November 2012November 2012

2012 Election Results: 2012 Election Results: Impacts and Next Impacts and Next Steps in CA Health Steps in CA Health

Policy:Policy:What’s New, What’s Next?What’s New, What’s Next?

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Obamacare Wins!Obamacare Wins!Implementation Steams Implementation Steams

AheadAheadWith the Supreme Court decision and the President’s re-With the Supreme Court decision and the President’s re-election, the Affordable Care Act is assured of election, the Affordable Care Act is assured of

implementation. While there’s more to do, “Obamacare” is implementation. While there’s more to do, “Obamacare” is the biggest Congressional action to:the biggest Congressional action to:

1)1) Provide new consumer protections Provide 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) Ensure security 2) Ensure 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 45 years; Would bring US from Biggest expansion of coverage in 45 years; Would bring US from

85% to 95% coverage.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) Begin to control health care costs3) Begin to control health care costs, for our families & , for our families & our govt.our govt.• 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

More Election ResultsMore Election Results

No supporter of the Affordable Care Act No supporter of the Affordable Care Act lost to an opponent of “ObamaCare”lost to an opponent of “ObamaCare”

– U.S. Senate: Democrats increased margins, including U.S. Senate: Democrats increased margins, including in tough states like Missouri and Montana where in tough states like Missouri and Montana where candidates defended the ACA. candidates defended the ACA.

– California House: Democratic gains includes likely California House: Democratic gains includes likely defeat of 3 incumbents and ACA opponents: Bilbray; defeat of 3 incumbents and ACA opponents: Bilbray; Bono Mack; Lungren. (Last two defeated by doctors Bono Mack; Lungren. (Last two defeated by doctors with safety-net experience: Dr. Raul Ruiz and Dr. Ami with safety-net experience: Dr. Raul Ruiz and Dr. Ami Bera)Bera)

– California Legislature: Democrats increased margins California Legislature: Democrats increased margins to 2/3 supermajorities. to 2/3 supermajorities.

Prop 30!Prop 30!Prevents “trigger cuts” to education & public safety, Prevents “trigger cuts” to education & public safety,

by raising $6 billion/year in revenue to the state by raising $6 billion/year in revenue to the state budget, through temporary increases in upper-budget, through temporary increases in upper-income tax rates, and a slight quarter-cent hike in income tax rates, and a slight quarter-cent hike in sales tax (which would still be less than last year).sales tax (which would still be less than last year).

Stabilizes budget after years of tough cutsStabilizes budget after years of tough cuts Health and human services 2Health and human services 2ndnd biggest budget biggest budget

item after education; 1/3 of the state budget.item after education; 1/3 of the state budget. $15 billion in cuts to health & human services in $15 billion in cuts to health & human services in

the last three years, such as:the last three years, such as:– Elimination of Denti-Cal and 9 other Medi-Cal benefitsElimination of Denti-Cal and 9 other Medi-Cal benefits– Elimination/transition of Adults Day Health CentersElimination/transition of Adults Day Health Centers– Elimination/transition of Healthy FamiliesElimination/transition of Healthy Families

No restorations triggered—but helps prevent No restorations triggered—but helps prevent further cuts to healthfurther cuts to health

Creates a firmer fiscal foundation for reformCreates a firmer fiscal foundation for reform

HEALTH REFORM:HEALTH REFORM:Next Steps &Next Steps &The Special The Special

SessionSession

California LeadingCalifornia Leadingon Health Reformon Health Reform

California needs to maximize the benefit—California needs to maximize the benefit—our health system needs all the help we can our health system needs all the help we can getget

California leads, and can show the way California leads, and can show the way among states with significant uninsured among states with significant uninsured populations…populations…

Fulfilling the Promise:Fulfilling the Promise:California 2010 LegislationCalifornia 2010 Legislation– Created an Exchange Created an Exchange that is transparent, consumer-that is transparent, consumer-

friendly, easy-to-use, fairly governed, and that friendly, easy-to-use, fairly governed, and that negotiates with the insurers to provide the best value to negotiates with the insurers to provide the best value to consumers: AB1602 (Perez) & SB900 (Alquist/Steinberg)consumers: AB1602 (Perez) & SB900 (Alquist/Steinberg)

– Ensured availability of child-only plans, prohibited Ensured availability of child-only plans, prohibited children with pre-existing conditions to be denied children with pre-existing conditions to be denied coverage, and limited higher rates:coverage, and limited higher rates: AB2244 (Feuer) AB2244 (Feuer)

– Made rate hikes (& justifications) public:Made rate hikes (& justifications) public: SB1163 SB1163 (Leno)(Leno)

– Conformed state lawConformed state law to many new federal consumer to many new federal consumer protections, including rescissions, dependent coverage protections, including rescissions, dependent coverage up to age 26, no cost-sharing for preventative care, etc.up to age 26, no cost-sharing for preventative care, etc.

ThThe Exchange in CAe Exchange in CACalifornia’s first-in-the-nation legislation to establish California’s first-in-the-nation legislation to establish

an Exchange post-reform:an Exchange post-reform:Provides for Provides for “selective contracting,”“selective contracting,” so it can so it can negotiate for individuals and small businesses, who negotiate for individuals and small businesses, who otherwise are left all alone at the mercy of the otherwise are left all alone at the mercy of the insurers.insurers.Can serve as the Can serve as the HR department for CAHR department for CA, getting a , getting a better deal, vetting products, providing neutral and better deal, vetting products, providing neutral and credible information, standardizing benefits, and credible information, standardizing benefits, and fixing issues that come up.fixing issues that come up.

Five board members appointed: HHS Secretary Diana Five board members appointed: HHS Secretary Diana Dooley (Gov. Brown); Kim Belshe and Susan Kennedy Dooley (Gov. Brown); Kim Belshe and Susan Kennedy (Gov. Schwarzenegger); Paul Fearer (Speaker Perez) ; (Gov. Schwarzenegger); Paul Fearer (Speaker Perez) ; Dr. Bob Ross (Senate President Steinberg).Dr. Bob Ross (Senate President Steinberg).

Initial work: Hired an Executive Director, Peter Lee, and Initial work: Hired an Executive Director, Peter Lee, and staff; created business plan; Sought and got $39 staff; created business plan; Sought and got $39 million in federal funds through 2012; Start work on million in federal funds through 2012; Start work on eligibility and enrollment systems; IT systems; eligibility and enrollment systems; IT systems; navigation; stakeholder process; public education and navigation; stakeholder process; public education and outreach; etc. outreach; etc.

Fulfilling the Promise:Fulfilling the Promise:California 2011 LegislationCalifornia 2011 Legislation– Reformed key systems to help consumers get Reformed key systems to help consumers get

coverage and care, to be ready ramping up to 2014:coverage and care, to be ready ramping up to 2014: Eligibility and Enrollment:Eligibility and Enrollment: AB1296(Bonilla) outlines a “no AB1296(Bonilla) outlines a “no

wrong door” philosophy for signing up Californians for coverage.wrong door” philosophy for signing up Californians for coverage.

Consumer Assistance:Consumer Assistance: AB922(Monning) enhances & expands AB922(Monning) enhances & expands the Office of Patient Advocates as a triage center for questions the Office of Patient Advocates as a triage center for questions and complaints about coverage and care.and complaints about coverage and care.

– Instituted new consumer protections and insurance Instituted new consumer protections and insurance oversight, to align with federal law:oversight, to align with federal law:

Medical Loss Ratio: Medical Loss Ratio: SB51(Alquist) would allow state SB51(Alquist) would allow state regulators to enforce new federal standards to ensuring regulators to enforce new federal standards to ensuring premiums dollars go to patient care, not administration and premiums dollars go to patient care, not administration and profit.profit.

Maternity Care:Maternity Care: AB210(Hernandez)/SB222(Evans) mandates AB210(Hernandez)/SB222(Evans) mandates maternity services as a basic benefit by July 2012.maternity services as a basic benefit by July 2012.

Fulfilling the Promise:Fulfilling the Promise:California 2012 LegislationCalifornia 2012 Legislation– Instituted new consumer protections and Instituted new consumer protections and

insurance oversight, to align with federal law:insurance oversight, to align with federal law: ESSENTIAL HEALTH BENEFITS: AB1453 (Monning) / SB951 ESSENTIAL HEALTH BENEFITS: AB1453 (Monning) / SB951

(Hernandez)—set a minimum standard for health plans (Hernandez)—set a minimum standard for health plans (equivalent to a Kaiser small group HMO), so consumers (equivalent to a Kaiser small group HMO), so consumers have more confidence that their coverage is have more confidence that their coverage is comprehensive.comprehensive.

SMALL GROUP MARKET REFORM: AB1083 SMALL GROUP MARKET REFORM: AB1083 (Monning) prevents small businesses from seeing spikes in (Monning) prevents small businesses from seeing spikes in insurance premiums if their workers get sick.insurance premiums if their workers get sick.

Also:Also: NOTICE OF COVERAGE OPTION DURING LIFE CHANGES: NOTICE OF COVERAGE OPTION DURING LIFE CHANGES:

AB792(Bonilla) requires that consumers are informed of AB792(Bonilla) requires that consumers are informed of their coverage options in the new Exchange when losing their coverage options in the new Exchange when losing coverage--such as during a job change, divorce, adoption, coverage--such as during a job change, divorce, adoption, and other circumstances. and other circumstances.

Fulfilling the Promise: Fulfilling the Promise: (LIHP)(LIHP)

Low Income Health ProgramLow Income Health ProgramA win for the county, the uninsured, and the health system:A win for the county, the uninsured, and the health system:

– County gets County gets new federal matching fundsnew federal matching funds, for dollars they , for dollars they already largely already spend on indigent care, helping their already largely already spend on indigent care, helping their health system and their local economy.health system and their local economy.

– Now 550,000 uninsured get Now 550,000 uninsured get coverage prior to 2014; a coverage prior to 2014; a medical homemedical home providing primary and preventative care, not providing primary and preventative care, not just care at the emergency room.just care at the emergency room.

– Since this coverage is grounded in county-based systems of Since this coverage is grounded in county-based systems of care, these new dollars go to care, these new dollars go to shore up safety-net shore up safety-net institutionsinstitutions, including public hospitals, community clinics, , including public hospitals, community clinics, and other providers.and other providers.

– This serves as This serves as a bridge to health reforma bridge to health reform, ensuring these , ensuring these patients are getting treated and in systems of care before patients are getting treated and in systems of care before 2014, and ready to get full Medi-Cal (or exchange-based) 2014, and ready to get full Medi-Cal (or exchange-based) coverage on day one, maximizing enrollment and federal coverage on day one, maximizing enrollment and federal funds for California.funds for California.

– This isn’t a long-term obligation: In fact, the more people are This isn’t a long-term obligation: In fact, the more people are enrolled in these programs, and thus quickly shifted to Medi-enrolled in these programs, and thus quickly shifted to Medi-Cal in 2014 with 100% funding by the federal government, Cal in 2014 with 100% funding by the federal government, the the more county resources can be refocused to better more county resources can be refocused to better serve the medically indigent who remain uninsured serve the medically indigent who remain uninsured after 2014.after 2014.

Reform is RealReform is Real Californians are feeling the benefits already.Californians are feeling the benefits already.

– 14,667 “uninsurable” Californians are enrolled in the Pre-Existing 14,667 “uninsurable” Californians are enrolled in the Pre-Existing Condition Insurance ProgramCondition Insurance Program for those denied coverage due to pre- for those denied coverage due to pre-existing conditions.existing conditions.

– 552,000 Californians are enrolled in coverage552,000 Californians are enrolled in coverage through the Low Income through the Low Income Health Program (LIHP) in 51 counties, which serves as bridge coverage for Health Program (LIHP) in 51 counties, which serves as bridge coverage for the low-income uninsured who will qualify for Medi-Cal in 2014.the low-income uninsured who will qualify for Medi-Cal in 2014.

– 355,927 young adults in California have coverage355,927 young adults in California have coverage who might who might otherwise have become uninsured, since they are covered by their parents’ otherwise have become uninsured, since they are covered by their parents’ insurance.insurance.

– 8,978,000 insured Californians gained new consumer protections8,978,000 insured Californians gained new consumer protections , , including Medical Loss Ratio requirements that require insurance companies including Medical Loss Ratio requirements that require insurance companies to spend more premium dollars on medical health care. to spend more premium dollars on medical health care. 1.9 million 1.9 million California residents received $74 million in rebatesCalifornia residents received $74 million in rebates from insurance from insurance companies who did not meet these minimums.companies who did not meet these minimums.

– California consumers saved over $100 million dollars in savings California consumers saved over $100 million dollars in savings from rate hikesfrom rate hikes that were retracted, reduced, or withdrawn due to rate that were retracted, reduced, or withdrawn due to rate review.review.

– 319,429 California seniors in Medicare saved $171,983,735319,429 California seniors in Medicare saved $171,983,735 in in prescription drug costs, an average of over $500 a patient facing the “drug prescription drug costs, an average of over $500 a patient facing the “drug donut hole.”donut hole.”

– Over 12 million Californians no longer have a lifetime limit on their health Over 12 million Californians no longer have a lifetime limit on their health insurance plan.insurance plan.

– Health plans in California must all cover maternity care.Health plans in California must all cover maternity care.

2013 Special Session 2013 Special Session Agenda:Agenda:

Consumer Protections & Insurer Consumer Protections & Insurer OversightOversight Watchdog the federal and state government to ensure that Watchdog the federal and state government to ensure that new new

consumer protections are implemented and enforcedconsumer protections are implemented and enforced..– Focus at the Department of Managed Health Care (DMHC) and Focus at the Department of Managed Health Care (DMHC) and

the Department of Insurance (DOI)the Department of Insurance (DOI)– Continued focus on rate review has generated hundreds of Continued focus on rate review has generated hundreds of

million in savings through scaled-back and withdrawn rate million in savings through scaled-back and withdrawn rate hikes.hikes.

Ensure Ensure Californians know about their new rights and Californians know about their new rights and optionsoptions..

Start to transition from the “Wild Wild West” insurance market: Start to transition from the “Wild Wild West” insurance market: phasing in benefits, standards, and options to be ready for 2014. phasing in benefits, standards, and options to be ready for 2014. (Bill numbers from previous session)(Bill numbers from previous session)

– INDIVIDUAL MARKET REFORM: AB1462 (Monning) / SB961 INDIVIDUAL MARKET REFORM: AB1462 (Monning) / SB961 (Hernandez)(Hernandez)

– COST SHARING LIMITS: AB1800 (Ma)COST SHARING LIMITS: AB1800 (Ma)– Maybe: RATE REGULATION: AB52(Feuer) / Scheduled for 2014 Maybe: RATE REGULATION: AB52(Feuer) / Scheduled for 2014

ballot measureballot measure Fight efforts to weaken, defund, undermine, and repealFight efforts to weaken, defund, undermine, and repeal

these consumer protections and the rest of reform.these consumer protections and the rest of reform.

2013 Special Session 2013 Special Session Agenda:Agenda:

Ensuring Californians Get Ensuring Californians Get Coverage: The Day One ChallengeCoverage: The Day One Challenge Eligibility and enrollment Eligibility and enrollment (bill numbers from prior session):(bill numbers from prior session):

– 2014 MEDI-CAL EXPANSION: AB43 (Monning) / SB 677 (Hernandez)2014 MEDI-CAL EXPANSION: AB43 (Monning) / SB 677 (Hernandez) Medicaid Benchmark BenefitsMedicaid Benchmark Benefits Eligibility and Enrollment RulesEligibility and Enrollment Rules Continuation of current State Programs: FamilyPACT, PRUCOL, etc.Continuation of current State Programs: FamilyPACT, PRUCOL, etc.

– PRE-ENROLLMENT: AB715 (Atkins)PRE-ENROLLMENT: AB715 (Atkins) Work to Work to implement and improve:implement and improve:

– Streamline enrollment in Medicaid, Healthy Families, the Streamline enrollment in Medicaid, Healthy Families, the Exchange and elsewhere; no wrong doors;Exchange and elsewhere; no wrong doors;

– Get ready so Get ready so millions of Californians get covered on Day millions of Californians get covered on Day One—JanuaryOne—January 1, 2014—and California maximizes federal 1, 2014—and California maximizes federal money.money.

– Create integrated system of “navigation”—right now, Create integrated system of “navigation”—right now, patchwork of county workers, brokers/agents, community patchwork of county workers, brokers/agents, community groups, etc.groups, etc.

– Work at the Legislature and at the Exchange, DHCS, etc.Work at the Legislature and at the Exchange, DHCS, etc.– Enrollment starts October 2013—ten short months Enrollment starts October 2013—ten short months

away.away.

Fulfilling the Promise:Fulfilling the Promise:What a Community Can DoWhat a Community Can Do

EducateEducate the Community about Their New Rights, Options, the Community about Their New Rights, Options, Benefits, and Consumer ProtectionsBenefits, and Consumer Protections

EngageEngage Communities and Consumers Every Step of the Way Communities and Consumers Every Step of the Way Maximize Federal DollarsMaximize Federal Dollars for County and Community for County and Community

– Grant opportunitiesGrant opportunities– Matching Dollars for Medi-Cal, Healthy Families, LIHP, etc.Matching Dollars for Medi-Cal, Healthy Families, LIHP, etc.

Aggressively Implement the Low-Income Health ProgramAggressively Implement the Low-Income Health Program Be ReadyBe Ready So Community Residents Get So Community Residents Get Coverage on Day OneCoverage on Day One

– Set a Goal and Date; Work backwards to Meet That GoalSet a Goal and Date; Work backwards to Meet That Goal– Systems in place for easy enrollment through no wrong doorSystems in place for easy enrollment through no wrong door

Transform the Safety-NetTransform the Safety-Net to Survive and Thrive to Survive and Thrive– A Business Plan for Safety-net institutionsA Business Plan for Safety-net institutions– An Assessment and Augmentation of County-wide CapacityAn Assessment and Augmentation of County-wide Capacity

Use the New Tools in the LawUse the New Tools in the Law– To focus on delivery system reform for To focus on delivery system reform for cost, quality, safety & equitycost, quality, safety & equity – To build To build health in all policieshealth in all policies, with place-based policy interventions, with place-based policy interventions

So Much More So Much More TTo Do:o Do:What Can What Can YouYou Do? Do?

1.1. Thank your member of Congress/Tell them not Thank your member of Congress/Tell them not to repeal it:to repeal it: C Call, write, or visit your Congressional all, write, or visit your Congressional Representative and thank them for their yes vote – or Representative and thank them for their yes vote – or attend a public event to thank them!attend a public event to thank them!

2.2. Share your story Share your story personal stories help others learn personal stories help others learn how they can benefit from reform – and they are a how they can benefit from reform – and they are a compelling advocacy tool!compelling advocacy tool!

3.3. Support state efforts to implement and improve Support state efforts to implement and improve reform reform let your local representatives know that you let your local representatives know that you support robust implementation and improvement of support robust implementation and improvement of reform.reform.

4.4. Write a letter to the editorWrite a letter to the editor in support of reform in support of reform and all its benefits. and all its benefits.

5.5. Join our mailing list Join our mailing list to keep up to date on to keep up to date on legislative development and get important action legislative development and get important action alerts! alerts!

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