County Supervisor Dave Roberts was our featured speaker at the September monthly club meeting. Dave, a former senior manager for the Healthcare Information and Management Systems, has been nationally recognized for reducing costs and improving the delivery of Medicare, Medicaid and children’s health insurance coverage. He worked for the U.S. Air Force at the Pentagon playing a key role in developing the military’s health insurance system Tricare. Both former President George W. Bush and President Obama appointed him as a health policy advisor.

Given his health insurance background, Dave is uniquely qualified to provide an overview of our President’s signature legislation, the Affordable Care Act (ACA) otherwise affectionately known as “Obamacare”.  Just this year Dave was appointed by the National Association of Counties to serve on its Health Steering Committee, a panel of county leaders and public health executives from across the country. The panel evaluates and recommends solutions for issues such as disease and injury prevention, health promotion, health disparities reduction and financing the delivery of health care.

In looking at the healthcare landscape across the country, Dave identified a few key issues in need of resolutions such as 60% of all bankruptcies in the country are due to health care related costs; the process is too paper driven which drives up costs; and many of the good ideas for resolving health care and health insurance issues were originally proposed by Republicans, but given the current political environment they won’t admit it and now criticism is coming from both sides of the aisle.

But Obamacare is here to stay and it’s the law of the land in spite of the 41 times House Republicans have voted to try and overturn it. The law actually gives states a lot of authority on how they want to implement the plan, and ultimately counties in all states have the responsibility for making it work. In Dave’s view, the new law is both Insurance reform AND Health system reform.

So what are the good things about Obamacare? First of all, key provisions are now in place that prevent rejection for pre-existing conditions and allow children to stay on parents’ insurance until age 26. The Medicare donut hole for prescriptions has been closed. Specifically in California, the law’s expansion of Medicaid expands MediCal benefits to an additional population. Previously 1 in 8 San Diegans qualified for MediCal, but with the expansion now 1 in 6 will qualify opening up coverage for an additional 138,000 residents. Likewise with the new health exchange, Covered California, 1 in 9 San Diegans are expected to purchase insurance at rates lower than the current individual market premiums.

Dave’s policy advisor, Lindsey Masukawa, provided further details. She explained that not only can adult children up to age 26 now get coverage, but parents can be covered along with them, and their caregivers too. Lower income citizens in the 0-200% of the Federal Poverty Level (FPL) will be MediCal eligible while those in the 200-400% FPL range will qualify for tax subsidies to help offset premimum costs. The remaining population above that threshold will not qualify for any subsidies and will buy their insurance in the private marketplace.

Lindsey also reviewed the mandatory services included under Obamacare. Some beneficial examples include: at least one drug in every class of drugs must be covered by a prescription plan; a person can go to any emergency room without pre-approval; hospitalization is covered for at least 3-5 days; pediatric care must include 2 dental visits a year per child; a pregnant woman can go to the doctor any time without paying for extra visits.

Policy Aide Lindsey Masukawa provides details on the key provisions within the Affordable Healthcare Act.

After Lindsey reviewed some of the lesser known highlights of the plan, Dave went on to highlight additional accomplishments within the County. He spoke again about his passion, one he shares with Supervisor Diane Jacobs: mental health care. In home outpatient treatment teams have been experimenting within the county and now they are expanding countywide with unanimous County Board support.

Slides Dave presented can be viewed below.

With over 17,000 county employees, whose mission is to effectively and efficiently implement federal and state programs, negotiations have been completed that resulted in a 4 year contract with a pay raise. The Board will soon vote on this. Dave continued to explain that given the many programs that are now the focus of attention, such as FACTSD (Facilitating Access to Coordinated Transportation) which provides low cost $5 trips for residents with mobility issues, and Live Well San Diego, a program “to help all County residents become healthy, safe and thriving”, San Diego county is ahead of the curve more than any other in the state.

Dave ended his talk by presenting Mary Borevitz, Club President, with a book entitled Bridging the Centuries:  The Jewel on the Bay, A History Commemorating the 60th Anniversary of the County Administration Center, 1938 – 1998.

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