1. CO-OPs Work in Ag, Can They
Work In Health Care Too?
Presented February 23, 2012 by Ed McClements, CLU, ChFC

2.  Guaranteed Insurability Regardless of Health
 Individual Mandate to Buy Coverage
 Unlimited Benefits (no Annual or Lifetime Caps)
 Plans Must Meet/Exceed Essential Benefit Levels
 Large Employer (50+) Mandate to PLAY or PAY*
*refers to a $2,000 per employee per yr. non-deductible tax
penalty to the employer if they do not offer employees
Essential Benefit plans with “Bronze Coverage” Level
Do You Have a Plan
to Deal With This?
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3. Although many hope that these health care reforms will be
eliminated before they go into full effect, it is looking less
and less likely this will occur…
 U.S. Supreme Court is set to rule this Summer on
the constitutionality of the Law
▪ Prediction* 1 – Individual Mandate Unconstitutional (5-4 vote)
▪ Prediction* 2 – The REST of the Reform STAYS
 Republicans Sweep Elections (unlikely but possible)
▪ Still questionable if Affordable Care Act is greatly altered
* STRICTLY my best informed opinion –
it carries NO legal force or effect!
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4. It is estimated that California’s agricultural
labor pool is about 400,000 workers
 WGAT had 19,697 as of 6/30/2010
 UABT had 12,789 as of 12/31/2010
 Self Funded Employer Plans (unknown but
unlikely to exceed 100,000 total participants)
Bottom-Line: An estimated 2 out of 3
farmworkers have no employer
provided health benefits
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5.  In 2014, plans with Annual Benefit Caps will no longer be
eligible for WAIVER status
 For example: instead of limiting losses at $25,000 per person
per year, these plans will need to offer UNLIMITED benefits
 Ag Associations are working hard to extend that deadline
Bottom-Line: Higher (possibly MUCH higher)
costs for these programs
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7. • Time off from work only taken for medical emergencies
• Location of medical services can be inconvenient
• Office hours for appointments are inconvenient for most
• Typical health plans have out-of pocket costs that are too high
• Current public programs (MediCal, etc.) raise concerns over
documentation issues (Deficit Reduction Act of 2005 requires
proof of citizenship / immigration status)
• County & State budget cuts make getting uninsured care harder
• New health insurance EXCHANGES not available to
undocumented workers
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8. True INNOVATION in
health care delivery
to drive down cost
and drive up access
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9.  Lowest Possible Cost
 High Quality Medical Clinics
 The New Essential Benefit Levels
 Easy Access to Medical Care
 Offer Low Cost Prescriptions
 Non-Profit and Member Run Structure
 HEAVILY Invest in Preventive Care
 No Requirement for Immigration Documentation
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10.  Instead of LARGE (and expensive) PPO networks, we
need to create a primary care network out of the top
SAFETY-NET clinics around the state
▪ Federally Qualified Health Care Centers
▪ Many awarded Joint Commission Quality Awards
▪ Proven dedication to Latino population
 Roll Mobile Medical Clinics to worksites
 Provide access to the MediCal Rx discount program
 Make it free and easy to get preventive care
 Make the whole program non-profit and member run
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11.  Provide each participant with a “Medical Home”
 Link primary care with specialists & ancillary medical services
 Work with HRSA – Health Resources Service Administration
 Federally Qualified Health Centers
 Rural Health Centers
 Carefully selected regional hospitals
 Use existing Mobile Medical Clinics / purchase if needed
 Reliance on Promotores to encourage
preventive health practices within
the population
* Exclusive Provider Organization
• Like a PPO, but a lot smaller
• Unlike an HMO, an EPO has no gatekeepers
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12. This Network IS PROPOSED. None of the above clinics have
committed to participate, since the CO-OP is still in its formation stage.
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13. Make it easy
for workers to
see a provider
Large groups create
economic efficiencies
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15.  The ACA provides for Consumer Operated and
Oriented Plans (CO-OPs)
 Dept. of Health & Human Services has $3.8 Billion
to lend (with low interest rate loans) to non-profit
groups for CO-OP formation (with a goal of at least
one CO-OP in each state)
 CO-OPs are like Credit Unions for health insurance
 We intend to use the Federal CO-OP funding
program to launch our new style of health plan
According to multiple
sources, we may be the
ONLY one in Calif. 15

16.  New Non-Profit Mutual Benefit Corporation
 Ag focused formation board
 Eventually, a member run health insurance company
 Created for the ACA CO-OP funding opportunity
 Seeking start-up and solvency loans from HHS
 Target underserved hourly wage workforce
 Focused on Latino cultural needs
 California initially but seeking multi-state growth
 Dramatically different from current health plans in
management, design and delivery
10% of premiums dedicated to prevention
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17. Operational
Health Insurer
by 1/1/2014
HHS/CMS
Funding Award
(mid 2012)
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2/23/2012

18.  Obtained CA approval of Articles of Incorporation for non-profit
 Currently have 14 Board / 6 Advisory commitments
 Held 3 Board of Directors meetings
 Approved initial by-laws
 Opened bank accounts
 Named Chair/Vice Chair/Sec. Treasurer/ Exec. Dir.
 Hired Milliman as actuarial consulting firm
 Hired top law firm for DOI regulatory assistance
 Hired public health policy / grant writer
 Initiated discussions with select providers
 Have raised most initial funding needed for HHS application
Filing formal application
prior to April 2, 2012
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19. Name Title Company
Ed McClements Sr. Vice President Barkley Insurance & Risk Management
Al Barkley CEO Barkley Insurance & Risk Management
Hacia Salud Roger Boman CEO Transwestern Ins. Administrators
George Ekizian President Ekizian & Associates Ins. Services
By-Laws call Rudy Avila HR Director Jaguar Farm Labor Contracting
Lynn Grayson CFO Boskovich Farms
for 15 Board Ron Hayduk President Coastal States Insurance Services
Lori LeSuer CFO Villa Park Orchards
Members Santiago Martin, Jr. President Cal Ag Resources
Glen Michael Managing Partner Benefits Administartion & Insurance Servicecs, LLC
Roy Nishomori President San Miguel Produce, Inc.
Juan Uranga Executive Director Center for Community Advocacy
Jerry Van Winderden President Westland Floral
Mark Weighall Agribusiness Controller Pandol Bros., Inc.
Matt Conroy President Conroy Farms
Henry Vega President Coastal Harvesting
Keith Ford President Ocean Breeze Ag Management
Rene Van Wingerden President Ocean Breeze International
Lenny Villagomez President All Ag
Tim Finster President CAPAX
Executive Director Board Members Advisory Members
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20. • CO-OP rules require that the majority
of the Operational Board be
comprised of members in the CO-OP
• Transition from Formation Board to
Operational Board must be completed
within 2 years of first membership
• Each “Care Area” will elect a regional
representative
• Care Area with greatest membership
will be able to seat the 8th regional
representative
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21.  Medical Provider
 Legal
 Insurance Management
 Insurance Distribution
 Labor Advocate
 Employer
 At Large
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22. • Each Care Area will have a Care
Committee (9 elected plan participants
+ a Hacia Salud representative
+ a local provider representative)
• Care Committees meet monthly
• Care Committees will oversee the
coordination of the preventive care
expenditures in their region
• Care Committees will oversee
development and funding of
PROMOTORES programs locally
• Care Committees will also oversee
community outreach funding
“life-changing-grants”, and
other health-focused programs
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23. Preventive Care
Budget
Care Area 1 - San Diego/Riv/SanBer/Imp $2,328,663
These
Care Area 2 - LA and OC $7,594,162
figures
Care Area 3 - Ventura and Santa Barbara $2,482,750 are
Care Area 4 - SLO and Monterey $5,692,454 expected
Care Area 5 - South San Joaquin Valley $3,381,014 to
Care Area 6 - Northern Cal $1,141,689 DOUBLE
Care Area 7 - Bay Area $2,282,125 in 2015
TOTAL First Year Preventive Care Budget $24,902,858
Participating clinics will be directly involved with the
planning for the use of these funds in their regions of
operation
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24.  October 15, 2011 – Letter of Intent to HHS
 November 1, 2011 – Selection of grant writer
 November 15, 2011 – Selection of actuary for feasibility study
 December 31, 2011 – CA certification of Articles of Inc.
 February 15, 2012 – First draft of feasibility study
 March 15, 2012 – Final application draft complete
 March 20, 2012 – Submission of application (deadline is 4/2/2012)
 June 15, 2012 – Notification of approval or denial of application
 August 1, 2012 – If approved, start-up funding begins: hiring of
core staff, begin contracting provider network, etc.
 December 1, 2012 – Ins. Co. application to CADOI
 June 1, 2013 – License approved
 August 1, 2013 – Launch public awareness / marketing campaign
 September 1, 2013 – Issue initial rates
 January 1, 2014 – First plan participants
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25.  All Hacia Salud Plans will be fully
compliant with ESSENTIAL BENEFIT
LEVELS (not yet defined for California)
 Target pricing for Bronze Level Benefits is
<$200 per month per individual
(up to age 39) in most areas of California
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26.  Hacia Salud will be operational January 1, 2014
 Hacia Salud will offer Bronze /Silver / Gold /
Platinum benefit levels to both the Individual
and Small Employer (SHOP) Exchange
 Hacia Salud will also offer the general public
access to the same plans that are available in the
exchanges
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27.  Our Estimate for total enrollment statewide:
 141,000 total participants by the end of 2014
 226,000 total participants by the end of 2015
 Our initial target for enrollment was within 5% of
the growth target established by our
independent actuary

28. In addition to farmworkers…
 Restaurant workers
 Hotel workers
 Janitorial Service employees
 Manufacturing workers
 Garment Industry workers
 Construction workers
 Landscapers
 Small business employees
 Individuals in need of low cost
& high value coverage
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29. State Organization Name Award Total
IA & NE Midwest Members Health $112,612,100
MT Montana Health Cooperative $58,138,300
NJ Freelancers CO-OP of New Jersey $107,213,300
NM New Mexico Health Connections $70,364,500
NY Freelancers Health Service Corporation $174,445,000
OR Freelancers CO-OP of Oregon $59,487,500
WI Common Ground Healthcare Cooperative $56,416,600
Total Awarded So Far $638,677,300
Earmarked Funding for Entire CO-OP Formation Program $3,800,000,000
Percentage Awarded So Far 16.807%
Potentail Funding Still Available $3,161,322,700
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30.  Can Hacia Salud help you:
▪ Understand how employer Play or Pay rules are likely to
impact your company?
▪ Create a strategy to deal with the expected changes to
health care in 2014?
 Can you help Hacia Salud:
▪ Submit a letter of support?
▪ Connect with a Community Clinic you use and can
recommend?
▪ Contribute financially to the formation effort?
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31. For more information, contact:
Ed McClements, CLU, ChFC
Sr. VP – Benefits for Barkley Ins.
Exec. Director – Hacia Salud CO-OP
(949) 232-9178
emcclements@haciasalud.org
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