California has a unique opportunity to fix our broken health care system and make a real difference in the lives of millions of Californians by taking action for health care reform this year. To make sure this happens, the It’s OUR Healthcare! coalition has come together in support of the following goals and guidelines for health care reform:
- Ensure access to quality health care and coverage at affordable and reasonable costs for all California consumers.
With costs spiraling out of control and more than 6.8 million uninsured Californians, reform efforts need to include all Californians and must take into account an individual’s ability to pay for services. Reform efforts should:
· Limit costs and premiums for consumers, with the total amounts scaled to income. In setting limits, calculations must include the total consumer cost for all aspects of health care including premiums, deductibles, co-pays, prescription drug costs, and other out-of-pocket medical expenses.
· Maintain strong standards for minimum benefits packages in all health insurance products.
· Establish a program like Unemployment Insurance or Disability Insurance to assist early retirees, workers between jobs and workers in a health care waiting period.
· Reject proposals that undermine high quality, affordable health for the Californians who already have it.
- Expand public coverage programs for children and adults.
More than nine million Californians rely on public coverage programs for their health care. Despite the wide reach of essential programs like Medi-Cal, Healthy Families, and Medicare, nearly seven million Californians still lack coverage. Health care reform efforts should:
· Expand eligibility in Medi-Cal and Healthy Families to cover all children regardless of immigration status.
· Work for the 2007 federal reauthorization and increased funding of the State Child Health Insurance Program (SCHIP), which provides two-thirds of the funding for California’s Healthy Families program. Funding levels should account for growth in the program, meeting the goal of covering all children, and covering the parents of the children in Healthy Families.
· Expand Medi-Cal to cover low-income adults, including those without children at home. These Californians are not eligible now, even if their income level is below the federal poverty level.
· Increase Medi-Cal rate reimbursements to improve access to providers for those on Medi-Cal.
· Simplify and streamline the Medi-Cal and Healthy Families programs so that families can more easily apply for, enroll in, stay on, and best use health coverage.
- Establish a standard for employers’ contribution to health care that helps fund the system, strengthens coverage for workers, and encourages union/employer cooperation.
48% of Californians receive employer-based health coverage, yet the quality, availability and stability of that coverage varies tremendously. Reform efforts should:
· Set a minimum standard for employer-based health coverage, similar to a minimum wage for pay. An appropriately set standard will help fund the system, level the playing field between employers, stabilize existing coverage for 17 million Californians and expand coverage to the 5.3 million uninsured Californians in working families.
· Require an employer contribution for coverage for all workers, including self-employed, part-time, seasonal, and intermittent employees.
- Place stronger rules and oversight over insurers for both access to and standards for coverage, to preserve and increase consumer protections so Californians can get the health care and coverage they need.
For millions of uninsured Californians, health insurance is simply unaffordable. For some, it is unattainable at any price because of the insurance industry’s behavior. To address these problems, reform efforts should:
· Ensure that all Californians, including those with pre-existing conditions, have access to coverage, rather than allowing insurers to cherry-pick potential policyholders based on whether or not they are a low health risk, denying coverage to those that need care.
· Prevent price discrimination based on age, gender, or illness.
· Ensure that a significant portion of premium dollars go to patient care, rather than overhead and profit.
· Standardize benefits so that purchasers can better shop between comparable plans with similar benefit designs.
· Adopt and implement rules for insurers that apply to both the individual and group markets as well as any public purchasing pool option.
- Expand group purchasing pools for consumers to share risk, as opposed to efforts to shift risk and place financial burdens and barriers on individual consumers and families.
Group purchasing pools, including employer purchasing pools and government programs, have amply demonstrated their success at lowering the cost of health care. Left on their own, individual consumers do not have the market power necessary to drive prices down and, as a result, end up paying the highest prices for identical services. To address these issues, health reform efforts should:
· Take steps toward consolidating consumer, government, and employer purchasing power rather than dispersing it.
· Allow individuals, employers, and the self-employed to participate in a publicly-operated health insurance purchasing pool.
· Establish a prescription drug purchasing pool that is accessible to all Californians and uses the power of bulk purchasing to lower the cost of medicine.
· Consolidate state prescription drug and health care purchasing to achieve the best possible rates for publicly supported programs and benefits.
- Preserve the safety net of emergency rooms, clinics, and public hospitals on which we all rely, especially people who are left out of the system and without coverage.
Public hospitals already work on very thin margins, and have the challenge of serving as both a trauma and emergency safety-net for all Californians and as the primary provider of care for society’s most vulnerable. To stabilize our vital safety net institutions, reform efforts should:
· Reject efforts to de-fund public hospitals and community clinics to pay for other parts of the health care system.
· Recognize the legally-mandated role that safety net providers have in providing care to all Californians and fund them appropriately.
· Ensure that all safety net institutions have adequate and appropriate facilities and medical personnel to meet the health care needs of the Californians that rely upon them.
- Support cost containment focused on prevention, safety, efficiency, transparency, and group purchasing so that consumers pay less and get more.
While reducing the cost of health care is extremely important to increasing access to care, it cannot be done by reducing care or cutting corners with patient health and safety. To lower costs, policymakers should instead look to health and safety improvements, increased transparency and efficiency measures including:
· Public health initiatives around obesity, diabetes, heart disease, smoking, and other major ailments, and systemic changes to promote a healthy environment.
· Recognizing that good nutrition is essential to good health by adequately funding nutrition programs for seniors, children, and low income, underserved groups.
· Efficiencies, including information technology initiatives, to help streamline bureaucracy and identify best practices.
· Requiring better assessment and planning of community needs for hospital services, providers and health infrastructure.
· Mandating insurer transparency and rate review.
· Limiting health insurance brokers’ fees.
· Ensuring that preventative care and disease management tools are provided to at low or no cost to patients on a pre-deductible basis.
· Requiring hospitals and pharmaceutical companies to provide complete safety and effectiveness information to the public about their services and products, allowing patients and purchasers to make informed, cost-conscious decisions.
- Meet the specific needs of the full diversity of California, toward equity and access for all.
While major health reform will generally help all Californians, different Californians have different needs. To reduce health disparities, specific policies are needed including:
· Oversight over the pending regulations at the Department of Managed Health Care and the Department of Insurance to set standards for cultural and linguistic access to care.
· Standards for health plans and providers to ensure that people with disabilities can get needed information and can access providers.
· State reforms to address the shortcomings of Medicare Part D prescription drug coverage by eliminating the newly-imposed co-payments for low-income “dual-eligible” seniors and people with disabilities and, to the maximum extent possible, easing the burden of the “donut hole” in coverage.
- Ensure that the debate includes, and that reforms take steps forward to, the goal of a comprehensive, universal health system, like Medicare for all.
A comprehensive and universal health care system would provide security for California families, substantial cost savings for taxpayers and employers alike, and better health outcomes for patients. Recognizing these benefits, policymakers should:
· Reject proposals that move the state further from this goal.
· Support immediate and concrete steps that move the state toward a comprehensive, equitably financed, and universal health care system. RMM@seniors.com
