1. PRESENTATION PREPARED BY SUSAN DOWNS KARKOS & MICHELE BAKER NOVEMBER 19 2009 Introduction to Health Care

2. Goals of the session Develop an understanding of the issues facing the U.S. healthcare system Develop an understanding of some of the issues Colorado lawmakers are discussing today to reform health care Develop an understanding of how government is involved in health care in the U.S. and Colorado Recognize how important it is to have a voice in health care discussions and what you can do to participate

3. Health Care: What are the key areas that are being discussed for reform? 1. Health care coverage (insurance) 2. Health care quality 3. Health care affordability (cost) 4. Health care transparency (clearness) 5. Health care accessibility (ease of use) 6. Health promotion and disease prevention/promoting healthy living

4. Health Care Coverage Types of Health Insurance:  Public insurance (Medicaid, SCHP+, Medicare, etc)  Private insurance (employer-based, individual- market)

5. Issues with health care coverage Who is eligible for coverage? Private Insurance: it depends! Lack of transparency in eligibility for private insurance, especially with pre-existing conditions Public Insurance- Eligibility factors include:  Income  Single vs. family  Age  Immigration status and others  Health status  Challenges to obtaining coverage:  Lack of trust in the program  Lack of understanding of the programs  Lack of understanding about who and what is covered  Systematic challenges (breaking into the system, paperwork required, time, etc)  Don’t qualify (ineligible)  Don’t know it’s even available!

6. Question for discussion How does health insurance coverage impact you or your community?  Do people have insurance?  Are they going without insurance?  Do people know about insurance options?  Are they confused?  What could be better?

7. Quality of health care Issues facing quality of care provided:  Medical errors  Misdiagnoses  Poor cost/benefit ratios  High costs with not high rates of improved health outcomes/status  Unequal care to populations (uninsured vs insured, SES, etc) *As a result, stakeholders involved in health care have made it a priority to reexamine the quality of care provided to Americans Principles of high quality health care include: Safety Effectiveness Patient-Centeredness Timeliness Efficiency Equity

8. Quality issues specific to immigrant communities: Racial and ethnic health disparities Language access (interpretation and translation) Cultural competency Diversity in the health care workforce

9. Discussion Question How do these health care quality issues impact your community? Are you seeing this in your community/family?

10. Health care costs/affordability Health care costs increase every year because of:  Advances in technology  Insurance for doctors (Medical Malpractice)  Increases from private market insurance companies  Increase costs for physicians and clinical services  Increase in costs for prescriptions  High costs for early life and end of life care (i.e. nursing homes home health care)  Administrative inefficiencies  Inefficient system How do we keep paying for health care?....we’re trying to figure this out right now!

11. Health Care Accessibility Barriers to Access: Uninsured Underinsured Illiteracy; Total or Functional Discrimination Disability

12. Health Promotion/ Disease Prevention Healthy People/Healthy Places: How do we encourage people to adopt these kinds of healthy behaviors? Healthy Eating – vegetable and fruit consumption, healthy/balanced diet Physical Activity- walking to work/school, jogging at the park, going to the park, taking the stairs in your apartment) Not engaging in smoking or drugs; drinking alcohol heavily Adequate sleep and physical rest Stress reduction/ minimization (exercise, yoga, deep breathing exercises, support groups)

13. Question for discussion What do you think would work in your community to help people engage in healthy behaviors? (i.e. healthy eating, physical activity, quit smoking, etc).

14. Government Involvement in Health Care Provides: Tax Incentives for Health Insurance Healthcare Coverage, Services & Facilities  Medicare: health care for the aged; a federally administered system of health insurance available to persons aged 65 and over  Medicaid: health care for the needy (those who can't afford it); a federally and state-funded program  State Child Health Insurance Program (SCHIP): cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid.  V.A.  Local Government Safety Nets Regulations: Federal, State, Local i.e. HIPPA (Health Insurance Portability and Accountability Act )

15. Where do we go from here? Health care reform  Federal Level  State Level Health care issues Colorado legislators are considering  Insurance policy reform in the State of Colorado (i.e. Restrict gender ratings in health insurance, Improve transparency and readability of insurance policies, Standardize EOB forms)  Medicaid Reform  Payment and reimbursement reform (i.e. Change reimbursement rates for providers who accept Medicaid)  Establish a dental carve out  Address funding mechanisms  Increase coverage /participation  Increasing public health/prevention policies (i.e. improve healthy living )  Increase provider workforce  Health Information Technology How may the Federal and State laws impact the immigration population and accessibility to care?

16. Having a voice! Why is it important to be involved? What difference can one person make? What can I do?