The past week has been a roller coaster for health care reform... but it ended on a great note.
The Senate Finance Committee, after suggesting progress in its "bipartisan" negotiations, admitted it was not ready to pass out a bill... or even produce one before the August recess. The other committee of jurisdiction, the Senate HELP (Health, Education, Labor and Pensions) Committee, had passed out its part of health reform two weeks ago. Senator Max Baucus put a deadline of September 15th for action by his Senate Finance Committee.
In the House of Representatives, two or three committees had done their work, but the remaining committee, Energy and Commerce, was being held up by conservative "Blue Dog" members. Negotiations broke down, were rejoined, and went back-and-forth in the past week.
In the last 48 hours, a deal was had between Energy and Commerce Chairman Henry Waxman (D-Los Angeles) and four of the committee "Blue Dogs." One of the concessions was time, having a committee vote this week but postponing a full floor vote until after the August recess. The substantive changes were more concerning, including reducing the subsidies to make health coverage affordable for low- and moderate-income consumers.
The Progressive Caucus, chaired by California Representative Lynn Woolsey pushed back, especially against changes in the public health insurance option and the affordability subsidies. They finally agreed to support the bill in negotiations when they worked to find other savings to restore some of those affordability subsidies. (More about the substance of the bill and amendments later.)
This evening, the House Energy and Commerce Committee did, in fact, pass the bill H.R. 3200 out of the committee, 31-28, with all but five Democrats voting for the measure. Those conservative "Blue Dogs" joined Republicans who were united in opposition.
For Californian Representatives who made up a sizable portion of the Committee, the vote was exactly party line. California Democrats, including New Democrats and Blue Dogs, voted for the measure: Henry Waxman, Lois Capps, Doris Matsui, Anna Eshoo, Jane Harman, Jerry McNerney. The two California Republicans voted against, including George Radanovich and even Mary Bono Mack, who occasionally has broken with Republicans on certain votes.
It was noted that the passage of the bill in this committee was historic--this committee, nor this country, had not reached this point in health reform in the early 1990s. And the passage does provide some much-needed momentum going into August recess. Health reform has passed four of five committees. This bill will be available for a full House floor vote right after the break in September.
There's a lot more work to do, but we should savor important steps in the process.
Here's a report by Cynthia Craft, communicatin & policy coordinator at Health Access, from the MRMIB meeting on Thursday:
Disclosing that it likely will have to purge some children from the Healthy Families Program, the Managed Risk Medical Insurance Board, or MRMIB, reported Thursday that the wait list for the program, which froze enrollment July 1, had grown to 33,146 children in just two weeks.
The number was higher than anyone had imagined, and it reflects the bitter irony of cutting health care assistance for kids of low-income, tax-paying, legal residents at a recessionary time when they most need help.
As it now stands, the Healthy Families Program has lost funds that total $533.4 million, including federal matching funds no longer available due to the $194 million cuts made by the Legislature and Gov. Schwarzenegger. The federal government returns $2 of taxpayer funds to Healthy Families for every $1 the state dedicates to the program.
Advocates laid blame at the feet of both the governor and the Legislature for the choices they made in balancing the state budget.
“This is really a dark hour in California, when we are jettisoning children over other interests,” said Steve Barrow of the California Premature Infant Coalition, which strives to reduce the statewide 10% premature birthrate.
The outlook for California’s children in this down economy is likely to get bleaker, still. MRMIB announced it was setting a public meeting date of August 13th to discuss disenrollment, or kicking currently enrolled kids out of the program.
Several health care advocates testifying before MRMIB warned of “dire consequences” if children lost continuity of care, particularly in the case of cancer treatments.
Nearly every one of the two dozen or so who testified spoke of collaborating to find help from outside funders to prop up the Healthy Families program until its financial outlook improves.
Already, the First 5 Commission passed a resolution to help fill the gap for Healthy Families. Kris Perry, executive director of First 5, said it “pledged to provide, with some of the others, some of the funds” for children up to five years old. It was clear that the First 5 Commission was in the position to assist – but only to a point.
Nevertheless, Cliff Allenby, the chair of MRMIB, told Perry, “Needless to say, we appreciate your efforts since we are clearly in a large hole.”
Many held out hope that legislators would be motivated to successfully challenge the cuts upon reconvening after summer recess Aug. 17th.
Healthy Families was established by the federal government for low-income working families to provide health care for their children. State budget cuts made it necessary to establish a wait list for new enrollees July 17, and 14,000 children signed up the first week. Those who are bumped from the program through the anticipated disenrollment would go to the end of the list.
Earlier this year, President Obama announced an expansion of Healthy Families, known in Washington as the SCHIP program, funded by tobacco tax money. The President heralded the move as an important step in his larger goal of reform aimed at extending coverage to the nation’s 42 million uninsured adults. During the previous administration, former President George W. Bush vetoed legislation expanding the program to cover more children.
But California’s troubles, which attendees at the hearing said included a void of “emboldened leadership” on the state level, led to the opposite of what Obama intended. Now, health care coverage is less accessible and less affordable for low-income, working families in California – at a time when several other states managed to cover more children.
Even for families fortunate enough to remain in the much-smaller Healthy Families Program, keeping their children covered will become increasingly difficult financially. MRMIB plans to shift more out-of-pocket costs on to families enrolled in the program. Some of the cost-shifting suggestions read aloud by a staff member Thursday were drastic enough to make audience members audibly gasp.
The proposals, which staff and MRMIB said had yet to be thoroughly analyzed, include:
* Paying for eye exams, but not for glasses. * Eliminating vision benefits altogether. * Rescinding a new rate increase to insurers such as Anthem Blue Cross. * Increasing medical co-pays, such as: -- Physician visits would rise from $5 to $10. -- Name-brand prescriptions would rise from $5 to $10. -- Inpatient hospitalization would rise from $0 to $250. -- Outpatient hospital services would rise from $5 to 20% of the service cost. -- Emergency room services would rise from $5 to $50 unless hospitalized. -- Medical transportation would rise from $0 to 20%. -- Durable medical equipment would rise from $0 to 20%. -- Basic outpatient mental health services would rise from $5 to $10. -- Inpatient alcohol and drug treatment would rise from $0 to $250 per admission. -- Outpatient alcohol and drug treatment would rise from $5 to $10. -- Eye exams, if not eliminated, would go from $5 to $25. -- Subscriber premiums would go from $20 per child to a maximum of $60, in the income range from 150%-200% of the federal poverty level. -- Subscriber premiums would go from $30 per child to a maximum of $90 for families in the range of 200%-250% of the federal poverty level.
As of June 2009, Healthy Families served 920,000 children. In recent months, the program has accepted 29,000 new enrollees monthly.
On Thursday, MRMIB members mostly sat silent while listening to input from the community. Those testifying with concerns about children’s health included Beth Capell, the advocate for Health Access California, who noted that health care costs were the major cause of homelessness for families prior to the launch of Healthy Families.
“We are about to return to those dark days,” Capell said, noting that the governor’s “blue pencil” cuts also obliterated funding for community health clinics.
Capell also pointed out that the number of children at risk of not having coverage in California is greater than the population of 40 states including Massachusetts.
Also testifying in support of children’s health care were representatives from Children Now, the 100% Coalition, the California Teachers Association, the American Academy of Pediatrics, Local Health Plans of California, California Children’s Hospital Association, the Children’s Coalition, PICO, California Primary Care Association, Santa Clara Health Plans and the Community Health Council.
That's a high bar: last month, they closed the door to new enrollments, instituted a "waiting list" which is really just a euphemism for denying coverage to 350,000 children over the next year.
But this meeting will be even tougher. With a $194 million shortfall due to the budget signed by Governor Arnold Schwarzenegger Tuesday (which includes $50 million that he did through a controversial line-item veto), the board may have to take even more drastic steps--to kick hundreds of thousands of children off of coverage.
It is projected that over 900,000 children would be denied coverage--doubling the number of uninsured children in California, undoing a decade of progress.
The San Jose Mercury News editorial board sums up the issues with appropriate disdain. The Governor and Legislature appropriately criticized insurers from rescinding coverage from patients, but their action here is as bad, yanking coverage during a bad economic time when such coverage is probably needed most. Coverage that won't be there during when you need it is no longer coverage. If Healthy Families starts disenrolling children from coverage, it fundamentally alters the program forever.
MRMIB will review options, including if any money can come from other sources like the First Five Commission, or from insurers who participate in the program. But the outlook is grim.
Here's how the White House framed health reform today, in terms of providing security for consumers, especially from the worst abuses of insurers:
The Security You Get from Health Insurance Reform:
* No Discrimination for Pre-Existing Conditions Insurance companies will be prohibited from refusing you coverage because of your medical history.
* No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
* No Cost-Sharing for Preventive Care Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
* No Dropping of Coverage for Seriously Ill Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
* No Gender Discrimination Insurance companies will be prohibited from charging you more because of your gender.
* No Annual or Lifetime Caps on Coverage Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
* Extended Coverage for Young Adults Children would continue to be eligible for family coverage through the age of 26.
* Guaranteed Insurance Renewal Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.
Many of these concepts are, or have been, bills here in California, including coverage for young adults dependents, to capping out-of-pocket expenses, to prohibiting gender discrimination.
At a Health Access California board meeting last week, it was remarked how much of our legislative agenda would be resolved if the health reform in the House of Representatives, H.R. 3200, was passed. And what's more remarkable is how most of these elements are the accepted consensus of health reform, rather than the controversial items.
GOVERNOR'S LINE-ITEM CUTS DEVASTATE CALIFORNIA HEALTH CARE * $50 Million More in Cuts to Healthy Families; Over 900,000 Kids to Be Denied Coverage
* Additional cuts to HIV/AIDS Care, Community Clinic Funding, Maternal/Child Health Programs, Medi-Cal County Administration, and Key Human Services
* Shocking, Large, Outrageous Cuts Will Deny Coverage & Care to Hundreds of Thousands of Californians, Impact Health System On Which We All Rely, and Hurt Our Economy
* More Updates on blog.health-access.org: Are These Cuts Legal?; Updates on Federal Health Reform; Wonkery on the Weekend; The Challege of August Recess for Reform; Governor Schwarzenegger's Knife; Reaction to the Passage of a Budget; The President Lays Our What's In It For You; The Governor's Budget "Reforms" of Medi-Cal; and much more...
Governor Arnold Schwarzenegger today signed a budget reduction package today, including an additional $600+ million in unilateral and controversial cuts, largely to health and human services.
BACKGROUND: In February 2009, the Governor signed a budget for the current fiscal year that included $15 billion in spending cuts to health and other vital services, as well as a spending cap plus five other proposals that voters rejected in a special election on May 19, 2009.
With the economy worsening, the Governor and the Budget Conference Committee proposed solutions to fill the growing budget deficit, a final budget was passed last week that was largely negotiated by the Governor and legislative leaders. Combined, the February and July solutions signed by the Governor, close a $60 billion budget gap in the state’s General Fund.
Governor Arnold Schwarzenegger today signed the budget that was passed last week, but not before making $650 million in additional "blue pencil" reductions. Over $516 million were in specific line-item veto cuts, with over $400 million of those to health and human services. The added cuts were jaw-dropping to many advocates for health and human services.
The Governor has zeroed out some programs, such as some state funding for community clinics, and others were preserved in name only. Healthy Families, which has grown over a decade to cover nearly one million children, will not be the same program, as it is now shuttered and will likely be actively kicking kids off coverage.
THE ADDITIONAL CUTS made unilaterally by Governor Schwarzenegger today include:
* An additional $50 million cut to Healthy Families, raising the total shortfall for the program to $194 million, well over half the program's state funding. As a result, Healthy Families will likely deny coverage for over 900,000 children, including actively disenrolling hundreds of thousands of kids, yanking their coverage away. This one budget cut would double the number of uninsured children in the state of California, undoing a decade of progress.
* Additional cuts of $52 million to programs under the Office of AIDS Prevention and Treatment, including education and prevention, therapeutic monitoring, counseling and testing, early intervention, home and community-based care, and housing.
* An additional $25 million cut that would eliminate state funding for community clinics, including Expanded Access to Primary Care. This is especially devastating when the number of uninsured are increasing, partially due to other cuts.
* An additional $12 million in cuts to Maternal, Child and Adolescent Health local assistance programs, including the Adolescent Family Life Program and the Black Infant Health program.
* An additional $60 million in Medi-Cal county administration, making it harder for California children, parents, seniors and people with disabilities to get on and stay on Medi-Cal coverage.
Other human services cuts include:
* An additional $80 million cut to funding for the Child Welfare Services Program, which responds to reports of abuse and neglect. * An additional $50 million cut to funding for Regional Center services for children up to age 5 who have developmental disabilities. * An additional $40 million in cuts to In-Home Support Services (IHSS) home care, further reducing eligibility. * An additional $16 million in cuts to domestic violence programs, largely battered women's shelters.
Consumer and community groups point out that California has better choices than to deny coverage to hundreds of thousands of children, or to make such devastating cuts to the health system on which we all rely. Check the Health Access website (http://www.health-access.org) and blog (http://blog.health-access.org) for the most up-to-date information.
THE OVERALL HEALTH BUDGET signed today, including the cuts made today, include the following cuts to health care:
* Denying hundreds of thousands of children health coverage. The Healthy Families program current covers nearly one million low-income children between 100-250% of the federal poverty level. The proposed cut of $194 million in state dollars (well above the recommendation of the Budget Conference Committee) would deny over 900,000 children coverage. First, the newly-imposed wait list would deny over 350,000 children over the course of the budget year. Second, the size of cut would force California to actively disenroll over 500,000 additional children--based on an assumption that the children would be kicked off during the time of annual renewal. depending on when they are disenrolled. In addition, for every dollar we cut in Healthy Families, we are losing two dollars in federal matching funds for our health system, and our economy.
* Making severe cuts to prevention-oriented and core health programs. While rejecting outright eliminations, the Budget Conference Committee made drastic cuts to a series of health care programs and services. The budget also includes:
o Cutting mental health, including reducing by $92 million of funds for the Mental Health Managed Care Services, and the Early and Periodic Screening, Diagnosis and Treatment program. A $14 million cut would eliminate state money for ancillary health services in Institutions for Mental Disease. o Cutting HIV/AIDS care, reducing funding by $85 million.
o Cutting Adult Day Health Care, limiting it three days a week and other changes, a $26.8 million cut o Cutting hospitals, taking $23 million from the Distressed Hospital Fund o Cutting funding for community clinics, zeroing state general fund support for programs like Expanded Access to Primary Care, (with cuts also to the Rural Health Services, Seasonal Migratory Worker and the Indian Health Program).
o Cutting maternal and child health care significantly, including the Black Infant Health Program; Adolescent Family Life Program, and others. o Cutting last-option health coverage for those rejected for “pre-existing conditions”, reducing the Major Risk Medical Insurance Program by $6.6 million. MRMIP already has a waiting list, with 7,100 enrollees, despite estimates of over 400,000 eligible “uninsurables.” o Cutting health coverage for mothers and newborns babies to get prenatal and post-natal care, reducing the Access for Infants and Mother program by $4.9 million. The cut would force a waiting list, basically denying care to pregnant women.
o Cutting all of the Immunization Program, for $18 million. o Cutting community application assisters that help enrollment in public coverage like Medi-Cal and Healthy Families, for $3 million. o Suspending a children’s dental disease prevention program, for $3 million.
* Advancing controversial Medi-Cal proposals that would make it harder for patients to get the care they need.
* One provision would seek to privatize county eligibility workers for Medi-Cal and other human services. As reported in the media, the legislative leaders agreed to a process to consider the Governor’s recent proposal to privatize and replace the current county workers who assist Californians enrolling in Medi-Cal and other social services with a private contractor like Maximus or Halliburton. The reports indicate that the consideration would allow stakeholders to vet the proposal and requires legislative approval. * Another provision would mandate managed care for seniors and disabilities on Medi-Cal. Consumer advocates have been long concerned about the impact on patients and their access to care and specialists, as well as funding impacts to safety-net institution.
It’s important to note that these and other cuts are on top of the cuts made in February 2009. Those cuts included the elimination of 10 benefits, including dental coverage, for the nearly 3 million adults (parents, seniors, and people with disabilities) with Medi-Cal coverage. Those went into effect recently on July 1, 2009.
Here's Assembly Speaker Karen Bass, with emphasis added by us:
“It’s a shame Governor Schwarzenegger is so eager to tear down the safety net that he appears willing to break the law to do it.I am asking Legislative Counsel for a definitive opinion on the legality of the governor’s actions."
"The cuts the governor made today will have catastrophic effects on children, domestic abuse victims, and seniors. The cuts the governor made today have broken the lifeline to the state’s most vulnerable and underserved. We sent the governor budget solutions that solved the deficit. He knows that. He knows we pledged to work with him on building up the reserve in August. He knows all that and still chose to take punitive measures against children and AIDS patients. It wasn’t too long ago when a 24 year old woman born with HIV pleaded with Legislators not to adopt the Governor’s proposal to eliminate the program that provides the drugs that keep her alive. It wasn’t too long ago when a disabled woman, needing both the assistance of a wheel chair and oxygen, pleaded to stay out of a nursing facility in the event her in-home assistance would be eliminated by the Governor.
“Throughout the past several months, Democrats in the Legislature worked to spare these vital services from elimination. The governor’s actions today have not just caused harm; his actions today put lives in jeopardy. He is cutting funding for the Black Infant Health Program at a time when African American babies have a mortality rate three times higher than white babies. The governor is choosing to make devastating cuts to child welfare services, leaving children and foster kids vulnerable. Earlier in the budget process the governor threatened to veto bills that charged oil companies the same fair share severance tax they pay in other states and to levy tobacco products for the harm they inflict on the health care system and the state’s general fund. Had the governor not stood up for big oil and big tobacco, these devastating cuts also could have been avoided.
“The governor said he wanted to take on waste, fraud, and abuse but that appears to have meant taking on victims of domestic abuse. That’s shameful, but not totally unexpected from an administration that has been historically hostile to safety net programs.
His Republican colleagues in the legislature blew up their deal and the governor takes it out on the sick, the young, the elderly and battered women—all cuts he has been dying to make since his May budget revisions. For our part, my colleagues and I will move forward to restore any of these unnecessary cuts that are found to be legal and build a responsible reserve to accompany the full deficit solution we sent the governor last week.
“I do also have to say this kind of game playing by the governor doesn’t bode well for success in terms of water, corrections, pensions or any of the other items the he is looking to in order to build some kind of real legacy. He and his staff may be lighting cigars to celebrate these cuts, but they should also be concerned about the devastating harm they are causing—and about burning their bridges.”
Governor Arnold Schwarzenegger signed the budget today, but not before making $650 million in additional "blue pencil" reductions. Over $516 million were in specific line-item veto cuts, with over $400 million of those to health and human services. The added cuts are jaw-dropping.
* An additional $50 million cut to Healthy Families, raising the total shortfall for the program to $194 million, well over half the program's state funding. As a result, Healthy Families will likely deny coverage for over 900,000 children, including actively disenrolling hundreds of thousands of kids, yanking their coverage away. This one budget would double the number of uninsured children in the state of California, undoing a decade of progress.
* Additional cuts totalling $52 million to programs under the Office of AIDS Prevention and Treatment, including education and prevention, therapeutic monitoring, counseling and testing, early intervention, home and community-based care, and housing.
* An additional $25 million cut that would fully eliminate state funding for community clinics, including Expanded Access to Primary Care. This is especially devastating when the number of uninsured are increasing, partially due to other cuts.
* An additional $12 million in cuts to Maternal, Child and Adolescent Health local assistance programs, including the Adolescent Family Life Program and the Black Infant Health program.
* An additional $60 million in Medi-Cal county administration, making it harder for California children, parents, seniors and people with disabilities to get on and stay on Medi-Cal coverage.
Other human services cuts include: * An additional $80 million cut to funding for the Child Welfare Services Program, which responds to reports of abuse and neglect. * An additional $50 million cut to funding for Regional Center services for children up to age 5 who have developmental disabilities. * An additional $40 million in cuts to In-Home Support Services (IHSS) home care, further reducing eligibility. * An additional $16 million in cuts to domestic violence programs, largely battered women's shelters.
There is a question of how legal these cuts are, given that this isn't a budget, but several bills to adjust the budget. Senate President Pro Tem Darrell Steinberg released a statement saying this "isn't the last word."
Right now, we're waiting for the Governor to announce his signing of the state budget at 11:00am. Kevin Yamamura of the Sacramento Bee has more details. Part of the question is what authority does the Governor actually have to make additional "blue pencil" cuts, given that this isn't actually a budget--that was passed in February--but a mid-year budget cuts package.
When we find out about the Governor's added cuts, we'll put our first report out via Twitter, at @healthaccess or www.twitter.com/healthaccess. (There's a Twitter feed on our homepage as well.)
But as always, we'll try to post information and analysis on this blog as soon as possible.
Is recess good or bad for reform? It's up to us...
Sunday, July 26, 2009
So there was a lot of back-and-forth this week on negotiations around federal health reform. President Obama's original timetable to have bills out of both the House and the Senate by August recess is not going to happen. It was always seen as ambitious, if not unrealistic, so it shouldn't be a surprise if it slipped a bit.
Instead, the new goal in the Senate is to have at least the Senate Finance Committee report out its version of the bill before recess in the next week or two, and then use the August recess to negotiate differences between that bill and the one earlier released by the Senate HELP Committee. That would allow the full Senate to debate the unified bill when they get back in September.
In the House of Representatives, two of committees have done their work, with the House Energy and Commerce Committee remaining. There continue to be negotiations with the "Blue Dogs" on the committee. We'll see if there can be a committee and/or floor vote before the recess.
Even in the most ambitious timetable never had a final health reform bill ready before the recess. The question wasa how far along in the process we would be.
What people are concerned about is not just slowing the process, but opponents using the August recess to organize the opposition. But Kevin Drum at Mother Jones magazine suggests that this is an opportunity as well in the August recess:
..there's more than one way to look at it anyway. The first way is the conventional one: Republicans are hoping that the August recess will slow things down. It gives them more time for attack ads, more time to manufacture uncertainty, and more time to drive wedges between unsteady allies on the pro-reform side.
That's all true. But the main thing that happens during the August recess is that everyone in Washington goes home and talks to people in their district. If their constituents are largely opposed to healthcare reform, it hurts the cause. But if they're pissed off about the status quo and want to know why Congress can't get off its butt and do something — well, that can actually speed things up.
Now, that's not normally what happens. And it won't this time either — unless Barack Obama's army of supporters are still ready to go out and answer the call of reform. I've long been skeptical about whether his famous electoral machine would continue to work after the campaign was over, but if there was ever a time to prove me wrong, it's now. If Obama's army is still willing to go out and do battle, they should show up now and start putting the fear of God into their congressmen. If that happens, the August recess will be the best thing that ever happened to healthcare reform.
I wouldn't bet the farm on that happening. But congressmen listen to their constituents when they go home for the holidays, and there's no reason reform advocates can't use that to their advantage. It all depends on whether we're really as motivated and as angry as the opposition. Are we?
This is a call not just to President Obama's supporters and network, but to anybody who cares about health reform. Here in California, we have 2 Senators and 53 Representatives to urge to get health reform done. That's our challenge, and our opportunity.
The Assembly applauded themselves when they finished their marathon floor session approving a state budget today. The sounds outside the chamber, and outside Sacramento, were not cheers. Here's some reaction from the health community:
From the California Medical Association:
“This is a devastating blow to the swelling ranks of California’s needy, who are struggling to get through the worst economic crisis in a generation,” said Dr. Dev GnanaDev, president of the California Medical Association. “These cuts dramatically increase the long-term health care costs borne by taxpayers, as the patients shut out of these programs now must turn to costly and overcrowded emergency rooms for care.”
“Leaving children without health care is irresponsible – from both a public health and fiscal point of view,” Dr. GnanaDev said. “Unfortunately, this forces many financially strapped families to choose between taking their kids to the doctor or feeding and clothing them. As a trauma surgeon, I see what happens when preventative care is eliminated; it results in more people getting sick and more people going to the ER.”
From Western Center on Law and Poverty:
"The California Legislature has been steamrolled by Governor Schwarzenegger into sacrificing poor families with children for the sake of political expediency. Whether these cuts were agreed to so the state can repay Prop 98 next decade or were agreed to because the Democrats could not stand the Governor's heat doesn't matter. It is shameful, disgraceful and one of the lowest moments in the history of social welfare in California. It is deeply offensive to hear Democratic leadership claim to have "saved the safety net" or that they will undo this in the future. They will never have the votes to restore CalWORKs and they should stop trying to deceive the public about the harm they have done," said Michael Herald, Western Center on Law & Poverty.
“There is a dark cloud over California today. We may be able to pay our bills in the short term but the bill will come due from the budget passed today which will cause human suffering, hunger, and sickness. Hundreds of thousands of children in California will lose health coverage. While other states also facing budget shortfalls are expanding their health programs, we are turning our backs on those in need," said Elizabeth Landsberg, Western Center on Law & Poverty.
From the California Labor Federation
“The state budget package passed today is the shame of California. The deep, unnecessary cuts included in this budget will turn the current economic storm battering families into a Category Five hurricane." said Art Pulaski, Executive Secretary-Treasurer, California Labor Federation.
“With this budget, the Governor and Legislature failed miserably in their primary duty to protect California families. The most painful part of this budget deal is that the catastrophic cuts to education, health care, public safety, state workers and programs for children, seniors and the disabled could have been avoided."
“The refusal by the Governor and Republican leadership to even consider popular revenue sources like a tobacco tax or oil severance fee created the roadmap to the disastrous budget we’re now saddled with. The accounting gimmicks the budget deal includes scuttle any hope of long-term fiscal stability. This is not a budget of shared sacrifice; the hardship falls disproportionately on low- and middle-income families.
“At every turn along the winding road that led to this budget, the Governor sided with wealthy special interests at the expense of working families. When given the choice to support a tobacco tax or eliminate children’s health care, he sided with Big Tobacco. When given the choice to lay off thousands of teachers, firefighters and police or tax Big Oil, he sided with Big Oil. When given the choice to close corporate tax loopholes or gut job-creating infrastructure projects, he sided with wealthy corporations.
“It’s never been clearer that our system needs reform. We need to eliminate the ludicrous two-thirds majority rule that allows a small minority of ideologues to hold the state budget hostage to their narrow demands. We need to fix the state’s outdated tax system to ensure that the wealthy and corporations pay their fair share. And we need new sources of revenue to ensure important programs in education, health care and other areas are adequately funded.
From Children's Defense Fund:
“While legislators speak about a budget that “shares the pain” they have chosen to abandon the next generation. Low income children who turn age six and would normally be enrolled in the healthy families program will be placed on a waiting list for health coverage." said Deena Lahn of the Children's Defense Fund of California.
"Elementary school students who benefited from a low student teacher ratio will have larger classrooms and less time to learn. Children and families who have received minimal cash assistance will have a greater likelihood of being homeless. Youth who expected reasonably priced and high quality higher education in the CSU system will be out of luck."
"Legislators agreed to all this and more to avoid doing anything on revenues, including closing corporate tax loopholes or imposing an oil severance fee.”
From Health Access California:
"This budget is a tragedy for all Californians." said Anthony Wright, executive director, Health Access California, the statewide health care consumer advocacy coalition. "For low-income children, pregnant women, or Californians of all incomes denied private insurance at any price due to pre-existing conditions, these legislators have closed the door to their last and only option for health care coverage."
"This budget shreds our state's safety net. As with other programs, Healthy Families will exist in name, but be a shadow of its former self, shuttered and actively kicking kids off coverage. Someone should ask the hundreds of thousands of families of those children who will be denied health care coverage about the state of our safety net," said Wright.
"California has better choices than to deny coverage to hundreds of thousands of children, or to make these devastating cuts to the health system on which we all rely," said Wright. "While there were no good choices in this budget crisis, these were the worst possible choices for our children, for our health system, and for our economy. The agreement of a budget like this is not a cause of celebration, but of embarrassment and shame for California." said Wright.
We are following the action on @healthaccess (also at www.twitter.com/healthaccess). You can follow us and others by searching for the hashtag #CAbudget.
President Obama's press conference, if anything, was designed to cut through the clutter and answer the simple question: Why health reform? He put it in the context of economic recovery, and or long-term deficit reduction, of the state of our health system, but ultimately he made the direct pitch about how it will benefit the average American--the voter.
This is not just about the 47 million Americans who don't have any health insurance at all. Reform is about every American who has ever feared that they may lose their coverage, if they become too sick or lose their job or change their job.
It's about every small business that has been forced to lay off employees or cut back on their coverage, because it became too expensive. It's about the fact that the biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.
So let me be clear. If we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket.
If we don't act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction. These are the stakes of the debate that we're having right now. I realize that with all the charges and criticisms that are being thrown around in Washington, a lot of Americans may be wondering: What's in this for me? How does my family stand to benefit from health-insurance reform?
If you have health insurance, the reform we're proposing will provide you with more security and more stability. It will keep government out of health care decisions, giving you the option to keep your insurance if you're happy with it. It'll prevent insurance companies from dropping your coverage if you get too sick. It will give you the security of knowing that if you lose your job, if you move, or if you change your job, you'll still be able to have coverage.
It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care, like check-ups and mammograms, that save lives and money.
Now, if you don't have health insurance, or you're a small business looking to cover your employees, you'll be able to choose a quality affordable health plan through a health insurance exchange, in a marketplace that promotes choice and competition
And finally, no insurance company will be allowed to deny you coverage because of a preexisting medical condition.
It's a strong argument. Hopefully it won't be obscured by all the race horse coverage about the political horserace (rather than the substantic policy issues).
The Governor's office came out with a new publicity document today extolling the "reforms" that they won.
It's kind of shocking that the first thing on that list of "reforms" is stopping cost-of-living adjustments (COLAs) indefinitely, for low-income children and families on CalWORKS, higher education, the judiciary, corrections, etc. As if there's no such thing as inflation. How is that "reform?"
On health care issues, here's what the Governor says is in the agreement:
Better Care Coordination in Medi-Cal and Centralizing Eligibility
Due to greater utilization of services, increased costs in the health care system and more individuals becoming eligible for services, Medi-Cal has been growing at a rate of approximately 8 percent per year. Since 2004, the Governor has been clear that without fundamental reforms, Medi-Cal is not sustainable. The Governor’s reforms will modernize the enrollment system and improve care coordination so that Medi-Cal will be better grounded to continue serving low-income, vulnerable Californians.
Reforms to Medi-Cal:
o Better care coordination for reduced costs. Slow the Medi-Cal growth rate by providing better care coordination for the various populations receiving Medi-Cal services. Authority would include mandatory enrollment into an organized system of care like a medical home model, enhanced primary care case management or managed care for seniors and persons with disabilities, those covered by both Medicare and Medi-Cal, children with significant medical needs, and a better integration of physical and behavioral health services.
o Centralized and modernized eligibility: Centralize and competitively procure enrollment functions instead of having each county make determinations. This would take an antiquated pen-and-paper system with 27,000 employees scattered through 58 counties and bring it into the 21st century. This proposal would include the eligibility process for CalWORKs, Medi-Cal and Food Stamps.
Savings: $1.8 billion in 2012-13.
Both issues are dubious in terms of the savings that can be achieved, and whether it will improve the situation for Medi-Cal patients. There are long-standing concerns about mandatory managed care for seniors and people with disabilities on Medi-Cal, both for the patients and for the health system. The privatization of eligibility work has generally been a failed experiment in other states, costing more and making it harder for people to get the coverage and services they need.
Maybe the proposals look better when we get more information. Maybe not.
As alerted on Twitter by Sacramento Bee's CapitolAlert, here's a document from Democratic legislative leaders outlining 'major victories' in budget deal: http://bit.ly/PZiNu
THE CURRENT BUDGET DEAL (AS WE UNDERSTAND IT): After weeks of negotiating between the Governor and legislative leaders, the current $26.5 billion package of budget “solutions” includes $15.5 billion in cuts, $2 billion to health and human services, including significant cuts to CalWORKS, IHSS, and other social service programs.
On health care, the most notable cuts include:
* Denying hundreds of thousands of children health coverage. The Healthy Families program current covers nearly one million low-income children between 100-250% of the federal poverty level. The proposed cut of $144 million in state dollars (well above the recommendation of the Budget Conference Committee) would deny well over 500,000 children coverage. First, the newly-imposed wait list would deny over 350,000 children over the course of the budget year. Second, the size of cut would force California to actively disenroll hundreds of thousands additional children. For every dollar we cut in Healthy Families, we are losing two dollars in federal matching funds for our health system, and our economy.
* Making severe cuts to preventative and core health programs. While rejecting outright eliminations, the Budget Conference Committee made drastic cuts to a series of health care programs and services. We understand the current budget deal increased the cut to Healthy Families, but have not heard of other changes.
Assuming that the budget deal adopted the Budget Conference Committee reductions without significant changes, the deal includes: o Cutting mental health, including reducing by $92 million of funds for the Mental Health Managed Care Services, and the Early and Periodic Screening, Diagnosis and Treatment program. A $14 million cut would eliminate state money for ancillary health services in Institutions for Mental Disease. o Cutting HIV/AIDS care, reducing funding by $33.5 million o Cutting Adult Day Health Care, limiting it three days a week and other changes, a $26.8 million cut
o Cutting hospital funds, taking $23 million from the Distressed Hospital Fund o Cutting community clinics, including many funding streams by around 30%, including Rural Health Services by $2.2 million; Seasonal Migratory Worker services by $1.9 million, Indian Health Program by $1.5 million, and Expanded Access to Primary Care by $8.4 million. o Cutting maternal and child health care by $11.5 million, including the Black Infant Health Program by nearly $1 million; Adolescent Family Life Program by $1.75 million, local county maternal and child health grants by $2.1 million, and maternal and child health state support by $3.5 million.
o Cutting last-option health coverage for those rejected for “pre-existing conditions”, reducing the Major Risk Medical Insurance Program by $6.6 million. MRMIP already has a waiting list, with 7,100 enrollees, despite estimates of over 400,000 eligible “uninsurables.” o Cutting health coverage for mothers and newborns babies to get prenatal and post-natal care, reducing the Access for Infants and Mother program by $4.9 million. The cut would force a waiting list.
o Cutting all of the Immunization Program, for $18 million o Cutting community application assisters that help enrollment in public coverage like Medi-Cal and Healthy Families, for $3 million o Suspending a children’s dental disease prevention program, for $3 million
* Advancing a controversial proposal to privatize county eligibility workers for Medi-Cal and other human services. As reported in the media, the legislative leaders agreed to a process to consider the Governor’s recent proposal to privatize and replace the current county workers who assist Californians enrolling in Medi-Cal and other social services with a private contractor like Maximus or Halliburton. The reports indicate that the consideration would allow stakeholders to vet the proposal and requires legislative approval.
* Advancing a proposal that may mandate managed care for seniors and disabilities on Medi-Cal. Consumer advocates have been long concerned about the impact on patients and their access to care and specialists, as well as funding impacts to safety-net institutions. The reports indicate that the proposal would allow stakeholders to vet the proposal and requires legislative approval.
It’s important to note that these and other cuts that are revealed as part of the current budget deal are on top of the cuts made in February 2009. Those cuts included the elimination of 10 benefits, including dental coverage, for the nearly 3 million adults (parents, seniors, and people with disabilities) with Medi-Cal coverage. Those went into effect recently on July 1, 2009.
We will continue to monitor the situation and see what other information is released.
In all the analyses of the California health reform, there's been a lot of talk about all sorts of issues. But I think an overlooked issue was one of trust.
When Senate Majority Leader John Burton--a legendary figure and now chair of the California Democratic Party--ran his health reform, SB2, an expansion of employer-based coverage in 2003, he pushed it through his power and personality. And while he and various stakeholders worked very hard on the details, he was able to push a product to legislative passage and a Governor's signature with support of many groups first of all because they trusted him. They trusted where he was coming from, what his intent was, and even his ability to fix something if it didn't work out as intended.
Health policy can get pretty complicated, and many people can be concerned about the potential impacts of any changes, and so trust of the authors can go a long way in providing the benefit of the doubt.
Ezra Klein reports about a phone call by President Barack Obama had with bloggers today where he details his desire to move the process forward, and get a bill--even one that doesn't do all that we want--through the House and Senate, so that we have the opportunity to influence the content in conference committee. As Ezra indicates, this is both a plea to not make the perfect the enemy of the good, but a plea for trust, that the President will work to make the final bill a good one, either in conference committee (and maybe in implementation). He may very well have that trust with the public, and perhaps with various stakeholders that are the base of a health reform effort.
In Massachusetts, there didn't seem to be too much trust with Governor Romney by health advocates or the Democratic legislature. But they didn't need to do so. He was a lame duck, and would not be around to implement the program. From afar, my sense is that they might have been more concerned about the details of the bill if they thought he would be the one carrying out the proposal.
In California in 2007, that trust was not there. Governor Schwarzenegger was enthused about health reform, but had gone through several transformations in his few years in Sacramento (as he has continued), and always seemed to relish the spotlight/limelight rather than the issue itself. He used his trust he built to get support from some business and Chamber of Commerce types, but he didn't have it with the core health reform stakeholders. Folks were understandably skittish about what his implementation would look like.
The term-limited legislative leaders did not have the same built up history and relationaships as Burton, and had their own fights with their "base" constituency--with components of labor, for example, that made that mutual trust hard. Some who were predisposed not to trust the legislative leaders pointed to the term limits ballot measure, concerned that that was the major motivator rather than the issue at hand. (Somewhat unfairly, I would say). The lack of trust made people look a second time at legislative language, looking for problems that may or may not be there. This is not to say that a second look isn't warranted. The issue is whether there is that trust in the first place.
In the present context, we should fight as hard as possible to get the House and Senate bills to be as strong as possible, to help create the best debate parameters within the Conference Committee. But it also means that we need the trust people have in President Obama to help us through.
So trust matters. Even when I did a post-mortem of California health reform, I downplayed trust because it is hard to extrapolate a tangible lesson for the future--after all, trust is not something that can be bought, but comes with time and experience. But I think that trust--whether of Representative Waxman, of Senator Kennedy, or of President Obama--will be a overlooked factor in whether health reform succeeds or not.
My colleague Mike Herald of Western Center on Law and Poverty and I appear in this ABC local news segment on the budget crisis, and the changing of our safety net.
I most object to the comment of the so-called taxpayer advocate, who apparently doesn't want a good value for his (or my) taxes. He seems to think California's safety-net was generous. It certainly has never been at the same place at New York or other major states.
And in health care, let's remember that before this crisis, California was 51st in the nation in per patient Medi-Cal spending. That's before the crisis, before we eliminated dental and other Medi-Cal benefits, for example. Or before we make the cuts proposed in this budget.
It's clear that Republican legislators and others who backed full elimination of Healthy Families and other programs, have different priorities for California, and a different sense of what a safety-net should provide. That will be an ongoing debate after this budget is full implemented
On July 1, nearly 3 million Californians--mostly low-income parents, seniors, and people with disabilities--lost ten key benefits in their Medi-Cal coverage. The biggest concern is dental coverage, which over 900,000 of these patients use in a given year. Other benefits these patients lost include podiatry, optometry, psychology, and speech therapy.
All of these cuts are foolish: Dental coverage allows for better nutrition and prevents emergency room visits. Podiatry is an early warning signal for diabetes, etc. But these decisions don’t even meet the “penny-wise” cliché. In addition to being cuts to preventative care, the state is losing $1.60 in federal matching funds for every dollar we cut, impacting our health system, and our economy.
And while those cuts focus on all adults on California’s safety-net programs, the children have not been spared. Far from it. Governor Arnold Schwarzenegger has proposed fully eliminating Healthy Families, California’s version of the state Child Health Insurance Program that covers nearly one million children.
Last Friday, July 17th, the board that runs Healthy Families closed enrollment, both to new applicants and even to those who are shifted from other state programs. Children on Medi-Cal coverage turning one or six-years-old in certain income categories will get a birthday gift of losing their health insurance. It is estimated that over 350,000 low-income children will be frozen out of health coverage and placed on a waiting list in the next year.
The news today is even worse: the cuts that legislative leaders just agreed to as an alternative to full elimination would force the program not just to impose a wait list, but also to actively dis-enroll hundreds of thousands more children from coverage. The consequences will be kids not getting glasses to see the blackboard, missing school for toothaches, and otherwise delaying care. One ailment or accident on the playground would put families at risk of financial ruin, and needed care will be delayed or avoided altogether. Children’s and other community groups don’t mince words when they say that cuts at this scale mean kids will die.
The Legislature will vote later this week on the Healthy Families cut and many other shameful cuts to health care--as well as education, human services for our most vulnerable, and the other functions of state budget. The Governor and legislative leaders should reconsider these tragic choices.
...I also think California’s seventh-worst uninsured rate in the nation contributes to the environment that allows such cuts to be even considered. After all, with several hundreds of thousands of uninsured children already, what’s hundreds of thousands more?
And that’s a notion that needs to fundamentally change with health reform.
In the context of a near-universal system, federal health reform would set a floor to prevent such cuts. Now, the number of children covered is arbitrary, and while policymakers may feel its nice to cover as many children as possible, it's not an imperative. Also during a budget crisis, federal health refrom provide the federal resources to meet these commitments that states may find it impossible, especially in bad budget times.
Its imperative that we work at both levels, at the state level to defend what we can and prevent the worst, while organizing for the best, with the potential of comprehensive health reform that might save us from ourselves.
In the Los Angeles Times, Jia-Rui Chong gets the good folks at the Managed Risk Medical Insuarance Board to talk about how many children would be impacted by the cuts, (Medical aid to children expected to take deep cuts, July 21, 2009)
The article is very helpful is giving specific impacts, both for Healthy Families, but two other programs, MRMIP and AIM, that are also subject to cuts. (Emphasis added):
Budget cuts are expected to be deep at the state agency that operates the Healthy Families program, said Ginny Puddefoot, spokeswoman for the Managed Risk Medical Insurance Board.
She said the state would cut $124 million from the agency's budget, on top of a $20-million shortfall it already has. Given that the federal government kicks in $2 for each dollar the state spends on the program, agency officials are looking at a $432-million hole in the coming fiscal year.
"Our budget last year was about $1.2 billion," she said. "So it [the new budget cut] has a huge impact on children."
At the end of June, when the insurance board was forecasting a $70-million cut from the state, along with the $20-million shortfall, it voted to freeze new enrollment. The freeze, which took effect July 17, will prevent more than 350,000 children from entering the program and stabilize enrollment at about 592,000 children by the end of June 2010, according to estimates. There are currently about 920,000 children enrolled.
But Puddefoot said the new budget deal will likely force them to take the additional step of actively taking children off the rolls when they come up for their annual re-enrollment, unless the agency can find additional funding. Those children will then be put on a waiting list, which has been frozen.
"We've done different scenarios based on assumptions, but our estimates at the end of June found that between 160,000 and 288,000 would need to be disenrolled throughout the year," she said...
Puddefoot said there also will be cuts affecting two other smaller programs the board oversees: the Major Medical Risk Insurance Program and Access for Infants and Mothers. The former provides insurance to people who are "medically uninsurable" and have been turned down by private insurance companies because of pre-existing conditions. Enrollment will have to be capped at its current 7,100. There are probably 400,000 people in the state who need the program but the agency cannot accept any more clients, Puddefoot said. Officials estimate the budget will be cut by $6 million.
Access for Infants and Mothers provides medical care for pregnant mothers and babies 30 days after delivery for women whose income is too high to qualify for Medi-Cal but who cannot afford private insurance. Officials will likely have to stop enrollment Jan. 1 because of a probable multimillion-dollar cut to the program.
So our initial projection that over a half-million children will be denied health care coverage is a conservative estimate, and it could be much more. The number of children with Healthy Families coverage could go from around 1 million to just around 300,000.
The other MRMIB programs also are not spared, and those cuts are tragic in their own right. There is no justification to cut pre-natal and post-natal care, which is well documented in having lifelong health impacts.
The cut to the state's high-risk pool, MRMIP, is a signal that these cuts are not just a shredding of the safety net for the poor. This program provides some basic coverage to those, because of "pre-existing conditions," who are denied private health at any price. The premiums in MRMIP are not cheap, but the typically middle-income folks on the program find it is their only alternative.
So this budget leaves us with a shadow of the safety net, the safety net that any of us might need, whether because of accident or emergency.
We are trying to get more information about the specifics of the budget deal for health care, beyond the shockingly large cut to the Healthy Families program, that would deny coverage to *well* over 500,000 children in the next year.
The Sacramento Bee Capitol Alert has this on the privitization of county worker who assist families with Medi-Cal enrollment:
State leaders agreed to develop a controversial plan that would centralize the enrollment of welfare and social service programs, possibly with a $2 billion annual contract with a private firm to run the system. Schwarzenegger has proposed the idea as a way to increase efficiency, but Democrats have warned that other states who privatized their enrollment systems have suffered higher costs and enrollment problems. Legislative aides said Monday that they agreed to explore a system that allows stakeholders to vet the proposal and requires legislative approval.
We understand there's a similar agreement about a proposal and process around mandatory Medi-Cal managed care for the "aged, blind, and disabled"--a longstanding and controversial issue. We'll get more information when we can.
C-SPAN has been showing the committee discussion, which includes several California members, including Democratic Representatives Waxman, Anna Eshoo, Lois Capps, Jane Harman, Doris Matsui, Jerry McNerney, as well as Republicans George Radanovich and Mary Bono Mack.
Reports of a budget deal, and $15 billion in cuts, are not a time for celebration. Certainly not when the cuts include severe cuts to health care, including coverage for children.
The cuts to Healthy Families, for example, go well beyond the $90 million cut decided by the Budget Conference Committee. The New York Times suggests it will be a $144 million cut, $53 million more than the previous cut.
California has better choices than to deny coverage to hundreds of thousands of children, or to make these devastating cuts to the health system on which we all rely. While there were no good choices in this budget crisis, these were the worst possible choices for our children, for our health system, and for our economy.
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. It should be shocking that our policymakers are making the choice to deny coverage to hundreds of thousands of children, and the only debate was how many."
These cuts are magnified because of the hundreds of millions in lost federal matching funds we need for an economic recovery. These cuts will not just directly impact hundreds of thousands of children and many of California’s most vulnerable, but they will ripple through the health care system and impact all Californians as a result. The agreement of a budget like this is not a cause of celebration, but of embarrassment and shame for California.
President Obama makes the case for health reform, and rebuts the critics he knows are coming.
The House Ways and Means Committee, chaired by California Congressman Henry Waxman, will restart their review of H.R. 3200 at 1:00pm Pacific on Monday, and work Monday, Tuesday, and Wednesday. President Obama holds a Wednesday prime time press conference on health reform issues. The press is on...
"Embarassing" was a frequent comment I heard when I was in DC earlier this week, made by various legislative staff of California lawmakers. The subject was the new waiting list, reported by the Sacramento Bee (source of the photo) and elsewhere, in Healthy Families program which has begun denying children the health coverage they need.
Our delegation worked really hard to pass the reauthorization of the state Child Health Insurance Program--which provides 2/3 of the funding for Healthy Families--and to make sure that the reauthorization was favorable for California. And now, that work may be for naught--given the Governor's proposal to end the program altogether, and even the likelihood that we would freeze enrollment and leave hundreds of millions of federal dollars back in DC.
Even in bad economic times, there are choices. And the shameful decision of California leaders, starting with Governor Schwarzenegger, is in stark contrast to many other states.
Despite budgets ravaged by the recession, at least 13 states have invested millions of dollars this year to cover 250,000 more children with subsidized government health insurance.
The expansions have come in the five months since Congress and President Obama used the reauthorization of the Children’s Health Insurance Program to vastly increase its funding and encourage states to increase enrollment. Although the federal government covers the vast majority of the cost, states set their own eligibility levels and must decide whether to spend state money in order to draw even more from Washington.
The states’ willingness to spend, even under excruciating budget pressures, is a measure of the support for expanding health care coverage to the uninsured as Congress and the administration intensify their negotiations over a new federal health care bill.
But a number of states decided that their depleted coffers did not allow them to insure additional children, even as a minority partner.
...in California, where Democratic legislators and Gov. Arnold Schwarzenegger, a Republican, are struggling to close the country’s largest budget gap, the state on Friday imposed a freeze on new enrollments.
California officials estimate that up to 350,000 eligible children may be relegated to a waiting list, and that attrition could lower enrollment by 250,000 by June. If money is not found, the losses there might overwhelm the cumulative gains in other states.
Health and Human Services Secretary Kathleen Sebelius said the potential for major reductions in California was “a huge concern.”
But over all, she said, the Obama administration was “very pleased that even in what are some of the worst budget times in a very long time, children’s health insurance continues to be an absolute top priority.”
The Children’s Health Insurance Program, known as CHIP, has been politically popular since its enactment in 1997 because it primarily benefits working families that earn too much to qualify for Medicaid but too little to afford private insurance.
In many states, eligibility expansions have passed with solid bipartisan support. In one of her final acts as governor of Kansas in April, Ms. Sebelius, a Democrat, signed a two-year expansion worth $4.4 million that had been approved by her overwhelmingly Republican Legislature...
Forty-eight states faced budget shortfalls this year, totaling $121.2 billion, according to the National Conference of State Legislatures. But in those that have managed to expand eligibility, governors and legislators said they viewed CHIP as a cost-effective investment.
“In a downturn, the number of people who need the safety net increases,” said Gov. Bill Ritter Jr. of Colorado, a Democrat, whose state levied $600 million in fees on hospitals, some of which will be used to cover an additional 21,000 children.
In Alabama, Democratic legislators overrode the veto of Gov. Bob Riley, a Republican, to extend coverage to 14,000 children at an additional cost to the state of $8 million.“Our economy is tough here,” said State Senator Roger H. Bedford Jr., a Democrat. “But our decision was to fund the health care needs of our children because a healthy child learns better and they don’t show up at the emergency room needing acute care.”
Other states expanding eligibility include Arkansas, Indiana, Iowa, Montana, Nebraska, North Dakota, Oklahoma, Oregon and West Virginia. Ohio passed a budget last week that includes an expansion, but its financing depends on the resolution of a court case.
Illinois, New York and Wisconsin, which had been paying for expansions with state money, are now applying for federal matching funds. And many states are enacting measures to make it easier for children to enroll and stay enrolled, steps encouraged by the federal legislation. Officials in those states and others said they had little choice but to leave federal money on the table.
In California, the Legislature beat back Mr. Schwarzenegger’s proposal to eliminate CHIP altogether but seems to have accepted the enrollment freeze.
“It is heartbreaking,” said Ginny S. Puddefoot, deputy director of the agency that administers the program there. “For those of us involved with children’s health care, this is just something we never imagined we would see.”
California's financial woes are bigger than most, but these other states have their own fiscal crises as well. And yet they are deciding where their priorities are. And right now, for children and health care, Alabama has better priorities than California.
With the passage this week of health reform H.R. 3200 in the House Ways and Means and House Education and Labor Committee early today, and the passage of another bill from the Senate Health, Education, Labor, and Pensions (HELP) Committee on Wednesday, health reform has now passed three of the five relevant committees.
Chairman Miller talked about the importance of the vote:
Floor votes are one committee away in both chambers: the House Energy and Commerce Committee in the House, and the Senate Finance Committee in the Senate.
Even though this is historic--this is the farthest that health reform has ever gotten at the federal level--President Barack Obama has a press conference today to be clear that he wasn't satisfied: he is seeking full passage of health reform this year.
In attacking the federal health proposals, Republicans have offered amendments to build a case against it. Some of the amendments would suspend the reform if waiting times go up, or if the proposal falls out of balance for even a year. The Democrats reject these amendments, easily arguing that it makes no sense, if some provisions need to be fixed or adjustments need to be made, to penalize people by taking away their health coverage.
Another amendment was to force members of Congress to get their coverage from the public health insurance option.
The House Committee on Ways and Means just passed H.R. 3200, the America’s Affordable Health Choices Act of 2009, by a vote of 23-18. The bill will cover 97 percent of Americans, according to CBO.
“Today’s vote is another historic step toward enacting health care reform this year,” said Health Subcommittee Chairman Pete Stark of California. “I look forward reconciling our changes with the other committees, and voting on the floor of the House to provide affordable, quality health care to all Americans.” Click here to view Chairman Stark’s opening statement.
The provisions will be merged with provisions currently under consideration in the Committees on Energy and Commerce and Education and Labor for consideration by the full House of Representatives in the coming weeks.
There are lots of other Californians on this Committee, including Democrats Woolsey and Dave, and Republicans McKeon, Hunter and McClintock, all who have been active in the amendment process.
Both this committee, and the Ways and Means Committee, are expected to vote out their parts of the bill in the next day or so.
There is more consideration, through early next week--and more drama--at the U.S. House Energy and Commerce Committee, chaired by California Rep. Henry Waxman. The Committee has enough conservative "Blue Dog" members that they may force changes to the bill. Stay tuned...
The Good News: With the fate of California's Healthy Families hanging in the balance, First 5 California passed a resolution yesterday that provided broad authority for the Commission to continue financial support for health coverage for kids.
The resolution did not allocate a specific dollar amount, but indicated they would help with the $90 million shortfall that Healthy Families would have under the Budget Conference Committee proposal. We'll know how big the hole is when the state budget is signed by the Governor. It is unclear whether First Five would--or is even able to--bridge the entire shortfall, however big it is. Additional financial commitments from other stakeholders were encouraged at the meeting.
First 5 California's commitment cannot be the only solution. The Legislature and Governor must also stand up for the most vulnerable children in California by funding the Healthy Families Program.
The Bad News: Unless there is a change, children will be denied health coverage starting TOMORROW, July 17th, and placed on a waiting list. The freeze will take place with the implementation of a waitlist to new enrollment in the Healthy Families program.
The Managed Risk Medical Insurance Board (MRMIB) determined this during their meeting on June 29, 2009, where they disclosed that sufficient funds are not available to cover the estimated costs of Healthy Families expenditures.
Unless there's a change, it'll be a sad day tomorrow.
SENATE COMMITTEES PASS INSURANCE REFORMS * Key Measures from Assembly Pass Senate Health & Judiciary Committees * Bills Included AB786(Jones) to Better Label Insurance Plans, Limit Out-of-Pocket Costs * Trio of Insurer Oversight Bills Focus on Controversial Rescission Practices * Next Stop: Senate Appropriations Committee for Fiscal Review, then to Senate Floor
* More Updates on blog.health-access.org: Senate HELP Passes Bill; House Bill Unveiled; Even Wall Street Agrees on the Broken Health System; California Blue Dogs on Health Reform and the Public Health Insurance Option; Health Reform Blog Updates; Kids Will Die; Budget Protests; Myths and Facts on the Governor's "Reform" of Medi-Cal Eligibility
SACRAMENTO – The Senate Health Committee, chaired by Sen. Elaine Alquist (D), and the Senate Judiciary Committee, chaired by Sen. Ellen Corbett, supported important health care consumer protections in the past two days. These and other bills will be going to the Senate Appropriations Committee, before going to Senate floor for a full vote.
HEALTH COMMITTEE ON INSURANCE REFORM: The bills included AB786 by Assemblyman Dave Jones (D), which aims to better label the insurance products sold to individuals, limit out-of-pocket costs, and ultimately help Californians avoid being sold “junk insurance” policies. Jones told committee members the bill, sponsored by Health Access, was critical to helping consumers know exactly what kind of coverage they are getting when they pay for an individual health care plan.
An increasing number of California consumers are being forced into the individual policy market as they lose employer-sponsored or group coverage in the state’s lingering economic downturn.
Thus, it is more crucial than ever that insurers represent policy features with more clarity and transparency regarding what health care procedures will be covered, and what portion of the medical debt will be shouldered by the consumer.
AB786 would institute a tiered system of defining the various benefits levels individual policies offer, allowing consumers to comparison shop in an “apples to apples” manner.
Currently, it is very difficult for consumers to obtain clear and accurate information about what their individual policies cover, and what they do not. This has left many consumers surprised by huge medical bills that they believed were covered by the policy they pay premiums on.
Martha Yvonne Fadlin, of San Jose , testified in support of AB 786. Fadlin, a 62-year-old licensed vocational nurse turned to the individual market for coverage when her job was down-sized from full time to part time and she no longer had her employer-provided insurance.
Fadlin said she shopped around, and researched plans by Blue Cross, Blue Shield and Kaiser. She ended up buying an individual policy from MultiPlan, whose ads she saw on television and seemed cheaper.
Although the health plan she bought claimed to cover hospitalization, emergency room visits, X-rays and other diagnostic tests, it was less than forthcoming with information telling her how much of those health care services it would cover in exchange for her $268 premium.
When Fadlin went to the doctor for severe abdominal pain, it was determined she should go to the hospital. Tests showed she suffered from diverticulitis and she went home with a prescription to help with her condition.
Her bill? Ten thousand dollars, of which MultiPlan paid only $2,000. She now owes a hospital bill of $8,000.
“It never occurred to me that an insurance company could say it covered something but only pay a tiny fraction of the cost,” she told committee members.
Speaking in support of the bill was Health Access California, Western Center for Law and Poverty, Congress of California Seniors, California Immigrant Policy Center, California Teachers Association, Californians for Disability Rights, California Alliance for Retired Americans, Jericho, and the American College of OBGYNs . AB 786 would also impose a maximum $10,000 out of pocket obligation for the policy holder and would standardize terms and definitions of coverage.
Testifying in opposition were Anthem Blue Cross, Health Net, the California Association of Health Plans, other insurers and a representative of agents and brokers who predicted that categorizing insurance policies in 10 tiers would be too difficult because he, for example, sells 136 types of individual insurance products.
Another key consumer protection bill that passed the Senate Health Committee Wednesday was AB244 by Assemblyman Jim Beall (D). AB244 would require mental health care parity for adults and youths for a range of mental and substance abuse disorders that benefit from treatment.
TUESDAY'S JUDICIARY COMMITTEE ACTIONS: This is the final week for policy committees to approve Assembly bills on their path through the Senate On Tuesday, the Senate Judiciary Committee, chaired by Ellen Corbett (D), passed three key pieces of legislation designed to combat the insurance industry’s practice of retroactively rescinding health care coverage for consumers who undergo costly medical care. Votes were along party lines.
The trio of insurance company oversight bills, supported by Health Access California , are:
* AB2, by De La Torre (D) and supported by the California Medical Association and other physician groups, would ensure an independent third party reviews all insurance company rescissions. Thus, the bill also raises the standard that insurance companies must meet before retroactively cancelling health care coverage of a consumer with an individual policy. Currently, health care plans yank coverage without any prior approval. If AB2 passes and becomes law, insurance companies will have to prove the customer willfully misrepresented his or her medical history to get coverage. AB2 also will require insurance companies to develop and use standardized, clear and easy-to-understand application questionnaires for consumers applying for a health care policy. Representatives of large health plans, including Anthem Blue Cross and Health Net, were joined by the California Chamber of Commerce in opposing the bill. Industry spokespersons did, however, concede that independent review of rescissions, which have targeted thousands of Californians in the past few years, could be acceptable--depending on the rules of the independent reviewer used--as was developing standardized, understandable application materials.
* AB730, also by De La Torre, was sponsored by the California Department of Insurance, which regulates the individual policy market. The legislation would increase penalties for wrongful rescission from $118 to $5.000- $10,000, closer to the level of fines the Department of Managed Care is able to use in its regulation of managed care insurers of group policies. Fines are levied in cases where an insurer is found to have unlawfully engaged in post-claims medical underwriting – or investigating a patient’s history only after the patient has undergone expensive medical care. Industry representatives said they were not opposed to increasing the fines from $118 per case, which Assemblyman Hector De La Torre said was too low, and “hardly a disincentive” to insurers.
* AB108, by Assemblywoman Mary Hayashi (D), would cap at 18 months the length of time an insurer has to rescind, cancel, or limit individual health care policies – or charge higher premiums – because of fraud by a consumer. The bill would reduce from 24 months to 18 months the window of opportunity for insurers to take action against a consumer who knowingly misrepresented their medical issues in order to obtain coverage.
While the legislative leadership is focused on the ongoing budget negotiations, the regular calendar of considering bills continues. For a full list of bills of interest to health care consumers, visit our website to get the Health Access California bill list, at: http://health-access.org/files/advocating/HAC%20Bill%20List%206-5-09.pdf
Visit the Health Access website, http://www.health-access.org, for more information on any of these issues. This update was reported by Cynthia Craft of Health Access California.
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.
