Author: ITUP

Proposition 45

The ongoing debate of insurance rate review will finally be in the hands of the voters come November 4 when the Insurance Rate Public Justification and Accountability Act, or Proposition 45, will be on the ballot. If approved, the measure would require health insurance companies to justify rate increases, under threat of perjury, and obtain prior-approval by the California Insurance Commissioner. This would only affect health plans in the independent and small group plan, which covers about 16% of the state population, approximately 6 million Californians. Employer-based plans would not be subject to the new rules.

To provide some context of the new rules, in 2011 a health insurance rate review system was created to regulate increases in health insurance rates. Currently, there are two authoritative entities that regulate health insurance including the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). Health insurance companies must submit proposed information on rate increases with either DMHC or CDI. These entities review rate increases and declare whether they are reasonable or not. However, the Insurance Commissioner, Dave Jones, has no authority to reject or approve any planned rate increases. Health insurance plans can voluntarily change rates increases if they are deemed unreasonable, however, the plans can also disregard an “unreasonable” ruling and proceed with planned rate increases.

On July 17, the report from the Legislative Analyst’s Office (LAO) analyzed some potential outcomes of the approval of the proposition. First, if approved, the proposition would require future and current rates to be approved. This means that rates filed after November 6, 2012 must also be approved. It is possible that insurance companies would be required to issue rebates to their consumers if rates are retroactively rejected. It is unclear if rebates would be issued for health plans that are no longer active. The California Public Interest Research Group (CALPIRG) reported 14 rate increases since 2011 that have been deemed unreasonable. Consumer Watchdog calculated this has cost Californians approximately $251 million. Therefore, it is possible Californians could receive rebates if they were enrolled in one of the “unreasonable” rate plans as labeled by CDI.

Additionally, the LAO discussed the future role of DMHC if the proposition were to pass. It is speculated that the responsibilities of DMHC could decrease, as the Insurance Commissioner’s authority grows. If the DMHC branch were to downsize, annual savings in the amount of several hundred thousand dollars would result due to reduction in administration costs. However, the LAO also suggested there could be additional regulatory workload, but no specifics were provided.

While rate regulation is an important aspect of affordable health care and cost containment, it is not without controversy. The ballot measure, sponsored by Consumer Watchdog, has the backing of the California Democratic Party, the Insurance Commissioner, other consumer groups (Consumer Federation of CA, Consumer Attorneys of CA), several unions (CA Nurses Association, United Teachers Los Angeles, California Federation of Teachers), and actor Dennis Quaid. Opponents of the measure include the CA Chamber of Commerce, physician/provider/hospital groups (CA Medical Association, CA Hospital Association, etc), CA Association of Health Plans, and some unions (United Contractors, International Brotherhood of Boilermakers, etc).

The proposition will be on this November’s ballot, and requires a simple majority to pass.


Author: Marina Acosta


Conference Reports

ITUP has prepared reports in preparation for the 18th Annual Statewide ITUP Conference. Featured topics include important issues like the future of the Exchange, the remaining uninsured, children’s coverage, payment reform, health care financing, provider workforce, and the future of substance use disorder services. The following reports will be featured at the conference and are available for download:

Looking Forward

Opportunities and recommendations for the evolution of California’s health care system

Policy Considerations for Covered California

Successes and challenges that the Exchange has faced so far and will face going forward

Toward a Better Medi-Cal Substance Use Disorder Benefit in California- Smart Investments for Improving Lives

Considerations for how to improve Medi-Cal’s substance use disorder treatment benefit

A Vision for Payment and Delivery System Reform: Moving from FFS to Improved Quality, Better Health, and Cost Containment

An inventory of payment and delivery system models by payor

Workforce Development in Healthcare

A discussion of the health care workforce and strategies for its development

California’s Remaining Uninsured

A look at who will remain uninsured, what programs exist to serve them, and what can California do improve access and coverage

Children’s Health Coverage Under the ACA

An analysis of how children are covered in California and recommendations for the evolution of children’s coverage

2014 Health Care Financing Report: Public Programs

Budget and expenditure details for state health care programs

Breaking down the impact of the employer mandate


Additionally, summaries of the ITUP issue and regional workgroups, as well as the Los Angeles Health Collaborative, are available here.


California’s Remaining Uninsured

By 2019, the ACA will reduce the number of uninsured by between 1.8 and 2.7 million people. Despite the significant reduction, between 3.1 and 4 millions of Californians may still lack insurance. There are numerous explanations for why California will have a significant population that will remain uninsured, but this group can be segmented into three categories: 1) undocumented immigrants; 2) individuals who are Medi-Cal eligible but not enrolled, and; 3) individuals eligible for Covered California but not enrolled.

In this series of reports, ITUP identifies who will remain uninsured, what resources are available to them, and how care to the uninsured is financed. The culmination is a set of policy options and recommendations for California to improve and expand access and coverage.

The full report is available for download here: Summary Uninsured: A Population Profile Uninsured: Hospital Financing Reforms Uninsured: Programs, Funding, and Reforms



Register for ITUP’s 18th Annual Conference

18th Annual Conference
Registration for ITUP’s 18th Annual Statewide Conference is NOW OPEN. The conference will be held at the Sacramento Convention Center on February 11, 2014, while the Awards and Networking Dinner will be held at the Citizen Hotel on February 10, 2014 from 6-9pm. (Registration for the Awards and Networking Dinner and the wait list for the dinner are BOTH CLOSED due to capacity)

Confirmed Speakers Include:
John Arensmeyer Founder & CEO, Small Business Majority
Kim Belshé Executive Director, First 5 LA
Diana Dooley Secretary, Health and Human Services Agency
Toby Douglas Director, Department of Health Care Services
Paul Fearer Board Member, Covered California
Jon Freedman Chief of Strategy, Regulatory and External Affairs, L.A. Care Health Plan
Sandra Goodwin President & CEO, California Institute for Mental Health
Scott Hauge President, Small Business California
Mitchell Katz Director, Los Angeles County Department of Health Services
David Lansky President and CEO, Pacific Business Group on Health
Peter Lee Executive Director, Covered California
Peter Long CEO, Blue Shield of California Foundation
Burt Margolin CEO, The Margolin Group
Louise McCarthy CEO, Community Clinic Association of Los Angeles County
David Panush Director of External Affairs, Covered California
Robert Ross President & CEO, The California Endowment
Sandra Shewry Director of State Health Policy, California HealthCare Foundation
Marvin Southard Director, Los Angeles County Department of Mental Health
Alan Weil Executive Director, National Academy for State Health Policy
Lucien Wulsin Executive Director, Insure the Uninsured Project

Download the working draft of the agenda here: Conference Agenda Conference Agenda.pdf
Conference fees:
$175 due by February 3

Click below to register for the conference:

Hotel Information
ITUP has reserved a block of rooms at the following hotels:

Hyatt Regency Sacramento – Reserve Here by January 20, 2014 to secure the rate at $179.

Citizen Hotel –  Reserve Here and enter the group code 1402INSURE by January 22, 2014 to secure the rate at $179. You can also contact the Citizen Hotel at (916)492-4460 and request the Insure the Uninsured Project rate.

In Case You Missed It….

In the past two weeks, ITUP has published a series of posts on the launch of Covered California and the Affordable Care Act. For your convenience, we’ve compiled all of the links onto one page:

Tomorrow is Now: Thought’s on California’s Implementation of the ACA

Forty Years!

Understanding the Government Shutdown

More of This, Please

Finding a Certified Enrollment Entity Near You

Understanding the ACA: an Employee’s Perspective

ObamaCare 101: The Affordable Care Act

ITUP hosted a series of educational trainings entitled ObamaCare 101: An Educational Training on the Affordable Care Act (ACA). During the trainings, ITUP discussed key components of the ACA and provided a comprehensive overview of how health coverage will change in California under health reform. The trainings were held around Los Angeles County for CCALAC (Community Clinics Association of Los Angeles County) member clinic’s frontline staff, other medical providers and community based organizations. This page is a resource for those who attended the trainings and others who find it useful. Another round of trainings will be held in the spring. Information about the spring trainings will be posted as it becomes available. As always, you can email the ITUP team at with questions.

Below you will find materials to help you understand and explain ObamaCare. Enjoy and distribute widely!


Webinars on ObamaCare 101

ITUP hosted two webinars on Medicaid Expansion and Covered California. You can find links to the recorded webinars below:

Medicaid Expansion Webinar

Medicaid Expansion Webinar Slides Medicaid Expansion Webinar Slides.pdf

Covered California Webinar

Covered California Webinar Slides Covered California Webinar Slides.pdf


Written Materials on ObamaCare

You can download all of ITUP’s written materials below:

ObamaCare 101 Tool Kit ObamaCare 101 Tool Kit.pdf L.A. County

Obamacare 101 Tool Kit LITE Obamacare 101 Tool Kit LITE.pdf L.A. County 101 Tool Kit CA.pdf Statewide 101 Tool Kit LITE CA.pdf Statewide Consumer Fact Sheet.pdf ObamaCare Employee Cheat Sheet ObamaCare Employee Cheat Sheet.pdf 101 Presentation Slides.pdf In color

ObamaCare 101 Presentation Slides ObamaCare 101 Presentation Slides.pdf In black & white 101 FAQs (updated) Insurance Cancellation FAQs (updated) California Eligibility and Enrollment Presentation Slides


Where to Go for Help With Enrollment

For those seeking in-person enrollment assistance for Covered California or Medi-Cal, search by zip code.

Videos Explaining ObamaCare 

Training videos are also available, courtesy of the Kaiser Family Foundation:



For more information, including a link to download the video, please visit English, Spanish


There’s An App for That!

To download Covered California’s mobile application, click the links below:

From iTunes:

From Google Play:



This outreach and education project is generously funded by the California Community Foundation and 

L.A. Care Health Plan in partnership with the Community Clinic Association of Los Angeles County


LA County DACA Task Force Workshop – June 22, 2013

This Saturday the LA County DACA task Force is hosting four free legal workshops to assist immigrants under 32 with DACA applications. If you know of immigrants who need to adjust their immigration status in the LA County area please let them know about this event.

 Share this with partners, colleagues, and friends to ensure that 100% of those who qualify for Obama’s Deferred Action program apply. Here is the link and flyer:


Save the Date for the Next ITUP Conference!

The dates are already set for ITUP’s 18th Annual Statewide Conference! Next year, the Awards and Networking Dinner will be held on February 10, 2014 at the Citizen Hotel, while the Conference will be held on February 11 at the Sacramento Convention Center. Mark your calendars, it’s only 10 months away!

Registration for the Conference is now Open!

Registration is now open for ITUP’s 17th Annual Conference, “ACA: The Final Countdown,” which will take place Tuesday, February 5, 2013 at the Sacramento Convention Center. This year we expect over 600 healthcare leaders to attend, including health plans, providers, advocates, employers, unions, and government representatives. The convening of such diverse and influential stakeholders will facilitate collaboration in promoting the efficient and sustainable implementation of health reform.

The evening prior to the conference, Monday, February 4th, 2013, ITUP will be hosting a Networking and Awards Dinner at the Sacramento Convention Center from 6:00 PM to 9:00 PM to honor board members of the California Health Benefit Exchange and for participants to connect and collaborate with ITUP board members, conference speakers, and other colleagues.

To register click HERE!
Register by January 18, 2013 to take advantage of the early registration price!
A working agenda is available for viewing:
Conference Agenda 2013


Confirmed Speakers
Jason T. Andrew, Founder & Chief Executive Officer, SMB & Insurance Associates
John Arensmeyer, Founder & Chief Executive Officer, Small Business Majority
Charles Bacchi, Executive Vice President, California Association of Health Plans
Carmen Balber, Washington Director, Health Access
Dennis Balmer, Deputy Director, Financial Solvency Standards Board, California Department of Managed Health Care
Kim Belshé, Executive Director, First 5 L.A.
Diana Bontá, Chief Executive Officer, The California Wellness Foundation
Alex Briscoe, Director, Alameda County Health Care Services Agency
Richard Chambers, President, Molina Healthcare
James Cruz, Medical Director, Molina Healthcare of California
Diana Dooley, Secretary, California Department of Health and Human Services
Toby Douglas, Director, California Department of Health Care Services
Paul Fearer, Board Member, Covered California
Len Finnocchio, Associate Director, California Department of Health Care Services
Jonathan Freedman, Chief of Strategy, L.A. Care Health Plan
Dean Germano, Chief Executive Officer, Shasta Community Health Center
Sandra Goodwin, President & CEO, California Institute for Mental Health
Betsy Imholz, Director of Special Projects, Consumers Union
Oscar Hidalgo, Communication & Public Affairs Director, Covered California
Ken Jacobs, Chair, Center for Labor Research and Education – UC Berkeley
Howard Kahn, Chief Executive Officer, L.A. Care Health Plan
Mitch Katz, Director, Los Angeles County Department of Health Services
Deborah Kelch, President, Kelch Policy Group
Rachel Klein, Executive Director, Enroll America
Bill Kramer, Executive Director for National Health Policy, Pacific Business Group on Health
Elizabeth Landsberg, Director of Legislative Advocacy, Wester Center on Law & Poverty
Peter V. Lee, Executive Director, Covered California
Peter Long, Chief Executive Officer, Blue Shield of California Foundation
Michael Lujan, Director, Small Business Health Options Program, Covered California
Cindy Mann, Director, Center for Medicaid & CHIP Services
Burt Margolin, President, The Margolin Group
Louise McCarthy, President and Chief Executive Officer, Community Clinic Association of Los Angeles County
Holly Mitchell, California State Assembly
Marian Mulkey, Director of Health Reform & Public Programs Initiative, California HealthCare Foundation
Eric Murray, Senior Vice President, California Association of Public Hospitals
Katherine Neuhausen, Robert Wood Johnson Foundation Clinical Scholar, UCLA Department of Family Medicine
Kathy Ochoa, Service Employees International Union
David Panush, Director of Government Relations, Covered California
Janice Rocco, Deputy Commissioner, California Department of Insurance
Andrea Rosen, Interim Director of Health Plan Management, Covered California
Wes Samms, Health Care Advocate, California Student Public Interest Research Group
Andy Schneider, Consultant
Rusty Selix, Executive Director, Mental Health Association of California
Sandra Shewry, Director of State Health Policy, California HealthCare Foundation
Suzie Shupe, Executive Director, California Coverage & Health Initiatives
Laurie Sobel, Senior Attorney, Consumer Union
Marvin Southard, Director, Los Angeles Department of Mental Health
Darren Urada, Asst. Research Psychologist, UCLA Integrated Substance Abuse Programs
Bill Wehrle, Vice President – Health Insurance Exchanges, Kaiser Permanente
Alan Weil, Executive Director, National Academy for State Health Policy
Micah Weinberg, Senior Policy Advisor, Bay Area Council
Ellen Wu, Executive Director, California Pan-Ethnic Health Network
Lucien Wulsin Jr., Executive Director, Insure the Uninsured Project
Bobbie Wunsch, Consultant, Pacific Health Consulting Group


ITUP’s 17th Annual Statewide Conference is sponsored in part by:

Hotel Accommodations
ITUP has reserved a block of rooms at a discounted rate of $179 at the Residence Inn. Reserve a room by January 25 to secure this rate and call the Residence Inn at (916) 443-0500 and request the Insure the Uninsured Project rate, or click here. Space is limited so please reserve a room fast!

Past Conference Materials
Materials from the 16th Annual Statewide Conference can be found here

The California Business Community Must Engage with Healthcare Reform

[The following blog post was written by Micah Weinberg, Senior Policy Advisor at the Bay Area Council]

The Affordable Care Act took some important first steps toward getting rising healthcare costs under control, but it’s time  to get down to brass tacks.  The Bay Area Council, a business-backed public policy organization devoted to advancing the common good, is stepping up to start actively participating in making federal healthcare reform work.  Our primarily focus is on improving the value that Californian businesses and individuals receive for their healthcare spending.

Here is what we have identified as the most important priorities:

1.      Preserve and Fully Fund Cost-Controlling Elements of Reform:  There are many provisions of the law that aim to bring down costs while improving the quality of care. Cost control is an essential component of healthcare reform, and Congress must fully fund these programs.  California also must continue to innovate in areas such as care coordination and value-enhancing medical technology.

2.      Create an Economic Environment that Rewards High-Value Care: We will continue to take steps to assure that our payments to providers reward quality and affordability and to create appropriate incentives that encourage value-conscious decisions by consumers.  It is important that these incentives be aligned across private and public payers so that the market consistently rewards actions that maximize the health of all Californians.

3.      Build a Successful California Health Benefit Exchange: We look forward to working in close coordination with the Exchange to drive higher quality and cost containment through value-based purchasing and rewarding efficient and coordinated care.

4.      Focus on Initiatives that Promote Patient Safety and Health Outcomes: As healthcare providers and purchasers, we are committed to working across sectors and with policymakers to promote prevention, patient safety and reduce the cost associated with preventable complications and infections, such as sepsis.

5.      Maintain Commitment to Public Health Goals:  The ACA encourages improved health through community-based prevention and public health strategies.  It also envisions an important role for employers through workplace wellness programs.  These initiatives – particularly those focused on addressing obesity and encouraging physical activity – should be supported and scaled up as quickly as feasible building on best practices and proven models.

6.      Provide Greater Transparency and Better Information for All Consumers: Both within and outside of the Exchange, employers and consumers must be able to compare much more easily health plans and products on the basis of quality and price.  Consumers and purchasers should also be able to easily access quality and outcomes data on treatments, providers, and technologies.

7.      Be Good Stewards of Resources by Making Government More Efficient: Reform implementation should make the system simpler and more effective for Californians by determining when programs can be combined and regulatory duplication eliminated.  This is essential within an environment of constrained public resources.  Government also has an important role in supporting the development and dissemination of state-of-the-art information technology and setting common standards that will improve the efficiency of healthcare transactions.

Bay Area businesses have a unique stake in this process.  At the Bay Area Council, our mission is to work with public and civic leaders to make the Bay Area the most innovative, globally competitive and sustainable region in the world.  Rapidly rising healthcare costs are unsustainable and they are compromising our global competitiveness but they can be solved by our innovation.

We must get dramatically more efficient at producing health.  The innovation that will power this change has been pioneered in our region.  Bay Area business models, purchasing strategies, and medical and technological innovation is a critical component of the transformation of our system.

But the Bay Area cannot go it alone.  Leadership is needed from the business community throughout the state to make health reform a priority and reality. We will engage in communication and outreach with corporations, the public, and other stakeholders on the potential of health reform; on how to best maximize its positive attributes; and on state and federal opportunities connected with health reform implementation.

The critical voice of business must support reforms that will enable needed change in today’s healthcare system.