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Back from the dead?
Wednesday, October 31, 2007
I am glad that I was a dissenting voice in at least one of the articles today about the so-called slim chances for health reform, as reported by Tom Chorneau in the San Francisco Chronicle and Bill Ainsworth in the San Diego Union-Trib. If there's anything that came out of today's hearing, it's that the health reform conversation is very much alive... but there's a lot more work to do. Numerous groups raised big and small issues with the Governor's proposal, respectfully yet firmly. But virtually all expressed continued enthusiasm to continue the debate. What was clear was that the Governor's plan was not going to be passed as is... but if the Governor is willing to compromise with the leadership in the Legislature, on key issues like affordability, fair financing, and cost containment, there's a deal to be had. As I told the reporters, if this were dead, we wouldn't be working this hard. Labels: Legislation, YearOfReform
posted by Anthony Wright |
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6:56 PM
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HC4all! :)
During the hearing inside the Capitol today and during a rally beforehand, thousands of people text-messaged the Governor, which the It's Our Healthcare! campaign helped facilitate by having those comments broadcast on a large screen display on the Capitol lawn for him and all to see. The messages were clear: we need affordable health care reform now, although different folks gave their own comments in their own ways. There's more at the Its Our Healthcare website, which has been picked up at other blogs, including Working Californians. The Sacramento Bee Capitol Alert gave its own tongue-and-cheek coverage, completely in the spirit of the day: OMG...
By Shane Goldmacher - Capitol Alert Published 9:54 am PDT Wednesday,
October 31, 2007
Consumer advocates and Arnold Schwarzenegger aren't acting like BFFs (best friends forever).
The "It's OUR Healthcare" coalition is mobilizing 2day to have folks send txt messages to the governor criticizing his health care package 2 coincide with 2day's Assembly hearing on the health care.
Here's the 411: The activists are asking regular Joes to text the letters "IOH" (it stands for It's Our Healthcare) to 30644. From there, instructions will be sent on how to text the governor. Any text messages sent will be broadcast on a giant screen parked outside the Capitol displaying the messages.
4real.
"It will be like a giant billboard with constantly changing messages about the need for healthcare reform from real people like you," Anthony Wright, executive director of Health Access, wrote to supporters this week.
The puns surrounding the Halloween effort - text-or-treat - are enough to make any1 LOL 4sure.
No word yet if Arnold wrote back MYOB.
Labels: Legislation, YearOfReform
posted by Anthony Wright |
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6:33 PM
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A long day...
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Close to Clinton? or right of Romney?
Tuesday, October 30, 2007
In defending the Governor’s proposal from criticism by consumer, labor, and community organizations, the Governor's health team makes the case that the Schwarzenegger proposal is similar to Hillary Clinton's health plan as a presidential candidate. Let’s leave aside whether that should immunize any reform plan from critique. While some media stories (like here and here) have picked this up this trope, it is significantly misguided. One could make the case that it is impossible to compare, given that we are having very different conversations in California, where we have been discussing health reform for the past five years, and the national debate which is just getting started. There’s also a very different level of detail between the legislative proposals in California like AB8 and what the Governor released a few weeks ago, and the very broad position papers of presidential candidates. On the policy concepts, there are some similarities, but that's to be expected in any serious health plan: A peanut butter sandwich and a BLT are pretty different, and it's easy to see why some people would like one and not the other even though, at the end of the day, they both are pieces of bread with a filling in the middle. Health reform is complicated, but it isn't rocket science. There's only three ways that people get coverage: 1) through enrolling in public programs, 2) through getting employer-provided benefits, and by 3) buying it on the individual market. At a conceptual level, there are only so many ways to improve access and affordability in these three arenas: expanding, funding, and streamlining public programs; setting a minimum employer contribution, and offering employers a statewide purchasing pool to buy into; and better regulating insurers in the individual market to provide better access to those with "pre-existing conditions" and providing subsidies or tax breaks. So there are similarities, but let’s not forget the key differences: Group coverage vs. individual market: Consumer groups generally believe that we get the best value for consumers through group coverage which can bargain for the best price, and allow individuals to share the risk and cost of health care--whether by public programs, employer-based benefits, or even a single-payer system, which would provide everyone with coverage into what would be essentially one big public program. The Democratic plans (and the state legislature’s AB8) all focus on expanding group coverage, through employers or public programs, including having a public insurance option, through Medicare or the Federal Employees Health Benefits Program. Their proposals do seek to fix the individual market (preventing insurers from denying people for pre-existing conditions, for example), but they also look to shrink it. The Schwarzenegger plan would expand the individual market, the least efficient, most expensive way to provide coverage. To its credit, it would also expand public program coverage as well, but not group coverage through employers. And the central focus is the individual mandate, to require up to one million Californians, without assistance, to buy coverage on the individual market—where they have the least market power. High deductibles/HSAs vs. comprehensive coverage: What is “coverage?” The Democratic plans set standards for what they mean by coverage, invoking Medicare or the Federal Employees Health Benefits Plan. In other words, fairly comprehensive coverage, that covers not just catastrophic care, but the preventative and disease management that will go a long way to reducing costs in the long run. AB8, the Legislative leaders’ plan, sets a standard that in their purchasing pool, maximum out-of-pocket exposure should be limited to $1500 for a premium of no more than 5% of wages. In contrast, the Governor’s plan in January defined minimum coverage as a $5,000 deductible policy with $10,000 out-of-pocket maximum. Such policies won’t be a benefit for the majority of Californians that have less than $10,000 in liquid assets. The new language does not define a minimum, but allows the Governor’s Secretary of Health to define it, with cost-sharing more or less than what was originally proposed. The Governor’s plan also has significant provisions to encourage so-called Health Savings Accounts, which only can be used with high-deductible policies. President Bush promotes high deductibles and HSAs as a way for consumers to financially participate in their own care. Consumer groups see them as simply a way to have more cost and risk shifted to the consumer. It’s perhaps the defining debate in health policy, and the Governor’s plan is very different from the Democrats here. Affordability for consumers: On the central issue of individual responsibility in these health plans, there's no comparison. Most health plans ask for responsibility from individuals, either through the tax system, or, as in the case of AB8, when you have been offered affordable group coverage. So while all plans include “individual responsibility,” there are significant differences. We have three options: 1) The Clinton proposal does have an “individual mandate,” but also includes a guarantee, that all Americans won’t have to pay more then a certain percentage of their income for health care. 2) The Romney proposal in Massachusetts is explicitly conditional on both the availability and affordability of health coverage. It also seeks to subsidize people through public programs, but only up to 300% of the federal poverty level. Especially since state funds were limited, the Massachusetts proposal decided instead to explicitly condition the mandate on affordability, and for those who aren’t subsidized, there’s exemption mechanisms. 3) The Schwarzenegger proposal for an individual mandate has no condition, limit, or exception. He would provide public coverage or subsidized coverage to some, but for those who are not eligible, there is no consideration of affordability. On the key issue of affordability, Schwarzenegger isn’t close to Clinton but is to the right of Romney, not acknowledging any condition whatsoever to the requirement. Again, in Massachusetts, they determined that it was better to give some people the choice to be uninsured than to be required to buy an unaffordable product. Calling for compromise: This is not to say that the Governor’s plan is without merit. On the contrary, Governor Schwarzenegger gets signficiant credit, especially in comparison with some in his party in the state legislature and the presidential campaign trail, who don’t even acknowledge health care as a major issue. They seem to say “take two HSAs and call me in the morning” or “let them eat clinics.” As highlighted above, there are major differences between his proposal and those by Democrats, both here in California and nationally. However, these are the exactly the debates we are should be having. These are resolvable differences, where there is already some common ground. But only if the Governor is willing to compromise. But it doesn’t help the discussion to pretend the differences don’t exist, because they matter, a lot, to California consumers in their everyday lives. Labels: Legislation, YearOfReform
posted by Anthony Wright |
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10:30 AM
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Balancing Interests on Balanced Billing....
From my colleague Elizabeth Abbott:"Balance billing" is the term for the practice of health care providers, who when in a billing dispute with an insurer, send the bill to the patient and place them in the middle of that dispute. It's something that health care consumers have long complained about. The state Department of Managed Health Care (DMHC) is trying to find a way to fairly and quickly decide those billing disputes without allowing these powerful combatants to stick the patient with the bill. These disputed bills often represent hundreds and even thousands of dollars that patients can often ill-afford to pay. Consumers often feel responsible for those bills and pay them to the detriment of housing, utilities, transportation or other expenses. Some consumers ignore these bills and risk being referred for formal debt collection and recovery which remains a leading cause of personal bankruptcy. We need to stop this practice. The question is how. DMHC held a public hearing on Wednesday in Burbank on their proposed new rule that would * ban consumers from being balanced billed for any amounts in dispute, * establish a formula for an interim payment amount for the doctor who provided the emergency services, and * institute an equitable system to decide on a fair final payment amount owed by the health plan for services rendered. Doctors argued strenuously that they were at a disadvantage against the powerful health care plans with multi-million dollar profits. They felt they were forced to send the disputed bills to their patients because they needed the leverage of the consumer to intercede on their behalf with health plans. Many physicians who gave testimony cited the loss of hospitals and trauma centers throughout California due to too few doctors and inadequate reimbursement. This further eroded the state’s ability to provide health care to its residents. Health plans said they had great difficulty signing up enough physicians, particularly specialists to staff emergency rooms, often in small towns and rural areas. They felt doctors were taking advantage of the system to extract large fees from health plans. They said as a result that physicians were reluctant to contract with health plans for reasonable rates to provide these ongoing services. There was lengthy testimony from both sides. In addition, consumer advocates argued that under no circumstances should patients be put in the middle between doctors and health plans over these disputed bills. DMHC announced it would hold two more public hearings on the issue in November (possibly one in San Diego and one in Sacramento), and would extend the date for public comment until the end of the month before issuing the final version of the regulation. Labels: DMHC, Insurers
posted by Anthony Wright |
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10:00 AM
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Mailbag...
Monday, October 29, 2007
In preparation for the Wednesday hearing on the Governor's health reform, here's the Health Access California 15-page letter to the Governor with our issues. The proposal isn't a bill, but most of the consumer, community, and constituency groups that I work with say they oppose the measure if there was no change... but we hope that by being clear about our concerns, it creates the conversation to get to a compromise that we can be actively in support. Labels: Legislation, YearOfReform
posted by Anthony Wright |
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6:51 PM
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Crash test...
Today's LA Times includes a reminder that an individual mandate doesn't create universal coverage: The Department of Insurance is unsure exactly how many of California's 23.2
million licensed drivers don't buy insurance. Estimates range from a low of 3.2
million to a high of 5.7 million. That's a 13-25% uninsurance rate. Let's remember that auto insurance is far smaller amount of money than a health insurance policy. On the other hand, for those who make the analogy, let's also remember that you don't need to get auto insurance for your car... you just need to get it for those you crash into. Labels: IndividualMandate, InTheNews, YearOfReform
posted by Anthony Wright |
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6:44 PM
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The young and the restless...
Aurelio Rojas in the Sacramento Bee has a terrific story about the young and uninsured, which Robert in Monterey at Calitics comments on extensively. As we stated on this blog previously and in the article, twentysomethings are the biggest slice of the uninsured, but's it not because they don't want coverage: it's that they are more likely to be low-income, to work at jobs that don't provide coverage, to not be eligible for public programs. When offered coverage, they take it up at similar rates as other age groups. The question is whether we can offer coverage that is affordable, available, and administratively simple. Labels: InTheNews, YearOfReform, YoungAndUninsured
posted by Anthony Wright |
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12:07 PM
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Getting educated from the Commonwealth...
Sunday, October 28, 2007
So I have a love/hate relationship with Massachusetts. I am a Bronxite who roots for the Yankees, and I'm beside myself that the Red Sox are up 3-0 in the World Series. (Go Rockies!) But I have fond memories goingt to college at Amherst, and loved the formal close of our Commencement, with the banging of a large staff and the pronouncement: "God save the Commonwealth of Massachusetts." On health policy, I was happy that Massachusetts helped focus attention on state reforms for expanding coverage, although I remind folks that California was one percentage point away a few years earlier, in 2003, with SB2 and Prop 72. On the actual reform plan, it's not our place to support or oppose the MA plan, but we have produced both discussion papers and fact sheets that discuss the various provisions, and to make clear the major differences between our two states. Even so, there is lots to learn from the discussion going on in Massachusetts. Our colleagues from Health Care for All Massachusetts (not affiliated with our board member Health Care for All California) have been liveblogging the deliberations of their "Connector" board, which makes for interesting, although wonky, reading. As expected, there's things that are working, and things that aren't. It's odd that the Governor's health proposal seems oblivious to these discussions, especially with regard to the individual mandate (whatever you think of the concept). No condition or exemption based on affordability and availability? No simplification/standardization of the individual market that we are requiring people to go into? Exempting employer-based coverage from what constitutes "minimum coverage" for the mandate? The Governor's proposal would benefit from a closer look at the consumer protections in the Massachusetts market (Health Access prepared a chart), and learning from their deliberations of what is working and what isn't... Labels: IndividualMandate, OtherStates, YearOfReform
posted by Anthony Wright |
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9:40 AM
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Waiting on waiting lists for kids coverage...
Wednesday, October 24, 2007
HEALTH ACCESS UPDATEWednesday, October 24, 2007 HEALTHY FAMILIES/SCHIP UPDATE: WAITING LIST AUTHORITY DEBATED* Federal dollars for SCHIP will run out Nov 16 without Congressional action
* MRMIB considers emergency regulations to enable agency to disenroll children in Healthy Families (CA's SCHIP), or put new enrollees on waiting lists
* Board will reconsider emergency regulations on November 5
New on the Health Access Weblog: Special Session Halloween Hearing; Corrections and Clarifications; DMHC Updates on Post-Claims Underwriting; HMO Report Card; Doonesbury The Managed Risk Medical Insurance Board (MRMIB), which oversees the Healthy Families program--California's version of the State Child Health Insurance Program--today decided it would wait until at least November 5 to decide whether it should adopt emergency regulations to pave the way for creating wait-lists and disenrolling children from the program. FEDERAL STALEMATE MRMIB executive director Lesley Cummings had recommended the board adopt the emergency regulations in light of the fact that the State Children’s Health Insurance Program (SCHIP) expired on September 30 and Congress and President Bush are still wrangling over how to continue the program – and for how much. Bush had originally allotted $25 billion over five years – which would cause California’s program to fall into deficit by the end of our fiscal year 2008. Meanwhile, Congress has proposed a total of $60 billion over five years, and enable expansions to the program, which the President opposes. The SCHIP legislation managed to obtain a veto-proof majority in the Senate, but failed twice in the House of Representatives – falling less than 20 votes short of 290 votes needed last week -- to override Bush’s veto of the Congressional SCHIP bill. Ronald Springarn from MRMIB said Washington insiders have reported that the Administration and Congressional leaders continue to work toward a compromise to continue the program. Sticking points continue to be whether families above 300% of poverty could be eligible for funding in states that allow it (such as New Jersey); and whether a threshold for low-income children enrolled in SCHIP would have to met before others are enrolled. HEALTHY FAMILIES SITUATION Director Cummings emphasized that the board action did not mean any of the 830,000 children currently enrolled would be kicked off imminently. Nor would it mean the program would institute a waiting list. Cummings said she viewed it as her job to guide the board to be financially responsible in managing the program. “You don’t have a farthing for this program on November 17,’’ she said. Healthy Families receives $2 for every $1 state dollar put into the program. While federal dollars may not come immediately, the 07-08 state budget has appropriated $392 million from the state’s general fund for the program. Other states have the ability to put children on waitlists or disenroll children. California, however, took that provision out of its regulations in 2001 when it sought a waiver to allow the extension of Healthy Families to parents of children in the program. The federal government, at the time, wanted to ensure that children were prioritized in enrollment before parents were covered. The waiver expired this year, and due to budget shortfalls in California reaching $38 billion, no parents were ever enrolled in Healthy Families. Based on analysis performed by Peter Harbage, Cummings layed out the fate of potentially all children currently enrolled in Healthy Families if the President had his way and funded SCHIP with only the $5 billion increase: Director Cummings emphasized that the board action did not mean any of the 830,000 children currently enrolled would be kicked off imminently. Nor would it mean the program would institute a waiting list. Cummings said she viewed it as her job to guide the board to be financially responsible in managing the program.
“You don’t have a farthing for this program on November 17,’’ she said. Healthy Families receives $2 for every $1 state dollar put into the program. While federal dollars may not come immediately, the 07-08 state budget has appropriated $392 million from the state’s general fund for the program.
Other states have the ability to put children on waitlists or disenroll children. California, however, took that provision out of its regulations in 2001 when it sought a waiver to allow the extension of Healthy Families to parents of children in the program. The federal government, at the time, wanted to ensure that children were prioritized in enrollment before parents were covered. The waiver expired this year, and due to budget shortfalls in California reaching $38 billion, no parents were ever enrolled in Healthy Families.
Based on analysis performed by Peter Harbage, Cummings layed out the fate of potentially all children currently enrolled in Healthy Families if the President had his way and funded SCHIP with only the $5 billion increase:
* 260,000 children would need to be disenrolled immediately 11/1 (next week); OR,
* 433,000 children would need to be disenrolled by 1/1/08; OR,
* Healthy Families would shut down, and disenroll all 830,000 children 7/1/08. Cummings said the sooner the state acted, the fewer children would be affected. If and when the board adopts regulations, it will take 32 days before they can act on those regulations. The proposed regulations would allow MRMIB to
* Establish a waitlist;
* Terminate enrollees at their annual eligibility review. Cummings repeatedly emphasized that this did not mean the board would begin taking these actions immediately. MRMIB Chair Cliff Allenby (the former director of the state’s Department of Social Services) said he understood the need to be fiscally responsible with the program, but hoped board members would be able to weigh the regulations in a more “leisurely’’ manner if the federal government took action that would not put California’s program in danger. ADVOCATES OPPOSE EMERGENCY REGULATIONS Children’s and health advocates stood to oppose the adoption of emergency regulations. Deena Lahn of the Children’s Defense Fund and the 100% Percent Campaign said such actions should not be considered an “administrative’’ matter, but something to be vetted by the Legislature. “Healthy Families has reached a peak…To allow disenrollment sends the wrong message,’’ she said. Lahn also suggested that if insufficient federal funding is available, the state should take over full financial responsibility for the 8,000 women enrolled in the Access for Infants and Mothers program, rather than the Healthy Families program. Beth Capell from Health Access California pointed out that the MRMIB board did not have the legal authority to establish emergency regulations based on “speculation” that the federal government may not act. Capell also noted that the regulations were not clear about how and when waiting lists and disenrollments would be unfurled, in what sequence and what would trigger the actions. Other advocates who spoke against the emergency regulations included Community Health Councils, Inc., California Catholic Conference and the California Nurses Association. DEFERRED ACTION UNTIL 11/5 Chairman Allenby motioned for the board to take a deliberative, but prudent process – waiting until November 5 to consider the regulations. In the meantime, he said, the board and MRMIB staff should carefully watch what Congress and the President do on SCHIP. Just as important, he and staff said, was to ensure members of Congress – particularly the California delegation – understands that the Healthy Families program could be in financially dire straits should additional funding not come through. A congressional report optimistically said the state could continue its program until July 1, 2008, but without context that after July1, the program would shut down. Harbage Consulting’s figures reflect the most realistic assessment of California’s program. CALL TO ACTION: The fate of more than 830,000 children is at stake. Advocates need to do two things:
1) Contact your congressional representative and make sure they understand the importance of the SCHIP program to Heatlhy Families. Also make sure they understand that the state’s program runs out of federal dollars in November and state agencies are paving the way to disenroll hundreds of thousands of children.
To find your Congressional Representative, visit: http://www.house.gov/. 2) Write MRMIB and urge them not to allow the board to waitlist or disenroll eligible children from Healthy Families. For information on MRMIB, visit: http://www.mrmib.ca.gov/
For more information, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org.
(Correction: the original UPDATE neglected to mention that MRMIB Chairman Allenby was the *former* director of DSS.) Labels: SCHIPHealthyFamilies
posted by Anthony Wright |
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11:36 PM
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Keeping the SCHIP afloat
The Managed Risk Medical Insurance Board just deferred adoption of emergency regulations that would enable the board to begin putting children eligible for Healthy Families on waitlists or disenrolling them from the program. The board, however, will take up the matter again on November 5. We'll have a detailed report later. Labels: SCHIPHealthyFamilies
posted by Hanh Kim Quach |
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12:34 PM
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Underwritten...
Yesterday, the Department of Managed Health Care released a draft of proposed regulations to stop insurers from retroactively denying people for health coverage. Because this is an informal comment process on "post-claims underwriting," the draft proposed regulation text is not posted to the Department’s web site. However, it was the subject of some press, by Lisa Girion in the Los Angeles Times, and Victoria Colliver in the San Francisco Chronicle, as well as California Healthline. It's good that the DMHC is going ahead with these regulations, but the draft doesn't have the timelines or clarity to be enforceable at this time. We look forward to working on this with the DMHC and the Department of Insurance as well. This issue also goes directly to the need for health reform: rescinding coverage that insurers have already agreed to provide is wrong; I don't think it's good to allow insurers to deny and discriminate against people for their "pre-existing conditions" in the first place. Labels: DMHC
posted by Anthony Wright |
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10:15 AM
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Halloween happenings
Tuesday, October 23, 2007
The special session will have its first hearing next week, by the Assembly Health Committee, chaired by Mervyn Dymally. It's the first legislative consideration of the 220-page bill language of the Governor's proposal, since he proposed it just two weeks ago. There won't be a vote on the measure (the Governor's language doesn't have a legislative author); so it will be an informational hearing. Health and consumer advocates should be clear about their issues with the Governor's plans, if we are going to get to a place where health reform that helps consumers can happen. It's a Halloween hearing, October 31st. I'll refrain from cheap puns. Labels: Schwarzenegger, YearOfReform
posted by Anthony Wright |
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9:51 PM
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Zonker would know what to do...
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Poor Credit. Bad Credit.
Gov. Schwarzenegger doesn't get much credit for his plan to to give tax credits for health coverage to middle-income Californians. A new analysis by the California Budget Project concludes the plan wouldn't help many people and could create the perverse incentive for businesses to drop coverage -- rather than increasing it. Here are the highlights: - 70% of Californians between 250% and 350% FPL (the qualifying income for the tax credits) would be disqualified because they have access to coverage on the job.
- That tax credit only applies to "minimum'' coverage -- a high deductible plan. If families want more coverage, they don't get a tax credit for it, which would encourage the use of plans with $10,000 deductibles for families who make $72,275 (for four people) annually.
To see the report, and other things the Budget Project has written, visit www.cbp.org. Labels: Affordability, Schwarzenegger, Underinsurance, YearOfReform
posted by Hanh Kim Quach |
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1:32 PM
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Mid-term grades....
Friday, October 19, 2007
Lots of coverage yesterday on the new Office of Patient Advocate's HMO Report Card. Lisa Girion in the Los Angeles Times, Gilbert Chan in the Sacramento Bee, Harrison Shepard in the Los Angeles Daily News, and Victoria Colliver in the San Francisco Chronicle. My colleague Beth Abbott here at Health Access is quoted, indicating our concern about the ratings which show average or below average level performance in many key measures. While report cards are important to provide consumers with comparative information, it seems we have not reached the point of competition based on quality. Why does the report card show so little improvement since last year or earlier? Why are there no top-rated health plans or medical groups? We think considerable work has to be done as a follow through to this information to ensure the consumers receive the highest quality health care in CA. Labels: Insurers
posted by Anthony Wright |
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5:27 PM
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Just the facts...
The good folks at MRMIB report that there hasn't been too many phone calls about the national SCHIP debate, despite all the national attention about the program and the debate. They think it is because California's program is called Healthy Families, and there's no reason a family would think that their child's Healthy Families coverage is SCHIP. There's been a lot of misinformation about the SCHIP program, so MRMIB put out a helpful fact sheet that tries to set the record straight about how SCHIP operates here in California, as Healthy Families. Labels: SCHIPHealthyFamilies
posted by Anthony Wright |
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5:10 PM
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Roll Call!
Thursday, October 18, 2007
The roll call for the SCHIP veto override indicates that the vote for the California delegation was similar, but even more partisan. Last time, Rep. Watson (D) and Rep. Herger (R) essentially abstained. This time, they voted predictably. The final result: 273-156 in the whole Congress, 35-18 among Californians. California's Democratic representatives all voted for SCHIP, as did only one Republican representative, Cong. Mary Bono; The rest of California's Republican delegation voted not to override the President's veto. Again, as we pointed out a few weeks ago, many other high-cost states, especially on the East Coast like New York and New Jersey, had many more of their Republican members support their state SCHIP programs. Here's the full list of the California YES votes on H.R.976:
Democrats: Joe Baca, Xavier Becerra, Howard Berman, Lois Capps, Dennis Cardoza, Jim Costa, Susan Davis, Anna Eshoo, Sam Farr, Bob Filner, Jane Harman, Mike Honda, Tom Lantos, Barbara Lee, Zoe Lofgren, Doris Matsui, Jerry McNerney, George Miller, Grace Napolitano, House Speaker Nancy Pelosi, Laura Richardson, Lucille Roybal-Allard, Loretta Sanchez, Adam Schiff, Brad Sherman, Hilda Solis, Pete Stark, Linda Sánchez, Ellen Tauscher, Mike Thompson, Maxine Waters, Diane Watson, Henry Waxman, Lynn Woolsey Republicans: Mary Bono The NO votes:
Republicans: Brian Bilbray, Ken Calvert, John Campbell, John Doolittle, David Dreier, Elton Gallegly, Wally Herger, Duncan Hunter, Darrell Issa, Jerry Lewis, Daniel Lungren, Kevin McCarthy, Buck McKeon, Gary Miller, Devin Nunes, George Radanovich, Dana Rohrabacher, Edward Royce
posted by Anthony Wright |
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3:33 PM
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SCHIP Vote... a Sad Day....
The good news is SCHIP got more votes on the second time, 273 (Aye), 156 (no). The bad news is that it wasn't enough: We need around 290 votes to override the President's veto. This is not good news for California or for kids. Labels: SCHIPHealthyFamilies
posted by Anthony Wright |
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12:51 PM
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An override for a birthday present?
Last week was my son's first birthday. He's one, and adorable, and I am not just saying that. People agree he's objectively cute. He's also very healthy. Yet in his first year, we've been to the doctor at least nine times; he's been sick from other kids at day care at least four times; and we had to go to the emergency room once. Thank god we have little Jefferson covered. It is in that context that I really hope that the Congress overrides President Bush's veto of the SCHIP (State Child Health Insurance Program). Labels: SCHIPHealthyFamilies
posted by Anthony Wright |
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12:24 AM
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Swift-boating a 2-year old....
Wednesday, October 17, 2007
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Gambling on a losing horse
Gov. Arnold Schwarzenegger's proposal to lease the state lottery to a private company to earn money for health care reform is quickly getting left in the dust. At a Senate hearing today, analysts from Wall Street firms said a 30 year lease would fetch about $15 billion up front -- less than half the $37 billion the governor thought California could get. Here's a report on the hearing on KQED's Capitol Notes blog. Labels: InTheNews, Schwarzenegger, YearOfReform
posted by Hanh Kim Quach |
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5:03 PM
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Scraping by
The California Budget Project today released its annual "Making Ends Meet" report detailing what families would actually need to earn to survive in this state. This is a much more reliable measure of poverty than what is typically used to determine public program eligibility, etc -- the federal poverty level, which was set in the 1960s based on the price of food and not updated since. What CBP found is that families (with children) need to earn between three to four times the minimum wage in order to pay for basic needs -- rental housing and utilities, food, transportation, health care and other essential costs. Comparing CBPs numbers to: - Minimum wage at $7.50 an hour;
- The median hourly wage of $17.42 (in 2006),
we can see that families are barely making it -- earning between $17.39 and $24.22 an hour. Relative to health care, the California Budget Project found families spending between 15.3 to 22 percent of their earnings on health care. These are families who aren't able to get coverage through work and don't qualify for public coverage. That's what makes our push for affordable health care even more important. Labels: Affordability, InTheNews, YearOfReform
posted by Hanh Kim Quach |
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12:57 PM
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From foundational details to 10,000 feet view
The recent spate of news stories about health reform have been all over the map. Today's stories include a USA Today article by Julie Appleby, and a San Francisco Chronicle article by Carla Marinucci and Tom Chorneau. They all try to take a look at this issue through a political lens, rather than the policy. My point in the Chronicle article was that if we are going to have a health care debate, we are going to need to actually debate some of the key policy elements, and that's healthy. It's too late in the year to only be talking about the broad areas of agreement, when there are major, outstanding issues that the Governor has yet to make any gesture on. I was amused that some of the commentators in Chronicle article were political operatives, trying to make a political point. So I was amused when they tried to compare the Clinton plan with the Schwazenegger plan: they are similar in their overall themes, but the debate is over core details. And one can get whiplash going from the very advanced California debate fove years in the making, to the very vague and preliminary DC debate. One of the debates on the Scwarzenegger plan is the very definition of what is "coverage"--is it a $5,000 deductible catatrophic plan and that's it (as in the January proposal)? or worse (as in last week's proposal, which hass no standard, and the ability to have sub-minimum plans through an employer)? This is a "detail" that none of the presidential candidates' plans, including Clinton, even mention. These are not policy wonk details: real people will think very differently about a proposal that seeks to provide comprehensive coverage, versus one that requires skimpy coverage. But the presidential plans don't go into that--althrough given how much they talk about not just the uninsured but the underinsured, I would be surprised if Clinton or Edwards or Obama came up with a $5,000 deductible plan as the standard. It's the difference between looking at a house from an overhead GoogleEarth shot, or being able to walk in and inspect it, it's foundation, its heating and cooling systems. You gotta be able to ask those tough questions, and see if they are fixable, or not. You could decide whether to buy the house if the "details" work out--or not. We'll see if the Governor gets the message, and finally suggests some affordability changes to his January proposal.. That's what we need to keep the momentumg going.
posted by Anthony Wright |
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12:24 AM
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Costco V. Walmart
Tuesday, October 16, 2007
Here's another thought on Dan Weintraub's column today, which concludes that lower wage workers would be hurt by the fight to require businesses to contribute at least 7.5 percent of payroll to coverage. It doesn't necessarily have to be that way. Consider the case of Costco v. Walmart. Both are discount retailers, but Costco pays higher wages and benefits.
Wages:
Health Coverage:
- Costco: 8-10 percent of premiums. Comprehensive coverage
- Walmart: High-deductible, sliding scale. ($5/month for a $2,0000 deductible or $62/month for a $500 deductible).
Waiting periods:
- Costco: 90 days for full-time, 6 months for part-time
- Walmart: 6 months for full time, one year for part-time.
Percent of employees with health coverage
Employee Turnover (estimate)
Labels: InTheNews
posted by Hanh Kim Quach |
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11:28 PM
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Jobs with Benefits
Sacramento Bee columnist Dan Weintraub today asserts that health care reform -- specifically AB8's demand for a 7.5 percent employer contribution -- will take a higher toll on workers because their employers will forgo giving them higher wages/raises because they'll want to make up the money they have to pay in higher health care somehow. The implication is that 7.5 percent is too high, and the Governor's proposal of 4 percent (or lower for smaller businesses) is more manageable. A couple of counterpoints: 1) Businesses already pay more than 7.5 percent: California businesses across the board on average, spend 8 percent of payroll already on health coverage according to this study by the UC Berkeley Labor Center. The universe of businesses that actually provide coverage actually spend closer to 11 percent of payroll. For businesses, then, to be required to spend 7.5 percent on health care is not a stretch. In fact, anything lower (such as the governor's 4 percent proposal) would cause employers -- weighing their costs -- to drop coverage for low-wage workers. This is otherwise known as "crowd-out." 2) Higher costs are offset by other benefits: The argument that higher health care costs would force employers to stop hiring new low-wage workers -- or laying them off -- "because the minimum legal compensation ....is higher than the value of the an extra worker's labor'' is a familiar one echoed during battles to increase the minimum wage. According to this study by the Economic Policy Institute, even though each workers' compensation is higher, the increased costs are offset by other "benefits'' such as lower turnover, lower recruiting and training, higher employer productivity, decreased absenteeism and higher morale. Additionally, the study points out -- "employers pay their workers less than the actual value of their work.'' According to a 2004 study, corporate profits increased by 57.5 percent, while private wage and salary income has actually decreased by 1.7 percent over the same period. 3) Providing low-wage workers with coverage would actually help the economy. A low-wage worker who does not have health coverage would have to dig deeper into their pockets to pay the full amount of the premium (in the unlikely case they decide they can "afford'' coverage on the individual market). A low-wage worker who receives benefits from their employer would actually spend that money, helping to boost the economy. Unlike higher wage workers, who generally receive coverage and are paid higher than the minimum wage, a low wage workers' pay gets spent on basic necessities. To the extent that having coverage frees up money, that worker would spend it. Higher wage workers tend to save their money because their wages and benefits are enough to cover what they need. Labels: InTheNews, YearOfReform
posted by Hanh Kim Quach |
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5:11 PM
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A Correction and Clarification...
Here's a correction and clarification about today’s Los Angeles Times story from Health Access California and Consumers Union. To correct the record, Chris Lehane has not been hired by the "It's Our Healthcare!" coalition and is not working for Health Access California nor Consumers Union . Lehane has been hired by the California Labor Federation on their media work around health care.
Over the past year, Health Access California and Consumers Union have been working closely together with AARP, California Labor Federation, and over 100 other groups as part of the "It’s Our Healthcare!" campaign to promote the need and urgency for health reforms that benefit consumers. California consumers need health care reform, and they need it now.
Our organizations, and the Its Our Healthcare! Campaign, remain committed to winning health care reform this year. As part of that campaign, we have spotlighted key issues of cost containment and affordability for low- and moderate-income consumers. At the same time, our groups are frustrated that the Governor has yet to move significantly to address these concerns, particularly about an individual requirement without condition, limit, or exemption based on affordability. Such elements of the Governor’s proposal, if retained, would force our groups to oppose the proposal. In order to get health reform that works for consumers, we will spotlight the elements that don’t work for consumers in the Governor’s plan.
Labels: InTheNews, Schwarzenegger
posted by Anthony Wright |
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1:39 PM
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Even More Vetoes...
HEALTH ACCESS UPDATE
Tuesday, October 16, 2007 GOVERNOR SIGNS AND VETOES HEALTH BILLS* Special Session Continues After Veto of Major Health Reform by Legislative Leaders
* Gov Also Vetoes Mental Health Parity, Working Disabled Coverage, Patient Dumping
* Gov Signs Insurance Rescission, Drug Labeling Bills, LA County Hospital Funding
* ALERT: In U.S. Congress, Child Health Insurance Veto Override Vote This Week
New on the Health Access WeBlog: More on SCHIP Prospects; More on the AB8 Veto; Fact Check on the Governor's AB8 Veto Statement; More on Other Specific Bills; The Story Behind the Political Attack on a 12-Year Old; Ed Boards Look at Leasing the Lottery; Marty OmotoGov. Arnold Schwarzenegger capped the 2007 Legislative session this past weekend by signing and vetoing more than 300 bills, including several of interest to health care consumer advocates. All told, Schwarzenegger signed 750 bills this year of the bills placed on his desk by the Legislature, and vetoed 214. MAJOR HEALTH REFORM BILL VETOED FRIDAY AFTERNOON
Most notably, Schwarzenegger vetoed AB8 (Nunez/Perata), the legislative leaders’ comprehensive health reform legislation that was supported by many health, consumer, labor, and community groups. AB8 would have expanded coverage to nearly 95 percent of California ’s population by making coverage more available, affordable, and automatic in each of the three ways that Californians get coverage: through on-the-job benefits, public programs, and the individual insurance market. AB8 would have been the biggest expansion of public program coverage since Medicare, for both children and parents; it would have set a minimum employer contribution to health coverage, much like the creation of the minimum wage, and also offer a new, affordable option for employers to buy coverage through a statewide health insurance pool, to allow smaller businesses and workers to reap the benefits and protections of group-negotiated coverage rates. It would also have limited insurer's ability to deny people based on their "pre-existing conditions." Under the concept of "shared responsibility," individual would need to take up group coverage offered by an employer, but AB8 would have established affordability guidelines to assure Californians would not have to pay more than 5 percent of their income for premiums and out-of-pocket costs. AB8 also reined in the underlying costs of health coverage by requiring providers to disclose price and quality information, among other cost containment measures. Read Schwarzenegger’s press release and veto message for AB 8 here. Read Health Access’ analyses of AB8 here, and a rebuttal and fact check to the governor’s veto here. As an alternative to AB8, Schwarzenegger suggested his own bill, the Health Care Security and Cost Reduction Act to be discussed in special session. Health Access has summaries of the proposal here and here. OTHER HEALTH CONSUMER BILLSThe debate over major health reform overshadowed most other health care legislation, but several other bills of interest to health advocates made it through the legislative process and onto the Governor's desk. The following is a rundown of other health legislation, supported by Health Access California and other consumer groups, that the governor acted on this session: SIGNED bills included: * DISABLED CHILDREN: AB910 (Karnette): Assures that children with mental or physical disabilities, who are privately insured, are not dropped from coverage after a certain age. * INSURANCE RESCISSIONS: AB1324 (DeLaTorre): Requires health plans to justify rescinding policies from enrollees to the Department of Insurance or Department of Managed Health Care. Health plans also may not recover the costs of claims for care provided to enrollees unless they can prove consumers purposely deceived them to obtain coverage. * DRUG LABELING: SB472 (Corbett): Requires the state Board of Pharmacy to come up with standardized drug labeling for prescription medications. * LA COUNTY FUNDING: SB474 (Kuehl): Protects Los Angeles patients impacted by the closure of the Martin Luther King Jr.-Drew Medical Center by ensuring that money that would gone to that hospital to care for patients will be sent to the county to disperse to other providers who will be asked to provide care. Also clarifies the California hospitals will continue to receive the same amount under the federal hospital financing waiver and extends the sunset date to 2007-08 fiscal year. Read the Governor's press release here. The Governor also signed SB350 (Runner), which makes technical changes, at the request of debt collectors, to California ’s landmark legislation (AB774 –Chan) last year that bans the practice of hospital overcharging of uninsured and underinsured patients. Health Access California, the sponsor of AB774, was neutral on the measure. VETOED bills included: * HEALTH REFORM AND COVERAGE EXPANSION: AB8 (Nunez/Perata): Legislative leadership’s health reform proposal that would have expanded public coverage programs, set a required employer contribution at 7.5% of payroll for both part-time and full-time workers, established a state-operated purchasing pool, reformed the individual insurance market, and put in place various cost containment efforts. Read the Governor's press release and veto message here. Read Health Access’ analysis of AB8 here and rebuttal of his veto here. * EMPLOYER DISCLOSURE: AB343 (Solorio): Would have required the state to disclose names of employers who, rather than providing health coverage, have many of their workers and their families on Medi-Cal and Healthy Families. Schwarzenegger vetoed a similar bill, AB1840 (J. Horton), last year. Read the Governor's veto message here. * MENTAL HEALTH PARITY: AB423 (Beall): Would have required health plans to provide mental health parity. Read the Governor's veto message here. * WORKING DISABLED: AB1113 (Brownley): Would have extended the Medi-Cal California Working Disabled Program and increased eligibility. Read the Governor's veto message here. * PATIENT DUMPING: SB275 (Cedillo): Would have prevented patient dumping by requiring hospitals to have written policies on discharging patients, and requiring hospitals to appropriately plan post-discharge care with their patients. Also prevented hospitals from moving patients to locations other than their residence without consent of the patient. Read the Governor's veto message here. For the broader list of legislation of interest to health consumer advocates, including legislation that did not make the Governor's desk this year, visit the Health Access California legislative page at: http://www.health-access.org/advocating/2007_bills.html. SCHIP VETO OVERRIDE VOTE THIS WEEK IN CONGRESS
On Thursday of this week – and possibly earlier – the U.S. House of Representatives will attempt to override President Bush’s veto of the $60 billion State Children’s Health Insurance Program legislation. The program expired on September 30 and Congress’ extension of the program also included $35 billion in additional funding, on top of Bush’s paltry allotment of $25 billion. Now, without authority to continue the program, California could run out of the federal dollars to run its Healthy Families Program by November 15th. Nearly 850,000 California children are able to see a doctor, dentist and obtain health care through Healthy Families. While the U.S. Senate passed the SCHIP legislation with a veto-proof majority, the House of Representatives fell 25 votes short of the 290 “aye” votes needed to withstand a veto. At the time of the vote, 45 Republicans crossed over to vote in favor of the Legislation to continue to provide health coverage to low-income children and families. Of those 45 Republicans, only one--Rep Mary Bono--was from California, despite our sizable California Republican caucus of 19 members, the specific and dire impacts on California, and the support of Republican Governor Arnold Schwarzenegger. ALERT: To see how California Representatives voted, click here. You can also click on the names listed to find their phone number, call and solidify their vote to override Bush’s veto. Labels: Updates
posted by Anthony Wright |
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12:50 AM
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The reviews are in...
Monday, October 15, 2007
The Governor's release of the legislative language of his health plan really didn't add too much. As we have blogged previously, the details included some things to make it a bit better, and others to make it a bit worse, from our point of view. The most noteworthy change was the inclusion of the leasing of the lottery to help fund a couple of shortfalls, and to provide a tax credit to some Californians between 250-350% of the federal poverty level. The details of the tax credit are sketchy, so we need to know more--but we know enough to know it's not enough, to address the real affordability issues raised in the context of the individual mandate. The details about leasing the lottery are also sketchy--but the editorial boards have already weighed in, mostly against the idea. The San Jose Mercury News, the Los Angeles Times, and the Sacramento Bee all pan the proposal. The fact that these three entities also make other--but different--suggestions about where to get the money--sales tax, income tax, insurer contribution, (although they don't mention a higher employer contribution--the one assessment that would impact the newspapers the most)--suggests why this is a tough issue to figure out.
posted by Anthony Wright |
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12:12 AM
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SCHIP Countdown
Sunday, October 14, 2007
The New York Times has a description about the SCHIP debate in a conservative district in Maryland. Similar debates are happening in California in no less than 18 districts. The override vote in the House is currently scheduled for mid-week. Can California contribute five new votes for SCHIP? Make the call to your California legislator. Today. Labels: SCHIPHealthyFamilies
posted by Anthony Wright |
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11:46 PM
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Bill Update
Saturday, October 13, 2007
Gov. Arnold Schwarzenegger has just vetoed AB1113 (Brownley), which would have increased the number of disabled Californians eligible for the California Working Disabled Program and extended the program another five years beyond the September 2008 sunset date. The program allows workers who are disabled and earning less than 250% of poverty ($25,500 annually) to buy Medi-Cal coverage. AB1113 would have allowed workers to keep their coverage for 12 months if they were temporarily without work. Click here to read the governor's veto statement. Labels: Legislation, MediCal, Schwarzenegger
posted by Hanh Kim Quach |
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2:40 PM
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Rebuttal and fact check...
Friday, October 12, 2007
The governor just posted his veto message for AB8, which -- though not unexpected -- was annoying because he clearly hasn't confronted the limitations of his own bill. Here's a point-by-point rebuttal of some of his statements in the press release (the fictions are repeated - in a form - in his veto message): - "AB 8 ...does not cover all Californians.''
Neither does the Governor's proposal. Not the January proposal. Neither the 220-page legislative language he released this week. His own modeling, by MIT Professor Jonathan Gruber, suggests that 800,000 people will be left uninsured under his proposal. In addition to that, there's another 1 million Californians that Gov. Arnold Schwarzenegger's proposals don't cover--the plans merely force those 1 million Californians to buy inadequate coverage on the individual market that they would have no guarantee they could afford. Even if that is considered "coverage"--which is undefined in the legislative language--we expect that many will not abide by the mandate, as many do not with the requirement to get auto insurance. In short, the Governor's "universal coverage" proposal is neither universal, nor coverage. He is setting a bar that his own proposal does not meet.
- "A 7.5 percent fee would force employers to shoulder the entire burden of health care reform.'' No one gets off free in AB8.
Employers make up just less than half of the financing for AB8. There are significant other funding sources: AB8 applies the principle of "individual responsibility" meaning those who can afford the coverage -- that it's 5 percent of their income to pay the premium and out-of-pocket costs - need to take it up. The state is kicking in money to help lower- and middle-income families get coverage. And the proposal bring in significant federal matching funds. Even insures are asked to help pay for those who are denied because of "pre-existing conditions." Lastly, the governor needs to do more homework. California businesses already spend an average of 8 percent of wages on healthcare, according to this study.
- AB8 would deal "a devastating blow to small business in California." Wrong again.
This UC Berkeley Labor Center study shows that the impacts of health reform on California businesses would be similar to a modest minimum wage increase. No enormous business implosion has occured. In fact, the study finds that nearly 80% of businesses (large AND small) would see less than a 2 percent increase in costs over the long run. And in fact, health reform would increase worker productivity as they wouldn't feel wedded to a job they weren't suited for just because of the health coverage.
- "Earlier this week, the Governor released language in a bill for for his comprehensive Health Care Security and Cost Reduction Act, which brings access to affordable health care to every California.'' The statement goes on to say his plan "increases affordability."
When is spending $10,000 for a deductible increasing affordability? The new legislative language allows the Secretary of Health and Human Services to set a "minimum coverage" level that is even higher than the $5,000 deductible previously proposed. And it allows any employer-based coverage to qualify, even without any limits. In this regard, the legislative language went in the wrong direction.
Labels: Legislation, Nunez, Schwarzenegger, YearOfReform
posted by Hanh Kim Quach |
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5:51 PM
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Expected but disappointing....
It's not often that any Governor has a chance to help millions of Californians with a stroke of the pen, but he just missed that opportunity minutes ago with the veto of AB8. With his pen, he could have made coverage more available and affordable for millions of Californians, whether through on-the-job benefits, through public programs, or the individual insurance market. We'll see what he is willing to put in its place. This is the fourth time in four years that the Governor Schwarzenegger has blocked a major health care reform that would have significantly expanded health coverage for over a million Californians: * the Governor campaigned against Prop 72 to expand worker coverage in 2004; * he vetoed AB772 to expand children's coverage in 2005; * he vetoed SB840 to expand coverage to all Californians through a single-payer system in 2006; and now * he vetoed AB8 that would have comprehensively expanded health coverage and that included financing in 2007. With his history of vetoes on health, the Governor needs to show flexibility and not just keep proposing what he set out in January. WORDS VS. ACTIONS: He says he wants reform, but vetoes the bills that pass the Legislature. He says he only will sign a universal coverage proposal, but his proposal is neither universal nor coverage—it doesn’t even define what coverage is. He says he wants only comprehensive reform, but he sets a standard that his own proposal doesn’t meet. He says he is willing to negotiate and be flexible, yet ten months into the process, he has just put out language, and it doesn’t move much from his January proposal. AB8 DESCRIPTION: AB8(Nunez/Perata) was a comprehensive health reform package that would expand health coverage to over 95 percent of Californians in the state -- and would be the most sweeping coverage expansion in four decades. Unlike the Governor's plan, which requires a 2/3 vote or a ballot measure, AB8 can be passed and financed as a majority vote, allowing it to get to the Governor's desk. AB8 would have made significant strides toward universal health coverage. Once enacted, 95 percent of Californians would have health coverage. * The full text of the bill is here, * Health Access’ comprehensive fact sheet on AB8 is here. * Health Access' analysis of the current barriers for consumers in getting coverage, and how AB8 (and SB840) would have addressed those issues, is available on our website, here. * Health Access letter to the governor on AB8 is here. KEY PROVISIONS: The high points of AB8 include: · Expands Medi-Cal and Healthy Families to cover all children, and most parents, who are citizens/legal residents up to 300%FPL. · Creates a statewide purchasing pool initially for employees and dependents of employers that choose to use the purchasing pool. A new, affordable option for employers to cover their entire workforce, the purchasing pool would cover an estimated three to four million people. · Establishes a minimum employer contribution to spend 7.5% of payroll on health benefits, either by paying into the purchasing pool or buying health insurance or other health benefits. · Establishes a ceiling – at 5 percent of income - for what consumers are required to pay annually for health costs (including premiums and out-of-pocket costs). · Reforms the individual insurance market so that coverage is available to anyone who wishes to purchase, by limiting insurers ability to deny people based on “pre-existing conditions,” and providing better funding coverage for those that are denied. · Brings in new federal dollars to California ’s health system, through these expansions of public programs and employer contributions. · Offers workers tax savings, by providing the ability to pay premiums, or share-of-premiums, with pre-tax dollars, for a savings of 15-40%. · Places other rules and oversight on insurers, including limiting the percentage of premium dollars that go to administration and profit, rather than patient care. · Provides modest reforms of job-based coverage to make it more accessible and affordable for employers. · Encourages use of health information technology and disease management.· Encourages cost savings through a bulk purchasing of prescription drugs, transparency of medical cost and quality information and creates a public insurer option to compete with private insurers to help keep premiums low. AB8 SETS A GOOD FOUNDATION AB8 (Nunez/Perata) is a comprehensive approach to both expand health coverage, and to secure coverage for those who have it, but are concerned that it won’t be there for them when they need it. It seeks to make health coverage more available, affordable, and automatic in each of the three ways that consumers now get coverage: through employer health benefits, public coverage programs, and the individual market. Passage and enactment of AB8 would have been historic, as it would be the biggest health care expansion of since the creation of Medicare 40 years ago; it would set a minimum employer contribution for health care, as significant as the establishment of the minimum wage 70 years ago. The proposal includes “shared responsibility” financing from employers, workers, state and federal government, and insurers. As a majority vote bill, it can be enacted into law with simply the Governor’s signature, without the need for additional financing or special federal waivers. If the governor wants something different or include different elements that would improve the bill, such as the Medi-Cal rate increase (and related hospital), he should start with the framework of AB8 and add to that. Labels: Legislation, Sacramento, Schwarzenegger, YearOfReform
posted by Anthony Wright |
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5:00 PM
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In the aftermath --
Gov. Arnold Schwarzenegger just signed SB474 (Kuehl) which will protect patients who live in Los Angeles and would have been impacted by the closure of the Martin Luther King Jr.-Drew Medical Center. It would provide up to $100 million to pay for services that would have otherwise been provided by King-Drew Medical Center, allowing the county to contract with other providers in the area to assure that patients could continue to receive care. The bill also assures safety net hospitals can continue getting the money they need. Labels: Kuehl, Legislation, Schwarzenegger
posted by Hanh Kim Quach |
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1:53 PM
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Quick report...
Thursday, October 11, 2007
There was a little action on health consumer bills in the past few days... A SIGNATURE: The Governor did sign one bill of note, SB 472 by Senator Ellen Corbett (D-San Leandro), which placed clear labeling requirements for prescription drugs. It was sponsored by senior, consumer, and community of color organizations. A VETO: For the third year in the row, the Governor vetoed a report to publicly disclose the employers whose workers (and children of workers) are on public programs. This year, the veto is of AB 343 by Assemblymember Jose Solorio (D-Anaheim). See veto message.
posted by Anthony Wright |
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6:03 PM
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The Real Story...
Jonathan Cohn at The New Republic has the complete back-and-forth of the latest blog war over SCHIP. It's a must-read, from several angles. The short version: Graeme Frost, a 12-year old, gave the Democratic radio address in defense of SCHIP, since he benefitted from it while having a severe brain trauma during a car accident. Conservative blogs and even politicians started attacking the Frosts personally, even publising their address and scoping their home, including questioning the financial position of the Frosts and whether they "deserved" coverage. As Cohn points out, most of the attacks were simply false. Points of interest: * As a consumer advocacy organization, we spend a lot of time talking with consumers who experience issues with the health system, and working to empower those Californians to tell their story, to policymakers and the press. In the world of politics where we simply can't compete in campaign contributions, it's the one power that consumer groups uniquely have over our industry opponents. * In the past five years, Health Access hass been responsible for the majority of uninsured people that have come up to testify in hearings in Sacramento. Usually, politicians and political pros are deferential to what they call "real people," who take time off of work and life (as opposed to those of us who are always here, and most of us who are paid be here.) So it is troublesome and surprising that the attacks became personal. * Because we know both reporters and legislators ask questions, we spend an inordinate amount of time to vet the story of the individual, making sure that the issue is relevant to the legislative debate at hand, that there aren't other extenuating issues. But apparently even that doesn't matter... * This goes to the very issue of individual "stories" as part of advocacy. For many, they already have a "frame" in their mind and will fit the story into that frame, and if it doesn't fit, they will explain it away. But the stories do illustrate the issue, and provide a hook for media coverage, so it's a part of our advocacy, and that of other consumer organizations. * Either way, it's an interesting debate that speaks to one's worldview: What if the Frosts really were financially better off? Why is it so bad that there's a program that insures that the child get coverage? At what point does somebody--even a child--become not "deserving" of help for health care?
posted by Anthony Wright |
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11:37 AM
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It's someone you know....
Marty Omoto is an warrior for people with disabilities, and I've had the pleasure of working with him over the years. He is also of the "send E-mail constantly" school of advocacy, trying to put out as much information so people can be the most effective in their efforts in trying to influence the sometimes opaque world of Sacramento. For those who don't have the pleasure of getting his E-mail updates, I wanted to post a selection from what he sent recently, explaining his absence. I am writing this note to let people know that I have been out of action for the past week and half due to my health (though avidly keeping track of the major news events of the world as covered by CNN and all the major news media, which of course means only what happens next to Britney Spears).
About a week and half ago I was hospitalized in Sacramento due to major internal bleeding that began - unknown to me at the time - the previous Wednesday (September 26). The doctors said it probably was happening over the past year, but reached a critical point at that time. In the next few days I lost nearly 50% of my blood volume (or, for those optimists who always see life as "half full", I retained half of my blood volume). At that point I was, according to the ER, very close to going into shock that could have led to cardiac arrest and a visit to the "other side". Well, I guess not a visit. I was rushed in time to the hospital on Sunday (September 30), where I was given a lot of blood transfusions, and IVs that pumped all sorts of things into me, though apparently not the good sense that so many people think I still need. Some things can't be corrected.... They later did several procedures to successfully stop the bleeding related to extreme hypertension (high blood pressure) that was, before this happened, over 250/140. Well, that just goes to show you that a person can walk around with all sorts of bad things going on inside. I am fine now - getting back my strength each day - and I am resuming work this week... Health Care and No Insurance I do not have medical insurance - but it is not by my choice. I don't have medical insurance - like so many others in this country and in California, because it is simply not affordable. And that makes health care and prescription drugs out of reach. I am living proof of that - as so many others are in this country and in this state.
Every doctor and nurse that treated me, asked me all sorts of questions, including, over and over, why I wasn't taking any medication for high blood pressure. They seem perplexed why I didn't. They were all wonderful and good people. But they seemed not to understand why a person with a health problem that might be solved by medication would end up at the ER.
Sometimes showing up at a hospital ER without medical insurance feels like going to church once a year all dressed up - with the pastor or priest or rabbi sort of staring and shaking their heads, with that look of "if you only would show up more often..." life would be so much better.
In the intensive care unit, most of the time I was too out of it to explain and would simply say "I don't have health insurance". That would generally stop any further questions on that topic, though I did wonder, upon hearing that news, if the nurses and doctors would start yanking out the tubes and somehow pump the blood transfusions back out of me. They were however, cool about it - but I just wondered if they understood. It just sometimes depends where one's life experience happens to come from. You can get pretty emotional after lying in ICU for awhile. I couldn't help think about what happened to my family and what happened to me and what could have happened. My family was pretty upset, including my dad who had lost his only two daughters in the last four years. I finally, in a very emotional quiet voice, told one doctor who seemed not to understand that "I didn't choose not to have health insurance. I can't afford it. My sister couldn't afford medication for her heart - and she died. My sisters died. Do you understand that we didn't choose for any of this to happen? Can you understand that? It's not that we didn't want to choose something better. We didn't have a choice." I said it very gently, because this particular doctor was so compassionate and simply seemed perplexed - like that devoted church person or pastor who doesn't understand why a person would only show up to church once a year. The doctor actually had tears in his eyes, and held my hand and just said softly "I am so sorry. I understand. I am so sorry."
California has the best hospitals, doctors, nurses and other health professionals in the world - if you are lucky enough to have access to them. This time, I was very, very lucky enough to get tremendously good and compassionate care. I was lucky to get any health care. Next time I may not. Too many other Californians share this same experience. If you are lucky, you might get health care. But luck should have nothing to do with it. Somehow, that needs to change.
Labels: HealthAccessCommunity, Schwarzenegger
posted by Anthony Wright |
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10:52 AM
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The quick and dirty report on the 220 pages...
Wednesday, October 10, 2007
HEALTH ACCESS UPDATE
Wednesday, October 10, 2007 GOVERNOR UNVEILS LEGISLATIVE LANGUAGE TO HIS HEALTH PROPOSAL* Essentially the January Proposal: Individual Mandate, Public Program Expansion, Etc.
* Some Changes Include: Tax Credit Intent; Revenues from Leasing the Lottery
* Lack of Movement on Key Issues, Including Affordability of Out-of-Pocket Costs
New on the Health Access WeBlog: More on SCHIP, Affordability, and the Gov’s Legislative Language.At a Tuesday afternoon press conference, Gov. Arnold Schwarzenegger released more than 200 pages of legislative language regarding his health reform proposal. This is the first major release of additional detail from the Governor since January, when Schwarzenegger released a 10-page concept paper he viewed as a blueprint to health care reform in the state. PROCESS: He said he hoped the conclude negotiations in the next few weeks, pass legislation this month, and then promote a November 2008 ballot measure that would have the financing elements which would pay for reforms and allow them to be enacted. The language, he said, “reflects months of negotiations’’ and is the “product of more than a year of discussions and negotiations.’’ Schwarzenegger said he and Assembly Speaker Fabian Nunez have been negotiating heavily and feels “There’s a will to fix it. Therefore we will get it done.’’ In a statement, the Speaker welcomed the language, but did not agree to carry it. The press conference indicated that the proposal will likely be a “committee bill”—meaning a proposal without a legislative author. Schwarzenegger emphasized that this draft released Tuesday was still a fluid document and the numbers and percentages would continue to change – particularly with respect to standards for affordability. SUBSTANCE: Many features of the latest draft are similar to the initial concept paper the Governor released in January, with some tweaks. LOTTERY: The biggest change, getting the biggest headlines, is the proposal to lease the operations of the state lottery, to raise about $2 billion/year to help finance the program. The proposal also includes: INDIVIDUAL MANDATE:* CONCEPT PAPER: A mandate that all Californians must have insurance coverage, without condition, exception, or limit. “Minimum credible coverage” was previously defined as a policy with a $5,000 deductible, and $10,000 out-of-pocket cost maximum. * CHANGE: The legislative language continues to have a broad mandate, and begins to detail the enforcement through various state agencies. The “minimum credible coverage” is no longer defined; instead the Secretary of Health and Human Services will define it; and employer-based coverage would count even if it was below the minimum. * COMMENT: The individual requirement is in force, even if the individual does not get help from an employer or public program. Unlike employers, hospitals, or counties, there’s no limit to the expected requirement based on income. PUBLIC PROGRAM EXPANSION:
* CONCEPT PAPER: Expansion of public coverage programs for all children up to 300% of the federal poverty level, and many qualified parents and adults without children at home up to 250% of the federal poverty level ($25K for an individual, $50K for a family of four). Some streamlining of these programs. * CHANGE: The legislative language is similar to what was proposed, with some tweaks: it no longer includes the “bright line” language that would have disenrolled many from no-cost Medi-Cal, and raises the qualification for no-cost Medi-Cal up to 150% of the poverty level ($15K for an individual; $30 for a family of four). * COMMENT: The public program expansion has been the area of greatest consensus between the Governor and the Legislature, although there are still issues about how to sustainably finance the expansion. And while there’s a limit of premium costs for those between 150-250% FPL at 5% of income, there’s no guideline for potential out-of-pocket costs, significantly diluting that protection. EMPLOYER CONTRIBUTION:
* CONCEPT PAPER: A requirement that employers of 10 or more workers spend at least 4% of payroll for health care benefits. * CHANGE: The legislative language does now include employers with fewer than 10 workers, setting a minimum requirement at a sliding scale of 0-4%. * COMMENT: There is not much change in this category, which has significant differences with AB8 (Nunez) in both contribution level (7.5% of payroll) and structure (for example, in getting coverage to part-timers). Given that employers who provide coverage currently spend over 12% of payroll for health care, consumer advocates are concerned that the less employers are expected to contribute, the more their workers are expected to bear in the context of an individual mandate. INSURANCE MARKET RULES:
* CONCEPT PAPER: Insurers would be prevented from denying people based on “pre-existing conditions,” and have to spend 85% of their premiums on patient care, rather than administration and profit. * CHANGE: The legislative language does have a phase-in that maintains the existing high-risk pool and intends to gradually reduce difference in rates based on health status. The limit on how much older people can be charged more than younger people is unspecified, left up to the regulators. And the “medical loss ratio”—how much insurers spend on patient care—is reviewed in terms of an insurer’s whole book of business, rather than product by product, or even market-by-market. * COMMENT: The change to allow unsubsidized individuals to get coverage through the purchasing pool is an improvement, but there are concerns that the language doesn’t prevent the insurers from being able to select risk through pricing, marketing, age rating, benefit design, etc. PROVIDER RATES AND FEES:
* CONCEPT PAPER: Medi-Cal rates would be increased for doctors and hospitals. In turn, the doctors and hospitals would pay a “dividend” in the form of a provider fee. * CHANGE: The legislative language does include the Medi-Cal rate increase for both doctors and hospitals, but no longer includes the assessment on doctors. * COMMENT: This element, supported by many advocates who want to see increased access and quality for Medi-Cal recipients, was not included in AB8 because of the 2/3 vote requirement for taxes and the resulting blockade by Republican legislators. The Governor and legislative leaders would get this piece by going through to the ballot. The bill continues to have various language about prevention (such as obesity and smoking cessation) and cost containment (such as transparency and information technology), which we will describe more in future alerts. AFFORDABILITY ISSUES: The Governor also acknowledged issues about affordability by placing intent language in the draft to suggest a “tax credit” for those between 250-350% of the federal poverty level. However, that tax credit is only for the premium, and does not include “out-of-pocket costs.” Consumer advocates have focused on the issue of affordability and out-of-pocket costs over the past several months—the Its Our Healthcare! campaign even ran ads with the tag line “it’s not real health care unless you can afford to use it.” But the Governor’s legislative language and the changes he made since January, don't address this issue, except for those who are just above the poverty level (100-150% of FPL) who would qualify for Medi-Cal with no cost-sharing. Other than that, the new language goes backwards: · The new legislative language gives the Administration the ability to set “minimum coverage” at any level. Consumer advocates disagreed with the level it was set at in January with a $5,000 deductible policy, but giving the Administration the ability to set it at a potentially worse level is not an improvement. · Whatever the “minimum coverage” that is set really won't be the minimum. Under the individual mandate, there’s no standard for employer-based coverage in terms of benefits or cost-sharing, so people could be called “covered” with less-than-minimum benefits. It also means that many people with even sub-par employer-based benefit will then be excluded from subsidized coverage or the tax credit--yet still subject to the mandate. · The language provides state tax breaks to promote Health Savings Accounts, (which can only be used with high-deductible plans). MANDATE WITHOUT AN AFFORDABILITY TEST: The Governor’s health care reform website has a chart showing how specific “hypothetical” people may get helped. http://gov.ca.gov/pdf/gov/HealthCare%20Reform_WhoBenefits%2010.9.07.pdfBut responding to the legislative language, consumer advocates are also concerned there are significant populations that would have the burden of an individual mandate, but would not get the assistance needed to meet the mandate with coverage that was actually of value to them. They include the following categories, each of which includes hundreds of thousands of Californians: * Low-income adults under 250% that would not qualify for subsidized coverage because of the documentation requirements of the Deficit Reduction Act, including both citizens and undocumented Californians. They would be subject to the mandate although it would simply be too expensive. * Low-income adults under 250% without children at home who are offered employer-based coverage at work with significant cost-sharing, high deductible health plans, or no out-of-pocket costs maximum. They would be forced to take up such coverage, with any associated costs, and many would thus not be eligible for public program coverage. * Medium-income individuals and families who would have no assistance offered. For example, this could include an individual 50- or 60-year olds at $40K, $50K, or $60K, but for whom to buy coverage on the individual market would require premiums and out of pocket costs of $10,000 or $20,000. NEXT STEPS: Health Access and other organizations and advocates are looking over the details. More will be posted on our website and blog, at http://www.health-access.org/blogger.html. To view other resources from the Year of Health Reform, visit our website, at: http://www.health-access.org/advocating/2007_healthdebate.html. Labels: Schwarzenegger, Updates, YearOfReform
posted by Anthony Wright |
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5:23 PM
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Not just the numbers...
We'll post our analysis shortly on the Governor's language... but one thing... The Governor suggested yesterday that it is just the numbers left to negotiate. Actually, it's not just the numbers. There's still issues about the fundamental framework. It starts with an individual mandate, without condition, exception, or limit. Health Access supports proposals that include individual responsibility. But we believe that individual responsibility comes only after individual consumers are offered coverage that is available, affordable, and administratively simple for the consumer. After that, a mandate is mostly moot: Californian consumers want coverage, desperately, and overwhelmingly. In AB8, which we supported, individuals are required to take up coverage that is offered through employers or a purchasing pool, if it was affordable. Affordability included affordable to get (premiums), affordable to use (out-of-pocket costs), and affordable in value (since it was negotiated by a large group). We have in the past supported other measures that included requirements on individuals to pay for or accept coverage and would do so again, but with similar protections, especially on affordability. GROUP VS. INDIVIDUAL COVERAGE: In contrast, we are deeply troubled by a framework that is based on expanding the individual insurance market, which is the least efficient, most expensive way to get coverage. AFFORDABILITY: Massachusetts, the only state to even enact an individual mandate (though it has yet to fully implement it), also recognized the need to have a clear statement that the mandate would be conditional on availability and affordability. CONSUMER PROTECTIONS: They did so with a much more robust regulatory oversight over their insurance market, a much higher concentration of group coverage, and only after putting additional consumer protections in place. If the Governor thinks that he'll get support by just nudging the numbers, he's mistaken. He needs to move from his January proposal.
posted by Anthony Wright |
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1:43 PM
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Defining affordability (or not)...
Consumer and health advocates from across the state, as part of the Its Our Healthcare coalition, are delivering thousands of keys to the Governor’s many district offices across the state. Their message? “Affordability is the key” in figuring out a health reform package. Luckily, affordability is a word very much on minds of many stakeholders and policymakers, including the Governor at his press conference yesterday. But are they talking about the same thing that consumers are talking about? So in looking at the Governor’s draft and the changes he made since January, it really doesn't address this issue, except for those who are just above the poverty level (100-150% of FPL) who would qualify for Medi-Cal with no cost-sharing. Other than that, the new language in some ways goes backwards:* Even though we disagreed with the level it was set at, we certainly agreed with the notion in the January proposal of setting a minimum standard of benefits. The new language no longer defines what the “minimum coverage” should be, leaving it up to the Secretary of Health and Human Services, and presumably the Governor. After proposing and now withdrawing from a $5,000 deductible plan, this gives the Administration the ability to set such “minimum coverage” at a any level, including a $10,000 deductible with no out of pocket maximums. (In California, insurers are already allowed to sell such policies.) * Whatever the “minimum coverage” that is set really won't be the minimum. Under the individual mandate, there’s no standard for employer-based coverage in terms of benefits or cost-sharing, so people could be called “covered” with less-than-minimum benefits. It also means that many people with even sub-par employer-based benefit will then be excluded from subsidized coverage or the tax credit--yet still subject to the mandate. * The language provides state tax breaks to promote Health Savings Accounts, (which can only be used with high-deductible plans), not only in future years but retroactively to 2005. Let's contrast this with AB8: AB8 said that no employee could be required to accept coverage if it cost more than 5% of wages for that employer. That’s not perfect: it means some people will face the choice of spending more or having no coverage. But it creates a labor market standard that no one should be expected to spend more than 5% on health benefits. Who is helped by this? Low-income working families, those who make less than 300%FPL where median spending on health care is over 5% now. And people who make more than 300% who have high health care costs whether it is because it is the year they have the heart attack or cancer or whether it is because they have multiple chronic conditions and coverage with high cost-sharing. The Governor’s proposal contains no such protections. It says every Californian must have coverage no matter who much they must pay out of pocket. If the employer offers coverage with a very high deductible, or with no out-of-pocket maximum, that counts as meeting the minimum. If the Secretary of Health and Human Services decides the minimum coverage is $2500 deductible There's not a lot in the law right now to help consumers with health care affordability--which leaves people uninsured. Both AB8 and the Governor's plan provide some help. But in the context of the individual mandate in the Governor's plan, people would be required to take up coverage that is clearly unaffordable to get, and unaffordable to usee. And that just doesn't work for consumers.
posted by Anthony Wright |
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2:15 AM
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Better late than never?
I can now say it without qualification--we have legislative language on the Governor's proposal! In both detail and substance, this is where we should have been in April: not just in having legislative language, but in terms of where the proposal has moved--or not moved--from January. It is similar to the "orphan" legislative language released last week, which we discussed, although there are differences. It served as a trial balloon. To see Health Access' 12-page letter responding to the "unowned" language, click here. The thing that will likely get headlines is the inclusion of the money from leasing out the lottery. Perhaps most noteworthy for consumer advocacy organizations is that he has not moved on an individual mandate without *any* conditions or tests on affordability. There's not many contituency groups--even those that support some of the public program expansions and other elements--that would or could go there.
posted by Anthony Wright |
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1:12 AM
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Governor introduces health reform language....
Tuesday, October 09, 2007
After 10 months, Gov. Arnold Schwarzenegger released the highly anticipated legalese to accompany his 10-page health reform concept paper released in January. This 220-page draft seems to have grown since last week, when a 195-page version was circulating for comments. My colleague Anthony posted comments and analysis about last week's language -- which was not claimed by the governor -- here and here and remains relevant to the latest document. Here's a quick take on some of the new elements of the plan: One new wrinkle: All employers -- not just those with more than 10 workers -- would be required to contibute to employee health care. Businesses would be asked to contribute, based on a sliding scale, of between 1 and 4 percent. AB8 (Nunez/Perata), which is the Legislative leaders' proposal, requires a 7.5 percent minimum contribution from employers. Ken Jacobs at the UC Berkeley Labor Center explains in this Sacramento Bee editorial why that 7.5 percent figure is important. (Essentially, businesses in the state already contribute an average of 8 percent and we shouldn't lower the bar and allow businesses to abrogate their current responsibilities.) Another new thing this week seems to be the addition of revenues from the state lottery. The governor's idea is to lease the operation of the lottery to a private company (though he specified that the concept did not involve privatizing the lottery), which would -- i suppose -- sell more tickets and make more money? This idea, Schwarzenegger said, is meant to supplant talk of a sales tax increase. Lastly, Bill Ainsworth at the San Diego Union Tribune asked the governor about affordability. Under this plan, Californians earning more than 350% of poverty ($72,275 for a family of four), would be responsible for buying their own coverage without any help at all (either subsidies or tax breaks). Such a family -- in today's insurance market -- could spend nearly $7,000 a year on premiums alone. The premiums alone are nearly 10 percent of the family income. And that's for coverage that isn't that great ($3,000 deductible, $500 prescription drug deduction, and $10,000 out-of-pocket maximum). The governor conceded that affordability was an issue, "We need to help people especially if it costs more than 5 percent'' of their income. All the figures in the current bill, he said, are up for negotiations. Stay tuned for more.... Labels: Affordability, Legislation, Sacramento, Schwarzenegger, YearOfReform
posted by Hanh Kim Quach |
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10:32 PM
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The lessons we learned in preschool...
Sharing. A story in the Wall Street Journal today describes new health plans that provide fixed premiums for employers. The plans, geared toward small- to medium-sized businesses, the businesses to sign a fixed-price contract with an insurer for a few years. But insurers have to make up the money somehow -- and that's where the concept of sharing -- or not -- comes in. Under the plans, worker deductibles could soar between $50 to $2,500. Co-pays for visits would increase as well. So while the business' prices are fixed; employees' aren't. As it is now, both businesses and employees alike share in the pain of rapidly increasing costs. A survey last month showed premiums are increasing 8.7 percent. Employees are paying a total of 10 percent more for premiums plus out-of-pocket costs. This new arrangement shifts all increases solely onto the shoulders of the employees. So what happened to shared responsibility? Labels: Employers, YearOfReform
posted by Hanh Kim Quach |
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11:53 AM
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What's he been doing all month?
Monday, October 08, 2007
So the governor's finally gotten moving on the bill signings, with less than a week left and 596 bills to swipe his pen across. In today's list, we have SB350 (Runner), requested by debt collectors, which makes minor technical changes to the landmark AB774 (Chan) anti-hospital overcharging bill last year. Health Access, Consumers Union and Western Center on Law and Poverty closely monitored the bill to make sure the new law, AB774, was not diluted in any way. Health Access took a neutral position on the bill. As many may recall, consumer advocates scored a major victory -- after five years -- last year when Gov. Arnold Schwarzenegger signed legislation that would ban hospitals from charging uninsured and underinsured patients thousands and tens of thousands of dollars for services that they charged insurance companies just a fraction (like 25% of what the uninsured paid). Uninsured and underinsured patients can now pay the same rate as Medicare. To read more about AB774, click here. Labels: MedicalDebt, Underinsurance, Uninsured
posted by Hanh Kim Quach |
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5:08 PM
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Humanely affordable
Of the many brain-stumping issues in the health reform debate, the one that seems to provoke the most visceral reaction from all sides seems to be: how to make health care affordable. The past decade, we've all been the victims of health premiums that increase at three times the pace of our salaries ... and everything else. We've noticed that the health plan just doesn't cover as much as it used to. And deductibles and co-pays are popping up where they weren't before. It's gotten so bad that more than 3,000 consumers from all over the state have submitted cards and keys with their health care stories, to be delivered to the Governor's offices this week. But what are people actually spending? A helpful report released last month by the UC Berkeley Labor Center answers that question. Researchers crunched data from the national Medical Expenditure Panel Survey -- shows what people are spending on health care. The numbers, for some, are bleak. A family of four, earning the median income in California -- $74,801 -- who is moderately healthy, and has regular health care expenses can expect to spend, at most, 5 percent of their income on health coverage AND out-of-pocket costs if they have to go out on their own and buy health coverage on the open market (meaning they don't get it through work.) If you can get coverage from your job, however, they'll end up spending just 2 percent of their income. Pretty good deal. On the other hand, if someone gets in a car accident, or breaks an arm, or is diagnosed with cancer or diabetes, the numbers are much more overwhelming. Even with coverage on the job, such a family could find themselves spending more than $6,000 to buy the coverage AND use the coverage. Those who have to go out and buy their insurance on their own would spend nearly $12,500 (16.7 percent of their income). As this Health Access report from earlier this year shows, the majority of Californians -- 60% -- have assets of less than $12,000 (excluding home equity). So that means they'd have to empty their savings, liquidate their car, their 401ks, furniture, to pay for one year's medical bills. That doesn't innoculate them from getting sick the following year, either, when there is nothing to sell off to pay the hospital bill. So as we continue debating what to do with AB8, health reform in California and nationally, someone should take a look and listen to what consumers are actually spending and ask themselves, is this right? Labels: Affordability, YearOfReform
posted by Hanh Kim Quach |
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12:05 PM
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Special Session: Where to Start?
Sunday, October 07, 2007
HEALTH ACCESS UPDATEMonday, October 8, 2007 SWEEPING REFORM, OTHER HEALTH BILLS TO BE SIGN OR VETOED THIS WEEK* AB8 (Nunez/Perata) would be largest expansion of public coverage since Medicare
* Governor has threatened to veto AB8; Special Session on health reform to continue
* ACTION ALERT: AB8 & its Affordability Standards Should Be Basis of Negotiations
* Other Special Session Updates, Including "Working Draft''
New on the Health Access WeBlog: SCHIP Updates; Rep. Watson's Vote; Humor from Tragedy; Override Strategy; Sec. Leavitt's Blog; Veto's Impact in California; Other Clips; Special Session Gossip; Analysis of the "Unowned" Legislative Language on Health Reform
All eyes are on Sacramento in the next few days, as Gov. Arnold Schwarzenegger has approximately one week to sign or veto over 500 pieces of legislation. BILL LIST: Up for consideration before this deadline is a handful of bills tracked by health consumer advocates, on everything from protecting consumers from insurance companies rescinding coverage, to broadening coverag to include mental health services; to expanding coverage for the working disabled. For a list of bills of interest to health advocates, visit the Health Access California legislative tracking page (with a companion printable flyer), at: http://www.health-access.org/advocating/2007_bills.htmlHEALTH REFORM PENDING
By far the most far-reaching proposal on the Governor's desk in health and likely any other issue is AB8(Nunez/Perata), a comprehensive health reform package that would expand health coverage to over 95 percent of Californians in the state -- the most sweeping coverage expansion in four decades. The bill was passed last month in the final days of the 2007 legislative session and would accomplish many of the goals Schwarzenegger laid out last year when he declared 2007 would be the "Year of Health Reform." Unlike the Governor's plan, which requires a 2/3 vote, AB8 can be passed and financed as a majority vote, allowing it to get to the Governor's desk. Instead of embracing AB8, though, Schwarzenegger has vowed to veto it. ANOTHER VETO? Schwarzenegger's fervor for health reform this year represents his own concession to a challenge, issued by the Legislature and health advocates over the past five years, who had passed significant and historic health coverage expansions, including an employer mandate, children’s coverage expansions and single-payer universal coverage measure, all of which he had opposed saying he wanted to find a “comprehensive’’ solution. If he follows through with a veto on AB8, it would be the fourth time he has blocked a major health care expansion effort. SPECIAL SESSION CONTEXT: The Governor has called a "special session" of the Legislature to consider a compromise health care reform. Recently, legislative language was released in Sacramento--unowned by anybody, but reflecting a proposal very similar to what the Governor announced in January. The Health Access WeBlog has a short description of the language, and how it compares with the Governor's original concept paper, both positively and negatively. Instead of this trial balloon, AB8 is made up of legislative language that has gone through the public legislative process. Short of the Governor signing the bill, AB8 should be the basis of negotiations. ACTION ALERT: CALL/WRITE THE GOVERNOR ON AB8(NUNEZ)
* Tell the Governor that he should sign AB8. * Tell the Governor that health care negotiations should start with how he would amend AB8. * Tell the Governor that any health care negotitations should include the types of affordability protections that are in AB8. Contact the governor at: Gov. Arnold Schwarzenegger State Capitol Sacramento , CA 95814 FAX: 916.445.4633 To view the letter Health Access sent to the governor on AB8, click here. WHAT AB8 DOES AB8 would make significant strides toward universal health coverage. Once enacted, 95 percent of Californians would have health coverage. Read the bill here, or read Health Access’ fact sheet on AB8 here. Here are the high points of AB8: · Expands Medi-Cal and Healthy Families to cover all children, up to 300%FPL and parents who are citizens/legal residents also up to 300%FPL. · Creates a statewide purchasing pool initially for employees and dependents of employers that choose to use the purchasing pool. A new, affordable option for employers to cover their entire workforce, the purchasing pool would cover an estimated three to four million people. · Establishes a minimum employer contribution to spend 7.5% of payroll on health benefits, either by paying into the purchasing pool or buying health insurance or other health benefits. · Establishes a ceiling – at 5 percent of income - for what consumers are required to pay annually for health costs (including premiums and out-of-pocket costs). · Reforms the individual insurance market so that coverage is available to anyone who wishes to purchase, by limiting insurers ability to deny people based on “pre-existing conditions,” and providing better funding coverage for those that are denied. · Brings in new federal dollars to California ’s health system, through these expansions of public programs and employer contributions. · Offers workers tax savings, by providing the ability to pay premiums, or share-of-premiums, with pre-tax dollars, for a savings of 15-40%. · Places other rules and oversight on insurers, including limiting the percentage of premium dollars that go to administration and profit, rather than patient care. · Provides modest reforms of job-based coverage to make it more accessible and affordable for employers. · Encourages use of health information technology and disease management. · Encourages cost savings through a bulk purchasing of prescription drugs, transparency of medical cost and quality information and creates a public insurer to compete with private insurers to help keep premiums low. AB8 SETS A GOOD FOUNDATION
AB8 (Nunez/Perata) is a comprehensive approach to both expand health coverage, and to secure coverage for those who have it, but are concerned that it won’t be there for them when they need it. It seeks to make health coverage more available, affordable, and automatic in each of the three ways that consumers now get coverage: through employer health benefits, public coverage programs, and the individual market. Health Access' analysis of the current barriers for consumers in getting coverage, and how AB8 and SB840 would address those issues, is available on our website, here. Passage and enactment of AB8 would be historic, as it would be the biggest health care expansion of since the creation of Medicare 40 years ago; it would set a minimum employer contribution for health care, as significant as the establishment of the minimum wage 70 years ago. The proposal includes “shared responsibility” financing from employers, workers, state and federal government, and insurers. As a majority vote bill, it can be enacted into law with simply the Governor’s signature, without the need for additional financing or special federal waivers. TIME TO ACT
AB8 is now sitting on the governor’s desk awaiting action. It’s time to act. Please write Gov. Schwarzenegger, advising him of AB8’s import. The Year of Health Reform should not end with a vetoed bill. If the governor wants something different or include different elements that would improve the bill, such as the Medi-Cal rate increase, he should start with the framework of AB8. Again, contact the governor at: Gov. Arnold Schwarzenegger State Capitol Sacramento , CA 95814 FAX: 916.445.4633 BONUS ALERT: The coalition Having Our Say, made up of groups representing communities of color, is seeking 1,000 signatures for their online petition, calling for health reform this year that reduces health disparities, increases access, and ensures affordability. The petition is at: http://www.thepetitionsite.com/2/health-care-reform-nowTo view the letter Health Access sent to the governor, click here. To view other resources from the Year of Health Reform, visit our website http://www.health-access.org/advocating/2007_healthdebate.html. Labels: Updates, YearOfReform
posted by Anthony Wright |
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11:47 PM
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Laughing or crying?
Friday, October 05, 2007
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18 Californians to go...
Rep. Diane Watson was the only Democrat from California that did not vote for SCHIP. She has posted on her website her reasoning, and how she is voting for the override of Bush's veto: “I am a strong and vocal supporter of SCHIP's reauthorization and expansion. I have voted twice this year to continue and expand the program. The compromise SCHIP bill that was brought to the House floor on September 25th troubled me; while it would have expanded SCHIP, it would have fallen short of the goal of ensuring that every child in America gets proper health care. The compromise would have extended SCHIP for five years, but would have left millions of American children---including tens of thousands in California---without health insurance coverage. For this reason, I felt I must cast a vote on behalf of those millions of children, and so I cast a vote of "present" – or "P" for protest" – in an effort to bring attention to
their plight.
I remain committed to expanding and extending the SCHIP program, and to providing health insurance for every American child. As expected, today the President vetoed the bill. When it is sent back to Congress, I will be voting to override his veto.”
Labels: SCHIPHealthyFamilies
posted by Anthony Wright |
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3:19 PM
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Comparing the Gov's plan with the unowned legislative language...
Thursday, October 04, 2007
While the orphan “working draft” in unowned by any policymaker, it is remarkably similar to the Governor’s proposal, about which our opinion was mixed, liking many elements, but strongly objecting to other pieces—including the individual mandate without regard to whether coverage is available or affordable. Our preliminary analysis of the Governor's proposal, available on our website still holds up. This “working draft” would have been appropriate for release in March or April, rather than October. However, we appreciate seeing the draft, to better engage in the dialogue. Insurance agent Alan Katz has posted the full document(!) of the orphaned legislative language on his health reform blog, along with his own commentary. So, like the Governor’s January proposal, we appreciate the focus on prevention and on encouraging information technology. We strongly support the significant expansion and streamlining of public programs, for children, parents, and adults without kids. However, it is hard to evaluate these components without seeing the financing needed to sustain these expansions. Other concepts of the Governor’s proposal that we liked, including the minimum employer contribution, are not included except for intent language, and we look forward to seeing that soon. We continue to have significant concerns about the adequacy of the financing, the individual mandate without any conditions, the reliance on high-deductible plans as minimum coverage, and the impact on the viability of the safety net, including public hospitals. MOVEMENT FORWARD: We acknowledge and appreciate that this draft has improved from the Governor’s proposal in key areas, most particularly in regard to public programs. We appreciate: * the abandonment of the “bright line” proposal that would have thrown current Medi-Cal recipients off the program and into coverage with greater costs and fewer benefits; * the expansion of no-cost Medi-Cal up to 150% of federal poverty level (FPL), or around $15K for an individual or $31K for a family of four; * the acknowledgement that some over 250% of FPL will also need help with affordability, although we think the idea of a tax credit may not cover those who need help, and would be very troublesome to actually implement; and * the provision allowing all Californians to join the purchasing pool, which would help organize the insurance market for consumer, making it easier to navigate and get the best deal. MOVEMENT BACKWARD: However, there are significant areas where the proposal has gotten worse, at least from our understanding (or maybe hope) of where the Governor’s proposal was from the concept paper. In some of these cases, the concept is the same, but the legislative language is ineffective--or has a opposite impact--than what was advertised and represented in January. These additional issues include: * The elimination of quarterly complaint and greivance reporting for HMOs, which seems to remove an important oversight over insurers. * The apparent increase in the permissible premium, for those making 150-200%FPL, at a level that is still too high--5%, which does not include out-of-pocket costs. * The lack of any standards for out-of-pocket costs in the subsidized pool. Given that one can drive the cost of a premium down by raising deductibles and cost-sharing, the limit of premiums provides small comfort. * An exemption from the minimum level of coverage for any and all employer plans. The draft still has, as a placeholder, an unacceptable $5,000 deductible (and $10,000 out-of-pocket max) plan as a minimum level of coverage under the individual mandate... but that even that low minimum does not apply to individuals who take up employer-based coverage, meaning they could have coverage with very skimpy benefits, or no out-of-pocket maximum. * A weak definition of the minimum Medical Loss Ratio (the amount spent on patient care rather than administration and profit), so that it applies to an insurers’ entire portfolio of business, meaning this rule would no longer provide assurance that any specific product is of good actuarial value. A limit that was product-by-product, or even market-by-market, would be more helpful to consumers. * The Healthy Action benefit seems to be less than advertised as well, since it only requires an insurer to offer such a product, but does not include smoking cessation or obesity programs as a mandated benefit. With no requirement, the policy seems more likely to be a way for insurers to identify risk, rather than a viable new benefit for consumers. If this is truly a priority, it needs to be a mandated benefit. * And most concerning, the guaranteed issue protections in the individual market seem hollow with the new details. Only a few high-deductible, low-benefit products will be guaranteed issue to begin with--so those with "pre-existing conditions" will only have access to the coverage in the market that is least suited to them. There would be little assurance that we would ever get to a second phase of having the full market guaranteed issue. Insurers will be able to use benefit design, marketing, and pricing to avoid those California customers that have health risks and needs. In particular, we believe older Californians will simply be priced out of the individual market, and the guaranteed access an illusion. Even on the concepts we support, this "working draft" needs a lot of work. Labels: Legislation, YearOfReform
posted by Anthony Wright |
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12:17 PM
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Little orphans...
Wednesday, October 03, 2007
This week, the game changed, and things got much more urgent and intense. And I am not just talking about the super-exciting Rockies-Padres game that ushered in the baseball postseason on Monday. We have legislative language! Sort of. There's a 200-page “working draft" that was distributed to stakeholders and media in the last several days. The reason it hasn't made news is because nobody is claiming ownership. It is “orphan” language. When we got it, we got major caveats as well: that many of the provisions are merely placeholders; that major sections, including the financing, are not included; and that there is significant disagreement among the Governor and the legislative leaders about the provisions included. We'll put out our analysis soon, but we are disappointed that we seem to back to square one with something very similar to the Governor’s January proposal, with only a few of our comments and concerns raised over the course of the year addressed. While we would have preferred having the Governor’s language much earlier in the year, we do appreciate having the language to seriously respond and react to--if that is what it takes to move the conversation forward. It's like when you work really hard on a document, but then the computer crashed, and you have to reboot and start again. It's frustrating, but the goal doesn't change. More later. Labels: YearOfReform
posted by Anthony Wright |
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5:12 PM
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Override!
Health and consumer advocates should keep the pressure on U.S. House members about the possibility of an override of the President's veto of children's health coverage, which he did today. We need 25 more votes from last week's House vote to override the veto. There's a handful of Democrats who didn't think it went far enough, or who had other issues. (For example, California Rep. Diane Watson voted "present.") Presumably, they can be convinced that they made their point, and to vote to override the President and get coverage to children. So theoretically, the California delegation could make the remaining difference itself, if all of the 18 California Republicans vote in the interest of their Republican Governor, their state, and the children of their district. Rep. Wally Herger did not vote, and so maybe that's a signal that he would vote for the override. Maybe not all of them are able to be convinced, but California could make a big difference in putting this over the top. It's essential. Labels: Bush, Federal, SCHIPHealthyFamilies
posted by Anthony Wright |
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10:27 AM
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Blaming the victim
The story that got my attention today was this LATimes story about saving $1 trillion through healthy living -- particularly the last sentence, where the researcher "blamed Americans' diet and sedentary lifestyle." There’s something to be said about an individual proactively exercising, not smoking, etc.... I totally agree with that. But these studies and stories don’t take into account the worker who must take 2 jobs to survive -- rides the bus, lives in an industrial area, has an aging parent at home to care for, maybe younger siblings, maybe children. Where does this person find time, beween family obligations, work and trying to get places on public transit, to exercise. And where could they exercise without exposing themselves to carcinogens. And if the answer is, "get a gym membership," where does a low-income worker find the $50 to $100 a month to join a gym? Labels: Prevention
posted by Hanh Kim Quach |
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10:13 AM
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Veto....
As expected, President Bush vetoed the children's health coverage bill this morning. Check out this Families USA video of cute, earnest kids all gushing over the president and all left stranded without coverage as a result of his veto. Labels: SCHIPHealthyFamilies
posted by Hanh Kim Quach |
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9:45 AM
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All SCHIP, all the time.
Tuesday, October 02, 2007
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True Democracy
The Wall Street Journal has an interesting story on how a stalwart Republican base, business, is defecting. Why? In part, because of social issues, such as environment and health care. "....In manufacturing sectors, such as the auto industry, some Republicans
want direct government health with soaring health-care costs, which
Republicans in Washington have been reluctant to provide..."
As costs continue to become unbearable, this gap will likely become more pronounced. Already, polls are showing that the majority of businesses believe in some kind of government role in health care reform.
A recent poll by the Small Business Majority found that 55% of business owners polled supported paying into a statewide pool -- run by the state, mind you -- to provide coverage for their workers. More (47%) favored reform efforts put forth by the governor and Legislative leaders than opposed (31-33%). As we go forward on reform, though, this means meaningful changes that help everyone -- not just one group or another. That means reducing the underlying cost of health care -- by making the system more efficient, reducing medical errors, oversight of premium rate increases, etc. That helps everyone: small businesses pay less; consumers pay less. What doesn't help everyone is this idea that's constantly brought up by Republicans to do away with "costly" mandates, like mammograms, the right to second opinions, childhood immunizations. They say this helps small business by allowing them to band together with similar businesses across state lines, and buy -- say -- a cheap policy from Mississippi, Texas or Alabama, which have fewer consumer protections. No offense to those states, but we never really want to follow their lead on anything else -- why start with health care. And while not having to pay for actual health care might make insurance really cheap, that doesn't help anyone. Labels: Employers
posted by Hanh Kim Quach |
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11:12 AM
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SCHIP Impacts in California...
Two good stories over the weekend spotlight the impact of the President's SCHIP veto to California. Bill Ainsworth in the San Diego Union-Tribune and Barbara Anderson in the Fresno Bee report that potentially hundreds of thousands of children wil lose coverage, as well as the wrench it throws into our health care reform debate. Beyond making clear the scale of the disruption, I tried to make the point in my quotes in these articles that there should be political ramifications, especially for the 18 California Congressional Representatives from California that voted against SCHIP. Today, according to the San Jose Mercury News and the Washington Post, California is joining several other states, including New York and New Jersey, in suing the Bush Administration about their unilateral efforts to restrict SCHIP. Labels: Federal, InTheNews, OtherStates, SCHIPHealthyFamilies
posted by Anthony Wright |
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10:26 AM
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