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tv   Californias Health Care Law  CSPAN  August 18, 2013 11:50am-1:21pm EDT

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sunday. take a look. >> first of all, i wanted to give them an opportunity to do the right thing after the coup had taken place. it was pretty clear to say the least that they have not only not changed, but they have orchestrated a massacre, as you mentioned, we don't know at thousand or many thousands wounded. we have no credibility. that is the problem because we know that the administration call the egyptians and said look, if you do a coup, we're going to cut off aid because that is the law. we have to comply with the law. -- and this administration did not do that after threatening to do so, we are not in compliance with the law about a coup, which is clearly what it is. and then we thought there was possibly a deal to be made where they would release a couple of the muslim brotherhood, including the former speaker of the parliament, in return for
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reductions of a number of demonstrators, the dialogue would move forward with the constitution and elections. obviously, general cc decided not to pursue that and rejected it and decided to use force as we saw today. in the last few days. with apache helicopters overhead,-- flying nothing is more symbolic of the united states of america siding with the generals. we have no credibility. we do have influence, but when you don't use that influence, then you do not have that influence. we could be cutting off the aid, the spare parts and maintenance of this military equipment that we have given the egyptians is important to their capabilities. assistance,nomic business, the imf loan -- many areas where we could exercise influence over the generals, and
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we are not doing any of it, and we are not sticking to our values. >> i agree with the president that the people of egypt have to decide their own future and this bloodshed, the violence in the street, has to stop. the practical reality is that most of the military aid for this fiscal year, 2015, has already been obligated and delivered. all of it except for four f-16's and maybe some helicopters. looking forward, i think the approach has to be cut to condition our future eight on specific steps towards the rule of law, and return to a mock receipt, respect for -- to democracy, respect for women, and release of prisoners, so the eight is released in blocks that are conditioned on those steps. >> there are no good guys here. but if the two, i think there's more opportunities to protect american interests if we work
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with the military. and continue our relationship with the military could we have to have access to the suez canal. al qaeda should not be allowed to gain for goals. our treaty with israel should be enforced. i don't think that can be done with the muslim bar there had -- brotherhood. it possibly can be done with the military. we should maintain our relationship with the military. we should lean on the military. i would not want to undercut them and allow the muslim brotherhood to come back because it they have shown they are not able of democracy. goal't know if immediate should be democracy per se, i think a stable government to respect human rights and minorities effective be done because that's what we have seen over the last few years at the aero spring, i did not know at this moment in time a democracy for egypt, if they should work toward a democracy or a stable government with human rights. we will see if we can influence that. >> you can listen to all of these sunday morning talk show
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that c-span radio, string them online at 12:00 noon. tomorrow, the air force association will be talking about military defense strategies and planning in a time of budget cuts. we will show you that live tomorrow morning 9:30 a.m. eastern. that will be on our companion network, c-span2. [applause] leader, house minority nancy pelosi held a town meeting thean francisco about california imitation of the healthcare law. >> good morning, everyone. good morning, everyone. thank you, chancellor, for your introduction. more importantly, for your extraordinary leadership. under your leadership, although things you described about ucsf are becoming a reality,
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following in the footsteps of the state chancellors, the first woman chancellor, a great leader across the country. a physician, scientist, and a businesswoman, private, public, nonprofit, experienced. you bring a depth of experience to your latest role as the first woman chancellor of ucsf, the birthplace of the biotech industry and the nation's crown jewel of biomedical research. that is how we see it. thanks to your vision, ucsf is devoting its mission to advance health worldwide by molding future leaders in health sciences, education, discovery, and patient care. by providing high-quality care to community clinics, by conducting innovative research at institutions across the globe, and by partnering with health organizations like covered california, ucsf is
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advancing the health of californians across the state and the nation. thank you, chancellor. [applause] more than three years ago, president obama with a stroke of a pen made health care for all americans a right, not a privilege, a reality. [applause] in doing so, president obama honored the values of our founders, of life, liberty, and the pursuit of happiness -- life -- a healthier life, liberty -- the freedom to pursue each of our happinesses, and if you are an artist, a cameraman, a writer, you could be self- employed, you could start your own
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business, you could change jobs. you could follow your own passion, not your policy, even if you had one. again, honoring the values of our founders, we go forward to make this a reality. it is a very important part of why it was important for us to have comprehensive health care for all americans. here in california, already 8.1 million californians are now receiving preventative services. 435 young adults are now safely covered by their parents' plans. that is in our state. seniors have saved over $500 million in prescription drug medication, and soon being a woman in california will no longer be a pre-existing medical condition. [applause]
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this morning we will hear from a very distinguished panel, and they will talk about the health care and access in california, covered california in particular. i want to acknowledge that i am glad to be here with the members of the official family of san francisco, senator mark leno. tom will be joining us. in any event -- thank you very much. the light is in my eyes. who else is here? david campos, supervisor david campos? and who was the voice of god? dana howard, the voice of god. thank you, dana howard.
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we will be hearing from peter lee. herb schwartz, the regional director of the health and services representing the obama administration in our region. barbara garcia. what an honor it is for me to be here with them because i know of their leadership and their work. john, ceo and founder of small business majority -- without him it would be impossible to pass the affordable care act. thank you for your tremendous work on that. [applause] and wendell, my senior health policy advisor resource to all members of congress, house and senate, and to the administration, on health policy.
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what does wendell think? is what we say all the time about this issue. that is what we all find out. thank you, wendell, for being here. [applause] as america's first health marketplace -- we take pride in that -- covered california is leading the way in establishing a bright and healthy future for the golden state by making sure insured as well as uninsured californians find plans that suit their needs and their pocketbooks. i say this plan is for you, because you can choose from so many plans. 13 comprehensive health plans here. every state that has established a marketplace has already announced premium rates that are lower than expected, and california has led the way. the disparities issue is major.
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ethnic, racial, whatever disparities have been in terms of incidents of disease susceptibility, not being in the health care loop enough, and it is an issue in which california has led the way because we are blessed with such diversity. the health care marketplace opens on october 1. californians will finally have access to affordable quality care they deserve. i am so pleased to see so many of you here from a cross- section, from labor, community service organizations, the public and private nonprofit sector, thank you all for being here. mr. paulson, the chairman of the san francisco labor council, is with us. thank you so much. [applause]
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the head of covered california is peter lee, and i want to make sure we have an appreciation of peter lee. from leading the center for health care rights to establishing the obama administration's new center for medicaid and medical innovation, mr. lee has dedicated more than 25 years to reducing costs and improving care in our health care system. with his hard work, with the staff of covered california, a strong and healthy life that was unattainable for so many will soon be an unalienable right for every californian. as we approach the open enrollment season, we are sure he will provide a good example of the affordable care act. thank you for delivering
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affordable quality care to our state. it is my pleasure now to introduce peter lee. [applause] >> we would not be here today but for the leadership of leader nancy pelosi. [applause] i also want very much to join the leader in appreciating the chancellor of the university of southern -- excuse me -- u.c. san francisco. i am tainted by another school in southern california. excuse me for that.
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that may be a little bit of orientation, and i hate to correct the voice of god, dana, but i will, which is fill out those questioned forms. i guarantee we will not get to them today. by completing those forms and putting in an e-mail that you have a question that you have, we will contact you and you will be part of making history. the questions you ask are questions that hundreds of other californians have. by your asking us, we have our chain, we have hundreds of staff, that will be answering your questions and answered questions millions of californians between now and when open enrollment closes at the end of march. we are making history. our panel will be answering many of those questions. fill out those cards, we will collect them, and answer many of them today. what we will do is i will spend a half-hour to orient you to where covered california is in the process, what it means to
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have affordable care, outreach, and then we will have 20 minutes of questions and answers with the panel, myself, and the distinguished panel you heard from leader pelosi. then we will hear remarks from leaders in california who have made sure that health care is a right. senator mark leno and others will do remarks to close and wrap up for this morning. that is what we are going to run through. i will start with a brief moment of audience participation, and i will ask you to raise your hand if you have health care coverage through your employer or through medicare. put your head up, please. you look around and i could do a quick scan. that is about 86% of you who raised your hand. [laughter] that is about the national
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average. what does the affordable care act do for you? the president said it, but it is important to note you keep your coverage. the expansion is for people in an individual market who are uninsured, but you keep your coverage. but all of a sudden you know that if you leave your job it does not mean you are leaving the world of health insurance. you have a guarantee you can always get insurance. you do not need to live in fear of being a job away from health insurance. good deal. those 14% of you that i saw, what does that mean for you? this is where history is happening on january 1 where coverage will now be available for 35 million americans, about 5 million californians. let's talk about affordable coverage being on the way and why californians do not have coverage.
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there are three big reasons we have many people in the state that do not have health care coverage. we have been doing focus groups, sitting down with thousands of californians to talk about this. they have a pre-existing condition, and the current health care system says you are unhealthy, we do not want you. second reason, your employer does not offer it. 99% of our employers offer coverage, and many small business offer coverage. the core reason people do not have coverage is it is not affordable. those of you that raised your hand get a leg up from your employer that helps pay the premiums. you would not be able to have it without the leg up. the affordable care gives that leg up, based on people's income, to all americans. it says we want to get everyone coverage, we want to give everyone a level playing field
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to have health care coverage. the leader talked about some of the advantages in place in the affordable care act. let me talk about the improvements that are coming down the track. first, guaranteed coverage. this means that you cannot be denied the cause of your health status. no annual limits. it is changing the world of health insurance. i have friends and colleagues and i know in many ways the health insurance has historically been about how to avoid sick people him because that is how to make money if they do not have to deliver care. we are changing that with the affordable care act, which is you have to take everyone. if a plan thinks they will win by avoiding sick people, they are wrong. it is bringing in people with cancer. we are changing the rules of the
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game. there are new rules. large employers us offer coverage or pay a penalty. the penalties will kick in in 2015. there are new obligations for individuals. individuals forget that leg up to help them buy coverage and there will be an obligation for them to pay a penalty if they do not. a very small penalty. i have spoken to thousands of californians who say i have heard about the penalty. they say i care about you making health care affordable. this part of getting everyone in the game. what is this right? one of the things that it does is define -- and this is nationally -- essential health benefits. these are the benefits that instead of wondering if they are covered by your health plan, you will know every health plan is covering maternity care, prescription drugs, labs,
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preventive care, and included in that preventive care is a preventative visit that costs you nothing. this is not just in covered california. this is in all markets. we are changing the world to benefit all americans. let's talk about who is eligible. it is legal california residents who are not eligible for subsidies, and not for undocumented immigrants and those recently incarcerated. it is important to note this. californians have a history of commitment to making sure everyone who lives in the state can have access to care. the affordable care act is making health care a right for americans. we also want to make sure that we are making sure that everyone who lives in this state gets access to care. we will need to support the safety net, community health clinics, hospitals, and there still will be people who do not
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have insurance. the act takes us a long way. who are we, and what is this covered california thing? i like to say we are public, but we are a dot-com. we will be out there marketing all over the place to provide new information about the one- stop place that californians can go to find out if they are eligible for medi-cal, or for a place to shop for choices they can make that are balanced, fairly represented, that they can get as good a deal through covered california. california was the first state after the passage of the federal care act to set up an exchange, now called covered california.
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california has set up a way that is anchored in the diversity and size of california. many other states have not done that. there are 16 states across the nation that will be state-based exchanges. every one of those, and there are 35 states watching what we do, watching what oregon does. how does the state-based thing work? we are sure we will do it right and better because we are from all over the state. we are overseen by a five-member board, and they are not in the room right now so i can pander to them, and it is a great board. they know health care, the diverse communities of the state, have one job, which is to make sure 5 million californians
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it access to coverage. you can get a sense of them by their vision and mission statement as they frame it. they start with a vision statement which says all californians get access to care. that is not an insurance vision. it is appropriate to be here which is a health care provider. it is about people getting the right care at the right time for the right provider. our mission is to increase the number of insured californians. our vision is to lower health care costs while increasing quality. our vision is to address health coverages that have been anchored in giving consumers the ability to remake the right choice. we are a tool for consumers, and that is what drives us. what do we offer? it is about portability, and we are the one place people can find out whether they are ells or form medi-cal.
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also defined if they get premium assistance to lower their costs. you will find through covered california benefit design that is designed so your copayments is not a deterrent to care, it is rather a standard benefit designed so you will not have the gimmicks of insurance. you will have designs that do not get into the way of getting care when you need it. zero deductibles for many plans, free preventive care, and lower out-of-pocket maximums. there are three things that are key. affordable products, we are letting people know the news and facts about what is available. dana spoke about the need to get people in enrollment. we have 12 plans available, but they will be different in each area.
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in san francisco, the plans will be anthem, blue shield, kaiser, and others, as well as medi-cal. different plans in los angeles and san diego. the importance is it is the largest nonprofit, but not just statewide plans. we reached out to recognize that health care is local. we wanted plans that are anchored in the communities they serve. we are so excited in san francisco to have a chinese community insurance plan. we are excited in sacramento for western health advantage. across the bay in alameda, the alameda alliance. we have plans with deep histories serving low-income
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people. and you come to covered california, you will find what your options are they somewhere you live. we will be offering six plans in providing services to small businesses. we will set up a shop. i will note that i worked in washington. i cease to not speak in acronyms. we speak in seventh grade or below or spanish or cantonese, and we speak clearly. the small business health options program is a new program for small businesses. the world is changing in a huge
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way for individuals. subsidies are large. for small business, right now small businesses are struggling with offering care. there are no penalties in place in the future of small business. we want them to continue to offer care, and they will be able to offer choice. they will say i have picked covered california. that my employee the whatever plans available to them. many of small businesses will be able to get a tax credit to lower their costs. we are not government insurance. we are not government doctors, hospitals, pharmacies. we are not death panels. we are not raising everyone's insurance costs. the discussions in washington and that being political footballs about pundits, etc.,
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and what we are moving to in california is facts. talking about what the real benefits are, what it means in premiums, affordability, and getting out at information. we need to get out a way from the theologies to that. that is what we will do now as we go forward. let's talk about milestones and timelines. many elements of the affordable care act are already in place. the leader noted we have hundreds of thousands of kids under 26 who have coverage today because of the affordable care act. nationally, 3 million americans have also because of that element alone. the big deal in terms of changing coverages effective january 1, 2014. that is a red letter day. that is the day as big as 50 years ago when america said our seniors should have a right to health care, and we launched medicare and at the same time poor low-income americans have a right to medicare. january 1 is when we say that right should be there for all americans. it is a huge day. we will be starting and we have
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already started community outreach, we will do our best in september, then in october, and there is an open enrollment. we will be educating californians that that open enrollment time is critical. it is during that time when a health plan can say i do not care what your health status is. guaranteed. we need to educate people that if they say i hear i will get coverage whenever i want, maybe i will wait until i get hit by that truck. you not wait. sign up in open enrollment.
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if you say in june i decided i would wait it out, you will not get your coverage. you will get another chance asked fall in october of 2014. they're setting up a system that is a new system that we will all become very familiar with. at stake is what it will take to make it work. affordability. there are two things that go into affordability. first is what you pay for premiums and the second is what you pay for out-of-pocket. that is what you pay when you see a doctor. both elements have critical parts of the act to make health care affordable. first, premium assistance. if you are a californian that makes less than about $16,000, you will be eligible for medi- cal. one of the thing that the leadership did with governor brown is to say we are going to expand medi-cal to take advantage of the affordable care act. about 1.5 million more californians will be newly eligible.
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what does this mean? how much assistance you get depends on how much money you make. if you make $16,000 a year, you will have all of your premium paid. if you make $50,000 a year, you will get a leg up, not the same size, but you will get a financial leg out. you make more than $50,000 as an individual, you will get the leg up of knowing you are buying a plan that is covering essential benefits, you cannot be denied or have it taken from you. everyone benefits. everyone is in the pool. but the premium assistance is targeted by income. what does it say about affordability?
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you will become familiar with a new concept, metal tiers, which define how rich is the health insurance you have. a bronze, silver, gold, platinum. a silver land means your insurance will cover 70% of your cost, and the balance is your deductible, your out-of-pocket. the premium is more for a richer plan. if you want to health insurance plan to cover virtually everything and you spend very little, your premium will be more. if you want to take more risk and spend less on premiums, you can pick up bronze plan. this is giving information to make choices. let's get concrete about this talk about the different plans that will be available for individuals in terms of benefit design.
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there are a lot of numbers, and all these slides are available at our website. a lot of numbers here. a couple things important. more details on the website. today, if you search for health plan, san francisco, you can find 75 health plans that cost from at my age from $200 to $1000. when you cannot tell is what they really cover. it is hard to figure out these rules of insurance for copayment. what we are having is standard benefit design. when you decide in san francisco to pick between different plans, you're picking the plans because they got the doctors you want, not because they are playing with the roles of the benefit design. what does that mean? if you are at the silver level, $45. you're not by the gimmicks of what it is going to cost.
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for that silver plan, maximum out-of-pocket, $6,350. it is a lot of money. health care is expensive. if you have something that sends you to the hospital in this state, you could have bills that are hundreds of thousands of dollars. health care expense is the number one reason that individuals have personal bankruptcy. with the affordable care act, the maximum, someone without a subsidy will spend is $6,300. let's talk about the financial support for lower income californians. he had a sliding scale benefit that reduces that for lower in come californians. we know if you make $20,000 a year and you say $45 for an office visit versus making sure i pay my rent, maybe i will not go. what we have is designed for that person who makes $20,000 or
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$17,000, their premium could be as low as $19. the rest will be that premium assistance. it is tiered based on income. it means going to the doctor. you make $17,000 a year, your primary visit is $3. that is a bus ride. these are the benefit designs. having benefits that are not gimmicks that are clear, standardize, that help he will get care. how will the rate be based? based on your age, zip code, your family size and what plan you select. you pick the level of benefits and you will see what your rates are.
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what will rates not be based on? not on your gender, health status, under pre-existing conditions, on tobacco use. this will say rate you will see out of the gate. let's get concrete and talk about jose. a hypothetical jose, 27, makes $31,000. at a silver plan -- next slide $83 a month from the federal government and the irs to help him by the plan he chooses. $186 at the chinese health plan. he could also say i do not want a silver plan. i want a bronze plan. i would like to have more risk. he can apply the $83 to his plans that will cost them $100 a month.
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we will educate people what their choices are. let's do another example. the taylor family. this is a couple with two kids. they make $58,000 a year. not a poor family, but they are still making ends meet. this is not easy living, with all due respect to san francisco. i know this. [laughter] $58,000, two kids, john, andrea. what is their circumstance? the premium of what the premium cost would be, $1000. they would get almost $700 in assistance to help them buy their coverage. that is a big leg up. they still have responsibility of spending up to $500 a month. they could also take a bronze plan that means their monthly premium would be as little as $150 a month.
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that premium assistance stays at the amount that they can use wherever they want. he could buy a richer plan. this is about choice to help them make the right choice. we have affordable plans. we have tools to help them be affordable. the next thing we need to do is educate people, to get out the misconceptions, to talk facts. we will do a huge amount of outreach to maximize enrollment. we will reach out to all californians and we will reach out to about 6 million californians eligible for subsidies, 2.5 million eligible for subsidies, but also we want everyone to have insurance. 2.7 million californians will be eligible for subsidies.
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they can shop in the individual market. we do not care where. get insured. the motto of getting coverage is what we will all be about. when we think about doing outreach, california is a very big state. in the bay area, there are about 400,000 subsidy-eligible individuals. san francisco has been a leader for providing expanded coverage. we are excited about the work the mayor is doing to convert already in healthy san francisco into other plans. there is huge potential. you look at the state of california and you look at many counties alone and you look at counties like alameda, riverside county, 180,000 subsidy-eligible people. that is more eligible people than in the state of utah. you look at how many eligible in san bernardino. that is more than that is a little than three or four other states combined. we are a big state. it is important to understand
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that diversity of our state. i have noted the 2.6 million californians that will be eligible for subsidies. half of them are latino. translated into 13 languages. in particular, besides speaking to the latino community, asian- pacific islanders represent 380,000 of our eligible people. that means our material must be in those languages, and particular chinese, mandarin, cantonese, and we are looking at building over time -- this is where at stage one we will put wanted our entire website in chinese. we are building materials and strategies to reach out. we will be doing in october big marketing. you will see us on tv, on the radio.
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you will read us in community newspapers. in mandarin in farsi, in local papers. you will not see us in the super bowl. you will see us if you watch a telenovela on univision. that is where you will see us. beyond doing advertising, we are reaching out in the grassroots, from community groups. we want to talk to people from where they live, work, shop, play, and pray. he have a network that is anchored in advocacy, community health centers, chambers of commerce, that we are starting today. we have trained thousands of to do outreach, to talk about issues, to talk about getting
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people insured, talking about the facts of coverage. this network has over 250 organizations. the asia-pacific legal center, san francisco human services network, some in this area, and these are a starting point. it is a good mix, but it is a group we need to build on so they are not just hearing about it from newspapers, they are talking about it in schools, to their neighbors about it in a way that is informed, educated. we will expand that. we will establish a community network. this will have partners and we need partners across the state. one of the things i have been so thrilled about coming back to california after a stint in washington is throughout california, doctors, nurses, health plans, advocates said
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let's do this thing right. let's implement the act to make it work. it will be a partnership opportunity to work with covered california to get the information out to get all californians insured. the network will have organizations like clinics and hospitals. i have been in these groups with young people. they are called the young invincibles. they are looking for these options. we need to reach out to people whose first language is not english. we need to reach out in the world communities and we will do that through our community outreach network.
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we have a link to that on our website. we need to get to our questions. we have affordable products. we have done marketing. then we need to enroll people. this is one of my true confession moments. i said we will build this website, it will be as easy as buying a book on amazon. this is confusing stuff. health care is confusing. it will be easier than doing your taxes on turbo tax. that means we will have a website where people can go through their choices, take their choices, but what it means is we need human beings, sitting down across the table from people going through questions. we think 90% of the initial enrollment will be talking to someone about their questions, not online.
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the online system will be great. this is confusing stuff. what does this mean? we will have a service center with people trained in the service center to answer people's questions and they will speak the language. we will be able to respond to them. we will have across the state insurance agents, certified, to help people and roll. we will have certified enrollment counselors. it is making the right choice available for each individual, giving them the choice to make the right choice for them. we know it will take people touching people to talk about these issues. i am excited we will have a dozen organizations in san francisco that have said we will help people and role. we will be working with hundreds of organizations across the state to help people enroll. start with open enrollment. it is not over then. after march 31, people can still
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enroll if they lose their jobs. medi-cal is open year-round. we are part of the new system. the enrollment, how do we help people enroll? we will have new tools for consumers to see what their plans are, what options are available that they might pick. he have today available representatives, people who can answer questions. monday through friday, 8:00 until 6:00, we will be open saturday in october. we are also having people in the
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field, and one of the main tools we will have is the little mapping function. i want to find somebody who speaks mandarin close to me. we will see who speaks the language and their hours of operation. we already have thousands of certified agents say we want to make this thing work. we want to be part of the all hands on deck. we are excited about where we are. we have hundreds of questions here. we will now go to questions with the panel, and i guarantee we will not answer them all. we will try to answer as many as we can. we will get back to you.
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this is part of making history. as the president said, there will be ups in the wrong. the perfect thing is we as a country have said health care is a right, where down the path, like 50 years ago when we said we will not stand by and have seniors not have health care. that was a big deal. today we say, of course, we have medicare, the right thing. we are on a path now saying all americans have a right to health care. with all of you, with the broad leadership throughout california, we are confident when we look back now there will be a day when we say americans did not have a right to health care, what was that about? i look forward to your questions. thank you very much for helping us make history. [applause]
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you heard we have a great panel. a number of questions came for some of the panel. covered california has great staff. a great team of people. our success is about this being a california-wide effort. it is about working with organizations across the state, working with ethnic organizations. i will ask the questioners to stand up, and they can do follow-ups. folks will hate this, but we have one rule -- do not try to take the mike. we will hold on to it. we have seen people taking the mike and not letting go. kate, are you here? if you are shy, the ready to have a follow-up question. this is for barbara garcia.
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what is going to happen to healthy san francisco? >> about 60 years ago san francisco created a universal program for uninsured. today we have 60,000 individuals. we estimate 40,000 will be eligible for medi-cal. 20,000 will continue to be in healthy san francisco. they will have health access. one of our messages to those who qualify for covered california is that is better than healthy san francisco because it is full insurance, has more benefits than an access program. >> my follow-up, transition. how would we transition for what
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is better? >> we are working with many of our patients, consumers, who are already part of this. in the state have a program that is a fast track to medi-cal. we have 10,000 individuals who are moving in that direction. we have 30 locations who will work with everyone who qualifies for that eligibility to transition. covered california, which i want them to know, we will be working with them hand in hand and with all of those who qualify for that service. >> and thanks to the leadership of san francisco. it has been incredible. san francisco has been a leader, but many other counties have low income health programs. we are working on the same issue.
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have issues statewide. we make sure if they go into private plans they have continuity of care. issues of transition are san francisco issues, but we are looking to do this in partnership with others. susan? stage right. one of the plans with regard to outreach, the chinese small business and workers, and when are there going to be -- i will do a follow-up question which relates to voter registration. you address the question. >> i want to do a shout out to peter and his team. they took on an unbelievable
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task in front of them. they have done a tremendous job. you cannot imagine putting all this together, the technology, working with all the groups like ours. many congratulations. for small business, we are working with every possible chamber, community group, and we have spanish language capability on our team. we have a materials in all languages. we are working with the ethnic chambers and groups out there. that is our model to partner with business organizations throughout the state, to make sure that we get the information directly to every community of color. >> we will be doing a lot of outreach in multiple languages targeting print in languages that are culturally specific to
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areas. i will ask a second question. when will our pre-populated voter regs be available to all? there is something called the motor voter law. california has been identified as a point where we are required to provide voter registration information after enrollment. we'll come up with a plan on how we can phase that in. they're making registration material available. what is going to get better over time? our job is to get people enrolled in coverage. also getting better at doing that as we meet the law going forward. >> about the small business coverage, i wonder when that will be available for small business, when the plans will be available for small business?
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>> what the plans are and which counties they are serving is available today. you can go to our website and see the plans available, and what the rates are and how they compare to the market. the specific rates and when you can buy will be october 1. for the small business options program, like individual markets, for coverage starting january 1. the full information, and that will be with the asian community, the small business health insurance is sold through licensed agents. that will be as of october 1. thank you. a question for herb schultz. will covered california offered discounts for income-eligible groups after they turn 65 and are thus not eligible for medi- cal without resource limit?
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this is megan. megan. herb, can you handle that? >> yes. peter and i have known each other since we were 22 and 24 in washington, when i had a lot of hair and his was darker. [laughter] i want to take one moment and say if we look back, we are 53 days to history. in 1984, at the national women's political caucus, i was a senior in college, and i got the opportunity to find out what san francisco already knew, and that is the first time i met leader nancy pelosi. i found out then what you have already known, and from working for a president and working for a secretary and working with a leader like nancy pelosi, she is not a historical figure because we got health care reform passed, but she is assuring that
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every resource of the federal government is being brought to bear for local implementation. i want to acknowledge that leadership, because it is in this region about state, local, tribal, and territorial implementation. [applause] it is one thing to stand up and pass it, but with our leaders here, you have set the example that we have to continue to press to make sure everybody that needs health care, they have a right to get it, and that they get it. thank you again to you. two quick things. not everybody is able to get on medicare. some of our immigrants that have come over that have not been in the system that are not able yet to get into there, and there are ways to be able to come into covered california even if you are post-65, if you're not eligible for the medicare program. we can talk about the details of
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how that is particularly none. but yes. >> follow-up? do not try to take that mike. >> i am sorry. [laughter] my concern was about the magi eligible group, the medi-cal expansion group, not seniors or people with disabilities, but they are eligible for medi-cal, without any asset test until they hit 65. once they hit 65, they are no longer eligible for medi-cal, unless they want to go into another medi-cal program that has an asset limit, a low asset limit. i am wondering for that group, then they might be eligible for covered california, but will there be any additional assistance for them? >> we could talk you about the medicare side of that, and what that program will bring.
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this will not be a marketplace issue. i want to make sure from the federal perspective that we can answer all the questions for you. i mentioned the leader has ensured that federally, we are bringing the resources. many of the organizations are not health and human services organizations, they are nonprofit and religious organizations. they have different types of organizations that are very important. we are working very hard to work with housing and urban development. we are working with you to make sure that all of our federal assistance programs are providing information about california.
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>> it is easy and right to get very quickly. people talk about averages. there are very specific questions about what you are eligible for. to get into very specific questions we will train people in each part of california. medicare and how to put these together. we need humans to walk through these issues. start getting answers ahead of time. make the right choice for you. >> and medicare and medicaid services, i give the e-mail and my cell phone. working with covered california, what was that?
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not until january 11. we have the casework capability with 500 people here., 415-265- 7049. we may not have all of the answers but we have experts as well as covered california and all of our colleagues appear. i hope you will use this and let us know, 24-7, how to help. >> a number of folks in congress and the white house, have the affordable health care act.
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two is exempt here. >> i also want to give a shout out to peter lee. i had the privilege of watching other states implement, relative to a lot of other states, is the cadillac. peter does not like that term. you are in much better shape than we are. in terms of the question, federal employees are employed by a large employer. they will retain their coverage to the federal health benefits program. which is like a large exchange. you could say to some extent that the affordable care act -- insurers and contractors --
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federal employees get a fixed amount of money, to a large extent, and shop on the exchange. there is one exception to that. congressional employees have to enter the exchange. members of congress and the official staff have to go into the exchange like ordinary americans, and because of a ruling that follows the law, will retain the congressional employees and their employer contributions and they will shop on the exchange where they reside. in some ways they were singled out and treated differently than other employees of large companies. politics dictated that just the federal employees and members of congress will enter the exchange.
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>> i was hoping to see some leadership by example. the leaders would be the first one to sign up for this? >> they will be. members of congress and the congressional staff, they will have the planned choices, the range of options to all californians. this is a state that leads by example. right now the federal employees have a lot of options. what we are doing is saying that all -- all americans have a lot of options. i will move to a couple of other questions and then move to outreach. we have about 15 minutes and we
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won't get to all of the questions. mitsy? how do you think the exchanges will affect the overall cost of providing health care? i will take a crack at this. this is a very important question. out of the gate, what they are doing is making healthcare available, but part of this is getting everyone insured and saying we have to get our arms around health care costs. health care costs more in the united states than anywhere else. part of what we had for the last 20 years is the shell game of saying, it is not my fault. we have many efforts in california and nationally to see how we deliver care. part of the contracts with covered california -- we require them to say, what are you doing that people with cancer are
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getting the right care every time. what are you doing to make sure that primary care -- is not a myth, this is developed. delivering care through group care -- group care. one thing we are doing is have the plans show how they are part of changing delivery, and how we are working with medicare, working with medicaid so the entire delivery system improves over time. health insurance is made up of health care costs. one of the important advances of the affordable care act is to make sure that the majority of the money we have is spent on healthcare dollars. to get you into the details in the weeds -- that what you spend
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on premiums is being spent on doctors and nurses and hospitals. we have to make sure people are getting the right care at the right time. >> what the affordable health care act did is organized the individual market. people will be able to vote and you will know the price of those different health plans and those charts that he put up, there were a lot of differences among the plans the californians can select from. nationally, health care costs have grown for the last three years at the slowest rate in the last 50 years. medicare rates and premiums have gone up very slowly compared to the historical average. they have lower the projections of medicare and medicaid by over $1 trillion, to show that some
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of this is through the recession, but part of this is the healthcare field, and the signal that the affordable health care act is sending. >> in all of the exchanges across the country we see the rates come in, both individual with the small business exchange. they came in way lower. this has stabilized across the country. >> for the last three and a half years the rest of the world to
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cornet health care. >> san franciscans because of the healthcare access have more access to emergency rooms, -- >> thank you very much. pamela navona. right up front. what about dental insurance coverage? this is very important. covering dental for kids, pediatric dental and pediatric vision. they don't cover necessarily. adult dental is not part of the standard practice.
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we will be adding those on in terms of the supplemental offer. we want to enable people to buy that. we will be adding in the dental options. we have six dental providers with what we are offering, with we have six dental providers with what we are offering, with dental premiums for kids as low as $10 per month and we will try to get every child in rolled in health and dental coverage. >> thank you very much. we have another six minutes and 832 questions. [laughter]
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we will have some closing remarks, some on the cost and quality and a couple of questions we have is on outreach. how can other people stand -- from three or four people saying, how does a community -- based organization become an enrollment site? another group says, i have 100 people who want to volunteer, they want more information. what can we do to be part of this? for all of these questions, one thing that is so comforting is we have such an outpouring of interest from people who know this is part of making history and they want to be part of it. we will be doing training, starting in august and september. we will be doing training
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throughout 2014. we have any organization that wants to be certified in enrollment, step up and we will train your people and we will not only train your people but we will pay them. certified enrollment counselors, covered california will pay $58 for everyone they helped to enroll. licensed insurance agents. they need to be certified to make sure they understand the rules. they say they don't know as much about medi-cal as the private market. but they know a lot. we will have regular information about the timing. not everyone will say that they want to learn everything.
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we will have a webinar, just to get a quick version of what you saw today. for any level of interest. no matter how much you want to roll up your sleeves. >> for all of us, friends and relatives and neighbors across the country, one of the biggest pieces of misinformation is if you don't have covered california, the people across the united states don't have access to the marketplace. 50 marketplaces will open on october 1. tell your friends and relatives that everyone can get the kinds of benefits we are talking about all across the country regardless of whether the federal government facilitates the market or we have an awesome organization like covered california. >> i appreciate that tip of the
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hat to what we are doing in california. this is an exciting partnership but i had the opportunity to work with leaders in more than one dozen states, like oregon. like washington. like colorado. they are doing great work. this is also a marketplace available to every single american. there are certain things we are doing that is a little bit different. standard benefit design is something we are it -- something that california is doing. we sat down and we were not picky about the health plans. -- we were picky about our health plan. our legislation said california should be an active purchaser. every single american now has the right to health care coverage. with that, i actually want to make sure that we stay close to on time.
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we will have responses to all these questions. we will send you an e-mail response, in the next couple of weeks. in doing that you are part of making history. before we turn to for individuals to do closing remarks, before we do that -- i would like to have the leader say a couple of remarks. >> peter, as you have said over and over, this is local and state and national. i want to acknowledge those officials who are here. we have heard from -- again, all of these things, every good thing have a legislative history, with more
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successes ahead. i want to thank barbara garcia and mayor lee for making san francisco a leader in respecting this as a right to all people. i want to come back to where we are. this is a question about cost. this is an important cost of healthcare, the cost of the insurance premium. if there was no other reason to pass the affordable health act. the reason we would have had to do this is because of cost. costs to individuals and family, competitive business internationally, local and federal and state government. the rate of increase has
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dramatically turned this way. one of the other points that was made, and i want to emphasize this, the law is about quality, of service, not quantity of procedures. this is about performance and not procedures. this is about value and not volume. you see an example of san francisco, where performances like this and compensation is like that. in many parts of the country, compensation is like that and performances like this.
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if you are not getting the proper care, and there is re- admissions to hospitals, and you are not sent home with the right partnership, that they have taken the lead on, the quality of life for the person is not healthy, and the cost to that person to the community, every aspect of the delivery of service. in every industry, competition lowers cost. competition lowers cost. up until now, the health- insurance industry. you have this facility here -- i need that. this will be a way to have competition that really reduces costs. this is really a very important part of it, as it makes us healthier. not just to have health care but prevention and wellness, the prevention and the health of america, not just the health care of america.
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that prevention -- just think of the entrepreneurial spirit, we you can start a business and do all of that and not be blocked by your policy. think of what that does in the society and the totality of a community -- vitality of a community. at the same time, lowering cost, which is important for everyone concerned starting with individual families. while we passed a federal law, the implementation and some of the pioneer work that led up to it was done locally. mayor lee, he is here. thank you, peter. [applause]
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>> we will still do some closing remarks. i want to thank the senior health advisor -- and herb schultz from the obama administration, barbara garcia. and now to join me here to do brief closing remarks, four of the individuals that have helped in california and the leader in providing this nationally. mark leno. if you can stand from down here, we have lee lend ye, the senator, and the leadership of california has been about development, local in san francisco but also a legislature that says we will implement the affordable care act, these individuals helped to host the town hall, as the hosts but also have been statewide leaders.
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i> i am holding the microphone. promise i will let go of it. [laughter] thank you all for being here. let me offer my praise to leader pelosi and president obama. this is a revolutionary accomplishment in washington. we are fortunate to have peter lee putting this together -- when he briefed the democratic caucus in the senate, it did take about as long as it took this morning. one of my colleagues said, wouldn't it just have been easier to do single-payer? and i said, yes. in the past year, upwards of 12 million californians did not have health care coverage during the calendar year. and this led to the debate on the senate floor looking at the bill. we have the best healthcare system in the world -- but this
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is just not true. we were ranked 37th among nations in access to health care and quality of healthcare. the cost of healthcare. --fe expectancy rates and into infant mortality rates. the insult to injury, it is twice as expensive as it is for our partners. the cost drivers are everything. this is not sustainable. in 1960, the united states was paying five percent of gdp on healthcare costs, 10% by 2000, 15% by 2010, now 18%. without the affordable care act, we would hit 50% of gdp on healthcare by 2050.
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the genius and the brilliance behind the affordable care act is investing in primary and preventive care so we can keep americans healthier, so we won't need all of the -- these things that draw costs upward. and so, with all of that, we are here as ambassadors, from each of the districts to continue to encourage californians to enroll. it is my pleasure to introduce the senior state senator from san francisco. >> thank you very much. it is because i am senior that i have a little bit more history.
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several years ago, there was a bill that came before the senate health committee, it was a healthcare reform but it was unfortunately not the healthcare reform that i could support. back then it was -- we killed that bill. it was not single-payer. the fact is there was an individual mandate. now, we have this particular bill, and i think that it is incumbent upon all of us to do everything that we can to make this bill and this law a success. the only way to make this bill and this law a success in this country is we have to reach out to many individuals who are not here.
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those individuals who are part of the language minority community. individuals in this country don't understand why i need to have health care. those are the individual populations that i have to get out there and talk to you all, you all need to talk to and all of the panelists need to talk to. we have to do that, not with a disincentive, but an incentive to say to them it is important to have health care, explain to them why this is. so that they want to do that, not because they are forced to do that. when you force people to do that, you have penalties -- all you will do is push them away. we have to all work together. this is a heavy lift for all of us. we have to find a way to ensure
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that everyone will have health care, and that they understand this is the place to get it. >> let me introduce, the senior member of the legislative delegation for san francisco, that is tom amiano. >> i know that he meant that as a compliment, he even gave me a bracelet that was inscribed, do not resuscitate. my car was broken into, and unfortunate san francisco experience, so the lesson i learned was not to go to the bag.hey stole my gym some comments that he alluded to, this is a significant step and i am excited by it.
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it does not dampen our commitment to single-payer and universal healthcare. we will get this, hopefully in our lifetime. from a certain generation -- i am concerned about the healthcare needs of the seniors, adult day care and things that have taken big hits in california. i am looking forward to solving those issues around long-term care. what is happening today, on a personal level, during the hiv crisis, particularly in the 70s and the 80s, with the demonization of certain demographics, there was very little advancement, even the middle-class person who contracted aids and had some health insurance, this was n nsidered a pre-existing moral issue for some doctors.
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many people died, because they could not get that kind of care. obviously, today that won't happen. i was very fortunate to be the biofather of a healthy san francisco -- this has been a good season for san francisco. when we rolled this out in the chinatown clinic, some of them came with their kids and for the first time they were allowed to have access to healthcare. there are some little demons out there -- if you want to know, check my facebook. they somehow think that healthy san francisco is in opposition to the aca. i was with the department of
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health when we talked about healthy san francisco and how because of political pressure, the undocumented -- and programs like healthy san francisco would stay in place and complement this, and make sure that we had a safety net. this is not the antithesis. this is a complement that enriches. for those who want to mess with it, if you want a visit to the
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emergency room, i can help with that. [laughter] if it's not broken, don't fix it. >> >> thank you, tom. my purpose is to warm up for tom, not to pick up after he left off. it is great to be here. i am joining the delegation for years and years -- thank you for being here, leader pelosi. we are making this happen -- without your help this would never have happened. we have so many people and all of you are here because you are community leaders. apart from networks, with access to other individuals and businesses and people, there are other community leaders. we need your help to get the word out. i have 40,000 people in my district without health insurance. we have to make sure that we are working hand-in-hand to pick that up.


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