1. Health Care Reform Michael R. Cousineau USC Keck School of Medicine

2. How will health care reform affect the greater Los Angeles area?  Will it decrease the number of uninsured?  How will affect safety net providers particularly public hospitals and community health centers?  Will it improve health?

3. Fundamental Components  Individual mandates  insurance reform –Pre existing –Life time caps –Limited age rating  Subsidies to increase affordability  Health Insurance Exchange for individuals and small businesses

4. Differences  Fewer people covered under the Senate version, (estimated at 31 million Senate vs 36 million in House version).  Medicaid Expansion --(150% in Senate version and 133% in House version)  Subsidies --House higher subsidies between 150 and 300% (House, Higher subsidies (300-400%, (Senate)  Exchange - National (House), State option (Senate) Public Option (House), non profit (Senate)

5. Differences  Insurance reform  Benefits  Cost containment  Financing –Taxing insurance (Senate) –Taxing wealthy (House) –Fess on non-participating employers

6. Los Angeles County Service Planning Areas and Health Districts  Large county with nearly 10 Million residents  Tremendous diversity  Both wealth and poverty  Many immigrants  Health care system

7. Issues for Los Angeles  High number of uninsured individuals and families: 1.6 million uninsured in Los Angeles County and nearly 200,000 uninsured children  Immigrants, undocumented not eligible under either of the two bills  Safety net providers, public hospitals and private DSH hospitals, - financed in part by reducing supplemental payments to these hospitals, rationale, fewer uninsured, so the need for cost shifts to the uninsured is less  Many small businesses

8. Health Insurance Status in the County of Los Angeles, 2007 Source: Los Angeles County Health Survey, 2007. Compiled by Amy Lightstone, Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, May 2009. Nonelderly Adults Percentage 95 Percent Confidence Interval Estimated Number of People Medi-Cal15.814.6-17.11,004,000 Medicare1.31.0-1.682,000 Private60.859.2-62.43,852,000 No insurance 22.020.7-23.41,396,000 Children Healthy Families 10.7%9.7-11.6298,000 Medi-Cal35.6%34.1-37.1992,000 Private45.4%43.8-46.91,264,000 Healthy Kids 1.4%1.1-1.739,000 No insurance 7.0%6.1-7.8194,000

9. Distribution of Uninsured Adults by Race and Ethnicity in Los Angeles County, 2007 Latino 70% White 11 % African American 8% Asian/Pacific Islander 11% Other < 1%

10. Uninsured by Poverty Status, Los Angeles County, 2007

11. * Estimated based on total Southern California enrollment figures. Source, Health Insurers serving Los Angeles County, Los Angeles Business Journal, May 2009. www.thefreelibrary.com. Accessed July, 2009.www.thefreelibrary.com Private Health Plan Enrollments in Los Angeles County, 2009. PlanMembership Kaiser Foundation Health Plan 1.12 million Anthem Blue Cross 850,000 * Pacificare 250,000 Health Net 398,000 LA Care Health Plan 783,000 Blue Shield of California 229,000 Cigna Healthcare of California 170,000 Aetna Health of California 106,000 Universal Care *75,000 SCAN 47,000

12. COMPARISON OF SMALL BUSINESS EMPLOYERS AS A PERCENT OF TOTAL BUSINESSES IN THE STATE AND COUNTY OF LOS ANGELES Source Los Angeles County Small Business Commission 2006-2007 Annual Report April 2008 1-100 Employees State % Total County % Total 101-500 Employees State % Total Los Angeles County 353,17630.0%91.5%5,16425.3% State of California 1,175,330100%--20,413100%

13. Impact on California  $3 Billion impact on the California budget (by the Governor’s Office)  Hinges on Medicaid and what is decided on a federal requirements for a match

14. Impact on California and Los Angeles County  $3 Billion impact on the California budget (by the Governor’s Office)  Safety net providers, public hospitals and private DSH hospitals, - Health Reform financed in part by reducing supplemental payments to these hospitals, rationale, fewer uninsured, so the need for cost shifts to the uninsured is less

15. The Health Care Safety Net  LA County Public Hospitals and health Centers Private Hospitals  Community Health Centers  Emergency departments

16. Disparities  Will this help to reduce disparities and improve health?

17. Leading Causes of Death in Los Angeles by Race/Ethnicity, 2005

19. Conclusions  A lot of good things in the bills,  Many problems  Not over, much tweaking and monitoring is needed  Senate version seems to be trumping house