Health Care Reform Health Care Reform

Michael R. CousineauMichael R. CousineauUSC Keck School of MedicineUSC Keck School of Medicine

How will health care reform affect How will health care reform affect the greater Los Angeles area?the greater Los Angeles area?

Will it decrease the number of uninsured?Will it decrease the number of uninsured? How will affect safety net providers How will affect safety net providers

particularly public hospitals and community particularly public hospitals and community health centers?health centers?

Will it improve health?Will it improve health?

Fundamental ComponentsFundamental Components

Individual mandates Individual mandates insurance reforminsurance reform

– Pre existingPre existing– Life time capsLife time caps– Limited age rating Limited age rating

Subsidies to increase affordabilitySubsidies to increase affordability Health Insurance Exchange for individuals Health Insurance Exchange for individuals

and small businesses and small businesses

DifferencesDifferences

Fewer people covered under the Senate version, Fewer people covered under the Senate version, (estimated at 31 million Senate vs 36 million in (estimated at 31 million Senate vs 36 million in House version).House version).

Medicaid Expansion --(150% in Senate version Medicaid Expansion --(150% in Senate version and 133% in House version) and 133% in House version)

Subsidies --House higher subsidies between 150 Subsidies --House higher subsidies between 150 and 300% (House, Higher subsidies (300-400%, and 300% (House, Higher subsidies (300-400%, (Senate)(Senate)

Exchange - National (House), State option Exchange - National (House), State option (Senate) Public Option (House), non profit (Senate) Public Option (House), non profit (Senate)(Senate)

DifferencesDifferences

Insurance reformInsurance reform BenefitsBenefits Cost containmentCost containment FinancingFinancing

– Taxing insurance (Senate)Taxing insurance (Senate)– Taxing wealthy (House)Taxing wealthy (House)– Fess on non-participating employersFess on non-participating employers

Los Angeles County Los Angeles County Service Planning Areas and Health DistrictsService Planning Areas and Health Districts

Large county with Large county with nearly 10 Million nearly 10 Million residentsresidents

Tremendous diversityTremendous diversity Both wealth and Both wealth and

povertypoverty Many immigrantsMany immigrants Health care systemHealth care system

Antelope Valley

Foothill

San Fernando

West

East Valley

West Valley

Pomona

Harbor

Whittier

Torrance

El Monte

Glendale

Long Beach

Central Alhambra

Bellflower

Inglewood

East LASouth-west

SanAntonio

Compton

North-east

Pasadena

South

Hollywood/Wilshire

South-east

SPA 1

SPA 2

SPA 3

SPA 8

SPA 5

SPA 7

SPA 4

SPA 6

Spas2002.shp

SPA 1 - Antelope Valley

SPA 2 - San Fernando

SPA 3 - San Gabriel

SPA 4 - Metro

SPA 5 - West

SPA 6 - South

SPA 7 - East

SPA 8 - South Bay

Service Planning Areas (SPA)

Issues for Los AngelesIssues for Los Angeles

High number of uninsured individuals and families: 1.6 High number of uninsured individuals and families: 1.6 million uninsured in Los Angeles County and nearly million uninsured in Los Angeles County and nearly 200,000 uninsured children200,000 uninsured children

Immigrants, undocumented not eligible under either of the Immigrants, undocumented not eligible under either of the two billstwo bills

Safety net providers, public hospitals and private DSH Safety net providers, public hospitals and private DSH hospitals, - financed in part by reducing supplemental hospitals, - financed in part by reducing supplemental payments to these hospitals, rationale, fewer uninsured, payments to these hospitals, rationale, fewer uninsured, so the need for cost shifts to the uninsured is lessso the need for cost shifts to the uninsured is less

Many small businessesMany small businesses

Health Insurance Status in the County Health Insurance Status in the County of Los Angeles, 2007 of Los Angeles, 2007

Source: Los Angeles County Health Survey, 2007. Compiled by Amy Lightstone, Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, May 2009.

Nonelderly Adults Percentage

95 Percent Confidence

Interval

Estimated Number of

People  

Medi-CalMedi-Cal 15.815.8 14.614.6 -- 17.117.1 1,004,0001,004,000  

MedicareMedicare 1.31.3 1.01.0 -- 1.61.6 82,00082,000  

PrivatePrivate 60.860.8 59.259.2 -- 62.462.4 3,852,0003,852,000  

No insuranceNo insurance 22.022.0 20.720.7 -- 23.423.4 1,396,0001,396,000  

ChildrenChildren  

Healthy FamiliesHealthy Families 10.7%10.7% 9.79.7 -- 11.611.6 298,000298,000  

Medi-CalMedi-Cal 35.6%35.6% 34.134.1 -- 37.137.1 992,000992,000  

PrivatePrivate 45.4%45.4% 43.843.8 -- 46.946.9 1,264,0001,264,000  

Healthy KidsHealthy Kids 1.4%1.4% 1.11.1 -- 1.71.7 39,00039,000

No insuranceNo insurance 7.0%7.0% 6.16.1 -- 7.87.8 194,000194,000  

Distribution of Uninsured Adults by Race Distribution of Uninsured Adults by Race and Ethnicity in Los Angeles County, 2007and Ethnicity in Los Angeles County, 2007

Latino70%

White

11%

African American8%

Asian/Pacific Islander11%

Other< 1%

Uninsured by Poverty Status, Los Uninsured by Poverty Status, Los Angeles County, 2007Angeles County, 2007

300% or above FPL, 138,000

200%-299% FPL, 189,000

100%-199% FPL, 498,000

0-99% FPL, 521,000

* Estimated based on total Southern California enrollment figures. Source, Health Insurers serving Los Angeles County, Los Angeles Business Journal, May 2009. www.thefreelibrary.com. Accessed July, 2009.

Private Health Plan Enrollments in Private Health Plan Enrollments in Los Angeles County, 2009. Los Angeles County, 2009.

Plan Membership

Kaiser Foundation Health PlanKaiser Foundation Health Plan 1.12 million1.12 million

Anthem Blue CrossAnthem Blue Cross 850,000 *850,000 *

PacificarePacificare 250,000250,000

Health NetHealth Net 398,000398,000

LA Care Health PlanLA Care Health Plan 783,000783,000

Blue Shield of CaliforniaBlue Shield of California 229,000229,000

Cigna Healthcare of CaliforniaCigna Healthcare of California 170,000170,000

Aetna Health of California Aetna Health of California 106,000106,000

Universal CareUniversal Care *75,000*75,000

SCANSCAN 47,00047,000

COMPARISON OF SMALL BUSINESS EMPLOYERS AS A PERCENT OF TOTAL BUSINESSES IN THE STATE AND

COUNTY OF LOS ANGELES Source Los Angeles County Small Business Commission 2006-2007 Annual Report April 2008

1-100 Employees

State % Total

County % Total

101-500 Employees

State % Total

Los Angeles County

353,176 30.0% 91.5% 5,164 25.3%

State of California

1,175,330 100% -- 20,413 100%

Impact on CaliforniaImpact on California

$3 Billion impact on the California budget $3 Billion impact on the California budget (by the Governor’s Office)(by the Governor’s Office)

Hinges on Medicaid and what is decided on Hinges on Medicaid and what is decided on a federal requirements for a matcha federal requirements for a match

Impact on California and Los Impact on California and Los Angeles CountyAngeles County

$3 Billion impact on the California budget $3 Billion impact on the California budget (by the Governor’s Office)(by the Governor’s Office)

Safety net providers, public hospitals and Safety net providers, public hospitals and private DSH hospitals, - Health Reform private DSH hospitals, - Health Reform financed in part by reducing supplemental financed in part by reducing supplemental payments to these hospitals, rationale, payments to these hospitals, rationale, fewer uninsured, so the need for cost shifts fewer uninsured, so the need for cost shifts to the uninsured is lessto the uninsured is less

The Health Care Safety NetThe Health Care Safety Net

LA County Public Hospitals and health LA County Public Hospitals and health Centers Private HospitalsCenters Private Hospitals

Community Health CentersCommunity Health Centers Emergency departmentsEmergency departments

DisparitiesDisparities

Will this help to reduce disparities and Will this help to reduce disparities and improve health?improve health?

Leading Causes of Death in Leading Causes of Death in Los Angeles by Race/Ethnicity, 2005Los Angeles by Race/Ethnicity, 2005

ConclusionsConclusions

A lot of good things in the bills,A lot of good things in the bills, Many problemsMany problems Not over, much tweaking and monitoring is Not over, much tweaking and monitoring is

neededneeded Senate version seems to be trumping houseSenate version seems to be trumping house