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DHS Government Relations Health Care Reform Implementation

DHS Government Relations Health Care Reform Implementation. Nurse Recognition & Celebration Wednesday, May 4 th , 2011. United States. County of Los Angeles. Americans without health insurance at a record high of 46.6 million in 2005. (Census Bureau)

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DHS Government Relations Health Care Reform Implementation

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  1. DHS Government RelationsHealth Care Reform Implementation Nurse Recognition & Celebration Wednesday, May 4th, 2011

  2. United States County of Los Angeles • Americans without health insurance at a record high of 46.6 million in 2005. (Census Bureau) • Family health insurance premiums rose by 71% since 2000. More than $4,500 in 2005 alone. (Kaiser Family Foundation) • The number of people without health insurance has increased by 6.8 million since 2000. The number of uninsured has increased every year since. (Census Bureau) • In 2007, 62% of all personal bacnkruptcies blamed on unaffordable medical bills (Sacramento Bee: Harvard/Ohio Study) • 2+ Million uninsured (Office of Planning and Analysis) • Nearly 700,000 patients served annually by DHS/PPP. 61% of all patients served are uninsured (OPA) • 2.7+ Million outpatient visits annually (OPA) • 476,000 Inpatient Days • 300,000+ Emergency Department visits annually (6,800+ trauma) • In 2008, Over 400 physicians and 66 nurses graduated from affiliated schools and CONAH (OPA) Health Care Reform:National and County Statistics

  3. Major Legislative IssuesMost Significant Restructuring in 4+ Decades • Patient Protection and Affordable Care Act (aka ACA) • California’s Implementation Legislation • Section 1115 Waiver “Bridge to Health Care Reform” • H.R. 1 / Judicial Actions • Budget Battles / Deficit Reduction

  4. Key Provisions of ACA • March 23, 2010 PPACA Signed by President • Mandates all U.S. Citizens and LPR to Maintain Minimum Level of Coverage Beginning in 2014 (penalties/cert. pops. excl.) • Spreads Cost of Medical Costs Over Broader Population • Relies Heavily on Employers to Provide Coverage to Workers (50+ empl.) • Up to 26 yrs. • Medicaid Expansion • Many Others

  5. Medicaid Expansion • All Individuals Under 65 (children, preg. Wom., parents & childless adults) with incomes up 133% FPL • Benchmark Benefit Package • 100% to states 2014-16; 95% 2017; 94% 2018; 93% 2019; 90% 2020+ • State Option to Expand April 2010

  6. Health Care Reform:Major Issues of Interest • Medicaid • DSH • GME • 340b • Other

  7. Henry Waxman (D-CA) Chair, Energy and Commerce George Miller (D-CA) Chair, Education and Labor Charles Rangel (D-NY) Chair, Ways and Means Health Care Reform:Key Officials Rep. Fred Upton Michigan Rep. John Kline Minnesota Rep. Dave Camp Michigan

  8. Numerous Stakeholders Key Partners for DHS • Private hospitals • Clinics • Physicians • Health Plans • Business • Labor • Others Health Care Reform:DHS Strategic Advocacy

  9. California’s Implementation • Swift Implementation: First State to Legislate Health Benefits Exchange • By 2019 Coverage Expanded to 9/10 non-elderly CA Residents • SB 1088 (Price) – Young Adults Up to 26 Years • AB 2244 (Feuer) – Prohibits denial to children w/ pre-existing cond. • AB 2470 (De la Torre) – Bars Rescission of coverage exc. Fraud • AB 2345 (De la Torre) – Req. Preventative Services w/o cost sharing • SB 1163 (Leno) – Requires Actuary Review of Ins. Rates • 3,000 to 5,000 bills per session

  10. Key Exchange Elements“Consumer Marketplace” • First State in Nation (AB 1602/SB 900) – Sept. 30, 2010 • 1602 (Perez) Enacts CA PPACA • 900 (Alquist) Establishes CA Health Benefits Exchange and Governance • Jan. 2014 Launch • 4/5 Board Appointments Made (4/20/11) • Diana Dooley, Kim Belshe, Susan Kennedy, Paul Fearer • Senate appointment pending • Place for individuals & small bus. to buy insurance • Determines Eligibility: • Platinum (90), Gold (80), Silver (70), Bronze (60) • Catastrophic available only to individuals under 30 • Basic levels of bens: Prev. Care, Hospital, presc. Drugs • Federal Grant Submission Sept. 30 2011 • 8 Mill CA in 2014

  11. DHS Leads the Way:“Medical Homes”

  12. Implementation Issues • “Essential Health Benefits” • State Budget Condition • Local Budget Conditions • Additional Judicial Challenges

  13. Additional Considerations for Los Angeles County • Remaining Uninsured • Young Invincibles • Cost Prohibitive • Others • DSH Reductions 2017/2019 • CA Safety Net Essential (clinics/pub. hospitals)

  14. Thank you.

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