It's a little dizzying watching the Republican presidential debates. And no more so than watching Mitt Romney talk about his biggest achievement in Massachusetts, health reform.
Of course there are some differences in the details--as would be expected when a state does something, versus the federal government. But the framework is pretty similar. And understanding the similarities totally undermines the overheated rhetoric by many Republican officeholders about how the federal law is an abomination and must be repealed.
It is a reminder that the Affordable Care Act was a bipartisan framework for dealing with health care reform, before Republicans opposed reform for purely political reasons.
Governor Romney can't even talk about his law in Massachussetts without mirroring the rhetoric of Affordable Care Act defenders, including President Obama. See this as well:
The Exchange Board met today for the second time this month, this time with a specific focus on the Essential Health Benefits. The Essential Health Benefits (EHB) are the minimum floor for what health insurance plans must cover, this is a key provision of the Affordable Care Act, which is intended to protect consumers from underinsurance and junk insurance. The federal government recently released a bulletin detailing an intended regulatory approach by which states are to select a reference plan, a plan that represents the scope of services and limits that all plans will be required to cover. The bulletin did not discuss cost-sharing and did not, at this time, lay out a specific EHB package.
The Board heard presentations from consultants and staff that provided background on the issue. The Exchange will be sending comments (in conjunction with the Department of Health Care Services, the Department of Insurance, the Department of Managed Health Care, and the Managed Risk Medical Insurance Board) to the federal government in response to the bulletin next week. You can see the draft comments here. The Exchange Staff summarized their comments into five overarching themes:
It is important to move toward a national standard.
It is appropriate to start by using each state’s employer-based benchmarks.
Appreciate the state flexibility during the 2 year transitional period.
The Exchange is concerned that carrier flexibility could undermine ACA’s goal of letting consumers better compare plans and makes it difficult for regulators as well.
The Exchange agrees with need for a separate guidance for Medi-Cal.
When the Board invited public comment on the Exchange’s comments, the line extended all the way to the auditorium’s back doors.
Key issues that were raised by consumer advocates include:
Need for clearer language around the issue of adverse selection and protections to prevent it.
Strong concern with the detrimental consequences of carrier flexibility.
Need for a eventual strong national standard that does not diminish California’s current standards, and a clear process to achieve this in 2 years.
Moving forward, the Exchange will be incorporating some of the stakeholder comments into their comments, which will be submitted to the federal government next week. Additionally, they will be asking for clarification on a number of issues that were not explained in detail in the bulletin, for example, when formal regulations will be released. Then, the board will move forward on selecting the appropriate benchmark plans to serve as the state’s Essential Health Benefits.
Peter Lee also provided an update on the CalHEERS solicitation. The second part of the solicitation was released today, which included model contracts, cost schedules, and updated program metrics.
The next meeting of the Exchange Board will be February 21, 2012.
Assembly Moves Health Bills Forward, Single Payer Falls Short in Senate
The California State Assembly passed 3 health related bills today.
AB 70 (Monning) would bolster the state's ability to respond to and secure prevention funding. This bill is important in ensuring that as we do the work to implement the Affordable Care Act, we are doing so with an eye toward promoting health and preventing illness, which will be essential to lowering health care costs in the long term.
AB 154 (Beall) would require private insurance to cover mental health and substance abuse, moving toward equity in the coverage of physical and mental health. Currently, those private insurance plans that do cover mental health and substance abuse are restrictive, forcing individuals to seek care through public programs, and resulting in a huge cost shift to state and local government and the taxpayers.
AB 441 (Monning) requires health impacts to be considered as part of regional transportation planning. The health of our communities are greatly impacted by broader public policy processes and including health impacts as part of the conversation in other policy discussions is going to be essential to improving the health of the most marginalized communities.
All 3 of these bills now go to the Senate, where they will move through the Committee process before hopefully coming up for a vote on the Senate floor.
The Senate took up SB 810 (Leno) today, which would guaranteed universal single-payer health care for all Californians. The bill garnered 19 votes, 2 shy of those needed to pass out of the Senate. The measure was granted reconsideration, which means it can be voted on again before the January 31st deadline. Senators Padilla, Rubio, Vargas, and Wright abstained, please call them and urge them to support SB 810.
The extended interview (posted on the web) goes into even more depth--actuarial value is discussed! Although in fairness, that term prompted an apology from Secretary Sebelius, and caused Jon Stewart to mock-fall-asleep.
Jon Stewart seems overly cynical. While there's certainly has been areas where the implementation of the law hasn't gone as far or been as complete as we would like it to, his assumptions start with the negative--even chastising the audience for being positive about some of the benefits. And the area where he questioned the most--the medical loss ratio, what Secretary Sebelius calls the 80-20 rule, to ensure than premium dollars go to patient care rather than administration and profit--the Administration has actually held up firm, despite a withering lobbying assault from insurers, brokers, and red states. Secretary Sebelius was right--they have rejected most waiver requests, and upheld a solid definition despite attempts by many to exclude brokers fees.
But the conversation is worth watching--Secretary Sebelius knows her stuff, and has the polish of someone who's been a Governor and an Insurance Commissioner, and I doubt any news program on any commercial network has had a conversation this detailed--and none with some laughs thrown in as well.
I thought, talking to Capitol Public Radio, it was a missed opportunity, when talking about the "make-or-break moment for the middle class," to incorporate the huge need to have the economic security that comes with coverage you can count on. And a missed opportunity to talk about the progress that has been made in that regard, from the 2.5 million young adults who now have coverage, to the millions more who have new consumer protections.
President Obama did reference those benefits: "I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny your coverage, or charge women differently than men."
But she agrees with those who were disappointed, like Aaron Carroll and Austin Frakt in JAMA, that regardless, health care will--by necessity--be a major topic through the rest of the rest, in Congress, the courts, and yes, the campaign.
Last week, in the State of the State, Governor Brown gave a poignant speech on California, it's past, and it's promising future. He focused on other issues, but if he wanted, he could have Incorporated health care, and the progress that California is making in implementing the Affordable Care Act, into his narrative about the state's renewal. We certainly have problems, but we are on a path to progress.
My guess is that President Obama will take about health care.. Not just health reform, but Medicare and Medicaid, certainly in the context of the budget. But given the President focus on the economy, it would be strange if he didn't touch on the need for a health system that provides families some financial security in the middle of these economically uncertain times.
Several California advocates are here, as is Peter Lee, executive director of the California Health Exchange, who just spoke at a plenary this evening. (we live tweeted both presentations, and more...) I wanted to spotlight Sebelius' speech, because it laid out the work of the next year. Here's just an excerpt:
In fact, I believe that over the next few months, we’ll see the biggest barrage of attacks and misinformation about the law that we’ve seen yet. The law’s opponents are going to take their best shot. And the reason why is that they know that the facts are not on their side.
When the health care law passed, they predicted everything short of Armageddon. But today, we can simply look at the facts. Instead of the economy crashing, we’ve had steady job growth, with health care leading the way. Instead of Medicare crumbling, seniors have seen their premiums fall even as they enjoy key new benefits. Instead of providers rebelling, we’ve seen an unprecedented wave of interest in the new tools the law gives doctors and nurses to improve care.
The law’s opponents are going to step up their attacks because they can see their window to attack is closing. At the same time, the upcoming anniversary of the law and a Supreme Court Decision will put a new spotlight on the law in the coming months. That makes those next few months critical. And if we want to come out of them in a stronger position than we are now, we need to do two things.
First, we need to educate people about the law. After two years of smears and misinformation, there are still far too many Americans who don’t know the basic facts about the law and the benefits available to them. There are too many seniors who are still putting off that colon cancer screening because they don’t know they no longer have to pay a co-pay. There are too many parents who are still worrying because they don’t realize that insurance companies can no longer turn away their children with pre-existing conditions. There are too many small business owners who aren’t aware that they’ll soon be able to band together to negotiate the same low rates as large employers.
In particular, we need to let people know about the parts of the law that can help them right now. The more we educate people about this law, the more they’ll be able to take advantage of its benefits. And the more they take advantage of its benefits, the harder it will be for the law’s opponents to take those benefits away
Second, we need to make sure those benefits reach people by continuing to implement this law as effectively as possible. As you know, the law gives states lots of flexibility to tailor reforms to their own needs, starting with the Exchanges. As a former Governor, I believe this is one of the law’s strengths. And our department is working hard to make sure states have the resources and support they need so that even as they take different paths, they all end up in the same place: with a health insurance market that finally works for consumers.
Today, we are at a make or break moment. On the one hand, we have the most important health legislation since Medicare and Medicaid. On the other hand, we have an opposition that wants to get rid of the law – and then dismantle Medicare and Medicaid along with it.
In the last year, we’ve seen the House pass a proposal that would cut Medicaid spending in half over the next decade, slashing funds for seniors in nursing homes and the poorest moms and kids. And they’ve put forward an even more extreme approach to Medicare that would replace guaranteed benefits with a voucher seniors can use to negotiate with insurance companies. Their claim is that this will help bring down costs, but we’ve already tested this theory with the Medicare Advantage program. It doesn’t work. Instead, we have higher costs and no improvements in care.
We can’t turn back. Not now. And as the calls for repeal get louder in the months to come, we need to remember exactly what the status quo they want to return to looked like. In the decade before the health care law passed, our health insurance market was crumbling. Tens of millions of Americans were locked or priced out of the market. Premiums were rising three times faster than wages. Employers were either shifting more of that burden onto families or dropping coverage altogether. And at the same time, there was little improvement in our overall health, even as health care spending rose to more than a sixth of our economy by 2010. The system was bad for families. It was bad for business. And it was bad for our economy.
The Executive Director’s report included an update on two solicitations that were released in December. The first was a $900,000 RFP for Communication Support, Research and Marketing, Outreach and Education. This is contract will be responsible for the development of a statewide marketing, outreach and education strategy; planning and implementing the initial marketing and communications, and branding for the Exchange; and developing a plan for implementing an assisters program. The second, a $600,000 contract is for health plan management and the development of criteria for Qualified Health Plans and Delivery System Reform. Proposals are due on January 30, 2012 for both of these solicitations, and both programs will begin on March 1, 2012. The Exchange, DHCS, and MRMIB is taking comments on both solicitations and will engage in a stakeholder process, especially on the Qualified Health Plan RFP. They had earlier engaged in a stakeholder process on outreach and enrollment.
The staff then presented an overview of the CalHEERS IT solicitation, which was released last month. The Exchange received over 1300 comments on the draft solicitation in the short comment period at the end of December. Many of these comments were incorporated in the final RFP, which will be released tomorrow. It will be a 2-part release, with contracting and financing documents as well as SHOP estimates being released on January 26, 2012. A contract is expected to be awarded in April, and the system will need to be ready on July 1, 2013. Part of the presentation was also intended to include estimates of the number of people that would actually be in the Exchange. UC Berkeley and UCLA worked with key experts in health care microsimulation modeling to refine these projections. Currently, they project that between 57% and 70% of those eligible will enroll, but more refined projections will be released shortly.
One thing that will be handled separately from the CALHEERS IT solicitation was the service center component that involves how the state will integrate the mail, in-person, and phone enrollment that is required by the ACA. Staff clarified that this portion will be considered as part of a process for service center planning that will begin on February 15 with the release of an inventory report. Between February 15 and February 28th, stakeholders will have the opportunity to comment on service centers, and the planning will be completed in April.
The next meeting of the Exchange will be on this coming Thursday, January 26th, open session is expected to begin around 12 noon and the Board will be discussing comments to the Federal Government related to the Essential Health Benefits. The Exchange seeks comments on the Essential Health Benefits, preferably in the next few days.
Tonight! Tune in to KCET as "Your Money Your Life" Discusses Medical Debt
Friday, January 13, 2012
Tonight's "Your Money Your Life" will discuss the issue of medical debt and how some Southern California residents are coping. You'll see Health Access' own Anthony Wright in the story. While health care reform seeks to eliminate some of the insurance company practices that cause medical debt, until 2014, this continues to be a devastating problem for many Americans.
The program airs tonight at 9pm, but you can watch a preview now on the KCET website.
If you or someone you know has medical debt or hospital bills you can not pay, please visit www.hospitalbillhelp.org to learn more about medical debt and the laws governing hospital fair pricing.
Here's a new video by our colleagues at Families USA, on what the federal budget fight actually means for people, and what the stark choices are:
Many health consumer advocates will be at Families USA's Health Action conference next week. You can read our tweets from the plenaries at @healthaccess, and we'll post reports here as well.
In the last two weeks, we saw Mitt Romney win the Iowa and New Hampshire primaries, and in both of his election night speeches, Romney cited the speeches of President Obama, four years earlier, in those states.
This prompted me to actually watch the President's speeches again from Iowa and New Hampshire.
And while much of the speeches were the poetry of that campaign, about hope and change, it was also notable to remember what policies were noted. It's a useful accountability moment, to both note that some of the goals cited by Obama have been accomplished, like ending the Iraq war, and others where there's clearly more work to do--such as action on climate change.
But was was also notable, way back when, was how prominent was the goal of health reform. It's a useful reminder to remember that President Obama campaigned on health care issues actively in 2008--both in the general election, and even in primaries--even when consultants told him it wasn't an issue that helped him, since his rival Hillary Clinton had so much credibility and goodwill on the issue herself. It also undermines those who claim that the "Affordable Care Act" was rushed into passage: it wasn't just that it took over a year of excruciatingly detailed debate--it was one of the main plank and platforms of the campaign.
Now we are embarking on a new campaign, where health care will again be a key issue--not just on the Affordable Care Act, but on Medicare and Medicaid. And once again, there'll be an opportunity for an accountability moment.
The real problem with "I like being able to fire people..."
Tuesday, January 10, 2012
Presidential candidate Mitt Romney is getting unwanted attention for his recent quote, "I like being able to fire people..." The campaign of rival Rick Perry has even made it into a cellphone ringtone.
Whatever the context, the problem for Romney is that the quote reminds people of his career as a corporate raider as head of Bain Capital. The full quote is actually about health policy, but the specific substance doesn't get any better for candidate Romney:
What the quote says: “I want individuals to have their own insurance. That means the insurance company will have an incentive to keep people healthy. It also means if you don’t like what they do, you can fire them. I like being able to fire people who provide services to me. If someone doesn’t give me the good service I need, I’m going to go get somebody else to provide that service to me.”
Candidate Romney said this after an unfactual swipe at "Obamacare," that somehow the Affordable Care Act would impose a health plan on individuals. In fact, for many Americans it will give them more choices--and more importantly, more affordable choices.
As Jonathan Cohn in The New Republic indicates, in order to get those choices presented, you need some clear market rules--regulations that the GOP presidential field has largely opposed.
As the Incidental Economist notes, the issue right now is that many people can't fire their health insurer (they can't get coverage if they are already sick), and that insurers don't have a strong incentive to keep their patients healthy (not compared with the incentives of simply avoiding people who need care.) The Affordable Care Act, which Romney wants to repeal, would actually go a long way to change this.
As Igor Volsky at ThinkProgress pointed out, the larger argument by Governor Romney was that it was good for people to pay *more* in health costs. But so many are already paying so much more, and are looking for relief from those costs, which provide a significant barrier to getting care.
Given Governor's Romney history on health issues, these aren't idle remarks. Let's hope there's more discussion about the health policy implications of Romney's "I like being able to fire people" quote.
On the website of the California Health Benefit Exchange, you can now check out the just-updated agenda for the January 17, 2012 Board meeting is posted to the Exchange's website.
In addition the the regular administrative and contractual updates, there will be discussion on the CalHEERS IT RFP. Another discussion topic will be on the potential enrollment in the Exchange.
Finally, the Exchange has announced an additional meeting on January 26, 2012, which will focus on the recently released federal bulletin regarding essential health benefits.
GOVERNOR PROPOSES STATE BUDGET WITH MORE UGLY CUTS TO HEALTH AND HUMAN SERVICES
* $842 Million Cut to Medi-Cal, including cuts to clinics, hospitals, and the shifting of "dual-eligible" seniors & people with disabilities to managed care plans; * $152 Million Cut to MRMIB, including a 25.7% cut to Healthy Families managed care plans that cover 875,000 children * Steep cuts to California's health and human services, even if voters approve revenues in November; Without revenues, it gets worse
SACRAMENTO-- Governor Jerry Brown today announced a 2012-13 California state budget, with $10.3 billion in additional cuts and revenues to address the ongoing deficit.
The majority of the $4.2 billion in proposed cuts are to health and human services, most notably Medi-Cal and CalWORKS. The budget also assumes the passage of a November 2012 intiative to raise revenues--but if voters do not approve those taxes, then another $5.4 billion in cuts to education and public safety would be triggered.
The Governor noted the severity of the proposed cuts in his press conference: "This is not nice stuff...It's not a pleasant path. It's not wine and roses. It's a prickly path."
The cuts of more than $1 billion in health services range from Medi-Cal to Healthy Families, from clinics to hospitals. Of particular note, the proposal would cut Healthy Families managed care plan rates by 25.7%, impacting access to care for over 875,000 children. The budget shifts 1.4 million vulnerable seniors and people with disabilities into managed care, when advocates have raised issues about access and continuity of care.
These cuts are on top of major health reductions in recent years, from the elimination of dental and other benefits, and cuts to doctors and hospitals directly, all impacting the millions of Californians with Medi-Cal coverage, and the health system on which we all depend. The cuts are poorly timed, in an economic downturn when these safety-net programs are even more in demand; when the local and state economy needs these dollars, and the federal matching dollars than would also be losts with these cuts; and when the state is attempting to get ready to take advantage of the benefits of health reform. Cuts to health and human services impact not just low-income California families, but our economy, and our health system.
The Governor is proposing these cuts for the 2012-13 budget, which is slated to be approved in June, but he is seeking early approval, in March, of some of the cuts. He spent most of his press conference talking about the need for California voters to pass revenues to balance these cuts with revenues, and his plan to place an initiative on the ballot with temporary taxes to prevent further cuts.
The proposed health cuts in the Governor's budget include:
* SHIFT OF "DUAL-ELIGIBLES" TO MANAGED CARE: This would shift 1.4 million low-income seniors and people with diabilities who get both Medicare and Medi-Cal (so called "dual-eligibles" of "Medi-medis") into managed care. Advocates have raised issues about patient populations that have already been shifted, and how access and transition problems would impact this particularly vulnerable population. Budget year savings: $678.8 million general fund.
* OTHER MEDI-CAL CUTS: This includes reducing laboratory rates, and no longer paying for certain services of "limited benefit." Budget year savings: $75 million general fund.
* COMMUNITY CLINIC CUTS: This would change payments to Federally Qualified Health Centers (FQHCs), for a reduction of $27.8 million general fund.
* HOSPITAL CUTS: This includes a one year "redirection" money allocated for public and private hospitals of $42.9 million general fund.
* MEDICAL THERAPY CUTS: This would reduce eligibility in the Medical Therapy Program, for families with incomes above $40,000/year. $91 million general fund.
* CHILDREN'S COVERAGE CUTS TO HEALTHY FAMILIES: The proposal would reduce Healthy Families managed care plans by 25.7 percent (to align with Medi-Cal rates), 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.) Budget year savings: $64.4 million general fund.
* AIDS DRUG ASSISTANCE PROGRAM (ADAP) CUTS: The budget would increase prescription drug cost-sharing, so patients would pay on average from $28 to $385 a month. Net savings projected of $14.5 million general fund.
The Governor proposes to enact these cuts regardless of the result of a November initiative to raise tax revenue. However, the failure of a revenue measure in November would lead to greater pressure to make even additional cuts in all areas, including health care, in the future.
Troublesome long-term trends... and troubling untruths from a legislator...
The Los Angeles Times had a good story today by Marc Lifsher, about disturbing trends in health care, both in terms of costs, in terms of employers no longer offering coverage to their workers, and about the shift of costs to workers.
The California Health Benefits Survey showed:
* Since 2002, family premiums rose 153%, more than five times the 29% increase in California's inflation rate. * The proportion of California employers offering coverage declined from 73% to 63% in the last two years. * Annual premiums were higher in California than nationally for individual coverage ($5,970 versus $5,429) and family coverage ($15,724 versus $15,073). * However, the employer contribution in California is significantly higher than the national average. Employers in California contributed $5,213 annually for single coverage and $11,921 for family coverage. * Workers at small firms were much more likely to cover at least half of the premium for family coverage than workers at large firms. * Workers at small firms with a deductible of $1,000 or more increased to 27% from just 7% in 2006.
These are long-terms trends, that just got worse during the economic downturn. As agreed by both myself and the head of the health plan association in the article, the light at the end of the tunnel is health reform, especially those provisions that go into effect in 2014.
What's even more outrageous that simply making stuff up, is that Rep. Camp cites the article (and me!) that makes exactly the opposite point: that the Affordable Care Act is the remedy, not the cause, to these worrying trends.
It's one thing to make up facts, it's another to just make the exact opposite point of the article he cites. Ridiculous.
Happy New Year! With the Legislature back in session today, Governor Brown has scheduled his release of the California State Budget on Tuesday, January 10th, at 9am.
As always, we'll tweet the health highlights @healthaccess, and post an analysis here later in the day.
We are bracing for the budget news, including to health and human services. We know the Governor will lay out billions of dollars of cuts. While some cuts, likely to education and public safety, will be triggered if voters reject revenues on the November ballot, the Governor will seek other cuts regardless in order to solve the remaining shortfall. It won't be pretty.
Enjoy the happy new year for the week we have left.
Happy New Year! A calendar of lots to do in 2012...
Friday, December 30, 2011
HEALTH ACCESS UPDATE Friday, December 30, 2011
Happy New Year! 2012 CALENDAR: MANY OPPORTUNITIES FOR POLICYMAKERS AND VOTERS TO IMPROVE OUR HEALTH SYSTEM IN THE NEW YEAR Please Consider Health Access Foundation in Your End-Of-Year Giving
Beyond What We Did Together This Year, There's A Full Calendar of Work to Do: * Expand Coverage to Californians in County-Based Low-Income Health Plans * Win the Revenues Needed to Support Health, Education, and Other Vital Services * Get CA's Exchange, Our New Health Insurance Marketplace of the Future, Ready for Reform * Make It Law That Insurers No Longer Deny Or Discriminate Based on Pre-Existing Conditions * Put In Place Maternity Coverage Requirements and Other Essential Benefits * Defend Health Reform in the Courtroom and on the Campaign
Make the 12/31 Deadline and Contribute to Health Access to Help: * Fight Budget Cuts, and Win the Reforms and Revenues to Sustain Our Health System * Implement *and* Improve Health Reform in California * Advocate and Organize for Consumers with Policymakers, the Press, and the Public
SACRAMENTO-- The new year of 2012 will be a major year for health care, as policymakers and voters are set to make key decisions on health policy throughout the year.
Policymakers and voters have the opportunity in 2012 to greatly improve the health care system that we all rely on. Californians will have an opportunity to demand a balanced solution to our budget crisis that brings in the revenues needed to sustain health, education, and other vital services. California will also continue to implement and improve upon the federal health law that has already provided new options and benefits to millions of Californians, and get ready for reform in 2014.
We in California made significant advances toward the promise of health reform in 2011, but as this calendar of highlights from 2012 shows, there's a lot more work to do in 2012. As we approach the end-of-year deadline, we hope you can contribute to Health Access Foundation to continue the progress. Through our joint efforts in 2012, from expansions of coverage to essential benefits to the Exchange, Californians can get closer to the core goal of the law: to have confidence that our coverage and care will be there for us when we need it.
For the first half of 2012, here's a few dates to plan around on health issues in California:
1/1/2012: Over 35 counties are launching their Low-Income Health Programs (LIHPs), joining 10 counties already up and running with 225,000 Californians covered. This "bridge to health reform" is bringing new federal dollars into California and our struggling health system, and getting people the care they need, as a ramp-up to 2014 and the full implementation of the Affordable Care Act. Most of the remaining counties are slated to launch sometime in the first half of 2012.
1/10/2012: On or around this date, Governor Jerry Brown will unveil his proposed 2012-13 California state budget, which will likely include more cuts, on top of those already made (elimination of dental and other benefits, provider rate reductions, etc.) in past years. Part of the budget will be dependent on the passage of revenues through a ballot measure this November. If those revenues don't pass, then Californians can expect even more cuts to health, education, and other vital services they depend on.
2/24/2012: Deadline for legislation to be introduced. It is likely that there will be several bills to implement and improve upon the federal health law. Among the goals of such legislation will be to maxmize enrollment in federally-funded health coverage expansions on the first day of 2014, and to put in place the insurance market reforms and consumer protections, so that in 2014 and beyond, individuals are no longer denied or discriminated against because of their health status.
3/23/2012: This will be the 2nd anniversary of the enactment of the Affordable Care Act, a time to acknowledge the new options, benefits, and consumer protections that millions of Californians now have as a result of the new federal law. This will also provide the context for oral arguments in front of the Supreme Court on the Affordable Care Act, scheduled for March 26-28. Opponents of the law have seen many appeals court judges, including noted conservatives, uphold the law, including the requirement on individuals to get coverage. The work will continue, both at the federal level with new regulations and consumer protections rolling out, and at the state level.
4/20/2012: This is the deadline for signature petitions to be turned in on ballot initiatives, starting the certification process to see what will be on the November 2012 ballot. The ballot is likely to include revenues to prevent further state budget cuts, and may include health-related measures on everything from rate regulation to hospital accountability. And of course, the November election will greatly impact the continued progress on health reform, by the outcome of the Presidential and Congressional races.
5/2012: Legislative action heats up: Bills need to pass the first house of the legislature by the end of May. In addition, the Governor will release his May Revision of the budget, and the Legislature will go into daily hearings and negotiations toward the goal of passing a budget by the late June deadlines.
6/2012: The new California Health Benefits Exchange, our health insurance marketplace of the future, plans this month to submit a major grant application to the federal government to fund its operation through its first year of full operation in 2014. In preparation for this, the Board will be making several foundational decisions on its goals, capacity, infrastructure, and business model for getting Californians covered on day one and beyond.
7/1/2012: While some of the health laws passed in 2011 go into effect on January, like the state enforcement of the medical loss ratio, some notable benefit mandates come into place on July 1. This includes maternity coverage, which will on this date be required to be included in individual and small group policies--reversing a disturbing trend in the last decade that left many pregnant mothers and infants without this crucial, life-changing care. Federal guidance that came out in late 2011 allow states some flexibility in setting "essential health benefits" in 2014 and beyond, so that will be another significant topic for policymakers in 2012.
Health Access looks forward to the new year, and the new opportunities to improve our health system. Through all these efforts, we look forward to your involvement, your partnership, and if possible, your contribution. Have a healthy and happy new year!
It's the future system by which Californians will easily sign up and get health coverage.
The California Exchange will be soon be putting out a "request for proposals" (RFP) for vendors to design such a system. And this holiday season, the Exchange is asking for input on the draft.
More California counties set to expand coverage in January...
Over 35 California counties will be expanding health coverage to tens of thousands of Californians on January 1, under new federal approval granted yesterday.
Ten large urban counties had already launched health expansions in July 2011. Just-released data show that now over 225,000 Californians are enrolled in these county-based Low-Income Health Programs (LIHPs), which are matched by new federal funds under the Affordable Care Act, and the state's new "bridge to reform" Medicaid waiver.
Now, the County Medical Services Program (CMSP), a consortia of 34 mostly rural counties, got federal approval to expand health care coverage to an additional 30,000 low income adults beginning January 1, 2012 under Path2Health. This coverage expansion will increase the number of low income adults served by CMSP to nearly 90,000 by the end of 2013.
These new county-based programs extend coverage to the uninsured using new federal matching funds, bringing dollars into local health systems and the California economy. These programs are a bridge to reform--helping our health system get ready for reform, linking uninsured people with a medical home, and helping every enrolled Californian get onto fully federally-funded coverage in January 2014.
With this CMSP announcement about Path2Health, now over 45 counties will have Low-Income Health Progams up and running on January 1, 2012. with most of the remaining counties going forward in early 2012. Potentially over a half-million Californians could get coverage through these LIHPs by 2014, when they are rolled into coverage under the Affordable Care Act.
Path2Health will provide no-cost health coverage to adult Californians who reside in the 34 counties and are at or below 100 percent of the federal poverty level, or about $10,890 annually for a single person.
Path2Health will provide coverage for medically necessary health care services, including primary care, emergency and hospital care, pharmacy services, and limited dental and vision care. It will also cover a set number of mental health and substance abuse counseling visits. Coverage will generally follow coverage provided under CMSP, a long-standing health coverage program serving indigent adults in the 34 counties. CMSP currently serves more than 60,000 low income adults each month.
Californians qualify for Path2Health if they are: a resident of one of the 34 counties Path2Health serves, have an income of up to 100 percent of the federal poverty level, are between 19 and 64 years of age, do not qualify for Medi-Cal, and meet federal citizenship and documentation requirements. More information about Path2Health is available at http://mypath2health.org.
The 2012 All-Star Consumer Representatives at the NAIC
Wednesday, December 21, 2011
We at Health Access California are really pleased that our Director of Administrative Advocacy, Elizabeth Abbott, has been reappointed as a designated consumer advocate at the National Association of Insurance Commissioners (NAIC).
Today, the NAIC has named 28 consumer liaison representatives for 2012. These handful of consumer advocates attend the conference calls and in-person meetings of the Insurance Commissioners from around the country, where they are typically outnumbered by hundreds (yes, hundreds--sometimes 1500 or more) insurance lobbyists and representatives.
The NAIC is a critical venue in the implementation of health reform, and is actually cited and given a specific role at least a dozen times in the Affordable Care Act. Beth Abbott and others have been very active in everything from the very contentious battle on the definition of the medical loss ratio, to the development of "model legislation" on the implementation of other key consumer protections. There work next year will be crucial in the development of policy to transition states to a new world where insurers will no longer be allowed to deny people for pre-existing conditions.
Here's the list of your 2012 all-star consumer representatives, some who focsu on health issues, others who focus on property & casualty, and other lines of insurance.
The three from California include: * Elizabeth Abbott: Director of Administrative Advocacy, Health Access * Amy Bach: Executive Director, United Policyholders * Bonnie Burns: Training and Policy Specialist, California Health Advocates
The others include: * Deeia Beck: Public Counsel, Office of Public Insurance Counsel/Texas * Brendan M. Bridgeland: Director, Center for Insurance Research * Sabrina Corlette: Research Professor, Georgetown University Health Policy Institute * Brenda J. Cude: Professor, University of Georgia * Joseph P. Ditre: Executive Director, Consumers for Affordable Health Care * Timothy Stoltzfus Jost: Professor, Washington and Lee University School of Law * Kathleen Gmeiner: Project Director, UHCAN Ohio * Karrol Kitt: Associate Professor, University of Texas at Austin * Peter Kochenburger: Executive Director, Insurance Law Center, University of Connecticut School of Law * Sonja L. Larkin-Thorne: Consumer Advocate, Avon, CT * Sarah Lueck: Health Policy Analyst, Center on Budget and Policy Priorities * Jennifer Mishory: Deputy Director, Young Invincibles * Andrea J. Routh: Missouri Health Advocacy Alliance * Daniel Schwarcz: Associate Professor of Law, University of Minnesota Law School * Barbara Yondorf: President: Colorado Consumer Health Initiative * Birny Birnbaum: Executive Director, Center for Economic Justice* * Stephen Finan: Senior Director of Policy, American Cancer Society Cancer Action Network * Carrie Fitzgerald: Senior Policy Advisor for Health, First Focus * Howard Goldblatt: Director of Government Affairs, Coalition Against Insurance Fraud * Marguerite Herman: Consumer Advocate, Project Healthcare * Adam Linker: Health Policy Analyst, North Carolina Justice Center * Stephanie Mohl: Government Relations Manager, American Heart Association * Lynn Quincy: Senior Policy Analyst, Consumers Union * Stuart Spielman: Senior Policy Advisor and Counsel, Autism Speaks * Cindy Zeldin: Executive Director, Georgians for a Healthy Future
Saying Goodbye to Junk Insurance: The Benefit of Essential Health Benefits in California...
Health Access has fought a long battle against junk insurance, the kind of limited benefit policies that leave patients in significant medical debt, even after paying premiums--and leave the rest of us in fear of the fine print, wondering if what we come down with is actually covered.
Former Insurance Commissioner John Garamendi sometimes called these "skeleton policies." Some policies permitted under California's Insurance Code cover only hospital care, but not doctor care, or only the second day in the hospital, but not the first, or that provide no coverage for prescription drugs except for a handful of generic drugs. These policies are not permitted for coverage regulated by the Department of Managed Health Care under the Knox-Keene Act: these policies must cover medically necessary doctor visits, hospitalization, lab, radiology, etc.
On Friday, Dec. 16, HHS issued a “bulletin” seeking comment on a proposed approach to “essential health benefits” that would in California outlaw junk insurance in the individual and small employer markets where it has been most prevalent. Essential health benefits (or EHB) are the minimum benefits that insurers must sell to individuals and small employers.
Other, earlier action by HHS on annual and lifetime limits had already made it clear that "mini-meds" and other limited benefit policies will not be allowed in the large employer market after 2014 and HHS re-affirmed that policy on Friday.
Federal Proposal: Not as Good as a Strong National Standard but Likely Okay for California
Like other consumer advocates, Health Access California had hoped for a strong national standard on essential health benefits.
We have been comforted to learn that nationally most employers, both large and small, cover a similar set of services that is very similar to what the vast majority of employers provide in California. The difference between large employers and small employers is that small employers tend to pay a smaller share of the premium or have higher copays and deductibles but they usually cover the same benefits as large employers.
A strong national standard was our first choice. But we had begun to be worried by what we heard from other states and from the national level. Some advocates talked about limits on hospital stays or caps on doctor visits as a possibility. The Institutes of Medicine recommended a dollar cap far below what is spent in California. So we were worried.
In our testimony to the federal HHS listening session in November, we pointed out that limits on medically necessary care would be a take-away for the nearly 20 million Californians who have coverage regulated by the Department of Managed Health Care. Coverage regulated by DMHC must by law and regulation cover medically necessary care, including hospitals, physicians, laboratory, radiology, hospice and other basic services.
The bulletin released on Friday indicates a proposed regulatory approach from the federal government. Similar to what was done for CHIP (Healthy Families in California), states are offered a menu of “benchmark plans” including: · One of the three largest plans for small employers by enrollment · One of the three largest state employee plans by enrollment · One of the three largest federal employee health plan options by enrollment · The largest HMO plan offered in the state’s commercial market by enrollment.
This gives each state flexibility, but within limits. National consumer advocates are appropriately concerned about what states will do with such flexibility. Each state has to pick one: what is California likely to do? What should advocates support?
Knox-Keene plus drugs (plus mental health/substance abuse plus more)
California's current standards have both gaping holes in the Insurance Code, but actually most of the market abides by a comprehensive standard in the Health and Safety Code called "Knox-Keene." The plans regulated by DMHC under the Knox-Keene Act cover more than 90% of Californians with coverage regulated at the state level. DMHC is the sole regulator of HMOs. Over two-thirds of small employer coverage is regulated by the Department of Managed Health Care.
All of this suggests that the kind of benefits most Californians get from their employer, benefits that cover medically necessary doctors, drugs, hospitalizations, lab/radiology, etc., should and will be the benchmark for essential health benefits. In the shorthand of advocates, this is known as Knox-Keene plus drugs (plus mental health and substance abuse treatment plus pediatric dental and vision). The addition of medications would mostly follow industry practice: The Knox-Keene which was enacted in 1975 did not include prescription drugs as a basic benefit though today over 95% of employers, large and small, purchase comprehensive prescription drug coverage.
Benefit Mandates: Mammograms, maternity, autism, and more
There have also been lots of questions about what happens with benefit mandates. Insurers in California complain that California has 46 benefit mandates: our response is to ask them which do they want to repeal? Pap smears, mammograms, childhood immunizations or diabetes supplies? Maternity coverage (enacted in 2011) or autism coverage (also enacted in 2011)?
The new federal guidance says that if the benchmark plan picked by a state includes benefit mandates, then the state can leave those in place, at least through the year 2016. This means that if California picks either the largest HMO plan or one of the three largest plans offered to small employers, then the benefit mandates in place today remain in place.
Because the recently enacted autism mandate does not include CalPERS, it is less likely that the state public employee plans offered by CalPERS will be the standard for benefits in California. And because federal employee health benefits limit reproductive services in a manner not permitted by the privacy clause of the California Constitution, as repeatedly interpreted by the California Supreme Court, it is less likely that the federal employee health benefits plans will be the benchmark chosen in California.
More to learn
We do not yet know precisely which products meet the standards proposed by the feds. We have some pretty good guesses but we await the regulators gathering solid information.
We also need to understand better what this means for autism, for mental health parity, for substance abuse treatment and for rehabilitative services as well as pediatric services, particularly vision and dental.
But for now, we can say that the proposed approach on essential health benefits is probably okay for California and certainly better than what we feared.
And at long last, it means the end of junk insurance. No longer will people who buy “catastrophic” coverage find it does not cover breast cancer like Susan Braig of Altadena. No longer will people who buy health insurance find that it does not cover $98,000 of hospitalization for a rattlesnake bite. Health insurance will actually cover the health care people need.
The California Health Benefit Exchange Board held it’s last meeting of 2011 today! We would be remiss to not acknowledge the tremendous amount of work that was accomplished in 2011. But of course, we’ve got ten miles behind us and ten thousand more to go.
One exciting change this meeting was that they used a conference line to allow people who watch the webinar because they are unable to attend in person to make comments as well.
The report from Executive Director Peter Lee included some modifications to the contract with IT RFP vendor ClearBest, expanding the responsibilities to include reviewing of responses to the RFP as well as project management. Lee also introduced 6 new staff members,with a number of familiar faces including David Maxwell Jolly, Chief Operations Officer, David Panush, and Gabriel Ravel. Lee acknowledged that neither the Board nor the senior staff currently appointed to the Exchange reflects the diversity of California, and that there would be 9 additional senior position descriptions to be posted tomorrow. He asked that stakeholders help spread the word and assist in the recruitment of quality applicants from diverse backgrounds. He also reported back on a number of meetings that he, the Exchange Board members, and staff from DHCS and MRMIB have conducted across the state in the last 4 weeks. They have been conducting this outreach effort to inform both the IT RFP and the coordinated outreach and marketing efforts they will undertake next. The solicitation for that will be released later in the week.
Katie Marcellus from the Exchange staff then made a brief presentation related to the Essential Health Benefits guidance that the Federal government released late last week. She described the options that the federal government is allowing states to use as benchmark plans upon which to base essential benefits and outlined some potential next steps that the Exchange should take.
The next and most highly anticipated item of discussion was the IT RFP which will be used to solicit IT vendors to create the California Healthcare Eligibility, Enrollment, and Retention System or CalHEERS. Staff provided an overview of what the RFP would contain, but the actual RFP was not released until this evening. Of importance to advocates interested in providing comments on the RFP, it can be found at the Exchange website: www.hbex.ca.gov and comments must be made through the comment matrix and submitted no later than December 30 at 5pm. The solicitation will officially be released on January 18. Director Bob Ross commented that this is beginning to feel “awfully real” with so many pieces falling into place.
The last item on the agenda was a presentation from Pacific Community Ventures about small businesses and the Exchange. The presentation centered around the results of survey and research data they collected from small business owners across the state. Their data indicates that many small business owners have little knowledge about the Exchange (or even about the small business tax credits that have been in place as a result of ACA for a year now). Given adequate information however, many said that they would likely participate, understanding the benefits of group purchasing, and of better apples-to-apples comparability. The study’s findings also indicate that reaching out to small businesses owned by ethnic minorities will be very important.
The Exchange Board will meet again in the new year on January 17, 2012. Until there, many advocates will be pouring over the RFP to make comments by the December 30th deadline. Happy Holidays!
Help Win the Budget and Policy Changes so Californians Get the Care We Need, When We Need It, Without Fear of Financial Ruin
What We Did Together This Year: * Expanded Coverage to 200,000+ Californians in County-Based Low-Income Health Plans * Got Insurers to Cover California Children with Pre-Existing Conditions * Helped Ensure New Access for 5,000+ in the Pre-Existing Condition Insurance Program * Won New Consumer Protections, from Maternity Coverage to Medical Loss Ratios * Helped Save Ratepayers Hundreds of Millions as Health Insurance Rates Scrutinized * Worked to Improve Consumer Assistance, Eligibility and Enrollment, to Be Ready for 2014
Health Access Needs Your Contribution to Help: * Fight Budget Cuts, and Win the Reforms and Revenues to Sustain Our Health System * Implement *and* Improve Health Reform in California * Advocate and Organize for Consumers with Policymakers, the Press, and the Public
Tough budget cuts at the state and federal level. Efforts to roll back recent progress in the courts and Congress. An uncertain economy and political environment.
Our efforts to implement and improve the Affordable Care Act have yielded real results for Californians, both in immediate benefits in 2011 and in investments that will yield fruit in 2014.
Here are some examples:
* When the ACA provision forbidding children being denied insurance due to pre-existing conditions went into effect, some insurers decided to withdraw “child-only” health policies altogether. Health Access developed, advocated, and won new rules so that insurers that don’t sell to children can’t sell to adults either. This got insurers this year to serve *all* children--and to provide price protections against overcharging as well.
* Californians saved millions of dollars as health insurers retracted, rolled back, and rebated their rate hikes, in part due to the new review of rates that we won, which require public disclosure of rate changes and their justifications. We are continuing to push for a broader rate regulation, to allow regulators to not just review but also to reject unjustified rate increases.
* Today in California, less that 15% of individual insurance market plans include maternity coverage. Our research showed women in some counties have only one option for maternity coverage; a $5,000 deductible plan. This will change next year, after a decade of Health Access, working with women's groups and others, supporting multiple efforts in California to require maternity care is part of the basic health benefit. The ACA does include maternity as a basic benefit in 2014, and Governor Brown signed bills this year to set the requirement early, in mid-2012, to the benefit of California families.
* In the midst of a budget crisis, California is actually expanding health care coverage using new federal funds, with over 200,000 getting care now. As part of the Medicaid waiver stakeholders advisory committee, Health Access helped develop the idea of allowing counties to use the federal matching dollars available under the ACA. These new county-based Low Income Health Programs could cover over a half-million Californians in the next two years, and then every enrolled person will be transferred into fully federally-funded coverage in January 2014. Health Access has actively organized in key counties to reach that goal.
These are just some of the advances where Health Access has had an impact. As you can see, Health Access plays an integral role in all of these efforts and more; fighting to protect California health care consumers; working with policymakers to achieve timely implementation of ACA provisions; and advocating for additional improvements in health care policies to ensure quality, affordable health care is accessible to everyone.
As we are moving forward to implement and improve federal health care reform, the state’s ongoing budget crisis threatens devastating cuts that jeopardize California’s existing health care safety-net on which millions already rely. We will make sure that the real cost and impacts of proposed cuts are understood, offer alternatives to them, and work with grassroots groups to make sure the voices of their constituents are heard.
At this crucial time, we need to both prevent the worst, such as budget cuts and efforts to repeal reform; as well as organize and advocate for the best, including better implementation and improvements that go beyond the federal law.
With your support, Health Access Foundation will continue to empower Californians to engage in the debate, and to win policy victories on behalf of health care consumers.
We would greatly appreciate your contribution to help make it a happy and healthy holiday season. Thank you for your consideration.
Sincerely,
Anthony E. Wright Executive Director
P.S. Opponents of health care reform are aggressively working to gut the ACA and undo the progress already made. Your support will not only help us continue efforts to implement and improve the ACA; you will also help us fight back and defend this historic law and the millions of Californians who benefit from it
With the state’s unemployment rate hovering above 11 percent, impending state budget triggers that are inciting rallies across the state, and 52% growth in health insurance premiums for California families over nearly the past decade, it’s hard to find truly good news…but here’s some: at a time when the economic recession hit hardest (2008 to 2010), over 97,000 fewer California children were uninsured, according to a new report by the Georgetown Center for Children and Families.
Much of the reduction in the number of uninsured kids can be attributed to the existence of Medi-Cal and the Healthy Families Program. These critical programs provide comprehensive health coverage for eligible low-income children that the vast majority of parents are satisfied with. Medi-Cal and the Healthy Families have filled the insurance void for children left by the shedding of employer-sponsored insurance, as an analysis by the UCLA Center for Health Policy Research points out.
There are good reasons to believe that more children will see this trend of increasing insurance coverage:
First, the Patient Protection and Affordable Care Act (ACA) of 2010 is already in full effect in California. In 2011 alone, hundreds of thousands of Californian children and youth gained coverage when children were no longer allowed to be denied coverage due to pre-existing conditions and when young adults could remain on their parents’ coverage up to age 26.
The California Health Benefit Exchange (HBEX) is working in overdrive to get up and running by 2014. In part, that means developing a seamless eligibility and enrollment system that will make it easier for families to enroll in health coverage – including for the 2 out of 3 uninsured California children who are eligible and could enroll in Medi-Cal or Healthy Families today but have not yet enrolled. There’s also a lot of good work being done to figure out how to make the enrollment experience work best for consumers and ensure there is appropriate and adequate assistance available to help families navigate the complex health care world.
Hundreds of thousands of kids will get affordable coverage through the HBEX’s individual and small business markets, and even more will have more secure coverage through their parents’ employers as a result of the ACA.
A new Health Affairs article finds that upon full ACA implementation, an estimated 3.2 million children can be expected to gain health care coverage nationally, and up to 95% of all children will have health coverage. Despite the enormous amount of work that still needs to be done, the ACA opportunities before California can bring us much closer to the more than decade-long goal of 100%coverage for all children…and that’s some good news for California’s kids!
GOP Budget Committee Chair Rep. Paul Ryan came out with another proposal today that fundamentally undermines the guarantee and protections in Medicare. It wouldn't be notable, other than he did it with Democratic Senator Ron Wyden.
This shouldn't be surprising: Senator Wyden has always gone his own way on health policy, especially if it was something that could be labelled "bipartisan." Unlike others, I was never a fan of his version of health reform that he co-authored with Republican Sen. Bennett of Utah--and thankfully, it really wasn't the basis for the Affordable Care Act; even the small provision that Sen. Wyden stuck in for a narrow slice of the population get stripped out in a more recent budget deal. But his efforts served a political functions, which was to get GOP Senators to even have the conversation about health reform--until it was toxic, so much so that Sen. Bennett was denied his shot at re-election.
But I don't see any merit in this Ryan-Wyden proposal. Just read Jonathan Cohn, Ezra Klein, and AustinFrakt to understand why this makes no sense as a policy or as a political proposal.
The White House, and key members of Congressional delegation (who happen to be from California), agree, and pushed back hard today. From The Hill:
House Minority Leader Nancy Pelosi (D-Calif.) charged that the plan shows Republicans want Medicare to “wither on the vine,” quoting remarks Gingrich made in 1995 about how Medicare would fare if faced with competition from private insurers. The White House also invoked Gingrich’s quote in a statement opposing the Wyden-Ryan proposal.
“We are concerned that Wyden-Ryan, like Congressman Ryan’s earlier proposal, would undermine, rather than strengthen, Medicare,” White House Communications Director Dan Pfeiffer said in a statement. “The Wyden-Ryan scheme could, over time, cause the traditional Medicare program to ‘wither on the vine’ because it would raise premiums, forcing many seniors to leave traditional Medicare and join private plans.”
Some congressional Democrats were upset with Wyden, saying he risked providing cover for Ryan’s unpopular Medicare plan.
Rep. Pete Stark (Calif.), the top Democrat on the Ways and Means Health subcommittee, said the substance of the new proposal is no better than Ryan's earlier effort. "Despite Wyden's claims otherwise, the Wyden-Ryan plan ends Medicare as we know it, plain and simple," Stark said in a statement.
Rep. Henry Waxman (D-Calif.) said he had not fully reviewed the proposal but that the premium support model, in general, often threatens seniors with higher costs. “I have serious doubts about what they’re proposing,” Waxman said.
On Friday, December 16, 2011, Richard Kronick, the Deputy Assistant Secretary for Health Policy in the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services (and former UC-San Diego professor) will be joined by Steve Larsen, Director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services, to make an important announcement about the Affordable Care Act.
We understand it will provide information on the development of an "essential benefits" definition.
WHO: * Richard Kronick, Deputy Assistant Secretary for Health Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services * Steve Larsen, Director, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
WHEN: Friday, December 16, 2011 at 2:45 p.m. (EST) DIAL IN: 888-790-2012 PASSCODE: Healthcare
with a background as a consumer advocate and community organizer on many issues, including health issues for the last ten years in California and New Jersey.
