Today the Assembly Budget Subcommittee on General Administration considered and adopted on a party-line vote 3-2 the proposed budget for the Department of Insurance. Since both the Senate and Assembly budget subcommittees have adopted the same language, the budget for the Department of Insurance for next year is close to final.
This budget includes funding for implementing state and federal legislation enacted last year, including SB1163 authored by Senator Mark Leno (and sponsored by Health Access) on rate review as well as AB2470 by Assemblymember De La Torre ending rescission.
Importantly, Republican Assemblymember Dan Logue asked whether the Legislative Analyst Office had opined that operating the exchange would require a two-thirds vote because of Prop. 26. The LAO responded that so long as the exchange levied fees for services provided, these would be fees under Proposition 26 rather than taxes requiring a two-thirds vote. Also, the statute that creates the exchanges gave the exchange authority to levy fees.
Overall, twelve judges have thrown out cases on the constitutionality of the health reform law. Of those two upheld the law. One judge in Virginia struck down just one provision. This Florida judge is the only one to challenge the full law.
Judge Vinson has produced a stunningly ideological and extreme opinion (that even invoked Tea Party rhetoric), legislating from the bench to reopen the health care debate by going well beyond precedent. Fortunately, the judge’s partisan findings are of limited impact because the U.S. Supreme Court will have the final say on the legal challenge to the Affordable Care Act. Two other federal district judges have already upheld the law.
Californians should be clear that they still have their new benefits, new health coverage options, and new consumer protections under the federal health law. Even this judge has allowed the implementation of health reform to continue, so California should continue to prepare, especially as it is likely the Supreme Court will ultimately uphold the full law.
Congress clearly has the authority to regulate the health insurance market, including protecting consumers from insurance industry abuses and reducing costs for families, seniors and businesses.
Californians already are benefiting from this law. Without the law in place, young adults would lose their coverage under their parents' coverage; millions would be subject to lifetime caps on health plan benefits and no limits on the share of premiums that could go to profits, executive pay and overhead; seniors would be forced to pay a co-payment for important preventive services, including an annual checkup.
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 likely to stay. 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.
Many Health Access California staff, board members, and allies braved tough weather and flying conditions--which caused many to get stalled at airports across the country--to attend the Health Action 2011 conference hosted by Families USA. There was special reason to go this year, after last year's passage of the historic health reform.
There was a star-studded list of presenters, including California Representatives Nancy Pelosi and Xavier Becerra. You can get a good sense of the comments and proceedings from the conference website, from our Twitter feed @healthaccess, or by using the Twitter hashtag #HA2011.
But the highlight was President Barack Obama himself, who thanked health and consumer advocates for their efforts in support of the passing of the Affordable Care Act. And the crowd was mightily appreciative of President Obama for his efforts as well.
The full text of his speech is at the White House website. A full feed of the video was broadcast at C-SPAN. Here's a few snippets from the talk from the Associated Press:
Here's some specific quotes from the speech:
Even before the pangs of this historic recession that we’ve just gone through -- so four years ago, that was still on the horizon -- our friends and neighbors were already dealing with the anxiety and the cruelty of a health care system that just did not work for too many American citizens.
We believed we could change that. We believed that we could finally guarantee quality, affordable care for every American. And even though I hadn’t announced my candidacy for this office, I joined you that day in a promise, that we would make health reform a reality by the end of the next President’s first term. That was our commitment.
That was our commitment, and together that is what we did. That is what you did. So thank you for all those years of work to help make it happen. I couldn’t be prouder of you.
Now, since I signed the Affordable Care Act into law 10 months ago, Americans already have more power, greater freedom, stronger control of their health care. This law will lower premiums. It is limiting costs. It is reigning in the worst abuses of the insurance industry with some of the toughest consumer protections this country has ever known. This is making a real difference for families across this country as we speak.
Now, it’s no secret that not everyone in Congress agrees with this law. And as I said on Tuesday, I believe that anything can be improved. As we work to implement it, there are going to be times where we say, you know what, this needs a tweak, this isn’t working exactly as intended, exactly the way we want. Here’s a way of doing it smarter, better. We may be able to serve families to lower costs and improve care every more.
And so I’m willing to work with anyone, Republican or Democrat, to make care better or to make their health care more affordable. I’ve even suggested we begin by correcting what was a legitimate concern, a flaw, in the legislation that placed unnecessary bookkeeping burdens on small businesses. I’m open to other ideas, including patient safety innovations and medical malpractice reform.
But here’s what I’m not open to, and I said this on Tuesday. I am not willing to just refight the battles of the last two years. I’m not open to efforts that will take this law apart without considering the lives and the livelihoods that hang in the balance....
Now, as important as what is happening right now is what isn’t happening right now. You may have heard once or twice that this is a job-crushing, granny-threatening, budget-busting monstrosity. That's about how it’s been portrayed by opponents. And that just doesn’t match up to the reality. I mean this thing has been in place now for 10 months, all right?
So let’s look at what’s happened over the last 10 months. Not only has the economy grown and added jobs since the Affordable Care Act became law, but small businesses across the country have already chosen to offer health care to hundreds of thousands of their employees, many for the first time. That’s something that regardless of politics, we should all celebrate.
Estimates from the Business Roundtable -- now this isn’t some left-wing organization -- the Business Roundtable, the organization of all the country’s largest corporations, and other experts indicate that health insurance reform could save large employers anywhere from $2,000 to $3,000 per family, per year, that they cover in health care costs by 2019. And that’s money that businesses can use to grow and invest and to hire. That’s money that workers won’t have to see vanish from their paychecks or bonuses in the form of higher deductibles or bigger co-payments. That’s good for all of us.
And I can report that granny is safe. In fact, grandma’s Medicare is stronger than ever. And if she was one of the millions of seniors who fell into the doughnut hole last year, she received a $250 check, or soon will, to help her afford her medications, and a new 50 percent discount on brand-name drugs, as part of the Affordable Care Act. (Applause.)
Finally, because it is absolutely true that we’ve got to get a handle on our deficits, that the debt we are carrying right now is unsustainable if we don't start taking action, it is important for us to be clear about the truth when it comes to health care reform.
Health reform is part of deficit reform. We know that health care costs, including programs like Medicare and Medicaid, are the biggest contributors to our long-term deficit. Nobody disputes this. And this law will slow these costs. That’s part of the reason why nonpartisan economists, why the Congressional Budget Office, have said that repealing this law would add a quarter of a trillion dollars to our deficit over the next decade, and another trillion dollars to our deficit in the decade after that. They’re not just making this up. And what’s more, repeal would send middle-class premiums up, would force large employers to pay that extra $2,000-$3,000 per worker, and shift control of your health care right back to the insurance companies.
Now, I’ve repeatedly said, I believe that our system of private insurance is strong and viable, and we need it to be. It saves lives. It employs large numbers of Americans. And by the way, it’s still making pretty good profits. But just as we are a people who believe in the power of the individual, the promise of the free market, we are also a people who believe, from the time of our founding, that we aspire to protect one another from harm and exploitation.
Our task has always been to seek the right balance between the dynamism of the marketplace, but also to make sure that it’s serving people. And sometimes that means removing barriers to growth by lifting rules that place unnecessary burdens on business, but other times it means enacting common-sense safeguards like these -- like the Affordable Care Act -- to ensure our American belief that hard work and responsibility should be rewarded by a sense of security and fair play.
That’s at the heart of this reform. That’s why we fought so hard for this reform. That’s why we have to keep on telling people across the country about the potential of this reform and what it means for them and their families. And that’s why we’re not going to fall back.
I don’t want to tell students that we’re booting them off their parents’ coverage. I don’t want to tell seniors that their medicine is out of reach again. I don’t want to tell Janine her taxes are going back up, or Gail that she’s got to choose between keeping her home and getting well. I don’t want to tell Dawn, or any other mother, that their child can’t get the care that he or she needs after all.
I don’t want that for America. I don't want that for our families. That’s not who we are and that’s not what we stand for. We don’t believe that people should have to hope against hope that they’ll stay healthy, or hang all their fortunes on chance. We don't believe, in a country like ours, that one in 10, one in eight of our citizens should be that vulnerable no matter how hard they’re working. We believe in something better.
So the time for fighting the battles of the last two years has now passed. It’s time to move forward. And these efforts -– strengthening our families, getting our fiscal house in order, allowing small businesses to grow, allowing entrepreneurs to strike out on their own free from crushing costs –- they’re critical to our economic success. And by reforming our health care system so it doesn’t dictate anybody’s economic fate, America can decide its own.
Today, after a thorough hearing about the health cuts, we write to describe proposed cuts that will result directly and quickly in patient deaths as well as homelessness and institutionalization.
People will die
Ten doctor, clinic and outpatient visits per year.
* People on kidney dialysis will be cut off after ten treatments when they need twelve to fifteen per month. So they will begin to die within 30 days of the implementation of the proposed budget cut. * People with cancer will be cut off after ten treatments. Standard treatments for breast cancer include external beam radiation is given five days a week, usually for six weeks and chemotherapy is done every two to three weeks for three to six months. In the words of the Cancer Society, “Ten doctor’s visits would not allow a woman to complete any one of these courses of treatment. Furthermore, these numbers do not take into account the visits required to diagnose the cancer, any visits that are required to determine the course of treatment, and visits that may be needed to address potential adverse reactions, like toxicity from the chemotherapy.” * Persons with HIV/AIDS will get ten visits per year, even if medication interactions or opportunistic infections require more. * Allergy injections will be cut off at ten, even if asthma attacks put the lives of patients at risk. * Organ transplants: no one who needs an organ transplant or who has had an organ transplant of any sort will get more than ten visits. This is worse than Arizona which only stopped coverage for certain kinds of organ transplants: this will affect ALL organ transplants.
The Administration says that 90% of beneficiaries will not be affected. These cuts affect the 10% sickest and poorest Californians on Medi-Cal. Will 10% of the 7.7 million plus Medi-Cal beneficiaries die? Perhaps not. Will tens of thousands die? Certainly.
This cut reduces the number of outpatient visits from 3.3 million to 2 million, a reduction of 40%. For the 700,000 Californians who will be affected by this cut, it is literally a choice between life and death.
Six prescriptions per month, not one more.
Today a woman testified who had been university faculty who has both bladder cancer and a neurological ailment: she now takes seven medicines a day when she is healthy and more when she gets sick.
Today California has a “soft” cap of six prescriptions: it means that someone who needs more can go through an authorization process to get them. This discourages frivolous use of medications but allows those who really need drugs to get them. This is what the Administration proposes to end.
How many Californians will die as a result? We don’t know. But many of them will be the same people affected by the cap on doctor visits: people on dialysis, those with cancer, HIV/AIDS, lupus and other extremely serious conditions.
Wound care
Most people will never need wound care. Most people will never have a bed sore so deep that you can see the bone. But for those Californians who are living at home and who rely on Medi-Cal, if they get a bed sore, their wound care will be so limited that they will never recover from it. Lack of adequate wound care kills people. Florence Nightingale knew as much. This budget proposal does not.
People will be homeless
$200 to go to the hospital, $50 to go to the emergency room—for people living on $600-$800 a month
The Governor’s budget includes copays of $100 a day for hospital care, up to $200. For someone living on $600 to $800 a month, this is literally a quarter or a third of their income. They will be faced with the choice of spending next month’s rent or not going to the hospital when it is medically necessary.
For many of us, $50 is not a lot. It is a lot if you are trying to get by on $600 a month. Some people who should go to the hospital will not. They will die. Other people will go to the emergency room: they will spend next month’s rent money or the money to pay the electric bill. If they spend next month’s rent, they will be homeless.
When I began this work 25 years ago, a visit to the emergency room was the most common cause of homelessness among families. This budget proposes to return us to those dark days.
People will be institutionalized
The budget proposes to eliminate the adult day health care that 34,000 Californians rely on: seniors, persons with disabilities, veterans, people who contributed. Every one of those who is eligible for adult day health care is eligible for nursing home care. Not all will be admitted. In some families, someone will quit their job to stay home to care for the family member but they will not be a nurse or a social worker or trained to care for those with severe limitations—it may be all right for a while (aside from the impoverishment of the family) but these seniors and persons with disabilities will destabilize at some point, beyond the capacity of the family member to cope. Then either the Californians who need care will be institutionalized or they will die.
May Ed Roberts Rest in Peace
For those of us who knew Ed Roberts or knew of him, we know he was not a peace-able soul. He served in the first Brown Administration and broke barriers for the disabled just as Martin Luther King fought for civil rights. Breaking barriers is not work for peaceful souls.
The cuts in this budget will prevent those with comparable disabilities from leaving their homes. The limits on wheelchairs will means that only the most basic wheelchairs (think about the wheelchairs at airports) will be available to those on Medi-Cal.
Cut after cut is aimed at seniors and those with disabilities. Who needs incontinence supplies or catheters? Who is bed bound and needs wound care? Who needs an adjustable wheelchair? Who needs multiple prescriptions or frequent doctor visits? Persons with disabilities and seniors.
With the State of the Union last night, there's been a lot of commentary. I had the pleasure of listerning to Jon Cohn of the New Republic yesterday evening, who later wrote that the President did what he needed to do on health care: vigorously defend the new law, acknowledge that improvement can and should be made, and move on with its implementation and other issues.
On the whole issue of repeal, here's a new White House White Board, talking about the implications of repealing the new law.
The Assembly Budget Subcommittee on Health and Human Services considered a proposal by the Department of Managed Health Care today to increase staffing in order to implement rate review and other important consumer protections passed last year.
DMHC plans to increase it's capacity to deal with consumer complaints. Additionally, the Department proposes to hire two actuaries to take on the task of reviewing rate filings from insurers.
Like the request from the Department of Insurance that the Senate considered earlier today, the funds (a much leaner $1.7 million) would come from special funds, and would have no impact on the State General Fund.
In both cases, the Legislative Analyst's Office opposed moving forward with staffing augmentations at this time, instead requesting more time to analyze redundancies between the requests from the two departments.
Advocates argued that any need for further study not hinder the need to move forward, especially in light of the plethora of premium increase filings from insurers in the state. The Subcommittee voted in favor of moving the request forward.
Resources for rate review and more in California...
The Senate Budget Subcommittee on State Administration and General Government considered the budget of the California Department of Insurance (CDI) this morning, including augmentations that would assist in the implementation of some of the insurance regulation legislation passed last year.
Under former Insurance Commissioner Poizner, the Department of Insurance was stripped of staff and budget. Commissioner Jones has requested additional resources, using the Insurance Fund (with no State General Fund impact) to add staff to the department, to work on rate review, insurance review related to rescissions, and other legislative requirements signed into law last year.
One of those requirement is a new rate review measure, SB1163, chapter 661 of 2010, authored by Senator Mark Leno and sponsored by Health Access California, which was based on federal law and guidance. It is also necessary to implement the Affordable Care Act in California; otherwise, the federal Health and Human Services Department would intervene to take over the responsibility for review of health insurance rate increases for individuals and small businesses for California.
The new rate review guidance and regulations under both state and federal law has important roles for both CDI and the Department of Managed Health Care (DMHC). It requires that insurers provide proposed rate increases 60 days in advance, that the departments accept public comment during the 60 day period and that insurers provide substantial evidence to support the rate increases. It also permits the regulators to hold public hearings and to retain actuaries to review any proposed rate increase.
At this time, no insurer and no health care service plan appears to be complying with the law which went into effect on January 1, and covers rate increases on or after that date.Anthem Blue Cross has filed rate increases with DMHC that are effective April 1 and that plainly fail to meet the standards of state law and federal guidance. Both Anthem Blue Cross, as well as Blue Shield, have argued that the law hasn't gone into effect yet, based on their late 2010 filing.
Both departments need the resources to pursue delinquent insurers who have shown scorn for state law and federal guidance. Both departments will also need resources to meet the new responsibilities of SB1163 to provide scrutiny of all health insurance rate increases for individuals and small businesses as well as unreasonable rate increases for larger businesses.
The sub committee disagreed on the importance of providing the Department of Insurance with adequate staffing and resources to fulfill its rate review and health insurance oversight responsibilities.While Chair Rubio expressed concerns that the request was not enough, Senator La Malfa expressed his hesitation to “prematurely” jump in to implementing “Obamacare”.La Malfa expressed a belief that the health care law in DC was “still taking shape” and protested to moving forward despite Commissioner Jones’ clarification that rate review and insurance oversight by the Department of Insurance were required by new California laws SB 1163 (Leno) and AB 2470 (De La Torre) that were signed by former Governor Schwarzenegger last year.Jones also touched upon the importance of early implementation.
Senator Rubio countered Senator La Malfa’s protests declaring that he felt there was no better use of public funds than to empower the Insurance Commissioner to protect consumers.“That’s good government” he said.
La Malfa voted against resources for DOI related to rate review, recissions, and the Exchange, but the subcommittee approved Commissioner Jones’ budget requests with 2 votes in support from Senators Rubio and Evans.La Malfa voted in favor of the 54 additional positions to support the department’s functions at large and that proposal was approved unanimously.
The corresponding Assembly Budget Subcommittee will soon also review this issue.
One of the key provisions of the Affordable Care Act (ACA) that will help more people get insured (2 million in California alone) is the expansion of Medi-Cal to cover individuals up to 133% of the Federal Poverty Level. This includes adults with no dependent children, which are currently left out of Medi-Cal, regardless of their poverty status.
The ACA implementation timeline doesn't have this major coverage expansion go into effect until 2014. However, under California's "Medicaid waiver," the state won approval from the Federal Government to start expanding Medi-Cal early in order to phase in federal reforms taking effect in 2014. In particular, it allows counties to use the funds that they currently spend on indigent care, and get federal matching funds to provide Medicaid-type coverage.
The new waiver also allows more counties to take advantage of these federal funds under the ACA. Most of the existing counties, and 13 new counties, have received planning grants from Blue Shield Foundation to help map out these coverage expansions. Fresno, Merced, Monterey, Placer, Riverside, Sacramento, San Bernadino, San Joaquin, San Luis Obispo, Santa Barbara, Santa Cruz, Stanislaus, and Yolo at least took this step to see if they will proceed with an expansion of coverage to their residents.
Eligible entities (a county, a city and county, or a consortium of counties serving a region consisting of more than one county) must submit letters of intent to the Department of Health Care Services by today, and full proposals by February 14th. However, DHCS will be allowing applications on a rolling basis after these deadlines. The state is calling this expansion program the Low Income Health Program or LIHP. These LIHPs expands a version of Medicaid to individuals between 19 and 64 years of age who have family incomes at or below 133 percent of the FPL (or less based on participating county standards), are not already enrolled in or eligible for Medicaid or CHIP, and who have otherwise been determined to be eligible for enrollment in the county program. Counties can also take advantage of additional funds to expand coverage up to 200% of the poverty level.
In these tight budget times, there will be no State General Fund dollars for the program. The LIHPs will use funds provided by counties or other county-based entities (again, money they currently spend on indigent care), matched by federal dollars.
We will provide additional updates once we know which counties will be participating in the expansion. Please contact Health Access if you would like support in advocating for expansion of Medi-Cal in the county that you live or work.
When the budget comes out, reporters ask various people about their reaction. In my case and many others, we provide analysis about what these impacts are.
The cuts to Medi-Cal are severe, and as outlined in our Health Access fact sheet, go beyond even what Gina Jackson describes. The proposals will also limit doctor visits to ten a year, and prescription drugs to six a year. If she had cancer or diabetes or another serious conditions (or a few), she could hit those caps and run out of coverage pretty quickly. She poignantly talks about the impact of eliminating dental coverage--seniors on Medi-Cal will also lose access to Adult Day Health Centers.
Let's make sure our elected leaders hear these voices as they make final budget decisions in the next several weeks. Hearings on specific cut proposals begin this week.
Earlier this week, dozens of Rep. Lungren's constituents visited his district office in Gold River, to inquire why he was voting to take away their health care, their benefits, and those of thousands of other folks in the area.
Others have blogged about it, here and there, and the Stockton Record and News10 covered it. But here's the well-edited video:
One of the talking points against the Affordable Care Act is that the requirement to get health coverage is unconstitutional, it's an idea the Founding Fathers would never have supported. The standard counter-argument was that the world--especially that of medicine, and the cost of health care--has changed since the 1700s.
In July of 1798, Congress passed – and President John Adams signed - “An Act for the Relief of Sick and Disabled Seamen.” The law authorized the creation of a government-operated marine hospital service and mandated that privately employed sailors be required to purchase health care insurance. [...]
The moral to the story is that the political right-wing has to stop pretending they have the blessings of the Founding Fathers as their excuse to oppose whatever this president has to offer.History makes it abundantly clear that they do not.
It turns out Thomas Jefferson also supported the same measure, meaning it had more support than you might have thought among the founders. Jefferson, of course, is the founder most often cited by the Obamacare-despising Tea Partyers as their intellectual and political forefather...
Adam Rothman, a Georgetown University history professor who specializes in the early republic, tells me:
Alexander Hamilton supported the establishment of Marine Hospitals in a 1792 Report, and it was a Federalist congress that passed the law in 1798. But Jefferson (Hamilton's strict constructionist nemesis) also supported federal marine hospitals, and along with his own Treasury Secretary, Albert Gallatin, took steps to improve them during his presidency. So I guess you could say it had bipartisan support....
...As Ezra Klein notes, this was in many ways similar to the system underlying the idea of Medicare-for-all -- they paid taxes in exchange for government run health care.
So let's leave the Founding Fathers out of this. I mean, they did put "promote the general welfare" right at the top of the Constitution, right?
The Daily Show with Jon Stewart tackled the issue of the big budget cuts proposed by various states and cities. It's very relevant to the current California situation, both to remind us that California isn't alone, and about the choices that confront us in the weeks and months ahead.
Two of the people there were young adults, one who worked for a printing press, another for a catering company, but neither who get coverage through their employer. They now can get their coverage through their mother--under the provision in the new federal law that allows children up to age 26 stay on their parents' health plan. The mother was there explaining the sense of security she feels in having coverage for her children.
The thing is, those young adults were two of 3,400 getting coverage from that single provision---in Rep. Dan Lungren's district alone. Others talked about seniors getting assistance with prescription drug coverage, or patients with pre-existing conditions having new options and choice.
It's particularly insulting that Rep. Lungren voted against health reform from his seat in California, given the state's significant efforts in implementing and improving the federal law. The San Jose Mercury News articles by Mike Zapler reinforced that sense with his article entitled "California leads nation in implementing health reform"
And here are district-by-district analyses of the impact of the Act, and its repeal. courtesy of California Representative Henry Waxman: http://democrats.energycommerce.house.gov/
Finally, for an actual debate on the law, here's a debate sponsored by Intelligence Squared US, featuring two authors whose writing I admire and follow: Paul Starr and Jonathan Cohn.
Debate on HR 2, the bill to repeal the new federal health law is set to begin on Tuesday. A vote is likely to come on Wednesday. While it is unlikely that HR 2 will make headway beyond the House, real threats to the implementation of the Affordable Care Act are on the horizon. Health Access California has submitted a letter to our California Congressional delegation, asking them to keep fighting for quality and affordable health care for all. We encourage you to submit letters, emails, faxes, and calls to your Representatives as well. The text of our letter is below if you'd like a sample.
Dear California Congressional Delegation:
As the statewide health consumer advocacy coalition, we have been working hard to implement and improve upon federal health care reform here in California.We write to urge you to commit to voting against HR2 and all efforts to repeal, replace, or defund the Patient Protection and Affordable Care Act (ACA).
The historic passage of the ACA has already begun to make a significant difference in the lives of Californians.We ask you to keep fighting in defense of those who have already begun to benefit from provisions already in effect, and the millions who anxiously await full implementation.
In light of the state’s budget crisis, the slow pace of economic recovery, and the dismantling of the safety net through budget cuts, California families need federal health reform to ensure access to quality and affordable health care and to secure a healthy economic recovery.In 2009, 8.2 million Californians were uninsured according to a new report by the California Health and Human Services Agency, and families that have coverage are still concerned whether it will be there for them when they need it.You are certainly aware that the Congressional Budget Office has warned that repeal would increase the federal deficit by $230 billion and according to the Centers for America Progress destroy up to 400,000 jobs; but the impact on the California economy would be of equally staggering magnitude.
According to a new study by Peter Long and Jonathan Gruber released this month in Health Affairs,California households would collectively receive $12.6 billion in benefits annually from the Affordable Care Act, including $4.8 billion in increased wages.The report also projects that by 2016, 96% of documented residents under 65 would be covered as a result of ACA. Seniors over 65 will save an estimated $9000 per year from the closing of the Medicare Part D “donut hole” (estimate by Kaiser Family Foundation).But we will not see any of this much needed economic stimulus if health reform is repealed.
Thanks to the Affordable Care Act, 576,500 children in California with pre-existing conditions are now eligible for coverage as a result of guaranteed issue according to Families USA.The Insure the Uninsured Project estimates that 396,000 adults who have been denied coverage due to pre-existing conditions now have access to insurance through PCIP, the federally funded high risk pool.Repealing the ACA would revoke these consumer protections.Additionally, California’s 392,000 small businesses, the cornerstone of our economy, would lose the tax credits that help them afford coverage for their employees.Healthcare.gov estimates that 196,000 young adults in California covered under their parents’ policies would lose access to health insurance; and the community clinics would lose $1.4 billion in funding, which would have a devastating impact on access to care.
In California, 269,623 seniors falling into the “donut hole” look forward to the closing the gap in coverage so they never again have to choose between the prescriptions that keep them healthy and their other daily living expenses.Rolling back provisions that extend Medicare solvency also threaten the health of our seniors and soon-to-be seniors.ACA’s Medi-Cal expansion will mean an additional two million low-income Californians will qualify for coverage, and an additional 2.4 million will be eligible for subsidies in the California Health Benefit Exchange, and they are counting on you to make sure implementation continues as scheduled.
We urge you to stand against the repeal efforts. We ask you to vote against increasing the deficit and dismantling historic legislation that promises to improve our health care system.
Blue Shield of California apparently thinks it's a big deal to abide by the letter of the law.... while at the same time, violating its spirit.
After a week of headlines for a series of rate increases that totalled 59%, Blue Shield played a game with the media today. they put out a press release saying they would submit their most recent rate increase to an independent actuary, calling their move "unprecedented." But that's actually already required by a new state law, SB1163, that is effective January 1. (Blue Shield say it doesn't apply because they filed the rate increase right before the new year; yet since the rate increase doesn't take effect until March, it applies, despite Blue Shield's assertions.) It's literally the least they can do.
For Blue Shield, this is trying to win a battle but possibly losing a war. Commissioner Jones may not have the ability to outright reject rates increases, but because of the new federal health law, and follow-up state laws, he has new authority in a range of areas: he has more investigative power in obtaining additional rate information, he can enforce a new and more strict medical loss ratio; and new rules for coverage for children with pre-existing conditions, and more. And his declarations about an insurers' rates can lead to barring an insurer from the new Exchange in 2014.
Most imporantly, Blue Shield's lack of cooperation simply makes the case to state legislators to provide full authority to approve or deny rates. Assemblyman Mike Feuer has a new bill, AB52, to do just that. And Blue Shield is now a new example about the need for that legislation to be passed.
The Clock is Ticking, Open Enrollment for Children with Pre-Existing Conditions Underway
Wednesday, January 12, 2011
For the first time in history, every child in California is now eligible for health insurance coverage. But it’s up to parents to take advantage of these opportunities to get better care and coverage for children, and more economic security for their families.
This wasn’t always the case, even for kids whose families were willing to buy insurance at any cost. Some children were denied coverage because of pre-existing conditions.
The new federal health law, the Patient Protection and Affordable Care Act, provides welcome relief. On Sept. 23, 2010, a key provision took effect that bars children from being denied coverage due to their health status.
In reaction, many of the larger health insurers in California announced that they would stop selling "child-only" policies—insurance for the children in a family, but not the parents—because they worried that parents would wait until their kids got sick before buying coverage. That enraged many parents.
Assemblyman Michael Feuer, D-Los Angeles, came to the rescue by introducing a bill that penalizes insurers who refuse to sell child-only policies by banning them from the broader individual market for five years. Insurers quickly realized that they couldn’t afford to jeopardize their bottom line – some 2.5 million Californians buy their own insurance. The insurers rejoined the children’s market as the state law went into effect January 1.
The California law goes a little farther than the federal law in that it also limits how much insurers can charge for children with pre-existing conditions, provided that they sign up during an open enrollment period. Under the state law, insurers cannot charge a child with health issues more than twice what they charge a healthy child.
This is an important improvement. The federal law prohibits outright denials, but it does not place a limit to what insurers can charge due to health status.
In order to get the price protection, children must be signed up during the open enrollment period, from January 1 through March 1. Other enrollment periods include the month of a child’s birthday and changes in family circumstances, such as a job switch, marriage, divorce, or a move to California.
The families that will take greatest advantage of the new law will be those who get their coverage through an employer but don’t elect dependent coverage for their kids. While this may represent only a small slice of California, it’s still tens of thousands of kids who now have new access—and new affordability—because of both the state and federal law.
The new law also builds on years of work to expand public programs, which provide subsidies to low- and moderate-income families under Medi-Cal and Healthy Families. Many children are eligible to enroll in these program, but don’t take advantage.
A great way to start the New Year is to make sure that every child you know is covered— whether by private insurance or public programs. For the first time ever, we have the tools to make the new federal health care reform law work.
Countdown clock courtesy of the 100% Campaign, please visit 100percentcampaign.org for more information on winning coverage for all children in California.
GOVERNOR BROWN PROPOSES SEVERE HEALTH CUTS THAT WOULD HARM CALIFORNIANS' HEALTH, OUR HEALTH SYSTEM & ECONOMY
REVENUES, TO PREVENT EVEN WORSE CUTS, DEPENDENT ON VOTERS
* Health care cuts would impact health & finances of over eight million Californians, and slash tens of thousands of jobs and frustrate economic recovery in California
* Medi-Cal patients would face limits on care; increased costs; reduced access to providers * Healthy Families vision coverage to be axed for one million children; increased costs, too
In what he described as both a “painful” and “honest” budget, Governor Jerry Brown's new budget announced today resolves a 18-month $25 billion deficit through a range of remedies. The budget recommends extending taxes (that must be approved by the voters), but even with those new revenues, the budget includes $12.5 billion in severe cuts, many of them to Health and Human Services.
The Governor asserted in his press conference today that it is time to put an end to 10 years of gimmicks and tricks, and time to take action to restore California’s fiscal solvency and put the state on the road to economic recovery and job growth. He proposed a 5-year extension of existing taxes, revenues that will have to be approved by the voters. He expressed his faith in voters’ willingness to approve the taxes, saying “I think people will want to protect and defend California.”
He called the cuts he proposed "serious" and that without revenues, they would need to be "draconian." Proposed reductions to key health and human services to will result in Californians being denied medically necessary care and facing greater financial strain. The cuts will also force the state to turn away hundreds of millions of dollars in federal matching funds that are might otherwise assist in California’s economic recovery.
Cuts to Medi-Cal
Governor Brown proposes to make $1.7 billion of cuts to Medi-Cal, the health care coverage that 7.7 million Californians depend upon, by limiting care, increasing cost sharing, reducing payments to doctors and providers, and other reductions.
PROVIDER RATE CUTS: Payments to Medi-Cal providers, including physicians, pharmacy, clinics, and some hospitals and nursing facilities would be reduced by 10% in order to get $9.5 million dollars in savings in 2010-11 and $709.4 million in 2011–12. California already has one of the lowest Medicaid provider rate reimbursements of all 50 states, and over half of doctors do not take Medi-Cal patients as a result.
HARD CAPS ON CARE: The budget proposal would limit care and coverage for Medi-Cal patients: o Limit doctor/clinic visits to 10/year, reducing the number of doctor visit Medi-Cal pays for from 3.2 million to 2 million, for a savings of 196.5 million in 2011-12. o Limit prescription drugs to 6 per month (with no exceptions unless for life-saving drugs), for a savings of $11.1 million in 2011-12. o Establish maximum benefit dollar caps on medical supplies (e.g., wound care, incontinence supplies) and durable medical equipment (e.g., wheelchairs and hearing aids), for a savings for $9.8 million in 2011-12.
If these caps on coverage are implemented, cutting Medi-Cal by a total $217.4 million in 2011-12, the sickest 10% of Medi-Cal patients will see their coverage run out--no longer covered to see a doctor, or get a prescription, or get an appropriate wheelchair, etc. There will be real impacts to the patient's health and life, as well as to their financial wherewithal.
NEW COSTS FOR CARE: Beneficiaries, many of whom earn less than $1000 per month, will now have to pay new copayments for doctor, clinic, and dental visits as well as prescription drugs, hospitalization, and emergency room visits. The savings, totalling $557.1 million in 2011-12, come from both the dollars collected for these low-income families, and the reduction in how these patients use services, even for necessary, prescribed care. The proposal would impact co-payments of: o $100/day for a hospital stay, up to a maximum of $200 (for a savings of $151.2 million in 2011-12); o $50 copayment for emergency room visits (for a savings of $111.5 million in 2011-12); o $5 copayment for doctor visits and prescriptions (to save $294.4 million in 2011-12).
ELIMINATE ADULT DAY HEALTH CARE: 27,000 seniors who receive services at 330 adult day health care centers would lose access to variety of coordinated and co-located health, therapeutic, and social services that allow them to live in their own homes. This is supposed to save $1.5 million in 2010-2011 and $176.6 million in 2011-2012.
Another benefit that will be eliminated is coverage for over-the-counter cough and cold medications and nutritional supplements, for a savings of $16.6 million in 2011-12.
Cuts to Healthy Families
Healthy Families, the State Children’s Health Insurance (SCHIP) in California that covers nearly one million children of low income families, will see a $38.5 million reduction.
ELIMINATE VISION COVERAGE: About $11.3 million of the cuts will be achieved by eliminating vision services to the almost 1 million Healthy Families enrolled children. These lower-income children would either not get or have to pay for eye check-ups and eyeglasses, which have been linked to academic success for students.
INCREASED PREMIUMS AND CO-PAYS: Additionally, the budget proposal shifts costs to low income families, for a total of $27.5 million. It would: * Increase monthly premiums for families between 200 and 250 percent FPL by $18 per child, an increase of 75%, (with a family maximum of $126); and for families between 150-200% FPL by $14/child by nearly 100%. These changes, on families of 150% of poverty level, or $27,500 for a family of three, would yield a savings of $22 million. * Raise emergency room co-payments from $15 to $50 and raising hospital inpatient services co-payments of $100 per day with a $200 maximum (for a savings of $5.5 million).
Other Budget Proposals
The Governor’s budget also proposes a shift of $1 billion from Proposition 10 funding (which is designated for the First 5 Commission) to pay for Medi-Cal for children under 5 years old.
The budget also proposed extending existing provider fees to draw down federal funds to our health system--both an existing hospital fee that helps fund Medi-Cal reimbursements, and a managed care plan fee that helps fund Healthy Families.
There are numerous cuts in other areas as well. For example, there's an increase in cost-sharing for many of the 39,500 AIDS patients in the AIDS Drug Assistance Program (ADAP), for a savings of $16.8 million.
The impacts go beyond the budget and health care. These reductions will also have economic impacts, first and foremost because of lost federal matching funds--for every state dollar cut, the state's health system and economy loses at least one other federal dollar.
Next Steps
The Legislature will now consider this budget, under a condensed timeline of 60 days. The push will be to complete work on the budget by March, so that a revenue package and related budget proposals can go to the voters by June 2011. Some temporary taxes expire July 2011, and if they do--either through legislative inaction or because the voters vote to end them, then the Legislature will need to make additional, much steeper, cuts.
For more information, contact the author of this report, Linda Leu, at lleu@health-access.org. As always, more information on the budget and health reform is available on our website at www.health-access.org.
The release reads: "Brown’s budget proposes $12.5 billion in spending reductions, $12 billion in revenue extensions and modifications, $1.9 billion in other solutions to close the gap and provide for a $1 billion reserve. Major spending reductions include $1.7 billion to Medi-Cal..."
Repeal vote postponed, and more important things...
There's so much and perhaps not much to say about the violent shooting in Arizona this weekend, targeted at Congresswoman Gabrielle Giffords. It's senseless and tragic, and our thoughts are with her and her family, and the many others shot and wounded, and their family members.
For the narrow purpose of this blog, it should be noted that the Congress is cancelling legislative actions for the next week--which means postponing the House vote to repeal the federal health law (which was symbolic anyway, given it's lack of support in the Senate and White House). That also means that many of the actions that health reform supporters--including Health Access California--were planning for this week are also postponed until we hear more of Congress' plans.
Health issues are also part of the overall news story here. Her party or positions shouldn't matter, but for the purpose of this blog on health policy, it's worth noting that her strong support of health reform. The NY Times described her various moderate-to-conservative positions, and then said, "But she was equally ardent in her support of the health care overhaul last year, and once told a reporter she was prepared to lose her seat to defend it."
She reportedly received threats and had her office vandalized during the health care debate last year. And her health care vote was the rationale for her district have a gunsight target on it on a Sarah Palin website--yet she managed to win a close election last fall.
Despite threats of losing her seat, or worse, she was committed to make the health care system better for all, and at this moment, we hope that same health care system is providing the treatment she needs to survive and thrive into the future. Fingers crossed for her, and the other victims.
U.S. HOUSE TO VOTE ON REPEALING NEW FEDERAL HEALTH LAW * Symbolic floor vote planned for next week, January 12, by new Republican leadership * Senate to block repeal attempt, but consequences would be grave for California * Implementation continues in California after 9 months; Much more work to do
Read Our Health Access Blog for More Updates; Also Follow Us on Facebook! Read Real-Time Updates on Legislation on Twitter @HealthAccess! If You Appreciate These Updates, Consider Joining Health Access!
Also: Working Families Summit Next Week January 12: Register Today!
With the new Republican majority officially installed in the House of Representatives, the legislative effort to repeal the Affordable Care Act is coming to a head.
REPEAL VOTE SET: The House is set to vote on the bill on January 12. Passage of a repeal bill would be no more than a symbolic win for Republicans, as the Senate has already vowed to block further movement of any repeal bill; and if that were not the case, a Presidential veto certainly would.
However, were a repeal to ever become law, the consequences would be significant. The Congressional Budget Office just calculated that such a repeal would have a $230 billion impact on the federal deficit.
More importantly, repealing the ACA would mean rolling back significant benefits that have already begun to help Americans struggling with health care coverage. Seniors who last year received rebate checks for the Medicare Part D prescription drug program are slated to begin receiving a 50% discount on drugs in the donut hole. Young adults who have disproportionately suffered from uninsurance and underinsurance will no longer be able to get coverage under their parents’ plans. People who have denied coverage due to preexisting conditions that are now covered under the new federal high risk pools would see their coverage disappear. And insurers would be allowed to revert to abusive practices that harm consumers such as annual and lifetime limits, rescissions, and denying coverage to sick children.
As our Health Access fact sheet details, California consumers would be disproportionately impacted, as a significant number of California workers are employed by small businesses who would no longer be able to receive tax credits for covering their workers. Hundreds of milliosn of dollars allocated to community health centers who serve those in need would disappear, along with the promise of $106 billion in tax credits to help middle class families pay for insurance in the exchange (starting in 2014). In the context of the state’s budget crisis and impending cuts to the safety net system, Californians are not only looking forward to, but depending on the current and future benefits of the ACA.
As California moves forward with an aggressive agenda to both implement and improve upon the ACA, Health Access invites individuals and organizations to join us in standing up to fight against repeal efforts. California should take this opportunity to also be a leader in moving reform forward.
CALL YOUR REPRESENTATIVE TODAY: Please call your Member of Congress to make sure that they cast a NO vote (against repeal) on January 12.
PARTICIPATE IN AN EVENT: Health and consumer advocates have scheduled events up and down the state to support the new law, and to rally against attempts to repeal it. Contact Patrick Romano at promano@health-access.org to get information about an event in your region on Tuesday or Wednesday.
SHARE YOUR STORY: Have you or someone you know already benefited from ACA’s early provisions? We need your story to ensure these consumer protections and new options continue!
For more information, contact the author of this update, Linda Leu, at lleu@health-access.org.
ALSO: REGISTER FOR CA WORKING FAMILIES POLICY SUMMIT: Health Access is Co-Sponsoring the 2011 California Working Families Policy Summit on Wednesday, January 12. Speakers will include Senator Carol Liu and Assembly Member Holly J. Mitchell, with State Insurance Commissioner Dave Jones delivering a keynote at the Summit luncheon. Health Access will be among the state's leading advocates will releasing recommendations to improve the health and well-being of California's families. Recommendations will focus on health care, welfare, school services, early learning, child care, asset building, housing, food stamps, nutrition programs and paid leave.
The California Working Families Policy Summit will be held on Wednesday, January 12, 2011, at the Sacramento Convention Center from 9:00 am to 4:30 pm. Registration opens at 8:00 am. Click here to register now! Early Registration ends January 7!
Last week the Office of Statewide Health Planning and Development (OSHPD) releaseda report on "Preventable Hospitalizations"or hospitalizations that could have been prevented if the medical condition had been treated earlier and on an outpatient basis.The report is based on data collected between 1999 and 2008.
Why do preventable hospitalizations matter? First and foremost, it is better to be less sick and to take care of medical problems before they escalate to the level where hospitalization is required. From a broader perspective, outpatient care is less effective, less expensive, and less risky (hospital acquired infections) than hospital care.
Where there were decreases in preventable hospitalizations, examining best practices around how to deliver accessible primary and preventive care can bring to light keys to reducing the incidence of major illnesses.Conversely, examining the contexts in which preventable hospitalizations are high can provide insight into areas where access to ambulatory care is lacking.
Overall, the data indicates that preventable hospitalizations decreased 6.8%. However preventable hospitalizations increased in relation to 3 highly prevalent health conditions: diabetes, urinary tract infections, and hypertension. The data also reveals some glaring disparities, with African Americans and residents of South Los Angeles being hospitalized at 2 or 3 times the state average. (Read more here.)
This report backs the notion that prevention saves money, and reinforces the importance of investing in preventive care, access to primary care, care coordination for those with chronic illnesses, etc.---all provisions of the Affordable Care Act that Republicans are currently attempting to defund and repeal.
Survey Says...Small Businesses More Likely to Cover Workers
Friday, January 07, 2011
Eight million Californians are self-employed or employed by small businesses. Yet these entrepreneurs and their employees make up 71% of the uninsured population in the state. This is because small business owners have been priced out or bullied out of the insurance market by staggering premiums and a lack of negotiating power.
But thanks to 2 key provisions of the Affordable Care Act, small business owners now report being more likely to start covering or continue covering workers (and themselves). The small business tax credit (already available) reduce the employer cost of providing coverage by providing credits between 35% and 50% of what they spend on benefits, ultimately saving California businesses up to $4.4 billion in the next 10 years. The Exchange will become available to small business owners by 2014, and will give business owners the benefits of large group coverage including the leverage of a larger purchasing pool, and lower administrative costs per employee.
According to a new national survey by Small Business Majority, a small business advocacy group founded and run by small business owners, the small business tax credit and the exchange will influence health insurance decisions.
One-third (33%) of employers who don’t offer health insurance said they would be more likely to do so because of the small business tax credits.
31% of respondents —including 40% of businesses with 3-9 employees—who currently offer insurance said the tax credits will make them more likely to continue providing insurance.
One-third (33%) of respondents who currently do not offer insurance said the exchange would make them more likely to do so.
The same is true for those who already offer insurance, with 31% responding that the exchange would make them more likely to do so.
However, most respondents are not familiar with the exchange or the tax credits; only 31% of respondents are familiar with the exchange and 43% are familiar with the tax credits.
5 + 9 = 59, Blue Shield Takes a Turn at Rate Increases
Thursday, January 06, 2011
Blue Shield of California has announced their intention to raise rates in the individual market up to 59% on March 1, 2011. Blue Shield raised rates on its 193,000 individual plan holders on October 1, 2010 and again on January 1, 2011. A March increase will bring the total increase in rates up to 59% in a 5 month period.
Newly elected Insurance Commissioner Dave Jones called upon Blue Shield to delay the increases by 60 days in order to allow thorough review of the rate filing. Jones will have help checking Blue Shield's math, if needed, from Secretary of Health and Human Services Kathleen Sebelius, as per rate review provisions of the ACA, HHS stands ready to assist states in ensuring adequate rate review.
Last year Health Access and many other consumer advocates supported legislation, AB 2578 (Jones), that would have given the Insurance Commissioner authority to reject unreasonable rate increases, but that bill failed to make it through the Legislature. Another bill, AB 2042(Feuer), sponsored by Health Access California but vetoed by Governor Schwarzenegger, would have prohibited insurers from raising rates more than once per 12 month period. Both are policies that the California legislature should revisit.
Today's news from Blue Shield draws further attention to the need for regulation of insurance rates.
The Senate Democrats have pre-empted the House of Representatives vote against for reform with a sharply-worded letter saying any repeal effort is simply dead--and taken the opportunity to spotlight just one of the benefits of the new law:
The new law provides that seniors will receive a 50-percent discount on the brand name drugs that they purchase while stuck in the "donut hole" and thus will save them thousands of dollars starting in 2011. According to the Department of Health and Human Services, seniors who have high prescription drug spending will save as much as $12,300 over the next 10 years and seniors with low drug costs will save an average of $2,400 over 10 years.
This is no minor reform. But almost as soon as it has taken effect, it is already in jeopardy.
The incoming House Republican majority that you lead has made the repeal of the federal health care law one of its chief goals. We urge you to consider the unintended consequences that the law's repeal would have on a number ofpopular consumer protections that help middle class Americans. The "donut hole" fix is just one measure that would be threatened by a repeal effort. Taking this benefit away from seniors would be irresponsible and reckless at a time when it is becoming harder and harder for seniors to afford a healthy retirement.
If House Republicans move forward with a repeal of the health care law that threatens consumer benefits like the "donut hole" fix, we will block it in the Senate. This proposal deserves a chance to work. It is too important to be treated as collateral damage in a partisan mission to repeal health care.
The new Republican leadership of the House of Representatives will have a vote to repeal the Affordable Care Act next Wednesday, January 12th.
Check out the front page of the Health Access website for a fact sheet on the dramatic impacts that a repeal would have on California--from the individuals who would lose access to coverage and new benefits and assistances, to the resources lost to the California health system and our budget.
Aaron Carroll at the Incidental Economist has a concise but explosive description of how--in one week--opponents of health reform have reversed themselves on every procedural and political issues they raised in 2009 and 2010:
There will be no hearings on the bill. No markups out of committee. No extended period for everyone to read it. No bipartisan meeting to discuss it. There will be no CBO scoring of the bill. It will be – and when you read this, please add lots of sarcasm in your head – “shoved down our throats.”
I’m all for continued debate and further reform. But theater masquerading as serious policy is no longer just silly. It’s doing harm....
Eugene Robinson at the Washington Post says this is an opportunity for supporters of the new federal health law to go on offense and make the case to the public about the need for these reforms:
"If we pass this bill with a sizable vote, and I think that we will, it will put enormous pressure on the Senate to do perhaps the same thing," Rep. Fred Upton, who will be chairman of the House Energy and Commerce Committee, said on "Fox News Sunday." "But then, after that, we're going to go after this bill piece by piece."
This sounds fine, until you actually look at the pieces. Already in effect are parts of the reform package that no self-interested politician is going to vote to take away. No child can be denied insurance coverage because of a preexisting condition. Coverage can no longer be canceled when the policyholder gets sick. Insurance companies can no longer impose annual or lifetime limits on payments for care. Adult children can remain on their parents' policies until they turn 26. Policyholders cannot be charged extra for seeking urgent care at an emergency room that is not in the insurance company's approved network of providers.
Those measures took effect in September. Another set of provisions became law on Saturday: requirements that insurance companies spend a certain percentage of the premiums they collect on care; a discount on prescription drugs for some seniors covered by Medicare; a rule that gives seniors free screening for cancer and other diseases.
Republican leaders aren't dumb enough to explicitly propose taking all these benefits away. But Democrats can, and should, force them to have that debate.
So the next week should focus people on exactly what the Republican leadership in the House of Representatives is seeking to do, and its impact on families.
Insurance Commissioner Dave Jones' first actions...
Monday, January 03, 2011
Governor Jerry Brown and several statewide constitutional officers were sworn in today, in a series of events from morning to night, in great venues from Memorial Auditorium to the California History Museum to the Sacramento Library. Attendees going from one to another could pledge allegiance many times.
Governor Brown's remarks--including his humorous ad libs--was important, setting a tone for a tough political debate around the budget.
Health issues were front-and-center at the evening ceremony of Insurance Commissioner Dave Jones. As we reported on our Twitter feed @healthaccess, Jones declared his goal that his Department of Insurance to become the "strongest consumer protection agency in the nation, bar none."
He laid out three top priorities: 1) implementing health reform; 2) consumer protection; and 3) fostering a vibrant and competitive marketplace.
While he laid out specifics in the other areas as well, he really focused on health reform, and abiding by the voters who chose an "activist" commissioner, he made news with several first steps he was taking this evening: * creating a new deputy commissioner of health reform, to elevate that work in the Insurance Department; * leading a new legislative effort to provide the Insurance Commissioner with the authority to approve or deny rate hikes; * declaring his intention to enforce the new federal health law in California, and many of the new provisions.
Insurance Commissioner Jones explicitly and forcefully contrasted his efforts to enforce the consumer protections under the new federal health law with the opposition of some of the new Congressional leadership. He stated his intention was to move forward with the consumer protections in California--regardless of the repeal attempts by Republicans in Congress.
With every insurance lobbyist in town in the room--and many, many others from the Sacramento area coming to see their hometown hero, Jones made it a point to take his first action this evening, and on the issue of health reform.
He signed emergency regulations to immediately enforce the new "medical loss ratio" provisions in the individual market, so that insurers spend at least 80% of their premium dollars on patient care, and not administration and profit. After signing the order and posing for pictures, the newly empower Jones told the crowd: "That felt good.. Cause as a legislator, you can't do that."
Jones ended by promising "action." We look forward to working with Insurance Commissioner Dave Jones, and seeing his many subsequent actions in the months and years to come.
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.
