Ed Mendel at the San Diego Union Tribune reports that our protracted, though expected, budget stalemate is leaving lots of rural hospitals in a bind. Many of these hospitals, which run on really thin margins as it is, are having to seek emergency loans from banks, which are also stretched thin because of larger economic issues -- like that mortage thing.
To exacerbate health care access, beginning next week, the state will not be paying Medi-Cal to the state's 600 community clinics. The clinics, which serve 3.6 million people annually, are the most efficient way to deliver regular preventive care to the Medi-Cal and uninsured population.
Ironically, the rural areas that are experiencing the most immediate problems are represented by Republicans, who have talked about how they don't want to cut provider rates and make sure health care access is preserved, but in conference committee voted against all of the rate reimbursement increases for providers who care for Medi-Cal recipients.
The National Federation of Independent Business this week unveiled their campaign to promote health reform from a business perspective. What I really liked was their "Faces of the Healthcare Crisis,'' a compilation of stories/testimonials of small businesses struggling with health care costs. The stories, not surprisingly, sound a lot like some of the consumer stories we get.
One guy, whose employees largely receive health care through their spouses, did not have insurance of his own. When he had chest pains, he delayed going to the ER. When the pain became excruciating, he finally relented and found he was having a heart attack, leaving him with $200,000 in hospital bills.(!!) Sounds like something out of our story database: uninsured, delayed care, high hospital bill.
We certainly empathize with many of the small businesses who want, very badly, to provide health care for their workers. It's expensive, and we have bills that can help:
Transparency (a la AB 2967 - Lieber, and which NFIB is supporting) allows health care buyers can gravitate toward providers that are effective and efficient.
Standardizing and organizing the individual market, a la SB 1522 (Steinberg), would cap out-of-pocket costs, ensure that every plan has doctors, hospitals, and preventive care. This would help give small businesses, who are worried about how much their workers can afford, more peace of mind.
Public insurer (SB 973 - Simitian) would allow small businesses to buy coverage from a public system that competes for business with private companies.
Anti-rescission (AB 1945 (De La Torre) and various other bills) would make harder for insurance companies to yank coverage from paying policy holders willy nilly.
Of course, (here's our 'I told you so' moment) what would have *really* helped was the 1993 Clinton Health plan, which was defeated with lots of help from NFIB. Through Clinton's plan, smaller businesses would have only had to pay up to 3.5 percent of payroll costs toward healthcare rather than the 20-plus percent they are now paying in a virtually unregulated market.
High gas prices, a sputtering economy, global food shortages the obesity epidemic and countless other apocryphal trends make the headlines and have spurred interest in locally grown goods, farmers markets and "Slow Food" (I'm still trying to figure out what the heck that is.)
I really love food. I love the farmers' market. I plan my weeks and weekends around the farmers market. I feel really fancy, wholesome and healthy buying my food directly from the Hmong and Latino farmers, and I prefer the taste of farmers' market food to Safeway (sorry, Steve Burd.) But the small family farmers who are raising goats, planting tomatoes and picking cherries are doing this at risk to their own financial well being and health. The Boston-based Access Project recently published a paper about the health care burdens that California's farmers face.
Farmers tend to be wealthier than the average citizen and are more likely to be insured. On average, they spent nearly $9,000 annually on premiums and out-of-pocket expenses, which constitutes between 9 and 44 percent of the family's income. High health care expenses:
Made it hard for farmers to pay other bills;
Meant farmers delayed investments in their farm;
Took time off farming/ranching.
According to the report author, Carol Pryor, "The survey shows that most farmers and ranchers are trying to do the right thing by getting coverage, but they aren't finding products in the (individual) market that are affordable and that provide them with financial protection if they get sick. This is a case of product failure.''
If not for moral reasons, wouldn't the like-minded food obsessed want to keep our farmers healthy?
I'll do a quick shameless plug for a few of our bills here that would start us down the track of easing health care burdens for farmers:
SB 1522 (Steinberg) would organize the individual insurance market, where family farmers need to buy their coverage, and establish a minimum benefit package that includes doctors visits, hospitals and preventive care;
AB 2967 (Lieber) woudl require insurers and healthcare providers to provide better data on the cost and quality of care, and create pressure to drive down rapidly escalating health care costs;
SB 973 (Simitian) would create a public insurer that would enable farmers to buy in to a system that is publicly run and competes with private insurers;
Rescission bills (AB 1945, AB 1150, AB 2549 and AB 2569) rein in the insidious insurer practice of retroactively cancelling coverage of people who have been paying premiums and believed they were covered.
Last week had a startling article by Julie Appleby at the USA Today about the result of a 36-state investigation of HealthMarkets, resulting in a $20 million settlement, for duping lots of health care consumers into buying substandard health coverage.
The investigation, prompted by numerous complaints, found that insurer HealthMarkets failed to properly train its sales agents, who didn't always fully disclose the limits of its health policies to consumers and sometimes did not pay for medical services promptly.
HealthMarkets, owned by three private-equity firms including the Blackstone Group, has about 612,000 policyholders in 44 states through its subsidiaries: Mega Life and Health Insurance, Mid-West National Life Insurance and Chesapeake Life Insurance.
The company sells an array of plans, many of which pay only limited amounts toward medical care. The settlement follows the January release of the investigators' findings, which covered company practices from 2000 to 2005.
"The severity of their actions certainly warranted that level of penalty. They hurt a lot of people," says Washington Insurance Commissioner Mike Kreidler, whose state and Alaska led the investigation. Since 2002, HealthMarkets has been fined by at least seven states and faced lawsuits from dozens of policyholders.
There has been lots of commentary on the web about these practices, and these products--at sites like Managed Care Matters, and The Health Care Blog which includes a report that these insurers and issues are active in California.
Recently, the Sacramento Bee profiled a story of a couple that got snookered into buying "junk insurance" by one of the companies listed above. That article, spotlighted the pending SB1522(Steinberg), sponsored by Health Access California, as a legislative remedy, to begin to address this troubling issue.
As someone who has been involved in organizing with senior citizen groups for over a decade, I have learned to recognize that some of my best allies will not be with us forever. But it doesn't make it any better.
Joan B. Lee, a leader in the Gray Panthers locally, statewide, and nationally, passed away Saturday night. She will be missed, not just as an advocate for seniors, people with disabilities, health care, and progressive ideals, but as someone who was known in the corridors of power in Sacramento, and had an impact.
She was an important ambassador between different groups: between different anti-war groups with different tactics here in Sacramento; between seniors and people with disabilities; between senior groups and Latino organizations; and between activists with different strategies around health reform.
We worked with her a lot on many issues, from fighting budget cuts to supporting the universal single-payer health care bill, SB840. We partnered with her and other groups on Medicare Part D, and I remember her actively distributing glossy postcards printed by the national Gray Panthers with a slogan I think she came up with: "PHRMA got the donut, we got the hole."
She was an active member of the OuRx coalition that was successful in a groundbreaking prescription drug discount program, and other key legislation. She was an active members of the Olmstead Advisory Committee, and always looked to bring in the perspective not just seniors but people with disabilities.
It was a pleasure to present in front of the Sacramento Gray Panthers group, which she helped convened monthly at the Hart Senior Center. She also was prominent statewide, as part of the Gray Panthers Affiliation of California Networks
UPDATE: A memorial service is scheduled for Friday, August 15, at 11 am, at the Unitarian Universalist Society of Sacramento, 2425 Sierra Boulevard, Sacramento, CA 95825. Refreshments will be served.
* Condolences can be sent to her family, including her husband Arnie, at their home in Sacramento, at 5313 Fernwood Way, Sacramento, CA 95841.
* Condolences to the Sacramento Gray Panthers can be sent to PO Box 19438, Sacramento, CA 95819
* Families would also feel the mulitple impacts of the cuts: the same family that loses Medi-Cal coverage for a child, or dental benefits for an adult, may also lose a cost-of-living increase in other types of assistance, from child care to in-home assistance for the elderly or disabled. Wes Woods at the Inland Valley Daily Bulletin reports about the impact in San Bernardino county.
* Kids would get the "triple whammy," according to reporting by Sarah Arnquist at The Health Care Blog. State budget cuts would only exacerbate the situation with counties that are being forced to drop children from coverage--some that has already been announced in Alameda County and could be done soon in counties like Los Angeles. This is under the backdrop of declining employer-based coverage for kids, and these state and county public programs would no longer be able to pick up the slack.
These are different regions, and there are multiple ways the cuts get felt (providers getting decreased funding but increased demand, families getting cut in multiple services, and cuts at the state and county level as well as the private sector), but it's clear that without a budget that prevents these cuts, Californians will feel them--from many different directions.
Our wishes go out to Joan Lee,who has been in the hospital for a few weeks now, battling cancer.
We at Health Access California have worked with Joan closely in her leadership role with the Gray Panthers, on everything from fighting budget cuts to fighting the price-gouging of prescription drug companies. Health Access has had a joint project with her and the Gray Panthers, along with other senior groups, around the implementation of Medicare Part D, and a broader range of senior health policy issues. She's been active in Democratic circles, and in building bridges between the senior and disability communities.
She was cited last year as a California Senior Leader by the UC-Berkeley School of Public Health, which described her as "a convenor of the Gray Panthers of Sacramento, national Gray Panther board member, and Vice President of the Congress of California Seniors, to name but a few. Joan Lee is well known in the State Legislature, and in Washington DC, as an articulate voice for better transportation, improving Medicare Part D, and policies to help prevent elder abuse. Returning to college to get a degree in Gerontology in her mid 50’s, she has fought for the rights of older adults on many fronts, including creating an innovative long term care program in Northern California and successfully advocating for medical schools to have required courses in gerontology."
We're pulling for her. Wishes can be sent to her and her husband Arnie at: Joan B. Lee (patient), c/o Kaiser Hospital , 2025 Morse Avenue, Sacramento, CA 95825.
They will need to take out lines of credit until a budget is passed, when they can finally get reimbursed. The cash crunch by the State of California, will, in effect, cause cash crunches at clinics and other health providers up and down the West Coast.
So we need a budget passed urgently--but we also need the right budget passed. The clinics and health providers won't be too happy if the reimbursements they will eventually get back are cut, this year and into the future. Or if it means that a million more uninsured Californians are showing up at their door.
On the budget: Do it. Do it right. Do it right now.
The NYTimes had a story this week about paying doctors more so they can do more preventive maintenance for their patients.
What a concept.
It seems that we learn really basic concepts at a very early age: that often (not 100% of the time, but frequently) you get what you pay. If you want higher quality, you pay more. We also learned that if you do things right and carefully the first time, you won't have to redo it later (I admit, this is a lesson I'm STILL trying to master).
The trend for our medical system, however, has been the opposite, leading to what we have now, which is harried doctors rushing from patient to patient paying a few minutes of attention.
But the NYTimes story points out that insurers are now applying these adages to medicine (as is Medicaid and Medicare). Higher compensation enables doctors to hire more staff to follow up with patients, answer questions when they call/e-mail and make sure they're up to date on tests.
It seems funny to say this is an innovation (because it seems like common sense to focus on wellness up front before patients get too sick after receiving episodic or inattentive care)....but hope the trend continues
Who gets impacted by the Medi-Cal cuts? Everybody. It impacts the health system on which we all rely.
Barbara Anderson of the Fresno Bee reports on the challenges to the Medi-Cal program, and in a separate article, solicits potential solutions from some key leaders in the Central Valley, where the system is so stretched already that the consequences of the cuts could be dire. I stated that we need to raise the revenues needed to prevent cuts as a first step; I also agree that then we need to pursue health reform, as put forward by Dr. Kratzer and Dr. Maffeo in the write-up.
The article mentions an ad campaign against the cuts sponsored by an unusually large spectrum of health care stakeholders: doctors, hospitals, insurers, health care workers, as well as seniors and consumers (including Health Access California). These are groups that usually don't agree on much--we are actively supporting bills this year opposed by one of these groups or another--but we agree on the severity of the cuts to the whole health system. These are deep, systemic cuts that would undermine the health system for the uninsured and insured.
This month's issue of Health Affairs contains two academic studies about the impact of consumer-directed health plans on consumer behaviors: one about CDHPs and drugs, and the other specifically about health service seeking behavior.
The papers examined whether such plans would make consumers more "cost conscious'' as proponents alleged they would. The evidence, so far, is: not really in a good way.
In the drug article, consumers were no more likely to seek out generics to save money. However, consumers with higher deductibles were two to three times more likely to skip or stop using high blood pressure, asthma and cholesterol drugs.
In the other article, consumers who weren't already really involved in seeking out information about their health treatments weren't going to be significantly more interested once they enrolled in these plans, however, those in high-deductible plans were a teensy bit more likelyto be more engaged than those in traditional plans.
What I found interesting about both studies was they compared behaviors of consumers in low- and high-deductible plans. As expected, consumers in high-deductible plans immediately ratcheted down their health consumption -- lowering drug doses and skipping doctors visits to save money. But by the second year, even consumers in lower-deductible consumer-directed plans started delaying and forgoing care.
These studies, quantifying and examining real consumer behavior in response to these health plan creations will be an important piece as we proceed with reform on the state and national level -- with some (not us) pushing for more consumer-directed involvement.
Blue Shield and Blue Cross settle on rescissions...
Thursday, July 17, 2008
Big day on rescissions. I was in Los Angeles, testifying before the LA County Commission on Insurance in support of SB840, health reform, and specific pending legislation on recissions--after all there are no less than four bills, sponsored by Assemblymembers De La Torra, Deleon, Hayashi, and Lieu, that include a number of reforms.
I thought I was providing the most up-to-date information, but a lot happened.
The Capitol Weekly and The Los Angeles Times reports on two major settlements, with Blue Shield to restore coverage to 450 rescinded patients and pay a $3 million fine, and Blue Cross to restore coverage to 1770 patients and pay a $10 million fine. Earlier settlements were already reached with Kaiser, HealthNet, and Pacificare, albeit with smaller fines and numbers of people impacted, given their market share.
We'll need to watch over the Department and the insurers to ensure their goals are reached for these consumers:"guaranteed issue coverage, a process for full monetary losses and no back premiums owed," as Department of Managed Health Care Director Cindy Ehnes had identified in the LA Times.
It's good that there has been a focus on getting these folks coverage as soon as possible, even as other court and other proceedings continue. The question is what laws can help moving forward so we radically reduce or eliminate these practices once and for all. The ideas pending include: * providing a independent review of all rescission cases; * standardizing the underwriting proccedings; * shortening the time frame where a patient can be rescinded; * eliminating bonuses paid to employees who rescind more patients; * protecting family members' coverage when a family member is rescinded; and * setting standards for brokers due diligence.
Finally, at the federal level, Congressman Henry Waxman and the House Committee on Oversight and Government Reform held a hearing on the subject, featuring testimony from several rescinded patients, a representative of the insurers, and from California, Secretary Dale Bonner, which oversees the DMHC. It put a federal spotlight on the issues, hopefully helped in getting some attention on these issues in a new light, maybe helped serve as an impetus for these settlements, and sets what being "a regular" may mean.
The LA Times today reveals that LA City Attorney Rocky Delgadillo is suing Blue Shield (for once, we're not picking on Blue Cross) for rescissions.
The featured story is this poor Portuguese couple, left with $60,000 in medical bills after Blue Shield retroactively cancelled their coverage. The insurer scrutinized the family's applications after the wife needed emergency surgery to remove her gall bladder. They couldn't find anything wrong with her application, so they mined her husband's application and VOILA -- he had a high cholesterol reading he had not disclosed: cancel!
Turns out, the poor man didn't even *realize* he had high cholesterol. He took Lipitor, but he was told by his doctor that "men his age often needed it.'' He doesn't speak English well. The agent filled out the application for them.
I always get nervous when I read these stories because it helps to illustrate exactly how vulnerable each and every one of us really is. This story, though, particularly touching because I have immigrant parents and my immigrant mother misunderstands things all the time -- *ALL* the time. She doesn't get jokes, and she can't tell stories without getting at least three facts wrong.
So, if she were ever at the mercy of the individual insurance market (if the myriad pre-existing conditions she and my father have don't already disqualify them from coverage), I would be reading about her rescinded coverage in the LA Times. Thank God for the retiree health care she has -- for now.....
I would be remiss if I didn't mention the big victory--not by the American League in the All-Star Game, but by seniors and doctors in the big Medicare showdown.
The U.S. House of Representatives and the U.S. Senate both voted overwhelmingly to override President Bush's veto of the Medicare bill, which reverses a cut to doctor's reimbursement rates in Medicare, pays for it with cut to overpayments to private insurers, and also installs some new consumer improvements for seniors. It was backed by consumer groups like AARP and Families USA, as well as the key doctors' lobby, the American Medical Association.
Some blogs that have good analysis include Managed Care Matters, Health Beat Blog, and the Health Care Policy and Marketplace Review. As the latter stated in an early post: "This vote was not about the doc cuts. It was about Medicare and its future." It's a big deal, for Medicare, and for the prospects of health reform.
After a long pause, SB840(Kuehl) was heard in Assembly Appropriations Committee today, it's first committee hearing since late year, where the bill went through much of the legislative process already. Rather than have the bill simply go to the Governor's desk for a certain veto, Senator Kuehl wanted to keep the bill alive and continue the organizing in support of the bill, and the concept.
Now in the second year of a two-year session, it is continuing down the legislative path. The bill attracted an unusually large number of backers--including Health Access California--for an Appropriations Committee, which is really focused on the financing of bills rather than the policy, and where authors often provide abbreviated testimony or even waive presentations altogether. It was predictable opposed by many the insurer and employer groups.
As expected, the bill was placed on suspense, with a final determination about if it will be released for a floor vote in a few weeks. The bill does not include financing: a companion bill with financing was stalled in the first policy committee last year, and would need to be updated anyway. Rather, the bill puts forward the concept, and would set in motion a process to determine the financing.
The reason for moving the bill is to keep the commitment to health reform alive, to keep SB840 in the policy discussion, and to advance the elements of single-payer--from group purchasing to public program coverage to progressive financing--in the health debate in the state and nation. Let's keep the mometum...
Like the MLB All-Star Game that just ended in my hometown Bronx, the California budget game is into extra innings. Senator Cogdill suggested an agreement might happen before the beginning of August, according to the Sacramento Bee Capitol Alert.
Maybe it could be called the Late-Summer Classic.
But the Senator continued to be opposed to tax increases to prevent cuts in his statements to the Sacramento Press Club. Does he recognize what that would mean? In health care alone, that means: * major cuts to hospitals and health providers, hitting hardest in rural areas like his own district; * cuts to benefits to millions of parents, seniors, and people with disabilities on Medi-Cal; and * over one million more Californians uninsured, all as a result of the budget cuts.
Even with the Legislature's current compromise budget voted out by the Budget Conference Committee, which include over $8 billion in revenues used to reject or restore the cuts, there are major cuts, most particularly a major whack to children's coverage, denying coverage to over a quarter-of-a-million children. * imposing paperwork and administrative burdens, requiring children's families to report every six months or lose coverage, with the intent and expectation of over 250,000 children losing coverage by 2011; * increasing Healthy Families premiums, which will have an impact on lowering enrollment of children in these low-income families by tens of thousands; and * suspending streamlining reforms passed in 2006 to better enroll tens of thousands of eligible but unenrolled children.
So, that's the choice. The "compromise" budget doesn't have many of the gimmicks, which have either been used up in previous years or rejected (such as borrowing against future lottery earnings). It does have ugly cuts, including on health care with the semi-annual reporting, at least one cut too deep.
But the alternative, with the cuts required without taxes and revenues, is unthinkable.
"If Senator John McCain’s radical plan for remaking American health care is to work, he will have to find a way to cover people like Chaim Benamor, 52, a self-employed renovator in this Baltimore suburb.... After being rejected by a number of commercial carriers, he turned to the Maryland Health Insurance Plan, one of 35 state programs for high-risk applicants whom no private company is willing to insure."
The McCain plan would eliminate the tax benefits for employer-based coverage, and thus push people from on-the-job group coverage into the individual market, where consumers (except in a few states) can be denied for "pre-existing conditions."
So what happens if one is denied? In California, your only option is the state's "high-risk" pool, MRMIP, the Major Risk Medical Insurance Program... but that now has a waiting period of over 1,000 patients!
And that's a program that has never been advertised, that's more expensive premiums than already-expensive market rates, and that caps annual benefits at a mere $75,000--less than a week in many hospitals.
Even though we suspect that the number of willing-to-pay-but-"uninsurable" customers are in the hundreds of thousands, the McCain plan would make this worse. And his only solution is to provide some federal assistance to plans like MRMIP. The question is: will it be enough?
With the new attention on the individual insurance market and "high-risk" pools, the Kaiser Family Foundation is hosting an "Ask the Experts" webcast tomorrow (Tuesday) at 10am Pacific Time on the subject. One of the experts is California's own Lesley Cummings, executive director of the MRMIB, which runs MRMIP. It should be interesting to hear her answers to question coming from a national perspective.
Don't get me wrong: MRMIP needs help and resources as soon as possible--AB2(Dymally) is a longstanding pending bill on this subject that Health Access California supports.
But the real solution is to reduce the number of people denied by insurance companies in the first place, either through the market power of group coverage, or by significantly regulating the individual market. Even in the context of health reform that does both, like in AB x1 1, it made sense to maintain and improve the high-risk pool to make sure the safety net was in place and strengthened for those who fall through the cracks.
What makes no sense is to make the problem worse, and pretend these already struggling problems are the solution.
Both Jonathan Cohn at The New Republic and Ezra Klein at the blog of the American Prospect report on how the HCAN principles are inclusive of a single-payer solution, and how they advance the single-payer cause strategically. The opportunity to advance elements of a single-payer solution--greatly expanded public coverage; defined benefits; group purchasing power; costs based on what patients can afford rather than how sick they are--is there, if we take advantage of it.
The most explosive, least reported story of the week--the equivalent of children getting pink slips:
Alameda Alliance for Health to close Healthy Kids Program, blames state funding woes San Francisco Business Times
A lack of permanent funding from public and private sources, and the failure of health-care reform in California is forcing the public Alameda Alliance for Health to close its Healthy Kids program, officials said Tuesday.
The closure, which will affect 1,000 poor children in Alameda County, is scheduled to take place Sept 30.
The Alliance is a non-profit, state-licensed health plan that attempts to make high quality health care services "accessible and affordable" to poor residents of the county, officials said, including children from families that don't qualify for other public programs, due to income requirements or residency status.
The Alameda County plan, started in 1996, provides services to 92,000 Alameda County residents through programs such as Medi-Cal, Healthy Families, Alliance Group Care and Alliance CompleteCare.
County officials called the pending closure "an act of last resort" and Lamirault added that some children who are losing their Healthy Kids coverage may be eligible for Kaiser Permanente's Child Health Plan.
The Alliance was one of 10 counties statewide that began its Healthy Kids program in the fall of 2005, officials said. Today 30 counties offer the program, which provides comprehensive health care coverage to more than 80,000 children each year.
Some funds from the nonprofit California Endowment were committed for the older participants, but significant funding from Alameda County's Tobacco Settlement Funds have been "redirected to support other county priorities," due to the state's budget crunch.
Alameda isn't the only county where this will happen. It's a shocking thing, for California counties to drop kids from coverage, but that's exactly what is happening.
It's a useful compilation of the research out there on cost containment, brought together in a readable package. The core message is that there are significant ways to cuts costs beyond the typical attempts to cut costs by cutting care.
While there is no one silver bullet to bring down health prices, there are several strategies that, together, can have a big impact. Health Access has a one-page fact sheet on controlling costs with a similar message, but the CALPIRG report gives good policy detail, especially in areas about reducing regional disparities in health spending, in administrative duplication, and in prescription drug purchasing. It's worth a read.
* Children's Coverage Gets Cut: More Than a Quarter-Million Kids to Lose Coverage * Other Devastating Cuts to Eligibility, Benefits, Rates Rejected/Restored for Now * These/Other Cuts Pending Unless New Taxes and Revenues Approved to Prevent Cuts
Click Here for What's New on the Health Access WeBlog: More on the Budget Cuts; Photos, reports from the Health Care for America Now! launch events; Medicare Bill Passes Senate
SACRAMENTO--The bi-cameral Budget Conference Committee completed work on a legislative budget proposal approved primarily by the four sitting Democrats on the committee, led by budget chairs Denise Ducheny and John Laird.
The Legislative plan for the $101 billion general fund calls for $8.2 billion in additional revenues, including higher income taxes for wealthier couples and higher taxes for businesses. These revenues come on top of the $5.1 billion in lottery revenues and $3.3 billion in deficit bonds proposed in the governor’s budget.
The Budget Conference Committee did reject--for now--many draconian cuts in health care, that would have resulted in over one million more Californians not getting health coverage as a result of the budget, and three and a half million Californians having to pay more and/or get less in terms of care and coverage.
Because no cut or restoration is final until a budget is approved, all cuts are still on the table until both parties in the Legislature can agree on taxes. These cuts are all still pending; the coverage impacts of all the pending cuts is detailed in a recent Health Access report, available on our website: http://www.health-access.org/preserving/Docs/HACoverageImpactReporto6-25Final.pdf
REAL CUTS, ESPECIALLY TO CHILDREN'S COVERAGE: Yet even under this Democrat-supported budget, children's coverage gets hit hard. Even with the additional revenues raised, more than a quarter-million children are expected to lose coverage if this Democratic version of the budget is fully implemented.
The cuts approved that would impact children's health coverage include:
* Imposing additional paperwork burdens so millions of children need to have their families file reports every six months, rather than annually, to keep their Medi-Cal coverage. It is estimated that such "semi-annual status reports" (SARS) would lead over 250,000 children to fall off coverage under full implementation by 2011. To take action, read the 100% Campaign report on the impacts here. * Increasing premiums in the Healthy Families program, which not only impose additional costs on hundreds of thousands of families, but likely lead tens of thousands of children to fall off coverage. * Suspending streamlining and enrollment reforms, which were passed into law two years ago--SB437(Escutia) with fanfare in an attempt to get tens of thousands of more children who are currently eligible but unenrolled into the program.
MAJOR CUTS RESTORED--IF REVENUES PASS: Many of the rest of the big-ticket health care cuts were rejected or partially restored. Assuming the new taxes and revenues, the Budget Conference Committee voted to prevent the:
* Cutting Medi-Cal eligibility for low-income working parents, causing 439,000 adults to lose coverage: * Cutting vital benefits (like dental coverage) for over 2.5 million parents, seniors and disabled patients on Medi-Cal: * Cutting rates by 10% for doctors, hospitals and other providers who take patients with Medi-Cal. This cut was approved in February and went into effect last week, but legislators are proposing to restore this cut going forward if the revenues can be raised.
Our Health Care Budget Cuts Scorecard provides a full accounting of all health items that were pending, and how they fared in the Assembly, the Senate, and in Conference Committee. It may also be found on our website: http://www.health-access.org/preserving/Docs/BudgetScorecard%20070908.pdf.
WHAT’S NEXT
The full houses will need to vote on the budget next – and that could happen as early as next week, though neither house has committed to a date. In order to pass, the budgets would need a two-thirds majority. If all Democrats vote for the budget, which would mean six Assembly Republicans and two Senate Republicans would also need to approve. With the revenue increases included in thie budget, and the many Republicans having signed "no new taxes" pledges, the gridlock in Sacramento may continue into the summer.
Health Access will continue to track budget developments as they occur, including posting fact sheets and materials on our website, at: http://www.health-access.org/index.htm
For information, please contact the author of this report Hanh Kim Quach, policy coordinator at hquach@health-access.org.
The Medicare bill passed the Senate a few hours ago! This is a good thing: it prevents a rate cut to doctors with Medicare patients--and do it by using savings creating by leveling the playing field between the basic Medicare program and private Medicare health plans. It would also provide new consumer protections and improvements in the Medicare program.
It got overwhelming bipartisan support in the House of Representatives, but there was some drama in the Senate before the July 4th holiday. The bill got 59 votes--one shy of being able to break a potential filibuster and advance.
The bill had unanimous Democratic support, and some Republican support--although not of Sen. John McCain, who was not present. The only Democratic vote that was not present was Sen. Ted Kennedy, ailing from his recent cancer diagnosis.
So it's a fitting moment when Sen. Kennedy, a champion on health care, made a rare appearance since his own health crisis to ensure this health reform passes.
Ultimately, he wasn't the swing vote: The final vote was 69 in favor: Enough to override President Bush's threatened veto!
It's good to see that *some* progress is possible in Congress...
The Los Angeles event in front of LA County Hospital was also a success. Nancy Berlin from the California Partnership moderated (pictured speaking, with Health Access California organizer Nancy Gomez to her right), and it featured several speakers, including Connie Leyva, president of the California Labor Federation and several others.
The headliner was Lt. Gov. John Garamendi (pictured, about to sign the "What Side Are You On?" statement of the Health Care for America Now campaign, supporting quality, affordable health care for all, as opposed to having consumers being left alone in the individual insurance industry.)
As a veteran of past reform effort since 1976, he reminds us the major insurance and other special interests opposed to health care reform, and why we need a big, broad coalition in support of reform if anything is going to happen.
Other participants of the LA event included: California Partnership, Health Access California, ACORN, AFSCME Council 36, United Nurses Association of California/AFSCME, MIWON, Committee of Interns and Residents/SEIU, Community Health Councils, ACLU of Southern California, Asian Pacific American Legal Center, California Labor Federation, California Latinas for Reproductive Justice, Children’s Defense Fund, Coalition for Human Immigrant Rights Los Angeles, Planned Parenthood, SEIU-United Healthcare Workers West, and the Universal Health Care Action Network.
(Pictured speaking is Joan Pirkle Smith, a longtime board member of both Health Access California and the Universal Health Care Action Network.)
Here's the first TV commercial from the Health Care for America Now effort, spotlighting the need for health reform, one that provides coverage we can count on:
It's was a sunny, optimistic day in San Francisco, as Mayor Gavin Newsom addresses the crowd on the steps of his City Hall, at the one of the over 50 launch events for the Health Care for America Now! campaign for federal health reform. "We've been here on these steps many times before, saying many of the same things. But this time feels just a little bit different. This time it feels like we share a feeling of a little more optimism." said Newsom.
"This is not just an ethical issue, though it is. This is not just a moral issue, though it is. This is an economic issue," the Mayor said. On the stalled effort in Sacramento, he said "we were that close. We were right there on the cusp on fundamental change. We know what needs to be done. Its time for leadership to get the job done."
Giselle Quezada of ACORN and Anthony Wright of Health Access California moderated the event and are to the left of the Mayor in the picture. Also pictured are John Arensmeyer of Small Business Majority, Leah Donahey of CREDO Mobile, and Dr. Stuart Bussey of the Union of American Physicians and Dentists of AFSCME.
Other speakers included Art Pulaski of the AFL-CIO, Conny Ford of the San Francisco Labor Council, Dr. Rachel Krebs-Falk of the Committee of Interns and Residents, Paul Kumar of SEIU-United Healthcare Workers West, and Amy Moy of Planned Parenthood Golden Gate. We had 20 media outlets attend, including television, radio, newspapers, and magazines.
It was a successful start to an important campaign.
The Legislative Budget Conference Committee just approved Semi-Annual reporting for children on Medi-Cal.
Right now, children renew their eligibility annually, and adults twice a year. But periodic status reporting is a *passive aggressive* way for the state to reduce the number of people in Medi-Cal by hoping they don't "report'' their status on time. Under Gov. Arnold Schwarzenegger's original -- more draconian -- proposal requiring reporting every three months, the administration assumed 471,500 children (a drop off of 24%) would be eliminated from the rolls.
We don't have officials numbers yet on how many children would lose coverage under semi-annual reporting. But let's just slice the Quarterly number in half -- just to give us a working number -- and say about 235,750 children would lose coverage under semi-annual reporting.
The compromise attempts to soften the blow by saying the semi-annual status reports will sunset (for children only, adults will continue to be semi-annual) by December 31, 2011. But what does the sunset really mean for the child who needs asthma inhalers this year. Who falls of his bike, next year. Who gets pneumonia, in two years?
They'd be in line, to get back on Medi-Cal. Long-suffering counties, who will not receive extra funding to process the additional paperwork as a result of Semi-Annual Status Reports, will have a hard time handling the extra load, meaning it will be harder for kids to get coverage.
Assemblyman John Laird, who sadly will be departing the Legislature this year, gave a fantastic speech about how he hated having to support this compromise.
"I'm extremely unhappy about this...it's not the right direction to go....I'm kicking and screaming, but going to vote for this. But, if there is a hint that people want to move toward something more draconian, I will wage a full-pitched fight and advocate to go back to where it is now (annual reporting.)"
Soon-to-be Sen. Mark Leno reiterated Laird's position also.
"I think we need to be honest about this. We're shifting the responsibilities of children to county hospitals and emergency rooms. It's not an efficient way to have health care provided."
Also part of the compromise: an assessment on the effects of semi-annual status reporting. But we won't get to see the results of it until December, 2010 -- when we have just a year left until the sunset.
Republicans got to dodge a vote. They wanted more kids to drop off rolls with quarterly status reports.
Overall, this is a really profoundly troubling budget and a really pathetic statement of our priorities when we let more than 200,000 children -- who otherwise would be eligible for coverage -- just fall off and go without healthcare.
And it's really sad that the choice had to come between cutting already inadequate Medi-Cal reimbursement rates for doctors who care for these kids -- or letting really low-income kids (living in families that earn less than $17,600 a year for three) go without health insurance.
This should not be the choice... of worse and worse. This should not be the state we are fighting for.
UNPRECEDENTED CAMPAIGN LAUNCHES TO WIN NAT'L HEALTH REFORM * $40 Million Campaign Starts in Over 50 Cities and 35 Capitols Across Country * Lt. Gov. Garamendi in Los Angeles & Mayor Newsom in San Francisco Headline CA Events * "Health Care for America Now" Campaign Launches TV Ads
Click Here for What's New on the Health Access WeBlog: Photos, comments and reports from the HCAN launch events in CA and DC; New HCAN TV Ads; Real Cuts Made to Kids Health Coverage: Conference Committee Approves Semi-Annual Status Reports for Children, Also Approves Healthy Families Premium Increase; (Full Budget Update Coming); More on the Health Budget Cuts; More on Medical Errors; Health Care Humor; Multiple Cuts on a County
LOS ANGELES & SAN FRANCISCO – In key California cities of national importance to the health care reform debate, and in 52 other cities across the country, including 37 state capitals (and in Washington, DC, with Elizabeth Edwards), a new national campaign is bringing together millions of Americans to demand quality, affordable health care for all.
Health Care for America Now (HCAN) is being launched nationally by over 100 national and local groups that represent community organizations, labor, doctors, nurses, women, small businesses, faith-based organizations, people of color, netroots activists, and think tanks. Health Care for America Now is organizing to assure that the first order of business of the next President and Congress is to pass legislation in 2009 that guarantees quality, affordable health care for all.
A BROAD COALITION: Health Care for America Now is an unprecedented coalition led by ACORN, AFSCME, Americans United for Change, Campaign for America 's Future, Center for American Progress Action Fund, Center for Community Change, MoveOn, National Education Association, National Women's Law Center , Planned Parenthood Federation of America, SEIU, United Food and Commercial Workers, and USAction.
Part of the effort will be to organize in communities around the country, and to get commitments from Congressional leaders to commit to making health care reform a top priority in 2009, and to commit to key principles. Congressional representatives will be asked "What side are you on?" in the a debate between reforms that provide a guarantee of quality, affordable health care we all can count on, or policies where consumers will continue to be at the mercy of the private health insurance industry, left alone to fend for yourself in a complicated, bureaucratic insurance market.
AN UNPRECEDENTED EFFORT: Starting today, the campaign is spending an initial $1.5 million on national television, print, and online advertising and is sending out an email blast to more than 5 million people. Over the next five months, Health Care for America Now plans to spend $25 million in paid media and have 100 organizers in 45 states.
THE CAMPAIGN IN CALIFORNIA: Leading the field effort in California is Health Access California, California ACORN, and the California Partnership, in active partnership with many of the California groups participating in the launch events, including: the California Labor Federation, AFSCME, CREDO Mobile, MoveOn, California Teachers Association, Committee of Interns and Residents, Planned Parenthood Affiliates of California, SEIU, Small Business Majority, Universal Health Care Action Network, United Nurses Association of California, United Food and Commercial Workers, and others.
This campaign focused on Congress will be coordinate with continued active efforts of California organizations to press for state-based health reform. The California effort is premised on the notion that there will be new opportunities at *both* the state and federal levels to push for health reform in 2009. California can and should be a leader, because of the urgency of the health care issue in California, because of the size and influence of our Congressional delegation, and because of our experience in developing and debating health care policy.
The events in California spotlighted the challenges and opportunities of this national campaign.
* An event in front of Los Angeles County Hospital spotlighted the city as “ground zero” for the health care crisis nationally, with closing emergency rooms and one of the highest rates of uninsured in the nation. “I’ve seen the insurers and the special interests line up against health reform again and again, and this campaign is needed to make sure it gets done.” said Lt. Gov. John Garamendi, who formerly served as California ’s Insurance Commissioner and was a leader in the national health reform debate in the early 1990s. “Nobody needs health reform more than Californians facing a broken health system,”
* An event in front of City Hall in San Francisco spotlighted a city not only hosts the leader of the U.S. House of Representatives, but that also shows health reform is possible—and meet many of the principles advanced by the HCAN coalition. “ San Francisco has shown that healthcare reform is not only the right thing to do but is economically feasible," said Mayor Gavin Newsom, who just celebrated the one-year anniversary of the implementation of their universal healthcare program, Healthy San Francisco. “What San Francisco has done is not the end but the beginning. We need our state and federal leaders to take immediate and aggressive action on health reform.”
Health Care for America Now offers a bold new vision for health care reform: Americans can keep the private insurance they have, but would also have new options, including a choice of private or public health coverage plans. The campaign also calls for new rules to be enforced on an insurance industry which consistently charges whatever it wants, sets high deductibles, denies coverage based on pre-existing conditions, and drops coverage when people get sick.
Health Access California will continue to report on both state and federal efforts on health reform, including the Health Care for America Now effort. Health Care for America Now started with a financial commitment of at least $500,000 from each of the 13 steering committee members and a $10 million grant from NY-based Atlantic Philanthropies. Health Care for America Now (“HCAN”), a section 501(c)(4) issue advocacy organization, is a broad coalition of nonprofit and political organizations that are working to promote quality, affordable health care for all Americans. HCAN and each of its members conducts and funds only activities appropriate to its tax and election law status.
The Sacramento Bee just posted this Hospital charge database of the 25 most common procedures by hospital. The Bee has compiled all the information reported to the Office of Statewide Health Planning and Development in 2006 and put it in an easy-to-use scroll down format.
The charges reflect what consumers would pay if they didn't have insurance -- in other words, the sticker price. Insurance companies negotiate far lower rates.
I'm finding it weirdly entertaining to see how broke I'd be ifI ever found myself uninsured.
If I ever needed a hip replacement, it'd cost *as little* as $40,000 at Mercy Hospital in Folsom or *as much as* $1o9,000 at UC Davis Med Center down the street from me.
If I ever got pneumonia, and needed a breathing tube: $362,000 at Mercy San Juan, a whopping $850,000 at Sutter Memorial.
Play with it. Have a heart attack. (Get an angioplasty -- $94,000 at Sutter, $140,000 at UC Davis.) Pass comprehensive health reform so no one gets these sticker prices.
With the announcement of the Health Care for America Now! campaign to push for national reform with a new President and a new Congress at the beginning of 2009, some may wonder about California's role in this national effort.
First things first: this is no way supplants or suggests a lack of commitment to the ongoing, multiple-year effort for state-based reform. That effort is ongoing, and will be highly coordinated with this new federal effort. We think there is an opportunities for health reform at both the state and federal levels in 2009. We simply think the federal government should be a partner and a leader for health reform, rather than an obstacle, which has been its position for several years.
More than that, California can and should be a leader in influencing the national debate. And it is well equipped to do so. The two locations for launch events tell the tale:
* No state feels more urgency for health reform than California. One of our events is in front of Los Angeles County Hospital spotlighted the city as “ground zero” for the health care crisis nationally, with closing emergency rooms and one of the highest rates of uninsured in the nation. Nobody needs health reform more than Californians facing a broken health system.
* No state will have a bigger voice in the debate, given our sizable and powerful Congressional delegation, led by the Speaker of the House, Nancy Pelosi, and key committee chairmen like Reps. George Miller, Pete Stark, Henry Waxman, and other leaders.
* No state has more experience considering and debating the various options for health reform over the last five years than California, at the state and even local level. Our event in front of City Hall in San Francisco spotlighted a city that not only hosts the leader of the U.S. House of Representatives, but that also shows health reform is possible—and meets many of the principles advanced by consumer advocates. The city last week just celebrated the one-year anniversary of the implementation of their universal healthcare program, Healthy San Francisco.
California has no choice but to be a leader in the national effort. And an important part of that is leading by example, by moving state-based reforms on a parallel track with the national conversation.
Later today, Health Access and many other key groups in California will help launch of a major campaign to win national health reform in 2009. The scale of the effort, called Health Care for America Now, is unprecedented ($40 mill, over 100 groups, over 100 organizers in 45 states) for comprehensive health care reform in 2009.
The California events in San Francisco and Los Angeles have their own star power, featuring SF Mayor Gavin Newsom and Lt. Gov. John Garamendi, both nationally-recognized leaders with significant health reform credentials, joining California Labor Federation leaders Art Pulaski and Connie Leyva and leaders of key community, consumer, business, and health care groups.
We'll have more coverage later today and the week, reporting about the activities of this broad ranging coalition. Leading the field effort in California is Health Access California, California ACORN, and the California Partnership, in active partnership with many of the California groups participating in the launch events, including: the California Labor Federation, AFSCME, CREDO Mobile, MoveOn, California Teachers Association, Committee of Interns and Residents, Planned Parenthood Affiliates of California, SEIU, Small Business Majority, Universal Health Care Action Network, United Nurses Association of California, United Food and Commercial Workers, and others. More later...
Just minutes ago, the six-person Budget Conference Committee approved premium increases in Healthy Families. The increases approved are dramatically smaller than what Gov. Arnold Schwarzenegger originally proposed.
In his budget, Schwarzenegger proposed a $7 per child increase for families earning 151% - 200% of the poverty level. The new version increases premiums by just $3 for this group, meaning the new rates would be $12 per child.
For families earning between 201% to 250% of the poverty level, rates would be increased by $4. The version approved today would increase rates by $2, which means rates would be $17 per child.
Under the governor's plan, it was estimated that about 60,000 children would become uninsured due to the increased costs. It's unclear what impact these smaller increases would have. These changes to the governor's budget are -- as with everything the Legislature has so far approved -- contingent upon new revenues.
The budget committee should be wrapping up conference tomorrow, it sounds like. Health advocates have one more issue on the table -- Semi-Annual Status Reports.
Today, they approved county administration for Medi-Cal processing *at current caseload levels*. This is key.
If they approve Semi-Annual Status Reporting, it means more administrative work for counties. But they didn't approve increased funding at that level. So....the people who are trying to submit their semi-annual status reports won't have their paperwork processed fast enough to stay on Medi-Cal because there's not enough county staff to do it. Eventually, more people will fall off -- and ironically -- right after the committee just approved funding for doctors so they can continue to take on patients.
I meant to call attention to this story last week:
A bunch of employees were laid off at Children's Hospital in Oakland. Mayhem ensued. Appointments, surgeries cancelled. Uncancelled. Patients stranded everywhere. The culprit: 10% Medi-Cal rate reductions, which went into effect Tuesday July 1.
While the budget conference committee on Thursday mostly restored these cuts, those restorations are *contingent* on there being more revenues. So if we don't have more revenues -- we can expect more of this....
Boston Globe has this story about a surgeon accidentally operating on the wrong side. Here's a memo that also went out in the hospital, in which hospital administrators explain what went wrong.
We have a bill this year - AB 2146 (Feuer), which would make sure the patient, who would have to undergo surgery on the correct side, is not charged for the flubbed one too.
When we saw him, he was on a "How The Man Sticks It To The Little Guy" run when he used health insurance as an example. First, he mentioned how lucky most of us feel if we can buy insurance through our employers (unspoken subtext: because if we get health insurance at work, we don't have to worry about being denied coverage because of preexisting conditions). But then we don't feel so lucky if we get sick and, even with coverage, get a pretty big bill. At least then, Jake joked, we could complain about how our boss was "sticking it to us." But some of us have to purchase our own insurance directly, so, he deadpanned: "I end up sticking it to myself! That doesn't seem right."
Then, in surprisingly fluent health insurance-speak, Jake went off about how he could barely keep up when his insurance broker was trying to explain his policy choices: an HMO, an HMO with a POS, a PPO, and variances between the deductible, premiums, co-pays, co-insurance and out-of-pocket maximums.
Jake asked "but which one is best" and the broker replied "it depends on the individual." And Jake, being a comedian, said: "Let's say, hypothetically, that the individual is me." The broker responded: "You have to make your own decision about what's best for you." At which point, Jake made a funny face that meant "You've got to be kidding" and the audience responded with gales of laughter.
Ha ha. To be honest, the retelling doesn't seem that funny... it just seems sad because it's so true. Some have argued that we don't need reforms to standardize the individual insurance market--like the pending SB1522(Steinberg)--because people have access to brokers. If you are lost (as many consumers are), it is useful to ask for directions, and it is useful to have a map. One doesn't obviate the need for the other. Both are helpful.
The blogger from the centrist New American Foundation agrees that the humor doesn't quite translate:
As things currently stand, no one (not even those of us who work on health policy for a living!) can make truly informed decisions about which health care policy is best for us. It is difficult to determine whether paying more up-front or taking the risk of paying more later or having more or less provider choice is the way to go. This kind of confusion is not funny, which is why transparency and consumer-friendly decision support tools (real ones, that real people can understand) must be part of any health reform.
With the Budget Conference Committee scheduled to come in on Sunday to make further decisions on the budget, Matthias Gafni in the Contra Costa Times has a great article about how multiple cuts are impacting a local community.
The article cites a report and compilation of statistics, done in collaboration with local organizations and leaders, spearheaded by Health Access and our outstanding organizer Jessica Rothhaar. She's worked in the area for years, and was able to help pull it together from an unusually set of community groups. It is available here: Contra Costa County Local Impacts Report
The partnership with other groups was important because the report did go beyond health issues to education, social services, and other areas that Health Access traditionally does not touch. But with the budget cuts being so broadly based, it made sense to get a look at how the full range of cuts is impacting the community as a whole.
Health Access working with organizations in other counties to do a similar analysis, but the results are similar: the scale of the cuts is devastating, and together they are even more so. These cuts need to be prevented, even if we need to raise revenues to do so.
BUDGET CONFERENCE COMMITTEE CLOSES OUT MOST HEALTH ITEMS * Democratic-supported budget would largely restore Medi-Cal rate reductions * California Discount Prescription Drug Program continues * Semi-Annual Reports and Healthy Families premium increases still in negotiations * Conference Committee could close down as early as this Sunday, July 6th
Click Here for What's New on the Health Access WeBlog: More on the Health Care Budget Cuts; the Onion on Kids Coverage; Update on MA; Provider Rates; A Clear, Stark Choice; Missed Budget Deadlines; Reporting "Never Events"; How Many More Uninsured Under the Legislature's Budget?; Where Our Premium Dollars Go; Patients, Not Paperwork; Blog Watch
The Budget Conference Committee, led by Senator Denise Ducheny and Assemblyman John Laird, met this Thursday afternoon and reached agreement on a number of items of note to health advocates.
These decisions largely reflect current agreement between the Democratic majorities in the legislature; no budget decisions are final until the Legislature approves a budget by a two-thirds votes, which requires Republican votes, and the Governor signs the budget. However, these decisions shape the parameters of the budget negotiations this summer. The issues addressed today include:
PRESCRIPTION DRUG DISCOUNTS: The California Prescription Drug Discount Program, AB 2911 (Nunez), supported by Health Access California and a broad "Rx Coalition" of consumer, labor and senior groups, was passed and signed into law in 2006. The program would allow up to five million Californians with no or inadequate prescription drug coverage to buy prescription drug at prices 40 to 60 percent below the sticker price. The discounts would be achieved through contracts with pharmacists and negotiations with drug manufacturers.
The program, though, has not yet been implemented due to budget constraints. The program was in danger of being deferred yet another year until a compromise on the measure was reached Thursday. Under the compromise, the program would be started and implemented in the budget year, but the state would defray the costs to administer the program with a small portion of the manufacturer rebates.
MEDI-CAL RATE REDUCTIONS: The Committee also voted to restore most of the 10 percent rate reductions which took effect two days ago. The higher rates will take effect September 1, 2008. Any services provided between July 1 and August 31 will be reimbursed at the lower rate. The partial rate restorations are all contingent upon a budget agreement that includes revenues.
Following is an accounting of how each individual cut was restored and how the committee votes:
* Providers: Restored most of 10% payment reduction ($158.3 million); Vote: 2-1, 2-1, Republican members voting no * Pharmacies: restored half (5%) of the payment reduction ($76.3 million); Vote: 2-1, 2-1, Republican members voting no * Pediatric Sub Acute Care: restored all of payment reduction ($1.8 million); Vote: 2-1, 2-1, Republican members voting no * Long-term Care: restored half (5%) of the rate restoration ($24.6 million); Vote: 2-1, 2-1, Republican members voting no * Managed Care rates: restored half (5%) of the payment reduction ($99.2 million); Vote: 2-1, 2-1, Republican members voting no * Breast and Cervical Cancer treatment: restored full amount of payment reduction ($1.2 million); Vote: 2-1, 2-1, Republican members voting no. * Non-Contract Hospitals: Compromise would treat small, rural and children’s hospitals as contract hospitals. Vote: 3-0, 3-0
CHILDREN SERVICES: Rates paid under the California Children’s Services (CCS) and Genetically Handicapped Persons Program (GHPP) would be mostly restored by September 1, contingent upon revenues. The governor had originally proposed a 10 percent rate reduction for these programs’ services. In both cases, the vote was 2-1, 2-1, with Republican voting against the partial restorations.
ITEMS REMAINING OPEN: Still in negotiations remain the Semi-Annual Status Reports and additional county administrative funding should those reports be approved. Healthy Families premium increases also remain open. Both would not only place paperwork and additional costs onto families with children on Medi-Cal and Healthy Families coverage, respectively, but would also cause a reduction in enrollment and an increase in California children without coverage.
The children's groups that make up the 100% Campaign are urging health advocates to call members of the Conference Committee to urge them to reject these additional barriers to kids' coverage. Their most recent alert is listed here: http://www.100percentcampaign.org/resources/updates/2008/update-080624.html
CALENDAR: The Budget Conference Committee is expected to return July 6th, Sunday evening to close out the remaining items. Legislative leaders hope to have a vote on the budget by mid-July.
The Senate plans to hold Appropriations hearing the upcoming week and Monday July 14th and then take summer break until August 4th. The Assembly plans to hold its last Appropriations before break on July 16th before leaving and returning on August 4th.
Health Access will keep advocates abreast of these activities. For information, please contact the author of this report Hanh Kim Quach, policy coordinator, at hquach@health-access.org.
The Budget Conference Committee a few minutes ago just partially restored the 10% Medi-Cal provider rate cuts that just took effect on Tuesday. The rates will be restored to their normal levels -- which are already among the lowest in the nation -- on September 1.
The conference committee closed out a bunch of other items also, which we'll post soon.
As we await to see what the Budget Conference Committee does about imposing more paperwork burdens to have hundreds of thousands of children fall off coverage, here's something for your holiday weekend amusement. From the Onion News Network, it's the only support I've seen for cutting children's health care:
NYTimes has a horror story about diabetes and how it creeps up on you and "eat(s) you alive,'' as one doctor described it. In addition to being the leading cause of blindness and amputation, diabetes also affects the afflicted in a myriad other ways from head to toe -- depression, sleep issues, stroke, dental and hearing problems, liver and kidney problems, *paralysis (!)* of the stomach, ulcers, and various sexual problems.
Cases of diabetes are growing -- 8 percent of the US population had it in 2007. And by 2050, it could be 25%, according to the Centers for Disease Control.
I'm fixating on this for two reasons. 1) I'm genetically predisposed to diabetes; my father was diagnosed in his mid-40s. 2) Our insurance coverage trends make it very difficult for people to maintain and keep this perfectly treatable disease at bay.
As more people (not us, mind you) advocate for more stripped down health plans, devoid of disease maintenance, it creates all kinds of barriers to getting the meds and seeing the doctor -- all necessities for a person with diabetes.
I'll do a quick, shameless plug for our SB1522 here, which not only would organize the individual insurance market, but also establish minimum benefits -- such as doctors, hospitals and preventive services. It's one of the ways we could begin to tame the unruly individual insurance market, which has been rapidly degenerating over the past few years.... unless we want a nation of diabetic zombies by 2050.
As July 1st, today got a lot of attention for being the start of the state's fiscal new year... and get another year where the budget is not done on time.
Presumably, a budget will be agreed to and signed into law later this summer. What's more important is that this is the first day that the 10% Medi-Cal provider rate cuts go into effect.
This doesn't just impact doctors, hospitals, and other providers. It hurt patients who find it harder to get a doctor, or specialist. (One study indicated that more than half of California doctors don't take Medi-Cal.) It is a major cut to the health care system on which we all rely. And unlike the delay in the budget, it is permanent, unless the Legislature reverses the cuts.
Let's be clear: the Democratic majorities are offering to restore these cuts. But that won't happen unless the Democrats in the Legislature are able to get their fellow Republican legislators to support the taxes needed to restore those cuts. And until such a decision is made, patients and providers will have to suffer with the cut and its consequences.
David Lazarus at the LA Times had an excellent column last weekend about health insurers charging men and women different rates. When Blue Shield and other insurers admit they're charging women higher premiums because they are higher "risks'' (Read: more expensive), they're coming clean about the industry's already discriminatory practices against women. Though, in doing so, it further widens the gap between what women and men pay for health care. Women will wind up spending more, not only to *buy* care, but also to *use* care, as has been the case.
Since the steady increase of high-deductible health plans (and in the absence of stronger consumer protections such as community rating and minimum benefit standards) insurers have been permitted to passive aggressively charge women more based on the fact that women are trying to be conscientious about their health.
A Harvard Medical School study last year found women ages 18-64 with consumer-directed health policies wound up spending 218% more on health care than men. "High-deductible plans punish women for having breasts and uteruses and having babies,'' said Dr. Steffie Woolhandler, one of the authors of the study.
We require various gynecological exams. We need birth control pills (as a result of co-activities with men). Sometimes we have babies (as a result of said co-activities) -- though high-deductible plans don't cover maternity anyway. We go to the doctor when we hurt. We generally seek more preventive care than men. Hmmmm. And I thought I was just being responsible.
A world that allows high-deductible plans to proliferate -- as envisioned by John McCain -- is essentially a world that legitimizes deadbeat insurers, who want to thrust more and more costs onto women in the name of keeping prices low. But for whom?
Editorial: Budget deal will do real damage to health care
The choice is clear: Increase taxes or let the impact fall on children and the elderly
...Faced with a $17 billion deficit, the governor and state lawmakers are considering cuts that would likely drop tens of thousands of children from the Medi-Cal program, the state's version of Medicaid. They also are considering restricting adult eligibility requirements for Medi-Cal, hurting families trying to transition from welfare to work.
Elderly patients would also take a hit. As part of a 10 percent cut scheduled to take effect today, the state plans to reduce payments received by pharmacists who serve Medi-Cal patients. Pharmacists say it would force them to lose money on commonly prescribed drugs, and to choose between taking fewer Medi-Cal patients or cutting staff and limiting hours...
Legislators, particularly Republicans who have taken a vow not to raise taxes under any circumstance, need to consider the consequences.
Start with children. Currently, about 3 million children in California receive health care through Medi-Cal, and eligibility for the program is determined annually. To save $92 million in the budget, Schwarzenegger wants to reinstate a rule that families on Medi-Cal submit paperwork every three months to prove their eligibility, instead of every 12 months.
About 150,000 children are expected to lose coverage this year – and 470,000 eventually – because their families either fail to file the required forms or they can't meet the program's eligibility rules. The quarterly reporting requirement will also add to the burdens of counties, who will have to process all the extra paperwork.
For these reasons and others, the Assembly rejected the administration's proposal, while the Senate has come back with a "compromise" – requiring Medi-Cal recipients to file paperwork twice a year, instead of four times.
This is hardly a compromise. As senators and Schwarzenegger are well aware, kicking poor people out of the Medi-Cal program will only force them to go to the emergency room, or avoid treatment for diabetes, high blood pressure and other chronic diseases.
While campaigning for health care reform last year, Schwarzenegger often talked about the "hidden tax" that uninsured people impose on hospitals, businesses and local governments. It would be revealing for the governor to calculate the hidden tax he will impose on this state if these Medi-Cal cuts are fully enacted.
A better option would be a modest, broadly distributed levy – yes, a tax – to prop up this state's health care program for the poor. Consider it a down payment on a once-and-future goal: a more universal system of health coverage
with a background as a consumer advocate and community organizer on many issues, including health issues for the last ten years in California and New Jersey.
