1. Health Care Reform: Challenges and Opportunities Marian Mulkey, MPP, MPH California HealthCare Foundation www.chcf.org State Association of County Retirement Systems Spring Conference May 15, 2009

2. C ALIFORNIA H EALTH C ARE F OUNDATION The Problems  Rising health care costs  Growing population of uninsured  Declining rate of employer-sponsored insurance  Ongoing concerns with health care quality

3. C ALIFORNIA H EALTH C ARE F OUNDATION Health spending represents a growing share of the US economy. Slide #3 of HC Costs 101, 2008

4. C ALIFORNIA H EALTH C ARE F OUNDATION In the US, health care spending is split between private and public sector.

5. C ALIFORNIA H EALTH C ARE F OUNDATION Most non-elderly Californians receive health coverage through employment… Source: California HealthCare Foundation, Snapshot: California’s Uninsured, 2008. Subsitute Slide 4, Unins snapshot 2008

6. C ALIFORNIA H EALTH C ARE F OUNDATION Yet employer-based coverage is steadily declining, and more are uninsured. Source: California HealthCare Foundation, Snapshot: California’s Uninsured, 2008. www.chcf.org/documents/insurance/CAUninsured08.pdf

7. C ALIFORNIA H EALTH C ARE F OUNDATION The uninsured are less likely to get the care they need. Source: Kaiser Family Foundation, The Uninsured: A Primer, October 2006

8. C ALIFORNIA H EALTH C ARE F OUNDATION Nationwide, on average adults receive recommended care less than half the time. Percentage of Adults Receiving Recommended Care, by Type 54.9% = Overall care 54.9% = Preventive care 53.5% = Acute care 56.1% = Chronic care Source: McGlynn EA, et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine, Vol. 348, No. 26, June 26, 2003, pp. 2635-2645

9. C ALIFORNIA H EALTH C ARE F OUNDATION Higher spending doesn’t necessarily mean higher quality California

10. C ALIFORNIA H EALTH C ARE F OUNDATION Premium and out-of-pocket expenses add up for consumers

11. C ALIFORNIA H EALTH C ARE F OUNDATION Health care expenses represent a substantial share of income

12. C ALIFORNIA H EALTH C ARE F OUNDATION Some policy approaches and ideas  Broad coverage expansion  Employers required to provide coverage (“pay or play”)  Individuals mandated to buy, insurers required to sell  Single payer (all participate, broad tax-based financing)  Other proposals  Reduce insurance and/or employer regulation  Make consumers more aware of prices  Reduce health care provider administrative burden  Use health information technology to better manage care  Change provider payments to reward “performance” rather than volume  Directly regulate new technology, and/or prices  And on, and on…

13. C ALIFORNIA H EALTH C ARE F OUNDATION Many groups have a stake in the health reform debate  Hospitals, doctors, and other health care providers  Employers  Labor unions  Insurance companies  Government agencies: federal, state, local  Consumer advocates  Citizens It’s much easier to agree that current system needs reform, than to agree on who should pay more or be obligated to behave differently to change it.

14. C ALIFORNIA H EALTH C ARE F OUNDATION Health Reform: Key Issues and Challenges  Coverage expansion addresses one aspect of larger set of problems  Who should pay? Who should be subject to mandates or other new requirements?  How should “affordability” be defined for:  Employers  Employees/ Individuals  Government  How should “quality” be defined and monitored?  How can costs be contained and quality improved, now and in future?

15. C ALIFORNIA H EALTH C ARE F OUNDATION What’s next?