recommendations for delivery system reforms and financing care for the remaining uninsured henry...
TRANSCRIPT
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 [email protected]
(619) 542-4343www.ccc-sd.org