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Stay WellStay WellAfford CareAfford Care
Secure Secure CoverageCoverage
July 31, 2008July 31, 2008SCI – San Francisco, CASCI – San Francisco, CA
Why, How, What, and WhenWhy, How, What, and When
The Why – call to actionThe Why – call to actionThe How – process lessonsThe How – process lessons
The What – policy lessonsThe What – policy lessonsThe When – next stepsThe When – next steps
Why: Vision 2006Why: Vision 2006
• Governor’s Vision: Governor’s Vision:
““A first-rate health care system that A first-rate health care system that is accessible to everyone, efficient is accessible to everyone, efficient and affordable”and affordable”
Basis for Moving ForwardBasis for Moving Forward
Status quo/inaction not an optionStatus quo/inaction not an option Gubernatorial leadership and resolveGubernatorial leadership and resolve Framework for reform Framework for reform
Broadly shared goalsBroadly shared goals Values and principlesValues and principles Comprehensive, not incrementalComprehensive, not incremental
Framework for Reform: 2007Framework for Reform: 2007
Essential elements of reformEssential elements of reform Health and WellnessHealth and Wellness Coverage for AllCoverage for All AffordabilityAffordability
GOVERNMENT
Healthy, productive & economically competitive state DOCTORS &
HOSPITALSExpanded insured
populationFair compensation
Shared BenefitShared Benefit
HEALTH PLANS Expanded market
Fair compensation
EMPLOYERS
Affordable coverage
Healthy, productive workforce
INDIVIDUALSAccess to
affordable coverageHealth care security
Healthier CA
Shared Responsibility Shared Responsibility
EMPLOYERSSupport employee access to affordable coverage
DOCTORS & HOSPITALS
Provide affordable, quality care
Share cost savings
GOVERNMENT Promote functional health care marketProvide access to affordable coverageFairly compensate Medi-Cal providers
INDIVIDUALS
Obtain health coverage
HEALTH PLANS Guarantee access to affordable coverage
Pass along savings
The HOW: Overall The HOW: Overall ApproachApproach
Gubernatorial LeadershipGubernatorial Leadership Small dedicated staff team in GOSmall dedicated staff team in GO Administration-wide workgroupAdministration-wide workgroup All ideas on the tableAll ideas on the table Comprehensive approach – Comprehensive approach –
prevention, coverage, cost prevention, coverage, cost containmentcontainment
The How: The How: Vehicles to AdoptionVehicles to Adoption
Concept PapersConcept Papers Policy BillPolicy Bill Financing by Ballot Financing by Ballot InitiativeInitiative
Historic Coalition of Historic Coalition of SupportSupport
Republican Governor and Democratic SpeakerRepublican Governor and Democratic Speaker Broad coalition for change – 2000+ meetingsBroad coalition for change – 2000+ meetings
Most insurers pro guaranteed issue and profit capsMost insurers pro guaranteed issue and profit caps Consumer groups, some unions pro-individual Consumer groups, some unions pro-individual
mandatemandate Business groups/local chambers pro-minimum Business groups/local chambers pro-minimum
employer contributionemployer contribution Hospitals pro hospital feeHospitals pro hospital fee Research, analysis, advocacy communitiesResearch, analysis, advocacy communities
Process Challenges in Getting to Process Challenges in Getting to YesYes
Timing, competing prioritiesTiming, competing priorities 2008 context – Term limits reform; 2008 context – Term limits reform;
Presidential election; November ballot Presidential election; November ballot initiative(s)initiative(s)
Unusual bedfellows means slow negotiationsUnusual bedfellows means slow negotiations Status quo as choice #2 for some groupsStatus quo as choice #2 for some groups Lack of broad base of legislative championsLack of broad base of legislative champions Easier to stop than to enact reformEasier to stop than to enact reform
How: Process LessonsHow: Process Lessons
Be Consistent With the MessagingBe Consistent With the Messaging Meet, Meet, and Meet AgainMeet, Meet, and Meet Again Keep The Issue in The Public EyeKeep The Issue in The Public Eye Build Your Coalition As Early As PossibleBuild Your Coalition As Early As Possible Use Neutral Third Parties to Conduct Use Neutral Third Parties to Conduct
Fiscal and Policy ResearchFiscal and Policy Research
What: Resonance of Key What: Resonance of Key ConceptsConcepts
Status Quo as UnacceptableStatus Quo as Unacceptable Hidden TaxHidden Tax Shared BenefitShared Benefit Shared ResponsibilityShared Responsibility Culture of CoverageCulture of Coverage
What: Policy AdvancesWhat: Policy Advances Coverage or expanded access for nearly all ofCoverage or expanded access for nearly all of California’s 5.1 million uninsuredCalifornia’s 5.1 million uninsured Coverage of all kids, regardless of immigrationCoverage of all kids, regardless of immigration statusstatus Personal responsibility for coveragePersonal responsibility for coverage Shared responsibility for financing – minimumShared responsibility for financing – minimum employer contributionemployer contribution Affordability mechanismsAffordability mechanisms Sweeping insurance market reformsSweeping insurance market reforms
What: Policy AdvancesWhat: Policy Advances Transparency and public reportingTransparency and public reporting Safety net provider protectionsSafety net provider protections Affirmation of the role of public health Affirmation of the role of public health
plansplans Comprehensive health and wellnessComprehensive health and wellness Medi-Cal provider rate increasesMedi-Cal provider rate increases Full financing outside the General Fund;Full financing outside the General Fund; mechanisms to protect the General Fundmechanisms to protect the General Fund
Policy Tension PointsPolicy Tension Points Affordability – cost for moderate income Affordability – cost for moderate income
individualsindividuals Individual mandate – exemptions, Individual mandate – exemptions,
enforcementenforcement Financing – employer fee; indexing to health Financing – employer fee; indexing to health
care cost inflationcare cost inflation Market reforms - timeline for elimination of Market reforms - timeline for elimination of
health status rating, sale of products below health status rating, sale of products below the minimumthe minimum
What: Policy LessonsWhat: Policy Lessons
More is more -More is more - Comprehensive versus incremental Comprehensive versus incremental
Post-partisanship tensions -Post-partisanship tensions - Market-based versus government-based Market-based versus government-based
Context matters -Context matters - State budget, economyState budget, economy
What: Policy LessonsWhat: Policy Lessons
It’s all about coverage - It’s all about coverage - Coverage versus cost containmentCoverage versus cost containment
Show me the money -Show me the money - Sources, adequacy of financingSources, adequacy of financing
When: Forward We GoWhen: Forward We Go
Our goals remain – prevention & wellness, Our goals remain – prevention & wellness, universality of coverage, cost containmentuniversality of coverage, cost containment
Our commitment to lead remainsOur commitment to lead remains
Our resolve remainsOur resolve remains
Timing of Next StepsTiming of Next Steps
Two-Phase Comprehensive ApproachTwo-Phase Comprehensive Approach Phase I – This Year (Legislative) Phase I – This Year (Legislative)
Cost ContainmentCost Containment PreventionPrevention Consumer ProtectionConsumer Protection
Phase II Phase II Coverage ExpansionCoverage Expansion Financing (Ballot Initiative)Financing (Ballot Initiative)
Contact Info:Contact Info: Kim Belshe, Secretary, Health and Human Kim Belshe, Secretary, Health and Human
Services AgencyServices Agency [email protected]@chhs.ca.gov
Richard Figueroa, Deputy Cabinet Richard Figueroa, Deputy Cabinet SecretarySecretaryOffice of Governor Arnold SchwarzeneggerOffice of Governor Arnold Schwarzenegger [email protected]@gov.ca.gov
Sandra Shewry, Director, Department of Sandra Shewry, Director, Department of Health Care ServicesHealth Care Services [email protected]@dhcs.ca.gov
