We've reported on the pending negotiations between the state and federal government around a Medi-Cal waiver, setting the rules and defining the resources available for the program that now covers over 7 million Californians, and will cover two million more under health reform.
Health Access California, which has been a named participant in the Medi-Cal Waiver Stakeholder Advisory Committee and several technical workgroups, has had top three goals we are looking from the waiver: 1) A bridge to health reform, in terms of early enrollment and expansion of coverage; 2) Bringing in new resources to the state of California and particularly funding for the safety-net, so it can survive and prosper under reform; and 3) Providing consumer protections for those in Medi-Cal, especially seniors and people with disabilities who are having their care shifted;
On Jan. 1, 2014, at least two million Californians will become newly eligible for Medi-Cal; but this is not to say that they will magically be enrolled when the ball drops in Times Square. Without carefully laying the proper groundwork, this and other provisions of health reform law won't have their full impact.
How to best make this transition for Medi-Cal, which currently serves more than seven million Californians -- including low-income children, parents, seniors and people with disabilities -- is just one of the key goals through the current negotiations between the state and federal governments over the program's next five years. The stakes are high on these and other issues, all considered as part of discussions around a new Medicaid waiver.
In addition to being ready to expand the program, the waiver is the key vehicle for bringing in new federal funds for California's beleaguered and overstretched safety net of health care providers. After years of running the Medicaid program with the lowest per-patient spending in the country, the state of California is currently requesting an additional $2 billion a year for the next five years from the federal government. Those resources would help our public hospitals and other key providers weather the storm of budget cuts and start to prepare for the many changes under health reform.
Some of those resources will be used to expand county-based initiatives to provide a medical home to low-income adults who now don't qualify for Medi-Cal. The state has proposed that starting next year counties be able to use a portion of the dollars they already spend on indigent care to draw down these new federal funds. Even more exciting than getting hundreds of thousands of Californians care for the first time, these county-based efforts can -- if done right -- serve as a bridge to reform, having all these folks ready to get full Medi-Cal coverage in January 2014.
We need to go further and set an explicit goal to have more than a majority --over one million -- of those newly eligible Californians enrolled on day one. Given that the federal government will pick up 100% of the costs for these newly insured for the first three years, the state of California has every incentive to get people in the door as soon as possible. We would be leaving money on the table in Washington, D.C., if we don't. To prepare, we should implement early expansions of programs that can be shifted to Medi-Cal and start pre-enrolling people early as well. It's an exciting opportunity, but only if we take advantage of it.
The waiver also seeks to change the way care is delivered for some, most particularly seniors and people with disabilities. One proposal would shift such vulnerable populations into more "organized delivery systems," including Medicaid managed care plans. While there is certainly room for improvement for these patients, particularly on coordinating care if it's done right, we need to ensure that the health plans are ready to care for this new population. We need to ensure that doctors' offices can accommodate people with disabilities and that health plans have the adequate number of specialists to meet these patients' specific needs. We need to ensure the transition is smooth for the patient, with no interruptions in care. We are urging that the final waiver include stronger consumer protections for these patients who need them the most.
In short, the waiver is full of both opportunities and challenges. The new federal health law opens new possibilities and potential, and we must make sure that through the waiver, the next five years of Medi-Cal helps fulfill its promise.
Have you visited the new website HealthCare.Gov, which helps explain, in one place the options people have for health coverage--public and private, old and new (and forthcoming under the new federal law)?
You haven't? Waiting for someone to explain the site to you? Or an invitation? Here it is, from the President of the United States:
4 Months After Passage, Health Reform Yet To Cause Apocalypse
Four months after the historic passage of the Patient Protection and Affordable Care Act - our new health reform law, American civilization has not crumbled, and the "crown jewel of socialism" has not destroyed our democracy.
As we've blogged previously, hundreds of thousands of seniors have received Medicare Part D Donut Hole refund checks, small business owners have started to take advantage of tax credits to cover their workers, and so on... still, no apocalypse.
Further evidence of the non-apocalypse was released today in the form of insurance company quarterly earnings. It turns out that as poor li'l big insurance begins to comply with health reform law, they aren't facing financial ruin, they aren't laying off all of their employees, and they aren't leaving their customers any less covered than they already were. WellPoint's second quarter earnings rose 4%, while United Health brought in $1.12 billion dollars. (More here.)
* Many Bills Heading to Appropriations Committee: Last Hurdle Before Final Floor Votes * Multiple Bills Would Implement & Improve Federal Health Reform in California * At Stake Are New Consumer Protections; New Federal Funds; New Rules for Insurers
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Key health consumer protection bills in the California legislature, including several that would implement and improve the federal health reform law passed earlier this year, are heading into their final month of consideration before final floor votes.
Several are being heard next week in Assembly and Senate Appropriations Commitees, which are one of the last legislative hurdles before the final push to pass measures out of the Legislature before the end-of-August deadline. If bills are passed, the Governor has the month of September to either sign or veto the measures.
At stake are bills that would draw down new federal funds, from specific grants for consumer assistance, rate review, and community transformation, to a new Medicaid waiver that is hoped to bring down an additional $2 billion into our beleaguered health care system and safety-net. Other measures would institute new consumer protections and new rules and oversight over insurers.
BELOW is a description of some of the key bills pending. The Health Access website has a bill list of legislation related to implementing and improving health reform, as well as a broader list of bills of interest to health care consumers.
Relevant bills that are up in Senate Appropriations Committee on Monday, August 2nd, at 10:00am. Organizational support letters on these measures are due today, Monday, July 26: * AB 342 (Perez) Waiver * AB 591 (De La Torre) Premium Increase Moratorium * AB 1503 (Lieu) Emergency Physician Overcharging * AB 1602 (Perez) Exchange * AB 2110 (De La Torre) Premium Grace Periods * AB 2244 (Feuer) Kids with Preexisting Conditions * AB 2345 (De La Torre) Preventive Services * AB 2470 (De La Torre) Rescission * AB 2450 (De La Torre) Post Claims Underwriting * AB 2787 (Monning) Ombudsperson (view full agenda here)
Several bills are also up in Assembly Appropriations Committee on Wednesday, August 4th, at 9:00am, with organizational support letters due later this week: * SB 810 (Leno) Single Payer * SB 900 (Alquist) Exchange * SB 1088 (Price) Dependent Coverage * SB 1163 (Leno) Premium Sunshine (view full agenda here)
Among the bills up next week is SB810(Leno), a longstanding bill to establish a universal, single-payer health care system. While Governor Schwarzenegger has vowed to veto the measure (and the financing requires a 2/3 legislative vote), supporters has pressed on in order to continue to present, refine, and organize for the vision of a truly universal health care system.
Many of the other bills seek to fulfill the promise of the new federal law passed earlier this year, including the following measures:
* AB 1602 (Perez) & SB 900 (Alquist/Steinberg) CALIFORNIA HEALTH BENEFITS EXCHANGE: Would establish the California Health Benefits Exchange, which would be a main way for individuals and small businesses to buy coverage and get federal affordability subsidies that will be available starting in 2014. The bills set up governance for this exchange, and allow it to use its bargaining power to negotiate for better prices and values for consumers in the exchange.
** Setting Minimum Standards
* SB 890 (Alquist/Steinberg) TRANSITIONING TO A MORE TRANSPARENT & STANDARDIZED MARKET: Standardizes and simplifies the individual insurance market, so that consumers can understand their coverage choices, make apples-to-apples comparisons, and have the security that coverage does not have hidden loopholes, or lifetime and/or annual caps on coverage. Sets standard of basic health care services for products at both the Department of Insurance as well as the Department of Managed Health Care products.
* AB 1825 (De La Torre) ENSURING MATERNITY CARE: Would require most health plans to cover maternity services.
* AB 1600 (Beall) REQUIRING MENTAL HEALTH PARITY: Would require most health plans to provide coverage for the diagnosis and treatment of a mental illness.
** Federal Medicaid Waiver
* AB 342 (Perez) & SB 208 (Steinberg) MEDI-CAL WAIVER: The state’s 1115 Medicaid Waiver would draw down up to $2 billion in federal funding to expand coverage to new medically indigent populations. The waiver would also move seniors and people with disabilities to Medi-Cal managed Care. The waiver is intended as a bridge between the existing Medi-Cal program and the full access expansion that will happen in 2014 as a result of federal reform.
** Providing Access for Those with Pre-Existing Conditions
* AB 2244 (Feuer) ACCESS AND AFFORDABILITY FOR CHILDREN WITH PRE-EXISTING CONDITIONS: Requires guaranteed issue, eliminates all pre-existing condition exclusions, and limits premium increases based on health status, phasing in modified community rating for children under age 19 in the individual market. Sponsored by Health Access California.
* AB 2470 (De La Torre) REGULATING RESCISSIONS AND MEDICAL UNDERWRITING: Establish standard information and health history questions used by health insurers on application forms, and requires insurers to complete medical underwriting and review for accuracy before issuing an individual a health plan contract or policy.
* AB 2540 (De La Torre) POSTCLAIMS UNDERWRITING: Outlaws and enacts a fine for rescinding, canceling, or limiting of a policy or certificate due to the insurer's failure to complete medical underwriting before issuing the policy or certificate or after a claim has been filed.
*** Regulating Insurer Rates
* AB 2578 (Jones) REQUIRING APPROVAL FOR RATE HIKES: Would require approval by the Department of Managed Health Care or the Department of Insurance of an increase in the amount of premium, co-payment, coinsurance, deductible, or other charges under a health plan.
* SB 1163 (Leno) SUNSHINE ON RATES: Would allow California to draw down new federal funds to institute rate review, to require insurers to disclose their justifications for rate increases.
* AB 591 (De La Torre) RATE MORATORIUM: Would (1) impose a 90-day moratorium on rate increases above average increases in the medical care consumer price index; (2) allow such increases if plans apply to DMHC or CDI to justify such increases; and (3) prohibit insurers from raising rates more than once per 12-month period.
* AB 2042 (Feuer) PROHIBITING MID-YEAR RATE HIKES: Insurers and HMOs cannot change or increase premiums, cost sharing, or benefits more often than once a year. Sponsored by Health Access California.
* AB 2110 (De La Torre) PROVIDING PREMIUM GRACE PERIODS: Would extend the grace period for premium payments from 10 or 31 days up to 50 days for most plans regulated by the Department of Insurance. Sponsored by Health Access California.
** Prevention
* AB 2287 (Monning) PREVENTION & WELLNESS: Would require the state to apply for community transformation grants to support prevention. Federal health reform provides for community transformation grants, a major element of wellness and prevention. These are grants for evidence-based, community prevention activities to reduce chronic disease rates and address health disparities.
* AB 2345 (De La Torre) COVERING PREVENTIVE SERVICES: Requires insurers to eliminate cost-sharing for some preventive services such as pap smears, mammograms, other cancer screenings, and immunizations; continues to permit co-pays and deductibles for managing asthma, diabetes, heart disease, and other chronic conditions.
** Additional Consumer Protections Under Reform
* SB 56 (Alquist) FACILITATING A PUBLIC HEALTH INSURANCE OPTION: Would authorize county-organized health plans and other health benefits programs to form joint ventures in order to create integrated networks of public health plans that pool risk and share networks, subject to the requirements of the Knox-Keene Act.
* SB 1088 (Price) ALLOWING YOUNG ADULTS TO STAY ON THEIR PARENTS’ COVERAGE: Would require group health, dental, and vision plans to allow dependent children to continue on their parents’ coverage through age 26.
* AB 2787 (Monning) FEDERAL GRANTS FOR STATE OMBUDSPERSON PROGRAMS: Establishes the Office of the California Health Ombudsman to educate consumers on their rights and responsibilities with respect to health care coverage, assist with enrollment in health care coverage, resolve problems in obtaining specified premium tax credits, etc.
* AB 1503 (Lieu) EMERGENCY ROOM PHYSICIAN FAIR PRICING: Would limit the amount that emergency room physicians and surgeons can charge an uninsured or underinsured patient with income below 350% of the federal poverty level. Sponsored by Health Access California.
* AB 542 (Feuer) NO PAY FOR NEVER EVENTS: Creates a process for ending Medi-Cal payments for never events (events that should never happen, such as surgery on the wrong body part), and requires insurers to stop paying for never events.
There are more than 570,000 businesses in California that employ 25 workers or fewer. Many of these businesses have struggled to take care of their workers' health care needs because they have been priced out of the market. Our colleagues at Small Business Majority and Families USA released a report yesterday that describes how the new federal health law helps small employers and their workers obtain quality, affordable health coverage.
Key Findings Include:
More than 4 million small businesseswill be eligible to receive a tax credit for the purchase of employee health insurance in 2010.
Approximately 1,198,700 American small businesseswill be eligible to receive the maximum tax credit in 2010.
At the MRMIB meeting yesterday, staff unveiled some new draft materials that they are developing for PCIP, including a supplemental application (intended to accompany the existing MRMIP application) and a summary of benefits document.
Along with the application form (which will be finalized sometime next month) comes a very useful overview that describes the differences between the 2 programs for individuals with pre-existing conditions, the existing high risk pool MRMIP and the new PCIP.
Here's a new video by the California Department of Managed Health Care explaining balance billing and your rights if you have these unfair bills. Take a look!
To date, MRMIB has received 3,000 email inquiries related to applying for PCIP, the new High Risk Pool created as a result of Federal Health Reform Law. 3,000 may seem like a large number, especially considering the short period of time has elapsed since the program’s inception. However, “large” is a relative term, and relative to the potential estimated 300,000+ people in California who need a Pre-existing Conditions Insurance Plan, it’s actually quite small.
But this is not the division that matters most.
MRMIB staff reported that 99% of inquiries received were received electronically, which means only 1% of inquires are from those who may lack access to the internet. As we move forward with implementation of PCIP, the Health Insurance Exchange, and other pieces of federal health reform law, it is important that we heed the digital divide. MRMIB has not demonstrated any interest in expanding outreach for PCIP beyond posting notices on a designated section of their website; and the Administration has indicated that the Exchange may be available online only. Technologies such as the Internet can be a tremendously efficient and convenient way to reach people, but it is important to remember who is being left out of the conversation, and in this case, who is being excluded from these programs.
Communities of color, adults over 60, people with disabilities, and people who live in rural areas are all less likely to have access to the internet, and some studies have shown that the digital divide is associated with worse health outcomes. The state needs to do its due diligence to be inclusive in its outreach efforts and enrollment processes to ensure that these new programs do not institutionally exclude some of the communities that need these programs the most.
There's been a lot of coverage about the departure of Leslie Margolin as the CEO of Anthem Blue Cross of California.
That's too be expected: Anthem Blue Cross became the poster child for bad behavior by insurers during the health reform fight... and the fact that they had to pull back their rate hikes of up to 39% didn't help their image.
That said, this is the California subsidiary of a much larger company--the largest insurer in the nation, and it's unclear how much of the practices we documented at www.sickofbluecross.com, or other issues, are due to one executive.
Nevertheless, hopefully this news development provides the opportunity for the company to start anew. Health reform provide new rules of the road--rules that Anthem Blue Cross opposed, and was the most vigorous in the industry in opposing, both at the state level in 2007, and during the federal debate in 2009.
The question now is whether they will accept the new rules to live by and adopt a new business model, one where they compete on cost and quality--or whether the company pushes against the new oversight, and tries to find new ways to avoid people who actually need care.
From rescissions to rate hikes, from opposition to reform to upstreaming dollars to their corporate parent, Anthem Blue Cross has been traditionally seen as a bad actor in the marketplace. Will they take the opportunity of health reform and new leadership to change that? That's the big question.
Health Access California, the statewide health care consumer advocacy coalition, announced today the results of board decisions on November 2010 ballot measures. Health Access California will supports the measures on State Parks (Prop 21), Repealing Corporate Tax Loopholes (Prop 24) and a On-Time Majority Vote Budget (Prop 25). Health Access California will also opposes measures that would harm health efforts (Prop 22, 26).
This fall, voters will have the opportunity to significantly impact the state budget and consequently, the health care system on which we all rely. Health Access California will work to ensure that voters recognize the impacts on their health and their health system in considering their positions on these ballot measures.
Health Access California took the following positions:
* YES on PROP 21: Proposition 21 not only invests in our state parks, but it also frees up resources to prevent prevent significant cuts to health, education and other vital services. Prop 21 is a win-win, providing Californians with the healthy choices while also helping support our budget and health system.
* NO on PROP 22: By protecting one part of the budget, Proposition 22 puts health, education and other core services at greater risk. This measure does nothing to help our budget crisis, and actually makes it harder to find a solution.
* YES on PROP 24: It was bad enough that last year's budget slashed funding to the health system on which we all rely; to giveaway corporate tax breaks at the same time just added insult to injury. Proposition 24 allows us to repeal those corporate tax break giveaways, helping prevent devastating cuts to health, education and other vital services.
* YES on PROP 25: The current budget process is undemocratic, allowing one-sixth of the legislature to hold up the budget for their own special interest demands. Proposition 25 restores majority rule, so budgets are not held hostage, and community clinics and other services are not left unpaid for months.
* NO on PROP 26: The worst measure on the ballot is Proposition 26, which protects polluters and other corporations from having to pay for the health, environmental, and other damage they cause. Tobacco, oil, insurance, and other companies are backing this measure to protect their profits, at the expense of consumers, our health, and the environment.
Health Access California will be active in the next few months organizing and educating Californians about the budget and health impacts on these initiatives.
Remember the math errors that led Anthem Blue Cross to have to withdraw its rate hikes of up to 39%?
As Duke Helfand of the LA Times reports, those errors were not found by some large firm in a big building with supercomputers humming, but by an individual consultant with a little help, working out of his home.
This only bolsters the argument that we need rate review and rate regulation, as soon as possible. A little bit of oversight goes a long way. It won't take huge resources to set up the rate regulation as envisioned in bills like AB2578(Jones), but it is completely necessary.
From Guest Blogger Molly Mather, Health Access Summer Intern
Today a boisterous crowd gathered in front of the State Building in downtown Oakland to protest the proposed state budget cuts to health care. There was a wide array of faces, both young and old, all urging legislators to raise revenues in lieu of cutting funding to the programs and services that, for many Californians, mean the difference between life and death. The event was one of five budget actions taking place this week as part of a Healthcare vs. Wealthcare Days of Action campaign, sponsored by Health Access and its partner organizations in the HHS Network and other allies.
Five speakers came up to the mic and gave a personal account of why they oppose the cuts. For example, Michelle Rousey, representing people with disabilities, gave a moving account of how for her, six prescriptions a month and 10 doctor visits a year does not even begin to cover the services she needs to maintain her health and independence.
Despite coming from different perspectives and representing different groups, the speakers’ messages were the same: legislators have a clear choice between protecting big oil and corporations and protecting the safety net on which we all rely. I think it’s fair to say that everyone at the rally is hoping and fighting for the right choice.
Karen Smulevitz, of United Seniors of Oakland and Alameda County, pulled the prescription medications she takes every day out of her bag and threw them one by one into the trash, wondering out loud how she would choose between her oral chemo pill for stomach cancer, her multiple asthma medications, and her osteoporosis medications, among others. And of course, no budget protest is complete without someone walking around in a Schwarzenegger mask making “cuts” with an oversized pair of scissors…
If the rally is proof of anything, it is that these cuts are not only opposed by the people that they would personally affect, but by Californians from all walks of life who hope to see the safety net held intact. Even for people who are not at risk of losing access to needed health care and services at this moment in time, it is hard to ignore that the safety net is there for a reason.
The Health Reform Law requires that insurance plans must cover evidence-based prevention services with no cost share to the consumer starting on September 23, 2010.The White House brought out the big guns today, with first lady Michelle Obama and Dr. Jill Biden joining Secretary Sebelius in announcing new regulations that lay out specific requirements for insurers.
The regulations delineate the evidence-based preventive services that must now be offered by new health insurance plans without deductibles, copays, or coinsurance.They include everything from blood pressure screening, cancer screening, cholesterol screening, obesity counseling, and smoking cessation programs, to a wide array of immunizations. (Click here to see the full list.)Research has shown that out of pocket costs contribute to underutilization of these services, and conversely that better coverage of preventive services results in expanded utilization.
“Getting access to early care and screening will go a long way in preventing chronic illnesses like diabetes, heart disease, and high blood pressure…that consume over 75% of the health care spending in this country,” said the First Lady.This is an important first step in redirecting the focus (and spending) in our health care system from taking care of us when we get sick, to keeping us from getting sick.Additionally, preventing chronic disease improves both the health of the individual and of our economy.Chronic disease leads to missed work days and a less productive workforce; and according to numerous studies, the impact of this lost labor is approximately $260 billion a year.
The implementation of this provision will directly impact 41 million Americans starting in September, and 88 million by 2013.
The First Lady also made specific mention of the burgeoning epidemic of childhood obesity, and the importance of early intervention in order to curb devastating long-term impacts.
In Los Angeles, Zocalo Public Square is hosting a convening on, What Health Reform Means for the Economy. I'm one of the five doctors, advocates and academics who have wrote short pieces about health reform for their website (see below). And this Thursday, Zócalo invites the California HealthCare Foundation's Marian Mulkey, Jan Spencley of San Diegans for Healthcare Coverage, Small Business Majority Founder and CEO John Arensmeyer, and Lucien Wulsin of the Insure the Uninsured Project to a panel starting at 7:30pm at NPR West.
Here's my entry:
It’s about security For our health care system, it’s the best of times, and the worst of times. Celebration over the new federal health reform law has been muted because of the crisis of the moment — our economic recession and resulting budget crisis. Governor Schwarzenegger has proposed health cuts that would not just imperil lives and harm our health care system, but would undermine our efforts at an economic recovery. The health cuts would be magnified due to the loss of federal matching funds, and would lead to the loss of over 42,000 jobs in both our health system and our wider communities. Most tax and revenue solutions would have less economic impact, and allow us to preserve these jobs along with basic health and human services.
Thankfully, the new federal law does provide some help. It prevents the state from making the worst of the cuts, and has already started providing new federal dollars in a variety of areas: tax credits to help small businesses cover their workers, $250 checks to seniors trying to afford prescription drugs, grant programs for community clinics, public health efforts, and medical professional training.
Over the next 10 years, California will see over $124 billion from the new law, much of it going directly to low- and moderate-income families to help them afford health care. This not only protects so many of our families from medical debt and bankruptcy, but provides funding and stability to our health system — which is one of our state’s major employers.
The new law will provide new energy for our economy. By preventing health insurers from denying care for pre-existing conditions, we allow a new generation of solo entrepreneurs to start their own businesses without worrying if they can’t get coverage.
At its core, the new law is less about health and more about providing economic security. It guarantees that families can get coverage without having to pay more than a percentage of their income in premiums. And it promises that such coverage will be there when we need it — without loopholes, rescission practices, or annual and lifetime caps that leave people with huge medical debt. This assurance will have profound benefits not just for our families and communities, but provides a stronger basis for economic growth moving forward.
In response to a opportunity for a $1 million grant from the new federal health reform law, Governor Arnold Schwarzenegger submitted a proposal to apply for the money to allow California regulators to better review and publicize health insurance rate increases before they go into effect. Dan Weintraub at HealthyCal.org has more.
This is not an endorsement of the rate regulation legislation by Assemblyman Dave Jones and others, that is currently pending in the state legislature. But it is a first important step to acknowledging that we need more oversight and public scrutiny on insurers. Here's the Governor's press release... but there is more to do to for consumers to have the full protections they need, to make sure that insurance company rates are justified.
California, meet PCIP (that's pronounced P-sip), the Pre-Existing Condition Insurance Plan. The MRMIB Board met today and moved forward with soliciting vendors to administer PCIP, the new option for those denied for pre-existing conditions. The staff presented an aggressive schedule that would have contracts negotiated in the beginning of August so that enrollment can begin sometime in August. A bidders conference will be held July 12 for proposals that will be due July 21st. Contract negotiations are set to begin August 5th. Coverage is still scheduled to begin in September.
MRMIB will be relying on the selected vendor to develop an outreach and marketing plan once they are selected in August. Prior to that, they have no plans for outreach outside of their website and existing partnerships. MRMIB has already received over 1,800 requests for information regarding PCIP applications. Applications are not yet available, but please check the Health Access website or the MRMIB website for updates.
For those who think they may be eligible for PCIP, please review the eligibility criteria and then email FHRP@mrmib.ca.gov with your name, phone number, and address. You will receive notice as soon as applications are available.
HHS cuts typically bring in federal matching funds, so a dollar cut from a health program in the general fund is actually 2-3 dollars cuts from our health system, and our economy. Also, health and human services can't be outsourced, so that money stays in California. And the services directly benefit low-income families, as well as low- and moderate-income workers (from home care workers to nurses to hospital support staff), who all tend to put that money right back in the economy, for buying groceries or paying rent. Health and human services are the best form of economic stimulant, and cuts to these programs are the worst possible choice for our economy.
The HHS cuts would have the impact of eliminating 37,000 jobs in the Bay Area. Compare that to the closing of the NUMMI auto plant, which was the elimination of nearly 5,000 jobs--and even factor in the 30,000+ jobs of various suppliers. Governor Schwarzenegger's health and human services budget is the economic equivalent of of closing another NUMMI auto plant in the Bay Area--and then several more around the state.
As readers of this blog know, Health Access has waged a long fight to eliminate “junk” insurance: insurance that costs less because it does not cover basic health services.
On June 22, the three month anniversary of health reform, the U.S. Department of Health and Human Services released new rules on annual and lifetime limits as well as rescissions and pre-existing condition exclusions.
The new rules on annual and lifetime limits effectively eliminate the junkiest of junk insurance effective September 23 of this year.
The rules require health insurers to cover all minimum essential benefits up to an annual limit of no less than $750,000 effective Sept. 23, 2010, no less than $1.25 million in 2012, no less than $2 million in 2013 and with no annual limits at all in 2014.
What are minimum essential benefits? Doctors, hospitals, lab, radiology, prescription drugs, mental health and substance abuse—and that is exactly what almost everyone thinks of as basic health benefits—except insurers who think that benefits with more holes than Swiss cheese are a good way to make money off unsuspecting consumers.
What does this mean in the real world?
One of the first people we met in this fight was Susan Braig: she was a freelancer who lived in Altadena. When she turned 50, she did what she thought was the responsible thing and bought health insurance. Since her income goes up and down, she bought what she thought was catastrophic coverage.
Then Susan got breast cancer---and her insurance covered virtually none of her care because it was a hospital-only policy and most of her care, from the lumpectomy to chemotherapy and other treatment was outpatient. She ended up tens of thousands of dollars in debt—and unable to get any other insurance because she was medically uninsurable.
Under the new rules, her insurance would have covered all of her care up to $750,000 a year this year---unless it excluded all care for cancer and disclosed this.
Another person we met was a woman who had retired early and opened a wine shop. Being responsible she bought health insurance that her broker told her was just as good as the coverage she had had at her corporate employment. It all went fine until she got bit by a rattlesnake while clearing out her new backyard and found out the insurance did not cover the first day of hospitalization, the only day she needed. The hospital billed her $98,000 for that day of care---fortunately, she found information about hospital discount protections on the Health Access website and negotiated the bill down to less than $10,000---still a lot of money but much more affordable than almost $100,000. Under the new rules, her insurer would have been required to cover all of her care---and presumably would have negotiated discounts with the hospital similar to what she negotiated for herself.
What the new rule means is no more health insurance that is hospital-only or doctor-only or that covers two doctor visits and one day in the hospital and nothing else. It means no more generic-only drug coverage for insurance regulated by the Department of Insurance.
Until 2014, insurers are allowed to exclude all care for a specific condition. That means insurers can continue to exclude prenatal care. That is wrong and Health Access will continue to support AB1825 (De La Torre) which requires maternity coverage and SB890 (Alquist) which requires insurers to cover the same basic benefits that HMOs and PPOs regulated by the DMHC have been required to cover since 1975.
And insurers are allowed to continue to have limits, including limits on visits and hospital stays, on grandfathered plans. Generally in the individual market, a plan is grandfathered if the increase in copays and deductibles is limited and the benefits are not reduced.
But starting September 23, less than six months from now, the annual limit on “minimum essential benefits” including doctors, hospitals, and drugs will be no less than $750,000, phasing out in 2014 when there will be no annual limits.
So adios, sayonara, adieu, good-bye and please never come back to the junkiest of junk health insurance.
The Managed Risk Medical Insurance Board (MRMIB) met yesterday and key to their agenda was the discussion of the new high risk pool. The mood was celebratory as the Board and staff discussed the Governor's signing of the 2 high risk pool bills (AB 1887 and SB 227) on Tuesday. Lesley Cummings, Executive Director of MRMIB stated that now that the bills have been chaptered, MRMIB must move as quickly as possible to make the new high risk pool available to the uninsurable.
The board gave staff direction on moving forward with creation of an application process as well as to adopt eligibility criteria. Staff is also working on soliciting vendors and plans to have a report back to the board in next week's meeting. The stated goal was to open up the application process in August and begin to cover people by September.
Health Access provided comments related to the importance of developing an outreach and marketing plan. MRMIP, the state's existing high risk pool has never been advertised, but we feel that it is important to start getting out the word that help is available for those who have been denied insurance coverage due to preexisting conditions. MRMIB will use their website, www.mrmib.ca.gov as an information hub for updates related to the high risk pool. Interested individuals should send an email with their name, address, and telephone number to FHRP@mrmib.ca.gov and you will be notified as soon as the application is available.
This information is also available on the new national health information website, at www.healthcare.gov.
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.
