THE PROMISE OF HEALTH CARE REFORM JUGGLING FUTURE OPPORTUNITIES

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THE PROMISE OF HEALTH CARE REFORM JUGGLING
FUTURE OPPORTUNITIES

• Presented by Bobbie Wunsch,
• Pacific Health Consulting Group
• bwunsch_at_pachealth.org
• February 23, 2011 Dance Palace

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JIGSAW PUZZLE

• Short-term state budget issues ugly
• Health Care Reform will dominate planning for
  next 3-5 years
• Expectations are high for community clinics and
  health centers
• Services to immigrants
• Create culture of coverage

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National Healthcare ReformFour Key Strategies

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STARTING LINE TO REFORM

• Expanded coverage
• Changing the rules to offer coverage
• Control health care costs
• Improve the health care delivery system
• Prevention individual and community-based
• Many more regulations
• Most details still need to be ironed out
• Community clinic expanded funding
• California has begun

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THREE PART FORMULA

• Require insurers to offer coverage to anyone who
  wants it
• Require everyone to have health insurance
• Preferred way to cover pre-existing conditions
• Broaden risk pool to include healthy less
  healthy
• Help people to afford the coverage that they are
  required to have through government subsidies

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INCLUDES

• Individual mandate requiring most to have
  insurance or face penalties
• Requires employers with gt200 employees to offer
  insurance
• Creates state-based exchanges with premium
  credits and cost sharing subsidies for low-income
  individuals and enrollment for small businesses
• Expands Medi-Cal
• Increases payments in Medi-Cal for primary care
  providers to 100 of Medicare in 2013 and 2014

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HOW IT WORKS FPL means Federal Poverty Level
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COVERAGE EXPANSION-MARIN

• Uninsured Rate Anticipated 2014 16
• Uninsured in Marin 2014 Ages 0-64 26,090
• Eligible for Medi-Cal Expansion 5,988
• Eligible for Subsidies in Exchange 11,455
• Ineligible Due to Citizenship Status 5,851
• Uninsured Rate by 2018 2.5

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ACA VISION FOR ENROLLMENT

• Easy, electronic, multiple ways to apply
  including kiosks, online, phone, mail, in person
• One application triggers multiple eligibility
  determinations- Medi-Cal, HF, Exchange subsidies
• Documentation of income and citizenship no asset
  test
• Assistance (when needed) from consumer navigators
• Consumer friendly design and access
• Uniform, understandable explanation of coverage
• Outreach and enrollment grants for vulnerable
  populations to assist in enrollment

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President Barak Obama

• "Simply put, in the absence of a radical shift
  towards prevention and public health, we will not
  be successful in containing medical costs or
  improving the health of the American people."

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Prevention Anticipated in HCR

• Establishment of a National Prevention, Health
  Promotion and Public Health Council to coordinate
  prevention, wellness, and public health
  strategies.
• Establishment of a Prevention and Public Health
  Fund to expand and sustain funding for prevention
  and public health programs, as well as task
  forces on Preventive Services and Community
  Preventive Services to develop, update, and
  disseminate evidenced-based recommendations on
  clinical and community prevention services.
• Grants for evidence-based community prevention
  and wellness programs that strengthen prevention
  activities, reduce chronic disease rates and
  address health disparities, especially in rural
  and frontier areas.  Funding for five years
  beginning in FY 2010.

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Prevention and Wellness includes

• Provides grants to small employers to establish
  wellness programs
• Provides TA to evaluate employer-based wellness
  programs
• Permits employers to offer employee rewards for
  participating in wellness programs and meeting
  certain health-related standards
• Requires chain restaurants/vending machines to
  disclose nutritional content
• Expands potential for school-based clinics and
  nurse run clinics
• Coverage of preventive services
• Requires health plans to provide coverage without
  cost-sharing for preventive services rated by the
  USPSTF recommended immunizations (CDC)
  preventive care for infants, children and
  adolescents (AAP/Bright Futures), and additional
  preventive care and screenings for women (IOM)
• Covers proven preventive services and eliminates
  cost-sharing for preventive services in Medicaid
  and Medicare

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COUNTDOWN TO 2014

• 24 months to plan
• 34 months till implementation

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RESOURCES Stay Informed!

• Kaiser Family Foundation kff.org
• Insure the Uninsured Project itup.org
• Commonwealth Fund commonwealthfund.org
• California HealthCare Foundation chcf.org
• Trust for Americas Health healthyamericans.org