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Stay Well Afford Care Secure Coverage July 31, 2008 SCI – San Francisco, CA

Stay Well Afford Care Secure Coverage July 31, 2008 SCI – San Francisco, CA. Why, How, What, and When. The Why – call to action The How – process lessons The What – policy lessons The When – next steps. Why: Vision 2006. Governor’s Vision:

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Stay Well Afford Care Secure Coverage July 31, 2008 SCI – San Francisco, CA

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  1. Stay Well Afford Care Secure CoverageJuly 31, 2008SCI – San Francisco, CA

  2. Why, How, What, and When • The Why – call to action • The How – process lessons • The What – policy lessons • The When – next steps

  3. Why: Vision 2006 • Governor’s Vision: “A first-rate health care system that is accessible to everyone, efficient and affordable”

  4. Basis for Moving Forward • Status quo/inaction not an option • Gubernatorial leadership and resolve • Framework for reform • Broadly shared goals • Values and principles • Comprehensive, not incremental

  5. Framework for Reform: 2007 • Essential elements of reform • Health and Wellness • Coverage for All • Affordability

  6. Shared Benefit GOVERNMENT Healthy, productive & economically competitive state EMPLOYERS Affordable coverage Healthy, productive workforce DOCTORS & HOSPITALS Expanded insured population Fair compensation INDIVIDUALS Access to affordable coverage Health care security Healthier CA HEALTH PLANS Expanded market Fair compensation

  7. Shared Responsibility GOVERNMENT Promote functional health care market Provide access to affordable coverage Fairly compensate Medi-Cal providers EMPLOYERSSupportemployee access to affordable coverage DOCTORS &HOSPITALS Provide affordable, quality care Share cost savings INDIVIDUALS Obtain health coverage HEALTH PLANS Guarantee access to affordable coverage Pass along savings

  8. The HOW: Overall Approach • Gubernatorial Leadership • Small dedicated staff team in GO • Administration-wide workgroup • All ideas on the table • Comprehensive approach – prevention, coverage, cost containment

  9. The How: Vehicles to Adoption • Concept Papers • Policy Bill • Financing by Ballot Initiative

  10. Historic Coalition of SupportRepublican Governor and Democratic Speaker • Broad coalition for change – 2000+ meetings • Most insurers pro guaranteed issue and profit caps • Consumer groups, some unions pro-individual mandate • Business groups/local chambers pro-minimum employer contribution • Hospitals pro hospital fee • Research, analysis, advocacy communities

  11. Process Challenges in Getting to Yes • Timing, competing priorities • 2008 context – Term limits reform; Presidential election; November ballot initiative(s) • Unusual bedfellows means slow negotiations • Status quo as choice #2 for some groups • Lack of broad base of legislative champions • Easier to stop than to enact reform

  12. How: Process Lessons • Be Consistent With the Messaging • Meet, Meet, and Meet Again • Keep The Issue in The Public Eye • Build Your Coalition As Early As Possible • Use Neutral Third Parties to Conduct Fiscal and Policy Research

  13. What: Resonance of Key Concepts • Status Quo as Unacceptable • Hidden Tax • Shared Benefit • Shared Responsibility • Culture of Coverage

  14. What: Policy Advances • Coverage or expanded access for nearly all of California’s 5.1 million uninsured • Coverage of all kids, regardless of immigration status • Personal responsibility for coverage • Shared responsibility for financing – minimum employer contribution • Affordability mechanisms • Sweeping insurance market reforms

  15. What: Policy Advances • Transparency and public reporting • Safety net provider protections • Affirmation of the role of public health plans • Comprehensive health and wellness • Medi-Cal provider rate increases • Full financing outside the General Fund; mechanisms to protect the General Fund

  16. Policy Tension Points • Affordability – cost for moderate income individuals • Individual mandate – exemptions, enforcement • Financing – employer fee; indexing to health care cost inflation • Market reforms - timeline for elimination of health status rating, sale of products below the minimum

  17. What: Policy Lessons • More is more - • Comprehensive versus incremental • Post-partisanship tensions - • Market-based versus government-based • Context matters - • State budget, economy

  18. What: Policy Lessons • It’s all about coverage - • Coverage versus cost containment • Show me the money - • Sources, adequacy of financing

  19. When: Forward We Go • Our goals remain – prevention & wellness, universality of coverage, cost containment • Our commitment to lead remains • Our resolve remains

  20. Timing of Next Steps • Two-Phase Comprehensive Approach • Phase I – This Year (Legislative) • Cost Containment • Prevention • Consumer Protection • Phase II • Coverage Expansion • Financing (Ballot Initiative)

  21. Contact Info: • Kim Belshe, Secretary, Health and Human Services Agency • kbelshe@chhs.ca.gov • Richard Figueroa, Deputy Cabinet SecretaryOffice of Governor Arnold Schwarzenegger • Richard.Figueroa@gov.ca.gov • Sandra Shewry, Director, Department of Health Care Services • Sandra.Shewry@dhcs.ca.gov

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