A Perspective on Canadian Health Care, via Health Care: On Location
Tuesday, May 31, 2011
Reposted from Health Care: On Location, a blog discussing health policy with an international focus by Joan Pirkle Smith, a Health Access California board member. Joan is spending quality time with her husband who is on location in Canada, and is using that opportunity to ask Canadians about what they think of their single-payer health care system. It's worth checking out, to get a more nuanced view of health systems in Canada and other countries.
The Attorney in 12A
As I sat down in 12C on my flight from Vancouver, my seatmate looked up from the flight magazine and gave me a friendly, “Hi!” By the time we were in the air, he had revealed he was a personal injury attorney traveling down to LA with his buddies to spend a long weekend at The Peninsula, the chief objectives of the trip being dinner at the Belvedere, Spago, and Melisse. Guess business in the personal injury field is doing all right in British Columbia. Before we moved on to more important subjects like my list of hidden restaurant treasures in LA, Mr. P.I. Attorney seemed happy to give me his take on the BC health care system as a patient, as an employer who provides extended health insurance (see Definitions) to his employees, and as a personal injury attorney.
As an individual, Mr. P.I. says his health care has all been good. When he had to have an ankle ligament tightened after an injury, he waited two days to see his family doctor and two months to have the surgery to repair it.
Interestingly, the main reason his wife works 25 hours per week is because her employer pays the premiums for their private extended health insurance as well as their Medical Services Plan(MSP) premium. This got me wondering how much the premiums are for the private, as well as the public insurance. Searching the Internet for extended health insurance coverage quotes, I found a pretty comprehensive policy for a 40something couple with 2 kids for about $320 per month and the MSP monthly premium for families earning more than $30,000 per year is $121. A savings of $441 dollars per month will certainly buy a few dinners at Spago.
Mr. P.I.’s law firm provides some help to their employees for purchasing extended coverage. Similar to the way employers in the US can choose whether to provide any level of health care coverage for their employees and can choose how much of the premium to cover, employers in British Columbia may provide different levels of extended coverage benefits. And some employers do not provide any extended health benefits at all. Also, different policies have different covered benefits, for example, medications, vision care, dental care, chiropractic care, physical therapy, private hospital rooms, and travel health insurance.
As in the US, more large employers provide health benefits than small employers. In Canada it also seems there is some correlation between higher paying jobs and employer-provided extended health insurance coverage. In Vancouver I’ve spoken to employees in clothing stores, the car rental agency, and the nail salon that don’t receive extended health care from their employers.
So it is commendable that Mr. P.I.’s rather small firm pays about half of the premium cost for their employees. Mr. P.I. raised another interesting point: When an employer covers these benefits in Canada, they are taxable. This has been a point of contention in the US health care debate.
Since Mr. P.I. is, well, a personal injury attorney and deals with clients needing health care, I decided to ask him about his cases. As it turns out, basic auto insurance is obtained through a government plan, ICBC, which all BC drivers are required to obtain. So Mr. P.I. ends up bringing cases against the ICBC to get health care costs covered.
Medical Services Plan ever gets sued for not covering services or because a delay in receiving services results in a bad outcome. I’m not talking about personal injury cases, but you know, the way HMOs and PPOs in the US get sued? He said he hadn’t heard about any individual suing the MSP for delayed treatment but he had heard about a case involving the MSP denying coverage for a course of treatment for autism. Seems to be uncommon, though
He did say there are medical malpractice lawsuits. I guess since doctors are reimbursed to provide all medically necessary care, if someone doesn’t get the care they need, it’s not because of a government insurance plan’s decision. It’s the result of a doctor’s decision so the doctor is to blame.
When I was just about done with my questions, I asked Mr. P.I., “If you got to vote on it, would you vote to have more privatization in the health care system?” I figured, this guy makes good money, if spending money on private health insurance could eliminate wait times for his family, wouldn’t he be in favor of that? He looked out the window and said with some hesitation, “Yeah, maybe I would…” Then he looked back at me, “But only if physicians were very limited on the amount of time they could spend practicing in private clinics vs. the time they spent in the public system.” In a follow-up email he wrote to me, “Our system is far from perfect, but I do think that it is pretty good, and is a good model for other similar countries to follow in principle."
These Canucks are darned proud of their health care, eh?
Once again, Atul Gawande of The New Yorker has a piece out that is must read--it's his Commencement address at Harvard Medical School, talking about the changes in medicine. He argues that medical schools need to shift to training put crews rather than cowboys--and that has implications for the health system as a whole.
On many other wonky issues, the new edition of the Health Wonk Review is out at the Health Affairs blog, which features our post reporting about the Basic Health Plan. Despite the questions that remain, Health Access now supports the bill, SB703(Hernandez), as a vehicle to improve affordability for low-income California families. The bill is up for a Senate vote this week.
Appropriations Passes Key Bills; Floor Votes This Week!
Monday, May 30, 2011
HEALTH ACCESS ALERT Monday, May 30, 2011 * Memorial Day Edition
RATE REGULATION & OTHER KEY HEALTH REFORM IMPLEMENTATION BILLS PASS HEALTH COMMITTEES IN CALIFORNIA ASSEMBLY AND SENATE
* Heavily Debated Rate Regulation Measure, AB 52 (Feuer), Goes to Vote This Week * AB1083 (Monning) on Small Buisness Coverage Passes Assembly Floor Vote * Other Key Bills on Eligibility, Enrollment, and Other Issues Face Floor Vote This Week
Read Our Health Access Blog! Join Us on Facebook! Follow Us on Twitter! The Assembly + Senate Appropriations Committees were live-tweeted and blogged...
Important health legislation heads for crucial floor votes this week, after being passed in key California Senate and Assembly Appropriations Committees on Thursday and Friday of last week. Bills have until this Friday, June 3rd, to be passed out of one house of the legislation, or they are stalled for the year.
Also last week, Budget Subcommittees on Health in both legislative houses reviewed the Governor's May Revision of the California Budget, including a much-discussed proposal to eliminate the Managed Risk Medical Insurance Board and shift 900,000 children from the Healthy Families Program to Medi-Cal. The two committees agreed to the shift in concept, but adopted different timelines and transitions that will need to be reconciled in the weeks to come. More about the delibereations on the California budget will be reported on the Health Access blog.
But the big focus this week is on legislation, as both the Assembly and Senate face a deadline to pass their bills in order for them to proceed to the next house. The Appropriations Committee passed many--but not all--of the measues related to implementing and improving health reform, sending them to floor votes.
DEBATE ON RATE APPROVAL
The most debated measure, by far, was AB52 (Feuer), the bill to give state regulators the authority to reject unjustified rate increases. The bill, strongly supported by consumer and community groups, but opposed by insurers, caused an unusual discussion in Assembly Appropriations. While Chairman Fuentes and some members urged the committee to focus on simply the General Fund implications of the bill for the purposes of committee, other members were withholding their votes on making policy amendments as a condition of a vote out of Appropriations. Assemblymembers Calderon and Solorio pushed hard for the author to accept amendments, and while Feuer expressed a desire to work with them on language, he was hesitant to accept an amendment on the spot without more thoroughly exploring the potential impact. Only when an absent member returned to the committee were there enough votes to pass the bill, with Calderon and Solorio voting against the bill, and Assemblymember Hall abstaining. AB52 moved out of committee with the minimum 9 votes required. After some amendments to address concerns of the opposition and some Assemblymembers, AB52 will be heard on the Assembly floor this week.
ALERT: Please continue to contact Assemblymembers and urge their support on this critical consumer protection, AB52(Feuer), to allow state regulators to reject unjustified rate increases.
BILLS MOVING FORWARD
Assemblymember Fuentes opened the Appropriations suspense file on Friday with some opening statements setting the context for the day’s considerations. He said the both the number of bills before the committee and the total dollar amount of those bills were at a record low, but that in spite of the state’s fiscal situation, the committee would be recommending moving 62% of the bills forward in an effort to “keep ideas, hope, and creativity alive.” He also said that his committee would be holding all benefit mandate bills until January in anticipation of federal guidance on the Minimum Essential Benefits Package, a position that the Senate Health Committee has asserted earlier in the session. That meant that the Assembly Appropriations Committee held AB154 (Beall), on mental health and substance abuse treatment coverage, and AB185 (Hernandez), on maternity coverage. (A similar bill on maternity coverage, SB155 by Senator Evans, is still active on the Senate side.)
Bills Moving to the Assembly Floor:
* AB43 (Monning) Expanding Medi-Cal eligibility to adults without dependent children up to 133% of the Federal Poverty level, with allowance for DHCS to phase in expanded eligibility. * AB52 (Feuer) Giving regulators at the Department of Insurance and the Department of Managed Health Care the authority to reject unreasonable and unjustified rate increase proposed by insurers. * AB242 (Perea) Conforming the state tax code to implement the Affordable Care Act. * AB714 (Atkins) Seeking to pre-enroll Californians into coverage so they can take advantage of federal subsidies when they become available on January 1, 2014. * AB792 (Bonilla) Providing automatic notification of Exchange eligibility upon specified life changes. * AB922 (Monning) Consolidating and improving health consumer assistance programs. * AB1296 (Bonilla) Streamlining eligibility and enrollment for Medi-Cal and other public programs. * AB1334 (Feuer) Putting in place new requirements for disclosure and standardization of benefits offered by health plans.
Bills Moving to the Senate Floor
Earlier in the week, the Senate Appropriations Committee also released many bills, but held others. One of the bills held was SB677 (Hernandez), to conform Medi-Cal to the new eligibility rules under the ACA starting in 2014. That bill will be available to move January of next year. Other bills to be voted on the Senate floor include:
* SB51 (Alquist) Implementing the Medical Loss Ratio requiring that 80 or 85% of premium dollars be spent on health care. * SB222 (Alquist) Authorizing local, county-based health plans to form regional joint ventures. * SB155 (Evans) Requires insurers to include maternity coverage in plans sold on the individual market. * SB703 (Hernandez) Creates a Basic Health Plan for Californian adults between 133% and 200% of the federal poverty level.
AB1083 PASSES ASSEMBLY
One bill that already passed the Assembly floor on Friday was AB1083 (Monning), a bill to conform California law to the requirements of the Affordable Care Act related to the small group insurance market. The bill would help small businesses have security and stability with their health insurance by giving them information about the Exchange, holding rates constant for 12 month periods, and prohibiting underwriting. Oddly, the debate about the bill had little to do with the substance, with six GOP Assemblymembers using the opportunity to attack the Affordable Care Act and health reform in general. Comments from members invoked other countries, ranging from Cuba to Canada and back, but with few exceptions, barely touched on the impact on small businesses. The bill passed the Assembly floor on a party line vote.
NEXT STEPS
More advocacy is needed to help these bills pass floor votes next week and then to move through the second house in the coming weeks.
California already has reformed its "small group" insurance market years ago, so the policy changes are incremental, rather than revolutionary. That said, by conforming to federal law, small businesses would get the benefit of greater stability, so that if a few of their workers get cancer or another expensive conditions, they don't get a huge premium spike because of it. They also would limit the premium increases that come from having a disproportionately older workforce.
None of this was really mentioned in the floor debate, which had virtually nothing to do with the bill in question, and simply relied on broad bromides about health care politics in general.
GOP Assemblymembers Logue, Halderman, Nestande, Donnelly, Harkey, and Grove all felt compelled to make a case against the Affordable Care Act--which was passed by the U.S. Congress and signed into law over a year ago. Some argued that we should wait, predicting the law would be struck down or be substantially changed. GOP Assemblyman Nestande rebutted his own argument to wait before doing anything on federal ACA, saying that "planning is a good thing," while also arguing not to move forward. Assemblywoman Harkey invoked "rationing," and Assemblywoman Grove recounted her experience in Canada.
Democratic Assemblymembers Davis, Pan, and Swanson rose in defense, in different ways. Given the rhetorical attack, Assemblyman Davis defended the notion of health reform in general. Assemblymember Swanson highlighted the goal of not having people denied for pre-existing conditions. Assemblyman Pan was the only speaker besides the author to actually invoke small businesses and their issues in buying coverage. And the author, Assemblyman Monning, closed by reminded his colleagues that his AB1083 isn't about Canada, or Cuba, or individual mandates.
It would have been more interesting if they actually debated the specific substance of the legislation--but that's probably true of every health reform-related bill, and of the ACA itself.
Today was a big day at the capitol, with budget subcommittees meeting to discuss proposals from the Governor’s May Revise, and the Senate Appropriations Committee meeting to decide which Senate bills will move on to the Senate Floor.
The Senate Appropriations Committee held a number of bills related to health, which means that those bills will not move forward and have the opportunity to be voted on this year--they will be "two year bills," available to move next year.Most significantly, SB677 (Hernandez) which would have made conforming changes to the Medi-Cal program in accordance with the Affordable Care Act and expanding eligibility for the program, was held. For those curious, SB810 (Leno) which would move California toward a Single Payer health care system, was not heard, as supporters sought additional fiscal analysis.
Bills related to the implementation of ACA that moved forward include:
SB51 (Alquist) implementing the Medical Loss Ratio to ensure premium dollars go to health care rather than administration and profit, and that consumers receive rebates when the MLR is not met.
SB222 (Alquist) which allows local county-run health plans to form joint ventures to expand their networks to become regional public health insurance plan options.
SB615 (Calderon), which requires those selling insurance to have specific training, including on public programs. An earlier version originally alarmed community groups by requiring all navigators at the Exchange to be licensed brokers, but amendments removed those provisions, and with that, opposition from many consumer groups.
SB155 (Evans) requires health insurance plans in the individual market to cover maternity services.
SB703 (Hernandez) would establish a Basic Health Plan to provide care to individuals from 133%-200% of the federal poverty level, an option for states under the Affordable Care Act.
In budget news, the Senate Budget Subcommittee #3 on Health and Human Services looked at the proposals from the Governor’s May Revise related to the Department of Health Care Services.
The Subcommittee moved many of the Governor’s proposals forward after lengthy discussion of a number of controversial proposals, including the elimination of the Department of Mental Health, Department of Alcohol and Drugs, reduction of funding for transitioning seniors using the now eliminated Adult Day Health Care services, and the transition of 900,000 children from Healthy Families to Medi-Cal.
In the case of shifting Healthy Families children, the Senate Subcommittee voted to adopt placeholder trailer bill language, and booked the full budget reduction--the reduction that raised significant concerns about appropriate provider capacity, access for patients, and transition readiness and timing.
The Senate Subcommittee did reject a few of the Governor's proposals, such as the idea to place Medi-Cal recipients on a "one-year lock-in" of their health plan. Advocates argued that this was a key consumer protection that was especially essential as seniors and people with disabilities were mandatorily enrolled in managed care.
The Subcommittee also rejected the Governor's proposal to fully eliminate not Adult Day Health Centers (ADHC), restoring the $85 million from the March budget for a follow-up program currently called Keeping Adults Free from Institutionalization (KAFI).
The Assembly Budget Subcommittee on Health meets on these issues tomorrow. The Assembly Appropriations Committee will also reveal what bills they are releasing for floor votes.
Amidst the temperamental rain and wind of Wednesday morning, nearly 2,000 people lined up in Sacramento for the Eighth Annual Disability Capitol Action Day. Marchers walked down L Street to the front lawns of the Capitol building, where they gathered to listen to the motivational words of community leaders and legislators supportive of their cause. The march, organized by The California Foundation for Independent Living Centers (CFILC), is an annual event which aims to mobilize people with disabilities as well as their loved ones to take grassroots initiative in the legislative process by reaching out to their policymakers.
The disabled community has experienced huge setbacks with California’s budget crisis, with only more cuts to come in the latest versions of the budget. Said one community member regarding the demands of the marchers, “We understand it is a difficult time for all Californians, and we are willing to make sacrifices and take our fair share of the cuts. We only ask that we be forced to make these sacrifices in reasonable amounts, no more or less than any other group represented in the budget.”
These demands were echoed throughout the morning in chants of “We’re here, we’re loud, we’re disabled and we’re proud!” and “Tax the oil, tax the booze, save the services we all use!” It was truly a motivational sight to see: hundreds upon hundreds of people gathered from all backgrounds and ethnicities, some English-speaking, some not, some in wheelchairs, others on their feet. As the morning progressed, despite the rain, the sense of solidarity on the Capitol lawn only increased.
The march was a call to action. Once it ended in the early afternoon, marchers went on to meet with or contact their policymakers to tell them about how the budget cuts affect their ability to lead normal lives, go to school, go to work, and be active members of their society. They hope that these appeals will bring about positive legislative changes for the community in these difficult times.
While there has been lots of focus on the Paul Ryan budget's proposal to end Medicare as we know it, the proposal also proposes a similarly radical change to Medicaid--even if the substance is different.
As Ezra Klein reports, there has been some concern that the focus on Medicare might make Medicaid more vulnerable. But he highlighted the defense of Medicaid by top White House official Gene Sperling.
"There is enormous discussion about the revenue side and the Medicare side. But from a policy perspective, from a values perspective, we should be very deeply troubled by the Medicaid cuts in the House Republican plan. . . . After they completely repeal the Affordable Care Act, which would take away coverage for 34 million Americans, according to the Congressional Budget Office. After they’ve completely repealed that, they do a block grant that would cut Medicaid by $770 billion. In 2021, that would cut the program by 35 percent. Under their own numbers, by 2030, it would cut projected spending in Medicaid by half. By 49 percent."
It's not just a policy perspective. It's a political perspective: voter don't like the attack on Medicaid either:
This month's Kaiser Health Tracking Poll found that 60 percent of poll respondents say they want to keep Medicaid as it is, with minimum standards set by the federal government. Only 13 percent would support major reductions in Medicaid spending. As Politico Pulse reported, "The poll calls into question the conventional wisdom that cuts to the program will be more easily accepted than cuts to Medicare."
"Fifty-three percent of respondents said they favored "no reductions" to Medicaid, while 59 percent said the same of Medicare. And Kaiser's research shows a much larger majority oppose the House-passed plan for Medicaid than Medicare. People were asked: Which would you prefer: keep Medicaid as is (60 percent) or change it (35 percent)? How important for you and your family is the Medicaid program? Not important at all (31 percent); very important (27 percent); somewhat important (22 percent) and not too important (18 percent)."
As the Kaiser Health Tracking Poll said itself: The findings come at a time of intense public debate in Washington about the future of entitlement programs such as Medicare and Medicaid as policymakers attempt to address rising public concerns about the federal deficit. While conventional wisdom and recent public opinion polling has suggested that dramatic changes in Medicare would be politically unpopular, the poll findings illustrate that major alterations to Medicaid also could strike a negative chord with many Americans. Support for maintaining the current program may be due at least in part to the public's personal connections to Medicaid and a strong sense of the program's importance. About half of Americans say they or a friend or family member has received Medicaid assistance at some point, and a similar share say the program is important to their family.
It's an important lesson to protect Medicare *and* Medicaid.
This is a big week for Medicare and in politics. Yesterday, a special election in New York was big political news, as the Democrat won in a heavily Republican district--in an election that seemed to be a referendum on Rep. Paul Ryan's budget and its proposal to privatize Medicare, as Politico and other outlets reported.
As House Minority Leader Nancy Pelosi (D-CA) said: "Kathy Hochul’s victory tonight is a tribute to Democrats’ commitment to preserve and strengthen Medicare, create jobs, and grow our economy, And it sends a clear message that will echo nationwide: Republicans will be held accountable for their vote to end Medicare.”
The Republican candidate had said she would have voted for the Paul Ryan budget. The implications in California are clear, where every single GOP House Republican actually did vote for the Ryan budget package, sending it to the Senate.
Earlier today, the U.S. Senate voted on the Paul Ryan budget, where it died on a 40-57 vote. All Democrats, including California's Senators Barbara Boxer and Dianne Feinstein, voted against the Ryan budget. The proposal, including those efforts to end Medicare and Medicaid as we know it, did get 40 votes, all from Republicans. Five Republicans defected: Senators Brown of Massachusetts, Snowe and Collins of Maine, Murkowski of Alaska and Paul of Kentucky.
So its clear that voters care about Medicare. And that this will be a key issue in both House and Senate seats in the next election, including in California.
The California Health Benefits Exchange Board met for the third time today.The business of the day consisted only of 2 action items, approving the minutes of the last meeting and to make a decision about the Federal Exchange Establishment Grant.The Board decided to apply for Level 1 Grant by the end of June, which will begin to bring more preliminary planning dollars into the state.
The board also announced an additional meeting to be held on June 15, 2011. This meeting will be attended by CMS Director Cindy Mann, Joel Ario of HHS, and other representatives of the federal government. At that meeting, the Board will vote on the very few policy decisions that need to be made regarding that grant.
The remainder of the meeting was devoted to discussion on two areas that will be integral to the implementation of the Exchange. The Exchange website now has the full packet of materials.
First the Board explored Program Integration.Various state departments that will interface with the Exchange made presentations to the board about their current functions and operations with an eye to relevance to the operations of the Exchange.The Department of Insurance and the Department of Managed Health Care gave useful presentations about the functions of their departments and the work they are already planning to do to. Board Member Belshe commented that this represented a paradigm shift from a world where individual departments and programs were concerned only with their own programs, to one where everyone works together toward a shared goal of coverage for every individual.
Exchange Board, staff, and advocates all agreed that seamless transitions for consumers was of the utmost importance, that departments must work together to create a “no wrong door” approach where no matter where consumers first make contact, that they are screened and enrolled seamlessly in to the appropriate program, and that as changes occur that might impact their eligibility, it will not be the responsibility of individual consumers to figure out their coverage transition.Advocates pointed out that this is an opportunity to solidify collaboration between state agencies in order to present a consistent face to consumers and insurers, and put an end to discrepancies between agencies.
The board then discussed at Eligibility and Enrollment, first looking at lessons learned from eligibility and enrollment for public programs through the counties, and at MRMIB’s practices in enrolling consumers into AIM, Healthy Families, and the high risk pools.Terri Shaw gave a presentation about the national project to design a 21st Century User Experience, which is working on elements that can be included in Exchange web portals across the country.
Advocates chimed in to emphasize the importance of making every door the right door to enter into coverage, taking extra measures to do outreach and education, to ensure cultural and linguistic appropriateness, to bring coverage to consumers rather than forcing them to seek it out, to address the needs of small businesses, and to collect the appropriate data to enable evaluation of what is working with what populations.
Tomorrow, the California Health Exchange has it's third meeting. Here's the agenda, which will include an action item on applying for federal grants to fund Exchange activities, and features discussions on program integration and on eligibility and enrollment: http://www.healthexchange.ca.gov/Documents/CA%20HBEX%20May%2024%20Meeting%20Agenda.pdf
The meeting is at a new location, the Employment Development Division, at 722 Capitol Mall. And for the first, time, the meeting will be webcast as well. Meeting materials should be available soon as well: http://www.healthexchange.ca.gov/Pages/MeetingSchedule.aspx
We'll also be live-tweeting it at www.twitter.com/healthaccess, using the hashtag #CaHEx, and we'll post an update on the blog as well...
Health Access is pleased to be able to co-sponsor tomorrow's Children’s Advocates’ Roundtable, the quarterly convening put on by the Children's Advocacy Institute. We'll be presenting, with a few of our colleagues, on health care reform and the impact and opportunities for children.
The Roundtable meeting will be held this Thursday, May 19 at the Secretary of State’s Office Multi-Purpose Room - First Floor (1500 11th Street) from 12 pm to 3 pm.
This is an exciting opportunity to hear from experts in the area of health care reform for children on the issue of implementing and improving the Affordable Health Care Act in California. The following speakers will be presenting :
· Anthony Wright, Executive Director, Health Access California · Elizabeth Landsberg, Legislative Director, Western Center on Law and Poverty · Deena Lahn, Policy Director, Children’s Defense Fund · Alison Lobb, Policy Analyst, California Coverage & Health Initiatives
In addition, there will be a discussion on this year’s state budget and we will hear analysis from the following experts in the area:
· Todd Bland Director, Social Services at the Legislative Analyst’s Office · Scott Graves Senior Policy Analyst, California Budget Project · Christian Griffith Committee Staff
If you have yet to RSVP, please do so, lunch will be provided and we would like to have an accurate count.
GOVERNOR RELEASES MAY REVISION OF BUDGET; TAX EXTENSIONS NEEDED TO PREVENT ADDITIONAL TOUGH CUTS TO HEALTH AND OTHER VITAL SERVICES
* Medi-Cal patients already face caps on doctor visits; increased costs; and reduced access to providers--cuts made in March budget for FY2011-12 * New proposals include continued push to eliminate Adult Day Health Centers; shift of 900,000 Healthy Families kids to Medi-Cal; Elimination of MRMIB, CMAC, other boards;
* If taxes allowed to expire, would force billions of additional cuts to health, education, etc.
Earlier today, Governor Jerry Brown released his May revision of his 2011-12 state budget proposal, which made additional changes to his January proposal to make steep budget reductions ($12 billion of budget cuts including $6 billion of cuts to health and human services already made in March), balanced with new revenues (largely extensions of current tax rates, still being debated).
The May proposal accounts for $6.6 billion in increased collected revenues above projections, which allowed him to scale back certain tax hike and education cut proposals and to pay off some state debt. Yet in his budget announcement, he said he didn't want people thinking "we're out of the woods"--"untrue!" The surge in revenues, according to the budget, is not enough to close the gap.
He cited an ongoing $10 billion structural deficit that needs to be addressed through either new revenues or additional cuts. In addition to the steep cuts made in March, the Governor seeks to close the deficit by raising revenues--by preventing current tax rates from expiring.
On health care, the budget does make some additional proposals beyond the severe cuts made in March, which , included caps on Medi-Cal doctor visits, significantly increased premiums and co-payments for low-income families, and drastic cuts to Medi-Cal providers.
For example, the Governor is maintaining his proposal to eliminate adult day health centers (ADHCs), even though when the Legislature did vote to eliminate them, it had also passed a proposal to re-establish the centers with half the funding.
The Governor also put forward a new proposal to eliminate various boards and agencies, including the Managed Risk Medical Insurance Board (MRMIB), California Medical Assistance Commission (CMAC), California Health Policy and Data Advisory Commission (CHPDAC), Public Health Advisory Committee (PHAC), and several others.
In particular, the abolition of MRMIB to move many its various programs--like Access for Infants and Mothers (AIM) and the high risk pools Major Risk Medical Insurance Program (MRMIP) and Pre-existing Condition Insurance Program (PCIP)--to the Department of Health Care Services (DHCS).
The 900,000 children who get coverage through the Healthy Families program, California's State Child Health Insurance Program (SCHIP), would be shifted to Medi-Cal. Administration officials indicate that their proposal would be to at least maintain children's eligibility and enrollment, coverage benefits, and cost-sharing level; the savings would come because Medi-Cal generally covers children at a lower cost, although concerns would need to be addressed about access to providers, physicians, and specialists under lower rates. One of strongest concerns was raised by MRMIB itself, which is an independent board.
The biggest cuts are those that are not listed--those cuts that would be forced if new revenues are not approved. Those revenues would require a 2/3 vote of the Legislature, including 4 Republican votes even if every Democrat voted for them. Otherwise, allowing revenues to expire on June 30th blows a new, big budget hole of billions of dollars, causing much steeper cuts in health, education, and other vital services.
While some statewide officials, included Treasurer Bill Lockyer, have called for what an "all-cuts" budget would look like, the Governor said he didn't "want to give Republicans a roadmap to ruin."
The budget Governor Brown did propose for fiscal year 2011-12, with the tax extensions, includes the following health items:
MEDI-CAL CUTS MADE IN MARCH FOR FY2011-12: · Limit access to doctor visits for 7.7 million Californians 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
· Raise the cost of care for Medi-Cal patients, the vast majority of whom are under the poverty level and have monthly incomes below $1,000, 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 coverage for over-the-counter drugs.
· 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.
· 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.
HEALTHY FAMILIES CUTS MADE IN MARCH FOR FY2011-12
* Increase monthly premiums for families between 200 and 250 percent FPL by $18 per child, an increase of 75%, (with a family maximum of $126); and for families between 150-200% FPL by $14/child by nearly 100%. * Raise emergency room co-payments from $15 to $50 and raising hospital inpatient services co-payments of $100 per day with a $200 maximum ($0.7 million).
NEW SELECTED MAY REVISE PROPOSALS FOR FY2011-12
* Shift 900,000 children from Healthy Families to Medi-Cal, which covers children for less money. The Governor's proposal seems to maintain eligibility, benefits, and cost-sharing, but questions remain on access to providers.
* Eliminate Adult Day Health Centers (ADHCs), budgeting only $25 million for transition costs. (The state Legislature booked ADHC elimination in March, but budgeted $85 million for a replacement program.)
* Eliminate various boards, including Managed Risk Medical Insurance Board (MRMIB), California Medical Assistance Commission (CMAC), California Health Policy and Data Advisory Commission (CHPDAC), and several others. MRMIB programs--Healthy Families, Access to Infants and Mothers, two "high-risk pools" would shift to be under the Department of Health Care Services.
As always, more information is available on our website at www.health-access.org. We also live-tweet and post breaking news (like today's announcement of the May Revise) on our Twitter feed, at www.twitter.com/healthaccess.
Yesterday at the Capitol, the California Health Care Foundation held a briefing based on a study they had commissioned about the financial feasibility of a Basic Health Program Option.
Under the Affordable Care Act, individuals between 133 and 400% of the federal poverty level would be eligible to purchase subsidized insurance coverage in the Exchange.The subsidies available through the Exchange will be available on a sliding scale, and individuals with the lowest income will be eligible for the largest subsidies; but some advocates are concerned that even with the richest subsidies, insurance might remain out of reach, or have too much cost-sharing, for those on the lowest end of the income scale.
The Basic Health Program is intended to be a different source of coverage from the Exchange for individuals from 133%-200% FPL. If the state were to create a BHP, everyone between 133-200% FPL would have to participate in that program and would not be allowed to buy coverage in the Exchange.The Federal Government would allocate 95% of the dollars they would have provided in subsidies to these individuals and give it to the State to run the BHP.The charge of the BHP would be to provide better care for less money.
The data presented at the briefing intended to answer the question of whether this charge is feasible.And to skip directly to the punch line, the consultants believe the answer to be “yes.”However, the discussion that followed the presentation of the data would indicate that actually, it’s complicated.Advocates and expert panelists questioned whether the assumptions that the data were based upon were reliable enough on to build public policy on, most notably because we don't know exactly what commercial because the health status of potential enrollees was not factored in.Additionally both panelists and audience members raised a number of concerns.Below is a summary of those concerns in a “Pros vs. Cons” list, acknowledging that most of these things are projections and concerns and none of them are guaranteed to come to pass.
PROs
Could provide more affordable care to low-income Californians--either better benefits, or less cost-sharing.
Could save the state money in some specific instances.
Provides one of the few opportunities to get federal funding to cover legal immigrants.
Could improve the risk mix of the Exchange.
Could spare low income individuals the ordeal of tax reconciliation, or having to pay back the federal government for subsidies if their income changes.
Could make it easier for individuals to transition between Medi-Cal and BHP as their income changes if appropriate eligibility, enrollment, and retention processes are put in place and if the program is housed at DHCS.
CONs
Could harm the Exchange by reducing the purchasing power by up to half and making the Exchange less than 25% of the individual market.
Could harm the risk mix of the Exchange, and thus could increase premiums in the Exchange.
Could divert crucial attention that is needed in setting up the Exchange.
Could further weaken the Medi-Cal provider network by drawing providers away from Medi-Cal into the better paying BHP.
Could leave the state on the hook to pay for program costs exceeding federal funds.
Could make it more difficult to remain seamlessly covered as individuals’ income increases and they become eligible for the Exchange.
Pat Powers, Interim Administrative Officer of the Exchange spoke up to urge lawmakers to proceed with caution considering all the unknown variables.
The Board of the California Health Benefit Exchange met for the second time today, still short their 5th member, who has yet to be appointed by the Senate. For those who have not been following this closely, the Board currently consists of Kim Belshe and Susan Kennedy appointed by former Governor Schwarzenegger; Paul Fearer, appointed by Assembly Speaker John Perez; and Diana Dooley, Secretary of Health and Human Services, who was elected Chair at the last meeting. As usual, we live-tweeted the meeting at our Twitter account @healthaccess, at the hashtag #CaHEx. For those who missed it, here's a summary below.
The first order of business was a report from the Interim Administrative Officer Pat Powers, who introduced herself, including her specific experience in the areas of small business and health care quality, and laid out the near and long term deliverables to be completed by staff. She cited the recruitment and hiring of an Executive Director and General Counsel, and the submission of the Exchange Planning Grant as the first priorities.
Ms. Powers devoted a significant portion of her report to opportunities for stakeholder participation. She mentioned opportunities such as public comment in meetings, a public comment form that allows written comment outside of the meetings, and plans to leverage technology to make the Board more accessible such as webcasting, and using the website and webinar. She also mentioned longer term goals to include stakeholders, including consumer groups, in workgroups. Kathleen Hamilton of the Children's Partnership and the 100% Campaign spoke up on the importance of including stakeholder input early, in the form of workgroups or other similar venues, so that their expertise and knowledge of the needs of the community could be incorporated into staff recommendations prior to the recommendations being presented to the board for action. Ellen Wu of the California Pan Ethnic Health Network encouraged the board to translate meeting materials and materials on the website to make them accessible to all Californians, and asked the Board to designate a staff person or create a workgroup to ensure the needs of communities of color and limited English proficient individuals, who make up 66% of those eligible for the Exchange, are represented in its governance.
The Board then heard reports from the subcommittees that were created at the last meeting. The Search/Recruitment Committee (consisting of Diana Dooley and Paul Fearer) presented the Duty Statements for the Executive Director and General Counsel, and asked for Board approval of those as well as the proposal to contract with a recruiting entity. The board adopted the proposals with an amendment suggested in public comment by Elizabeth Landsberg of Western Center on Law and Poverty, which was that the ED have expertise not only in private market programs but also in public programs.
The Exchange Establishment Grant Subcommittee, consisting of only Kim Belshe, jokingly reported meeting "24-7" and achieving a "striking degree of unanimity". Belshe has already begun working with Powers to delve deeper into the opportunities available through these federal grants. They reported attending an Exchange establishment meeting in Denver and having learned more about the grants, are planning to come to the Board at the next meeting to recommend action, potentially to change the level of grant the state applies for. The thinking is that rather than submit a long term Level II grant in September, the Board may submit a Level I grant in June, and take a little more time with the larger Level II grant that requires a four-year budget.
The remainder of the agenda consisted of 4 expert presentations on policy issues that will impact the exchange: An overview of the Individual and Small Group Markets, Projections of Potential Exchange Enrollment, the Small Business Health Options Program (SHOP), and the Basic Health Program Option. You can find the presentation materials on the Exchange website. (Speaking of which, there are a couple fake exchange websites out there that are run by agents and brokers, so look for the real thing at www.healthexchange.ca.gov)
The presentation about the Basic Health Program Option spurred a robust discussion about the impact a basic health program might have on the Exchange. A basic health program would take 95% of the funding that would have gone to providing subsidies to individual between 133% and 200% of the Federal Poverty Level, and use that money to provide alternative coverage that is intended to be more affordable. First and foremost, there is concern for the feasibility of "buying more for less" and whether this is possible. Secondly, many advocates expressed concern that this would mean taking a significant subset of people out of the exchange, and an even more significant portion of the heavily subsidized population (since subsidies are provided on a sliding scale, those with 133-200% will be receiving the highest subsidies) out of the Exchange, potentially harming both the purchasing power of the Exchange. There was discussion of what the impact of this would be on the risk mix of the Exchange, but without better data on the health status of individuals eligible for each option, it is difficult to draw concrete conclusions. SB703 (Hernandez) is a bill that would establish a Basic Health Program, and that is moving through the legislative process right now.
The California Health Care Foundation is sponsoring a briefing tomorrow May 12 at the Capitol at which they plan to reveal findings from their studies on the Basic Health Programs.
Also of note, the Low Income Health Programs, or county based Medi-Cal expansion programs that we have been advocating for along with our colleagues at Western Center on Law and Poverty and others, was mentioned several times as an important vehicle as early enrollment and a bellwether to learn from. Monitoring the implementation of the LIHPs will likely prove instructive for broader expansions in 2014, specifically by providing sample population characteristics such as health status of those who take up health care expansion, as well as providing lessons learned on eligibility and enrollment and other implementation mechanisms. Health Access has an organizing resource website about the LIHPs, to help Californians advocate for these LIHPs in their home county.
The Exchange Board will meet again on May 24, and that meeting will be webcast. More details to come.
GOP CONGRESSIONAL REPRESENTATIVES FACE QUESTIONS ABOUT VOTE TO END MEDICARE AND MEDICAID AS WE KNOW IT, AND SHIFT BILLIONS OF DOLLARS IN COSTS TO CALIFORNIA
* Pushback in California and Nationwide Against Party-Line Vote in House of Representatives on Ryan Budget Proposal to End Medicaid and Medicare As We Know It
* Governor Brown, Senators Boxer and Feinstein Oppose to Medicaid "Block Grant" Proposal, Warn That Would Shift Billions of Dollars in Costs to Cash-Strapped California
* CBPP Study: Ryan Proposal Would Have Meant $35 Billion in Less Medicaid $ to CA in 2000-09; Much More in Future
Also: LA Health Access Convening Tomorrow with Dr. Mitch Katz: Update on Healthy Way LA, and on Pending State Legislation to Implement and Improve Health Reform
Less than a month after their vote on a budget resolution, members of the U.S. House of Representatives are facing mounting questions about and opposition to this 2012 budget plan to end Medicare and Medicaid as we know it.
The vote on the budget plan authored by Rep. Paul Ryan (R-WI), taken right before the Easter recess, was passed with all Republican votes, opposed by all Democratic members and 4 Republicans from outside California. In California, all California Republicans voted for the proposal, to 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. The proposal also repeals the Affordable Care Act, leaving the millions of Californians who would be newly covered under the law uninsured.
Health advocates warned that if this budget were ever to be enacted, the ramifications of this proposal--essentially repealing and/or replacing Medicare, Medicaid and the Affordable Care Act--would be devastating, from seniors and families paying far more for care and coverage to millions more becoming uninsured. Advocates charge that the Ryan proposal passed 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.
A California Budget Project analysis indicates that the overall House budget's "binding cap" on federal spending "would force deep and immediate cuts to core public services... In the near term, the House budget plan proposed to deeply cut and dramatically restructure programs that assist millions of seniors and other Californians, including Medicare, Medicaid, and Supplemental Nutrition Assistance Program (SNAP) food assistance. Over the longer term, the House budget plan assumes the elimination of federal funding for a range of programs and services, potentially including education, medical research, environmental protection, and housing and child care assistance." The Center for Budget and Policy Priorities has much more fact sheets and information about the Ryan budget, its impact on health and other services, and because of its tax giveaways, its minimal impact on reducing the deficit.
Of specific concern for California is the impact of such a proposal on the already strained California budget crisis. The proposal, voted on by all California GOP Representative, would make the California budget deficit signficantly worse by billions of dollars--forcing the state to either raise taxes or make worse cuts. 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."
With Congress back in session, this debate is playing out in several ways. The GOP-controlled House is continuing to pass bills to repeal certain aspects of the Affordable Care Act, including a bill last week to defund the creation of state Exchanges. Another bill has been introduced to remove the maintenance-of-effort requirement in federal law that prevent states from cutting eligibility and enrollment is Medicaid and SCHIP.
The main venue is the current debate over raising the nation's debt ceiling, a routine but necessary vote that GOP lawmakers are insisting be packaged with major cuts and policy changes, including the elements of the Ryan budget. It's unclear what negotiation will yield. Advocates are working to simply inform Californians and Americans about the vote, the proposal, and its impact for California. As always, more information is available on our website at www.health-access.org. We also post breaking news (like today's discussion at the second meeting of the California Exchange board) on our Twitter feed, at www.twitter.com/healthaccess.
LA BREAKFAST BRIEFING: LIHP/HEALTHY WAY LA UPDATE WITH DR. MITCH KATZ; LEGISLATIVE UPDATE: Tomorrow morning, Thursday, May 12th, Health Access is hosting a breakfast briefing in Los Angeles on the implementation of health reform, featuring Dr. Mitch Katz, Director of the Los Angeles County Health Department. Dr, Katz will give an update on LA's Low-Income Health Program (LIHP), Healthy Way LA. Health Access California will also provide an update about pending health reform-related legislation. The event is from 9am-12noon at Planned Parenthood L.A., 400 W. 30th Street, Los Angeles, CA 90007. Please RSVP to Nancy Gomez at ngomez@health-access.org.
A new report released today by the U.S. Department of Health and Human Services (HHS) shows that few families without health insurance have the financial assets to pay potential hospital bills. On average, uninsured families can only afford to pay in full for approximately 12-percent of hospital stays they may experience – and even higher income uninsured families are unable to pay for most potential hospital stays. Hospital stays for which the uninsured cannot pay in full account for 95% of the total amount hospitals bill the uninsured.
This is an issue that we at Health Access has focused on, leading to the passage of legislation to help the uninsured deal with hospital bill. Advice for those with hospital bills can be found at the website http://www.hospitalbillhelp.org/.
But the point of the study seems to be to explode the myth that the uninsured just get hospital care anyway. While hospitals do have to take people in an emergency to stabilize them, they are not under an obligation to provide preventive, ongoing disease management, cancer treatment, or any other form of non-emergency care. And even for emergency care, the hospitals send a bill--and it's typically the largest bill (with the possible exception of a mortgage) that anybody will get in their life.
On releasing this study, HHS Secretary Kathleen Sebelius said:
“One of the most enduring myths in American health care is that people without health insurance can get care with little or no problem. Nothing could be farther from the truth. The result is families going without care – or facing health care bills they can’t hope to pay. When the uninsured cannot afford the care they receive, that cost must be absorbed by other payers. This is why expanding access to affordable health insurance under the Affordable Care Act is so important.”
Approximately 7 million Californians are uninsured. The report found that most uninsured people in America have virtually no savings. In fact, the median financial assets for all uninsured families are just $20. Even among higher income families, assets are low. Half of families with income at 400-percent of the Federal Poverty Level (FPL), or $89,400 a year for a family of four in 2011, have financial assets below $4,100.
Every year, nearly 2 million uninsured Americans are hospitalized. With 58-percent of these hospital stays resulting in bills of more than $10,000, most uninsured people are unable to afford potential hospital bills. Even the top 10-percent of uninsured families with the most assets are estimated to be able to pay the full bill for only half of potential hospital stays. Uninsured families can, on average, afford to pay the full bills for only about 12-percent of the hospital stays they might experience, bills that account for just 5-percent of the total amount hospitals bill them.
The high cost of hospitalization means that lacking health insurance poses a greater risk of financial catastrophe than lacking car insurance or homeowner’s insurance. Although people are 50-percent more likely to have car accident than to be hospitalized in a given year, the average bill for a hospital visit is over two and a half times higher than the average loss for a car accident. And, while the bill for a single hospitalization is about the same as the average loss from a house fire, a person is ten times more likely to be hospitalized than to experience a house fire.
Join the Jewish Funds for Justice and other national advocacy groups in an intergenerational action to stand up for Medicare this Mother's Day! Medicare needs to be protected for our mothers and grandmothers now, but also preserved for our children in the future.
From the "Worried Sick About Medicare" site:
The problem: The House of Representatives has passed a budget that divides families – people over 55 get Medicare while people under 55 get a voucher program that will double the amount they have to pay for health insurance when they’re old. This means tomorrow’s seniors will be worse off than seniors today, increasing poverty rates which have dropped by almost two-thirds since Medicare was enacted in 1965. While Medicare cuts were temporarily taken off the table this week, that’s merely a reprieve in the plan to destroy a bedrock entitlement program that’s worked for almost half a century. And even now members of Congress are looking for back door ways of enacting Medicare cuts.
The truth: Parents and grandparents will not sit back while Medicare is degraded for their children and grandchildren. Our families stand united to protect Medicare.
Mother’s Day Action:
Post a picture of a mother or grandmother standing up for the future of Medicare on the wall of this page. The picture can be with or without their kids. Ideally, hold a sign in the photo with a message like: “Another mother for Medicare” “My kids deserve Medicare too!” “Divide and conquer? That’s not the American way!” …or your own message!
Change your Facebook status to: “This Mother’s Day, my family is standing up for Medicare” with a link to this page.
Share the Facebook link to your photo with your Congress members, along with a message like, “This is what America’s mothers look like. Our family won’t allow you to degrade Medicare for the next generation.” Click here to email your Senators and Representative or at http://www.emailthecongress.com/emailcongress.html
Mother's Day Series: Healthy Kids Make Every Day Mother's Day!
In honor of Mother's Day, we've been highlighting some of the timely health issues related to moms. This post comes courtesy of our colleagues at the 100% Campaign...
Healthy Kids Make Every Day Mother’s Day
Are you looking for that perfect Mother’s Day gift? Every mom wants to know her kids are healthy and safe. So, give the special mom in your life the best gift of all – health coverage for her children!
Low-cost and no-cost children's health insurance is available now! Parents can: * Call 1-877-KIDS-NOW (543-7669) to talk with a specialist about Medi-Cal and Healthy Families; or * Apply online at www.healtheapp.net * Learn more about California’s health coverage options for children at www.100percentcampaign.org/needinsurance
Help us share this Mother’s Day message by downloading a flyer here to post in your community.
Because healthy women are healthy moms, recent federal developments are troubling.
On May 4, the House of Representatives passed HR3, the latest in their war on women's health. The bill will limit womens' access to the full range of reproductive health care. In addition the bill would block access to mammograms and other preventive services, and punish businesses and families that try to buy or keep comprehensive women's health benefits.
Our own Senator Barbara Boxer is helping to lead the charge against the measure, and is working to block the bill when it gets to the Senate. In a statement released right after the passage of HR3 in the House, she said
“Instead of keeping their promise to focus on jobs, House Republicans want to raise taxes on small businesses and families and take away women’s access to a full range of reproductive care. This extreme measure would even force IRS auditors to investigate personal and private health care decisions. We will fight in the Senate to stop this ideological attack on millions of American women.”
Mother's Day Series: Budget Cuts Mean More Tough Choices for Moms
Friday, May 06, 2011
The state's budget crisis has meant devastating cuts to services for children, forcing moms (and dads!) to make tough choices as they try to stretch family budgets to make ends meet.
About to take effect are cuts to children's health insurance include a $38.5 million reduction to Healthy Families, the State Children’s Health Insurance (SCHIP) in California that covers nearly one million children of low income families:
• Increase monthly premiums for families between 200 and 250 percent FPL by $18 per child, an increase of 75%,(with a family maximum of $126); and for families between 150-200% FPL by $14/child by nearly 100%. These changes, on families of 150% of poverty level, or $27,500 for a family of three, would yield a savings of $22 million.
• Raise emergency room co-payments from $15 to $50 and raising hospital inpatient services co-payments of $100 per day with a $200 maximum (for a savings of $5.5 million).
• The budget also makes $3 million cut in vision services.
Past increases in cost sharing have forced parents to make the difficult decision to drop coverage for their children. According to the 100% Campaign, 50,000 kids became uninsured in part due to increased premiums.
In addition, cuts to human services in programs such as CalWORKs and child care are putting even more strain on low-income parents. Further cuts are still being proposed to solve the state's still unresolved budget deficit.
Mother's Day Series: Mandating Maternity Care, Don't Forget Where You Came From!
Thursday, May 05, 2011
Prenatal care throughout pregnancy has been proven to have profound impacts on the lives and health of both mother and child. The fact that so many insurers do not provide maternity coverage, a basic necessity for women of child bearing age (not just for women planning to have babies, as 65% of US pregnancies are unplanned!), while covering basic benefits for men, can be considered discriminatory. A common argument, that because insurance is based on pooled risk, it would be unfair for men to have to pay for maternity care because it is a service they will never use, conveniently forgets the fact that by virtue of being born, all men have benefited from maternity care. Yet the forgetting continues: a sharp downward trend indicates that plans offering maternity services have decreased from 82% in 2004 to 19% last year and 12% this year.
In the last couple weeks, both the Senate Health Committee and the Assembly Health Committee have passed bills that would mandate insurers selling plans on the individual market to cover maternity care including prenatal care and other services. AB185 by Assemblymember Hernandez and SB 155 by Senator Evans are both moving forward to Appropriations committees. The bills would require maternity care in health plans sold on the individual market, something that will be required in health plans under the federal law in 2014.
The Senate Health Committee met today, this was the last opportunity for health bills from the Senate to move forward.
Supporters of SB810 (Leno) packed the hearing room to show their support for a single-payer universal health care system. This measure is a successor to previous bills (SB840) by former Senator Kuehl that were vetoed by Governor Schwarzenegger in 2006 and 2008.
In presenting the bill, Senator Leno explained the 3 main benefits of the bill would be:
1. lowering premiums – which would attract employers to the state and create new jobs
2. lower administrative costs – which would benefit providers
3. lower premiums – which would make coverage more affordable for consumers
Witnesses testified of the tremendous cost savings that the state could realize if we could reduce non health care related spending from over 30% to 5% of total healthcare spending that the single payer system promises.
Some concerns were expressed about potential conflicts with the implementation of federal health reform (mostly by opponents of SB810 that had also been opponents of the Affordable Care Act), but Senator Leno stated that he believed the efforts were complementary. He suggested that if SB810 pass in this 2011-12 session, there would likely be another fight at the ballot, either by a referendum by opponents or the need to voters to approve the financing, likely in 2014. It would be appropriate to continue the implementation of the ACA and coverage expansions in 2014, as the state in 2015 is able to prepare financing and apply for the federal permissions that are available under the federal law in 2017, and perhaps sooner. Leno also cited that Vermont has passed a similar bill to kick-start a process toward single-payer, and its Senators are seeking a bill to allow for such a federal waiver earlier.
A long line of supporters traveled from all corners of the state to testify in support of the bill, and it passed out of committee with 5 Aye votes.
The committee also heard SB615 (Calderon), to which Health Access and other consumer and community groups were previously opposed, but the author and committee had adopted a number of the amendments that removed such opposition. The bill now no longer restricts the field of individuals who can help people get coverage to licensed brokers.The bill now simply creates a standard of training that would apply to anyone selling certain health plans.SB615 received unanimous support in its amended form.
And now all the health bills that will be moving forward this year, including those passed in previous weeks, are off to Appropriations Committee.If they survive that committee, they will be up for vote on the floor of their house of origin (Senate bills on the Senate floor and Assembly bills on the Assembly floor), and if they survive that process, will move through the same process in the second house.
Assemblyman Bill Monning opened his Assembly Health Committee similarly to his Senate counterpart last week, by addressing a mix of legislation mandating specific health benefits. But unlike his Senate colleague, Chairman Monning stating that the Assembly Health Committee would be holding votes on these benefit mandate bills.
This was in contrast to Senator Ed Hernandez, Chair of the Senate Health Committee, who had announced last week that the Senate committee would not act on benefit mandate bills prior to the announcement of federal minimum essential benefit standards, and hold the bills without prejudice until next year.
Monning had a different take, and asserted the purpose of the Health Committee is to hear bills based on their health policy merits, without regard to matters such as state financing, which falls under the purview of the Appropriations Committee.He further stated that these hearings provide an opportunity to inform national conversations, as in the case of the development of Minimum Essential Benefits.
Along those lines, when presenting AB1334 (although not a mandate bill), Assemblymember Mike Feuer, encouraged California to do better than the federal health law to protect consumers, saying “integration [into federal law] when we can is important, and leadership when we can is important.”Feuer referenced last year’s AB2244, which went beyond the federal standards for protecting children with pre-existing conditions, bringing insurers back into market for children's coverage and providing additional access and affordability. AB2244 has received national acclaim for its important role in protecting the health of children and the children’s insurance market in the state.
AB1334 which attempts to simplify for California families, the daunting task of purchasing health insurance passed this afternoon in Health Committee.The bill would help consumers navigate the individual insurance market, where products vary so greatly with respect to price, benefits, co-payments, coinsurance, and a variety of other factors, that consumers are often unable to accurately determine which plans might meet their needs in the most cost effective manner.Feuer explained that the bill would help consumers by doing two things: first, it would inform consumers whether the plans they are considering meet federally defined Minimum Essential Benefits (and thus, if they were buying substandard coverage prior to 2014), and secondly, require that plans sold on the individual market can only vary slightly from the tiered benefit categories defined by actuarial value in the Exchange.AB1334 passed out of Health Committee and moves on to Appropriations.
AB1296 was presented by author Assemblymember Susan Bonilla as the “no wrong door, one open door” bill for health insurance.The bill would streamline and modernize eligibility and enrollment systems to make it easier for Californians to apply for insurance by assuring that no matter what coverage they apply for, they are accepted and directed to the appropriate program.It will no longer be up to the consumers to figure out what programs they might be eligible for and where they can apply. This effort will be fully funded by the federal government through the Affordable Care Act.The bill passed on party lines and moves on to Appropriations.
AB1083 by Assemblymember Monning also implements part of the Affordable Care Act by conforming California’s current rules for the small employer or “small group” market.Virgina Donohue, owner of a small business called Pet Camp, testified eloquently about the challenges small businesses face in providing health care to their workers in the current market, a system where insurers are allowed to charge vastly higher rates for workers based on age.“As a society,” she said, “we don’t want small employers shedding older workers because their health costs are higher, if I were motivated solely by finances, that is exactly what I would do…the system that exists now is simply unacceptable.”AB1083, which would limit how much a company with older workers could be charged, and also limit rate hikes for small buisness that happen to have workers who become sick, also passed on party lines.
Also moving out of health committee today was AB310 (Ma) which would limit the amount that insurers could charge consumers in “coinsurance” for 4th tier prescription drugs that are often used for individuals with chronic or genetic illnesses and prevent disability.These individuals must often pay to 30% in coinsurance for prescriptions, which can be so cost prohibitive that many chose to forgo treatment for illnesses such as Multiple Sclerosis.Insurers argued that they opposed the bill because it would discourage consumers from using less costly generic drugs, but in reality, consumers testified on behalf of the bill precisely because their prescriptions were too costly, and many of the applicable drugs do not have generic versions.
This is the last meeting the committee will have to consider health related bills originating in the Assembly.The next time the committee meets, in June, will be to consider bills from the Senate.
Annoyed by double-digit health insurance rate hikes? Venerable LA Times columnist George Skelton took a break from reporting on the budget and Governor Jerry Brown to focus on insurance rates, and to support the legislative push for rate regulation--AB 52 (Feuer). It even mentions our national partner organization, Health Care for America Now. It's worth a full read, but here are excerpts:
Insurance companies inadvertently have been making that case against themselves recently by announcing staggering double-digit rate increases, then backing off in the face of government scrutiny and public outrage.
Aetna Inc. and Anthem Blue Cross scaled back planned premium hikes, and Blue Shield of California canceled one altogether after new state Insurance Commissioner Dave Jones denounced the increases as excessive. In total, 865,000 policyholders got lucky.The insurers didn't have to cave. It was strictly voluntary.
In fact, Anthem planned to proceed Sunday with a rate hike averaging 16%, plus higher deductibles and co-pays, for nearly 151,000 customers. This despite the state Department of Managed Health Care — a separate entity from the insurance commissioner — proclaiming Friday that the increase was "unreasonable."...
Jones is sponsoring a bill (AB 52), carried by Assemblyman Mike Feuer (D-Los Angeles), that would require insurers to obtain approval from state regulators before increasing medical insurance rates.
The rates could be modified or denied by the managed healthcare department or the insurance commissioner. Generally, the department assesses HMO plans and the commissioner oversees other policies, including PPOs. Currently both entities can review rates but can't reject them....
Citing federal government data, he adds that healthcare costs nationally rose 3.4% last year, while California insurers were proposing rate hikes of up to 39%. His bill cleared its first committee hurdle last week, but with only Democratic support. One freshman Democrat — Richard Pan, a Sacramento County physician — joined Republicans in voting against it.
The medical profession largely opposes the measure because it would curtail the flow of money into the healthcare industry. Insurance and healthcare lobbyists worked the hall outside the committee room. They are two of the most powerful interests in the Capitol. Health and accident insurers contributed around $1.4 million to legislators' political kitties during the last election cycle, according to MAPLight, a nonpartisan group that researches money's influence on politics. The medical profession kicked in at least $4 million.
[S]upporters of the rate-control bill... point to large profit increases reported by insurers last year, including 21% for UnitedHealth, 13% for WellPoint — parent of Anthem — and 38% for Aetna, according to a national activist organization called Health Care for America Now...
As an assemblyman, Jones carried three similar bills, progressing further each time. Last year, his measure was killed by the Senate on the final night of the legislative session.
The bill's time has come. We don't hear much controversy about auto or homeowner policies these days, not like what we heard before voters gave strong regulatory powers to an elected insurance commissioner. We shouldn't be leaving medical coverage costs solely to the whim of the insurance industry.
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.
