This week will start with the federal health reform debate going to another level, as Senator Ted Kennedy introduces his bill for health reform in the U.S. Senate Committee on Health Education Labor and Pensions. It's only the first, not the last, word in the debate: Senator Baucus' Finance Committee will likely have a bill, as will their counterparts in the House of Representatives.
Also in the Kennedy clan, Governor Schwarzenegger will go in a completely different direction, presenting a speech on Tuesday about the budget--and likely defending his cuts-only budget that would lead to over 2 million more uninsured and other devastation.
The Budget Conference Committee will take up the health cuts for discussion (and possible vote) on Friday, June 5th.
We'll also have coverage through the week of the legislative session, as bills are up for final floor votes before the end-of-week deadline.
Other items of note:
* According to the New York Times, hospitals are starting to mobilize against any "charity care" provisions in health reform, the notion that in return for nonprofit, tax-exempt status, hospitals have special obligations to serve the uninsured.
* I am having a back-and-forth at KQED's Healthy Ideas forum that gets ideological quickly, rather than focusing on how we can secure and expand coverage to people, and in an efficient way.
* Back in print media, we have a new op-ed in Capitol Weekly, suggesting the disconnect between the Governor's previous support for health reform, and his current budget stance.
In yet another example of how different people view the budget problems and the budget solutions in Sacramento, Governor Schwarzenegger's Director of Finance Mike Genest defended how so many of the budget solutions are falling on the poor and most vulnerable in California with this statement:
“If you look at what the government does, the government doesn’t provide services to rich people. We don’t provide many services even to the middle class. . ."
Wait a minute. To be fair, I think I know what he's trying to say, given the question, but it came out so garbled as to be counterfactual--especially if Californians need to understand the nature of these cuts.
Let's just be clear: State government provides services to all Californians. The big categories are education, health + human services, and then public safety--essential services for people of every region, income, class, and ideology.
More than half of the state budget is education, both K-12 and higher education. Most children are impacted by these cuts. There's a lot of students who go to public schools or the University of California.
The next biggest item is healthcare. The big item is Medi-Cal, which is provides health coverage to 6.8 million mostly low-income children, parents, seniors and people with disabilities. But in covering 1 of 5 Californians, many middle-income families benefit, since it covers their grandparents. Medi-Cal is such a major funding source for the health system on which we all rely--and sut to Medi-Cal really do impact all of us.
According to the California Health Care Foundation, Medi-Cal: "Is the nation’s largest Medicaid program in terms of the number of people it serves, 6.6 million, and is the second largest in terms of dollars spent, $40 billion.
"Is the source of health coverage for: • Almost one in five of Californians under age 65; • One in three of the state’s children; and • The majority of people living with AIDS.
"Pays for: • Forty-six percent of all births in the state; • Two-thirds of all nursing home residents; and • Almost two-thirds of all net patient revenue in California’s public hospitals.
"Brings in more than $20 billion in federal funds to California’s health care providers."
Given that we go to the same hospitals and providers, there's no way that you make the proposed cuts to health care, and patients throughout the state won't be impacted--through reduced services, reduced quality, increased waiting times, and more crowded emergency rooms.
With health care and other "safety net" services we should remember that these services are there in part for middle-class families--as a safety-net--when times get tough. When a family member loses a job, gets a divorce, or comes down with a medical emergency, these services help provide health coverage, take care of child or an elderly parent, or help pay the college tuition. They can help take care of a family member with a disability.
There's been a lot of focus on the closure of state parks, and other cuts that visibly impacct everybody. But when we talk about the big items that state government funds--education, health care, and public safety--we all are impaccted, even if it isn't as visible.
It's a fundamental misinterpretation to talk about even about the social services that are focused on low-income families as something that is a cut to "them." These services are ultimately insurance for "us." They help "middle-class" folks during life-changing moments. And they help people who happen to be low-income as a given moment to become "middle-class."
Maybe this mentality--that it's really just "those" poor people being impacted--is why the Administration is so comfortable choosing to announce these cuts, rather than to support revenues, and so what it takes to get the votes, to avoid these cuts.
These cuts are the Governor's choices and priorities. I don't think they are those of Californians.
When the LAO suggested that the deficit was $3 billion more than the eye-popping $21 billion, the logical response was to finally put away the "no new taxes" rhetoric and indicate it was time to start looking at revenue increases.
The new cuts include the elimination of adult day care, a significant cut in the Californians who get IHSS home care, a 5% reduction in salary for all state employees, and $68 million additional dollars found when completely eliminating the Healthy Families program.
In tight-fisted Legislature, some wins, some losses...
Thursday, May 28, 2009
AB786 Moves To The Floor: A bill making it easier for consumers to comparison shop for individual health insurance policies passed through the Assembly Appropriations Committee on Thursday, on a straight party line vote.
Democrats favored the development of an apples-to-apples approach to buying and selling insurance because it would help eliminate “junk insurance,” policies that at first may seem legitimate, but which offer very little coverage when medical claims are filed.
Republicans, on the other hand, voted against AB 786 (Jones), which specifically requires California regulators to come up with standard categories under which consumers could compare various features that various insurance companies sell – with transparency.
The bill, authored by Assembly Health Committee Chairman Dave Jones (D) and sponsored by Health Access California, is especially important in California, where there is a high number of small business owners and entrepreneurs who must shop for their own health insurance, rather than obtaining it from an employer.
The bill will now advance to the full Assembly for a floor vote next week....
More Appropriations Reports: Only half of the 450 bills heard by the Assembly Appropriations Committee survived the legislative panel’s especially close scrutiny of potential costs to the state. Committee Chair Kevin de Leon somberly opened the hearing by noting that California is at a perilous crossroads of having to cut costs and possibly programs to backfill an estimated budget deficit of about $24 billion. Many of Governor Arnold Schwarzenegger’s proposed cuts so far have targeted public programs such as Medi-Cal and Healthy Families, threatening to leave as many as 2 million people without any health care coverage.
Assemblyman Jim Nielson, vice chair of Assembly Appropriations, was succinct in his opening comments: “For the next couple of years, we urge all interests to exercise restraint in coming to the Legislature for (program funding.) To everyone who has ideas that cost money, we urge you to just say “no.’”
Outcomes were mixed for other important health care legislation that Health Access is tracking through the Legislature:
AB 2(De La Torre) would prohibit the cancellation or rescission of individual health care coverage when time comes to pay the medical bills. It passed on a party line vote and will now go to the full Assembly.
AB 244 (Beall) would require health plans and insurers to cover mental health and substance abuse to the same extent they cover other health conditions, creating parity. The measure advanced to the full Assembly.
AB 542 (Feuer) would withhold payment for “never events,” shorthand for neglectful medical care and mistakes that never should happen to anyone under medical care. It passed on a party line vote, advancing to the Assembly floor.
SB 227 (Alquist), which requires insurers to accept members of a high-risk pool of health consumers, passed out of the Senate Appropriations Committee and goes next to the full Senate.
Some measures that were held in Appropriations include:
AB 1314 (Jones) and SB 56 (Alquist), bills that were vehicles for continuing conversations on comprehensive health reform, were held in Appropriations committees in both houses.
AB 29 (Price), which would have extended to 27 the age that children can be considered dependents for purposes of health coverage, was held in Appropriations Committee.
AB 214 (Chesbro) would have required group health plans and insurers to cover durable medical equipment at parity with other health benefits. It was held in Appropriations.
SB 810 (Leno), which would establish a single-payer health care system for California, was held by the Senate Appropriations Committee, Senator Mark Leno (D) said he would bring it up again next year.
SB 341 (DeSaulnier) sought to have University of California experts evaluate scientific studies on the safety and effectiveness of pharmaceuticals - and their possible adverse reactions. The information would then have been publicized on a website. It was held in the Senate Appropriations Committee.
Those measures held in Appropriations could be available for passage in January 2010.
Earlier today, the Assembly passes two Health Access California sponsored bills, which now head toward the Senate.
AB1503 (Lieu) would prevent uninsured self-pay patients from being overcharged by emergency room physicians, which often charge 3-4 times what insurance companies pay for exactly the same services. This bill follow up from a 2006 law that prohibits hospital overcharging of the uninsured. The bill got broad bipartisan support, with 52 votes from both Democrats and Republicans, and zero "no" votes.
AB1521 (Jones) provides for better disclosure by insurance brokers when selling health coverage plans. It got 42 votes from Democrats, 23 votes from Republicans, with 15 members not voting or not on the floor during the unofficial tally.
We look forward to their hearing at the Senate Health Committee in the next few weeks.
To hear the impassioned pleas of dozens of health care advocates testifying before the budget conference committee Wednesday, you had to wonder what in the world the governor was thinking when he drew up his slash-and-burn proposed budget cuts.
Surely, he can’t be serious.
Does Arnold Schwarzenegger really want to be remembered as the governor who denied health care to as many as 2 million Californians in need during the worst economic plunge in modern times?
If so, he got a boost from the public on Wednesday, as the diagnosed, the disabled, the wheelchair-bound, and the newly unemployed joined health-care professionals, advocates, county officials and other consumers in warning of the dire consequences of the governor’s proposals.
With an overflowing crowd waiting for an unprecedented chance to offer their 90 seconds of testimony to a budget committee that’s usually closed to public comment, Assemblywoman Noreen Evans (D), the committee’s chair, put matters in perspective:
“This crisis is of historic magnitude,” Evans announced. “We are not just focused on the crisis of the moment. The people of California have said fix this thing in a lasting, constructive way -- and we want your ideas.”
She did get some ideas (cut administrative overhead, for one; trim prison spending, for another), some solid reasoning and plenty of emotion during the hours of public comment to follow:
Many expressed dismay that California would be content to lag so far behind the rest of the nation in providing health care for children through the Healthy Families program. Schwarzenegger proposes eliminating the program, even though it is funded by $2 of federal money for every $1 California spends….
…which was one reason (but not the only one) that led so many speakers to use the axiom “penny wise, but pound foolish” as did mental health advocate Rusty Selix in reacting to the proposed severe cuts.
Others said Healthy Families and Medi-Cal – also on the governor’s chopping block – are the programs that keep low-income families from financial ruin in case of a medical emergency.
Several pointed out that some cuts in medication can result in people cycling in and out of jail or prison, a much more expensive option than providing care.
Health Access’ Beth Capell told legislators that “the cuts that are proposed are the kind that turn recessions into great depressions.”
Capell and others suggested revisiting a tobacco tax; others suggested a dime-a-drink alcohol tax.
Spokesmen for Indian health programs noted that any reduction in health services will have long-lasting implications: “We are making decisions that might save us money today, but will hurt us later -- and may lead to loss of life."
Many noted that people will end up in the emergency room, further straining hospitals hit hard by the down economy, and costing more in the long-run.
SEIU's Mary Hernandez was blunt: “The idea of adding 2 million people to the uninsured is unimaginable.”
One spokesman opposing the elimination of health services for new legal immigrants declared: “What we are looking at is an absolute evisceration of our safety net services.”
Perhaps no one was more moving, however, than the young woman who was diagnosed with HIV at age 6, having contracted it at birth. She was recently laid off. “I get $57 a week in unemployment. Without these programs, I can’t afford the medications that keep me from getting AIDS.” She began to sob. “I want to live this life. Please don’t allow these cuts to take place. You’ll cut my life.”
We wonder if this is what Schwarzenegger had in mind when he said he wants California to have a “robust debate” about its budgetary process.
California's single-payer universal health care legislation, SB810, will be a two-year bill, and will be parked at the Senate Appropriations Committee for the remainder of this year. The bill will be picked up again next year in 2010, the second year of the 2009-10 two-year legislative session. Senator Mark Leno issued a statement today on the subject:
Today, in response to California’s ongoing and unprecedented budget crisis, the Senate Appropriations Committee was forced to hold a large majority of the bills on its suspense calendar. SB 810, our bill to establish single payer universal health care in California, was not an exception.
Faced with the loss of 25% of our General Fund revenues, the legislature must direct its undivided attention toward avoiding the gruesome cuts proposed by the Governor, which would fundamentally dismantle our most basic health, social, and educational infrastructures.
Let me be clear in saying that SB 810 is alive and well in the Senate Appropriations Committee, and the next opportunity to move the bill will be in January, 2010. This does not represent a change to our overall strategy for SB 810 to be a 2-year bill, nor does it affect or prevent us from doing the important work we already are doing to advocate and educate the public about the importance of single payer in our communities and in the legislature.
Even if SB810 advanced this year, Governor Schwarzenegger has vowed to veto it again, as he has two times before. In addition, the financing for the proposal would need a two-thirds vote of the legislature. So rather than rush the bill to the Governor for a near-certain veto, it makes sense to hold the bill, and continue to organize and educate around the benefits and provisions of a single-payer health system, and to use the bill to positively influence the broader debate on health reform in the state and nationally. We'll keep you posted...
Our newly redesigned, newly renamed Health Access Blog, newly relocated at http://blog.health-access.org/, will continue to be a central place for quick updates about the health care budget cuts.
But there's some other new resources for good information about the budget. The most notable is the blog by Budget Conference Committee Chair Noreen Evans, Assemblywoman from Napa Valley, who has taken a leadership role in highlighting the tragic choices presented by the Governor's budget--a role that we hope the legislative leaders would take up.
She even presented this Internet video, that explodes several myths about the budgeting process. She explains how the majority of our increased spending is simply taking into account population and inflation, that our structural deficit is caused more by tax cuts rather than increase program spending, and how much of the state budget is restricted due to voter initiatives.
And finally, don't forget California Budget Bites, by the team led by Jean Ross at the California Budget Project. Many other media and political sites will cover the budget, the big story in Sacramento this year, but these blogs, along with us here at Health Access, will confront the devils that are in the details.
GOVERNOR PROPOSES ADDITIONAL CUTS TO HEALTH & HUMAN SERVICES * Governor Seeks Elimination of Healthy Families, CalWORKS, Various Clinic Programs * Medi-Cal Cut To Be Negotiated with Federal Govt Goes From $750 Million to $1 Billion; * Cuts Would Deny Coverage for Dialysis, Cancer Treatment, HIV Testing, Mental Health, Etc. * Cuts Would Harm Health System & Economy; Hundreds of Millions in Lost Federal Funds * Governor Rejects The Long-Term Revenues Needed to Prevent Devastating Cuts
More Updates on the NEWLY REDESIGNED Health Access Blog: Listening to the Electorate; The Results of a Cuts-Only Budget; Eliminating Healthy Families?; Without Reform, It's Getting Worse; Fighting Against So-Called "Flexibility"; The Budget Conference Committee; The Day After the Election; Getting to Universal Coverage
Today, Governor Arnold Schwarzenegger released details of new, additional cuts totaling over $5.5 billion to the state budget, on top of what he proposed a few weeks ago. And because of the continued deterioration in the economy, the Administration has promised to release by Friday another $3 billion in cuts to be considered on top of that.
On May 14th, he had proposed a variety of "budget solutions"--including many cuts and no revenues--to address a $21.3 billion deficit in the 2009-10 budget year, with some cuts contigent on the failure of Propositions 1C, 1D & 1E. Last week, he announced he was abandoning a plan to borrow over $5 billion dollars, and instead simply proposing to make additional cuts. Today's list of cuts detailed those cuts, which include the wholesale elimination of Healthy Families, CalWORKS, CalGrants, CFAP/CAFI, Cand other programs and services.
The economic crisis has caused the budget agreed to by the Governor and legislative leaders to fall out of balance by a projected $3 billion additional dollars. Yet the Governor has yet to budge from his cuts-only approach to the budget, and has indicated he will seek even more cuts.
BUDGET CONFERENCE COMMITTEE HEARING TOMORROW: Tomorrow, Wednesday, May 27th, the Budget Conference Committee, chaired by Assemblywomen Noreen Evans, will take public testimony on the cuts to health and human services, starting at 9:00am in Room 4203 of the State Capitol. This may be the only public hearing that will allow testimony on these cuts. The agenda is as follows:
9:00 – 10:30 Medi-Cal and Healthy Families Program Issues 10:30 – 11:30 Public Health, Drug Medi-Cal, Prop 36, & Emergency Medical Services Noon – 1:30 Developmental Services 1:30 – 3:00 In-Home Supportive Services 3:00 – 4:00 CalWORKs, SSI/ SSP , CFAP/CAPI 4:00 – 5:00 Child Welfare Services, Foster Care
COMMITTEE DISCUSSION ON NEW CUTS: The Budget Conference Committee heard the outlines of the new cuts today, which sparked some limited discussion, and calls from legislators for more analysis about the budget, financial, and economic, as well as health, impacts of these cuts.
Some members, like Senator Denise Ducheny, asked whether some of these cuts would not create more costs, as people end up in emergency rooms or elsewhere, even within the budget year. "What makes you think this doesn't create a cost shift?... Will people just die and we won't have to take care of them?" she asked.
Senator Mark Leno talked about how the AIDS Drug Assistance Program "literally keeps people alive," and asked for information about the increased cost of ermegency room visits as a result of the cut. Senator Alan Lowenthal asked if there was a "longitudinal" analysis, and asked for the "long-range implications" of these cuts.
Assemblywoman Noreen Evans was alarmed when she noted that dialysis would be cut for some patients, exclaiming that her father was going through such treatment, and was not optional. She also noted that some cuts, like the elimination of HIV Testing, would have public health impacts. Assemblyman Kevin DeLeon pointed out the cuts to community clinics, arguing that for many Californians, "this is the only safety-net they have."
THE NEWLY PROPOSED CUTS: The cuts detailed today include both increases in previously-announced cuts, and new services targeted for reductions or eliminations. They include:
* $302.3 million from the elimination of the Healthy Families program, denying coverage to over one million children. The Governor had previously proposed to limit eligibility to just twice the poverty level, to deny 225,000 children, but he has now expanded his proposal to include full elimination.
* $34.8 million in additional Medi-Cal cuts to eliminate certain "state-only" programs that don't get federal funds, thus denying coverage to specific populations for breast and cervical cancer treatment, postpartum care, dialysis, and non-digestive nutrition.
* $55.5 million in new cuts to the AIDS Drug Assistance Program (ADAP) to impose additional costs and restrict drug coverage for tens of thousands of Californians with AIDS. This proposal would also reduce or eliminate other Office of AIDS programs, including HIV Counseling and Testing, Epidemiologic Studies, Therapeutic Monitoring Program, and Home and Community Based Care.
* $34.2 million from the elimination of funds for various community clinic programs that provide preventative and primary care, including funding for Indian Health, Seasonal and Agricultural and Migratory Workers, Rural Health Services Development, and Expanded Access to Primary Care (EAPC).
* $20.2 million from the elimination of state funding for Maternal, Child, and Adolescent Health programs. This proposal goes beyond the significant cuts proposed on May 14th.
* $64 million in new cuts in Mental Health Managed Care Services. * $28 million in new cuts to Early and Periodic Screening, Diagnosis, and Treatment Services (EPSDT), eliminating general fund support for certain county programs.
PREVIOUSLY PROPOSED CUTS: These cuts are on top of the cuts the Governor announced May 14th. Those that are not mentioned above include:
* $132.2 million in reduced health benefits to those in CALPERS; * $125 million in reducing health services for legal immigrants; * $60 million out of Proposition 99 funded-programs, redirecting money from county health funds, clinics, the Breast Cancer Early Detection, Asthma, rural health, the Access for Infants and Mothers program which provides prenatal care, and the Major Risk Medical Insurance Program, which provides coverage for those denied for "pre-existing conditions." * $36.8 million by cutting rates for family planning services; * $25.5 million in reducing adult day health care benefits to three days a week; * $24.6 million to local health jurisdictions of HIV education and prevention; * $20 million by cutting payments to private hospitals, a 10% cut in general support; and * $8.8 million through a 10% rate reduction for certain substance abuse treatment services in Medi-Cal; * $2.9 million in suspending a comprehensive school-based prevention program on dental disease; and * $2.7 million by eliminating application assisters that help children & families enroll in coverage.
In Medi-Cal, there is also a new prescription drug purchasing effort to save $75 million, and a new anti-fraud initiative targeted at adult day health centers, pharmacy, doctors, durable medical equipment, and transportation, with the goal of saving $47.9 million.
There are other human services cuts as well, to IHSS home care, SSI/SSP for seniors, and also includes the elimination of CalWORKS, as well as the elimination of CAPI and CFAP for legal immigrants. Senator Ducheny began to total that the cuts seemed to negatively impact over two million California children.
The headlines say the Governor heard the voters "loud and clear." But what did he hear? It's hard to see the message that led to Governor's stubborn cuts-only approach and amazingly reckless proposals to wholesale eliminate Healthy Families, Cal Grants, CalWORKS, state funding for parks, and other key programs.
After all, the voters didn't just reject the propositions that would have made cuts to health and other vital services (Prop 1D for children's services, Prop 1E for mental health), but those initiatives got the lowest vote totals of any of the measures.
People voted against Proposition 1A for lots of reasons... while some voted against the spending cap, some voted against the taxes that were linked, and some voted against gimmicks and being asked to do the job of the Legislature, and against being offered such narrow options.
In the same poll by David Binder where voters reaffirm their opposition to Proposition 1A and the other measures on the ballot, they say they want to protect health and education and other key services, and they support a range of revenue options.
“The lesson coming away from this election is that Californians want real solutions that protect the services the state provides, and that Californians are willing to explore revenue options to pay for the services they want,” Binder said. “Voters are not against all tax increases; they did not oppose Prop. 1A because of taxes. They are looking for a balanced approach that shares the burden and moves the state forward.”
And again, let's remember that Prop 1A was a sequel to Proposition 76, the "Live Within Our Means" Act in 2005, that got 36% of the vote. Proposition 1A got a similarly bad vote. So it is ironic that the Governor uses the "live within our means" rhetoric to justify proposals to cut coverage for 2 million Californians.
The message was to tell the policymakers to get back to work, protect key priorities, and come up with a balanced solution to the budget. The Governor's proposal is completely contrary.
Nearly 2 Million Californians Could Lose Coverage Under Governor's Proposed Health Budget Cuts
* Governor Proposes Elimination of Healthy Families Program for Over 1 Million Children * Governor Also Seeks Federal Permission for $750 Million Cut to Medi-Cal Eligibility * Such Medi-Cal Eligibility Cuts Could Impact 975,000 Children, Parents, Aged, Disabled * Under Medi-Cal/SCHIP Cuts, California Would Lose Hundreds of Millions in Federal Funds * Many Other Health Cuts in Consideration
A new report by Health Access Foundation details how more than 2 million Californians could lose or be denied health care coverage under Governor Arnold Schwarzenegger’s latest budget proposal.
Because the Governor is focused on a cuts-only budget solution, 2 million Californians could lose coverage, and face severe health and financial impacts as a result. Advocates argue that cuts of this magnitude, and this substantial an increase in the uninsured, will have a dramatic impact on the health system we all rely on. If enacted, this would be the most profound rollback of health coverage in the history of the nation. The economic impacts would be significant as California will lose hundreds of millions of dollars in federal matching funds, for our health system, and our economy.
The Health Access report focused on two main proposals:
* The just-announced proposal to eliminate the Healthy Families program, which currently provides health coverage to 910,000 children and is projected to cover over 1 million children in the budget year. Though it would cut $387 million from general fund spending, it would lead to an outsized loss of at least $712 million in federal funds. California would be the only state in the nation not to cover these low-income children.
* A proposed $750 million cut in Medi-Cal eligibility and other reductions, which would mean a loss of $1.2 billion in federal matching funds, and a combined nearly $2 billion cut to our health system and economy. The Governor has proposed revisiting past efforts at cutting Medi-Cal that would deny coverage to 978,500 children, parents, seniors, and people with disabilities. Such cuts would endanger over $8 billion in money from the economic stimulus package, so Governor Schwarzenegger is seeking permission from the federal government to make these cuts. The previous proposals include:
* Denying low-income parents: Today, a family of three earning a Federal Poverty Level income of $18,310 could qualify for Medi-Cal. Under the governor’s proposal, eligibility would be limited to 72% of the federal poverty level – or a family of three that earns no more than $11,169. That change would lead to the loss of coverage for an estimated 433,600 working parents.
* Imposing paperwork burden so families fall off coverage: The governor proposes quadrupling bureaucratic paperwork a family must file each year to win eligibility for children’s’ coverage under Medi-Cal, figuring that the more forms there are to fill out, the less likely a family is to keep up with the burdensome paperwork. To get access to Medi-Cal, parents would have to submit forms every three months. This change would knock an estimated 471,500 children off public health insurance.
* Imposing significant costs on seniors and people with disabilities such as those enrolled in the Aged, Blind, and Disabled program, which would lead people to have to pay more for health coverage. This change would cause 73,364 people to lose no-cost coverage.
The Governor argues that additional cuts are the message from Tuesday's defeat of his package of ballot propositions. But the voters disputed this by giving the least support to his propositions to make cuts to mental health, children's care and other vital services. Health, consumer, and community organizations argue that given the size of the deficit, we need all options--including taxes and revenues--on the table to prevent the worst of these cuts.
Wow. Could California eliminate the Healthy Families program, and coverage for nearly 1 million children along with it? Could we be the only state in the nation that doesn't cover these low-income kids, and turns away significant federal money?
Governor Arnold Schwarzenegger today issued the following statement on his budget proposal: “Based upon information I gathered in meetings I held while in Washington D.C., discussions with the legislative leaders, and the will of the people who said loudly and clearly in Tuesday’s election that they want Sacramento to live within its means, yesterday I directed my Department of Finance to bring me additional options to cut state spending so that we can eliminate the need to seek borrowing in the form of a revenue anticipation warrant in the revised state budget I have proposed.”
But it was Ana Matosantos, deputy director of Finance, who revealed in testimony to the Budget Conference Committee today that the Governor was proposing stark cuts, including the full elimination of Healthy Familes, CALWORKS, Cal grants, and state support of parks.
The proposals are irrational, belligerent, and reckless. With the federal government paying two-thirds of the cost, Healthy Families provides one of the best bangs for the buck in all of state government. We would turn away two federal dollars for every dollar we cut. The proposal is not just beyond draconian, it's beyond belief--if the budget crisis were not so severe and the Governor were not so mercurial.
By suggesting this as part of a cuts-only budget approach, the Governor has betrayed every commitment he has made to children or to health care. The voters explicitly rejected additional cuts to children and health services on Tuesday--indeed, those propositions got the lowest vote totals of all the measures. The Governor should not take his anger out on the children of California.
On the eve of new unemployment figures to be released by California's Employment Development Department, a new Health Access study documents an increasing rate of uninsurance to accompany the growth in unemployment, with at least a half-million Californians losing health coverage in the last 18 months of recession.
A second, national study shows how current trends, especially the erosion of employer-based coverage, could leave millions more uninsured over the next 10 years. Under the best economic scenario, this could result in 53 million Americans becoming uninsured; under the worst scenario, 66 million could lose coverage.
Both studies document the very high cost of maintaining the status quo. The need for health investment and health reform is urgent, as California legislators begin to consider significant health care cuts, but also as key Congressional committees start to consider comprehensive health reform--reforms which could change these trends.
The new Health Access report, "Resuscitating an Ailing Economy: Investing in Health Care," finds:
* As a result of the economic recession, over 1 million Californians have become unemployed in the past 18 months. * As families lose jobs that provide coverage, over 500,000 Californians have become newly uninsured. * These numbers may increase when the Economic Development Department releases new information about the state's unemployment figure (now at 11.2%) on Friday, May 22nd. * The report suggests that investment in health coverage programs and health reform can prevent Californians from becoming uninsured, can help create jobs and spur economic growth -- as well as prevent negative health, economic and community impacts of increased uninsurance.
The new Robert Wood Johnson Foundation (RWJF) report, "Health Reform: The Cost of Failure," had researchers from the Urban Institute prepared the analysis using its Health Insurance Policy Simulation Model, estimating how coverage and cost trends would change between now and 2019. The study examined three alternative scenarios, including a "best case" and a "worst case" based on employment, income growth, and increase in health care costs. The report finds:
* Individuals and families would see health care costs dramatically increase. Total individual and family spending on premiums and out-of-pocket costs could increase 68 percent by 2019 in the worst-case scenario. Even under the best case scenario, health care costs would likely increase at least 46 percent. * Businesses could see their health care costs double within 10 years. The model shows that employer spending on premiums would more than double – from $429.8 billion in 2009 to $885.1 billion in 2019. Even under best-case economic conditions, employer spending on health insurance premiums would increase 72 percent. The result would likely be far fewer Americans being offered or accepting employer-sponsored health insurance (ESI). Estimates suggest a drop from 56.1 percent of Americans being covered by ESI in 2009, to as few as 49.2 percent by 2019. * Spending on government insurance programs could double. In the worst case scenario, spending on Medicaid and the Children’s Health Insurance Program could increase from $251.2 billion this year to $519.7 billion in 2019, as more people are priced out of private insurance and become eligible for government programs. Enrollment in these programs could increase to 20.3 percent in 2019 in the worst case, or one in every five Americans. That’s an increase of 13.3 million people from current figures. * Millions more people would be uninsured. The model projects that without reform, 65.7 million people could be uninsured by 2019, compared to 62.2 million in the intermediate case and 53.1 million under the best case. The report makes clear that the biggest effects of not having health reform would be felt by families with moderate incomes, who have less access to public coverage. Under the model, the number of middle-income earners without insurance would increase sharply from 12.5 million in 2009 to as many as 18.2 million in 2019.
"We need national health reform not just to prevent our broken health system from getting worse, but to allow for a sustainable economic recovery that is not burdened by increasing health care costs and rising numbers of uninsured." said Wright. "We need health reform that brings down the cost of health care, and provide coverage that Californians can count on when they need it."
For more information about the reports, the implications for proposed health care cuts in California, or for the debate in Washington, DC, on health care reform, contact Health Access, or visit our newly updated website and blog, updated daily, at http://www.health-access.org/.
Clearly, the centerpiece will be the $750 million cut to Medi-Cal requested as a "waiver" from federal requirements when California accepted the stimulus dollars.
We understand Governor Schwarzenegger was in Washington, DC, arguing for so-called "flexibility" to make $750 million in Medi-Cal cuts. Health Access and other organizations will be clear with the federal government and the California Congressional delegation that the Governor's request would deny coverage to hundreds of thousands of California children, parents, seniors, and people with disabilities. Such a change would remove the accountability Washington built into the economic stimulus package, and undermine the current effort for health care reform.
Making the eligibility cuts that the Governor has suggested would take an Act of Congress. The federal stimulus law clearly says that states will only get the increased Medicaid money if they make no changes to their “eligibility standards, methodologies, or procedures” as of July 1, 2008. That is why the Legislature had to reverse the September 2008 change requiring children to renew their Medi-Cal eligibility twice a year -- to avoid losing $8 billion dollars in federal matching dollars.
In the next few days, Health Access and other organizations will release more detailed information about the impacts of a $750 million Medi-Cal cut.
Back to work. The new, improved, and expanded Budget Conference Committee will be made up of five legislators from both the Assembly and Senate instead of the usual three.
They will include: * Assemblymember Noreen Evans (D-Santa Rosa) as Chair * Assemblymember Kevin de León (D-Los Angeles) * Assemblymember Bob Blumenfield (D-Woodland Hills) * Senator Denise Ducheny (D-San Diego) * Senator Bob Dutton (R-Rancho Cucamonga) * Senator Mark Leno (D-San Francisco) * Senator Alan Lowenthal (D-Long Beach) * Senator Mimi Walters (R-Laguna Hills)
The final two Assembly Republican appointments to the Conference Committee are still being finalized. A spot budget bill (SB 61) will move on Thursday morning (May 21) to establish the budget conference committee, which will be tasked with closing the $21 billion budget gap. It will begin with an overview of the budget from the Department of Finance and Legislative Analyst's Office. On Friday, the Conference Committee will hear testimony on the state's cash management issues.
Next week, May 25-28, the conference committee will use its meetings to get public testimony. Health issues are expected to be heard on Wednesday, May 27th.
Votes will start June 1st. The Legislature is aiming to have the conference committee finish its work by mid-June, and put out proposals to the floor to amend the 2009-10 budget package. The goal is to get those passed and in law prior to the start of the fiscal year (July 1).
Voters rejected locking flawed formulas into the state constitution, which would have limited the state's ability to invest in its future.
Looking forward, we need a budget that gets us out of our current mess, with the Legislature making the tough choices of persuing not just cuts but also revenues to prevent the worst of the cuts. We need to deal with the current budget crisis, rather than be distracted by constitutional amendments that further handcuff our ability to respond to our future needs.
There's a lot of spinning about the mandate with regard to cuts and taxes. If anything, voters sent a clear signal against more cuts. Voters opposed cuts to health and other vital services with their Prop 1D and 1E votes. Voters also opposed a spending cap for a second time in four years, defeating Prop 1A by a similar margin to Prop 76 in 2005. (For all the talk about the impact of the taxes linked to Prop 1A, voting tallies exceeded by only a couple of percentage points the results of the Prop 76 vote, which was just a spending cap.)
These are important points to remember as we begin budget talks tomorrow....
Regardless of what happens tomorrow, Tuesday, we are going right back into the budget process. According to Greg Lucas of California's Capitol and other sources, a Budget Conference Committee will begin meeting Thursday, May 21st, to deal with the $15-21 billion deficit. One hearing on May 22nd will be on cash management.
The Legislature will seek to amend the existing budget, approved in February, that technically goes through June 2010. The process won't go through budget subcommittees, but is expected to take public testimony next week in an expanded ten-member budget conference committee, with three Democrats and two Republicans from each house. They are expected to start voting on June 1st.
But this should not be a surprise. We have an "individual mandate" for drivers to have auto insurance, and yet have a noncompliance rate of around 15%--although it ranges depending on the state. For the most part, the issue isn't enforcement: my assumption--confirmed by survey research--is that the vast majority of people want health coverage-desperately; the question is will the reform remove the barriers and provide the assistance needed? Will the reform make coverage more available and affordable? Will it be easy to enroll--or even automatic?
So what the reform includes matters a lot in terms of how "universal" it is. Provided that affordability is assured, I don't think the mandate is as important as an automatic-enrollment mechanism, as with Medicare or on-the-job benefits.
These kinds of structural issues matter, I think, even more than Ezra's initial take that some of the remaining uninsured will be undocumented immigrants. According to UCLA research, undocumented are a small fraction--about one-fifth--of the uninsured. Around 75% of them are workers or family members of workers, more of whom may--and should--get coverage from their employer under a reformed health system. At the very least, we can all agree that if you work and pay your dues, you should get coverage. And Ezra points out why that's important, regardless of where you are in the immigration debate. But health reform is a much broader issue that affects everyone, insured and uninsured.
Our job as consumer advocates and organizers is to push for the policies to make coverage more available and affordable for all, and for the financing to make that a reality.
For those looking for Friday links, there's a new edition of Health Wonk Review, at Workers Comp Insider by Julie Ferguson. As the discussion on federal health reform heats up, this biweekly forum should get more interesting.
There's also the ongoing dialogue at KQED's Healthy Ideas, which has gone through a second round of comments about core health reform issues. We at Health Access are participants in both forums, with much of interest from other worthy contributors.
For those still wondering about those propositions in the May 19th election this coming Tuesday, there's a good, inteligent debate by good people on both sides, at the website for the California Center for Research on Women and Families (CCRWF). Our contibution isn't focused on May 19th--it is simply a broad update on legislation and budget issues regarding health care--but there's many contributions from people on boths sides of the propositions.
We've written elsewhere about our take on Proposition 1A, and I was taken by the assessment of Mark Paul of the New America Foundation, which includes the analysis that several services, including "higher education, health, social services, parks and the environment — will be ratcheted down over time. And major initiatives to address pressing state problems, such as the health care reform proposed in 2007 by Governor Schwarzenegger, will become simply impossible to enact." We agree with that assessment.
MAJOR HEALTH CUTS PROPOSED IN GOVERNOR'S BUDGET PROPOSALS
* Governor To Ask Federal Government for Permission for a $750 Million Medi-Cal Cut * Cuts Would Harm Health System & Economy; Hundreds of Millions in Lost Federal Funds * Governor Rejects Proposing Long-Term Revenues Needed to Prevent Devastating Cuts
More Updates on the NEWLY REDESIGNED Health Access Blog: More on the Bad Budget Day; Major Developments on Federal Health Reform; The Purple Bus Lady Rolls Through California; Coverage When It Counts; How to Finance Health Reform; President Obama's Health Reform Week; U.S. Senate Assignments; Lots of Links on Health Reform; A Saturday Morning in San Diego with Rep. Susan Davis; Taming "The Beast"; More on Spending Caps Across the Country
Today, Governor Arnold Schwarzenegger announced several proposal cuts to fill a $15.4-21.3 billion deficit in the 2009-10 budget year. The economic crisis has caused the budget agreed to by the Governor and legislative leaders to fall out of balance.
The Governor's "2009-10 May Revision General Fund Proposals," available at the Department of Finance website at http://www.dof.ca.gov/, includes a package of largely cuts to fill a $15.4 billion shortfall, and then additional “contingency proposals” if Propositions 1C (and to a lesser extent, 1D & 1E) fail on the May 19th ballot next week.
"To look for new revenues is out of the question," said the Governor at his press conference. His package includes cuts, borrowing, selling state-owned properties, eliminating some state agencies and boards, accelerating revenues, shifting funds and laying off 5,000 state employees.
SPECIFIC HEALTH CUTS: There are nearly $2 billion in additional cuts to health and human services. If Propositions 1C (as well as 1D and 1E) are rejected, there is an additional $600 million cuts in health and human services.
* The biggest health cut is a $750 million cut to Medi-Cal, contigent on negotiating a waiver from the federal government. The Schwarzenegger Administration wants to revisit rollbacks in eligibility that are now restricted by the federal government in order for California to accept billions in federal stimulus dollars. Those rollbacks were not explicitly specified in the Governor's summary, but have included in the past: * the denial of Medi-Cal coverage to hundreds of thousands low-income parents under the poverty level (a range from around $13-$18,000/year for a family of three); and * the imposition of quarterly status reports on children, with the savings coming from over 250,000 children dropping coverage as a result. * Since these previous proposals do not add up to $750 million in savings, even after full implementation over several years, other cuts and savings would have to be found as well to meet this goal.
* Other specific health cuts include: * $132.2 million in reduced health benefits to those in CALPERS; * $125 million in reducing health services for legal immigrants; * $36.8 million by cutting rates for family planning services; * $20 million by cutting payments to private hospitals, a 10% cut in general support; and * $2.7 million by eliminating certified application assisters that help children & families enroll in coverage
In Medi-Cal, there is also a new prescription drug purchasing effort to save $75 million, and a new anti-fraud initiative targeted at adult day health centers, pharmacy, doctors, durable medical equipment, and transportation, with the goal of saving $47.9 million.
There are other human services cuts as well, to IHSS home care, SSI/SSP for seniors, CALWORKS for low-income families, and also includes the elimination of CAPI and CFAP for legal immigrants.
* If Proposition 1C fails, the projected budget deficit grows by $5 billion. If Proposition 1D & 1E fail, the deficit grows by nearly $1 billion. In those circumstances, the Governor's "contingency budget" includes: * $54.4 million in eliminating Healthy Families coverage for over 225,000 children (who are betweeen 2005-250% of the federal poverty level, or between $36,000-$45,000 for a family of three) * $60 million out of Proposition 99 funded-programs, redirecting money from county health funds, clinics, the Breast Cancer Early Detection, Asthma, rural health, the Access for Infants and Mothers program which provides prenatal care, and the Major Risk Medical Insurance Program, which provides coverage for those denied for "pre-existing conditions." * $25.5 million in reducing adult day health care benefits to three days a week; * $24.6 million to local health jurisdictions of HIV education and prevention; * $10 million cut in maternal, child and adolescent health grants; * $8.8 million through a 10% rate reduction for certain substance abuse treatment services in Medi-Cal; and * $2.9 million in suspending a comprehensive school-based prevention program on dental disease.
THE POLITICS OF THE PROPOSITIONS: The Governor used his press announcement to argue for the package of proposition on the May 19th ballot next week. His document says the budget depends on the passage of 1A, 1B, 1C, 1D, and 1E, even though Propositions 1A and 1B do not have an impact on this or next year's budget. Proposition 1C, which would provide a cash advance from lottery proceeds, is the ballot measure that would make the major difference.
Some health advocates, including Health Access California, argue that Prop 1A, even though it would bring in revenues in 2011-12, includes a constitutional spending cap that would make it harder to ever restore these cuts, even when the economy improves and the state has more revenue.
Regardless of what happens with the fate of the propositions, there is an ugly budget with awful choices on cuts and/or taxes this year, and there continues to be a long-term mismatch between the revenues the state brings in, and the education, health and other vital services that Californians expect and deserve.
The work of consumer and health advocates is to continue to demonstrate the impact of these proposed cuts, not just to directly impacted Californians who will lose their coverage or care, but to the health system and economy as a whole, and all Californians as a result.
We'll have posts later today about the health impact of the budget, and will be also do what we can on Twitter, at @healthaccess, or www.twitter.com/healthaccess.
There are no good choices in this budget, but that doesn't mean that some options are not worse than others--and additional cuts are absolutely worse. Additional proposed cuts to health care will have devastating impacts not just on patients directly affected, but also the health system we all rely on.
As Matthew Yi indicates in the San Francisco Chronicle today, some cuts would force us to lose billions in federal stimulus dollars, but even for every dollar we cut from health programs like Medi-Cal and Healthy Families, we are turning away even more dollars from the federal government at a time when our health system and economy needs them most.
After cutting $19 billion in the past couple of years, California has cut $15 billion just in February. We simply need additional taxes and revenue to prevent cuts of unimaginable impact.
The Governor is expected to use these number to promote the propositions, but really only Proposition 1C has a major impact on this year's deficit. In fact, Proposition 1A doesn't take effect for two years and won't make a dime's worth of difference on this or next year's budget.
The Governor highlighting the severity of these cuts makes our case against Proposition 1A, since the spending cap will make it much harder to ever restore these cuts, even when the economy improves and we have more revenue.
The focus of solving this budget mess should not be the propositions--which adds to the budget gridlock but doesn't even help with the long-term budget crisis--but the Republican legislators who mindlessly stick to their no-new-taxes pledge and use the two-thirds voting rule to prevent a sensible, shared, and sustainable solution to this budget crisis.
Every week, Health Access encounters people whose lives have been transformed by our health care system--those who find themselves denied for pre-existing conditions, or facing an enormous hospital bill that threatens to push them into bankruptcy. Many of them are moved to take action to change the health system--some of them sign-up for our E-mail alerts, others makes themselves available to testify at a press conference or hearing in Sacramento.
Kathie McClure outdoes most of them. She decided to focus her passion for health reform by driving a purple bus from her hometown in Georgia through the country, talking about the need for reform. Kathie's son, Chris, has Type I Diabetes, and her daughter, Caitlin, has Epilepsy. Kathie's children face a lifetime of health insurance crises, unaffordable insurance premiums, medical expenses, and drug costs. So Kathie is taking time off from her law practice to campaign for health reform.
She also founded an organization, at http://www.votehealthcare.org/ to help her in her mission and travels, and she has also been blogging at http://blog.votehealthcare.org/ as she stops throughout the South and West. She's not come to California, and Health Access has been happy to help host her.
She's been an inspiration to many who meet her. We were happy to have her as part of our town hall meeting with Representative Susan Davis in San Diego, and at a Mother's Day event in Los Angeles, and in our locations across the state.
(Right, McClure with Patrick Romano, the California director for the Health Care for America Now! campaign, along with Nancy Gomez, the Southern California organizer for Health Access. Above, the purple bus with some of the San Diego town hall participants; and other photos from the Mother's Day-themed event in Los Angeles.)
We will need the passion and commitment of Kathie and many others like her if we are to finally win major, comprehensive health reform this year.
Today, President Obama met with leaders of the U.S. House of Representatives on health reform, the third day in a row that the President has focused on health care in his public schedule. He's clearly launching a full campaign on the issue. Here's the press conference, which includes three California representatives of importance: Speaker Pelosi, Chairman Waxman, and Chairman Miller:
The news is that they are committing to pass health reform on the House floor by July 31st, before the August recess. The implication is that the U.S. Senate will do the same--as Chairmen Baucus and Kennedy have committed--and they will use the August recess to negotiate out the differences between the House and the Senate, and pass a full plan as soon as September.
It also means that we expect to see the first versions of bills in a few weeks, with subcommittees taking up those bills next month, in June.
Making health care coverage more affordable for Californians who are laid off from their jobs is certainly a priority. And so, Gov. Arnold Schwarzenegger has signed legislation that does just that for former employees of small businesses.
The bill, AB 23, uses federal stimulus funds to subsidize 65 percent of the cost of Cal-COBRA coverage for the newly unemployed of businesses from 2 to 19 workers.
COBRA coverage, which continues a laid-off worker's existing health care coverage for a period of up to nine months, is notoriously expensive and priced out-of-reach for many who have lost their jobs in this down economy. While the individual would still have to pay 35 percent of the premium, the subsidy can help a lot of Californians "between jobs" make ends meet while staying covered.
While the federal COBRA law only goes to employers of 20 or more, Cal-COBRA extends the option to workers of smaller employers. The bill, co-authored by Assemblymembers Dave Jones (D) and Nathan Fletcher (R), extends the new subsidy as well--but it requires proof of involuntary termination, and allows anyone who was laid off since September 1, 2008 to resume coverage.
The legislation, on a fast-track to take advantage of federal premium assistance, was sponsored by California Insurance Commissioner Steve Poizner. Health Access California was in support with many other organizations.
The California Health Care Foundation is hosting an important briefing this Friday, May 15. In a talk entitled "Health Insurance When It Counts -- What Does It Cover?", leading health academics Karen Pollitz and Eliza Bangit of Georgetown University's Health Policy Institute will present research findings on a comparison of cost-sharing and coverage associated with the design of California health insurance products in the individual and small group market. The researchers explored three health conditions -- breast cancer, heart attack, and diabetes.
When purchasing health insurance, consumers often don't have a sense of what will be covered in the event of a serious illness. That's why Health Access California is sponsoring AB786(Jones), to set some standards so consumers know what they are buying, can so some comparion shopping, and can have confidence that their coverage will at least cover both doctor and hospital bills, and have an out-of-pocket cost maximum. Without knowing all the findings, we think such a research project like this was long overdue, and hopefully it will help spark the discussion abotu the needed policy remedies.
The event is Friday, May 15th, 10:30AM - 12:00PM, at the California State Capitol, Room 112, Sacramento. More information is on the California Health Care Foundation's website. To RSVP , contact Danny Sandoval at dsandoval@chcf.org or 916.329.4542.
But certainly, there are some sources of funding that should be preferred by policymakers, while others that may be necessary if not ideal.
For example, some have offered the notion of a modest tax on tobacco, alcohol, or soda. A tobacco tax was a funding mechanism for the State Child Health Insurance Program--providing the double benefits of funding children's coverage, but also reducing smoking, especially among teens. California's AB x1 1 included a tobacco tax as a funding mechanism as well.
Alcohol and soda consumption also have health impacts--albeit different ones from tobacco--and so a consumption tax makes sense. Some may argue that it may have a disproportionate impact on lower-income consumers, but that issue is mitigated given that the benefit of expanded coverage will go disproportionately to those same populations.
But tops on my list for funding is revisiting the favorable tax treatment of Health Savings Accounts, passed as part of the infamous Medicare Part D package early in the Bush Administration.
There's a bill being considered today, Wednesday, in the Senate Revenue and Taxation Committee--SB 353 (Dutton), to provide a state tax deduction for HSAs to mirror the federal one. Health Access California opposes the state bill, and wouldn't mind if the federal tax benefit went away as well.
Here's three reasons: * The opportunity cost is high. For the same money to provide tax benefits for HSAs, we could increase coverage for a lot more people under Medicaid or SCHIP. If the goal is more people covered, you actually don't get very much bang for the buck. * The benefit largely goes not to the low- and moderate-income working families, but to the young, healthy, and wealthy. HSAs are tied to high-deductible health plans that attract a certain demographic. Many lower-income folks won't have the excess money to invest in an HSA, and thus don't get the benefit of the tax deduction. * From a health policy point of view, it doesn't make sense to subsidize underinsurance. Maybe HSA's were a bandaid in the absense of health reform. But the goal of health reform will be to reduce uninsurance and underinsurance, so it doesn't make sense to subsidize high-deductible health plans. Health reform will get rid of high deductibles, but there's no reason to encourage them.
These funding sources won't be enough, but they are a start. Yes, these proposals will have significant political opposition, but so will any financing plan. The benefit of these efforts is they not only provide funds, but help the health system as a whole.
I am continuing to post at the "Healthy Ideas" website of KQED Health Dialogues, which is having a wide ranging conversation on expanding coverage, improving quality and access, slowing health care costs, and eliminating health disparities. I am only one of a list of impressive contributors, where there is a range of opinion, including some points I disagree with:
While we've been talking about health reform for months (and in California, years), it seems that the debate went into high gear this week. While the White House meeting with the health industry got most of the headlines, the more specific, sticky, and significant debate was at the U.S. Senate Finance Committee, chaired by Senator Max Baucus.
Yesterday, the Committee released a 60+ page paper, Policy Options for Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans. It provides the framework and lays out some of the options for health reform: expansion of public health programs, individual market reform and a health insurance "exchange," required individual and employer contributions to health coverage, a public health insurance option, and much more.
We could--and will!--do 100+ blog posts on the ideas and issues presented on the coverage and financing aspects of reform--in fact, we have, when Sacramento has debated these issues in years past. But it's a sign that we are finally getting serious.
Some have characterized this as a "voluntary" commitment by the industry--and that is something to be wary about. Health Access California has been correctly skeptical of past industry attempts here in our state of avoiding reform with "voluntary guidelines," like on the issue of hospitals overcharging the uninsured, or "voluntary discounts" by prescription drug companies. In the latter case, we fought an initiative battle, that the pharmaceutical companies spent $80 million on, on the very issue of a "voluntary" drug discount program, versus one where the discounts were negotiated. In both cases, the industries were trying to stop--or at least delay--legislation.
This time, the industry groups aren't promising to control costs as an alternative to reform. They're promising to control costs as part of reform. In fact, some of the efficiency steps they are proposing wouldn't even be possible without the sorts of changes now under discussion in Washington, because they require changes in legislation.
If the "voluntary commitment" was explicitly posed as an alternative to health reform, or even of key reform elements--like the public health insurance plan, or bulk purchasing of prescription drugs and medical devices--then it would be a concern. But these efforts should not be--and don't have to be--mutually exclusive. And we should all be very clear about that in the weeks ahead...
A lot of news on the federal health reform front today. The biggest is the announcement, in the form of a meeting with President Obama and letter from key health industry leaders, including organizations representing insurers, drug companies, hospital, device manufacturers, doctors, and health workers, to commit to $2 trillion in health care savings over the next 10 years.
I'll add my two cents later. The details are not fully fleshed out, but the importance of the announcement today is more political than policy: that the federal health reform discussion is now more serious than it was before.
The size of California's budget deficit is massive. The Sacramento Bee reports that the projected deficit for 2009-10 is now $15.4 billion to $21.3 billion--with the $5 billion of that swing dependent on the fate of Proposition 1C (and the final $1 billion on Props 1D & 1E).
The Governor says they will release a budget of what will happen with and without the full package (often lumping in Prop 1A into this year's mess, when it won't have an impact for two years.), but regardless of the fate of any of the measures, the budget will look beyond bleak.
In Kevin Yamamura's Bee article on Sunday, I tried to even imagine what the health cuts might look like, but given the cuts already made, anything else is simply unfathomable. We'll see...
Early this past Saturday morning, over 150 Californians came out to a town hall meeting in San Diego, sponsored by the Health Care for America Now! campaign, for the purpose of winning quality, affordable health care for all America.
We were excited to have Representative Susan Davis speak and answer questions. She's on the key House Education and Labor Committee (chaired by California Representative George Miller), one of the three committees any health reform will have to go through in the House of Representatives. She and several other California Representatives will have crucial votes on the many amendments to strengthen and weaken the proposals that will be discussed.
Her district is there, too--it voted 54% to support Proposition 72 in 2004, a requirement that employers contribute to the health care of their workers. That's one important issue of many that she and the rest of her committee will face, as keys component of any health reform. Many other issues came up as well, from cost containment to a public health insurance option, showing how thorny the details of health reform will be.
We were also pleased to have Professor Rick Kronick of UC-San Diego, who also was a senior health policy analyst for the Clinton White House during the last effort at health reform. He offered thoughts about the urgency of reform, and about what we need to do differently this time to win.
Here's Congresswoman Davis with representatives of the sponsoring organizations of the town hall, including ACORN, California Partnership, Health Access California, SEIU State Council and SEIU Local 221.
These groups and others, as part of Health Care for America Now!, are doing other events and town halls throughout the summer. We have a limited window to pass health reform, and so we need to express our opinions now. For more information on the HCAN campaign in California, contact Patrick Romano, at promano@health-access.org.
Ezra Klein of The American Prospect (and soon to be of the Washington Post) has the scoop about how Senator Baucus has distributed work around health reform to his fellow Senators.
Jay Rockefeller: Medicaid Expansion, Premium Subsidies, Quality Improvements Kent Conrad: Comparative Effectiveness, Chronic Care Management Jeff Bingaman: Pay-for-Performance, Bundled Payments, IHS John Kerry: Heath Information Technology, Exchange, Small Business Tax Credit Blanche Lincoln: Small-Group Rating Reforms, Small Business Tax Credit Ron Wyden: Tax Exclusion, Non-Group Rating Reform Chuck Schumer: Public Plan Debbie Stabenow: Employer Pay-or-Play, Medicare Buy-in, HIT Maria Cantwell: Long-Term Care Reform, Workforce Issues Bill Nelson: Graduate Medical Education, Medicare Part D Bob Menendez: Disparities, Individual Requirement Tom Carper: Fraud and Abuse, Prevention and Wellness, Transparency
This gives a welcome sense that they are getting into the nitty-gritty of the details of health reforms, even if one wonders about how they are dividing the work, how these aspects will be integrated, and why certain topics are included in the first place.
These assignements got particular attention when Senator Schumer asked questions about the inclusion and specifics of a public health insurance option--which was reported as both that Senator Schumer was defending the concept, and that he was proposing a compromise. Richard Kirsch at the Health Care for America Now blog clarifies the confusion.
Health Access was pleased to be part of a press conference this morning, where CALPIRG Education Fund released a new report looking at how much money insurers in California and nationwide spend on actual health care, rather than administrative overhead, marketing, and profits. The report found that requiring insurers to spend 85 cents of every premium dollar on patient care is a strong, achievable standard that will protect consumers.
The press conference was with Senator Elaine Alquist, chair of the Senate Health Committee, who is the author of SB316, which would set such a standard. We'll keep reporting about this important bill as it moves through the Senate in the next month.
The U.S. Senate Finance Committee, chaired by Sen. Max Baucus (D-Montana) is having a "roundtable" right now on "Expanding Health Care Coverage" as part of health reform.
We are also participating in a new Healthy Ideas online forum, sponsored by KQED Public Radio and HealthDialogues. Lots of smart people have kicked things off with beginning posts... It should be an interesting conversation.
If the website looks different, it is! We've been working for months to redesign this site to make it a better resource for advocating on behalf of quality, affordable health care for all Californians.
The changes add new resources and materials, make our existing fact sheets and information easier to find and easier to read, and generally increase our ability to educate and activate Californians to get involved in improving our health system.
Please let us know if you have comments and suggestions about the new site, at weblog@health-access.org.
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.
Here's Congresswoman Davis with representatives of the sponsoring organizations of the town hall, including ACORN, California Partnership, Health Access California, SEIU State Council and SEIU Local 221.
