Health care advocates have invited Congressman Susan Davis to join a town hall meeting on Saturday morning, May 2nd, to talk about the need to reform our health care system and why comprehensive health care reform must happen in 2009. The event will be one of over a hundred already taken place in 43 states nationwide over the past month. The people of San Diego will share with Rep. Davis their input about health care and voice their concerns against those who say we can’t afford to fix the system now.
Health Care for America Now (HCAN) has been holding events across the country during the months of April and May to stress the point that health care reform is an urgent must-do for Members, especially now that the Federal budget has passed.
Those in the San Diego area are invited to this Health Care Town Hall Forum, this Saturday, May 2, 2009 from 9:30am -11:00am.
It will be at the Scottish Rites Center, 1895 Camino Del Rio South, San Diego, CA 92108
Speakers include Representative Susan Davis (CD 53), as well as Dr. Rick Kronick, University of California at San Diego, and Anthony Wright, executive director, Health Access California.
Health Care for America Now! and many other groups are sponsoring a town hall this Saturday
The Senate Health Committee, chaired by Senator Elaine Alquist, met today. Our colleague Cynthia Craft provides the background on the most radical bill on the agenda:
S.B. 92 (Aanestad, R) was a proverbial everything-but-the-kitchen sink, 34-point partisan pitch in the form of a bill that, in the end, only one soul voted for: the author Senator Sam Aanestad himself. Even fellow Republican Senator Tony Strickland asked that his earlier “yea” vote be changed to “no” at the end of the day. And Republican Dave Cox stayed altogether mum.
Representing the bill as a product of the entire Republican Senate Caucus, Aanestad affectionately called the massive package by its apparently GOP caucus-designated nickname, “The Beast.” S.B. 92 would have offered a “free market” alternative to health reform, particularly another single-payer legislative push that Sen. Aanestad suggested was likely to earn another veto from the Governor.
But opponents, including Health Access California, spotlighted just a few of the conservative ideological statements embedded in the bill’s nearly three dozen provisions: an anti-illegal immigrant tax on remittances sent out of the country via Western Union, a swipe at organized labor with flexible work schedules; and an attempt to allow out-of-state unregulated insurers to come into California to do business, without having to abide by California consumer protections. And those were just three of the 34 points that sunk S.B. 92.
Even more than last year's version, the bill was an impressive compendium of proposals that Health Access California opposes, from allowing insurers to provide coverage that excludes certain ailments and body parts, allowing for limb-by-limb coverage, to the promotion of Health Savings Accounts, which are ways to promote high-deductible health plans.
Senator Aasnestad made the final plea to allow a vehicle for health reform to proceed. He said he expected that the Governor may have his own health reform proposal this year, but as of now, ther only comprehensive approach is a single-payer bill that he had new assurances would be vetoed. Senator Alquist corrected him, and referred to her own SB56(Alquist) as a vehicle for comprehensive reform. Again, the bill stalled with only one vote in support.
Regardless of what some Democratic leaders say, Governor Schwarzenegger and Republican legislative leaders are campaigning for Proposition 1A as a "spending cap."
Is that a wise decision? The recent history suggests that a spending cap is something that causes people to oppose, not support, a measure.
Regarding Proposition 1A, John Wildemuth at the San Francisco Chronicle reported earlier about the comparison with the spending cap imposed in Colorado. Proponents and opponents recognize that Colorado infamous "TABOR," or Taxpayers' Bill of Rights, was a much harsher cap than the one proposed in Prop 1A. But that doesn't make Proposition 1A benign. After all, it was something forced on the ballot by Republican leaders as the price for passing a budget, and has the same ideological intent of constraining spending. Is that the direction that voters really want to go? As Wildemuth indicates:
"In Colorado, which led the way with its 1992 spending cap, voters have suspended key provisions of their measure to free money for state services. Colorado's experience has helped persuade voters in other states to reject plans for their own spending limits. Oregon, Nebraska and Maine voted down initiatives in 2006, and efforts to get the caps on the ballot in other states have been unsuccessful."
In focusing on other failed attempts in other states, the article actually neglects Governor Schwarzenegger's last attempt at imposing a spending cap on the state, Proposition 76. During the special election in 2005, Proposition 76 got only 37.6% of the vote, with 62.4% against. It did the worst of all of Governor Schwarzenegger's proposals that year.
Some pundits have suggested that these measures may go down because of the extension of the tax increases: there's no doubt that some opposition to Prop 1A is coming from that direction. But Prop 76 and oher evidence suggests that the spending cap may be the greater liability for the measure. Think about this: the recent Field poll has Proposition 1A, at 40%, and 49% against. That means Proposition 1A, a spending cap with tax increases, is doing *better* than a spending cap alone, Proposition 76, did.
Fundamentally, voters simply aren't excited about placing caps and limits on health, schools, higher education, or other vital services that they depend on.
INSURANCE OVERSIGHT LEGISLATION IN ASSEMBLY HEALTH COMMITEE * AB786(Jones) Passes to Set Standards for Individual Insurance & Limit "Junk" Plans * Other Bills Pass On Rescissions, Mental Health Parity, Medical Loss Ratio, Etc. * Committee Rejects Bill on Rate Regulation for Health Coverage
More Updates on the Health Access WeBlog: Coverage That Counts; Call Her Secretary Sebelius; Opinions on Prop 1A; Blue Cross Calling on Health Reform; Prescription Drug Legislation; Update on Budget Hearings; Reforming the "High Risk" Pool
A number of measures to place new oversight over the health insurance industry cleared a critical first hurdle Tuesday, as the Assembly Health Committee, chaired by Assemblyman Dave Jones, wrapped up its policy scrutiny role by the April 30 deadline. The bills now advance to the Assembly Appropriations Committee, where their fiscal impacts will be examined.
The consumer protections regarding health insurance that were considered, all supported by Health Access California, included:
* INSURANCE STANDARDS: A.B. 786 (Jones) would provide new information and standards on health plans for individual consumers buying health coverage. The bill is designed to make it easier for consumers to make informed choices while shopping on the “individual” market (as opposed the group-policy market). Authored by Committee Chair Dave Jones (D), the measure would encourage “apples-to-apples” price comparisons and the development of clear categories of services and benefits, so people better understood what they are buying with their premiums. It also seeks to limit the sales of “junk” insurance, or policies that offer only very limited benefits–often to the surprise of the consumer.
One testifier, Ehren Thompson, then a personal trainer at 24-hour fitness, reported buying coverage as an individual from MEGA that ultimately did not cover his surgery. A doctor diagnosed him with a inguinal hernia and admitted him to a hospital for surgery immediately, but after overnight preparation, he was released from the hospital with a $2,000 bill but without surgery because it wasn't covered. For four months in pain, he negotiated with the insurer and scheduled outpatient surgery. Ultimately, MEGA's hospital coverage was limited to $1,000, leaving Thompson in debt for over $12,000, for which he is in collections.
AB 786 is sponsored by Health Access California, with support coming from Consumers Union, Western Center on Law and Poverty, AARP, AFSCME, California Immigrant Policy Center, California Medical Association, Congress of California Seniors, and SEIU. Opposition came from various health insurers and the Chamber of Commerce. The measure drew ideological opposition from Republicans on the committee, with Assemblywoman Audra Strickland (R) proclaiming, “frankly, one man’s junk insurance is another man’s coverage." Assemblyman Anthony Adams (R) insisting the bill insults the intelligence of consumers, that they can't figure out the insurance market by themselves. Jones replied that he and the Republicans had “fundamental differences” in that he sees some products as "false choices"–and his colleagues on the other side of the aisle don’t recognize that as an issue. There are some products that have people paying premiums but without getting any significant value. The measure passed with all Democrats on the committee in support and Republicans against.
* RESCISSIONS: A.B. 2 (De La Torre) provides for an independent review of any rescissions of individual health care coverage. Author Hector De La Torre cited statistics showing that “every major insurer” had illegally rescinded hundreds of individual policies of consumers who had faithfully paid their health premiums. His bill would protect consumers against this practice, where paying patients are accused of having incorrectly disclosed their medical history. A spokesman for the California Medical Association, told committee members that “health plans exist to provide coverage to patients, not to yank coverage away.” Consumer groups were in support, insurers were in opposition, with a representative from Blue Shield spoke against the measure, saying he feared the bill would unfairly favor attorneys who were filing legal actions against insurers. A version of this measure was vetoed by Governor Schwarzenegger last year, but the author specified some changes that could lead to a different result this year. The measure passed with Democrats in support.
* MENTAL HEALTH COVERAGE: A.B. 244 (Beall) would require health care policies to cover expanded mental health services. Currently, plans are required to cover serious mental illness but not the less-severe conditions that could lead up to serious disorders if left untreated. Assemblyman Jim Beall Jr. (D) pointed out that the Obama Administration has already announced its intent to expand mental health services, and said that California has some catching up to do. The measure passed with Democrats in support.
* DISCLOSING ADMINISTRATION & PROFIT: A.B. 812 (De La Torre) would require insurers to disclose medical-loss ratios, information already provided to two state regulatory departments, albeit in different forms. De La Torre (D) said the measure would add transparency, create a better comparable standar, and provide consumers and regulators critical information about the percentage of premiums being used for medical coverage versus the percentage devoted for the profit of parent companies and shareholders. The measure passed with Democrats in support.
* RATE REGULATION: A.B. 1218 (Jones) on the other hand, fell victim to opposition and failed to pass out of committee. It would have required health care insurers to seek approval for new rate hikes. Jones and his supporters of consumer groups and labor unions argued that, if health care insurance followed the model of auto insurance in California, which is regulated under Proposition 103, insurers would benefit from healthy profits and consumers would benefit from lower overall rates. Assemblyman Adams (R) called the measure “old school liberalism." The measure stalled with eight Democrats in support, but the rest either opposed or not voting, including all Republicans and Democratic Assemblymembers Block, Hall, Hayashi, Hernandez, and Salas.
Other bills relating to insurers included efforts A.B. 591(De La Torre) to require insurers to provide a list of plan contracts/policies offered or issued in California so consumers can better information about their plan; and A.B. 598 (De La Torre) to help create streamlined billing codes for health services. Both measures got bipartisan support.
Another bill of interest to consumers was A.B. 542 (Feuer), which seeks to withhold public insurance payments to hospitals for so-called “never” events–or adverse medical conditions or errors that “never should have happened.” Health Access California spoke in support of the bill, citing severe, life-threatening bedsores as an example of poor hospital care that does not deserve reimbursement.
Finally, serving as a placeholder for a broader discussion on health reform was A.B. 1314 (Jones), which won approval from the committee. It provides a vehicle for comprehensive health reform by requiring the California Health and Human Services Agency to engage with stakeholders to develop a plan to enact broad-based reforms to the state’s health care system and to present the plan to the Legislature no later than April, 1, 2010. The development of a plan would move forward both with, or without, federal action. Health Access California expressed its encouragement for the discussion and is in support of the bill, which advanced without much committee discussion Tuesday.
All bills needed to pass policy committees by April 30. The next hurdle for the bills will be Assembly Appropriations Committee, which must pass bill by the end of May. Health Access will continue to provide updates on actions taken in the Legislature. For a broader list of interest to health advocates and Health Access California , check out the bill list on our website.
We'll soon post a full report from Tuesday's Assembly Health Committee, but most of the 45+ bills passed out, including AB786(Jones), which would set standards in the individual insurance market.
As the bill's sponsors, Health Access California thinks it is critical as an important consumer protection against underinsurance: providing patients with basic information about the health products they are purchasing, allowing them to make apples-to-apples comparisons between plans, and weeding out specific "junk" products that are so limited as to be meaningless.
Examples of such "junk" coverage is hospital-only coverage, which people buy not realizing how much medical care--from surgery to cancer treatment--is providing in an outpatient setting. Or a plan that actually covers so little as to be meaningless: for example, covering $1,000 of a hospital stay, when any bill for even a day at a hospital will be multiple times that.
This discussion is crucial in the context of the federal health reform debate, because if we are going to talk about expanding coverage, or mandating coverage, or providing security that coverage will be there when you need it, we need to set a minimum definition of what "coverage" means.
The key point is that coverage isn't fully scalable. It's makes sense that if one can't afford the premiums for a fully comprehensive health plan, the instinct is to find a less comprehensive plan with a cheaper premium. But there's a point when the coverage is so minimal--for example, a coverage product that only covers $200/day of a hospital stay, when the charge is far greater--that the plan does not provide any of the benefits of being insured--and the plan just provides a false sense of security.
There's only one thing worse than being uninsured, and that's paying a premium for the priviledge.
Here's just two quick opinion articles from the Los Angeles Times on Proposition 1A.
One is by columnist Michael Hiltzik, where he says: "The bottom line is that 1A does nothing to narrow the existing budget deficit, and may make deficits worse in the future. As the nonpartisan California Budget Project points out, because the costs of many services provided by state government, such as healthcare, grow much faster than inflation, the formula will squeeze almost every other budget category. That makes Proposition 1A a time bomb."
Another is by former state Treasurer Phil Angelides, who comments: "The measure would actually deepen California's budget woes. It would require that money be stashed away in a rainy-day fund even though the state is already pulling in less money each year than it spends. That's a little like telling a family facing foreclosure that they're not putting enough money away in their 401(k) account. Even in tough budget years, it would force additional cuts of more than $1 billion -- an amount equal to about one-third of the University of California system's budget."
"Proposition 1A would squeeze spending on crucial investments in colleges and healthcare, and it would prevent the state from restoring needed programs as the economy rebounds. It also would lock confusing, complicated, autopilot budget language into the state Constitution -- making it harder, not easier, to adopt common-sense budgets. With complex formulas and linear regression models cemented into law, the already daunting task of budgeting would be that much harder."
To be fair, the editorial board of the LA Times did ultimately support the measure, but grudgingly: "The reserve fund is closely linked to the spending cap, and that gives us pause, because The Times has long objected to hands-free budgeting -- decision-making that removes human thinking from the fiscal planning process. But after several decades' worth of ballot measures that impose formulas... California finds itself so far down the robo-budgeting road that it may need a bit more automation just to regain its bearings."
I am not sure that the logic holds, that the solution for auto-pilot budgeting is even more auto-pilot budgeting. To me, it seems Prop 1A just adds a whole other layer of paralysis, obscuring the accountability we need to fix the budget mess. We'll see what the voters say May 19th.
There's well over 40 bills scheduled to be heard tomorrow afternoon in Assembly Health Committee, chaired by Assemblyman Dave Jones (D-Sacramento).
Several of the bills would put new and needed oversight over the insurance industry. Bills includes A.B. No. 786 (Jones), sponsored by Health Access California, which would provide standards for individual health care coverage, creating coverage choice categories so consumers could make "apples-to-apples" comparisons, and limit "junk" insurance.
Other bills of note include: * A.B. No. 2 (De La Torre), which would provide an independent review for any recissions of individual health care coverage. * A.B. No. 244 (Beall), which would require health care coverage to include expanded mental health services. * A.B. No. 812 (De La Torre), which would require disclosure of the medical loss ratios of specific health care coverage plan products. * A.B. No. 1218 (Jones), which would require health care insurers to seek approval for rate hikes.
Finally, A.B. No. 1314 (Jones), provides a vehicle for comprehensive health reform both with or without federal action.
The nomination of Governor Kathleen Sebelius (picutred here with Speaker Nancy Pelosi of California) to be U.S. Secretary of Health and Human Services will be voted on tomorrow, Tuesday, on the U.S. Senate floor.
She's the last cabinet member of the Obama Adminstration to be approved. Despite the Governor's impressive credentials working across party lines in a "red" state, it shows how difficult and polarizing health care issues can be.
Getting her in place with crucial before the recent news about swine flu, given the significant issues to be attended to in our health care system, and President Obama's emphasis on health care reform.
Yesterday’s Sacramento Bee had a front page story by Bobby Calvan about how Blue Cross is phone banking its members about health reform.
If you are suspicious about an insurer being "for reform," you should be. The story correctly says that Anthem Blue Cross strongly opposed health reform here in California in 2007 and had a hand in its defeat. More information about their role is at our website, http://www.sickofbluecross.com/.
There were other opponents that made a difference as well, such as the tobacco industry that opposed the late addition of a tobacco tax to the financing. Did the opposition of Blue Cross matter? Of course. Was it decisive? Not in our experience. We believe that we can win federal national reform, too, even if Wellpoint/Anthem/BlueCross attempts to oppose it. But only if win make clear what the insurance companies' interests are, and how they differ with the interests of consumers.
But more amusing to us, was that one of the Blue Cross members they called was Joan Pirkle Smith, a long time member of the Health Access California Board. As indicated in the Bee, she's been a supporter of single payer health care, such as HR 676 and SB810 (Leno). Joan has also supported comprehensive reform efforts from SB2/Prop. 72, the employer-based coverage expansion in 2003 and 2004, to AB 8 and AB x1 1 in 2007. I first met Joan during the fight for Prop. 186, the single payer ballot initiative here in California in 1994. She worked hard on HMO reform during the 1990s. We are proud of the Health Access community of organizations and individuals who, like Joan, keep trying to fix our broken health care system.
The drug wars go on here in California: consumer advocates continuing to fight the pharmaceutical industry--the legal one--for safer drugs and better prices.
SB438(Calderon) this year was similar to last year's SB1096(Calderon), a measure widely opposed by consumer groups. SB1096 allowed pharmacists to sell prescribing information to drug companies so drug companies could do even more targeted marketing to consumers. SB438 is slightly better in terms of privacy protections but still has many of the same flaws. Thankfully, it will not proceed this year.
Another bill, SB341(DeSaulnier) would expand the comparative effectiveness efforts at the federal level to California by adding counter-detailing, that is education of physicians and consumers about comparative effectiveness of drugs by impartial sources rather than leaving doctors and patients to rely on drug company marketing. What is that purple pill anyway? This bill failed in Senate Health with Republicans opposed and Democrats Gil Cedillo and Gloria NegreteMcLeod present but not voting. It has been amended to delete the fee on drug companies and is scheduled for hearing again on this Wednesday, 4/29, in Senate Health. We will see if the outcome is any different.
Today, Senate Budget Subcommittee 3 on Health and Human Services, chaired by Senator Mark Leno, met to hear budget issues related to Healthy Families and Medi-Cal. Much of the discussion related to implementation of new federal laws, particularly ARRA (the federal recovery act) and CHIPRA (the re-authorization of kids’ coverage). No actions were taken, pending the outcome of the May 19th election and the subsequent May revision of the budget estimates.
A few things worthy of note from the hearing:
· The caps on dental benefits for kids on Healthy Families appear to violate the new federal law---good news again from our friends at the federal level. Oh, and our orthodontia benefit might need to be improved as well.
· As required by recent federal law, MRMIB is implementing citizenship documentation for kids on Healthy Families. They think that 90% of the kids can be done automatically by crosschecking birth certificates which have been computerized for some time now. For the remaining 10%, for those under age 16, they can accept attestation by the parent. They are still trying to figure out what to do about 17 and 18 year olds.
· The Medi-Cal program is focusing on national health reform, the hospital waiver renewal and fraud.
· Lots of discussion of implementation of the ARRA (American Recovery and Reinvestment Act). Complaints that some of the cuts made as a result of the infamous budget trigger violate the Maintenance of Effort requirements in the ARRA, mostly on home care and SSI. Sadly the elimination of adult dental, podiatric, and other key benefits does not appear to be contrary to federal law.
· Medi-Cal is moving to electronic verification of assets: the welfare directors and Western Center on Law and Poverty have letters in expressing concern about the broad vague language proposed for the trailer bill. And oh, by the way, did Congress forget study after study has shown that people poor enough for Medi-Cal don’t have assets? Most seniors and persons with disabilities who are poor enough to be on Medi-Cal would be lucky to have $2000 in the bank—and if they did, it would just be because they had first and last months rent saved up, as they are supposed to. Health Access ran a project and sponsored a bill and some years ago on eliminating the asset test: we lost that fight not because there's a lot of low-income people with assets who want Medi-Cal, but because it was demonstrated that the elimination of this administrative barrier would lead to more people with little or no assets ending up enrolled in Medi-Cal, and thus it would be a cost to state government.
· Medi-Cal managed care: in our blog posts from 2005, you would have read screen after screen about the Administration proposals to expand managed care, including forcing seniors and people with disabilities into HMOs. While most of the Administration’s proposal failed, there were expansions of Medi-Cal managed care for working families into counties adjacent to those larger, urban counties where it already existed. Well, here we are four years later and four of the 13 counties are still not ready because of lack of provider networks (in Merced, Lake, and Mendocino? Gee, is that a surprise? Not to anyone who has sat through a CalPERS health benefits discussion.)
Compared to most budget hearings in recent months, it was a pretty quiet day. There was a Assembly Budget Committee earlier this week that also delved into some of these issues as well... but the tough stuff will come after the May Revise, when we know how big the damage is.
Our new Health Access colleague, Cynthia Craft, reports from today's Senate Health Committee, which passed some key health measures today. Of particular note was two bills to assist those who are denied for "pre-existing conditions," and thus cannot get health insurance at any price:
SB 227, Alquist (D), would launch an overdue overhaul of the state’s 20-year-old health insurance program of last resort for Californians deemed by insurance companies to be too sick to enroll. Of two measures on the topic in the Senate Health Committee Wednesday, SB227 had a greater reach, offering more opportunities to extend coverage to the so-called “high-risk” individuals whom health plans blacklist as “medically uninsurable.”
The bill would update the state’s "high-risk" pool for those who are denied private coverage, called the Major Risk Medical Insurance Program (MRMIP), so it would have no annual benefit cap, and raises the program’s lifetime benefit cap to $1 million or more – from the currently inadequate $75,000 cap. (The removal of the cap allows California to be eligible for federal funds it would otherwide not be.) The money from a relatively minor insurer assessment--a version which is in place in over two dozen states--would also expand the program to benefit many more people with pre-existing conditions. Presently, the program can insure only 7,100 statewide, while the true need in California is estimated as high as 790,000, Alquist testified. “So long as we allow health plans to reject people, we need to offer them an alternative,” Alquist told the committee. Speaking in support of the bill were representatives from the Congress of California Seniors and Health Access California. The California Labor Federation raised concerns in opposition not to the program, but to the funding source. The concern is that an assessment on health plans would be passed on in higher premiums, even for group coverage which do not exclude sick people, and so are already doing their share. Committee members urged Alquist to work with organized labor to address the federation’s concerns, and she expressed a willingness to do so. SB 227 advanced to the Senate Appropriations Committee.
In SB 57, Aanestad (R), Republican Sam Aanestad proposes different changes to the state’s Major Risk Medical Insurance Program, including increasing deductible and maximum out-of-pocket expenses; requiring an option to purchase a health benefit plan with a health savings account; and requiring three declinations in the private market or proof of a qualified medically uninsurable condition in order to qualify. Speaking in opposition to the bill was Health Access California, which stated that additional deductibles and cost-sharing was particularly inappropriate for a population needing care, and said that the proposed cap of 10,000 people was not acceptable, considering that “hundreds of thousands” of California have been denied coverage and are likely in need of this program. The measure stalled in Committee.
If you think you will ever be in a position where you are seeking to buy health coverage but are denied for so-called "pre-existing conditions," then these debates over MRMIP are important. It's frankly a band-aid for a much more systemic problem with the individual insurance market, one that hopefully will be given a broader fix within comprehensive health reform. But until then, California consumers need a place to go.
KEY CONSUMER PROTECTIONS PASS ASSEMBLY HEALTH COMMITTEE IN A FLURRY OF APRIL BILL ACTION * Bipartisan Vote to Ensure Fair Pricing by Emergency Room Doctors * Process Begins on Renegotiating California's Hospital Financing Waiver * Other Medi-Cal Changes Also Pass Committee
More Updates on the Health Access WeBlog: Health Reform Hearings in the House; The Timetable for Federal Reform; Gender Discrimination; Honoring Frank Russo; The Packaging of Prop 1A; Married for Health Coverage?
In a hearing lasting over four hours, the Assembly Health Committee, chaired by Assemblyman Dave Jones (D-Sacramento), considered several bills that would impact California health care consumers. Some of the highlights include:
Self-Pay Patients To Get Help on ER Doctor Bills
AB 1503, Lieu (D) would require emergency room physicians to charge rates to lower-income patients who do not have health insurance. Currently, uninsured individuals treated in emergency rooms are frequently charged three to four times more what insurers pay for exactly the same service. The measure specifies that ER doctors would have to offer eligible patients rates that are no higher than those paid by Medicare, Medi-Cal or similar government programs. Physicians also would have to offer payment plans, rather than submit unpaid bills to collection agencies.
The measure prohibits wage garnishments or liens, and prohibits the forced sale of a patient’s home as a means of collecting the debt. These consumer protections already apply to hospital billing under AB774(Chan) of 2006, and in this bill would be extended to individual ER physician billing. As of 2007, about 6.5 million Californians were without health insurance. Research pinpoints medical debt as the leading cause of personal bankruptcy in the United States . The bill got support from Health Access California, ACORN, Western Center for Law and Poverty, Congress of California Seniors, Jericho, and others. The bill won unanimous bipartisan support in committee, and AB 1503 advances to the Assembly Appropriations Committee.
Key Medi-Cal Reforms Pass
Hospital Financing Waiver Process Starts: AB 342, Bass (D) and Jones (D), a companion bill to its Senate counterpart, SB 208 (Steinberg), lays the groundwork for the state to negotiate a new Medicaid waiver from the federal government, a crucial component of financing for the state's public and safety-net hospitals, and for the health system as a whole. Specifically, the bill gives the go-ahead for the state to draft a comprehensive waiver from federal Medicaid rules, with an eye toward preserving and strengthening safety-net providers and maximizing federal funds. The measure is not fully detailed, but sets the stage for negotiations with stakeholders, many of whom testified with their interests and concerns as part of the process in developing this plan. AB 342 overwhelmingly won passage to the Assembly Appropriations Committee.
Fewer Payment Hassles for Medi-Cal Enrollees: AB 1142, Price (D), would reduce unnecessary headaches for Medi-Cal beneficiaries by requiring hospitals and providers to make an extra effort to bill the program, instead of unnecessarily sending the bill to the patient. The bill calls for a series of actions following patient care to ensure Medi-Cal consumers are not wrongfully pursued for debt that the program would cover. It would require hospitals to share eligibility status with hospital-based providers, ambulance services and other appropriate professionals. Fines up to three times the amount of the Medi-Cal payment would result if the provider has proof of Medi-Cal eligibility but pursues collection from the patient instead, resulting in a negative credit report. AB 1142 got support from Western Center on Law and Poverty, and children's, labor, low-income, and consumer organizations, including Health Access California. The bill advanced the Assembly Appropriations Committee on a strict party-line vote, with Republicans voting “nay.”
Extended Medi-Cal Coverage for Disabled Workers: AB 1269, Brownley (D), would make health coverage more affordable for many working people who are disabled. Specifically, it would extend eligibility for Medi-Cal under the California Working Disabled Program for 26 weeks effective March 1, 2010. Groups representing people with disabilities, health providers, and consumers, including Health Access California, supported AB 1269. The bill advanced, with voting along party lines, to the Assembly Appropriations Committee.
Less Bureaucracy, Duplication for Medi-Cal Enrollees: AB 963, Ammiano (D), would lessen paperwork for low-income individuals and families who apply for food stamps, also streamlining their applications for Medi-Cal eligibility. It would require stakeholder groups, the Department of Social Services, counties and the Statewide Automated Welfare System to coordinate efforts in a collaboration to update data sharing, technology and administrative procedures to ensure continued health coverage for eligible people whose status in other programs changes. The measure, which advanced to the Assembly Appropriations Committee, prohibits the Department of Health Care Services from imposing duplicative and burdensome paperwork requirements. Health Access California is in support of AB 963.
Some Bills Stall
The committee passed most bills it considered, with the exception of a ten percent fee on alcohol to fund alcohol and drug programs, and a measure to require disclosure of employer's claims data. AB 562, Cook (D), failed to pass when lawmakers’ concerns about ensuring employee privacy trumped the bill author’s call for greater transparency. The stated purpose of the bill was to give mid-sized small business employers more information about where their health care dollars are going while they shop for policies. Insurance underwriters testifying in favor of the measure said business owners who pay a portion of their workers’ premiums should be able to discern what costs lie behind their investment when negotiating with insurers. The bill was opposed by both health insurers and privacy advocates, and some Health Committee members expressed concern that too close a look at the health care costs would expose employees to discrimination, termination or simply compromise their privacy. The bill failed to advance out of committee, and is up for reconsideration. (Health Access California did not take a position on the measure.)
Given the length of the hearing, some bills were "put over" to be considered during next week's hearing. All bills need to pass policy committees by April 30. Health Access will continue to provide updates on actions taken in the Legislature. For a broader list of interest to health advocates and Health Access California , check out the bill list on our website.
The Witness List includes Consumers Union (a Health Access California board member) and the president of Watts Healthcare Corporation from Los Angeles:
* Uwe E. Reinhardt, Ph.D., James Madison Professor of Political Economy and Professor of Economics and Public Affairs, Princeton University, Princeton, New Jersey * Bill Vaughan, Senior Policy Analyst, Consumers Union * William D. Hobson, Jr., MS, President and CEO, Watts Healthcare Corporation, Los Angeles, California * David Borris, Owner, Hel’s Kitchen Catering, Northbrook, Illinois * Kenneth L. Sperling, Global Health Management Leader, Hewitt Associates, on behalf of National Coalition on Benefits * Linda Blumberg, Ph.D., Principal Research Associate, The Urban Institute
The House Education and Labor Committee, chaired by California Rep. George Miller, is hosting a Health, Employment, Labor, and Pensions (HELP) subcommittee hearing on Thursday, April 23, to "examine various health care reform proposals that will guarantee quality and affordable health insurance coverage for all Americans." It will be broadcast online at the committee
* Karen Davenport, director of health policy, Center for American Progress * David Himmelstein, associate professor of medicine, Harvard University * Michael Langan, principal, Towers Perrin * William Oemichen, president and CEO, Cooperative Network, Madison, Wisc. * Ron Pollack, executive director, FamiliesUSA * Janet Trautwein, executive vice president and CEO, National Association of Health Underwriters * William Vaughan, senior health policy analyst, Consumers Union
The House Energy and Commerce Committee, chaired by California Rep. Henry Waxman, is the other key committee that will craft and consider health reform legislation, and they had had hearing and will soon as well.
When Melody Barnes was here in California, she added extra urgency to President Obama's nationally televised quote that "let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year."
She said at the White House forum two weeks ago that in order to pass a bill "this year," then we have essentially "100 days" to craft legislation in order to meet that goal..essentuial
The shortness of the timeline is underscored by Senators Baucus and Kennedy, chairs of the key Senate committees, which yesterday proposed that they will mark up a bill in June! The full text of the letter is at The Treatment.
Mike Zapler at the San Jose Mercury News has the story about women getting a triple whammy... having to buy individual health insurance--which is already the most expensive, least efficient way to get coverage, having to pay more as a woman, and having to pay more to get basic services--like maternity.
It spotlights legislative efforts to ban gender discrimination in underwriting--AB 119 (Jones) + and SB54(Leno)--and to require the coverage of maternity care--AB 98 (De La Torre).
Speaking of legislation, another big week coming up in the legislature: Bills up in Assembly Health Committee on Tuesday include a health insurance rate regulation bill, AB1218(Jones), AB2(De La Torre) on rescissions, and several bills on Medi-Cal enrollments and eligibility.
The Senate Health Committee on Wednesday will consider different efforts to change MRMIP, the state's "high risk" pool for those denied for pre-existing conditions, AB227(Alquist) and SB57(Aanestad), as well as broader health reform issues.
We'll report on it right here, as well as on our Twitter account, at @healthaccess, or www.twitter.com/healthaccess
On Monday evening, Health Access will join many other key organizations to honor Frank Russo and the work of the California Progress Report. With the decline of newspapers, the California Progress Report has provided a vital independent progressive voice on a wide range of policy issues. We appreciate that it has republished many of our updates and posts from Health Access and other health related posts, and it has been a useful place to keep up what other groups are doing on other issues.
Frank Russo founded the California Progress Report and made it a heavily tracked website for California news and information, from a range of sources--citizen activists, legislative leaders, and key constituency organizations. As a result, it reports the stories at the state Capitol and throughout California that no one else is covering. Frank has moved on to work in the Capitol, but we should try to ensure that the California Progress Report continues.
We are supporting the Consumer Federation of California Education Foundation's efforts to maintain and develop the site. If you are in Sacramento Monday, or if you or your organization can otherwise help, we hope you can too.
So much of the campaign around Prop 1A is to package it with the other initiatives, and then sell the entire package as a whole, even though the parts are very different, with different consequences.
The Governor has made two arguments. One is to sell the package as the ultimate solution to our budget crisis: "We have a chance to fix this once and for all." But no one believes that. Not the LAO. Not his own budget crunchers. Not the budget passed earlier this year, nor the pending ballot measures package, solve the fundamental issue of the mismatch between the level of services the state provides, and the revenues the state brings in. Severe cuts were made, but the revenues are temporary. And even in the short-term, given the extent of the economic crisis, California has a significant deficit on May 20th regardless of the vote on May 19th.
Unable to continue that argument with a straight face, there's a new line. The new tact has been arguing that the state will fall off a cliff if the package is voted down. But let's tease out the package: Proposition 1A will have zero impact on the deficit on May 20th. The impacts of its passage, whether of additional revenues for 1-2 years in 2011-13, or the long-term constitutional contraints on spending and investment, don't kick in for a few years.
The measures that do have an impact on the deficit on May 20th are Propositions 1C, and to a lesser extent, Props 1D & 1E. Proposition 1C would allow the state budgeters to book $5 billion in budget solutions. While some may question the wisdom or even the actual ability of California to "securitize" the lottery, it's Proposition 1C's failure that will make the deficit $5 billion bigger.
Similarly, if Props 1D &1E are voted down, and the general fund is thus not able to take money from voter-approved funds for services for children and the mentally ill, then the general fund deficit is bigger, but at a smaller scale--less than $1 billion for both measures.
It would be more forthright if the proponents, in their alarmist rhetoric, focused on Proposition 1C, arguing that if that measure goes down, the budget outlook of cuts or taxes would be significantly worse. But they don't think they can sell it. So they are trying to package it with the other measures, and use the elements of Prop 1A to somehow sell Proposition 1C.
Besides, the Governor in particular sees his legacy in Prop 1A. As he said, "I mean, I've been fighting for five years now for budget reform, to put a rainy-day fund aside and to put a certain cap on spending. I wasn't successful. I tried through the Legislature when I first came into office; I tried in 2005 to go directly to the people, but apparently it wasn't inclusive enough so that failed -- the idea was good but it failed. And so here was our chance again…. "
There's an irony here. He failed in 2005 to pass a spending cap in Proposition 76, which was unpopular from the start. Voters didn't like placing limits on the services they depend on--education, health care, public safety, etc; nor did they like giving the Governor unilateral authority to make certain cuts. (I believe they still don't.) The opponents used Proposition 76 to help discredit the Governor and the entire package, including other measures that ended up losing by much closer margins.
Now the Governor is trying to use another spending cap proposal to prop up his entire package. But it's a fundamentally unpopular notion to begin with, so I don't know if it will be successful. It seems it is a strange strategy, given recent history.
As we noted last year, a Kaiser Family Foundation poll showed that 7% of Americans said they made a decision about marriage based on the need for health coverage.
This music video from Runawaybox graphically advances this trend into public consciousness (it's OK for work... barely):
With current economic conditions and long-term trends, more people are losing access to employer-based group coverage, and are find themselves in the wild, wild west of the individual insurance market, which is the most expensive, least efficient way to get coverage--if you aren't denied for a "pre-existing condition" in the first place.
It's a truly broken system when the only or best place to get health coverage is at the altar.
SENATE HEALTH COMMITTEE CONSIDERS KEY MEASURES * Single-payer universal coverage bill advances again–despite past Schwarzenegger vetoes. * Workers let go from the small businesses would qualify for health care assistance. * Bill stalls to provide greater public access to unbiased data on prescription drugs
ALERT: Support Needed Next Week on Bills on Underinsurance, Overcharging
More Updates on the Health Access WeBlog: New Report Released on Underinsurance; Board of Equalization Asks Nonprofit Hospitals For Information; Assembly Health Committee Update; Opposition on Prop 1A; More on the Public Health Insurance Option
The Senate Health Committee, chaired by Senator Elaine Alqust (D), on Wednesday approved a measure to expand financial aid for continued health care coverage to workers laid off by small businesses through 2009. The bill taps into federal stimulus money from Washington to make COBRA coverage substantially more affordable.
Also, prodded by a roomful of over 100 Californians supporting a single-payer solution to the health crisis, Senate Health Committee members also voted to advance a bill that would set up a SB810(Leno).
At the same time, however, there was not enough support to pass a bill to establish "academic detailing" to offer the public unbiased consumer information on the safety and cost of pharmaceutical medications.
The following looks in more detail at these bills, which Health Access California is active in supporting:
SINGLE PAYER HEALTH CARE COVERAGE
* SB 810 (Leno) outlines a comprehensive reform to create single payer universal health coverage system in California. Such a system would extend health care services to all residents, through the existing network of largely private doctors and hospitals, but with the state negotiating and providing reimbursements.
The proposal has the support of advocates who say it would eliminate existing disparities in Californians’ access to health care, and save California money in the long run by keeping the citizenry productive and healthy, and eliminating an insurance company middleman.. Assemblyman Mark Leno (D) said the change is needed also because health care is costing too many consumers too much money, without delivering enough positive results. Single payer bills similar to SB 810--most recently SB840(Kuehl)--have been passed by the California Legislature before, only to be vetoed by Gov. Arnold Schwarzenegger, who has labeled such proposals “socialized medicine.” The proposal does not include the financing component at this time.
Supporters included a broad rage of several dozen organizations, including Health Access California. Many organizations that sent members to pack the committee hearing room of over 100 people who wanted to voice their support. In testimony in favor of the bill, leaders of the California Physicians' Alliance and California Nurses Association made the case on both economic and health grounds.
A coalition of insurers, providers, and businesses opposed, including Anthem Blue Cross, America ’s Health Insurance Plans, Health Net, California Association of Health Underwriters and others voiced opposition to the proposal. A representative of California Chamber of Commerce predicted it would lead to fiscal chaos, and said the state should wait to see what the Obama Administration proposes for health care reform. Republican Senator Aanestad debated points with Senator Leno over the lessons of Canada and issues around cost.
Committee members voted along party lines in advancing the bill to the next Senate committee, with Democrats in support and Republicans in opposition.
EXPANDED HEALTH CARE COVERAGE FOR JOBLESS * AB 23 (Jones) got broad bipartisan support through the Senate Health Committee. The bill would tap into federal stimulus dollars to allow a greater range of laid-off Californians to qualify for COBRA subsidies to stay covered. The federal economic recovery package was designed to aid employees who were let go – through no fault of their own – helping them obtain subsides to extend their job-based health care coverage. The bill extends that assistance to workers of smaller businesses--from 2-19 people--in alignment with California's specific Cal-COBRA law.
Senate Health Committee members noted the urgency of the measure and sent it along to the next committee. AB 23 will provide up to 65 percent of the cost of extending health care coverage through the federal COBRA program. It applies to people losing their jobs from September 1, 2008 to December 31, 2009.
No organization or person registered opposition to AB 23. Among those in support were a range of consumer, labor and provider organizations. The bill was sponsored by the California Department of Insurance, and did not have significant opposition.
TRANSPARENCY ON PRESCRIPTION DRUGS
* SB341 (DeSaulnier) proposed to have the University of California provide consumers and doctors the latest reliable information on the safety and cost-effectiveness of pharmaceuticals, including on a public website.
The bill also proposed to level the playing field in doctors’ offices by sending UC researchers or representatives to physicians’ workplaces to share unbiased information about drugs to doctors. Pharmaceutical companies have for years been taking advantage of opportunities for face-to-face access to doctors, by sending employees called “detailers” to talk to physicians directly about the drugs they are marketing as well as engaging in ceaseless advertising to consumers about those drugs.
SB 341 would remedy this at a time when some widely-marketed drugs, like Vioxx, have already been found to cause adverse side effects. Senator Mark DeSaulnier (D) said the bill is necessary because consumers need better, centralized access to unbiased information about prescription drugs in part to counteract expensive drug company marketing and advertising campaigns. In response to questions by his fellow Senate Health Committee members, he agreed to examine whether his proposal overlapped with federal efforts and, if so, amend the bill.
SB341 builds on the efforts of the Obama Administration to control health care costs by getting better information about the comparative effectiveness of prescription drugs. Vioxx was not only harmful, it was only marginally more effective than ibuprofen but it was lots more expensive.
In addition, a representative from the advocacy group Community Catalyst said "academic detailing" proposals such as SB 341 are already up and running in several other states, including Pennsylvania , Vermont and Maine . The California Alliance for Retired Americans is the sponsor, with other supporters including the Mental Health Association in California , the AFL-CIO and Health Access California , among others.
Opposition came from Pharmaceutical Research and Manufacters of America and other drug companies. They argued that UC is already the “partner” of the pharmaceutical manufacturers. Plus, they said, the information is already available if one knows where to look. Mainly, they argued against the fee to pay for this information, and that the bill was unnecessary because the recent federal stimulus package included funding for comparative effectiveness research. They failed to mention that the drug companies vigorously but unsuccessfully opposed those very provisions and then fought hard to make them meaningless, a fight that still continues in DC.
SB 341 was the only bill that did not win enough votes to advance out of committee. With a party line vote, with Democrats in support but Senators Cedillo and Negrete-McLeod present in the room but not voting, it failed to pass. It was granted reconsideration and could be heard as early as next week. It also needs to pass Senate Revenue and Taxation before April 30.
UNDERINSURANCE BILLS ALERT: Earlier today, Health Access co-released a national report on "underinsurance" with Community Catalyst, while spotlighting AB786 that directly addresses the issue. Next week, the Assembly Health Committee will consider two crucial consumer protection bills sponsored by Health Access California
SUPPORT LETTERS ARE WELCOME FOR:
* AB786(Jones) to set standards for coverage, allowing for apple-to-apples comparison shopping and limiting "junk" insurance.
* AB1503(Lieu) to prevent overcharging of the uninsured and underinsured by emergency room physicians.
Please get your organizational letters of support faxed to the Assembly Health Committee, chaired by Assemblymember Dave Jones, State Capitol, Room 6005, Sacramento , CA 95814 . The fax is: 916-319-2197.
Health Access will continue to provide updates on actions taken in the Legislature. For a broader list of interest to health advocates and Health Access California , check out the bill list on our website.
Today the Board of Equalization acted, on a 3-2 vote, to require that non-profit hospitals report to it in July and September of this year about whether those hospitals are complying with the basic requirements of California law with respect to non-profit tax status as well as AB774, on hospital overcharging. The Board expect to put out a report in February of next year (2010).
The hospitals opposed this and attempted to delay the vote until another year, another decade, maybe another century.
However, Board Members Betty Yee, who proposed the motion, former Assemblymember Judy Chu, and Controller John Chiang prevailed. While the motion to conduct a stakeholder process passed a few months ago 5-0, this time Board Members Bill Leonard and Michelle Steel both voted no. Although the Board of Equalization is technically non-partisan, the vote was along party lines.
Under California law, including a decades-old court case named Rideout, after a hospital of that name, nonprofit hospitals are generally expected to have revenues in excess of expenditures of less than 10% (otherwise known as profits). However, non-profit hospitals may accrue greater “surplus” revenues if they use those “surplus” revenues for debt retirement, facility expansion or reserve for operating contingencies.
For those of you who are not tax geeks, here is an example: a few years ago Sutter Tracy had revenues in excess of expenditures of 24%. Pretty healthy return for a “non-profit”. It is this sort of thing that made the BOE think perhaps they should take a look and request information about what “non-profit” hospitals were spending their surplus revenues on.
The information request also requires hospitals to provide their charity care and discount payment policies as well as the number of liens and amount collected from liens. They are also looking at joint ventures and executive compensation and for personal inurement, since there is some lingering notion that those who are in charge of non-profits should not be among the wealthiest in our society.
The BOE also asked for corporate organization charts: we have seen a few of these over the years: we call them octopus charts because of how convoluted they are. All too often, remarkably enough, the land-use intensive, less profitable elements of the health system are held by the non-profit while the lucrative elements are held by for-profit affiliates or subsidiaries. Again, this is the sort of thing that has piqued the interest not only of the Board of Equalization but also of the U.S. Senate Finance Committee where under current chair Max Baucus (D-Montana) and former chair Chuck Grassley (R-Iowa) the committee has pressed the Internal Revenue Service to revise the reporting requirements for non-profit hospitals.
None of the data that the Board of Equalization required for its efforts is available from any other source: all of the financial reporting that is done to the Office of Statewide Health Planning and Development (OSHPD) is done on a facility basis while the BOE looks at taxable units. A hospital system can have 20 or 30 hospitals but it may have only two or three taxable units depending on its corporate structure (hence the need for the corporate organization chart).
In the relatively near future, we will have better information on whether “non-profit” hospitals are really non-profits—or whether they are behaving more like their for-profit counterparts.
The number of Americans paying more for health insurance policies that cover less has increased 60 percent since 2003, a troubling trend that is exacerbated by and contributing to the economic crisis according to a national report released today by Community Catalyst in collaboration with Health Access California and Consumers Union.
“When Coverage Fails: Causes and Remedies for Inadequate Health Insurance” can be found at www.communitycatalyst.org/assets/pdfs/WhenCoverageFails.pdf. It outlines the implications of a growing “underinsurance” problem and urges government leaders to act to ensure families who purchase insurance get the coverage they need.
At a press conference this morning, Assemblymember Dave Jones (D-Sacramento), Chairman of the Assembly Health Committee, said “Consumers should know that their health insurance coverage will be there for them when they need it. Increasingly expensive health insurance policies that don’t cover the basic needs of policyholders threaten the financial and physical well being of California families. The medical debt incurred by many who purchase these policies harms our already weakened economy. We need common-sense protections that limit the financial risk to families and give them the tools to make good decisions. My bill, AB786, would set standards so that consumers could make apples-to-apples comparisons and it would limit the sale of “junk” insurance."
Approximately 6 million Californians —one in five insured adults—are underinsured, a problem that is made worse by the down economy. Many insurance plans are marketed as financial protection in case of major medical needs, but have such extreme gaps in coverage that consumers are effectively paying to be uninsured. Some plans that are marketed as “catastrophic” coverage, but which only pay for care delivered on an inpatient basis, even though 80% of medical procedures, including surgery, chemotherapy and dialysis, are now done in outpatient settings. Other forms of "junk" insurance include plans that do not cover hospital care, or that cover only a tiny fraction of the cost of hospital care, which can easily run to $5,000 a day.
That is what happened to Laura Burwell, a small business owner in Chico, who spoke this morning. When Laura retired from her corporate job of 30 years and became part owner of a small wine shop, she purchased health coverage through a broker, who promised that her new coverage was comparable to the comprehensive plan she had had through her employer. In 2008, Laura was bitten on the finger by a rattlesnake while weeding in her backyard, and spent twenty-nine hours in the local Intensive Care Unit. Her bill came to for over $73,000. Her insurance covered just $3,000 of that bill, leaving Laura in significant debt.
Most people who are underinsured don’t know they’re underinsured until they’re in debt, said Laurie Sobel, Senior Attorney for Consumers Union, the publisher of Consumer Reports magazine. “Many people who think they have adequate health insurance actually have coverage so riddled with loopholes, limits, exclusions, and gotchas that it won’t come close to covering their expenses if they fall seriously ill,” Sobel said. The May 2009 issue of Consumer Reports includes an investigation into junk insurance, and identifies seven warning signs that a plan might be junk. “7 Signs a Health Plan Might Be Junk,” can be found at www.consumerreports.org/health
Small business owners face a high risk of being underinsured, said John Karatzas, California Project Director of Small Business Majority, which is supporting AB786. “Small business owners are the ones out there trying to buy coverage in the individual market,” said Karatzas. “They know how to crunch numbers better than most, and even they can’t figure out what their options are, because different plans have different deductibles, co-pays, out-of-pocket maximums, benefits, and networks. AB786 is a commonsense reform that will help small business.”
Assemblyman Jones’s bill, AB 786, would:
· Require all health plans to be classified into five tiers. Consumers would be able to know if a certain plan is a top-tier comprehensive plan, or a bottom-tier “bare bones” plan, or something in between.
· Require insurers to offer one “benchmark” plan in each tier. Consumers would be able to make cross-insurer,apples-to-apples price comparisons with the confidence of knowing that benchmark plans in a given tier have similar cost-sharing and benefits. The benchmark plan would be the lowest-price plan in each tier.
· Weed out “junk” insurance. The bill would require all plans, including bare-bones plans, to at least cover doctors’ visits, hospital and preventive services; no more “hospital only” plans could be sold. The bill would also direct state regulators to set overall limits on out-of-pocket costs.
In addition to its work at the state level with AB786(Jones), Health Access California is working with the national Health Care for America Now! campaign for federal health reform that provides for quality and affordable coverage for all Americans. As several speakers said, individual consumers should not be left all alone at the mercy of the big insurance companies. Health reform needs to include strong oversight of the insurers to ensure basic standards of coverage.
KEY HEALTH MEASURES PASS ASSEMBLY HEALTH COMMITTEE * Young adults up to age 27 would qualify for coverage as dependents. * Agents would be required to disclose compensation from health insurers. * Private insurers would have to cover medical equipment such as wheelchairs, lifts. * Insurers would pay higher fines for rescinding coverage after clients’ medical bills arrive.
* ALERT: Letters of Support Due for Bills Next Week on Underinsurance, Overcharging
More Updates on the Health Access WeBlog: More on Prop 1A; Leveling the Playing Field for a Public Health Insurance Option; New Studies on How Many More Californians are Uninsured; The White House Forum on Health Reform; Health Wonk Review, Yogi Berra Edition; Gender Discrimination and Maternity Coverage Bills in Play; Healthy San Francisco Upheld!; The "Trigger" Cuts; Sen. Sanders Introduced Single-Payer; Semi-Annual Status Reports Suspended.
The Assembly Health Committee on Tuesday approved a number of key health consumer protections. The measures would expand guarantees of coverage to Californians who are underinsured, uninsured or, in some cases, just plain inadequately served by their health care providers.
One of the bills would sharply increase civil fines in response to the insurer practice of retroactively canceling policies after patients become sick and need expensive treatments. Another would address a vast, and quickly expanding, demographic of the uninsured--young adults transitioning between school and careers that offer financial stability and benefits.
Yet another would require insurance brokers and employees to reveal their financial interests–such as paid commissions – in selling certain health care policies. One measure would require private providers to cover more of the costs of doctor-ordered medical equipment, something Medicaid and MediCal already do.
The following looks at these bills, all sponsored or supported by Health Access California, in more detail:
DISCLOSURE OF AGENT COMMISSIONS
* AB1521 (Jones) would require health insurance agents and other sellers of health insurance to notify consumers of the commissions they receive when they sell a client on a certain insurer’s coverage plan. The bill would also impose a duty of “honesty, good faith and fair-dealing” on the brokers and employees, in addition to the requirement to reveal their financial interests.
Assemblyman Dave Jones (D) said this would provide the transparency that consumers need to better choose a health care plan. Jones pointed to other industries, such as real estate, where agents are required to reveal such detailed financial information as commissions and fees. Supporters included Health Access California, the sponsor, as well as the California Labor Federation and other consumer and labor organizations.
Beth Capell, of Health Access California, testified that some consumers have been sold health care plans that were not in their best interest, citing the case of a woman who wanted a comprehensive plan but was sold a plan that ultimately only covered $3,000 of her $73,000 medical bill. Greater transparency would help consumers avoid such traps, consumer advocates testified, as well as provide better understanding of where premium dollars go.
Speaking in opposition were independent brokers as well as health insurance plans, including Anthem Blue Cross, Association of California Life and Health Insurance Companies, California Association of Health Plans, California Insurance Wholesalers Association, Civil Justice Association of California, Health Net, Insurance Brokers and Agents of the West, and the National Association of Insurance and Financial Advisors of California. They questioned the need for such legislation, and that there was significant competition in the industry to keep costs down.
The bill got a party line vote, with ten Democrats in support and Republicans against, with Assemblymember Nava not present and Assemblymembers Hayashi and Hall not voting. The bill advances to the Assembly Insurance Committee.
RESCISSIONS
* AB730 (De La Torre) would increase from $118 to a maximum of $5,000 the civil penalty for rescinding, canceling or limiting coverage. In cases where it can be proven that the provider knew the act was illegal, but committed it anyway, the fine could rise to up to $10,000. The bill will now advance to the Assembly Judiciary Committee. According to Assemblyman Hector De La Torre, AB730 is needed because some insurance companies consider the current fines, levied by the California Department of Insurance, an affordable cost of doing business compared to paying for expensive medical care should a policy-holder need it.
Supporters included the California Department of Insurance, AIDS Healthcare Foundation, California Association of Marriage and Family Therapists, California Medical Association, California Psychological Association, Professional Fiduciary Association, and Health Access California.
DEPENDENT COVERAGE
* AB29 (Price) raises the age limit for dependent coverage to 26, rather than 19, the current limit for a young adult not enrolled in school. (Presently, for college students, dependent coverage may continue until age 22). The bill intends to help cover the gap in health care coverage that occurs after a young adult leaves home, but before he or she is settled into a career that allows enough stability and financial security to provide and afford health care coverage. Currently, young adults are the fastest growing large demographic segment that is uninsured or underinsured. The subscribers electing to extend this coverage to their dependents would continue to pay the premiums. The bill moves on to the Assembly Appropriations Committee.
Supporters included the American College of Obstetricians and Gynecologists, American Federation of State, County and Municipal Employees, AFL-CIO, California Commission on the Status of Women, California Medical Association, California Public Interest Research Group, and Health Access California.
Opposition came from the insurance industry, including Anthem Blue Cross, Association of California Life and Health Insurance Companies, California Association of Health Plans, Health Net, as well as the California Chamber of Commerce.
DURABLE MEDICAL EQUIPMENT
* AB214 (Chesbro) would require health plans to cover physician-ordered durable medical equipment such as wheelchairs, canes, support lifts, oxygen tanks and more, at the same level the private providers would cover medical services. Currently, such equipment is covered through Medicare and MediCal but most private plans provide no more than $2,000 toward the cost of these items, or explicitly exclude coverage altogether. Assemblyman Wes Chesbro (D) said this amounts to an unfair burden on patients and taxpayers, alike, with the public, budget-strapped sector bearing the ultimate costs of a patient’s inability to rely on DME to resume a productive life. Chesbro noted that the estimated cost to an individual to add such coverage to a health plan would be no more than $2.09. Industry opponents targeted this amount as too expensive. The measure advances to the Assembly Appropriations Committee.
Supporters included Disability Rights California (sponsor), Disability Rights Education and Defense Fund (sponsor), National Multiple Sclerosis Society – California Action Network (sponsor), AFL-CIO, and many other groups.
Opposition came from Anthem Blue Cross, Association of California Life and Health Insurance Companies, California Association of Health Plans, California Chamber of Commerce, Health Net, and others.
ALERT: Next week, the Assembly Health Committee will consider two crucial consumer protection bills sponsored by Health Access California. SUPPORT LETTERS ARE DUE TODAY, WEDNESDAY, FOR: * AB786(Jones) to set standards for coverage, allowing for apple-to-apples comparison shopping and limiting "junk" insurance. * AB1503(Lieu) to prevent overcharging of the uninsured and underinsured by emergency room physicians.
To have your organization included in the committee analysis, please get your organizational letters of support faxed by the end of the day Wednesday to the Assembly Health Committee, chaired by Assemblymember Dave Jones, State Capitol, Room 6005, Sacramento, CA 95814. The fax is: 916-319-2197.
Bills need to pass policy committees by April 30. Health Access will continue to provide updates on actions taken in the Legislature. For a broader list of interest to health advocates and Health Access California , check out the bill list on our website.
We'll soon post an update from the Assembly Health Committee hearing earlier today.
Tomorrow, we'll have Senate Health Committee, which will consider SB810(Leno), the single-payer universal health care bill. A bill to get some attention is SB341, a bill to provide doctors better information on the effectiveness of prescription drugs. It's sponsored by the California Alliance for Retired Americans, but opposed by some of the prescription drug industry.
We'll also be putting out a new report on underinsurance, but more about that later. Stay tuned...
“Prop 1A won’t be able to do what its supporters claim,” added Marty Hittleman, President of the California Federation of Teachers in the press statement. “This constitutional amendment, supported by the Governor and legislators was developed with no public scrutiny and won’t stop the budget chaos. Once voters read this proposal with their own eyes, they will see that it is flawed and overly complicated, and will give extraordinary new and unrestricted power to the governor and his political appointees, with no checks and balances.”
For a fuller discussion of the problems of Proposition 1A, you can read this transcript of a Los Angeles Times editorial board visit of Janis Hirohama of the League of Women Voters, Jean Ross of the California Budget Project, and myself. It's appropriately titled, "short-term revenue, long-term problems."
The National Coalition on Health Care is coming to town with a forum tomorrow, Tuesday, April 14, from 8:30 a.m. to 1:00 p.m., at the CALPERS building, Lincoln Plaza North, 400 Q Street, here in Sacramento. You can click here to register.
The National Coalition on Health Care is one of those nonpartisan coalitions that include business and labor, providers and patient advocates, and so the conversation should be interesting. There's some common goals and objectives, but we know there's real differences one you get into the details...
Speakers will include (in alphabetical order): · John Arensmeyer, Founder and CEO, Small Business Majority · Barbara Blake, State Secretary, United Nurses Associations of California · Denny Delk, Member of the National Board, American Federation of Television and Radio Artists · Ted Epperly, M.D., President, American Academy of Family Physicians · Stephenie Foster, Senior Vice President for Government Relations, American Legacy Foundation · Gregory A. Franklin, Assistant Executive Officer, Health Benefits Branch, California Public Employees' Retirement System · Mark Goldberg, Executive Vice President, National Coalition on Health Care · Leif Haase, Director, California Program, New America Foundation · Scott Hauge, President, Small Business California · Elizabeth Imholz, Special Projects Director, Consumers Union of U.S., Inc. · Edward Levine, M.D., Partner, McKinsey & Co., Global Healthcare Practice · Paul Markovich, Chief Operating Officer, Blue Shield of California · Joel E. Miller, Senior Vice President for Operations, National Coalition on Health Care · Kathy Rallings, Regional Uniserv Staff, California Teachers Association · Jim Schlotz, Regional Uniserv Staff, California Teachers Association · Herb Schultz, Senior Health Policy Advisor, Office of Governor Schwarzenegger · Richard Allen Williams, M.D., Clinical Professor of Medicine, UCLA School of Medicine, and President and CEO, The Minority Health Institute, Inc. · Anthony Wright, Executive Director, Health Access California · Lucien Wulsin, Jr., Executive Director, Insure the Uninsured Project
The other point of interest is the mix of national and state voices, so it should be interesting to hear the back-and-forth between the California experience and the conversation of the moment at the national level.
In a panel at ITUP earlier this year, the question was asked of a panel of stakeholder representatives what they thought of a public health coverage option. None of them, including those representing providers, labor, employers, insurers, and consumers, rejected it out-of-hand. Even the California Association of Health Plans acknowledged that had members that were public (largely county-run), and they, and others, said they would want such a public health insurance plan to be on a "level playing field" with the private coverage.
For skeptics, it meant that the public health coverage plan should not have special advantages in competiting with private plans. For proponents of a public health insurance option, like myself, we sought a "level playing field" to ensure that private insurers should have to play by the same rules (not deny people for pre-existing conditions, maintain a similar minimum benefit standard, etc.), and not undermine the public plan. Yet both skeptics and proponents used the term "level playing field."
This week, UC-Berkeley Professor Jacob Hacker put out a new report called "Healthy Competition", sponsored by the Institute for America's Future. He lays out how a public health insurance option could compete fairly with private insurance, still achieve the benefits that proponents seek: to drive down costs, increase quality, and give all Americans a real choice in their health care.
For public plan choice to provide such guarantees, however, the public plan must be properly structured, compete on a truly “level playing field” with private plans, and have the authority to use its bargaining power as one of many tools to encourage greater value in health care delivery. The most effective and easily implemented model for the new public plan is a “Medicare-like” plan that builds on Medicare’s administrative infrastructure and basic framework of coverage but is separate from Medicare’s risk pool and departs from Medicare in a number of key respects regarding payment and benefits.
To create a level playing field requires attention to the “three R’s” of workable public-private competition: rules that are the same for both the public plan and private plans, risk adjustment that protects plans from being competitively is advantaged if they enroll a less healthy group of people, and regional pricing that allows private plans and the public plan to compete within regions on the same terms, rather than having the public plan compete on a national basis with regionally based private plans (whose premiums may be lower or higher in any given region).
Finally, giving the public plan the authority to bargain for reasonable rates is an essential item on the menu of cost control—and one that the Congressional Budget Office (CBO) and other budget watchdogs are likely to “score” as producing savings (in contrast with many other currently favored cost-control strategies). Nonetheless, there are reasonable concerns about how the new public plan will use its bargaining power—concerns reflected in current proposals for a price-taking (rather than price-making) public plan that would have limited ability to secure fair rates.
As my colleagues at Health Care for America Now indicate, these rules, while leveling the playing field, would still result in the immense savings and the true choice that Americans need.
Hacker also emphasizes a point he, and other public plan advocates, have made before: That a public plan is an essential backstop to private plans, since–even with the best regulations–some private insurers might find ways to avoid covering sick people or addressing their needs properly. In other words, a public plan is essential to make sure private plans don’t keep conducting business the way many of them do now.
But it is on cost control where, Hacker says, the advantages of a public plan are most apparent. It’s not just that public insurance plans operate with lower administrative costs. It’s also that public plans have more bargaining leverage–and, to some extent, are more willing to use their bargaining leverage–than private insurers. A recent report from the Lewin Group backs up this claim: It found that a public plan, using government bargaining power, could reduce premiums dramatically–by around 30 percent.
The White House Health Reform road show is over, after playing in several smaller venues (Iowa, Vermont, North Carolina) before ending with a big-city blowout in Los Angeles.
Reactions have ranged: Some were disappointed that there wasn't much focus on specific solutions to the health care problems mentioned. Particular policies, from subsidies to single-payer, even the Obama plan was not really discussed.
The problems listed were many: Avonnet Peeler, who we connected with the event planners, told the first and very poignant story of her husband. They had missed an insurance payment, and he had been denied due to a "pre-existing condition" when trying to get back on. When leukemia treatments blew through his capped coverage, he had bills in excess of $800,000. When she tried to fall into our Medi-Cal program, the eligibility restrictions were so tight as to deny her because of her 25-year old car.
While many commentators referred to her heart-wrenching story, we didn't get to policy solutions to the situation she decribed. A few did mention requiring insurers to take all comers, including those at risk of "pre-existing conditions." But no one mentioned setting a standard for coverage that doesn't allow people such significant medical debt. And no one mentioned the needed reforms and expansions of our existing public coverage safety-net, from removing the asset test to simplifying the application process.
Melody Barnes, the domestic policy advisor to President Obama, made a point that we may have only 100 days, in order to get health reform done this year. So we better get started getting into the tough specifics. Congressional roundtables and hearings are underway, and that's where the real action is--on Capitol Hill.
But ultimately it is important and good to put a spotlight on the health reform issue, and to have leaders--elected, appointed, and those of key stakeholders--publicly state their commitment to health reform, and to the urgency of doing it this year. But now the work begins, on the policy and the organzing front to make President Obama's goals a reality.
There will be a lot of deja vu tomorrow. In 2006, Governor Schwarzenegger hosted a health care summit also with Dr. Oz moderating, with many of the same participants. In that summit, the Governor promised that next year would the "year of health reform." I remember having the shortest quote in the Los Angeles Times the next day, calling the event "surreal." We'll see what the impression is this year.
This is expected to be a different event, with much more participation by "real people" with stories of their experiences in the health care system. Back in 2006, nobody knew what Governor Schwarzenegger was thinking with regard to health reform. This year, President Obama comes with a clear commitment and principles, and a plan he actively promoted during the campaign.
Health Care for America Now! will be leafletting the Los Angeles, Oakland, and San Diego cites in support of the Obama principles, urging participants to take the next step and call Congress, both on the urgency of reform, to pass something this year, but also on the principles, on everything from ensuring affordability to providing a public health insurance option.
Two California-specific reports came out this week on the uninsured, as noted by the Sacramento Bee and other papers, and they are sobering.
Families USA came out with a California-specific report, Americans at Risk, that showed a new light to the regular uninsured numbers. It's commonly understood that the number of uninsured is in the 5-7 million range in California, 44-46 million nationally. But those numbers seem to imply that the uninsured are a self-contained, even if large, population--rather than the reality than being uninsured is a condition that anybody can fall into.
In fact, Californians are more likely to become uninsured than residents of all but a few other states. The studies looks at the uninsured over two years, and finds that over 12 million Californians, or 37% of Californians under 65, have been uninsured at some point in 2007-08. More about the research is reported by the Los Angeles Times, as well as publicradio.
Even more distressing is that the researchers projected what would happen to health coverage rates as the economy recovers, and they found that even when the economy recovers from the recession, the number of people who are uninsured will continue to grow.
Certainly a compelling context for the Forum on Health Reform Monday, in Los Angeles, which is ground zero for the uninsured crisis nationally.
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.
