The federal government today granted California permission to make significant cuts to Medi-Cal provider rates, raising new concerns about access to care for California patients. Other proposed Medicaid rate cuts were rejected, however, and a new, public monitoring system was required to continually assess whether Medi-Cal patients have adequate access to the care they need.
IMPACT ON ACCESS: Even before these cuts, California has one of the worst Medicaid provider reimbursement rates in the nation. These additional cuts will clearly impact access to care for millions of Californians. While we are concerned about the impacts of the cuts that were allowed to go forward, it's important that other provider cuts were rejected as going too far in restricting access. The new monitoring system now required by the federal government is essential in publicly documenting the real access to care that Medi-Cal patients have.
MANY CUTS ALLOWED: The cuts approved, proposed under both the Schwarzenegger and Brown Administrations, include a 10% provider cut on many outpatient services, including physicians, clinics, optometrists, therapists, laboratories, dental, durable medical equipment, and pharmacy, and a 10% provider cut on freestanding nursing and subacute facilities, and distinct part/nursing facility-B services.
SOME CUTS REJECTED: The cuts rejected include a 10% cut to physician and clinic services for children, home health services or distinct part subacute facilities. Other cuts to other long-term care facilities are still under review.
NEW MONITORING IS CRUCIAL: Moving forward, the state now has a monitoring system required in its state plan, based on 23 metrics, to measure access to care by Medi-Cal patients. They include: How many Medicaid recipients have a usual source or care? How many providers are participating in Medicaid? How many Medicaid patients have seen a doctor at least once? Is there an increase in ER visits by Medicaid patients?
It will be crucial for both California and the federal government to closely monitor if Medicaid patients truly have access to care. A Medicaid card can't be simply a license to hunt for a provider when there's no one to take them.
REVENUES NEEDED TO RESTORE CUTS: Ultimately, California needs revenues to restore and prevent these cuts, and shore up the health care system on which we all rely. We are all impacted if our doctors, hospitals, and health providers are cut to the bone.
DOCTOR VISIT LIMITS & CO-PAYS PENDING: We continue to await the federal government's decision on two additional cuts proposed by California to impose a limit of doctor visits and onerous cost-sharing on low-income families, violating the minimum standards of Medicaid law. For both the sake of our families and our health system, the federal government needs to prevent California or other states from undermining the minimum standards for providing coverage.
The federal government has approved a range of Medicaid provider rates requested by California under both Governor Schwarzenegger and Governor Brown, rejected others, and instituted new monitoring with regard to patient's ability to access care. We'll post more information shortly.
Department of Health Care Services Director, Toby Douglas, will host a 4:30 p.m. conference call on this decision. We invite you to join the call by dialing toll-free 1-888-566-5917 passcode 6418059.
Live from DC! Keeping Coverage Through Life Transitions
Today, UC-Berkeley and Health Access are releasing a paper entitled, "Maintaining Health Coverage During Life Transitions," providing policy recommendations that use the new framework of the Affordable Care Act to help people stay insured even durin job loss, divorce, and other changes in life circumstances.
There's a panel today hosted by the Center for American Progress in Washington, DC, on this very topic, including our own Beth Capell, who is a co-author on the paper.
Our friends in Minnesota have a Halloween-themed video encouraging people to pay attention to the Supercommittee, which will be making decisions on Medicaid, Medicare, and Social Security:
Exchange Approves Vision, Mission, and Values... and more...
Friday, October 21, 2011
The Board of the California Health Benefits Exchange met for the ninth time today. New to the dais today was the newly hired Executive Director, Peter Lee.
The first substantive discussion held in open session was the adoption of the Vision, Mission, and Values of the Exchange. Lee prefaced the review of the proposed language by saying that words are important, process were important--and that the results that the Exchange eventually achieves are the true measure by which their success would be evaluated.
Peter Lee suggested several changes up front, and then suggested others after the Board heard and discussed comments made by stakeholders.(Health Access was pleased that many of the suggested changes were taken.) The language modified and adopted (to my best ability to follow) is:
Vision Improve the health and health care and its affordability for all Californians
Mission The California Health Benefit Exchange will increase the number of insured Californians, improve quality, and lower health care costs by facilitating and innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.
Values Consumer Focused: The exchange puts the people it serves – including patients and their families, small business and their workers – at the center of its efforts, recognizing the diverse cultural, language, economic, educational and health status needs of Californians, and provides an easily accessible, consumer friendly experience for all.
Affordability: The Exchange will promote affordability while assuring the accessibility and quality in providing health insurance across the entire state.
Catalyst: The Exchange will foster innovation in the provision of high-value health care, the promotion of prevention and wellness, and the reduction of health disparities, through insurance coverage and stimulating change in the health care system.
Integrity: The Exchange will earn a reputation for trust, speed, agility, responsiveness, reliability, cooperation, accountability and transparency.
Partnership: The Exchange welcomes and will actively work with consumers, providers, health plans, employers and other purchasers, government partners, and others to help shape and guide its efforts.
Results: The exchange will measure its results based on how it contributes to expanding coverage and access, promoting better health, wellness and health equity, and reducing costs for all Californians.
(Please check the Exchange website for the official version once it is posted)
The Board also discussed a number of the proposed federal regulations related to health reform, and in particular the comments that the Board of the Exchange has or will be submitting in conjunction with the DHCS and MRMIB. The various entities felt it appropriate to coordinate their response as they will be taking some of these actions together.
The Board’s consultants flagged a number of issues for the Board that the state should weigh in on. Among those were the process by which individuals will be screened for eligibility for new coverage programs. Additionally, the Board looked at rules that govern how the affordability subsidies will be calculated, handled, disbursed, and reconciled. Key issues include the calculation of affordability, particularly in cases where dependent coverage is unaffordable but not taken into account, as well as COBRA. Other issues raised by stakeholders included the role of brokers and the importance of measures to mitigate adverse selection. The Board delegated authority to the Executive Director to finalize and submit comments at the end of the month.
The last item that the Board discussed today was the design of the IT systems to partner the Exchange, DHCS, and MRMIB, which is temporarily being called the California Affordable Coverage Enrollment System. Staff emphasized that this discussion, meant to frame the solicitation of IT vendors, is simply a discussion of systems, business processes and functionality. Mr. Lee also shared the staff’s timeline – he expects that in the next month or 6 weeks, staff will have draft specifications out for public comment in hopes of having an RFP out by the end of the year. The confusing discussion served to underscore the complexity of implementing the back end of a “no wrong door” eligibility and enrollment system. Perplexity revolved around whether a single application would be used for enrollment statewide, or whether different applications would feed into a single portal, and whether this decision needs to be made prior to IT systems being built. Consumer advocates contend that the IT systems can not be thought of without the context of the consumer experience, no matter what their diverse needs and with an eye on the needs of the system in the future, not just the immediate implementation deadlines.
In partnership with leading academics at UC-Berkeley, Health Access California is very pleased to unveil a new paper next week. We will talk about it at a special Washington, DC, panel next Thursday:
Opening Remarks: Topher Spiro, Managing Director for Health Policy, Center for American Progress
Panelists: Ken Jacobs, UC Berkeley Labor Center Beth Capell, Health Access California Mark Iwry, Senior Advisor to the Secretary and Deputy Assistant Secretary for Retirement and Health Policy, U.S. Department of the Treasury Helen Morrison, Deputy Benefits Tax Counsel, U.S. Department of the Treasury
Nearly half of all Americans can be expected to go without coverage at least once over a ten year period. Even small bouts of un-insurance can have negative outcomes on individuals’ health and financial stability. Key triggers of loss of coverage include: unemployment, reduction in work hours, changing jobs, moving and divorce. COBRA benefits are currently the main option for people who lose job-based coverage, but take-up rates are low due to high costs at a time of reduced income. The new health insurance exchanges have the potential to provide seamless coverage for those who lose employer-sponsored insurance due to life transitions. Achieving this full potential will require action by the federal and state entities charged with implementing the Affordable Care Act (ACA).
At this event, a panel of experts will present data from a new policy brief to be released at the event and provide recommendations for the federal government and the states on ACA implementation to maximize coverage after life transitions.
Earlier this week, the San Francisco Board of Supervisors voted in favor of closing a healthcare loophole in the groundbreaking Healthy San Francisco program.
Overview: The 2006 Healthcare Security Ordinance required that San Francisco employers must provide healthcare to their employees. Employers can do this in one of three ways: pay for private insurance, enroll their workers into Healthy San Francisco, or enroll their workers into a Health Reimbursement Account (HRA).
The loophole lies within the Health Reimbursement Account. If an employer chooses to provide healthcare through an HRA, workers must submit a medical receipt to their employer for reimbursement. But there are issues: · Some businesses are pocketing unclaimed HRA funds at the end of the year--a sum total of over $50 million as profit--even as they misleadingly charging customers for their worker health care expenses. · Some businesses are overly restricting how they define a qualified reimbursement (e.g. no vision reimbursements, no dental reimbursements, etc), in this way getting more money back at year’s end. · Some businesses are not notifying workers that they have available health funds through an HRA.
Supervisor David Campos’s amendment closes this loophole by stating that HRAs must roll-over from year to year and thereby ensuring that workers will have continuous access to health funds and preventing overly restrictive HRAs. Moreover, Supervisor Campos legislation requires employers to notify their works of their HRAs.
Thanks to Supervisors Campos, Cohen, Mar, Avalos, Kim and Mirkarimi, who all voted yesterday in favor of closing this loophole, the amendment passed to guarantee that workers have continuous health care, which was the original intent of the law.
But it’s not over! Interim Mayor Ed Lee’s has indicated that he will veto this legislation when it reaches his desk. Moreover, the Chamber of Commerce and the Golden Gate Restaurant Association (GGRA) have been using every tactic to eliminate Healthy San Francisco, first through failed lawsuit and now by getting two mayoral candidates to move their legislation undermining Healthy SF. This is despite of compromise and amendments from six Supervisors and the Close the Loophole Coalition comprised of heath, labor, faith-based and community advocates.
PLEASE JOIN US in urging Mayor Ed Lee to protect workers healthcare by signing David Campos’ amendment!
Mayor Lee has until October 28th to Approve, Ignore or Veto the Campos Amendment, which would close the Healthy SF loophole. Say please take action TODAY!
Peter Lee just started his new job as the executive director of the California Health Benefit Exchange this week. And on Friday, he'll have his first board meeting in that role. (He attended last meeting, but that was prior to his start date and a short vacation.)
The Low Income Health Program (LIHP) is the expansion of Medi-Cal to childless adults that is made possible by the Affordable Care Act and the state's 1115 Medicaid Waiver. Counties have joined the federal-state partnership to expand Medi-Cal prior to the 2014 implementation date designated by the ACA.
Today the Department of Health Care Services held a day long conference, hosted by the Blue Shield Foundation, to discuss the progress, challenges, and opportunities faced by counties in implementing the program. 10 Counties: Alameda, Contra Costa, Kern, Los Angeles, Orange, San Diego, San Francisco, San Mateo, Santa Clara, and Ventura began enrollment in July of this year and according to the enrollment numbers from August, 196,471 Californians are now covered!
The Institute of Medicine announced the names of 65 new members today in conjunction with its annual meeting today--and the very distinguished list includes 20 Californians. Election to the IOM is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service.
In addition to the list of Californians, we also note and congratulate Tim Jost, a highly-respected professor of law in Virginia who serves with us as a designated consumer representative at the National Association of Insurance Commissioners; and Atul Gawande, the Massachussetts surgeon who writes for the New Yorker.
California should be proud of our UC system, with multiple inductees coming from multiple campuses, including Berkeley, Davis, UCLA, San Diego, and San Francisco, as well as other California institutions like Stanford, CalTech, and RAND. Again, congratulations to the new Californians, which include:
* Barbara Abrams, Dr.P.H., R.D., professor of epidemiology, maternal and child health, and public health nutrition, School of Public Health, University of California, Berkeley * Carolyn R. Bertozzi, Ph.D., investigator, Howard Hughes Medical Institute; and T.Z. and Irmgard Chu Distinguished Professor of Chemistry and professor of molecular and cellular biology, University of California, Berkeley * Claire D. Brindis, Dr.P.H., M.P.H., professor, departments of pediatrics and obstetrics, gynecology, and reproductive health sciences, and director, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco * Patricia A. Conrad, Ph.D., D.V.M., professor, department of pathology, microbiology, and immunology, School of Veterinary Medicine, University of California, Davis * Mark E. Davis, Ph.D., Warren and Katharine Schlinger Professor of Chemical Engineering, California Institute of Technology, Pasadena * Diana L. Farmer, M.D., professor of surgery, pediatrics, and obstetrics, gynecology, and reproductive sciences; vice chair of surgery, School of Medicine; and chief of pediatric surgery, Benioff Children's Hospital, University of California, San Francisco * Margaret T. Fuller, Ph.D., professor, departments of developmental biology and genetics, Stanford University School of Medicine, Stanford, Calif. * Daniel H. Geschwind, M.D., Ph.D., Gordon and Virginia MacDonald Distinguished Professor, departments of neurology, psychiatry, and human genetics, and director, program in neurogenetics and Center for Autism Research and Treatment, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles * Richard J. Jackson, M.D., M.P.H., professor and chair, department of environmental health sciences, School of Public Health, University of California, Los Angeles * Yuet Wai Kan, M.B., D.Sc., Louis K. Diamond Professor of Hematology, departments of medicine and laboratory medicine, University of California San Francisco Medical Center, San Francisco * Michael Karin, Ph.D., Distinguished Professor of Pharmacology and Pathology, School of Medicine, University of California, San Diego * Claire Pomeroy, M.D., M.B.A., CEO, University of California Davis Health System, and vice chancellor for human health sciences and dean, School of Medicine, University of California, Davis * David A. Relman, M.D., Thomas M. and Joan C. Merigan Professor, departments of medicine and microbiology and immunology, Stanford University School of Medicine, Stanford, Calif. * James P. Smith, Ph.D., Distinguished Chair in Labor Markets and Demographic Studies, RAND Corp., Santa Monica, Calif. * David A. Tirrell, Ph.D., Ross McCollum-William H. Corcoran Professor and professor of chemistry and chemical engineering, California Institute of Technology, Pasadena * Abraham C. Verghese, M.D., professor of medicine and senior associate chair for the theory and practice of medicine, Stanford University, Stanford, Calif. * Barbara Vickrey, M.D., M.P.H., professor and vice chair, department of neurology, David Geffen School of Medicine, University of California, Los Angeles * David Vlahov, R.N., Ph.D., dean and Endowed Professor in Nursing Education, School of Nursing, University of California, San Francisco * Mark E. von Zastrow, M.D., Ph.D., professor and Friends of LPPI Endowed Chair for Research in Schizophrenia and Depression, department of psychiatry, University of California, San Francisco * Cun-Yu Wang, D.D.S., Ph.D., No-Hee Park Endowed Professor and Chair, division of oral biology and medicine, School of Dentistry, University of California, Los Angeles
Friday brought "sad but not surprising" news that the Administration was halting work on the CLASS Act, a voluntary long-term care insurance plan that was included in the Affordable Care Act. Secretary Sebelius said that the actuaries has done the review, and that they couldn't make it pencil out, given the constraints of the law.
Two quick points: One is that the CLASS Act was a self-contained section of the federal health law, and is not really part of the architechture of the rest of the Act. Even former Republican Senator Judd Gregg, the author of the amendment that forced the actuarial review that led to the CLASS Act's demise, called it a "sidecar" that wouldn't impact the overall bill (even though he opposes that, too, as he was interviewed by the Washington Post's Sarah Kliff).
As Jonathan Cohn notes in his write-up, having the CLASS Act dismissed really doesn't have any impact on the other provisions of the Affordable Care Act. Those who oppose the CLASS Act are generally those who oppose the solutions that would fix the CLASS Act--or any other solution to the long-term care needs of Americans.
As both Secretary Sebelius and the Center for Budget and Policy Priorities note, long-term care is still a big issue our country needs to tackle. Unfortunately, we are still having the debate about even whether to ensure that people can get basic care.
Earlier this year, the Orange County Board of Supervisors voted to restrict its county-based health plan, CalOptima, from participating in the Exchange, the health insurance marketplace of the future.
A new HealthyCal article further delves into that decision, which seems foolhardy on several fronts--handcuffing CalOptima from a potential business strategy, and denying Orange County residents an option--even one that can be called, in some ways, a "public option." Thankfully, it seems that the deal
Legislative Wrap Up: CA Continues To Lead In Implementing Health Reform
Monday, October 10, 2011
HEALTH ACCESS ALERT Monday, October 10, 2011
GOVERNOR BROWN SIGNS KEY HEALTH BILLS INTO LAW; CALIFORNIA CONTINUES TO LEAD IN IMPLEMENTING HEALTH REFORM
In the last week before the Governor's deadline to sign or veto bills, Governor Brown signs key bills into law that help to implement health reform and other health bills. * AB1296 (Bonilla) on Streamlining Eligibility and Enrollment * AB922 (Monning), to Improve Consumer Assistance * SB222 (Evans/Alquist) & AB210 (Hernandez) to Require Maternity Coverage * SB51 (Alquist) to Implement the Medical Loss Ratio, Requiring Insurers to Devote 80-85% of Premium Dollars on Patient Care, Not Administration or Profit * SB202 (Hancock) on Ballot Measure Timing
Earlier in the session, Governor Brown also signed important health legislation including: * AB151(Monning), Guaranteed Issue for MediGap Plans * ABx1 21 & ABx1 30 (Blumenfield), to Extend "MCO Tax" to Fund Healthy Families
Not all bills will become law this year, the Governor vetoed: * SB408(Hernandez), Hospital Change of Ownership Oversight
And other bills, like rate regulation (AB52), were held for further consideration next year.
Read Our Health Access Blog for More Updates; Also Follow Us on Facebook! Read Real-Time Updates on Legislation on Twitter @HealthAccess! We Live-Tweeted Yesterday's Bill Signings, and Blogged It Too! If You Appreciate These Updates, Join/Renew Your Health Access Membership!
Yesterday, Governor Brown signed legislation to improve California's health system and institute key consumer protections.
One measure, SB51 (Alquist), would allow state regulators to enforce new federal standards that ensure that at least 80%-85% of health insurance premiums go to medical care. Another bill, AB1296 (Bonilla), revamps eligibility and enrollment systems in public health programs, to better allow millions of Californians to get the coverage they need in 2014 and beyond.
Bills signed earlier in the week included key consumer protections for Californians, from requirement that maternity services are covered in all health plans, in AB210(R. Hernandez)/SB222(Evans/Alquist), to SB922(Monning), a reorganization and expansion of consumer assistance for California patients.
All these health bills get California ready for reform in different ways, implementing federal health care law and making improvements to prepare California for a health system of the future. Some measures, like the medical loss ratio, are just adopting the new federal standard at the state level. The maternity bills take an additional step in implementing the standard early, so Californians get the benefit sooner and the market has time to adjust. Others, like the revamp of eligibility and enrollment and of consumer assistance, are improvements that become urgent given the expansions of coverage in 2014.
These bills also build upon legislation implementing and improving the Affordable Care Act that was enacted last year, that set up the first-in-the-nation-after-health-reform Exchange, that instituted rate review of insurance rate hikes, that allowed children with pre-existing conditions to get affordable coverage, that allowed young adults to stay on their parents coverage, and that eliminated cost-sharing for preventative care.
With Governor Brown signing all the ACA-related bills this year, California continues to lead the nation in implementing health reform, but health advocates indicate there is much more to do to fulfill its promise by 2014.
SELECTED HEALTH REFORM BILLS SIGNED BY GOVERNOR BROWN
* STREAMLINING ELIGIBILITY AND ENROLLMENT: AB1296 (Bonilla) requires the California Health and Human Services Agency establish a standardized single application form and related renewal procedures for Medi-Cal, the Healthy Families Program, the Exchange, and county programs. This sets a framework so that millions of Californians gain meaningful and easy access to coverage is expanded under the Affordable Care Act.
* IMPROVING CONSUMER ASSISTANCE: AB922 (Monning) improves the Office of Patient Advocate to provide better assistance to California health care consumers by providing a central, enhanced center to handle consumer questions and complaints, and for them to be triaged to the appropriate agencies, whether regulatory or administrative, state or federal, etc. The bill also transfers the Office of Patient Advocate, and the Department of Managed Health Care, to the Health and Human Services Agency.
* GUARANTEEING MATERNITY COVERAGE: SB222 (Evans/Alquist) & AB210 (Hernandez) requires that health plans sold in the individual and small group markets, respectively, stop discriminating against women and provide as a basic benefit, maternity care and maternity-related care, starting in July 2012. This will ensure Californians get needed care, and prevent them from falling onto taxpayer-funded programs, but also would allow for a smoother phase-in to the federal requirement that maternity be included in an essential benefits package in 2014.
* REQUIRING PREMIUM DOLLARS TO BE SPENT ON HEALTH CARE: SB51 (Alquist) allows state regulators to enforce the Medical Loss Ratio provision of the Affordable Care Act that requires insurers in the large group market to spend 85% of premium dollars on health care and insurers in the small group and individual markets to spend 80% of health care dollars on actually providing health care rather than for administration or profit.
* GUARANTEED ISSUE FOR SENIORS: AB151 (Monning) assures that those who previously covered by Medicare Advantage plans have guaranteed issue for Medi-Gap coverage.
Also Of Interest: Some bills of interest to health advocates included:
* ELECTIONS: SB202 (Hancock) will, as a policy going forward for ballot measures not yet scheduled, place initiatives on general election ballots in November, rather than primary elections where far fewer Californians vote. The measure also delays a vote on a “spending cap/rainy day fund” previously placed on the June 2012 ballot by the Legislature. Under the bill, the vote on “spending cap” constitutional amendment, opposed by Health Access California and other health advocates since it would force cuts in key programs, would be pushed back for two years to 2014, given the ongoing budget issues including the need to pay down debt rather than divert dollars to a "rainy day fund."
* COVERAGE FOR KIDS: ABx1 21 and ABx1 30 (Blumenfield) are budget trailer bills that would maintain funding for children's coverage by extending a Managed Care Organization (MCO) tax, which in turn will help bring down federal dollars to fund Healthy Families. These bills also prohibit, for one year, the immediate shift of the Healthy Families population into Medi-Cal.
Governor Brown did veto some health bills, including SB408(Hernandez), a bill supported by consumer and labor organizations to close a loophole in the oversight of hospital ownership transfers. Other health bills of note signed by Governor Brown this year included SB946(Steinberg), a requirement (until 2014) for insurers to cover certain types of autism treatment.
Next Year: Not all health reform-related measures this year advanced to the Governor's Desk. Notably, high-profile rate regulation legislation, AB52 (Feuer), was held by the author because there was not enough support in the Senate at this time.
Other health reform implementation measures, sponsored by Health Access California--AB714 (Atkins) and AB792 (Bonilla) to easily enroll people into coverage starting in 2014, and AB1083 (Monning) to reform the small group market aligned with federal rules--were held as “two-year” bills will be considered next year, along with several other measures that will need to be passed next year, to be ready for 2014 implementation of the federal Affordable Care Act. On a parallel track and timeline, SB810(Leno), to create a single-payer universal health system, will also be considered next year as well. These bills will be part of a full agenda of health legislation next year.
For any questions or comments, contact the author of this report, Linda Leu, at lleu@health-access.org.
Here's a new political attack ad on health care, by the campaign of Rick Perry--Governor of a state with a shocking 25% uninsured rate, the worst in the nation--going after Mitt Romney, former Governor of a state with a 2% uninsured rate, the best in the nation.
There was a time where Governor Romney understood his health reform law was the crowning achievement of his career. So much so that he included the Massachusetts law in his official state portrait. We at Health Access California never claimed it was a perfect law, and we had our critique, but it has been successful at getting people covered and did have many good elements--many of which were included in the federal health reform.
So when Governor Romney distances himself from the law, or tries to claim a false distinction between the Massachusetts law and the federal law, it's fair for his opponents to call him on that--even if it unfairly disparaged the federal health law in the procress, and is done in such an over-the-top way that it evokes a summer action movie trailer.
It has long been the ground zero of the uninsured crisis in America. As a result, Los Angeles can't afford not to take advantage of every opportunity under the new Affordable Care Act to improve its health care system.
Through Low-Income Health Programs (LIHPs) like Healthy Way LA and other efforts in other counties, California is one of the few places nationally where there is an expansion of public coverage prior to 2014. As correctly described in the article, it's a huge benefit to the county--and crucial as a way for the county to be ready for reform.
The article is worth reading in full, but's here a few excerpts:
In one of the largest expansions of health coverage to the uninsured, Los Angeles County is enrolling hundreds of thousands of residents in a publicly funded treatment program and setting the stage for the national healthcare overhaul.
The county hopes to register as many as 550,000 patients and is assigning them to medical clinics for services at no cost to them. At the same time, the county is transforming its healthcare system to be less focused on acute care and more on primary care. The changes are expected to reduce costs, streamline care and attract patients.
Under President Obama's controversial healthcare overhaul, millions more uninsured Californians will be eligible for Medicaid — the healthcare program for the poor — beginning in 2014. Even as the debate over the law continues in Washington, California is starting that expansion now and using federal dollars to do so. Altogether, the state expects to receive $2.3 billion to expand and modernize its Medicaid program, known as Medi-Cal, now available only to certain low-income residents.
In L.A. County, the stakes are high. In 2014, the newly insured county residents will be able to seek treatment wherever they want. To keep them with the county, health leaders recognize that they must make the system one of choice rather than of last resort. Otherwise, the only patients left will be illegal immigrants and others still ineligible for public coverage.
"Our survival depends on it," said Mitchell Katz, director of the county Department of Health Services. Unless the healthcare system improves, he said, "if people have choice, they won't choose us and the system will implode."...
Health workers began signing patients up for a program called Healthy Way L.A. in July and so far have enrolled 24,000, many of whom are receiving services. County residents are eligible if they are between the ages of 19 and 64, citizens or permanent residents of five years and earn less than 133% of the federal poverty level (about $14,500 for an individual and $29,700 for a family of four).
Over the next two years, the county will pay half the cost for Healthy Way L.A. — or about $300 million — and the federal government will pay the other half. By 2014, when the patients become eligible for Medi-Cal, the federal government will pick up the entire tab, which will help bolster the financially strapped county's health system. The county also expects to receive about $300 million more for other changes.
"It's the county's job to provide care for the uninsured," Katz said. "If I have an opportunity to get half of that paid for by the federal government, I'd be a fool not to take it."
Healthy Way L.A. and other programs throughout the state will ensure that there isn't a flood of new patients or any delay in receiving federal dollars for their care in 2014, said Anthony Wright, executive director of the California advocacy group Health Access.
"We are taking this two years to get fully ramped up so we are ready on Day One," Wright said. "The more Los Angeles [County] enrolls people in the next two years, the more folks will be on the federal rather than the county dime."
In other words, the federal government is now providing matching dollars to the existing funds counties use to provide indigent care. And the more people get enrolled in these matched Low Income Health Programs, the more folks will be enrolled on Day One, January 1, 2014, into Medi-Cal coverage. So this isn't a long-term financial cost to the county--those enrolled will be 100% federally funded in 2014 and beyond.
All California counties have applied for these Low-Income Health Plan dollars, with the recent exception of Fresno. Los Angeles is one of ten counties which previously had pilot coverage initiatives have already started enrolling; the other counties are expected to go forward early in 2012. Health and community organization will be watching and working with counties to make sure we fully take advantage of these opportunities.
California Continues Its Leadership in Implementing Health Reform...
Sunday, October 09, 2011
Earlier today, Governor Brown signed legislation to improve California's health system and provide key consumer protections. One measure, SB51(Alquist), would allow state regulators to enforce new federal standards that ensure that at least 80%-85% of health insurance premiums go to medical care. Another bill, AB1296(Bonilla), revamps eligibility and enrollment systems in public health programs, to better allow millions of Californians to get the coverage they need in 2014 and beyond.
These bills are aligned with other measures signed this week by Governor Brown that would get California ready for reform in 2014, including key consumer protections for Californians, from a requirement that maternity services are covered in all health plans, to a reorganization and expansion of consumer assistance for California patients.
Governor Brown has rightly seized the opportunity to both improve our health system for California consumers. California's health system needs all the help it can get, and we should take advantage of the opportunities under the Affordable Care Act to adopt new consumer protections and revamp the structures that assist California families get care.
Under these new laws, Californians can now be assured that at least 80% of our health coverage premium dollars are going to patient care, rather than insurance company administration and profit. Governor Brown's signature on SB51 give state regulators the ability to enforce the federal standard, improving the previous California law. From ensuring maternity coverage to other consumer protections, it's crucial that consumers get the benefit of the Affordable Care Act and that the states provides for a smooth transition to a better health marketplace.
To get ready for the reforms scheduled for 2014, and to improve the experience for families in our health system today, we are pleased Governor Brown signed legislation to revamp the process of signing up for coverage, and in getting consumer assistance. With these signed bills, California continues to lead the nation in implementing health reform, but has much more to do to fulfill its promise by 2014. If he chooses, with these bills as a foundation, Governor Brown can lead in building a health system for California's future.
These bills also build upon legislation implementing and improving the Affordable Care Act that was enacted last year, that set up the first-in-the-nation-after-health-reform Exchange, that instituted rate review of insurance rate hikes, that allowed children with pre-existing conditions to get affordable coverage, that allowed young adults to stay on their parents coverage, and that eliminated cost-sharing for preventative care.
** SELECTED HEALTH REFORM BILLS SIGNED BY GOVERNOR BROWN
* 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 222 (Evans/Alquist)/ AB 210 (R. Hernandez) MATERNITY COVERAGE: Requires that maternity services be covered in individual and small group health coverage products, respectively.
* AB 922 (Monning) CONSUMER ASSISTANCE: Improves consumer assistance, which will be needed with the implementation of federal health reform, by augmenting the Office of Patient Advocate as a central place for Californians to call with questions or complaints about health care and coverage.
* AB 1296 (Bonilla) ELIGIBILITY AND ENROLLMENT: Outlines a "no wrong door" policy as part of revamping of eligibility and enrollment processes into Medi-Cal, Healthy Families, and the Exchange, to be ready for federal health reform in 2014
* AB 151 (Monning) GUARANTEED ISSUE FOR MEDI-GAP: Allows seniors to switch from Medicare Advantage plans back to traditional Medicare by providing "guaranteed issue" access to Medi-Gap plans without regard to pre-existing conditions.
This included two bills that would implement health reform in California--AB51(Alquist), to enforce the federal "medical loss ratio" standards for insurers, and AB1296(Bonilla), to improve eligibility and enrollment.
Disappointingly, he also vetoed SB408(Hernandez) on better oversight on hospital ownership transfers.
He signed AB922, by Assembly Health Committee Chair Bill Monning, sponsored by Health Access California and Western Center on Law and Poverty, to improve the state's ability to assist consumers. Right now, a regular consumer doesn't know where to call for a question or complaint about their health plan. This would augment and reposition the Office of Patient Advocate (OPA) as central place for consumers to call, which could them triage them to the right place. This is important as we head to 2014, under federal health reform, when four million more Californians will be getting coverage, and millions more will have new rights and options.
The Governor also signed SB202, to ensure that initiatives are decided by the most number of voters by scheduling them for November general elections, rather than in primaries with smaller turnout. Here's his signing message.
Today, health, consumer, women's and medical groups cheered the signing of SB222 (Evans/Alquist) and AB210 (Hernandez) to require maternity care as a basic benefit in health plans.
In signing these bills, Governor Brown is helping new mothers get the maternity coverage they need, which will provide a healthier start to their children, financial security for their families, savings for taxpayers, equity for women, and benefits for society into the future.
These health bills also continue California's efforts to get ready for reform, not just implementing but improving upon the federal health law. While maternity will be a basic benefit in 2014 under the federal Affordable Care Act, these bills allow Californians to get the benefit earlier, and give our insurance market time to make the transition smoothly.
Today, as part of the implementation of the federal law, the Institute of Medicine is issuing recommendations on essential benefits, but the signing of these bills shows that the federal law is already having a positive impact on what insurance covers.
In signing AB210 and SB222, Governor Brown can ensure Californians get the maternity coverage they need from their insurer, and not have to fall onto taxpayer-funded programs. The bills are stopping a sickening spiral downward that happens when there are not clear rules and oversight on insurers. While this has already been required in group and HMO plans, these bills will stop a dangerous drop in the number of health plans covering maternity in the individual market--from over 80% seven years ago to less than 15% today, with only one or two high-deductible plans even offering the coverage with maternity in some California counties. Now women and families will have the security that if that get pregnant, they will get the care they and their baby will need.
In 2012, health care will be front and center--although I suspect the question will be broadened to whether the candidates want to repeal Medicare, Medicaid, or the Affordable Care Act. We'll see how the issue fares.
Governor Brown, sign AB210 and SB222 to make maternity coverage a basic benefit in health insurance. That's the message from the Los Angeles Times and the Sacramento Bee editorial boards today, joining consumer and health groups, doctors and even some insurers. They are worth a read, if only to see two different yet equally compelling arguments.
Why is this important? Here's our colleague Beth McGovern, from the California Commission on the Status of Women, giving one perspective as she answers a press question:
But there's many other arguments as well.
While it seems difficult to argue that maternity care is vital to life, in the past few years, insurers in the individual market have relegated maternity coverage to a rarely-offered “optional” benefit. Six years ago, over 80% of plans included maternity, while now only 12% do. (This is one of the startling findings in the analysis on maternity benefits done by the California Health Benefits Review Program.) In some parts of the state, it is less than 1%.
Health Access staff checked the availability of health insurance that provides coverage for maternity in four markets in California: Redding, Bakersfield, Monterey, and Sacramento. · In Monterey and Redding, literally 78 out of 79 products did not cover maternity. · In Bakersfield and Sacramento, literally 80 out of 94 products did not cover maternity. · In Monterey and Redding, only one product offered by one plan out of 79 products offered in the individual market for a woman age 32 covers maternity, a Blue Shield PPO with a $5,000 (five thousand dollar) deductible. · In Bakersfield and Sacramento, out of 94 products offered in the individual market, the same Blue Shield PPO, one Healthnet PPO with $1,500 deductible and 11 Kaiser products covered maternity.
A family would have to look long and hard to find the one or two products that cover maternity. Those who purchase individual coverage with maternity face higher premiums because the costs of prenatal care are not spread across all purchasers of individual coverage.
Lack of access to pregnancy related services can have extremely detrimental effects on the health of mothers and children. As a result, the state of California allows pregnant women to be covered under Medi-Cal, and programs like Access for Infants and Mothers (AIM). When insurers fail to recognize maternity care as an essential health benefit, California taxpayers are then left picking up the tab. In 2006, 41.3%, or 232,241 births to resident Californians were paid by the Medi-Cal program. This number has inevitably grown as fewer and fewer insurers offer this benefit.
The Affordable Care Act signed into law by President Obama in March 2010 will define a set of minimum essential benefits that must be covered by all insurance plans by 2014, and maternity care will be included. But it is crucial for California to adopt this standard for maternity coverage in 2012 rather than waiting until 2014—not just to provide the benefit to California women, to our health providers, and to taxpayers as early as possible, but also to provide for an appropriate and smooth transition in 2014.
We need to give the health insurance market time to adjust to including this as a standard benefit for the entire market. In 2014, other changes in the insurance market rules will affect pricing of premiums, particularly in the individual and small employer markets. Finally, California has seen a startling decline in plans with maternity coverage over the past five years, and it is crucial that we halt that decline now, so the shock to the market is less severe than it would otherwise be, and less disruptive to consumers. We join with some insurers and health plans in supporting this measure as an appropriate “glide path” to full implementation of the federal law.
The two bills passed by the California Legislature, AB210 (Hernandez) and SB222 (Evans/Alquist) would implement a maternity care mandate in advance of 2014. Every child born in California deserves a safe and healthy start to life and it is important that Governor Brown sign these two important bills.
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.
