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Health Care Reform Health Care Reform
Michael R. CousineauMichael R. CousineauUSC Keck School of MedicineUSC Keck School of Medicine
How will health care reform affect How will health care reform affect the greater Los Angeles area?the greater Los Angeles area?
Will it decrease the number of uninsured?Will it decrease the number of uninsured? How will affect safety net providers How will affect safety net providers
particularly public hospitals and community particularly public hospitals and community health centers?health centers?
Will it improve health?Will it improve health?
Fundamental ComponentsFundamental Components
Individual mandates Individual mandates insurance reforminsurance reform
– Pre existingPre existing– Life time capsLife time caps– Limited age rating Limited age rating
Subsidies to increase affordabilitySubsidies to increase affordability Health Insurance Exchange for individuals Health Insurance Exchange for individuals
and small businesses and small businesses
DifferencesDifferences
Fewer people covered under the Senate version, Fewer people covered under the Senate version, (estimated at 31 million Senate vs 36 million in (estimated at 31 million Senate vs 36 million in House version).House version).
Medicaid Expansion --(150% in Senate version Medicaid Expansion --(150% in Senate version and 133% in House version) and 133% in House version)
Subsidies --House higher subsidies between 150 Subsidies --House higher subsidies between 150 and 300% (House, Higher subsidies (300-400%, and 300% (House, Higher subsidies (300-400%, (Senate)(Senate)
Exchange - National (House), State option Exchange - National (House), State option (Senate) Public Option (House), non profit (Senate) Public Option (House), non profit (Senate)(Senate)
DifferencesDifferences
Insurance reformInsurance reform BenefitsBenefits Cost containmentCost containment FinancingFinancing
– Taxing insurance (Senate)Taxing insurance (Senate)– Taxing wealthy (House)Taxing wealthy (House)– Fess on non-participating employersFess on non-participating employers
Los Angeles County Los Angeles County Service Planning Areas and Health DistrictsService Planning Areas and Health Districts
Large county with Large county with nearly 10 Million nearly 10 Million residentsresidents
Tremendous diversityTremendous diversity Both wealth and Both wealth and
povertypoverty Many immigrantsMany immigrants Health care systemHealth care system
Antelope Valley
Foothill
San Fernando
West
East Valley
West Valley
Pomona
Harbor
Whittier
Torrance
El Monte
Glendale
Long Beach
Central Alhambra
Bellflower
Inglewood
East LASouth-west
SanAntonio
Compton
North-east
Pasadena
South
Hollywood/Wilshire
South-east
SPA 1
SPA 2
SPA 3
SPA 8
SPA 5
SPA 7
SPA 4
SPA 6
Spas2002.shp
SPA 1 - Antelope Valley
SPA 2 - San Fernando
SPA 3 - San Gabriel
SPA 4 - Metro
SPA 5 - West
SPA 6 - South
SPA 7 - East
SPA 8 - South Bay
Service Planning Areas (SPA)
Issues for Los AngelesIssues for Los Angeles
High number of uninsured individuals and families: 1.6 High number of uninsured individuals and families: 1.6 million uninsured in Los Angeles County and nearly million uninsured in Los Angeles County and nearly 200,000 uninsured children200,000 uninsured children
Immigrants, undocumented not eligible under either of the Immigrants, undocumented not eligible under either of the two billstwo bills
Safety net providers, public hospitals and private DSH Safety net providers, public hospitals and private DSH hospitals, - financed in part by reducing supplemental hospitals, - financed in part by reducing supplemental payments to these hospitals, rationale, fewer uninsured, payments to these hospitals, rationale, fewer uninsured, so the need for cost shifts to the uninsured is lessso the need for cost shifts to the uninsured is less
Many small businessesMany small businesses
Health Insurance Status in the County Health Insurance Status in the County of Los Angeles, 2007 of Los Angeles, 2007
Source: Los Angeles County Health Survey, 2007. Compiled by Amy Lightstone, Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, May 2009.
Nonelderly Adults Percentage
95 Percent Confidence
Interval
Estimated Number of
People
Medi-CalMedi-Cal 15.815.8 14.614.6 -- 17.117.1 1,004,0001,004,000
MedicareMedicare 1.31.3 1.01.0 -- 1.61.6 82,00082,000
PrivatePrivate 60.860.8 59.259.2 -- 62.462.4 3,852,0003,852,000
No insuranceNo insurance 22.022.0 20.720.7 -- 23.423.4 1,396,0001,396,000
ChildrenChildren
Healthy FamiliesHealthy Families 10.7%10.7% 9.79.7 -- 11.611.6 298,000298,000
Medi-CalMedi-Cal 35.6%35.6% 34.134.1 -- 37.137.1 992,000992,000
PrivatePrivate 45.4%45.4% 43.843.8 -- 46.946.9 1,264,0001,264,000
Healthy KidsHealthy Kids 1.4%1.4% 1.11.1 -- 1.71.7 39,00039,000
No insuranceNo insurance 7.0%7.0% 6.16.1 -- 7.87.8 194,000194,000
Distribution of Uninsured Adults by Race Distribution of Uninsured Adults by Race and Ethnicity in Los Angeles County, 2007and Ethnicity in Los Angeles County, 2007
Latino70%
White
11%
African American8%
Asian/Pacific Islander11%
Other< 1%
Uninsured by Poverty Status, Los Uninsured by Poverty Status, Los Angeles County, 2007Angeles County, 2007
300% or above FPL, 138,000
200%-299% FPL, 189,000
100%-199% FPL, 498,000
0-99% FPL, 521,000
* Estimated based on total Southern California enrollment figures. Source, Health Insurers serving Los Angeles County, Los Angeles Business Journal, May 2009. www.thefreelibrary.com. Accessed July, 2009.
Private Health Plan Enrollments in Private Health Plan Enrollments in Los Angeles County, 2009. Los Angeles County, 2009.
Plan Membership
Kaiser Foundation Health PlanKaiser Foundation Health Plan 1.12 million1.12 million
Anthem Blue CrossAnthem Blue Cross 850,000 *850,000 *
PacificarePacificare 250,000250,000
Health NetHealth Net 398,000398,000
LA Care Health PlanLA Care Health Plan 783,000783,000
Blue Shield of CaliforniaBlue Shield of California 229,000229,000
Cigna Healthcare of CaliforniaCigna Healthcare of California 170,000170,000
Aetna Health of California Aetna Health of California 106,000106,000
Universal CareUniversal Care *75,000*75,000
SCANSCAN 47,00047,000
COMPARISON OF SMALL BUSINESS EMPLOYERS AS A PERCENT OF TOTAL BUSINESSES IN THE STATE AND
COUNTY OF LOS ANGELES Source Los Angeles County Small Business Commission 2006-2007 Annual Report April 2008
1-100 Employees
State % Total
County % Total
101-500 Employees
State % Total
Los Angeles County
353,176 30.0% 91.5% 5,164 25.3%
State of California
1,175,330 100% -- 20,413 100%
Impact on CaliforniaImpact on California
$3 Billion impact on the California budget $3 Billion impact on the California budget (by the Governor’s Office)(by the Governor’s Office)
Hinges on Medicaid and what is decided on Hinges on Medicaid and what is decided on a federal requirements for a matcha federal requirements for a match
Impact on California and Los Impact on California and Los Angeles CountyAngeles County
$3 Billion impact on the California budget $3 Billion impact on the California budget (by the Governor’s Office)(by the Governor’s Office)
Safety net providers, public hospitals and Safety net providers, public hospitals and private DSH hospitals, - Health Reform private DSH hospitals, - Health Reform financed in part by reducing supplemental financed in part by reducing supplemental payments to these hospitals, rationale, payments to these hospitals, rationale, fewer uninsured, so the need for cost shifts fewer uninsured, so the need for cost shifts to the uninsured is lessto the uninsured is less
The Health Care Safety NetThe Health Care Safety Net
LA County Public Hospitals and health LA County Public Hospitals and health Centers Private HospitalsCenters Private Hospitals
Community Health CentersCommunity Health Centers Emergency departmentsEmergency departments
DisparitiesDisparities
Will this help to reduce disparities and Will this help to reduce disparities and improve health?improve health?
Leading Causes of Death in Leading Causes of Death in Los Angeles by Race/Ethnicity, 2005Los Angeles by Race/Ethnicity, 2005
ConclusionsConclusions
A lot of good things in the bills,A lot of good things in the bills, Many problemsMany problems Not over, much tweaking and monitoring is Not over, much tweaking and monitoring is
neededneeded Senate version seems to be trumping houseSenate version seems to be trumping house