CARA CARA Leadership TrainingLeadership Training

20082008

Health CareHealth Care

What’s Today What’s Today About?About?

Status of the Status of the health care debate, health care debate, California and California and Nationally?Nationally?

What’s our health What’s our health care strategy for care strategy for 2008?2008?

Presidential PoliticsPresidential Politics

Together We Win!

Massachusetts Health Care Massachusetts Health Care ReformReform

Chapter 58 Signed Into Law on April 12, 2006

Set a model for the NationSet a model for the Nation

Raised FPL to qualify for Medicaid Raised FPL to qualify for Medicaid (additional people get insurance)(additional people get insurance)

No cost control on insurance companiesNo cost control on insurance companies No quality improvementsNo quality improvements ““Insurance Connector”- establishes rates Insurance Connector”- establishes rates

and plan designs for the individual mandateand plan designs for the individual mandate Requires individuals to purchase insuranceRequires individuals to purchase insurance Only requires a $295 per year employer Only requires a $295 per year employer

contribution per yearcontribution per year

The California Speaker moves The California Speaker moves health care….health care….

In 2006, the Assembly/Senate passed In 2006, the Assembly/Senate passed SB 840 out of each house SB 840 out of each house

The Governor vetoed the billThe Governor vetoed the bill

I’m StunnedI’m Stunned

2007 Governor’s “State of 2007 Governor’s “State of the State” - Makes health the State” - Makes health care a priority care a priority

Raises FPL for Medicaid Raises FPL for Medicaid Employers must contribute Employers must contribute

4% of payroll4% of payroll Proposes MRMIB become Proposes MRMIB become

administrator of State’s administrator of State’s health insurance programs health insurance programs (it will be California’s (it will be California’s Connector)Connector)

No cost controlsNo cost controls Mandates individuals to Mandates individuals to

purchase insurancepurchase insurance

Speaker’s Proposal - AB 8Speaker’s Proposal - AB 8

Raised FPL to 300% to qualify for Medicaid Raised FPL to 300% to qualify for Medicaid (additional people get insurance)(additional people get insurance)

Proposal has no real cost controlsProposal has no real cost controls No quality improvementsNo quality improvements Does offer good language on “Transparency”Does offer good language on “Transparency” MRMIB becomes administrator of California’s MRMIB becomes administrator of California’s

Insurance SystemInsurance System Does not require individuals to purchase insurance Does not require individuals to purchase insurance Requires employer contribution of 7.5%Requires employer contribution of 7.5% Caps out of pockets costs for workers at 5%Caps out of pockets costs for workers at 5%

When You Go Into When You Go Into Bargaining With Your Bargaining With Your

Bottom Line……………..Bottom Line……………..

The good, bad and uglyThe good, bad and uglyAB X 1 1AB X 1 1

What we ended up with:What we ended up with: FPL to 250% to qualify for FPL to 250% to qualify for

MedicaidMedicaid Employer contribution, but Employer contribution, but

the majority of employers the majority of employers would have to contribute 4% would have to contribute 4% of payroll or less – employees of payroll or less – employees must take up coveragemust take up coverage

No cost controlNo cost control No quality improvementNo quality improvement Individuals required to take Individuals required to take

up and purchase individual up and purchase individual insurance plans (Tammy insurance plans (Tammy Hotchkiss)Hotchkiss)

When you breed donkeys and elephants you get a deformed product

Presidential Candidates Presidential Candidates

Democrats:Democrats:Keep current Keep current

insurance in placeinsurance in placeGovernment is a Government is a

WatchdogWatchdogPrivate/public plansPrivate/public plansSome quality Some quality

measurersmeasurersIndividual mandatesIndividual mandates

Republicans:Republicans: Keep current Keep current

insurance in placeinsurance in place Electronic record Electronic record

keepingkeeping Report cards on Report cards on

qualityquality Individual Individual

mandatesmandates

The Employer Based Health The Employer Based Health Insurance System is Insurance System is

CrumblingCrumbling

47 Million Uninsured in 200647 Million Uninsured in 2006Number of uninsured, in millions

31 33 33 35 3539 40 40 41 41 42 43

39 38 4042

56

47454343

0

20

40

60

1987 1990 1993 1996 1999* 2002 2005 2008 2011

Projected2013

*1999–2006 estimates reflect the results of follow-up verification questions and implementation of Census 2000-based population controls.Note: Projected estimates for 2007–2013 are for nonelderly uninsured based on T. Gilmer and R. Kronick, “It’s the Premiums, Stupid: Projections of the Uninsured Through 2013,” Health Affairs Web Exclusive, April 5, 2005.Source: U.S. Census Bureau, March Current Population Survey, 1988–2007.

Let’s Not Squander Our Let’s Not Squander Our Opportunity Opportunity (it only comes every 16 (it only comes every 16

– 20 years)– 20 years)

You can’t heal the wound of the health You can’t heal the wound of the health care crisis with a band aidcare crisis with a band aid

Every time a claim is filed it is a “loss” Every time a claim is filed it is a “loss” for an insurance companyfor an insurance company

““You Can’t Cross a Chasm in You Can’t Cross a Chasm in Small Steps” – David Lloyd Small Steps” – David Lloyd

GeorgeGeorge

Source: G. Claxton, J. Gabel et al., "Health Benefits in 2007: Premium Increases Fall To An Eight-Year Low, While Offer Rates And Enrollment Remain Stable," Health Affairs, September/October 2007 26(5):1407–1416. Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2007, and Commonwealth Fund analysis of National Health Expenditures data.*Estimate is statistically different from the previous year shown at p<0.05.^Estimate is statistically different from the previous year shown at p<0.1.Note: Data on premium increases reflect the cost of health insurance premiums for a family of four. Historical estimates of workers’ earnings have been updated to reflect new industry classifications (NAICS).

12.0

18.0

0.8

6.1*7.7*

13.9^

12.9*10.9*

8.2*

5.3*

11.2*

8.5 9.2*

0

5

10

15

20

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Health insurance premiums

Workers earnings

Overall inflation

National health expendituresper capita

Increases in Health Insurance Premiums Increases in Health Insurance Premiums Compared with Other Indicators, 1988–2006Compared with Other Indicators, 1988–2006Percent

Monthly Percentage Change in Health Monthly Percentage Change in Health InsuranceInsurance

Stock Price Index, 1996–2006Stock Price Index, 1996–2006

Source: J.C. Robinson, “The Commercial Health Insurance Industry in an Era of Eroding Employer Coverage,” Health Affairs, Nov.–Dec. 2006 25(6):1475–86.

2005 HMO 2005 HMO ProfitProfit

The nation's HMOs The nation's HMOs report:report:

$3.6 billion in profit, $3.6 billion in profit, first quarter 2005first quarter 2005 or 21% increase or 21% increase

over 2004over 2004 152.7 percent in 152.7 percent in

20022002 60.9 percent in 200360.9 percent in 2003 32.9 percent in 200432.9 percent in 2004

Source:Weiss Ratings, Inc

Health Care Health Care ExecutivesExecutives

H. Edward HanwayH. Edward Hanway Cigna Cigna $15,036,700$15,036,700

Michael McCallisterMichael McCallisterHumanaHumana $29, 298,568$29, 298,568

Larry Glasscock Larry Glasscock WellpointWellpoint $21,677,134$21,677,134

Jay GellertJay GellertHealthNetHealthNet $3,875,444$3,875,444

Stephen Hemsley Stephen Hemsley UnitedHealthUnitedHealth $4,258,717$4,258,717

Source: Modern Health Care- July 30, 2007

Per Capita Spending on Health Per Capita Spending on Health Care – 2006Care – 2006

(How Does GM Compete In A Global Market?)(How Does GM Compete In A Global Market?)

SSource: Organization for Economic Co-Operation and Development (OECD) Health Data 2006(in U.S. dollars adjusted for purchasing power parity)

$6,102

$4,077 $3,966$3,165 $3,159 $3,041

2,8252,2492,546

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

U.S.

Switz

Nor

way

Cana

da

Germ

any

Net

her

Swed

en

U.K.

Japa

n

U.S. Leads the WorldU.S. Leads the World

One of the Best systems in the One of the Best systems in the world with technology and state-world with technology and state-of-the-art facilitiesof-the-art facilities

Health spending per capitaHealth spending per capita Infant Mortality RateInfant Mortality Rate % of un-insured% of un-insured Low life expectancyLow life expectancy

According to the World Health According to the World Health Organization, the U.S. Health Organization, the U.S. Health Care System Ranks 37Care System Ranks 37thth in in Overall PerformanceOverall Performance(right below Costa Rica, and right (right below Costa Rica, and right

above Slovenia)above Slovenia)

What Is To Be Done?What Is To Be Done?““I don’t believe I don’t believe

there’s any there’s any problem in this problem in this country,country,no matter how no matter how tough it is,tough it is,that Americans,that Americans,when they roll up when they roll up their sleeves,their sleeves,

can’t completely can’t completely ignore”ignore”

““George Carlin”George Carlin”

For CaliforniaFor CaliforniaSB 840SB 840

ChoiceChoice – SB 840 allows – SB 840 allows consumers total freedom to consumers total freedom to choose personal primary care choose personal primary care provider (Government won’t provider (Government won’t choose your doctor)choose your doctor)

Freedom from “Paper”Freedom from “Paper” – – Medical providers no longer Medical providers no longer have to go to an HMO to ask have to go to an HMO to ask for services for patientsfor services for patients

High Quality – High Quality – An office of An office of Health Care Quality, headed Health Care Quality, headed by a chief medical officer, not by a chief medical officer, not an insurance company bean an insurance company bean countercounter

(“Evidence Based” standards, (“Evidence Based” standards, no more Vioxx debacles)no more Vioxx debacles)

What’s Covered?What’s Covered?

Benefits Benefits – Hospital, medical, surgical, – Hospital, medical, surgical, mental health, dental, vision, mental health, dental, vision, prescription drugs, medical prescription drugs, medical equipment, emergency care, skilled equipment, emergency care, skilled nursing after hospitalization, hearing nursing after hospitalization, hearing aids, health education……..aids, health education……..

A comprehensive benefits package!A comprehensive benefits package!

Retirees – SB 840Retirees – SB 840

3.5% health tax on 3.5% health tax on pension, social pension, social security, dividends security, dividends (capped at 200,000)(capped at 200,000)

Part B premium under Part B premium under Medicare would no Medicare would no longer have to be paidlonger have to be paid

No co-payments or No co-payments or deductiblesdeductibles

Fully covered Fully covered prescription drugsprescription drugs

HR 676 - ConyersHR 676 - Conyers H.R 676 provides:H.R 676 provides: for all medically necessary for all medically necessary

servicesservices including primary care, including primary care,

inpatient careinpatient care outpatient careoutpatient care emergency careemergency care prescription drugsprescription drugs durable medical equipmentdurable medical equipment long-term carelong-term care mental health servicesmental health services dentistrydentistry

eye careeye care chiropractic chiropractic substancesubstance abuse treatment.abuse treatment. Patients have their choice of Patients have their choice of

physiciansphysicians providersproviders hospitalshospitals clinics clinics

Why won’t politicians say Why won’t politicians say “yes” to single payer? “yes” to single payer?

Without Educated Without Educated Communities…..Communities…..

Harry and Harry and Louise was the Louise was the most effective most effective tool for the tool for the insurance insurance lobby in lobby in historyhistory

Where are Harry and Louise Where are Harry and Louise Now?Now?

Their daughter is Their daughter is out of college with out of college with no health insuranceno health insurance

Their son’s Their son’s employer just employer just increased the increased the worker’s premium worker’s premium for insurance by for insurance by $100 per month$100 per month

Louise has high Louise has high blood pressure, blood pressure, diabetes and diabetes and asthma asthma

Harry spends his Harry spends his evenings over his evenings over his computer trying to computer trying to figure out what his figure out what his Part D benefit isPart D benefit is

How do we win?How do we win?

It’s Up to Us!It’s Up to Us! Seniors – Be a part Seniors – Be a part

of this movementof this movement Host house partiesHost house parties Make presentations Make presentations

at your church, club at your church, club or community groupor community group

Focus on passing Focus on passing resolutions in resolutions in supportsupport

Specific StrategiesSpecific Strategies

ResolutionsResolutions Calculate savings for the employer (cost Calculate savings for the employer (cost

calculation sheet)calculation sheet)

Focus on resolutions at the Commissions Focus on resolutions at the Commissions on Agingon Aging

Work with others of “like mind”Work with others of “like mind”

InsightsInsights

““Americans can be relied Americans can be relied upon to do the right upon to do the right thingthing

– – after they’ve after they’ve exhausted all the exhausted all the other possibilities.”other possibilities.”

Winston ChurchillWinston Churchill

Cornerstones Of Our Democracy Cornerstones Of Our Democracy

1848 – First Women’s 1848 – First Women’s Rights Convention Rights Convention held in Seneca Falls, held in Seneca Falls, New York – 1972 The New York – 1972 The Equal Rights Equal Rights Amendment is passed Amendment is passed by Congress by Congress

1831 Nat Turner leads 1831 Nat Turner leads a slave revolt in a slave revolt in Virginia – 1964 Civil Virginia – 1964 Civil Rights Act is enactedRights Act is enacted

Late 1940s – 50s Late 1940s – 50s Congress debates Congress debates Medicare – Signed into Medicare – Signed into law July 30, 1965law July 30, 1965

20?? – The great 20?? – The great nation of America nation of America provides health provides health insurance to allinsurance to all

Something to Ponder….Something to Ponder….

We have publicly We have publicly funded:funded:

Military to protect usMilitary to protect us Police and fire to keep Police and fire to keep

us safeus safe Education to educate Education to educate

all childrenall children Why don’t we have Why don’t we have

publicly funded health publicly funded health care for everyone?care for everyone?

“First they ignore you. Then they laugh at you. Then they fight you. Then you win”!“Gandhi”