DHS Government DHS Government RelationsRelationsHealth Care Reform ImplementationHealth Care Reform Implementation

Nurse Recognition & CelebrationNurse Recognition & CelebrationWednesday, May 4Wednesday, May 4thth, 2011, 2011

Health Care Reform:Health Care Reform:National and County National and County StatisticsStatistics

Americans without health Americans without health insurance at a record high of 46.6 insurance at a record high of 46.6 million in 2005. (Census Bureau)million in 2005. (Census Bureau)

Family health insurance Family health insurance premiums rose by 71% since premiums rose by 71% since 2000. More than $4,500 in 2005 2000. More than $4,500 in 2005 alone. (Kaiser Family Foundation) alone. (Kaiser Family Foundation)

The number of people without The number of people without health insurance has increased health insurance has increased by 6.8 million since 2000. The by 6.8 million since 2000. The number of uninsured has number of uninsured has increased every year since. increased every year since. (Census Bureau)(Census Bureau)

In 2007, 62% of all personal In 2007, 62% of all personal bacnkruptcies blamed on bacnkruptcies blamed on unaffordable medical bills unaffordable medical bills (Sacramento Bee: Harvard/Ohio (Sacramento Bee: Harvard/Ohio Study)Study)

United States

2+ Million uninsured2+ Million uninsured(Office of Planning and Analysis)(Office of Planning and Analysis)

Nearly 700,000 patients served Nearly 700,000 patients served annually by DHS/PPP. 61% of all annually by DHS/PPP. 61% of all patients served are uninsured patients served are uninsured (OPA)(OPA)

2.7+ Million outpatient visits 2.7+ Million outpatient visits annually (OPA)annually (OPA)

476,000 Inpatient Days476,000 Inpatient Days

300,000+ Emergency 300,000+ Emergency Department visits annually Department visits annually (6,800+ trauma)(6,800+ trauma)

In 2008, Over 400 physicians and In 2008, Over 400 physicians and 66 nurses graduated from 66 nurses graduated from affiliated schools and CONAH affiliated schools and CONAH (OPA)(OPA)

County of Los Angeles

Major Legislative IssuesMajor Legislative IssuesMost Significant Restructuring in 4+ Most Significant Restructuring in 4+ DecadesDecades

Patient Protection and Affordable Patient Protection and Affordable Care Act (aka ACA)Care Act (aka ACA)

California’s Implementation California’s Implementation LegislationLegislation

Section 1115 Waiver “Bridge to Section 1115 Waiver “Bridge to Health Care Reform”Health Care Reform”

H.R. 1 / Judicial ActionsH.R. 1 / Judicial Actions Budget Battles / Deficit ReductionBudget Battles / Deficit Reduction

Key Provisions of ACAKey Provisions of ACA

March 23, 2010 PPACA Signed by PresidentMarch 23, 2010 PPACA Signed by President Mandates all U.S. Citizens and LPR to Maintain Mandates all U.S. Citizens and LPR to Maintain

Minimum Level of Coverage Beginning in 2014 Minimum Level of Coverage Beginning in 2014 (penalties/cert. pops. excl.)(penalties/cert. pops. excl.)

Spreads Cost of Medical Costs Over Broader Spreads Cost of Medical Costs Over Broader PopulationPopulation

Relies Heavily on Employers to Provide Coverage Relies Heavily on Employers to Provide Coverage to Workers (50+ empl.)to Workers (50+ empl.)

Up to 26 yrs.Up to 26 yrs. Medicaid ExpansionMedicaid Expansion Many OthersMany Others

Medicaid ExpansionMedicaid Expansion

All Individuals Under 65 (children, All Individuals Under 65 (children, preg. Wom., parents & childless preg. Wom., parents & childless adults) with incomes up 133% FPLadults) with incomes up 133% FPL

Benchmark Benefit PackageBenchmark Benefit Package 100% to states 2014-16; 95% 100% to states 2014-16; 95%

2017; 94% 2018; 93% 2019; 90% 2017; 94% 2018; 93% 2019; 90% 2020+2020+

State Option to Expand April 2010State Option to Expand April 2010

Health Care Reform:Health Care Reform:Major Issues of Major Issues of InterestInterest

MedicaidMedicaid DSHDSH GMEGME 340b340b OtherOther

Health Care Reform:Health Care Reform:Key OfficialsKey Officials

George Miller (D-CA)Chair, Education and Labor

Charles Rangel (D-NY)Chair, Ways and Means

Henry Waxman (D-CA)Chair, Energy and Commerce

Rep. Dave CampMichigan

Rep. Fred UptonMichigan

Rep. John KlineMinnesota

Health Care Reform:Health Care Reform:DHS Strategic AdvocacyDHS Strategic Advocacy

Federal Elected &Appointed Officials

State Elected &Appointed Officials

Board ofSupervisors

TradeAssociations

CommunityBased

Organizations

Key Partners for DHS

•Private hospitals

•Clinics

•Physicians

•Health Plans

•Business

•Labor

•Others

Numerous Stakeholders

California’s California’s ImplementationImplementation•Swift Implementation: First State to Legislate Health Benefits Exchange

•By 2019 Coverage Expanded to 9/10 non-elderly CA Residents

•SB 1088 (Price) – Young Adults Up to 26 Years

•AB 2244 (Feuer) – Prohibits denial to children w/ pre-existing cond.

•AB 2470 (De la Torre) – Bars Rescission of coverage exc. Fraud

•AB 2345 (De la Torre) – Req. Preventative Services w/o cost sharing

•SB 1163 (Leno) – Requires Actuary Review of Ins. Rates

•3,000 to 5,000 bills per session

Key Exchange Key Exchange ElementsElements“Consumer Marketplace”“Consumer Marketplace” First State in Nation (AB 1602/SB 900) – Sept. 30, 2010First State in Nation (AB 1602/SB 900) – Sept. 30, 2010

– 1602 (Perez) Enacts CA PPACA1602 (Perez) Enacts CA PPACA– 900 (Alquist) Establishes CA Health Benefits Exchange and 900 (Alquist) Establishes CA Health Benefits Exchange and

GovernanceGovernance– Jan. 2014 LaunchJan. 2014 Launch

4/5 Board Appointments Made (4/20/11)4/5 Board Appointments Made (4/20/11)– Diana Dooley, Kim Belshe, Susan Kennedy, Paul FearerDiana Dooley, Kim Belshe, Susan Kennedy, Paul Fearer– Senate appointment pending Senate appointment pending

Place for individuals & small bus. to buy insurancePlace for individuals & small bus. to buy insurance Determines Eligibility:Determines Eligibility:

– Platinum (90), Gold (80), Silver (70), Bronze (60)Platinum (90), Gold (80), Silver (70), Bronze (60)– Catastrophic available only to individuals under 30Catastrophic available only to individuals under 30– Basic levels of bens: Prev. Care, Hospital, presc. DrugsBasic levels of bens: Prev. Care, Hospital, presc. Drugs

Federal Grant Submission Sept. 30 2011Federal Grant Submission Sept. 30 2011 8 Mill CA in 20148 Mill CA in 2014

DHS Leads the Way:DHS Leads the Way:“Medical Homes”“Medical Homes”

Implementation IssuesImplementation Issues

““Essential Health Benefits”Essential Health Benefits” State Budget ConditionState Budget Condition Local Budget ConditionsLocal Budget Conditions Additional Judicial ChallengesAdditional Judicial Challenges

Additional Additional Considerations for Los Considerations for Los Angeles CountyAngeles County Remaining UninsuredRemaining Uninsured

– Young InvinciblesYoung Invincibles– Cost ProhibitiveCost Prohibitive– OthersOthers

DSH Reductions 2017/2019DSH Reductions 2017/2019 CA Safety Net Essential CA Safety Net Essential

(clinics/pub. hospitals)(clinics/pub. hospitals)

Thank you.Thank you.