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Latinos and California Health Care Reform. Sumi Sousa Office of the Assembly Speaker California State Assembly. Context. What happens with the Latino population drives CA. Latinos constitute 35\% of CA residents Latinos will become the largest race/ethnic group in CA by 2011

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latinos and california health care reform

Latinos and California Health Care Reform

Sumi Sousa

Office of the Assembly Speaker

California State Assembly

context
Context
  • What happens with the Latino population drives CA.
    • Latinos constitute 35% of CA residents
    • Latinos will become the largest race/ethnic group in CA by 2011
    • Latinos will constitute 52% of CA’s population by 2042.
  • 6.7M non-elderly Californians are uninsured for all or part of the year. 60% are Latino.
  • 1 in 3 Latinos in California is uninsured.
context1
Context
  • California embarked upon a serious health care reform effort in 2007-08, wanting to address:
    • Unsustainable growth in the cost of health care
    • The large and growing population of uninsured and related problems of health care access
    • Dysfunctional individual market
    • Prevention agenda
    • Improvements to the overall health care delivery system
  • Short window of opportunity
    • Republican Governor in mid-2006 says 2007 will be “Year of Health Care Reform”
    • CA’s 2/3 vote requirement for taxes and 2008 elections meant a deal must be struck by the end of 2007/early 2008.
context2
Context
  • Significant constraints related to financing
    • 2/3 vote requirement for taxes
    • ERISA
  • Significant Political Constraints
    • Children’s health ballot initiative had just been defeated in 11/06
    • Previous, more modest reform attempt had been defeated in 2004
    • 2/3 vote requirement meant Governor had no Republican votes
    • Politics of immigration
what would ab 1x have done
What Would AB 1x Have Done?
  • Established a system of near universal coverage.
  • Employer and individual responsibility: Pay or play with an individual mandate
  • Established a purchasing pool for workers in firms not offering coverage and tax credits (subsidies) for coverage for lower income workers.
  • Individual market reforms, including guarantee issue.
  • 85/15 medical loss ratio
  • Major public program expansions (Medi-Cal and Healthy Families) for low-income Californians, including childless adults.
what would ab 1x have done1
What Would AB 1x Have Done
  • $2.3B Medi-Cal rate increase funded via a 4% quality improvement fee assessed on hospitals
  • Public Health and Prevention Programs: Obesity, diabetes, tobacco cessation
  • $1.75 per pack increase in the tobacco tax
  • Scope of practice changes to increase supply and availability of health care providers
how would it have affected why was it important for latinos
How Would It Have Affected/Why Was It Important for Latinos?
  • Coverage
  • Affordability
  • Access
  • Prevention/Public Health
  • Workforce
coverage
Coverage
  • 1 in 3 Latinos is uninsured in CA
  • Uninsured in CA are largely low income workers.
    • 84% of the uninsured in CA are workers and their family members
    • Latinos work in firms with the lowest offer rates amongst all groups in CA – 70% (for ex., whites = 90.2%).
    • They have one of the lowest take up rates in CA – 80%.
  • So structure of the employer “Pay or Play” important for Latinos.
    • Minimum spending requirement of 1% - 6.5%, depending on payroll size
    • Purchasing pool w/ the available tax credit meant there was a place for lower income families to purchase comprehensive, affordable coverage
  • Contained a major expansion of the state’s Medi-Cal and Healthy Families (SCHIP) programs.
    • Medi-Cal and Healthy Families expansion would have covered California’s 800,000 low income uninsured children regardless of documentation status.
    • Undocumented children are 4.1% of all children in CA and 18.5% of uninsured children.
coverage1
Coverage
  • Coverage program for remaining uninsured adults (ineligible for the pool or any public programs), via state’s non-profit community clinics.
    • Significant expansion of an existing state-only program which funds primary care services to low income uninsured adults.
    • Undocumented adults 19 – 64 are 8.9% of all adults and 25.3% of uninsured adults in CA.
  • Gruber estimates that AB 1x would have resulted in 71% of California’s uninsured gaining coverage, and an overall coverage rate of 98% of documented adults and 100% of children in CA.
    • Individual mandate exempted people below 250% of FPL whose premiums would have been greater than 5% of income – essentially, the undocumented.
affordability
Affordability
  • 41.1% of CA’s non-elderly population have incomes below 250% of FPL.
  • 61.6% of the Latino non-elderly population have incomes below 250% of FPL, 80.3% have incomes below 400% of FPL.
  • In addition to public program expansion which ensure free or very low cost coverage, AB 1x contained significant affordability provisions for lower income workers.
    • Required establishment of Sect. 125 plan
    • Purchasing pool for non-offering employers
    • Advanceable, refundable tax credit via the purchasing pool for those 250% - 400% of FPL.
    • Favorable cost sharing for products offered in the pool
      • Incomes up to 150% = 0 cost sharing
      • Incomes 150% - 250%, premiums limited to 5% of income.
access
Access
  • More than half of uninsured children in CA are eligible for public coverage. 68% of the eligible but unenrolled are Latino.
  • So enrollment simplification measures for Medi-Cal and Healthy Families, including elimination of the asset test, changing of the deprivation standard and simplification of the semi-annual status report are particularly important for Latinos.
  • Increased income limits to 300% of FPL for kids.
  • $2.3B Medi-Cal rate increase for CA’s hospitals and physicians
    • CA’s low reimbursement rates have created a serious access problem for recipients.
    • 53% of all Medi-Cal recipients are Latino.
prevention
Prevention
  • The Community Makeover Grants - Obesity Prevention
    • Grants for all the state’s local public health officers for purposes of healthy eating, living, and overall obesity prevention.
    • Particularly focused on changing environmental and lifestyle factors, such as gaining access to fresh foods, location of supermarkets in urban core, open space for physical activity.
  • Nearly 7 out of 10 Latino adults in California is overweight or obese.
prevention1
Prevention
  • Diabetes
    • Created the CA Diabetes Prevention Program within Medi-Cal to provide diabetes prevention and management services to all adult fee for service Medi-Cal recipients
    • Similar to obesity prevention programs, focused on education, prevention and lifestyle changes.
    • Would have worked with health plans and providers on incorporating culturally and linguistically appropriate lifestyle coaching, self-management, in addition to clinical interventions.
    • Diabetes prevalence is 8% for Latinos adults overall in CA. However 21% of Latino adults age 50 – 64 have diabetes, the highest amongst any race or ethnicity for this age group.
prevention2
Prevention
  • Tobacco cessation
    • California has been a leader in tobacco education and prevention
    • AB 1x contained an expansion of existing tobacco cessation programs, including Smoker’s Helpline which is available in 6 languages.
    • Allowed community clinics to bill for smoking prevention and cessation as a part of primary care services.
    • Tobacco tax = additional $1.75 per pack (current taxes = 87 cents per pack)
workforce
Workforce
  • CA faces a severe shortage of health care professionals, particularly in rural and low-income areas of the state. There’s an even greater shortage of minority health care professionals.
  • AB 1x would have established a scope of practice in law for nurse practitioners and expanded their ability to supervise medical assistants in clinical settings other than community clinics.
  • AB 1x also contained money for health care workforce training programs in Los Angeles County that incorporated more minorities into the health care professions.
latinos have a huge stake in health care reform
Latinos Have A Huge Stake in Health Care Reform
  • Both at the state and national level, Latinos have much to gain in health care reform.
  • Important that future policy decisions related to health care reform, particularly in the area of affordability and prevention, pay close attention to the demographic trends of this population.
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