POST-ELECTION UPDATE ON HEALTH REFORM IMPLEMENTATION
* AP Declares Congressmen Costa and McNerney Winners, All CA Representatives Who Voted for Health Reform Were Re-Elected; Results Provide Momentum for Implementation
* Bad Budget News, with Initiative Results and $25 Billion Deficit; Special Session Dec 6th * California Gets New Medicaid Waiver; Starts Up New Option for Pre-Existing Conditions * DMHC Fines Insurers on Provider Payments; CDI Gives Poor Grades to PPOs * HHS Releases New Regulations on Medical Loss Ratios
Read Our Health Access Blog for More Updates; Also Follow Us on Facebook! Read Real-Time Updates on Legislation on Twitter @HealthAccess!
For California health care and consumer advocates, this means that every California member of Congress that voted for the new federal health law--33 Representatives and our 2 Senators--was re-elected.
Californians also elected a Senator who championed the law in Barbara Boxer and a Governor who pledged to implement it in Jerry Brown, against candidates who held "repeal and replace positions. These results, along with the election of several pro-reform candidates for key statewide positions, like Dave Jones for Insurance Commissioner and Kamala Harris for Attorney General, provides strong momentum for an aggressive effort to implement and improve the new federal health law in California.
The Health Access blog, at blog.health-access.org, has been reporting on many developments related to fulfilling the promise of reform. Here are other highlights:* The election results in California were decidedly mixed with regard topropositions, with good and bad news regarding the state budget. While the passage of Proposition 25 will improve the budget process by allowing a majority-vote budget, that victory is outweighed by the passage of Propositions 22 & 26, which blew billion-dollar holes in current and future budgets, and making it harder to impose fees to get corporations to remedy the health and environmental harm they cause.
* The budget news got even worse when the Legislative Analysts Office released projections--partially due to those and other ballot results--that the 2011-2012 budget would see a $25 billion deficit of more than $6 billion in the current year (2010-2011) and more than $19 billion for 2011-2012. A special session on the budget is expected to start next Monday, December 6th.
* On election day, Governor Schwarzenegger announced the finalization of the Medicaid waiver agreement between the State of California and the federal government. The waiver determines the future of the Medicaid program for the next five years, and as such has been cast as a "bridge to health reform," especially since it includes the ability of counties to get federal matching funds to expand coverage to low-income Californians in advance of the federal expansions in 2014.
* California's efforts to take advantage of the opportunities under the new federal health law has been compared as the "Dr. Jekyll and Mr. Hyde" in relation to Texas, whose leaders are musing as whether to withdraw from the Medicaid program--although it'll be clear that such a move would be disastrous for their citizens and their health system.
* In late October, California began another benefit of the new federal health law, in earnest providing a new option to those denied private health coverage because of their health status. This new, federal funded "Pre-Existing Condition Insurance Plan" (PCIP), run by the California Major Risk Medical Insurance Board (MRMIB), now has over 600 enrollees in its first couple of weeks of operation, but is the last and only option for tens of thousands of Californians until the new federal law prohibits insurers for denying people for pre-existing conditions in 2014.
* While her Department cranks out new regulations and rulemakings, Health and Human Services Secretary Kathleen Sebelius recognizes that the action on implementing the new health law is at the state level, as she met with a select group of state-based consumer advocates, including Health Access California, to discuss the work ahead to fulfill the promise of reform at the state level.
* Finally, in order to remind us the importance of health reform and the need to do even more, the LA Times reported on a new study that reminded us of the problems with high deductible plans. These health plans impose deductibles of more than $5,000 and may cause members to delay care, putting people in financial jeopardy.
$5 million in fines for insurers on provider payment...
Monday, November 29, 2010
Earlier today, the California Department of Managed Health Care (DMHC) announced nearly $5 million in fines against the seven largest health plans in the state for violations in paying claims (late, inaccurate, or otherwise) to thousands of doctors, hospitals, and other health care providers statewide. The fines--along with restitution to these providers of millions of dollars--are the result of an 18-month investigation of the insurers stemming from provider complaints. In addition to penalties, the DMHC has ordered changes to health plans’ payment practices.
Audits found that all seven plans violated the minimum legal threshold of paying 95 percent of their claims correctly, and that not only did the plans not pay some claims accurately, but the appeals process was also often flawed. Five of seven plans were found to violate provider dispute resolution procedures--the methods providers must use to protest an underpayment or claims denial and get a corrected payment.
The health plans receiving fines are: * Anthem Blue Cross for $900,000; * Blue Shield of California for $900,000; * United/PacifiCare for $800,000; * HealthNet for $750,000; * Kaiser Foundation Health Plan for $750,000; * Cigna for $450,000; and * Aetna for $300,000 ...for a total of $4.85 million.
Why should consumers care? Patients expect health plans to pay claims to doctors and hospitals fairly and promptly so they can get the care they need. Consumers would rather that the time and resources of health providers go to patient care, rather than in fighting to get insurers to pay correctly. And ultimately, consumers should not get caught in disputes between providers and plans. It's good the DMHC is using its existing authority to require prompt, fair payment of claims... and the new federal health law will provide more tools for the overall oversight over insurers.
Health care and consumer advocates were pleased earlier this year when all California Democrats in Congress--33 Representatives and our two Senators--voted for the new federal health law. California and Michigan were the only two states of the twelve biggest that had unified support--not New York, Massachusetts, Illinois, or others. That's despite the fact that California has the biggest delegation (with seven) of "Blue Dog" Democrats.
This week's final election results confirms an equally important statistic, that every California Congressmember who voted for health reform was re-elected. This jibes with polls that suggest that there is majority support for the new federal health law--and provides momentum for the need to both implement and improve upon it.
One final note of late-breaking election news: Californians also apparently also elected Kamala Harris as Attorney General, who said she would not support the actions of some other state AGs in suing against the federal health reform law.
The U.S. Department of Health and Human Services today released regulations to make sure our premium dollars go to patient care, rather than administration and profit. These rules on "medical loss ratios" are a key piece of the new federal health law, and they go into effect January 2011. That's why the National Association of Insurance Commissioners were so busy this past year in crafting the regulation--and why our colleague Beth Abbott, who serves as a NAIC consumer representative, was on so many conference calls in these negotiations with literally hundreds of insurance industry lobbyists. Insurers tried to define "patient care" broadly, and argue for several loopholes, and we are glad that HHS rebuffed most of those attempts.
In general, the new MLR rule is a commonsense and fair regulation, providing important new protections and choices to consumers and levels the playing field for insurers. The industry now has clear goals that responsible companies can achieve, and if insurance companies don’t comply they’ll have to pay rebates to their customers.
We'll have more analysis soon, but it's a big step...
It's not just that he railed against "government-run" health care while demanding some of his own--which would literally be the same type of coverage, through a health insurance exchange, that is provided under the new federal law.
He also seemed clueless about the current barriers to health coverage. Harris, a Maryland state senator who works at Johns Hopkins in Baltimore and several hospitals on the Eastern Shore, also told the audience, “This is the only employer I’ve ever worked for where you don’t get coverage the first day you are employed.” In fact, most employers have some form of waiting period, often of several months, before being allowed to sign up for health coverage. Some retailers and other employers are known for having waiting periods for as long as two years--so they technically offer coverage, but only a fraction of their workforce is eligible. The new federal health law, which Harris seeks to repeal, would actually limit waiting periods for employer-based coverage to no more than three months.
Dear Senator McConnell and Representative Boehner:
We were surprised to read in today’s article “GOP frosh: Where’s My Health Care?” in Politico that some of your incoming members are unhappy with the health benefits they are eligible to purchase under the Federal Employees Health Benefits Program (FEHBP) – particularly the fact that there is a delay before benefits take effect. Ironically, this is the same predicament millions of Americans currently find themselves in.
It is amazing that your members would complain about not having health care coverage for a few weeks, even after campaigning to repeal the Affordable Care Act, which will help provide coverage to millions of Americans who find themselves without health insurance for months or even years.
We also find it interesting that members of the Republican conference would have no problem taking away health coverage from hard-working Americans, but expect expanded coverage for themselves and their families. The system set up by the Affordable Care Act will allow Americans to choose the plan that works best for them from a variety of private insurance plans, just like the FEHB program that members of Congress are now able to access. The uninsured, small-business employees, and the self-employed will now be able to benefit from this same choice and competition.
It begs the question: how many members of the Republican conference will be forgoing the employer-subsidized FEHBP coverage and experiencing what so many Americans find themselves forced to face?
If your conference wants to deny millions of Americans affordable health care, your members should walk that walk. You cannot enroll in the very kind of coverage that you want for yourselves, and then turn around and deny it to Americans who don't happen to be Members of Congress. It is worth noting that in 2011, the Federal government will pay $10,503.48 of the premiums for each member of Congress with a family policy under the commonly-selected Blue Cross standard plan.
It is important for the American people to know whether the members of Congress and members-elect who have called for the repeal of health insurance reform are going to stand by their opposition by opting out of the care available to them at the expense of hard-working taxpayers. We look forward to your response in the coming days about exactly how many of the members in the Republican conference will be declining their taxpayer-supported health benefits.
Today, the California Department of Insurance released a new report card, showing Californians giving poor grades to their PPOs in key areas such as customer service.
Health Access attended the release of the 2nd annual PPO report card today, (see picture; Insurance Commissioner Steve Poizner is not in the frame). The new report card has two improvement over last year: includes all of the "big six" insurers, including Blue Shield which did not participate in last year's ratings; and it includes customer satisfaction ratings for the first time. This complements a long-time annual report card on HMOs provided by California’s Department of Managed Health Care (DMHC) and the Office of Patient Advocate since 2001.
According to the California Department of Insurance (CDI), while other states collect similar data for PPOs, California is the only state to analyze it, and offer it in a consumer-friendly, interactive format that includes summary ratings as well as the more detailed underlying measurements.
As reported by CDI, none of the six PPOs on the report card received the highest four-star rating, but Aetna, CIGNA HealthCare of California and UnitedHealthcare (California) each received three stars overall for delivering quality clinical care. Anthem Blue Cross, Blue Shield of California and Health Net each received two stars overall in that category. Rating criteria included asthma care, checking for cancer, diabetes care and treatment of children. The ratings are based on a set of standard measures developed by the National Committee on Quality Assurance.
These first round of grades on customer satisfaction is startling. All PPOs got the mediocre 2-3 star ratings for getting care easily; all insurers except Aetna received the lowest, single-star rating for plan service: helpful customer service, getting information about your costs, and paying claims.
California insurers need to shape up in a big way. PPOs typically provide a greater range of access to providers, but too many Californians don't feel they are getting good service and information about what is covered, what they have to pay, and what their options are. When people are sick, the last thing they want is the hassle of dealing with an insurance company. For an industry that spent $86 million against health reform, insurers have a lot of reforming they need to do, from answering the phone quicker, to providing better information about payment.
Usually these customer satisfaction ratings reflect more favorably for insurers, because most people haven't need major care in a given year, and thus report being satified with the security of having an insurance card in their wallet. For insurers to get such poor grades, they really needed to have earned them.
These grades also show the need for additional transparency and oversight for insurers. We need to require these types of report cards that measure several areas of delivery of health care to consumers in the midst of significant change in the marketplace.
As we implement federal health reform in California, we need to ensure that purchasers and consumers have information like this at the time they are making a purchasing decision--something that we hope the new health insurance exchange will do. We need to institute the reforms needed to standardize the market, set high expectations for insurers, and make it easy for consumers to understand their benefits and their options. Our goal should be to have insurers compete on price, quality, and customer service, rather than simply on how deftly they can avoid paying the claims of sick patients. Right now, insurers really don't compete on quality or customer service, which is why they get away with such grades.
Earlier today, Congresswoman Nancy Pelosi was re-elected to lead the Democratic caucus of the House of Representatives, as Minority Leader in the next Congress. (Other Californians that won leadership posts was Xavier Becerra, as Vice-Chair of the Democratic Caucus; and Kevin McCarthy, as Majority Whip of the Republican Caucus.)
The big debate this fall is the potential extension of the Bush-era tax cuts... and of particular controversy, the tax cuts for income above $250,000/year.
The position of still-Speaker Nancy Pelosi is clear: "The position that we have, and which is the position the president has put forth, is that everybody should get a tax cut in our country," the outgoing Speaker told NPR. "The problem comes," she said, "when an additional tax cut to the wealthy is two percent that will heap $700 billion in debt" upon the country's children... Pelosi said that the cuts, instituted by the GOP in 2001 and 2003, have not been effective."Those tax cuts have been effect for a very long time, they did not create jobs," she said.
Even California's moderate Democratic Senator Dianne Feinstein agrees. Earlier today, she said: "I don't see the logic in delaying tax cuts for middle class Americans as part of an effort to make sure that the rich get richer. I would caution my Republican colleagues against holding middle-class tax cuts hostage for the benefit of the two percent of Americans who have the privilege to be wealthy."
Tax cuts targeted to the wealthy (who might pocket the money or invest overseas) make little economic sense, especially if they need to be paid for by cutting key programs like Medicaid and Medicare that are central for our health care system, and our economy (since those health care dollars can't be outsourced, and go directly back into local economies).
We hope the rest of the California delegation follows this lead.
Of the many meetings that I had last week in Washington, DC, around the crucial work of implementing and improving the new federal health law, the highlight was my lunch with the U.S. Secretary of Health and Human Services Kathleen Sebelius. She broke bread with a handful of consumer advocates, to discuss the work ahead to fulfill the promise of reform at the state level.
Given that the real work of implementation is at the state level (as well as last Tuesday's elections), she is perhaps ideal for this job in providing guidance and resources to the states, as a former Insurance Commissioner and Governor of the red state of Kansas.
The Secretary got to hear about how implementation was proceeding in various states, and opinions about how she could advance the effort. Secretary Sebelius blogged about our meeting on the new web portal www.healthcare.gov, a resource that continues to get better as a very comprehensive resource for people to understand their rights and options when getting health insurance.
My colleagues at Health Care for All, Massachussetts also blogged on the meeting, reflecting on some of the lessons they have learned from their early implementation of their state-based reform.
Finally, Politico reported on the visit, which simply indicates the work that Secretary Sebelius has done to engage Governors in the many practical ways that health and human services are essential to the work of the states.
It was a good meeting, and it underscored the notion that the responsibility for making reform real, for people to get the care and coverage that they need, is in the states, in Sacramento and state capitols and local communities. We have our work cut out for us.
When in DC this week, I was with health and consumer advocates from other states, including from Texas, which recently has made news considering withdrawing from the Medicaid program--something that is unlikely but sort of shocking just to think about.
Tough budget times mean people look at extreme options, and California has not been immune--remember Governor Schwarzenegger proposed eliminating California's state child health insurance program, Healthy Families, as well as dramatically scaling back Medi-Cal coverage for millions of Californians. But those options were rejected by the Legislature for what they were--extreme, absurd, unworkable, costly, and counterproductive, if not simply wrong and immoral.
Finally, she responded to conservatives who say Governors could somehow replace Medicaid without the benefit of federal matching funds--a notion I dismiss in the article. The reason and impact of eliminating Medicaid would be to several cut health care services--and not just for low-income people, but also for the health system as a whole. While there is always ways to make any system more efficient, it's hard--no, impossible--to provide the same quality of coverage to the same number of people without the federal government's 50% share (which, in Texas, given the formulas, is actually 60%). Even with some continued alternative program, the result would be to dramatically scale back those services, and that investment in the health system and the economy. And speaking of alternatives, the federal government does provides waivers to allow for some innovation, although given the significant dollars by the federal government, there should be some basic standards and requirements that go with such funding.
In another post, Khimm compares the different approaches of Texas and California, calling the two states the "Jekyll and Hyde" of health reform, in which she highlights our state's just-finalized Medicaid waiver as a way that California is taking advantage of the benefits of the new federal health reform. She appropriately writes that after seeing the final law, Schwarzenegger switched from seeing the federal health law as a burden to seeing it as a benefit for the state--and went to work using it to help, not hurt, our budget and fiscal situation. The Medicaid waiver provides California with ways to not just help our budget deficit, but to actually expand coverage--given the state budget crisis, using county funds matched with federal dollars.
Texas' thinking makes sense if health care is merely seen as a line-item in a budget, a drain in the state's coffers. Health care should be seen as in investment, a valued asset alongside our education, transportation, and public safety systems, and a way to bring in new federal funds and toward economic vitality and recovery.
California's waiver helps provide a map, one we shouldn't backtrack from as we embark on the next stage of the budget crisis, with both Governor Schwarzenegger and Governor-elect Brown.
A fight about deficit is a fight about health care...
Friday, November 12, 2010
Here in DC, there's a lot of talk about the recent rough draft by the staff of the Deficit Commission chairs, and how it could (and should) impact health care. I could write a long post about it.
Or I could link to Brad Delong at UC-Berkeley, who says that the caps envisioned would "require not just the repeal of the Affordable Care Act but the elimination of Medicare as we know it", and who is also quoted at Talking Points Memo.
Or I could link to Kevin Drum at Mother Jones magazine, who explains why the fight over deficit reduction is should really be about health care, and why the Deficit Commission is seriously misguided in attaining its goal of deficit reduction.
Or I could link to Ezra Klein or Jonathan Cohn, who provide good context as well, as they often do.
I'll write that post, but that's all good reading until then.
On Wednesday, the Legislative Analyst's Office released its fiscal analysis of the 2011-12 budget, and the result was not pretty. It projects a deficit in the current (2010-11) year of over $6 billion, and a deficit of over $19 billion for the budget year of 2011-12. It's worth reading.
On Friday, we just have to hope no other shoe drops. Combined with the federal developments that suggest additional cuts coming down the pike, that's enough bad news we can take this week.
"Republicans fresh off their victory on Election Day say their first priority will be to dismantle the new health care law. And believe me, there's nothing people without a job love more than less health care."
This is no joke. I am in DC this week and getting a sense of what the next two years will look like. Very few people expected a full repeal of health reform to go farther than passage in the House of Representatives... but there are real threats to health reform with the new GOP majority in the House and narrower margins in the Senate.
It's not just the potential defunding of some aspects of health reform. It's that the new Republican leaders will block attempts at extending funding for key health and other programs that have been used to prevent cuts in the middle of an economic downturn and help along a recovery. This includes FMAP--the increased federal funding for Medicaid, which expires June 2011--the expiration of which will cause additional problems with our budget deficit. This including many other things, even includes the blocking of extending unemployment benefits.
While voters had jobs on their minds, the newly elected House majority will have an impact on jobs, alright. It's gonna be a long two years...
These health plans, which can impose deductibles of more than $5,000, may cause members to delay care and can put families in financial jeopardy should a health crisis arise, note the authors of the report, Profiling California’s Health Plan Enrollees: Findings from the 2007 California Health Interview Survey. Yet high-deductible plans are often the only insurance many Americans – especially the self-employed or those with low-incomes – can afford.
The report, which profiles California’s nearly 32 million insured residents, found that a total of 3 million commercially insured Californians were enrolled in high-deductible plans in 2007. Enrollment in high-deductible health plans is particularly high among members of preferred provider organizations (PPOs) – 28 percent of all commercial PPO members reported having a deductible higher than $1,000. Among commercial health maintenance organization (HMO) plan members, 14 percent reported having such plans.
High deductible plans, defined by the California Health Interview Survey as plans that have out-of-pocket deductibles of $1,000 or more for individuals or $2,000 or more for families, can exceed $5,000 annually.
“Many Californians can’t afford higher-premium plans, especially in the current economic climate,” said the report’s lead author, Dylan Roby, a Center research scientist. “But the alternative – high-deductible plans – may cost less initially, but can cost thousands of dollars when you need health care. When that much money is on the line, a health emergency can also become a financial emergency.”
What does the Republican takeover of the House of Representatives mean for health reform? Not much, certainly in the short term. The law is the law, and will be the law; even Republicans concede that repeal efforts will fail, as long as the President is the President (and the Senate is the Senate).
As I told New America Media, Californians shouldn't let the political rhetoric get in the way of them finding out about the new options and benefits to which they are (and will be) entitled.
Here's a clip from the Newshour from PBS that explores the impact of the election on health reform:
Taking stock and continuing to fix our broken health system...
Wednesday, November 03, 2010
How did health reform fare as a political issue in the elections?
It's unclear. In California, the two headline races saw the well-funded candidates who endorsed "repeal and replace" positions lose, to Senator Barbara Boxer who voted for and championed the new law, and Governor-elect Jerry Brown, who pledged to implement the law.
Across the country, many House Democrats lost, whether or not they voted for the health reform measure.
One part of health reform, the "individual mandate," was on the ballot in three states, with anti-mandate initiatives passing in conservative Arizona and Oklahoma, but another measure being defeated in the swing state of Colorado, which also re-elected Senator Bennet who voted for reform.
"Yes, voters want more and better jobs and are worried about spending and a larger role for government. But anyone who thinks this election is a mandate to repeal the entire Obama health care bill or abolish the Department of Education or repeal any amendment to the Constitution is somebody who truly doesn’t understand public opinion or elections." said Stuart Rothenberg, Roll Call Contributing Writer.
So what does this election mean for health reform? Voters still want coverage that will be there for them when they need it, and the security that going to get care doesn't mean facing medical debt or bankruptcy. We still have the same problems in our health care system we have yesterday. The law is still the law, and its effective implementation over the next few years will go a long way to fix some of those problems.
California has started down the path, by passing legislation to start setting up a health insurance exchange, and this week agreeing to a new Medi-Cal waiver, both of which are key elements to ensure a smooth and successful transition to a better health system. But there is so much more to do to fulfill the law's promise so Californians can get the full benefits. We are pleased that there is renewed leadership in California to take aggressive action to implement and improve the federal law moving forward.
UPDATE: The California Endowment has put out a similar message in a new TV featuring Dr. Oz:
The election results will have a big impact on our health care, and on the California budget. On the propositions that impact the budget, there was a little good news, and some bas news.
The passage of Proposition 25 won't fix all our budget problems, but it will improve the budget process. No longer will a small group of legislators be able to hold the entire budget hostage, making the budget late and health providers unpaid. No longer will a small group of legislators be able to demand corporate tax breaks, that drain our budget and force additional cuts to health and other vital services. And if there is a ridiculous tax giveaway or a major cut to health care, then it will be clear who is behind that proposal and legislators will be more accountable for their decisions--they will no longer be able to blame the 2/3 vote.
The very bad news is the projected (but not finalized) passage of Proposiiton 22 & 26, which blow billion-dollar holes in the current budget, and future budgets, making our budget crisis even worse--forcing even worse cuts to vital services. Prop 26 was the closest measure of the night, and was backed by oil, tobacco and other companies to protect themselves for paying for remediate the health and environmental harm they cause. If these polluters don't pay, taxpayers will--either in reduced services or increased taxes. It's very unfortunate that Prop 26 passed, and we may not know the full extent of the damage it causes to the state budget--there will likely be significant litigation about the full scope of Prop 26.
The budget landscape has certainly changed. We'll see how these changes, along with a new Governor and many new Senators and Assemblymembers, impact the budget process and the final product.
New Coverage, and Investments on our Health System, Under New Medicaid Waiver
Governor Schwarzenegger just announced the finalization of a "Medicaid waiver" agreement between the state and federal government. This new Medicaid waiver is a big deal... it's a plan for the next five years for Medi-Cal, key state-federal program that covers over 7 million low-income California children, parents, seniors and people with disabilities, and is a central funding source for our entire hospital and health care system.
With this new Medicaid waiver, California takes another important step toward an improved and reformed health care system. The new waiver includes key investments in the health care system on which we all rely, and allow for the early expansion of coverage as a transition to 2014. Of particular interest, the waiver allows counties to get federal matching funds to cover low-income Californians, helping those families, our health care system, and our economy, and providing a bridge to health reform in 2014.
Patient advocates had three goals for this waiver: 1) to win needed investments for our state and for our struggling health care system, 2) to start expanding coverage options and other benefits of the new federal law as a "bridge to health reform," and 3) to ensure consumer protections for those in Medi-Cal, especially seniors and people with disabilities who are being shifted to managed care. We made progress on all fronts, even while there is always more work to do.
California's five-year plan for Medi-Cal was expiring, and it was crucial that the new five-year plan included an aggressive effort to make sure Californians can take advantage of the benefits of the new federal law.
California’s waiver, officially titled California’s “Bridge to Reform: A Section 1115 Waiver Proposal,” advances the state’s health care goals in four specific areas:
1. Expands Coverage to More Uninsured Adults · The waiver allows all counties to participate in the successful county-based Health Care Coverage Initiative. This initiative offers comprehensive benefits to low-income adults currently ineligible for Medi-Cal coverage, and DHCS estimates that as many as 500,000 adults aged 19 to 64 could enroll. Under the new waiver, counties participating in the initiative will immediately begin phasing in coverage for these childless adults. In 2014, these enrollees will transition into full Medi-Cal coverage or into the new California Health Benefit Exchange established by recent legislation enacted by the Governor under the Patient Protection and Affordable Care Act.
2. Ensures Funding to Support Access to Care · The waiver expands on the existing Safety Net Care Pool to provide payment for uncompensated care and ensure support for safety net hospitals and other critical state health programs that deliver services to the uninsured.
3. Improves Care Coordination for Vulnerable Populations · Under the waiver, up to 400,000 seniors and persons with disabilities will have access to more organized delivery of care in managed care plans, offering them more accountable and coordinated services and delivering improved health outcomes. · In later years of the waiver, the state will pilot organized systems of care for children with special health care needs to improve care coordination, consumer satisfaction, health outcomes and cost effectiveness.
4. Improves Quality of Care · The waiver establishes a Delivery System Reform Incentive Pool to support California’s public hospitals in transforming their delivery systems to improve access, care coordination and health outcomes of the patients they serve. Pool investments in infrastructure improvements and system innovation and redesign will be tied to hospital improvements in care coordination, quality and efficiency.
To learn more about the details of California’s “Bridge to Reform: A Section 1115 Waiver Proposal,” please click here.
We remember just a month ago that the state budget was passed by the Legislature, 100 days past the official deadline. The Legislature and the Governor made their budget decisions, but the budget isn’t final: California voters have the final say TODAY, and depending on YOUR VOTE on key propositions, will either prevent or force additional cuts to health, education, and other vital services.
This isn’t some future threat. Propositions 22 and/or Proposition 26 would blow a billion-dollar hole in our current California budget, forcing either new cuts in health and other key services, or new taxes. Because they would go into effect retroactively for 2010, passage of either measure would undo major budget solutions already in place, leaving the Legislature scrambling to either raise taxes or cut core services even more.
Both measures would also impact budgets in future years. Proposition 22 would protect local government redevelopment agencies—at the expense of other state priorities like health care. When there are tough budget choices to be made, all options need to be on the table.
What would really make future budgets worse is the passage of Proposition 26. This measure makes it much harder to impose fees on corporations—requiring a two-thirds legislative vote--to remedy the health or environmental harm they cause. If the state can’t impose those fees, those costs then have to be paid for by the general taxpayer. In protecting polluters and other corporations, Proposition 26 is a receipt for additional cuts and more taxes.
Hopefully, California voters can not just vote against making a bad budget worse, but can improve both the process and outcome. This November, Californians can vote for a fairer budget that prevents additional cuts by supporting Propositions 21 and 24.
The Governor had recently proposed to zero-out funding for state parks, and future budget deficits make that a continued threat. Proposition 21 funds the state park system—and gives all California motorists free access to state parks--in return for a small license fee. The measure would also free up some resources to prevent cuts to health, education, and other key services.
However bad the budget situation look now, it’s going to get worse in a few years. Proposition 24 maintains corporate taxes at the same level it has been, rather than allowing special interest tax break of over a billion-and-a-half dollars go into effect. If that corporate giveaway goes into effect, it’s simple math that it needs to come out of education and health care—the main two areas of state spending. Proposition 24 would help prevent the cuts, and the loss of the economic activity and federal matching funds that would go with them.
Those unfair corporate tax deals were slipped into the budget at the last minute last year, without public hearings and at the demand of just a handful of legislators. It’s Exhibit A on why voters need to reform the budget process and support Proposition 25—which would allow a budget to pass by majority vote, rather than the two-thirds requirement that empowers one-third of one-half of the legislature to hold up the entire process.
This year, just a handful of legislators were able to hold the budget hostage in order to get special tax giveaways, appointments, and special interest policy changes. Proposition 25 can stop the legislative hostage-taking by a few so we can finally pass a budget that serves all of California.
The vast majority of California’s state budget goes to support education and health care, and so if you care about these and other vital services, you have a stake in key propositions when voting today. The decisions that voters make today will either force additional cuts, or begin to fix our broken budget process.
Prop 24: Education and health vs. corporate tax breaks...
Monday, November 01, 2010
Massive cuts to education, health care, and other key services. Significant tax increases. Marathon legislative sessions that lasted through the night. The state budget passed in 2009 was loved by nobody.
In health care, over three million California parents, seniors, and people with disabilities at or under the poverty level lost a range of key medical benefits—from dental to vision to podiatry to psychology services. State funding for community clinics was zeroed out. Major services to provide care from everything from maternal care to AIDS was severely cut.
In the midst of the elimination and evisceration of key programs and services that all Californians depend on, what added insult to injury was the inclusion of major corporate tax breaks. In the middle of major cuts, some legislators held up the budget unless they got included corporate tax giveaways that would take effect in a few years.
It’s hard to believe. While the state was making severe cuts, the legislature passed corporate tax giveaways to dig the hole deeper in future year—necessitating additional cuts in the future.
If these corporate tax breaks are allowed to go into effect, the state budget would lose over $1.3 billion dollars—thus forcing either additional cuts to health, education, and other vital services, or new taxes on the rest of us.
That’s why we need to pass Proposition 24, to repeal these corporate tax giveaways, leaving the tax levels at where they are. Proposition 24 will prevent additional cuts to programs and services like education and health that already have been hit hard.
To give a sense of what $1.3 billion means, it is more than the entire cost of our state’s Healthy Families program, which provides health coverage to 900,000 low-income children. With just a fraction of $1.3 billion, we could restore all the Medi-Cal benefits and community clinic funding cut in that 2009 budget.
Passing Proposition 24 makes sense for our families, and our health and education systems, but also our economy. Giving corporate tax breaks provides no guarantee of jobs or economic stimulus in California.
In contrast, investing in core services like health care provides the biggest “bang for our buck” in improving our economy. For example, most health and human service programs provide federal matching fund—for every dollar we spend in Medi-Cal or Healthy Families, we get another dollar or two from the federal government, for our health system, and in our economy. California has made cuts that have prevented our state from claiming federal matching funds that are rightfully ours, and forced us to leave those dollars in Washington, DC.
Investments in health, human services, as well as education, also are smart economically because they can’t be outsourced. By definition, they go to pay for jobs here in California, from nurses aides to teachers. The economic benefits of these dollars, whether they go directly to low-income families or middle-income workers, are sure to get recycled in our economy. There no guarantee with a corporate tax break that they just don’t save those dollars out-of-state or even overseas. A study by UC-Berkeley academics revealed that spending on health and human services provided many multiple times more jobs than upper-income or corporate tax breaks.
This is not the time to be giving away corporate tax breaks worth over $1 billion, not when we are making such dire cuts to schools and hospitals that we all rely on.
Proposition 24 doesn’t increase taxes, it simply maintain them and repeals a tax break that has yet to take effect. If Proposition 24 fails, then that will only increase pressure to make additional cuts or raise other taxes on the rest of us. That’s not good for our state or our economy.
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.
