The federal health reform debate continues full steam ahead.
The Kaiser Family Foundation has a useful chart of the three leadership measures, the one "discussion draft" proposal in the House of Representatives, and the two others--which are in various forms of public release--in the Senate.
There are other proposals, both big and small floating around Capitol Hill(from single-payer and the Wyden-Bennett bills, to specific legislation on specific issues), but they will largely serve as ideas that will influence the three leadership bills are the main vehicles being authored by the key committees that have jurisdiction.
Due to the pace of Congressional discussions, the attached chart does not capture some of the more recent revisions we’ve heard about. For instance, just yesterday, the Senate HELP Committee released more details of their bill, including a public plan option and an employer mandate for employers with more than 25 employees, which has been scored at $611.4 billion (not including Medicaid) and is stated to cover over 97 percent of Americans. And Senate Finance Committee members continue to work on the cost of their bill, in part by tinkering with the level of subsidies.
We'll have more analysis--much more--in the next few days.
The picture above is of Representative Xavier Becerra, a key member of the leadership of the House of Representatives, who appeared at a packed Health Care for America Now town hall this Monday. He is pictured with leaders from California Partnership, Children's Defense Fund - California, and Health Access California.
We at Health Access California wish the best to Representative Henry Waxman, who is recovering from a fainting spell earlier in the week. He was at Cedars-Sinai hospital, and even had to cancel an appearance on The Daily Show with Jon Stewart last night.
Californians need him healthy, since we are in the stretch run for comprehensive health reform, and he's a central player as the Chairman of the Energy and Commerce Committee, which has responsibility over health reform--as well as environmental legislation like the climate change Waxman-Markey bill passed last week.
The Chairman has a new interesting new book out, entitled The Waxman Report, which was favorably reviewed in the Los Angeles Times, and details his many legislative accomplishments. We are going to need his experience and savvy--as well as the trust he has built up over the year--in order to get this done.
As July 1st hits, a budget fix for California is apparently nowhere in sight. So how is this year different from years past?
Besides the alarming $24 billion hole in California's budget, we seem to have a different Governor. As recently as 2007-08, Gov. Schwarzenegger was actively advocating for health reform. Now he proposes to endanger the intergrity of the very programs on which health reform would be built.
The "Year of Reform" governor sought to expand and improve Medi-Cal. Today, our public health programs seem to be a prime place he goes to find "savings" in the state budget. While, on one hand, he's demanding big-picture solutions from legislative leaders, with the other hand he's passing around a new package of proposals that could, in effect, make Medi-Cal coverage less accessible.
Under the guise of modernizing the system and "bringing California into the 21st Century," Schwarzenegger would eliminate 27,000 county workers who currently help Medi-Cal recipients with complex enrollment procedures. He calls person-to-person interaction an "antiquated process...relying on slow and time-consuming face-to-face and mail-in processes that are only available between 9-5 and lack uniformity across counties."
Moving the process online, he says, will be "taking advantage of the latest technologies to allow people to apply and enroll in state programs faster and with fewer hassles -- all while reducing costs." It almost sounds too good to be true.
Advocacy groups like the Western Center on Law & Poverty find this alarming.
People need the help of those county workers -- their face-to-face interaction, and step-by-step assistance -- to successfully enroll in Medi-Cal or determine their eligibility. Medi-Cal is an exceedingly complex program.
Advocacy groups also know that a process to apply for Medi-Cal online is already underway, and believe this should be but one of several options for people to sign up for Medi-Cal. The online project is being carefully monitored by stakeholders who want to make sure it's fair, accessible and works well as it proceeds.
Yet the Governor's proposal is something else--a wholesale privatization, turning enrollment into a for-profit private vendor like Maximus. Such privatization makes government programs less transparent and accountable -- and can lead to time lags in enrolling patients (thus saving the state money). Other states have tried privatizing the management of health care eligibility and enrollment with little success.
Even Texas cut the cord on its privatization effort, finding itself without the promised savings and short on workers who previously administered the program. The Fort-Worth Star Telegram reported that, in the end, offices were understaffed, calls went unanswered and Texas was left with "fallout from a major experiment in state government that nearly everyone called a disaster."
To be clear, Schwarzenegger's proposal isn't intended to simplify and eliminate the various enrollment barriers, like the asset test or regular redeterminations. It's meant to undo the network of people that help low-income families navigate this complex and confusing system.
This could result in fewer people enrolling in Medi-Cal, especially since the least likely population to have online access at home include low-income seniors and people with disabilities. Those are the people who Medi-Cal is responsible for serving -- and California already spends less on their care than other states.
So what may seem logical -- taking advantage of online capabilities -- may turn into a barrier, a barrier that results in fewer people receiving Medi-Cal health insurance. But that may be the point.
As we wait to see the news about a possible budget deal--and the prospects of more and more cuts--it's important to note that the ramifications of past cuts are just being felt in a widespread manner.
Tomorrow, July 1st, the inability to raise revenues to solve California ’s budget crisis will hit home will millions of Californians, with parents, seniors and people with disabilities that lose dental and other key benefits. Health Access has a revised fact sheet on our website that describes the eliminated benefits, and their fiscal, health, and human impacts.
Let's be clear: Millions of Californians will live sicker and die younger as a result of these cuts. These budget cuts reflects choices, and it is sad that our policymakers chose to cut off millions of Californians from basic care, rather than finding the revenues needed to maintain these needed services.
The elimination of these benefits also mean we lose significant more dollars in federal matching funds, meaning the cut to our health system is magnified. Not only will hundreds of thousands incur significant medical debt, and other will simply not get needed care, but the lack of these preventative care will impose broader costs on the health system in the long run.
The benefits that will be eliminated tomorrow include:
* DENTAL CARE, including routine teeth cleanings and x-rays as well as procedures such as root canals. Certain dental procedures, such as tooth extractions, which can be performed by a physician, will still be covered if the beneficiary can find a doctor who will do the procedure. Patients impacted in a given year: 909,090
* OPTICIAN SERVICES and optical lab services, which include the filling of and fittings for prescription eyeglasses and contact lenses. Patients impacted in a given year: 485,873
* OPTOMETRY SERVICES provided by an optometrist, include routine eye examinations and other preventive screenings. Some procedures will still covered, at a higher expense to Medi-Cal, when provided by an ophthalmologist. Patients impacted in a given year: 214,522
* PODIATRY SERVICES, which refer to the care and treatment of feet, are important in helping people remain mobile. Patients impacted in a given year: 85,129
* INCONTINENCE CREAMS AND WASHES, which are prescribed to help incontinent patients keep their skin clean and dry, and to avoid irritation and infection. Patients impacted in a given year: 65,591
* ACUPUNCTURE SERVICES, which is the use of small needles to treat pain and other health problems, and is an important alternative to pharmaceutical treatments. Patients impacted in a given year: 32,906
* AUDIOLOGY SERVICES, including hearing aids, and the services to screen, diagnose, and evaluate the need for hearing aids will only be limited to those performed by physicians as part of a routine exam. Patients impacted in a given year: 28,061
* CHIROPRACTIC SERVICES, which can help treat and lessen chronic back pain. Patients impacted in a given year: 12,439
* MENTAL HEALTH PSYCHOLOGY SERVICES and behavioral therapy services by a psychologist (previously limited to two treatments per month), unless the patient is severely mentally ill. Patients impacted in a given year: 4,970
* SPEECH THERAPY SERVICES provided by speech therapists. Patients impacted in a given year: 1,593
The Managed Risk Medical Insurance Board (MRMIB) voted today to create a waiting list effective July 17, 2009, which would mean children seeking health coverage would be denied until space opens up in the Healthy Families program.
Effective July 1, 2009, children with Medi-Cal coverage whose family income has increased--so they are no longer eligible for Medi-Cal--will not be enrolled in Healthy Families, and will go on the waiting list.
Tens of thousands of children enroll every month--a number that has climbed as a result of the economic downturn--and each of them would be forced to wait and go without coverage.
The decision is a result of an expected $90 million shortfall in state dollars--one that is in the Budget Conference Committee proposal. It was the "compromise" after not eliminating the program in its entirety. But the cut isn't final--and in fact, the Governor and legislative Republicans are seeking additional budget cuts as we write.
The Senate is currently debating the majority-vote budget package of cuts and just about $2 billion in revenues increases to deal with the $24 billion state budget deficit. The Governor has said that he will veto any proposal that does not address the entire $24 billion or that raises taxes.
Thus, the Governor is attempting to force dramatic cuts. Senate President Steinberg has pointed to the deadline at the end of June, the end of the day tomorrow, in order for some of these budget solutions to take hold. So we will see what agreement, if any, comes about in the next 36 hours.
And as we focus on the crisis of the moment of the next 36 hours, Time Magazine takes a broad view about the origins of the California budget crisis that goes back 36 years.
Finally, earlier this week, nearly 10,000 people expressed their opinion that health care can't wait, and the need for comprehensive health reform that includes a public health insurance option in Washington DC. Here's a small video snippet of the rally, featuring former Gov. Howard Dean, actress Edie Falco, and many others:
While the budget battles continue in Sacramento, I've been in Washington, DC, with several dozen California leaders, visiting with many in the California delegation on health reform.
Although you might not notice it with the deaths of Michael Jackson and Farah Fawcett, today there was a rally in Washington, DC, of nearly 10,000 folks from around the country for an incredibly large Health Care for America Now "lobby day," paralleled by dozens of "echo" events across the country, including in San Francisco, Fresno, Los Angeles, and San Diego.
It was good to hear our the excitement and the seriousness of purpose from Congressional leaders and their staff. It was fun to see a glimpse of a meeting of the House Energy and Commerce Committee, which included testimony from Californians like John Arensmeyer of Small Business Majority, and Howard Kahn of L.A. Care--which is the current largest "public health insurance option" in the nation, but hopefully won't be after health reform passes.
We need to keep the pressure on... the momentum is significant, but we were also warned that there's a lot of work to quell the opposition, to specific important provisions, and to the whole enterprise of health reform. Lots more to do!
As much outrage as there is about rescissions, there's a larger-scale problem of people being denied for pre-existing conditions. David Lazarus at the Los Angeles Times has a heartbreaking story of one such couple.
The state's safety-net program for those denied for private coverage due to their health status is full. It has a waiting list of hundreds of people, despite never advertising. And as Lazarus says:
But it's not easy to get into. It's not comprehensive. And it's not cheap.
He goes even further:
It currently takes as long as four months to be enrolled in MRMIP. And even then, you have to wait three months more for coverage of prescription drugs to kick in.
To accommodate more people, the state created a companion system, the Guaranteed Issue Pilot Program, which now provides coverage to about 6,000 people. But that program was closed to new enrollment after participating insurers balked at some of the state's terms.
Under MRMIP, California taxpayers pay 40% of the premiums to enroll people in individual plans offered by Kaiser Permanente, Blue Shield and Anthem Blue Cross. Those premiums can run as much as 37% higher than market rates for similar individual policies because of the enrollees' medical history.
And the $75,000 cap on annual coverage is among the lowest such limits among similar state programs nationwide.
The story does not mention that MRMIP is one of the many programs where the tobacco tax funds dedicated to the program is being diverted becomes of the budget cuts, so that waiting list will only expand--and some may need to be kicked off the program in the first pace.
The article talks about how federal health reform can help: preventing insurers from denying coverage due to "pre-existing conditions" in the first place, and creating a public health insurance option that would be a real option for patients.
At the state level, there's a pending reform bill, SB 227, sponsored by Senator Elaine Alquist, chair of the Senate Health Committee, to provide some reforms of the MRMIP high risk pool, to opne it up to more people and remove that annual cap. But even that bill won't be able to meet the real need that is out there. The conservative estimate is that over 400,000 are denied coverage due to their health status.
Just another reason for urgency on federal health reform...
On multiple Sunday monring, George Will has suggested during his commentary on ABC's This Week with George Stephanopolous that health reform would be easy if they just dropped all these demands and adopted "the Healthy Americans Act"--the Wyden-Bennett bill. The chief House sponsor is California Representative Anna Eshoo.
Senator Ron Wyden deserves a lot of credit.. at a time when President Bush reigned and health care reform was not in the national conversation, he aggressively pursued Republican Senators to see what they would support in a health reform package. His ability to bring on Republican Senators helped some start to believe that health reform was a live issue again.
Will says that there's over 70 votes for the Wyden-Bennett bill, but it's far from clear it would get such support from the left and the right of the Senate. It's unclear if even all the 10-20 sponsors would vote for the bill, including the full financing and other aspects of the legislation.
Will has said that the major difference with the Obama plan is the public health insurance option. That's a major difference, but it's not the main objection. In his desire to get Republican co-sponsors, Wyden did not include a public health insurance option, even though he has said he's not opposed to the concept. The bill is really less a bipartisan bill, than one to explore what Republican Senators would support.
But now we are in a different era, headed by President Obama, and the framework of a health plan he spent over $100 million promoting during the campaign. So politically, it makes sense to not abandon that electoral mandate for another framework, such as the Wyden approach.
I am skeptical of the Wyden approach of aggressively encouraging people into an individual insurance, however reformed. Proponents say it won't be the broken individual market of today. But to the extent that the problem is that individuals simply won't have the market power against the big insurers, some of the same problems will persist--even if the most obvious issues, such as people being denied for pre-existing conditions--will be thankfully outlawed. That's why I would prefer the current approach by Congressional leadership of expanding group coverage--whether through employers, public programs, or otherwise. This also explains the rationale for the public health insurance option, giving consumers on more tool against the private insurers--namely, the ability to take their business elsewhere.
The reason why the Wyden-Bennett bill is still even talked about is that it got a favorable "score" from the Congressional Budget Office, an analysis that suggests that the plan would be revenue neutral.
But the way it gets to be budget-neutral should give consumers pause. It defines a basic benefit package, but allows the value of those benefits to degrade over time. Rather than raising the revenues needed to make sure the guarantee of quality coverage is there for consumers, the bill allows that assurance to become weaker and weaker. The point of health reform is to more broadly share the risk of rising health costs, rather than continue the existing shifting of risk onto patients and families.
The Wyden bill served it's mission ably in kick-starting the health reform discussion nationally, well before Iowa caucuses and "Yes, We Can." There may be provisions and lessons of interest, but the framework being discussed in the key committees in the one that President Obama ran on, and won on.
How can Californians engage in the health reform debate?
I often get the question: Do we support the House/Tri-Committee bill? The HELP/Kennedy bill? The Finance/Baucus bill? But these aren't the right question, or at least, not the most useful ones.
First of all, they are all in draft form, and undergoing changes in real-time. And they are going to change significantly in the weeks ahead. The House bill will go through three committees, and be subjected to various proposed amendments. Senate bills will be considered by two committees, and ultimately merged into one product before heading to the floor.
These are the vehicles for health reform, but they will change over the weeks, especially as they go through the committee process, and face amendments and negotiation. This would be true if we started with a single-payer system, or a Wyden-like individual market approach--no legislation is unchangeble. So our main action is not to "support H.R. X" or oppose "S. Y" or anything like that.
The advocacy needed is to support the concept and urgency of health reform, this year, and to support or oppose specific principles and provisions that are important for patient. Whether it is the public health insurance option, for having all employers contribute their fair share, or the need for subsidies up the income spectrum past 400% of the federal poverty level, those are the debates that will make the difference in what the House and the Senate pass, and become the fodder for a House-Senate compromise.
It's not that I don't have opinions on any of this. Of the actual bills proposed, I prefer the single-payer model as proposed by Rep. Conyers or Rep. McDermott, over the individual market approach as proposed by Sen. Wyden. Of the main committee vehicles, which all follow a similar framework to what President Obama campaigned on, I've been impressed by the House vision and version, and concerned abou the direction I am hearing from the Senate committees at the moment.
Congressional representatives need to hear support, for example, for the public health insurance option, which is a key provision, as well as a principle--that consumers should not be left all alone at the mercy of the individual insurance industry. There's no bill number, but it's at the center of the conversation as we speak.
There will be a moment to be ready, to respond to the predicted deluge of amendments. See you soon
Major congressional caucuses push health reform...
Monday, June 22, 2009
Rep. Michael Honda stood with Health Care for America Now, Health Access California, and other groups this morning in San Jose, to releasee new California-specific report today today showing that racial and ethnic disparities in health outcomes constitute a crisis, one that requires the attention of health care providers, policymakers, and communities alike. As the study shows, in California, communities of color and immigrants face barriers in accessing health care including lack of insurance coverage, limits to geographic access, and cultural and linguistic challenges.
“Since the publication of the momentous 2002 Institute Of Medicine study confirming the depth and breadth of disparities in health care faced by racial and ethnic minorities in the United States, I have worked tirelessly with my colleagues to reform our health care system to correct these inequities” said Representative Mike Honda (D – San Jose), chair of the Congressional Asian Pacific American Caucus. “Children should not have to translate complicated medical information for their parents, patients should have access to quality, affordable care regardless of the language they speak, the color of their skin, or where they live. The public option within health reform is a singular opportunity to both expand competition in the health care industry and rectify injustices faced by too many in our communities.”
This took on special emphasis this week because the Congressional TriCaucus - comprised of the Congressional Black Caucus (chaired by CA Rep. Barbara Lee), the Congressional Hispanic Caucus and the Congressional Asian Pacific American Caucus (chaired by CA Rep. Honda) – and the Congressional Progressive Caucus (chaired by CA Rep. Lynn Woolsey) -- altogether 120 House and Senate Members -- will hold a news conference on Wednesday, June 24 at 10 am expressing unprecedented, united, and strong support for comprehensive healthcare reform, of which the cornerstone must be a robust public health insurance option.
At the press conference this morning, Honda joined Health Care for America Now (HCAN); Asian Americans for Community Involvement (AACI); Asian Immigrant Women Advocates (AIWA); California Immigrant Policy Center (CIPC); California Pan Ethnic Health Network (CPEHN); the Having Our Say Coalition; Health Access California, and Services, Immigrant Rights, and Education Network (SIREN) in highlighting the specific needs of our communities and calling upon Congressional leaders to include them in the Health Reform Debate. The report is available at: http://www.health-access.org/files/expanding/Ideas%20in%20Action%20The%20Heatlh%20Equity%20Challenge%20CA%206-20-09.pdf
"As three-quarters of the uninsured in this state, communities of color have the most at stake in health reform” according to Martin Martinez, Policy Director at the California Pan Ethnic Health Network. “If the United States is going to be positioned for a successful future, we need to make sure that everyone has access to affordable, comprehensive, and culturally and linguistically appropriate health care. We urge Congress to act this year to enact meaningful reform that addresses these inequalities in health."
The debate over health reform in Washington DC represents a historic opportunity to achieve quality and affordable health care for all; it is critical that reform efforts take into account the specific needs of immigrants and communities of color. We must expand and simplify public programs to cover all low-income individuals, and give everyone the option of buying into a public plan. We must also invest in building healthy communities to address the underlying causes of the obesity and chronic disease epidemics that are disproportionately affecting communities of color.
I admit I haven't read all 852 pages of the House bill, but the more I look, there's good stuff. There's some work to do, and areas where the bill is silent--especially on some financing elements.
But it is important to note some of the provisions that have been patient protections that are small provisions of the bill, but on their own are important and that have been long advocated for: a ban on balance billing; a requirement that all health insurance plans would have to spend at least 85% of revenues on patient care; the establishment of a floor of basic benefits include maternity and well-baby care; additional assistance for early retirees; and the closing of the donut hole in Medicare Part D. We'll have a fuller report later.
Until then, here's the press conference where they released the bill. The first two speakers, and two of the three Chairmen, are Californians: Rep. George Miller of the Education and Labor Committee, and Rep. Henry Waxman of the Energy and Commerce Committee. Also standing is Rep. Pete Stark, who chairs the Health Subcommittee of the Ways and Means Committee, and who was recognized at the end of the press conference for his decades of work on these issues.
It features the three chairmen of the relevant House committees, and it is remarkable how they are all working together--this is not normal, or usual, but it is welcome. It shows that they understand the urgency enormity of the issue and the moment.
The whole press conference is moving, and provided me hope after a long week.
With health reform heating up, the Health Care for America Now! campaign went door-to-door yesterday, as reported by Bobby Caina Calvan of the Sacramento Bee. In not just Sacramento but Volunteers, from ACORN and other community groups, went and talked to their neighbors about health care reform, and urged them to get involved in the debate.
Tomorrow, HCAN, Health Access, and other groups will be releasing a new release about health equity--and why health reform is so central to communities of color. We are pleased that Rep. Mike Honda is joining us to release the report in San Jose on Monday.
Later this week, I'll be going to Washington, DC with several dozen Californians to visit Congressional offices and participate in a major HCAN rally on Thursday, June 25th. And that's just a little of what is going on. The campaign for health reform is in full throttle now.
Here's a new video about the California budget and the impacts of the health care cuts from the centrist New America Foundation--with whom we don't agree on everything, but they work to be thoughtful. With colorful pie charts and some suggestive accompanying music, they make the point that a single-minded focus on the budget leads to health cuts that simply make no sense if considered regarding the cut's true impact:
Last year, we made a similar point about the cost shift of these budget cuts when we commissioned a study, "Adverse Reaction: Proposed Health Budget Cuts Would Lead to Increased Health Insurance Premiums." The Governor has made his similar point when he referred to the "hidden tax" in our private premiums, yet he continues to insist on cuts to Healthy Families, and continue to oppose even the revenues he supported during health reform.
The Senate HELP Committee began mark-up on their bill this week and ran into some snags over the public plan option, the employer mandate, and the overall price tag. The Congressional timeline is beginning to slip as the Senate Finance Committee has postponed its markup in order to better understand the CBO cost estimates and strive for a bipartisan bill. A slideshow of the Finance committee's proposal started to circulate. A bipartisan group of former Senate Majority Leaders also got in on the action by unveiling their own health reform proposal. Speaker Pelosi has insisted that the House bill will include a public plan option. Meanwhile, House Republicans are developing their own health reform plan.
While there are details to look at and likely to work out, this House package would be a major improvement over the current broken system, and help Californians get and keep the coverage they want and need.
We are not surprised that California Congressional leaders, including Speaker Pelosi, Chairman Waxman, Chairman Miller, Chairman Stark, and others have put forward a strong proposal. Californians know that we need major health reform, and we need it urgently. The problems in the health system are significantly bigger in California, and it's not a surprise that our condition has translated into such overwhelming support for broad public (as seen by the Field Poll yesterday, and some of our key policymakers as well.
From an economic view, the budget choice is clear...
HEALTH ACCESS UPDATE Friday, June 19th, 2009
NEW REPORT UNVEILS ECONOMIC IMPACTS OF PROPOSED HEALTH AND HUMAN SERVICE CUTS
* Over 600,000 Jobs Lost Under the Governor’s Proposal; A Decline of 2.2% of GDP * Conference Committee Report Significantly Reduces Impact, But Still 220,000 Jobs Lost * Report Shows Health & Human Service Cuts Have Dramatically Worse Impact Than Taxes, Taking Into Account Lost Federal Funds, and Multiplier Effects; * HHS Cuts Are Over Four Times Worse For Economy Than Upper-Tax Bracket Restoration
* More Updates on the Health Access Blog: New House Bill on Health Reform!; New Field Poll Shows Californians Overwhelmingly Support Health Reform; Trying to See the Humor in Health Reform; A Mistaken CBO Analysis; Budget Budget Choices for California
* Follow Health Access California on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget and health reform issues.
As the Legislature prepares to consider tough choices to balance an over $20 billion deficit, a new report reveals that the health and human service cuts proposed would also have a dramatic negative impact on California’s economy.
Compiled by Health Access California and available on the Health Access website, the report, “The Worst Prescription for California’s Economy: Analyzing the Economic Impacts of Health and Human Service Budget Cuts,” reveals that the severe cuts in the Budget Conference Committee’s proposal would have significant economic impacts; and that the Governor’s budget proposal would be even more dramatic damage to the state’s economy. Both would mean lost federal funding to California ; hundreds of thousands of lost jobs; and hundreds of thousands of Californians without coverage.
“These health and human service cuts are the worst of both worlds: they not only directly deny people the services that California families need, the cuts cripple our ability to get out of this economic downturn,” said Anthony Wright, executive director, Health Access California, the statewide health care consumer advocacy coalition. “The Governor’s cuts make no sense, since in order to save a few state dollars, California gives up a lot of federal dollars, for our health system, and our economy.”
The Governor’s proposed budget includes dramatic cuts, including the elimination of Healthy Families, CALWORKS, Adult Day Health Centers , as well as major cuts to IHSS home care and many other programs. In addition to the human impacts, the Governor’s budget cut proposals to health and human services would have dramatically negative economic consequences:
· California will lose $7.5 billion in federal funds for health and human services programs this year alone. · Over 600,000 Californian jobs will be lost. · The state’s economy (GDP) will shrink by more than two percent. · Over two million more Californians will lose health coverage, increasing the number of uninsured by one-third.
“The Governor's proposal to eliminate CalWORKs will devastate low income families and the communities they live in. Landlords won't get the rent, electric companies won't get paid, the corner store will have less customers but the homeless shelters will be full,” said Michael Herald of the Western Center on Law and Poverty. “Our legal service offices are getting unprecedented number of calls from frightened recipients worried they will become homeless. It is morally irresponsible of the Governor to threaten to cut off aid to vulnerable families while refusing to even consider tax increases.”
The economic consequences are particularly significant for health and human services for multiple reasons:
· Many health and human services are tied to federal matching funds, so for every dollar we cut from state spending, the state’s economy loses double, triple, or more in economic activity.
· Since spending in health and human services by definition happens in-state and is unable to be “outsourced,” there’s a significant “multiplier effect” where dollars are spent in the community and then spent again, creating economic activity. This study relies on Council of Economic Advisors (CEA) data and formulas for estimating the multiplier effect.
· Funding for health and human services are spent directly into the economy. Both as staff salaries (such as nurses) and as direct assistance to poor families, the beneficiaries of health and human service spending are low- and moderate-income Californians who are likely to spend that money quickly back into the community, by necessity, rather than save it. Studies indicate that such directed resources to lower-income families have a more substantial “multiplier effect” to the local economy.
These factors make it so that cuts to health and human services have a much bigger impact than a commensurate increase in taxes. In a tough budget situation where legislators must choose either service cuts or tax increases, the negative impact of bigger cuts is over 3 to 1. The study reviews an even more stark comparison with restoring the upper tax bracket, where the impact would be offset by a sizable deduction in federal income taxes.
“This package of cuts goes in the complete opposition direction of President Obama’s economic stimulus bill. President Obama had it right, that the top priority was to recover and reinvest in our country, starting with the people who need the most help,” said Wright. “While all our budget options have economic impacts, the choice is clear. If you want to revive the economy, the worst possible action is to make the health and human service cuts proposed, lose those federal dollars and all the resulting economic activity. Those who are concerned about the economic impact of tax increases should recognize that the economic impact of cuts are multiple times greater.”
"This new report is consistent with a recent study released by Beacon Economics, which demonstrates that cuts to human services programs such as Food Stamps, CalWORKs and General Assistance have severe negative economic impacts, with an estimated $1.32 in economic activity lost for every dollar cut. Investment in human services programs is critical to state and local economies," said Frank Mecca of the County Welfare Directors Association.
The Budget Conference Committee also has negative economic impacts, even though they are significantly less severe than the Governor’s proposal. The economic impacts of the health and human service cuts in the Budget Conference Committee budget package include the loss of over $1.24 billion in federal funds for health and other programs in the budget year, about 220,000 Californian lost jobs, and a shrinkage in GDP of 1.3%. An estimated 550,000 more Californians will be denied health coverage, both in children being directly denied coverage, and in families losing health coverage due to job loss.
Californians know that we need major health reform, and we need it urgently. The problems in the health system are significantly bigger in California, and it's not a surprise that our condition has translated into such overwhelming support for broad health reforms.
What is noteworthy is that what may be controversial in Washington, DC, is not in California, given the level of our crisis, and our elected leaders in Congress should take note. Californians support a range of provisions that are now being debated in DC. They include:
* 85% of Californians support "the choice of a public health insurance option, that can compete with the private insurers and make sure they play by the rules." * 81% of Californians support "requiring health insurance companies to offer coverage to anyone without regard to their health condition." * 70% of Californians support "expanding state government programs for low-income people, such as Medi-Cal and the State Child Health Insuance Program." * 69% of Californians support "requiring employers to offer health insurance to their workers or pay money into a government fund that will pay to cover" their workers. also support requiring employers to help provide health coverage to their workers. These are critical components that should be in any health reform package."
On the public health insurance option, there's been concerted effort to ensure that is included in health reform by coalitions like Health Care for America Now.
Federal health reform has arrived. The Senate Health, Education, Labor, and Pensions (HELP) Committee started the "markup" of their bill today. Other proposals are expected from the Senate Finance Committee, and from the House of Representatives.
The debate didn't start great, with Senators Enzi, McCain, and Gregg coming out guns blazing, not exactly setting a bipartisan tone.
To get a sense of the debate, Senator Judd Gregg likened the legislation to something you'd get if "Rube Goldberg, Ira Magaziner, and Karl Marx" got together to which Senator Barbara Mikulski replied, "Our current system is a combination of Adam Smith, Darth Vader and the Invasion of the Body Snatchers."
Perhaps they should leave the health reform humor to the professionals:
Incomplete scoring of a legislative proposal. Lots of explanations and recalculations. Concern about the timeline to pass a bill. Smells like a health reform debate!
Yesterday, the Congressional Budget Office released an analysis of the preliminary bill coming out of the Senate Health, Education, Labor and Pensions (HELP) Committee. The big issue is that it would cover about 15 million of the uninsured, far less than what people are aiming for as part of a comprehensive proposal
It's not that the numbers are preliminary. It's that they are wrong. As both Ezra Klein and Jonathan Cohn point out, the CBO numbers, by focusing on a partial bill, don't take into account major provisions of the bill that weren't ready for review at the time. According to the CBO estimates, available at The Atlantic website here.
The two major engines of coverage expansion are: * setting a standard for employers to contribute to the health care of their workers, so more people get and keep their on-the-job coverage, and * extending Medicaid to subsidize the coverage of lower-income families that otherwise can't afford it. Neither component was in the bill analyzed by CBO.
It's like trying to see how fast a runner is, but only if he had not one but both legs amputated. Given how all these component interact with one another, it's hard to see any usefulness in these numbers.
If our experience in California is any guide, there will be lots of disputes with CBO in the future about how to properly model the impact of a proposal. This is just something else entirely.
LEGISLATORS MAKE SEVERE HEALTH CUTS, REJECT FULL ELIMINATIONS * Budget Conference Committee Makes Big Health Cuts: $1 Billion in Medi-Cal, Many More * Major Cuts, Not Full Eliminations of State $, for Healthy Families, AIDS Programs, Clinics * In Order to Prevent the Worst of the Severe Cuts, Revenues and Taxes Needed
* More Updates on the NEWLY REDESIGNED Health Access Blog: More on Budget Cuts; The California Congressional Delegation Speaks Out on Health Reform and the Public Health Insurance Option; Health Bills Pending; Better Budget Choices for California
* Follow Health Access California on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget and health reform issues.
On Monday, the Budget Conference Committee of the California Legislature revisited some of the proposed cuts that they had delayed making last week during their first look at the Governor's budget proposal. As with last week, the legislators have made severe cuts, but rejected even worse proposals.
The Committee, chaired by Assemblywoman Noreen Evans, made significant cuts but largely rejected full-scale eliminations of Healthy Families and a variety of other programs and services. Significant reductions were made for most of the cuts the Governor has proposed.
* A $1 billion cut in Medi-Cal as part of "flexibility and stabilization" negotiations with the federal government, largely around "federal funds which are past due." These include: * $700 million that the state claims were disability expenses to the state that shold have been covered by the federal government, by enrolling those on Medi-Cal who are also eligible for Medicare due to disability more promptly; * $75 million in redoing "clawback" calculations related to the implementation of Medicare Part D; * An adjustment of Medicare Part B payments that should have been paid by Medicare, not Medi-Cal * An effort to reclaim over $400 million from provisions in the current hospital waiver that was negotiated in 2005. * It is notable that the list of possible reductions does NOT include provider rate cuts or the eligibility reductions that were originally raised and discussed when this proposal was first floated a few weeks ago.
* A $70 million cut to Healthy Families, which would establish and send children to a waiting list for coverage, unless other sources of funding or donations were made. (Last year, the First Five Commission provided $17 million to Healthy Families to prevent a waiting list from being established, but this is a significantly bigger hole to fill.) This cut is actually *bigger* than the Governor's original $54 million cut to roll back eligibility for over 225,000 children between 200-250% of the federal poverty level. Without additional assistance, a $70 million cut could mean the Healthy Families program bars any new children from enrolling for a long while, denying well over two hundred thousand of children coverage.
* The rejection of the elimination of Medi-Cal coverage for *legal* immigrants (such as those with PRUCOL status).
* $34 million would be shifted from the distressed hospital fund rather than making the Governor's cut to the state's private Disproportionate Share Hospitals (DSH).
* A 30% cut to state funding of community clinic programs.
* A $11 million, rather than $16 million, cut to Maternal Child Adolescent programs, like the Black Infant Child Program.
* A cut of $35.5 million cut from about $80 million provided for AIDS and HIV programs, both education and prescription drug service programs.
* A $26.5 million reduction in Adult Day Health Care Centers, as opposed to a full elimination as the Governor and the Republicans on the committee supported. The compromise proposal would cap the use the ADHCx for 3 days.
* A cut to small and rural hospitals, narrower that what the Governor proposed.
* The cutting of nearly half, rather than all, of the state's poison control system.
Republican legislators voted for the full elimination of these programs, including Healthy Families, the statewide source of coverage for nearly 1 million lower-income children.
The Republican legislators on the Committee--notably Assemblyman Roger Niello and Senator Bob Dutton---often berated their Conference Committee for waiting to make the tough decisions, and for not making these cuts... But Assemblymembers Evans and DeLeon and Senator Lowenthal spoke eloquently for need for other options, and to prioritize between spending cuts. But on AIDS programs and other such efforts, they made clear, "people will die," if the program is eliminated.
The Budget Conference Committee, chaired by Assemblywoman Noreen Evans, is expected to make decisions on outstanding issues--including the bulk of the health and human service cuts--later today, Monday. We'll try to Twitter the results at @healthaccess, and have a post here about the specific health care cuts.
Among the items previously "held open" that the Budget Conference Committee is considering includes:
* A controversial proposed waiver the governor is seeking from the federal government, which the Department of Finance said would save the general fund $1 billion. The governor says the waiver will allow him flexibility to operate outside of some of the federal government’s Medicaid rules, and the conditions of accepting billions from the economic stimulus package, the American Reinvestment and Recovery Act. * Elimination of the Healthy Families program that serves nearly 1 million children. Abolishing the program would save the general fund $368 million but would also cost the state $644 million in matching federal funds. While the committee has suggested it would not eliminate the program, it still is possible that there could be premium increases or eligibility reductions. * Elimination of all general fund support, or $34.2 million, for community health clinics -- including rural, seasonal migratory worker clinics and American Indian health clinics, as well as the Expanded Access to Primary Care Clinics. Together, the clinics provide about 2.3 million visits annually for low-income and uninsured people * Elimination of maternal and child health (MCH) funding for the black infant health program designed to help “at risk” pregnant women and parents; the Adolescent Family Life program, which helps 17,000 pregnant teens up to 18; a birth defects monitoring program; a local county grant program aimed at improving the health of young women and families * A proposal to restrict Medi-Cal services to new legal immigrants and people allowed to relocate to the U.S. by the federal government – such as survivors of the Vietnam War who aided U.S. troops. * Reduced funding for AIDS programs, from HIV education and preventions, to assistance for AIDS drugs. * A proposal to eliminate Adult Day Health Care opened a discussion as to whether various programs aimed at helping the elderly, including Alzheimer’s victims, shouldn’t be re-examined, restructured and streamlined to make them more efficient. The proposal, which the Department of Finance said would save $170.5 million, was held over previously as well.
"We don't have the votes for single-payer, which I support," said Miller, chairman of the House Education and Labor Committee, one of the three committees with jurisdiction over health care legislation. "But if we can't do single-payer, then I believe President Obama has struck the best balance between maintaining the private system with enough government involvement to keep the insurance companies honest and provide access to affordable health care for everyone..."
"I think it's going to happen," Miller said of the restructuring legislation. "People recognize the shortcomings of the system they now have. The economy has shown the vulnerability of families at all levels when people lose their jobs and their health care. It's very hard to see how you fix the American economy if you don't fix health care."
Health consumer protection bills head to 2nd house...
HEALTH ACCESS UPDATE Friday, June 12th, 2009
HEALTH CONSUMER PROTECTION BILLS HEAD TO SECOND HOUSE * Assembly & Senate Passed Bills on Insurance Regulation, from Gender Rating to MRMIP * Legislation to Require a Minimum % of Premiums to Go to Patient Care Stalls in Senate * Bills to Set Standards for Insurance, Prevent ER Overcharging Heads to Senate Health
* More Updates on the NEWLY REDESIGNED Health Access Blog: The Choice to Prevent Budget Cuts; Health Wonk Review; The Public Health Insurance Option
* Follow Health Access California on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget and health reform issues.
Last week was the deadline for legislation to pass floor votes, in either the Assembly or the Senate, in order to proceed for the year.
Several key consumer and patient protections were passed in the past few weeks, including regulations limiting the retroactive denial of coverage; the setting of standards so insurers better label their coverage options; prohibitions on gender-based price discrimination; a reform of the state's high-risk pool, and protections to prevent the overcharging of the uninsured in emergency rooms.
One bill that did not pass the Senate was the setting of medical loss ratios for insurance coverage, so that a minimum percentage of premiums would be required to go to patient care, rather than administration, marketing and profit. Since this is the first year of a two year session, this and other stalled bills will be available for continued movement in January of next year.
Below is a list of health consumer protection bills introduced in the 2009 session of the California State Legislature that have passed their house of origin and are now heading toward hearing by policy committees in the second house. A one-page summary of these bills, and a second page of those bills that have stalled for the year, is available on the Health Access website: http://health-access.org/files/advocating/HAC%20Bill%20List%206-5-09.pdf
This list will be updated regularly through the year and available at www.health-access.org. Below are the active bill now moving to policy committees in the next few weeks, through late June and early July.
INSURANCE OVERSIGHT & MARKET REFORMS
AB 786 (Jones): INSURANCE MARKET STANDARDS: Would sort health insurance policies into six categories, ranging from “comprehensive” to “catastrophic.” Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing, and assist consumers in making apples-to-apples comparisons between plans. Would weed out “junk” insurance by developing minimum benefit standards. Health Access California is the sponsor.
AB 1521 (Jones) BROKER COMPENSATION: Would require disclosure and place limits on how health insurance brokers are compensated by insurers. Health Access California is the sponsor.
AB 119 (Jones) GENDER RATING: Would prohibit insurers from charging different premium rates based on gender. Similar to SB 54 (Leno).
SB 54 (Leno) GENDER RATING: Would prohibit insurers from charging different premium rates based on gender. Similar to AB 119 (Jones).
SB 227 (Alquist) HIGH-RISK POOL: Would require insurers to accept members of the highrisk pool at the rate set by MRMIB or pay a fee used to fund MRMIP. Would also increase the tobacco tax funds dedicated to fund MRMIP.
RESCISSION
AB 2 (De La Torre) INDEPENDENT REVIEW: Would create an independent, third-party review process when an insurer wishes to rescind a consumer’s health policy and also require state review before approval. Also raises the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his health history.
AB 730 (De La Torre) POST-CLAIMS UNDERWRITING FINES: Would impose fines on insurers unlawfully engaging in post-claims medical underwriting.
AB 108 (Hayashi) TIME LIMIT: Would impose an 18-month time limit in which insurers have to rescind, cancel, or limit individual health care policies or charge higher premiums because of fraud once a consumer’s application is approved.
INSURANCE BENEFIT MANDATES
AB 98 (De La Torre) MATERNITY COVERAGE: Would require most health plans to cover maternity services.
AB 244 (Beall) MENTAL HEALTH PARITY: Would require most health plans to provide coverage for all diagnosable mental illnesses.
MEDI-CAL ELIGIBILITY & RETENTION
AB 1142 (Price) PROOF OF ELIGIBILITY: Would require hospitals, as soon as they have proof of a person’s Medi-Cal eligibility, to provide all information regarding that person's Medi-Cal eligibility to all other providers.
AB 1269 (Brownley) DISABLED WORKERS: Would allow, to the extent that federal financial participation is available, workers with disabilities who are otherwise eligible for Medi-Cal but are temporarily unemployed to elect to remain on Medi-Cal for a period up to 26 weeks.
DOCTOR AND HOSPITAL OVERSIGHT
AB 1503 (Lieu) EMERGENCY ROOM FAIR PRICING: Would limit the amount that emergency room physicians and surgeons can charge an uninsured or underinsured patient with income below 350% FPL. Health Access California is the sponsor.
AB 542 (Feuer) ‘NEVER EVENTS’: Bans hospitals from billing patients or insurers when they have made an avoidable mistake, such as operating on the wrong person, prescribing the wrong drugs, or leaving foreign objects inside a surgery patient.
AB 171 (Jones) DENTAL CONSUMER PROTECTIONS: Would prohibit dentists’ offices from offering high-interest loans to patients while they are under the influence of anesthesia. Would also prohibit dental offices from charging lines of credit before services have been rendered.
SB 196 (Corbett) PRICE TRANSPARENCY: Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contract between providers and insurers.
HOSPITAL FINANCING & WAIVER
AB 1383 (Jones) HOSPITAL COVERAGE DIVIDEND FEE: Would, per federal approval, impose a coverage dividend fee on hospitals for the purpose of increased reimbursement and children’s coverage expansion. Adopted with urgency. Watch
AB 342 (Bass) HOSPITAL WAIVER: Repeals the existing waiver authorization which expires September 2010 and acts as a placeholder for waiver discussions with the federal government. Adopted with urgency. Watch.
SB 208 (Steinberg) HOSPITAL WAIVER: Repeals the existing waiver authorization which expires September 2010 and acts as a placeholder for waiver discussions with the federal government. Adopted with urgency. Watch.
There's been a lot of good reporting about the dramatic impacts of the proposed budget cuts. The only problem is that the cuts are sometimes cast as inevitable.
Let's be clear. These cuts are a choice. A choice by our leaders and policymakers.
And they are the worst possible choice they can make.
I make that point in an op-ed in the San Francisco Chronicle, not just detailing the health care cuts' devastating impact on coverage, on our health system, and our economy--but also pointing to possible solutions.
We need the revenues and taxes needed to prevent the cuts that are beyond the pale. We recognize the political obstacles, but anything else is simply not acceptable
Health Wonk Review has a full, robust biweekly compendium of posts at Joe Paduda's Managed Care Matters, whic week all focused on the health reform debate.
Much of the debate is on the proposal to have a public health insurance option, so people are not solely at the mercy of the big insurance companies. It is strange this is controversial in the national debate: after all, in California, we have several public health coverage options, such as local county-run plans.
Given that most of the plans have an individual requirement to take coverage, the public health insurance option becomes even more important to making everything work. Imagine the requirement that all children enroll in school without the creation of a public school system.
The American Medical Association was reported to be dead set against the public option, but today they clarified their position and left room for negotiation, as reported by Health Care for America Now's blog.
Last week, the "Blue Dog" coalition of conservative Representatives put out a statement in favor of health reform, but with lots of provisions to restrict a public health insurance option, including a "trigger" mechanism that would delay or ultimately deny any such choice. But since then, many members of the Blue Dogs have distanced themselves from the statement, and come out in favor of strong public health coverage option.
We need to make sure that people who are happy with the coverage they have can keep it. We need to make sure that the American people will be able to keep their doctors, and have a say in their health care decisions. But we must expand the options, so that Americans who don't like their plan, or don't have health care coverage, have a choice. And we can't afford to wait for an arbitrary "trigger" to be pulled to put this reform into operation. If that is part of the bill, reform will likely never happen.
A public plan that provides true competition will be an important part of this reform. According to data from the Kaiser Family Foundation, a widely respected non-profit health policy research foundation, nearly two thirds of Americans agree with me that we need to make sure that all Americans have access to affordable health care by providing an alternative to the private insurance options that are on the market.
Harman, in a statement, said she supports a public option without a trigger. "I will oppose any plan that does not include this option, and am unwavering in my opposition to the so-called 'Blue Dog trigger,'" said Harman. [...]
Harman said she's sticking by her pledge.
"I am proud to have signed the HCAN (Health Care for America Now!) pledge to seek universal coverage," she said. "I am a strong supporter of universal health coverage, which is why I support the health care reform plan being developed by President Obama, Senator [Ted] Kennedy, and Congressman [Henry] Waxman. Like them, I believe that the bill must include a public health insurance option which guarantees all Americans access to quality, affordable health care."
Rep. Loretta Sanchez (D-Calif.), a Blue Dog who also signed the pledge, told the Huffington Post she backs a public option without a trigger. "America can't afford to wait for health care reform. While a single-payer system would be ideal, I am prepared to support other measures that also reduce costs, preserve doctor choice, and assure affordable, quality health care for all Americans," she said in a statement. "I think a public option without a trigger would be a good way to fix what's wrong with health care while preserving what works."
Our public option is going to be just another aspect of it. Put it out there, and they can compete. I think we're going to have to have competition … to get the best possible health care at the lowest cost possible.
We're checking in with other Congressional offices up and down the state, but the trend looks good.
First round on health cuts from the Budget Conference Committee...
Tuesday, June 09, 2009
HEALTH ACCESS UPDATE Wednesday, June 10th, 2009
BUDGET CONFERENCE COMMITTEE REVIEWS GOVERNOR'S HEALTH CUTS * Committee to Decide Later on Major Cuts to Medi-Cal, Healthy Families, AIDS Programs * Cuts Made to Alzheimer's Services, Asthma, Application Assisters, AIM, MRMIP, Etc. * Some Cuts Considered Way Too Severe: "A Bright Red Moral Line" * Governor Continues to Reject Revenues Needed to Prevent Devastating Cuts
* More Updates on the NEWLY REDESIGNED Health Access Blog: California's Cartoon Future; Previous Posts From Budget Conference Committee; The Real Start of National Health Reform; Unprotected While Still Paying Premiums; The New Kaiser Health News; A Lack of Competition in California's Insurance Market; Passage of Key Bills in the Legislature; Maternity Coverage Debated; Who Is Impacted By the Budget Bloodbath?; Report from Appropriations Committee; New Budget Blogs
* Follow Health Access California on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget and health reform issues.
Over the last two days, the Budget Conference Committee of the California Legislature have been reviewing the full range of cuts to health and human services. They have made severe cuts, and rejected even worse proposals.
Stymied by a lack of big-picture information, the Committee chaired by Assemblywoman Noreen Evans did not take final action on a number of sweeping health care program cuts proposed by Gov. Arnold Schwarzenegger to help balance California’s teetering budget. They "held open" these cuts, but with the expectation that many specific decisions would be made by Monday.
The committee took a pass on voting on several of the harshest cuts until a more comprehensive look at the impacts could be pulled together. It is still possible, even likely, that many of the programs "held open" may get cut, especially if the legislature does not raise the revenues needed to offset these cuts.
Among the items held open were:
* A controversial proposed waiver the governor is seeking from the federal government, which the Department of Finance said would save the general fund $1 billion. The governor says the waiver will allow him flexibility to operate outside of some of the federal government’s Medicaid rules, and the conditions of accepting billions from the economic stimulus package, the American Reinvestment and Recovery Act. The LAO said the savings were “speculative” at best. The proposal was held over when Committee Vice Chair Denise Ducheny (D) sought more specific information, noting that California already has lowest per-patient Medicaid spending in the nation.
* Elimination of the Healthy Families program that serves nearly 1 million children. Abolishing the program would save the general fund $368 million but would also cost the state $644 million in matching federal funds. It would also make California the only state in the nation to totally opt out of the federal Children’s Health Insurance Program, which provides $2 to match every $1 spent by the state. Said Committee Chair Noreen Evans, “I think we have a moral obligation to take care of our children. To eliminate a program like this is just indefensible. I will not support the elimination of this program – but I will think about cuts.”
* Elimination of all general fund support, or $34.2 million, for community health clinics -- including rural, seasonal migratory worker clinics and American Indian health clinics, as well as the Expanded Access to Primary Care Clinics. Together, the clinics provide about 2.3 million visits annually for low-income and uninsured people;
* Elimination of maternal and child health (MCH) funding for the black infant health program designed to help “at risk” pregnant women and parents; the Adolescent Family Life program, which helps 17,000 pregnant teens up to 18; a birth defects monitoring program; a local county grant program aimed at improving the health of young women and families;
* A proposal to restrict Medi-Cal services to new legal immigrants and people allowed to relocate to the U.S. by the federal government – such as survivors of the Vietnam War who aided U.S. troops. The latter group “tends to be refugees as a whole, mostly political refugees” said Ducheny. She favored finding out if the federal government is willing to devote more funds to help pay for health care services for this population.
* Reduced funding for AIDS programs that Senator Mark Leno (D) said has reduced the threat of AIDS in California from the level of an epidemic.
* A proposal to eliminate Adult Day Health Care opened a discussion as to whether various programs aimed at helping the elderly, including Alzheimer’s victims, shouldn’t be re-examined, restructured and streamlined to make them more efficient. The proposal, which the Department of Finance said would save $170.5 million, was held over as well.
The committee’s frustration was evident, with Vice Chair Denise Ducheny (D) demanding a more comprehensive analysis of the piecemeal, disjointed cuts proposed to health care programs. Evans scolded Department of Finance, saying the committee needs to be able to make informed decisions. “We simply don’t have the information we need by virtue of how this budget is worked out,” Evans said.
Also rankling Evans were the governor’s requests for money to hire anti-fraud staff in various positions – at the same time as current state employees are asked to shoulder cutbacks in compensation. “I think adding new positions when we are furloughing employees is not a good way to go,” Evans said. “This is a problem. Why, with furloughs, would we ask for more money? I’m not really in favor of approving more positions.”
But Assemblyman Roger Niello (R) pushed his colleagues to make hard choices swiftly, noting the budget deficit of $24 billion represents a 25 percent reduction in revenue flowing into the state’s coffers. “Excuse me for sounding like a Republican, but government is not the only answer to our problems,” Niello said, adding that the private sector as a whole has not taken as hard a hit as state government has.
CUTS MADE: A variety of cuts were made--often with relatively small savings but big impaccts. Niello pressed for elimination of $20 million in state funding for the Domestic Violence Shelter Program, which would reduce services to over 105,000 battered women. He said that community supporters, nonprofit foundations and philanthropists should step up their donations to the shelters. “This is a perfect example of the many difficult decisions we’re going to have to make,” Niello said. From a personal perspective, I support the shelters – I have donated money to them and will continue to do so as a member of the community.”
Though the governor’s proposal would have eliminated all general fund support for the shelters, Republican Assembly members on the committee said they could back a 50 percent cut. Ducheny asked for a less onerous generous 10 percent cut, then compromised and proposed the 20 percent cut the committee eventually adopted.
Assemblymember Kevin de Leon (D) said he was struggling with approving any cuts to the shelters, noting that he has family members who have been victims of domestic violence and sought refuge in the shelters. Of the governor’s original, harsher proposal, de Leon said, “This is a real tough one. This is not a haircut, it is a decapitation. If the economy continues to sour, demands for these services will be needed more than ever,” as stress and financial strain impact more family lives, he said.
* The budget committee met the governor halfway on another proposed cut. The Governor proposed eliminating general fund support for Alzheimer’s Research Centers, of which there are 10 throughout the state. The committee agreed to a 50 percent funding cut, with the stipulation that the $3 million saved would go toward providing services instead of research.
Other cuts that were decided on included:
* The one-time elimination of support for the immunization assistance program, for $18 million in savings, in light of economic stimulus funds going to the same purpose. * The suspension of a children's dental disease prevention program that served 300,000 children, for a savings of $2.9 million. * The elimination of certified application assisters that help low-income families apply, stay enrolled, and use Medi-Cal and Healthy Families coverage, for a savings of $2.7 million, with the probability of reducing enrollment as a result. * A $6.6 million reduction in the Major Risk Medical Insurance Program (MRMIP), which provides some coverage to those "uninsurable" patients denied for "pre-existing conditions"--and already has a waiting list. * A $4.9 million reduction in funding for Access for Infants and Mothers (AIM), which provides health care to over 13,000 pregnant women. * A reduction in funding for the state Asthma program
After a dramatic discussion, the committee voted against killing the programs, packaged together to shave $20 million off California’s gigantic $24 billion deficit. “If we go with the governor’s proposals No. 2, 3, 4 and 5, people will die,” Assemblyman Kevin de Leon (D) told his colleagues.
Assemblyman Robert Blumenthal (D) was blunt: “This is a bright red moral line we cannot cross. It’s something I am very worried about.”
Still, the prospect of drawing a line when the task of balancing the budget seems so Sisyphean struck Senator Bob Dutton (R) as impractical. The budget must be balanced by June’s close. “I don’t think it’s right saying people are going to die,” Dutton said. “I mean, I could die in a car crash today when I leave here. I still support the governor’s proposal.”
The Committee also rejected family planning funds, which had the benefit of providing a 9:1 match from the federal government.
ONGOING EFFORTS: While a budget for 2009-10 was approved in February, these budget cuts are part of a Governor's proposal to solve a $24 billion deficit that has emerged since then, as part of the economic recession. The Governor has yet to budge from his all-cuts approach to the budget, and has rejected raising taxes and revenues as a way to prevent the worst of these cuts.
In addition to the $2.4 billion in health care cuts, there are other severe cuts to other human services as well, to IHSS home care, SSI/SSP for seniors, CalWORKS, CAPI and CFAP.
The Budget Conference Committee will soon revisit the cuts "held open" in the next few days. Committee Chair Evans indicated the goal of having the Committee finish their work by Monday.
This report was written by Cynthia Craft of Health Access California. More commentary will be available on the newly-redesigned Health Access website at http://www.health-access.org, and our blog, at http://blog.health-access.org.
A scarily specific parody about the cuts that California is contemplating, from Slate magazine.
As someone with heritage from Ecuador, my only complaint is that if we go through with these cuts, we'll give actual banana-producing countries a bad name.
The team at Health Access will continue following the Budget Conference Committee's review of the health care cuts, both on this blog and on our Twitter account at @healthaccess, or www.twitter.com/healthaccess.
After a dramatic discussion, the committee voted against killing the programs, packaged together to shave $20 million off California’s gigantic $24 billion deficit. “If we go with the governor’s proposals No. 2, 3, 4 and 5, people will die,” Assemblyman Kevin de Leon (D) told his colleagues.
Assemblyman Robert Blumenthal (D) was blunt: “This is a bright red moral line we cannot cross. It’s something I am very worried about.”
Still, the prospect of drawing a line when the task of balancing the budget seems so Sisyphean struck Senator Bob Dutton (R) as impractical. The budget must be balanced by June’s close. “I don’t think it’s right saying people are going to die,” Dutton said. “I mean, I could die in a car crash today when I leave here. I still support the governor’s proposal.”
The unprecedented public committee meeting offered a rare peek at how deeply divided five Assembly members and five Senators can become when the stakes are so high. Tension was palpable between the two political parties, between Assembly members and Senators, between urban and rural elected representatives – even between those who believed previously struck budget agreements should prevail, and those who believed all bets were off.
Many items on the governor’s chopping block were “held open” for later discussion, and votes, following committee members’ request for more data from the Department of Finance and the Legislative Analyst’s Office.
That was the case with a controversial proposed waiver the governor is seeking from the federal government, which the Department of Finance said would save the general fund $1 billion. The governor says the waiver will allow him flexibility to operate outside of some of the federal government’s Medicaid rules, and the conditions of accepting billions from the economic stimulus package, the American Reinvestment and Recovery Act. The LAO said the savings were “speculative” at best. The proposal was held over when Committee Vice Chair Denise Ducheny (D) sought more specific information, noting that California already has lowest per-patient Medicaid spending in the nation.
Also controversial, and held over, was a proposal to restrict Medi-Cal services to new legal immigrants and people allowed to relocate to the U.S. by the federal government – such as survivors of the Vietnam War who aided U.S. troops.
The latter group “tends to be refugees as a whole, mostly political refugees” said Ducheny. She favored finding out if the federal government is willing to devote more funds to help pay for health care services for this population.
A proposal to eliminate Adult Day Health Care opened a discussion as to whether various programs aimed at helping the elderly, including Alzheimer’s victims, shouldn’t be re-examined, restructured and streamlined to make them more efficient. The proposal, which the Department of Finance said would save $170.5 million, was held over.
Two of the budget trims that were approved Monday called for conducting a therapeutic category review of antipsychotic drugs for mental illness (an estimated savings of $1.5 million) and requiring manufacturers’ rebates on HIV/AIDS and cancer drugs.
More quotes and blow-by-blow descriptions of votes and discussion are at the Twitter feed at www.twitter.com/healthaccess. The committee resumes its examination of cuts in health care services at 10 a.m. on Tuesday, June 9th.
As of this writing, the committee has made some tough cuts already, but had kept "open" cuts like the elimination of the California Poison Control System, the $1 billion unspecified cut to Medi-Cal (based on federal "flexibility"), and the 10% cuts to private "safety-net" hospitals. We'll have a full report later today.
The Budget Conference Committee is scheduled to come back on Monday, June 8th at 2pm to start discussing and reviewing specific health care cuts. At stake is the health care coverage of over 2 million Californians, and the state's health system on which we all rely.
While we in California have been focused on bills and budget, the federal health reform debate is now in full force. Earlier this week, President Obama sent key Senators a letter detailing more of his requirement, from more emphasis on cost containment to the need for a public health insurance option.
Friday, a "draft of a draft" of was released by Senator Ted Kennedy's office of a health reform bill. We'll have an update and some analysis later. (Courtesy of The Hill, here's a copy of the 170+ pages, which is understood to be only a part of a broader package.) Other proposals, especially in the House, will also be introduced. Now, the debate is very real.
Lawmakers and regulators in states including Texas, Vermont and New York are pushing new efforts to make health insurers' consumer communications clearer, though many states already have some requirements on their books. Rhode Island's health insurance commissioner wants to make insurers write all documents at an eighth-grade level. A California bill would classify insurance plans by their levels of coverage.
Why is this important? The new study from earlier this week on personal bankruptcies makes the point: Over 60% of bankruptcies involve medical bills as a factor, and around 75% of those bankruptcies are people with health coverage. In many cases, their coveraeg has let them down. At a minimum, people expect health coverage to prevent them from going into bankruptcy. If it doesn't do that, then it doesn't deserve to be called coverage.
The Budget Conference Committee is slated to reconvene at 1:30, on higher education and child care issues.
We expect that health issues will be up tomorrow, Saturday, and human services issues on Monday. We'll provide more updates here an on Twitter, at @healthaccess, or www.twitter.com/healthaccess.
Kaiser Health News is a new, nonprofit journalism site, providing new reporting that is offered on the web and to other media outlets. We've commented on the wrenching changes in the media, and this is an attempt to continue good journalism around health issues even as the industry is in turmoil.
The excellent journalists behind Kaiser Health News are very familiar to California readers. They include Julie Appleby, who reported in California before going on to a prominent national health beat at USA Today, and Jordan Rau, the infamous Los Angeles Times reporter who just moved from Sacramento.
The Assembly passed AB786(Jones), sponsored by Health Access California, to provide better transparency in the health insurance market, and more confidence for consumers in their coverage. Republican legislators opposed the proposal as "limiting choice." Recognizing the problems of "junk" insurance, Assemblyman Solorio spoke in favor of the bill after some amendments were taken.
Other bills that passed include AB2(De La Torre) to regulate insurance rescissions, and SB227(Alquist) to reform the MRMIP high-risk pool.
One bill that didn't pass was SB316(Alquist) to set a standard for medical loss ratios in insurance companies.
More later on these bills, but mostly back to the budget...
Health insurance premiums for California working families have increased 96 percent from 2000 to 2007. At the same time, the median earnings of California workers increased 19 percent from $25,740 to $30,702. That means health insurance premiums for California working families have risen five times faster than wages.
Wihle not the only cause of rising health premiums, one factor is the marked concentration in the health insurance market. In virtually every area of California, the new report shows that just a couple of companies have over half the health insurance market. Individual consumers and small businesses have no market power against the Blue Cross and other big insurers, who can set the premiums and the benefits
Consumer groups argued that these finding show it’s time for real comprehensive health reform that includes regulation and the choice of a public health insurance plan so patients are no longer at the mercy of the private health insurers in California. At the state level, they also support AB786(Jones), providing standards for coverage, up in the California Assembly today.
“For too long, insurance companies have competed based on dropping the sick, rather than through lowered costs and higher quality. Now this new research shows that they haven’t even been competing much at all!” said Michael Russo, health care advocate and staff attorney for CalPIRG. “The choice of a public health insurance plan will give consumers better options – and will keep insurers honest.”
The American Medical Association reports that the health insurance marketplace is dangerously concentrated with 94 percent of local markets in the United States currently considered highly concentrated. And contrary to what the health insurance industry claims, these mergers have undermined market efficiency. Premiums nationwide have gone up an average of more than 87 percent over the past six years.
“There is no real choice or competition in the private health insurance market, and only giving everyone the option of a public health insurance plan will guarantee we get quality, affordable health care we all can count on this year,” said Marty Martinez, policy director for the California Pan-Ethnic Health Network. “A public health insurance option will force private health insurance companies to control cost, guarantee quality, stop hiding what they will and won’t cover, and put people’s health before corporate profit.”
Some facts about the insurance industry in California:
* Anthem Blue Cross, a subsidiary of WellPoint Inc. and the state’s largest insurer, controlled 30 percent of the California market in 2008. Together Wellpoint, with Kaiser Permanente, they hold 58 percent of the California market.
* Such consolidation is especially true in smaller markets. By itself, WellPoint, Inc. (Anthem Blue Cross) holds 60 percent of the market in Salinas and more than 50 percent of the markets in San Luis Obispo and Redding .
* Health insurance premiums for California working families skyrocketed by 96 percent from 2000 to 2007.
* For family health coverage in California during that time, the average annual combined premium for employers and employees rose from $6,227 to $12,194.
* For family health coverage in California , the average employer’s portion of annual premiums rose 91 percent, while the average worker’s share grew by 111 percent.
On the conference call releasing the report was Linda Jackson, of Grass Valley , CA , who has experienced the problems in this concentrated and confusing health insurance market. They lost their coverage after being laid off by Formica after 34 years of working there. She and her husband, in their late 50s, now pay over $1100/month, even though they are relatively healthy. They have been shopping around for coverage but their options are limited, and she is worried about getting any new coverage she gets may not be comparable to her current coverage in terms of benefits.
The concentration in the health insurance market is seen not just impacting premiums, but the quality of the health policies and the benefits they provide. The lack of competition is further exacerbated by a confusing and unstructured marketplace, where consumers find it impossible to compare plans. At the federal level, health reform proposals offer a “health insurance exchange” that would standardize and set basic benefit levels, and a public health insurer as a new, affordable option for people to secure basic coverage.
At the state level, AB786(Jones) would set basic health insurance standards to allow for better “apples-to-apples” comparisons, and limit “junk” insurance. Health Access California, the sponsor of AB786, argues that consumers need health reforms that provide greater oversight and standards for the insurance industry, who right now dictate the terms of coverage with their market power. The bill is scheduled to be voted on in the California Assembly today, Wednesday, June 3rd, 2009.
The report is also being released as insurance companies executives from across the nation are coming to San Diego , California , for the annual conference of their trade association, America ’s Health Insurance Plans (AHIP). The report is being release in advance of a Rally for Health Reform, on Thursday, 8-10am, in front of the AHIP conference at the San Diego Conference Center , 111 W. Harbor Drive.
The report was prepared by Health Care for America Now - the nation's largest health care campaign - is made up of more than 1000 organizations representing more than 30 million people nationwide. President Obama and more than 190 Members of Congress support HCAN’s principles for health care reform. All across the country, HCAN supporters are organized and mobilized to stress the urgent need for health care reform in 2009 -- reform that finally puts our health care needs before insurance company profits.
The Governor's speech was short and anti-climatic. Nothing new. Even the falsehood were repeats of past statements. We had some real-time comments on Twitter, at www.twitter.com/healthaccess. Feel free to follow us at @healthaccess.
From a longer perspective, on The New Republic's The Treatment blog, I posted on how health reform might prevent future efforts to cut coverage out from underneath patients, because of the sexy-sounding "Automatic Countercyclical Stabilizer."
If you think providing maternity care to women who are covered by health insurance is a no-brainer, you’d have been surprised to listen to the debate that developed over the topic Tuesday on the Assembly floor.
It seems that many Republicans believe that adopting mandates – even something as basic as AB 98’s requirement that individual policies include maternity services -- is simply going too far. Currently, group policies cover maternity care, but individual policies purchased by people such as the self-employed, don’t necessarily provide such coverage.
“These mandates increase health care costs for everyone,” argued Audra Strickland (R), a former teacher and mother of two who is a member of the Assembly Health Committee.
And Republican Anthony Adams stood to say that men shouldn’t have to pay for a service for women.
Oops. Did someone forget that, generally speaking, men play a role in the process that results in a baby? And that fathers, as well as mothers, are deeply invested in seeing their children born healthy?
Anna Marie Caballero (D) countered that women in the insurance risk pool pay a share to cover prostate cancer, and so men should not complain about pitching in to cover maternity services. “Women and children deserve the same quality of care as men,” Caballero said.
AB 98’s author, Hector De La Torre (D), estimated that individual policy holders would face a $7.17 increase if maternity care were mandated – saving the state budget a substantial sum by shifting the costs of uninsured services to consumers.
“We need to end this disparity,” De La Torre said, of the difference in coverage from group policies and individual policies.
Democrats prevailed, and voted 41 to 23 (preliminary vote tally) to pass the bill out of the Assembly and send it to the Senate.
This week will start with the federal health reform debate going to another level, as Senator Ted Kennedy introduces his bill for health reform in the U.S. Senate Committee on Health Education Labor and Pensions. It's only the first, not the last, word in the debate: Senator Baucus' Finance Committee will likely have a bill, as will their counterparts in the House of Representatives.
Also in the Kennedy clan, Governor Schwarzenegger will go in a completely different direction, presenting a speech on Tuesday about the budget--and likely defending his cuts-only budget that would lead to over 2 million more uninsured and other devastation.
The Budget Conference Committee will take up the health cuts for discussion (and possible vote) on Friday, June 5th.
We'll also have coverage through the week of the legislative session, as bills are up for final floor votes before the end-of-week deadline.
Other items of note:
* According to the New York Times, hospitals are starting to mobilize against any "charity care" provisions in health reform, the notion that in return for nonprofit, tax-exempt status, hospitals have special obligations to serve the uninsured.
* I am having a back-and-forth at KQED's Healthy Ideas forum that gets ideological quickly, rather than focusing on how we can secure and expand coverage to people, and in an efficient way.
* Back in print media, we have a new op-ed in Capitol Weekly, suggesting the disconnect between the Governor's previous support for health reform, and his current budget stance.
In yet another example of how different people view the budget problems and the budget solutions in Sacramento, Governor Schwarzenegger's Director of Finance Mike Genest defended how so many of the budget solutions are falling on the poor and most vulnerable in California with this statement:
“If you look at what the government does, the government doesn’t provide services to rich people. We don’t provide many services even to the middle class. . ."
Wait a minute. To be fair, I think I know what he's trying to say, given the question, but it came out so garbled as to be counterfactual--especially if Californians need to understand the nature of these cuts.
Let's just be clear: State government provides services to all Californians. The big categories are education, health + human services, and then public safety--essential services for people of every region, income, class, and ideology.
More than half of the state budget is education, both K-12 and higher education. Most children are impacted by these cuts. There's a lot of students who go to public schools or the University of California.
The next biggest item is healthcare. The big item is Medi-Cal, which is provides health coverage to 6.8 million mostly low-income children, parents, seniors and people with disabilities. But in covering 1 of 5 Californians, many middle-income families benefit, since it covers their grandparents. Medi-Cal is such a major funding source for the health system on which we all rely--and sut to Medi-Cal really do impact all of us.
According to the California Health Care Foundation, Medi-Cal: "Is the nation’s largest Medicaid program in terms of the number of people it serves, 6.6 million, and is the second largest in terms of dollars spent, $40 billion.
"Is the source of health coverage for: • Almost one in five of Californians under age 65; • One in three of the state’s children; and • The majority of people living with AIDS.
"Pays for: • Forty-six percent of all births in the state; • Two-thirds of all nursing home residents; and • Almost two-thirds of all net patient revenue in California’s public hospitals.
"Brings in more than $20 billion in federal funds to California’s health care providers."
Given that we go to the same hospitals and providers, there's no way that you make the proposed cuts to health care, and patients throughout the state won't be impacted--through reduced services, reduced quality, increased waiting times, and more crowded emergency rooms.
With health care and other "safety net" services we should remember that these services are there in part for middle-class families--as a safety-net--when times get tough. When a family member loses a job, gets a divorce, or comes down with a medical emergency, these services help provide health coverage, take care of child or an elderly parent, or help pay the college tuition. They can help take care of a family member with a disability.
There's been a lot of focus on the closure of state parks, and other cuts that visibly impacct everybody. But when we talk about the big items that state government funds--education, health care, and public safety--we all are impaccted, even if it isn't as visible.
It's a fundamental misinterpretation to talk about even about the social services that are focused on low-income families as something that is a cut to "them." These services are ultimately insurance for "us." They help "middle-class" folks during life-changing moments. And they help people who happen to be low-income as a given moment to become "middle-class."
Maybe this mentality--that it's really just "those" poor people being impacted--is why the Administration is so comfortable choosing to announce these cuts, rather than to support revenues, and so what it takes to get the votes, to avoid these cuts.
These cuts are the Governor's choices and priorities. I don't think they are those of Californians.
When the LAO suggested that the deficit was $3 billion more than the eye-popping $21 billion, the logical response was to finally put away the "no new taxes" rhetoric and indicate it was time to start looking at revenue increases.
The new cuts include the elimination of adult day care, a significant cut in the Californians who get IHSS home care, a 5% reduction in salary for all state employees, and $68 million additional dollars found when completely eliminating the Healthy Families program.
In tight-fisted Legislature, some wins, some losses...
Thursday, May 28, 2009
AB786 Moves To The Floor: A bill making it easier for consumers to comparison shop for individual health insurance policies passed through the Assembly Appropriations Committee on Thursday, on a straight party line vote.
Democrats favored the development of an apples-to-apples approach to buying and selling insurance because it would help eliminate “junk insurance,” policies that at first may seem legitimate, but which offer very little coverage when medical claims are filed.
Republicans, on the other hand, voted against AB 786 (Jones), which specifically requires California regulators to come up with standard categories under which consumers could compare various features that various insurance companies sell – with transparency.
The bill, authored by Assembly Health Committee Chairman Dave Jones (D) and sponsored by Health Access California, is especially important in California, where there is a high number of small business owners and entrepreneurs who must shop for their own health insurance, rather than obtaining it from an employer.
The bill will now advance to the full Assembly for a floor vote next week....
More Appropriations Reports: Only half of the 450 bills heard by the Assembly Appropriations Committee survived the legislative panel’s especially close scrutiny of potential costs to the state. Committee Chair Kevin de Leon somberly opened the hearing by noting that California is at a perilous crossroads of having to cut costs and possibly programs to backfill an estimated budget deficit of about $24 billion. Many of Governor Arnold Schwarzenegger’s proposed cuts so far have targeted public programs such as Medi-Cal and Healthy Families, threatening to leave as many as 2 million people without any health care coverage.
Assemblyman Jim Nielson, vice chair of Assembly Appropriations, was succinct in his opening comments: “For the next couple of years, we urge all interests to exercise restraint in coming to the Legislature for (program funding.) To everyone who has ideas that cost money, we urge you to just say “no.’”
Outcomes were mixed for other important health care legislation that Health Access is tracking through the Legislature:
AB 2(De La Torre) would prohibit the cancellation or rescission of individual health care coverage when time comes to pay the medical bills. It passed on a party line vote and will now go to the full Assembly.
AB 244 (Beall) would require health plans and insurers to cover mental health and substance abuse to the same extent they cover other health conditions, creating parity. The measure advanced to the full Assembly.
AB 542 (Feuer) would withhold payment for “never events,” shorthand for neglectful medical care and mistakes that never should happen to anyone under medical care. It passed on a party line vote, advancing to the Assembly floor.
SB 227 (Alquist), which requires insurers to accept members of a high-risk pool of health consumers, passed out of the Senate Appropriations Committee and goes next to the full Senate.
Some measures that were held in Appropriations include:
AB 1314 (Jones) and SB 56 (Alquist), bills that were vehicles for continuing conversations on comprehensive health reform, were held in Appropriations committees in both houses.
AB 29 (Price), which would have extended to 27 the age that children can be considered dependents for purposes of health coverage, was held in Appropriations Committee.
AB 214 (Chesbro) would have required group health plans and insurers to cover durable medical equipment at parity with other health benefits. It was held in Appropriations.
SB 810 (Leno), which would establish a single-payer health care system for California, was held by the Senate Appropriations Committee, Senator Mark Leno (D) said he would bring it up again next year.
SB 341 (DeSaulnier) sought to have University of California experts evaluate scientific studies on the safety and effectiveness of pharmaceuticals - and their possible adverse reactions. The information would then have been publicized on a website. It was held in the Senate Appropriations Committee.
Those measures held in Appropriations could be available for passage in January 2010.
Earlier today, the Assembly passes two Health Access California sponsored bills, which now head toward the Senate.
AB1503 (Lieu) would prevent uninsured self-pay patients from being overcharged by emergency room physicians, which often charge 3-4 times what insurance companies pay for exactly the same services. This bill follow up from a 2006 law that prohibits hospital overcharging of the uninsured. The bill got broad bipartisan support, with 52 votes from both Democrats and Republicans, and zero "no" votes.
AB1521 (Jones) provides for better disclosure by insurance brokers when selling health coverage plans. It got 42 votes from Democrats, 23 votes from Republicans, with 15 members not voting or not on the floor during the unofficial tally.
We look forward to their hearing at the Senate Health Committee in the next few weeks.
To hear the impassioned pleas of dozens of health care advocates testifying before the budget conference committee Wednesday, you had to wonder what in the world the governor was thinking when he drew up his slash-and-burn proposed budget cuts.
Surely, he can’t be serious.
Does Arnold Schwarzenegger really want to be remembered as the governor who denied health care to as many as 2 million Californians in need during the worst economic plunge in modern times?
If so, he got a boost from the public on Wednesday, as the diagnosed, the disabled, the wheelchair-bound, and the newly unemployed joined health-care professionals, advocates, county officials and other consumers in warning of the dire consequences of the governor’s proposals.
With an overflowing crowd waiting for an unprecedented chance to offer their 90 seconds of testimony to a budget committee that’s usually closed to public comment, Assemblywoman Noreen Evans (D), the committee’s chair, put matters in perspective:
“This crisis is of historic magnitude,” Evans announced. “We are not just focused on the crisis of the moment. The people of California have said fix this thing in a lasting, constructive way -- and we want your ideas.”
She did get some ideas (cut administrative overhead, for one; trim prison spending, for another), some solid reasoning and plenty of emotion during the hours of public comment to follow:
Many expressed dismay that California would be content to lag so far behind the rest of the nation in providing health care for children through the Healthy Families program. Schwarzenegger proposes eliminating the program, even though it is funded by $2 of federal money for every $1 California spends….
…which was one reason (but not the only one) that led so many speakers to use the axiom “penny wise, but pound foolish” as did mental health advocate Rusty Selix in reacting to the proposed severe cuts.
Others said Healthy Families and Medi-Cal – also on the governor’s chopping block – are the programs that keep low-income families from financial ruin in case of a medical emergency.
Several pointed out that some cuts in medication can result in people cycling in and out of jail or prison, a much more expensive option than providing care.
Health Access’ Beth Capell told legislators that “the cuts that are proposed are the kind that turn recessions into great depressions.”
Capell and others suggested revisiting a tobacco tax; others suggested a dime-a-drink alcohol tax.
Spokesmen for Indian health programs noted that any reduction in health services will have long-lasting implications: “We are making decisions that might save us money today, but will hurt us later -- and may lead to loss of life."
Many noted that people will end up in the emergency room, further straining hospitals hit hard by the down economy, and costing more in the long-run.
SEIU's Mary Hernandez was blunt: “The idea of adding 2 million people to the uninsured is unimaginable.”
One spokesman opposing the elimination of health services for new legal immigrants declared: “What we are looking at is an absolute evisceration of our safety net services.”
Perhaps no one was more moving, however, than the young woman who was diagnosed with HIV at age 6, having contracted it at birth. She was recently laid off. “I get $57 a week in unemployment. Without these programs, I can’t afford the medications that keep me from getting AIDS.” She began to sob. “I want to live this life. Please don’t allow these cuts to take place. You’ll cut my life.”
We wonder if this is what Schwarzenegger had in mind when he said he wants California to have a “robust debate” about its budgetary process.
California's single-payer universal health care legislation, SB810, will be a two-year bill, and will be parked at the Senate Appropriations Committee for the remainder of this year. The bill will be picked up again next year in 2010, the second year of the 2009-10 two-year legislative session. Senator Mark Leno issued a statement today on the subject:
Today, in response to California’s ongoing and unprecedented budget crisis, the Senate Appropriations Committee was forced to hold a large majority of the bills on its suspense calendar. SB 810, our bill to establish single payer universal health care in California, was not an exception.
Faced with the loss of 25% of our General Fund revenues, the legislature must direct its undivided attention toward avoiding the gruesome cuts proposed by the Governor, which would fundamentally dismantle our most basic health, social, and educational infrastructures.
Let me be clear in saying that SB 810 is alive and well in the Senate Appropriations Committee, and the next opportunity to move the bill will be in January, 2010. This does not represent a change to our overall strategy for SB 810 to be a 2-year bill, nor does it affect or prevent us from doing the important work we already are doing to advocate and educate the public about the importance of single payer in our communities and in the legislature.
Even if SB810 advanced this year, Governor Schwarzenegger has vowed to veto it again, as he has two times before. In addition, the financing for the proposal would need a two-thirds vote of the legislature. So rather than rush the bill to the Governor for a near-certain veto, it makes sense to hold the bill, and continue to organize and educate around the benefits and provisions of a single-payer health system, and to use the bill to positively influence the broader debate on health reform in the state and nationally. We'll keep you posted...
Our newly redesigned, newly renamed Health Access Blog, newly relocated at http://blog.health-access.org/, will continue to be a central place for quick updates about the health care budget cuts.
But there's some other new resources for good information about the budget. The most notable is the blog by Budget Conference Committee Chair Noreen Evans, Assemblywoman from Napa Valley, who has taken a leadership role in highlighting the tragic choices presented by the Governor's budget--a role that we hope the legislative leaders would take up.
She even presented this Internet video, that explodes several myths about the budgeting process. She explains how the majority of our increased spending is simply taking into account population and inflation, that our structural deficit is caused more by tax cuts rather than increase program spending, and how much of the state budget is restricted due to voter initiatives.
And finally, don't forget California Budget Bites, by the team led by Jean Ross at the California Budget Project. Many other media and political sites will cover the budget, the big story in Sacramento this year, but these blogs, along with us here at Health Access, will confront the devils that are in the details.
GOVERNOR PROPOSES ADDITIONAL CUTS TO HEALTH & HUMAN SERVICES * Governor Seeks Elimination of Healthy Families, CalWORKS, Various Clinic Programs * Medi-Cal Cut To Be Negotiated with Federal Govt Goes From $750 Million to $1 Billion; * Cuts Would Deny Coverage for Dialysis, Cancer Treatment, HIV Testing, Mental Health, Etc. * Cuts Would Harm Health System & Economy; Hundreds of Millions in Lost Federal Funds * Governor Rejects The Long-Term Revenues Needed to Prevent Devastating Cuts
More Updates on the NEWLY REDESIGNED Health Access Blog: Listening to the Electorate; The Results of a Cuts-Only Budget; Eliminating Healthy Families?; Without Reform, It's Getting Worse; Fighting Against So-Called "Flexibility"; The Budget Conference Committee; The Day After the Election; Getting to Universal Coverage
Today, Governor Arnold Schwarzenegger released details of new, additional cuts totaling over $5.5 billion to the state budget, on top of what he proposed a few weeks ago. And because of the continued deterioration in the economy, the Administration has promised to release by Friday another $3 billion in cuts to be considered on top of that.
On May 14th, he had proposed a variety of "budget solutions"--including many cuts and no revenues--to address a $21.3 billion deficit in the 2009-10 budget year, with some cuts contigent on the failure of Propositions 1C, 1D & 1E. Last week, he announced he was abandoning a plan to borrow over $5 billion dollars, and instead simply proposing to make additional cuts. Today's list of cuts detailed those cuts, which include the wholesale elimination of Healthy Families, CalWORKS, CalGrants, CFAP/CAFI, Cand other programs and services.
The economic crisis has caused the budget agreed to by the Governor and legislative leaders to fall out of balance by a projected $3 billion additional dollars. Yet the Governor has yet to budge from his cuts-only approach to the budget, and has indicated he will seek even more cuts.
BUDGET CONFERENCE COMMITTEE HEARING TOMORROW: Tomorrow, Wednesday, May 27th, the Budget Conference Committee, chaired by Assemblywomen Noreen Evans, will take public testimony on the cuts to health and human services, starting at 9:00am in Room 4203 of the State Capitol. This may be the only public hearing that will allow testimony on these cuts. The agenda is as follows:
9:00 – 10:30 Medi-Cal and Healthy Families Program Issues 10:30 – 11:30 Public Health, Drug Medi-Cal, Prop 36, & Emergency Medical Services Noon – 1:30 Developmental Services 1:30 – 3:00 In-Home Supportive Services 3:00 – 4:00 CalWORKs, SSI/ SSP , CFAP/CAPI 4:00 – 5:00 Child Welfare Services, Foster Care
COMMITTEE DISCUSSION ON NEW CUTS: The Budget Conference Committee heard the outlines of the new cuts today, which sparked some limited discussion, and calls from legislators for more analysis about the budget, financial, and economic, as well as health, impacts of these cuts.
Some members, like Senator Denise Ducheny, asked whether some of these cuts would not create more costs, as people end up in emergency rooms or elsewhere, even within the budget year. "What makes you think this doesn't create a cost shift?... Will people just die and we won't have to take care of them?" she asked.
Senator Mark Leno talked about how the AIDS Drug Assistance Program "literally keeps people alive," and asked for information about the increased cost of ermegency room visits as a result of the cut. Senator Alan Lowenthal asked if there was a "longitudinal" analysis, and asked for the "long-range implications" of these cuts.
Assemblywoman Noreen Evans was alarmed when she noted that dialysis would be cut for some patients, exclaiming that her father was going through such treatment, and was not optional. She also noted that some cuts, like the elimination of HIV Testing, would have public health impacts. Assemblyman Kevin DeLeon pointed out the cuts to community clinics, arguing that for many Californians, "this is the only safety-net they have."
THE NEWLY PROPOSED CUTS: The cuts detailed today include both increases in previously-announced cuts, and new services targeted for reductions or eliminations. They include:
* $302.3 million from the elimination of the Healthy Families program, denying coverage to over one million children. The Governor had previously proposed to limit eligibility to just twice the poverty level, to deny 225,000 children, but he has now expanded his proposal to include full elimination.
* $34.8 million in additional Medi-Cal cuts to eliminate certain "state-only" programs that don't get federal funds, thus denying coverage to specific populations for breast and cervical cancer treatment, postpartum care, dialysis, and non-digestive nutrition.
* $55.5 million in new cuts to the AIDS Drug Assistance Program (ADAP) to impose additional costs and restrict drug coverage for tens of thousands of Californians with AIDS. This proposal would also reduce or eliminate other Office of AIDS programs, including HIV Counseling and Testing, Epidemiologic Studies, Therapeutic Monitoring Program, and Home and Community Based Care.
* $34.2 million from the elimination of funds for various community clinic programs that provide preventative and primary care, including funding for Indian Health, Seasonal and Agricultural and Migratory Workers, Rural Health Services Development, and Expanded Access to Primary Care (EAPC).
* $20.2 million from the elimination of state funding for Maternal, Child, and Adolescent Health programs. This proposal goes beyond the significant cuts proposed on May 14th.
* $64 million in new cuts in Mental Health Managed Care Services. * $28 million in new cuts to Early and Periodic Screening, Diagnosis, and Treatment Services (EPSDT), eliminating general fund support for certain county programs.
PREVIOUSLY PROPOSED CUTS: These cuts are on top of the cuts the Governor announced May 14th. Those that are not mentioned above include:
* $132.2 million in reduced health benefits to those in CALPERS; * $125 million in reducing health services for legal immigrants; * $60 million out of Proposition 99 funded-programs, redirecting money from county health funds, clinics, the Breast Cancer Early Detection, Asthma, rural health, the Access for Infants and Mothers program which provides prenatal care, and the Major Risk Medical Insurance Program, which provides coverage for those denied for "pre-existing conditions." * $36.8 million by cutting rates for family planning services; * $25.5 million in reducing adult day health care benefits to three days a week; * $24.6 million to local health jurisdictions of HIV education and prevention; * $20 million by cutting payments to private hospitals, a 10% cut in general support; and * $8.8 million through a 10% rate reduction for certain substance abuse treatment services in Medi-Cal; * $2.9 million in suspending a comprehensive school-based prevention program on dental disease; and * $2.7 million by eliminating application assisters that help children & families enroll in coverage.
In Medi-Cal, there is also a new prescription drug purchasing effort to save $75 million, and a new anti-fraud initiative targeted at adult day health centers, pharmacy, doctors, durable medical equipment, and transportation, with the goal of saving $47.9 million.
There are other human services cuts as well, to IHSS home care, SSI/SSP for seniors, and also includes the elimination of CalWORKS, as well as the elimination of CAPI and CFAP for legal immigrants. Senator Ducheny began to total that the cuts seemed to negatively impact over two million California children.
The headlines say the Governor heard the voters "loud and clear." But what did he hear? It's hard to see the message that led to Governor's stubborn cuts-only approach and amazingly reckless proposals to wholesale eliminate Healthy Families, Cal Grants, CalWORKS, state funding for parks, and other key programs.
After all, the voters didn't just reject the propositions that would have made cuts to health and other vital services (Prop 1D for children's services, Prop 1E for mental health), but those initiatives got the lowest vote totals of any of the measures.
People voted against Proposition 1A for lots of reasons... while some voted against the spending cap, some voted against the taxes that were linked, and some voted against gimmicks and being asked to do the job of the Legislature, and against being offered such narrow options.
In the same poll by David Binder where voters reaffirm their opposition to Proposition 1A and the other measures on the ballot, they say they want to protect health and education and other key services, and they support a range of revenue options.
“The lesson coming away from this election is that Californians want real solutions that protect the services the state provides, and that Californians are willing to explore revenue options to pay for the services they want,” Binder said. “Voters are not against all tax increases; they did not oppose Prop. 1A because of taxes. They are looking for a balanced approach that shares the burden and moves the state forward.”
And again, let's remember that Prop 1A was a sequel to Proposition 76, the "Live Within Our Means" Act in 2005, that got 36% of the vote. Proposition 1A got a similarly bad vote. So it is ironic that the Governor uses the "live within our means" rhetoric to justify proposals to cut coverage for 2 million Californians.
The message was to tell the policymakers to get back to work, protect key priorities, and come up with a balanced solution to the budget. The Governor's proposal is completely contrary.
Nearly 2 Million Californians Could Lose Coverage Under Governor's Proposed Health Budget Cuts
* Governor Proposes Elimination of Healthy Families Program for Over 1 Million Children * Governor Also Seeks Federal Permission for $750 Million Cut to Medi-Cal Eligibility * Such Medi-Cal Eligibility Cuts Could Impact 975,000 Children, Parents, Aged, Disabled * Under Medi-Cal/SCHIP Cuts, California Would Lose Hundreds of Millions in Federal Funds * Many Other Health Cuts in Consideration
A new report by Health Access Foundation details how more than 2 million Californians could lose or be denied health care coverage under Governor Arnold Schwarzenegger’s latest budget proposal.
Because the Governor is focused on a cuts-only budget solution, 2 million Californians could lose coverage, and face severe health and financial impacts as a result. Advocates argue that cuts of this magnitude, and this substantial an increase in the uninsured, will have a dramatic impact on the health system we all rely on. If enacted, this would be the most profound rollback of health coverage in the history of the nation. The economic impacts would be significant as California will lose hundreds of millions of dollars in federal matching funds, for our health system, and our economy.
The Health Access report focused on two main proposals:
* The just-announced proposal to eliminate the Healthy Families program, which currently provides health coverage to 910,000 children and is projected to cover over 1 million children in the budget year. Though it would cut $387 million from general fund spending, it would lead to an outsized loss of at least $712 million in federal funds. California would be the only state in the nation not to cover these low-income children.
* A proposed $750 million cut in Medi-Cal eligibility and other reductions, which would mean a loss of $1.2 billion in federal matching funds, and a combined nearly $2 billion cut to our health system and economy. The Governor has proposed revisiting past efforts at cutting Medi-Cal that would deny coverage to 978,500 children, parents, seniors, and people with disabilities. Such cuts would endanger over $8 billion in money from the economic stimulus package, so Governor Schwarzenegger is seeking permission from the federal government to make these cuts. The previous proposals include:
* Denying low-income parents: Today, a family of three earning a Federal Poverty Level income of $18,310 could qualify for Medi-Cal. Under the governor’s proposal, eligibility would be limited to 72% of the federal poverty level – or a family of three that earns no more than $11,169. That change would lead to the loss of coverage for an estimated 433,600 working parents.
* Imposing paperwork burden so families fall off coverage: The governor proposes quadrupling bureaucratic paperwork a family must file each year to win eligibility for children’s’ coverage under Medi-Cal, figuring that the more forms there are to fill out, the less likely a family is to keep up with the burdensome paperwork. To get access to Medi-Cal, parents would have to submit forms every three months. This change would knock an estimated 471,500 children off public health insurance.
* Imposing significant costs on seniors and people with disabilities such as those enrolled in the Aged, Blind, and Disabled program, which would lead people to have to pay more for health coverage. This change would cause 73,364 people to lose no-cost coverage.
The Governor argues that additional cuts are the message from Tuesday's defeat of his package of ballot propositions. But the voters disputed this by giving the least support to his propositions to make cuts to mental health, children's care and other vital services. Health, consumer, and community organizations argue that given the size of the deficit, we need all options--including taxes and revenues--on the table to prevent the worst of these cuts.
Wow. Could California eliminate the Healthy Families program, and coverage for nearly 1 million children along with it? Could we be the only state in the nation that doesn't cover these low-income kids, and turns away significant federal money?
Governor Arnold Schwarzenegger today issued the following statement on his budget proposal: “Based upon information I gathered in meetings I held while in Washington D.C., discussions with the legislative leaders, and the will of the people who said loudly and clearly in Tuesday’s election that they want Sacramento to live within its means, yesterday I directed my Department of Finance to bring me additional options to cut state spending so that we can eliminate the need to seek borrowing in the form of a revenue anticipation warrant in the revised state budget I have proposed.”
But it was Ana Matosantos, deputy director of Finance, who revealed in testimony to the Budget Conference Committee today that the Governor was proposing stark cuts, including the full elimination of Healthy Familes, CALWORKS, Cal grants, and state support of parks.
The proposals are irrational, belligerent, and reckless. With the federal government paying two-thirds of the cost, Healthy Families provides one of the best bangs for the buck in all of state government. We would turn away two federal dollars for every dollar we cut. The proposal is not just beyond draconian, it's beyond belief--if the budget crisis were not so severe and the Governor were not so mercurial.
By suggesting this as part of a cuts-only budget approach, the Governor has betrayed every commitment he has made to children or to health care. The voters explicitly rejected additional cuts to children and health services on Tuesday--indeed, those propositions got the lowest vote totals of all the measures. The Governor should not take his anger out on the children of California.
On the eve of new unemployment figures to be released by California's Employment Development Department, a new Health Access study documents an increasing rate of uninsurance to accompany the growth in unemployment, with at least a half-million Californians losing health coverage in the last 18 months of recession.
A second, national study shows how current trends, especially the erosion of employer-based coverage, could leave millions more uninsured over the next 10 years. Under the best economic scenario, this could result in 53 million Americans becoming uninsured; under the worst scenario, 66 million could lose coverage.
Both studies document the very high cost of maintaining the status quo. The need for health investment and health reform is urgent, as California legislators begin to consider significant health care cuts, but also as key Congressional committees start to consider comprehensive health reform--reforms which could change these trends.
The new Health Access report, "Resuscitating an Ailing Economy: Investing in Health Care," finds:
* As a result of the economic recession, over 1 million Californians have become unemployed in the past 18 months. * As families lose jobs that provide coverage, over 500,000 Californians have become newly uninsured. * These numbers may increase when the Economic Development Department releases new information about the state's unemployment figure (now at 11.2%) on Friday, May 22nd. * The report suggests that investment in health coverage programs and health reform can prevent Californians from becoming uninsured, can help create jobs and spur economic growth -- as well as prevent negative health, economic and community impacts of increased uninsurance.
The new Robert Wood Johnson Foundation (RWJF) report, "Health Reform: The Cost of Failure," had researchers from the Urban Institute prepared the analysis using its Health Insurance Policy Simulation Model, estimating how coverage and cost trends would change between now and 2019. The study examined three alternative scenarios, including a "best case" and a "worst case" based on employment, income growth, and increase in health care costs. The report finds:
* Individuals and families would see health care costs dramatically increase. Total individual and family spending on premiums and out-of-pocket costs could increase 68 percent by 2019 in the worst-case scenario. Even under the best case scenario, health care costs would likely increase at least 46 percent. * Businesses could see their health care costs double within 10 years. The model shows that employer spending on premiums would more than double – from $429.8 billion in 2009 to $885.1 billion in 2019. Even under best-case economic conditions, employer spending on health insurance premiums would increase 72 percent. The result would likely be far fewer Americans being offered or accepting employer-sponsored health insurance (ESI). Estimates suggest a drop from 56.1 percent of Americans being covered by ESI in 2009, to as few as 49.2 percent by 2019. * Spending on government insurance programs could double. In the worst case scenario, spending on Medicaid and the Children’s Health Insurance Program could increase from $251.2 billion this year to $519.7 billion in 2019, as more people are priced out of private insurance and become eligible for government programs. Enrollment in these programs could increase to 20.3 percent in 2019 in the worst case, or one in every five Americans. That’s an increase of 13.3 million people from current figures. * Millions more people would be uninsured. The model projects that without reform, 65.7 million people could be uninsured by 2019, compared to 62.2 million in the intermediate case and 53.1 million under the best case. The report makes clear that the biggest effects of not having health reform would be felt by families with moderate incomes, who have less access to public coverage. Under the model, the number of middle-income earners without insurance would increase sharply from 12.5 million in 2009 to as many as 18.2 million in 2019.
"We need national health reform not just to prevent our broken health system from getting worse, but to allow for a sustainable economic recovery that is not burdened by increasing health care costs and rising numbers of uninsured." said Wright. "We need health reform that brings down the cost of health care, and provide coverage that Californians can count on when they need it."
For more information about the reports, the implications for proposed health care cuts in California, or for the debate in Washington, DC, on health care reform, contact Health Access, or visit our newly updated website and blog, updated daily, at http://www.health-access.org/.
Clearly, the centerpiece will be the $750 million cut to Medi-Cal requested as a "waiver" from federal requirements when California accepted the stimulus dollars.
We understand Governor Schwarzenegger was in Washington, DC, arguing for so-called "flexibility" to make $750 million in Medi-Cal cuts. Health Access and other organizations will be clear with the federal government and the California Congressional delegation that the Governor's request would deny coverage to hundreds of thousands of California children, parents, seniors, and people with disabilities. Such a change would remove the accountability Washington built into the economic stimulus package, and undermine the current effort for health care reform.
Making the eligibility cuts that the Governor has suggested would take an Act of Congress. The federal stimulus law clearly says that states will only get the increased Medicaid money if they make no changes to their “eligibility standards, methodologies, or procedures” as of July 1, 2008. That is why the Legislature had to reverse the September 2008 change requiring children to renew their Medi-Cal eligibility twice a year -- to avoid losing $8 billion dollars in federal matching dollars.
In the next few days, Health Access and other organizations will release more detailed information about the impacts of a $750 million Medi-Cal cut.
Back to work. The new, improved, and expanded Budget Conference Committee will be made up of five legislators from both the Assembly and Senate instead of the usual three.
They will include: * Assemblymember Noreen Evans (D-Santa Rosa) as Chair * Assemblymember Kevin de León (D-Los Angeles) * Assemblymember Bob Blumenfield (D-Woodland Hills) * Senator Denise Ducheny (D-San Diego) * Senator Bob Dutton (R-Rancho Cucamonga) * Senator Mark Leno (D-San Francisco) * Senator Alan Lowenthal (D-Long Beach) * Senator Mimi Walters (R-Laguna Hills)
The final two Assembly Republican appointments to the Conference Committee are still being finalized. A spot budget bill (SB 61) will move on Thursday morning (May 21) to establish the budget conference committee, which will be tasked with closing the $21 billion budget gap. It will begin with an overview of the budget from the Department of Finance and Legislative Analyst's Office. On Friday, the Conference Committee will hear testimony on the state's cash management issues.
Next week, May 25-28, the conference committee will use its meetings to get public testimony. Health issues are expected to be heard on Wednesday, May 27th.
Votes will start June 1st. The Legislature is aiming to have the conference committee finish its work by mid-June, and put out proposals to the floor to amend the 2009-10 budget package. The goal is to get those passed and in law prior to the start of the fiscal year (July 1).
Voters rejected locking flawed formulas into the state constitution, which would have limited the state's ability to invest in its future.
Looking forward, we need a budget that gets us out of our current mess, with the Legislature making the tough choices of persuing not just cuts but also revenues to prevent the worst of the cuts. We need to deal with the current budget crisis, rather than be distracted by constitutional amendments that further handcuff our ability to respond to our future needs.
There's a lot of spinning about the mandate with regard to cuts and taxes. If anything, voters sent a clear signal against more cuts. Voters opposed cuts to health and other vital services with their Prop 1D and 1E votes. Voters also opposed a spending cap for a second time in four years, defeating Prop 1A by a similar margin to Prop 76 in 2005. (For all the talk about the impact of the taxes linked to Prop 1A, voting tallies exceeded by only a couple of percentage points the results of the Prop 76 vote, which was just a spending cap.)
These are important points to remember as we begin budget talks tomorrow....
Regardless of what happens tomorrow, Tuesday, we are going right back into the budget process. According to Greg Lucas of California's Capitol and other sources, a Budget Conference Committee will begin meeting Thursday, May 21st, to deal with the $15-21 billion deficit. One hearing on May 22nd will be on cash management.
The Legislature will seek to amend the existing budget, approved in February, that technically goes through June 2010. The process won't go through budget subcommittees, but is expected to take public testimony next week in an expanded ten-member budget conference committee, with three Democrats and two Republicans from each house. They are expected to start voting on June 1st.
But this should not be a surprise. We have an "individual mandate" for drivers to have auto insurance, and yet have a noncompliance rate of around 15%--although it ranges depending on the state. For the most part, the issue isn't enforcement: my assumption--confirmed by survey research--is that the vast majority of people want health coverage-desperately; the question is will the reform remove the barriers and provide the assistance needed? Will the reform make coverage more available and affordable? Will it be easy to enroll--or even automatic?
So what the reform includes matters a lot in terms of how "universal" it is. Provided that affordability is assured, I don't think the mandate is as important as an automatic-enrollment mechanism, as with Medicare or on-the-job benefits.
These kinds of structural issues matter, I think, even more than Ezra's initial take that some of the remaining uninsured will be undocumented immigrants. According to UCLA research, undocumented are a small fraction--about one-fifth--of the uninsured. Around 75% of them are workers or family members of workers, more of whom may--and should--get coverage from their employer under a reformed health system. At the very least, we can all agree that if you work and pay your dues, you should get coverage. And Ezra points out why that's important, regardless of where you are in the immigration debate. But health reform is a much broader issue that affects everyone, insured and uninsured.
Our job as consumer advocates and organizers is to push for the policies to make coverage more available and affordable for all, and for the financing to make that a reality.
For those looking for Friday links, there's a new edition of Health Wonk Review, at Workers Comp Insider by Julie Ferguson. As the discussion on federal health reform heats up, this biweekly forum should get more interesting.
There's also the ongoing dialogue at KQED's Healthy Ideas, which has gone through a second round of comments about core health reform issues. We at Health Access are participants in both forums, with much of interest from other worthy contributors.
For those still wondering about those propositions in the May 19th election this coming Tuesday, there's a good, inteligent debate by good people on both sides, at the website for the California Center for Research on Women and Families (CCRWF). Our contibution isn't focused on May 19th--it is simply a broad update on legislation and budget issues regarding health care--but there's many contributions from people on boths sides of the propositions.
We've written elsewhere about our take on Proposition 1A, and I was taken by the assessment of Mark Paul of the New America Foundation, which includes the analysis that several services, including "higher education, health, social services, parks and the environment — will be ratcheted down over time. And major initiatives to address pressing state problems, such as the health care reform proposed in 2007 by Governor Schwarzenegger, will become simply impossible to enact." We agree with that assessment.
MAJOR HEALTH CUTS PROPOSED IN GOVERNOR'S BUDGET PROPOSALS
* Governor To Ask Federal Government for Permission for a $750 Million Medi-Cal Cut * Cuts Would Harm Health System & Economy; Hundreds of Millions in Lost Federal Funds * Governor Rejects Proposing Long-Term Revenues Needed to Prevent Devastating Cuts
More Updates on the NEWLY REDESIGNED Health Access Blog: More on the Bad Budget Day; Major Developments on Federal Health Reform; The Purple Bus Lady Rolls Through California; Coverage When It Counts; How to Finance Health Reform; President Obama's Health Reform Week; U.S. Senate Assignments; Lots of Links on Health Reform; A Saturday Morning in San Diego with Rep. Susan Davis; Taming "The Beast"; More on Spending Caps Across the Country
Today, Governor Arnold Schwarzenegger announced several proposal cuts to fill a $15.4-21.3 billion deficit in the 2009-10 budget year. The economic crisis has caused the budget agreed to by the Governor and legislative leaders to fall out of balance.
The Governor's "2009-10 May Revision General Fund Proposals," available at the Department of Finance website at http://www.dof.ca.gov/, includes a package of largely cuts to fill a $15.4 billion shortfall, and then additional “contingency proposals” if Propositions 1C (and to a lesser extent, 1D & 1E) fail on the May 19th ballot next week.
"To look for new revenues is out of the question," said the Governor at his press conference. His package includes cuts, borrowing, selling state-owned properties, eliminating some state agencies and boards, accelerating revenues, shifting funds and laying off 5,000 state employees.
SPECIFIC HEALTH CUTS: There are nearly $2 billion in additional cuts to health and human services. If Propositions 1C (as well as 1D and 1E) are rejected, there is an additional $600 million cuts in health and human services.
* The biggest health cut is a $750 million cut to Medi-Cal, contigent on negotiating a waiver from the federal government. The Schwarzenegger Administration wants to revisit rollbacks in eligibility that are now restricted by the federal government in order for California to accept billions in federal stimulus dollars. Those rollbacks were not explicitly specified in the Governor's summary, but have included in the past: * the denial of Medi-Cal coverage to hundreds of thousands low-income parents under the poverty level (a range from around $13-$18,000/year for a family of three); and * the imposition of quarterly status reports on children, with the savings coming from over 250,000 children dropping coverage as a result. * Since these previous proposals do not add up to $750 million in savings, even after full implementation over several years, other cuts and savings would have to be found as well to meet this goal.
* Other specific health cuts include: * $132.2 million in reduced health benefits to those in CALPERS; * $125 million in reducing health services for legal immigrants; * $36.8 million by cutting rates for family planning services; * $20 million by cutting payments to private hospitals, a 10% cut in general support; and * $2.7 million by eliminating certified application assisters that help children & families enroll in coverage
In Medi-Cal, there is also a new prescription drug purchasing effort to save $75 million, and a new anti-fraud initiative targeted at adult day health centers, pharmacy, doctors, durable medical equipment, and transportation, with the goal of saving $47.9 million.
There are other human services cuts as well, to IHSS home care, SSI/SSP for seniors, CALWORKS for low-income families, and also includes the elimination of CAPI and CFAP for legal immigrants.
* If Proposition 1C fails, the projected budget deficit grows by $5 billion. If Proposition 1D & 1E fail, the deficit grows by nearly $1 billion. In those circumstances, the Governor's "contingency budget" includes: * $54.4 million in eliminating Healthy Families coverage for over 225,000 children (who are betweeen 2005-250% of the federal poverty level, or between $36,000-$45,000 for a family of three) * $60 million out of Proposition 99 funded-programs, redirecting money from county health funds, clinics, the Breast Cancer Early Detection, Asthma, rural health, the Access for Infants and Mothers program which provides prenatal care, and the Major Risk Medical Insurance Program, which provides coverage for those denied for "pre-existing conditions." * $25.5 million in reducing adult day health care benefits to three days a week; * $24.6 million to local health jurisdictions of HIV education and prevention; * $10 million cut in maternal, child and adolescent health grants; * $8.8 million through a 10% rate reduction for certain substance abuse treatment services in Medi-Cal; and * $2.9 million in suspending a comprehensive school-based prevention program on dental disease.
THE POLITICS OF THE PROPOSITIONS: The Governor used his press announcement to argue for the package of proposition on the May 19th ballot next week. His document says the budget depends on the passage of 1A, 1B, 1C, 1D, and 1E, even though Propositions 1A and 1B do not have an impact on this or next year's budget. Proposition 1C, which would provide a cash advance from lottery proceeds, is the ballot measure that would make the major difference.
Some health advocates, including Health Access California, argue that Prop 1A, even though it would bring in revenues in 2011-12, includes a constitutional spending cap that would make it harder to ever restore these cuts, even when the economy improves and the state has more revenue.
Regardless of what happens with the fate of the propositions, there is an ugly budget with awful choices on cuts and/or taxes this year, and there continues to be a long-term mismatch between the revenues the state brings in, and the education, health and other vital services that Californians expect and deserve.
The work of consumer and health advocates is to continue to demonstrate the impact of these proposed cuts, not just to directly impacted Californians who will lose their coverage or care, but to the health system and economy as a whole, and all Californians as a result.
We'll have posts later today about the health impact of the budget, and will be also do what we can on Twitter, at @healthaccess, or www.twitter.com/healthaccess.
There are no good choices in this budget, but that doesn't mean that some options are not worse than others--and additional cuts are absolutely worse. Additional proposed cuts to health care will have devastating impacts not just on patients directly affected, but also the health system we all rely on.
As Matthew Yi indicates in the San Francisco Chronicle today, some cuts would force us to lose billions in federal stimulus dollars, but even for every dollar we cut from health programs like Medi-Cal and Healthy Families, we are turning away even more dollars from the federal government at a time when our health system and economy needs them most.
After cutting $19 billion in the past couple of years, California has cut $15 billion just in February. We simply need additional taxes and revenue to prevent cuts of unimaginable impact.
The Governor is expected to use these number to promote the propositions, but really only Proposition 1C has a major impact on this year's deficit. In fact, Proposition 1A doesn't take effect for two years and won't make a dime's worth of difference on this or next year's budget.
The Governor highlighting the severity of these cuts makes our case against Proposition 1A, since the spending cap will make it much harder to ever restore these cuts, even when the economy improves and we have more revenue.
The focus of solving this budget mess should not be the propositions--which adds to the budget gridlock but doesn't even help with the long-term budget crisis--but the Republican legislators who mindlessly stick to their no-new-taxes pledge and use the two-thirds voting rule to prevent a sensible, shared, and sustainable solution to this budget crisis.
Every week, Health Access encounters people whose lives have been transformed by our health care system--those who find themselves denied for pre-existing conditions, or facing an enormous hospital bill that threatens to push them into bankruptcy. Many of them are moved to take action to change the health system--some of them sign-up for our E-mail alerts, others makes themselves available to testify at a press conference or hearing in Sacramento.
Kathie McClure outdoes most of them. She decided to focus her passion for health reform by driving a purple bus from her hometown in Georgia through the country, talking about the need for reform. Kathie's son, Chris, has Type I Diabetes, and her daughter, Caitlin, has Epilepsy. Kathie's children face a lifetime of health insurance crises, unaffordable insurance premiums, medical expenses, and drug costs. So Kathie is taking time off from her law practice to campaign for health reform.
She also founded an organization, at http://www.votehealthcare.org/ to help her in her mission and travels, and she has also been blogging at http://blog.votehealthcare.org/ as she stops throughout the South and West. She's not come to California, and Health Access has been happy to help host her.
She's been an inspiration to many who meet her. We were happy to have her as part of our town hall meeting with Representative Susan Davis in San Diego, and at a Mother's Day event in Los Angeles, and in our locations across the state.
(Right, McClure with Patrick Romano, the California director for the Health Care for America Now! campaign, along with Nancy Gomez, the Southern California organizer for Health Access. Above, the purple bus with some of the San Diego town hall participants; and other photos from the Mother's Day-themed event in Los Angeles.)
We will need the passion and commitment of Kathie and many others like her if we are to finally win major, comprehensive health reform this year.
Today, President Obama met with leaders of the U.S. House of Representatives on health reform, the third day in a row that the President has focused on health care in his public schedule. He's clearly launching a full campaign on the issue. Here's the press conference, which includes three California representatives of importance: Speaker Pelosi, Chairman Waxman, and Chairman Miller:
The news is that they are committing to pass health reform on the House floor by July 31st, before the August recess. The implication is that the U.S. Senate will do the same--as Chairmen Baucus and Kennedy have committed--and they will use the August recess to negotiate out the differences between the House and the Senate, and pass a full plan as soon as September.
It also means that we expect to see the first versions of bills in a few weeks, with subcommittees taking up those bills next month, in June.
Making health care coverage more affordable for Californians who are laid off from their jobs is certainly a priority. And so, Gov. Arnold Schwarzenegger has signed legislation that does just that for former employees of small businesses.
The bill, AB 23, uses federal stimulus funds to subsidize 65 percent of the cost of Cal-COBRA coverage for the newly unemployed of businesses from 2 to 19 workers.
COBRA coverage, which continues a laid-off worker's existing health care coverage for a period of up to nine months, is notoriously expensive and priced out-of-reach for many who have lost their jobs in this down economy. While the individual would still have to pay 35 percent of the premium, the subsidy can help a lot of Californians "between jobs" make ends meet while staying covered.
While the federal COBRA law only goes to employers of 20 or more, Cal-COBRA extends the option to workers of smaller employers. The bill, co-authored by Assemblymembers Dave Jones (D) and Nathan Fletcher (R), extends the new subsidy as well--but it requires proof of involuntary termination, and allows anyone who was laid off since September 1, 2008 to resume coverage.
The legislation, on a fast-track to take advantage of federal premium assistance, was sponsored by California Insurance Commissioner Steve Poizner. Health Access California was in support with many other organizations.
The California Health Care Foundation is hosting an important briefing this Friday, May 15. In a talk entitled "Health Insurance When It Counts -- What Does It Cover?", leading health academics Karen Pollitz and Eliza Bangit of Georgetown University's Health Policy Institute will present research findings on a comparison of cost-sharing and coverage associated with the design of California health insurance products in the individual and small group market. The researchers explored three health conditions -- breast cancer, heart attack, and diabetes.
When purchasing health insurance, consumers often don't have a sense of what will be covered in the event of a serious illness. That's why Health Access California is sponsoring AB786(Jones), to set some standards so consumers know what they are buying, can so some comparion shopping, and can have confidence that their coverage will at least cover both doctor and hospital bills, and have an out-of-pocket cost maximum. Without knowing all the findings, we think such a research project like this was long overdue, and hopefully it will help spark the discussion abotu the needed policy remedies.
The event is Friday, May 15th, 10:30AM - 12:00PM, at the California State Capitol, Room 112, Sacramento. More information is on the California Health Care Foundation's website. To RSVP , contact Danny Sandoval at dsandoval@chcf.org or 916.329.4542.
But certainly, there are some sources of funding that should be preferred by policymakers, while others that may be necessary if not ideal.
For example, some have offered the notion of a modest tax on tobacco, alcohol, or soda. A tobacco tax was a funding mechanism for the State Child Health Insurance Program--providing the double benefits of funding children's coverage, but also reducing smoking, especially among teens. California's AB x1 1 included a tobacco tax as a funding mechanism as well.
Alcohol and soda consumption also have health impacts--albeit different ones from tobacco--and so a consumption tax makes sense. Some may argue that it may have a disproportionate impact on lower-income consumers, but that issue is mitigated given that the benefit of expanded coverage will go disproportionately to those same populations.
But tops on my list for funding is revisiting the favorable tax treatment of Health Savings Accounts, passed as part of the infamous Medicare Part D package early in the Bush Administration.
There's a bill being considered today, Wednesday, in the Senate Revenue and Taxation Committee--SB 353 (Dutton), to provide a state tax deduction for HSAs to mirror the federal one. Health Access California opposes the state bill, and wouldn't mind if the federal tax benefit went away as well.
Here's three reasons: * The opportunity cost is high. For the same money to provide tax benefits for HSAs, we could increase coverage for a lot more people under Medicaid or SCHIP. If the goal is more people covered, you actually don't get very much bang for the buck. * The benefit largely goes not to the low- and moderate-income working families, but to the young, healthy, and wealthy. HSAs are tied to high-deductible health plans that attract a certain demographic. Many lower-income folks won't have the excess money to invest in an HSA, and thus don't get the benefit of the tax deduction. * From a health policy point of view, it doesn't make sense to subsidize underinsurance. Maybe HSA's were a bandaid in the absense of health reform. But the goal of health reform will be to reduce uninsurance and underinsurance, so it doesn't make sense to subsidize high-deductible health plans. Health reform will get rid of high deductibles, but there's no reason to encourage them.
These funding sources won't be enough, but they are a start. Yes, these proposals will have significant political opposition, but so will any financing plan. The benefit of these efforts is they not only provide funds, but help the health system as a whole.
I am continuing to post at the "Healthy Ideas" website of KQED Health Dialogues, which is having a wide ranging conversation on expanding coverage, improving quality and access, slowing health care costs, and eliminating health disparities. I am only one of a list of impressive contributors, where there is a range of opinion, including some points I disagree with:
While we've been talking about health reform for months (and in California, years), it seems that the debate went into high gear this week. While the White House meeting with the health industry got most of the headlines, the more specific, sticky, and significant debate was at the U.S. Senate Finance Committee, chaired by Senator Max Baucus.
Yesterday, the Committee released a 60+ page paper, Policy Options for Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans. It provides the framework and lays out some of the options for health reform: expansion of public health programs, individual market reform and a health insurance "exchange," required individual and employer contributions to health coverage, a public health insurance option, and much more.
We could--and will!--do 100+ blog posts on the ideas and issues presented on the coverage and financing aspects of reform--in fact, we have, when Sacramento has debated these issues in years past. But it's a sign that we are finally getting serious.
Some have characterized this as a "voluntary" commitment by the industry--and that is something to be wary about. Health Access California has been correctly skeptical of past industry attempts here in our state of avoiding reform with "voluntary guidelines," like on the issue of hospitals overcharging the uninsured, or "voluntary discounts" by prescription drug companies. In the latter case, we fought an initiative battle, that the pharmaceutical companies spent $80 million on, on the very issue of a "voluntary" drug discount program, versus one where the discounts were negotiated. In both cases, the industries were trying to stop--or at least delay--legislation.
This time, the industry groups aren't promising to control costs as an alternative to reform. They're promising to control costs as part of reform. In fact, some of the efficiency steps they are proposing wouldn't even be possible without the sorts of changes now under discussion in Washington, because they require changes in legislation.
If the "voluntary commitment" was explicitly posed as an alternative to health reform, or even of key reform elements--like the public health insurance plan, or bulk purchasing of prescription drugs and medical devices--then it would be a concern. But these efforts should not be--and don't have to be--mutually exclusive. And we should all be very clear about that in the weeks ahead...
A lot of news on the federal health reform front today. The biggest is the announcement, in the form of a meeting with President Obama and letter from key health industry leaders, including organizations representing insurers, drug companies, hospital, device manufacturers, doctors, and health workers, to commit to $2 trillion in health care savings over the next 10 years.
I'll add my two cents later. The details are not fully fleshed out, but the importance of the announcement today is more political than policy: that the federal health reform discussion is now more serious than it was before.
The size of California's budget deficit is massive. The Sacramento Bee reports that the projected deficit for 2009-10 is now $15.4 billion to $21.3 billion--with the $5 billion of that swing dependent on the fate of Proposition 1C (and the final $1 billion on Props 1D & 1E).
The Governor says they will release a budget of what will happen with and without the full package (often lumping in Prop 1A into this year's mess, when it won't have an impact for two years.), but regardless of the fate of any of the measures, the budget will look beyond bleak.
In Kevin Yamamura's Bee article on Sunday, I tried to even imagine what the health cuts might look like, but given the cuts already made, anything else is simply unfathomable. We'll see...
Early this past Saturday morning, over 150 Californians came out to a town hall meeting in San Diego, sponsored by the Health Care for America Now! campaign, for the purpose of winning quality, affordable health care for all America.
We were excited to have Representative Susan Davis speak and answer questions. She's on the key House Education and Labor Committee (chaired by California Representative George Miller), one of the three committees any health reform will have to go through in the House of Representatives. She and several other California Representatives will have crucial votes on the many amendments to strengthen and weaken the proposals that will be discussed.
Her district is there, too--it voted 54% to support Proposition 72 in 2004, a requirement that employers contribute to the health care of their workers. That's one important issue of many that she and the rest of her committee will face, as keys component of any health reform. Many other issues came up as well, from cost containment to a public health insurance option, showing how thorny the details of health reform will be.
We were also pleased to have Professor Rick Kronick of UC-San Diego, who also was a senior health policy analyst for the Clinton White House during the last effort at health reform. He offered thoughts about the urgency of reform, and about what we need to do differently this time to win.
Here's Congresswoman Davis with representatives of the sponsoring organizations of the town hall, including ACORN, California Partnership, Health Access California, SEIU State Council and SEIU Local 221.
These groups and others, as part of Health Care for America Now!, are doing other events and town halls throughout the summer. We have a limited window to pass health reform, and so we need to express our opinions now. For more information on the HCAN campaign in California, contact Patrick Romano, at promano@health-access.org.
Ezra Klein of The American Prospect (and soon to be of the Washington Post) has the scoop about how Senator Baucus has distributed work around health reform to his fellow Senators.
Jay Rockefeller: Medicaid Expansion, Premium Subsidies, Quality Improvements Kent Conrad: Comparative Effectiveness, Chronic Care Management Jeff Bingaman: Pay-for-Performance, Bundled Payments, IHS John Kerry: Heath Information Technology, Exchange, Small Business Tax Credit Blanche Lincoln: Small-Group Rating Reforms, Small Business Tax Credit Ron Wyden: Tax Exclusion, Non-Group Rating Reform Chuck Schumer: Public Plan Debbie Stabenow: Employer Pay-or-Play, Medicare Buy-in, HIT Maria Cantwell: Long-Term Care Reform, Workforce Issues Bill Nelson: Graduate Medical Education, Medicare Part D Bob Menendez: Disparities, Individual Requirement Tom Carper: Fraud and Abuse, Prevention and Wellness, Transparency
This gives a welcome sense that they are getting into the nitty-gritty of the details of health reforms, even if one wonders about how they are dividing the work, how these aspects will be integrated, and why certain topics are included in the first place.
These assignements got particular attention when Senator Schumer asked questions about the inclusion and specifics of a public health insurance option--which was reported as both that Senator Schumer was defending the concept, and that he was proposing a compromise. Richard Kirsch at the Health Care for America Now blog clarifies the confusion.
Health Access was pleased to be part of a press conference this morning, where CALPIRG Education Fund released a new report looking at how much money insurers in California and nationwide spend on actual health care, rather than administrative overhead, marketing, and profits. The report found that requiring insurers to spend 85 cents of every premium dollar on patient care is a strong, achievable standard that will protect consumers.
The press conference was with Senator Elaine Alquist, chair of the Senate Health Committee, who is the author of SB316, which would set such a standard. We'll keep reporting about this important bill as it moves through the Senate in the next month.
The U.S. Senate Finance Committee, chaired by Sen. Max Baucus (D-Montana) is having a "roundtable" right now on "Expanding Health Care Coverage" as part of health reform.
We are also participating in a new Healthy Ideas online forum, sponsored by KQED Public Radio and HealthDialogues. Lots of smart people have kicked things off with beginning posts... It should be an interesting conversation.
If the website looks different, it is! We've been working for months to redesign this site to make it a better resource for advocating on behalf of quality, affordable health care for all Californians.
The changes add new resources and materials, make our existing fact sheets and information easier to find and easier to read, and generally increase our ability to educate and activate Californians to get involved in improving our health system.
Please let us know if you have comments and suggestions about the new site, at weblog@health-access.org.
Health care advocates have invited Congressman Susan Davis to join a town hall meeting on Saturday morning, May 2nd, to talk about the need to reform our health care system and why comprehensive health care reform must happen in 2009. The event will be one of over a hundred already taken place in 43 states nationwide over the past month. The people of San Diego will share with Rep. Davis their input about health care and voice their concerns against those who say we can’t afford to fix the system now.
Health Care for America Now (HCAN) has been holding events across the country during the months of April and May to stress the point that health care reform is an urgent must-do for Members, especially now that the Federal budget has passed.
Those in the San Diego area are invited to this Health Care Town Hall Forum, this Saturday, May 2, 2009 from 9:30am -11:00am.
It will be at the Scottish Rites Center, 1895 Camino Del Rio South, San Diego, CA 92108
Speakers include Representative Susan Davis (CD 53), as well as Dr. Rick Kronick, University of California at San Diego, and Anthony Wright, executive director, Health Access California.
Health Care for America Now! and many other groups are sponsoring a town hall this Saturday
The Senate Health Committee, chaired by Senator Elaine Alquist, met today. Our colleague Cynthia Craft provides the background on the most radical bill on the agenda:
S.B. 92 (Aanestad, R) was a proverbial everything-but-the-kitchen sink, 34-point partisan pitch in the form of a bill that, in the end, only one soul voted for: the author Senator Sam Aanestad himself. Even fellow Republican Senator Tony Strickland asked that his earlier “yea” vote be changed to “no” at the end of the day. And Republican Dave Cox stayed altogether mum.
Representing the bill as a product of the entire Republican Senate Caucus, Aanestad affectionately called the massive package by its apparently GOP caucus-designated nickname, “The Beast.” S.B. 92 would have offered a “free market” alternative to health reform, particularly another single-payer legislative push that Sen. Aanestad suggested was likely to earn another veto from the Governor.
But opponents, including Health Access California, spotlighted just a few of the conservative ideological statements embedded in the bill’s nearly three dozen provisions: an anti-illegal immigrant tax on remittances sent out of the country via Western Union, a swipe at organized labor with flexible work schedules; and an attempt to allow out-of-state unregulated insurers to come into California to do business, without having to abide by California consumer protections. And those were just three of the 34 points that sunk S.B. 92.
Even more than last year's version, the bill was an impressive compendium of proposals that Health Access California opposes, from allowing insurers to provide coverage that excludes certain ailments and body parts, allowing for limb-by-limb coverage, to the promotion of Health Savings Accounts, which are ways to promote high-deductible health plans.
Senator Aasnestad made the final plea to allow a vehicle for health reform to proceed. He said he expected that the Governor may have his own health reform proposal this year, but as of now, ther only comprehensive approach is a single-payer bill that he had new assurances would be vetoed. Senator Alquist corrected him, and referred to her own SB56(Alquist) as a vehicle for comprehensive reform. Again, the bill stalled with only one vote in support.
Regardless of what some Democratic leaders say, Governor Schwarzenegger and Republican legislative leaders are campaigning for Proposition 1A as a "spending cap."
Is that a wise decision? The recent history suggests that a spending cap is something that causes people to oppose, not support, a measure.
Regarding Proposition 1A, John Wildemuth at the San Francisco Chronicle reported earlier about the comparison with the spending cap imposed in Colorado. Proponents and opponents recognize that Colorado infamous "TABOR," or Taxpayers' Bill of Rights, was a much harsher cap than the one proposed in Prop 1A. But that doesn't make Proposition 1A benign. After all, it was something forced on the ballot by Republican leaders as the price for passing a budget, and has the same ideological intent of constraining spending. Is that the direction that voters really want to go? As Wildemuth indicates:
"In Colorado, which led the way with its 1992 spending cap, voters have suspended key provisions of their measure to free money for state services. Colorado's experience has helped persuade voters in other states to reject plans for their own spending limits. Oregon, Nebraska and Maine voted down initiatives in 2006, and efforts to get the caps on the ballot in other states have been unsuccessful."
In focusing on other failed attempts in other states, the article actually neglects Governor Schwarzenegger's last attempt at imposing a spending cap on the state, Proposition 76. During the special election in 2005, Proposition 76 got only 37.6% of the vote, with 62.4% against. It did the worst of all of Governor Schwarzenegger's proposals that year.
Some pundits have suggested that these measures may go down because of the extension of the tax increases: there's no doubt that some opposition to Prop 1A is coming from that direction. But Prop 76 and oher evidence suggests that the spending cap may be the greater liability for the measure. Think about this: the recent Field poll has Proposition 1A, at 40%, and 49% against. That means Proposition 1A, a spending cap with tax increases, is doing *better* than a spending cap alone, Proposition 76, did.
Fundamentally, voters simply aren't excited about placing caps and limits on health, schools, higher education, or other vital services that they depend on.
INSURANCE OVERSIGHT LEGISLATION IN ASSEMBLY HEALTH COMMITEE * AB786(Jones) Passes to Set Standards for Individual Insurance & Limit "Junk" Plans * Other Bills Pass On Rescissions, Mental Health Parity, Medical Loss Ratio, Etc. * Committee Rejects Bill on Rate Regulation for Health Coverage
More Updates on the Health Access WeBlog: Coverage That Counts; Call Her Secretary Sebelius; Opinions on Prop 1A; Blue Cross Calling on Health Reform; Prescription Drug Legislation; Update on Budget Hearings; Reforming the "High Risk" Pool
A number of measures to place new oversight over the health insurance industry cleared a critical first hurdle Tuesday, as the Assembly Health Committee, chaired by Assemblyman Dave Jones, wrapped up its policy scrutiny role by the April 30 deadline. The bills now advance to the Assembly Appropriations Committee, where their fiscal impacts will be examined.
The consumer protections regarding health insurance that were considered, all supported by Health Access California, included:
* INSURANCE STANDARDS: A.B. 786 (Jones) would provide new information and standards on health plans for individual consumers buying health coverage. The bill is designed to make it easier for consumers to make informed choices while shopping on the “individual” market (as opposed the group-policy market). Authored by Committee Chair Dave Jones (D), the measure would encourage “apples-to-apples” price comparisons and the development of clear categories of services and benefits, so people better understood what they are buying with their premiums. It also seeks to limit the sales of “junk” insurance, or policies that offer only very limited benefits–often to the surprise of the consumer.
One testifier, Ehren Thompson, then a personal trainer at 24-hour fitness, reported buying coverage as an individual from MEGA that ultimately did not cover his surgery. A doctor diagnosed him with a inguinal hernia and admitted him to a hospital for surgery immediately, but after overnight preparation, he was released from the hospital with a $2,000 bill but without surgery because it wasn't covered. For four months in pain, he negotiated with the insurer and scheduled outpatient surgery. Ultimately, MEGA's hospital coverage was limited to $1,000, leaving Thompson in debt for over $12,000, for which he is in collections.
AB 786 is sponsored by Health Access California, with support coming from Consumers Union, Western Center on Law and Poverty, AARP, AFSCME, California Immigrant Policy Center, California Medical Association, Congress of California Seniors, and SEIU. Opposition came from various health insurers and the Chamber of Commerce. The measure drew ideological opposition from Republicans on the committee, with Assemblywoman Audra Strickland (R) proclaiming, “frankly, one man’s junk insurance is another man’s coverage." Assemblyman Anthony Adams (R) insisting the bill insults the intelligence of consumers, that they can't figure out the insurance market by themselves. Jones replied that he and the Republicans had “fundamental differences” in that he sees some products as "false choices"–and his colleagues on the other side of the aisle don’t recognize that as an issue. There are some products that have people paying premiums but without getting any significant value. The measure passed with all Democrats on the committee in support and Republicans against.
* RESCISSIONS: A.B. 2 (De La Torre) provides for an independent review of any rescissions of individual health care coverage. Author Hector De La Torre cited statistics showing that “every major insurer” had illegally rescinded hundreds of individual policies of consumers who had faithfully paid their health premiums. His bill would protect consumers against this practice, where paying patients are accused of having incorrectly disclosed their medical history. A spokesman for the California Medical Association, told committee members that “health plans exist to provide coverage to patients, not to yank coverage away.” Consumer groups were in support, insurers were in opposition, with a representative from Blue Shield spoke against the measure, saying he feared the bill would unfairly favor attorneys who were filing legal actions against insurers. A version of this measure was vetoed by Governor Schwarzenegger last year, but the author specified some changes that could lead to a different result this year. The measure passed with Democrats in support.
* MENTAL HEALTH COVERAGE: A.B. 244 (Beall) would require health care policies to cover expanded mental health services. Currently, plans are required to cover serious mental illness but not the less-severe conditions that could lead up to serious disorders if left untreated. Assemblyman Jim Beall Jr. (D) pointed out that the Obama Administration has already announced its intent to expand mental health services, and said that California has some catching up to do. The measure passed with Democrats in support.
* DISCLOSING ADMINISTRATION & PROFIT: A.B. 812 (De La Torre) would require insurers to disclose medical-loss ratios, information already provided to two state regulatory departments, albeit in different forms. De La Torre (D) said the measure would add transparency, create a better comparable standar, and provide consumers and regulators critical information about the percentage of premiums being used for medical coverage versus the percentage devoted for the profit of parent companies and shareholders. The measure passed with Democrats in support.
* RATE REGULATION: A.B. 1218 (Jones) on the other hand, fell victim to opposition and failed to pass out of committee. It would have required health care insurers to seek approval for new rate hikes. Jones and his supporters of consumer groups and labor unions argued that, if health care insurance followed the model of auto insurance in California, which is regulated under Proposition 103, insurers would benefit from healthy profits and consumers would benefit from lower overall rates. Assemblyman Adams (R) called the measure “old school liberalism." The measure stalled with eight Democrats in support, but the rest either opposed or not voting, including all Republicans and Democratic Assemblymembers Block, Hall, Hayashi, Hernandez, and Salas.
Other bills relating to insurers included efforts A.B. 591(De La Torre) to require insurers to provide a list of plan contracts/policies offered or issued in California so consumers can better information about their plan; and A.B. 598 (De La Torre) to help create streamlined billing codes for health services. Both measures got bipartisan support.
Another bill of interest to consumers was A.B. 542 (Feuer), which seeks to withhold public insurance payments to hospitals for so-called “never” events–or adverse medical conditions or errors that “never should have happened.” Health Access California spoke in support of the bill, citing severe, life-threatening bedsores as an example of poor hospital care that does not deserve reimbursement.
Finally, serving as a placeholder for a broader discussion on health reform was A.B. 1314 (Jones), which won approval from the committee. It provides a vehicle for comprehensive health reform by requiring the California Health and Human Services Agency to engage with stakeholders to develop a plan to enact broad-based reforms to the state’s health care system and to present the plan to the Legislature no later than April, 1, 2010. The development of a plan would move forward both with, or without, federal action. Health Access California expressed its encouragement for the discussion and is in support of the bill, which advanced without much committee discussion Tuesday.
All bills needed to pass policy committees by April 30. The next hurdle for the bills will be Assembly Appropriations Committee, which must pass bill by the end of May. Health Access will continue to provide updates on actions taken in the Legislature. For a broader list of interest to health advocates and Health Access California , check out the bill list on our website.
We'll soon post a full report from Tuesday's Assembly Health Committee, but most of the 45+ bills passed out, including AB786(Jones), which would set standards in the individual insurance market.
As the bill's sponsors, Health Access California thinks it is critical as an important consumer protection against underinsurance: providing patients with basic information about the health products they are purchasing, allowing them to make apples-to-apples comparisons between plans, and weeding out specific "junk" products that are so limited as to be meaningless.
Examples of such "junk" coverage is hospital-only coverage, which people buy not realizing how much medical care--from surgery to cancer treatment--is providing in an outpatient setting. Or a plan that actually covers so little as to be meaningless: for example, covering $1,000 of a hospital stay, when any bill for even a day at a hospital will be multiple times that.
This discussion is crucial in the context of the federal health reform debate, because if we are going to talk about expanding coverage, or mandating coverage, or providing security that coverage will be there when you need it, we need to set a minimum definition of what "coverage" means.
The key point is that coverage isn't fully scalable. It's makes sense that if one can't afford the premiums for a fully comprehensive health plan, the instinct is to find a less comprehensive plan with a cheaper premium. But there's a point when the coverage is so minimal--for example, a coverage product that only covers $200/day of a hospital stay, when the charge is far greater--that the plan does not provide any of the benefits of being insured--and the plan just provides a false sense of security.
There's only one thing worse than being uninsured, and that's paying a premium for the priviledge.
Here's just two quick opinion articles from the Los Angeles Times on Proposition 1A.
One is by columnist Michael Hiltzik, where he says: "The bottom line is that 1A does nothing to narrow the existing budget deficit, and may make deficits worse in the future. As the nonpartisan California Budget Project points out, because the costs of many services provided by state government, such as healthcare, grow much faster than inflation, the formula will squeeze almost every other budget category. That makes Proposition 1A a time bomb."
Another is by former state Treasurer Phil Angelides, who comments: "The measure would actually deepen California's budget woes. It would require that money be stashed away in a rainy-day fund even though the state is already pulling in less money each year than it spends. That's a little like telling a family facing foreclosure that they're not putting enough money away in their 401(k) account. Even in tough budget years, it would force additional cuts of more than $1 billion -- an amount equal to about one-third of the University of California system's budget."
"Proposition 1A would squeeze spending on crucial investments in colleges and healthcare, and it would prevent the state from restoring needed programs as the economy rebounds. It also would lock confusing, complicated, autopilot budget language into the state Constitution -- making it harder, not easier, to adopt common-sense budgets. With complex formulas and linear regression models cemented into law, the already daunting task of budgeting would be that much harder."
To be fair, the editorial board of the LA Times did ultimately support the measure, but grudgingly: "The reserve fund is closely linked to the spending cap, and that gives us pause, because The Times has long objected to hands-free budgeting -- decision-making that removes human thinking from the fiscal planning process. But after several decades' worth of ballot measures that impose formulas... California finds itself so far down the robo-budgeting road that it may need a bit more automation just to regain its bearings."
I am not sure that the logic holds, that the solution for auto-pilot budgeting is even more auto-pilot budgeting. To me, it seems Prop 1A just adds a whole other layer of paralysis, obscuring the accountability we need to fix the budget mess. We'll see what the voters say May 19th.
There's well over 40 bills scheduled to be heard tomorrow afternoon in Assembly Health Committee, chaired by Assemblyman Dave Jones (D-Sacramento).
Several of the bills would put new and needed oversight over the insurance industry. Bills includes A.B. No. 786 (Jones), sponsored by Health Access California, which would provide standards for individual health care coverage, creating coverage choice categories so consumers could make "apples-to-apples" comparisons, and limit "junk" insurance.
Other bills of note include: * A.B. No. 2 (De La Torre), which would provide an independent review for any recissions of individual health care coverage. * A.B. No. 244 (Beall), which would require health care coverage to include expanded mental health services. * A.B. No. 812 (De La Torre), which would require disclosure of the medical loss ratios of specific health care coverage plan products. * A.B. No. 1218 (Jones), which would require health care insurers to seek approval for rate hikes.
Finally, A.B. No. 1314 (Jones), provides a vehicle for comprehensive health reform both with or without federal action.
The nomination of Governor Kathleen Sebelius (picutred here with Speaker Nancy Pelosi of California) to be U.S. Secretary of Health and Human Services will be voted on tomorrow, Tuesday, on the U.S. Senate floor.
She's the last cabinet member of the Obama Adminstration to be approved. Despite the Governor's impressive credentials working across party lines in a "red" state, it shows how difficult and polarizing health care issues can be.
Getting her in place with crucial before the recent news about swine flu, given the significant issues to be attended to in our health care system, and President Obama's emphasis on health care reform.
Yesterday’s Sacramento Bee had a front page story by Bobby Calvan about how Blue Cross is phone banking its members about health reform.
If you are suspicious about an insurer being "for reform," you should be. The story correctly says that Anthem Blue Cross strongly opposed health reform here in California in 2007 and had a hand in its defeat. More information about their role is at our website, http://www.sickofbluecross.com/.
There were other opponents that made a difference as well, such as the tobacco industry that opposed the late addition of a tobacco tax to the financing. Did the opposition of Blue Cross matter? Of course. Was it decisive? Not in our experience. We believe that we can win federal national reform, too, even if Wellpoint/Anthem/BlueCross attempts to oppose it. But only if win make clear what the insurance companies' interests are, and how they differ with the interests of consumers.
But more amusing to us, was that one of the Blue Cross members they called was Joan Pirkle Smith, a long time member of the Health Access California Board. As indicated in the Bee, she's been a supporter of single payer health care, such as HR 676 and SB810 (Leno). Joan has also supported comprehensive reform efforts from SB2/Prop. 72, the employer-based coverage expansion in 2003 and 2004, to AB 8 and AB x1 1 in 2007. I first met Joan during the fight for Prop. 186, the single payer ballot initiative here in California in 1994. She worked hard on HMO reform during the 1990s. We are proud of the Health Access community of organizations and individuals who, like Joan, keep trying to fix our broken health care system.
The drug wars go on here in California: consumer advocates continuing to fight the pharmaceutical industry--the legal one--for safer drugs and better prices.
SB438(Calderon) this year was similar to last year's SB1096(Calderon), a measure widely opposed by consumer groups. SB1096 allowed pharmacists to sell prescribing information to drug companies so drug companies could do even more targeted marketing to consumers. SB438 is slightly better in terms of privacy protections but still has many of the same flaws. Thankfully, it will not proceed this year.
Another bill, SB341(DeSaulnier) would expand the comparative effectiveness efforts at the federal level to California by adding counter-detailing, that is education of physicians and consumers about comparative effectiveness of drugs by impartial sources rather than leaving doctors and patients to rely on drug company marketing. What is that purple pill anyway? This bill failed in Senate Health with Republicans opposed and Democrats Gil Cedillo and Gloria NegreteMcLeod present but not voting. It has been amended to delete the fee on drug companies and is scheduled for hearing again on this Wednesday, 4/29, in Senate Health. We will see if the outcome is any different.
Today, Senate Budget Subcommittee 3 on Health and Human Services, chaired by Senator Mark Leno, met to hear budget issues related to Healthy Families and Medi-Cal. Much of the discussion related to implementation of new federal laws, particularly ARRA (the federal recovery act) and CHIPRA (the re-authorization of kids’ coverage). No actions were taken, pending the outcome of the May 19th election and the subsequent May revision of the budget estimates.
A few things worthy of note from the hearing:
· The caps on dental benefits for kids on Healthy Families appear to violate the new federal law---good news again from our friends at the federal level. Oh, and our orthodontia benefit might need to be improved as well.
· As required by recent federal law, MRMIB is implementing citizenship documentation for kids on Healthy Families. They think that 90% of the kids can be done automatically by crosschecking birth certificates which have been computerized for some time now. For the remaining 10%, for those under age 16, they can accept attestation by the parent. They are still trying to figure out what to do about 17 and 18 year olds.
· The Medi-Cal program is focusing on national health reform, the hospital waiver renewal and fraud.
· Lots of discussion of implementation of the ARRA (American Recovery and Reinvestment Act). Complaints that some of the cuts made as a result of the infamous budget trigger violate the Maintenance of Effort requirements in the ARRA, mostly on home care and SSI. Sadly the elimination of adult dental, podiatric, and other key benefits does not appear to be contrary to federal law.
· Medi-Cal is moving to electronic verification of assets: the welfare directors and Western Center on Law and Poverty have letters in expressing concern about the broad vague language proposed for the trailer bill. And oh, by the way, did Congress forget study after study has shown that people poor enough for Medi-Cal don’t have assets? Most seniors and persons with disabilities who are poor enough to be on Medi-Cal would be lucky to have $2000 in the bank—and if they did, it would just be because they had first and last months rent saved up, as they are supposed to. Health Access ran a project and sponsored a bill and some years ago on eliminating the asset test: we lost that fight not because there's a lot of low-income people with assets who want Medi-Cal, but because it was demonstrated that the elimination of this administrative barrier would lead to more people with little or no assets ending up enrolled in Medi-Cal, and thus it would be a cost to state government.
· Medi-Cal managed care: in our blog posts from 2005, you would have read screen after screen about the Administration proposals to expand managed care, including forcing seniors and people with disabilities into HMOs. While most of the Administration’s proposal failed, there were expansions of Medi-Cal managed care for working families into counties adjacent to those larger, urban counties where it already existed. Well, here we are four years later and four of the 13 counties are still not ready because of lack of provider networks (in Merced, Lake, and Mendocino? Gee, is that a surprise? Not to anyone who has sat through a CalPERS health benefits discussion.)
Compared to most budget hearings in recent months, it was a pretty quiet day. There was a Assembly Budget Committee earlier this week that also delved into some of these issues as well... but the tough stuff will come after the May Revise, when we know how big the damage is.
Our new Health Access colleague, Cynthia Craft, reports from today's Senate Health Committee, which passed some key health measures today. Of particular note was two bills to assist those who are denied for "pre-existing conditions," and thus cannot get health insurance at any price:
SB 227, Alquist (D), would launch an overdue overhaul of the state’s 20-year-old health insurance program of last resort for Californians deemed by insurance companies to be too sick to enroll. Of two measures on the topic in the Senate Health Committee Wednesday, SB227 had a greater reach, offering more opportunities to extend coverage to the so-called “high-risk” individuals whom health plans blacklist as “medically uninsurable.”
The bill would update the state’s "high-risk" pool for those who are denied private coverage, called the Major Risk Medical Insurance Program (MRMIP), so it would have no annual benefit cap, and raises the program’s lifetime benefit cap to $1 million or more – from the currently inadequate $75,000 cap. (The removal of the cap allows California to be eligible for federal funds it would otherwide not be.) The money from a relatively minor insurer assessment--a version which is in place in over two dozen states--would also expand the program to benefit many more people with pre-existing conditions. Presently, the program can insure only 7,100 statewide, while the true need in California is estimated as high as 790,000, Alquist testified. “So long as we allow health plans to reject people, we need to offer them an alternative,” Alquist told the committee. Speaking in support of the bill were representatives from the Congress of California Seniors and Health Access California. The California Labor Federation raised concerns in opposition not to the program, but to the funding source. The concern is that an assessment on health plans would be passed on in higher premiums, even for group coverage which do not exclude sick people, and so are already doing their share. Committee members urged Alquist to work with organized labor to address the federation’s concerns, and she expressed a willingness to do so. SB 227 advanced to the Senate Appropriations Committee.
In SB 57, Aanestad (R), Republican Sam Aanestad proposes different changes to the state’s Major Risk Medical Insurance Program, including increasing deductible and maximum out-of-pocket expenses; requiring an option to purchase a health benefit plan with a health savings account; and requiring three declinations in the private market or proof of a qualified medically uninsurable condition in order to qualify. Speaking in opposition to the bill was Health Access California, which stated that additional deductibles and cost-sharing was particularly inappropriate for a population needing care, and said that the proposed cap of 10,000 people was not acceptable, considering that “hundreds of thousands” of California have been denied coverage and are likely in need of this program. The measure stalled in Committee.
If you think you will ever be in a position where you are seeking to buy health coverage but are denied for so-called "pre-existing conditions," then these debates over MRMIP are important. It's frankly a band-aid for a much more systemic problem with the individual insurance market, one that hopefully will be given a broader fix within comprehensive health reform. But until then, California consumers need a place to go.
KEY CONSUMER PROTECTIONS PASS ASSEMBLY HEALTH COMMITTEE IN A FLURRY OF APRIL BILL ACTION * Bipartisan Vote to Ensure Fair Pricing by Emergency Room Doctors * Process Begins on Renegotiating California's Hospital Financing Waiver * Other Medi-Cal Changes Also Pass Committee
More Updates on the Health Access WeBlog: Health Reform Hearings in the House; The Timetable for Federal Reform; Gender Discrimination; Honoring Frank Russo; The Packaging of Prop 1A; Married for Health Coverage?
In a hearing lasting over four hours, the Assembly Health Committee, chaired by Assemblyman Dave Jones (D-Sacramento), considered several bills that would impact California health care consumers. Some of the highlights include:
Self-Pay Patients To Get Help on ER Doctor Bills
AB 1503, Lieu (D) would require emergency room physicians to charge rates to lower-income patients who do not have health insurance. Currently, uninsured individuals treated in emergency rooms are frequently charged three to four times more what insurers pay for exactly the same service. The measure specifies that ER doctors would have to offer eligible patients rates that are no higher than those paid by Medicare, Medi-Cal or similar government programs. Physicians also would have to offer payment plans, rather than submit unpaid bills to collection agencies.
The measure prohibits wage garnishments or liens, and prohibits the forced sale of a patient’s home as a means of collecting the debt. These consumer protections already apply to hospital billing under AB774(Chan) of 2006, and in this bill would be extended to individual ER physician billing. As of 2007, about 6.5 million Californians were without health insurance. Research pinpoints medical debt as the leading cause of personal bankruptcy in the United States . The bill got support from Health Access California, ACORN, Western Center for Law and Poverty, Congress of California Seniors, Jericho, and others. The bill won unanimous bipartisan support in committee, and AB 1503 advances to the Assembly Appropriations Committee.
Key Medi-Cal Reforms Pass
Hospital Financing Waiver Process Starts: AB 342, Bass (D) and Jones (D), a companion bill to its Senate counterpart, SB 208 (Steinberg), lays the groundwork for the state to negotiate a new Medicaid waiver from the federal government, a crucial component of financing for the state's public and safety-net hospitals, and for the health system as a whole. Specifically, the bill gives the go-ahead for the state to draft a comprehensive waiver from federal Medicaid rules, with an eye toward preserving and strengthening safety-net providers and maximizing federal funds. The measure is not fully detailed, but sets the stage for negotiations with stakeholders, many of whom testified with their interests and concerns as part of the process in developing this plan. AB 342 overwhelmingly won passage to the Assembly Appropriations Committee.
Fewer Payment Hassles for Medi-Cal Enrollees: AB 1142, Price (D), would reduce unnecessary headaches for Medi-Cal beneficiaries by requiring hospitals and providers to make an extra effort to bill the program, instead of unnecessarily sending the bill to the patient. The bill calls for a series of actions following patient care to ensure Medi-Cal consumers are not wrongfully pursued for debt that the program would cover. It would require hospitals to share eligibility status with hospital-based providers, ambulance services and other appropriate professionals. Fines up to three times the amount of the Medi-Cal payment would result if the provider has proof of Medi-Cal eligibility but pursues collection from the patient instead, resulting in a negative credit report. AB 1142 got support from Western Center on Law and Poverty, and children's, labor, low-income, and consumer organizations, including Health Access California. The bill advanced the Assembly Appropriations Committee on a strict party-line vote, with Republicans voting “nay.”
Extended Medi-Cal Coverage for Disabled Workers: AB 1269, Brownley (D), would make health coverage more affordable for many working people who are disabled. Specifically, it would extend eligibility for Medi-Cal under the California Working Disabled Program for 26 weeks effective March 1, 2010. Groups representing people with disabilities, health providers, and consumers, including Health Access California, supported AB 1269. The bill advanced, with voting along party lines, to the Assembly Appropriations Committee.
Less Bureaucracy, Duplication for Medi-Cal Enrollees: AB 963, Ammiano (D), would lessen paperwork for low-income individuals and families who apply for food stamps, also streamlining their applications for Medi-Cal eligibility. It would require stakeholder groups, the Department of Social Services, counties and the Statewide Automated Welfare System to coordinate efforts in a collaboration to update data sharing, technology and administrative procedures to ensure continued health coverage for eligible people whose status in other programs changes. The measure, which advanced to the Assembly Appropriations Committee, prohibits the Department of Health Care Services from imposing duplicative and burdensome paperwork requirements. Health Access California is in support of AB 963.
Some Bills Stall
The committee passed most bills it considered, with the exception of a ten percent fee on alcohol to fund alcohol and drug programs, and a measure to require disclosure of employer's claims data. AB 562, Cook (D), failed to pass when lawmakers’ concerns about ensuring employee privacy trumped the bill author’s call for greater transparency. The stated purpose of the bill was to give mid-sized small business employers more information about where their health care dollars are going while they shop for policies. Insurance underwriters testifying in favor of the measure said business owners who pay a portion of their workers’ premiums should be able to discern what costs lie behind their investment when negotiating with insurers. The bill was opposed by both health insurers and privacy advocates, and some Health Committee members expressed concern that too close a look at the health care costs would expose employees to discrimination, termination or simply compromise their privacy. The bill failed to advance out of committee, and is up for reconsideration. (Health Access California did not take a position on the measure.)
Given the length of the hearing, some bills were "put over" to be considered during next week's hearing. All bills need to pass policy committees by April 30. Health Access will continue to provide updates on actions taken in the Legislature. For a broader list of interest to health advocates and Health Access California , check out the bill list on our website.
The Witness List includes Consumers Union (a Health Access California board member) and the president of Watts Healthcare Corporation from Los Angeles:
* Uwe E. Reinhardt, Ph.D., James Madison Professor of Political Economy and Professor of Economics and Public Affairs, Princeton University, Princeton, New Jersey * Bill Vaughan, Senior Policy Analyst, Consumers Union * William D. Hobson, Jr., MS, President and CEO, Watts Healthcare Corporation, Los Angeles, California * David Borris, Owner, Hel’s Kitchen Catering, Northbrook, Illinois * Kenneth L. Sperling, Global Health Management Leader, Hewitt Associates, on behalf of National Coalition on Benefits * Linda Blumberg, Ph.D., Principal Research Associate, The Urban Institute
The House Education and Labor Committee, chaired by California Rep. George Miller, is hosting a Health, Employment, Labor, and Pensions (HELP) subcommittee hearing on Thursday, April 23, to "examine various health care reform proposals that will guarantee quality and affordable health insurance coverage for all Americans." It will be broadcast online at the committee
* Karen Davenport, director of health policy, Center for American Progress * David Himmelstein, associate professor of medicine, Harvard University * Michael Langan, principal, Towers Perrin * William Oemichen, president and CEO, Cooperative Network, Madison, Wisc. * Ron Pollack, executive director, FamiliesUSA * Janet Trautwein, executive vice president and CEO, National Association of Health Underwriters * William Vaughan, senior health policy analyst, Consumers Union
The House Energy and Commerce Committee, chaired by California Rep. Henry Waxman, is the other key committee that will craft and consider health reform legislation, and they had had hearing and will soon as well.
When Melody Barnes was here in California, she added extra urgency to President Obama's nationally televised quote that "let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year."
She said at the White House forum two weeks ago that in order to pass a bill "this year," then we have essentially "100 days" to craft legislation in order to meet that goal..essentuial
The shortness of the timeline is underscored by Senators Baucus and Kennedy, chairs of the key Senate committees, which yesterday proposed that they will mark up a bill in June! The full text of the letter is at The Treatment.
Mike Zapler at the San Jose Mercury News has the story about women getting a triple whammy... having to buy individual health insurance--which is already the most expensive, least efficient way to get coverage, having to pay more as a woman, and having to pay more to get basic services--like maternity.
It spotlights legislative efforts to ban gender discrimination in underwriting--AB 119 (Jones) + and SB54(Leno)--and to require the coverage of maternity care--AB 98 (De La Torre).
Speaking of legislation, another big week coming up in the legislature: Bills up in Assembly Health Committee on Tuesday include a health insurance rate regulation bill, AB1218(Jones), AB2(De La Torre) on rescissions, and several bills on Medi-Cal enrollments and eligibility.
The Senate Health Committee on Wednesday will consider different efforts to change MRMIP, the state's "high risk" pool for those denied for pre-existing conditions, AB227(Alquist) and SB57(Aanestad), as well as broader health reform issues.
We'll report on it right here, as well as on our Twitter account, at @healthaccess, or www.twitter.com/healthaccess
On Monday evening, Health Access will join many other key organizations to honor Frank Russo and the work of the California Progress Report. With the decline of newspapers, the California Progress Report has provided a vital independent progressive voice on a wide range of policy issues. We appreciate that it has republished many of our updates and posts from Health Access and other health related posts, and it has been a useful place to keep up what other groups are doing on other issues.
Frank Russo founded the California Progress Report and made it a heavily tracked website for California news and information, from a range of sources--citizen activists, legislative leaders, and key constituency organizations. As a result, it reports the stories at the state Capitol and throughout California that no one else is covering. Frank has moved on to work in the Capitol, but we should try to ensure that the California Progress Report continues.
We are supporting the Consumer Federation of California Education Foundation's efforts to maintain and develop the site. If you are in Sacramento Monday, or if you or your organization can otherwise help, we hope you can too.
So much of the campaign around Prop 1A is to package it with the other initiatives, and then sell the entire package as a whole, even though the parts are very different, with different consequences.
The Governor has made two arguments. One is to sell the package as the ultimate solution to our budget crisis: "We have a chance to fix this once and for all." But no one believes that. Not the LAO. Not his own budget crunchers. Not the budget passed earlier this year, nor the pending ballot measures package, solve the fundamental issue of the mismatch between the level of services the state provides, and the revenues the state brings in. Severe cuts were made, but the revenues are temporary. And even in the short-term, given the extent of the economic crisis, California has a significant deficit on May 20th regardless of the vote on May 19th.
Unable to continue that argument with a straight face, there's a new line. The new tact has been arguing that the state will fall off a cliff if the package is voted down. But let's tease out the package: Proposition 1A will have zero impact on the deficit on May 20th. The impacts of its passage, whether of additional revenues for 1-2 years in 2011-13, or the long-term constitutional contraints on spending and investment, don't kick in for a few years.
The measures that do have an impact on the deficit on May 20th are Propositions 1C, and to a lesser extent, Props 1D & 1E. Proposition 1C would allow the state budgeters to book $5 billion in budget solutions. While some may question the wisdom or even the actual ability of California to "securitize" the lottery, it's Proposition 1C's failure that will make the deficit $5 billion bigger.
Similarly, if Props 1D &1E are voted down, and the general fund is thus not able to take money from voter-approved funds for services for children and the mentally ill, then the general fund deficit is bigger, but at a smaller scale--less than $1 billion for both measures.
It would be more forthright if the proponents, in their alarmist rhetoric, focused on Proposition 1C, arguing that if that measure goes down, the budget outlook of cuts or taxes would be significantly worse. But they don't think they can sell it. So they are trying to package it with the other measures, and use the elements of Prop 1A to somehow sell Proposition 1C.
Besides, the Governor in particular sees his legacy in Prop 1A. As he said, "I mean, I've been fighting for five years now for budget reform, to put a rainy-day fund aside and to put a certain cap on spending. I wasn't successful. I tried through the Legislature when I first came into office; I tried in 2005 to go directly to the people, but apparently it wasn't inclusive enough so that failed -- the idea was good but it failed. And so here was our chance again…. "
There's an irony here. He failed in 2005 to pass a spending cap in Proposition 76, which was unpopular from the start. Voters didn't like placing limits on the services they depend on--education, health care, public safety, etc; nor did they like giving the Governor unilateral authority to make certain cuts. (I believe they still don't.) The opponents used Proposition 76 to help discredit the Governor and the entire package, including other measures that ended up losing by much closer margins.
Now the Governor is trying to use another spending cap proposal to prop up his entire package. But it's a fundamentally unpopular notion to begin with, so I don't know if it will be successful. It seems it is a strange strategy, given recent history.
As we noted last year, a Kaiser Family Foundation poll showed that 7% of Americans said they made a decision about marriage based on the need for health coverage.
This music video from Runawaybox graphically advances this trend into public consciousness (it's OK for work... barely):
With current economic conditions and long-term trends, more people are losing access to employer-based group coverage, and are find themselves in the wild, wild west of the individual insurance market, which is the most expensive, least efficient way to get coverage--if you aren't denied for a "pre-existing condition" in the first place.
It's a truly broken system when the only or best place to get health coverage is at the altar.
SENATE HEALTH COMMITTEE CONSIDERS KEY MEASURES * Single-payer universal coverage bill advances again–despite past Schwarzenegger vetoes. * Workers let go from the small businesses would qualify for health care assistance. * Bill stalls to provide greater public access to unbiased data on prescription drugs
ALERT: Support Needed Next Week on Bills on Underinsurance, Overcharging
More Updates on the Health Access WeBlog: New Report Released on Underinsurance; Board of Equalization Asks Nonprofit Hospitals For Information; Assembly Health Committee Update; Opposition on Prop 1A; More on the Public Health Insurance Option
The Senate Health Committee, chaired by Senator Elaine Alqust (D), on Wednesday approved a measure to expand financial aid for continued health care coverage to workers laid off by small businesses through 2009. The bill taps into federal stimulus money from Washington to make COBRA coverage substantially more affordable.
Also, prodded by a roomful of over 100 Californians supporting a single-payer solution to the health crisis, Senate Health Committee members also voted to advance a bill that would set up a SB810(Leno).
At the same time, however, there was not enough support to pass a bill to establish "academic detailing" to offer the public unbiased consumer information on the safety and cost of pharmaceutical medications.
The following looks in more detail at these bills, which Health Access California is active in supporting:
SINGLE PAYER HEALTH CARE COVERAGE
* SB 810 (Leno) outlines a comprehensive reform to create single payer universal health coverage system in California. Such a system would extend health care services to all residents, through the existing network of largely private doctors and hospitals, but with the state negotiating and providing reimbursements.
The proposal has the support of advocates who say it would eliminate existing disparities in Californians’ access to health care, and save California money in the long run by keeping the citizenry productive and healthy, and eliminating an insurance company middleman.. Assemblyman Mark Leno (D) said the change is needed also because health care is costing too many consumers too much money, without delivering enough positive results. Single payer bills similar to SB 810--most recently SB840(Kuehl)--have been passed by the California Legislature before, only to be vetoed by Gov. Arnold Schwarzenegger, who has labeled such proposals “socialized medicine.” The proposal does not include the financing component at this time.
Supporters included a broad rage of several dozen organizations, including Health Access California. Many organizations that sent members to pack the committee hearing room of over 100 people who wanted to voice their support. In testimony in favor of the bill, leaders of the California Physicians' Alliance and California Nurses Association made the case on both economic and health grounds.
A coalition of insurers, providers, and businesses opposed, including Anthem Blue Cross, America ’s Health Insurance Plans, Health Net, California Association of Health Underwriters and others voiced opposition to the proposal. A representative of California Chamber of Commerce predicted it would lead to fiscal chaos, and said the state should wait to see what the Obama Administration proposes for health care reform. Republican Senator Aanestad debated points with Senator Leno over the lessons of Canada and issues around cost.
Committee members voted along party lines in advancing the bill to the next Senate committee, with Democrats in support and Republicans in opposition.
EXPANDED HEALTH CARE COVERAGE FOR JOBLESS * AB 23 (Jones) got broad bipartisan support through the Senate Health Committee. The bill would tap into federal stimulus dollars to allow a greater range of laid-off Californians to qualify for COBRA subsidies to stay covered. The federal economic recovery package was designed to aid employees who were let go – through no fault of their own – helping them obtain subsides to extend their job-based health care coverage. The bill extends that assistance to workers of smaller businesses--from 2-19 people--in alignment with California's specific Cal-COBRA law.
Senate Health Committee members noted the urgency of the measure and sent it along to the next committee. AB 23 will provide up to 65 percent of the cost of extending health care coverage through the federal COBRA program. It applies to people losing their jobs from September 1, 2008 to December 31, 2009.
No organization or person registered opposition to AB 23. Among those in support were a range of consumer, labor and provider organizations. The bill was sponsored by the California Department of Insurance, and did not have significant opposition.
TRANSPARENCY ON PRESCRIPTION DRUGS
* SB341 (DeSaulnier) proposed to have the University of California provide consumers and doctors the latest reliable information on the safety and cost-effectiveness of pharmaceuticals, including on a public website.
The bill also proposed to level the playing field in doctors’ offices by sending UC researchers or representatives to physicians’ workplaces to share unbiased information about drugs to doctors. Pharmaceutical companies have for years been taking advantage of opportunities for face-to-face access to doctors, by sending employees called “detailers” to talk to physicians directly about the drugs they are marketing as well as engaging in ceaseless advertising to consumers about those drugs.
SB 341 would remedy this at a time when some widely-marketed drugs, like Vioxx, have already been found to cause adverse side effects. Senator Mark DeSaulnier (D) said the bill is necessary because consumers need better, centralized access to unbiased information about prescription drugs in part to counteract expensive drug company marketing and advertising campaigns. In response to questions by his fellow Senate Health Committee members, he agreed to examine whether his proposal overlapped with federal efforts and, if so, amend the bill.
SB341 builds on the efforts of the Obama Administration to control health care costs by getting better information about the comparative effectiveness of prescription drugs. Vioxx was not only harmful, it was only marginally more effective than ibuprofen but it was lots more expensive.
In addition, a representative from the advocacy group Community Catalyst said "academic detailing" proposals such as SB 341 are already up and running in several other states, including Pennsylvania , Vermont and Maine . The California Alliance for Retired Americans is the sponsor, with other supporters including the Mental Health Association in California , the AFL-CIO and Health Access California , among others.
Opposition came from Pharmaceutical Research and Manufacters of America and other drug companies. They argued that UC is already the “partner” of the pharmaceutical manufacturers. Plus, they said, the information is already available if one knows where to look. Mainly, they argued against the fee to pay for this information, and that the bill was unnecessary because the recent federal stimulus package included funding for comparative effectiveness research. They failed to mention that the drug companies vigorously but unsuccessfully opposed those very provisions and then fought hard to make them meaningless, a fight that still continues in DC.
SB 341 was the only bill that did not win enough votes to advance out of committee. With a party line vote, with Democrats in support but Senators Cedillo and Negrete-McLeod present in the room but not voting, it failed to pass. It was granted reconsideration and could be heard as early as next week. It also needs to pass Senate Revenue and Taxation before April 30.
UNDERINSURANCE BILLS ALERT: Earlier today, Health Access co-released a national report on "underinsurance" with Community Catalyst, while spotlighting AB786 that directly addresses the issue. Next week, the Assembly Health Committee will consider two crucial consumer protection bills sponsored by Health Access California
SUPPORT LETTERS ARE WELCOME FOR:
* AB786(Jones) to set standards for coverage, allowing for apple-to-apples comparison shopping and limiting "junk" insurance.
* AB1503(Lieu) to prevent overcharging of the uninsured and underinsured by emergency room physicians.
Please get your organizational letters of support faxed to the Assembly Health Committee, chaired by Assemblymember Dave Jones, State Capitol, Room 6005, Sacramento , CA 95814 . The fax is: 916-319-2197.
Health Access will continue to provide updates on actions taken in the Legislature. For a broader list of interest to health advocates and Health Access California , check out the bill list on our website.
Today the Board of Equalization acted, on a 3-2 vote, to require that non-profit hospitals report to it in July and September of this year about whether those hospitals are complying with the basic requirements of California law with respect to non-profit tax status as well as AB774, on hospital overcharging. The Board expect to put out a report in February of next year (2010).
The hospitals opposed this and attempted to delay the vote until another year, another decade, maybe another century.
However, Board Members Betty Yee, who proposed the motion, former Assemblymember Judy Chu, and Controller John Chiang prevailed. While the motion to conduct a stakeholder process passed a few months ago 5-0, this time Board Members Bill Leonard and Michelle Steel both voted no. Although the Board of Equalization is technically non-partisan, the vote was along party lines.
Under California law, including a decades-old court case named Rideout, after a hospital of that name, nonprofit hospitals are generally expected to have revenues in excess of expenditures of less than 10% (otherwise known as profits). However, non-profit hospitals may accrue greater “surplus” revenues if they use those “surplus” revenues for debt retirement, facility expansion or reserve for operating contingencies.
For those of you who are not tax geeks, here is an example: a few years ago Sutter Tracy had revenues in excess of expenditures of 24%. Pretty healthy return for a “non-profit”. It is this sort of thing that made the BOE think perhaps they should take a look and request information about what “non-profit” hospitals were spending their surplus revenues on.
The information request also requires hospitals to provide their charity care and discount payment policies as well as the number of liens and amount collected from liens. They are also looking at joint ventures and executive compensation and for personal inurement, since there is some lingering notion that those who are in charge of non-profits should not be among the wealthiest in our society.
The BOE also asked for corporate organization charts: we have seen a few of these over the years: we call them octopus charts because of how convoluted they are. All too often, remarkably enough, the land-use intensive, less profitable elements of the health system are held by the non-profit while the lucrative elements are held by for-profit affiliates or subsidiaries. Again, this is the sort of thing that has piqued the interest not only of the Board of Equalization but also of the U.S. Senate Finance Committee where under current chair Max Baucus (D-Montana) and former chair Chuck Grassley (R-Iowa) the committee has pressed the Internal Revenue Service to revise the reporting requirements for non-profit hospitals.
None of the data that the Board of Equalization required for its efforts is available from any other source: all of the financial reporting that is done to the Office of Statewide Health Planning and Development (OSHPD) is done on a facility basis while the BOE looks at taxable units. A hospital system can have 20 or 30 hospitals but it may have only two or three taxable units depending on its corporate structure (hence the need for the corporate organization chart).
In the relatively near future, we will have better information on whether “non-profit” hospitals are really non-profits—or whether they are behaving more like their for-profit counterparts.
Here's Congresswoman Davis with representatives of the sponsoring organizations of the town hall, including ACORN, California Partnership, Health Access California, SEIU State Council and SEIU Local 221.