For the last week, we have stated what seems obvious: that health reform is a huge boon for California, especially given the particularly acute health system crisis our state faces. Given our large uninsured population and other factors, California is likely to disproportionately benefit.
Somehow, Governor Schwarzenegger has been on a different message, and the California Representatives that won this huge benefit aren't pleased with his Administration's misleading characterization of the reform.
Here's the letter recently sent by four leading California members of Congress:
The Honorable Arnold Schwarzenegger, Governor of California State Capitol Building Sacramento, CA 95814
Dear Governor Schwarzenegger:
We are writing to explain the benefits of the new health reform legislation for California.
Your Secretary of Health and Human Services estimated this week that the legislation would cost California $2 billion to $3 billion annually. This is an incomplete and misleading assessment because it fails to take into account billions of dollars worth of new federal tax and health care benefits that will go to California's families and small businesses.
We have enclosed an analysis of the many benefits that the health reform law will bring to California and its residents. Over the next ten years, Californians will receive $124 billion in new federal support for health care coverage.
These new benefits include $106 billion in tax credits and other federal funding to pay for health care coverage for California families, $4.3 billion in tax credits to small businesses that purchase health insurance for their employees, and $9.3 billion in federal assistance to California seniors in the Part D drug donut hole. The legislation will also extend health care coverage to 3.8 million uninsured California residents and improve coverage for 21 million residents with employer-based or individual health insurance.
We hope this information is helpful to you as you evaluate the health care reform legislation and its many benefits to the state and California families.
Sincerely,
Rep. Henry A. Waxman, Chairman, Committee on Energy and Commerce Rep. George Miller, Chairman , Committee on Education and Labor Rep. Pete Stark, Chairman, Subcommittee on Health, Committee on Ways and Means Rep. Zoe Lofgren, Chairman, California Democratic Congressional Delegation
The passage of federal health reform has not ended our work... In fact, we've been busier than ever.
We've been in coalition, policy and legislative meetings, starting the full-fledged effort to implement and improve health reform, to fulfill the promise of reform right here in California.
There's a lot of work to do, from re-regulating and re-imagining the individual insurance market, to transforming Medi-Cal to be ready on day one for many newly-eligible Californians.
But we also want to recognize the great work done by the great leaders from the California delegation that made health reform possible. With the Health Care for America Now coalition, we've been doing "Thank You!" events, such as the one pictured above right with Speaker Nancy Pelosi and Representative George Miller in San Francisco this past Monday. We've greeted Representatives Jackie Speier, Lynne Woolsey, and Mike Thompson at the airport with our appreciation.
And we have been part of large constituencies going to visit the offices of our members of Congress, up and down the state. Pictured left is a large delegation (including Health Access organizers Nancy Gomez and Angela Woods, board member Joan Pirkle Smith, and many allies) that crowded into Representative Adam Schiff's office, all there to thank him for his vote for historic health reform.
There's a lot of work to do, but more celebrations are in order as well!
We congratulate Dr. Donald Berwick for his pending nomination as the head of the Centers for Medicare and Medicaid Services (CMS). We've greatly appreciated his work to improve the quality of health care--and of the patient experience--and our interactions with him, most recently on winning standards for timely access to care.
Dr. Berwick has been clear that cost control and quality improvement are not in conflict. And he is clear that one way is to engage patients in medical decisions--not by shifting costs to consumers, but by informing them about their choices and explaining their options to them. That's a welcome distinction:
Today, we welcomed back Elizabeth Abbott, who spent the last several days in Denver, at the meeting of the National Association of Insurance Commissioners. She represents Health Access California as a consumer representative to this group of insurance regulators that meet quarterly, one of two dozen consumer advocates amidst a sea of insurance industry lobbyists.
California's unemployment rate stayed flat at a troubling 12.5% in February 2010, according to new data released today.
Our state leaders need to focus on decisions that protect and promote jobs. Unfortunately, the Governor is proposing budget cuts just to health would cost the state’s economy more than 42,000 jobs.
Health Access California released a new report on Thursday detailing the impact on jobs of Governor Schwarzenegger’s 2010-11 proposed budget cuts to health care programs in California. Entitled, “Cuts to Health Care are Bad for the Economy,” the new report demonstrates that sweeping health care cuts in California would cost the state more than 42,000 jobs, at the very minimum.
The job-loss estimate is based on research by the University of California at Berkeley, which calculated that cuts (or investments) to health care services has the biggest "jobs-per-billion" impact than other budget solution, significantly more than tax increases on the high-income earners or an oil severance tax. That research is on the web at: http://laborcenter.berkeley.edu/californiabudget/budget_solutions_jobs10.pdf
Frankly, there is no place where you get more bang for your buck than investing in health and human services, both because of federal matching funds, and because benefits to low- and moderate-income families get recycled into the economy quickly. Nothing has a worse economic impact than cutting health and human services, which leads to lost federal funds and ripple effects in our health system and economy.
In addition to severe job losses, the Health Access report reveals that California would experience an estimated $2.7 billion loss in business activity across the state, thus further hindering California’s much-needed economic recovery at a time when joblessness is at its worst in decades.
Other findings showed that: * The Governor’s proposed cuts to Adult Day Health Care would lead to a loss of more than 7,500 jobs across 327 statewide facilities. * The Governor’s plans to eliminate In-Home Support Services (IHSS) would result in the loss of more than 370,000 home-care jobs across the state – even more than the total number of jobs lost across all sectors from January through December 2009.
Furthermore, the report shows that health care jobs are vital for California’s economic recovery. Not only is the health care industry a major source of jobs in California, with 12 of the 50 largest in-state employers directly involved in healthcare services; but the health care industry (alongside education) was the only industry sector to see an increase in jobs in California – adding nearly 23,000 jobs in 2009 alone.
The Governor’s proposal to slash $6.4 billion from California’s vital safety net couldn’t come at a worse time. When more and more families are struggling to get back on their feet, the Governor’s proposal not only decimates vital services for those Californians currently out of work, but also imposes severe challenges further hindering California’s economic recovery – including cuts to programs that would otherwise contribute desperately-needed Federal funds, such as Medi-Cal and Healthy Families.
STATE BUDGET STARTS TO GET SCRUTINIZED, ESPECIALLY IN LIGHT OF HEALTH REFORM
* Federal Health Reform "Reconciliation" Package Passes Both Senate and House * 2010-2011 State Budget Gets Its First Glances of Scrutiny * Senate Budget Subcommittee Rejects Harsh Cuts That Go Against Fed Health Reform * Assembly Budget Subcommittee Grills Adminstration on Impact of Budget Cuts
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Yesterday, both the U.S. Senate and House of Representatives took final votes on the on a "reconciliation" package of important improvements to historic health reform legislation signed by the President earlier this week.
THE REFORM IMPROVEMENTS: The new changes would provide more assistance to California's families and small businesses struggling with the cost of coverage, and to the state of California and its budget as well. The changes would:
* increase the financial assistance for low- and moderate-income families to afford insurance premiums, and to protect them against excessive out-of-pocket costs--especially important in a state with a high cost-of-living like California.
* improve drug coverage for seniors by eliminating the Medicare prescription drug coverage "donut hole" that currently leaves some seniors on the hook for thousands of dollars of drug costs.
* improves the financial assistance to states like California and our health system in multiple ways: * eliminates the special Nebraska provision and instead increases the federal assistance for any expansion of Medicaid, by covering 100% of the cost in the first three years, and at worst in the tenth year, continuing to provide a significant 9:1 federal match. (California's normal matching rate is 1:1.) * provides resources for a significant increase in Medicaid reimbursement rates for primary care physicians for two years, especially helpful for California that has some of the lowest rates in the nation; * delays and narrows the excise tax on high-cost health insurance plans, which were more prevalent in California due simply to our high cost-of-living; * improves the formulas for payments to safety-net (DSH) hospitals.
Although health care for low-income Californians has traditionally been a state and county responsibility, the federal governmet, under health reform with this package of improvements, will provide California with over $70 billion between 2013 and 2019 to subsidize public and private coverage for low- and moderate- income individuals and families. In particularly, the federal government would cover approximately 97% of the costs of expanding Medi-Cal to new populations over that period.
ALERT: As our nation goes forward on coverage expansion, California should not go backward with additional health care cuts that take us and our health system in the wrong direction. California should take advantage of this opportunity to draw down billions in federal funds for our health system and our economy. While health reform helps prevent some eligibility cuts, other programs are left vulnerable to budget cutting.
* CALL YOUR LEGISLATOR to urge them to reject health care cuts, especially to Medi-Cal benefits and other key services. Click here (hyperlink to www.leginfo.ca.gov/yourleg.html) to enter your zip code and find your legislators' phone numbers.
* If you have Medi-Cal and use threatened optional benefits (see below) and are willing to tell us your story to help stop the cuts, please ALSO contact Jessica Rothhaar at jessicar@health-access.org or 510-873-8787 ext. 107 to tell us what it would mean to lose coverage for the products and services you need. Your story can make a difference!
* To join our fight against health care budget cuts, also email jessicar@health-access.org with your city & zip code. We will let you know about upcoming meetings, town halls, rallies and opportunities to meet with your local legislator. Together, we are stronger than we are apart!
BACK IN SACRAMENTO, ACTION STARTS ON 2010-2011 STATE BUDGET -- Already, federal health reform is guiding California’s lawmakers' thinking as they begin the process of considering the next round of state budget cuts to health and human services. Against the backdrop of Congressional action on the historic Patient Protection and Affordable Care Act, legislative subcommittees in both the Assembly and Senate launched their examination of the governor’s proposed 2010-2011 state budget.
SENATE HEARING: On Thursday, a state Senate Budget Subcommittee rejected the harshest of Gov. Arnold Schwarzenegger’s proposals to scale back publicly funded medical services, partially because they did not meet the standards set by the new federal health reform law, finalized by the U.S. House on Thursday.
As we begin a national effort to increase coverage, the new federal law prevents states from undercutting it's effort by reducing eligibility to existing public programs--what’s called “a maintenance of effort.”
Schwarzenegger’s proposed budget threatens to reduce access to health care for nearly 2.7 million people in need, including 875,000 children. This would raise the number of uninsured Californians to more than 10 million. “The whole thing is nonsensical,” said Sen. Mark Leno (D), chair of the subcommittee. “The concept is to improve access to health care, not to dismantle what the federal government has just achieved.” Under Leno’s leadership, the panel rejected the most devastating cuts, the so-called trigger cuts that Schwarzenegger would “pull the trigger on” if his demands for $6.9 billion in added federal funds is not met. Rejected were:
· The wholesale elimination of the Healthy Families federal-state program that provides low-cost medical coverage to children of low-income families who pay modest premiums. About 1 million children rely on Healthy Families for their health care.
· A stiffening of eligibility requirements for Medi-Cal so that millions of Californians, including working families, children, and the aged, blind and disabled would no longer qualify for public medical care.
· Eliminating nine categories of Medi-Cal benefits – on top of 10 other medical services that Schwarzenegger eliminated last year. The nine are: hearing aids, physical therapy, occupational therapy, orthotics, access to independent rehab facilities, outpatient heroin detoxification, medical supplies, prosthetics, and durable medical equipment such as wheelchairs and oxygen tanks.
· Imposing mandatory co-pays upon Medi-Cal recipients, a move that providers said would create a barrier to access to medical care and could threaten patient flow at vulnerable community clinics. The California Primary Care Association opposed this proposal, reporting that six of its clinics have closed and others statewide suffered a loss of $70 million due to last year’s budget cuts.
· Imposing twice-yearly paperwork requirements on families with young children who receive state-funded health care. The move is designed to reduce the number of children receiving care. A representative from the Department of Health Care Services said an estimated 471,000 children would be dropped from the program because their families expected to fall behind on the twice-yearly paperwork. The subcommittee ordered this proposal rejected and replaced with only annual enrollment paperwork requirements, in keeping with the mandates of the new federal health care law.
Other aspects of the 2010-2011 health and human services budget were put off until the administration provides more detail in the governor’s May revision of his budget package. Ad important as theses votes are, No vote is final unless the entire budget if final and signed.
ASSEMBLY HEARING: Meanwhile, Californians hard-hit by the deep recession are coping with severe cuts from Schwarzenegger’s budget cuts last year. Ten core Medi-Cal services were eliminated last year: dental care, podiatry, chiropractic services, infection-preventing skincare products for the incontinent, optometry, audiology services, optician services, acupuncture, speech therapy and psychological services. In addition, the Healthy Families program was suspended for two months while funding was secured to patch the hole left by the governor’s cuts to the children’s health insurance program. One consequence to the 2009-2010 budget cuts has been an increase in use of emergency room services, including for emergency dental care.
Another, which Assemblymember Noreen Evans (D) has vowed to reverse, is a six-month freeze of new enrollment in the Every Woman Counts breast cancer early detection and treatment program for low-income women. In addition, the governor unilaterally closed the program to women aged 40 to 50, allowing only women 50 and older to be screened. Evans, a member of the Assembly Budget Subcommittee, which met Wednesday, said the governor took the action against the Legislature’s wishes and she would work to ensure full access to the program is restored.
Other action by the Assembly Budget Subcommittee included fact-finding and questioning administration officials on how many Californians would be affected by proposed health and human services budget cuts. In a majority of cases, administration officials were unable to answer the Assemblymembers’ queries.
Assemblyman Wes Chesbro (D) chastised the administration’s representatives for proposing radical cuts without the data to measure the impact on Californians.
“Our California budget is about real lives and real families and cascading effects of many of the cuts that have occurred,” Chesbro said, stressing that one family in need may suffer multiple cutbacks in multiple health care programs.
Coming up will be an Assembly Budget Subcommittee on the governor's 2010-2011 budget proposal at which the public will be able to testify.
The House of Representatives just passed, by a vote of 220-207, a package of "reconciliation" improvements to the historic health reform package signed by the President earlier this week.
This was after the Senate passed the package--after hours of brushing back GOP amendments in what was known as vote-a-rama--by 56-41 earlier today.
It now goes to President Obama for his signature. The work on this bill is done.
Instead of being concentrated in Congress for just over a year, health reform will spur frenetic activity over the next five years across the nation, at both the federal and state level, in venues both legislative and regulatory.
The work that needs to be done at the federal level, especially at the Department of Health and Human Services, is immense. But the much of the action will also shift to the states, who have traditionally taken the lead on two central components of health reform: insurance regulation, and the administration of public coverage programs. With federal standards and guidance, each state has a role in everything from expanding and streamlining its Medicaid programs, to setting up the new exchanges which will provide a new, regulated market for consumers to purchase coverage. In essence, the bill spurs 50 different health reforms.
My colleague Richard Kirsch, National Campaign Manager, Health Care for America Now, sounds a similar note and the end of his statement today:
“It’s impossible to overstate the breadth of what our nation’s achieved with the passage of comprehensive health care reform. We have closed the book on decades of struggle to make good, affordable health care a right - and not exclusively a privilege – for America’s families.
We have created a vehicle by which to eliminate insurance industry abuse, to make health care more affordable for working families and small businesses, to close the Medicare “doughnut hole” for seniors, to help young adults maintain coverage as they strike out on their own, and to bring all of us the peace of mind and security of knowing we are no longer just one accident or illness away from bankruptcy.
With the closing of this volume, we also prepare to open another. We will need to continue to hold lawmakers and big insurance accountable and make sure we implement reform in way that truly achieves good, affordable health care for all.”
HISTORY & HELP: OBAMA SIGNS COMPREHENSIVE HEALTH REFORM BILL; ASSEMBLY MOVES SWIFTLY ON COMPANION HEALTH REFORM BILLS FOR CA
* Historic Bill to Provide Immediate Help to Californians, This Year * CA Assembly Revives Rate Regulation Bill, With Support from Consumers * Unfair Practice of Rescissions To Get Independent Review Under Assembly Bill * Bill to Undo Schwarzenegger Cut of Breast Cancer Program Moves Forward * Federal Reform Movement Gives New Momentum to Previously Stalled CA Bills
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HISTORY: President Barack Obama signed historic health reform legislation yesterday, legislation that will provide security and stability to those with coverage, and new, affordable options for those that don't. When fully implemented in 2014, the bill has the potential of reducing the number of uninsured Americans by 32 million, and preventing people from becoming uninsured due to a loss of income, being between jobs, or due to health status.
IMMEDIATE HELP: At the signing ceremony, the President emphasized the immediate benefits of the reforms. For Californians in 2010, the health reform will:
1. Prevent people from being denied coverage based on “pre-existing conditions.”
- Soon, people who are uninsured due to a pre-existing condition will be able to buy insurance through a special insurance program. Right now, Californians are left in a lurch: our state has a small, underfunded "high-risk pool" that currently has a waiting list--even though it is estimated that over 400,000 have been denied coverage due to health status. - Within 6 months of passage, no new health plan will be able to discriminate against children with pre-existing conditions. - In a few years, no insurance plan will be able to deny coverage to anyone for pre-existing conditions.
2. Provide people with more security, by outlawing the worst insurance company abuses. Insurance companies will:
- No longer be able to cancel insurance coverage retroactively when you get sick. Over 6,000 Californians had their coverage rescinded in the past several years, and health reform would end the practice of rescission. - No longer be able to put lifetime limits on the dollar value of benefits - No longer be able to place co-payments or cost-sharing on key preventive benefits
3. Provide real relief to young adults and their families, to seniors, and to small businesses. Health reform will:
- Allow young adults up to age 26 to stay covered on their parents’ insurance - Reduces prescription drug costs for seniors. Seniors whose spending falls into Medicare’s prescription drug donut hole will have hundreds of dollars of immediate help and the entire coverage gap will be eliminated over time. - Gives subsidies to small businesses. Small businesses choosing to offer coverage to workers will receive a tax benefit of up to 35% of premiums.
SENATE RECONCILIATION: The effort to improve health reform began today as well, as the Senate start to debate a package of "reconciliation" improvements that were passed by the House of Representatives. They are expected to vote on the package before the end of the Easter recess at the end of the week.
NO MORE EXCESSIVE RATE HIKES: It didn't take long for federal health care reform to spur movement of related, complementary legislation in the California Capitol. The combination of President Obama signing the historic health care reform bill this morning and, back in California, continuing outrage over Anthem Blue Cross' rate hikes and the company's sending profits to out-of-state corporate parent WellPoint, Inc., provided new momentum to a bill for rate increase reviews.
Assemblyman Dave Jones (D), the previous chair of the Assembly Health Committee, had tried twice before with versions of this bill, AB 2578. Supporters hope the third time is the charm. Under the leadership of new chair Assemblyman William Monning (D), the Assembly Health Committee members moved the bill on to the Assembly Appropriations Committee, the next stop in the legislative process.
It remains to be seen whether the Governor likes the idea of installing rate review on for-profit and non-profit insurers. But one thing is sure: Legislators from all over California have been hearing from plenty of constituents unhappy about the profiteering bad behavior of Anthem Blue Cross and other insurers.
One consumer who attended the hearing just to speak up for himself as an individual testified that his health insurance premium had ballooned from $600 a month to $1,100 a month in just nine months. Such wild rate hikes may be the insurers’ way of purging aging baby boomers and others they calculate may soon need their benefits – and replacing them with new customers buying less generous plans.
AB 2578, co-authored by Assemblyman Mike Feuer (D) and supported by Health Access California, California Labor Federation, Consumer Watchdog, Consumers Union, would extend the kind of regulation that Proposition 103 requires for auto and other policies to health insurance policies.
The bill would fill a need left unfilled by federal health reform. Although Sen. Dianne Feinstein (D) worked with President Obama to try to insert rate regulation in the federal bill, procedural process rules prevented that from happening. Rather, the federal bill requires that insurers spend at least 85% of the consumer’s premium dollar on health and medical expenses, keeping only 15% for administrative expenses.
As it stands now, AB 2578 would trigger a review for rate increases over 7%, conducted by the Department of Insurance or the Department of Maernaged Health Care. In recent years, insurers have imposed double-digit premium increases on consumers annually, so that the average policy in California expanded in cost by 130% since 1999, Jones said.
Speaking out in opposition to the legislation was the Chamber of Commerce, the California Association of Health Plans, the California Medical Association, Health Net and Anthem Blue Cross. Assemblymembers Anthony Adams, Ted Gaines and Audra Strickland voted against the bill.
RESCISSIONS TO GET INDEPENDENT REVIEW UNDER BILL: The Assembly Health Committee also voted in favor of passing AB 2470, authored by Assemblyman Hector De La Torre (D), out of committee.
Though an insurance industry spokesman testified that firms have cleaned up their act since the Los Angeles Times first wrote a series of stories exposing the practice of insurers' rescinding policies once patients incurred medical expenses, De La Torre said the Department of Insurance has been less than forthcoming with information to support that statement.
Insurers also stated that the new federal health reform prohibits rescission immediately, and eventually moves to a guaranteed issue market--and so the bill is unnecessary. De La Torre welcomed the federal law, but said that the bill would provide the regulation to implement the new federal reform. In addition, state regulators have been too slow in coming up with their own regulations that they promised to unveil a year ago this month.
Stalled last year, De La Torre said the bill was needed because consumers were vulnerable to insurance company abuses in the four year window until the federal reform phases out denials for "pre-existing conditions" in the individual market altogether. It is in the individual market that the recissions -- fully 6,000 of them between 2004 and 2009-- took place in California. In only 5% of those cases were consumers compensated, said De La Torre.
Arguing against the bill was the California Association of Health Plans, the Chamber of Commerce, California Life and Health Insurance Companies.
EVERY WOMAN COUNTS, REALLY! -- Assemblywoman Noreen Evans (D), challenging the Schwarzenegger Administration over an unapproved cut of public breast cancer prevention and treatment services, ushered through the committee a bill that states the Legislature's intent to reverse the governor's decision.
Evans, who earlier held a hearing and orchestrated a Capitol steps bakesale to call attention to the cuts and raise money (about $3,800) for the program, reiterated that the Administration was specifically told "no" -- it could not go through with the cutbacks -- but it did so anyway.
The governor needs the Legislature's consent to make the kinds of changes to the program that it did starting in January of 2010. Breast cancer screenings were scaled back to just women 50 and above, eliminating the service for those who previously could access it starting at age 40. Experts testified that many deadly, aggressive breast cancers tend to show up before age 50.
The governor also unilaterally froze enrollment in the "Every Woman Counts" program for the first six months of this year in order to save money. Again, the Legislature had said no to this proposal last June. The bill passed out of Assembly Health on Tuesday, and will pick up details about its funding (through the tobacco tax provided by Proposition 99 ) before it moves to the next commitee, Evans said.
NEW MOMENTUM EVIDENT ON HEALTH INSURANCE REFORM: President Obama's signing of the federal health reform legislation clearly gave a boost to bills to shape up California's insurance industry practices. Supporters spoke about the importance of a fresh era of transparency and consumer protection.
Also speaking in support of AB 2578, Assemblymember Mary Salas (D) said: "This bill is so important at this historic moment."
President Obama today signed comprehensive health care reform into law... and this evening, the Senate is taking up a package of improvements. Hopefully, those improvements will be passed and the President will sign them within the next week.
Here in California, the Assembly Health Committee today was considering important improvements as well.
* The Assembly Health Committee just passed Assembly Bill 2578 (Jones and Feuer). AB 2578 requires that prior approval be obtained before health insurance rates are increased. HMOs and health insurers would need to receive approval from the Department of Managed Health Care (DMHC) or the Department of Insurance for proposed rate increases. Rates requiring approval include premiums, co-payments, and deductibles.
The majority of the committee members voted for the bill, but the vote total is not final, as some Members may add on their votes later in the hearing. AB 2578 is supported by individuals, families and business that have been victims of dramatic health insurance rate increases and organizations such as the California Labor Federation, Consumer Watchdog, Health Access, California Public Interest Research Group (CALPIRG), Consumer Federation of California, and Consumers Union.
* As I write this, the committee is reviewing AB2470 (De La Torre), to regulate the practice of rescissions, the retroactive denial of coverage. This is something that is barred in the national reform signed today, except for proof of fraud and "intentional misrepresentation." Assemblyman De La Torre welcomed the new health reform, but stated there was a need to provide details to how the federal law is implemented, and that's what the law would do.
It was a beautiful day, but I mostly was on my couch, watching C-SPAN, and posting commentary on www.twitter.com/healthaccess. The Huffington Post condensed the full floor debate into ten minutes. Below is the video, and some of the quotes from the day, particularly from California Representatives.
* CA Rep Judy Chu talked about Eric, a young member of her staff... Getting chemo, he reached 24 and lost coverage under his parents' plan. He then was denied coverage based on pre-existing conditions. He only had coverage because of the job with the Congresswoman, but this plan would help him, and others like him. * CA Rep Doris Matsui described her constituents Tim's + Elizabeth's problem with the health system: "If it's not working for them, it's not working for me." * CA Rep Dennis Cardoza: "My wife has been a doctor for 30 yrs. She tells me every night of stories of patients who get sick, but denied coverage. My wife has to fight with insurers "to let her practice medicine the way she was trained at UC-Davis Med School." "My brother, who owns a small business, saw his premiums are going up 75%.""I am going to vote for this bill, and I am going to vote for it proudly.. "It is desperately needed, desperately long overdue." * CA Rep Henry Waxman: Health reform "builds on what works today.. and it reforms what doesn't. It fundamentally reforms the practices of insurers." * MI Rep John Dingell, after being introduced by Rep. Henry Waxman: "Today is a day that is going to rank with the day we passed the Civil Rights bill of 1964... and Social Security..." * CA Rep Eshoo: I am priviledged to be part of a Congress that votes for this "life affirming" health reform, which will "perfect the union." * CA Rep Mary Bono Mack's descriptions: "secret deals" "shell game" "does nothing"... She gave the impression she was opposed... * CA Rep Lois Capps highlighted prevention: after this bill, "no more co-pays for preventative screenings." * GA Rep John Lewis: "The American people need health care, and they need it now.. Answer the call of history, and pass health care." * CA Rep Mike Thompson: "I've worked for quality, affordable health care for all for years, since my first campaign." "In my district, 63,000 uninsured residents will have access to coverage" * CA Rep Devin Nunes: Health reform brings back "ghost of communism," and it "continues failed Soviet socialist experiment".. we should "say no to totalitarianism." * Vice Chair & CA Rep Xavier Becerra: "Today is a day of history. Today we accomplish what 100 years of Congresses could not." * MD Rep Van Hollen: "The day after this leg is signed by President Obama, Americans will see the world is not coming to an end." * CA Rep Lynn Woolsey: "The whole nation needs health reform but no one needs it more than women..." "..being a woman is a pre-existing condition"
Speaker Nancy Pelosi arrived to a standing ovation, to give a speech that journalist Marc Ambinder called "the best speech I've seen her give." She started by stating that we are honoring the vow of our founding fathers, from the Declaration of Independence, for "life, liberty and the pursuit of happiness." This reform will provide healthier lives, and more liberty to pursue happiness. "This is an American proposal..." she emphasized. Citing the linkage with student aid legislation, she said that health reform and education were two issues that were ultimately about opportunity for the American people. "One word: opportunity."
Speaker Pelosi made the link to the economy. "Imagine an economy where people can change jobs or start a business without worrying that they would lose their health coverage." She continued, "The best action to reduce deficit, to improve economy, to create jobs.. ...is to pass health reform." She praised the health reform for emphasizing prevention, wellness, and innovation.. It "will create 4 million jobs.. will save $1.3 trillion from the deficit."
Speaker Pelosi references her predecessor who said "all politics is local," by stating that in fact, especially with health reform, "politics is personal." She recounts, "I saw a grown man cry" when he couldn't pay his medical bills...
She refers to over 350 groups support of health reform: AARP, AMA, Catholic Health Assn, United Methodist Church, Voices for American's Children, and many others. She also pointed out that the bill includes over 200 Republican amendments, and after over a year of debate, it's time to pass it.
Referencing the late Senator Kennedy, Pelosi calls health reform the "great unfinished business" of our society and says the reform will establish health care "is a right and not a privilege."
And after that, the vote tally went up. Like a New Year's Eve countdown, but utterly more rare and consequential, the bill slowly but surely had over 216 votes.
CALIFORNIANS HAVE CAUSE TO CELEBRATE WITH PASSAGE OF HISTORIC HEALTH REFORM IN THE HOUSE OF REPRESENTATIVES
* All House Democrats from California Supported Health Reform; All Republicans Opposed * Major Victory for California Leaders, Starting with Speaker Pelosi, Key Chairmen * Consumer and Community Groups Cheer Passage of Health Reform
* Reform Will Provide Immediate Relief for Children, Seniors & Small Businesses * Crucial Package of "Reconciliation" Improvements Head to Senate * Work Begins to Implement and Improve at the Federal & State Level
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HISTORY: On Sunday evening, the House of Representatives, by a vote of 219-212, voted to pass a comprehensive and historic health reform package that would provide more security and stability for those who have coverage, and new, affordable choices for those that don't. It would prevent the worst abuses of the insurance industry, expand coverage to 32 million uninsured, and put in place the tools to control health care costs.
The House passed two measures: the health reform bill passed by the Senate late last year, which heads to President Barack Obama for his signature Tuesday; and a "reconciliation" package of changes and improvements, that will be considered by the Senate within the next week, under a budget process that requires a straight majority of 51 Senators for passage.
HOW IT HELPS: The bill was mainly a victory for health care consumers, for both the insured, and the uninsured--both who benefit. Under the proposal, most consumers will be required to have coverage, but with that requirement comes signficant reforms and relief to help people meet that requirement.
IF YOU ARE INSURED, nothing requires you to change your coverage; but it will make your coverage more secure and stable: * It makes it more likely your employer continues to offer coverage, and set minimum standards for such coverage. * It improves Medicare; It expands and streamlines Medicaid. * It fixes the “individual market," giving individuals the bulk purchasing power of large purchasers, preventing "junk" insurance, and stopping denials for health status. * It provides the foundation to bring down the overall costs of health care.
IF YOU ARE UNINSURED OR UNDERINSURED, you will need to get coverage, but there will be new help and new options to ensure coverage is: * AVAILABLE: No denials or different rates for pre-existing conditions. * AFFORDABLE: Subsidies/affordability credits for low- & mid-income families, so you don’t have to pay more than a percentage of their income (based on a sliding scale up to 9.5%). * ADEQUATE: Minimum benefit standards and a cap on out-of-pocket costs, so no one goes into significant debt or bankruptcy. * ADMINISTRATIVELY SIMPLE: The Exchange provides choice and convenience, making it easy to sign up for and compare plans. * ALSO: Other efforts attempt to bring down the cost of coverage.
THE SUPPORTERS: The passage of health reform also is a win for many who supported it, starting with President Obama and Speaker Nancy Pelosi of San Francisco, who is widely credited with keeping health reform alive even when others believed the effort to be dead. Other Californian House members of note were key leaders like Democratic Caucus Vice Chair Xavier Becerra; Education and Labor Committee Chairman George Miller; Energy and Commerce Committee Chairman Henry Waxman; Way and Means Committee member Pete Stark, who chaired the Health Subcommittee; and many others, including leaders of key caucuses.
All California House Democrats voted for health reform; all California Republicans voted against it. The supporters included several members from more competitive districts--including Representatives Dennis Cardoza, Jim Costa, Jerry McNerney, and Loretta Sanchez--that decided in the last several days, especially after a Congressional Budget Office analysis showed that the reform would actually reduce the deficit in the first ten years by over $130 billion, and reduce the deficit in the second ten years by over $1.2 trillion.
Appreciation also goes to many health advocates from around the state. This includes the many organizations that are part of Health Care for America Now, which Health Access California leads in California, working with the Alliance of Californians for Community Empowerment and the California Partnership. This broad coalition started an aggressive field operation in July of 2008 to both push for health reform and for key principles.
THE ELEMENTS: What did health and consumer advocates win? Here's a top ten list:
* Near-universal coverage for all, largely through group coverage and its purchasing power. * New consumer protections: New rules and oversight on insurers that include the abolition of underwriting and limits on age-based rates and on premiums dollars going to administration and profit. * The biggest expansion of Medicaid since its creation 45 years ago, completing a commitment for millions in and near poverty. * Sliding scale subsidies tied to income: Consumers will pay for coverage not based on how sick they are, but what they can afford. * The end of most junk insurance and bankruptcies due to medical bills, with a cap on out-of-pocket costs. * Fair share financing, including an employer assessment as important in concept as the minimum wage was for pay * Assistance for small business, and their low-wage workers to be able to afford coverage. * More sustainability and improvements for existing public programs, filling the donut hole in Medicare & simplifying Medicaid. * The tools for cost containment and quality improvement in health care generally, from prevention to IT to bulk purchasing. * Momentum to do more in the future, politically and policy-wise, in health care and beyond
NEXT STEPS: But to fulfill the promise of health reform, the work to implement and improve it begins today.
The Senate needs to pass the package of House-passed improvements this week. The reforms are crucial, including greater affordability subsidies for low- and moderate-income families; the closing of the donut hole in the Medicare prescription drug coverage for seniors; greater consumer protections; the narrowing and delay of an excise tax on high-cost health plans; and more assistance to states like California for its Medicaid program.
Even after passage of the reconciliation package, the work to implement and improve health reform will continue at the federal level, and explode at the state level. Many items that were not included in this round of reform at the federal level--like rate regulation and the public health insurance option--already are pending as state legislation. The state's plans to renegotiate its Medicaid waiver will need to be rethought with the goals of health reform in mind. California will need to set up a new health insurance exchange. And the campaign efforts will need to continue, not just to defend health reform from the continued attacks, but to make sure it is implemented correctly.
That's the challenge of the next week, the next months, the next years, and the next decade. For more information about how to stay involved, become a member, visit our blog, join our E-mail list, Twitter feed, and Facebook page, and continue to be involved with Health Access California and Health Care for America Now--California.
I'm not sure it has sunk in yet, that health reform will be the law of the land. The House of Representatives passed both the Senate health reform bill, which will go to the President for his signature Tuesday, and the "reconciliation" package of changes and improvements, that will be considered by the Senate in the next week.
As much as the vote is historic, it's really about the help it will provide for millions of Californians. Immediately, there will be relief for seniors with their prescription drugs and small businesses with the premiums of their workers' healthcare. Soon, it will prevent the worst abuses of the health insurance industry, and help make coverage more affordable. With millions of Californians losing their health coverage and seeing health insurance rate hikes, and concerned that their coverage won't be there for them when they need it, we Californians needed this shot in the arm.
We thank the Democratic Representatives in California that united to support health reform, siding with California families, rather than the insurance companies. This reform will stop denials for pre-existing conditions, expand coverage, and provide real relief for those struggling with health costs.
Californians are more likely to find themselves uninsured, to be denied for pre-existing conditions, to not get on-the-job benefits. In the last two years, nearly two million Californians lost their coverage. We need this reform to prevent millions more from becoming uninsured, and thus living sicker, dying younger, and being one emergency from financial ruin." said Wright.
To fulfill the promise of health reform, we look forward to the work to implement and improve it, starting this week in the Senate.
We did it! THANK YOU to all who worked for this day.
There was a day of one minute speeches on health reform. Like Twitter posts limited by 140 characters, they require some creativity, or they are banal. Rep. Xavier Becerra of Los Angeles, the vice-chair of the House Democratic Caucus, gave one of the more poignant speeches of the day.
With all the talk about the history, let's talk about the help it provides:
IF YOU ARE INSURED, nothing requires you to change it; but it will make your coverage more secure and stable: * It makes it more likely your employer continues to offer coverage, set minimum standards for such coverage. * It improves Medicare and expands Medicaid. * It fixes the “individual market," giving individuals the bulk purchasing power of large purchasers. * It provides the foundation to bring down the overall costs of health care
IF YOU ARE UNINSURED OR UNDERINSURED, you will need to get coverage, but there will be new help and new options to ensure coverage is: * AVAILABLE: No denials or different rates for pre-existing conditions. * AFFORDABLE: Subsidies/affordability credits for low & mid income families, so we don’t have to pay more than a % of their income. * ADEQUATE: Minimum benefit standards and a cap on out-of-pocket costs, so no one goes into significant debt or bankruptcy. * ADMINISTRATIVELY SIMPLE: The Exchange provides choice and convenience, making it easy to sign up for and compare plans. * ALSO: Other efforts attempt to bring down the cost of coverage.
California especially benefits from health reform...
Given the extent of our state’s health care crisis, California would especially benefit from health reform:
EXPANDED COVERAGE: California has one of the worst insurance rates in the country. Health reform would cover most Californians, reducing the uninsured by roughly two-thirds. According to researchers at UC-Berkeley, close to 4 million Californians who were uninsured, in the individual market or had unaffordable employer sponsored insurance in 2007 would qualify for Medicaid or subsidized coverage in the exchange. This would provide relief to our beleaguered health system and safety-net.
STABILIZED EMPLOYER-BASED COVERAGE: California has one of the worst rates of employers offering coverage. Health reform would provide over $4 billion in new tax credits for California small business in the next ten years to help them provide coverage.
SUBSIDIES FOR LOW-WAGE WORKERS: California has a disproportionately large percentage of low-income workers. Health reform would expand Medi-Cal to individuals and families below 133% of the poverty level (over 2 million Californians will be newly covered), and provide significant subsidies to families under 400% FPL. Californians with an income of $14,404 a year would save $5,159 on average on premiums and out-of-pocket costs under the proposal compared to what they would spend in the current individual market. Those with an income of $43,320 a year would save $904 a year under the proposal. No one will have to pay more than a percentage of their income, on a sliding scale basis, for an insurance premium.
A BETTER WAY TO BUY COVERAGE: California’s individual insurance market is the biggest in the nation, but leaves Californians at most risk of being denied for “pre-existing conditions,” rescissions, and other insurer abuses. Health reform provides a new Health Insurance Exchange where insurers can’t rescind or deny coverage for “pre-existing conditions,” there are standards to prevent “junk” insurance, and consumers can make better comparisons between plans.
RECOGNITION OF OUR DIVERSE POPULATION: Health reforms recognizes the growing diversity of California and the nation, and the need for investment in language access; workforce development; and other provisions for our diverse population.
The House of Representatives is now starting 2 hours of debate on health reform.
All indications is that, barring any surprises, all California Democrats will be voting for health reform, and all California Republicans will be voting against it. In the last few days, California's Democratic Representatives in more competitive districts came around in support: Rep. Jerry McNerney (Stockton); Rep. Dennis Cardoza (Modesto); Rep. Jim Costa (Bakersfield), and Rep Loretta Sanchez (Orange County). We thank them, and Californians will thank them in the weeks and months ahead.
Support has come from usual and unusual quarters, from groups like the AARP to the American Medical Association, and newspapers like The Bakersfield Californian. We'll have more as night continues, but it looks good.
* I wrote in the New Republic and in Capitol Weekly about the policy implications of the UCLA study showing that the number of uninsured jumped by nearly 2 million, to over 8 million Californians.
For those watching TV, we also may be on CBS Evening News and NBC Nightly News today, tomorrow, or the next day, in the wake of health reform. Stay tuned...
Regardless of what happens tomorrow, you have to give it to Speaker Nancy Pelosi (D-San Francisco)... she's been an absolute champion, and we wouldn't be anywhere this close to health reform without her leadership.
Two articles, one in Politico, the other in the New York Times, detail just how extensive her role has been, both in bringing health care back into contention, and in driving the best possible bargain for her House members (and not unrelatedly, for consumers, and for California).
Her beginnings are chronicled in the excellent book A Rage for Justice, which chronicles the congressional baron Phil Burton--whose San Francisco district Nancy Pelosi now serves.
I was in awe in 2003 when state Senate President Pro Tem John Burton--Phil's brother, now the head of the Democratic Party--corralled the votes of his Senate to pass SB2, which started the momentum of the past decade to the current point in the health debate. In his own style, Burton reminded his colleagues about why they were there--as elected officials, as Democrats, as friends and colleagues. Now, on a much bigger stage, its up to Speaker Pelosi to do the same.
This Saturday morning, the House Rules Committee will meet at 10am (7am Pacific).
Both Congresswoman Doris Matsui (D-Sacramento) and Congressman Dennis Cardoza (D-Stockton-Modesto-Fresno) serve on the powerful House Rules Committee, which will vote on the key "reconciliation" package, so that it is considered Sunday by the full House, alongside the health reform proposal passed in the Senate by supermajority late last year. The reform effort will not proceed without passage in the Rules Committee.
(A multi-ethnic, multi-generational range of organizations will react to the House Rules Committee vote this afternoon at a press conference at Sacramento State, hopefully thanking our area Representatives.)
The Rules Committee will also vote on what if any amendments go to the floor. Here's a list of proposed amendments. The vote today otherwise sets up a historic vote on the House floor for Sunday, expected around 2pm (11am Pacific), with some speeches and debate beforehand.
A vote on health reform may happen as early as Sunday afternoon!
Californians have taken to the streets in support of health reform. On Wednesday, over 100 Californians rallied in Orange County, in Rep. Loretta Sanchez's district. Yesterday, the activity was outside the Central Valley offices of Rep. Dennis Cardoza, in Fresno, Modesto, and Stockton.
The comprehensive health reform package would provide security and stability for those with coverage concerned about losing it, and would provide new, affordable options for those currently without coverage.
The new changes would provide more assistance to California's families and small businesses struggling with the cost of coverage, and to the state of California and its budget as well. The changes would: * increase the financial assistance for low- and moderate-income families to afford insurance premiums, and to protect them against excessive out-of-pocket costs--especially important in a state with a high cost-of-living like California. * improve the provisions to eliminate the Medicare prescription drug coverage "donut hole" that currently leaves some seniors on the hook for thousands of dollars of drug costs. * improves the financial assistance to states like California in multiple ways: * eliminates the special Nebraska provision and instead increases the federal assistance for any expansion of Medicaid, by covering 100% of the cost in the first three years, and at worst in the tenth year, continuing to provide a significant 9:1 federal match. * provides resources for a significant increase in Medicaid reimbursement rates for primary care physicians for two years, especially helpful for California that has some of the lowest rates in the nation; * improves the formulas for payments to safety-net (DSH) hospitals.
The Congressional Budget Office "scored" the proposal covering 32 million people, and reducing the deficit by $138 billion in the first ten years, and over $1 trillion in the second ten years.
Californian Susan Braig, an Anthem Blue Cross of California policyholder whose breast cancer was largely uncovered, is spotlighted in a Health Care for America Now video urging Congress to vote for reform. Watch it here: http://www.youtube.com/watch?v=waV_2q9Z2jc&feature=player_embedded
It's the season of March Madness, and like in other arenas, a good score matters. And we got one today! And the (likely) final bill!
Here's the reconciliation package to improve the Senate health reform bill, that the House of Representatives will likely vote on Sunday, along with the Senate measure. http://rules.house.gov/bills_details.aspx?NewsID=4606
Yesterday, over 100 people rallied in Bakersfield in front of Congressman Jim Costa's office, urging him to support health reform, as he did once before.
Speakers included Dolores Huerta (pictured), professor and radio talk show host Mark Martinez, Dr. Holly Spohn-Gross, Reverend Byrd Tetzlaff, and Katherine Ernst, who described her own experiences with a broken health care system.
But that's just the beginning of the strong show of support for health reform in the Central Valley. Today, Wednesday, March 17th, the Health Care for America Now! coalition will start running TV ads in the Central Valley, making a final case for health reform. The ads spotlight Anthem Blue Cross of California’s recent rate hikes – up to 39% on individual policy holders and 75% on small business owners.
The ad is part of a large national buy starting Tuesday and Wednesday in 17 districts nationwide. The $1.7 million ad buy runs Tuesday or Wednesday through Friday and is scheduled to coincide with the expectation of a vote on health care legislation by week’s end. Ads start running in 11 districts on Tuesday. Those are as follows: Jason Altmire (PA-04), John Boccieri (OH-16), Jim Costa (CA-20), Suzanne Kosmas (FL-24), Harry Mitchell (AZ-05), Scott Murphy (NY-20), Brad Ellsworth (IN-08), Earl Pomeroy (ND), Bill Foster (IL-14), Steve Driehaus (OH-01), and Alan Mollohan (WV-01).
* "It’s happening everywhere." * "Health insurance companies jacking up premiums. Crushing small businesses and working families across America." * "Right here in California, we’ve seen our rates go up by 10, 20, even 39 %, in just the past few weeks." * "Remember, if the insurance companies win, we lose." * "Tell Congressman Jim Costa. To keep standing up for us, not the insurance companies." * "Pass health insurance reform now. "
As reported by Duke Helfand of the LA Times, there's shocking figures about a *huge* increase in the uninsured. Nearly 2 million Californians lost their health insurance from 2007 to 2009, largely due to a deep recession and mass layoffs.
New estimates from the UCLA Center for Health Policy Research show a 25 percent increase in the number of uninsured since 2007, when 6.4 million Californians lacked insurance, according to the authors of the new policy brief, Number of Uninsured Jumped to More Than Eight Million from 2007 to 2009.
The shocking increase in people losing insurance spotlights the problem that even for those of us who are insured, coverage may not be there for us when we need it.
Today, nearly one-quarter of all adult Californians lack coverage and the number of uninsured increased among all age groups, even among children, despite their better access to public health insurance safety-net programs. The hardest hit, however, were California's working adults. The recession of 2008-09 reduced those percentage of those getting job-based coverage to less than 50 percent for all Californians under 65.
Although public coverage among Californians increased slightly from 15% in 2007 to 16% in 2009, this did not offset the decline in employment-based insurance, as public programs had in previous years, especially for children. Yet the situation could get worse: the Governor’s budget proposes to eliminate coverage for hundreds of thousands --and without federal reform and resources, over two and a half million more Californians.
The overall UCLA report is shocking and sobering, and should be required reading, especially for any Representative thinking about voting against health reform this week.
A new Robert Wood Johnson Foundation (RWJF) report today projects that if significant reform efforts are not enacted, by 2015 there could be as many as 59.7 million people uninsured nationwide – and further estimates that the number could swell to 67.6 million by 2020 – with middle-income families hardest hit. An estimated 49.4 million individuals were without health coverage in 2010. The report, conducted by researchers from the Urban Institute, was released today as a part of Cover the Uninsured Week. For more information, see http://www.covertheuninsured.org/
The analysis, conducted by the Urban Institute, shows that the middle class would suffer most without reform. The uninsured rate for middle-class families earning 200-399 percent of the federal poverty level (FPL) – roughly $40,000-$75,000 a year – would rise by nine percentage points, from 19 percent to 28 percent over the next 10 years. Overall, the share of the uninsured from all families with incomes higher than about $40,000 would rise from 44 percent to 53 percent in 2020.
For employers who continued to offer health insurance benefits, an increasing amount of the costs would likely be passed on to workers. At the same time, individuals and families would face higher out-of-pocket costs for premiums and health care services. Spending for families and individuals would jump by 34 percent in 2015 and by 79 percent in 2020.
Families in California can’t afford to see our health care costs rise by more than a third in five short years. Already there are over million people in our state who lack health coverage and do not get the care they need. These individuals are forced to gamble every day that they won’t get sick or injured. Our businesses are struggling under the weight of ever increasing health care costs.
Now more than ever, we must make significant changes to our health care system to decrease costs and ensure that all Americans have quality, affordable care to keep our families healthy and financially secure.
Federal health reform legislation would benefit California immensely, by providing new and affordable choices for the uninsured, more security for the underinsured, much needed stability to our safety net, and real savings for our state budget. California needs real solutions to our health care crisis, and without reform, the future health and security of California’s families are at stake.
His full take is worth noting, but it seems some messages come through: "People" "Need" "Insurance" is a clear sentiment that comes through, with the issue of whether people can "Afford" it or whether it is "Affordable" also raised.
Those opposed to health reform focus more on "Government" and "Cost." Which is ironic, given that this proposal is not especially reliant on government, which is seen more of a regulator, rather than as a provider--the plan doesn't even include the much-debated public option. And the plan is actually a major cost-saver (according to the CBO), and the most ambitious attempt to date to control health care costs.
I am surprised that words like "security" and "stability," often used by the president, are not prevalent. In my view, that's the strongest argument for reform: that people will have basic financial security, so that coverage will be there for them when they need it. That lack of economic security--for the uninsured and insursed--is the most distressing part of our system today.
Speaker Nancy Pelosi said Friday in a declarative statement that the final health reform bill will not include a "public option."
The public option was an important part of the original proposal, and an important part of our advocacy, even though it wasn't the only important part of health reform--there's still a lot of good element. It's still a shame it's not included--Pelosi and many others had been active warriors for the concept, and our California delegation was united in its active support. Our two Senators, Senator Barbara Boxer and Dianne Feinstein, were supportive early on and are current signatories to a little to include it in the final reconciliation package. In the House delegation, it was a major element of both leadership from California, including Speaker Pelosi and key committee chairs, but other caucus leadership and members of the Progressive and Ethnic Caucuses. Even among our seven Blue Dogs from California, five were early supporters of not just health reform but the public option, and even those that were reluctant on health reform didn't base their qualms on the idea of a public option.
So we in California did our part, but such support for the public option was not uniform across the country, not enough to make it over the hump. Here's Speaker Pelosi:
Speaker Pelosi deserves credit for being straight with us, and she has the credibility to be so candid. As she said, she's a longtime single-payer supporter, and was very active in favor of a public option. I believe that if she says it's not in the cards, then it's not... and I also agree with her other statements that other elements of the health reform--from an active, negotiating exchange to rate review--help ensure the same goal, to prevent individuals from being left alone at the mercy of the big insurers.
Speaker Pelosi has been instrumental in keeping alive health reform as a whole, and she deserves huge credit for that alone.
The passage of health reform then creates an opportunity to revisit the public option in the future. At the state level, there's been an public option bill in the California Legislature, one that would be *much* easier to implement if we had the broader framework of this bill: an exchange, better rules on insurers, etc. After all, a public option in today's marketplace, to survive, would simply have to act like current insurers.
And there may be opportunities at the federal level to revisit the public option... that's why it is good that Senators Boxer and Feinstein and other Senators have made their support known. We won't stop fighting for it, even as we continue to work for health reform.
A vote is likely for next week on health reform in the House of Representatives, with votes to reconcile differences and make improvements in the Senate the week after that.
So difference would this reform make? The biggest changes, like the expansion of Medicaid, would not fully kick in until 2014 (these changes take time and some need to be phased in) but there's a lot of immediate benefits in 2010 that we can anticipate:
In 2010, health reform would:
1. Prevent people from being denied coverage based on “pre-existing conditions.”
- Immediately, people who are uninsured due to a pre-existing condition can buy insurance through a special insurance program. Right now, Californians are left in a lurch: our state has a small, underfunded "high-risk pool" that currently has a waiting list--even though it is estimated that over 400,000 have been denied coverage due to health status. - Within 6 months of passage, no new health plan could discriminate against children with pre-existing conditions. - In a few years, no insurance plan could deny coverage to anyone for pre-existing conditions.
2. Provide people with more security, by outlawing the worst insurance company abuses. Insurance companies could:
- No longer cancel insurance coverage retroactively when you get sick. Over 6,000 Californians had their coverage rescinded in the past several years, and health reform would end the practice of rescission. - No longer put lifetime limits on the dollar value of benefits - No longer place co-payments or cost-sharing on key preventive benefits
3. Provide real relief to young adults and their families, to seniors, and to small businesses. Health reform would:
- Allow young adults up to age 26 to stay covered on their parents’ insurance - Reduces prescription drug costs for seniors. Seniors whose spending falls into Medicare’s prescription drug donut hole will have hundreds of dollars of immediate help and the entire coverage gap will be eliminated over time. - Gives subsidies to small businesses. Small businesses choosing to offer coverage to workers will receive a tax benefit of up to 35% of premiums.
The popularity of health reform is improving, and these specific & immediate benefits will make it more so, once it is passed.
The upshot is we are moving closer to a House vote as early as next week, and Senate votes the week after. The momentum is unmistakable.
One of the ongoing narratives is the opposition to reform of Wellpoint/Anthem Blue Cross. The White House continues to spotlight the company and appropriately rebut its claims. They'v e come a long way since their days as a nonprofit safety-net provider, as public radio's Sarah Varney explains with the help of our colleague Lori Sobel at Consumers Union. Jon Cohn at The New Republic has a similar take. Instead, Anthem Blue Cross has refined a business model based on collecting premiums from the healthy and avoiding the sick, as I wrote on this blog, that has been picked up by the California Progress Report and the new web portal HealthyCal. All of these stories indicate that this is a natural evolution based on our current laws and regulations which allow such practices, and what we need is a reformed system to remove the incentives for insurers' bad behavior.
That's exactly what Congress will be voting on in the next week or two.
Earlier today, the Accountability and Administrative Review Committee, chaired by Assemblyman Hector De La Torre, held a key hearing on the headline-grabbing issue of rescissions.
The hearing usefully sought to follow up on the settlements that regulators got insurers to agree to offer to restore coverage to the 6,000 people who had their coverage yanked from them. Here are reports from the Shaya Tayefe Mohajer at the Associated Press and Daniel Weintraub at Healthy Cal. We'll have more soon.
OK, it's not the big health reform bill, or even a comprehensive jobs bill, but it was a portion of a jobs package that would provide big benefits for health care in California.
One in a series of bills on jobs, this emergency relief package, the “American Workers, State and Business Relief Act,” was approved by a vote of 62-36. Much thanks to Senators Barbara Boxer and Dianne Feinstein for their support. It will go to the House of Representatives, who have passed their own version of a jobs bill, before it goes to the President for his signature.
The legislation, (H.R. 4213), has an extension of unemployment and benefits and contains several health-related provisions that are of particular importance to California, including: * Extending the COBRA subsidy from the earlier stimulus bill. For unemployed California families, the average monthly COBRA premium is $1,107. The COBRA premium assistance reduced this cost to $388 per month, and without this benefit, unemployed Californians could lose $720 a month. * Providing help to the state budget through a six month extension of the enhanced Federal Medical Assistance Percentage (FMAP) enacted under the American Recovery and Reinvestment Act, which otherwise would end on December 31, 2010. This extension through June 2011 would provide an increase of $1.5 to $2 billion in federal funding for California's 2010-11 budget. * Delaying a 21.2 percent cut in payments to physicians who treat California's 4,672,923 Medicare beneficiaries and many TRICARE enrollees in California.
The COBRA subsidy will be welcome for California, with our high unemployment rate. And the relief for our state budget is crucial, to help close our deficit and prevent much, much worse budget cuts. The House had passed these elements in other bills, but it's very good news that the Senate has finally acted.
While acknowledging that he has voted for unthinkable cuts, and that there will be awful cuts going forward, the Speaker showed some impressive knowledge and passion about some of the health care cuts proposed in the past year. He talked personally and policy-wise about proposals to cut kidney dialysis, and about other cuts from AIDS drug assistance, and family planning.
And with the elimination of the Healthy Families program which covers over 900,000 children, and the total who would lose coverage under the Governor's proposal is 2.7 million Californians. It's a staggering impact.
And let's not forget: even with *all* the federal funds the Governor has requested, the Governor's proposal would cut over 300,000 Californians from coverage.
Earlier today, thousands of people descended on the Ritz-Carlton in Washington, DC, where America's Health Insurance Plans (AHIP), was having its annual conference. They blocked the streets, wrapped the hotel in yellow police crime tape, and sent a powerful message that Congress should listen to us, not the insurers.
The insurers, both as themselves and through the US Chamber of Commerce, announced multi-million dollar ad buys against health reform.
President Obama is amping up the stakes in the last few weeks. In his road show, he's shown sharper language. He again called out California's biggest insurer: "Anthem Blue Cross just jacked up premiums by nearly 40%. 40%! Anyone's paycheck gone up 40%?" He also references his Congressional opposition: "To Republicans: You had 10 years, what happened?"
As the President said, "The U.S. Congress owes the American people an up or down vote on health care. The time for talk is over. We need to see where people stand."
It’s true, as Jonathan Cohn points out, that the nation’s largest health insurer, Wellpoint, has been “among the most hostile to reform.” And as unearthed by Ezra Klein, at least one investment bank states the reason clearly: “Should health reform fail, Wellpoint would be a primary beneficiary.”
You may not know Wellpoint’s name, but even if you don’t live in my state, you may have heard of their California subsidiary, Anthem Blue Cross. Their rate hikes have been repeatedly spotlighted by the White House, and have been the subject of over a half-dozen inquiries.
The scrutiny comes with the eye-popping rate hikes, and with being the biggest, both in the nation, and in many states like California. But the scrutiny should go beyond the rate hikes to their overall business practices—and the broken health system that rewards bad behavior. To reinforce Ezra Klein’s point, they have perfected a business model based on collecting premiums from the healthy and avoiding as much as possible actually providing coverage to those who are sick.
It starts with their aggressive denial of people with pre-existing conditions—we have many stories of people being denied not just in their 50s but in their 20s, and even for relatively minor issues like heartburn.
Most controversially, Anthem Blue Cross of California had the most number of rescissions in the state, the odious practice investigating patients after a major claim for the purpose of retroactively cancelling a patient’s coverage--even if they have paid months and months of premiums--if they found an inaccuracy on the patient’s application regarding their medical history. They created even more of an uproar when they sent letters asking doctors to turn their patients about unreported pre-existing conditions.
The company also works to ensure that mostly healthy people come to them in the first place. They specialize in cheaper, “bare-bones” plans with high-deductibles or that leave out key benefits. At a recent Congressional hearing, Chairman Henry Waxman of California grilled Wellpoint executives about why the biggest increases were going to more comprehensive plans, including those with maternity coverage, with an effort to shift people into plans where consumer face more financial risk. As the committee staff report indicates:
"Internal documents suggest that WellPoint’s business plan includes moving consumers into less generous plans. This strategy appears to have three components. First, WellPoint’s highest rate increases seem to apply to their most comprehensive insurance plans. Maternity care is a marker for a more comprehensive package of benefits. A chart of proposed rates shows that WellPoint’s highest rate increases apply to the only two product families regulated by the Department of Insurance with maternity coverage. The chart also shows that for the most part, WellPoint proposed lower increases within specific product lines for the versions with higher deductibles than for the versions with lower deductibles."
Anthem uses benefit design, but also marketing, to avoid older folks and get more than its fair share of young and healthy people—also called “cherry-picking.” A classic example is a product like “Tonik,” which is marketed to 19 to 29 year olds, and has higher cost-sharing and omits maternity coverage—the most likely need for coverage for young women. It was perhaps the only insurance product that has been mocked by The Daily Show.
With this and other strategies, the company has been able to send over $525 million from California policyholders to Wellpoint’s Indiana headquarters in just 2009. Wellpoint got over $4.2 billion in earnings since acquiring Anthem in 2004, according to reporting by Lisa Girion of the LA Times. This is despite an agreement with state regulators that the merger would not siphon California policyholder dollars to the out-of-state . Anthem Blue Cross waited out the three years of the agreement, and sent $950 million to the corporate parent the week after.
These practices, yielding these dollars, are why the company has been on the front lines of opposing health reform.
When Governor Schwarzenegger proposed health reform in California in 2007, other insurers were willing (with caveats) to consider living by new rules, like guaranteed issue. As the biggest player in the market, Anthem Blue Cross of California stood alone apart, investing $2 million in an opposition campaign. (My organization and others launched a counter campaign, www.sickofbluecross.com, which continues today).
Other insurers have been ambivalent about health reform, which would mean more potential customers--but that includes sicker patients that they would rather not take, and more accountability and oversight over their operations. Health reform would mean a profound transformation for the industry: insurers competing on cost, quality, and customer service, rather than risk selection and avoiding sick people.
Anthem Blue Cross of California, and its parent company Wellpoint, has internalized the perverse and inequitable incentives of the current, broken individual insurance market: it thrives and profits from the status quo. The only surprise in the investment bank’s analysis that Wellpoint would be a primary beneficiary of reform failing was that it was stated so clearly. The rest of us would be a beneficiary of reform passing, changing the system so such bad practices are no longer good business.
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.
Yesterday, over 100 people rallied in Bakersfield in front of Congressman Jim Costa's office, urging him to support health reform, as he did once before.
