Author: ITUP

The Evolving Safety Net in Southern California: Building New Models of Care for the Remaining Uninsured

Throughout the summer of 2014, ITUP met with health care leaders in Southern California to discuss caring for the remaining uninsured post-ACA implementation, building consensus and strengthening collaboration. Through one-on-one interviews with stakeholders, county-specific meetings bringing together a myriad of stakeholders, and extensive data analysis, we prepared in-depth reports on organizing care and coverage for the uninsured in Los Angeles, Orange, San Diego, Kern, Riverside, and San Bernandino counties. The project, funded by the California Wellness Foundation, resulted in a summit of key leaders from across the six counties in October.

This page is a resource for participants in the project. The documents below are password protected (participants have been emailed the password), however additional reports available to the public are forthcoming.

Summary of Ideas for Discussion

Consolidated Summary of Remaining Uninsured Meetings

Community Clinic Data

Hospital Data


Public Reports:

For a detailed overview of the remaining uninsured and policy options to cover them, see ITUP’s series on the remaining uninsured.

For information on models of financing care for the undocumented, see ITUP’s report.



Register for ITUP’s 2015 Conference

Register Now

ITUP’s 19th Annual Conference will be held on February 17, 2015 at the Sacramento Convention Center. The Awards and Networking Dinner will follow the conference.


conference 2015 save the date half



February 17, 2015 Conference at the Sacramento Convention Center:

This year’s conference will focus on the next steps to build on the initial successes of ACA implementation in California.

Conference sessions will review how Covered California and the Medi-Cal expansion are working and discuss how they should evolve for the newly insured and already insured. Questions that speakers and panelists will explore include: How do we improve health outcomes for the newly insured? How do we design and build care and financing for the remaining uninsured? How do we integrate/coordinate care? How do county and state health programs evolve? What can we learn from other states? What is our long-term vision for health reform?


8:45 AM                Welcome and Introduction

Lucien Wulsin, Executive Director, Insure the Uninsured Project
Howard KahnBoard Chair, Insure the Uninsured Project


9:00 AM                Medi-Cal – All Your Questions Answered

California’s Health and Human Services Agency and Department of Health Care Services will discuss California’s implementation of the Affordable Care Act’s Medicaid Expansion, the managed care expansions, and the waiver renewal.

Diana Dooley, Secretary, California Health and Human Services
Mari Cantwell, Deputy Director Health Care Programs, California Department of Health Care Services
Burt Margolin, President, Margolin Group (Moderator)


10:00 AM               Covered California – What’s Next?

Covered California will discuss lessons from the most recent open enrollment period, plans for the future of Covered California, intersections with Medi-Cal and employment-based coverage, and payment and delivery system reforms.

Peter V. Lee, Executive Director, Covered California
Burt Margolin, President, Margolin Group (Moderator)


10:45 AM               Break


11:00 AM                Morning Breakout Sessions:

  • Special Populations – Behavioral Health

This panel will discuss California’s care and treatment for mental illness and substance use disorders, outcomes and program accountability, the behavioral health waiver, and how behavioral heath services should be coordinated/integrated with each other and with physical health services.

Clayton Chau, Medical Director Behavioral Health, L.A. Care Health Plan
Brenda Grealish, Chief, Mental Health Services Division, California Department of Health and Human Services
John Lozier, Executive Director, National Health Care for the Homeless Council
Jenny Montoya Tansey, Project Director, Health Matters, Californians for Safety and Justice
John Connolly, PhD, Deputy Director, Insure the Uninsured Project (Moderator)


  • Remaining Uninsured – Provider Counties

This panel will outline recommendations for delivery system reforms and financing care for the remaining uninsured in those counties with public hospitals and clinics. This will include collaboration and partnerships among public and private clinics and hospitals in caring for the uninsured; the design and renewal of California’s §1115 waiver, and interfaces between Medi-Cal managed care and safety net care to the uninsured.

Mitchell Katz, Director, Los Angeles Department of Health Services
Alex Briscoe, Director, Alameda County Health Care Agency
Colleen Chawla, Deputy Director and Director of Policy and Planning, San Francisco Department of Public Health
Dolores Alvarado, CEO, Community Health Partnership, Santa Clara County
Burt Margolin, President, Margolin Group (Moderator)


  • Remaining Uninsured – Payor Counties

This panel will discuss their recommendations for delivery system reforms and financing care for the remaining uninsured in those counties with private safety net hospitals and clinics.

Henry Tuttle, Chief Executive Officer, Council of Community Clinics-San Diego
Isabel Becerra, Executive Director, Coalition of OC Community Health Centers
Jon D. Gilwee, Executive Director, Government Affairs, UC Irvine Health
Lucien Wulsin, Executive Director, Insure the Uninsured Project (Moderator


12:15 PM                Lunch     


12:45 PM                  Keynote Speaker
United States Congressman Xavier Becerra – California’s 34th Congressional District


1:30 PM                  Featured Speakder: National Perspective

Neera Tanden, President, Center for American Progress
Burt MargolinPresident, Margolin Group (Moderator)


2:30 PM                  Afternoon Breakout Sessions:

  • Payment and Delivery System Reforms – The Private Sector

This panel will discuss the implementation of direction of payment and delivery system reforms in commercial markets.

Ann Boynton, Deputy Executive Officer of Benefit Programs, Policy, & Planning, CalPERS
Jeffrey Rideout, Chief Medical Officer, Covered California           
Kristen Miranda, Vice President, Strategic Partnerships & Innovation, Blue Shield of California
Thomas M. Priselac, President & CEO, Cedars-Sinai Health System
Sharon Levine, Director and Senior Advisor for Public Policy, Pharmacy and Professional Development, The Permanente Medical Group
Richard Chambers, President, Molina Health Care (Moderator)


  • Payment and Delivery System Reforms – The Public Sector

This panel will discuss the implementation of direction of payment and delivery system reforms in public sector programs such as Medi-Cal, Medicare, and county health.

Mari Cantwell, Deputy Director Health Care Programs, CA Dept. of Health Care Services
Jon Freedman, Chief of Strategy & Government Relations, L.A. Care Health Plan
Alan McKay, Chief Executive Officer, Central Alliance Health
Castulo De La Rocha, President & CEO, AltaMed Health Services
Lucien Wulsin, Executive Director, Insure the Uninsured Project (Moderator)


  • Electronic Health Records, Health Information Exchanges, and E-medicine

This panel will discuss the importance, progress, and future evolution of advances in information technology in health care

Patricia M. Connolly, Associate Executive Director, The Permanente Group
William Henning, Chief Medical Officer, Inland Empire Health Plan
Daniel Chavez, Executive Director, San Diego Health Connect
David Watson, CEO, CalIndex
Sophia Chang, Chief Program Officer, California HealthCare Foundation (Moderator)


3:45 PM                   Break


4:00 PM                  Future of Reform

Speakers from other states will describe the arc of their reform efforts. Then panelists will discuss the options for future reform efforts in California.

Tom Traylor, VP of Federal, State and Local Programs, Boston Medical Center
James W. Hunt, Jr., President, Massachusetts League of Health Centers
Cheryl Bartlett, Commissioner, Massachusetts Department of Public Health
Hector Flores, Chair, Department of Family Medicine, White Memorial Medical Center
Peter Long, President, Blue Shield of California Foundation (Moderator)



February 17, 2015 Awards Reception and Dinner  (5:30 PM)

After the conference, ITUP will host an Awards Reception and Dinner.

This year we will be honoring exemplary leadership in community health.




Materials from the 18th Annual ITUP Conference are available here.

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!