Last week several Health Access staff joined with 27 other advocates from across California at Health Action 2015 (#HA20), Families USA’s 20th annual conference. In terms of content, #HA20 struck a delicate balance between pushing ahead with “health reform 2.0” (health system transformation, health equity, and more) and the continuing work of basic health reform implementation, especially in those states that didn’t do the Medicaid expansion.
Thanks to the tweets running throughout the 3-day conference, and to Families USAs handy blog summaries of the proceedings, those who could not attend (or who found their attention wandering…) can virtually re-live the 3-day event. More than any other I’ve attended, this conference exemplified the use of social media to stimulate buzz around the events. (We helped: Health Access came out in the top 10 list of viral influencers.)
Rather than duplicate Families’ conference summary, we bring you insights for California—insights you can use for the work at hand.
Health Care System Transformation
Who doesn’t want better care? For “system transformation” to work, people need practical options for accessing care in the right settings—coverage serves this critical structural function. In other words, you can’t improve a system, if so many people are not in it.
But States like California that are making good progress on enrollment are right to ask: how can we sustain these coverage expansions? If you wanted, you could spend the entire conference in the often murky wonklands of “Health Reform 2.0.”–but these issues got their own track. But Families USA gets credit that most presenters stayed accessible without losing too much of the nuances of this critical and sometimes obscure work.
“If we care about expanding access, we must deal with the related issues of rising costs, of suboptimal quality, and prevention,” says plenary speaker Reed Tuckson, a trail blazer in health equity and community prevention strategies. In another plenary we learned the clock is ticking on this work: Demographic changes related to the aging of the baby boomers and increasing diversity of the U.S. population add to the case to minimize waste and inefficiency in health care delivery systems. “The strength of this country rests with immigrants, as it always has,” says plenary speaker Paul Taylor. If we may finish his fine sentence:” and even more so if they have coverage.”
Speaking of waste and excess spending…keynote speaker Senator Elizabeth Warren noted, “We already brought health insurance to 10 million more people [3 million in California!), yet our total health spending is less than if we’d done nothing at all.” But guess who’s still making obscene amounts of money? The blockbuster drug industry, of course. Sen. Warren gave us a sneak preview of a new bill to be introduced this week, the “Medical Innovation Act,” that would create a fund (“swear jar”) that major drug companies must pay into when they commit fraud and need to settle lawsuits brought by the federal government. That fund would be dedicated to restoring the much diminished budget of the National Institutes of Health.
Health Equity Woven Throughout Conference Sessions
As noted by closing plenary speaker John McDonough, this was the first conference to feature equity and disparities in most, if not all, of the plenaries and workshops—rather than confined to a separate track. Place matters—but how many of us know about communities like Camden New Jersey that have found tools from community organizing to involve patients’ families in efforts to make care accountable in very practical ways to patients’ needs. Another plenary speaker, Senator Sherrod Brown (D-OH) also reminded us of how health status and longevity is connected to zip code.
If anyone knows where health equity work is headed—and where the opportunity lies to eliminate health inequalities, it is Health Action regular Dr. Brian Smedley. Most of the focus areas recommended by Dr. Smedley, will resonate for California advocates, particularly those working on the Medi-Cal waiver renewal and the state budget process: expanding health professions training programs, improving cultural competence, expanding community health centers, addressing low Medicaid reimbursement rates, and linking social determinants of health to prevention efforts. “It’s hard to eat better and exercise when community conditions don’t support those behaviors,” said Dr. Smedley.
California Not Alone on Several Critical Issues
- Provider Access: California‘s insurance markets and Medi-Cal have their access challenges—and this is why, even as I write, Health Access is sponsoring legislation to establish standards for provider directories (learn more about our efforts and lessons for other states in the slides from Beth Capell’s well attended workshop). It was gratifying (and not) to learn that California is NOT ALONE in facing such challenges.
- Simplifying Choices on Exchanges: Several state-based exchanges and the federally facilitated marketplace, healthcare.gov, are learning the hard way that it’s possible to give too many choices in the new marketplace for insurance. Over 120,000 enrollees in Covered California picked a bronze product, even though they were eligible for a silver Cost Sharing Reduction product—with copays of less than $10 for a doctor visit and much better cost sharing generally. These Californians make less than $30,000 a year and yet bought a product with a deductible of $5,000—when they were eligible to buy something with a deductible as low as $75. California is on the path to simplifying plan choices (learn more here), but we have a ways to go.
- Key Health Programs at Stake in the Federal Budget. With both houses of Congress controlled by Republicans, the need to re-authorize CHIP, fully fund Medicaid, and maintain and enhance other vital health reform initiatives cannot be overstated. Bruce Lesley of First Focus reminded us that the ACA was designed to sit on top of CHIP and Medicaid. If CHIP disappeared or was re-configured in harmful ways (for example by dropping the “ICHIA” option for states to cover immigrants kids and parents without having to wait 5 years), states could see shortfalls and/or out-of-pocket costs for kids could become unmanageable.