Ramping Up Mobilization for Health Care Reform: The EQUAL Health Network

1. Ramping Up Mobilization for Health Care Reform:The EQUAL Health Network Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL Health Network www.equalhealth.info 415-922-6204 ershaffer@gmail.com APHA Session 281 Sunday, November 7, 2010 4:00 PM-5:30 M

2. Health Care Reform 2010 • Public health organizations and advocates played active roles in promoting and supporting proposals to expand coverage for health care in 2009 and 2010, a central matter of social justice. • The national debate polarized the public and served as a lightning rod for competing policy agendas at a time of economic instability. • The contentious nature of the debate and the outcome illuminate the importance of ramping up mobilization for further progressive reforms. EQUAL Health Network

3. Why is This Controversial? • Critiques • “Statist” government takeover • Corporate takeover • Significant though limited reforms • Important to claim and build on victories • Use policy space to address limits EQUAL Health Network

4. Outline • What the Affordable Care Act does • Conflicting critiques • Political and economic context • Wins, losses for ongoing mobilization EQUAL Health Network

5. What Happened Patient Protection and Affordable Care Act (PPACA) The new law takes important steps to expand coverage and improve quality, and begins to control costs Significant though limited reforms Important to claim and build on victories Use policy space to address limits July, 2010 5 EQUAL Health Network EQUAL/Center for Policy Analysis

6. Uninsured: Dying from a Toothache in the U.S. A man in his early 20s with a worsening dental infection was unable to afford a dentist. He finally saw a physician who prescribed an antibiotic, but the patient was unable to pay for the prescription. He came to our clinic when the infection had spread to his chest. He died soon after admission. The egregious is commonplace in our non-system. JAMAVol. 286 No. 20, November 28, 2001"Within the System of No-System," Robert L. Ferrer, MD, MPH EQUAL Health Network

7. The Problems:People Are Suffering • 50 million in U.S. uninsured • 6.7 million uninsured in California • 44,000 deaths each year due to lack of health insurance • 1 person died every 12 minutes • 60% of U.S. bankruptcies due to health costs • 75% of medical bankruptcies happen to people with health insurance EQUAL Health Network

8. The Great Risk Shift in Health Care 69.0% Private employer-provided health insurance Over 15 percentage point decline Percent covered by own employer insurance 54.9% Source: Economic Policy Institute, State of Working America, 2006/2007 EQUAL Health Network

9. EQUAL Health Network

10. Adjusted odds of mortality by race and insurance status EQUAL Health Network

11. ACA: The Gains • Expanded Coverage and Access • Improving Quality • Consumer Protections ALL = Lower Costs • How Will We Benefit? 11 EQUAL Health Network

12. ACA Benefits Phased In 2010-2020 2010-2013 Consumer protections Affordability and quality improvements 2014: Major coverage expansions Health Insurance Exchanges For individuals, small business employees Individual Mandate, Employer contributions Medicaid Expanded Everyone up to 133% of poverty level 2020: Medicare drug price “doughnut hole” gone 12 EQUAL Health Network

13. Public Health Grant Programs • Public Education Campaigns • Centers on Excellence on Depression • Education and Training Grants & Loan Repayment • Community Health Centers • School-based Health Clinics • Community Transformation Grant • Early Childhood Home Visitation EQUAL Health Network

14. Coverage: Now New High Risk Pool: Pre-Existing Condition Insurance Plans (for uninsured with pre-existing conditions) Covers Young Adults through Age 26 on parents’ coverage 14 EQUAL Health Network

15. Affordability: Now • Rebates begin to close the Medicare Part D Donut Hole: $250 this year • Small business tax credits of up to 35% • States and feds can reject “unreasonable” premiums • Reduces cost of early retiree coverage EQUAL Health Network

16. Quality: Now • Free preventive care • Decision point: Will HRSA cover contraception thru prevention? * Exception for “Grandfathered plans” • Increased funding for Community Clinics • More money for primary care and public health EQUAL Health Network

17. Consumer Protections: Now Discrimination against children with pre-existing conditions prohibited Rescissions Illegal (withdrawal of care) Bans lifetime limits on $ amount of coverage Annual limits phased out 17 EQUAL Health Network

18. Consumer Protections:“Medical Loss Ratio” • 80-85% of premium must be spent on health care (vs. admin., profit) • Rebates • Current policy debate: “Wellness programs” run by insurance co.s = Medical care? or Marketing? EQUAL Health Network

19. 2014: Major coverage expansions Medicaid Expanded Everyone up to 133% of poverty level $14,404 for individuals $29,326 for a family of four Health Insurance Exchanges For individuals, small business employees Individual Mandate, Employer contributions 19 EQUAL Health Network

20. Coverage: Medicaid: 2014 Will cover everyone up to 133% of poverty 16 million would be newly covered (2 million in California will be eligible) CA: $15,000 individual; $30,400 family of four Maintains Healthy Families Maintenance of Effort til then Undocumented immigrants generally not covered 20 EQUAL Health Network

21. State Insurance Exchanges, 2014: Who Uninsured individuals, self-employed and small businesses can buy coverage NOT FOR MEDICARE!! Safety net for insured who lose a job Applies to Members of Congress 21 EQUAL Health Network

22. Insurance Reform: Limits on Insurance Premiums • Cannot charge more if: • You are sick • You are female (Gender-rating) • Age-rating limited, 3:1 • No more annual or lifetime limits • Administrative costs limited • No underwriting • Easier to compare plans , 22 EQUAL Health Network EQUAL Health Network

23. Premiums on the Exchange Premium contributions limited based on income as a percent of Federal Poverty Level (FPL): • 150% FPL ($16,245/yr): $ 68/month • 200% FPL ($21,660/yr): $113 • 250% FPL ($27,075/yr): $191 • 300% FPL ($32,490/yr): $ 257 Hardship exemption: Available if lowest cost plan exceeds 8% of an individual’s income EQUAL Health Network

24. Costs of coverage for subsidy eligible individuals in exchange compared to existing non-group market (premium and out-of-pocket) EQUAL Health Network

25. Estimated Health Insurance Coverage in 2019 Figure 6 Total Nonelderly Population = 282 Million EQUAL Health Network SOURCE: Congressional Budget Office, March 20, 2010 Return to KaiserEDU Tutorials

26. Financing Health Reform, 2010-2019 Figure 15 Federal savings New revenues Total Cost = $938 Billion Savings to Federal Deficit = $124 Billion EQUAL Health Network Source: Congressional Budget Office, 2010 Return to KaiserEDU Tutorials

27. National Deficit With and Without Health Reform EQUAL Health Network

28. Significant Limits Reproductive Health – Retreat from current law Contraception (High-risk pools) Abortion care (Exchanges) Immigrants’ inclusion: Undocumented cannot purchase thru Exchange Affordability State options for innovative approaches Single payer 28 EQUAL Health Network

29. ACA: Political Views • Expands government role in assuring and providing coverage and regulating insurance • Concessions from drug, insurance, hospital industries • Civil society lost on important issues • But finance capital still vehemently opposed EQUAL Health Network

30. Always a Tough Road July, 2010 30 EQUAL Health Network EQUAL/Center for Policy Analysis

31. Health Care Considered #1 Drag on Economy- Until Fall, 2008 • Speculative bubbles burst • Houses/real estate • Finance • Wars • Tax breaks for wealthy • Redistribution of income • Reverse Robin Hood EQUAL Health Network

32. Unemployment by Race, Dec. 2007- Aug. 2010 EQUAL Health Network

33. Home Prices Jan. 96 – June 2010 EQUAL Health Network

34. Income Inequality 1979-2005: EPI • Bottom fifth of households: average, inflation-adjusted income growth of just $200 over the entire 26-year period. • By contrast, a small number of households at the top 0.1% of the income scale saw average income growth of almost $6 million over the same time. • 1947 and 1973: income growth was distributed roughly equally, with the poorest 20% of families seeing income growth at least as fast as the richest 20% EQUAL Health Network

35. Contending Forces • Wall Street/Finance capital • Now own/direct many corporations • Agenda: • Reduce regulation, standard of living • Cut taxes, cut public sector • The Public/Civil society • Want jobs, accountable businesses and government EQUAL Health Network

36. Competing Policy Agendas:Economic growth/recovery • Create wealth through financial maneuvers • Government funnels contracts, minimizes taxes, regulation, social spending • “Companies that maximize shareholder wealth… have higher productivity, greater increases in shareholder wealth, and greater employment gains..” McKinsey Nov. 1994 • Create wealth through productivity • Government supports baseline survival, can advance social justice and wellbeing • Guarantees rule of law – financial regulation Empower organizations of civil society - unions • Invest in productivity: Health care reform, Education, Energy, Environment EQUAL Health Network

37. Progressive Political Agendas • Restore rule of law, political stability • Empower organizations of civil society • Health care reform • Energy • Union rights • Financial regulation EQUAL Health Network

38. Conflicting Priorities • Non-health care business • Maintain control of workforce • Minimize health care expenses • Health care businesses • Preserve revenue generation: Drugs, hospitals, professional groups, technology • Resist regulation • Public: Affordable, quality health care, with choice of providers EQUAL Health Network

39. Economy Slow 2010 • Personal consumption low • Trade imbalance: • U.S. importing more than exporting • Low interest rates • Government spending not enough • Slump in state and local spending • Defense spending doesn’t compensate • The U.S. economy remains starved for aggregate demand • Economic Policy Institute EQUAL Health Network

40. Corporate media July, 2010 40 EQUAL Health Network EQUAL/Center for Policy Analysis

41. Who Owns Your TV? • General Electric: NBC, A&E, History Channel • Walt Disney: ABC, ESPN • News Corp: Fox • CBS: CBS • Sold Salt Lake City network to 4 Points Media, subsidiary of Cerberus, which owned Chrysler • Viacom: Comedy Central • Time Warner: CNN, HBO, TCM EQUAL Health Network

42. Election 2010 • Republican agenda: • Fight about health care as lead up to 2012 election • Focus on abortion • Moderate Democrats and Republicans: • Deficit Commission: Slash Medicare, Social Security • Free trade/expand exports • Dems beat big money in CA • VT governor stumping for single payer EQUAL Health Network

43. Boehner Proposal Sept. 2010 • Cut non-security related spending back to fiscal year 2008 levels and enact a two-year freeze on all current tax rates • EPI: Lose another 1 million jobs EQUAL Health Network

44. Stay Mobilized!!! • Corporate domination of campaign spending was successful in many races – but not all • Analyze what’s working and do more of it • Traditional advocacy groups limited – unions, women, seniors, etc. • Take the initiative to create vehicles for advocacy EQUAL Health Network

45. The ACA: Educate, Defend, Implement • Regulations.Gov • Comment on Medical Loss Ratio, repro rights • State activities • Implement exchanges • Incorporate larger businesses sooner • Create public insurance EQUAL Health Network

46. Reproductive Rights • Contraception is a preventive health care service • Abortion has been stigmatized and marginalized • 30% of women have had an abortion • “Safe rare and legal” not sufficient’ • Overturn Hyde amendment limiting federal funding EQUAL Health Network

47. Immigrants • Of the 12.3 million immigrants without health insurance, more than half (6.3 million) are working, and about 900,000 are children. • Other countries treat US nationals abroad: Demand reciprocity. EQUAL Health Network

48. State and National Single Payer Campaigns • Reclaim the importance role of effective, accountable government in creating affordable health care, economic prosperity and a socially just society • Defend Medicare and Social Security EQUAL Health Network

49. ACA: Steps Towards Single Payer Expands coverage Required financing by government, individuals and employers will create incentives for greater cost controls New quality measures and delivery system reforms will guide cost control while protecting benefits 49 EQUAL Health Network

50. Work with EQUAL Join the EQUAL Listserv Send a blank message to join-equal@list.equalhealth.info See our website: www.centerforpolicyanalysis.org Thanks for contributions to this presentation to: Keely Monroe, Lisa Kernan Social Justice Fellow; EQUAL partners including Deborah LeVeen, Elinor Blake, Karl Keener, Joel Adelson, Lee Lawrence, Robert Mason; and Jacob Hacker 50 EQUAL Health Network