At the National Governors Association today, President Obama signalled his support for giving states flexibility--including the ability to opt out of the coverage requirements on individuals and employers, if they can otherwise meet the coverage and benefits goals of the Affordable Care Act.
In a nationwide call with advocates this morning, members of the White House policy team reiterated that this is not a retreat or a lack of commitment to the goals of the Act, as some of the early reporting seems to indicate.
First of all, this state flexibility is actually something envisioned in the law itself. The bill that the President is endorsing--sponsored by Senators Wyden of Oregon and Brown of Massachussetts--moves up this flexibility from 2017 to 2014. As the White House position paper states:
Beginning in 2017, the current law allows States the flexibility to receive a State Innovation Waiver so they may pursue their own innovative strategies to ensure their residents have access to high quality, affordable health insurance. These strategies – which must provide affordable insurance coverage to at least as many residents as the Affordable Care Act and must not increase the federal deficit – could include allowing large employers to purchasecoverage through State Exchanges or increasing the number of benefit levels to provide more choices for individuals and small businesses...
The proposal offers States more flexibility while ensuring that all Americans, no matter where they live have access to affordable, accessible health insurance. Additionally, the proposal includes built-in protections to ensure that these waivers do not increase the Federal budget deficit...
Under the Affordable Care Act, State Innovation Waivers allow States to propose and test alternative ways to meet the shared goals of making health insurance affordable and accessible to all Americans, including those living with pre-existing conditions.
Specifically, State Innovation Waivers are designed to allow States to implement policies that differ from the new law so long as they: · Provide coverage that is at least as comprehensive as the coverage offered through Exchanges – a new competitive, private health insurance marketplace. · Make coverage at least as affordable as it would have been through the Exchanges. · Provide coverage to at least as many residents as the Affordable Care Act would have provided. · Do not increase the Federal deficit.
So it is important to state what this proposal is not: it does not states out of their "maintenance of effort" requirements; it does not allow states to opt-out of the individual and employer requirements without putting something else in place that would be just as effective.
And there's the dare: for all the Republican opponents of the Affordable Care Act who say "repeal and replace," it calls the question. The new proposal offers to Governors the ability to "repeal" if they have a workable plan to "replace" it to meet the same goals of comprehensive coverage to as many people.
Once they are engaged in the policy conversation, rather than political rhetoric, they'll start to appreciate the policy decisions and trade-offs in the ACA. Some might rise to the challenge: Vermont's Governor has expressed strong interest in a single-payer solution, and that is an approach that could meet the standards. One can imagine different ways to encourage on-the-job benefits, for example. Here's other suggestions from the White House document:
The Affordable Care Act offers considerable flexibility to States without waivers. It also recognizes that new, creative effective ideas may emerge. While States have the freedom to develop their own proposals that may qualify for a State Innovation Waiver, some proposals that could qualify include:
* A streamlined system that links tax credits for small businesses with tax credits for low-income families.
* Alternatives to the individual responsibility provision – such as automatically enrolling individuals in health plans – that achieve similar outcomes.
* Alternative health plan options to increase competition and provide consumers with additional choices.
* An increase in the number of benefit levels to provide more choices for individuals and small businesses.
* Immediately allowing large businesses interested in doing so to purchase health insurance through the new private marketplace, the State-based health insurance Exchange.
What won't meet the standards is simply more tax breaks or more deregulation of insurers. There is another proposal in Congress, backed by Republicans, that wants to give states the ability to opt-out of the Act--with no provision for coverage or benefits or protections. But then that makes the debate clear, and separates those who want to achieve the same goals through different means, and those who simply don't agree with the goals of increased coverage and security to start with.
The dare is not just to Governors, but to Congress as well. Congress can grandstand on "repeal and replace," but here's a viable, bipartisan proposal that the President just endorsed. Senators argue that states need flexibility, and here the President is willing to provide it. Will they take "yes" for an answer?
But the main strategy is to engage Governors and Congressional Representatives in the actual practical conversations of reforming our health system. We'll see if it works.
Another opportunity to sign up for coverage for California's children...
Friday, February 25, 2011
Today is the LAST day for parents to enroll their children for private coverage during an "open enrollment period"--which could mean cheaper rates, even if they have a "pre-existing condition." Here's a series of Frequently Asked Questions from our friends at MomsRising:
Insurance Commissioner Dave Jones, bill author Assemblyman Mike Feuer, many of his colleagues, and even Secretary Kathleen Sebelius cut public service announcements about this window of opportunity that parent have to sign children up for coverage. If they do so before March 1st, they can have get a better premium than outside this open enrollment period, where insurers won't be limited on what they can charge children with pre-existing conditions.
After today, the other "open enrollment" period will be during the child's birthday month. But if you know a child that's uninsured, there's no reason to wait and take the risk that they get sick between now and then....
The Canadian-born Bieber never plans on becoming an American citizen. "You guys are evil," he jokes. "Canada's the best country in the world." He adds, "We go to the doctor and we don't need to worry about paying him, but here, your whole life, you're broke because of medical bills. My bodyguard's baby was premature, and now he has to pay for it. In Canada, if your baby's premature, he stays in the hospital as long as he needs to, and then you go home."
Not that we would endorse Bieber's full political agenda--from the nationalism to his comments in the article on abortion that were admittedly not fully thought out.
But that doesn't detract from the fact that the pop star is right that our current system leaves some people broke, and all of us more financially insecure.
As part of the transition to the new Brown Administration, Cindy Ehnes is stepping down as the head of the Department of Managed Health Care (DMHC). I was pleased to speak last night at Cindy's farewell party, alongside the head of the HMO Association.
Cindy had previously served as a consumer representative in Colorado, and we have appreciated her accessibility and availability for consumer and constituency groups over her tenure. We've often supported the DMHC's work, but when we haven't, she's been always willing to talk and meet. On one contentious issue, I recalled one conference call with her on the awkward date of December 23rd. It was good of her to have the meeting--and yes, she remembered it was two-and-a-half hours. Even when we disagreed, we knew she cared about the patients.
While Daniel Zingale did major lifting in getting the new Department of Managed Health Care up and running ten years ago, he left a full portfolio of issues for Cindy. For seven years, she has worked through these tough issues, clearing the slate for the work of a new director to implement the new federal health law. Her work includes overseeing the implementation of many landmark, in some cases first-in-the-nation, consumer protections, from ensuring language access to preventing rescissions to cracking down on fradulent "discount" health plans.
Most recently, new rules on waiting times for getting an appointment have started to come online. This video features her explaining the importance of the new regulations:
Most of all, Cindy and her colleagues at the DMHC and in state government deserve to be saluted for their public service--in my mind the highest calling. Despite the recent rash of some folks who happen to have large megaphones have saying uncharitable things about public servants and government in general, the truth is the vast majority of people appreciate the work done not for profit but on behalf of the people. The DMHC, its director, and its staff helps people get the care they need, when they need it--and that is greatly appreciated, and should be honored.
We thank Cindy for her service, and continue to look forward working with the DMHC.
That's opposed to one judge that struck down one provision (the requirement for individuals to obtain coverage), and one Judge Vinson that wildly overreached in striking down the entire law.
"It is pure semantics to argue that an individual who makes a choice to forgo health insurance is not 'acting,' especially given the serious economic and health-related consequences to every individual of that choice. Making a choice is an affirmative action, whether one decides to do something or not do something. They are two sides of the same coin. To pretend otherwise is to ignore reality."
When the ACA wass being debated, most constitutional scholars thought this wasn't really an issue, and thought if it ever did get to the Supreme Court, it would be a unanimous ruling for the law's constitutionality. Many have now considered the politicization and polarization of the courts--and even the Supreme Court. But even now, there's a general belief that it will be upheld in the end.
To work out final differences between the Senate and Assembly plans for the California budget, a new Budget Conference Committee is set to meet tomorrow, Wednesday, at 10am in Sacramento.
Assemblymember Bob Blumenfield will chair, with Sen. Mark Leno serving as committee vice chair. (The Assembly and Senate trade off chairing the Conference Committee in alternating years, and Sen. Leno chaired last year.)
The Budget Conference Committee includes:
SENATORS: * Sen. Mark Leno (Democrat – San Francisco, 3rd State Senate District) * Sen. Alan Lowenthal (Democrat – Long Beach, 27th State Senate District) * Sen. Gloria Negrete McLeod (Democrat – Chino, 32nd State Senate District) * Sen. Bill Emmerson (Republican – Riverside, 37th State Senate District) * Sen. Bob Huff (Republican – Diamond Bar, 29th State Senate District)
ASSEMBLYMEMBERS: * Assm. Bob Blumenfield (Democrat – Van Nuys, 40th Assembly District) * Assm. Felipe Fuentes (Democrat – Slymar, 39th Assembly District) * Assm. Nancy Skinner (Democrat – Berkeley, 14th Assembly District) * Assm. Diane Harkey (Republican – Dana Point, 73rd Assembly District) * Assm. Jim Nielsen (Republican – Gerber, 2nd Assembly District)
On health issues, the major issue that needs to be resolved between the Assembly and Senate is the fate of Adult Day Health Centers. Both made cuts, but the Senate version functionally eliminated the funding except for a $25 million block grant.
The discussions start tomorrow, but they won't be lengthy--they'll be done in time for floor votes next week.
Tomorrow, the HHS Network, including Health Access California, is having a rally at 12 noon on the North Steps of the Capitol to spotlight the steep cuts in health and human services in the proposed California budget.
Later that evening, at 5:30 on the West Steps of the Capitol, there will be another rally, protesting a budget bill in Wisconsin, in solidarity with the thousands who have been voicing their opposition in Madison and around that state.
In particular, they have been outraged at an attempt to use a budget crisis as a way to circumvent the collective bargaining rights of the unions of teachers, nurses, and other public workers. The unions have already said they are willing to concede the increased payments for pensions and other monetary issues. The pushback is on the attempt to use the budget situation to leverage ideological demands and political power. That rings true here in California as well, where we have seen elected leaders use the budget process as a vehicle for leveraging changes in all sorts of public policy and political gain.
For those who want to follow the action in Wisconsin, including moving commentary and videos, I recommend the website http://www.wearewisconsin.org/, as well as the related Facebook page of Citizen Action of Wisconsin, our HCAN and USAction sister organization that does wonderful work on health care, worker's rights, and more.
[UPDATED:] And this fight isn't just about worker's rights. Wisconsin Governor Walker is a leading opponent of the federal health law, and his budget bill would also give the Governor unchecked authority to restructure and slash, without legislative authority, BadgerCare, the state's Medicaid/SCHIP expansion. It's sad because the program has been innovative and has bipartisan roots, ironically pioneered by the state's former Republican Governor Tommy Thompson, who on to be U.S. Secretary for Health and Human Services. Jonathan Cohn has more at The New Republic.
So in the spirit of solidarity, we'll be at both rallies today.
Key federal officials from the Department of Health and Human Services are the featured presenters at a briefing this Thursday in Sacramento.
The topics are two key elements of the federal Affordable Care Act (ACA): the Pre-Existing Condition Insurance Program (PCIP)--a new option for those denied by private insurers because of their health status--and the Consumer Assistance Program (CAP)--new resources to help patients navigate the health system. Both of these programs are up and running now, and this forum is to help organization better inform their members about these benefits.
The briefing is Thursday, February 24, 2011, 1:00 p.m. to 2:30 p.m. It will be at the California Department of Health Care Services, East End Complex, 1500 Capitol Avenue, Auditorium, Sacramento, CA 95814
The speakers include: * Richard Popper & Eliza Bangit, Center for Medicaid and Medicare Services, HHS * Herb K. Schultz, Region IX Director, HHS * Janette Casillas, Executive Director of the California Managed Risk Medical Insurance Board * Cindy Ehnes, Director of California Department of Managed Health Care * Janice Rocco, Deputy Insurance Commissioner for Health Policy
Folks can RSVP to Eric Alborg at eric.alborg@hhs.gov or call (415) 437-8500.
With all the focus we have given to the state budget, we have neglected the important and looming fight around the federal budget.
Several parts are in motion, leading to a potential standoff and possible government shutdown in early March.
Last week, President Obama unveiled his budget for 2011-12, which includes an overall freeze on discretionary spending--including cuts in important programs. The Center for Budget and Policy Priorities, while disagreeing with some specific cuts, said that it was "an important step toward addressing the nation’s long-term fiscal challenge, cutting the deficit enough to stabilize the debt as a share of the economy." The President is also set to negotiate with Congressional leaders on further changes in the major parts of the budget--including Medicaid, Medicare, and Social Security.
The budget seeks to protect certain investments, and maintains the priority on health care and reform that the President has championed. The U.S. Department of Health and Human Services has detailed breakdowns of the President's proposals with regard to these critical areas.
But while this just starts the conversation about the 2011-12 budget, Congress is currently debating the budget of the current year, 2010-11. Right now, federal agencies only are funded into March--Congress will need to pass a continuing resolution by then to avert a government shutdown.
But the GOP-controlled House of Representatives have said they won't pass such a resolution without steep, immediate cuts for the current year. Mid-week, the House Republicans passed a mid-year budget bill full of both steep overall reductions, and narrowly targeted ideological statements to defund certain specific elements of laws they don't like. This included defunding the staffing and implementation of various elements of the federal health law (as well as various environment and financial regulations), and attacking organizations like Planned Parenthood. This also included an eye-popping $1.3 billion cut to community health centers--a fund for community clinics championed by President George W. Bush.
GOP House leadership has made this extreme document their demand, and they have said they will not pass a continuing resolution at current spending levels, leading to an impasse with the Senate and the President.
The stakes are high as March fast approaches. As much as the state budget crisis is a big deal, it's worth watching the federal fight as well, especially as it gets more intense over the next few weeks.
This morning, the Assembly Budget Committee approved, in one vote along partisan lines, a broad budget proposal package that adopted many--but not all--of Governor Brown's proposals. Most of the cuts are adopted, with a major exception of hard caps on doctor visits, prescription drugs, durable medical equipment and medical supplies.
The one major area where there isn't conformity between the Assembly and the Senate is on Adult Day Health Centers, which Governor Brown proposed to eliminate. The Assembly rejects elimination and makes a partial cut of $28 million. The Senate, earlier today, basically cut all but $25 million for use as a block grant. This difference--and others--will likely be decided in a Budget Conference Committee which starts meeting on Tuesday.
From the analysis, here's the relevant portions about health care cuts:
Medi-Cal Major Issues:
• Mandatory Co-pays. Cuts Medi-Cal by $557.2 million by mandating that beneficiaries pay co-payments as follows: 1) $5 for every physician or clinic visit; 2) $3 (generics) or $5 per prescription; 3) $50 for emergency room visits (for emergencies or non-emergencies) and $100 per day, with a maximum of $200 per admission, for inpatient services; and 4) $5 for every dental visit.
• Rate Reductions. Cuts Medi-Cal by $729.6 million General Fund by reducing rates paid to Medi-Cal providers and skilled nursing facilities by ten percent.
• Utilizations Controls. Cuts Medi-Cal by $17.2 million by eliminating coverage of over-the-counter cough and cold products, limiting coverage of enteral nutrition products to tube fed (giving discretion to DHCS to grant exemptions), and imposing an annual dollar maximum on hearing aids of $1,510 per year. Denies caps on physician visits, prescriptions, durable medical equipment and medical supplies.
• Adult Day Health Care. Cuts $28 million from ADHC by enforcing existing medical acuity eligibility criteria, consolidating state administration of the program, and making other reforms to the program, without eliminating the benefit.
• Medi-Cal Managed Care Tax. Secures on-going revenue by making permanent (with a 3-year sunset) the tax on Medi-Cal managed care organizations.
Healthy Families Major Issues:
• Healthy Families Premiums. Cuts Healthy Families by $22 million General Fund by increasing monthly premiums paid by families enrolled in the program.
• Healthy Families Co-pays. Cuts Healthy Families by $5.5 million General Fund by increasing co-payments paid by families for hospital services, consistent with hospital co-pays in Medi-Cal.
• Healthy Families Vision Coverage. Cuts Healthy Families by $3 million General Fund for support of vision coverage, without eliminating the benefit.
Other Health Major Issues:
• Proposition 10 Fund Shift to Medi-Cal. Cuts Medi-Cal by $1 billion General Fund by replacing it with $1 billion in Proposition 10 reserves and eliminates the State Prop 10 Commission for on-going savings of approximately $89 million annually, to cover Medi-Cal services for children 0-5 years of age. Denies proposal to shift fifty percent of local funding on an on-going basis.
• Proposition 63 Fund Shift to State Mental Health Programs. Cuts $900 million General Fund primarily from Medi-Cal by replacing it with $861 million in Proposition 63 funds for: AB 3632, EPSDT, and Mental Health Managed Care.
• AIDS Drug Assistance Program Cost Savings. Cuts $77 million in General Fund reflecting: $7 million in administrative savings and an increase in federal funds; and a $70 million allocation from the Safety Net Care Pool. Directs the administration to expand eligibility in the CARE/HIPP Program and facilitate enrollment of ADAP clients into the HIPP Program, the Pre-Existing Condition Insurance Program, and Low-Income Health Insurance Programs for additional General Fund savings in ADAP. Achieves equivalent savings without increasing cost sharing for ADAP clients.
• Emergency Preparedness Reductions. Cuts $5.8 million in General Fund for maintaining the state's medical supplies stockpile and mobile field hospitals for major public health emergencies.
The Senate Starts Making Tough Budget Decisions...
Thursday, February 17, 2011
HEALTH ACCESS UPDATE Thursday, February 17, 2011
SENATE BUDGET COMMITTEE APPROVES SEVERE HEALTH CUTS, REJECTS HARD CAPS; MORE PRELIMINARY DECISIONS TO COME
REVENUES, TO PREVENT EVEN WORSE CUTS, DEPENDENT ON VOTERS IN JUNE
* Senate Budget Committee approves increased costs, reduced access to providers for nearly 8 million Californians; rejects the most severe hard caps on care * Assembly Committee to vote soon on limits on care; increased costs; reduced access to providers for Medi-Cal patients
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, Join/Renew Your Health Access Membership!
Today, the Senate Budget Committee adopted nearly $1.5 billion of cuts to the state's Medi-Cal program, which provides coverage to 7.7 million Californians, largely low-income children, parents, seniors, and people with disabilities. The cuts included a steep 10% reduction to already-among-the-lowest-in-the-nation Medi-Cal provider rate reimbursements; big increases in cost sharing, including $50 emergency room co-pays and $100 hospital stay co-pays for Medi-Cal patients under the poverty level; and reductions in other benefits.
But the Committee rejected $200 million of cuts that the Budget Committee Chair, Senator Mark Leno (D-San Francisco) described as the "most untenable, most cruel-hearted" cuts, including hard caps on the number of doctor visits and prescription drugs that Medi-Cal patients may get, or the dollar amount of medical equipment or medical supplies.
This hearing marked the beginning of preliminary decisions on budget cuts, after a few weeks of an expedited set of hearings of proposed cuts by the Assembly and Senate Budget Subcommittees on Health and Human Services. Consumers and advocates have given heart-wrenching testimony, with advocates explaining the health and financial consequences to families, as well as broader impacts on the health system and the economy.
Even those who proposed the cuts admitted the life-and-death implications of cutting off coverage for necessary medical treatment after ten doctor visits and restricting patients to six prescriptions per month. The proposed hard cap on doctor visits would apply to kidney dialysis, chemotherapy, and other regular treatments that would run out in weeks, leaving patients to die.
While hearing the staff presentation about the proposed hard cap on physician visits, Senator Leno asked “does this action make us a death panel?” The Committee ultimately did reject that specific proposal, but made other severe cuts to Medi-Cal and Healthy Families.
Committee members agreed that none of the cuts were desirable, but the severity of the budget crisis required sacrifice. Senator Leno sighed about the "breathtaking actions" the Committee was taking right before voting to impose mandatory and higher co-payments on Medi-Cal patients under the poverty level. Senator Huff led his Republican colleagues to vote for Governor Brown's proposed cuts--even those that Democrats voted to reject--in part because he did not know what the Democrats were proposing to cut instead.
Before considering the proposal to fully eliminate vision coverage for the nearly one million children in the Healthy Families program, Senator Leno even recounted his own "vivid memory" as a 4th grade student, suddenly being able to see again after a visit to an eye doctor and receiving glasses. For that cut, the Democratic majority voted to reject the $11 million proposal to eliminate vision coverage, but to instead restrict coverage for $3 million in budget savings.
Ultimately, even with all the statements of regret, the Senate Budget Committee approved a number of proposals that will undoubtedly lead to worsened health outcomes, worsened quality of life, financial harm, and more.
CUTS ACCEPTED IN SENATE BUDGET COMMITTEE:
· Reduce Medi-Cal provider rates, including nursing homes and intermediate care facilities, despite California having one of the lowest Medicaid provider rates in the country (47% of Medicare rates), and that nearly half of doctors already don't take new Medi-Cal patients.
· Raise the cost of care for Medi-Cal patients, the vast majority of whom are under the poverty level and have monthly incomes below $900, including: o $100/day for a hospital stay, up to a maximum of $200. o $50 copayment for emergency room visits. o $5 copayment for doctor, clinic, dental, and pharmacy visits and prescriptions.
* Eliminate Medi-Cal coverage for over-the-counter drugs * Limit coverage for hearing aids and enteral nutrition products for adults.
* Increase monthly premiums for Healthy Families coverage for children in 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%. * Raise emergency room co-payments for Healthy Families coverage for children in families from $15 to $50 and raising hospital inpatient services co-payments of $100 per day with a $200 maximum ($0.7 million).
CUTS REJECTED BY SENATE BUDGET COMMITTEE:
· Limit care and coverage for 7.7 million Californians with Medi-Cal coverage including millions of low-income families, seniors, and people with disabilities and chronic illness, including: o Limit doctor/clinic visits to 10/year. o Limit prescription drugs to 6 per month (with no exceptions unless for life-saving drugs). o Establish maximum benefit dollar caps on medical supplies (e.g., wound care, catheters, incontinence supplies) and durable medical equipment (e.g., wheelchairs), impacting 20,000 patients/year.
* Eliminate vision care for nearly 1 million children covered by Healthy Families, including coverage for eyeglasses. (An alternative proposal was adopted to yield partial savings by restricting coverage.)
In discussions with his Republican counterparts, Committee Chair Mark Leno expressed a commitment to reaching the Governor’s proposed reduction target numerically and to following the broad architecture of that proposal. Though Leno estimated that Democrats would reject 10% of Governor Brown’s proposed cuts to “soften the roughest edges”, but he promised to propose alternative solutions, including ongoing cuts to achieve the same amount in savings.
Next Steps
The Senate Budget Committee will continue deliberations today, and the full Assembly Budget Committee will begin hearings tomorrow. The goal is to complete the budget process by early March so that a revenue package and related budget proposals can go to the voters by June 2011.
CALL-IN ACTION: The HHS Network, of which Health Access California is a leader, has been asking Californians to call their state legislative leaders to be a champion for these programs, to reject the worst of the cuts. Click here to start to call legisators TODAY!
DAY OF ACTION: A day of action is scheduled for next week in Sacramento. For more information and to get involved in the HHS Network, contact Jessica Rothhaar at jessicar@health-access.org.
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.
Some have asked about the fate of Adult Day Health Centersm, which is slated to be zeroed out in the Governor's budget. That issue didn't come up today in Senate Budget Committee, but it is likely to come up very soon. We'll see what happend tomorrow.
But there was action on the proposal to eliminate ADHCs, by a coalition who unveiled television ads against the proposal, talking about not just the impact on families, but on the longer-term costs to the state:
The Senate Adopts Many Health Cuts, But Rejects "Death Panel" Caps...
The Senate Budget committee met today to consider, among other things, the Governor’s proposed cuts to Health and Human Services.The Committee moved swiftly, as if pulling off a band-aid, to shorten if not to assuage the pain of their actions.While hearing the staff presentation about the proposed hard cap on physician visits, Senator Leno asked “does this action make us a death panel?” He apparently though yes, since the committee rejected that cut.
Cuts Approved By Committee
10% Reduction to Medicaid Providers
10% Reduction to Intermediate Care Facilities for the Developmentally Disabled
10% Reduction to Nursing Homes
Acceptance of additional General Fund Savings
Mandatory Copay on Physician and Clinic Visits
Mandatory Pharmacy Copay
MandatoryHospital Copay
Mandatory Dental Copay
Eliminating Over the Counter Cough and Cold Medicines
Reduce Enteral Nutrition Products Benefits
Limit Hearing Aid Benefits
Redirect $1 Billion in Proposition 10 (First 5) funds – committee approved subcommittee recommendation to redirect these funds for 1 year only
Increase Premiums for Healthy Families
Hospital Copays for Healthy Families
Cuts Rejected By Committee
Hard Cap of 10 Physician/Clinic Visits per year
Hard Cap of 6 prescriptions per month
Hard Cap on Durable Medical Equipment
Hard Cap on Medical Supplies
Healthy Families Vision Coverage – committee voted to reject the elimination of vision coverage in Healthy Families, but to implement cost containment measures that would result in $3 million in savings.
Committee Chair Mark Leno expressed a commitment to reaching the Governor’s proposed reduction target numerically and to following the broad architecture of that proposal.Though Leno estimated that the Committee would reject 10% of Governor Brown’s proposed cuts to “soften the roughest edges,” he promised to propose alternative solutions, including ongoing cuts not proposed by the Governor, to achieve the same amount in savings.
This Valentine's Day, thanks to the health care law, new protections mean that you and your loved ones may be eligible for important preventive services at no cost to you – helping you stay healthy, avoid illness, and improve your health. And new rights help you enjoy greater security for you and your family.
If you haven't sent your Valentine's cards yet--or even if you have, share this E-card with your friends and loved ones so they know about their new rights and options.
Earlier today, Health Access California spotlighted one specific benefit, working with Insurance Commissioner Dave Jones and Assembly Members Roger Dickinson and Mike Feuer. Health Access California board member Kelly Hardy of Children Now (also representing the 100% Campaign) spoke for us at a news conference today at the UC Davis Medical Center to highlight a critical open-enrollment period for kids' health insurance that began on January 1, 2011 and ends on March 1.
During the open enrollment period, parents can sign up their children for more affordable health insurance. As a result of President Obama's federal health care reform plan and AB 2244 by Assemblymember Feuer and Health Access, children with pre-existing conditions cannot be denied coverage - they also cannot be charged rates that are more than double the rates of healthy kids. Parents of healthy children without insurance should also sign their kids up during this period; kids who don't sign up during open enrollment periods may be subject to a 20 percent surcharge on their insurance rates for a full year.
The combination of the federal health law and the state law, which has been in effect since January 1, gives California children access to affordable care and a healthy future by ensuring that certain children cannot be denied coverage or priced out of the market. It also prohibits insurers that sell individual market policies in California from refusing to sell or renew coverage to children with pre-existing conditions - it also bans insurers from the individual market for five years if they do not sell policies to children.
So it's an excellent time to give children coverage, before the end of this open enrollment period, March 1st.
It's being written by Jonathan Gruber, an MIT economist who has been an advisor to the Massachusetts reform effort and served on the board of their Exchange (called a "Connector" in MA) there. He was an advisor to California's effort at health reform in 2007-8, as well as to the federal policymakers, providing a computer model that takes certain assumptions about how employers and individuals will respond to policy changes, to make predictions about the impact of certain policies: the decrease in the uninsured, the increase in public programs, the shift between employer-based care and the Exchange, etc.
Yet this comic book, not his more serious writings, that is getting serious attention, from the AP to Comedy Central.
For the first anniversary of First Lady Michelle Obama's "Let's Move!" initiative, U.S. Health and Human Services Secretary Kathleen Sebelius said it was an "easy call" to come to California, given the state's leadership on health reform and efforts around prevention and wellness. She visited a Sacramento school this morning to highlight national and local efforts at health and fitness.
She was joined by Sacramento Mayor Kevin Johnson, Superintendent of Public Instruction Tom Torlakson, California Endowment CEO Dr. Bob Ross, and others.
Students went through some exercises with Slamson and others from the Sacramento Kings (Secretary Sebelius was properly attired in purple for the event). Secretary Sebelius spotlighted the investments in health and prevention in the stimulus act as well as the history Affordable Care Act. But the main focus was the Let's Move! effort to deal with the issue of childhood obesity, ensuring that children have access to healthy food, opportunities to get fresh produce and visiting farmers' market, availability of parks and play areas, and time for regular physical activity.
While she was in town, Secretary Sebelius also reportedly had meetings with Governor Brown about the budget, and with Insurance Commissioner Jones about implementing insurance regulations in the new federal health law. As the bottom picture shows, the Governor's top health cabinet member, Diana Dooley, also had a chance to talk to her U.S. counterpart, in a meeting of the HHS Secretaries.
Last Friday California's new Attorney General Kamala Harris released a statement in defense of the Affordable Care Act in conjunction with 7 other Attorney Generals from Connecticut, Iowa, Maryland, New York, Delaware, Vermont, and Hawaii. The statement asserted the constitutionality of the law as well as the importance of the law to the millions in each of these states who are already or will soon benefit from its provisions.
These State Attorney Generals are part of a coalition that filed an amicus brief last month supporting the constitutionality of the health reform law. The 9 signatories of the brief join the dozen federal judges who have thrown out constitutional challenges to ACA and 2 that have ruled in favor of the law.
Just to review the score:
Judges Who Ruled Against Entire ACA: 1
Judges Who Ruled Against One Provision of the ACA: 1
Judges Who Threw Out Cases Against ACA: 12
Judges Who Upheld the ACA: 2
The nine State Attorney Generals matter, considering that California and New York are two of the three most populous states in the nation. We in California are fortunate to have an Attorney General who is representing her constituents and the Constitution. Read the complete statement here.
President Obama got asked about the legal challenges to the Affordable Care Act before the Super Bowl on Sunday. The President defended the law against attacks by Bill O'Reilly:
If you want more than Obama's quick explanation of the continuing judicial process, The New York Review of Books went in depth into the constitutional arguments around the new federal law.
Blue Shield of California, after proposing a series of increases in recent months totalling up to 59%, is backtracking, but only a bit. Yesterday, the insurer agreed to delay their latest increase, set to go into effect March 1, for 60 days to give Insurance Commissioner Dave Jones time to review the filing.
A review of the filing, under the new rate review law in California, may show that the rate hike is not justified. Commissioner Jones is seeking full authority to reject unjustified rates through AB52(Feuer). Until then, he has some ability to ask for documentation and question the information provided by Blue Shield.
Today, our ally Consumers Union, the nonprofit publisher of Consumer Reports magazine, put out a statement that based on their analysis of the insurer's documentation. Their release, entitled, Blue Shield Rate Hike Not Supported By Insurer's Filing, and the acompanying letter to Commissioner Jones, suggests that the delay is needed in order to review the filing.
Cuts for the whole family: Assembly Sub 1 Considers Cuts to Health Care for Children, Adults, Seniors, and People With Disabilities
In today’s 4th of 7 hearings on the Health and Human Services Budget, the Assembly Subcommittee heard specifics of proposals to make reductions in Healthy Families, Medi-Cal, and Adult Day Health Care, among other things.A packed hearing room shared compelling personal stories about how these programs sustain life, and conversely how they or their family members might die or suffer greatly if proposed cuts are enacted.
The testimony was received by sympathetic Assembly members, who asked numerous questions to try to determine the true cost of cutting vital programs.In many of these cases, savings projections did not consider indirect costs such as cost shifts that may end up costing the state more money, such as moving seniors from Adult Day Health Centers to nursing homes and limiting access to preventive and primary care, which may lead to more expensive hospital care.
In considering the elimination of vision services in the Healthy Kids program, advocates pointed out that vision services are crucial to academic success, as 80% of what children learn is learned visually and 1 out of every 4 children need vision correction.The subcommittee expressed interest in hearing a plan that VSP, the provider of vision services to a majority of Healthy Families beneficiaries, is working on to reduce costs while still saving the program.
In the discussion of levying co-pays in the Healthy Families program, members probed staff on whether the savings projections took into account the costs to the state to track payments of co-pays and the resources that would be required to collect.Additionally, we believe that the proposed co-pays violate the federal limit on cost sharing.But of course, the immeasurable cost of placing financial barriers to access to children’s health care is that California’s children will simply not be able to grow up with access to the health care they need to become thriving members of our communities.
Also proposed were cuts to Healthy Families funding, cuts that are to be passed on to the consumers in the form of premium increases.Another increase in Healthy Families premiums will likely make it difficult for many families to continue to participate in the program.However, there is strong reason to question the legality of this cut as it likely violates the Maintenance of Effort requirements for states to maintain eligibility levels.
Proposed cuts to the Adult Medi-Cal program were even more brutal, with hard caps on doctor and clinic visits as well as prescription drugs.The committee members heard testimony from real Californians who feared they would end up hospitalized or institutionalized if they weren’t able to access their regular medical care and prescription drugs.All of these alternatives would mean higher costs to the state which were not included in the estimated savings presented by the Administration.The proposal is also unclear as to how physicians and clinics would be expected to keep track of whether patients were approaching or had exceeded their hard caps.Members of the committee seemed to understand the inevitability of morbidity related to these cuts and asked for the Department to provide projections on how many people would die as a result of these restrictions.
Finally, the committee heard the proposal to eliminate Adult Day Health Care Services, a proposal that has been defeated several times before.Scores of seniors, family members, and service providers testified to the devastating effect that closing ADHC would have on its clients, who would no longer be able to live independent dignified lives.Staff acknowledged that elimination of the program would likely be challenged legally due to potential violations of the Americans with Disabilities Act, and that they did not include in the projected savings, the costs the state to provide alternative services to these frail elderly, or the costs that might be incurred as a result of the impact closing these centers would have on families.
Today’s hearing put real faces behind the outcry that these cuts will cost lives.Members of the budget subcommittee recognized the gravity of the situation and demonstrated commitment to hearing the whole story and looking at budget proposals in the context of the lives of California communities, and not simply as dollars and cents.
Which counties are considering expanding undertaking the coverage expansions under the new Medicaid wavier and the new federal health law? The following counties have send letters of interest to the State.
1. Alameda County 2. Alpine County 3. Contra Costa County 4. Fresno County 5. Glenn County 6. Kern County 7. Los Angeles County 8. Merced County 9. Monterey County 10. Orange County 11. Placer County 12. Riverside County 13. Sacramento County 14. San Bernardino County 15. San Diego County 16. San Francisco County 17. San Joaquin County 18. San Luis Obispo County 19. San Mateo County 20. Santa Clara County 21. Santa Cruz County 22. Ventura County 23. Yolo County
Counties are right to be interested. Counties can use the money they already spend on indigent care, and get federal matching funds to provide coverage. This means that their low-income residents can get better care through better-coordinated coverage; the counties' safety-net providers get more insured and paying customers, and can build loyalty with this new patient population; the county get those new federal funds flowing through its health system and its economy; and this provides a smooth transition to health reform, as these enrolled patients are in systems of care and automatically enrolled in full Medicaid coverage on day one of 2014.
We are watching this closely. If you are interested in advocating at your county--either because the county is not on the above list, or because you want to make sure they are undertaking the most aggressive implementation possible--contact Linda Leu at Health Access, at lleu@health-access.org.
Governor Jerry Brown sounded the budget alarm bells, and called on the legislature to put the question of taxes to the voters. He was funny and postmodern in commenting on his own speech--and to reaction to it--throughout.
The main point was to make the case to put his budget--and the tax extensions in it--to a vote of the people:
Let me read to you, Article 2, Section 1 of the California Constitution: “All political power is inherent in the people. Government is instituted for their protection, security and benefit, and they have the right to alter or reform it when the public good may require.”
When democratic ideals and calls for the right to vote are stirring the imagination of young people in Egypt and Tunisia and other parts of the world, we in California can’t say now is the time to block a vote of the people. In the ordinary course of things, matters of state concern are properly handled in Sacramento. But when the elected representatives find themselves bogged down by deep differences which divide them, the only way forward is to go back to the people and seek their guidance. It is time for a legislative check-in with the people of California.
At this moment of extreme difficulty, it behooves us to turn to the people and get a clear mandate on how we should proceed: either to extend the taxes as I fervently believe or cut deeply into the programs from which--under federal law--we can still extract the sums required. Unfortunately, these would most probably include: elementary, middle and high schools, the University of California, the California State University system, prisons and local public safety funding, and vital health programs.
My plan to rebuild California requires a vote of the people, and frankly I believe it would be irresponsible for us to exclude the people from this process. They have a right to vote on this plan. This state belongs to all of us, not just those of us in this chamber. Given the unique nature of the crisis and the serious impact our decisions will have on millions of Californians, the voters deserve to be heard.
Do I like the choices we face? No. I don’t. But after serious study of the options left us by a $25 billion deficit, the budget I have proposed is the best I can devise. If any of you have other suggestions that you think are better, please, share them with us. After all, we are in this together.
Much has been written about the 14 minute speech. But in tough times, it was good to get a little but of optimism at the end:
Wherever I look, I see difficult choices. But I also see a bright future up ahead and a California economy that is on the mend. When we get our budget in balance, California will be in a strong position to take advantage of its many assets and its strategic location on the Pacific Rim. As the countries of Asia and south of our border continue to thrive and expand their trade, our state will play a leading role, as it always has, and reap unimagined benefits.
We have the inventors, the dreamers, the entrepreneurs, the venture capitalists and a vast array of physical, intellectual and political assets. We have been called the great exception because for generations Californians have defied the odds and the conventional wisdom and prospered in totally unexpected ways. People keep coming here because of the dream that is still California, and once here, their determination and boundless energy feeds that dream and makes it grow.
When I first came to Sacramento, Steve Jobs and Steve Wozniak had not yet invented their personal computer. There was no wind generated electricity, and we didn’t have the nation’s most advanced building and appliance efficiency standards as we later adopted. Of course, Yahoo, Google, Facebook and Twitter did not exist—not even in someone’s imagination.
California’s economy has grown from less than 200 billion dollars when first I came to this rostrum to now over two trillion dollars expected this year. California has been on the move—a marvel, even a miracle and some kind of gift.
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.
