California health reform proposal
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California Health Reform Proposal Proposed by Governor Schwarzenegger January 8, 2007 Health Insurance Coverage of the Nonelderly in California, Massachusetts, and the U.S., 2004-2005 Total Population: 35.8 million 6.3 million 256.3 million Uninsured: 6.7 million 677,000 45.4 million

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California health reform proposal l.jpg

California Health Reform Proposal

Proposed by Governor Schwarzenegger

January 8, 2007


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Health Insurance Coverage of the Nonelderly in California, Massachusetts, and the U.S., 2004-2005

Total Population:

35.8 million

6.3 million

256.3 million

Uninsured:

6.7 million

677,000

45.4 million

SOURCE: KCMU/Urban Institute Analysis of the March 2005 and 2006 Current Population Survey. Two-year pooled estimates also used for the United States.


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Covering All Californians Massachusetts, and the U.S., 2004-2005

  • Individual Mandate

  • Public Coverage Expansions

    • All children to 300% FPL

    • Legal parents and childless adults up to 100% FPL

    • County-based coverage for undocumented adult immigrants up to 250% FPL

  • Subsidies for Adults 101-250% FPL

    • For purchasing pool or share of employer-sponsored insurance premium

  • Insurance Market Reforms

    • New purchasing pool

    • Guaranteed issue for plans

    • 85% of plan revenues on patient care

  • Financing

    • Medicaid/SCHIP federal match

    • 4% of payroll fee for non-offering employers with 10+ employees

    • “Coverage dividend” fee of 4% for hospitals, 2% for physicians

    • Reprogramming of current state, county, and local funding


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Proposed Coverage by Poverty Level Massachusetts, and the U.S., 2004-2005

Above 300% FPL

SOURCE: Governor’s Health Care Proposal, January 8, 2007


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How the Uninsured are Covered Massachusetts, and the U.S., 2004-2005

People in Thousands

Total: 4.6 million Uninsured

SOURCE: Governor’s Health Care Proposal, January 8, 2007. Coverage estimations are approximations.


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Financing for California’s Reform Plan Massachusetts, and the U.S., 2004-2005

Dollars in Billions

$12.1 billion

$12.1 billion

Prevention/Wellness

State Savings*

125 Plan State Tax Loss

Local Funds

County Coverage for Adult Undocumented Immigrants

County Funds**

Employer Fee

Subsidies for Low-Income Adults

Provider Fee

Medi-Cal/SCHIP Expansion

Medi-Cal Payment Increases

Federal Funds

*The state expects to save $203 million through the elimination of several state programs after the reform (Access for Infants and Mothers, Managed Risk Medical Insurance Program, and MediCal Share-of-Cost)

** County funds will be available from the relief of other county obligations


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Key Challenges in California Massachusetts, and the U.S., 2004-2005

  • Large number of uninsured

  • Political challenges

    • Individual mandate

    • Employer fee

    • Provider fee

    • Coverage of immigrants

  • Affordability of coverage

  • Adequacy of benefits and subsidies in purchasing pool

  • Ability of individual market to meet increased demand

  • Long-term funding challenges


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