As we wait to see the news about a possible budget deal--and the prospects of more and more cuts--it's important to note that the ramifications of past cuts are just being felt in a widespread manner.
Tomorrow, July 1st, the inability to raise revenues to solve California ’s budget crisis will hit home will millions of Californians, with parents, seniors and people with disabilities that lose dental and other key benefits. Health Access has a revised fact sheet on our website that describes the eliminated benefits, and their fiscal, health, and human impacts.
Let's be clear: Millions of Californians will live sicker and die younger as a result of these cuts. These budget cuts reflects choices, and it is sad that our policymakers chose to cut off millions of Californians from basic care, rather than finding the revenues needed to maintain these needed services.
The elimination of these benefits also mean we lose significant more dollars in federal matching funds, meaning the cut to our health system is magnified. Not only will hundreds of thousands incur significant medical debt, and other will simply not get needed care, but the lack of these preventative care will impose broader costs on the health system in the long run.
The benefits that will be eliminated tomorrow include:
* DENTAL CARE, including routine teeth cleanings and x-rays as well as procedures such as root canals. Certain dental procedures, such as tooth extractions, which can be performed by a physician, will still be covered if the beneficiary can find a doctor who will do the procedure. Patients impacted in a given year: 909,090
* OPTICIAN SERVICES and optical lab services, which include the filling of and fittings for prescription eyeglasses and contact lenses. Patients impacted in a given year: 485,873
* OPTOMETRY SERVICES provided by an optometrist, include routine eye examinations and other preventive screenings. Some procedures will still covered, at a higher expense to Medi-Cal, when provided by an ophthalmologist. Patients impacted in a given year: 214,522
* PODIATRY SERVICES, which refer to the care and treatment of feet, are important in helping people remain mobile. Patients impacted in a given year: 85,129
* INCONTINENCE CREAMS AND WASHES, which are prescribed to help incontinent patients keep their skin clean and dry, and to avoid irritation and infection. Patients impacted in a given year: 65,591
* ACUPUNCTURE SERVICES, which is the use of small needles to treat pain and other health problems, and is an important alternative to pharmaceutical treatments. Patients impacted in a given year: 32,906
* AUDIOLOGY SERVICES, including hearing aids, and the services to screen, diagnose, and evaluate the need for hearing aids will only be limited to those performed by physicians as part of a routine exam. Patients impacted in a given year: 28,061
* CHIROPRACTIC SERVICES, which can help treat and lessen chronic back pain. Patients impacted in a given year: 12,439
* MENTAL HEALTH PSYCHOLOGY SERVICES and behavioral therapy services by a psychologist (previously limited to two treatments per month), unless the patient is severely mentally ill. Patients impacted in a given year: 4,970
* SPEECH THERAPY SERVICES provided by speech therapists. Patients impacted in a given year: 1,593
The Managed Risk Medical Insurance Board (MRMIB) voted today to create a waiting list effective July 17, 2009, which would mean children seeking health coverage would be denied until space opens up in the Healthy Families program.
Effective July 1, 2009, children with Medi-Cal coverage whose family income has increased--so they are no longer eligible for Medi-Cal--will not be enrolled in Healthy Families, and will go on the waiting list.
Tens of thousands of children enroll every month--a number that has climbed as a result of the economic downturn--and each of them would be forced to wait and go without coverage.
The decision is a result of an expected $90 million shortfall in state dollars--one that is in the Budget Conference Committee proposal. It was the "compromise" after not eliminating the program in its entirety. But the cut isn't final--and in fact, the Governor and legislative Republicans are seeking additional budget cuts as we write.
The Senate is currently debating the majority-vote budget package of cuts and just about $2 billion in revenues increases to deal with the $24 billion state budget deficit. The Governor has said that he will veto any proposal that does not address the entire $24 billion or that raises taxes.
Thus, the Governor is attempting to force dramatic cuts. Senate President Steinberg has pointed to the deadline at the end of June, the end of the day tomorrow, in order for some of these budget solutions to take hold. So we will see what agreement, if any, comes about in the next 36 hours.
And as we focus on the crisis of the moment of the next 36 hours, Time Magazine takes a broad view about the origins of the California budget crisis that goes back 36 years.
Finally, earlier this week, nearly 10,000 people expressed their opinion that health care can't wait, and the need for comprehensive health reform that includes a public health insurance option in Washington DC. Here's a small video snippet of the rally, featuring former Gov. Howard Dean, actress Edie Falco, and many others:
While the budget battles continue in Sacramento, I've been in Washington, DC, with several dozen California leaders, visiting with many in the California delegation on health reform.
Although you might not notice it with the deaths of Michael Jackson and Farah Fawcett, today there was a rally in Washington, DC, of nearly 10,000 folks from around the country for an incredibly large Health Care for America Now "lobby day," paralleled by dozens of "echo" events across the country, including in San Francisco, Fresno, Los Angeles, and San Diego.
It was good to hear our the excitement and the seriousness of purpose from Congressional leaders and their staff. It was fun to see a glimpse of a meeting of the House Energy and Commerce Committee, which included testimony from Californians like John Arensmeyer of Small Business Majority, and Howard Kahn of L.A. Care--which is the current largest "public health insurance option" in the nation, but hopefully won't be after health reform passes.
We need to keep the pressure on... the momentum is significant, but we were also warned that there's a lot of work to quell the opposition, to specific important provisions, and to the whole enterprise of health reform. Lots more to do!
As much outrage as there is about rescissions, there's a larger-scale problem of people being denied for pre-existing conditions. David Lazarus at the Los Angeles Times has a heartbreaking story of one such couple.
The state's safety-net program for those denied for private coverage due to their health status is full. It has a waiting list of hundreds of people, despite never advertising. And as Lazarus says:
But it's not easy to get into. It's not comprehensive. And it's not cheap.
He goes even further:
It currently takes as long as four months to be enrolled in MRMIP. And even then, you have to wait three months more for coverage of prescription drugs to kick in.
To accommodate more people, the state created a companion system, the Guaranteed Issue Pilot Program, which now provides coverage to about 6,000 people. But that program was closed to new enrollment after participating insurers balked at some of the state's terms.
Under MRMIP, California taxpayers pay 40% of the premiums to enroll people in individual plans offered by Kaiser Permanente, Blue Shield and Anthem Blue Cross. Those premiums can run as much as 37% higher than market rates for similar individual policies because of the enrollees' medical history.
And the $75,000 cap on annual coverage is among the lowest such limits among similar state programs nationwide.
The story does not mention that MRMIP is one of the many programs where the tobacco tax funds dedicated to the program is being diverted becomes of the budget cuts, so that waiting list will only expand--and some may need to be kicked off the program in the first pace.
The article talks about how federal health reform can help: preventing insurers from denying coverage due to "pre-existing conditions" in the first place, and creating a public health insurance option that would be a real option for patients.
At the state level, there's a pending reform bill, SB 227, sponsored by Senator Elaine Alquist, chair of the Senate Health Committee, to provide some reforms of the MRMIP high risk pool, to opne it up to more people and remove that annual cap. But even that bill won't be able to meet the real need that is out there. The conservative estimate is that over 400,000 are denied coverage due to their health status.
Just another reason for urgency on federal health reform...
On multiple Sunday monring, George Will has suggested during his commentary on ABC's This Week with George Stephanopolous that health reform would be easy if they just dropped all these demands and adopted "the Healthy Americans Act"--the Wyden-Bennett bill. The chief House sponsor is California Representative Anna Eshoo.
Senator Ron Wyden deserves a lot of credit.. at a time when President Bush reigned and health care reform was not in the national conversation, he aggressively pursued Republican Senators to see what they would support in a health reform package. His ability to bring on Republican Senators helped some start to believe that health reform was a live issue again.
Will says that there's over 70 votes for the Wyden-Bennett bill, but it's far from clear it would get such support from the left and the right of the Senate. It's unclear if even all the 10-20 sponsors would vote for the bill, including the full financing and other aspects of the legislation.
Will has said that the major difference with the Obama plan is the public health insurance option. That's a major difference, but it's not the main objection. In his desire to get Republican co-sponsors, Wyden did not include a public health insurance option, even though he has said he's not opposed to the concept. The bill is really less a bipartisan bill, than one to explore what Republican Senators would support.
But now we are in a different era, headed by President Obama, and the framework of a health plan he spent over $100 million promoting during the campaign. So politically, it makes sense to not abandon that electoral mandate for another framework, such as the Wyden approach.
I am skeptical of the Wyden approach of aggressively encouraging people into an individual insurance, however reformed. Proponents say it won't be the broken individual market of today. But to the extent that the problem is that individuals simply won't have the market power against the big insurers, some of the same problems will persist--even if the most obvious issues, such as people being denied for pre-existing conditions--will be thankfully outlawed. That's why I would prefer the current approach by Congressional leadership of expanding group coverage--whether through employers, public programs, or otherwise. This also explains the rationale for the public health insurance option, giving consumers on more tool against the private insurers--namely, the ability to take their business elsewhere.
The reason why the Wyden-Bennett bill is still even talked about is that it got a favorable "score" from the Congressional Budget Office, an analysis that suggests that the plan would be revenue neutral.
But the way it gets to be budget-neutral should give consumers pause. It defines a basic benefit package, but allows the value of those benefits to degrade over time. Rather than raising the revenues needed to make sure the guarantee of quality coverage is there for consumers, the bill allows that assurance to become weaker and weaker. The point of health reform is to more broadly share the risk of rising health costs, rather than continue the existing shifting of risk onto patients and families.
The Wyden bill served it's mission ably in kick-starting the health reform discussion nationally, well before Iowa caucuses and "Yes, We Can." There may be provisions and lessons of interest, but the framework being discussed in the key committees in the one that President Obama ran on, and won on.
How can Californians engage in the health reform debate?
I often get the question: Do we support the House/Tri-Committee bill? The HELP/Kennedy bill? The Finance/Baucus bill? But these aren't the right question, or at least, not the most useful ones.
First of all, they are all in draft form, and undergoing changes in real-time. And they are going to change significantly in the weeks ahead. The House bill will go through three committees, and be subjected to various proposed amendments. Senate bills will be considered by two committees, and ultimately merged into one product before heading to the floor.
These are the vehicles for health reform, but they will change over the weeks, especially as they go through the committee process, and face amendments and negotiation. This would be true if we started with a single-payer system, or a Wyden-like individual market approach--no legislation is unchangeble. So our main action is not to "support H.R. X" or oppose "S. Y" or anything like that.
The advocacy needed is to support the concept and urgency of health reform, this year, and to support or oppose specific principles and provisions that are important for patient. Whether it is the public health insurance option, for having all employers contribute their fair share, or the need for subsidies up the income spectrum past 400% of the federal poverty level, those are the debates that will make the difference in what the House and the Senate pass, and become the fodder for a House-Senate compromise.
It's not that I don't have opinions on any of this. Of the actual bills proposed, I prefer the single-payer model as proposed by Rep. Conyers or Rep. McDermott, over the individual market approach as proposed by Sen. Wyden. Of the main committee vehicles, which all follow a similar framework to what President Obama campaigned on, I've been impressed by the House vision and version, and concerned abou the direction I am hearing from the Senate committees at the moment.
Congressional representatives need to hear support, for example, for the public health insurance option, which is a key provision, as well as a principle--that consumers should not be left all alone at the mercy of the individual insurance industry. There's no bill number, but it's at the center of the conversation as we speak.
There will be a moment to be ready, to respond to the predicted deluge of amendments. See you soon
Major congressional caucuses push health reform...
Monday, June 22, 2009
Rep. Michael Honda stood with Health Care for America Now, Health Access California, and other groups this morning in San Jose, to releasee new California-specific report today today showing that racial and ethnic disparities in health outcomes constitute a crisis, one that requires the attention of health care providers, policymakers, and communities alike. As the study shows, in California, communities of color and immigrants face barriers in accessing health care including lack of insurance coverage, limits to geographic access, and cultural and linguistic challenges.
“Since the publication of the momentous 2002 Institute Of Medicine study confirming the depth and breadth of disparities in health care faced by racial and ethnic minorities in the United States, I have worked tirelessly with my colleagues to reform our health care system to correct these inequities” said Representative Mike Honda (D – San Jose), chair of the Congressional Asian Pacific American Caucus. “Children should not have to translate complicated medical information for their parents, patients should have access to quality, affordable care regardless of the language they speak, the color of their skin, or where they live. The public option within health reform is a singular opportunity to both expand competition in the health care industry and rectify injustices faced by too many in our communities.”
This took on special emphasis this week because the Congressional TriCaucus - comprised of the Congressional Black Caucus (chaired by CA Rep. Barbara Lee), the Congressional Hispanic Caucus and the Congressional Asian Pacific American Caucus (chaired by CA Rep. Honda) – and the Congressional Progressive Caucus (chaired by CA Rep. Lynn Woolsey) -- altogether 120 House and Senate Members -- will hold a news conference on Wednesday, June 24 at 10 am expressing unprecedented, united, and strong support for comprehensive healthcare reform, of which the cornerstone must be a robust public health insurance option.
At the press conference this morning, Honda joined Health Care for America Now (HCAN); Asian Americans for Community Involvement (AACI); Asian Immigrant Women Advocates (AIWA); California Immigrant Policy Center (CIPC); California Pan Ethnic Health Network (CPEHN); the Having Our Say Coalition; Health Access California, and Services, Immigrant Rights, and Education Network (SIREN) in highlighting the specific needs of our communities and calling upon Congressional leaders to include them in the Health Reform Debate. The report is available at: http://www.health-access.org/files/expanding/Ideas%20in%20Action%20The%20Heatlh%20Equity%20Challenge%20CA%206-20-09.pdf
"As three-quarters of the uninsured in this state, communities of color have the most at stake in health reform” according to Martin Martinez, Policy Director at the California Pan Ethnic Health Network. “If the United States is going to be positioned for a successful future, we need to make sure that everyone has access to affordable, comprehensive, and culturally and linguistically appropriate health care. We urge Congress to act this year to enact meaningful reform that addresses these inequalities in health."
The debate over health reform in Washington DC represents a historic opportunity to achieve quality and affordable health care for all; it is critical that reform efforts take into account the specific needs of immigrants and communities of color. We must expand and simplify public programs to cover all low-income individuals, and give everyone the option of buying into a public plan. We must also invest in building healthy communities to address the underlying causes of the obesity and chronic disease epidemics that are disproportionately affecting communities of color.
I admit I haven't read all 852 pages of the House bill, but the more I look, there's good stuff. There's some work to do, and areas where the bill is silent--especially on some financing elements.
But it is important to note some of the provisions that have been patient protections that are small provisions of the bill, but on their own are important and that have been long advocated for: a ban on balance billing; a requirement that all health insurance plans would have to spend at least 85% of revenues on patient care; the establishment of a floor of basic benefits include maternity and well-baby care; additional assistance for early retirees; and the closing of the donut hole in Medicare Part D. We'll have a fuller report later.
Until then, here's the press conference where they released the bill. The first two speakers, and two of the three Chairmen, are Californians: Rep. George Miller of the Education and Labor Committee, and Rep. Henry Waxman of the Energy and Commerce Committee. Also standing is Rep. Pete Stark, who chairs the Health Subcommittee of the Ways and Means Committee, and who was recognized at the end of the press conference for his decades of work on these issues.
It features the three chairmen of the relevant House committees, and it is remarkable how they are all working together--this is not normal, or usual, but it is welcome. It shows that they understand the urgency enormity of the issue and the moment.
The whole press conference is moving, and provided me hope after a long week.
With health reform heating up, the Health Care for America Now! campaign went door-to-door yesterday, as reported by Bobby Caina Calvan of the Sacramento Bee. In not just Sacramento but Volunteers, from ACORN and other community groups, went and talked to their neighbors about health care reform, and urged them to get involved in the debate.
Tomorrow, HCAN, Health Access, and other groups will be releasing a new release about health equity--and why health reform is so central to communities of color. We are pleased that Rep. Mike Honda is joining us to release the report in San Jose on Monday.
Later this week, I'll be going to Washington, DC with several dozen Californians to visit Congressional offices and participate in a major HCAN rally on Thursday, June 25th. And that's just a little of what is going on. The campaign for health reform is in full throttle now.
Here's a new video about the California budget and the impacts of the health care cuts from the centrist New America Foundation--with whom we don't agree on everything, but they work to be thoughtful. With colorful pie charts and some suggestive accompanying music, they make the point that a single-minded focus on the budget leads to health cuts that simply make no sense if considered regarding the cut's true impact:
Last year, we made a similar point about the cost shift of these budget cuts when we commissioned a study, "Adverse Reaction: Proposed Health Budget Cuts Would Lead to Increased Health Insurance Premiums." The Governor has made his similar point when he referred to the "hidden tax" in our private premiums, yet he continues to insist on cuts to Healthy Families, and continue to oppose even the revenues he supported during health reform.
The Senate HELP Committee began mark-up on their bill this week and ran into some snags over the public plan option, the employer mandate, and the overall price tag. The Congressional timeline is beginning to slip as the Senate Finance Committee has postponed its markup in order to better understand the CBO cost estimates and strive for a bipartisan bill. A slideshow of the Finance committee's proposal started to circulate. A bipartisan group of former Senate Majority Leaders also got in on the action by unveiling their own health reform proposal. Speaker Pelosi has insisted that the House bill will include a public plan option. Meanwhile, House Republicans are developing their own health reform plan.
While there are details to look at and likely to work out, this House package would be a major improvement over the current broken system, and help Californians get and keep the coverage they want and need.
We are not surprised that California Congressional leaders, including Speaker Pelosi, Chairman Waxman, Chairman Miller, Chairman Stark, and others have put forward a strong proposal. Californians know that we need major health reform, and we need it urgently. The problems in the health system are significantly bigger in California, and it's not a surprise that our condition has translated into such overwhelming support for broad public (as seen by the Field Poll yesterday, and some of our key policymakers as well.
From an economic view, the budget choice is clear...
HEALTH ACCESS UPDATE Friday, June 19th, 2009
NEW REPORT UNVEILS ECONOMIC IMPACTS OF PROPOSED HEALTH AND HUMAN SERVICE CUTS
* Over 600,000 Jobs Lost Under the Governor’s Proposal; A Decline of 2.2% of GDP * Conference Committee Report Significantly Reduces Impact, But Still 220,000 Jobs Lost * Report Shows Health & Human Service Cuts Have Dramatically Worse Impact Than Taxes, Taking Into Account Lost Federal Funds, and Multiplier Effects; * HHS Cuts Are Over Four Times Worse For Economy Than Upper-Tax Bracket Restoration
* More Updates on the Health Access Blog: New House Bill on Health Reform!; New Field Poll Shows Californians Overwhelmingly Support Health Reform; Trying to See the Humor in Health Reform; A Mistaken CBO Analysis; Budget Budget Choices for California
* Follow Health Access California on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget and health reform issues.
As the Legislature prepares to consider tough choices to balance an over $20 billion deficit, a new report reveals that the health and human service cuts proposed would also have a dramatic negative impact on California’s economy.
Compiled by Health Access California and available on the Health Access website, the report, “The Worst Prescription for California’s Economy: Analyzing the Economic Impacts of Health and Human Service Budget Cuts,” reveals that the severe cuts in the Budget Conference Committee’s proposal would have significant economic impacts; and that the Governor’s budget proposal would be even more dramatic damage to the state’s economy. Both would mean lost federal funding to California ; hundreds of thousands of lost jobs; and hundreds of thousands of Californians without coverage.
“These health and human service cuts are the worst of both worlds: they not only directly deny people the services that California families need, the cuts cripple our ability to get out of this economic downturn,” said Anthony Wright, executive director, Health Access California, the statewide health care consumer advocacy coalition. “The Governor’s cuts make no sense, since in order to save a few state dollars, California gives up a lot of federal dollars, for our health system, and our economy.”
The Governor’s proposed budget includes dramatic cuts, including the elimination of Healthy Families, CALWORKS, Adult Day Health Centers , as well as major cuts to IHSS home care and many other programs. In addition to the human impacts, the Governor’s budget cut proposals to health and human services would have dramatically negative economic consequences:
· California will lose $7.5 billion in federal funds for health and human services programs this year alone. · Over 600,000 Californian jobs will be lost. · The state’s economy (GDP) will shrink by more than two percent. · Over two million more Californians will lose health coverage, increasing the number of uninsured by one-third.
“The Governor's proposal to eliminate CalWORKs will devastate low income families and the communities they live in. Landlords won't get the rent, electric companies won't get paid, the corner store will have less customers but the homeless shelters will be full,” said Michael Herald of the Western Center on Law and Poverty. “Our legal service offices are getting unprecedented number of calls from frightened recipients worried they will become homeless. It is morally irresponsible of the Governor to threaten to cut off aid to vulnerable families while refusing to even consider tax increases.”
The economic consequences are particularly significant for health and human services for multiple reasons:
· Many health and human services are tied to federal matching funds, so for every dollar we cut from state spending, the state’s economy loses double, triple, or more in economic activity.
· Since spending in health and human services by definition happens in-state and is unable to be “outsourced,” there’s a significant “multiplier effect” where dollars are spent in the community and then spent again, creating economic activity. This study relies on Council of Economic Advisors (CEA) data and formulas for estimating the multiplier effect.
· Funding for health and human services are spent directly into the economy. Both as staff salaries (such as nurses) and as direct assistance to poor families, the beneficiaries of health and human service spending are low- and moderate-income Californians who are likely to spend that money quickly back into the community, by necessity, rather than save it. Studies indicate that such directed resources to lower-income families have a more substantial “multiplier effect” to the local economy.
These factors make it so that cuts to health and human services have a much bigger impact than a commensurate increase in taxes. In a tough budget situation where legislators must choose either service cuts or tax increases, the negative impact of bigger cuts is over 3 to 1. The study reviews an even more stark comparison with restoring the upper tax bracket, where the impact would be offset by a sizable deduction in federal income taxes.
“This package of cuts goes in the complete opposition direction of President Obama’s economic stimulus bill. President Obama had it right, that the top priority was to recover and reinvest in our country, starting with the people who need the most help,” said Wright. “While all our budget options have economic impacts, the choice is clear. If you want to revive the economy, the worst possible action is to make the health and human service cuts proposed, lose those federal dollars and all the resulting economic activity. Those who are concerned about the economic impact of tax increases should recognize that the economic impact of cuts are multiple times greater.”
"This new report is consistent with a recent study released by Beacon Economics, which demonstrates that cuts to human services programs such as Food Stamps, CalWORKs and General Assistance have severe negative economic impacts, with an estimated $1.32 in economic activity lost for every dollar cut. Investment in human services programs is critical to state and local economies," said Frank Mecca of the County Welfare Directors Association.
The Budget Conference Committee also has negative economic impacts, even though they are significantly less severe than the Governor’s proposal. The economic impacts of the health and human service cuts in the Budget Conference Committee budget package include the loss of over $1.24 billion in federal funds for health and other programs in the budget year, about 220,000 Californian lost jobs, and a shrinkage in GDP of 1.3%. An estimated 550,000 more Californians will be denied health coverage, both in children being directly denied coverage, and in families losing health coverage due to job loss.
Californians know that we need major health reform, and we need it urgently. The problems in the health system are significantly bigger in California, and it's not a surprise that our condition has translated into such overwhelming support for broad health reforms.
What is noteworthy is that what may be controversial in Washington, DC, is not in California, given the level of our crisis, and our elected leaders in Congress should take note. Californians support a range of provisions that are now being debated in DC. They include:
* 85% of Californians support "the choice of a public health insurance option, that can compete with the private insurers and make sure they play by the rules." * 81% of Californians support "requiring health insurance companies to offer coverage to anyone without regard to their health condition." * 70% of Californians support "expanding state government programs for low-income people, such as Medi-Cal and the State Child Health Insuance Program." * 69% of Californians support "requiring employers to offer health insurance to their workers or pay money into a government fund that will pay to cover" their workers. also support requiring employers to help provide health coverage to their workers. These are critical components that should be in any health reform package."
On the public health insurance option, there's been concerted effort to ensure that is included in health reform by coalitions like Health Care for America Now.
Federal health reform has arrived. The Senate Health, Education, Labor, and Pensions (HELP) Committee started the "markup" of their bill today. Other proposals are expected from the Senate Finance Committee, and from the House of Representatives.
The debate didn't start great, with Senators Enzi, McCain, and Gregg coming out guns blazing, not exactly setting a bipartisan tone.
To get a sense of the debate, Senator Judd Gregg likened the legislation to something you'd get if "Rube Goldberg, Ira Magaziner, and Karl Marx" got together to which Senator Barbara Mikulski replied, "Our current system is a combination of Adam Smith, Darth Vader and the Invasion of the Body Snatchers."
Perhaps they should leave the health reform humor to the professionals:
Incomplete scoring of a legislative proposal. Lots of explanations and recalculations. Concern about the timeline to pass a bill. Smells like a health reform debate!
Yesterday, the Congressional Budget Office released an analysis of the preliminary bill coming out of the Senate Health, Education, Labor and Pensions (HELP) Committee. The big issue is that it would cover about 15 million of the uninsured, far less than what people are aiming for as part of a comprehensive proposal
It's not that the numbers are preliminary. It's that they are wrong. As both Ezra Klein and Jonathan Cohn point out, the CBO numbers, by focusing on a partial bill, don't take into account major provisions of the bill that weren't ready for review at the time. According to the CBO estimates, available at The Atlantic website here.
The two major engines of coverage expansion are: * setting a standard for employers to contribute to the health care of their workers, so more people get and keep their on-the-job coverage, and * extending Medicaid to subsidize the coverage of lower-income families that otherwise can't afford it. Neither component was in the bill analyzed by CBO.
It's like trying to see how fast a runner is, but only if he had not one but both legs amputated. Given how all these component interact with one another, it's hard to see any usefulness in these numbers.
If our experience in California is any guide, there will be lots of disputes with CBO in the future about how to properly model the impact of a proposal. This is just something else entirely.
LEGISLATORS MAKE SEVERE HEALTH CUTS, REJECT FULL ELIMINATIONS * Budget Conference Committee Makes Big Health Cuts: $1 Billion in Medi-Cal, Many More * Major Cuts, Not Full Eliminations of State $, for Healthy Families, AIDS Programs, Clinics * In Order to Prevent the Worst of the Severe Cuts, Revenues and Taxes Needed
* More Updates on the NEWLY REDESIGNED Health Access Blog: More on Budget Cuts; The California Congressional Delegation Speaks Out on Health Reform and the Public Health Insurance Option; Health Bills Pending; Better Budget Choices for California
* Follow Health Access California on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget and health reform issues.
On Monday, the Budget Conference Committee of the California Legislature revisited some of the proposed cuts that they had delayed making last week during their first look at the Governor's budget proposal. As with last week, the legislators have made severe cuts, but rejected even worse proposals.
The Committee, chaired by Assemblywoman Noreen Evans, made significant cuts but largely rejected full-scale eliminations of Healthy Families and a variety of other programs and services. Significant reductions were made for most of the cuts the Governor has proposed.
* A $1 billion cut in Medi-Cal as part of "flexibility and stabilization" negotiations with the federal government, largely around "federal funds which are past due." These include: * $700 million that the state claims were disability expenses to the state that shold have been covered by the federal government, by enrolling those on Medi-Cal who are also eligible for Medicare due to disability more promptly; * $75 million in redoing "clawback" calculations related to the implementation of Medicare Part D; * An adjustment of Medicare Part B payments that should have been paid by Medicare, not Medi-Cal * An effort to reclaim over $400 million from provisions in the current hospital waiver that was negotiated in 2005. * It is notable that the list of possible reductions does NOT include provider rate cuts or the eligibility reductions that were originally raised and discussed when this proposal was first floated a few weeks ago.
* A $70 million cut to Healthy Families, which would establish and send children to a waiting list for coverage, unless other sources of funding or donations were made. (Last year, the First Five Commission provided $17 million to Healthy Families to prevent a waiting list from being established, but this is a significantly bigger hole to fill.) This cut is actually *bigger* than the Governor's original $54 million cut to roll back eligibility for over 225,000 children between 200-250% of the federal poverty level. Without additional assistance, a $70 million cut could mean the Healthy Families program bars any new children from enrolling for a long while, denying well over two hundred thousand of children coverage.
* The rejection of the elimination of Medi-Cal coverage for *legal* immigrants (such as those with PRUCOL status).
* $34 million would be shifted from the distressed hospital fund rather than making the Governor's cut to the state's private Disproportionate Share Hospitals (DSH).
* A 30% cut to state funding of community clinic programs.
* A $11 million, rather than $16 million, cut to Maternal Child Adolescent programs, like the Black Infant Child Program.
* A cut of $35.5 million cut from about $80 million provided for AIDS and HIV programs, both education and prescription drug service programs.
* A $26.5 million reduction in Adult Day Health Care Centers, as opposed to a full elimination as the Governor and the Republicans on the committee supported. The compromise proposal would cap the use the ADHCx for 3 days.
* A cut to small and rural hospitals, narrower that what the Governor proposed.
* The cutting of nearly half, rather than all, of the state's poison control system.
Republican legislators voted for the full elimination of these programs, including Healthy Families, the statewide source of coverage for nearly 1 million lower-income children.
The Republican legislators on the Committee--notably Assemblyman Roger Niello and Senator Bob Dutton---often berated their Conference Committee for waiting to make the tough decisions, and for not making these cuts... But Assemblymembers Evans and DeLeon and Senator Lowenthal spoke eloquently for need for other options, and to prioritize between spending cuts. But on AIDS programs and other such efforts, they made clear, "people will die," if the program is eliminated.
The Budget Conference Committee, chaired by Assemblywoman Noreen Evans, is expected to make decisions on outstanding issues--including the bulk of the health and human service cuts--later today, Monday. We'll try to Twitter the results at @healthaccess, and have a post here about the specific health care cuts.
Among the items previously "held open" that the Budget Conference Committee is considering includes:
* A controversial proposed waiver the governor is seeking from the federal government, which the Department of Finance said would save the general fund $1 billion. The governor says the waiver will allow him flexibility to operate outside of some of the federal government’s Medicaid rules, and the conditions of accepting billions from the economic stimulus package, the American Reinvestment and Recovery Act. * Elimination of the Healthy Families program that serves nearly 1 million children. Abolishing the program would save the general fund $368 million but would also cost the state $644 million in matching federal funds. While the committee has suggested it would not eliminate the program, it still is possible that there could be premium increases or eligibility reductions. * Elimination of all general fund support, or $34.2 million, for community health clinics -- including rural, seasonal migratory worker clinics and American Indian health clinics, as well as the Expanded Access to Primary Care Clinics. Together, the clinics provide about 2.3 million visits annually for low-income and uninsured people * Elimination of maternal and child health (MCH) funding for the black infant health program designed to help “at risk” pregnant women and parents; the Adolescent Family Life program, which helps 17,000 pregnant teens up to 18; a birth defects monitoring program; a local county grant program aimed at improving the health of young women and families * A proposal to restrict Medi-Cal services to new legal immigrants and people allowed to relocate to the U.S. by the federal government – such as survivors of the Vietnam War who aided U.S. troops. * Reduced funding for AIDS programs, from HIV education and preventions, to assistance for AIDS drugs. * A proposal to eliminate Adult Day Health Care opened a discussion as to whether various programs aimed at helping the elderly, including Alzheimer’s victims, shouldn’t be re-examined, restructured and streamlined to make them more efficient. The proposal, which the Department of Finance said would save $170.5 million, was held over previously as well.
"We don't have the votes for single-payer, which I support," said Miller, chairman of the House Education and Labor Committee, one of the three committees with jurisdiction over health care legislation. "But if we can't do single-payer, then I believe President Obama has struck the best balance between maintaining the private system with enough government involvement to keep the insurance companies honest and provide access to affordable health care for everyone..."
"I think it's going to happen," Miller said of the restructuring legislation. "People recognize the shortcomings of the system they now have. The economy has shown the vulnerability of families at all levels when people lose their jobs and their health care. It's very hard to see how you fix the American economy if you don't fix health care."
Health consumer protection bills head to 2nd house...
HEALTH ACCESS UPDATE Friday, June 12th, 2009
HEALTH CONSUMER PROTECTION BILLS HEAD TO SECOND HOUSE * Assembly & Senate Passed Bills on Insurance Regulation, from Gender Rating to MRMIP * Legislation to Require a Minimum % of Premiums to Go to Patient Care Stalls in Senate * Bills to Set Standards for Insurance, Prevent ER Overcharging Heads to Senate Health
* More Updates on the NEWLY REDESIGNED Health Access Blog: The Choice to Prevent Budget Cuts; Health Wonk Review; The Public Health Insurance Option
* Follow Health Access California on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget and health reform issues.
Last week was the deadline for legislation to pass floor votes, in either the Assembly or the Senate, in order to proceed for the year.
Several key consumer and patient protections were passed in the past few weeks, including regulations limiting the retroactive denial of coverage; the setting of standards so insurers better label their coverage options; prohibitions on gender-based price discrimination; a reform of the state's high-risk pool, and protections to prevent the overcharging of the uninsured in emergency rooms.
One bill that did not pass the Senate was the setting of medical loss ratios for insurance coverage, so that a minimum percentage of premiums would be required to go to patient care, rather than administration, marketing and profit. Since this is the first year of a two year session, this and other stalled bills will be available for continued movement in January of next year.
Below is a list of health consumer protection bills introduced in the 2009 session of the California State Legislature that have passed their house of origin and are now heading toward hearing by policy committees in the second house. A one-page summary of these bills, and a second page of those bills that have stalled for the year, is available on the Health Access website: http://health-access.org/files/advocating/HAC%20Bill%20List%206-5-09.pdf
This list will be updated regularly through the year and available at www.health-access.org. Below are the active bill now moving to policy committees in the next few weeks, through late June and early July.
INSURANCE OVERSIGHT & MARKET REFORMS
AB 786 (Jones): INSURANCE MARKET STANDARDS: Would sort health insurance policies into six categories, ranging from “comprehensive” to “catastrophic.” Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing, and assist consumers in making apples-to-apples comparisons between plans. Would weed out “junk” insurance by developing minimum benefit standards. Health Access California is the sponsor.
AB 1521 (Jones) BROKER COMPENSATION: Would require disclosure and place limits on how health insurance brokers are compensated by insurers. Health Access California is the sponsor.
AB 119 (Jones) GENDER RATING: Would prohibit insurers from charging different premium rates based on gender. Similar to SB 54 (Leno).
SB 54 (Leno) GENDER RATING: Would prohibit insurers from charging different premium rates based on gender. Similar to AB 119 (Jones).
SB 227 (Alquist) HIGH-RISK POOL: Would require insurers to accept members of the highrisk pool at the rate set by MRMIB or pay a fee used to fund MRMIP. Would also increase the tobacco tax funds dedicated to fund MRMIP.
RESCISSION
AB 2 (De La Torre) INDEPENDENT REVIEW: Would create an independent, third-party review process when an insurer wishes to rescind a consumer’s health policy and also require state review before approval. Also raises the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his health history.
AB 730 (De La Torre) POST-CLAIMS UNDERWRITING FINES: Would impose fines on insurers unlawfully engaging in post-claims medical underwriting.
AB 108 (Hayashi) TIME LIMIT: Would impose an 18-month time limit in which insurers have to rescind, cancel, or limit individual health care policies or charge higher premiums because of fraud once a consumer’s application is approved.
INSURANCE BENEFIT MANDATES
AB 98 (De La Torre) MATERNITY COVERAGE: Would require most health plans to cover maternity services.
AB 244 (Beall) MENTAL HEALTH PARITY: Would require most health plans to provide coverage for all diagnosable mental illnesses.
MEDI-CAL ELIGIBILITY & RETENTION
AB 1142 (Price) PROOF OF ELIGIBILITY: Would require hospitals, as soon as they have proof of a person’s Medi-Cal eligibility, to provide all information regarding that person's Medi-Cal eligibility to all other providers.
AB 1269 (Brownley) DISABLED WORKERS: Would allow, to the extent that federal financial participation is available, workers with disabilities who are otherwise eligible for Medi-Cal but are temporarily unemployed to elect to remain on Medi-Cal for a period up to 26 weeks.
DOCTOR AND HOSPITAL OVERSIGHT
AB 1503 (Lieu) EMERGENCY ROOM FAIR PRICING: Would limit the amount that emergency room physicians and surgeons can charge an uninsured or underinsured patient with income below 350% FPL. Health Access California is the sponsor.
AB 542 (Feuer) ‘NEVER EVENTS’: Bans hospitals from billing patients or insurers when they have made an avoidable mistake, such as operating on the wrong person, prescribing the wrong drugs, or leaving foreign objects inside a surgery patient.
AB 171 (Jones) DENTAL CONSUMER PROTECTIONS: Would prohibit dentists’ offices from offering high-interest loans to patients while they are under the influence of anesthesia. Would also prohibit dental offices from charging lines of credit before services have been rendered.
SB 196 (Corbett) PRICE TRANSPARENCY: Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contract between providers and insurers.
HOSPITAL FINANCING & WAIVER
AB 1383 (Jones) HOSPITAL COVERAGE DIVIDEND FEE: Would, per federal approval, impose a coverage dividend fee on hospitals for the purpose of increased reimbursement and children’s coverage expansion. Adopted with urgency. Watch
AB 342 (Bass) HOSPITAL WAIVER: Repeals the existing waiver authorization which expires September 2010 and acts as a placeholder for waiver discussions with the federal government. Adopted with urgency. Watch.
SB 208 (Steinberg) HOSPITAL WAIVER: Repeals the existing waiver authorization which expires September 2010 and acts as a placeholder for waiver discussions with the federal government. Adopted with urgency. Watch.
There's been a lot of good reporting about the dramatic impacts of the proposed budget cuts. The only problem is that the cuts are sometimes cast as inevitable.
Let's be clear. These cuts are a choice. A choice by our leaders and policymakers.
And they are the worst possible choice they can make.
I make that point in an op-ed in the San Francisco Chronicle, not just detailing the health care cuts' devastating impact on coverage, on our health system, and our economy--but also pointing to possible solutions.
We need the revenues and taxes needed to prevent the cuts that are beyond the pale. We recognize the political obstacles, but anything else is simply not acceptable
Health Wonk Review has a full, robust biweekly compendium of posts at Joe Paduda's Managed Care Matters, whic week all focused on the health reform debate.
Much of the debate is on the proposal to have a public health insurance option, so people are not solely at the mercy of the big insurance companies. It is strange this is controversial in the national debate: after all, in California, we have several public health coverage options, such as local county-run plans.
Given that most of the plans have an individual requirement to take coverage, the public health insurance option becomes even more important to making everything work. Imagine the requirement that all children enroll in school without the creation of a public school system.
The American Medical Association was reported to be dead set against the public option, but today they clarified their position and left room for negotiation, as reported by Health Care for America Now's blog.
Last week, the "Blue Dog" coalition of conservative Representatives put out a statement in favor of health reform, but with lots of provisions to restrict a public health insurance option, including a "trigger" mechanism that would delay or ultimately deny any such choice. But since then, many members of the Blue Dogs have distanced themselves from the statement, and come out in favor of strong public health coverage option.
We need to make sure that people who are happy with the coverage they have can keep it. We need to make sure that the American people will be able to keep their doctors, and have a say in their health care decisions. But we must expand the options, so that Americans who don't like their plan, or don't have health care coverage, have a choice. And we can't afford to wait for an arbitrary "trigger" to be pulled to put this reform into operation. If that is part of the bill, reform will likely never happen.
A public plan that provides true competition will be an important part of this reform. According to data from the Kaiser Family Foundation, a widely respected non-profit health policy research foundation, nearly two thirds of Americans agree with me that we need to make sure that all Americans have access to affordable health care by providing an alternative to the private insurance options that are on the market.
Harman, in a statement, said she supports a public option without a trigger. "I will oppose any plan that does not include this option, and am unwavering in my opposition to the so-called 'Blue Dog trigger,'" said Harman. [...]
Harman said she's sticking by her pledge.
"I am proud to have signed the HCAN (Health Care for America Now!) pledge to seek universal coverage," she said. "I am a strong supporter of universal health coverage, which is why I support the health care reform plan being developed by President Obama, Senator [Ted] Kennedy, and Congressman [Henry] Waxman. Like them, I believe that the bill must include a public health insurance option which guarantees all Americans access to quality, affordable health care."
Rep. Loretta Sanchez (D-Calif.), a Blue Dog who also signed the pledge, told the Huffington Post she backs a public option without a trigger. "America can't afford to wait for health care reform. While a single-payer system would be ideal, I am prepared to support other measures that also reduce costs, preserve doctor choice, and assure affordable, quality health care for all Americans," she said in a statement. "I think a public option without a trigger would be a good way to fix what's wrong with health care while preserving what works."
Our public option is going to be just another aspect of it. Put it out there, and they can compete. I think we're going to have to have competition … to get the best possible health care at the lowest cost possible.
We're checking in with other Congressional offices up and down the state, but the trend looks good.
First round on health cuts from the Budget Conference Committee...
Tuesday, June 09, 2009
HEALTH ACCESS UPDATE Wednesday, June 10th, 2009
BUDGET CONFERENCE COMMITTEE REVIEWS GOVERNOR'S HEALTH CUTS * Committee to Decide Later on Major Cuts to Medi-Cal, Healthy Families, AIDS Programs * Cuts Made to Alzheimer's Services, Asthma, Application Assisters, AIM, MRMIP, Etc. * Some Cuts Considered Way Too Severe: "A Bright Red Moral Line" * Governor Continues to Reject Revenues Needed to Prevent Devastating Cuts
* More Updates on the NEWLY REDESIGNED Health Access Blog: California's Cartoon Future; Previous Posts From Budget Conference Committee; The Real Start of National Health Reform; Unprotected While Still Paying Premiums; The New Kaiser Health News; A Lack of Competition in California's Insurance Market; Passage of Key Bills in the Legislature; Maternity Coverage Debated; Who Is Impacted By the Budget Bloodbath?; Report from Appropriations Committee; New Budget Blogs
* Follow Health Access California on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget and health reform issues.
Over the last two days, the Budget Conference Committee of the California Legislature have been reviewing the full range of cuts to health and human services. They have made severe cuts, and rejected even worse proposals.
Stymied by a lack of big-picture information, the Committee chaired by Assemblywoman Noreen Evans did not take final action on a number of sweeping health care program cuts proposed by Gov. Arnold Schwarzenegger to help balance California’s teetering budget. They "held open" these cuts, but with the expectation that many specific decisions would be made by Monday.
The committee took a pass on voting on several of the harshest cuts until a more comprehensive look at the impacts could be pulled together. It is still possible, even likely, that many of the programs "held open" may get cut, especially if the legislature does not raise the revenues needed to offset these cuts.
Among the items held open were:
* A controversial proposed waiver the governor is seeking from the federal government, which the Department of Finance said would save the general fund $1 billion. The governor says the waiver will allow him flexibility to operate outside of some of the federal government’s Medicaid rules, and the conditions of accepting billions from the economic stimulus package, the American Reinvestment and Recovery Act. The LAO said the savings were “speculative” at best. The proposal was held over when Committee Vice Chair Denise Ducheny (D) sought more specific information, noting that California already has lowest per-patient Medicaid spending in the nation.
* Elimination of the Healthy Families program that serves nearly 1 million children. Abolishing the program would save the general fund $368 million but would also cost the state $644 million in matching federal funds. It would also make California the only state in the nation to totally opt out of the federal Children’s Health Insurance Program, which provides $2 to match every $1 spent by the state. Said Committee Chair Noreen Evans, “I think we have a moral obligation to take care of our children. To eliminate a program like this is just indefensible. I will not support the elimination of this program – but I will think about cuts.”
* Elimination of all general fund support, or $34.2 million, for community health clinics -- including rural, seasonal migratory worker clinics and American Indian health clinics, as well as the Expanded Access to Primary Care Clinics. Together, the clinics provide about 2.3 million visits annually for low-income and uninsured people;
* Elimination of maternal and child health (MCH) funding for the black infant health program designed to help “at risk” pregnant women and parents; the Adolescent Family Life program, which helps 17,000 pregnant teens up to 18; a birth defects monitoring program; a local county grant program aimed at improving the health of young women and families;
* A proposal to restrict Medi-Cal services to new legal immigrants and people allowed to relocate to the U.S. by the federal government – such as survivors of the Vietnam War who aided U.S. troops. The latter group “tends to be refugees as a whole, mostly political refugees” said Ducheny. She favored finding out if the federal government is willing to devote more funds to help pay for health care services for this population.
* Reduced funding for AIDS programs that Senator Mark Leno (D) said has reduced the threat of AIDS in California from the level of an epidemic.
* A proposal to eliminate Adult Day Health Care opened a discussion as to whether various programs aimed at helping the elderly, including Alzheimer’s victims, shouldn’t be re-examined, restructured and streamlined to make them more efficient. The proposal, which the Department of Finance said would save $170.5 million, was held over as well.
The committee’s frustration was evident, with Vice Chair Denise Ducheny (D) demanding a more comprehensive analysis of the piecemeal, disjointed cuts proposed to health care programs. Evans scolded Department of Finance, saying the committee needs to be able to make informed decisions. “We simply don’t have the information we need by virtue of how this budget is worked out,” Evans said.
Also rankling Evans were the governor’s requests for money to hire anti-fraud staff in various positions – at the same time as current state employees are asked to shoulder cutbacks in compensation. “I think adding new positions when we are furloughing employees is not a good way to go,” Evans said. “This is a problem. Why, with furloughs, would we ask for more money? I’m not really in favor of approving more positions.”
But Assemblyman Roger Niello (R) pushed his colleagues to make hard choices swiftly, noting the budget deficit of $24 billion represents a 25 percent reduction in revenue flowing into the state’s coffers. “Excuse me for sounding like a Republican, but government is not the only answer to our problems,” Niello said, adding that the private sector as a whole has not taken as hard a hit as state government has.
CUTS MADE: A variety of cuts were made--often with relatively small savings but big impaccts. Niello pressed for elimination of $20 million in state funding for the Domestic Violence Shelter Program, which would reduce services to over 105,000 battered women. He said that community supporters, nonprofit foundations and philanthropists should step up their donations to the shelters. “This is a perfect example of the many difficult decisions we’re going to have to make,” Niello said. From a personal perspective, I support the shelters – I have donated money to them and will continue to do so as a member of the community.”
Though the governor’s proposal would have eliminated all general fund support for the shelters, Republican Assembly members on the committee said they could back a 50 percent cut. Ducheny asked for a less onerous generous 10 percent cut, then compromised and proposed the 20 percent cut the committee eventually adopted.
Assemblymember Kevin de Leon (D) said he was struggling with approving any cuts to the shelters, noting that he has family members who have been victims of domestic violence and sought refuge in the shelters. Of the governor’s original, harsher proposal, de Leon said, “This is a real tough one. This is not a haircut, it is a decapitation. If the economy continues to sour, demands for these services will be needed more than ever,” as stress and financial strain impact more family lives, he said.
* The budget committee met the governor halfway on another proposed cut. The Governor proposed eliminating general fund support for Alzheimer’s Research Centers, of which there are 10 throughout the state. The committee agreed to a 50 percent funding cut, with the stipulation that the $3 million saved would go toward providing services instead of research.
Other cuts that were decided on included:
* The one-time elimination of support for the immunization assistance program, for $18 million in savings, in light of economic stimulus funds going to the same purpose. * The suspension of a children's dental disease prevention program that served 300,000 children, for a savings of $2.9 million. * The elimination of certified application assisters that help low-income families apply, stay enrolled, and use Medi-Cal and Healthy Families coverage, for a savings of $2.7 million, with the probability of reducing enrollment as a result. * A $6.6 million reduction in the Major Risk Medical Insurance Program (MRMIP), which provides some coverage to those "uninsurable" patients denied for "pre-existing conditions"--and already has a waiting list. * A $4.9 million reduction in funding for Access for Infants and Mothers (AIM), which provides health care to over 13,000 pregnant women. * A reduction in funding for the state Asthma program
After a dramatic discussion, the committee voted against killing the programs, packaged together to shave $20 million off California’s gigantic $24 billion deficit. “If we go with the governor’s proposals No. 2, 3, 4 and 5, people will die,” Assemblyman Kevin de Leon (D) told his colleagues.
Assemblyman Robert Blumenthal (D) was blunt: “This is a bright red moral line we cannot cross. It’s something I am very worried about.”
Still, the prospect of drawing a line when the task of balancing the budget seems so Sisyphean struck Senator Bob Dutton (R) as impractical. The budget must be balanced by June’s close. “I don’t think it’s right saying people are going to die,” Dutton said. “I mean, I could die in a car crash today when I leave here. I still support the governor’s proposal.”
The Committee also rejected family planning funds, which had the benefit of providing a 9:1 match from the federal government.
ONGOING EFFORTS: While a budget for 2009-10 was approved in February, these budget cuts are part of a Governor's proposal to solve a $24 billion deficit that has emerged since then, as part of the economic recession. The Governor has yet to budge from his all-cuts approach to the budget, and has rejected raising taxes and revenues as a way to prevent the worst of these cuts.
In addition to the $2.4 billion in health care cuts, there are other severe cuts to other human services as well, to IHSS home care, SSI/SSP for seniors, CalWORKS, CAPI and CFAP.
The Budget Conference Committee will soon revisit the cuts "held open" in the next few days. Committee Chair Evans indicated the goal of having the Committee finish their work by Monday.
This report was written by Cynthia Craft of Health Access California. More commentary will be available on the newly-redesigned Health Access website at http://www.health-access.org, and our blog, at http://blog.health-access.org.
A scarily specific parody about the cuts that California is contemplating, from Slate magazine.
As someone with heritage from Ecuador, my only complaint is that if we go through with these cuts, we'll give actual banana-producing countries a bad name.
The team at Health Access will continue following the Budget Conference Committee's review of the health care cuts, both on this blog and on our Twitter account at @healthaccess, or www.twitter.com/healthaccess.
After a dramatic discussion, the committee voted against killing the programs, packaged together to shave $20 million off California’s gigantic $24 billion deficit. “If we go with the governor’s proposals No. 2, 3, 4 and 5, people will die,” Assemblyman Kevin de Leon (D) told his colleagues.
Assemblyman Robert Blumenthal (D) was blunt: “This is a bright red moral line we cannot cross. It’s something I am very worried about.”
Still, the prospect of drawing a line when the task of balancing the budget seems so Sisyphean struck Senator Bob Dutton (R) as impractical. The budget must be balanced by June’s close. “I don’t think it’s right saying people are going to die,” Dutton said. “I mean, I could die in a car crash today when I leave here. I still support the governor’s proposal.”
The unprecedented public committee meeting offered a rare peek at how deeply divided five Assembly members and five Senators can become when the stakes are so high. Tension was palpable between the two political parties, between Assembly members and Senators, between urban and rural elected representatives – even between those who believed previously struck budget agreements should prevail, and those who believed all bets were off.
Many items on the governor’s chopping block were “held open” for later discussion, and votes, following committee members’ request for more data from the Department of Finance and the Legislative Analyst’s Office.
That was the case with a controversial proposed waiver the governor is seeking from the federal government, which the Department of Finance said would save the general fund $1 billion. The governor says the waiver will allow him flexibility to operate outside of some of the federal government’s Medicaid rules, and the conditions of accepting billions from the economic stimulus package, the American Reinvestment and Recovery Act. The LAO said the savings were “speculative” at best. The proposal was held over when Committee Vice Chair Denise Ducheny (D) sought more specific information, noting that California already has lowest per-patient Medicaid spending in the nation.
Also controversial, and held over, was a proposal to restrict Medi-Cal services to new legal immigrants and people allowed to relocate to the U.S. by the federal government – such as survivors of the Vietnam War who aided U.S. troops.
The latter group “tends to be refugees as a whole, mostly political refugees” said Ducheny. She favored finding out if the federal government is willing to devote more funds to help pay for health care services for this population.
A proposal to eliminate Adult Day Health Care opened a discussion as to whether various programs aimed at helping the elderly, including Alzheimer’s victims, shouldn’t be re-examined, restructured and streamlined to make them more efficient. The proposal, which the Department of Finance said would save $170.5 million, was held over.
Two of the budget trims that were approved Monday called for conducting a therapeutic category review of antipsychotic drugs for mental illness (an estimated savings of $1.5 million) and requiring manufacturers’ rebates on HIV/AIDS and cancer drugs.
More quotes and blow-by-blow descriptions of votes and discussion are at the Twitter feed at www.twitter.com/healthaccess. The committee resumes its examination of cuts in health care services at 10 a.m. on Tuesday, June 9th.
As of this writing, the committee has made some tough cuts already, but had kept "open" cuts like the elimination of the California Poison Control System, the $1 billion unspecified cut to Medi-Cal (based on federal "flexibility"), and the 10% cuts to private "safety-net" hospitals. We'll have a full report later today.
The Budget Conference Committee is scheduled to come back on Monday, June 8th at 2pm to start discussing and reviewing specific health care cuts. At stake is the health care coverage of over 2 million Californians, and the state's health system on which we all rely.
While we in California have been focused on bills and budget, the federal health reform debate is now in full force. Earlier this week, President Obama sent key Senators a letter detailing more of his requirement, from more emphasis on cost containment to the need for a public health insurance option.
Friday, a "draft of a draft" of was released by Senator Ted Kennedy's office of a health reform bill. We'll have an update and some analysis later. (Courtesy of The Hill, here's a copy of the 170+ pages, which is understood to be only a part of a broader package.) Other proposals, especially in the House, will also be introduced. Now, the debate is very real.
Lawmakers and regulators in states including Texas, Vermont and New York are pushing new efforts to make health insurers' consumer communications clearer, though many states already have some requirements on their books. Rhode Island's health insurance commissioner wants to make insurers write all documents at an eighth-grade level. A California bill would classify insurance plans by their levels of coverage.
Why is this important? The new study from earlier this week on personal bankruptcies makes the point: Over 60% of bankruptcies involve medical bills as a factor, and around 75% of those bankruptcies are people with health coverage. In many cases, their coveraeg has let them down. At a minimum, people expect health coverage to prevent them from going into bankruptcy. If it doesn't do that, then it doesn't deserve to be called coverage.
The Budget Conference Committee is slated to reconvene at 1:30, on higher education and child care issues.
We expect that health issues will be up tomorrow, Saturday, and human services issues on Monday. We'll provide more updates here an on Twitter, at @healthaccess, or www.twitter.com/healthaccess.
Kaiser Health News is a new, nonprofit journalism site, providing new reporting that is offered on the web and to other media outlets. We've commented on the wrenching changes in the media, and this is an attempt to continue good journalism around health issues even as the industry is in turmoil.
The excellent journalists behind Kaiser Health News are very familiar to California readers. They include Julie Appleby, who reported in California before going on to a prominent national health beat at USA Today, and Jordan Rau, the infamous Los Angeles Times reporter who just moved from Sacramento.
The Assembly passed AB786(Jones), sponsored by Health Access California, to provide better transparency in the health insurance market, and more confidence for consumers in their coverage. Republican legislators opposed the proposal as "limiting choice." Recognizing the problems of "junk" insurance, Assemblyman Solorio spoke in favor of the bill after some amendments were taken.
Other bills that passed include AB2(De La Torre) to regulate insurance rescissions, and SB227(Alquist) to reform the MRMIP high-risk pool.
One bill that didn't pass was SB316(Alquist) to set a standard for medical loss ratios in insurance companies.
More later on these bills, but mostly back to the budget...
Health insurance premiums for California working families have increased 96 percent from 2000 to 2007. At the same time, the median earnings of California workers increased 19 percent from $25,740 to $30,702. That means health insurance premiums for California working families have risen five times faster than wages.
Wihle not the only cause of rising health premiums, one factor is the marked concentration in the health insurance market. In virtually every area of California, the new report shows that just a couple of companies have over half the health insurance market. Individual consumers and small businesses have no market power against the Blue Cross and other big insurers, who can set the premiums and the benefits
Consumer groups argued that these finding show it’s time for real comprehensive health reform that includes regulation and the choice of a public health insurance plan so patients are no longer at the mercy of the private health insurers in California. At the state level, they also support AB786(Jones), providing standards for coverage, up in the California Assembly today.
“For too long, insurance companies have competed based on dropping the sick, rather than through lowered costs and higher quality. Now this new research shows that they haven’t even been competing much at all!” said Michael Russo, health care advocate and staff attorney for CalPIRG. “The choice of a public health insurance plan will give consumers better options – and will keep insurers honest.”
The American Medical Association reports that the health insurance marketplace is dangerously concentrated with 94 percent of local markets in the United States currently considered highly concentrated. And contrary to what the health insurance industry claims, these mergers have undermined market efficiency. Premiums nationwide have gone up an average of more than 87 percent over the past six years.
“There is no real choice or competition in the private health insurance market, and only giving everyone the option of a public health insurance plan will guarantee we get quality, affordable health care we all can count on this year,” said Marty Martinez, policy director for the California Pan-Ethnic Health Network. “A public health insurance option will force private health insurance companies to control cost, guarantee quality, stop hiding what they will and won’t cover, and put people’s health before corporate profit.”
Some facts about the insurance industry in California:
* Anthem Blue Cross, a subsidiary of WellPoint Inc. and the state’s largest insurer, controlled 30 percent of the California market in 2008. Together Wellpoint, with Kaiser Permanente, they hold 58 percent of the California market.
* Such consolidation is especially true in smaller markets. By itself, WellPoint, Inc. (Anthem Blue Cross) holds 60 percent of the market in Salinas and more than 50 percent of the markets in San Luis Obispo and Redding .
* Health insurance premiums for California working families skyrocketed by 96 percent from 2000 to 2007.
* For family health coverage in California during that time, the average annual combined premium for employers and employees rose from $6,227 to $12,194.
* For family health coverage in California , the average employer’s portion of annual premiums rose 91 percent, while the average worker’s share grew by 111 percent.
On the conference call releasing the report was Linda Jackson, of Grass Valley , CA , who has experienced the problems in this concentrated and confusing health insurance market. They lost their coverage after being laid off by Formica after 34 years of working there. She and her husband, in their late 50s, now pay over $1100/month, even though they are relatively healthy. They have been shopping around for coverage but their options are limited, and she is worried about getting any new coverage she gets may not be comparable to her current coverage in terms of benefits.
The concentration in the health insurance market is seen not just impacting premiums, but the quality of the health policies and the benefits they provide. The lack of competition is further exacerbated by a confusing and unstructured marketplace, where consumers find it impossible to compare plans. At the federal level, health reform proposals offer a “health insurance exchange” that would standardize and set basic benefit levels, and a public health insurer as a new, affordable option for people to secure basic coverage.
At the state level, AB786(Jones) would set basic health insurance standards to allow for better “apples-to-apples” comparisons, and limit “junk” insurance. Health Access California, the sponsor of AB786, argues that consumers need health reforms that provide greater oversight and standards for the insurance industry, who right now dictate the terms of coverage with their market power. The bill is scheduled to be voted on in the California Assembly today, Wednesday, June 3rd, 2009.
The report is also being released as insurance companies executives from across the nation are coming to San Diego , California , for the annual conference of their trade association, America ’s Health Insurance Plans (AHIP). The report is being release in advance of a Rally for Health Reform, on Thursday, 8-10am, in front of the AHIP conference at the San Diego Conference Center , 111 W. Harbor Drive.
The report was prepared by Health Care for America Now - the nation's largest health care campaign - is made up of more than 1000 organizations representing more than 30 million people nationwide. President Obama and more than 190 Members of Congress support HCAN’s principles for health care reform. All across the country, HCAN supporters are organized and mobilized to stress the urgent need for health care reform in 2009 -- reform that finally puts our health care needs before insurance company profits.
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.
