As several reporters try to assess the legacy of Governor Arnold Schwarzenegger, it's time to consider his record on health issues--where he's been all over the place.
Is he a Governor who vetoed multiple and various efforts at state health care reform, attacked the federal law, eliminated dental, vision and other benefits for millions of Californians, starved our health system of revenues and threatened to further slash the coverage of millions of low-income children and families and fully eliminate our Healthy Families program? Or is he the Governor who signed some key consumer protections, led a bold effort at state health reform, which in turn helped spurred the historic health law that he embraced, and who has laid the foundation for its successful implementation despite opposition from his own party?
Amazingly and surprising, both descriptions are true.
The common headline being used for Schwarzenegger's tenure is "moderate" or "mixed," but that simply doesn't describe it. The words doesn't been to describe how wildly inconsistent--even iconoclastic--the Governor has been, in proposing the unthinkable, both for good and for bad.
He didn't come in with a specific agenda on health care. His only mention of health issues in his recall campaign was in his only debate appearance, where he expressed support for the Healthy Families program that covers low-income children. Yet his very first budget proposed to slash the program--something the Democratic legislature rejected, in what became a pattern throughout his tenure.
He said he would not be beholden to special-interest money, yet became the largest recipient of contributions from the pharmaceutical industry, along with other corporate interests. He vetoed several bills opposed by drug companies, but after a $80 million-dollar ballot initiative fight over a prescription drug discount program, he eventually agreed to a compromise program that did accept the notion that the government should be allowed to negotiate for the best possible prices. This was a bill that he highlighted along with global warming and the minimum wage as his new "post-partisan" path when seeking re-election in 2006. Yet the discount program has yet to be implemented due to lack of start-up money because of the budget crisis.
On consumer protections, he has been mixed--we at Health Access California was pleased that he signed key patient protections for the uninsured, limiting what they can be charged by hospitals and emergency room doctors. Yet he has also vetoed many good bills over the years.
For a majority of his term, Governor Schwarzenegger was an obstacle to reform. In 2004, he campaigned against Prop 72, an expansion of employer-based health coverage, and probably was a deciding factor for the initiative, which got 49.2% of the vote, not passing. In 2005, he vetoed AB772(Chan) to provide universal coverage for children. In 2006, he vetoed the framework SB840 (Kuehl) of a single-payer health care system.
To his credit, after saying No, No, No to various reforms, in 2007 he put forward a health reform plan to which he could say "yes." And to his credit, it was bold, and took ideas from proposals he had previously opposed, including placing regulations on insurers and requirements on employers, who had been key allies of his.
Yet the same disregard for public opinion that gave him the freedom to be a Republican making a major push for health reform also meant that that he was long resistant to compromise in a way that would be acceptable to Democratic legislators--or to address a regular voter's concerns about affordability. A decent compromise was struck, but not without a split in the coalition for reform, and the budget crisis looming, and the clock ultimately running out.
And the budget is where any assessment of Governor Schwarzenegger's legacy begins and ends. Under his rule, California eliminated basic benefits for literally millions of Californians--including dental, vision, psychology, and more. While rejected, he proposed far more severe cuts--ones that would have denied coverage altogether for millions of California children and families--and so-called "reforms" that would handcuff our states' ability to invest in our future.
His solutions didn't solve the problem: he leaves with a $26 billion hole for the next Governor to address. While faced with a structural deficit to begin with, and later an economic crisis, this Governor actively made the problem worse. His first act as Governor was to cut the "car tax"--the vehicle license fee, which provided billions of dollars a year in revenues to the state. That one act--the reduction of revenues, as well as the resulting debt service--forced additional cuts to health, education, and other vital services that have been made--or that still are to come. To the extent that the Governor reluctantly supported revenues once in 2009, those were temporary, and their expiration leaves the state in another, deeper hole starting next year.
Assessing the state of health care from when he started his tenure to today, it's hard to conclude things are better off because of the cuts, and the continuing looming budget crisis. The vehicle license fee reduction, and its destabilizing impact on our budget, is the original sin that was never atoned. It colors his health care legacy, and his Governorship, negatively.
To the extent there is optimism in the health care arena in California, it comes from the passage of the federal Affordable Care Act. Governor Schwarzenegger's earlier push helped create political momentum for reform, and the federal law does mirror the California proposal in several respects. Consistently inconsistent, he both gave statements of support for the push for federal reform, then emerged as a critic earlier this year in his State of the State. But after its passage, he embraced the reform, took credit for many of its ideas, and pledged to implement it successfully in California.
Of the bills on his desk in September to implement and improve upon federal health reform, he signed half of them--7 of 14, and vetoed others--including good bills on standardizing the market, requiring maternity and mental health coverage, and foster a public health insurance option.
But some of his signatures are of nationally significant bills, including the first-in-the-nation legislation to set up an health insurance exchange under federal reform; a bill to ensure insurers to cover children with pre-existing conditions, and to limit how much they are charged; and legislation implementing a Medicaid waiver that allows for early expansion of coverage to low-income adults, as a "bridge to health reform." While he could have done more, he has put California is a good position to take advantage of the new federal health law, as it starts to roll out in the next several years. His new appointments to the Exchange--Kim Belshe and Susan Kennedy--will mean his record on health has yet to be completed.
In fact, Governor Schwarzenegger's legacy is in the hands Governor-elect Jerry Brown.
Brown will decide if California makes the most of the opportunities under the new federal health law, building upon the foundation that Governor Schwarzenegger set.
And most of all, our new Governor has the massive undertaking of dealing with our budget crisis, and digging out from the additional hole created by his predecessors. He will see if California makes the cuts that Governor Schwarzenegger set in motion with his budget policies, or if he can win a balanced solution that deals with the deficit while preserving the health system on which we all rely. The stakes are higher than ever.
Governor Schwarzenegger has announced his intention to appoint two top aides to sit on the 5-member board of the new California health insurance exchange: Susan Kennedy, his chief of staff, and Kim Belshe, his secretary of health and human services for the entirety of his term.
California was the first state in the nation to take this central step of implementing the new federal health reform law by passing legislation, AB 1602 (Perez) and SB 900 (Alquist/Steinberg), to establish a new health insurance Exchange.
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.
Governor Schwarzenegger got the opportunity to appoint the first two slots, of which all five are for staggered terms. Two other slots will be nominated by the Assembly and Senate leadership, respectively. A fifth slot will be filled by Governor Brown's Secretary of Health and Human Services, Diana Dooley. The appointments are subject to important conflict-of-interest requirements that they do not represent health insurers or the industry, so the Exchange can freely negotiate on behalf of consumers and purchasers of coverage.
With these first appointments, California can begin its' important work to make getting health coverage easier and more affordable. By setting up a new exchange, California consumers will have a one-stop shop for consumers to easily compare plans and purchase health coverage, and get subsidies to ensure affordability.
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). 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.
As we indicated in Anthony York's LA Times post, Governor Schwarzenegger made such high-powered appointments because he knows the Exchange is a big deal, with the potential to have a positive impact on millions of Californians. The board has a lot of work to do to get this new purchasing pool up and running by 2014. The new board will determine criteria by which the exchange negotiates with insurers, and will help organize the marketplace so consumers can make meaningful comparisons and choices. This new board will work to set up seamless eligibility and enrollment systems, both to get health coverage and to get the new federal subsidies that will be available for individuals, families, and small businesses. These new appointees should move quickly so that 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.
We look forward to the new appointments by the Senate and Assembly to round out the team and begin this important work.
Here's HHS Secretary Kathleen Sebelius posted a video recounting the highlights of her work and that of her Department. The list obviously starts with the Patient Protection and Affordable Care Act--but she touches on some less-heralded parts of the law, and other developments of interest to health advocates and Americans in general.
It seems right to feature Secretary Sebelius' highlights, not just because of the substance of her list--from the new laws to new funds for key areas like community clinics to new efforts at prevention, fraud detection, and scientific research--but also because one of my personal highlights of the year was to meet with Sebelius herself this fall. It was great to get her take on the work ahead to implement and improve upon the new federal law. As a former Governor and Insurance Commissioner of Kansas, she is very familiar with the state-federal interactions that will become even more important in the next few years. More than that, it really seems she understands and is driven the human impact of her work. We hope her next year isn't simply defense, but similarly productive.
On January 1st, Californians will have some additional patient protections against insurance company abuses, as a result of laws passed in 2010 that build off the new federal health law. These new California laws will provide new oversight on insurers, from providing new access and affordability for children with pre-existing conditions, and new scrutiny on health insurance rate hikes.
These new patient protection laws provide new benefits and options for Californians consumers, and place greater oversight over insurers to prevent the worst abuses of the industry, as California adapts to the new federal health law. California is on its way to fulfilling the promise of the new federal law, by both implementating and improving upon it.
In particular, the California Department of Managed Health Care (DMHC) and Department of Insurance (DOI) will have new powers under both state and federal law to regulate insurers. Starting in 2011:
* Children can’t be denied for pre-existing conditions, to encourage insurers to continue to offer child-only coverage, and to set new limits on how much such children can be charged, under AB2244(Feuer), sponsored by Health Access California.
The new law is already having an impact, as insurers have announced that starting January 1st, they will sell policies to all children, even those with pre-existing conditions--which is a welcome and much-needed change. If families sign their children up in open enrollments periods--including the first two months of 2011, the child's birthday month, or a life change in the family--they get the benefit of a limited rate. In those open enrollment periods, children with pre-existing conditions can't be charged a premium more than twice what any other child is charged. Now that every child is now eligible for coverage, families should consider a new year's resolution to cover all their children.
* Health insurance rate hikes must go through a public rate review, including making public both the rate hike request and its justifications, under SB1163(Leno), sponsored by Health Access California.
Starting January 1st, health insurers will need to give more notice and more justification of their rate hikes in a more public way. When Anthem Blue Cross' infamous 39% rate increase came under such scrutiny earlier this year, it had to be withdrawn--and this new law will given every rate increase that level of scrutiny. Ratepayers will get 60 days notice of rate hikes, and the insurers will have to show more of their data. This is be a good first step toward more transparency and accountability for insurers, as we make the case for broader rate regulation.
* Other patient protections that conform state law to the federal Affordable Care Act include a ban on rescissions, under AB2470(De La Torre); the requirement that there be no cost-sharing for preventative care in new health policies, under AB23345(De La Torre); and the requirement to allow young adults up to age 26 to stay on their parents' health coverage, under SB1088(Price).
It's good to have a federal cop on the beat regulating insurers, but overseeing the insurance industry continues to be the primary responsibility of state regulators. These new California laws provide new options and new consumer protections against the worst insurance company abuses.
* Finally, California was the first-in-the-nation state to pass legislation, after the federal law, to implement it by setting up a new health insurance exchange. The exchange will be a purchasing pool, providing individuals and small businesses with subsidies to afford coverage, standardized benefits and the ability to comparison shop, and the barganing power of group purchasing. While this will take a few years to set up leading up to 2014, Governor Schwarzenegger is expected to make the first two appointments to the Board before he leaves office on January 3rd.
The heart of health reform, the Exchange will be a one-stop shop where millions of individuals and small businesses can get the bulk purchasing power that now only large employers and public programs enjoy. The first appointments to the Exchange and its first actions of the Exchange will be crucial in seeing if we can set this new marketplace up in time, and do it right.
An updated 9-month status report of the implementation of the federal health law in California report on how many Californians are actively taking advantage of the new options and benefits under the new law, and how California is improving upon it.
Insurance Commissioner-elect Jones names his team...
Wednesday, December 29, 2010
Yesterday, Insurance Commissioner-elect Dave Jones announced his top appointments at the California Department of Insurance (CDI).
Jones has re-appointed senior career officials to leadership positions who have decades of insurance regulatory experience, including Deputy Commissioners Joel Laucher, Tony Cignarale, Rick Plein, Robin Baker and Sherwood Girion. He has re-appointed several senior leaders who are currently serving Insurance Commissioner Steve Poizner, including General Counsel Adam Cole, Deputy General Counsel Patricia Staggs, and Deputy Commissioner Byron Tucker, as well as appointing leaders who served Insurance Commissioner John Garamendi, including Chief Deputy Nettie Hoge. He has also appointed key staffers who have served in his Assembly office, like Deputy Commissioners Janice Rocco and Chris Shultz.
We at Health Access, and many other health and consumer advocates, look forward to working with Commissioner Jones and his new team--we've appreciated our work with many of them before, in both legislative, regulatory, and advocacy positions.
Here are bios from the Insurance Commissioner-elect's press release:
The new members of the executive staff include:
Nettie Hoge, Chief Deputy Commissioner Nettie Hoge, on behalf of the Commissioner, will oversee all operations and policy matters at CDI. Hoge has extensive leadership experience at CDI. Prior to starting her own consulting business, which focused on issues including consumer advocacy and education, Hoge served as Policy Director in the Office of the California State Lieutenant Governor. Before that she worked in two different Deputy Commissioner positions, and as Health Policy Advisor at the CDI she advised Insurance Commissioner John Garmendi on key insurance policy issues with a special emphasis on health insurance, and developed and implemented the Insurance Commissioner’s positions on health care reform, while at the same time as managing the staff of the Consumer Services Division and the Policy and Research Division. Hoge has also spent time working as the executive director of a non-profit advocacy group for utility ratepayers (TURN) and as a legal advocate. She earned her Bachelor of Arts degree from Washington State University and her Juris Doctor from the University of San Francisco School of Law.
Janice Rocco, Deputy Commissioner, Health Policy Rocco comes to CDI with extensive experience in the California State Legislature, having worked there the last twelve years. Most recently Rocco served as Chief of Staff to then-Assembly Member Dave Jones. Previously, she worked as a Senior Consultant to the Legislative Women’s Caucus and also as Chief of Staff to former Assembly Member Hannah-Beth Jackson. Earlier, Rocco worked for Planned Parenthood of Santa Barbara, Ventura and San Luis Obispo Counties and has been involved in a number of legislative and statewide electoral campaigns. She serves on the national Board of the National Organization for Women. Rocco earned a Bachelor of Arts degree from the University of California, Santa Barbara.
Geoff Margolis, Special Counsel and Deputy Commissioner Margolis most recently served as a Principal Assistant to then-Assembly Member Dave Jones, handling all aspects of legislation. Previously, he worked at CDI as a Senior Staff Attorney, performing highly sensitive and very complex legal work, including litigation and legal analysis. Margolis also has significant experience working as a private attorney, on a variety of issues including insurance law, business law, entertainment and sports and law, legislative law, alternative dispute resolution, and public relations. Margolis has also served for 10 years as a Sacramento Superior Court Temporary Judge, and is a certified Mediator for the 3rd District Court of Appeals. He earned his Bachelor of Arts degree from the University of California, Los Angeles and his Juris Doctor from the University of the Pacific, McGeorge School of Law.
Michael Martinez, Deputy Commissioner and Legislative Director Martinez comes to CDI from the international law and consulting firm Manatt, Phelps, & Phillips, LLP where he served as Manager of Public Affairs and Legislative Advocate since 2000. He represented many non-profit organizations, local governmental entities, and companies, primarily advocating on complex policy and budget issues in the healthcare, public health, technology, natural resources, and legal aid sectors. Previously he worked at a global public relations firm managing statewide campaigns. Martinez serves as Board Vice President of the Equality California Institute. He earned double Bachelor of Arts degrees from Stanford University.
Chris Shultz, Deputy Commissioner, Community Programs Shultz will manage insurance programs that benefit under-served communities. He recently served as Legislative Director to then-Assemblymember Dave Jones. Before that, he worked as Public Affairs Director for The Ulum Group, one of Oregon ’s top five public relations and public affairs firms. Shultz previously held positions in state government as Jones’ Chief of Staff and Capitol Office Director for former State Senator Dede Alpert. He managed a $175 million education technology grant program in the administration of former Governor Gray Davis. Shultz earned his Bachelor of Arts degree with honors from the University of the Pacific.
Patricia Tenoso Sturdevant, Deputy Commissioner, Policy Sturdevant will focus on policy and special projects for the Commissioner. She is a recognized consumer protection lawyer with expertise in abusive insurance practices and health care law. Most recently Sturdevant served as Assistant Chief Counsel for the California Department of Managed Health Care, where she obtained a precedential ruling that health care contracts in the individual market cannot be terminated unless the health plan proves that the enrollee misrepresented his/her health history. She was formerly Executive Director and General Counsel of the National Association of Consumer Advocates in Washington, D.C. Sturdevant has extensive experience as a public interest lawyer at San Francisco firms Sturdevant & Sturdevant and Alioto & Alioto, and in Los Angeles at the Western Center on Law and Poverty. Sturdevant is President-elect of California Women Lawyers and winner of the Ronald M. George Public Lawyer of the Year Award for 2009. She earned both her Bachelor of Arts degree with honors and her Juris Doctor from the University of California, Los Angeles.
The new appointments are subject to final approval by Governor-elect Jerry Brown.
Jones has also retained the following members of the CDI executive staff:
Adam Cole, Deputy Commissioner and General Counsel Adam Cole will advise the Insurance Commissioner and direct the operations of the Legal Division. Cole has served as General Counsel to outgoing Insurance Commissioner Steve Poizner since 2007. Previously, Cole practiced law at the San Francisco-based office of the law firm Heller Ehrman, LLP where he directed complex litigation matters with a focus on insurance recoveries for California policyholders. He also served at the law firm of Covington & Burling in Washington, D.C. where he represented clients in litigation against insurance companies. Cole has also represented Legal Aid societies and serves as a Board of Director of the Central Pacific Region of the Anti-Defamation League. Cole earned his Bachelor of Arts Degree from Yale University, magna cum laude, and his Juris Doctor from Harvard Law School, cum laude.
Tony Cignarale, Deputy Commissioner, Consumer Services and Market Conduct Since 2007, Cignarale has served as Deputy Commissioner of Consumer Services and Market Conduct Branch at CDI. He previously served as Chief of the Consumer Services Division at CDI, directing the statewide activities of the Consumer Services Division, which include the Consumer Hotline and consumer complaint investigation units. In addition to overseeing Consumer Services functions, Cignarale oversees the Market Conduct Division, which performs on-site examinations of insurer practices. Cignarale also served at CDI as an Associate and Supervising Compliance Officer. In 2004, he was the recipient of the Insurance Commissioner’s Leadership and Teamwork Award. Cignarale earned his Bachelor of Science degree from Clarkson University and his Juris Doctor from William Howard Taft University, School of Law.
Byron Tucker, Deputy Commissioner, Communications and Press Relations Tucker was appointed to the position of Deputy Commissioner, Communications & Press Relations on December 1, 2003. He is responsible for providing strategic direction and management oversight to the Department's Communications Office, and serves as a spokesperson to the media. Mr. Tucker previously served as Senior Deputy Press Secretary to Governor Gray Davis for three years, overseeing all media operations and strategy for Southern California. In addition to his role as senior spokesperson for the Governor, he provided management oversight to the Governor's Los Angeles office communication staff. Mr. Tucker also served as Press Secretary and spokesperson for State Controller Kathleen Connell for four years where he coordinated all media relations and public outreach. He earned his Bachelor of Science degree in Marketing from California State University, Los Angeles.
Sherwood “Woody” Girion, Deputy Commissioner, Financial Surveillance Girion has previously served as a Deputy Commissioner of the both the Rate Regulation and Consumer Services & Market Conduct Branches at CDI. Girion has more than 33 years of experience with the Department, including establishing the first Consumer Services Bureau, which eventually grew into today's Consumer Services & Market Conduct Branch. He has also served as the Department's Chief of the Financial Analysis Reinsurance and Technical Support Bureau, and as Chief of the Financial Analysis Division. He earned his Bachelor of Arts degree from California State University, Sacramento and holds a Masters of Public Administration degree from California State University, Dominguez Hills.
Rick Plein, Deputy Commissioner, Enforcement Plein was appointed Deputy Commissioner of the Enforcement Branch in 2008 and will continue to serve in this capacity. Plein has more than 20 years of law enforcement experience, having been hired as an investigator for the CDI Fraud Division in 1992. During his career at CDI, Plein has served both Northern and Southern California through a variety of assignments including Supervising Fraud Investigator, Chief Investigator-Fraud Division Headquarters, Chief Investigator-Sacramento Regional Office and Bureau Chief-Northern Region. Plein earned his Bachelor of Arts degree from California State University, Fullerton.
Joel Laucher, Deputy Commissioner, Rate Regulation Laucher has served as the Deputy Commissioner of the Rate Regulation Branch since 2009, managing the property-casualty rate review and prior approval process. He has previously worked in a variety of capacities at CDI, including as Chief of the Market Conduct and Consumer Services Divisions, as well as Chief of the Field Rating and Underwriting Bureau. He has also worked as a Commercial Lines Underwriter at the Great American Insurance Company and the Commercial Union Insurance Company. Laucher earned his Bachelor of Arts degree from the University of California, Santa Cruz.
Robin E. Baker, Deputy Commissioner, Administration and Licensing Services Baker has served as the Deputy Commissioner of the Administration and Licensing Services Branch since February 2010. She has over 33 years of experience in a variety of roles in state government, including two prior appointments as Chief of Administration. She also spent 16 years at the Department of Finance, working primarily as a Principal Program Budget Analyst. Baker has developed an in-depth expertise in the state’s administrative processes and procedures, state legislative and fiscal processes, fiscal and policy analysis, personnel management, and program planning and policy development. Baker earned her Bachelor of Arts degree from the University of California, Los Angeles.
Patricia Staggs, Deputy General Counsel Patricia Staggs, who has served as Deputy Chief Counsel to the Insurance Commissioner for the past 3 years, will continue on in the same capacity. Staggs, who has also served as Interim General Counsel, has supervised a bureau in the Legal Division since 1989, including the Corporate Affairs Bureau, Policy Approval Bureau, Compliance Bureau, and Conservation and Liquidation Bureau. As Deputy General Counsel, Staggs manages and supervises the Legal Division, overseeing its budget, personnel, and other administrative duties. She also oversees legislative analysis and support provided to CDI’s Legislative office, and provides legal advice to Department staff and members of the public on insurance matters. Staggs earned her Bachelor of Arts of Degree from the University of California, Los Angeles and her Juris Doctor from Hastings College of Law in San Francisco.
Ioannis Kazanis, Press Secretary, Communications and Press Relations Kazanis is the primary spokesperson for the CDI, where he also directs the day-to-day operations of the Press Office. He previously served as a Communications Advisor and the Chief Speechwriter for State Superintendent of Public Instruction Jack O’Connell. He also spent time as a Public Information Officer at the California School Boards Association and as Press Secretary to former Assembly Member Nicole Parra. Prior to that, Kazanis worked as a Special Assistant at AKT Development Corporation, a large land development company in Northern California. Kazanis also served in the Administration of former Governor Gray Davis as an Assistant Press Secretary. He earned his Bachelor of Arts degrees from the University of California, Davis and a Masters in Public Administration from the University of Southern California, State Capitol Center.
One year later, law's implementation continues, despite challenges...
HEALTH ACCESS UPDATE Wednesday, December 29, 2010
DESPITE CHALLENGES, IMPLEMENTATION OF FEDERAL HEALTH LAW CONTINUES
* New status report of CA implementation after 9 months (1 year since Senate passage) * Legal and political challenges will get headlines, but work continues * Californians seeing new protections and options now; January 1 brings new benefits * Much more work to do in 2011, for California to take full advantage of the law's promise
Read Our Health Access Blog for More Updates; Also Follow Us on Facebook! Read Real-Time Updates on Legislation on Twitter @HealthAccess!
One year after the U.S. Senate first passed the Patient Protection and Affordable Care Act, and nine months since President Obama signed it (with some improvements that followed), Californians are seeing the new options and benefits, and the state is moving forward to fully implement and improve upon the new law.
Challenges persist, including legal and political obstacles at the federal level, and a looming budget crisis at the state level. Here are some highlights from the Health Access blog in December that provide new updates on health policy in California, and put both the victories and challenges in perspective.
PUTTING THE CHALLENGES IN CONTEXT
* Many wonder what the Republican takeover of the U.S. House of Representatives or the various legal challenges and court rulings will mean for the federal health law passed earlier this year. Some of these attacks are untrue, and/or won’t be a factor, while other threats are in fact, threatening. But others have little chance of ever coming to pass. And it’s important for people to know that the new consumer protections, benefits and options that many families have been anxiously awaiting or have already begun to rely upon will continue.
* While a federal judge in Virginia ruled that one provision of the Affordable Care Act around "individual responsibility" was unconstitutional, he rejected the request to strike down the entire law. It’s important to note that several other legal challenges to the new federal health reform had been dismissed earlier this year, and other judges have upheld the constitutionality of both the requirement for individuals to have coverage, and the new federal law as a whole. So the Virginia case (and a similar Florida case, now being considered) will go to high appeals courts over the next months and year, and likely to the Supreme Court.
* At the state level, the biggest concern for health care and everything else is the state budget crisis. Governor-elect Jerry Brown held budget forums in Sacramento and Los Angeles to explain the depth of the problem, and it’s daunting. It’s important to note that the federal health law has been a benefit, not a burden, to the state’s budget woes.
NEW UPDATES ON CALIFORNIA BENEFITING FROM THE NEW LAW
* New rate review regulations came out from the U.S. Health and Human Services Department requiring insurers to publicly justify their rates. These new regulations, with the new California law SB1163 (Leno) that goes into effect on January 1, will force insurers to give consumers more notice with regard to rate hikes, and to provide the supporting documentation for those increases. As Secretary Sebelius points out in a “White House White Board” video, Anthem Blue Cross’ 39% increases last year had to be retracted because the insurer’s justifications didn’t add up. This is a step for better transparency while health advocates continue to work for rate regulation.
* New estimates presented to the MRMIB Board of Directors suggest the enrollment capacity for the Pre-Existing Condition Insurance Plan to be approximately 24,300. Depending on a number of variables (like how quickly people enroll in PCIP), the federal funding for the program could support as few as 15,400 and as many as 40,400 individuals. The program just started a few months ago, and has over 900 Californians enrolled, so there's more work to do to let people know about this new option.
* The issue of “junk insurance” got more attention with a U.S. Senate hearing on the issues, which featured California Senator Barbara Boxer. There’s more to do to phase-out these plans by 2014, when more of the federal health reform takes effect.
* California has been long remiss in not requiring maternity coverage as a basic benefit, and this has allowed major coverage gaps in our states, especially for those who buy coverage as individuals. As reported in an LA Times article by Duke Helfand, Governor Schwarzenegger has vetoed several bills to mandate maternity coverage—but perhaps a new Governor will be more inclined.
* While California is being spotlighted for its aggressive implementation of federal health reform, it is passing on a competitive funding opportunity for states to design information technology infrastructure for operating health insurance exchanges. With or without this "Early Innovator" grant, there's a lot more for California to do to simplify and streamline our eligibility and enrollment systems to be ready in 2014.
The report includes detractors and supporters--including Health Access California--but the most important were the several people interviewed whose lives will improve as a result of the law. The piece also specifically focused on Fresno, with an interview with a community clinic director and Representative Jim Costa. It's worth your viewing.
Under new health law, more small businesses offering coverage...
Monday, December 27, 2010
For those who have followed the trends, it's startling news. Insurers are reporting that more small employers are signing up for coverage for their workers, as reported by Noam Levey of the LA Times.
For years and years, we've seen a gradual erosion in employer-based coverage, centered with small businesses but including medium and large businesses as well. This has been consistent during prosperous times as well as recessions.
So a reversal of that trend is big news--and it's just one impact of the new federal health law. There is a new significant tax credit for small employers offering coverage to their workers, and it's having an impact.
Let's hope the press picks up on these positive developments from the law. This weekend, on Meet The Press, a political panel broached health reform, even though it was clear they knew very little about the subject. Bob Woodward said he "knew a guy" who read the law twice, and Tom Brokaw was just wrong in talking about the costs to small business--he didn't realize that there is no requirement on small businesses, but rather a tax credit.
And one that is helping small businesses, and their workers.
A year ago, the U.S. Senate had just passed by 60 votes a comprehensive health reform measure. It wasn't the end of the process by a long shot, and there were moments since where the prospect of reform were greatly in doubt--most notably after the election of Republican Scott Brown to replace Ted Kennedy in Massachusetts.
But that historic Senate vote, to pass the Republican filibuster with the unanimous vote of the Democratic Senators, was as important as any other in the law's passage, and that Senate measure served as the backbone of what finally became law.
Nine months ago, on March 23rd, President Obama signed that piece of legislation, the Patient Protection and Affordable Care Act (ACA) into law.
And since then, California have started to see the new options and new benefits from the law, from financial assistance for seniors and small businesses, to new consumer protections against insurance company abuses. More will come as of January 1, including from the laws passed as the state level.
Our new law brings Christmas cheer to CA children..
Wednesday, December 22, 2010
A Los Angeles Times article by Duke Helfand out today reports that California insurers will re-start selling "child-only" policies on January 1st, after they stopped selling such policies because they wanted to avoid covering children with pre-existing conditions.
The move is in response to a new California law (AB2244, by Assemblyman Mike Feuer and sponsored by Health Access California) that goes into effect January 1st, which among other things would bar insurers who didn't sell "child-only" policies from selling new products in the lucrative individual insurance market for five years.
With the federal Affordable Care Act, this new California law, and these announcements from insurers, it's official: every California child is now eligible for coverage, and that's big news. It's a big deal that all children, regardless of pre-existing conditions, can get the coverage and care that they need, and that their family doesn't have to go into debt to do it.
Health and child advocates--and insurers--should get the word out to families that these new options are available. The 100% Campaign has launched a "Health for the Holidays" education campaign encouraging families to sign their children up for coverage.
The new law, AB2244, not only brings insurers back into the market but also limits how much insurers can charge children with pre-existing conditions. Under the new law, children who sign up in an open-enrollment period can't be charged more than twice what other children are charged for the same plan. The open enrollment periods include the first 60 days of 2011, the child's birthday month, and during other changes in life circumstances (change of job or marital status for parent, moving to the state, etc.).
We are pleased that California policymakers took the opportunity to not just implement but improve upon the new federal health law. It wasn't Santa, but the combination of the federal health law and a new California law that changed the behavior of insurers from naughty to nice. This is not just good news for children and their families, this is a important step toward a more just health system.
On August 16, HHS awarded $46 million to 45 states and the District of Columbia to help them improve their oversight of proposed health insurance rate increases. This is part of $250 million that the health reform law makes available to states to take action against insurers seeking unreasonable rate hikes.
Later this year, the California Legislature passed and Governor Schwarzenegger signed SB1163, by Senator Mark Leno, to increase the authority of regulators to review rates, force insurers to justify their rates and make that information public. That state law goes into effect on January 1--and positions California to take advantage of the new regulations announced today.
In 2014, the Affordable Care Act empowers states to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance exchanges.
There's more to do: Both Senator Dianne Feinstein at the federal level, and Assemblymember Dave Jones at the state level, proposed to give regulators full authority to approve and deny rates. While those efforts stalled, we continue to actively support those proposals, but today's announcement is a good first step toward a more accountability and transparency for insurers.
Why does rate review matter. Secretary Sebelius went to the White House White Board to explain, and used California as an example:
There's a new MS. MIB! Starting January 1, 2011, Janette Casillas will be the new Executive Director of California's Managed Risk Medical Insurance Board, or MRMIB (often pronounced "mister mib").
It's a big job. Succeeding Lesley Cummings, Mrs. Casillas has been MRMIB’s Chief Deputy Director for 3 years, and has been with MRMIB for 12 years in several capacities, and before that in the Department of Health Services.
MRMIB runs four key programs that provide subsidized health coverage: * the Healthy Families Program, California's Child Health Insurance Program (CHIP), that provides coverge to over 800,000 low-income children; * the Access for Infants and Mothers program (AIM) that covers pregnant women; and two "high-risk" insurance programs that cover those denied by private insurers because of pre-existing conditions conditions: * the state's ongoing Major Risk Medical Insurance Program (MRMIP); and * the new federally-funded Pre-Existing Condition Insurance Plan (PCIP).
In all, MRMIB programs serve nearly 1 million Californians and MRMIB administers more than $2 billion in state and federal funds in the provision of this care.
We look forward to working with Ms. Casillas in the years to come, as the implementation of the new federal health law continues...
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Earlier this year, we celebrated the passage of historic federal health care reform. It was a hard fought campaign, and we in California are proud that many key consumer protections and ideas that were pioneered in our state were included in the final legislation. The new law provides tangible gains for California patients that include new consumer protections regulating insurance company abuses, providing funds to expand coverage and help make care affordable for low- and moderate-income families, and laying the foundation for reducing costs, improving quality, and encouraging prevention and wellness.
Health Access was thankful the major grassroots organizing and campaign work in California paid off, helping ensure that every Congressional Democrat—33 Representatives and our two Senators—supported health reform, despite California's large contingent of “Blue Dogs,” the most (7) of any state. Of the 12 biggest states, only California and Michigan showed such unity on such a crucial issue.
But we were mindful that with that victory our work didn’t end, but it exploded with a new array of challenges and opportunities. Its success or failure here in California depends on our continued activity and vigilance in the coming months and years.That's why we need your support.
Consumer and community advocates have the daunting task of guiding specific policy and regulatory implementation to ensure that health reform is consumer-friendly, and fulfills its promise; at the state and federal levels, through legislation and regulation.
We started quickly, and California has taken the lead implementing and also improving upon the federal law.
Several new laws were enacted this year. Most significant was the creation of a state health insurance Exchange, a core element of health reform. Beginning in 2014, the new Exchange will be the one-stop shop for getting health coverage for individuals and small businesses, providing easy-to-compare choices, accessing federally-funded subsidies to make coverage affordable, and amassing the bulk purchasing power of millions of Californians to bargain for the best price and value.
We also passed laws to enact and improve upon key consumer protections in the federallaw, such as to ensure access to coverage for children with pre-existing conditions. There's more work to do on this issue and many more.
Also important is the new Medicaid Waiver agreement between the state and federal governments establishing a plan for the next five years for Medi-Cal, the 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. The new waiver includes important investments in the health care system, and at our urging allows 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.
As historic as our victory to pass the federal law, and as significant as our work to get California to act quickly and affirmatively is, there’s much more to do at regulatory agencies and in the legislature to put the pieces together to fulfill the promise of health reform.
At the same time we are moving forward to implement and improve federal health care reform, the state’s ongoing budget crisis threatens devastating cuts that jeopardize California’s existing health care safety-net on which millions already rely.
Now, more than ever, Health Access is in a crucial position to protect against further budget cuts and work to restore health care services in California, while undertaking to implement and protect the federal health reform law.
Your gift will help us educate the public about the benefits of health care reform, and fight back against the powerful opposition that is already working to “repeal and replace” this landmark law.
It will also help us guard against significant setbacks from budget cuts that threaten to cripple our health system, our families, and our economy. We will make sure that the real cost and impacts of proposed cuts are understood, offer alternatives to them, and work with grassroots groups to make sure the voices of their constituents are heard.
At this crucial time, we need to prevent the worst, both with budget cuts and efforts to repeal reform; but also to organize and advocate for the best, for both a better implementation and to go beyond the federal law.
With your support, Health Access Foundation will continue to empower Californians to engage in the debate, and to win policy victories on behalf of health care consumers.
We would greatly appreciate your contribution to help make it a happy and healthy new year. Thank you for your consideration.
Sincerely,
Anthony Wright Executive Director Health Access Foundation
The health care debate itself offered so many choices (last year's winner was about "death panels"), but this was not just error by some, or statement by fringe leaders, but a standard talking point. As PolitiFact says, "The phrase is simply not true." Several other independent observers have debunked this, including FactCheck.org, and others.
When Speaker Boehner's office was asked about why they repeatedly used such an obviously false phrase, the spokesperson simply repeated it again.
Assembly Speaker John Perez has announced the new Committee assignments for 2011-12 legislative session.
In this crucial time, we have good legislative leaders in the Assembly, starting with Speaker John Perez himself, who actively supported efforts to implement the federal health law as soon as he became Speaker, and is meeting in DC this week about the new Exchanges.
We are excited to work with the chairs of the key policy and budget committees on health:
Assemblymember Bill Monning (D-Santa Cruz/Monterey) will continue to chair the Assembly Health Committee. Last year, Chairman Monning was very involved in the implementation of the new federal health law and sponsored key bills, and is expected to continue his leadership role in health issues--an area in which he and his wife (a physician) have had a longstanding interest and history. He also will serve on the Assembly Budget Subcommittee on Health.
Assemblymember Holly Mitchell (D-Los Angeles) will chair the Assembly Budget Subcommittee on Health. She's a new member, but has deep knowledge of these issues, as a former legislative staffer on health and human services issues under then-State Senator, now-retiring-Congresswoman Diane Watson, and as an advocate with our ally Western Center on Law and Poverty, and our board member California Black Woman's Health Project.
Here are the committee lists:
Assembly Health Committee
Assemblymember Bill Monning, Chair Assemblymember Tom Ammiano Assemblymember Toni Atkins Assemblymember Susan Bonilla Assemblymember Mike Eng Assemblymember Richard Gordon Assemblymember Mary Hayashi Assemblymember Roger Hernandez Assemblymember Bonnie Lowenthal Assemblymember Holly Mitchell Assemblymember Richard Pan Assemblymember V. Manuel Perez Assemblymember Das Williams
Assemblymember Dan Logue, Vice Chair Assemblymember Martin Garrick Assemblymember Allan Mansoor Assemblymember Brian Nestande Assemblymember Jim Silva Assemblymember Cameron Smyth
Assembly Budget Subcommittee No. 1 on Health and Human Services
Assemblymember Holly Mitchell, Chair Assemblymember Wesley Chesbro Assemblymember Bill Monning Assemblymember Bob Blumenfield (Alternate)
Assemblymember Kevin Jeffries Assemblymember Allan Mansoor Assemblymember Jim Nielsen (Alternate)
Administration Declines Opportunity for Exchange Grant
Wednesday, December 15, 2010
In October, the Department of Health and Human Services (HHS) announced a competitive funding opportunity for states to design information technology infrastructure for operating health insurance exchanges. These "Early Innovator" grants were intended to provide incentives to states (who would have to create IT infrastructure for exchanges anyway) to demonstrate leadership by creating simple, consumer-oriented IT models that could then be used by all states in their efforts to establish exchanges.
The Schwarzenegger administration announced today that California would NOT be applying for the grant due to a "lack of consensus." Consumer advocates are disappointed that the Administration is letting this important funding opportunity pass. Part of the issue was the Administration's preferred online-focused approach to application and enrollment, a process that many were concerned did not provide the assistance that many Californians would need to get enrolled in coverage. Regardless of the different options moving forward, we hope the new Brown Adminstration makes this a priority ASAP, so that California has the time to get ready for 2014.
New estimates presented to the MRMIB Board of Directors today suggest the enrollment capacity for the Pre-Existing Condition Insurance Plan to be approximately 24,300. Depending on a number of variables (like how quickly people enroll in PCIP), the federal funding for the program could support as few as 15,400 and as many as 40,400 individuals.
As of the beginning of December, enrollment had increased (by 63% in November) but was still only covering around 800 individuals, a fraction of those that California has been funded to serve. Communities of color and non-English speakers are underrepresented.
The program has done outreach by calling brokers and offering them cash incentives for enrolling people, and has added an outreach tab on their website where materials can be downloaded for people who do not have Internet access.
This rate of enrollment reiterates the great importance of creating a glide path to full implementation of federal reform so that we are ready from day one to take full advantage of future federal funding and opportunities to provide coverage to more people. As we begin to plan for implementation of Medicaid expansion and the Exchange, we must move quickly to ensure access to those who need coverage.
Today's MRMIB meeting was also significant as it marked the retirement of Lesley Cummings as the Executive Director of the agency. We look forward to working with the Executive Director, once appointed, in order to ensure that the interests of consumers are served in the programs MRMIB oversees.
California has been long remiss in not requiring maternity coverage as a basic benefit, and this has allowed major coverage gaps in our states, especially for those who buy coverage as individuals. This issue is spotlighted by an LA Times article by Duke Helfand, and on one California family of Joanna Joshua and Kyle Winning who faced limited choices and significant problems.
The article reports that out of 295,000 California women of childbearing age who buy their own policies, 81% do not have maternity benefits.
The article mentions various legislative attempts to require maternity benefits, which were vetoed multiple times by Governor Schwarzenegger. We'll see if Governor Brown stakes a different position.
There's also an additional argument: with the implementation of federal health reform, maternity will be a required benefit in 2014. So the question is no longer whether it should be in a basic benefit package, but when we should do it. It makes a lot of sense to phase in the requirement over the next few years, not just to provide a benefit to consumers but to smoothly transition the marketplace. This will be one of several issues that will be revisted in the next year or two.
The consumer representatives also include academics like Tim Jost and advocates from our fellow state-based health consumer advocacy groups in Maine, Massachusetts, Colorado, Texas, and Wyoming, as well as national groups like Consumers Union, National MS Society, American Cancer Society Cancer Action Network, and Georgetown University Health Policy Institute. Two other representatives from California include Amy Bach of United Policyholders and Bonnie Burns from California Health Advocates. Newly appointees for 2011 include consumer representatives from the Center for Budget and Policy Priorities, Young Invincibles, the American Heart Association, the Brain Injury Association, and Autism Speaks.
The good news is that these consumer advocates get access to key conference calls and meetings where a lot of key issues are discussed around the implementation of the Affordable Care Act--the NAIC is given specific tasks in the ACA at least a dozen times.
The bad news is that there are literally hundreds of hours of meetings and conference calls, and these handful of consumer advocates need to counter the force of literally hundreds of insurance industry lobbyists. They have been remarkable effective given their numbers and their limited resources.
We are very glad that the team is back together again, with some new good additions, in 2011 and the crucial implementation work coming.
Many Americans wonder what the Republican takeover of the U.S. House of Representatives or the various legal challenges and court rulings will mean for the federal health law passed earlier this year—including the new consumer protections, benefits and options that many families have been anxiously awaiting or have already begun to rely upon. Some of these threats are in fact, threatening. But others have little chance of ever coming to pass.
The key fact is that the Affordable Care Act (ACA) is now the law of the land, and even with their electoral victories, opponents of health care reform lack the power to repeal the law. Of particular note, the consumer protections that started to take effect this year—from prohibiting insurers from canceling coverage when someone gets sick, to eliminating co-payments for preventative care—will continue.
While there are some areas of concern, seniors need not fear that they will lose their $250 prescription drug rebates. Young adults who have recently gained coverage under their parents’ plans need not fear becoming uninsured again. People previously denied coverage due to their health status need not worry that the new pre-existing condition insurance program (PCIP) option will disappear. Small business owners can rest assured their tax credits for providing health care to their workers are safe.
Nonetheless, here is a look at some of the threats to the ACA and an assessment of how worried consumers should be.
Congressional Repeal: With the Republicans winning a majority in the House, they will likely act quickly to pass a bill seeking to repeal ACA. The bill will make a big splash in the headlines, then stall in the Senate, where the Democrats still hold sway. A complete repeal of the bill would mean an increase in the federal deficit, which would be politically unpopular. Without the real possibility of repeal, the health care reform law will remain the law, and newly enacted consumer protections will remain intact. The possibility of a full repeal is dependent on the results of the 2012 presidential elections; without a change in party, repeal won’t happen.
Congressional Oversight: The House GOP can use its oversight authority to bury the Department of Health and Human Services (HHS) in investigative hearings and try to distract the agency from the work of implementing the ACA. However, though HHS plays an important role, most of the work to implement the law will need to be done by the individual states.
Defunding: Republicans have threatened to hobble the ACA by refusing to appropriate any money to help the law take effect. But most of the funding needed to implement the law does not require congressional approval. Nor can Congress take away funds for expanding Medicaid or creating state insurance Exchanges. That said, a showdown is likely in those areas that need Congressional approval—from funding for consumer assistance programs, to investments in prevention and public health, to pilot programs aimed at reducing the cost of health care. These programs need active support to continue in the next Congress.
Judicial Challenges: The majority of the legal challenges to ACA have been dismissed, but there are a few still making their way through the courts. A Republican-appointed judge in Virginia ruled on Monday that the ACA’s requirement that individuals must have coverage is unconstitutional—but he allowed the rest of the law to stand. The ruling will be appealed, and if it is upheld, the ACA can be fixed to deal with the legal issues. California reformers remember that Healthy San Francisco, a version of health care reform for low- and middle-income residents of that city, was struck down by the first court that reviewed it, but eventually upheld by the U.S. Supreme Court. Until the Supreme Court weighs in, implementation of the ACA will continue.
State Cooperation: Gubernatorial elections that resulted in victories by opponents of the federal health law do pose a threat to the ACA. States have considerable leeway to implement the ACA; in the name of ideology, they could even refuse federal dollars meant to provide health care to their residents and to benefit their doctors, nurses, hospitals, and clinics.
California has not had this problem. Voters re-elected every congressional representative who voted for the ACA, as well as a new governor and attorney general who have pledged to fight for it. California has moved forward aggressively, passing some of the first bills in the nation to implement and improve upon the federal law.
The bottom line is this: California’s families should disregard most of the political theater in Washington D.C. and see how health care reform benefits them. With a disproportionate share of uninsured Americans, and a health care system at a breaking point, California needs all the help it can get. California voters should take advantage of the new benefits and options under ACA—and continue to press our elected leaders to seize the opportunities available for our state.
This was originally written for New America Media by Linda Leu and Anthony Wright of Health Access California.
Please see this important opportunity from our colleague Mike Odeh at Children Now:
One of the most important gifts an uninsured child can receive this holiday season is the gift of health care. Nearly 7 out of 10 uninsured children in California are eligible for a health coverage program but not enrolled, so help us spread the word to parents that coverage for their children is available.
You can help by sharing information with parents on how to apply for children’s coverage.
Download a flyeror choose from one of four card designs [1, 2, 3, 4], to share with a family you know! Share the information with parents at your place of worship, workplace, PTA meetings, school events, or kids’ sports events. Together, with your help, we can make 2011 a healthier year for California children (also available in Spanish).
Get the message out with the sample posts below that you can TWEET, TEXT, or POST on your Facebook page!
The book recounts his time as a senior insurance executive at Cigna, and then his transition after retirement to an outspoken critic of the insurance industry and of corporate public relations. He came to many people's attention on June 24, 2009, as a "whistleblower" testifying in the Senate on the pending health reform bill:
"My name is Wendell Potter, and for twenty years I worked as a senior executive at health insurance companies. I saw how they confuse their customers and dump the sick—all so they can satisfy their Wall Street investors." That statement began a very public effort to spotlight insurance industry practices. Wendell Potter's actions, including appearing regularly in print and on MSNBC and other cable TV outlets, helped provide a counterbalance to insurance industry attempts to undermine the bill.
When the bill passed, he could have just faded back into the woodwork, but he signed up for real work, as a designated consumer representative at the National Association of Insurance Commissioners. He served along with our Health Access colleague Beth Abbott and about a dozen others, to counter the pressure for literally hundreds and hundreds of insurance company lobbyists--on issues relating to the implementation of the new federal health law. He's helped provide a spotlight to the behind-the-scenes work at the NAIC, publishing op-eds in the Huffington Post and elsewhere about what is going on, and working with advocacy groups like Health Care for America Now!
Working closely with Wendell at the NAIC, we appreciate his work and recommend his book. We are happy to cosponsor an event for him to speak today at The California Endowment, an event that quickly filled up. There are other events in Pasadena and elsewhere before he leaves the state. But even if you don't get to see him in person, we hope his voice will be heard as we embark on the critical role to fulfill the promise of the new federal law.
Just when we were ready to completely give up hope that higher purpose could transcend partisan politics, today President Obama signed into law the bipartisan-supported Healthy, Hunger-Free Kids Act.
Championed by First Lady Michelle Obama and California Representatives George Miller and Lynn Woolsey, the law passed with unanimous consent in the Senate before being signed into law by the President today. The law allocates $4.5 billion to child nutrition programs over the next 10 years to support programs such as school lunch, upon which 32 million children in America depend on as an important source of nutrition. For some, school lunches and school breakfasts are the most reliable source of nutrition they have. In addition to expanding access to and improving the quality of school lunches, the law also limits junk food in schools (though it is not a "cookie ban").
As obesity and childhood obesity epidemics sweep the country, causing diabetes, heart disease, and other health problems that are taxing the health care system, nutrition will play a key role in the health landscape of the future.
After several legal challenges to the new federal health reform earlier had been dismissed earlier this year, and other judges have upheld the constitutionality of the new federal law, another federal judge in Virginia ruled today on the Affordable Care Act, declaring one provision around "individual responsibility" as unconstitutional, but rejecting the plaintiff's request to strike down the entire law.
Multiple judges have dismissed challenges to the federal law, and upheld it as constitutional, and we have confidence that will be the case when all the litigation is complete. As the Virginia judge said, 'the final word will undoubtedly reside with a higher court,' in the months and years ahead.
For Californians, we've seen this before: The groundbreaking Healthy San Francisco law was challenged by a lower court ruling, but was eventually upheld on appeals all the way through the Supreme Court. While the legal issues were different, we expect a similar result--that the health reform law will be upheld and California will be able to get the new options and benefits from the law.
What's important for patients to know is that the consumer protections under the new federal law are still in place, and are unchallenged.
In fact, even this judge rejected arguments to strike down the entire Affordable Care Act, and focused on just the requirement of individuals to have coverage. Even if this provision is struck down, it is fixable with other alternative policies to encourage people to get and keep coverage,
The implementation of the new federal law will and should continue, especially in California, where we need all the help with our health system we can get.
Thanks to the new federal health law -– more than 27,000 young adults were added to their parents’ health plans effective next month. CalPERS also removed lifetime limits from all plans that previously had included them.
Most of interest, CalPERS took advantage of subsidies for early retiree coverage to keep premium costs down; this program helped hold premiums to their lowest increase in 14 years, and CalPERS estimates savings of about $200 million for more than 115,000 early retirees and their families.
Even though it was only a small mention in today's budget forum, I feel the need to disagree and clarify a comment about health reform made by the former and future Finance Director Ana Matosantos. Slide 9 of her budget presentation flags "threats and future pressures," and includes federal health reform on the list, alongside pensions, a deficit on unemployment insurance, and budgetary borrowing. In her verbal presentations, she correctly stated that there aren't any costs in the next several years.
Two comments: the $3.5 billion stated cost of health reform is a *very* high estimate--and that's only after 2020-21. In the current year, health reform is actually providing hundreds of millions of dollars in state savings, in both the current year, budget year, and on. The new Medicaid waiver, which takes advantage of new opportunities under the new federal law, brings in a couple of billion of dollars a year for the next year years, and a portion of that helps our state budget situation. So any calculation of health reforms "costs" should include how it provides savings--not to mention benefits, such as more Californians covered, etc.
Those costs do not start this year, next year, or for a while. The state's Medi-Cal program doesn't get expanded until 2014, and 100% of the cost of the newly eligible population is federally funded for three years, until 2017. Only in 2017-18 does the state need to contribute, scaling up to 10% of the cost in 2020--and even then, the federal government picks up 90% of the cost.
As for the cost in 2020, the number is high, and assumes a significant Medicaid provider rate increase. While such an increase is highly desired given our very low rates currently in place, it's not something required by the new federal law. California may want to revisit its rate structure, but that's a longstanding issue only partially related to the federal law.
Beyond the grant opportunities in the health law, and the funds we secured through the Medicaid waiver, we should see the Affordable Care Act as an opportunity to maximize federal funds--as a benefit, not a burden.
Governor-Elect Jerry Brown convened a budget forum this morning to discuss the budget situation with the purpose of reaching consensus on the facts related to the budget crisis. "We can’t come to agreement if we don’t have a consensus on the underlying facts," he said, "then we can discuss full range of solutions."
* The biggest General Fund expenditure is Education, with 30% going to K-12 Education and another 10.6% going to Higher Ed. Health Care is next at 22.3%, followed by Human Services at 10.8%.
* 71% of all General Fund goes toward local assistance.
* The LAO's projected deficit is $25.4 billion, with an additional potential loss of $2.7 billion (as a result of the proposed action in Congress now pending around the Estate Tax), which would result in a total deficit of $28.1 billion.
* Without revenue growth or ongoing solutions, deficit will persist. Full recovery from the recession could take up to 8 years.
* Recent budget solutions have been temporary or never materialized. In the last 3 years 74%, 84%, and 85%.
* California's credit rating is the lowest of all states, and is at risk of further down grading as a result of the structural problems with our budget process.
* We could face another cash crunch as early as July.
The complete presentations by Governor-Elect Brown, Treasurer Lockyer, and Controller Chiang can be found here. On the dais was also Senate President Pro Tem Darrell Steinberg, Assembly Speaker John Perez, and Assembly Minority Leader Connie Conway. Senate Minority Leader Bob Dutton was in attendance, but in the audience and not on stage.
Following the presentation of facts, which Brown called the worst budget yet, there were a series of questions and answers. But there is no question that this is going to be a gruesome budget.
Assemblyman Bill Monning drew applause when he asked about potential revenue sources. Brown deferred to the others on the dais and Speaker Perez suggested putting the Oil Severance Tax and the Income/Sales Tax Swap back on the table. Representatives from counties asked questions about realignment.
In concluding the forum, the Governor-Elect acknowledged the hard work ahead but expressed confidence that if we all work together, and everyone gives a little, we can get the state back on track. "Everything should be on the table," he said, "and everyone should be at the table to talk about it."
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.
