January 2015January 2015

The Affordable Care Act & The Affordable Care Act & California:California:

What’s New, What’s Next, What’s New, What’s Next, and What Do We Need to Do?and What Do We Need to Do?

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 today, throughIn each of the ways people get coverage today, through

1)1) an employer (over a half)an employer (over a half)2)2) a public program (around a third), ora public program (around a third), or3)3) buying it as an individual (5%)buying it as an individual (5%)

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

Securing On-the-Job Securing On-the-Job Coverage:Coverage:

Subsidies and StandardsSubsidies and Standards Around half of all Californians (18 million) already Around half of all Californians (18 million) already have coverage through their employer, andhave coverage through their employer, and reform reform will make on-the-job coverage more secure and will make on-the-job coverage more secure and reliablereliable

Many small employers of low-wage workers will Many small employers of low-wage workers will receive significant subsidiesreceive significant subsidies (tax credits up to (tax credits up to 35% of premiums) to help pay for coverage.35% of premiums) to help pay for coverage.

Larger employers (over 50 FTEs) will either cover their Larger employers (over 50 FTEs) will either cover their workers, or may have to contribute to their care—workers, or may have to contribute to their care—setting a standard much like the minimum wage does setting a standard much like the minimum wage does for pay:for pay:– Provide Health Benefits for Full-Time, Non-Seasonal workers Provide Health Benefits for Full-Time, Non-Seasonal workers

OROR– Pay a penalty for Full-Time, Non-Seasonal worker in exchange Pay a penalty for Full-Time, Non-Seasonal worker in exchange

($2,000/$3,000 depending on coverage offer)($2,000/$3,000 depending on coverage offer)– Full-Time and Non-Seasonal Defined:Full-Time and Non-Seasonal Defined:

Full-Time=Average 30 hours per week in monthFull-Time=Average 30 hours per week in month Non-Seasonal=120 days for one employer in a yearNon-Seasonal=120 days for one employer in a year

Improving Public Programs: Improving Public Programs: MedicareMedicare

Nearly a third of Californians (10 million+) get Nearly a third of Californians (10 million+) get coverage thru Medicare, Medicaid, SCHIP, etc.coverage thru Medicare, Medicaid, SCHIP, etc.

For seniors,For seniors, Medicare Medicare will remain intact and will remain intact and be strengthened so it is more stablebe strengthened so it is more stable– No reductions in Medicare benefit package; some No reductions in Medicare benefit package; some

improvements:improvements:– Closes “donut hole” gap in prescription drug coverageCloses “donut hole” gap in prescription drug coverage

Right now, coverage runs out at around $2,830/year; doesn’t kick Right now, coverage runs out at around $2,830/year; doesn’t kick back in until over $4,550.back in until over $4,550.

In 2010, impacted seniors will get $250 rebateIn 2010, impacted seniors will get $250 rebate Annual improvements until drug coverage becomes completeAnnual improvements until drug coverage becomes complete

– No cost-sharing for preventative screenings & careNo cost-sharing for preventative screenings & care– Roots out waste, fraud, and abuse, especially overpayments Roots out waste, fraud, and abuse, especially overpayments

to insurance companies in Medicare Advantage.to insurance companies in Medicare Advantage.– Extends solvency of Medicare for nearly a decadeExtends solvency of Medicare for nearly a decade

Improving Public Programs: Improving Public Programs: MedicaidMedicaid

Medi-CalMedi-Cal (Medicaid) has been expanded (Medicaid) has been expanded to cover lowest-income families, including to cover lowest-income families, including adults without dependent childrenadults without dependent children– Expands Medicaid for all under 138% of the federal Expands Medicaid for all under 138% of the federal

poverty level (excluding undocumented immigrants)poverty level (excluding undocumented immigrants)– Before reform, adults without kids at home excludedBefore reform, adults without kids at home excluded– Two million additional Californians on Medi-Cal nowTwo million additional Californians on Medi-Cal now– For newly-eligible population, federal government will For newly-eligible population, federal government will

pay 100% of costs for 2014-2016; By 2020, will pay up pay 100% of costs for 2014-2016; By 2020, will pay up to 90% of costto 90% of cost

– Reduces paperwork and eligibility barriersReduces paperwork and eligibility barriers Example: Removes complicated “asset test” that is Example: Removes complicated “asset test” that is

barrier to enrollment, and that prevents poor families barrier to enrollment, and that prevents poor families from savingfrom saving

– SCHIP (formerly Healthy Families in CA) intactSCHIP (formerly Healthy Families in CA) intact

Covered California: A New Covered California: A New Insurance Market & ChoicesInsurance Market & Choices

New market rules/consumer protections prevents denials or New market rules/consumer protections prevents denials or surcharges for pre-existing conditions; new standards surcharges for pre-existing conditions; new standards against “junk” insurance: minimum essential benefits; against “junk” insurance: minimum essential benefits; minimum actuarial value; medical-loss ratio; out-of-pocket minimum actuarial value; medical-loss ratio; out-of-pocket cap; etc. cap; etc.

Covered California Covered California offers new affordable coverage options.offers new affordable coverage options.– Affordability credits Affordability credits will be provided for coverage will be provided for coverage

purchased in the Exchange for families earning up to purchased in the Exchange for families earning up to 400% FPL (~$92K for family of 4).400% FPL (~$92K for family of 4).

– The Exchange can use its The Exchange can use its bargaining power to provide bargaining power to provide the “group rate”the “group rate” for individuals and small businesses, for individuals and small businesses, to get the best possible price.to get the best possible price.

– TheThe Marketplace will make it Marketplace will make it easier to understandeasier to understand and and get a quality, affordable health plan, offering a range of get a quality, affordable health plan, offering a range of easy-to-compare insurance products, with basic benefits.easy-to-compare insurance products, with basic benefits.

Sliding Scale SubsidiesSliding Scale Subsidies

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…

New Numbers!New Numbers!FROM OUR 4-YEAR ACA REPORT/After 1FROM OUR 4-YEAR ACA REPORT/After 1stst Enrollment Period Enrollment Period““Mission Advanced, But Not Accomplished”:Mission Advanced, But Not Accomplished”:Over 1.4 million Californians picked plans in Covered California (goal Over 1.4 million Californians picked plans in Covered California (goal was 700K by March; 1 million by end of 2014 and 2was 700K by March; 1 million by end of 2014 and 2ndnd enrollment period); enrollment period);Over 2 million Californians determined eligible for Medi-Cal;Over 2 million Californians determined eligible for Medi-Cal;Over 430,000 young adults on parents coverage; others getting Over 430,000 young adults on parents coverage; others getting guaranteed issue individual coverage; small business tax credits; etc.guaranteed issue individual coverage; small business tax credits; etc.Over half of the uninsured now covered; 3.5 million Over half of the uninsured now covered; 3.5 million Californians in new ACA coverage optionsCalifornians in new ACA coverage optionsBig demand despite problems:Big demand despite problems: website glitches; call center wait website glitches; call center wait times for 30-50 minutes; inadequate number of community enrollment times for 30-50 minutes; inadequate number of community enrollment counselors; provider search function not working; negative press..counselors; provider search function not working; negative press..Millions of other Californians with new consumer protections Millions of other Californians with new consumer protections and financial assistance.and financial assistance.No-cost preventive care; not lifetime/annual limits; etc.No-cost preventive care; not lifetime/annual limits; etc.Rate rebates, roll backs, and retractions from Rate Review & MLRRate rebates, roll backs, and retractions from Rate Review & MLROver 300,000 on Medicare saved $183 million in prescription drug Over 300,000 on Medicare saved $183 million in prescription drug costscosts

CALIFORNIA IMPLEMENTSMillions with new consumer protections; financial assistance3.5+ 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

Fulfilling the Promise:Fulfilling the Promise:Making Enrollment EasierMaking Enrollment Easier

Outreach & education, eligibility and mass enrollment is Outreach & education, eligibility and mass enrollment is a moral, public health, and financial imperativea moral, public health, and financial imperative

Need continued improvements to Need continued improvements to make it easier to get on make it easier to get on and stay on coverage:and stay on coverage:

– Streamlined and simplified enrollment in Medicaid, Covered Streamlined and simplified enrollment in Medicaid, Covered California; no wrong doors; need to improve consumer California; no wrong doors; need to improve consumer experienceexperience

– Expand integrated and better-trained system of enrollment Expand integrated and better-trained system of enrollment assistance and “navigation”: Call center employees, county assistance and “navigation”: Call center employees, county workers, brokers/agents, community enrollment counselors, workers, brokers/agents, community enrollment counselors, etc.etc.

– More to do: Increased capacity; Smoother enrollment More to do: Increased capacity; Smoother enrollment systems, online and otherwise; more trained enrollment systems, online and otherwise; more trained enrollment counselors on-the-ground; More targeted outreach, in CA’s counselors on-the-ground; More targeted outreach, in CA’s diverse communities, in multiple languages; Improved diverse communities, in multiple languages; Improved selection tools; focus on retentionselection tools; focus on retention

– If successful, we can ultimately cover 2/3 of California’s 7 If successful, we can ultimately cover 2/3 of California’s 7 million uninsured.million uninsured.

Health Reform 2.0Health Reform 2.01) Unfinished Business1) Unfinished Business–Medi-CalMedi-Cal: benefits, provider rates, etc.: benefits, provider rates, etc.–Covered CaliforniaCovered California: quality ratings; : quality ratings; improving health plan standards; options for improving health plan standards; options for the unbanked; pediatric dental coverage; the unbanked; pediatric dental coverage; other triaged & delayed decisionsother triaged & delayed decisions–Consumer protections once coveredConsumer protections once covered: : network adequacy/timely access, cost-network adequacy/timely access, cost-sharing, etc.sharing, etc.–Getting insurers to compete not on avoiding Getting insurers to compete not on avoiding sick people, but on cost, quality, customer sick people, but on cost, quality, customer service, and prevention and wellnessservice, and prevention and wellness–Cost containment and quality Cost containment and quality improvementimprovement2) Next Steps: Fulfill Promise of 2) Next Steps: Fulfill Promise of ReformReform3) A Platform for More3) A Platform for More

“What I would do if I were a Democrat running four years from now, I’d say, you know what, dental care will be included in Obamacare.”

“GIFTS”

* Medi-Cal: Adult Dental Restored May 2014* Covered California:

• Pediatric Dental in Stand-Alone Plans in 2014• Pediatric Dental Embedded in 2015• Family Dental Offered as Additional Option

California Has About 3 California Has About 3 Million Remaining Million Remaining

UninsuredUninsured

2323

Which Which County County

Safety-Nets Safety-Nets Serve Serve

Patients Not Patients Not Legally Legally

Present?Present?AlamedaAlameda

Contra Costa (only children)Contra Costa (only children)Fresno (<67% FPL)Fresno (<67% FPL)

KernKernLos Angeles (<133% FPL)Los Angeles (<133% FPL)

Riverside Riverside San FranciscoSan Francisco

San MateoSan MateoSanta ClaraSanta Clara

Santa Cruz (<100%FPL)Santa Cruz (<100%FPL)

(Most to 200% FPL or more)(Most to 200% FPL or more)

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 local this issue remains for local policymakers, states, counties, and private providers. 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. (i.e. more we promote employer-based coverage, the more we cover. (i.e. AB880)AB880)

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.

                                                                                                                                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

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-net, more rational, more transparent, with a stronger safety-net, new consumer protections and incentives aligned for 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 helpon affordability, some folks will need more help ::•Uninsured undocumented immigrantsUninsured undocumented immigrants•Those in “family glitch”: family members for workers with Those in “family glitch”: family members for workers with employer based coverage affordable for just themselvesemployer based coverage affordable for just themselves•Some over 400% federal poverty level (typically older, in Some over 400% federal poverty level (typically older, in high-cost areas) who don’t have affordability guarantee.high-cost areas) who don’t have affordability guarantee.•Those in Exchange who find monthly premiums/cost Those in Exchange who find monthly premiums/cost sharing still a burden, and may/may not decline coverage.sharing still a burden, and may/may not decline coverage.

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

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 [AB880(Gomez)]Employer-Based Coverage [AB880(Gomez)]More on Affordability & Cost ContainmentMore on Affordability & Cost Containment

– Prop 45 On the Ballot: Health Insurance Rate RegulationProp 45 On the Ballot: Health Insurance Rate RegulationPublic Option/Single-Payer/Etc.Public Option/Single-Payer/Etc.

A Platform OnA Platform OnOther IssuesOther Issues

SB35(Padilla)

“The federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago...” – David Leonhardt, The New York Times, 323/2010

Beyond Preventing Medical Bankruptcy:Progressive Revenue & Distribution * Income SupportAffordability * Health Jobs * On-The-Job BenefitsEconomic and Community Development

Changes to coverage, Changes to coverage, mental health, and mental health, and substance abuse substance abuse treatment can and should treatment can and should have ripple effects have ripple effects throughout criminal throughout criminal justice, policing, county justice, policing, county services, and corrections…services, and corrections…

PreventionPrevention Outside the health systemOutside the health system

– Beyond no cost-sharing for preventative care, Beyond no cost-sharing for preventative care, and other delivery system reformsand other delivery system reforms

Health In All PoliciesHealth In All Policies– Housing, Zoning, Education, Environmental, Housing, Zoning, Education, Environmental,

Transportation, Food Security, Public Safety, and Transportation, Food Security, Public Safety, and other services all vital.other services all vital.

– Place matters: Major opportunity for county-Place matters: Major opportunity for county-based policy interventionsbased policy interventions

Major Investments in Public HealthMajor Investments in Public Health Community Transformation GrantsCommunity Transformation Grants Other PoliciesOther Policies

– Menu labeling, etc.Menu labeling, etc.

A Political Realignment for A Political Realignment for Prevention and More?Prevention and More? “Big Food vs. Big Insurance” --Pollan, 9/9/09“Big Food vs. Big Insurance” --Pollan, 9/9/09

What it Means to Repeal in What it Means to Repeal in CACA

LEAVE CONSUMERS AT THE MERCY OF INSURER ABUSES. LEAVE CONSUMERS AT THE MERCY OF INSURER ABUSES. allowing insurers to:allowing insurers to:

deny almost 400,000 Californians deny almost 400,000 Californians for “pre-existing conditions”;for “pre-existing conditions”; impose arbitrary annual and lifetime capsimpose arbitrary annual and lifetime caps on coverage, leaving on coverage, leaving insuredinsured patients patients

at risk of medical debt and bankruptcy; andat risk of medical debt and bankruptcy; and sell “junk” coveragesell “junk” coverage that does not provide basic benefits. that does not provide basic benefits.

DENY MILLIONS HELP WITH HEALTH CAREDENY MILLIONS HELP WITH HEALTH CARE Deny Deny 2 million 2 million uninsured Californians access to coverage through Medicaid;uninsured Californians access to coverage through Medicaid; Deny Deny 3.8 million 3.8 million uninsured Californians access to new coverage through individual uninsured Californians access to new coverage through individual

health insurance and prevent improvements to coverage for health insurance and prevent improvements to coverage for 21 million 21 million Californians Californians with employer or individual plans.with employer or individual plans.

Condemn Condemn 66,000 66,000 more California families a year to bankruptcy due to health care more California families a year to bankruptcy due to health care costs.costs.

Prevent Prevent 3.2 million 3.2 million young adults in California (under age 26) to obtain coverage on young adults in California (under age 26) to obtain coverage on their parents’ insurance plans.their parents’ insurance plans.

Deny all Deny all 4.5 million4.5 million California seniors free preventive services California seniors free preventive services

REJECT RESOURCES AND FEDERAL FUNDS FOR CALIFORNIANSREJECT RESOURCES AND FEDERAL FUNDS FOR CALIFORNIANS Deny Californians access to Deny Californians access to $106 billion $106 billion in tax credits would mean in tax credits would mean increased increased

health insurance premium costs for millions of California familieshealth insurance premium costs for millions of California families Increase taxes on up to 392,000 California small businesses by $4.3 billion, Increase taxes on up to 392,000 California small businesses by $4.3 billion,

by stopping small business tax credit.by stopping small business tax credit. Increase prescription drug costs for 794,000 California seniors by $9.3 Increase prescription drug costs for 794,000 California seniors by $9.3

billion,billion, by leaving the Medicare Donut Hole unfilled. by leaving the Medicare Donut Hole unfilled. Eliminate $1.4 billion in new funding to California community health Eliminate $1.4 billion in new funding to California community health

centerscenters..

For more informationFor more informationWebsite: http://www.health-access.orgWebsite: http://www.health-access.orgBlog: http://blog.health-access.org Blog: http://blog.health-access.org

Facebook: www.facebook.com/healthaccessFacebook: www.facebook.com/healthaccessTwitter: www.twitter.com/healthaccessTwitter: www.twitter.com/healthaccess

Health Access CaliforniaHealth Access California1127 111127 11thth Street, Suite 234, Street, Suite 234, SacramentoSacramento, CA 95814, CA 95814916-497-0923916-497-0923

414 13414 13thth Street, Suite 450, Street, Suite 450, OaklandOakland, CA 95612, CA 95612510-873-8787510-873-8787

1930 Wilshire Blvd., Suite 916, 1930 Wilshire Blvd., Suite 916, Los AngelesLos Angeles, CA 90057, CA 90057213-413-3587213-413-3587