2012 Election Results: Impacts and Next Steps in CA Health Policy: What’s New, What’s Next?

1. November 2012 2012 Election Results: Impacts and Next Steps in CA Health Policy:What’s New, What’s Next? www.health-access.org www.facebook.com/healthaccess www.twitter.com/healthaccess

2. With the Supreme Court decision and the President’s re-election, the Affordable Care Act is assured of implementation. While there’s more to do, “Obamacare” is the biggest Congressional action to: • Provide new consumer protections to prevent the worst insurance industry abuses • Biggest reform of insurance practices ever: no denials for pre-existing conditions; no rescissions; no lifetime/annual caps on coverage; etc • 2) Ensure security for those with coverage, and new and affordable options for those without coverage • Biggest expansion of coverage in 45 years; Would bring US from 85% to 95% coverage. • Expansion of Medicaid and a new exchange, with affordability tax credits so premiums are tied to income, not how sick we are. • 3) Begin to control health care costs, for our families & our govt. • Multiple efforts to ensure quality & reduce cost • Biggest deficit reduction measure in a generation. • Big investments in prevention, with unbooked savings Obamacare Wins!Implementation Steams Ahead

3. More Election Results • No supporter of the Affordable Care Act lost to an opponent of “ObamaCare” • U.S. Senate: Democrats increased margins, including in tough states like Missouri and Montana where candidates defended the ACA. • California House: Democratic gains includes likely defeat of 3 incumbents and ACA opponents: Bilbray; Bono Mack; Lungren. (Last two defeated by doctors with safety-net experience: Dr. Raul Ruiz and Dr. Ami Bera) • California Legislature: Democrats increased margins to 2/3 supermajorities.

4. Prop 30! Prevents “trigger cuts” to education & public safety, by raising $6 billion/year in revenue to the state budget, through temporary increases in upper-income tax rates, and a slight quarter-cent hike in sales tax (which would still be less than last year). Stabilizes budget after years of tough cuts • Health and human services 2nd biggest budget item after education; 1/3 of the state budget. • $15 billion in cuts to health & human services in the last three years, such as: • Elimination of Denti-Cal and 9 other Medi-Cal benefits • Elimination/transition of Adults Day Health Centers • Elimination/transition of Healthy Families • No restorations triggered—but helps prevent further cuts to health • Creates a firmer fiscal foundation for reform

5. HEALTH REFORM:Next Steps &The Special Session

6. California Leadingon Health Reform • California needs to maximize the benefit—our health system needs all the help we can get • California leads, and can show the way among states with significant uninsured populations…

7. Fulfilling the Promise:California 2010 Legislation • Created an Exchange that is transparent, consumer-friendly, easy-to-use, fairly governed, and that negotiates with the insurers to provide the best value to consumers: AB1602 (Perez) & SB900 (Alquist/Steinberg) • Ensured availability of child-only plans, prohibited children with pre-existing conditions to be denied coverage, and limited higher rates: AB2244 (Feuer) • Made rate hikes (& justifications) public: SB1163 (Leno) • Conformed state law to many new federal consumer protections, including rescissions, dependent coverage up to age 26, no cost-sharing for preventative care, etc.

8. The Exchange in CA California’s first-in-the-nation legislation to establish an Exchange post-reform: • Provides for “selective contracting,” so it can negotiate for individuals and small businesses, who otherwise are left all alone at the mercy of the insurers. • Can serve as the HR department for CA, getting a better deal, vetting products, providing neutral and credible information, standardizing benefits, and fixing issues that come up. • Five board members appointed: HHS Secretary Diana Dooley (Gov. Brown); Kim Belshe and Susan Kennedy (Gov. Schwarzenegger); Paul Fearer (Speaker Perez) ; Dr. Bob Ross (Senate President Steinberg). • Initial work: Hired an Executive Director, Peter Lee, and staff; created business plan; Sought and got $39 million in federal funds through 2012; Start work on eligibility and enrollment systems; IT systems; navigation; stakeholder process; public education and outreach; etc.

9. Fulfilling the Promise:California 2011 Legislation • Reformed key systems to help consumers get coverage and care, to be ready ramping up to 2014: • Eligibility and Enrollment: AB1296(Bonilla) outlines a “no wrong door” philosophy for signing up Californians for coverage. • Consumer Assistance: AB922(Monning) enhances & expands the Office of Patient Advocates as a triage center for questions and complaints about coverage and care. • Instituted new consumer protections and insurance oversight, to align with federal law: • Medical Loss Ratio: SB51(Alquist) would allow state regulators to enforce new federal standards to ensuring premiums dollars go to patient care, not administration and profit. • Maternity Care: AB210(Hernandez)/SB222(Evans) mandates maternity services as a basic benefit by July 2012.

10. Fulfilling the Promise:California 2012 Legislation • Instituted new consumer protections and insurance oversight, to align with federal law: • ESSENTIAL HEALTH BENEFITS: AB1453 (Monning) / SB951 (Hernandez)—set a minimum standard for health plans (equivalent to a Kaiser small group HMO), so consumers have more confidence that their coverage is comprehensive. • SMALL GROUP MARKET REFORM: AB1083 (Monning) prevents small businesses from seeing spikes in insurance premiums if their workers get sick. Also: • NOTICE OF COVERAGE OPTION DURING LIFE CHANGES: AB792(Bonilla) requires that consumers are informed of their coverage options in the new Exchange when losing coverage--such as during a job change, divorce, adoption, and other circumstances.

11. Fulfilling the Promise: (LIHP)Low Income Health Program A win for the county, the uninsured, and the health system: • County gets new federal matching funds, for dollars they already largely already spend on indigent care, helping their health system and their local economy. • Now 550,000 uninsured get coverage prior to 2014; a medical home providing primary and preventative care, not just care at the emergency room. • Since this coverage is grounded in county-based systems of care, these new dollars go to shore up safety-net institutions, including public hospitals, community clinics, and other providers. • This serves as a bridge to health reform, ensuring these patients are getting treated and in systems of care before 2014, and ready to get full Medi-Cal (or exchange-based) coverage on day one, maximizing enrollment and federal funds for California. • This isn’t a long-term obligation: In fact, the more people are enrolled in these programs, and thus quickly shifted to Medi-Cal in 2014 with 100% funding by the federal government, the more county resources can be refocused to better serve the medically indigent who remain uninsured after 2014.

12. Reform is Real • Californians are feeling the benefits already. • 14,667 “uninsurable” Californians are enrolled in the Pre-Existing Condition Insurance Program for those denied coverage due to pre-existing conditions. • 552,000 Californians are enrolled in coverage through the Low Income Health Program (LIHP) in 51 counties, which serves as bridge coverage for the low-income uninsured who will qualify for Medi-Cal in 2014. • 355,927 young adults in California have coverage who might otherwise have become uninsured, since they are covered by their parents’ insurance. • 8,978,000 insured Californians gained new consumer protections, including Medical Loss Ratio requirements that require insurance companies to spend more premium dollars on medical health care. 1.9 million California residents received $74 million in rebates from insurance companies who did not meet these minimums. • California consumers saved over $100 million dollars in savings from rate hikes that were retracted, reduced, or withdrawn due to rate review. • 319,429 California seniors in Medicare saved $171,983,735 in prescription drug costs, an average of over $500 a patient facing the “drug donut hole.” • Over 12 million Californians no longer have a lifetime limit on their health insurance plan. • Health plans in California must all cover maternity care.

13. 2013 Special Session Agenda:Consumer Protections & Insurer Oversight • Watchdog the federal and state government to ensure that new consumer protections are implemented and enforced. • Focus at the Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) • Continued focus on rate review has generated hundreds of million in savings through scaled-back and withdrawn rate hikes. • Ensure Californians know about their new rights and options. • Start to transition from the “Wild Wild West” insurance market: phasing in benefits, standards, and options to be ready for 2014. (Bill numbers from previous session) • INDIVIDUAL MARKET REFORM: AB1462 (Monning) / SB961 (Hernandez) • COST SHARING LIMITS: AB1800 (Ma) • Maybe: RATE REGULATION: AB52(Feuer) / Scheduled for 2014 ballot measure • Fight efforts to weaken, defund, undermine, and repeal these consumer protections and the rest of reform.

14. 2013 Special Session Agenda:Ensuring Californians Get Coverage: The Day One Challenge • Eligibility and enrollment (bill numbers from prior session): • 2014 MEDI-CAL EXPANSION: AB43 (Monning) / SB 677 (Hernandez) • Medicaid Benchmark Benefits • Eligibility and Enrollment Rules • Continuation of current State Programs: FamilyPACT, PRUCOL, etc. • PRE-ENROLLMENT: AB715 (Atkins) • Work to implement and improve: • Streamline enrollment in Medicaid, Healthy Families, the Exchange and elsewhere; no wrong doors; • Get ready so millions of Californians get covered on Day One—January 1, 2014—and California maximizes federal money. • Create integrated system of “navigation”—right now, patchwork of county workers, brokers/agents, community groups, etc. • Work at the Legislature and at the Exchange, DHCS, etc. • Enrollment starts October 2013—ten short months away.

15. Fulfilling the Promise:What a Community Can Do • Educate the Community about Their New Rights, Options, Benefits, and Consumer Protections • Engage Communities and Consumers Every Step of the Way • Maximize Federal Dollars for County and Community • Grant opportunities • Matching Dollars for Medi-Cal, Healthy Families, LIHP, etc. • Aggressively Implement the Low-Income Health Program • Be Ready So Community Residents Get Coverage on Day One • Set a Goal and Date; Work backwards to Meet That Goal • Systems in place for easy enrollment through no wrong door • Transform the Safety-Net to Survive and Thrive • A Business Plan for Safety-net institutions • An Assessment and Augmentation of County-wide Capacity • Use the New Tools in the Law • To focus on delivery system reform for cost, quality, safety & equity • To build health in all policies, with place-based policy interventions

16. So Much More To Do:What Can You Do? • Thank your member of Congress/Tell them not to repeal it: Call, write, or visit your Congressional Representative and thank them for their yes vote – or attend a public event to thank them! • Share your story personal stories help others learn how they can benefit from reform – and they are a compelling advocacy tool! • Support state efforts to implement and improve reform let your local representatives know that you support robust implementation and improvement of reform. • Write a letter to the editor in support of reform and all its benefits. • Join our mailing list to keep up to date on legislative development and get important action alerts! • Sign up at www.health-access.org for E-mail updates • Check out our daily blog, at blog.health-access.org • Check out our Facebook and Twitter feeds

17. For more information Website: http://www.health-access.org Blog: http://blog.health-access.org Facebook: www.facebook.com/healthaccess Twitter: www.twitter.com/healthaccess Health Access California 1127 11th Street, Suite 234, Sacramento, CA 95814 916-497-0923 414 13th Street, Suite 450, Oakland, CA 95612 510-873-8787 1930 Wilshire Blvd., Suite 916, Los Angeles, CA 90057 213-413-3587