New Health Access Report Details Dramatic Expansions in California’s County Health Care Safety-Net

Today, Health Access released a new report detailing the dramatic changes to California’s health care safety net programs at the county level. As the Affordable Care Act implementation has cut the number of uninsured Californians in half and the state has taken additional steps to cover all children, many California counties have extended their health care safety net programs to better serve the remaining uninsured. Counties have responded in various ways, from expanding coverage options to undocumented immigrants to providing new benefits to those already covered. A year ago, less than ten counties served undocumented Californians outside of the emergency room; on Monday, that number will expand to 47 counties.

On Monday, more Californians in 35 of the state’s most rural counties will be able to benefit from the latest expansion of the County Medical Services Program (CMSP) which includes virtually all the counties north of the Bay Area and Sacramento to the Oregon border and many in the Sierra Nevada mountains and in the Central Valley. CMSP is expanding eligibility in its main indigent care program, including raising the income level from 200% to 300% of the federal poverty level ($60,480 for a family of three). CMSP is also offering a new limited primary care benefit of three doctor visits and some pharmacy coverage to those in its program, as well as to residents (138-300% FPL) regardless of immigration status. Potentially thousands of Californians will benefit from these expansions, as well as those of other counties that have launched similar pilot programs in the last year.

Health Access’ new report, “Profiles of Progress: California Counties Taking Steps to a More Inclusive and Smarter Safety-Net,” examines the expansion in the County Medical Services Program (CMSP) along with an in-depth analyses of how six other counties adjusted their safety net programs in response to changes in need and funding. These counties include: Contra Costa, Los Angeles, Monterey, Sacramento, Santa Clara, and Fresno.

While the Affordable Care Act has gone a long way to provide new coverage options, it has been left to California and its counties to figure out how to provide care for the remaining uninsured, including those explicitly excluded from federal help due to immigration status. Taking their responsibility seriously to provide health care to the remaining uninsured, more and more California counties are thankfully taking steps to a more inclusive and smarter safety-net. This month’s expansion in 35 rural counties of primary and preventive care is another step forward to a healthier California. Thousands of Californians are benefitting from these new pilot programs, but there’s more work to do in many counties and statewide to further expand and strengthen our health system on which we all rely.

Speaking on a press conference call today were county leaders, advocates and individuals, including County Supervisors that recognized the broader benefits and policy rationale for these expansions. The report and the press conference call also highlighted the grassroots advocacy that helped bring about this rapid change.

The report predicts that additional California counties will also launch similar efforts in the near future, especially under new financial structures under both state law and the new federal Medicaid waiver and its Global Payment Program, which has incentives to offer preventive care and other treatments prior to the need for emergency or episodic care. In turn, these actions at the county level also provide additional momentum at the state level for inclusive health policies.

Budget Focus at Covered California Board Meeting

This post was written by Kate Burch

The Covered California board meeting on May 12 addressed several controversial issues. You can find a recording of the board meeting, links to the presentations, reports, proposed regulations, attachments, and other materials here.

Market Analysis

Covered California contracted with PwC for an in-depth analysis of the direction of the health insurance market over the next 6 years. The presentation to the board included information about enrollment projections with different scenarios (major changes to the economy, change in subsidies, change in minimum wage, etc.). Covered California used the projections and scenarios from this research to make their enrollment and income projections for the coming years. These projections are an important part of how Covered California budgets for future years.

Budget Proposal

Covered California staff presented a proposed budget to the Board. The coming fiscal year will be the first year that Covered California is operating without any federal funding, relying solely on their reserves and the fees assessed from participating health plans for their funding. The proposed 2016-2017 budget is $308 million, which is $25 million lower than the 2015-2016 budget. These are some of the changes expected in the 2016-2017 budget.

  • Previously, health plans were paying a flat per member per month fee. Beginning in 2017, plans will pay 4% of the premium for the individual market.
  • 2016-2017 will be the last year that Covered CA has a call center in Contra Costa County; in future years they will rely on two call centers rather than three.
  • Covered California proposes ending their relationship with the Health Consumer Alliance, and instead instituting an ombudsman program to help resolve consumer issues independent of the service center.
  • Funding for the Navigator Program was cut to $5 million, down from both the $13 million approved in the 2015-2016 budget and the $10 million actually awarded to Navigator Grantees.

Consumer advocates provided extensive comments. The two main areas of interest were the relationship with Health Consumer Alliance and the reduced Navigator Program. Advocates emphasized the importance of an outside entity providing consumer assistance in certain complicated cases, which will no longer happen if Covered California ends their relationship with Health Consumer Alliance. Establishing an ombudsman program within Covered California will be insufficient to replace the work of the Health Consumer Alliance.

Consumer advocates also spoke strongly in support of the Navigator Program. Certified Enrollment Counselors called in to the board meeting to express the importance of the individual assistance they are able to provide. Advocates spoke in favor of funding the Navigator Program at the same level as last year, if not higher, and strongly opposed cutting the funding in half.

The budget was presented for discussion; Covered California staff will present a final version of the budget for board approval in June.

Navigator Program

Covered California staff provided an update on the success of the Navigator Program this year. Navigators provide outreach, education, enrollment assistance, renewal assistance, and post-enrollment support, and specialize in reaching and supporting some of the hardest to reach populations.

During Open Enrollment 3, Certified Enrollment Counselors in the Navigator Program enrolled, renewed, and retained 77,154 people.

Covered California staff recommends inviting 46 of the current 68 Navigator Grantees to renew their Navigator contract for 2016-2017. The 46 organizations that Covered California wants to continue as Navigators had an average cost of $166 per enrollment/renewal, and the organizations that will not be invited to renew their contracts had an average cost of $575 per person assisted.

Covered California recommends a target of $200 per person assisted. With a recommended funding level of $5 million, Covered California anticipates the Navigator Program helping 25,000 people in 2016-2017, which is 50,000 fewer people than in 2015-2016.

Special Enrollment

The Covered California Board approved the Individual Eligibility and Enrollment Regulations for re-adoption that were presented at the April board meeting. Within those regulations, the Board approved making changes to the Special Enrollment policy.

For the remainder of 2016, Covered California will require that a statistically significant random sample of people enrolling during the Special Enrollment Period provide documentation to prove the qualifying life event (QLE) that they attested to. If Covered California can’t verify the QLE, the individual will be ineligible to enroll during the Special Enrollment Period. Covered California will evaluate the results of their random sample to get a clearer picture of what is actually happening with the population that enrolls outside of Open Enrollment.

The changes adopted do not reflect the new federal interim final rule issued on May 6 that imposes new requirements on people who are eligible because of a permanent move. We can expect to see further updates to the eligibility and enrollment regulations in future months to align with the new federal regulation.

Language on the application will more strongly explain consumers’ financial liability for incorrectly attesting to a qualifying life event, and will require that consumers acknowledge that they might be asked to verify their qualifying life event.

Hundreds Gather at Capitol to Support #Health4All

On Monday morning, hundreds of health and immigrant rights advocates convened on the steps of the Capitol to rally in support of “Health For All,” press legislators to pass bills like SB 10 (Lara) and SB 1418 (Lara), and celebrate the historic first day of expanding comprehensive Medi-Cal to undocumented children in California.

The “Health4All” rally and lobby day was on the same day of the implementation of “Health4All Kids,” a measure allowing all low-income children, regardless of immigration status, to enroll in full-scope Medi-Cal (California’s version of Medicaid). Starting May 16, all income-eligible children have access to comprehensive, zero-cost or low-cost Medi-Cal benefits, including dental and mental health coverage as well as the full array of health benefits.

Advocates also called on legislators to take action for the undocumented adults and families who remain excluded from health coverage. Moved by the passage of last year’s historic “Health4All Kids” measure, advocates are now urging lawmakers to provide coverage to their families and undocumented adults through bills currently moving in the legislature such as SB 10 and SB 1418. The Health4All Coalition continues to advocate for expanding full-scope Medi-Cal to all low-income undocumented adults and allowing undocumented immigrants to purchase coverage through Covered California.

Here are the comments of our Executive Director Anthony Wright:

Below are other comments from a range of Health4All coalition partners:

“Allowing all Californians to buy health insurance through Covered California regardless of immigration status would make our health system stronger; California should conform our custom of inclusion, and seek a waiver from this counterproductive exclusion in the federal law. This proposal is not just a benefit for working immigrant families to more easily sign up for coverage, but would be a boon for the health system on which we all rely. We are all better off if we all have access to primary and preventive care and the financial security that comes with coverage,” said Anthony Wright, executive director of Health Access California, the statewide health care consumer advocacy coalition

“Today’s Health4All lobby day is an affirmation of the momentum and support behind building an inclusive vision of health care, so that no one is excluded from coverage, no matter where they were born. With today’s first day of enrollment to full-scope Medi-Cal coverage for undocumented children, we celebrate a historic first step in the fight for Health for All. Now we call on our legislators to support SB 10 and SB 1418 so that undocumented adults and mixed-status families across California can access health coverage and enroll together. California is stronger when everyone is covered,” said Cynthia Buiza, Executive Director, California Immigrant Policy Center.

“Today marks a major milestone for thousands of immigrant families and for the future of California. The expansion of health coverage to every low-income child in California, no matter where they were born, is an investment in their ability to learn today and contribute to our communities tomorrow. And as we celebrate this important victory, we must recognize the work is not complete until all family members can enroll in quality, affordable coverage. If we want every child to have a bright future, let’s provide coverage to all Californians, regardless of immigration status,” said Mayra E. Alvarez, President, The Children’s Partnership.

“California is built on the dreams of immigrant families in search of a better future for their children,” said Alex Johnson, Executive Director, Children’s Defense Fund-California. “Now these children will have the health coverage they need to survive and thrive. California is taking a historic step to level the playing field so that all children in the state have a healthy start in life.”

“The California Black Health Network is proud that as of today all undocumented children in our state will qualify for full-scope Medi-Cal. With this momentous victory, we urge legislators to vote in favor of SB 10 and extend health coverage to all Californians. California is home to immigrants from all over the world, including countries in Africa, the Caribbean, and Latin America. California needs to continue leading the effort to provide affordable and accessible health care to all families regardless of immigration status,” said Doretha Williams-Flournoy, Interim President and CEO, California Black Health Network.

“We have achieved a victory for California children and thanks to the ACA, close to 125,000 young adults in California with DACA are now eligible for Medi-Cal coverage. But current state law allows arbitrary barriers like income to prevent many young people from getting the health care coverage they need,” said Gustavo Herrera, Director of Young Invincibles’ Western region. “Access to health care is a human right that should be available to all. We urge lawmakers to support SB 10 and ensure that one dollar or one piece of paper doesn’t determine who gets quality, affordable health care.”

“Medi-Cal has been the driving force in cutting the state’s rate of child uninsurance in half since 2001 and it’s exciting we are on the cusp of finally ensuring that all children in California have access to the health coverage they need,” said Kelly Hardy, Senior Managing Director of Health Policy at Children Now. “It’s also important to remind families that Medi-Cal enrollment is open all year round.”

“California has taken a bold and compassionate step forward to improve the health of our children and our communities. It is my sincerest hope that our momentum continues and that one day we can say we have achieved health for all,” said Carmela Castellano-Garcia, President and CEO, CaliforniaHealth+ Advocates.

“Health4All Kids is just the beginning to assuring health care access to all undocumented youth regardless of immigration status. Through our grassroots advocacy and partnership with champions like Senator Ricardo Lara and other state legislature representatives we will get the job done in making Health4All for all undocumented Californians a California budget priority,” said Maribel Nunez, Director, California Partnership.

“We are thrilled that California is on track to begin health care coverage for all children on May 16th. This is an enormous investment in our state’s future and a giant step towards eliminating health disparities in our state. Moving forward, we hope to see more investments like this in health care for all so adults can enjoy the same benefits as their children,” said Sarah de Guia, Executive Director, California Pan-Ethnic Health Network.

Governor’s Budget May Revision Continues Health Reform Progress and Also Recession-Era Cuts to Health Care

On Friday, Governor Jerry Brown released the May Revision to his proposed 2016-17 State Budget, which continues California’s commitments on health care and health reform. It also maintains many of the cuts made to health and human services during the recession and does not make additional investments needed to reduce barriers to coverage, increase access for Medi-Cal patients, or cover the remaining uninsured.

Continued progress under health reform: The budget continues the progress California has made under the Affordable Care Act. This includes the additional steps the state has taken beyond the ACA such as, starting Monday, the Medi-Cal expansion to all children regardless of immigration status. The May Revision estimates that more children—185,000 of an estimated 250,000—will enroll and $188.2 million in general fund dollars in budgeted for this expansion.

Another notable change in the proposed May Revision would delay shifting new legal immigrants from Medi-Cal to Covered California until technical and administrative issues are resolved, which will prevent some of these individuals from inadvertently losing coverage.

No restorations to recession-era cuts: In this revised budget, the Governor continues many recession-era cuts to health and human services, including to Medi-Cal benefits and provider rate reimbursements. In 2009, key Medi-Cal benefits from podiatry to vision were eliminated and they continue to be denied in this budget. After $15 billion in HHS cuts, health advocates will continue to push to restore cuts to Medi-Cal and other public health programs. Health Access will continually update our Budget Scorecard as the legislature weighs these proposals. California should invest in removing barriers to coverage, ensuring Medi-Cal patients have access to benefits and providers, and extending care to the remaining uninsured.

Governor Brown warned about a future recession and the “zig zag reality” of up and down revenues, which he likened to “riding a tiger.” He urged caution of any new spending, “I’m going to be pretty resolute on this budget,” invoking an Aesop’s fable of the ant and the grasshopper. Health advocates invoked other aphorisms about the value of prevention, investments and against penny-wise and pound foolish decisions. They argued that California needs to better balance between preparing for the possibility of the next recession and undoing the ongoing damage from the last recession.

Estate Recovery: This budget does not address some key policy issues. For example, the budget does not remove the estate recovery provision that discourages patients from signing up for Medi-Cal coverage. SB 33 (Hernandez), which would limit Medi-Cal estate recovery, is pending in the Assembly, and would need to be considered in the budget.

Immigrant health care: While the budget includes funding committed last year to continue Health4All Kids and ensure all low-income children are eligible for Medi-Cal, our health system would be stronger if we covered all income-eligible Californian adults, regardless of immigration status. Consumer advocates will continue to push for SB 1418 (Lara) in the legislature and in the budget process, to extend Medi-Cal coverage to all Californians regardless of immigration status, and is pending in the Assembly. Also pending is SB 10 (Lara), to allow undocumented immigrants to buy a health plan through Covered California with their own money.

Revenues on the ballot this fall: Voters this fall will have their own impact on future budgets, as they decide on ballot measures that will determine if California is forced to make cuts to education, health and other vital services, or if key investments can be made. While not taking a position on the initiatives, Governor Brown made clear he projects significant deficits if the upper-income taxes from Proposition 30 were not extended, thus forcing significant cuts. By extending the existing rate on high-income earners as well as increasing the tobacco tax, Californians can prevent cuts to vital services and make the investments needed in the health care system on which we all rely.

 

 

A California Resolution to the Primary Debate on the Future of Health Reform

Blog post written by Anthony Wright, Executive Director of Health Access California

Since Health Access does not endorse candidates, I have refrained from commenting on the Presidential primary debates. There has been little to analyze on the Republican side, given the minimal substance on health policy, besides the standard talking points about the repeal of Obamacare.

On the Democratic side, the health care debate has been more interesting. Secretary of State Hillary Clinton has embraced the Affordable Care Act and outlined a series of proposals to not just defend it but “build on it” for increased affordability, expanded access and improved quality.

While Senator Bernie Sanders voted for and supported the Affordable Care Act, he strongly advocates for a broader revamp of our health system to create “a Medicare-for-all health care system.”

As opposed to re-litigating whether the Affordable Care Act should have been enacted in the first place, this debate on the Democratic side has been useful to begin the crucial national discussion of what should be the next steps to improve the health care system. But too often the debate, or the descriptions of it, have been stuck in pre-existing primary fight frames about incrementalism vs. revolutionary change, progressivism vs. pragmatism, broad visions vs. detailed plans, inside vs. outside–as if these concepts are necessarily opposed to each other and policy change doesn’t require some interplay between these forces. As an organization that has been involved in making real policy change that improves the lives, and health, of Californians, we know that progress requires both broad visions and detailed plans, the inside play and the outside action, and a balancing of progressive objectives with pragmatic realities. These are not either/or, making progress requires both.

While I admire both candidates, I wish they had engaged this debate a bit more constructively. Senator Sanders talks about single-payer no differently from ten years ago, as if the Affordable Care Act never passed, as if there was not just policy progress but political lessons that have been learned from the country’s decade-long grand debate on health reform. He is right to put forward a grand vision where health care is a right for all Americans, but missed an opportunity to provide not just technical and fiscal details but to lay out a strategy of how we could transition to such a system from the world we are today–both politically and policy-wise. And while Senator Clinton was right to focus on concrete, specific steps that could provide tangible and immediate benefit to consumers, she never connected her various proposals into a broader vision of quality, affordable health care for all Americans, and was too quick to dismiss single-payer as politically unrealistic. While undoubtedly true in the short term, certainly with a Republican Congress, our political vision should not be restrained by what is possible in the moment–and indeed it is the job of our political leaders to stretch the boundaries of the debate. If nothing else, she would be good if she could be clear in responding to how her agenda is any more realistic with a Republican Congress-if there is a strategy on key issues, like how hard would it be for any member to vote against additional affordability in the form of tax credits, or to point to a growing bipartisan angst on prescription drug prices.

As the primary fight winds down, there is an opportunity. Recognizing he is likely not to win the nomination, Senator Sanders seems to be focusing on influencing the party platform and its positions, including the endorsement of Medicare-for-all single payer. In addition, I agree with Jonathan Cohn of the Huffington Post, that Sanders could have an important voice on health policy in coming years, advocating for “the most successful and popular elements” that “lay the groundwork” to that goal.

What are those elements? Cohn suggests having the government negotiate on prescription drug prices, and in particular the adoption of a true “public option” that would compete with the private plans. But there is a broader agenda than just the public option, which was a rallying point that we actively organized in support of during the effort to pass the ACA.

Supporting “single payer” has become shorthand for some advocates for a range of different improvements and reforms, and politically and policy-wise it is better to spell out those goals specifically. When folks support Medicare for All, they usually are seeking a health system that is more universal, progressively financed, cost-effective, streamlined and efficient, comprehensive, and prevention-oriented. Those are goals we can make progress toward that provide policy and political momentum for additional reform. A single-payer financing system that help facilitate those goals, but it’s not the only way, and the details matter–for example, it’s technically possible to have a single-payer system that is based on regressive taxation or unaffordable cost-sharing. And making progress on specific goals are not just tangible victories that would help people, but would provide momentum and policy progress toward additional reform.

Beyond the public option, another idea would be for Clinton to adopt a goal that would be an element of a single-payer system that progressives support–that no American should have to pay more than a percentage of their income to get basic health insurance, based on a progressive sliding scale. Through the subsidies available in the exchanges, the Affordable Care Act took a dramatic step toward this goal away from the previous regressive individual market, where what you paid was based on how old and sick you were. But the ACA’s guarantees of affordability have exceptions and caveats and despite the best efforts of many, the tax subsidies were never sufficient to provide coverage as affordable as most employer coverage. Senator Clinton has already proposed increasing the subsidies and tax credits available under the ACA to provide better affordability–it wouldn’t be too far a stretch to be able to make that broad guarantee that has been the hallmark of Senator Sanders’ proposals, and that is clear and understandable as a political rallying cry and policy goal. 

In their debate about universality, one key question is how to include undocumented immigrants–a question that arises in designing a single-payer system or in each of the multiple programs that exist today. In an early debate, both Senators Clinton and Sanders endorsed the ability of immigrants being able to buy coverage in the exchanges with their own money–something California is seeking to do through SB10(Lara) and a 1332 waiver. Senator Clinton has supported allowing states to go further with immigrant inclusivity, including with 1332 waivers–but perhaps she could detail how these state efforts build toward a truly universal health system, and how that helps the health system be stronger for everyone.

Senator Clinton could also follow the California’s example by encouraging the federal and state exchanges to be active purchasers, bargaining for the best value and driving standard benefits and improved quality. The principle of increasing the bargaining power is core to single-payer proposals, but was also an essential part of the law creating Covered California that was signed by Republican Governor Schwarzenegger, and has been part of the California policy landscape for years at CALPERS and Healthy Families and Medi-Cal under Administrations of both parties. This greater negotiating leverage helps provide more oversight over the insurance industry overall as well as reducing the cost of coverage with the potential for improving health outcomes and reducing health disparities.

Similarly, using the federal government’s bargaining power to take action on prescription drug costs is likely an area of policy agreement between the two Democratic candidates. Beyond the specific policy proposals, it also would be an important test case for politicians to stand up to a big-money industry, an industry that has not been afraid to spend obscene amounts of money to get its way.

In her position papers, Senator Clinton has also identified issues about capping the cost-sharing for specialty drugs, mirroring California’s law AB339 sponsored by Health Access California. She could broaden that, as both she and Senator Sanders have talked about out-of-pocket costs broadly, from deductibles to co-pays. She could outline not just specific proposals but some general goals on unfair out-of-pocket costs–ones that could likely get bipartisan support, like our state effort has this year against surprise out-of-network medical bills.

Each of these elements by itself may not be the “political revolution” that Senator Sanders seeks. But each of them could become major fights with key parts of the health industry–whether insurers, drug companies, or providers–that provides the “what side are you on” clarity that has provided the spark of Sanders’ message. And together, these efforts would dramatically improve the health system and bring us closer to the vision. Opponents might say that the ACA and these efforts to implement and improve it are a “slippery slope” to single-payer, but I think that metaphor is reverse. Rather, advocates are scaling a mountain–we have made progress up the mountain, and we are that much closer to the peak, but let’s be clear-eyed that the air is thinner, the angles steeper. As with climbing a mountain, we need to be strategic and smart as we make additional steps up toward an improved health system.

#Health4All Continues to Gain Momentum

Last Tuesday, the Assembly Health Committee voted on SB 10 (Lara), which expands health care coverage to all Californians, regardless of immigration status, by authorizing the state to apply for a federal waiver that would allow undocumented immigrants to buy coverage through Covered California using their own money.

Consumer and immigrant advocates showed their strong support for SB 10, testifying in support of this important bill and submitting letters of support. Advocates have been working for expanding access to quality, affordable health care coverage to all Californians, regardless of immigrant status. SB 10 now heads to the Assembly Appropriations Committee.

Health4All Conference and Lobby Day
Join Health4All’s Conference & Lobby Day on May 15-16. The conference will take place at Sacramento State on Sunday, May 1. Monday, May 16. the march will start at 10 am at Embassy Suites and end on the north steps at the Capitol for the rally. Register today!

For more information:
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Consumer Advocates Raise Concerns About Aetna-Humana Mega-Merger at CDI Hearing

On April 27, the California Department of Insurance held a hearing on the proposed merger of Aetna and Humana. This hearing takes place after a public meeting held by the Department of Managed Health Care (DMHC) in January.

This hearing comes on the heels of a Senate Health Committee hearing this month on SB 932 (Hernandez), a bill that ensures that mergers and consolidations in California’s health care marketplace do not have a negative impact on cost, quality, and access to care for California consumers. Currently, two of four major health insurance mergers have been finalized by the state of California; Blue Shield of California acquired Care1st last year and Centene’s proposal to acquire Health Net was approved with conditions by state regulators in March. The Aetna-Humana merger is one of two mergers still pending, along with Anthem-Cigna. Other hospital and health mergers have also taken place, including the Daughters of Charity Health System purchase by an investment firm in 2015.

Tam Ma, Health Access California’s Policy Counsel, provided comment on behalf of California consumers, raising questions about Aetna’s track record in California and if they should be allowed to have even greater market share. Specifically, she made the case that to ensure that this merger—and others— is in the public interest, insurers should not be allowed to get bigger unless they commit to getting better, sharing skepticism about whether bigger is actually better for consumers.

Lack of Consumer Protections a Concern

In her testimony, Tam Ma focused on Aetna’s track record in California’s commercial market and its lack of respect for California law as well as basic consumer protections.

  • Routine Medical Survey: Through DMHC’s most recent Routine Medical Survey, Aetna was found to have three major deficiencies, of which one had still not been corrected three years later. Although Aetna reported they have corrected this deficiency, it is disappointing it took them 3 years to do something as basic as posting information about consumer rights on its website.
  • Enforcement actions:  Aetna has been the subject of numerous enforcement actions by DMHC, most of which stem from its poor handling of patient grievances, from which it has had 45 violations since 2011. Aetna has accumulated over $100,000 in fines in the last year alone and in 2014 was fined $200,000 for failing to process claims and provider disputes in a timely manner.
  • Unreasonable rate increases: Aetna has proceeded with 7 rate increases that both DMHC and CDI have found to be unreasonable. As a result, small businesses had to pay more than they should have for care. Should this merger be approved, it must be conditioned on the promise that Aetna will not continue to engage in price gouging.
  • Reducing Market Competition: According to an analysis by Cattaneo and Stroud, the Aetna-Humana merger is likely to reduce competition in the Medicare market in eight California counties, including Fresno, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego and Ventura. These are among the most populous counties in California and are home to 24 million consumers, 60% of the state’s population.

Consumers Union, CALPIRG and the Greenlining Institute raised similar issues and questions as Health Access, including concerns about unreasonable rate increases, skepticism about passing savings along to consumers, concerns with low consumer satisfaction scores and unease with Aetna’s lack of attention to diversity and health disparities.

Consumers Union predicts that the $1.25 billion in synergies is more likely to go to increased profits than to reduced premiums or improved service. They also made the case that Aetna’s claim that market turbulence forced it to adopt steep rate increases despite the regulators’ misgivings, but changes in the marketplace have affected all the plans while Aetna stands out for resisting transparency and failing to provide relevant information to the regulators. Further, with increased market power from a merger, there is no reason to believe that the larger company would improve its responsiveness to regulators or sensitivity to consumer rate burdens. Therefore, Aetna’s extreme history of resistance around rate review should be factored into this deal, if this merger is approved at all. Lastly, Consumers Union made that case that consumers need assurances that the newly combined plan will lift up consumer interests and improve their lot rather than leaving consumers carrying the weight of this deal.

CALPIRG reinforced the issue of Aetna going ahead with charging rates deemed unreasonable by state regulators, and reviewed findings of a study they recently published. Aetna had one of the worst track records on this issue–many other insurer were more likely to roll back or retract a rate hike found unreasonable by a regulator.

The anti-competitive effects of this merger, coupled with Aetna’s poor track record, make it likely that quality will continue to go down while prices continue to go up for consumers. Consumer advocates pressed that it is unlikely that Aetna will pass along efficiencies and cost savings to consumers and other purchasers if they have repeatedly pursued unreasonable rate increases.

The Greenlining Institute focused its concerns on Aetna’s lack of attention to supporting diversity and addressing health disparities, arguing that Aetna must acknowledge the need for greater diversity at all levels of their business, especially among executive and board-level management. They questioned Aetna’s commitment to its own “Racial & Ethnic Equality” initiative considering only 14 percent of executive positions and 15 percent of its board of directors are people of color. Additionally, only 31 percent of Aetna’s employees are people of color. Aetna cannot adequately meet the needs of Californians unless they reflect the populations that they serve.

Further, Greenlining urged Aetna to provide concrete assurances that they will train, recruit, and hire a diverse workforce that reflects California and build its supplier diversity network with small, minority-owned businesses, which are a key engine of economic development for communities of color. However, from 2013-2014, Aetna took a significant step backwards by decreasing its investments in diverse suppliers by over $1.1 million, resulting in an overall decrease from 0.77% diverse spending in 2013 to 0.07% in 2014. Additionally, Aetna ceased its partnerships with African-American small businesses and also terminated its contracts with Women Business Enterprises. Even more disappointing, Aetna did not partner with any Disabled Veteran Business Enterprises, LGBT Business Enterprises, or Multi-Certified Business Enterprises in 2013 or 2014. Given that California represents the largest market for diverse businesses, this record is embarrassing and unacceptable.

Greenlining also focused their comments on Aetna’s need to invest significant resources towards upstream, preventive health improvements in underserved communities. For example, they must focus investments towards vital community health resources such as affordable housing, environmental improvements, jobs and workforce development, grants to community-based organizations, and other strategies that target the root cause of poor health. If this merger proceeds without a clear commitment to improving health and economic outcomes for communities of color, then California will continue to suffer from systemic barriers that have led to such blatant health and wealth disparities.

The Community Reinvestment Coalition made complementary comments, particularly on the issue of how Aetna invests in California, and whether it uses the COIN program to target investments.

Health Access and other consumer advocates concluded by urging state regulators and policymakers to conduct a thorough assessment of Aetna’s track record on consumer protections and unreasonable rate increases, along with recommendations for conditions that must be included for this merger to bring any benefit to consumers.

If you or your organization would like to submit comments about this merger or the larger questions at stake concerning mergers in general, you have until Friday, April 29, 5:00 pm to submit your comments to mergercomments@insurance.ca.gov.

Legislative Priorities Clear Deadlines

As the April 22 policy deadline approached, all of Health Access’ priority bills made it over the finish line. Last week, the legislative committees voted on two important bills that will increase transparency in our health care system.

Transparency for Prescription Drug Costs

Prescription drugs are the health service most commonly used by consumers and contribute to soaring out-of-pocket costs. AB 2436 (Hernandez), heard in the Assembly Health Committee on Tuesday, seeks to increase transparency in drug prices by giving consumers more information about the cost of their prescription drugs and how much they will have to pay. In committee, the bill was amended to remove a provision that would also require the drug company to disclose the cost of the same drug in Canada, Germany and Mexico, which typically have lower prescription drug costs than the US–it now focuses on providing consumers with more information about how much they have to pay for their medications, and what health plans pay for those drugs.

Shining a Light on Mega Mergers and Anti-Competitive Practices

As mega-mergers sweep the health care industry in California and across the nation, consumer and patient advocates are urging policymakers to put consumers over companies.  On Wednesday, SB 932 (Hernandez) was heard in the Senate Health Committee and requires health industry mergers to be scrutinized by state regulators to ensure that they are in the interest of consumers. It also requires regulators to hold public hearings on mergers, which provides consumer advocates opportunities to offer comment and feedback on these deals. Health Access and other consumer and patient advocates support the measure and have long called for more scrutiny as state regulators examine these deals. The bill also prohibits health providers such as hospitals from engaging in anti-competitive behavior in their contract negotiations with payors.

Both AB 2436 and SB 932 will be considered by the Appropriations Committee. For sample letters of support, click here.

Health4All – 1332 Waiver Gains Momentum

This Tuesday, the Assembly Health Committee will be voting on SB 10 (Lara), which expands health care coverage to all Californians, regardless of immigration status, by authorizing the state to apply for a federal waiver that would allow undocumented immigrants to buy coverage through Covered California using their own money. Consumer and immigrant advocates support expanding access to quality, affordable health care coverage to all Californians, regardless of immigrant status–our health system is stronger when everyone is included. For sample letter of support, click here.

For updates on these important bills, be sure to follow our Facebook page or sign-up for our e-advocate list!

New Staff Joins Health Access Team

In the last several months we have welcomed four new teammates to the Health Access team, including two organizers in the last week! Learn more about the entire Health Access team here.

Jose Tapia joined Health Access in late 2015 as our new Administrative & Legislative Assistant. José received his BA in Political Science from the University of California, Los Angeles (UCLA). He is a native to Los Angeles and has previously worked as an intern with several Congressional offices in Southern California. Thanks in part to his diverse upbringing, José has a strong commitment to ensure all Americans have access to quality and affordable health care. Prior to coming along to Health Access, José worked with Doctors for America in Washington, D.C.

Bethany Snyder joined Health Access in December 2015 as our new Director of Communications. Bethany has over 15 years’ experience in health care advocacy, communications and public affairs. She is an expert in managing strategic communications, leading successful advocacy initiatives, designing innovative outreach programs and running high-profile campaigns. Having worked for various health care organizations, Bethany has a passion for expanding health care access and ensuring the sweeping changes to our health care system benefit those most in need.

Aurora Garcia joined Health Access as our Southern CA Community Organizer, this month. Aurora has over six years of experience working in the nonprofit sector, which began with working with The Council of Mexican Federations where she fundraised for programs designed to help the Latino community. With a greater desire to organize, she began working as the CA Outreach Coordinator for Young Invincibles advocating on issues impacting young adults and in 2014, Aurora transitioned to California Partnership as the Los Angeles Organizer and Coordinator where she worked on advocacy and training on the state budget and its impact on low income communities.

Yasmin Peled also joined Health Access this month as our Northern CA Community Organizer. Yasmin received her BS in Molecular, Cell and Developmental Biology from the University of California, Santa Cruz (UCSC). While studying at UCSC, Yasmin got her start in health care advocacy running a mobile health care clinic for the homeless and under-served in Santa Cruz County. Prior to joining Health Access, Yasmin worked with Families USA in Washington, D.C., with a focus on health equity issues.

Patient-Protection Bills Moving Forward in Legislature

With the legislative session in full-swing, Health Access California’s bills are moving full steam ahead!

Last week, SB 908 and SB 1135 both passed the Senate Health Committee. SB 1135 (Monning) helps consumers know there are time limits on how long they have to wait to get health care appointments and who to complain to if they have problems with their health plan. Among other provisions, the legislation would put the state regulator’s complaint number on the insurance card. SB 908 (Hernandez) gives consumers and purchasers the information they need to decide if they want to stay with a health plan that has an unreasonable rate increase. Both of these measures now move to the Senate Appropriations Committee.

This week, the Senate Health Committee passed SB 997 (Lara), which allows low-income, undocumented children currently covered by Kaiser Permanente to remain with Kaiser, if they chose to, while enrolling in full-scope Medi-Cal coverage. It is now goes to the Senate Appropriations Committee as well.

Two measures addressing transparency in prescription drug prices are also gaining traction. SB 1010 (Hernandez) would require insurers and health plans to provide detailed, publicly available information on prescription drug costs for large employers and state purchasers, such as CalPERS, the Medi-Cal program, Corrections, and the Department of General Services. It passed the Senate Health Committee this week and now goes to the Senate Appropriations Committee.

Another bill addressing drug prices, AB 2436 (Hernandez), will be heard in the Assembly Health Committee next week. This bill gives consumers more information about the cost of their prescription drugs, how much they will have to pay, what their health plan pays for the drug, and also the cost of the same drug in Canada, Germany and Mexico.

For more information about all of Health Access’ sponsored legislation, click here. To track all health care bills that impact California consumers, check out our Bill Tracking Matrix. An updated version is posted every Monday morning.

Want to take action to ensure these bills become law? Click here to learn how!