Recommendations for Delivery System Reforms

and Financing Care for the Remaining Uninsured

Henry TuttleChief Executive Director

San Diego, CA www.ccc-sd.org

ITUP Conference | February 17, 2015

Remaining Uninsured Data

Pre ACA Post ACA

San Diego 22% 14% Riverside 34% 20% Imperial 34% 21%

Pre ACA Post ACA

San Diego 9% 5%Riverside 9% 7%Imperial 12% 8%

Adults (19-64)

Youth (0-18)

Enrollment Issues

In addition to policy considerations, not all of those eligible for medical coverage have enrolled into the available programs. Of the adult population in San Diego, 14% of the population is uninsured.Of this group, 45% are eligible for Medi-Cal or Covered California with subsidies.

Factors for non enrollment include: cost, concerns, fears of government programs, and being uninformed

As of late 2014, 27% of the those uninsured adults in San Diego County who remain uninsured are undocumented. This increases to 28% in Riverside County, and 30% in Imperial County.

2019 Remaining Uninsured ProjectionsCALIFORNIANS UNDER

AGE 65 PROJECTED TO REMAIN UNINSURED -

HIGH SIGN-UP SCENARIO

California - 2019

San Diego County – 2019

ELIGIBLE FOR MEDI-CAL550,000 40,000

ELIGIBLE FOR COVERED CA SUBSIDIES

380,000 30,000

NON-SUBSIDY ELIGIBLE CITIZENS & LEGAL IMMIGRANTS

440,000 40,000

NOT ELIGIBLE DUE TO STATUS 1,350,000 100,000

TOTALS 2,720,000 210,000

Policy Considerations

• SB 4 (proposed) - Lara Bill would provide access to health coverage to all Californians, regardless of immigration status.

• The Lara Bill is pending before the California Senate Rules Committee as of Jan 2015.

• Federal Actions (DAPA/DACA) – recent executive action should qualify some additional undocumented for Medicare.

Medicare Shift & Transformation• In President Obama’s February 4, 2015 budget proposal, there

are a number of health related changes to Medicare reimbursements, no longer based exclusively on patient load.

• Proposed federal budget reductions as proposed in the Obama budget to Medicare would impact health care providers and result in structural reforms to Medicare, and likely to Medi-Cal as well.

• A funding source as a result of Medicare changes - Cadillac premium tax issues.

Potential Funding Options

• Undocumented drivers’ license fee

• Money orders to Mexico & other countries’ fees

• California medical device tax

• Hospital tax

• Medical provider tax

Potential Funding Options…

• Pharmacy tax - both prescription & non prescription medication

• Increase criminal background check fees

• Excess earnings on Health Savings Accounts or 529 college plans

• Tobacco settlement

• County General Fund - can be used to cover costs of unfunded health coverage for the undocumented

Potential Funding Options…

• Tax deductible contributions, through crowd source funding or other mechanism

• Marijuana sale additional tax

• Medical marijuana dispensary tax

• Increased cigarette tax

• Medical provider license fee taxes

For additional information, or copies of referenced documents, please contact:

Henry Tuttle htuttle@ccc-sd.org

(619) 542-4343www.ccc-sd.org