WE WE WILL BE STARTING JUST A
FEW MINUTES AWAY FOR SOME OF OUR
MEMBERS TO ARRIVE THERE HAVE
BEEN MULTIPLE MEETINGS GOING ON
IN THE BUILDING SO I'VE.
ASK YOUR PATIENCE AND I BY
PROMISE WILL BE STARTING VERY
SOON THANK YOU
GOOD AFTERNOON.
WE ARE STILL WAITING FOR
MEMBERS TO RIDE THIS IS BEING
TELEVISED AND AT A RESPECT FOR
THE PANELISTS AND EVERYBODY
WHO'S HERE I WOULD LIKE TO GO
AHEAD AND GET STARTED THIS
AFTERNOON SO.
OFFERS WILL THANK EVERYBODY FOR
BEING HERE OF VERY MUCH
APPRECIATE THAT. GOOD AFTERNOON
AND WELCOME TO THE THIRD IN A
SERIES OF HEARINGS OF THE SELECT
COMMITTEE ON HEALTHCARE DELIVERY
SYSTEMS AND UNIVERSAL COVERAGE.
WE SPEND MORE THAN TWENTY HOURS
IN THESE HEARINGS ARE LEARNING
FROM HEALTH CARE EXPERTS AND WE
WILL LIKELY SPEND ANOTHER TWENTY
HOURS LEARNING EVEN MORE.
THESE HOURS WERE FAR EXCEED THE
ATTENTION THIS IMPORTANT ISSUE
HAS REESE WOULD HAVE RECEIVED A
SINGLE POLICY HEARING OF THE
ASSEMBLY HEALTH COMMITTEE. AND I
MAKE NO APOLOGIES FOR THAT.
WE ARE RESPONSIBILITY MAKE SURE
THAT THE RECOMMENDATIONS WE
INTEND TO PUBLISH TO SPRING
COULD PROVIDE A PATHWAY TO
HEALTH CARE. FOR EVERYONE WHO
CALLS CALIFORNIA HOME.
THIS HEARING WILL FOCUS ON
ACCESS TO CARE AND UNDERSTANDING
HEALTH CARE PRICING.
PROVIDING COVERAGE IS NOT THE
SAME AS PROVIDING CARE WE NEED
TO MAKE SURE THAT ANY SYSTEM
THAT HAS THE HEALTH CARE
PROVIDERS WE NEED.
WE'VE TO HAS THEM WHERE WE NEED
THEM AND.
.
WE HAVE HEALTHCARE PROVIDERS AND
WHERE WE NEED THEM TO BE.
WHETHER YOUR PHYSICIAN HOSPITAL
A HOSPITAL NURSE NURSE
PRACTITIONER DENTIST MENTAL
HEALTH PROVIDER. YOU MUST BE
REIMBURSED FAIRLY FOR THE CARRY
PROVIDE WITHOUT THAT WILL
CONTINUE TO STRUGGLE TO HAVE
ENOUGH PROVIDERS ESPECIALLY IN
RURAL COMMUNITIES TO MEET THE
NEED.
WE ALSO NEED TO UNDERSTAND ALL
OF THE COST DRIVERS AND FIND
WAYS TO BALANCE COSTS WITH THE
BENEFITS AND WE PROVIDE.
TODAY WILL BE.
HAVE JOINING A SPEAKERS FROM
THE CALIFORNIA HEALTHCARE
FOUNDATION GEORGETOWN
UNIVERSITY.
VANDERBILT UNIVERSITY THE KAISER
FAMILY FOUNDATION THE UCSF
SCHOOL OF MEDICINE AND STANFORD
UNIVERSITY.
WE WILL AT THE ALLOWING UP WE
WILL HAVE PUBLIC COMMENT AT THE
END OF.
TODAY'S OF PROCEEDINGS WERE APT
TO AFTER A PANELS.
I KNOW WE HAVE MANY PASSIONATE
PEOPLE IN THE AUDIENCE WOULD
LIKE TO ENSURE THE PUBLIC
COMMENT. PERIOD WILL GIVE.
CHANCE FOR PEOPLE TO SPEAK.
ENCOURAGE EVERYONE TO BE
RESPECTFUL AT DURING THAT TIME
IN THE COMMENTS WILL BE LIMITED
TO TWO MINUTES EACH.
MORE DETAILED WRITTEN COMMENTS
ARE WELCOME AND THEY CAN BE
SUBMITTED TO THE COMMITTEE FOR.
FOR THE PUBLIC RECORD.
I AM I WOULD LIKE TO SAY IN THE
PROCEEDINGS TODAY THAT WE ASK
THAT THERE'S NO.
NO APPLAUSE NO BOOS CATCALLS
ANYTHING LIKE THAT THIS IS A AND
A DIFFERENCE THE SPEAKERS SO
THAT WE CAN.
CONDUCTOR PROCEEDINGS WITH
MINIMAL INTERRUPTIONS AND I ASK
YOU TO RESPECT THAT PLEASE.
I'D LIKE TO NOW TURN THIS OVER
TO.
MY CO CHAIR A DOCTOR WALKING
AROUND THE LEFT TO OFFER ANY
OPENING COMMENTS I GUESS I
SHOULD INTRODUCE MYSELF I'M JIM
WOOD CHAIR OF THE HEALTH
COMMITTEE.
GOOD LUCK.
START OVER. IT'S OKAY.
GOOD AFTERNOON.
THIS IS THE FOURTH IN A SERIES
OF HEARINGS THAT WILL HELP US TO
EXPLORE THE WAYS TO IMPROVE OUR
STATE'S HEALTH CARE SYSTEM AND
PROVIDE UNIVERSAL HEALTHCARE FOR
ALL CALIFORNIANS.
IN OUR PREVIOUS HEARINGS WE
FOCUSED ON CALIFORNIA'S CURRENT
SYSTEMS INCLUDING PUBLIC
PROGRAMS.
THEINDIVIDUAL MARKET EMPLOYER
BASED PROGRAMS THE SAFETY NET
PROGRAMS AND THE CURRENT GAPS IN
COVERAGE.
WE'VE ALSO HEARD ABOUT MULTIPLE
MODELS OF UNIVERSAL COVERAGE
SYSTEMS IN OTHER COUNTRIES.
AT OUR LAST HEARING WE FOCUSED
ON DIFFERENT MODELS AND PROGRAMS
FROM AROUND THIS COUNTRY.
AND THAT TODAY'S HEARINGS WE
WILL HEAR FROM EXPERTS WHO HAVE
RESEARCHED THE CHALLENGES PEOPLE
HAVE HAD IN ACCESSING CARE. AND
SOME OF THE CAUSES OF THE HIGH
PRICES IN OUR HEALTHCARE SYSTEM.
THIS COMMITTEE'S CHARGE IS TO
FIND WORKABLE SOLUTIONS THAT
WILL EXPAND HEALTH CARE COVERAGE
AND INCREASE ACCESS TO CARE.
A BETTER ORGANIZED SYSTEM
COVERING EVERY CALIFORNIAN WOULD
ALMOST CERTAINLY CUT OUR HEALTH
CARE COSTS.
EVERY OTHER DEVELOPED NATIONS
SPENDS LESS
ON THEIR HEALTHCARE THAN WE DO.
BUT WITH BETTER RESULTS.
WE HOPE TO FIND A SYSTEM OR
SYSTEMS THAT WILL PROVIDE
COVERAGE TO ALL BY EXAMINING THE
EFFICIENCIES AND COST CONTROL
MECHANISMS UTILIZED IN OTHER
MODELS.
WE WILL LOOK FOR EVERY SINGLE
WAY TO REDUCE OUT OF POCKET
COSTS TO CONSUMERS BY LOOKING
FOR WAYS TO MAKE OUR SYSTEM MORE
EFFICIENT.
I AM PARTICULARLY INTERESTED IN
THE ISSUES OF ACCESS TO CARE AND
UNDERSTANDING ALL OF THE REASONS
THAT PEOPLE ARE FEELING TO GET.
THE HEALTHCARE THAT THEY NEED.
AS IN THE E. R. DOCTOR I HAD TO
TREAT INDIVIDUALS THAT COULDN'T
GET PREVENTIVE CARE.
OR COULDN'T FIND OR AFFORD TO
SEE A POSITION UNTIL THEY NEEDED
TO COME TO THE ER.
WHEN PEOPLE ARE RELYING ON THE
E. ARE FOR THEIR HEALTH CARE THE
MOST EXPENSIVE CARE AVAILABLE WE
KNOW THE SYSTEM IS NOT WORKING.
WE INTEND TO WORK TOWARD THE
IDEAL THAT HEALTHCARE IN
CALIFORNIA IS A HUMAN RIGHT.
AS I HAVE SAID IN THESE LAST
HEARINGS
WE ARE CALIFORNIA WE DON'T
FOLLOW WE LEAD.
SO WITHOUT FURTHER ADO I'D LIKE
TO OFFER MY COLLEAGUES WHO ARE
HERE TO MAKE ANY OPENING
STATEMENTS THAT THEY WOULDN'T.
GREAT WILL GO AHEAD AND GET
STARTED.
WITH OUR FIRST.
FOR SPOKEN HAVE DOCTOR ARE MISS
AND LARRY LEVAN.
SEES ME.
THE CO EXECUTIVE DIRECTOR OF A
PROGRAM FOR THE STUDY OF HEALTH
REFORM AND PRIVATE INSURANCE
FROM KAISER FAMILY FOUNDATION SO
PLEASE COME ON UP.
STERN LEVITT
.
HAVE GOOD AFTERNOON CARE WOULD
CHAIR ROMULAN THANKS FOR.
HOLDING THESE HEARINGS AND
THANKS FOR THE OPPORTUNITY TO
SPEAK.
I'M GOING TO.
TALK FOR A LITTLE BIT ABOUT TO
A FRAGMENTATION.
IN OUR HEALTHCARE SYSTEM AND
WHAT IT MEANS FOR PATIENTS AFTER
THE ABILITY TO CONTROL COSTS.
TO GUARANTEE POPULATION HEALTH.
AND EQUITY IN THE HEALTHCARE
SYSTEM YEAH I THINK IT'S FAIR TO
SAY THAT NO ONE WOULD DESIGN OUR
HEALTHCARE SYSTEM. OF FROM
SCRATCH AND END UP WITH THIS
CRAZY QUILT IF WE HAD TO DO IT
ALL OVER AGAIN.
BUT IT IS THE SYSTEM WE HAVE
AND UNDERSTANDING ITS
IMPLICATIONS BOTH GOOD AND BAD.
MAY HELP TO INFORM WHAT BETTER
SYSTEM MIGHT LOOK LIKE AND HOW
BEST TO TRANSITION TO THAT.
I'M TO PROVIDE THAT KIND OF
BIRDS EYE VIEW OF.
OF THE HEALTHCARE SYSTEM AND
AND FRAGMENTATION IN IT.
THAT I THINK YOU'RE GOING TO
HEAR MORE DETAIL FROM THIS
MARKET THE PANELISTS.
TO FOLLOW.
IT'S GOOD AND IT'S GONNA STOP
RIGHT NOW UNTIL WE CAN ASK.
FOR THE QUIET OUTSIDE.
PART
.
BUT YOU KNOW.
SIX.
HELLO
.
SO.
MR LEVIN HOW LOUDLY CAN YOU
SPEAK SO I COULD SPEAK HAVE
POLITICAL.
.
JUST WAIT TO THE GENTLEMAN IS A.
NO THAT'S OKAY.
THANK YOU.
ONCE OVER THE PICTURE OF OF
HEALTH COVERAGE IN OUR CURRENT
SYSTEM I THINK THIS PICTURE IS
QUITE FAMILIAR. TO MEMBERS OF
THE COMMITTEE.
THEIR VARIETY OF ESTIMATES OF
OF HEALTH COVERAGE IN IN
CALIFORNIA BUT I THINK THIS
GIVES A GOOD PICTURE. OF THE
DIVERSITY OF OF COVERAGE.
AS YOU CAN SEE EMPLOYER BASED
INSURANCE.
EVEN AFTER IMPLEMENTATION OF
THE AFFORDABLE CARE ACT IS STILL
THE MAIN SOURCE OF COVERAGE OF
FOR CALIFORNIANS AND PEOPLE IN
IN EVERY OTHER STATE IN THE
COUNTRY.
AND IMPORTANTLY.
IN ADDITION TO BEING A.
A SIGNIFICANT SOURCE OF
COVERAGE AYE EMPLOYER BASED
INSURANCE IS ALSO LARGELY OUT
OF.
THE CONTROL OF STATE REGULATION.
LARGELY CONTROLLED TICKLING
SELF INSURED EMPLOYER PLANS
UNDER THE FEDERAL TO WRESTLE AW
SO LEAST IN THE CURRENT SYSTEM.
AND THE LARGEST SOURCE OF
COVERAGE IS LARGELY OUT OF OUT
OF STATE CONTROL.
ARM AS YOU KNOW MEDICAID.
IS ALSO A LARGE SOURCE OF
COVERAGE.
GREW BIGGER GREW QUITE RAPIDLY
FOLLOWING YEAH IMPLEMENTATION
THE AFFORDABLE CARE ACT THAT
WHICH CALIFORNIA WAS CERTAINLY A
PROACTIVE IN.
IN THEIR CAL I MEAN
CALIFORNIA'S MEDICAL PROGRAM IS
IS LIKELY THE OUT ONE OF IF NOT
THE LARGEST
A PUBLIC INSURANCE PROGRAM.
IN IN THE COUNTRY.
MAYBE ONE MORE IMPORTANT THAN
HOW PEOPLE ARE COVERED AT ANY
ONE TIME WHICH IS WHAT THIS THIS
CHART SHOWS. IS THE ENORMOUS
CHURN ACROSS SOURCES OF COVERAGE
AS PEOPLE CIRCUMSTANCES CHANGE
HOW PEOPLE CHANGE JOBS LOSE JOBS
GAME JOBS.
INCREASE OUR INCOME DECREASED
THEIR INCOME.
PEOPLE CHANGE VERY VERY
FREQUENTLY FROM ONE SOURCE OF
INSURANCE TO ANOTHER AND IT'S
THOSE.
IT'S THOSE TRANSITIONS FROM ONE
SOURCE INSURANCE TO ANOTHER
THAT'S OFTEN CREATES
DISRUPTIONS.
IN THE SYSTEM AND YOU'LL HEAR
MUCH MORE ABOUT THAT THAT CHURN
IN INSURANCE.
FROM JOHN GRAVES LATER.
NOW.
THE.
.
ONE OF THE THAT THE MAIN REASON
FOR THE CHALLENGES THAT THE
CHALLENGES THAT THESE
DISRUPTIONS ARE.
BECAUSE AS PEOPLE TRANSITION
FROM ONE TYPE OF INSURANCE TO
ANOTHER.
IS BECAUSE EACH SECTOR OF OF
THE HEALTH INSURANCE SYSTEM HAS
VERY DIFFERENT RULES AND VERY
DIFFERENT PROCEDURES.
CERTAINLY ELIGIBILITY.
IS VERY DIFFERENT ANYTIME
SOMEONE TRANSITIONS FROM ONE
SOURCE INSURANCE TO ANOTHER.
TO HAVE TO GO THROUGH
ELIGIBILITY PROCESS THAT PROCESS
CAN CERTAINLY BE QUITE
BURDENSOME OPTICALLY IN THE CASE
OF MEDI CAL OR COVERED
CALIFORNIA.
CARSHARING VARIES NOT ONLY
BETWEEN SECTORS BETWEEN MEDI CAL
EMPLOYER BASED INSURANCE
MEDICARE.
AND INDIVIDUAL INSURANCE BUT
ALSO AMONG ENSURE INSURANCE
COMPANIES AND NOT JUST THE LEVEL
OF DEDUCTIBLES OR CO PAYS OR CO
INSURANCE. UP BUT WHAT THOSE
DEDUCTIBLES OR CO PAYS APPLY TO
AND THAT CREATES COMPLICATIONS
AND CONFUSION AFTER PATIENTS AS
WELL AS FOR HEALTHCARE
PROVIDERS.
I WOULD NOTE THAT THEY COVER
CALIFORNIA HAS MADE GREAT
STRIDES IN IN MINIMIZING SOME OF
THIS. COMPLICATION BY
STANDARDIZING COVERAGE.
TO A MUCH GREATER EXTENT ACROSS
INSURERS THAT IS TRUE ANOTHER
OTHER SECTORS.
.
ALSO I NETWORKS OF FIZZ
PHYSICIANS IS POTENTIALLY THE
BIGGEST SOURCE OF COMPLICATION
FOR PATIENTS AND FRANKLY FOR
PROVIDERS AS WELL.
OUR SYSTEM IS STILL NOT GOOD AT
KEEPING DIRECTORIES OF.
IN NETWORK DOCTORS AND
HOSPITALS UP TO DATE.
PATIENTS CAN ALWAYS EASILY
IDENTIFY WHICH DOCTORS ARE IN A
PARTICULAR NETWORK.
EITHER WHEN THEY CHOOSE THE
PLAN OR WHEN THEY ACTUALLY
ACCESS CARE.
THIS CAN LEAD TO SURPRISE
MEDICAL BILLS.
WHEN YOU FIND YOURSELF BEING
TREATED BY AN OUT OF NETWORK.
PROVIDER.
.
UNOPENED UNBEKNOWN STEVE TO YOU.
CALIFORNIA CERTAINLY MAKE
PROGRESS WITHOUT WITH THE
SURPRISE MEDICAL BILL LAUP.
THAT WENT INTO EFFECT LAST YEAR.
BUT SELF INSURED EMPLOYER PLANS
WHICH ARE.
A LARGE SOURCE OF COVERAGE OR
OUTSIDE OF THAT THAT STATE
REGULATION.
SIMILAR TO NETWORKS ARE DRUG
FORMULARY STEVE THROUGH THE LIST
OF DRUGS.
THAT EACH INSURER COVERS.
THOSE AGAIN VARY TREMENDOUSLY
FROM SECTOR TO SECTOR AND FROM
PLAN TO PLAN.
AND IT'S NOT JUST WHICH DRUGS
AND ENSURE COVERS.
BUT WHICH SO CALLED TIER OF
COST SHARING.
THAT DRUGS ON WHETHER YOUR DRUG
IS ON THE FIRST YEAR OF COST
SHARING WITH A LOCAL PAYMENT.
FOR THE HIGHEST TIER OF COST
SHARING A TYPICALLY FOR
SPECIALTY DRUGS WHICH WITH A
VERY HIGH CO INSURANCE THAT CAN
RUN INTO THE HUNDREDS IF NOT
THOUSANDS.
OF DOLLARS SO SO MANY PATIENT
TRANSITIONING FROM ONE INSURER
OR ONE TYPE OF INSURANCE TO
ANOTHER CAN FIND THEMSELVES AYE
NEEDING TO CHANGE DRUGS CHANGE
DOCTORS CHANGE HOSPITALS. OR PAY
VERY DIFFERENT AMOUNTS FOR THEIR
CARE.
ALSO CERTAINLY PRICES AND WILL
HEAR A LOT ABOUT PRICING YOU'LL
HEAR A LOT ABOUT PRICING TODAY.
PRICES VARY TREMENDOUSLY FROM
ONE SECTOR IS SECTOR TO ANOTHER
I THINK AS MEMBERS OF THE
COMMITTEE VERY NO WELL.
PRICES PAID BY MEDICARE ALL ARE
FAR LOWER THAN PRICES PAID BY
COMMERCIAL INSURANCE.
OR MEDICARE UP THE PRICES ALSO
VARY TREMENDOUSLY FROM ONE
REGION OF THE STATE TO ANOTHER.
PRICES IN THE BAY AREA ARE MUCH
HIGHER THAN PRICES IN.
IN SOUTHERN CALIFORNIA.
IN THE.
TREMENDOUSLY FROM ONE INSURER
TO ANOTHER.
ARE.
ALSO THEIR PROCEDURES THAT
INSURERS USE.
TO MANAGE OR AUTHORIZE CARE.
PRIOR AUTHORIZATION TO SEE A
SPECIALIST OR TOGETHER NMR AYE
OR TO.
ACCESS HOSPITAL CARE.
THESE PROCEDURES WHICH VARY
FROM INSURER TO INSURER AGAIN
OUR SOURCE OF CONFUSION AFTER
PATIENTS AS WELL AS PROVIDERS.
AND IN FINALLY GOVERNANCE.
THERE IS NO ONE WHO IS IN
CHARGE OF CALIFORNIA'S
HEALTHCARE SYSTEM WHO IS
RESPONSIBLE FOR. GUARANTEEING
POPULATION HEALTH FOR
CONTROLLING COSTS FOR INSURING
QUALITY.
FOR ENSURING EQUITY.
YOU KNOW WE HAVE.
HERE WE HAVE. MULTIPLE PUBLIC
AGENCIES RESPONSIBLE FOR
REGULATING INSURANCE IN
CALIFORNIA.
WE'VE GOT AGENCY RESPONSIBLE
FOR RUNNING MEDI CAL.
COUNTIES ALSO PLAYING A MAJOR
ROLE.
IN ADMINISTERING.
MEDI CAL.
A PRIVATE INSURERS.
WHICH CAN RANGE FROM NONPROFIT
TO FOR PROFIT.
TO COMMUNITY BASED PLANS.
AND ALSO EMPLOYERS AS WELL AND
SO WE VERY BALKANIZED APPROACH
EPICALLY COMPARED TO OTHER
COUNTRIES IN OUR OVERSIGHT OF
THE HEALTH CARE SO.
I'M SETS A THINKING ABOUT THE
CONSEQUENCES OF THIS.
AND I WOULD SAY ALMOST EVERY
CONSEQUENCE OF THIS
FRAGMENTATION.
HAS A FLIP SIDE AND I WOULD
HESITATE TO.
CALL THESE CONSEQUENCES GOOD OR
BAD OR POSITIVE OR NEGATIVE.
BECAUSE IT VERY MUCH DEPENDS.
ON YOUR VALUES.
AND.
AND AND HOW YOU VIEW THEM.
BUT I THINK IT'S IMPORTANT
UNDERSTAND THE CONSEQUENCES SO
SORE POINT TO FIRST ARE
CERTAINLY COSTS AND YOU KNOW
WITH NO CENTRAL OVERSIGHT. OF
HEALTH CARE COSTS IN THE SYSTEM.
IT'S OFTEN VERY DIFFICULT TO
CONTROL THOSE COSTS
AND YOU KNOW WE AND.
WE IN HEALTH POLICY OFTEN REFER
TO THIS AS THE WATER BALLOON
EFFECT
AND IF YOU PUSH ON ONE. PART OF
THE HEALTH SYSTEM IN ONE PART OF
A WATER BALLOON AT THE COST TEND
TO SHOW UP IN SOME OTHER PART OF
THE WATER BILL AND.
AND WITHOUT ANY ABILITY FOR
CENTRAL OVERSIGHT IT'S VERY
DIFFICULT TO CONTROL THE OVERALL
SIZE OF THE THE WATER BUILDING.
NOW THE FLIP SIDE OF THAT IS
THAT.
THIS KIND OF LACK OF CONTROL
ALSO IN SOME SENSE PROVIDES A
SAFETY VALVE IF THE CONSTRAINTS
ON COSTS ARE ARE TOO TIGHT.
YOU HAVE THE THE THE.
AT THE HEALTH SYSTEM IT YOU
KNOW IF IF THERE'S A. AYE A FLU
EPIDEMIC HAS IN FACT WHERE WE
SEEM TO BE HAVING RIGHT NOW.
IN THE UNITED STATES.
YOU KNOW THERE THERE'S THAT
THERE'S NO EXPLICIT DECISION
THAT NEEDS TO BE MADE TO RELAX
THAT THE COST CONSTRAINTS.
.
ANOTHER CUT CONSEQUENCE WHICH I
ALLUDED TO IS IS DISRUPTION OF
CARE GIVEN THE CHURN. IN THE
HEALTH INSURANCE SYSTEM THE
RAPID TRANSITIONS FROM ONE TYPE
OF INSURANCE.
TO ANOTHER SHE PLANS WITH
DIFFERENT NETWORKS DIFFERENT
DRUG FORMULARIES A ANY CHANGE IN
PLAN CAN REQUIRE CHANGING DOCTOR
CHANGING HOSPITAL WHERE CHANGE
IN IN MEDICATION AND LEAD TO
SURPRISE MEDICAL BILLS.
THIS AWESOME RAISES
ADMINISTRATIVE COSTS IN IN IN
MANAGING THE SYSTEM BOTH FOR
PROVIDERS.
AND FOR INSURERS.
I WOULD SAY THE FLIP SIDE OF
THAT IS THAT IT CREATES
OPPORTUNITIES FOR INNOVATION.
YOU KNOW I DON'T TO MAKE TO.
TOO STRONG A CASE FOR THIS.
BECAUSE FRANKLY MUCH OF THE
INNOVATION AND PAYMENT REFORM.
HAS COME FROM MEDICARE.
AND.
AND SPREAD TO TO THE PRIVATE
SECTOR.
UNIT BUT CERTAINLY ANYTIME YOU
HAVE MULTIPLE PAYERS
MULTIPLESECTORS.
THERE'S GREATER OPPORTUNITY TO
INNOVATE AND.
IN BOTH QUALITY AND AND COSTS.
.
AND GET UP A SINGLE PUBLIC PLAN
PUTTING ALL YOUR EGGS IN THAT
SINGLE BASKET A POTENTIALLY
LEADS TO.
STAGNATION IN IN THE SYSTEM.
ARM.
I WOULD SAY ALSO IN A AND AGAIN
I LIEU TO TO THIS.
WITH.
THE LACK OF OF ANY CLEAR
ACCOUNTABILITY FOR THE HEALTH
CARE SYSTEM.
IN ONE AGENCY OR ONE BODY WITH
THAT DISPERSED CONTROL NO ONE IS
ACCOUNTABLE FOR ENSURING QUALITY
COST CONTROL OR AFFORDABILITY.
AND CERTAINLY NOT THE HEALTH OF
THE POPULATION AS AS A WHOLE.
NATIONAL EFFORTS YOU'RE A YEARS
AGO.
TRIED TO CREATE LOCAL HEALTH
PLANNING AGENCIES.
TO TO FOCUS SOME OF THAT
CONTROL IN A IN A SINGLE.
IN A SINGLE.
AGENCY.
IN THOSE FRANKLY LARGELY FAILED.
BECAUSE THEY ALSO DID NOT
CONTROL THE MONEY.
AND I THINK OUR EXPERIENCE IN
HEALTHCARE IS THAT ANY ABILITY
ANY EFFORT TO TRY TO. TO HOLD
THE HEALTH SYSTEM ACCOUNTABLE
WITHOUT CONTROL OVER THE FLOW OF
FUNDS.
IS LIKELY TO FAIL.
I'M IN I WOULD SAY* FRANKLY.
THIS FRAGMENTATION LEADS TO
TEARING IN THE HEALTHCARE
SYSTEM.
WHERE WHAT YOU?
WHAT COVERAGE YOU GET WHAT
ACCESS YOU HAVE HOW AFFORDABLE
COVERAGE IS?
DEPENDS VERY MUCH ON.
ON YOUR INCOME AND YOU AND YOUR
RESOURCES.
THIS DOESN'T ALWAYS WORK IN THE
DIRECTION YOU MIGHT THINK FOR
EXAMPLE LOWER INCOME PEOPLE IN
MEDI CAL ARE COVERED CALIFORNIA
WITH ACCESS TO COST SHARING
SUBSIDIES.
GET COVERAGE WITH MORE
COMPREHENSIVE BENEFITS AND LOWER
COST SHARING THEN MOST PEOPLE IN
EMPLOYER BASED PLANS.
AT THE SAME TIME THE NETWORKS
OF PROVIDERS IN THOSE PLANTS IS
OFTEN NARROWER AND ACCESS AT
TIMES CAN BE MORE MORE
DIFFICULT.
YOU KNOW THE FLIPSIDE IN AGAIN
THIS THIS DEPENDS ON YOUR
VALUES.
TEARING PERMITS.
GOVERNMENT PROGRAMS TO PAY LESS.
YOU KNOW A SINGLE SYSTEM WOULD
ALMOST CERTAINLY REQUIRE HIGHER
PRICES HIGHER PAYMENTS ON THE
PART OF MEDI CAL.
TO PHYSICIANS AND AND HOSPITALS.
.
AND IT PROVIDES AUTONOMY.
FOR CONSUMERS AND EMPLOYERS.
YOU KNOW ANY TIERED SYSTEM
ALLOWS AN ESCAPE FROM THAT
SYSTEM.
AND ALLOWS PEOPLE WHO CAN
AFFORD MORE TO TO BUY MORE.
AND WHETHER THAT'S.
WHETHER THAT'S.
AND APPEALING.
CHARACTERISTIC OR NOT AGAIN
DEPENDS ON YOUR VALUES.
.
LOOKING INTERNATIONALLY AND AND
I THINK WE TALKED ABOUT THIS IN
THE LAST HEARING.
ONE THING THAT CLEARLY
DISTINGUISHES THE U. S. FROM
OTHER COUNTRIES IS THAT ALL
OTHER COMPARABLE HIGH INCOME
COUNTRIES PROVIDE ESSENTIAL
UNIVERSAL COVERAGE.
AND I WITH IT WITH AT LEAST
NINETY NINE POINT NINE PERCENT
OF THE POPULATION COVERED.
WE IN THE UNITED STATES IN
CALIFORNIA CLEARLY DO NOT.
WE'VE MADE TREMENDOUS PROGRESS
UNDER THE AFFORDABLE CARE ACT A
CUTTING THE NUMBER OF UNINSURED.
DRAMATICALLY OF THE MORE
RECENTLY THE NUMBER VENTURED
SEEMS TO BE RISING AGAIN.
WITH THE CHANGE IN
ADMINISTRATION.
BUT WE ARE STILL FAR SHORT OF
COVERING.
THE WHOLE POPULATION.
.
NOW I THINK NOT WELL UNDERSTOOD.
IS THAT WHILE ALL OF THESE
OTHER COUNTRIES PROVIDE
UNIVERSAL COVERAGE A SINGLE
PAYER IS NOT THE NORM IN IN MOST
HIGH INCOME COUNTRIES AROUND THE
WORLD.
APPEAR SINGLE PAYER SYSTEM WITH
MINIMAL PATIENT COST SHARING.
IS SIMPLY NOT THE WAY THAT MOST
OTHER COUNTRIES HAVE ACHIEVED
UNIVERSAL COVERAGE.
THEIR COUNTRIES LIKE GERMANY
AND SWITZERLAND THAT RETAIN A
SUBSTANTIAL ROLE FOR PRIVATE
HEALTH INSURANCE.
THAT'S I WOULD NOTE THAT THAT
IN ALL THOSE CASES THOSE
INSURERS ARE NONPROFIT AND NOT
FOR PROFIT.
AS MOST INSURERS ARE IN THE
UNITED STATES.
THERE'S ALSO SIGNIFICANT COST
SHARING IN A NUMBER OF THESE
COUNTRIES INCLUDING FRANCE
GERMANY AND SWITZERLAND.
AND IN SOME CASES PEOPLE CAN
BUY SUPPLEMENTAL INSURANCE TO
FEELING THAT COST SHARING MUCH
LIKE THEY DO IN MEDICARE.
HERE.
AND WHILE ALL OF THESE OTHER
COUNTRIES HAVE UNIVERSAL
COVERAGE.
THAT DOESN'T MEAN THAT EVERYONE
GETS EXACTLY THE SAME THING A
NUMBER OF COUNTRIES CREATE
OPPORTUNITIES FOR PEOPLE WITH
MEANS TO PAY MORE TO GET MORE.
BUT THE BASIC LEVEL OF COVERAGE
IN THESE COUNTRIES IS CERTAINLY
A MUCH HIGHER BAR THAN WE HAVE
HERE IN THE U. S..
TOM AND I WOULD SAY THAT WHILE
WHILE SINGLE PAYER IS NOT THE
NORM.
INTERNATIONALLY.
OTHER COUNTRY CERTAINLY CARVE
OUT A MUCH GREATER ROLE FOR
GOVERNMENT OVERSIGHT OF THE
HEALTHCARE SYSTEM.
THAN WE DO IN THE UNITED STATES.
SOME NOW CERTAINLY A SINGLE
PAYER.
WOULD.
SUBSTANTIALLY.
REDUCE THE FRAGMENTATION IN THE
HEALTH CARE SYSTEM.
BY ITS NATURE A SINGLE PAYER A
PLAN ELIMINATES.
THE DISRUPTION.
FROM SWITCHING FROM ONE TYPE OF
INSURANCE OR ONE PLAN TO
ANOTHER.
IT PROVIDES A MECHANISM FOR
CONTROLLING COSTS.
AND FOCUSES ACCOUNTABILITY FOR
THE HEALTH CARE SYSTEM IN ONE
PLACE.
.
GETTING TO THAT POINT AT WHICH I
THINK I TALKED ABOUT IN THE LAST
A HEARING.
WOULD CERTAINLY BE A DISRUPTIVE.
AND I THINK A SINGLE PAYER PLAN.
RAISES IMPORTANT QUESTIONS
ABOUT GOVERNANCE IF YOU'RE GONNA
FOCUS THAT LEVEL OF
RESPONSIBILITY AND CONTROL. IN
ONE PLACE.
WHAT IS THE GOVERNMENT'S
GOVERNANCE OF THAT GOVERNMENT
AGENCY QUASI GOVERNMENT AGENCY?
YOU KNOW WHO WHO ADVISES WHO
CONCLUDED THAT AGENCY CONSULT
WITH.
AND.
HOW IS IT ADMINISTERED?
CERTAINLY BY INSTAPUNDIT
PROGRAMS WHETHER BUY INTO
MEDICARE ALIBI INTO MEDICARE AT
FEDERALLY WOULD HELP.
REDUCE FRAGMENTATION OF THE
OTHER OF COURSE NOT TO THE
EXTENT OF A SINGLE A GOVERNMENT
PLAN.
TOM. AND I WOULD SAY A LOT OF
THE CONSEQUENCES CONSEQUENCES OF
FRAGMENTATION TEND TO REVOLVE
AROUND DIFFERENCES IN PRICES.
AND PROVIDER NETWORKS.
IN THAT TYPE OF FRAGMENTATION
AND.
DISRUPTION FOR PATIENTS AND
PROVIDERS THAT COULD BE
MITIGATED THROUGH.
AND ALL PAY RATE SETTING SYSTEM
FOREXAMPLE.
WHERE ALL PLANS?
PAYS THE SAME.
THE SAME RIGHTS THE SAME RATES.
TO THE SAME PROVIDERS.
OR EVEN THROUGH A MORE UNIFORM
PRICING SYSTEM WHERE ALL PLANS
AND PROVIDERS WERE REQUIRED TO.
OPERATE.
A SIMILAR PRICING STRUCTURE
EVEN IF THE PRICE LEVELS.
WERE NOT THE SAME SO SHORT OF A
SINGLE PAYER PLAN AT LEAST
REGULATING THE PRICING.
COULD.
COULD COULD REDUCE SOME OF THE
DISRUPTION.
FOR FOR PATIENTS.
WITH A SIMILARLY GREATER
UNIFORMITY IN BENEFITS ANDCOST
SHARING.
AS COVER CALIFORNIA HAS DONE.
WOULD ALSO.
BIG THE SYSTEM MUCH SIMPLER.
AND REDUCE AGAIN SOME OF THAT
ADMINISTRATIVE OVERHEAD AND SOME
OF THAT COMPLICATION.
I AM. AND FINALLY I WOULD SAY
THAT THAT WHILE OUR OUR MEDICAL
CARE SYSTEM IS IN MANY WAYS THAT
A TECHNOLOGICAL MARVEL.
OUR ADMINISTRATION OF THE
HEALTHCARE SYSTEM IS IN MANY
WAYS INCREDIBLY BACKWARDS.
TECH TECHNOLOGICALLY.
AS THAT VOX NEWS REPORTED TO
ADD JUST RECENTLY THE FAX
MACHINE IS STILL. A IS STILL
QUEEN IN THE HEALTHCARE SYSTEM
EVEN THOUGH IT'S HARD TO FIND IN
IN THE REST OF THE OF THE
ECONOMY.
IT WE COULD REDUCE SOME OF THAT
SOME OF THIS COMPLICATION.
IN THE HEALTH CARE SYSTEM FOR
PATIENTS BUT CERTAINLY BY NO
MEANS ARE OLDER MOST.
THROUGH GREATER TRANSPARENCY.
I'M GREATER.
AVAILABILITY OF DATA.
AND IN SOME WAYS UNLEASHING THE.
THE.
THE TECHNOLOGICAL INNOVATION.
THAT WE HAVE IN CALIFORNIA AND
SILICON VALLEY AND AND DOWN
SOUTH.
AND DEVELOPING TOOLS.
AND TECHNOLOGIES THAT WOULD.
THAT WOULD HELP SIMPLIFY
THE SYSTEM.
BEFORE WE MOVE ON TO OUR NEXT.
.
PENALTIES.
YOU HAVE ANY QUESTIONS PERSONAL
THANK YOU VERY MUCH WITH THE
OVERVIEW REALLY APPRECIATE THAT.
QUESTIONS FOR MISTER LEVITT.
AS YOU.
THANK YOU FOR YOU'RE A
PRESENTATION I THINK A CERTAINLY
YOUR YOUR DIAGNOSIS OF WHY WE
HAVE THE FRAGMENTATION IN THE
SYSTEM THAT WE DO IS.
CERTAINLY SPOT ON FROM WHAT I
UNDERSTAND THAT I THINK YOU'VE
LAID OUT OF SOME OF THE CHOICES
WE HAVE. ARM IF YOU WERE HEALTH
CARE'S R. CALIFORNIA.
AMONG THESE DIFFERENT.
OPPORTUNITIES THAT WE HAVE WHAT
WOULD YOU WOULD YOU UP FOR.
CAN I TURN DOWN THAT HEALTHCARE
IS OUR JOB.
YOU CAN TURN A DOWN BUT WE'D
LIKE YOU TO ADVISE HIM.
I.
AS AN ORGANIZATION THE KAISER
FAMILY FOUNDATION DOESN'T
DOESN'T ADVOCATE ANY PARTICULAR.
SO WE WILL STIPULATE YOU'RE NOT
SPEAKING FOR OUR KAISER BUT ARE
SPEAKING AS A. INDIVIDUAL WHO
HAS A LOT OF EXPERTISE IN THIS.
I MEAN I WOULD TAKE AND IT YOU
KNOW AND NO ONE WOULD DESIGN OUR
CURRENT SYSTEM.
IF GIVEN THE ABILITY TO TO TO
DO SO FROM THAT FROM SCRATCH AND
AND I WOULD CERTAINLY SAY.
AT GREATER TRANSPARENCY.
GREATER UNIFORMITY AND PRICES.
WOULD BE AN ENORMOUS STEP IN.
BOTH CONTROLLING COSTS.
IN SIMPLIFYING THE SYSTEM.
AND YOU KNOW WELL THAT WOULD
CERTAINLY BE A A HEAVY LEFT OF
BOTH TECHNICALLY AND
POLITICALLY.
IT WOULD.
IT WOULD IT WOULD MAKE AN
ENORMOUS DIFFERENCE.
AND.
YOU KNOW I I THINK WOULD BE A.
TO IT TAKING THAT STEP YOU KNOW
WHETHER YOU SUPPORT.
A SINGLE PAYER SYSTEM ARE NOT
TAKING THAT STEP.
WOULD BE.
IT YOU KNOW WOULD BE AT A
MINIMUM THE TRANSITION.
TO A A A A LESS EXPENSIVE.
FAIRER SIMPLER AND SIMPLER
HEALTH CARE'S.
SO INTERNET A CONTRIVED.
YEAH I HEAR WHAT YOU'RE SAYING
YOU'RE SAYING YOU YOU'D BE OPEN
POTENTIALLY TO THE IDEA OF
SINGLE PAYER.
.
I I I I I'M.
.
I THINK AND I AND I THINK I SAID
THIS AT THE LAST HEARING AND
IT'S IT SINGLE PAYER AYE I THINK
SINGLE PAYER IS THE ONLY WAY.
PROBABLY THE ONLY WAY TO GET
TEETH TO UNIVERSAL COVERAGE.
SO.
.
CERTAINLY IF THAT IS THE GOAL
THEN I THINK A A SINGLE PAYER
SYSTEM OR SOMETHING VERY SIMILAR
TO IT.
IS THE ONLY WAY TO DO THAT AND
AND I WOULD SAY REALLY.
THAT THE FUNDAMENTAL. THINK THE
KEY TO THAT IS.
ITS TAX BASE FINANCING.
WHERE EVERYONE IS AUTOMATICALLY
COVERED?
WHERE IT'S NOT A VOLUNTARY
SYSTEM WHERE YOU HAVE TO SIGN
UP?
OHIO OR OR PAY PREMIUMS YOU KNOW
WHETHER OR NOT THERE'S AN
INDIVIDUAL MANDATE.
OR NOT.
AND.
I WOULD ALSO SAY THAT AT A
SINGLE. PAYER SYSTEM OF OF SOME
SORT.
OR EVEN A SYSTEM OF.
YOU KNOW NONPROFIT INSURERS
TODAY NEGOTIATE.
PRICES.
WITH PROVIDERS SIMILAR TO
GERMANY.
IS.
IS THE MOST EFFECTIVE WAY TO I
CERTAINLY REDUCE ADMINISTRATIVE
COSTS AND
TROUT COSTS OVERALL. I I
APPRECIATE YOUR ANSWER CERTAINLY
SOMEONE WHO ALSO SUPPORTS THE
VISION OF OF SINGLE PAYER. ON
AND I THINK WHAT I HURT MY NEXT
QUESTION WAS GONNA BE IF THERE
IS A VARIATION OF A SINGLE
PAYER.
SYSTEM AND OTHER COUNTRIES THAT
YOU WERE MORE OPEN TO IT SOUNDS
LIKE GERMANY.
YEAH I THINK YOU HAVE IT AGAIN
IF YOU LOOK AT OTHER COUNTRIES.
THAT THEY THEY HAVE ALL GOT
OTHER HIGH INCOME COUNTRIES HAVE
ALL ACHIEVED UNIVERSAL COVERAGE.
BUT HAVE DONE SO IN IN VERY
DIFFERENT WAYS AND THROUGH A
VERY DIFFERENT RATES.
YOU KNOW WHICH RANGE FROM.
AFT A FULLY.
A NATIONAL HEALTHCARE SYSTEM
LIKE IN THE UNITED KINGDOM.
SINGLE PAYER SYSTEM LIKE IN
CANADA TO.
MULTIPLE NONPROFIT INSURERS
LIKE IN GERMANY AND SWITZERLAND.
WHAT THEY ALL HAVE IN COMMON IS
EVERYONE IS GUARANTEED? COVERAGE
AND THERE IS SOME OF MUCH LARGER
ROLE FOR GOVERNMENT AND.
IN NEGOTIATING R. SETTING
PRICES.
AND THEN IN THE FINAL QUESTION
GIVEN THE POLITICAL REALITIES OF
THE TRUMP ADMINISTRATION WHAT
ADVICE COUNSEL WOULD YOU HAVE
FOR US OR FOR A HYPOTHETICAL
HEALTH CARE IS OUR CALIFORNIA.
TO DESIGN A SYSTEM WITH THE IDEA
THAT AWFULLY SOMEDAY IN THE
FUTURE IT'S CLOSER TO WHAT YOU
JUST LAID OUT.
I'M HYI I WOULD SAY AND I
THINK.
YOU YOU ALL UPSET THROUGH THESE
HEARINGS HALF WORK ON THESE
ISSUES EVERY DAY.
I MEAN THIS IS ENORMOUSLY
COMPLICATED.
YOU KNOW DESIGNING A SYSTEM.
IS COMPLICATED THINKING ABOUT
THE KIND OF WAIVERS.
THEY WOULD REQUIRE THAT WOULD
REQUIRE FROM THE FEDERAL
GOVERNMENT.
IS TECHNICALLY COMPLICATED AS
WELL AS POLITICALLY DIFFICULT.
AND SO THIS IS NOT SOMETHING
THAT THAT THAT HAPPENS
OVERNIGHT.
SO I THINK YOU KNOW GOING
THROUGH THIS PROCESS OF THINKING
ABOUT.
WHERE YOU WANNA DOT?
EVEN IF YOU CAN'T GET THERE.
POLITICALLY WITH THE CURRENT
ADMINISTRATION IS IMPORTANT
BECAUSE THAT PROCESS GUY COULD
VERY WELL TAKE YEARS.
AND.
AND SIMILARLY THINKING ABOUT
THE TRANSITION STEPS.
YOU KNOW IT SAM. YOU KNOW
SOMETIMES AND HEALTH CARE AS IN
IN ALL OF PUBLIC POLICY WE THINK
ABOUT WHAT'S POSSIBLE TODAY.
AND THAT'S COMPLETELY
APPROPRIATE BUT YOU ALSO WANT TO
THINK ABOUT WHERE YOU WANT TO
GET TO AND WHETHER THOSE
INCREMENTAL STEPS ARE. KIND OF
ON THE PATH TO.
TO WHERE YOU ULTIMATELY WANT TO
GO.
ANSWER ONE FROM ITS HER ONE
FINAL QUESTION SOUND THE ONE
MAJOR HEALTH CARE CHANGE IN OUR
SYSTEM THAT'S DIFFERENT FROM THE
LAST YEAR IN THAT WE HAD.
WAS THAT.
THE TRUMP ADMINISTRATION AND
HIS REPUBLICAN ALLIES HAVE
ELIMINATED THE INDIVIDUAL MAN.
ABOUT WHAT YOUR THOUGHTS ABOUT
WHETHER THAT'S SOMETHING WE
SHOULD TRY TO RESTORING
CALIFORNIA IN THE NEAR TERM.
YEAH I THINK.
IN CALIFORNIA HAS.
AS YOU KNOW DEBATED AN
INDIVIDUAL MANDATE IN IN THE
PAST NUMBER YEARS AGO UNDER
GOVERNOR SCHWARZENEGGER.
AND IT'S CERTAINLY A
CONTROVERSIAL BUT CERTAINLY NOT
THE MOST POPULAR.
ASPECT OF THE AFFORDABLE CARE
ACT.
I WOULD SAY OUR POLLING SHOWS
THAT IF YOU EXPLAIN TO PEOPLE.
THE PURPOSE OF THE INDIVIDUAL
MANDATE.
THAT IT'S FAIR TO HELP BROADEN
THE RISK POOL LOWER PREMIUMS.
IT SURE THAT EVERYONE IS
RESPONSIBLE FOR GETTING
COVERAGE.
HAD IT HAS MUCH LESS OPPOSITION.
DAN DAN INITIALLY.
YEAH I THINK CALIFORNIA
PARTICULARLY WITH THE INCOME TAX
STRUCTURE WE HAVE HERE IS WELL
POSITIONED TO IMPLEMENT AN
INDIVIDUAL MANDATE.
IT IF YOU IF YOU SO CHOOSE.
YOUR MARYLAND IS ACTUALLY
PURSUING.
THAT AS WELL.
IT HAS AN INTERESTING IDEA TO
ALLOW PEOPLE.
TO SORT PUT ASIDE THEIR PENALTY.
IN A FUND THAT THEY COULD DO
AND USED TO BUY INSURANCE.
SO IT'S A PENALTY THAT THAT
THAT IS OF USE TO THAT
INDIVIDUAL.
LATER ON RATHER THAN JUST GOING
INTO THE. INTO THE GENERAL FUND.
I THINK THERE ARE OTHER
APPROACHES CALIFORNIA COULD TAKE
AT AND MITIGATE THE EFFECT OF
REPEALING INDIVIDUAL MANDATE.
CERTAINLY
EXPANDING OUTREACH
SIGNIFICANTLY.
BECAUSE THERE ARE MANY PEOPLE
OUT THERE WHO ARE ELIGIBLE FOR
MEDICARE I'LL ELIGIBLE FOR
PREMIUM SUBSIDIES FOR COVER
CALIFORNIA. ABOUT ARE NOT
ENROLLED SO EXPANDING OUT REACH.
COULD HAVE. A BIG EFFECT TO
BRINGING HEALTH YOUR PEOPLE.
INTO THE POOL.
AND EVEN CONSIDER EXPANDING.
SUBSIDIES.
YOU KNOW IN MANY WAYS THAT THE
STICK OF THE INDIVIDUAL MANDATE
IS THE FLIP SIDE OF THE CARROT.
OF THE SUBSIDIES.
SO WITHOUT THE STICK EXPANDED
SUBSIDIES.
COULD ALSO HELP IMPROVE IMPROVE
THE SYSTEM.
GREAT THANK YOU VERY MUCH THANK
YOU MISTER.
TREATMENT SHIP QUESTION.
ANYONE ELSE.
THIS WATER.
THANK YOU MISTER CHAIR OF.
THANK YOU FOR COMING. I KNOW
THERE'S A LOT OF INFORMATION SO
I JUST TRIED IT.
BRIEFLY GO OVER ONE OF THE
THINGS THAT CAME TO MY ATTENTION
WAS ON OLDER AMERICANS AND THAT
THE ISSUES THAT THEY HAVE TO
DEAL WITH. TRYING TO ACCESS
CARE.
YOU KNOW AS WE'VE GONE THROUGH
THESE HEARINGS WE'VE GOTTEN A
LOT OF INFORMATION. THAT WE DID
HAVE THE COMMONWEALTH FUND
REPORT IT DURING ONE OF OUR
HEARINGS WHICH WAS IN A VERY IN
DEPTH.
I AM. WE KNOW THAT OLDER
AMERICANS HAVE WORSE HEALTH
OUTCOMES.
AND THEY'RE PAYING HIGHER COSTS
FOR THAT.
BUT WHEN YOU LOOK AT THE US
POPULATION WHAT WE'RE SEEING THE
SILVER SO NAMI.
MORE THAN TEN THOUSAND ADULTS
TURNED SIXTY FIVE EVERYDAY.
AND I'M BY TWENTY SIXTEEN NINETY
POINT TWO MILLION AMERICANS
ALMOST A QUARTER OF THE
POPULATION WILL BE SIXTY FIVE OR
OLDER.
BUT THEN WHEN WE LOOK AT YOU
KNOW FROM WHAT WE SAW FROM THIS
COMMONWEALTH. FUND.
STUDY THAT.
UNDER CORNER OF OLDER AMERICANS
IN THE PAST YEAR AND NOT EVEN
SEEN A DOCTOR WHEN THEY'RE SICK.
AND NOT FEEL DISTANT.
PRESCRIPTION ORDERED SKIP THE
MEDICATION DOSE WHEREAS IN OTHER
COUNTRIES.
THEY'RE DOING A LOT BETTER IN
THAT REGARD IN.
YOU KNOW I.
HOW DO WE YOU KNOW REALLY WOKE
BECAUSE A LOT OF THEM A DUAL
ROLE? MAYBE THEY WEREN'T INSURED
AT ALL THAN THEIR INTO MEDICAID
MEDICARE.
AND WE'RE NOT ADDRESSING ALL OF
THAT AND WHAT YOU SEE IS THE
TRENDS.
GOING FORWARD YOU KNOW AS FAR AS
BEING ABLE TO KEEP.
ACCESS IS WILL'S COVERAGE FOR
THESE FOLKS.
HERE I THINK YOU KNOW DE.
FIRST OF ALL IT WITH THAT WITH
OLDER AMERICANS ACT YOU KNOW
MANY OF WHOM WERE UNINSURED
BEFORE THEY TURN SIXTY FIVE AND
AND GAINED ELIGIBILITY FOR
MEDICARE.
WE'RE SEEING THE EFFECTS OF.
MANY YEARS OF LACK OF COVERAGE
AND AND AND LACK OF ACCESS.
AND THAT KIND OF COMES HOME TO
ROOST.
WHEN THEY.
WHEN THEY TURN SIXTY FIVE AND
END UP IN IN MEDICARE.
.
YOU KNOW I I ALSO I MEAN
MEDICARE IS A A UNIVERSAL NEAR
UNIVERSAL.
SYSTEM FOR FOR OLDER AMERICANS.
BUT IT'S FAR FROM PERFECT
INSURANCE.
YOU KNOW IF YOU STACKED
MEDICARE UP TO A TYPICAL
EMPLOYER PLAN IT DOESN'T ALWAYS
COMPARE VERY WELL AND IT HAS
SUBSTANTIAL COST SHARING.
NO CAP ON ON OUT OF POCKET
COSTS.
YOU KNOW MANY PEOPLE COMPENSATE
FOR THAT.
BY BUYING SUPPLEMENTAL
INSURANCE IN ROLLING IN A
MEDICARE ADVANTAGE.
PRIVATE INSURANCE PLAN.
OR OR THROUGH MEDI CAL.
OR MEDICAID AS A AS A TOOL
ELIGIBLE LIST IF THEIR INCOMES
ARE ARE LOW.
BUT YOU KNOW I EIGHT THINK WHAT
WHILE WHILE MEDICARE IS IS DOES
PROVIDE THAT UNIVERSAL COVERAGE.
IT'S.
YOU KNOW IT'S FAR FROM WITHOUT
PROBLEMS AND MEN AND SOME OF THE
SAME PROBLEMS THAT THAT PLAGUE.
YEAH PLAGUE PLAGUE THE SYSTEM
FOR PEOPLE UNDER AGE SIXTY FIVE
AS WELL NOW I'M AND WE'RE
LOOKING AT HERE HOW WE COMPARE
TO OTHER COUNTRIES.
.
LOCAL LOTS OF FOLKS LOOK AT
CANADA AS A SYSTEM.
TWENTY NINE PERCENT OF OLDER
CANADIANS REPORT WAITING SIX
MORE DAYS. FOR A DOCTOR'S
APPOINTMENT WHEN THEY'RE SICK
COMPARED TO EIGHTEEN PERCENT OF
U. S. SENIORS.
AND.
ON. MY IN LAWS MY HUSBAND'S MOM
AND DAD BOTH THE CANADIAN FROM
QUEBEC. AND THEY HAVE RELATIVES
WHO LIVE THERE AND THEY ARE
REGULARLY CROSSING THE BORDER
INTO THE UNITED STATES TO ATTACK
OUR HEALTHCARE.
AND THAT'S A FACT THAT PLEASE
TRULY SO.
YOU KNOW THERE'S A LOT TO WAIT
HERE AS FAR AS YOU KNOW BUT I
DON'T WANNA LEAVE OLDER.
CITIZENS OUT BECAUSE THEY ARE A
GROUP THAT YOU KNOW IS GROWING
DAY BY DAY. ON. THE OTHER THING
IS I AM CURRENT RATES AND TRENDS
OF.
CERTAIN HEALTH CARE AND
TREATMENTS
THINGS LIKE WELL CHILDCARE
VISITS
CERVICAL CANCER SCREENINGS
BREAST CANCER SCREENINGS
TIMELINESS OF THE FIRST PRENATAL
VISIT.
FREQUENCY OF PRENATAL CARE
TIMELY POSTPARTUM CARE. ON.
I WENT ON THE WHOLE CARE
AFFECTED THIS DATA AND
INFORMATION SET THEM WEBSITE.
I GUESS IT'S COOL HEAD THIS
HIDEOUS HIDEOUS YOUR* AND.
.
YOU KNOW THAT'S ANOTHER THING
WE'RE GOING TO HAVE TO LOOK AT.
IN MY FEET FOR ANOTHER HEARING
BUT HOW ARE OUR CURRENT RATES
AND TRENDS OF THESE.
TOPICS WILD CHILD CARE VISITS.
POST CARE HOW ARE THOSE.
EFFECTIVE EIGHT VERSUS.
OTHER NATIONS AS WELL AS.
BETWEEN THE INSURANCE COMMERCIAL
INSURANCE MEDICO. MARKETPLACE.
TO HAVE DATA ON THOSE THAT WE
WAIT WE DO HAVE SOME THAT WOULD
BE HAPPY TO TO TO PROVIDE THAT.
AND.
YOU KNOW I THINK WE WE WE TEND
TO FOCUS ON ON COVERAGE IN AND
COSTS.
BUT CERTAINLY THAT THE QUALITY
OF HEALTHCARE THE OUTCOMES ARE.
ARE JUST AS A POINT AND A
IMPORTANT THOSE KIND OF LAUGHED
AT A CENTRAL POINT OF
ACCOUNTABILITY NOW AS WELL.
IN WHICH A COMPARED TO OTHER
COUNTRIES I MEAN WE SPEND FAR
MORE.
THAN OTHER COUNTRIES ON ON
HEALTHCARE.
EIGHTEEN PERCENTOF GDP AND IN
THE UNITED STATES COMPARED TO
ELEVEN PERCENT IN.
SIMILAR HIGH INCOME COUNTRIES
BUT INTERESTINGLY THOSE OTHER
COUNTRIES TEND TO MAKE UP SOME
OF THAT GAP THROUGH.
SOCIAL SERVICES GOT A SPEND
MUCH MORE ON THINGS LIKE HOUSING
AND
FOOD ASSISTANCE AND.
.
AND OTHER SOCIAL SERVICES THAT.
YOU KNOW ARE NOT UNCONNECTED TO
TO HEALTH CARE AND AND ACCESS TO
SOME OF THE THINGS THAT YOU
TALKED ABOUT. PLAN THAT WILL TIE
IN WITH THE SENIOR CITIZEN CARE
BECAUSE A LOT OF THEM JUST NEED
BASIC.
YOU KNOW LIVING TO HELP THEM BUT
JUST AS A RAPPER.
.
WHEN WE LOOK AT THE HIDEOUS
CHARTS.
A AND THEY COMPARED TO MARSHALL
MEDICAID AND MEDICARE WELL
CHILDCARE VISITS.
IT LOOKS AS THOUGH.
COMMERCIAL HMO AND PPO DOING
FINE BUT THE MEDICAID HMO HAS
THE LOWEST RATES OF.
CHILD. WELL VISITS.
HERE IN THE IT DOES EVERY THOSE
COMPARISONS ARE ARE VERY TOUGH.
BECAUSE.
YOUR COMMERCIAL INSURERS
PRICKLY EMPLOYER BASED INSURERS
ARE COVERING A VERY DIFFERENT.
POPULATION.
THEN.
THAT THEN THERE MEDI CAL WHICH
IS NOT SAY THERE AREN'T ISSUES
OF ACCESS IN MEDI CAL I THINK
THEE THERE ARE.
BUT IT'S IT'S VERY DIFFICULT TO
TO ZURICH CONTROLLER GUY IN A
STATISTICAL WAY.
FOR THOSE THOSE VERY DIFFERENT
POPULATIONS I MEAN I YOU KNOW
THAT SOMEONE HAS LOW INCOME
WHOSE.
STRUGGLING.
IF YOU KNOW WHAT THEIR
HOUSEHOLD BUDGET.
ON EVERYTHING INCLUDING
HEALTHCARE.
YOU KNOW TRIBE STRUCK WITH PAIN
FOR FOOD STRUGGLE WITH HOUSING.
THAT'S GOING TO IMPACT THEIR
ABILITY TO TAXES HEALTH CARE AS
WELL.
THANK YOU.
YOU KNOW FIRST I. WANTED TO
REPEAT YOUR STATEMENT TO MAKE
SURE I GOT IT CORRECT BUT. MY
UNDERSTANDING WAS THAT YOU SAID
THAT NO ONE IS TRYING TO
RECREATE OUR HEALTHCARE DELIVERY
SYSTEM.
I THINK I KNOW NO ONE WOULD.
YEAH. YEAH THAT FRAGMENTATION
THEN SHOULD LEAD US TO REALLY
LOOKING AT THE CONSEQUENCES THAT
YOU HAD ON YOUR PAGE
SO I WANTED TO READ THEM BACK TO
YOU TO. MAKE SURE THAT THE
VALUES.
THAT WE'RE TRYING TO PROTECT OR
ARE WE A DIFFERENT ENTITY MOVING
TOWARDS A DIFFERENT.
SO YOU SAY BY HAVING A
FRAGMENTED HEALTH CARE SYSTEM WE
MAKE IT MORE DIFFICULT TO
CONTROL COSTS.
WE RISK DISRUPTIONS IN CARE AND
WE AVOID CLEAR ACCOUNTABILITY
FOR COST TO POPULATION HEALTH.
WELL CREATING A TIERED
HEALTHCARE SYSTEM.
THOSE STATEMENTS
MAKE ME REALIZE THAT THIS
FRAGMENTED HEALTHCARE DELIVERY
MODEL. IS CAUSING SOME OF THE
PROBLEMS WE HAVE WITH THEM
HEALTHCARE.
WE HAVE.
A SAYING THAT IT'S A EUPHEMISM
BUT IT'S AN APPLE A DAY KEEPS
THE DOCTOR AWAY. THAT AN OUNCE
OF PREVENTION IS WORTH A POUND
OF CURE.
THAT FRAGMENTATION REALLY LEADS
TO AN UNDER INVESTMENT IN
DEPARTMENT OF PUBLIC HEALTH AND
OTHER AGENCIES THERE REALLY DO
HELP TO KEEP OVERALL HEALTHCARE
COSTS DOWN.
MIGHT.
QUESTION IS GOING TO BE.
IN YOUR CLOTHES YOU SAID THAT AN
OPTION TO BUY EN.
OR AND ALL PAYER MODEL WERE TWO
EXAMPLES THAT WE SHOULD
CONSIDERING
AND I WANTED TO UNDERSTAND FROM
YOU HOW THAT WOULD HELP US.
TO ADDRESS THE CONSEQUENCES THAT
YOU LISTED HERE.
YES I I THINK IN IN IN A COUPLE
WAYS.
.
A GREAT GREATER REGULATION OF
PRICING AND AND ALL PAYER RATE
SETTING SYSTEM.
.
WOULD IT WOULD HELP TO ADDRESS
THE COST SIDE.
YOU KNOW THE THING THAT.
THAT THAT THE THING THAT
DIFFERENCE THIRD THE REASON WE
SPEND SO MUCH MORE ON
HEALTHCARE.
IN OTHER COUNTRIES IS NOT
BECAUSE WE USE MORE HEALTH CARE
IT'S BECAUSE WE PAY HIGHER
PRICES.
THEN THEN THAN OTHER COUNTRIES.
SO IT ALL PAYER RATE SETTING
SYSTEM OF SOME SORT WOULD HELP
TO ADDRESS.
THAT DEBT PRICE ISSUE.
WHICH WOULD CERTAINLY STILL
LEAVE A LOT OF THE OTHER
FRAGMENTATION.
YOU KNOW THEY'RE THERE WOULD
STILL BE NETWORKS.
OF OF PROVIDERS ALTHOUGH I
THINK A MORE REGULATED PRICING
STRUCTURE I WOULD EVEN.
SOME OF THAT OUT AND INCREASED
MORE UNIFORM NETWORKS.
THERE STILL BE DIFFERENCES AND
BENEFITS DIFFERENCES AND COST
SHARING.
YOU KNOW BUT IT BUT A LOT OF
THE.
KIND OF BACK AND COMPLICATION.
AND AND HIGH COST OF THE
CURRENT SYSTEM COULD BE
ADDRESSED.
THROUGH THRALL PAIR RATE
SETTING.
YOU KNOW AS A BY AND AYE I
WOULD SEE IS.
BUY INTO MEDICARE ALIBI INTO
MEDICARE FEDERALLY.
IS IS SORT OF A STEP IN THE
DIRECTION. ARMED.
YOU KNOW IF.
II IF A SINGLE PAYER SYSTEM IS.
IT IS IS WHERE YOU WANT TO GO
BUT IT'S IT IT'S TOO DIFFICULT
TO GET THEIR.
IMMEDIATELY THEN.
A BY AND PARTICULARLY BY AND
WHERE.
A LOT OF THE POPULATION EVEN
EMPLOYERS HAVE THE CHOICE OF
BUYING INTO THAT SYSTEM.
IS A WAY OF KIND EASING INTO IT.
SO WHAT DO YOU KNOW IT DOESN'T
GET THERE OVERNIGHT. DOESN'T GET
THERE IMMEDIATELY IT DOESN'T
ADDRESS ALL OF THE FRAGMENTATION
IMMEDIATELY.
BUT IT STARTS TO MOVE IN THAT
DIRECTION.
ONE OF THE ISSUES THAT I REALLY
HAVE WITH FRAGMENTATION IS.
TURNING I KNOW WE'RE GOING TO
TALK ABOUT THAT LATER IN THE
DISCUSSION BUT.
YOU KNOW WE TEND TO FOCUS OUR
DISCUSSIONS ON THE ON INSURED
RATHER THAN THE UNDERINSURED OR
THE PEOPLE WHO ARE JUST.
STRUGGLING TO MAKE ENDS MEET
AND.
WE MUST HAVE THAT SUBSTANTIVE
DISCUSSION ABOUT HOW WE REMOVE
SOME OF THAT FRAGMENTATION SO
THAT WE CAN.
MAKE SURE THAT WE CAN HELP WITH
THAT.
AND.
THAT'S JUST A COMMENT I WANNA
LEAVE IT THERE UNTIL WE HEAR THE
CONVERSATION LATER.
I WANNA THANK YOU OF MISTER
LEVITT AND I REALLY APPRECIATE
THAT I KNOW WILL HAVE YOU BACK
AT THE END FOR.
DISH ADDITIONAL COMMENTS BUT I
BUT I JUST WANNA AND APPRECIATE
THE OVERVIEW I THINK IT'S
IMPORTANT TO SAT.
TO SET FOR SPECIAL FOR FOLKS
WHO HAVEN'T BEEN TO ANY OF OUR
HEARINGS BEFORE.
AND ONE OF THE FEW THINGS THAT
I AGREE WITH WHAT MAY BE THE
ONLY THING I AGREE WITH WITH OUR
CURRENT ADMINISTRATION IS THAT
HEALTHCARE IS COMPLICATED.
AND.
BEYOND THAT I HAVE A REAL
PROBLEM WITH SOME THE THINGS
GOING ON OUT OF THE STATE.
BUT YEAH I THINK IMPORTANT TO
ME.
THE TAKE AWAY FROM HERE IS.
TRANSITIONS AND I THINK THAT'S
AN IMPORTANT CONVERSATION THE I
AGREE WITH YOU.
KNOWING WHAT EVER INVENT THE
SYSTEM WE HAVE IN THE UNITED
STATES AGAIN.
IT'S BEEN.
IT'S BEEN A HORRIBLE HORRIBLE
PROBLEM FOR ALL OF US FOR FOR A
VERY LONG TIME.
I APPRECIATE THE INFORMATION
ABOUT MEDICARE I'M I'M IN AND I
WILL SAY THAT I HEAR FROM PEOPLE
ALL THE TIME I WON A SINGLE
PAYER MEDICARE FOR ALL UNIVERSAL
HEALTHCARE SYSTEM.
AND I GO WOW WHAT DO YOU REALLY
WANT. BECAUSE.
THEY'RE ALL DISTINCTLY
DIFFERENT. AND I THINK WHAT
PEOPLE REALLY WANT IS HIGH
QUALITY CARE ON AT A REASONABLE
COST.
DEAL GET TO DOCTORS.
AND GET GET THE CARE THEY NEED
WITHOUT BANKRUPTING THEM THAT'S
WHAT I THINK WEEKLY AND SO I
APPRECIATE THE OR VIEW BECAUSE.
YOU'VE
I POINTED OUT MEDICARE IS NOT A
PERFECT SYSTEM.
AND YOU THERE ARE SIGNIFICANT
COSTS RELATED TO THAT ON THAT
THE OUR TRANSITIONS THAT ARE
GOING TO BE INVOLVED ON TO TO
GET TO WHERE WE NEED TO GO. AND.
AND I THINK IT'S IMPORTANT AS
WE CONTINUE THIS DISCUSSION TO
RECOGNIZE THOSE THOSE ISSUES
AND.
APPRECIATE APPRECIATE YOU BRING
UP FOR ITSELF THANK YOU VERY
MUCH AND I WILL GO AHEAD AND
BRING UP OUR OUR OUR NEXT PANEL.
WHICH IS GOING TO BE.
AYE RELATED TO ACCESS TO CARING
COVERAGE.
WELL ACTUALLY HEAR FROM ALL FOUR
PANELISTS BEFORE WE GO TO
QUESTIONS FROM THE PANEL.
AND.
DOCTOR REGULAR WILL GO AHEAD
AND INTRODUCE OUR OUR FIRST
PANELIST.
SO IF WE CAN HAVE SABRINA COR
LET. CHRIS PERONI JANET KAUFMAN
AND JOHN GRAVES COME FORWARD.
AND AS THEY DO WELL BE READING
THE BIO FOR SABRINA QUICKLY
.
THANK YOU AND I'VE BEEN
CORRECTED I THINK IT'S CHRIS
PERON SO SORRY ABOUT THAT.
SABRINA CORPS LET OUR FIRST
PRESENTER IS A RESEARCH
PROFESSOR AT THE CENTER ON
HEALTH INSURANCE REFORMS AT
GEORGETOWN UNIVERSITY.
AT THE CENTER ON HEALTH
INSURANCE REFORMS SHE DIRECTS
RESEARCH ON PRIVATE HEALTH
INSURANCE AND THE UNIVERSITY AND
INSURANCE MARKETS
SHE PROVIDES EXPERTISE AND
STRATEGIC ADVICE TO INDIVIDUALS
AND ORGANIZATIONS. ON FEDERAL
AND STATE HIT WITH INSURANCE
LAWS AND PROJECT THANK YOU FOR
COMING HERE TODAY.
THANK YOU DOCTOR AND GOT THANK
YOU.
.
TO PUT IT I REALLY APPRECIATE
THE OPPORTUNITY TO BE HERE
TODAY.
AND TAKE PART IN THIS VERY VERY
IMPORTANT SERIES OF HEARINGS.
.
SO JUST A MOMENT ABOUT THE
CENTER ON HEALTH INSURANCE
REFORMS AND WHERE GEORGETOWN
UNIVERSITY'S MCCOURT SCHOOL OF
PUBLIC POLICY.
WE'RE PART OF A LARGER TEAM THE
STUDIES HEALTH POLICY ISSUE
ISSUES MEDICARE MEDICAID
CHILDREN'S HEALTH INSURANCE.
BUT CHEER R. CENTER FOCUSES
PRIMARILY ON PRIVATE HEALTH
INSURANCE AND PRIVATE.
HEALTH INSURANCE MARKETS.
AND HOW THEY FIVE BAND EVOLVING
I'M PARTICULARLY.
OVER.
.
PASSAGE OF THE AFFORDABLE CARE
ACT.
AND.
AND MORE RECENT EFFORTS TOO.
ROLLED OUT LAW BACK.
I AM SO I'M GONNA TALK.
PRIMARILY TODAY ABOUT THE
INDIVIDUAL PRIVATE HEALTH
INSURANCE MARKET.
AND SOME OF THE.
ISSUES THAT HAVE BEEN EMERGING
AROUND PLAN CHOICE AND THE
PRICES THAT CONSUMERS PAY IN
THAT MARKET.
YOU SAW A LITTLE BIT FROM.
LARRY LEVITT SLIDES BUT I THINK
SOME KEY CHARACTERISTICS OF THE
INDIVIDUAL MARKET IN CALIFORNIA
AS WELL AS IN OTHER STATES.
IS A RELATIVELY SMALL MARKET
AND CERTAINLY COMPARED TO.
MEDI CAL
AS WELL AS EMPLOYER BASED OR.
EMPLOYER SPONSORED INSURANCE.
ROUGHLY TWO POINT THREE MILLION
PEOPLE ENROLLED.
WITH OVER HALF OF THEM IN
COVERED CALIFORNIA.
AND THE MAJORITY OF THOSE.
RECEIVING PREMIUM SUBSIDIES.
YOU COMPARE THAT TO MEDI CAL
WITH TEN POINT FIVE MILLION OUR
EMPLOYER BASED COVERAGE WITH
ELEVEN POINT EIGHT IT'S A IT'S A
RELATIVELY SMALL MARKET. IT ALSO
TENDS TO BE A FAIRLY
TRANSITIONAL MARKET.
PEOPLE CYCLE AND AND CYCLE OUT
WHICH IS VERY ARM BUT THEY'RE
VERY DIFFERENT FOR EXAMPLE THAT
MEDICARE.
ANY COULD BE DUE TO LIFE
CIRCUMSTANCES IT COULD BE YOUR
YOU KNOW RECENT COLLEGE GRAD WHO
JUST HASN'T QUITE FIGURED OUT
THEIR CAREER PATH YOU HAD OR.
THE MIDDLE AGED MOM WHO DECIDES
TO TAKE SOME TIME OFF WORK TO
CARE FOR AN AGING PARENT IT
COULD BE THAT PERSON YOU DECIDES
TO TAKE OFF WORK ON IT A YEAR
TOO EARLY BEFORE THEY TURN SIXTY
FIVE AND BECOME ELIGIBLE FOR.
MEDICARE ALSO COULD BE INCOME
CHANGES THAT MIGHT CAUSE YOU TO
COME INTO THE INDIVIDUAL MARKET
FOR EXAMPLE IF YOU GET MORE
HOURS AT WORK OUR SMALL PAY
RAISE YOU COULD LOSE
ELIGIBILITY.
FOR MEDICAID.
BUT IT'S ALSO I THINK IMPORTANT
NO DOUBT WHILE THIS IS A SMALL
MARKET IT'S A TRANSITIONAL
MARKET FOR A LOT OF PEOPLE. IT
IS THE ONLY MARKET AND THEY ARE
THERE FOR A LONG TIME FEES MIGHT
BE ENTREPRENEURS. ARTISTS.
MUSICIANS FREELANCERS OUT
FARMERS AND RANCHERS IT'S REALLY
CRITICAL FOR THOSE FOLKS THIS IS
REALLY THE MARKET THAT THEY HAVE
AND IT'S GOT TO BE STABLE AND
IT'S GOING TO BE AFFORDABLE FOR
THEM.
I DON'T TALK A WHOLE LOT ABOUT
THE PROTECTIONS THAT THE ACA
BROUGHT TO THE INTERNAL MARKET
BECAUSE I THINK AFTER THESE
HEARINGS YOU PROBABLY ARE PRETTY
FAMILIAR WITH THOSE. ON BUT AS
WE THINK ABOUT THE WAY THE
INDIVIDUAL MARKET HAS EVOLVED
AND WHERE IT'S GOING OVER IN THE
YEARS TO COME I THINK IT'S
HELPFUL TO THINK A LITTLE BIT
ABOUT THE ACA. IN SOME WAYS IS
A.
DALLEK KID IN GRAND BARGAIN
BETWEEN THE GOVERNMENT INSURERS
AND CONSUMERS RIGHT SO ON THE
ONE HAND THE GOVERNMENT SAID TO
INSURANCE COMPANIES OKAY YOU'RE
GONNA TAKE. SICK PEOPLE YOU HAVE
TO TAKE THEM AND ACCEPT THEM
GUARANTEED ISSUE YOU CAN'T
CHARGE THEM A HIGHER RATE. ON
YOU GOTTA COVER A PRETTY BASIC
SET OF ESSENTIAL HEALTH BENEFITS
BUT IN EXCHANGE WERE GONNA MAKE
SURE YOU GET SOME HELP THE
PEOPLE IN YOUR POOL THROUGH THE
INDIVIDUAL MANDATE. ON THEM ARE
GONNA GIVE YOU THESE PREMIUM AND
COST SHARING SUBSIDIES TO HELP
MAKE THAT COVERAGE AFFORDABLE.
WE SAID TO CONSUMERS WILL WE'RE
GOING TO GIVE YOU THE SECURITY
OF AFFORDABLE COMPREHENSIVE
COVERAGE EVEN IF YOU HAVE
PREEXISTING CONDITIONS BUT YOU
CAN'T FREE RIDE OFF THE SYSTEM
RIGHT YOU GOTTA SIGN UP BEFORE
YOU GET SICK.
YOU WILL THAT BARGAIN SUCH AS
THAT IS.
IS BEEN CHECKED IS BEING
CHALLENGED.
IS UNDER ACTIVE THREAT.
WHETHER IT'S THROUGH THE
REPEATED REPEAL A TIMES LAST
YEAR AND AND POTENTIALLY FUTURE
ONES AND THE CONGRESS.
THE MORE RECENT SUCCESSFUL
EFFORT TO REPEAL THE INDIVIDUAL
MANDATE.
THE LOSS OF THE COST SHARING
SUBSIDIES ON WHICH THE TRUMP
ADMINISTRATION POLL LAST YEAR.
AS WELL AS RECENT EFFORTS.
BY THE TRUMP ADMINISTRATION TO
ENCOURAGE THE EXPANSION AND SALE
OF ALTERNATIVE INSURANCE PROJECT
PRODUCTS THAT DON'T HAVE TO
COMPLY WITH THE AFFORDABLE CARE
ACT THERE SIMPLY UNDER WRITTEN
BECAUSE THEY CAN.
DENY.
POLICIES TO STICK
PEOPLE ALL OF THOSE ISSUES ARE
STARTING TO FRAY DIED.
BARGAIN AND AND CAUSING.
MANY INSURERS THAT ARE
PARTICIPATING IN THE MARKETPLACE
IS TO WONDER WHETHER THAT THE
FEDERAL GOVERNMENT REMAIN
A TRUSTED PARTNER.
THAT'S AND I THINK IT'S
IMPORTANT TO KNOW THAT STATE
LEVEL DECISIONS REALLY DO MATTER
I'M CALIFORNIA'S A GREAT EXAMPLE
OF THAT.
WITH ROBUST PUBLIC OUTREACH AND.
ENROLLMENT CAMPAIGNS EARLY
DECISIONS THAT REALLY LIMITED
SOME OF THE.
.
CHALLENGES THAT SOME EXCHANGES
ARE FACED WITH.
SICK OR OVERLY SICK POPULATIONS.
AND COVERED CALIFORNIA'S ACT OF
PURCHASING MODEL OVERALL
CALIFORNIA IS IN MUCH BETTER
SHAPE THAN STATES WITH THE
FEDERALLY RUN MARKETPLACES AND
ALSO JUST A FEW INDICATORS OF
THOUGHT SO. THIS SLIDE SHOWS ON
PLAN PARTICIPATION IN THE
FEDERALLY FACILITATED
MARKETPLACE IS OUR FF I'M
COMPARED TO COVERED CALIFORNIA.
BETWEEN TWENTY FOURTEEN AND
TWENTY EIGHTEEN YOU'LL SEE
CALIFORNIA AND TWENTY FOURTEEN
HAVE ELEVEN CARRIERS AND AND
TWENTY EIGHTEEN HAVE ELEVEN
CARRIERS. FOR THE ALPHA FOUND
THAT AVERAGE JUST SLIPPED FROM
FIVE CARRIERS PER STATE TO
THREE.
AND FORTY EIGHT PERCENT OF
COUNTIES NATIONWIDE HAVE JUST
ONE INSURER PARTICIPATING.
NOW I WOULD SAY THIS REMARKABLE
STABILITY THAT WE SEE IN COVERED
CALIFORNIA DOES MASK SOME EXITS
AND ENTRANCES WAS AYE UNITED
HEALTHCARE LEAVE EARLY ON AN
OSCAR COMMAND. IT ALSO MASKS
SOME BIG REGIONAL CHANGES ON FOR
EXAMPLE THE RECENT RETRENCHMENT
OF BOTH ANTHEM AND HEALTH.
NOT TO TAKE A MOMENT HERE AND
DRILL DOWN A LITTLE BIT IN THE
PLAN CHOICE THAT COVER
CALIFORNIA ENROLLEES HERE ARE
FACING AND I'D LIKE TO. THANK
AND ACKNOWLEDGE THAT CALIFORNIA
HEALTHCARE FOUNDATION AND THE
WORK OF.
ONE OF THEIR ANALYSTS KATY
WILSON WHO REALLY HELPED ME PULL
AND ANALYZE SOME OF THIS DATA.
BUT I THINK WHAT YOU'RE SEEING
HERE WITH THIS THIS SLIDE IS.
THAT FOR THE FIRST TIME IN
TWENTY EIGHTEEN ABOUT FIVE
PERCENT OF COVERED CALIFORNIA
AND COVERED CALIFORNIA
ENROLLEES.
ONLY HAVE ONE INSURER TO CHOOSE
FROM.
AND THERE'S BEEN A DECLINE FROM
ALMOST HALF OF COVERED
CALIFORNIA ENROLLEES HUMMING
SIR MORE INSURER OPTIONS TO JUST
TWENTY FIVE PERCENT HAVING SIX
OR MORE OPTIONS.
AND THIS SLICES SHOWS A.
AT A LITTLE BIT HOW THE
POPULATION IS AFFECTED BY THIS.
AND I APOLOGIZE FOR THE VERY
SMALL FONT.
BUT HOPEFULLY YOU CAN SEE THAT.
IT'S RELATIVELY FEW ENROLLEES
IN THESE AREAS WITH FEWER
CHOICES SIXTY SIX THOUSAND.
COVER CALIFORNIA ENROLLEES HAVE
ONE CARRIER.
WITH THOSE THAT EFFECT
CONCENTRATED IN IN MONTEREY
SANTA BARBARA SAN LUIS OBISPO
YOU COMPARE THAT WITH.
MORE POPULATED AREAS SUCH AS
LOS ANGELES COUNTY ON RETAINING
A PRETTY ROBUST CHOICE OF
INSURERS.
OF COURSE ANOTHER IMPORTANT
INDICATOR OF A MARKETS HEALTH
OUR PREMIUM TRENDS.
AND HERE AGAIN COVER CALIFORNIA
IS DOING PRETTY DARN WELL.
YOU'LL SEE HERE THAT THE
AVERAGE PREMIUM GROWTH IN THE
FEDERALLY FACILITATED
MARKETPLACE VERSUS COVERED
CALIFORNIA.
IN BOTH PLACES BETWEEN TWENTY
FOURTEEN AND TWENTY FIFTEEN
STARTED BETWEEN SORT OF THREE
AND FOUR PERCENT.
ENROLLMENT I'M SORRY PREMIUM
GROWTH.
BUT BY TWENTY EIGHTEEN.
THE PREMIUM GROWTH IN THE ITEM
WAS THIRTY SEVEN PERCENT WARS
AND COVERED CALIFORNIA WAS JUST
TWELVE POINT FIVE PERCENT. AND I
THINK THAT REALLY DOES BEGAN
POINT TO SOME OF THE STRONG
POLICY DECISIONS ON THAT THE
STATE MADE EARLY ON.
AS WELL AS ALONG THE WAY. OF
COURSE AND A AS WITH EVERYTHING
IN HEALTHCARE YOU'VE TO DRILL
DOWN A LITTLE BIT.
THESE AVERAGES THE STATE WIDE
AVERAGES DO YOU MASK IMPORTANT
REGIONAL VARIATIONS.
SO FOR EXAMPLE MUCH BIGGER
PREMIUM INCREASES IN THE
NORTHERN COUNTIES.
THIRTY THREE PERCENT BETWEEN
SEVENTEEN TO SEVENTEEN AND
EIGHTEEN COMPARED MUCH LOWER.
INCREASES IN MORE URBAN AREAS
LIKE SACRAMENTO AND SAN FRAN.
SO WHAT'S DRIVING INSURER
DECISIONS HERE AND WE HAD AN
OPPORTUNITY TO GO
OUT IN THE FIELD LAST YEAR AN
INTERVIEW A WIDE RANGE OF
ENSURE.
BENEATH ABOUT WHAT.
WAS CAUSING THEM TO NO LONGER
PARTICIPATE OR TO CONTINUE
PARTICIPATING IN THE MARKET
PLACES AROUND THE COUNTRY.
AND AT THE FIRST THING WOULD
JUST SAY IS THAT INSURERS HERE
ARE NOT MONOLITHIC IN THEIR
APPROACH TO A LARGE NATIONAL FOR
PROFIT CARRIER LIKE UNITED. IS
LIKELY TO HAVE A VERY DIFFERENT
APPROACH THAN A REGIONAL
NONPROFIT WHICH AGAIN MIGHT HAVE
A DIFFERENT APPROACH THAN OF
FORMER MEDICAID ONLY PLAN OR AT
THE BLUE CROSS BLUE SHIELD
CARRIERS. AND THEY'RE OF COURSE
REGIONAL DIFFERENCES ON IN MANY
STATES THE BLUE CROSS BLUE
SHIELD PLAN IS THE BACKBONE OR
IN MANY CASES THE ONLY CARRIER
ON THE EXCHANGE.
BUT IN OTHER STATES SUCH AS
IOWA THE BLUE CROSS PLAN NEVER
SERIOUSLY CONSIDERED
PARTICIPATING BUT WE DID PICK UP
ON SOME I THINK IMPORTANT
THEMES.
AREN'T NUMBER ONE.
FOR.
CARRIERS NETWORK NETWORK NIGHT
MY NETWORK BUILDING AND
MAINTAINING THAT PROVIDER
NETWORK AT AN AFFORDABLE PRICE
CAN BE VERY CHALLENGING AND
RURAL AREAS.
OFTEN THERE'S ONLY ONE HOSPITAL
SYSTEM OR PROVIDER THERE'S
PROVIDER GROUP.
THAT HAS AN EFFECTIVE MONOPOLY
ON THAT CAN MAKE IT DIFFICULT
FOR THOSE CARRIERS.
AND WE ALSO REALLY HER
DIFFERENCES IN TERMS OF OVERALL
APPROACH TO WE FOUND GENERALLY
THAT CARRIERS THAT PRE A CA
WERE.
STRONGLY COMMITTED TO THE
INDIVIDUAL MARKET OR HAD STRONG.
SHARE IN AND LOW INCOME
POPULATIONS PERHAPS BECAUSE OF
MEDICAID BUSINESS HAVE TENDED TO
STAY COMMITTED TO THE MARKET
PLACES. ON CONVERSELY INSURERS
THAT HAD A SMALL INDIVIDUAL
MARKET PRESENCE BEFORE THE ACA
OR WHOSE BUSINESS MODELS WERE
VERY DEPENDENT ON RISK SELECTION
OUR UNDERWRITING.
HASN'T BEEN MOST LIKELY TO EXIT
THE MARKET.
AND OF COURSE ABILITY TO SET
PREMIUMS ARE PRICE FOR RISK
IS REALLY REALLY CRITICAL AND.
ONE THING ABOUT INSURANCE
COMPANIES IS THERE THAT KIND OF
RISK AVERSE.
IF IF.
IF THAT'S TIME MIGHT SURPRISE
YOU BUT IT'S TRUE.
BUT PRICING FOR RISK IS.
.
CAN BE CHALLENGING IN RURAL
AREAS AND SOME OF THAT IS JUST
THE LACK OF POPULATION DENSITY
SO FOR EXAMPLE THERE IS A COUNTY
IN OHIO THAT. FOR THE LONGEST
TIME THEY COULDN'T GET AN
INSURER TO GO IN THERE THERE
WERE ONLY THREE HUNDRED AND
TWENTY EIGHT.
MARKETPLACE ENROLLEES IN THAT
COUNTY WELL JUST ONE PERSON WITH
HEMOPHILIA OUR A NEO NAY BABY OR
AN ORGAN TRANSPLANT CAN TOTALLY
THROW OFF YOUR ACTUAR THE
ASSUMPTIONS IN YOUR PRICING
STRATEGY.
AND THE RISKS FOR CARRIERS
THERE ARE COMPOUNDED BY THE FACT
THAT THEY HAVE TO SUBMIT THEIR
PREMIUMS FOR REGULATORY REVIEW
CLOSE TO A YEAR BEFORE THEY'RE
ACTUALLY IMPLEMENT IT.
SO THERE'S A LONG LAG TIME
BEFORE THEY THOSE RATES ARE INTO
FACT IN A LOT CAN HAPPEN BETWEEN
WHEN YOU PUT THEM FORWARD FOR
REGULATORY REVIEW AND WHEN YOU
ACTUALLY USE THEM. AND OF COURSE
THAT'S ONLY MADE MORE DIFFICULT
AND AND POLICY ENVIRONMENT
THAT'S VERY UNCERTAIN AND THAT
CAN CHANGE ON YOU AT ANY MOMENT
AND THE DECISION OF THE TRUMP
ADMINISTRATION ON THE COST
SHARING SUBSIDIES IS JUST ONE
EXAMPLE OF.
I'M BUT SHOULD WE CARE RIGHT.
WE ULTIMATELY SAW ALL COUNTIES
IN THE COUNTRY COVERED THIS YOUR
I'M AND MAYBE IT'S OKAY IF AN
INSURANCE COMPANY HAS A MONOPOLY
IN A GIVEN AREA ON MAYBE THAT
THAT'S GOOD FOR THEM RIGHT THEY.
CAN SET THEIR PRICES AS HIGH AS
THEY WANT.
BUT IN GENERAL I'M WE SEE THAT
THERE ARE REAL BENEFITS FOR
CONSUMERS WHEN OUR PLAN CHOICES.
CERTAINLY FIRST AND FOREMOST
AFFORDABILITY AND WE'LL SEE AND
I'LL SHOW YOU IN A COUPLE MORE
SLIDES MORE INSURERS MEANS.
LOWER PRICES
ALSO AT LEAST IN THEORY.
IT KNOWING THAT YOUR CUSTOMERS
CAN VOTE WITH THEIR FEET EVERY
YEAR PROMISE INSURERS TO PAY
MORE ATTENTION TO CUSTOMER
SERVICE AND IMPROVE QUALITY.
BUT THERE ARE ALSO RISKS.
THE WAY THE MARKET PLACES ARE
STRUCTURED.
YOU TO MAINTAIN THE VALUE OF
YOUR PREMIUM TAX CREDIT
CONSUMERS HAVE TO SHOP AND THEY
HAVE TO SHOP EVERY SINGLE YEAR.
THAT MAKES IT MORE LIKELY
THEY'RE GOING TO SWITCH PLANS
SWITCH NETWORKS BECOME THERE'S
MORE OPPORTUNITY FOR CONSUMER
CONFUSION BENEFIT DESIGN
CHANGES.
ALL THAT CAN AFFECT OVERALL
QUALITY OF CARE AND THE
CONTINUITY OF CARE PARTICULAR
FOR PEOPLE WITH CHRONIC
CONDITIONS.
SO THESE NEXT TWO SLIDES I'M I
HAVE TO GIVE CREDIT TO THE URBAN
INSTITUTE FOR THIS REALLY.
SORT OF DROVE DOWN INTO THE
AFFORDABILITY ISSUE AND THE
IMPACT OF COMPETITION ON
AFFORDABILITY. SO WE'LL JUST SEE
HERE ON THE SHOWS THE AVERAGE
BENCHMARK MONTHLY PREMIUM BY
ENSURE PARTICIPATION SO FOR.
AREAS WITH JUST ONE INSURER THE
AVERAGE MONTHLY PREMIUM IS ABOUT
FOUR HUNDRED AND FIFTY ONE
DOLLARS A MONTH.
BUT IN AREAS WITH SIX OR MORE
INSURERS THAT DROPS TO TWO
HUNDRED AND SEVENTY DOLLARS A
MONTH.
SO MORE CARRIERS TENDS TO MEAN
LOWER PRICES WITH THAT SORT OF
KEY CUT POINT I THINK BETWEEN
TWO AND THREE CARRIERS. AND THIS
SLIDE JUST CLOSE UP SHOWS A
SLIGHTLY DIFFERENT.
ANGLE ON THAT SHOWING MEDIUM
PERCENT SHEEN'S IN THE BENCHMARK
PREMIUM BETWEEN TWENTY SIXTEEN
AND TWENTY SEVENTEEN NOW
PREMIUMS WENT UP ACROSS THE
BOARD AND TWENTY. SEVENTEEN BUT
YOU'LL SEE THAT.
AREAS WITH JUST ONE ENSURE HAD
AVERAGE PREMIUM INCREASES OF
THIRTY PERCENT.
WHEREAS.
IT COUNTIES WITH ONLY WITH SIX
OR MORE CARRIERS HAD INCREASES
OF ONLY FIVE PERCENT.
SO IS WE LOOKED ACROSS THE
STATES CONFRONTING.
CHALLENGES WITH SINGLE ISSUE
ARE BARE INSURER COUNTIES.
WE REALLY SAW A WIDE RANGE OF
STATE ACTIONS.
AND.
AND THAT'S WITHOUT ALONG A
CONTINUUM FROM.
MORE GOVERNMENT.
FOCUSED ACTIONS SUCH AS OUR
MEDICAID BUY IN LEGISLATION IN
NEVADA AND MINNESOTA TO.
REQUIREMENTS DIED ON TO AND
COMPANIES THAT IF YOU'RE GONNA
PARTICIPATE IN THE STATE
MEDICAID PROGRAM OR THE STATE
EMPLOYEES BENEFIT PROGRAM YOU.
HIDE TO PARTICIPATE IN THE
MARKETPLACE AND A NUMBER OF
STATES DID IT TOOK ON A NUMBER
OF REGULATORY.
EFFORTS TO MITIGATE THE RISK
FOR CARRIERS.
TO FOR EXAMPLE WASHINGTON AND
HAS BEEN BE LOOKING AT THEIR
OPERATING AREAS OHIO ALLOWED
CARRIERS TO DROP GOLD LEVEL
PLANS.
IOWA GAVE CARRIERS ACCESS TO
PREMIUM DATA THERE WERE A NUMBER
OF ACTIONS THAT STATES HAVE
TAKEN TO TRY TO MAKE THIS RISKY
SITUATION LAST RISKY
CARRIERS.
OHIO GAVE INSURERS MORE
FLEXIBILITY AND NETWORK DESIGN
AND OTHERS OF COURSE JUST USED
POLITICAL OR MORAL PRESSURE
WHICH WORKED FOR TWENTY EIGHTEEN
THAT MAY BE ON LESS SUSTAINABLE
LONG TERM.
WITH THAT I WILL CLOSE IN THE
FIRST YEAR QUESTIONS.
YOU VERY MUCH.
OUR NEXT SPEAKER MISTER PERRIN.
SHE'S.
A LOT OF TABS HERE'S.
MR PERUN IS THE DIRECTOR OF
IMPROVING HELP IMPROVE ACCESS AT
THE CALIFORNIA HEALTHCARE
FOUNDATION WHICH WORKS TO ENSURE
ALL LOW INCOME CALIFORNIANS CAN
GET THE CARE THEY NEED WHEN THEY
NEED NEEDED. CHRIS OVERSEAS A
FOUNDATIONS EFFORTS TO EXPAND
ACCESS TO FOR. TWO FOR BOOK
COVERS TO STRENGTHEN THE
MEDICARE PROGRAM AND FOSTER
DELIVERY SYSTEM TRANSFORMATION
AND WORKFORCE SOLUTIONS THAT
EXPAND THE CAPACITY OF SAFETY
NETWORK INNOVATIONS PROVIDE
TIMELY HIGH QUALITY. AND PATIENT
CENTERED CARE.
A PEROT WHEN YOU'RE READY RIGHT
GOOD AFTERNOON CHAIR WOULD CHAIR
RAMBLE AND MEMBERS OF THE
COMMITTEE. AND THANKS TO THE
INVITATION TO TALK WITH YOU
TODAY ABOUT.
MEDI CAL AND RELEASE ACCESS TO
CARE.
ALSO I WANTED THINK.
THAT COMMITTEE STAFF FOR.
ALL THE WORK YOU DATED IN
HELPING US PREPARE FOR THIS
HEARINGS MUCH APPRECIATED.
AB THE CALIFORNIA HEALTHCARE
FOUNDATION WE BELIEVE THAT ALL
CALIFORNIANS SHOULD HAVE ACCESS
TO COMPREHENSIVE AFFORDABLE
HEALTH CARE COVERAGE.
AND WE'VE BEEN MONITORING ACCESS
TO CARE IN THE MEDICAL PROGRAM
FOR TWO DECADES.
ARE PARTNERING WITH US IN THE
TOP RESEARCHERS HERE IN
CALIFORNIA AS WELL AS
NATIONALLY.
AND A ALSO PARTNER WITHOUT MANY
DIFFERENT PARTNERS IN THE PUBLIC
AND PRIVATE SECTOR TO IMPROVE
ACCESS TO COVERAGE IN CARE. FOR
LOW INCOME CALIFORNIANS.
AND WE'VE ALSO PART IN RECENT
YEARS WITH THE GOVERNMENT HEALTH
CARE SERVICES TO SURVEY.
MEDI CAL ENROLLEES.
AND.
TO DEVELOP DOSH FORCE TO BETTER
MONITOR ACCESS TO CARE.
A LOT FOR MY PRESENTATION TODAY
I'M GOING TO BRIEFLY DESCRIBE A
FRAMEWORK.
FOR HOW WE THINK ABOUT.
ACCESS TO CARE FOR.
FOR ANYBODY REALLY BUT LOW
INCOME POPULATIONS. AND THEN I'M
GONNA SHARE SOME FINDINGS FROM
OUR RESEARCH AND RESEARCH DONE
BY OTHERS.
AND FOCUS ON NON ELDERLY ADULTS
SINCE THEY ARE THE FOCUS OF OUR
EFFORTS TO EXPAND OUR COVERAGE
OF THE REMAINING UNINSURED. WHEN
FOCUS ON CALIFORNIA RESEARCH.
AND.
AND THEN FOCUS ON THE
COMPARISON BETWEEN MEDI CAL.
AND THE UNINSURED AND MEDICARE
I'LL AND.
THE INDIVIDUAL MARKET.
.
SINCE AGAIN.
THINKING ABOUT THE CHOICES THAT
WE HAVE BEFORE US.
I WANNA DISCUSS IT BRIEFLY SOME
KEY PROGRAM FEATURES.
IN THE MEDICARE PROGRAM THAT I
THINK ARE IMPORTANT ADDRESSING
ACCESS TO CARE FOR ANY LOW
INCOME POPULATION.
AND I BRIEFLY SUMMARIZE THE FOR.
PRESENTING SOME OPPORTUNITIES
FOR IMPROVEMENT.
SO AS WE THINK ABOUT DIFFERENT
WAYS.
TO MEASURE.
ACCESS TO CARE.
WE WORKING WITH RESEARCHERS AT
MATHEMATICA POLICY RESEARCH
ABOUT THIS FRAMEWORK.
LOOKS AT THREE AREAS POTENTIAL
ACCESS ON WHERE THE
CHARACTERISTICS OF OUR COVERAGE
SYSTEM IN OUR HEALTH CARE TO
LEASE THE RELEASE SYSTEM ARE
THEY PROMOTING. A ACCESS TO
CARE.
REALIZE ACCESS WITH THE ACTUAL
EXPERIENCE OF PEOPLE AND THEN
FINALLY HEALTH OUTCOMES.
WHEN WE START AT THE TOP SOME
OF THOSE ARE THE MOST THE
EASIEST MEASURES TO COLLECT
THESE DATA TO COLLECT AND OFTEN
THE MOST DIRECTLY ATTRIBUTABLE
TO THE POLICY CHOICES THAT WE
MAKE. AS WE WORK FARTHER DOWN
THIS LIST.
YOU GET INTO A NUMBER OF
COMPLEXITIES IN TERMS OF
ATTRIBUTION BOTH TO THE POLICY
DECISIONS AND ALSO.
THE COMPLEXITIES OF BOTH
MEASUREMENT AND THE DIFFERENCES
IN YEAH I DEFER POPULATIONS
AND DISCUSS AND IT ON ALL THREE
ELEMENTS.
BEFORE A GETTING STARTED IN
THIS CAME UP IN THAT.
QUESTION AND AND A QUESTIONS TO.
TO LARRY LEVAN ABOUT.
MEDICARE POPULATIONS ANOTHER
POPULATIONS THERE ARE IMPORTANT
DIFFERENCES IN THE POPULATIONS
ACROSS DIFFERENT COVERAGE TYPES.
AND NEEDS HAVE AS VERY
IMPORTANT LOCATIONS FOR WHAT WE
SEE IN THE ACCESS DATA.
SO WHEN WE COMPARE MEDI CAL.
ENROLLEES TO THOSE WITH PRIVATE
COVERAGE WE COMPARE THEM TO THE
ENSURE ITS REALLY IMPORTANT
UNDERSTAND THAT WE'RE NOT
COMPARING APPLES TO APPLES.
AND.
WE CAN DIED A LITTLE DEEPER
INTO THAT.
ONE THER THING TO MENTION IS
THAT.
MIGHT IN MY PRESENTATION I AM
NOT GOING TO TALK ABOUT CHILDREN
FOR THAT PART PARTLY FOR THAT
REASON I MENTION BEFORE WHERE
ARE THE REMAINING UNDERSHIRT
ARE.
PREDOMINANT DEALT IN FACT NINETY
PERCENT OF CHILDREN HERE IN
CALIFORNIA.
ARE COVERED I THINK A LARGE
PART TO A NUMBER OF MEDI CAL
EXPANSIONS. ON BUT WHAT I WOULD
SAY ABOUT CHILDREN IS THAT THE
RESEARCH.
GENERALLY SHOW THAT CHILDREN
AND MEDI CAL.
THEIR EXPERIENCE OF ACCESS IS
SIMILAR TO CHILDREN WITH
EMPLOYER SPONSORED INSURANCE.
AND TENDS TO BE MUCH BETTER
THAN ADULT MEDI CAL ENROLLEES.
WE HAVE SPECIAL PROTECTIONS FOR
CHILDREN INCLUDING THE EARLY AND
PERIODIC SCREENING DIAGNOSIS AND
TREATMENT REQUIREMENTS. WE HAVE
SPECIAL HIGHER PAYMENT RATES FOR
SPECIALTY CARE AND THE
CALIFORNIA CHILDREN'S SERVICES
PROGRAM.
SO THERE'S A NUMBER OF
CONCEIVING FACTORS TO THE FACT
THAT CHILDREN.
ENJOY BETTER ACCESS THAN.
ADULTS IN THE MEDICARE PROGRAM.
IN THE LAST TWO YEARS.
HOWEVER WE HAVE SEEN.
AS SURPRISING RISE IN THE
SHERIFF.
PARENTS REPORTING DIFFICULTY
FINDING SPECIALISTS
UP FOR THEIR CHILDREN.
WE ARE FORTUNATE D. H. YES IT'S
CREATED A NEW DASHBOARD. TO
MONITOR CHILDREN'S ACCESS TO
HEALTH.
IN IT SHOWS MIXED PICTURE
STEADILY INCREASING UTILIZATION
MENTAL HEALTH SERVICES.
BUT OPPORTUNITIES TO IMPROVE
ACCESS TO AND USE OF DENTAL
SERVICES AND SOME DECLINES IN
QUALITY OF CARE OVER TIME SO I
IMPORTANT POPULATION BUT WON'T
BE THE FOCUS OF THE REMAINDER OF
MY PRESENTATION.
AT THE CALIFORNIA HEALTHCARE
FOUNDATION WE HAVE BEEN
FORTUNATE WORK WITHOUT DOCTORS
ANY BY MEN AND DR AGENDA KAUFMAN
TO.
TRACK OVER ABOUT TWO DECADES
PHYSICIAN PARTICIPATION IN THE
MEDICARE PROGRAM USING A.
HE'S. DEAD AND WE END WITH THE
MEDICAL BOARD OF CALIFORNIA
USING A SUPPLEMENTAL SURVEY THE
PHYSICIANS ARE ASKED TO COMPLETE
WHEN THEY RENEW THEIR LICENSES
AND IT GIVES US A UNIQUE
INSIGHT.
INTO PHYSICIAN PARTICIPATION IN
THE PROGRAM SOMETHING THAT
FRANKLY WHEN WE TALK ABOUT THIS
IN OTHER AT NATIONAL CAN
BEATINGS OTHER STATES ARE REALLY
QUITE JEALOUS OF.
NOT WHAT WE FIND.
FROM THIS WORK IS THAT ABOUT
SIXTY FOUR PERCENT OF MEDI CAL
ISCHEMIA PHYSICIANS CALIFORNIA
PARTICIPATE IN THE MOAT AND AND
MEDICARE PROGRAM AND SIXTY
PERCENT. ACCEPTING NEW PATIENTS
AND AS YOU CAN SEE THAT'S ARE
QUITE A BIT LOWER THAN IT IS FOR
OTHER FORMS OF INSURANCE AND
QUITE A BIT ABOVE TO
PARTICIPATION IN SERVING THE
UNINSURED.
I DOCTOR COFFIN ENTER TEAM IN
THE LATEST SURVEY HAVE ALSO
FOUND THAT. THE RATIO OF
PHYSICIANS.
TWO ENROLLEES
IS.
IN TWO THOUSAND AND FIFTEEN IS
BELOW NOT ONLY NATIONAL
GUIDELINES BUT ALSO THE
DEPARTMENT'S OWN STANDARDS FOR
ITS MANAGED CARE PLANS.
SO WE DON'T HAVE ENOUGH
PHYSICIANS TO SERVE THE MEDI CAL
POPULATION ACCORDING TO THE
STATE'S OWN STANDARDS.
I DO WANT TO ACKNOWLEDGE THAT
DISPOSITION SUFFER PORTED DATA.
THAT IN SOME REPORTED DATA IN
GENERAL HAS ITS LIMITATIONS ARE
WE HAVE EXAMINED A NUMBER OF
OTHER WAYS TO TRACK POSITION
PARTICIPATION THE PROGRAM
INCLUDING FROM.
I DRUG CLAIMS AND MEDICAL CLAIMS
AND FOUND THIS TO BE A SUPERIOR
METHOD.
A FROM THE SAME SURVEY WE ASKED
POSITIONS.
WHY THEY DO NOT PARTICIPATE
MORE IN THE MEDICARE PROGRAM AND
WE FOUND THAT THE NUMBER ONE
REASON? THAT PUBLIC TO NO ONE'S
SURPRISE HIS PAYMENT.
BUT THEY GET A NUMBER OF OTHER
REASONS AS WELL AND WHEN WE TALK
WITH.
PHYSICIANS PARTICIPATING IN THE
SAFETY NET ONE OF THE THINGS
THAT WE OFTEN HEAR IS A CONCERN
OF THEIRS PROTECTING AMONG
PRIMARY CARE PHYSICIANS. IS THE
DIFFICULTY THEY HAVE REFERRING
PATIENTS TO SPECIALTY CARE.
IT'S ESPECIALLY CARE IS A
PARTICULAR CHALLENGE FOR MEDI
CAL ENROLLEES.
ONE OF THE BENEFITS WE HAVE IN
CALIFORNIA IS THE CALIFORNIA
HEALTH INTERVIEW SURVEY.
AS A GENERAL POPULATION SURVEY
CONDUCTED ANNUALLY AND.
IT ALLOWS US SOME VERY ROBUST.
COMPARISONS BETWEEN DIFFERENT
POPULATIONS INCLUDING MEDICAL
POPULATIONS KNOWS WHAT OTHER
SOURCES OF COVERAGE.
AND HERE A FEW SLIDES TO
COMPARE ACCESS TO CARE FOR MEDI
CAL ENROLLEES TO OTHER PAYERS
AND WE SEE THAT ACCESS TO CARE
FOR ADULTS MEDI CAL ENROLLEES.
IS GENERALLY COMPARABLE TO
ADULTS IN THE INDIVIDUAL MARKET
AND CERTAINLY MUCH BETTER THAN
THE UNINSURED.
ONE KNOW WHERE THE FINING
REFLECTED IN THAT CHART IN THE
UPPER LEFT IS THAT MEDI CAL
ENROLLEES ARE. JUST AS LIKELY TO
HAVE THE USUAL SOURCE OF CARE.
AS THOSE WITH COVERS TO THE
INDIVIDUAL MARKET THE WHERE THEY
GET THEIR CARE IS DIFFERENT AS
YOU CAN SEE THE MAJORITY OF MEDI
CAL ENROLLEES SAY THEY GET THEIR
CARE FROM HELL CENTER CLINIC.
RIZZI MAJORITY OF THOSE IN THE
INDIVIDUAL MARKET GET THEIR CARE
CITY GET THEIR KAREN ADOPTERS
OFFICE.
AND THIS IS CONSISTENT WITH SOME
DATA THAT WE'VE.
HOW FROM MEDICARE MANAGED CARE
PLANS THAT SAY FORTY PERCENT OF
THEIR MEMBERS?
GET THEIR CARE FROM FEDERALLY
QUALIFIED HEALTH CENTERS ARE
LOOKALIKES.
AND FIFTY PERCENT OF THE NEW
NEWLY ENROLLED MEDI CAL MEMBERS.
UNDER THE AFFORDABLE CARE ACT.
NOW USING.
THAT CALIFORNIA HEALTH SURVEY
AYE INTERVIEW DATA AGAIN.
LOOKING AT.
TAKING A CLOSER LOOK AT SOME OF
THE ACCESS WE SEE THAT ADULTS.
AND RELEASE ARE LESS LIKELY TO
FOR GARE FORIT FOR GO CARE. DUE
TO COST.
BUT HAVE MORE DIFFICULTY
GETTING TIMELY CARE.
SO WITH THAT SURVEY ASKED PEOPLE
WHY WHETHER THEY FORGO CARE AND
WHY THEY FOR GEAR FORGO CARE AND
YOU CAN SEE THAT OTHER REASONS
ARE QUITE DIFFERENT AND WE'RE
GONNA GET INTO THOSE.
IN JUST A BIT.
ANOTHER LOOK AT THIS ISSUE OF
TIMELY ACCESS IS FROM A STUDY
DONE IN SACRAMENTO BY DOCTOR
JOINED ON THE COUNTER TEAM UC
DAVIS.
USING A SECRET SHOPPER APPROACH
THEY CALL THE OFFICES OF
PHYSICIANS LISTED IN MEDI CAL
HEALTH PLAN PROVIDER DIRECTORIES
AS ACCEPTING NEW PATIENTS.
THE BLUE BARS SHOW THE PERCENT
OF PHYSICIANS WHO HAD ANY
AVAILABLE APPOINTMENT.
OFFER A NEW PATIENT.
IN SOME COUNTIES ONE HALF OF
THOSE CONTACTED SAID THEY HAD AN
AVAILABLE APPOINTMENT WELL IN
OTHER AREAS AS FEW AS ONE IN
FOUR PHYSICIANS. HAD AN
AVAILABLE PLANE AGAIN ONLY
PHYSICIANS WHO SAID THEY WERE
ACCEPTING NEW PATIENTS WERE
CONTACTED AS PART OF THE STUDY.
THE ORANGE BAR SHOWS WHAT
HAPPENS WHEN THOSE SAME POSITION
OFFICES WERE ASKED WHETHER. THEY
HAD ANY APPOINTMENT WITHIN TEN
DAYS.
WITH ANY PROVIDER IN THE
PRACTICE
SO THE FIRST QUESTION WAS JUST
ASKING ABOUT A PARTICULAR
PROVIDED IT WAS JUST IN THE
PROVIDER DIRECTORS ACCEPTING
PATIENTS THE SECOND QUESTION
SAYING. ANY PROVIDING A PRACTICE
CAN I GET IN WITHIN TEN DAYS
WHICH IS.
STATE STANDARD FOR PRIMARY CARE.
IN MOST CASES THE VALUE DROPS
DRAMATICALLY INDICATING THE
POSITIONS CANNOT MEET THIS I
NEED IN A TIMELY MANNER.
AND ONE COUNTY YOU BUT THAT THAT
PERCENT ACTUALLY RISES. A THIS
REFLECTS THAT IN SOME CASES.
EVEN THOUGH THE ORIGINAL
PHYSICIAN MAY NOT HAVE AN
INVALID VALVE APPOINTMENT
ANOTHER PHYSICIAN TO PRACTICE.
DOES.
EMERGENCY ROOM USE IS CERTAINLY
A HOT TOPIC IN MEDI CAL.
ONE THAT PEOPLE PLAY CLOSE
SCRUTINY TO AND PART BECAUSE IT
CAN OFTEN BE A SIGNAL OF POOR
ACCESS AND.
AND ALL AND ALSO BECAUSE OF ITS
HIGH COST.
NOT THESE FIGURES SHOWN ON THIS
PAGE REFLECT THE PERCENT OF
PEOPLE BY COVERS TYPE THAT
VISITED D. E. D.. AT LEAST ONCE
IN THE PAST YEAR. AND AS YOU CAN
SEE MEDI CAL ENROLLEES RECEIVED
SIGNIFICANTLY MORE LIKELY TO
VISIT THE E. D. THAN THOSE WHAT
OTHER SOURCES OF COVERAGE.
AND ALSO MORE LIKELY THAN THE
UNINSURED WHO OFTEN AVOID ANY
TYPE OF COSTLY CARE.
A CLOSER LOOK AT THE AD THAT TO
DATE HOWEVER REVEAL THAT THESE
DIFFERENCES ARE LARGELY A
REFLECTION OF DIFFERENCES IN THE
POPULATIONS.
SO WHEN WE LOOK AT JUST THOSE
UNFAIR POOR HEALTH WE SEE THAT
GAP BETWEEN MEDI CAL AND THESE
OTHER.
PAYERS SHRINK AND WE CONTROL
FOR BOTH. A HEALTH STATUS IN
DISABILITY WE SEE THE GAP.
.
SHRINK EVEN FURTHER SO
OFTENTIMES THE DIFFERENCES THAT
WE SEE IN ACCESS ARE NOT SO MUCH
A FUNCTION OF THE PROGRAM BUT OF
THE POPULATIONS THEY SERVE IN
THE VARIETY OF CHALLENGES THEY
FACE IN THEIR LIVES.
I DECIDED CHARTS.
WHICH LOOKS AT JUST THE MEDICAL
POPULATION TOUCHES ON A SIMILAR
ISSUE. YOU CAN SEE THAT AMONG
THE MEDICARE POPULATION WITHIN
THE MEDICAL PROPOSITION THERE A
WIDE DIFFERENCES IN THEIR
EXPERIENCES GETTING ACCESS TO
CARE. THIS IS NO BY NO MEANS A
COMPREHENSIVE LOOK AT THIS
ISSUE.
BUT IT DOES HIGHLIGHT THAT.
THAT THE PROGRAM IS SERVING
DIFFERENT ENROLLEES IN DIFFERENT
WAYS.
BOTH IN TERMS OF THEIR
CHARACTERISTICS AND AND ALSO
GEOGRAPHICALLY.
SINCE NINETY PERCENT MEDI CAL.
AND RELEASE ARE NOW SERVE TO
MANAGED CARE PROGRAM I THOUGHT
TO BE INTERESTING SPENT LITTLE
TIME ON USELESS AND LITTLE TIME
ON THE MANAGED CARE PROGRAM. OF
THIS FIRST SLIDE COMES FROM THE
DEPARTMENT HEALTH CARE SERVICES'
OWN MEDI CAL MANAGED CARE
PERFORMANCE DASHBOARD. THOUGHT
AND IT SHOWS THE TREMENDOUS
VARIATION IN PERFORMANCE.
ACROSS MANAGED CARE PLANS IN
MEDI CAL.
THAT THE NAMES OF THE PLANS ARE
PROBABLY TOO SMALL TO SEE BUT I
HOPE THE MAJOR POINT ISN'T LOST.
THAT THERE IS THIS TREMENDOUS
VARIATION.
AND THAT.
WHAT WE SEE ERE IS THAT THERE
ARE SOME PLANS FOR WHOM THAT ARE
PROVIDING EXCELLENT QUALITY OF
CARE? ENOUGH ALL MEDI CAL
ENROLLEES WERE IN PLANS A
PROVIDED THAT LEVEL OF QUALITY
AND ACCESS.
THERE WOULD BE A MUCH GREATER
ACCESS TO PRIMARY AND PREVENTIVE
CARE FOR ALL MEDICAL ENROLLEES.
AGAIN LOOKING AT THE MEDI CAL
MANAGED CARE PROGRAM.
.
MEMBER WALDRON.
REFERRED TO.
THE HE JUST A DATA SET QUALITY
AYE DATA.
THAT IS.
ESTABLISHED BY THE NATIONAL
COMMITTEE FOR QUALITY ASSURANCE.
AND THIS LOOKS AT SIX OF THE
MEASURES THAT THE DEPARTMENT
HAS.
DECIDED TO USE IN WHAT'S CALLED
ITS AUTO ASSIGNMENT ALGORITHM
THIS AS AN OUT OF THIS IS AYE
AYE METHOD BY WHICH THE
DEPARTMENT. TAKES IN RELEASE YOU
DON'T USE A HEALTH PLAN
THEMSELVES.
AND USES TO ASSIGN THOSE
BENEFICIARIES TO A HEALTH PLAN
WHAT ESSENTIALLY MEANS IS THAT
HE'S OF THE SIX MEASURES THAT D.
H. YES WITH THAT STAKEHOLDERS
THAT IS A REALLY KEY MEASURES
FOR US IN TERMS OF MEASURING
QUALITY SITE AYE AMONG THE MANY
MEASURES THAT WE COULD LOOK AT.
THIS IS WHY.
I'M LOOKING AT THE SIX HERE
TODAY. AND WHAT YOU CAN SEE IS
THAT THE QUALITY OF CARE AND
MEDICARE MANAGED CARE IS SIMILAR
TO THE NATIONAL MEDICAID
AVERAGE.
BUT NOT IMPROVING.
AND THERE'S A COUPLE OF OF WAYS
TO LOOK AT THIS.
THIS ISSUE ON THE ONE HAND WE
WOULD HOPE TO SEE CONTINUOUS
IMPROVEMENT IN THE PROGRAM OVER
TIME IN MANAGED CARE.
THAT IS A LARGELY A CHARGE OF
THE PROGRAM. ARE ON THE OTHER
HAND GIVEN THE RAPID GROWTH IN
THE PROGRAM. AT IN THE LAST FEW
YEARS.
IT MIGHT BE SOME SMALL COMFORT
COMFORT THERE HASN'T BEEN A
SERIOUS DECLINING QUALITY THERE
CERTAINLY BEEN CALLS AND
QUESTIONS ABOUT WHETHER OR NOT.
MEDICAID PROGRAMS NATIONALLY CAN
HANDLE BOTH THE TRADITIONAL
MEDICAID POPULATION EXPANDED
POPULATION AND THE STATE IT
WOULD SUGGEST THAT THE QUALITY
OF CARE HAS NOT DETERIORATED FOR
MEDI CAL DURING THIS PERIOD BY
MARCH.
I WANTED TO ALSO MENTION THE
PUBLIC PLANS PLAY A VERY UNIQUE
ROLE IN THE MEDICARE PROGRAM. A
YOU CAN SEE THE EIGHT REPRESENT
THE THREE.
BLUE R. BLUISH LIKE SEGMENTS OF
THIS.
THIS CHART HERE SO THEY ACCOUNT
FOR MAJORITY OF THE MEMBERS.
BUT EVEN MORE THAN THAT WHEN WE
COMPARE THE PERFORMANCE OF THE
PUBLIC PLANS TO THE COMMERCIAL
PLANS PARTICIPATING IN MEDICARE
I'LL. IN THOSE COUNTIES.
WHERE THERE ARE BOTH KINDS OF
PLANS I GENERALLY THE PUBLIC
PLANS PERFORM BETTER AND WHEN WE
HAVE LOOKED TO SEE WHAT
INVESTMENTS?
A HEALTH PLANS ARE MAKING IN
THEIR COMMUNITIES TO IMPROVE
THEIR DELIVERY SYSTEMS GENERALLY
WHAT SERVICES IS A LARGE
INVESTMENTS BY PUBLIC PLANS THIS
IS NOT UNIVERSALLY TRUE.
SOME PLANS ARE TAKING A MORE
ACTIVE ROLE THAN OTHER BUT
GENERALLY SPEAKING IT'S FAIR TO
SAY THAT THE PUBLIC PLANS ARE
ARE TAKING A DEEPER AND LONGER
TERM INVESTMENTS IN THEIR
COMMUNITIES.
SO I WANT TO MENTION SEVERAL
FEATURES OF MEDI CAL THAT ARE
INTENDED TO PROMOTE BETTER
ACCESS BECAUSE I THINK THIS IS
IMPORTANT CONSIDERING. ANY TYPES
OF COVERAGE OPTIONS THAT YOU
GIVE TO LOW INCOME CALIFORNIANS.
THE FIRST IS THAT MEDICAID IS A
VERY EXPANSIVE BENEFIT.
INCLUDING DENTAL COVERAGE AND
TRANSPORTATION SERVICES.
THAT HAS NO OR LOW PREMIUMS AND
COST SHARING.
THERE ARE NUMEROUS LEGAL AND
ADMINISTRATIVE PROTECTIONS FOR
MEDI CAL ENROLLEES I MENTIONED
THE EPT AT EP STT REQUIREMENTS
BEFORE.
THERE ARE HIGHER PAYMENTS FOR
SELECTED PROVIDERS.
UNDER THE CALIFORNIA CHILDREN'S
SERVICES FOR ATHLETIC QUALIFIED
HEALTH CENTERS FOR EXAMPLE. AND
THEN THERE'S UNIQUE ENROLLMENT
OPTIONS SO THERE'S YEAR ROUND
ENROLLMENT IN MEDI CAL.
WHICH IS SOMETHING THAT IS NOT
AVAILABLE ON THE INDIVIDUAL
MARKET OR THROUGH EMPLOYER
SPONSORED INSURANCE.
I ALSO WANTED TO MENTION THE
MOST MEDI CAL ENROLLEES HAVE A
POSITIVE PERCEPTION OF THE
PROGRAM SO DESPITE. MANY OF THE
CHALLENGES WHEN YOU ASK
BENEFICIARIES ABOUT THEIR
EXPERIENCE. IN GENERAL THEY SAY
IT'S GOOD.
WHEN YOU ASK THEM ABOUT THE
PERCEPTION THAT IT CAL MOST SAY
IT'S EITHER A VERY GOOD PROGRAM.
OR PRETTY GOOD PROGRAM.
NOW THIS WAS A SURVEY THAT WAS
DONE BEFORE THE AFFORDABLE CARE
ACT WAS ENACTED BEFORE THE
EXPANSION.
WE DID THIS SURVEY IN
PARTNERSHIP WITH THE DEPARTMENT
HEALTH CARE SERVICES WE WOULD.
APPRECIATE THE OPPORTUNITY TO
DO IT AGAIN I'D LOVE TO PARTNER
WITH THEM TO DO THAT.
BUT SO FAR HAVE NOT HAD THE
OPPORTUNITY TO DO SO.
BUT DISS.
WAS A STATE WAS A STATE OF THE
ART SURVEY THAT LOOKED ACROSS A
LOT OF THE SURVEY DATA AND THAT
IT CAL AND RELEASE FOCUSES ONLY
ON THE MANAGED CARE POPULATION
IN THIS LOOKED AT BOTH A MEDIC.
THE MANAGED CARE AND THAT AND
THE FEE FOR SERVICE POPULATION
WHICH IS IMPORTANT BECAUSE THE
FEE FOR SERVICE POPULATION
INCLUDES.
A LOT OF SENIORS PEOPLE
DISABILITIES WHO REQUEST TO
RECEIVE MEDICAL EXEMPTIONS.
SO THIS IS JUST A SUMMARY OF THE
FINDINGS.
IN THE INTEREST OF TIME I WON'T
REPEAT THEM HERE.
BUT.
I WILL ADD THAT WHILE MEDI CAL
DOES FACE SOME BIG CHALLENGES
AND MEDICAL AND RELEASE ARE
CERTAINLY MUCH BETTER OFF.
BECAUSE OF THE PROGRAM.
AND THEN I WANTED TO LEAVE WITH
SOME IDEAS FOR IMPROVING ACCESS.
.
THE FIRST IS THAT THERE'S
CLEARLY AN OPPORTUNITY TO
IMPROVE HEALTH PLAN PERFORMANCE
AND ONE SIMPLE IDEA. IS TO THAT
COULD HAVE GREAT IMPACT IS TO
PAY THEM DIFFERENTLY.
FOR EXAMPLE EXAMPLE JUST AS MANY
MEDI CAL HEALTH PLANS.
PAY THEIR PROVIDERS WITH A PAY
FOR PERFORMANCE BONUS AND WE
COULD DO THE SAME IN THE STATE
PAYING HEALTH PLANS MORE THAT
ARE IMPROVING. QUALITY AND
ACCESS
PERFORMING BETTER AND PAYING
THOSE LAST THE DOWN.
A SECOND IS TO ENCOURAGE PLANS
TO EXPAND ACCESS TO TELEHEALTH.
THE PUBLIC HEALTH CARE SYSTEMS
IN SAN FRANCISCO AND LOS ANGELES
HAVE USE ELECTRONIC
CONSULTATIONS AND REFERRAL
SYSTEMS WITH GREAT IMPACT.
REDUCING UNNECESSARY SERVICES
AND VISITS TO SPECIALISTS THAT
COULD BE AVOIDED.
AND CUTTING OFFMONTHS OF
WAITING TIMES FOR THOSE THAT
NEEDED SPECIALTY CARE.
SIMILARLY LIVE VIDEO AND STORED
FOR TELEHEALTH R. CONNECTING
BOTH RURAL AND URBAN. PIPED UP
PROVIDERS WITHOUT SPECIALISTS.
AND IMPROVING ACCESS TO THOSE
AREAS ARGUABLY ANY PLANET
SERVING AND.
RURAL POPULATION OR RECEIVING
AN EXEMPTION FROM THE NETWORK
ADEQUACY A TIMELY ACCESS GENDER
SHOULD HAVE A ROBUST TELEHEALTH
PROGRAM TO BETTER MEET THE NEEDS
OF THEIR ENROLLEES.
A THIRD THROUGH.
ITS WAIVER THE MEDICAL PROGRAM
HAS BEEN INVESTING BILLIONS IN
THE TRANSFORMATION OF CARE
DELIVERY.
SYSTEMS THROUGH THE PUBLIC YOU
SEE AN DISTRICT HOSPITALS.
I IN THE STATES SUBS USED
DELIVERY SYSTEM SUCH EFFORTS TO
BUILD THE CAPACITY.
WE NEED NOW ARE IMPORTANT AYE
IN THE AND NOW IN THE FUTURE AND
SHOULD BE EXPANDED UPON. TIED TO
INCLUDE VALLEY QUALIFIED HEALTH
CENTERS.
FOURTH WE NEED TO INVEST IN
BUILDING A WORKFORCE FOR THE
FUTURE.
ONE THAT EMPHASIZES PATIENTS
CENTER TEAM BASED CARE
ASSEMBLYMAN WOULD AND SENATOR
HERNANDEZ ARE SERVING ON THE
CALIFORNIA FUTURE HEALTH
WORKFORCE COMMISSION AND I HOPE.
THAT THE RECOMMENDATIONS OF
THAT.
COMMISSION WILL BE DISCUSSED IN
ACTED UPON.
AND THEN FIFTY FINALLY FOR ALL
THAT WE DO TO TRACK NETWORK
ADEQUACY TIMELY ACCESS TO HEALTH
OUTCOMES.
WE COULD AND SHOULD DO BETTER
AYE I REALLY ACTUALLY APPLAUD
THE EFFORTS BY THE DIRECTOR
DIRECTOR SHELLEY REGARDED HER
TEAM TO ADVANCE BETTER
MEASUREMENT. OF ACCESS AND BRING
GREATER TRANSPARENCY.
THIS WORK SHOULD.
CONTINUING BE EXPANDED UPON.
THANKS FOR THIS OPPORTUNITY AND
I'M AND I PARTICULAR.
NEXT WE HAVE JANET KAUFMAN WHO'S
AN ASSOCIATE PROFESSOR AT UC SAN
FRANCISCO SCHOOL OF MEDICINE.
SHE WORKS OUT THE FULL OF HARDLY
INSTITUTE FOR HEALTH POLICY
STUDIES THE HEALTH FORCED CENTER
AS WELL AS THE DEPARTMENT OF
FAMILY AND COMMUNITY MEDICINE.
AT THE UNIVERSITY OF CALIFORNIA
SAN FRANCISCO.
WITHOUT FURTHER ADO THANK YOU
FOR JOINING US TIME AND THANK
YOU ASSEMBLYMEMBER AROUND LOIS
THANK YOU ASSEMBLYMEMBER WOULD
AND THAT THE WHOLE COMMITTEE AND
AND ESPECIALLY THANK THE STAFF
FOR THEIR GUIDANCE IN PREPARING
THIS PRESENTATION.
NOT SO I'M GONNA TALK ABOUT
ACCESS TO PHYSICIANS IAN IN
CALIFORNIA AND I THINK IT'S.
FITTING THAT MR PROTEIN IRE UP
FOLLOWING ONE ANOTHER BECAUSE I
WHILE HE'S GIVEN YOU SOME VERY
VALUABLE INFORMATION FROM OUR
WORK ON PHYSICIAN PARTICIPATION
IN MEDICARE HOW. MICHAEL WAS STE
TO GIVE YOU A BROADER CONTEXT.
AND NOW WHILE WE COULD
CERTAINLY.
HEARING MANY DIFFERENT TYPES OF
PROFESSIONALS IN THE HEALTHCARE
WORKFORCE.
IN CONSULTATION WITH THE
COMMITTEE STAFF.
WE THOUGHT WAS IMPORTANT FOCUS
ON PHYSICIANS BECAUSE SO MUCH OF
THE CARE THAT IS DELIVERED IN
OUR SYSTEM. IS DRIVEN BY THE
DECISIONS POSITIONS MAKE AROUND
DIAGNOSIS AND TREATMENT PLANS AT
ALL.
I SO I'M GONNA REALLY GIVE YOU A
HIGH LEVEL OVERVIEW OF CURRENT
SUPPLY GEOGRAPHIC DISTRIBUTION
TALK A LITTLE ABOUT MEDICAL
EDUCATION. UP WANT TO SPEND A
FEW MINUTES ON CONTRIBUTIONS OF
NURSE PRACTITIONERS IN A
PHYSICIAN'S ASSISTANTS TO
PRIMARY CARE BECAUSE THEY DO
PLAY AN IMPORTANT ROLES
PARTICULARLY. IN RURAL AND INNER
CITY AREAS AND THEN TALKS ABOUT
STRATEGIES FOR MEETING.
OPPOSITION WORKFORCE NEEDS ARE
IN THE STATE.
MUCH OF THIS.
THAT ARE PRESENT WILL.
COME FROM RESEARCH THAT WE HAVE
NOT CONDUCTED.
FOR THE CALIFORNIA HEALTHCARE
FOUNDATION OTHER FUNDERS I'M I'M
GONNA PERCENT SOME FINDINGS FROM
THE EIGHTY SECOND SURVEY THE
MEDICAL BOARD DOES THE
MANDATORY.
SURVEY AYE IN THIS SURVEY AYE IS
DONE UNDER THE AUSPICES OF E.
BE.
UP FIFTEEN EIGHTY SIX.
A BILL YOUR PREDECESSORS
APPROVED IN TWO THOUSAND ONE AND
AND I WILL TELL YOU THAT THERE
TO WHEN WE PRESENT. OUGHT TO
NATIONAL AUDIENCES FOLKS ARE
IMPRESSED AT THE ARRAY OF DATA
THAT WE HAVE ON PHYSICIANS IN
THE STATE AND AND I THINK IN
FACT IN SOME OTHER PROFESSIONS
FOLKS. WISH WE HAD ANYTHING
WHERE NEAR THE DATA NO NURSING
WOULD BE AND I THINK THE ONLY
PROFESSION WERE QUITE.
SAME LEVEL IN CALIFORNIA.
I'VE SO POSITION WORKFORCE OF
FIVE ARE A KEY FINDING SPIKE KEY
THINGS TO REMEMBER.
UP ONLY FIFTY ONE PERCENT OF
PHYSICIANS IN CALIFORNIA WHO
HAVE A CALIFORNIA LICENSE
PROVIDE PATIENT CARE.
IN CALIFORNIA SO WE HAVE TO BE
REALLY CAREFUL WHEN WE LOOK AT
THE NUMBER OF LICENSEES.
IT'S AN OVERSTATEMENT ABOUT ONE
THIRD OF OUR PHYSICIANS ARE
PRIMARY CARE PHYSICIANS AND TWO
THIRDS ARE SPECIALISTS AND WHILE
THERE MULTIPLE WAYS TO DEFINE
PRIMARY CARE.
OUR TEAM DEFINES IT ADDS FAMILY
MEDICINE GENERAL INTERNIST
GENERAL PEDIATRICIANS AND DIED
GENERAL PRACTICE AND THAT'S
PRETTY WIDELY ACCEPTED
DEFINITION.
POINT THREE GEOGRAPHIC
DISTRIBUTION OF PHYSICIANS
ACROSS CALIFORNIA IS HIGHLY
UNEVEN WILL SAY WILL MORE ABOUT
THAT.
FOURTH OUR PHYSICIANS DO NOT
REFLECT THE DIVERSITY OF OUR
POPULATION. AND FIFTH MANY
PHYSICIANS ARE LIKELY TO RETIRE
WITHIN THE DECADE THE NEXT
DECADE PARTICULARLY. IN RURAL
AREA SO THERE IS A SILVER
TSUNAMI IN THE GENERAL
POPULATION ISN'T MEMBER WALDRON
ALLUDED TO BUT THERE'S ALSO SO
PERSON ARMY AMONG PHYSICIANS.
SO THIS IS JUST TO REINFORCE
THE POINT I MADE A ABOUT THE
NEED TO RECOGNIZE THAT MANY
PHYSICIANS WERE LICENSED TO
PRACTICE IN CALIFORNIA. DON'T
PROVIDE PATIENT CARE IN THE
STATE SOME OF THE MAINTAIN THEIR
LICENSE BUT THEIR NORMAL BUT THE
RETIRED THEY THEY WANT TO HOLD
ON TO THE LICENSE THE MONEY TO
WILL VOLUNTEER WORK. BUT THEY'RE
NOT ACTIVELY PRACTICING OTHERS.
.
PRACTICE IN OTHER STATES BUT
THEY ONE HOLD ON TO THE
CALIFORNIA LICENSE.
SUMMER STILL IN TRAINING THEY
HAVEN'T COMPLETED THAT RESIDENCY
YET AND SO THEY HAVE A LICENSE
BUT THEY'RE NOT.
A FULL MEMBER OF THE WORK FORCE
JUST YET.
I'M SO BASED ON RESPONSES TO THE
MANDATORY SURVEY WE ESTIMATE
THAT THERE ABOUT SEVENTY ONE.
THOUSAND POSITIONS WITH THE
CALIFORNIA LICENSE WHO PROVIDE
PATIENT CARE.
AND OF THOSE ABOUT SIXTY ONE
THOUSAND PROVIDE PATIENT CARE
TWENTY OR MORE HOURS PER WEEK
SORTS A REALLY BIG PART OF THEIR
WORK WEEK NORMAN IN ACADEMIA
WHERE I'M FROM WE'VE A LOT OF
PHYSICIANS. WHO DO PATIENT CARE
MAYBE ONE MAYBE TWO DAYS A WEEK
AND SPEND THE REST OF THEIR TIME
DOING RESEARCH AND TEACHING?
I AM SO THIS GRAPH.
DIVIDES THE STATE INTO TEN
DIFFERENT REGIONS AND PLOTS
RATIOS OF PRIMARY CARE
PHYSICIANS AND SPECIALISTS
POSITIONS TO POPULATION. THE
REASON WE PLOT THE RATIOS RATHER
THE NUMBERS IS AS YOU KNOW VERY
WELL.
THE POPULATION OF THE DIFFERENT
REGIONS OF OUR STATE VARIES
TREMENDOUSLY WE HAVE VERY DENSE
URBAN CORES LIKE SAN FRANCISCO
IN VERY WORLD PLACES AND MR
AROUND WHAT MISTER WOODS
DISTRICTS AND OTHER DISTRICTS.
IN SO PUTTING THEM ON THE RATIO
POPPER CAPITA YOU GIVES YOU A
SCALE WHERE YOU CAN MAKE
MEANINGFUL COMPARISONS. AND ONE
OF THE KEY THINGS WE SEE HERE IF
WE LOOK AT THE PRIMARY CARE
PHYSICIANS IN GOLD AND THE
SPECIALISTS IN BLUE.
IS THAT.
THE INLAND EMPIRE.
NORTHERN IN SIERRA AND SAN
JOAQUIN VALLEY REGION'S TEND TO
HAVE SOME OF THE LOWEST RATIOS
OF BOTH PRIMARY CARE AND
SPECIALIST POSITIONS TO
POPULATIONS OF SAN JOAQUIN
VALLEY. INCLUDES FRESNO COUNTY.
MR RAMBLERS DISTRICT NORTHERN
SIERRA.
INCLUDES MUCH OF MISTER WOODS
DISTRICT EXCEPT PERSON NO
MECHANIC WHICH IS IN THE GREATER
BAY AREA SO LOT OF VARIATION YET
EVEN MORE VARIATION RATIO
SPECIALIST A POPULATION. OUGHT
THEN PRIMARY CARE.
BUT IT'S IMPORTANT TRAIL DOWN
BELOW THE REGIONAL AREA BECAUSE
WHEN WE LOOK AT THESE MULTI
COUNTY REGION'S IT'S MAY ASKING
VARIATION EVEN WHEN WE LOOK AT A
PLACE LIKE LOS ANGELES. OUGHT
COUNTY.
WITHIN THAT COUNTY THERE'S
QUITE A WIDE VARIATION IN SUPPLY
AND SO THIS IS A MAP PREPARED BY
THE OFFICE OF STATEWIDE HEALTH
PLANNING AND DEVELOPMENT. OF
PRIMARY CARE HEALTH PROFESSIONS
AYE SHORTAGE AREAS AND I
APOLOGIZE THAT'S.
CUTTING OFF ON THE SCREEN A
LITTLE BIT BUT I'M THE PARENT
HEALTH PROFICIENCY ORTIZ AREAS
THESE ARE AREAS DESIGNATED BY
THE FEDERAL GOVERNMENT IN
PARTNERSHIP WITH POSH BID. AYE
THAT ARE DEEMED TO HAVE CRITICAL
SHORTAGES IN THIS CASE CRITICAL
SHORTAGES OF PRIMARY CARE
PHYSICIANS AND SO THIS MEANS
THESE ARE AREAS THAT HAVE FEWER.
THAN ONE PRIMARY CARE PHYSICIAN
POORER THIRTY FIVE HUNDRED
PEOPLE WHICH IS ABOUT LESS THAN
TWENTY NINE PRIMARY CARE
PHYSICIANS PER ONE HUNDRED
THOUSAND.
POPULATIONS OF THIS IS QUITE
LOW.
I'M.
AND IF WE LOOK AT THIS MAP THE
AREAS THAT ARE IN THE RUST COLOR
ARE A PRIME MAKERS SHORTAGE AREA
FOR THE WHOLE POPULATION THAT
MEANS ANYBODY WHETHER YOU'RE
INSURED UNINSURED. WHETHER YOU
HAVE PRIVATE INSURANCE MEDICARE
MEDI CAL THERE'S A SHORTAGE THE
CREAM COLORED AREAS ARE AREAS
WHERE THERE'S A STORAGE OF
PROVIDERS WILLING TO SERVE A
PARTICULAR POPULATION COULD BE
MEDI CAL BENEFICIARIES COULD BE
FARMWORKERS COULD BE UNINSURED.
I'M SO THINK POINTING
GEOGRAPHICALLY THE VAST MAJORITY
THE SERIES ARE IN RURAL AREAS
HOWEVER IF YOU NOTICE IF YOU
LOOKED DOWN.
SEE WHERE LOS ANGELES COUNTY IS
MUCH OF THE COUNTY IS ADEQUATE
BUT THERE'S SOME LITTLE POCKET
YOU KNOW SMALL POCKETS.
OF SHORTAGE IN THOSE ARE PLACES
LIKE THE HIGH DESERT IN
PARTICULARLY SOUTH CENTRAL BOYLE
HEIGHTS INNER CITY.
AREAS AND SO YES GEOGRAPHICALLY
MOSTLY WORLD BUT LET'S NOT BUT
IMPORTANT TO NOT FORGET THAT
THERE ARE A LOT OF FOLKS IN
INNER CITY AREAS.
THAT HAVE SHORTAGES OF PRIMARY
CARE PHYSICIANS.
THIS OUR MAP IS FOR MENTAL
HEALTH PROFESSIONALS.
THAT PURPLE ARE AREAS THAT HAVE
A SHORTAGE OF MENTAL HEALTH
PROFESSIONALS FOR ALL THE
POPULATIONS OF THIS WOULD BE
PSYCHIATRISTS PSYCHOLOGISTS.
LICENSED CLINICAL SOCIAL
WORKERS OTHERS THERAPIST.
THE.
BLUISH PURPLE THE LIGHTER COLOR
THAT'S A SHORTAGE IS FOR
PARTICULAR SEGMENTS OF THE
POPULATION. AGAIN.
OR MORE RURAL PARTS OF THE
STATE.
R. I HEAR COVERED THE.
THE MORE RURAL PARTS OF OUR
STATE ACCOUNT FOR THE LARGEST
GEOGRAPHIC AREAS THAT HAVE
SHORTAGES BUT AGAIN WE SEE SOME
INNER CITY AREAS ALSO STRUGGLING
WITH SHORTAGES OF MENTAL HEALTH
PROFESSIONALS.
I'M.
RACIAL ETHNICALLY DIVERSITY
ISSUE WELL KNOW WE ARE ONE OF
THE MOST RACIALLY ETHNICALLY
DIVERSE AYE STATES IN THE
NATION.
R. PHYSICIAN WORKFORCE NOT SO
MUCH OF WE LOOK ON THE RIGHT
HAND SIDE OF THE SLIDE THAT'S
THE CALIFORNIA POPULATION IN
TWENTY FIFTEEN.
ACCORDING TO THE CENSUS BUREAU
AT THAT TIME SIX PERCENT OF OUR
POPULATION.
WAS AFRICAN AMERICAN THIRTY
EIGHT PERCENT OF LATINO AND WE
SEE IF WE LOOK ON THE LEFT SIDE
THAT'S ALL PHYSICIANS IN THE
NEXT TO THAT PRIMARY CARE
PHYSICIANS.
.
FOUR PERCENT OF OUR PHYSICIANS
ARE AFRICAN AMERICAN VERSUS SIX
PERCENT OF THE POPULATION AND IF
WE LOOK AT LATINOS SOME EVEN
BIGGER GRAPHS SEVEN PERCENT OF
PHYSICIANS ARE LATINO VERSUS
THIRTY EIGHT PERCENT OF THE
POPULATION. I PUT NURSE
PRACTITIONERS AND PHYSICIAN
ASSISTANTS ON THE SCRAP AS A
BENCH PREGNANCY.
EIGHT BOTH ARE BETTER IN TERMS
OF PROPORTIONAL ATENAS BUT STILL
NOWHERE NEAR POPULATION.
PARITY WHY DOES THIS MATTER WHY
I THINK WE PRETTY GOOD EVIDENCE
THAT PEOPLE OFTEN FORM STRONGER
BONDS WITH A HEALTH PROFESSIONAL
OF THE SAME RACE ETHNICITY. AND
THE FOLKS AT HER COMMON CULTURAL
BACKGROUND AND OFTENTIMES A
COMMON LANGUAGE MAY BE ABLE TO
COMMUNICATE BETTER WITH A HEALTH
PROFESSIONAL. ABOUT THEIR HEALTH
CONDITION AND BE MORE WILLING TO
TRUST THE ADVICE THAT THEY'RE
GIVEN.
EACH DISTRIBUTION OF ACTIVE
PATIENT CARE PHYSICIANS SO
TWENTY SEVEN PERCENT OF REACTIVE
PATIENT CARE PHYSICIAN SO THESE
ARE PHYSICIANS WHO PROVIDE
PATIENT CARE TWENTY OR HOURS A
WEEK.
TWENTY HOURS PER WEEK OR MORE SO
TWENTY SEVEN PERCENT OF THEM.
WANT A LITTLE MORE THAN ONE IN
FOUR ARE AGE SIXTY. OR OLDER AND
NOW SOME OF THEM WILL KEEP
WORKING FOR MANY YEARS BUT A LOT
OF THEM AT THE AS THEY REACH
INTO THEIR SEVENTIES WERE EITHER
RETIRE OR SUBSTANTIALLY CUT BACK
THEIR WORK HOURS.
I'M IN SOME REGIONS OF THE STATE
HAVE PERCENTAGES OF DOCTORS AGE
SIXTY YEARS OR OLDER THAT ARE
EVEN HIGHER SO THE NORTHERN AND
SIERRA THAT WOULD BE MISTER
WOODS DISTRICT THIRTY SEVEN
PERCENT OVER A THIRD. OUR AGE.
SIXTY OR OLDER.
THIRTY TWO PERCENT IN THE
CENTRAL COAST AND ABOUT THIRTY
PERCENT IN LOS ANGELES IN THE
SAN JOAQUIN VALLEY.
AND IN GENERAL IT'S HARD TO SAY
THAT RURAL AREAS OF THE STATE
TEND TO HAVE OLDER PHYSICIANS
ARE THEY IN URBAN AREAS.
A FEW FACTS ABOUT MEDICAL
EDUCATION AND IT HAS YOU KNOW.
POSITIONS FIRST COMPLETE
MEDICAL SCHOOL AND THEN GO ON TO
COMPLETE A RESIDENCY PROGRAM.
ARMS SHOW IN TWO THOUSAND
SIXTEEN THE LATEST YEAR FOR
WHICH.
I HAVE COMPLETE DATA ONE
THOUSAND FIVE HUNDRED AND
SEVENTY ONE PEOPLE GRADUATED
FROM A CALIFORNIA. MEDICAL
SCHOOL.
IN OVER TWO THIRDS ABOUT ELEVEN
THOUSAND OF THOSE WERE FROM AN
ALLOPATHIC IN INDY GRANTING
SCHOOL SO THAT WOULD BE THE
UNIVERSITY CALIFORNIA MEDICAL
SCHOOLS LOMA LINDA STANFORD
UNIVERSITY OF SOUTHERN
CALIFORNIA. AND THEN WE HAVE TO
OSTEOPATHIC DO GRANTING SCHOOLS
THOSE NUMBERS ARE GOING TO GO UP
BECAUSE WE SEVERAL MEDICAL
SCHOOLS.
THAT ARE HAVE EITHER STARTED TO
ENROLL OR WILL BEGIN TO ENROLL
STUDENTS IN THE NEXT SEVERAL
YEARS.
RESIDENCY WE HAVE ABOUT TWO
SOUTH WE HAVE TWO THOUSAND FIVE
HUNDRED FIFTY FOUR FIRST YEAR
MEDICAL STUDENTS.
IN TWENTY SEVENTEEN AND
RESIDENTS ITS REALLY IMPORTANT
TO LOOK AT RESIDENCY DATA
BECAUSE. WHERE A PERSON DOES HIS
OR HER RESIDENCY IS A MUCH
STRONGER PREDICTOR OF WHERE
AVAIL PRACTICE?
OUGHT THEN WHERE THEY GO TO
MEDICAL SCHOOL A LOT OF PEOPLE
MOVE AROUND A LOT OF OUR
CALIFORNIANS GO OUT OF STATE.
FOR MEDICAL SCHOOL AND THEN COME
BACK FOR RESIDENCIA RESIDENCIES
RELATED IN TERMS OF GETTING
FOLKS WHERE WE NEED THEM TO GO.
THAT'S WHERE WE WANT TO FOCUS.
.
IN TWENTY SEVENTEEN WE HAD ABOUT
ONE THOUSAND WHO WERE FIRST YEAR
RESIDENTS IN A NON PRIMARY CARE
SPECIALTY. AND ABOUT FIFTEEN
HUNDRED WHO WERE FIRST YEAR
RESIDENTS IN A PRIMARY CARE
SPECIALTY HOWEVER I NOTE THAT OF
THOSE STARTING IN A PRIMARY CARE
SPECIALTY. HAFER ARE LIKELY TO
GO ON A SUB SPECIALISTS WHO SAY
THEY DO A GENERAL INTERNAL
MEDICINE RESIDENCY. AND THEN
THEY GO ON THE SUB SPECIALIZED
IN CARDIOLOGY ERGASTER NEUROLOGY
IN IN THOSE ARE SURELY IMPORTANT
SPECIALTIES BUT I THINK IN OUR
STATE WE STRUGGLE THE MOST OF
PRIMARY CARE SUPPLIES THAT WE
NEED TO KEEP THAT AND WE NEED TO
JUST. WHEN WE SEE THAT FIFTEEN
HUNDRED NUMBER REMEMBER THAT NOT
ALL FIFTEEN HUNDRED ARE GOING TO
PROVIDE PRIMARY CARE.
OKAY ROOM BRIEFLY CONTRIBUTIONS
OF NURSE PRACTITIONERS AND
PHYSICIAN AYE ASSISTANCE
I'M SO MPS AND PAC ARE A MAJOR
SOURCE OF PRIMARY CARE
PARTICULARLY IN RURAL CARACALLA
FORGET THEY DO PLAY IMPORTANT
ROLE AND FILLING GAPS IN SOME OF
OUR RURAL AREAS. WHERE CLINICS
AND OTHER PROVIDERS STRUGGLE?
AYE TO RECRUIT PHYSICIANS
HOWEVER IT'S IMPORTANT KEEP IN
MIND THAT NUMBERS HAVE BEEN
PIECING PA'S IN CALIFORNIA ARE
MUCH SMALLER.
THEN THE NUMBERS OF PHYSICIANS
AND SO WHY THINK IT'S CERTAINLY
IMPORTANT TO LOOK AT INCREASING
THEIR NUMBERS IT'S IMPORTANT
RECOGNIZE THAT YOU'RE STARTING
FOR A MUCH SMALLER BASE.
IN OUR TEAM AT THE AYE UCSF
MYSELF MY COLLEAGUE CHANCE BATS.
HAVE JOHN SOME PROJECTIONS OF
FUTURE SUPPLIES OF PRIMARY CARE
NURSE PRACTITIONERS PHYSICIAN
ASSISTANTS AND PRIMARY CARE
PHYSICIANS.
IN OUR CONCLUSION IS THAT
NUMBERS OF PRIMARY CARE IN PEACE
MPAS RESPECTED TOOK TO INCREASE
PARTICULARLY IF INCREASES IN
RISK OF IN IN ENROLLMENT. IN
TRAINING PROGRAMS CONTINUE AT
THE CURRENT PACE BUT THEIR
GROWTH MAY NOT BE SUFFICIENT TO
OFFSET THE PROJECTED DECREASE IN
THE NUMBER OF PRIMARY CARE
PHYSICIANS THAT ON THE POSITION
SITE. WE'RE NOT TRAINING NEW
PHYSICIANS AT THE SAME RATE AS
FOLKS ARE EXITING THE
PROFESSION.
I MEAN THIS IS JUST TO HELP
REINFORCE THAT POINT WHERE SOME
DATA.
WHEN WE ADD UP INDIES AND DE
OWES THE TWO TYPES OF POSITIONS
WE GET ABOUT THIRTY THOUSAND
PRIMARY CARE.
PHYSICIANS IN THE STATE I AM IF
WE A OUT UP IN PEACE MPAS AND
PRIMARY CARE. UP WE GET ABOUT.
TWELVE I TWELVE THOUSAND
THIRTEEN THOUSAND IT IN OTHER
KEY THING HERE IS I THINK IT'S
REALLY IMPORTANT TO NOTE THAT
LIKE PHYSICIANS. THERE ARE LARGE
PROPORTIONS OF IN PEACE MPAS WHO
ARE SPECIALISTS THEY DON'T ALL
PROVIDE PRIMARY CARE AND IN FACT
THERE'S A YOU KNOW BIG MARKET
FOR WORK IN PEACE MPAS IN
SPECIALTY CARRIED NATIONWIDE.
A RECENT STUDY OF AB JOB
ADVERTISEMENTS FOR IN PNP JOBS
FOUND THAT THE MAJORITY OF JOBS
FOR ON THE SPECIALLY SIDE
SPECIALTY PRACTICES ALSO TEND TO
PAY BETTER.
I'M SO I DON'T THINK IT'S ANY
SURPRISE THAT WE'RE SEEING YOUR
PRE LARGE PROPORTIONS OF MPS
MPAS GO THAT ROUTE.
SO NOW LET ME COMMENT BRIEFLY ON
STRATEGIES FOR MEETING PHYSICIAN
WORKFORCE. NEEDS.
IN THIS IS A TYPOLOGY THAT OUR
COLLEAGUES AND I PREPARED OFF
FOR A FORTHCOMING REPORT IN
THERE DO THE TYPOLOGY IS KIND OF
A WAY TO GIVE YOU A AWAY THE
TAXI GIVE FOUR BIG BUCKETS OF
STRATEGIES THAT COULD BE
UTILIZED.
TO.
.
ADDRESS POSITION WORKFORCE
CHALLENGES IN CALIFORNIA IN THE
FIRST IS ENHANCING THE
EDUCATIONAL PIPELINES INCREASING
THE NUMBER OF PEOPLE. ENTERING
MEDICAL SCHOOL OTHER HEALTH
PROFESSIONS THAT PROVIDE PRIMARY
CARE. VERTICALLY FOCUSING AND IN
ADDITION TO JUST PRODUCING MORE
TARGETING AND FOCUSING ON FOLKS
WHO ARE INTERESTED IN PROVIDING
PRIMARY CARE. IN UNDERSERVED
AREAS OF THE STATE AND PREPARING
THE SPOKES TO PRACTICE
EFFECTIVELY IN THOSE SETTINGS
SECOND WOULD BE CREATING
INCENTIVES FOR RECRUITMENT AND
RETENTION A PRIMARY CARE FOR
SPECIALS AND UNDERSERVED AREAS
AND HAS WE TRAIN MORE. CREATING
THE INCENTIVES AS THEY FINISH
RESIDENCY REBA TRUCK TO GO TO
THE PLACES WE NEED THE MOST.
THIRD MAXIMIZING THE EXISTING
WORKFORCE IN THAT'S NUMBER A LOT
FOR A LOT OF THINGS TO CHRIS
TALKED ABOUT. AROUND DELIVERY
REFORM PAYMENT REFORM EXPANDED
USE OF.
TECHNOLOGY IN TELEHEALTH IN
OTHER AREAS CAN ALSO ENCOMPASS
AYE CHANGES IN STATE. OUR SCOPE
OF PRACTICE
REGULATION NEO SO THAT FOLKS ARE
USED TO THE FULL EXTENT THEIR
CAPACITY THERE ARE SOME
PROFESSIONS MOST NOTABLY NURSE
PRACTITIONERS WERE OUR SCOPE OF
PRACTICE IS CONSIDERABLY MORE
RESTRICTIVE THAN THAT OF MANY
STATES.
UP AND THEN LASTLY YOU KNOW
BECAUSE I'M IN AT AN ACADEMIC
WHO LIKES TO PLAY WITH DATA.
LEVERAGING DATA AND I THINK NOT
ONLY BECAUSE IT'S INTERESTING
BUT BECAUSE IT'S IMPORTANT TO
KNOW TO MAKE THEM SOUND
DECISIONS ABOUT OUR WORKFORCE
INVESTMENTS IT'S IMPORTANT TO
COLLECT AND ANALYZE DATA SO THAT
WE KNOW ARE THE THING ARE WE ARE
THE THINGS THAT WERE. ARE OUR
ATTEMPTS TO STE FIX THE PROBLEM
REALLY WORKING.
I AM SO FEW KEY TRADE OFFS THAT
I THINK ARE IMPORTANT AS. OUGHT
YOU THINK ABOUT INVESTMENT
STRATEGIES IN THE PHYSICIAN
WORKFORCE EIGHT I THINK
EXPANDING TRAINING CAPACITY IN
RECRUITING PEOPLE WHO WANT TO
PRACTICE IN UNDERSERVED AREAS
AND PEOPLE WHO REFLECT THE
STATE'S. RACIAL ETHNIC DIVERSITY
THESE ARE CRITICAL THESE ARE
FUNDAMENTAL TO ADDRESS THE
STRUCTURAL DEFICITS IN
CALIFORNIA'S POSITION WORKFORCE.
BUT IT'S REALLY IMPORTANT TO
REMEMBER THAT THESE ARE NOT
QUICK FIXES.
IN LARGE PART DUE TO THE LENGTH
OF TRAINING THAT. MEDICAL SCHOOL
TAKES FOUR YEARS WE HAVE A FEW
EXAMPLES OF THREE OR PROGRAMS
BUT THE MAJORITY OF FOLKS ARE
DOING FOUR YEARS OF MEDICAL
SCHOOL. AND AT LEAST THREE YEARS
OF RESIDENCY AND MANY MORE THAN
THREE YEARS AND SOME OF THE
SPECIALTIES.
AND SO WE NEED TO AUGMENT TRAIT
STRATEGIES THAT FOCUS ON
EXPANDING TRAINING.
A PASSERBY WITH STRATEGIES THAT
AS I SAID INCENTIVIZE NEW GRADS
TO PRACTICE IN UNDERSERVED AREAS
SUPPORT RETENTION OF POSITION IN
THOSE AREAS. ENCOURAGE TEAM
BASED PRACTICE SO THAT WHERE
THERE ARE THINGS THAT ARE
NECESSARY TO MEET PEOPLE'S
PRIMARY CARE NEEDS THAT CAN BE
DONE BY SOMEONE OTHER THAN THE
POSITIONS THAT WERE DOING THAT
IN A TEAM BASED WAY THAT COULD
BE COMMUNITY HEALTH NURSE IT
REGISTERED NURSES. COULD BE
COMMUNITY HEALTH WORKERS ALL
COACHES PHARMACISTS LOT OF FOLKS
WHO COULDN'T DENTISTS.
OR OVERTURN THE DENTAL
HYGIENISTS.
BUT THE IDEAS WE WANT WE DON'T
HAVE A WHOLE TEAM SO THAT THE
GOAL IS HOW TO WHERE HARRY
BRINGING THE FULL TEAM TO BEAR.
TO MEET HEALTH NEEDS AND NOT
JUST ASKING THE PHYSICIAN TO DO
ABSOLUTELY EVERYTHING THAT'S
JUST NOT. SUSTAINABLE.
SEWER CONCLUSION REAL QUICKLY
YES SOME RURAL INNER CITIES A
CALIFORNIA HAVE SHORTAGES OF
PHYSICIANS IN SOME PLACES IT'S
NOT JUST.
A SHORTAGE OF PHYSICIANS WILLING
TO PARTICIPATE IN ANY PARTICULAR
INSURANCE PROGRAM IT'S A
SHORTAGE OF PHYSICIANS. AND IT
THE SHORTAGES ARE LIKELY TO GET
WORSE UNLESS THE STATE.
TAKES ACTION AND CERTAINLY IN
PEACE MPAS.
ARE HELPFUL VERY IMPORTANT BUT
THEY'RE NOT A PANACEA JUST
RAMPING UP IN PNP TRAINING ISN'T
GOING TO SOLVE THE PROBLEM WE
NEED A COMPREHENSIVE STRATEGIC
PLAN. THAT ENGAGES MULTIPLE
STAKEHOLDERS AND AS AYE MR PRONE
MENTIONED.
THE CALIFORNIA FUTURE WORKFORCE
COMMISSION IS WORKING ON JUST
SUCH A COME CONGREGANTS OF PLAN
AND URGE YOU TO.
PARTICIPATE IN THOSE
DELIBERATIONS.
AND THANK YOU.
THANK YOU THANK YOU VERY MUCH DR
KAUFMAN.
WE WILL GO AHEAD AND MOVE ON TO
DOCTOR JOHN GRAVES.
.
WHO IS AN ASSISTANT PROFESSOR
AT VANDERBILT VANDERBILT
UNIVERSITY SCHOOL OF MEDICINE
WHERE HE HOLDS APPOINTMENTS AND
APARTMENT OF OF HEALTH POLICY IN
THE PARCHMENT OF MEDICINE?
IS INTERDISCIPLINARY RESEARCH
FOCUSES ON THE DEVELOPMENT
IMPLEMENTATION AND EVALUATION OF
HEALTH CARE REFORMS AT THE STATE
AND THE FEDERAL LEVEL.
GRAVES THANK YOU WHAT'S A
PRIVILEGE TO BE WITH YOU TODAY
I'M. HAPPY TO HAVE MADE IT AYE
NATIONAL HEADS ANNUAL SNOW STORM
THIS WEEK WHICH IS CLOSE SCHOOL
FOR SIX DAYS AND I SOMEHOW MADE
IT OUT OF THAT WILL BE A
CALIFORNIA. YEAH.
SO OF MY ROLE.
.
IN TESTIMONY TODAY IS TO REALLY
PULL ON THE THREAT OF COVERAGE
CHURN NOT ONLY IN CALIFORNIA BUT
BASED ON MY OWN RESEARCH AND
THAT OF OTHERS.
IN THE UNITED STATES MORE
BROADLY.
AND WHAT I'D LIKE TO DO IS GO
IS IS LAY OUT.
SOME INFORMATION FOR YOU NOT
ONLY ON THE PREVALENCE OF
TRANSITIONS ARE TURNED OVER IN
IN IN HEALTH INSURANCE UNITED
STATES. BUT ALSO TALK ABOUT ITS
CONSEQUENCES FOR ACCESS COSTS
AND UTILIZATION AND THEN SPEND A
FEW MINUTES TALKING ABOUT SHORT
TERM AND LONGER TERM ISSUES THAT
WILL COME UP.
OF BOTH FEDERALLY AND AT THE
STATE LEVEL.
AND THAT YOU'LL NEED TO PAY
ATTENTION TO.
MOVING FORWARD AS YOU GO
THROUGHOUT YOUR YOUR PROCESS
HERE.
SO JUST TO SET US ALL ON THE
SAME STAGE.
WHAT WE GENERALLY MEAN WHEN WE
REFER TO CHURN IS TRANSITIONS IN
HEALTH INSURANCE THAT ARE DUE TO
CHANGES IN INCOME? A PERSON'S
JOB CIRCUMSTANCES OR THEIR
FAMILY CIRCUMSTANCES GETTING
MARRIED DIVORCED ETCETERA.
SO THIS IN THIS COULD BE ARE
MOVING FROM EMPLOYER BASED PLAN.
DUE TO A JOB CHANGE INTO A
PERIOD WITHOUT HEALTH INSURANCE
A COULD MEET MEAN MOVING FROM
MEDICAID OUT INTO A COVER
CALIFORNIA BECAUSE OF AN INCOME
CHANGE IT CETERA. BUT IT CAN
ALSO MEAN OTHER THINGS.
SUCH AS ARE JUST TRANSITIONING
FROM ONE EMPLOYER BASED PLAN TO
ANOTHER AND I'LL GET INTO THAT A
LITTLE BIT IN A MINUTE.
SO THE TOP PLATE NUMBER I WANT
YOU TO TAKE AWAY IS THAT BASED
ON OUR RESEARCH WHAT WE FOUND IS
THAT EACH YEAR ONE IN SIX U. S.
ADULTS.
CHANGE THEIR PRIMARY SOURCE OF
HEALTH INSURANCE.
THIS IS ACTUALLY A LOWER
ESTIMATE BECAUSE THIS IS
BASICALLY PEOPLE CHANGING THEIR
THE SOURCE OF HEALTH INSURANCE
WHETHER THAT'S TO AN EMPLOYER
MOVING INTO THE MARKETPLACE OR
BECOMING UNINSURED OR MOVING
FROM MEDICAID TO OTHER
MARKETPLACES ETCETERA. YOU CAN
THINK OF THE ADDITIONAL MILLIONS
OF PEOPLE A YEAR THAT ARE
TRANSITIONING BETWEEN ARE THE
SAME TYPE OF HEALTH INSURANCE
FOR EXAMPLE FOR A WITH THE JOB
CHANGE MOVING FROM ONE JOB TO
ANOTHER. HAS A COMPLETELY
DIFFERENT.
.
HEALTH PLANS AND PROVIDERS
FORMULAS IT'S ADDRESS THAT WOULD
BE ON TOP OF THIS ONE IN SIX
NUMBER THAT I'M SHOWING HERE.
WE ESTIMATED USING SOME BACK OF
THE ENVELOPE CALCULATIONS THAT
FOR HERE IN CALIFORNIA OVER THE
NEXT TWO YEARS ABOUT ELEVEN
MILLION CALIFORNIANS ARE GOING
TO CHANGE THEIR CURRENT SOURCE
OF INSURANCE.
AND IF YOU BREAK THIS DOWN THAT
MEANS THAT ABOUT FOUR POINT TWO
MILLION PEOPLE WHO TODAY OUR
COVER TO AN EMPLOYER ARE GONNA
TRANSITION OUT OF THAT EMPLOYER
SPONSORED COVERAGE IN EITHER
GOING TO COVER CALIFORNIA WILL
BECOME ELIGIBLE FOR MEDICARE
OUT.
OR BECOME UNINSURED FOR SOME
PERIOD OF TIME.
ANOTHER FOUR MILLION WOULD COME
OUT OF THE MEDICAL PROGRAM OVER
THE NEXT TWO YEARS AND AGAIN GO
INTO ONE OF THESE OTHER
CATEGORIES.
EIGHT HUNDRED THOUSAND.
WOULD COME OUT OF.
THEY'RE CURRENTLY IN THE COVER
CALIFORNIAN A MARKETPLACE PLAN
ARE GOING TO COME OUT OF THAT
COVERAGE AND IT'S ESTIMATED BY
COVER CALIFORNIA. THAT EVERY
MONTH ROUGHLY FIVE TO TEN
THOUSAND PEOPLE MOVE BETWEEN
COVERED CALIFORNIA AND MEDICAL.
I WANT TO KIND OF SET A BACKDROP
BEFORE I TALK ABOUT THE IMPACT
OF THE ACA ON COVERAGE TURN AND
MOVING FORWARD. ON BY DISCUSSING
WHY IT IS WE'RE SEEING MORE AND
MORE TRANSITION OR TURN OVER IN
THE U. S. HEALTH INSURANCE.
ONE KEY FACT ON THE CONTRIBUTES
TO THIS IS THE FACT THAT ARE IN.
THE THE U. S. HEALTH INSURANCE
SYSTEM WELL FRAGMENTED IS BUILT
ON THE CHASSIS OF EMPLOYMENT
BASE TO HEALTH AND.
AND WHAT WE'VE SEEN OVER THE
LAST TWENTY YEARS IS A GRADUAL
EROSION OF EMPLOYMENT BASED
HEALTH INSURANCE.
SO YOU CAN SEE ON THIS GRAPH IS
THE BIT ABOUT TWENTY YEARS AGO
IN NINETEEN NINETY NINE.
TWO THIRDS OF NON ELDERLY AND.
POPULATION IN THE UNITED STATES
WAS INSURED THROUGH AN EMPLOYER.
BY TWENTY FOURTEEN ON THE EVE OF
THE COVERAGE EXPANSIONS ON OF
THE AFFORDABLE CARE ACT THAT
NUMBER HAD GONE FROM SIXTY SEVEN
PERCENT. DOWN TO FIFTY SIX
PERCENT
AND JUST TO GIVE YOU A SENSE OUR
SUMS SLIDES THAT LARRY LEVITT
SHOWED EARLIER SHOW THAT IN
CALIFORNIA THAT FIFTY SIX OF THE
NATIONAL AMBER CALIFORNIA'S
EXCELLENT AT LOWER THAN THAT OF
I BELIEVE FORTY EIGHT PERCENT.
SO.
WHAT ARE THE REASONS ARE
CONTRIBUTING FACTORS TO THIS
EROSION OF ON OF OF A PLAN IN
PLACE INSURANCE?
ONE IS THE FACT THAT EMPLOYERS
ARE LARGELY STARTING TO GET OUT
OF THE GAME. AS RISING
HEALTHCARE COSTS TO PUT THE
PINCH ON THEM THEY JUST DECIDED
THAT OFFERING HEALTH INSURANCE
IS A FORM OF COMPENSATION IS
JUST SOMETHING THAT THEY CAN NO
LONGER AFFORD AND SO ARE MORE
AND MORE EMPLOYERS ARE DECIDING
NOT TO OFFER HEALTH INSURANCE
BENEFITS TO THEIR EMPLOYEES.
ANOTHER REASON IS MOBILITY IN
THE U. S. OUR LABOR MARKET
WHEREAS ONE OR TWO GENERATIONS
AGO AN INDIVIDUAL MIGHT HAVE TWO
OR THREE JOBS OVER THE COURSE OF
THEIR LIFETIME. NOWADAYS IT'S
NOT UNCOMMON TO HAVE EIGHT NINE
TEN JOB CHANGES OVER.
OVER YOUR WORKING.
LIFE YEARS AND SO WITH THAT
COMES CHANGES IN EMPLOYMENT YOU
MIGHT BE OUT OF A JOB FOR A FEW
MONTHS OR AYE IN A WAITING
PERIOD IF YOU STARTED A NEW JOB
IN CANTON ROLE FOR ANOTHER.
A FEW MONTHS.
WANTS THAT JOB STARTS.
ANOTHER CONTRIBUTING FACTOR IS
THE SO CALLED GET ECONOMY IN
JUST THE RISE OF THE OF THE USE
OF CONTINGENT* R. ARE.
CONTRACTED WORKERS.
AND SO IN THAT CASE THOSE ARE
INDIVIDUALS THAT WOULD HAVE TO
GO OUT AND PURCHASE COVERAGE ON
THEIR OWN BECAUSE THEY'RE UNDER
CONTRACT THEY'RE NOT ACTUALLY
EMPLOYEE OF A FIRM THAT WOULD
OFFER THEM HEALTH INSURANCE
BENEFITS.
SO WHAT WE FOUND IN OUR RESEARCH
IS THAT IF YOU THINK ABOUT
INDIVIDUALS THAT CURRENTLY HAVE.
POLICY THROUGH THEIR EMPLOYER
ABOUT A QUARTER OF THEM ARE
GOING TO TRANSITION OFF OF THAT
POLICY OVER THE NEXT TWO YEARS.
AND THAT'S A RISE OF ABOUT TEN
PERCENT SINCE THE EARLY TWO
THOUSANDS
SO THAT COULD EITHER MEAN
BECOMING UNINSURED ARE GOING
INTO DIFFERENT COVER SITE OR
COULD MEAN JUST SIMPLY SWITCHING
PLANS. GOING TO NEW JOB WITH
EMPLOYMENT BASED HEALTH
INSURANCE.
THE POPULATION GROUPS THAT ARE
MORE LIKELY TO EXPERIENCE THIS
TYPE OF CHURN PERHAPS NOT
SURPRISINGLY YOUNG ADULTS LOW
INCOME ADULTS HISPANIC ADULTS.
MORE SURPRISINGLY TO US ADULTS
IN FAIR POOR HEALTH ARE MORE
LIKELY TO EXPERIENCE TRANSITIONS
OF COVERAGE AND SERVICE INDUSTRY
WORKERS AS WELL.
THOSE LESS LIKELY TURN
TRANSITION ARE OLDER ADULTS
MARRIED ADULTS FEMALES AND
ADULTS WITH A COLLEGE DEGREE
VOWED MENTIONED THAT THESE
ADULTS.
EVEN THOUGH THEY HAVE LOWER
TRANSITION RATES STILL
EXPERIENCE COVERAGE TRANSITIONS
ON THE ORDER OF ONE IN FIVE OR
TWENTY PERCENT OVER A TWO YEAR
PERIOD SO IT'S NOT LIKE THEY'RE
THEY'RE THEY'RE THEY'RE STAYING
IN COVERAGE FOR LONG PERIODS OF
TIME RELATIVE TO THESE OTHER.
WHAT WE FOUND ALSO IS THAT
LEADING INTO THE PERIOD?
OF THE ACA.
ONE MITIGATING FACTOR KEEPING A
LOT OF THESE INDIVIDUALS FROM
BECOMING UNINSURED.
WAS THAT INCREASE AMERICANS ARE
INCREASINGLY RELIANT WHEN THEY
LOSE A JOB WITH HEALTH INSURANCE
BENEFITS ON OBTAINING A COVERAGE
THROUGH A FAMILY MEMBER. WHO
THEMSELVES HAS A JOB WITH HEALTH
INSURANCE BENEFIT?
SO WHAT WE FOUND WAS THAT FROM
TWO THOUSAND FORTY TWO THOUSAND
THIRTEEN THE LIKELIHOOD THAT A
POP THAT SOMEBODY WITH THE
POLICY AND EMPLOYMENT BASE
POLICY.
WAS ABLE TO FIND A NEW JOB WITH
HEALTH INSURANCE BENEFITS WENT
DOWN BY FIFTEEN PER SE.
AT THE SAME TIME THE PROBABILITY
THAT THAT POLICY HOLDER. WAS
ABLE TO GET COVERAGE THROUGH A
FAMILY MEMBER AFTER THAT JOB
CHANGE INCREASE TO FULL.
NOW EMPLOYERS HAVE REALIZE THIS
AND THEY'VE INCREASINGLY
STARTED.
IMPOSING SURCHARGES MAKING IT
MORE EXPENSIVE FOR INDIVIDUALS
TO COVER FAMILY MEMBERS OR IN
MANY CASES RETIREES WE CERTAINLY
HAVE THAT A VANDERBILT.
MANY OF YOU MAY HAVE
EXPERIENCES THAT ARE IN YOUR
FAMILIES AS WELL.
SO WITH THAT BACKS UP I'D LIKE
TO.
.
TO DISCUSS THE ACA AND ITS ROLE
IN AFFECTING COVERAGE TURN IN
THE UNITED STATES.
THE FIRST TAKE AWAY FROM R. WORK
IS THAT OVERALL CHURN RATES HAVE
NOT REALLY CHANGED MUCH WITH THE
AFFORDABLE CARE ACT IN PLACE.
NO WELL OVERALL CHURN RATES HAVE
BEEN HAVE BEEN CHANGED
THE NATURE OF THOSE THAT TURNED
HAS CHANGED QUITE A BIT.
WHAT I MEAN BY THAT IS WE'RE
SEEING INCREASED RETENTION
PUBLIC PROGRAMS LIKE MEDICAL?
AND FEWER PEOPLE BECOMING
UNINSURED SO THESE TRANSITIONS
FROM INSURANCE TO UNINSURED
STATUS AREBECOMING LESS
PREVALENT OVER TIME.
IN IN THE WAKE OF THE
AFFORDABLE CARE ACT.
THE WAY TO THINK ABOUT THIS.
IS WELL IS THAT UNDER THE
AFFORDABLE CARE ACT AMEND
AMERICANS ARE SPENDING LESS TIME
BEING ON ENSURE.
IT'S THE WAY TO THINK ABOUT THIS
IS TO THINK ABOUT ALL OF THE
UNINSURED PEOPLE TODAY THAT
OFTEN BECOME UNINSURED AT
VARIOUS POINTS IN TIME SOME
WALKS EXIT SOONER THAN OTHERS.
A LOT SOME PEOPLE SPEND A LOT
OF TIME ON THIS HIGHWAY BEFORE
THEY.
TEAM COVERAGE.
WHAT WE'VE SEEN UNDER THE
AFFORDABLE CARE ACT IS THAT MORE
PEOPLE ARE GETTING OFF THE EXIT
SOONER?
INTO THINGS LIKE NON GROUP
COVERAGE LIKE OUT TO COVER
CALIFORNIA THE MARKETPLACES
THAT'S THE DIFFERENCE BETWEEN
THE RED LINE IN THE BLUE LINE
THERE'S THAT JUMP. THAT RED LINE
WAS THE TWO YEARS PRIOR TO THE
AFFORDABLE CARE ACT.
TERMS OF THINKING ABOUT THESE
CARS EXITING THE HIGHWAY FROM
UNINSURED STATUS INTO THE MARKET
PLACES AND THE BLUE LINE IS THAT
TWO YEARS FOLLOWING THE
AFFORDABLE CARE ACT'S COVERAGE.
LIKEWISE WE'VE SEEN THE SAME
DYNAMIC WITH MORE PEOPLE THAT
WERE UNINSURED OBTAINING.
PUBLIC COVERAGE.
SOONER.
IN IN PROGRAMS LIKE MEDICARE
AGAIN THE DIFFERENCE BETWEEN THE
RED LINE BEING THE PRE ACA LINE
AND THE BLUE LINE BEING.
POST A CA LINE.
THERE'S TWO OTHER THOUGHT
DYNAMICS THAT A CHANGE WITH THE
AFFORDABLE OR NOT CHANGED WITH
AFFORDABLE CARE ACT I SHOULD
SAY.
ONE CONCERN OF A EXPANSIONS A
PUBLIC COURAGEOUS IS THAT THERE
ARE GOING TO BE INDIVIDUALS THAT
HAVE AYE. TO EMPLOYER BASED
OFFER OF INSURANCE BUT WHO ALSO
BECAUSE OF THEIR INCOME WOULD BE
ELIGIBLE FOR THAT PUBLIC OPTION
IT FOR THAT PUBLIC PUBLIC
COVERAGE IN WOULD TAKE IT UP
BECAUSE IT'S CHEAP.
THIS IS KNOWN AS CROWD OUT THE
IDEA BEING THAT.
ITS IT'S.
.
ABOUT YOUR UTILIZING TAX
RESOURCES TO GIVE INDIVIDUALS
COVERAGE THAT WOULD HAVE
COVERAGE THROUGH AN EMPLOYER THE
PRIVATE SECTOR WOULD A PROVIDED
THEM ANYWAY SO TO COVER ALL OF
THE UNINSURED. IT TAKES MORE.
IT TAKES MORE THAN JUST
COVERING THOSE UNINSURED BECAUSE
THEY'RE GOING TO BE INDIVIDUALS
THAT COULD HAVE GOTTEN AYE
COVERAGE ELSEWHERE ON THE PRICE.
WHAT WE'VE ACTUALLY SEEN IN THIS
WAS A CONCERN A WITH ANY
COVERAGE EXPANSION LET ALONE
JUST THE ACA? IS THAT THEY'RE
ACTUALLY HAS NOT BEEN VERY MUCH
EVIDENCE OF THIS CROWD OUT WITH
THE IN PARTICULAR EXPANSES OF
MEDICAID TO LOWER INCOME ADULTS.
ANOTHER DYNAMIC WE'VE SEEN.
IS THAT TRANSITIONS FROM
EMPLOYER BASED COVERAGE TO
UNINSURED STATUS HAVE NOT
CHANGED.
WHAT THAT MEANS IS THAT
INDIVIDUALS THAT ARE LOSING
THEIR PLAYER BASE POLICIES FOR
WHATEVER REASON WHETHER THEY
DON'T KNOW ABOUT IT WHETHER THE
SUBSIDIES ON AND OFF?
?
OR WHATEVER IT IS THEY'RE JUST
NOT FINDING THE MARKET PLACES OR
EVEN PUBLIC COVERAGE AN
ATTRACTIVE OFFER TO THEM AND
THIS IS BEEN A SURPRISE TO US.
I LIKE TO SPEND A COUPLE MINUTES
TALKING ABOUT THE CONSEQUENCES
OF HAVING SET THE STAGE FOR HOW
MUCH TURN THERE'S AN ASSIST.
SOME RESEARCH FROM OTHERS ARE
CALLING UP AT HARVARD PUBLISHED
LAST YEAR.
FOUND THAT INDIVIDUALS ARE
TRANSITIONING OFF OF PRIVATE
PLAN.
THEIR UTILIZATION OF PRIMARY
CARE SERVICES WENT UP FORTY
SEVEN PERCENT IN THE MONTHS
FOLLOWING THAT TRANSITION FROM A
PRIVATE PLAN.
INDIVIDUALS THAT ARE
TRANSITIONING OFF OF MEDICAID
THEIR PRIMARY CARE UTILIZATION
WENT UP TWO HUNDRED AND THREE
PERCENT.
AND THEN LEVELED OFF EVENTUALLY
OVER TIME.
EDIE VISITS AMONG THOSE A
SWITCHING OFF OF THE MEDICAID
PROGRAM WHAT FIFTEEN PER.
AND THIS SPEAKS TO OUR A COMMON
THEME THAT WE HEARD TODAY.
WHICH IS THAT AS YOU'RE
TRANSITIONING FROM ONE PLANT TO
ANOTHER A ONE PLAN TO UNANSWERED
STATUS.
THERE'S NOT ONLY ADMINISTRATIVE
COSTS THAT GO ALONG WITH THAT
BUT CHANGES IN BENEFITS
STRUCTURE CHANGES AND PROVIDER
NETWORKS AND THAT'S REALLY
PLAYING OUT INTO HAVING TO
ESTABLISH. REALLY REESTABLISH
CARE RELATIONSHIPS IN A NEW PLAN
WITH A PRIMARY CARE PHYSICIAN IN
THIS CASE OR JUST NOT BEING ABLE
TO QUICKLY NAVIGATE THIS NEW
HEALTH CARE SYSTEM THAT YOU'RE.
THAT YOU YOU'RE IN WHEN YOU
WEEDS FOR EXAMPLE TRANSITION OFF
OF MEDICAID AND JUST SHOWING UP
IN THE E. D. BECAUSE IT'S A
LITTLE BIT EASIER THAN FINDING.
A AN APPOINTMENT.
ONE STRATEGY THAT.
I'M SURE YOU'VE HEARD ABOUT
THAT INSURERS ARE INCREASINGLY
TURNING TO AS A WAY TO SAVE ON
BOB PLAYING POSSUM PREMIUMS
ASSIST TO TURNING TO NARROW
NETWORKS AND AGAIN THIS IS GONNA
ACT OF THE FINDINGS FROM THE
PREVIOUS SLIDE. BUT RESEARCHERS
FOUND IS THAT EVEN.
THAT NEVER NETWORKS CAN SAVE
THE CAN LOWER PREMIUM COSTS
INDIVIDUALS.
BUT ALL OF THE SAVINGS ARE
CONCENTRATED AMONG PEOPLE WHO
ARE ABLE TO MAINTAIN THEIR
PRIMARY CARE PHYSICIAN AFTER
THEIR SWEAT.
AGAIN SPEAKING TO THESE ISSUES
OF OF INCREASE UTILIZATION AS
PEOPLE RE NAVIGATE THE SYSTEM
UNDER A NEW PLAN.
ONE SURVEY OF INDIVIDUALS ARE
CHURNED ENOUGH THREE STATES
KENTUCKY ARKANSAS AND TEXAS.
SELF REPORTED ARE A THIRD OF
THEM SELF REPORTED EITHER
SKIPPING DOSES OF THE
MEDICATIONS ARE STOP TAKING
MEDICATIONS
DURING THE PERIOD WHERE THEY
EITHER DIDN'T HAVE INSURANCE. OR
IN ADDITIONAL SIXTEEN PERCENT
HAD TO CHANGE THEIR MEDICATIONS
BECAUSE OF CHANGES THAT FORMULA.
JOHN IS VERY IMPORTANT.
AS WE IN PARTICULAR AS WE THINK
ABOUT.
COVERAGE PROVIDED TO THE MARKET
PLACES I IN TERMS OF ITS IMPACT
ON ACCESS TO AND CONTINUITY OF
CARE.
ONE DYNAMIC THAT HAS BEEN I
THINK A LITTLE BIT UNDER
REPORTED IS THAT MANY
MARKETPLACE PLANS OFFER VERY
LITTLE OUT OF NETWORK COVERAGE.
THIS IS IMPORTANT BECAUSE ALL OF
THE FINANCIAL PROTECTIONS PUT IN
PLACE BY THE AFFORDABLE CARE ACT
WHETHER THAT'S.
THE ELIMINATION OF LIFETIME A
BENEFIT CAPS OF THE ANNUAL.
CAPS ON INDIVIDUALS OUT OF
POCKET SPENDING ALL OF THIS
FINANCIAL PROTECTION VIGT THAT
THE ACA PUT IN PLACE.
DO NOT APPLY TO ANY CARE
RECEIVED OUT OF THAT WORK IN
YOUR PLAN.
SO WHAT YOU SEE IS AND THIS.
PLOT ON THE LEFT HAND SIDE OF
THE TOP ONE IS FOR PRIMARY CARE
THIS IS THE PERCENTAGE OF SILVER
PLANS WITH NO OUT OF NETWORK
COVERAGE FOR PRIMARY CARE ON THE
TOP. IF URGENT CARE ON THE
BOTTOM.
THE TWENTY FOURTEEN THE FIRST
YEAR THE MARKET PLACES ABOUT
HALF OF THE SILVER PLANS OFFERED
NO OUT OF NETWORK THERE WERE HMO
PLANS THAT OFFER NO OUT OF
NETWORK COVERAGE FOR. PRIMARY
CARE IN ABOUT A THIRD OF THEM
OFFERED NO OUT OF NETWORK
COVERAGE IF YOU WERE SEE AWAY
FROM HOUSING NEED URGENT CARE.
YOU WERE AT THE WHIMS OF
WHATEVER THEY CHARGED YOU IT WAS
NOT CONSIDERED AN THAT WORK.
WITH YOUR EAR PLAN WOULD NOT
COVER SOME PORTION OF IT.
BY TWENTY EIGHTEEN THESE NUMBERS
ROSE FROM.
FORTY SEVEN PERCENT IN TWENTY
FOURTEEN FOR PRIMARY CARE TO
ABOUT SIXTY SEVEN PERCENT FOR
PRIMARY CARE.
IN TWENTY EIGHTEEN. AND ABOUT
SIXTY ONE PERCENT OF
SILVER PLANS IN THE MARKETPLACES
OFFERED NO OUT OF NETWORK
COVERAGE IN TWENTY EIGHTEEN FOR
URGENT CARE SERVICES.
SO TO THE EXTENT THAT YOU
TRANSITION FROM ONE PLAN TO
ANOTHER AND WANT TO MAINTAIN ANY
EXISTING PRIMARY CARE
RELATIONSHIPS.
THE FINANCIAL PROTECTIONS OF THE
AFFORDABLE CARE ACT ARE NOT
PROTECTING YOU FROM WHATEVER
COSTS THOSE NEIGHBORING.
THE OTHER DYNAMIC THAT I'D
REALLY LIKE TO EMPHASIZE IS THAT
MANY OF US WHO ARE INSURED
THROUGH AN EMPLOYER HAVE ACCESS
TO PROVIDER NETWORKS WITH A VERY
BROAD BROAD FOOTPRINT.
EMPLOYERS GENERALLY TEND TO PICK
PLAY OR OFFER PLANS THAT HAVE A
WIDE PROVIDER FOOT PRINT.
TO OFFER AS MANY CHOICES TO
THERE AND IT TO THEIR.
EMPLOYEES AS POSSIBLE.
BUT WHETHER IT'S THE MARKET
PLACES THROUGH THE RISE OF A
NARROW NETWORKS OR EVEN IN THE
MEDICAID PROGRAM WHERE NETWORKS
TEND TO BE NEAR WHERE NOT ONLY
BECAUSE THEY OF THE USE OF
MANAGED CARE PLANS THAT HAVE.
MORE RESTRICTED NETWORKS BUT
ALSO DUE TO LOWER PARTICIPATION
RATES IN MEDICAID RELATIVE TO
PRIVATE PLANS.
SO THAT THOSE OF US WATCHING OUT
OF EMPLOYER PLANS AND INTO THESE
OTHER.
PLAN ARE REGION'S WHAT IF YOU
MEDICAID OR THE MARKET PLACES
ARE JUST FINDING MUCH MORE
NARROW NETWORKS THAN WHERE YOU
STILL AND THAT'S GOING TO HAVE.
IT'S GONNA AMPLIFY OF THE
IMPLICATIONS IN TERMS OF
UTILIZATION AYE COSTS AS AS WE
TRY TO RE NAVIGATE A A NEW
HEALTH.
PLAN.
IN THE WAKE OF THE CHANGE.
I'M GONNA GIVE YOU A
VISUALIZATION IN JUST A MINUTE
BUT I WANT TO SET YOU UP FOR
THIS. JUST TO SHOW YOU HERE
LOCALLY WHAT IT LOOKS LIKE FOR
SOMEBODY CHANGING MARKETPLACE
PLANS AND WHAT WOULD. WHAT WOULD
MEAN FOR THEIR PRIMARY AND
ACCESS TO PRIMARY CARE?
YOU CAN THINK OF THIS
VISUALIZATION HERE ON THE LEFT
IS THIS KIND OF HUB AND SPOKE
MODEL OF A OF A PRIMARY CARE
NETWORK FURNITURE THE INSURER
BEING THERE IN THE MIDDLE. IN
VARIOUS PRIMARY CARE PHYSICIANS
IN THE GEOGRAPHIC AREA.
THAT ARE IN THAT WORK FOR THAT
PLAN THERE IS THE SPOKES ARE
COMING OUT OF THAT HUB.
ON THE RIGHT YOU'RE GONNA SEE
WHAT THAT'S GOING TO LOOK LIKE
FOR HERE IN SACRAMENTO FOR ONE
PLAN IS ACTUALLY GONNA BE
KAISER.
TO YOU CAN SEE THE IN NETWORK
PCP IS THIS THE SMALL DOTS IN
THE ENSURE THERE IN THE MIDDLE.
THIS IS WHAT THE PRIMARY CARE
NETWORK LOOKS LIKE FOR
SACRAMENTO COUNTY AND TWENTY
SEVENTEEN.
AND WHAT YOU CAN SEE IS KAISER
THERE'S A STAFF MODEL HMO
BASICALLY EXISTING OUTSIDE OF.
THE NETWORKS OF THE OTHER
SYSTEMS.
BUT IF YOU ARE FOR EXAMPLE
INSERTED THROUGH SADR WHICH IS
HERE ON THE LOWER. LEFT IN YOUR
PRIMARY CARE WAS IN YOUR PRIMARY
CARE PHYSICIAN WAS A NETWORK AND
YOU WANTED TO SWITCH TO ANY ONE
OF THESE PLANTS.
IT'S VERY UNLIKELY THAT YOU
WOULD FIND THE A PRIMARY CARE
PHYSICIAN WAS IN THAT WORK FOR
THOSE OTHER PLANTS.
EVEN PLANS OFFERED BY THE SAME
ENSURE SUCH AS ANTHEM HERE.
WE'RE GONNA HAVE VERY DIFFERENT
PROVIDER NETWORKS.
AND IF THIS IS VICENTINA
COMPLICATED. THAT'S BECAUSE THIS
IS VISENTINI VERY COMPLICATED.
SO CHARMED AMONG THE.
BOTH INDIVIDUALS AND PLANTS AS
WE HAVE PLANNED EXITING AND
ENTERING EVERY YEAR PUTS AN ONUS
ON REGULATORY AND POLICY
APPROACHES TO ENSURE ACCURATE
AND ACCESSIBLE PROVIDER
NETWORKS.
IT'S IMPORTANT TO KNOW THAT WE
FACE CHALLENGES FROM THESE THIS
TURNOVER IN TURN MATTER WHERE WE
GO FOR HERE FROM HERE.
AS EMPLOYER BASED COVERAGE
BECOMES LESS PREVALENT.
MORE INDIVIDUALS ARE GOING TO
RELY ON COVERAGE OUTSIDE OF
EMPLOYMENT THROUGH THE
MARKETPLACES AS THEIR PRIMARY
SOURCE OF INSURANCE
EITHER THE TRANSITION AREA
POLICY IS THEY'RE GOING IN
BETWEEN JOBS. OR AS A PERMANENT
POLICY MOVE FORWARD.
ENSURE WITHDRAWALS MEANS THAT
MEET PEOPLE MUST SWITCH PLANTS.
SO EVEN IF THEY DIDN'T WANT TO
THEY'RE GONNA HAVE TO SEE
CHOOSE A NEW PLAN TO HAVE ONE
AUDIO ASSIGNED TO THEM THAT MAY
OR MAY NOT HAVE THE SAID THEIR
SIDE OF PROVIDERS IN THAT WORK.
BUT EVEN IF WE GOT TO THE KIND
OF.
.
I DEAL A LEASE IN THE
COMPETITIVE SENSE OF HAVING A
COMPETITIVE MARKET.
IT'S GONNA RELY ON PEOPLE
SHOPPING AROUND FOR NEW
INSURANCE PLAN EVERY YEAR.
AND WHAT THAT MEANS IS PEOPLE
ARE GOING TO HAVE TO HAVE GOOD
INFORMATION ON WHETHER OR NOT
THEIR PRIMARY CARE PHYSICIAN
THEIR CARDIOLOGISTS. OR EVEN
JUST A.
HOSPITAL THAT THEY MAY OR MAY
NOT HAVE EVER USED IS IN THAT
WORK IN ONE PLAN VERSUS ANOTHER.
SO I THINK THE COMMON THREAD
RUNNING THROUGH ALL OF THE
POLICY SOLUTIONS TO THIS.
THE BASIS FOR INFORMED CONSUMER
AND PATIENT CHOICES OF
INFORMATION.
AND AS THE STATE THE FEDERAL
GOVERNMENT UNDER THE AFFORDABLE
CARE ACT NOT ONLY UNDER
PRESIDENT OBAMA BUT ALSO UNDER
PRESIDENT TRUMP HAS LARGELY
DEFER TO STATES TO DECIDE HOW TO
DEFINE THESE THESE NETWORK
ADEQUACY. AND NETWORK.
REGULATION THIS YEAR.
BUT THE TOP THE TOP LINE FOR ME
IS THAT ENSURING ACCURATE AND UP
TO DATE PROVIDER DIRECTORIES IS
KEY TO WHATEVER STRATEGY YOU USE
BUT BEFORE.
SO THERE'S THREE P. QUESTIONS
THAT I WOULD PUT OUT TO YOU.
TO KEEP AN EYE ON MOVING
FORWARD.
FIRST WE'RE WAITING REGULATORY
GUIDANCE FROM THE TRUMP
ADMINISTRATION ON THE USE OF SO
CALLED SHORT TERM INSURANCE
PLANS.
SHORT TERM INSURANCE PLANS HAVE
EXISTEDALONGSIDE THE ACA EVER
SINCE IT WAS ENACTED IN AND AND
AND PUT IN PLACE IN TWENTY
FOURTEEN.
BUT THE OBAMA ADMINISTRATION
REALLY.
CRAMPED DOWN ON THE ABILITY OF
INDIVIDUALS TO USE SHORT TERM
PLANS WHICH ARE NOT COMPLIANT
WITH THE ACA'S REGULATORY
GUIDELINES ON ESSENTIAL HEALTH
BENEFITS AND THINGS THAT ARE
NOT.
LEASE UNDER IT PREVIOUSLY WHEN
THEY WERE NOT COMPLIANCE IN THE
TERMS OF.
COMPLYING WITH THE INDIVIDUAL
MANDATE YOU IF YOU BOUGHT ONE OF
THESE SHORT TERM PLANS WHICH
GENERALLY UNDER RIGHT THEY HAVE
MUCH.
SKIP YOUR BENEFIT STRUCTURES
ETCETERA YOU BOUGHT ONE OF THESE
THINGS YOU HAD TO PAY THE
MANDATE PENALTY
IT WAS NOT COMPLY
PLAN.
NOW WITH THE ELIMINATION OF THE
MANDATE THE BRAKES HAVE
BASICALLY BEEN TAKEN OFF OF THE
SHORT TERM PLANS AND WE'RE
EXPECTING FURTHER REGULATORY
GUIDANCE. ON THAT'S GOING TO
ALLOW PEOPLE FOR EXAMPLE TO
STRING TOGETHER MANY SHORT TERM
PLANS
YOU KNOW A THREE MONTH PLAN A
SIX MONTH PLAN THERE'S EVEN
PLANS.
THAT LAST FOR THREE HUNDRED AND
SIXTY FOUR DAYS.
OF SHORT TERM INSURANCE.
AND SO THIS IS GOING TO BE
SOMETHING I'M WORTH KEEPING AN
EYE ON.
THE OTHER.
ITEM AS I MENTIONED IS
MANDATING.
OR A QUANTITATIVE PROVIDER
NETWORK ADEQUACY STANDARDS WHICH
A LARGELY IN THE CONTROL OF
STATES AS IT PERTAINS TO HOW
THEY APPLY. TO THE ACA PLANS ARE
IN THE US AND.
EXPANSION OF CONSUMER
INFORMATION TOOLS TO MAKE SURE
THAT INDIVIDUAL SHOPPING FOR
INSURANCE PLANS HAVE ACCESS TO.
AN UP TO DATE.
PROVIDER NETWORK.
ANOTHER OPTION AVAILABLE TO
STATES ARE ONLY TWO OF WHICH
HAVE TAKEN UP ARE THUS FAR.
WOULD BE NEW YORK IN MONTANA IS
SO CALLED TWELVE MONTH
CONTINUOUS ELIGIBILITY FOR
MEDICAL ADULTS MEANING THAT ONCE
YOU'RE. DEEMED ELIGIBLE FOR THE
MEDICAL PROGRAM.
YOU ARE THEN ELIGIBLE FOR THE
REMAINING OF FOR A TWELVE MONTH
PERIOD AS OPPOSED TO IF YOU HAVE
A LIFE OR INCOME CIRCUMSTANCE
CHANGE THAT MIGHT MAKE YOU
INELIGIBLE AT SOME POINT THE
FUTURE.
.
IT REQUIRES THAT AN AMENDMENT TO
YOUR STATE PLAN BUT IT IS AN
OPTION AVAILABLE.
THANK YOU.
BOB THANK YOU VERY MUCH THANK
YOU OP ALL YOU PANEL SOME OF
LIKE TO OPEN IT UP FOR QUESTIONS
FROM THAT DíAS.
MISTREATMENT.
I THINK YOU OFFER. UMPIRE HAVE.
QUICK QUESTION. THANK HER FOR
MISS KAUFMAN BUT THE FIRST ONE
THE POSITION SHORTAGE THAT YOU
REFERENCED IS THAT PARTICULAR TO
CALIFORNIA OR IS THAT NATIONWIDE
NOW THERE IS A DIFFERENCE IN
CALIFORNIA FROM WHAT WE'RE
SEEING OTHER PLACES.
OKAY SO IS THERE A DIFFERENCE
BETWEEN CALIFORNIA AND THE REST
OF THE U. S. WELL I THINK THIS.
.
THE AGING OF THE FISHES XIN
WORKFORCE IS A NATIONAL
PHENOMENON.
IS DATA SAID OUR SUPPLY OF
PHYSICIANS.
ASH ALSO SAY THAT THE
DIFFERENCE BETWEEN URBAN AND
RURAL AREAS IS A NATIONAL
PHENOMENON WHERE EVER GO ACROSS
THE NATION RURAL AREAS. HAVE
FEWER POSITIONS IN URBAN AREAS
BUT RELATIVE TO OTHER STATES TO
TAKE WHERE ANY IN A WORSE
POSITION.
THEN THEN MANY THAN MANY STATES
BUT NOT BY NO MEANS THE WORST
AND WHY DO YOU THINK THAT IS.
I'M.
YOU KNOW I DON'T KNOW THAT WE
HAVE A GOOD REASON I THINK ONE
REASON MAY BE THAT WE.
A HAVE LESS.
MEDICAL EDUCATION CAPACITY
RELATIVE TO THE SIZE OF OUR
POPULATION THAT MANY STATES AND
IN BOTH THE MEDICAL SCHOOL
LEVEL.
AND THE RESIDENCY LEVEL THAT IF
YOU LOOK AT A PLACE LIKE IN NEW
YORK NEW YORK I THINK IS WHAT AT
THE OTHER EXTREME YOU MIGHT SAY
THEY'RE GOING OVER CAPITALIZE
BUT COMPARED TO SAY. A TEXAS OR
FLORIDA WHICH HAS HAD MUCH MORE
SUBSTANTIAL.
GROSS IN MEDICAL EDUCATION OVER
THE LAST DECADE WE'RE UNDER
CAPITALIZED.
PAN AND THE SECOND QUESTION IS I
WAS ARE VERY INTERESTED IN YOUR.
NURSE PRACTITIONER DR.
.
SLIDE WE WE GET SOME LEGISLATION
LAST YEAR TO TRY TO.
HELPING CREE SOME ABILITY FOR
NURSE PRACTITIONERS TO PRACTICE
AND I'M JUST WONDERING IF YOU
HAVE ANY COMMENT WHETHER THERE'S
ANY EVIDENCE.
ABOUT.
.
KIND OF.
THE MODEL OF OF AREAS THAT
UTILIZE MORE NURSE
PRACTITIONERS.
FOR WHAT DOCTORS ARE DOING IN
OTHER PLACES IN TERMS OF HOW
COME.
SO I THINK I AM STUDIES THAT
HAVE MADE HEAD TO HEAD
COMPARISONS OF PRIMARY CARE
PHYSICIANS AND NURSE
PRACTITIONERS. AND PHYSICIAN
ASSISTANTS WHEN LOOKING WITHIN
THEIR SCOPE OF PRACTICE MEAN
LOOKING AT THOSE THINGS THAT IN
PEACE MPAS IMPRESSED PRIMARY
CARE PHYSICIANS ARE ALL. TRAINED
TO DO THAT THERE REALLY AREN'T
SIGNIFICANT.
DIFFERENCES.
IS WALDRON.
THANK YOU MISTER CHAIR.
.
A COUPLE QUICK QUESTIONS.
FROM MISTER PEROT. IN YOUR OF
PRESENTATION.
.
I JUST OF TWO QUESTIONS LONG WAS
REGARDING THE PROVIDER
PARTICIPATION.
.
NOT ENOUGH PHYSICIANS ACCEPTING
NEW.
NEW MEDI CAL PATIENTS.
.
THAT THE REIMBURSEMENT
REIMBURSEMENT RATES COULD BE
PART OF THAT ANOTHER ISSUE WAS
GETTING REFERRALS TO SPECIALTY
CARE.
IN MEDICO.
ACTUATION SO.
THE LACK OF BEING ABLE TO GET
REFERRALS TO SPECIALTY CARE IS
THAT DRIVEN BY THE LACK OF
SPECIALTY CARE PROVIDERS OR IS
IT DO TO REGIONAL ISSUES YOU
KNOW YOU CAN'T. GET TO A
SPECIALIST IN A RURAL AREA AND
IT'S JUST KIND OF AVERAGE. WHAT
WOULD BE?
THE MAIN REASON FOR THAT IT'S.
IT'S IT'S ALL THE ABOVE SO THAT
THAT.
FIRST QUESTION CHILDREN THAT
CHART ON THE LEFT WAS ASKED OF
ALL PHYSICIANS SO ALL THE ALL
THE ANSWERS THERE. WERE ANSWERS
THAT WERE GIVEN BY BOTH PRIMARY
CARE PHYSICIANS AND SPECIALISTS.
SO IT'S IT'S MANY OF THE SAME
REASONS SO IT'S IT'S IT'S
SPECIALISTS ARE NOT
PARTICIPATING IN MEDICARE
PROGRAM FOR.
BECAUSE OF RATES BECAUSE OF THE
ADMINISTRATIVE BURDEN BECAUSE OF
THE OF THE RANGE OF ISSUES AND
THEN CERTAINLY THE GEOGRAPHIC.
THE AGGRIEVED GEOGRAPHIC ISSUE
IS THAT IS AN IMPORTANT ONE.
WHAT ONE OF THE THINGS THAT WE
FIND IN OUR WORK IN?
IN TELEHEALTH IS THAT.
.
WHAT ONE OF THAT ONE OF THE ONE
OF THE CHALLENGES THAT PRIMARY
CARE PHYSICIANS UNDERSTANDABLY
THEY PREFERRED TO REFER TO THIS
AND THEY KNOW THEY KNOW WELL?
AND IF THEY'RE GOING TO REFER
OUT FOR A CONSOLE THEY PREFER IT
THAT.
STATE SPECIALIST ALSO THEN BE
AVAILABLE FOR AN APPOINTMENT.
THAT'S OFTEN NOT NOT.
POSSIBLE CRITICALLY IN RURAL
AREAS.
AND SO THERE IS WE FIND.
SOME.
COURTING TIME.
WHEN ONE INTRODUCES AYE
TELEHEALTH INTO A PRIMARY CARE
PRACTICE OF PHYSICIANS GETTING
TO KNOW ONE ANOTHER IT'S PERHAPS
ONE REASON THAT.
THAT DAY.
E. CONSUL DID YOU REFERRAL
SYSTEMS HAVE WORKED SO WELL IN
SOME OF THE PUBLIC HOSPITAL
SYSTEMS IS BECAUSE THERE IS A
GREATER FAMILIARITY OF THE
PHYSICIANS AMONG EACH OTHER BUT.
SO THERE'S THOSE THERE'S AS
RANGE OF REASONS.
OKAY
AND THEN THE SECOND QUESTION WAS
OF YOU HAVE SOME CHARTS ON PAGE
THIRTEEN OF YOUR. UP PRESENT IT
WOULD JUST SHOW THE QUALITY OF
CARE AND MEDI CAL. MANAGED CARE
SIMILAR TO THE NATIONAL MEDICAID
AVERAGES.
BUT WE'RE NOT IMPROVING WHICH IS
KIND OF THEIR.
ARE THERE ANY STATES THAT ARE
DOING BETTER ARE WHEN YOU LOOK
OVERALL ANOTHER. THIS TYPE OF
THE UNABOMBER LOOKING AT THEY
THINK HE THIS CHART OTHER ANY
OTHER DOING BETTER IS NEW YORK
DOING BETTER SAY THAN.
THEN WE ARE IS IN A SENIOR YEAH
LIKE THAT IT'S HARD TO COMPARE.
.
FOR ALL THE SAME REASONS THAT
IT'S HARD TO COMPARE MEDI CAL TO
OTHER FORMS OF COVERAGE HERE IN
CALIFORNIA BECAUSE OF THE.
DIFFERENCES IN THE POPULATIONS
THE SAME IS TRUE WHEN COMPARING
MANAGED CARE PROGRAMS ACROSS
STATES FOR EXAMPLE SEVERAL YEARS
AGO WE EXPANDED THE MEDICAID
MANAGED CARE PROGRAM TO SENIORS
AND PERSONS WITH DISABILITIES.
AND SO THEY'RE THEY'RE INCLUDED
IN OUR RATES.
AND YOU MIGHT LOOK AT ANOTHER
STATE WHERE THE DOZEN EXPAND ITS
MANAGED CARE PROGRAM.
TO THAT POPULATION AND AND THEY
WOULDN'T BE INCLUDED THE RIGHT
SO IT'S IT'S AGAIN OFTEN APPLES.
TO ORANGES.
COMPARISON.
.
YOU KNOW THAT I WAS STANDING WE
DO SOME SEE SOME STATES.
YOU KNOW THE ONE THAT STICKS
OUT IN MY MIND IS MASSACHUSETTS.
OUT IS.
WRITTEN ONE.
WHO HAS A NUMBER OF UP PLANS
THAT OFTEN WILL WIN AWARDS AND
EVEN IN THE MEDICAID SPHERE?
SO THERE ARE SOME STATES THAT
SEEM TO BE DOING BETTER.
YEAH CASTLES BENCHMARKS.
THE WELL CHILD VISITS. BREAST
CANCER SCREENING
THINGS LIKE THAT.
THERE.
THE DOING BETTER THE WE ARE OKAY
I'M. THEN REALLY QUICK.
DOCTOR COUGHED MOVED.
FOR YEAH YOUR YOUR CHART WHO'S
SHOWING THE.
.
RATIO OF ACTIVE PATIENT CARE
PHYSICIANS PER ONE HUNDRED
THOUSAND.
BY REGION. PART OF MY DISTRICT
IS THE INLAND EMPIRE MOVEMENT I
NOTICE THIRTY FIVE.
PRIMARY CARE PHYSICIANS AND I
KNOW WHEN I MEET WITH MY
PHYSICIANS AND THE RIVERSIDE
MEDICAL ASSOCIATION.
THEIR BIGGEST ISSUE IS
REIMBURSEMENT RATES
BUT THEY ARE SO MUCH LOWER THAN
OTHER AREAS EVEN AROUND THE
STATE. THAT THEY'RE HAVING TO
DEAL WITH.
.
YOU NOBLE WHEN YOU SEE LIKE THIS
IT'S REALLY HIGHLIGHTED.
AND I THINK INTO ONE OF THE
THINGS WE REALLY HAVE TO DO IS
GET. HILL LOOKING AT THAT ISSUE
IS THERE ANYTHING ELSE BESIDE
RATES THAT COULD BE. IMPACTING
THEM BECAUSE YOU KNOW EVEN WITH
DANTICAT ALL THAT PART OF MY
DISTRICT.
PEOPLE CANNOT ACCESS IT AND TO
CALL.
DENTIST WITHIN FIFTY MILES OF.
WHERE THEY LIVE SOUND
SO RIGHT YOU KNOW IT IS A RIGHT
I THINK RATES ARE ARE PART OF IT
AYE I THINK?
IT WILL BE INTERESTING IN YOUR
REGION AT LEAST ON THE MAT ARE
AMONG PHYSICIANS TO SEE WHAT
HAPPENS AS. I AM YOU KNOW YOUR
NEW MEDICAL SCHOOL AT UC
RIVERSIDE.
BEGINS TO GRADUATE IN IS THOSE
FOLKS FINISH THEIR RESIDENCY.
WILL THEY PRACTICE IN THOSE
AREAS OF RIVERSIDE THAT ARE OF
GREATEST.
I NEED.
SO I THINK THEY THINK THAT'S
BEEN ONE AGENT YOU HAVEN'T HAD
AS MUCH COMPARED TO SAY LOS
ANGELES OR SAN DIEGO OR EVEN
AREN'T. YOU HAVEN'T HAD AS MUCH
AND MANY PHYSICIANS IN TRAINING.
IN IN THE LOCAL AREA AND AND SO
I THINK THAT'S ONE THING THAT
PAYMENT IS CERTAINLY CERTAINLY
IN TERMS OF FOLKS WILLINGNESS.
I'VE TO PARTICIPATE IN THE
MEDICARE PROGRAM IS AS MR PEROT
SHOWED. THAT THE A BIG PART IN
INSECT ALSO IN IN TERMS OF NOT
JUST PAYMENT. BUT THE
ADMINISTRATIVE REQUIREMENTS AND
COMPLEXITIES TO PARTICIPATE IN
THE MEDI CAL PROGRAM THAT NOT
ONLY ARE YOU BEING PAID LESS
BUT.
YOU'RE STRUGGLING MORE TO GET
PAID AT ALL.
AND YOU KNOW THAT
UNDERSTANDABLY FOR INDEPENDENT.
PRACTICES WHETHER THEIR
PHYSICIANS R. DENNIS TENDS TO
MAKE FOLKS FRUSTRATED UNHAPPY
AND SOMETIMES SAY.
NO I'M NOT WILLING TO
PARTICIPATE IN THE PROGRAM IT'S
TOO MUCH HASSLE.
AND JUST REAL QUICK THE SECOND
UNDER.
.
WHICHI THOUGHT WAS EXCELLENT
STRATEGIES FOR EXPANDING THE
PRIMARY CARE CAPACITY OF MORE
THAN ONE OF THE FIRST THINGS IS
EXPANDING TRAINING IN MEDICAL
SCHOOL AND RESIDENCY.
.
YOU KNOW WHAT WE'VE SEEN AND I
HAVE WRITTEN NUMEROUS CLINICS IN
MY DISTRICT BECAUSE I ACTUALLY
HAVE SOME OF THE LOWEST INCOME.
RIGHT CENSUS TRACKS IN THE
NATION IN MY MY DISTRICT.
THE LACK OF ABILITY TO GET
REFERRALS IS THE KEY THAT'S WHY
IT'S KIND SPARKED MY INTEREST.
BUT WHEN YOU'RE IN A CLINIC YOU
KNOW HOW HOW DO WE DO WITH THE
CHRONIC CARE ISSUES.
IF WE ARE YOU WORKING IN ONE
WITHOUT SOME SPECIAL SO SO SOME
SPECIALISTS.
EXPANDING THE TRAINING TO GET
SOME KNOWLEDGE OF CHRONIC CARE.
ALLERGY.
YOU KNOW I'M TREATMENTS.
THE OPIOID CERTIFICATIONS ARE
SO NEEDED.
EVEN EIGHT AIDS HIV WHEN YOU
HAVE A PATIENT COME IN EVEN
BEING ABLE TO COUNSEL THEM AND
IN A PRIMARY CARE SIX SO
CRITICAL.
YES NOW I THINK IT'S ACRE OF
SORTS A FEW THINGS THERE.
MR PRONE.
TOUCHED UPON THE POTENTIAL OF
TELEHEALTH E. CONSOLES AND YOU
DON'T CERVANTES HER MEANS HERE
FRANCISCO IN LOS ANGELES THAT
YOU CONSULTAR PROVIDED A WAY FOR
THE PRIMARY CARE PHYSICIANS TO
INTERACT WITH SPECIALIST
POSITIONS WHO ARE OFF.
SITE AND GET THAT COACHING
THERE'S ALSO A MODEL WE HAVE IN
CALIFORNIA STARTED IN NEW MEXICO
BUT BUT EXPORTED AROUND THE
NATION AND THE WORLD WHICH IS
CALL PROJECT ECHO WHICH IS A
MODEL FOR THE SHERATON LEARNING.
PARTNERSHIP BETWEEN PRIMARY
CARE PHYSICIANS AND SPECIALISTS
THAT REALLY.
WORKS ON UPSCALING PRIMARY CARE
PHYSICIANS TO ENHANCE THEIR
CAPACITY TO MANAGE PEOPLE WITH
PARTICULAR ILLNESSES
STARTED WITH HEPATITE HABSI IN
IS GOING TO HIV MANY OTHER.
OUGHT CONDITION SO THOSE ARE
GOOD MODELS THAT THE SECOND
THING I WOULD POINT OUT AND A
LOT OF OUR CLINICS I THINK ARE
QUITE SAVVY ABOUT THIS IS WHEN
IT COMES TO MANAGING CHRONIC
ILLNESS.
THE REFERRALS AND AVAILABLE TO
SPECIALISTS ARE NOT THE ONLY
THING THAT MATTERS PARTICULARLY
FOR OUR CHRONIC ILLNESSES FOR
WHICH.
R.. BEHAVIOR R. ABILITY TO
MANAGE MEDICATION REGIMEN MANAGE
OUR DIET.
THOSE ARE SENSITIVE PHYSICAL
ACTIVITY.
THAT FOR GETTING FOLKS TO MANAGE
THOSE PARTS OF THE ILLNESS.
PEOPLE LIKE HEALTH COACH ISN'T
COMMITTEE HEALTH WORKERS THAT
THESE FOLKS PARTICULARLY. IF
THEY'RE FROM THE SAME COMMUNITY
THE SAME. SPEAK THE SAME
LANGUAGE SAME RACIAL ETHNIC
GROUP THAT OFTEN THOSE FOLKS.
GET MOR TRACTION THAN EITHER A
PRIMARY CARE PHYSICIAN OR
SPECIALIST IN HELPING PEOPLE DO
THE THINGS THEY NEED TO DO TO
MANAGE THEIR OWN ILLNESS AND AS
A WATER CLINICS ARE. ARE ARE
SAVVY ABOUT THIS OUR MEDICAID
PROGRAM COULD BE SAVVIER IN
REIMBURSING.
FOR THOSE SERVICES SO THAT ALL
OF OUR.
CLINT FEDERALLY QUALIFIED HEALTH
CENTERS WILL HAVE MAKES
CAN HAVE THE ABILITY TO HIRE
PERMANENTLY THE KIND OF STAFF
WHO CAN WORK WITH THEIR PATIENTS
ON CHRONIC ILLNESS MANAGEMENT.
SURGICAL.
PROFESSOR COFFIN I WANT TO THANK
YOU FOR FOR YOUR PRESENTATION
AYE AYE.
THIS IS A TOPIC I THINK
THOSE OF US WHO'VE BEEN FOCUSED
ON HEALTH CARE HERE IN THE
LEGISLATURE BUT THINKING ABOUT
BUT OFTEN HAS GOTTEN LOST IN THE
LARGER DEBATE AROUND. WHAT TO DO
WITH THE HEALTHCARE SYSTEM AND?
AYE I HAVE A JUST A COMMENT AND
THEN A.
A QUESTION THAT THE COMMENT IS.
AYE I THINK AND I MY GUESS IS
OUR COLLEAGUES WILL AGREE THAT
WHATEVER WE END UP DOING IF
THERE'S A PACKAGE OF BILLS AND
MOVE FORWARD IN THIS AREA. WE
REALLY SHOULD THINK HARD ABOUT
INCLUDING SOME ELEMENTS OF OF
HOW WE ADDRESS SHORTAGES
PROVIDER SHORTAGES.
IT IN DIFFERENT PARTS OF THE
STATE.
HOW WE THINK ABOUT THE FUTURE
OF OF OF EDUCATION HOW WE THINK
ABOUT?
R. SHORTAGES WHEN IT COMES TO
NURSE PRACTITIONERS AND.
PHYSICIAN ASSISTANTS
ECCENTRICITIES PROBABLY AN
OBVIOUS POINT BUT ONE THAT I
THINK OFTEN GETS LOST IN A. ONE
I THINK THE CHAIRS FOR OF REALLY
INCLUDING YOU AS PART OF THIS
THIS PANEL. NAM WHEN I WAS GOING
THROUGH YOUR PRESENTATION YOU
USE LANGUAGE LIKE NEED TO KNOW
WHAT ARE THE STRATEGIES WE NEED
TO EMPLOY AND AND THERE'S. THEIR
PROJECT.
BROAD PHRASES WE NEED TO AUGMENT
STRATEGIES TO INCENTIVIZE NEW
GRADUATES RETAIN PHYSICIANS
THINK ABOUT HOW TO GET MORE
PRIMARY CARE DOCTORS STRATEGIC
PLANS THAT ENGAGE MULTIPLE
STAKEHOLDERS. IS THERE. ARE IS
OUR COMPREHENSIVE PLAN THAT
EXISTS OUT THERE MEAN COULD YOU.
ARE OR ARE THERE OTHERS WHO
WOULD BE ABLE TO SAY WHAT WOULD
WE NEED TO DO TO CHANGE THE
BALANCE.
PRIMARY CARE DOCTORS FIRST
SPECIALIST TO GET THE THAT THAT
THE NUMBERS THAT WE NEED IN THE
RIGHT PLACES.
I'D LOVE TO KNOW IF IF THERE'S
CONSENSUS ON ON WHAT THAT WOULD
TAKE HOW MANY MORE MEDICAL
SCHOOLS WHERE WOULD THEY BE
WATER BELONGED FORGIVENESS
PROGRAMS THESE ARE ALL DETAILS
THAT WE KNOW WE HAVE TO WORK OUT
BUT MY GUESS IS.
LIKE YOU.
AND OTHERS HAVE PROBABLY
THOUGHT HARD ABOUT THIS ALREADY
SO THAT'S AN EXCELLENT QUESTION
I THINK AS MR CRONIN I
MENTIONED.
.
PERHAPS YOU OUT OF THE ROOM AT
THAT TIME.
THE CALIFORNIA FUTURE HEALTH
WORKFORCE OF COMMISSION WAS
LAUNCHED THIS PASSPORT FALL.
ASSEMBLYMEMBER WOOD IS A MEMBER
AS IS SENATOR ED HERNANDEZ.
THE OTHER MEMBERS INCLUDE
REPRESENTATIVES OF HEALTH PLANS
EMPLOYERS EDUCATIONAL
INSTITUTIONS.
A UNIONS.
OTHER ORGANIZATIONS AS
INTENTIONALLY A GROUP OF
MULTIPLE STAKEHOLDERS.
WHO'S CHARGED IS TO PRODUCE A
STRATEGIC PLAN FOR HEALTH
WORKFORCE DEVELOPMENT IN
CALIFORNIA.
THE TARGET.
TIME FOR RELEASE OF THAT IS
FALL OF TWENTY EIGHTEEN THE
COMMISSION'S HELD TWO MEETINGS
THUS FAR NEXT MEETING IN
FEBRUARY. ARE IN THE COMMISSION
THAT HAS.
STIRS SUBCOMMITTEES WORKING ON
ISSUES INCLUDING PRIMARY CARE.
MENTAL HEALTH AND CARE FOR THE
AGING POPULATION SO I I THINK
THAT'S THE GROUP ARE THAT'S
TAKING THAT ON AND WITH
ASSEMBLYMEMBER WOULD YOU HAVE A
KIND TO IT. BY TO THAT GROUP.
THERE CERTAINLY MANY OTHER
ORGANIZATIONS THAT ARE ENGAGED
BUT THAT'S REALLY THE I WOULD
SAY THAT THE VEHICLE FOR A
COMPREHENSIVE PLAN AT THIS
MOMENT GRID NO PRESSURE DOCTOR
WOULD BUT. HOW NNOVA CAN FOR TO
THAT THING THAT MUCH SO?
?
MISS COLLETTE.
I APPRECIATED YOUR COMMENT ABOUT
THE.
DELICATE
GRAND.
BARGAIN.
VERY VERY INTERESTING VERY
INTERESTING
STATEMENT THERE.
I'M CURIOUS.
IN YOU KNOW. REPRESENTING A
DISTRICT WHERE HAVE FIVE
COUNTIES.
AND A VERY RURAL DISTRICT AND
THE CHALLENGES WE HAVE AROUND.
PLANNED AVAILABILITY AND COST.
IN OTHER STATES I MEAN YOU
MENTION JUST ACT AS THE STATE
WAS A COUNTY HAVE LIKE THREE
HUNDRED AND TWENTY FOUR PEOPLE
IS THAT RIGHT. NET AND SO HOW
THAT'S A PRETTY PRETTY THIN RISK
POOL.
ONE PERSON GETS A HANG NAIL
THAT MIGHT BE A PROBLEM.
BUT BUT HOW IT IN OTHER STATES
HAVE HAD THEY LOOKED AT
DIFFERENT WAYS OF COOLING DE HAD
HAS STATES MANY DIFFERENT WAYS
OF POOLING THAT BECAUSE. YOU
KNOW IT IS IT IS AN ISSUE PRETTY
CALIFORNIA.
WHICH IS ESSENTIALLY YOU LEAVE
SACRAMENTO YOU GO NORTH IT'S
RURAL OKAY AND SO YET YET WE
HAVE MUCH LOWER PREMIUMS IN IN
SOUTHERN CALIFORNIA HAVE THERE
BEEN MODE MOVEMENTS IN OTHER
STATES A SALE OKAY. PLANS.
THIS IS THE WAY IT'S GOING TO BE
AND WE'RE GONNA PULL ALL RURAL
PEOPLE AND MAKE THEM INTO ONE
POOL OR AT THAT HAVE THERE BEEN
OTHER STRATEGIES BECAUSE IT IS
IT IS EXTREMELY FRUSTRATING.
THAT.
YOU KNOW I'M THE PEOPLE OF MY
COMMUNITIES ARE NO LESS HEALTHY
THAN THE PEOPLE IN OTHER PARTS
OF LOS ANGELES YET WE'RE PAYING
HIGHER PREMIUMS AND THAT'S IN
THERE'S A FUNDAMENTAL.
UNFAIRNESS THERE SO HELP ME WITH
HELP ME WITH YEAH SURE SO WHEN
WE LOOK AT SOME OF THE ACTIONS
OF OTHER STATES I'M CERTAINLY
YOU MAY ALREADY HEARD ABOUT THIS
AND NUMBER STATES HAVE LOOKED AT
REINSURANCE ON WHICH IS
ESSENTIALLY INSURANCE FOR THE
INSURANCE COMPANIES BUT WHAT IT
DOES. IS IT IT.
AID ESSENTIALLY.
FOR SAY FOR EXAMPLE FOR US
SMALL.
RISK POOL. WHERE YOU HAVE A HIGH
COST PERSON WITH HEMOPHILIA OR?
HIV AIDS ARE YOU THOSE WRITTEN
MILLION PLUS DOLLAR CONDITIONS.
IT ESSENTIALLY.
.
PROVIDES A QUESTION.
TO PROTECT THOSE IN CHARGE FROM
THAT REALLY EXTRAORDINARILY HIGH
COST.
GROUP OF PATIENTS SO FOR
EXAMPLE ALASKA AYE IMPLEMENTED A
REINSURANCE PROGRAM IN TWENTY
SEVENTEEN.
THEY WENT FROM PREMIUM
INCREASES OF ABOUT FORTY NINE
PERCENT TO NINE PERCENT SO THEY
REALLY BROUGHT THOSE PREMIUM
INCREASES DOWN.
VERY SUBSTANTIALLY BY
IMPLEMENTING A REINSURANCE
PROGRAM.
A STATE LIKE WASHINGTON AS I'M
ALSO LOOKING AT REINSURANCE BUT
THEY ALSO ARE LOOKING OUT THOSE
RATING REGION'S RIGHT.
AND YOU KNOW RIGHT NOW THE
EVERY STATE IN CALIFORNIA AS YOU
KNOW HAS NINETEEN RATING REGIONS
BUT DIFFERENT STATES APPROACH
THEIR RATING REGIONS IN
DIFFERENT WAYS AND SO WASHINGTON
AND.
IS IS LOOKING AT COULD THEY
WERE REDESIGNED THOSE RATING
REGION'S THOSE GEOGRAPHIC RATING
REGIONS TO MAKE IT.
TO MORE ADEQUATELY ALLOW.
CARRIERS TO PRICE FOR THE REST
THAT THEY FACED IN THOSE REGIONS
SO WASHINGTON MIGHT BE ANOTHER
STATE TO LOOK AT.
IN AS YOU'RE TALKING THAT WE'RE
TO TALK TO LIVE ABOUT THE PUBLIC
OPTION IF YOU'RE IF CALIFORNIA
WOULD LOOK AT A PUBLIC AUCTION
OPTION WHAT WOULD YOU FOR MEDI
CAL. AND WHAT WOULD YOU HOW
WOULD YOU SUGGEST WE CRAFT THAT.
TOILETS WITH EVERYTHING
HEALTHCARE POLICY OF COURSE THE
DEVIL'S IN THE DETAILS ON THE
MEAN ONE APPROACH AND AND THAT'S
INTERESTING OF COURSE BECAUSE
I'M I WAS POINT OUT WHEN.
I'M TALKING TO REPUBLICANS.
IN WASHINGTON DC IS THAT IN
FACT THE REPUBLICAN LED CONGRESS
WHEN THEY CREATED THE MEDICARE
PART D. PROGRAM CREATED A PUBLIC
OPTION FALL BACK. IN THAT
PROGRAM AND THE IDEA WAS IF THEY
COULDN'T GET A PRIVATE CARRIER
TO PARTICIPATE THERE WOULD BE
THIS.
PUBLIC OPTION AND THAT WOULD
COME IN AND PRIDE AND IT TURNED
OUT MEDICARE PART D. DIDN'T NEED
IT THEY HAD ENOUGH PRIVATE
INSURERS BUT THE POINT IS THAT
THERE WAS. THIS WAS A REPUBLICAN
IDEA. BUT.
CERTAINLY IN A IN A STATE COULD.
SET UP A FALLBACK OPTIONS SO
THAT IF THEY COULDN'T GET A
PRIVATE INSURER TO CON MEN THERE
MIGHT BE AN ENTITY THAT WOULD
CONTRACT WITH THE STATE. I'M NOW
THERE ARE COMPLICATED ISSUES
ABOUT HOW YOU SET UP PRABHAT. AT
WORK HOW DO YOU REIMBURSE
PROVIDERS
HOW DO YOU DO CLAIMS
ADMINISTRATION WHO BEARS THE
RISK SO THOSE ARE ALL KINDS OF
QUESTIONS YOU WANT TO GET INTO
BUT THAT MIGHT BE ONE OPTION ON
YOU MAINTAIN THE CURRENT
STRUCTURE BUT YOU SAID LOOKING
FOR DOWN TO ONE CARRIER? OR
THERE'S A RISK OF NO CARRIER
WE'RE GONNA HAVE A THE STATE
STEP IN AND PROVIDE THAT
COVERAGE.
OF MIST MISTER PRONE.
BUT KIND OF FOLLOW UP ON MISS
WALDRON'S QUESTION WE TALKED
ABOUT.
ONE OF THE CHALLENGES THAT
PHYSICIANS IN A PRIMARY CARE
PHYSICIANS HAVE WHY NOT
PARTICIPATE IN THE MEDICARE
PROGRAM IS THE. IS THE LACK OF
OF AVAILABILITY OF SPECIALISTS
SO AS A PARTICIPATION PRIMARY
CARE. PARTICIPATION VERSES
SPECIALTY PRODUCE PARTICIPATION
WHAT THE PERCENTAGE OF PRIMARY
CARE POSITIONS THAT PARTICIPATE
IN MEDI CAL VERSUS THE
PERCENTAGE OF. SPECIALTY
PHYSICIANS WHO PARTICIPATE DO
YOU HAVE THAT NUMBER YOU'VE
GIVEN US UNCLOG A GROUP NUMBER
BUT. BUT MY INSTINCT IS THAT A
WHOLE LOT MORE PRIMARY CARE FOR
PROVIDERS PROVIDE YOU
PARTICIPATE AND A WHOLE LOT LESS
SPECIALISTS IS THAT A FAIR
CHARACTERIZATION DO YOU HAVE
THAT NUMBER.
THE END IF I MISS IT I'M SORRY.
I'D.
WHICH I WILL.
NEED TO PULL OUT.
THAT DID THAT IT DOES SHOW THAT
WOULD THE RATIOS OF.
OF.
F. F. T. EASE A BOTH.
OF PRIMARY CARE PHYSICIANS AND
SPECIALISTS.
TO THE POPULATION WHICH IS.
THINK EARLY IN THIS.
AND YOU CAN SEE THAT THERE ARE.
THERE ARE MORE.
AS USE HIS OFFICE TO FIND THE
TWO GROUPS THERE ARE MORE
SPECIALIST PARTICIPATING.
AS A RATIO THAT YOU KNOW THAT
AS A RATIO TODAY AND WILL
POPULATION SO THAT'S I'M. ON.
SHOULD BE SLIGHT ELEVEN. OKAY
SKINNY SIDE FIVE.
.
OKAY GREAT THANK.
GO AHEAD PLEASE.
OKAY CAN MEET. UP TO D SO I
THINK IT'S A GREAT QUESTION BUT
I THINK IT'S IMPORTANT TO NOTE
THAT WHEN WE HAVE THOSE TO BE
CLUMPS OF PRIMARY CARE
PHYSICIANS AND SPECIALS WE MASK
A LOT OF VARIATION. WITHIN
SECTION THE SPECIAL THAT WE LOOK
UP MORE NARROWLY EMERGENCY
MEDICINE PHYSICIANS NO SURPRISE
ARE THE MOST LIKELY TO
PARTICIPATE IN THE MEDICARE
PROGRAM BECAUSE QUITE FRANKLY
THEY DON'T HAVE AS MUCH CHOICE
IN TALLEST AS IF A PATIENT
PRESENTS A JUROR ET ISSUE IN
WELL NO. MEMBER OF NAMBLA YOU'VE
GOT IT ASSESS IT WE STABILIZE IN
YOU DON'T ASK QUESTIONS ABOUT
INSURANCE.
AT THE OTHER END OF THE SPECTRUM
WE HAVE PSYCHIATRY LOWEST RATE
OF PARTICIPATION IN THE MEDICAL
PROGRAM A SPECIALITY WHERE.
SOME FOLKS IN THE SPECIALLY
JUST DON'T KNOW PROTECT ANY FORM
OF INSURANCE YOU KNOW NOT NOT
NOT YOU KNOW DOESN'T MATTER
COULD BE THE BLUE PLATED. ANTHEM
PLAN THEY STILL WON'T TAKE IT.
SO.
THAT SEPARATION AND THEN AMONG
PRIMARY CARE PHYSICIANS
PEDIATRICIANS MUCH MORE LIKELY
BY THE AND THE GENERAL
INTERNISTS IN THE FAMILY
PHYSICIANS.
YEAH PLEASE
THING THAT.
AGAIN THE SAME THINK YOU THE
SAME SURVEY THAT THAT JASMINE
APART OUT IS.
THERE'S.
THERE'S CAN SEVERAL VARIATION
IN TERMS OF WHERE PEOPLE
PRACTICE IN THEIR PARTICIPATION
SO IF YOU PRACTICE IN A.
VERY CLEVER HEALTH CENTER
YOU'RE MUCH MORE LIKELY FOR
SPAIN MEDICAL PROGRAM SHIHAD
THEN NOT AND.
IN CHI A KAISER DOCKS MORE SO
PRIVATE PRACTICE STOCKS MUCH
LESS SO.
AND.
TO ENFORCE ON THANK YOU IT'S
ACTUALLY IT'S A PLEASURE WORKING
WITH YOU.
.
A PROFESSOR COUGHLIN ON THE ON
THE ON THE ON THE TASK FORCE WHO
WERE WORKING ON. THE A ONE THAT
YOU TALKED ABOUT THE AGE
DISCREPANCY BETWEEN POSITIONS IN
DIFFERENT TOWNS IN ONE OF MY
COUNTIES A FIFTY PERCENT OF
PHYSICIANS ARE OVER THE AGE OF
SIXTY TWO. AND.
THAT.
THAT THAT MAY BE A HIGH NUMBER
FOR OTHER OTHER AREAS BUT THAT
THAT NUMBER OF OF.
HIGHER AGE PHYSICIANS IN RURAL
COMMUNITIES REALLY IS IS A IS A
IS A IS A REAL REALITY.
AS WE TRANSITION TO SINGLE
PAYER ON WE KNOW IN OTHER
COUNTRIES THAT.
THAT THIRTY PERCENT OF THE FOR
OF POSITIONS TO YOUR ROUGHLY I
MEAN AS A NUMBERS WE HEARD FROM
COMMONWEALTH FOLKS. OF THAT AT
THIRTY PERCENT.
R. ARE PRINT ARE.
OUR EYES SPECIALIST AND SEVENTY
PERCENT PRIMARY CARE.
VERSUS WHAT WE HAVE NOW WHICH
IS JUST THE OPPOSITE SEVENTY
PERCENT OF OUR PHYSICIANS ARE A
ROUGHLY ARE SPECIALISTS IN AND
THIRTY PERCENT OR PRIMARY CARE.
ANY IDEA HOW LONG IT WOULD TAKE
US TO TRANSITION TO TO TO DO
THAT BECAUSE YOU'VE YOU'VE
POINTED OUT VERY QUICKLY THAT WE
IN CáC COMPANY DON'T REALLY
EVEN HAVE THE CAPACITY EDUCATE.
THE NUMBER OF DOCTORS WE NEED TO
MAINTAIN OUR OWN POPULATION
SO.
THE HOW YOU KNOW HOW WE GET
THERE.
AYE I DON'T KNOW THAT I'D I'D
WANT TO HAZARD A GUESS BUT
LIKELY UP SOMETHING ELSE THAT'S
DIFFERENT BETWEEN THE U. S. E.
AND MANY OTHER.
DEVELOPED COUNTRIES IN AND AND
THAT IS WE LARGELY EXPECT OUR
PHYSICIANS TO SELF FINANCE.
THEIR EDUCATION CORRECT
I'D THEY ASSUME A LOT OF THOUGHT
A JET YOU KNOW THE AVERAGE E. I
THINK AT THIS POINT IS ABOUT
HUNDRED NINETIES THAT HUNDRED
NINETY THOUSAND.
.
IT IN MANY OTHER COUNTRIES ARE
THE COST OF MEDICAL EDUCATION IS
HIGHLY SUBSIDIZED FROM YOU KNOW
TUITION IS MUCH.
UP LOW WERE FOR IT FOR MEDICAL
SCHOOL I'M SURE AGAIN THAT MAY
WELL BE ONE REASON WHY THOSE
COUNTRIES.
SUCCEED MORE INTRIGUED MORE
PRIMARY CARE PHYSICIANS.
STUDIES THAT LOOK AT SPECIALTY
CHOICE AMONG U. S. PHYSICIANS
SAY THAT DEBT AND FINANCE IS ONE
OF THE BEST SELLING UP THE ONLY
ONE BUT IT'S IT'S ONE OF THE
MOST IMPORTANT ONES.
SICKENING OTHER COUNTRIES DON'T
HAVE QUITE AS BIG OF A GAP OFTEN
IN.
SALARIES AND REIMBURSEMENT FOR
PRIMARY CARE PHYSICIANS
AN OUNCE BEYOND SPECIALISTS SO
THAT'S ANOTHER PIECE OF IT ARE
IN AND SECONDLY I THINK AND YOU
KNOW I SAY THIS IS. YOU KNOW AS
SOMEONE WHO'S BEEN IN THE
UNIVERSITY CALIFORNIA THAT I
THINK WE.
WE OFTEN IN THE WAY OUR
PHYSICIANS OUR EDUCATED WE
EDUCATE IN A WAY. THAT IT SENDS
A MESSAGE TO OUR MEDICAL
STUDENTS THAT SPECIALTY CARE IS
WHERE IT'S AT YOU DON'T WANT TO
BE A PRIMARY COOPER AND SO
THERE'S THAT CULTURE CHANGE I
THINK ACTUALLY THAT'S THE
HARDEST THAT'S EVEN HARDER. THAN
X. THEN EXPANDING. CAPACITY
SUBSIDIZING EDUCATION.
AND AND CHANGING REVERSED WHICH
ARE HEAVY LIFTS THE CALLED THE
UP BUT THE HARDEST THING
SOMETIME IS TO CHANGE.
INSTITUTIONS.
AND THE FINAL QUESTION I HAVE
FOR A PROFESSOR GRAVES.
THANK YOU.
SEE YOU KNOW WHAT IS YOUR
LOOKING AT SOME OF THE
CHALLENGES WE'RE LOOKING AT THE.
I USE THE WORD BYZANTINE.
NETWORK OF OF OF PEOPLE HOW
THEY GET CARE BASED ON THEIR ON
PLANS AND AND AND NETWORKS.
.
DO YOU THINK IT BE HELPFUL TO
REQUIRE HEALTH PLANS TO HAVE THE
SAME NETWORK. OF PROVIDERS FOR
ALL THE PLANTS.
WELL.
I WOULD START WITH THE PRINCIPLE
I WOULD START WITH IS JUST
INFORMATION AND ACCURACY.
AND THAT THE FIRST STEP IS TO
ENSURE THAT WHATEVER NETWORK
THEY HAVE.
THE THE PEOPLE ARE CHOOSING A
PLAN.
BASED ON GOOD IN CURRENT UP TO
DATE INFORMATION.
SO THAT WOULD BE THE FIRST IF
IF I WOULD GO DOWN THE ROAD.
OF NETWORK REGULATION THAT
WOULD BE THE FIRST STEP THAT I
WOULD HAVE IN THAT PROCESS.
THERE IS.
.
SOME BENEFIT TO HAVING
STANDARDIZE NETWORKS ON THE
OTHER HAND IT HAS BEEN PROVEN.
ARE AT IT IS SHOWN THAT
INDIVIDUALS WHEN SURVEYED ARE
WILLING TO SELECT A PLAN THERE
WILLING TO MAKE THE TRADE OFF
BETWEEN AN AIR OR NETWORK IN A
LOWER PREMIUM.
AND SO.
YOU REALLY HAVE TO KEEP THOSE
ISSUES IN MIND.
WIN.
WHEN THINKING ABOUT STE EITHER
STANDARDIZING NETWORK SOBRE ARE
ARE MANDATING CERTAIN NETWORK
SIZES.
YOU CAN THINK OF.
IN THIS XIN LIKE KAISER.
FOR EXAMPLE A REQUIRING THEM TO
TAKE ON MORE PROVIDERS THAN
THEY.
NECESSARILY WOULD OTHERWISE.
WOULD REQUIRE CONTRACTING WITH
PEOPLE WHO ARE NOT FAMILIAR WITH
THEIR INFORMATION SYSTEMS.
WITH THEIR CARE GUIDELINES
ETCETERA SO THEY ARE CHALLENGES
TO.
THAT THAT SPEAK TO ISSUES OF
QUALITY.
AND COSTS.
THEIR TRADE OFFS.
THAT WOULD BE ASSOCIATED WITH
IT WITH ANY KIND OF.
PARTICULARLY STRONG MOVE
TOWARDS.
KIND OF MANDATED NETWORK.
BUT IT IT'S IT'S BEDEVIL THIS
FOR YEARS IN CALIFORNIA TO TRY
TO GET UP TO DATE PROVIDER
NETWORKS IS OFTEN THE CASE THE
PHYSICIAN DOESN'T EVEN KNOW WHAT
PLAN THEY BELONG TO A. FRIEND
THAT'S THAT IS A PROBLEM FOR FOR
FOR CONSUMERS FOR PATIENTS.
WHO ARE YOU MAY THINK THAT
THEY'RE THEY RECOVERED AND IT
WAS A BIG? BIG CHALLENGE WE WERE
LOOKING AT THE ON HOW TO GET RID
OF THE SURPRISE BILLING ISSUE IN
CALIFORNIA BECAUSE. IT'S SO
CONFUSING OUT THERE AND IN THIS
DAY AND AGE WITH ALL THE
TECHNOLOGY WE HAVE.
TO NOT BE ABLE TO HAVE ACCURATE
PROVIDER NETWORKS IS IS IS
REALLY CONFOUNDING QUITE FRAIL
AYE I LIKE IN IS THAT IF YOU ASK
SOMEBODY TO GET FROM. HERE TO
ANY POINT IN CALIFORNIA IT'S
AKIN TO.
GIVING THEM A MAP FROM NINETEEN
FIFTY. AS OPPOSED TO LETTING
THEM USE GOOGLE MAPS YOU KNOW IF
THEY'RE GONNA GET THERE
EVENTUALLY BUT THEY'RE GONNA GET
LOST ALONG THE WAY THE BUT IT'S
MAY HAVE CHANGED SO EXACTLY
THAT'S THE POINT.
IF YOU REMAIN.
FIRST I'D
I JUST WANT TO APPRECIATE THE.
DANCE AND.
TEASE THAT YOU BRING TO THE
TABLE HERE TODAY.
NICE TO ACTUALLY GET BACK TO
WORK AND REALLY FOCUS ON.
ISSUES THAT FACE EVERY DAY
CALIFORNIANS.
I WANTED TO START MY QUESTIONS
BY.
WITH YOU SABRINA CORRELATE IF I
COULD PLEASE
AND I'M GONNA GO DOWN IN ORDER
THAT YOU PRESENTED.
YOU HAD MENTIONED THAT.
NETWORKS WHERE THE MAIN DRIVER
FOR INCREASES IN PRICE ARE OTHER
STATES DOING AND MANAGING THAT
WORKS DIFFERENTLY THAN WE DO.
WHAT COULD WE LEARN FROM THEIR?
SURE WELL.
I CAN'T REMEMBER NOW WHETHER IT
WAS A CRISIS OR JOHN WHO TALKED
ABOUT HOW THIS ISSUE OF NETWORK.
REGULATION IS REALLY A STATE
LEVEL ISSUE FOR THE MOST PART
AND I WOULD SAY THAT. THE VAST
MAJORITY OF STATES ARE
DO NOT HEAVILY REGULATE NETWORKS
AT LEAST IN THE INDIVIDUAL
MARKET OR THE MARKETPLACE SAYS.
AND IN FACT IN THIS PAST YEAR
WHERE WE SAW A LOT OF AREAS OF
THE COUNTRY THAT WERE AT RISK OF
LOSING THEIR INSURERS. ON MANY
STATES RELAXED THEIR NETWORK
ADEQUACY STANDARDS SO FOR
EXAMPLE IN SOME OF THE COUNTIES
IN OHIO THAT WERE AT RISK THERE
WERE REAL CHALLENGES THAT THE
CARRIERS FACED IN CONTRACTING
WITH.
OUR HOSPITAL SYSTEMS AND AND
PROVIDER GROUPS THAT HAD
EFFECTIVE MONOPOLIES IN THESE
RURAL AREAS AND SO TO THE STATE
EFFECTIVELY SAID OKAY WELL WE
WILL LET YOU FOR EXAMPLE
CONTRACT WITHOUT IT INDIANA. AT
PROVIDER SYSTEM INSTEAD AND
THOSE FOLKS IN OHIO ARE GONNA
HAVE TO GO ACROSS STATE LINES TO
TO GET THEIR CARE SAID THERE
WERE WAS DEFINITELY SOME
FLEXIBILITY GIVEN TO THE
CARRIERS ON THAT ISSUE. JUST TO
GET THEM TO PARTICIPATE.
DON'T MEAN TO GENERALIZE BUT IT
SEEMS LIKE YOUR TESTIMONY.
WOULD STATE THAT MORE INSURANCE
CHOICE.
BENEFITS INCREASING
AFFORDABILITY AND QUALITY.
WELL IS WHEN IT COMES TO THE
MARKET PLACES THERE IS PRETTY
STRONG EVIDENCE THAT THE MORE
INSURERS ARE THAT ARE COMPETING.
AND THE LOWER THE PREMIUM FOR
THE CONSUMER. AND THE LOWER THE
ANNUAL PREMIUM INCREASES SO YOUR
DATA THOUGH ALSO SEEMS TO SHOW
THAT CALIFORNIA WAS HAVING
DECREASING NUMBER OF.
COMPETITORS WITHIN THE INSURANCE
MARKET IS IT THEN. SAFE TO SAY
WILL HAVE DECREASING
AFFORDABILITY AS WELLAS
DECREASING QUALITY WELL
STATEWIDE AND THE CALIFORNIA.
COURT CALIFORNIA'S HAD PRETTY
STABLE ENSURE PARTICIPATION ON
AVERAGE.
BUT OF COURSE THAT MASK SOME
PRETTY BIG REGIONAL DIFFERENCES
SO FOR EXAMPLE ON IT YOU KNOW WE
SAW MUCH HIGHER PREMIUM
INCREASES IN THE NORTHERN%
COUNTIES.
THIS YEAR THAN IN MORE URBAN
AREAS LIKE SAN FRANCISCO
SACRAMENTO AND NOT MAYBE AND I
CAN'T SAY DEFINITIVELY FOR SURE
BUT THAT MAY BE A FUNCTION OF
THE LACK OF. BOTH PROVIDER AND
INSURER CHOICE.
DOVE TAILS HERE NOW ON TO WHAT
DOCTOR WHAT IS SAYING.
IF WE WERE TO DO A PUBLIC OPTION
OR TO LOOK AT A MEDI CAL BY.
DOES THAT HELP TO INCREASE
AFFORDABILITY AND QUALITY BY
HAVING MORE OPTIONS ON.
WELL IT COULD BUT AGAIN THE
DEVIL WILL BE IN THE DETAILS ON
HOW MUCH WILL PROVIDERS BE PAID
BY THE PUBLIC OPTION PLAN.
WHAT PROVIDERS WILL BE AND THE
NETWORK?
WILL PUBLIC OPTION PLAN DETER
OTHER INSURERS PRIVATE INSURERS
FROM COMING IN THEM THAT MIGHT
COME IN OTHERWISE SO THOSE ARE
ALL SORT OF ISSUES YOU TO SORT
OF THINK THROUGH AND AS YOU
DESIGN SOMETHING LIKE THAT.
FROM FINALLY THESE RATING
REGIONS THAT YOU REFERENCED THE
NINE TEEN OF THEM.
CAN YOU EXTRAPOLATE A LITTLE BIT
MORE ON THAT THAT'S A NEW.
TERM THAT I WOULD LIKE TO HEAR
MORE YEAH SURE SO AS YOU MAY
RECALL THE AFFORDABLE CARE ACT
INCLUDED A NUMBER OF CONSUMER
PROTECTIONS.
INCLUDING LIMITS ON HOW MUCH
INTEREST CAN VARY THE PREMIUM
RATES THAT THEY CHARGE CONSUMERS
TO FOR EXAMPLE THEY CAN'T CHANGE
RATES BASED ON. HEALTH STATUS OR
GENDER THERE'S LIMITS ON AGE
THERE ALSO LIMITS ON.
IDEA THEY ARE ALLOWED TO RATE
DIFFERENTLY BASED ON THE
GEOGRAPHIC REGION THAT THEY'RE
COVERING.
BUT THERE ARE LIMITS SO FOR
EXAMPLE THEY CAN'T TAKE A TINY
SLICE OF LOS ANGELES AND SAY
WE'RE GONNA CHARGE.
YOU KNOW A THOUSAND DOLLARS IN
HERE AND ANOTHER SLICE OF LOS
ANGELES AND TWO HUNDRED DOLLARS
THERE.
THE STATE IS WITH US EACH STATE
WAS TOLD TO COME UP WITH WHAT
ARE CALLED RATING REACH AND SO.
WHILE CARRIERS ARE ALLOWED TO
VERY RATES BASED ON.
THE GEOGRAPHY THEY CAN ONLY DO
IT WITHIN LIMITS CALIFORNIA SET
UP NINETEEN RATING REGIONS.
AND I AM NOT AN EXPERT IN HOW
CALIFORNIA DESIGN THOSE RATING
REASONS OR WHAT WHAT.
SYPHAC FACTORS THE USED BUT
ESSENTIALLY IT'S.
YOU KNOW KNOWING THAT FOR
EXAMPLE NORTHERN CALIFORNIA HAS
AND MUCH HIGHER PROVIDER PRICES
AND SOUTHERN CALIFORNIA SO
THAT'S IT'S A DESIGNED TO
REFLECT THOSE DIFFERENCES IN
PROVIDER BECAUSE.
PRIMARILY.
I'M GONNA COME BACK TO IT BUT
I'M WONDERING NOW IF SOME OF
THOSE READING REGION'S MAY
PRECIPITATE WHAT WE'RE SEEING
WITH THEN PROVIDERS IN REGIONS
AS WELL.
GEORGE THINK IF I MAY I'D LIKE
TO MOVE ON TO.
.
MR PRODI. UP.
YOU KNOW I REALLY WANTED TO DO
IN ON THIS BECAUSE.
.
YOU SAID THAT.
THE PHYSICIAN PARTICIPATION IN
MEDI CAL IS INSUFFICIENT AND HAS
NOT KEPT PACE WITH THE
ENROLLMENT GROWTH.
CAN YOU REPEAT WHAT STATE AND
FEDERAL POSITION TO PATIENT
RATIOS WE ARE NOT MEETING AS A
STATE AND.
DOES THAT PUT AT RISK ANY FUNDS
FOR US AS.
WELL THERE WERE SOME NATIONAL A
GUIDELINES.
ESTABLISHED BY THE COUNCIL ON
GRADUATE MEDICAL EDUCATION.
QUITE SOMETIME AGO.
AND THOSE ARE THE FEDERAL
GUIDELINES AND I'M REFERRING TO
THE STATE THAT DEPARTMENT HEALTH
CARE SERVICES.
FOR PRIMARY CARE HAS
ESTABLISHED.
PRIMARY CARE TO MEMBER RATIOS
FOR ITS MANAGED CARE PLANS.
AND THAT'S THE STATE RATIO THAT
I'M REFERRING TO.
AND WITH THAT.
LARGE EXPANSION AND.
.
MEDICAL PROGRAM.
HOW WE GOING SEEN A RELATIVELY
MODEST EXPANSION IN THE NUMBER
OF PHYSICIANS PARTICIPATING OR
AT LEAST IN THE SHARE OF THEIR
TIME PARTICIPATING?
?
IN IN MEDI CAL AYE AND SORT
HASN'T KEPT PACE
A TO THE BEST OF MY KNOWLEDGE
WE'RE NOT. PUTTING AT RISK ANY.
FEDERAL FUNDS PER SE.
UNDER THE LAST ADMINISTRATION
THERE WAS.
QUITE A CLOSE LOOK.
BY THE ADMINISTRATION ON
CALIFORNIA'S ACCESS ISSUES THERE
WAS SOME MANDATED STUDIES THAT
CALIFORNIA MUST DO. THINK THE
LEGISLATURE SUPPORT AS WELL
LEGISLATION THAT CALIFORNIA'S
MANDATED TO DO BECAUSE THEY WERE
CONCERNED ABOUT.
ACCESS AND HOW IT MIGHT.
CHANGE AFTER THE EXPANSION.
AND AND FRANKLY THERE WERE
CONCERNS EVEN BEFORE THE
EXPANSION ABOUT ACCESS AND MEDI
CAL SO.
.
THERE HAS BEEN AT TIMES FEDERAL
PRESSURE OR TO ON CALIFORNIA
ABOUT.
ENSURING APPROPRIATE ACCESS
BUT TO MY KNOWLEDGE.
THERE HOW MANY FEDERAL
PENALTIES.
FOR NOT BEING AS REQUIREMENTS.
YOU EARLIER YOU HAD MENTIONED
THAT PUBLIC PLANS WERE DOING A
BETTER JOB OF INVESTING.
INTO TARGETED PROGRAMS TO EXPAND
ACCESS TO CHURCH SEEMS LIKE THIS
IS.
A WAY TO ENCOURAGE.
THOSE PUBLIC PLANS TO MAKE SURE
THAT WERE TRAINING OF THE
WORKFORCE OF TOMORROW
PARTICULARLY IN REGIONS LIKE
MINE.
THE NEXT QUESTION I WAS HOPING
TO ASK.
IN LIGHT OF THE FACT THAT WE
LEARNED THAT FIVE TO TEN
THOUSAND.
MEDI CAL THE COVERED CALIFORNIA
PATIENTS WERE CHURNING EACH
MONTH.
ARE THERE THINGS THAT MEDI CAL
OR COVERED CALIFORNIA COULD DO
TO BETTER.
TO BETTER PREVENT INDIVIDUALS
FROM HAVING GAPS IN COVERAGE.
BUT I KNOW THERE'S A NUMBER OF
EFFORTS ALREADY UNDER WAY. TIMES
WHEN THINGS.
THERE'S IT YOU KNOW THERE'S
ALREADY BEEN A NUMBER OF EFFORTS
UNDER WAY AT THE ADMINISTRATIVE
LEVEL TO.
TO IMPROVE THOSE HANDOFFS.
WHEN PEOPLE CHANGE COVERAGE
EITHER.
.
THEIR INCOMES GO UP IN THERE.
THEY'RE NO LONGER HALOGEN FOR
MEDI CAL.
AND VICE VERSA SORT OF A WARM
HAND OFF BETWEEN.
WHEN WHEN THAT PEOPLE UNCOVER
CALIFORNIA LONGER ELIGIBLE THAT
COVER CALIFORNIA SHARING
INFORMATION WITH THE STATE TO
MAKE SURE THAT THERE'S. THERE'S.
THEN SOMEHOW REACHED ON TED TO
INDIVIDUALS.
.
YOU KNOW MORE CONSISTENCY AND
PROVIDER NETWORKS WOULD PUT
CERTAINLY HELP.
.
WE TALKED ABOUT THAT ISSUE.
EARLIER IN TERMS OF THERE'S A
NUMBER OF COMPLEXITIES ABOUT WHY
THAT DOESN'T DOESN'T HAPPEN.
CERTAINLY PAYMENT RATES ARE ARE
ARE ONE OF THEM.
BUT THERE'S A NUMBER OF OTHERS
SO.
.
BEYOND THAT I'M NOT MUCH I HAVE
OTHER IDEAS TO OFFER.
THEM MENTIONED AT THE END OF MY
TALK ONE OPTION AVAILABLE TO THE
STATE TO US.
WEAVER.
IT WOULD BE TO IMPOSE TWELVE
MONTH CONTINUES ELIGIBILITY.
OR A FOR MEDI CAL ADULTS YOU
HAVE IN PLACE FOR CHILDREN
ALREADY.
BUT THAT WOULD BE AN OPTION
WOULD REQUIRE AMENDING YOUR
STATE WAIVER.
ANOTHER ISSUE THAT COMES UP IS.
.
WHETHER OR NOT.
MANAGED CARE PLANS THAT ARE
OFFERING TO THE MEDI CAL
PROPERLY XIN THEY MAY OR MAY NOT
ALSO BEOFFERING.
COVERED CALIFORNIA PLANS AS
PART OF THEIR SERVICE LINES.
AND EVEN IF THEY ARE OFFERING
BOTH THEY MAY OR MAY NOT BE
OFFERING BOTH IN A PARTICULAR
GEOGRAPHIC AREA. SO THERE ARE
THINGS THAT SOME STATES HAVE
THOUGHT ABOUT WHETHER THAT'S
FAVORABLE CONTRACTING TERMS FOR
PLANS THAT OFFER BOTH.
ON THE EXCHANGE AND IN THEIR
MANAGED CARE MEDICAID MANAGED
CARE POPULATION SO THERE ARE
SOME AVENUES YOU CAN GO DOWN
THERE AS WELL TO ENSURE THAT.
.
AN INDIVIDUAL TURNING OUT OF ONE
PROGRAM AND THE OTHER COULD HAVE
A SOFT LANDING SPOTS IN A PLAN
THAT LOOKS VERY MUCH LIKE THE
PLAN THAT THEY'RE COMING OUT OF
IN TERMS OF PROVIDER NETWORKS
AND.
SO THOSE WOULD BE TO TO OPTIONS
THAT THAT YOU COULD CONSIDER.
NEXT I'D LIKE TO TURN TO TALK.
AND.
.
YOU KNOW I'M.
.
PLEASE TYPE TRADING DATA UCSF
FRESNO.
RESIDENCY TRAINING PROGRAM AND
KNOW THE HARD WORK THAT MANY OF
YOU ACADEMICS ARE DOING.
AND REALLY WANT TO FOCUS IF I
COULD ON.
THE UNDER CAPITALIZATION MEDICAL
EDUCATION PARTICULARLY AS WE
LOOK AT REGIONS THAT ARE BEING
LEFT BEHIND. THOSE NUMBERS
JUMPED OFF THE PAGE TO ME COMING
FROM THE SAN JOAQUIN VALLEY IN
FROM THE INLAND EMPIRE.
AS THE FIRST LATINO MEDICAL
DOCTOR THAT OUR STATE IS EVER
ELECTED TO STATEWIDE OFFICE
I'M QUITE AWARE MYSELF THAT
THERE ARE VERY.
FEW OF US WHO HAVE A VOICE.
SO I'D LIKE YOUR OPINIONS ON HOW
WE CAN BETTER INCREASED
DIVERSITY TO ENSURE THAT PEOPLE.
ARE.
BUILDING TRUST BOTH CULTURALLY
AND LINGUISTICALLY WHAT THE
PEOPLE WHO ARE PROVIDING CARE.
OKAY SO HOW TO INCREASE.
.
DIVERSITY IN THE PHYSICIAN
WORKFORCE ON HEALTH WORKFORCE
GENERALLY.
WELL YOU KNOW I THINK THERE ARE.
.
CERTAINLY NUMBER ONE IS
ADDRESSING OUR EDUCATIONAL
INEQUITIES.
MANY OF OUR LATINO CHILDREN
AFRICAN AMERICAN UNDER ITS
ASIAN.
YOU KNOW WHAT ATTEND SCHOOLS ARE
THAT.
DO NOT PREPARE THEM AS WELL.
FOR COLLEGE ENSUED DOING WHAT WE
CAN UP TO PREPARE THEM YOU HAVE
IN YOUR DISTRICT AS I THINK YOU
KNOW DOCTOR I'M CATHY FLORES AND
OTHERS WORKING ON THE DOCTOR'S A
COMMANDING ME THAT'S EVEN
WONDERFUL EXAMPLE. OF OF WORKING
WITH PROMISING.
YOUNG UP PEOPLE FROM MANY
RACIAL ETHNIC GROUPS IN THE CITY
OF FRESNO AND SURROUNDING RURAL
AREAS SO THAT'S IMPORTANT THE
OTHER PLACE WHERE WE KNOW A LOT
OF.
YOUNG PEOPLE.
PARTICULARLY YOUNG
UNDERREPRESENTED MINORITY YOUNG
PEOPLE FALL OFF THE TRACK FOR
HEALTH PROFESSIONS IS IN
COLLEGE.
THAT A LOT OF THEM GET TO
COLLEGE HE AND YOU KNOW IT
PARTIBUS ACADEMIC IT IS SOME
CHALLENGES IN ACADEMIC
PREPARATION. PART OF IT IS
SOCIAL YOU GO TO A COLLEGE WHERE
A LOT OF PEOPLE DON'T LOOK LIKE
YOU. THEIR FAMILIES HAVE MUCH
MORE MONEY THAN YOU DO.
YOU HAVE TO YOUKNOW YOU ARE
BECAUSE YOU ARE LARGELY SELF
FINANCING YOUR EDUCATION YOU
ARE.
LEADING UP TO WORK QUITE A BIT
AND SO A LOT OF YOUNG PEOPLE
THEY DON'T DO THAT WELL IN WHAT
WE CALL. A.
EITHER POLITELY THE GATEWAY
COURSES OR NOT SO POLITELY THE
WAITER COURSES.
AND MATHEMATICIAN AND CRITICALLY
IN CHEMISTRY THEY DON'T DO WELL.
THEY GET DISCOURAGED AND THEY
TAKE THEMSELVES OUT OF THE
RUNNING UNFORTUNATELY SOMETIMES.
THEY GET BAD ADVICE FOCUSING
WELL YOU KNOW IF YOU GOT TO SEE
IN CHEMISTRY FORGET ABOUT IT
NINO IT'S HOPELESS DON'T YOU
SHOULDN'T DO ANYTHING. IN THE
HEALTH PROFESSIONS AND SO WE
NEED MUCH BETTER ADVISING AGAIN
WE HAVE EXAMPLES YOU HAVE A. A
PROGRAM AT CSU FRESNO.
YOUR HEALTH CHRIS OPPORTUNITY
PROGRAM THAT'S WORKS VERY HARD
AND NUMBER OF OUR.
UC'S HAVE PROGRAMS THAT WE NEED
MORE THAT I THINK ON EVERY
COLLEGE CAMPUS IN CALIFORNIA WE
NEED SOMETHING THAT WORKS FOR US
OUR YOUNG PEOPLE FROM
DISADVANTAGED BACKGROUNDS WHO
HAVE A PASSION TO SERVE. IN THE
HEALTH PROFESSIONS TO SAY WHAT
CAN WE DO TO GET YOU TO THE
PLACE WHERE YOUR COMPETITIVE TO
ENTER A HEALTH PROFESSION AND IF
NOT. MEDICINE OR DENTISTRY YOU
KNOW MAYBE THERE'S A ROLE FOR
YOU IN PUBLIC HEALTH.
AND IN ANOTHER PROFESSION BUT
BUT TO YOU KNOW NOT DISCOURAGE
THAT PASSION BUT JUST YOU MUST
HAVE KNOWN THAT I. USE
TO BE A COP WORKED WITH THE
DOCTORS ACADEMY DR FLORISSANT
HAD SOME STUDENTS AS WELL.
TURNOUT UP FOR.
KNOW HOW IMPORTANT IT IS FOR
OUR COMMUNITY TO HAVE PROBLEMS
JUST LIKE.
YOU KNOW FIGHT CANNOT.
LIKE TO MOVE ON TO MR GRAVES
ONLY SO THAT I CAN ENSURE THAT
WE HAVE TIME FOR PUBLIC DIM
QUESTIONS AS WELL.
YOU KNOW I WAS. REALLY MOVED BY.
.
THE TESTIMONY WHERE HE SAID MORE
LIKELY TO TRANSITION WHEN I'M
LOOKING AT THOSE RISK FACTORS
WHAT I LOOK AT IS MY COMMUNITY.
YOU'RE TALKING ABOUT.
YOUNG. HISPANIC LATINOS WHO ARE
IN SERVICE INDUSTRIES THAT THE.
COMMUNITY I REPRESENT AND.
THE TURNING SEEMS TO INCREASE
UTILIZATION AND INCREASE COST.
HOW HEARD AT THE END YOU WERE
REALLY WANTING US TO TAKE A LOOK
AT PROVIDER DIRECTORIES? SAID
THAT WE NEED TO ENSURE ACCURATE
AND UP TO DATE PROVIDER
DIRECTORIES.
HOW?
WHAT SPECIFICALLY COULD WE DO OR
MANDATE TO ENSURE THAT THE
PROVIDER DIRECTORS WE HAD ARE
ACTUALLY ADEQUATE?
WELL I SHOULD I SHOULD SAY.
THE IMPACTS OF TURN ON
UTILIZATION REALLY GO BOTH WAYS.
THAT THAT INCREASING UTILIZATION
IS ONCE THEY GET BACK ON A PLAN.
BUT THEN THERE'S OF COURSE THE
DROP OFF IN UTILIZATION THAT
OCCURS AS WE SAW WITH THE SELF
REPORTED THIRTY FOUR PERCENT
DROPPING A MEDICATION. THAT
HAPPENS SAY IF THEY TRANSITION
AWFUL PLAN INTO SOME PERIOD OF
BEING ON IT SHORT SO I I WOULD I
WANT TO EMPHASIZE THAT IT GOES
BOTH WAYS.
BUT IT FROM A HEALTH SYSTEM
PERSPECTIVE YOU WE SEE THAT
UTILIZATION INCREASE.
WHICH IN TURN WOULD INCREASE
THE PLAN COSTS AND PREMIUMS AND
AND THINGS LIKE THAT.
IN TERMS OF STRATEGIES FOR
ENSURING UP TODAY PROVIDER
NETWORKS.
THE FEDERAL GOVERNMENT.
DID GO DOWN THE ROAD OF OF
PENALIZING PLANS.
THERE'S A LONG HISTORY OF
ENSURING.
PROVIDER NETWORK ADEQUACY
THROUGH THE MEDICARE ADVANTAGE
PROGRAM FOR EXAMPLE THERE STEEP
PENALTIES IMPOSED ON INSURERS.
THERE'S AUDITS.
SECRET SHOPPER STUDIES ANY
NUMBER OF AVENUES THAT THAT YOU
COULD GO DOWN.
AS WAS MENTIONED EARLIER THE
ROLE OF REGULATION A PROVIDER
NETWORKS HAS LARGELY BEEN
REACTIVE I IN MANY STATES THAT
IS A REACTIVE TO SPECIFIC
CONSUMER COMPLAINTS ABOUT NOT
BEING ABLE TO PROVIDE. ARE TO TO
FIND A PROVIDER AS OPPOSED TO.
OF A MORE.
.
A DIFFERENT STRATEGY OF EITHER
FINING OR.
R. AUDITING PLANNED.
GREAT AND.
WITH THAT I THINK WE WILL MOVE
ON TO OUR NEXT PANEL AND. THANK
YOU ALL FOR COMING HERE. THANK
YOU VERY VERY MUCH APPRECIATED.
SO OUR NEXT PANELIST SO THAT THE
NEXT PANEL WILL BE UNDERSTOOD
ABOUT UNDERSTANDING ADDRESSING
HIGH PRICES.
SO I HAVE.
AARON TRASK.
.
LAURENCE BAKER.
AND THAT OUR A RETURN OF WELL OF
LARRY LEVITT
.
I.
WHICH.
GENERATED SUNSET BUT.
AND WHERE.
WE'RE GONNA GO FOR.
LIKE LAST
.
THANK YOU.
FIRST I'D LIKE TO INTRODUCE
AARON TRASH THE ASSOCIATE
DIRECTOR OF HEALTH POLICY AT THE
SHE FOR CENTER FOR HEALTH POLICY
AND ECONOMICS AT THE UNIVERSITY
OF SOUTHERN CALIFORNIA.
GREAT THANK YOU VERY MUCH.
THINK YOU TO THE CHAIRS INTO
THIS COMMITTEE AND TO THE STAFF
FOR HOSTING THIS MEETING AND FOR
INVITING ME TO GIVE SOME REMARKS
HERE TODAY.
WE'VE HEARD A LOT FROM THOSE
PRYOR'S OF PANEL IMPAIR SPEAKERS
ABOUT FRAGMENTATION IN OUR
SYSTEM.
IN TERMS OF KIND OF SOURCES OF
HEALTH INSURANCE COVERAGE AND
I'D LIKE TO SHIFT GEARS A LITTLE
BIT AND THINK ABOUT. THAT
FRAGMENTATION AND ITS IMPACT ON
HEALTH CARE PROVIDERS IN THE
SENSE THAT OUR PROVIDERS ARE
TREATING PATIENTS WHO ARE
COVERED BY DIFFERENT SOURCES OF
COVERAGE. AND GETTING PAID VERY
DIFFERENT RATES.
IN DOING SO.
AND SO THE KIND OF EMPHASIS
TODAY IS IN THINKING ABOUT YOU
KNOW WHAT DOES THAT MEAN FOR
PROVIDERS HOW ARE THEY GETTING
PAID HOW TO THESE PRICES VARY.
AND WHAT MIGHT IT MEAN IF WE
START TO THINK ABOUT APPROACHES
TOWARD A MORE UNIFORM RATE
SETTING STRUCTURE ACROSS
DIFFERENT PAYERS IN THE STATE.
THINK I'LL JUST START UP BY
SETTING A QUICK DEFINITION WHEN
I TALK ABOUT PAYMENT RATES ARE
REIMBURSEMENT TO PROVIDERS WHAT
I'M TALKING ABOUT IS THE TOTAL
ACTUAL DOLLARS THAT ARE P. TO
THAT PROVIDER FOR TREATING A
PATIENT. AND THOSE DOLLARS COULD
BE PAID BY SOME COMBINATION
PERHAPS OF THE HEALTH PLAN AND
SOME PATIENT OUT OF POCKET COST
SHARING IN THE FORM OF A
DEDUCTIBLES OR CO INSURANCE THE
KIND OF THAT. THE TOTAL ACTUAL
PRICE THAT THE PROVIDER
RECEIVES.
AYE AS REIMBURSEMENT FOR
TREATING THESE PATIENTS.
SO WE'VE HEARD ABOUT THE KIND OF
THREE MAJOR SOURCES OF HEALTH
INSURANCE COVERAGE ON IN
CALIFORNIA AND ALSO ACROSS THE
COUNTRY THE MEDICARE PROGRAM
COMMERCIAL HEALTH PLANS ARE
PRIVATE HEALTH PLANS. AND ALSO
THE MEDICAID PROGRAM.
AND BEFORE GETTING INTO THE KIND
OF VERY DIFFERENT.
LEVELS OF PAYMENT RATES THAT
THESE DIFFERENT PROVIDERS PAY
HAVE THOUGHT IT WOULD BE HELPFUL
THAT JUST ALSO SET THE STAGE A
IN IN.
EXPLAINING THAT THE THEY ARRIVE
AT THESE RATES IN VERY DIFFERENT
WAYS AS WELL.
AND SO IN THE CASE OF THE
MEDICARE PROGRAM THE FEDERAL
GOVERNMENT ADMINISTRATIVELY SETS
PAYMENT RATES AND BASICALLY SAYS
HERE'S WHAT WE PAY HOSPITALS AND
PHYSICIANS FOR TREATING MEDICARE
PATIENTS. TAKE IT OR LEAVE IT.
MOST PROVIDERS CHOOSE TO TAKE IT
INTO TREAT MEDICARE PATIENTS AND
ACCEPT THOSE PAYMENT RATES.
BUT ULTIMATELY THERE'S REALLY
NO BACK AND FORTH IN IN THIS
IT'S A IT'S A LEVEL THAT SET BY
THE FEDERAL GOVERNMENT.
IN VERY STRONG CONTRAST TO THAT
WE HAVE THE COMMERCIAL MARKET
WHERE PRIVATE HEALTH PLANS
ENGAGE IN NEGOTIATIONS WITH
PROVIDERS LIKE HOSPITALS AND
PHYSICIANS. AND ESSENTIALLY
NEGOTIATE WHAT IS THE LEVEL OF
PAYMENT GOING TO BE. AND
ULTIMATELY THESE PAYMENT RATES
REFLECT THAT THE KIND OF
RELATIVE BARGAINING LEVERAGE
BETWEEN PROVIDERS IN BETWEEN
HEALTH PLANS IN THE AREA. AND
TEND TO VARY CONSIDERABLY I'M
ACROSS DIFFERENT PROVIDERS IN
DIFFERENT COMMERCIAL HEALTH
PLANS.
FINALLY IN THE CASE OF THE
MEDICAID PROGRAM IT'S UP TO
STATE GOVERNMENTS TAKEN TO
DETERMINE THE LEVEL OF
REIMBURSEMENT RATES IN THEIR
MEDI IN THEIR RESPECTIVE
MEDICAID PROGRAMS.
AND IN THE CASE OF CALIFORNIA
THE MEDICARE PART MEDI CAL
PROGRAM THE STATE GOVERNMENT
SETS UP PAYMENT RATES FOR
PHYSICIANS. AND NEGOTIATE
PAYMENT RATES WITH HOSPITALS.
SO WHAT DOES THIS LOOK LIKE IN
TERMS OF WHAT A PROVIDER
ACTUALLY GETS PAID FOR TREATING
A PATIENT THAT'S COVERED ONE OF
BY WHAT BY ONE OF THESE
DIFFERENT SOURCES OF INSURANCE
COVERAGE.
SO FIRST I'M GONNA FOCUS ON
HOSPITALS FOR THE FOR THE FIRST
YOU SLICE AND THEN WILL SWITCH
TRANSITION TO PHYSICIANS.
BUT THIS CHARTER SHOWING YOU
THAT AVERAGE PAYMENT THAT A
HOSPITAL RUSHED RECEIVES FOR
TREATING AN IN PATIENT.
FOR TREATING A PATIENT AS AN IN
PATIENT IN THE HOSPITAL
DEPENDING ON THE SOURCE OF
INSURANCE COVERAGE OF THAT
PATIENT.
SO THE TOP LINE IS AN ORANGE
THIS IS PATIENTS COVERED BY
PRIVATE HEALTH PLANS. THE MIDDLE
LINE IN IN PURPLE IS A MEDICARE
PATIENTS AND THE BOTTOM LINE AND
BLEW HIS MEDICAID PATIENTS.
AND WHAT YOU CAN SEE IS THAT ON
AVERAGE ACROSS THE COUNTRY
PRIVATE HEALTH PLANS ARE PAYING
HOSPITALS CONSIDERABLY MORE THAN
MEDICARE AND MEDICAID PAYS THOSE
HOSPITALS.
SO IN TWENTY TWELVE IT WAS ABOUT
SEVENTY FIVE PERCENT OR ABOUT
THREE QUARTERS MORE FOR
TREATING.
PRIVATELY INSURED PATIENTS FOR
ESSENTIALLY THE SAME SERVICE AS
A MEDICARE MEDICAID PATIENTS IN
YOUR HOSPITAL.
ONE OTHER KIND OF IMPORTANT
TAKEAWAY POINT FROM THIS CHART
IS THAT THAT RELATIVE MARKUP FOR
THESE HIGHER RELATIVE PAYMENTS
FROM PRIVATE HEALTH PLANS.
HAVE INCREASED CONSIDERABLY OVER
TIME AND SO BACK IN THE EARLY
NINETIES AND EARLY TWO THOUSANDS
PRIVATE HEALTH PLANS WERE PAYING
AND MODESTLY OR JUST A LITTLE
BIT MORE THAN MEDICARE. AND IN
MORE RECENT YEARS WERE AT THE
POINT WHERE PRIVATE HEALTH PLANS
ARE PAYING CONSIDERABLY MORE
THAN MEDICARE AND MEDICAID
PROGRAMS ARE PAYING HOSPITALS.
NOW THESE ARE AVERAGE.
PAYMENTS WHICH.
KIND OF MASK AS YOU'VE HEARD IN
MANY DIFFERENT INSTANCES TODAY
THAT MASK CONSIDERABLE
VARIATION.
AS OUR NEXT SPEAKER IS GOING TO
FOCUS A LOT ON VARIATION IN KIND
OF THE DRIVERS OF THIS BUT I
JUST WANTED TO POINT OUT THAT
THERE'S ESSENTIALLY. HAD THIS
MIDDLE OF THE ROAD HOSPITAL
THAT'S RECEIVING.
ABOUT THREE QUARTERS MORE FOR
TREATING A PRIVATELY INSURED
PATIENTS AND TREATING A MEDICARE
PATIENT THERE'S A LOT OF
VARIATION AROUND. THAT KIND A
MIDDLE AVERAGE PAYMENT WHERE YOU
SEE SOME HOSPITALS GETTING PAID
MUCH MORE THAN THAT FOR
PRIVATELY INSURED PATIENTS AND
SOME HOSPITALS GETTING PAID MUCH
LESS THAN THAT FOR TREATING
PRIVATELY INSURED PATIENTS.
THESE KIND OF RELATIVE MARKUPS
OVER WHAT HOSPITALS GET PAID FOR
COMMERCIAL PATIENTS COMPARED TO
WHAT THEY GET PAID FOR TREATING
MEDICARE PATIENTS.
THOSE MARKUPS VERY IN MANY
DIFFERENT WAYS SO IN ONE WAY
THEY VARIAS ACROSS DIFFERENT
GEOGRAPHIC AREAS WHERE FOR
EXAMPLE. A SIEMENS HOSPITAL
PAYMENTS FOR PRIVATELY INSURED
PATIENTS TEND TO BE HIGHER IN
SAN FRANCISCO MARKET THAN THEY
DO IN THE LOS ANGELES MARKET.
THEY ALSO VERY ACROSS HOSPITALS
WITH IN A MARKET SO THAT IS TO
SAY THAT YOU KNOW ONE HOSPITAL
IN LA IS GETTING PAID MORE THAN
ANOTHER HOSPITAL IN LA ON
AVERAGE FROM PRIVATE HEALTH
PLANS.
THERE'S ALSO VARIATION EVEN
WITHIN A HOSPITAL IN THE SENSE
THAT DIFFERENT COMMERCIAL PAYERS
PAY THAT HOSPITAL DIFFERENT
RATES SO THEY MAY HAVE
NEGOTIATED A DIFFERENT RATE. FOR
THEIR ANTHEM PATIENTS THAN THEY
MAY HAVE FOR THEIR HEALTH NET
PATIENTS OR KIND OF ALL THESE
DIFFERENT SOURCES OF VARIATION.
SO AGAIN AS I MENTIONED OTHER
NECK SPEAKER WILL KIND OF. DELVE
INTO THIS A BIT MORE AND AND THE
DRIVERS OF THIS VARIATION BUT
WHAT I WANT TO FOCUS ON FOR THE
PURPOSES OF MY COMMENTS IS
ESSENTIALLY THE NOTION THAT. WE
HAVE A LOT OF VARIATION BOTH ON
THE PRIOR SLIDE ACROSS DIFFERENT
SOURCES OF COVERAGE AND ON THIS
SIDE ON THIS SLIDE ACROSS
DIFFERENT SOURCES OF PRIVATE
HEALTH INSURANCE COVERAGE.
AND IF WE THINK ABOUT MOVING
TOWARD A POLICY KIND OF
DIRECTION WHICH IS A MORE
UNIFORM OF RATE SETTING OR A
MORE UNIFORM PAYMENT STRUCTURE
APPROACH TO THIS WOULD BE
SOMETHING LIKE A SINGLE PAYER
SYSTEM. OR EVEN SOMETHING LIKE
AN ALL PAYER RATE SETTING A TYPE
OF APPROACH.
ESSENTIALLY WHAT THAT'S AKIN TO
YOU ON THESE CHARTS IS DRAWING A
ST HORIZONTAL LINE SOMEWHERE AND
SAYING WE'RE GOING TO PAY
PROVIDERS AT THIS LEVEL.
AND SO WHAT THAT MEANS IN TERMS
OF THE KIND OF REACTION OR
EXPERIENCE OF PROVIDERS IS GOING
TO VARY CONSIDERABLY DEPENDING
ON WHERE THEY'RE STARTING FROM
BOTH IN THE MIX OF THE TYPES OF
PATIENTS THEY SEE. AND ALSO IN
THEIR RELATIVE COMMERCIAL
PAYMENTS.
SO ONE POINT IS THAT ESSENTIALLY
KIND OF MOVING TOWARD A MORE
UNIFORM RATE STRUCTURE IS GOING
TO CREATE WINNERS AND LOSERS AND
THAT'S GOING TO BE YOU KNOW
CREATE ITS OWN SET OF CHALLENGES
AND OPPORTUNITIES.
A SECOND POINT IS JUST
FUNDAMENTALLY WHERE DO YOU DRAW
THAT LINE AT WHAT LEVEL IS THE
APPROPRIATE AMOUNT OF PAYMENT TO
BE PAID IF WE'RE GOING TO MOVE
TOWARD ONE SIDE OF RATES.
THERE'S A LOT OF STOCK IN
FIGURING OUT AND SETTING THAT AT
AN APPROPRIATE LEVEL.
SETTING TOO HIGHLY OF SYSTEM
KIND OF FISCAL CONSTRAINTS AND
IN YOUR YOU KNOW IS THIS THE
RIGHT ALLOCATION OF RESOURCES
AND ARE WE SPENDING TOO MUCH ON
HEALTHCARE.
SETTING THAT RITA TO LOWER THE
LEVEL COULD LEAD TO CONCERNS
ABOUT ACCESS AND WORKFORCE KIND
OF FUTURE OUR INCENTIVES TO TO
ENTER INTO THE HEALTHCARE
PROFESSION AND THE QUALITY OF
CARE THAT'S DELIVERED.
AND SO ONE KIND OF POTENTIAL
STARTING POINT IN THINKING ABOUT
HOW YOU MIGHT SET THAT READ OR
HOW YOU MIGHT START THINKING
ABOUT WHERE USES AT THAT RATE IS
TO LOOK PERHAPS TO WHAT MEDICARE
PAYS HOSPITALS.
THIS IS A VERY MEDICARE'S VERY
LARGE PAYER OF HOSPITALS HAS A
VERY KIND A WELL KNOWN PUBLICLY
AVAILABLE RATE STRUCTURE THAT
THEY PAID TO HOSPITALS.
AND SO YOU CAN THINK ABOUT YOU
KNOW AS A STARTING POINT IF WE
LOOKED AT THE MEDICARE PAYMENT.
THE HOSPITAL PAYMENT MECHANISM
AS A STARTING POINT FOR FOR
REACHING THIS KIND OF UNIVERSAL
RATE STRUCTURE.
WHAT WOULD THAT MEAN FOR
HOSPITALS ARE ESSENTIALLY OUR
MEDICARE'S?
PAYMENT RATES TO HOSPITAL
SUFFICIENT IN TERMS OF COVERING
HOSPITAL'S COSTS.
SO IT TURNS OUT THAT ON AVERAGE
ACROSS THE COUNTRY THE ANSWER IS
ESSENTIALLY THAT THEY'RE NOT
THAT.
ON AVERAGE HOSPITALS LOSE MONEY
ON MEDICARE PATIENTS OUR HOW THE
OPERATING MARGIN IN TERMS OF
THEIR MEDICARE PATIENTS OF ABOUT
NEGATIVE SEVEN PERCENT.
SO WHAT THAT MEANS IS THAT THE
PAYMENTS THAT THEY RECEIVE FOR
MEDICARE PATIENTS DO NOT COVER
THE COSTS THEY INCUR FOR
TREATING MEDICARE PATIENTS ON
AVERAGE ACROSS THE COUNTRY.
BUT AGAIN THIS MASKS VARIATION
ACROSS DIFFERENT TYPES OF
HOSPITALS AND SO IF YOU SEE IN
THIS.
THIS CHART BELOW THEIR THEIR
WE'VE KIND OF GROUP HOSPITALS OR
THE AUTHORS HAVE GROUP HOSPITALS
INTO THREE DIFFERENT POCKETS.
HEAD OF DEPENDING ON
ESSENTIALLY.
AT HOW MUCH MONEY THEY LOSE OR
DON'T LOSE ON MEDICARE PATIENTS
SO THE FIRST THAT OF CALLED SO
THIS IS BROKEN UP BY THEN THE
PROFIT MARGIN ON MEDICARE
PATIENTS.
THE FIRST US HEAD OF COLUMNS IS
ESSENTIALLY HOSPITALS THAT LOSE
A LOT OF MONEY TREATING MEDICARE
PATIENTS.
THE MIDDLE SET OF COLUMNS IS
PETER'S AYE HOSPITALS THAT LOSE
HIM MODERATE TELL TO SMALL
AMOUNTS OF MONEY ON TREATING
MEDICARE PATIENTS.
AND THE RIGHT MOST COLUMN IS
HOSPITALS THAT ACTUALLY HAVE
POSITIVE PROFIT MARGINS ON
MEDICARE PATIENTS OR MAKE MONEY
TREATING MEDICARE PATIENTS.
AND SO THAT THE POINTS HERE ARE
KIND OF ESSENTIALLY THAT THERE
ARE IN FACT SOME HOSPITALS THAT
HAVE POSITIVE PROFIT MARGINS AT
MEDICARE RATES.
AND THE SECOND PULL BUT THERE
ARE MANY THAT DON'T AS WELL RATE
AND THE SECOND.
KIND OF POINT IMPORTANT POINT
HERE IS THAT. REALLY THIS
VARIATION STEMS FROM HOSPITAL
COSTS AND THE COST STRUCTURE.
THAT DIFFERS ACROSS THESE
HOSPITALS.
AND SO YOU THINK ABOUT YOU KNOW
STARTING FROM A PLACE OF
MEDICARE PAYMENT RATES AND AND
WOULD THAT BE AN ADEQUATE AMOUNT
OF PAYMENT TO PAY HOSPITALS OR
SHOULD WE GO UP FROM THERE HOW
MUCH SHOULD WE THINK ABOUT GOING
UP FROM THERE.
ON THE ONE HAND ON AVERAGE
MEDICARE PAYMENTS ARE NOT
COVERING COSTS ON THE OTHER HAND
THERE ARE SOME HOSPITALS THAT
ARE ABLE TO MAKE THIS WORK AND
THERE'S SOME EVIDENCE AND AND
PERHAPS SOME SUGGESTION THAT.
YOU KNOW WE THAT HOSPITALS THAT
HAVE TO RESPOND TO STRONGER
FISCAL PRESSURE AND STRONGER
COST CONSTRAINTS ARE ABLE TO
OPERATE MORE EFFICIENTLY AND
REDUCE THEIR COST STRUCTURE. AND
THAT YOU MAY GET SOME OF THOSE
BENEFITS BUT THIS IS THAT AT A
YOU KNOW TOUGH BALANCING POINT
BETWEEN SETTING A RATE TOO HIGH
AND SETTING A RE TO LOW AND
THEIR IMPLICATIONS ON BOTH
SIDES.
OF OUT WHERE YOU DIED OUT ON
THAT.
ONE OTHER IMPORTANT POINT FOR
THINKING ABOUT KIND OF.
CONVERGING TOO A STANDARDIZED
PAYMENT APPROACH IS NOT JUST THE
THE RATE OR THE LEVEL THAT YOU
MIGHT SET THESE PAYMENTS. BUT
ALSO THE MECHANISM FOR HOW YOU
KIND OF DESIGN THESE PAYMENTS TO
HOSPITALS.
SO IT TURNS OUT THAT NOT ONLY DO
THE LEVELS OF PAYMENT VARY
ACROSS MEDICARE MEDICAID AND
COMMERCIAL INSURERS. BUT ALSO
HOW THEY ACTUALLY THE METHOD OR
HOW THEY ACTUALLY A KIND OF
DESIGN THESE PAYMENTS AND THE
METRIC FOR THOSE PAYMENTS ALSO
VERY ACROSS PAYERS.
SO IN THE CASE OF THE MEDICARE
PROGRAM.
MEDICARE PAYS HOSPITALS USING
SOMETHING CALLED DIAGNOSIS
RELATED GROUPS ARE DRG USE WHICH
IS ESSENTIALLY A FIXED.
PAYMENT FOR A GIVEN CONDITION
AND SO IF YOU'RE PATIENT THAT
SHOWS UP WITH A JOINT
REPLACEMENT IT DOESN'T REALLY
MATTER WHETHER YOU SEE IN OURS
TEN TIMES A DAY OR FIVE TIMES A
DAY OR IF YOU STAY FOR DAYS OR
THREE DAYS. THE MEDICARE PAYMENT
IS GOING TO BE THE SAME FOR THAT
FIX CONDITION THERE SOME MINOR
ADJUSTMENTS FOR HELL OTHER KIND
HEALTH CONDITIONS IN THOSE TYPES
OF THINGS BUT GENERALLY
SPEAKING.
FIXED PAYMENT FOR CAN PER
CONDITION.
NOW IN CONTRAST TO THAT MANY
COMMERCIAL PAYERS IN CALIFORNIA
ACTUALLY USE A PER DIEM BASED
REIMBURSEMENT STRUCTURE FOR
HOSPITALS. AND SO THAT MEANS
THAT THEY'VE ESSENTIALLY
NEGOTIATED A PER DAY READ THAT
THE PATIENT STAYS IN THE
HOSPITAL.
IN THE CASE OF THE MEDI CAL
PROGRAM THERE WAS A RECENT
POLICY CHANGE WHERE OUR STATE
MOVED FROM PER DIEM BASED
PAYMENTS TO DRG BASED PAYMENTS.
AND SO THEY'RE KIND OF.
ADVANTAGES AND DISADVANTAGES TO
DIFFERENT WAYS OF PAYING
HOSPITALS AND DIFFERENT TYPES OF
INCENTIVES BUT THE OVERARCHING
POINT IS THAT NOT EVERYONE'S
DOING THIS THE SAME WAY AND AS
YOU THINK ABOUT THE KIND OF
CHALLENGES AND AND ALSO
POTENTIALLY OPPORTUNITIES. OF
MOVING TOWARD A UNIFORM.
TYPE OF PAYMENT.
NOT ONLY ARE YOU TALKING ABOUT
THE LEVEL BUT YOU'RE ALSO
TALKING ABOUT THE MECHANISM
FIRST FOR HOW YOU ENGAGE IN
PAYING PROVIDERS.
ONE FINAL COMMENT ON A IN TERMS
OF.
HOSPITAL REIMBURSEMENT IN
CALIFORNIA.
IS OUT LOOKING OUT RELATIVE
PAYMENT LEVELS FROM THE MEDICARE
PROGRAM TO HOSPITALS.
AND IF YOU MEMBER FROM THE FIRST
SLIDE ON AVERAGE ACROSS THE
COUNTRY MEDICAID PAYMENTS TO
HOSPITALS ARE JUST BELOW WERE A
PRETTY SIMILAR TíNH TED
MEDICARE PAYMENTS TO HOSPITALS
JUST SLIGHTLY BELOW.
AND IN TERMS BUT AGAIN YOU MAY
BE PICKING UP ON THE THEME THAT
MASKS A LOT OF VARIATION ACROSS
STATES IN TERMS OF HOW STATE SET
THEIR THEIR HOSPITAL PAYMENTS
FOR THE MEDICAID PROGRAM.
SO THIS.
DASHED LINE IN THE MIDDLE IS
THAT ONE WHICH IS ESSENTIALLY
THE THE NATIONAL AVERAGE
PAYMENTS TO HOSPITALS FOR
TREATING MEDICAID PATIENTS. AND
WHAT YOU SEE IS THA CALIFORNIA
FALLS VERY MUCH IN THE MIDDLE OF
THE BALLPARK HERE IN THE SENSE
THAT WE'RE VERY CLOSE TO THE
NATIONAL AVERAGE IN TERMS OF
OUR.
MEDI CAL PAYMENTS TO HOSPITAL.
SO JUST TO KIND OF SUMMARIZE
WHAT I'VE REVIEWED ON HOSPITALS
ESSENTIALLY THAT THE TAKEAWAY
POINT IS THAT PRIVATE INSURERS
TEND TO PAY MUCH MORE. THAN
MEDICARE AND MEDICAID PROGRAMS
IN TERMS OF OF PAYMENTS TO
HOSPITALS FOR TREATING PATIENTS
ESSENTIALLY WITH THE SAME
CONDITION.
AND THAT YOU MOVING TOWARD MORE
OF A UNIFORM RATE STRUCTURE
WOULD CREATE WINNERS AND LOSERS
DEPENDING ON WHERE YOU SET THAT
LEVEL. AND ALSO WHERE DIFFERENT
HOSPITALS KIND OF STE FALL NOW
COMPARED TO WHERE YOU SET THAT
LEVEL.
MOVING INTO ITS AS AN
INFORMATION ABOUT PHYSICIAN
PAYMENTS THAT THE KIND OF
GENERAL OVER ARCHING STORY IS
PRETTY SIMILAR TO THE HOSPITAL
STORY IN THAT COMMERCIAL HEALTH
PLANS TEND TO PAY. A HIGHER THAN
MEDICARE AND MEDICAID TENDS TO
PAY LESS THAN MEDICARE BUT
THERE'S SOME KIND OF IMPORTANT
NUANCES OUR DIFFERENCES. AYE TO
GO THROUGH ON THE PHYSICIAN
REIMBURSEMENT SIDE AS WELL.
BUT SO THE KINDA MEAN STARTING
POINT HERE SO THIS IS DATA ON A
NATIONAL AVERAGE PAYMENTS FOR A
PRIMARY CARE ESSENTIALLY OFFICE
VISIT CHECK UP.
AND WHAT YOU CAN SEE IS THAT ON
AVERAGE OF PATIENTS WITH
EMPLOYER SPONSORED INSURANCE
COVERAGE POSITIONS THAT TREAT
THOSE PATIENTS ARE GETTING PAID
ON AVERAGE ABOUT EIGHTEEN
PERCENT HIGHER THAN THEY GET
PAID FOR TREATING MEDICARE
PATIENTS.
I'M SO AGAIN A MARKUP OVER
MEDICARE ALTHOUGH NOT AS BIG OF
A MARK UP AS WE SAW IN THE
HOSPITAL SIDE.
I'M IN CONTRAST THE THEY HAD A
RELATIVE PAYMENT LEVELS FROM
MEDICAID PLANS ARE MUCH LOWER ON
IN THE SENSE THAT ON AVERAGE
ACROSS THE COUNTRY UP.
PHYSICIANS GET PAID ABOUT THREE
QUARTERS. OF WHAT THEY WOULD
HAVE GOTTEN PAID FOR TREATING A
MEDICARE PATIENT WHEN THEY TREAT
A MEDICAID PATIENT.
STARTING FROM THIS KIND OF.
MARKUP OF ABOUT EIGHTEEN
PERCENT OVER MEDICARE FOR THE
COMMERCIALLY INSURED PATIENTS.
THAT'S THE THAT KIND OF A BASIS
FOR PRIMARY CARE PHYSICIANS BUT
WE ACTUALLY SEE THAT THIS
RELATIVE MARKUP OVER MEDICARE
VARIES CONSIDERABLY ACROSS
DIFFERENT TYPES OF PHYSICIANS.
AND WE SEE MUCH HIGHER MARKUPS
OVER MEDICARE OF FOR SPECIALISTS
SO FOR EXAMPLE COMPARED TO THAT
EIGHTEEN PERCENT HIGHER PAYMENT
FOR PRIMARY CARE PHYSICIANS FOR
AN OFFICE VISIT.
ON AVERAGE RADIOLOGISTS
INTERPRETING A CAT SCAN WOULD
GET PAID ABOUT DOUBLE FOR
TREATING A COMMERCIALLY INSURED
PATIENTS. OUT COMPARED TO WHAT
THEY WOULD GET FOR A MEDICARE
PATIENTS.
INTERESTINGLY ENOUGH THOUGH IN
THINKING ABOUT CALIFORNIA AND
KIND OF HOW WE COMPARE TO THE
NATIONAL PICTURE IT TURNS OUT
THAT PRIVATE HEALTH PLANS IN
CALIFORNIA ACTUALLY APPEAR TO BE
DOINGA KIND OF BETTER JOB THAT
AVERAGE. AT CONSTRAINING THE USE
OF MARKUPS IN THE IN THE
COMMERCIAL MARKET SO WHAT I MEAN
BY THAT IS THAT. COMMERCIAL A
PAYMENT RATES IN CALIFORNIA ARE
LOWER THAN AVERAGE ACROSS THE
COUNTRY.
I MEAN YOU SEE AGAIN THAT.
COME THAT PAYMENT RATES TO
PHYSICIANS FOR COMMERCIALLY
INSURED PATIENTS ARE HIGHER IN
SAN FRANCISCO THAN IN LOS
ANGELES BUT IN BOTH MARKETS IN
THIS CASE AT LEAST IN THIS YEAR
A SOURCE THEIR LOWER THAN THE
AVERAGE ACROSS THE COUNTRY.
I FINALLY ONE LAST POINT ON
PHYSICIAN PAYMENTS IS FOCUSING
IN ON THE MEDI CAL PROGRAM AND
THIS IS ANOTHER.
SOURCE WHERE CALIFORNIA ANOTHER
EXAMPLE OF CALIFORNIA BEING A
PARTICULARLY LOW OUT WIRE. SO
THIS IS NOW LOOKING AT MEDICAID
PAYMENTS FOR TREATING A MEDICAID
PATIENT AS COMPARED TO A
MEDICARE PATIENT.
WHAT YOU SEE IS ON AVERAGE
POSITIONS GET PAID ABOUT THREE
QUARTERS OF?
WHAT THEY WOULD HAVE GOTTEN
PAID FOR MEDICARE PATIENTS WHEN
THEY TREAT A MEDICAID PATIENTS?
IN CONTRAST IN CALIFORNIA THAT
I'VE THAT'S CLOSER TO ABOUT HALF
AS MUCH.
SO PHYSICIANS ARE RECEIVING VERY
LOW REIMBURSEMENT FOR TREATING
MEDICARE PATIENTS BOTH COMPARED
TO OTHER PAYERS LIKE MEDICARE
BUT ALSO IN COMPARE IN
COMPARISON TO OTHER STATES
AROUND THE COUNTRY THAT WE HAVE
A PARTICULARLY LOW
REIMBURSEMENT.
OF RATE STRUCTURE FOR PHYSICIANS
IN THE MEDICAL PROGRAM.
NOW THAT HAS IMPLICATIONS YOU'VE
HEARD ABOUT ON ACCESS AND
PARTICIPATION BUT JUST ONE SLIDE
HERE TO TO.
KIND OF REITERATE THIS POINT
AND AND DRAW THE CONNECTION
BETWEEN PAYMENT RATE LEVELS AND
ACCESS TO CARE.
ON THIS IS A SURVEY OF
PHYSICIANS THAT ASKS.
WOULD YOU BE WILLING TO ACCEPT
A NEW PATIENTS IN YOUR PRACTICE.
AT AND THEN FOLLOW THAT UP WITH
WHAT AND WHAT'S THEIR SOURCE OF
INSURANCE COVERAGE
AND SO ACROSS THE COUNTRY ABOUT
SIXTY NINE PERCENT OF PHYSICIANS
WOULD BE WILLING TO ACCEPT IN
NEW MEDICAID PATIENTS.
IN CONTRAST IN CALIFORNIA WERE
MUCH LOWER THAN THAT ABOUT FIFTY
FOUR PERCENT.
NOW IN CONTRAST IN CALIFORNIA
ABOUT SEVENTY SEVEN PERCENT OF
PHYSICIANS SAY THEY WOULD BE
WILLING TO ACCEPT A NEW A A NEW
COMMERCIALLY INSURED OR OUT
MEDICARE INJURED PATIENT.
SO YOU DON'T NECESARIAMENTE
COMPARE THE FIFTY FOUR PERCENT
TO A HUNDRED BUT STILL WERE
CONSIDERABLY LOWER THAN THE
NATIONAL AVERAGE IN TERMS OF
ACCEPTING A NEW MEDICAID PATIENT
AND ALSO MUCH LOWER THAN WHAT
YOU SEE. OF FOR COMMERCIALLY
INSURED AND MEDICARE INSURED
PATIENTS.
SO ESSENTIALLY JUST JUST
SUMMARIZE OF WHAT I SAID ON
PHYSICIANS. THAT COMMERCIAL
MARKUPS OVER MEDICARE.
EXIST IN THE PHYSICIAN MARKET
AT LEAST ON AVERAGE AS WELL.
THEIR MORE MODEST FOR OFFICE
VISITS AND TEND TO BE MUCH
HIGHER FOR SPECIALISTS.
ON CALIFORNIA'S PRIVATE HEALTH
INSURERS APPEAR TO BE DOING HAVE
A BETTER JOB THAN THE NATIONAL
AVERAGE IN TERMS OF HOLDING DOWN
THESE MARKUPS OVER MEDICARE FOR.
FOR COMMERCIALLY INSURED
PATIENTS BUT MEDI CAL PHYSICIAN
FEES ARE PARTICULARLY LOW
ESPECIALLY IN COMPARISON TO
NATIONAL METRICS.
SO TAKE AWAY POINTS ON PROVIDER
PAYMENT OVER ALL I THINK IF I
CAN LEAVE YOU.
WITH WITH TWO MAIN POINTS OF
AND IT SAYS ONE IS THAT
DIFFERENT US SORT DIFFERENT
PAYERS ARE DIFFERENT SOURCES OF
HEALTH INSURANCE COVERAGE. ARE
PAYING PROVIDERS VERY DIFFERENT
RATES FOR DOING THIS SEEMS
SERVICE PROVIDING THE SAME
SERVICE TO PATIENTS.
AND SO YOU NO IT THAT KIND OF
SPECIFICS VARY BUT THE GENERAL
MESSAGE IS THAT IF YOU THINK
ABOUT HOW TO MEDICARE BEING IN
THE MIDDLE THAT PRIVATE HEALTH
INSURERS ARE PAYING MUCH MORE
THAN MEDICARE AND MEDICAID TENDS
TO BE PAYING. LESS THAN MEDICARE
NOW HOW BIG THOSE GAPS ARE AND
YOU KNOW THAT THAT TYPE OF THING
VARIES ACROSS DIFFERENT TYPES OF
SERVICES DIFFERENT HOSPITALS
DIFFERENT SPECIALISTS. ON
DIFFERENT PRACTICES ALL OF THOSE
THINGS BUT THE GENERAL MESSAGES.
MEDICARE IN THE MIDDLE PRIVATE
INSURANCE ABOVE MEDICAID BELOW.
I THINK THE SECOND POINT IS
ESSENTIALLY JUST THAT YOU KNOW
FOODS IN KIND OF PICKING UP ON
SOME OF THE THE FRAGMENTATION
ISSUES THAT WE'VE DISCUSSED.
THAT THESE UP PROVIDERS HAVE TO
KIND OF DEAL WITH THE
ADMINISTRATIVE CHALLENGES OF YOU
KNOW SENDING OF OF NEGOTIATING
CONTRACTS WITH MANY DIFFERENT
PAYERS.
OF.
.
ESSENTIALLY LEARNING HOW TO
SUBMIT THEIR CLEANS AND
ACCURATELY KIND OF GET THESE
THINGS PROCESS WITH THESE
DIFFERENT PAYERS. AND ALSO MANY
DIFFERENT PAYERS YOU KNOW HAVE
INCENTIVE PROGRAMS FOR
PHYSICIANS ARE FOR HOSPITALS AND
YOU KNOW MEDICARE INCENTIVIZE IS
PARTICULAR TYPES OF CARE.
MEDICAID MAY HAVE DIFFERENT
KIND OF GOALS ARE DIFFERENT.%
FINANCIAL LEVERS TO IN
INFLUENCE POSITION AND BEHAVIOR
HOSPITAL BEHAVIOR EVEN DIFFERENT
PRIVATE HEALTH PLANS YOU KNOW
ONE MAY BE IMPLEMENTING A PAY
FOR PERFORMANCE PROGRAM ANOTHER
MAYBE IMPLEMENTING. MORE ABOUT
KIND OF VALUE BASED CARE OR KIND
OF THE ON TOTAL COST OF CARE
TYPE PROGRAM. AND AND PROVIDERS
REALLY HAVE TO THINK ABOUT YOU
KNOW HOW DO I RECONCILE ALL OF
THESE DIFFERENT INCENTIVES ALL
OF THESE DIFFERENT INTERACTIONS
WITH PAYERS.
AND THAT'S ADMINISTRATIVELY
CHALLENGING IT CAN ALSO BE
CHALLENGING FOR THEM TO SHAPE
THEIR KIND OF PRACTICE DECISIONS
AROUND ALL OF THESE DIFFERENT.
OUR CONTRACTS THAT THEY'RE
PRESENTED WITH IN THIS
FRAGMENTED SYSTEM TODAY.
AND SO ONE OPPORTUNITY FOR
MOVING TOWARD A MORE UNIFIED
KIND OF RESTRUCTURE IS THINKING
ABOUT YOU COULD KIND OF
STREAMLINED THOSE PROCESS THESE
AND YOU WOULD HAVE A VERY LARGE
PATIENT VOLUME YOU COULD
POTENTIALLY REALLY. ON ENCOURAGE
PHYSICIANS TO DO DIFFERENT
THINGS WITH THEIR PATIENTS WHEN
YOU'RE TALKING ABOUT ALL OF
THEIR PATIENTS AND NOT JUST A
THIRD OF THEIR PATIENTS ARE HALF
OF THEIR VISION.
BUT ON THE OTHER HAND YOU KNOW
WE WHEN WE HAD A MOVE TOWARD ONE
SINGULAR APPROACH FIRST OF ALL.
GET SETTING NOT THAT GREAT LEVEL
RIGHT IN THAT KIND OF MECHANISM
RIGHT BECOMES VERY IMPORTANT AND
THAT'S VERY CHALLENGING AND
THAT'S GOING TO MEAN DIFFERENT
THINGS FOR DIFFERENT PROVIDERS
IN TERMS OF WHERE THEY ARE
TODAY.
IT ALSO CAN STIFLE SOME OF THESE
ARE POTENTIAL INNOVATIONS IF ONE
INSURER IS THINKING OF SOMETHING
DIFFERENT THAN MEDICARE
DIFFERENT THAN A DIFFERENT
PRIVATE INSURER.
IF YOU MOVE JUST TOWARD ONE
APPROACH YOU LOSE SOME OF THAT
INNOVATION AND EXPERIMENTATION
AND SEEING WHAT WORKS AND WHAT
WORKS MIGHT DIFFER IN DIFFERENT
SETTINGS.
SO YOU MAY LOSE SOME OF THE
ABILITY TO KIND OF MONITOR AND
EVALUATE AND FALLS IN THAT WAY.
BUT I THINK ESSENTIALLY THE
POINT IS YOU KNOW THERE ARE
MANY.
KIND OF CONCERNS AND CHALLENGES
AND ADMINISTRATIVE DIFFICULTIES.
WITH WITH THE KIND OF CURRENT
SYSTEM TODAY PROVIDERS RECEIVE
VERY DIFFERENT PAYMENT LEVELS
ACROSS THEIR DIFFERENT PATIENTS.
AND THAT YOU KNOW THERE
OPPORTUNITIES IN MOVING TOWARD A
UNIFIED APPROACH BUT IT'S NOT
IT'S AT NOT.
SMALL HURDLE TO THINK ABOUT
SETTING THAT.
APPROPRIATELY THAT'S GOING TO
REPRESENT A SIGNIFICANT CHANGE
FROM THE STATUS QUO THAT'S GOING
TO MEAN VERY DIFFERENT THINGS TO
DIFFERENT PROVIDERS. AND IT'S
VERY IMPORTANT TO KIND OF
STEPPED OUT AT THE RIGHT LEVEL
AND DOING SO WILL HAVE VERY HURT
OR NOT DOING SO WOULD
ESSENTIALLY HAVE. VERY
PROBLEMATIC POTENTIALLY VERY
PROBLEMATIC CONSEQUENCES ON A
NUMBER OF DIFFERENT ANGLES.
AND A PATH NOT.
GREAT BIG THANK YOU.
VERY MUCH APPRECIATE THAT OUR
NEXT SPEAKER IS A PROFESSOR
LAURENCE BAKER.
WHO IS A HEALTH ECONOMIST AND
PROFESSOR OF HEALTH RESEARCH AND
POLICY AT STANFORD?
WHERE HE APPLIES ECONOMIC AND
STATISTICAL ANALYSIS TO STUDY
CHALLENGES FACING THE HEALTHCARE
SYSTEM?
PROFESSOR.
THANK YOU ABOUT THE FLOODS COME
UP.
LOOK PROMISING THANK YOU SO
MUCH.
CHAIR WOULD CHAIR AROUND WITH
THEM MEMBERS OF THE COMMITTEE
IT'S A PLEASURE TO BE HERE AND
TALK WITH YOU ABOUT PRICE
VARIATIONS AND CONSOLIDATION SO
BE BASED ON SOME OF THE WORK
THAT.
THAT I'VE DONE WITH COLLEAGUES
AND OTHERS HAVE DONE. I'M.
WHAT'S HE SO I WAS I MIGHT THE
OUTLINE GENERALLY SUPPLY CLIP
ABOUT PRICE VARIATIONS
PARTICULARLY AND HOSPITALS AND
DOCTOR TRISH IS DONE A LITTLE
BIT OF THAT SO OUT.
IT PASSED A LITTLE BIT OF WHAT
THE BEGINNING AND I WANT TO TALK
ABOUT THE ROLE OF CONSOLIDATION
THE HOSPITAL MERGERS
PARTICULARLY AND THEIR EFFECT ON
PRICES AND HOW WE.
THINK ABOUT THAT AND THEN COME
AROUND AT THE END TOO LITTLE
DISCUSSION OF SOME THINGS THAT A
STATE MIGHT THINK ABOUT IN TERMS
OF.
MANAGING SOME OF THE PRICE
ISSUES THAT WE HAVE THE HEALTH
CARE SO.
HOW ONE GUY TO SPEND THE CONTEXT
HEALTHCARE IS REALLY EXPENSIVE?
YOU SHOULD TWEAK THAT.
PRICES ARE AN IMPORTANT
COMPONENT OF HEALTHCARE SPENDING
INCREASES WE TALKED A LITTLE BIT
ABOUT THAT BUT WE WE USE A LOT
OF HEALTH CARE IN THE THE TYPES
AND THE AMOUNTS OF HEALTH CARE
WE CONSUMER PART OF OUR STORY.
BUT PRICES PARTICULARLY OVER THE
LAST FIVE OR TEN YEARS HAVE BEEN
OF A BIG PART OF IT OF THE
INCREASES THAT WE'VE BEEN
SEEING.
I AND THE PART OF THE STORY WITH
PRICES IS THE FACT THAT WE TEND
TO USE MARKET MECHANISMS AT
LEAST QUITE OFTEN IN THE U. S.
HEALTHCARE SYSTEM IN CALIFORNIA.
TO SET THESE PRICES MARKETS HAVE
SOME THINGS TO RECOMMEND THEM IN
MARKETS CAN FAIL. AND IF MARKETS
FAIL THEN WE MAY COME UP WITH
PRICES THAT WERE NOT SO HAPPY
WITH.
.
CONSOLIDATION MERGERS THE
FORMATION VERY LARGE SYSTEMS AND
PROVIDER NETWORKS IS AYE IS PART
OF THE STORY OF MARKET FAILURE
POTENTIALLY IN THE HEALTHCARE.
WE TALKED ABOUT THIS A LITTLE SO
VERY JUST OUT TO SO MOST SKIP
PAST THIS IMMEDIATELY HEALTHCARE
PRICES OF BEEN RISING VERY
QUICKLY HOSPITALS ARE A PART OF
THAT.
THIS SLIDE HIGHLIGHTS SIX
PERCENT INCREASES IN TWO
THOUSAND FIFTEEN ALONE IN
MEDICAL HOSPITAL ADMISSION
PRICES. AYE THAT'S CONSIDERABLY
FASTER THAN INFLATION IT'S A
GOOD COMPONENT OF RAPIDLY RISING
HEALTHCARE COSTS AND IT GOES
ACROSS DIFFERENT SECTORS I'M
FOCUSING ON HOSPITALS
PARTICULARLY IT SO YOU SEE THAT
HOUSE.
AS DOCTOR TRICIA'S MENTIONED
THERE ARE IMPORTANT VARIATIONS
IN HOSPITAL PRICES AROUND THE
COUNTRY AND WITH IN CALIFORNIA.
THIS IS IN SOME SENSE A
REITERATION OF THE SLIDE THAT
THAT SHE HAD A MOMENT AGO AYE
THIS SIMPLY COLORS PARTS OF
CALIFORNIA AND PARTS OF THE
COUNTRY. ACCORDING TO AN AVERAGE
PRICE FOR A HOT A BASKET OF
HOSPITAL SERVICES CALCULATED
FROM ABOUT DATA FROM PRIVATE
INSURANCE COMPANIES.
I AND THE DARKEST BLUE AREAS ARE
THE HIGHEST THE LATEST BLUE
AREAS ARE THE LOWEST AND IF I'M
PERMITTED A CERTAIN STATISTICAL
FLEXIBILITY THERE'S ABOUT A
THREE TIMES DIFFERENCE BETWEEN
THE TOP AND THE BOTTOM HERE.
AND SO YOU SEE CVM. THAT PARTS
OF SOUTHERN CALIFORNIA MORE%
OFTEN LOOKING A LITTLE BIT
LIGHTER COLORED THAN PARTS OF
NORTHERN CALIFORNIA SOME BIG
PRICE DIFFERENCES WITHIN
CALIFORNIA BUT OF COURSE IF YOU
LOOK AROUND THE STATEMENT RUN
THE COUNTRY. THINGS VERY QUITE A
BIT FROM ONE PLACE TO ANOTHER.
SIMILARLY TO WHAT WE'RE JUST
TALKING ABOUT.
I'M GONNA SKIP TO THIS SLIDE
RIGHT HERE.
THERE ARE IMPORTANT DIFFERENCES
ACROSS PAYERS AGAIN IS DOCTOR
TRICIA'S POINTED OUT MEDICAID
AND MEDICARE PRICES ARE OFTEN
LOWER. THEN COMMERCIAL PRICES
ARE AND THE ONLY POINT THAT I
WOULD MAKE TO ADD ON TO THAT IS
THAT FOR IS IN THE SLIDE HERE
WHICH IS BASED ON WORK THAT I
DID WITH COLLEAGUES A LITTLE
WHILE AGO IN WHICH WE. LOOKED AT
MEDICARE PRICES COMPARED TO
COMMERCIAL PRICES BUT ALSO
COMPARED TO MEDICARE ADVANTAGE
PRICES.
I MEDICARE ADVANTAGE PLANS ARE
ARE PRIVATE PLANS A CONTRACT
WITH THE MEDICARE PROGRAM TO
TAKE CARE SENIORS ARE WHO
ELECTED ROLE IN THOSE PLANS.
AND THOSE MEDICARE ADVANTAGE
PLANS LOOK AT SOMETHING LIKE
COMMERCIAL PLANS IN THAT THEY
NEGOTIATE THE PRICES WITH
HOSPITALS THAT ARE GOING TO BE
IN THEIR NETWORK SO THEY HAVE A.
DIFFERENCE THERE'S A DIFFERENCE
BETWEEN THE PRICES THAT ARE USED
FOR HOSPITALS OUT WENT OUT.
TRADITIONAL MEDICARE PATIENT IS
SEEN AT A HOSPITAL WHICH ARE
ADMINISTERED PRICES SET OUT
THROUGH A ADMINISTRATIVE PROCESS
WASHINGTON.
AND COMMIT AND MEDICARE
ADVANTAGE PRICES WHEN A SENIOR
AND A MEDICARE ADVANTAGE PLAN
GOES TO THE HOSPITAL THEY'LL
RECEIVE THE HOSPITAL WILL BE
PAID OUT NEGOTIATED RATE WITH
THE MEDICARE ADVANTAGE PLAN.
WHEN WE MAKE COMPARISONS HERE WE
IN THIS PARTICULAR PAPER IN THE
STUDY WE LOOKED AT FEE FOR
SERVICE MEDICARE PRICES IN TWO
THOUSAND NINE AND TWO THOUSAND
TWELVE FOR A BASKET OF TWENTY
FIVE COMMENT SERVICES. AND WE
LABEL THAT PRICE ONE HUNDRED IN
THE MIDDLE IN THE RED BAR.
WE THEN LOOK AT THE PRICES THAT
COMMERCIAL PLANS ARE PAYING FOR
THAT SAME BASKET IN THE SAME
GEOGRAPHIC AREAS. WE SEE THE
GREEN BARS IN THEIR CONSIDERABLY
HIGHER AS WE. NOTED BEFORE.
SIXTY FIVE PERCENT HIGHER IN
TWO THOUSAND TWELVE.
BUT THEN WE LOOK AT THE MEDICARE
ADVANTAGE PRICES SAME BUNDLE OF
SERVICES AGAIN IN THE SAME
GEOGRAPHIC AREAS PAID BY NOW
MEDICARE ADVANTAGE PLANS. AND
HERE THEY'RE ACTUALLY WILL BE
LOWER NINETY PERCENT NINETY ONE
PERCENT EVEN THOUGH THESE ARE.
SIMILAR TO COMMERCIAL PLANS IN A
LOT OF WAYS AND I WANT TO POINT
OUT THE DIFFERENCE BECAUSE WILL
COME UP WHEN WE TALK ABOUT
POSSIBLE. THAT ACTIONS THAT
SOMEONE MIGHT TAKE.
IT SEEMS TO US WHEN WE DID THIS
RESEARCH AND LOOKED AT THESE
RESULTS THAT HAVE VERY PORTANT
CONSIDERATION IS THAT.
CONTEXT IN WHICH THE
NEGOTIATIONS HAPPENING.
IN A COMMERCIAL PLAN ADDICT IN
THE COMMERCIAL PLAN CONTACTS IF
A HOSPITAL IN A PLAN DON'T REACH
AGREEMENT. AND THE HOSPITAL IS
LEFT OUT OF THE NETWORK OF THE
PLAN IF A. PERSON FROM THAT
PLAN.
GOES TO THE HOSPITAL THEY. WILL
BE CHARGED OUT OF NETWORK RATES
WHICH CAN BE SET AT THE
DISCRETION OF THE HOSPITAL AND.
THIS I'M SURE OFTEN CAN BE QUITE
HIGH.
IN THE MEDICARE ADVANTAGE
CONTACTS WHEN.
HEALTH PLAN NEGOTIATES WITH A
HOSPITAL IF THEY DON'T REACH AN
AGREEMENT AND THE HOT HOSPITALS
OUT OF THE NETWORK. BUT A
PATIENT GOES THERE ANYWAY THE
HOSPITAL IS PAID THE MEDICARE
FEE FOR SERVICE RATE THEY DO NOT
GET TO SET THE RATE THAT THEY
WOULD LIKE.
THAT IS THAT AND TO IT THERE
CONSTRAINED TO NEGOTIATE WITHIN
THAT.
BALANCE OF KNOWING THAT IF THEY
DON'T AGREE ON A RATE THEN
PATIENTS THERE MAY BE OUT OF THE
NETWORK PATIENTS WILL STILL BE
ABLE TO GO THERE. BUT THEY'LL BE
OUT THE HOSPITAL ONLY BE PAID TO
MEDICARE RATE WHICH IS A
SIGNIFICANT CONSTRAINT ON THE
NEGOTIATIONS.
WHEN THE PRICES ARE BEING SET
BETWEEN THE PLAN IN THE HOSPITAL
AND YOU CAN SEE HERE RESULTS IN
VERY DIFFERENT PRICES EITHER
COME OUT OF THOSE NEGOTIATIONS.
THE CONTEXT CAN BE IMPORTANT AYE
THAT'S THE POINT THAT I WOULD
WANT TO MAKE FROM THIS.
SO THAT'S SLIDER A VERSION OF IT
A MINUTE AGO SHOWING AGAIN THAT
MEDICAID PAYMENT RATES ARE.
SIMILAR TO MEDICARE PAY RATES A
LITTLE BIT LOWER FOR HOSPITALS
IN THE COMMERCIAL AS MUCH.
OKAY SO
SO A LITTLE BIT NOW AND.
THE ROLE OF CONSOLIDATION ONE
OF THE THINGS THAT'S BEEN
HAPPENING RAPIDLY.
IN THE HEALTHCARE SYSTEM
HEALTHCARE SYSTEMS AROUND THE
COUNTRY AYE IS CONSOLIDATION OF
PROVIDERS I'VE.
FOCUSED HERE ON HOSPITALS AB
WE'LL TALK ABOUT MERGERS OF
HOSPITALS TO FORM LARGER
SYSTEMS.
OTHER FORMS OF INTEGRATION
BETWEEN MULTIPLE HOSPITALS TO.
BUT THEMSELVES IN A POSITION TO
WORK TOGETHER TO BARGAIN
TOGETHER FOR FOR THE PRICES THAT
THEY'LL BE PAID. THIS US SLIDE
HIGHLIGHTS BEEN NUMBER OF
MERGERS THAT THE AMERICAN
HOSPITAL ASSOCIATION HAS
DETECTED OVER THE LAST.
QUITE A NUMBER OF YEARS NOW
BACK TO NINETEEN NINETY EIGHT.
AND YOU CAN SEE IN THE GREEN
BARS A LOT IN MANY YEARS
HUNDREDS OF HOSPITALS AROUND THE
COUNTRY MERGING QUITE A FEW
DEALS SINCE TWO THOUSAND TEN. A
FIVE HUNDRED AND SIXTY ONE
HOSPITALS IS HAPPENING IN
CALIFORNIA AS WELL I TO THE
POINT WHERE THERE ARE FEWER AND
FEWER INDEPENDENT HOSPITALS IN
THE STATE. MOST OF THE MARKETS
IN CALIFORNIA ARE DOMINATED BY A
COUPLE OF LARGE SYSTEMS ARE ONE
OR TWO LARGE PLAYERS SOME CASES
THREE.
AND DUH THAT NORMAL METRICS
THAT WE HAVE FOR IT FOR
IDENTIFYING HIGHLY CONCENTRATED
MARKETS WHICH TO
BUT MOST OF OUR HOSPITAL MARKETS
ARE CONCENTRATED. AYE IN AN
ECONOMIC SENSE.
CONSOLIDATION IS ALSO HAPPENING
IN OTHER PARTS OF THE HEALTHCARE
SYSTEM AS WELL PHYSICIAN
PRACTICES ARE GETTING LARGER.
AYE IN THIS IS HAPPENING TO
MERGERS IT'S ALSO HAPPENING
THROUGH NORMAL ATTRITION OF.
OR CHANGES IN THE THE
DEMOGRAPHICS IN THOUGH THE WORK
PATTERNS OF PHYSICIANS NEW
PHYSICIANS TEND TO ENTER AND
JOIN LARGER PRACTICES.
OLDER PHYSICIANS AS THEY EXIT
TEND TO BE LEAVING SMALLER
PRACTICES AND SO THAT TENDS TO
REINFORCE THE. DIRECTION OF THE
MOVEMENT AS WELL.
YOU CAN SEE SOME STATISTICS UP
THERE IN THAT. IN WORK THAT
WE'VE DONE OVER THE TWO
THOUSANDS AND NOW INTO A TWENTY
FIVE THIRTEEN AND FOURTEEN.
.
VERY SUBSTANTIAL INCREASES IN
THE NUMBER OF PHYSICIANS IN
CALIFORNIA IN THE COUNTRY AYE
AND PRACTICES OF MORE THAN A
HUNDRED. AND TO ADD TO THE POINT
WHERE IT'S NOW THIRTY FORTY
PERCENT OF THE PHYSICIANS IN THE
COUNTRY ARE IN THOSE THAT THAT
SIZE A PRACTICE.
THERE'S IMMIGRATION THAT'S BEEN
GOING ON BETWEEN HOSPITALS AND
PHYSICIANS SO YOU'LL HEAR ABOUT
HOSPITALS PURCHASING THE
PRACTICES OF PHYSICIANS OR
OTHERWISE FORMING ORGANIZATIONS
IN WHICH LARGE.
MULTIPLE TYPE PROVIDER TYPE OF
ORGANIZATIONS ARE FORMING.
THERE'S BEEN CONSOLIDATION OF
INSURANCE COMPANIES AND PROPOSED
CONSOLIDATION SOME OF WHICH WAS
NOT ALLOWED BY THE COURTS BUT
SOME OF WHICH IS GONE THROUGH
OVERTIME. I TWO POINT WE HAVE
FEWER INSURANCE COMPANIES THAT
WORKING IN THE HEALTHCARE SYSTEM
AS WELL.
AND THEN I WILL EVEN LEAVE OFF
OTHER KINDS OF THE IMMIGRATION
IT'S BEEN HAPPENING THERE ARE
CASES IN WHICH AYE INSURERS ARE
INTEGRATING WITH HEALTHCARE
PROVIDERS.
ACCOUNTABLE CARE ORGANIZATIONS
ARE VERSION OF INTEGRATION WITH
LOTS OF DIFFERENT KINDS OF.
ENTITIES OVER TYPE SO I THERE
QUITE A FEW VERSIONS OF
INTEGRATION IT'S DRIVING LARGER
AND LARGER ORGANIZATIONS ON THE
PROVIDER SIDE PARTICULARLY TO
SOME EXTENT ON THE INSURANCE
SIDE.
MISS AFFECT THE BARGAINING.
THAT DETERMINES THE PRICES THAT
ARE CHARGED IN THE COMMERCIAL
SPACE.
WE CAN WALK THROUGH A MINUTE ON
WHY THIS IS HAPPENING.
THREE OR FOUR THINGS COME UP.
.
LET'S SEE.
THERE'S.
ONE IS JUST SIMPLY THE TREND
THERE'S BEEN A A. GLOBAL TREND
IF YOU WELL TOWARD CONSOLIDATION
THERE ARE LARGER AND LARGER
ORGANIZATIONS IN MANY.
PARTS OF THE ECONOMY IN HEALTH
CARE IT'S GOTTEN GOING OVER THE
LAST DECADE OR SO AND I THINK
PART OF THE TREND NOW IS JUST
MAKING SURE YOU'RE NOT THE LAST
ONE STANDING BY YOURSELF. I'VE
EVERYONE ELSE'S MERGING IN
GETTING BIGGER SO THERE'S A
CERTAIN AMOUNT OF TRENDING TO
IT.
AYE BUT IT'S PARTLY ALSO
REACTION TO POLICY PAYMENT
REFORMS.
MEANINGFUL USE FOR AYE IT
SYSTEMS FOR HEALTHCARE PROVIDERS
EYES ALL SEEM TO REWARD LARGER
ENTITIES THAT CAN MANAGE THE
COMPLEXITY OF THESE KINDS OF
ARRANGEMENTS BETTER SO SOME TO
SOME EXTENT BEING PUSHED BY
POLICY.
SOME EXTENT IT'S IN A ATTEMPT TO
IMPROVE MARKET POSITION AND A
GAIN OF PRICING ADVANTAGE TO
ENHANCE REFERRALS IF YOU HAVE A
BIGGER STRUCTURE YOU MAY BE IN A
BETTER POSITION TO SURVIVE IN
THE MARKETPLACE.
I AND I OWN I MENTION THIS
MINUTE AGO THERE'S I THINK IN A
LOT OF PARTS OF THE ECONOMY
YOU'LL SEE LARGER ORGANIZATIONS
AS IT AND COMMUNICATIONS AND
MANAGEMENT ABILITIES. YOU HAVE
EVOLVED OVER THE YEARS TO MAKE
IT POSSIBLE TO RUN LARGE
ORGANIZATIONS MAYBE IN WAYS THAT
YOU COULDN'T TWENTY YEARS AGO.
I LEFT ONE OFF FEAR THAT I'LL
JUST MENTION THAT IS I THINK
THERE'S POSSIBILITY ALSO THAT
THESE LARGE ORGANIZATIONS CAN
HAVE QUALITY.
ADVANTAGES IN SOME CASES THEY
MAY BE ABLE TO DO A BETTER JOB.
OF.
IDENTIFYING THE BEST TREATMENTS
OF DIFFUSING KNOWLEDGE OF HAVING
THE INFRASTRUCTURE IN PLACE TO
DELIVER HIGHER QUALITY AND SO
THAT'S SOMETHING TO TAKE INTO
CONSIDERATION AS WELL.
NOW WHAT HAPPENS WHEN WE GET
THIS CONSOLIDATION.
FEW DIFFERENT THINGS HAPPEN.
ONE THING THAT HAPPENS IS
GENERALLY HIGHER PRICES.
AND SO PRETTY MUCH THE ACADEMIC
RESEARCH THAT IS LOOKED AT
CONSOLIDATION SUGGEST THAT WHEN
YOU GET. MORE CONCENTRATED
MARKETS WHEN YOU GET LARGER AND
LARGER ENTITIES BUT
SPREADING IN BARGAINING AYE THEY
HAVE SOME MARKET POWER THAT THEY
CAN EXERT IN THAT BARGAINING AND
THEY CAN INCREASE THE PRICES
THAT THEY ARE ABLE TO GET.
THIS HAPPENS AT HOSPITALS.
PLAY HAPPENS FOR PHYSICIAN
GROUPS IT HAPPENS IN AND OF.
PRETTY BROAD VARIETY OF CONTEXT
AYE AND THE LITERATURE IS PRETTY
CONSISTENT ON THIS POINT.
INSURANCE BARRED INSURANCE
CONSOLIDATION ON THE OTHER HAND
THE COUPLE OF STUDIES THAT WE
HAVE SIX GOES THE OTHER
DIRECTION IF YOU CONSOLIDATED
SHARON'S COMPANIES YOU TEND TO
GET LOWER PRICES OF COURSE THEY.
BARGAIN ON THE OPPOSITE SIDE OF
THE TABLE AND THEY TEND TO FORCE
DOWN THE PRICES THAT ARE PAID
TO.
DOCTORS.
EQUALITY EVIDENCE I WILL TELL
YOU IS A LITTLE BIT MIX OF
BENEFIT YOU STUDIES OUT THERE.
DIVERSE.
THEY LOOK AT DIFFERENT CONTEXT
IT'S.
PROBABLY UNDER DEVELOPED IN THE
OVERALL SENSE BUT YOU GET SOME
MIXED RESULTS ON THE ONE HAND
THERE ARE SOME WELL.
IDENTIFIED EXAMPLES OF LARGER
SYSTEMS THAT DO A GREAT JOB ON
MEETING QUALITY STANDARDS ON
PROVIDE AND HITTING QUALITY
METRICS ON THE KIDS FEW
DISCOURSE THAT WE TALKED ABOUT
BEFORE. EYES KAISER IS THAT WHEN
THE GETS HELD UP FROM TIME TO
TIME AS A AS A GOOD EXAMPLE.
NO SYSTEM IS PERFECT BUT BUT
THEY DO PRETTY WELL ON THEIR
QUALITY SQUARES THE
INTERMOUNTAIN.
.
THE HEALTH CARE THE GEISINGER
CLINIC SOME SOME OTHER EXAMPLES
ARE ARE OFTEN HELD UP AS CASES
WHERE LARGE ORGANIZATIONS CAN DO
BETTER.
THAT THE SAME TIME THE ACADEMIC
LITERATURE IS A IS.
.
HAS HAS I HAD A HARD TIME
FINDING THOSE SAME BENEFITS WHEN
YOU LOOK AT JUST THE AVERAGE RUN
OF THE MILL MURDER THAT YOU SEE
OUT THERE. SO WHEN YOU SEE
LARGER GROUPS FORM WHEN YOU SEE
MERGERS HAPPEN WHEN YOU SEE THE
GENERAL TRENDS THAT WE'VE BEEN
HAPPENING AND YOU LOOK OUTSIDE
WHAT ARE SOME OF THE. THE BEST
PERFORMING LARGE GROUPS WE'VE
HAD A HARDER TIME FINDING THE
QUALITY ADVANTAGES COMING FROM
SOME OF THOSE MERGERS. AYE
DESPITE THE HOPE THAT THEY MIGHT
HAVE BEEN THERE NOW SOME OF THAT
LITERATURE IS ONLY FOLLOWED
THESE AND TEASE FOR A FEW YEARS
I AM.
THE LITERATURE ITSELF ISN'T AS
BIG AS YOU MIGHT LIKE.
AND SO THERE MAY BE MORE TO THE
STORY THAN WE KNOW AT THIS POINT
BUT IF YOU HAD TO SUMMARIZE IT
RIGHT NOW WHAT WE KNOW IS THAT
CONSOLIDATION HAS HAS PUSHED
SEEMS HAVE PUSHED ALONG PRICE
INCREASES.
I'M BUT MAYBE NOT ALWAYS PRODUCE
THE QUALITY BENEFITS THAT WE
MIGHT HAVE HOPED WOULD HAVE COME
FROM IT ALTHOUGH THERE STILL ARE
SOME FOLKS WHO ARE HOPEFUL THAT
THEY MIGHT BE OUT THERE
SOMEWHERE.
DRIVERS OF HIGH COMMERCIAL
PRICES LET'S TALK A LITTLE BIT
THEN ABOUT HOW WE BRING THIS
BACK TO PRICES IN WHAT WE MIGHT
WANT TO THINK ABOUT IN THIS IN
THE STATE CUT.
WHY PRICES HIGN WHERE THEY
GOING UP I THINK CONSOLIDATION
IS PART OF OUR STORY?
IF YOU LOOK AT THE TRENDS
TOWARD LARGE ORGANIZATIONS AYE
AND WE LOOK AT.
THE.
THE PRICE AFFECTS A GO WITH
THEM THIS HAS TO BE PART OF THE
STORY FOR GOING TO MANAGE PRICES
WE PROBABLY HAVE TO. HAVE A LOOK
AT CONSOLIDATION IN THE.
THERE ARE OTHER SOURCES OF
MARKET POWER.
ESPECIALLY ON THE PART OF SOME
LARGE HOSPITALS EVEN IF YOU'RE
NOT IN A BIG SYSTEM BUT YOU ARE
A MUST HAVE HOSPITAL FOR
EXAMPLE.
AYE ANY INSURER WOULD WANT TO
HAVE YOUR HAVE TO HAVE YOU IN
THE NETWORK IN ORDER TO SELL
THEIR PRODUCT. YOU CAN HAVE SOME
MARKET POWER AND THAT'LL BE IT
AND IT'LL BE A UP DRIVER OF
PRICING.
OF ALL T!I COST STRUCTURES A
IS AN IMPORTANT CONSIDERATION.
HEALTHCARE PROVIDERS THROUGHOUT
THE STATE THROUGHOUT THE COUNTRY
HAVE FIGURED OUT HOW TO DELIVER
SERVICES.
OFTEN VERY VALUABLE SERVICES
THAT PEOPLE WANT THAT DOCTORS
WOULD LIKE TO BE PROVIDING THAT.
.
COMMUNITIES WOULD BE
DISAPPOINTED IF THEY DIDN'T
HAVE.
SOME OF THE ART ARE EXPENSIVE
THOUGH AND CITIES PROVIDERS HAVE
MADE INVESTMENTS IN BUILDINGS
AND STAFF AND OTHER THINGS THAT
HAVE MADE THEIR GIVEN THEM OUT A
CONSTRUCT YOUR. AYE THAT CAN BE
QUITE EXPENSIVE AND SO THAT'S
PART OF IT NEGOTIATION AS WELL
AND SOMETHING THAT WE HAVE TO
CONSIDER. IF WE START TO THINK
ABOUT PRICES WE START TO PUSH
TOO MUCH I'M PRICES AYE AND YOU
PUSH UP AGAINST SOME OF THESE
PROVIDERS ARE HOSPITALS THAT
HAVE MADE BIG INVESTMENTS. I
COULD PUT SOME THEM IN A
DIFFICULT CIRCUMSTANCE I COULD
PUT COMMUNITIES IN DIFFICULT
CIRCUMSTANCES THAT MAKES IT
HARDER FOR THEIR THE OTHER
POPULATION TO GET THE SERVICES
THAT THEY WANT.
AT THE SAME TIME WE WANT TO BE
ABLE TO. CONSTRAINED PRICE
INCREASES THAT ARE WARRANTED AND
SO WE HAVE TO THINK ABOUT THESE
COST STRUCTURES AS PART OF THE
STORY.
I OF COURSE I AS WE GO FORWARD
WE CONTINUE TO STRUGGLE HERE AND
AROUND THE COUNTRY WITH THE
ARRIVAL OF NEW AND COSTLY
TREATMENTS THERE ARE SOME
TERRIFIC THINGS THAT ARE BEING
DEVELOPED. AS SOME OF THEM ARE
PHENOMENALLY EXPENSIVE AYE SOME
OF THEM MAY BE PHENOMENALLY
EXPENSIVE BECAUSE OF THAT THE
INSURANCE AYE THAT WE HAVE.
.
BUT THERE MAY BE OTHER THINGS
OTHER CONSIDERATIONS THERE TOO
THESE ARE THINGS THAT WE HAVE TO
CONSIDER.
LET ME.
I TALK FOR A MOMENT JUST ABOUT
THIS UP SUFFICIENT PRESSURE FROM
CONSUMERS.
ONE OF THE THINGS THAT I THINK
IS AS BENEFIT CHAIR OF OUR
HEALTHCARE SYSTEM.
.
AND PART OF THE NEGOTIATIONS
STRUCTURE THAT HAS ALLOWED HIGH
PRICES TO
SERVES. AS THE FACT THAT THE
FOLKS WHO ARE MOST CONCERNED
ABOUT HIGH PRICES AND HIGH
HEALTHCARE SPENDING ARE PRETTY
DIFFUSE.
THEIR EMPLOYERS INVOLVED IN
PURCHASING HEALTH INSURANCE ARE
THE WORKERS ARE INVOLVED ALL OF
US THE POPULATION IS INVOLVED AT
SOME LEVEL IN PAYING FOR THAT
HEALTH INSURANCE.
THE GOVERNMENT.
STATE GOVERNMENT THE FEDERAL
GOVERNMENT IS INVOLVED INSURANCE
COMPANIES ARE INVOLVED.
BUT IT'S.
PRETTY DIFFICULT SOMETIMES FOR
EVERYBODY TO GET ON THE SAME
PAGE WITH WHETHER WE'RE TRYING
TO NEGOTIATE FOR LOWER PRICES
ARE WE'RE TRYING TO PUSH ON ONE
TYPE OF IN ONE AREA OR NOT IN
ANOTHER AREA. AND THIS DIFFUSE
SIZE SORT OF SENSE OF POWER IN
SOME CASES PEOPLE WHO SAY IT'S
NOT MY PROBLEM I DON'T KNOW HOW
THAT GETS DONE I'M PAYING THE
BILL AT SOME LEVEL BUT I HAVE NO
AGENCY TO GO OUT. AND TAKE THIS
ON IS PART OF OUR PROBLEM.
AND IT MAKES IT HARDER TO PUT%
PRESSURE ON HEALTHCARE COST
GROWTH WHEN WE SEE IT.
BECAUSE THERE ARE SO MANY
PEOPLE INVOLVED IN SO MANY
DIFFERENT ASPECTS OF THE
DISCUSSION AND IT'S HARD FOR
THEM TO PUT THEIR THEIR FINGER
ON IT. ULTIMATELY THAT
POPULATION CALIFORNIA PAYS
CALIFORNIA'S HEALTHCARE BILLS.
BUT I DON'T ALWAYS KNOW HOW MY
MONEY'S GOING THROUGH THE SYSTEM
AND IT'S HARD FOR ME TO FIGURE
OUT HOW TO BE PART OF THAT
DISCUSSION AT SOME.
SO I THINK THAT MAKES IT MORE
DIFFICULT TO IMAGINE THAT WE
HAVE A WORLD IN WHICH WE'RE
BALANCING THE VALUE THAT WERE
GETTING THE PRICE THAT WERE
PAYING.
IF SO MANY THAT SO MANY
DIFFERENT PEOPLE WITH SO MANY
DIFFERENT AND SOMETIMES.
IMP INCOMPLETE IDEAS ABOUT HOW
THE MONEY IS FLOWING ARE PART OF
THE DISCUSSION.
OKAY SYSTEM POLICY
CONSIDERATIONS TO FINISH UP
THESE ARE BASICALLY OF TO START
IN THE CONTEXT OF A SYSTEM IN
WHICH WOULD WHICH WE MAINTAIN
SOME OF THE FEATURES OF OUR
CURRENT SYSTEM BUT WHAT COULD A
STATE DO. TO TRY AND MAKE THE
BARGAINING WORKED OUT BETTER IF
YOU WILL SO WE GET CLOSER TO
PRICES THAT WE CAN.
VIEW AS REFLECTING THE VALUE
THAT WE LIKE TO BE GETTING FROM
OUR HEALTHCARE SYSTEM.
THE FIRST THING IS MANAGING
CONSOLIDATION AYE WE'VE HAD A
TREND TOWARD IT THERE MIGHT I
CAN ONLY IMAGINE THERE WILL BE
MORE.
AND I THINK IT'S APPROPRIATE
FOR A STATE TO TAKE AN INTEREST
IN THE THE STRUCTURE OF ITS
HEALTHCARE MARKETS AND TO TAKE
IT TAKE A LOOK AT THAT. I WOULD
HAVE TO A COURSE INTERACT WITH
FEDERAL EFFORTS THE FTC OF THE
DEPARTMENT OF JUSTICE ALSO TAKE
AN INTEREST IN MERGERS.
AN ANTITRUST POLICY.
BUT THESE THINGS AFFECT STATES
AS WELL AS THE FEDERAL
GOVERNMENT SO TO THE EXTENT THAT
THE STATE WOULD WANNA MONITOR
ITS MARKETS AND DECIDE IF THERE
WERE ACTIONS IT WOULD WANT TO
TAKE I THINK THAT'S APPROPRIATE.
SOMETIMES DIFFICULT TO KNOW
EXACTLY HOW TO DO THAT BUT THERE
ARE METRICS THAT EXISTS THERE
ARE. AYE DEATH HIRSCHMAN HER
FROM DAHLE INDEX BOTHER R.
CONSOLIDATION YOU KNOW WE CAN
TALK LONGER ABOUT THESE IF YOU
WANT TO. CONFIRM MY CLASS
SOMETIME WE'LL TALK ABOUT OF A
TAIL.
YOU KNOW BUT THERE ARE THINGS
YOU CAN DO THERE ARE TOOLS YOU
CAN USE IN WAYS YOU CAN TAKE A
LOOK AT THE US AND THAT MAY BE
THAT STATE EFFORTS TO REVIEW
MERGERS MIGHT BE APPROPRIATE AND
WOULD HELP.
I THINK IMPROVING THE CONTEXT
FOR ENSURE BARGAINING IS IS
HELPFUL SO THERE ARE INSURANCE
COMPANIES THAT DO TRY AYE TO
NEGOTIATE RATES WITH PROVIDERS
AND SOMETIMES. IT'S HARDER FOR
THEM THAN IT NEEDS TO BE SO IT
MAY BE THAT WE CAN GET SOME
ADVANTAGE THERE. I'LL POINT OUT
A COUPLE OF THINGS ONE IS I'M
JUST A THING TO KEEP IN MIND ONE
OF THE INTERESTING TRADEOFFS IS
AS WE'VE TALKED ABOUT ISSUES
TODAY IS BETWEEN NETWORK
STRUCTURE. AYE AND AND
BARGAINING ABILITY SO I DOCTOR
GRAVES POINTED OUT I THINK
IMPORTANTLY THAT.
IF YOU HAVE NARROW NETWORKS AND
COMPLICATED NETWORKS IT CAN BE
HARD FOR PATIENTS.
I ONE OF THE THINGS THAT IT IS
INTERESTING ONE OF THINGS THAT
IS INTERESTING THOUGH IS THAT
THE ABILITY OF AN INSURANCE
COMPANY TACTIC A HOSPITAL OUT OF
THE NETWORK IF THEY DON'T COME
UP WITH A REASONABLE PRICE. IS
AN IMPORTANT COMPONENT OF
BARGAINING AND SO EFFORTS TO SAY
SYSTEMATICALLY SAY EVERY
HOSPITAL HAS TO BE IN A NETWORK.
I WOULD PUT TREMENDOUS POWER IN
THE HANDS OF THE HOSPITAL WHEN
THEY WOULD GO TO NEGOTIATE WHAT
THEIR RATES ARE GOING TO BE. ON
SO THAT'S AN IMPORTANT
CONSIDERATION WHEN YOU SET THOSE
KINDS OF POLICIES THERE'S
CLEARLY ARE CLEARLY TRADE OFFS
ON BOTH SIDES BUT WE DON'T WANT
TO GO TOO FAR ONE WAY OR THE
OTHER WE MIGHT MAKE A MISTAKE.
THE SECOND THING I'LL JUST POINT
OUT IS THAT LIMITATIONS ON OUT
OF NETWORK PRICES CAN HAVE
IMPORTANT EFFECTS AS WE SAW WITH
MEDICARE ADVANTAGE. I KNOW THE
STATE OF CALIFORNIA HAS.
MADE SOME EFFORTS TO THINK
ABOUT OUT OF NETWORK PRICING AYE
AND I'LL SIMPLY SAY THAT THOSE
CAN BE.
IMPORTANT AYE AND MAY BE VERY
VERY USEFUL AND MANAGING PRICE
GROWTH A BECAUSE THEY AFFECT THE
BARGAINING THAT GOES ON A
COMMERCIAL PLANS. AND SO THAT
MAY BE SOMETHING TO CONSIDER.
ENCOURAGING INDIVIDUAL PARTS OF
INSURANCE I THINK IS ANOTHER WAY
TO TO STRENGTHEN THE HAND OF
PEOPLE WHO ARE NEGOTIATING FOR
REASONABLE RATES. ARE COVERED
CALIFORNIA'S BEEN VERY
SUCCESSFUL.
AS A MARKETPLACE AND
ENCOURAGING THE USE OF THAT TO
THE EXTENT THAT THAT THAT STATE
POLICY CAN HELP THAT GROW AND
FLOURISH.
I THINK WOULD.
ALSO PUT MORE POWER IN THE HANDS
OF PEOPLE WHO ARE NEGOTIATING
RATES AND ALLOW SOME PRESSURE
TO.
BROUGHT TO.
I'LL KNOW THAT ENCOURAGING
PRICE TRANSPARENCY IS PROBABLY
PART OF OUR STORY I'D VERY HARD
AS YOU ALL KNOW TO SEE THE
PRICES FOR
PEOPLE TO KNOW WHAT'S GOING ON
AND I KNOW CALIFORNIA'S I'D SAID
THEY'RE JUST DISCUSSIONS NOW
ABOUT THIS AND I ENCOURAGE.
THOSE.
I WILL JUST OFFER THE CABBIE
OUT THAT ONCE IN AWHILE I'M.
SO SOMETIMES WE CALL THIS THE C.
E. O. PROBLEM AND AND THEIR
ECONOMICS WORLD WHERE.
PUBLICATION OF ALL THE CEO
SALARIES DID NOT MAKE THEM GO
DOWN AYE IT MADE HIM GO UP WHEN
THE FOLKS AT THE BOTTOM OF THE
PILE FIGURED OUT WHAT THEY COULD
BE GETTING IF ONLY THEY DID A
BETTER JOB OF NEGOTIATING.
RIGHTED SO JUST SIMPLY
PUBLISHING ALL THE PRICES IN
CALIFORNIA.
MIGHT OR MIGHT NOT MAKE THEM GO
DOWN IT MIGHT JUST YEAH I INFORM
ALL THE PEOPLE GETTING LESS THAT
THEY COULD BE SHOULD BE TRYING
TO GET MORE. YOU HAVE TO PUBLISH
THE PRICES IN THE CONTEXT OF A
STRUCTURE THAT ALLOWS THE
DOWNWARD PRESSURE TO BE BROUGHT
TO BEAR TO USE THAT TO TRY TO
DRIVE DOWN PRICES.
AND I COME UP TO PRICE
REGULATION WHEN I JUST TALKED
ABOUT ARE THINGS THAT YOU COULD
TRY THAT MIGHT HELP IN THE
CONTEXT OF A THE THE SITUATION
THAT WE ARE IN NOW. AYE IT MAY
BE THAT THOSE ARE INSUFFICIENT
TO IF MARKETS ARE TO
CONCENTRATED THE HORSES OUT OF
THE BARN IF THERE ARE OTHER
REASONS THAT WE. ARE GOING TO
HAVE A HARD TIME MANAGING IT AYE
WE MAY GET TO SOME A SITUATION
WHERE WE WANT TO. TALK ABOUT
THINGS THAT DOCTOR TRISH WAS
TALKING ABOUT TRYING TO MANAGE
OUR PRICE STRUCTURE A LITTLE
MORE AGGRESSIVELY. I'M I THINK
THAT UP FOR ME COMES MAYBE I'M.
THAT SOUNDS LIKE IT MIGHT BE
CHALLENGING.
CERTAINLY WOULD BE POLITICALLY
CHALLENGING IN THERE'D HAVE TO
BE DISCUSSIONS WITH HEALTHCARE
PROVIDERS BUT SOMETHING LIKE THE
MARYLAND MODEL DOES OFFER AN
OPPORTUNITY TO THINK ABOUT HOW
YOU DO THAT. AND MAYBE MOVING IN
THAT DIRECTION IS ULTIMATELY
WHERE WE NEED TO GET TO GO SO I.
I'LL SUGGEST THAT I THINK THAT
THAT COULD BE AN IMPORTANT THING
TO THINK ABOUT. I'M.
WRAPPING UP.
MAYBE I JUST NOTICED THAT YOU
ARE OFF QUITE FAMILIAR IT SOUNDS
ABOUT SUBSIDY ABOUT THESE
ISSUES.
AYE RURAL AREAS MAY NEED SPECIAL
CONSIDERATION IN THESE KINDS OF
DISK.
A LOT OF THE ECONOMIC THEORIES
IN THE ECONOMIC IDEAS PRESUME
SOME NOTION SOMEPLACE OF FOUR
OUT FOR BARGAINING IN
NEGOTIATION AND THAT PRESUMES
MULTIPLE HOSPITALS FOR EXAMPLE.
THAT YOU CAN TALK TO AND IF YOU
DON'T HAVE THAT IN AN AREA.
.
SOME OF THESE WON'T WORK AS WELL
AYE AND IF YOU TOOK DRAMATIC
ACTION IN A CLOSED HOSPITALS IN
RURAL AREAS AND TOOK ACCESS AWAY
FROM PEOPLE THAT COULD BE A REAL
PROBLEM AS WELL AND SO IT MAY.
BE THAT THERE WOULD HAVE TO BE
UNIQUE CONSIDERATIONS ARE
SPECIAL CONSIDERATION GIVEN. TO
RURAL AREAS AND ANY EFFORT TO
MANAGE PRICES I'D MIGHT BE THAT
YOU NEED TO SYSTEMS IN SOME
SENSE TO MAKE SURE THAT YOU
DIDN'T DO DAMAGE IN THOSE AREAS.
AND I'LL JUST WRAP UP THEN BY
MAKING ONE MORE POINT IN THAT IS
I THINK THAT I HAVE TALKED A LOT
ABOUT PRICES AND THINGS THAT YOU
TO DO FOR PRICES.
I SPENT A LOT OF MY OWN TIME
RESEARCHING THESE ISSUES AND SO
I THINK PRICES ARE PARDONED FOR
PRICES SAKE. BUT WE SHOULDN'T
STOP THERE BECAUSE MANAGING OUR
PRICES HAS IMPLICATIONS FOR HOW
WE RUN OUR HEALTHCARE SYSTEM AND
FOR THE ACCESS THAT WE CAN MAKE
AVAILABLE TO PEOPLE AROUND THE
STATE. FOR THE LONG TERM
SUSTAINABILITY OF A YOU KNOW THE
FINANCING SYSTEMS THAT WE HAVE
AND SO. AS I THINK THIS IS
IMPORTANT FOR MANY REASONS AND
ACTUALLY GETTING A HANDLE ON
SOME OF THE HIGH AND RISING
PRICES WOULD ALLOW.
EFFORTS TO EXPAND COVERAGE TO
GO FORWARD MORE EASILY IT WOULD
HAVE OTHER IMPORTANT ADVANTAGES
AND SO FROM A. BROADER
PERSPECTIVE IT'S IMPORTANT I
THINK.
THANK YOU VERY MUCH.
THANK YOU FOR YOUR TESTIMONY AND
NEXT WE HAVE PLAY REAL OF THE
CAN THINK.
THANKS AGAIN TO THAT TO THE
COMMITTEE.
AYE AYE I'M WELL AWARE THAT I
STAND BETWEEN YOU AND PUBLIC
COMMENTS I PROMISE TO BE. TO BE
BRIEF.
BECAUSE THAT IS CERTAINLY
IMPORTANT.
AS WELL.
AS IT SLIDES ARE BEING.
SET UP.
YOU KNOW I'M GONNA TALK ABOUT.
ADMINISTRATIVE COSTS IN IN THE
HEALTH CARE SYSTEM.
AND THAT THIS IS CERTAINLY NOT
THE DRIVING FORCE OF OF HEALTH
CARE REFORM. AND IT PALES IN
COMPARISON TO THE OVERALL EFFORT
TO GET MORE AFFORDABLE COVERAGE.
AVAILABLE TO MORE PEOPLE.
AND YOU CERTAINLY DON'T SEE A
LOT ABOUT FIRST OCCURS AROUND
SAYING REDUCE HEALTHCARE
ADMINISTRATIVE COSTS NOW.
.
BUT.
BUT IT IS POTENTIALLY A WAY TO.
TO REDUCE COMPLEXITY IN THE
SYSTEM.
AND ALSO I THINK AS AS LAWRENCE
SUGGESTED FREE UP RESOURCES.
TO EXPAND COVERAGE.
TO THE EXTENT ADMINISTRATIVE
COSTS.
REPRESENT WASTE IN A SENSE IF
WE CAN REDUCE THAT WASTE.
THEN WE HAVE MORE MONEY
AVAILABLE.
TO TO COVER PEOPLE.
.
SO I THINK IT'S HELPFUL TO LOOK
AT WHAT WE THINK OF AS AS
ADMINISTRATIVE COSTS AND AND I
THINK THE WAY TO A THINK ABOUT
THIS IS THAT.
ADMINISTRATIVE COSTS ARE
BASICALLY EVERYTHING WE SPEND IN
THE HEALTHCARE SYSTEM.
THAT IS NOT PATIENT CARE.
SO THE WAY TO THINK ABOUT THIS
IS IT'S KIND OF WHAT WE SPEND
FOR.
PEOPLE WEARING SUITS.
FOR MEN AND WOMEN WEARING SUITS
RATHER THAN MEN AND WOMEN
WEARING A WHITE COATS OR OR
SCRUBS.
AND IF HE'S GOING TO GO DOWN
THE LIST OF WHAT THIS
REPRESENTS.
IT CERTAINLY PROFIT.
AND YOU KNOW MUCH OF OUR
HEALTHCARE SYSTEM IS.
IT RUNS ON PROFIT.
NOT NECESSARILY HOSPITALS BUT
CERTAINLY PHYSICIAN GROUPS.
AND CERTAINLY MOST OF OUR
HEALTH INSURERS AS WELL.
THINK WE FOCUS A LOT ON SORT OF
THE INSURANCE ASPECTS OF
ADMINISTRATION SO THAT'S THINGS
LIKE BILLING. CLAIMS PAYMENT.
AND OTHER INSURANCE RELATED
COSTS.
THERE CERTAINLY IN A
COMPETITIVE COMMERCIAL SYSTEM A
LOT OF MARKETING.
AND IT'S NOT JUST INSURERS IT
CERTAINLY HOSPITALS AND
PHYSICIAN GROUPS AS WELL.
AND OTHERS PARTS OF OF THE
ADMINISTRATIVE COSTS THAT I
THINK WE WOULDN'T NECESSARILY.
DEPENDING ON YOUR PERSPECTIVE
THINK OF AS AS KIND OF WASTE.
AND THAT'S CARE MANAGEMENT AND
CLINICAL ADMINISTRATION I MEAN
YOU KNOW HOSPITALS INSURANCE
COMPANIES ARE BIG ORGANIZATIONS
AND IT REQUIRES SOME AMOUNT OF
ADMINISTRATION TO TO MAKE THEM
FUNCTION.
YOU KNOW WE TALK A LOT ABOUT
THE DIFFERENT SECTORS OF OF
HEALTH INSURANCE AND HEALTH
COVERAGE IN CHURN AMONG THOSE
SECTORS.
AND SORT OF DETERMINING
ELIGIBILITY AND MANAGING THE
ENROLLMENT.
IS.
IF YOU TO PRINT REQUIRES
ADMINISTRATIVE EXPENSES AND
INDUCTANCE DEVEN INCLUDE THINGS
LIKE AYE HR DEPARTMENTS IN
EMPLOYERS THAT HAVE TO MANAGE
THE HEALTH BENEFITS.
FOR THEIR WORKERS.
AND THEN THERE IS THE THE
GOVERNMENT.
GOVERNMENT ADMINISTRATION YOU
KNOW RUNNING MEDICARE MEDICAID
AGENCIES RUNNING RUNNING
MEDICARE IT CETERA.
SO FOR PUT SOME NUMBERS ON THE
S. ASSUR FOCUSING FIRST ON ON
HEALTH INSURANCE.
AND.
YOU KNOW FIRST THING TO KNOW IS
THAT THE ADMINISTRATIVE COSTS
ASSOCIATED WITH HEALTH INSURANCE
HAVE INCREASED DRAMATICALLY.
OVER OVER RECENT DECADES.
ESSENTIALLY DOUBLING FROM THREE
AND A HALF PERCENT OF TOTAL
HEALTH CARE.
SPENDING TO A SEVEN POINT NINE
PERCENT OF OF HEALTHCARE
SPENDING.
BUT IT'S REALLY IMPORTANT TO
LOOK AT THE AT HOW THAT VARIES
TREMENDOUSLY FROM ONE SECTOR TO
ANOTHER.
SO IF WE LOOK AT MEDICARE.
IN REALLY HERE WE'RETALKING
ABOUT TRADITIONAL FEE FOR
SERVICE POINT FOUR PERCENT.
OF OF TOTAL HEALTH SPENDING IN
IN MEDICARE.
NOW IT'S A LITTLE MISLEADING.
GIVEN HOW THE CURRENT MEDICARE
SYSTEM IS RUN.
WHERE A LOT OF PEOPLE NOW AND
ROLE IN PRIVATE PLANS THROUGH
MEDICARE ADVANTAGE OR PART D.?
PRIVATE INSURANCE PLANS FOR
DRUGS.
IF YOU INCLUDE THE
ADMINISTRATIVE OVERHEAD IN THOSE
INSURANCE PLANS THE CONTRACT
WITH MEDICARE.
IN MINISTRY OF COSTS REPRESENT
SEVEN PERCENT.
OF OF TOTAL HEALTH SPENDING.
NOW MEDICAID EVEN AS A PUBLIC
SYSTEM.
ALSO CONTRACTS PRIMARILY WITH
PRIVATE INSURERS.
TO DELIVER.
MEDI CAL BENEFITS OR MEDICAID
BENEFITS YEAH IN OTHER STATES.
PARTICULARLY FOR WOMEN.
AND.
.
IN ADULTS AND CHILDREN.
IN SO OVERALL ADMINISTRATIVE
COSTS AND MEDICAID ARE TEN POINT
SEVEN PERCENT OF HEALTH SPENDING
IF YOU INCLUDE THE OVERHEAD. IN
THOSE INSURERS THAT MEDICAID
CONTRACTS WITH.
AND CERTAINLY PRIVATE INSURANCE
NOT SURPRISINGLY.
IS THE.
IS THIS IS THE.
HAS THE HIGHEST OVERHEAD MANY
SECTOR AT ELEVEN POINT FIVE
PERCENT ON AVERAGE.
THOUGH EVEN THAT VARIES
TREMENDOUSLY.
YOU KNOW A LARGE EMPLOYER WITH
A A LARGE GROUP.
THAT SELF INSURED.
MIGHT BE QUITE A BIT LOWER THAN
THAT.
INDIVIDUAL INSURANCE WHICH HAS
HIGHER MARKETING COSTS HIGHER
ENROLLMENT COST I WILL GENERALLY
BE HIGHER THAN THAT.
ROUGHLY IN THE RANGE OF OF
TWENTY PERCENT.
AND DON'T KNOW IF FOCUSING ON.
ADMINISTRATIVE COSTS INSURERS
THE FOR THE CHARACTER ACTUALLY
DID I TOOK STEPS TO TRY AND.
TRYING REDUCE THESE COSTS.
BY SETTING AYE AYE CAPTAIN
WHAT'S KNOWN AS THE MEDICAL LOSS
RATIO AND THAT'S THE RATIO OF.
HEALTHCARE EXPENSES THAT AN
INSURER PAYS OR CLAIMS.
TO THE OVERALL PREMIUMS THAT
ENSURE TAKES TAKES SEN.
THAT THIS APPLIES TO
INDIVIDUALS AND.
INSURED GROUPS PRIMARILY SMALL
GROUPS BECAUSE SELF INSURED
EMPLOYERS DON'T.
YOU KNOW DON'T CONTRACT.
DON'T BUY INSURANCE FROM AN
INSURER.
AND. IF YOU LOOK AT WHAT THIS
INCLUDES SAID SAID THE.
THE.
RECEDED MINISTRY TO PART OF IT
CERTAINLY INCLUDES WHAT WE THINK
OF AS AS CLAIMS PAYMENT
MARKETING.
BROKER COMMISSIONS PROFITS.
THE.
THE DEFINITIONS IN THE
AFFORDABLE CARE ACT ALSO
INCLUDED.
WINNER KNOWN AS QUALITY
ENHANCEMENT EXPENSES AS PART OF
OF THE HEALTH CARE PORTION OF
THE RATIO SO SO ANYTHING ENSURE
DOES OR NUMBER OF THINGS AN
INSURER CAN DO TO IMPROVE
QUALITY. ACCOUNT AS AS.
AS HEALTH CARE EXPENSES RATHER
THAN THAN OVERHEAD.
NOW IN GENERAL THAT LOSS RATIO
RULES IN THE AFFORDABLE CARE ACT
WHICH REQUIRED.
INDIVIDUAL AND SMALL BUSINESS
INSURERS TO SPEND AT LEAST
EIGHTY PERCENT OF THEIR PREMIUM
REVENUES ON ON CARE OR QUALITY
IMPROVEMENT.
HAVE NOT BEEN REALLY
CONSTRAINING.
AND THAT'S PARTLY BECAUSE.
IN IN MANY STATES INSURERS HAVE
BEEN LOSING MONEY SO.
SO SO THAT THE LOS RICH YOU'RE
HAVING COME INTO PLACE THAT HAS
NOT BEEN TRUE IN CALIFORNIA.
AND HAS NOT BEEN TRUE IN THE
LAST YEAR WHERE MOST INSURERS
ARE ACTUALLY MAKING MONEY ON
THIS MARKET.
BUT THE MARKET'S BEEN VERY
PRICE COMPETITIVE.
AND HAS DRIVEN PREMIUMS.
DOWN AND THE LOSS RATIOS UP.
BUT IT HAS HAD AN EFFECT.
YEAH INDIVIDUALS AND SMALL
BUSINESSES HAVE GOTTEN A
SUBSTANTIAL REBATES WHERE
INSURERS.
I DON'T MEET THE LOSS RATIO
BUT. MOST OF THE RESEARCH
SUGGESTS THAT.
ABOUT TWENTY TO TWENTY FIVE
CENTS OF EVERY DOLLAR IN
HOSPITALS AND AND PHYSICIAN
GROUPS.
GOES TOWARDS ADMINISTRATION.
NOW REMEMBER THIS
ADMINISTRATION IS NOT JUST.
YOU KNOW.
DEALING WITH INSURANCE COMPANIES
IT'S ALSO.
MANAGING THE CLINICAL
ENTERPRISE YOU KNOW MANAGING
THAT DOCTORS AND.
AS.
MANY OF SNOW DOCTORS IN YEAH I
CAN BE DIFFICULT MANAGE
SOMETIMES.
.
THE.
SERVE IN IF YOU CAN BREAK THAT
DOWN IN IN THIS IS BASED ON WORK
DATA JIM CON FROM UCSF AND.
RICK CHRONIC FROM UC SAN DIEGO
DID A NUMBER OF YEARS AGO BUT
IT'S STILL A PRETTY RELEVANT AYE
IF YOU LOOK AT THE TOTAL
ADMINISTRATIVE COSTS IN
CALIFORNIA HOSPITALS. IT'S ABOUT
TWENTY ONE PERCENT. OF TOTAL
COSTS BUT IF YOU FOCUS ON JUST
THE KIND OF BILLING AND
INSURANCE RELATED COSTS. THAT
MIGHT BE A TARGET OF A OF A.
HEALTH REFORM.
APPROACH.
THAT TOTAL SIX POINT SIX TO TEN
POINT EIGHT PERCENT SOCIALIST
STILL SUBSTANTIAL AMOUNT.
BUT NOT MOST OF THE
ADMINISTRATIVE COSTS.
IN A HOSPITAL AND IT'S A VERY
SIMILAR STORY WITH.
WITH PHYSICIAN GROUPS WHERE
TOTAL ADMINISTRATIVE COSTS ARE
TWENTY SIX POINT SEVEN PERCENT.
IN BILLING INSURANCE RELATED
COSTS ARE THIRTEEN POINT NINE
PERCENT.
NOW I'M NO ANOTHER WAY TO THINK
ABOUT THIS IS COMPARING.
THE U. S. TO ANOTHER COUNTRY
LIKE STEM THAT REDUCE THIS KIND
OF
BUILDING AN INSURANCE OVERHEAD.
YOU COULD REDUCE STATE NOT JUST
ADMINISTERED COSTS INSURANCE
COMPANIES BUT THE ADMINISTRATIVE
COSTS IN PHYSICIAN GROUPS AND
HOSPITAL SUBSTANTIALLY AS AS
WELL.
NOW. JUST TO CONCLUDE ANYTHING
THINKING ABOUT HOW THAT MIGHT
HAPPEN.
THEIR NUMBER OF POLICY DESIGN
QUESTIONS THAT WOULD INFLUENCE.
HOW MUCH ADMINISTRATIVE COSTS
COULD BE REDUCED IN IN A
HEALTHCARE REFORM PLAN?
YOU KNOW ONE IS HOW MUCH COST
SHARING PATIENTS ARE RESPONSIBLE
FOR.
SOME SINGLE PAYER PLANS CALL
FOR THE COMPLETE ELIMINATION OF
PATIENT COST SHARING.
IN THAT WOULD CERTAINLY CREATE
A MUCH SIMPLER MUCH.
LESS ADMINISTRATIVELY COMPLEX
SYSTEM.
IT ALSO IS MORE EXPENSIVE.
IF YOU WERE TO ELIMINATE ALL
ALL PATIENT CARSHARING.
IN MOST COUNTRIES HAVE NOT DONE
THAT.
NONE SECOND IS IS THERE STILL A
NEED FOR ELIGIBILITY SYSTEMS TO
DIFFERENTIATE BETWEEN HIGH
INCOME AND LOW INCOME PEOPLE.
SO FOR EXAMPLE IS IT A SYSTEM
WHERE LOW INCOME PEOPLE GET
ENHANCED BENEFITS OR LOWER
DEDUCTIBLES.
IN WHICH CASE YOU HAVE TO HAVE
SOME KIND OF ELIGIBILITY
APPARATUS.
TO DO THAT AND THAT TAKES A
ADMINISTRATIVE.
ADMINISTRATIVE EFFORT.
.
HE NO WE WE WE WE THINK OF.
A SINGLE PAYER SYSTEM IS BEING
MUCH SIMPLER AND IT CERTAINLY
IS.
BUT IT IS STILL A PAIR OF
HEALTH CARE MINUTE WILL STILL BE
UNDER PRESSURE TO CONTROL COSTS.
AND OME OF THAT PRESSURE FOR
CONTROL MAY INVOLVE.
PUTTING AT PUTTING IN PLACE
PAYMENT SYSTEMS THAT THAT LAUREN
AND AARON TALKED ABOUT.
PUTTING IN PLACE PRIOR
AUTHORIZATION YOU KNOW FOR
HOSPITALIZATIONS OR OR SPECIALTY
CARE.
IN THAT AGAIN ALL TAKES
ADMINISTRATIVE OVERHEAD SO SOME
OF THAT ADMINISTRATIVE OVERHEAD
THAT INSURERS ARE NOW SPENDING
MIGHT TRANSLATE TO A A PUBLIC
PLAN. ARM AS WELL.
IN AND FINALLY JUST HOW COMPLEX.
THAT THE SYSTEM IS AND AND I
WOULD DO THAT.
.
CONCLUDE BY LEAVING YOU WITH
THAT. SORT OF A SUGGESTED GOAL
WHICH.
FOR ALL OF THIS WHICH I THINK
IS SIMPLICITY.
YOU KNOW WE WE HEALTHCARE
EXPERTS I HAVE A KNACK FOR
MAKING THINGS.
COMPLICATED. HOME AND.
IN CERTAINLY YOU KNOW A DESIRE
TO TO SATISFY COMPETING
INTERESTS ARE COMPETING
STAKEHOLDERS I GENERALLY
INCREASES THE COMPLEXITY.
OF A PROGRAM OR A PLAN.
BUT YOU KNOW SELLING A HEALTH
REFORM PLAN TO THE PUBLIC AND
MAKING IT SUSTAINABLE.
I THINK REQUIRE SOMETHING
THAT'S.
THAT'S MUCH SIMPLER THEN.
THEN THEN WHAT WE HAVE NOW AND
AND EVEN THEN THE AFFORDABLE
CARE ACT WHICH ITSELF IS THAT.
IS QUITE COMPLEX.
THANK YOU.
SO UP A FEW THINGS WERE GOING TO
NOW TAKE QUESTIONS TO THE DíAS
I DO WANT TO BOMB NOTIFY THOSE
WHO ARE HERE AND ATTENDANCE
WE'RE GOING TO TAKE PUBLIC
COMMENT AFTER. THIS PANEL AND A
CONSUMER PANEL WHICH WILL
TESTIFY FOR A TOTAL OF.
TEN MINUTES.
THERE ARE THREE MICROPHONES
WHICH WILL BE AVAILABLE TWO OF
THEM ARE HERE ON THE LOWER LEVEL
AND ONE IS ON THE UPPER LEVEL SO
FEEL FREE TO LINE UP IF YOU
WOULD LIKE BUT WANTED TO GIVE
YOU THE HEADS UP. THAT WILL BE
ASKING QUESTIONS OF THIS PANEL
BEFORE WE ASK QUESTIONS OF THE
NEXT.
WITH THAT IF THERE ARE PEOPLE
WHO ARE HERE I.
QUESTIONS.
HOW TO BE REALLY QUICK BECAUSE I
WANT TO GO TO PUBLIC COMMENTS IS
PLEASE WE CAN?
FOR THOSE WHO ARE HERE AND A
WEEK.
MY FIRST QUITE YOU KNOW I I
MEAN I'M NOT A HEALTHCARE
PROFESSIONAL I'M TOOL CIVILIAN
SO I'VE PRETTY MUCH LEARNED.
EVERYTHING I KNOW ABOUT
HEALTHCARE FROM THE LAST IN THE
SERIES OF HEARINGS SO EXCUSE ME
IF MY QUESTIONS ARE.
REALLY ADELINE. KAISER CREDIT
BECAUSE OUR HOUSE CARE MODEL
WITHIN ITS LITTLE UNIVERSE IS IT
IN IT IN AN OF ITSELF AS IT
CONTAINS SYSTEM A SINGLE PAYER
SYSTEM.
KIND OF AND HOW IT OPERATES.
YOU GONNA SAY NO OFFICE NO NO
NOT REALLY AND. NOW SO I'M A
SINGLE PAYER SYSTEM WE WOULD
NORMALLY SAY IS.
.
COMMONLY AYE TAX FINANCE
GOVERNMENT RUN SYSTEM THAT
PROVIDES INSURANCE TO A LARGE
GROUP OF THE POPULATION HAWKEYE
AND SO KINDER. I YOU KNOW IF YOU
IF YOU USE THAT A LARGE DELIVERY
NETWORK LIKE THAT TO PROVIDE
CARE FOR A. BUNCH OF CALIFORNIA
FOR EXAMPLE MAKE IT CLOSER TO IT
BUT I DON'T THINK WE NORMALLY
SAY KAISER IS A SINGLE PAYER
SYSTEM GOT IT HAS SOME
SIMILARITIES.
SO
IT SOUNDS LIKE THE
ADMINISTRATIVE COSTS.
DEALING WITH THE IN THE
ADMINISTRATION THE INSURANCE.
SO OF ADMINISTRATION OF THE
SYSTEM NOT INTERNAL COSTS AT
ANY.
HEALTHCARE SYSTEM WHETHER IT'S
SINGLE PAYER OR NOT HAS THE
STATISTIC YOU SHOW TO THE
DEFENSE IN THE U. S. AND CANADA
YOU'RE LOOKING AT ABOUT TEN
PERCENT DIFFERENCE.
TO ADMINISTER. THAT.
.
UP.
THAT SYSTEM AS OPPOSED TO THE
SYSTEMS THAT WE HAVE HERE.
SO ONE OF THE THINGS THAT I WAS
VERY INTERESTED IN LISTENING FOR
YOU TOUCHED ON IT A BIT. I'M
PARTICULARLY MISTER BAKER BUT
ALSO MISTER LEVITT.
IS OUR SYSTEM DRIVEN BY.
MARKET FORCES.
AS OPPOSED TO THE EUROPEAN
SYSTEMS ALL OF WHICH.
TAKE A LOT THAT SEEMS TO ME TAKE
A LOT OF THOSE MARKET. DRIVERS
OUT OF THE SYSTEM AND REPLACE
THEM WITH PURE REGULATION.
OR A LOT OF REGULATION SO THEY
HAVE THEY HAVE HAVE AS FAR AS I
UNDERSTAND IT THEY HAVE VERY
HEAVILY REGULATED COST
CONTAINMENT.
WHERE IS OURS IS COMPLETELY
MARKET DRIVEN?
SO.
.
JUST A COMMENT IT JUST IT SEEMS
TO ME THAT THE DIFFERENCE IN THE
COST THEN BETWEEN AT TEN PERCENT
THAT BUT THAT IS IS ATTRIBUTABLE
TO THE SYSTEM.
THAT IF WE WERE TO IMPLEMENT
WHAT'S A SINGLE PAYER TOMORROW
WITHOUT THE REST OF THE COST
CONTAINMENT WE'RE REALLY LOOKING
AT SAVING TEN PERCENT BUT WHAT
THE DIFFERENCES IS THAT THEY
ARE.
REGULATING ACROSS THEIR ENTIRE
SYSTEM.
SO THEY'RE SAYING WE'RE GOING ON
NOT ALLOW THE MARKET WHETHER
IT'S HOSPITALS DOCTORS INSURANCE
COMPANIES ANYONE
PHARMACEUTICALS.
ANY COMPANY OR PERSON WHO
TOUCHES HEALTHCARE.
WE'RE GOING TO REGULATE THE
PROFITS OR IF THE PAYMENT
PERIOD.
AND THAT'S WHERE THEY'RE GETTING
THE BULK OF THEIR COST SAVINGS.
SO SINGLE PAYER.
ITS ELEGANT IT'S OF.
EFFICIENT.
BUT HE DOESN'T GET YOU THERE
WE'VE GOT TO TAKE A REALLY GOING
TO BE SERIOUS ABOUT CONTROLLING
COSTS.
WE HAVE TO TAKE THE.
THE WE CAN'T ALLOW THE FREE
MARKET ANY LONGER WITH ITS
CONSOLIDATIONS AND ITS LACK OF
BALANCE IN TERMS OF BEING ABLE
TO CONTROL THOSE COSTS.
WE AS THE GOVERNMENT.
ARE THE ONLY ONES IN THE
POSITION OF ACTUALLY TAKING ALL
OF THOSE UNREGULATED PROFITS.
THAT ARE RIGHT WE HAVE BEEN
DRIVING THOSE COSTS UP AND UP
AND UP.
OUT OF THE SYSTEM.
RIGHT.
I MEAN IS I AM I AM SORT OF
HEARING.
NO I WOULD SAY THERE THERE ARE
COMPARING THE U. S. SYSTEM TO
TO.
INTERNET OTHER HIGH INCOME
COUNTRIES THERE REALLY TO.
TO TWO SOURCES OF OF SAVINGS
WHEN HIS ADMINISTRATION.
WHICH WE TALKED ABOUT EVEN THAT
THAT CANADIAN EXAMPLE IS JUST
HOSPITALS SO THAT'S ACTUALLY
JUST A PIECE.
A PIECE OF IT YOU WOULD ALSO SEE
SAVINGS AND.
IN HEALTH INSURANCE KNOW
ADMINISTRATION.
AND AND PROFIT.
THE OTHER THE OTHER.
AS YOU SUGGESTED IS IT'S IT'S
PRICES GENERALLY THAT THAT EVERY
OTHER SYSTEM.
CARVES OUT A GREATER ROLE FOR
GOVERNMENT.
IN IN REGULATING PRICES.
MANY VARIES FROM ONE SYSTEM TO
ANOTHER.
HOW IT'S DONE?
AND HOW COMPREHENSIVE IT IS BUT
I I WOULD SAY EVERY OTHER.
HIGH INCOME COUNTRIES REGULATES.
PRICES.
IN ONE ONE WAY OR OR ANOTHER.
NOW THERE IS A SOURCE OF THOSE
ARE TWO SOURCES OF SAVINGS.
FROM MOVING TO A.
SINGLE PAYER OR TAX FINANCE
SYSTEM.
I MEAN THERE IS A SOURCE OF
COSTS TO OBVIOUSLY.
YOU KNOW COVERING.
YOU KNOW WE DON'T PROVIDE
UNIVERSAL COVERAGE SO COVERING
AS ADDITIONAL PEOPLE.
PARTICULARLY COVERING THEM AT
LOWER COST PATIENT CARSHARING.
WOULD COST MONEY SO KIND OF THE
CALCULATION IS HOW MUCH COULD
YOU SAVE.
ON THE BY REDUCING
ADMINISTRATION REDUCING PRICES
AND THEN HOW MUCH WOULD IT COST
IN ORDER TO BRING EVERYONE INTO
THE SYSTEM.
RIGHT SO ON.
I MEAN YOU KNOW THAT THAT SHOWS
THE KIND OF THE.
TO REALLY BRING THE THE TRUE.
COST SAVINGS THAT WE WOULD NEED
TO DO WE WANT TO DO IS GOING TO
TAKE OF OBVIOUSLY A TREMENDOUS
AMOUNT OF CHANGE YOU TALKED
ABOUT THE DISRUPTIVE EFFECT AND.
OVER LEVEL OF REGULATION THAT
WE CERTAINLY HAVE NEVER HAD WITH
HEALTHCARE IN THIS COUNTRY THAT
I KNOW OF.
.
UP IT'S YOU KNOW IT'S JUST.
YOU KNOW WE WE LOOK AT ALL THESE
OTHER COUNTRIES THAT ARE HAVING
AT LEAST EQUAL IF NOT BETTER
HEALTHCARE RESULTS.
WITH THE REGULATION AND.
YOU KNOW SEEM TO HAVE GOTTEN
UNDER CONTROL WHAT SEEMS TO BE
EVEN WITH A CA. A AN UNRAVELING
SYSTEM.
WITH COSTS REALLY SPIRALING A
LOT HE HAS REALLY ACROSS THE
COUNTRY MAYBE LESS IN CALIFORNIA
AND WE DO HAVE COST CONTAINMENT
RIGHT IN MEDICAID MEDI CAL AND
THE VA SYSTEM.
DOES HAVE A LOT YOU KNOW APPEAR
GOVERNMENT CONTROL OF THOSE
COSTS AND WE SEE NOSY SHOWN
LOWER COSTS.
LOOKS LIKE PRETTY GOOD DELIVERY
OF OF CARE YOU KNOW THAT DOCTORS
MAYBE AREN'T HAPPY WITH THE
REIMBURSEMENT RATES.
.
IN HOSPITALS BUT BUT
FUNCTIONING.
SO. THAT'S SORT OF MY TAKE AWAY
HERE BUT IF I'M MISSING BIG
PIECES ARE.
YOU KNOW I'D.
YEAH.
FILL ME IN.
NOW THIS OUT ADD A LITTLE BIT TO
SO WHAT LARRY SAID I THINK BIG
THE KEY IS WHO'S GONNA PUSH BACK
INTO THERE ARE LOT OF THINGS
PUSHING PRICES UP.
THERE'S A LOT OF.
WELL WE TALKED A LOT ABOUT A LOT
OF THEM IN THE US HAS BUILT A
VERY DIFFUSE.
SET OF FOLKS ON THE OTHER SIDE
OF THE TABLE THAT HAVEN'T GOTTEN
THEIR ACT TOGETHER IN THE WAY
THAT SOME THE EUROPEAN SYSTEMS
BY ONE MECHANISM OR ANOTHER MORE
GOVERNMENT MORE EMPOWERED. OTHER
PROVIDERS HOW ARE THERE INSURERS
HOWEVER YOU DO IT AYE HAS BEEN
ABLE TO PUSH BACK THAT CREATES
THEN THAT WOULD CREATE THEN
ATTENTION TO CREATE SOME SOME.
OF PRESSURE IN THE US FOR LOWER
PRICES TO THE EXTENT OF PRICES
ARE HIGHER THAN THEY HAVE TO BE
TO DELIVER SERVICES. IT WOULD
ALSO PUT PRESSURE ON OTHER.
ASPECTS OF OUR DELIVERY SYSTEM
IT MIGHT MEAN DIFFERENT KINDS OF
HOSPITALS IT MIGHT BE DIFFERENT
SERVICES AVAILABLE IT MIGHT MEAN
DIFFERENT KINDS OF DOCTORS IN
THE SYSTEM IN THE LONG RUN.
MAYBE THAT WOULD BE GOOD FOR US
A BUT IT WOULD ENTAIL SOME
CHANGE TO THAT PUSH BACK WOULD
CREATE A LOT OF THAT TENSION IN
THE DISCUSSION ABOUT WHAT OUR
SYSTEM IS GOING TO LOOK LIKE. IN
THE FUTURE IT WOULD MAKE A
DISCUSSION ABOUT LOWER COSTS
BECAUSE OF CHANGES IN HEALTHCARE
DELIVERY AND WHO'S DELIVERING IT
HOW MUCH WE'RE PAYING THEM.
THOSE DISK DOES DISCUSSIONS WHAT
HAPPENED IN THE CONTEXT OF
THAT'S I THINK THAT'S THE OTHER
THING THAT'S HAPPENED IN THOSE
IN THOSE OTHER SYSTEMS. IS
THEY'VE HAD MANY YEARS OF THOSE
DISCUSSIONS WE WOULD HAVE TO
START THEM FRESH THEY BE
DIFFICULT TO DO. AYE BUT THEY
WOULD THAT WOULD SORT OF PUSH US
IN THAT DIRECTION AS YOU SEE.
ASSEMBLYMEMBER WALDRON.
THANK YOU MISTER CHAIR ARM OF
THIS CqC AS I CAN.
BEING ABLE TO TALK ABOUT THE
ADMINISTRATIVE COSTS IS IN A
SOMETHING I'VE BEEN LOOKING
FORWARD TO HOLY THROUGH ALL
THESE HEARINGS.
.
MY BROTHER IS A PHYSICIAN IN NEW
YORK AND HE HAS TO BASICALLY
COVER THE COST OF ABOUT NINETY
FIVE TWO HUNDRED TWENTY THOUSAND
A YEAR. JUST DEALING WITH PLAN
THE NILES
AND PAPERWORK.
APPEALS.
SO HAD THEY HAVE THEM IN THE
OFFICE SPACE STAFF TO HANDLE IT.
A FULL TIME JOB.
.
WHAT THEY GET IS IN NO RESPONSE
OF OLD THEY'VE LOST THE
PAPERWORK THEN THEY HAVE TO
RESCIND THE NAME RECESS I MEAN?
YOU KNOW IT'S A CONSTANT PROBLEM
MEANWHILE THE PATIENCE WAITING
THE PATIENT IS IN NO.
LOST IN THE SHUFFLE LITERALLY
I'M.
THEM WE LOOK AT OTHER THINGS
LIKE EVIDENCE BASED CARE VERSUS
THE UNNECESSARY TREATMENTS AND
EXTRA TESTS BECAUSE PEOPLE
AFRAID OF GETTING SUED. ON IN
THOSE IS HOLD A LEVEL BEYOND
JUST
I CARE IN YOU KNOW HOW WE HOW WE
TRYING TO DO WITH ACCESS.
FOR EXAMPLE MY MOTHER LOVES
EIGHTY THREE CURRENTLY BUT SHE
HAS A BACK INJURY.
IT TOOK THREE DOCTORS TO FINALLY
GET A REFERRAL TO SO SHE CAN GET
AN EPIDURAL BUT IN THE MEANTIME
SHOULD BE CLEARED BY AN
NEUROLOGISTS WHO WAS TRYING TO
FIGURE OUT IF SHE HAD DEMENTIA.
AND SHE'S EIGHTY THREE SHE GETS
UPSET SHE DOESN'T CLEARLY OF
DEMENTIA BUT THEY HAVE TO GO
THROUGH ALL THESE OTHER THINGS
BEFORE THEY FINALLY GIVEN UP
ADORO AND IS JUST UNNECESSARY
UNNECESSARY UNNECESSARY. YOU OF
PHYSICIANS WHO WERE STARING AT A
SCREEN AND I KNOW BECAUSE I
BRING MY SON IN FOR HIS. REGULAR
YOU KNOW CHECK OF EVERY YEAR
THEY SERVE THE SWING THE NOT
LOOKING AT THE PATIENT WHAT THEY
USE TO THERE'S JUST SO MUCH
PAPERWORK. SO MUCH BUREAUCRACY
THAT WE WE HAVE NO MATTER WHAT
WE DO WE HAVE TO CUT THAT AND
YOU KNOW I'M.
I I'M GLAD THAT THIS WAS BROACH
THAT THE HEARING HAS IT'S BEEN
ONE OF MY FRUSTRATIONS OVER WAY
THROUGH.
.
YOU KNOW I DON'T KNOW WHAT WHAT
WE'RE GONNA DO ABOUT. THOSE THAT
PAPERWORK SHUFFLE BUT OKAY.
REALLY QUICKLY I'M THE OTHER
ISSUE IS.
THIS.
HOW CURRENTLY WAS SET UP WHEN
WE HAVE A PATIENT COMING IN FOR
TREATMENT?
IF WE HAVE PATIENT A THEY
COMMAND.
PRESENTING WITH THE WHATEVER
THAT THEY.
DISEASE IS.
.
THEY'RE TOLD THEY NEED TO JUST
STEP THERAPY AND THEY FAIL.
THEN THE COMEBACK STEP THERAPY
AND THEY FAIL.
MEANWHILE THE PHYSICIAN ALREADY
KNOWS WHAT THEY WANT THEY'VE
GONE THROUGH YOU KNOW GETTING
DENIED.
WITHIN THE YEAR THE BUDGET YEAR
THE PATIENT WILL HOPEFULLY GET
WHAT THE PHYSICIAN WANTED IN THE
BEGINNING.
BUT MEANWHILE WHERE QUALITY OF
LIFE WAS LESS IF IT'S A
COMMUNICABLE DISEASE THERE'S YOU
KNOW THE VIRAL LOAD ISSUE IN THE
COMMUNITY THERE'S
HOSPITALIZATION COSTS.
GETTING A HANDLE ON WHAT'S.
STEPPED THIRD BE FAILURES R. IS
IMPOSSIBLE I'VE TRIED TO THE
DEPARTMENT OF HEALTH CARE
SERVICES AND OTHERS TO FIND OUT
WHAT IS A COST. PER PATIENT.
FOR EACH OF FAILURE OF THE STEP
THERAPY.
THAT'S A COSTS THOUGH IT'S A AND
IT'S OF THE WHOLE BUREAUCRACY.
.
IN ADDITION IT UP WE IF WE LOOK
TOWARD INDIVIDUALIZED MEDICINE
OR VALUE ADDED HEALTH CARE AND
THAT'S WHAT I HOPE CAN BE PART
OF THIS DISCUSSION.
THERE'S SOME IS THERE AND THIS
IS THE QUESTION IS THERE SOME
TRUTH.
TO THE IDEA OF GETTING THE BEST
CARE UP FRONT.
REALIZE SAVINGS IN THE LONG RUN.
ISN'T IT PART OF THIS EQUATION.
YEAH MAN I THINK ONE OF THE
CHALLENGES WOULD THE FRAGMENTED
SYSTEM THAT WE HAVE TODAY IS
THAT IF THERE ARE KIND OF LONG
RUN DOWNSTREAM BENEFITS. THOSE
IN A MAY ACCRUE NOT TO THE KIND
OF PAYER THAT HAS TO MAKE THE
INVESTMENTS UP FRONT RIGHT AND
SO IF YOU IMAGINE SOMETHING
THAT'S GOING TO REDUCE YOUR COST
OF CARE WHEN YOU'RE SEVENTY
THAT'S A BENEFIT THAT ACCRUES
TO.
YOU AS A MEDICARE PATIENT BUT IF
THAT REQUIRES TREATMENT AT THE
AGE OF FIFTY THAT'S A COST THAT
OCCURS TO YOUR YOUR CURRENT
HEALTH PLAN WHICH IS NOT.
GENERALLY THE MEDICARE PROGRAM
MADE AND SO THERE IS CERTAINLY
SOME.
HAD A MISALIGNMENT OF THE TIMING
OF THE KIND OF FINANCING OR
FUNDING OF HEALTHCARE AND THE
POTENTIAL DOWNSTREAM BENEFITS
THAT CREATES THESE. AYE
DIFFERENCES IN INCENTIVES THAT
YOU MENTIONED AND I THINK YOU
KNOW THAT'S THAT'S KIND OF A.
UNFORTUNATE COMPONENT OF THE
WAY THAT THAT THIS SYSTEM IS
CURRENTLY STRUCTURED THAT DOES
SOME OF THE FINANCIAL INCENTIVES
ARE NOT IN PLACE TO INVEST IN IN
LONG TERM.
IN CARE THAT HAS LONG TERM
BENEFITS I'M AT LEAST FROM THE
FINANCIAL PERSPECTIVE OF
INSURERS.
THE MORE CHURN YOU HAVE AN
ASSIST.
YOU KNOW THE THE MORE THAT THAT
PROBLEM GETS EXACERBATED AS
WELL.
EXACTLY IF PEOPLE AREN'T STAYING
ON A PLAN.
LONG ENOUGH LONG TERM THEN THEY
KNOW THAT THEY DON'T HAVE TO
COVER THEM OVER TIME WHEN THAT.
IN A LIVER TRANSPLANT OR
WHATEVER HITS.
AND THAT'S AN ISSUE AND I FEEL
LIKE WE REALLY NEED TO ADDRESS
IT BECAUSE IN THE END THIS THE
PATIENTS A FALLING THROUGH THE
CRACKS AND SUFFERING.
.
AND THEN JUST REALLY QUICKLY THE
LAST THING IS WHERE DOES
INNOVATION FALL ANALYSTS.
IF WE COULD HAVE YOU KNOW.
THE NEW TECHNOLOGIES AND DATA
DRIVEN CARE OF THE ONLY THINGS
THAT WE KEEP HEARING ABOUT
TALKING ABOUT.
WE'RE GOING TO LOSE THAT NO
MATTER WHAT SYSTEM WE END UP
WITH.
THIS I THINK IT'LL CREATE COST
SAVINGS IN THE LONG RUN.
THANK YOU.
WITHOUT AMOUNTS TO REALLY COOK
QUESTIONS IF I CAN FIRST DR
TRISH.
IF CALIFORNIA WERE TO MOVE TO A
SINGLE PAYER OR TO AND ALL PAYER
RATE SETTING SYSTEM.
DO WE CURRENTLY HAVE ENOUGH
INFORMATION IN THE COST REPORTS
AND DISCHARGE DATA FILED ITH
THE HARSH PAD. TO EFFECTIVELY
NEGOTIATE HOSPITAL BUDGET AND
SET PROVIDER RATE PAYMENT.
RATES.
AND WHAT DATA AND CONSIDERATIONS
SHOULD WE BE LOOKING AT TO HELP
MANAGE YOUR TWO YEAR INFLATION.
AS WELL AS TO MAKE SURE THAT WE
DON'T HAVE ABRUPT DISRUPTIONS IN
INCOME FOR PROVIDERS.
SO THANK YOU FOR THE QUESTION I
MEAN I THINK THERE MAY BE
DIFFERENT DATA SOURCES THAT ARE
AVAILABLE TO YOU KIND OF THE
STATE OR STATE GOVERNMENTS BUT
AT LEAST FROM A RESEARCHERS
PERSPECTIVE I WOULD SAY WE DON'T
HAVE THE ADEQUATE DATA TO FULLY.
KINDA COMPREHENSIVELY UNDERSTAND
WHAT HEALTHCARE PROVIDERS ARE
GETTING PAID ACROSS THE FULL
SPECTRUM OF DIFFERENT PAYERS AND
OF DIFFERENT COMMERCIAL PLANS
YOU KNOW IN PARTICULAR IN THE
CASE OF. OTHER COMMERCIAL
INSURERS. THESE NEGOTIATED RATES
ARE CONSIDERED KIND OF
PROPRIETARY.
YOU KNOW INFORMATION OR
PROPRIETARY RATES AND SO THERE
ARE SOME DATA SOURCES AVAILABLE
BUT THEY'RE NOT COMPREHENSIVE IN
IN THE HARSH THE OSCAR DATA IS A
GREAT SOURCE OF INFORMATION ON.
KENNY UTILIZATION OF IN PATIENT
AND EDIE CARE BUT YOU CAN HAVE
TO TO ESTIMATE THE PAYMENTS THAT
HOSPITALS GET PAID THE ACTUAL
DATA IS NOT INCLUDED IN IN THAT
DATA SAID.
AND I THINK YOU KNOW IT THIS.
THIS IS NOT A.
STRAIGHTFORWARD SIMPLE ANSWER
AND THAT THERE'S A LOT OF
POTENTIAL DOWNSTREAM
IMPLICATIONS OF AND OF WORKFORCE
CONSIDERATIONS AND ACCESS AND I
I THINK THAT.
MORE BROADLY MAKING AVAILABLE
ON DATA TO STUDY THESE TYPES OF
QUESTIONS YOU KNOW THERE ARE
SOME GREAT.
ECONOMISTS OUT THERE THERE ARE
SOME GREAT MODELERS OF KIND OF
PREDICTING FUTURE PROVIDER
BEHAVIOR OF PREDICTING CONSUMER
BEHAVIOR ALL OF THOSE THINGS AND
SO.
BETTER DATA AND SOME KIND OF
INVESTMENT IN ANALYTICS CAN
CERTAINLY YOU KNOW INFORM THESE
TYPES OF A DECISIONS AND SETTING
RATES.
SO OFFLINE I'D LIKE IF YOU COULD
TO HELP MY OFFICE FIGURE OUT
WHAT THOSE DATA POINTS ARE SO
THAT WE CAN ACTUALLY WORK ON
THAT BUT WANT TO DO IT. AT A
TIME WHEN WE HAVE MORE IF OKAY
GREAT THANK YOU IF I CAN ASK
DOCTOR BAKER TO WHAT EXTENT CAN
EXISTING ANTI TRUST LAWS BE USED
SUCCESSFULLY TO COMBAT.
THE ANTI COMPETITIVE EFFECTS OF
CONSOLIDATION
AND WHAT CAN YOU TELL US ABOUT
THE ROLE OF STATE PURSES FEDERAL
LAW AND POLICY IN ACCOMPLISHING
THIS GOAL.
AB AND IT SHORT ANSWERS BE
INCOMPLETE IN SOME SENSE SO I'M.
FEDERAL LAWS CAN BE HELPFUL THE
PROBLEMS.
SOME OF THE PROBLEMS AT THE
MOMENT DISTINCT INCLUDE THAT
SHEER NUMBER OF MERGERS AN
ACTIVITY THAT THE FTC IN THE DOJ
TRY TO MONITOR.
AND SO.
.
TO SOME EXTENT STATES TAKING AN
INTEREST IN THEIR OWN CONCERNS
MAY BE USEFUL BECAUSE THEY JUST
DON'T HAVE THE RESOURCES TO LOOK
AT EVERYTHING THAT'S OUT THEIR
EVEN THOUGH THE LAW MIGHT ALLOW
THEM TO TAKE ON SOME OF THESE
ISSUES.
ARE THERE ARE THERE ARE
DEFICIENCIES IN THE CURRENT LAWS
ESPECIALLY AS THEY.
AS THEY RELATE TO PHYSICIANS I
THINK SO I ONE OF THE ISSUES IS
JUST THIS THE.
THE DEFINITION OF A REVIEWABLE
EVENT I HAVE TO REACH A CERTAIN
SCALAR CERTAIN SIZE TO BE
SUBJECT TO THE LAWS AND SO IF
YOU I'M. ARE A LARGE.
PROVIDER GROUP AND YOU START
MERGING WITH A COUPLE OF SMALL
ONE OR TWO PERSON PRACTICES
OFTEN THOSE TRANSACTIONS ARE NOT
REVIEWABLE. UNDER THE CURRENT
LAWS AND SO THERE ARE SOME SOME
ISSUES WITH THE EXTENT TO WHICH
WE CAN USE THE CURRENT STRUCTURE
TO HANDLE SOME OF THE
CONSOLIDATION THAT'S BEEN GOING
ON. I'M YOUR SECOND QUESTION I
THINK IS WHAT CAN ASSIST WHAT
WERE THE DIFFERENCES BETWEEN
STATE AND FEDERAL LIVE I THINK
THAT IS AN INTERESTING. AYE
ISSUE I'M NOT A. LAWYER AN
ANTITRUST LEGAL SCHOLAR CELLS
TRY TO STEER CLEAR OF GIVING YOU
REALLY DETAILED LEGAL ADVICE ON
THIS MATTER.
.
BUT I THINK THERE ARE THIS THE
STATE CERTAINLY.
HAS A LICENSING ISSUE PLACE AND
SING AND OTHER COMPLIANCE
REQUIREMENTS OF HEALTHCARE
PROVIDERS AND THAT PROBABLY
GIVES IT SOME ABILITY TO LOOK AT
WHO'S MERGING AND WORKING
TOGETHER. THERE MAY BE OTHER
THINGS THAT STATES CAN DO AND
I'LL I'LL JUST NOT TRY TO SAY
ABOUT MY NOTE IT'S A CHALLENGING
ISSUE.
BUT THERE ARE STATES
MASSACHUSETTS FOR EXAMPLE HAS
TAKEN A GREAT INTEREST IN THE
ISSUES AND IN THE ACTIVITIES OF
OF PROVIDERS IN THEIR STATE AND
MANAGED TO DO IT SO I THINK
THERE ARE WAYS FOR STATES TO DO
IT.
IT MAY BE.
PARALLEL TO ARE DIFFERENT THAN
JUST DO THE STANDARD ANTI TRUST
LAWS.
THANK YOU.
WITHOUT I WANTED TO THANK THIS
PANEL FOR.
YOUR PRESENTATIONS AND AGAIN
YOUR EXPERTISE.
I'D LIKE TO CALL OUR CONSUMER
PANELISTS UP NEXT.
GEN FLORIAN BETSY SOME HOLES
.
THANK YOU FOR THIS OPPORTUNITY A
COMMENT THE WORK OF THE SELECT
COMMITTEE COULD NOT BE MORE
TIMELY AND IMPORTANT.
A NATIONALLY REPRESENTATIVE
SURVEY BY CONSUMER REPORTS LAST
YEAR AFFECT INTRODUCED MYSELF
BETSY EMOTES FROM CONSUMERS
UNION THE POLICY AND ADVOCACY
ARM OF CONSUMER REPORTS.
A NATIONALLY REPRESENTATIVE
SURVEY DONE BY CONSUMER REPORTS
LAST YEAR FOUND THAT HEALTH CARE
REMAINS THE TOP AND A GROWING
CONSUMER CONCERN OF ALL THE
SUBJECT AREAS WE STUDIED. ONE
KEY FINDING WAS THAT MORE THAN
HALF OF RESPONDENTS NATIONALLY
SAID THEY LACK CONFIDENCE THAT
THEY OR THEIR LOVED ONES WILL BE
ABLE TO AFFORD HEALTH INSURANCE
IN THE FUTURE.
DESPITE THE PUBLIC CONFUSION
CREATED BY SOME.
FEDERAL ACTORS IN TWENTY
SEVENTEEN THE FACT IS THAT WE
HAVE MADE HUGE STRIDES. UP
NATIONALLY ON BROADENING ACCESS
TO COVERAGE UNDER THE AFFORDABLE
CARE ACT INTO THE MEDICAID
EXPANSION AND OF COURSE THE
STATE OF CALIFORNIA. AND
PARTICULARLY STANDS OUT AMONG
THE STATE'S FOR ALL THE PROGRESS
THAT WE'VE MADE HERE.
YES WE'VE HEARD ALL DAY LONG.
CHALLENGES CERTAINLY REMAIN AND
I'VE BEEN ASKED TO DISCUSS A
COUPLE OF THESE CHALLENGES FROM
THE CONSUMER PERSPECTIVE SUCH A
CHUNK THREE TODAY WE'RE GONNA
KEEP IT REALLY BRIEF BECAUSE I
KNOW THERE'S A LOT OF FOLKS
WANNA GET THEIR COMMENTS.
FIRST JUST TO PRICES A CONSUMERS
PAY AND COST TO THE SYSTEM.
CONSUMER CONCERNS ABOUT COST
GETTING IN THE WAY OF GETTING
NEEDED CARE A DIMINISHED WITH
THE AFFORDABLE CARE ACT YET
PREMIUM INCREASES. AND RISING
DEDUCTIBLES DO PRESENT BARRIERS
THAT MAKE COST OF COVERAGE AND
CARE UNAFFORDABLE FOR SOME
CALIFORNIANS.
COVERED CALIFORNIA'S MANAGED TO
MODERATE PREMIUM INCREASES ON
THE EXCHANGE ON AND OF COURSE
THE IMPACT OF EVEN THOSE
PREMIUMS HAS BEEN SOFTENED BY
THE.
PREMIUM TAX CREDITS THAT THE
VAST MAJORITY NEARLY NINETY
PERCENT OF ENROLLEES THERE
RECEIVE.
BUT.
FOR THOSE.
ABOVE THAT INCOME LEVEL FOR THE
SUBSIDIES AND FOR SOME BELOW
THAT LEVEL IT IS STILL A
STRUGGLE TO PAY FOR HEALTH
COVERAGE IN COSTS.
AND OF COURSE UNDOCUMENTED
CALIFORNIANS ARE NOT ELIGIBLE
FOR THOSE SUBSIDIES AT ALL.
THERE'S A RANGE OF WAYS
CALIFORNIA CAN MAKE COVERAGE FOR
THOSE WITHOUT EMPLOYER INSURANCE
A AFFORDABLE AND WE URGE YOU TO
EXPLORE THEM IN THE COMING YEAR.
SHORT OF OUR PERHAPS GRANDEST
VISION OF FOR A SIMPLIFIED A
UNIVERSAL CARE SYSTEM WE ARE TO
DO IN THE AYE EXPLORE ENHANCE
SUBSIDIES FOR THOSE AT FOUR
HUNDRED OR JUST A LITTLE OVER
FOUR HUNDRED AND AS WELL AS
THOSE UNDER.
THAT LIMIT.
OF THE FEDERAL POVERTY LEVEL
AND CONSIDER PERHAPS CAPPING THE
MAXIMUM PERCENTAGE OF INCOME
THAT ANY CONSUMER SHOULD HAVE TO
PAY FOR HEALTH INSURANCE
PREMIUMS IN CALIFORNIA'S TWO
EXAMPLES OF THINGS TO LOOK AT.
IT'S TEMPTING JUST TO FOCUS ON
COST TO THE INDIVIDUAL BECAUSE
THAT'S HOW WE REALLY FEEL THAT
OUR FAMILIES AND OURSELVES AND
OUR FRIENDS.
BUT UNDERLYING SYSTEM COSTS AS
WE'VE HEARD TODAY I'M ALSO
CANNOT BE IGNORED. ON THOSE
COSTS.
CONTRIBUTE TO THE UPWARD SPIRAL
BUT SPIRAL OF PREMIUMS
GOVERNMENT EXPENDITURES IN THEY
SUPPRESS WORKERS WAGES.
IT'S WELL ESTABLISHED THAT A FOR
DECADES.
HEALTH EXPENDITURES IN THE
UNITED STATES HAVE GROWN AT A
MUCH HIGHER RATE THAN IN OTHER.
INDUSTRIALIZED COUNTRIES IN
EVIDENCE SHOWS THAT THE HIGH
PRICES NOT GREATER UTILIZATION
ARE THE PRIMARY DRIVER.
US PAYS MORE THAN COMPARABLE
NATIONS FOR THE SAME HEALTH CARE
PROCEDURES SERVICES DRUGS AND
DEVICES.
AND WHILE PER CAPITA COSTS IN
CALIFORNIA OR LOWER THAN THE
UNITED STATES AS A WHOLE
PERSONAL SPENDING IN CALIFORNIA
OVER FIVE TO TEN YEARS. I'M
ACTUALLY GREW FASTER THAN THE
NATIONAL AVERAGE SO THE GAP
BETWEEN FEDERAL AND CALIFORNIA.
ON PER CAPITA SPENDING IS
CLOSING BUT NOT IN A GOOD WAY
IT'S ALL STILL GOING UPWARD.
POLICY MAKERS HAVE OF COURSE
TRIED A VARIETY.
OF APPROACHES TO SQUEEZE
GREATER VALUE OUT OF OUR
HEALTHCARE SYSTEM THAT IS
IMPROVE QUALITY WHILE ALSO
CONTAINING COSTS.
MAINLY THROUGH MARKET BASED
INCENTIVES AND SOMETIMES
PENALTIES.
WHILE THESE STEPS HAVE TEMPERED
INCREASES IN RECENT YEARS WE
NEED TO DO MORE.
CALIFORNIA NEEDS A FOCUSED
INITIATIVE TO UNDERSTAND THE
SOURCES OF RISING COSTS WITH
PARTICULARITY AND TO TACKLE
THEM.
STEPS THAT SOME OTHER INSTEAD OF
STATES HAVE TAKEN TO DO SO
INCLUDE CREATION OF A COST
COMMISSION. OUGHT TO ZERO IN ON
MEASURING VALUE INTO YOUR I'LL
COMMENT ASSEMBLYMEMBER AROUND A
LOT WHEAT I THINK WE DO NOT HAVE
THE DATA SO ANOTHER THING SOME
STATES HAVE DONE IS TO ESTABLISH
ALL PAYER. DATA BASES TO LEARN
WHERE THE SPECIFIC DRIVERS LIE.
AND ALSO SETTING ACTUAL CAPS ON
ON GROWTH RATES.
THE SECOND CHALLENGE CATEGORY
I'LL JUST TOUCH ON HIS CONSUMER
UNDERSTANDING IN NAVIGATION
WE'VE HEARD A LOT ABOUT THAT
TODAY AS WELL. QUALITATIVE
RESEARCH BY CONSUMERS UNION I'M
OVER THE PAST FEW FEW YEARS
ACTUALLY PROVE SO WE INTUITIVELY
NOW CONSUMERS ARE LOST IN THE
JARGON AND THE MASS OF HEALTH
INSURANCE.
CULTURE IN TERMS OUR COURSE THE
MOST CONFUSING.
AND THEY COME THEIR COMPOUNDED
BY GENERAL NUMERACY PROBLEMS IN
THE AMERICAN PUBLIC THE NEED TO
APPLY THE TERMS AND THEN
NUMERICAL OPERATIONS INTO THE
MALL SEQUENTIALLY MAKES IT
VIRTUALLY IMPOSSIBLE FOR PEOPLE
TO FIGURE OUT. YOUR COSTS.
AGAIN COVER CALIFORNIA'S DONE
COMMENDABLE WORK TO LESSEN THESE
CHALLENGES WITH STANDARDIZED
CONSUMER FRIENDLY COST SHARING
PLANS IN THE METAL TEARS. AND
RESEARCHERS HAVE SUGGESTED THAT
THESE COST SHARING OPTIONS AND
ALSO A LIEU LIMITED NUMBER OF.
PLAN CHOICES HELPS CONSUMERS
MAKE THE BEST CHOICES FOR
THEMSELVES SO. AS I THINK MR
LEVITT MENTIONED EARLIER FURTHER
STANDARDIZATION AND PLAN
OFFERINGS DESIGNS TERMS AND
DEFINITIONS WOULD WOULD BENEFIT
CONSUMERS.
FURTHERMORE ON.
BIG MORE VIGOROUS SUSTAINED
PUBLICITY IS NEEDED ON IN OUR
OPINION ABOUT THE STATE
REGULATORS WHO CAN HELP
CONSUMERS THROUGH THE MAZE AND
CAN ANSWER CONSUMER OF. PROBLEMS
CAN HELP RESOLVE THOSE PROBLEMS
WITH THEIR COVERAGE IN A TWENTY
FIFTEEN SURVEY BY CONSUMERS
UNION THAT WE DIDN'T HEAR IN
CALIFORNIA. EIGHTY FIVE PERCENT
OF CALIFORNIANS DID NOT KNOW OF
WHO THE STATE REGULATORS WHERE
THEY COULD HELP THEM WITH THEIR
HEALTH INSURANCE PROBLEMS.
PRETTY SHOCKING.
I'M MORE OVER PLAN NETWORKS ARE
AS WE'VE HEARD ALL DAY LONG NOTS
NOT EASY TO UNDERSTAND.
STANDARD SIGNALS OF NETWORK
BREATH ARE LACKING FOR EXAMPLE
BROAD NARROW ULTRA NARROW AND
BUT THESE KIND OF TERMS WOULD
HELP OR LABELS WOULD HELP
CONSUMERS GIVE THEM CUES ABOUT
THE TRADE OFFS THEY MAY BE
MAKING IN CHOOSING A PLAN.
AND THE THIRD POINT I JUST TOUCH
ON BRIEFLY THE THIRD CATEGORY OF
CHALLENGES IS THE NEED FOR
GREATER EFFICIENCIES ANOTHER
THING WE'VE HEARD A LOT ABOUT
TODAY.
IN A TWENTY SIXTEEN COMMONWEALTH
FUND SURVEY OF CONSUMERS
EXPERIENCES AMERICANS I WILL SAY
TIED WITH NORWEGIANS.
UP TOP THE LIST OF RESIDENTS OF
WEALTHY NATIONS
FRUSTRATED WITH POOR CORPORATE
CORPS CARE COORDINATION SUCH AS
TEST RESULTS NOT BEING AVAILABLE
AT THE TIME OF AN APPOINTMENT
DUPLICATE TESTING ORDERED. LACK
OF SHARED INFORMATION BETWEEN
SPECIALISTS AND PRIMARY CARE
DOCS
AND CONFLICTING INFORMATION
RECEIVED FROM DIFFERENT
PROVIDERS.
THERE WE'VE TALKED ALL DAY
ABOUT WAYS TO IMPROVE THE
EFFICIENCY ONE I'LL JUST MENTION
I'M IS HEALTH INFORMATION
TECHNOLOGY. AND WHICH CAN HELP
IN COURT CARE COORDINATION
TRACKING HEALTH QUALITY.
AND SUPPORTING ACHIEVING HEALTH
EQUITY. CONSUMERS VALUE THE USE
OF H. I. T. ON TO TRACK THEIR
TEST RESULTS COMMUNICATE WITH
THEIR PROVIDERS AND EVEN CORRECT
ERRONEOUS INFORMATION IN SOME
CASES IN THEIR RECORDS.
YET MANY IMPEDIMENTS REMAIN TO
GETTING A GOOD.
HEALTH.
.
INFORMATION TECHNOLOGY
INFRASTRUCTURE AND GETTING
EVERYBODY TO PARTICIPATE SO WE
ARE TO DO IT AS WELL LOOK AT
THAT TIME IF YOU'RE INCENTIVES
THAT COULD BE.
OFFERED TO ELECTRONIC HEALTH
RECORD ADOPTION IMPROVED INTER
OPERABILITY SO SYSTEMS CAN TALK
TO EACH OTHER AND REALLY GET THE
BENEFITS OF SHARING.
AND OVERALL I JUST WANNA CLOSE
AND TURNED TO MY COLLEAGUE JAN
FLOREY ON TO SAY CONSUMERS UNION
LOOKS FORWARD TO WORKING WITH
YOU TO ADDRESS THESE CHALLENGES
I THINK THESE SESSIONS HAVE BEEN
ENORMOUSLY INFORMATIVE. AND WE
LOOK FORWARD TO BUILDING ON THE
TREMENDOUS PROGRESS WE'VE MADE
OVER THE PAST SEVERAL YEARS BUT
OF COURSE NOT TO REST ON OUR
LAURELS. CALIFORNIA DOES LIKE TO
LEAD AND. THEY'RE DOABLE
CONCRETE STEPS THAT WE CAN TAKE
TO BUILD ON OUR SHARED VISION
FOR UNIVERSAL CARE SO.
THANK YOU VERY MUCH THINKING.
I GOOD AFTERNOON OR EVENING
WHENEVER WE ARE NOW HAVES I'M
GEN FLORI WITH WESTERN CENTER ON
LAW AND POVERTY. AND WESTERN
CENTER IS CALIFORNIA'S OLDEST
AND LARGEST LEGAL SERVICES
SUPPORT AGENCY WORKING DIRECTLY
WITH LEGAL SERVICES PROVIDERS
AROUND THE STATE IN PARTICULAR
MEMBERS OF THE HEALTH CONSUMER
ALLIANCE WHO OFFER FREE WILL
LEGAL ASSISTANCE TO HEALTH
CONSUMERS AROUND THE STATE OF
CALIFORNIA.
I'VE BEEN ASKED TO DISCUSS THE
ISSUES ARE LEGAL SERVICES
PARTNER SEE ON THE GROUND IN
HELPING CONSUMERS ACCESS HEALTH
CARE IN OUR CURRENT HEALTHCARE
SYSTEM.
SPECIFICALLY ISSUES FACED BY
CONSUMERS MOVING FROM ONE
PRODUCT TO ANOTHER WHAT WE'RE
NOW CALLING CHURN.
BUT FIRST TO GIVE SOME CONTEXT
JUST A COUPLE YEARS AGO WHEN I
WAS A SUPERVISING ATTORNEY AT A
LOCAL HEALTH CONSUMER CENTER THE
BIGGEST PROBLEM THAT WE FACED
WAS THE POPULATION WE NOW CALL
THE EXPANSION ADULTS. NOT HAVING
ACCESS TO MEDICARE OUT AND
BASICALLY TELLING THEM THAT WE
HAD TO WAIT UNTIL THEY'RE. NOT
CONDITION DETERIORATED TO SUCH
THE CASE THAT THEY QUALIFY FOR
MEDI CAL ON THE BASIS OF
DISABILITY.
AND THEN FOR THOSE JUST OVER
THAT INCOME LIMIT.
THIS SITUATION WAS JUSTICE DIRE
PRETTY MUCH EVERYONE NEEDING
HEALTH CARE HAD A PRE EXISTING
CONDITIONS THAT THEY WERE EITHER
REFUSE CARE ENTIRELY ARE PRICED
OUT OF THE MARKET.
SO JUST LATER LEVEL FROM WHERE
WE'VE COME.
WHAT WE'RE LOOKING AT NOW IS A
DIFFERENT KIND OF BEAST?
WHAT WE FIND NOW IS THAT FEW
CONSUMERS HAVE THE LUXURY OF
REMAINING WITH THE SAME HEALTH
PLAN AND HEALTH PROVIDERS
THROUGHOUT THEIR LIFE? MANY LOW
INCOME CONSUMERS IN PARTICULAR
MOVE AMONG MEDI CAL COVER
CALIFORNIA AND EMPLOYER
SPONSORED COVERAGE DUE TO
UNSTABLE WORKING CONDITIONS.
THIS MOVEMENT THROUGH THE HEALTH
CARE MARKET BRINGS THE FOLLOWING
KINDS OF PROBLEMS.
WHEN CHOOSING A PLAN CONSUMERS
WITH HIGH HEALTH NEEDS MUST
SOLVE A COMPLEX MATRIX TO ENSURE
THAT ALL OF THEIR DRUGS AND
PROVIDERS ARE COVERED.
SOME CONSUMERS MIGHT TRY TO STAY
WITH THE SAME CARRIER NOT
REALIZING THAT FOR MOST CARRIERS
THE PROVIDER NETWORK VARIES
ACROSS LINES OF BUSINESS IN
OTHER WORDS ANTHEM GROUP BLUE
CROSS EMPLOYER COVERAGE IS NOT
THE SAME AS ANTHEM BLUE CROSS
INDIVIDUAL COVERAGE OR ANTHEM
BLUE CROSS MEDI CAL.
ADDITIONALLY IN SOME AREAS JUST
BECAUSE SOMEONE HAS JOINED A%
PARTICULAR PLAN THAT DOES NOT
MEAN THEY HAVE ACCESS TO ALL THE
PROVIDERS IN THAT PLAN AS THE
PLANTS THEMSELVES ARE FURTHER
DIVIDED INTO PROVIDER SUBGROUPS.
MANY CONSUMERS ARE LEFT WITH THE
CHOICE OF WHO DO THEY LIKE
BETTER THEIR PRIMARY CARE DOCTOR
OR THEIR ONCOLOGIST.
FURTHER COMPLICATING THE CHOICES
THAT NOT ALL PLANS IN THE
PRIVATE MARKET COVERED THE SAME
PRESCRIPTION DRUGS SO CONSUMERS
WHO NEED PARTICULAR MEDICATIONS
MUST COMPARE DRUG FORMULARIES TO
PICK THE RIGHT PLAN.
MOST OF THEM COMPARE WE EVEN
READ A DRUG FORMULARY I FIND IT
DIFFICULT MYSELF.
AGAIN WHICH WOULD YOU PREFER THE
RIGHT MEDICATION OR STAINED WITH
THE PREFERRED DOCTOR.
CHANGES IN PREMIUM PRICE CAN
ALSO REQUIRE CONSUMERS TO CHANGE
PLANS EVERY YEAR IN BOTH THE
EMPLOYER MARKET AND THE
INDIVIDUAL MARKET THE CHEAPEST
PLAN AVAILABLE TO A GIVEN
CONSUMER CAN CHANGE FROM YEAR TO
YEAR.
BECAUSE PLANS ARE EXPENSIVE TO
BEGIN WITH MANY CONSUMERS MAY
SHOP EVERY YEAR TO FIND THE BEST
DEAL.
BEYOND THE PREMIUM PRICE
CONSUMERS ALSO REQUIRED AB
COMPLEX UNDERSTANDING OF HEALTH
COVERAGE TERMINOLOGY TO
UNDERSTAND WHAT THEY OVER ANY
GIVEN SERVICE WHEN A DEDUCTIBLE
APPLIES WHAT'S THE DIFFERENCE
BETWEEN A CO PANICO INSURANCE.
AND WHAT'S THE MAXIMUM AMOUNT
THAT CAN BE REQUIRED TO PAY IN
ANY GIVEN YEAR.
IN ADDITION CHANGES IN A
CONSUMERS INCOME CAN CAUSE
INDIVIDUALS TO MOVE BETWEEN MEDI
CAL AND COVERED CALIFORNIA
MULTIPLE TIMES A YEAR.
FOR MANY PEOPLE THESE
TRANSITIONS ARE NOT SEEM LESS
AND RESULT MONTHS OF OVERLAPPING
COVERAGE CAUSING CONFUSION WHEN
THEY GO TO GET SERVICES AND IN
SOME CASES REQUIRING LOW INCOME
CALIFORNIANS TO CONTINUE PAYING
PREMIUMS THAT THEY DO NOT
ACTUALLY OWN CANNOT AFFORD.
CHANGES IN A PLANTS PROVIDER
NETWORK CAN ALSO FORCE PLAN
CHANGES SUCH AS WHEN ONE MEDI
CAL MANAGED CARE PLAN RECENTLY
STOPPED CONTRACTING WITH THE
LARGEST HOSPITAL SYSTEM IN THE
SACRAMENTO AREA.
FINALLY WHETHER IN MEDI CAL ON
PRIVATE INSURANCE CONSUMERS.
WHO KNOW THEY WILL BE CHANGING
PLANS GENERALLY CANNOT WORK WITH
THEIR NEW PLAN AHEAD OF TIME TO
SET APPOINTMENTS GET PROPER
REFERRALS TO SPECIALISTS ARRANGE
FOR PRESCRIPTION REFILLS?
THEY MUST WAIT UNTIL THEIR PLAN
ENROLLMENT IS ACTIVE BEFORE
ARRANGING FOR THE SERVICES.
WELL THIS MIGHT SEEM LIKE A
SHORT PERIOD OF TIME TO GO
WITHOUT ACCESS TO CARE FOR
PEOPLE WITH HIGH MEDICAL NEEDS
TO DISRUPTIONS CAN BE DANGEROUS.
AND FOR MANY PEOPLE THOSE
DISRUPTIONS ARE OCCURRING MORE
AND MORE FREQUENTLY AS A BOUNCE
TO THE SYSTEM.
NOW UNFORTUNATELY THERE'S NOT
ONE EASY SOLUTION TO THIS
PROBLEM.
WHILE PERSONALLY I WOULD LOVE A
SINGLE PAYER SYSTEM THE CURRENT
PROPOSAL WE HAVE BEFORE US IS
DEPENDENT ON A DISCRETIONARY
FEDERAL WAIVER OF MEDICARE AND
MEDICAID LAW.
THE FORDS FINANCING AND LAST
WEEK THE TRUMP ADMINISTRATION
MADE ABUNDANTLY CLEAR THAT IT
WOULD NOT BE GRANTING ANY
WAIVERS EXPANDING ACCESS TO
HEALTHCARE. INSTEAD IT WOULD
LOOK TO GRANT WAIVERS
RESTRICTING ACCESS TO HEALTH
CARE BY IMPOSING ADDITIONAL
BURDENS ON PEOPLE SUCH AS WORK
REQUIREMENTS. PREMIUMS AND LOCK
OUT PERIODS AND THEY DID JUST
THAT AND GRANTING CAN'T THE
STATE OF KENTUCKY JUST SUCH A
WAIVER.
THIS MOVES US AWAY FROM OUR
SHARED GOAL OF GUARANTEED ACCESS
TO HEALTH CARE AND BACK TOWARDS
ONLY CARE FOR THOSE WHO CAN PAY
FOR IT OR THOSE WHO DESERVE IT.
.
FOR THOSE OF US WHO HAVE SPENT
YEARS WORKING TO IMPLEMENT
HEALTH CARE REFORM WE KNOW IT'S
NOT EASY WE KNOW WE CAN GET
EVERYTHING WE WANT IMMEDIATELY
BUT THERE ARE ALSO WAYS TO
IMPROVE FRAGMENTATION.
ONE EXAMPLE.
LAST YEAR ANTHEM BLUE CROSS
ANNOUNCED THAT IT WOULD BE
LEAVING THE INDIVIDUAL MARKET
AND SUIT IN SEVERAL REGIONS OF
COVERED CALIFORNIA.
THIS HAD THE EFFECT OF
POTENTIALLY DESTABILIZING OUR
ENTIRE MARKET ON COVERED
CALIFORNIA.
CONSUMER ADVOCATES WORKED
QUICKLY WITH A LEGISLATOR TO
PASS SB ONE THIRTY THREE TO
EXPAND OUR CONTINUITY OF CARE
PROTECTION SO THAT THOSE WHO
WERE FORCED TO PICK A PLAN AND
WE'RE IN THE MIDDLE OF TREATMENT
WOULD HAVE ADDITIONAL TIME TO
FIND YOU PROVIDERS.
ANTHEM BLUE CROSS WORKED WITH
THE OTHER COVER CALIFORNIA PLANS
TO CREATE A SYSTEM WHICH PATIENT
RECORDS COULD BE TRANSMITTED TO
AVOID SOME OF THE MOST COMMON
DISRUPTIONS IN MOVING FROM ONE
PLANT TO THE NEXT.
CONSUMER ADVOCATES WORKED WITH
COVER CALIFORNIA TO ENSURE THAT
CONSUMERS WOULD RECEIVE
SUFFICIENT INFORMATION ABOUT THE
CHANGE AND THAT THOSE WHO DID
NOT PICKING YOU PLAN WOULD BE
ASSIGNED TO A NEW PLAN AND NOT
GO WITHOUT COVERAGE.
WELL IT'S TOO SOON TO EVALUATE
HOW SUCCESSFUL THAT PROJECT HAS
BEEN. AND SO FAR WE'RE NOT
RECEIVING A WHOLE BUNCH OF CALLS
ABOUT PROBLEMS WITH IS THAT OUR
HEALTH CONSUMERS CENTERS BUT
WE'LL GIVE IT A FEW MORE WEEKS
TO SEE IF IT'S. ACTUALLY WORKED
OUT IT HAS CREATED A TESTING
GROUND FOR EASING DISRUPTIONS AT
CONSUMERS FACE WHEN CHANGING
COVERAGE.
CONSUMER ADVOCATES HAVE ALREADY
BEAT BEGUN DISCUSSION DISCUSSING
OPTIONS WITH THE DEPARTMENT OF
HEALTH CARE SERVICES.
TO SEE IF SIMILAR PLANNING CAN
BE DONE IN COORDINATING CARED
FOR ENROLLEES MOVING FROM ONE
MEDI CAL PAYMENT SYSTEM TO
ANOTHER OR FROM ONE MEDI CAL
PLAN TO ANOTHER.
SO IN SHORT THE WORK OF
IMPLEMENTING THE AFFORDABLE CARE
ACT IN THE CONTINUED REFORM OF
OUR HEALTHCARE SYSTEM IS NOT
DONE WE STILL HAVE POPULATIONS
THAT HE COVERAGE INCLUDING
UNDOCUMENTED ADULTS AND SMALL
POPULATIONS OF SENIORS. WE STILL
HAVE PEOPLE THAT CANNOT AFFORD
CARE EVEN WITH SUBSIDIES AND WE
STILL HAVE SIGNIFICANT
CHALLENGES IN CREATING SEAMLESS
TRANSITIONS IN MOVING FROM
PROGRAM TO PROGRAM AND PLAN THE
PLAN.
BUT THERE ARE STEPS THAT WE CAN
TAKE NOW TO EXPAND ELIGIBILITY
FOR MEDICARE PROGRAM TO IMPROVE
SUBSIDIES TO EASE TRANSITIONS
BETWEEN CLANS.
SO THAT WE HAVE THE BEST SYSTEM
THAT WE HAVE AND THEN PERHAPS AT
ONE POINT WE CAN GET TO A MORE
UNIFIED SYSTEM THAT WOULD MAKE
ALL OF THESE PROBLEMS GO AWAY.
THANK YOU VERY MUCH.
WITH THAT WE'RE GOING TO MOVE TO
PUBLIC COMMENT.
AS I STATED EARLIER THERE ARE
TWO MIKES ON THE BOTTOM FLOOR
AND A WIRELESS MIKE ON THE TOP.
WE'RE GOING TO START ON OUR
LEFT AND IF WE CAN.
TWO MINUTES PLEASE JUST BECAUSE
OF PEOPLE.
AND.
START WITH THAT THINKING.
OAY HIGH.
MY NAME IS MARTHA KUHL.
AYE AM THE TREASURER OF
CALIFORNIA NURSES ASSOCIATION I
AM. A.
I'VE BEEN IN ARE IN FOR OVER
THIRTY SIX YEARS AND I'M A
PEDIATRIC HEMATOLOGY ONCOLOGY
TRANSPLANT NURSE.
AND FOR THOSE WHO DON'T KNOW
WHAT THAT IS I TAKE CARE OF KIDS
WITH VERY SERIOUS DISEASES.
CANCER AND OTHER DISEASES OF THE
BLOOD.
AND HAVING ATTENDED THESE
HEARINGS IT IS CLEAR THAT THE
PREMISE HAS BEEN.
THAT HEALTHCARE IS VERY COMPLEX.
AND THE EXPERT WITH WILL TELL US
WHAT THE PROBLEMS ARE AND WILL
HELP TO SOLVE THEM.
BUT MANY HAVE GIVEN WIDELY
VARYING ANSWERS.
NURSES CAN TELL YOU THAT WE
ALREADY KNEW. WE KNEW THAT.
WE PRACTICE IN A TIERED MULTI
PAYER SYSTEM.
WHERE SOME GET EXCELLENT CARE?
SOME GET SOME CARE AND SOME GET
NO CARE AT ALL.
HEALTH IS TREATED AS A
COMMODITY.
AND PATIENTS GET THE CARE THEY
CAN AFFORD.
NURSES KNOW THAT ACCESS TO
HEALTH CARE SHOULD NOT BE
COMPLICATED.
ARE CALLING AND OUR DUTY IS TO
GIVE EVERY PATIENT.
EVERY PATIENT PATIENT ADVOCATES.
AS PATIENT ADVOCATES TO PROVIDE
A SINGLE STANDARD OF CARE.
WE AS A CARING AND COMPASSIONATE
SOCIETY.
CAN MAKE THE DECISION TO
GUARANTEE HEALTH CARE AS A
SOCIAL AND ECONOMIC RIGHT.
THAT'S WHAT WE HAVE TO DO. FOR
EVERY PROBLEM IDENTIFIED TODAY
FOR EVERY PROBLEM IT QUESTION
ASKED TODAY THE ANSWER IS THAT
WE GUARANTEE HEALTH CARE.
SO.
RATHER THAN HOLD THESE HEARINGS
WHERE YOU CAN'T LEGISLATE.
RENDON SHOULD RELEASE SP FIVE
SIX TWO AND YOU AS ASSEMBLY. AS
OUR LEGISLATORS SHOULD DEMAND TO
COME TO YOUR COMMITTEE.
AND YOU CAN ADDRESS ANY ISSUES
AND CONCERNS HERE IN THIS ROOM
WITH ALL OF US AND GUARANTEE
HEALTH CARE FOR US ALL.
DO YOUR JOB ADVANCE SP FIVE SIX
TWO THROUGH THE USUAL
LEGISLATIVE PROCESS THANK YOU
OUR PATIENTS CAN'T WAIT.
THE KEY.
COMMITTEE MEMBERS THREE TIMES A
BEHALF THE CALIFORNIA MEDICAL
ASSOCIATION OTHER LOT
INFORMATION THIS HEARING TODAY
SO I'M GOING TO LIMIT MY
COMMENTS TO PHYSICIAN WORKFORCE
ISSUES. UP FIRST I DO WANT TO
ADDRESS ASSEMBLYMEMBER FRIEDMAN
QUESTION ABOUT WHY CALIFORNIA
SEEMS TO HAVE.
A HIGHER UP POSITION SHORTAGE
AS COMPARED TO OTHER STATES MOST
OF GRADUATE MEDICAL MEDICAL
EDUCATION FUNDING THIS IS
RESIDENCY SLOTS.
IT'S FEDERAL MONEY IT ACTUALLY
FROZE THOSE RATE THEM LOCKED
INTO A RATIO BASED ON ABOUT THE
MID TO LATE NINETEEN NINETIES.
SINCE THEN OUR POPULATIONS
INCREASE.
AT A MUCH HIGHER RATE COMPARED
OTHER STATES SO WE WOULD ARGUE
FORGET THEM MUCH LESS IN OUR
FAIR SHARE FEDERAL FUNDING. I'M
READY METAL MEDICAL EDUCATION
AND AND THAT'S WHY WE RAN PROP
FIFTY SIX.
A COALITION OF HEALTH CARE
PROVIDERS A CONSUMER ADVOCATES
AS WELL AND A LOT OF BIG YOU
DOCTOR WEIR AND DOCTOR
REGULATORS INCREASE FUNDING FOR
GRADUATE MEDICAL EDUCATION IN
THAT. PROPOSITION WE HAD TO HAVE
SOME BUDGET FIGHTS TO GET IT
BACK UP IN THE ACTUAL BUDGET BUT
IT IS THEIR RIGHT NOW BUT BUT
THERE'S SOME ADDITIONAL MONEYS.
DONE THAT WE CAN.
GET FROM THAT PROPOSITION.
GOING FORWARD ON THIS COMMITTEE
I THINK THERE'S THREE ISSUES.
THE MEDICAL ASSOCIATION WOULD
LIKE TO TACKLE A AS IT RELATES
TO WORKFORCE.
THAT THREE POLICY IDEAS WOULD
BE LONGER PAYMENT.
RESI PROGRAMS THAT
NONTRADITIONAL FACILITIES LIKE
CLINICS AND INCREASED GRADUATE
MEDICAL EDUCATION FUNDING FROM
STATE ONLY FUNDS A TO INCREASE
OUR SLOTS SO WE LOOK FORWARD TO
WORKING WITH THE COMMITTEE ON
DEVELOPING THOSE IDEAS.
AS LEGISLATIVE EUROSPORT THANK
YOU GOD.
YES SIR.
HI GOOD AFTERNOON I THINK YOU
ALL FOR SHOWING UP TO THIS LONG
HEARINGS AND DUKING IT OUT WEST.
MY NAME SHAUNA HEFFERNAN I AM
PROUD UNION NURSE I AM A JOHNS
HOPKINS UNIVERSITY GRADUATE AND
I'VE BEEN A NURSE FOR ALMOST A
DECADE NOW. I DO SURGICAL
RECOVERY ANESTHESIA AND I'VE
BEEN A CRITICAL CARE NURSE HERE.
TRANSPORT IN SACRAMENTO FOR
SOME YEARS AS WELL SO I'VE BEEN
TO ALMOST EVERY FACILITY HERE IN
NORTHERN CALIFORNIA AND I CAN
TELL YOU THAT THE CARE VARIES.
WIDELY.
THERE IS A STANDARD OF CARE AND
THE SCOPE OF PRACTICE AND EVERY
PERSON DESERVES THE RIGHT TO THE
SAME. STANDARD OF CARE.
BASED ON INCOME CLASS RACE THESE
ARE NOT VARIABLES THAT US AS
NURSES CONSIDER TO BE IMPORTANT.
I WANTED TO ADDRESS.
THE FEDERAL MANDATE AND SAY
THAT.
YOU HAVE TO BUY CAR INSURANCE
TO DRIVE ON THE ROAD. FOR ALL
HUMAN BEINGS ON THIS PLANET AND
WE SHARE THE AIR IN THE
RESOURCES AND EVERYONE NEEDS TO
HAVE SOME COVERAGE IN ORDER TO
ENSURE OUR EXISTENCE AS HUMAN
BEINGS.
IT IS A RIGHT IT'S NOT SOMETHING
WE CAN LIVE WITHOUT.
IT'S NOT.
BUYING AND NICER PAIR OF PANTS
OR A NICER CAR. IT'S ABSOLUTELY
SOMETHING THAT NONE OF US CAN
LIVE WITHOUT IT'S A HUGE
EXPENDITURE FOR BUSINESS AND
SENATE BILL FIVE SIX THAT YOU
WOULD ALLOW US TO HAVE THAT
MECHANISM OF COST CONTROL. AN
MRI DOES NOT COST TWENTY FIVE
HUNDRED DOLLARS AN XRAY DOES NOT
COST FIVE HUNDRED DOLLARS WE'VE
ALLOWED INSURANCE COMPANIES TO
BILL WHATEVER THEY WANT IN THE
SHADOW PRICING THE MECHANISMS OF
THE FREE MARKET ARE NOT IN PLAY
HERE. THEY'RE OUT OF CONTROL AND
IS THE ROLE OF GOVERNMENT
YOUR ROLE. TO REGULATE THIS
PROCESS.
THE DEBATE GOING BACK TO THE
FOUNDING OF OUR COUNTRY OF
FEDERAL VERSUS STATE POWER IS.
EXACTLY HERE TODAY IN THAT I
DON'T CARE WHAT THIS PRESIDENT
HAS DECIDED HE'S GOING TO DO
THIS IS OUR STATE WE CAN MAKE AN
INDEPENDENT PLAY AND WE CAN SET
THE STANDARD FOR THE FUTURE AND
SHOW. A MODEL THAT WORKS NOW AND
IN THE FUTURE FOR ALL AMERICANS
THINK KIM.
I'VE IT'S POSSIBLE I'D LIKE TO
GIVE THE ASSEMBLY OF THESE
PACKETS IT'S ONE FOR EACH
ASSEMBLY MEMBER.
IF YOU GIVE IT AS ARGENTEUIL
DELIVER.
I NEVER STILL FOUNTAIN I AM WITH
ENACT UNIVERSAL HEALTH CARE FOR
CALIFORNIA.
SINGLE PAYER ORGANIZATIONS OVER
HUNDRED TWO THOUSAND SUPPORTERS
A STATEWIDE.
WERE SPONSORING THE CALIFORNIA
HEALTH CARE ROADBLOCK MOVIL ACT.
A CONSTITUTIONAL AMENDMENT. BY
ITSELF WILL NOT IMPLEMENT
UNIVERSAL HEALTHCARE BUT WILL
ENABLE ANY FUTURE HEALTH CARE
LEGISLATION IN THE STATE WITHOUT
HAVING GO THE BALLOT EACH TIME.
CAL MATTERS WROTE ABOUT. THE.
CONSTITUTION AMENDMENT. EARLIER
THIS YEAR A FOLDER HEALTH
INITIATIVE CAMPAIGN PROPOSES TO
SET UP A HEALTH CARE FUND EXEMPT
FROM THE SPENDING CAPS AND
REVENUE SHARING REQUIREMENTS. TO
CONSTRAIN OTHER AREAS OF THE
BUDGET MOST BUDGET EXPERTS ARGUE
THAT THIS IS A NECESSARY FIRST
STEP BEFORE THE LEGISLATURE CAN
PASS.
STATE RUN SINGLE PAYER HEALTH
INSURANCE PROGRAM.
AYE JUST AS AN EXAMPLE OF.
WHAT'S HAPPENING HERE TOTAL
HEALTHCARE SPENDING IN
CALIFORNIA IS FOUR HUNDRED
BILLION DOLLARS.
AND OF THE STATE SIMPLY HELD
THAT AND PAID IT BACK OUT TWO
HUNDRED BILLION DOLLARS WOULD
AUTOMATICALLY BE SENT TO OUR
EDUCATION VIA PROP NINETY EIGHT.
PROP FOR WITH REBATE HUNDRED
NINETY FOUR BILLION DOLLARS FROM
THE OTHER HALF BACK TO TAXPAYERS
HEALTH CARE WOULD BE LEFT WITH
ALMOST NOTHING.
I THE CONSTITUTIONAL MIMIC COSTS
NOTHING AND SPECIFICALLY WRITTEN
THAT WAY DELEON SAID IT HAS NO
DIRECT FISCAL IMPACT.
IN ALTON BE EXEMPT FROM PROP
NINETY EIGHT PROP FOR THEIR
OTHERWISE LEAVES THESE
RESTRICTIONS INTACT.
I MEAN DOESN'T GET ANYTHING ODD
SO IF YOU BELIEVE IT'S TIME FOR
CALIFORNIA START TAKING CONTROL
OF ITS HEALTH CARE. AND PLEASE
HELP US GET.
CALIFORNIA HEALTHCARE ROADBLOCK
MOVE LACKED ON THE TWENTY
EIGHTEEN BALLOT THANK YOU.
THANK YOU SIR.
CAN RELIGION WITH A CALIFORNIA
PAN ETHNIC HEALTH NETWORK CPN
APPRECIATE THE CONVERSATION HERE
TODAY ONE FOCUS MY COMMENTS STAY
ON THE QUALITY OF CARE
PARTICULARLY IN MEDI CAL.
WOULD WE WOULD AGREE WITH MANY
OF THE POINTS AND MR CRONIES.
PRESENTATION.
IT IT'S NOT OKAYED THAT OF MEDI
CAL PERFORMS JUST OKAY COMPARED
TO THE REST NATION AND. NOT OKAY
THAT IT'S NOT IMPROVING.
GETS READ SIZE OF OF THE
POPULATION IT SERVES AND THE
DIVERSITY OF THE POPULATION
INSERTS WHICH BRINGS ME TO MY
NEXT POINT WHICH IS THE QUALITY
OF CARE HOUSE TO REALLY
CONSIDER.
EQUITY IN DISPARITIES REDUCTION
IF NOT LOOKING AT RACE ETHNICITY
GENDER GEOGRAPHIC REGION INCOME.
ALL THOSE OTHER THINGS AND
WE'RE NOT GOING TO BE LOOKING AT
THAT WORKS REDUCE MORE IMPROVING
QUALITY IN THE LONG RUN THOSE
DISPARITIES WILL NOT. DECREASE.
TO REALLY SPEAK OUT CONSERVE
THAT WAY AND WE'RE GOING TO BE
LOOKING AT THE.
OUTCOMES AND AND PERFORMANCE
AND WE NEED TO MAKE SURE THAT.
THOSE ARE A KEY PART OF THAT
COUNTRY.
SO DO ARE SADISTIC.
AS THIS COMMITTEE CONSIDERS WAYS
TO PROVIDE.
THANK YOU VERY MUCH.
GOOD EVENING CHAIRS AND MEMBERS
MAY SHOCK OF DATA WITH THE
SERVICE EMPLOYEES INTERNATIONAL
UNION CALIFORNIA STATE COUNCIL.
DITTO EVERYTHING. OUR COLLEAGUE
FROM C. PEN JUST SAID ON MEDI
CAL AND DISPARITIES AND QUALITY.
ALSO WANT TO FOCUS MY REMARKS
ON A DOUBLING DOWN ON SOME OF
THE TESTIMONY RELATED TO COST
CONTAINMENT AND PRICES.
AS THIS SELECT COMMITTEE
HEARING PROCESS HAS SHOWN A
COMMON FEATURE OF ALL THE
UNIVERSAL HEALTHCARE SYSTEMS
WHETHER THEIR SINGLE PAYER OR
MULTI PEER AROUND THE WORLD IS
THAT THEY DO REGULATE PRICES AND
CONTROL COSTS.
FAR MORE AGGRESSIVELY THAN WE DO
IN THE UNITED STATES AND THAT IN
ORDER TO MAKE SURE THAT SUCH A
SYSTEM IS SUSTAINABLE IN THE
LONG RUN WE NEED TO BE MUCH MORE
AMBITIOUS ABOUT HOW WE APPROACH
THAT.
AND THAT WE ARE A UNION OF HIGH
HEALTHCARE WORKERS WHO STAND
READY OUT TO WORK WITH THE
LEGISLATURE TO TACKLE THOSE VERY
DIFFICULT ISSUES BECAUSE AT THE
BARGAINING TABLE EVERY SINGLE
DAY. WE ARE THE ONES WHO ARE
SEEING THE INCOME IN A COLOR
QUALITY GAP GROW AND GROW EVEN
FOR HARD WORKING PEOPLE.
AND I THINK THAT IT'S
GOVERNMENT AND WORKERS WHO SHARE
COMMON CAUSE BECAUSE OUR
EMPLOYERS CAN TO SHIFT THOSE
COSTS ON TO US. AND SO.
THE MOMENT IS RIGHT FOR US TO
START TO TAKE ACTION ON THIS WE
LOOK FORWARD TO WORKING WITH YOU
THINK YOU.
THANK YOU.
I GOOD EVENING MR CHAIRS AND THE
MEMBERS AND TAM MA WITH HEALTH
ACCESS CALIFORNIA WHERE THE
HEALTH A STATEWIDE HEALTHCARE
CONSUMER ADVOCATES THE
COALITION.
ONE ECHO THE COMMENTS OF MY
CONSUMER ADVOCATES COLLEAGUES TO
SERVE ON THE PANEL TODAY AND
ALSO JUST REITERATE HOW
IMPORTANT IT IS TO ADDRESS.
HEALTHCARE COSTS
AT THE PREVIOUS HEARING.
FORMER VERMONT GOVERNOR PETER
SHUMLIN THEY'LL REALLY EMPHASIZE
THAT.
THE STATE NEEDS TO TACKLE COST
CONTAINMENT.
IF IT'S GOING TO TRY TO ACHIEVE
LARGER HEALTH REFORM AND
UNIVERSAL COVERAGE AND I THINK
EVERYTHING THAT YOU HEARD TODAY
FROM THE PANELISTS YES BUT VERY
MUCH SPOKE TO THAT.
.
AS THE LATE AND GREAT.
MOVE A RIGHT HEART STATED IT'S
THE PRICES STUPID AND WE KNOW
THAT PEOPLE UNITED STATES SPEND
MORE MONEY ON HEALTHCARE THAN
ANY OTHER COUNTRY AND WE ALSO
YOU'LL USE LESS HEALTH CARE THE
THAT'S WHAT WE NEED TO TACKLE
AND HEALTH ACCESS HAS BROUGHT
BILLS IN THE PAST AND WILL
CONTINUE TO BUILD BRING BILLS IN
THE FUTURE TO INCREASE
TRANSPARENCY. TO GET A BETTER
HANDLE ON PRICES UNTIL OF
CONSOLIDATION AND WHAT NOT AND
WE VERY MUCH APPRECIATE YOUR
EFFORTS TODAY AND LOOK FORWARD
TO WORKING WITH YOU OF THIS
UPCOMING SUCH.
THANK YOU.
MR SHARE MEMBERS TERAFLOPS FROM
THE CALIFORNIA LABOR FEDERATION
AMID ECHO MY SISTERS FROM.
BRENT HELP ACCESS AN STI YOU.
R. TWELVE HUNDRED AFFILIATED
UNIONS NEGOTIATE FOR AND PAY FOR
HEALTH CARE FOR TWO MILLION
MEMBERS.
AND THEY SEE. THE MONEY THAT
GOES OUT FOR EVERY HOSPITAL
VISIT FOR EVERY DOCTOR'S VISIT
FOR ALL THE OUT PATIENT CARE
THAT IS GIVEN FOR ALL OF THE
PREMIUMS
AND THEY KNOW THAT THAT IS MONEY
COMING DIRECTLY OUT OF OUR
MEMBERS POCKETS.
IT'S MONEY THEY'RE NOT GETTING
IN RAISES IN WAGES AND AND
CONTRIBUTIONS TO PENSIONS IT IS
GOING TO HEALTH CARE.
AND THIS IS KILLING OUR UNIONS
AT THE TABLE AND IN ORGANIZING
AND IT IS HURTING PEOPLE ACROSS
THE STATE IT IS WHAT IS AS THE
SISTER MESSY AYE YOU SAID
FUELING. IN EQUALITY IN THE
STATE THIS IS NOT JUST A HEALTH
CARE ISSUE THIS IS AN ECONOMIC
ISSUE ANNA OF FAIRNESS AND
JUSTICE ISSUE FOR THE STATE OF
CALIFORNIA. AND WE VERY MUCH
APPRECIATE THAT YOU'RE TAKING ON
THE ISSUE OF PRICES.
THAT IS
KIND OF THAT ONE OF THE KEY IN
REINING IN COSTS WE HAVE TO DEAL
WITH THE PRICE OF HEALTH CARE.
AND WE HAVE DONE AS A LOT OF
WORK ON TRANSPARENCY WE RISK
SPONSORS OF AN S. B. SEVENTEEN.
AND. WE MAY NEED AS A STEP TAKEN
A STEP FORWARD AND MOVE FROM
TRANSPARENCY TO SOME FORM OF
PRICE REGULATION.
SO WE APPRECIATE THE DISCUSSION
THANK YOU THANK YOU.
CHAIRS AND ASSEMBLYMEMBERS MY
NAME IS SANDY READING I'M AN
OPERATING ROOM NURSE OF THIRTY
YEARS AND ON THE BOARD OF
DIRECTORS FOR THE CALIFORNIA
NURSES ASSOCIATION. I WOULD LIKE
TO THANK THE CAO THANK YOU FOR
STAYING LATE AND THANK THE CAL
LABOR FED FOR ENDORSING SENATE
BILL FIVE SIX TWO.
WE'VE ALSO HEARD A LOT OF
STATISTICAL AND ANALYTICAL DATA
AND I'D LIKE TO SHARE SOME OF MY
OWN.
BEING A NURSE FOR THIRTY YEARS
IN THE OPERATING ROOM I CAN TELL
YOU THAT THE STUDIES DO SUPPORT
THAT IF YOU SEE YOUR DOCTOR IN A
TIMELY MANNER ON A REGULAR
BASIS.
TAKE THE PRESCRIBED TREATMENT
AND THE MEDICATIONS WITHOUT
SPLITTING YOUR PILLS THEN YOU
WILL HAVE BETTER OUTCOMES.
THAT'S A NO BRAINER. S. B. FIVE
SIX TWO WHICH FACILITATE THAT
WE'VE ALSO HEARD THAT HEALTH
CARE IS EXPENSIVE.
OF COURSE WE KNOW IT'S EXPENSIVE
ESPECIALLY IF YOU LIVE IN THE
UNITED STATES.
PATIENT SHOULDN'T BE COMMODITIES
AND WE SHOULDN'T CAPITALIZE ON
THEIR ILLNESSES
IT REALLY DISCUSS ME TO SEE THIS
HAPPEN EVERY DAY IN MY PRACTICE.
AS A PATIENT GOES TO SLEEP AND
I'M HOLDING THEIR HAND WHILE
THEY'RE UNDERGOING GENERAL
ANESTHESIA I WONDER HOW MANY
PATIENTS AREN'T MAKING IT TO MY
OR TABLE.
RIGHT WE HAVE TO HAVE THE
EVERYBODY THAT NEEDS THE CARE
GET THE CARE THAT THEY NEED AND
HAVE THAT SINGLE STARE STANDARD
OF CARE.
WE DO NEED I HEARD MERGERS
SOMETIMES BECAUSE MARKET
FAILURES YES THEY DO BIGGER IS
NOT ALWAYS BETTER.
S. B. FIVE SIX TWO WOULD
ALLEVIATE A LOT OF THE PROBLEMS
THAT WE'RE HEARING TODAY. AND.
IT IS.
WHAT WE'RE ASKING IS THAT YOU
MEET WITH THE SPONSORS ADDRESS
ALL OF THE AMENDMENTS THAT HAVE
BEEN SITTING THERE FOR MONTHS?
AND.
DO THE DEMOCRATIC PROCESS WE
ELECTED OUR ELECTED OFFICIALS TO
REPRESENT US AND WHEN IT'S BEING
THE BILL IS BEING HELD HOSTAGE.
THEN NOBODY CAN DEBATE IT NOBODY
CAN LISTEN TO THE AMENDMENTS
THAT WE PUT FORWARD. AND NOBODY
CAN PASS THIS BILL THAT WE SO
DILIGENTLY NEED NOW. YES.
THE PRESIDENT DID SAY SOMETHING
ABOUT WAIVERS BUT YOU KNOW WHAT
I'M AYE OR TABLE IF I GET A CAR
ACCIDENT VICTIM I'M NOT GONNA
SAY YOUR CHANCES ARE VERY GOOD.
I'M NOT GOING TO WORK FOR YOU
I'M GONNA DO MY DARNDEST AND I
WILL FIGHT UNTIL WE GET THIS
PAST JUST LIKE I FIGHT FOR MY
PATIENTS EVERYDAY. THANK YOU.
WELL IT'S AFTER FIVE O'CLOCK.
MY NAME IS JEFF TARGET YEAR I AM
AN ADVOCATE.
PART A DOG FIGHT I'M CARVE CAR.
I'M PART OF POWELL AND THERE'S A
MULTIPLE OTHERS I'M A NATIVE
SACRAMENTO IN.
SINGLE PAYER HOW MANY TIMES DOES
IT HAVE TO COME UP AND FOR THIS
COMMITTEE.
WHY IN THE WORLD WAS THERE NO
ANALYST PUT YOU HAD OVER A YEAR
AGO UP THE BILL AND HOW YOU
FACILITATE SINGLE PAYER?
I'M SORRY.
YOU DON'T HAVE ANYTHING SO
PLEASE MAKE IT WORK RENDON GET
OFF YOUR* AND MAKE THIS
HAPPEN THANK YOU.
I COULD AFTERNOON AND AGAIN
THANK YOU FOR LETTING US STAY
HERE LATE.
MY NAME IS LESLIE ESTHER I AM A
NURSE OR REGISTERED NURSE FROM
EUREKA CALIFORNIA. I WORK ON AN
IN PATIENT REHABILITATION UNIT
THAT'S PRIMARILY STROKES AND
DRAMATIC BRAIN INJURY.
WE HEARD A LOT OF SUGGESTIONS
TODAY OF HOW WE COULD TWEAK ARE
VERY FRACTURED AND BROKEN
HEALTHCARE SYSTEM.
I.
ALONG WITH MANY OTHER
CALIFORNIA ORIENTS IT'S MY
CONTENTION THAT THIS TYPE OF
INCREMENTALISM. IS NOT THE
ANSWER TO THE CRISIS IN OUR
HEALTHCARE SYSTEM. IN THIS STATE
AND INDEED IN THIS COUNTRY.
INCREMENTALISM MAY BRING US A
STEP CLOSER TO UNIVERSAL HEALTH.
COVERAGE.
BY WAY OF FOR PROFIT INSURANCE
COMPANIES BUT IT DOES NOT BRING
US UNIT BAR GUARANTEED UNIVERSAL
HEALTHCARE COVERAGE.
WHEN YOU CALL FOR THE FORMER
JUST A.
WHEN YOU CALL ONLY FOR UNIVERSAL
HEALTH CARE IS HAVE THE LATTER
BEING SILENT ABOUT THE
GUARANTEED UNIVERSAL HEALTH
CARE.
IT'S MORALLY INDEFENSIBLE AND
IT'S IT'S BEING DONE SO IN THE
FACE OF MANY THAT ARE REALLY
NEEDLESSLY SUFFERING AND EVEN
DYING.
CALIFORNIA AT THIS POINT SHE
JUST BOLDLY LEAGUE.
SINGLE PAYER HEALTHCARE COVERAGE
FOR ITS CITIZENS.
THANK YOU.
I THINK YOU I'M BRIAN STUMP OR I
LIVE IN THE VITAL AYE
CALIFORNIA.
AND THE LIKE TO TELL YOU THAT AN
INSURANCE COMPANY CAN'T
PRESCRIBE AN ASPIRIN. YOU'VE
NEVER HEARD OF SOMEBODY TAKEN A
BROKEN ARM TO AN INSURANCE AGENT
AND WHY IS SIMPLE. INSURANCE
COMPANIES DON'T DO HEALTH CARE.
BUT IT'S ABOUT MAKING MONEY AND
YOU'RE NOT ABLE TO SELF INSURE
A AND YOU CAN'T AFFORD THE RISK
THEN YOU NEED INSURANCE I'M THE
FIRST PERSON TO TELL YOU THAT. I
OWN A SMALL CORPORATION IRAN FOR
TWENTY SEVEN YEARS. AND.
IE.
AND INTERESTED IN COULD COST I
THINK THAT THE REPUBLICANS
SHOULD PROBABLY BE SPIRITING
THIS THING THEY'RE SUPPOSED TO
BE INTERESTED IN BUSINESS THE
CHAMBER OF COMMERCE CAME HERE.
WHEN THIS THING WAS INTRODUCED
AND SPOKE AGAINST IT. WHY THEY
DID I DON'T KNOW BECAUSE
PROBABLY NINETY EIGHT PERCENT OF
THEIR?
PEOPLE WOULD GAIN GREATLY WITH
A. SINGLE PAYER.
FARMERS SMALL PEOPLE THAT LIVE
IN JIM WOOD SYRIA.
THAT ARE BUSINESSMEN.
THEY'D GAIN OF BY THIS.
AND. OUR LIST DISCUSSIONS GOTTA
BE ABOUT HEALTH CARE YOU KNOW
NOT NOT ABOUT INSURANCE.
IS THAT MY TIME.
YOU WILL LIKE IT. WELL OKAY
WOMEN SO.
.
SINGLE PAYER THAT POLAND REPORT
SHOWS WE CAN SAVE THIRTY EIGHT
MY HALF BILLION DOLLARS.
JIM ARE PART OF THAT THIRTY
EIGHT MAY HAVE BILLION DOLLARS
COULD BE USED FOR SCHOLARSHIPS
FOR MEDICAL PROVIDERS DOCTORS
AND OTHER PEOPLE.
IT WITH THE PROVISION THAT
NOW I'D.
YOU KNOW I DID OKAY I'M THAT I'M
ON SINGLE PAYER NOW I'VE GOT
MEDICARE I LIVE IN MARIN COUNTY
SO I'M NOT TALKING ABOUT THIS OR
YOU KNOW FOR MYSELF THIS IS FOR
YOUR PEOPLE.
GOOD AFTERNOON EVERYONE MY NAME
IS THE PLANES HAD I NOT BEEN A
REGISTERED NURSE FOR THIRTEEN
YEARS. AND I CURRENTLY WORK AND
MEDICAL TELEMETRY.
.
THE REAL PROBLEM HERE REALLY IS
THE LACK OF POLITICAL WILL.
ALL THE COUNTER ATTACK
ABOUT WHAT SUPPOSEDLY LACKING IN
SB FIVE SIX TWO.
ARE NOT WHAT MATTERS.
IT'S ABOUT DEVELOPING THE
COURAGE.
WE NEED THE POLITICAL WILL TO
TAKE ON INSURANCE COMPANIES.
DRUG MANUFACTURERS IN FOR PROFIT
HOSPITALS.
I FEEL THE ASSEMBLY DEVELOPS
THAT COURAGE
ALL THE CONCERNS ABOUT S. B.
FIVE SIX TWO BEING WOEFULLY
INCOMPLETE.
OR WE CAN'T DO IT BECAUSE OF
PROP NINETY EIGHT GAM LIMIT AT
SARAH.
NEITHER ALL AGES DIVERSIONARY
TACTICS
BE SIGNED A KEEP. FOCUSED ON THE
FACT THAT THERE IS SOME BEER AT
LACK OF POLITICAL WILL IN THE
ASSEMBLY.
DEFINITELY HEALTH CARE IS A
BASIC HUMAN RIGHT.
AND ALL SEEM TO AGREE.
AND YET SADLY AND
DISAPPOINTINGLY SPEAKER RENDON
SAID IT'S CRIMINAL FOR THE
NURSES TO BE SEEN CALIFORNIA CAN
PROVIDE GUARANTEED HEALTHCARE TO
EVERYONE.
WE NEED HEALTH CARE.
WE NEED GUARANTEED HEALTHCARE
FOR ALL.
WE NEED S. B. FIVE SIXTY TWO
POUNDS THANK YOU.
THANK YOU GOOD EVENING I'M PENNY
CLARK A LIVE IN MARIN I'M NOT A
NURSE AND A LAWYER. BUT I'VE
BEEN FOLLOWING SINGLE PAYER FOR
A LONG TIME MANY YEARS.
AND I HAVE SEEN THE RESISTANCE
TO IT THAT I DON'T UNDERSTAND
EXCEPT THE ANSWER'S GOT TO LIE
IN THE BACK ROOM SOMEWHERE
BECAUSE IT'S SUCH AN OBVIOUS WIN
WIN. SITUATION.
IF WE DIDN'T HAVE HEALTH
INSURANCE COMPANIES AND THE
PROFIT THAT IS ATTACHED TO
HAVING HEALTH INSURANCE
COMPANIES WE WON'T NEED TO TALK.
ABOUT COVERAGE IN PLANS AND
PREMIUMS AND UP LIFETIME CAPS
AND DENIAL OF CLAIMS AND COPAYS
IT CETERA ETCETERA ETCETERA AND.
SOMETIMES THE ANSWER TO THE
PROBLEM. IS NOT MOST COMPLEX
WHEN IT'S THE SIMPLEST ONE.
AND I THINK THAT'S WHAT WE HAVE
TODAY.
JUST I THOUGHT WELL THIS DOESN'T
AFFECT ME BUT I LOOK BACK OVER
MY LIFE AND I REALIZE WHAT HE ON
IT HAS IN MANY WAYS.
MANY YEARS AGO MY MY DOCTOR WHO
WAS A SINGLE PAYER SUPPORTER.
COULDN'T IT. HAVE AN EXPLANATION
FOR ME WHEN I COULDN'T GET THE
ANTI DEPRESSANT I NEEDED FROM
BLUE CROSS THEY WOULD THEY WOULD
PAY FORCE FOR PROZAC THEY WOULD
PAY FOR PAXIL BUT THEY WOULDN'T
PAY FOR RESULT LOFT.
AND I ASK HIM WHY AND HE SAID
WELL PENNY THAT'S PROBABLY
BECAUSE THEY DIDN'T GIVE A BIG
ENOUGH.
TO THE.
THE MANUFACTURE THE BILL.
SO ALL IN ON BEYOND THAT I FOUND
MYSELF COUPLE YEARS AGO GOING
DOWN TO TIJUANA. FOR A CROWN
BECAUSE I COULDN'T AFFORD IT UP
HERE I DROVE TO TO YOU WANNA
STAY THERE THREE DAYS PAID FOR
THAT CROWN FOR LESS THAN HALF OF
WHAT IT WOULD COST ME UP HERE.
SO WE REALLY DO NEED THIS AND I
HOPE YOU ALL DO IN THE FUTURE.
NOW NEXT YEAR WHENEVER STE JUST
KEEP PRESSING THE FACTS SPEAK
FOR THEMSELVES KEEP PRESSING FOR
THIS BILL. WE NEED.
THANK YOU.
BUT EVEN IMPLEMENTED PATRICK
BURNS AND WITH THAT CALIFORNIA'S
ASSOCIATION OF HEALTH
UNDERWRITERS THE.
INSURANCE AGENTS AND BROKERS TO
WORK WITH OUR COMMUNITIES EVERY
DAY BY MAKING SURE OUR CUSTOMERS
CALIFORNIA CONSUMERS HAVE ACCESS
TO AFFORDABLE HEALTHCARE THROUGH
EVERY TYPE OF HEALTH CARE
ARRANGEMENT.
INCLUDING MEDICARE MEDICAID HOW.
INDIVIDUAL PROGRAMS EITHER
THROUGH COVER CALIFORNIA OR
OUTSIDE THE EXCHANGE.
AND EMPLOYER BASED PROGRAMS BOTH
INSURED AND SELF FUNDED
ARRANGEMENTS.
THROUGH OUR EFFORTS AMONGST MANY
OTHERS.
CALIFORNIA'S NOW AT A RECORD
LEVEL OF HEALTH INSURANCE
COVERAGE WITH THE UNINSURED RATE
AT SIX POINT EIGHT PERCENT.
THE LAST WHILE OF COURSE IS THE
HARDEST ONE WE STAND WITH THE
COMMITTEE TO SUPPORT UNIVERSAL
COVERAGE FOR ALL CALIFORNIANS.
WE KNOW THAT MOST CALIFORNIANS
ARE CURRENTLY HAPPY WITH THEIR
HEALTHCARE COVERAGE BUT WE ALSO
KNOW THAT HAVING SOME WHO DONT
DO NOT HAVE ACCESS IS WRONG.
AND THAT THE COSTS ARE TOO HIGH.
WE URGE THE SELECT COMMITTEE OF
THE LEGISLATURE TO WORK TOGETHER
WITH ALL STAKEHOLDERS TOWARD
FINDING SOLUTIONS THAT ADDRESS
MARKET STABILIZATION.
VIABLE COST CONTAINMENT
SOLUTIONS AND FINDING ACCESS
SOLUTIONS FOR THOSE CURRENTLY
WITHOUT ACCESS KAHU
INTERNATIONAL ORGANIZATION A
WORKING TOWARDS THESE GOALS AS
WELL. AND GOLF CALIFORNIA AND ON
A NATIONAL BASIS.
COM WHO BELIEVES THAT WE SHOULD
NOT.
DISMANTLED THE EXCELLENT WORK
THAT SO MANY STAKEHOLDERS AND
THE LEGISLATURE HAS COMPLY HAVE
COMPLETED OVER THE LAST EIGHT
YEARS.
TO PUT IT TO MAKING
CALIFORNIA'S PUBLIC AND PRIVATE
PARTNERSHIP.
DEVELOP INTO AN INNOVATIVE AND
JUST ABOUT THE MOST COST
EFFECTIVE SYSTEM.
IN THE COUNTRY.
BUT.
WE'RE CERTAINLY WILLING AND
HOPEFUL AND WANT TO WORK WITH
YOU TO DEVELOP A FUTURE
SOLUTIONS.
THANK YOU VERY MUCH.
SIR.
HELLO EVERYONE AND THANKS FOR
THESERIES OF HEARINGS.
EXCEPT FOR THE OBVIOUS MISSING
ELEMENT IN THEM AND THAT WOULD
BE A CERTAIN NUMBER OF HOURS
SPENT ON SINGLE PAYER AS AN
ECONOMIC AND AS A PATIENT CARE
SYSTEM.
I AM A NURSE PRACTITIONER I'VE
BEEN A NURSE FOR FORTY THREE
YEARS A NURSE PRACTITIONER FOR
THIRTY NINE OF THOSE YEARS.
AND I WILL TELL YOU THERE'S
ANOTHER LITTLE SAME KIND ALIKE.
AN APPLE A DAY KEEPS THE DOCTOR
AWAY THAT I'D LIKE TO POINT OUT
TO ALL OF YOU AND THAT IS. THE
DEFINITION OF INSANITY IS DOING
THE SAME THING OVER AND OVER
AGAIN EXPECTING DIFFERENT
RESULTS.
MY ENTIRE PRACTICE LIFE HAS BEEN
SPENT.
PLAYING GAMES WITH TWEAKING THE
SYSTEM WHICH IS ALL THAT WE
HEARD ABOUT A SYSTEM THAT CANNOT
WORK AND SHOULD NOT WORK.
I AM A CLINICIAN I AM NOT A
PROVIDER.
I GIVE PEOPLE CARE NOT PRODUCT.
AND MY PEOPLE WHO COME TO MY
CLINIC OUR PATIENTS NOT
CONSUMERS
THERE'S A MARKET PARADIGM FOR
HEALTHCARE THAT SIMPLY NEEDS TO
GO AWAY.
I'LL CONTEST ONE NUMBER THAT I
HEARD TODAY AND THAT IS THE
ADMINISTRATIVE COST DIFFERENCES
BETWEEN PRIVATE INSURANCE.
MEDICARE AND MEDICARE ADVANTAGE
AND I'LL ALSO POINT OUT.
WE APPARENTLY ARE WE WASTING AT
LEAST SIX PERCENT OF OUR TAX
DOLLARS IN MEDICARE TURNING IT
OVER TO PRIVATE INSURANCE
COMPANIES.
TO MANAGE THE ADVANTAGE THAT WE
COULD HAVE WRITTEN AN TO THE
MEDICARE LAWS IN THE FIRST
PLACE.
THE DIFFERENCE.
THAT I'M HEARING IN HEALTH
AFFAIRS MAGAZINE IN THE NEW
ENGLAND JOURNAL OF MEDICINE. IN
MANY OTHER MEDICAL AYE AND
MEDICAL ECONOMICS MAGAZINES OF
INSURANCE.
COST.
IS TWENTY ONE PERCENT NOT ELEVEN
SO IF YOU WANT TO TALK ABOUT
SAVING MONEY THERE'S A MUCH
BIGGER AMOUNT OF IT. AND I WILL
TELL YOU THAT THE SIMPLE
SOLUTION HERE IS A UNIVERSAL
PUBLIC SYSTEM WHERE THE.
PAY THE PAYMENTS ARE MADE TO
THE PEOPLE PROVIDING THE CARE
AND I KNOW I'M OVER TIME I'M
GONNA GO TO SEE TWO MORE
SECONDS.
S. B. FIVE SIXTY TWO IS WHERE
YOU NEED TO START AND THAT NEEDS
TO GO BACK TO THE ASSEMBLY.
THERE IS NO DIFFUSE PUSH BACK
IT'S SIMPLY BEING IGNORED.
GOOD EVENING MY NAME IS THEO
SLATER AND THE NATIONAL
CHAIRPERSON FOR THE CALIFORNIA
NATIONAL PARTY.
SINGLE PAYER HEALTHCARE IS THE
ONLY SYSTEM THE FEDERAL
GOVERNMENT CAN'T UNDERMINE WITH
HIS COMMERCE POWERS LIKE THEY DO
NOW WITH ERISA.
THEREFORE SINGLE PAYER IS THE
ONLY VIABLE VEHICLE TO PROVIDE
CALIFORNIA WITH THE SORT OF
COVERAGE PROVIDED BY MODERN
DEMOCRACIES AROUND THE WORLD.
THAT TRUMP CAN'T UNDERMINE.
THE CALIFORNIA NATIONAL PARTY
SUPPORTS S. B. FIVE SIX TWO AS
THE WAY FORWARD FOR ADDRESSING
THE NEEDS OF ALL CALIFORNIANS.
HEALTH INSURANCE COMPANIES
PROVIDE NO CARE TO ANYONE AND
MERELY RATION CARE BY WEALTH.
THE STATUS QUO IS BAD FOR
CALIFORNIA AND ONLY GOOD FOR THE
HUGE AND WASTEFUL CORPORATIONS
WHO HOLD OUR PEOPLE HOSTAGE AND
PROFIT FROM OUR SUFFERING.
PLEASE PASS SB FIVE SIXTY TO NOW
CALIFORNIA CAN'T AFFORD ANY
FURTHER DELAY. THANK YOU.
MY NAME IS DIANE AFFORDABLE. I
LIVED IN CANADA OF MORE THAN
TWENTY YEARS.
WE RAISED OUR CHILDREN UNDER
THEIR SYSTEM I HAVE SEEN SINGLE
PAYER IN ACTION AND IT WORKS.
WHAT?
?
I'VE BEEN A VOLUNTEER FOR SINGLE
PAYER SINCE I RETURNED FOR
TWENTY FIVE YEARS.
WE JUST KEEP COMING BACK.
BUT I LIKE HISTORY AND SO I'D
LIKE TO PAINT A LITTLE PICTURE
HERE WE ARE IN THIS ROOM. RIGHT
NOW JUST US.
AND THE BEHIND US STRETCHES
HUMAN HISTORY MANY THOUSANDS OF
BABY MILLIONS OF YOUR.
AND THERE BEFORE US.
MANY THOUSANDS AT LEAST
MAYBE MUCH MORE.
SO WHERE ARE WE NOW.
WELL ACCORDING TO SOME OF THE
ECONOMISTS I READ WE ARE LIVE
THE GREATEST INEQUALITY IN
WEALTH AND INCOME SINCE NINETEEN
TWENTY NINE.
I WANNA REPEAT THAT WE HAVE THE
GREATEST INEQUALITY.
IN INCOME AND WEALTH SINCE
NINETEEN TWENTY NINE.
THAT'S A PRETTY SIGNIFICANT SOME
PEOPLE HAVING A REAL HARD TIME
RIGHT NOW AND CHICO OUR STREETS
HAVE
SO MANY HOMELESS.
AND IS OT GOING TO GET BETTER
RIGHT AWAY IT MAKE IT MUCH
WORSE.
OKAY IN THE SIDE.
.
THE ALSO AUTOMATION IS GOBBLING
UP JOBS.
MAKING.
SUGGESTING IT MAY GET WORSE.
TOMMY DOUGLAS WHO WAS A PRIME
MINISTER OF CANADA WHEN SINGLE
PAYER WAS BROUGHT IN HE IS
STILL.
CHOSEN AS THE MOST ADMIRABLE
CANADIAN IN SURVEYS WHEN THEY
RUN THESE THINGS.
A SO HERE'S A LEGACY FOR US ALL.
I URGE YOU TO MOVE TOWARD A
UNIVERSAL NOT FOR PROFIT
SINGLE PAYER. GOVERNMENT FUNDED
HEALTH CARE FOR HOME.
HUMAN.
HELLO MY NAME'S DAVE MARIN.
I'M THE DIRECTOR OF RESEARCH
AND POLICY FOR THE CALIFORNIA
FREEDOM COALITION AND I'M
SPEAKING ON BEHALF OF THE PUBLIC
OPTION TO SINGLE PAYER WORKING
GROUP.
SO WHEN PEOPLE TALK ABOUT
SINGLE PAYER IN CALIFORNIA THERE
LIKE OWE HOW ARE WE GOING TO
CONTAIN COSTS HOUSE GOING TO
WORK WITH OTHER COVER. LIKE NO
NO WE ALREADY HAVE A. A SINGLE
PAYER SYSTEM A PUBLIC SINGLE
PAYER SYSTEM COST CONTROLS IN
CALIFORNIA WE JUST DON'T HAVE
ENOUGH CALIFORNIANS IN IT.
AND TALKING WE READ THIS FACT
SHEET WHICH SHOULD BE IN YOUR
POCKET LAYING THE GROUNDWORK FOR
SINGLE PAYER.
EMERGED I'M TALKING ABOUT THAT
PUBLIC MEDI CAL MANAGED CARE
PLANS SO.
MORE THAN NINETY PERCENT OF
CALIFORNIANS ARE IN A COUNTY
WITH THE PUBLIC PLAN. A A PUBLIC
MANAGED CARE PLAN IS IT'S ONE
THAT'S
NONPROFIT AND THE PREMIER
PRIMARILY DEDICATED TO MEDIC
MEDIC HOW. THERE'S ALSO PRIVATE
INSURERS AND MEDICARE OTHERS
ALSO FEE FOR SERVICE.
THE GOOD THING ABOUT THE PUBLIC
PLANS IS THERE'S A MOST ONE FOR
COUNTING SU KNOW WHAT THE PUBLIC
PLAN IS.
AND THEY WON'T GET UNDERFOOT
WHEN YOU TRY TO FLIP THE SWITCH
FROM A PREMIUM BE SYSTEM TO
TAXPAYERS SYSTEM.
THEY WANT SAY THEY WON'T USE THE
PROFITS THEY'RE MAKING TO LOBBY
INSTANT KILL SINGLE PAYER.
SO.
HOW DO YOU GET MORE PEOPLE ON A
ONE OF THESE PLANTS WELL?
I MEDI CAL BY IN.
THE GREAT THING ABOUT AMERICA
BY AND IS SPIKES IN DEMAND SAID
AT THE LAST PRESENTATION YOU
DON'T NEED A FEDERAL WAIVER FOR.
YOU CAN SET THE PRICE
TO-WHATEVER YOU WANT IT COULD BE
A
LITTLE BIT MORE EXPENSIVE THAN
MEDI CAL IS NOW TO GET MORE
MONEY INTO THE SYSTEM TO MAKE
MEDICAL BETTER IF YOU HAVE MORE
PEOPLE IN MEDI CAL THE PROVIDER
NETWORKS GET BIGGER.
PEOPLE ALREADY START TO SEE THE
BENEFITS OF SINGLE PAYER SO.
THEIR TWO THINGS THAT ARE REAL
IMPORTANT ONE IS YOU NEED AN
EMPLOYER BY SO FOR EXAMPLE.
LA IS PUBLIC PLAN LA CARE.
COVERS TWO MILLION PEOPLE
THEY ALSO HAVE A THEY'VE BEEN
UNCOVERED CALIFORNIA SINCE
TWENTY THIRTEEN THROUGH ELLIE.
CARE COVERED.
WHICH IS GREAT IT COVERS TWENTY
THOUSAND PEOPLE YOU'RE NOT GOING
TO GET THE SCALE YOU WANT
WITHOUT AN EMPLOYER PLAN.
AND THE OTHER THING IS TAKE A
HARD LOOK AT THESE PRIVATE
ENTITIES THAT ARE MEDI CAL.
AND THERE IS A SLIGHTLY WAS
CHRIS PONY SLIDE NUMBER TWELVE
WHERE THEY LINE THEM ALL UP. IF
YOU LOOK CLOSELY AT THAT IF YOU
LOOK AT THE COUNTIES WHERE
THERE'S BOTH THE PUBLIC PLAN IN
A PRIVATE PLAN THERE'S THERE'S
THIRTEEN COUNTIES LIKE THAT. IN
ONLY FOUR DOES ANY PRIVATE PLAN
BE.
THE PUBLIC PLAN
SO.
I IT'S NOT CLEAR WHAT WE'RE
DOING.
THANK YOU FOR YOUR TIME.
THANK YOU SIR.
MY NAME IS WILLIAM BRONSTON I'M
A PHYSICIAN.
I WAS THE MEDICAL DIRECTOR FOR
TWO STATE DEPARTMENTS IN
CALIFORNIA FOR THIRTY YEARS THE
DEPARTMENT OF DEVELOPMENTAL
SERVICES IN THE DEPARTMENT WE
HAVE.
I BEEN AROUND A LONG TIME MAYBE
TWICE AS LONG AS MANY OF YOU OUT
THERE AND I AM VERY DEEPLY
FAMILIAR WITH WHAT'S GOING ON AS
A HEAD. OF THE PHYSICIANS FOR A
NATIONAL HEALTH PROGRAM HERE. A
MEMBER ORGANIZATION THAT
INCLUDES TWENTY THOUSAND OF US
IN THE UNITED STATES COMMITTED
TO FAIRNESS AND JUSTICE AND A
SINGLE PAYER. WE ARE ABSOLUTELY
UNCOMPROMISING LEE COMMITTED TO
KEEPING IT SIMPLE.
KEEPING IT SIMPLE MEANS HAVING A
SYSTEM WHERE PEOPLE CAN GO WITH
NO OUT OF POCKET EXPENSES OF ANY
KIND.
WHICH IF THEY HAVE TO PAY ONE
DOLLAR INTERFERES AND RESULTS IN
OUTCOME MEASURES THAT DROP.
IN GETTING THE SERVICES THEY
NEED FROM ANY LICENSE CALIFORNIA
PHYSICIAN OR HEALTH PROVIDER.
AND GOING HOME AND HAVING THE
PROVIDER BILL THE TRUST AGENCY
THAT HAS BEEN CREATED IN FIVE
SIXTY TWO.
YOU NO THAT WE ARE IN A ELECTION
YEAR.
AND THIS YEAR. THE ISSUE OF
SINGLE PAYER IS GOING TO BE THE
GOVERNING ISSUE THAT'S GOING TO
DIVIDE THE PEOPLE THAT NGUYEN
FROM THE PEOPLE THAT LOSE.
WE'RE IN A SITUATION WHERE THERE
AREBRILLIANT BRILLIANT LEADERS
IN THE STATE OF CALIFORNIA THAT
WILL FIGHT TRUMP TO THE GROUND
IF THE FEDERAL GOVERNMENT TRIES
TO BLOCK MONIES FROM US.
WE HAVE THE PEOPLE POWER AND THE
DOCTOR POWER. AND THE NURSE
LEADERSHIP IN THIS AGENDA THAT
WILL TRANSFORM THE STATE INTO A
MORE DEMOCRATIC MORE HUMANE MORE
PROFOUNDLY INTIMATE MORE CARING
AND MERCIFUL SOCIETY.
THAT'S WHAT'S AT STAKE THAT'S
WHAT THE DARK MONEY DOESN'T WANT
TO HAPPEN AND I HOPE THAT NONE
OF YOU ARE SOMEHOW SEDUCED. BY
THE DARK MONEY WE HAVE THE DATA
I WANT TO THANK YOU VERY MUCH
YOUR COMMITMENT AND JUST KNOW
THAT THIS IS THE BEGINNING. OF
THE END OF THE OLD WAY WHERE
MONEY IS THE ISSUE THAT WE'RE
TALKING ABOUT NOT THE QUALITY OF
LIFE OF EVERY HUMAN BEING IN THE
STATE OF CALIFORNIA. THANK YOU.
A THANK YOU SO MUCH I APPRECIATE
IT I THINK YOU FOR THE IS
INFORMATIVE HEARINGS MY NAME IS
AMY HI AM SHY GUY AND THE
LEGISLATIVE AND POLITICAL
DIRECTOR FOR. THE CW A LOCAL
NINETY ONE NINETEEN WE REPRESENT
APPROXIMATELY FIFTEEN THOUSAND.
RESEARCHERS AND OTHER TECHNICAL
AND PROFESSIONAL EMPLOYEES
WITHIN THE TEN CAMPUSES AND FIVE
MEDICAL CENTERS OF THE UC
SYSTEM.
A TWO THOUSAND WORKERS THAT ARE
AND.
COMMUNITY COLLEGES AND THREE
NATIONAL LABORATORIES.
I WOULD JUST LIKE TO MENTION THE
REASONS WHY ALTHOUGH WE HAVE
ENJOYED THESE INFORMATIVE
HEARINGS WHY WE THINK THAT WE
ARE STILL IN FAVOR OF SB FIVE
SIXTY WERE DEFINITELY IN FAVOR
OF S. B. FIVE SIX TWO AND WOULD
ENJOY HEARING ABOUT THAT TOPIC.
HEALTH CARE OF COURSE IS A
FUNDAMENTAL HUMAN RIGHT. AND WE
HAVE KNOWN THAT SINCE THE UN
DECLARATION OF HUMAN RIGHTS IN
NINETEEN NINETY FOUR SO IT'S
BEEN AWHILE. AND I WE WOULD LIKE
THE REAFFIRMATION THAT
HEALTCARE IS A FUNDAMENTAL
HUMAN RIGHT. AYE AS SARAH FLUX
AND STATED THE BEST AND SIMPLER
SWAYED TO REMOVE HEALTH CARE
FROM THE BARGAINING TABLE IS
SINGLE PAYER AND WE ACTUALLY ARE
AT THE BARGAINING TABLE WITH YOU
SEE RIGHT NOW IT WOULD BE
WONDERFUL IF WE COULD REMOVE
THAT AS A BARRIER TAKE REACHING
AN AGREEMENT. EDUCATION IS ALSO
A FUNDAMENTAL HUMAN RIGHT AND WE
DID ENJOY THE CONVERSATION
ABOUT.
THAT COST OF ATTAINING A
MEDICAL DEGREE BECAUSE WE SHOULD
REMOVE TUITION AND FEES IN
MEDICAL EDUCATION FROM THE
HEALTH CARE COST EQUATION TO
INCREASE PROVIDERS AND TOTAL AND
DIVERSITY OF PROVIDERS
SPECIFICALLY. WE SHOULD PAY FOR
THE FREE TUITION AND FEES.
MEDICAL EDUCATION FROM THE
BILLIONS AND BILLIONS OF LEAST
THIRTY SIX BILLION DOLLAR PER
YEAR SAVINGS FROM THE GREEDY FOR
PROFIT HEALTH INSURANCE
CORPORATIONS THAT ARE LEECHING
OFF OF OUR LIVES. SO WE SURE
WOULD APPRECIATE YOUR
CONSIDERATION AND THANK YOU VERY
MUCH.
THANK YOU.
HI MY NAME IS CAROLYN DOWN AMID
A CAMPAIGN ORGANIZER WITH A
HEALTHY CALIFORNIA CAMPAIGN AND
I JUST WANT TO SAY THAT I'VE
BEEN IT'S ALL OF THESE HEARINGS
AND THEY'VE BEEN VERY
INFORMATIVE. BUT I ALWAYS WALK
AWAY WITH THE SAME CONCLUSION
AND MAYBE I'M A LITTLE BIASED
THAT S. B. FIVE SIX TWO ANSWERS
A LOT OF THE QUESTIONS THAT ARE
BROUGHT UP HERE. AND I WANT TO
THANK YOU ALL FOR YOUR.
DEEP QUESTIONS AND I KNOW THAT
TO MANY OF YOU HAVE.
COME TO SOME OF THE SIMILAR
CONCLUSIONS THAT MANY OF US HAVE
THAT SINGLE PAYER IS THE ANSWER
TO. UP EMPLOYEE ISSUES EMPLOYER
ISSUES THE.
COST CONTAINMENT SO.
TRANSPARENCY ALL THE THINGS
THAT EVERYBODY WANTS TO NIBBLE
AROUND THE EDGES SINGLE PAYER
ACTUALLY GETS RIGHT TO IT SO I
WANT TO ASK YOU FIRST OF ALL I
WANT TO.
ASK ABOUT YOUR COMMITMENT YOU
MADE TO THE CALIFORNIA NURSES
ASSOCIATION THAT S. B. FIVE SIX
TWO WOULD BE A PANEL. I'M HOPING
YOU WILL FULFILL THAT COMMITMENT
THAT THE NEXT HEARING. AND I
ALSO WANT TO ASK YOU TO GET
SPEAKER RENDON TO MOVE THIS BILL
TO THE FLOOR BECAUSE AS SOMEONE
STATED EARLIER.
THIS COMMITTEE CANNOT LEGISLATE
YOU'VE BEEN DONE A GREAT JOB
INFORMING US BUT THIS COMMITTEE
CANNOT LEGISLATE WE NEED.
S. B. FIVE SIX TWO IN THE HEALTH
COMMITTEE DOCTOR WOULD.
AND THEN IN THE APPROPRIATIONS
COMMITTEE AND THEN TO THE
ASSEMBLY FLOOR PLEASE DO THAT
THANK YOU.
MY MY NAME'S KEITH MCALLEN.
I'M A PHYSICIAN ASSISTANT I WAS
MOST RECENTLY AT A FAMILY
PRACTICE DOWN IN SALINAS.
A COUPLE OF POINTS HERE NOT
REGARDING A GOVERNOR OUT SHUMLIN
AYE IT MAKES NO SENSE AT ALL TO
SUGGEST THAT WE PROVE THAT WE
CAN CONTAIN COST BEFORE
IMPLEMENTING SINGLE PAYER SINGLE
PAYER IS THE MECHANISM. OF COST
CONTAINMENT R. HE HAS GREAT
THINGS TO TEACH US AND WE SHOULD
LISTEN TO ON THAT ON THAT POINT.
HE'S OFF BASE.
DOCTOR RANDALL IF A REGULAR
THANK YOU SO MUCH FOR BRINGING
UP THE TERM UNDER INSURED IN
SALINAS I HAD MANY PATIENTS WHO
WERE ON.
THAT NEEDED HEALTH INSURANCE
THEY WERE UNINSURED AND I HAD
MANY ELDERLY ON MEDICARE THE
BULK OF MY PATIENT PANEL WAS
EVERYBODY IN THE MIDDLE THAT'S
CALLED UNINSURED. WANTED THINGS
WERE NOT REALLY APPRECIATING IS
THAT EMPLOYMENT BASED HEALTH
CARE INSURANCE IS A DIMINISHING
BENEFIT OVER TIME. AREN'T YOU
CAN GO TO P. NH P. DOT ORG AND
LOOK AT THE DATA I'LL BE HAPPY
TO PASS THAT ALONG TO YOU.
YEAH MEDICARE FOR ALL HER FORTY
SEVENTH IN THE NATION IN
REIMBURSEMENTS.
THE LAST PANEL CINDY MAN SPOKE
OF MEDICARE FOR ALL THAT'S
THAT'S JUST ABSURD THAT'S AN
ABSURD PROPOSITION TO PUT FORTH.
REGARDING ABOUT TALKING ACCESS
TALKING ACCESS IS NOT TALKING
ABOUT HEALTHCARE REFORM. THE
OPIOID EPIDEMIC.
AB WHAT ARE WE TALKING ABOUT
NOBODY'S TALKING ABOUT PAIN
MANAGEMENT REFORM KNOW WHERE
ACROSS THE UNITED STATES.
WORKERS COMP NOT BEING
DISCUSSED IN MY SHOULD BRING IN
SINGLE PAYER. LONG TERM SUPPORT
SERVICES NOBODY'S TALKING ABOUT
FIXING THAT.
AND PUSHED BACK AGAINST THE
DIABETES TSUNAMI THAT'S NOT
GONNA HAPPEN WHEN OUNCES OF
PREVENTION ARE DISCARDED BECAUSE
THERE'S MONEY IN PARENTS OF
CARE.
.
AND THEN THE THAT THE BIG THE
BIG SIGH THING THAT I THINK WE
ALL NEED TO THINK ABOUT AND I
THINK OF THE UNDERWRITERS WHO
WERE JUST TOP HERE NOW. THE
BUSINESS LEADERS WHO KNOW WHAT
THEY'RE TALKING ABOUT REGARDING
HEALTH CARE REFORM SAY PRIVATE
INSURANCE BRINGS NOTHING TO THE
HEALTH CARE TABLE EXCEPT COST.
THANK YOU.
FOR ARE NOT PURPLE OVERTHROW YOU
KNOW.
PRACTICED EMERGENCY MEDICINE FOR
THIRTY UNITS WHICH ARE
PROVINCIALLY FIGURED OUT WHAT
WAS A MONUMENT TO THE FAILURE OF
PREVENTATIVE MEDICINE.
.
IN LOOKING AT THE LARGER PICTURE
OF OUR WORK AND SINCE THIS IS A
POLITICAL ORGANIZATION.
ONE MIGHT REVIEW WHAT HAPPENED
TO WINSTON CHURCHILL.
HE WAS A WAR HERO.
HE WAS WELL REGARDED BY THE.
ENGLISH PUBLIC.
HE LOST THE ELECTION AFTER THE
SECOND WORLD WAR.
AND YOU KNOW WHAT THE ISSUE WAS.
HEALTHCARE.
THEY REJECTED HIM.
THE HERO FOR THE SECOND WORLD
WAR WAS REJECTED.
FIRMLY.
BECAUSE HE DIDN'T SUPPORT.
HEALTHCARE.
SO YOU MIGHT.
INCIDENT THAT.
CONSIDERING.
HELLO DOCTOR RANDY.
IT'S ARE RECALL CHICKENS HERE I
AM A DISABILITY RIGHTS ADVOCATES
DISABILITY RIGHTS ACTIVIST AND
DISABILITY RIGHTS EXTREMIST I'M
ALSO A MEMBER AND SECRETARY OF
CAPITAL PEOPLE FIRST.
WHICH IS AN ORGANIZATION RUN BY
AND FOR PEOPLE WITH
DEVELOPMENTAL DISABILITIES HERE
IN THE GREATER SACRAMENTO COUNTY
AREA. I'M A CONSTITUENT OF
SENATOR JIM NIELSEN IS BUT A
CONSTITUENT OF ASSEMBLYMAN KIM
COOLIES CAN POLICE.
WITH TWO MINUTES ALL GIVEN FOR
ME TO SPEAK I DON'T KNOW WHERE
TO START BUT I WILL SAY THIS.
PRESIDENT TRUMP HIMSELF ALONG
WITH.
HIS REPUBLICAN ALLIES IN
CONGRESS.
AND IN THIS LEGISLATURE AS WELL
AS EVERYONE WHO VOTED FOR THEM.
WILL NOT.
DO NOT WANT TO SEE.
AN INCREASE IN THE RATES TO
MEDICAID OR MEDICARE.
AND BY THE WAY MEDICAID MEDICARE
AL IS CALIFORNIA'S MEDICAID
PROGRAM AND WITH THAT SAID.
GOVERNOR JERRY BROWN DOES NOT
WANT TO RAISE THE RATES HE DOES
NOT WANT TO TO SEE THE RATES
RAISED FOR MEDI CAL PROVIDERS HE
WANTS TO KEEP IT AS IS.
THAT'S WHAT NUMBER ONE NUMBER
TWO.
OF WITH THAT SAID SENSE OUR
PRESIDENT AND EVERYONE WHO
EVERYONE IN THIS LEGISLATURE WHO
VOTED FORUM AS WELL AS PRIVATE
CITIZENS WHO VOTED FOR HIM.
DON'T WANT TO EXPAND ACCESS TO
HEALTH CARE THE WAY TO GET TO
UNIVERSAL SINGLE PAIR HEALTH
CARE IN THIS STATE S. B. FIVE
SIXTY TWO. AND BY PASSING HIM
WOULD BE TO AND THIS IS ALSO A
GOOD WAY TO RAISE THE MEDIC CAL
RATES.
IS WHY NOT YOU KNOW HOW WE FUND
K. TWELVE AND AND COMMUNITY
COLLEGES IN THE STATE WHY NOT DO
THE SAME WITH. MEDICAL SCHOOLS
NOT JUST POSITIONS BUT ALSO
PHARMACISTS
SOCIAL WORKERS
AND PSYCHOLOGISTS AND
PSYCHIATRISTS
NOW.
I HEARD THE TERM UNDER INSURED
MENTION SEVERAL TIMES DURING
THIS HEARING.
AND.
SORRY I'M A LITTLE BIT NERVOUS
BECAUSE I FEEL PRESSURED TO STOP
BUT.
WHAT I HEARD I HAVE MEDIC CAL
AND MEDICARE BY THE WAY IF YOU
HAVE MEDI CAL AND MEDICARE? LIKE
ME NOT ONLY IT'S BECAUSE YOUR
ELDERLY BUT BECAUSE YOU'RE
DISABLED LIKE I AM.
EVEN IF YOU HAVE MEDICARE AND
MEDICAID ALWAYS MEDICARE BEING
THE PRIMARY INSURER YOU'RE STILL
UNDER INSURED.
SO THE TAKE TOWARD THE TAKE
HOME POINT THAT I FORGOT TO
BRING UP AT THE LAST HEARING
THAT WHICH WE HAD A BROWN THE
TAIL END OF OCTOBER OF LAST
YEAR.
TWENTY SEVENTEEN
THAT WE NEED TO. AS A WAY TO
FUND SINGLE PAYER HEALTHCARE AND
AS A WAY TO INCREASE.
UP PROVIDER RATES TO ALLOW MORE
DOCTORS IN THE STATE TO TAKE
MEDI CAL AS WELL AS
PSYCHOLOGISTS
AND SOCIAL WORKERS IN DENISON
CHIROPRACTORS.
AND NOT WE NEED TO FIND OUR
MEDICAL SCHOOLS THE WAY WE FIND
K. TWELVE AND COMMUNITY COLLEGES
JUST LIKE WHAT WE DO WITH. PROP
NINETY EIGHT.
THANK YOU.
THANK YOU RICH TO A CERTAIN
PUBLIC APPROVAL.
HELLO THANK YOU FOR BEING HERE.
MY NAME IS SUMMER ROSE AND I
JUST WANNA SAY THAT IT WASN'T
UNTIL OF THE PROGRESS OF
OBAMACARE AND COVERED CALIFORNIA
THAT I WAS ABLE TO HEAR. I SPENT
TWENTY FIVE YEARS OF MY LIFE
BASICALLY HAVING TO SIT RELIEVED
RIGHT.
SUPER CLOSE TO PEOPLE IN ORDER
TO BE TO HAVE A CONVERSATION
WITH THEM. I LOOK NORMAL PEOPLE
THINK I'M.
YOU KNOW LOOK PUNCH PERCENT OKAY
THEY SAY HELLO TO ME FROM JUST
FIVE FIVE FEET AWAY AND I DON'T
SAY A LOS THAN THEY THINK.
HERSHEY'S RUGE DOESN'T LIKE ME
AND I HAVE NO IDEA WHAT PEOPLE
ARE THINKING AS OPPOSED PEOPLE
WHO ARE BLIND YOU KNOW YOU CAN
SAY HEY I CAN SEE THAT. BUT IF I
CAN'T HEAR I SAID I CAN SAY HM
I DIDN'T HEAR THAT BECAUSE I
DIDN'T HEAR THAT. I'VE BEEN SO
DISCONNECTED FROM THE FROM THE
WORLD IN THAT WAY FROM MY PEERS
FROM MY LOVED ONES FROM BEING UP
TO HAVE A NORMAL LIFE WITH
PARTNERS.
AND ABSOLUTELY S. B. FIVE SIXTY
TWO WILL HELP ERADICATE. THE
ISSUE THAT I HAD WEEDING.
LITERALLY UNTOLD HOME CARE SO
THAT I COULD HEAR FORTY THREE
YEARS OLD. THE.
TOOK ME SEVEN YEARS YOU KNOW
THIRTY FIVE YEARS OLD I'M
FINALLY ABLE TO START MY LIFE
THIS IS A HUGE HUGE PERSONAL
ISSUE.
PLEASE PASS FIVE SIXTY TWO IT'S
REALLY NEED FOR ME. IF I LOSE
THESE ITEMS AYE I GET STRESSED
OUT OF MY KIND OF I LOSE THEM.
THIS SPORT THOUSAND DOLLARS I
HAVE TO REPLACE AND I MIGHT HAVE
ONE REPLACEMENT BUT THEN I HAVE
TO WAIT ANOTHER I DON'T KNOW HOW
MANY YEARS. WHO GET THE REPLACE
ON CONSTANTLY UNDER STRESS ALSO
IF I LOSE THEM AND HAVE TO TAKE
THEM OUT NOTED MY HEADSET ONTO
YOUR ON MY PHONE?
THIS IS SO PERSONAL THIS IS SO
DEEP THIS IS SO REAL AND I'M NOT
THE ONLY ONE WHO'S DEALING WITH
THIS IS A DISABILITY TO PEOPLE
ALL OVER THIS COUNTRY WHO NEED
THIS AND I REALLY WANT
CALIFORNIA. TO BE THE ONE THAT
PUSHES THIS THROUGH LET THIS BE
OUR LEGACY PER PERSONAL REASON
FOR ME. FOR OTHER CHILDREN YOU
CAN HEAR ME I JUST HEARD A HOME
TURNS A BLIND PEOPLE WE FINALLY
HAVE A DRUG BUT IT'S A MILLION
DOLLARS. SUIT TO HELP SO MANY BE
OF TO SEE AGAIN IT'S ABSOLUTELY
INSANE IT'S OUTRAGEOUS WE ALL
HAVE A RIGHT TO HAVE ALL OF OUR
SENSES WITH US. YOU KNOW HOME
OVER SENSES THAT WE CAN. PROVIDE
YOU KNOW WE'D BE OPEN UP SITTING
MEMBER OF SOCIETY AND
CONTRIBUTE.
PLEASE AGAIN FIVE SIXTY TWO
THANK YOU
THANK YOU.
WITH THAT I'M GOING TO BRING IT
UP TO THE DíAS TO SEE IF ANY
MEMBERS HAVE ANY CONCLUDING
REMARKS.
JUST VERY BRIEFLY I WANT TO
THANK THAT THE COMMITTEE AND THE
CHAIR ALL THE PANELISTS.
I CERTAINLY FOR ONE FEEL LIKE
I'M GETTING A MASTER'S DEGREE IN
HEALTH CARE POLICY. ON THIS AND
I WANT TO THANK THE MEMBERS OF
THE PUBLIC WHO HAVE BEEN SO
PATIENTLY. WAITING THIS
AFTERNOON AND I HAD JUST A QUICK
REALLY CLARIFICATION QUESTION I
KNOW THERE WERE. MANY MEMBERS OF
THE PUBLIC CAN AND OUR
CONSTITUENTS TO.
WHO WERE HOPING THAT THERE WAS
GOING TO DISCUSSION OF
STAKEHOLDER PROPOSALS LIKE
SINGLE PAYER IT IS MY
UNDERSTANDING THAT WE HAVE?
A COUPLE MORE HEARINGS IN
FEBRUARY AND THERE WILL
ABSOLUTELY BE A HEARING ON
SINGLE PAYER I JUST WANNA AYE I
BELIEVE THAT'S THE CASE BUT I
HAD THE CHANCE TO. CHAT WITH
CHAIRS AND I JUST WANTED TO COME
FROM THE.
THERE WILL BE UP THERE WILL BE A
PANEL OR A GROUP DISCUSSION OF
OF A PROPOSALS OF WHICH IT ONE
OF THEM WILL BE S. B. FIVE SIXTY
TWO.
GREAT.
WELL AGAIN LOOKING FOR TO THE
CONVERSATION AND THANK EVERYONE
FOR ALL THEIR WORK.
THAT WILL BE ON FEBRUARY
SEVENTH.
HERE IN SACRAMENTO.
ANY OTHER COMMENTS FROM THE
DíAS.
WITH THAT WE WILL CONCLUDE
TODAY'S HEARING AND THANK YOU
AGAIN FOR COMING AND
PARTICIPATING THANK YOU ALL