Senate Health Committee holds 3+ hour hearing on rate regulation and AB52, passes other key bills...

Thursday, June 30, 2011

HEALTH ACCESS UPDATE
Thursday, June 30, 2011

SENATE HEALTH COMMITTEE HOLDS EXTENSIVE HEARING ON RATE REGULATION PROPOSAL AB52 (FEUER), PASSES OTHER KEY HEALTH REFORM BILLS

* Consumers, labor, employers testify extensively about the merits of AB52 to empower state regulators to reject unjustified rate hikes; Health industry continues effort to stop momentum
* Committee moves other key legislation forward that will implement and improve upon the Affordable Care Act: AB714, AB792, AB922, and AB1083

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* The Assembly + Senate Appropriations Committees were live-tweeted and blogged...


Yesterday, the Senate Health Committee, chaired by Senator Ed Hernandez (D-Los Angeles), considered many key bills to implement and improve upon the new federal health law.

The highlight was an over 3-hour discussion on a measure, AB52 (Feuer) to provide state regulators with the ability to reject unjustified rate increases. But the committee had previously decided not to hold a vote today, but rather schedule that until next week. ALERT: Health and consumer advocates are urging Californians to call members of the Senate Health Committee to urge them to support AB52 to help address rising health costs!

After that marathon session, several other health reform bills did come before the committee, and were voted out, moving forward in the legislative process.

Key Health Consumer Legislation Clears Senate Health Hurdle

Due to the extensive hearing on AB52, most other bills before the committee today enjoyed limited scrutiny and all were expeditiously moved forward. Among those were four important proposals, all sponsored or co-sponsored by Health Access California, that begin the work of implementing provisions of the federal health care law.

AB714 (Atkins) seeks to pre-enroll eligible Californians into coverage, either Medi-Cal or the Exchange. The bill potentially identifies and streamlines the enrollment process for over two million Californians prior to January 1, 2014, when the major (fully-federally funded) coverage expansion pieces of the Affordable Care Act (ACA) will go into effect. This allows California to immediately take advantage of the billions of federal dollars associated with covering more Californians, and to have a large and stable risk pool for the Exchange enrolled on Day One. This is a unique opportunity for the state to lead the nation in enjoying the benefits of the ACA as soon as they become available.

AB792 (Bonilla) would facilitate seamless transitions between public and private coverage programs and help to foster a culture of coverage. More than half of the uninsured are uninsured for less than a year, but unfortunately, individuals often incur medical costs while uncovered. AB792 would provide notice to individuals experiencing qualifying life events that may result in the loss of coverage and inform them of their eligibility for coverage in the Exchange or other programs.

AB922 (Monning) seeks to create a hub for consumer assistance and grievances so that consumers can easily find their own way through the tangled web of agencies, regulators and administrators that currently regulate and operate health insurance. The bill would make the Office of the Patient Advocate a go-to place for consumers should they have complaints, questions, or need other assistance.

AB1083 (Monning) is an important measure to implement the small group market provisions of the ACA, and adopts reforms that help small businesses get coverage for their workers. The bill would codify the requirements of the ACA in California law except where existing state law provides stronger protections for consumers.

Rate Regulation

The primary focus of the meeting though, was the hearing on AB52 (Feuer) which would give insurance regulators authority to give prior approval for proposed rate increases. Last year’s SB1163 gave regulators the authority to review rates and documents purporting to justify increases, but does not grant any authority for regulators to explicitly deny excessive, inadequate, discriminatory rates. Already, an insurer has gone ahead with a rate that the state regulator deemed as "unreasonable." AB52 would allow California to catch up to the 34 other states and the District of Columbia when it comes to empowering regulators to protect consumers from unjustified rates.

Assemblymember Feuer and Insurance Commissioner Dave Jones opened the hearing by outlining how this bill will make a significant difference in the lives of California families, and addressing some of the misleading misinformation that the industry opposition continues to repeat. Chair Hernandez asked a range of questions, as did many other members of the Senate Health Committee.

The Committee heard testimony from 6 panels, the first three comprised of proponents and the other three made up of opponents.

The first panel consisted of consumer advocates, who spoke about the importance of protecting consumers from prohibitive and budget breaking premium increases, particularly in the context of the new world of health reform where individuals will all be mandated to purchase insurance. The panel included a constituent from Senator Hernandez’s district who testified that after a series of premium increases quadrupled his mother’s monthly insurance payments, she was faced with the choice of paying for her mortgage or her insurance. She chose to stay in her home and to join the ranks of the uninsured, hoping each day that her chronic conditions do not force her to seek care in the emergency room.

The second panel, consisting of labor and a few employer organizations, clearly demonstrated from their own experience that the Exchange’s large group purchasing power would not likely be adequate to protect consumers from prohibitively costly insurance premiums. One labor advocate spoke of the experience of one of her members, a mother of two teenaged sons who’s insurance premiums have increased so much that she could no longer afford to cover both of her children. She was forced to choose only one of her children to cover, and shortly after one son was dropped from the policy, he was involved in a serious car crash, leaving this working mother with enormous medical costs that she is not sure how she will afford.The third panel consisted of a broader constituency of supporters for the bill.

The three opposition panels consisted of providers, insurers, and other opponents. Their testimony tried to raise many questions to slow down the measures' momentum. The providers invoked the fear factors that rate regulation would lower provider payments and cause providers to stop providing services despite a lack of evidence that this has happened in any of the other states where regulators have prior approval authority. It was noted that the CMA's opposition is contrary to the position of the American Medical Association, which has supported rate regulation. Additionally, opponents claimed that rate regulation would undermine the Exchange, without any substantial evidence to contest Commissioner Jones and Assemblymember Feuer’s explanations of how rate regulation is a necessary and complimentary to the Exchange. Supporters invoked Oregon as a state with a pro-active rate regulator authority, and Massachusetts as a state with both an Exchange and a rate regulation process. In their testimony, opponents of AB52 continued to confuse the issue by calling any efforts to evaluate and adjust or reject rate increases “arbitrary” “rate setting”. (They did not address the arbitrary nature of their proposed rate increases that often times are exponentially higher than the rate of medical inflation.)

Finally, committee members, including GOP Senator Tony Stickland, asked the confusing argument offered by opponents that this bill does not merit support because it does not address the plethora of underlying costs that have created the crisis in our healthcare system. Yet neither the author, the sponsor, or any of the bill’s supporters have ever claimed that AB52 was a magic bullet for all that ails the health care system, simply that it’s merits lie in its ability to make better one important piece of the problem, that Californians simply can not afford arbitrary rate increases and are losing coverage and suffering negative health outcomes as a result.

At the end of the hearing, Committee Chair Hernandez said he remained unsure of his position but expressed interest in working with the author on amendments that would be necessary for his support. AB52 will be voted on in the Committee’s meeting next week.

More advocacy will be needed to move this measure forward. In the words of Assemblymember Feuer, this is an opportunity for legislators to do something positive for the people of California (considering the harmful context of the budget) and it should be evaluated based on the fact that it will make life better for Californian families and small businesses.

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, Legislation, Updates

posted by Anthony Wright | Permalink | 10:49 AM


 

Thunder, Lightning, and a Budget..

Tuesday, June 28, 2011

However improbable it was to have a rainstorm in late June in Sacramento, it's not as unique as a budget passed before the end of the fiscal year. Yet tonight, the California Legislature on its way to passing a budget for the Governor's signature.

It's not a pretty budget: The Senate calculates a total of $14.6 billion in real cuts (NOT including another $2.5 billion in potential “trigger” cuts that would occur if revenue projections fall short). They say they have reduced the on-going structural deficit that was $26.65 billion in January by 75%. Overall General Fund expenditures for the 2011-12 fiscal year are $85.960 billion. That compares to current year 2010-11 expenditures of $91.480 billion.

An additional $2.5 billion in reduced expenditures could occur if they are triggered by a shortfall in anticipated revenue. The cuts in health and human services that could be triggered include $100 million in cuts to services for the developmentally disabled and $100 million in cuts to IHSS, with other cuts as well.

More to come.

Labels: Budget

posted by Anthony Wright | Permalink | 7:24 PM


 

Objection We Can Believe In

Governor Brown sent a letter to the White House yesterday expressing his strong objections to proposed reductions to Medicaid. The proposed reductions, being discussed as part of a budget deal around the "debt ceiling" vote, would result in tremendous cost shifts to the state that would bring devastating harm to our safety-net.

Text of the Governor's letter below:


June 27, 2011
The President
The White House
Washington, DC 20500

Dear Mr. President:

I write to object strongly to two Medicaid budget reduction proposals under consideration by your administration: (I) curtailing or eliminating Medicaid provider taxes; and (2) creating a single, or blended, federal matching rate for Medicaid and the Children's Health Insurance Program (CHIP) with a resulting reduction in federal financial participation.

Provider taxes are a critical source of revenue used by California and the majority of states to help meet ever-growing Medicaid costs. This revenue is essential to compensate for the significant cost-control constraints imposed by federal maintenance-of-effort provisions, mandatory eligibility and benefits requirements, and mandatory cost-based reimbursement for some providers. We are further constrained by ever-present litigation that challenges our reductions to provider payment rates and optional benefits.

The proposal to create a blended federal matching rate for Medicaid and CHIP cannot achieve the planned savings without a blatant cost shift to states. California is already disadvantaged by the current Medicaid matching rate based on per capita income that does not account for the significant percentage of Californians living in poverty. We will be further disadvantaged under the Medicaid expansions mandated under the Affordable Care Act because we will get no credit for our leadership on previous Medicaid eligibility expansions. And despite operating one of the most cost-efficient Medicaid programs in the nation, California continues to struggle under the current Medicaid funding formula. We simply cannot sustain further reductions in federal support.

California has enacted huge and extraordinarily painful spending cuts to close our multibillion dollar budget gap. We did our part to reduce state and federal Medicaid spending by eliminating optional benefits, reducing provider payments and requiring beneficiary cost sharing. However, none of our requests to implement these actions has yet been acted on by your administration.

The Medicaid reduction proposals you are now considering would not only cripple Califomia's Medicaid program but would have disastrous ramifications for education, public safety and other critical state programs.

I thoroughly understand the need to address deficits at the state and federal level, but these proposals to shift several billion dollars in Medicaid costs to California would be devastating and would clearly move us in the wrong direction.

Respectfully yours,

Edmund G. Brown Jr.
cc: Secretary Kathleen Sebelius

Labels: Brown, Budget, Federal, Obama

posted by Linda Leu | Permalink | 3:02 PM


 

Exchange Board Approves Grant Application

The fifth meeting of the Exchange Board today welcomed the fifth and final appointee to the Board, Dr. Bob Ross, though the Board was still not quite whole, with Susan Kennedy absent for the day.

The meeting began with a report from Acting Administrative Officer Pat Powers. Ms. Powers touched on a number of important subjects:

1. Misleading Websites. There is a private company that has set up a website with the address cahealthbenefitsexchange.com. This is NOT the Exchange's official website, it is a commercial website that is very easily confused with the real Exchange website as it mimics some of the official website's design elements, colors, etc. Ms. Powers reported that this has already caused confusion among consumers, and that this matter has been referred to the Attorney General's Office for follow up. Beth Abbott of Health Access testified that there are other sites recently created by brokers and other commercial interests that have adopted similar names to the Exchange. Ms. Abbott encouraged the Board to ramp up branding and PR efforts to get the real Exchange out there, and to work on search engine optimization. The real Exchange website can be found at www.healthexchange.ca.gov or at www.HBEX.ca.gov.

2. Ms. Powers again invited stakeholders to submit leads for appropriate candidates for the Executive Director position. The recruitment brochure can be found here, and leads can be submitted to Pam Derby at CPS Executive Search, resumes@cps.ca.gov.

3. Staff is working on a conflict of interest code for the Board which will be brought forward in the July or August meetings.

4. Last but not least, as the Board wraps up the grant application process, their next focus will be on strategic visioning for the Exchange, particularly around the customer service experience. This process will engage stakeholders and span the 4 months from July through October. Stakeholder meeting dates will be announced next week.

But the main event for this meeting was the proposed grant application put together by the grant subcommittee of one (Board Member Kim Belshe) and the staff. The full proposal incorporated some of the comments that consumer advocates made at the last meeting in addition to those made through letters submitted the the Board. Advocates acknowledged the greater emphasis (and pushed for more) to be placed on consumer assistance, stakeholder engagement, and all four pathways to eligibility and enrollment (online, mail, phone, in-person) as opposed to a singular focus on IT systems, as well as for dedicated resources to linguistic and cultural access. In addition, the Board added language committing to accessibility for people with disabilities.

Several Board members spoke up in agreement with advocates' comments related to the importance of cultivating the multiple pathways to eligibility and enrollment.

Dr. Ross commented on the importance of stakeholder engagement and on consumer assistance. He expressed appreciation for advocates such as Health Access, Western Center on Law and Poverty, Consumers Union, NHELP, SEIU and a number of our coalition partners for our letters and input into the proposal.

Generally advocates appreciated the tremendous job that the staff and Board member did on this very heavy lift and appreciated the Board's openness to accepting suggestions from stakeholders. Some lingering concern remains around whether the proposed timeline, which doesn't address policies around eligibility and enrollment until late in the year, allows enough time for legislative action. If legislation is not acted upon until 2012, it will not take effect until 2013, which may not leave adequate time for Exchange planning.

The board approved the grant proposal on a vote of 4-0 and it will be submitted tomorrow or the day after. The next regularly scheduled meeting of the Exchange board is calendared for July 22, 2011.

Labels: Exchange, HealthReform

posted by Linda Leu | Permalink | 11:46 AM


 

Budget Plan B

Monday, June 27, 2011

Earlier today, Governor Brown held a press availability with Assembly Speaker John Perez and Senate President Pro Tem Darrell Steinberg. We reported on it on Twitter, but here's more.

The big news was that Governor Brown recognized that the Republican legislators, due to their "religious reluctance to consider a budget solution that included revenues," were simply never going to agree to a budget deal. And as a result, they were no longer looking at a special election this year.

Rather, they would balance the budget this year and make progress on the structural deficit, and place a revenue measure on the ballot for November 2012 to address the rest of the structural deficit.

The Sacramento Bee and KQED have details. The new budget package does include tough cuts, on top of the drastic cuts made earlier this year that included severe hits to Medi-Cal and other health and human services.

In the new proposal, if anticipated projected revenues don't come through, additional cuts would be "triggered." Many of those cuts are in education (including cutting school days), but $200 million are slated for health and human services as well.

Health advocates will remember that awful cuts, including the elimination of Medi-Cal benefits--including the elimination of dental, vision, and a variety of other covered services--were the subject of a "trigger" in 2009--and the trigger was "pulled."

These additional cuts would not have to be contemplated if we found a way to extend current tax levels, which would have maintained enough revenue to balance the budget. Instead, later this week, certain taxes will expire and blow a hole in our budget that we'll spend the next two years--if not more--trying to grapple with. Ugh.

Labels: Budget

posted by Anthony Wright | Permalink | 10:37 PM


 

Health Bills Pass Committees

Thursday, June 23, 2011

On Tuesday the Assembly Health Committee approved SB222 (Alquist), which would give local health plans and initiatives explicit authority to enter in to joint ventures and in short, allow them to create public health insurance options.

Labels: HealthReform, Legislation

posted by Linda Leu | Permalink | 2:25 PM


 

Dr. Bob Ross on the Exchange...

Wednesday, June 22, 2011

The board of the California Health Benefits Exchange has been operating for a few months with a vacancy in one of its five slots--but that changes today.

Senate President pro Tempore Darrell Steinberg announced the selection of Dr. Robert Ross, the CEO of The California Endowment (TCE), as the Senate Rules Committee appointment.

Before coming to the Endowment, where he has served for over a decade, Dr. Ross, of Altadena, was the director of Health and Human Services for San Diego County. Ross lists his party registration as independent. His term on the board will end January 1, 2016. We should note that The California Endowment is a funder of Health Access Foundation, and other allied health and community organizations.

Ross is the Senate's appointment to the the five-member board, which is also made up of Health and Human Services Secretary Diana Dooley; former chief of staff Susan Kennedy and former Health and Human Services Secretary Kim Belshe, both appointed by former Governor Schwarzenegger; and Paul Fearer, appointed by Assembly Speaker John Pérez.

The next meeting of the Exchange is Tuesday, June 28th, when the board is expected to vote and finalize a grant proposal to the federal government to fund its activities for the next year.

Labels: Exchange, HealthReform

posted by Anthony Wright | Permalink | 6:18 PM


 

Health Bills Up in Policy Committees This Week

Monday, June 20, 2011

We're off and running again! Some of the health consumer bills that made it to the second house will be heard in the legislature in policy committees this week.

Labels: HealthReform, Insurers, Legislation

posted by Linda Leu | Permalink | 4:59 PM


 

Anthem Blue Cross Reduces Rate Increase for Small Businesses

Insurance Commissioner Dave Jones announced today that Anthem Blue Cross will be reducing a proposed quarterly premium increase from 6% to 3%. This will impact approximately 18,000 Californians.

Commissioner Jones was able to review the company's rate increase proposal based on legislation that was passed last year (SB1163 Leno) that requires insurers to justify their increases.

While this increase may seem small, these small increases have been the straws breaking the camels' backs for many small businesses struggling to survive the depressed economy and the triple digit health insurance premium increases they've endured over the past decade.

And while it is good news the Commissioner Jones has facilitated this roll back of the increase, it is also important to remember that history has shown that when left to decide whether to act in the interest of consumers or to act in the best interest of their own profits, they have chosen profits each time. Californians can not afford to let insurers decide when they will raise rates and by how much.

Read Commissioner Jones' press release here.

Labels: BlueCross, InsCommissionerJones, Insurers

posted by Linda Leu | Permalink | 2:42 PM


 

Providing Perpective on Provider Rates...

Sunday, June 19, 2011

Late last year the Center for Studying Health System Change released a study about the variation in provider rates which concludes that providers, specifically hospitals, have the upper hand in payment negotiations. And that this is part of a pattern of increasing leverage that providers wield, commanding higher rates.

Using Medicare as a point of reference, the study (based on data from the Medicare Payment Advisory Commission) found that hospitals in the Los Angeles area have negotiated inpatient payment rates averaging 149% of Medicare and outpatient rates averaging 277% of Medicare. In the San Francisco area, average inpatient rates negotiated by hospitals are 210% of Medicare and outpatient rates average 366% of Medicare.

So when we hear that "rate regulation will force insurers to lower provider payments” from opponents of AB52 (Feuer) to argue against giving insurance regulators the authority to reject rate increases that are unreasonable and unjustifiable, we are skeptical. In a health care system where payers, insurers, and providers battle over affordability issues, are providers really the victims?

This data, coupled with what we know about health insurance company profits would seem to suggest that the only parties *not profiting* in this system are rate paying consumers.

Labels: Hospitals, Insurers, Legislation

posted by Linda Leu | Permalink | 1:23 AM


 

Brown Vetoes Budget

Thursday, June 16, 2011

Wow.



Here's the letter that accompanied the veto...

Labels: Budget

posted by Anthony Wright | Permalink | 12:39 PM


 

At least it's on time...

Wednesday, June 15, 2011

The California legislature passed a state budget today.

Perhaps the most notable item is that it was an on-time budget, and even done during daylight hours, after years of late--and late-night--sessions. Many attribute the change to Proposition 25. While there's a lot of attention to the legislators losing pay if the budget was late, the real breakthrough was the ability to pass a budget by majority vote--without Republican votes.

Up until then, Governor Brown and legislative leaders sought to negotiate with Republicans to extend current tax levels--to prevent their expiration from blowing a hole in the budget. But it didn't seem like they were willing to close a deal, as they were wedded to a list of 41 bullet points that included a spending cap, regulatory drollbacks, and more.

So the budget doesn't include those revenues, and the hole is addressed through additional cuts, some one-time fixes, and some minor revenues. The major cuts to health care were made in March, and more cuts were booked to Medi-Cal in this last round (although they are based on certain assumptions, rather than policy changes).

What this budget doesn't do is include the revenues and reforms needed to fix out budget problems once and for all--that still requires a 2/3 vote of the legislature, and hence Republican votes.

Until then--whether in the next weeks as Governor Brown considers this budget, or over the next several months, we as health advocates will continue to be clear about the awful impacts of the steep cuts already made, and the consequences of what additional cuts would be forced without extended revenue.

Labels: Budget

posted by Anthony Wright | Permalink | 9:19 PM


 

The Exchange Board Episode 4: Guest Starring Joel Ario

The California Health Benefits Exchange Board held their fourth meeting today.

The first substantive presentation made by Joel Ario, Director of Office of Health Insurance Exchanges at the Center for Consumer Information and Insurance Oversight (CCIIO) at the Center for Medicaid and State Operations. Ario outlined the vision for Health Insurance Exchanges from the federal perspective, touching on a variety of themes important to consumers. He said Exchanges should be competitive marketplaces, providing open, transparent, aggressive competition between insurers not based on risk selection but on cost and quality. He also touched on the importance of program integration and a high quality customer service experience for consumers including real-time eligibility determinations.

Ario also talked about the progress that the federal government has made doing their part in helping states get their Exchanges going, including planning and early intervention grants, and the development of guidance and regulations, including the highly anticipated Minimum Essential Benefits Standards which should be released in the fall.

His timeline for moving forward with Exchanges is as follows:

2011:
* Establishment grants
* IT: IT innovator states will move forward, the federal government will work on building of federal hub, and work on more plans for the federal fallback managed option
* HHS is close to completion on the first set of proposed rules, perhaps in the next few weeks.
* Essential benefits standard expected in the fall.

2012:
* Finalize two set of rules on Exchanges.
* Complete IT builds
* Certification of states’ Exchanges, Secretary of HHS must determine whether states have met the requirements for Exchanges.

2013:
* Insurers will come in for contracting, bidding process must begin.
* Enrollment process begins before Jan 1, 2014
* Information technology testing--Exchanges will need to be operational.

Ario encouraged the state to be "as ambitious as you can be" with Exchange grant proposals and supported Secretary Dooley's insistence that California be a "pace car" for ACA implementation.

The bulk of the remaining meeting was spent discussing the Exchange planning grant application draft. Today's discussion served as an opportunity for board members and stakeholders comment on the draft grant proposal. The Board will be taking action (to potentially approve the application) at the June 28th meeting and will be accepting written comments from stakeholders until then as well. You can view the grant overview here and the summary here and provide comments. The application proposes a $40 million budget, with 75 FTEs but with most of the resources going to consultants.

Consumer advocates provided a number of comments at the meeting. Broadly, there was a strong emphasis on a desire for additional resources to be allocated for consumer assistance, stakeholder participation, and outreach and public education. Additionally advocates petitioned the board to consider cultural and linguistic access for limited English proficient consumers both in the Exchange customer service experience and in the current planning and implementation process. Pat Powers, the Exchange's Acting Administrative Officer reported that future meetings would take place in other parts of the state so that more stakeholders can participate, and that the Board would also hold stakeholder convenings throughout the state. Advocates asked that those meetings be translated to be accessible to all.

The Board was also given an update on the progress of the Executive recruitment process. A recruitment brochure has been created and the Board hopes to be interviewing Executive Director candidates by July and have an ED hired by August. The General Counsel will be hired next and they hope to have that individual in place by October. Staff encouraged the Board and stakeholders to contact the recruiter with leads or suggestions for suitable candidates.

The next meeting of the Exchange will be on July 28th, where they will take final action on the grant application.

Additionally, a stakeholder webinar will be held on Monday June 20 from 10:30am - noon. This will be another opportunity for the general public and a broader group of stakeholders to weigh in. We will provide more information as it becomes available.

Labels: Exchange, HealthReform, Insurers

posted by Linda Leu | Permalink | 4:26 PM


 

A wish list that may include a fountain of youth...

Monday, June 13, 2011

Back in March, the negotiations over the California budget blew up when GOP Senators released an infamous list of 53 demands--a wish list of items, some of which were unrelated to the budget, or that would actually make the situation worse.

Back in negotiation mode now, we have a new list released by the Senate Republicans--more streamlined (for example, restoration of funding for county fairs is no longer listed), but still massive with no less than 41 demands.

Senate Republicans continue to demand this 41-point wish list just to agree to temporary tax extensions to preserve funding for education, health, and other vital services. In just the area of health care, the cuts already made are resulting in a less healthy, less caring, less secure state. We shudder to think what additional billions of dollars of cuts would look like. All we need to do to prevent such added cuts, if the GOP Senators allow, is extend current tax rates, rather than letting some revenues expire and blow a hole in our state budget.

As part of the package, Senate Republicans are proposing a spending cap.

The California Budget Project examined the spending cap proposal against important criteria, and finds it falls short:
- The choice of a base year.
- The choice of an inflation factor.
- Whether it is really a cap masking as a budget reserve.
- Whether it is really a new infrastructure funding program masquerading as a spending limits.

As CBP reminds us, a spending cap has been rejected by voters twice in less than a decade. Ultimately, a spending cap would handcuff our ability to invest in the future and bring in federal matching funds for our health system and our economy. The GOP spending cap proposal doesn't even take into account an aging population, medical inflation or other real and anticipated needs of California. Unless they have discovered a fountain of youth, it's a deeply unserious, deeply destructive proposal.

Labels: Budget

posted by Anthony Wright | Permalink | 6:22 PM


 

Ellen Wu becomes a Ms. MIB

California's Managed Risk Medical Insurance Board (known as MRMIB) is in the center of the debate in Sacramento, with a proposal to shift many of its functions to the Department of Health Care Services.

Despite that, or actually more importantly because of it, there's important work at MRMIB to continue to provide health coverage to 900,000 children in the Healthy Families program, the thousands of people with "pre-existing conditions" getting coverage through high risk pools (MRMIP and PCIP), etc.

In that vein, our colleague Ellen Wu, executive director of the California Pan-Ethnic Health Network (CPEHN), has been tapped to join the MRMIB board. Congratulations to Ellen!

Here's her comments on the blog of MomsRising!:


Helping MRMIB Prioritize Children and Families During Transition
Posted June 10th, 2011 by Ellen Wu

At this critical time for California’s safety-net programs, I am honored to have been appointed by Senate President pro Tem Darrell Steinberg to serve on the state’s Managed Risk Medical Insurance Board (MRMIB). MRMIB oversees the Healthy Families Program, which provides low-cost health, dental, and vision coverage to children in low-wage families. MRMIB also oversees four other programs benefiting low-income Californians, the elderly and disabled: Access for Infants and Mothers Program, County Health Initiative Matching Fund Program, Major Risk Medical Insurance Program, and the Pre-existing Conditions Insurance Plan Program.

In Governor Jerry Brown’s May Revise, he proposed transitioning the close to 900,000 children in Healthy Families to Medi-Cal in the 2011-12 fiscal year, as well as the elimination of MRMIB and the transfer of the other programs to the Department of Health Care Services. The legislature is now developing their proposal for the transition. As MRMIB is in this uncertain period, we must make sure that our first priority are the children and families in these programs, and that there is continuity of care. We will work to ensure that they continue to receive the same services, and that they will not have to pay more for their care.

I am excited about joining a group of leaders that has pioneered a “no wrong door” approach to enrollment and that has greatly enhanced the ability of eligible applicants to receive the health care they need. I am grateful for this opportunity and realize the great challenge ahead. I look forward to working with providers, policymakers, and other advocates as we build a healthier future for California’s kids.

Labels: HealthAccessCommunity, Insurers, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 2:48 PM


 

An announcement from Blue Shield...

Friday, June 10, 2011

To great fanfare, Blue Shield of California earlier this week announced a voluntary "cap on profit," and a rebate of $167 million to policyholders.

After many recent rate increases, Blue Shield of California's announcement is welcome for those consumers getting rebates. But beyond the Blue Shield press release, there was a lot of questions that came to our mind: How would these figures on revenues, costs, reserves, and other factors are being calculated? How would this commitment be enforced?

It's important that the oversight of the new federal law has ushered in new accountability on insurers, but we need additional state authority and action to make the promise real. That's why we need to pass the pending rate regulation bill, AB52(Feuer), to ensure that California consumers don't get overcharged on the front end, by Blue Shield or any other insurer.

Wendell Potter and others believe that the recent Assembly passage of AB52(Feuer) factored into Blue Shield's decision. After all, insurers in states with rate regulation have had their profit restricted to less than 2% of net income, especially during this recussion. But more than that, we want to ensure that people don't get overcharged on the front end--when they make decisions about whether to get coverage or not. So Blue Shield lobbied against AB52, as did other insurers and industry. We'll see if other insurers follow suit--whatever their motive is.

We will have more as we find out more information.

Labels: Insurers, Legislation

posted by Anthony Wright | Permalink | 12:05 AM


 

Outnumbering the tea party in GOP districts...

Thursday, June 09, 2011

On the afternoon of Monday, June 6, a crowd gathered on the generally quiet 15th Street in Modesto, California, across from state Senator Anthony Cannella’s office. On one side of the street, close to the Senator’s office, was a small group of seven from the Tea Party and Americans for Prosperity (the front group funded by the Koch Brothers), and on the other side of the street was the significantly larger counter-demonstration consisting of 65 people from labor groups, faith-based groups, senior citizens’ organizations, and local educators.

Both sides were there for one reason: to show their support for or opposition to Governor Brown’s proposed revenue extensions. The Tea Partiers were bemoaning the extensions (which they represent as “new” taxes), with signs exclaiming “We are taxed enough already” and “No new taxes”.

The counter-demonstration was organized by Health Access and allied groups, supported by Congregations Building Communities, Valley Progressives, the North Valley Labor Federation, the California Association of Retired Americans, United Domestic Workers, and more such groups of citizens. They stood in solidarity for the hour-long demonstration, chanting their message with phrases such as “Stop the Drop!” and “Tax the oil, tax the booze, save the services that we all use!” and holding up signs urging passers-by to honk for a fair budget.

Touching accounts of the ways in which budget cuts have harmed individuals, their families, and their communities were given by senior citizens, disabled persons, educators, and other hard working members of the community. There was a strong overall sense of solidarity within the counter-demonstration, which really spoke to the gravity of the situation being faced by the various groups suffering from the effects of the failing budget.

Along with representatives of several local media outlets, Senator Cannella’s Deputy Chief of Staff shuttled back and forth between the two groups and listened to what the people had to say. Senator Cannella, a Republican, has shown some inclination to taking into account the needs of his constituents prior to assuming a position on the budget.

For more information on the event, check out the Capital Public Radio story at http://www.capradio.org/articles/2011/06/06/dueling-rallies-target-potential-state-budget-swing-vote

(Reported by Health Access intern Nikita Khetan)

Labels: Budget

posted by Anthony Wright | Permalink | 10:43 PM


 

Key Health Reform Passes the Halfway Mark Through the Legislature

Tuesday, June 07, 2011

HEALTH ACCESS ALERT
Friday, June 3, 2011

CALIFORNIA LEGISLATURE VOTES TO MOVE FORWARD RATE REGULATION, OTHER KEY BILLS PASS TO IMPLEMENT AND IMPROVE NEW FEDERAL HEALTH LAW

* Assembly Passes AB52(Feuer), to Protect Consumers from Unjustified Rate Increases

* Other Insurance Oversight Bills Pass on Maternity Coverage, SB155(Evans), Small Business Health Coverage, AB1083(Monning), and a "Medical Loss Ratio," SB51(Alquist), to Ensure Premium Dollars Go To Patient Care

* Several Bills Would Improve Eligibility and Enrollment--AB43(Monning), AB714(Atkins), AB792(Bonilla), AB1296(Bonilla)--So Californians Maximize Coverage and Federal Funds

The Assembly + Senate Floor Votes were live-tweeted and blogged... Follow us on Facebook, Twitter, and our blog and website!

Important California legislation to implement and improve upon the new federal health law passed full floor votes in the California Legislature today. The California Assembly passed high-profile, heavily-debated bills like AB52(Feuer), on rate regulation, so consumers are protected from unjustified rate hikes, and the California Senate passed other measures that will provide crucial consumer protections for Californians. Other bills seek to streamline and simplify eligibility and enrollment systems so that Californians get the coverage they want and need, and that the state maxmizes the number of people covered and the amount of federal funds coming into our health system.

These bills move forward to face scrutiny in the Health Committees, Appropriations Committees, and then on the floor of the second house.

SELECTED HEALTH REFORM BILLS THAT PASSED THE SENATE FLOOR

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 703 (Hernandez) BASIC HEALTH PLAN: Creates a Basic Health Plan for Californian adults between 133% and 200% of the federal poverty level, as allowed under the Affordable Care Act.

SB 728 (Hernandez) RISK ADJUSTMENT: Requires the new Health Insurance Exchange to set up risk adjustment, so insurers compete not based on who had sicker or healthier patients, but on cost and quality and other factors.

SELECTED HEALTH REFORM BILLS THAT PASSED THE ASSEMBLY FLOOR

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 242 (Perea) TAX CONFORMITY: Conforming the state tax code to implement the Affordable Care Act.

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.

AB 1083 (Monning) SMALL GROUP INSURANCE REFORM: Provides stability and security to small business purchasers of health coverage, so they don't face additional spikes in their premiums due to the health of their workforce. Further limits the impact of the age of their workforce on their premiums, also in conformity to the Affordable Care Act.

AB 1296 (Bonilla) ELIGIBILITY AND ENROLLMENT: Streamlining eligibility and enrollment for Medi-Cal and other public programs.

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.

NEXT STEPS

More advocacy is needed as these bills pass face scruitiny in policy committees in the second house in the coming weeks.

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.

***CORRECTION: AB 43 (Monning), which expanded Medi-Cal eligibility according to the rules under the Affordable Care Act, was originally reported as having passed. AB43 was actually moved to inactive at the request of the author, held on the Assembly floot as a two-year bill. (The rules don't have to amended until 2013-14, and the bill will be available to move in January 2012.)

Labels: HealthReform, Insurers, Legislation, Updates

posted by Anthony Wright | Permalink | 7:56 AM


 

Floor Session Update, AB52 & More Key Health Bills Move Forward

Thursday, June 02, 2011

In late evening floor action last night, the Senate passed SB728, Senator Hernandez's bill on risk adjustment. More action today resulted in the passage of all but one of our bills, AB1334 (Feuer), which will be considered tomorrow.

Senate Floor
SB703 (Hernandez) Creates a Basic Health Plan to serve low-income Californians

Assembly Floor
AB1296 (Bonilla) Streamlining eligibility, enrollment, and retention in public programs, including the development of one statewide application.
AB 916 (Perez) Requires the State to seek funding opportunities through the Affordable Care Act and other sources for promotores.
AB922 (Monning) Improving consumer protection by improving the Office of the Patient Advocate.
AB52 (Feuer) Giving regulators rate approval authority to protect health insurance consumers.

Mr. Monning's bill sparked some "debate" as the proposal to better assist health care consumers inspired some Republicans to rehash a number of myths about the treachery of "Obamacare."

Mr. Feuer's bill was heard amidst a Republican "walk out" around the issue of whether they could hold a GOP caucus, so the opposition in the discussion came from Democratic members. Mr. Calderon and Mr. Solorio spoke out in strong opposition, this time largely citing concerns about rate regulation's interaction with the new Exchange as the reason for their opposition as well as giving mention to concerns over the politicizing of health insurance rates. Assemblymember Monning reminded his colleagues that the authority the bill gave regulators was approval authority based on actuarial data and other facts, not arbitrary authority. Assemblymember Huffman, one of the bill's co-authors spoke in support saying that this bill is fundamentally about "where do you stand? who are you with?" encouraging other members to stand with their constituents, and the hundreds of thousands of health care consumers suffering from insurance industry abuses. In the end, neither Calderon or Solorio voted for or against the bill, choosing instead to join Democratic Assembly members Buchanan, Galgiani, Huber, and Perea in abstaining. Assemblymember Hall was not present at the time of the vote. Assemblymember Pan was the only Democratic "no" vote, joined later by most Republican Assemblymembers. AB52 now heads to the Senate.

Many, many thanks to all of our friends and allies who have made calls, sent letters, and visited your Assemblymembers about these bills, we look forward to your support as we redouble our efforts in moving these bills through the second house. Onward!

Labels: HealthReform, Insurers, Legislation

posted by Linda Leu | Permalink | 3:54 PM


 

Assembly and Senate Floor Votes Move Key Bills Forward

Wednesday, June 01, 2011

All of the health reform-related bills that were voted on today passed their first floor vote, marking the half-way point to enactment.

Obamneycare...

 

The Exchange Discusses Essential Health Benefits

 

Assembly Moves Health Bills Forward, Single Payer ...

 

Comedy about Coverage: Stewart vs. Sebelius

 

Health care in the State of the Union...

 

The State of the Health System...

 

Secretary Sebelius lays out the stakes...

 

First Exchange Board Meeting of 2012!

 

Tonight! Tune in to KCET as "Your Money Your Life...

 

What federal "budget cuts" actually mean...