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CARA CARA Leadership TrainingLeadership Training
20082008
Health CareHealth Care
What’s Today What’s Today About?About?
Status of the Status of the health care debate, health care debate, California and California and Nationally?Nationally?
What’s our health What’s our health care strategy for care strategy for 2008?2008?
Presidential PoliticsPresidential Politics
Together We Win!
Massachusetts Health Care Massachusetts Health Care ReformReform
Chapter 58 Signed Into Law on April 12, 2006
Set a model for the NationSet a model for the Nation
Raised FPL to qualify for Medicaid Raised FPL to qualify for Medicaid (additional people get insurance)(additional people get insurance)
No cost control on insurance companiesNo cost control on insurance companies No quality improvementsNo quality improvements ““Insurance Connector”- establishes rates Insurance Connector”- establishes rates
and plan designs for the individual mandateand plan designs for the individual mandate Requires individuals to purchase insuranceRequires individuals to purchase insurance Only requires a $295 per year employer Only requires a $295 per year employer
contribution per yearcontribution per year
The California Speaker moves The California Speaker moves health care….health care….
In 2006, the Assembly/Senate passed In 2006, the Assembly/Senate passed SB 840 out of each house SB 840 out of each house
The Governor vetoed the billThe Governor vetoed the bill
I’m StunnedI’m Stunned
2007 Governor’s “State of 2007 Governor’s “State of the State” - Makes health the State” - Makes health care a priority care a priority
Raises FPL for Medicaid Raises FPL for Medicaid Employers must contribute Employers must contribute
4% of payroll4% of payroll Proposes MRMIB become Proposes MRMIB become
administrator of State’s administrator of State’s health insurance programs health insurance programs (it will be California’s (it will be California’s Connector)Connector)
No cost controlsNo cost controls Mandates individuals to Mandates individuals to
purchase insurancepurchase insurance
Speaker’s Proposal - AB 8Speaker’s Proposal - AB 8
Raised FPL to 300% to qualify for Medicaid Raised FPL to 300% to qualify for Medicaid (additional people get insurance)(additional people get insurance)
Proposal has no real cost controlsProposal has no real cost controls No quality improvementsNo quality improvements Does offer good language on “Transparency”Does offer good language on “Transparency” MRMIB becomes administrator of California’s MRMIB becomes administrator of California’s
Insurance SystemInsurance System Does not require individuals to purchase insurance Does not require individuals to purchase insurance Requires employer contribution of 7.5%Requires employer contribution of 7.5% Caps out of pockets costs for workers at 5%Caps out of pockets costs for workers at 5%
When You Go Into When You Go Into Bargaining With Your Bargaining With Your
Bottom Line……………..Bottom Line……………..
The good, bad and uglyThe good, bad and uglyAB X 1 1AB X 1 1
What we ended up with:What we ended up with: FPL to 250% to qualify for FPL to 250% to qualify for
MedicaidMedicaid Employer contribution, but Employer contribution, but
the majority of employers the majority of employers would have to contribute 4% would have to contribute 4% of payroll or less – employees of payroll or less – employees must take up coveragemust take up coverage
No cost controlNo cost control No quality improvementNo quality improvement Individuals required to take Individuals required to take
up and purchase individual up and purchase individual insurance plans (Tammy insurance plans (Tammy Hotchkiss)Hotchkiss)
When you breed donkeys and elephants you get a deformed product
Presidential Candidates Presidential Candidates
Democrats:Democrats:Keep current Keep current
insurance in placeinsurance in placeGovernment is a Government is a
WatchdogWatchdogPrivate/public plansPrivate/public plansSome quality Some quality
measurersmeasurersIndividual mandatesIndividual mandates
Republicans:Republicans: Keep current Keep current
insurance in placeinsurance in place Electronic record Electronic record
keepingkeeping Report cards on Report cards on
qualityquality Individual Individual
mandatesmandates
The Employer Based Health The Employer Based Health Insurance System is Insurance System is
CrumblingCrumbling
47 Million Uninsured in 200647 Million Uninsured in 2006Number of uninsured, in millions
31 33 33 35 3539 40 40 41 41 42 43
39 38 4042
56
47454343
0
20
40
60
1987 1990 1993 1996 1999* 2002 2005 2008 2011
Projected2013
*1999–2006 estimates reflect the results of follow-up verification questions and implementation of Census 2000-based population controls.Note: Projected estimates for 2007–2013 are for nonelderly uninsured based on T. Gilmer and R. Kronick, “It’s the Premiums, Stupid: Projections of the Uninsured Through 2013,” Health Affairs Web Exclusive, April 5, 2005.Source: U.S. Census Bureau, March Current Population Survey, 1988–2007.
Let’s Not Squander Our Let’s Not Squander Our Opportunity Opportunity (it only comes every 16 (it only comes every 16
– 20 years)– 20 years)
You can’t heal the wound of the health You can’t heal the wound of the health care crisis with a band aidcare crisis with a band aid
Every time a claim is filed it is a “loss” Every time a claim is filed it is a “loss” for an insurance companyfor an insurance company
““You Can’t Cross a Chasm in You Can’t Cross a Chasm in Small Steps” – David Lloyd Small Steps” – David Lloyd
GeorgeGeorge
Source: G. Claxton, J. Gabel et al., "Health Benefits in 2007: Premium Increases Fall To An Eight-Year Low, While Offer Rates And Enrollment Remain Stable," Health Affairs, September/October 2007 26(5):1407–1416. Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2007, and Commonwealth Fund analysis of National Health Expenditures data.*Estimate is statistically different from the previous year shown at p<0.05.^Estimate is statistically different from the previous year shown at p<0.1.Note: Data on premium increases reflect the cost of health insurance premiums for a family of four. Historical estimates of workers’ earnings have been updated to reflect new industry classifications (NAICS).
12.0
18.0
0.8
6.1*7.7*
13.9^
12.9*10.9*
8.2*
5.3*
11.2*
8.5 9.2*
0
5
10
15
20
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Health insurance premiums
Workers earnings
Overall inflation
National health expendituresper capita
Increases in Health Insurance Premiums Increases in Health Insurance Premiums Compared with Other Indicators, 1988–2006Compared with Other Indicators, 1988–2006Percent
Monthly Percentage Change in Health Monthly Percentage Change in Health InsuranceInsurance
Stock Price Index, 1996–2006Stock Price Index, 1996–2006
Source: J.C. Robinson, “The Commercial Health Insurance Industry in an Era of Eroding Employer Coverage,” Health Affairs, Nov.–Dec. 2006 25(6):1475–86.
2005 HMO 2005 HMO ProfitProfit
The nation's HMOs The nation's HMOs report:report:
$3.6 billion in profit, $3.6 billion in profit, first quarter 2005first quarter 2005 or 21% increase or 21% increase
over 2004over 2004 152.7 percent in 152.7 percent in
20022002 60.9 percent in 200360.9 percent in 2003 32.9 percent in 200432.9 percent in 2004
Source:Weiss Ratings, Inc
Health Care Health Care ExecutivesExecutives
H. Edward HanwayH. Edward Hanway Cigna Cigna $15,036,700$15,036,700
Michael McCallisterMichael McCallisterHumanaHumana $29, 298,568$29, 298,568
Larry Glasscock Larry Glasscock WellpointWellpoint $21,677,134$21,677,134
Jay GellertJay GellertHealthNetHealthNet $3,875,444$3,875,444
Stephen Hemsley Stephen Hemsley UnitedHealthUnitedHealth $4,258,717$4,258,717
Source: Modern Health Care- July 30, 2007
Per Capita Spending on Health Per Capita Spending on Health Care – 2006Care – 2006
(How Does GM Compete In A Global Market?)(How Does GM Compete In A Global Market?)
SSource: Organization for Economic Co-Operation and Development (OECD) Health Data 2006(in U.S. dollars adjusted for purchasing power parity)
$6,102
$4,077 $3,966$3,165 $3,159 $3,041
2,8252,2492,546
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
U.S.
Switz
Nor
way
Cana
da
Germ
any
Net
her
Swed
en
U.K.
Japa
n
U.S. Leads the WorldU.S. Leads the World
One of the Best systems in the One of the Best systems in the world with technology and state-world with technology and state-of-the-art facilitiesof-the-art facilities
Health spending per capitaHealth spending per capita Infant Mortality RateInfant Mortality Rate % of un-insured% of un-insured Low life expectancyLow life expectancy
According to the World Health According to the World Health Organization, the U.S. Health Organization, the U.S. Health Care System Ranks 37Care System Ranks 37thth in in Overall PerformanceOverall Performance(right below Costa Rica, and right (right below Costa Rica, and right
above Slovenia)above Slovenia)
What Is To Be Done?What Is To Be Done?““I don’t believe I don’t believe
there’s any there’s any problem in this problem in this country,country,no matter how no matter how tough it is,tough it is,that Americans,that Americans,when they roll up when they roll up their sleeves,their sleeves,
can’t completely can’t completely ignore”ignore”
““George Carlin”George Carlin”
For CaliforniaFor CaliforniaSB 840SB 840
ChoiceChoice – SB 840 allows – SB 840 allows consumers total freedom to consumers total freedom to choose personal primary care choose personal primary care provider (Government won’t provider (Government won’t choose your doctor)choose your doctor)
Freedom from “Paper”Freedom from “Paper” – – Medical providers no longer Medical providers no longer have to go to an HMO to ask have to go to an HMO to ask for services for patientsfor services for patients
High Quality – High Quality – An office of An office of Health Care Quality, headed Health Care Quality, headed by a chief medical officer, not by a chief medical officer, not an insurance company bean an insurance company bean countercounter
(“Evidence Based” standards, (“Evidence Based” standards, no more Vioxx debacles)no more Vioxx debacles)
What’s Covered?What’s Covered?
Benefits Benefits – Hospital, medical, surgical, – Hospital, medical, surgical, mental health, dental, vision, mental health, dental, vision, prescription drugs, medical prescription drugs, medical equipment, emergency care, skilled equipment, emergency care, skilled nursing after hospitalization, hearing nursing after hospitalization, hearing aids, health education……..aids, health education……..
A comprehensive benefits package!A comprehensive benefits package!
Retirees – SB 840Retirees – SB 840
3.5% health tax on 3.5% health tax on pension, social pension, social security, dividends security, dividends (capped at 200,000)(capped at 200,000)
Part B premium under Part B premium under Medicare would no Medicare would no longer have to be paidlonger have to be paid
No co-payments or No co-payments or deductiblesdeductibles
Fully covered Fully covered prescription drugsprescription drugs
HR 676 - ConyersHR 676 - Conyers H.R 676 provides:H.R 676 provides: for all medically necessary for all medically necessary
servicesservices including primary care, including primary care,
inpatient careinpatient care outpatient careoutpatient care emergency careemergency care prescription drugsprescription drugs durable medical equipmentdurable medical equipment long-term carelong-term care mental health servicesmental health services dentistrydentistry
eye careeye care chiropractic chiropractic substancesubstance abuse treatment.abuse treatment. Patients have their choice of Patients have their choice of
physiciansphysicians providersproviders hospitalshospitals clinics clinics
Why won’t politicians say Why won’t politicians say “yes” to single payer? “yes” to single payer?
Without Educated Without Educated Communities…..Communities…..
Harry and Harry and Louise was the Louise was the most effective most effective tool for the tool for the insurance insurance lobby in lobby in historyhistory
Where are Harry and Louise Where are Harry and Louise Now?Now?
Their daughter is Their daughter is out of college with out of college with no health insuranceno health insurance
Their son’s Their son’s employer just employer just increased the increased the worker’s premium worker’s premium for insurance by for insurance by $100 per month$100 per month
Louise has high Louise has high blood pressure, blood pressure, diabetes and diabetes and asthma asthma
Harry spends his Harry spends his evenings over his evenings over his computer trying to computer trying to figure out what his figure out what his Part D benefit isPart D benefit is
How do we win?How do we win?
It’s Up to Us!It’s Up to Us! Seniors – Be a part Seniors – Be a part
of this movementof this movement Host house partiesHost house parties Make presentations Make presentations
at your church, club at your church, club or community groupor community group
Focus on passing Focus on passing resolutions in resolutions in supportsupport
Specific StrategiesSpecific Strategies
ResolutionsResolutions Calculate savings for the employer (cost Calculate savings for the employer (cost
calculation sheet)calculation sheet)
Focus on resolutions at the Commissions Focus on resolutions at the Commissions on Agingon Aging
Work with others of “like mind”Work with others of “like mind”
InsightsInsights
““Americans can be relied Americans can be relied upon to do the right upon to do the right thingthing
– – after they’ve after they’ve exhausted all the exhausted all the other possibilities.”other possibilities.”
Winston ChurchillWinston Churchill
Cornerstones Of Our Democracy Cornerstones Of Our Democracy
1848 – First Women’s 1848 – First Women’s Rights Convention Rights Convention held in Seneca Falls, held in Seneca Falls, New York – 1972 The New York – 1972 The Equal Rights Equal Rights Amendment is passed Amendment is passed by Congress by Congress
1831 Nat Turner leads 1831 Nat Turner leads a slave revolt in a slave revolt in Virginia – 1964 Civil Virginia – 1964 Civil Rights Act is enactedRights Act is enacted
Late 1940s – 50s Late 1940s – 50s Congress debates Congress debates Medicare – Signed into Medicare – Signed into law July 30, 1965law July 30, 1965
20?? – The great 20?? – The great nation of America nation of America provides health provides health insurance to allinsurance to all
Something to Ponder….Something to Ponder….
We have publicly We have publicly funded:funded:
Military to protect usMilitary to protect us Police and fire to keep Police and fire to keep
us safeus safe Education to educate Education to educate
all childrenall children Why don’t we have Why don’t we have
publicly funded health publicly funded health care for everyone?care for everyone?
“First they ignore you. Then they laugh at you. Then they fight you. Then you win”!“Gandhi”