Rev. 2.4.11 ©2011 Unitarian Universalist Legislative Ministry of California Health Care Reform 2011 Part of the Central Valley Education

Rev. 2.4.11

©2011 Unitarian Universalist Legislative

Ministry of Californiawww.uulmca.org 1

Health Care Reform 2011

Part of the Central Valley Education Project

Unitarian Universalist Legislative Ministry of California

Bring Federal Health Care Reform Home to California!

Sponsored by the California Endowment and

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©2011 Unitarian Universalist Legislative Ministry of California

www.uulmca.org 2

Three Part Presentation

I. Why the U.S. needs federal health care reform

II. How federal health reform can help you

III. What you can do to implement & improve health care in California

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Part I

Why the United States Needs Health Care Reform

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People are suffering

50 million in U.S. uninsured in January 20108 million individuals are uninsured in CaliforniaCalifornians are less likely to get coverage through

their employer and must buy insurance on their own 44,000 deaths each year due to lack of health insurance

1 person died every 12 minutes Many of these individuals had pre-existing health

conditions and could not purchase insurance at any price

Because of state budget cuts, fewer “safety net” public health resources for individuals and families

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US families pay MORE for LESS health care

Families in the United States pay more for health care than any other country in the world, but rank only #37 in health outcomes according to the World Health Organization.

The United States is the only major industrialized country where for-profit companies provide most people their health insurance.

60% of U.S. bankruptcies due to health costs; 75% of medical bankruptcies happen to people with health insurance.

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Part II

How Federal Health Reform Can Help YOU

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Patient Protection and Affordable Care Act (ACA) covers 32 million previously uninsured people

Reduces the federal deficit $650 Billion to $1.3 Trillion by 2019

Brings federal money into California for health care

Creates a framework upon which we can build a universal health care system.

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The ACA makes health insurance affordable

Medicaid (Medi-Cal) Expands in 2014 Covers people with incomes up to 133% Federal Poverty Level (FPL)

(~$29,000 for a family of 4). Includes adults without dependent children.

California State Insurance Exchange Begins in 2014 3 to 4 million Californians can purchase affordable, high-quality

individual policies online in a state regulated “pool.” Exchange has bargaining power of a very large company Guaranteed coverage regardless of pre-existing conditions Affordability credits provided and out-of-pocket costs limited for

individuals and families at 133-400% FPL (~$88,000 for family of four) California Pre-Existing Condition Insurance Plan Started in

2010 Provides coverage today for individuals with pre-existing conditions Funding for program—$40 million—from the federal government

Eliminates the “Hidden Tax” paid by individuals with insurance. No co-pays for preventive care visits and screenings.

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Protects consumers from insurance company abuses

End of policy recessions for minor mistakes on initial health questionnaires.

Lifetime insurance payout limits banned and annual limits phased out.

Insurance companies can no longer deny policies to individuals with pre-existing conditions.

Premium rate hikes of over 10% for individual insurance plans require review by California insurance regulators.

Equal premiums for women and men beginning 2014. Health plan premiums only vary based on age (3:1 ratio), geographic area, tobacco use (1.5: 1 ratio), and number of family members.

Private insurance companies must spend 80% to 85% of premiums on medical care or provide rebates to consumers.

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Guaranteed issue for children with pre-existing health conditions

Prohibits insurers from denying children up to age 19 for coverage because of pre-existing conditions

Insurers cannot charge sick children more than 2x the cost of coverage for healthy child

To lock in best premium rate, parents must enroll their children in “open enrollment period:” Feb 28, 2011, birthday month, or with major life changes.

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The ACA helps young adults

Lowers Costs for Young Adults No co-pays for preventive care

visits and screenings

Security of Insurance Coverage Young adults can now be covered

on parents’ plan until age 26.

Estimated to impact over 4 million young adults nationwide.

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Federal reform helps “Baby Boomers” ages 50 to 64

8.5 million baby boomers are without insurance and another 9.7 million are underinsured with high out-of-pocket cost policies.

8.2 million baby boomers will gain coverage in 2014.

Baby boomers can purchase individual insurance today in California’s Pre-Existing Condition Insurance Plan

Reinsurance program supports employers and union-based plans covering early retirees.

Community Living Assistance Services and Supports (CLASS) provides a daily payment for in-home services

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Federal health helps seniors

Part D Doughnut Hole closed by 2020

Prescription drug costs could shrink $700 for a typical Medicare beneficiary with Medicare Part D

This year drug companies will give seniors 50% off brand drugs while in the gap

Free preventive health services such as vaccinations and cancer screenings and personalized prevention plans

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Medicare rates stay steady

Part A – Hospital Coverage No changePart B – Doctor & Outpatient Care No

change No reduction in payments to doctors in 2011

Part C – Medicare Advantage Plans Reduction in payments for administrative costs. Medicare says the reductions are fair because the plans are paid $1,000 more per person on average than the traditional fee-for-service program spends on a typical senior.

Part D – Prescription Coverage Doughnut Hole Closed by 2020

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Federal reform helps women

Choice of providers, direct access to Ob/Gyn Care

End of higher premiums for women than men

No fees or co-pays for essential female health screenings, but limits on some reproductive health services.

Watch out for H.R. 3 --No Taxpayer Funding for Abortion Act

“Hyde Amendment on Steroids” Deny tax credits to companies that

offer health plans that cover abortions Block anyone with insurance that

covers abortions from receiving federal subsidies, even if the abortion portion is paid separately with personal funds.

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Federal health reform helps low income families

$11 Billion for Community Health Clinics

Security for Californians on MediCal and Healthy Families

Expanded MediCal Coverage. In 2014, Medicaid coverage expands to cover individuals with incomes below 133% of the federal poverty level

Counties can expand MediCal coverage before 2014.

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ACA helps small businesses offer health benefits

4 million small businesses and non-profits qualify for tax credits that cover up to 35% of employees’ insurance premiums (increases to 50% in 2014)

Small businesses are already responding to promise of tax credits and offering insurance coverage to employees

Small employers can purchase employee health benefits through the State Insurance Exchange beginning 2014

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We Can Do Better! Areas Needing Improvement

Fair access to health care for immigrants Legal immigrants 5-year waiting period, but can purchase

insurance through a state insurance exchange. Undocumented immigrants have NO guaranteed access

to Medi-Cal or the State Insurance Exchange. Mental health parity in private insurance plans Coverage of maternity care in all private plans Adult dental and vision care in MediCal Early implementation of MediCal expansion State regulation of insurance premiums

increases Full coverage of women’s reproductive health

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Part III

What You Can Do to Implement & Improve Health Care in California

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Proposed Budget Cuts Will Hurt Essential Safety Net Services

Hard Caps on Care: Limit doctor/clinic visits to 10/year Limit prescription drugs to 6 per month (with no exceptions unless

for life-saving drugs) Establish maximum benefit dollar caps on medical supplies (e.g.,

wound care, incontinence supplies) and durable medical equipment (e.g., wheelchairs and hearing aids)

New Costs for Care: $100/day for hospital stays, up to a maximum $200 $50 co-payment for emergency room visits $5 co-payment for doctor visits and prescriptions

Eliminate Adult Day Care: 37,000 seniors will lose services at 330 adult day health care centers

Eliminate Vision Care for Children: About $11.3 million of the cuts will be achieved by eliminating vision services to the almost 1 million Healthy Families enrolled children.

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California 2011 legislation to watch

AB 154 (Beall) Requires private insurance policies to treat any mental illness defined in the DSM IV.”

AB 52 (Feuer)/SB 51 (Alquist) Require approval from the Department of Managed Health Care and the Department of Insurance for increases in health care premiums, co-payments, or deductibles.

AB 181 (Portantino) Foster youth: mental health bill of rights. Maternity Coverage in Private Health Plans Joint Venture County MediCal Plans SB 56 by Alquist in 2010 Single Payer May be SB810. Will be by Sen. Leno Apples to Apples Comparison of Ins. Plans—Alquist SB 890 in

2010 AB 3632 Funding

On October 8, 2010, Governor Schwarzenegger vetoed $133 million in funding for services through county mental health departments to special education students who need mental health services to stay in school.

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Latest information on Single Payer in 2011

Sen. Leno working to procure “SB 810” number for the bill.

Single Payer bill in 2011 will include more information on how the transition will be funded. Looking to commission a study on cost savings with Single Payer and start-up costs.

Movement to add Single Payer bill to statewide ballot in 2012 or 2014.

SB56-like bill creating joint venture systems with multiple counties for MediCal care. An opportunity for California to experience a positive experience with a public option program.

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You can help make universal health care a reality!

Share your health care story! Elected officials and the media want to know how health reform is helping you.

Sign up for alerts and advocacy opportunities with UULM at www.uulmca.org.

Push your county officials for an aggressive implementation of the MediCal Waiver program so they can cover more low-income families before 2014

Share this information with your family, friends and community!

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Additional resources

UU Legislative Ministry of CA: www.uulmca.org Health Access: www.health-access.org EQUAL: www.centerforpolicyanalysis.org Kaiser Family Foundation: www.kff.org U.S. ACA education website: www.healthcare.gov PICO: www.piconetwork.org National Immigration Law Center: www.nilc.org The Healing of America by T.R. Reid. © 2009 Available at your

local bookstore or online book website.

UU Voices for Health Care Curriculum

This free, adaptable seven-session healthcare curriculum educates and empowers us to take action within our communities. Each session is self contained.

Download for free at www.uulmca.org

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Thank you!

The CVEP project is sponsored by HEALTH ACCESS CALIFORNIA, a statewide health care consumer advocacy coalition, advocating for the goal of quality, affordable health care for all Californians. Go to www.health-access.org for more information

CVEP Partners:EQUAL Health Network: a program of the Center for Policy Analysis dedicated to producing thoughtful, reliable information on policies that affect the public’s health. www.centerforpolicyanalysis.org

Imagen Public Relations LLC: Headed by PR pro, Virginia Madueño, imagen is recognized as one of the preeminent marketing/public relations companies in California. www.imagenpr.com

This presentation is brought to you by the Central Valley Education Project & UULM CA

Documents

Rev. 2.4.11 ©2011 Unitarian Universalist Legislative Ministry of California Health Care Reform 2011 Part of the Central Valley Education