It's still worth sharing more tidbits from the Senate Committee on Budget and Fiscal Review, chaired by Sen. Denise Moreno Ducheny, (D) earlier this week. Though the hearing was scheduled to last three hours, it ended up being twice that long -- such was the passion of the stakeholders and the complexity of the fiscal topic.
A few of the governor's proposals were raked over the coals, in some cases because the math didn't add up to equal the level of hardship the administration would impose by cutting crucial programs. Other proposals, glimpsed through the lens of recent history, seemingly deflated on the basis of that historical fact alone.
Consider the governor's persistence on the matters of zapping Proposition 10 and Proposition 63. Remember, these were two propositions placed before the voters in the true Democratic tradition of a) allowing folks to vote yea or nay, and b) tallying up the results and c) committing the results to official record.
Proposition 10, otherwise colloquially known for creating the First Five Commission, established programs that Californians believed were needed to help our kids get the leg-up on a world, not to mention a nation, that has been swiftly overtaking us in educating our next generations. California voters first approved it in 1998, rejected overturning it in 2000, and then later once again reiterated their approval of the program to begin nurturing and schooling children ages birth through age 5 in preparation for a robust education.
Proposition 63, the Mental Health Services Act, was approved by the voters and, then again, last May,was also protected when voters rejected the budget initiative to raid the mental health fund to help cover the general fund deficit.
Certainly, in Yogi Berra's terms, as someone pointed out in committee testimony, the governor's proposals are looking like "deja vu all over again."
County spokespeople testified it cost them $68.1 million to put the budget initiatives on the ballot last May -- only to see voters reaffirm what they said they wanted in the first place. Lo and behold, that $68.1 million has yet to trickle down to the counties as reimbursement from the state for holding the May 2009 special election, though one county spokeswoman testified hopefully, "It's in the governor's budget now. . . for that we are grateful."
When we get health reform, Speaker Nancy Pelosi of California will be a major reason. The New Republic's Joanthan Cohn commented that she "has been nothing short of heroic over the past week" on keeping health reform alive as legislators remembers that despite a special election in a specific state, the need and urgency and political imperative of passing health reform has fundamentally not changed.
As reported by Carolyn Lochhead of the San Francisco Chronicle, Pelosi had strong words today keeping the momentum up. She said that while some parts of health care reform may be done piecemeal, but "That doesn't mean that is a substitute for doing comprehensive. It means we will move on many fronts, any front we can."
"We will go through the gate. If the gate is closed, we will go over the fence. If the fence is too high, we will pole vault in. If that doesn't work, we will parachute in. But we are going to get health care reform passed for the American people for their own personal health and economic security and for the important role that it will play in reducing the deficit."
President Obama on health care & more: "We don't quit."
Wednesday, January 27, 2010
Health reform is alive. Speaker Pelosi has indicated she can pass the Senate bill in the House with the appropriate Senate changes through budget reconciliation. But President Obama set the new tone tonight at the State of the Union:
Now let’s be clear – I did not choose to tackle this issue to get some legislative victory under my belt. And by now it should be fairly obvious that I didn’t take on health care because it was good politics.
I took on health care because of the stories I’ve heard from Americans with pre-existing conditions whose lives depend on getting coverage; patients who’ve been denied coverage; and families – even those with insurance – who are just one illness away from financial ruin.
After nearly a century of trying, we are closer than ever to bringing more security to the lives of so many Americans. The approach we’ve taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market. It would require every insurance plan to cover preventive care. And by the way, I want to acknowledge our First Lady, Michelle Obama, who this year is creating a national movement to tackle the epidemic of childhood obesity and make our kids healthier.
Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office – the independent organization that both parties have cited as the official scorekeeper for Congress – our approach would bring down the deficit by as much as $1 trillion over the next two decades.
Still, this is a complex issue, and the longer it was debated, the more skeptical people became. I take my share of the blame for not explaining it more clearly to the American people. And I know that with all the lobbying and horse-trading, this process left most Americans wondering what’s in it for them.
But I also know this problem is not going away. By the time I’m finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans, and neither should the people in this chamber.
As temperatures cool, I want everyone to take another look at the plan we’ve proposed. There’s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here’s what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people.
More on the budget hearing from Jessica Rothhaar, who directs our budget organizing for Health Access California:
The hearing room was overflowing with Californians from around the state. The big turnout conveyed the severe impact of the cuts absolutely clear.
Senators Ducheny, Leno and Lowenthal also repeatedly expressed disbelief that the LAO was recommending adoption of the Governor’s cuts without accounting for the additional costs of consequences they admitted would happen, such as additional ER admissions, uncompensated care, homelessness, HIV/AIDS infection rates, etc. or the political impossibility of others, such as the taking of Prop. 10 and Prop. 63 money to backfill other programs. On the flip side, Senator Ducheny did ask several times whether less drastic cuts might be possible to several of the programs under discussion, such as to Healthy Families vision coverage.
Among the groups speaking against the cuts at yesterday's hearing included: AIDS Healthcare Foundation; Alliance of Californians for Community Empowerment (ACCE); AltaMed; Alzheimers Association; The ARC; Asian Pacific American Legal Center (LA); Bayview Adult Day Health Care; CA Alliance of Retired Americans; CA Association of Adult Day Services; CA Association of Family Health Centers; CA Association of Health Plans; CA Association for Health Services at Home; CA Association of Public Hospitals and Health Systems; CA Commission on the Status of Women; CA Disability Community Action Network; CA Hospital Associationl CA Immigrant Policy Center; CA Medical Association; CA Primary Care Association; Casa Pacifico ADHC; Children Now and the 100% Campaign; Children’s Specialty Care Coalition; County Health Directors Association of CA; County Mental Health Directors Association of CA; County Welfare Directors Association of CA (CWDA); Developmental Disabilities Council of Alameda County; Easter Seals; Elderday ADHC; Futures Explored; Graceful Senescence ADHC; Hemophilia Council of CA; Loma Linda University Medical Center; National Alliance for the Mentally Ill; Oral Health Access Council; Para Los Ninos; Placer Independent Resource Services; Planned Parenthood Affiliates of CA; Resources for Independent Living; Sacramento CARES; San Diego Council of Community Clinics; San Francisco AIDS Foundation; United Association of California Care Providers (UACC); and Western Center on Law and Poverty.
There was particularly awesome turnout and testimony organized by the California Association of Adult Day Services, which had members there from just about every district represented on the Budget Committee, including San Diego, San Bernardino, Santa Cruz, San Francisco, Contra Costa and Los Angeles. Let's keep it up!
There was no escaping the sharp wit and quick tongue of Sen. Denise Moreno Ducheny (D), chair of the Senate Committee on Budget and Fiscal Review, on Tuesday as the panel heard its first airing of the rationale behind the governor's budget proposals to drastically slash taxpayer-funded health services -- for the second year in a row.
Again and again, Ducheny offered succinct retorts that, in effect, signaled to the admininstration that Gov. Arnold Schwarzenegger's ideas amounted to little more than glasses-half-empty. In nearly every area of cuts described, Ducheny demanded more data before moving forward on the governor's punishing health-care cuts for California's most vulnerable populations at a time when the prolonged recession continues to drag down the state's economy.
More than once, Ducheny and other senators questioned why revenue-raising options were not considered as alternatives to decimating services to taxpaying, lower-income citizens. "Most of these programs were started in the first place with the theory that they would save us Medi-Cal dollars in the long run," Ducheny said, demanding more concrete figures from the administration's Department of Finance as it outlined proposed cuts in adult day health care, Healthy Families coverage for children, mental health programs, HIV-AIDS drug assistance and more.
"It's a pig in a poke, is what it is," Ducheny said, chiding the finance department and the Legislative Analyst's Office representatives for not presenting more details to support the claim of potential savings. "It's a bit of an irony that, if we're the seventh-richest state in the union, why the people who put us there couldn't help us more, by paying a [higher] Vehicle License Fee, for example."
Said Sen. Mark Leno (D-San Francisco): "When the governor talked about 'Sophie's Choices,' he didn't suggest revisiting the tax breaks for revenues. He didn't say that was one of 'Sophie's Choices.'"
Still, time and again, both the LAO and DOF representatives fell short in their explanations of how the puzzle pieces of the governor's proposed budget cuts fit together in a way that made sense in helping Californians weather the tsunami of a persistent recession.
Those offering testimony against the governor's cuts raised the discussion to a blunt level not frequently heard in such a formal setting. They spoke of the elderly and the frail expiring before being able to find a bed in a long-term nursing home. They spoke of children being left behind to fail in classrooms; they spoke of more and more people becoming homeless, hopeless, ailing and unjustly relegated to being second-class citizens. Phrases like "fiscally foolish," "morally reprehensible" and "appalling and horrific" replaced the more polite, mutually beneficial language that advocates typically offer up in legislative hearings.
Regarding the proposal that Healthy Families vision care benefits be dropped for children whose low-income parents pay 150% more in premiums than they did a year ago, Ducheny said, "How are the children going to 'Race to the Top' if they can't read?"
Senator Roderick Wright, a Democrat from Los Angeles, provoked the most heated discussion in dismissing what he called "the euphemisms regarding 'reduction of services.'"
Should the governor's proposals be adopted, Wright said, "We are voting to let people die. If we don't face the consequences of these cuts, if we don't face the fact that we are discussing life or death for some folks. . .we are doing a disservice to the public."
We'll have more reports about health reform from DC through the week. But one message: this is *totally* doable.
There is a path for health reform. Some call it "two-step," others call it "Senate plus reconciliation." But it's the same path, and perhaps the only path: The House passes the Senate bill, and a package of improvements that would be passed by the Senate through a limited budget reconciliation process. This still takes two final floor votes, needing 218 votes in the House, and 51 in the Senate.
This is a situation where the best policy and best politics align.
We need comprehensive health reform, and failure to pass such a broad reform (or passing a dramatically scaled back version of reform) won't begin to solve basic issues: getting insurers to compete based on cost and quality, rather than avoiding sick people; having people pay for coverage based on what they can afford, rather than how sick they are.
But other options are also politically problematic. Small reforms and/or starting anew wouldn't work, would not provide the necessary political benefit, and would bring up all sorts of new issues, new opponents, and take much more time and effort.
That's the procedural path is clear. The only question is the political will.
He noted he is uninsured—by choice. And that he is concerned about the waste and barriers to coverage by insurance companies—and he may have been overcharged—all issues addressed in the health reform bills. Rush said:
I'm not gonna get health insurance. I'm not going to inflate my bill by 35%. This cost me 30% less than had insurance been involved here. There was not one bureaucrat determining whether or not I was gonna get treatment. There wasn't a death panel here.
He seems to be referring that a lot of insurance premium dollars go to costs beyond patient care. That’s why the health reform bills set minimum medical loss ratios—the industry’s term for the money that is “lost” to care, rather than administration, marketing, and profit.
He also seems concerned about insurance bureaucrats denying care. The health reforms also include independent medical review—a component of a patient’s bill of rights package that has been passed in many states but stalled at the national level until now—so that if an insurer does deny coverage for medically necessary care, patients have the ability to get a third party to review, and possibly overturn, the decision.
His solution to insurance industry abuses is to not get insurance. As a multi-millionaire, Limbaugh had the ability to pay, as he said, just using a credit card.
But for the rest of us, health coverage is not just a good idea, it is essential. It's not an option to be on the hook for thousands (or possibly tens or hundreds of thousands of dollars) if we get sick.
How much did he pay for his short stay? He indicates it’s around the price of a car.
In the first place, you don't need to make $33 million a year or $50 million to afford what happened. I'll put it to you this way. My expenses were less than the cheapest car that you will go out and buy today other than one of these little bubble smart cars. It was five figures less than the average car. Yet for some reason it's immoral for people to have to pay for that. I don't have insurance. "I'm sure he has insurance." No. I pay cash for it and it was less than the price of a car. And just as is the case with a car you could finance your health care coverage. You don't have to come up with the whole lump sum, hospitals, doctors, work with you on this.
As someone who is uninsured, self-pay patient, Limbaugh probably gets charged on average of three times what insurers and public programs pay, for exactly the same service.
That’s because hospitals have a “chargemaster,” or sticker price, for their services that are inflated well beyond the actual cost of providing care. Insurers and public programs, with their market power, have the ability to negotiate the rate down. The uninsured, without that bargaining power, are stuck with the inflated rate.
The cruel irony of our health care system is those with the least are charged the most. In California, the average hospital charge is four times what most insurers pay. I’ve worked with patients who a 3-hour visit to the ER cost $12K; a one-night stay for an appendectomy cost $26K; and people who have racked up six figures in debt. These are the kinds of numbers that force regular middle-income people—however responsible they are—into collections and bankruptcy.
There have been class-action lawsuits about these unfair billing practices, and California and a few other states now cap how much hospitals can charge uninsured within certain incomes. (We have a website, www.hospitalbillhelp.org, to help Californians struggling with high hospital bills.) The Senate health reform places some oversight over hospital pricing policies, which has been a longtime interest of Senator Grassley.
But the ultimate way to prevent this practice of overcharging is to get people into group coverage, where they have the purchasing power to negotiate the best rate. Coverage provides a way for people to share in the risk and cost of health care: even if you are healthy today, you have financial security when (not if) those chest pains, or another ailment, comes upon you, you don’t have the additional shock of a huge bill. And that’s the heart of health reform.
So Rush’s alternative to health reform seems radical: he's not just against health insurance reform, but against health insurance. For most people who can’t absorb a five or six-figure trip to the hospital, that’s a prescription for financial ruin—or worse.
A lot of people say, "Rush, you're really running a risk here of sounding out of touch when you talk about how you can pay for this.”
Yep. Before we agree with those opposing health reform, we should understand what their proposal is.
California’s performance ranking in five key areas, including health care, dropped a grade on the annual report card issued by Children Now, leaving the Golden State with its most tarnished marks in the 20-year history of the advocacy group’s rating system.
Due mainly to brutal cuts in the state’s FY09-10 budget by the Legislature and the governor in children’s programs, California “earned the worst grades ever” for 2009, said Ted Lempert, president of Children Now. Lempert, a former state legislator, summed up the state’s dire performance during a legislative briefing held in the Capitol on Monday afternoon for staff members of the Legislature.
Still, Lempert, joined by vice president Wilma Chan and Kelly Hardy, associate director of health policy for Children Now, tried to emphasize the possibilities for improvement in coming budget discussions. “There are lots of opportunities to move forward this year on children’s health,” Hardy told the group. The silver lining in getting California’s children through the tough budget cuts last year came in the form of an unprecedented financial boost from the federal government.
The increase in federal matching funds did not pull California out of its economic doldrums, however; it merely helped keep pace somewhat with the increased need brought about by the loss of job-based health coverage as more and more parents became unemployed, Hardy said. The areas in which California performed worse than in previous years were:
Children’s oral health: the state’s marks dropped from a “C to a D” Infant health: the state’s marks dropped from a “B- to a C+” Adolescent health: the state dropped from a “B- to a C+” K-12 education: the state dropped from a “C- to a D” Integrated services: the state dropped from a “D+ to a D”
In response to legislative staff questions about the methodology of Children Now’s assessment, Lempert responded that the organization examined statistics, policy program decisions and also took a broad view of the outlook for the 9.4 million children currently living in California. In the final analysis, he said, “The methodology was similar to the academic grading process in that it was somewhat subjective.”
There was widespread recognition in the room that things will not become rosier overnight. “We know this is going to be another bad year for children in the California budget,” Chan said. “But people in this building have to make kids a higher priority – so our children and our economic future won’t become sicker.” The report card can be found online at the Children Now website, reports and research section.
California health reform advocates have seen health reform proposals die, whether by a veto or a vote. This just doesn't seem to be one of those times.
The only other path, short of complete abdication, is a drastically scaled back, unrecognizable proposal that would reopen all sorts of difficult conversations, and may provide some help to specific folks but no one would call it close to health reform.
This week, many of us will be in Washington, DC, and may have additional insights into what is going on. As always, we'll have reports on health reform and the California budget, from DC and Sacramento.
This morning, Saturday, Janaury 23rd, at 11:00am, keep the push on for health reform!
IN SAN FRANCISCO: San Francisco Federal Building, 90 7th St., San Francisco 94103 (Meet at 7th and Mission)
Californians will hold umbrellas – rain or shine – to illustrate the need for better coverage and honk for health care signs calling on Members of Congress not to leave consumers at the mercy of the insurance industry.
IN LOS ANGELES: Clinica Romero, 2032 Marengo St., Los Angeles, CA 90033
Los Angeles community members performing street theatre to illustrate abuses by insurance companies and why health care reform efforts are needed to be to assure affordable, secure health coverage for all.
Some have interpreted Speaker Nancy Pelosi's remarks as a signal that health reform is dead. Here's a transcript of some of her statements today, where she expresses the need and urgency for health reform. She's says her caucus can't pass the Senate bill as is. But it seems like it's a path for moving forward, but with changes. One way is to use the budget reconciliation process to make amendments. Read it for yourself:
PELOSI: Many of you have asked many questions about where we go from here. Let me congratulate the new Senator, Senator Brown from Massachusetts. While the results of the Massachusetts election may have diminished by one in the number of Senators in the Senate, last year this time there were 58 Senators, I remind you, 58 Democratic Senators, now there are 59. It has not diminished the need for affordable quality health care reform and for health care to be available to all Americans. As a right not a privilege.
The need for us to address health insurance reforms to end discrimination based on preexisting conditions, to stop rescissions, that when people are sick even though they have health insurance their policy has a rescission, to say that if you pay your premiums and do so on time and you get sick your plan will not -- your insurance will not be canceled. The list goes on and on. The idea of medical loss ratio that insurance companies should pay five percent of the premiums they collect on benefits. These and other issues to hold the insurance companies accountable. The McCarran-Ferguson, repealed McCarran-Ferguson exemption to the antitrust laws for the insurance company. As I say, these and other needs are still there.
There are still 30 million people in our country without health insurance. But the most important point I think is that the present system is unsustainable. We can not afford an upward spiral of cost. Families can't, businesses can't, our economy can't in terms of our international competitiveness, and certainly the Federal budget cannot. So we are going to have to continue to go in a forward direction to lower cost, to hold the insurance companies accountable, to make sure what we do is affordable to the middle class and to -- as we expand access to quality affordable health care. It is still a very exciting initiative, ranks right up there with Social Security and Medicare. And we are meeting with our Members on every level -- as a Caucus, in different groups of the Caucus, to hear how they perceive as the best way to go, how they would prefer to go forward, but we will go forward.
QUESTION: Madam Speaker, given the fact that there seems to be widespread unease in your Caucus about taking up the Senate bill and passing it and fixing it, is that option being discarded at this point?
PELOSI: Nothing is discarded, everything is on the table. You characterize it correctly; "unease" would be a gentle word in terms of the attitude of my colleagues toward certain provisions of the Senate bill. Let me remind you that over 80 percent of that bill, our two bills, are similar. So there are important initiatives in the Senate bill. But there are certain things that members just cannot support. For example, the Nebraska piece of it. And so what they would want to see fixed is that there be equity among states, more fairness, and that that policy shouldn't be made on the basis of one Senator, but on the basis of one country for -- to name one example. There has always been unrest in our Caucus about the excise tax on so called Cadillac benefits and so, you know, just to name a few.
So in its present form without any change, I don't think it is possible to pass the Senate bill in the House. There is some part of our Caucus that would say let's just take these pieces. We recognize health care has to be done -- health care reform has to be done, let's take some pieces of it and go forward. Others are saying let's just get it done and move on. But everybody recognizes that something needs to be done.
QUESTION: Madam Speaker, does that mean the Senate bill in its present form you will not pass?
PELOSI: I don't see the votes for it at this time, no. I mean, the Members have been very clear in our Caucus about the fact that they didn't like it before it had the Nebraska provision and some of the other provisions that are unpalatable to them. But there is a recognition that there is a foundation in that bill that is important. So one way or another, those areas of agreement that we have will have to be advanced, whether it is by passing the Senate bill with any changes that can be made or just taking pieces of the bill. But everything is on the table. In other words, what we are doing now is very calm, we have to get a bill passed. We know that, that is a predicate that we all subscribe to. We have to pass legislation.
QUESTION: But passing the Senate bill and then trying to fix it later is not an option?
PELOSI: There are some fundamentals in there that that make it problematic for our Members. And some Members say, and I respect this, some of the concerns that were expressed in Massachusetts were about certain provision of the Senate bill. We want obviously to hear and heed what was said there and what is said across the country. What was said in Massachusetts was not news to anyone, it was just expressed in an election. But it is hard it say, well, we don't like the special provision for [Nebraska] -- and that had a lot of resonance around the country, again most recently expressed in Massachusetts. So they don't see why something that wasn't even a fundamental part of the bill to begin with, that has been rejected by the American people is something they should be called upon to vote for. That doesn't sound like they heard the message of Massachusetts.
QUESTION: Just to be clear on that, you are ruling out passing the Senate bill unchanged, but are you not...
PELOSI: We are not ruling out anything. I am saying to you we are ruling out -- everything is on the table and everything, every decision that we have to make -- now we are legislating here now, so this may be more on the subject than you want to know. But in legislating, we have to know what our possibilities are, and that means in both Houses and with the White House. And every time you make a decision, you have to make a choice; you don't like this but is it better than that. I am saying to you right now that the Members -- in every meeting that we have had there would be nothing to give me any thought that that bill could pass right now the way it is.
QUESTION: You mentioned that as an option, the pieces. Given the unease among your Members about the Senate bill and trying to fix that, is that a more likely option?
PELOSI: Well, I don't think anybody disagrees with, "Let's pass the popular part of the bill," but some of that popular part of the bill is the engine that drives some of the rest of it. But again, we are not in a big rush; pause, reflect upon what our possibilities are, see what the support is in the Caucus. We have to always go where we can build consensus. So certainly there would be great consensus to take the most popular part of the bill and advance it, but I don't know what -- and that would be positive, but we have serious other structural things that have to be done, systemic changes that have to happen to again hold the insurance companies accountable. [Sound of clock chiming.] Have we, did we get a new clock? Or have we not been here at this time of day? Oh, it is 10 o'clock? It must be Eastern time, Western, some time, other time.
But again, however we achieve it we must arrive at accountability of the insurance companies, and I talked about that package earlier, any discrimination of preexisting conditions, no rescissions, stopping them from canceling policies even though people have paid their premiums but because they get sick their policies cancel. The list goes on, medical loss ratio, McCarran-Ferguson, repealing the exemption that they have to antitrust laws. Again in the Senate bill good language that talks about if the insurance companies raise rates in this next couple of years before the exchanges are established, then they would not be able to participate in the exchange. You know, those kinds of things -- accountability. Affordability is very important. Affordability for the middle class. That is one of the main purposes of bill is to make it affordable to the middle class. And so to the extent that any one of these initiatives, or the decision may be to proceed with the full bill, I don't know, but there isn't a market right now for proceeding with the full bill unless some changes are made in the Senate.
President Barack Obama was interviewed by ABC News today. He made clear that he heard the anger of Massachusetts votes, but he didn't back away from health reform. In fact, he made the case for continuing the effort. Neither is Speaker Nancy Pelosi backing away:
The need and urgency for health reform that was true last year and last week is still true today and this week and this year. Families continue to wonder if their coverage is going to be there for them if they need it.
The urgency for health reform does not change because of one special election in the state where health reform least mattered, since they already adopted many of reform's benefits, from regulating insurers so there are no denials for pre-existing conditions, to providing subsidies to low and moderate income families to afford coverage. Even the candidate opposed to national health reform did not oppose the policies in Massachusetts once they were adopted.
Given the extent of California's health crisis, Californians need health reform more than ever, and to pass a final proposal quickly. Californians are more likely to be uninsured, face a higher cost-of-living, are at greater risk to be denied for coverage for pre-existing conditions, and are less likely to be offered on-the-job coverage. Health reform would disproportionately help Californians, providing new choices for the uninsured, more security for the underinsured, stability for our safety net, and savings for our state budget.
We thank the President and Speaker Pelosi for her leadership in continuing the effort to solve the pressing problems that patients face. We look forward to working with them, especially our California Congressional delegation led by Speaker Pelosi, to pass health reform and to continue to improve our health system in the months and years to come.
“Health Care for America Now is committed to winning a guarantee of good, affordable health care we all can count on, and we will continue to push aggressively to get the best health care reform bill possible to the President’s desk for his signature as quickly as possible.
Tuesday’s vote was not a referendum on health care reform. It was a referendum on a particular candidate in a climate in which people, hard pressed by the economy, are impatient for change. When it comes to the need to make good health care affordable, nothing is different today than it was yesterday. Congress must keep going and finish reform right.
Fixing health care now is vital to fixing our economy. In survey after survey, voters continue to voice strong support for forcing health insurers to stop excluding people with pre-existing conditions, guaranteeing everyone has access to good, affordable coverage, and requiring health plans to spend premiums on medical care, not profits.
The people of Massachusetts already have benefit from health care reform. It’s time the rest of the country had the same access to good, affordable care.
We are on track to pass a strong bill, and we will stay focused on that until the President signs the bill into law.”
I would add that we at Health Access are pleased by Speaker Pelosi's continued leadership on this issue. And maybe that comes from the fundamentals: After all, the need and urgency for health reform from last year and last week didn't change this week and this year, because of a single result of a special election in a specific state. The election in question was in the state where health reform least mattered--as opposed to California, where it matters possibly most of all, given our large percentages of uninsured, lower-wage workers, people at risk of being denied for pre-existing conditions, etc. Even in Massachusetts, the candidate in opposition to national health reform did not dare oppose the identical state reforms already in place.
And that's the lesson. Pass a bill--a good bill--and health reform won't be the political issue it is now.
CALIFORNIANS WIN FIRST-IN-NATION CONSUMER PROTECTIONS SETTING STANDARDS FOR TIMELY ACCESS TO CARE * CA Department of Managed Health Care Announces New Standards Today in LA * HMO Patients Can Expect Quick Phone Advice; Urgent Care within 2-3 Days Routine Appointments within 2-3 Weeks * Timely Access Rules To Help Prevent Health Problems From Getting Worse; and Reduce Unneeded Trips to Emergency Rooms
* Read Our Health Access Blog for More on the Massachusetts Senate Election, and How Health Reform Can Advance, and Why It Must * Join Us on Facebook! Follow Us on Twitter!
SACRAMENTO--California consumers will have greater assurance of getting appointments and care when they need them. New first-in-the-nation consumer protections are being put in place this week by the California Department of Managed Health Care. As a result, consumers should get a primary care appointment within 10 days, an appointment with a specialist within 15 days and urgent care much more quickly.
Taking effect January 17th, these new regulations to ensure timely access to care implement a 2002 law (AB2179, authored by Assemblywoman Rebecca Cohn, and sponsored by Health Access California), and respond to common consumer complaints about their inability to get health care advice or appointments within a reasonable amount of time.
These groundbreaking consumer protections will help ensure that HMO patients get the care they need, when they need it. Consumer advocates argued that care delayed is often care denied, leading to worse health outcomes or unnecessary visits to the emergency room. These new first-in-the-nation patient rights will provide consumers with clear expectations about how quickly they should get in to see a doctor or specialist.
The new rules ensure that when managed care consumers agree to a limited network of providers, insurers fulfill their promise that their networks of doctors and specialists have the capacity to take care of their paying patients. While the concept of timely access to health care was one of the cornerstones of the original Knox-Keene Act of 1975 that established and regulated managed care in California, it remained largely unrealized and unenforced.
For the first time, the new consumer protections detail specific time-elapsed standards by which patients can expect to get a telephone questioned answered, an urgent care appointment, or a routine appointment for a primary care doctor or specialist.
Here are some examples of the new Consumer Time Elapsed Standards contained in the regulation:
* Triage or screening by telephone 24-7 * Waiting time for telephone triage no longer than 30 minutes * During normal business hours, waiting time to speak to a plan’s customer service representative no longer than 10 minutes * 48 hours for urgent care appointments that do not require prior authorization * 96 hours for urgent care appointments requiring prior authorization (including specialists) * 10 business days for non-urgent primary care appointments * 15 business days for non-urgent appointments with specialists * 10 business days for non-urgent appointments with a mental health care provider * 15 business days for non-urgent appointments for ancillary services (x-rays, lab tests, etc.) for diagnosis or treatment of injury, illness, or other health condition
For Dental Plans * 72 hours for urgent care * 36 business days for non-urgent care * 40 business days for preventive care
Consumers who believe they have been denied timely access to care, should promptly complain to their health plan. If that doesn’t resolve the issue, they should file a complaint with the Department of Managed Care (DMHC) at the HMO Help Line at (888) HMO-2219 [(888) 466-2219] or (877) 688-9891 [TDD] or at www.hmohelp.ca.gov
These new first-in-the-nation consumer protections have several benefits for individual patients and for the health system:
* Patients will get some clear standards for how long they should—and should not—wait to see a doctors or specialists. They also have a place to com * Patients will get better guidance about when and where to get treated, through telephone triage and urgent care appointments within 1-3 days. This may reduce inappropriate use of emergency rooms, where patients face long waits and expensive cost-sharing. * Emergency room overcrowding may be eased, since the recent increases have been with *insured* patients—who likely could not get in to their doctors in a timely manner.Health outcomes can improve if problems are caught early and before they grow, when there are more and usually less expensive options for treatments. * New attention to wait times can expose broader issues with a health insurer’s lack of an adequate network of provider, lack of appropriate financial resources to patient care, regional shortages, insufficient accountability or oversight of providers, or financial insolvency. * In an era of health reform, when people have been scared about talk of waiting lists and rationing, these rules provide reassurance that patients get the care they need, and that the reforms work to reduce, rather than expand, waiting times.
Consumer groups, including Health Access California, Western Center on Law and Poverty, and the California Pan-Ethnic Health Network, were pleased that the Department did not adopt industry proposals to allow health plans to determine their own standards, or to exempt providers offering language interpretation services.
The rules will be officially unveiled at a press conference today at Cedars-Sinai Hospital in Los Angeles. More information, including fact sheets, is available at http://www.health-access.org, and at http://www.dmhc.ca.gov.
First of all, it isn't news that Bay State voters have the ability to pull the lever for the GOP. Before the current Governor, the last Democrat in the statehouse in Boston was Michael Dukakis, when I entered college at Amherst a generation ago. Since then, Republicans have run the state for the last 17 of 20 years.
The Massachusetts Senate election has now been won by an opponent of health reform.
But was health reform what the election was about? Yes, in part. It was also about the economy, bank bailouts, unemployment, the conviction record of that state's attorney general, and (strangely) what team Curt Shilling roots for.
Don't get me wrong, it was also about health reform, although it was in the state where the bill least mattered, since they had already put in place some (though not all) of the reforms, from regulating insurers so there are no denials for pre-existing conditions, to affordability subsidies so low- and moderate-income people can better afford coverage.
Let's remember that the rest of the country voted for President Obama, who explicitly ran on health reform; the rest of the country voted for the remaining 59 health reform-supporting Senators; the rest of the country voted for the majority of the House of Representatives.
There were no exit polls today. But according to Rasmussen polling tonight (which tends rightward), 53% of MA electorate today approves of Obama, 38% disapproved. President Obama polled well ahead of the candidate in Massachusetts.
The need for health reform was real and urgent last week, and those same factors make it necessary and urgent next week. It's momentum and urgency was not based on how popular or easy it was--although it was popular, and likely will be again. That's the case with past programs and reforms--but only once they pass and their benefits are known.
There are options for moving forward. The House can pass the Senate version, putting in place a framework that then can be improved in the future--especially through the budget process, which takes a simply majority of 51 votes rather than 60. And it can be improved not just at the federal, but at the state level as well.
It will take those who voted for health reform to have the courage of their convictions, and to push reform forward not just because it is the right thing to do, but because those who voted for reform have a better case to make when they run on something rather than nothing. And that after listening to voters, there are improvements to make.
Now it is up to Speaker Pelosi to make that case to her members, that the Senate bill isn't the end of the effort, but the beginning... and that there is political reward in the continuing campaign to make it better.
It was there that a 2006 reform got people talking again about health reform in a big way. (Maine and California got some attention in 2003 for reforms, but not as much.) The Massachusetts law was widely scrutinized (including by us at Health Access), either as a reform to emulate or to indicate what was missing.
So it is strange that the election in that state tomorrow for U.S. Senate matters so much. After all, Massachusetts voters already have had a very similar health reform for a couple of years, and have shown no sign of seeking to repeal it.
The concern is that if the Democrat loses, then supporters of health reform only have 59, rather than the needed supermajority of 60 votes. There may be other options, from trying to pass something before a new Senator is seated (there's been lots of lame duck sessions over the years), to simply having the House adopt the Senate bill as is (as Jon Cohn describes here). As Ezra Klein writes, there should be no question that the health reform push needs to go on, regardless of what happens.
As tweeted at @healthaccess and @sovernnation, Speaker Nancy Pelosi told KCBS today that she was not worried about Massachusetts Senate race, she was confident Coakley will win... and that they will pass health care "one way or another."
In order to secure stimulus funds from Washington, D.C., the Senate Health Commitee, chaired by Sen. Elaine Alquist (D), voted on Wednesday to advance a bill to officially undo the state's requirement for semi-annual reporting for Medi-Cal.
As a condition of receiving enhanced federal funds, states must refrain from efforts at reducing Medicaid enrollment, such as using semi-annual reporting, which has been shown to create a barrier for people trying to access the state-and-federally funded program.
"It makes sense to support this common-sense measure to keep 174,000 kids covered with health insurance, " Elizabeth Landsberg of the Western Center on Law & Poverty told committee members.
Also speaking in favor of the bill was Beth Capell for Health Access California, the California Medical Association, Molina Health Care of California, and advocates for the disabled and children's access to health care.
The bill must pass the full Senate by the end of the month to advance to the Assembly. Committee member Sen. Dave Cox (R ), was the only one to vote against it, while Vice Chair Tony Strickland (R ) joined Democrats in voting to pass the bill.
In other action, the Senate Health Committee also voted to send SB270 (Alquist) along to the Appropriations Committee. The measure would create a health information technology advisory panel to advise the Governor and the Legislature on health information technology in California.
Back in DC, legislative leaders from both the House and Senate have been in long negotiations at the White House for over five hours. There's a rumor that President Obama has urged them to stay in until the framework of a bicameral health reform deal is agreed to.
If we had our druthers, the House would prevail in most of the differences. I participated with a panel of experts, convened by Jonathan Cohn of The New Republic, that came up with the same result. Cohn has also been busy explaining the negotiation to "Fresh Air" public radio listeners.
Fingers crossed on our Congressional leaders coming to a good and equitable resolution. Many of my thoughts on federal health reform have found a forum on Cohn's blog at The New Republic, called The Treatment. I have appreciated having the platform on national health policy issues (and the editing), and have now posted there 20 times in the past year. Here are the posts, many of which are still very relevant to the current debate:
That's how Assemblywoman Noreen Evans began her statement as chair of the Assembly Budget Committee, as they started deliberation.
She was clear that the budget proposal was not acceptable, that "there was a lot of sacrifice, but it isn't shared." She said that since the Governor's proposal wasn't acceptable, the Legislature would not use the Governor's budget as a framework, and would have to take it upon themselves to craft somthing that then the Governor would respond to.
Senator Mark Leno, the current author of the bill, was joined at the rally by its previous author, Senator Sheila Kuehl. Other speakers included Jim Kahn, President of the California Physicians Alliance, labor leaders, and others.
The bill, SB810 (Leno) is expected to come up for a full Senate vote this month.
Our Facebook (www.facebook.com/healthaccess) page has some of the many news clips from the eleven events last week from around the state by health and human service advocates.
There will be more to come in the weeks ahead. Budget hearings are starting this week...
It's worth repeating, at the beginning and the end of the health reform discussion: Affordability is paramount. As the House and Senate begin their negotiations over a final health reform bill, that needs to be the central question: does the bill provide people the help they need to afford coverage? This is important for people and for policymakers, as policy and as politics.
That's the subject of the letter was signed by more than 750 organizations, organizational leaders, congregations, clergy and local and state elected officials, from 46 states, representing more than 100 million people.
The United States is closer than ever before to making quality affordable health care available to all families.
Yet, health care reform can only succeed if it makes coverage truly affordable for ordinary families who are finding it more and more difficult to get the care they need. Requiring people to purchase health insurance that costs too much and covers too little would frustrate the fundamental goals of health reform and undermine the public support needed to pass and sustain reform.
The House of Representatives has passed health reform legislation that would cover 36 million people, 96 percent of all legal residents. The House covers five million more people than the Senate. We urge you to support the coverage provisions in the House bill, so that millions of Americans are not left uninsured after the passage of comprehensive health reform.
On the critical question of making coverage affordable, the House legislation sets premiums and out-of-pocket costs at levels that are likely to be affordable to lower-income working families. The House does a much better job in protecting lower-income people. The Senate approach provides somewhat better protections for middle-income workers, but would require lower-wage workers to buy insurance that costs many thousands of dollars more than the House legislation. We urge you to take the best elements of both approaches to create legislation that would protect all families from costs they cannot afford.
The letter was sponsored by our partner groups Community Catalyst, PICO, SEIU, Center for Community Change, and many other groups. We were pleased to be work with and be joined by dozens and dozens of key California leaders in this effort.
GOVERNOR ANNOUNCES BUDGET FOR MORE "MONSTER" FY10-11 CUTS * Gov. Schwarzenegger Has Budget Proposal Similar--but More Severe--Than Last Year * Millions of Californians Could Lose Coverage and Care; Dramatic Impacts * Details Below on $2.9 Billion in Health and Human Services Cuts * An Additional $3.5 Billion of HHS Cuts Would Be Triggered Without Federal Funds
* For News on the Budget, Read Our Blog! Join Us on Facebook! Follow Us on Twitter!
With California bogged down by a $19.9 billion deficit for the next 18 months, Gov. Arnold Schwarzenegger on Friday once again proposed balancing the state’s budget not with new revenues back with devastating cuts to the state’s least-fortunate -- including up to 6.4 billion dollars of cuts in health and human services. Under the cuts, over 1.5 million Californians, and likely many more, would have their coverage eliminated, other key services would be scaled back, and California would lose jobs and federal matching funds.
As he has in last year's budget cycles, Schwarzenegger proposed severe cuts to health and human service programs, the kinds of safety-net services Californians expect their government to extend to the public in times of deep need, that provide help in getting the state and its people back to work.
In some of the governor’s harshest budget scenarios threatened to shut down altogether a range of existing essential health and human services if the federal government did not respond favorably to his demand for $6.9 billion in federal tax dollars.
“Tough times still lie ahead,” Schwarzenegger proclaimed in announcing a package of budget proposals that included some “monster” cuts that would either lead to “real reform” or a continuation of “the budget roller coaster.” Schwarzenegger said he would declare a fiscal emergency and call a special session of the Legislature so lawmakers would be forced to focus on solutions to the deficit.
Afterwards, Democratic Assembly Speaker Karen Bass succinctly said of the governor’s proposals: “I call this budget a big pile of denial.” Bass said the governor’s budget plan was simply and plainly “a non-starter” because “it’s calling for the virtual elimination of the safety net.” Besides Bass’ comments, early indications were that Schwarzenegger’s plan had fallen flat with the Legislature’s Democratic leadership, whose cooperation the governor will need to adopt the state’s annual budget.
Senate President Pro Tempore Darrell Steinberg opened his statements to reporters with a blunt: “You’ve got to be kidding me.” He later noted that the governor’s budget solutions lacked “creativity.” Senator Denise Ducheny, chair of the Senate Budget Committee, said she saw in the budget “a recycling of exactly the same proposals he’s had before.” The main difference, Ducheny said, was that previously Schwarzenegger tended to blame the Legislature for a lack of fiscal solutions and, on Friday, the governor focused on blaming Washington D.C.
Indeed, Schwarzenegger did everything but identify the federal government as a foe, leaning heavily on the theme of fiscal fairness. This lead Bass to note that the governor struck a nearly inappropriate tone: “Typically he threatens the Legislature. Now he’s threatening the president of the United States.”
The governor pledged to fly to Washington D.C. with all four partisan legislative leaders to demand the $6.9 billion he said the federal government owes California. Schwarzenegger made the case that, for every $1 Californians pay in federal taxes, the state only gets an average of 78 cents back. (Ironically, his cuts would cause California to lose even more in federal matching funds.)
The governor is also seeking more reimbursement funds for Medi-Cal expenses, saying California receives only 50 cents on the dollar, while the average for states is 57 cents. Chief among the governor’s deep cuts are those that would eliminate coverage and care to millions of Californians, ironically forgoing substantial matching federal fund dollars as a result.
The Governor plans to ask for a $2.9 billion cut in health and human services (including $1.1 billion in Medi-Cal), and an additional $3.5 billion cut in health and human services if California does not get the federal money he seeks.
But even with a massive infusion of federal funds, the Governor would still propose to eliminate coverage to hundreds of thousands of Californians, including children. Health experts say these devastating cuts would further unravel the health care system that we all rely on, where we have already seen services scaled back and full clinics close. Health Access recently released an assessment of the health cuts in the 2009-10 budget, six months in.
THE GOVERNOR'S PROPOSED "TRIGGER" CUTS
The following is a list of proposed cuts and eliminations that the governor proposes to be "triggered" if additional federal funds are not forthcoming:
* Eliminate coverage and benefits for millions in Medi-Cal ($532 million), including: * Reduce Medi-Cal eligibility to the minimum allowed under current federal law (about 72% of the Federal Poverty Level for most adults and 133% FPL for children and pregnant women). For example, this would reduce eligibility for low-income parents from an income of up to $18,310 for a family of three to around $13,000. While this tightening of eligibility standards would not be allowed under the stimulus package until January 1, 2011, it would eliminate coverage for 250,000 Californians in the first six months, coverage for 450,000 in the year after that, and hundreds of thousands more in future years. * Eliminate many Medi-Cal programs (including the Family PACT program for family planning services, the CHDP Gateway for transitional children's coverage, Breast and Cervical Cancer Treatment Program, and the Medically Indigent long-term care program). * Eliminate many remaining optional benefits (including medical supplies like diabetic test strips, prosthetic limbs, orthotics, wheelchairs and other durable medical equipment, hearing aids and other benefits).
* Eliminate the Healthy Families Program, affecting all 874,762 children currently enrolled ($126 million); * Eliminate various health services programs, (including Access for Infants and Mothers, MRMIP's high-risk pools for those denied coverage for pre-existing conditions, Every Women Counts, Asthma control program, and Expanded Access to Care Program), funded by Proposition 99 (tobacco tax) funds, subject to voter approval ($115 million); * Eliminate mental health services funded by Proposition 63 (Mental Health Services Act), shifting the $847 million to fund existing mental health services; * Eliminate CalWORKS, the state's welfare-to-work program ($1.044 billion); and * Eliminate the In-Home Supportive Services programs that provides home care to those not able to assist themselves. ($495 million)
BASE BUDGET PROPOSAL (REGARDLESS OF WHETHER FEDERAL DOLLARS ARE FORTHCOMING) Specifically, as described below, the budget proposal makes a number of cuts to health and human services programs, redirects funding from other sources to health care programs, and relies on significant receipt of federal funds.
Cuts to Medi-Cal: · $750 million in cuts to Medi-Cal by placing limits on services and applying utilization controls, increasing cost-sharing for Medi-Cal beneficiaries, and making “other programmatic changes,” potentially affecting the 7 million Californians on Medi-Cal; · $118 million to eliminate Medi-Cal coverage for recent legal immigrants, effective March 1, 2010, affecting about 90,000 legal immigrants; · $104 million to eliminate the Medi-Cal adult day health care benefit, effective March 1, 2010, affecting about 35,000 frail adults; · $55 million to delay payment to Medi-Cal institutional providers, requiring doctors and hospitals to “float” the state; · $26.4 million from aggressive elimination of fraud in Medi-Cal; and · $28.7 million to rescind a rate increase for Medi-Cal family planning services.
Cuts to the Healthy Families Program: · $85.3 million (including $10.5 million for the current fiscal year) by tightening eligibility requirements for the Healthy Families Program from 250% of the federal poverty level (FPL) to 200% of the FPL, effective May 1, 2010, affecting roughly 225,000 children, plus an additional corresponding $3.9 million cut to the California Children’s Services program for Healthy Families-eligible children; · $21.7 million by eliminating vision coverage from the HFP benefit package and increasing monthly premiums in families 151-200% of the FPL, effective July 1, 2010, affecting 167,000 children.
Other cuts to Health and Human Services programs: · $950.5 million in reducing eligibility, payments and services in the In-Home Support Services (IHSS) program; · $146.1 million by reducing benefits for CalWORKS recipients; · $306.9 million by reducing benefits for recipients of SSI/SSP; · $60 million by eliminating the California Food Assistance Program; · $200 million by reducing support for Regional Centers; · $18 million by eliminating the Substance Abuse Offender Treatment Program.
A redirection of funding to avoid more health care cuts: · Reduce $240 million from children’s health coverage to be replaced by newly enacted hospital fees; · Reduce $36 million from Medi-Cal to be replaced by one-time Proposition 99 (tobacco tax) reserve funds; · Reduce $25 million from the Access for Infants and Mothers (AIM) program to be replaced by one-time use Proposition 99 (tobacco tax) reserve funds; · Reduce $550 million in General Fund expenditures on high-priority health and social programs serving children to be replaced by state and local Proposition 10 (California Children and Families Act) funding, subject to voter approval; and · Reduce $452.3 million in General Fund expenditures on EPSDT services for children and mental health managed cared to be replaced by Prop 63 (Mental Health Services Act) funding, subject to voter approval.
A reliance on federal funding to avoid more health care cuts: · $1 billion from federal funds owed to the state for disabled Medicare-eligible individuals and the rate of Medicare Part D coverage · $1.8 billion from increasing the standard federal matching assistance percentage (FMAP) for Medi-Cal from 50 to 57 percent; · $1.5 billion from continuation of an increased FMAP (through June 30, 2011) as part of ARRA, the economic recovery act.
On the Health Committee, there are 9 members, 6 Democrats. This means that if a bill is to pass Health Committee, and all Republicans oppose it, it can't lose more than one of the Democratic votes.
Governor Schwarzenegger released his proposed 2010-11 budget today, which includes severe cuts and no new revenues.
As part of the cuts, the Governor proposes a $2.9 billion cut in health and human services (including $1.1 billion in Medi-Cal), and an additional $3.5 billion cut in health and human services if California does not get a major infusion of federal funds.
The Governor proposes shocking cuts eliminating coverage and care for millions of Californians, which will have dramatic impacts on not just these families but on the health system on which we all rely. Even *with* a massive infusion of federal funds, the Governor would still propose to eliminate coverage to hundreds of thousands of Californians, including children.
This is an anti-jobs budget that not just harms California families and our healthcare system, but our economic recovery. The most effective way to create jobs is invest in Californians, and in their health and in services to help all of us get through a tough time. This proposal completely undermines our economic recovery efforts.
The economic impacts of these health and human service cuts would be multipled because we would not just lose jobs but billions in federal matching funds.
Governor Schwarzenegger's office came out with a statement accusing Health Access California of "twisting the facts" and comparing "apples and oranges" about the Governor's stance on health reform. Carla Maranucci at the San Francisco Chronicle has the back-and-forth. We stand by our statements, and here's the facts:
Two years ago, as part of his health reform proposal, ABx1 1, the Governor was willing to raise the revenues to expand the same Medicaid program to the same population, and was willing to raise the revenues to do it, with a 50% of the cost paid for by the federal government.
The current health reforms will expand the same Medicaid program to the same population with the federal government paying for 100% of the expansion population for the first several years, and over 80% from the eighth year on. Much of that small cost to the state--much smaller than what the Governor projects--would be offset by savings elsewhere.
This isn't apples and oranges. The comparison isn't even apples and apples. We are talking about the very same apple.
To be clear: we support and prefer the House health reform proposal that would provide even more assistance to states, by having the federal government pick up over 90% of the cost of the newly eligible population in the eighth year on. That would be a productive means of advocacy for the Governor, rather than attacking the overall health reform package that would provide a new infusion of billions of dollars in needed subsidies to California families, small businesses, and yes, the state of California.
2010: THE NEW YEAR BRINGS MORE CUTS TO CONTEST * Gov. Schwarzenegger To Unveil FY10-11 Budget Proposal on Friday, 11:30 a.m. * Health Access Reveals "The Damage Already Done" Six Months Into 2009-10 Budget * Stakeholders Meet for First Medi-Cal Waiver Committee Meeting
* 2010 Promises to be a Big Year! Join Us on Facebook! Follow Us on Twitter!
BUDGET TO BE ANNOUNCED FRIDAY: California Governor Arnold Schwarzenegger announces the release of his new FY2010-2011 budget around 11:30 a.m. on Friday. All expectations are that the budget proposal will include more painful cuts in programs vital to California's health and struggling economy. Health Access will review and report later tomorrow on the proposal's impact on health and human services, with quick reactions on our blog and on Twitter.
ASSESSING "THE DAMAGE ALREADY DONE" BY CUTS BEFORE CONTINUING: In anticipation of that announcement, Health Access California today released a new report detailing the six-month impact of nearly $2 billion in cuts already made to the state’s healthcare system in the current budget year. Entitled “The Damage Already Done: A Report on the Impacts of the 2009 Health Care Budget Cuts, Six Months In,” the report documents many of the effects these cuts have had on individual patients, families, health providers, and our economy.The finding? Just six months into the 2009 budget, hundreds of thousands of Californians have been denied care or coverage for key services, and we see indications of the health system we all rely on is crumbling, with five clinics closing. These cuts are starting to ripple through the health system and our economy, as we lose health jobs and federal matching funds, and people don’t get the help they need to get through these tough times. Six months into those cuts, families are suffering harmful impacts of being denied access to a range of critical services such as dental care, basic prevention and affordable health care options. We hope this assessment informs the discussion about whether the state can afford to cut more.
THE GOVERNOR'S ANTI-JOBS, ANTI-HEALTHCARE STATE OF THE STATE: But the indications are not positive. Yesterday, the Governor presented his State of the State address. The Governor focused on jobs, but by suggesting tax breaks and credits that would only make the deficit bigger and force additional cuts. He conveyed that the budget will include painful cuts, but did not acknowledge the lost jobs and lost federal funds that would result.
The Governor took the opportunity to oppose the health reform proposals in Congress, completely contrary to the health plan he supported merely two years ago. Health Access believes his reasoning is based on faulty assumptions, and has very different numbers of the fiscal impact of Medicaid expansions in health reform on California. Beyond that, California--with its large percentage of uninsured people and low-wage workers--is likely to disproportionately benefit from the billions of federal dollars to help families and small business, and the state, afford coverage.
MEDI-CAL WAIVER STAKEHOLDER PROCESS STARTS: In this busy week, Thursday marked the first gathering of the stakeholder committee appointed to help guide the state Department of Health Care Services in its 1115 Medi-Cal federal waiver process. The renegotiation of our state's Medi-Cal waiver with the federal government will provide challenges and opportunities regarding the Medi-Cal coverage of 7 million California children, parents, seniors, and people with disabilities. More information is at the Department of Health Care Services website.
A REQUEST FOR THE NEW YEAR: From fighting budget cuts to fulfilling the promise of health reform, 2010 will be a very busy year. We’ll need your help, so resolve to join and contribute: Consider contributing to the Health Access Foundation!
The Damage Already Done by the 2009-10 Health Cuts...
As Governor Schwarzenegger is poised to release his proposal for next year’s state budget, the proposal is expected to include a slew of additional cuts to health and human services.
In anticipation of that announcement, Health Access California today released a new report detailing the six-month impact of nearly $2 billion in cuts already made to the state’s healthcare system in the current budget year. Entitled “The Damage Already Done: A Report on the Impacts of the 2009 Health Care Budget Cuts, Six Months In,” the report documents many of the effects these cuts have had on individual patients, families, health providers, and our economy.
The finding? Just six months into the 2009 budget, hundreds of thousands of Californians have been denied care or coverage for key services, and we see indications of the health system we all rely on is crumbling, with five clinics closing. These cuts are starting to ripple through the health system and our economy, as we lose health jobs and federal matching funds, and people don’t get the help they need to get through these tough times. We deserve a budget that supports, not undercuts, the health of our communities.
Since the Governor signed the budget in July 2009, slashing nearly $2 billion from the health care system, some cuts have been partially averted through various actions. The delay and uncertainty, however, have generated grave consequences. In many cases, cuts were made, resulting in very real human hardships and economic impacts for Californians.
Those impacts include:
* Almost three million low-income adults have lost ten important benefits, such as dental care, vision care, speech therapy, and psychological services – in the last six months, over 450,000 Californians in poverty have either had to forego or pay for dental care; another 240,000 have lost coverage for prescriptions eyeglasses; * About 93,000 children waited uninsured for Healthy Families coverage until the cut was averted by non-government donations and higher cost sharing for 269,000 children on the program; * Five community clinics in the state have already been forced to shut down and hundreds of workers have been laid off, an additional 10 clinics are on the brink of closure; * Thousands of AIDS/HIV patients have been denied access to needed services and affordable medications they rely on; * About 300,000 low-income women no longer have access to life-saving breast cancer screenings; * Six domestic violence shelters were temporarily closed while the Legislature passed a bill to find ways to keep shelters open, and even afterwards, most have been forced to reduce services;
The ripple effects of these cuts will continue beyond these short six months, as we see more layoffs and closures of services, and the impacts of people not getting care or preventative services comes to back to haunt us.
“The Damage Already Done” will be distributed at multiple press conferences this week held to address the broader topic of health and human service cuts. Events are scheduled for San Francisco, San Bernardino, and Sacramento this Thursday morning as well as Bakersfield, San Diego, Los Angeles, Fresno, and Modesto on Friday, January 8th.
After much anticipation throughout the fall, we are finally having the first stakeholder meeting around the new Medi-Cal waiver.
As you may know, the current agreement between the state and federal government about the administration of Medi-Cal runs out in September of this year. There's lots to discuss, from areas of agreement to issues of contention. In this process, there's lots for California, for low-income patients, and for our health care system to gain, and lots for us to lose.
The first meeting is today, Thursday, January 7th. It is public, starting at 9:30am – 12:30pm at the Sacramento Convention Center, Room 204. All the materials for the festivities are at the Waiver Renewal website of the CA Department of Health Care Services: http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx
Governor Schwarzenegger's State of the State speech today was anti-jobs and anti-healthcare.
The most effective way to create jobs is invest in Californians, and in their health and in services to help all of us get through a tough time. The investment's impact would be multiplied because of federal matching funds, further helping our economic recovery.
Yet the Governor proposed tax cuts and credits that would force even deeper reductions in health and human services, resulting in not just more lost jobs but also lost federal matching funds needed for our economy. And the Governor opposed a healthreform that would actually provide significantly more money for California families, our health system, and our economy.
THE FACTS ABOUT HEALTH REFORM: The pending health reforms in Congress would provide billions of dollars in new and necessary help to California families and small businesses struggling to afford their premiums. As a state with a high uninsured rate and large population of lower-wage workers, California will likely disproportionately benefit.
Health reform would also expand Medicaid for 1.5 million low-income uninsured Californians in 2013 or 2014, with the federal government picking up the full cost of that expansion for the first several years. Only eight years from now--two Governors from now--would there be any additional cost to the state of California, and those dollars will be matched at more than a 4:1 rate.
For California, health reform is a benefit, not a burden--and its a bargain to boot. Any additional costs are minimal and don't even take effect until eight or nine years from now, and would be offset by savings in other areas. And in return for such investments, our state would cover over 1.5 million more low-income Californians through Medi-Cal, with the federal government picking up over 80% of the tab--a better match than our current programs now.
The Governor's hypocrisy on health reform is stunning. Two years ago, the Governor was willing to raise the revenues needed to expand Medicaid to cover the same population--with the federal government contributing 50% of the cost. Now, the Governor opposes the same expansion when the federal government is offering well over 80% of the cost.
In the health reform bill, some states do better than California, some do worse. We support additional federal assistance for California, but the way to argue for more money is not to misrepresent the bill. And the best way to get more money from our health care system, and our economy, is to make the health care investments now that will bring in the federal money that is already sitting there with our name on it--and prevent the cuts that make us lose even more jobs and federal funds.
Health Access refutes the Governor's numbers about the fiscal impacts of health reform on California, which are based on faulty assumptions. Health Access recently published an analysis of the cost of implementing national health reform in California, which show the dramatically different estimates than what the Governor has stating. The cost to CA in the year 2019 ranges from a savings of almost $200 million under the House bill with moderate take-up rates to costs of about $800 million under the Senate bill with high take-up.
The Governor’s estimate of $3 billion assumes that outpatient Medi-Cal provider rates would be 80% of Medicare and that 100% of those eligible for Medi-Cal would enroll. While Health Access supports Medi-Cal provide rate insurances, federal health reform does not require Medi-Cal provider rates to be 80% of Medicare. Health Access supports maximizing enrollment in Medi-Cal but CBO assumes that only half of those eligible will enroll. The Governor also ignores the fact that for the first several years, the federal government will pick up 100% of the cost of newly eligible populations.
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.
