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

2. Health Care Reform: National and County Statistics Americans without health insurance at a record high of 46.6 million in 2005. (Census Bureau) 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) 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) 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) In 2007, 62% of all personal bacnkruptcies blamed on unaffordable medical bills (Sacramento Bee: Harvard/Ohio Study) United States 2+ Million uninsured 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) Nearly 700,000 patients served annually by DHS/PPP. 61% of all patients served are uninsured (OPA) 2.7+ Million outpatient visits annually (OPA) 2.7+ Million outpatient visits annually (OPA) 476,000 Inpatient Days 476,000 Inpatient Days 300,000+ Emergency Department visits annually (6,800+ trauma) 300,000+ Emergency Department visits annually (6,800+ trauma) In 2008, Over 400 physicians and 66 nurses graduated from affiliated schools and CONAH (OPA) In 2008, Over 400 physicians and 66 nurses graduated from affiliated schools and CONAH (OPA) County of Los Angeles

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

4. Key Provisions of ACA March 23, 2010 PPACA Signed by President 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.) 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 Spreads Cost of Medical Costs Over Broader Population Relies Heavily on Employers to Provide Coverage to Workers (50+ empl.) Relies Heavily on Employers to Provide Coverage to Workers (50+ empl.) Up to 26 yrs. Up to 26 yrs. Medicaid Expansion Medicaid Expansion Many Others Many Others

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

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

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

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

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 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) 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 Place for individuals & small bus. to buy insurance Determines Eligibility: 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 Federal Grant Submission Sept. 30 2011 8 Mill CA in 2014 8 Mill CA in 2014

11. DHS Leads the Way: “Medical Homes”

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

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

14. Thank you.