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THE PROMISE OF HEALTH CARE REFORM JUGGLING FUTURE OPPORTUNITIES

THE PROMISE OF HEALTH CARE REFORM JUGGLING FUTURE OPPORTUNITIES. Presented by Bobbie Wunsch, Pacific Health Consulting Group bwunsch@pachealth.org February 23, 2011 Dance Palace. JIGSAW PUZZLE. Short-term state budget issues ugly

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THE PROMISE OF HEALTH CARE REFORM JUGGLING FUTURE OPPORTUNITIES

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  1. THE PROMISE OF HEALTH CARE REFORM JUGGLING FUTURE OPPORTUNITIES Presented by Bobbie Wunsch, Pacific Health Consulting Group bwunsch@pachealth.org February 23, 2011 Dance Palace

  2. 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

  3. National Healthcare ReformFour Key Strategies 3

  4. 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

  5. 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

  6. INCLUDES…… • Individual mandate requiring most to have insurance or face penalties • Requires employers with >200 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

  7. HOW IT WORKS*FPL means Federal Poverty Level

  8. 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%

  9. 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

  10. 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."

  11. 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.

  12. 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

  13. COUNTDOWN TO 2014 • 24 months to plan • 34 months till implementation

  14. 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 America’s Health: healthyamericans.org

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