With new data being published about health coverage and medical debt, it's clear we need state and federal action to prevent Californians from falling into uninsurance and underinsurance.
In total, nearly one in seven non-elderly adults in California (13 percent) have some kind of medical debt...
In addition, Californians with medical debt were much more likely than those without debt to delay getting the care they needed. Those with debt were twice as likely to report delays in care: 32.3 percent reported delays in getting needed care, compared with 16.1 percent of those without medical debt...
Also, medical debt can lead to loans and bankruptcy: Among those with medical debt, more than half (55.4 percent) reported financial consequences ranging from an inability to pay for basic necessities to credit card debt to a declaration of bankruptcy.
The study shows that Californians are appropriately concerned about the cost of getting needed care--even when they have coverage. We need action on health reform so we are not at such high risk of losing coverage, and to ensure that such coverage is comprehensive. When people pay a premium, they shouldn't then be saddled with debt for simply getting the care they need.
Here's two pieces of legislation to address the issues, both state and federal, and specific and comprehensive:
* AB786(Jones) would better label insurance products and ensure that all health insurance plans had a cap on out-of-pocket costs, so no plan left premium-paying patients with unlimited financial risk. The bill was approved by the Senate Appropriations Committee last week and is scheduled to be voted on by the full Senate next week.
* H.R. 3200, the comprehensive health reform package in the U.S. House of Representatives, would not only secure, stabilize, and expand health coverage for nearly all Americans, but it would also cap out-of-pocket costs. It would set minimum benefit standards and abolish "caps" on benefits that leave insured people with significant medical bills. The bill has passed the three committees of jurisdiction and is expected to get a vote on the House floor in September.
Today, the UCLA Center for Health Policy Research put out its biannual report compiling data from the California Health Interview Survey (CHIS), the most comprehensive look at health coverage and issues in our state. It's a seminal source of information for health policymakers and advocates, and we'll have a lot to say and post about its findings--especially about the new and disturbing information about medical debt--in the next few days and months. But we should take a moment to send not just our congratulations but our good wishes to E. Richard Brown, UCLA Professor in the School of Public Health, the Director of the Center for Health Policy Research, and the Principal Investigator for CHIS. Beyond being one of California's foremost academic experts on health policy, he's been a good resource, friend, and colleague of Health Access over many years.
On August 10th, Rick had the unfortunate opportunity to experience the health care system first hand when a brain aneurysm ruptured. The good news is that we have heard he has just recently been transferred out of the ICU to a regular hospital bed at UCLA.
We wish him the best for a safe and speedy recovery, and our thoughts are with him. He's an important and valued member in the health policy and advocacy communities, and we look forward to working with him soon!
It looks like Anthem Blue Cross of California is willing to be the bad guy again in the national debate. As Ben Smith in Politico writes and excerpts, they have sent a mass E-mail to their subscribers, making false charges and repeating scare tactics about health reform proposals.
With a 33 million customer list, insurance giant Wellpoint is now actively fueling the misinformation campaign against health insurance reform and America’s Affordable Health Choices Act. In a recent email to customers, California insurer Anthem Blue Cross, a Wellpoint subsidiary, attacked the bill on key fronts.
Myth: The House bill will cause “tens of millions of Americans to lose their private coverage and end up in a government-run plan…”
Fact: Actually, according to non-partisan Congressional Budget Office (CBO), private insurance coverage will expand by 16 million under reform. And under the House bill, no one can ever be forced onto the public health insurance option. The only way someone would be in the public plan is as a result of their own individual choice...
Myth: The House bill will limit “customers' choices of the products they can purchase and how they can purchase health coverage…"
Fact: The heart of the House bill is actually to create MORE choice and MORE options – and to help more Americans afford those options. If you have a private insurance plan now, the House bill:
* provides competition to help make your plan more affordable,
* ends the insurance company practices of discrimination based on age, pre-existing condition, or a newly discovered illness,
* ends copays for preventive care, caps what you pay out-of-pocket, but eliminates yearly or lifetime cost caps on what insurance companies pay, and
* requires a minimum set of benefits to help protect you from the fine print in a flimsy plan.
If you need to purchase health insurance, the bill creates an Insurance Exchange, providing one-stop shopping where you can compare and find the best and most affordable plan for you. All those using the Insurance Exchange will have a range of choices – various private plans, and the public plan.
Myth: The House bill will increase the “premiums of those with private coverage by imposing new mandates and coverage requirements.”
Fact: The House bill promotes competition—designed to make your private insurance premiums more affordable—and offers affordability credits to those who need them. The bill’s minimum benefit requirements (the so-called “coverage requirements” under attack) are modest (less than the average benefit offered today), will NOT lead to increased premiums, and are designed to protect Americans from insurance company whims and fine print.
Furthermore, the bill contains numerous provisions to lower your costs, with caps on what you pay but not what insurers cover, no copays for your preventive care, and ending discrimination against you for getting sick or having a pre-existing condition...
For more health insurance reform myth busting, please click here.
Changing the channel and the health reform debate..
Saturday, August 29, 2009
Are the tea party protest fading? Health Access staffers and allies have been to many Congressional town halls in the last few weeks. Despite the media narrative, my sense is that after the first week of August, health reform supporters have matched and often outnumbered opponents. In some areas, like the town halls of Rep. Diane Watson or of Rep. Judy Chu, they don't show up with any visible presence at all. The "tea party"activists have called protests against Representative Henry Waxman, Senator Dianne Feinstein, and others, yet the number of health reform supporters have outnumbered the opponents by 5 to 1.
Has the opposition already peaked? While focused more on environmental issues, the Sacramento "tea party" rally had a significant turnout on Friday, but fell it well short of the 10,000 people advertised, and also was significantly less than the turnout earlier at a previous protest in April. Maybe the reason was that this time, it didn't feature a Fox News star, Neil Cavuto, as a headliner.
Fox News certainly has played a role in organizing the opposition. But even the mainstream media has promoted bad behavior, focusing on the tactics of disruption rather than the substance of the debate.
The town halls have been more like Fox's reality show programming than their baseball coverage, by focusing and encouraging outrageous behavior. The town hall coverage has been like if Fox focused on the fights in the stands rather than the game on the field. Fox does show most of the people in the stands, the cheers and jeers, and the signs supporting or opposing a certain team. But if someone runs onto the field, the camera turns away, not to encourage people from doing the same and ruining the event for everyone.
Beyond Joe Buck and Joe Millionaire, the Fox network provides another model for a way out of August into the fall season—American Idol. It starts with large casting calls--frankly bigger than any of the protests opposing reform. It goes on to give 15 minutes of fame to the most outrageous, most outlandish of performers. (This could include protest from the British representative--perhaps Simon Cowell could have tweeted #WeLoveTheNHS). But as we go into the fall, quality of voice matters. Popular support matters.
As health reformers, we need talk to our friends and neighbors. The novelty acts fall away as we concentrate on some key voices, even if we’ve heard the words before. And hopefully like health reform, a winner passes through the final gauntlet—maybe not everyone’s top choice, but one that is deserving.
This report, prepared as the last week for fiscal committees to take action is winding down, is by Health Access advocate Beth Capell:
Today, the Senate Appropriations Committee took action on numerous important health measures; some of the news is good, some of it is bad.
In a very difficult state budget year in the midst of the worst economic downturn since the 1930s, it is not surprising that Appropriations members would be cautious about letting out measures that increase cost. Still the bad news is never pleasant.
Good news: bills that passed....
AB786 (Jones-D), the Health Access-sponsored bill to provide consumer protections in the individual market.
AB2 (DeLaTorre-D) on independent review of rescinded policies.
AB98 (DeLaTorre-) on maternity coverage for products regulated by the Department of Insurance.
AB108 (Hayashi-D) limiting the period in which rescissions may take place to 24 months.
AB1142 (Price-D) on minimizing balance billing of Medi-Cal patients by requiring hospitals to notify doctors if patients have Medi-Cal coverage.
AB1269 (Brownley-D) on working disabled adults being covered by Medi-Cal, although implementation was delayed until 2011.
Bad news: bills that were held....
AB1521 (Jones-D) on health insurance agents, Health Access sponsored.
AB730 (DeLaTorre-D) fines for rescission of policies.
For Healthy Families: Some possible good news, some troublesome choices....
This morning, MRMIB acted by emergency regulations to increase co-pays for children on Healthy Families, for everything from doctor's visits to prescription drugs to emergency room visits.
Based on the savings from the increased co-pays and the funding from the First Five commission that will help to cover children ages 0-5, MRMIB voted to delay disenrollment from October 1 to November 1, with notices going out to families deferred from September 1 to October 1.
Sadly, the waiting list has now grown to 70,780 children as enrollment remains closed.
Within the hour of MRMIB's action, the Senate Appropriations Committee voted on AB1422 by Assembly Speaker Karen Bass (D). This measure reconfigures an assessment on Medi-Cal HMOs from a provider fee to a smaller gross premium tax that will be used to draw down federal funds to restore Medi-Cal rate cuts to Medi-Cal HMOs and to provide funding for the Healthy Families program. This is an urgency measure that requires a two-thirds vote.
AB1422 will also increase premiums for the low-income children who depend on the Healthy Families program. The combined actions of MRMIB and the provisions of AB1422 will increase costs for low-income families through both premiums and copays.
The effort to enact AB1422 has been led by the HMOs that serve Healthy Families enrollees. It is also supported by Health Access, the 100% Campaign, California Primary Care Association and others.
AB1422 has had cautious bi-partisan support in the three committees that have now heard the measure: Senate Revenue and Taxation as well as Senate Health yesterday and Senate Appropriations today.
In agreeing to vote for the measure today, Senate Appropriations Vice-Chair Dave Cox (R) said he was willing to vote for the measure because of the increased premiums, increased cost sharing and the commitment by the First Five Commission to help fund to Healthy Families coverage for children ages 0-5.
Cox also noted that given the threat of H1N1 virus at the start of the school year, he was not willing to take the risk to the health of the community by having 600,000 children losing health coverage. But again, he said that his vote was only good for this committee and he had further concerns that needed to be resolved.
Five Senate Republicans have now supported AB1422: Roy Ashburn, Cox, Jeff Denham, Abel Maldonaldo and Mark Wyland. The only "No" vote so far has been Senator Mimi Walters, R-Tustin.
Seeing a slightly brighter financial picture on the horizon, the Managed Risk Medical Insurance Board on Thursday postponed for one month the process of kicking kids out of the Healthy Families program.
Disenrollment will begin with notices mailed to families on October 1, instead of September 1 as originally planned.
Board members and staff voiced hope that, somehow, more funds will surface to save them from having to follow through with the disenrollment plan, adopted by voice vote earlier this month.
Perhaps coincidentally, the 30-day reprieve came as the nation marked the death of Senator Edward Kennedy, an original author of the nationwide children’s health insurance program, or SCHIP, which in California is known as Healthy Families.
President Obama’s ARRA economic stimulus initiative called for an expansion of SCHIP, pledging beefed-up funding of $2 in federal matching funds for every $1 that states invest in the program.
While at least a dozen states have managed to use the added federal funds to grow their SCHIP programs to cover more children than ever, California’s stubborn budgetary problems due to the lingering recession has led to cutbacks -- and less services for fewer children.
The final version of the state budget crafted by the Legislature and Governor Arnold Schwarzenegger targeted Healthy Families with $194 million in cuts.
That amounted to a substantial financial blow to the program for low-income, working, taxpaying families in California – those whose income is too high to qualify for Medi-Cal and too low to afford health insurance for their kids on the open market.
Still, the blow was softened greatly by an $81.4 million commitment from the voter-approved First Five Commission, which pitched in funds to cover about 200,000 children ages 0 to 5 for one year.
Childrens’ advocacy groups and coalitions such as Children Now, The 100% Campaign and the Children’s Health Initiative have been persistent in urging MRMIB to tread cautiously while implementing program cutbacks due to insufficient funds.
One advocate stood up from her seat in the MRMIB auditorium Thursday upon hearing the board discuss delaying disenrollment. Called on by a puzzled Chair Cliff Allensby, the advocate blurted out: “Thanks. I just wanted to say ‘thanks.’’’
Meanwhile, the number of children whose names have been added to a waiting list for access to Healthy Families coverage has grown to 70,788, following a consistent trend of an 11 percent increase since the last count was released on August 20.
Most of the children seeking access to Healthy Families live in Southern California, the board’s staff reported, where population density necessitates greater services than elsewhere in the state. More than half of the children signed up on the waiting list reside in five Southern California counties.
A portion of the brighter financial picture for Healthy Families comes from higher fees to be paid by the families served. Generally, co-pays that were $5 for services will rise to $10 -- or up to $15, in the case of paying for prescription name-brand drugs when a generic version is available.
Visits to the emergency room will result in a co-pay hike from $5 to $15 whenever hospitalization is not required.
Premiums for those families with incomes that are 150% to 200% of the federal poverty level will increase from a family maximum of $36 to $48.
Premiums for families earning from 200% to 250% of the federal poverty level will rise from a family maximum of $51 to $72.
The changes seem bound to remain in place even if more funding is found, something that staff told board members is almost certain to materialize through an anticipated "complicated array of solutions.”
With the passing of Senator Ted Kennedy, much will be made of his famous family, and his longstanding efforts to pass comprehensive health reform and universal coverage, including taking a major leadership role this year, despite his brain cancer.
He did sponsor various efforts at health reform in previous years and era. In our national rememberance, it should not go unnoticed the bills he did help pass into law, that make a difference in people's lives today: Sen. Kennedy led efforts to pass COBRA and HIPAA so those leaving job-based coverage could keep it, the Ryan White AIDS Care Act, the Mental Health Parity Act, and the State Child Health Insurance Program (SCHIP) to cover low-income kids.
There's a historic picture in my colleague Beth Abbott's office of President Johnson signing Medicare over 40 years ago, with an elderly President Truman, who had championed universal health care a generation earlier, looking on. It is sad that Senator Kennedy won't join President Clinton when President Obama signs health reform this year.
Health reform can and should pass on its own merits, not to eulogize anyone. But Senator Kennedy's career is a testament that such reforms can have direct, powerful, meaningful improvements in people's lives.
Just a quick update: Senate Appropriations met on Monday. They heard and considered some key health bills, which then were placed on suspense.
The bill including AB786(Jones), to limit out-of-pocket costs and better label products in the individual insurance market; AB1521(Jones) to limit unfair reimbursement practices for brokers; and SB1142(Price), which prevent Medi-Cal patients from getting unfair bills.
The committee will decide soon whether they are held for the year, or they proceed to the Senate floor.
TWO burning questions are at the center of America’s health care debate. First, should employers be required to pay for their employees’ health insurance? And second, should there be a “public option” that competes with private insurance?
Answers might be found in San Francisco, where ambitious health care legislation went into effect early last year...
The early results are in. Today, almost all residents in the city have affordable access to a comprehensive health care delivery system through the Healthy San Francisco program...
Although not formally insurance, the program is tantamount to a public option of comprehensive health insurance, with the caveat that services are covered only in the city of San Francisco. Enrollees with incomes under 300 percent of the federal poverty level have heavily subsidized access, and those with higher incomes may buy into the public program at rates substantially lower than what they would pay for an individual policy in the private-insurance market.
To pay for this, San Francisco put into effect an employer-health-spending requirement, akin to the “pay or play” employer insurance mandates being considered in Congress. Businesses with 100 or more employees must spend $1.85 an hour toward health care for each employee. Businesses with 20 to 99 employees pay $1.23 an hour, and businesses with 19 or fewer employees are exempt. These are much higher spending levels than mandated in Massachusetts, and more stringent than any of the plans currently under consideration in Congress. Businesses can meet the requirement by paying for private insurance, by paying into medical-reimbursement accounts or by paying into the city’s Healthy San Francisco public option.
There has been great demand for this plan. Thus far, around 45,000 adults have enrolled, compared to an estimated 60,000 who were previously uninsured. Among covered businesses, roughly 20 percent have chosen to use the city’s public option for at least some of their employees. But interestingly, in a recent survey of the city’s businesses, very few (less than 5 percent) of the employers who chose the public option are thinking about dropping existing (private market) insurance coverage. The public option has been used largely to cover previously uninsured workers and to supplement private-coverage options.
Through our experience working on health-care-reform efforts in California and Washington (one of us worked for President George W. Bush’s Council of Economic Advisers), we have seen how concern over employer costs can be a sticking point in the health care debate, even in the absence of persuasive evidence that increased costs would seriously harm businesses. San Francisco’s example should put some of those fears to rest. Many businesses there had to raise their health spending substantially to meet the new requirements, but so far the plan has not hurt jobs.
As of December 2008, there was no indication that San Francisco’s employment grew more slowly after the enactment of the employer-spending requirement than did employment in surrounding areas in San Mateo and Alameda counties. If anything, employment trends were slightly better in San Francisco. This is true whether you consider overall employment or employment in sectors most affected by the employer mandate, like retail businesses and restaurants...
The San Francisco experiment has demonstrated that requiring a shared-responsibility model — in which employers pay to help achieve universal coverage — has not led to the kind of job losses many fear. The public option has also passed the market test, while not crowding out private options. The positive changes in San Francisco provide a glimpse of what the future might look like if Washington passes substantial health reform this year.
We need to ensure that the California delegation takes these lessons from San Francisco back into the debate in DC.
Also, the Fresno Bee comes out for health reform. Let's hope California's Central Valley Blue Dogs, Representatives Dennis Cardoza and Jim Costa, are listening:
There are 47 million Americans without health insurance, and we all pay for their health care through our taxes and in increased insurance premiums. How do we cover them at a cost that doesn't break the U.S. treasury?
There are at least 12 million Americans who have "pre-existing conditions," allowing insurance companies to deny coverage or put them in a costly high-risk pool with high deductibles and limited coverage. This must be fixed because this is one of the most unfair parts of the current system. The concept of pre-existing conditions was developed by insurance companies to pad their profits by limiting their payouts. Insurance is based on spreading risk among a broad pool of people. But if the insurance companies only have to cover healthy people, why have insurance at all? People with health problems must be covered at a fair cost.
Millions of Americans are stuck in their jobs because they fear losing their health insurance if they go to another job. We must find a way to allow workers to move from job to job without worrying about whether they'll have health coverage.
We must make an investment in preventative care to limit the overall cost of health care. That will improve the quality of life of individuals and be a wise financial decision in the long run by treating illness before they require costly hospital care. There must be incentives for Americans to lead healthy lives, including maintaining a healthy weight and stopping smoking.
We must rein in the escalating costs of health care in a way that does not compromise care. That can be done in many ways through efficiencies such as improving the wasteful and duplicative billing and insurance claims system.
It's time to step back and look at ways to improve the nation's health care system for everyone. But right now the debate is being seen through a political lens, and that is a losing proposition.
Access to quality health care at an affordable price should not be a political issue.
The Central Valley will have a key role to play before health reform is done.
He pulled lots of punches. He didn't bring up her sordid history attacking the Clinton health reform effort with outright lies. He didn't bring up that the American Medical Association supports H.R.3200. He didn't bring up the many, many experts that have discredited her.
But it still gratifying to see someone who is outright lying being called out on it. The second half was not shown on TV, but put on the web. It's the better half, and is worth your time:
We often hear predictions about the dire consequences if health reform passes. When Healthy San Francisco was passed a few years ago, opponents from a portion of the business community--largely fast food and chain restaurants that don't provide coverage to their workers-- foretold of awful job losses as a result.
Healthy San Francisco has been a success in reducing the number of uninsured by 75%, but what about article in the San Francisco Chronicle by Healther Knight, entitled "Study finds SF health plan didn't hurt jobs," says it (emphasis added):
San Francisco's first-of-its-kind universal health care program and its mandate that employers provide health care has not resulted in feared job losses, according to a new study by a UC Berkeley researcher.
Crunching quarterly data from the U.S. Labor Department, the researcher found that since the inception of Healthy San Francisco's employer mandate in 2008, the city's growth rate across all employment sectors was similar to or better than other Bay Area counties. While San Francisco saw its employment rate shrink due to the struggling economy, it actually shrank less than other counties.
This held true in retail, food service, restaurants and hotels, the sectors most strongly impacted by the health care ordinance because they traditionally have a lot of low-income workers and aren't as likely to offer health insurance as higher-paying industries.
"The San Francisco experiment is working, and it's working well," said Ken Jacobs, chair of the university's Center for Labor Research and Education. "There's no evidence of any impact of the ordinance on employment in San Francisco."
The statistics were unveiled Thursday as part of a push by big-name labor leaders and Mayor Gavin Newsom to hype Healthy San Francisco as a public option that's working - and that could be a model for the rest of the country as it remains mired in a heated debate over health care reform.
"The sky has not fallen - the world as we know it did not come to an end," said Newsom, adding the controversial policy didn't prompt businesses to leave, bureaucracies to sprout up or the city's economy to crater.
For those who predict gloom-and-doom with health reform, the real question should be what does the world look if there is no reform. The status quo isn't an option--the situation on health care will get worse.
Not much has changed, that is, except for these two things: Group health insurance premiums have gone up another 11 percent, more than double the rate of inflation, and about 1 million more Californians have lost their insurance because they were either laid off or their employers dropped coverage.
Those two developments alone ought to be enough to cause any mortal to demand that Congress not blow this latest opportunity to fix a badly broken system.
They show that the existing system is not really a system at all, doesn’t work and is getting worse.
In 1999, as data collected by the Kaiser Family Foundation show, the average group health insurance premium for a family of four, was $5,791. By 2008, the cost had more than doubled to $12,680. In four of those nine years, there were double-digit annual percentage increases. In none of those years was the increase less than 5.5 percent.
Employers have been squeezed, hospitals have bled red ink, doctors have been pinched and ordinary folks have seen their healthcare costs soar. The employee share of costs for employer-based policies shot up 117 percent from 1999 to 2008, from $1,543 to $3,354, and that added cost was compounded by higher deductibles and copays.
Through it all, health-insurance companies have largely remained profitable.
But this annual process of raising premiums by twice or three times the rate of inflation cannot go on forever, or even much longer.
Look at that figure of the average cost of a group health plan for a family of four —$12,680 — and ask yourself this: At what price will your employer be forced to throw in the towel? Will it be when a family policy costs $15,000? $20,000? $25,000?
With prices that high, how can anyone feel secure that he or she will have health insurance next year or the year after that?
Having closely followed the health-reform efforts in California two years ago, I know that it is complicated stuff. There are a lot of moving, interrelated parts: providers, private insurers, consumers, employers, labor unions — and not even all the players in the same categories have the same interests.
But while health reform is complicated, it’s not rocket science.
A system built on shared risk cannot work unless everyone, or nearly everyone, is sharing the risks — and it doesn’t work now because about one in five Americans does not have insurance. That’s why the failed California bill, the bill now in the House and the bill now in the Senate have as their principal focus the goal of getting everyone insured.
Each includes a mandate that everyone have insurance, a requirement that all employers either provide a policy to workers or pay a fee, a framework of subsidies to make sure everyone who is forced to buy insurance can afford it, and a requirement that insurance companies respond to a universal-coverage mandate by making their products universally available.
And there is one other common element: an attempt to force price discipline on an insurance industry that will be handed millions of new customers as a result of the mandates...
If the momentum for reform is squandered this time, all America will look back two years from now and see the same price for failure that Californians have seen: 6,380 people losing their health coverage every week and the cost of a family policy marching relentlessly upward toward a day when the private insurance system will collapse under the weight of its own expense.
Without health reform, we didn't just get stuck with the broken status quo. It got worse, just like everyone predicted.
So which predictions should we listen to this time: the unfounded, unsupported warning of those opposed to reform, or the real consequences if we do nothing?
Tough times = 63,000 kids wishing, waiting for health care
Thursday, August 20, 2009
Continuing its trajectory of growth, the waiting list for Healthy Families has reached 62,955 California children whose families are seeking affordable health care coverage for their kids.
The list has grown by about 3,000 children per work day since the state’s Managed Risk Medical Insurance Board started taking names instead of enrollees July 17 because of state budget cuts.
The new tally was announced Thursday at a MRMIB meeting, one of a series held to consider cost-cutting options for its insurance programs of last resort for low-income, working Californians unable to afford health care coverage on the open market.
The meeting took a somber tone as MRMIB, its staff and children’s advocates continued with their task of doing the least harm to their programs while following the mandate of Governor Schwarzenegger to “live within our means,” through severe state budget cuts.
For every dollar in state general funds denied to Healthy Families, at least $2 in federal matching funds is lost. Schwarzenegger and the Legislature slashed $194 million from the children’s health care program in the last round of budget cuts.
No one in the MRMIB auditorium on Thursday seemed eager to embrace the brutal consequences of drastic program cutbacks looming on the horizon.
Nonetheless, the staff of MRMIB made several recommendations, mainly embracing the least onerous cutbacks or cost-sharing proposals that require families to pay more out-of-pocket -- or lose coverage for certain health care services. The board was reminded that, although they must ultimately vote to recommend changes, they “are not the deciders.” Only after statutes are approved by the Legislature would any changes get enacted. Among the recommendations the board must ultimately make are:
Come October 1st, continuing with plans to disenroll children from Healthy Families, barring a miracle of additional funds being pledged. Already, the First Five Commission has offered up $81.4 million to cover an estimated 200,000 children up to age 5 for a year. On Thursday, it was clear that many people still held out hope that an angel funder will yet surface – whether from the public or private sector.
Placing tens of thousands of children – and likely more – on the bulging waiting list during the fiscal year that ends July 1, 2010.
Imposing higher co-pays and premium payments on families lucky enough to have their children still covered, for now, by Healthy Families program. Board staff on Thursday recommended that, for emergency room visits, co-pays rise from $5 to $15, a proposed hike that is less severe than those earlier considered. Co-pays for non-preventative health, dental and vision would increase from $5 to $10, and co-pays for brand name prescription drugs would increase from $10 to $15, with generic drugs increasing from $5 to $10. Staff recommended against increasing subscriber premiums, saying the hike was “a bit too much in this economic environment.”
Eliminating whole categories, or levels, of health care services for current enrollees. Staff recommended rejecting proposals to eliminate vision, mental health and substance abuse treatment. Dental services would be cut back to a level consistent with what state employees get.
Freezing new enrollment in the Access for Mothers and Infants, or AIM, program for pregnant women receiving prenatal care. It turns out that, because fewer women have enrolled in the program, the date to freeze pregnant women out has been delayed from January 1, 2010 to March 1, 2010. And, babies born to women in the program would be guaranteed coverage in Healthy Families for their first year of life.
Pulling funding from Rural Health Demonstration Projects underway in a number of counties. So far, seven dental care programs and two health care programs have been cut.
Several children’s groups urged the board and its staff to approach program cutbacks so that those who most need the health care services get top priority. A letter from the California Children’s Health Initiatives asked the board “find solutions that do the least harm to vulnerable children and those needing care.” Krystal Moreno Lee of Children Now told the board, “The clock is ticking. We hope you look at and exhaust every avenue available to avoid disenrolling children from the program.”
CA LEGISLATURE RECOVENES; HEALTH BILLS PENDING IN LAST MONTH * Key Bills Pending Include Insurer Oversight: Capping Out-Of-Pocket Costs, Rescissions * One Month to Get Bills Passed Last Committee, Floor Votes, and Onto Governor's Desk * Initiatives Include Continued Post-Budget Efforts to Restore Some Cuts
* More Updates on blog.health-access.org: Tough Choices at MRMIB; Mad Men: Donald Draper on Prevention and Health Reform; Coverage in the Counties; Health Reform Made Easy; The Public Option Is In Our Court; President Obama, Editorialist; The Budget Battles Aren't Over; Good and Bad News on Healthy Families; Will Health Reform Get the Colbert Bump?; The Launch of HospitalBillHelp.Org; The Plight of the Underinsured; The Lawsuits Against the Line-Item Vetoes; Is Bigger Better? Health Reform: What's In It For You?; We're 4th (Worst) in Coverage in California; etc...
* Follow Health Access California on Facebook at www.facebook.com/healthaccess and on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget, bills, and federal health reform. Our Twitter followers were the first to find out about MRMIB's actions on Healthy Families last week, and we will cover the board meeting again this week!
This week, the California state Legislature returned from a recess to begin a final month of deliberations on a range of bills and policy issues. In addition, both Senate President Pro Tem Darrell Steinberg and Assembly Speaker Karen Bass have indicated that a top priority will be to attempt to restore some of the health and human services cuts made by Governor Schwarzenegger under a disputed line-item veto authority.
In terms of legislation that is largely not related to the budget, key health bills focus on additional insurer regualtions and oversight, including the better labeling of health plans and capping of out-of-pocket costs; preventing gender discrimination in the pricing of health insurance; limiting the insurer practice of rescissions; mandating certain key benefits like maternity and mental health; and prohibiting certain types of compensation to brokers.
Below is a list of health consumer bills introduced in the 2009 session of the California State Legislature that have passed their house of origin and recently passed the relevant policy committee(s) in the second house. The Health Access California website has this bill list in handout form, as well as a full list online of both active and stalled legislation--both of which will be regularly updated as the month continues.
AB 786 (Jones): INSURANCE MARKET STANDARDS: Would sort health insurance policies into a number of categories, based on benefit comprehensiveness and cost-sharing. Organization of plans into these categories and standard terminology would enable consumers to better track premium, benefits and cost-sharing, and assist consumers in making comparisons across plans. Health Access California is the sponsor.
AB 1521 (Jones): BROKER COMPENSATION: Would 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.
Insurance Rescissions
AB 2 (De La Torre): INDEPENDENT REVIEW: Would create an independent review process when an insurer wishes to rescind a consumer’s health policy, create new standards and requirements for medical underwriting, and requires state review before plan 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): POSTCLAIMS UNDERWRITING: Would impose fines on insurers unlawfully engaging in post-claims medical underwriting.
AB 108 (Hayashi): TIME LIMIT: Would impose a 24-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 171 (Jones) 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): HOSPITAL CLOSURES: Requires public notice of hospital closure or reduction/elimination of emergency medical services.
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 drawing down federal funds for increased reimbursement and children’s coverage expansion.
Even with the legislature back in session, budget-related action this week will be at the Managed Risk Medical Insurance Board this Thursday, and for the next couple of Thursdays.
This small board (pictured in this somewhat outdated photo), which directs a relatively small staff, has the privilege (or burden) of running three health care programs--all of which are closing their doors to new enrollment.
The cuts have been made by the Governor and the Legislature. For AIM for pregnant mothers, MRMIP for those denied by private insurers for "pre-existing conditions," or Healthy Families for low-income children, the question is now *how* these are made. It involves some ugly choices. In order to save some money to keep some more kids covered, do they cut benefits for all remaining children? Do they terminate coverage for some kids immediately, or wait--with the risk they will have to kick off more kids as a result?
For the biggest of the programs, Healthy Families, they should hold off and see if the last month of the legislative session yields some assistance that might prevent some more children from being kicked off coverage. The calvary needs to come.
We'll twitter from the MRMIB meeting any news at @healthaccess, or www.twitter.com/healthaccess and also blog here later in the day to keep you up-to-date.
Plenty has changed since 2006, the latest year that the uninsured of California was counted by the U.S. Census. But even then, many months before the current recession hit, the percentage of people living without health insurance in our state was startling.
This week, the Sacramento Bee laid out the statistics, finding quite a disparity between those with health insurance and those without. Just in the five-county region The Bee covers, Yolo County posted an uninsured rate of 22 percent of people under 65, while the more prosperous Placer County -- with more employment-based coverage -- posted a 13.7 percent rate.
That's quite a disparity, and the article by Phillip Reese and Anna Tong is worth reading. But the Bee doesn't limit information to its circulation area, it also posts online a comprehensive rundown of each of California's 58 counties' uninsured rate, along with an interactive map of the state and rollover charts.
Here's a sampling of what the authors wrote:
"The uninsured present an immense fiscal and public health challenge: 18,000 Americans die each year because they aren't covered, according to the Institute of Medicine, a nonprofit research organization. This is because having insurance is closely tied to health outcomes: The uninsured won't see a doctor regularly, and if they seek care it is likely to be inadequate or too late.
Moreover, the uninsured are a cost for society: One economist recently estimated the tab at $56 billion per year, 75 percent of which is paid by governments. In cash-strapped California, that cost is critical: 6.6 million residents went uninsured in 2007, more than in any other state, according to the California Healthcare Foundation."
You can bet that, with massive layoffs and small businesses closing since that Census count, the number of those among us -- members of our communities -- who are going without health insurance is a great deal larger. Factor in the Governor and Legislature's cuts in health and insurance programs for lower-income Californians, their children and the elderly, and you get an unimaginable sum of fellow Californians without access to affordable, quality health care -- notably, preventative health care, with better outcomes.
This is what the conversation about health care reform boils down to, not pumped-up talking points and hyper-emotive protests based on misinformation. This is not a partisan issue. It is a people issue. And the bottom line is that the majority of Americans have already voted -- for substantive change for a better future for our country.
The big TV event this weekend was the season premiere of Mad Men, the AMC show that depicts the life of New York advertising executives and their families in the early 1960s.
It is smartly written and filmed to highlight the differences in everything from fashion to gender relations. Guest New York Times columnist Timothy Egan made a fascinating contribution about the changes in public health:
My parents and their friends were nicotine fiends, the women smoking even during late pregnancy. The high point of tobacco addiction was around 1964, when 42 percent of adults smoked. Today, the figure is less than 20 percent — a modern low.
I remember rattling around inside a station wagon filled with secondhand smoke. No seat belts, of course. And after the ride, we 6-year-olds reeked of Lucky Strikes.
Now, smokers are such pariahs that the actors on the set of “Mad Men” can’t even puff real cigarettes; they have to use herbal ones, or run afoul of the law.
If a driver of that station wagon had a drink or two before getting behind the wheel, so what? Drunken driving was a respected social skill. Last year, 11,773 Americans died in accidents involving drunken driving — tragically high, but down by more than 50 percent from a generation ago.
Roger Sterling, the silver-haired sybarite in the “Mad Men” ad agency, suffered a major heart attack, telegraphed from his first three-martini lunch. Today, coronary heart disease is still the leading cause of mortality in the United States, but the death rate from heart attacks is down 72 percent since 1960.
The brooding, unfathomable ad man at the center of the show, Don Draper, has high blood pressure. When his doctor asks how much he’s boozing, he admits, after some hesitation, to five drinks a day. He also has sexual problems, unable to match the passion of his stunning wife, a Grace Kelly look-alike who is a shrink session away from going full Betty Friedan.
...Is all of this progress, a march toward a more tolerant, equitable, less socially inauthentic society? Sure. Plus, Don Draper would have Lipitor for his heart and Viagra for his sexual troubles.
For a show in the 1960s, explicit politics and policy is only in the background on the show--in the premiere on Sunday, the only reference was to an ad executive bemoaning the 60%+ upper-income tax brackets of the day. And the serious health care issues that led to the passsage of Medicare and Medicaid in the late 60s are not shown.
But there's a lot here to inform our health reform debate. It's a useful reminder about the significant progress that there has been in not just sexual politics, but in the realm of prevention and public health:
* Tobacco control, which has included taxation, limiting its use in public spaces, medical research, educating young children, litigation, major public awareness efforts, and the overall changing of social mores.
* Drunk driving reductions through changes in law and increases in penalties and enforcement, as well as a major public education effort that includes changing its social acceptability.
* Seat belts took a combination of ensuring that they were provided as standard in cars, and then a variety of public education strategies to get people to use them.
These things, by themselves, have saved untold lives and increased are life expectancy. Like the cause of gender and racial equality, these didn't happen overnight or without struggle. Each of these efforts were long, concerted, multi-year, multi-pronged campaigns by many players. And it's not over yet: For example, while the three martini lunch may not be as prevalent, we may not have some to terms with the full health impact of alcohol, so there is more work to do for groups like the Marin Institute.
The current conversation on health insurance reform, as the President not calls it, is less about people's health, and more about the health of their finances, and the health of the economy. That's not a bad thing: it's essential to prevent people who go bankrupt for medical reasons, or to remove the economic insecurity that so many people feel when they need care, either for age or accident.
There are elements of the reform bills that focus on prevention, doing more research, focusing on public health efforts, and making sure that there are no financial barriers to screening and preventative care. Here's a prevention fact sheet on H.R.3200:
Beyond the policy specifics, my hope is that once we finally make a public policy commitment for quality, affordable health care for all, that such a changes creates a platform and investment to move toward a healthier environment and society.
So I can imagine another form of entertainment 50 years from now, where our current technology looks quaint, our fashion looks sophisticated, our music is nostalgic, and some of our current diet and lifestyle choices, as well as current policies and industry practices, look as unhealthy and silly as the smoking and drunk driving scenes in Mad Men today.
Reformers typically must wage battle on two front: one against the opponents who argue the facts, and those who do so with confusion, lies, and mistruths. Defenders of the status quo don't have an easier job: they don't necessarily have to make a cogent argument against reform, or for an alternative. They merely have to sow enough confusion, distrust and doubt to get people to fear the unknown.
Health reform can be legitimately complicated, and so it is particularly vulnerable to this kind of attack. But health reform doesn't have to be complicated. Like an iPod, it can be complicated on the inside, but reasonable easy to understand for the regular user.
I watched the Sunday shows this weekend, and yet most media outlets picked up on a story that I didn't, that the White House was seeming to back away from the "public health insurance option" as part of its health reform plan.
That was the headline in the New York Times, Washington Post, AP and other stories. But the text of all of these articles don't reference some internal document or leak by White House staff. It's all based on a tea-leaf reading of these Sunday shows, where the Obama Administration officials have said what they have said on these shows for weeks and months: that the public health insurance option is part of the President's proposal, something he argues for every time he talks about the bill, but he's not drawing any lines in the sand at this point.
An administration official said tonight that Health and Human Services Secretary Kathleen Sebelius "misspoke" when she told CNN this morning that a government run health insurance option "is not an essential part" of reform. This official asked not to be identified in exchange for providing clarity about the intentions of the President. The official said that the White House did not intend to change its messaging and that Sebelius simply meant to echo the president, who has acknowledged that the public option is a tough sell in the Senate and is, at the same time, a must-pass for House Democrats, and is not, in the president's view, the most important element of the reform package.
A second official, Linda Douglass, director of health reform communications for the administration, said that President Obama believed that a public option was the best way to reduce costs and promote competition among insurance companies, that he had not backed away from that belief, and that he still wanted to see a public option in the final bill.
"Nothing has changed," she said. "The President has always said that what is essential that health insurance reform lower costs, ensure that there are affordable options for all Americans and increase choice and competition in the health insurance market. He believes that the public option is the best way to achieve these goals."
The public health insurance option is not the only part of health reform, but it is important. With regulation of the insurance industry, it makes sure that individuals are not left all alone at the mercy of the big insurers. It provide competition and choice, especially if the insurers continue some of their abusive practices. The CBO has scored that it will save money for both consumers and taxpayers alike.
But I think the coverage was overblown because the issue isn't the White House; it is Congress. The President can't sign a bill that Congress doesn't place on his desk. So while the President has some influence, it's ultimately up to Congress. And that means it is up to us.
Virtually all the Democrats in California, even the "Blue Dogs," said they support a public health insurance option. Many California leaders in House of Representatives, from Speaker Nancy Pelosi to Congressional Black Caucus Chair Barbara Lee have stated that a public health insurance option is a top issue for them.
We as health advocates need to continue our advocacy for health reform in general, and for a public health insurance option, to support these champions, and to shore up waverers. President Obama is committed to sign health reform with a public option. We should encourage him to continue to speak up and fight for it.
But it's up to Congress, and that means it is up to us...
UPDATE: From the Swampland blog at Time magazine, here's a transcript of White House spokesman Robert Gibbs, indicating the White House hasn't changed its support of the public health insurance option, and the bills in play still contain a public health insurance option:
Q Just to be completely clear, has anything changed on the public option?
MR. GIBBS: No. I challenge you guys all to go back and see what we've said about this over the course of many, many, many, many months, and you'll find a boring consistency to our rhetoric.
Q The rhetoric, as you say, might be consistent, but the movement on the ground, so to speak, toward legislation hasn't been. Is there any recognition now that a public option is looking less likely to be part of a final deal?
MR. GIBBS: Let me make sure I understand your question, because I want to know if it's -- is this predicated on legislative developments since Congress has been out of session, or are we trying to match the stampede of a series of stories to if not the consistent language that we've all been saying to some now legislative vote?...
Q But you guys have -- you haven't exactly come out publicly since Sebelius' statement yesterday, come in front of the cameras to speak to us, to downplay --
MR. GIBBS: Because nothing has changed.
Q But you haven't downplayed the remarks and the coverage either.
MR. GIBBS: No, no, I think many people talked to you all yesterday. I think people sent e-mails. David Axelrod called people... Nothing has changed. I mean, we can go out and say nothing has changed, but that seems sort of silly since nothing has changed.
Look, in terms of the political realities, obviously there's a public plan -- or public option in the House bill. There is a public option in the HELP bill. I don't know what the Senate Finance Committee will come out with.
As if President Barack Obama didn't have enough to do, today he weighed in as a New York Times op-ed contributor, describing health reform. He makes the case not to the uninsured, but to the insured. It's interesting because it is a compelling case, but also how he makes the pitch. Here's some snippets:
I don’t have to explain to the nearly 46 million Americans who don’t have health insurance how important this is. But it’s just as important for Americans who do have health insurance. There are four main ways the reform we’re proposing will provide more stability and security to every American.
First, if you don’t have health insurance, you will have a choice of high-quality, affordable coverage for yourself and your family — coverage that will stay with you whether you move, change your job or lose your job.
Second, reform will finally bring skyrocketing health care costs under control, which will mean real savings for families, businesses and our government....
Third, by making Medicare more efficient, we’ll be able to ensure that more tax dollars go directly to caring for seniors instead of enriching insurance companies... And our reforms will also reduce the amount our seniors pay for their prescription drugs.
Lastly, reform will provide every American with some basic consumer protections that will finally hold insurance companies accountable. A 2007 national survey actually shows that insurance companies discriminated against more than 12 million Americans in the previous three years because they had a pre-existing illness or condition. The companies either refused to cover the person, refused to cover a specific illness or condition or charged a higher premium.
We will put an end to these practices. Our reform will prohibit insurance companies from denying coverage because of your medical history. Nor will they be allowed to drop your coverage if you get sick. They will not be able to water down your coverage when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses. No one in America should go broke because they get sick.
Most important, we will require insurance companies to cover routine checkups, preventive care and screening tests like mammograms and colonoscopies. There’s no reason that we shouldn’t be catching diseases like breast cancer and prostate cancer on the front end. It makes sense, it saves lives and it can also save money.
Can you talk about cuts without talking about them?
Saturday, August 15, 2009
The Bee editorial board this Saturday bemoans that "after months of haggling... the two most powerful men in California government are still not on the same page." Yet its condemnation is not for Governor Schwarzenegger, who unilaterally cut another half-billion dollars in vital services, beyond his agreement with legislative leaders.
Their misplaced scolding is for Senator President Pro Tem Steinberg, who is suing (as are several groups) over the Governor's authority to make such cuts.
What's remarkable about the editorial is that it makes no attempt to acknowledge the serious constitutional issues about unchecked gubernatorial power to cut outside the once-a-year budget, without legislative approval or oversight. Voters rejected "spending cap" proposals that included similar power grabs (although with differences in the details) in both 2005 and earlier this year. Yet the Governor is assuming this power anyway.
What's misleading about the editorial is that it treats the legislature as a monolith. It says the legislature rejected over $1 billion in budget solutions, without specifying it was, by many accounts, specifically the Assembly Republicans who balked. Instead, the Governor didn't punish them, but rewarded them with cuts to the safety-net that they had sought, with the fallout on the vulnerable Californians who rely on the services he cut.
And yes, what's most shameful about the editorial is that nowhere does it mention the actual substance of the cuts, mostly to health and human services. How can these cuts be discussed without even mentioning what they are, and their impacts--such as zeroing out state funding for community clinics and battered women's shelters, or additional, steep cuts to maternal and child health, AIDS and HIV treatment and prevention, and children's health insurance.
The legislature had already agreed to cuts that were beyond the pale, for example forcing California to actively kick children off of Healthy Families coverage--but the Governor's additional cuts threaten the viability of the program as a whole. The Budget Conference Committee spent several weeks to be deliberate in making cuts, and all that was undone by the Governor's veto pen. If anything, the legislature already had went too far, too deep, and we--and particular our children--will suffer the consequence.
These would be inconvenient facts to mention in the editorial's desire to be "safely beyond the budget debate." Whether those that directly are served by these programs, or for all Californians who rely on our health system, the rest of us are hardly beyond the debate, but are going to start feeling it first hand.
Those who are suing the Governor--which includes but is not limited to Senator Steinberg, since several health provider, social service, and other community groups are as well--are right to do so, both to preserve check-and-balances, and on the sheer human impact of the cuts. Too bad the Bee didn't want to even tell it readership what we were talking about.
The good news for the Healthy Families program on Thursday was an $81.4 million commitment from the First Five Commission to keep 200,000 children ages 0-5 enrolled in the program for the remainder of the fiscal year.
The bad news? Despite at first seeming to want to delay the decision, the Managed Risk Medical Insurance Board, or MRMIB, voted to begin kicking kids off the health care program this fall.
On advice of staff, MRMIB declared that insufficient funding forced the board to prepare to disenroll children from Healthy Families beginning October 1.
Families with kids getting health care through the program – those who don’t benefit from the First Five funding, that is -- will get 30-day disenrollment notices as their annual re-enrollment dates approach. Those children can then be added to the end of a long wait list to get re-enrolled if the program’s finances improve.
Since the list was established July 17, an average of more than 3,000 children per work day have been signed up for the waiting list. Currently the list stands at 55,202 children of working families that can’t afford health insurance, but whose household incomes are higher than the threshold for MediCal.
Health care under the program is not free. The taxpaying, working families pay co-payments for services and prescriptions, as well as premiums to get their kids in Healthy Families, known nationally as SCHIP, a program expanded by President Obama earlier this year.
As California watched its fortunes dwindle this year, the Legislature and Governor Schwarzenegger ordered severe cutbacks in health and human services. Meanwhile, at least a dozen other states have managed to take the $2 in federal matching funds for every state dollar spent and use the augmentation to grow and expand their SCHIP programs.
Counting the forgone federal matching funds, California’s health care economy, not to mention children’s care, is losing a total of $533.4 million – thanks to the cuts made by the governor and Legislature.
This has left Healthy Families with a $194 million funding deficiency, staff members told the board, as well as an inability to continue serving the bulk of the program’s 921,787 child clients.
Even with the First Five’s $81.4 million, the California Budget Project estimates that nearly 800,000 kids will lose access to affordable health care because of Healthy Family’s decline. The cutbacks could not come at a worse time for working Californians trying to weather the persistent recessionary storm clouds that linger over the state.
Children’s advocates applauded and praised the generosity of the First Five Commission, which at first was expected to allocate around $30 million to help keep Healthy Families alive for kids through age 5. As it is, the much larger gift will allow for coverage of 200,000 children only through June 2010.
Wendy Lazarus, director of the Children’s Partnership, urged MRMIB members to exercise caution in making decisions about the future of the program.
“I ask that you consider that the next 45 days are going to be critical,” Lazarus said. “You’re going to have to look at what is safe, and what is riskier for children. At this point, we think that fewer kids will be served by the program than you do.”
Pending are lawsuits filed by several parties that specifically challenge the legality of the governor's deep cuts, made through line-item vetoes after a budget deal was already negotiated with the Legislature. MRMIB announced it will meet again August 20th, and August 27th. Among the decisions to be taken up is how much more money to charge families whose kids remain in Healthy Families, and what medical services can be eliminated or pared back.
The options currently before them are less severe than those listed as possibilities during last month’s MRMIB meeting. They now include:
• Increasing family co-pay maximums from $250 to $300. • Increasing program co-pays for health services, drugs, dental services and vision care from $5 to $10 for non-preventative services. • Increasing co-pays for name-brand drugs (when a generic version is available) to $10 to $15. The standard co-pay for generics would remain at $10. • Increasing co-pays for emergency room visits from $5 to $25 unless hospitalization is required. • Increasing subscriber premiums to $20 per child, with a maximum of $60 per family whose income falls within 150-200 percent of the federal poverty level. • Increasing subscriber premiums to $30 per child, with a maximum of $90 per family whose income falls within 200-250 percent of the federal poverty level. • Eliminating vision benefits. • Eliminating mental health and substance abuse benefits. • Scaling back dental benefit coverage. • Eliminating benefits for biofeedback, acupuncture or chiropractic care.
The Colbert Report last night featured an interview with Jonathan Cohn of The New Republic (who edits the blog The Treatment where I contribute occasionally) making the case for health reform against the host, who in his wacky way was actually was more reasonable than the current opposition arguments.
Cohn makes the important case for reform, and refutes one of the worst myths out there, that somehow everybody already has access to healthcare. He points out that access to the emergency room isn't the same: in the best case scenario, we want people to have access to care so they don't need to go to the ER later.
But he points out not just the health but financial consequence of being uninsured: when you go to the emergency room, you get a bill. If anything he understates it, since that bill is likely to be 3-4 times what an insurer pays for exactly the same service.
This points out the reason for the Hospital Fair Pricing Act and the new www.HospitalBillHelp.Org website that we unveiled today, which informs people of their consumer rights and financial options.
But given that those options are often limited and inadequate, it also spells out the desperate need for health reform.
With California's large and growing uninsured & underinsured population, we at Health Access are really pleased to unveil a new website--http://www.HospitalBillHelp.org--to help California patients know their consumer rights and financial options to deal with the biggest bill they get in their entire life. Here's the release that announces the new resource:
New Consumer Protection Website Informs Consumers against Underinsurance and Overcharging By Hospitals and Health Providers
HospitalBillHelp.org provides help for growing number of uninsured and underinsured in CA; informs consumers about their rights and financial options, including under new, first-in-nation fair pricing law
On Wednesday August 12th leading consumer protection groups in California announced the launch of HospitalBillHelp.org, a new consumer information website that helps patients deal with hospital and other medical bills, including inflated charges, “junk” insurance, and aggressive collections practices. The new site is part of a collaborative effort called the California Health Initiative on Overcharging and Underinsurance (IOU), led by Health Access and including Consumers Union, Western Center on Law and Poverty, ACORN, CALPIRG, Congress of California Seniors, and other consumer and community groups.
Visitors to HospitalBillHelp.org will find many resources informing them about their consumer rights and financial options in dealing with hospital, including under California’s first-in-the-nation Hospital Fair Pricing Act, a 2006 law authored by Assemblywoman Wilma Chan and sponsored by Health Access California, which limits the common practice of charging uninsured and underinsured patients more for care than everybody else pays.
Typically, hospitals and doctors overcharge self-pay patients three to four times what insurance companies and government programs pay for exactly the same procedures. The Hospital Fair Pricing Act, effective since January 2007, limits the amount that most uninsured and underinsured patients have to pay to the amount that a public insurer would pay for the same care. In most cases, this will be the Medicare price, which is 65-85% less than the inflated price. The Hospital Fair Pricing Act also requires hospitals to adequately inform patients about their charity care and discount policies.
However, despite clear rules outlined in the Hospital Fair Pricing Act, many California hospitals are still failing to inform uninsured and underinsured patients about their right to a fair price.
"In our current health system, self-pay patients lack bargaining power, and are asked to pay more than anybody else for needed care. HospitalBillHelp.org is a new and unique one-stop shop for the nearly 10 million Californians who are either uninsured or underinsured. HospitalBillHelp.org lets Californians know what their consumer rights and financial options are, so that individual patients get what insurers already get: a fair price for hospital care, " said Anthony Wright, Executive Director of Health Access. "If you have a large hospital bill and need help paying it, or if you need hospital care and can't afford it, this website can help you."
Medical debt is a growing problem for low- and middle-income consumers, especially those who are self employed or between jobs. Some go without health coverage and others purchase “junk” or “catastrophic” insurance plans with extreme gaps in coverage. Both scenarios put consumers at tremendous risk of overwhelming medical debt or delay receiving treatment when needed.
The case of Laura Burwell of Chico, CA is demonstrative of the way in which deceptive “junk” insurance policies and the failure of hospitals to inform patients of their options can have traumatic consequences. Laura thought she was buying comprehensive coverage when she purchased health insurance with a $281 monthly premium, a $500 deductible and $50,000 in hospital coverage. She didn't realize that her hospital coverage was capped at $3,000 a day, until a rattlesnake bite landed her in the Intensive Care Unit and with a $73,000 hospital bill.
"There I was thinking I was covered for $50,000," Burwell said, “but my insurance only paid $3,000 and then I was responsible for the rest.”
Fortunately for Laura, she was protected by California ’s Hospital Fair Pricing Act, which prohibits hospitals from charging underinsured and uninsured patients more than Medicare would pay for the same care. In her case, that meant her final bill was reduced to $7,300, one-tenth the original bill. Laura hopes HospitalBillHelp.org will help other consumers faced with high hospital bills.
"The hospital never told me I was entitled to a discount. I had to do a lot of research on my own before I even found out about the Fair Pricing Act. This new website is going to make it a lot easier for Californians to get a fair price for hospital care,” she said.
The site also provides a wide variety of tools, features, resources and information to help consumers better understand their legal rights and financial options, including links to public health insurance options and applications, information on how to get discounted health care and even an Underinsurance Calculator to figure out whether you count as underinsured under any of the definitions commonly used.
“In May 2009, Consumer Reports published an article describing seven signs that a health insurance plan might be ‘junk’ insurance. Consumers can use HospitalBillHelp.org and use the site’s resources to discover loopholes in their own insurance plans, or as a helpful guide when purchasing new plans,” said Laurie Sobel, senior attorney with Consumers Union. “The site provides important information to help consumers make informed decisions when purchasing health insurance and steps to take to ensure that hospitals recognize their rights as stipulated under California ’s fair pricing law.”
When visiting HospitalBillHelp.org consumers can also research ways to get a discount on an existing bill, who to call for help and instructions on what to do when a hospital doesn’t follow the law. Furthermore, the site features a directory to help patients locate the closest and most affordable hospitals where they may be eligible for discounted care, regardless of their income.
"Western Center has long advocated for the needs of low-income uninsured people who are saddled with unaffordable hospital bills,” said Jen Flory, attorney with the Western Center on Law & Poverty. “We're pleased to have a website that breaks down into plain English the complex programs that are available to help and provide information to those who might qualify."
Other useful resources available on the site include information and steps on troubleshooting other common hospital and insurance billing problems, such as getting an independent medical review if an insurance company denies an individual coverage, and finding information on the prohibition against balance billing of HMO patients for out of network Emergency Room visits.
While the site serves as an important resource for consumers, including providing steps and information on how Californians can take advantage of our state's strong consumer protection laws, the major problems in our health care system require broad federal health reform, like that proposed in H.R.3200, and further steps to ensure that self-paying patients and consumers are sufficiently protected against overcharging by health providers, like AB1503(Lieu), and inadequate private health insurance policies, like AB786(Jones).
"Whether it is overcharging, underinsurance, or care that is just plain unaffordable, the need for health reform is urgent. This website helps inform consumers about their rights and options, but they are limited. If anything, our work on HospitalBillHelp.org only reaffirmed our urgency for comprehensive health reform, like that which President Obama has proposed." said Anthony Wright of Health Access California. "And California can continue to take the lead with specific reforms pending in the state legislature, by passing AB1503(Lieu) to prevent overcharging by emergency room doctors, and AB786(Jones) to prevent people being trapped in plans that leave them with unlimited financial risk."
Whether it's been the policy debates on the web, or the less-than-civil discourse at some of the town hall meetings held by Congressmen, Health Access has been following, and reporting, on the health reform debate on Twitter, at @healthaccess, or www.twitter.com/healthaccess.
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Here's a few selected tweets and links from the last few days of activity. For the uninitiated, all tweets must be less than 140 characters, so abbreviations are a must. Some other codes: #healthreform is a "hashtag" that allows the "tweet" to be easily searchable. RT means "re-tweet," meaning we are repeating what another Twitter user (which all start with an @) is saying and passing it along, sometimes with a comment.
Again, a few @healthaccess tweets from the last few days: * Reports from LA town hall suggest crowd approaching 2000, both #healthreform supporters and opponents (60-40 supporters, our guess)about 3 hours ago
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.
