Perhaps the most lobbied bill not just in health care but in the whole legislature, AB52(Feuer) would allow state regulators to reject unjustified rate hikes by health insurance companies. It was a common sense consumer protection that was widely supported by the public, and by a broad coalition of consumer, community, and constituency groups.
Assemblymember Feuer, the author of Assembly Bill 52, announced today that he was parking the measure. Despite an outpouring of strong support from small business, working families and consumers throughout CA, the bill has hit a temporary roadblock in the Senate. Right now, not enough Senators are prepared to vote for any form of health insurance rate regulation. Until a majority of the Senate supports giving the state authority to reject excessive health insurance increases, millions of Californians will continue to pay unreasonable rates or not be able to afford to go to the doctor at all.
We always knew the Senate floor vote was our last and highest legislative hurdle--it is where a similar bill died last year. This year, we restarted from scratch and yet kept the momentum, taking the bill all the way through the full Assembly and the appropriate Senate committees. Since this was the first year of a two-year session, AB52 is now a two-year bill, which means we won't have to start at the beginning again next year--it will be available to be voted on by the full Senate next year without going through all the other hoops.
The delay will give us the time to make our case and change some minds. We will work to convince state Senators of the need for the reform, and the urgency that the public feels. With every rate increase, the support for additional insurance oversight will also increase.
We have lots of examples of health reforms and consumer protections that took multiple years in the Legislature before finally breaking through and becoming law. Californians should continue to press the issue, especially with their state Senators.
Today is the last day of subsidies that made COBRA health coverage affordable. Phil Galewitz has a good article on these subsidies, which were included in the ARRA stimulus package, and were extended in subsequent pieces of legisation, but no longer.
Even though it had its limits, the COBRA subsidy was a big help for those who could take advantage of it. As people lost jobs, they also lost their health coverage—a double whammy that the COBRA subsidy helped some families avoid.
The help was not universal: other families who were already uninsured, or whose company went bankrupt or who otherwise didn't have COBRA available to them, were out of luck--but for those who got this financial assistance, it was a critical lifeline.
The loss of the COBRA subsidy means some families will lose coverage, and thus join the ranks of the uninsured—not just living sicker and dying younger, but being one emergency from financial ruin. The best case scenario is that families who are already struggling and between jobs will have to pay more to stay insured, leaving less money for the other necessities of life.
It’s also a shame that the COBRA subsidy couldn’t have lasted a little longer, as a true bridge to the Exchanges under health reform, where they will get coverage subsidized on a sliding scale. Now, many families will become uninsured, and we’ll have to find them again in a few short years.
The biggest finding is that a small percentage of those that will benefit from the law realize it. From KFF:
Although estimates are that 32 million uninsured Americans will gain coverage under the ACA, only about half of non-elderly Americans currently without coverage say they are familiar with the chief components in the law designed to achieve this goal. Perhaps because awareness of these coverage expansions is low, nearly half (47%) of the uninsured do not expect to be affected at all by the health reform law, either positively or negatively. But three in ten (31%) do say it will help them get health care. Fourteen percent expect to be hurt by the law, mainly because they worry they will be required to buy coverage they cannot afford.
So we have a lot of work to do to educate people about the new law. Health Access California is sponsoring two bill that would help in the future: AB714 and AB792, which provides for information and automatic applications for those Californians in need of new coverage options. AB714 assists those attached to current programs, like those in FamilyPACT program, or those parents whose kids have Healthy Families coverage. AB792 provides this information at critical life events when people are likely to lose coverage, whether a job loss or a divorce. Both bills made their way through the Assembly, but are now two-year bills, awaiting final consideration by the Senate next year.
Drew Altman of KFF says its not about marketing, but about waiting until people actually see the full implementation in 2014. But we have to make that work--and that's a much bigger job.
Overall, I'm not shocked of the findings: the debate over health reform provided more heat than light, and so it's now the harder slog of implementation when people see the benefits in action, especially in 2014. We are seeing now that *both* support and opposition numbers are lessening. My guess it that what it really means is that people didn't know what was in the Affordable Care Act to begin with--they just knew that in this polarized environment, they were supposed to be on one side or another--and with the attention on other issues, there's an opening to get those who were opposed to take another look, and to get others to actually appreciate the specific benefits, as they come online.
In 2014 under the Affordable Care Act, health plans will need to include essential health benefits (EHB), which fall under 10 general categories including emergency services, behavioral health treatment, and preventive services and chronic disease management.
The Department of Health and Human Services (HHS) requested that the Institute of Medicine (IOM) recommend the criteria and methods for determining and regularly updating the EHB package. Today, the IOM released a report summarizing the workgroups that they held around the country.
To be clear, the IOM will release a final report with recommendations on these processes in the early fall of 2011--that's what everybody is waiting for with some suspense.
Until then, it's interesting to see what came out of the public workshops held in Washington, DC (January 13-14, 2011), and here in California in Costa Mesa, CA (March 2, 2011). The workshops brought together experts from federal and state governments, employers, insurers, healthcare providers, consumers, and healthcare researchers. Speakers discussed topics such as the need to balance the generosity of EHB with affordability of insurance products, in consideration of how insurers design benefits, and incorporating evidence into benefit priority decisions, among other issues. This document summarizes the workshops.
In particular, one chapter focuses on "Lessons from California Benefit Review Processes," which features testimony from the CA Department of Managed Health Care, the California Health Benefit Review Program, and from us at Health Access California. We hope the final consensus report is informed by California's experience.
RATE REGULATION AND OTHER KEY HEALTH REFORM BILLS PASS APPROPRIATIONS COMMITTEES, HEAD TO FINAL FLOOR VOTES
* Rate Regulation Bill AB52 (Feuer) Moves Forward to Senate Floor.
* Insurance Oversight "Medical Loss Ratio" Bill, SB51(Alquist), Would Ensure Premium Dollars Go To Patient Care, Rather Than Administration and Profit
* AB1296(Bonilla) Would Improve Eligibility and Enrollment So Californians Maximize Coverage and Federal Funds
* AB922(Monning) Would Improve Consumer Assistance, to Help Address Questions and Complaints
* Assembly Appropriations Holds Benefit Mandate Bills Related to Autism & Maternity Care; Key Bills on Exchange Enrollment Also Held as 2-Year Bills.
SACRAMENTO -- Important California legislation to improve our health system for the future and implement the new federal health law are headed to final floor votes, after passing key Appropriations Committees in both the Assembly and Senate.
The California Senate passed high-profile, heavily-debated bills like AB52(Feuer), on rate regulation, so consumers are protected from unjustified rate hikes. Other bills that advanced included crucial consumer protections for Californians, from a reorganization and expansion of consumer assistance for California patients, to the streamlining of eligibility and enrollment systems so that Californians get the coverage they want and need. Another bill would limit the amount of our premium dollar that goes to administration and profit, rather than patient care.
All these bills now head to final floor votes. Legislation must pass out of the full Legislature in the next two weeks, by the final deadline of September 9th. Governor Brown would then have until October 9th to sign or veto those measures that do pass.
RATE REGULATION: Perhaps the most high-profile and lobbied bill in the legislature this year, AB52 would give state regulators, the Department of Insurance and the Department of Managed Health Care, the authority to reject unjustified rate increases. Strongly supported by consumer, labor, and community groups but oppose by insurers and other parts of the health industry, the bill now heads to the Senate floor. Assemblyman Feuer is currently negotiating amendments to attract support from enough Senators.
HELPING CONSUMERS: Also making it out of the Senate Appropriations committee was AB1296 (Bonilla) which would streamline eligibility and enrollment processes to create a seamless, "No Wrong Door" consumer experience for individuals seeking health coverage, whether from Medi-Cal or the new Exchange. AB922 (Monning) will better equip the Office of the Patient Advocate to better serve the millions of new health insurance consumers, to better answer questions and complaints, leading up to the full implementation of the federal health reform law.
CONSUMER PROTECTIONS: The Assembly Appropriations Committee moved two important bills by Senator Alquist forward to the Assembly floor. SB51 will implement the Medical Loss Ratio requirements in California and gives the state enforcement authority. The Medical Loss Ratio requires insurers to spend 85% of premium dollars on the delivery of health care in the large group market, and 80% of premium dollars in the individual and small group markets. This measure protects consumers and the value and confidence in products, ensuing that premium dollars go to patient care, not administration and profit.
SB222 would allow local health plans and initiatives to form joint ventures to create networks for local public health insurance options, a component of the Affordable Care Act that did not survive the politics of the federal debate.
TWO-YEAR BILLS: Some bills did not move forward, including SB703 (Hernandez) to set up a Basic Health Plan. Other two-year measures include AB714 (Atkins) and AB792 (Bonilla), two Health Access-sponsored bills that would notify and pre-enroll eligible individuals into new coverage available in 2014. AB727 (Mitchell) on healthy food purchasing was also stalled in committee. These are being held as two year bills that can be taken up again next year.
The Committee heard a lengthy presentation by Senate Pro Tem Steinberg on SB770, a benefit mandate bill that would require insurers to cover services related to autism, but the Committee took no action to move the bill forward this year. Assembly Appropriations also chose not to move SB155, Senator Evans' maternity care mandate bill forward even though the Senator worked to gain industry support for the bill. SB155 stalled, despite having no opposition. (The Ventura County Star had a good write-up on the need and urgency of the bill today.)
FINAL FLOOR VOTES: The bills that moved forward today represent one more step toward implementing and improving federal health reform law at home in California. Some bills, which did not have fiscal implications, were already on the floor, like AB1083(Monning), to adopt many of the federal reforms with regard to small group insurance. Though all these bills have cleared several hurdles to reach this point, they still must face floor votes in the next two weeks. They must pass both houses before they can move on to the Governor's desk for consideration.
Health Access will continue to track these bills, via these E-mail updates, as well as our blog, and Facebook and Twitter feeds.
California's new Health Benefits Exchange has named its first Executive Director, Peter Lee, as it prepares to create a purchasing pool that in 2014 and beyond will provide more affordable, federally subsidized, coverage to millions of Californians.
We've already posted the press release from the Exchange, and its got some coverage, but we also want to send our Congratulations to Peter as he assumes his new role creating a new consumer-friendly marketplace of the future, to dramatically help Californians to get affordable health coverage. Whether in his current role at the Center for Innovation at CMS/HHS in the Obama Administration, or his previous leadership role at the Pacific Business Group on Health, Peter has been a longtime champion of large purchasers using their bargaining power to get the best value in coverage and care. It's appropriate he will lead the effort to allow millions of Californians to pool together to bargain for the best price and value with the insurance industry.
Why does this pick matter? With this pick, the Exchange is being clear that not only do they have the authority to negotiate with insurers for the best value, they plan to actively use it. This Exchange will be transformative--a sea-change from the current individual market where consumers and small businesses are left all alone at the mercy of the big insurers.
Peter Lee will have the opportunity to structure a market where insurers compete based on cost and quality, customer service and wellness, rather than how effectively they avoid people who need care, and confuse the rest of us with the complexity of their benefits.
We welcome a director who has experience as a consumer advocate. Peter Lee had been director of the Center for Health Care Rights, where we worked with him on consumer protections and other issues. The point of the Exchange is to empower the consumer, by providing good information about coverage and care, by providing subsidies to make coverage affordable, and by pooling together their bargaining power to vet products and gets the best price and value. Lee's background will be helpful in fulfilling the promise that California families have an ally on their side, as they try to navigate the health insurance marketplace.
California was the first state in the nation to take this central step of implementing the new federal health reform law by passing legislation in 2010, AB 1602 (Perez) and SB 900 (Alquist/Steinberg), to establish a new health insurance Exchange. Many other states have followed suit this year.
In 2014, the new Exchange will be the new one-stop shop for getting health coverage for individuals and small businesses, both providing easy-to-compare choices, access to federally-funded subsidies to make coverage affordable, and the bulk purchasing power (similar to large employers or CALPERS) of millions of Californians to bargain for the best price and value.
The chair of the Exchange board is Governor Brown's Secretary of Health and Human Services, Diana Dooley. Governor Schwarzenegger appointed two of his top aides, his chief of staff Susan Kennedy and his secretary of health and human services secretary Kim Belshe. Assembly Speaker John Perez made his appointment of Paul Fearer, a Union Bank executive who is chair of the board of the Pacific Business Group on Health. The Senate Rules Committee, chaired by Senate President Pro Tem Darrell Steinberg, recently appointed Dr. Bob Ross, CEO of The California Endowment. The appointments are subject to important conflict-of-interest requirements that they do not represent health insurers or the industry, so the Exchange can freely negotiate on behalf of consumers and purchasers.
An estimated 3-4 million or more Californians who will be eligible to participate in the exchange starting 2014 (and more in future years as larger employers are allowed to join in).
We've been livetweeting @healthaccess on the Appropriations Committee's decisions today.
On the Senate side, the big news on the health care bills, especially those that implement/improve the Affordable Care Act, is that key pieces of legislation did advance:
* AB52(Feuer) on rate regulation;
* AB1296(Bonilla) on improving eligibility and enrollment; and
* AB922(Monning) on improving health consumer assistance.
We are still awaiting Assembly Appropriations, and will post later tonight an update.
While we wait for the Appropriations Committees in both the Senate and Assembly to decide the fate of key health care bills (like AB52 on rate regulation, but several others), let's highlight one that we have focused on for a longtime: the issue of requiring maternity coverage as a basic benefit.
Seven years ago, a woman could pretty much count on the assumption that if she had insurance, it would cover maternity care. Federal law required all employer-sponsored group health plans provide that benefit, and 82 percent of policies purchased in the individual insurance marketplace included the coverage.
Today, the federal mandate for group health plans still applies, but the ratio in the individual insurance market has been turned upside-down: Only 13 percent of policies sold in California cover prenatal care and labor and delivery costs for new mothers.
Among private insurers, say health care advocates, the trend reflects a race to provide the lowest-cost policies that provide the least amount of coverage.
"If you don't have a good floor, you allow the market to force a race to the bottom," said Anthony Wright, executive director of Health Access California. "As costs have gone up, insurers have looked at ways to provide a cheaper product."
The exclusion comes as a surprise to many expectant mothers, says Dr. Philip Diamond, a San Diego physician who chairs the legislative committee for the state chapter of the American Congress of Obstetricians and Gynecologists.
"Women often don't know," he said. "They get pregnant, then make an appointment to see me. When they learn they don't have coverage, they quickly have to find other options and it delays their early prenatal care."
Those other options typically involve enrolling in publicly funded insurance programs. To privately pay for maternity service would cost $14,000, the average cost for an uncomplicated delivery.
All that could change beginning next year, depending on the outcome of a bill that would require all individual policies to include maternity benefits. The measure, SB 155 by Sen. Noreen Evans, D-Santa Rosa, is the only one of a handful of proposed coverage mandates introduced in the Legislature this year that lawmakers have allowed to move forward.
It will face its toughest hurdle today, when the Assembly Appropriations Committee decides whether to allow it to advance to a vote of the full Assembly.
We hope SB155(Evans) advances today and passes into law.
Beyond providing a real benefit to Californians, it would also allow a smoother transition, a "glide path" to 2014, when maternity coverage will be part of an essential benefits package. Starting in 2012 with this benefit will give the market time to adjust, and prevent the gaming of the market by the insurers. We'll report what happens...
Peter V. Lee Named First Executive Director of the California Health Benefit Exchange
Pat Powers to continue as Acting Administrative Officer through the end of December
SACRAMENTO – The California Health Benefit Exchange Board unanimously approved the appointment of Peter V. Lee as its first Executive Director, Chair Diana Dooley announced today.
“Peter is a nationally respected leader in health care who has led innovative projects aimed at promoting health, improving care quality and reducing cost in the health care delivery system,” said Dooley, who is also California Health and Human Services Secretary. “His more than 25 years of health policy experience and deep understanding of California’s challenges and opportunities make him the right leader to ensure the success of our new health insurance marketplace.”
As Executive Director, Lee will oversee the planning, development and ongoing administration and evaluation of the California Health Benefit Exchange. He will join the Health Benefit Exchange on October 17, 2011.
“I am honored, humbled and excited by the opportunity to lead the California Health Benefit Exchange,” said Lee. “It is an historic time in reforming our health care system and the California Health Benefit Exchange will serve as a national trailblazer toward establishing new consumer-oriented health insurance marketplaces to help more people have access to quality affordable health care.”
Lee currently serves as the Deputy Director for the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS) in Washington DC where he has helped shape initiatives to identify, test, and support new models of care in Medicare and Medicaid that can result in higher quality care while reducing costs. Previously he served as the Director of Delivery System Reform at the federal Health and Human Services’ Office of Health Reform.
“Peter’s leadership has helped to chart a course toward a patient-centered, value-based health care system,” said Kathleen Sebelius, Secretary of Health and Human Services. “I’m encouraged that we will be able to keep working with him as he applies his talents to launching the Exchange in his home state of California.”
From 2000-2008, he served as the Executive Director and Chief Executive Officer of the Pacific Business Group on Health in San Francisco. From 1995-2000, Lee served as the Executive Director of the Center for Health Care Rights and from 1993-1995, he practiced law at Tuttle and Taylor in Los Angeles. From 1984-1993, he served in a variety of leadership positions in Washington DC, including the Director of Programs for the National AIDS Network. Lee holds a Juris Doctorate from the University of Southern California and a Bachelor of Arts from the University of California at Berkeley.
California was the first state to create a Health Benefit Exchange following the passage of federal health care reform. It is charged with creating a new insurance marketplace in which individuals and small businesses will be able to purchase competitively priced health plans using federal tax subsidies and credits beginning in 2014.
The Exchange is overseen by a five-member board appointed by the Governor and Legislature; the California Health and Human Services Secretary serves as an ex officio voting member and is its current Chair.
A report from Beth Abbott, our director of Administrative Advocacy:
The California Health Benefit Exchange conducted its seventh meeting--and some would argue, its most substantive to date, on August 23, 2011 in Sacramento. They delayed the opening of the public session until 12:30 pm in order to provide sufficient time for the board to give full consideration to personnel and contracting matters in a closed session. The meeting lasted until almost 4:00 pm. The highlights were:
Personnel
The Personnel Sub-committee, consisting of Diana Dooley and Paul Fearer, made a recommendation to the full board on the selection of an Executive Director. In closed session, the recommendation was unanimously adopted. They will now begin negotiations with the unnamed candidate whom they hope will result in that individual reporting as soon as possible to the Director position.
Diana Dooley, interim Exchange Board chair, was elected the permanent chair, now that all five board members had been appointed and were present for the vote.
The full board also announced the extension of the contract for the Interim Executive Director, Pat Powers, until December 31, 2011 for coordination and transition until the new ED reports.
They approved the extension of the recruiting contract to recruit and hire the remaining senior level exchange staff to replace (or augment) loaned staff, acting/assisting staff, and consultants.
They briefly discussed the Conflict of Interest policy. Consumer advocates asked that its adoption be postponed until they had a chance to more thoroughly review it. The board agreed but emphasized the urgency in its adoption.
Administrative & Federal Funding
The Exchange received their $39 M establishment level one grant that they requested.
Enrollment and Eligibility
Yolanda Richardson said they have begun their stakeholder process on enrollment and eligibility. They were particularly interested in the goals of providing value, efficiency, and transparency.
(Consumer advocates urged that the questions be expanded and appreciated that some meetings will be held in person in the future.)
Bill Obernesser gave an overview of their progress on IT and market research, most notably their market research questionnaire results from the industry on administrative and IT services. They received a good return (19 responses) and 7 companies were deemed to be most relevant in their answers. He stressed the staff and consultants were not making determinations, but were purely seeking information.
(Consumer advocates urged a re-examination of foundational principles underlying some of the questions and hoped that there would be an opportunity to examine those principles as this process went forward.)
Public comment, mostly from consumer advocates, but also health plans, associations, brokers/agents groups, and others urged examination of broader questions, “to get the fundamentals right” because the exchange would be enrolling millions of consumers, to be sure to integrate cultural and linguistic access to care, and not overly rely on technology when consumers need a variety of pathways to enroll.
Strategic Visioning
The board reflected their preferred language for the options for the Vision, Mission and Guiding Principles. It generated a lively discussion from several board members. This was an extension of the consideration of the models presented at the July meeting and some consensus emerged around the concepts of accessibility, innovation, transparency, efficiency, cost containment, improved health status, and world class customer service. The final language will be considered at the September meeting.
Federal Regulations
Lesley Cummings gave an overview of several of the federal regulations released by the federal government since the last Exchange meeting. She has asked other organizations for their early draft comments as she prepares the formal response from the exchange board. These regulations deal with the federal/state process for shared functions, multi-state plans, CO-OPs, reinsurance and risk adjustment, as well as the very lengthy exchange regulation itself. She welcomes comments from any interested party and urges that they be sent to her at Lesley.cummings@hbex.ca.gov.
Of particular note is that the Exchange will start at 10am in closed session, apparently to interview--and perhaps decide--on the new Executive Director of the Exchange. Pat Powers has been serving in that position in the interim, and the board has been conducting a search for the past few months for a permanent director.
The Exchange website has been recently updated to indicate that they expect that the open session will start at 12:30pm, starting with annoucements of their actions in closed session.
The rest of the agenda includes--now that all five members are present--the formal election of a chair, which has been (and is likely to continue to be) HHS Secretary Diana Dooley. Pat Powers will go over a range of items, from the conflict-of-interest policy to the status of the $39 million Level I grant the Exchange got from the federal government, to updates on eligibility and enrollment workgroups and pending legislation--a topic of some contention last time.
The board will also continue its conversation on strategic visioning, and have a conversation on the pending federal Exchange regulations. The website has a full complement of meeting materials.
As always, we'll try to tweet the proceedings at @healthaccess, using the hashtag #CAHBEx (we has been using #CaHEx, but we figured we should go with the HBEx acronym that the Exchange itself is using.) We'll also tweet if we find the schedule changes. We'll also post a quick summary on this blog later in the day.
We posted the announcement of the CHIPRA funding to better enroll children in coverage, not just because it highlights that there are real, demonstrated, proven ways to improve enrollment and get people the coverage they want and need. We wanted to highlight the policy solutions, and that there are resources going to advance those solutions... but also to highlight the specific efforts in California that are doing the good work and who are getting some funding as a result.
Here are the California grantees, as announced this week:
Focus Area 1: Using Technology to Facilitate Enrollment and Renewal (10 grants) * CA ($1,259,565) Fresno Healthy Communities Access Partners represents 41 health center sites in five Central California counties. Using a web-based application, called One-e-App, the grantee will facilitate enrollment and renewal in Medicaid and CHIP. Trained multilingual, multicultural Certified Application Assistors will conduct community outreach to promote health coverage enrollment and link children to health services through a medical home.
Focus Area 2 – Focusing on Retention (4 grants)
* CA ($850,000) Alameda Health Consortium will work with eight Federally Qualified Health Centers (FQHCs), as well as school-based clinics, to improve the retention of Medicaid and CHIP benefits for children in Berkeley, Oakland, Haywood and Freemont, California. The grantee will use a variety of methods to alert families about the need to renew their coverage and to provide renewal assistance. Materials and assistance will be available in five languages - English, Spanish, Chinese, Vietnamese and Cambodian – reflecting the diversity of the community.
Focus Area 3 – Engaging Schools in outreach, enrollment and renewal activities (7 grants)
* CA ($982,170) Los Angeles Unified School District will expand the capacity for outreach and enrollment in health coverage in 13 wellness center school complexes. School and district data will be used to identify and target services to children who are eligible for health insurance but uninsured. District application assistors and health care advocates will alert families of eligible children to health coverage opportunities and help get eligible children enrolled, using the online application. One-e-App. Application assistors also will be linked to health care providers at the district wellness centers so eligible children can be enrolled in coverage when they seek care.
* CA ($769,313) Mendocino County Office of Education heads a consortium of eight organizations that will collaborate to implement strategies to increase enrollment and retention of children in MediCal and Healthy Families (California’s Medicaid and CHIP programs). The project will focus attention on helping children stay covered when they move from primary to middle school and from middle school to high school. A toolkit of promising practices will be disseminated statewide through Teachers for Healthy Kids, California School Boards Association and the California Children’s Health Initiatives.
Focus Area 4—Reaching Out to Groups Likely to Experience Gaps in Coverage (14 grants)
* CA ($1,000,000) California Primary Care Association will strengthen outreach and enrollment in community clinics and health centers across California. The grantee will increase the number of Certified Application Assistors and will conduct training to build the capacity of outreach staff to reach uninsured Latinos. An earned media campaign will be implemented to connect families to enrollment and work will continue to ensure that individuals in the target population are connected to a health home.
HHS Awards $40 Million to Sign Children Up for Health Coverage!
Friday, August 19, 2011
A News Release from the HHS Press Office August 18, 2011:
HHS awards $40 Million in grants to sign up children for health coverage
Secretaries Sebelius and Duncan encourage governors to support back-to-school enrollment
WASHINGTON, D.C. – The U.S. Department of Health and Human Services (HHS) today announced $40 million in grants for efforts to identify and enroll children eligible for Medicaid and the Children’s Health Insurance Program (CHIP). Grants were awarded to 39 state agencies, community health centers, school-based organizations and non-profit groups in 23 states. The two-year grants are authorized under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009.
“Today’s grants will help us identify and enroll children in Medicaid and the Children’s Health Insurance Program, ensuring that more children have the health care they need,” said HHS Secretary Kathleen Sebelius. “Keeping Americans healthy from a young age is the right thing to do, and it saves money by avoiding preventable diseases and conditions as they get older. The activities we are funding will help eligible children get covered, stay healthy and prepare them to succeed in school.” The grants will build on the Secretary’s Connecting Kids to Coverage Challenge to find and enroll all eligible children and support outreach strategies that have been shown to be successful. Grants were made in five focus areas:
1. Using technology to facilitate enrollment and renewal (approximately $20 million to ten grantees)
2. Retaining eligible children in coverage (approximately $3 million to four grantees)
3. Engaging schools in outreach, enrollment and renewal activities (approximately $5 million to seven grantees)
4. Reaching children who are most likely to experience gaps in coverage (approximately $10 million to fourteen grantees)
5. Ensuring eligible teens are enrolled and stay covered (approximately $3 million to four grantees).
Grant amounts range from $200,000 to $2.5 million with the largest grants going to the technology focus area. For a list of grantees, please visit: http://www.insurekidsnow.gov/professionals/reports/chipra/CHIPRA-Cycle-II-Grant-Summaries.pdf
“We are making great progress enrolling eligible children in Medicaid and CHIP and the grants released today help keep these important efforts moving forward. They are a part of our commitment to help all eligible children get the health coverage they need,” said Cindy Mann, CMS deputy administrator and director of the Center for Medicaid, CHIP and Survey & Certification.
A new study just released by the Urban Institute and the Robert Wood Johnson Foundation found that, despite an increase in eligible children between 2008 and 2009, the total number of eligible but uninsured children declined from 4.7 million in 2008 to 4.3 million in 2009, in part due to outreach and enrollment efforts.
Today’s CHIPRA outreach grant announcement follows the August 12, 2011 release of a joint letter from HHS Secretary Kathleen Sebelius and Education Secretary Arne Duncan to the nation’s governors urging them to encourage schools to “undertake children’s health coverage outreach and enrollment activities when classes begin this fall.” The letter suggests promising strategies such as enlisting school athletic coaches to help promote enrollment. HHS is supporting such efforts by providing a strategy guide to states, schools, community groups, and other stakeholders as part of the “Get Covered, Get in the Game” initiative the agency conducted in 2010 with CHIPRA funding.
CHIPRA, together with the Affordable Care Act, allocates a total of $140 million for enrollment and renewal outreach, including $112 million in grants to states, community groups and health care providers, $14 million specifically for organizations serving American Indians and Alaska Natives (AI/AN), and $14 million reserved for national enrollment campaign activities. The first $40 million in grants, as well as $10 million in AI/AN grants, were awarded in 2009 and 2010, respectively
Back to School! Put Health Insurance on Your School Supply List!
Thursday, August 18, 2011
As millions of California children (of all ages) head back to school, there is an opportunity to inventory and purchase the supplies that kids will need to be successful in school in the next year. We'd like to join our colleagues at the100% Campaignand theYoung Invinciblesto highlight the fact that healthy kids learn better!
According to the 100% Campaign, children showed a 63% improvement in paying attention and keeping up with school activities when they went from being uninsured to being covered under Healthy Families.
The 100% Campaign has developed aBack To School Checklist with a list of important "to-do"s for parents to ensure that children are ready for school.
The Young Invincibles has created a Back to School Toolkit to assist college students in getting covered as part of their back to school shopping!
Please pass these resources along to any who may need it!
Every Californian has been affected by the cuts to balance California’s budget, none more than low-income seniors, students and people with disabilities, and all Californians who use our state's health system.
Now, online retail giant Amazon.com wants to overturn the one small victory we won this year in the broad effort to close corporate tax loopholes: the Sales Tax law that would require online vendors to collect sales tax just as California’s “bricks and mortar” vendors do. This new law will provide California with $200 million in desperately needed revenues to prevent further cuts to vital public services to health, education, and other key areas. It also helps local business by closing the loophole that lets online retailers like Amazon.com undercut them.
Fight back by telling Amazon.com to play by the same rules all other California businesses do! If Amazon.com is unwilling to contribute to the well-being of our state, then we need to tell Amazon.com that we won’t contribute to their profits!
California loses more than $1 billion each year in uncollected taxes on Internet sales because out-of-state online retailers like Amazon.com refuse to collect state and local sales taxes owed on consumers’ purchases. This has given online retailers an unfair advantage over “brick and mortar” businesses who have no choice but to charge their customers sales tax.
As important, by not charging their California customers state and local sales tax, Amazon.com has deprived our state of hundreds of millions of dollars over the years.
Over time, the lack of revenues have helped contribute to wide-scale cutbacks to essential health care and human services programs that serve the most vulnerable Californians. Amazon.com has made billions by doing business in California. Now they want to overturn legislation passed at a time of unprecedented fiscal crisis, after California cut $14.6 billion from basic public services ranging from schools and parks to health care for children, seniors and people with disabilities.
The recently passed Sales and Use Tax Law would eliminate an unfair advantage for giant online retailers like Amazon.com competing with locally owned and family operated businesses in California. The Sales and Use Tax Law would generate approximately $200 million in additional annual sales tax revenues for the State of California – helping to lessen the need to make steep cuts to critical health care and human service programs.
There’s no reason why Amazon.com or any other large corporation should have an unfair advantage over local businesses in California. All we ask is that Amazon.com and other online retailers follow the same rules as everyone else doing business in our state.
President Obama started his Midwest tour today, and had some comment about the federal health law, both its benefits, and even what to call it. While not directly commenting on the term "ObamaCare," the President says he doesn't mind "Obama Cares," because, well, as he says, "I do care."
The federal government released new regulations on the Exchange and Medicaid eligibility today, and also granted $39 million to California to fully fund the next year of operation of the state's new Health Benefits Exchange, as it prepares to create a purchasing pool that in 2014 and beyond will provide more affordable, federally subsidized, coverage to millions of Californians.
Getting these $39,421,383 in funds are the next step in creating a new consumer-friendly marketplace of the future, for Californians to get affordable health coverage. Under the new federal health law, the Exchange will allow millions of Californians to pool together to bargain for the best price and value with the insurance industry. This will be transformative from the current individual market where consumers and small businesses are left all alone at the mercy of the big insurers.
The three proposed rules also released today by HHS and Treasury focus on the following:
* Easy, Simple Access to Coverage for Consumers and Small Businesses: New rules will make it easy for consumers to enroll in high-quality health plans and get help paying for health coverage through premium tax credits and cost sharing reductions. Small employers participating in the Small Business Health Options Program will be able to offer their employees a choice of health plans and cut their costs with new tax credits.
* Health Insurance Premium Tax Credit: Individuals and families will receive premium tax credits to help defray insurance costs, increasing access to health coverage for millions of middle class American families.
* Medicaid Eligibility: Coordinating the Exchange with Medicaid and Children’s Health Insurance Program eligibility will make enrollment seamless for qualified Americans and reduce the administrative burden on states.
Comments on the rules are being sought, with a deadline in 75 days. Forums are being planned by HHS, including one in Sacramento, CA.
So what does this mean? Individuals will no longer be charged based on how sick they are, but on how much they can afford, with federal subsidies available in the Exchange based on a sliding scale. With this Exchange, we have the opportunity to structure a market where insurers compete based on cost and quality, customer service and wellness, rather than how effectively they avoid people who need care, and confuse the rest of us with the complexity of their benefits.
California was the first state in the nation to take this central step of implementing the new federal health reform law by passing legislation in 2010, AB 1602 (Perez) and SB 900 (Alquist/Steinberg), to establish a new health insurance Exchange. Many other states have followed suit this year.
In 2014, the new Exchange will be the new one-stop shop for getting health coverage for individuals and small businesses, both providing easy-to-compare choices, access to federally-funded subsidies to make coverage affordable, and the bulk purchasing power (bigger than large employers or CALPERS) of millions of Californians to bargain for the best price and value.
An estimated 3-4 million or more Californians who will be eligible to participate in the exchange starting 2014 (and more in future years as larger employers are allowed to join in).
The chair of the Exchange board is Governor Brown's Secretary of Health and Human Services, Diana Dooley. Governor Schwarzenegger appointed two of his top aides, his chief of staff Susan Kennedy and his secretary of health and human services secretary Kim Belshe. Assembly Speaker John Perez made his appointment of Paul Fearer, a Union Bank executive who is chair of the board of the Pacific Business Group on Health. The Senate Rules Committee, chaired by Senate President Pro Tem Darrell Steinberg, recently appointed Dr. Bob Ross, CEO of The California Endowment. The appointments are subject to important conflict-of-interest requirements that they do not represent health insurers or the industry, so the Exchange can freely negotiate on behalf of consumers and purchasers.
The board has a lot of work to do to get this new purchasing pool up and running by 2014--and that's why the new resources are important. The board will determine criteria by which the exchange negotiates with insurers, and will help organize the marketplace so consumers can make meaningful comparisons. This board will work to set up seamless eligibility and enrollment systems for health coverage and to the new federal subsidies that will be available for individuals, families, and small businesses. The Administration and the Exchange should move quickly--including with pending legislation--so that Californians will be positioned to be ready on day one to maximize enrollment and take advantage of billions of dollars in new tax credits and subsidies to help families and small businesses afford coverage.
Brent Barnhart, 68, of Danville, has been appointed director of the Department of Managed Health Care. Barnhart was senior counsel at Kaiser Foundation Health Plan from 1996 to 2009 and a policy committee consultant to the California State Assembly from 1993 to 1996. He was the legislative affairs director at Blue Cross of California from 1991 to 1993 and senior attorney and legislative advocate from 1983 to 1987. Barnhart served as counsel and secretary at the Association of California Life and Health Insurance Companies from 1987 to 1991 and was the California legislative director of the American Civil Liberties Union from 1975 to 1983. This position requires Senate confirmation and the compensation is $142,965. Barnhart is registered decline-to-state.
Shelley Rouillard, 55, of Sacramento has been appointed chief deputy director of the Department of Managed Health Care. Rouillard has served as deputy director of the Benefits and Quality Monitoring Division at the Managed Risk Medical Insurance Board since 2007. She was program director at the Health Rights Hotline for Legal Services of Northern California from 2006 to 2007 and from 1996 to 2004. Rouillard was chief of health policy at the Office of Health Policy and Plan Administration at the California Public Employee Retirement System in 2005. She was the principal at Rouillard Consulting from 2001 to 2004 and served as director of Network Operations at HealthCare Compare Corporation from 1991 to 1996. Rouillard was a legislative advocate at the California Rural Legal Assistance Foundation from 1987 to 1991. This position does not require Senate confirmation and the compensation is $125,000. Rouillard is a Democrat.
John Shen, 61, of Berkeley, has been appointed chief of the Long Term Care Division at the Department of Health Care Services. Shen was the executive director of the Marin Community Clinic from 1997 to 2011. He was a health care consultant from 2003 to 2007, working for Marin County Health and Human Services, Southwest Community Health Center, and Contra Costa County Health Plan. Shen held multiple positions at On Lok Senior Health Services from 1997 to 2003 and 1979 to 1995, including health plan director from 2001 to 2003. He served as the geriatric planning director at Mount Sinai Medical Center in New York from 1995 to 1997. This position does not require Senate confirmation and the compensation is $122,196. Shen is a Republican.
House Democratic Leader Nancy Pelosi has chosen her fellow California Representative Xavier Becerra, of Los Angeles, along with Reps. Chris Van Hollen and James Clyburn, as her three picks for the "SuperCommittee" designated to come up with a deficit reduction package.
Becerra will be the only Californian in the room (as well as the only Latino, and one of two people of color, with Rep. Clyburn). He's be joined by the three picks from the Senate Democrats: Senators Patty Murray (D-WA), John Kerry (D-MA), and Max Baucus (D-MT). The Republican Senators will be Jon Kyl (R-AZ), Rob Portman (R-OH), and Sen. Pat Toomey (R-PA). House Republicans include Reps. Jeb Hensarling (R-TX); Dave Camp (R-MI) and Fred Upton (R-MI).
Although its not intuitive and oftentimes confusing for California consumers, oversight of health coverage is divided between the California Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI), which have unique statutory histories, administrative structures, and legal frameworks.
The report states that there are few defenders of California’s two-regulator system. That certainly includes consumer groups like Health Access California, which has supported a unified regulator for years.
California Healthline asked us to contribute our thoughts on the subject in a recent edition of their online Think Tank, Should the State Consolidate Health Plan Regulation? How? When? An abbreviated version of our response is there, along with those of others, but here's our full response:
It's not good for consumers to be unsure who they should complain to about their health plan (even if the two regulators work to refer patients to one another). It's not good for the regulator to only have detailed information about part of the market. It's never good to have insurers be able to choose their regulator, and go "forum shopping," based on which has more leniant rules or less aggressive oversight.
That said, there’s a lot in our health system that is indefensible. While there are areas where California has exhibited leadership in consumer protection--independent medical review, timely access, language access, etc.--but there are other aspects of our insurance market which resemble the wild, wild West, from denials for pre-existing conditions to "junk" insurance that still leaves people in debt. That's why there has been a longstanding push for reform in California, and why, despite all the barriers, the Affordable Care Act passed.
And that's the historic opportunity of the moment--the implementation of the new federal law over the next few months and years. In order to both implement and improve the Affordable Care Act, the task is California needs to:
* Upgrade our existing laws, standards to meet both the letter and the spirit of the law.
* How do we prevent insurers from gaming the market between now and 2014, and
* How do we manage a smooth transition into 2014?
* Even after 2014, how do we really transition the market to one where there is robust competition on price, benefits, quality, and customer service, rather than risk selection?
There’s a fair question about whether an integration in 2012 and 2013 would assist or distract from the work to implement the ACA by 2014. There are some changes that have to happen anyway. Either way, California should have an explicit effort and policy, in all the work to get ready for 2014, to align mission, goals, standards, practices, systems, definitions, regulations, etc., of the two regulators so that a consolidation is best facilitated.
When this issue has come up, the issue that everybody immediately gravitates to is about overall authority and governance: Department of Managed Health Care, or Department of Insurance? But the politics around that question has stymied the significant work to better align the law and process and standards accordingly—which is what ultimately matters for consumers. We have that opportunity with the Affordable Care Act. We appreciate the report for spelling out the complexity and nuance of the task before us.
In implementing health reform, it’s crucial that we bring benefit standards up to federal standards, that we have a robust consumer complaint and assistance program, that we are vigilant in preventing the gaming of the market leading up to 2014 and beyond, including by ensuring consistent interpretations of federal law.
We know that departments and regulations can be remade. The Department of Managed Health Care was born as a stand-alone patient protection agency when the HMO Patients Bill of Rights was passed and health regulation was taken out of the aptly-named Department of Corporations over ten years ago, and it made a big difference, whether in improving consumer assistance or access to care. In just the past year, we see the Department of Insurance making its own changes under Commissioner Jones, creating a new deputy commissioner for health care, a recognition that health coverage is not just another insurance product, and seeing the bring their rate review expertise into the health field for the first time under new authority by the ACA.
The framework of the ACA helps work toward consolidation that brings the best of both worlds, not the worst. While there’s certainly ways a consolidation could be a problem for consumers, we think it’s worth moving toward. But consolidation isn’t a goal in its own right—it’s a means, along with other aspects of implementing health reform, to the goal of a strong insurance oversight, a vibrant, transparent, accountable and affordable marketplace, and robust consumer protections.
Late Saturday, a new demand from Republican negotiators stunned White House officials. In a conference call with senior administration aides, McConnell’s staff noted that the deal called for sharp cuts in military spending as part of the trigger. The Republican staff members said that getting votes on their side of aisle for the bill would be difficult because of that. As a sweetener, the Republicans asked, would the White House agree to add Medicaid cuts to the trigger?
Talking on a speaker phone in budget director Jacob Lew’s office, Gene Sperling, Obama’s top economic adviser, began to explain why the White House could not go along. Lew interrupted.
“No!” the typically mild-mannered Lew yelled. “The answer is simply no! No, no!”
More on Medicare and Medicaid and the debt ceiling deal...
Sunday, August 07, 2011
Yes, it was insane that the United States came as close as it did to default. Even in this weekend's debate on the appropriateness of Standard & Poor's decision to downgrade the nation's credit rating, no one disputes that. (The questions were much more whether the U.S. still is the safest investment in the world, the $2 trillion math error by the rating firm, and the standing of Standard & Poor's to make such a call.)
But our question is what the impact of the debt ceiling deal will be on health care.
The new issue of Health Wonk Review, hosted by Joe Paduda this week, highlights a post that predicts significant Medicare cuts to providers like hospitals, drug companies, and Medicare Advantage insurers. (This week's edition also spotlights our Health Access blog post on what Exchanges should be.)
Katherine Howitt at Community Catalyst gives a breakdown on the impact on Medicaid--and suggests the deal doesn't cut Medicaid or save Medicaid, but merely sets up the next fight on health care issues, including this crucial program.
Again, our advocacy may have made the difference is protecting health care from severe cuts, but we need to be vigilant and active as the process continues.
The report discusses the 3 most important gains for children in low-income families under the Affordable Care Act. The reports says children will benefit from 1. increased access for parents, which will lead to increased likelihood of children being covered; 2. more participation in existing public programs due to increased outreach and enrollment; and 3. increased eligibility through coverage subsidies.
However, the report points out that none of these gains are an inevitability. They must be implemented by local policymakers as they debate key policy proposals around children's coverage, the state budget, and (hopefully) improved eligibility and enrollment practices.
Covering more of the state's uninsured kids, along with the broader promise of health care reform can not be taken for granted, the less than sexy implementation work that is being done now must be done with advocacy and input from concerned stakeholders. Anyone who is concerned with the state of health care in the state, with the health of children and our community at large, must read this report as a call to action.
For additional perspective, Deena Lahn, Policy Director at the Children's Defense Fund blogged about the report here, and you can read the full report here.
Today, the California Managed Risk Medical Insurance Board (MRMIB) announced that it got federal approval to lower premiums for the Pre-existing Condition Insurance Program (PCIP), which provides coverage to Californians denied for private coverage.
This is great news for all Californians who have been or could be denied for pre-existing conditions. But just because these Californians are denied for coverage at any price doesn't mean affordability isn't an issue as well. It's welcome news that not only is the new Affordable Care Act providing an option for those denied from buying coverage, but that the premiums will be more affordable.
Run by the state but 100% federally funded, the PCIP "high risk pool" started in October 2010 providing a new option to those denied for pre-existing conditions. Previously, the only option for Californians denied due to the health status was a state-run program that was much more expensive and often had a waiting list. That program, the Major Risk Medical Insurance Program (MRMIP) continues to operate as well, and both are administered by the MRMIB board.
It's critical that California aggressive market this new option and these new premiums. It's great that over 3,500 Californians are getting affordable access to coverage they wouldn't have because of the new federal health law, but many more can benefit. California can draw down hundreds of millions of dollars in federal dollars, to provide greater economic security to families and to the benefit of the health system on which we all rely.
For more information on the PCIP, please visit www.pcip.ca.gov.
It was a hostage situation, where the House Republicans were clear that they would full faith and credit of the United States to make their point. It's hard to play chicken with someone willing to drive off the cliff. And over the weekend, we saw a situation where it was clear that Speaker Boehner did not have full control over his caucus--that he couldn't necessarily make a deal even if he wanted to. The House didn't approve the original Boehner package that didn't even include revenues--which suggested they were willing to shoot the metaphorical hostage of the world economy.
So while incredibly disappointing, those who were surprised by an all-cuts, no-revenues package were likely not paying attention in the last week or so, where all the likely proposals no longer included revenues. That said, those latest proposals, and this final one, also didn't include many of the awful proposals that were being discussed to be included in a "grand bargain." The price of those revenues in earlier proposals would have been worse cuts, whether they were $100 billion in cuts in an already underfunded Medicaid, or a repeal of the CLASS Act provision of the Affordable Care Act. As Ezra Klein noted, this is a lowest-common denominator deal where there wasn't compromise on the big issues.
So of course, there are cuts, and no revenues. For those of us who have experienced the debates around the California budget over the last several years, it was sadly familiar and perhaps expected. After all, Governor Jerry Brown offered a very generous package of reforms and proposals to state legislative Republicans in order to just get a few votes in each legislative house to pass a budget with revenues. Even that small number of Republicans would not budge--which was a far lower numerical bar than President Obama had to surmount. He needed seven Republican Senators to join a unified Democratic Senate caucus, as well as the support of a GOP-controlled House.
Like in California after Prop 25 allowed them to pass a budget without revenue by majority vote, the consolation prize for Democrats was not in the core issue on the size of the cuts, but in their substance and structure. The cuts are backloaded, with relatively few of them occurring in 2012, to give the economy a little more time to recover. And the domestic cuts are balanced by cuts in defense, which have been traditionally been off-limits. In a plus for health care in general (and the implementation of the Affordable Care Act in specific), Medicaid and Social Security are off-limits in both rounds of cuts, for now.
The second round of cuts would be determined by a joint deficit committee, sometimes called a "SuperCongress". If a joint deficit committee does not come up with enough deficit solutions later this year, a trigger would impose additional across-the-board cuts to domestic and defense spending starting in 2013. The trigger does not include cuts to Medicare beneficiaries (like benefit cuts, cost-sharing increases, or age eligibility changes) but would includes a 2% cut to Medicare providers, which could results in some access issues.
So in the end, this is really just the beginning. It sets up an even higher-stakes battle this fall around the budget and a deficit reduction package, and set up the next election and right afterwards as determinative. The winners of the next election will be have the tools--to make steep cuts to core services (if not to fundamentally end Medicare, Medicaid, and other programs as we know them), or to let the Bush-era tax cuts expire and use that opportunity to achieve significant budget savings. The 2012 election was already going to be decisive, but this deal upped the ante even more.
HOW DID THEY VOTE? California Republican Representatives, including those in leadership like Rep. McCarthy and Rep. Dreier, largely voted for the debt ceiling deal. The three was didn't were Reps. McClintock, Nunes, and Hunter.
The Democratic caucus was evenly split 95-95, and the same was generally true among Californians, although with more voting against the proposal. California Democratic Representations who voted for the debt ceiling include Minority Leader Pelosi, and (roughly from north to south) Reps. Thompson, Garamendi, Speier, Eshoo, Costa, Capps, Sherman, Berman, Bass, Schiff, Davis, & Loretta Sanchez.
Democrats who voted against the #debtceiling deal included (again, from north to south), Reps. Woolsey, Matsui, Stark, Miller, McNerney, Honda, Lee, Lofgren, Cardoza, Farr, Waxman, Becerra, Hahn, Roybal-Allard, Richardson, Napolitano, Chu, Linda Sanchez, and Filner. Representative Baca did not vote.
HHS Enacts Preventive Health Services Guidelines for Women
US Health and Human Services Secretary Kathleen Sebelius announced this morning that the HHS would adopt recommendations made from the Institutes of Medicine to help close the gaps in coverage for US women and move toward ending health disparities experienced by women. The IOM released a study last week outlining the services necessary to women's well-being.
Secretary Sebelius announced the adoption of these recommendations today, in what she describes as part of the effort to prioritize prevention and wellness. "The Affordable Care Act helps stop health problems before the start," she said. "These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need."
The services that insurers will have to provide with no cost share starting August 1, 2012 will include:
well-woman visits;
screening for gestational diabetes;
human papillomavirus (HPV) DNA testing for women 30 years and older;
sexually-transmitted infection counseling;
human immunodeficiency virus (HIV) screening and counseling;
FDA-approved contraception methods and contraceptive counseling;
breastfeeding support, supplies, and counseling; and
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.
