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Stay Well Afford Care Secure Coverage

Stay Well Afford Care Secure Coverage. Our Broken Health Care System. 6.5 Million Uninsured. 20% of Population. Source: California Health Interview Survey, 2005. 84% of the Uninsured Work. Source: California Health Interview Survey, 2005. The Hidden Tax. Cost to Insured. 10% of premium.

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Stay Well Afford Care Secure Coverage

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  1. Stay WellAfford CareSecure Coverage

  2. Our Broken Health Care System 6.5 Million Uninsured 20% of Population Source: California Health Interview Survey, 2005

  3. 84% of the Uninsured Work Source: California Health Interview Survey, 2005

  4. The Hidden Tax Cost to Insured 10% of premium Actual Cost of Medical Care Uninsured 10% of premium Source: New America Foundation

  5. The Hidden Tax Cost to Insured 17% of premium Actual Cost of Medical Care Uninsured 17% of premium Medi-Cal Underfunding Source: Administration Analysis of “Cost Shift Hydraulic,” Dobson

  6. Hidden Tax Individuals: $455 Families: $1,186 Source: New America Foundation

  7. California Health Spendingin Billions 2004 1994 1984 Source: Centers for Medicare and Medicaid Services

  8. Rising Insurance Premiums Health Insurance Premiums Inflation Wage Growth Source: CA Employer Health Benefits Survey 2005, Dept. of Finance

  9. Fixing Our Broken System • Reduce the hidden tax; lower costs • Coverage for all; support better care • Healthy California

  10. Governor’s Health Care Initiative • Prevention / Wellness • Shared Responsibility / Coverage for All • Affordability

  11. Governor’s Health Care Initiative • Prevention / Wellness

  12. Prevention & WellnessHealthier State – Long Term Affordability • Offer Consumers Incentives and Rewards • Tied to preventive health practices • Diabetes prevention and treatment

  13. Prevention & WellnessHealthier State – Long Term Affordability • Reduce Medical Errors • E-prescribing of all prescriptions • Strengthen patient safety & accountability

  14. Prevention & WellnessHealthier State – Long Term Affordability • National Leader: Prevent Obesity • Implement comprehensive strategy to reverse obesity epidemic: public awareness & outreach, improve access to nutritious foods and physical activity

  15. Prevention & WellnessHealthier State – Long Term Affordability • Continue Tobacco Control Leadership • Increase assistance to those seeking to quit smoking

  16. Governor’s Health Care Initiative • Prevention / Wellness • Shared Responsibility / Coverage for All

  17. Shared Benefit INDIVIDUALS Access to affordable coverage Healthier CA

  18. Shared Benefit GOVERNMENT Healthy, productive & economically competitive state INDIVIDUALS Access to affordable coverage Healthier CA

  19. Shared Benefit GOVERNMENT Healthy, productive & economically competitive state DOCTORS & HOSPITALS Fairly compensated INDIVIDUALS Access to affordable coverage Healthier CA

  20. Shared Benefit GOVERNMENT Healthy, productive & economically competitive state DOCTORS & HOSPITALS Fairly compensated INDIVIDUALS Access to affordable coverage Healthier CA HEALTH PLANS Expanded market Fair compensation

  21. Shared Benefit GOVERNMENT Healthy, productive & economically competitive state EMPLOYERS Affordable coverage Healthy, productive workforce DOCTORS & HOSPITALS Fairly compensated INDIVIDUALS Access to affordable coverage Healthier CA HEALTH PLANS Expanded market Fair compensation

  22. Shared Responsibility INDIVIDUALS Obtain Health Coverage

  23. Fixing the Broken System GOVERNMENT • INDIVIDUALS • Must secure health coverage for themselves and their children • Personal responsibility for health and wellness • Contribute to paying for their coverage DOCTORS & HOSPITALS EMPLOYERS HEALTH PLANS

  24. Shared Responsibility GOVERNMENT Promote a functional health care system Provide access to affordable coverage Fairly compensate Medi-Cal providers INDIVIDUALS Obtain health coverage

  25. Fixing the Broken System INDIVIDUALS • GOVERNMENT • Expand Healthy Families/Medi-Cal for all children in families earning under $60K • Subsidies to families between $20K-$50K provided through new purchasing pool • County responsible for access for undocumented • Expand Medi-Cal to adults in poverty • $4 billion increase in Medi-Cal reimbursement rates DOCTORS & HOSPITALS EMPLOYERS HEALTH PLANS

  26. Shared Responsibility GOVERNMENT Promote functional market Provide access to affordable coverage Fairly compensate Medi-Cal providers DOCTORS & HOSPITALS Provide affordable, quality care Share cost savings INDIVIDUALS Obtain health coverage

  27. Redistribution to Providers New Funds to Providers $10 - $15 Billion $3.5 Billion Coverage Dividend from Providers

  28. Fixing the Broken System GOVERNMENT • DOCTORS & HOSPITALS • 2% fee on physician revenues – 4% on hospital revenues • Participation in patient safety initiatives • At least 85% of hospital payments spent on patient care INDIVIDUALS EMPLOYERS HEALTH PLANS

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

  30. Fixing the Broken System GOVERNMENT • HEALTH PLANS • Guarantee coverage • Only base rates on age and geographic area in the individual market • 85% of premiums dedicated to patient care • Offer “Healthy Actions” rewards and incentives within benefit packages DOCTORS & HOSPTIALS EMPLOYERS INDIVIDUALS

  31. Shared Responsibility GOVERNMENT Promote functional health care market Provide access to affordable coverage Fairly compensate Medi-Cal providers EMPLOYERSSupport employee 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

  32. Fixing the Broken System GOVERNMENT • EMPLOYERS • Offer 125 plans to allow employees to make pre-tax contributions to coverage • Contribute to the cost of coverage – non-offering employers with 10 or more employees will contribute 4% of payroll < 10 employees = 80% of all CA employers DOCTORS & HOSPTIALS INDIVIDUALS HEALTH PLANS

  33. Universal Coverage - Adults

  34. Universal Coverage - Children

  35. Governor’s Health Care Initiative • Prevention / Wellness • Shared Responsibility / Coverage for All • Affordability

  36. Affordability: Short Term • Reduce hidden tax • Tax breaks for individuals & businesses tied to purchase of health insurance • Enhance insurer & hospital efficiency by requiring 85% of premiums & hospital dollars on patient care • Remove regulatory barriers • Reduce regulatory red tape

  37. Affordability: Short Term • Remove regulatory barriers: • Barriers to low-cost delivery models (e.g. retail medical clinics) • 24-Hour Coverage Pilot: Combine workers’ compensation with traditional health coverage – Cal-PERS opt-in for private sector • Prioritize hospital seismic retrofit based on “worst first”

  38. Affordability: Short Term • Reduce regulatory red tape that stifles health plan product innovation and increases cost

  39. Affordability: Long-Term • Health prevention & wellness • Health IT: Paperless system w/ strong privacy protections within 10 years • Medi-Cal rate increases tied to performance measures • Enhance health care quality & efficiency through improved performance measurement • Monitor & evaluate market function & costs and revise as necessary

  40. Affordability: Long-Term • Enhance health care quality & efficiency through improved performance measurement • Monitor & evaluate market function & costs • Revise as necessary

  41. FISCAL IMPACT Prevention $300 Tax Incentive $900 Counties $2,000 Subsidized Coverage $2,270 Medi-Cal/HFP Coverage $2,638 Medi-Cal Rate Increase $4,039 $12 Billion Other - $203 Employer in lieu $1,000 County Redirect $2,000 Physician/Hospitals Recapture $3,472 Federal Fund Increase $5,474 Cost Funding in millions

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