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Santa Clara County Health Coverage Expansion Analysis

Explore implications of national health reform on Santa Clara County's uninsured population, eligibility, affordability, and implementation strategies. Analyze impacts, coverage options, and challenges, focusing on expanding access and affordability.

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Santa Clara County Health Coverage Expansion Analysis

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  1. Implications for Coverage Expansion Efforts Sarah Muller September 2010

  2. Outline • Overview of Santa Clara County • Who Will be Eligible for Health Coverage Under National Health Reform? • Affordability • Preparing for Implementation: Issues to Consider

  3. Health Insurance Programs Available to Santa Clara County Residents • Children: Medi-Cal, Healthy Families, Healthy Kids • Adults: • Medi-Cal (limited to pregnant women and the disabled) • Healthy Workers (enrollment began in March 2010- provides affordable health insurance for low-middle income workers in small businesses) • Medicare

  4. Uninsured in Santa Clara County • Santa Clara County uninsured: 200,000 • Recent UCLA report indicated up to 314,000 uninsured • Income: at least 130,000 are under 300% of FPL ($32,500/yr) • Racial demographics: 68% are Latino or Asian, 25% White • Gender: Male 56%, Female 44% • 71% of the uninsured are working at least 20 hours per week

  5. Why are the Number of Uninsured Increasing? • Rising premiums: • Between 2000-2009 health premiums rose 130% • Fewer employers are offering affordable employer-based health insurance • Only 38% of low-middle income adults had health coverage on the job • Worker premium contributions rose from $1,477 to $3,308 (2000-09) • Individual health insurance is often too expensive for low and middle income families • Economic Recession

  6. National Health Reform- Overview • Dramatic expansion of health care coverage for adults • New subsidies available to low and middle income families • Insurance market reforms to make health care coverage more accessible • Employer mandate for large employers/ tax credits for small employers • Individual mandate: Everyone will be required to purchase health coverage • Hardship exemptions will be made for some individuals • Undocumented immigrants exempt from mandate

  7. How Will National Health Reform Impact the Uninsured in Santa Clara County? • Expanding health care coverage: • 48k eligible for Medi-Cal • 90-100k eligible for subsidized health coverage • 46k remaining uninsured

  8. Affordability on the Insurance Exchange • Premium contributions will be limited based on income: • 150% of FPL($16,245): $68/month • 200% of FPL ($21,660): $113/ month • 250% of FPL ($27,075): $191/month • 300% of FPL ($32,490): $257/month • Hardship exemption: will be available to individuals whose lowest cost plan option exceeds 8% of an individual’s income

  9. Preparing for Health Reform Implementation: Issues to Consider • Opportunities for the Santa Clara Valley Health and Hospital System • Preparation for Medi-Cal eligible population • Coverage option with public providers? • Coverage does NOT equal Access • Need to develop strategies to address the ongoing needs of those left behind: undocumented, mentally ill/ homeless that will still be hard to insure

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