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February 2014February 2014
Strategic Planning forStrategic Planning for
HEALTH ACCESS:HEALTH ACCESS:
What’s New, What’s Next,What’s New, What’s Next,
and What Do We Need to Do?and What Do We Need to Do?
www.health-access.org
www.facebook.com/healthaccess
www.twitter.com/healthaccess
BFDBFD
Biggest Congressional Action for Consumer Protections; Coverage Expansion; Cost Containment
It Was Up To UsIt Was Up To Us
To:To:
““Because of the money and resources, California is frequently touted asBecause of the money and resources, California is frequently touted as
the state that is implementing the Affordable Care Act most actively andthe state that is implementing the Affordable Care Act most actively and
aggressively.aggressively. The stakes couldn’t be higher.”The stakes couldn’t be higher.” – POLITICO– POLITICO
““California is a particularly important test for Obamacare.California is a particularly important test for Obamacare. It’sIt’s
not just the largest state in the nation. It’s also one of the states mostnot just the largest state in the nation. It’s also one of the states most
committed to implementing Obamacare effectively. ...committed to implementing Obamacare effectively. ... If California can’tIf California can’t
make the law work, perhaps no one can. But if California canmake the law work, perhaps no one can. But if California can
make the law work, it shows that others can, too.”make the law work, it shows that others can, too.” –Ezra Klein,–Ezra Klein,
Washington PostWashington Post
““The ACA can’t succeed if California fails,”The ACA can’t succeed if California fails,” –Drew Altman,–Drew Altman,
president of the Kaiser Family Foundation.president of the Kaiser Family Foundation.
"If this works in California,
eventually America will follow your lead…
If it comes off the rails here,
it will give aid and comfort to everyone
who really just wants to say, 'I told you so.‘”
–President Bill Clinton.
California LeadingCalifornia Leading
on Health Reformon Health Reform
 Together, we passed several dozen bills to implement andTogether, we passed several dozen bills to implement and
improve health reform, worked at many agencies, andimprove health reform, worked at many agencies, and
defended it politically (not one ACA supporter lost).defended it politically (not one ACA supporter lost).
 We did this despite a budget crisis (and a GovernorWe did this despite a budget crisis (and a Governor
focused on it)—preventing some cuts, winning revenuesfocused on it)—preventing some cuts, winning revenues
and restorations.and restorations.
California shows the way:California shows the way:
especially among statesespecially among states
with high uninsured rateswith high uninsured rates
CALIFORNIA IMPLEMENTS
Millions with new consumer protections; financial assistance
3.5+ million Californians with new coverage already
Uninsured cut in half; Average rate hike 4.2%
CALIFORNIA IMPROVES
EARLY:
Low-Income Health Programs
Children with pre-existing conditions
Maternity coverage
BETTER:
Exchange that negotiates & standardizes
Medi-Cal express lane enrollment options
Coverage of legal & DACA immigrants
LGBT inclusion
CONTEXT: Challenges andCONTEXT: Challenges and
OpportunitiesOpportunities
 POLICY & POLITICSPOLICY & POLITICS
 HEALTH INDUSTRYHEALTH INDUSTRY
CONTEXT: Challenges andCONTEXT: Challenges and
OpportunitiesOpportunities
ORGANIZATIONORGANIZATION
ADVOCACYADVOCACY
MEDIA/TECHNOLOGYMEDIA/TECHNOLOGY
THE MOVEMENTTHE MOVEMENT
Policy AgendaPolicy Agenda
 Expanding Coverage
 Implementing and Improving Health Reform and the Affordable Care Act
 Improving the Consumer Experience with Eligibility and Enrollment
 Extending Help to All Californians (#Health4All, etc.)
 Protecting Consumers
 Ensuring Care and Coverage: Oversight Over Insurers and Health Plans
 Controlling Costs and Improving Quality: Oversight Over Providers and the
Delivery System
 Preventing Disparities and Advancing Equity
 Encouraging a Healthier California
 Investing in Public Health and the Safety-Net: Budget Advocacy
 Promoting Prevention
 Seeking a Stronger Social Contract Beyond Health Care
SB35(Padilla)
“The federal government’s biggest attack on
economic inequality since inequality began rising
more than three decades ago...” – David
Leonhardt, The New York Times, 323/2010
Beyond Preventing Medical Bankruptcy:
Progressive Revenue & Distribution * Income Support
Affordability * Health Jobs * On-The-Job Benefits
Economic and Community Development
Changes to coverage,Changes to coverage,
mental health, andmental health, and
substance abuse treatmentsubstance abuse treatment
can and should have ripplecan and should have ripple
effects throughout criminaleffects throughout criminal
justice, policing, countyjustice, policing, county
services, and corrections…services, and corrections…
2015 Legislative Agenda2015 Legislative Agenda
                                                                                                                                
RICH PEDRONCELLI, ASSOCIATED PRESS
The chairman of the California Legislative Latino Caucus plans to propose a new law that would expand access to health
insurance for all Californians, including those living in the country illegally.
State Sen. Ricardo Lara, D-Bell Gardens, is working with a broad coalition of organizations to map out the details of a bill that
would cover undocumented immigrants, who are excluded from insurance coverage under the national Affordable Care Act,
or ACA.
“Immigration status shouldn’t bar individuals from health coverage, especially since their taxes contribute to the growth of our
economy,” Lara said in a news release.
NEWS
State senator wants
health care for all
immigrants
By ROXANA KOPETMAN / ORANGE COUNTY REGISTER
Published: Jan. 10, 2014 Updated: 6:04 p.m.
LEGISLATIVE CAMPAIGNLEGISLATIVE CAMPAIGN
2015 Legislative Agenda:2015 Legislative Agenda:
Returning LegislationReturning Legislation
 SB4: Health4AllSB4: Health4All (was SB1005)(was SB1005)
 Prescription Drug Cost SharingPrescription Drug Cost Sharing : (was AB1917): (was AB1917)
 Large Employer Junk Insurance LoopholeLarge Employer Junk Insurance Loophole (was AB2088)(was AB2088)
 Follow-Up To Outreach of Licensed OccupationsFollow-Up To Outreach of Licensed Occupations (was AB792)(was AB792)
 SB33: Limiting Estate RecoverySB33: Limiting Estate Recovery (was SB1124)(was SB1124)
 All Payer DatabasesAll Payer Databases
 Continuity of CareContinuity of Care (was SB1100)(was SB1100)
 AG Review of Nonprofit Hospital TransactionsAG Review of Nonprofit Hospital Transactions (was SB1094)(was SB1094)
 CHBRP ReauthorizationCHBRP Reauthorization
 Community Benefits?Community Benefits?
2015 Legislative Agenda:2015 Legislative Agenda:
Potential LegislationPotential Legislation
 Medicaid WaiverMedicaid Waiver
 SB137(Hernandez) Provider DirectoriesSB137(Hernandez) Provider Directories
 ““Surprise Bills”/Balance BillingSurprise Bills”/Balance Billing
 Rate Regulation/Review ReduxRate Regulation/Review Redux
 Reference PricingReference Pricing
 Coverage ExclusionsCoverage Exclusions
 Clean-Up LegislationClean-Up Legislation
 Other?Other?
Medicaid WaiverMedicaid Waiver
Goals:
More federal money for a safety-net that
survives and thrives
Improved/coordinated access to remaining
uninsured
Incentives that work for patients on
cost/quality/equity
Better integration with human services
Are these the right goals? The right details? What’s missing?
State BudgetState Budget
Goals:
#Health4All
Limiting Estate Recovery in Medi-Cal
Access in Medi-Cal: Provider Rates
Other Restorations:
– Medi-Cal Benefits
– Public Health Programs
Anti-Poverty Agenda/HHS Network
Issues:
Medicaid Waiver
MCO Tax
CCI
For more informationFor more information
Website: http://www.health-access.orgWebsite: http://www.health-access.org
Blog: http://blog.health-access.orgBlog: http://blog.health-access.org
Facebook: www.facebook.com/healthaccessFacebook: www.facebook.com/healthaccess
Twitter: www.twitter.com/healthaccessTwitter: www.twitter.com/healthaccess
Health Access CaliforniaHealth Access California
1127 111127 11thth
Street, Suite 234,Street, Suite 234, SacramentoSacramento, CA 95814, CA 95814
916-497-0923916-497-0923
414 13414 13thth
Street, Suite 450,Street, Suite 450, OaklandOakland, CA 95612, CA 95612
510-873-8787510-873-8787
1930 Wilshire Blvd., Suite 916,1930 Wilshire Blvd., Suite 916, Los AngelesLos Angeles, CA 90057, CA 90057
213-413-3587213-413-3587

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Strategic Planning for Health Access California

  • 1. February 2014February 2014 Strategic Planning forStrategic Planning for HEALTH ACCESS:HEALTH ACCESS: What’s New, What’s Next,What’s New, What’s Next, and What Do We Need to Do?and What Do We Need to Do? www.health-access.org www.facebook.com/healthaccess www.twitter.com/healthaccess
  • 2. BFDBFD Biggest Congressional Action for Consumer Protections; Coverage Expansion; Cost Containment
  • 3. It Was Up To UsIt Was Up To Us To:To:
  • 4. ““Because of the money and resources, California is frequently touted asBecause of the money and resources, California is frequently touted as the state that is implementing the Affordable Care Act most actively andthe state that is implementing the Affordable Care Act most actively and aggressively.aggressively. The stakes couldn’t be higher.”The stakes couldn’t be higher.” – POLITICO– POLITICO ““California is a particularly important test for Obamacare.California is a particularly important test for Obamacare. It’sIt’s not just the largest state in the nation. It’s also one of the states mostnot just the largest state in the nation. It’s also one of the states most committed to implementing Obamacare effectively. ...committed to implementing Obamacare effectively. ... If California can’tIf California can’t make the law work, perhaps no one can. But if California canmake the law work, perhaps no one can. But if California can make the law work, it shows that others can, too.”make the law work, it shows that others can, too.” –Ezra Klein,–Ezra Klein, Washington PostWashington Post ““The ACA can’t succeed if California fails,”The ACA can’t succeed if California fails,” –Drew Altman,–Drew Altman, president of the Kaiser Family Foundation.president of the Kaiser Family Foundation. "If this works in California, eventually America will follow your lead… If it comes off the rails here, it will give aid and comfort to everyone who really just wants to say, 'I told you so.‘” –President Bill Clinton.
  • 5. California LeadingCalifornia Leading on Health Reformon Health Reform  Together, we passed several dozen bills to implement andTogether, we passed several dozen bills to implement and improve health reform, worked at many agencies, andimprove health reform, worked at many agencies, and defended it politically (not one ACA supporter lost).defended it politically (not one ACA supporter lost).  We did this despite a budget crisis (and a GovernorWe did this despite a budget crisis (and a Governor focused on it)—preventing some cuts, winning revenuesfocused on it)—preventing some cuts, winning revenues and restorations.and restorations. California shows the way:California shows the way: especially among statesespecially among states with high uninsured rateswith high uninsured rates
  • 6. CALIFORNIA IMPLEMENTS Millions with new consumer protections; financial assistance 3.5+ million Californians with new coverage already Uninsured cut in half; Average rate hike 4.2% CALIFORNIA IMPROVES EARLY: Low-Income Health Programs Children with pre-existing conditions Maternity coverage BETTER: Exchange that negotiates & standardizes Medi-Cal express lane enrollment options Coverage of legal & DACA immigrants LGBT inclusion
  • 7.
  • 8. CONTEXT: Challenges andCONTEXT: Challenges and OpportunitiesOpportunities  POLICY & POLITICSPOLICY & POLITICS  HEALTH INDUSTRYHEALTH INDUSTRY
  • 9. CONTEXT: Challenges andCONTEXT: Challenges and OpportunitiesOpportunities ORGANIZATIONORGANIZATION ADVOCACYADVOCACY MEDIA/TECHNOLOGYMEDIA/TECHNOLOGY THE MOVEMENTTHE MOVEMENT
  • 10. Policy AgendaPolicy Agenda  Expanding Coverage  Implementing and Improving Health Reform and the Affordable Care Act  Improving the Consumer Experience with Eligibility and Enrollment  Extending Help to All Californians (#Health4All, etc.)  Protecting Consumers  Ensuring Care and Coverage: Oversight Over Insurers and Health Plans  Controlling Costs and Improving Quality: Oversight Over Providers and the Delivery System  Preventing Disparities and Advancing Equity  Encouraging a Healthier California  Investing in Public Health and the Safety-Net: Budget Advocacy  Promoting Prevention  Seeking a Stronger Social Contract Beyond Health Care
  • 12. “The federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago...” – David Leonhardt, The New York Times, 323/2010 Beyond Preventing Medical Bankruptcy: Progressive Revenue & Distribution * Income Support Affordability * Health Jobs * On-The-Job Benefits Economic and Community Development
  • 13.
  • 14. Changes to coverage,Changes to coverage, mental health, andmental health, and substance abuse treatmentsubstance abuse treatment can and should have ripplecan and should have ripple effects throughout criminaleffects throughout criminal justice, policing, countyjustice, policing, county services, and corrections…services, and corrections…
  • 15. 2015 Legislative Agenda2015 Legislative Agenda
  • 16.                                                                                                                                  RICH PEDRONCELLI, ASSOCIATED PRESS The chairman of the California Legislative Latino Caucus plans to propose a new law that would expand access to health insurance for all Californians, including those living in the country illegally. State Sen. Ricardo Lara, D-Bell Gardens, is working with a broad coalition of organizations to map out the details of a bill that would cover undocumented immigrants, who are excluded from insurance coverage under the national Affordable Care Act, or ACA. “Immigration status shouldn’t bar individuals from health coverage, especially since their taxes contribute to the growth of our economy,” Lara said in a news release. NEWS State senator wants health care for all immigrants By ROXANA KOPETMAN / ORANGE COUNTY REGISTER Published: Jan. 10, 2014 Updated: 6:04 p.m. LEGISLATIVE CAMPAIGNLEGISLATIVE CAMPAIGN
  • 17. 2015 Legislative Agenda:2015 Legislative Agenda: Returning LegislationReturning Legislation  SB4: Health4AllSB4: Health4All (was SB1005)(was SB1005)  Prescription Drug Cost SharingPrescription Drug Cost Sharing : (was AB1917): (was AB1917)  Large Employer Junk Insurance LoopholeLarge Employer Junk Insurance Loophole (was AB2088)(was AB2088)  Follow-Up To Outreach of Licensed OccupationsFollow-Up To Outreach of Licensed Occupations (was AB792)(was AB792)  SB33: Limiting Estate RecoverySB33: Limiting Estate Recovery (was SB1124)(was SB1124)  All Payer DatabasesAll Payer Databases  Continuity of CareContinuity of Care (was SB1100)(was SB1100)  AG Review of Nonprofit Hospital TransactionsAG Review of Nonprofit Hospital Transactions (was SB1094)(was SB1094)  CHBRP ReauthorizationCHBRP Reauthorization  Community Benefits?Community Benefits?
  • 18. 2015 Legislative Agenda:2015 Legislative Agenda: Potential LegislationPotential Legislation  Medicaid WaiverMedicaid Waiver  SB137(Hernandez) Provider DirectoriesSB137(Hernandez) Provider Directories  ““Surprise Bills”/Balance BillingSurprise Bills”/Balance Billing  Rate Regulation/Review ReduxRate Regulation/Review Redux  Reference PricingReference Pricing  Coverage ExclusionsCoverage Exclusions  Clean-Up LegislationClean-Up Legislation  Other?Other?
  • 19. Medicaid WaiverMedicaid Waiver Goals: More federal money for a safety-net that survives and thrives Improved/coordinated access to remaining uninsured Incentives that work for patients on cost/quality/equity Better integration with human services Are these the right goals? The right details? What’s missing?
  • 20. State BudgetState Budget Goals: #Health4All Limiting Estate Recovery in Medi-Cal Access in Medi-Cal: Provider Rates Other Restorations: – Medi-Cal Benefits – Public Health Programs Anti-Poverty Agenda/HHS Network Issues: Medicaid Waiver MCO Tax CCI
  • 21. For more informationFor more information Website: http://www.health-access.orgWebsite: http://www.health-access.org Blog: http://blog.health-access.orgBlog: http://blog.health-access.org Facebook: www.facebook.com/healthaccessFacebook: www.facebook.com/healthaccess Twitter: www.twitter.com/healthaccessTwitter: www.twitter.com/healthaccess Health Access CaliforniaHealth Access California 1127 111127 11thth Street, Suite 234,Street, Suite 234, SacramentoSacramento, CA 95814, CA 95814 916-497-0923916-497-0923 414 13414 13thth Street, Suite 450,Street, Suite 450, OaklandOakland, CA 95612, CA 95612 510-873-8787510-873-8787 1930 Wilshire Blvd., Suite 916,1930 Wilshire Blvd., Suite 916, Los AngelesLos Angeles, CA 90057, CA 90057 213-413-3587213-413-3587