R ecom m endations f or
D elivery S ystem R ef o rm s
and F inancing Care
f or the R em aining Uninsured
ITUP Conference | February 17, 2015
Henry Tuttle
Chief Executive Director
San Diego, CA
www.ccc-sd.org
Remaining Uninsured Data
Adults (1964)
Youth
(0-18)
Pre ACA
San Diego
Riverside
Imperial
San Diego
Riverside
Imperial
22%
34%
34%
Post ACA
14%
20%
21%
Pre ACA
Post ACA
9%
9%
12%
5%
7%
8%
Enrollment Issues
In addition to policy considerations, not all of those eligible for
medical coverage have enrolled into the available programs.
Of the adult population in San Diego, 14% of the population is uninsured.
Of this group, 45% are eligible for Medi-Cal or Covered California with subsidies.
Factors for non enrollment include:
cost, concerns, fears of government programs, and being uninformed
As of late 2014, 27% of the those uninsured adults in
San Diego County who remain uninsured are undocumented.
This increases to 28% in Riverside County, and 30% in Imperial County.
2019 Remaining Uninsured Projections
California 2019
San Diego
County – 2019
550,000
40,000
ELIGIBLE FOR
COVERED CA SUBSIDIES
380,000
30,000
NON-SUBSIDY ELIGIBLE
CITIZENS & LEGAL IMMIGRANTS
440,000
40,000
NOT ELIGIBLE DUE TO STATUS
1,350,000
100,000
TOTALS
2,720,000
210,000
CALIFORNIANS UNDER
AGE 65 PROJECTED
TO REMAIN UNINSURED HIGH SIGN-UP SCENARIO
ELIGIBLE FOR MEDI-CAL
Policy Considerations
• SB 4 (proposed) - Lara Bill would provide access to health
coverage to all Californians, regardless of immigration status.
• The Lara Bill is pending before the California Senate Rules
Committee as of Jan 2015.
• Federal Actions (DAPA/DACA) – recent executive action should
qualify some additional undocumented for Medicare.
Medicare Shift & Transformation
• In President Obama’s February 4, 2015 budget proposal, there
are a number of health related changes to Medicare
reimbursements, no longer based exclusively on patient load.
• Proposed federal budget reductions as proposed in the
Obama budget to Medicare would impact health care
providers and result in structural reforms to Medicare,
and likely to Medi-Cal as well.
• A funding source as a result of Medicare changes Cadillac premium tax issues.
Potential Funding Options
• Undocumented drivers’ license fee
• Money orders to Mexico & other countries’ fees
• California medical device tax
• Hospital tax
• Medical provider tax
Potential Funding Options…
• Pharmacy tax - both prescription & non prescription medication
• Increase criminal background check fees
• Excess earnings on Health Savings Accounts or 529 college plans
• Tobacco settlement
• County General Fund - can be used to cover costs of unfunded
health coverage for the undocumented
Potential Funding Options…
• Tax deductible contributions, through crowd source funding
or other mechanism
• Marijuana sale additional tax
• Medical marijuana dispensary tax
• Increased cigarette tax
• Medical provider license fee taxes
For additional information, or copies of referenced
documents, please contact:
Henry Tuttle
htuttle@ccc-sd.org
(619) 542-4343
www.ccc-sd.org