Transcript UULM Mental Health Community Power Point 2011

Bring Federal Health Care
Reform Home to California!
Health Care Reform 2011
Mental Health Focused Presentation
Part of the Central Valley
Education Project
Unitarian Universalist Legislative Ministry of California
Sponsored by the California Endowment and
Rev. 2.16.11
©2011 Unitarian Universalist Legislative
Ministry of California
www.uulmca.org
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Unitarian Universalist Legislative
Ministry of California
Since 2001, UULM of California has empowered the moral voice of UUs, their
partners, and individuals of conscious by educating, organizing, and
advocating for public policies that uphold the public good. We affirm:
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Respect for the inherent worth and dignity of every person
Justice, equity and compassion in human relations
Respect for the interdependent web of all existence of which we are a part
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Recognition that affordable, high quality health care is a human right
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©2011 Unitarian Universalist Legislative
Ministry of California
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Four Part Presentation
I.
Why the U.S. needs federal health care
reform
II.
What health care reform offers to all
Americans
III.
How health care reform helps
individuals dealing with mental health
issues
IV.
What you can do to implement &
improve health care in California
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©2011 Unitarian Universalist Legislative
Ministry of California
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Part I
Why the United States
Needs Health Care Reform
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©2011 Unitarian Universalist Legislative
Ministry of California
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People are suffering
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50 million in U.S. uninsured in January 2010
 8 million individuals are uninsured in California
 Californians are less likely to get coverage through their
employer and must buy insurance on their own
44,000 deaths each year due to lack of health insurance
 1 person died every 12 minutes
 Many of these individuals had pre-existing health conditions
and could not purchase insurance at any price
 Because of state budget cuts, fewer “safety net” public health
resources for individuals and families
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Ministry of California
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US families pay MORE
for LESS health care
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Families in the United States pay more for health care
than any other country in the world, but rank only #37
in health outcomes according to the World Health
Organization.
The United States is the only major industrialized
country where for-profit companies provide most
people their health insurance.
60% of U.S. bankruptcies due to health costs; 75% of
medical bankruptcies happen to people with health
insurance.
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Ministry of California
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Part II
What Federal Health
Reform Offers All
Americans
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Ministry of California
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Patient Protection and Affordable
Care Act (ACA) covers 32 million
previously uninsured people
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Reduces the federal deficit
$650 Billion to $1.3 Trillion
by 2019
Brings federal money into
California for health care
Creates a framework upon
which we can build a
universal health care
system.
©2011 Unitarian Universalist Legislative
Ministry of California
www.uulmca.org
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The ACA makes health insurance affordable
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Medicaid (Medi-Cal) Expands in 2014
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California State Insurance Exchange Begins in 2014
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3 to 4 million Californians can purchase affordable, high-quality individual
policies online in a state regulated “pool.”
Exchange has bargaining power of a very large company
Guaranteed coverage regardless of pre-existing conditions
Affordability credits provided and out-of-pocket costs limited for individuals
and families at 133-400% FPL (~$88,000 for family of four)
California Pre-Existing Condition Insurance Plan Started in 2010
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Covers people with incomes up to 133% Federal Poverty Level (FPL)
(~$29,000 for a family of 4). Includes adults without dependent children.
Provides coverage today for individuals with pre-existing conditions
Funding for program—$40 million—from the federal government
Eliminates the “Hidden Tax” paid by individuals with insurance.
No co-pays for preventive care visits and screenings.
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Ministry of California
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Protects consumers from
insurance company abuses
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End of policy rescission for minor mistakes on initial health
questionnaires.
Lifetime insurance payout limits banned and annual limits phased out.
Insurance companies can no longer deny policies to individuals with
pre-existing conditions.
Premium rate hikes of over 10% for individual insurance plans require
review by California insurance regulators.
Equal premiums for women and men beginning 2014. Health plan
premiums only vary based on age (3:1 ratio), geographic area, tobacco
use (1.5: 1 ratio), and number of family members.
Private insurance companies must spend 80% to 85% of premiums on
medical care or provide rebates to consumers.
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Ministry of California
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Guaranteed issue for children with
pre-existing health conditions
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Prohibits insurers from denying
children up to age 19 for coverage
because of pre-existing conditions
Insurers cannot charge sick
children more than 2x the cost of
coverage for healthy child
To lock in best premium rate,
parents must enroll their children:
in open enrollment period of JanFeb 2011, birthday month, or when
family has a major life change.
©2011 Unitarian Universalist Legislative
Ministry of California
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The ACA helps young adults
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Lowers Costs for Young Adults
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Security of Insurance Coverage
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No co-pays for preventive care
visits and screenings
Young adults can now be covered
on parents’ plan until age 26.
Estimated to impact over 4 million
young adults nationwide.
©2011 Unitarian Universalist Legislative
Ministry of California
www.uulmca.org
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Federal health reform helps
those on Medicare
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Free annual wellness visit and
personalized prevention plans
Free preventive health services
such as vaccinations and cancer
screenings
Close Medicare Part D “doughnut
hole” by 2020
This year drug companies will
give 50% discount off brand drugs
for individuals in the doughnut
hole.
©2011 Unitarian Universalist Legislative
Ministry of California
www.uulmca.org
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ACA helps small businesses
offer health benefits
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4 million small businesses and non-profits
qualify for tax credits that cover up to 35% of
employees’ insurance premiums (increases to
50% in 2014)
Small businesses are already responding to
promise of tax credits and offering insurance
coverage to employees
Small employers can purchase employee
health benefits through the State Insurance
Exchange beginning 2014
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©2011 Unitarian Universalist Legislative
Ministry of California
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We Can Do Better! Areas
Needing Improvement
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Fair access to health care for immigrants
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Legal immigrants 5-year waiting period, but can purchase
insurance through a state insurance exchange.
Undocumented immigrants have NO guaranteed access to
Medi-Cal or the State Insurance Exchange.
Adult dental and vision care in MediCal
Full coverage of women’s reproductive health
Single Payer possible in California by Sen. Mark
Leno
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Ministry of California
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Part III
How Federal Health
Reform Helps People with
Mental Health Issues
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Ministry of California
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Increased access to individual
private health insurance policies
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Approximately 90% of people with serious mental
illnesses are unemployed. This means they do not have
an employer-based health insurance plan. The ACA
helps these individuals purchase individual private
insurance plans.
Health insurers will have to sell and renew policies to all
who apply (called “guaranteed issue and renewal”)
beginning 2014.
Insurers cannot deny coverage for a pre-existing
condition beginning in 2014.
No health plan can have a lifetime (now) or annual limit
(by 2014) on benefits.
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©2011 Unitarian Universalist Legislative
Ministry of California
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Increased access to individual
private health insurance policies
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Premiums may only vary by a limited amount
and only on the basis of a few factors (tobacco
use, age, geographic area and family size).
Health insurers cannot discriminate based on a
person’s mental or physical disability.
Young adults (up to age 26) must be allowed
coverage under their parents’ health insurance,
if their parents so desire.
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©2011 Unitarian Universalist Legislative
Ministry of California
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California State Insurance
Exchange will cover mental health
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Policies sold through the California State Insurance
Exchange must comply with the federal Mental Health
Parity and Addiction Equity Act of 2008
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Requires health insurance plans offer coverage of mental health
and substance abuse treatment comparable to the coverage
offered for medical benefits.
ACA states that mental health treatment is a designated
“essential health benefit” that will be further defined by
the Secretary of Health and Human Services. Two key
provisions require:
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emergency services must be provided without a preauthorization requirement
the cost-sharing requirement for essential health services must
be the same whether provided in-network or out-of-network
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©2011 Unitarian Universalist Legislative
Ministry of California
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California State Insurance
Exchange will cover mental health
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The law makes premium tax credits available to help
individuals with incomes from 133% to 400% of the
federal poverty level.
Limits the total of out-of-pocket costs and provides costsharing subsidies for individuals and families in
exchange to around $11,000 a year:
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Those with the lowest incomes will pay a share of no more
than 6% of their health care costs;
this rises in steps so that people with incomes at 400% of
poverty would pay no more than 30% of costs.
©2011 Unitarian Universalist Legislative
Ministry of California
www.uulmca.org
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Improvements to MediCal,
Medicare & Dual Elligibles
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Creates health care “homes” in Medicaid for people who have
more than one chronic condition. These entities will provide
comprehensive care management, coordination and referrals to
appropriate community services.
Includes $50 million for grants from the Substance Abuse and
Mental Health Services Administration for co-locating primary care
on-site in community mental health agencies.
Access to medications in the class of benzodiazapines and
barbiturates, currently included in the list of excludable drugs in
Medicaid, is improved.
Provisions to streamline the MediCal application process for
individuals with disabilities.
Individuals on Medicare because of psychiatric disability will benefit
from the closing of Medicare’s Part D doughnut hole.
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©2011 Unitarian Universalist Legislative
Ministry of California
www.uulmca.org
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California’s New MediCal Waiver
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New 1115 MediCal waiver - “California Bridge to Reform” - began
Nov. 1, 2010 and run for five years. If requirements and milestones
met, brings $10 billion in federal funds into California.
Waiver’s major components:
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Medicaid Coverage Expansion (MCE) for people with income at or below
133% of federal poverty level (FPL) (Alameda & Contra Costa have
applied)
**Mandatory enrollment of Seniors and Persons with Disabilities (SPDs)
on MediCal into MediCal Managed care plans. Dual eligibles are not
required to enroll in MediCal Managed Care plans. (California SB 208)**
Interested in advocating for an effective, expansive MediCal Waiver
program in your county? Contact Policy Analyst Linda Leu at Health
Access—lleu@[email protected].
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©2011 Unitarian Universalist Legislative
Ministry of California
www.uulmca.org
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Part III
What You Can Do to
Implement & Improve
Health Care in California
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©2011 Unitarian Universalist Legislative
Ministry of California
www.uulmca.org
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Proposed Budget Cuts to
Watch!
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Check out the Health Access flyer on specific MediCal budget cuts.
Proposal to divert voter-approved Mental Health Services Act (Proposition
63) funds to the General Fund.
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PRO: Considering massive cuts to the entire MediCal program it may be helpful to limit
those basic health costs by making Prop 63 funds available to MediCal.
CON: No promise that Prop 63 funds will go back into MediCal program once the funds go to
the general fund.
CON: Local communities have already greatly benefited from these effective Mental Health
Services Act programs. For example, after just one year in an adult Full Service Partnership
program in San Diego County funded by the Act, clients experienced: 67% fewer days of
homelessness, 32% fewer emergency room visits, 17% fewer jail days, and 14% fewer
hospitalizations
AB 3632 Funding
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Governor Schwarzenegger vetoed $133 million in funding for services through county mental
health departments to special education students who need mental health services to stay in
school. On October 21, 2010, a lawsuit to preserve lifeline services for up to 20,000 students
statewide was filed in federal court by Mental Health Advocacy Services.
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©2011 Unitarian Universalist Legislative
Ministry of California
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California 2011 legislation to
watch
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AB 154 (Beall) Requires private insurance policies to include the
“diagnosis and treatment of a mental illness of a person of any age
and would define mental illness for this purpose as a mental disorder
defined in the Diagnostic and Statistical Manual of Mental Disorders
IV.”
AB 52 (Feuer)/SB 51 (Alquist) Require approval from the
Department of Managed Health Care and the Department of
Insurance for increases in health care premiums, co-payments, or
deductibles.
AB 181 (Portantino) Foster youth: mental health bill of rights.
SB (to be determined) (Alquist) Transitioning to a more transparent &
standardized market.
SB (to be determined) (Alquist) Public Option Would authorize
county-organized health plans and other health benefits
programs to form joint ventures to create integrated networks of
public health plans that pool risk and share networks, subject to
Knox-Keene requirements.
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©2011 Unitarian Universalist Legislative
Ministry of California
www.uulmca.org
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Additional resources
UU Voices for Health Care Curriculum
This free, adaptable seven-session healthcare curriculum
educates and empowers us to take action within our
communities. Each session is self contained.
Download for free at www.uulmca.org
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Bazelon Center for Mental Health Law: www.bazelon.org
UU Mission Peak Mental Health Ministry:
www.mpuuc.org/mentalhealth/mentalintro.html
Health Access: www.health-access.org
Kaiser Family Foundation: www.kff.org
U.S. ACA education website: www.healthcare.gov
The Healing of America by T.R. Reid. © 2009 Available at your local
bookstore or online book website.
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©2011 Unitarian Universalist Legislative
Ministry of California
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Thank you!
This presentation is brought to you by the
Central Valley Education Project & UULM CA
The CVEP project is sponsored by HEALTH ACCESS
CALIFORNIA, a statewide health care consumer
advocacy coalition, advocating for the goal of quality,
affordable health care for all Californians. Go to
www.health-access.org for more information
CVEP Partners:
EQUAL Health Network: a program of the Center for Policy
Analysis dedicated to producing thoughtful, reliable information on policies
that affect the public’s health. www.centerforpolicyanalysis.org
Imagen Public Relations LLC: Headed by PR pro, Virginia
Madueño, imagen is recognized as one of the preeminent marketing/public
relations companies in California. www.imagenpr.com
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©2011 Unitarian Universalist Legislative
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