The other big debate in Senate Finance Committee was on amendments by Republican Senators Grassley and Kyl about whether health reform should set a basic minimum for the actuarial value of health insurance plans. This was a big deal discussion that we felt compelled to tweet at www.twitter.com/healthaccess: After wall, if we are going to have "universal coverage," you need to define "coverage" as to be meaningful.
Senator Kyl and Grassley's case was that such a standard would be a government intrusion that would limit choice in the marketplace, including many products that many people have chosen now. Senators Kyl and Grassley indicated how some states have significant percentage of people with plans that have actuarial values of 40%, 50%, 60%--less than the 65% minimum in the Senate Finance Committee bill.
Just to be clear, Kyl sought to allow insurers to continue to sell "junk" plans that cover less than half of the costs that an average patient would incur.
In rebuttal, Senator Baucus called such plans with lower actuarial value of 65% "pseudo-insurance." He said Kyl's amendment is an "amendment for the status quo," since it would allow "terrible plans" in the marketplace, and allow insurers to "take advantage of people."
Frankly, the minimum standard should be higher than 65%, even for the "bronze" plan. Can you imagine paying premiums and still facing 35% of costs after a significant medical incidence and expense?
As described by the Senate Finance Committee staff, there is a need to strike a balance between the affordability of the premium on front end, and meaningful coverage (and signifincant costs) on back end. Some people will want comprehensive coverage *("gold") that covers over 90% of their medical costs, others will save on the premium even if it means taking a risk of larger costs if medicaly expenses are incurred. But at a certain point the premium no longer becomes worth it, and the coverage is just providing a false sense of security.
While that ideal balance is probably closer to 75%, it is important to note, as Senator Grassley did, how much of our current markets are full of these products that provide little value. Think of the plans near the 65% minimum ("bronze") as subprime coverage. The "junk" plans below 65% actuarial value are the predatory lending of health insurance.
Senator Bingaman helpfully brought up the issue of the "underinsured," that the point of the bill was not just to cover the insured but provide greater security and help to the underinsured.
Why is this important? Because so many low- and moderate-income people live paycheck to paycheck, have debt in everything including credit cards and mortgages. As our study from a few years ago indicated, around 1/2 of families have $5-10K or less of assets outside their home (http://bit.ly/10pJz3) So low- and moderate-income families are at risk of bankruptcy and/or losing home if key benefits not covered, or if cost-sharing too much.
If this sounds like the debate here is California around AB786 (Jones), held on the Senate floor until next year, you are right. Even some of the clarifications are the same. For example, Senator Conrad had to correct Kyl, to say: The bill doesn't limit us to only 5 plans, there would be lots of variation within 5 categories. (Like AB786 in CA)
Another side issue was that since the plan wants to allow people to keep the coverage they have, it would grandfather allowing people to keep the plans they have, even if they are under the minimum standard, but that those plans could not be sold to new patients. It's not ideal, but is a start from the sad state of affairs in the current individual market.
Lots of people followed the Senate Finance Committee debate today, which started with a debate on the public health insurance option, and ended with a debate on setting the minimum standards for the value of insurance.
Check out our Twitter feed at www.twitter.com/healthaccess for the blow-by-blow, often retweeting others who were also providing good coverage of the day's deliberations.
The focus was clearly the debate over the public option. Two amendments were extensively debated. Senator Rockefeller's amendment lost five Democratic votes. Senator Schumer's amendment lost three--those of Senator Baucus, Conrad, and Lincoln. In other for it to be accepted, we needed all but one Democrat to vote for the amendment.
Jonathan Cohn at The New Republic says it was predictable, and it was. But regardless of the outcome--either way it went, the fight over the public health insurance wasn't going to end today. Let's remember that of the five committees with jurisdiction on health reform, the other four committees all supported a plan with a public health insurance option. There are at least three other opportunities to improve the Senate Finance proposal, on issues like affordability, employer responsibility, and the public health insurance options, in multiple ways: * when the Senate Finance proposal is merged with the Senate HELP Committee proposal; * on the Senate floor through an amendment; * and in conference committee, when the differences between the Senate and House versions are worked out.
It's clear the public health insurance option doesn't just have the support of a majority of Americans, but a majority (51+) of the Senate. At this moment, it doesn't have 60 votes... which means that the opportunities are there, but it will be a challenge. We need to continue to express the need and urgency for health reform, while at the same time continuing our advocacy for the principles that are necessary.
Here's some reaction from Health Care for America Now!, the national coalition of 1000+ organizations which has been leading the fight for the public health insurance option, and which Health Access is proud to be the lead partner organization in California. Here's the statement by national campaign manager Richard Kirsch:
“Today, a vast majority – more than ¾ - of the Democrats on the Senate Finance Committee joined with all of the Democrats on the Senate HELP Committee to support giving us the choice of a strong public health insurance option. Now four of the five committees that have tackled health care legislation have included a public health insurance option, and the Senate Finance Committee as a whole has proven it’s out of step with the rest of Congress, the President, and a large majority of the American public. As Senators Schumer and Rockefeller said, the public health insurance option is clearly gaining momentum, and we are confident it will be in the final bill that lands on the President’s desk.
The Democratic Senators who spoke out in support of the public health insurance option today made it very clear they understand we cannot leave Americans out in the cold without real choice and competition and at the mercy of the private health insurance companies which will only continue to put their corporate profits before people’s health care needs.”
Will the Governor sign on to greater insurer oversight?
Monday, September 28, 2009
While most of the comprehensive health reform action is at the federal level, there are some important and specific reforms on the Governor's desk, reports Susan Ferriss at the Sacramento Bee.
Even though a lot of health policy is done at the federal level, it is the states that currently regulate insurance companies. Even those federal health reforms pending in Congress that would change the way insurers conduct their business leave an important role for state-based standards.
So it is important that California take advantage of the opportunity to make progress in reforming the ways that health insurers do business. Especially since any federal reform will take years to fully implement.
* AB 119 (Jones): GENDER RATING, to prohibit insurers from charging different premium rates based on gender.
* AB 2 (De La Torre): INDEPENDENT REVIEW, to 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 98 (De La Torre): MATERNITY COVERAGE, to require all individual insurance policies to cover maternity services.
* AB 244 (Beall): MENTAL HEALTH PARITY, to require most health plans to provide coverage for all diagnosable mental illnesses.
These are some of the big hot button issues in health reform. These issues have been cited in the national health reform debate--from the reaction to the policy of rescission, to the debate last Friday on whether maternity coverage is necessary or not. These types of issues--like whether people should be discriminated against based on gender or health status, or what insurers need to include as part of a basic benefit package--are also very much in the discussion in other states as well.
If you have an opinion on whether Governor Schwarzenegger should sign these bills, let him know.
The fight over how people get help in the first place...
As part of the budget agreement, many legislators supported Assembly Bill 7 (Centralized Enrollment for Public Social Services) and the governor enthusiastically signed it into law. Who could be against saving the state millions of dollars by streamlining and automating the process for applying for public social services like Medi-Cal, food stamps, and the temporary assistance to low income families known as CalWORKS? In addition to promising lower costs for the state, the law was heralded as promoting greater efficiency in the application process, more consistency in the eligibility decisions from county to county, and increasing access to these programs for eligible people by making better use of technology.
But hold on... are those claims really true? As the state begins this week to implement this law, the picture is much clearer. Advocates have looked at the experiences in several other large and medium-sized states that have tried to implement similar so-called “reforms.”
The results in these states give California a preview of what we can actually expect: significantly increased costs to the program, less access to benefits especially by seniors and people with disabilities, and substantial loss of health insurance and benefits by eligible people currently enrolled in programs because of new barriers and confusing systems.
Here is what we know now:
Although the new system is advertised as saving California as much as $500 million a year, these savings are not considered likely as a result of these changes. The Administration has failed to factor in the very real start-up costs, the price of new technology, nor evaluated the risk that California may lose the significant reimbursement we currently receive from the federal government utilizing our current application processes.
Other states who have embarked on similar reforms as California have actually incurred increased costs for “contracting out” the application process. Texas, Indiana, Ohio, Wisconsin, and the District of Columbia, among others who have tried to implement a computer-driven application process, have not seen any savings. Instead, they have spent millions of dollars in new contracts, hardware, software, training, and public education campaigns that ultimately were not successful. These states had to respond to these disastrous results by abandoning their “reform” efforts altogether, cancelling expensive contractual arrangements, reconstructing the county and state systems they had just dismantled at great cost, conducting investigations of private contractors, all the while being the subject of scathing reviews by the press and government watchdog organizations. The failures in those states were characterized by independent reviewers as full of “cost overruns and overcharges,” “wasted tax dollars, “and “profiteering at taxpayers’ expense.”
Other states who have tried to move toward a centralized, privatized internet application for public programs have not achieved increased access or better quality and consistency in determinations of eligibility. They have found that too many vulnerable individuals do not have access to the Internet or the capability to use an automated application process. Those states found that they could not achieve significant costs savings by closing county offices. They realized that local in-person access to application assistance remained essential to the viability of their assistance programs and computerized applications should remain an alternative, but not the only way to apply.
Much of the frustration with complex programs such as Medi-Cal should be focused on simplifying the rules for eligibility, not creating barriers by imposing technology. This change is likely to discourage eligible people from applying for public programs without making needed changes to simplify the program rules.
The language in the law calls for a Stakeholders’ Advisory Committee to work with the administration to streamline implementation, keep costs under control, and increase genuine access to public programs. Health Access is committed to working to improve this process and achieve better results with a broad coalition of organizations who serve seniors, people with disabilities, children, labor, low- income families, and others. We will work collectively to ensure that this change brings genuine improvements to the process and does not spend money frivolously on technology that enriches consultants without adding value to consumers and taxpayers.
Stay tuned for developments as this process unfolds.
posted by Elizabeth C Abbott | Permalink | 5:25 PM
Can't go wrong with choreography...
Sunday, September 27, 2009
Earlier this year, John Mackey, the CEO of Whole Foods, wrote an op-ed in the Wall Street Journal, where he opposed the health reform proposals in Congress now. Even more troublesome, he argued for a set of boilerplate deregulatory proposals that would make our health care crisis wrose.
At least one White House official, Ms. DeParle, has gone so far as to make a house call. When Senator Dianne Feinstein, Democrat of California, expressed misgivings about how expanding Medicaid would affect California’s budget, Ms. DeParle gathered some charts and dropped in on a Saturday. They spent nearly three hours talking over coffee in Ms. Feinstein’s den.
That's not a small amount of outreach for a Senator not on a relevant Senate Committee. But when this gets to the floor, every vote will count.
Senator Feinstein has been equivocal in support of health care reform. While many have been disappointed in her lack of championing a public health insurance option, she has been fairly clear in being supportive of the general concept.
But on health reform in general, her tone has been more skeptical than supportive:
* In late August, she put a long missive laying out her thoughts on health reform, which were unhelpfully titled, "Concerns About Health Reform."
Some of the questions she raises are legitimate--from the need for affordability for California's families facing a high cost-of-living, to the impact on our budget to the need to protect our safety-net hospitals--and are appropriate for someone looking out for California's interests and specific needs. There are other concerns that are misguided--for example, the impact on the state budget is inflated--and other points that are contradictory. In another post, we'll go into the Senator's statement in a more detailed way.
What's most disappointing is that California's health care situation is in a particularly bad situation--and so California is likely to disproportionately benefit from health reform. Someone from California could be expected to be a vocal champion for the urgency of health reform--even if she also looked out for the important specifics.
It's good that the White House is walking the Senator through the specifics. It's up to Californians to make clear their support for health reform and their sense of urgency in the next few days and weeks.
"This is one for the people," said plaintiff Herbert "Les" Greenberg. The judge "could not understand what Blue Cross did not understand about the law, which is clear on its face."
The award might be small change for Anthem, whose corporate parent, WellPoint Inc., netted $2.5 billion last year.
According to a Times analysis published Feb. 18, Anthem sold thousands of policies that were intended to be safety nets for the sick, jobless and uninsurable at premiums that exceeded state-issued rates. At the time, Anthem said it had erred and pledged to make amends. And Anthem did mail out refund checks. But Greenberg, an investment lawyer, said the $12 check he got fell far short of what he believed he was owed.
It's not easy to get Blue Cross to answer for their policy or their practices. Here's a good video (done by an iPhone) of the San Francisco protest earlier this week, which also got featured with a photo in the New York Times. It features video of Patrick Romano and audio of Linda Leu, both of Health Access California and the national Health Care for America Now campaign.
The Senate Finance Committee, chaired by Senator Max Baucus, has recessed for the weekend and will come back Tuesday morning, where key amendments--like those about the public health insurance option--will be taken up. I expect that there will be lots of staff work over the weekend, maybe even some deals.
The debates are interesting to listen to. Here's one exchange of note, between Senator Stabenow and Senate Kyl, on whether the Secretary of Health and Human Services should be allowed to set a minimum benefit package.
I hope Governor Schwarzenegger is listening to Senator Stabenow. The legislature passed AB 98 (De La Torre): to require all individual insurance policies to cover maternity services, and he has until October 11th to sign or veto it. We have a societal, financial, and familial interest in ensuring that maternity care is part of a basic benefit package. The point of health coverage is that we pool our resources so when we need coverage it is there, whether is is maternity care for some women, or treatment for prostate cancer for some men.
The Education and Labor Committee of the U.S. House of Representatives, chaired by California Representative George Miller has put out a useful interactive quiz on our current health care crisis. I confess I got a less-than-perfect score...
The quiz is important in reminding us not just to look at the bills, but the condition of the current status quo in health care.
At TNR's The Treatment, I joined many much-more disinguished experts in ranking of the Baucus bill. Under the "Truman score" Jon Cohn developed, the Baucus bill got a 6.1 out of 10. In such a life and death issues, my comparison isn't a batting average but a driving test--and 61% is a failing grade in most circumstances. Jon Cohn promises an evaluation of the status quo, which I imagine will get even worse marks. It reminds us why we health reform is so necessary.
Here's a White House video that describes the benefits of health reform in four minutes:
Health Access is giving trainings--longer but more in-depth--around the state to help health reform advocates and community leaders understand the health reform proposals, the "pressure point" issues that are still at issue in the content of the proposals, answer any questions they have, and help them talk about health reform to others. For a training in your area, contact your local Health Access organizer, or Patrick Romano the California campaign director of Health Care for America Now! at promano@health-access.org.
HEALTH ACCESS UPDATE Tuesday, September 22nd, 2009
AS SENATE FINANCE COMMITTEE STARTS TO MARK UP HEALTH REFORM, CALIFORNIANS PROTEST POLICIES/PRACTICES OF ANTHEM BLUE CROSS * Senator Baucus Begins Marathon Sessions to Consider 500+ Amendments to His Proposal * Health Reformers Protest State's & Nation's Biggest Insurer, Wellpoint/Anthem Blue Cross * Wellpoint/Anthem a Major Opponent, But Its Practices Show Need for Health Reform * http://www.sickofbluecross.com/ Relaunched to Spotlight Insurers' Actions
* More Updates on http://blog.health-access.org: AB1422 Signed to Prevent Children From Being Denied Healthy Families Coverage; The Outstanding #Health Reform Issues to Learn and Link About; HCAN on Colbert; New Census Figures to Fight Over; President Obama: It Could Happen to You; We are Number 37!; Hospital Fee Drama; Momentum for Health Reform;
The debate over national health reform is heating up, with the Senate Finance Committee, chaired by Senator Max Baucus (D-Montana), beginning Tuesday to consider, or "mark-up," its version of a health reform bill in marathon session through this week.
Consumer and community advocates are urging several amendments and changes to the proposal, including 1) increasing the financial subsidies for low- and moderate-income families to ensure that coverage is affordable for them, both in premiums and in out-of-pocket costs; 2) improving and changing the structure of the assessment on larger employers which don't provide health coverage to their workers, to provide more security and stability for on-the-job benefits; and 3) including the choice of a public health insurance option for individual who do have to purchase coverage on their own, as a way to provide more choice and competition and to help bring down costs. Other key changes being sought include allowing undocumented immigrants to purchase coverage with their own money and wages (as opposed to using federal funds), to better negotiating drug purchasing savings as to more fully cover seniors for prescriptions
Whatever amendments are taken or not, the health reform proposal is likely to evolve as it goes through the process. Any bill emerging from the Senate Finance Committee will need to be merged with its counterpart in from the Senate Health Committee, previously chaired by the late Senator Ted Kennedy. After such a proposal passes the full Senate, it would need to be reconciled with whatever the House of Representatives passes. Currently, all three House Committees have passed a more generous and ambitious bill, H.R.3200 in July. Only that final product, after going back to the Senate and House for floor votes, then will be able to go to President Obama's desk.
So while health reform has never moved as far in the 40+ years since the passage of Medicare, there's a long process to go, and many organizations and interests, from consumers and community groups, to insurance companies, will have many more opportunities to intervene.
PROTESTS OF WELLPOINT/ANTHEM BLUE CROSS: In that spirit, also on Tuesday, hundreds of customers of Anthem Blue Cross of California , a subsidiary of Wellpoint, protested with California Health Care for America Now partners, including Health Access California, California Partnership, California Labor Federation, California ACORN, MoveOn.org, and SEIU. The protests were held outside the insurance company’s offices in six locations in California, over 100 nationally. They included a rally of 300+ people in downtown Los Angeles and of 250+ people in downtown San Francisco .
In the current national health policy debate, Wellpoint, the largest insurer in the nationa and in California , has emerged as a principle opponent of health reform. Wellpoint’s subsidiary, Anthem Blue Cross of California, sent out communications to both its consumers and its employers with false and misleading attacks against H.R. 3200, the main health reform bill in the House of Representatives.
Health Access and other consumer groups made the point that Anthem Blue Cross of California is not just the main opposition to health reform; it’s the poster child for why we need reform in the first place. It’s their abusive practices that are the very reason for health reform. This soridid history of Anthem Blue Cross's opposition to health reform, and anti-cosnumer protections, are being documents at a newly-relaunched website at http://www.sickofbluecross.com/.
The point of the actions across the nation was to point out that if big insurers profit from the status quo, consumers lose unless we have reform. Anthem Blue Cross has opposed comprehensive health reform in California in 2007, opposes specific bills on the Governor’s desk, and is now aggressively attacking the key legislation moving in Congress.
At these events, consumers and many community organizations rallied in support of the House bill, H.R. 3200, drafted by California committee chairs like Representatives George Miller, Henry Waxman, and Pete Stark, and supported by Health Care for America Now!, which would prohibit many of the anti-consumer practices that Anthem Blue Cross is known for, including rescinding coverage, denying people for pre-existing conditions, and providing inadequate benefits. The bill would also provide a public health insurance option as a choice to compete with private insurers like Anthem Blue Cross.
During the actions, HCAN and partners revealed that the health insurance companies are spending $641,000 a day to oppose reform because they profit by keeping the system exactly the way it is, In these actions, the advocates urged that company to stop it's opposition to health reform, and its practices of those who deny claims; raise premiums, co-pays, and deductibles at will; reject patients based on pre-existing conditions; and refuse to cover the treatments our doctors prescribe.
The crowds gathered before noon at San Francisco, Los Angeles, and other locations, and demanded to see the company’s chief executive to ask her to sign the following pledge:
Stop Denying Our Care!
We are here to demand that CEO Angela Braly of WellPoint, parent company of Anthem Blue Cross of California who made $8.7 million last year to deny care to WellPoint/Anthem Blue Cross of California customers, agree to the following.
Effective immediately:
1 Anthem Blue Cross of California will not stand between a doctor and a patient when it comes to deciding what care that patient needs. No one at Anthem Blue Cross of California will substitute their judgment for the judgment of the patient’s physician in deciding if care is medically necessary.
2. Anthem Blue Cross of California will not deny coverage or raise rates for individuals or businesses based on a pre-existing medical condition, and will end arbitrary caps on payments for necessary medical care.
3. Anthem Blue Cross of California will terminate any policy or incentive that rewards employees financially or otherwise for denying care and rejecting claims.
4. Anthem Blue Cross of California will not use any resources – including members’ funds, employees, and facilities — to lobby against and oppose any aspect of the health reform proposals supported by President Obama and being considered by members of the United States Congress, including but not limited to a national public health insurance option available on day one.
Events in Los Angeles and San Francisco included testimony from many who have personal experience with Anthem Blue Cross of California’s anti-consumer practices, of having their insurance rescinded when they became sick, of having to fight in ongoing appeals to have prescribed medications covered, of finding their current coverage unaffordable and of being denied coverage due to pre-existing conditions.
Other speakers included doctors and other community and organizational leaders, including California Labor Federation head Art Pulaski of San Francisco . The groups also leafleted passers-by, both to urge them to call their Senator, and to find out more about Anthem Blue Cross’ behavior at the re-launched website http://www.sickofbluecross.com/. The San Francisco event even featured a volunteer in a Sick of Blue Cross costume.
The Los Angeles event also featured state Assemblymember Hector De La Torre, highlighting bills now on the Governor’s desk opposed by Anthem Blue Cross of California.. These bills include his AB 2, to protect consumers against rescission, and will put an end to this shameful practice. Anthem Blue Cross was found to have the most number of rescissions, yet they oppose reform, both the pending state bill, but also the federal reform H.R. 3200, which would completely outlaw the practice.
In California, there were also events as Sacramento, San Jose, Santa Ana and San Diego and hundreds more across the country today, fed up customers and advocates for health care reform held protests and declared, “Big Insurance: Sick of It.” Flagship events in Minneapolis , Indianapolis , Philadelphia , Milwaukee , and Hartford drew thousands of protestors to health insurance company headquarters or to events where they could confront health insurance CEOs.
Health Care for America Now (HCAN) is a national grassroots campaign of more than 1100 organizations representing 30 million people dedicated to winning quality, affordable health care we all can count on in 2009. We are doctors, nurses, community organizations, small business owners, faith-based groups, people of color, seniors, and children’s and women’s rights groups. Founded July 8, 2008, HCAN is the nation’s largest health care campaign fighting to win a guarantee of quality, affordable health care for all with the choice of a strong national public health insurance option in 2009.
Governor Schwarzenegger signed AB1422 today, which along with increased premiums, increased copays, and contributions from First Five provide the resources to prevent loss of Healthy Families coverage for over 900,000 children. Anticipating this signature, the Managed Risk Medical Insurance Board has already started processing the nearly 90,000 children that have been left uninsured on a waiting list for the last month or so. We should have never have been in this situation, but this is good news that such a major crisis was averted.
Health Access California joined the 100% Campaign, the community clinics, Western Center on Law and Poverty, and other organizations in supporting AB1422 by Assembly Speaker Karen Bass which creates a gross premium tax on managed care organizations that can be used to draw down federal match to fund Healthy Families. But it was our frequent adversaries, the HMOs and health insurers themselves, that provided essential support for the bill.
We here at Health Access California go head to head with HMOs and insurers day after day, year after year. HMOs and insurers are among our most frequent adversaries and only rarely on the same side with us. So it is a rare day when we give them credit for helping to get something good done. They had their own interest in supporting the measure, but it still was a good thing to do.
Particular credit is due to John Ramey, who now heads the association that represents the local initiatives, California’s home grown public options for Medi-Cal and Healthy Families. John Ramey was one of the first staff at MRMIB when it was created. We know him more recently from his work with the Chamber of Commerce opposing an employer mandate ballot measure in 2004---and in working with Governor Schwarzenegger for health reform in 2006-07. John was committed to avoiding the destruction of the Healthy Families program as a result of the devastating cuts done in the July budget: he revived the notion of reconfiguring the existing provider fee for HMOs into a gross premiums tax that could draw down federal match.
I know the lobbyists who are on staff with the various insurers and HMOs as well as the trade association lobbyists and the very highly paid contract lobbyists from some of the highest billing lobbying firms in Sacramento. I spend a lot of time in the halls of the Capitol with these folks. The lobbying firms included Lang Hansen O’Malley and Miller as well as Sloat Higgins, both firms that bill a million dollars or more a quarter (http://cal-access.sos.ca.gov/Lobbying/Firms) One of these contract lobbyists once accused me of wanting government-run health care because of the modest reforms to label products in our AB786! So the gulf that exists between their world and mine is not just about who their clients are and how much they charge but their perspective on issues.
I watched over the last few weeks as these lobbyists sweated vote by vote to pull out the victory that looks easy from the vote totals but was very much a day by day effort. These lobbyists assured Republican legislators that there was no official opposition, even from many conservative tax groups, and that at the last critical moment, the Chamber of Commerce senior lobbyist came to lobby on our side of the fight. It is the tradition on the corporate side to hire both conservative Republicans and former Democratic staff: it meant that the face of this fight was often a HMO trade association lobbyist who used to lobby for the Chamber of Commerce or a HMO staff lobbyist that is a former Republican staffer well known for his conservatism.
Credit is also due to Sumi Sousa, Speaker Bass’ staff; David Panush, staff to Pro Tem Steinberg and Jennifer Kent in the Governor’s office. The three of them worked in tandem to make this happen. While their bosses get the public credit (after all Bass, Steinberg and Schwarzenegger were elected, not the staff!), the staff does a lot of the day to day, hour by hour work to get things done.
Of course, thanks are also due to the many advocates who supported this effort as well—but for once, we had the easier assignment.
In a year when we have seen such devastating cuts in health and human services, it is good to have averted the worst of the cuts to Healthy Families.
The Senate Finance Committee is starting its public deliberations on health reform today. If you don't have C-SPAN, you can follow some of the action on Twitter, by journalists and bloggers like @jcohntnr, @ktumulty, @NewHealthDialog and @wonkroom.
We at Health Access (@healthaccess) are following it as well, and will RT (re-tweet) posts from these and other observers, as well as add our own observations. Follow us at @healthaccess!
Schwarzenegger also uses video to display a mischievous side. One in particular landed on national news networks – a 27-second spot of Schwarzenegger waving a giant knife in July before telling followers that they gave him great ideas.
The governor intended for the clip to be humorous, as if the camera caught him in the middle of his everyday big-knife-waving routine.
Of course, critics also use Twitter. Social-services advocates took offense as the video came during tense budget talks in which Schwarzenegger sought deep cuts.
Health Access, which represents low-income Californians, wrote: The video adds insult to injury, literally.
Days later, Schwarzenegger told reporters, "You've got to have a little sense of humor. That's me. You sent a governor to Sacramento, not El Stiffo."
If you live in California, you’re probably familiar with WellPoint, the biggest insurer in the nation, and their California subsidiary, Anthem Blue Cross - the biggest insurer in the state.
Chances are, many of you reading this are also aware of how WellPoint/Anthem Blue Cross have implemented an aggressive policy aimed at covering only the healthy and doing everything in their power to avoid covering those deemed a “high-risk,” because of so-called “pre-existing conditions.”
But did you know that WellPoint and its subsidiary have also been engaged in an aggressive campaign effort to derail national health reform? Just last month, it was reported that Anthem Blue Cross sent an e-mail to millions of their subscribers littered with false information and outright lies about the House Health Reform Bill, H.R. 3200.
The people of California are fed up. We’re tired of the big insurance companies spending big money to undermine the real reform we so desperately need. Join us on Tuesday September 22nd in Los Angeles and San Francisco as we stand up to California’s most notorious private insurance company.
Los Angeles: What: “Big Insurance: Sick of It” Rally Where: Anthem Blue Cross, 801 S. Figueroa St., Los Angeles When: Tuesday, September 22, 2009 at 11:00 am
San Francisco Bay Area: What: “Big Insurance: Sick of It” Rally Where: Anthem Blue Cross - 2 Embarcadero Center, San Francisco, CA When: Tuesday, September 22, 2009 at 11:30 am
Why WellPoint and Anthem Blue Cross? Wellpoint is the biggest insurer in the nation. Anthem Blue Cross of California, its subsidiary, is the biggest insurer in California, with 6.8 million customers relying on it for coverage. Starting with a “robo-call” campaign in April, Anthem Blue Cross urged subscribers into action to help defeat health reform. More recently, Wellpoint called subscribers and urged them to write letters to Congress per instructions on its fake “grassroots” website. Wellpoint has 33.5 million subscribers — who likely are unaware its CEO is on the record as favoring “profits over people.” Wellpoint & its Anthem Blue Cross of California are the insurer most aggressively opposed to health reform:
In just the first six months of 2009, Wellpoint spent nearly $3 million lobbying Capitol Hill against health reform, targeting the public option that would give them competition in the marketplace.
Just last month, Anthem Blue Cross sent E-mails to California subscribers with false information attacking H.R.3200, the House version of health reform.
California’s Attorney General is investigating complaints that Anthem Blue Cross violated labor law in telling their employes to play politics by attending town halls as opponents of health reform — and signing sample letters to their Congressmen urging the defeat of health reform.
This is not a new role for them. In 2007, Anthem Blue Cross & Wellpoint were the leading opponent to the health reform push of Governor Schwarzenegger, spending over $2 million on a deceptive ad campaign against the proposal.
In Sacramento, they consistently oppose not just big comprehensive health reforms, but even small, specific, common-sense bills at the state legislature. They oppose bills to: stop insurers from charging women more than men; require labeling of insurance policies so consumers know what they are buying, stop insurers from the unfair practice of yanking coverage of people who get sick, make maternity coverage standard in policies, and place a limit on out-of-pocket costs for customers.
Wellpoint and Anthem Blue Cross aren’t just the leading opposition to health reform; they and their anti-consumer practices are the reason we need health reform so urgently.
They are one of the most aggressive companies in denying people coverage for so-called “pre-existing conditions.”
They had the largest cases of rescissions, where insurers retroactively yank people’s coverage away from them after medical bills come in. In February 2009, California fined Anthem Blue Cross $1 million for yanking coverage of 2,330 customers who submitted medical bills. It took the $1 million fine to get Anthem Blue Cross to actually cover those medical expenses that customers paid for when they bought coverage.
They hike rates without justification. Some 80% of individual policy subscribers in California got premium increases of up to 39% in the past year — just as the recession was tightening its grip on people’s household budgets. In fact, Anthem Blue Cross has decided to target the “individual” policy market aggressively in California because it is the least regulated and offers the highest profits. More than a third — about 3 million — of its policies sold in California are the less-regulated individual policies.
They aggressively engage in “cherry-picking,” an insurance industry practice that markets coverage to young, healthy people and avoids those who may need medical care. They market “skeleton” or “junk insurance” with bare-bones coverage for consumers, leaving consumers with significant debt, even after paying premiums.
Anthem Blue Cross and Wellpoint choose profits over people. Wellpoint CEO Angela Braley told shareholders, “We will not sacrifice profitability for membership.” Braley’s executive salary? Upwards of $10 million annually, plus stock options and benefits.
Wellpoint and Anthem Blue Cross of California needs to stop using our premium dollars to oppose health reform, and to stop the practices that make health reform so necessary in the first place.
But the big health reform event last week was the release of Senator Max Baucus' "Chairman's Mark," which will be the basis by which the Senate Finance Committee will be considering, and amending, in the next week. Within a familiar framework for those following this debate, there are many issues of significant concern.
Paul Krugman has an apt analysis of the issues in his recent New York Times column--that health reform won't have everything health advocates want, but can still be supportable and even a major improvement over the status quo--but the Baucus plan really need to improved in three big ways: 1) the level of subsidies and assistance to low- and moderate-income families to make coverage affordable; 2) the structure and level of assessment on employers who don't provide coverage to their workers; and 3) the inclusion and structure of the public health insurance option.
Ron Brownstein of The Atlantic, who smart about politics and about health care, makes a point about good aspects of the Baucus plan--but even he agrees that it asks too much of low- and moderate-income families and too little of employers, and that it should be fixed in that regard.
And let's remember, while we haven't come so far with health reform since the creation of Medicare and Medicaid over 40 years ago, there's still a ways to go. Which means there are opportunity to improve the bill, especially as it gets merged with the other, better proposals in the Senate and especially the House. The Health Care for America Now website usefully lays out the process going forward.
The first step is the process of amending the Baucus proposal in Senate Finance Committee. Many of the issues above, and so many more, are touched on by the 564 amendments proposed. This is the debate of the next week or two.
In a hearing today, the Managed Risk Medical Insurance Board agreed to restart enrolling children in Healthy Families coverage tomorrow, September 17th, after making a formal finding that funding is now sufficient to avoid disenrolling children currently enrolled in the program.
While Governor Schwarzenegger has yet to sign AB1422(Bass), the bill that helps bridge the funding gap by drawing down new federal funds, he has committed he will sign it.
As quoted in their press release, Lesley Cummings, Executive Director to the Board, stated, “Today, the Board was able to make a finding that there are sufficient funds at this time to fully cover estimated expenditures in the Healthy Families Program. I am happy to announce there will be no disenrollments and the program will be open to new enrollment beginning tomorrow. Our administrative vendor, Maximus, has already begun processing applications from the waiting list. The Board’s finding was made possible by three key actions: the passage of AB 1422, program changes to cut expenditures, and the generous commitment from the state First Five Commission to provide funding for children ages 0 to 5 in the program. We are extremely grateful for the huge outpouring of support for the Healthy Families Program and the fact that hundreds of thousands of children in California will have access to health care as a result.”
The "program changes to cut expenditures" were additional costs placed on these low-income families, including increases in subscriber premiums and co-payments for health care services that will save the program approximately $17.5 million this year, effective November 1.
In the short amount of time that enrollment was closed, the waiting list grew to 87,000-plus children. It will take Maximus, the administrative vendor, about 30 days to notify families as to whether their children are eligible and have been enrolled in the program. Actual health care coverage once enrolled begins after 10 days.
All supporters of quality, affordable, health care for all have a tough balancing act: being a clear, strong voice for the urgency and necessity of health reform, while at the same time insisting on the provisions and policies to make it workable and meaningful.
Luckily, we have an example of a very good reform proposal to support with H.R.3200, and to a lesser extent, the version of the Senate bill passes by the Kennedy HELP Committee. These are proposals to rally around.
But the proposal coming out of the Senator Baucus' Senate Finance Committee does raise serious concerns. The framework is similar to the other proposals that we support. But the details matter on key issues on affordability, securing employer-based coverage, and the public health insurance option. And some of those details are very concerning.
Here are some issues of importance, some major, some specific. There's a lot of links below, but they are worth your time--it's my best compilation of the current flashpoints regarding the details in the debate:
* Michael Scherer of Time.com's Swampland reports about a troubling push to include undue exclusions for undocumented immigrants from the exchange to buy coverage. It's one thing to bar federal funds from subsidizing coverage for undocumented immigrants--which is in all the bill being considered (without comment on whether that's a good or bad policy--that's in the bills now.) It makes no sense to exclude them from buying private coverage with their own money and wages--it leaves them uninsured, health providers often unpaid, and simply places more paperwork burdens on the rest of us.
We have our work cut out for us not just to pass health reform, but to make it a good health reform. The Senate Finance Committee isn't the end of the process, but a step along the way. If this was easy, it would have been done before.
In his first show after a three week vacation, Stephen Colbert interviewed Richard Kirsch, the national campaign director for Health Care for America Now!, the coalition of over 1,000 organizations working for quality, affordable health care for all, this year. Health Access California is proud to be the lead partner organization for HCAN in California.
I've known Richard for over a decade, as he is on leave from being the longtime executive director of Citizen Action of New York, where I got to know him when I was at New Jersey Citizen Action. He has his own humor, but in these situations, his job was to be the straight man, which he did well despite the grilling by Colbert. Colbert's questions were only slightly more ridiculous than some of the allegations thrown out by right-wing media. Enjoy.
Uninsurance--it's bigger--not smaller--than you think.
Monday, September 14, 2009
How many uninsured are there?
Maybe we are asking the wrong question. Here's a better question: How many people will experience uninsurance in the future?
We need to be thinking of uninsurance as a condition--one that can (and will) impact us all--as opposed to a population--one that can be minimized and marginalized.
Most estimates of the uninsured are for a specific point in time, or over the course of only one year. When just looking at a two-year period, far more people--nearly 1 in 3--find themselves uninsured, as Families USA has calculated using Census data. And for every day they are uncovered--and most of them are uncovered for more than six months--they are likely to not get care and/or face the risk if not the reality of financial ruin. One trip to the emergency room without coverage can mean thousands of dollars of unexpected bills.
For those who say that two years is too long a period to evaluate, please let our Congress know--as they are busy fretting about the ten-year cost of health reform. If we are going to calculate the ten-year cost, we ought to calculate the ten-year benefit, of how many Americans will be prevented from falling into uninsurance, preventing the gaps that are disruptive to both quality care and a family’s financial stability.
President Obama understands this: This weekend, he cited a new Treasury Department report that indicates about half of non-elderly Americans went uninsured for some portion of 1997-2006. With the continuing erosion of coverage without health reform, the number who would benefit by not having such a gap in coverage over the first ten years of health reform is likely well over half the country. That’s not a problem, or a benefit, to minimize.
My post goes on (and on!) to rebut the range of attacks on the number of 46.5 million uninsured that was recently updated by the U.S. Census Bureau last week. It's a bad sign for the debate when we are arguing about basic facts. But it also shows that health reform opponents don't even have a good sense of the actual problem--much less how H.R.3200 and other health reforms will solve it.
Here's a clip from President Obama's speech to over 15,000 in Minnesota, making the case that the benefits of passing health reform will be felt by millions more than just the uninsured, but also those who might experience a gap in coverage over the next many years.
Young adults from 18 to 34 years old make up more than half of the nation’s uninsured population—largely due to the fact that they tend to have lower incomes. For those in their 20s and 30s who do have health insurance, peace of mind isn't necessarily part of the deal.
Recently, public radio’s Terry Gross interviewed two young women who were diagnosed with cancer in their 20s. The “Fresh Air” segment was planned around the theme of healing through humor and the notion of “cancertainment” becoming popular among young patients.
The conversation turned quite serious, though, when Gross asked her guests -- writers Iva Skoch and Kairol Rosenthal -- about their health insurance.
In short, they said, the hurdles and hassles of dealing with health insurance were so overwhelming they had little time or energy to focus on healing. They had to put their thoughts about having cancer, undergoing treatment, and positive healing, on hold while trying to survive their insurance nightmares.
One ended up rejecting care in the U.S. and seeking cancer treatment in another country – one considered far less advanced than the United States. The other had to muster up super-human strength to fight for her coverage.
Here are some condensed snippets of the interview with Skoch and Rosenthal. It’s worth listening to the entire broadcast -- or reading the transcript -- to get a sense of what these young women have gone through. And yes, parts of the interview are funny – the parts after they talk about insurance. Skoch (pictured at right):“I went to the doctor (in New York) and my diagnosis (of colon cancer) was covered. But I’m originally from Prague, which has socialized medicine, and I decided to go and get treatment there, simply because I honestly was not able to deal with all the billing issues.
Just from the first week after being diagnosed, I had a stack of bills about two inches. I constantly dealt with people from insurance companies, trying to figure out what I have to pay, what I don’t have to pay. I was going through this life-changing experience, and it seemed like all I could focus on was these billing issues. So that was ultimately what made me decide to go back to the Czech Republic and get treatment there.
I got great care. It is different than being treated in the U.S., and I think the biggest difference is that it’s a very efficient kind of care. It’s really all business. So I think that was probably the biggest difference, (no) bedside manners.
And I really did not have to wait…because I think everybody felt that I was young, and they needed to push me ahead. So I really did not have to wait any more than I wait when I go to see my doctor in the U.S.
Part of my treatment was taking Avastin, which is a very new drug, and it’s not actually chemo. It’s a bio-based drug that basically starves your tumors from blood supply. In the U.S. a lot of insurance companies don’t want to cover it because it costs tens of thousands of dollars. (In Prague) it was never an issue of cost. I never got a single bill for anything.”
Rosenthal (pictured at right): “I actually had health insurance the day that I was diagnosed (with thyroid cancer). But when I called to get a second opinion, the nurse said, ‘I’m sorry. You don’t have any health insurance.’ And to me, hearing that I had no health insurance was way more startling than even hearing that I had cancer in the first place.
My employer had forgotten to submit my COBRA paperwork… I was leaving a job, and I had filled out all of the paperwork, and I submitted what I needed to submit, but they didn’t submit what they needed to submit. Now, my problem was, because I had been diagnosed with cancer just a week before, I now had a pre-existing condition, so I was not able to go out and obtain my own health insurance.
It was up to me to spend my time on the phone with the COBRA administration and with the privatized company that was administering the COBRA. That’s what I did for the first month after my diagnosis. I was on the phone Monday through Friday, nine to five, haggling with people. And I ended up sort of weasling my way into getting back on to COBRA.
The image that kept coming to mind over and over again is you hear these legends or myths about children who are trapped underneath a car and their moms are just suddenly empowered with this Herculean strength and they’re able to pick up this massive hunk of mental and get their child out from this trapped situation. And I kept thinking, I feel like the child and the mother at the same time and I am just trapped underneath this incredibly complex and suffocating system of health care and I’m trying to save myself, and I have to use my own energy to do it.
I was constantly on the phone, nine to five. I had to present a good case. But it was really exhausting. So when these phones shut down at nighttime, I was a wreck. I mean, I was hysterical. I was crying all of the time. People think that when you are diagnosed with cancer, it’s about healing, taking a bath, lighting candles. I was utterly exhausted, frustrated and completely freaked out that I might die because I don’t have access to health insurance.”
By the time Kairol Rosenthal won her battle with the bureaucrats, her thyroid cancer had spread to 30 lymph nodes. She’s never been in remission. Iva Skoch’s colon cancer is in remission.
In the last hours of the legislative session, literally between 5:30AM and 6AM Saturday September 12, the California Legislature passed AB1383 by Assemblyman Dave Jones which will create a hospital provider fee that will be used to fund children’s coverage and to improve Medi-Cal reimbursement to hospitals (now 51st in the nation). It passed the Senate 24-5 and the Assembly 52-22 as a fee measure. In the Senate, the vote was party-line, in the Assembly a few Republicans voted in support.
Because the Senate Republicans were blockading all two-thirds vote measures on the last day of the legislative session over un-related budget matters, the bill has been amended to eliminate the urgency clause and to go into effect January 1, 2010 so that it no longer required a two-thirds vote. The amendment also eliminated the appropriation that would have funded the work of the Department of Health Care Services in implementing the measure.
The amendments also included some seemingly minor tweaks to the formula or model that were needed to bring it into compliance with federal requirements for the provider fee.
At this moment, we do not know whether the elimination of the urgency clause means half-year money for the fiscal year 2009-10 or full-year money. Provider fees take months to implement in any case.
Whether it is six months worth of better funding for hospitals and children’s coverage or a full year, Health Access is supportive of the measure.
More importantly, we do not know how the Schwarzenegger Administration will respond to the revised measure. So there is work to do to persuade the Governor to sign the bill.
While we wait for the end-of-session, here's a rock video worth watching, which goes through the list of countries that have better health indicators than the United States--and refers to more recent developments in the health reform debate as well.
The city hall featured is right here in California, in Santa Monica.
The video is so up-to-date it even manages to even get a picture of the now-infamous Rep. Joe Wilson. Amusingly, his opponent has raised over $1 million in the 48 hours since the South Carolina Republican's outburst during the President's speech.
At this moment the California Legislature is still in session: one of the bills they are waiting to pass is AB1383 by Assemblymember Dave Jones, which would bring in $2 billion to California’s health care system including $320 million for children’s coverage.
The log jam we wrote about earlier today has been broken: they are waiting for amendments that would adjust the bill so it does not violate the federal requirements for hospital provider fees. We can only hope that the agreement that was reached this evening did not come too late to be enacted in what are literally the last hours of the legislative session for this year.
LATEST UPDATES at www.twitter.com/healthaccess: @healthaccess With other 2/3 bills, AB1383(Jones) to draw down new fed $ for HC fails in Sen as an urgency measure due to lack of R votes. Being sent back to Senate Rules Com. (2:30am))
Health reform was in the air, and the subject of a (8am!) panel on the subject, moderated by Tom David from Tides, and with Crystal Hayling, President & CEO, Blue Shield of California Foundation, and coming from DC, Roger Hickey, Founder & Co-Director, Campaign for America's Future.
At this moment, AB1383 by Assemblymember Dave Jones--which would create a hospital provider fee, part of which would be used for increased Medicaid reimbursements and for children’s coverage--hangs in the balance. Yesterday Governor Schwarzenegger sent a letter saying he will veto the measure because the model used for the development of the hospital provider fee is fatally flawed.
The California Hospital Association proposal for the hospital provider fee appears to violate the requirements of the federal Centers for Medicare and Medicaid Services for provider fees. These requirements are complicated but not particularly mysterious: more than 30 states, including California, have provider fees for nursing homes and more than 20 states have provider fees for hospitals. It is unfortunate that it is just now in the closing hours of the legislative session the problems with the CHA provider fee proposal have been discovered—and that it puts at risk $320 million in possible funding for protecting and expanding children’s coverage, especially in these tough budget times.
Efforts are underway to find amendments that resolve these difficulties but at this moment it is not at all certain what the outcome will be.
Health Access has been supportive of AB1383—because California needs more children’s coverage, not less and because Medi-Cal reimbursement for hospitals is 51st in the country so it needs to be improved as well.
HEALTH ACCESS UPDATE Thursday, September 10th, 2009
ON PENULTIMATE DAY OF SESSION, ASSEMBLY ADOPTS TWO CRUCIAL HEALTH CARE BILLS FIXING INDIVIDUAL INSURANCE MARKET * AB2, Bill to Provide Regulation on Rescissions of Insurance Policies, Passes Assembly * Assembly Also Passes AB98, Adding Maternity Coverage to Individual Policies * US Census Pegs U.S. Uninsured at 46.3 Million; CA’s Uninsured Rate is 18.5%
* More Updates on blog.health-access.org: The Grim New Census numbers; Liveblogging the Big Speech; Obama’s Big Speech; Last Week of Session; Healthier from Health Reform? Again, Affordability is the Key!; The Full Healthy Families Report, with Updated Info; Gov Will Sign, and No Kids Kicked Off…
* 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. Join our Twitter followers!
SACRAMENTO -- Two Assembly bills to ensure fairness and consumer protection for those who buy individual health insurance policies passed the Assembly on Thursday, heading to the Governor’s desk.
AB2 (De La Torre, D) would provide consumer protection for customers who buy individual insurance policies, seek medical attention and then lose their coverage when insurers rescind the policies to avoid paying medical bills.
Specifically, the bill would establish a new procedure for independent review of such policy rescissions. Insurers would not be allowed to rescind coverage without approval from a regulator. Only if it is determined that a customer willfully held back pertinent information about a relevant pre-existing condition would the rescission stand. Assemblyman De La Torre said that insurers should not be allowed to be judge, jury and executioner in such cases, but that an independent review was needed.
The bill would also reform and standardize the questionaire that people fill out when they apply for coverage, another important reform.
The second bill, AB98 (De La Torre, D) adds maternity coverage to mandated health care services that individual policies must cover. Some Republican lawmakers argued against the measure, saying men should not have to share the cost burden to provide coverage for maternity services. However, De La Torre argued that, currently, women share a cost burden of covering standard services such as prostate cancer coverage and medication for men such as Viagra.
Describing his bill as truly representative of family values – and a “civilized California ” – De La Torre estimated that the added expense to ensure that maternity services were included in all individual coverage plans would cost only an added $7 a month for customers.
Both bills passed the Assembly Thursday on concurrance, having already passed the Senate, and so are heading to the Governor's desk.
Other bills of interest to health advocates (listed on the Health Access website) that passed and are heading to the Governor's desk, also supported by Health Access California, include:
* AB119 (Jones, D), prohibiting gender discrimination in pricing premiums differently based on gender. * AB730 (De La Torre, D), would impose fines on insurers unlawfully engaging in post-claims medical underwriting. * AB108 (Hayashi, D), would impose a 24-month time limit in which insurers have the right to rescind, cancel or limit individual health care policies or charge higher premiums because of fraud once a consumer's application is approved. * AB244 (Beall, D) would require most health plans to provide coverage for all diagnosable mental illnesses. * AB196 (Corbett, D) would require public notice of hospital closure or reduction/elimination of emergency medical services. * AB171 (Jones, D) 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. * AB1142 (Price, D) 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. * AB1269 (Brownley, D) 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 of up to 26 weeks. * AB 23 (Jones, D) was signed by the governor on May 12, 2009. The law requires insurers to provide notice to individuals eligible for Cal-COBRA that federal funds are available to assist with Cal-COBRA premiums.
NEW CENSUS FIGURES: Meanwhile, as the Assembly adopted fixes for those policy holders in the individual market, new figures were released Thursday showing that the number of uninsured people in the United States continues to rise.
The U.S. Census Bureau released its latest count of the nation’s uninsured, putting the number at 46.3 million in 2008. California ’s uninsured are pegged at 6.7 million for the same year – a number greater than the entire population of the state of Indiana.
When updated to reflect 2009 figures, the numbers undoubtedly will grow. Since 2008, several million more people have lost their jobs, and their employer-based coverage. Even before the recession, the number of uninsured was on an upward trajectory as insurance costs continued to rise.
Nationwide, the number of people covered by private health insurance declined from 202 million to 201 million between 2007 and 2008. Meanwhile, those covered by government health insurance rose from 83 million to 87.4 million. And the number of people with job-based insurance dropped from 177.4 million to 176.3 million.
The new figures come the day after President Obama’s address to Congress laying out his health care reform proposal. A CNN/Opinion Research Corp. poll reported a 14-point gain nationally in approval ratings for the President’s health care plans -- 67% of those who watched the speech said afterward that they support the President’s health care proposal.
The new Census data shows renewed urgency for health reform for the country, and California. California continues to have one of the worst uninsured rates (18.5%) in the country, and that doesn't take into account the most recent losses concentrated in California due to the recession, high unemployment, and budget cuts. If anything, the Census numbers underestimate the problem, since they only look at people who are uninsured in a given year, rather than a greater amount of time.
Here's California Senator Barbara Boxer on the Rachel Maddow Show, talking about her short conversation with the President after his big health reform speech yesterday:
Health insurance reform: The first step in health reform
Earlier this year, I participated on a panel at the conference of the California Pan-Ethnic Health Network, where I, as an advocate for health access and coverage, was supposed to "debate" public health advocates, about which is more important. It was a debate that neither side engaged, because we recognized it to be a false choice: both are important.
That said, I tried to make the point that for those interested in actually improving the health of Californians, health insurance reform wasn't a solution but a necessary foundation. Health insurance reform is more about our families' economic health than their medical health. But if we make the societal commitment to universal health care, and make changes to the incentives in the medical system, then suddenly we have a basis to actually build healthier communities and society.
That’s why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry...
We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care.
The American way of eating has become the elephant in the room in the debate over health care... But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America’s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet...
As things stand, the health care industry finds it more profitable to treat chronic diseases than to prevent them. There’s more money in amputating the limbs of diabetics than in counseling them on diet and exercise.
As for the insurers, you would think preventing chronic diseases would be good business, but, at least under the current rules, it’s much better business simply to keep patients at risk for chronic disease out of your pool of customers, whether through lifetime caps on coverage or rules against pre-existing conditions or by figuring out ways to toss patients overboard when they become ill.
But these rules may well be about to change — and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook — and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change.
The moment these new rules take effect, health insurance companies will promptly discover they have a powerful interest in reducing rates of obesity and chronic diseases linked to diet. A patient with Type 2 diabetes incurs additional health care costs of more than $6,600 a year; over a lifetime, that can come to more than $400,000. Insurers will quickly figure out that every case of Type 2 diabetes they can prevent adds $400,000 to their bottom line. Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits.
When health insurers can no longer evade much of the cost of treating the collateral damage of the American diet, the movement to reform the food system — everything from farm policy to food marketing and school lunches — will acquire a powerful and wealthy ally, something it hasn’t really ever had before.
...But what happens when the health insurance industry realizes that our system of farm subsidies makes junk food cheap, and fresh produce dear, and thus contributes to obesity and Type 2 diabetes? It will promptly get involved in the fight over the farm bill — which is to say, the industry will begin buying seats on those agriculture committees and demanding that the next bill be written with the interests of the public health more firmly in mind....
In the same way much of the health insurance industry threw its weight behind the campaign against smoking, we can expect it to support, and perhaps even help pay for, public education efforts like New York City’s bold new ad campaign against drinking soda...
...All of which suggests that passing a health care reform bill, no matter how ambitious, is only the first step in solving our health care crisis. To keep from bankrupting ourselves, we will then have to get to work on improving our health — which means going to work on the American way of eating.
But even if we get a health care bill that does little more than require insurers to cover everyone on the same basis, it could put us on that course.
For it will force the industry, and the government, to take a good hard look at the elephant in the room and galvanize a movement to slim it down.
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.
