Health Care Reform and You

1
Health Care Reformand You

• How to get from the mess were in to the only
  solution that makes sense

2
What were about to see

• History of labor and universal health care
• Current state of the US health care system
• Universal health care legislation in California
• What we can do to make things better

3
A brief history of labor and health care
1915
American Association for Labor Legislation

• Submits model plan to state legislatures
• WWI intervenes
• AMA flip flops
• Plan defeated

4
A brief history of labor and health care
1935

• Social Security Act

• Early version of bill includes national health
  insurance
• Killed by AMA and insurers

5
A brief history of labor and health care
1943 - 48
AMA postcard, front side
The Murray-Wagner-Dingell Bill
6
A brief history of labor and health care
1943 - 48
AMA postcard, back side
Keep Politics Out of This Picture When the life
or health of a loved one is at stake, hope
lies in the devoted service of your Doctor. Would
you change this picture? Compulsory health
insurance is political medicine. It would bring
a third party a politician between you and
your doctor. It would bind up your familys
health in red tape. It would result in heavy
payroll taxes and inferior medical care for you
and your family. Dont let that happen here!
The Murray-Wagner-Dingell Bill
7
A brief history of labor and health care

• 1940s Defeat of national health insurance
• 1950s Collective bargaining-based health care
  for union members, and political advocacy on
  behalf of non-union workers
• 1960s onward employment-based
• health care in America

8
1965
A brief history of labor and health care

• Medicare
• Medicaid

9
America Different, but it worksfor a while

• The only employment-based health care system in
  the advanced industrial world
• Supplemented by Medicare and Medicaid
• England National Health Service
• Canada Single payer system
• Other European countries one or the other, or
  some combination of the two

10
1980s Problems begin to mount

• Increasing co-pays for office visits, medicines
• Higher deductibles
• Employee share of premium grows
• Losing pay increases to maintain health coverage
• Less dependent coverage
• Paying for growing numbers of uninsured and
  underinsured

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The sincerest form of flattery...
12
Sounds Great.How About Political Reality?
13
1994
Ballot initiative Proposition 186
Us
Them
Insurance company red alert CMA stays
neutral Arguments government intrusion, high
taxes, bureaucratic nightmare 30 million dollars

• Grass roots education and
• fundraising strategy
• 1500 house parties
• 2.5 million dollars raised from
• unions, community groups, health
• care organizations, and individuals

14
Percent of Firms Offering Health Benefits
Declined Over 20002005
Source Kaiser Family Foundation, Employer
Health Benefits 2005 Annual Survey
15
The Union Advantage
Your union membership stands between you and the
trend of declining workplace-based health care
coverage
16
Current state of the US health care system

• Growing numbers of uninsured
• Rising costs
• Employers shifting higher share of coverage onto
  workers
• No transparency of procedures and outcomes
• Fragmentation of delivery

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2007
(California 7 million)
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Profile of the Uninsured

• 46 million non-elderly Americans
• 64 from low-income families
• 81 from working families
• 80 adults
• 52 ethnic minorities
• 79 American citizens
• More likely to be employed in small businesses,
• service industries, blue collar jobs, and work
  part-time

19
The Human Cost Personal Bankruptcies
54
N1771 bankruptcy filers Health Affairs,
February 2, 2005
20
Health care per capita by country
Source OECD Health Data 2006 (in U.S. dollars
adjusted for purchasing power parity)
21
What are we getting for our health care dollar
now?
22
The Health Care Americans Get

• One-third uninsured or underinsured
• HMOs deny care to millions more with expensive
  illnesses
• Death rates higher than other wealthy nations
• 20 of health care dollar goes to
  administration
• Destruction of the doctor-patient relationship

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Insurance Overhead Spending
OECD, 2003
24
Covers 38 of employees
The future of workplace-based health care?
25
The Problem Summarized

• Too expensive and costs rising
• Uneven quality of care with no transparency
• One third uninsured or underinsured
• Declining numbers of workers covered through the
  workplace collective bargaining now a
  problematic way to deliver health care
• Administrative waste for profit executives and
  investors making billions

26
Would you prefer the current system or national
health insurancelike Medicarerun by
governmentfinanced by taxpayers?
Washington Post/ABC News Poll, 2003
27
What is being proposed in 2007?

• Market-based reforms
• Employer mandate (pay or play)
• Other incremental reforms
• Unique state plans (e.g., Massachusetts)
• Universal coverage ideas

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2007 California Dreamin

• Governors plan devil in the details
• Don Perata SB 48, employer mandate
• Fabian Nunez employer mandate
• Sheila Kuehl SB 840, single payer

29
Governors Plan

• Every individual required to purchase coverage,
  employer-provided or private with minimum 5,000
  deductible
• Employers with 20 or more workers provide
  coverage or pay 4 of payroll (state average
  8 school districts average 14)
• Family of 4 with annual income between 20K and
  50K required to contribute 600 - 3,000 per
  year for coverage
• Plan must cover physician, hospital, emergency
  services and prescriptions other services at
  individual expense

30
Peratas Plan

• Requires workers and their dependents to have
  minimum health coverage
• All employers required to pay percentage of wages
  or pay a higher percentage into a trust fund for
  workers and dependents
• Available plans to be high quality with extras
  covered by individual

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Nunezs Plan

• Working individuals offered coverage by employers
  must accept for coverage of workers and
  dependents
• Employers with 2 or more employees required to
  provide coverage or pay a fee based on percentage
  of payroll
• If employer does not offer coverage, employee
  required to pay a percentage of income

32
Kuehls Plan SB 840

• Covers all Californians with comprehensive
  services
• One payer, one plan (Single payer)
• Employers and individuals contribute percentage
  of payroll or income to pay for coverage
• State uses purchasing power to pay for services,
  prescriptions and equipment
• Maintains choice of providers
• Portable

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What does Dobie Gillis have to do with health
care reform in California?
Author of Senate Bill 840
State Senator Sheila Kuehl (D-Santa Monica)
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What is single payer health care?

• Public financing one public payer
• Universal covers everybody
• Comprehensive covers all medical needs
• Private and public providers with individual
  choice of doctors
• Controls costs through global budgets and bulk
  purchasing, not clinical micromanaging
• Portable
• Accountable

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Every western democracyexcept one.
Who has a single payer system?
36
Even we have a single payer system for part of
the population. Its called

• Medicare

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Labor on health care reform

• Guarantee affordable quality health care for all
  Californians
• Contain health care costs
• Employers and government must join workers in
  sharing responsibility and risk
• Ensure patient choice and protect doctor-patient
  relationship
• Improve quality of care
• Oppose reduction of any current and future
  retiree medical benefits

Labors Principles for Health Care Reform,
California Labor Federation, 2006
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Advantages of single payer for schools

• Decreased health care costs
• More available for salaries
• More available for educational programs
• Everybody coveredfull-time, part-time,
  certificated, classified, students and their
  families

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Financing Universal Health Care
Medicare
Single payer health care fund
Rx
Eye Care
Medicaid
Employer payroll tax
Doctor
Employee payroll tax
Hospital
Lewin 2004
40
How would the payroll tax work?

• 8.17 employer
• 3.78 employee
• 11.95 total

Estimate from Lewin Group Report, 2006
41
SB 840 savings for patients

• No co-pays
• No deductibles
• No premiums
• No out of pocket expenses

42
Projected savings for selected California School
Districts

• Large District example
• Los Angeles CCD (4,000 certificated)
• Employer onlysaves 40 million
• Combined employer/employeesaves 29.7 million
• Medium District example
• Berkeley USD (700 certificated)
• Employer onlysaves 4.9 million
• Combined saves2.8 million
• Small District example
• Summerville HSD (40 certificated)
• Employer onlysaves 155,000
• Combinedsaves 2,681

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But wont I have to pay more under SB 840 than I
do now?

• Your school district is spending, on average, 14
  of payroll on health insurance
• Under SB 840, it will pay 11.95
• The difference (2.05) can be bargained as an
  immediate salary increase
• As each additional years state savings is
  accumulated, it will go into the Prop 98 base,
  and be available for educational program and
  school employee salary

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SB 840 Benefits

• Inpatient and outpatient
• ER visits
• All physician services, including pregnancy
• Prescription drugs
• Mental health and substance abuse treatment
• Rehabilitation

• Vision care, including glasses
• Hearing exams and aids
• Durable medical equipment
• Home health and adult daycare
• Dental care
• Lab and diagnostic tests

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SB 840 Eligibility

• All state residents eligible
• Individuals lacking legal immigration status
  (i.e., undocumented) included if they document
  residence

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Summary Universal Health Care

• Leads to better outcomes
• Would cost no more or save money
• Americans want it
• Educators want it
• Can be accomplished in California
• (SB 840)
• Can be accomplished nationally (various bills)

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What can we do?
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Fill out an SB 840 support card right now.
Dear Arnold
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Join the CFT Health Care Action Team

• Ask your school board to endorse SB 840
• Ask your local to hold a health care forum
• Come to CFT Speakers Training and go speak to
  community groups
• Represent CFTs position at your local state
  legislators office