What makes SB 840 different from our current health care plans?
SB 840 will provide coverage to every Californian, regardless of income or employment status. For the first two years, the coverage will have no deductibles or office visit co-pays and will provide complete freedom of choice regarding doctors and hospitals. After that, deductions and co-pays are limited to no more than $250 per individual or $500 per family, with a waiver for low income persons. All medical services are covered-including vision, dental, mental health, prescription drugs and up to 100 days of care in a skilled nursing facility.
Who determines what medical treatment I will receive?
The decision on medical treatment lies with your primary physician. There is no other gatekeeper for medical services. However, if you see a specialist without a referral from your primary physician, you may be liable for costs.
Isn't this socialized medicine? Won't care be rationed?
The California Health Insurance Reliability Act (CHIRA) retains a privately run medical system; doctors, hospitals, laboratories all remain privately owned. It's only the payment that is in the hands of a public agency. The legislation provides that benefits may be enhanced-not reduced-although subsequent legislation could always alter that.
I like the idea of universal coverage-but won't that require huge new taxes?
According to the actuarial study conducted by the Lewin Group, a conservative actuarial firm, SB 840 will actually reduce overall healthcare spending in California by nearly $8 billion in the first year and nearly $70 billion over ten years. While utilization of health services is expected to increase, enormous savings are projected from reducing administrative costs from insurers, negotiating bulk discounts on prescription drugs and an increased emphasis in primary care.
The Lewin Group's funding model estimates that a percentage tax on payroll of about 12% would pay for universal care when combined with Medicare and other existing public healthcare expenditures. This would save school districts billions. For example, if we take a teacher member who earns $50,000 per year, that means that full coverage for the employee and all dependents would cost $6000-far less than most Districts pay for insurance now. That leaves more money on the table for other uses.
How will this be run?
A health insurance commissioner elected every eight years with a two-term maximum will supervise the system. He will serve as the Chair of the Health Insurance Policy Board, which will contain seven officers appointed by him, two representatives from Regional Planning Boards and the state public health officer. A Public Advisory Committee to advise the board, representing doctors, nurses, hospitals, dentists, health practitioners, pharmacists, mental health providers, consumers, businesses, and labor will be appointed by the Assembly, the Senate, and the Governor.
Several other panels and boards are established by the act including a consumer advocates office, a health care quality office, and a health planning office.
Won't doctors and hospitals hate this?
Doctors and hospitals are being squeezed by our current health care system. They are required to negotiate with a plethora of different insurance vendors on reimbursement costs, navigate a maze of different reporting forms and deal with endless bureaucratic conflicts and errors. Hospitals in particular have enormous write offs due to treating patients with inadequate or non existent coverage. This will simplify their lives and cut their costs. One source for all reimbursement, no exclusions, everybody covered. The Lewin Group projects that hospitals will save over $3.5 billion in administrative costs-and doctors over $6.6 billion.
In addition, doctor and hospital representatives will be part of the Board which establishes reimbursement rates. So they'll now have input into the process of determining reasonable costs for care.
Who WILL fight it then?
Insurers and brokers will hate it and do whatever they can to defeat it. We're talking over $9 billion in fees and commissions here. The Wal-Marts and McDonalds of the world who currently provide little or no coverage will be outraged.
What about alternative medicine?
Chiropractic care, acupuncture and religious healing protected by state and federal statutes are included. Other alternative care is not specifically addressed by the law.
Where can I get more information?
http://www.healthcareforall.org/index.html
These FAQs are made available to you courtesy of the California Staff Organization.