David McGhee, CEO, ACHD Goal: Describe a Legislators views on - PowerPoint PPT Presentation

David McGhee, CEO, ACHD

Goal: Describe a Legislator’s views on Healthcare Districts and their role in California

Moderator: Barry Jantz, CEO, Grossmont Healthcare District

Senator Joel Anderson • Fallbrook Healthcare District • Grossmont Healthcare District • Palomar Health

Goal: Describe the legislative perspective and background work that takes place when policy is created and moved through the Legislative process.

Rony Berdugo Legislative Aide Senator Ed Hernandez

Sam Chung Legislative Director Assemblymember Jeff Gorell

Janus Norman Political and Legislative Advocate American Federation of State County Municipal Employees

Kyle Packham Advocacy & Public Affairs Director California Special Districts Association

Goals: • Advocate effectively for Healthcare Districts • Communicate the priority legislative issues facing Healthcare Districts

David Panush, Director External Affairs, Covered California

Covered California Overview David Panush Director, External Affairs Covered California April 8, 2013 Association of California Healthcare Districts 2013 Legislative Day

Covered California Governance Independent Public Entity with Qualified Board Board Members: Diana Dooley , Board Chair and Secretary of the California Health and Human Services Agency, which provides a range of health care services, social services, mental health services, alcohol and drug treatment services, income assistance and public health services to Californians Kim Belshé , Senior Policy Advisor of the Public Policy Institute of California, former Secretary of California Health and Human Services Agency, and former Director of the California Department of Health Services Paul Fearer , Senior Executive Vice President and Director of Human Resources of UnionBanCalCorporation and its primary subsidiary, Union Bank N.A., Board Chair of Pacific Business Group on Health, and former board chair of Pacific Health Advantage Robert Ross, M.D. , President and Chief Executive Officer of The California Endowment, previous director of the San Diego County Health and Human Services Agency from 1993 to 2000, and previous Commissioner of Public Health for the City of Philadelphia from 1990 to 1993 Susan Kennedy , Nationally-recognized policy consultant, former Deputy Chief of Staff and Cabinet Secretary to Governor Gray Davis, former Chief of Staff to Governor Arnold Schwarzenegger, former Communications Director for U.S. Senator Dianne Feinstein, and former Executive Director of the California Democratic Party

Covered California Vision & Mission Vision • Improve the health of all Californians • Access affordable care • Provide high quality care Mission • Increase insured Californians • Improve health care quality • Lower costs • Innovative, competitive marketplace • Choice & value

Key Dates • Fall 2013 Pre Enrollment begins • January 1, 2014 Coverage begins • January 1, 2015 Federal funding ends

Major Activities 2013 - 2014 • Qualified Health Plans (QHPs). Evaluate, select, certify and contract with QHP issuers to provide coverage through the individual and SHOP exchanges. • Marketing, Outreach, Education . Refine and implement marketing, outreach, and public education program leading to the first open enrollment period in 2013 and 2014. • California Health Eligibility, Enrollment & Retention System (CalHEERS). Refine, test and bring online. • Small Business Health Options Program (SHOP). Establish to serve small employers and their employees.

Subsidies Available to help with Cost A “sliding scale” subsidy will be provided based on income for individuals and families earning between 138 and 400 percent of the federal poverty level. The size of the subsidy depends on both the income and family size of eligible individuals. The table below illustrates the tax credit subsidy for a family of four at several income levels. Assumes: 2014 projected income of a 45 year-old policyholder and the family buys a plan that has a 70 percent actuarial value (the policyholder would be responsible for 30 percent of all covered benefits, the health insurer would be responsible for the remaining 70 percent). Does not include cost-sharing which is also available. Percent Annual Unsubsidized Annual Annual Unsubsidized Monthly Monthly of FPL Income Annual Tax Credit Premium Monthly Premium Premium after Premium after Tax Premium Credit Credit Credit 150% $35,137 $14,245 $12,840 $1,405 $1,187 $1,070 $117 $46,850 $14,245 $11,294 $2,952 $1,187 $941 $246 200% $70,275 $14,245 $7,569 $6,676 $1,187 $631 $556 300% 399% $93,700 $14,245 $5,344 $8,901 $1,187 $445 $742

Essential Health Benefits The Patient Protection Affordable Care Act requires health plans and health insurers that offer coverage in the small group or individual market, inside and outside of the Exchange, to cover specified categories of benefits. These Essential Health Benefits categories are: – Ambulatory patient services – Emergency services – Hospitalization – Maternity and newborn care – Mental health and substance use disorder services, including behavioral health treatment – Prescription drugs – Rehabilitative and habilitative services and devices – Laboratory services – Preventive and wellness services and chronic disease management – Pediatric services, including oral and vision care With the signing of SB 951 and AB 1453, state law has established the Kaiser Small Group HMO 30 as the EHB benchmark plan in California.

Consumers Trade Off Up Front Affordability with Expected Out-of-Pocket Costs Catastrophic Average Rich 90% vs 10% 80% vs 20% 70% vs 30% 60% vs 40%

Making Care More Affordable PREMIUM OUT-OF-POCKET AFFORDABLE COST CARE 2.6 million Californians Standardized True eligible for benefits limit out transparency on subsidized care of pocket costs up front and out pay a % of their based on sliding of pockets costs. income; scale; Federal Most copays are government not subject to pays balance deductibles

2014 Standard Plans for Individuals – Key Benefits Platinum Gold Silver Bronze COPAYS IN THE GREEN SECTIONS ARE NOT SUBJECT TO ANY DEDUCTIBLE CATEGORIES IN BLUE ARE SUBJECT TO DEDUCTIBLES AND COUNT TOWARD THE ANNUAL OUT-OF-POCKET MAXIMUM $5,000 Deductible for No Deductible No Deductible No Deductible Medical and Drugs Preventive Care Copay No Cost – 1 Ann Visit No Cost – 1 Ann Visit No Cost – 1 Ann Visit No Cost – 1 Ann Visit $20 $ 30 $45 $60 for 3 Visits Primary Care Visit Copay $40 $50 $65 $70 Specialty Care Visit Copay $40 $60 $90 $120 Urgent Care Visit Copay $150 $250 $250 $300 Emergency Room Copay $25 $30 $45 30% Lab Testing Copay $40 $50 $65 30% X-Ray Copay $5 or less $20 or less $25 or less $25 or less Generic Medication Copay $2,000 Medical HMO HMO Deductible Outpatient Surgery -- $250; Outpatient Surgery -- HMO High cost and infrequent services like Hospital -- $250 per day up $600; Hospital -- $600 per Outpatient Surgery -- 30% of Your Plan’s Hospital Care, Outpatient Surgery, and to 5 days day up to 5 days $600; Hospital -- $600 Negotiated Rate Imaging (MRI, CT, Pet Scans). PPO PPO per day up to 5 days 10% 20% PPO 20% Brand Medications may be subject to an $250 Drug Deductible No Separate Drug Annual Deductible before you Pay the None None then you pay the Copay Deductible Copay Amount Preferred Brand Copay After Deductible is $15 $50 $50 $50 Paid ANNUAL MAXIMUM OUT-OF-POCKET COST $4,000 for you and $8,000 $6,400 for you and 6,400 for you and 6,400 for you and $12,800 TO YOU for your family $12,800 for your family $12,800 for your family for your family