Within the same 24 hours of the Governor's signing of the first-in-the-nation bills to set up a new health insurance exchange, California received a $1 million grant from the federal government to start planning and set-up of this new, one-stop shop for health insurance consumers.
The U.S. Department of Health and Human Services (HHS) awarded $1 million to California, as part of grants to help 48 states and the District of Columbia plan for the establishment of health insurance exchanges. A key part of the Affordable Care Act, starting in 2014, health insurance exchanges – new, competitive, consumer-centered private health insurance marketplaces – will put greater control and greater choice in the hands of individuals and small businesses.
Americans will have the same health care choices as members of Congress – who will also purchase coverage through the exchanges. Individuals and families purchasing health insurance through exchanges may also qualify for tax credits and reduced cost-sharing depending on their income.
According to the Health and Human Services Department website, the $1 million grant will be administered by the California Health and Human Services Agency, and will be devoted to: * Establish an Exchange Board and recruit key staff. * Analyze the current public and private insurance markets. * Convene stakeholders and the general public to gather input. * Develop a multi-year plan for Exchange planning tasks. * Collect data on the demographics of the current and projected population, profiles of insurance markets offering coverage in California and estimates of how the Affordable Care Act will change the number of uninsured Californians.
Right now, individuals and small businesses are all alone at the mercy of the big insurers. The potential of the exchange is to level the playing field between consumers and insurers, providing easy-to-compare plans, credits and subsidies to afford coverage, and the bulk purchasing power of millions of Californians.
The signing of the bills starts this process. The grant helps fund it and get it going. Well timed!
Earlier today, Governor Arnold Schwarzenegger vetoed both AB1825(De La Torre) to require maternity care as a basic benefit, and SB890(Alquist), a patient protection measure that would have helped consumers avoid "junk" coverage by setting some key standards for health coverage, and better categorizing the health insurance market for better comparison shopping. The bill would have conformed state law to the new federal health law in key areas, ensuring Californians benefits from these new consumer protections.
* MATERNITY COVERAGE: AB 1825, by Assemblyman De La Torre, would have phased in a requirement for all health insurance plans to cover maternity care. Plans would have been required to have maternity coverage, but until 2014 they can impose a one-year waiting period. This measure would have helped provide equity for women trying to buy coverage, save the state money by preventing women from having to rely on public programs for maternity benefits, and crucially help provide the public health benefit of getting babies the prenatal and early care coverage needed to live healthy and productive lives.
* AVOIDING "JUNK" INSURANCE: SB 890 by Senator Alquist would have reformed the individual insurance market, by setting basic benefit levels and classifying health plans in tiers (Platinum, Gold, Silver, Bronze) to allow consumers better ability to make apples-to-apples comparisons based on actuarial value, so that consumers can have some idea of how much of their medical costs they may need to pay out-of-pocket with different health plans.
The bill would have helped the California implement and transition to federal health reform in other ways as well: * by instituting the new federal requirements on medical loss ratios, to ensure that premiums dollars go to patient care rather than administration and profits; and * by eliminating annual and lifetime caps on coverage that cause individuals with serious illnesses to incur significant medical debt.
While the Governor signed important bills to implement federal health reform today, we are disappointed he vetoed key patient protections as well. He vetoed a bill to phase in maternity coverage as a basic benefit, to provide equity to women and savings for the state,
We are also saddened that he vetoed SB890, which would have helped prevent consumers find out too late that they have junk insurance that doesn't cover their health costs. It was needed to implemented health reform by eliminating annual and lifetime caps on coverage, and by ensuring premium dollars go to patient care rather than insurer's administration and profit. Categorizing plans based on actuarial value will allow consumers to make apples-to-apples comparisons and to have some idea of how much they will be responsible for paying out-of-pocket.
Right now, consumers are flummoxed by the over 100 choices in the individual insurance market, and rightly concerned that some of those choices won't cover them when they need it. California lost an important opportunity to transition to a standardized and transparent marketplace for health insurance.
He vetoed the bill by Assemblyman De La Torre on requiring maternity coverage as part of a basic benefit package. We are awaiting news of SB890, by Senator Alquist, to help consumers avoid "junk" health insurance.
So no child can be denied or priced out of coverage..
Earlier today, Governor Schwarzenegger signed a bill, AB2244(Feuer) to help ensure access and affordability for coverage for children, especially those with pre-existing conditions. This bill directly counters the recent decisions of some California insurers suggesting that they won't sell coverage to children in the individual market.
This new law would bar insurers from the lucrative individual insurance market who seek to discriminate by denying children coverage. We are pleased that the Governor took the opportunity of this bill on his desk to help bring the insurers back in line. Because of federal health reform and this new law working together, California children will be able to get the coverage they need.
The law would ensure that all children have access to coverage--and that children with pre-existing conditions also have some limit on what they cacn be charged. This not only implements the new federal health law, but it also improves upon it by ensuring affordability, and allowing for a smoother transition to the additional reforms in 2014.
AB2244, by Assemblyman Feuer and sponsored by Health Access California, would do three things: * It would conform state law to the new federal requirement that insurers not deny children for pre-existing conditions. * It would also limit the premiums paid by children with pre-existing conditions from being more than twice what other children pay for the same insurance policy, if they sign up within an annual open enrollment period. * Finally, if an insurer decides not to sell child-specific insurance as of the effective date--January 1, 2011, that insurer would be barred from selling new plans in the individual insurance market--a lucrative market--for five years.
An analysis of AB 2244 states that the bill could save the state millions of dollars, as kids currently covered by public insurance move to the private insurance market.
Anthem Blue Cross, Aetna and other insurers would rather deny coverage to all children than have to cover some that happen to have pre-existing conditions. These decisions by some health insurers show the need for the new federal law and for additional oversight like this law. Hopefully, this new law not only brings insurers back into the market, but gets them to think about moving away from their business model focused on avoiding and denying those who need care, and to one where they compete on cost, quality, prevention, and efficiency.
Earlier today, Governor Schwarzenegger signed two key bills to set up a new health insurance exchange, allowing California to be the first state in the nation to take this central step of implementing the new federal health reform law.
AB 1602 (Perez) and SB 900 (Alquist/Steinberg) are companion bills. The bills establish a new health insurance Exchange as required by the federal health reform law. In 2014, the new Exchange will be the new one-stop shop for getting health coverage for individuals and small businesses, both providing easy-to-compare choices, access to federally-funded subsidies to make coverage affordable, and the bulk purchasing power (similar to large employers or CALPERS) of millions of Californians to bargain for the best price and value.
Californians should be proud of this first-in-the-nation measure to implement health reform by setting up a new exchange, which will be a one-stop shop for consumers to easily compare plans and purchase health coverage, and get subsidies to ensure affordability. Many states are moving with determination to set up their exchanges in early 2011, but our legislative calendar required us to move quicker. With the signing of this bill, Californians will be positioned to be ready on day one to take advantage of billions of dollars in new tax credits and subsidies to help families and small businesses afford coverage.
The bills allow millions of Californians to pool together to bargain for the best price and value with the insurance industry, as opposed to the current individuals market where consumers and small businesses are left all alone at the mercy of the big insurers. Those insurers who opposed these bills profit from the status quo; This gives new power to consumers and small businesses.
This is a big step to a better health care system.
An estimated 3-4 million or more Californians who will be eligible to participate in the exchange starting 2014 (and more in future years as larger employers are allowed to join in).
AB1602(Perez) sets up the exchange. SB900(Alquist/Steinberg) sets up its governance. SB900 has passed both the Assembly and the Senate, and heads to the Governor's desk. AB1602 has passed the Senate and goes to the Assembly for concurrence, before also heading to the Governor's desk.
GOVERNOR SIGNS LIEU BILL TO LIMIT EMERGENCY ROOM DOCTOR CHARGES FOR THE UNINSURED
GOVERNOR VETOES PATIENT PROTECTIONS, Including * AB1600(Beall), to Require Mental Health Parity in Health Coverage * AB2042(Feuer),to Limit Rate Hikes and Changes to Once a Year * AB542(Feuer), to Prevent Medi-Cal Payment for "Never Event" Medical Errors * AB2540(De La Torre) on Increase Fines for Rescissions * SB56(Alquist), to Foster New Public Health Insurance Options
KEY HEALTH REFORM BILLS LEFT on the Governor's Desk, Still Pending for Final Day: * AB1602(Perez) & SB900(Alquist), to Create a New Health Insurance Exchange * SB890(Alquist), to Categorize Benefits to Allow for Better Comparisons of Plans * AB1825(De La Torre), to Phase-In Maternity Coverage as a Basic Benefit * AB2244(Feuer), to Limit Premiums for Children with Pre-existing Conditions * AB2470(De La Torre) on Eliminating Rescissions * SB1088(Price), to Allow Young Adults Up to Age 26 To Stay on Parental Coverage * SB1163(Leno), to Provide 60 Day Notice and Transparency on Rate Hikes * AB2345(De La Torre), to Eliminate Cost-Sharing for Preventative Care
The Governor has begun to sign and veto the patient protection bills on his desk, including over a dozen measures to implement and improve upon the new federal health law. He has one last day, until the end of today, Thursday, September 30th, to make final decisions on whether to sign or veto the pending legislation.
A list of the measures related to implementing federal health reform, and how they fared in the California Legislature, is available on the front page of the Health Access website.
GOVERNOR SIGNS AB1503(Lieu) TO PREVENT UNFAIR CHARGES BY EMERGENCY ROOM DOCTORS FOR THE UNINSURED: Governor Schwarzenegger signed one key patient protection yesterday, AB 1503, sponsored by Health Access California. The bill provides consumer protections to ensure uninsured and underinsured patients are charged fair prices for emergency physician services. The bill would require physicians who provide emergency medical services in hospitals to implement a discount payment policy, including a limited rate, for financially qualified patients. The bill would also place limits on the collections activities of these physicians.
These protections are needed because emergency room patients are not in a position to shop around or bargain for the best price. These first-in-the-nation fair pricing consumer protections ensure that self-pay emergency room patients pay a fair price. Just like with hospital bills--an issue addressed in earlier legislation in 2006--uninsured patients shouldn't have to pay significantly more than what is billed to other payers and insurers, as has often been the case.
THE GOVERNOR'S VETOES: The Governor also vetoed several bills yesterday, including the following:
* MENTAL HEALTH PARITY: AB1600, by Assemblyman Beall, would have required mental health parity in private coverage. The bill would have ensured that patients should be covered for mental health similarly to how they are covered for physical health, and provided a smoother transition to the minimum benefit standards under federal health reform in 2014. See veto message.
* LIMITING RATE HIKES TO ONCE A YEAR: AB2042, by Assemblyman Feuer, and sponsored by Health Access California, would have limited health plans from raising rates or changing premiums, cost-sharing, or benefits to once a year. The bills were intended to provide stability to patients who want to know their premiums don't change mid-year, and thus mess up their budget. See veto message.
* JOINT VENTURES AND PUBLIC HEALTH INSURANCE OPTIONS: SB56, by Senator Alquist, would have fostered new public health insurance options by allowing county-based Medicaid managed health care plans (such as Alameda Alliance for Health, LA Care, and San Francisco Health Plan) to enter into joint ventures, offer broader provider networks, and be viable choices in the marketplace. See veto message.
* FINES FOR RESCISSION: AB2540, by Assemblyman De La Torre, would have increased fines 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. Still pending is the other bill by Assemblyman De La Torre that curtails the practice of rescission itself. See veto message.
* MEDICAL ERRORS: AB542, by Assemblyman Feuer, would have set up a process toward the goal that Medi-Cal would no longer pay for "never events," major medical errors that should not "never" happen--like surgery on the wrong body part. This bill was intended to encourage providers to set up systems that prevent such errors before they occur. See veto message.
In most of the veto messages, the Governor suggested that the bill was unnecessary and the objective of the measure could be accomplished in another way and sometimes better. Health and consumer advocates have said they are committed to continue to work, with this Governor and with whoever the next Governor is, on these issues: ending rescission, to reducing adverse events and medical errors, to expanding the role of Medicaid managed care plans, and to reviewing rate hikes annually.
KEY BILLS STILL PENDING. Announcements on the following key patient protections measures--including those that would celebrate their passage to date-- are due by the end of today. They include:
Creating a Consumer-Friendly, Transparent Health Insurance Market
* CREATING A NEW EXCHANGE WITH BARGAINING POWER: AB 1602, by Speaker Perez and SB 900, by Senate Health Committee Chair Alquist and Senate President Pro Tem Steinberg are complementary measures that establish a new health insurance Exchange, a core element of the new federal health reform law. In 2014, the new Exchange will be the new one-stop shop for getting health coverage for individuals and small businesses, both providing easy-to-compare choices, access to federally-funded subsidies to make coverage affordable, and the bulk purchasing power (similar to large employers or CalPERS) of millions of Californians to bargain for the best price and value.
Without an exchange, individual consumers are at the mercy of the big insurers, without any purchasing power, in a complex and confusing marketplace. A new, independent exchange can dramatically improve the way Californians individuals and small businesses get coverage—making such decisions easier, more understandable, and more affordable. With over 4 million Californians eligible to participate in the exchange in 2014 (and more later), these bills begin a process to ensure a new exchange is ready to help patients and draw down federal subsidies on day one. AB1602 establishes the new, indepedent agency; SB900 set ups its governance, as a 5-member board to be appointed by the Governor and Legislature.
Setting Minimum Standards
* TRANSITIONING TO A MORE TRANSPARENT AND COMPARATIVE MARKET: SB 890 by Senator Alquist, would reform the individual insurance market, by setting basic benefit levels and classifying health plans in tiers (Platinum, Gold, Silver, Bronze) based on actuarial value. This would allow consumers better ability to make apples-to-apples comparisons, so that consumers can have some idea of how much of their medical costs they may need to pay out-of-pocket with different health plans.
The bill helps California implement and transition to federal health reform in other ways as well: * by instituting the new federal requirements on medical loss ratios, to ensure that premiums dollars go to patient care rather than administration and profits; and * by eliminating annual and lifetime caps on coverage that cause individuals with serious illnesses to incur significant medical debt.
* MATERNITY COVERAGE: AB 1825, by Assemblyman De La Torre, phases in a requirement for all health insurance plans to cover maternity care. Plans would be required to have maternity coverage, but until 2014 they can impose a one-year waiting period. This measure starts to provides equity for women trying to buy coverage, saves the state money by preventing women from having to rely on public programs for maternity benefits, and crucially helps provide the public health benefit of getting babies the prenatal and early care coverage needed to live healthy and productive lives.
Providing Access, Including for Those with Pre-Existing Conditions
* ACCESS & AFFORDABILITY FOR CHILDREN WITH PRE-EXISTING CONDITIONS: AB 2244, by Assemblyman Feuer, implements the federal prohibition on denying coverage to children with pre-existing conditions, and limits the amount that insurers can charge to cover those children. While the federal health law takes a crucial first step this September, by prohibiting insurers from denying coverage to children with pre-existing conditions, this state bill would take another step in making reform real, by also limiting how much insurers can charge children with pre-existing conditions, within an open enrollment period. The measure would also bar those insurers not selling child-only products from selling new products in the full individual market for five years.
Federal law will prohibit such premium differences in 2014, but this bill phases in this affordability help sooner, and provides a smoother glide path for California's market to transition. Proponents say the bill would save tens of millions in the state budget, giving families the opportunity to buy private insurance rather than having them fall onto public health coverage programs.
* ELIMINATING RESCISSIONS: AB2470, by Assemblyman De La Torre, would help implement health reform by seeking to eliminate rescissions, so patients don't have their coverage yanked away at the time when they most need it. The bill would standardize the process of underwriting and asking about pre-existing conditions when accepting subscribers in the first place, and require regulatory approval for any insurer seeking to retroactively deny coverage due to fraud. This is an important protection in the interim until 2014, when insurers will be required to take patients without regard to pre-existing conditions.
Other Consumer Protections
* REQUIRING 60-DAY NOTICE AND TRANSPARENCY ABOUT RATE HIKES: SB 1163, by Senator Leno, would require insurers to make information public about premium increases, available for review not just by the regulator but by the public on the insurers’ and regulators’ websites. The bill would also require insurers give 60 days notice to consumers and to the public before raising premiums. Currently, this information is not public, even the notice of a rate hike: insurers only need to give 30 days indication to subscribers, and there is no public notice requirement. This bill expands California regulators' authority, especially at the Department of Managed Health Care, to review rate information and better take advantage of the new federal funding available.
* YOUNG ADULT COVERAGE: SB1088, by Senator Price, would implement the federal health law that allows young adults up to age 26 to stay on their parents' group coverage.
* PREVENTATIVE CARE: AB 2345, by Assemblyman De La Torre, would implement the federal health law by requiring insurers to eliminate cost-sharing for some preventive services such as pap smears, mammograms, other cancer screenings, and immunizations.
The passage of this legislation is an important step toward establishing California as a leader in the implementation of health care reform. If the Governor signs these bills into law, California consumers will begin to benefit from some of the provisions of the federal law as well as some state-only improvements.
A new report by Health Access California documents the new patient protections in place as a result of the new federal health law, as well as additional changes that are coming online from both the federal government and from California-specific implementation efforts, including potential pending state legislation now on the Governor's desk.
The day's big victory was the signing of AB 1503 (Lieu) to limit emergency room doctor overcharges. The bill would require physicians who provide emergency medical services in hospitals to implement a discount payment policy, including a limited rate, for financially qualified patients. The bill would also place limits on the collections activities of these physicians. AB 1503 is part of a larger fight that Health Access has waged on behalf of uninsured consumers being overcharged for hospital care and other medical services far in excess of what insurance companies or insured consumers are charged.
The bills vetoed by the Governor today include some measures that would have improved upon federal reform by phasing in mental health coverage, and facilitating public health insurance options. The 5 bills vetoed are:
* MENTAL HEALTHPARITY: AB1600, by Assemblyman Beall, requires mental health parity in private coverage. The bill would have ensured that patients should be covered for mental health similarly to how they are covered for physical health. This bill would have saved Californians money, treating mental health issues before they get worse and become a burden on our safety-net.
* LIMITING RATE HIKES TO ONCE A YEAR: AB2042, by Assemblyman Feuer, and sponsored by Health Access California, would limit health plans from raising rates or changing premiums, cost-sharing, or benefits to once a year. This bill would have provided stability to consumers in this time of economic hardship, allowing families to budget and plan their finances knowing that their premiums would not change multiple times a year.
* JOINT VENTURES AND PUBLIC HEALTH INSURANCE OPTIONS: SB56, by Senator Alquist, would foster new public health insurance options by allowing county-based Medicaid managed health care plans (such as Alameda Alliance for Health, LA Care, and San Francisco Health Plan) to enter into joint ventures, offer broader provider networks, and be viable choices in the marketplace. This would have provided California consumers the option of getting coverage without being at the mercy of private insurance companies.
* FINES FOR RESCISSION: AB2540, by Assemblyman De La Torre, would increased fines 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.
* MEDICAL ERRORS: AB542, by Assemblyman Feuer, would have set up a process toward the goal that Medi-Cal would no longer pay for "never events," major medical errors that should not "never" happen--like surgery on the wrong body part. This bill was intended to encourage providers to set up systems that prevent such errors before they occur.
In most of the veto messages, the Governor suggested that the bill was unnecessary and the objective of the measure could be accomplished in another way. While we thought all these bills were worthy of our support, we will continue to pursue progress on these issues with this Governor, who has engaged on these broader issues: from ending rescission, to reducing adverse events and medical errors, to expanding the role of Medicaid managed care plans, and to reviewing rate hikes annually. We will pursue these objectives with this Administration in its remaining months—and to press ahead with the next Governor whoever that is.
We continue to await the Governor's actions on key bills such as AB 1602 (Perez) and SB 900 (Alquist) that would make California the first state to create a health insurance exchange after the passage of health reform law.
Under federal health law, #32.2 million announced for more CA providers in CA...
HHS Secretary Kathleen Sebelius has announced $320 million in grants under the Affordable Care Act (ACA) to strengthen the health care workforce--with $32.2 million of the grant funding in California.
$27.2 million in California will go to improve and expand the primary care workforce under the Prevention and Public Health Fund of the Affordable Care Act. Also, another $5 million in Health Profession Opportunity Grants will provide low-income individuals with education, training and supportive services that will help them prepare to enter and advance in careers in the healthcare sector.
The programs are designed to build the primary care workforce and provide community-based prevention. California and other states will receive funding to support comprehensive workforce planning and implementation strategies that best address local current and projected workforce shortages.
California grantees include:
For Advanced Nursing Education Expansion: * Western University of Health Sciences, Pomona, $1,056,000
Expansion of Physician Assistant Training Program * University of Southern California, Los Angeles, $704,000 * Riverside Community College District/Moreno Valley Campus, Moreno Valley, $2,117,808 * Samuel Merritt College, Oakland, $1,232,000
Nurse Managed Health Clinics * The Regents of the University of California, San Francisco, $1,497,320 * Tides Center - Women's Community Clinic, San Francisco, $1,459,366
Personal and Home Care Aide State Training Program * Board of Governors, California Community College, Sacramento, $749,960
Primary Care Residency Expansion * Regents of the University of California, Davis, $1,920,000 * Regents of the University of California, La Jolla, $2,880,000 * Catholic Healthcare West/St. Mary Medical Center, Long Beach, $1,920,000 * The Regents of the University of California, Los Angeles, $1,920,000 * Children's Hospital & Research Center, Oakland, $3,840,000 * ...and three grants to the Regents of the University of California, San Francisco, each at $1,920,000
State Health Care Workforce Grants: Planning * California Department of Employment Development, Sacramento, $150,000
California is also getting another $5 million in Health Profession Opportunity Grants, administered by the Administration for Children and Families’ Office of Family Assistance, as part of 32 grants to entities in 23 states. These grants will provide low-income individuals with successful training programs for a variety of healthcare professions, including: home care aides, certified nursing assistants, medical assistants, pharmacy technicians, emergency medical technicians, licensed vocational nurses, registered nurses, dental assistants, and health information technicians. The $5 million grant is going to the serve TANF Recipients and Other Low-Income Individuals through the San Diego Workforce Partnership, Inc.
Another day went by with Governor Schwarzenegger signing and vetoing various bills, but none of the patient protection measures related to health reform.
We did see full-page ads--we suspect funded by some insurers--in the Sacramento Bee and Los Angeles Times signed by the Chamber of Commerce and NFIB against the two bills to set up a health insurance exchange.
I understand why an insurer like Anthem Blue Cross might be opposed, not wanting an exchange that would have real bargaining power to negotiate with them for the best price and value for individual consumers and small business. Jon Cohn in The New Republic sees why as well, and thinks that is a good reason to support the bills.
But why the business groups? Some insurers are members of the Chamber of Commerce, but their position seems to counter the interests of the rest of their membership. After all, the exchange will give small businesses the purchasing clout that only large employers have now--and will be the place where small business can access tax credits to better afford coverage for their workers. Micah Weinberg of the New America Foundation has more, as he cites the support of employer groups from Small Business Majority and the Pacific Business Group on Health.
We have two days to find out what the Governor will do.
In tonight's California gubernatorial debate, there wasn't a single word devoted to health care. Not from the journalists, and not brought up by the candidates. Not about health care cuts. Not about regulating insurers. Not about implementing health reform...
Health care is a primary responsibility of the states, and is an area where Governor can have their biggest impacts. Health care is the second biggest part of the California budget--second only to education. Insurance regulation has been entirely an issue overseen at the state level, until this year.
The next Governor of California will have the significant challenge and opportunity to improve our health system, under the new federal health law--but it will be up to them to maximize federal funds coming to our state, and be aggressive in the oversight over the insurers and the industry.
California has one of the worst health crises in the country, with one of the largest percentage of uninsured, of people not getting coverage through work, and of people being denied for pre-existing conditions. The federal health law will provide some direct relief, but to do so it will require a thoughtful implementation.
Here's hoping future debates provide thoughtful questions and answers about this key area.
Assembly Health Chair Monning on the bills on the Gov's desk...
Monday, September 27, 2010
In last week's Democratic weekly radio address, Assemblymember Bill Monning (D-Carmel), Chair of the Assembly Committee on Health, made the case for why Governor Schwarzenegger should sign bills that will enact federal health care reforms in California.
Hello, this is Assembly Health Committee Chair Bill Monning.
For Californians concerned about health care – and all of us are -- September 23rd marked an important day.
That’s the day key consumer protections from federal health reform went into effect.
These protections include allowing your kids to stay on your coverage until their 26th birthday, guaranteeing that all children can be offered health insurance regardless of a pre-existing condition they may have; and guarantees no co-pays or deductibles for several important preventive services, such as smoking cessation services and immunization.
Assembly Democrats have authored bills making sure several of these protections will be the law of the land in California – if the Governor signs the bills.
One critical piece of legislation to protect consumers and small businesses is AB 1602, authored by Assembly Speaker John Pérez, to create the California Health Benefits Exchange. I’m proud to be a co-author on this bill.
The Exchange will be the consumer friendly marketplace where individuals and small businesses can easily understand their insurance choices and costs and, most importantly, where they can claim their federal premium subsidies and tax credits to buy affordable coverage.
In establishing the Exchange, California is positioning itself to help working people and small businesses draw down several billion dollars in available federal tax credits and for the first time, giving them the purchasing power of very large employer groups.
In a state with the most uninsured and underinsured, where close to 2 million people lost their job-based coverage in the last two years because of the recession, AB 1602 is a major step forward for all Californians.
Governor Schwarzenegger has an important decision to make.
He can sign vital bills to protect Californians against the insurance company abuses that have become far too common in our state.
Or he can side with the tea partiers and far right Republicans who have no solutions to our health care crisis other than to say no.
It’s time the governor heard from Californians who are literally sick and tired of the health care status quo.
Let the governor know you want him to move forward with health care reforms because no Californians should have to go broke just to stay healthy.
This is Assembly Health Committee Chair Bill Monning. Thank you for listening.
As health care consumers got new patient patient protections effective this week--the six-month mark from passing the Patient Protection and Affordable Care Act, health care and consumer advocates are awaiting whether Governor Schwarzenegger will allow California to take the next steps, by signing key bills on his desk to implement and improve upon federal health reform.
The Governor had over 750 bills sent to him by the Legislature this year--and he has less than a week to sign or veto, by the deadline of September 30th.
Because of his trip to Asia and an ailment, the Governor didn't even start going through the bills on his desk until yesterday, when he released his first batch of signatures and vetoes. This batch did not include any of the health reform-related measures.
What's at stake? The Governor can sign laws that conform state law to the new federal rules, but also laws that go beyond the federal minimums, and that go early, so more Californians can benefit.
If the Governor signs the bills to set up an exchange, AB1602/SB900, California can be ready on day one for families and small businesses to take advantage of federal funds to better afford coverage. The Governor pledged earlier this year to work to implement the federal health reform law to maximize the benefit for Calfornians, including setting up a new health insurance exchange, and he should seize the opportunity with the bills on his desk.
With his pen, the Governor has the power the ability to ensure more access for children to get coverage, and more affordability for those with pre-existing conditions. The Governor can also ensure that maternity coverage and mental health benefits are part of basic insurance plans, and are phased in early.
With consumers just starting to see the results of additional oversight on insurers, which has been desperately needed, there is much more is left to do, to implement and improve reform, so we can fulfill the promise of the law. Our Governor should build upon the foundation of the federal law, and sign the pending legislation to take advantage of the law's opportunities, from early adoption of consumer protections and coverage options, to ensuring that Californians know their new rights and options.
For more information on the bills, check out the new report by Health Access California documents the new patient protections in place as a result of the new federal health law, as well as additional changes that are coming online from both the federal government and from California-specific implementation efforts, including the potential pending state legislation now on the Governor's desk.
In noting the six-month anniversary, here are a couple of "blog carnivals" that compile and highlight dozens of blog posts relevant to health reform, its impact and implementation.
Anthem Blue Cross, Aetna and other insurers are holding children hostage in their attempts to weaken new federal patient protections. Some insurers would rather deny coverage to all children than have to cover some that happen to have pre-existing conditions.
That's why we need Governor Schwarzenegger to sign pending legislation to counter these anti-child decisions by insurers. AB2244 would bar insurers from the lucrative individual insurance market who seek to discriminate by denying children coverage. The Governor has the bill on his desk to fix this problem, and bring the insurers back in line.
These decisions by some health insurers show the need for the new federal law and for additional oversight. Insurers need to move away from a business model focused on avoiding and denying those who need care, and to one where they compete on cost, quality, prevention, and efficiency.
AB2244, by Assemblyman Feuer and sponsored by Health Access California, would conform state law to the new federal requirement that insurers not deny children for pre-existing conditions. It would also limit the premiums paid by children with pre-existing conditions from being more than twice what other children pay for the same health policy, if they sign up within an annual open enrollment period. Finally, if an insurer decides not to sell child-specific insurance, that insurer would be barred from selling new plans in the individual market for five years.
An analysis of AB 2244 states that the bill could save the state millions of dollars, as kids currently covered by public insurance move to the private insurance market.
HEALTH ACCESS UPDATE Wednesday, September 22, 2010
SIX MONTHS SINCE PASSAGE OF NEW HEALTH LAW, CALIFORNIANS BEGIN TO BENEFIT FROM NEW PATIENT PROTECTIONS
* New Health Reform Six-Month Status Report Documents How New Federal Law Is Impacting Californians, with Major Provisions Coming Into Effect Sept. 23rd
* Key Bills Pending on the Governor's Desk to Implement and Improve the Federal Law
Health Access Roundup: Troubling New Census Data; Governor Signs Hospital Fee Legislation; Major PacifiCare Fines; Protesting for a Fair Budget at the Capitol; Happy Birthday to the DMHC; and More... Read Our Health Access Blog for More Updates.
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Tomorrow, September 23, 2010, marks six months since President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA), a historic comprehensive federal health care reform law.
A new report by Health Access California documents the new patient protections in place for California consumers as a result of the new federal health law. The report includes those new consumer protections and option that are coming into effect as a result of the six-month mark since the federal law's enactment on September 23rd, and from California-specific implementation efforts, including potential pending state legislation now on the Governor's desk. For a copy of this six-month status report on the implementation of health reform in California, go to the Health Access website at: http://www.health-access.org/files/advocating/Health%20Care%20Reform%206%20Month%20Status%20Report%209-21-10.pdf
Several patient protections and other elements of that federal law begin to take effect on September 23. The six-month mark also provides an opportunity to review how California consumers are beginning to benefit, what new patient protections are in place or coming soon, and how California is proceeding with efforts to implement and improve upon the new federal law.
Over the next ten years, the new Affordable Care Act will put in place policies to provide new consumer protections and new oversight and rules for insurers; make coverage affordable for individuals, families, and small businesses; and encourage efforts to tame the costs of health care, with benefits for both our economy and our federal deficit.
Some provisions began immediately, many others take effect on September 23, and additional benefits will become available through 2014, when the bulk of reforms are instituted.
Californians are already beginning to feel the effects of reform, including getting additional consumer protections from the most abusive insurance company practices; feeling more secure about their current coverage; and receiving financial assistance to afford coverage for early retirees, seniors, and small businesses. Patients with pre-existing conditions--including children and adults--will have more option and access to coverage starting this month.
The report also details the dozen-plus bills recently passed by the California State Legislature and pending on the Governor's desk that would both bring state law into compliance with PPACA, and in some cases extend consumer protections and benefits beyond federal requirements. In addition to reflecting the unique needs of the state and the support for more robust reform, certain elements may serve as models for other states beginning the process of implementing PPACA.
* To read more about the pending bills on the Governor’s desk, click here. Please take a minute to call the Governor today to ask for his signature on the bills to set up an exchange (AB1602/SB900) and other important health reform measures. Call his office today at (916) 445-2841. Press 0 to bypass the automated message and speak with a live person.
* Governor Schwarzenegger did sign one health bill last week, AB1653 (Jones) which moves California closer to claiming more federal dollars for the state’s health care system. The additional federal funds for health care will be used to increase Medi-Cal payments for hospitals. * Alarming data released this month by the U.S. Census Bureau show troubling increases in both poverty and uninsurance, with over 43 million people live in poverty, and over 50 million uninsured, the most ever to be recorded. Click here to read a more in-depth summary.
* PacifiCare was cited for almost one million infractions and fined up to $9.92 billion. Infractions include mismanaging medical claims, refusing to pay for covered benefits, losing thousands of patient records, and failure to pay claims to doctors. Read the update.
With all the talk about the implementation of health reform this week, you might want a primer on what the health reform law actually does. It's an effort at an even-handed description of the Patient Protection and Affordable Care Act, narrated by news commentator Cokie Roberts:
And in terms of conveying the overall structure and philosophy of reform, I think is still the best five minutes on the subject: http://www.youtube.com/watch?v=B1DgGzVtdMQ
It's not a surprise that Dan Walters in the Sacramento Bee has a negative column about some of the health care bills on the Governor's desk. He railed against Governor Schwarzenegger's attempts at reform in 2007. But he was wrong in his analysis then, centering his criticism on how such reforms would be struck down by the courts. (And in fact when the similar Healthy San Francisco was upheld by the courts, the event went unnoticed by columnist Walters).
What is surprising was how much Walters simply copied talking points from Anthem Blue Cross and the Chamber of Commerce--and how he got basic facts just utterly wrong in the process, revealing a disturbing lack of basic fact-checking. In referencing two bills to implement the new federal health law, SB900/AB1602, that set up a new health insurance exchange, a new one-stop marketplace for consumers to connect with coverage, Walters states the exchange would take over Medi-Cal--which is simply false. He states it could unilaterally expand basic benefits and increase costs, which is false. And he hints it could be a big cost to the state, which is false--the exchange would be funded by federal funds to start up, and by fees on insurers after 2014. The column is a smear job, pure and simple. Just to be clear his opinion, he even uses the term "Obamacare," a term only used by opponents.
The exchange would be a boon for consumers and for California--it would provide a way for individuals to easily purchase private coverage and get federal funds to afford that coverage. That's why it is essential to sign the bills this year--so California has the time to get ready, so that our families and small businesses are ready on day one to draw down the billions in federal tax credits and subsidies to help make coverage affordable.
The bills also allow the exchange to negotiate with the insurers for the best possible price and value--much like large employers do now, giving small business and individual families some of the group discounts that large purchasers get. But that's why Anthem Blue Cross and some other insurers are opposed--and hence the opposition.
...he should sign two bills laying the groundwork for California's health insurance exchange – the major piece of the national health reform legislation signed by President Barack Obama on March 23.
States need to be ready for business on Jan. 1, 2014.
While Massachusetts and Utah established state-based health exchanges before passage of the federal health care reform law, California's Senate Bill 900 and Assembly Bill 1602 clearly mark the most important state legislation since the federal health care reform law passed.
Schwarzenegger should seal California's leadership role by signing the bills sooner rather than later.
Three years to set up an exchange may seem like a lot of time, but it goes by quickly when you're trying to set up databases and work with health insurers...
But it's well worth it. The Massachusetts exchange, which began in 2007, has helped keep premium rate increases below the national average, reduced the number of people getting free care at hospital emergency rooms and has given the state the lowest share of uninsured residents (2.6 percent).
Under California's proposed exchange, 3 million to 4 million Californians – including small businesses with up to 100 employees – who don't have insurance or have insurance that is inadequate to meet their current and potential health care needs would be able to comparison shop in one place for a health plan – and access federally funded subsidies to make coverage affordable.
Under the two bills passed by the Legislature, Californians would get standardized information about insurance plans – in an easy to understand format showing what's covered and what's not and the cost – so they can make informed choices.
Equally important, the exchange would be able to bargain – as large employers and entities such as CalPERS already do – taking advantage of economies of scale to get better prices for consumers. This can be a powerful force for price competition in the market to the benefit of all Californians.
Many Californians would be eligible, based on their income, for a federal premium subsidy to help them purchase coverage through the health benefits exchange. California should not leave those federal dollars on the table.
While some states are suing to block implementation of the federal health law, California is at the front of the line to make it work for its residents.
Even as the budget remains stalemated, that's an achievement – if Gov. Schwarzenegger signs the two bills.
As we ramp up to the September 23rd kick-off of key patient protections coming online, more information is coming out.
Here's a video that spotlights the ability of young people being able to stay on their parents' health coverage. It says "For the first time in American history, an entire generation - our generation - can Get Covered." Take the pledge and learn more at http://www.getcoveredca.org/.
The U.S. Census Bureau asked us to stand up and be counted. New numbers are in for 2009, and they are BIG! The Bureau released stunning new data on income, poverty and health insurance for 2009. On health coverage specifically, California has shattered records on the numbers and percentages of uninsured and Medicaid enrollment demonstrating a desperate need for the health reforms promised in the Affordable Care Act. * Nationally, the percentage of people without health insurance increased to 16.7 percent in 2009 from 15.4 percent in 2008. The number of uninsured people increased to 50.7 million in 2009 from 46.3 million in 2008.
* In California, the total uninsured in 2009 was 7.2 million compared to 2008’s number 6.7 million--a jump of nearly a half-million more uninsured. This is the highest rate of number of uninsured persons, and the highest rate of uninsurance, ever found in California, using the current Census methodology.
* California is tied with Nevada for the fifth worst uninsurance rate in the nation.
* The change reveals a decrease of people with private insurance, with the national percentage of people covered by private health insurance decreasing from 66.7 percent to 63.9 percent. The percentage of people covered by employment-based health insurance is 55.8 percent nationally, is the lowest since 1987, the first year that comparable health insurance data were collected.
First and foremost, this data reinforces the need for a strong safety net in California, especially in economic times like these. As many middle-income families lose private health coverage, our public insurance programs like Medicaid have done heroic work in providing some security for many more. Those enrolled in Medi-Cal increased by 11 percent in 2009 from 2008. According to the Census, total Medi-Cal enrollment went from 5.7 million in 2008 to 6.3 million in 2009. Roughly 1 in 5 (19.3 percent) Californians were enrolled in Medi-Cal for the full year in 2009. This is the highest enrollment level and highest rate found under the current Census methodology, since 1987.
Yet policymakers are considering, in responding to California's budget crisis, making the situation much worse, by ordering additional cuts to Medi-Cal and other core services at exactly the time they are most needed.
And many more need the help.The data shows that millions of real people in California (7.2 million) do not have access to affordable health care. We see a record number of Californians losing coverage, and thus living sicker, dying younger, and being one emergency away from financial ruin.
Various provisions of the federal health reform law between now and 2014 would expand patient protections and coverage options. A number of California bills that would begin to help address some of the problems identified by the census if they are signed by the Governor. His Administration is also negotiating a Medicaid waiver that would work to expand coverage earlier than 2014. But there is still much more work to be done.
Today's numbers are a sobering reminder that the ability of all Californians to lead healthy and productive lives depends on our work toward ensuring access to quality and affordable health care to all our communities.
In Capitol, 500 protest those blocking a fair budget..
Wednesday, September 15, 2010
Governor Schwarzenegger arrived back from Asia today, which hopefully will start moving the California budget negotiations along. As Judy Lin of the AP reports, we are about the set the record for the latest budget. Ever. In California history.
But matters as much as a timely budget is a fair budget--one that doesn't eviscerate health, human services, and other vital programs--a point made today by 500 Californians who rallied today in the Capitol, singing song of protests in the Capital Rotunda, and leaving black roses on the bear statue in front of Governor Schwarzenegger's office. (See the photo from @SEARAC_Jonathan's Twitter feed.) Apparently, Assembly Republican Leader Garrick posted guards outside his office.
With all the health reform bills on the Governor's desk, it may be useful to highlight the different types of reform.
Many of them are plain-vanilla measures simply conforming state health insurance laws to the new federal reform, especially for those patient protections that start to come online this September 23rd: allowing young adults to join their parents' plan; no cost-sharing for preventative care; no annual or lifetime caps on coverage; etc.
Other proposals attempt to adapt to the Affordable Care Act in greater detail than what is in federal law, and in those details they work not just to implement but to improve upon the federal law. For example, the health insurance exchange bills set up exchanges in California as encouraged by the federal law, and make various decisions that are left up to the states.
But I want to spotlight reform that not just implement and improve health reform, but also provide for a better and smoother transition in the insurance market between now and 2014, when the biggest elements of health reform kick in. These include: * access and affordability for children with pre-existing conditions, by not just implementing the federal law prohibiting of denying such coverage, but also limiting how much more such children can be charged. In 2014, neither children nor adults will be allowed to be denied or charged different because of their health status. * categorizing plans in the Platinum/Gold/Silver/Bronze tiers based on actuarial value, so consumers can make some general comparisons between plans. In 2014, these will be more specific tiers in the exchange. * phasing in some minimum benefit standards early, such as maternity coverage and mental health parity. These will be part of the basic benefit package in 2014.
The benefits of these bills, if signed by the Governor this month, are several. First of all, the measures would provide important consumer protections earlier than the federal law requires. But I also think it is important to have policies that allow for a smoother slide path to 2014, from the "wild, wild west" of California's insurance market, to a more regulated and transparent market. The transition to guaranteed issue, modified community rating, and other market reforms are big, and it would be smarter to phase them in over the next three years, rather than simply wait until 2014 and go from 0-60 in one quick swoop. It's like moving a fishtank in your house: the new location is going to be better, but you have to be careful in the transition.
One point is we don't want the insurers to use the next three years as a way to game the marketplace. There's a fear that insurers may work even harder to avoid sick people in this period before 2014, knowing they will no longer be able to deny them afterwards. Those who are the most aggressive in this regard before 2014 will have an advantage of having a healthier risk pool to cover in 2014 and beyond. That's a problem, and part of the way to solve that is to start putting in place the new rules of the road, so that the market can adjust slowly but clearly.
John Sepulvado of Capital Public Radio recently profiled hair stylist Alexis Nagle, and how she would benefit from health reform in 2014. More specifically, he addresses how the new health insurance exchanges would help a consumer like Alexis have an easy one-stop shop to get coverage--without regard to pre-existing conditions.
But as Alexis says, perhaps the most attactive part of the exchange won't be the simplicity-of-use or the easy-to-compare options, but the most obvious benefit--it'll be the place that many Californians can get subsidies and tax credits to better afford coverage. For many Californians under 400% of the federal poverty level--around median income--the exchange will offer subsidies if a basic coverage package is more than a certain percentage of one's income. So if coverage costs more than a percentage of a family income, on a sliding scale from 2%-9.5%, the subsidies will make up the different between that percentage and the cost of coverage. For many families, that federal assistance could be in the hundreds or even thousands of dollars. For California's health system and economy, that's nearly $123 billion in federal funds over the next ten years.
As Sarah Varney of National Public Radio reported earlier in the month, key bills passed the legislature in the past few weeks and now are pending on the Governor's desk. They would not just set up an exchange, but make it a meaningful one: a true purchasing pool, that would negotiate for the best price and value for consumers. This use of "selective contracting" would provide to individual consumers and small businesses some of the discounts and benefits that large employers and purchasers currently have now. The bill has conflict-of-interest protections, so that insurers are not on the governance of the exchange, and thus not on both ends of the bargaining table.
The two exchange bills, AB1602 and SB900, contain a number of carefully crafted measures to assure the viability of the exchange while allowing the market for health insurance to flourish. Given the failure of an earlier California purchasing pool for small businesses, these steps are important to protect the viability of the proposed exchange while allowing insurers to develop new products.
By signing AB1602 and SB900, the Governor has the chance to lead on health care once again. AB1602 and SB900 would put California where it belongs, as the first state in the nation to implement federal health reform. We'll see what he does in the next few weeks...
The U.S. Department of Health and Human Services (HHS) today announced a grant of $3.6 Million to Santa Clara County Public Health Department for obesity prevention, as part of a $31 million batch of additional awards to promote public health activities in ten communities.
So on behalf of Health Access California, our condelences to the family and co-workers of Victor Hugo Perez Zavala, a promising 24-year old DMHC staffer who was shot to death this weekend as an innocent bystander. As a report in the Sacramento Bee indicated, "he worked for the California Department of Managed Health Care, the state's HMO consumer rights organization, and got satisfaction from helping people solve their insurance dilemmas...."
The California Department of Managed Health Care Director Cindy Ehnes talked about DMHC's record of accomplishments and milestones on their 10-year anniversary to a crowd of well-wishers last week. My colleagues Anthony Wright, Health Access Executive Director, and Beth Capell, Legislative Advocate, both spoke of the creation of the agency, its unique role nationally and in the state, and the long list of hard-fought achievements brought to reality by the DMHC leadership and staff. There were many luminaries in attendance to mark the event, and some distinguished guests with whom we were at swords' points only a matter of months ago over the consumer perspective on a particular policy. However, all in all, it was a convivial occasion.
I also attended the 10-year anniversary event and I especially enjoyed it. In the five years since I have worked for Health Access I have had the role of Director of Administrative Advocacy. This means I work with state agencies, including DMHC, to give testimony at public hearings and in written documents on their proposed regulations representing the consumer perspective. To be sure, we have not always agreed. However, I have had the privilege of having working directly with the fine managers and staff at DMHC who make all of this a reality. They include current and former managers and staff (in alphabetical order, to show no preference): Emilie Alvarez, Ellen Badley (recently returned!), Warren Barnes, Susan Burger, Suzanne Chammout, Ed Heidig, Christina Hooke, Tim LeBas, Sherri Lowenstein, Rick Martin, Maureen McKennan, Braulio Montesino, Lynne Randolph, Bobbie Reagan and many others. It is truly a distinguished crew!
So, at the occasion where all were commemorating the accomplishments of the DMHC in its first decade, I think Anthony hit the right note: There are many things for them to be proud of, but with many key features of health care reform soon to be effective with the six-month anniversary of the health care reform law being signed, DMHC is facing many new challenges and responsibilities. We are confident that they are undertaking their enhanced role with intelligence and enthusiasm and the "The Best is Yet to Come!"
posted by Elizabeth C Abbott | Permalink | 2:09 PM
Happy Birthday to the DMHC!
Last week, the California Department of Managed Health Care (DMHC) celebrated its tenth anniversary. It was an occassion worth marking, as the nation's first and only department solely focused on protecting patients and watching over insurers. Before the DMHC, HMOs and managed care insurance companies were regulated by the suspiciously-named Department of Corporations.
It was the passage of the HMO Patients' Bill of Rights--with many bills sponsored by Health Access California--that created the new department and began a new chapter in consumer protection in the state. We were pleased to speak at the event last week, and recalled that the Department is responsible for implementing many first-in-the-nation patient's rights, including the first to establish an Independent Medical Review program to evaluate treatment decisions, the first to change rescission practices, the first to establish guidelines for waiting times for appointments with physicians, the first to require that health plans provide language access, including interpreters and translated consumer materials at all points-of-service, and more.
* More than 1 million consumers have been assisted by the Help Center.
* The DMHC has recovered more than $14 million for consumers through its Help Center and Enforcement Offices.
* The Help Center has administered nearly 12,000 Independent Medical Reviews, and slightly more than half were decided in favor of consumers, allowing them to receive care that was previously denied.
* As the result of the DMHC’s actions to end rescissions, the number of consumers who had coverage improperly rescinded or cancelled was reduced from a high of 1,552 in 2005 to only four in 2009.
* Nearly $35 million in fines and penalties have been assessed to health plans that were in violation of the law.
* The Provider Complaint Unit has received more than 29,500 provider complaints and has recovered more than $22 million in payments owed to physicians and hospitals.
* The Licensing Division has approved more than 85 new plans and products now available to the public.
* A total of 18 unlicensed discount health card companies have been ordered to cease operations or become licensed.
* The DMHC oversaw the transition of 2,313 kidney patients to transplant lists at other hospitals after the closure of a Northern California kidney transplant center in 2006. A subsequent enforcement action resulted in a $3 million contribution to Donate Life California, for outreach efforts which resulted in increased organ donations.
* The DMHC secured more than $450 million in community benefits for California consumers through the establishment of community investment programs.
Congratulations should go to both Daniel Zingale, the founding director of the Department under Governor Davis, and Cindy Ehnes, the current director under Governor Schwarzenegger, for keeping the focus on patients. Credit should also go to the Department's staff, at a time when government service is too often maligned, for keeping their commitment in such a vital function.
Our comments at the event said that given our role in its creation, we considered the Department an accomplishment, but also a focus of our continued attention, as a needed check on the abuses of the health insurance industry. While we haven't agreed with the Department on every decision, California consumers appreciate what the Department has done, but need it to do even more.
And under health reform, it will: the Department will have more responsibilities. The new federal health law adopts many existing California protections as the standard nationwide, but also provides a host of patient protections new to Californians. The Department will need to ensure that insurers comply with the new requirements, and transition smoothly to the newly regulated marketplace of 2014.
Under both the federal health law and new implementing state legislation, the Department will have new responsibilities--for example, one bill pending on the Governor's desk, SB1163(Leno), would provide new authority for the Department to review rates and rate hikes. Consumer and community groups, including Health Access California, the California Pan-Ethnic Health Network, Consumers Union, Western Center on Law and Poverty, and many others, will work to increase the Department's ability to protect patients, now under the new framework of federal health reform.
The passage of the HMO Patients' Bill of Rights--and the creation of the DMHC--was the biggest advance in patient rights in the last decade.. until this year, with the passage of the federal health reform bill, along with the (hoped-for) signature of companion consumer protection legislation now pending on the Governor's desk. So marking the 10 years for the DMHC is not just an opportunity to look back, but important in setting the stage to move forward.
Earlier today, Governor Schwarzenegger signed one bill, AB 1653, authored by Assemblyman Dave Jones, which moves California closer to claiming more federal dollars for our state's beleaguered health care system. The additional $3.2 billion in federal funds for health care would be used to increase Medi-Cal payments to hospitals, and to help prevent cuts in children's health coverage.
The bill is an update from Assemblyman Jones’ AB 1383 from 2009, and was the result of negotiations with the federal Centers for Medicare and Medicaid Services (CMS) to get approval for a Hospital Provider Fee program proposed in that earlier legislation, which allows California to draw down the additional federal funding. The bill also allows California to better take advantage of the enhanced federal matching funds that are available under the American Reinvestment and Recovery Act (ARRA) for the 21 months spanning April 1, 2009, to December 31, 2010. Payments will be made retroactively.
When the effort started before the passage of federal health reform, the dollars are helpful in sustaining our health system as it prepares for full implementation in 2014; and for preventing further cuts as part of our ongoing budget crisis.
Hopefully, this will help seal the negotiation and get the final approval from the federal government on the hospital provider fee and these federal dollars.
This welcome development just serves as a preview to two other, urgent questions: 1) the status of the state's negotiations with CMS on the bigger Medicaid waiver, and 2) the Governor's actions on the bills on his desk on other health issues, including the implementation of federal health reform.
Fool me once, shame on you! Fool me one million times, you owe $9.92 billion dollars!
Tuesday, September 07, 2010
The LA Times reports today that PacifiCare faces fines up to $9.92 billion dollars for close to one million incidences of mismanaging medical claims, refusing to pay for covered benefits, losing thousands of patient records, and failure to pay claims to doctors.Furthermore, state regulators at the Department of Insurance received countless complaints that the company ignored consumers’ requests for help. The $9.92 billion fine is based on a $10,000 penalty for each of the 992,936 violations that regulators have investigated and validated.(Read the whole article here.)
One of the provisions of the Federal Health reform law that goes into effect on September 23, 2010 (read more at healthcare.gov) provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process.Clearly, no such system was in effect for the 1,000,000 consumers who suffered at the hands of PacifiCare, now owned by United Health, the very same United Health that raked in $81 billion in profits last year.For any who still believe that the free market can take care of the problems in our health care system, I present 1 million witnesses to the contrary.
Last week the California Legislature ended its session with mixed results, passing some insurance regulation bills, but rejecting others.This month, Governor Schwarzenegger has the opportunity to sign these bills into law, and making California a safer place to be insured.
KEY PATIENT PROTECTIONS NOW ON GOVERNOR'S DESK Key Measures to Implement and Improve Health Reform Passed CA Legislature; Governor Schwarzenegger to Sign or Veto in September
Bills on Governor's Desk Include: * AB1602(Perez) & SB900(Alquist), to Create a New Health Insurance Exchange * SB890(Alquist), to Categorize Benefits to Allow for Better Comparisons of Plans * AB1825(De La Torre), to Phase-In Maternity Coverage as a Basic Benefit * AB1600(Beall), to Require Mental Health Parity in Health Coverage * AB2244(Feuer), to Limit Premiums for Children with Pre-existing Conditions * AB2470 & AB2540(De La Torre) on Eliminating Rescissions * SB56(Alquist), to Foster New Public Health Insurance Options * SB1088(Price), to Allow Young Adults Up to Age 26 To Stay on Parental Coverage * SB1163(Leno), to Provide 60 Day Notice and Transparency on Rate Hikes * AB2042(Feuer),to Limit Rate Hikes and Changes to Once a Year * AB1503(Lieu), to Prevent Emergency Room Doctor Overcharges for the Uninsured * AB2345(De La Torre), to Eliminate Cost-Sharing for Preventative Care * AB542(Feuer), to Prevent Medi-Cal Payment for "Never Event" Medical Errors
The California Legislature ended their session last week after passing over a dozen patient protection measures. If signed by the Governor, these bills will implement and improve a number of provisions of federal health care reform law, enacting a number of new consumer protections.
These bills that passed are now on the desk of Governor Arnold Schwarzenegger. He has the month of September to decide to sign or veto the hundreds of bills on his desk, including the following measures:
Creating a Consumer-Friendly, Transparent Health Insurance Exchange
* CREATING A NEW EXCHANGE WITH BARGAINING POWER: AB 1602, by Speaker Perez and SB 900, by Senate Health Committee Chair Alquist and Senate President Pro Tem Steinberg are complementary measures that establish a new health insurance Exchange, a core element of the new federal health reform law. In 2014, the new Exchange will be the new one-stop shop for getting health coverage for individuals and small businesses, both providing easy-to-compare choices, access to federally-funded subsidies to make coverage affordable, and the bulk purchasing power (similar to large employers or CalPERS) of millions of Californians to bargain for the best price and value.
Now, individual consumers are at the mercy of the big insurers, without any purchasing power, in a complex and confusing marketplace. A new, independent exchange can dramatically improve the way Californians individuals and small businesses get coverage—making such decisions easier, more understandable, and more affordable. With over 4 million Californians eligible to participate in the exchange in 2014 (and more later), these bills begin a process to ensure a new exchange is ready to help patients and draw down federal subsidies on day one. AB1602 establishes the new, indepedent agency; SB900 set ups its governance, as a 5-member board to be appointed by the Governor and Legislature.
Setting Minimum Standards
* TRANSITIONING TO A MORE TRANSPARENT AND COMPARATIVE MARKET: SB 890 by Senator Alquist, would reform the individual insurance market, by setting basic benefit levels and classifying health plans in tiers (Platinum, Gold, Silver, Bronze) based on actuarial value. This would allow consumers better ability to make apples-to-apples comparisons, so that consumers can have some idea of how much of their medical costs they may need to pay out-of-pocket with different health plans.
The bill helps California implement and transition to federal health reform in other ways as well: * by instituting the new federal requirements on medical loss ratios, to ensure that premiums dollars go to patient care rather than administration and profits; and * by eliminating annual and lifetime caps on coverage that cause individuals with serious illnesses to incur significant medical debt.
* MATERNITY COVERAGE: AB 1825, by Assemblyman De La Torre, phases in a requirement for all health insurance plans to cover maternity care. This measure provides equity for women trying to buy coverage, saves the state money by preventing women from having to rely on public programs for maternity benefits, and crucially provides the public health benefit of getting babies the prenatal and early care coverage needed to live healthy and productive lives.
* MENTAL HEALTH PARITY: AB1600, by Assemblyman Beall, requires mental health parity in private coverage. The bill ensures that patients should be covered for mental health similarly to how they are covered for physical health.
Providing Access, Including for Those with Pre-Existing Conditions
* ACCESS & AFFORDABILITY FOR CHILDREN WITH PRE-EXISTING CONDITIONS: AB 2244, by Assemblyman Feuer, implements the federal prohibition on denying coverage to children with pre-existing conditions, and limits the amount that insurers can charge to cover those children. While the federal health law takes a crucial first step this September, by prohibiting insurers from denying coverage to children with pre-existing conditions, this state bill would take another step in making reform real, by also limiting how much insurers can charge children with pre-existing conditions, within an open enrollment period.
Federal law will prohibit such premium differences in 2014, but this bill phases in this affordability help sooner, and provides a smoother glide path for California's market to transition. Proponents say the bill would save tens of millions in the state budget, giving families the opportunity to buy private insurance rather than having them fall onto public health coverage programs.
* ELIMINATING RESCISSIONS: AB2470, by Assemblyman De La Torre, would help implement health reform by seeking to eliminate rescissions, so patients don't have their coverage yanked away at the time when they most need it. The bill would standardize the process of underwriting and asking about pre-existing conditions when accepting subscribers in the first place, and require regulatory approval for any insurer seeking to retroactively deny coverage due to fraud. This is an important protection in the interim until 2014, when insurers will be required to take patients without regard to pre-existing conditions.
A related measure, AB2540, by Assemblyman De La Torre, would enact/increase fines 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.
Reviewing Health Insurance Rates
* REQUIRING 60-DAY NOTICE AND TRANSPARENCY ABOUT RATE HIKES: SB 1163, by Senator Leno, would require insurers to make information public about premium increases, available for review not just by the regulator but by the public on the insurers’ and regulators’ websites. The bill would also require insurers give 60 days notice to consumers and to the public before raising premiums. Currently, this information is not public, even the notice of a rate hike: insurers only need to give 30 days indication to subscribers, and there is no public notice requirement. This bill expands California regulators' authority, especially at the Department of Managed Health Care, to review rate information and better take advantage of the new federal funding available.
* LIMITING RATE HIKES TO ONCE A YEAR: AB2042, by Assemblyman Feuer, would get health insurers to limit plans from raising rates or changing premiums, cost-sharing, or benefits to once a year. This is intended to provide stability to patients who want to know their premiums don't change mid-year, messing with their annual budget.
New Options and Expanded Coverage for Consumers
* JOINT VENTURES AND PUBLIC OPTIONS: SB56, by Senator Alquist, would foster new public health insurance options by allowing county-based Medicaid managed health care plans (such as Alameda Alliance for Health, LA Care, and San Francisco Health Plan) to enter into joint ventures, offer broader provider networks, and be viable choices in the marketplace.
* YOUNG ADULT COVERAGE: SB1088, by Senator Price, would implement the federal health law that allows young adults up to age 26 to stay on their parents' group coverage.
Encouraging Prevention and Better Care
* MEDICAL ERRORS: AB542, by Assemblyman Feuer, would set up a process toward the goal that Medi-Cal would no longer pay for "never events," major medical errors that should not "never" happen--like surgery on the wrong body part. This bill is intended to encourage providers to set up systems that prevent such errors before they occur.
* PREVENTATIVE CARE: AB 2345, by Assemblyman De La Torre, would implement the federal health law by requiring insurers to eliminate cost-sharing for some preventive services such as pap smears, mammograms, other cancer screenings, and immunizations.
Other Consumer Protections
* EMERGENCY ROOM DOCTOR CHARGES FOR THE UNINSURED: AB1503, by Assemblyman Lieu, provides consumer protections to ensure uninsured and underinsured patients are charged fair prices for emergency physician services. The bill would require physicians who provide emergency medical services in hospitals to implement a discount payment policy, including a limited rate, for financially qualified patients. The bill would also place limits on the collections activities of these physicians.
The passage of this legislation is an important step toward establishing California as a leader in the implementation of health care reform. If the Governor signs these bills into law, California consumers will begin to benefit from some of the provisions of the federal law as well as some state-only improvements. Additional advocacy is needed to ensure signing of these bills.
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.
