The Debate Continues on the County Safety-Net and the Remaining Uninsured
Wednesday, May 22, 2013
HEALTH ACCESS UPDATE Wednesday, May 22, 2013 DEBATE CONTINUES ON CRUCIAL COUNTY SAFETY-NET FUNDS
* As part of California Budget debate, next few weeks will determine implementation of the Affordable Care Act, and California's commitment to the remaining uninsured.
* As U.S. Senate Judiciary Committee passes immigration reform bill, questions about whether California will provide safety-net care and coverage for those on a "path to citizenship."
* Governor Brown wants state to cut $300 million-$1.3 billion from the current $1.4 billion fund that now goes to county safety net for public health, public hospitals, clinics, etc.
* Recent Health Access Concept Paper argues for preserving funding for the public hospital safety net, and extending county Low-Income Health Programs for the Remaining Uninsured
* WEBINAR TODAY at 1PM on Safety-Net Care for Immigrants and the Remaining Uninsured
Following the Governor's May Revision of the State Budget, California legislators are moving quickly to resolve outstanding questions on the implementation of health reform, including the expansion of Medi-Cal, and particularly the issue of funding the county safety-net for the remaining uninsured.
At stake are the funds that support public hospitals, clinics, county low-income health programs, and public health efforts--about $1.4 billion from vehicle license fees that goes from the state earmarked for county health programs.
Governor Jerry Brown has conditioned his support of the Affordable Care Act's Medi-Cal expansion on a state-county realignment of these funds, wanting the state to get any savings that may come from the ACA reducing the number of uninsured.
Advocates and counties want to ensure the survival of the state's safety-net of public hospitals and community clinics that are there when we need it, from trauma and burn centers to basic care services for those who have no other option.
The historic Affordable Care Act is estimated to reduce the number of uninsured by one-half to two-thirds, but that would still potentially leave 3-4 million remaining uninsured in California. A majority would be citizens or legal residents, and a significant portion of these will be from communities of color. These communities stand to benefit most from the expansion of health care services but may be hardest to reach and the least informed about health care choices.
Around one million of the remaining uninsured would be immigrants for whom a new immigration process could offer a roadmap to citizenship. The U.S. Senate Judiciary Committee yesterday passed a comprehensive immigration bill, but one that would bar those on a path to citizenship from federally-funded health care for many years.
The paper makes the case for protecting county safety-net dollars, and extending county Low-Income Health Programs to the remaining uninsured. Rather than allowing them to expire at the end of the year when their current enrollees are shifted to the expanded Medi-Cal program, these LIHPs can continue their work to provide more efficient and effective primary and preventative care to the remaining uninsured--not just emergency and episodic care.
The concept has gotten significant support in the legislature, among stakeholder organizations (in this joint statement), and in editorial boards, including:
WEBINAR TODAY:The California Endowment today is hosting an informational webinar featuring community advocates from Health Access and other key organizations to brief partners on the Governor’s proposed May Revise budget and its implications for the safety net. Special consideration will be given to a proposal for the remaining uninsured involving the state’s Low Income Health Programs. Also, updates will be provided on Comprehensive Immigration Reform legislation and its implications on health.
Presenters include: Marielena Hincapie, Executive Director of the National Immigration Law Center (NILC) and Angelica Salas, Director of the Coalition for Humane Immigrant Rights of Los Angeles (CHIRLA), to present on developments on Comprehensive Immigration reform.
On the issue of these county safety-net funds and extending Low-Income Health Programs, presenters include Anthony Wright, Executive Director of Health Access; Vanessa Cajina, Policy Advocate at the Western Center on Law and Poverty; Ronald Coleman, Government Affairs Manager of the California Immigrant Policy Center (CIPC); and Chad Silva, Policy Director of the Latino Coalition for a Health California (LCHC).
MORE ON LIHPs AND THE REMAINING UNINSURED: A success story, LIHPs in 53 counties now cover over 550,000 otherwise uninsured Californians, virtually all of whom will become eligible for full Medi-Cal on January 1, 2014. While not full coverage, LIHPs offer more than episodic and emergency room care for the uninsured, providing a medical home with primary and preventative care services. Instead of letting the LIHPs expire, California should extend the LIHPs to the remaining uninsured—both continuing our commitment to all Californians, and using our dollars in the most effective and efficient way. This unique opportunity represents a viable way to fulfill the goal of providing access to care and coverage to Californians regardless of income or immigration status.
1.Confirming that California is undertaking a statewide Medi-Cal expansion, under the Affordable Care Act, along with an aggressive effort to enroll as many Californians as possible.
2.Preserving the state realignment dollars for the first three years, in which the federal government is funding the expansion at 100%, would allow for capacity building to meet the needs of the newly insured as well as the remaining uninsured during this peak.
3.Keeping those state dollars should be contingent on a maintenance of effort requirement to assure counties continue to spend at least what they are spending now, including their own county dollars, on the remaining uninsured, public health and related health needs.
4.Encouraging counties to redirect existing Low Income Health Programs to serve the remaining uninsured; Counties would be encouraged to maintain their LIHP-like or Healthy San Francisco-type programs using these state realignment dollars.
5.Ensuring, after three years, half of state realignment funds continue to go to counties to perform public health functions, as envisioned in the original 1991 realignment, as well as base 17000 safety-net responsibilities.
6.Linking the remaining portion of this funding stream to LIHP enrollment, so counties are funded in line with the demand and their commitment. The first three years provide time when counties have the opportunity to build their enrollment back up, but then the state can yield savings as the ACA is implemented and overall demand goes down.
7.Allocating some state savings to support safety-net institutions through a state funding stream.
8.Instituting accountability and transparency into the state-county relationship going forward.
The broad coalition supporting this proposal includes the AARP, AFSCME, California Immigrant Policy Center, California Labor Federation, California Pan Ethnic Health Network, Latino Coalition for a Healthy California, Health Access California, PICO California, SEIU California, and the Western Center on Law and Poverty.
Their campaign to provide safety-net coverage for the remaining uninsured includes grassroots efforts, media, and is using the hashtag #Health4All on Twitter.
For everyone who worries about the launch of the Affordable Care Act, please read this article by Sarah Kliff at the Washington Post's Wonkblog.
It's not that worries and concerns aren't justified, as we are 225 days away from coverage expansion on January 1, 2014, and less than five months from open enrollment in October.
It's that our county has been here before, and the headlines over 45 years ago before the launch of Medicare were remarkably similar--the same scaling up of outreach efforts, the same guessing game about what might happen, the same concerns about capacity, and the same alarm about political resistance, especially in Southern states.
You think our outreach efforts are good? Here's one example of the success and the type of outreach back then:
Of the 19 million seniors eligible for Medicare, 93 percent enrolled by the summer of 1966. Social Security Administration Commissioner Robert Ball “enlisted the U. S. Forest Service to send Forest Rangers out into the woods in search of elderly hermits whom he might be able to enroll.”
The Governor's Proposal on the Remaining Uninsured, and Ours...
Friday, May 17, 2013
The $1.4 billion dollars that goes to fund public hospitals, clinics, county low-income health programs, and public health in general is the subject of serious negotiations in the last few months. The Governor's May Revise says that "the state has an interest in maintaining a strong safety-net to ensure access to health care services," but the Governor also wanted to claim savings, and argues for "a mechanism will be established to determine the level of county savings" that the state could take back.
The Remaining Uninsured LIHP
proposal aligns with the Governor's "mechanism" in several
* Rather than an "all or nothing"
programmatic realignment, they both offer a more flexible framework for
* They both works off a formula
& variable that is based on actual experience on the ground in the counties,
as we see the impact of ACA implementation.
* They both treats counties in
different situations differently, where they face different levels of demands,
different pace of enrollment, and different.
* The Governor stated principle was
that he didn't want to pay for the same person twice. The Remaining Uninsured LIHP proposal embraces
this--funding is tied to LIHP enrollment, requiring counties to document the
people they serve that aren't on Medi-Cal or private
* The Governor's budget says it
wants to prioritize and maximize coverage (and federal funds). The LIHP proposal
does that, requiring that all who come into a county health system are screened
for Medi-Cal/Covered CA, and only after are left to the countyLIHP. Our proposal would utilize
opportunities to use federal funds for emergency Medi-Cal before augmenting with
these state safety-net dollars.
* The Governor's budget says it
wants the mechanism to encourage efficiency and cap costs. The LIHP proposal
does this, encouraging a capitated medical home model that offers primary and
preventative care that is more efficient and effective, not just expensive
episodic and emergency room care.
However, there are major differences
between the Governor's approach and that outlined in our Remaining Uninsured
* The Governor's proposal takes too
much, too soon. It takes from safety-net funds $300 million in year one, $900 million in year two, and $1.3
billion (more than 75%) in year three--at a time of peak demand for the health
* The Remaining Uninsured LIHP
proposal would maintain safety-net funding for three years--when less state savings is
needed because the newly-eligible in Medi-Cal are 100% federal
* The Governor's proposal says it
recognizes the costs of public health, a strong safety-net, and serving the
remaining uninsured--but the aggressive estimates only leave less than 25% for
* The Remaining Uninsured LIHP
proposal guarantees 50% for public health and basic health functions even after
three years, but then ties the rest to LIHP
* The Governor's proposal would take
savings first, and offer a "true-up" later. This is backwards, short-changing
county health system at a time of peak demand, with
uncertainty leading to decisions to downgrade care.
* The Remaining Uninsured LIHP
proposal allows a period of full funding first, giving time for the LIHPs to
grow enrollment, and then to have allotment by based on actual enrollment and
* The Governor's proposal does not encourage a medical home, primary or preventative care.
* The Remaining Uninsured LIHP
proposal is built on primary and preventative care, not just
episodic and emergency room care, just like California is doing in Medi-Cal and the
* The Governor's proposal would
allow the Low-Income Health Programs to expire at the end of this year, leaving
counties on their own, and many going backwards in what they provide the
* The Remaining Uninsured LIHP
proposal continues explicit state support for the LIHPs, as the state has done
through two waivers over multiple years;
* The Governor's proposal would
shift money out of health care to backfill existing
programs in other areas.
* The Remaining Uninsured
LIHP, to the extent there are savings, helps keeps the money to its original purpose of serving the uninsured to the extent it is warranted, to make sure *all* Californians are covered and
For these reasons, because it aligns
with the Governor's principles but solves the problems in the mechanism he has
proposed, we are urging legislators to continue to support extending the LIHPs
for the remaining uninsured.
Summary of the May Revise on Health Care: Movement on Medi-Cal, But Continued Cuts
Tuesday, May 14, 2013
HEALTH ACCESS UPDATE
Tuesday, May 14, 2013
IN MAY REVISION OF STATE BUDGET, GOVERNOR BROWN MOVES TOWARD RESOLUTION FOR A TIMELY STATE MEDI-CAL EXPANSION UNDER THE ACA.
BUT BUDGET SEEKS 75%+ CUT TO COUNTY SAFETY NET FUNDS, WOULD CONTINUE CUTS TO MEDI-CAL PROVIDER RATES AND DENTI-CAL.
* California Governor Brown commits to state-based Medicaid expansion with standard benefits under the Affordable Care Act to start on January 1
* Expansion conditioned on a cut of $300 million and eventually $1.3 billion (over 75%) of the funds to serve the 3-4 million remaining uninsured. Cuts would undermine safety-net of public hospitals, community clinics, and Low-Income Health Programs.
* Budget continues Medi-Cal cuts to dental care and to worst-in-nation Medi-Cal provider rates, misses opportunity for targeted restorations to draw down new federal matching funds.
Governor Jerry Brown announced his May Revision of the California State Budget today, declaring for the first time in decades a multi-year balanced budget. In his brief remarks unveiling the proposal, the Governor highlighted the planned investments in education, as promised in the campaign for Proposition 30, as well as the work to implement the Affordable Care Act (ACA).
OVERALL HEALTH SUMMARY: The Governor's proposal budget makes progress from his previous proposals on the urgent work to expand Medi-Cal under the ACA, but it would also continue steep cuts to Medi-Cal benefits and provider rates, and it seeks to take county health funds that would undermine California's safety-net of public hospitals, clinics, and county-based low-income health programs.
MEDI-CAL EXPANSION: In his remarks, Governor Brown committed implement the Affordable Care Act and "expand Medi-Cal generously, boldly and prudently," and to be ready on day one. The budget includes $1.5 billion in federal funds to implement the Medi-Cal expansion (including only $21 million in state funds, largely for administration). Advocates have urged that California needs to move urgently to take full advantage of the benefits of the Affordable Care Act, and this budget makes progress in getting the state to move forward.
While they are still significant differences to work out, the Governor and the Legislature are now moved closer to a resolution to take advantage of this historic opportunity to improve the health system we all rely on. New details for the Governor's proposal on Medicaid expansion include:
* The commitment to a state-based expansion, rather than the previously-proposed county-based option that was widely seen as unworkable.
* Medi-Cal benefits for the newly-eligible will be the same as those currently eligible, including long-term care, which would be subject to an assets test.
* The Administration proposes to shift pregnant women and recent legal immigrants now in state-funded programs onto private insurance through Covered California, but to provide "wrap around" coverage for all cost-sharing and benefits not federally-funded.
* While the Governor continues to insist on linking Medi-Cal expansion to a state-county realignment, he is no longer seeking an "all-or-nothing" programmatic realignment of responsibilities, but rather a more flexible financial "mechanism" that recognizes actual costs and experience, and the differences between the counties.
CUTTING CARE FOR THE REMAINING UNINSURED: That said, counties, health providers, and consumer advocates argue that the Governor's proposal takes too much money too soon.
As the federal Affordable Care Act is ready to expand coverage and increase investments in our health system, this state budget would seek to cut $300 million immediately and $1.3 billion in 2016--over 75% of the funds to serve the remaining uninsured through the county health infrastructure built up over years.
Health advocates argue we should not prematurely reduce the resources already set aside to serve the 3-4 million remaining uninsured, and that we need to fulfill the promise of the health reform to all Californians, including those who fall through the cracks.
CONTINUING CUTS TO MEDI-CAL: At the time of transition to health reform when the health care system will need all the capacity available, this budget would go forward with big cuts for both public and private health care providers, which would make it harder for both the insured and uninsured to get the care they need when they need it.
The Governor continues pending cuts to Medi-Cal provider rates, already some of the lowest in the nation, and which prevents many Californians from getting in to see a doctor or specialist when they need it. The budget continues the denials of key Medi-Cal benefits, including dental benefits to over 3 million low-income Californians.
Cancelling the pending Medi-Cal provider rate cut or restoring dental coverage would bring in one-to-one federal matching dollars for those now in Medi-Cal, but be fully federally funded for those newly-eligible under the Affordable Care Act. By not making smart, targeted investments and restorations, that's money not coming into our state, not helping families get needed care, not improving our health system, and not advancing our economic recovery.
OTHER HEALTH UPDATES: The Governor's May Revise budget also makes other adjustments of note:
* The budget includes $71.9 million for increased county administration costs related to implementing the Affordable Care Act and enroll Californians in new coverage.
* The Coordinated Care Initiative, to combine services for seniors and people with disabilities in both Medi-Cal and Medicare, will have an adjusted rollout that starts the demonstration project in January 2014, pushed back from October of this year.
* The budget proposes to revive the Managed Care Organization tax as a sales tax on health plans to help draw down federal funds to support health programs in the budget.
* The budget no longer includes a proposal to cut $135 million from Medi-Cal managed care plans from unspecified efficiencies.
The expectation is that the California Legislature will pass an adjusted budget on time, by June 15. Thus, the next four weeks are crucial for the implementation of the Affordable Care Act, the future of the Medi-Cal program, the state's commitment to the remaining uninsured, and more. More updates will be forthcoming.
In releasing his May Revision of the California Budget, Governor Brown gave a full-throated commitment to expand
Medi-Cal under federal health reform generously, boldly and prudently, and to
be ready on day one. California can and should take full advantage of the
benefits of the Affordable Care Act.
But as the same time, the Governor's proposed
budget would continue steep cuts to Medi-Cal benefits and provider rates, and
undermine California's safety-net of public hospitals, clinics, and
county-based low-income health programs.
As the federal Affordable Care Act is ready to expand coverage and
increase investments in our health system, this state budget would seek to cut
$300 million and eventually $1.3 billion in funds to serve the remaining
uninsured, including the county health infrastructure we have built up over
years. California needs a safety-net that
survives and thrives, and we should not prematurely reduce the resources already
set aside to serve the 3-4 million remaining uninsured. We need to fulfill the
promise of the health reform to all Californians, including those who fall
through the cracks. We agree with the Governor that we shouldn't provide care twice, but for the remaining
uninsured, we still need to provide basic care once.
At the time we need all the capacity we can get, this budget
would go forward with cuts for both public and private health care
providers, which would make it harder for both the insured and uninsured
to get the care they need when they need it. The
Governor continues pending cuts to Medi-Cal provider rates, already some of the
lowest in the nation, and which cause Californians problems seeing a doctor or
specialist in a timely manner. The budget continues the denials of key Medi-Cal
benefits, including dental benefits to over 3 million low-income
Smart, targeted restorations of these benefits would be matched not
just one-to-one for those now in Medi-Cal, but be 100% paid for by the federal
government for those newly-eligible under the Affordable Care Act. It's insane
not to make that investment to get that immediate return for California
families, for our health system, for our economy. The
California comeback isn't reflected in this health care budget, and would
be hampered as we short-sightedly deny California needed federal matching
dollars, including new dollars available under the Affordable Care Act, which
are desperately needed in our financially strapped health system. By not
making targeted investments and restorations, that's money that is not coming
into our state, not helping families get needed care, not improving our health
system, and not advancing our economic recovery.
Here's what we will be asking as we read the May Revision of Governor Brown's budget this morning:
* Will California maximize the
benefits of the Affordable Care Act, including newly available federal
funds? Will we expand Medi-Cal fully and urgently? Will we draw down
federal funds for outreach and enrollment?
* Will California continue our commitment to the
remaining uninsured? Will the Governor tie Medi-Cal expansion to a
state-countyrealignment that threatens to undo our
safety-net of public hospitals, community clinics, and Low-Income Health
* Will California restore the worst of the cuts
to Medi-Cal? Or will the Governor seek to continue the pending cut to
the worst-in-the-nation provider rates? To continue denying over 3 million
low-income Californians dental coverage?
Editorial support for safety-net coverage for the remaining uninsured...
Monday, May 13, 2013
As we await Governor Brown's May Revise budget, the main health question is: Will California maximize the benefit for Californians when implementing the Affordable Care Act? And will the Governor continue California's commitment to the remaining uninsured?
The state estimates that half of the uninsured will sign up for insurance in the exchange or through Medi-Cal. But some 3 million to 4 million will remain uninsured – 3 million citizens, plus 1 million noncitizens who are not eligible for coverage.
What to do about the remaining uninsured? Counties historically have taken care of the medically indigent, and receive some money from the state for that – about $700 million this year. Since about half would become insured, Brown indicated in his January budget that he wanted to "capture" the county savings to pay the state's costs for Medi-Cal expansion.
The counties point out, rightly, that the federal government covers 100 percent of the cost of the Medi-Cal expansion for 2014, 2015 and 2016.
They argue that during this three-year transition period, they will continue to cover the remaining uninsured and need to ramp up to enroll those eligible for Medi-Cal and the exchange.
Brown should heed their concern. But he should not issue the counties a blank check. Dollars should be distributed by actual numbers of the remaining uninsured cared for by the county safety net. And that care should provide a "medical home," with preventive and primary care – as counties have built up with the existing Low- Income Health Program – to avoid expensive crisis care.
Last week a group of nonprofits offered a sensible compromise, proposing that counties keep the funds if they spend them on a more efficient way to deliver care to the needy...
The proposal by Health Access and other nonprofit advocacy groups would let counties keep the money from sales taxes and vehicle fees for three years, while the feds cover the full cost of the Medi-Cal expansion. After that, counties would receive a set amount per indigent person they enroll in an HMO-style healthcare network, with any leftover dollars reverting to the state. This would make counties much more accountable for the money they receive, while giving the uninsured preventive and coordinated care that's far more cost-efficient than what they receive at clinics and emergency rooms.
The bottom line is that federal law requires counties to provide emergency care to anyone who needs it, regardless of ability to pay or immigration status. But that's the most expensive form of care. The Health Access proposal offers a better approach to public health, while leaving counties free to decide who should be eligible for the benefits. The state should embrace it.
New Concept Paper Unveils a Solution for the Remaining Uninsured
Friday, May 10, 2013
HEALTH ACCESS UPDATE: Wednesday, May 8th, 2013 NEW CONCEPT PAPER PROPOSES SAFETY-NET COVERAGE FOR THE
REMAINING UNINSURED AS CALIFORNIA IMPLEMENTS THE ACA
* Proposal in New Health Access Paper Released Today Would Resolve Logjam
Over California’s Implementation
of the ACA, Preserve Funding for PublicHospital Safety Net, and
ExtendCounty Low-Income Health
Programs from Remaining Uninsured
Health care advocates representing
California’s diverse communities today unveiled a plan to ensure access to
health care and coverage for all Californians as part of a full and inclusive
vision of implementing the Affordable Care Act (ACA). The coalition of
organizations representing consumers and communities of color called on elected
leaders to commitment to work for a full expansion of Medi-Cal, and to protect
the health care safety net for those who will remain uninsured.
Advocates argues that California is stronger when every
person has access to care and coverage, which promotes healthier and more
financially stable families and communities. The proposal urges California to
fully expand the coverage options in the Affordable Care Act, and also continue
the state's commitment to provide safety-net care and coverage to the remaining
uninsured, including those following a path to citizenship.
advocates wanted to ensure the survival of the state's safety-net of public
hospitals and community clinics that are there when we need it, from trauma and
burn centers to basic care services for those who have no other option.
The historic Affordable Care Act is
estimated to reduce the number of uninsured by one-half to two-thirds, but that
would still potentially leave 3-4 million remaining uninsured in California. A
significant portion of these will be from communities of color. These
communities stand to benefit most from the expansion of health care services but
may be hardest to reach and the least informed about health care choices.
Approximately one million of the remaining uninsured would be new American
immigrants for whom a new immigration process could offer a roadmap to
Community, labor, and faith
organizations backed a set of recommendations detailed in a concept paper
released today by Health Access California. The groups are seeking that these
concepts be included in the state budget proposal expected to be adopted in June. The concept paper, “Continuing California’s
Commitment to the Remaining Uninsured,” is on the front page of the
Health Access website at www.health-access.org, and sets forth a plan that
A) Resolve the a current political
logjam that has stalled implementation of some parts of the ACA:
The current state
budget proposal set up a heated negotiation between the state and counties over
$1.4 billion in funds to care for indigent Californians who don’t quality for
Medi-Cal. Governor Brown’s administration argues for a state-county realignment
where the state could shift funding away from (or new responsibilies to)
counties, destabilizing systems needed to care for those who will remain
The concept paper suggests a
win-win solution: counties maintain some of the money for existing public health
and safety net services for the uninsured. The remaining portion is tied to a
county's continued commitment to serving the uninsured through the successful
Low-Income Health Programs, with the state capturing savings if counties shift
their clients to other programs.
B) Preserve funding for the public
hospital safety net: Under the Health Access proposal,
existing county-based Low-Income Health Programs -- which would otherwise expire
at the end of 2013 – would remain in place to serve Californians who would be
left uninsured through the ACA. These programs would be funded by a portion of
the dollars that currently go to counties for the care to the
C) Fulfill promise of the
Affordable Care Act: California has a stake in the health and
success of every person, regardless of immigration status. The proposal ensures
that the three to four million people who will remain uninsured after ACA
implementation won’t lose access to basic safety net services.
The broad coalition joining
today’s announcement included the AARP, California Immigrant Policy Center,
California Pan Ethnic Health Network, Latino Coalition for a Healthy California,
Health Access California, PICO California, SEIU California and the Western Center on Law and Poverty. Their campaign to provide safety-net coverage for the remaining uninsured includes grassroots efforts, media, and is using the hashtag #Health4All on Twitter.
Today, Governor Brown signed key legislation to provide new consumer protections to prevent denials because of pre-existing conditions, and provide other crucial insurer oversight, as provided for in the federal Affordable Care Act. The new laws also take some important California-specific steps forward for consumers.
These laws are critical to get California ready to take advantage of the benefits available starting in January 1, 2014, when
pre-existing condition denials will be history. These reforms are essential efforts to making reform real on the ground here in California. These bills ban pre-existing condition denials and discrimination, and limit how much Californians
can be charged due to their age.
AB x1 2 (Pan) and SB x1 2 (Hernandez) were needed to give state regulators the authority to enforce the law, and to adapt these new consumer protections to the California market. As always, California is seeking not just to implement the Affordable Care Act, but to go beyond federal law in California-specific ways:
* The laws include LGBT families, in accordance with California law and definitions of "family."
* The laws ban tobacco rating that prevents smokers from getting the care and coverage they need to help them break their addiction.
* The laws limit rate increases to once a year, which ensures insurers are more transparent about their rate hikes and allows
consumers to better budget and not face unexpected and destabilizing rate hikes
The overall goal is not just banning denials or discrimination due to pre-existing conditions, but to get insurers to actually compete on cost and quality and customer service, rather than on avoiding sick people. We no longer have to imagine
a world where people no longer have their crucial life choices like career and marriage constrained in order to get health coverage. These bills represent a revolution in getting people health coverage, but in allowing Californians to live their lives and follow their dreams and entrepreneurial spirit.
Our leaders still have more work to do so Californians are ready to take
advantage of these new benefits on January 1, 2014, which is now less than 240
days away. We need the Governor and Legislature to finish negotiations on
Medi-Cal expansion so we are ready to start open enrollment in October, just
five months away. The legislative special session continues with
AB1x1 and SB1x1 on Medi-Cal expansion, and SB1x3 on a "bridge plan."
The California State Senate moved key health consumer legislation forward today.
This morning the Senate Governance and Finance Committee heard SB768 (de Leon), which would impose an additional tax on tobacco products in order to fund tobacco cessation programs and the health care safety net. This is the first time the tobacco tax, which is currently priced at 33rd in the country, will have been raised in 15 years, and would generate over $1.2 billion dollars just in the first year. The author argued that this will continue to generate revenue in addition to bringing in cost savings from a reduction in tobacco related diseases. SB768 passsed Governance and Finance on a party line vote.
SB768 was heard in Senate Health Committee in the afternoon. Senator Monning made the point that the public health arguments for this bill are indisputable, and urged his fellow committee members to vote accordingly. Senator de Leon made the point that currently, taxpayers pay $3.1 billion dollars to subsidize the harm done by the tobacco industry. The bill passed Senate Health on a party line vote as well.
The Senate Health Committee also heard SB509 (DeSaulnier) that puts into place the necessary authority for Covered California, the Exchange, to perform employee background checks. This bill passed unanimously (Senator Wolk was absent) and moves forward as an urgency measure to ensure that the Exchange can continue its sprint to enrollment day.
The Covered California Board of Directors held a short meeting this morning. The meeting was scheduled for the purpose of allowing the board to take action on the proposed model contract (between Covered California and Qualified Health Plans), but covered a few additional topics too.
The Model Contract is the template for the contracts that will be signed between Covered California and all of the health plans whose products will be offered in the Exchange. This contract sets the rules for health plans and is an important place for the Board to make policy decisions that protect consumers and promote health and equity. In the board's last meeting, they received a great deal of feedback from stakeholders on the draft of the contract that they presented. The draft considered by the Board today reflected some changes that were made as a result of those comments. Some key revisions are:
* Staff reiterated Covered California's commitment to their seven principles of Active Purchasing
* Covered California will not allow HSA plans in the Silver Tier because this will interfere with the calculation of subsidies.
* The board was disinclined to allow alternate plan designs in the individual market, sticking with the emphasis on standardized plans to help consumers make apples-to-apples comparisons.
* Contracted plans will be required to only sell standardized plans in the individual market in and out of the Exchange.
The Board approved the amended Model Contract with 4 votes in favor (Susan Kennedy left before the vote). And with that, the intense negotiating with health plans begins, with announcements of participating plans expected late May.
Additionally, the board heard an update on the Assisters Program. Covered California Director Peter Lee explained that they 3 keys to success of the Exchange are: 1. Affordable plans, 2. successful outreach and education, and 3. simple enrollment process. Assisters and Navigators are important to this third element, to make sure that consumers that need help signing up for coverage can get it quickly and effectively. Staff will be presenting a comprehensive proposal related to Assisters at the next board meeting. Topics that will likely elicit debate include continued discussion about the background check requirements for individuals who wish to become Assisters.
Lastly, staff presented proposed regulations related to Assisters which would prohibit both Assisters from accepting compensation from Agents and Agents from paying Assisters to ensure that consumers are truly getting unbiased assistance. These regulations will be voted on in a future board meeting.
The next Covered California Board meeting will be Thursday, May 23.
Senate Health Committee had extensive discussion today about a number of issues related to improving the health and well-being of Californians.
The first revolved around workplace wellness programs. While some large employers have claimed success in promoting prevention and health at the worksite, other employers have used wellness programs ties to health insurance to shift costs to employees and to discriminate against workers with health conditions. For example, if an employer rewards workers for reducing their body mass index, it is inevitably penalizing workers with health conditions that prohibit or make it difficult for them to do the same. Similarly, with an incentive to go to the gym, if an employee lives in an under-resourced community with no gyms, and is unable to participate in the program, they are penalized.
What is even more concerning are programs that base incentives on health status - things like weight and blood pressure and cholesterol which can be mitigated by personal responsibility, but can also largely be determined by genetics and socioeconomic conditions. If workers with poorer health status are penalized by missing out on incentives or are forced to pay higher shares of cost, this had a discriminatory impact based on health status/pre-existing conditions that we have fought to outlaw through the Affordable Care Act. Creating an institutional practice where healthy people pay less, is in effect creating a policy of charging sick people more - when sick people are charged too much, they don't get health coverage and care and they get sicker. Data has shown that low income people of color suffer the most from these disincentives.
Senator Monning's bill, SB189 would put into place some important consumer protections (such as basing incentives on participation in programs instead of outcomes and minimizing the increased premiums charged to less healthy workers) that ensure that wellness programs do not unintentionally shift costs to less healthy workers or discriminate based on health status or other factors.
After lengthy debate, the bill passed with the minimum five votes, and Senators Wolk and DeSaulnier not voting.
The other health and wellness related discussion was sparked by another bill by Senator Monning, SB622, which would impose a $0.01/fluid ounce tax on sweetened beverages in order to fund childhood obesity prevention programs. Experts testified about the impact that sweetened beverages and the sharp increase in consumption of "liquid calories" has had on the obesity epidemic and proposed this as one way in which to begin reversing the trend. The bill was widely supported by consumer advocates and health care providers but opposed (not surprisingly) by manufacturers and big business. SB622 passed out of committee on a party line vote.
The committee also took up SB161 (Hernandez) related to Stop Loss Coverage. This bill provides protections to small business employees getting coverage through "self-insured" "stop loss" plans by requiring guaranteed issue, guaranteed renewability, and increasing the "attachment point" or employer liability to $65,000 for the entire firm and $13,000 per covered life. SB161 passed with 7 votes (party-line).
Additionally the committee heard SB126 (Steinberg) extending behavioral services to individuals with autism, and passed the measure with bipartisan support. Other bills included SB780 (Jackson) which requires insurers regulated by the Department of Insurance to notify consumers if provider groups terminate contracts so that they don't go to non contracted providers and risk expensive bills. SB780 passed on party lines. SB800 (Lara) requires notice to be given to parents of children enrolled in Healthy Families that they may be eligible for coverage in the Exchange in order to facilitate maximum enrollment in the Exchange programs. SB800 got bipartisan support and also moves forward.
Assembly Health Passes Key Measures to Strengthen Medi-Cal and the Safety Net
Assembly Health Committee passed two important bills on Tuesday that will strengthen the state's health care safety net.
AB880 (Gomez) AB880, the Employer Fair Share For Worker Health Act builds on the existing foundation in existing health care system and the Affordable Care Act, that individuals, employers, and government share in the cost of health care. The ACA requires large employers to pay an assessment to help support the Exchange if their workers need to get subsidized insurance coverage there because they either do not offer coverage or they do not offer affordable coverage. However, the ACA does not address the threats by some large employers to reduce workers' wages and hours so much that they would not end up using the Exchange, but qualifying for Medicaid (Medi-Cal in California) for those under 133% of the poverty level.
AB880 would impose a state fine on these employers so that they are not allowed to shift the cost of providing healthcare to their workers to taxpayers. This bill would only apply to large companies (with over 500 workers), and the money raised would go toward Medi-Cal provider rates, strengthening the safety net, and caring for the remaining uninsured.
Assemblymember Gomez, the bill's author, argued that if we allow big businesses to shirk their responsibilities at the tax payers' expense, what is at stake is the entire state budget and the state's economic recovery.
AB880 (Gomez) passed out of Assembly Health Committee on a party line vote. It will be heard in Assembly Revenue and Taxation Committee before moving forward, and must receive a two-thirds vote for final passage.
AB900 (Alejo) was also heard by Assembly Health Committee today. This bill would stop some of the 10% rate cut to Medi-Cal providers passed in 2010 from going into effect (much like SB640 by Senator Lara). Consumer advocates, safety-net providers, hospitals, and other stakeholders all testified to the devastating effect that this cut would have, especially in the context of the state's already low provider reimbursement rates. AB900 passed out of committee unanimously.
The passage of these measures represent a very positive step toward ensuring that all Californians have access to affordable coverage, but more diligence is required to ensure that these and other proposals are implemented to their fullest potential.
The California Chamber of Commerce released this video this week, that attempted to answer questions for business owners about the Affordable Care Act. Former local TV reporter Kevin Riggs hosts the segment, with answers from Peter Lee of Covered California, which will host the "SHOP Exchange" small business marketplace for health insurance.
What's notable about this segment is that it exists. While some business groups like Small Business Majority and even the Bay Area Council have been supportive and engaged on health reform issues, others chose to simply distort and demonize the law for political purposes--spending millions on misleading campaign ads.
When doing that, it was awkward for them at the same time to educate their members about the new benefits and options under the law--like the small business tax credit to be able to afford coverage, or the coming new small business health insurance marketplace.
Hopefully this video and other materials are a sign that we are past the politics, and can get to the business of educating people with the fact and with news they can use. We want Californians to take full advantage of the law, and we need the Chamber and other business groups to achieve that goal. posted by Anthony Wright | Permalink | 5:56 PM
Upcoming deadlines for commenting at the Exchange...
Friday, April 26, 2013
Covered California is accepting comments on a range of issues in the next two week. Our colleague Cary Sanders at CPEHN just compiled the deadlines for those wishing to weigh in:
26th – Comments on QHP Model Contract
30th – Comments on CMS’ Proposed Rules on Navigators (so Covered California can
incorporate into theirs which are due May
– Comments on Eligibility & Enrollment (draft regs & single streamlined
application to email@example.com),
webinar TBA on Draft Regs in Mid-May
The mantra was "repeal and replace" Obamacare, but it's been clear from some time that Republican leaders in Washington have little in the way of a health plan of their own. As Dana Milbank at the Washington Post amusingly explains, they can't even support one concept (high-risk pools) that has been in past Republican health reforms plans to help people with pre-existing conditions.
As the article shows, even their plan to gut Obamacare ran into disagreement among themselves about *how* to gut it.
Republican leaders had scheduled a vote in the chamber for Wednesday on a plan to help people with preexisting health problems get insurance — part of a broader scheme by Majority Leader Eric Cantor (Va.) to make Republicans appear to care about the little guy. But the conservatives lunching in the Rayburn House Office Building were not biting...
One after the other, they vowed to defeat the Republican leaders’ bill, which they said was not much better than President Obama’s health-care reform:
The wall of conservative opposition appeared to doom Cantor’s warm-and-fuzzy strategy, and party leaders were looking foolish. At the leadership team’s morning news conference, The Post’s Paul Kane asked Cantor if he had the votes to pass his Helping Sick Americans Now Act.
“Well, listen, this is — that is the whip’s purview,” Cantor replied, shifting the blame to Majority Whip Kevin McCarthy (CA). McCarthy had no good answer, so he quoted a movie line. “The first rule of Fight Club: We don’t talk about Fight Club,” he said.
He didn’t need to talk about it; House Republican leaders’ actions said it all. At 3:30 p.m., they pulled the bill from consideration rather than let it face certain defeat...
At the conservatives’ luncheon, the nine lawmakers dutifully parroted these arguments. “We’re shifting money from one part of Obamacare we don’t support to another part of Obamacare we don’t support. That’s a non-starter for me,” Amash said.
Instead, the members demanded another vote on repealing the law — “even if it’s just symbolic,” as Radel put it. (For those keeping score at home, the attempt would be the 40th.)