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HomeMy WebLinkAboutMINUTES - 03252003 - SD2 BOARD OF SUPERVISORS < - y COU ►TA MUM FROM: William Walker, MD Health Services Director DATE. March 13,2003 SUBJECT: State Insurance Program SPECIFIC REQUEST($)OR RECOMMENDATIONS)&BACKGROUND AND JUSTIFICATION Recommendation- In ecommendati n-In light of the growing number of uninsured and underinsured in the Contra Costa community,the state, and the nation, the Board of Supervisors should adopt the policy position that it is essential that every person in our community have equal access to high quality, comprehensive,affordable health insurance. The feasibility of implementing various specific state bills on universal coverage should be evaluated by Family and Human Services Committee of the Board. Backuround:_ The number of uninsured, already an alarming number, is again growing rapidly due to: • an economic downturn which has lead to rising unemployment • a war which is causing jab dislocations • consolidated hospitals which are negotiating higher payments • rising pharmaceutical drug costs * costly new technology in diagnostics and treatment • taken together, these factors have resulted in escalating health insurance copayments, deductibles,and premiums In a 2001, study by UCLA, it was estimated that in Contra Costa County, on average, there were 7.1 percent of the non-elderly adults who lacked health insurance. That amounts to over 42,000 uninsured non-elderly adults in our county. In addition, there were another 10,000 uninsured Children residing in Contra Costa County. This baseline of some 52,040 uninsured children and adults residing in Contra Costa County does not begin to count those who have inadequate insurance. In 2001 in California,over six million children and non-elderly adults were uninsured for all or part of the year. Over half of these uninsured were uninsured for more than a year. There are substantial disparities in coverage stability across ethnic and racial groups. Latinos are the least likely to be insured all year and the:most likely to be uninsured all year. Given that family coverage now costs $6,000 or more a year, even moderate-income families may require help to obtain and maintain coverage. In fact,lack of health insurance,a problem traditionally associated with the poor and unemployed now is increasingly impairing the middle class. According to Census Bureau (continued on attachment) Discal 1p tract Not known at this time. It depends on which universal coverage bill is ultimately passed into legislation. CONTINUED ON ATTACHMENT: Yes SIGNATURE RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE ✓'"APPROVE OTHER i.. SIGNATURE S ACTION OF BOARD � 25, E APPROVED AS RECOMMENDED X OTHER X **SEE ATS JUMM FOR BOARD AaIC N** VOTE OF SUPERVISORS UNANIMOUS I HEREBY CERTIFY THAT THIS IS A TRUE (ABSENT ) ) AND CORRECT COPY OF AN ACTION TAKEN AYES: t NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT. ' ABSTAIN:II OF SUPERVISORS ON THE DATE SHOWN. DISTRICT III SEAT VACANT Contact Person: Milt Carnhl,CEO,CCHP!Teresa O'Riva,CCHP ATTESTED March 25 2003 CC: Milt Camhi,CEO,CCHP JOHN S'WEET'EN,CLERK OF THE BOARD OF SUPERVISORS AND C LINTY ADMINISTRATOR 4 J BY: .DEPUTY 111.11................................................................ ............................... Board of Supervisors Page 2 Date: March 19,2003 figures, over 57 percent of those who lost their health coverage in 2001 had annual incomes over $75K. Many of those who lost coverage either became unemployed or were priced out of the health insurance market by rapidly rising insurance premiums. The recent economic downturn, especially in California has particularly impacted middle-income families because many of the job losses have been in higher-wage industries such as technology and telecommunications. Increasingly,the new faces of the newly uninsured are not just the traditional welfare population but middle class Americans. New analysis shows that rising unemployment will inevitably lead to a substantial increase in the number of people uninsured. One statistical model developed at MIT shows that every percentage point rise in the unemployment rate leads to an increase of about 1.2 million in the number of people uninsured. The consequences of these growing uninsured and underinsured among our community have community-wide implications. The Institute of Medicine recently noted that"it is mistaken and dangerous to assume that the prevalence of uninsurance ... harms only those who are not insured." The large and growing number of uninsured residents in a community can affect access to care for the entire community.Communities with high rates of uninsured residents are more likely to reduce hospital services,and to take resources away from disease prevention and surveillance programs to cover the increasing costs of uncompensated care. Moreover, large numbers of uninsured inevitably leads to overcrowded emergency rooms,more costly hospital and physician services,and fewer community physicians and specialists willing to be on call and available for patients for whom they do not expect to be adequately reimbursed. The burden inevitably and increasingly fans on safety net providers such as Contra Costa Regional Medical Center,the county's health centers,the county's public health,and mental health systems to cart for the uninsured and underinsured. Against this backdrop we have, at the federal and state levels, several new proposals to address health coverage for the uninsured. While there is little disagreement this needs to be a statewide priority,there is not yet agreement on how this priority should be addressed. The proposals range from expanding government health programs to offering tax incentives to those who buy insurance to mandatory employer-based plans. As a first step, our county Board of Supervisor should adopt a policy statement that in light of the growing number of uninsured and underinsured,this Board maintain it is essential that every person have equal access to high-quality comprehensive,affordable,health insurance. The feasibility of specific state bills on providing such coverage should be evaluated by the Family and Human Services Committee of the Board. Universal Coverage Bills INOW" Status: 01/13/2003—Referred to Com. on HEALTH, Summary: Existing law establishes the Healthy Families Program,administered by the Managed Risk Medical Insurance Board,to arrange for the provision of health care services to eligible children meeting certain household income requirements. Existing law authorizes the expansion of the program to uninsured parents or other adults responsible for children enrolled in the program subject to approval of a federal waiver making available federal funds for that purpose and appropriation of requisite state matching funds. Under existing law,the Healthy Families Program becomes inoperative on January 1,2004. This bill would require the board to additionally expand the program to provide coverage to employed childless adults who are uninsured for health care coverage and who meet certain household income requirements, subject to approval of a federal waiver and appropriation of state matching funds. Comments: This bill is the most incremental of the five major"reform''bills introduced. ■ Childless adults are the major group of individuals that now have no coverage except through counties under W&I Code Section 17,000. ■ However,current federal law does not make any reference to using federal funds under Healthy Families to cover adults without children, and it is not clear what possible basis CMS would have to grant a"waiver." Status: 03/10/2003—Referred to Com. on HEALTH. Summary: Under existing law,a small employer,as defined,may participate on a voluntary basis in a program to provide health care coverage to its employees. This bill'would require every employer with 500 or more employees to provide health care coverage to its employees and their dependents effective January 1, 2004,and would impose this requirement on all other employers effective January 1, 2005. The bill would designate various methods by which an employer may satisfy this requirement, including paying into the California Health Care Coverage Pool,which would be created by the bill. The bill would make the Managed Risk Medical Insurance Board responsible for administering and operating the pool. ........................................................I................ ................ ................................................................. .................. "Board of Supervisors Page 3 Date: March 19,2003 Comments: ■ This bill has been called"pay or play light." • The Chamber will vigorously oppose all of the major reform proposals,with the possible exception of the Blue Shield proposal, • Labor favors a broader pay or play proposal, sponsored by Burton. Status: 02/24/2003—In ASM RULES awaiting referral to ASM. HEALTH. Summary: Existing law provides health care coverage programs to segments of the population meeting specified criteria who are otherwise unable to obtain health care coverage. This br'll would state the intent of the Legislature to enact the Healthy California Act of 2003 to ensure access to health care coverage for all Californians. Comments: • This bill will embody the proposal made by Blue Shield CECT Bruce Bodaken in his speech before the San Francisco Commonweadh Club last December. • Blue Shield's proposal has the support of Kaiser Permanente, the CMA,and the hospitals. • Labor favors the Burton pay or play proposal,but probably will not oppose this bill. ■ This bill could likely be supported by several major health plans,but opposed by others. The points of contention among plaits include.the scope of the"essential"benefit package(some plans favor a more comprehensive benefit design; others want less expansive products to serve as the basis for a minimum benefit package);whether the proposal should include guaranteed issue, and worries that the proposal could invite rate regulation. Status: 01/08/2003—In SEMI RULES awaiting referral. Summary: This bill would declare the intent of the Legislature to develop an employer-based health care coverage system that provides health insurance to every employee in California. Comments: ■ Labor's pay or play proposal is the bill everyone is watching, largely because it was commandeered by Sen. Burton, the President Pro Tem of the Senate. • There is no language yet available on this bill. What size of employer they will include, and what scope of benefits they will require are still the subject of discussions. „ , _ .W Status: 03/17/2003 - SEN HEALTH. Set,first hearing. Hearing canceled at the request of author. Summary: Existing law provides for the creation of various programs to provide health care services to persons who have limited incomes and meet various eligibility requirements. These programs include the Healthy Families Program administered by the Managed Risk Medical Insurance Board,and the Medi-Cal program administered by the State Department of Health Services. Existing law provides for the regulation of health care service plans by the Department of Managed Health Care and health insurers by the Department of Insurance.This bill would establish the California Health Care System to be administered by the newly created Health Care Agency under the control of an elected Health Care Commissioner. The bill would make all California residents eligible for specified health care benefits under the California Health Care System,which would, on a single-payer basis,negotiate for or set fees for health care services provided through the system and pay claims for those services. The bill would prohibit deductibles or copayments during the initial first 2 years of operation of the health care system,but would authorize the commissioner to establish deductibles and copayments thereafter. -................................................................................. ......................................... ADDENDUM TO ITEM S1D.2 March 25, 2003 The Board of Supervisors considered the recommendations from the Health Services Director regarding the growing number of uninsured and underinsured in the Contra Costa Community and the State Insurance Program Universal Coverage Bills. Dr. Walker's presented the following Universal Coverage Bills: AB30 (Richman) Expand Healthy Families to Include Childless Adults; AB 1527 (Frommer) "Pay or Play" Phased-in System; AB 1528 (Cohn) Blue Shield Proposal; SB2 (Burton) "Pay or Play" System; and SB921 (Kuehl) Single Payer System. He advised that the California Association of Public Hospitals Board of Directors met and decided not to take a position on any of the bills except SB2 (Burton). The Chair then invited those who wished to address the Board and the following persons presented testimony: John Dalaymple, AFL-CIO, 1333 Pine Street, Martinez Rollie Katz, Local One, P.O. Box 222, Martinez Cesar, SEIU Local 1877, 2759 26th, Oakland Supervisor Gioia advised that the report the Board receive did not have language or information regarding SB2 (Burton) and since the Public Hospitals Board of Directors took a position in favor of the bill, he requested Dr. Walker to summarize the content of the new language and the direction of the bill. Dr. Walker summarized that the bill would require employers to provide coverage for employees and dependants. Employees would pay up to 20% of the cost or pay into the state health purchasing program to be run by the Managed Risk Medical Insurance Board. Milt Camhi also added that SB2 does have a prescription drug benefit. Supervisor Gioia moved to approve the recommendations presented today and support in concept the State Insurance Program Universal Coverage Bills and directed the Health Services Director to return on April 1, 2003 with ftirther information regarding SB2 (Burton)Pay or Play System for discussion. .......... ......... ...................................... ............................ ''I'll-,.......I...I..,............................................................................. . ......... .......... Page 2 March 25, 2003 SD.2 The action of the Board: ❑ SUPPORTED in concept the position of the growing number of uninsured and underinsured in the Contra Costa Community, and the State Insurance Program Universal Coverage Bills a DIRECTED the Health Services Director to return to the Board of Supervisors on April 1, 2003 with further information regarding SB2 (Burton) Pay or Play System. ................................ .. ..........................