Author: ITUP

ITUP ACA Watch, Issue 2 — Congressional Budget Office Scores the American Health Care Act

The second Issue in the series provides information and analyses on the independent, nonpartisan Congressional Budget Office (CBO) review of the American Health Care Act (AHCA). The GOP proposed AHCA would dismantle significant portions of the federal Affordable Care Act. This ACA Watch describes key provisions of the AHCA and highlights the CBO’s most significant findings. Notably, CBO projects dramatic increases in the number of uninsured nationwide.

Download ACA Watch, Issue 2 here

Where Should We Be Going?

The Affordable Care Act (ACA) created a hybrid with many moving parts: incorporating employer mandates, individual responsibility and refundable tax credits (shared responsibility), and a Medicaid expansion. It is unclear which parts over time will give way to others. Some predict the demise of employment-based coverage; there is no evidence that is happening.  Others predict death spirals in the individual market where only the very ill participate; there is no evidence of that either.  So far there appears to be a steady equilibrium between employment-based coverage, the Medicaid expansion, and the individual market Exchanges; employment-based coverage is holding steady while the Exchanges and Medi-Cal grow to cover the uninsured. Both the young and middle aged are participating in the Exchanges.

The ACA shifts the delivery system away from the hospital emergency room towards primary care and prevention. It builds incentives for plans and providers to improve quality and outcomes.  It creates important incentives to restrain the growth in health spending.  In the following report, we highlight where we should be going with health reform implementation and where we are at in the present.

Download the full report here: Where Should We Be Going?


California’s §1115 Waiver Renewal

California’s §1115 waiver recently expired on October 31, 2015, and HHS granted a temporary extension of the waiver until December 31, 2015.  On October 31, 2015, DHCS and CMS announced
a conceptual agreement that outlines the major components of the waiver renewal. There are several improvements in the renewed waiver, while also room to continue to improve the MediCal
program. Highlights of provisions in the new waiver, known as Medi-Cal 2020 are included in this ITUP report.

Download ITUP’s full report here:  California §1115 Waiver Renewal

10 More Reasons to Attain Health Insurance Through Covered CA

Open Enrollment closes tomorrow! For those that need a last minute nudge, here are 10 more reason why you should get covered!

1. Because you will need a Doctor’s note when you call into work sick and go fishing instead

2. In case your new belly piercing gets infected

3. Because you need glasses to watch movies on your Iphone

4. So you don’t have to make a choice between setting your broken leg or buying a new snow board after your awesome crash

5. Your asthma is keeping you from achieving the Genius Book of World Record for underwater belching

6. Because giving up your morning triple shot toasted coconut and salted caramel macchiato would make life not worth living

7. You need professional help when your friend refuses to help you put that stuff on your gnarly toenail fungus again

8. When an ambulance ride to the ER cuts into the vacation fund that you saved by eating nothing but ramen noodles (the freeze-dried kind) for the past two years

9. When you eat a habanero pepper (with seeds) that your ex-friend told you was “not hot at all” and now you have a hole in your tongue the size of a jawbreaker!!!!

10. Because all the cool kids have CoveredCA Health Insurance Cards!

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.



ITUP 2015 Conference

ITUP’s 19th Annual Conference and Awards Reception were held on February 17, 2015 at the Sacramento Convention Center.

Download the agenda here: Conference Agenda

conference 2015 save the date half

Conference Evaluation Form 

We are all about quality improvement, so please fill out our evaluation form and let us know what you thought went well and what we could do better. We appreciate your feedback!

Evaluation Form 


Conference Photos

These photos from the 2015 ITUP Conference and more, are posted on our facebook page.

Conference Materials

ITUP has prepared reports in preparation for the 19th Annual Statewide ITUP Conference. Featured topics include important issues like Medi-Cal managed care, the remaining uninsured, premium assistance, Covered California, 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:

Where Are We Going

Solo and Small Group Physician Practices in California

2013 OSHPD Clinic and Hospital Data Summaries

Medi-Cal Managed Care: Raising the Bar for Quality and Outcomes

These reports and the rest of the materials contained in the conference binder are available for download.

Session Notes

Medi-Cal_All Your Questions Answered – Jennifer Kent and Mari Cantwell, California Department of Health Services

Covered California – Peter Lee

National Perspective– Neera Tanden, Center for American Progress

Future of Reform – Massachusetts Panel

Special Populations Behavioral Health

Payment & Delivery System Reform: Public Sector

Payment & Delivery System Reforms: Private Sector

Remaining Uninsured: Provider Counties

Remaining Uninsured: Payor Counties

Health Information Exchanges and E-medicine


2015 Conference Teaser Slides

Awards Dinner Slides

Medi-Cal Managed Care

Remaining Uninsured – Payor Counties


Remaining Uninsured – Provider Counties

Community Health Partnership (CHP) Member Health Centers and Santa Clara County – Dolores Alvarado, Community Health Partnership, Santa Clara County

Remaining Uninsured – Payor Counties

Remaining Uninsured: Orange County – Isabel Becerra, Coalition of Orange County Community Health Centers

Pre – Post ACA Hospital Utilization Experience – Jon Gilwee, UC Irvine Health

Recommendations for Delivery System Reforms and Financing Care for the Remaining Uninsured – Henry Tuttle, Council of Community Clinics – San Diego

Payment and Delivery System Reforms

Getting There Together: Creating Sustainable Value Through New Partnerships – Kristen Miranda, Blue Shield of California

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

San Diego Health Connect Overview – Daniel Chavez, San Diego Health Connect

Future of Reform

Changing Our Stripes: Health Centers & Health Care Reform – James Hunt Jr., Massachusetts League of Health Centers

Health Reform in Massachusetts: From Coverage to Costs – Kate Nordahl, The Blue Cross Blue Shield of Massachusetts Foundation

The Future of Reform – Thomas P. Traylor, Boston Medical Center

2016 Conference

ITUP has also started planning our 20th Annual Conference, which will be held on February 8 and 9, 2016. To help us plan another thoughtful and informative conference, we welcome thoughts on speakers and topics of interest. Please email Daphne Radfar at The deadline for all submissions is June 1, 2015.

  2016 Conf sae date website

ITUP’s programs and conference are funded by:








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.