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Stay Well Afford Care Secure Coverage. Our Broken Health Care System 6.5 Million Uninsured 20% of Population Source: California Health Interview Survey,

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  • Stay Well Afford Care Secure Coverage
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  • Our Broken Health Care System 6.5 Million Uninsured 20% of Population Source: California Health Interview Survey, 2005
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  • 84% of the Uninsured Work
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  • Emergency Departments Closing Source: Office of Statewide Health Planning and Development
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  • The Hidden Tax Actual Cost of Medical Care Uninsured Cost to Insured 10% of premium Source: New America Foundation
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  • Actual Cost of Medical Care Uninsured Cost to Insured 17% of premium Medi-Cal Underfunding Source: Administration Analysis of Cost Shift Hydraulic, Dobson The Hidden Tax
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  • Hidden Tax Individuals: $455 Families: $1,186 Source: New America Foundation
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  • California Health Spending in Billions Source: Centers for Medicare and Medicaid Services 1984 1994 2004
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  • Rising Insurance Premiums Inflation Wage Growth Health Insurance Premiums Source: CA Employer Health Benefits Survey 2005, Dept. of Finance
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  • Drivers of Cost: Chronic Diseases Source: Centers for Disease Control and Prevention, 2003, U.S. Data $153 $151 BILLION Cancer & Diabetes Smoking & Physical Inactivity
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  • Drivers of Cost: Medical Errors 23,000 Deaths Cost: >$4 Billion Source: CA Department of Health Services
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  • Uninsured: Financial Impact Source: Illness and Injury as Contributors to Bankruptcy, Health Affairs Web Exclusive, February 2005 Medical Cause for Bankruptcy Other Personal Bankruptcies
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  • Fixing Our Broken System Reduce the hidden tax Lower costs Support better care Healthy California
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  • Prevention / Wellness Shared Responsibility / Coverage for All Affordability Governors Health Care Initiative
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  • Prevention / Wellness Governors Health Care Initiative
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  • Prevention & Wellness Healthier State Long Term Affordability Prevention & Wellness Healthier State Long Term Affordability Offer Consumers Incentives and Rewards Tied to preventive health practices Diabetes prevention and treatment
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  • Prevention & Wellness Healthier State Long Term Affordability Prevention & Wellness Healthier State Long Term Affordability Reduce Medical Errors E-prescribing of all prescriptions Strengthen patient safety & accountability
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  • Prevention & Wellness Healthier State Long Term Affordability Prevention & Wellness Healthier State Long Term Affordability National Leader: Prevent Obesity Implement comprehensive strategy to reverse obesity epidemic: public awareness & outreach, improve access to nutritious foods and physical activity
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  • Prevention & Wellness Healthier State Long Term Affordability Prevention & Wellness Healthier State Long Term Affordability Continue Tobacco Control Leadership Increase assistance to those seeking to quit smoking
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  • Prevention / Wellness Shared Responsibility / Coverage for All Governors Health Care Initiative
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  • Shared Benefit INDIVIDUALS Access to affordable coverage Healthier CA
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  • GOVERNMENT Healthy, productive & economically competitive state Shared Benefit INDIVIDUALS Access to affordable coverage Healthier CA
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  • GOVERNMENT Healthy, productive & economically competitive state DOCTORS & HOSPITALS Fairly compensated Shared Benefit INDIVIDUALS Access to affordable coverage Healthier CA
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  • GOVERNMENT Healthy, productive & economically competitive state DOCTORS & HOSPITALS Fairly compensated Shared Benefit HEALTH PLANS Expanded market Fair compensation INDIVIDUALS Access to affordable coverage Healthier CA
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  • GOVERNMENT Healthy, productive & economically competitive state DOCTORS & HOSPITALS Fairly compensated Shared Benefit HEALTH PLANS Expanded market Fair compensation EMPLOYERS Affordable coverage Healthy, productive workforce INDIVIDUALS Access to affordable coverage Healthier CA
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  • Fixing the Broken System Creating an efficient, competitive market dynamic
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  • Payment Sources Commercial payer overpayment Medi-Cal/Uninsured Underpayment
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  • Shared Responsibility INDIVIDUALS Obtain Health Coverage
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  • GOVERNMENT INDIVIDUALS Must secure health coverage for themselves and their children Personal responsibility for health and wellness Contribute to paying for their coverage DOCTORS & HOSPITALS Fixing the Broken System HEALTH PLANS EMPLOYERS
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  • INDIVIDUALS Obtain health coverage Shared Responsibility GOVERNMENT Promote functional market Provide access to affordable coverage Fairly compensate Medi-Cal providers
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  • INDIVIDUALS GOVERNMENT Expand Healthy Families/Medi-Cal for all children in families earning under $60K Subsidies to families between $20K-$50K provided through new purchasing pool Expand Medi-Cal to adults in poverty County responsible for access for undocumented $4 billion increase in Medi-Cal reimbursement rates DOCTORS & HOSPITALS Fixing the Broken System HEALTH PLANS EMPLOYERS
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  • Shared Responsibility INDIVIDUALS Obtain health coverage DOCTORS & HOSPITALS Provide affordable, quality care Share cost savings GOVERNMENT Promote functional market Provide access to affordable coverage Fairly compensate Medi-Cal providers
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  • Redistribution to Providers $10 - $15 Billion $3.5 Billion New Funds to Providers Coverage Dividend from Providers
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  • GOVERNMENT DOCTORS & HOSPITALS 2% fee on physician revenues 4% on hospital revenues Participation in patient safety initiatives At least 85% of hospital payments spent on patient care INDIVIDUALS Fixing the Broken System HEALTH PLANS EMPLOYERS
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  • Shared Responsibility HEALTH PLANS Guarantee access to affordable coverage Pass along savings DOCTORS & HOSPITALS Provide affordable, quality care Share cost savings INDIVIDUALS Obtain health coverage GOVERNMENT Promote functional market Provide access to affordable coverage Fairly compensate Medi-Cal providers
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  • GOVERNMENT HEALTH PLANS Guarantee coverage Only base rates on age and geographic area in the individual market 85% of premiums dedicated to patient care Offer Healthy Actions rewards and incentives within benefit packages Pass along savings DOCTORS & HOSPTIALS Fixing the Broken System INDIVIDUALS EMPLOYERS
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  • Shared Responsibility EMPLOYERS Support employee access to affordable coverage DOCTORS & HOSPITALS Provide affordable, quality care Share cost savings GOVERNMENT Promote functional health care market Provide access to affordable coverage Fairly compensate Medi-Cal providers INDIVIDUALS Obtain health coverage HEALTH PLANS Guarantee access to affordable coverage Pass along savings
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  • GOVERNMENT EMPLOYERS Contribute to the cost of coverage non- offering employers with 10 or more employees will contribute 4% of payroll < 10 employees = 80% of all CA employers Offer 125 plans to allow employees to make pre-tax contributions to coverage DOCTORS & HOSPTIALS Fixing the Broken System HEALTH PLANS INDIVIDUALS
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  • Universal Coverage - Adults 4.8 million uninsured 4.1 million adults 650,000 Medi-Cal 600,000 opt for employer-based coverage 1 million purchasing pool 900,000 individual unsubsidized coverage 750,000 local coverage
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  • Universal Coverage - Children 4.8 million uninsured 750,000 children 220,000Medi-Cal 210,000 opt for employer-based coverage 250,000 Healthy Families 50,000 parental responsibility for coverage
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  • Governors Health Care Initiative Prevention / Wellness Shared Responsibility / Coverage for All Affordability
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  • Affordability: Short Term Reduce hidden tax Tax breaks for individuals & businesses tied to purchase of health insurance Enhance insurer & hospital efficiency by requiring 85% of premiums & hospital dollars on patient care
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  • Affordability: Short Term Remove regulatory barriers: Barriers to low-cost delivery models (e.g. retail medical clinics) 24-Hour Coverage Pilot: Combine workers compensation with traditional health coverage Cal-PERS opt-in for private sector Prioritize hospital seismic retrofit based on worst first
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  • Affordability: Short Term Reduce regulatory red tape that stifles health plan product innovation and increases cost
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  • Affordability: Long-Term Health prevention & wellness Health IT: Paperless system w/ strong privacy protections within 10 years Patient Health Records over shorter-term Medi-Cal rate increases tied to performance measures, cost

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