GOOD AFTERNOON LIKE TO GO AHEAD
AND GET STARTED HERE.
FOR THIS JOINT --
JOINT MEETING --
WE WILL --
HAVE SOME COMMENTS AND THEN
OWNED BY.
THE CHAIRS AND OTHER MEMBERS TO
COME IN IF THEY IF THEY WISH AS
MOST OF PERSONAL THANK YOU VERY
MUCH FOR BEING HERE ON ON TODAY
IT'S BEEN QUITE A DAY ALREADY
WITH THE STATE OF THE STATE
ADDRESS AND APPRECIATE PEOPLE --
PEOPLE COMING UP TO JOIN US
TODAY SO GOOD AFTERNOON ONCE
AGAIN. ONE OF THE MOST CRITICAL
ISSUES IN HEALTH CARE IS
AFFORDABILITY.
AFFORDABLE PRESCRIPTIONS
AFFORDABLE TREATMENTS AFFORDABLE
HEALTHCARE PREMIUMS AND OUT OF
POCKET COSTS.
AND ALTHOUGH WE CAN CONTINUE TO
STRIVE TO MAKE PREMIUMS MORE
AFFORDABLE WE CAN'T FORGET.
THERE IS NO SUCH THING AS
AFFORDABILITY WITHOUT COST
CONTAINMENT.
CONTINUE TO STRUGGLE TO PAY
THEIR PREMIUMS AN OUT OF POCKET
COSTS AND SOME OF STOP PAYING
FOR COVERAGE ALL TOGETHER.
ALTHOUGH CALIFORNIA'S ME
TREMENDOUS GAINS AS A RESULT OF
THE ACA IN THE INDIVIDUAL MARKET
IS STILL QUITE A WAYS TO GO.
WITHOUT FURTHER STATE ACTION THE
NUMBER OF UNINSURED IN STATE
COULD RISE FROM THREE AND A HALF
MILLION AS REPORTED AND FOR TWO
THOUSAND SIXTEEN TWO FOUR
MILLION.
IN TWENTY TWENTY AND FOUR POINT
FOUR MILLION IN.
TWENTY TWENTY THREE THERE AT
LEAST ONE POINT TWO MILLION
CALIFORNIANS WHO REMAIN
UNINSURED DESPITE BEING ELIGIBLE
TO PURCHASE COVERAGE TO COVER
CALIFORNIA.
WITH OR WITHOUT SUBSIDIES.
PREMIUM SO CITIES ARE BASED ON A
FORMULA POVERTY LEVEL WITH THE
UPPER LIMIT SET BY THE ACA AT
FOUR TIMES THE FEDERAL FEDERAL
POVERTY LIMIT.
THIS MAKING THIS THIS MAY BE
HELPFUL TO SOME PEOPLE IN
CALIFORNIA --
BUT NOT ENOUGH INCLUDING THE
MIDDLE CLASS FOUR TIMES THE
FEDERAL POVERTY LEVEL IS
EQUIVALENT TO FIVE TIMES THAT
LEVEL IN CALIFORNIA AND SIX
TIMES AT MORE COSTLY AREAS OF
THE STATE.
LAST YEAR WE PROPOSED A BILLION
DOLLAR BUDGET PACKAGE OF BILLS
AND BUDGET ITEMS TO IMPROVE
ACCESS TO HEALTH CARE.
AMONG THOSE PROPOSALS WERE BILLS
OFFER BY MID POCKET BY MR CHIU
MISTER FRIEDMAN AND DOCTOR
ARAMBULA TO TACKLE AFFORDABILITY
ISSUES.
BUT THESE BILLS EITHER LANGUAGE
TO TO COSTA WERE VETOED BY
GOVERNOR BROWN.
THIS YEAR I INTRODUCED
LEGISLATION SIMILAR MS
FRIEDMAN'S BILL LAST YEAR WHICH
IS ANOTHER ATTEMPT TO MAKE THE
COST OF PREMIUMS MORE AFFORDABLE
TO THOSE WHO ARE CURRENTLY
OUTSIDE OF THE SUBSIDY ELIGIBLE
RANGE.
AND SO FAR THIS YEAR AT LEAST
THREE OTHER BILLS HAVE BEEN
INTRODUCED BY MY COLLEAGUES IN
THE SENATE AND THE AND THE
ASSEMBLY.
DESPITE CALIFORNIA'S PROGRESS
REDUCING THE RATE OF UNINSURED.
A RECENT FEDERAL POLICY CHANGES
ARE MAKE ARE HAVE A DETRIMENTAL
IMPACT.
COVER CALIFORNIA EXPERIENCE A
TWENTY THREE POINT 7% DROP IN
THE NUMBER OF NEW CONSUMER
SIGNING UP FOR COVERAGE IN.
TWENTY NINETEEN A REFER TO THOSE
POLICY CHANGES IN WASHINGTON DC.
AS DEATH BY A THOUSAND CUTS.
EITHER HAVE THE MAYBE THE CALL
THEM BY SIMPLE ANOTHER SYMBOL
NAME WHICH IS SABOTAGE.
ON A MORE POSITIVE NOTE WE HAVE
A GOVERNOR WHO THROUGH HIS A
RECENT ANNOUNCEMENTS IS INVESTED
IMPROVING AND EXPANDING HEALTH
CARE FOR ALL CALIFORNIANS.
UP FOR ALL THE PEOPLE CALL
CALIFORNIA HOME.
AND THIS IN THE FIELD TO BE
TALKING ABOUT THE AFFORDABILITY
CHALLENGES AND THE BEARS TO
ENROLLMENT IN THE INDIVIDUAL
MARKET.
POTENTIAL FUNDING IN
IMPLEMENTATION CONSIDERED --
CONSIDERATIONS ALSO BE.
DISCUSSED ABOUT.
OUR SPEAKERS INCLUDE LARA LUCIA
HEALTH CARE PROGRAM DIRECTOR
FROM UC BERKELEY.
A LABOR CENTER PETER LEAVE THE
EXECUTIVE DIRECTOR COVER
CALIFORNIA.
RIGHT WILL SEE THE PRINCIPLE
FISCAL AND POLICY ANALYST FOR
THE LEGISLATIVE ANALYST'S OFFICE
AND A REPRESENTATIVE FROM THE
DEPARTMENT OF FINANCE.
WILL TAKE PUBLIC COMMENT ON THE
SUBJECT OF TODAY'S HEARING AT
THE END OF OUR AGENDA IN ORDER
TO ENSURE ALL WHO WISH TO SPEAK
OF WILL THAT WILL ASK FOR A
LIMIT OF TWO MINUTES ALL THE WE
HAVE ONE SPEAKER WE HAVE GRANTED
FIVE MINUTES.
TO LET ME --
TRIES OVER TO MY COLLEAGUE --
DOCTOR ARAMBULA SAY A FEW WORDS
AND THEN AND THEN DOCTOR PAN AND
OTHER MEMBERS AS WELL.
DOCTOR ARAMBULA.
THANK YOU.
NOT USED TO GOING BEFORE
SENATORS AND MAYBE IT'S
APPROPRIATE SINCE WERE USED TO
TIME LIMITS AND BUT WITH THAT
I'D LIKE TO START BY THANKING
BOTH CHAIRMAN WOULD IN CHAIRMAN
PAN FOR THEIR LEADERSHIP ON
INCREASING HEALTH INSURANCE
AFFORDABILITY FOR CALIFORNIANS.
IT IS AN ISSUE THAT ASSEMBLY
MEMBER WHAT AND I SPENT OVER
THIRTY HOURS LAST YEAR AND ARE
SELECT COMMITTEE ON HEALTHCARE
DELIVERY IN UNIVERSAL COVERAGE
IN THE LAST LEGISLATIVE SESSION.
HAVE MADE GREAT STRIDES AS A
STATE IN OUR IMPLEMENTATION OF
THE AFFORDABLE CARE ACT AND HAVE
EXPANDED COVERAGE TO SO MANY
AMERICANS.
AND CALIFORNIANS.
I AM GRATEFUL TO THE PANELISTS
WHO HAVE JOINED US TODAY.
ESPECIALLY FROM COVER CALIFORNIA
FOR THEIR DEDICATION TO THIS
EFFORT.
ESPECIALLY AS WE LOOK AT THE
THREATS THAT ARE COMING FROM OUR
FEDERAL ADMINISTRATION.
WELL WE HAVE COME A LONG WAY IN
HEALTHCARE WE STILL HAVE FURTHER
TO GO TO REACH UNIVERSAL
COVERAGE.
AND A PRIMARY COMPONENT OF THAT
IS TO INCREASE AFFORDABILITY OF
HEALTH INSURANCE.
FAR TOO MANY PEOPLE IN OUR STATE
BAY ON WHETHER THEY CAN AFFORD
THE CARE.
AND PAY FOR IT DESPITE HAVING
ACCESS TO HEALTH INSURANCE.
AND ALSO DESPITE MANY CONSUMERS
RECEIVING PREMIUM TAX CREDITS
AND COST SHARING SUPPORTS.
MONTHLY PREMIUMS AND OUT OF
POCKET EXPENSES ARE JUST TOO
EXPENSIVE.
I AM PLEASED TO SEE SO MANY
PROPOSALS WE PUT FORWARD.
AND THOSE THAT WE HEARD FROM
ADVOCATES AND ARE SELECT
COMMITTEE HEARINGS AND IN MY
BUDGET SUBCOMMITTEE AND HEALTH
AND HUMAN SERVICES LAST YEAR.
NOW RECOGNIZED IN THE GOVERNOR'S
JANUARY BUDGET.
I AM GRATEFUL THE GOVERNOR
NEWSOME AGAIN IS PLEDGING HIS
DEDICATION TO THE AFFORDABILITY
AND HEALTHCARE IN HIS STATE OF
THE STATE ADDRESS EARLIER TODAY.
I AM OPTIMISTIC THAT WE CAN
IMPLEMENT AND BUILD ON THE
GOVERNOR'S PROPOSALS TO IMPROVE
AFFORDABILITY AND HEALTH CARE.
I LOOK FORWARD TO OUR
DISCUSSIONS TODAY TO HELP US TO
ANALYZE OUR CURRENT OPTIONS ON
AFFORDABILITY PARTICULARLY
FOCUSING ON HOW WE WILL FUND AND
IMPLEMENT THESE IDEAS.
IN ORDER TO HELP US TO REACH OUR
GOALS.
THANK YOU AGAIN TO MY FELLOW CO
CHAIRS ON THIS INFORMATIONAL
HEARING TO OUR FELLOW ASSEMBLY
MEMBERS AND SENATORS FOR YOUR
ENGAGEMENT AND TO OUR PANELISTS
FOR YOUR EXPERTISE THAT YOUR
SHARING WITH US TODAY.
I LOOK FORWARD TO HEARING.
THANK YOU VERY MUCH I WANT TO
THANK --
BOTH --
CHAIR AND DOCTOR WOULD AND CHAIR
KNOCKED ARAMBULA.
FOR YOUR WORK IN YOUR STAFF'S
WORK ON A PUTTING THIS HEARING
TOGETHER I ALSO WANT TO WELCOME.
MEMBERS OF THE SENATE HEALTH
COMMITTEE IN THE BUDGET SO HUMAN
SERVICES --
PROUD TO HAVE MY VICE CHAIR --
CENTER STONE AS WELL AS SIR HER
CONDO HERE AND ACTUALLY THEY
SAID ON BOTH OF THOSE COMMITTEES
AS WELL WITH ME SO WE HAVE.
TO THAT --
TEAM HERE --
LOOKING VERY MUCH WORKING --
CLEVERLY WITH ALL OF YOU ON MANY
IMPORTANT HEALTH POLICY FISCAL
ISSUES THEY'LL COME BEFORE US
THIS YEAR --
IT'S NOT REFLECT THAT --
WHEN I WAS --
CHAIR OF THE ASSEMBLY HEALTH
COMMITTEE YOU KNOW SITTING THAT
SURE WE WERE PASSING THAN USUAL
LEGISLATION ESTABLISHED
ESSENTIALLY.
COVERED CALIFORNIA AND EXCHANGE
AND SO FORTH AND AND SINCE THAT
TIME HERE IN CALIFORNIA --
WE HAVE TAKEN THE LEAD AND NOT
ONLY IMPLEMENTING THE AFFORDABLE
CARE ACT BUT IMPROVING ON IT.
EXPANDING ACCESS AND TODAY WE'RE
TALKING ABOUT THE DRESSING
AFFORDABILITY.
WELL WE ARE TAKING ACTION
UNFORTUNATELY AT THE FEDERAL
LEVEL WE'VE SEEN EFFORTS TO
UNDERMINE THE ACA INCLUDING --
EFFORTS TO DESTABILIZE THE
INSURANCE MARKET WHICH LED TO
THEM THIS YEAR ALONE A 5%
INCREASE IN HEALTH INSURANCE
PREMIUMS.
THAT IS THE WRONG WAY TO GO SO
I'M LOOKING FORWARD TO HEARING
OUR SPEAKERS TODAY TALK ABOUT
SOME OF THE OPTIONS THAT WE HAVE
TO ACTUALLY IMPROVE THE ACA MAKE
IT MORE AFFORDABLE AND SURE THAT
EVERY CALIFORNIA HAS ACCESS TO
HEALTH CARE.
AND SAID VIRTUALLY SENSE OUR TOP
THEY CROSSES BOTH POLICY FISCAL
COMMITTEES IT'S REALLY IT IS
APPROPRIATE THAT WE ARE HERE
TODAY TO LEARN MORE ABOUT THESE
OPTIONS ON PLEASETHAT WE'RE
DOING THIS KIND OF QUAD
COMMITTEE HEARING HERE.
AND SINCE ONLY THIS IS NOT ISSUE
AND I ONCE AGAIN THANK THE
ASSEMBLY FOR YOUR TREMENDOUS
WORK LAST YEAR AND LAYING THE
GROUNDWORK.
BUT THIS IS CERTAINLY SOMETHING
THAT HOPEFULLY WE CAN ALL COME
TOGETHER BOTH HOUSES BOTH SIDES
OF THE AISLE AND MOVE THIS
FORWARD.
SO WELL WITH THAT --
AGAIN THANK YOU --
BOTH CHAIR WOULD AND NOW AFTER
WE ALLOW OTHER MEMBERS THEN I
WILL GO AHEAD INTRODUCE OUR
FIRST SPEAKER THINKING WELL
THANK THANK YOU VERY MUCH
SENATOR PAN DOCTOR AND WE LIVE
UNDER THE MEMBERS WHO HAVE ANY
COMMENTS BEFORE WE GET STARTED
[inaudible]
SEEING NONE.
ALL RIGHT THANK YOU MIGHT VERY
MUCH --
CHAIR KNOCKED WOULD SO OUR FIRST
PANELIST TODAY IS --
LAURA LAUREL LOOSE LUCY YEAH --
WHO'S THE HEALTH PROGRAM CARE
PROGRAM DIRECTOR OVER THE UC
BERKELEY LABOR CENTER AND I
UNDERSTAND THAT --
PEOPLE SHOULD HAVE A COPY OF THE
SLIDES THAT YOU WILL BE
PRESENTING SO VERY MUCH LOOKING
FORWARD TO YOUR A MARKS
REGARDING AFFORDABILITY ISSUES.
AFFORDABILITY CONCERNS AS A
BARITONE MOMENT AN INDIVIDUAL
MARKET THANK YOU AND WELCOME
[inaudible]
GOOD AFTERNOON.
AT AS DOCTOR PAN SAID I'M LAURA
LY CNN THE DIRECTOR OF THE
HEALTHCARE PROGRAM AT THE UC
BERKELEY LABOR CENTER.
THANKS FOR THE OPPORTUNITY TO
PRESENT OUR RESEARCH ON THE
PROGRESS WE'VE MADE UNDER THE
ACA AND ALSO THE AFFORDABILITY
TO CHALLENGES THAT REMAIN.
I WANTED TO START BY REVIEWING
THE PROGRESS THAT WE'VE MADE --
SPECIFICALLY IN THE INDIVIDUAL
MARKET MORE CALIFORNIANS WHO
GENERALLY DON'T HAVE JOB BASED
INSURANCE BY COVERAGE ON THEIR
OWN.
BEFORE THE AFFORDABLE CARE ACT
THERE ONE POINT FIVE MILLION
CALIFORNIANS ENROLLED IN THAT
MARKET.
AND A AS OF TWENTY SEVENTEEN
THERE WERE AROUND TWO POINT TWO
MILLION PEOPLE ENROLLED.
AND A LOT OF THAT ENROLLMENT
INCREASE IS DUE TO THE SUBSIDIES --
THAT ARE PROVIDED UNDER THE
AFFORDABLE CARE ACT BUT ARE ALSO
DUE TO OTHER.
FACTORS IN THE AFFORDABLE CARE
ACT LIKE THE INDIVIDUAL MANDATE
WHICH IS BEING ZEROED OUT THIS
YEAR.
UNDER FEDERAL POLICY LIKE THE
REQUIREMENT THAT INSURERS
OFFERED ALL REGARDLESS OF PRE
EXISTING CONDITIONS AND THE
STRONG OUT REGION IN MOMENT.
EFFORTS CONDUCTED BY COVERED
CALIFORNIA ALSO HAVE CONTRIBUTED
TO THE ENROLLMENT GROWTH --
THAT WE'VE SEEN.
SO THEIR APPROXIMATELY ONE POINT
TWO MILLION CALIFORNIANS WHO GET
PREMIUM SUBSIDIES --
THROUGH THE THROUGH COVERED
CALIFORNIA --
THOSE ARE ALSO CqC PREMIUM
SUBSIDIES ARE ALSO CALLED
ADVANCE PREMIUM TAX CREDITS OR
EAT PTC'S.
AND PEOPLE WHO WITH INCOME BELOW
ROUGHLY FORTY EIGHT THOUSAND
DOLLARS FOR A SINGLE PERSON OR
NINETY EIGHT THOUSAND DOLLARS
FOR A FAMILY OF FOUR ARE
ELIGIBLE FOR THESE PREMIUM
SUBSIDIES.
AND THEY HAVE AN AVERAGE VALUE
OF AROUND FOUR HUNDRED AND FORTY
FOUR DOLLARS A MONTH --
THAT THEORY BASED ON INCOME.
ABOUT HALF OF THOSE WHO GET
PREMIUM SUBSIDIES THEY'RE
COVERED CALIFORNIA ALSO GET HELP
WITH FINDING.
OUT OF POCKET COSTS.
THROUGH LOWER DEDUCTIBLES AND
COPAYMENTS AND OTHER COST
SHARING AND THAT'S A ALSO
REFERRED TO AS COST SHARING
REDUCTIONS OR CSR.
AND AND THESE ARE AVAILABLE TO A
RELEASE AT THE LOWER END OF THE
INCOME SCALE AN AVERAGE ABOUT A
HUNDRED AND THIRTY DOLLARS A
MONTH.
DEPENDING ON INCOME AND ALSO
DEPENDING ON MEDICAL USE.
SO EVEN THOUGH THE TRUMP
ADMINISTRATION DE FUNDED AS THE
FEDERAL PAYMENTS FOR THESE COST
SHARING REDUCTIONS --
CALIFORNIA ENROLLEES STILL SEE --
THIS FINANCIAL ASSISTANCE WITH
OUT OF POCKET COSTS AND A IN WE
CAN TALK MORE IN A QUESTIONING --
LISTED IT AS THEY'RE ABLE TO
RECEIVE THAT WITHOUT A LARGE
INCREASE IN PREMIUMS.
SO THE PREMIUM SUBSIDIES
SIGNIFICANTLY DECREASE HOW MUCH
PEOPLE --
WHO ARE RECEIVING SUBSIDIES PAY?
ON A MONTHLY BASIS THE AVERAGE --
NET PREMIUM CONTRIBUTION BY
CONSUMERS INCOMING CALIFORNIA
WITH SUBSIDIES IS AROUND A
HUNDRED AND FIFTEEN DOLLARS A
MONTH.
AND THAT SUBSTANTIALLY LESS THAN
THE RANGE OF AND SUBSIDIZED
PREMIUMS OF AROUND TWO HUNDRED
AND FIFTY DOLLARS A MONTH ALL
THE WAY UP TO OVER THIRTEEN
HUNDRED DOLLARS A MONTH.
AND THOSE THAT UNSUBSIDIZED
PREMIUM RANGE VARIES.
BASED ON REGION AND ALSO BASED
ON AIDS EVEN THOUGH THE
AFFORDABLE CARE ACT LIMITED HOW
MUCH PREMIUMS CAN VERY BASED ON
AGE OLDER PEOPLE --
IS STILL CAN PAY UP TO THREE
TIMES MORE THAN THE YOUNGEST
PEOPLE.
SO WITH THE SUBSIDIES TO COVER
CALIFORNIA AND THE OTHER
AFFORDABLE CARE ACT PROTECTIONS
IN THE MEDI CAL EXPANSION --
WE'VE SEEN AN INSURANCE DROP
SIGNIFICANTLY --
UNDER THE AFFORDABLE CARE ACT IN
THE END THAT'S DUE TO
CALIFORNIA'S EFFECTIVE
IMPLEMENTATION OF THE AFFORDABLE
CARE ACT AND ALSO THE STEPS THE
STATE HAS TAKEN --
TO HELP PROTECT THAT PROGRESS IN
THE FACE OF A FEDERAL TEAMS AS
SO WE ESTIMATE THAT THE AN
INSURANCE RATE FOR THE NON
ELDERLY IN CALIFORNIA DROP FROM
AROUND SEVENTEEN POINT 6% BEFORE
THE AFFORDABLE CARE ACT. TO TEN
POINT 4% IN TWENTY SIXTEEN BUT
THAT AN INSURANCE RATE COULD
START CREEPING BACK UP --
TO TWELVE OR 13% IN THE NEXT FEW
YEARS PRIMARILY DUE TO THE
INDIVIDUAL MANDATE PENALTY
BEINGS THERE ABOUT.
SO WE PROJECT THAT IN TWENTY
TWENTY FOUR MILLION CALIFORNIANS
COULD BE UNINSURED WITHOUT
FURTHER STATE ACTION AND THAT
COULD GROW TO FOUR POINT FOUR
MILLION BY.
TWENTY TWENTY THREE OF THOSE
FOUR MILLION UNINSURED
UNDOCUMENTED MAKE UP THE LARGEST
GROUP BUT THE NEXT LARGEST GROUP
IS THE MAIN APPROXIMATELY ONE
MILLION CALIFORNIANS I'VE
HIGHLIGHTED HERE.
WHO ARE ELIGIBLE FOR COVERED
CALIFORNIA IT BUT WOULD NOT BE
ENROLLED UNDER OUR PROJECTIONS
AND HALF OF THEM?
WOULD BE ELIGIBLE FOR SUBSIDIES
UNDER THE ACA AND HALF WOULD NOT --
BE ELIGIBLE DUE TO THEIR INCOME
[inaudible]
IN.
AS SO THIS THIS AS DAVID JUST
SHOWS THAT THOSE WHO WOULD BE
UNANSWERED IN ELIGIBLE FOR
COVERED CALIFORNIA OR SPREAD
ACROSS A RANGE OF INCOME LEVELS --
AND WHEN YOU LOOK AT IT AS THE
REASONS THAT PEOPLE WHO ARE
ELIGIBLE FOR COVERAGE CALIFORNIA
REMAIN UNANSWERED --
IT.
THE THE CALIFORNIA HEALTH
INTERVIEW SURVEY DATA SHOWS THAT
COST AS THE TOP REASON FOR
LACKING INSURANCE AMONG THIS
GROUP.
AND THAT'S TRUE REGARDLESS OF
WHICH INCOME LEVEL YOU'RE
LOOKING AT SO AFFORDABILITY
CONCERNS NOT ONLY PERSIST FOR
THOSE WHO REMAIN UNANSWERED.
BUT ALSO FOR THOSE WHO FOR SOME
OF THOSE WHO HAVE ENROLLED IN
THE INDIVIDUAL MARKET.
AS THIS IS A FROM A SURVEY
CONDUCTED BY RESEARCHERS AT
HARVARD AMONG CALIFORNIA
INDIVIDUAL MARKET ROWLEY'S AND
TWENTY SEVENTEEN AND AMONG
INDIVIDUAL MARKET ENROLLEES
ROUGHLY FOUR OUT OF TEN REPORTED
SOME OR A LOT OF DIFFICULTY AND
AFFORDING PREMIUMS.
AND YOU CAN SEE THAT THE THE
TRENDS ARE ARE RELATIVELY
SIMILAR ACROSS INCOME LEVELS.
ABOUT THREE OUT OF TEN
INDIVIDUAL MARKET ENROLLEES
REPORTED A DIFFICULTY WITH OUT
OF POCKET COSTS WITH THE
SLIGHTLY SMALLER SHARE OF THE
HIGHER INCOME --
AMONG THIS GROUP REPORTING THOSE
DIFFICULTIES.
SO THESE AFFORDABILITY
CHALLENGES CAN HAVE CONSEQUENCES
OF COURSE FOR THOSE WHO HAVE AN
ROLES.
FIRST -- THE
SAME SURVEY SHOWED THAT --
OF INDIVIDUAL MARKET ENROLLEES.
WHO NEEDED CARE REPORTED THAT
THEY EITHER DELAYED OR DID NOT
GET CARE DUE TO CONCERNS ABOUT
COST?
A ALMOST A THIRD OF INDIVIDUAL
MARKET ENROLLEES IN --
TWENTY SEVENTEEN REPORTED SOME
KIND OF FINANCIAL STRESS RELATED
TO THE COST OF CARE AS SOME
BORROWED MONEY TO PAY FOR CARE
SOME CUT OTHER NECESSITIES LIKE
FOOD OR HOUSING TO PAY FOR CARE.
AND SOME.
EXPERIENCED BOTH TYPES OF
FINANCIAL STRESS.
SO I WANT TO FOCUS FOR A MINUTE
JUST ON THE AFFORDABILITY
CHALLENGES FOR THOSE WHO ARE
ELIGIBLE FOR AFFORDABLE CARE ACT
SUBSIDIES.
THIS GRAPH SHOWS.
HOW MUCH PEOPLE ARE REQUIRED TO
PAY UNDER THE AFFORDABLE CARE
ACT ON PREMIUMS AS A SHARE OF
INCOME?
WHICH RANGES FROM AROUND 2% OF
INCOME AT THE LOWEST INCOME
LEVELS TO ALMOST 10% AT THE
HIGHER INCOME LEVELS --
WHEN YOU COMBINE THAT WITH OUT
OF POCKET COSTS SOME PEOPLE WITH
TYPICAL HEALTHCARE USE CAN SPEND
MORE THAN 10% OF THEIR INCOME ON
HEALTHCARE COSTS?
AND PEOPLE WITH THE HIGHEST
LEVEL OF MEDICAL USE CAN SPEND
UP 22230% OF INCOME ON
HEALTHCARE COSTS. TO TAKE ONE
SPECIFIC EXAMPLE AS SINGLE
PERSON EARNING THIRTY THOUSAND
DOLLARS WHICH IS.
ABOUT FOURTEEN DOLLARS AN HOUR
FOR SOMEONE WORKING FULL TIME SO
JUST A LITTLE BIT MORE THAN THAT
THE STATEWIDE MINIMUM WAGE
SOMEONE EARNING THIRTY THOUSAND
DOLLARS WOULD PAY TWO HUNDRED
DOLLARS PER MONTH.
ON PREMIUMS --
FOR THE SEX OVER PLAN WHICH IS
THE THE BENCHMARK PLAN.
AND DEPENDING ON YOU KNOW HOW
MUCH THEY'RE PAYING FOR VINCE
AND WHETHER OTHER CIRCUMSTANCES
ARE THAT COULD BE CHALLENGING
FOR SOMEONE AT THAT INCOME LEVEL.
SO THIS IS A HYPOTHETICAL
EXAMPLE OF THE A COUPLE.
AND WHO EARNS A LITTLE TOO MUCH
FOR AFFORDABLE CARE ACT
SUBSIDIES SO TAKE FOR EXAMPLE IT
TO FIFTY FIVE YEAR OLDS LIVING
IN SAN MATTEO AND EARNING ABOUT
SEVENTY FOUR THOUSAND DOLLARS A
YEAR.
THIS COUPLE WOULD PAY A COMBINED
TOTAL OF OVER THIRTEEN HUNDRED
DOLLARS A MONTH IN PREMIUMS
THAT'S MORE THAN 20% OF THEIR
INCOME JUST ON PREMIUMS.
ON TOP OF THAT THEY'D HAVE TO
PAY THE FULL COST FOR ANY HEALTH
CARE THEY USE.
A IT ED BEYOND THE FIRST THREE
OUTPATIENT VISITS WHICH THEY
COULD THEY COULD GET WITH A
COPAY BUT BEYOND THAT THEY'D
HAVE TO PAY THE FULL COST OF
CARE UP TO THE SIXTY THREE
HUNDRED DOLLAR ANNUAL DEDUCTIBLE --
THAT APPLIES TO EACH OF THEM.
AT THE END SO THIS EXAMPLE IS
REALLY TO ILLUSTRATE THAT THE
THERE'S SIGNIFICANT
AFFORDABILITY CONCERNS
ESPECIALLY FOR THOSE ABOVE 4100%
OF THE FEDERAL POVERTY LEVEL
WHERE THE ECA CLIFF ENDS ARE IS.
A AND ALSO ESPECIALLY FOR OLDER
INDIVIDUALS WHO FACE HIGHER
PREMIUMS.
ANOTHER ASPECT OF THIS EXAMPLE
IS THAT PEOPLE WHO ARE NOT
ELIGIBLE FOR SUBSIDIES ARE NOT
PROTECTED FROM THE RISING THE
RAPIDLY RISING HEALTH CARE COSTS.
OF THE WITCHER PROBLEM ACROSS
OUR ENTIRE HEALTHCARE SYSTEM --
BUT ALSO THE FACT TO A
INDIVIDUALS AT LIKE THIS EXAMPLE.
AS ASSEMBLY MEMBER WOULD MENTION
IN INTRODUCTION THE HIGH COST OF
LIVING IN THE STATE.
ADDS TO THE AFFORDABILITY
CHALLENGES THAT PEOPLE FACE WITH
HEALTHCARE WITH THE HIGH COST
THE MONEY LEFT OVER IN THEIR
HOUSEHOLD BUDGETS --
FOR HEALTH CARE AFTER PAYING FOR
RENT IN CHILD CARE AND OTHER
EXPENSES --
IN THE AFFORDABLE CARE ACT'S
PREMIUM ASSISTANCE DOES NOT TAKE
INTO ACCOUNT COST OF LIVING.
AND WE ESTIMATE THAT FOUR TIMES
THE FEDERAL POVERTY LEVEL WHICH
IS THE UPPER INCOME LIMIT FOR
PREMIUM SUBSIDIES --
IS EQUIVALENT TO FIVE TIMES THAT
LEVEL ACROSS THE STATE AND SIX
TIMES THAT LEVEL AND A HIGH COST
REGION LIKE SAN FRANCISCO.
AND SO MORE ASSISTANCE IS NEEDED.
AT THE LOWER INCOME LEVELS AND
ASSISTANCE IS NEEDED UP TO A
HIGHER INCOME LEVELS.
SO TO SUM UP WE WE'VE MADE
SUBSTANTIAL GAINS IN CALIFORNIA
BOTH IN TERMS OF INDIVIDUAL
MARKET ENROLLMENT LEVELS AND
AFFORDABILITY.
BUT THERE ARE MULTIFACETED --
CHALLENGES THAT REMAIN IN TERMS
OF AFFORDABILITY NOT ONLY FOR
THAT INST UNINSURED BUT ALSO FOR
THOSE WHO HAVE INSURANCE IN THE
INDIVIDUAL MARKET --
FOR BOTH INDIVIDUALS WHO ARE
ALREADY ELIGIBLE FOR AFFORDABLE
CARE ACT SUBSIDIES AND FOR
MIDDLE CLASS CONSUMERS WHO ARE
INTO MUCH ESPECIALLY OLDER
INDIVIDUALS.
AND TO THE AFFORDABILITY
CONCERNS ARE NOT JUST ABOUT
PREMIUMS BUT ALSO OUT OF POCKET
COSTS.
AND THE CONSEQUENCES OF THESE
CHALLENGES ARE AND NOT ONLY AN
INSURANCE BUT ALSO AND CAN
CREATE BARRIERS TO CARE AND
FINANCIAL AND SECURITY.
AND SO I THINK IT'S REALLY
IMPORTANT THE DISCUSSION WE'RE
HAVING TODAY ABOUT POLICY
OPTIONS AND I WELCOME ANY
QUESTIONS.
I THINK WELL THANK YOU THANK YOU
VERY MUCH.
SCEA.
SO -- IT'S
QUESTIONS FROM MEMBERS RE MUCH
FOR THE PRESENTATION --
I AM I A AND THE AND THE
INFORMATION IS REALLY
INTERESTING AND AND SOBERING FOR
SOME PEOPLE OBVIOUSLY --
YOU TALKED EARLIER ABOUT COST
SHARING REDUCTIONS CAN YOU
ELABORATE ON THAT FOR THE PEOPLE
IN THE AUDIENCE WHO MIGHT NOT
KNOW WHAT YOU'RE TALKING ABOUT
THERE.
YES SO THOSE THAT'S THE
FINANCIAL ASSISTANCE WITH
DEDUCTIBLES AND COPAYMENTS
THAT'S OFFERED TO PEOPLE WHO
EARNED TOO AND TO HIS INCOME IS
EQUIVALENT TO TWO HUNDRED AND
50% OF THE FEDERAL POVERTY LEVEL
OR LESS.
THAT'S ASSISTANCE THEY GET ON
TOP OF PREMIUM SUBSIDIES --
AND AS IT USED TO AND I
REGIONALLY UNDER THE AFFORDABLE
CARE ACT --
THAT ASSISTANCE WAS REIMBURSED
TO INSURERS FROM THE FEDERAL
GOVERNMENT --
AND THE TRUMP ADMINISTRATION
ENDED FEDERAL FUNDING THROUGH
THAT MECHANISM BUT WHAT THE
STATE HAS DONE --
IT IT IS --
INSTRUCTED INSURERS --
TO CONTINUE TO PRIDE THAT THAT
COST SHARING ASSISTANCE BUT THE
COST OF THAT IS THEN ADDED TO
THE PREMIUMS FOR CERTAIN PLANS
AND COVERE CALIFORNIA THE
SILVER PLANS --
AND SINCE.
THE VAST MAJORITY OF PEOPLE WHO
ARE ENROLLING IN THE SILVER
PLANS TO COVER CALIFORNIA
RECEIVINGPREMIUM SUBSIDIES.
THE COST IS ULTIMATELY PAID VIA
THE THAT'S GREAT THANK YOU.
AND I'M YOU KNOW THIS NUMBER WAS
SEEN BEFORE IN IT SO IT IT IT IS
A LITTLE MIND BOGGLING TO ME
STILL.
THAT WE STILL HAVE NEARLY A
MILLION PEOPLE WHO ARE ELIGIBLE
FOR MEDICARE OUT THAT DON'T TAKE
ADVANTAGE OF IT --
DO YOU HAVE ANY THOUGHTS ON HOW
WE HOW WE HOW WE CLOSE THAT GAP
YEAH.
AND IT IT IS A LARGE NUMBER AND
I THINK IT'S DEFINITELY WORTH
MORE INVESTIGATION INTO WHY
THEY'RE UNINSURED I MEAN --
TO EXPLANATIONS ARE SOME OF THE
MAY NOT REALIZE THERE AND THEN
SHARED A OTHERS.
MAY HAVE DIFFICULTY ENROLLING OR
MAYBE UNANSWERED FOR SHORT
PERIODS OF TIME --
TO I THINK A WE SHOULD CONTINUES
INTO THE STRONG EFFORTS. TO TO
MAKE SURE PEOPLE KNOW WHETHER
ELIGIBLE FOR AND TO HELP THEM
AND RULE --
AND ALSO LOOK IT EFFORTS --
TO ENROLL PEOPLE IN IN MORE
AUTOMATIC WAYS WHEN THEY'RE
ENROLLED IN OTHER PUBLIC
PROGRAMS THAT AND INDICATE THAT
THEY'RE ELIGIBLE FOR MEDI CAL OR
WHEN THEY UNDERGO A CERTAIN LIFE
TRANSITIONS WHERE PEOPLE ARE
LIKELY TO ALSO EXPERIENCE A A
CHANGE IN HEALTH INSURANCE.
OTHER QUESTIONS RIGHT SO I HAVE
A COUPLE --
SO FOR FIRST OF ALL I AGAIN
THANK YOU SO MUCH FOR YOUR
PRESENTATION --
IN IN TERMS OF WE'VE WE POINTED
I THINK --
SAID -- DOC
WOULD POINTED OUT WE HAVE
MILLION PEOPLE ELIGIBLE FOR MEDI
CAL -- TO
AREN'T SIGNED UP WE ALSO.
KNOW THAT ONE OF THE THINGS
WE'RE CONCERNED ABOUT IS THIS
CLIFF AT 4100% OF A THIRD PARTY
LEVEL BUT I ALSO NOTE THAT --
WE HAVE FIVE HUNDRED NINETY
THOUSAND YOU DO GET SUBSIDIES --
WHO HAVEN'T SIGNED UP EITHER --
SO MAYBE IT'S THE SAME ANSWER
BUT DO YOU WANT TO MAYBE THINK --
SPECULATE A LITTLE BIT ABOUT
THAT --
INVITATIONS THEY SPECULATE IF
THE DANNY DATA THAT'S OUT THERE
ABOUT WHO THEY ARE AND WHAT AND
IS IT --
LACK A YOU KNOW THAT THESE
HEARING OUT OF THE MANDATE THAT
MIGHT BE ARE OF WHAT WHAT ARE
SOME WELL ACTUALLY.
WHAT WERE SOME THE THINGS THAT --
WE MIGHT DO TO ENGAGE --
THOSE THOSE FOLKS SURE SO FOR
PEOPLE WHO ARE ALREADY ELIGIBLE
FOR AFFORDABLE CARE ACT
SUBSIDIES WHEN YOU LOOK AT THE
SURVEY DATA AND THOSE PEOPLE WHO
REMAIN ENROLLED ARE ASKED WHY DO
YOU REMAIN IN THE ROLE OF THE
COST IS DEFINITELY THE BIGGEST
THREE WE DO PROJECTED THAT GROUP.
WILL GROW --
WITH THE INDIVIDUAL MANDATE
PENALTY BEING ELIMINATED --
BUT AS FOR MANY THE THE
SUBSIDIES JUST ARE NOT ENOUGH --
AND AND AND A LOT OF THAT HAS TO
DO WITH COST OF LIVING AND
FINANCIAL AND SECURITY AND NOT
HAVING THAT THE ROOM AND THEIR
FAMILIES BUDGETS TO TO PAY FOR
THOSE PREMIUMS --
WOULD YOU SAY THAT IS PEOPLE ARE
GENERALLY HEALTHIER AND PERHAPS
USE HEALTH CARE SERVICES LESS
THAN PEOPLE WHO SIGN UP --
I'D I'D HAVE TO LOOK AT OUR OUR
EXACT ESTIMATES ON THAT BIT
THERE CERTAINLY ARE PEOPLE WHO
REALLY NEED THE CARE AND MAY
HAVE CHRONIC CONDITIONS WHO ARE
AMONG THE UNINSURED --
AND AND SO I DON'T THINK WE CAN
ASSUME THAT.
THE PEOPLE WHO ARE GOING WITHOUT
INSURANCE --
I DON'T NEED IT --
OKAY AND AS FAR AS YEAH SO WHAT
ACTUALLY THE OTHER QUESTION I
HAD WAS --
OR DO YOU HAVE A TABLE WHERE YOU
LOOKED AT WE SURVEYED PEOPLE
ABOUT THE FIND THAT TABLE HERE --
EVERY PEOPLE ABOUT THE UPPER.
PASSED THE THAT SEE HERE --
YES I THINK IT'S THE ONE ON PAGE --
EIGHT WHERE YOU'RE ASKING ABOUT
PEOPLE SAYING THEY HAVE A
CHALLENGES WITH --
DIFFICULTY PAYING HEALTHCARE
COSTS.
AND I WOULD MAKE NOTE THAT --
SO WE HAVE THE PEOPLE WHO GET
THE SUBSIDIES THE TWO HUNDRED
FIFTY FOUR HUNDRED AND THE FOUR
HUNDRED PLUS --
IN THOSE NUMBERS ARE AT LEAST
SOMEWHAT SIMILAR IT'S NOT SO --
NOW WITHFOR CZ FOUR HUNDRED
PLUS THE CHALLENGES IS THAT IF
YOU'RE AT 8100% YOU MIGHT NOT BE
FEELING AS MUCH AS IF YOU'RE
CLOSER TO FORM SOME JUST ONE IN
TERMS OF THE CLIFF THE FACT.
AND AND AND WITH THAT --
IN TERMS OF A SLIDE IN TERMS OF
THE SURVEY DATA I I KNOW WHAT
THERE'S A WAY SOMEONE ACTUALLY
DRILLED INTO THE PEOPLE WHO ARE
CLOSER TO FOUR HUNDRED PLUS WHO
ARE.
CLOSER TO FOUR HUNDRED WHEN YOU
SEE FOUR HUNDRED PLUS VERSUS
PEOPLE WHO MAY BE MUCH FARTHER
AWAY FROM FOUR HUNDRED WHETHER.
THAT PEOPLE WHO ARE JUST OVER
THE BRINK --
WITH -- THAT
THEY WOULD PARTICULARLY HAVE A
GREATER CONCERNS ARE ISSUES WITH
THAT GETTING THE COVERAGE SINCE
THEY HAVE NO SUBSIDIES SO I KNOW
THERE'S A WAY TO LOOK AT THAT
SELL INSURANCE TERMS OF THIS
FOUR HUNDRED PLUS EXACTLY HOW
FAR OUT YOU'RE TALKING FROM.
FOUR HUNDRED RATE AT SO THIS WAS
A SURVEY CONDUCTED BY
RESEARCHERS AT HARVARD AND AND
MASSACHUSETTS GENERAL HOSPITAL --
AND I DON'T KNOW IF THEY HAVE
THE ABILITY TO LOOK AT THEM MORE
SPECIFICALLY IT GROUPS ABOUT
4100% OF THE FEDERAL POVERTY
LEVEL BUT THIS.
IS THESE RESULTS WOULD INCLUDE
ALL INCOME LEVELS ABOVE A 4100%
OF THE FEDERAL POVERTY LEVEL.
AND I GUESS ONE OTHER QUESTION
AND AND I NOTICED --
WOULD BE IS TO CERTAIN EXTENT WE
WERE SET CERTAIN STANDARDS RIGHT
FOR SUBSIDIES BASED ON A
PERCENTAGE OF INCOME THROUGH THE
ACA ETCETERA --
I GUESS THE QUESTION IS WHERE IS
THAT ONE TWENTY ON YOU THE WIND
SU HI HOW LOW JUST LINE HAVE TO
BE.
AT WHAT POINT DO YOU SAY WELL
YOU KNOW THE HEALTH CARE AND WE
CAN TALK ABOUT WHETHER IT'S TOO
EXPENSIVE AND ALL THAT BUT
CERTAIN POINT LIKE WHAT POINT DO
YOU SAY THAT --
THIS IS HOW MUCH YOU SHOULD
EXPECT TO PUT IN YOUR INCOME TO
COVER HEALTH CARE --
I MEAN SOME PEOPLE SAY SHOULD BE
ZERO BUT I THINK --
BUT AT THE OTHER PEOPLE WOULD
SAY WELL PEOPLE SHOULD BE
EXPECTED BASICALLY SOMETHING
INTO IT.
SO AT AT ANY SENSE OF WORD
INFLECTION POINT IS.
IT'S A REALLY GOOD IN HARD
QUESTION --
THE I THINK THE GENERAL
STRUCTURE THAT THE AFFORDABLE
CARE ACT HAS SET UP IN TERMS OF
PEOPLE PAYING AS AS A SLIDING
SCALE PERCENTAGE OF INCOME.
IS IS A GOOD ONE AND I ALSO.
YOU KNOW THE RECOGNITION THAT
PEOPLE AT LOWER INCOME LEVELS
CAN AFFORD LESS IN TERMS OF OUT
OF POCKET COSTS BUT THE EXACT
LEVELS ARE ARE NOT AFFORDABLE
ENOUGH YET --
I I DON'T THINK THERE'S EVER
GOING TO BE ONE PERFECT STANDARD
OF BECAUSE OFFICE OF LIVING
VARIES EVEN WITHIN THE STATE AND
BETWEEN FAMILIES EVEN IN THE
SAME REGION BASED ON THE VARIETY
OF CIRCUMSTANCES.
AS BUT I THINK AS LONG AS WE'RE
SEEING -- A
HIGH NUMBER OF UNINSURED AND
PEOPLE SAYING THAT THE REASON
FOR THAT THEY NOT SIGNED UP IS
BECAUSE THEY CAN'T AFFORD IT.
THAT WE STILL HAVE AN
AFFORDABILITY PROBLEM IN AS LONG
AS WE SEE PEOPLE REPORTING TO
SURVEYS THAT.
THEY'RE NOT ACCESSING CARE THEY
NEED BECAUSE THE OUT OF POCKET
COSTS ARE TOO HIGH I THINK IT'S
AN INDICATOR THAT WE STILL HAVE
A PROBLEM SO --
A I GUESS THE ANSWER IS I THINK
YOU HAVE TO BE A LITTLE BIT
TRIAL AND ERROR TO SEAMANS WE'VE
IF WE MAKE IMPROVEMENTS AND SEE
IS THAT ENOUGH THEM BECAUSE
PEOPLE DO VALUE.
HEALTH CARE AND WANT TO BE
HEALTHY AND WHEN WHEN COST IS
NOT A BARRIER --
I THINK THEY WILL IN WRONG.
OKAY ALL RIGHT --
SIMILAR FRAZIER.
CAN WE GO BACK TO THE SLIDE WORK
SHOW THE THE ELDERLY --
YEAH SO WE HAVE THIRTEEN SIXTY
TWO A MONTH --
IN THE U..
WELL OVER.
FIFTY FIVE SO THAT'S THAT'S
REALLY.
THE WORD ELDERLY.
SO.
THE DEFINITION I GUESS --
SO. THIRTEEN SIXTY TWO PER MONTH.
THE LOOK AT A TOTAL OF COPAYS UP
TO SIXTY THREE HUNDRED WHICH
GOES TO ABOUT.
TWENTY TWO THOUSAND AND CHANGE
STORY.
TWO THOUSAND SIX FORTY FOUR AND
IF THEY MADE SEVENTY FOUR
THOUSAND WERE 30% TAX BRACKET
YOU KNOW THE THINGS NINE TO
FIFTY ONE THOUSAND SO THE NET
ABOUT THIRTY THOUSAND DOLLARS
YEAR.
THAT SOUNDS ABOUT RIGHT.
SO WHAT'S AFFORDABLE ABOUT THAT
YEAH THATTHAT'S WHY THIS GROUP
REALLY NEEDS HELP --
IN THIS IS THAT IT WAS A FAIR
FOR EVERYBODY RIGHT THIS IS THE
AT A IS NOT THE EVEN THE WORST
CASE EXAMPLE THIS IS A FIFTY
FIVE YEAR OLD COUPLE NOT A SIXTY
FOUR YEAR OLD COUPLE BUT THIS.
YEAH I THINK I THINK THIS
DEMONSTRATES THE REASON WHY WHY
WE'RE TALKING ABOUT POLICY
OPTIONS TODAY TO IMPROVE
AFFORDABILITY FOR THIS GREAT.
YEAH ROSE INCOME VERSES.
ACTUALLY THAT WORSE IS THE CO
PAYS AND ALL OF OUT OF POCKET
EXPENSES AS INCLUDE PHARMACY HAS
A AS THE IF THE SIXTY THREE
HUNDRED DOLLARS.
THAT DOES I BELIEVE.
THAT DOES INCLUDE PHARMACY
[inaudible]
SO.
I GOT WORKABLE AND A HUNDRED YOU
KNOW THAT HAS SOME KIND A
MEDICAL BENEFITS BECAUSE I WOULD
NEVER BE ABLE FOR THAT.
YEAH.
YES ARE CENTERED RAZA --
I'M SORRY FIVE YOU MIGHT HAVE
MISSED THIS I MIGHT HAVE MISSED
THIS BUT WHAT IS THE IMPACT OF
ANY DO YOU KNOW.
ABOUT -- THE
NUMBER AND PERCENTAGE OF
EMPLOYER COVERED HEALTH CARE.
AS FAR AS YOU KNOW THE COST.
ON EVERYONE ELSE MY
UNDERSTANDING IS IT'S IT'S
DECREASED.
SO DO YOU HAVE ANY INFORMATION
ABOUT THAT.
IMPACT.
OVER ONE EVERYBODY --
WELL IF YOU THINGS ABOUT THE
COMPARISON BETWEEN EMPLOYER
SPONSORED INSURANCE AN
INDIVIDUAL MARKET COVERAGE I
THINK IS YOUR QUESTION.
AS TAKE UP RATES ARE HIGHER FOR
EMPLOYER SPONSORED INSURANCE --
THE AT BUT LET ME LET ME THINK
ABOUT HOW TO SIMPLY SAY THIS
THERE THERE HAS BEEN RESEARCH
COMPARING FOR EXAMPLE HOW MANY
BUT SHARE OF THE MARKET PAYS
MORE THAN 10% OF THEIR INCOME ON
PREMIUMS.
AND IN THE INDIVIDUAL MARKET
THAT'S A MUCH HIGHER SHARE
PAYING THAT HIGH COST BURDEN ON
PREMIUMS THAN AN EMPLOYER
SPONSORED INSURANCE.
AND THEN ON THE OUT OF POCKET
COSTS SIDE OF THE THE
COMMONWEALTH FUND.
MEASURES UNDER INSURANCE OR OR
HOW MANY PEOPLE HAVE INSURANCE
THAT COVER THEIR THEIR FINANCIAL
RISK WHEN THEY NEED CARE AND
UNDER INSURANCE IS MORE OF AN
ISSUE IN THE INDIVIDUAL MARKET
THAN AN EMPLOYER SPONSORED
INSURANCE.
THAT SAID --
EMPLOYER SPONSORED INSURANCE --
HAS.
LAKE OUR ENTIRE HEALTHCARE
SYSTEM YOU KNOW THE COSTS HAVE
GROWN RAPIDLY --
AND AS AN PREMIUMS WORKERS COMP
PREMIUMS FOR WORKERS HAVE GROWN
RAPIDLY AND THEIR OUT OF POCKET
COSTS HAVE ALSO BEEN GROWING.
HI DEDUCTIBLES AND JOB BASED
COVERAGE HAVE BEEN INCREASINGLY
MORE COMMON --
OVER THE LAST DECADE ALTHOUGH IN
CALIFORNIA WE'VE BEEN FORTUNATE
THAT WE HAVEN'T SEEN.
IT QUITE AS DRAMATIC TRENDS IN
TERMS OF THE GROWTH OF
DEDUCTIBLES AND JOB IS COVERAGE
AT THE SCENE NATIONALLY.
UP IT WHATEVER YOU HAVE ON THAT
COULD SURE SURE THAT AS WELL
PLEASE.
BE HAPPY.
TO OKAY ANY OTHER QUESTIONS YES --
OUR CHURCH ARAMBULA.
IT'S ALMOST A RHETORICAL
QUESTION BUT I FEEL LIKE
SOMETIMES WE HAVE TO MOVE
THROUGH THE THE DISCUSSION TO
MAKE SURE WERE ALL ON THE SAME
PAGE.
CAN YOU SPEAK TO WHAT ROLE THE
REPEAL OF THE INDIVIDUAL MANDATE
HAS HAD ON AFFORDABILITY.
HAS IT MADE.
PREMIUMS MORE OR LESS.
WELL I THINK WE'RE WE'RE STILL
EARLY AND SEEING WHAT AFFECTS
THE THOSE HEARING OUT OF THE
PENALTY.
HAS AND WILL HAVE HAVE --
BUT THE LAST YEAR.
MS AND COVERED CALIFORNIA IT DID
INCREASE AND I THINK IT WAS
THREE AND A HALF. THREE AND A
HALF PERCENT OF THAT INCREASE
WAS ATTRIBUTABLE TO THE
INDIVIDUAL MANDATE PENALTY GOING
AWAY AND THAT WAS BECAUSE OF
INSURERS EXPECTATION --
THAT IT WOULD BE HEALTHIER
PEOPLE AND WHO WOULD BE MORE
LIKELY TO DESCEND ROLE WITHOUT A
PENALTY SO AS WE ARE USING YOUR
EXAMPLES OF UNDER INSURANCE WE
SHOULD.
TAKE INTO --
LIGHT THAT THAT VANDALISM THAT
OCCURRED AT THE FEDERAL
ADMINISTRATION IS UNDERMINING
OUR ABILITY TO PROVIDE
AFFORDABLE HEALTHCARE INSURANCE.
AND ASSESS THE TATES US AS A
STATE NEEDING --
TO TRY TO REPLACE IT AS OUR
GOVERNOR IS PROPOSING AS WELL AS
LOOKING TOWARD SUBSIDIES TO HELP
MAKE HEALTH CARE MORE AFFORDABLE
AND SO.
WELL WE HAVE A FEDERAL
ADMINISTRATION THAT IS
UNDERMINING US I'M ENCOURAGED BY
MUCH OF WHAT WE'RE DOING HERE.
AT OUR STATE WIDE LEVEL TO HELP
TO DEFEND AND BUILD UPON WHAT
WE'RE DOING.
WHAT THE AFFORDABLE CARE ACT SO?
THANK YOU FOR YOUR PRESENTATION
TODAY.
OKAY ANY OTHER QUESTIONS.
CASEY NINE AGAIN THANK YOU SO
VERY MUCH --
TO SEE IF THE PRESENTATION THANK
YOU.
FOR IT WOULD BE.
THANK YOU VERY MUCH WILL GO
AHEAD AND MOVE ON TO OUR SECOND
PANEL HERE --
THIS ME TALKING BOUT
AFFORDABILITY PROPOSALS AND
FUNDING OPTIONS TO IMPROVE
AFFORDABILITY IN CALIFORNIA.
OF JOINING US WILL BE --
PETER LEAD THE EXACT DIRECTOR
CAL COVER CALIFORNIA.
RYAN MILLER THE ASSISTANT
PROGRAM BUDGET MANAGER FOR THE
DEPARTMENT OF FINANCE AND RYAN
WILL SEE THE PRINCIPLE FISCAL
POLITICIAN POLICY ANALYST FOR
LEGISLATIVE ANALYST'S OFFICE SO.
IN THAT ORDER SO.
THANK YOU IN.
THANK YOU SO MUCH [inaudible]
HI [inaudible]
BACK [inaudible]
GOOD
.
SHOW YOU'RE GOING.
PICKING TOPIC SO FIRST --
COMMITTEE CHAIRS MEMBERS THANK
YOU SO MUCH FOR THE OPTION TO BE
WITH YOU TODAY --
AND IT WAS A GREAT PRESENTATION
YOU GOT ABOUT LAME SOME OF THE
GROUNDWORK EARLIER --
AS ALL OF YOU KNOW SINCE TWO
THOUSAND AND FOURTEEN CALIFORNIA
HAS REALLY MADE REMARKABLE
PROGRESS I WON'T.
REVIEW ALL OF THAT --
BUT IT IS IMPORTANT TO KNOW HOW
MUCH WE WERE.
AND WE'VE DONE THAT THROUGH
HAVING A VERY COMPETITIVE
MARKETPLACE THROUGH ROBUST
COMPETITION THROUGH --
COMMON BENEFIT DESIGNS ALL TALK
ABOUT IN A MOMENT --
THROUGH MARKETING AND I I DON'T
WANT TO DO A PARTICULAR THANK
YOU TO ALMOST EVERYONE OF YOU
NOT ONLY HAVE LEGISLATIVE BUT
WORKING WITH YOUR CONSTITUENTS
OF HELP GET THE WORD OUT --
AS WE'VE TRAVELED THE STATE
WE'VE HAD MEMBERS ON BOTH SIDES
OF THE AISLE PROMOTED ROLE MIGHT
GET THE INFORMATION OUT THAT'S
PART OF WHAT'S MADE IT WORK HERE
IN CALIFORNIA --
IT'S WORK IN THAT NOT ONLY HIGH
AND ROLAND BUT A HEALTHY
RESPECTS.
OF THE WRIST MIX OF THOSE ENSURE
THE INDIVIDUAL MARKET ABOUT 20%
HEALTHIER THAN THE REST THE
NATION.
MEETING THE PREMIUMS IF WE HAVE
THE SAME HEALTH STATUS.
AS FOLKS DID IN OTHER STATES IN
THE NATION.
HEALTHCARE WOULD BE 20% MORE
EXPENSIVE IN CALIFORNIA THAT IT
IS BECAUSE OF OUR HEALTHY
RESPECTS --
ALL THAT SAID.
THERE ARE CHALLENGES SUMMER
ABSOLUTELY IN THE CONTEXT OF
RECENT FEDERAL POLICY DECISIONS
SUCH AS THE REMOVAL OF THE
INDIVIDUAL MANDATE PENALTY.
OTHERS ARE A IN THE NATURE OF
THE AFFORDABLE CARE ACT ORIGINAL
STRUCTURE WAS NEVER PERFECT OUT
OF THE GATE IT HAD ISSUES THAT
LED TO SOME OF THE CHALLENGES
WERE SEEN THAT STILL NEED TO BE
ADDRESSED ISSUES.
WITH REGARD TO PREMIUM STILL
BEING ON AFFORDABLE CLIFF ON
CHALLENGES OF COST SHARING
PREMIUMS IN GENERAL.
SO WITH THAT --
I'D LIKE TO START BY DOING A
VERY QUICK REVIEW WHAT HAPPENED
THIS MOST RECENT OPEN ENROLLMENT
PERIOD -- AS
YOU KNOW WE JUST AND OPEN
ENROLLMENT PERIOD LAST MONTH IT
WAS OUR SIX THE OPEN ENROLLMENT
PERIOD --
CALIFORNIA HAS DONE A VERY GOOD
JOB BOTH IN ROLLING TO KEEP
PEOPLE KEEPING PEOPLE INJURED
YOU SEE ON THE LEFT HAND SIDE
HERE.
OUR NEW ENROLLMENTS EACH YEAR
WHICH HAS BEEN RELATIVELY FLAT
OVER THE LAST FOUR YEARS IT
DROPPED.
IN. 1924%.
THAT'S A VERY LARGE DROP IT'S
LARGER THAN WE THOUGHT THE
ESTIMATES WERE THAT THE DROP OF
ENROLLMENT BECAUSE OF THE
REMOVAL OF THE PENALTY WOULD BE.
ANYWHERE FROM 7226% WE'RE ON THE
HIGH END.
UP WE LOOKED AT THAT IN A ISSUE
BRIEF THAT I KNOW YOU'VE ALL
RECEIVED --
ON ANALYZING WHAT HAPPENED AND
WHY -- AND
I'D MAKE A COUPLE OBSERVATION
FIRST.
HOW WE COMPARE TO THE REST OF
THE NATION --
ON THE RIGHT HAND SIDE YOU SEE
WHAT HAPPENED THE REST OF THE
NATION OVER THE LAST FOUR YEARS.
THE REST OF THE NATION THOSE
PARTS OF AMERICA SIR BY THE
FEDERALLY FACILITATED
MARKETPLACE.
HAD SEEN BETWEEN TWO THOUSAND
AND SIXTEEN TWO THOUSAND
EIGHTEEN A PRECIPITOUS DROP IN
ENROLLMENT.
THEY IN ESSENCE HAD ALREADY
PRICED OUT THE PEOPLE OF A ON IN
THIS LAST OPEN ENROLLMENT PERIOD
THEY SAW AN ADDITIONAL 16% DROP --
WE IN CALIFORNIA SAW A BIGGER
DROP THIS YEAR BECAUSE WE HAVE A
LOT OF HEALTHY PEOPLE.
OUR CHALLENGES THE STATE IS TO
MAKE SURE WE DON'T FOLLOW IN THE
FOOTSTEPS OF OTHER STATES THAT
ARE PRICED --
PEOPLE THAT ARE NOT SUBSIDIZED
AND THAT ARE NOT SICK OUT OF
COVERAGE --
THAT'S WE SEEN REST OF THE
NATION.
WHAT DID WE SEE IN TERMS OF WHO
DID NOT SIGN UP WE DID ANALYSIS
BACKWARDS UPSIDE DOWN SIDEWAYS
AND FOUND A COUPLE THINGS --
FIRST SOME OF THE THEORIES OF
WHO MIGHT NOT IN ROLE DIDN'T
TURN OUT TO BE TRUE IT WASN'T
MORE LIKELY TO NOT A ROLE IF YOU
WERE YOUNGER.
IT TURNS OUT THAT --
YOUNG INVINCIBLE SO TO SPEAK OR
NOT YOUNG AND STUPID --
THEY ACTUALLY SIGNED UP IN OR
DROP COVERAGE OF THE SIMILAR.
AS OTHER GROUPS OF THE TWO
GROUPS THAT WE SAW SUBSTANTIALLY
HIGHER.
DROPS IN ENROLLMENT WE'RE NUMBER
ONE PEOPLE TO SIGN UP FOR BRONZE
PLANS WHICH IS A HIGH DEDUCTIBLE
PLANS WHICH WE HAVE SEEN.
BEING HEALTHIER POPULATION
GENERALLY PEOPLE ARE HEALTHY BY
THE HIGH DEDUCTIBLE PLAN --
THAT CAUSES GREAT CONCERN THE
OTHER IS SUBSTANTIALLY HIGHER
DROPS OF UNSUBSIDIZED
INDIVIDUALS --
NOT A SURPRISE BUT A A TROUBLING
NOTE.
THE OTHER THING WE DID SEE IS
SOME HIGH --
ENROLLMENT FROM NON ENGLISH
SPEAKERS SPANISH SPEAKERS KOREAN
CHINESE --
WE DON'T THINK THAT'S A FACTOR
FROM THE PENALTY --
WE THINK THAT'S A RELATED A
PUBLIC CHARGE I'M HAPPY TO TAKE
QUESTIONS ON THAT LATER.
WE DID ABSOLUTELY SEE THOUGH
THAT THE REMOVAL OF THE PENALTY
BECAUSE PREMIUMS TO GO UP --
WE HAD AN EIGHT POINT 7% AVERAGE
PREMIUM INCREASE --
ABOUT HALF OF THAT WAS BECAUSE
SPECIFICALLY OF HEALTH PLANS
PRICING FOR THEIR EXPECTATION.
THAT THERE WOULD BE A DROP OF
ENROLLMENT AND HEALTHIER PEOPLE
WOULD DROP.
THEY ALL SAID AND WE NEGOTIATE
VERY ACT WITH OUR PLANS --
WE WANTED THEM TO PRICE RIGHT WE
DON'T UNDER PRICED OR OVERPRICED --
BUT THEY NOTED THAT THAT WAS THE
FIRST STEP DEPENDING ON WHAT
HAPPENS THEY WOULD BE NEEDED TO
LOOK AT THEIR PRICING FOR TWO
THOUSAND AND TWENTY AND TWENTY
ONE IN ROMAN GOES DOWN MORE NEXT
YEAR YOU'LL SEE A BIGGER PREMIUM
INCREASE.
JUST BECAUSE OF THE HEALTH MIX
SO THAT'S WE SAW IN TWO THOUSAND
AND NINETEEN NEXT.
I WANT TO NOTE THAT WE WERE
CHARGED WITH.
DEVELOPING A REPORT FOR YOU.
AND WE WERE HAPPY TO PROVIDE
THAT REPORT IT WAS PART OF THE
LEGISLATIVE MANDATE TO DEVELOP
DELIVER THIS TO YOU THE
LEGISLATURE THE GOVERNOR AND THE
HEALTH CARE DELIVERY.
SYSTEMS COUNCIL.
ON HOW TO IMPROVE AFFORDABILITY.
NOW THAT I'D NOTE THAT.
YOU'LL SEE IN THIS REPORT A
RANGE OF POLICY OPTIONS THAT
PROVIDE A ROADMAP FOR YOU --
AND THE GOVERNOR THAT YOU CAN
TAKE THEY AREN'T THEY HERE'S THE
RIGHT WAY IT'S RATHER OPTIONS
THEM IN A RUN THROUGH.
THE IT IS VERY CLEAR THOUGH --
THAT THE PATH TO AFFORDABILITY.
IS NOT ONE THAT'S BEING TAKEN IN
MANY PARTS OF THE NATION --
WHERE WHAT IS BEING CALLED
AFFORDABILITY IS GIVING
CONSUMERS MORE CHOICE OF SHORT
TERM PLANS PRODUCTS THAT ARE
THERE WHEN PEOPLE NEED THEM
CALIFORNIA --
THIS LEGISLATURE OUTLAWED SHORT
TERM PLANS BECAUSE THEY ACTUALLY
OFTEN SERVE AS BAIT AND SWITCH
FOR CONSUMERS.
AND THEY SCREEN PEOPLE WHO HAVE
PRE EXISTING CONDITIONS THEY
PRICE THINGS DIFFERENTLY
CALIFORNIA HAS SAID LET'S BUILD
ON THE AFFORDABLE CARE ACT AND
THAT'S WE'RE GONNA BE TALKING
ABOUT HERE AND SOME OF THE
OPTIONS.
BEFORE YOU --
I WOULD NOTE THAT THIS REPORT --
WAS DEVELOPED --
WITH THE THE KEY WORK OF PEOPLE
AND COVER CALIFORNIA'S POLICY
TEAM A PARTICULAR KATIE RAVEL
BUT ALSO --
WEST AGAIN --
FROM UCLA IN THE CLOSE TO LIMóN
FROM STAKEHOLDERS MANY OF WHOM
ARE HERE WITH YOU --
I THINK --
TO PROVIDE COMMENTS LATER --
BUT ALSO --
WITH LEGISLATIVE STAFF AND A
BROAD COMMUNITY INPUT --
I THINK IT'S A A GOOD READ --
THOUGH IT'S PRETTY DEEP SO I'M
NOT GOING TO GET IT TO ME THE
CHARTS.
BUT I WANT TO KNOW WHAT WE DID
IS FIRST.
WE PROVIDE IT TWO APPROACHES TO
THINK ABOUT WHAT YOU COULD DO.
ONE IS WHAT WE CALL A
COMPREHENSIVE COMBINATION WHICH
IS SORT OF THE ALL IN STRATEGY.
WHICH LAID OUT FIRST ENHANCE
PREMIUM AND COST SHARING SUPPORT
BOTH ABOVE AND BELOW 4100% OF
POVERTY --
WHICH IS BASICALLY SAYING LET'S
MAKE IT MORE AFFORDABLE BUILT
INTO THE PREMIUM AND CULTURE.
SECOND OPTION LAYERED ON TOP OF
THAT.
IMPLEMENT A PENALTY IN
CALIFORNIA THIRD LAYERED ON TOP
OF THAT IS HAVE A REINSURANCE
PROGRAM THAT'S WHERE THE THE
COMPREHENSIVE ALL IN STRATEGY.
THE OTHER OPTION.
BUT WAS TO LAY OUT --
IS ME. EIGHT DISTINCT POLICY
OPTIONS SO TO GIVE YOU A EIGHT
TOOLS IS A LET'S PICK THIS AND
THIS AND THE DATE OPTIONS ARE A
MIX OF EITHER PREMIUM SUPPORT OR
COST.
SHARING REDUCTIONS IF YOU'VE
HEARD ABOUT FROM LUCIA.
AND THEN A SEPARATE PIECE OF
REAL MANDATE PENALTY THESE ARE
ALL LAID OUT IN IN GREAT DETAIL
IN THE REPORT --
A COUPLE THINGS THAT I WOULD
CALL OUT AND THEN I I WON'T
SPEND A MOMENT --
WITH THE TAKE AWAYS OF THIS IS --
FIRST TAKE AWAY IS THE OF THE
POLICY OPTIONS IN TERMS OF THE
POLICY OPTIONS BEFORE THE STATE
THE WOULD HAVE.
THE BIGGEST EFFECT ON ENROLLMENT --
IT'S REINSTATING THE PENALTY IS
BY FAR THE WITH THE REPORT THE
NUMBERS OF PEOPLE THAT WOULD BE
BOTH NOD STE TO BUY COVERAGE AND
BECAUSE PREMIUMS WE LOWER WOULD
HAVE BY FAR THE LARGEST EFFECT
ON INCREASING ROLE.
OF THE OTHERS HAVE A BUILDING
AFFECT.
IN TARGET DIFFERENT PEOPLE
DEPENDING UP YOU'RE TARGETING
SUBSIDIES ABOVE OR BELOW 40% OF
POVERTY.
REMEMBER BELOW 40% OF POVERTY
PEOPLE ARE GETTING ON IT INCOME
ADJUSTED BASIS FINANCIAL SUPPORT
FROM THE FEDERAL GOVERNMENT.
ABOVE 40% THEY'RE GETTING
NOTHING.
BUT THERE'S A LOT OF PEOPLE
BELOW 4% SO THAT THAT'S THE
TRADE OFF OF THE REPORT GOES
THROUGH.
SO -- I
WANTED TO SPEND A MOMENT --
TO TALKING SOLUTION TO THE GIVE
YOU A MISSION HOPE WHAT HAPPENS
WITH THE CLIP.
ON IN THIS IS --
FOR IT IT'S EASY TO GET LOST IN
NUMBERS I A TALK ABOUT TWO
ARCHETYPE PEOPLE BOTH TO LIVE IN
ALAMEDA COUNTY ONE HIS TWENTY
SEVEN YEARS OLD.
THIS SHOWS HOW MUCH IS A TAX
CREDIT CURRENTLY --
AND YOU'LL SEE IN THE DARK BLUE
IS A TAX CREDIT THEY GET IT
THERE PUT UP TO A 100% 50% OF
POVERTY.
THEIR SPENDING FIFTY DOLLARS AND
THE TAX CREDIT IS COVERING THE
REMAINING. THREE HUNDRED FIFTY
DOLLARS THAT'S THE DARK BLUE BUT
AS SOON AS THE AFFORDABLE SO
POVERTY.
THEY'RE GETTING NOTHING AND
THEY'RE RESPONSIBLE 41100% OF
THE PREMIUM ABOUT.
YOU KNOW FOUR HUNDRED FIFTY
DOLLARS TWENTY SEVEN YEAR OLD.
MAKE THAT PERSON A FIFTY FIVE
YEAR OLD AND YOU'LL SEE DARK
BLUE IS THE PREMIUM TAX CREDIT
UNDER THE AFFORDABLE KERA.
SO THAT FIFTY FIVE YEAR OLD.
ELDERLY PERSON A SUBJECT OF OF
OF THAT --
FIFTY FIVE YEAR OLD PERSON OLDER
THAN -- YOU
KNOW YOUNGER THAN ME BY A FEW
YEARS.
WOULD GET A YOU KNOW SIX HUNDRED
DOLLARS WOULD BE PAYING FOUR
HUNDRED DOLLARS STILL A LOT OF
MONEY FORTY DOLLARS A MONTH.
A CHALLENGE FOR THEM --
COVERING THEIR PREMIUM BUT THE
MOMENT THEY INCH OVER THAT 4100%
LINE ALL OF A SUDDEN THEY'RE IN
FOR NINE HUNDRED DOLLARS
ENTIRELY --
SO THAT'S THAT GIVES YOU THAT
THE DISTINCTION OF WHAT IS THAT
CLIP MEAN IN TERMS OF THE
GRAPHICS.
LET ME THEN TELL YOU THAT STORY
PER TO INDIVIDUALS --
TO GIVE YOU A SENSE OF BELOW 40%
AND ABOVE 40%.
SO THIS IS AND I WILL GIVE HUGE
CREDIT WHEN YOU LOOK TO THE
REPORT --
PAGE THIRTY TWO AND THIRTY THREE
SPELL THESE OUT WITH A NUMBER OF
HYPOTHETICAL PEOPLE THEY REALLY
HELPED BRING IT HOME.
IS IN THE UNDER. 40% OF POVERTY
ALFONZO TWENTY FIVE YEARS OLD
LOW COST AREA AND IT'S VERY
IMPORTANT IN A CALIFORNIA.
NORTHERN CALIFORNIA REGION
GENERALLY COST 30% MORE FOR
HEALTHCARE PREMIUMS OF SOUTHERN
CALIFORNIA.
SO -- NOW
THAT'S A REALLY BIG ISSUE OTHER
DOCTOR WOULD YOUR NOTE ABOUT
COST CONTAINMENT WRIT LARGE IS A
VERY IMPORTANT MIND AT ALL OF US.
IT'S THE REALITY OUR CONSUMERS
ARE SO THIS INDIVIDUAL RIGHT NOW --
MAKES ABOUT OVER TO A PERCENT OF
THE FEDERAL POVERTY LEVEL HE
GETS --
QUITE A BIT OF FINANCIAL SUPPORT --
HIS PREMIUM FOR THE SECOND
LOWEST SILVER PLAN IS THREE
FIFTY DOLLARS BUT HE ONLY PAID A
HUNDRED THIRTY SIX DOLLARS.
BUT IF YOU'RE MAKING TWENTY FIVE
THOUSAND DOLLARS.
PAYING A HUNDRED AND THIRTY SIX
DOLLARS CAN BE STEEP --
UNDER THE OPTION TO OF THE
COMPREHENSIVE WHICH IS THE
OPTION WITHOUT REINSURANCE WE
JUST PICK ONE IS A STRONG AND
WITHOUT GIVING YOU EIGHT HUNDRED
ROSE -- UPON
SO WE GET MORE FINANCIAL HELP
STILL SPENDING FORTY DOLLARS A
MONTH FOR THE SAME COVERAGE AND
IT WOULD BE THAN 2% OF HIS
INCOME INSTEAD OF 7% SIX AND A
HALF PERCENT.
COULD MAKE SOME SENSE.
NEXT MODEL LET'S TAKE IT TO
AARON FRANCIS ON SIXTY TWO YEARS
OLD -- THEY
MAKE.
SEVENTY FIVE THOUSAND THAT ABOVE
40% OF POVERTY NOT A LOT BUT A
GOOD BIT ABOVE I'M NOT NO ONE
WOULD SAY SOMEONE MAKING SEVENTY
FIVE THOUSAND IS A POOR PERSON.
NOW YOU LIVE IN SAN FRANCISCO OR
TRYING TO RENT A HOUSE IT'S A
CHALLENGE BUT TO SEPARATE SO
SEVENTY FIVE THOUSAND ABOUT 40%
POVERTY.
ON TO AFFORD.
A SECOND LOW SILVER PLAN IT
WOULD COST THEM TWO THOUSAND TWO
HUNDRED AND FIFTY DOLLARS PER
MONTH.
OKAY -- THAT
PLAN WOULD MEAN IT WOULD TAKE
36% OF THEIR INCOME FOR THE
PREMIUM ALONE.
NOT INCLUDING THEIR OUT OF
POCKET COSTS THEN GETTING A
SILVER PLAN MEETING OUT OF
POCKET WOULD COVER MOST OF THEIR
HEALTHCARE THEY WOULDN'T HAVE TO
PAY.
OUT OF POCKET FOR A LOT BUT THEY
MIGHT HAVE.
TO BUT JUST PREMIUM. 36% OTHER
IN.
UP YET AS MISTER FRAZIER NOTED --
IT'S HARD TO CALL IT AFFORDABLE --
TO THAT FAMILY AND THERE ARE
THOUSANDS OF FAMILIES LIKE THAT
IN PARTICULAR IN NORTHERN
CALIFORNIA IN ABOVE.
FRESNO ONE NORTH --
HAVING PREMIUM SUPPORT THAT GOES
ABOVE THAT.
MIGHT MEAN DEPEND ON WHAT THE
LEVELS OF THESE ARE THEY STILL
BE PAYING SIX HUNDRED DOLLARS --
BUT IT WOULD MAKE IT FAR MORE
AFFORDABLE FOR THEM HAVING 9% OF
THEIR INCOME GOING TOWARDS
HEALTHCARE AND DOCTOR PAN YOUR
QUESTION WHAT'S THE RIGHT LEVEL.
YOU KNOW I DON'T HAVE A MAGIC
ANSWER FOR THAT.
THE AFFORDABLE CARE ACT HAD A
GREAT DATED A GREEDY ASIANS ON
INCOME THAT STARTED AT BASICALLY
2% AND WHAT UP 29%. FOR PEOPLE
AT 40% OF POVERTY BUT THEN IT
WAS ZERO ABOVE 40% --
IT DOES MAKE SENSE TELL PEOPLE
EARN MORE HAVE A HIGHER
PERCENTAGE OF THEIR INCOME.
THEY HAVE MORE DISPOSABLE INCOME --
DOESN'T MAKE SENSE TO GO FROM 9%
236% BY THE FACT OF A CLIFF --
THAT WAS A PROBLEM OF THE RITUAL
AFFORDABLE CARE ACT IT'S LOOKING
AT TODAY --
LAST I WANT TO JUST VERY BRIEFLY
SO AS WE TALK ABOUT THE OPTIONS
TO MAKE SURE YOU ALL UNDERSTAND.
THE COMMON PATIENTS THAT ARE
DESIGNED WE HAVE AND THE TWO
ELEMENTS ONLY UNDERSTAND IS --
YOU HEAR A LOT ABOUT DEDUCTIBLES --
I'D REMIND YOU THAT FOR
EVERYTHING THAT SHADED IN BLUE
IS NOT SUBJECT TO A DEDUCTIBLE.
WHICH MEANS THE VAST MAJORITY OF
PEOPLE IN THE INDIVIDUAL MARKET
BOTH WITH COVER CALIFORNIA AND
THE BY DIRECTOR THEIR PLANS.
WHEN THEY GET A SILVER PLAN KNOW
OUTPATIENT SERVICES ARE SUBJECT
TO A DEDUCTIBLE?
BUT THAT STANDARD SILVER PLAN
MEANS YOU GO TO A PRIMARY CARE
DOCTOR YOU'RE SPENDING FORTY
DOLLARS.
IF YOU'RE LOWER INCOME FORTY
DOLLARS A LOT OF MONEY.
WHICH IS WHY THE COST SHARING
REDUCTION PLANS.
ARE SO IMPORTANT.
AND DEPENDING ON YOUR INCOME YOU
WON'T SPEND FORTY DOLLARS TO SEE
A DOCTOR IF YOU'RE QUITE LOW
INCOME AT ABOUT A 150% OF
POVERTY IT'S FIVE DOLLARS IF YOU
MAKE MORE MAYBE IT'S THIRTY FIVE
OR FIFTEEN BUT THAT'S JUST TO
MAKE REAL THIS WHOLE COST
SHARING REDUCTION.
SUBSIDIES IT SOUNDS LIKE THIS
THING FOR THE PLANS IT IS NOT
FOR THE HEALTH PLANS.
IT HELPS CONSUMERS GET CARE
MAKES IT AFFORDABLE SO IF YOU
HAVE -- IF
YOU'RE MAKING. TWENTY THOUSAND
DOLLARS A YEAR AND YOU'RE TOLD.
YOU'VE GOT TO SPEND FORTY
DOLLARS TO SEE A DOCTOR MANY
TIMES YOU'LL SKIP THE DOCTOR BUT
IF YOU'RE TOLD WE'RE GONNA
PROVIDE YOU MORE FINANCIAL HELP
IT'S FIFTEEN DOLLARS GREAT
YOU'LL BE ABLE TO THE DOCTOR
MORE SO THAT'S THAT'S OF THE
COST YOUR MCAT MECHANICS WERE --
LAST I WOULD JUST NOTE IN IN
CLOSE AND I LOOK FORWARD YOUR
QUESTIONS IS --
I DO THINK THAT --
IT'S NOT OUR JOB TO SAY WHICH IS
THE RIGHT.
YOU KNOW PIECES TO PUT TOGETHER
HERE BUT I DO THINK THE
LEGISLATION THE GOVERNOR HAVE A
RIGHT BY THINKING OF PAIRING
PENALTIES AND SUBSIDIES.
THE ISSUES OF BEHAVIORAL
ECONOMICS NOBEL PRIZE TO
TAILORED --
CHICAGO.
A KNOWLEDGE MAKES SENSE A
KNOWLEDGE OF WORKS --
EVERYONE TO PAY MORE IN THE
ABSENCE OF THE PENALTY.
ALSO PEOPLE ABOVE THE CLIP ON
THE AFFORDABLE CARE ACT LEFT
THEM OUT AND IT'S AN ISSUE
THAT'S A CHALLENGING TENS OF
THOUSANDS OF CALIFORNIANS --
THE OTHER THING THAT I WOULD
NOTE IS THAT MANY PEOPLE.
STILL WOULD NOT GET SUBSIDIES.
BUT BY HAVING A WORKING
INDIVIDUAL MARKET THAT HAS LOWER
PREMIUM INCREASES EVEN PEOPLE
THAT SUBSIDIES WILL BE ABLE TO
BUY AND STILL WILL BE BLIND SO
IT BENEFITS EVEN PEOPLE HAVING
THE A PENALTY.
PEOPLE THE DOCKET SUBSIDIES WILL
BE PAYING LOWER PREMIUMS WITHOUT
SUBSIDIES BECAUSE THE PREMIUMS
GOING DOWN FROM HEALTHY RESPECTS.
SO WE ARE DONE --
WE LOOK FORWARD TO CONTINUING
OUR WORK AT COVER CALIFORNIA IN
THE STATE OF CALIFORNIA LOOK FOR
YOUR QUESTIONS THANK YOU.
THANK YOU VERY MUCH MISTER LEVY.
HI RYAN MILLER DEPARTMENT OF
FINANCE.
WELL I I THINK THAT MISTER LEE
AND THIS WAS THE DEFINITELY SET
THE STAGE FOR THIS DISCUSSION
TODAY SO I WON'T TAKE TOO MUCH
TIME.
TO DISCUSS --
THE FACTORS LEADING THE
ADMINISTRATION'S PROPOSAL --
BUT VERY VERY SORRY INTERJECT
AND HAD A QUESTION IT'S AN
APPROPRIATE TO ASK AT AT THE
GENERAL THAT PREVIOUSLY SPOKE
WITH THAT BE OKAY BEFORE WE MOVE
FORWARD ADDRESS IF WE CAN JUST
TWO QUESTIONS AT THE AFTER OKAY
THANK SOMEONE.
THINK YOU ALL ACROSS THE STATE.
BUT YEAH VERY BRIEFLY --
UNDER THE ACA CALIFORNIA MADE
SIGNIFICANT GAINS IN REDUCING
THE UNINSURED RATE.
AND THEN --
SLOWING THE GROWTH OF PREMIUMS --
AND YOU KNOW IT IN AND WHILE
IT'S DIFFICULT I THINK TO TO
SORT OF TEASE OUT EXACTLY WHAT
FACTORS THAT WOULD BE AS A
RESULT OF THE LOSS OF THE
MANDATE VERSUS OTHER THINGS THAT
ARE HAPPENING IN THE HEALTHCARE
MARKET.
I THINK IT'S GENERALLY ACCEPTED.
THAT THE LOSS OF THE FEDERAL
MANDATE IS EXPECTED TO INCREASE
THE RATE OF THE UNINSURED --
IN SO THE ADMINISTRATION
PROPOSES --
TO REINSTATE THE MANDATE AT THE
STATE LEVEL BEGINNING IN --
TWENTY TWENTY THE MANDATE --
WOULD BE MODELED OFF OF THE
FEDERAL PENALTY WHICH IS EITHER
A FLAT AMOUNT OR A SHARE OF
INCOME MOST PEOPLE PAY THE FLAT
AMOUNT WHICH IN TWENTY EIGHTEEN
WAS EQUAL. TO SIX HUNDRED NINETY
FIVE DOLLARS PER ADULT PLAN
ABOUT THREE HUNDRED FIFTY
DOLLARS PER CHILD UP TO A
MAXIMUM.
OF ABOUT TWENTY ONE HUNDRED
DOLLARS --
WE EXPECTED THE MANDATE WILL
GENERATE ROUGHLY FIVE HUNDRED
MILLION DOLLARS IN PENALTY
REVENUE WHICH WE DEDICATE. TO
PROVIDING SUBSIDIES --
IF YOU'RE COVERED CALIFORNIA --
SO RECOGNIZING THE CHALLENGES
THAT HAVE ALREADY BEEN DISCUSSED
IN THIS HEARING --
BOTH FOR THOSE WHO ARE CURRENTLY
ELIGIBLE FOR FEDERAL SUBSIDIES
BUT ALSO THOSE WHO --
HAVE INCOMES ABOVE THE THE CLIFF
THAT MISTER LEE DESCRIBED --
THE ADMINISTRATION PROPOSES TO
MAKE THOSE SUBSIDIES AVAILABLE --
FOR INDIVIDUALS BETWEEN TWO SEND
OF THE FEDERAL POVERTY LEVEL AND
6100% OF THE FEDERAL POVERTY
LEVEL -- NOW
FOR THOSE BETWEEN TUTORED 450%
40% -- THE
SUBSIDIES WOULD BE IN ADDITION
TO THOSE ALREADY AVAILABLE FROM
THE FEDERAL GOVERNMENT --
BUT AGAIN GOING TO THAT SORT OF
CLIFF A FACT --
IN IN IN --
COVER CALIFORNIANS REPORT --
THEY THEY HIGHLIGHT THAT
UNSUBSIDIZED INDIVIDUAL MARKET
PARTICIPANTS --
PAY FOUR THOUSAND DOLLARS MORE
PER YEAR ON AVERAGE IN PREMIUMS
THAN DO SUBSIDIZED INDIVIDUAL
MARKET PERSISTENCE --
AND SO AGAIN RECOGNIZING THE
AFFORDABILITY CHALLENGES FACED
BY THIS GROUP --
WE PROPOSE EXTENDING THOSE
SUBSIDIES --
TO PEOPLE BETWEEN FOUR HUNDRED
AND 6100% OF THE FEDERAL POVERTY
LEVEL -- NOW
WE'RE CURRENTLY WORKING WITH
COVERED CALIFORNIA AND WITH THE
FRANCHISE TAX BOARD --
ON THE DETAILS OF THE TRAILER
BILL LANGUAGE --
I KNOW YOU'RE GOING TO HAVE A
LOT OF QUESTIONS FOR US AND I
HOPE TO BE HELPFUL TODAY --
WERE ALSO LISTENING TO FEEDBACK
FROM STAKEHOLDERS THAT WE'VE
ALREADY RECEIVED BASED ON THE
DETAILS THAT WE HAD --
WRITTEN IN THE BUDGET SUMMARY --
WE HOPE TO ISSUE THE TRAILER
BILL LANGUAGE SOON WE LOOK FOR
DISCUSSING THIS ISSUE MORE WITH
YOU IN THE BUDGET PROCESS --
AND I AM HAPPY TO ANSWER
WHATEVER QUESTIONS I CAN AT THIS
POINT THANK YOU.
GOOD AFTERNOON.
RYAN WILL SEE WITH THE
LEGISLATIVE ANALYST'S OFFICE.
AND THIS AFTERNOON I WILL BE
PROVIDING AN OVERVIEW OF THE LA
AS COMMON AND WE'RE JUST
PRESENTED.
AND I WILL THEN PRESENT SOME
COMMENTS ON SOME --
POSSIBILITIES FOR FUNDING
PROPOSALS INTENDED TO INCREASE
AFFORDABILITY AND INDIVIDUAL
HEALTH INSURANCE MARKET.
AND ALSO HAVE SOME ADDITIONAL
COMMENTS ON THE FOLLOWING PANEL
ABOUT IMPLEMENTATION.
CONSIDERATIONS I'M ALWAYS
SPEAKING TODAY FROM A HAND OUT
THAT SHOULD HAVE BEEN
DISTRIBUTED TO YOU ALL BEGIN ON
PAGE TWO OF THE HAND OUT --
WITH WITH OUR OFFICES COMMENTS --
TO START OFF WITH ON THE
INDIVIDUAL MANDATE WELL THE FULL
EXTENT.
OF THE IMPACT OF A STATE
INDIVIDUAL MANDATE IS UNCERTAIN
IT MAY BE ONE OF THE MOST
EFFECTIVE TOOLS THE STATE HAS TO
INCREASE ENROLLMENT --
AND IN COVERAGE AND TO REDUCE
THE COST OF OF COVERAGE IN THE
INDIVIDUAL MARKET AS HAS BEEN.
MENTIONED THE COVER CALIFORNIA
PROJECTIONS AND SHOW THAT A
STATE INDIVIDUAL ANDATE COULD
RESULT IN.
NEARLY THREE HUNDRED SIXTY
THOUSAND ADDITIONAL --
PEOPLE ENROLLING IN COVERAGE AND
THAT --
ESTATE INDIVIDUAL MANDATE COULD
ALSO LEAD TO A AVERAGE REDUCTION
IN MONTHLY PREMIUMS OF ABOUT
TWENTY FOUR DOLLARS --
PER MONTH FOR PEOPLE THAT ARE
THESE ARE RELATIVELY LARGE
EFFECTS COMPARED WITH.
MOST OF THE OTHER INDIVIDUAL
OPTIONS REPRESENTED IN THE COVER
CALIFORNIA REPORT.
AND AT THE SAME TIME ESTATE
INDIVIDUAL MANDATE WOULD
GENERATE REVENUES FOR THE STATE --
THESE WOULD LIKELY BE OFFSET TO
SOME DEGREE BY INCREASE STATE
COSTS AND MEDI CAL BECAUSE AS
HAS BEEN MENTIONED NOT EVERYONE
AND THAT'S ELIGIBLE FOR MEDI CAL
IS ENROLLED IN IT'S EXPECTED
THAT -- WITH
THE END OF THE FEDERAL PENALTY --
SOME --
PEOPLE CURRENTLY ENROLLED IN
MEDICARE WILL WILL LOSE THAT
WILL DROP THAT COVERAGE --
AND A STATE MANDATE WOULD
ENCOURAGE.
WHO ARE ELIGIBLE TO SEEK OUT AND
AND MAINTAIN THAT COVERAGE BUT
EVEN WITH THOSE OFFSETTING COSTS
AND A STATE INDIVIDUAL MANDATE
IS IS VERY LIKELY --
COST EFFECTIVE --
APPROACH FOR THE STATE TO
CONSIDER FROM A STATE BUDGET
PERSPECTIVE.
THAT BEING SAID THERE ARE
TRADEOFFS ASSOCIATED WITH STATE
INDIVIDUAL MANDATE --
COSTS OUTSIDE THE STATE BUDGET
IN PARTICULAR THE INDIVIDUAL
MANDATE WOULD RESULT IN SOME
INDIVIDUALS APPERSON COVERAGE
WHERE THEY ARE OTHERWISE WOULD
NOT HAVE --
ALTHOUGH THEY WOULD BENEFIT FROM
HAVING THAT COVERAGE --
BUT MORE SPECIFICALLY GENERATE
REVENUES FOR THE STATE AT THE
EXPENSE OF INDIVIDUALS THAT
CHOOSE TO CONTINUE TO NOT HAVE
COVERAGE --
PERHAPS BECAUSE THEY DON'T VIEW
THE OPTIONS AS AFFORDABLE.
IN LIGHT OF THESE COSTS AND
SORRY IF I GET TO THAT ON
BALANCE AND CONSIDERING THE THE
DIFFERENT FACTORS A PLAY WE WE
RECOMMEND THAT THE LEGISLATURE
GIVE SERIOUS CONSIDERATION.
TO AND THE ADMINISTRATION'S
PROPOSAL TO ENACT AN INDIVIDUAL
MANDATE.
BUT IN LIGHT OF THE COST THAT AN
INDIVIDUAL MANDATE WOULD IMPOSE
ON SOME HOUSEHOLDS WE DO MAKE WE
DO THINK IT MAKES SENSE.
AFTER THE LEGISLATURE TO
CONSIDER AN INDIVIDUAL MANDATE
IN CONJUNCTION WITH --
ADDITIONAL POLICIES THAT WOULD --
IMPROVE AFFORDABILITY.
I'M.
AS BEEN MENTIONED AT THIS POINT
RELATIVELY FEW DETAILS HAVE BEEN
RELEASED --
SO FAR ABOUT THE STRUCTURE OF
THE SUBSIDIES --
BUT IF THEY WOULD BE FUNDED FROM
ABOUT FIVE HUNDRED MILLION
DOLLARS ROUGHLY THE AMOUNT
ESTIMATED TO BE GENERATED BY THE
PENALTY.
THEY WOULD BE RELATIVELY MODEST --
AND COMPARES THESE WHICH ARE
ESTIMATED TO BE OVER SIX BILLION
DOLLARS IN.
TWENTY EIGHTEEN HAVING SAID THEY
WOULD -- YOU
KNOW EASE COMPLIANCE WITH THE
STATE INDIVIDUAL MANDATE --
MAN AND THEREFORE WORTH
CONSIDERING --
WE RECOMMEND THAT THE
LEGISLATURE CONSIDER --
THE GOVERNOR'S PROPOSED
SUBSIDIES IN THE CONTEXT OF AN
ARRAY OF POSSIBLE OPTIONS
INCLUDING THOSE.
AT REFERENCE IN THE COVER
CALIFORNIA REPORT AND AND
DETERMINE WHICH SET OFPOLICIES
WOULD BEST A LINE WITH THE
LEGISLATURE'S PRIORITIES.
AND DESIRES FOR FOR BUDGETARY
COMMITMENT --
WITH THAT I WILL MOVE ON TO SOME
COMMENTS ABOUT.
SOME POSSIBLE FUNDING SOURCES
THAT THE LEGISLATURE COULD USE.
AND TO PAY FOR POLICIES INTENDED
TO IMPROVE AFFORDABILITY.
BEGINNING ON PAGE.
FOUR AND THE HAND OUT LIST HAS
SOME OF THE CONSIDERATIONS THAT
THE LEGISLATURE WOULD WANT TO
KEEP IN MIND. FOR USING
INDIVIDUAL MANDATE PENALTY
REVENUES.
THE FIRST ISSUE IS THAT THE
INDIVIDUAL MANDATE HAS A POLICY
GOAL OF ENCOURAGING PEOPLE TO
TAKE A COVERAGE OR CONVERSELY
DISCOURAGING PEOPLE FROM GOING
WITHOUT COVERAGE.
AND AND THIS POLICY GOAL IS AT
ODDS WITH A SECONDARY GOAL OF
CREATING REVENUES TO PAY FOR FOR
SUBSIDIES --
IN OTHER WORDS IF THE
LEGISLATURE WERE THE POLICY GOAL
THAT WOULD MEAN --
LEADING TO AS FEW PEOPLE AS
POSSIBLE AT GOING WITHOUT
COVERAGE AND PAYING THE PENALTY
BUT THIS THEN WOULD RESULT IN.
LESS REVENUE AVAILABLE TO PAY
FOR THE SUBSIDIES.
ANOTHER THING TO KEEP IN MIND
WITH AN INDIVIDUAL MANDATE
PENALTY.
IS TIMING AT REVENUES FROM A
STATE INDIVIDUAL MANDATE PENALTY --
IF IT WAS MODELED ON THE FEDERAL
INDIVIDUAL MANDATE --
WOULD BE COLLECTED IN THE MONTHS
FOLLOWING THE YEARTHAT IT WAS
FIRST IMPLEMENTED THROUGH TAX
RETURNS.
AND IF THE LEGISLATURE WHICH TO
USE THOSE FUNDS TO COVER
SUBSIDIES BUT ALSO WISH TO MAKE
THE SUBSIDIES AVAILABLE AT THE
SAME TIME THAT THE PENALTY WHEN
TO AFFECT.
IT MIGHT BE NECESSARY TO PROVIDE
SOME UP FRONT FUNDING ON A ONE
TIME BASIS TO COVER THE FIRST
YEAR OF SUBSIDIES.
TURNING TO PAGE --
FIVE AND THE HAND OUT --
ANOTHER.
POTENTIAL SOURCE OF FUNDING FOR
AFFORDABILITY POLICIES IS.
A RENEWED AT MANAGED CARE
ORGANIZATION OR MCO TAX PACKAGE.
BY WAY OF BACKGROUND AND THE
STATE CURRENTLY LEVEES ATTACKS
ON MANAGED CARE ORGANIZATIONS OR
NCOS.
THAT ALLOWS THE STATE TO
LEVERAGE SIGNIFICANT FEDERAL
FUNDING IN THE MEDICARE PROGRAM.
AS PART OF THE CURRENT MCO TAX
PACKAGE THIS TAX REDUCTIONS TO
CERTAIN INSURERS.
TAKEN ALL TOGETHER THIS RESULTS
IN A NET GENERAL FUND BENEFIT OF
ABOUT ONE POINT FIVE BILLION
DOLLARS EACH YEAR.
THE CURRENT NCO TAX PACKAGE IS
GOVERNED BY STATE LAW AND ALSO
THE FEDERAL GOVERNMENT APPROVALS.
AND IS SCHEDULED TO SUNSET AT
THE END OF THE TWENTY EIGHTEEN
NINETEEN FISCAL YEAR.
THE GOVERNOR HAS NOT PROPOSED TO
EXTEND THE MCO TAX PACKAGE AS
PART OF HIS BUDGET.
HOWEVER RECENT FEDERAL APPROVAL
OF SIMILAR INSURANCE INSURANCE
TAX -- AT
POLICIES AND OTHER STATES AND
MEAN THAT IT'S LIKELY THAT THE
FEDERAL GOVERNMENT WOULD APPROVE --
A RENEWAL OF CALIFORNIA'S MCO
TAX.
IF THE STATE WERE TO RENEW THE
MCO TAX PACKAGE.
AND WE ESTIMATE THAT THIS WOULD
GENERATE GENERAL FUND SAVINGS OF
BETWEEN SEVEN HUNDRED AND EIGHT
HUNDRED MILLION DOLLARS IN --
TWENTY NINETEEN TWENTY AND
POTENTIALLY AROUND ONE POINT
FIVE BILLION DOLLARS ANNUALLY IN
LATER YEARS.
AND THESE GENERAL FUND SAVINGS
FREED UP RESOURCES COULD BE USED
TO FIND VARIOUS LEGISLATIVE
PRIORITIES.
INCLUDING AFFORDABILITY POLICIES.
TURNING TO PAGE SIX TIME WE
DISCUSS SOME.
CONSIDERATIONS FOR USING A
SUGARY DRINKS TAX --
FIRST CONSIDERATION FOR A SUGARY
DRINK TAXES THAT SIMILAR TO THE
INDIVIDUAL MANDATE SUCH ATTACKS
WOULD HAVE --
BOTH A POLICY AND A FISCAL GOAL.
AT THE POSSIBLE THE SUGARY DRINK
TAX WOULD BE TO REDUCE
CONSUMPTION OF SUGARY BEVERAGES
AND POTENTIALLY LEAD TO IMPROVED
HEALTH.
AND THE FISCAL GOAL WOULD BE TO
RAISE REVENUES HE'S [inaudible]
AND AS WE NOTED IN A RECENT
REPORT -- ON
THIS SUBJECT IMPLEMENTING A
SUGARY DRINK TAX WOULD --
REQUIRE THE LEGISLATURE TO MAKE
SEVERAL KEY DESIGN DECISIONS --
SOME OF THESE DECISIONS INCLUDE
AT WHAT TYPES OF DRINKS TO
INCLUDE.
IN THE BASE OF THE TAX --
WHETHER THAT TAX BASE WOULD AND
BE RELATED TO THE VOLUME OF
DRINK OR THE AMOUNT OF SUGAR
THAT'S IN.
THE DRINK OR SOMETHING ELSE AND
WHAT THE TAX RATE ON THIS WOULD
BE.
AND FINALLY LIKE THE INDIVIDUAL
MANDATE PENALTY A SUGARY DRINKS
FISCAL GOAL OF RAISING REVENUE
COULD CONFLICT WITH THE POLICY
GOAL.
OF REDUCING CONSUMPTION --
A SUGARY BEVERAGE TAX COULD
POTENTIALLY DECLINE OVER TIME
SIMILAR TO SOME OTHER EXCISE
TAXES LIKE THE TOBACCO TAX.
AND IN THIS COULD CREATE A
MISMATCH BETWEEN THE REVENUES
GENERATED BY THE TAX AND THE
COST OF THE SUBSIDIES THAT.
THE TAXES INTENDED TO SUPPORT.
ON PAGE.
SEVEN WE NOTE THAT THE
LEGISLATURE COULD USE EXISTING
GENERAL FUND RESOURCES TO
SUPPORT AFFORDABILITY PROPOSALS
BUT OF COURSE THIS WOULD REQUIRE
DIVERTING FUNDS.
FROM OTHER ON GOING --
PRIORITIES.
ALTERNATIVELY THE LEGISLATURE
COULD MAKE CHANGES TO INCREASE
REVENUES TO THE GENERAL FUND --
AS WE KNOW IT IN THE HAND OUT TO
HAVE THE THREE MAIN SOURCES OF
REVENUE FOR THE GENERAL FUND
INCLUDE THE PERSONAL INCOME TAX
SALES AND USE TAX.
AND THE CORPORATION TAX.
ANOTHER ALTERNATIVE TO CONSIDER
WOULD BE TO DEPOSIT THE REVENUES
FROM ANOTHER REVENUE SOURCE SUCH
AS INDIVIDUAL.
MANDATE PENALTY OR SUGARY DRINKS
TAX INTO THE GENERAL FUND AND
THEN USE THE GENERAL FUND. TO
SUPPORT THE AFFORDABILITY POLICY.
THIS WOULD HAVE AND THE
ADVANTAGE.
AND AVOIDING THE CONFLICT
BETWEEN AND THE THAT THE
MISMATCH BETWEEN THE REVENUES
COMING IN AND THE COSTS OF OF
THE POLICY.
AND IT WOULD ALSO GIVE THE
LEGISLATURE MORE FLEXIBILITY IN
THE DESIGN OF THE AFFORDABILITY
POLICY.
LASTLY ON PAGE AIDS --
WE PROVIDE SOME COMMENTS ON THE
POSSIBILITY OF USING POTENTIAL
FUTURE SAVINGS FROM INCREASED
EFFICIENCY.
IN THE HEALTHCARE SYSTEM.
AND TO PAY FOR AFFORDABILITY
POLICIES.
AN AS IS BEEN NOTED IN RECENT
YEARS A LEGISLATURE AMONG OTHERS
HAS RAISED CONCERNS ABOUT THE
UNDERLYING COST.
AND EFFICIENCY AND ACCESS IN THE
STATE'S HEALTH CARE SYSTEM.
AND AS PART OF THE TWO THOUSAND
EIGHTEEN NINETEEN BUDGET PACKAGE
THE LEGISLATURE APPROVED --
TO MULTI YEAR EFFORTS INTENDED
TO EXPLORE AND ISSUES RELATED TO
THESE CONCERNS THE FIRST IS THE
HAVE FUNDING TO PLAN AND DEVELOP
A DATABASE THAT WOULD COLLECT
INFORMATION ON HEALTHCARE COSTS
AND UTILIZATION.
AND THE SECOND IS THE CREATION
OF A COUNCIL ON HEALTH CARE
DELIVERY SYSTEMS WHICH IS TASKED
WITH PROVIDING THE LGISLATURE
WITH.
RECOMMENDATIONS FOR MORE
STRUCTURAL REFORMS TO THE
STATE'S HEALTH CARE SYSTEM.
THESE EFFORTS WILL TAKE TIME --
BUT TO THE EXTENT THAT
EFFICIENCIES ARE IDENTIFIED IT
IS POSSIBLE THAT AT SOME POINT
THE STATE COULD HAVE REDUCE
COSTS.
AND FOR HEALTH CARE INCLUDING
FOR HEALTH PROGRAM.
AND THE SAVINGS COULD --
BE USED --
TO FIND A VARIETY OF POLICIES.
HOWEVER THE TIMING AND MAGNITUDE
OF ANY POTENTIAL SAVINGS FROM
SUCH EFFICIENCIES ARE.
ARE VERY ANSWERED.
AND THAT CONCLUDES MY COMMENTS
FOR THIS PANEL AND I'D ALSO
HAPPY HAPPY TO TAKE ANY
QUESTIONS ALSO NOTE THAT --
I HAVE SEVERAL COLLEAGUES HERE
FROM THE LA --
THEY HAVE MORE DETAILED
EXPERTISE AND SOME OF THE ITEMS
THAT WE'VE.
REVIEWED AS PART OF THESE
COMMENTS AND THEY'RE ALSO
AVAILABLE TO ANSWER ANY DETAILED
QUESTIONS YOU HAVE.
GREAT WELL THANK YOU VERY MUCH
FOR THESE --
VERY IMPORTANT PRESENTATIONS AND
WILL ALASKA ARE MY COLLEAGUES
WERE --
QUESTIONS --
SENATOR RUBIO.
THANK YOU AND THIS WAS FOR THE
PREVIOUS GENTLEMEN --
I THINK I HEARD YOU I READ THE
THE REPORT AND YOU NOTED THE
DECLINE IN ENROLLMENT. FOR NON
ENGLISH SPEAKERS AND I JUST
WANNA KNOW THERE'S I HAVE
SEVERAL QUESTIONS SO ONE IS
THERE A CORRELATION BETWEEN THE
DROP IN ENROLLMENT AND THE
OUTREACH EFFORTS TO THOSE.
COMMUNITIES AND IS THERE ANY
PARIS AND DOLLARS SPENT OUT OUT
REACH PREVIOUS YEARS TEN NOW.
AND THIRD HOW DO WE PLAN TO
IMPROVE THOSE EFFORTS MOVING
FORWARD.
GREAT THANK YOU VERY MUCH THE
QUESTION BUT ABSOLUTELY NO
CORRELATION OF CHANGES NOT REACH
WE HAVE FOR MANY YEARS BEEN VERY
INVESTED IN WE DO --
PAID ADS IN LANGUAGE IN KOREAN
AND SPANISH IN --
CHINESE --
IN OTHER LANGUAGES WE DO --
MEDIA WORK IN THOSE COMMUNITIES
OUR HYPOTHESIS ON WHY WAS THERE
A DROP IN IN LANGUAGE.
IS CONCERNS IN THOSE COMMUNITIES
ABOUT THE PUBLIC CHARGE PROPOSED
REGULATIONS THE FEDERAL LEVEL --
I SPENT A LOT OF TIME TRAVEL IN
THE STATE I SPENT A LOT OF TIME
TALKING TO REPORTERS.
IN CHINESE TRANSLATED UP A VERY
GOOD CHINESE SPEAKER --
YEAH OTHERS SPEAKING IN SPANISH
AND AND KOREAN AND WAS QUITE
ANSWERING THE THAT.
I WAS ASKED RECENTLY ABOUT
PUBLIC CHARGE I WAS NEVER ASKED
WHAT THE PENALTY --
SO THERE'S NO ZERO CORAL OUR
OUTREACH --
BUT THE THE ONE THING WE
IDENTIFIED THAT WE ALSO HEARD
FROM --
COMMUNITIES.
THEY WERE WORKING DOING OUTREACH
AND AGENTS WAS THAT CONCERNED --
NOW WHY DID THAT SHOW UP ONLY IN
IN LANGUAGE IN OUR DATA ANALYSIS
AND NOT FOR INSTANCE --
IN THI --
DIFFERENCE IN LATINO ENROLLMENT
DIDN'T SHOW UP THERE THE
DIFFERENCE IN THE DROP.
OUR HYPOTHESIS IS THAT YOU'RE
MORE APT TO HAVE PEOPLE SPEAK IN
LANGUAGE --
BE MORE CONNECTED TO THE RECENT
IMMIGRANT COMMUNITIES AND MORE
CONCERNED ABOUT --
THE INAPPROPRIATELY BEING SCARED
OFF FROM GETTING COVERS BECAUSE
THE PUBLIC CHARGE ISSUE --
AND SO I'D BE HAPPY TO TALK MORE
ANOTHER TIME ABOUT OUR OUT REACH --
INVESTMENTS WE MAKE A LOT OF THE
GETS REALLY IMPORTANT --
STAND THAT IN CALIFORNIA.
WE HAVE A STATE BASED
MARKETPLACE COVER CALIFORNIA IN
DOLLARS IN A FULL RANGE OF
ADVERTISING COMMUNITY OUT REACH
NAVIGATOR AWARDS.
IN CONTRAST TO THE FEDERAL
GOVERNMENT WHICH SUPPORTS OUT
REACH FOR THIRTY NINE STATES
SPENDS TEN MILLION DOLLARS ON
ADVERTISING --
AND ABOUT THE SAME ON THE
NAVIGATOR PROGRAM SO WE ARE
SPENDING A LOT WE THINK WE'RE
SPENDING IT WELL --
WE DID INVEST MORE THIS YEAR A
LOOKING AT THE POTENTIAL IMPACT
OF THE PENALTY REMOVAL --
BUT THAT --
YOU KNOW ACROSS THE WHOLE RANGE
OF SPECTRUM OF TARGETS WERE
TRYING TO ENROLL.
THANK YOU FOR THAT.
THINK HM [inaudible]
ARAMBULA.
THANK YOU MISTER CHAIR AND HI I
WANT TO FOCUS MY COMMENTS IF I
CAN ON THE INDIVIDUAL MANDATE.
AND I WANNA MAKE SURE I GET THE
RIGHT RYAN HERE AND SO I BELIEVE
IT'S RYAN MILLER --
WITH DEPARTMENT OF FINANCE --
I'M HOPING YOU CAN SPEAK TO THE
FIVE HUNDRED MILLION IN PENALTY
REVENUES.
WHEN THOSE WILL BE RECEIVED HOW
THE TIMING WITH WHEN SUBSIDIES
WOULD BEGIN?
AND WHETHER OR NOT THERE NEEDS
TO BE A BRIDGE SOURCE OF FUNDING
TO PROVIDE FOR THE INTERMENT
TIME.
AND THEN I'D LIKE TO FOLLOW THAT
UP BY ASKING.
ABOUT WHAT WOULD OCCUR IF THE
FEDERAL GOVERNMENT WAS WORK TO
REINTRODUCE --
THE PENALTY WHAT EFFECT THAT --
AND TO OUR BUDGET.
THANK YOU --
ACTUALLY MISTER BOWLES AND I
WERE FORMERLY COLLEAGUES OF THE
CONFUSION OF THE NAMES --
RELIEF WAS EVEN A GREATER
PROBLEM THAT --
SO AS I MENTIONED WE'D LIKE --
TO WEPROPOSE BEGINNING THE
PENALTY --
WITH THE TWENTY TWENTY TAX YEAR
OF AN FTP WOULD BE ADMINISTERING
THAT -- TAX
FILERS WOULD BEGIN --
TO MAKE THOSE PENALTY PAYMENTS --
IN EARLY TWENTY TWENTY ONE WHEN
THEY FILE THEIR TAXES --
FOR FOR TWENTY TWENTY AND SO --
RECOGNIZING THAT SHOULD THE SORT
OF TIMING CHALLENGES THERE --
WE DO INTEND TO HAVE --
SOME ONE TIME A SOLUTION WE
HAVEN'T WORKED OUT ALL THE
DETAILS BUT SOMETHING TO ENSURE
THAT THE SUBSIDIES CAN BE AGAIN --
DESPITE THOSE TIMING CHALLENGES
QUESTION --
CONCERNING --
POSSIBLE FEDERAL REINTRODUCTION
OF THE MANDATE --
WE ALSO ARE CONTEMPLATING US
SOME KIND OF MECHANISM TO HAVE
THE STATE MANDATE WORK IN
CONCERT WITH A POSSIBLE FUTURE
REINTRODUCTION SO.
IT -- I
THOUGHT THE ONLY --
REALLY SPOKE WELL OF IT OF THE
PARADOX OF ACTUALLY WANTING TO
GET EVERYONE COVERED.
THEREFORE THEN NOT HAVING THE
PENALTY REVENUES TO HELP WITH
THE SUBSIDIES.
BUT IT DOESN'T DEAL WITH THE
AFFORDABILITY PEACE OF THIS
WHICH MANY OF US IN THE
LEGISLATURE ARE GOING TO NEED
BEFORE WORK TALKING ABOUT A
PENALTY.
WE'RE GOING TO NEED AS MUCH
CARROT AND STICK IN THIS
EQUATION TO MAKE SURE WERE
ADDRESSING THE NEEDS OF OUR
CONSTITUENTS AND SO --
WOULD JUST ENCOURAGED THIS
ADMINISTRATION AGAIN TO REALLY
TAKE A HARD LOOK AT THE MCO TAX.
TO SAY THAT WE'VE HAD THIS IN
PLACE FOR YEARS AND I MAY
PROVIDE THE BRIDGE UNTIL WE CAN
RESOLVE MANY OF THE OTHER ISSUES
REGARDING THE PENALTY SO.
WITH THAT THANK YOU MISTER CHAIR
[inaudible]
DR.
THANK YOU FOR WITH --
I GUESS MY FIRST QUESTION IS --
FOR FINANCE FOR MISTER MILLER --
SO I JUST WANT TO CLARIFY WHAT
IS --
GOVERNOR'S PROPOSAL IN TERMS OF
WHAT KIND OF SUBSIDIES AS A
PLANE SUPPLY SO WE HAVE
INDIVIDUAL MANDATE GOT THAT
ACTUALLY THE BILL FOR THAT AS
WELL WORKING --
GOVERNOR'S OFFICE --
BUT IN TERMS OF THE SUBSIDIES
ITSELF BECAUSE A FAULT WITH
COVER CALIFORNIA TERMS OF THEIR
REPORT. FOR THE FIVE HUNDRED
MILLION OF WHAT CUT SO YOU HAVE.
WHAT YOU PROVIDE WHAT KIND OF
LEVEL SUBSIDY PROVIDING FOR THE
FOR ARE YOU DOING?
SCHERING SUPPORT AS WELL WITH
THAT FUND'S ASSETS --
SO I JUST WANT TO GET CLARITY AS
FAR AS FIVE HUNDRED MILLION
BECAUSE I SEE A MUCH LARGER
NUMBER ON THE COVER CALIFORNIA
HOUSES WHAT ARE WE TRYING TO DO.
YEAH AN YOU KNOW I I UNDERSTAND
THE THE INTEREST THERE ARE
CERTAINLY AND YOU KNOW THE
TIMING OF THIS COVER CALIFORNIA
REPORT IS IS REALLY FORTUNATE
BECAUSE IT'S HELPING US.
A GREAT DEAL THINK ABOUT THOSE
QUESTIONS AS WELL UNFORTUNATELY
I DON'T HAVE DETAILS TO SHARE
TODAY BUT AS I MENTIONED EARLIER
WE LOOK FORWARD TO DISCUSSING
THESE WITH YOU IN THE IN THE
BUDGET PROCESS.
OKAY SO -- I
JUST MAKE NO TO THE DIFFERENCE
IN SCALE --
STUFF FROM THE COVER CALIFORNIA
REPORT --
AGAIN YOU KNOW --
SERVICE GOING BACK TO WHAT --
CHEN ARAMBULA SAID WE WANT TO BE
SURE ON THE FORTY BILLY SIDE.
WE GOT THE IDEA ABOUT A PENALTY
WE NEED MORE PEOPLE TO BE PART
OF MANY PEOPLE TO BE TOGETHER --
I'VE MADE NOTE THAT JUST BECAUSE
YOU START OFF THE YEAR HEALTHY
DOESN'T MEAN YOU'LL AND THE
YOU'RE HEALTHY.
RIGHT AND SO IF YOU DON'T HAVE
COVERAGE THAT DOES BECOME A COST
THAT GETS SPREAD OUT TO
EVERYBODY ELSE WHO ACTUALLY
BOUGHT COVERAGE.
SO.
IT'S A LITTLE DIFFERENT SO I GET
LOOKING MAKING PEOPLE HAVE TO
BUY INSURANCE BUT THE THING IS
THAT'S INSURANCE OTHERWISE --
I MEAN THAT THAT YOUR YOUR RISK
WHETHER YOU'RE YOUNG OR OLD
YOU'RE AT RISK OF HAVING HEALTH
PROBLEMS.
AND WE DON'T WANT TO HAVE TO
ABANDON PEOPLE --
BECAUSE OF THAT --
SO I GUESS THE THE QUESTION --
FOR SLEEPY --
SO IN YOUR PROPOSAL AND SERVE
THE OPTION I GUESS THE OPTION
ONE WELL OPTION TWO IS THE AD
THE INDIVIDUAL MANDATE I THINK
WE ALL SEEMS LIKE MOST OF US
AGREE WITH THAT WE'LL SEE --
BUT IN TERMS OF THE SUBSIDIES --
ARE YOU LOOKING AT NIGHT --
JUST TRYING TO I WAS ALSO
LOOKING AT THE GRAPH ON PAGE
TWENTY FOUR AND A REPORT WAS SO
THIS YEAR'S YOU'RE PROPOSING
SUBSIDIES THAT GO BEYOND 6100%
OF ARE JUST UP 26100% FPL.
CALL FRIENDS ON OKAY.
THE STAFF HERE.
AT OUR OFFICE RIGHT [inaudible]
IS.
EVERY CLUB THERE'S A HOLE RIGHT
IN.
THAT MODELS OF THE SESSION
RATHER.
IS A DAY TO DAY FOR YOU TO OF
THE REPORT FRANK THEN WHEN THE
THE REPORT MODEL NUMBER OF
DISCRETE OPTIONS.
AND WHAT WE'VE HEARD FROM THE
GOVERNOR'S OFFICE IS A THIS IS A
COMBINATION OF SOME OF THE
OPTIONS HERE SO WE HAVEN'T MET
THEM ALL TOGETHER THE DEPARTMENT
PLANETS LOOKING AT HOW TO BRING
THEM TOGETHER SO.
AS YOU HEARD FROM A DEPARTMENT
OF FINANCE THEY'RE LOOKING AT AT
ONE INCREASING FINANCIAL HELP
FOR PEOPLE TO MAKE FROM.
TWO FIFTY TO FOUR HUNDRED AN
INCREASING HELP FOR PEOPLE MAKE
FROM FOUR HUNDRED SIX HUNDRED
OKAY SO --
IN OUR OPTIONS RUN THROUGH --
YOU'LL SEE OPTIONS --
T. FIVE AND TK SIX ON PAGE
FORTY TWO ARE SPECIFIC REAL BID
OTHERS WHEN THIS.
IS --
OPTIONS OF FORTY SIX HUNDRED
THAT WOULD COST THREE HUNDRED
MILLION DOLLARS WITH DIFFERENT
LEVELS SUPPORT OPPOSING.
ANOTHER PIECE ON THE PRIOR PAGES
OPTIONS FOR PEOPLE TO MAKE LESS
THAN 40% AND SO IT IT THE
COMBINATIONS OF THERE'S THERE'S
SHOT SORT OF A TWO BY TWO SQUARE
OF OPTIONS.
HOW MUCH ARE YOU FUNDING
FINANCIAL HELP CITIES THAT
PREMIUM TILL PEOPLE GET THEIR
COVERAGE?
AND IT'S ABOVE AND BELOW.
FOUR HUNDRED OR HOW MUCH YOU
DOING FOR CULTURE RIGHT EACH OF
THESE OFFICE LAYOUT THOSE OFFER
THAT'S EXACTLY I THINK.
THE GOVERNOR'S OFFICE DEPARTMENT
PLANTS OF LOOKING AT YEP IT IS
ABSOLUTELY THE CASE THAT.
YOU KNOW WITH.
THE THE FIVE HUNDRED MILLION
ISHQ.
TARGET TO USE FOR SUBSIDIES --
YEAH THE I MEAN THE THING THAT
IT'S IMPORTANT NOTICE BUT WHEN
YOU'RE DEALING WITH THOSE --
PEOPLE RIGHT ABOVE THE CLIFF.
NOT MANY PEOPLE CAN USE A LOT OF
SUBSIDY DOLLARS.
BECAUSE THEY ARE WAY UNDER WATER
TODAY -- SO
BENEFITING --
THE NEW ENROLLMENT OF FIFTY
THOUSAND OR SO IS ACTUALLY
RELATIVELY EXPENSIVE THREE
HUNDRED MILLION DOLLARS IN THE
SO.
AS OPPOSED TO SPREADING SMALLER
NUMBERS ACROSS A LOT OF PEOPLE
AT THAT TWO FIFTY FOUR HUNDRED
WOULD ENCOURAGE MORE PEOPLE TO
GET COVER --
IT WILL HELP MORE PEOPLE BUT
SMALLER DOLLAR AMUNTS ON A PER
PERSON BASIS THAT SELF AND AGAIN
THAT THAT'S WHAT THE REPORTS
TRYING TO LAY OUT THE POLICY
OUGHT TO GET FOR YOU RATHER SAY
HERE'S THE EXACT RIGHT FOR NOW
OKAY I GOT THAT I THINK --
BUT I THINK TO A CERTAIN EXTENT
I THINK THIS IS GOING TO MUCH WE
WANT TO WORK WITH I THINK WAS
SUGGESTED WE MIGHT LOOK AT ELLIE
IS SUGGESTED WE HAD OTHER
REVENUE SOURCES ARE.
ARE EVEN GENERAL FUND HOW MUCH
WE WANT TO PUT IN ESPECIALLY
WE'RE GONNA DO AN INDIVIDUAL
MANDATE I THINK THERE'S ALSO --
I I GET THE IDEA IN TERMS OF
WELL HOW MANY PEOPLE WE CAN HELP
AND CERTAINLY SINCE THE BELOW
FOUR HUNDRED ALREADY HAVE
EXISTING SUBSIDIES FEDERAL
CREDITS AT CETERA.
WE DON'T NEED TO PUT HIS.
FOOT AS MUCH PER PERSON RIGHT TO
TO BE ABLE TO MAKE A DIFFERENCE.
ALSO A BIG NOTE THAT THE PEOPLE
OVER THE CLIFF RIGHT I MEAN WE
MAY HAVE TO SPEND MORE PER
PERSON WE'RE ACTUALLY WE'RE NOT
JUST TALKING ABOUT PEOPLE OVER
4100% WERE TELL YOUR PEOPLE
REFORM 2%.
OR ESSENTIALLY ELDER LEVEL
ELDERLY CDL STUDY I WILL USE
THAT ALL OTHER.
USEFUL --
THE WHAT ADVANCED YOUTH MATURE
ATTENDANCE PERSONALLY TALK AT
HAND RIGHT NOW.
SAY BUT RIGHT.
SO BUT I MEAN IT'S SO PEOPLE
BEFORE THEY CAN GET ON TO
MEDICARE RIGHT SO I MEAN THE
REASON THAT THEY COST A LOT MORE
IS BECAUSE WELL.
AS BECAUSE THEY ARE AT HIGHER
RISK OF GETTING SICK AND THAT'S
WHY WE THAT'S WHY EVEN THOUGH GO
OUT COMPARED TO YOUNG NO THAT IT
WAS THERE FOR THAT WE JUST ALLOW
THAT REALLY RUN IT WOULD BE EVEN
MORE EXPENSIVE.
SO THE THE CHALLENGE HERE THOSE
IT'S ALSO IN MANY WAYS WE TALK
ABOUT THE IMPORTANCE OF HAVING
INSURANCE THAT'S THERE WHEN YOU
NEED IT RIGHT.
AND THAT'S SOMETHING THAT YOU
KNOW WE'VE ALL TALKED ABOUT HERE
IN CALIFORNIA WE DON'T THAT'S
WHAT WOULD HAVE SHORT TERM PLANS
IT'S UNDER A WE DON'T MAKE
PROMISES WE DON'T KEEP.
SO TO ME THAT AND EVEN THOUGH IT
MAY BE YOU KNOW THERE MAY BE
FEWER PEOPLE HELPED PER DOLLAR --
THAT IS A POPULATION I THINK
THAT YOU'RE GOING TO HEAR A LOT
FROM WHO HAVE.
A VERY LARGE NEEDS BECAUSE
BASICALLY THEY'RE FACING THE
CLIFF [inaudible]
AND TRUE I'D AND I'M NOT SAYING
THAT PEOPLE WHO ARE MAKING LESS
ARE NOT HAVING THEIR
AFFORDABILITY ISSUES BUT THEY
BUT I MEAN WHEN YOU'RE TALKING
ABOUT -- I
NOW JUMP UP THAT NINE HUNDRED
RIGHT I MEAN SIMILARLY DOUBLING
RIGHT FROM WHEN YOU'RE CROSSING
THE LINE --
THIS FREEMAN'S AND GIVEN THAT
THE HOW HIGH THIS PREMIUMS ARE --
FOR PEOPLE OF THAT AGE BRACKET --
I THINK WE NEED TO FIGURE OUT
HOW TO HELP THEM RIGHT --
SO BECAUSE THEY'RE THE ONES WHO
BASICALLY SAY WALL BRADY GOT I
DON'T GET SICK ARE MORE LIKELY
TO GET SICK.
BUT I'M GONNA TAKE THE PENALTY
AND THEN GOD BLESS ME IF YOU
KNOW I A CREEL AT THAT DOES
SOMETHING BAD HAPPENS AND I
THINK WE NEED TO LOOK AT THAT.
ONE I GUESS ONE QUESTION IS THE
6100% I MEAN.
REALIZE THAT TO YOUR WE WANT TO
TRY TO HELP PEOPLE OR LOWER
INCOME BETTER BUT ZERO REASON
FOR THE 6100% --
DUTY WHAT A WHAT A AS OF WHAT
WITH WHAT DOES THAT MEAN FOR
SOMEONE WHO LIVES AND IT WAS
POINTED OUT EARLIER WHO LIVES IN
THAT AREA I MEAN I REPRESENTS
ACTING METTLE TO BUT I MEAN.
WHAT WHAT THE SIX IS AT THE
SECOND PERCENT THE RIGHT PLACE
WE IS THAT THE RIGHT PLACE RIGHT --
SO WE HAVE TALK ABOUT PREMIUM
HELP AND WHEN WE TALK ABOUT COST
OF IT.
SO -- SO
THAT I MEAN I THINK WE NEED TO
POSE SOME OF THOSE QUESTIONS AND
LOOK AT SO WHAT IS THE I GUESS
WE DO SOME SENSITIVITY ANALYSIS
LOOK AT LIKE WHAT WHAT'S THE YOU
KNOW WHAT.
WHAT WHAT WHERE THE INFLECTION
POINTS ARE RIGHT THIS IS THAT
HIGH ENOUGH OR IS THAT WE CREATE
A NEW CLASS THAT --
WE'RE GONNA BE STRUGGLING WITH.
IF I COULD TALK SEND THESE TWO
THINGS IN YOUR THE COMPREHENSIVE
MODEL HAS NO CLICK AT THE END
PART THAT'S PART OF WHY IT'S
MORE EXPENSIVE --
BUT THE PERCENTAGE OF INCOMES
RISES AS IT GOES UP BUT IN BACK
TO THE QUESTION AN INFLECTION
POINT IF YOU'RE THE PERSON OVER
THE CLIP IT DOESN'T IF IT'S LIKE
A INFLECTION MATTER WHAT.
BUT THE NUMBER OF PEOPLE DROPS
DRAMATICALLY AS YOU GO UP THE IN
COUNTRY BECAUSE OVER 6100%.
GENERALLY PEOPLE MAKING THAT
MUCH MONEY HUGE PERCENT OF THEIR
INCOME AND I JUST THINK THAT'S
AN IMPORTANT THING TO NOTE THE
OTHER TO NOTE IS THAT.
IT IS ALSO.
AN ISSUE OF WHERE YOU LIVE IN
YOUR HEALTHCARE COSTS SO
SACRAMENTO LIKE THE BAY AREA IS
2230% MORE EXPENSIVE THAN LA
THERE REALLY PEOPLE HERE WHO ARE
FOR THE SAME COVERAGE --
ARE SPENDING EIGHT HUNDRED
DOLLARS MORE A MONTH THAN THE
EXACT SAME COVERAGE IN LOS
ANGELES AND THAT'S AN ISSUE THAT
THAT HAVING A JUST LIKE THIS
THAT INCOME BASED.
AND BASED ON THE COST OF YOUR
HEALTH CARE WHERE YOU LIVE
ADJUST.
FOR OKAY AND THEN I ONE OTHER
QUESTION --
AND IN THE REPORT I KNOW THAT WE
DIDN'T REALLY TOUCH ON IT HERE
YET -- I
JUST MENTIONED REINSURANCE I
KNOW THAT THERE'S SOME
CHALLENGES BECAUSE OF THE WAY
THAT MADE THE OUR RELATIONSHIP
WITH THAT THE CURRENT
ADMINISTRATION --
BUT CAN YOU AT THERE LOOKS LIKE
THERE'S SOME POTENTIAL
OPPORTUNITIES PERHAPS IN THE
FUTURE IF --
WE HAVE --
CAN YOU JUST TOUCH ON THAT
BECAUSE IT LOOKS LIKE THERE'S AN
OPPORTUNITY TO DRAW DOWN.
A RESOURCES AS WELL WELL TWO
THINGS AT ONE THING I'D GO TO
THIS IS WHERE I APPRECIATION FOR
THE LEGISLATURE CALLING WE
DIDN'T JUST DELIVER IT TO YOU WE
DELIVERED IT TO CONGRESS --
AND OF THE CORD A MINISTRATION
IN MANY WAYS REINSURANCE I THINK
IS --
ECONOMICALLY PHENOMENALLY SOUND
INSTRUMENT BUT IT WAS IN PLACE
AT THE FEDERAL LEVEL FOR THE
FIRST THREE YEARS THE AFFORDABLE
CARE ACT --
THE FEDERAL GOVERNMENT BRINGING
IT BACK HAS BEEN IN DISCUSSION
AS PART OF BIPARTISAN
DISCUSSIONS FOR STABILIZE AN
INDIVIDUAL MARKETS ACROSS THE
NATION --
DOING IT ON A STATE BASIS WHERE
STATES FROM SOME OF THE MONEY
SEVEN STATES HAVE DONE THAT --
BUT I THINK.
IT DEPENDS ON WHAT THE THE
MATCHES SO TO SPEAK TO LEVERAGE
FEDERAL FUNDS TO MAKE THERE'S
UNCERTAINTY ABOUT HOW THE
ADMINISTRATION WOULD MATCH FUND
ESPECIALLY CALIFORNIA RESURGENT
A PENALTY.
AT THE SAME TIME IS A SOUGHT
REINSURANCE FUNDS --
FOR REINSURANCE SO I APPRECIATE
THAT I IF I WANT TO BE SURE WE
KEEP DOWN THE RADAR SCREEN AND
ISSUE BECAUSE I THINK IT'S AN
OPTION WE SHOULD CONSIDER
EXERCISING AT SOME POINT --
SO PERHAPS AT A TIME WHERE --
THERE MAY BE A MORE REASONABLE --
DISCUSSION ABOUT WHAT THE
FEDERAL MATCH WOULD BE AND I
THINK THAT'S REPORT THE OTHER
THING I WOULD JUST MAKE NOTE
ALSO IS IS THAT THE DOLLARS WE
SPEND ON HEALTHCARE --
JOE ONLY THEIR LOCAL THEY STAY
HERE AND THEN THE PEOPLE THAT IS
DOLLARS EMPLOYEE --
THEN PAY TAXES SO THERE IS AN
ECONOMIC.
SO WE OF CLEARLY HEALTH CARE IS
A COST FOR SOMETHING WE NEED TO
ALSO RECOGNIZE THAT.
SO SOME OF THE MONEY WE'RE
PUTTING IN.
ACTUALLY IS SPECIAL WE CAN DRAW
THE MORE FEDERAL MONEY AND OF
THOSE THROUGH CREDITS OR OTHER
TYPES OF THINGS WILL ALSO COME
BACK TO OUR OWN ECONOMY HERE --
YEAH IT'S THERE'S NOT TOO MUCH
OF HEALTH CARE THAT'S EXPORTER
IMPORTED FROM OTHER STATES OR
OTHER OF THE COUNTRY'S MOST OF
ITS RIGHT HERE SO I WANT TO KEEP
THAT IN MIND TOO WHEN WE'RE
TALKING ABOUT HOW WE DO THE
MONEY HALLETT.
CIRCLES AROUND AND ACTUALLY --
SHE BENEFITS CAN BENEFIT OUR
ECONOMY TO THANK YOU.
HELLO JUST BE PUT ON THAT POINT
IT ONE OF THESE YOU'LL SEE IN
THE REPORT.
IS VIRTUALLY ALL OF THE OFFICE
OF THE EXPAND COVERAGE EXPAND
FEDERAL SPENDING IN CALIFORNIA
BECAUSE THERE'S MORE ADVANCED
PREMIUM TAX CREDIT WHEN YOU GET
INCREASED ENROLLMENT.
MANY THIS BILLION IN ROLES ARE
GETTING FEDERAL.
TAX CREDIT SO IT IT DOES HAVE
THAT EFFECT IT EVEN FROM US
RIGHT HERE.
THANK YOU DOCTOR PAN --
FRAZIER.
THE THING MISTER OF HAS THERE
BEEN ANY CONSIDERATION OF FOR
THE MAYBE THE INTELLECTUAL
DEVELOPMENT.
DEVELOPMENTALLY --
DECEMBER COMMUNITY IN FISCAL --
OF DISABLED COMMUNITIES AS FAR
AS WHEN YOU LOOK AT THE
MEDICALLY FRAGILE THE OP
OFTENTIMES IT --
THERE ARE COMPLETELY --
GARNER BUT HEALTH AS WELL WE'RE
FOR AB AND ALL THAT I HAVEN'T
SEEN ANYTHING THAT COVERS.
YOU KNOW THE IDT CHILDREN OR
ADULTS THERE ARE.
EACH OF THEIR PARENTS --
I I ACTUALLY IN THIS IS --
BUT A IN THE SCOPE MORE A DH CS
AND MEDI CAL IN THOSE RANGE OF
PROGRAMS AND WITHIN COVERED
CALIFORNIA --
BECAUSE THE INCOME STANDARDS ARE
ABOVE.
A 130% OF POVERTY OFTEN DOESN'T
HIT THERE WE DO HAVE A RANGE OF
THINGS THAT ARE PER EACH OTHER
HEALTHCARE NEEDS DIRECTLY MET
BUT IF YOU'RE.
ASKING INCREDIBLY GOOD QUESTION
IS SORT OF LARGELY OUT OF OUR
SCOPE OF OF WEARABLES LIKE IS.
THE REASON I ASK IS SOMETIMES
THERE ARE.
INDIVIDUALS IT DON'T GET DIRECT
SERVICES.
AND THEY'RE THEY'RE THEY'RE
CALLED THE TWEETERS RIGHT.
AND SO HAVE WE TAKEN THAT INTO
CONSIDERATION WHEN WHEN YOU LOOK
AT THAT --
POPULATION --
SINGLE PARENT.
MAKES TOO MUCH MONEY BUT A LOT
OF INVOLVEMENT WITH.
OF MEDICALLY FRAGILE --
FOR DUAL DIAGNOSIS.
SO I MEAN THERE'S A POPULATION
THERE THAT THAT.
I THINK HAS BEEN MISSED.
WELL I SURE HAVE A POLL OF THE I
DON'T THINK WE'RE MISSING
POPULATION BUT I THINK THAT YOU
SHOULD KNOW THAT --
WITHIN COVERED CALIFORNIA AS AN
EXAMPLE OF VERY SIGNIFICANT
PORTION OF OUR AND ROLLED
PARENTS HAVE CHILDREN WHO HAVE
MEDICAL COVERAGE IS PART OF THE
DYNAMICS OF THE AFFORDABLE CARE
ACT IS TO HAVE A LOWER.
INCOME THRESHOLD FOR MEDI CAL --
FOR CHILDREN THEY DO FOR PARENTS
SO WE ACTUALLY SPENT A LOT OF
TIME --
WORKING.
VERY CLOSELY FAMILIES.
HAVE ALL OF THE HEALTH CARE
NEEDS MET EVEN THOUGH THERE IS
ABSOLUTELY THE CASE THE A LOT OF
FAMILIES THAT HAVE.
DIFFERENT COVERAGE OF KIDS
VERSUS PARENTS.
AND THESE KIDS.
TURN INTO ADULTS AND NEVER LEAVE
HOME.
IF THEIR KIDS ARE LEAVING HOME
THEY ARE THEY ARE I WOULD BET
DOLLARS TO DOUGHNUTS THEIR
COVERAGE WOULD CONTINUE AS
PERMANENT DISABLED AND UNDER A
PUBLIC PROGRAM.
NOT UNDER COVER CALIFORNIA'S --
SUBSIDIZE --
HEALTHCARE COVERAGE BUT SO SO
THAT'S WHERE THAT'S WHERE THE
THE BATON GETS PASSED SO TO
SPEAK UNDERSTOOD THANK YOU.
THANK YOU [inaudible]
MR BLOOM.
THANK YOU MISTER CHAIRMAN THANK
YOU FOR INCLUDING ME AND IT IN
THIS HEARING BECAUSE I WANT TO
SOLICIT YOUR INSIGHT ON ON THE
ISSUE OF PREVENTION --
BECAUSE OBVIOUSLY THIS IS ABOUT
HEALTH INSURANCE AFFORDABILITY
BUT ONE OF THE DRIVERS OF IN
AFFORDABILITY OF HEALTH
INSURANCE IS --
INCREASING AMOUNTS OF DISEASE IN
THE GENERAL POPULATION --
ONE OF THE LEADING EXAMPLES OF
THAT IS --
DIABETES THAT SECONDARY --
TO OBESITY AND AND THAT MANY
OTHER NEGATIVE HEALTH CARE
OUTCOMES THAT --
OTHER CAN FOLLOW --
CERTAINLY --
AND AND IN ADDITION TO THAT --
EXTRAORDINARY COST FOR EXAMPLE
NO STE WITH DIABETES --
AND OF MISTER WILLS THE I SPOKE
ABOUT -- THE
POTENTIAL FOR USING REVENUE FROM
THE SUGAR SWEETENED BEVERAGE
SHOW A TAX --
THAT'S SOMETHING BECAUSE THAT I
MY EARS PERK UP ON BECAUSE I'VE
BEEN THE AUTHOR OF THAT
LEGISLATION FOR THE PAST TWO
YEARS AND THAT.
THE AUTHOR THIS YEAR AND IN FACT
THAT HE DOES TO GENERATE A
CONSIDERABLE ABOUT OF REVENUE
AND IN IN OUR MODELING.
BUT THE EXPENDITURE PLAN IS
FOCUSED ON PREVENTION EFFORTS --
AND AND SO IT JUST WONDERING IF
YOU CAN --
DISCUSS HOW THIS FITS INTO THE
OVERALL PLANNING BECAUSE
OBVIOUSLY THE A DISEASE YOU
PREVENT --
EVERY DISEASE THAT YOU PREVENT
LOWERS THE OVERALL COST OF
HEALTH CARE FOR EVERYONE --
SECTORS IN THE SEC KIRSTINE WITH
THE LEGISLATIVE ANALYST'S OFFICE
QUESTION THROUGHOUT THE RESERVE.
SO AS WE NOTED I THINK SO WE AT
LEAST REPORT IN --
SUGARY DRINK TAXES AND CERTAINLY --
SO AS A SORT OF A FIRST STEP IN
THAT SORT OF ACT CHAIN OF
CAUSATION THAT YOU'RE DESCRIBING --
WOULD BE --
FOR THE TAX TO HAVE SERVED THE
BEHAVIORAL AFFECT OF REDUCING --
SUGAR SWEETENED BEVERAGE
CONSUMPTION IN AND WE DO
ESTIMATE --
IN THE REPORT AND IN OUR
ANALYSIS OF A SIMILAR INITIATIVE --
LAST YEAR THAT --
IT SAYS STATEWIDE TAX OF THE
MAGNITUDE UNDER DISCUSSION WOULD
HAVE THIS A SUBSTANTIAL EFFECT
IN THAT REGARD --
THE QUESTION THEN IS --
BASED ON THAT INITIAL RESPONSE
GAUGING SORT OF THE MAGNITUDE OF
SUBSEQUENT --
CHANGES IN AND HEALTH SUCH AS
THE CHANGE IN IN DIABETES THAT
YOU'RE REFERRING TO AND AND
CERTAINLY --
OF THAT SOMETHING THAT'S SORT OF
BEEN DISCUSSED IN CONTEMPLATED I
THINK IN OUR WORK WE WEREN'T --
JUDICIARY THE COMPLEXITY OF SOME
OF THE BEHAVIORAL RESPONSES THAT
COULD OCCUR WE WEREN'T IN A
POSITION TO TO QUANTIFY THAT AND
I THINK THAT IS SOMETHING
CERTAINLY THAT IS --
A POSSIBILITY.
THANK YOU I WOULD JUST POINT OUT
THAT -- AT
TWO CENTS PER OUNCE THE
PROJECTED REVENUE --
FROM THE SUGAR SWEETENED
BEVERAGE TAX WOULD BE SOMEWHERE
IN THE NEIGHBORHOOD OF ONE POINT
EIGHT TWO TWO BILLION DOLLARS.
ANNUALLY --
THAT'S A CONSIDER THAT HAS
POTENTIAL --
FOR SCHOOL NURSES --
FOR OF LOCAL HEALTH CARE
PROGRAMS AND THE LIST GOES ON
AND ON AND SO A COMPREHENSIVE
PROGRAM --
WOULD TAKE --
OF THAT NATURE WOULD TAKE
CALIFORNIA FOR EXAMPLE ON
DIABETES PREVENTION FROM THE
LEAST FUNDED STATE IN THE
COUNTRY --
ACCORDING TO A STUDY IN --
TWENTY FIFTEEN TO THE MOST WELL
FUNDED A PROGRAM IN THE COUNTRY.
IF YOU SENATOR STONE.
THANK YOU INTO CHAIR --
THIS REALLY THANK YOU FOR THE
PRESENTATION MY FIRST --
STINT ON THE HEALTH COMMITTEE
AND GETTING AND COVER CALIFORNIA.
THANK YOU ALL FOR YOUR
PRESENTATIONS AND IT WAS --
MENTION THAT ABOUT 3% OF THE
INCREASE THAT WE SEE ON AN
ANNUAL BASIS AND HEALTH CARE NOW
COULD BE A TURN REAL --
TO NOT HAVING THE MANDATE IS
THAT CORRECT.
THAT'S PROBABLY A LITTLE MORE
THAN THAT OKAY AT IN THE MULTI
YEAR AFFECTED NOT HAVING
APPARENTLY WOULD GO UP THE ONE
YEAR AFFECT IN TWO THOUSAND
NINETEEN WAS ABOUT HALF OF THE
EIGHT POINT 7% INCREASE WAS
ABOUT ABOUT 4%.
IN ONE YEAR SO WE THINK SOME OF
THE PLANS PRICED A LITTLE BIT
FOR THE PRIOR YEAR THEY WOULD
PRICE MORE FOR NEXT YEAR THE
OVERALL ESTIMATES WE SEE
NATIONALLY OR THAT --
OVER TWO TO THREE YEARS VISIT
ROLES IN THE ATTACK ABOUT 10% --
IMPACT ON PREMIUM OKAY AND WHAT
IS THE ABSENT THE OF THE PENALTY
WHAT IS ARE THE NATURAL
INCREASING COSTS FOR HEALTHCARE
FROM NATURAL HIGH I I HAVE
TROUBLE TALK ABOUT NATURAL
INCREASES IN HEALTHCARE COSTS
BECAUSE ACTED UP.
IS A THE THE GENERALLY THE THE
HEALTH CARE COST OF LIVING SO TO
SPEAK HAS BEEN ABOUT 526% --
IN COVER CALIFORNIA OVER THE
LAST THAT'S KIND OF HIS OF
SEVERAL FEDERAL POLICY OVER THE
LAST YEARS BUT SO YOU SHOULD
LOOK AT ABOUT 627% IS WHAT
HEALTHCARE CP I HAVE BEEN.
OKAY AND AND I CERTAINLY
UNDERSTAND THE WE ONE INCREASE
THE POOL OF PEOPLE SUBSCRIBING
TO COVER CALIFORNIA NOTABLY
HEALTHY PEOPLE WHICH ARE GOING
TO DRAIN THE A COVER CALIFORNIA
MUCH LESS --
MY DISTRICT IS REALLY DIVERSE
I'VE GOT SOME VERY WEALTHY AREAS
INDIAN WELLS FRENCH MIRAGE AREA
AND I'VE GOT SOME VERY POOR
AREAS.
THE MECCA AREA --
COACHELLA AREA --
CAN WE TALK ABOUT --
PUTTING IN A A STATE PENALTY IS
A BIT MAKE SOME MY CONSTITUENTS
RATHER NERVOUS --
I CERTAINLY --
EMPATHIZE WITH THE MATURE PEOPLE
THAT ARE FIFTY SIX YEARS OLDER
WHICH I AM --
WILL SET UP A FEW THINGS --
THAT YOU KNOW I THINK THAT CLIFF
IS A IS A STEEP CLIFFS YOU KNOW
AND WE HAVE A LOT OF SENIOR
CITIZENS THAT --
YOU KNOW ARE LIVING LONGER --
HEALTHIER --
G. BUT OF THE PLANET THEIR
FUNDING IS NOT THAT THEY PUT
AWAY FOR RETIREMENT ISN'T
MATCHING THE THE LONGEVITY OF
THEIR LIVES.
SO.
WHAT I WOULD LIKE TO SEE IN A
COVER CALIFORNIA PLAN IS
SOMETHING THAT IS NOT PUT --
ARE.
LITTLE PEOPLE TO MAKE LESS MONEY --
AND FINANCIAL PERIL TO THE POINT
WHERE THEY CAN'T AFFORD TO GET
INSURANCE AND I CERTAINLY DON'T
WANT TO PUT OUR SENIOR
POPULATIONS --
IN PERIL OF EXHAUSTING THEIR
SAVINGS AND HAVING FINANCIAL
DEVASTATION --
AND WHILE I APPRECIATE THE THAT
THE HEALTH ATTRIBUTES OF A OF A
SODA TAX --
WILL BE SEEN AND MANY OTHER
TAXES THAT HAVE BEEN IMPLEMENTED
IN THE STATE OF CALIFORNIA IN
THE PAST FOUR YEARS THAT I'VE
BEEN HERE --
HAVE BEEN VERY REGRESSIVE THAT
THE THE LOWER INCOME POPULATIONS
ARE ARE REALLY BEARING THE BRUNT --
DISORDER TAX AFFECTING NOTICE
ARISE AND GASOLINE TAXES AFFECT
ME NO BUT THEY DO AFFECT MY
CONSTITUENTS.
SO GETTING BACK TO I'M GOING I'M
GOING TO APPOINT YOU'RE JUST
SECOND BUT RE INSTITUTING A
STATE MILLION DOLLARS PER YEAR --
AND AND IT WAS UNCLEAR ABOUT THE
CLIFF IS NOT GOING TO HELP THE
PEOPLE OF THE CLIFF.
OR ARE THEY GOING TO BE.
IF I COULD AND I THINK YOUR YOU
AS A LEGISLATION I GOT A LOOK AT
WHAT COMBINATION OF PULSES BUT
IF YOU'RE LOOKING ONLY RICHER
THE PENALTY IT WOULD ABSOLUTELY
HELP PEOPLE ABOVE 40% OF POVERTY.
FAR MORE THAN WOULD HELP PEOPLE
BELOW 40% OF POWERS A BACK TO
THE REGRESSIVE SIDE.
IF YOU ARE MAKING BELOW 40% OF
POVERTY --
AND PREMIUMS DROPPED BY 10% OVER
THREE YEARS.
YOU PAY THE SAME AMOUNT THE TAX
CREDIT JUST GOES DOWN.
IF YOUR ABOUT 40% OF POVERTY AND
PREMIUMS GO DOWN 10% OVER THREE
YEARS YOU GET ALL OF THAT SO TO
SPEAK YOU HAVE A HUNDREDS OF THE
BENEFIT SO.
THAT THE THING IS THAT THE AND I
I ACTUALLY UNDERSTAND THAT --
FAMILIES IT'S LIKE YOUR BROCCOLI
NO ONE WANTS TO BE TOLD TO ROCK
LIKE -- BUT
THE PRIME BENEFICIARIES OF A
PENALTY ARE ONE THE PEOPLE WHO
ARE KNOWLEDGE TO GET INSURANCE
AND DON'T END UP IN THE HOSPITAL
HAVE A FIFTY THOUSAND DOLLAR
DEBT. TO THE ON SUBS RIGHT
PEOPLE THEY'RE PAYING LESS AND
PRE BUT THE THE PRIME NON
BENEFICIARIES --
SO TO SPEAK FINANCIALLY BACK TO
THE THE IT'S A NOT A REGRESSIVE.
GRAHAM BUT THEY'RE NOT
BENEFITING FROM THIS BECAUSE
THEY JUST GET A LOWER TAX RATE.
THAT MAKES SENSE IT MAKES SENSE
AND SO OBVIOUSLY THE MORE
BENEFICIARIES SO WE CAN GET INTO
THE SYSTEM THE MORE ABOUT HIM
ACTUALLY GETTING IT'S IT'S
BETTER FOR EVERYBODY.
SO THE LAST THING I'M GOING TO
MENTION IS THAT --
THERE STILL WILL BE AN IMPACT ON
LOWER INCOME PEOPLE.
AND IF YOU LOOK AT OUR OUR
GENERAL FUND ROUGHLY 50% OF IT
IS MADE UP OF 1% OF OUR
POPULATION THAT IS THE WELL TO
DO -- THE
TOP BUT TAX RATE I THINK IN
STATE CALIFORNIA KNOWS THIRTEEN
POINT 3% WHICH REPRESENTS MAYBE
ABOUT --
FIFTY BILLION DOLLARS FORTY FIVE
TO FIFTY BILLION DOLLARS AND
ELECTED LA --
TO MAYBE AND THE DEPARTMENT OF
FINANCE TO OPINE THAT IF WE
RAISE THAT THIRTEEN POINT 3%. TO
THIRTEEN POINT 43% ACCORDING TO
MY CALCULATIONS I GUESS IS THE
FIVE HUNDRED MILLION DOLLARS OR
IF YOU INCREASE IT BY A POINT
AND A HALF GOING FROM THIRTEEN
POINT.
THREE TO THIRTEEN POINT FOUR
FIVE IT RAISES A BILLION DOLLARS
AND WITH THAT SUFFICE SO THAT WE
DON'T HAVE.
TO ENTERTAIN THESE THINGS TAXES
AT THE LOWER LEVEL THAT ARE.
WHETHER THEY ARE REGRESSIVE
THEY'RE PERCEIVED AS BEING
REGRESSIVE.
AND SATISFYING THE NEEDS OF
MAKING THAT THE COVER CALIFORNIA.
WORKABLE HOLE AND SAY FOR
EVERYBODY TO FEEL THAT THEY CAN
GET INSURANCE WITHOUT
BANKRUPTING THEMSELVES.
CAROLINE TO THE LEGISLATIVE
ANALYST'S OFFICE SO I'D HAVE.
TO GO BACK AND LOOK SPECIFICALLY
AT THE FIGURES THAT YOU
REFERENCE IN TERMS OF THE AMOUNT
OF REVENUE RAISED.
BUT IN TERMS OF INCREASING --
THE RE TAX THERE ARE THERE ARE A
VARIETY OF WAYS TO INCREASE THE
RATES THERE COULD BE AN ACROSS
THE BOARD INCREASED EVERY RATE.
IF YOU INCREASED EVERY RATE --
BY -- POINT
007% YOU WOULD RAISE ABOUT A
BILLION DOLLARS AND THEN THAT
SCALES FROM THERE ALTERNATIVELY
YOU COULD PROPORTIONALLY RAISE
ALL OF THE RATES --
TO RAISE A BILLION DOLLARS THAT
WOULD REQUIRE RAISING EACH RATE
BY 1% OF THAT RATE SO THE BOTTOM
RATE IS 1% YOU WOULD RAISE IT TO
ONE POINT 001% AND SO FORTH SO
THEY ARE ALL TURN AS WAS
ELOQUENTLY STATED THOUGH THE
HIGHER YOUR INCOME THE LESS OF
AN IMPACT.
THESE HIGHER --
AMOUNTS ARE ON YOUR BUDGET SO
THE WEALTHY ARE YOU ARE THE LESS --
OF IN YOUR TENT --
THESE ADDITIONAL COSTS ARE --
AND THAT'S WHY I I PREFER
SPECIFICALLY LOOKED AT THE TOP.
INCOME EARNERS THAT YOU DON'T
WANT TO RAISE THE STATE INCOME
TAX -- YOU
KNOW PROP --
THIRTY WE DIDN'T SEE A MASS
EXODUS OUT OF THE STATE OF
CALIFORNIA BY THE VERY WEALTHY
THE LIKE THE SUNSHINE AND LOVE
THE BEACHES AND I'M.
WONDERING IF WE LIMITED IT TO
THE WE'VE PUSHED A POINT HALF
ABOVE.
WOULD IT GET AS THE BILLION
DOLLARS THAT I HAVE CALCULATED
IN MY MIND THAT WOULD COME TO
THE STATE OF CALIFORNIA.
I HAVE TO GET BACK TO THAT
SPECIFICALLY I'M SORRY I DON'T
HAVE THAT NUMBER IN FRONT OF ME
BUT JUST FOR A POINT OF
REFERENCE IF YOU SIMPLY RAISED --
RATES ON THOSE MAKING OVER TWO
HUNDRED THOUSAND SO THAT THAT IS
GETTING INTO THE UPPER ECHELONS
YOU WOULD ONLY NEED TO RAISE THE
RATE BY POINT 22% TO GET A
BILLION DOLLARS [inaudible]
IN REVENUE.
IF AT I'LL BE VERY GLAD I'M NOT
GONNA SPEAK TO TAX AND REVENUE
SIDE.
BUT ALMOST BIG TO TWO THINGS ONE
BLOCK OF HEALTH COMMITTEE I WANT.
TO COVERED CALIFORNIA IS A
LITTLE BIT MORE THAN HALF OF THE
INDIVIDUAL MARKET IT'S IT'S
REALLY COOL WE TALK ABOUT WHAT
WE'RE TALKING ABOUT.
THEIR ABOUT A MILLION PEOPLE
THAT BUY DIRECT FROM BLUE SHIELD
OR KAISER IN THE INDIVIDUAL
MARKET WITH THOSE SUBSIDIES UP
THERE BY OUR BENEFIT DESIGN WE
NEGOTIATE OUR PRICES AND DAY
BENEFIT THERE THE ABOUT THE FOUR
HUNDRED UP ONE NUMBER --
TWO YOUR OBSERVATION ABOUT
HEALTHIER IT'S REALLY IMPORTANT
IN SOME WAYS WE CARE MORE ABOUT.
THAT PERSON MY AGE.
NOT BEING SCARED AWAY THE YOUNG
PERSON BE LIKE TAKE FOUR TIMES A
PREMIUM.
AT THE PROBLEM OF HAVING
PREMIUMS GOING UP AND HAVING ON
SUBSIDIZED PEOPLE DROP ALL.
THESE --
OLDER PEOPLE AND I'LL TELL YOU
THE THEY'RE GONNA BE OLD PEOPLE
THINK I CAN MAKE AND THAT'S
ABOUTFORMULA THAT THE FINAL
THING.
THAT I KNOW IS --
ONE OF SIX CALIFORNIANS HAVE
BEEN IN THE INDIVIDUAL MARKET IN
THE LAST FIVE YEARS ONE OF SIX
SO A LOT OF YOUR CONSTITUENTS
MAY NOT. TO WOULD TO TWO POINT
TWO MILLION PEOPLE IN INDIVIDUAL
MARKET TODAY BUT OVER THE LAST
FIVE YEARS IT'S A CHANGING
MARKET PEOPLE LOSE THEIR JOB
THERE IN AND OUT ITS AT OUR
CENTER.
AND HAVING THIS PART OF THE
MARKET BE STABLE IS PART OF THE
BENEFITS THE ENTIRE COLUMN.
THANK YOU VERY MUCH.
THANK YOU VERY MUCH --
ANYONE ELSE BEFORE ASKING
QUESTIONS.
OKAY -- I
GUESS THE THE ADVANTAGE OR
DISADVANTAGE GOING TO THE END IS
THAT A LOT OF QUESTIONS A VERY
GOOD ANSWER BUT I DO HAVE A
COUPLE OF A COUPLE IN ITS FIRST --
HE MAY NEED TO CALL FARM TEAM
FOR THIS ON THIS ONE SO I'M
CURIOUS --
AND NUMBERS --
WE TALK ABOUT THE MCO TAX WHERE
THE MONEY GOES NOW HOW MUCH OF
THAT GOES TO MEDI CAL.
THIS ROOM WAS THE LA OUT SO THE
MCO TAX AS WAS MENTIONED EARLIER
RESULTS IN GENERAL FUND SAVINGS
IN THE MEDICARE PROGRAM.
ON SOME LEVEL THOSE SAVINGS ARE
AVAILABLE FOR ALLOCATION ACROSS.
THE STATE'S BUDGET AND IN THE
PAST THERE HAS BEEN A CONNECTION
MADE BETWEEN.
THE GENERAL FUND SAVINGS IN
MEDICARE FROM THE MCO TAX.
AND A RESTORATION OF AND REDUCE
SERVICE HOURS IN THE IN HOME
SUPPORTIVE SERVICES PROGRAM.
THAT HAD AN ANYA THE HAS AN
ANNUAL COST ABOUT THREE HUNDRED
MILLION DOLLARS A YEAR BUT
BEYOND THAT AND THE MCO TAX
REVENUES --
AND THEIR AFFECT ON THE GENERAL
FUND THE NET REDUCTION IN IN
GENERAL FUND SPENDING OF ONE
HALF BILLION DOLLARS.
IT'S NOT REALLY ALLOCATED TO ANY
PARTICULAR PLACES JUST SPREAD
ACROSS THE BUDGET IT ALLOWS THE
STATE TO DO --
MORE EXPENDITURES IN THAT AMOUNT.
SO THAT WOULD LEAD ME TO MY
QUESTION TO MR MILLER.
IT'S CLEAR IN THE BUDGET
PROPOSAL THAT THE MCO TAXES NOT
BEING CONSIDERED FOR RENEWAL
CONSIDERING THE ONE POINT FIVE
BILLION DOLLAR POTENTIAL HERE
ACROSS THE GENERAL FUND.
ALSO CONSIDERING THE FACT THAT
MANDATE MONEY SHOULD IT SHOULD
WE PASS A MANDATE WILL BE
DELAYED.
YOU'RE POTENTIALLY LOOKING AT A
TWO BILLION DOLLAR [inaudible]
HIT HERE.
IS THE ADMINISTRATION
CONSIDERING THE MCO TAX AND AND
IF NOT WHY NOT.
WELL AS YOU KNOW IT'S NOT PART
OF THE PROPOSAL AT THIS TIME WE
CONTINUE TO LISTEN FROM
STAKEHOLDERS AND IN THE IN THE
MAY REVISE WE MAY HAVE A
PROPOSAL --
I I BELIEVE TO MISTER WILL THESE
POINT OF ONE OF THE GOALS OF THE
AT MCO TAXES TO DRIVE DOWN
ADDITIONAL FEDERAL DOLLARS IN
THOSE DOLLARS ARE ALSO AVAILABLE
IN THE MEDICAL PROGRAM --
ONE OF THINGS INITIALS WE ALSO
MENTIONED EARLIER WAS THE THE
IDEA THAT.
BECAUSE OF THE SOME OF THE
CHALLENGES OF I'LL OF HAVING THE
ONLY REVENUE IN A SPECIAL FUND --
THE LA --
SUGGESTED THAT THE LEGISLATURE
AND THE FUNDED OUT OF THE
GENERAL FUND INSTEAD. ONE THING
I THINK WE WOULD POINT TO IS
THAT YOU THEN ALSO HAVE THESE
KINDS OF CHALLENGES THE MISTER
WILL DELUDE TO WHAT THE MCL TAX
THAT IS --
IT'S DIFFICULT IN THE GENERAL
FUND TO REALLY SAY WHAT THOSE
DOLLARS ARE BEING USED --
FOR AND AND AND WITH REGARD TO
THIS PROGRAM IT WOULD BE
SIMILARLY DIFFICULT TO SAY WHAT
THE PENALTY REVENUES ARE GOING
FOR HOW MUCH IS YOU KNOW GOING
TO BE USED FOR ONE THING OR
ANOTHER ANYWAY --
BUT I I GUESS MY POINT IS IS
BEING USED SOMEWHERE SO WE HAVE
A WE'RE GONNA HAVE POTENTIAL ONE
POINT FIVE BILLION DOLLAR LESS
IT'S GOING TO BE USED.
ADD UP AND POTENTIAL IF WE ARE
ABLE -- TO
IF WE HAVE THE MANDATE --
MONEY COMING IT'S STILL GONNA
THEY'RE STILL GONNA BE A LAG SO
THERE'S ANOTHER FIVE HUNDRED
MILLION DOLLARS POTENTIAL TWO
BILLION DOLLARS HERE.
THAT.
WE WE ONLY HAVE SO BIG SURPLUS
SO -- AND I
GUESS FOR ME LEAVING FEDERAL
MONEY ON THE TABLE --
I DON'T UNDERSTAND.
I DON'T UNDERSTAND THAT SO SO I
GUESS I'M ONE ECHO --
DOCTOR ARAMBULA WE WOULD REALLY
LIKE YOU TO TO TWO BILLION
DOLLAR A LOT OF MONEY AND AND
ESPECIALLY THE FACT THAT THERE'S
FEDERAL MONEY OUT THAT WE
POTENTIALLY MIGHT LEAVE ON THE
TABLE.
ANYWAY I KIND OF THAT I WILL AND
AND THEN MY FINAL QUICK MY FINAL
THING IS NOT A QUESTION BUT A
COMMENT MORE OR LESS --
MISTER LEVY I'M WITH WINDS ASKED
ABOUT THE COST OF WILL CALL CALL
THE COST OF LIVINGBUT THE COST
OF A NEW COSTA INCREASES OF
HEALTH CARE IN GENERAL.
BEING AT 5% ROUGHLY A WHEN YOU
CONSIDER INFLATION BEING WELL
BELOW THAT.
IT GOES BACK TO MY ORIGINAL CON.
YOU KNOW COMMENTS WE HAVE TO
FIND A WAY AROUND COST
CONTAINMENT HERE WE CAN'T THIS
IS UNSUSTAINABLE UNSUSTAINABLE
GOING FORWARD SO ANYWAY I WILL.
LEAVE IT AT THAT AT THIS POINT
SO AT THIS POINT --
PASSES OVER TO DOCTOR AND THANK
YOU MISTER CHAIR AND I LIKE WHEN
YOU'RE ON A SOAPBOX.
TOM FOR OUR THIRD PANEL WE'RE
GOING TO FOCUS ON IMPLEMENTATION
AND HOW CALIFORNIA CAN IMPLEMENT
AFFORDABILITY OPTIONS --
WE WILL HAVE RYAN WELLESLEY AND
PETERLEE.
THANK YOU AGAIN AROUND WE'LL SEE
WHAT THE LEGISLATIVE ANALYST'S
OFFICE --
FOR THIS PANEL I WILL BE
PROVIDED SOME HIGH LEVEL
COMMENTS ABOUT SOME --
CONCEPTUAL WAYS THAT IN
PARTICULAR PREMIUM ASSISTANCE
COULD BE --
PROVIDED --
CONTINUE NINE OF OUR HAND OUT WE
HIGHLIGHT AND THREE POTENTIAL
CONCEPTS THE FIRST.
IS A REFUNDABLE ADVANCE OF ALL
TAX CREDIT ESSENTIALLY SOMETHING
THAT WOULD BE MODELED AFTER THE
FEDERAL ADVANCE PREMIUM TAX
CREDIT --
JUST TO BRIEFLY RUN THROUGH HOW
THIS WOULD WORK AND FOR EXAMPLE
COVER CALIFORNIA COULD.
ESTIMATE HOW MUCH STATE --
CREDIT A PERSON WOULD BE
ELIGIBLE FOR THE BEGINNING OF
THE YEAR BEFORE COVERAGE STARTS.
AND THEN THE CONSUMER COULD HAVE
THE OPTION TO ADVANCE SOME OR
ALL OF THAT TO IMMEDIATELY
REDUCE THEIR PREMIUMS THAT THEY
PAY EVERY MONTH.
AND THEN --
AT THE END OF THE YEAR WHEN THEY
FILE THEIR TAXES THEY WOULD.
FIND OUT HOW MUCH THEY WERE
ULTIMATELY ELIGIBLE FOR IF THEY
HAD CREDIT THAT WASN'T ADVANCE
THAT WOULD BE PROVIDED --
AS A REDUCTION IN THEIR TAX BILL
OR REFUND.
AND IF --
THEY ACTUALLY WOUND UP BEING
ELIGIBLEFOR LESS CREDIT THAN
THEY HAD ADVANCED THEY WOULD
THEN HAVE TO MAKE A PAYMENT.
AS PART OF OUR TAXES TO TRUE
THAT UP.
ANOTHER CONCEPT IS TO DO A
REFUNDABLE TAX CREDIT THAT WOULD
NOT BE ADVANCE BOWL.
SO IN THIS CASE --
THE INDIVIDUAL BE ABLE TO
ADVANCE THE ASSISTANCE TO
IMMEDIATELY REDUCE THEIR MONTHLY
PREMIUMS UP FRONT BUT WHAT
INSTEAD.
PAY THE FULL PREMIUM AND WOULD
THEN -- BE
ABLE TO CLAIM THE CREDIT.
AT THE END OF THE YEAR WHEN
THEIR FATHER TAXES.
A THIRD CONCEPT AND IS SOMETHING
THAT IS USED IN SOME OTHER
STATES WHICH IS.
A UP FRONT SUBSIDY THAT IS FULLY
ADVANCED TO INSURERS TO
IMMEDIATELY REDUCE MONTHLY
PREMIUMS.
BUT WOULD NOT BE RECONCILED
THROUGH THE TAX SYSTEM AT THE
END OF THE YEAR SON THIS SINCE
IT'S NOT A TAX CREDIT.
LIKE THE OTHER TWO OPTIONS.
AND THESE THREE CONCEPTS AND
WOULD HAVE DIFFERENT
IMPLICATIONS FOR IT THE STATE'S
ADMINISTRATIVE COMPLEXITY
[inaudible] FOR THE STATE'S
APPROACH TO PROGRAM INTEGRITY
VERIFYING INFORMATION THAT
HOUSEHOLDS PROVIDE IN MAKING
SURE THAT THAT ASSISTANCE IS
GOING WHERE IT SHOULD.
AND ALSO FOR THE LEVEL OF NEW
ENROLLMENTS IN COVERAGE THAT
THAT THEY MIGHT INDUCE THEN I'LL
JUST WALK THROUGH.
HOW THESE THREE CONCEPTS COULD
BE DIFFERENT ON THOSE DIMENSIONS?
FOR THE REFUNDABLE ADVANCE WILL
TAX CREDIT THAT WOULD BE MODELED
ON A PTC.
THIS WOULD CREATE NEW WORKLOAD
FOR COVER CALIFORNIA
SPECIFICALLY AS I SAID BEFORE
ESTIMATING THE AMOUNT OF
ASSISTANCE.
AND THEN ALLOWING AND CONSUMERS
TO ADVANCE THAT TO ENSURE IS
THAT THEY WOULD LIKE --
COVER CALIFORNIA WOULD LIKELY
ALSO ENGAGE IN ON GOING --
ADJUSTMENTS TO THE AMOUNT OF
ADVANCED ASSISTANCE --
TO REFLECT CHANGES IN HOUSEHOLD
SITUATIONS THIS WOULD BE AND
PART. TO LIMIT THE EXTENT CAME
IN WITH THEIR TAXES AT THE END
OF THE YEAR --
THIS OPTION WILL ALSO CREATE
SUBSTANTIAL NEW RESPONSIBILITIES
FOR THE FRANCHISE TAX BOARD.
AND WHICH WOULD BE RESPONSIBLE --
FOR THE RECONCILIATION PART OF
THIS THIS WOULD INVOLVE
SIGNIFICANT INTEGRATION AND DATA
SHARING WITH OTHER AGENCIES --
FRANCHISE TAX WHERE WE NEED TO
KNOW HOW MUCH --
CREDIT WAS ADVANCED.
AND INTO WHO AND THEN AND THEN
WHAT WOULD NEED TO WORK THROUGH
THAT PROCESS OF OF PROCESSING
REFUNDS WERE NECESSARY IN MAKING
SURE THAT'S ALL RECONCILED --
FOR PROGRAM INTEGRITY IN
VERIFYING INFORMATION THAT
PEOPLE RECEIVE --
IT'S LIKELY THAT --
COVER CALIFORNIA WOULD BE ABLE
TO LEVERAGE SOME OF THE SAME
PROCESSES THAT ARE USED FOR THE
ADVANCED PLAN TAX CREDIT --
SPECIFICALLY VERIFYING HOUSEHOLD
INFORMATION AGAINST ELECTRONIC
DATA SOURCES --
AND THOSE SAME PROCESSES COULD
BE USED FOR ADJUSTING THE
CREDITS THROUGH THE YEAR --
AND THEN AS ITS TAX CREDIT AND
THE AMOUNT OF ASSISTANCE WOULD
BE TIED TO THE INCOME THAT'S
REPORTED ON TAX FROM SO THAT'S
AN ADDITIONAL LEVEL OF
VERIFICATION.
IN TERMS OF NEW ENROLLMENT IN
HEALTH COVERAGE --
IT'S LIKELY THAT RECEIVING THE
ASSISTANCE UP FRONT AS A AN
ADVANCED --
CREDIT WOULD RESULT IN A
RELATIVELY GREATER IMPACT ON NEW
ROMAN BECAUSE PEOPLE WOULD BE
ABLE TO ACT ON HAVING THOSE
LOWER COSTS IMMEDIATELY. FOR THE
SECOND CONCEPT A REFUNDABLE NON
INVENCIBLE TAX CREDIT.
AND THIS WOULD NOT --
NECESSARILY RESULT IN
SIGNIFICANT NEW WORKERS RECOVER
CALIFORNIA.
THEY WOULD BE INVOLVED WITH
CERTIFYING THAT IN A HOUSEHOLD
PURCHASE COVERAGE AND THAT THAT
MEETS THE REQUIREMENTS OF THE
CREDIT THAT THERE WOULDN'T BE A
NEED TO ESTIMATE THINGS
NECESSARILY ADVANCE ALTHOUGH.
THAT'S SOMETHING THAT COULD BE
LOOKED AT AND JUST AS A TO GIVE
HOUSEHOLDS --
HEADS UP THAT THEY MIGHT BE
ELIGIBLE FOR SOMETHING --
BUT IT IT WOULD STILL RESULT IN
AB IT MIGHT BE A LITTLE LESS
INVOLVED BECAUSE THERE WOULD BE
WOULDN'T BE THE NEED TO READ AND
GET INFORMATION ABOUT ADVANCED
CREDITS BUT THERE IS STILL BE A
LOT OF WORKLOAD FOR FTP.
THIS WOULD BE SIMILAR --
TO OTHER REFUNDABLE.
TAX CREDITS FOR EXAMPLE THE
STATE HAS A REFUNDABLE EARNED
INCOME TAX CREDIT.
AND FOR PROGRAM INTEGRITY YOU
WOULD HAVE THE VERIFICATION
THROUGH THE TAX SYSTEM.
AND MOST SIGNIFICANTLY FOR THIS
OPTION IT WOULD PROBABLY HAVE A
RELATIVELY MORE LIMITED A FACT
ON NEW ENROLLMENT.
BECAUSE PEOPLE WOULD NOT
NECESSARILY SEE THAT REDUCTION
IN THEIR OUT OF POCKET COSTS FOR
PREMIUMS UP FRONT THEY WOULD
HAVE TO ESSENTIALLY FRONT THAT
MONEY PAY THE FULL PREMIUM.
IN ANTICIPATION OF RECEIVING A
REFUND AT THE END OF THE YEAR SO
WE WOULD EXPECT RELATIVELY MORE
LIMITED --
CHANGES KNOWN ROLAND. FOR THE
FINAL --
CONCEPT AND SIMILAR TO SOMETHING
BASED ON THE PTC COVER
CALIFORNIA WOULD BE ESTIMATING --
CREDIT AMOUNTS WOULD BE UPDATING --
SIR NOT CREDIT NOT SUBSIDY
AMOUNTS WOULD BE.
UPDATING SAID THE AMOUNTS
THROUGH THE YEAR AND AND A PTZ
PROCESSES COULD PROBABLY BE
LEVERAGE FOR THAT.
BUT THIS WOULD NOT RESULT IN NEW
WORKLOAD BOARD AND SINCE THERE
WOULD BE NO END OF YEAR
RECONCILIATION.
AND AS FAR AS PROGRAM INTEGRITY
GOES THIS OPTION WOULD LACK THE
FINAL RECONCILIATION THROUGH THE
INCOME TAX SYSTEM WHICH MEANS
THAT.
SOME HOUSEHOLDS COULD WIND UP
WITH A LITTLE BIT MORE OR A
LITTLE BIT LESS ASSISTANCE
OVERALL THROUGH THE YEAR THAN
THEY WOULD HAVE.
IF THERE HAD BEEN THAT FINAL
VERIFICATION --
THIS WOULD TAKE ON PARTICULAR
SIGNIFICANCE IF THE AMOUNTS OF
THE ASSISTANCE WERE WERE LARGE
AS OPPOSED TO RELATIVELY SMALL --
AND FINALLY THIS WOULD HAVE
SIMILAR EFFECTS ON NEW
ENROLLMENT AS AND A B. T. C.
LIKE OPTION WHERE THE ASSISTANCE
IS PROVIDED UP FRONT.
ULTIMATELY THE LEGISLATURE WOULD
NEED -- TO
AWAY THE TRADE OFFS PRESENTED BY
THESE DIFFERENT CONCEPTS.
AND AND DETERMINE WHICH OPTION
BEST ALIGNS WITH ITS PRIORITIES.
AND THAT'S ALL THE COMMENTS I
HAVE ON THIS ISSUE.
GREAT -- SO.
THAT [inaudible]
FIRST THE THE REPORT WE PROVIDED
OUTLINED IMPLEMENTATION CONCERNS
A COUPLE THINGS IS TO STATE THE
OBVIOUS.
THERE WOULD BE SIGNIFICANT
POLICY AN OPERATIONAL ISSUES FOR
IN PARTICULAR --
COVER CALIFORNIA FRANCHISE TAX
BOARD DEPEND ON THE POLICIES.
IN FOR HELP PLANTS [inaudible]
THAT SAID.
THE PATHWAY TO MAKE THINGS
DOABLE TO ACT QUICKLY IS TO
BUILD ON EXISTING STRUCTURES
UNDER THE AFFORDABLE CARE ACT TO
THE EXTENT ANY POLICY OPTIONS
WERE.
DIFFERENT MORE VARIED IT WOULD
MULTIPLY DRAMATICALLY BOTH THE
COMPLEXITY INVITATIONAL JUST
SUCH AS AN OVERALL COMMENT --
I THINK THE REVIEW YOU HEARD I
THINK IT'S AGREE WITH VIRTUALLY
EVERYTHING NOTED ALSO HIGHLIGHT
A COUPLE ELEMENTS.
IS FIRST --
BUT GIVEN THE VARIOUS TOOLS
OUTLINED IN A REPORT OF A COMMON
ON EACH [inaudible]
PREMIUM SUBSIDIES.
THE BIG ISSUE IS A DANCEABLE
VERSES REFUNDABLE THE REPORT
ENTIRELY LOOKS AT ADVANCE OF ALL.
END NOTES --
IN THE REPORT OF LIMITATION IF
THE INSTEAD THIS IS WHERE TO
MAKE THESE REFUNDABLE DISCOUNT
DRAMATICALLY THE ENROLLMENT IT
IS ABSOLUTELY CLEAR BY ANY
ECONOMICS OUT THERE THAT.
THE YOU SAY YOU PUT MONEY UP
FRONT AND YOU GET IT BACK LATER.
THAT WOULD NOT BENEFIT LOWER
INCOME PEOPLE AND HIGHER INCOME
PEOPLE EVEN THEY WOULD BE LESS
APT TO USE IT SO YOU THE WAS ON
THE IMPLEMENTATION SIDE --
THE KEY ISSUES THAT WE HAVE IN
PLACE ROBUST VERIFICATION
PROCESSES THAT WE COULD CLICK
THE SWITCH AND DO THAT FOR ABOUT --
FOUR HUNDRED INCLUDING UPDATES
ON CHAINS OF INCOME.
PUTTING IN PLACE RECONCILIATION
PROCESSES --
WOULD TAKE MORE TIME --
AND WOULD BE A MORE SIGNIFICANT
BURDEN FOR FRANCHISE TAX BOARD
OR FOR COVER CALIFORNIA --
ON COST SHARING OF ONE OF THE
REASONS.
TO SHARE WITH YOU EARLIER THE
DIFFERENT STRUCTURE THE COST
SHARING STRUCTURES IS --
IF.
SUPPORT FOR EXPANDED COST
HEARING WAS BUILT ON EXISTING
STRUCTURES.
HEALTH PLANS COULD IMPLEMENT IT
QUITE QUICKLY --
WHICH MEANS IF YOU SAY WE'RE
GOING TO GIVE UP ADDITIONAL COST
SHARING SUPPORT TO TAKE SOMEONE
THAT WOULD HAVE BEEN IN A SILVER
PLAN TO A GOLD PLAN.
PRETTY EASY TO DO BUT IF YOU'RE
SAYING WE WANT TO GO TO A THING
THAT DOESN'T EXIST RIGHT NOW AND
HAVE AN ACTUAL REAL VALUE OF
EIGHTY TWO AND A HALF PERCENT.
WAY DIFFICULT SO THINK ABOUT THE
STRUCTURES OF EXPANDING COST
SHARING USING EXISTING
STRUCTURES --
ON THE PENALTY.
THE CLEARLY THERE ARE ISSUES --
EXPORT.
THERE'S ALSO ISSUES FOR POLICY
MAKERS AND FOR US TO IMPLEMENT.
TO THE EXTENT POLICIES ARE
DIFFERENT FROM THE FEDERAL
STANDARDS FOR WHO GETS A PENALTY
HOW IT'S ADMINISTERED THE DOLLAR
AMOUNTS.
YOU'LL BE MORE COMPLEX BOTH TO
ADMINISTER AND MORE COMPLEX IN
THE EVENT.
THERE IS A RETURN TO THE FEDERAL
PENALTY.
SO HAVING THINGS IN SYNC IS BOTH
FASTER AND EASIER.
AND AGAIN I THINK MANY OF US
THINK THERE MAY BE A DAY IN THE
NOT DISTANT FUTURE WHEN THE
FEDERAL GOVERNMENT REINSTITUTE A
FEDERAL PENALTY SO THAT'S AN
ISSUE ON THE A PETITION THE
PENALTY --
WE SPOKE ABOUT REINSURANCE.
IF THE STATE WERE TO PURSUE
REINSURANCE WOULD HAVE TO
DEVELOP AT THIRTEEN THIRTY TWO
WAIVER --
THAT UNTO ITSELF IS A NOT
INSUBSTANTIAL PROJECT --
TO OBTAIN THE FEDERAL OFFSET
FUNDING AND IT WOULD BE SUBJECT
TO THE FEDERAL REVIEW OF THAT
WAIVER PROPOSAL WITH
UNCERTAINTIES RELATED TO WHAT
THAT GOT --
IN TERMS THE STATE AGENCY
RESPONSIBILITIES AGAIN THE I
NOTED THAT THE TWO THE ENTITIES
THAT WOULD BE MOST IMPACT WOULD
BE COVERED CALIFORNIA --
WE HAVE A TRACK RECORD OF BEING
ABLE TO BE PRETTY NIMBLE.
THAT DOESN'T MEAN TURNING ON
ABSOLUTE DIME.
ALTER WHAT TIME IS SECOND THE
OTHER WOULD BE THE FRANCHISE TAX
BOARD -- THE
OTHER ENTITIES IS HEALTH PLANS
THEMSELVES.
AND I WOULD NOTE THAT HEALTH
PLANS.
ARE ACTUALLY.
STARTING PLANNING.
SO HEALTH PLENTY TO BE GIVEN
SOME CERTAINTY --
IN THE NEXT FEW MONTHS
UNDERSTAND WHAT'S HAPPENING TO
DEVELOP THEIR PRICES.
FOR TWENTY TWENTY SO THEY NEED
INSOFAR AS POLICIES WOULD.
BE PUT IN PLACE TO AFFECT THEM
FOR THE NEXT.
PLAN YEAR OF THEY NEED THAT --
BY SUMMER AND WE COULD TALK MORE
ABOUT THE SPECIFIC TIME IN THE
OTHER ENTITY THAT MIGHT BE
AFFECTED DEPARTMENT HEALTHCARE
SERVICES MEDICAL.
BUT VERY IMPORTANT NOTE THAT ALL
OF OUR ENROLLMENT PROCESSES ARE
UNDER SOMETHING CALLED CAL
HERE'S SOME OF YOU ARE FAMILIAR
WITH.
STERN YOU ARE FAMILIAR GILLARD
ABOUT CAL HERE'S PART OF HEALTH
COMMITTEE BUT ITS THE THE ON THE
SYSTEM BY WHICH PEOPLE APPLY FOR
FINANCIAL HELP.
WHEN WE PEOPLE PEOPLE COME TO
OUR DOOR THEY DON'T KNOW IF
THEY'RE ELIGIBLE FOR MEDICAL OR
COVER CALIFORNIA'S SUBS OR NOT?
IT'S A COMMON SYSTEM WE SHARE
WITH -- DHS
FOR MEDICAL --
IF WE ARE GOING TO NOT SOMETHING
THAT WAS IN OUR WORK PLAN.
WE THINK WE CAN DO IT --
BUT IT WOULD AFFECT PRIORITIES
THAT ARE ALREADY ON THE BOOKS
THAT WOULD AFFECT.
THE DEPARTMENT HEALTHCARE
SERVICES MEDI CAL AND THAT'S THE
ISSUE THAT WE NEED TO LOOK AT IT
TO THE OTHER IMPACTS ON TIMING
OF LIMITATION.
AS A STATE WE'VE SHOWN WE CAN BE
NIMBLE MOVE FAST BUT THAT
DOESN'T MEAN THERE AREN'T RIPPLE
EFFECTS [inaudible]
THANK YOU.
ANY QUESTIONS FROM COLLEAGUES
[inaudible]
DR PAM.
ACTUALLY DID HAVE A QUESTION
WELL DIFFERENT AND WHAT BOTH OF
YOU PERCENT ABOUT --
SO ONE OF THE ISSUES THAT'S COME
UP IN A CA FROM NATION
NATIONALLY IS THE FAMILY GLITCH.
RIGHT.
DO YOU SEE IN TERMS OF OUR OWN
IMPLEMENTATION THAT --
THINGS THAT WE MIGHT DO TO TRY
TO A DRESS THAT I MEAN WE TALK
ABOUT PROVIDING SOME OF THESE SO
FORCE -- OF
COURSE SO THE PRICE TAG OF THAT
OF COURSE IS SOMETHING WE DON'T
HAVE TO DISCUSS BUT NO WORDS
WERE HERE TRYING TO FIGURE HOW
TO MAKE THINGS AFFORDABLE WE
HAVE PEOPLE CAUGHT.
IN THE FAMILY GLITCH THAT
HAPPENED WITH THE NATIONAL EASE
THE OVERALL ACA.
SO MISTER THEM FOR NOW MY GUESS
IS IN THE AUDIENCE. 17% OF
PEOPLE NO THE GLITCH WELL THE
OTHERS KNOW WHAT SORT OF OR
DON'T KNOW WHAT --
JUST TO REMIND YOU ALL WHAT THE
FAMILY GLITCH IS.
IN THE AFFORDABLE CARE ACT BAKED
INTO THE LAW.
THERE'S INCOME STANDARD A WHEN
YOU GET FINANCIAL HELP.
HOWEVER THOSE INCOME STANDARDS
HAVE A GLITCH RELATIVE TO IF ONE
MEMBER OF A FAMILY HAS EMPLOYER
BASED COVERAGE AND OTHER MEMBERS
OF THE FAMILY DO NOT HAVE
EMPLOYER BASED COVERAGE THAT'S
AFFORDABLE.
THE STANDARD FOR DETERMINING HOW
MUCH OF A SUBSIDY THEY'D GET
ISN'T BASED ON THE INDIVIDUAL
AND ALL THE WHOLE FAMILY SO IT'S
A IT IS A GLITCH IN THE LAW --
WE DID NOT MODEL THOSE AYE WE
ACTUALLY LOOK AT THE END IS TO
THE DIRECTION OF THE LEGISLATURE
WAS GIVEN THE EXISTING STRUCTURE
THE AFFORDABLE CARE ACT WHAT
COULD WE DO IN CALIFORNIA.
THE GLITCHES BAKED INTO THE ACA
IS A WE CAN FALL THE TALK THE
MORE OFFLINE AND LOOK AT BUT
THIS IS ONE OF THE THINGS
RUNNING THE GOVERNOR.
SAID IN HIS LETTER TO CONGRESS
IN DAY ONE IN OFFICE TO SAY.
GET YOUR HOUSE IN ORDER SO TO
SPEAK.
FIX THINGS THE AFFORDABLE CARE
ACT INCLUDING THINGS YOU'RE
LOOKING AT RIGHT NOW IN
CALIFORNIA THE FAMILY WHICH IS
ONE OF THOSE.
THANK YOU WELL CERTAINLY --
IT IS SOMETHING THAT'S BAKED IN
A NATIONAL I HOPE THERE'S
FEDERAL ACTION ON THIS --
I'M NOT TERRIBLY OPTIMISTIC AT
THE UNFORTUNATELY --
BUT I WAS ALSO THINKING ABOUT
WELL WHAT ARE SOME OF THE
OPTIONS WE MIGHT HAVE TO AT
LEAST MITIGATE SOME OF THAT --
AS WERE TRYING TO THINK ABOUT
AFFORDABILITY HERE IN OUR STATE.
BUT I AGREE ULTIMATELY WE CAN'T
REALLY FIX IT HERE SB SIX
FEDERALLY.
IN IN SO FAR AS CALIFORNIA
PROVIDES RICHER SUBSIDIES AT ANY
LEVEL UP PEOPLE THAT ARE
OTHERWISE AFFECT THE LET'S HAVE.
MORE SUBSIDIES TO HELP SO TO
SPEAK BUT IT'S STILL THE GLITZ
DOESN'T GO AWAY IT'S JUST
AMELIORATED SOME.
THANK YOU OTHER COLLEAGUES.
SEEING NONE I'D LIKE TO DRAW
SOME OF THE CONCLUSIONS THAT I
THINK YOU'VE STATED BUT JUST
WANT TO MAKE SURE WERE --
CLEAR ON YOU BELIEVE IN BUILDING
UPON THE EXISTING STRUCTURES OF
THE ACA.
AND THAT A REFUNDABLE ADVANCE
BOWL TAX CREDIT WOULD BE MOST
EFFECTIVE. TO MAKE SURE THAT
WE'RE HELPING TO KEEP PREMIUMS
DOWN THAT SEEMS TO BE THE
DIRECTION THAT THE COMING
CALIFORNIANS.
BUT YOU KNOW IT IT REALLY JUST
DEPENDS ON THE LEGISLATURE'S
RELATIVE PRIORITIES FOR
COMPLEXITY VERSES --
THE IMPACT ON ENROLLMENT VERSES
AND OPPORTUNITIES TO VERIFY THE
INFORMATION THAT'S PROVIDED AND
THE DIFFERENT OPTIONS.
ARE STRONGER OR WEAKER ON THOSE
DIFFERENT THINGS IF IF YOU WANT
TO EMPHASIZE --
INCREASED ENROLLMENT THAN IT
DOES APPEAR THAT IT WOULD BE
CRITICAL TO PROVIDE THAT
ASSISTANCE UP FRONT AS AN MISTER
LEE MENTIONED --
ON THE OTHER HAND --
YOU KNOW TRYING THINGS UP
THROUGH THE TAX SYSTEM COULD
POTENTIALLY --
PROVIDE SOME MARGINAL INCREASED
PROGRAM INTEGRITY --
BUT AGAIN IT'S GOING TO DEPEND
ON THE AMOUNT OF THE CREDITS
THAT WE'RE TALKING ABOUT A
WHETHER THAT SORT OF ADJUSTMENT
IS IS WORTH IT.
IN MAYBE THIS IS AN APPROPRIATE
TIME TO SAY WE CAN'T GET INTO
THE SPECIFICS OF EACH OF THE
LEGISLATIVE PROPOSALS THAT --
US ON THE DíAS MAY BE OFFERING --
CO AUTHORING.
BUT TO ACTUALLY SAY THAT A
DOLLAR FIGURE IS NEEDED SO THAT
WE CAN THEN WORK BACKWARDS TO
FIGURE OUT HOW MUCH OF A SUBSIDY
WE CAN PROVIDE.
HOW MUCH OF A CARROT THERE IS
AVAILABLE?
IS NOT INHERENTLY DETERMINED BY
WHAT TYPE OF PENALTY WE HAVE BUT
RATHER WHAT WE WANT TO SEND THAT
GOAL OUT THE FIRST YEAR.
AND SO I'M JUST TRYING TO WORK
WITH STAKEHOLDERS TO MAKE SURE
WE CAN HAVE THAT.
DISCUSSION IN ADVANCE OF THE MAY
REVISE WHICH IS COMING SO THAT
WE CAN --
MAKE SURE WERE --
SUBSIDIES WE CAN.
PEOPLE CAN'T MAKE ENDS MEET.
AND I KEEP COMING BACK TO YOUR
POINT ABOUT 60% --
CPI GROWTH WITHIN HEALTH CARE.
EIGHT STRUGGLED TO FEEL LIKE
ENDS ARE MEETING WHEN IT BECOMES
HARDER AND HARDER EACH YEAR TO
MEET THE EXPENSES OF HEALTH CARE.
AND WE HAVE TO FIGURE OUT AS THE
LEGISLATURE HOW TO BEND THE COST
CURVE -- YOU
KNOW WHAT HAS GONE UNSAID
THROUGH THIS DISCUSSION TODAY
WAS -- THE
PROPOSAL REGARDING
PHARMACEUTICALS AND THE NEED TO
HELP.
TO NEGOTIATE --
WITH A THIRD OF ALL CALIFORNIANS
AND BE ABLE TO MAKE SURE THAT WE
ARE EFFECTIVELY BENDING THAT
COST CURVE SO.
I LOOK FORWARD TO THOSE CONTINUE
DISCUSSIONS AND THANK THIS PANEL
FOR YOUR PRESENTATION ON
IMPLEMENTATION.
GREAT THANK YOU VERY MUCH.
THIS WAS A THANK YOU TO ALL OUR
PANELISTS TODAY IT'S BEEN --
IT'S BEEN VERY INTERESTING --
VERY VALUABLE INFORMATION FOR US
AS WE MOVE FORWARD --
WE WILL GO AHEAD AND MOVE INTO
PUBLIC COMMENTS WE DON'T HAVE A
HUGE NUMBER OF PEOPLE HERE SO
WE'LL JUST HAVE YOU LINE UP AT
THE MICROPHONE AS WE HAVE IN THE
PAST AND WILL WITH CHIP.
BUT YOU GO AHEAD ALSO OR EXCUSE
ME.
THANK YOU THANK YOU AT DR WOULD
I I JUST --
I ALSO WANT TO THANK THE
PANELISTS FOR THE PRESENTATION --
I WOULD MAKE NOTE THAT THE
SENATE HEALTH COMMITTEE WE ARE
LOOKING AT TO ONE OF THE BIGGEST
EXPENDITURES WE SPEND IS ON
CHRONIC CONDITIONS THAT'S ABOUT
7080% OF OUR HEALTHCARE SPENDING
WE ARE LOOKING AT HOW WE CAN.
BETTER INCENTIVIZE CARE OF
CHRONIC CONDITIONS FOR EXAMPLE
AND MEDICARE ADVANTAGE PLANS ARE
FOCUSED ON A BETTER MANAGEMENT
THEY'VE BEEN ABLE TO SAVE UP
225% -- IT'S
REALLY ABOUT DELIVERY REFORMS SO
WE ARE LOOKING AT AND THIS ONE
OF COURSE WORK WITH THAT.
SIMPLY COLLEAGUES AND LOOKING AT
WHAT WE CAN DO IN TERMS OF
TARGETING DATA SOURCES OF
EXPENDITURE AND IMPROVING --
CARE DELIVERY SO --
I THINK THEY'LL CERTAINLY THIS
HIGHLIGHTS ON SOME OF THE NEEDS
THAT WE NEED TO DO IN TERMS OF
MAKING CARE AFFORDABLE CERTAINLY
WE WANNA TRY PRESS THE COST SIDE
AS WELL.
AND AGAIN THANK YOU SO MUCH.
THANK YOU THANK YOU VERY MUCH AT
THIS TIME WILL WE WILL TAKE
PUBLIC COMMENT --
WILL ASK YOU TO PLEASE CONFINE
YOUR COMMENTS TO THE HEARING
INFORMATION TODAY.
AND WE'VE ASKED THAT THE
COMMENTS BEING LIMITED TO TWO
MINUTES WITH THE ONE EXCEPTION
OF OF MR DEAL FOUNTAIN.
WE'VE -- BY
PRETTY LISA JUST ANNOUNCE WHO
YOU ARE AND WHAT WE REPRESENT
AND WE LOOK FOR TO COMMENTS
THANK YOU.
THANK YOU --
MY NAME IS ALLISON HOUSTON WITH
THE CHILDREN'S DEFENSE FUND OF
CALIFORNIA AND I'M SPEAKING
TODAY ON BEHALF OF CDF BUT ALSO
ALL THE OTHER MEMBERS OF THE
CALIFORNIA CHILDREN'S HEALTH
COVERAGE COALITION WHICH
INCLUDES --
UNITED WAYS CHILDREN NOW THE
CHILDREN'S PARTNERSHIP AND THE
CHILDREN'S COVERAGE AND HEALTH
INITIATIVES --
AND WE WANTED TO THANK YOU FOR
THIS IMPORTANT DISCUSSION ABOUT
FORD AFFORDABILITY AND
PARTICULARLY WANTED TO THANK --
DOCTOR PAN FOR RAISING THE ISSUE
OF THE FAMILY GLITCH --
AND OF COURSE WE TO HOPE THERE
WILL BE A NATIONAL FIX AND HAVE
BEEN WORKING TOWARDS THAT FOR
SOME TIME BUT WE DON'T SEE IT.
HAPPENING ANYTIME SOON AND SO
WHAT WE'RE ASKING IS THAT THE
CHILDREN WHO FALL INTO THE
FAMILY GLITCH NOT BE DOUBLY
PENALIZED BY ANY --
BY ANY CALIFORNIA SOLUTION
THAT'S DEVELOPED THIS YEAR OR IN
OR IN FUTURE YEARS --
I THINK CATEGORICALLY EXCLUDING
THEM BY VIRTUE OF THE FACT THAT
THEY'RE NOT ELIGIBLE FOR THE
FEDERAL SUBSIDIES WOULD LEAVE
THEM DOUBLY PENALIZED AND IT FOR
INSTANCE EVEN IF A HE IS
APPROVED THIS YEAR.
WE ASK THAT PEOPLE WHO FALL INTO
THE GLITCH BECAUSE ARE ELIGIBLE
FOR THAT SUBSIDY WHICH WOULD
HELP THEM WITH THE CHALLENGES
THAT THEY'RE FACING OFF IN
PAYING ON MULTIPLE PREMIUMS IN
MOST FAMILIES --
AND WE DID APPROACH THE
AFFORDABILITY --
WORKGROUP TO ASK THEM TO LOOK AT
AFFORDABILITY FROM A PREMIUM
STACKING PERSPECTIVE FOR YOU
LOOK AT ALL THE VARIOUS PREMIUMS
IN A HOUSEHOLD --
TO LOOK AT THE WHOLE HOUSEHOLD
BURDEN WE THINK THAT'S A MUCH
FAIRER WAY AND WE DID IT IT
WOULD ALSO ADDRESS OTHER FOLKS
BE ON THOSE WHO FALL INTO THE
GLITCH --
WITH THEIR AFFORDABILITY
CHALLENGES BUT THEY WERE NOT
ABLE TO MODEL THAT BUT I DO
THINK THAT'S A ANOTHER WAY
LOOKING FORWARD TO MAKE SURE
THAT FAMILIES WHO ARE DEALING
WITH THAT EMPLOYEE PREMIUM
CHILD'S PREMIUM SPOUSES PREMIUM --
AREN'T --
UNFAIRLY EXCLUDED AND I THINK
YOU TODAY.
THANK YOU VERY MUCH.
HI GOOD AFTERNOON M. J. D. S. ON
BEHALF OF HEALTH ACCESS
CALIFORNIA THE STATE WIDE HEALTH
CARE CONSUMER ADVOCACY COALITION
WORKING FOR FOR DOUBLE AND
QUALITY HEALTHCARE FOR ALL
CALIFORNIANS.
WERE PLEASE ARE NOT TO BE HERE
IN SUPPORT OF THE AFFORDABILITY
PROPOSALS AND ALSO THE
REINSTATEMENT OF THE INDIVIDUAL
MANDATE PENALTY AT THE STATE
LEVEL. TO PARTIALLY FUND THE
SUCH AFFORDABILITY PROPOSALS
ALTHOUGH WE WE WE DO RECOGNIZE
THAT -- THAT
REVENUE SOURCE IS A DECLINING
REVENUE SOURCE AND WE LOOK
FORWARD TO HAVING THOSE
CONVERSATIONS WITH THE
LEGISLATURE AND ADMINISTRATIONS
TO SEE WHAT THE PROPER SOURCES
OF FUNDING AREN'T THERE ARE.
AS MENTIONED BEFORE
AFFORDABILITY REMAINS TO BE A
TOP CONCERNS FOR CALIFORNIANS
THOSE WITH INSURANCE AND THOSE
WITHOUT INSURANCE --
MANY OF THOSE THAT HAVE
INSURANCE STILL CANNOT AFFORD
THE INSURANCE THAT THEY HAVE DUE
TO FOOD COST RENT BECAUSE
TRANSPORTATION COSTS AND ANY
OTHER BASIC NECESSITIES.
AND WE KNOW THAT THE REMAINING
UNINSURED ABOUT FIVE HUNDRED TO
SIX HUNDRED THOUSANDS OF THEM
ARE UNINSURED EVEN THOUGH THEY
ARE ELIGIBLE.
FOR A FEDERAL SUBSIDIES TO HELP
AFFORD COVER HELPS THOSE WITH
COVERAGE MOVE INTO BETTER
COVERAGE AND THOSE WITHOUT
COVERAGE INTO NEW COVERAGE SO WE
WOULD.
EMPHASIZE LOOKING AT OPTIONS
THAT WOULD DO ODD BOTH OF THOSE
THINGS AND THEN LASTLY OUR GOAL
CONTINUES TO BE TO SOME WITHOUT
AND CAP --
WHAT INDIVIDUALS PAY 2% OF THEIR
INCOME BASED?
A SLIDING SCALE AND TARGETING
FINANCIAL HELP TO THE LOWEST OF
THOSE WITH --
ESPECIALLY THOSE BELOW FOUR
HUNDRED AND 210050% OF F. P. ALL
AND ALSO HELPING THOSE RIGHT
ABOVE THAT INCOME CLIP.
WE LOOK FORWARD TO WORKING WITH
YOU AGAIN ON THE LEGISLATURE AND
THE ADMINISTRATION TO FIGURE OUT
HOW WE CAN SOLVE THIS
AFFORDABILITY PROBLEM IN THE
NEXT FEW WEEKS THANK YOU
[inaudible]
VERY MUCH [inaudible]
WE GOOD AFTERNOON UNTIL FOUNTAIN
WITH AN ACTING VERSE HEALTH CARE
FOR CALIFORNIA --
THANK YOU SENATORS
ASSEMBLYMEMBERS AND DOCTOR WOULD
FOR GIVE ME THE EXTRA A FEW
MINUTES -- I
AM WANTING TO TALK ABOUT TODAY
JUST REALLY BRIEFLY ABOUT --
WHO WE ARE A --
HUNDRED SEVENTEEN THOUSAND
CALIFORNIANS SUPPORTERS.
OF WE ALSO --
IF THERE'S JUST A LITTLE BIT
ABOUT HOW MUCH CALIFORNIA IS
ANGRY ABOUT WHAT THEY CAN'T
AFFORD -- WE
JUST HAD A POLL RELEASED UNIONS.
ARE WILLING TO PAY INCREASED
TAXES FOR SINGLE PAYER.
ON THE SECOND POLE IS 51%
CALIFORNIANS WANT TO DUMP
PRIVATE INSURANCE FOR SINGLE
PAYER --
THIS JUST GIVES YOU AN
INDICATION HOW ANGRY PEOPLE ARE
I'M GOING BACK TO THE FORD
ABILITY HERE --
I'M GLAD THAT UNDER INSURED WAS
TALKED ABOUT IT DOESN'T SEEM TO
BE TALKED ABOUT JUST AS FAR AS
PEOPLE WHO ARE NOT INSURED --
I BELIEVE THE NUMBERS HAVE GONE
UP RECENTLY --
ABOUT ALMOST HALF THE POPULATION
IF THEY GET A FIVE HUNDRED
DOLLAR BILL --
THEY CAN'T AFFORD IT OR AT LEAST
THEY ARE SCRAMBLING TO FIGURE
OUT A WAY TO AFFORD SUCH A BILL --
IT'S IT'S A HUGE PROBLEM THE
NUMBERS THAT THEY HAD IN ARE
ACTUALLY SOMEWHAT CORRECT --
I BELIEVE FROM THE TWENTY
SIXTEEN STUDY I LAST SAW.
IT AS FAR AS AFFORDABILITY WITH --
PREMIUMS AND WE HAVE --
TO I THINK LAW GETS LOST.
AS FAR AS WHAT PEOPLE --
PAY -- I
BELIEVE THAT I EMPLOYER INSURERS --
TO PEOPLE ARE PAYING ABOUT
TWENTY THOUSAND DOLLARS A YEAR
ON AVERAGE ON THE ON THE HIGH
END -- IT IS --
AND THAT IS GROWING AND WE ARE
TALKING ABOUT --
THINGS ABOUT YEAH 8% 5%
INCREASES IN PREMIUMS --
THAT'S NOT GETTING BETTER --
IF YEAR EVEN IF --
EVEN IF INFLATION IS 3% PEOPLE
SALARIES DON'T EVEN GO UP 3% A
YEAR SO THEY CAN'T EVEN AFFORD
THAT IT'S IT'S EVEN WORSE --
I I JUST ONE TOUCH ON PEOPLE
TALK ABOUT PRIVATE INSURANCE AND
HAVING BETTER CHOICES THE
NETWORKS ARE SMALL AND IN FACT
WHAT WE JUST SAW WAS SUTTER --
THEY'RE CUTTING OFF THEIR
NETWORKS --
TO I BELIEVE IT'S BLUESHIELD IN
MY CORRECT TONIGHT ANYWAY --
SO THERE'S A WHOLE BUNCH OF
CUSTOMERS WE CAN'T EVEN GET TO
THEIR DOCTORS THROUGH THAT --
SF GENERAL SECRETARY GUESTS HAVE
GENERALLY MIGHT OF HEARD ABOUT
THAT --
BILLION PATIENTS BALANCE BILLING
AND HE'S --
ON THE HOOK FOR NINETY THOUSAND
DOLLARS.
I'M SO HE'S INSURED AND THAT'S
WITH INSURANCE.
SO IT JUST BECAUSE YOU HAVE
INSURANCE DOESN'T MEAN YOU CAN
ACTUALLY AFFORD --
HOSPITAL ANYMORE --
NOW WITH THE MANDATE IF YOU'RE
GOING TO MANDATE SUCH A THING
AND I BELIEVE THE THE IS IS IT
THE BENEFIT WAS LIKE TWENTY FOUR
DOLLARS --
IS THAT IF WE REINSTATE A
MANDATE WELL THAT'S RIDICULOUS
WITH GIVE YOU JUST SAW THE THE
GRAPHICS WITH WHERE THEY ARE YOU
KNOW ONE THOUSAND ONE HUNDRED
DOLLARS ONE THOUSAND TWO HUNDRED
DOLLARS.
WAS TWENTY FOUR DOLLARS.
ON THAT AND ASSIST THE PREMIUM
THAT'S THAT DOESN'T COUNT THAT
DOESN'T INCLUDE THEIR
DEDUCTIBLES ARE OR THEIR CO PAYS
TWENTY FOUR DOLLARS IS NOTHING.
IF YOU TRY --
TO IF YOU TRY TO REINSTATE THE
MANDATE --
WILL OPPOSE IT 1100% AT THIS
POINT WE NEED TO HEAR MORE ABOUT
HOW YOU GUYS YOU CAN MAKE IT
AFFORDABLE.
ON FOR THE REST OF THE PEOPLE
HERE.
REINSURANCE --
NOW IT'S ACTUALLY PER BUT IS FAR
AS A GIVEN THAT TO PRIVATE
INSURANCE --
WE BELIEVE THAT'S A SUBSIDY THAT
ON THAT WE WILL FIGHT AS WELL IT
SHOULD ONLY GO TO PUBLIC --
INSURANCE ON IT OTHERWISE
THEY'RE SOCIALIZING THEIR LOSSES
AND THE PROFITS OF WE SEEM
KAISER.
AT LEAST A COUPLE YEARS AGO HAD
A THREE BILLION DOLLAR PROFIT --
SO I YOU KNOW IF YOU'RE
SUBSIDIZING THAT THANK YOU
YOU'RE SUBSIDIZING THAT.
ARE THEN YOU KNOW WHAT WHY WHY
ARE WE SUBSIDIZING THE PROFITS --
AND LASTLY THE COUNCIL
HEALTHCARE DELIVERY SYSTEMS NOW
I WAS WALKING AROUND DELIVERING.
A COUPLE OF FLYERS --
TO EVERYBODY --
SO.
I I MIGHT HAVE MISSED WHERE --
GAVIN NEWSOM I DON'T THINK HE
WAS HE WAS HE NOW.
OKAY GREAT GREAT --
BECAUSE THEN WE CAN START
TALKING ABOUT THE FIVE MILLION
DOLLARS --
TO START RESEARCHING --
BETTER METHODS OF RATHER THAN
JUST DUMPING MONEY INTO PRIVATE
INSURANCE AND NOT CAN YOU
BENEFITS SO.
THAT'S ABOUT ALL I HAVE TO SAY
THANK YOU.
GOOD AFTERNOON GENTLER ON BEHALF
OF WESTERN CENTER ON LAW AND
POVERTY -- I
HAD THE PRIVILEGE OF BEING ABLE
TO PARTICIPATE IN THE AB
EIGHTEEN TEN WORK GROUP AND SO I
DO WANT TO DRILL DOWN ON A
COUPLE OF THE LESSONS THAT WE
LEARNED IN THEIR FIRST OF ALL
WHEN WE'RE TALKING ABOUT CLIFFS
IN HERE ONE OF THE THINGS THAT
WESTERN.
CENTER ALWAYS TALKS ABOUT IS
THERE'S AN ADDITIONAL CLIFF AND
THAT'S THE ONE WHEN YOU MOVE
FROM MEDICAID TO COVER
CALIFORNIA --
GOING FROM ABSOLUTELY FREE
COVERAGE TO COVERAGE THAT HAS
PREMIUM COSTS EVEN THOUGH
THEY'RE LOW AND HAS COME.
OUT OF POCKET COSTS EVEN THOUGH
THEY'RE LOW IT'S STILL VERY
DIFFICULT FOR FAMILIES
PARTICULARLY THOSE WHO HAVE BEEN
IN DEEP POVERTY FOR YEARS.
AND THEN END UP FINALLY GETTING
A PAYCHECK THAT PUTS THEM OVER
THE MEDI CAL LIMIT --
YOU KNOW WHEN YOU'VE BEEN IN
THAT SITUATION FOR A LONG TIME
YOU HAVE A LOT OF UNMET NEED TO
HAVE A LOT OF DEBT YOU HAVE A
LOT OF APPLIANCES OUR CARS ARE
ALL SORTS OF THINGS THAT --
SO WE WOULD HIGHLY ENCOURAGE ANY
PROPOSAL TO ALSO INCLUDE PEOPLE
BELOW 210050% OF THE FEDERAL
POVERTY LEVEL --
WHEN WE WORKED ON THE
AFFORDABILITY WORK GROUP WE WERE
ABLE TO SEE SOME OF THE MODELING
THAT WENT INTO THIS AND SOME OF
THE GOOD NEWS AS WAS REFERRED TO
HERE IS THAT --
IT IS CHEAPER TO HELP THESE
PEOPLE BECAUSE OF THE SUBSIDIES
THAT ARE AVAILABLE --
AND ALSO THE TAKE UP RATE IS A
LOT HIGHER WE'RE GETTING OVER A
HUNDRED TWENTY THOUSAND PEOPLE
ENTERING THE MARKET BASED ON
SOME OF THE MODELING AT THESE
LOWER INCOME LEVELS COMPARED TO
MUCH SMALLER AMOUNTS HIGHER
INCOME LEVELS.
AND THEN FINALLY ON THE
INDIVIDUAL MANDATE WE ARE
CONCERNED THAT AN INDIVIDUAL
MANDATE BE PROPOSED WITHOUT
ADDITIONAL ASSISTANCE TO PEOPLE
AT LOWER INCOME LEVELS ARE WHAT
WE HAVE SEEN OF WHO IS PAYING
THE INDIVIDUAL MANDATE IN
CALIFORNIA WE BELIEVE THE
MAJORITY OF THEM ARE ACTUALLY
AND HOUSEHOLDS EARNING LESS.
THAN 210050% OF THE FEDERAL
POVERTY LEVEL SO WE WOULD NOT
WANT TO SEE A REVERSE ROBIN HOOD
SITUATION WHERE WE ARE TAKING
MONEY FROM LOWER INCOME
HOUSEHOLDS TO PAY FOR HEALTHCARE
FOR HIGHER INCOME HOUSEHOLDS.
EVERYBODY NEEDS HELP AND YOU
KNOW WE'RE HAPPY TO SEE POLICIES
HELPING UP AND DOWN THE INCOME
SCALE BUT WE DON'T WANT THESE
PEOPLE LEFT OUT THANK YOU.
THANK YOU.
GOOD AFTERNOON THANK YOU FOR
YOUR LEADERSHIP ON THIS QUAD
COMMITTEE MY NAME IS ON A HOUSE
ABOUT I'M WITH UNITED WAYS OF
CALIFORNIA MOSTLY HERE ON BEHALF
OF THE CHILDREN'S HEALTH
COVERAGE COALITION.
I WANNA LINE MY COMMENTS SO THAT
I DON'T TAKE SO MUCH TIME WITH
MY COLLEAGUES WITH THE
CHILDREN'S DEFENSE FUND --
AND JUST WANT TO RAISE AGAIN THE
ISSUE THE FAMILY GLITCH --
IN PARTICULAR --
WHAT WE KNOW AS RAISE MY DOCTOR
PAN -- WE'RE
REALLY CONCERNED ABOUT HOW THIS --
ISSUE IS AFFECTING PREMIUMS FOR
CHILDREN'S AND AND SPOUSES AND
THE FINANCIAL STRESSES PLACED ON
HOW PLACES ON HOUSEHOLDS THE
FAMILY WHICH MEANS EITHER
CHILDREN AND SPOUSES MUCH PAY
MUST PAY MUCH MORE IN THEIR
PREMIUMS --
OR WITHOUT SUBSIDIES OR ALL
TOGETHER --
AND REALLY WE KNOW THAT BOTH OF
THESE OPTIONS ARE NOT IN KEEPING
WITH OUR STATES ENSURE --
COMMITMENTS TO COVERAGE AND
AFFORDABILITY WE URGE THE FAMILY
GOOD SHOULD BE INCLUDED IN ANY
OF THE STATE'S AFFORDABILITY
ASSISTANCE SOLUTIONS THANK YOU
AGAIN FOR YOUR LEADERSHIP.
THANK YOU TEARS IN MEMBERS LINDA
TO NARROW ITS ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK --
WE WANNA LINER COMMENTS WITH
THOSE MADE BY WESTERN CENTER AS
WELL AS HEALTH ACCESS WE WOULD
JUST UNDERSCORE THE IMPORTANCE
OF AFFORDABILITY FOR
HISTORICALLY DISENFRANCHISED
COMMUNITIES --
NAMELY COMMUNITIES OF COLOR.
AND SO WITH THAT SAID YOU KNOW
WE BELIEVE THAT SUBSIDIES ON
CONTINUE TO BE INSUFFICIENT FOR
SOME OF THE MOST NEED IN.
MOST NEED CALIFORNIANS WHO ARE
BELOW 210050% OF THE FEDERAL
FEDERAL POVERTY LEVEL AND WHO
DESERVE GREATER ASSISTANCE SO AS
TO NOT FOR GO THEIR HEALTHCARE.
AND RESORT TO YOUR SERVICES AS A
PRIMARY CARE.
THERE'S BEEN A DIP IN COVERED
CALIFORNIA ENROLLMENT FOR
LIMITED ENGLISH PROFICIENT
COMMUNITY MEMBERS AND WE KNOW
THAT ONE MILLION PEOPLE WHO ARE
ELIGIBLE FOR MEDIC HOW --
ARE NOT AND ROLLED --
SO FROM C. PENS PERSPECTIVE YOU
KNOW WE SEE AN OPPORTUNITY HERE
FOR THE STATE TO REALLY INVEST
IN COMMUNITY BASE NAVIGATORS WHO
CAN HELP PEOPLE GET INTO THE
MEDICAL PROGRAM FOR THE HARDEST
TO REACH.
HOW THE LARGEST LANGUAGE
BARRIERS AND THESE FOLKS HAVE
TRUST IN THE COMMUNITIES AND CAN
CONTINUE TO DISPEL ANY
MISINFORMATION --
AND ATTACKS ON ON HEALTH CARE --
BY THE FEDERAL MUCH.
THANK YOU MISTER CHAIR AND
MEMBERS AT NICK LOUISE US ON
BEHALF OF THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS --
WE WANT TO THANK THE COMMITTEE
FOR THE INFORMATIVE HEARING
TODAY -- AND
FOR THE OPPORTUNITY --
TO WORK COLLECTIVELY ON WAYS --
TO MAKER HEALTHCARE SYSTEM MORE
AFFORDABLE AND ACCESSIBLE --
OUR MEMBERS ARE VERY ENCOURAGED
BY THE GOVERNOR'S BOLD AGENDA
AND HEALTH CARE SPACES YEAR AND
WE'RE VERY EXCITED THAT WE'RE
GONNA BE ON DISCUSSING THE ISSUE
OF MARKET STABILIZATION THIS
YEAR --
THROUGH THE GOVERNOR'S AGENDA
THROUGH THE CORRESPONDING --
YOU KNOW LEGISLATIVE EFFORTS
THAT HAVE BEEN INTRODUCED --
WE JUST WANTED TO LET YOU KNOW
YOU KNOW WE STAND READY TO WORK
WITH THE ADMINISTRATION THE
LEGISLATURE --
TO A PROTECTED SIGNIFICANT GAINS
THAT WE'VE MADE UNDER THE
AFFORDABLE CARE ACT IN STABILIZE
OUR MARKET --
WITHOUT A STABLE FOR FOUNDATION --
WE SPECIFICALLY SUPPORT EFFORTS
TO ENACT A STATE BASED
INDIVIDUAL MANDATE.
AND CORRESPONDING ASSISTANCE TO
INDIVIDUALS --
AS A PURCHASE COVERAGE --
AS EARLY ADOPTERS OF THE
AFFORDABLE CARE ACT CALIFORNIA'S
DEFINITELY UNIQUELY POSITIONS
TOO YOU KNOW ACHIEVE A SYSTEM
THAT CAN PROVIDE AFFORDABLE
UNIVERSAL HEALTH CARE SO --
WE JUST WANNA BE A PART OF THE
CONVERSATION THANK YOU FOR THE
HEARING TODAY AND THANK YOU VERY
MUCH.
THANK YOU MR CHAIRMAN MEMBERS
THERESA START WITH KAISER
PERMANENTE A ALSO WANTED TO
THANK YOU FOR THIS HEARING AND
WE WANT TO EXPRESS OUR STRONG
SUPPORT FOR THE AFFORDABILITY
PROPOSALS THAT WERE DISCUSSED
TODAY INCLUDING THE INDIVIDUAL
MANDATE.
AND WE'VE APPRECIATED HAVING
CONVERSATIONS WITH MANY OF YOU
OVER THE LAST YEAR ABOUT HOW
IMPORTANT THAT MARKET
STABILIZATION IS.
A CONCRETE STEPS TO HELP KEEP
PREMIUMS DOWN FOR CALIFORNIA AND
THE LEGISLATURE AND GOVERNOR
BROWN LAST YEAR TOOK A NUMBER OF
STEPS IN THAT DIRECTION AND
THOSE EFFORTS HAVE LAID THE
GROUNDWORK AND THESE PROPOSALS
ARE THE VERY CRITICAL NEXT STEP
AND WE ESPECIALLY WANT TO THANK
THE GOVERNOR.
FOR HIS TREMENDOUS LEADERSHIP ON
THIS TOPIC WE ALSO WANT TO
EXPRESS OUR APPRECIATION TO
COVER CALIFORNIA AND FOR THE AB
EIGHTEEN TEN WORK GROUP. FOR THE
AFFORDABILITY OPTIONS REPORT
THEY PRESENTED HERE TODAY IT'S
AT A VERY GOOD ANALYSIS AND WE
ARE SUPPORTIVE OF THOSE OPTIONS
AS WELL AND KNOW THAT THEY CAN
BRING REAL MEANINGFUL FINANCIAL
HELP TO CONSUMERS.
AS DISCUSSED THERE ARE STILL
MANY CHALLENGES AHEAD BUT WITH
THESE VERY CONSTRUCTIVE AND
PRACTICAL APPROACHES DISCUSSED
HERE TODAY WE BELIEVE WE ARE ON
THE RIGHT TRACK. TO ACHIEVE
UNIVERSAL COVERAGE AND
AFFORDABILITY FOR ALL
CALIFORNIANS AND WE LOOK FORWARD
TO OUR CONTINUED PARTNERSHIP
WITH THE LEGISLATURE WITH COVER
CALIFORNIA AS WELL AS WITH THE
ADMINISTRATION THANK YOU.
GOOD AFTERNOON CHEN MEMBERS
MITCHELL COVERED IT WITH US YEAH
YOU CALIFORNIA PROUD MEMBERS OF
THE CARE FOR ALL CALIFORNIA
COALITION WHICH HAS BEEN CALLING.
FOR IMPROVING AFFORDABILITY AND
COVERED CALIFORNIA FOR
INDIVIDUALS IN THE INDIVIDUAL
MARKET AS ONE OF THE MAIN
STRATEGIES FOR GETTING US TO
UNIVERSAL COVERAGE IN CALIFORNIA.
ALONG WITH ADDRESSING COSCO
SEEMS THAT CAME UP IN TODAY'S
HEARING --
DOCTOR CAN SAID EARLIER THAT WE
DO NOT WANT TO MAKE PROMISES
THAT WE CAN'T KEEP AS A STATE
AND WE AGREE WE THINK THAT ONE
OF THE PROMISES THAT'S NOT BEING
KEPT IS.
TO THOSE INDIVIDUALS WHO ARE
BEING ASKED TO CAN GET COVERAGE
IN THE PAY FOR IT EVERY MONTH --
BUT THEN THEY FIND AT THE END OF
THE DAY THAT COVERAGE DOESN'T
TAKE THEM ALL THE WAY THERE THEY
CAN'T AFFORD TO ACTUALLY USE
THAT THAT COVERAGE --
WHEN THEY MOST NEED IT A STUDY
THAT CAME OUT --
VERY RECENTLY WHICH TRYING TO
REPLICATE SOME OF THE STUDIES
HELP.
LEAD TO THE ACA FOUND THAT
MEDICAL BANKRUPTCIES REMAINED
ALMOST UNCHANGED PRE IMPOSED ACA
AND THESE ARE PEOPLE WHO ARE
MIDDLE CLASS LARGELY BECAUSE
LOWER INCOME FOLKS QUALIFY FOR
MEDI CAL ARE LIKELY NOT THE
PEOPLE WHO ARE GOING --
TO FILE FOR BANKRUPTCY AND SO WE
KNOW THAT COSTS ARE STILL A
SIGNIFICANT ISSUE IN THIS IS
EVEN IN STATES THAT EXPANDED
MEDICAID OBVIOUSLY --
MISTER LEE MENTIONS THE VALUE OF
COVERAGE IN THE DIFFERENTIAL IN
WAY INDIVIDUALS WILL PAY IN
NORTHERN CALIFORNIA VERSUS
SOUTHERN CALIFORNIA.
AND AGAIN THIS GOES TO THE
UNDERLYING COST STRUCTURE AND
SOMETHING THAT WE DO NEED TO
WORK ON OUTSIDE OF HERE WE CAN
CONTINUE TO POUR MONEY INTO
SUBSIDIES BUT IF WE DON'T
CONTAIN THE COSTS OF THE
UNDERLYING COVERAGE THAT THEY'RE
GETTING.
IT'S GOING TO BE UNSUSTAINABLE
IN THE LONG RUN AND TO THAT
POINT -- WE
AGREE WITH THE COMMENTS TODAY
THAT AFFORDABILITY SO FROM
STARTING WITH THOSE WHO ARE
LEAST ABLE TO AFFORD IT AT THE
LOWER LEVELS OF INCOME BUT YES
DEFINITELY GOING UP 25100% 6100%
EVENTUALLY.
AND WE NEED THE MANAGED CARE TAX
TO BE RENEWED SO THAT WE CAN
SUPPORT THE OVERALL HEALTH CARE
SYSTEM THANK YOU.
RAINY X. CALIFORNIA'S DISABILITY
RIGHTS -- I
AGREE ALLOWING MISTER FOUNTAIN
SAID OVER THERE.
AND HERE'S HERE'S A COUPLE
STORIES FOR YOU I'VE UP MY
FRIEND HAS.
NO HEALTH CARE COVERAGE.
HE SAID.
BECAUSE OF HIS PRE EXISTING
CONDITION HAS HEALTH CARE SO
MUCH THAT HE'S WILLING TO TAKE
THE PENALTY.
HE'LL TAKE THE PENALTY AND
YOU'LL GET USE DRUGS FROM
WHEREVER HE CAN GET THEM FROM.
THE SECOND STORY IS MY PARTNER
WAS CAUGHT IN A REAL GAP BECAUSE
HE LOST HIS JOB AND HE LOST HIS
HEALTH CARE COVERAGE.
AND HE DIDN'T GO TO ANY OTHER
HEALTH CARE COVERAGE IN FACT YOU
DIDN'T GET ANY HEALTH CARE
COVERAGE NOW HE GETS THIS LETTER
AND WE'RE TRYING TO FIGURE OUT.
NGUYEN WAS THE PENALTY.
ELIMINATED WASN'T ELIMINATED AND
IF IT'S NOT HOW COME THEY
HAVEN'T SENT HIM A BILL YET.
SO HERE WE ARE COVERED
CALIFORNIA THEY SEND ME A LETTER
GO YOU KNOW WHAT USING HEALTH
CARE COVERAGE SO NOW WE'RE GOING
TO TAKE THIS OFF YOUR TAXES.
HE'S GOING.
NOBODY SENT ME A LETTER THAT I
NEED HEALTH CARE COVERAGE.
THIS IS NOT RIGHT WE NEED TO
CLEAN THIS UP IF EVERYBODY OUT
HERE FOR ME I WANT SINGLE PAYER.
THAT'S THE ANSWER COLORS IS
SEAMLESS EVERYTHING WORKS BUT
FOR NOW SINCE WE HAVE THIS ISSUE
WE UP -- TO
MIGHT TO PEOPLE THAT I KNOW ARE
NOT GOING TO GET COVERAGE.
NEVER GOING TO GET COVERAGE
BECAUSE ONE THEY DON'T
UNDERSTAND THE SYSTEM AND TWO
BECAUSE THEY HAVE A PRE EXISTING
CONDITION YOU NEED TO FIX THIS.
GOOD AFTERNOON KEREN LAYING ON
HAVE A THE COUNTY MEDICAL
SERVICES PROGRAM WHICH IS IN A
STATE CREATED PROGRAM OF THE
THIRTY FIVE MOST RURAL COUNTIES
IN CALIFORNIA.
WANTED TO HIGHLIGHT SOME WORK
THAT THEY'RE DOING NOW --
NOT WAITING FOR LEGISLATION
THEY'LL BE THIS MONTH A NEW
HEALTH BENEFIT FOR UNDOCUMENTED
ADULT PERSONS.
AND IT WILL BE A ZERO MONTHLY
PREMIUM ZERO DOCTOR VISIT UP CO
PAY AND ONLY FIVE DOLLARS. FOR
THEIR PRESCRIPTION HEALTH
COVERAGE THEY'RE PAYING FOR IT
THROUGH THEIR REALIGNMENT
DOLLARS THAT THEY GET AS PART OF
THE GPA THAT THEY OPERATE.
ON BEHALF OF THE COUNTIES TO
DELIVER MEDICALLY INDIGENT ADULT
SERVICES THEY'RE VERY EXCITED
ABOUT IT OR START INFORMATION OF
YOUR STAFF.
THEY LOOK FOR TO THE
CONVERSATION THE BUDGET
COMMITTEE TO ENSURE THAT THOSE
REALIGNMENT DOLLARS CONTINUE TO
FLOW TO THEIR PROGRAM. TO MAKE
SURE THIS IS A SUSTAINABLE MODEL
THEY'RE GOING TO BE BRINGING
BACK REPORTS THE LEGISLATURE IN
TWENTY TWENTY TWO OF THE
UNIVERSITY OF CALIFORNIA IS
GOING TO PROVIDE.
SO LOOK FOR TO TALKING TO YOU
MORE ABOUT EDUCATING YOURSELF ON
THIS EXCITING NEW OPTION FOR
HEALTH CARE THE GOVERNMENTS.
GOOD AFTERNOON KELLY BEAM ON
BEHALF OF THE CALIFORNIA MEDICAL
ASSOCIATION WE SUPPORT --
THE CREATION OF THE STATE LEVEL
THE STATE LEVEL IN WHAT YOU
INDIVIDUAL MANDATE AND TO ENSURE
THAT WE STABILIZE THE WRIST
POLLS --
PENDING FUTURE REFORMS AND WE
ALSO SUPPORT THE EXPANSION OF
PREMIUM SUBSIDIES AND ALSO COST
SHARING REDUCTIONS AND FOR LOW
INCOME AND MIDDLE CLASS
CALIFORNIANS.
AND TO ENSURE THAT MORE
CALIFORNIANS ARE ABLE TO GETTING
COVERAGE AND ACCESS CARE THANK
YOU.
GOOD AFTERNOON A MARKER BURKE --
WITH SMALL BUSINESS MAJORITY I
AND JUST WANTED --
TO HAD A COUPLE THINGS ONE
PURSUE THE CONVERSATION
REGARDING THE FAMILY GLITCH A
LOT OF OUR SMALL EMPLOYERS AS A
STRUGGLING WITH HOW AND WHEN TO
OFFER INSURANCE IS A REAL
CHALLENGES SO APPRECIATE THAT
PART OF THE DISCUSSION.
I'M ARE SCIENTIFIC OPINION
POLLING SHOWS THAT SMALL
BUSINESS OWNERS ARE STILL
CONCERNED ABOUT THE COST OF
HEALTH CARE THERE BEEN SOME
INCREDIBLE STRIDES THAT HAVE
BEEN MADE WITH THE ACA.
THERE OVER THREE HUNDRED AND
SEVENTY THOUSAND THAT ARE
CURRENTLY IN COVER CALIFORNIA
ACCESSING QUALITY CARE AND SO
WE'RE REALLY ENCOURAGED ABOUT
THE GAINS THAT HAVE BEEN MADE --
BUT HERE IN CALIFORNIA THE
AVERAGE INCOME FOR ANY
INCORPORATED SMALL BUSINESS
OWNER IS FIFTY FOUR THOUSAND
DOLLARS A YEAR WHICH PUTS THOSE
BUSINESS OWNERS RIGHT ABOVE THE
THRESHOLD TO WRITE OFF THAT
CLIFF.
WHICH IS AROUND FIFTY KA YEAR
AND SO WE'RE REALLY ENCOURAGED
ABOUT THE WITH THIS CONVERSATION
THANK YOU FOR THIS HEARING WE
LOOK FOR TO WORKING WITH YOU AND
WITH THE ADMINISTRATION TO
ENSURE THAT.
CALIFORNIA SMALL BUSINESS OWNERS
HAVE ACCESS TO QUALITY
AFFORDABLE INSURANCE THANK YOU.
GREAT THANK YOU VERY MUCH IS
THERE ANYONE ELSE.
OKAY SEE NO ONE WILL THANK YOU
VERY MUCH EVERYONE FOR BEING
HERE THANK YOU TO OUR CHAIRS AND
COLLEAGUES AND WITH THAT WE WILL
GO AHEAD JR IN THE MEETING TODAY
THANKS AGAIN