Health Care Options Project
HCOP – Nine Options for Health Care Reform in California (2002)
HCOP Executive Summary (2002)
In October 1999, the Governor signed SB480 (Solis). This law calls upon the Secretary of the California Health and Human Services Agency (CHHS) to examine options for providing health care coverage to Californians — approximately 6.3 million of whom lack coverage. The state legislation calls for a process that involves both public and private sector stakeholder groups in examining the various reform options.
To implement SB 480, CHHS applied for and received a one-year State Planning Grant of $1.2 million from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services on February 28, 2001, establishing the Health Care Options Project, designed to meet the requirements of SB 480. The grant provided an opportunity to develop and update ideas and options on how to expand coverage in California.
The goal of HCOP was to guide the state in a systematic exploration of different approaches to achieving expanded coverage by engaging in an in-depth examination of a range of reform options. An ambitious undertaking of HCOP was to provide policy makers and the public with detailed information about the costs and coverage impacts of different approaches to extending access to coverage. By using sophisticated economic modeling, the HCOP was able to estimate for each of the proposals how many people would become covered, the characteristics of the people that would be covered, the changes in their out-of-pocket costs, and the financial impacts on public and private payers, including employers. The options were then reviewed using a public process.
Health Access undergoes research and advocates quality, affordable, universal health care for all. These nine proposals as well as the HRSA, Lewin Summary, and the AZA Consulting Summary of the proposals are now applicable to many pieces of legislation introduced in the last several years and serve as important resources for policy analysts and lawmakers. Health Access also has its own report card on the nine proposals available: HCOP Report Card.
The Nine Proposals
The Cal-Health Option
This proposal would create the California Health Care Program (Cal-Health), which will coordinate the Healthy Families program through MRMIB, and the Medi-Cal program through DHS by providing a uniform and simplified application process. This option provides for outreach efforts to increase enrollment in the Healthy Families and Medi-Cal programs for those persons currently eligible but not enrolled. It also seeks to expand health insurance coverage under the Healthy Families program for parents of eligible children in families with incomes up to 250% of the federal poverty level (FPL). There will be a standard uniform benefits packages (SUBP) that can be offered by commercial carriers to persons with incomes above 250 percent of FPL and to small firms. Additionally, it seeks to extend coverage under Medi-Cal (under 133% of FPL) and Healthy Families (133%-250% of FPL) for non-custodial adults who are not eligible for any other health insurance programs.
Cal Care: A Single Payer Health Care System for California, developed by Judy Spelman and others; Health Care for All. This reform proposal also would replace current health financing arrangements with a single, publicly financed health insurance program that would cover all Californians. Savings from reduced administrative costs and other cost-savings features would help finance the extension of coverage to previously uninsured people. This proposal differs from the previous proposal in some areas of benefits and administration.
The CHOICE Option
CHOICE Option, submitted by Helen Halpin Schauffler and Sara B. McMenamin, University of California at Berkley. Under this reform option, a public program (CHOICE) would be created to offer coverage to working Californians and their dependents. Employers would pay a payroll tax to help fund health coverage for their workers, but would receive a refund for workers who chose to be covered through coverage offered by the firm. Workers (and their dependents) could enroll in CHOICE by paying premium that varies with their wages. Workers and their dependents who are enrolled in Medi-Cal or Healthy Families also could enroll in CHOICE. In addition, the proposal includes an outreach initiative aimed at individuals eligible but not enrolled in existing public programs.
The California PacAdvantage Program
The California PacAdvantage Premium Program, developed by Katie Horton, Peter Harbage, and Jennifer Ryan. This reform proposal would make subsidized coverage available to small employers and their employees with incomes below 350% of poverty through the state’s existing non-profit small purchasing pool.
The California Health Services Plan
The California Health Service Plan, developed by Ellen Shaffer. This reform proposal also would replace current health financing and delivery arrangements with a single, publicly financed health care program that would provide health services to all Californians. Savings from reduced administrative costs and other cost-savings features would help finance the extension of coverage to previously uninsured people. Under this proposal, health care services would be provided through the public sector by hospitals and other facilities operated by the state and through health care professionals employed by the state.
Healthy California, developed by Rick Brown, UCLA, and Rick Kronick, University of California San Diego. This reform proposal would make coverage available to all citizens and legal residents through a new public program called Healthy California. In stage one a federal wavier would be sought to cover low-income adults and to integrate existing public programs into the new Healthy California. The income thresholds for current public programs also would be relaxed to permit the state to achieve federal matching payments for all families that enroll in the program. In the second stage, a pay-or-play premium requirement for employers would be instituted to help finance the system.
The Single Payer Option, developed by James G. Kahn and others, University of California at San Francisco. This reform proposal would replace current health financing arrangements with a single, publicly financed health insurance program that would cover all Californians. Savings from reduced administrative costs and other cost-savings features would help finance the extension of coverage to previously uninsured people.
Managed Care Expansion Plan, Working Partnerships, USA
The Managed Care Expansion Plan, submitted by Working Partnerships, USA. Under this reform option, subsidies for coverage would be gradually phased-in over 15 years to California residents under 400% of poverty. Coverage would be provided through the managed care plan models currently serving Medi-Cal enrollees.
Managed Care Expansion Plan, ITUP (4.2 MB)
The Managed Care Expansion Plan, submitted by the Insure the Uninsured Project. This reform option would use a combination of strategies to reduce the number of uninsured, including an 1115 waiver to cover low-income adults, providing coverage to Medi-Cal and Healthy Families enrollees through employer plans when it is cost-effective, a refundable tax credit targeted to employers with low-income employees, and a refundable tax credit or voucher for individuals not offered employer-provided coverage.
Analysis and Summaries
Report by The Health Resources and Services Administration, U.S. Department of Health and Human Services on the state of the uninsured, the overall health care environment, the Healthcare Options Project, and recommendations for a federally runned healthcare program.
Report created by The Lewin Group Inc. and prepared for The California Health and Human Services (CHHS) Agency to summarize the nine proposals and provide information on employer premium subsidies, employer contribution requirements, single payer programs, and an analyses of the effects of the proposals.
AZA Consulting Report
Made by Claudia Williams, AZA Consulting. The paper does not focus on these common and shared improvements, but instead addresses how differences among proposals might produce varying results. It analyzes the proposed reforms, pointing to their differences, and suggests how these alternative designs might affect or contribute to the outcomes of interest.