1. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org1 Health Care Reform 2011 Mental Health Focused Presentation Part of the Central Valley Education Project Unitarian Universalist Legislative Ministry of California Bring Federal Health Care Reform Home to California! Sponsored by the California Endowment and

2. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org2 Unitarian Universalist Legislative Ministry of California Since 2001, UULM of California has empowered the moral voice of UUs, their partners, and individuals of conscious by educating, organizing, and advocating for public policies that uphold the public good. We affirm:  Respect for the inherent worth and dignity of every person  Justice, equity and compassion in human relations  Respect for the interdependent web of all existence of which we are a part  Recognition that affordable, high quality health care is a human right

3. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org3 Four Part Presentation I. Why the U.S. needs federal health care reform II. What health care reform offers to all Americans III. How health care reform helps individuals dealing with mental health issues IV. What you can do to implement & improve health care in California

4. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org4 Part I Why the United States Needs Health Care Reform

5. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org5 People are suffering  50 million in U.S. uninsured in January 2010 8 million individuals are uninsured in California Californians are less likely to get coverage through their employer and must buy insurance on their own  44,000 deaths each year due to lack of health insurance 1 person died every 12 minutes Many of these individuals had pre-existing health conditions and could not purchase insurance at any price Because of state budget cuts, fewer “safety net” public health resources for individuals and families

6. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org6 US families pay MORE for LESS health care  Families in the United States pay more for health care than any other country in the world, but rank only #37 in health outcomes according to the World Health Organization.  The United States is the only major industrialized country where for-profit companies provide most people their health insurance.  60% of U.S. bankruptcies due to health costs; 75% of medical bankruptcies happen to people with health insurance.

7. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org7 Part II What Federal Health Reform Offers All Americans

8. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org8 Patient Protection and Affordable Care Act (ACA) covers 32 million previously uninsured people  Reduces the federal deficit $650 Billion to $1.3 Trillion by 2019  Brings federal money into California for health care  Creates a framework upon which we can build a universal health care system.

9. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org9 The ACA makes health insurance affordable  Medicaid (Medi-Cal) Expands in 2014 Covers people with incomes up to 133% Federal Poverty Level (FPL) (~$29,000 for a family of 4). Includes adults without dependent children.  California State Insurance Exchange Begins in 2014 3 to 4 million Californians can purchase affordable, high-quality individual policies online in a state regulated “pool.” Exchange has bargaining power of a very large company Guaranteed coverage regardless of pre-existing conditions Affordability credits provided and out-of-pocket costs limited for individuals and families at 133-400% FPL (~$88,000 for family of four)  California Pre-Existing Condition Insurance Plan Started in 2010 Provides coverage today for individuals with pre-existing conditions Funding for program—$40 million—from the federal government  Eliminates the “Hidden Tax” paid by individuals with insurance.  No co-pays for preventive care visits and screenings.

10. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org10 Protects consumers from insurance company abuses  End of policy rescission for minor mistakes on initial health questionnaires.  Lifetime insurance payout limits banned and annual limits phased out.  Insurance companies can no longer deny policies to individuals with pre-existing conditions.  Premium rate hikes of over 10% for individual insurance plans require review by California insurance regulators.  Equal premiums for women and men beginning 2014. Health plan premiums only vary based on age (3:1 ratio), geographic area, tobacco use (1.5: 1 ratio), and number of family members.  Private insurance companies must spend 80% to 85% of premiums on medical care or provide rebates to consumers.

11. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org11 Guaranteed issue for children with pre-existing health conditions  Prohibits insurers from denying children up to age 19 for coverage because of pre-existing conditions  Insurers cannot charge sick children more than 2x the cost of coverage for healthy child  To lock in best premium rate, parents must enroll their children: in open enrollment period of Jan- Feb 2011, birthday month, or when family has a major life change.

12. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org12 The ACA helps young adults  Lowers Costs for Young Adults No co-pays for preventive care visits and screenings  Security of Insurance Coverage Young adults can now be covered on parents’ plan until age 26. Estimated to impact over 4 million young adults nationwide.

13. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org13 Federal health reform helps those on Medicare  Free annual wellness visit and personalized prevention plans  Free preventive health services such as vaccinations and cancer screenings  Close Medicare Part D “doughnut hole” by 2020  This year drug companies will give 50% discount off brand drugs for individuals in the doughnut hole.

14. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org14 ACA helps small businesses offer health benefits  4 million small businesses and non-profits qualify for tax credits that cover up to 35% of employees’ insurance premiums (increases to 50% in 2014)  Small businesses are already responding to promise of tax credits and offering insurance coverage to employees  Small employers can purchase employee health benefits through the State Insurance Exchange beginning 2014

15. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org15 We Can Do Better! Areas Needing Improvement  Fair access to health care for immigrants Legal immigrants 5-year waiting period, but can purchase insurance through a state insurance exchange. Undocumented immigrants have NO guaranteed access to Medi-Cal or the State Insurance Exchange.  Adult dental and vision care in MediCal  Full coverage of women’s reproductive health  Single Payer possible in California by Sen. Mark Leno

16. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org16 Part III How Federal Health Reform Helps People with Mental Health Issues

17. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org17 Increased access to individual private health insurance policies  Approximately 90% of people with serious mental illnesses are unemployed. This means they do not have an employer-based health insurance plan. The ACA helps these individuals purchase individual private insurance plans.  Health insurers will have to sell and renew policies to all who apply (called “guaranteed issue and renewal”) beginning 2014.  Insurers cannot deny coverage for a pre-existing condition beginning in 2014.  No health plan can have a lifetime (now) or annual limit (by 2014) on benefits.

18. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org18 Increased access to individual private health insurance policies  Premiums may only vary by a limited amount and only on the basis of a few factors (tobacco use, age, geographic area and family size).  Health insurers cannot discriminate based on a person’s mental or physical disability.  Young adults (up to age 26) must be allowed coverage under their parents’ health insurance, if their parents so desire.

19. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org19 California State Insurance Exchange will cover mental health  Policies sold through the California State Insurance Exchange must comply with the federal Mental Health Parity and Addiction Equity Act of 2008 Requires health insurance plans offer coverage of mental health and substance abuse treatment comparable to the coverage offered for medical benefits.  ACA states that mental health treatment is a designated “essential health benefit” that will be further defined by the Secretary of Health and Human Services. Two key provisions require: emergency services must be provided without a pre- authorization requirement the cost-sharing requirement for essential health services must be the same whether provided in-network or out-of-network

20. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org20 California State Insurance Exchange will cover mental health The law makes premium tax credits available to help individuals with incomes from 133% to 400% of the federal poverty level. Limits the total of out-of-pocket costs and provides cost- sharing subsidies for individuals and families in exchange to around $11,000 a year:  Those with the lowest incomes will pay a share of no more than 6% of their health care costs;  this rises in steps so that people with incomes at 400% of poverty would pay no more than 30% of costs.

21. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org21 Improvements to MediCal, Medicare & Dual Elligibles Creates health care “homes” in Medicaid for people who have more than one chronic condition. These entities will provide comprehensive care management, coordination and referrals to appropriate community services. Includes $50 million for grants from the Substance Abuse and Mental Health Services Administration for co-locating primary care on-site in community mental health agencies. Access to medications in the class of benzodiazapines and barbiturates, currently included in the list of excludable drugs in Medicaid, is improved. Provisions to streamline the MediCal application process for individuals with disabilities. Individuals on Medicare because of psychiatric disability will benefit from the closing of Medicare’s Part D doughnut hole.

22. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org22 California’s New MediCal Waiver  New 1115 MediCal waiver - “California Bridge to Reform” - began Nov. 1, 2010 and run for five years. If requirements and milestones met, brings $10 billion in federal funds into California.  Waiver’s major components: Medicaid Coverage Expansion (MCE) for people with income at or below 133% of federal poverty level (FPL) (Alameda & Contra Costa have applied) **Mandatory enrollment of Seniors and Persons with Disabilities (SPDs) on MediCal into MediCal Managed care plans. Dual eligibles are not required to enroll in MediCal Managed Care plans. (California SB 208)**  Interested in advocating for an effective, expansive MediCal Waiver program in your county? Contact Policy Analyst Linda Leu at Health Access—lleu@ lleu@health-access.org. lleu@health-access.org

23. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org23 Part III What You Can Do to Implement & Improve Health Care in California

24. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org24 Proposed Budget Cuts to Watch!  Check out the Health Access flyer on specific MediCal budget cuts.  Proposal to divert voter-approved Mental Health Services Act (Proposition 63) funds to the General Fund. PRO: Considering massive cuts to the entire MediCal program it may be helpful to limit those basic health costs by making Prop 63 funds available to MediCal. CON: No promise that Prop 63 funds will go back into MediCal program once the funds go to the general fund. CON: Local communities have already greatly benefited from these effective Mental Health Services Act programs. For example, after just one year in an adult Full Service Partnership program in San Diego County funded by the Act, clients experienced: 67% fewer days of homelessness, 32% fewer emergency room visits, 17% fewer jail days, and 14% fewer hospitalizations  AB 3632 Funding Governor Schwarzenegger vetoed $133 million in funding for services through county mental health departments to special education students who need mental health services to stay in school. On October 21, 2010, a lawsuit to preserve lifeline services for up to 20,000 students statewide was filed in federal court by Mental Health Advocacy Services.Mental Health Advocacy Services

25. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org25 California 2011 legislation to watch  AB 154 (Beall) Requires private insurance policies to include the “diagnosis and treatment of a mental illness of a person of any age and would define mental illness for this purpose as a mental disorder defined in the Diagnostic and Statistical Manual of Mental Disorders IV.”  AB 52 (Feuer)/SB 51 (Alquist) Require approval from the Department of Managed Health Care and the Department of Insurance for increases in health care premiums, co-payments, or deductibles.  AB 181 (Portantino) Foster youth: mental health bill of rights.  SB (to be determined) (Alquist) Transitioning to a more transparent & standardized market.  SB (to be determined) (Alquist) Public Option Would authorize county-organized health plans and other health benefits programs to form joint ventures to create integrated networks of public health plans that pool risk and share networks, subject to Knox-Keene requirements.

26. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org26 Additional resources  Bazelon Center for Mental Health Law: www.bazelon.orgwww.bazelon.org  UU Mission Peak Mental Health Ministry: www.mpuuc.org/mentalhealth/mentalintro.html www.mpuuc.org/mentalhealth/mentalintro.html  Health Access: www.health-access.orgwww.health-access.org  Kaiser Family Foundation: www.kff.orgwww.kff.org  U.S. ACA education website: www.healthcare.govwww.healthcare.gov  The Healing of America by T.R. Reid. © 2009 Available at your local bookstore or online book website. UU Voices for Health Care Curriculum This free, adaptable seven-session healthcare curriculum educates and empowers us to take action within our communities. Each session is self contained. Download for free at www.uulmca.orgwww.uulmca.org

27. Rev. 2.16.11 ©2011 Unitarian Universalist Legislative Ministry of California www.uulmca.org27 Thank you! The CVEP project is sponsored by HEALTH ACCESS CALIFORNIA, a statewide health care consumer advocacy coalition, advocating for the goal of quality, affordable health care for all Californians. Go to www.health-access.org for more information www.health-access.org CVEP Partners: EQUAL Health Network: a program of the Center for Policy Analysis dedicated to producing thoughtful, reliable information on policies that affect the public’s health. www.centerforpolicyanalysis.orgwww.centerforpolicyanalysis.org Imagen Public Relations LLC : Headed by PR pro, Virginia Madueño, imagen is recognized as one of the preeminent marketing/public relations companies in California. www.imagenpr.com www.imagenpr.com This presentation is brought to you by the Central Valley Education Project & UULM CA