Anthem Blue Cross Shamelessly Advances Unreasonable Rate Hike...

Friday, April 29, 2011

Californians and consumers should be outraged today by Anthem Blue Cross' decision to impose an unfair rate increase on 120,000 Californians, even after its regulator, the California Department of Managed Health Care (DMHC), declared the rate hike "unreasonable" under a new law today.

Anthem Blue Cross is shameless and irresponsible in continuing to raise health insurance premiums, even when that rate hike has been officially declared as unreasonable by its regulator. This rate hike is Exhibit A on why the California legislature needs to pass the pending rate regulation bill, AB52, to explicitly allow state regulators the opportunity to deny unjustified and unreasonable rates.

The DMHC's declaration is the first time a regulator declared a rate hike "unreasonable" under a new California "rate review" law passed last year, SB1163(Leno), which was sponsored by Health Access California. The new rate review law, effective on Janaury 1, 2011, requires insurers to provide public notice of rate hike and to publicly justify their rate increases to their regulator.

Partially from the new federal health law, this new transparency and oversight has been a tool that Insurance Commissioner Jones has successful used to get insurers to reduce their rate increases. But when an insurer is shameless, then the regulator needs not just a magnifying glass but a hammer in his toolbox.

The current law does not give regulators explicit ability to approve or deny rates. Under current law, regulators can publicly declare rates to be unreasonable. And in 2014 and beyond under the new federal health law, regulators can advise the new Health Insurance Exchange on whether "particular health insurance issuers should be excluded from participation in the Exchange based on a pattern or practice of excessive or unjustified premium increases."

The pending rate regulation law, AB52(Feuer), would take the next step, and provide authority to the Department of Managed Health Care and the Department of Insurance to approve or deny health insurance rate increases. AB52, strongly supported by consumer groups including Health Access California but opposed by health insurers and other parts of the industry, passed the Assembly Health Committee this past Tuesday; the bill now heads to the Assembly Appropriations Committee and likely to a floor vote in the California Assembly at the end of May/first week in June.

Labels: BlueCross, HealthReform, Insurers

posted by Anthony Wright | Permalink | 3:46 PM


 

This Week's Hot Health Committee Action...

Thursday, April 28, 2011

HEALTH ACCESS ALERT
Thursday, April 28, 2011

RATE REGULATION & OTHER KEY HEALTH REFORM IMPLEMENTATION BILLS PASS HEALTH COMMITTEES IN CALIFORNIA ASSEMBLY AND SENATE

* Rate Regulation, AB52(Feuer), Would Allow Regulators to Deny Unjustified Rate Hikes
* Key Bills Pass To Implement New Federal Rules and Consumer Protections in State Law
* Some Seek to Improve Eligibility and Enrollment So More Californians Get Care
* Bills Move Onto Appropriations Committee, Then Onto Floor Votes in May

Read Our Health Access Blog! Join Us on Facebook! Follow Us on Twitter!
The Assembly and Senate Health Committees were live-tweeted and blogged...


SACRAMENTO--Key legislation to implement and improve upon the federal Affordable Care Act are moving forward this week, passing key Health Committees in the Assembly and Senate, respectively.

Some bills were heard in Assembly Health Committee on Tuesday; others in Senate Health Committee on Wednesday. The bills included measures to conform state law to the new federal law with regard to everything from Medi-Cal eligibility rules in 2014 to consumer protections regarding how much insurers have to spend on patient care rather than administration and profit. Several bills sought to streamline eligibility and enrollment to maximize the number of Californians who will benefit from expanded coverage. Other proposals would place new oversight on insurance companies, from rate regulation to requiring maternity coverage.

For a full list of legislation impacting health care consumers, visit our full bill list on the Health Access website. There's also a list of bills specifically related to implementing the Affordable Care Act in California. Full reports from the commitee hearings are on our blog, at https://blog.health-access.org.

AB52(Feuer) RATE REGULATION: The most high-profile bill was AB52(Feuer), which would give regulators the explicit ability to approve or deny rates. While supported by consumer, community, labor, and other organizations, AB52 was vigorously opposed by insurers and other parts of the health industry.

Assemblyman Feuer argued on behalf of California’s families and small businesses that are struggling under “astronomical health insurance rates that skyrocket unchecked.” Along with Insurance Commissioner Dave Jones, Feuer presented evidence that insurance companies’ rates needed the oversight that currently exists for car and homeowners insurance. Feuer and Jones pointed to the fact that while medical costs rose 3.4%, proposed health insurance rate increases went up to 80%, and insurance company profits rose 17%. Both made the strong case that regulators need the authority to step in and protect consumers in cases where proposed rates are unreasonable and are not sufficiently justified by evidence presented. Proponents also pointed to the many other states that require some form of prior approval from regulators for health insurance rate increases. They emphasized the experiences of California small businesses struggling to take care of their workforce while staying afloat and the millions of Californians who have dropped coverage as a result of prohibitive costs.

The opponents called rate regulation simply a “distraction” from the work of bringing down costs of health care. Mr. Feuer reminded the committee to measure the bill against the status quo, which is failing to make health care affordable and accessible to consumers, and that the bill is intended to be part of the solution, not to solve every problem in the health care system. Several members expressed concern that this bill (if it reduces rates) would negatively impact physician and hospital reimbursement. M r. Feuer referenced a LA Times editorial that points out “that insurers and healthcare providers have a shared incentive to raise premiums”.

After a lengthy debate, AB52 (Feuer) passed out of Assembly Health Committee with 12 votes, largely on party lines with nearly all Democrats voting for the bill, and new Democratic Assemblyman Richard Pan voting with GOP members in opposition.

ENSURING AND MAXIMIZING CALIFORNIANS GETTING COVERAGE

AB43 (Monning) MEDICAL EXPANSION: This bill would in state law allow for the expansion of Medi-Cal, starting January 1, 2014, under the Affordable Care Act. According to federal law, adults under 133% of the federal poverty level will quality for Medi-Cal starting in 2014 regardless of whether they have dependent children. Assemblymember Monning spoke of the importance of ensuring that the state stands ready to enroll as many eligible Californians into coverage as possible on day one. This will also allow the state to begin taking full advantage of federal dollars, which will cover 100% of costs for newly eligible Medi-Cal enrollees. AB43 passed out of Assembly Health Committee and moves on to Appropriations.

SB677 (Hernandez) MEDI-CAL ELIGIBILITY: This measure would implement the changes in Medi-Cal eligibility rules in 2014. The current eligibility rules are notoriously complicated, and this bill will simplify them by eliminating the assets test and using instead the Modified Adjusted Gross Income (MAGI) test currently used for tax purposes. The old assets test was both ineffective in keeping ineligible individuals off public programs (poor people don’t have assets), and an unnecessary barrier to breaking the cycles of poverty by prohibiting low-income families from saving. SB677 passed out of Senate Health Committee on party lines.

AB714 (Atkins) PRE-ENROLLMENT: Assemblymember Atkins referred to this bill as the “conveyor belt to the front door of the Exchange”, also known as our “pre-enrollment” bill. This bill will provide notice to nearly 3 million or so Californians currently enrolled in one of the state’s existing programs such as FamilyPACT, AIM, etc., that they may become eligible for the Exchange when it goes live. It also provides for early enrollment starting in 2013. AB714 passed Assembly Health on party lines.

AB792 (Bonilla) AUTOMATIC ENROLLMENT: This bill provides for more seamless transitions between coverage in certain life situations that have traditionally resulted in temporary if not extended uninsurance. Prior to 2014 the bill would require employers to provide information about the Exchange to terminated employees as they would provide COBRA notices; it requires other state agencies to provide this information when individuals file for divorce, unemployment, adoption, and other life changes. After 2014, the bill creates a culture of coverage by enrolling individuals in these situations into the Exchange (unless they decline coverage) by default rather than letting them go without insurance unless they take proactive action. AB792 also passed out of Assembly Health on party lines.

NEW RULES ON INSURERS; NEW OPTIONS FOR CONSUMERS

SB155 (Evans) MATERNITY COVERAGE: The bill would require maternity care in health plans, something that will be required in health plans under the federal law in 2014. (Other mandate bills were held in Senate Health, awaiting federal guidance on an essential minimum benefits standard. Senator Evans said that it was becoming more difficult for women to find health plans that cover maternity care in the individual market, citing a sharp downward trend in the plans that offer these services, which have dropped from 82% in 2004 to 19% last year and 12% this year. Witnesses testified about the importance of early maternity services early in pregnancy and the impact that prenatal care can have on child health and delivery outcomes. SB155 passed out of Senate Health Committee with some bipartisan support.

SB51 (Alquist) MEDICAL LOSS RATIO: Part of the implementation of the Affordable Care Act, this bill puts into California law the federal “Medical Loss Ratio” requirements, to ensure dollars go to patient care, rather than administration or profit. The ACA requires that insurers spend 80% of premium dollars on health care in the small group and individual market plans, and 85% of premium dollars on providing care in the large group market, it further requires that insurers that do not meet Medical Loss Ratios provide annual refunds to customers. SB51 passed out of the Senate Health Committee on party lines.

AB151 (Monning) GUARANTEED ISSUE FOR MEDIGAP: This measure would protects seniors from unintended consequences of changes in Medicare. The bill provides guaranteed issue for seniors who wish to transition from Medicare Advantage plans to Medi-Gap plans. AB151 garnered some bipartisan support and moves forward as well.

SB222 (Alquist) PUBLIC HEALTH PLANS JOINT VENTURES: A reincarnation of SB52(Alquist) last year. The bill would allow local health plan initiatives and county organized health systems to form joint ventures. These entities could form joint ventures to broaden their networks so that their local coverage programs could become regional public health insurance options. SB222 passed out of Senate Health Committee with some bipartisan support.

Contact the author of this update, Linda Leu at Health Access (lleu@health-access.org), for more information on these bills or for a list of health reform related bills.

Labels: HealthReform, Insurers, Legislation, MediCal, Updates

posted by Anthony Wright | Permalink | 8:55 AM


 

Senate Health Committee Moves Key Bills Forward

Wednesday, April 27, 2011

At the beginning of the Senate Health Committee this afternoon, Senator Hernandez focused on a handful of bills on benefit mandates. Saying they were awaiting federal guidance about the essential minimum benefits as part of the federal health law, he announced a decision on the part of the committee to hear but not vote on health insurance benefit mandate bills, holding them as two-year bills. He stated that the action was not to be seen as opposition, but it was the intent of the committee and the leadership to wait for federal guidance about minimum essential benefits before taking any action, regardless of their house of origin. For this month, that only holding two bills, one by Senator Steinberg and another by Senator Pavley, for which they took extensive testimony. (Another measure, by Senator Simitian, was amended to remove the mandate portion of a large measure.) That said, Chair Hernandez stated that the committee did intend to move forward with benefit mandate bills related to benefits that were explicitly mentioned in the federal law--such as maternity coverage, as addressed in SB155.

SB155 by Senator Noreen Evans would require maternity care in health plans, something that will be required in health plans under the federal law in 2014. Senator Evans said that it was becoming more and more difficult for women to find health plans that cover maternity care in the individual market, citing a sharp downward trend in the plans that offer these services, which have dropped from 82% in 2004 to 19% last year and 12% this year. Witnesses testified about the importance of early maternity services early in pregnancy and the impact that prenatal care can have on child health and delivery outcomes. Other witnesses pointed out that plans that provide necessary medical care for men, but not for women were discriminatory, and plans that charge women more to provide them with necessary health care were discriminatory as well.

SB51 by Senator Elaine Alquist also relates to the implementation of the Affordable Care Act, specifically, it puts into California law the federal “Medical Loss Ratio” requirements. Because insurance companies think of money that they have to spend on actually providing health care to their customers, they use the term “medical loss” to refer to those dollars. The ACA requires that insurers spend 80% of premium dollars on health care in the small group and individual market plans, and 85% of premium dollars on providing care in the large group market, it further requires that insurers that do not meet Medical Loss Ratios provide annual refunds to customers.

SB677 (Hernandez) is the Chair’s bill to implement the changes in Medi-Cal eligibility rules. The current eligibility rules are notoriously complicated, and this bill will simplify them by eliminating the assets test and using instead the Modified Adjusted Gross Income (MAGI) test currently used for tax purposes. The old assets test was both ineffective in keeping ineligible individuals off public programs (poor people don’t have assets), and an unnecessary barrier to breaking the cycles of poverty by prohibiting low-income families from saving. Conforming to the federal law and simplifying eligibility and enrollment will no doubt be key to ensuring that as many as possible of the state’s 7 million uninsured residents get covered and that the state can take full advantage of federal funds as they become available.

Last but certainly not least, the committee heard SB222 by Senator Alquist. This is the reincarnation of SB52 from last year, also carried by Senator Alquist. The bill would allow local health plan initiatives and county organized health systems to form joint ventures. These entities could form joint ventures to broaden their networks so that their local coverage programs could become regional public health insurance options.

All of these bills passed out of Senate Health Committee and will next face scrutiny from the Senate Appropriations Committee and then hopefully, move to the Senate floor.

Labels: HealthReform, Insurers, Legislation

posted by Linda Leu | Permalink | 7:46 PM


 

Assembly Health Passes Rate Regulation and Other Key Bills, Additional Hurdles Ahead

Tuesday, April 26, 2011

Assembly Health Committee held a lengthy hearing over AB52 (Feuer) today which would grant regulators at the Department of Insurance and the Department of Managed Health Care to approve or deny health insurance rate increases that are determined to be excessive or unjustified based on an objective review of evidence.

Assemblyman Feuer, the bill’s author, argued on behalf of California’s families and small businesses that are struggling under “astronomical health insurance rates that skyrocket unchecked.” Along with Insurance Commissioner Dave Jones, Feuer presented evidence that insurance companies’ rates are in desperate need of the oversight that currently exists for car and homeowners insurance. Feuer and Jones pointed to the fact that while medical costs rose 3.4%, proposed insurance rate increases went up to 80%, and insurance company profits rose 17%. Both made the strong case that actions of insurers just in the past few years have demonstrated the need for independent and objective review of health insurance rates, and that regulators need the authority to step in and protect consumers in cases where proposed rates are unreasonable and are not sufficiently justified by evidence presented.

Proponents also pointed to the 35 other states that require some form of prior approval from regulators for health insurance rate increases, and presented evidence that rates are lower there than they would have been without regulation. They emphasized the experiences of California small businesses struggling to take care of their workforce while staying afloat and the millions of Californians who have dropped coverage as a result of prohibitive costs.

The opponents called rate regulation simply a “distraction” from the work of bringing down costs of health care and suggesting that low Medi-Cal reimbursement rates were forcing providers to try to make up for low public reimbursement by demanding more from private insurers. Mr. Feuer reminded the committee to measure the bill against the status quo, which is failing to make health care affordable and accessible to consumers, and to keep in mind that this bill is intended to be a substantial part of the solution, not to solve every problem of the health care system.

Insurers also argued that if regulators were granted the authority to regulate rates, and if the exercise of that authority in fact impacts the insurers’ bottom line, they are “concerned” that they might then have to make changes that would reduce access and quality for consumers. Several members expressed concern that this bill (if it reduces rates) would negatively impact physician and hospital reimbursement. Mr. Feuer referenced a LA Times editorial that points out “that insurers and healthcare providers have a shared incentive to raise premiums”.

Assemblymember Pan joined members Nestande and Mansoor in vocally opposing the bill, registering lingering concerns and dissatisfaction with the witnesses’ answers to his questions related to the experiences of other states. Assemblymember Monning encouraged members to consider this legislation from a consumer lens, and act to protect their constituents. AB52 (Feuer) passed out of Assembly Health Committee with 12 votes.

While the rate regulation bill would provide much needed relief to the millions of Californians who have private insurance, several other bills heard in committee today will expand coverage to allow the millions more uninsured Californians access to affordable coverage. The comparative brevity of discussion on these bills enjoyed were partially a result of a bipartisan interest in ending the committee meeting before nightfall.

AB43 (Monning) is the bill that would make the appropriate changes to state law to allow for the expansion of Medi-Cal, starting January 1, 2014, under the Affordable Care Act. According to federal law, adults under 133% of the federal poverty level will quality for Medi-Cal starting in 2014 regardless of whether they have dependent children. Assemblymember Monning spoke of the importance of ensuring that the state stands ready to enroll as many eligible Californians into coverage as possible on day 1. This will also allow the state to begin taking full advantage of federal dollars, which will cover 100% of costs for newly eligible Medi-Cal enrollees. AB43 passed out of Health Committee and moves on to Appropriations.

AB714 (Atkins) is what Assemblymember Atkins referred to as the “conveyor belt to the front door of the Exchange”, also known as our “pre-enrollment” bill. This bill will provide notice to the 3 million or so individuals currently enrolled in one of the state’s existing programs such as FamilyPACT, AIM, etc., that they may become eligible for the Exchange when it goes live. It also provides for early enrollment starting in 2013. AB714 passed Assembly Health on party lines.

AB792 (Bonilla) provides for more seamless transitions between coverage in certain life situations that have traditionally resulted in temporary if not extended uninsurance. Prior to 2014 the bill would require employers to provide information about the Exchange to terminated employees as they would provide COBRA notices; it requires other state agencies to provide this information when individuals file for divorce, unemployment, adoption, and other life changes. After 2014, the bill creates a culture of coverage by enrolling individuals in these situations into the Exchange (unless they decline coverage) by default rather than letting them go without insurance unless they take proactive action. AB792 also passed out of Assembly Health on party lines.

AB151 (Monning) is an important measure for protecting seniors from unintended consequences of changes in Medicare. The bill provides guaranteed issue for seniors who wish to transition from Medicare Advantage plans to Medi-Gap plans. AB151 garnered some bipartisan support and moves forward as well.

Labels: HealthReform, Insurers, Legislation

posted by Linda Leu | Permalink | 8:59 PM


 

Key Health Bills Up This Week!

Monday, April 25, 2011

HEALTH ACCESS ALERT
Monday, April 25, 2011

CALIFORNIA'S EFFORTS TO IMPLEMENT AND IMPROVE HEALTH REFORM MOVE FORWARD AS NEW EXCHANGE BOARD HOLDS ITS FIRST MEETING; KEY BILLS COMING UP THIS WEEK IN LEGISLATIVE COMMITTEES, FROM RATE REGULATION TO STREAMLINING ENROLLMENT

* Exchange Board Began Multi-Year Effort to Create Purchasing Pool by 2014.
* Key Bills Up to Implement New Federal Rules and Consumer Protections in State Law
* Some Seek to Improve Eligibility and Enrollment So More Californians Get Care
* Rate Regulation, AB52(Feuer), Would Allow Denial of Unjustified Rate Hikes

* Read Our Health Access Blog! Join Us on Facebook! Follow Us on Twitter!
* Last week's historic 1st meeting of the Exchange was live-tweeted and blogged by us!

SACRAMENTO--California's efforts to implement and improve upon the federal Affordable Care Act are moving forward, as evidenced this week with many key bills up in Assembly Health Committee on Tuesday, and in Senate Health Committee on Wednesday. Bills to be considered include measures to streamline eligibility and enrollment to maximize the number of Californians who will benefit from expanded coverage, as well as proposals to place new oversight on insurance companies, from rate regulation to new consumer protections to ensure premium dollars go to patient care.

FIRST EXCHANGE MEETING: Even last week, during a legislative recess, there was progress made with the first meeting of the California Health Benefits Exchange, beginning a multi-year effort to create a subsidized purchasing pool that will offer affordable & available coverage to millions of Californians starting in 2014. As live-tweeted at @HealthAccess, the board members were aware of the importance of their charge, as they began the basic work of starting to look for staff leadership, and in starting an application to draw down the needed federal funds. A full report is available on the Health Access blog.

KEY BILLS UP THIS WEEK: Important legislation to implement and improve upon the new federal health law is being heard in the California legislature. The federal law celebrated its one-year anniversary of enactment last month, and a recent Health Access report detailed how many Californians were taking advantage of the new benefits, options, and consumer protections.

While last year's legislation put Caifornia ahead of many other states in making health reform a reality for our residents, additional legislation is needed to maximize the benefit for California and Californians, and to ensure a smooth glidepath leading to the full federal health reform implementation in 2014.

RATE REGULATION UP FOR VOTE TOMORROW: The most high-profile bill up this week would give regulators the explicit ability to approve or deny rates. A bill to institute rate regulation over health insurance, AB52(Feuer), which is supported by a range of consumer advocacy organizations, including Health Access California, is currently set to be heard and voted on tomorrow, Tuesday, April 25th, in Assembly Health Committee. Senator Feinstein, who has authored a similar federal proposal, recently came out in support of this state measure.. ACTION ALERT: Call Assembly Health Committee members to urge them to support AB52(Feuer), to protect Californians from unjustified and unreasonable insurance rate hikes.

BILLS TO BE VOTED ON IN COMMITTEES TUESDAY AND WEDNESDAY, THIS WEEK AND NEXT: Health Committees in both the State Senate and Assembly will see a flury of activity this and next week, as dozens of health consumer bills are up for votes before the legislative deadline to pass the measures through policy committees. For a full list of legislation impacting health care consumers, visit our full bill list on the Health Access website.

LEGISLATION ON ACA IMPLEMENTATION: Several of the bills up in the next two days are those specifically related to implementing the Affordable Care Act in California. One big category are bills to ensure that Californians get the care and coverage that they need, through streamlined, simplified eligibility, enrollment, and consumer assistance systems in the state. Another category is a range of bills to implement and provide better consumer protections and insurer oversight. Contact the author of this update, Linda Leu at Health Access (lleu@health-access.org), for sample letters on some of these bills or for a list of health reform related bills.

Below are selected measures up in the next week, highlighted from health bills that are intended to implement and improve certain provisions in the federal health reform law and prepare the state for other provisions contained in the law. The full implementation list is regularly updated and can be found at www.health-access.org. (The Health Access website also has a broader bill list of interest for health care consumers.)

** ASSEMBLY HEALTH COMMITTEE ON TUESDAY, APRIL 26th: Selected Health Reform Bills

* AB 43 (Monning) EXPANDING MEDI-CAL: Expands Medi-Cal eligibility to persons under 133% of the Federal Poverty level who are not pregnant, don't have dependent children, and are under the age of 65, effective January 1, 2014.
* AB 52 (Feuer) RATE REGULATION: Provides authority to the Department of Managed Health Care and the Department of Insurance to approve or deny health insurance rate increases.
* AB 151 (Monning) GUARANTEED ISSUES FOR SENIORS ON MEDI-GAP: Assures that those previously covered by MedicareAdvantage have guaranteed issue for Medi-Gap coverage.
* AB 714 (Atkins) PRE-ENROLLMENT: Requires existing programs such as MRMIB and Family PACT as well as hospitals to provide information about the California Health Benefits Exchange to their members for the purpose of pre-enrolling them into th Exchange to receive subsidized coverage in January 2014.
* AB 792 (Bonilla) AUTOMATIC ENROLLMENT: Ensures continuous coverage through life circumstances such as divorce or unemployment by requiring that consumers receive information about the Exchange when filing for divorce, unemployment, etc. Would also require insurers to provide this enformation to individuals dropping off coverage after 2014.

** SENATE HEALTH COMMITTEE ON WEDNESDAY, APRIL 27th: Selected Health Reform Bills

* SB 51 (Alquist) MEDICAL LOSS RATIO: Ensures that premium dollars go to patient care rather than administration or profit. Requires (per the Affordable Care Act) that insurers who do not spend the specified percentage of premium dollars on patient care provide refunds to patients.
* SB 155 (Evans) MATERNITY CARE: Phases in maternity care benefit mandate by requiring new health insurance policies submitted after January 1, 2012 to provide coverage for maternity services. Federal law will require coverage of maternity care starting in 2014.
* SB 222 (Alquist) COUNTY-RUN HEALTH INSURANCE OPTIONS: Allows counties, county special commissions, or county health authorities that govern, own, or operate a local initiative health plan or county-organized health system to form joint ventures to offer health plans to individuals and groups.
* SB 677 (Hernandez) MEDI-CAL RULES: Implements changes to Medi-Cal required by the ACA including eliminating the asset test and changing income standard to MAGI, effective January 1, 2014.
* SB 810 (Leno) SINGLE-PAYER UNIVERSAL HEALTH CARE: Establishes a universal single-payer health care system in California, where all residents would get specified health benefits. Sets up a California Healthcare Agency to manage such a system, and a California Healthcare Premium Commission to recommend needed financing.

** ASSEMBLY HEALTH COMMITTEE ON TUESDAY, MAY 3rd: Selected Health Reform Bills

* AB 1083 (Monning) REFORMING THE SMALL GROUP MARKET: Conform and phase-in new insurance market rules for small businesses, particularly so that small employers don't get additional premium spikes based on the health of their workforce.
* AB 1334 (Feuer) STANDARDIZING BENEFITS: Requires plans to categorize all products offered in the individual market into five tiers according to the actuarial value and would require disclosure of this and other information.

Labels: HealthReform, Legislation, Updates

posted by Anthony Wright | Permalink | 5:57 PM


 

Rally for Children, Stand Against Budget Cuts for Kids

Our friends at Children Now invite you to join Stand for Kids, a pediatricians advocacy group is holding 4 rallies this week to protest budget cuts on the state and federal levels that will have huge impacts on the health of children. Children, like seniors, people with disabilities, and other vulnerable populations are likely to be hit with a "double whammy" of cuts in state and federal budget proposals.

Labels: Budget

posted by Linda Leu | Permalink | 2:38 PM


 

Too Close to Home...

Friday, April 22, 2011

Folks are already talking about the 2012 presidential campaign, and the big concern of one of the candidates...

Though Mitt Romney is considered to be a frontrunner for the 2012 Republican presidential nomination, the national spotlight has forced him to repeatedly confront a major skeleton in his political closet: that as governor of Massachusetts he once tried to help poor, uninsured sick people.

Romney, who signed the state's 2006 health care reform act, has said he "deeply regrets" giving people in poor physical and mental health the opportunity to seek medical attention, admitting that helping very sick people get better remains a dark cloud hovering over his political career, and his biggest obstacle to becoming president of the United States of America.

"Every day I am haunted by the fact that I gave impoverished Massachusetts citizens a chance to receive health care," Romney told reporters Wednesday, adding that he feels ashamed whenever he looks back at how he forged bipartisan support to help uninsured Americans afford medicine to cure their illnesses. "I'm only human, and I've made mistakes. None bigger, of course, than helping cancer patients receive chemotherapy treatments and making sure that those suffering from pediatric AIDS could obtain medications, but that's my cross to bear."

"My hope is that Republican voters will one day forgive me for making it easier for sick people—especially low-income sick people—to go to the hospital and see a doctor," Romney added. "It was wrong, and I'm sorry."

According to Romney, if he could do things over again, he would do everything he could to make certain that uninsured individuals got sicker and sicker until they died. Promising his days of trying to provide medical coverage to the gravely ill are behind him, Romney said that if elected president, he would never even think about increasing anyone's quality of life or trying to lower the infant mortality rate.

In addition, Romney repeatedly apologized for wanting to help people suffering from diabetes, Crohn's disease, and anemia.

"I don't know what got into me back then," Romney said. "Wanting to make sure people were able to have health insurance if they left their job. Providing a federally funded website so individuals could compare the costs of insurance providers. Making certain that somebody who earns less than 150 percent of the poverty level can receive the same health care coverage as me or any government official. All I can say is that I was young and immature, and I am not that person anymore."

"The only solace I can take is in the hope that some of the folks I helped were terminally ill patients who eventually withered away and died," Romney added.

Yes, this story was satire in The Onion, but it is sadly indicative of the current political discourse. I don't know whether to think better or worse of Romney because of his about health care history and reversals.

Labels: Federal, Funny, HealthReform

posted by Anthony Wright | Permalink | 5:06 PM


 

The California Health Benefits Exchange is Born!

Wednesday, April 20, 2011

The California Health Benefits Exchange Board held its first meeting today in Sacramento. The Board, staff, and nearly 100 stakeholders in the audience were well aware of the significance of the meeting, which represents the first official and concrete action toward expanding coverage and extending consumer protections to the 4 million Californians.


The meeting ended 2 hours early, but with the enormity of the task ahead, Board Chair Diana Dooley warned attendees that this was not likely to happen again.

For more blow-by-blow from the meeting, we live-tweeted the proceedings at @healthaccess (www.twitter.com/healthaccess), using the hashtag #CaHEx--which others used as well.

Labels: Exchange, HealthReform, Insurers

posted by Linda Leu | Permalink | 2:53 PM


 

Tomorrow, and the Exchange, Couldn't Come Soon Enough

Tuesday, April 19, 2011

The first meeting of the Exchange Board is tomorrow and we at Health Access couldn't be more excited. The Exchange represents an opportunity to cover perhaps over 4 million Californians in 2014 and beyond when it is fully enrolled. The board meetings will provide consumers with an opportunity to make public comments and weigh in on the decisions made by the Exchange Board. The early decisions can be formative and indicative of how well consumer needs will be met moving forward.

Labels: Exchange, HealthReform, Insurers

posted by Linda Leu | Permalink | 2:33 PM


 

CA's GOP Representatives Vote to End Medicaid/Medicare, Shift Billions of Cost to California

Friday, April 15, 2011

Earlier today, the U.S. House of Representatives voted on a 2012 budget plan (with all Republican votes, opposed by all Democratic members and 4 Republicans from outside California) to end Medicaid and Medicare as we know it. The proposal would replace Medicare with a voucher program to buy private coverage, and replace Medicaid with a "block grant" program that would shift billions of dollars of costs to California.

It's deeply disturbing that any California Representative--much less the entire GOP caucus in California--voted to end Medicare and Medicaid as we know it, given the dramatic impact not just on our seniors and families, but on the health system on which we all rely, and on our precarious state budget.

If this budget were ever to be enacted, the ramifications would be devastating, from seniors and families paying far more for care and coverage to millions more becoming uninsured. The Ryan proposal passed today by the House GOP does nothing to control the main issue of medical inflation but simply shifts major costs of care from the federal government to states, seniors, and families--all to pay for trillions of dollars in tax cuts.

It's especially mindblowing, given the California budget crisis, that any California Representative would have voted to make it signficantly worse by billions of dollars--forcing the state to either raise taxes or make worse cuts.

The proposal to turn Medicaid into a block grant alone would cost California billions of dollars. If this Medicaid "block grant" proposal was put in place in 2000, California would have lost $35 billion in federal Medicaid dollars from 2000-2009, according to an analysis by the Center for Budget and Policy Priorities. In 2009, the reduction in federal Medicaid dollars to California would have been 31%.

California GOP Representatives, who all voted for the Ryan budget and the Medicaid "block grant" proposal, were going against the advice of California's elected leaders, who warned of the devastating impact on California citizens and the state as a whole.

* Governor Jerry Brown co-signed an April 4th letter from 16 Governors to Congressional leaders, warning against a "transformation of the Medicaid program's finances that significantly shifts the costs and risks to states" and that would "severly undercut our ability to provide health care to our residents and adequately pay providers."

* Senator Barbara Boxer co-signed an April 12th letter with other Senators to President Obama, opposed to a Medicaid block grant or other spending cap, stating that "complying with a spending cap would thus require unprecedented draconian cuts to Medicaid over time."

* Senator Dianne Feinstein wrote her own letter on April 12th, warning that "Converting Medicaid to a block grant would harm the 7.2 million Californians who currently receive basic health care from the state program, Medi-Cal, and would shift costs to the state, counties, beneificiaries, and health care providers. Through such proposals, California stands to lose an estimated $147.8 billion--$878.7 billion in federal investment in Medi-Cal, and an additional $60.1 billion from the Medicaid expansion included in the Affordable Care Act."

Given the dramatic and draconian impact to our state and our health system, Californians should be outraged by any Representative who voted for this budget. We will be actively educating Californians about these proposals, and the ready and realistic alternatives that are pending.

Labels: Budget, Federal, MediCal, Medicare

posted by Anthony Wright | Permalink | 3:12 PM


 

An interpreter, a broker, and an agent walk into a committee...

Thursday, April 14, 2011

The Senate Health Committee met Wednesday afternoon and considered a bill that would begin the process of risk adjustment in the Exchange. Even though the Affordable Care Act puts a lot of safeguards in place, including requiring all insurers to cover people regardless of health status, it may still be possible for some insurers to find some way to reduce the number of sick people they cover, and thereby reducing their costs and increasing their profits. The process of risk adjustment would create a mechanism by which insurers that have cherry-picked more desirable policy holders, or bear less than their share of risk, would transfer money to those bearing a heavier burden. AB728 (Hernandez) would begin to set up risk adjustment in the state, including beginning data collection, in preparation for 2014 when the Exchange begins operations. AB728 passed out of Health Committee and moves forward to Appropriations.

The Committee also considered SB616 (DeSaulnier), a bill that would require the state to apply for grants available under the Affordable Care Act that would provide wellness incentives under Medi-Cal. Many health advocates are often wary of wellness incentives because if implemented incorrectly, they may work to advantage the healthy people at the expense of the unhealthy, reinforcing and deepening existing health disparities. For example, giving discounts on insurance premiums to people who belong to a gym is in effect requiring individuals who do not have access to a gym due to how much money they make, where they live, or whether they have a disability or illness, to pay more for health insurance. This also allows for “backdoor underwriting,” allowing insurers to further identify and segment the healthy from the rest of us for discriminatory purposes. However, when implemented with equality in mind, wellness incentives can encourage people to get healthier. Advocates tenuously expressed support for the measure with these caveats. Health Access and our colleagues at the California Pan Ethnic Health Network have adopted a “Support if Amended” position while our colleagues at the Western Center on Law and Poverty have a “Support in Concept” position. The bill passed out of committee and we will continue to monitor it as it moves forward.

The Committee also passed SB442 (Calderon) which would require hospitals to renew and strengthen their commitment to using trained culturally and linguistically competent interpreters in providing care to limited English proficient or deaf patients upon request. The bill encourages discussion of cultural or religious traditions that might influence medical treatment or care, and also allows for the use of Video Medical Intrepretation where in person interpreters are not available.

Meanwhile, on the Assembly Side, the Assembly Insurance Committee also heard AB736 (Calderon) related to insurance brokers, which could potentially have an impact on the sale of health insurance. The bill would amend the insurance code for the benefit of health insurance brokers and agents and to the detriment of consumers. It would allow agents and brokers to charge fees for their services directly to individual consumers and businesses in order to bypass the federal law that establishes a "Medical Loss Ratio" which protects consumers by requiring that a percentage of premium dollars actually go toward care. The bill undercuts the Exchange by making it more profitable for brokers and agents to sell products outside of the Exchange, therefore providing incentive for them to steer consumers away from the Exchange, where they are protected under a number of new consumer protection laws. AB736 also reduces transparency in health care costs. The bill passed out of committee with 11 votes and we will continue to watch it moving forward.

Labels: Insurers, Legislation, MediCal

posted by Linda Leu | Permalink | 8:49 AM


 

Clear CA opposition to Medicaid block grants...

Wednesday, April 13, 2011

Earlier today, President Obama presented his vision for deficit reduction, as well defending Medicaid and Medicare from proposals to fundamentally replace them. Some initial thoughts.

President Obama was right to say our current budget debate is about the kind of future we want and the country we want. The framing pushed back against the "you are on your own" narrative so prevalent in DC these days, reminding us that our country has a long history and tradition of investing and working together for common goals and purposes. Finally, President Obama was absolutely right to vigorously defend Medicaid and Medicare as key commitments we have made to ensure that we all have some basic security, especially when confronting the issues and costs and risk of health care.

A good portion of the speech was a point-by-point rebuttal to Paul Ryan's House GOP plan. As tough as he was, President Obama's strong critique of the House GOP proposal, to basically end Medicare and Medicaid as we know it, was not as harsh as how that proposal would be felt by our state, our seniors, and our families. The Ryan proposal does nothing to control the main issue of medical inflation but simply shifts major costs of care from the federal government to states, seniors, and families--all to pay for trillions of dollars in tax cuts.

The President's deficit reduction plan was serious and centrist--and we have some concerns with specific elements, both about the need for a more balanced approach that includes additional revenues, and about the specifics of the cuts and targets for both discretionary and entitlement programs. While also appreciating the overall direction, the Center on Budget and Policy Priorities has a good, detailed critique of the specifics. But it was good that the President push back against a pessimistic plan that would forceour country to abandon not just seniors, children, or families, but the very notion that we should provide basic security to our citizens, and support to the health system on which we all rely."

We are pleased that California leaders have already weighed in against the destructive proposal to block grant Medicaid, shifting billions of dollars of cost onto on already beleaguered state.

* Governor Jerry Brown co-signed an April 4th letter from 16 Governors to Congressional leaders, warning against a "transformation of the Medicaid program's finances that significantly shifts the costs and risks to states" and that would "severly undercut our ability to provide health care to our residents and adequately pay providers."

* Senator Barbara Boxer co-signed an April 12th letter with other Senators to President Obama, opposed to a Medicaid block grant or other spending cap, stating that "complying with a spending cap would thus require unprecedented draconian cuts to Medicaid over time."

* Senator Dianne Feinstein wrote her own letter on April 12th, warning that "Converting Medicaid to a block grant would harm the 7.2 million Californians who currently receive basic health care from the state program, Medi-Cal, and would shift costs to the state, counties, beneificiaries, and health care providers. Through such proposals, California stands to lose an estimated $147.8 billion--$878.7 billion in federal investment in Medi-Cal, and an additional $60.1 billion from the Medicaid expansion included in the Affordable Care Act."

Given the dramatic and draconian impact to our state and our health system, every member of Congress from California should vote against the Ryan proposal when it comes up before the House of Representatives in the next few days. We will be actively educating Californians about these proposals, and the ready and realistic alternatives that are pending.

Labels: Budget, Federal, Obama

posted by Anthony Wright | Permalink | 5:21 PM


 

President Obama on the "Future We Want"

President Obama was right today in framing the debate about the budget and the deficit not as simply cutting and spending, but about our values, about the future we want. He went in detail on health care, and both why Medicare, Medicaid, and the Affordable Care Act need to be preserved, and proposals for changes. We'll have comment on those changes later, but it's important to understand the President's both frame and specific policies.

Because it was so fundamental to both the budget and health issues that we are focused on for the next year, here are extended clips from the speech (emphases are mine):

* On what budget debates are really about:

This debate over budgets and deficits is about more than just numbers on a page, more than just cutting and spending. It's about the kind of future we want. It's about the kind of country we believe in. And that's what I want to talk about today.

From our first days as a nation, we have put our faith in free markets and free enterprise as the engine of America's wealth and prosperity. More than citizens of any other country, we are rugged individualists, a self-reliant people with a healthy skepticism of too much government.

But there has always been another thread running throughout our history - a belief that we are all connected; and that there are some things we can only do together, as a nation. We believe, in the words of our first Republican president, Abraham Lincoln, that through government, we should do together what we cannot do as well for ourselves. And so we've built a strong military to keep us secure, and public schools and universities to educate our citizens. We've laid down railroads and highways to facilitate travel and commerce. We've supported the work of scientists and researchers whose discoveries have saved lives, unleashed repeated technological revolutions, and led to countless new jobs and entire industries. Each of us has benefitted from these investments, and we are a more prosperous country as a result.

Part of this American belief that we are all connected also expresses itself in a conviction that each one of us deserves some basic measure of security. We recognize that no matter how responsibly we live our lives, hard times or bad luck, a crippling illness or a layoff, may strike any one of us. "There but for the grace of God go I," we say to ourselves, and so we contribute to programs like Medicare and Social Security, which guarantee us health care and a measure of basic income after a lifetime of hard work; unemployment insurance, which protects us against unexpected job loss; and Medicaid, which provides care for millions of seniors in nursing homes, poor children, and those with disabilities.

We are a better country because of these commitments. I'll go further - we would not be a great country without those commitments.

For much of the last century, our nation found a way to afford these investments and priorities with the taxes paid by its citizens. As a country that values fairness, wealthier individuals have traditionally born a greater share of this burden than the middle class or those less fortunate. This is not because we begrudge those who've done well - we rightly celebrate their success. Rather, it is a basic reflection of our belief that those who have benefitted most from our way of life can afford to give a bit more back. Moreover, this belief has not hindered the success of those at the top of the income scale, who continue to do better and better with each passing year.

* On the root causes of the deficit issue:

As a result of.. bipartisan efforts, America's finances were in great shape by the year 2000. We went from deficit to surplus. America was actually on track to becoming completely debt-free, and we were prepared for the retirement of the Baby Boomers.

But after Democrats and Republicans committed to fiscal discipline during the 1990s, we lost our way in the decade that followed. We increased spending dramatically for two wars and an expensive prescription drug program - but we didn't pay for any of this new spending. Instead, we made the problem worse with trillions of dollars in unpaid-for tax cuts - tax cuts that went to every millionaire and billionaire in the country; tax cuts that will force us to borrow an average of $500 billion every year over the next decade. To give you an idea of how much damage this caused to our national checkbook, consider this: in the last decade, if we had simply found a way to pay for the tax cuts and the prescription drug benefit, our deficit would currently be at low historical levels in the coming years.

Of course, that's not what happened. And so, by the time I took office, we once again found ourselves deeply in debt and unprepared for a Baby Boom retirement that is now starting to take place. When I took office, our projected deficit was more than $1 trillion. On top of that, we faced a terrible financial crisis and a recession that, like most recessions, led us to temporarily borrow even more. In this case, we took a series of emergency steps that saved millions of jobs, kept credit flowing, and provided working families extra money in their pockets. It was the right thing to do, but these steps were expensive, and added to our deficits in the short term. So that's how our fiscal challenge was created.

This is how we got here. And now that our economic recovery is gaining strength, Democrats and Republicans must come together and restore the fiscal responsibility that served us so well in the 1990s. We have to live within our means, reduce our deficit, and get back on a path that will allow us to pay down our debt. And we have to do it in a way that protects the recovery, and protects the investments we need to grow, create jobs, and win the future. ...

We can solve this problem. We came together as Democrats and Republicans to meet this challenge before, and we can do it again. But that starts by being honest about what's causing our deficit. You see, most Americans tend to dislike government spending in the abstract, but they like the stuff it buys. Most of us, regardless of party affiliation, believe that we should have a strong military and a strong defense. Most Americans believe we should invest in education and medical research. Most Americans think we should protect commitments like Social Security and Medicare. And without even looking at a poll, my finely honed political skills tell me that almost no one believes they should be paying higher taxes.

Because all this spending is popular with both Republicans and Democrats alike, and because nobody wants to pay higher taxes, politicians are often eager to feed the impression that solving the problem is just a matter of eliminating waste and abuse -that tackling the deficit issue won't require tough choices. Or they suggest that we can somehow close our entire deficit by eliminating things like foreign aid, even though foreign aid makes up about 1% of our entire budget.

So here's the truth. Around two-thirds of our budget is spent on Medicare, Medicaid, Social Security, and national security. Programs like unemployment insurance, student loans, veterans' benefits, and tax credits for working families take up another 20%. What's left, after interest on the debt, is just 12 percent for everything else. That's 12 percent for all of our other national priorities like education and clean energy; medical research and transportation; food safety and keeping our air and water clean. Up until now, the cuts proposed by a lot of folks in Washington have focused almost exclusively on that 12%. But cuts to that 12% alone won't solve the problem.

So any serious plan to tackle our deficit will require us to put everything on the table, and take on excess spending wherever it exists in the budget. A serious plan doesn't require us to balance our budget overnight - in fact, economists think that with the economy just starting to grow again, we will need a phased-in approach - but it does require tough decisions and support from leaders in both parties. And above all, it will require us to choose a vision of the America we want to see five and ten and twenty years down the road.

* On Paul Ryan's "deeply pessimistic" vision:

One vision has been championed by Republicans in the House of Representatives and embraced by several of their party's presidential candidates. It's a plan that aims to reduce our deficit by $4 trillion over the next ten years, and one that addresses the challenge of Medicare and Medicaid in the years after that. Those are both worthy goals for us to achieve.

But the way this plan achieves those goals would lead to a fundamentally different America than the one we've known throughout most of our history. A 70% cut to clean energy. A 25% cut in education. A 30% cut in transportation. Cuts in college Pell Grants that will grow to more than $1,000 per year. That's what they're proposing.

These aren't the kind of cuts you make when you're trying to get rid of some waste or find extra savings in the budget. These aren't the kind of cuts that Republicans and Democrats on the Fiscal Commission proposed. These are the kind of cuts that tell us we can't afford the America we believe in. And they paint a vision of our future that's deeply pessimistic. It's a vision that says if our roads crumble and our bridges collapse, we can't afford to fix them. If there are bright young Americans who have the drive and the will but not the money to go to college, we can't afford to send them. Go to China and you'll see businesses opening research labs and solar facilities. South Korean children are outpacing our kids in math and science. Brazil is investing billions in new infrastructure and can run half their cars not on high-priced gasoline, but biofuels.

And yet, we are presented with a vision that says the United States of America - the greatest nation on Earth - can't afford any of this. It's a vision that says America can't afford to keep the promise we've made to care for our seniors. It says that ten years from now, if you're a 65 year old who's eligible for Medicare, you should have to pay nearly $6,400 more than you would today. It says instead of guaranteed health care, you will get a voucher. And if that voucher isn't worth enough to buy insurance, tough luck - you're on your own. Put simply, it ends Medicare as we know it.

This is a vision that says up to 50 million Americans have to lose their health insurance in order for us to reduce the deficit. And who are those 50 million Americans? Many are someone's grandparents who wouldn't be able afford nursing home care without Medicaid. Many are poor children. Some are middle-class families who have children with autism or Down's syndrome. Some are kids with disabilities so severe that they require 24-hour care. These are the Americans we'd be telling to fend for themselves.

Worst of all, this is a vision that says even though America can't afford to invest in education or clean energy; even though we can't afford to care for seniors and poor children, we can somehow afford more than $1 trillion in new tax breaks for the wealthy.

Think about it. In the last decade, the average income of the bottom 90% of all working Americans actually declined. The top 1% saw their income rise by an average of more than a quarter of a million dollars each. And that's who needs to pay less taxes? They want to give people like me a two hundred thousand dollar tax cut that's paid for by asking thirty three seniors to each pay six thousand dollars more in health costs? That's not right, and it's not going to happen as long as I'm President.

The fact is, their vision is less about reducing the deficit than it is about changing the basic social compact in America. As Ronald Reagan's own budget director said, there's nothing "serious" or "courageous" about this plan. There's nothing serious about a plan that claims to reduce the deficit by spending a trillion dollars on tax cuts for millionaires and billionaires. There's nothing courageous about asking for sacrifice from those who can least afford it and don't have any clout on Capitol Hill. And this is not a vision of the America I know.

* On President Obama's plan...

Today, I'm proposing a more balanced approach to achieve $4 trillion in deficit reduction over twelve years. It's an approach that borrows from the recommendations of the bipartisan Fiscal Commission I appointed last year, and builds on the roughly $1 trillion in deficit reduction I already proposed in my 2012 budget. It's an approach that puts every kind of spending on the table, but one that protects the middle-class, our promise to seniors, and our investments in the future.

The first step in our approach is to keep annual domestic spending low by building on the savings that both parties agreed to last week - a step that will save us about $750 billion over twelve years. We will make the tough cuts necessary to achieve these savings, including in programs I care about, but I will not sacrifice the core investments we need to grow and create jobs. We'll invest in medical research and clean energy technology. We'll invest in new roads and airports and broadband access. We will invest in education and job training. We will do what we need to compete and we will win the future.

The second step in our approach is to find additional savings in our defense budget. As Commander-in-Chief, I have no greater responsibility than protecting our national security, and I will never accept cuts that compromise our ability to defend our homeland or America's interests around the world... Just as we must find more savings in domestic programs, we must do the same in defense...

The third step in our approach is to further reduce health care spending in our budget.

Here, the difference with the House Republican plan could not be clearer: their plan lowers the government's health care bills by asking seniors and poor families to pay them instead. Our approach lowers the government's health care bills by reducing the cost of health care itself.

Already, the reforms we passed in the health care law will reduce our deficit by $1 trillion. My approach would build on these reforms. We will reduce wasteful subsidies and erroneous payments. We will cut spending on prescription drugs by using Medicare's purchasing power to drive greater efficiency and speed generic brands of medicine onto the market. We will work with governors of both parties to demand more efficiency and accountability from Medicaid. We will change the way we pay for health care - not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results. And we will slow the growth of Medicare costs by strengthening an independent commission of doctors, nurses, medical experts and consumers who will look at all the evidence and recommend the best ways to reduce unnecessary spending while protecting access to the services seniors need.

Now, we believe the reforms we've proposed to strengthen Medicare and Medicaid will enable us to keep these commitments to our citizens while saving us $500 billion by 2023, and an additional one trillion dollars in the decade after that. And if we're wrong, and Medicare costs rise faster than we expect, this approach will give the independent commission the authority to make additional savings by further improving Medicare.

But let me be absolutely clear: I will preserve these health care programs as a promise we make to each other in this society. I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs. I will not tell families with children who have disabilities that they have to fend for themselves. We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations.

* On tax reform

The fourth step in our approach is to reduce spending in the tax code. In December, I agreed to extend the tax cuts for the wealthiest Americans because it was the only way I could prevent a tax hike on middle-class Americans. But we cannot afford $1 trillion worth of tax cuts for every millionaire and billionaire in our society. And I refuse to renew them again.

Beyond that, the tax code is also loaded up with spending on things like itemized deductions. And while I agree with the goals of many of these deductions, like homeownership or charitable giving, we cannot ignore the fact that they provide millionaires an average tax break of $75,000 while doing nothing for the typical middle-class family that doesn't itemize. My budget calls for limiting itemized deductions for the wealthiest 2% of Americans - a reform that would reduce the deficit by $320 billion over ten years. But to reduce the deficit, I believe we should go further. That's why I'm calling on Congress to reform our individual tax code so that it is fair and simple - so that the amount of taxes you pay isn't determined by what kind of accountant you can afford. I believe reform should protect the middle class, promote economic growth, and build on the Fiscal Commission's model of reducing tax expenditures so that there is enough savings to both lower rates and lower the deficit. And as I called for in the State of the Union, we should reform our corporate tax code as well, to make our businesses and our economy more competitive.

* In closing...

This is my approach to reduce the deficit by $4 trillion over the next twelve years. It's an approach that achieves about $2 trillion in spending cuts across the budget. It will lower our interest payments on the debt by $1 trillion. It calls for tax reform to cut about $1 trillion in spending from the tax code. And it achieves these goals while protecting the middle class, our commitment to seniors, and our investments in the future.

So this is our vision for America - a vision where we live within our means while still investing in our future; where everyone makes sacrifices but no one bears all the burden; where we provide a basic measure of security for our citizens and rising opportunity for our children. Of course, there will be those who disagree with my approach. Some will argue we shouldn't even consider raising taxes, even if only on the wealthiest Americans. It's just an article of faith for them. I say that at a time when the tax burden on the wealthy is at its lowest level in half a century, the most fortunate among us can afford to pay a little more. I don't need another tax cut. Warren Buffett doesn't need another tax cut. Not if we have to pay for it by making seniors pay more for Medicare. Or by cutting kids from Head Start. Or by taking away college scholarships that I wouldn't be here without. That some of you wouldn't be here without. And I believe that most wealthy Americans would agree with me. They want to give back to the country that's done so much for them. Washington just hasn't asked them to.

Others will say that we shouldn't even talk about cutting spending until the economy is fully recovered. I'm sympathetic to this view, which is one of the reasons I supported the payroll tax cuts we passed in December. It's also why we have to use a scalpel and not a machete to reduce the deficit - so that we can keep making the investments that create jobs. But doing nothing on the deficit is just not an option. Our debt has grown so large that we could do real damage to the economy if we don't begin a process now to get our fiscal house in order.

Finally, there are those who believe we shouldn't make any reforms to Medicare, Medicaid, or Social Security out of a fear that any talk of change to these programs will usher in the sort of radical steps that House Republicans have proposed. I understand these fears. But I guarantee that if we don't make any changes at all, we won't be able to keep our commitments to a retiring generation that will live longer and face higher health care costs than those who came before.

Indeed, to those in my own party, I say that if we truly believe in a progressive vision of our society, we have the obligation to prove that we can afford our commitments. If we believe that government can make a difference in people's lives, we have the obligation to prove that it works - by making government smarter, leaner and more effective.

Of course, there are those who will simply say that there's no way we can come together and agree on a solution to this challenge. They'll say the politics of this city are just too broken; that the choices are just too hard; that the parties are just too far apart. And after a few years in this job, I certainly have some sympathy for this view. But I also know that we've come together and met big challenges before...

This larger debate we're having, about the size and role of government, has been with us since our founding days. And during moments of great challenge and change, like the one we're living through now, the debate gets sharper and more vigorous. That's a good thing.

As a country that prizes both our individual freedom and our obligations to one another, this is one of the most important debates we can have. But no matter what we argue or where we stand, we've always held certain beliefs as Americans. We believe that in order to preserve our own freedoms and pursue our own happiness, we can't just think about ourselves. We have to think about the country that made those liberties possible. We have to think about our fellow citizens with whom we share a community. And we have to think about what's required to preserve the American Dream for future generations.

This sense of responsibility - to each other and to our country - this isn't a partisan feeling. It isn't a Democratic or Republican idea. It's patriotism.

Labels: Budget, Federal, Obama

posted by Anthony Wright | Permalink | 11:53 AM


 

California as the bogeyman...

With our California Health Benefits Exchange set to meet next week, April 20th, it's important to highlight one of its key abilities: to be able to negotiate for the best price and value for its members.

Yet some continue to oppose that key consumer benefit. Thank you to Wendell Potter for bringing the new Choice and Competition Coalition to our attention, just announced at their new website: http://www.choiceandcompetitioncoalition.org/

In a article entitled The ‘Front Group’ Hall of Shame, Wendell Potter describes the new effort:

So what do the insurer’s newest coalition hope to achieve? Well, according to a brief item on an industry website, the first priority is to assure that states set up their required health insurance “exchanges” in ways that protect the interests of insurers and the agents and brokers who sell their products. Of course, they won’t describe it that way.

The reform law gives states wide latitude in how they operate their exchanges. Utah already has an exchange, and the insurance industry really likes it. That’s because the exchange is little more than a website where insurers can post all their benefit plans, even the ones that all but guarantee the purchasers will be underinsured. Those plans, by the way, are very profitable for insurers because they rarely have to pay out much in claims. Utah officials do relatively little to assure state residents that they are getting any value for what they buy.

California, on the other hand, is taking an approach the insurance companies hate. When the California exchange is up and running in 2014, it will vet the insurers’ benefit plans and only offer those it deems to be of value to consumers.

According to a recent story in Politico, the CCC will include America’s Health Insurance Plans (AHIP), the insurance industry’s big lobbying group; AHIP’s longtime ally, the U.S. Chamber of Commerce; PhRMA, the drug makers’ lobbying group, and the National Association of Health Underwriters, which represents agents and brokers. The CCC will be advocating for exchanges that “promote competition and preserve consumer choice.” The story said the group “is likely to advocate for exchanges that allow maximum participation, unlike the selective contracting model employed by California.”

AHIP spokesman Robert Zirkelbach as saying, “Many stakeholders agree that exchanges must be true marketplaces that maximize choice and competition so that consumers and small businesses can purchase the plan that best meets their needs.”

I am so grateful I no longer have to say stuff like that to the media. But I do agree with Zirkelbach that many stakeholders want the exchanges to be more like Utah’s and less like California’s. And those stakeholders are the 1,300 health plans AHIP says it represents and the agents and brokers who worry that their services will no longer be needed if the states’ exchanges do what Congress intended. And that is to provide us with the information we need to help us select the coverage that will protect us from financial ruin if we get sick or injured and help us avoid the junk insurance.

I, for one, am just so glad there's a voice out there for the voiceless businesses, providers, brokers, and insurers, protecting us consumers against those awful ideas from California. I hate it when a California bill, signed by a Republican Governor and backed by various business, providers, and insurers, take ahold in Hollywood and corrupt the young and impressionable minds of health policy wonks elsewhere.

Labels: Exchange, HealthReform

posted by Anthony Wright | Permalink | 11:32 AM


 

Assembly Health Committee Moves Forward on Waiver Update

Tuesday, April 12, 2011

In a short meeting of Assembly Health Committee today, the committee members passed AB1066 by Speaker Perez related to the “Bridge to Reform” portion of California’s 1115 Medicaid Waiver. The bill gained bi-partisan support.

The bill would enact some technical and conforming statutory changes that would enable the state to move forward with the "Bridge to Reform" plan, which would put California on a glide path toward full Medicaid Expansion under the Affordable Care Act in 2014. The bill also puts into law the specific formulas to make funding available for the state’s public hospitals.

The county-based Medi-Cal expansion, or Low-Income Health Programs (LIHP) planning is already underway in California counties. Though all 58 counties have expressed interest in participating in the program, the extent to which they decide to implement expansion has been left to county discretion. Some counties see the health and financial benefits of expanding coverage to as many as possible and providing coverage to those who might otherwise seek more expensive acute care in public hospital settings. However, many other counties are proceeding with a great deal of caution, proposing measured incremental expansions.

We encourage advocates to contact your county supervisors to ask that they aggressively pursue this opportunity to draw down federal funding and to provide much needed health services in your community. For more information on how your county is proposing to implement LIHP, click here. For additional advocacy tools for robust implementation of LIHP, please click here.

The bill moves on the Assembly Appropriations.

Labels: HealthReform, Legislation, MediCal

posted by Linda Leu | Permalink | 2:31 PM


 

The Exchange is Coming! The Exchange is Coming!

Monday, April 11, 2011

The inaugural meeting of the California Health Benefit Exchange Board is scheduled for April 20 in Sacramento. Though we are still one appointment shy of a full governance board, there's some real buzz that the very first meeting of the Exchange has been scheduled!

Labels: Exchange, HealthReform, Insurers

posted by Linda Leu | Permalink | 4:28 PM


 

The next fight over Medicare and Medicaid..

The more we learn, the more I realize that I wasn't harsh enough about the deficit reduction proposal put forward by Rep. Paul Ryan last week.

In short, it's a right-wing wish list, dressed up as deficit reduction when it would actually make the problem much worse.

There's nothing new, courageous, or correct in proposing to give tax breaks to those in the top tax brackets and corporations, to repeal the Affordable Care Act and replace it with nothing to control costs, and to simply shift the risk and burden of increasing health care costs onto states and families, by replacing Medicare with a voucher program, and Medicaid with a block grant program.

Paul Krugman calls it "ludicrous and cruel," and cites its fraudulent assumptions and outcomes:

People like me don’t say that the Ryan plan is too radical; we say that it’s a fraud. The spending cuts are largely fake, either because they’re just magic asterisks or because they wouldn’t survive politically; the revenue estimates are fake, because they combine huge tax cuts with vague assurances that extra revenue will be found by closing loopholes. There’s no there there — except for big tax cuts for the rich and pain for the poor.

Fairly conservative "New Democrat" analysts like William Galston, a deficit hawk, say that it's a step backward, not forward, for the conversation that is needed about the deficit. As Jonathan Cohn has reported, "Even relatively conservative Democrats see the plan as a non-starter, with none other than Senate Finance Chairman Max Baucus vowing "not on my watch.""

The Center for Budget and Policy Priorities has more about how it doesn't actually reduce the deficit, and how it targets low-income families.

As for alternatives, Ezra Klein reminds us that there is an alternative that makes progress in controlling health costs--the Affordable Care Act. Matt Yglesias makes a similar point. Several fellow Representatives who are progressive have a "People's Budget" that is more responsible both in terms of balancing cuts (which are shared more broadly, including defense) with revenues (allowing the Bush tax cuts for the wealthy to expire, among other items).

Current law would allow the cost controls in the Affordable Care Act to take effect (reducing costs), and allow the Bush tax cuts to expire (raising revenue). Just allowing current law to work itself out would go a long way to reduce the deficit--some further adjustments can get you the rest of the way there.

President Obama is set to give a sppech on Wednesday outlining some principles around long-term deficit reduction, including on Medicaid and Medicare. We'll see the contours of this next, big fight over health care in this nation.

Labels: Budget, Federal, MediCal, Medicare, Obama

posted by Anthony Wright | Permalink | 7:16 AM


 

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