recommendations for delivery system reforms and financing care for the remaining uninsured henry...
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Recommendations for Delivery System Reforms
and Financing Care for the Remaining Uninsured
Henry TuttleChief Executive Director
San Diego, CA www.ccc-sd.org
ITUP Conference | February 17, 2015
Remaining Uninsured Data
Pre ACA Post ACA
San Diego 22% 14% Riverside 34% 20% Imperial 34% 21%
Pre ACA Post ACA
San Diego 9% 5%Riverside 9% 7%Imperial 12% 8%
Adults (19-64)
Youth (0-18)
Enrollment Issues
In addition to policy considerations, not all of those eligible for medical coverage have enrolled into the available programs. Of the adult population in San Diego, 14% of the population is uninsured.Of this group, 45% are eligible for Medi-Cal or Covered California with subsidies.
Factors for non enrollment include: cost, concerns, fears of government programs, and being uninformed
As of late 2014, 27% of the those uninsured adults in San Diego County who remain uninsured are undocumented. This increases to 28% in Riverside County, and 30% in Imperial County.
2019 Remaining Uninsured ProjectionsCALIFORNIANS UNDER
AGE 65 PROJECTED TO REMAIN UNINSURED -
HIGH SIGN-UP SCENARIO
California - 2019
San Diego County – 2019
ELIGIBLE FOR MEDI-CAL550,000 40,000
ELIGIBLE FOR COVERED CA SUBSIDIES
380,000 30,000
NON-SUBSIDY ELIGIBLE CITIZENS & LEGAL IMMIGRANTS
440,000 40,000
NOT ELIGIBLE DUE TO STATUS 1,350,000 100,000
TOTALS 2,720,000 210,000
Policy Considerations
• SB 4 (proposed) - Lara Bill would provide access to health coverage to all Californians, regardless of immigration status.
• The Lara Bill is pending before the California Senate Rules Committee as of Jan 2015.
• Federal Actions (DAPA/DACA) – recent executive action should qualify some additional undocumented for Medicare.
Medicare Shift & Transformation• In President Obama’s February 4, 2015 budget proposal, there
are a number of health related changes to Medicare reimbursements, no longer based exclusively on patient load.
• Proposed federal budget reductions as proposed in the Obama budget to Medicare would impact health care providers and result in structural reforms to Medicare, and likely to Medi-Cal as well.
• A funding source as a result of Medicare changes - Cadillac premium tax issues.
Potential Funding Options
• Undocumented drivers’ license fee
• Money orders to Mexico & other countries’ fees
• California medical device tax
• Hospital tax
• Medical provider tax
Potential Funding Options…
• Pharmacy tax - both prescription & non prescription medication
• Increase criminal background check fees
• Excess earnings on Health Savings Accounts or 529 college plans
• Tobacco settlement
• County General Fund - can be used to cover costs of unfunded health coverage for the undocumented
Potential Funding Options…
• Tax deductible contributions, through crowd source funding or other mechanism
• Marijuana sale additional tax
• Medical marijuana dispensary tax
• Increased cigarette tax
• Medical provider license fee taxes
For additional information, or copies of referenced documents, please contact:
Henry Tuttle htuttle@ccc-sd.org
(619) 542-4343www.ccc-sd.org
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