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Starting the Supreme Court watch...
Thursday, May 24, 2012
I got up early this morning because of a rumor, that there was a slight possibility that the Supreme Court would rule on the Affordable Care Act at 10am Eastern. Even though I knew it was unlikely, the slight possibility was enough to focus the mind on how important this decision is.
They did release some opinions today, but none on the ACA. The decision is most likely in late June. Here's an article in the National Journal that states it would be highly unlikely for the Court to rule early--after all, it's a big complicated decision, and if you were writing a big paper with many other colleagues, wouldn't you want to take all the time possible to get it right?
That said, that doesn't mean that I won't been keenly watching in the next few weeks, including next Tuesday, the next day that the Supreme Court releases judicial opinions.
posted by Anthony Wright |
Permalink |
2:21 PM
"A Tick-Tock Situation"
Wednesday, May 23, 2012
The California Health Benefit Exchange Board of Directors met again today, just one week after the last meeting, a reflection of how quickly the Exchange is having to move to be ready for 2014. Government Relations Director David Panush said "we're moving fast because we have to" and quoted board member Kim Belshe in calling this "a tick-tock situation".
The Board was initially working toward a submission of a Level 2 Exchange Planning Grant on June 29 to request funds from the federal government for the next stage of implementation. However, the Board decided that applying for a second Level 1 grant in the same time frame affords them more flexibility. After that grant application is submitted, the Board will be working toward submitting a "blueprint" of the Exchange that is due to the federal government September 14, 2012.
To that end, an aggressive work plan lays ahead of the Exchange's board and growing staff.
June 12 Meeting
Discussions: SHOP Exchange
Consumer Outreach Focus Groups
Service Center Options
Consumer Assistance/Ombudsman
Draft Level 1 Grant
Announcement of CalHEERS Vendor
Decisions: Outreach and Marketing Plan
Scope, Policies, and Budget of Assisters, Navigators, Brokers
June 19 Meeting
Discussions: Qualified Health Plans
Cost Sharing
Decisions: SHOP Exchange
Level 1 Grant
July 19 Meeting
Discussions: Qualified Health Plans & Benefit Design
Assister and Navigators Training and Oversight
Decisions: Consumer Assistance/Ombudsman
Assisters and Navigators
Service Centers
August 23 Meetings
Decisions: Qualified Health Plans Benefit Design and Policies
Assisters and Navigators Training and Oversight
Stakeholder Engagement Processes
September 18
Health Plan Solicitation
Today's meeting included in-depth discussions of the draft Outreach and Marketing plan presented by Ogilvy, and the draft recommendations on Navigators and Assisters presented by Heath and Associates.
The draft Marketing and Outreach plan appropriately catered to the diverse needs of Californians, and many present in the audience recognized the consultants' work on the plan. One component of the plan includes grant programs to engage community based groups, who are already trusted messengers, in helping with the outreach for the Exchange. Many stakeholders were very supportive of this idea. The plan is posted on the Exchange website ( direct link here) and written comments will be accepted until May 31.
The Navigators and Assisters proposal from Health and Associates was a bit more controversial. It is likely that many people will require in-person assistance navigating the Exchange and other new coverage options starting in 2012. Some estimates suggest that up to 75% of these individuals will need in-person assistance. The Board heard comments expressing varying perspectives on who should be compensated for providing that help. Many entities that the consultants do not recommend compensating for that service testified why they should get paid, but advocates warn that providing payments to those who directly benefit from enrolling people may create a financial incentive for steering. The proposal is also available on the Exchange website ( direct link here) and comments will also be accepted until May 31.
The Exchange Board is moving quickly to make decisions and get the Exchange up and running. For those who have yet to weigh in on any of the topics discussed today or on future agendas, do not delay in submitting those comments to the Exchange.
Health reform, job creator
Monday, May 21, 2012
Yes, health reform provides new consumer protections, expands and secures health coverage, and works to reduce the cost of health care. But for some, that isn't enough. Some ask: does it create jobs?
On Sunday, a prominent employer group released a new
report that answers that yes, federal health care reform will add tens of thousands of jobs
to the California economy.
The report was conducted by the Bay Area Council Economic Institute (BACEI) is a public-private institution that typically advocates for business interests. The reports goes over each provision of the Affordable
Care Act (ACA) and attempts to quantify the potential economic impact.
“On net, this analysis
suggests that upon full implementation in California, the Affordable Care Act
will have a positive impact on California’s economy with variation across
regions based largely on their socioeconomic makeup. Full implementation of the
Affordable Care Act as compared to the non-reform scenario in 2010 would have
resulted in 98,861 new jobs in California (a 0.6% increase in total employment)
and $4.4 billion in additional gross state output,” report authors write.
Read the full report at:
http://www.bayareaeconomy.org/media/files/pdf/AffordableCareActWeb.pdf
Labels: HealthReform, Research
posted by Anthony Wright |
Permalink |
12:40 PM
Out of the mouths of Governors....
Thursday, May 17, 2012
We got lots of retweets yesterday quoting Governor Jerry Brown during his May Revise press conference Monday. As George Skelton noted in the LA Times, in the middle of all the talking about austerity was a passionate defense of government and a concise argument against the cuts:
"Government is a nurse. It's a
teacher. It's a highway patrolman. It's someone working in a mental hospital.
And when we cut, that's what we cut," he said.
There are other less profound but still amusing quotes from the press conference:
"There are ideologues who say
government is an abstraction that you can just completely eviscerate with no
impact in the real world. Well that isn't true."
The state budget: "It's a pretzel palace of incredible complexity."
"What that means is that things that are good in and of themselves have got to
be stopped or curtailed if we are going to have balance.”
"In some ways you are a declinist... I am a bouyant optimist."
“..I would urge a modicum of stoicism and less of indulging your propensity to immediate gratification”
"The capitalist system is not coincident with your expectations of exactitude."
Labels: Budget, Funny, GovBrown
posted by Anthony Wright |
Permalink |
3:54 PM
CTO: IMHO #CaHBEx DTRT @EOD
Tuesday, May 15, 2012
The Exchange Board met today and tested out a new meeting schedule. Chair Diana Dooley explained that the Board wanted to get stakeholder feedback before the Closed Session discussion of the federal partnership opportunity and the CalHEERS IT contract.
Peter Lee gave a brief Executive Director’s report, primarily highlighting the schedule for the next few very busy weeks. Tomorrow morning, the Exchange will be hosting a Marketing, Outreach, & Education and Assisters Program Stakeholder Webinar. Next week’s board meeting (that’s right, there is another board meeting next week, May 22 at 10am) will include discussion of the following broad issues:
- The Level II Exchange Grant
- Outreach and Marketing
- Assisters, Navigators, Brokers, and Consumer Assistance
- SHOP Options
The Service Center options discussion will be moved back to the June 12th meeting.
Lee then introduced Amanda Cowley from CCIIO, the federal Center for Consumer Information and Insurance Oversight, who shared some information about the Federal Exchanges and Federal Partnership Options. Some states have never intended to create their own Exchange for various reasons, while other states may find themselves unsure of whether they will be operational by the designated start date and may want to partner with the federal government on a transitional or permanent basis on all or parts of the Exchange operations.
The Exchange Board brought up this possibility in the last meeting and both the Board and stakeholders had a number of questions for Ms. Cowley about how exactly a partnership might work. While she did not have the answers to all of the questions, she did say that CCIIO was open to states helping to shape the specifics of the partnership model. In asking about the timing of opting into a partnership, Dr. Ross, in asking about the timing for when the state would have to opt in, delivered the laugh line of the day: “Is there a point where we send you an OMG text,” he asked, “when your answer will be LOL?” He seemed to be reflecting some anxiety, shared by the rest of the board, about being ready, particularly on the technology front, in time.
Advocates expressed concern about what the federal partnership might mean for California. Health Access’ Beth Capell, Elizabeth Landsberg from Western Center on Law and Poverty, and Betsy Imholz of Consumers Union were among advocates who testified on behalf of the interest of consumers. Relinquishing control of vital components of the Exchange to the federal government might mean a bigger challenge ensuring a “no wrong door” and seamless experience for consumers. (Board member Kim Belshe asked questions around this issue.) This may also make it more difficult to ensure realtime eligibility determinations and horizontal integration with screening for human services programs. Consumer assistance being provided by the federal government may also mean call centers where individuals have less of an understanding of the unique needs of Californians, and may not have the language access capacity that California needs and requires.
After hearing this consumer feedback, the Board adjourned to a long closed session, which was extended multiple times, in order to discuss the progress of the CalHEERS IT contract as well as whether the possibility of adjusting that contract as part of partnering with the federal government.
When the Board finally reconvened in open session, Executive Director Peter Lee reported that the Board agreed, based on the status of the contract negotiations in progress that they felt comfortable moving forward as a state-based exchange and not opting in to a federal partnership. The final result of the contract negotiations will be announced at next week’s board meeting.
So, CTO, IMHO CA HBEX DTRT @EOD. (For those of you who don’t speak text: check this out, in my humble opinion the California Health Benefits Exchange did the right thing at the end of the day).
posted by Linda Leu |
Permalink |
6:54 PM
The New Budget: A Body Blow for California's Health System
Monday, May 14, 2012
HEALTH ACCESS UPDATE: Monday, May 14,
2012
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GOVERNOR BROWN PROPOSES REVISED CALIFORNIA
BUDGET
WITH MORE UGLY CUTS
TO HEALTH AND OTHER CORE
SERVICES
Health cuts a "body blow"
to the health system Californians rely
on, including:
* Major cuts to
California health care providers: hospitals (public, private, & district);
nursing homes; community clinics; etc.
* Shifting
seniors/people with disabilities to managed care plans, with concerns about
transition, continuity of care,
access
* Reducing funding
for children's coverage, by eliminating Healthy Families and transferring 875,000
children into Medi-Cal
* Steep cuts likely for our California health system, even if
voters approve revenues in November; Without revenues, it gets
worse
Read Our Health Access
Blog for More Updates; Also Follow Us on Facebook!
Read Real-Time Updates on
Legislation on Twitter @HealthAccess!
|
Governor Jerry Brown announced today a revised 2012-13 California
budget to solve a newly revised $16 billion deficit. Half of the Governor's
budget solution to the deficit is $8 billion in additional budget cuts,
including over $1.2 billion in Medi-Cal alone. Nearly $6 billion in tax
revenues, making up 35% of the Governor's budget solutions, would result from a
proposed ballot measure pending approval by the voters in
November.
Health advocates called the budget "a body blow to
the health system all Californians depend on." Few California patients will not
feel the impacts of these budget cuts and changes in some way, from the cuts to
health coverage for children in Healthy Families to seniors and people with
disabilities in Medi-Cal; from the cuts to community clinics to nursing homes,
from private hospitals to district hospitals to public
hospitals.
In a YouTube video
announcing the new size of the deficit released this weekend, Governor Brown
also stated that state spending "is now at its lowest level in decades."
In fact, cuts proposed in the new budget would be
cumulative on top of $15 billion in cuts to health and human services already
made in recent years, from the elimination of dental and other benefits for
millions, and other cuts to doctors, clinics and hospitals
directly.
The Governor's 2012-2013 proposed budget already had
proposed steep cuts that are retained in the new revision: The proposal cuts
children's health care in the Healthy Families program by 25%, ultimately by
shifting its 875,000 children into Medi-Cal, raising concerns about disrupting
care and access to providers. The proposal also shifts 1.4 million
"dual-eligible" seniors and people with disabilities into managed care. While
this proposal has been modified in its timing and scope, there remains concerns
about access and transition issues, including about whether the health plans are
ready to care for such vulnerable patient populations.
This revised budget also includes hundreds of
millions of dollars in new cuts, particularly to hospitals and nursing homes
that millions of Californians depend on. These include cuts to public hospitals,
district hospitals, private hospitals, and nursing homes. A reimbursement change
to community clinics continues in the Governor's proposal, despite being
rejected in some legislative committees.
Health and human service
advocates argue that these are the wrong cuts at the wrong time, during a
economic downturn when Californians need such help the most, and when we need to
get ready for health reform to maximize the benefit for our families and our
state. They called for a rational budget conversation that includes seeking more
revenues, not just more cuts.
The pending health cuts include:
* DIRECT CUTS TO HEALTH PROVIDERS: HOSPITALS,
NURSING HOMES, AND CLINICS: The proposal includes significant
additional cuts to health care providers beyond the January budget,
including
* hospital payment cuts to supplemental payments to
private hospitals; elimination of of public hospital grants, etc., for $150
million general fund savings;
* an additional $100 million designated for public
hospitals under the federal Medicaid waiver would be taken for state general
fund savings;
* an additional cut to district hospitals
(non-designated public hospitals) of $75 million; and
* nursing homes reimbursement changes for $47.6
million and another for $23.3 million in general fund
savings.
* The budget still includes a January proposal
that the Governor seeks would change payments to Federally Qualified Health
Centers (FQHCs), for a reduction of $27.8 million general
fund.
* HEALTHY FAMILIES CUTS TO CHILDREN'S
COVERAGE: The proposal would reduce Healthy Families managed care plans
by 25.7 percent, impacting access to care for the 875,000 children covered by
the program. The budget proposal would also shift children from Healthy Families
to Medi-Cal. The budget year savings is adjusted to be $48.6 million general
fund.
* SHIFT OF "DUAL-ELIGIBLES" TO MANAGED
CARE: This proposal, as part of a broad "coordinated care initiative,"
would shift 1.4 million low-income seniors and people with disabilities who get
both Medicare and Medi-Cal (so called "dual-eligibles") into managed care.
Advocates have raised issues about patient populations that have already been
shifted, and how access and transition problems with impacts this particularly
vulnerable population. The budget year savings is estimated at $663.3. million
general fund.
* OTHER MEDI-CAL
CUTS:
* The Governor revised his proposal to impose
cost-sharing on Medi-Cal patients which was adopted by the Legislature last year
but rejected by the federal government. A new, more narrow proposal, would seek
$15 co-payments on non-emergency ER visits, and $1-3 co-payments on specific
prescription drugs, for a $20 million general fund
savings.
* Other budget proposals continuing from January seek
to reduce laboratory rates, and to no longer paying for certain Medi-Cal
services, for a $75 million general fund
savings.
The Governor proposed to enact these cuts regardless
of the result of a November initiatives to raise tax
revenue.
These budget items will be considered by the state
Legislative committees in the next several weeks, in advance of a June 15th
deadline to pass a budget.
Health Access will continue to
put out timely updates in the next several days on blog, Twitter, Facebook, and
E-mail as we learn more about the state budget, as well as about tomorrow's
Exchange meeting, updates on legislation, and other
items.
|
Labels: Budget, GovBrown, MediCal, SCHIPHealthyFamilies, Updates
posted by Anthony Wright |
Permalink |
6:36 PM
John Glass, R.I.P.
This Saturday, I was pleased to speak about the Affordable Care Act at a symposium at Pasadena City College hosted by several chapters of both the League of Women Voters and Health Care for All California, entitled "California & National Health Care: Where Are We Now?" Other presenters included friends like Dr. Don McCanne, Dr. Bob Peck, and Dr. Bruce Hector of Physicians for a National Health Program, Doris Nelson of Health Care for All California, Joan Pirkle Smith who is on the board of Health Access California and UHCAN, and several others.
The event was special because it turned into a touching tribute for John Glass, a longtime activist for single-payer, and for heath reform and peace and social justice generally. John Glass passed away suddenly just this past week. This was a shock--I am many others were actually planning to see him at the Saturday event, and folks say he looking forward to it. It was the kind of event you would expect him to be at, since he seemed to be omnipresent in support of the good causes and fights.
In the ceremony, it was noted that key officials--former state Senator Sheila Kuehl, Representative Howard Berman, Los Angeles Mayor Antonio Villaragoisa reached out to the family. But it's appropriate he was honored on Friday at a peace vigil and was featured on a leaflet (posted here)--because he always was passing out leaflets on the causes he cared about and was passionate about getting people involved in these issues.
We worked with John over the years--and he would remember and still have materials from the early days of Health Access over 20 years ago. We'll miss John and his passion and activism. Labels: HealthAccessCommunity, SB840
posted by Anthony Wright |
Permalink |
1:48 AM
New Report: A Recipe for Improved Consumer Assistance...
Thursday, May 10, 2012
HEALTH ACCESS UPDATE
Thursday, May 10, 2012
NEW “SECRET SHOPPER” SURVEY OF STATE HEALTH AGENCIES REVEALS RECIPE ON MEETING CONSUMER ASSISTANCE NEEDS UNDER HEALTH REFORM
Over 200 “mystery” calls made to four state agencies, with common consumer questions; California agencies largely met key standards,
But with crush of calls expected, need more consistent, coordinated, prioritized effort.
Groups argue consumer assistance needs to be a priority as millions of Californians get new options, new benefits and new consumer protections under health reform;
The report shows the right ingredients are there—but they need to be put together.
Budget (including May Revise) debate will include consumer assistance capacity;
Exchange to discuss consumer assistance and service center issues at June meeting.
California consumers can and do get answers
from key state agencies to their questions and concerns about health care—and
mostly timely, accurately, and with good service. However, the results were
sometimes uneven, and the state is going to need to augment, improve, and better
coordinate its consumer assistance capacity as it approaches the opportunity and
challenge of health reform. That’s the finding of a
new study by Health Access, California's statewide health care consumer
advocacy coalition, which conducted a survey of over 200 “mystery shopping”
calls to four California health agencies.
Over a dozen callers posed questions to four state
health agencies on enrollment in state coverage programs, or concerns about
their coverage with private insurers. The callers rated their experience—both in
quantitative measure like the time it took to pick up the phone and reach a
customer service representative, and qualitative measures, such as the person’s
knowledge and professionalism.
With health reform being implemented over the next
few years, California needs to augment and improve its
consumer assistance capacity, so that millions of Californians are best able to
take advantage of their new options, new benefits, and new consumer
protections. The report concludes that all the ingredients are there—different
state departments have shown different strengths, and a better coordinated,
better resourced focus can provide world-class customer service--if this goal is
made a priority.
Over 200 calls were made, with 50 calls each placed
to four agencies: the Department of Insurance; the Department of Managed Health
Care; the Department of Health Care Services (which runs Medi-Cal) and the
Managed Risk Medical Insurance Board (which runs the Healthy Families program
and the Pre-Existing Condition Insurance Program). While there was some
variation between departments (who were asked different questions based on their
authority), the results were generally consistent with standards for hotlines
for Medicare and Social Security.
* State agencies averaged 10 seconds for time to
first connection, with the best agency at 7.3 seconds. In most cases, consumers
only needed to go through two automated questions response units (ARUs) to reach
a live person.
* While over 80% of the calls reached a live person,
none of the agencies met the 94% standard that Social Security sets for itself.
The average wait time to get a live person was less than 5 minutes, with most
agencies averaging at 2:20 minutes.
* Our evaluators gave their average customer service
ratings on accuracy, promptness, and knowledge a 3.7, on a scale of 1-5, with
the best departments getting a 4.3.
The report serves as a baseline to evaluate
California’s
current consumer assistance capacity, as key decisions will be made in the next
few months. This includes:
- in the state budget allocations for each of the four
departments (including those supported by federal funds and grants and by fees
on insurers)
- in Administration’s revamping of the Office of the
Patient Advocate as part of its implementation of SB922 (Monning) passed last
year, and
- at the Exchange, which will begin unveiling its plan
for their customer service call center
at their June meeting.
Many of the departments did well, showing the
positive ingredients that can be assisted. The report offers a “recipe” for
providing quality consumer assistance:
1.
Access
- consumers
should be able to reach a customer service representative (CSR) close to 95% of
the time (Model Agency: CDI)
- agencies
should answer calls quickly and ensure short hold times – the wait for a live
CSR should be no longer than 4 min (Model Agencies: CDI, MRMIB)
- agencies
should demonstrate ability to answer consumer questions without significant
delay (Models: DMHC, DHCS)
2.
Training
- customer
service representatives should be knowledgeable – score at least 4 out of 5 by
callers rating CSR Knowledge (Model Agencies: MRMIB, DMHC)
- agencies
should adopt continual training programs to keep staff informed of changes in
policy and be able to provide up to date information reflecting any changes
within 24 hours (Model Agency: MRMIB)
3.
Performance Management
- agencies
should continually monitor quality of call center operations and service (Model
Agency: CDI) – CDI has clear mechanisms in place to evaluate the quality of the
customer service their CSRs provide, with regular audits and evaluations
4. World
Class Customer Service
- agencies
should provide consumers with excellent customer service, act as advocates for
consumers, and provide warm hand offs when consumers need help from other places
(Model Agency: DMHC)
***
In other news, Assembly and
Senate Appropriations Committees have been considering and voting on a range of
bills related to implementing health reform, many of which are heading to floor
votes before the end of May. Health Access' Twitter (http://www.twitter.com/healthaccess)
and blog (http://blog.health-access.org) feature
ongoing updates on the legislative progress of this legislation and budget
items, with detailed description of policy hearings here, here,
here, here,
here,
and here.
Also, we will put out timely
updates in the next several days on blog, Twitter, Facebook, and E-mail as we
learn more about the state budget and the expectation of additional cuts in the
May Revise.
posted by Anthony Wright |
Permalink |
6:57 AM
Over 10,000 in California in PCIP...
Wednesday, May 09, 2012
At the MRMIB Board meeting today, it was announced that California's Pre-existing Condition Insurance Program (PCIP) now has over 10,000 enrollees.
It's by far the biggest PCIP of any state, as is appropriate. PCIPs were created under the Affordable Care Act, as a way to provide care to those denied for pre-existing conditions until 2014, when such behavior by insurers will no longer be allowed.
This program is ensuring Californians who need care are getting it. PCIP enrollees pay premiums, but the $761 million in new federal funds for California are crucial to keep those premiums affordable. Here's MRMIB's accounting of the care it is paying for with the federal funds under the ACA, just in the first three months of the year. That's real care that is needed--and that's real revenue to the health care system on which we all rely.
Yet another benefit of the Affordable Care Act... Labels: HealthReform, Insurers
posted by Anthony Wright |
Permalink |
10:48 PM
Another ways the high uninsurance impacts the insured...
Tuesday, May 08, 2012
Being uninsured means you live sicker, die younger, and are one emergency away from financial ruin. But we've also made the case that even insured folks face a "hidden tax" of higher premiums because of a high uninsured rate due to uncompensated care. And as medical costs are a major cause of bankruptcy, a high uninsured rate also doesn't help a community's economic stability.
Now there's evidence that a high uninsured rate also put a strain on the health care system on which we all rely--and has an impact on health outcomes and even mortality, whether we are insured or not.
The Washington Post's Sarah Kliff reports on this California-based study:
Health-care economist N. Meltem Daysal compared outcomes for insured heart attack patients in California over a six-year period, 1999 to 2006, when the state saw a 19 percent reduction in mortality rates for such cases. Across the state, however, there was huge variation in how health outcomes were improving: San Francisco and Los Angeles had decreases between 26 percent and 30 percent, while in Sacramento, the drop was just 13 percent.
Daysal wanted to know what was different about the patients in the three cities. He controlled for basic demographic information, like age and race, as well as a set of preexisting risk factors that were present at admission, like a history of heart failure or hypertension.
What he saw was cities that treated more uninsured patients seeing worse outcomes for those who came in with coverage. Daysal estimates that, if uninsurance were eliminated, there would be 3 to 5 percent fewer deaths among those who already had coverage.
What’s happening here? Daysal describes it as “negative spillover,” where the hospitals that treat more uninsured patients end up footing a higher bill for uncompensated care. That takes away resources they could be spending on hiring better doctors, upgrading medical equipments or making a whole host of investments that could improve health outcomes. Worse care, for all patients treated at the facility, ensues.
Another reason why we should be proud we have expanded coverage to over 330,000 Californians, and why we need to continue with the important work of the Affordable Care Act. As much as the new law has been heralded for its efforts to provide consumer protections or control costs, we can't forget the benefits of expanding coverage to millions of Californians and Americans--not just for those newly covered, but for the rest of us.
posted by Anthony Wright |
Permalink |
11:00 AM
A slow jam on health care?
Monday, May 07, 2012
Remember when President Obama slow jammed the news on the Jimmy Fallon show?
The actual issue he was talking about was student loans for college. Yet that issue has been slowed, and jammed up in the health care debate.
Without Congressional action, interest rates on student loans will double this summer. The GOP House leadership had previously opposed action, but shifted to support preventing that interest rate hike on college students... but paying for it by slashing critical funds for health and prevention.
As opposed to the President's proposal to fund the program by closing certain tax loopholes, Republicans want to fund this important student loan initiative by cutting $6 billion from the Prevention and Public Health Fund set up in the Affordable Care Act.
As Families USA describes, "the Prevention and Public Health Fund is already having a positive impact. It's providing training for new primary care doctors (we're currently 30,000 short) and doubling the number of smokers calling the national quit hotline. It's funding breast and cervical cancer screenings for hundreds of thousands of women, expanding opportunities for HIV/AIDS testing, and supporting suicide prevention. It's been used to fight obesity by creating a network of 600 healthy corner stores in Philadelphia and putting in sidewalks in Merced County, California, so kids can walk to school. The fund works by providing grants to states and communities for these critical preventive efforts. One in six Americans already benefits from this work to promote better long-term health."
Thankfully, President Obama and Senate Majority Leader Reid have opposed this short-sighted raid on health funds. After all, preventing disease by fighting obesity and smoking, screening for cancer, making sure kids get vaccinations, and strengthening our primary care system all saves money.Some calculate that every dollar put into proven community-based prevention programs yields $5.60 down the road.
But we need to be vigilant. And if not in this battle, the Republicans keep coming back to pick apart the Affordable Care Act--and then attack it later if it doesn't yield all the promised results. We can't let this cynical strategy be successful.
posted by Anthony Wright |
Permalink |
11:43 PM
New national attention on hospital debt collection practices..
Friday, May 04, 2012
About a week ago, the New York Times broke a major story on the issue of hospital billings and collections. It's an issue we've done a lot of work on, leading to the passage of the Hospital Fair Pricing Act in 2006, and educating pa tients about the consumer protections in California law through our website, http://www.hospitalbillhelp.org/.
But while we heard lots of horror stories about aggressive billing and collections practices by hospitals, the story of Accretive Health was new, as the company was seen as embedding debt collectors in the emergency room and at the bedside. Since then, the article in the Times has spurred other reports in radio, TV, and even the business press, as they watched Accretive's stock market position dive. We are looking into whether California hospitals have similar arrangements, getting around some of the consumer protections we put in place in California in 2006.
We are glad this story is getting national attention, and not just because we are quoted in it. For one, it provided Stephen Colbert fodder not just on health policy in general, but on the need for the Affordable Care Act as well. Take a look...
Labels: HealthReform, Hospitals, MedicalDebt
posted by Anthony Wright |
Permalink |
12:03 AM
Pedal to the metal...
Tuesday, May 01, 2012
What should California do if the Supreme Court strikes down a part (or all) of the Affordable Care Act?
It's should be a moot point, since we have confidence that the Supreme Court will follow past precedent and uphold the law in its entirety. That said, California Healthline's Think Tank asked several leaders this question, and we are gratified that HHS Secretary Dooley and the chairs of the two legislative health committees agreed with consumer groups, including Health Access, that California needed to move forward with health reform, regardless. If the court strikes the law (or a part of it), it doesn't mean the very real problems go away.
Here are all the mini-essays, for your perusal:
Diana Dooley, Secretary, California Health & Human Services Agency
State Sen. Tom Harman (R-Huntington Beach), Vice-chair, Senate Committee on Health
State Sen. Ed Hernandez (D-West Covina), Chair, Senate Committee on Health
Betsy Imholz, Special projects director, Consumers Union
Bill Kramer, Executive director national health policy, Pacific Business Group on Health
Elizabeth Landsberg, Director of legislative advocacy, Western Center on Law and Poverty
Assembly member William Monning (D-Carmel), Chair, Assembly Health Committee
Anthony Wright, Executive director, Health Access California
Labels: HealthReform, OtherBlogs
posted by Anthony Wright |
Permalink |
8:05 PM
Business, from bills to budget...
Monday, April 30, 2012
Just because the deadline for bills to pass policy committee passed last Friday doesn't mean it wasn't a busy day in the state Legislature.
As folks who follow our Twitter feed know, the Senate Appropriations Committee heard many, many bills, and even passed several health reform related measures, which were not candidates for suspense, like SB951(Hernandez), to set an essential health benefits standard for health coverage, and SB1081(Fuller) providing a new options for Tulare County to take advantage of Low-Income Health Program funds. Other bills, like SB970(DeLeon), on streamlining eligibility and enrollment for both health and human services programs, went on suspense--where its fate will decided in a few weeks, along with hundreds of other bills.
In the afternoon, the Assembly Budget Subcommittee on Health heard the Governor's budget proposals related to the Department of Health Care Services (DHCS). The subcommittee, chaired by Assemblywoman Holly Mitchell, adopted several of budget's proposals, but held most of the major cut items open, reserving judgement until after the May Revision of the budget.
Of particular note, however, the subcommittee rejected the Brown Administration's proposal to change how community health centers get reimbursed, with a bipartisan vote, as Republican Shannon Grove voted with the Democratic majority, as Democrat Wes Chesbro gave his vote "with gusto." Another rejected cut would have "locked-in" Medi-Cal enrollees into a health plan for a full year before being able to change plans. No decisions are final, however, until after the Legislature passes and the Governor signs a final budget.
Speaking of budgets, May Revise is just around the corner....
posted by Anthony Wright |
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11:58 PM
The Exchange Board Talks SHOP
Thursday, April 26, 2012
The California Health Benefits Exchange Board met today in Sacramento. The Chairwoman, HHS Secretary Diana Dooley, called the meeting to order with a moment of silence for Rick Brown, the founding director of the UCLA Center for Health Policy Research, who recently and unexpectedly passed away last week.
Peter Lee began the substance of the meeting with his Executive Director's update, which included an update on contracting and staffing. The Exchange continues to hire in order to meet the high demands of the tremendous amount of work it must accomplish in a short amount of time.
The Board did not yet make a decision related to the selection of a CalHEERS vendor yet, but that decision is expected by the May 15th meeting. Lee also said that the Board would explore partnerships with the federal government, including the possibility of using federal information technology systems to get up and running for the first few years.
Lee also provided a brief update on the work that Ogilvy and Heath have been doing related to outreach, including focus groups in Fresno and Los Angeles in English and in Spanish. One lesson of note was that the target population for the Exchange--uninsured working families from 133-400% of the poverty level live in a "culture of coping," of worrying about health care and workarounds to get care. More detailed reports on this work, as well as Heath's research about models for utilizing Assisters, will be presented in the May meeting.
The most substantive item on this meeting's agenda, however, was the landscape discussion of the SHOP Exchange, or the Small Business Health Options Program. The panelists each discussed their ideas for creating a successful SHOP Exchange from various perspectives.
Sandra Hunt of Price Waterhouse Cooper gave an overview of the SHOP planning process, including key policy considerations and decisions that needed to be made as well as the timeline by which each task needed to be accomplished. The key design considerations she highlighted included:
- Product Portfolio
- Qualified Health Plan Selection and Management
- Employer Choices
- Marketing Strategies
- Benefits Administration
- Operational Design
Many of these decisions must be made beginning in June.
John Grgurina, of San Francisco Health Plan, and formerly of PacAdvantage, California's previous small business exchange, spoke both from the plan perspective, and from the PacAdvantage perspective. He provided a number of "lessons learned". He emphasized the importance of highlighting the benefits of the Exchange, including tax credits, to the three major participants: plans, brokers, and small employers. He also warned of overestimating the leverage the Exchange would have with insurers.
John Arensmeyer, from Small Business Majority, presented the small employer perspective. Based on research that Small Business Majority has conducted, Arensmeyer recommended that the SHOP emphasize choice, customer service, and conduct thorough outreach.
Reacting to the panelists were Roxanna Bautista from the Asian & Pacific Islander American Health Forum, who spoke of the challenges faced by individuals who were self-employed and mixed-status families; and a representative of brokers and agents, who emphasized their role in facilitating coverage for small businesses.
Clearly, a great deal of thinking and hard work is going to be required in order to create a SHOP exchange that will help the small businesses and small business employees of California gain access to quality and affordable health care.
The next meeting of the Exchange Board will be May 15, 2012. Labels: Exchange, HealthReform
posted by Linda Leu |
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9:57 PM
Deadline Day in Senate Health Committee
Senate Health Committee held its deadline week hearing this afternoon. With members in and out of committee due to other committee meetings, most bills were held on call until the end of the meeting – making for a suspenseful 6pm finish.
Passing out of committee was SB1313 (Lieu) on deceptive marketing. Senator Lieu’s bill is intended to prevent deceptive marketing and other issues that might hinder Californians from enrolling in quality health coverage in 2014 as a result of the Affordable Care Act. Projections suggest that between one-third and one-half of these individuals will be limited English proficient. The bill sets a standard for marketing and representation of options and requirements of the ACA so that bad actors are not allowed to take advantage of consumers who may be confused by new provisions of the law and trick them into paying into plans that do not meet the requirements of the law. This bill is sponsored by our colleagues at Consumers Union, California Pan Ethnic Health Network, and the California Immigrant Policy Center.
Betsy Imholz of Consumers Union testified to the importance of assuring that consumers are given clear notice if they are purchasing plans that do not cover the minimum essential health benefits, which would put them at risk for tax penalties. Ronald Coleman of the California Immigrant Policy Center testified that immigrants are particularly vulnerable as they are frequently targeted based on their limited English proficiency, and their frequent reluctance to report crime perpetrated against them and the high need for health coverage in these communities.
Some Senators wanted additional amendments, but moved the bill forward for the time being. The bill passed out of Health Committee with Senators Hernandez, Alquist, DeLeon, DeSaulnier, Rubio, and Wolk voting in support.
Also making it out of Health Committee and moving on to Appropriations is SB1431 (DeLeon). Senator DeLeon’s bill, sponsored by the Department of Insurance, seeks to better regulate “stop-loss coverage,” which is offered to those employers that self-insure their workers. For small businesses, this can be a risky proposition, and so this bill protects consumers in the small group insurance market, and protects the market from instability and adverse selection.
Another bill successfully moving forward is SB1487 (Hernandez), Senator Hernandez’ bill which is intended to, in the author’s words “signal the legislature’s intent to enact any measures necessary to implement the ACA” no matter what happens on the federal level because of the millions of Californians already benefiting from federal health reform and the millions more that are waiting. The bill also extends Medi-Cal to former foster youth up to age 26 – while the federal law and previous state legislation give parents the right to cover their children on their insurance policies up to age 26. This bill passed out of Committee along party lines.
SB1195 (Price) establishes new standards surrounding the audits of pharmacies by pharmacy benefit managers. Proponents of the bill testified that they are interested in ensuring that audits can continue but in a more fair way. Opponents testified that the bill would make it difficult for purchasers such as pharmacy benefit managers to detect fraud and abuse and work to save money for their clients, and the health system in general. Health Access joined unions, insurers, and other purchasers of health care in opposing this bill, but the bill passed out of Senate Health and moves on to Rules Committee.
Two measures did not proceed:
SB1373 (Lieu) did not garner enough votes to move out of committee. This consumer group-supported measure would have required hospitals to provide notice to consumers to inform them that the care they are receiving might involve out-of-network providers and that they should contact their health plan about additional costs. It was opposed by hospitals and other providers, and Chairman Hernandez did not support it, saying it was not ready to proceed.
SB1320 (Harman) purportedly addresses health care access issues by defining and legitimizing “retainer practices,” also known as “concierge medicine,” where doctors require up-front annual payments to be seen. While these practices give consumers the option to pay physicians directly for primary care, they do not have to provide access to any other necessary medical services. These practices also give consumers the impression that their health care needs are covered, but are exempt from regulatory oversight. Senator Alquist vocalized opposition to the bill, expressing concern that the lack of regulation would mean patients would have no recourse if they encountered fraud or discrimination. Senator Hernandez also highlighted a concern that this would rob the regular insurance pool of needed primary care physicians. SB1320 failed.
With that, all of the bills that will move forward this year have moved out of the first policy committee. Most of these bills move on to Appropriations Committee in the following weeks.
For a refresher on the legislative process in California, check out this handy guide to How a Bill Becomes a Law in California.
posted by Linda Leu |
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8:53 PM
Measure Protecting Consumers From High Out of Pocket Costs Passes Assembly Health
Wednesday, April 25, 2012
Assembly Health Committee considered AB1800 today, a bill by Assemblymember Ma, which would help cap health care costs for ten million Californians with insurance, who are going into debt and facing tough economic choices between health care and costs of daily living. Over 1.9 million Californians paid $3 billion dollars above and beyond their out of pocket maximums in 2011 alone.
Melanie Rowan, a resident of San Francisco, spoke about what this has meant to her family. Ms. Rowan suffers from Multiple Sclerosis, and just one medication she needed to maintain her functions of daily life and care for her family cost her over $800 per month. Ms. Rowan spoke of going into credit card debt in order to feed the “bottomless pit of health care expenses” and living in relentless fear of fluctuating costs and uncertainty about when she would ever be able to dig her way out of debt. This bill will implement limits on out of pocket costs that are part of the Affordable Care Act. Further, the bill provides consumers with a better understanding of how much their insurance plan will require them to pay out of pocket by consolidating deductibles into one single deductible.
In urging support from Committee members, Assemblymember Ma called affordability an essential part of the momentous health care reform legislation. No longer should Californians have to choose between paying for groceries to feed their families and the care necessary to preserve their own health.
AB1800 (Ma) passed with 12 votes and moves on to consideration by the Assembly Appropriations Committee.
Another health reform-related bill that was discussed was Assemblymember Gordon’s bill AB1846 related to CO-OPs, a new form of health plan allowable under the Affordable Care Act. Consumer advocates nationally and here in California have been concerned that such CO-OPs could circumvent requirements placed on other insurers, including ones that the state or the Health Benefits Exchange put in place to benefit California consumers. Assemblymember Gordon agreed in concept to amendments (including those proposed by Health Access California) to create a regulatory context to ensure that should a CO-OP come to California, there is adequate oversight and consumer protection. With amendments taken, the bill passed without opposition.
The Committee also heard AB1553 (Monning) related to the transition of seniors and persons with disabilities to Medi-Cal managed care. The bill addresses some serious issues that have arisen from past budgetary action that required this transition. Some individuals with serious medical conditions, and who have relied upon specific providers to manage these conditions under a fee for service model, have had difficulty maintaining continuity of care during the transition. They will, under this bill, be able to receive a temporary exemption from the managed care requirement, as a needed consumer protection. AB1553 moves forward to Appropriations.
The most contested bill of the hearing was AB1742(Pan), requiring health plans to accept assignment of benefits in PPO health plans when consumers go out-of-network. The bill was sponsored by the California Medical Association and opposed by insurers and Health Access California representing consumer groups. Chairman Monning sought significant amendments, as did Health Access, to require disclosure to consumers on estimated prices, to put limits on the financial exposure to consumers, and to ensure that the bill did not endanger existing consumer protections against balance billing. Given that the author and sponsor did not accept many of the amendments, Chairman Monning recommended a No vote. The bill got 8 votes, which was not enough to proceed.
Today was the last Assembly Health Committee hearing before the deadline to pass policy committee. Tomorrow, the Senate Health Committee also hears a range of bills related to health reform in it's deadline week hearing.
posted by Linda Leu |
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9:48 AM
Preventing the "bottomless pit" of out-of-pocket costs...
Tuesday, April 24, 2012
This afternoon, the Assembly Health Committee heard AB1800(Ma), a bill to cap out-of-pocket costs, as part of the implementation of the Affordable Care Act, which Health Access California is co-sponsoring with the Northern California MS Society. Here's the powerful testimony of one of the witnesses in support:
My name is Melanie Rowen, I live in San Francisco and I have MS. To prevent my MS from progressing, potentially causing serious disability in my future, I need to take one of the very few MS drugs available.
When I first called to order my medication, I learned that my insurance plan required me to pay 30 percent of the price - my monthly cost for that one medication alone ended up averaging about $800. And that was only one of my medical expenses.
I couldn't afford it, but I went into credit card debt to pay for it anyway, because my neurological function is so important.
Worse than the debt, though, was the relentless fear about how far this would go - the price of my medication fluctuated, and every year I had no idea how much more I would end up paying or when or how I would be able to dig myself out of the red. The constant stress and uncertainty was the last thing I needed when I was supposed to be focusing on staying healthy.
If AB 1800 had been in effect, my whole life would have been different - I would have been able to count on medical expenses of $6k per year and no more, instead of the basically limitless costs I faced. For now, my story has a happy ending because I changed jobs and now work for the UC system, where I can get insurance that covers my costs predictably, at a level I can afford.
But without AB 1800, there is no security for the thousands of Californians, particularly those living with chronic diseases like MS, who still face a bottomless pit of health care expenses in a market in which they have no bargaining power. I urge the Committee to pass AB 1800.Labels: Affordability, Insurers, Legislation
posted by Anthony Wright |
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3:20 PM
A Big Loss: Rick Brown, RIP
Monday, April 23, 2012
Rick Brown, the founding director of the UCLA Center for Health Policy Research, was giving a talk in Louisville, Kentucky last week when he suffered a major stroke unexpectedly.
It was an honor to help celebrate his career in a February 8th symposium at UCLA--which he reminded me was not his retirement. While he was stepping down as the head of the Center, he planned to continue to teach, and to lead the other institution he founded and built--the California Health Interview Survey (CHIS), the definitive source for health research data in our state. He was passionate and working to the end.
We'll all miss Rick (even those who don't know him), as a researcher who provided good answers to the right questions, about coverage and care, health and wealth. Even after AskCHIS, there was AskRick, and he was always excellent at providing the answers, in a long policy report or brief (many of which live on my desk for easy reference), or in a short quote in the newspaper (we regularly sent many reporters needing an authoritative source for a number to him and the Center). Rick succeeded at being both a good academic, and a good advocate--actually informing the policy debate in Sacramento to the benefit of all Californians.
Rick supported Health Access and our work not just professionally with his research but personally with his guidance and friendship. For many of our organization's earlier years, he even chaired the Health Access Foundation board. He contributed and always inquired about how we all were doing. There's so much to thank him for. It's sad to think I won't see him again on a panel describing the impacts of health policy reforms, in the halls of a conference beaming about his family, or in a CHIS meeting going over the questions for the next two years (and how they can get funded).
After he saw his close friend Paul Wellstone also die too young, and various efforts at health reform in California stall, I am just glad he got to see President Obama (who he advocated for) pass the Affordable Care Act. Rick would have been as anxious as anyone, on pins and needles, about the Supreme Court decision and the presidential election. It's up to us to fulfill the promise that he worked so hard on.
To share your memories of Rick's life and achievements, his colleagues at UCLA have set up a memorial website where you can do so: www.rememberingrick.com.
If you would like to send private condolences, flowers or other commemorations to Rick's family directly, they can be reached at:
Marianne Brown
1348 Hill Street
Santa Monica, CA 90405
Marianne.P.Brown@gmail.com
posted by Anthony Wright |
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6:13 PM
Busy week, legislatively and administratively
HEALTH ACCESS UPDATE
Monday, April 23, 2012
BUSY WEEK AHEAD IN CALIFORNIA HEALTH REFORM IMPLEMENTATION
LEGISLATIVELY AND ADMINISTRATIVELY
* Health Committees pass major bills to set an essential health benefits standard, reform the individual health insurance market, and more.
* Legislative committees head into deadline week with other health reform implementation bills pending, including bills to cap out-of-pocket costs, and prevent deceptive marketing.
* Department of Health Care Services briefs stakeholders on Medicaid waiver, Low-Income Health Programs, eligibility and enrollment, and other health reform implemention efforts.
* Health Benefits Exchange holds Thursday board meeting, with a focus on small business.
Read Our Health Access Blog for More Updates; Also Follow Us on Facebook!
Read Real-Time Updates on Legislation on Twitter @HealthAccess!
If You Appreciate These Updates, Join/Renew Your Health Access Membership!
This upcoming week showcases the diversity of work being undertaken by California to implement and improve the federal Affordable Care Act, both legislatively and administratively.
KEY BILLS PASSED: In the last few weeks, the Assembly and Senate committees have passed key bills related to health reform, including two to set a standard for essential health benefits for health insurance, and two others to reform the individual insurance market and ban the practice of denying care to those with pre-existing conditions.
Health Access' blog ( http://blog.health-access.org/) features full reports on each of the past several hearings of Assembly and Senate Health Committees: in March in the Assembly, and in the Senate, in April when the committees passed the essential health benefit bills, and also legislation on wellness programs (in the Assembly) and bills to streamline enrollment for health and human services (in the Senate), and finally last week, with the individual market and other bills in the Assembly, and then in the Senate.
In addition, the blog also has a report on last Monday's Assembly Budget Subcommittee on Health, which heard the Governor's proposal on the future of the Healthy Families. The committee did vote to approve only the portion of the proposal to directly implement health reform, approving a shift of those children at or under 133% of the poverty level from Healthy Families into Medi-Cal. Other issues were tabled.
DEADLINE WEEK: Health Committees will be busy this week, the final week for bills that were introduced in 2012 to pass out of the first policy committee, by April 27th.
Related to health reform implementation are bills like AB1800(Ma), to put in place the ACA's cap on out-of-pocket costs and other consumer protections, pending in Assembly Health Committee on Tuesday. Another measure of strong interest is SB1313(Lieu), to prevent deceptive marketing practices, up for a vote in Senate Health Committee on Wednesday. Several other measures--including ones that raise concerns and even opposition from consumer advocates--are also pending.
A list of the many bills that are pending to fulfill the promise of the federal health reform is available on the Health Access website, including those that have already advanced part-way through the legislative process last year.
DHCS AND EXCHANGE MEETINGS: The work of health reform implementation is not just in the legislature--in many areas, the main action is administrative, at the Department of Health Care Services and the Health Benefits Exchange, as well as elsewhere. Stakeholders, including health, consumer, and community groups, will get public briefings this week on the progress of health reform in California
The Department of Health Care Services has expanded the scope of their Stakeholder Advisory Committee, originally focused on the Medicaid waiver, to include all aspects of health reform implementation. The Committee meets nearly all day Monday, April 23rd, with briefings on Low-Income Health Programs, the transfer of seniors and people with disabilities into managed care, eligibility and enrollment , and DHCS' relationship with the Exchange. Meetings are public, with a limited opportunity for public comment at the end.
The Exchange will have its own board meeting and forum for providing public updates on Thursday, April 26th, and accepting public comments, both in person and over the phone/webcast. On the agenda includes an update on Exchange planning, and a more in-depth review of the development of the small business health exchange. Meetings are public.
Here's a quick preview of the upcoming week:
Monday, April 23rd, 10:00am-3:30pm
* Department of Health Care Services, Stakeholder Advisory Committee
Sacramento Convention Center
Public listen-only call in number: 1-877- 953-7991; Participant Code: 6532559
* The agenda includes reports on Medicaid waiver and health reform implementation issues, including targeted discussions on presumptive eligibility and provider gateways, Low-Income Health Programs, and transitions seniors, people with disabilities, and dual-eligibles into managed care.
Tuesday April 24, 1:30pm
* Assembly Health Committee
Meetings are held in Room 4202 of the State Capitol.
* Among the pending bills is AB1800 (Ma), sponsored by Health Access California and the MS Society, to limit cost sharing for consumers, and creates a single deductible so that consumers do not have to meet separate deductibles for health care, pharmacy, etc.
Wednesday April 25, 1:30pm
* Senate Health Committee
Meetings are held in Room 4203 of the State Capitol.
* Among the pending bills is SB1313 (Lieu), sponsored by California Pan-Ethnic Health Network, California Immigrant Policy Center, and Consumers Union, which seeks to prevent efforts to mislead consumers, as health care reform brings more options to consumers.
Thursday, April 26, 12:30pm open session
* Health Benefits Exchange, Board Meeting
Employment Development Department, 722 Capitol Mall
* The meeting is webcast. The agenda includes a reports on personnel, legislation, contracting, federal exchange regulations, and overall Exchange planning. There will also be a more specific panel of presentations on the planning for the small business Exchange.
Labels: Exchange, Legislation, MediCal, Updates
posted by Anthony Wright |
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8:30 AM
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