“One Nation, Insured” ITUP’s 14th Annual Conference Student Intro Session Insure the Uninsured Project ( February 10, 2010 Sacramento Convention Center Sacramento, CA

Student Intro Session Overview About ITUP ▫Mission Statement ▫What We Do Crash Course in CA Health Policy ▫Uninsured Populations ▫Regional Variations ▫Types of Coverage ▫The Safety Net ▫§1115 Waiver ▫Budget ▫Previous Reform Today’s Conference ▫Objectives ▫Attendees ▫Networking

Insure the Uninsured Project Mission Statement “ITUP’s mission is to work with state policy makers, counties, health plans, employers, unions, community groups, providers and other public and private entities to increase coverage of California’s uninsured.”

Insure the Uninsured Project What We Do ITUP achieves it’s mission through: ▫Annual Conferences ▫Regional Workgroups ▫Issue Workgroups ▫Reports ▫Technical Assistance We can be found at: ▫ ▫ ▫ ▫Fan Page: Insure the Uninsured Project ▫

The Uninsured in California Survey CHIS ▫CHIS is a California specific survey of health insurance and health status conducted by UCLA.  According to CHIS (2007), about 6.5 million Californians are uninsured over the course of the year.

The Uninsured in California Populations 7 million uninsured (7 th highest by percentage) ▫55% between 18 and 40 years old ▫Young adults have highest uninsured rate at 25% ▫61% have incomes under 200% FPL ▫25% have incomes over 300% FPL ▫85% are working or the spouses/children of workers ▫15% are legal permanent residents ▫64% are US citizens

The Uninsured in California Low-Income

The Uninsured in California Variation by County *Residents under 65 with no health insurance at some point in 2006 Source: P. Reese, Interactive Map: Counties with the Most Uninsured, The Sacramento Bee, Aug. 16, 2009

The Uninsured in California Variation by Region Regional variation in uninsured rate Bay Area (9.3%) Sacramento (9.6%) San Joaquin Valley (17.2%) Los Angeles (17.8%) Access to care ▫49% report no usual source of care, compared to 6% of privately insured and 12% of publicly insured

California’s Flex Workforce Temporary, seasonal, part-time, self- employed micro-businesses and contract workers (estimated 16% of workforce) ▫Child care, agriculture, real estate, construction, service industries High rates of uninsured ▫12% receive coverage through job Industry wide coverage ▫Potential building blocks if financing for care to low wage workers can be accessed

Private Coverage in California 60% of Californians privately insured Employer coverage ▫70% of businesses offer coverage (63% nationally) ▫3-9 employees: 60% offer coverage ▫10-50 employees: 83% offer coverage ▫27% of lower wage firms offer coverage ▫Rate of coverage shrunk by 4% from due to high premium increases Individual coverage ▫2 million buy through individual market ▫Prices rising sharply and extent of coverage shrinking

Public Coverage in California Eligibility Breakdown

The §1115 Waiver Coverage Initiatives Five-year waiver approved through August 2010 ▫Funds to reimburse safety net providers ▫$180M annually for last three years to create “Coverage Initiatives” 10 counties received allocations to expand coverage under pilot programs ▫Alameda, Contra Costa, Kern, Los Angeles, Orange, San Diego, San Francisco, San Mateo, Santa Clara and Ventura

CA Budget Revisions Implications to Health Programs Budget revisions in February and July closed a $60B budget gap, but cut over $2B from the health care system with cuts to: ▫Medi-Cal coverage and benefits ▫Enrollment and administration ▫Nursing homes and long-term care ▫Hospitals ▫Mental health services and providers ▫HIV/AIDS programs and providers ▫Community clinics ▫Battered women’s shelters

Proposed Bi-Partisan Reform ABX1 1 Individual Mandate with hardship exclusions Employer pay or play Financing: individuals, employers, government and providers ▫Counties and federal government to pay part of coverage match for MIAs ▫Hospitals to pay part of match for rate increases and coverage expansions to the uninsured MRMIB (state purchasing pool) to set benefits level

Expand Medicaid to 150% FPL, CHIP to 300% FPL Refundable tax credits on a sliding scale to 400% FPL through state purchasing pool (Exchange) Require cost/quality transparency, P4P Managed competition Triggered repeal of reforms if costs exceeded revenues and the state government failed to balance the program’s deficit Proposed Bi-Partisan Reform ABX1 1

ITUP’s 14th Annual Conference Maximizing The Day Conference Objective: ▫Bring together over 450 leaders and experts in health policy to discuss ways to best implement federal reform in CA. How to Maximize the Day ▫Write down questions ▫Utilize your glossary ▫Read up on sessions and speakers before attending ▫Disperse during lunch ▫Network….

ITUP’s 14th Annual Conference Attendees Who is here? ▫California Hospital Association ▫Children’s Health Initiative ▫LA Health Action ▫Children Now ▫Small Business California ▫First 5 ▫Department of Health & Human Services ▫Latino Coalition for a Healthy California ▫California Primary Care Association ▫MRMIB ▫San Francisco Health Plan ▫Community Health Alliance of Humboldt-Del Norte ▫Central California Alliance for Health ▫California Endowment ▫California Medical Association ▫Health Net of California, Inc ▫California Program on Access to Care ▫National Health Law Program ▫CA Department of Healthcare Services ▫CenCal Health ▫Consumers Union ▫The Children’s Partnership ▫Office of the Governor ▫The Actors Fund ▫Lucile Packard Foundation ▫California Wellness Foundation ▫UCLA Center for Health Policy Research ▫Blue Shield of California ▫Campaign for Effective Patient Care ▫Council of Community Clinics ▫New America Foundation ▫The Center to Promote HealthCare Access ▫California Budget Project ▫Corporation for Supportive Housing ▫Child and Family Guidance Center ▫Integrated Behavioral Health Project ▫SEIU ▫Children’s Defense Fund ▫Kaiser Permanente ▫Health Access ▫Center for Government Studies ▫….and many more

ITUP’s 14th Annual Conference Networking A few pointers… ▫Politely introduce yourself ▫Have a purpose (i.e. question, comment, compliment) ▫Keep it brief (1-2 min) ▫Be gracious of the person’s time ▫Ask if you can contact person ▫Set up informational interview

For resources and additional information we are available at: (310)