Senator Feinstein announces support for state rate regulation bill...
Thursday, March 31, 2011
California Senator Dianne Feinstein released a letter today strongly supporting a rate regulation now pending in the California Legislature, AB52 by Assemblymember Mike Feuer. Under this legislation, which had been carried in previous years by now-Insurance Commissioner Dave Jones, state regulators would have the authority to reject excessive health insurance rate increases, to protect individual consumers and small businesses.
Feinstein wrote:
"It is critical to protect California consumers and businesses, and AB 52 will give the State Insurance Commissioner and the Director of the Department of Managed Health Care the authority to reject excessive, inadequate, or unfairly discriminatory rate increases.
“Insurance companies are driven by the need to return profits to shareholders, and without proper regulatory oversight, will continue to raise rates and drop people from coverage to maximize their profits. It is clear that California’s state regulators need the authority to reject excessive rate hikes.”
The bill would build upon newly-implemented federal and state law improving the health insurance rate filing and review process. Senator Feinstein has a similar measure pending at the federal level, the Health Insurance Rate Review Act (S. 137), which would give the Secretary of Health and Human Services the authority to deny or modify rate increases found to be unjustified.
But the action is now at the state level: AB 52 (Feuer), supported by a variety of consumer, community, and health groups, including Health Access California, will be heard in the Assembly Health Committee this coming Tuesday, April 5, 2011.
Earlier today, Governor Jerry Brown and legislative leaders acknowledged the breakdown of budget negotiations with Republican lawmakers, and that those GOP legislators had succeeded in preventing Californians from voting in June on a California Budget solution.
Here's Governor Brown:
What has been a budget crisis and a political crisis now will become a public health crisis, and an education crisis. By not letting voters consider a package of tax extensions to solve the California budget crisis, Republican legislators are forcing $13 billion in additional cuts, to education, public safety, as well as even more to health and human services.
To simply let California vote, Senate Republicans demanded a 53-point wish list--a ransom note with a series of demands to enact an agenda that was largely rejected by California voters last November. This very detailed list was the price to merely get one-third of one-half of the California Legislature to agree to merely let Californians vote on a budget solution.
Here's Senator President Pro Tem Darrell Steinberg:
Governor Brown rightly pointed out that many of the 53 items related to the budget crisis would actually make the deficit worse. The GOP legislators would want to remove elimination of Enterprise Zones and other corporate taxes, creating an even bigger hole that would force health and education cuts. They want restorations in certain programs--the Williamson Act, county fairs--while arguing for even steeper cuts, like hard caps on doctor visits for Medi-Cal patients, and the full elimination of Adult Day Health Centers.
We shudder to think what an additional $12 billion of cuts look like. All we needed to do to prevent such additional cuts is extend current tax rates, rather than letting some revenues expire. We can prevent major damage to California, if we prevent key revenues from expiring on June 30th, and blowing a $12 billion hole in the budget. We have 90 days before that budget bomb blows up.
Over the weekend, it was revealed that in return for supporting a special election to allow Californians to vote on Governor Brown's budget solution, GOP Senators had put forward a list of over 53 items. Among those bullet points was the demand for a constitutional spending cap--even though such caps have been rejected by California voters previously, in both 2005 and 2009.
Kevin Yamamura at The Sacramento Bee describes the issue, and cites a letter opposing a spending cap by several health and human service organizations, including Health Access California. While it's clear the GOP Senators' demands go far beyond the debate over a cap, we should be clear about how significant just that one demand is--and the impact it would have. So here's the letter sent earlier this month to the Governor and legislative leadership, citing our major concerns with such a proposal:
The Honorable Jerry Brown, Governor
The Honorable John Pérez, Assembly Speaker
The Honorable Darrell Steinberg, Senate President pro Tempore
Dear Governor and Legislative Leaders:
Thank you for standing strong in support of a budget that includes sustainable revenue solutions, revenues which would prevent even more dangerous and potentially life-threatening cuts to essential health care and human services.
We know you face more difficult choices in the days ahead. We are counting on you to continue to be champions for California’s low-income families, seniors, and people with disabilities. Please continue to stand firm against a spending cap that would limit the state’s ability to provide critical health and human services to a growing and aging state whose needs can’t be capped to an arbitrary formula.
You are keenly aware that California’s budget crisis is largely driven by dramatic declines in revenues resulting from the Great Recession, not excessive spending. According to the California Budget Project, projected revenues for FY 2011-12 are $41.4 billion below the forecast the Legislative Analyst made for this time period in 2007. State spending as a share of the State’s economy has declined significantly over the last decade and will decline further under the Governor’s proposed budget.
At the same time, low-income families, seniors, and people with disabilities have been dealt relentless blows by the Great Recession and by severe reductions in critical services including Medi-Cal, SSI, In-Home Supportive Services, CalWORKs, and child care.
A spending cap such as that proposed in ACA 4 of 2010, would prevent California from responding to demographic and economic challenges, such as the aging of the baby boomers and the need to increase the supply of high-skilled workers, limit the state’s ability to rebuild these core public institutions when the economy improves; or to make the investments necessary for our economic growth, or to realize the opportunities created by federal health reform.
Specifically, this kind of cap:
1. Will lock-in health and human services spending at levels that should be a floor, not a ceiling. As the current recession has caused revenues to plummet, the state has dramatically pared back health and human services for our most vulnerable, and a spending cap would ensure they can never be restored—even in future times when services would be needed for economic growth. With such a cap in place, California would miss out on opportunities to draw down federal matching funds for health and human services, and other attempts to jump start economic activity.
2. Will force additional cuts to health and human services because such a cap fails to account for rising health care costs, which are growing faster than inflation. Between 1990 and 2004, for example, national per capita health care expenditures more than doubled, rising by 123 percent, while the Consumer Price Index (CPI) for California, which measures inflation in households’ purchases, rose by just 45 percent.
3. Will result in health and human services being “crowded out” of the budget. Under normal (“Test 2”) conditions, the Proposition 98 guarantee is tied to the change in per capita personal income growth. Between 1990-91 and 2007-08, per capita personal income grew at an average annual rate of 4.0 percent, while the CPI rose by 3.0 percent, on average. Over time, this disparity would result in education “crowding out” all other state spending.
On behalf of the Health and Human Services Network of California, a network of advocates, consumers, and allies working together for strong health care and human services in California, we ask you to stand strong against a spending cap that would handcuff our will prevent restoration of critical health and human services and limit California’s investment in our future.
Thank you for your leadership.
Nancy Berlin, Director California Partnership
Anthony Wright, Executive Director, Health Access California Paul Tepper, Executive Director, Western Center on Law and Poverty Reshma Shamasunder, Director, California Immigrant Policy Center
The current negotiations around the California budget have come down to the last few days.
The Governor wants a 2/3 vote to support the placement of a June ballot measure to consider a package of tax extensions to solve the California budget crisis--or to decide that we would rather the $13 billion in additional cuts, to education, public safety, as well as even more to health and human services. But it's already too late to have a vote in the first week of June, and in a few days, it will be too late for any date in June.
Yet at this late date, the Senate Republicans presented a 53-point wish list as their offer--a ransom note with a series of demands to enact an agenda that was largely rejected by California voters last November. Here's the full, long list.
Put another way (as we did on Twitter @healthaccess last night), this very detailed list is the price to merely get 1/3 of 1/2 of the California Legislature to agree to merely let Californians vote on a budget solution.
And it's not like the Senate Republicans actually have presented a credible counter-proposal about how otherwise you would balance the California budget.
Others pointed out that the list is dominated by ideological non-budget items: attacks on unions, teachers, environmental laws, regulations, etc.
And what worse, many of the items related to the budget crisis would actually make the deficit worse. They would want to remove elimination of Enterprise Zones and other corporate taxes. They want restorations in certain programs--the Williamson Act, county fairs--while arguing for even steeper cuts when they ask for the "original" proposed cuts from earlier in the years. Such cuts would mean hard caps on doctor visits for Medi-Cal patients, and the full elimination of Adult Day Health Centers.
It's depressing that we have a political system that empowers such bad behavior. And that we haven't found two Senators outside the majority Democratic caucus to take the leadership role that's available in offering voters a choice about California's future.
POSTSCRIPT: Earlier in the day, Senator President Pro Tem described how "ridiculous" the process is...
The Governor signs the cuts, await the other half...
Thursday, March 24, 2011
The Health and Human Services Network of California issued the following statement in response to the Governor’s signing of the $12 billion state budget cuts previously passed by the state legislature:
The enactment of these significant and life threatening cuts marks a sad day for California. Not only will these dangerous cuts cost many Californians their primary sources of support, independence, and in many cases even their lives; they also pose an irreparable harm to California’s much-needed economic recovery, costing the state thousands of public and private sector jobs.
At this critical stage in the budget process, the question of whether or not the legislature will pass the remaining elements of the Governor’s proposal, which aim to solve the state budget deficit with a mix of cuts and revenues, remains to be answered.
Californians understand that an all-cuts solution to California’s $26 billion deficit, on top of the $16 billion in cuts made over the last three years, will devastate California’s basic public infrastructure, including its schools, health care and social services for children, seniors and people with disabilities.
It is absolutely imperative that the legislature pass the Governor’s revenue package, which includes eliminating the ineffective enterprise zone tax break and closing the loophole that lets corporations choose how their profits are taxed. Equally important is allowing California voters the opportunity to weigh in on this fundamental question of California’s future by passing the Governor’s modest tax extensions and putting them to a vote in the June Special Election.
If we don’t close these tax loopholes and allow voters to have a say on these revenue solutions, California would not only sacrifice more jobs and families, but the remaining shortfall would have to be accounted for with billions more in cuts.
The HHS Network and its hundreds of partners and allies strongly urge legislators to stand up for what they know is right: close these egregious loopholes and give the people of California an opportunity to decide whether or not our recovery efforts will include these revenue proposals.
ACA's Anniversary: Time for Celebration, and Education...
Wednesday, March 23, 2011
HEALTH ACCESS UPDATE
Tuesday, March 22, 2011
On One-Year Anniversary of the Affordable Care Act...
NEW REPORT REVEALS HUNDREDS OF THOUSANDS OF CALIFORNIANS DIRECTLY BENEFITING FROM FEDERAL HEALTH LAW, JUST ONE YEAR IN
Seniors, Small Businesses, Young Adults, Those with Pre-Existing Conditions Get Direct Help; Millions Get Security of New Consumer Protections
California Leads Nation in Implementation of Federal Law, But Much More to Do To Maximize Benefits; Over a Dozen Bills Pending in California Legislature for 2011.
Sacramento Event (with cake!) at 11am Wed., March 23rd, Oak Park Community Center; Please come, Join Rep. Matsui & Commissioner Jones; RSVP to rauguste@health-access.org
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!
SACRAMENTO—Californians have reason to celebrate this week, as both grassroots events and report releases signal the one-year anniversary of the enactment of historic federal health reform. One year ago tomorrow, March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA), a historic law that provides the biggest reforms of our era in three areas: 1) Providing new consumer protections to prevent the worst insurance industry abuses. 2) Ensuring affordability and security for those with coverage, and new and affordable options for those without coverage, including the biggest expansion of coverage since creating Medicare. 3) Helping control health costs, improve quality, and encourage prevention and wellness.
Earlier today, one of the authors of the law, California Representative Henry Waxman was presented with a birthday cake and given a standing ovation at a celebration at Cedars-Sinai hospital in Los Angeles, by leaders including Insurance Commissioner Dave Jones, Rep. Karen Bass, HHS Regional Director Herb K. Shultz, and Californians who have gotten specific benefit from the law. The event was moderated by Jon “Bowser” Bauman of Sha Na Na, who was active, with many others in attendance, in advocating for the law.
Tomorrow, a Sacramento press event will feature Congresswoman Doris Matsui, Insurance Commissioner Dave Jones and key organization and community leaders. Consumer and health advocates are invited to attend and enjoy the ACA's birthday cake. The event is tomorrow, Wednesday, March 23rd, at 11:00am at the Oak Park Community Center. If you wish to attend, please RSVP to rauguste@health-access.org.
These events are not just for celebration but for education, to better inform Californians about their new benefits, options, and consumer protections--and also to know what would be lose with efforts to repeal or defund the law.
The report, authored by Health Access California, the statewide health care consumer advocacy coalition, reveals that hundreds of thousands of Californians are getting direct benefits—either coverage or financial assistance—as a result of the new law. The law is making a difference, from the tens of thousands of young adults on their parents' insurance and those with pre-existing conditions taking advantage of new options for coverage, to the hundreds of thousands of seniors and small businesses getting direct financial help to afford coverage. In addition, millions of Californians now have more security and confidence in their coverage, stemming from the new consumer protections and increased insurance oversight in place.
Those Californians who directly benefited include, but are not limited to: * Over 100 employers and trusts got specific financial assistance with early retiree coverage. * Nearly 1800 Californians who had been denied private coverage for their health status, who now have coverage through the new Pre-Existing Condition Insurance Program (PCIP); * Thousands of children with pre-existing conditions who now have new access to coverage. * Tens of thousands of young adults (out of nearly 200,000) who now get coverage through their parents’ health insurance. * Hundreds of thousands of Blue Shield of California and Anthem Blue Cross of California policyholders who has their rate hikes withdrawn or reduced, respectively, due to additional scrutiny that came in part due to the new law. * Hundreds of thousands of Californians who get coverage through a small business that qualifies for a tax credit to better afford to provide coverage. * Hundreds of thousands of seniors who got a $250 check to assist with prescription drug costs.
The one-year status report identifies California as a leader in taking advantage of opportunities of the law, from enacting over a half-dozen laws to implement and improve the ACA, to applying for federal grant funds, to negotiating a new Medicaid “waiver” with the federal government.
Millions more Californians will benefit, and qualify for direct financial assistance in the next year and beyond, but only if the implementation continues at both the federal and state level. In addition to preventing efforts to repeal or defund the law, California can takes additional steps to maximize the benefits, according to the report.
In releasing the report, health and consumer advocates outlined legislative, regulatory and other crucial implementation activities that are pending, including over a dozen bills pending for 2011 in the California legislature to implement and improve the federal health law. One group of bills would continue to improve consumer protections and insurance company oversight; another package would seek to make it easier for Californians to get and keep coverage through reforms to our eligibility and enrollment systems.
Finally, in addition to continuing progress at the state level, consumer groups urged against any efforts to repeal or defund the law at the federal level--efforts which would disadvantage these hundreds of thousands of Californians immediately, and millions in the near future.
Wednesday, March 23rd, is the one-year anniversary of President Obama's signing of the Affordable Care Act into law, we'll mark the event with celebration, and more importantly, education.
Health Access California, Health Care for America Now-California, and many other organizations are hosting events Tuesday, Wednesday and Thursday to highlight the new options, benefits, and consumer protections that Californians are now enjoying, and that more could take advantage of if they knew about them.
Tomorrow, Tuesday, March 22nd, a major event at Cedars-Sinai features Congressman Henry Waxman, who chaired one of the key committees responsible for reform, Congresswoman Karen Bass. In addition to Representatives who helped pass the measure, it also includes Insurance Commissioner Dave Jones, who now is actively moving to make the law work here in California. Many other key community leaders and government officials will speak, including Jon "Bowser" Bauman, of the band and TV show Sha-Na-Na, who has become a health advocate in his own right and was active in the effort to pass the law last year.
On Wednesday, March 23rd, the celebration moves to Sacramento, with Congresswoman Doris Matsui, Insurance Commissioner Dave Jones, and other key community and government leaders.
Also, watch for our upcoming release of a one-year status report on California's implementation of health reform. While it will update the previous report we've issued at the 3-month, 6-month, and 9-month intervals, the one-year report will provide new data and highlight individual Californians impacted by the federal law.
More good news about why increased oversight--both legislatively and regulatorily--makes a difference.
Less than a week after Blue Shield of California decided to withdraw its rate increases for the remainder of 2011, Anthem Blue Cross announced their intent to delay and reduce its most recently proposed health insurance rate increase.
It's welcome news, and well-timed with the one-year anniversary week of the Affordable Care Act, which provided for greater scrutiny of insurance rates and was implemented here in California. This once again shows that scrutiny matters, and why California need to go further with the passage of AB52 (Feuer) to provide regulators explicit authority to approve and deny rates.
Insurance Commissioner Dave Jones released the following statement, below:
“Today, I am pleased to announce good news for over 600,000 Californians who have individual or family plan health insurance from Anthem Blue Cross.
“As a result of the Department of Insurance review, Anthem Blue Cross is reducing its rate increase from 16.4 percent to 9.1 percent; delaying the effective date of the rate increase from April 1st to July 1st; and delaying increases in co-payments and deductibles proposed for April 1st to January 1, 2012. All told, this will save Anthem Blue Cross policyholders a total of at least $40 million. But this decision by Anthem Blue Cross to reduce its rate increase underscores the need to give the Insurance Commissioner the authority to reject excessive rate hikes, an authority that I do not have.
“During my first week as Insurance Commissioner, I asked the four largest health insurers with pending rate increases to delay implementation of those rate increases for 60-days beyond their original implementation date. I asked for this delay so that I would have adequate time to thoroughly review those rate filings. To its credit, Anthem Blue Cross quickly agreed to my request to delay their rate increase, originally scheduled for April 1st, to June 1st.
“We reviewed the rate filing information submitted by Anthem at the end of last year. We requested additional information about Anthem’s proposal. We have posted the rate filing and the supplemental information on the Department of Insurance website for the public to see.
“After reviewing the information that Anthem provided at our request, we determined that what was described as an average increase of 9.8% was more accurately described as an increase of 16.4%. There are two reasons the rate increase was really 16.4%, not 9.8%.
“First, the rate increase included co-payment and deductible increases in most Anthem Blue Cross individual plans. One of the more troubling aspects of the proposal was that some deductibles would have gone up in the middle of the calendar year. Someone could have spent enough out-of-pocket to have met their deductible in April, only to be told in June that a medical visit would not be covered because their deductible amount had increased in the middle of the year. Increasing the deductible mid year is akin to moving the goal posts further downfield. When factoring in these benefit reductions and deductible increases, the value of the rate increase was actually 13.4%.
“Second, the original rate filing proposed to increase premiums by 1.3% for each month the rate increase was delayed after April 1st. Delaying the rate increase to June 1st meant that the actual average rate increase, including the delay and the benefit reductions, was actually a total of 16.4%.
“In our review of the rate filing, we also reached different conclusions about the trend of medical prices, utilization and membership than Anthem had reached in its rate filing. Based on this analysis and the impact of an over 16% increase in rates on Anthem Blue Cross policyholders, I asked Anthem Blue Cross to reconsider its rate increase.
“Anthem Blue Cross is announcing today that it is reducing its rate increase from an average of 16.4% to an average increase of 9.1% beginning July 1st, rather than April 1st. Changes to the co-payment and deductible amounts will be delayed until January 1st. This will result in over 600,000 policyholders saving money. For some it may be the difference between whether they keep their current coverage, switch to a plan that offers less benefits or drop coverage altogether. The total savings to policyholders is estimated to be at least $40 million.
“I am pleased that Anthem Blue Cross has agreed to lower their proposed rates because this decision will have a significant positive financial impact on the affected policyholders.
“Many of the Anthem policyholders who contacted my office about Anthem’s latest rate filing were unaware that as Insurance Commissioner I lack the authority to reject excessive rate hikes. That continues to be the case. Insurance companies get to set their rates and I can only request that they make a change, which is not the system that consumers want or deserve. Anthem Blue Cross has decided to reduce its rate proposal, but this reduction does not change the fact that prior rate increases remain in effect and they have hit consumers hard.
“Health insurers still hold all the cards and consumers remain at their mercy. As a member of the State Legislature I authored three bills over five years to give the Insurance Commissioner the authority to reject excessive rate hikes. I have that authority for auto, property and casualty insurance, under a law called Proposition 103. Since Proposition 103 was passed by the voters in 1988, we have saved consumers and businesses billions of dollars in excessive premiums because the Insurance Commissioner has rejected excessive increases for those insurance lines. Health insurance is every bit as important as car insurance.
“I am asking again that the Legislature give me the authority to reject excessive health insurance rate increases. The bill I introduced as a member of the State Legislature has been re-introduced as Assembly Bill 52 by Assembly Member Mike Feuer. AB 52 would give me the power to reject excessive rate increases. Californians should write, call and email their legislators and urge them to support Assembly Bill 52.”
This evening, the California Legislature approved major cuts to health and human services, including $1.6 billion in cuts to Medi-Cal. The votes for AB97, the health care trailer bill which detailed the cuts, were bipartisan and well over the majority need: 36 out of 40 votes in the Senate; 56 out of 80 votes in the Assembly.
Fully understanding the magnitude of the budget crisis, this is a sad day for California. These cuts will impose costs and reduce access care to over eight million Californians with Medi-Cal or Healthy Families coverage. These severe cuts make it harder for our health system to be there for us when we need it. Because of these cuts passed with an overwhelmingly bipartisan vote, California is a less healthy, less caring, less secure state tonight.
The impact of these cuts will be significant, to the health of individual families, our health system on which we all rely, and our attempts at economic recovery. At a time of economic distress in California, these cuts will put administrative and financial barriers to care, place greater fiscal strain on families, and turn away hundreds of millions of dollars in federal matching funds for our economy.”
· CAP ON DOCTOR VISITS: Limit access to doctor visits for 7.7 million Californians on Medi-Cal including millions of low-income families, seniors, and people with disabilities and chronic illness, including: o Limit doctor/clinic visits to 7/year, unless certified as meeting specific criteria by a physician
· INCREASED COSTS: 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, and Healthy Families children up to 250% of the poverty level, including: o $100/day for a hospital stay, up to a maximum of $200. o $50 copayment for emergency room visits.
* Impose a $5 copayment for doctor, clinic, dental, and pharmacy visits and prescriptions in Medi-Cal. * Eliminate coverage for over-the-counter drugs in Medi-Cal. * Increase Healthy Families 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%.
· PROVIDER RATES: Reduce Medi-Cal provider rates by 10%, despite California having one of the lowest Medicaid provider rates in the country, and that half of doctors already don't take Medi-Cal coverage.
· ADULT DAY HEALTH CARE: Eliminate Medi-Cal adult day health care, impacting 27,000 patients and 330 centers statewide--although replacing it with a scaled down program with half the funding.
This latest withdrawal by Blue Shield shows that scrutiny matters. The new spotlight on rising health insurance rates, placed by the new federal health law and aggressive implementation at the state level, is having the desired impact of saving consumers money. This shows why California needs to take the next step of passing rate regulation, so regulators have the explicit authority to deny unjustified rate hikes.
Let's remember that this is the third insurer that has withdrawn or reduced rates as a result of additional scrutiny and requests that they justify those rates. New federal and state laws now make these rate hikes public, but we need to take the next step, to pass the rate regulation bill now pending in the California legislature. Blue Shield says they want a focus on the medical costs driving health care costs--but that's what rate regulation can help do.
New consumer protections and rate review processes just kicked-in on January 1. The California Department of Managed Health Care (DMHC) and Department of Insurance (DOI) will have new powers under both state and federal law to regulate insurers. Starting in 2011, health insurance rate hikes must go through a public rate review, including making public both the rate hike request and its justifications to be actuarially sound, under the federal health law and SB1163(Leno) at the state level.
A bill to institute rate regulation over health insurance, AB52(Feuer), which Health Access California and other consumer advocates support, is currently pending in the California Legislature. It would take the next step of allowing regulators to explicitly deny unreasonable or unjustified rate increases.
Where we are, sadly, on the budget. The Democratic legislators supporting awful, awful cuts. And the Republicans haven't put forward a "meaningful alternative," and seem to be getting in the way of the plan that is in discussion, not letting it get on the ballot for a vote of the people.
This year's budget drama is approaching a climax in the next week. The Budget Conference Committee has approved $12.5 billion of significant cuts, over half to health and human services.
As awful as the cuts are, the question is whether they will get worse. The budget depends on a vote of the California people to approve the extension of current tax rates, in order to fill the remaining $12 billion hole. The Governor is seeking Republican votes to place the question on a June ballot, and has been negotiating with five GOP Senators and possibly others. They have days, not weeks, to make a deal in order to be ready by the June ballot.
That said, the question may shift to what the GOP legislators want in return for their vote--not to raise taxes, but simply to put the question to the electorate. They have suggested that they want pension changes, the weakening of environmental laws, and most odious a spending cap--the kind of cap that would handcuff the state's future ability to invest in key services, or even keep up with health care inflation. Spending caps have been defeated at the ballot in 2005 and 2009.
So with all this drama going on, this year's California Budget Project conference on Thursday will be timely. The theme, "We the People: Assessing California's Century of Direct Democracy" goes directly to some of the problems that led up to this crisis; and part of the solution in that potential June election.
We look forward to the conference, especially since the agenda features a plenary with Justine Sarver, executive director of the Ballot Information Strategy Center, in Washington, DC. She has extensive background in California, from the San Diego Central Labor Council to the ACLU. She served on the Health Access California board when at Planned Parenthood for many years, and actually served as our president of Health Access Foundation--until she left to work for the Obama campaign and eventually work at the U.S. Department of Health and Human Services.
Nancy Gomez, a "tireless worker for the right of access to health care for all"
Sunday, March 13, 2011
We are proud of the amazing staff we have at Health Access California, who are small in numbers but very smart, savvy and effective, working with our broader coalition. This weekend, we are glad that one of our talented organizers has been recognized by a major newspaper: our own Nancy Gomez, our Southern California organizer, is profiled as an "outstanding woman" this weekend in La Opinion. In the article, Nancy is correctly described as "a tireless worker for the right of access to health care for all, including universal basic rights."
The article describes Nancy's background, from her degree in medical sociology to her time in the U.S. Navy, from her experience working to help provide social services to those with AIDS and other issues, before becoming an organizer with Health Access, and running our Los Angeles office. It goes on, in Spanish:
"Después de que me gradué de la universidad, supe que quería trabajar en lugares donde pudiera servir a gente con enfermedades crónicas o en desventaja económica o social", afirmó Gómez.
A partir del 2008, la trabajadora social se unió a Health Access, una agencia dedicada a promover la campaña Health Care for America Now! (HCAN) en el estado de California. "Esta campaña tenia como meta lograr que los Estados Unidos se tuviera un sistema de cobertura médica universal para todas las personas en el país", comentó la maestra en sociología.
Gómez añadió: "Trabajamos dos años sin parar para educar a la comunidad, para entrevistarnos con congresistas y abogar para poder conseguir que pasara la ley. No logramos conseguir todas nuestras metas, pero si logramos pasar una ley con un impacto muy poderoso para toda la población. Cosa que no se había logrado desde la Ley de Medicare hace mas de 40 años."
Una trabajadora incansable por el derecho al acceso al cuidado médico para todos, entre otros derechos básicos universales, Gómez dice que no descansará en pelear por lo que es justo, porque para ella su trabajo significa "que todo el tiempo y energía que he brindado a mis diferentes tareas laborales han dado fruto y han ayudado a cambiar y mejorar vidas para las personas que carecen de oportunidades, ya sea por su nivel económico, educacional o social."
Here's a rough translation of this excerpt (with help from GoogleTranslate):
"After I graduated from college, I knew I wanted to work in places where I could serve people with chronic illness or economic or social disadvantage," said Gomez.
Since 2008, the social worker joined Health Access, an agency leading the Health Care for America Now! (HCAN) campaign in the state of California. "This campaign was to ensure that the United States has a system of universal health coverage for everyone in the country," she said.
Gomez added: "We worked two years without stopping, to educate the community, and to meet with congressmen and policymakers, all to pass this new law. We did not achieve every one our goals, but we did pass a law with a powerful impact for the entire population--something that had not been achieved since the Medicare Act over 40 years ago."
Some background: There's some agreement among President and many members of Congress around a very specific change in the Affordable Care Act, around small business reporting that some have said are too onerous. Repealing the enhanced 1099 reporting provisions would, however, reduce some revenues, and the problem arises if finding our how to offset that money.
The House passed H.R. 4, which is authored by Northern California Representative Dan Lungren, to repeal the enhanced 1099 reporting provisions created by the ACA; and it pays for 1099 repeal by changing the rules for subsidies that families will get to afford coverage in 2014 and beyond.
It would increase the amount by $500, and sometimes more, that some low- and moderate-income families will have to repay at the end of the year if their income was higher than expected and as a result they received a larger premium tax credit in the Exchange throughout the year.
This pay-for is harmful to moderate-income families and undermines the ACA because it would:
· Increase the financial penalty on moderate-income families for having found a better job or gotten a raise. These new costs will impose financial hardship on already-struggling families. · Reduce the number of people who will enroll in the advanced tax credits, since they will fear this type of unexpected financial penalty. This means fewer people will get the coverage they need.
House Republicans don't seem to mind supporting this cost increase on working families, partially because they don't support the ACA to begin with, and they think that those having to pay these charges will blame the ACA, rather than those who voted for this change.
The Senate will soon be voting on H.R. 4 soon. If the Senate does repeal the 1099 reporting requirement, it should do so in a manner that does not increase taxes on middle-class families and drive up the ranks of the uninsured. The Senate has passed a 1099 repeal measure by Senator Nelson (FL) that found revenues in a different ways, and it should stick to that or find another path.
As the Obama Administration notes, “H.R. 4 would result in tax increases on certain middle-class families that incur unexpected tax liabilities, in many cases totaling thousands of dollars, notwithstanding that they followed the rules.” Families’ financial security should be put in jeopardy simply by accepting a better job, working more hours, receiving an increased wage or bonus, or through a drop in household size. It could also result in more than a quarter of a million more Americans going uninsured. Individuals and families who fear facing potentially crippling repayment penalties will be more likely to remain uncovered. Finally, the loss of those subsidies make it harder to truly create the systems for seamless coverage that would make our health system work best.
There are specific, stringent enforcement provisions in the Affordable Care Act to combat fraud and abuse that have nothing to do with this issue—the concern relates to families that are trying to make ends meet and who will choose not to purchase coverage because of the concern with these penalties at the end of the year. The Senate should find an alternative to H.R. 4.
The eyes of the nation continue to be on Wisconsin, as the state Senate used a parliamentary trick--splitting a "budget repair" bill of all fiscal elements, so that the measure--including the stripping of collective bargaining rights--could avoid the need for the quorum. The necessity of that elusive quorum, only needed for fiscal bills, had been blocked because of the walkout of the 14 Democratic Senators, who are behind state lines in Illinois to prevent state police from forcibly bringing them to the Capitol.
Beyond the substance of Wisconsin legislation, there's also been a facile comparison by some about the procedural issues, saying that the Wisconsin measure was "jammed through" like the federal health care bill.
Let's forget that that the legislative minority (the Wisconsin Senate Democrats) had a much higher burden to invoke the supermajority rule--they had to leave the state, at personal and political risk--and in a way that can't last forever. It's an extreme action taken to counter an extreme bill. In contrast, the filibuster in the Senate has become commonplace, where Republicans don't even have to go on the floor (Mr. Smith Goes To Washington style), and they invoke it so often it has become the norm, not the exception. A supermajority requirement isn't a great idea, but if it exists, the threshold to invoke it should be high enough that it is rare--not for every piece of legislation or nomination (as in the Senate) or every budget vote every year (as in the California legislature).
The real difference is that the issue of stripping collective bargaining rights was never discussed in the Wisconsin gubernatorial campaign, and then Governor Walker is attempting to push this new idea through in the first weeks of the legislative session.
In contrast, health care reform was a major platform of President Obama's campaign--the issue of which he spent over 80% of the television advertising dollars in the last month of the campaign. The measure took over a year to pass (it went into March of 2010). Much of that time was spent negotiating with the minority party (remember the Gang of Six in the Senate?), and despite the fact that Republican legislators walked away from those talks, the result of those negotiations ended up being the base legislation for the final product.
There's no definition of "jammed through" that includes a year-long process and deliberation, including such significant bipartisan outreach, and inclusion of the opposing party's ideas. And there's little comparison with the travesty in Wisconsin.
If there's a comparison, it's the passage of the health law repeal bill, which was rushed through in the first weeks of the House of Representatives without a single hearing.
Of particular note, her new role gives her the ability to fulfill her role as member of the new Health Benefits Exchange board, without any specific conflicts of interest of being directed associated with the health industry.
For a better sense of her views about her work and mission at the Exchange, California Healthline interviewed here and the transcript is of interest. The link includes a video of her comments.
As many as 20% of patients at California's emergency departments leave without being seen, according to a new study published in the Annals of Emergency Medicine, HealthDay reports. For the study, researchers analyzed information from a database run by the Office of Statewide Health Planning and Development. The database contained information on 9.2 million ED visits that occurred at 262 nonfederal hospitals in California during 2007.
We've focused on regulations to ensure timely access to care as a way to reduce the burden on emergency rooms--getting people care before they need to show up at an ER. But it's especially troubling when patients can't get timely access at an ER, and for whatever reason simply can't get seen.
They took testimony about processes here in California, from independent medical review at the Department of Managed Health Care, to the California Health Benefits Review Program.
Here's a sample of my testimony that spotlights the importance of the IOM process, and the new federal law in general:
Financial Security and the Fine Print
The Affordable Care Act is a landmark piece of legislation that seeks to resolve a series of major issues. While it has been called health reform, the Act is actually as much about economic security as health coverage. It has the potential to solve the problem of medical bankruptcy—achieving the goal that was repeated virally during the health reform debate: “No one should die because they don’t have healthcare. No one should go broke because they get sick.”
Having served for a decade as the executive director of Health Access California, the statewide health care consumer advocacy coalition, I know that patients and consumers share a fundamental fear about whether their coverage will be there for them when they need it.
Consumers are worried about “the fine print”—the exclusions, loopholes, and caveats that mean that the care they need will not be covered when they eventually need it, leaving them in financial ruin when they are really sick.
In many ways, the Affordable Care Act provides major consumer protections against consumers getting trapped in the fine print of insurance contracts. Among the protections that are provided by ACA: • Strict regulation of rescissions, losing coverage when you try to use it. • No denials of coverage for pre-existing conditions or being denied coverage when you need it. • An end to lifetime and annual limits that means insurance cuts off just when you need it the most. • A standard on medical loss ratios, so most of your premium dollar goes to patient care, rather than administration and profit. • An actuarial value standard, so a plan covers a certain percentage of a patient population’s care. • Subsidies on a sliding scale, out-of-pocket maximums, and other minimum benefit protections.
The debate in which the Institute of Medicine is engaged about the nature of the essential health benefit is perhaps the most important remaining debate about the fine print and its impact on financial security.
The essential benefit standard can uphold or undermine the spirit of the law expressed through these numerous consumer protection provisions—to make real the promise that coverage will be there for us when we need it.
The Layperson’s Definition on What Constitutes Health Coverage
Opinion Research: 2006: Our work is informed by many years of state health reform efforts in California, from an effort to expand employer-based coverage in 2003 and 2004, to a state proposal by Governor Schwarzenegger in 2007 and 2008 similar to what was passed federally. Health Access participated in privately funded opinion research in the year 2006 in preparation for the health reform efforts in 2007. During that research, we participated in 14 focus groups in which we asked consumers and small businesses what constituted basic health care benefits. The list was remarkably consistent from group to group: • Doctors • Hospitals • X-ray, lab • Prescription drugs • Mental health parity
Consumers and small businesses regarded basic benefits as those benefits covered by most employer-based coverage in California.
There is a layperson’s definition of coverage, which includes an expectation of coverage for basic services. In these focus groups, consumers were horrified to discover that lifetime limits or annual caps could leave other consumers exposed to tens of thousands or even hundreds of thousands of dollars in costs.
People buy coverage and make life decisions about their coverage based on this layperson’s definition—and so when they find holes in the benefits, it leaves people in financial trap. We know what that looks like in California because a small share of health insurance is regulated by the Department of Insurance where there is no standard for an essential benefit or basic health services. Here are some real examples:
• Susan Braig, Altadena, a self-employed graphic designer, bought what she thought was catastrophic coverage when she turned 50. She got breast cancer---and virtually none of her care was covered because what she had purchased was a hospital-only plan and almost all breast cancer treatment was outpatient. She ended up tens of thousands of dollars in debt and uninsurable.
• Laura Burwell, retired to Chico to open a wine shop and bought what she was told was coverage just as comprehensive as what she had previously from her very large employer. . She was clearing out her backyard, got bit by a rattlesnake, was taken to a local hospital, only to discover that her coverage did not cover the first and most expensive day in the hospital. Her bill for that first day of care was over $73,000 and her insurance covered only $3,000, leaving her on the hook for $70,000 in hospital care.
These two California consumers did the right thing and voluntarily purchased health insurance but saw their financial security destroyed by the fine print.
There is no benefit to consumers to having insurance products with these types of holes in coverage experienced by these consumers. One cannot, and should not be expected to, anticipate needing care for one ailment or not another; or inpatient rather than outpatient care; or a certain number of hospital days or prescription drugs. Even when these plans prominently disclose the holes in their benefits (which many do not), they rely on consumers lacking actuarial and medical information to provide context and evaluate risk appropriately.
Simplicity matters: insurance is a complex and confusing world, and it is in the consumers’ interest to standardize as much as possible, to minimize the number of variables they need to consider when choosing a plan. In fact, we want a health care system where insurers compete based on key elements of cost and quality, rather than on the confusing nature of their benefit design.
While many may seek ways to make a premium more affordable, the benefit package is the last place to seek such savings. A cheap premium is always attractive, but even cheap junk is still junk. To undermine a basic benefit package is to violate the point of coverage to begin with, which is to provide economic security and piece of mind.
We'll post our full testimony, and the whole proceedings of the IOM essential benefits committee, when it comes online.
The latest Health Wonk Review is at the Lucidicus Project, which we don't often agree with, but which does feature one of our recent posts of President Obama's "double dare" to give states flexibility to meet the goals of the Affordable Care Act. Healthblawg also goes into this issue.
It's been a while since we have highlighted the Health Wonk Review, but it's always a useful compilation of informative and analytical posts. Take a look at past editions:
CONFERENCE COMMITTEE APPROVES BUDGET WITH SEVERE HEALTH CUTS; PACKAGE NOW GOES TO FLOOR VOTES NEXT WEEK
* Medi-Cal patients would face caps on doctor visits; increased costs; and reduced access to providers; Those on Healthy Families would face higher premiums and co-payments. * Adult Day Health Care eliminated, but $85 million set aside for reborn, scaled-back program.
Today, the Budget Conference Committee of both Senators and Assembly representatives approved a package of $12.5 billion in cuts, and that relies ona vote of the California electorate for $12 billion in revenues to fill a remaining state budget deficit.
Assemblyman Bob Blumenfield, chair of the Budget Conference Committee, repeatedly stated how tough the cuts were, and how far "out of our comfort zone" he and his fellow Democrats were going. To make the point, he said he was "so far out of my comfort zone, it's like Charlie Sheen at a rehab clinic, times ten." He said those who don't recognize these as "real cuts" to the safety net and other vital programs "should not deny the misery these cuts will cause."
Health and human services were significantly cut, including 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.
Looking for additional savings, the Committee revisited a previously-rejected proposal to place caps on the number of doctor visits that Medi-Cal patients may get. The original proposal would place a hard cap on doctor visits of 10 a year, with no exceptions. The approved budget puts in place a "soft cap" of seven doctor visits a year, but allows more if a doctor certifies them as medically necessary. The expectation is that the proposal will reduce the number of doctor visits that Medi-Cal pays for in a given year by 15%.
The budget also includes a major cut in Adult Day Health Care. The Governor had proposed full elimination, and the Senate and Assembly made major cuts--but of different scales. The final compromise was to formally eliminate the program, but to recreate the program in a scaled-back, less costly form with $85 million--an amount that split the difference between where the two legislative houses proposed.
Ultimately, even with all the statements of regret, the Budget Conference 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 BUDGET CONFERENCE COMMITTEE:
* Reduce Medi-Cal provider rates by 10%, including doctors, hospitals, 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.
* Limit doctor visits to seven/year for 7.7 million Californians with Medi-Cal coverage including millions of low-income families, seniors, and people with disabilities and chronic illness, unless additional visits are specifically certified by a doctor as medically necessary.
* 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 adult day health care, impacting 27,000 patients and 330 centers statewide--and replacing it with a scaled-down program.
* 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).
Next Steps
The budget now goes to floor votes in both the Assembly and the Senate, expected for next week. Governor Brown is actively seeking a 2/3 vote for this "comprehensive" package, including from some Republicans. In fact, the head of the Chamber of Commerce indicated there may be support for a "comprehensive" package today, suggesting momentum on this effort. The goal is to complete the budget process by mid-March so that a revenue package and related budget proposals can go to the voters by June 2011.
In related news, dozens of organizations sent a letter, organized by the HHS Network, to the Legislature in support of the revenues in the budget. You can read the HHS Network’s sign-on letter in support of the Governor’s proposed revenue package, along with the list of organizations signed on, by clicking here. If your organization would like to sign-on to the letter and join the HHS Network in calling on legislators to support the Governor’s revenue proposals, please e-mail the HHS Network at hhsnetworkca@gmail.com.
A budget is never done until signed. But it's still surprising when a cut that many thought was rejected by both houses and soundly defeated comes back, even in a more limited form.
Both the Assembly and Senate rejected Governor’s proposal to institute a “hard cap” that would limit patients with Medi-Cal coverage to just 10 office visits per year, for a reduction of $392.9 million ($196.5 million GF).
The new proposal adopted by the Budget Conference Committee this afternoon goes as follows:
Due to a fiscal crisis, an alternative of a “soft cap” at 7 visits is proposed for a reduction of $89.7 million ($44.9 million GF). This “soft cap” would apply to Adults. Children (21 years and under), pregnant women, and residents in Long-Term Care facilities are exempt. The “soft cap” would apply to both Medi-Cal Fee-for-Service and Managed Care plans.
It affects outpatient primary care and specialty care provided under the direction of a Physician in the following settings: Hospital Outpatient Department; Outpatient Clinic; Federally Qualified Health Centers (FQHCs); Rural Health Centers; and Physician Offices.
All visits above 7 would be subject to Physician “self-certification” that they are medically required. The savings level assumes that 15 percent of the visits above 7 would not be certified. An October 1, 2011 implementation date is assumed.
Dozens of organizations support revenues to prevent cuts...
The Health and Human Services Network of California, which includes Health Access in its leadership, recently collected signatures from dozens of organizations all across the state urging Democratic legislators to continue to support Governor Brown’s $12 billion revenue package.
Non-profits, health and human services providers, and advocacy organizations from every corner of California signed on to the letter in hopes of encouraging legislators to pass the Governor’s revenue proposals and allow them to go before California voters in the June Special Election.
These modest and reasonable revenues represent the bare minimum that California needs to maintain core government services. Even with these revenues, California’s most vulnerable citizens will still suffer tremendously as the result of $12 billion in dangerous and potentially life-threatening cuts to vital health care and social services programs, including Medi-Cal, CalWORKS, IHSS, child-care and others. Without these revenues, the pain will be twice as bad.
California’s low- and middle- income families started 2011 still reeling from the impact of the worst economic recession in decade. California’s slow recovery has left unemployment still well above 12%, with projections for weak job growth through 2012. Californians’ average household income has fallen, and we expect 2010 data will show more even families fell into poverty over the past year.
Against this context, the deep budget cuts Governor Brown has proposed will be especially dramatic. Failure to reach the Governor’s revenue target of $12 billion would mean even more brutal cuts would have to be made – in turn putting more lives at stake and costing the state thousands of public and private sector jobs. Thus, protecting the critical public structures that California’s low-income families, seniors, people with disabilities and children count on is of the utmost necessity.
An obvious starting point is eliminating special tax breaks for large corporations that have failed to deliver the jobs and economic growth they have promised. The Governor has taken this crucial first step by proposing to eliminate Enterprise Zones, which have been proven time and again to have no statistically significant effect on job creation or growth. This proposal will save California an estimated $924 million this year, and more than $600 million per year thereafter.
Currently, California and Missouri are the only states in the nation that allow multinational corporations to choose how their profits are taxed. The Governor has proposed bringing California up to speed with the overwhelming majority of states in the country by requiring nearly all corporations to use a single formula for assessing how profits are taxed, based solely on the percentage of their sales that occur within California. This will generate nearly $500 million in 2010-11, and nearly $1 billion in 2011-12.
Minimizing cuts to vital health and human services will require new revenues and a critical look at these tax loopholes and others which benefit large corporations but don’t deliver the jobs or economic stimulus that Californians so desperately need. Therefore, the first vital step to getting California back on track must be placing these revenue solutions before California voters in the June election.
You can read the HHS Network’s sign-on letter in support of the Governor’s proposed revenue package, along with the list of organizations signed on, by clicking here.
If your organization would like to sign-on to the letter and join the HHS Network in calling on legislators to support the Governor’s revenue proposals, please e-mail the HHS Network at hhsnetworkca@gmail.com.
Republished from the California Progress Report, posted by Nancy Berlin, Executive Director, California Partnership Anthony Wright, Executive Director, Health Access California Paul Tepper, Executive Director, Western Center on Law & Poverty Reshma Shamasunder, Executive Director, California Immigrant Policy Center
Announced today, Speaker John Perez made his appointment to California's Health Benefits Exchange.
Paul Fearer, Senior Executive Vice President at Union Bank, had also been Director of Human Resources there. Prior to joining Union Bank in 1990, Mr. Fearer spent 14 years in human resources at Stanford University, including service as Deputy Director of Human Resources Services. Mr. Fearer is Chairman of the Pacific Business Group on Health.
Mr. Fearer would join the five member board with Governor Brown's Health and Human Services Secretary Diana Dooley, and two appointments made by Governor Schwarzenegger, Susan Kennedy (his former chief of staff) and Kim Belshe (his former HHS Secretary). The remaining slot has yet to be appointed by the Senate Rules Committee, chaired by Senate President Pro Tem Darrell Steinberg.
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.
