbillhelp.org Private providers: clinics, hospital charity Private providers: clinics, hospital charity

carecare Counties as the final safety-net optionCounties as the final safety-net option

– Counties have a “17000” obligation to provide basic care Counties have a “17000” obligation to provide basic care – California’s 58 counties continue to vary widely on their California’s 58 counties continue to vary widely on their

service to the uninsured, especially on:service to the uninsured, especially on:– How they provide care; What care they provide; and to How they provide care; What care they provide; and to

who, especially based on income & immigration status.who, especially based on income & immigration status.– Amidst 58 counties, 12 have public hospitals;Amidst 58 counties, 12 have public hospitals;– 12 “Article 13” counties just have clinics, or contract with 12 “Article 13” counties just have clinics, or contract with

private providers; or are a hybridprivate providers; or are a hybrid– 36 small rural counties in County Medical Service Program36 small rural counties in County Medical Service Program

Self-Reporting:Care Beyondthe ER forUndocumented Adults

AlamedaFresnoKernLos AngelesRiverside San FranciscoSan MateoSanta ClaraSanta CruzVentura

Prior to 2009:Contra CostaSacramentoYolo

Steps ForwardSteps ForwardReport:Report:ACA Led to Significant ReductionsACA Led to Significant Reductions

In County Indigent Care ProgramsIn County Indigent Care Programs-Continued need throughout stateContinued need throughout state-County programs with broad eligibility well-usedCounty programs with broad eligibility well-used

- ““Now We Can Say Yes”Now We Can Say Yes”- Los Angeles, Alameda, San Francisco, Santa Clara, San Los Angeles, Alameda, San Francisco, Santa Clara, San

Mateo, Etc.Mateo, Etc.- Over 90,000 in My Health LAOver 90,000 in My Health LA

-Those with restricted eligibility have few to serveThose with restricted eligibility have few to serve- Fresno victory this past weekFresno victory this past week- Efforts to expand Sacramento, Contra Costa, CMSP, etc.Efforts to expand Sacramento, Contra Costa, CMSP, etc.

Re-Orient Safety-Net, Do It BetterRe-Orient Safety-Net, Do It Better– The Lessons of LIHP: Primary/Preventative The Lessons of LIHP: Primary/Preventative

Medical Home, rather than episodic/emergency Medical Home, rather than episodic/emergency carecare

– Extending Eligibility to the Remaining Uninsured Extending Eligibility to the Remaining Uninsured Bridge to a Statewide SolutionBridge to a Statewide Solution

County & Statewide SolutionsCounty & Statewide SolutionsUndocumented explicitly excluded from federal help;Undocumented explicitly excluded from federal help; even under even under immigration reform, many aspiring citizens will be on a “path to immigration reform, many aspiring citizens will be on a “path to citizenship” of over a decade, restricted from federal help with health citizenship” 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 this issue remains for local policymakers, states, counties, and private providers. local 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 residents Most undocumented residents are working, and some are covered through on-the-job benefits. The are working, and some are covered through on-the-job benefits. The more we promote employer-based coverage, the more we cover. more we promote employer-based coverage, the more we cover.

SAFETY-NET FUNDING: SAFETY-NET FUNDING: From the county safety-net and public From 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 moving Some counties are moving forward with extending coverage-like medical homes with primary forward with extending coverage-like medical homes with primary and preventive care.and preventive care.

STATE-ONLY/MIRROR PROGRAMS: STATE-ONLY/MIRROR PROGRAMS: Philosophically, all Philosophically, all Californians should be eligible for the level of benefits offered by the Californians should be eligible for the level of benefits offered by the Affordable Care Act. If federal government doesn’t provide, state can Affordable Care Act. If federal government doesn’t provide, state can go on its own.go on its own.

Making #Health4All History Making #Health4All History *This Year**This Year*

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Continuing California’s Coverage of “Deferred Continuing California’s Coverage of “Deferred Action” Immigrants: Action” Immigrants: The President’s executive action The President’s executive action had the impact of expanding the category of immigrants had the impact of expanding the category of immigrants covered by state-funded Medi-Cal. covered by state-funded Medi-Cal. We need to defend We need to defend and secure this major victory. Also: and secure this major victory. Also:

Secure and Expand our County Safety-Net Secure and Expand our County Safety-Net Programs: Programs: Counties are the last resort of coverage. Counties are the last resort of coverage. Some counties are enhancing their safety-net for the Some counties are enhancing their safety-net for the remaining uninsured, with programs like My Health LA. remaining uninsured, with programs like My Health LA. We need to encourage more counties to care for the We need to encourage more counties to care for the undocumented.undocumented.

Making Progress to a Statewide Solution for Making Progress to a Statewide Solution for #Health4All:#Health4All: An effort now in its third year, we can An effort now in its third year, we can take another step to Health4All, expanding Medi-Cal to take another step to Health4All, expanding Medi-Cal to more immigrants, and setting up the structure for a more immigrants, and setting up the structure for a mirror marketplace so everyone can seek coverage.mirror marketplace so everyone can seek coverage.

                                                                                                                                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 immigrantsBy ROXANA KOPETMAN / ORANGE COUNTY REGISTERPublished: Jan. 10, 2014 Updated: 6:04 p.m.

LEGISLATIVE CAMPAIGN LEGISLATIVE CAMPAIGN BEGINSBEGINS

Continuing California’s Continuing California’s Commitment to Covering Commitment to Covering

ImmigrantsImmigrants Progress made on California-specific efforts to cover:Progress made on California-specific efforts to cover:

–legal immigrants, including recent immigrants here legal immigrants, including recent immigrants here less than 5 years;less than 5 years;–People Residing Under the Color of Law (PRUCOL); People Residing Under the Color of Law (PRUCOL); now including DACA Dream Act students; to include now including DACA Dream Act students; to include those covered under DAPA when the President’s those covered under DAPA when the President’s executive order is upheld.executive order is upheld.

Legislative proposal mirrors ACA: SB4(Lara)Legislative proposal mirrors ACA: SB4(Lara)Similar to last year’s SB1005(Lara):Similar to last year’s SB1005(Lara):State-only Medi-Cal for those not legally present, State-only Medi-Cal for those not legally present, similar to other non-federally covered populationssimilar to other non-federally covered populations

–Building off emergency Medi-CalBuilding off emergency Medi-Cal Allowing undocumented immigrants to buy (unsubsidized, with their own money) coverage through Covered California. If federal waiver denied, set up “mirror marketplace.”

Financing #Health4AllFinancing #Health4AllLOS ANGELES TIMES:LOS ANGELES TIMES:

““Study sees modest costs in Study sees modest costs in healthcare for immigrants here healthcare for immigrants here illegally”illegally”By Patrick McGreevy * May 21, 2014By Patrick McGreevy * May 21, 2014

Increased health of poor Californians could reduce Increased health of poor Californians could reduce costs down the road, study sayscosts down the road, study says

Extending healthcare to people in the country illegally would cost the state a modest Extending healthcare to people in the country illegally would cost the state a modest amount more but would significantly improve health while potentially saving money amount more but would significantly improve health while potentially saving money for taxpayers down the road, according to a study released Wednesday.for taxpayers down the road, according to a study released Wednesday.

The study by the UCLA Center for Health Policy Research estimates that the net The study by the UCLA Center for Health Policy Research estimates that the net increase in state spending would be equivalent to 2% of state Medi-Cal spending, or increase in state spending would be equivalent to 2% of state Medi-Cal spending, or between $353 million and $369 million next year, while the net increase in spending between $353 million and $369 million next year, while the net increase in spending would be up to $436 million in 2019. Enrollment in Medi-Cal would increase by up to would be up to $436 million in 2019. Enrollment in Medi-Cal would increase by up to 730,000 people next year and up to 790,000 in four years.730,000 people next year and up to 790,000 in four years.

Financing #Health4AllFinancing #Health4All These Californians already in our health system today, These Californians already in our health system today,

getting care in the most expensive, least efficient way.getting care in the most expensive, least efficient way. More effectively use existing dollars & revenue streams:More effectively use existing dollars & revenue streams:

– Maintaining funds for restricted scope Medi-Cal for emergency Maintaining funds for restricted scope Medi-Cal for emergency carecare

– Savings from existing programs that serve this populationSavings from existing programs that serve this population– Natural recoupment from county realignment formulaNatural recoupment from county realignment formula– Leverage existing MCO and hospital provider feeLeverage existing MCO and hospital provider fee– More effectively use existing state-only Medi-CalMore effectively use existing state-only Medi-Cal– Opportunities under the Medi-Cal waiverOpportunities under the Medi-Cal waiver

President Obama’s executive action and “deferred action”President Obama’s executive action and “deferred action” Decisions to deal with the remaining costs:Decisions to deal with the remaining costs:

– Additional revenues face a 2/3 voteAdditional revenues face a 2/3 vote– Making this a budget priorityMaking this a budget priority, against other priorities, against other priorities– Further reductions in cost: Further reductions in cost: Phasing in/starting with a down Phasing in/starting with a down

payment with a proposal under a certain budget?payment with a proposal under a certain budget?

SB4(Lara) is a fraction of the cost of last year’s SB1005.SB4(Lara) is a fraction of the cost of last year’s SB1005.

Core MessagesCore Messages

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Investing in California: Investing in California: Undocumented Californians are an Undocumented Californians are an economic engine for the state. An overwhelming percentage economic engine for the state. An overwhelming percentage work and pay taxes. They are an economic asset. Investing in work and pay taxes. They are an economic asset. Investing in them is investing in our state.them is investing in our state.

Prevention Makes Economic Sense: Prevention Makes Economic Sense: Emergency room Emergency room treatment is an expensive substitute for preventive care. It treatment is an expensive substitute for preventive care. It makes economic sense to invest in preventive services that makes economic sense to invest in preventive services that minimize the risk of chronic disease and more chronic minimize the risk of chronic disease and more chronic treatment later on.treatment later on.

Increasing Access to Affordable Care is the Responsible Increasing Access to Affordable Care is the Responsible Thing to do:Thing to do: Everyone—regardless of ability to pay or legal Everyone—regardless of ability to pay or legal status—should have access to affordable health care. After status—should have access to affordable health care. After Obamacare, the remaining uninsured, including the Obamacare, the remaining uninsured, including the undocumented, should have access to affordable care, undocumented, should have access to affordable care, including a comprehensive set of preventive services and a including a comprehensive set of preventive services and a health home.health home.

Organizing and Organizing and Communications: We Need Communications: We Need Action & Stories!Action & Stories!

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Next Steps: Fulfilling the Full Next Steps: Fulfilling the Full Promise of Health ReformPromise of Health Reform

““What we are getting here is not a mansion but a starter home. What 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 It’s got a good foundation: 30 million Americans are covered. It’s got a good roof: A lot of protections from abuses by insurance got a good roof: A lot of protections from abuses by insurance companies. It’s got a lot of nice stuff in there for prevention and companies. It’s got a lot of nice stuff in there for prevention and wellness. But, we can build additions as we go along in the wellness. But, we can build additions as we go along in the future” –Senator Tom Harkinfuture” –Senator Tom Harkin

Including the Excluded/Covering the UndocumentedIncluding the Excluded/Covering the UndocumentedFixing Flaws in the Law/Closing GapsFixing Flaws in the Law/Closing Gaps

– Employer-Based Coverage [Post SB2, AB880]Employer-Based Coverage [Post SB2, AB880]More on Affordability & Cost ContainmentMore on Affordability & Cost Containment

– Health Insurance Rate Regulation (Post-Prop 45)Health Insurance Rate Regulation (Post-Prop 45)Public OptionPublic OptionPath to Single-Payer, Etc.Path to Single-Payer, Etc.

A Platform OnA Platform OnOther IssuesOther Issues

2015 Legislative Agenda:2015 Legislative Agenda:Priority Budget Items & Priority Budget Items &

BillsBills SB4(Lara): Health4AllSB4(Lara): Health4All

Other Other BudgetBudget Items: Items: Limiting Estate Recovery in Medi-Cal Access in Medi-Cal: Provider Rates Other Restorations to Medi-Cal Benefits, Public Health

Programs

Out-of-Pocket Cost-Sharing Out-of-Pocket Cost-Sharing (Health Access-sponsored bills)(Health Access-sponsored bills) AB339(Gordon): Prescription Drug Cost SharingAB339(Gordon): Prescription Drug Cost Sharing SB137(Hernandez): Accurate Provider DirectoriesSB137(Hernandez): Accurate Provider Directories AB533(Bonta): “Surprise Bills”/Balance BillingAB533(Bonta): “Surprise Bills”/Balance Billing AB (Bonta): Double Deductibles and Out-of Pocket CostsAB (Bonta): Double Deductibles and Out-of Pocket Costs AB248(Gordon): Large Employer Junk Insurance LoopholeAB248(Gordon): Large Employer Junk Insurance Loophole

SB26(Hernandez): All Payer DatabaseSB26(Hernandez): All Payer Database

Medicaid WaiverMedicaid WaiverGoals:More federal money for a safety-net that survives and thrivesImproved/coordinated access to remaining uninsuredIncentives that work for patients on cost/quality/equityBetter integration with human services

Are these the right goals? The right details? What’s missing?

Cost ContainmentCost Containment PreventionPrevention: Major investments in prevention and public health; : Major investments in prevention and public health;

Change delivery system to promote primary and preventative care; Change delivery system to promote primary and preventative care; no cost-sharing for preventative care to encourage use; other no cost-sharing for preventative care to encourage use; other efforts like menu labeling.efforts like menu labeling.

Bulk PurchasingBulk Purchasing through group coverage, and a new exchange, to through group coverage, and a new exchange, to bargain for better rates.bargain for better rates.

Abolishing UnderwritingAbolishing Underwriting and its expense and incentives, getting and its expense and incentives, getting insurers to compete on cost & quality rather than risk selection.insurers to compete on cost & quality rather than risk selection.

Information TechnologyInformation Technology to foster electronic records, reduce to foster electronic records, reduce bureaucracy, get better data on cost & qualitybureaucracy, get better data on cost & quality

Better Research from Transparency EffortsBetter Research from Transparency Efforts on prices and on prices and health outcomes; and on health outcomes; and on comparative effectivenesscomparative effectiveness of key of key treatments.treatments.

Patient SafetyPatient Safety measures to reduce hospital-acquired infections, measures to reduce hospital-acquired infections, reduce hospital re-admissions, etc. reduce hospital re-admissions, etc.

Payment ReformsPayment Reforms to reward quality & better health outcomes, to reward quality & better health outcomes, including better care coordination and disease management; including better care coordination and disease management;

Coverage for all both directly (prevention, reduces cost-Coverage for all both directly (prevention, reduces cost-shift) reduces costs and helps provides policy tools for shift) reduces costs and helps provides policy tools for further effort.further effort.

Slipperly Slope?Slipperly Slope?Or Scaling the Mountain…Or Scaling the Mountain…

The Path to Single PayerThe Path to Single PayerSince its founding, Health Access has been a strong supporter of a universal health care system that provides quality, affordable health care to all Californians--a Medicare-for-all single-payer system. That history has included support for single-payer legislation, including bills by Senator Kuehl (SB971, SB810) and Leno (SB840) in the past decade, and  Proposition 186 (in 1994) and bills authored by Senator Petris a generation ago.

When we fight for single-payer we are fighting for:a universal system, that offers coverage and care to everybody, rather than leaving millions uninsured, and so many more millions at risk of becoming uninsured;a progressively financed system, where what we pay for health care is based on what we can afford, rather than how sick we are, and where the tax structure is also progressive, capturing unearned income;a cost-effective system, which pools patients together and leverages their purchasing power to negotiate the best prices from providers;a comprehensive system, where people can count on a basic standard of benefits, rather than wonder if their coverage will actually cover them when they need it;an efficient system, which streamlines the bureaucracy associated with the marketing, administration, and profit-taking of multiple private insurance companies; anda prevention-oriented system, which has the right incentives in place to invest in wellness and that moves away from false incentives for insurers to avoid risk.

Opportunities Opportunities This YearThis Year

Focused Attention:Focused Attention:Now-JuneNow-June CountiesCounties

– SupervisorsSupervisors– AdministratorAdministrator– Health DepartmentsHealth Departments

StateState– GovernorGovernor– State Legislative LeadersState Legislative Leaders– Legislative ProcessLegislative Process– Budget ProcessBudget ProcessObstacles: Money, Messaging, Priorities, Obstacles: Money, Messaging, Priorities,

PoliticsPolitics

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