Busy Day...

Thursday, May 31, 2007

Lots of happenings on health today in Sacramento:

* The Appropriations Committee (Frank Russo gives some flavor here) passed the health care reform plans, as expected.

* More information came out about the release of Sicko, the Michael Moore film, including a premiere that night hosted by Speaker Fabian Nunez in Sacramento on June 12th, as well as a 2p.m. rally that day with Sen. Kuehl and the California Nurses Assocation. (Jon Myers at KQED and Jordan Rau at LA Times have reports).

* On the other side of the spectrum, the Pacific Research Institute hosted a luncheon panel at noon attacking any health care reform, from the Governor Schwarzenegger's proposal to Senator Kuehl's.

* Together for Health Care, a pro-reform coalition that includes California Medical Association, Catholic Healthcare West, California Labor Federation, SEIU, Blue Shield of California, Kaiser Permanente, HealthNet, AARP, Silicon Valley Leadership Group and the California Teachers Association have launched their first ad. The tagline: "If we don't make health care better, it will keep getting worse." Hard to disagree.

The coalition is one of the rash of new health policy coalitions at the state and federal level. (Here's a scorecard.) It's a sign of the times that momentum is gaining on reform, and that is in itself is positive. Yet the diversity of the group (which includes some members and allies as well as sometime and frequent adversaries of Health Access California) means that their agreement is general, not too much beyond broad principles. (Here's one press report.)

Labels: InTheNews, Legislation, Nunez, OtherBlogs, Perata, Sacramento, SB840, YearOfReform

posted by Anthony Wright | Permalink | 6:25 PM


 

What's in the water in Sacramento?

Wednesday, May 30, 2007

With the whales having departed Sacramento (and, it seems, the San Francisco Bay), the focus in the Capitol City comes back to the budget, and health care.

The Budget: The Budget Conference Committee has been named: Assemblymember John Laird (D) will chair, along with his colleagues Mark Leno (D) and Roger Niello (R), and Senators Denise Ducheny (D), Dennis Hollingsworth (R) and Mike Machado (D). You can expect committee hearings shortly, to bridge the differences between the various budget proposal.

Health Proposals: The Appropriations Committee in both houses vote tomorrow, May 31st, to pass out a slew of bills. I don't expect too much trouble from the proposals on the table: AB8 (Nunez), SB48 (Perata), or SB840(Kuehl). This is not just because of the juice of the authors: the committee really focuses on the fiscal impact to the states, and they all have related financing that would not impact the overall budget. (Kuehl's would not be implemented without financing, which is in another bill.)

Passage means that these proposals continue to move to the full legislative chamber of the Assembly or the Senate for their first floor vote in the next few weeks. It will be a whale of a time!

Labels: Budget, Nunez, Perata, Sacramento, SB840, YearOfReform

posted by Anthony Wright | Permalink | 4:14 PM


 

Real stories...

I would be remiss if I didn't point out some articles in the papers. Not because Health Access California is mentioned, but because they offer poignant stories from actual California families about our health system today.

* Bill Ainsworth at the San Diego Union-Tribune features real stories of people dealing with high-deductible plans, and how they would be impacted by an individual mandate, for better and worse. A companion story also documents about how people make tough life decisions simply for the security of health coverage.

* Aurelio Rojas of The Sacramento Bee has the story of Senator Gil Cedillo, not as a legislator, but as a son, dealing with his mother's hospitalization. (Calitics and Working Californians picks up on the story)

That's our organizing is so focused on having California health care consumers simply tell their stories. It is what should inform the current debate on how to make the health system better. (Sometimes, those stories help inform our policy development work. Other times, with the explicit permission of the person, we connect real people with the media, as with the Union-Tribune story. As Victoria Colliver in the San Francisco Chronicle reports, we also did this with Michael Moore's new movie, Sicko.)

Story sharing is the primary work of the Its Our Healthcare! coalition, to make sure that our voices, the voices of California consumers, are front and center in the debate. Check out the constantly-updated website!

Labels: Affordability, InTheNews, OtherBlogs, Underinsurance, YearOfReform

posted by Anthony Wright | Permalink | 1:28 AM


 

The "hidden" reasons for reform...

Tuesday, May 29, 2007

You don't have to be a fan of the New America Foundation to take sides with it over the unabashedly conservative Hoover Institution.

Dan Walters has a questionable column in today's Sacramento Bee that gives way too much credence to a Hoover study trying to downplay the notion of a "hidden tax" in health care.

The "hidden tax" is a phrase Governor uses a lot, to talk about the amount that health premiums are higher because of the uninsured population. The New America Foundation released a study last year often cited by Schwarzenegger. Families USA had a similar conclusion in 2005 with its study documenting "the increased cost of care."

As I have previously said, I don't like the the Governor's rhetoric around a "hidden tax," he tends to blame the victim: the uninsured person who typically is not offered coverage on the job, is not eligible for public programs, and who finds that buying coverage as an individual is either unaffordable or even unavailable, because of "pre-existing conditions." This rhetoric has consequences: if the problem is that people are uninsured, rather than the barriers that lead them to be uninsured, it's no wonder that Schwarzenegger and New America Foundation both see the "individual mandate" as a solution--something we disagree with.

But it is important to acknowledge that our current fragmented health system comes with a cost, to all of us. One of the problems is the lack of fair and equitable financing, with most employers providing coverage to all their workers, but many that don't.

We all pay more when Wal-Mart and McDonald's pay less. It's the same health care system, of doctors and hospitals, and if some manage to not pay their fair share into the system, we all pick up the burden. (Let's remember, the uninsured get it worst, getting charged more than others and facing collections and bankruptcy. But there are costs that are borne in the overall system.)

In some states, they actually have an explicit fee on insurance to help fund the safety-net hospitals and providers that care for the uninsured. So employers and purchasers are able to directly see, on their bill, how much they are paying for a broken health system that leaves people uninsured.

The New America Foundation, in its analysis defending its work, actually pointed out Hoover didn't question the notion of a "hidden tax," just its size. And the New America Foundation makes a credible case that it is bigger than what Hoover estimates.

The thing that rankled me most about the Walters column was the notion that reducing the "hidden tax" was "the most appealing premise" of health care reform. Let's put aside the millions of uninsured who would get coverage, and no longer live sicker, die younger, and be one emergency away from financial ruin. Let's put aside the community, economic, and public health benefits.

It seems to me that there are other reasons why an *insured* person would want a change in our health system:

* SECURITY: Even insured people recognize that they are one job change, one divorce, or other life event, from being uninsured. Reforms could provide more security that they keep the coverage they have now (through an employer or a universal system), are more likely to have coverage at their next job, are more likely to have a safety net if they fall upon hard time, and are more likely to have coverage even if they get sick.

* AFFORDABILITY: Aside from efforts to simply shift the burden of costs onto consumers, most of the ideas to contain costs in the health care system work better when more people are in the system. Whether its information technology, or prevention, or bulk purchasing, or better planning (not to mention fair financing), the cost savings work best in a universal system, rather than our current a fragmented system where it is hard to implement these efforts. For those who are insured, we can best slow the growth in health care costs better if we deal with the uninsured issue as well.

There's no disagreement that there's a cost to the status quo. But let's recognize the other benefits of reform as well.

Labels: Affordability, CostContainment, Employers, IndividualMandate, InTheNews, Research, Sacramento, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 3:56 PM


 

$950 million is real money...

Monday, May 28, 2007

No sooner do we try to tease out the profit motives of BlueCross in opposing new rules and oversight, than we find that the stakes are even higher than we think.

Lisa Girion at the LA Times has the scoop:


State regulators are investigating whether a $950-million dividend Blue Cross of California sent to its Indianapolis-based parent violates an agreement the companies made to limit such payments to keep premiums down and maintain the quality of healthcare benefits, officials said Friday.

Officials said the parent, healthcare giant WellPoint Inc., should have taken no more than $141 million out of California. They called the higher amount excessive, particularly as Blue Cross, which serves more than 7 million state residents, has continued to raise premiums. The state Department of Managed Health Care also is considering expanding its probe to determine whether there are any other potential violations of the three-year agreement, part of a deal to win the agency's approval for a corporate marriage that created the nation's largest health benefits provider.

Cindy Ehnes, director of the Department of Managed Health Care, said she was shocked to learn of the $950-million payday for WellPoint, whose total profit last year was $3.1 billion on $57 billion in revenue.


The merger of Wellpoint and Anthem in 2004, creating the nation's largest health insurer, was controversial, for everything from massive executive payouts, to the question of whether it would truly help patients, not just profits. Then-Insurance Commissioner Garamendi extracted a series of "undertakings," or conditions that the new insurer would have to agree to, in order for the merger to be deemed in the public interest and approved.

The question is whether California BlueCross ratepayers are paying inflated premiums to finance the business expenses and profits of the parent company, Wellpoint.

Normally, the state doesn't look at such information. But the Department of Insurance (and the Department of Managed Health Care) used the merger as a leverage point to place some oversight over BlueCross' behavior. But that authority to keep BlueCross in check has a three-year expiration date.

Let's see how the regulator use this authority. Let's make sure that health reform includes additional oversight over insurers that won't expire.

The undertakings are here. Here's Blue Cross' 2005 report on its compliance with the undertakings.

Labels: BlueCross, CostContainment, Insurers, InTheNews, YearOfReform

posted by Anthony Wright | Permalink | 2:12 PM


 

What is BlueCross afraid of?

Friday, May 25, 2007

More BlueCross blog backlash: Juls Rosen at Working Californians posted her response to the BlueCross ads at dailykos.

At Calitics, dday agrees with our post that there will be a backlash against BlueCross:

"There couldn't be a more reviled corporate entity around these parts than Blue Cross, the team who systematically tried to throw any sick person off their rolls and reduce any effort to get them to actually pay for medical treatment, which after all is their entire job. ... If Blue Cross is the face of health care status quo, I'd say change is a-comin'.

In a comment, Calitics guru Brian Leubitz asks, "WTF are they so scared of?" It's an important question, and the answer suggests that $2 million in opposition might be a down payment.


Blue Cross blues: A review of their "coalition" website is clear about the many reforms that they oppose. The shocking reality is that the practices that consumers hate about insurance companies are actually legal:
* denying to sell people coverage because of their age or health status;
* cherry-picking, using different rates and marketing to avoid people who actually need care;
* diverting premium dollars from patient care to administration, marketing, and profit;
* selling scaled-back plans with limited benefits and high cost-sharing that don't cover much;
* raising rates without explanation or justification.

They are directly attacking the proposals on the table, by the Governor, the Senate President Pro Tem, and the Assembly Speaker, all of which would set new rules and oversight to prevent at least some of these practices.


Health Access California is advocating for new or stronger rules on all these fronts, as well as for SB840, which would radically reduce the role of BlueCross and insurers in general. But even the new rules and reforms that are close to a consensus between the legislative leaders and the Governor would still change the business model that BlueCross relies on.

Two examples:
* The ad directly attacks "guaranteed issue," since BlueCross wants the ability to continue to deny people because of their health status. It's a lot more profitable to sell coverage only to people who won't file claims.
* The website directly attacks setting a "minimum medical loss ratio" meaning that 85% of the premium dollar would go to patient care, rather than adminstration, marketing and profit. The fact that this is a common element of the plans of Schwarzenegger, Nunez, and Perata give BlueCross hearburn: BlueCross HMO has only 78.9% go to patient care; individual who buy the BlueCross PPO only have 51% of their premium dollar go to patient care.


How much money is at stake for BlueCross, the biggest of the California insurers? This San Jose Mercury News article tries to answer (boldface is mine):

How much money Blue Cross makes in California can be difficult to discern, but financial reports that the company files with the state give strong indications about its profitability. In 2005, it sent more than $500 million in profits to parent company WellPoint - the nation's largest health insurer - from its California HMO business alone, which has about 4.5 million members. It reported profits of 10 percent - more than double the HMO profits of HealthNet and Pacificare, Blue Cross' largest for-profit competitors.

Blue Cross' margins on so-called preferred provider plans (or PPOs) - which are subject to less state oversight - are much larger. Documents from a Department of Insurance hearing last year pegged profits for such plans at an average 18 percent, compared with 5 percent for competitor HealthNet. For plans sold to individuals, Blue Cross' profits averaged 27 percent, compared with 15 percent for HealthNet.

No wonder BlueCross likes the status quo, and seeks to block any change, including the ones in discussion now. The comparison to Enron becomes more and more apt.

(Thanks to Matt Ortega at Its Our Healthcare! for re-imagining the BlueCross logo.)

Labels: BlueCross, Insurers, OtherBlogs, YearOfReform

posted by Anthony Wright | Permalink | 2:33 PM


 

The BlueCross backlash begins...

There's a little coverage of Blue Cross firing their first shot at health reform--of the type Blue Cross probably didn't want.

Bill Bradley at New West Notes is dismissive of the ads, and agrees with my assessment not only is the energy analogy wrong, but that the ads may backfire for Blue Cross.

Mike Zapler at the San Jose Mercury News points out the ads were made by the same firm behind the "Harry and Louise" ads of the early 90s. He also reports on the Governor's reaction.

Laura Kurtzman at the AP and Tom Chorneau at the San Francisco Chronicle also report that the response of us at Health Access California was joined by the California Medical Association, calling the ads “abominable.”

Labels: BlueCross, InTheNews, OtherBlogs, YearOfReform

posted by Anthony Wright | Permalink | 10:31 AM


 

More fact-checking, from Fresno to Albany...

Thursday, May 24, 2007

Another study that explodes BlueCross' stunning assertion about the "affordability" of the California individual insurance market.

Bottom line: If you are 20 and never had a health issue ever, you can probably get a good deal in California. But if you are older and/or and in less-than-perfect health, California becomes less "affordable," quickly. In New York, with guaranteed issue, access to coverage is ensured, and the standard rate for a comprehensive package may be more expensive for some, it is less expensive for others.

The study: A national study in 2001 by the Kaiser Family Foundation, authored by Karen Pollitz and Richard Sorian at Georgetown University, and Kathy Thomas, had seven hypothetical applicants, from a 24-year old waitress with hay fever, to a 36-year old with knee surgery 10 years ago, to a 48-year old breast cancer survivor, apply for insurance. They applied to 19 insurers and HMOs in eight markets, including Fresno, California.

The result: Only 10% of application were accepted as "clean" offers--35% were either rejected, and over half (53%) were offered with a premium increase or a benefit limit.

The California conclusion: Carriers in Fresno (and Indiana) had more frequent rejections and premium surcharges than insurers in other markets. On average, applicants were offered coverage only about half of the time in Fresno, compared to about two-thirds of the time in other communities. Applicants in Fresno had surcharges apply 58% of the time, compared to 25%-39% in the other markets.

So any "rate" listed for California ignores how many people are rejected, and how many get a different and higher rate, due to their age and health status.

Comparison with New York: Blue Cross also slams guaranteed issue states, including New York, for having the highest rates in the nation. As a born and bred New Yorker, I hate to break it to them--everything, including insurance, costs more in New York.

But from this study, the hypothetical consumers applied for health insurance in Albany, New York--all got coverage. They all would have been sold a standard policy at a standard rate without any exclusion riders or other coverage penalties for their health conditions. The average premium for our single applicants in Albany was $4,104 per year--only slightly higher than the average premium ($3,996 a year) quoted to many applicants in less regulated markets.

In short, costs in New York, with "guaranteed issue" and "community rating" were similar to those in unregulated states, on average (recognizing that in other states, some paid more and some paid less). But everybody had access to comprehensive coverage, which is not the case in California, despite what BlueCross says.

Labels: BlueCross, GuaranteedIssue, Insurers, OtherStates, Research

posted by Anthony Wright | Permalink | 3:44 PM


 

WWJD? in PA? in CA?

Sometimes, you don't need to comment. The lead of this Pennsylvania Patriot News story is "What would Jesus do about Pennsylvania's health care crisis?"

Labels: InTheNews, OtherStates

posted by Anthony Wright | Permalink | 1:42 PM


 

"Unintended consequences" of BlueCross' ad campaign

In opposing reforms to prevent them from denying Californians coverage, Blue Cross is bringing up the energy crisis, but the analogy might backfire.

Newspapers and even this blog have already chronicled BlueCross' bad behavior in the marketplace, and their overall opposition to any health care reform.

Now they have launched a $2 million-plus ad campaign, under the name "Coalition for Responsible Healthcare Reform." (The LA Times' Political Muscle covers it here.) Blue Cross should be ashamed, spending millions to retain their ability to deny coverage to Californians.

The ads say "Remember how the rash enery deregulation of the energy market in California spawned power outages and soaring rates? Let's not go there again."

But if the energy crisis is the analogy, then Blue Cross is Enron, taking advantage of an unregulated California market and leading to a blackout of coverage for millions. But even the now-disgraced Enron never had the gall to run ads arguing that they should be allowed to continue to manipulate the market.

Because there are so few rules on insurers now, Californians are concerned now they are one job change or life event away from facing a blackout of coverage. We have over 6 million Californians in a coverage blackout. Frankly, we have tolerated deregulation for too long: new and fair rules would increase the security that Californians have now with their coverage, so they are not denied because of their health status.

BlueCross' ad campaign may backfire with the public. They won't believe BlueCross, and they will make it clear to Californians what we can win with health reform.

DOING A FACT CHECK: I think Californians know better than to believe Blue Cross and their misleading statements, especially the absurd notion that buying health coverage as an individual is affordable now. Their ad won't persuade most Californians that individual insurance is affordable now, from a 50-year old woman in the Bay Area, to anybody that takes a handful of prescriptions a year.

Blue Cross' price comparisons matches apples and oranges. It's different products, different people, and different states:
* The list price in many states does not include the significant mark up for age or those who have even minor health issues.
* The states with "guaranteed issue" are Northeast states which started with higher costs of living and higher insurance costs generally.
* Finally, you can't compare a product that actually covers you when you are sick, to one that will not.

We'll have more later in the day.

Labels: Affordability, BlueCross, InTheNews, OtherBlogs, OtherStates, YearOfReform

posted by Anthony Wright | Permalink | 11:01 AM


 

Poverty: It's bad for your health

A big piece of health reform rhetoric -- coming from multimillionaire CEOs -- is the need for personal responsibility and healthy lifestyle choices.

This LA Times story today re-highlights what I thought was a long-established fact, poor women -- many of whom happen to be minorities -- suffer disproportionately from chronic diseases such as diabetes, heart disease, stroke etc.

The study notes that poverty and lack of insurance are complicit in causing these diseases in this population.

As health advocates, we know that the uninsured are twice as likely to forgo medical care and half as likely to fill prescriptions they need, causing their chronic conditions to get worse.

And as members of Congress and various others are learning this week in an empathy exercise, a $3-a-day food stamp allowance that as many as 26 million Americans live on is not enough to live healthy lives. Healthy fresh fruits and vegetables are perishable and more expensive, so what's left is higher sodium, higher sugar, higher calorie foods.

If this emphasis on "healthy lifestyles'' and "healthy choices" really is going to be a part of the reform debate, let's be real about the "choices" that are out there for poor people. Will Safeway stop stocking up on potato chips and candy and offer discounts on fruits and vegetables? Will health insurers start eliminating copays and coinsurance to help people manage their chronic diseases?

Otherwise, there doesn't really seem to be much of a choice.

Labels: HealthyLiving, InTheNews

posted by Hanh Kim Quach | Permalink | 7:39 AM


 

After the slightly off-color joke about Paris Hilton...

Governor Schwarzenegger revisited The Tonight Show last night, where he was introduced as "easily the most popular Republican in the entire country," a phrase that has a bit more edge than Jay Leno is known for.

After suggesting that Jay Leno's proposed 60th birthday idea of having a registered nurse jump out of a bran muffin was "kinky" (will CNA respond?) and admitting to watching all of Paris Hilton's "movies," the Governor talked about health care.

Labels: GuaranteedIssue, IndividualMandate, Insurers, InTheNews, Schwarzenegger

posted by Anthony Wright | Permalink | 12:21 AM


 

Killing jobs? or Killing people?

Wednesday, May 23, 2007

The Chamber of Commerce has just released its annual list of "job-killer'' bills. Among them -- AB8 and SB48, the Legislature's health reform legislation. You'll recall that both bills woudl require businesses to dedicate 7.5 percent of their income to pay for health care for their employees.

(They also opine about "green energy'' and "green building" bills. Maybe global warming doesn't kill jobs.)

Now maybe nobody at the Chamber ever gets sick, but I'm thinking that many of the Chamber's member businesses know better. According the National Committee for Quality Assurance, sicker employees are less productive(Duh) and expensive. Businesses lose about $1.2 billion annually due to heart disease, asthma, hypertension, depression, diabetes, and smoking-related illness. And that 7.5 percent, if anyone up there in the Chamber ivory tower cared to do the math – is less than many businesses pay now for health care.

And, to take the Chamber on its own terms, I can think of no worse "job-killer'' for an employee than being dead. (You think I'm exaggerating, but 18,000 people die a year because they are uninsured making it the sixth leading cause of death in the U.S., according to the Institute of Medicine).


So what do you say?

Will it be a job killer? Or people killer?

Labels: HealthyLiving, Research, Uninsured

posted by Hanh Kim Quach | Permalink | 11:38 AM


 

Need coverage -- and soothsayer

Monday, May 21, 2007

This LA Times story over the weekend helps consumers strategize and build a patchwork health coverage plans for their family, based on what they anticipate their health needs will be.

It's an interesting concept requiring families to look at their past few years of medical bills to determine if they really need a traditional, more comprehensive plan, or can go with a high deductible.

It sounds kind of like looking at a mutual fund's past performance, and anticipating how much it will earn in the future.

The story says that traditional plans, with lower deductibles and good coverage "are still costly"

For a family with a risky medical history, the cost of these policies is
stratospheric.

Uh. Yeah. But a family with a risky medical history is most likely to need good coverage to ensure they don't get sicker.

The story emphasizes the notion that insurance is there to protect assets. But what good is insurance if it deters you from seeing the doctor because of cost. What good is insurance if you have to predict what kinds of services you'll need? You might as well just get a fortune teller to help you plan your child's broken arm and your unexpected heart attack.

Labels: InTheNews, Underinsurance

posted by Hanh Kim Quach | Permalink | 10:34 AM


 

The health debate goes multimedia...

Sunday, May 20, 2007

After a big week, it's time to take a quick check of other blogs and media:

TEXT: There's another edition of Health Wonk Review at Health Care Policy and Marketplace Review blog, which links to several articles of interest, including a conservative critique of the Massachusetts reform, an assessment that highlights the good and the bas about "retail" health clinics, and a detailing of the most recent bad acts by insurance companies.

Of most interest to me was the two links commenting on the new study about the uninsured getting charged multiple times what insurers get charged for the same service. On is at Health Affairs. InsureBlog has a critique that totally misses the point: I would imagine that if hospitals didn't charge such outrageous prices, maybe a few more of the uninsured might actually be able to pay the bill. And regardless, the charged amount--the inflated rate--is the bill that goes to collections and court. The price matters to the person getting the bill.

AUDIO: Back to California politics, KQED's Capitol Notes has now started a weekly podcast of analysis of Sacramento happenings. This week's features the health care, along with the budget and whales(!)

The health care section is amusing. It starts with a negative tone, led by Anthony York playing Eeyore, suggesting all the reasons health reform won't happen this year. But then after ten minutes of conversation, they all seem to come around to the notion that something might happen. (Will business accept a 7.5% minimum employer contribution? Don't most do a lot more now? Aren't some businesses signalling they would support such a standard?... Won't somebody simply put anything that passes on the ballot to kill it? But didn't it come very close time? And wouldn't Schwarzenegger be on the other side of the issue this time?...


VIDEO: Finally, Michael Moore's new film Sicko premiered at Cannes this weekend. It's a comparison of the American health care system with that of other countries. The reports suggests it focus on not just the uninsured but the insured who have issues with our private insurance companies.

Health Access was contacted for stories for the feature, although I hear we were not the only ones: one rumour was that they had hundreds of stories to choose from by the time they were done.

The movie comes out June 29th. It should be interesting to see how it impacts the debate in California and around the nation.

Labels: Hospitals, InTheNews, OtherBlogs, OtherStates

posted by Anthony Wright | Permalink | 10:50 PM


 

Now, is there a return policy on that kidney too?

Friday, May 18, 2007

I always thought it was really screwy that medical professionals could bill patients to correct medical mistakes that the professionals -- not the patients -- made.

Really, we all make mistakes. So the issue really isn't that doctors are making mistakes; it's what they do to make up for them. For most of us, making a mistake is mortifying and often means fixing it -- even if we have to eat the cost.

Unfortunately, that's not always the case in the medical profession. If a mistake is made and a patient ends up back in the hospital/doctor's office, then it means a second or third chance to charge for what should have been done right the first time.

So it really seems like a no-brainer that a Pennsylvania hospital system is providing a warranty for medical care, according to this story in the NY Times.

Already, the Geisinger Health System in Pennsylvania has seen results. Last year, patients who received heart bypass surgeries could return back to the hospital if they had complications -- at no cost to the insurance company.

Well, duh. That seems reasonable. I'd be mad if I had to pay twice.

Since they implemented that policy, the system has found that patients don't return as often, and spend fewer days in the hospital.

Seems like this kind of policy could be a good deal for everyone. No one likes being sick and getting sicker, after you thought you were taken care of, is the worst. And...it's cheaper.

Labels: Hospitals, InTheNews, OtherStates

posted by Hanh Kim Quach | Permalink | 1:27 PM


 

When you come to a fork in the road, take it.

Thursday, May 17, 2007

With all the attention on the financing details of the legislative leader proposals, we shouldn’t ignore the universal health care proposal, SB840(Kuehl), and the attention it has been getting.

There was a good article by Tom Chorneau in the San Francisco Chronicle about the continuing effort. Senator Kuehl says that she plans to put her bill on the Governor’s desk, but it might be in 2008, regardless of what happens this year with the other proposals.

I think Steve Maviglio at the California Majority Report mis-read the article. Kuehl was quoted as saying, "People might say, why are you doing this if we passed that other bill? And I'll say I still think this is the better answer," said Kuehl. "This is will not go away because someone passed a half-assed bill." Unlike Maviglio, I don’t think she was referring to the Nunez bill or the Perata bill--the latter of which she voted for and is a co-author.

She *has* been a critic of the Schwarzenegger proposal--and rightfully so, in our opinion. There are components that don't meet the "do no harm" test that we share with Senator Kuehl. And we agree with her about being vigilant about whatever comes out of the negotiation between the legislative leaders and the Governor.

She is also right that whatever passes and is signed this year--even if it is really good--will probably not be truly universal, and there will be room for improvement. Last year, California passed a global warming bill. It didn’t stop the conversation—it increased interest. There are dozens of new bills on the subject. A health care bill this year—even a good one—will not stop the momentum. (This dday post at Calitics makes the same point.)

Maviglio is right about the opportunity we have this year—to provide security and affordability for those who have coverage, to dramatically expand it for those that don’t, to take several steps toward the goal of universal coverage. Yet he falls into the construct he criticizes.

There’s no conflict between advocating for the vision of a universal single-payer system, and working for positive reforms in this year’s debate--in fact, it is strategic. For the last four years, many advocates and groups have advocated on multiple tracks, supporting a range of health reforms, from expanded children's coverage to an minimum employer contribution to single-payer. There's no need to attack one reform in order to promote another--in fact, it can be counterproductive.

It's good we have an active leader like Senator Kuehl, promoting the vision of a truly universal system. It helps the debate to have SB840 on the table. It's also good that she is supporting and playing an active role in helping shape the legislative leadership proposals to see what we can win this year, toward the goal of quality, affordable health care for all.

Labels: ExpandingCoverage, InTheNews, Kuehl, OtherBlogs, Perata, SB840, YearOfReform

posted by Anthony Wright | Permalink | 5:45 PM


 

Here's something that ruffles my feathers....

It kind of sounds like saline implants for chicken breasts. Whatever it is, it's certainly not "natural."

Apparently, Tyson Foods, Inc. and Pilgrim's Pride Corp. have been calling their chickens -- which are kept moist with injections of a salt water, seaweed concoction and "natural flavor" -- "100% All Natural Marinated Fresh Chicken'' or something like that. (Here's the story in the WSJ.)

Gross.

Their claim is that the chickens have no "artificial ingredients'' because salt and seaweed are both natural. ** So is the saline (sterile salt water) in some breast implants, but no one calls them natural. **

Anyway, this labeling is making real poultry farmers mad because their chickens are really natural.

"Seaweed occurs naturally in the ocean, -- not in chickens,'' said Lampkin Butt, president of Sanderson Farms.

Now, what does this have to do with health reform?

Here's the nexus. Lots of people are suddenly calling for "healthier living,'' which includes healthier eating. All this talk about personal responsibility needs to be coupled with changes in corporate behavior and policy to actually provide healthier choices to begin with.

The problem with the saline-breast chickens is that they contain more sodium than au'naturale chickens. More sodium means "potential health implications,'' according to the American Medical Association. Mr. Butt (his real name) is right.

But the information about the exact "natural'' content of the saline-breast chickens isn't clear unless consumers read the really, really tiny print on the label. Most people don't read the tiny print. They just read the "100% natural" and assume that it's true.

This type of misleading labeling is pervasive in the packaged food industry. The same problem exists for labeling of trans fats, which are bad for reasons I won't go into here. A person should not eat more than 2 grams of trans fats a day.

So, you could feel really virtuous and check the label on everything you eat and think you've hit the target. But if a food item contains less than .5 grams of trans fats, then it can be listed is zero. So if you have six items of food with .4 grams of transfats, you've exceeded your limit.

My rambling point is this, that there is broad complicity in our unhealthy lifestyles. Sure, we need to watch what we eat and exercise, but another part of reform and prevention is also changing the culture that enables companies to dupe consumers -- whether it's about food, or health insurance.

Labels: HealthyLiving, InTheNews

posted by Hanh Kim Quach | Permalink | 12:02 PM


 

Gruberfest

As Jon Myers of KQED's Capitol Notes point out, the buzz yesterday in health reform discussions was MIT professor Jonathan Gruber who held his briefing yesterday to a standing-room only crowd at the State Capitol yesterday. No encores, but you half-expected T-shirts to be sold in the hallway.

The presentation is at the health reform website of the California HealthCare Foundation, which is funding his work. He gave a remarkably matter-of-fact presentation, and answered questions crisply--a surprise for an academic economist. He joked that he would get electro-shocked at any speculation beyond his model and what is backed up from the academic literature.

So for those looking for all the answers, he didn't have them. Some of the assumptions were those given to him by others: for example, the population data was provide by the California Health Interview Survey (CHIS), or the cost of a health product, which was taken from today's market. What he provides is the spreadsheet, which takes this data and makes assumptions about "how individuals and firms react to policy interventions." That enables the estimates about where people will end up, and how much it will cost.

It was interesting--a wonk rock concert, if you will.

Labels: ExpandingCoverage, OtherBlogs, Research, Sacramento, YearOfReform

posted by Anthony Wright | Permalink | 10:24 AM


 

Not suprised....

Wednesday, May 16, 2007

We already knew that the U.S. ranks 21st in life expectancy and 23rd in infant mortality, in spite of spending more than any other industrialized nation on health care, according to OECD stats.

The Commonwealth Fund yesterday just released a report reaffirming that notion.

It's not a surprising revelation for those of us working in health care, but hopefully, it will provide a jolt to those who insist that America has the best health care in the world.

That's not to say the other systems (in Australia, Canada, Germany, NZ and the UK) are perfect -- but they spend about half as much money -- per person -- being imperfect than we do.

Key findings of the report are that the U.S.:

• Is the most inefficient -- costing the most while providing the least.
• Is the most inequitable, leaving low- and middle-income citizens with no health coverage.
• Does poorly on chronic disease management.
• Is behind in adopting information technology to help manage chronic illnesses and see exactly what other treatments any given patient is on before prescribing care.
• Has horrible access because it lacks universal healht coverage.

The only measure that the U.S. does well on is preventive care. But, really, what good is preventive care (discovering you have diabetes) when you can't get your chronic disease managed?

Hopefully, such a report will help convince proud Americans who are convinced that we have the best health care in the world, that while America is great on many things -- it's not really on health care.

Labels: CostContainment, International, Research

posted by Hanh Kim Quach | Permalink | 2:28 PM


 

The money's on the table

Tuesday, May 15, 2007

HEALTH ACCESS UPDATE
Tuesday, May 15, 2007

NEW NUMBERS FOR NUNEZ AND PERATA PLANS ON HEALTH REFORM

* Democratic legislative leaders release financial specifics on health care proposals
* Proposals would cover over two-thirds of uninsured; provide more security for workers
* Momentum for reform prospects, affordability for consumers and employers highlighted

New on the Health Access WeBlog: Theresa Mary Johnson, RIP

Over two-thirds of uninsured Californians would have health coverage under newly fleshed out proposals released by both Assembly Speaker Fabian Nunez and Senate President Pro Tem Don Perata Tuesday.

The new numbers show how each lawmaker’s health expansion plan would be paid for and provide more specifics on how coverage would be provided. Under the notion of "shared responsibility," the proposals would set a minimum contribution for employers at 7.5 percent of wages (for both full- and part-time workers) toward worker health care; would create a statewide purchasing pool as a new option for employers to cover their workers; would expand public programs; would take advantage of federal tax breaks and matching funds; and would place new rules on insurers and reform the insurance market.

This is the first time that the legislative leaders have released the new figures since they both introduced their health coverage proposals in December, which were both aimed at increasing health coverage among California ’s uninsured. The numbers fill in many blanks for AB8(Nunez) and SB48(Perata/Kuehl), and show how their measures would pencil out in the real world.

The Legislative leaders worked with MIT economist John Gruber (who also modeled Gov. Arnold Schwarzenegger’s proposal), funded by the California Health Care Foundation, to run their plans through a computer model, which came up with the numbers that showed the contributions needed in order to make the health plan balance out. Professor Gruber will be presenting his model tomorrow at the State Capitol.

Here's some information about the two plans with some of the new details:

• Coverage expansion to the uninsured: Both cover 3.4 million (69% of uninsured)
• Minimum employer contribution for health expenditures: Both set it at 7.5% of total Social Security wages (capped at $97,500) on health expenditures (for both full time and part-time employees), or pay an equivalent amount into the California Health Trust Fund
• Employers who are exempted:
• SB48(Perata) has no exemptions.
• AB8(Nunez) exempts business operating for fewer than 3 years, with fewer than 2 employees, or with a payroll less than $100,000.
• Number of Californians in statewide purchasing pool:
• AB8(Nunez): Cal-CHIPP – 3.23 million projected to enroll
• SB48(Perata): Connector – 4.1 million projected to enroll (3.6 million adults, 500,000 children.)
• Estimated premium for individuals: For both: Individuals would pay between 0 to 2.8 percent of income for coverage. Families of four (with only one worker): Up to 4.5 percent on income.
• Requirement on individuals:
• AB8(Nunez): Must take up coverage if employer offers coverage, and it’s deemed affordable.
• SB48(Perata): Individual mandate unless income is below 400% of poverty ($40,840 for an individual, $82,600 for a family of four) OR health coverage is more than 5 percent of a person’s income.
• Assistance for low-income families:
• AB8(Nunez): Families and workers below 300% of poverty ($30,630 individual, $61,950 family of four) would receive some relief if they purchased coverage through their employer (through premium assistance), or through Cal-CHIPP.
• SB48(Perata): Families and workers below 300% of poverty would pay a portion of the estimated $224 (per member per month) premium based on a sliding scale.
• Benefits on which estimated are based: Standard coverage, which includes doctors’ visits, hospital coverage, labs and prescription drugs.
  

IMPACT ON WORKERS AND CALIFORNIANS

Under these proposals, most workers would either have their employer provide health coverage, or would get their coverage through a statewide purchasing pool. In the pool, the contribution for workers to pay toward health care would be based on ability to pay. The pool would also use a Section 125 federal tax break to reduce the cost of coverage. Both proposals provide some kind of relief for workers and families who earn less than 300% of poverty.

The following chart shows impacts on both single workers and families.


As the table shows, single workers would spend no more than 2.8 percent of their annual income on coverage; families would spend no more than 4.5 percent on their premiums.

Coverage offered would also be considered comprehensive plans, with "Knox/Keene benefits," which cover doctors, hospital visits, as well as prescription drugs.

Both of these proposals provide a more affordable option for workers than is considered in Gov. Arnold Schwarzenegger’s plan. In Schwarzenegger’s proposal, a worker in the “subsidized” insurance pool person earning between $19,600 to $24,500 (201-250% of poverty) would be asked to spend about 6 percent of their income on premiums alone. That does not include deductibles of $500 and a maximum of $3,000 for the year. In the Schwarzenegger proposal, for families earning more than 250% of poverty, there would be a requirement to buy bare-bones high-deductible plans, with out-of-pocket costs of up to $10,000.

IMPACT ON EMPLOYERS

For many employers, the plans would not have an impact. The plans include a minimum employer contribution of 7.5 percent of wages (for both part- and full-time employees) for health expenses. Assembly Speaker Nunez’ proposal does exempt some smaller businesses. If employers do not wish to spend money on health services themselves, they can contribute an equivalent amount to the statewide purchasing pool, which would use the money to help buy coverage for the workers.

The amount proposed in both plans is far lower than the amount that firms who offer health insurance are already spending for coverage. According to the analyses of both plans, 61.5 percent of businesses already provide health coverage that amounts to an average of 13.8 percent of wages ($79.4 billion total).

However, the Democrat leaders’ proposals require a greater contribution than the 4 percent contribution that was recommended by Gov. Schwarzenegger when he unveiled his plan in January. At that time, the CEO of Safeway, Steve Burd, said the amount was too low. Schwarzenegger also exempted employers with fewer than 10 employees.

OTHER ELEMENTS

Remaining elements that are not addressed here, would remain the same as when introduced initially, such as expansion of Healthy Families to cover all children under 300 percent of poverty, and insurance market reforms to allow people to get coverage regardless of their health status.

WHAT’S NEXT

This is only the first step – of many first steps. Both proposals still must be vetted by each house’s Appropriations committee in the next couple of weeks, which will consider the fiscal implications to the state.

With this financial information, Perata and Nunez’s proposals can be compared alongside two other health reform proposals in the discussion, Gov. Arnold Schwarzenegger’s and Sen Sheila Kuehl’s.

Health Access will continue to provide timely news and analysis as the health reform debate this year continues. For more information, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org.

Labels: Affordability, Employers, Legislation, Nunez, Perata, Research, Updates

posted by Hanh Kim Quach | Permalink | 6:50 PM


 

Fighting to the end, may she rest in peace.

Sad news: Theresa Mary Johnson, president of the Older's Women League of California, passed away this weekend.

A mother of nine (!) children, she was a spirited and forceful advocate for social justice and universal health care. Her death was a shock to many of us, as she was active as ever, just last week presiding over OWL's annual Mother Day's event. She recently testified before the California legislature's health committees in favor of SB840(Kuehl), and other bills. This and last January, we went as a group to Washington, DC, and visited several Capitol Hill offices on Medicare Part D issues, where she made strong points to key Congressional staffers.

Betty Perry, OWL's public policy director and chair of the Health Access California board, greatly appreciated her leadership and partership with the advocacy work. We will miss Theresa Mary, and offer condolences to Betty and the rest of the OWL and senior advocacy community.

Labels: HealthAccessCommunity, Medicare, SB840

posted by Anthony Wright | Permalink | 11:04 AM


 

Woe is them....

This Wall Street Journal (subscription required) story this AM made me cock my head.

Here's the first sentence:

"Major U.S. health insurers appear to remain on steady footing even though some companies said that they had spent an unexpectedly high percentage of premium revenue in the latest quarter on patients' health bills." (italics is mine)

Cue the violins, because the story goes on to say:

UnitedHealth Group Inc. posted a disappointingly high medical-loss ratio

(Translation: Medical-loss ratios is the technical term for spending money paying for health care)

Let me get this straight: so it's a sad and "disappointing" day when health insurers have to do their job? Pay for health care?

If I were a health insurer today, I'd hide my face in shame.

This story unwittingly illustrates exactly what is wrong with the current system -- an emphasis on bottom-line profits -- not patients.

Labels: Insurers, InTheNews

posted by Hanh Kim Quach | Permalink | 6:49 AM


 

No news is good news?

Monday, May 14, 2007

HEALTH ACCESS UPDATE
Monday, May 14, 2007


GOVERNOR RELEASES MAY REVISION OF BUDGET
· April tax revenues give budget some slack; Few changes in health programs
· AB1324 (De La Torre) on insurance rescissions passes Assembly

New on the Health Access WeBlog: Responses on Biz Coalitions, Update on Rescission Bill


Gov. Arnold Schwarzenegger unveiled his May revision of the $145.9 billion state budget Monday. In spite of the molasses-slow housing market, a little bump from April’s tax season helped tide the budget over for this year. The full budget and a summary is available at:
http://www.ebudget.ca.gov/Revised/BudgetSummary/BSS/BSS.html

After several budget hearings over the past several months, this announcement begins a month-long legislative sprint to consider these changes, and negotiate a budget for the 2007-08 budget year.

NO MAJOR CHANGES IN HEALTH PROGRAMS

Schwarzenegger’s Health and Human Services budget does not expand or increase eligibility in any health programs.

The Governor's health reform proposal is not included--and was not expected to be included--in this budget proposal. To the extent that major health reform passes this year, those changes and programs will be reflected in next year's budget process.

The budget estimates the money needed for Medi-Cal, Healthy Families to continue to provide coverage for Californans who are eligible and enrolled. Here's a short update on key health programs:

· Medi-Cal provides coverage to many low-income seniors, people with disabilities, children, and in some cases their parents.
· Remainder of 06-07: $35.4 billion ($13.6 billion general fund). This now covers 6.5 million eligible Californians.
· For 07-08: $37.7 billion ($14.7 bilion general fund) to cover an estimated 6.6 million eligible Californians in any given month.

· Healthy Families: covers children in families up to 250% of poverty.
· Remainder of 06-07: $1 billion ($362.2 million general fund). Now covers 844,000 children.
· For 07-08: $1.1 billion ($400.4 million general fund) to cover 920,000 children.

· Access for Infants and Mothers: covers some pregnant women
· Remainder of 06-07: $124.4 million. Serves 1,606 women monthly.
· For 07-08: $133.2 million to serve about 1,159 women monthly.

Other changes included a new rate methodology for Medi-Cal managed health plans to be phased in, costing $214.3 million ($107.1 million general fund); and an $39.4 million increase in county and other adminstration costs for implementation of the federal citizenship verification requirements under the Deficit Reduction Act.

The budget proposes to continue to fund small but important programs to which the federal government will no longer provide matching funds, like the Healthy Families to Medi-Cal "Bridge" that covers about 2,000 new children a month. The proposal would continue the program this year, costing $1.5 million, and restructure the program to allow future federal funding starting July 2007.

OTHER PRIORITIES

In the overall budget, Schwarzenegger pays down $3.1 billion in debt, including paying off some debt early. Democratic legislative leaders contrasted this choice with his proposal to not give cost-of-living increases for elderly, blind and disabled SSI paychecks, which amount to about $860 a month per person. KQED reporter John Myers’ asked Schwarzenegger whether this tactic was like “making an extra mortgage payment when you can’t pay the utility bills.” Schwarzenegger said it wasn’t the ideal situation, but that he wanted to pay off more debt.

Assembly Speaker Fabian Nunez called the proposal “mean-spirited” and said Schwarzenegger’s May Budget proposal would not pass as it is now. By paying off debt early, Assembly Budget Chairman John Laird said the governor was choosing “Wall Street over California’s children, seniors and people with disabilities.’’

WHAT HAPPENS NEXT

Each house of the Legislature will finish putting together their versions of the budget this month. Then begins the process of combining the Assembly, Senate and Governor proposals before the July 1 fiscal year begins.

OTHER HEALTH HAPPENINGS

Also on Monday, AB1324 (De La Torre), which re-states existing law that bans insurance companies from cancelling coverage if policyholders had applied for insurance in good faith.

The bill directly addresses Blue Cross' habit of cancelling patients's coverage after expensive claims were made, as uncovered in the LA Times. The patients were left uninsured and on the hook for hundreds of thousands in treatments.About 6,000 patients later joined together in a class action suit against the insurer, and have been joined by doctors and hospitals.

The insurance plan has been fined by the Department of Managed Health Care for this practice and on Friday, Blue Cross agreed to change its policy on how it decides to cancel coverage.AB1324 passed on Monday on a 47-16 bipartisan vote (unofficial tally). Seven Republicans, including Bill Emmerson and Alan Nakanishi who are both members of the Assembly Health Committee, voted in favor of the bill.

For a list of other bills of interest to health advocates, visit http://www.health-access.org/advocating/2007_bills.html.

Our blog, updated daily, has other updates on the health reform debate this year, including a newly-posted scorecard to keep track of the various healthcare coalitions:
http://www.health-access.org/blogger.html

For more information, contact Hanh Kim Quach, the author of this report, at hquach@health-access.org.

Labels: Budget, DMHC, Insurers, Legislation, MediCal, Updates

posted by Anthony Wright | Permalink | 6:38 PM


 

Calm waters...

No major announcements, good or bad, in the health budget of today's May Revise.

(For those wondering, the Governor's health reform proposal is not included--and was not expected to be included--in this budget proposal. To the extent that major health reform passes this year--including the revenues--that will be reflected in next year's budget process.)

We are reviewing the details of the May Revise. Here's the basic stats for the key health coverage programs, Medi-Cal and Healthy Families.:

* The number of Californians getting Medi-Cal coverage is decreasing a bit, by around 1%, to about 6,602,900, which probably is related to the improving economy. The May Revision includes total Medi-Cal expenses at $37.7 billion ($14.7 billion general fund).

* Healthy Families is continuing its steady increase in covering more children, by about 9%, to about 919,500. Taking into account renewed efforts to maximize enrollment, the May Revision includes Healthy Families expenses at $1.1 billion ($400.4 million general fund).

Labels: Budget, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 1:46 PM


 

Cutting the strings...

The Assembly just passed AB1324 (De La Torre), which clarifies that insurers can't rescind coverage if the policy holder had completed applications in good faith.

The bill attempts to address a rash of instances, uncovered in the LA Times, where Blue Cross cancelled patients' coverage after expensive claims were made, leaving them uninsured and on the hook for hundreds of thousands in treatments.

About 6,000 patients later joined together in a class action suit against the insurer, and have been joined by doctors and hospitals.

On Friday, Blue Cross agreed to change its policy on how it decides to cancel coverage.

AB1324 passed on Monday on a bipartisan vote. Seven Republicans, including Bill Emmerson and Alan Nakanishi who are both members of the Assembly Health Committee, voted in favor of the bill.

Labels: BlueCross, Insurers, Legislation

posted by Hanh Kim Quach | Permalink | 1:24 PM


 

May flowers?

The "May Revise" of the state budget will be released today at 1:00pm. You can watch the release at the Governor's website, or just download the documents at the Department of Finance website.

Only a few years ago, those of us concerned with the state's health care system braced themselves for this announcement, fearing major cuts. Now, that's less of a concern, given better economic news and a higher priority for health care. But there is still lots of things to watch.

We'll post our quick analysis of the Governor's new health budget later in the day.

Labels: Budget, Sacramento, Schwarzenegger

posted by Anthony Wright | Permalink | 9:53 AM


 

The Rorscarch test...

Sunday, May 13, 2007

The response to the Governor's press event (here's the video and transcript) with some of the CEOs with the Coalition to Advance Healthcare Reform was interesting. The Sacramento Bee and the San Jose Mercury News both covered the event, but it was the blogs that really took notice.

Frank Russo at the California Progress Report has a full report, as does KQED's John Myers. Both wonder about the specifics that these CEOs would agree to, including those that would impact their businesses. Although coming from different places, Jon Fleishman at the FlashReport and Randy Bayne at Capitol Notes are more pointed, suspicious of what these businesses might support. Yet another viewpoint is that of Speaker Fabian Nunez, who took it as a sign of momentum for reform.

Labels: InTheNews, OtherBlogs, Schwarzenegger

posted by Anthony Wright | Permalink | 11:12 PM


 

Are they saying they were wrong?

Friday, May 11, 2007

Blue Cross now says it's no longer going to willy-nilly cancel people's insurance policies when they have a suspicion that policyholders didn't disclose *everything* about their health history since they were 1.

Now, the health insurance giant says it will ask policyholders when they see a problem with their applications before deciding to cancel their policies.

It's nice to see, now, that Blue Cross believes in the presumption of innocence unless proven guilty.

Not only are they going to make applications easier to understand, they're saying that if applicants made an honest mistake, then the insurance company will continue the patient's insurance.

Is Blue Cross saying they were wrong to unilaterally -- and without notice -- cancel patients' policies while they were in the middle of expensive medical treatments?

Not quite. With 6,000 former policyholders suing the company, it was getting kind of expensive.

Their 180-degree change in policy isn't quite the stunning admission I would have hoped for, but I'll take it.

Labels: BlueCross, Insurers, InTheNews

posted by Hanh Kim Quach | Permalink | 12:34 PM


 

This sounds good and all, but....

Thursday, May 10, 2007

The governor, a bunch of California CEOs and some lawmakers aligned themselves outside the Capitol this morning – squinting, sweating and soaking up cancerous sun rays – and showing how excited they are to fight for health care reform.

It’s Safeway CEO Steve Burd’s Jet-Setting CEO Show. Earlier this week, he was in Washington D.C. promoting the Coalition to Advance Healthcare Reform. (Here's a San Diego Union-Tribune story about Burd and his coalition).

Joining him today was Del Monte Foods, BumbleBee Foods, Long’s Drug Stores and a smattering of other big businesses. Altogether, nearly 40 corporations – including a number of insurers (except Blue Cross) have signed on with Burd to campaign for health reform.

First thing’s first. We’re glad that after years and years of fighting and disagreeing with us, California’s deep-pocketed CEOs, agree that we need to fix health care and make sure people can lead healthier lives, and get the health care they need, when they need it.

We appreciate that one of the coalitions core tenets is “Financial Assistance for Low-Income Individuals” and encouraging healthier lifestyles. We’re all for that.

But (you knew there had to be a “but”) I want to quibble with a few of their assertions and kvetch a bit.

First, Burd said “25% of the uninsured have the financial wherewithal to pay for insurance.’’
I’m not sure where he gets his numbers.

Judging from the latest California Health Interview Survey, if everyone who is currently uninsured and made more than $50,000 a year purchased health care, we could cross off 18%. That’s significantly below the “quarter of the uninsured’’ that Burd talks about. And we can’t really assume that all 18% can afford coverage. A number of those are families who have children. A family, with an income of $50,000 in Oakland, is unlikely to be able to afford health coverage. Backing out the families with kids, we’re down to 14%.

Secondly, many of speakers referenced the role that individual responsibility plays in leading healthy lifestyles. In particular, the CEO of Del Monte Foods talked about nutritious eating to ensure that people live longer.

I think that’s a fabulous idea -- but since when is canned fruit (steeped in sugar) a health food? Del Monte’s pear halves contain more than twice as many carbohydrates and nearly twice the calories as the same fresh piece of fruit (I'm an obsessive calorie counter). Of course – canned fruits are also less expensive – which will be part of my point.

Really, though, the point these CEOs are trying to make is that diabetes, heart disease, asthma and obesity (the biggest cost drivers in health care) are easily preventable if people take responsibility and take care of themselves. That means exercising, taking your meds, seeing the doctor when you're supposed to, etc.

First off, a lot of what determines whether or not you get one of these chronic diseases is genetics. So, if I could have chosen a father who doesn’t have heart disease and diabetes (my father is 130 pounds, a tennis player and hiker, NOT overweight), that would have been the best way for me to exercise prevention.

But many people are able to manage their diseases with healthier living...

....That assumes, though, that struggling families, who are considered middle-income, have time after working two jobs to exercise.

...That assumes that you can afford to buy or rent a house far from the carbon-spewing industrial areas, further from the freeway, away from fields where they are spraying pesticides (or even away from Fresno, where Bay Area smog rolls in)

...That assumes that you can afford fresh fruits and vegetables, not ones preserved in cans.

...That assumes that your neighborhood is safe enough for your children to actively play in the streets, and walk to school.

...That assumes that you can afford the regimen of drugs, inhalers and follow up visits that are required to manage your disease.

(** Note: while plans say they cover 100% of "preventive" care,
they don't mean managing chronic diseases, although covering chronic disease is a new "phenomenon" that is written about in this WSJ article that I blogged about yesterday)

If CEOs are going to insist on individual responsibility, the other pieces (government and employer and corporate responsibility) need to be a piece of the solution too.

I was disappointed that Burd didn't come out and definitively say -- as he has in the past -- that an employer mandate is necessary and 4% contribution from employers is too low. This is an important point because without being in an employer-pool, workers making $15 an hour ($30,000 a year) would have to go out and buy insurance on their own at exhorbitant rates.

Again, I do appreciate that big business is pushing health reform and annoying some of their smaller compatriots.

But loosely saying that "the market'' should be allowed to work, when it hasn't been controlled thus far, is no longer enough. Emergency rooms are packed to the gills and sick people are dying because they can't get in.

We've been talking about health reform for decades, it's time to get specific and move forward.

Labels: HealthyLiving, InTheNews, YearOfReform

posted by Hanh Kim Quach | Permalink | 4:23 PM


 

You need a scorecard to keep track? Here it is...

Wednesday, May 09, 2007

By popular demand, here's a scorecard of the new state and national coalitions around healthcare reform. I might miss some, and won't include ongoing, existing coalitions (like Health Access California) as well as those that focus on one specific piece of legislation, like Sen. Wyden's bill or the Kennedy/Dingell bill at the national level, or SB840 or universal children's coverage here in California.

These descriptions are short summaries, and not meant as endorsements or critiques. I'll try to refrain from much editorializing:


Better Health Care Together
* Got the most press for having SEIU and Wal-Mart together at the annoucement, it also includes the Center for American Progress, CWA on the labor side, and high-profile businesses such as communications companies AT&T, Qwest, and Intel, and temp agencies Kelly Services and Manpower, among others.
* Vague but broad principles, that by 2012 every American should have "quality, affordable health insurance coverage."

Health Care Coalition for the Uninsured
* Includes many of the different health industry stakeholders, from insurers to providers to some business and consumer groups, including the American Hospital Association, American Medical Association, American Public Health Association, America's Health Insurance Plans, Blue Cross and Blue Shield Association, Catholic Health Association, Chamber of Commerce, AARP, and Families USA.
* With a federal focus, this coalition has probably the most specific (if less ambitious) health plan, mostly around expanding public programs for children as a priority, and expanding tax credits for individual private insurance.

Divided We Fail
* Smaller coalition but seemingly a bigger commitment from its three main members: AARP, SEIU, and the Business Roundtable.
* National reach but with statewide activity, focused on "access to health care and long-term financial security."

Coalition to Advance Healthcare Reform
* Mostly Fortune 500 businesses, led by Safeway head Steve Burd, including other supermarkets and drugstore chains (Raley's, Price Chopper, CVS, Longs), retail goods manufacturers (H.J. Heinz, Clorox, Wrigley, General Mills, Kraft, PepsiCo), insurers (Aetna, Kaiser, Blue Shield of California, Pacificare, Cigna), and drug companies and others (GlaxoSmithKline, Eli Lilly, PG&E.)
* Mostly national in scope, but Safeway and other members have been very active in the California debate. Principles include: "Market-Based Healthcare System; Universal Coverage with Individual Responsibility; Financial Assistance for Low-Income Individuals; Healthier Behavior and Incentives; Equal Tax Treatment"

Together for Health Care
* California-focused health care stakeholders, including California Medical Association, Catholic Healthcare West, SEIU, Blue Shield, Kaiser, HealthNet, California Labor Federation, California Teachers Association, Silicon Valley Leadership Group, etc.
* Broad principles, committed to "universal coverage," "shared responsibility" and "sustainable and equitable financing." Members say they are focused on creating a positive environment for reform in California this year, even as different members have different viewpoints on the proposals on the table.


While these aren't "strange bedfellow" coalitions, I would be remiss not to include:

Its Our Healthcare
* Growing coalition of 50+ consumer and constituency organizations, including AARP, ACORN, AFSCME, Consumers Union, Health Access California, CALPIRG, SEIU, California Alliance for Retired Americans, California Labor Federation, California Council of Churches, IMPACT, California Pan-Ethnic Health Network, California Primary Care Association, Congress of California Seniors, Latino Coalition for a Healthy California, and many others.
* This public campaign is to ensure that consumer voices and principles are reflected in the policy debate this year, to win reforms this year that benefit health care consumers.

Having Our Say
* California-focused coalition of groups that specifically represent communities of color, led by the California Pan-Ethnic Health Network, the California Immigrant Policy Center, and the Latino Issues Forum, and many others.
* Working with Its Our Healthcare, but with a focus on addressing issues of equity in the health system, to meet the needs of the diversity of California.


Finally, while all of the above coalitions emphasize their support of healthcare reform (even as they are vague or have different notions of what that is), one new coalition has a much more negative tone, with their emphasis explicitly against any employer requirement. The California Small Business Health Coalition is led by the California Restaurant Association, California Small Business Association, National Federation of Independent Businesses, and others, including large employers like Yum! Brands (KFC and Taco Bell). On the positive side, they do state their support for lower health costs and expanded children's coverage.

We'll try to keep you updated with all this activity...

Labels: ExpandingCoverage, YearOfReform

posted by Anthony Wright | Permalink | 4:16 PM


 

We hate to gloat, but...

Health Access' Legislative Advocate, Beth Capell, is beaming.

She's right -- again -- and she's got a Wall Street Journal article, (subscription required) quoting big businesses and insurers such as Marriott International and Aetna, to prove it.

Her unlikely new allies are singing the praises of LOWERING co-pays to cut costs, rather than INCREASING them, as the trend has been the past decade.

"Behind the about-face (on co-pays) is mounting evidence that higher
copayments may not make long-term economic sense. While hey've curbed drug
spending in the short run, studies show they've also discouraged people from
taking essential medicines."

As a result, some employers -- such as Marriott and Proctor & Gamble -- and health plans, mainly Aetna, are reducing or eliminating co-pays for patients with chronic diseases -- such as diabetes, and heart disease.

Since eliminating co-pays on asthma drugs, Pitney Bowes, the giant mail managing company, reports spending 19% less ANNUALLY for EACH asthma patient compared with six years ago.

Mariott reports that the expense of waiving and halving copays is more than paid for by their newfound savings.

"Over the next several years, we think we'll see even better results,'' said
JIll Berger, Marriott's vice president of health and welfare.

Now, Marriott's going *nuts* -- waiving copays all over the place -- on childhood immunizations, mammograms and colonoscopies, the Journal reports.

I'm glad these businesses are "discovering'' the wisdom of this tactic, and frankly, am a little miffed about why others aren't following. It's kind of like getting the oil changed in your car, you do a little regular and preventive maintenance on the front end to avoid something really bad, expensive and hard to explain on the back end.

Hopefully, these new allies can help prosletize on this front, since many of their colleagues have declined to hear it from the experts.

Labels: Affordability, CostContainment, InTheNews

posted by Hanh Kim Quach | Permalink | 10:49 AM


 

The coalitions of the willing...

The announcement earlier this week in the LA Times about the Safeway-led health care coalition would have been more momentous, if it wasn't that it sounded like a lot of similar announcements in the past few months, at both the state and federal level.


These new coalitions often are made up of so-called "strange bedfellows," and have vague names, like "Together for Health Care," "Divided We Fail," "Coalition to Advance Healthcare Reform," and "Better Health Care Together." They usually also have vague principles, which show that while the organizations involved are interested in being supportive of some reforms, they haven't agreed together on too many specifics yet.


My take? It's yet another sign there's new interest and momentum for health care reform. It's welcome that some new players, especially in the business community, are not simply just opposing various reform ideas as a reflex. We have worked with some of leading organizations in these groups, and know that there are areas of agreement, as well as areas where we agree to disagree. But it is appropriate to be skeptical of the goals and policies of Safeway, or insurers, or drug companies. So consumer advocates also need to be watchful and vigilant that some of these groups may well advance some proposals that are not in the best interest of the consumer.



There new entities are distinct from specific coalition efforts around specific proposals, like SB840 or universal children's coverage, or long-standing coalition organizations with specific missions, like Health Access California. It also distinct from the public campaign that we are actively involved with, Its Our Healthcare!

You'll notice that Its Our Healthcare, as a consumer campaign, it is getting its own press as well. But with all these new coalitions, we thought it was important to have a vibrant coalition effort focused on the public interest, on representing and activating the patient voice.

Coming soon: a scorecard of these coalition efforts...

Labels: ExpandingCoverage, InTheNews, YearOfReform

posted by Anthony Wright | Permalink | 12:26 AM


 

Spins a web...

Tuesday, May 08, 2007

The Health Affairs study on hospital overcharging that Hanh describes got national attention, including in the blogosphere from everybody from Juls Rosen to Ezra Klein.


The issue has been a focus and passion of Health Access California for five years, and its not a surprise that California, with one of the biggest problems, was one of the first and most ambitious in passing a law to solve it. AB774(Chan) was a big victory that will help many people avoid bankruptcy, but there's more work to do: hospital charges need to become transparent to relate to actual cost; and nobody should be left alone without group coverage.


While with Ezra, check out his review of Spider-Man 3. He gives it thumbs down for dialogue, but manages to see the movie as a message for universal health care. Given how many people saw it, hopefully others see it that way as well...

Labels: Hospitals, InTheNews, MedicalDebt, OtherBlogs

posted by Anthony Wright | Permalink | 4:06 PM


 

Mr. Near-Universe?

We attended a big, colorful rally today sponsored by the California Nurses Association and many others in support of SB840(Kuehl) and creating a universal, single-payer health care system.

For those of us that support universal health care, Senator Kuehl made an important point in her remarks, that the Governor's proposal is not universal--that simply telling people to buy coverage that may be unaffordable to buy, or to use, may have a universal impact, but won't provide universal coverage.

So it was misleading, as some media reports did last week, to say that the Governor's plan is more expansive that the legislative leaders, even if he calls it "universal." Speaker Nunez and Senate President Pro Tem Perata are simply more forthright about what their proposals do, and don't do. And their proposals are far less likely to make people get unaffordable coverage, which provides little help to the patient or to the health system.

Citing Speaker Nunez's press release about his health plan, blogger Randy Bayne asked if being "near-universal" is like being a little bit pregnant. It's a good joke, although I appreciate that Speaker Nunez is being honest. It doesn't mean his proposal isn't worthy of support--it expands coverage and health security and brings us closer to a truly universal system. But it is helpful to be clear.

Labels: Kuehl, Nunez, OtherBlogs, SB840, Schwarzenegger

posted by Anthony Wright | Permalink | 1:31 PM


 

Soaking the poor...

Health Affairs' new issue, today, contains an excellent examination of hospital overcharging practices nationwide. (The study is summarized in these LA Times and SF Chronicle articles).

Essentially, it confirms what we advocates already knew: that hospital are routinely charging uninsured patients at least 2.5 times what Medicare and insurance companies pay for the same exact procedures.

In California, it's worse, with hospitals charging 4 times what Medicare allows, making it the third most egregious state in hospital overcharging. The results are similar to a Health Access investigation in 2004 called "Your Money or Your Health", that examined one hospital chain's pricing practices by looking at bankruptcy records.

What really blows is this: When the hospitals increase what they "charge'' it means that insurers can negotiate bigger discounts -- so insurers aren't paying higher rates.

"When the hospital increases its charges,...only self-pay (uninsured or
underinsured) patients are expected to pay the higher charges.''

And really, if someone is uninsured, it's most likely because they can't afford insurance in the first place. So how on earth could they afford the highest rates? The study finds that the collection rate from the uninsured is only about 10 percent.

Basically, this practice just means huge amounts of stress for patients who must deal with their illnesses, bills, and aggressive, name-calling debt collectors banging on their doors.

Now, the Health Affairs study looks at 2004 rates. That's two years before California passed AB774(Chan), sponsored by Health Access California, which took effect on January 1 of this year. It prevents this sort of overcharging for patients who are underinsured or earn less than 350% of poverty ($35,735 for an individual). Things should be a bit better for uninsured and underinsured patients now, as Anthony said in the SF Chronicle article:

"The ER visit that might have cost thousands of dollars may now cost several
hundred or a thousand dollars, which is still a lot of money, especially for
lower-income patient," he said. "But the patient at least has a fighting chance
to pay."

Labels: Hospitals, InTheNews, MedicalDebt, Research

posted by Hanh Kim Quach | Permalink | 11:25 AM


 

The door has slammed... keep banging!

Friday, May 04, 2007

My colleague Elizabeth Abbott just returned from a conference where she reported that one of the governor's many health care advisers, Herb Schultz, told conference attendees that the governor would definitely veto SB840 if it passed the Legislature again this year.

It's a shame that the governor would still take this position in spite of the fiscal wisdom of SB840 -- the $8 billion a year it could save the state, while delivering health care to everyone.

As we mourn -- again -- what we suspected (that SB840 would again get vetoed), this doesn't mean we shouldn't continue to be very active in supporting SB840, in organizing to get the Governor and those who have voted against it to change their minds. In addition, we have other health reform measures that are advancing. AB8 and SB48 will be heading to their respective houses' Appropriations committees in the next month.

While not perfect, if we work on them, both of these bills will give us a chance to get more Californians affordable health coverage.

Labels: Nunez, Perata, SB840, Schwarzenegger

posted by Hanh Kim Quach | Permalink | 12:32 PM


 

A senior moment...

I've been on the road speaking a lot. Yesterday, I presented on the health reform debate to a conference on Healthy Aging.

My message to them, not shockingly: seniors need to be engaged in this health reform and coverage expansion discussion. In part, I wanted to blow up the myth that seniors and their concerns aren't relevant because they largely have coverage through Medicare and Medi-Cal.

1) In fact, it is because they do have such coverage that they need to pay attention. Every time there is a recession or a deficit, we face calls to cut these programs. As health and consumer advocates, we argue that the increases in these programs are actually less than the overall private market, which leads us to conclude: We don't have a Medicare problem, We don't have a Medicaid problem, we have a health care problem.

And unless we fix the overall health care system problems, cutting Medicare or Medi-Cal isn't going to help. At the same time, Medicare and Medi-Cal will also be targeted for cuts until we get a handle on the overall system.

2) Medicare is a model, for those of us who support a universal, single-payer plan (like SB840), and related plans. Senator Kennedy and Representative Dingell just introduced a "Medicare for All" bill last week, allowing people to buy-in to Medicare. Professor Jacob Hacker calls his proposal "Medicare for Many." Introducing younger, healthier populations into Medicare, which right now is by definition older and sicker, could actually help the long-term financial picture for the program.

3) Many seniors rely on Medi-Cal, which could in store for major improvements. On the table are major Medi-Cal rate increases, which could increase access to care for many seniors, children, and people with disabilities. This also includes Medi-Cal expansions, not just for children but for low-income parents and adults without children at home: that's a big hole in our current system now, one that a lot who are in the 50-65 year old range fall through.

4) Speaking of the 50-65 year olds, they have perhaps the most to gain from comprehensive health reforms. Many are in the types of jobs that don't provide health coverage, and would benefit from an expansion of employer-based health coverage. Early retirees and others often find it impossible to buy coverage as an individual, either because it is unaffordable or unavailable, because of "pre-existing conditions" that virtually anybody who has lived sevreal decade has. Reforms on the table include prohibitions for insurers to deny or discriminate against consumers because of their health status.

5) Seniors are the biggest users of health care. Any effort to change or improve health care will naturally have a disproportionate impact on those who interact with the system the most.

6) Everybody has an intergenerational stake. Seniors also care about their own care, but that of their children and grandchildren. They want their family to have the social compact they had, where if they worked and paid taxes, they would have the security of health coverage. But they recognize that wihout action, that compact is unravelling.

Seniors can be an important voting block and political constituency, and so the success of reform, both in terms of if something gets passed and what gets passed, could hinge on the senior community.

Labels: Budget, CostContainment, MediCal, Medicare, SB840, YearOfReform

posted by Anthony Wright | Permalink | 7:14 AM


 

I expected a little more...

Thursday, May 03, 2007

An article in the Wall Street Journal today titillates us with talk of a "rift'' between Republicans in Congress and the Bush Administration over money for children's health insurance.

Republicans and Republican candidates are representing states that have acknowledged that more needs to be done to cover middle income children. These states are applying for waivers that will allow them to include more children beyond the ceiling set by the federal governmnet at 200% of poverty level -- $34,340 for a family of three. (California is one of those Republican-led states that is seeking to expand its children's coverage program).

But none (except former Arkansas Gov. Mike Huckabee) is taking the President's meager allotment for the program to task. They're not even really inquiring about it.

The president has proposed to fund the State Children's Health Insurance Program at a piddling $5 billion over the next five years, which would leave many states -- including California -- woefully short of the amount they need. Advocates believe the amount should be an additional $65 billion over the next five years. Democrats are fighting for another $50 billion.

If health care reform is going to happen, funding children's coverage a cornerstone to that plan. All elected leaders -- Democrats and Republicans alike -- need to be pressuring the administration to increase those costs.

That will definitely involve more direct confrontation than what is going on now.

Labels: Bush, InTheNews, SCHIPHealthyFamilies

posted by Hanh Kim Quach | Permalink | 11:02 AM


 

Why they gotta be that way?

Wednesday, May 02, 2007

Here's an interesting story in the LA Times this past weekend that highlights the inefficiencies in our current health system.

Blue Cross-Blue Shield health plans have agreed to pay $128 million to more than 900,000 physicians who charged that the Blues systematically paid them for less expensive procedures than the ones that were performed.

In addition to the $128 million settlement, the physicians will also have about $49 million in legal fees.

Rather than paying $172 million on the back-end, why didn't the Blues (and other health plans that were initially sued and settled) not pay the right amount in the first place, saving themselves and physicians the expense, energy and stress of going to court.

All that effort that went into fighting over claims could have actually gone to patient care.

This Wall Street Journal article (subscription required) from February that reported insurers and providers were spending an extra $20 billion a year -- in administrative costs -- to sort out claims need to be re-submitted several times and routinely denied by insurers.

$20 billion!

That's enough to:

• Expand Medicaid to 5 million people nationwide, making a dent in our 47 million uninsured
• Expand coverage to all California children for more than 2 years
• Pay to increase Medi-Cal reimbursements to providers in California for 10 years.

Labels: BlueCross, InTheNews

posted by Hanh Kim Quach | Permalink | 11:06 AM


 

Arnold's day...

Tuesday, May 01, 2007

We hear that now that the prison issue has come to some resolution, the Governor is re-focusing on health care reform.

John Myers at KQED Capitol Notes suggests his day today has a significant health care theme:


Fly On The Wall: Most political reporters would love to be at two unusual events today on Governor Schwarzenegger's schedule... both of which are private meetings.

This afternoon, the guv is speaking to a meeting of the California Restaurant Association and, we're told, taking questions from those in attendance. The topic: Schwarzenegger's health care reform ideas. That's a proposal about which the restaurant industry has been quite vocal about its unhappiness, especially on the governor's call for new health care mandates on employers.


Let's remember that it was the fast-food and chain restaurants (McDonald's, Yum Brands, Outback Steakhouse, etc.) that were the bulk of the opposition to Proposition 72, raising around 70% of the funds against that proposal.

But also check out the other item on the Gov's agenda:


Later this afternoon, the governor is scheduled to meet here in Sacramento with GOP presidential candidate Mitt Romney. While the two have spoken on the phone before, the governor's aides say this is their first face-to-face chat. Romney has been working hard in recent weeks to plant his flag on the conservative side of the GOP universe for the coming primary... a place that Schwarzenegger seems to have taken off his political map. By the way, Schwarzenegger is also scheduled to attend Thursday afternoon's GOP presidential debate at the Ronald Reagan Library in Simi Valley.


Gov. Mitt Romney was supposed to be at Gov. Schwarzenegger's "Health Care Summit" last year to present the plan he signed (and partially vetoed). He couldn't make it, and he sent his Secretary of Health (who I sat next to). You would imagine health reform would be a big discussion point for their first meeting. But since then, Gov. Romney has been suspiciously quiet about health reform in his home state during his presidential campaign.

He doesn't want to own the individual mandate, nor the costs of the private market plans, nor other elements he insisted on. Yet he also doesn't want to highlight what many would consider the good aspects of the Massachusetts plan, including more than a 100,000 people getting coverage--through the expansion of public programs.

Maybe they will talk about the weather.

Labels: Employers, OtherBlogs, OtherStates, Schwarzenegger

posted by Anthony Wright | Permalink | 5:32 PM


 

Not a Nicholas Cage movie...

After last week's committee discussions and actions (detailed extensively on this blog) as the legislative leaders' health reform bills passed their respective health policy committees, the question I get most often asked is: "What's Next?"

In a technical sense, both bills now go to Appropriations Committees this month, where they get evaluated for their fiscal impact. While both leaders are not expected to have a problem getting their bills out of committeee, both Speaker Nunez and Senate President Pro Tem Perata have said they are expected to release the result of the fiscal modeling of their plans in the near future. Then, it will be more clear the level of costs and benefits (literally) to make the plans pencil out.

Even beyond the brewing budget battle, May means money: we'll also have Jonathan Gruber, the modeler from MIT courtesy of the California Health Care Foundation, out here in Sacramento to present his underlying assumptions on May 16th.

Labels: Legislation, Nunez, Perata, Research, Sacramento

posted by Anthony Wright | Permalink | 12:40 AM


 

Did Rush Limbaugh endorse the employer mandate?

 

Catching up...

 

Finish health reform right...

 

Thinking about ten years ago...

 

2009 Year in Review: The Best & Worst of Times...

 

Ways to fix the Senate health reform bill...

 

Help us fulfill the promise in 2010...

 

The policy that's fit to print...

 

Christmas Eve comments...

 

Senate Passage! 60!