Three Cornerstones of Health Care Reform

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1 Three Cornerstones of Health Care Reform 1. Increased coverage through expansion of public programs (Medi-Cal/Medicaid) 2. Reform and redesign of insurance markets (Health Benefit Exchanges) 3. Delivery system and payment reform Source: Frank, 2011

2 Key Elements of Health Care Coverage Expansion Establishment of state-based health plan exchanges for individuals and small businesses (up to 100 employees) Medi-Cal Expansion to 133% FPL Individual mandate to maintain minimum essential coverage otherwise tax penalties Premium and cost-sharing subsidies for those at 133% to 400% of poverty Source: Frank, 2011

3 Health Insurance Exchanges Reorganize individual and small group markets Exchanges will certify plans as qualified To be qualified plans must meet essential benefits requirements and other marketing and quality requirements Scope of benefits must be equal to typical employer plans The Mental Health Parity and Addiction Equity Act applies Source: Frank, 2011

4 Medi-Cal/Medicaid Expansion New Mandatory Eligibility Group to 133% FPL Income limit: $14,404 for individuals and $29,326 for families of four Regardless of traditional eligibility categories (thus including childless adults) No asset test Mandatory by 2014 Optional beginning April, 2010 (at any level up to 133% FPL) People who will be picked up by the Medi-Cal expansion is disproportionally people with mental and SU disorders Source: Frank, 2011

5 The California Health Benefit Exchange Source: Achieving Equity by Building a Bridge from Eligible to Insured at

6 Source: Achieving Equity by Building a Bridge from Eligible to Insured at

7 Source: Achieving Equity by Building a Bridge from Eligible to Insured at

8 The California Health Benefit Exchange: Recommendations 1. Target resources for consumer assistance to those with the highest needs. 2. Invest in culturally and linguistically appropriate marketing and outreach. 3. Involve communities of color in decisionmaking processes. 4. Strengthen data collection efforts to help identify and address disparities. Source: Achieving Equity by Building a Bridge from Eligible to Insured at

9 The California Health Benefit Exchange: Recommendations 5. Invest in primary care and workforce diversity in underserved areas. 6. Ensure collaboration between state and local government agencies and providers across public programs to maximize enrollment. 7. Promote prevention and wellness. Source: Achieving Equity by Building a Bridge from Eligible to Insured at

11 Source: Soto-Taylor, 2013

12 Source: Soto-Taylor, 2013

13 Source: Soto-Taylor, 2013

14 Source: Soto-Taylor, 2013

15 Source: Soto-Taylor, 2013

16 Source: Soto-Taylor, 2013

17 Find out how much you would save if insured through Covered California Source:

18 Find out how much you would save if insured through Covered California Source:

Summary ACA will improve access to insurance for the majority of immigrants, whether through the Exchange, employerofferings or Medi-Cal expansion We need to address patient navigation and

19 Summary ACA will improve access to insurance for the majority of immigrants, whether through the Exchange, employerofferings or Medi-Cal expansion We need to address patient navigation and decision-making Subsidies, cost-sharing, and cultural competency 21% of recent immigrants with access to Exchange/Medi-Cal are Latino Of documented, recent immigrant Latinos, 52% are uninsured Physician supply, urgent care, and ER use While the undocumented will be largely left out Employers could increase offering Non-Exchange Individual Market will be guaranteed issue Source: Roby, 2011

20 Source:

21 Para Repasar: 4 Things to Remember About the Law Ends the worst insurance company abuses Makes health insurance more affordable Strengthens Medi-Cal (Medicaid) Provides better options for coverage Source:

22 Top Ways the Affordable Care Act is Improving the Lives of Latinos 1. The Affordable Care Act addresses cost 2. Beginning in 2014 approximately 2.3 million Latinos who are self-employed or small business owners may be eligible to purchase affordable health care insurance. 3. Thousands of Latinos under the age of 26 have already gained access to health insurance. 4. Strategic investments in community health centers and promotoras received more support 5. Before the Affordable Care Act, insurance companies could legally deny coverage to Latino children with diabetes or other pre-existing conditions or charge them substantially more. That s not the case anymore Source: Pereira & Meth, Center for American Progress, 2012

23 Pre-Existing Conditions Program (PCIP) On February 16, 2013, the federally-run PCIP suspended acceptance of new enrollment applications until further notice. State-based PCIPs continued accepting enrollment applications through March 2, PCIP is a temporary program for those locked out of the current insurance marketplace. The program has a limited amount of funding from Congress PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide. Source:

24 What are the Timelines to Enroll in an Insurance Program? Starting 2014, the Affordable Care Act guarantees that all Americans regardless of their health status or pre-existing conditions will finally have access to quality, affordable coverage. People will be able to apply for affordable health insurance coverage choices in Health Insurance Marketplaces when open enrollment begins on October 1. The Health Insurance Marketplace will offer a choice of quality, affordable health plans. Coverage begins on January 1, Source:

25 Hot off the Press!: Governor Brown s Revised Budget Proposal The new proposal includes a state-based expansion of Medi-Cal to childless adults up to 138% FPL, as authorized by the Affordable Care Act (ACA). Unfortunately, it also includes unspecified cuts to county safety-net programs, which are critical to serve the 3-4 million remaining uninsured. After 2014, recent legal immigrants currently eligible for state-only Medi-Cal but not enrolled, will be eligible for Covered California with the same premium, cost-sharing, and benefits they would have received in Medi-Cal. This would also extend to recent legal immigrants who are childless adults and have been in the U.S. less than five years. The proposed budget does not restore previous cuts to health care services. Source: CPEHN News Bulletin, 2013

26 The Time is Now Are you going to allow yourself, your family, your friends, your neighbors fall through the cracks? Or Se van a poner las pilas y aprovechar esta gran oportunidad?

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