The Legislature spotlights better budget choices...
Monday, May 31, 2010
Last week provided a major reframing of the state budget debate. Both the Senate and Assembly leadership put forward their own frameworks for solving the budget crisis, and did so by rejecting the worst of the cuts proposed by Governor Schwarzenegger.
The two plans are different, but they show that there are better budget choices for California than to either eliminate or eviscerate basic health and human services, undercutting our families and our economy.
A new UC-Berkeley study, also released last week, shows that dramatic impact of the Governor's proposed cuts, cuts that would result in 331,000 lost jobs, in both the public and private sector.
We'll have more analysis on the comparative health and economic impacts of these plans very shortly, but until then, get the information from the legislators themselves:
President Obama's recent commencement speech at the University of Michigan is worth reading in its entirety, about his reflections on government, politics, civility, participation, and citizenship. His philosophy of government is instructive for those of us who were deeply involved in the debate on health reform (the emphases are mine):
First of all, American democracy has thrived because we have recognized the need for a government that, while limited, can still help us adapt to a changing world. On the fourth panel of the Jefferson Memorial is a quote I remember reading to my daughters during our first visit there. It says, “I am not an advocate for frequent changes in laws and constitutions, but...with the change of circumstances, institutions must advance also to keep pace with the times.”
The democracy designed by Jefferson and the other founders was never intended to solve every problem with a new law or a new program. Having thrown off the tyranny of the British Empire, the first Americans were understandably skeptical of government. And ever since we’ve held fast to the belief that government doesn’t have all the answers, and we have cherished and fiercely defended our individual freedom. That’s a strand of our nation’s DNA.
But the other strand is the belief that there are some things we can only do together, as one nation -– and that our government must keep pace with the times. When America expanded from a few colonies to an entire continent, and we needed a way to reach the Pacific, our government helped build the railroads. When we transitioned from an economy based on farms to one based on factories, and workers needed new skills and training, our nation set up a system of public high schools. When the markets crashed during the Depression and people lost their life savings, our government put in place a set of rules and safeguards to make sure that such a crisis never happened again, and then put a safety net in place to make sure that our elders would never be impoverished the way they had been. And because our markets and financial systems have evolved since then, we’re now putting in place new rules and safeguards to protect the American people. Now, this notion -- this notion, class, hasn’t always been partisan. It was the first Republican President, Abraham Lincoln, who said the role of government is to do for the people what they cannot do better for themselves. And he’d go on to begin that first intercontinental railroad and set up the first land-grant colleges. It was another Republican, Teddy Roosevelt, who said, “the object of government is the welfare of the people.” And he’s remembered for using the power of government to break up monopolies, and establish our National Park system. (Applause.) Democrat Lyndon Johnson announced the Great Society during a commencement here at Michigan, but it was the Republican President before him, Dwight Eisenhower, who launched the massive government undertaking known as the Interstate Highway System.
Of course, there have always been those who’ve opposed such efforts. They argue government intervention is usually inefficient; that it restricts individual freedom and dampens individual initiative. And in certain instances, that’s been true. For many years, we had a welfare system that too often discouraged people from taking responsibility for their own upward mobility. At times, we’ve neglected the role of parents, rather than government, in cultivating a child’s education. And sometimes regulation fails, and sometimes their benefits don’t justify their costs.
But what troubles me is when I hear people say that all of government is inherently bad. One of my favorite signs during the health care debate was somebody who said, “Keep Your Government Hands Out Of My Medicare” -- which is essentially saying “Keep Government Out Of My Government-Run Health Care Plan.”
When our government is spoken of as some menacing, threatening foreign entity, it ignores the fact that in our democracy, government is us. We, the people -- (applause.) We, the people, hold in our hands the power to choose our leaders and change our laws, and shape our own destiny.
Government is the police officers who are protecting our communities, and the servicemen and women who are defending us abroad. Government is the roads you drove in on and the speed limits that kept you safe. Government is what ensures that mines adhere to safety standards and that oil spills are cleaned up by the companies that caused them. Government is this extraordinary public university -– a place that’s doing lifesaving research, and catalyzing economic growth, and graduating students who will change the world around them in ways big and small.
The truth is, the debate we’ve had for decades now between more government and less government, it doesn’t really fit the times in which we live. We know that too much government can stifle competition and deprive us of choice and burden us with debt. But we’ve also clearly seen the dangers of too little government -– like when a lack of accountability on Wall Street nearly leads to the collapse of our entire economy.
So, class of 2010, what we should be asking is not whether we need “big government” or a “small government,” but how we can create a smarter and better government. (Applause.)
Because in an era of iPods and Tivo, where we have more choices than ever before -- even though I can't really work a lot of these things -- but I have 23-year-olds who do it for me -- -- government shouldn’t try to dictate your lives. But it should give you the tools you need to succeed. Government shouldn’t try to guarantee results, but it should guarantee a shot at opportunity for every American who’s willing to work hard.
So, yes, we can and should debate the role of government in our lives. But remember, as you are asked to meet the challenges of our time, remember that the ability for us to adapt our government to the needs of the age has helped make our democracy work since its inception.
just when you thought it was safe to refocus on the state legislature, with budget and bill deadlines looming, we get a reminder that we can't not let up the focus on Congress.
Congress has gone on their Memorial Day holiday break, but without addressing the needed extensions in either COBRA or FMAP. Both the COBRA and FMAP provisions were stripped from the House “Extenders” Package, H.R. 4213 today.
Both provisions would have extended federal aid that was in the federal stimulus pacakage, the American Reinvestment and Recovery Act, aid that is soon set to expire. The COBRA provision would extend the premium assistance that is being provided to those who lost their jobs during this recession but are trying to afford to stay insured. The FMAP provision extends the enhanced federal Medicaid matching dollars that would otherwise run out on December 31, 2010--the six month extension means almost $2 billion for California's state 2010-11 budget.
H.R. 4213, which had other extensions of both assistance and tax breaks, were passed in two parts. A package of tax extensions and unemployment benefits were approved 215-204. A scaled-back version of the fixes to Medicare physician payments was approved 245-171, which includes small increases this year and next year. The Senate still needs to act on the bills when it returns from recess on June 7th.
Despite this setback, we need to work to ensure that Congress considers the crucial FMAP and COBRA provisions when they return.
Friday afternoon, at the Assembly Appropriations Committee, key bills supported by Health Access California, were passed. Next they will move to the Assembly Floor for votes as early as next Tuesday. The deadline for them to pass the full Assembly is next Friday, June 4th, and then it’s off to the Senate to do it all over again.
The bills which passed out include:
· AB 2244 (Feuer), a Health Access sponsored measure which implements guaranteed issue for kids, including phasing-out higher premiums for kids with pre-existing health conditions, and
· AB 1602 (Speaker John Perez) which implements key elements of federal health reform, including creating the California health benefits exchange.
Also of note that passed to the floor include: · AB 1600 (Beall) which expands parity for mental health and creates parity for substance abuse treatment · AB1640 (Evans): Breast and cervical cancer screening, amended to be contingent on funding in the budget · AB1653 (Jones) which would extend the hospital provider fee for six months · AB 1825 (De La Torre) which requires coverage of maternity services, · AB1887 (Villines) which implements the new federal high risk pool: an urgency was added. (Health Access is in a support if amended position and wants to see the new high risk pool happen this year.) · AB2470 (De La Torre) which would set standards for independent review of recissions · AB2578 (Jones) which requires prior approval of health insurance rate increases · AB2599 (Bass) which codifies the agreement between LA County and UC to re-open MLK hospital in South LA.
Almost all of these passed on party-line votes.
We’re down to the wire as the deadline for floor action is next Friday and most bills will be voted on Wednesday or Thursday. So please get your letters of support to the full Assembly as soon as possible.
Bills that were held on suspense and will not proceed this year: · AB1595 (Jones) which would have expanded Medi-Cal eligibility in 2014 · AB1606 (Coto) which would required Medi-Cal to establish specified disease management programs · AB2025 (De La Torre) which would have implemented the 1115 waiver (both the Speaker and the Pro Tem have measures intended to do this). · AB2170 (Lowenthal): prescription drug copays
We'll keep you up to date on the bills in both the Assembly and the Senate as they face crucial consideration next week.
For bills going through the legislative process in California, one minute they’re in and the next, either they’re out and on their way to a floor vote next week or held in suspense and dead for the year. Call it the day of deciding California's Next Top Model Legislation.
At the Senate Appropriations Committee on Thursday, chaired by Senator Christine Kehoe, we were pleased to say a fond Auf Wiedershen to six bills of interest to health care consumers.(For a fuller list of bills of interest to health care consumers pending in the Legislature, visit the Health Access California legislation web page, and print out the Health Access California bill list.)
First up, Senator Alquist’s two bills that deal with the individual market and the exchange, SB 890 and SB 900. Authored by the Chair of the Senate Health Committee with the Senate President Pro Tem, these are flagship bills in the effort to implement health reform. (The Health Access California website has a list of bills specifically around the theme of implementing and improving health reform.)
Second, Senator Leno’s bill on rate review (SB 1163) and his bill on timely access (SB 1200). Next, Senator Price’s bill allowing young adults to stay on their parent’s coverage through age 26 (SB 1088) and lastly, Senator Steinberg’s bill (SB 1283) regarding health care grievances.
In all these cases, congratulations, you’re out- Auf Wiedershen! And the next stop is the Senate Floor with votes as early as next Tuesday, June 1---so health care advocates should get your letters of support out to the full Senate today if possible.
Of those that remained held on suspense and dead for this year include Senator Cox’s bill SB 1063 on the Healthy Families Program, and Senator Price’s bill SB 1409 concerning the South LA hospital project fund.
The deadline for floor action is next Friday. We will have a report later today on the Assembly Appropriations Committee which is meeting later this morning.
(Thanks to Beth Capell and Nellie Price for covering the hearing.)
The marathon Senate Budget and Fiscal Review Committee, chaired by Senators Denise Ducheny, on Wednesday started at 10:30 a.m. and didn’t finish until around 8 p.m., with only a 45 minute lunch break.
HEALTHY FAMILIES: Various cuts under the Managed Risk Medical Insurance Board (MRMIB) were considered. MRMIB executive director Lesley Cummings stated in her summary that the Governor had left some good news in his May Revise regarding MRMIB and Healthy Families, but Senator Ducheny commented that for once, the “Governor chose to comply with the law for a change.” She was referring to health reform and its "maintenance of effort" requirements that prevent cuts in eligibility or enrollment.
One of the proposals was an increase to copayments for children in the Healthy Families program. Last November, copayments were increased by 100% for those children from 150-250% of the poverty level. The new proposal increases copayments again for ER visits and certain non-emergency services, including to all children enrolled. Republican Senator Roy Ashburn commented that these increases were not “relevant when we’re talking about small dollars." But Senator Ducheny was quick to point out that for a family making less than $25,000 a year with 2-3 children, who then had to pay $250 a year in copayments was significant.
The committee also voted to reject the eliminate of vision care in Healthy Families, as well as premiums increases. One 10-3 vote was to reject premium increases, cuts to Healthy Families copayments and cuts to vision care, all in one swoop.
MEDI-CAL: In Medi-Cal and the broader Department of Health Care Services, the big news is that all of the major cuts to services were rejected and the proposed trailer bill accompanying the 1115 waiver was moved to policy committee, but the $337 million in savings from mandatory enrollment of seniors and persons with disabilities into managed care in a twelve month period was adopted.
The committee also rejected a hospital inpatient rate freeze by 8-2, and the elimination of providing assistance for the premiums of Medicare Part B by a 8-1 vote. They also packaged a range of the worst of the cuts to Medi-Cal.
The following issues were all voted on at once to deny. The proposals were rejected together in one swoup with a vote of 6-2: * Elimination of selected over-the-counter drugs * Hard Cap: six prescription outpatient drugs * Hard Cap: durable medical equipment * Hard Hap: Certain medical supplies * Hard Cap: hearing aid expenditures * Hard Cap: 10 visits for outpatient primary and specialty care provided under physicians * Mandatory copayments for physicians & FQHC/RHC office visits * Mandatory copayments: Dental office * Mandatory copayments for hospital inpatient days * Mandatory copayments for emergency room visits * Mandatory copayments for non-emergency room visits * Mandatory copayments: pharmacy copayments * Limit internal nutrition to tube feeding
The committee asked many questions surrounding these issues, such as how much a hearing aid costs these days, and how is there really savings associated in capping people at 10 office visits per year. Senator Leno asked how 10 visits would be tracked to which he was told that no more claims would be paid after a patient had filed 10 visits to the doctor.
Chair Ducheny was very skeptical of the mandatory copayments, asking “How do you make it mandatory? There is still a Hippocratic oath, isn’t there? What doctor is going to deny seeing someone over $5?” She also added that it seemed awkward and that she didn’t think the federal waiver would approve such mandatory payments.
A proposal to make changes to Medi-Cal Program eligibility processing was rejected, with an understanding to find an alternative that achieves half of the savings. Another proposed cut was a fund shift around Expanded Access to Primary Care Clinics, that was denied 8-1.
After health and many other issues, the committee adjourned for the *night* and Chair Ducheny thanked everyone, stating they would pick up tomorrow for the rest of the budget issues (transportation, finance) after Appropriations and then again Friday on the floor. She added, “You didn’t really think you’d be going home, did you?”
Thank you to Nellie Price for her report from the committee...
We will shortly post updates on the latest on budget developments with regard to health care cuts. Until then, another really good source is the website for the HHS Network, at www.hhsneworkca.org.
Health Access is proud to be part of the HHS network, to spotlight the importance of health and human services for both our state's families, and our economic recovery. Check it out!
It's a good story. George Skelton at the LA Times reported earlier this week about a Reagan-era arm-wrestling match to decide whether to implement a cut to Medi-Cal, specifically Medi-Cal co-pays.
Amusing anecdote, if a bit scary to learn how public policy is sometimes dictated. Skelton seems to think higher co-payments for people under the poverty level is acceptable enough to put it up to an arm-wrestle. I don't think that is not a good process to decide policy--and not just because I'd probably lose that particular contest to Governor Schwarzenegger.
Skelton did at least quote me with some of the counter-arguments (to co-payments, not arm-wrestling): these are vulnerable populations who make less than $1000 a month, where cash can be scarce. But one main point that was not quoted: The issue of co-payments is really about denial of care: do we want to allow providers to deny care to a patient under the poverty level beause they don't have $5? or $50? or $100? For those providers who take the patients anyway, it's another provider rate cut. And yet that's the best-case scenario. So we disagree.
Thankfully, the columnist comes out against the vast majority of health cuts proposed, including the hard caps on prescription drugs and doctor and clinic visits. He recognizes that $5o for an emergency room visit or $100 for a hospital day stay is way too much for poor people.
And he recognized the larger point about priorities and values: the Governor's budget seeks to impose new costs on the very poor before even considering delaying corporate tax breaks or upper-income taxes. That's as unfair as an arm-wrestling contest between me and a bodybuilding Governor.
Many, many groups line up against the health cuts...
Friday, May 21, 2010
HEALTH ACCESS UPDATE Friday, May 21st, 2010
ASSEMBLY BUDGET COMMITTEE HEARS HOWLS AGAINST HEALTH CUTS * Dozens of organizations testify against cuts, caps, and cost-sharing in Medi-Cal * Gov proposes limits on drugs (6/month) and doctor visits (10x/year) * Cuts to Medi-Cal & Healthy Families could impact 8 million Californians
The Assembly Budget Subcommittee No. 1 on Health and Human Services, chaired by Assemblyman Dave Jones, heard a torrent of testimony in opposition to Governor Arnold Schwarzenegger’s proposal for health care cuts that were part of the May Revision of his 2010-2011 budget.
Raising many concerns, the subcommittee agree to leave many items open, rather than to approve proposals to impose caps and cost-sharing worth over $523 million in cuts to Medi-Cal, and another $14 million in Healthy Families.
CUTS TO MEDI-CAL:
In describing the cuts, director Toby Douglas acknowledged the severity of the proposals, saying they “are not what we want to do.” Whlie acknowledging the severity of the $19.1 billion budget deficit, Assemblyman Jones countered there are budget choices to making these cuts, from eliminating “corporate welfare” to raising revenues.
The Medi-Cal “cost containment” package announced with specifics in the May Revise Budget, would:
· Limit care and coverage for 7 million Californians including millions of seniors and people with disabilities and chronic illness, to save $90 million, including: o Limit doctor/clinic visits to 10/year to save $69 million, with “no exceptions,” as Toby Douglas stated; o Limit prescription drugs to 6 per month (except for life-saving drugs, although undefined) to save $4 million. o Eliminate coverage for over-the-counter drugs to save $13 million. o Establish maximum annual benefit dollar caps on medical supplies (e.g., diabetes management test strips & lancets, wound care, incontinence supplies) and durable medical equipment (e.g., wheelchairs and hearing aids) to save $3.8 million.
· Raise the cost of care for Medi-Cal patients, the vast majority of whom are under the poverty level and have monthly incomes below $1,000, to save $218.8 million. Administration official admitted that these costs “would be higher than in other states,” and that these and other elements would require a federal waiver.” The costs include: o $100/day for a hospital stay, up to a maximum of $200, to save $59 million. o $50 copayment for emergency room visits to save $41.5 million. o $5 copayment for doctor visits and prescriptions to save $118 million.
· Eliminate Medi-Cal coverage for recent legal immigrants to save $118 million, affecting about 90,000 legal immigrants who have resided in the US for less than five years;
· Eliminate the Medi-Cal adult day health care benefit to save $104 million, affecting about 35,000 frail adults; · Move seniors and people with disabilities from their current doctors into mandatory managed care to save $137 million. This proposal is being discussed as California’s Medicaid waiver (Section 1115) renewal negotiation; · Eliminate coverage of Medicare Part B premiums for beneficiaries whose income exceeds the Medi-Cal eligibility threshold by less than $500 per month to save $1 million;
· Freeze Medi-Cal rates for hospitals at current levels to save $65 million; · Reduce Medi-Cal rates for radiology to 80% of the Medicare rate to save $10.5 million; · Reduce Medi-Cal rates for family planning services;
Republican Assemblyman Emmerson and others raised concerns and asked if there were more equitable ways to get similar savings, rather than hard caps on benefits. A person who needs a more complex wheelchair “isn’t going anywhere” with an annual cap on durable medical equipment of $1604, he said.
The Administration justified some of these caps and cuts as stating they would still meet, in aggregate, the needs of 90% of Medi-Cal enrollees--a standard they believed would be approved by the courts. But in testimony, many testifiers pointed out the problem in such a structure--that those with the highest needs would be impacted the most.
Democratic Assemblyman Chesbro asked the Department if the analysis included the impact of cuts in one area could increasing costs in other areas. He mentioned that a cap on durable wheelchair equipment or a special bed would discourage many hospitals for discharging patients in a timely manner, increasing costly hospital stays. Toby Douglas of the Administration calculated that “those cost shifts are not accounted for,” due to the uncertainty of making that calculation.
Even some Republicans raised specific issues. GOP Assemblymember Nestande, who endorsed many of the elements of the paln and the concept of imposing cost-sharing on Medi-Cal recipients, argued that a $50 emergency room visit was “a little bit high.”
Chairman Jones summed his thoughts more fully: “I think these are terrible proposals. I can’t find a one of them that makes any sense at all to me.” In leaving the item open, as the Assemblymembers wait for more information, he said he “couldn’t imagine a scenario where we can do these things.”
CUTS TO HEALTHY FAMILIES
The committee also heard testimony about Healthy Families, which provides coverage for nearly 1 million low-income children, largely between the poverty line and two-and-a-half times the official poverty level. Previous proposals sought to significantly reduce the number of people on Healthy Families.
The federal health reform law of 2010, which seeks to expand care and coverage, includes a “Maintenance of Effort” (MOE) requirement that explicitly prevents states from cutting eligibility or enrollment in programs like Medi-Cal and Healthy Families. (A similar MOE was also included in the economic stimulus package, tied to additional Medicaid dollars.)
The penalty for violating these MOEs is the loss of federal Medicaid matching dollars—in California, over $26 billion. For this reason, the Governor has retracted his earlier proposals to eliminate Healthy Families altogether and roll back Medi-Cal eligibility to reduce the rolls by over 1.5 million people.
Instead, the Governor now seeks to cut both Medi-Cal and Healthy Families by going around these restrictions. The MOE applies only to eligibility and enrollment, not to benefits. So efforts to restrict the eligibility for families at 200-250% needed to be retracted, while the proposal to eliminate vision benefits continues to be on the table.
Advocates testified that they believe that some proposals, such as increasing premiums for Healthy Families, are likely to violate federal health reform, by causing eligible Californians to drop off coverage altogether. The proposals would:
* Increase monthly premiums for families between 200 and 250 percent FPL by $18 per child, an increase of 75%, (with a family maximum of $126). $13.3 million General Fund reduction. An earlier proposal would also increase premiums for children from 150-200% FPL by $14/child. Many believe such premium increases violate federal health reform by changing enrollment procedures. * Raise emergency room co-payments from $15 to $50 ($2.5 million) and raising hospital inpatient services co-payments of $100 per day with a $200 maximum ($0.7 million), for an overall reduction of $3.2 million General Fund. * Eliminate vision care for children, including coverage for eyeglasses.
The committee also held open and did not vote on the cuts to Healthy Families.
Another Californian joins the national health reform team...
Thursday, May 20, 2010
Californian Peter Lee will be joining the Obama Administration to help implement health reform after leading the Pacific Business Group on Health as both CEO and as Executive Director for National Heath Policy. Effective June 1st, Lee will assume the post of Director of Delivery System Reform, in the U.S. Department of Health and Human Services’ Office of Health Reform.
Lee joins other Californians in implementing health reform at the national level at the U.S. Department of Health and Human Services.
The list of errors is gruesome, and is a reminder of why these are called "never events." They aren't "sometimes events" or "stuff happens" events, but errors where there should be systems and fail-safes in place to ensure they never happen. We need more reporting and scrutiny on these errors, and more accountability. We have supported legislation to have the state Medi-Cal program join Medicare in not paying for such care, along with the corrective actions like the fines announced today.
We also need to encourage the systems that ensure that these problems don't happen. One example stood out because the solution was clear:
In Riverside, Parkview Community Hospital was fined after a surgeon with hospital privileges in July removed the wrong kidney from a Spanish-speaking patient with a kidney tumor. Investigators found out the patient was not provided an interpreter before he consented to the surgery. Francisco Torres, 72, lost his one healthy kidney, was placed on dialysis and sued the surgeon and hospital for medical negligence.
While this is a severe example, it's problems like this why we and many of our allies have advocated for language access standards in both public and private health coverage, and why we have been so active with our Video Medical Interpretation project, in trying to ensure that language is not a barrier to quality, appropriate care.
Here's a useful web tool from California Congressman Henry Waxman's Energy and Commerce Committee to help people understand how the new federal health reform helps people in different situations:
With everything going on last week, from the budget to the Medicaid waiver, we neglected to announce that on Thursday, the full Assembly passed AB2042, authored by Assemblyman Mike Feuer and sponsored by Health Access California. AB2042 simply says that insurers and HMOs cannot change or increase premiums, cost sharing or benefits more often than once a year.
When Anthem Blue Cross of California sent out its now famous notices about rate hikes up to 39%, it also included the caveat that they may seek additional increases mid-year. Californians deserve some measure of economic stability, including the ability to predict their costs for a full year. The bill had a margin of 48-27, along party lines with Democrats supporting and Republicans opposing. Onto the Senate, with this and other bills...
Today, Governor Arnold Schwarzenegger proposed a new California budget that eliminated or eviscerated health and human services.
In a tough budget situation, Governor Schwarzenegger’s revised budget represents the worst possible choice for California families, for our health system, and for our economy. At a time when millions are looking for relief, the Governor has proposed cuts that will deny medically necessary care, place greater financial strain on families, and turn back hundreds of millions of dollars in federal matching funds for our economy.
THE SPECIFIC HEALTH IMPACT: California children and families, seniors and people with disabilities will find their prescriptions and doctors visits limited, their coverage for certain treatments capped, and significant costs for getting doctor and hospital care. Some of these cuts will not just delay and deny care, but will have life and death impacts.
BETTER CHOICES FOR CALIFORNIA: There are better choices for California—ones that balance cuts with revenues, preserves the health system we all rely on, and fosters our economic recovery. In contrast, Governor Schwarzenegger’s budget undermines our ability to create jobs and our health infrastructure--the foundation on which we need to take advantage of the new opportunities under health reform.
NO NEW TAXES?: Governor Schwarzenegger says there are no new taxes in his proposal, and that’s true for corporations. For eight million in low-income California families, there are significant increased costs to have and access basic medical care. This doesn’t just hurt those families, but our shared health system and our economy.
THE SPECIFIC OF THE HEALTH CARE CUTS
Federal law, through the economic stimulus dollars and the new health reform law, prevented Governor Schwarzenegger from cutting Californians off of coverage under Medi-Cal and Healthy Families.
Despite this, the proposal has severe cuts that will make it harder for eight million Californians from getting the care they need. The proposals include $523 million in general fund dollars to Medi-Cal, and another $16.5 million cut in Healthy Families. Other key human services, including CalWORKs, IHSS, mental health, child care, and other programs are either eliminated or eviscerated. The health cuts include:
* A cut to Medi-Cal of $523 million, limiting or placing financial barriers to care for over 7 million Californians, mostly low-income families, seniors, and people with disabilities. The impacts include: * Limiting doctor or clinic visits to 10 a year, for a population that includes seniors and people with disabilities. * Elimination of coverage for over-the-counter drugs, and caps on benefits for hearing aids, durable medical equipment like wheelchairs, wound care supplies, urological supplies, etc. * Copays of $5 for doctor visits, $50 copay for ER visits and $100 per day for hospital stays. (Remember that individual Medi-Cal patients have incomes of less than $10,800/year for an individual, $18,310/year for a family of three). * Shifting seniors and persons with disabilities into mandatory Medi-Cal managed care. * Freezing hospital rates
* Increase in premiums and cost sharing in Healthy Families, for a savings of $16.5 million.
* The budget continues to include elimination of coverage for 90,000 legal immigrants, and for Adult Day Health Centers now used by 35,000 frail adults.
ON THE ECONOMIC IMPACT: Health Access California released a report earlier in the year entitled, “Cuts to Health Care are Bad for the Economy,” which shows that such sweeping health care cuts in California would cost the state more than 42,000 jobs, at the very minimum. The report 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
There is no place in the budget 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. You can't outsource health care. 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.
Yesterday, the Managed Risk Medical Insurance Board met and discussed the Healthy Families program, and in particular, the potential of a new high risk pool under federal health reform.
It was reported that the U.S. Department of Health and Human Services is now providing guidance to states that have decided to establish and operate high risk pools (as opposed to those states who are simply letting the federal government run a pool for their residents). There is a requirement that premiums may not exceed 100 percent of the standard rate--which is different than our existing MRMIP high-risk pool, which charges considerably more. States have been instructed that if they want to set up their own plan, they must comply by July 1, which means applications need to be submitted by June 1.
The thinking is that the new high-risk pool would be separate from MRMIP, patterned after MRMIP, but different to comply with federal rules, in order to get the $761 million of federal funds allocated.
The board had several questions, commenting on how flexible the Federal Administration would be willing to be with the states. It was commented on that perhaps looking at exactly how many states were not just showing interest in the solicitation (around 30), but were going to follow through, would be helpful.
(Thanks to Beth Abbott and Nellie Price for attending and reporting.)
Today, Governor Schwarzenegger will unveil his May Revise budget, which is expected to be awful. We will Twitter (www.twitter.com/healthaccess) on the announcement and blog here our first analysis as soon as possible.
To get a sense of the devastation, look at the Governor's January proposal. He proposed a series of steep cuts in a base budget, but then included a "trigger" proposal of program eliminations and other stunners if California didn't get $7 billion of federal funds. California is likely to get more than half of that sum, but some of those requests were improbable to start with. So expect a budget that includes elements of the extreme "trigger" budget. If a state has a $20 billion deficit and doesn't include taxes or revenue in the solution, all that's left are ugly, conscience-shocking choices.
Our partner Health Care for America Now (HCAN), the nationwide coalition that led the successful fight for health reform, released a report today showing that the five largest for-profit health insurance companies cashed in on double-digit rate hikes to record huge profit gains in the first three months of 2010 while providing skimpier benefits to hard-pressed consumers.
The five companies reported combined net income of $3.2 billion, a 31 percent leap from the same period in 2009. The combined commercial enrollment of the five companies fell by 2.85 million members in only 15 months. And among the 86 million people who remain enrolled in employer-sponsored and individual health plans, many saw their benefits shrink and their out-of-pockets costs grow.
California Senator Dianne Feinstein (D-CA), along with Representative Jan Schakowsky (IL-9), joined HCAN’s media conference call today, and they argued in favor of the companion bills they are sponsoring, the Health Insurance Rate Authority Act of 2010. This legislation would make health insurance more affordable for families and small businesses by providing authority to stop excessive rate hikes. The bills would empower the Health and Human Services Secretary to block unfair premium increases.
“I’ve come to the conclusion that the driving force in this sector of our economy is profits for shareholders—it isn’t good coverage for beneficiaries, and that’s a problem,” said Senator Feinstein.
As those of us in California know, WellPoint (through Anthem Blue Cross of California) was proposing increases as high as 39 percent until an independent expert retained by California officials unmasked the WellPoint rate hikes, concluding they were based on highly inaccurate data. “WellPoint is turning out to be the poster child for unbridled greed,” said Representative Schakowsky. “You’ve got to wonder about WellPoint’s rate calculations in other states.”
The health insurance industry argues that rising medical costs are to blame for runaway premiums, but rate hikes for years have greatly surpassed the growth of medical costs, wages and overall inflation. From 2000 to 2008, premiums for families enrolled in employer-sponsored health plans increased 97 percent, while rates for individuals in workplace health plans climbed 90 percent, according to the HCAN report. During that same period, private insurers’ payments to health care providers rose only 72 percent, medical inflation increased 39 percent, wages grew 29 percent and overall inflation climbed 21 percent.
Along with tough enforcement of the new health reform law enacted in March, the Feinstein/Schakowsky bills will put an end to unjustified rate increases that are turbo-charging profits, and it will keep health insurance companies from running roughshod over the financial security of the American people.
JOINT LEGISLATIVE HEARING REVIEWS HEALTH REFORM OPPORTUNITIES * Legislators Get a Deep Look at Actions that States Need to Take to Implement Reform * Also This Week: Release of Gov’s “May Revise” Budget; Draft Medi-Cal Waiver Plan
The year’s health policy debate is kicking into high gear this week, balancing California’s interest in implementing and improving health reform with our state’s tough budget situation. On Friday, Governor Schwarzenegger will unveil his proposed May Revise of the state budget, including no new taxes but "absolutely terrible cuts.“
EXCITEMENT OVER HEALTH REFORM: But despite the Capitol bracing for the bad budget news budget news, there was a sense of optimism in the air, as yesterday, the California state legislature held a special joint hearing of both the Senate and Assembly Health Committees to review the challenges and opportunities of health reform. While legislators have already begun consideration of over a dozen specific bills to implement and improve aspects of health reform, this is their first sustained examination of federal health reform since its passage over a month ago. It was covered in the Sacramento Bee, the San Francisco Chronicle, and HealthyCal.com.
Senator Elaine Alquist, chair of the Senate Health Committee, heralded the “once in a lifetime opportunity” to implement health reform, and indicate her personal goal to not just implement but to “build upon” the federal law.
Assemblyman Bill Monning, chair of the Assembly Health Committee, indicated his “excitement and enthusiasm” for “maximizing the opportunities” under health reform. He expressed his approval that the Governor had directed his staff to implement reform. “This is good news,” he said.
CALIFORNIA’S IMPLEMENTATION: Marian Mulkey from the California HealthCare Foundation started the hearing with a broad overview of the federal health reform, the state’s role, and the provisions that need to be implemented in both the short and long term. She projected that of the 7 million uninsured in California, 2 million of them will be newly enrolled in Medi-Cal; and another 2-4 million will newly get private coverage, with help of the new subsidies or new market rules. That will leave still leave 1-2 million uninsured in California alone.
Alan Weil of the National Academy of State Health Policy spoke on specific opportunities for states under federal health reform. His top 10 list of advice for states included: · Be strategic with the insurance market exchange · Regulate commercial health insurance market effectively: “New standards won’t enforce themselves,” Weil said to audience laughter. · Simplify and integrate eligibility systems · Expand provider and health systems capacity · Attend to benefit design · Focus on the dually eligible (those seniors and people with disabilities in both Medicaid and Medicare programs) · Use new data to drive improvements in the health system · Pursue public health goals · Engage public in policy development and implementation · Demand quality and efficiency from the health care system
Senator Alquist asked what one action would be to bend the cost curve, to which Weil responded is that “the most important thing to know is that there isn’t just one thing,” before talking about multi-sector coordinated efforts to establish concrete goals so there’s accountability, community priorities and measurable goals, especially around public health.
In response to legislator questions, Assemblyman Monning spotlighted his legislative efforts to maximize federal funds for both workforce development, and for ensuring an ombudsman program and other consumer assistance in California. Senator Alquist invoked her bills as well, including SB227 to implement a high-risk pool for those denied by pre-existing conditions, and SB890, a comprehensive proposal to reform the individual insurance market that includes medical loss ratio standards.
CREATING AN EXCHANGE: Jon Kingsdale, director of the Commonwealth Health Insurance Connector described the Massachusetts experience with exchanges. He stressed the need for a central, trusted source of information to counter misinformation. Mr. Kingsdale said that without such information, everyone will be nervous and asking “What is happening to me?” To outline the magnitude of the task, he cited that in just 2 years, the connector held 338 town hall meetings statewide and had a series of telephone conference calls. Mr. Kingsdale quickly did the math, converting the numbers for what that would translate to for California. “Statewide, California would have 1,700 meetings in 2 years, responding to 12,000 phone calls per week”—even before the program is up and running.
According to Kingsdale, the core mission of any exchange is to create a market and “to sell insurance… a commercial enterprise with public policy goals.” He suggested that an exchange could reduce distribution costs that can be as high as 20% of premiums in a state like California. In Massachusetts, they have been able to bring those costs initially down below 5%, and are now at 3%. Mr. Kingsdale spotlighted the ability of an exchange to negotiate for the best possible price, and the success that the exchange has had in doing so.
Another important role of the Exchange is to make getting insurance easy to use: the best thing that has come out of the Connector has been how many people have used it. He has been stopped on the street and thanked, he has been told numerous times how easy it is to get enrolled, and he is surprised at the various mixes of people taking advantage of it.
Assemblyman Monning inquired as to whom makes up their governing structure in Massachusetts. Mr. Kingsdale suggested the board include “customers” like consumers, labor, who will be the users of the exchange and can drive change, rather than people representing the health industry from insurers or providers.
MEDI-CAL WAIVER: David Maxwell-Jolly of the Department of Health Care Services spoke next on the impact of Federal Health Care Reform on the Medi-Cal Section 1115 Waiver.
Earlier this week, the Schwarzenegger Administration had unveiled a new, just-released plan for the waiver, which will govern the next five years of this critical safety-net program. The proposal has evolved from its original inception, most notably to take advantage of some new opportunities available under the new health reform law.
Maxwell-Jolly indicated his goals with the waiver were to slow long-term growth in health costs, reform the delivery of care, and to begin expansions of care to uninsured in California, and preserve the infrastructure that the state needs to be ready for 2014.
STAKEHOLDERS WEIGH IN: Beth Capell of Health Access California, stating she was “delighted a federal law was in place” and California will and should “improve upon it,” both in getting more Californians enrolled and in regulating insurers, especially in the individual market. Elizabeth Landsberg of Western Center on Law and Poverty said she “excited about implementation because poor people have a lot to gain.” She pressed that eligibility needs to be seamless. Sara Flocks of the California Labor Federation expressed strong support for health reform but cited concerns that some large employers would game the system by changing workers hours, and this issues needed to be monitored. Dr. Ellen Shaffer of the Center for Policy Analysis spoke briefly in support of federal health reform, and about how implementation can be concurrent with consideration of single payer reforms.
John Arensmeyer of Small Business Majority [organization name corrected from original post] expressed that small businesses pay up to 18% more than large businesses in buying coverage, reiterating the sentiment that size matters. So he sought a large exchange that is “aggressive” in bargaining for the best price, and that insurance rules should be the same inside and outside of the exchange. Charles Bacchi of the California Association of Health Plans indicated how some insurers were adopting elements of health reform quickly, but cautioned to go slow in other areas, and against legislative efforts that were unrelated or went beyond federal reform. Dr. Phil Phinney of the California Medical Association Board of Trustees, gave highlights from the CMA perspective, including reiterating comments by legislators on increasing the workforce to meet increased demand. Other public comments, generally supportive, came from Suzie Shupe, of California Children’s Health Initiative, Caroline Negrete of California Alliance for Retired Americans and OWL, and Erica Murray of California Association of Public Hospitals.
As Assemblyman Monning stated, this hearing was “only a first step” in the process. Next steps involve both the budget, the negotiations around a Medicaid waiver, and a series of bills, from setting up a new high-risk pool to a full exchange, to be considered in the next few weeks and months.
Thanks to Nellie Price and Tony Torres for their reporting on the hearing.
This week marks when all the health policy debates of the year kick into high gear...
* Tomorrow, Wednesday, at 1:30pm the California state legislature holds a special joint hearing of both the Senate and Assembly Health Committees to review the challenges and opportunities of health reform. Health Access is one of several panelists explaining the issues. While legislators have already begun consideration of over a dozen specific bills to implement and improve aspects of health reform, this is their first sustained examination of federal health reform since its passage over a month ago.
* Thursday, the Schwarzenegger Administration will convene the Stakeholder Advisory Committee for the Medicaid waiver (which Health Access sits on). There, we will go over the Administration's new draft, just-released plan for the waiver, which will govern the next five years of this critical safety-net program. The proposal has changed from its original inception, most notably to take advantage of some new opportunities available under the new health reform law. We'll have more comments on the new proposal--including the good, the bad, and the missing--shortly.
* Friday, Governor Schwarzenegger will unveil his proposed May Revise of the state budget. Shane Goldmacher of the LA Times quotes a gubernatorial spokesperson as indicated there will be no new revenues proposed, only "absolutely terrible cuts. " There's no doubt that includes health and human services.
This week sets the stage for the rest of the year, with regard to legislation, the budget, and the negotiations between the state and federal government on the Medicaid waiver.
The passage of health reform doesn't end the day-in, day-out struggle for workers getting coverage on the job.
It certainly helps: some small employers will get tax credits this year to help them provide coverage to their workers. By 2014, large employers who don't provide coverage may find that they need to chip in to the coverage if their lower-wage workers appropriately take advantage of the available affordability credits. The cost control efforts may help to slow the rate of growth in the price of premiums. And at the very least, the law will help establish some standards for on-the-job coverage: no waiting periods longer than 90 days, no coverage that had annual caps or limits that leaves patients on the hook for catatrophic medical bills.
But at the end of the day, there's the question of what benefits the employer provides his workers and their families. The hope is that providing decent benefits would become even more of the norm, and those employers that don't will be the exception that can be called out... like the San Francisco hotels mentioned in this fun video.
There's a lot of polling that Californians support the new federal health reform law, and when they know more details--including the costs and the benefits, the arguments against and the arguments for--they support it even more.
That said, there is a challenge, which is that many don't believe the benefits will actually materialize for them. People have become so distrustful of politics and government that they are disinclined to believe that things can get better, that a problem--like people being denied for pre-existing conditions, or patients going broke due to medical bills--can be solved. So there is a disbelief and discounting of promises of progress, not just when a bill is pending and the skepticism is understandable, but even after the law is signed.
It seems that health reformers were not fighting conservatism, but cynicism. There may be conservative solutions or progressive solutions to health care and other issues. Many would argue that the health reform included both. But if people don't feel that any solutions are possible, then that's profoundly disempowering.
Cynicism also has a policy impact: Cynicism engenders a small-c conservative impulse: that any change will inevitably be bad; that the most logical impulse is to turn inward; in health reform, it leads people to be very protective of the coverage they have, even if they have all sorts of problems with it, rather than take any risk. It leads to "your on your own" policies and against the community solutions that are actually the most effective and efficient.
Reformers and progressives sometimes feed into cynicism with our critiques of policy and politics. Those critiques are not wrong, whether about the influence of money in politics, the barriers of supermajority requirements, or the lack of leadership by specific elected officials. But if we don't show where there is possibility for hope, then this worldview leads to an obvious conclusion: is the political process is that bad, then anything that can come from it will be bad as well. Instead, we should be realistic about the barriers to progress while also being clear about the strategy to surmount them.
I was reminded of the corrosive nature of cynicism from an unlikely source: Conan O'Brien, whose comedy tour came through Sacramento this past week. It was a good show, but it also recalled for me the last part of his farewell speech from the Tonight Show. For his fans who felt he was treated unfairly, he made a striking statement against cynicism (starting at about the 3:20 mark):
"All I ask of you is one thing: please don't be cynical. I hate cynicism -- it's my least favorite quality and it doesn't lead anywhere. Nobody in life gets exactly what they thought they were going to get. But if you work really hard and you're kind, amazing things will happen."
It was striking that the comedian took such pains to make the point, but it's real: cynicism gets us nowhere, not inn our personal or professional lives, and not in politics or policy.
At a similar time earlier this year, President Obama said as much in his state of the union, understanding why there is so much cynicism, but making a case against it:
Unfortunately, too many of our citizens have lost faith that our biggest institutions – our corporations, our media, and yes, our government – still reflect these same values. Each of these institutions are full of honorable men and women doing important work that helps our country prosper. But each time a CEO rewards himself for failure, or a banker puts the rest of us at risk for his own selfish gain, people's doubts grow. Each time lobbyists game the system or politicians tear each other down instead of lifting this country up, we lose faith. The more that TV pundits reduce serious debates into silly arguments, and big issues into sound bites, our citizens turn away.
No wonder there's so much cynicism out there. No wonder there's so much disappointment.
I campaigned on the promise of change – change we can believe in, the slogan went. And right now, I know there are many Americans who aren't sure if they still believe we can change – or at least, that I can deliver it.
But remember this – I never suggested that change would be easy, or that I can do it alone. Democracy in a nation of three hundred million people can be noisy and messy and complicated. And when you try to do big things and make big changes, it stirs passions and controversy. That's just how it is.
Those of us in public office can respond to this reality by playing it safe and avoid telling hard truths. We can do what's necessary to keep our poll numbers high, and get through the next election instead of doing what's best for the next generation.
But I also know this: if people had made that decision fifty years ago or one hundred years ago or two hundred years ago, we wouldn't be here tonight. The only reason we are is because generations of Americans were unafraid to do what was hard; to do what was needed even when success was uncertain; to do what it took to keep the dream of this nation alive for their children and grandchildren.
Why do I bring this up?
Because the challenge of health reform is not just to educate people about the law, or even to implement or improve on it.
I firmly believe that health reform will improve millions of people's lives: people who get care that wouldn't otherwise, and prevent people from going bankrupt when they get sick who otherwise would. Many more will get some financial help in affording the care and coverage they need, and all of us will have a more stable, secure and affordable coverage than we would otherwise.
But health reform can, implemented right, do even more. A well-implemented and improved reform can promote the idea that big problems facing our nation are solvable. It can rekindle the American"can-do" spirit of optimism and hope and progress, to make additional progress on health issues and other issues. So those are the stakes: health reform cannot only reduce the number of uninsured, or the cost of care, it can help reduce cynicism itself.
On Friday, California Assembly Speaker John Perez provided a report on his trip to Washington, and in particular on help for the California budget situation. Of news value, he reports that U.S. House Speaker Nancy Pelosi believes the Congress will pass the extension of additional FMAP--the enhanced federal Medicaid matching funds that is worth over $1.5 billion to our Medi-Cal program--by the end of the month.
He also spotlights the work to implement health reform, both in expanded coverage options and in new patient protections.
This week Senate President pro Tem Darrell Steinberg and I traveled to Washington DC as part of our effort to work more closely with our partners in the California Congressional delegation and President Obama’s administration to make sure that Californians have the federal support we need to ensure a strong and lasting economic recovery takes root in California. This was a very productive trip. And I'm pleased to report significant progress with federal reimbursement requests at meetings we held with Speaker Nancy Pelosi and the California Congressional delegation. We also had a number of very productive discussions with members of the Obama administration, including a meeting with Secretary of Health and Human Services Kathleen Sebelius, where we discussed California’s budget and the implementation of federal health care reform.
One of the most important items we discussed is a six month extension of the enhanced federal match the state receives for its Medi-Cal program that serves California's low income seniors, disabled, and children and their families. This extension is worth $1.5 billion to the California budget.
We were heartened to hear from Speaker Pelosi that she expects this to pass by the end of the month.
We also worked with our federal partners on implementing health care reform in our state so that Californians can begin to take advantage of extended coverage options and groundbreaking new patient protections as soon as possible.
California is clearly in a health care crisis. And the new protections in this bill, including outlawing practices of denying coverage for pre-existing conditions, are a vital of our economic recovery.
At the state level, work continues on legislation I’ve introduced that helps Californians take advantage of the newly expanded coverage and patient protections.
Of course job creation continues to be our main focus at the state level and I’m pleased our meetings in Washington this week show we have a strong partnership in those efforts. I look forward to continued cooperation at every level, and I’m confident that I’ll be able to maximize the tools we need to create jobs, balance the budget and protect Californians.
Time to take the next step in investigating the insurers
Wednesday, May 05, 2010
Yesterday, Health Access California urged state regulators in letters this week to undertake a broader investigation on planned health insurance rate hikes, as reported today by Duke Helfand in the Los Angeles Times. Last week, Anthem Blue Cross of California withdrew applications to increase rates by up to 39%, after an independent analysis of their rate filings showed several problems, including double-counting and arithmatic errors.
Oversight matters. Anthem Blue Cross' admission of error and withdrawal of the rate hike proposals show why we need regulators to have active oversight over the insurance industry. This review was done under existing law, which provides very limited authority, and it was still able to find basic problems in arithmetic and double-counting. This shows why more extensive oversight is needed, which is why we are calling on regulators to take this next step.
Health Access is calling for a similar independent analysis of rate filings by *all* insurers in both the individual and small group market. The only full evaluation that was done was of Anthem Blue Cross in the individual market. If regulators found significant problems in the one rate filing they looked at, that's reason to look harder at all of them. Anthem Blue Cross didn't even bother to check its math, and there's no reason to think others are different.
Copies of the letters to the California Department of Insurance, and the California Department of Managed Health Care are available on the Health Access website, at: http://www.health-access.org/item.asp?id=31
The letter also urges regulators to take advantage of resources in the federal health reform law to do more vigorous reviews of insurance rates. In addition, Health Access continues to seek more aggressive rate approval authority. We need regulators to take advantage of the new resources to review rate under the federal health reform that passed, and to push for additional rate review and approval authority, as is being considered at both the state and federal levels.
Federal health reform would create health insurance exchanges, where people buying coverage as individuals could join and benefit from group purchasing to negotiate for better prices and value. There are also pending proposals at both the state and federal levels to have rate review and approval authority, especially in the period before 2014 when the exchange come into full effect. * At the federal level, California Senator Feinstein has a proposal to regulate rates at the federal level, especially for states that don't have a rate review process. * California is one of those states that does not have rate review, but there are pending bills. Assemblyman Dave Jones has a rate approval bill, AB2578. State Senator Mark Leno has a bill for insurers to disclose their rate methodology, SB1163.
How well do hospitals help patients regarding the bill?
Earlier today, Health Access California participated in the release of a new hospital survey by Community Catalyst and The Access Project, showing that many hospitals are still not telling patients about financial assistance programs for which they may be eligible. This release follows the enactment of new requirements on nonprofit hospitals, as part of national health reform, to inform patients of financial assistance programs for which they may be eligible.
Yet stronger government oversight is needed to ensure that non-profit hospitals inform patients about patient financial assistance programs for which they may be eligible.
The new report, “Best Kept Secrets,” is based on a national survey of non-profit hospitals conducted by The Access Project in the summer of 2009. The survey found that while most hospitals mentioned the existence of financial assistance programs on either their websites or over the telephone, only about a quarter provided information regarding eligibility for financial assistance. Fewer than half provided a financial assistance application form. A small percentage provided information on their websites that listed the discounts available to people at different income levels.
These findings are comparable to Health Access’ experience with California's groundbreaking Hospital Fair Pricing Act of 2006, which requires hospitals to provide significant discounts to eligible patients and to tell patients how to apply for the discount.
Nearly three years after enactment of the Fair Pricing Act, we here at Health Access still hear regularly from California consumers through our consumer assistance site, http://www.hospitalbillhelp.org/, that hospitals provided inaccurate, incomplete or no information to them about their right to apply for a Fair Price discount.
Health Access' Jessica Rothhaar, the director of our Health Initiative on Overcharging and Underinsurance, reports that many patients are never given the opportunity to apply for a Fair Price discount as required by the law, but simply told that they are not eligible for financial assistance. In others, hospitals tell patients that they are eligible for an “uninsured discount,” but then offer a slightly discounted price that is still substantially higher than the Medicare price to which these patients are legally entitled.
Rothhaar said Health Access tries to work with individual hospitals to get patients the discounts to which they are entitled, and encourages consumers to report violations to the California Department of Public Health, Division of Licensing and Certification. She said Health Access would be working with the state to strengthen oversight and enforcement of the Fair Pricing Act. “Hospital charity care is and will continue to be an important part of our health care safety net,” said The Access Project director Mark Rukavina. “Both federal and state governments must ensure that hospitals receiving tax breaks are also fulfilling their charitable obligations.”
According to Jessica Curtis, director of the Hospital Accountability Project at Community Catalyst, “The report’s findings are disappointing given that hospital billing and collection issues have been closely scrutinized over the last decade by Congress and many state governments.” She added, “It will be important for the federal government to develop regulations establishing very clear standards for tax-exempt hospitals and monitor hospital behavior for compliance.”
Deborah O’Sullivan, who sought care at a hospital in Stockton, found out about the Hospital Fair Pricing Act when she saw a sign in the hospital Emergency Room, but the sign didn’t tell her what the law was or how to apply. When she asked the hospital, they offered her an “uninsured discount” of just 20%. It was not until she looked up the law online that Deborah found and called Health Access. “Health Access told me what the law really says is, that we have a legal right not to pay more than the Medicare rate, because I am uninsured and under 350% of the federal poverty level, so the $7800 they tried to charge me after the “discount” was still too high.” Based on the help from www.hospitalbillhelp.org and Health Access, she applied for the Fair Price discount. "The hospital finally agreed, and we paid them $3,000. If Health Access hadn’t told us the truth, we would still be making payments on that one visit to the ER.”
Assembly Health met today and voted on a number of measures, including AB2110 (De La Torre), a bill sponsored by Health Access California and supported by a number of consumer groups, to say that individuals who buy their own insurance should have a grace period of 50 days in which to pay their premiums. People who are a little late with their payments shouldn't find themselves uninsured and, often, uninsurable. As Assemblymember Hector De La Torre said in presenting the measure, in these tough economic times, people need a little more time to pay their bills. The measure passed 11-4 on a party line vote.
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.
