This is ITUP’s 20th and my 70th birthday, and its now time for me to step away for a dynamic new leader (Deborah Kelch, Deborah@itup.org ) to help with building the next steps of health reform for every Californian. We still need coverage for undocumented adults and a financing plan to help them pay for basic coverage. But we need to turn our vision to better health outcomes for those with new insurance. In California over the next year we will have 1.5 million with Covered California and 13.5 million with Medi-Cal coverage according to Governor Brown’s recently proposed budget. We need to begin to reimburse for better outcomes, assure an adequate workforce and delivery system in underserved rural communities and knit our programs together to provide whole person care to those suffering with debilitating mental illness or severe substance addictions. We need to assure that premium increases stay low and out of pocket becomes more affordable.
As I leave, there is so much for all of us to celebrate. In December 2013 before the ACA coverage expansions began, 7.8 million Californians had Medi-Cal coverage. By July 2015, 1.3 million Californians had Covered California coverage and 12.5 million were enrolled in Medi-Cal due to the Affordable Care Act. So we had 6 million Californians with new coverage last summer, and this may reach 7 million over the coming year. Those newly insured need education on how to use their new benefits and coverage so they don’t just go to the local ER.
I began my involvement back in the early ‘70s with clients who first woke my passion to correct one of the great injustices in this nation. At the time I was a recent graduate from the University of Virginia School of Law working for the Greater Boston Legal Services representing clients in East Boston, Roxbury and the South End. I want to thank them for the chance to represent them and share a few stories. One, a Vietnam veteran, got a job, then a letter from the local welfare office that his family’s Medicaid coverage was terminated. I said ‘this must be a mistake, we can’t have a system in this country where you get a job and your family loses health coverage” – the working parent rule that disqualified families if one parent was working full time. He said “don’t worry about me I can get my care from the local VA; I’m worried about my wife and kids”. I replied “ It must be a mistake, I’ll do the legal research and get it taken care of.” I pored over the law books and had to confess that was exactly the system we had in this country and I said “this makes no sense I’ll start working to change it”. I thought it was just a simple policy mistake and would take a few months to correct. It’s taken 40 years. A second was a young woman, a recent college graduate working a clerical job in Boston. She got very sick and couldn’t work until she recovered; her employer laid her off. This was just after Massachusetts terminated all Medicaid coverage for individuals like her; you had to be aged, permanently and totally disabled, a child or a single parent to be eligible, no matter how low your income or how non-existent your resources – that’s the MIA exclusion rule. A third was a nurse, a refugee from a devastating civil war in her own country, legally admitted in this country. When she got sick, could not work and sought to apply for assistance for herself and her family, the local welfare office turned her down saying because her husband was not also disabled, they could get no help – that was the two parent rule that disqualified intact families. A fourth was an artist and a mother who wanted to donate her own organ to save her daughter’s life. The well-respected Boston academic hospital said “you have to give us a check for $100,000 before we perform this operation” – an utter impossibility for this family. The local welfare office had turned her down saying “while we agree you are a US citizen, we don’t think you have legal residence in Massachusetts”. That was just plain wrong and unconstitutional to boot. She got coverage.
I remember my days sitting in the local district court in Dorchester or East Boston waiting for my client’s case to be called (sometimes it was an eviction, sometimes a consumer debt collection) while listening to case after case brought by high priced lawyers representing Mass General or Deaconess Hospital against some poor uninsured family who couldn't possibly pay their huge bill. What was the point of all that?
With the Affordable Care Act in place in California, these stories are ancient history, and let us hope never to be repeated. I recognize that there are persisting political efforts to repeal it, but I do not believe you can or we will un-ring this bell of freedom for millions and millions of Americans. I have to thank President Obama for his leadership and courage that made this possible in my lifetime and to thank Governors Schwarzenegger and Brown for their decisions to implement the ACA in such a path breaking way here in California.
I have many, many people to thank for helping me on this journey. First and foremost my family members who are here, my wife, my sister and my step-daughter and her partner. I come from a very large family; I’ve been blessed with 3 moms (one still living) and am one of 11 children that my father helped raise. My sister Therese has flown in from England to be here with us today. My wife Katie is here; we have been together for almost 16 far too short years; she’s put up with this conference scheduled just after our anniversary and just before Valentine’s Day – no more. I have 4 step children and three grandchildren and another on the way. My step-daughter Lisa and her partner Byron have come up from her day job working with teachers in the Oakland School District just to make sure that I really do actually retire. Dear friends, such as Terry Freidman, Elise Karl and Jim Wheeler, are here tonight to wish me well.
I cannot have survived and thrived in this job without the ITUP family – many current and former staffers are here tonight. I love and thank all of you, but special thanks to Daphne and her family, her sister, and her cousins who have been with me from the very start of ITUP for the last 20 years. Right now we have one of ITUP’s best staffs ever -- which I’m going to miss every day as they transition to our new ED: Marina Acosta, Dora Khoubian, Jeffrey Kim, Lyndsey Nolan, Daphne Radfar and Sara Watson. They are not just wonderful and passionate health policy wonks, but a marathon runner, a biker, a scuba diver, a hiker and two of the world’s fastest moving moms. We have been so fortunate to have Peter Long, Van Ta, Brooke Fox, Adam Dougherty, Ashley Cohen, Kandis Driscoll, Alison Klurfeld, Christine Chen, Kiwon Yoo, Christina Vane Perez, Chauntrece Washington, Michelle Marciniak, Carolina Coleman, John Connolly and so many other wonderful young men and women work here. We want to particularly thank the intern pipeline -- our suppliers from academia: Jeff Oxendine (UC Berkeley’s HCC), Mike Cousineau (USC), Walter Zelman (Cal State LA) and Gerry Kominski (UCLA).
ITUP would never have existed without the support of lots of great friends who helped so much at important points along the way: just to name a few -- Andy Schneider, Burt Margolin, Rick Brown, Lesley Cummings, MaryAnne O’Sullivan, Kim Belshe, Steve Thompson, Jim Lott, Mandy Johnson, John Fredenburg, Lois Salisbury, Sandra Shewry, Wendy Lazarus, Ruth Holton, Tangerine Brigham, Peter Lee, Jim Schultz, Judith Bell, Margie Swartz, Dave Panush, John Ramey, Maria Lemus, Bob Stern, Tracy Westen, Ralph Silber, Joel Diringer, Shawnalynn Smith and Beth Capell. I treasure our past times together and thank you for your support.
What we have tried through ITUP is to build broad collaborations on the hard and really tough choices for the necessary progress on health reform -- among safety net clinics and hospitals; advocates, doctors and health plans; business and labor; counties and the state. We have tried to provide forums to educate and discuss important issues in advance before they become polarized and caricatured: just to name a few recent ones: the §1332 and 1115 waiver opportunities to coordinate Medi-Cal, Covered California and even Medicare; simplifying and integrating child health programs to offer whole child care and whole family coverage; integrating physical and behavioral health to get better health outcomes; developing premium assistance to help with affordability of premiums and out of pocket. At ITUP’s best, I hope we have offended each and everyone of you just a little in the name of forward progress.
I particularly want to thank our funders who have made ITUP possible. Tom David and Gary Yates and Judy Belk, Sandra, Ruth and Padmini from The California Wellness Foundation you believed in ITUP as our founding and longest lasting funder (and helped fund the founding of so many of our partners, what a gift and what vision and foresight). Bob Ross, Joel Diringer, Laura Hogan, and now Fig from The California Endowment, thank you for beginning to fund us in the year 2000 to develop our regional workgroups and local reports that help us to reach nearly every community in California that is struggling to provide excellent care to its low-income residents. Peter Long and Crystal Hayling and Richard, Brenda and Rachel from Blue Shield of California Foundation, thank you for your kind, generous and timely support of our issue workgroups and policy papers, you helped deepen our policy work just as California and the nation debated, decided and implemented coverage opportunities for nearly every Californian. You are number one, our largest funder. Rose Veniegas, Guillermo Flores and the California Community Foundation, our newest funder, thank you for your support of our education and training materials on the ACA and helping to fund the search for a new Executive Director; we so enjoy working with you. Kaiser Permanente we deeply appreciate your support of our workgroups, our reports, our search for a new executive director and the conference; thank you Sherri Novick, Christina Wildlake and Angela Coron, Ryan Yamamoto; we have enjoyed the opportunity to learn so much from your staff who participate actively on our Boards, at the conference and in the issue workgroups. LA Care you have been a partner, a friend and a funder on so many efforts: Healthy Kids, coverage for child care workers, ACA training and behavioral health integration; thank you Howard and Jon, Roland, Shawalyn and John Baackes. Sandra Hernandez, Mark Smith, Chris Perrone, Jill Yegian, and Marian Mulkey the California HealthCare Foundation, deep in your archived files, you will find that you were one of our earliest funders as well; we appreciate your ongoing support of our work on behavioral health, and the executive director search. ITUP looks forward to continuing to work together with all of you and Deborah Kelch, our new Executive Director.
I cannot say thanks too many times to Howard and our whole Board: Jim Lott, Laura Hogan, Tangerine Brigham, Richard Chambers, Sharon Levine, John Arensmeyer, Barbara Garcia, and Lesley Cummings. You have been a steady support and guide for ITUP and I specially appreciate your yeoman’s work and wisdom in finding us a spectacular new executive director to replace me. Howard, I particularly appreciate your timely retirement from LA Care, just so you could devote full time to ITUP’s transition and my succession. Our Board of Advisors has been with us for over 15 years and meets quarterly and annually to discuss, assess and plan ITUP’s priorities. You have all played such key roles in the incredible progress California has made. Thank you so very much. Our Leadership Council consists of the new generation of California’s health leaders, individuals who are on the ground implementing the ACA, who tell us without any filters what is working, what is not and why. Will you all join me in thanking our Boards, funders and staff?
As for my next steps, I’d like to do some training and teaching on the ACA, some consulting and some writing on California’s implementation; we will see how that works out. I hope to never again have to let a staffer go or see them leave far too soon, that’s been the hardest part of this job for me and one I’m so happy to leave behind. Most of all I look forward to being home every day with Katie, the kids, the grand children and the doggies. For those of you who would like to do so, please stay in touch and join me for a good talk and walk if you are in LA. All the very best, and so many thanks to each of you for the vital work you have done and will do for California.