Health Care Waiting Room

By now you have probably seen the commercials on TV, heard something on the radio, or even read it in this blog— open enrollment for health insurance through Covered California is happening now through Feb. 15, 2015, so there is no better time to make sure you and your employees get covered.

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Last Monday, 10 new state senators and 27 new assembly members were sworn in.  Simultaneously, a number of health care-related initiatives were announced, including several carried over from last year.

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At our last Health Care Council Meeting, we had a great discussion on issues to include in our 2015 advocacy agenda. In this, California’s section 1115 “Bridge to Reform” Waiver arose. Set to expire in October of 2015, the current 5-year demonstration waiver provides initiatives to invest in the state’s health care delivery system to tackle the significant changes spurred on by the Affordable Care Act (ACA).

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Earlier this week we all woke up to a post-midterm political scene, and although the results haven’t lead to any grand predictions of sweeping regulatory or legislative health care reform in the coming state and congressional sessions, a few items are worth keeping an eye on.

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When it comes to getting health care coverage for Los Angeles County’s residents, some of the very hardest-to-reach populations are those who are homeless or mentally ill. Although these are people who will most likely qualify for free Medi-Cal coverage, it’s estimated that up to 77 percent don’t understand or take advantage of the social services available to them. In continuation of this Chamber’s efforts to reach our county’s residually uninsured, including the homeless and mentally ill, today our Health Care Council will be discussing regional efforts to provide comprehensive mental health services and coordinated care with Supervisor Michael Antonovich and United Way.

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Last month, Chamber Members heard from Hector De La Torre, executive director of the Transamerica Center for Health Studies (TCHS). As a nonprofit focused on helping consumers and businesses navigate the health care landscape, TCHS provided valuable information about the ACA’s implementation over the past year and the challenges facing our small businesses. Their most recent report, One Year In: Americans and Businesses Respond to the ACA, builds on this discussion

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Employers want affordable health coverage for their employees without sacrificing the delivery of health services. One option to consider is the integrated health care model in which the health plan, the hospital and the doctors work together in a coordinated way to benefit patients. 

The term “integrated health care” has been used to describe a variety of situations: the combination of traditional and alternative medicine, the provision of sick care and wellness under one umbrella, the treatment of physical and behavioral problems at the same time, etc. In this article, we discuss the four important benefits of the integrated health care model and the emerging Accountable Care Organization (ACO) model.

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One of the largest—and most controllable—contributors to rising health care costs in the United States today is overutilization, or overuse, of the health care system. Yet cost is not the only consequence of overutilization—also at stake is health, quality of life, and in some cases, life itself. In fact, the United States spends a significant amount more per person on health care than any other country in the world, and yet U.S. health outcomes are equal to or worse than those in other countries.

Understanding the key drivers behind overutilization is an important step for you as both a business owner and a health care consumer. By understanding the drivers, you can help identify the highest quality and most fairly priced care for you and your employees.

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Charity Care in L.A.’s Diverse Communities

Despite the Affordable Care Act (ACA) mandate, there are certain groups of people that will not be able to obtain health insurance and who will (in essence) “fall through the cracks.” This population is composed primarily of those exempt from the individual mandate because insurance options are not affordable, those who opt out of the individual mandate and face resulting penalties and undocumented immigrants and legal residents of less than five years. According to a 2010 report by the Center for Health Care Strategies, the estimated 20 million individuals who are not able to take advantage of ACA will have to depend, to one degree or another, on charity care programs.

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Since 2010, the government has offered a tax break for certain small businesses that offer qualifying employer-sponsored health plans to assist employers with premium costs and contributions. The health reform law, known as the Patient Protection and Affordable Care Act (ACA) does not require small businesses to provide health insurance coverage for employees.  However, for those small businesses that have chosen to provide, or are already looking into providing, coverage to employees through Covered California’s Small Business Health Options Program (SHOP) in 2014, the tax credit can help ease the overall costs. 

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