Fuzzy Math: Kids should count when determining whether family insurance is affordable
Tuesday, November 29, 2011
Since when is 14,000 no different than 5,000? When the U.S. Treasury Department estimates the affordability of a family's health insurance. If it goes uncorrected, their fuzzy math may deny affordable health coverage to 270,000 Californians--122,000 of whom are children.
While premiums continue to rise across the board, families face particularly steep increases. Since 2003, families have seen their employer-sponsored health insurance premiums increase by 50%, according to a new Commonwealth Fund report. Currently, the average cost for a family to purchase health insurance is just under $14,000. By comparison, single employee coverage costs $5,000 per year. We can all agree that $14,000 is much more than $5,000. Certainly parents feel that difference when writing a check for their family coverage. For the average family making budget decisions around their kitchen table, $5,000 versus $14,000 is the difference between affordable and not. But, according to the Treasury Department, they would make no distinction between the two. Huh?!
The Affordable Care Act (ACA) has already strengthened coverage for families, particularly for children, and more benefits are on the way. The Exchanges and federal subsidies that begin in 2014 will make insurance more affordable for families. However, a very significant proposed ACA regulation by the Treasury Department would ask families to ignore the additional premium cost of their dependents in determining whether employer-sponsored family insurance is affordable. This fuzzy math would make some employer-sponsored family insurance seem more affordable than it really is. And that, in turn, reduces the likelihood that any given family will qualify for tax subsidies designed to make private insurance more affordable.
The ACA requires that, to qualify for federal premium subsidies, families must not have access to affordable employer coverage. That makes sense. But calculating what is affordable for a family by including only the cost for one person in that family sure doesn't.
In California, as across the country, this proposed rule will have a real impact on children getting coverage. A recent California analysis shows that 270,000 Californians would be able to access federal insurance subsidies if families could count their dependents' premium costs when calculating whether their employer-sponsored coverage is affordable. Most notably, 122,000 of those Californians are children--that amounts to about 1 in every 70 children living in California. These children have family incomes too high to qualify for public insurance programs like CHIP and Medicaid but their incomes would still render $14,000 prohibitively expensive. The availability of federal subsidies will make the difference between purchasing insurance or not.
The ACA's "affordability test" was crafted so as not to spend federal subsidies when affordable employer coverage is available, which makes sense. However, proponents of the proposed rule say that calculating the whole families' premium costs in the "affordability test" would generate too large a federal price tag. However, the California analysis, estimates that the federal cost of such a change to the proposed rule is magnitudes less than previous estimates.
Making ACA work for kids and families means getting the implementation right. Let's start by changing the "affordability test" in the Treasury Department's exchange subsidies rule to include the whole family's premium costs. That common-sense change would help children get the health care they need. It also makes "kitchen table" math sense.
Let's build ACA regulations that they make sense in the real world.
This post was authored by our friends and ally, Guest Blogger Kristen Golden Testa, of the The Children's Partnership.
We at Health Access California have also been working on this issue, sometimes known as the "firewall" or "family affordability" test. We are heartened that some of our California delegation, from Leader Pelosi to Representative Stark, are leading efforts on this, but we need all our elected officials, in Congress and in the Administration, to fix this, to make health reform work best for children and families.
Still working on closing the health care loophole in San Francisco...
A week ago, on Tuesday November 15th, the San Francisco Board of Supervisors voted 6-5 on Supervisor David Chiu’s legislation related to SF's landmark Healthcare Security Ordinance (HCSO).
Supervisor David Campos and the coalition of labor groups, workers, healthcare advocates, and businesses (including Health Access) began the discussion around closing a troublesome HCSO loophole earlier this year. Yet these same groups came together to express their opposition to Supervisor Chiu’s legislation, which ultimately passed.
The coalition opposed Chiu’s legislation because it does not resolve the Healthcare Security loophole. The loophole currently allows employers to avoid providing health coverage or paying into the Healthy San Francisco program but putting money into a worker's Health Reimbursement Account, but then the employer can recapture those dollars if not used by a certain, arbitrary date. Chiu's legislation would allow this to continue, and also places the landmark Healthy San Francisco program at risk of legal action.
Earlier this month Mayor Ed Lee vetoed the original ordinance authored by Supervisor Campos that would have allowed workers' Healthcare Reimbursement Accounts to rollover from year to year, which would have successfully closed the loophole, thereby reinforcing the culture of coverage that the original authors intended to create.
Following the veto, Supervisor Cohen made amendments to a competing version of the law authored by Supervisor Chiu. The Chiu/Cohen legislation allows employers to take back unused health care funds after 2 years instead of at the completion of the calendar year as they are doing today.
The central issue with the Chiu/Cohen legislation is that it provides an incentive for employees to continue setting up Health Reimbursement Accounts as a way to meet the requirements of the law, rather than full coverage. By then setting restrictions on the use of those funds, they can basically ensure that they recover many of those dollars after two years (e.g. employers will continue to ban workers from using HRA funds for vision, dental and/or other standard healthcare benefits).
In addition, the problems with the loophole will persist despite the Chiu/Cohen legislation. This includes: · The city will continue to provide an incentive to employers to use Health Reimbursement Accounts (HRAs) over health insurance or the Healthy San Francisco program. · Responsible businesses that provide health insurance or use the Healthy San Francisco program will continue to unfairly compete with employers that exploit the loophole. · Taxpayers will continue to unfairly foot the bill for uninsured workers who have insufficient funds in their accounts to cover their care. · Consumers will continue to be tricked, being told on a restaurant bill they are paying another dollar for health care for workers, when actually employers continue to ultimately pocket these surcharge fees.
Despite the passage of the Chiu/Cohen amendments, the coalition of labor groups, workers, healthcare advocates, and businesses that began the discussion around this issue will continue to advocate for a meaningful resolution to the healthcare loophole.
This update was written up by Health Access Community Organizer Rose Auguste; for more information, contact her at rauguste@health-access.org.
* County-Based, Federally-Matched Low-Income Health Plans Enroll 200,000 * New Options for Those With Pre-existing Conditions, including 5,000 in PCIP * New Consumer Protections Adopted, from Maternity Coverage to Medical Loss Ratios * Californians Save Hundreds of Millions as Health Insurance Rates Scrutinized * New Funds for Prevention & New Exchange, CA's Health Insurance Marketplace of the Future * New Laws Reform Consumer Assistance, Eligibility and Enrollment
You are INVITED: Our Annual CPEHN/Health Access HOLIDAY PARTY This THURSDAY, December 1st, 4-8pm at Max's in Oakland. (See below for details.)
In 2011, Californians are getting new coverage and new consumer protections, as a result of the federal Patient Protection and Affordable Care Act and the state’s active efforts to take advantage of the new resources and benefits for a beleaguered health system.
After federal passage of the health reform in 2010, California started its work implementing the law with the adoption of a “bridge to reform” Medicaid waiver agreement with the federal government, and the passage of several bills that established a new Health Insurance Exchange, instituted rate review, and adopted key consumer protections in the federal law.
That progress was not guaranteed to move forward, with a new Governor focused on a major budget crisis, and significant work left to do to ensure Californians get the health reform benefits that they need and are entitled to now, and for the state to be ready for the full implementation in 2014.
Yet 2011 showed both meaningful results for California consumers and communities, and progress toward our overall goal of getting the best possible implementation of health reform for Californians.
· NEW OPTIONS FOR THOSE DENIED COVERAGE: Patients with pre-existing conditions have new access to coverage with over 5,000 Californians getting coverage in a new Pre-existing Condition Insurance Program (PCIP), and the implementation of a new state law to ensure that children have access to private coverage regardless of health status. o For children, the Affordable Care Act outlawed denials for pre-existing conditions, and a new state implementation law forced insurers to recommit to selling “child-only” health policies, and in limiting how much insurers could charge children with pre-existing conditions. State legislators, regulators, and consumer and community groups worked to publicize the open enrollment period that provides that price protection for children. o For adults, pre-existing condition denials will be no longer allowed in 2014. Until then, a new federally-funded PCIP is now available, and over 5,000 Californians are now enrolled. At the urging of consumer groups, the Managed Risk Medical Insurance Board, which runs the new program, adopted a more aggressive approach to outreach.
· FEDERAL FUNDS AND EARLY EXPANSIONS: Nearly 200,000 low-income Californians have coverage through county-based Low-Income Health Programs (LIHPs), and potentially over a half-million will get coverage in the next two years, prior to 2014. o The new program extends coverage to the uninsured, and allows counties to get a federal match for their existing funds for indigent care. This brings new funds into local health systems and the California economy, links uninsured people with a medical home based in the community safety-net, and provides a bridge to health reform as every enrolled person will be transferred onto fully federally-funded coverage in January 2014. o Ten large counties that already had pilot programs launched this expanded coverage effort on July 2011. Over 90,000 Californians are newly enrolled as of August, adding to over 100,000 rolled-over from those previous pilots. Most of the remaining counties are currently planning to start up a LIHP in early 2012.
· INSURANCE RATE HIKES REVIEWED AND ROLLED BACK: California consumers saved hundreds of millions of dollars in health coverage premiums. o Proposed rate hikes were scaled back and withdrawn altogether by health insurance companies, and one insurer even rebated money to consumers. o These savings were partially as a result of new rate review requirements in federal and state law for insurers to publicly file justifications of their rates, aggressive implementation and negotiation by California’s new Insurance Commissioner, and advocacy by consumer groups, as regulations were proposed and new filings reviewed. o Legislation to further increase insurer oversight, AB52 (Feuer) which would give regulators the explicit authority to reject unjustified rate hikes, advanced in the Legislature as well, and is pending for next year.
· NEW CONSUMER PROTECTIONS IN PLACE: California adopted additional consumer protections, in accordance with federal law. o Governor Brown signed legislation, SB51(Alquist), to authorize state regulators to enforce the new federal standards on a medical loss ratio—a minimum for how much of a premium goes to patient care rather than administration and profit. o The Governor also signed legislation—AB210(Hernandez), SB222(Evans)—to mandate maternity coverage as a basic benefit eighteen months prior to it being required by federal law, which gives California families the consumer protection earlier, and also provides our insurance market time to adjust.
· NEW FEDERAL FUNDS FOR A HEALTHIER FUTURE: Millions have been invested to start California’s new health coverage marketplace of the future, encourage prevention, and more. o California’s new Health Insurance Exchange accomplished key goals in its first year, including: hiring a new Executive Director, applying for and getting a $40 million federal grant for its 2nd year of operation, adopting a mission, vision, and values statement, and more. Consumer and constituency groups have attended and actively participated in over ten public board meetings, and new stakeholder workgroups. o Beyond the Exchange grant, California agencies also got significant federal grants for everything from rate review (to the Department of Insurance and Department of Managed Health Care) to community transformation grants to support prevention efforts (to various county health departments and the Public Health Institute).
· IMPROVING THE WAY CALIFORNIANS GET HELP WITH CARE AND COVERAGE: Other legislation signed by the Governor reformed key systems that help Californians get the care and coverage they need—and which will become even more crucial in 2014 as four million more Californians get coverage, and millions more have new rights and options. o One law, AB1296(Bonilla), set key guidelines for revamping eligibility and enrollment, toward the goal of a “no wrong door” approach. o Another, SB922(Monning), enhanced and moved the Office of Patient Advocate to be a clearinghouse for questions and complaints about coverage, so Californians get consumer assistance and/or are triaged to the right place among many agencies
This list represents significant progress, especially as the state budget crisis continues to loom large, and other challenges to the federal health law loom.
The California legislature also advanced legislation this year, toward the goal of getting millions of Californians enrolled quickly into health coverage on day one in 2014. The measures, pending for a final vote next year, would help get Californians covered as soon as possible: AB714(Atkins) would pre-enroll people who are connected to existing programs (parents of Healthy Families children, FamilyPACT enrollees, etc); AB792(Bonilla) would help people automatically apply for coverage for those who become uninsured during life transitions (job loss, divorce, etc.). Next year’s legislative agenda includes these measures, as well as other proposals to adopt the federal insurance market reforms, Medi-Cal expansions, and other key consumer protections.
HOLIDAY PARTY: We invite you to celebrate this progress with us and our allies at the California Pan-Ethnic Health Network, at the 7th Annual CPEHN/Health Access Holiday Party, this THURSDAY, December 1st, from 4-8pm, at Max's, 500 12th Street, Oakland (right near the 12th Street/Civic Center BART station). We hope to see you there!
As we head into Thanksgiving week and the holiday season in general, we want to give celebrate and give thanks for the progress we've made this year.
We want to invite our members and allies to join us for our annual CPEHN/Health Access Holiday Party, which will be held on Thursday, December 1st, from 4pm-8pm, at Max's Diner and Bar in Oakland. The address is 500 12th Street, right near the 12th Street BART station.
We look forward to seeing our friends and colleagues from the California Pan-Ethnic Health Network, but also the broader community of consumer and health advocates and activists. See you there!
Today the National Association of Insurance Commissioners had a plenary phone call to discuss and vote on a resolution that recommends that Congress exempt the fees insurance agents and brokers from "medical loss ratio" calculations. While it was a loss for consumer advocates, the final vote was very close: 26 yes votes, 20 no votes, and 5 abstentions.
Health Access California and other consumer advocates across the nation were watching closely: this resolution, if followed, would weaken a key consumer protection, one that ensures that 80-85% of our premium dollars, at a minimum, go to patient care, rather than administration and profit. This rule has already required some insurers to issue rebates to consumers. Removing broker's commissions from the calculation allows more money to be spent on these adminstrative and marketing costs, and less money for rebates or for patient care. Elizabeth Abbott, our director of administrative advocacy, and a designated consumer representative at the NAIC, has been working for months on this issue, and argued in previous meetings that the compromise struck last year was fair, and done through a exhaustive and appropriate process.
Susan Voss, President of the NAIC, opened the floor for discussion after going over minor changes, including Wisconsin removing itself as a sponsor of the resolution. There were numerous arguments for and against the resolution, including strong concerns about the process by which the resolution came to this point and the effect on consumers. Commissioners arguing for the resolution included Wayne Goodwin (NC), James Donelon (LA), Roger Sevigny (NH), and Karen Stewart (DE). Commissioners arguing against the resolution include Mike Kreidler (WA), Teresa Miller (OR), Thomas Leonardi (CT), Dave Jones (CA), Robert Easton (proxy for NY), and Mike Rothman (MN). Each of their arguments is summarized below.
Wayne Goodwin, Commissioner from North Carolina, opened the discussion with his reasons for supporting the resolution: • Mr. Goodwin wants to focus on consumer protection. He fears that the medical loss ratio as it stands will negatively impact services that agents and brokers can provide to consumers. North Carolina requested an MLR waiver for that very reason. • The NAIC has considered this several times, created a task force to study the issue, and has received plenty of data that seem to lend validity to the complaints and concerns he has heard, so it’s time to act.
Mike Kreidler, Commissioner from Washington, spoke up in opposition to the resolution: • As the longest-serving Commissioner, he has never seen the NAIC go through a process like this, where a controversial resolution comes forward based on anecdotes rather than fact, and goes to a vote without getting a proper review. • This resolution won’t help the producers in Washington. If the NAIC really wants to do something to ensure producers aren’t harmed, there should be a mandate to insurance companies that they have to pay a certain amount in commissions and rebates, but no one will propose that. This resolution only helps the insurance companies, not agents, brokers, or consumers. • Later in the discussion, Mike Kreidler put forward a motion to commit the resolution to a committee or taskforce for further study before a final vote. The motion was seconded by Tom Leonardi from Connecticut. The motion failed with 26 no votes, 24 yes votes, and 2 people abstaining or not voting.
Teresa Miller, the Insurance Administrator from Oregon, also spoke against the resolution: • The resolution jeopardizes the credibility of the NAIC, which is currently highly regarded. She feels that the NAIC loses objectivity with this resolution, which diminishes the NAIC’s voice and divides the membership. • The NAIC’s focus should be on how to implement the ACA and protect the insurance-buying public
Thomas Leonardi, Commissioner from Connecticut, added his voice to the opposition to the resolution: • Saying that this is about opposing agents or brokers misses the point. He is concerned that the resolution is being put forward without a conclusive report from a working group studying it. • The resolution is very consumer unfriendly and will cost hundreds of millions of dollars. • The resolution puts HHS on the spot and asks them to do something they’re not empowered to do. This won’t win NAIC any friends on the federal level, and it makes NAIC look very political and partisan.
Dave Jones, Commissioner from California, opposes the resolution for two reasons: • He has procedural concerns. The resolution hasn’t been heard by any committee. It was first sent to some commissioners secretly. There hasn’t been an open process around this, and there won’t be any opportunity for public comment. • As for his content concerns, the medical loss ratio is one of the most important provisions of the ACA. The B committee was given very narrow charge that did not include changing the MLR. The committee’s study found that states that had implemented a higher MLR did not see a diminishment in consumer access. Also, where agents and brokers have been taken out of the medical loss ratio, a lot of money that would have been available no longer was. • No consumer organizations are supporting this resolution, they’re all asking for opposition because of the negative impact on consumer access. Brokers have an important role in the market, but this resolution doesn’t even guarantee they’ll continue to play that role.
Robert Easton, speaking for Superintendent Ben Lawsky of New York, added his opposition to the resolution: • The resolution is a symbolic gesture that puts HHS on the spot when it’s really up to Congress to act. New York is supportive of the role agents and brokers play; they bring real value to consumers. But at bottom the MLR law benefits consumers by driving down premiums. A change resulting in higher costs for consumers is one that New York can’t support.
Mike Rothman, Commissioner from Minnesota, added his opposition to the resolution and his agreement with the other opposing comments. He added that Minnesota is a good example of how the medical loss ratio works in real time, and it works well there.
James Donelon, Commissioner from Louisiana, spoke up in support of the resolution: • The ACA specifically names the NAIC as the body to establish uniform definitions relating to the any items that go into the numerator of medical loss ratio calculation, so this resolution is well within the NAIC’s range.
Roger Sevigny, Commissioner from New Hampshire, spoke to counter the claims that the resolution wasn’t heard by a committee. He stated that the resolution was heard by the highest committee – the Executive Committee.
Karen Stewart, Commissioner from Delaware, added her support of the resolution: • Delaware has to protect their consumers. Since the majority of Delaware residents have private insurance, the medical loss ratio doesn’t really relate to most Delaware consumers. • Delaware does have a small insurance company that has been at 80 – 88% MLR for years. They are being merged with a larger company because they can’t carry that high an MLR and stay in business.
After the motion to commit the resolution for further study failed, a vote was called on the original resolution. The resolution passed with 26 yes votes, 20 no votes, and 5 abstentions.
Susan Voss, President of the NAIC, concluded with a statement that they will be reviewing the whole issue about process.
We thank our California Insurance Commissioner Dave Jones for speaking out against the resolution and voting against it. The closeness of the votes show that this isn't over--the NAIC is clearly not speaking in one voice, and so the work continues.
(Thanks to my Health Access colleague Kate Burch for writing up these notes from the NAIC meeting.)
HHS Listening Session on Minimum Essential Benefits Package
Monday, November 21, 2011
The Department of Health and Human Services held a listening session today in order to hear various stakeholders’ input on the Minimum Essential Health Benefits package, the provision of the Affordable Care Act that protect consumers from incomprehensive health insurance. The EHB package is a critical part of the Affordable Care Act, it requires that insurance plans in the small group and individual markets cover all essential health benefits so that consumers no longer pay for coverage then find that their benefits don’t cover them when they get sick, and that consumers no longer face bankruptcy or medical debt due to uncovered medical care. This was the l0th of 10 listening sessions held by HHS across the country to provide the public and opportunity to provide input as HHS formulates their regulations on EHB.
HHS Region 9 Director Herb Schultz kicked off the session by framing the discussion around 3 overarching themes that the regulations will define:
* What is the process for defining the minimum essential health benefits package?
* How to account for needs of diverse populations?
* What will the process for updating the definition be?
Nancy De Lew, a key HHS staff person who has helped to facilitate other listening sessions summarized some of the comments heard elsewhere, and asked those testifying to answer a number of questions that HHS is grappling with:
* Where should the final regulations fall on the continuum of comprehensiveness vs affordability?
* Where should we land on the continuum of specificity (as related to specific rare conditions)?
* ACA directs HHS to look at “typical employer based coverage”, should large group or small group plans be used as this reference point?
* How should HHS weigh uniformity vs state flexibility?
Over 120 people attended the listening session by conference call and over 150 individuals attended in person to testify. Various advocates from disease groups and provider groups spoke in support of services specific to their constituencies. Many individuals spoke on behalf of prevention, treatment, primary care, and disease management as a means of saving money that would otherwise be spent on later more acute care.
Some of our colleagues at NHeLP and other organizations testified that the language of the ACA specifies that the Secretary of Health and Human Services alone has the authority to determine the minimum essential health benefits package, allowing state flexibility would mean that the promise of health reform would not be realized for many individuals based only on the state they live in. Additionally, some argued that basing the package on what is currently typically covered in the small group market would be problematic because those plans generally have more limited benefits and networks, and this would set the bar too low moving forward. Others testified that even using large group plans as the model might not represent significant reform, and Medicaid and other federal programs should be used as models.
Health Access testified that HHS should consider using Knox-Keene (plus prescription drugs) as a standard for developing the EHB definitions. Knox-Keene currently protects most Californians from underinsurance, this standard has worked for 35 years, and if HHS develops standards less stringent than Knox-Keene, though not perfect, these protections that 20 million Californians currently enjoy may be compromised. One of the intentions of the EHB is to relieve consumers from fear of the fine print that often thwart health insurance consumers, to that end the EHB standard can not include caps and limits. Another concern related to the IOM recommendations is that it didn’t explore the multi-dimensional nature of affordability – in addition to premiums, out of pocket costs must be considered in order to ensure that insurers do not simply shift costs to beneficiaries through that channel. Additionally, we are concerned that cost targets on the benefit side would also result in cost shift to consumers. Finally, we suggested looking at the Independent Medical Review process currently used in California, as well as CHBRP which currently reviews mandate proposals, be considered as models in developing mechanisms for constantly evolving the definition of essential benefits.
Schultz emphasized that this is not the only opportunity to comment. Comments will be accepted in writing or through meetings with HHS Region 9 staff before regulations are released, during the regulation comment period, and afterwards. Schultz can be reached by phone at 415-265-7049 or by email at herb.schultz@hhs.gov. Comments can be emailed to Region9ORD@hhs.gov.
Rewriting the Constitution to Force Cuts to Medicare and Medicaid...
Friday, November 18, 2011
Instead of acting to create jobs, the U.S. House of Representatives voted to effectively force steep cuts in Social Security and Medicare by voting to rewrite the Constitution.
All but one of California's GOP Representatives voted for a so-called "Balanced Budget Amendment," backing an agenda that would cripple the economy, gut Social Security, Medicare and Medicaid, while protecting tax breaks for millionaires and prosperous corporations. The vote among California Representatives was party line, with virtually all GOP Representatives, including Rep. Dan Lungren of Sacramento, voting for the constitutional amendment (Rep. Dreier was the lone CA GOP to vote against). Most Democrats voted against the measure, with the exceptions of Reps. Costa and Cardoza of the Central Valley.
We are pleased that the Republican House leadership's attempt to write the destruction of Medicare and Medicaid into the Constitution failed, but sorely disappointed that so many California Representatives voted for it. At a time when we need to create jobs and improve our health care system and options, it's just troubling that the proposals in the House of Representatives would do the opposite.
BACKGROUND
House Republican leaders held a vote on Friday for a radical balanced budget amendment. However, their proposed amendment is “balanced” in name only. Their dangerous proposal would devastate the economy and slash Social Security, Medicare and Medicaid.
· According to Macroeconomic Advisors, “If a balanced budget amendment were being enforced for Fiscal Year 2012, “the effect on the economy would be catastrophic.” If the budget were balanced through spending cuts, those cuts would total about $1.5 trillion in 2012 alone, which would result in the loss of 15 million MORE job losses, double the unemployment rate from 9 percent to approximately 18 percent, and cause the economy to shrink by about 17 percent. [Center on Budget and Policy Priorities, 11/8/11]
· Chambers: Balanced Budget Amendment Would Do More Harm Than Good. John Chambers, head of Standard & Poor’s sovereign ratings division, said that passing a balanced budget amendment would do more harm than good: “In general, we think that fiscal rules like these just diminish the flexibility of the government to respond. Also, when Congress has a long track record of trying to bind itself with various rules, but the rules when it comes to - when push comes to shove, they don't bind very much. So, it would be-even if you had a balanced budget amendment you have some questions about its credibility. And it would just reduce your flexibility in a crisis.” [Washington Post, 8/9/11]
· Balanced Budget Amendment Would Force Severe Cuts to Social Security, Medicare and Medicaid. Proponents of the balanced budget measure have pointed to a budget plan prepared by the Republican Steering Committee as the blueprint for achieving a balanced budget. Using that as the basis for analysis, the Center on Budget and Policy Priorities projects that $1.2 trillion would be cut from Social Security from 2018 through 2021 and another $1.25 trillion from Medicare, Medicaid and the Children’s Health Insurance Program. [Center on Budget and Policy Priorities, 11/15/11]
· Balanced Budget Amendment: Great for the 1%; Devastating for the 99%. If Republican leaders were actually serious about balancing the budget, they wouldn’t be forcing folks on Main Street to do all the sacrificing while letting Wall Street and corporations that ship jobs overseas completely off the hook. By changing the rules to require two-thirds votes of the House and Senate to waive the balanced budget requirement or to raise the federal debt ceiling, a willful minority could continue to extract unreasonable demands and hold the entire U.S. economy hostage.
It's stirring to see all the activity around the "Occupy Wall Street" movement around the country, from the New York City epicenter to California's most high-profile site, #OccupyOakland, including yesterday's bridge occupations from the Brooklyn Bridge to Los Angeles.
While protestors keep coming back, this raises the question of what's next for the movement, and what the Occupy movement is about.
Among the many issues that Occupy addresses, health care does keep coming up.
If you browse through the "We Are the 99%" feed of people taking photos with their handwritten stories, many of them describe issues with the health care system--from the high cost of health care, to going without health care, to facing medical bills or bankruptcy. It's moving to read these stories, and to see the faces of people describing a broken health system.
But health care isn't just one many greivances of the Occupy movement, along with financial industry regulation, bank practices and tax fairness. Our broken health care system is major factor in the central issue of income inequality.
Clearly there's a correlation between income and health coverage. Those with lower income are less likely to get coverage on the job, and are more likely to find buying coverage unaffordable (or unavailable, because of pre-existing conditions). In this way, health benefits are extremely regressive, exacerbating the differences in financial security.
The the causation also works the other way. Lack of comprehensive health coverage leads not just to less care and worse health care outcomes, but also places people one emergency away from financial ruin. As people face medical bills and bankruptcy, uninsurance helps drive poverty.
To fix these issues, we passed the Affordable Care Act: securing and expanding coverage, providing financial assistance to low- and moderate-income families to be able to afford coverage, and attempting to deal with the cost of care.
But given the nature of the broken health care system, the Affordable Care Act by default ends up going to the heart of the issues of the Occupy movement--perhaps more so than the Dodd-Frank financial regulation law.
For all the political and economic uncertainties about health reform, at least one thing seems clear: The bill that President Obama signed on Tuesday is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.
It's a big statement. The whole article is worth reading, but here's just an excerpt (and to Leonardt's credit, he was reporting on this well before the Occupy movement got more of the media interested):
Over most of that period, government policy and market forces have been moving in the same direction, both increasing inequality. The pretax incomes of the wealthy have soared since the late 1970s, while their tax rates have fallen more than rates for the middle class and poor.
Nearly every major aspect of the health bill pushes in the other direction. This fact helps explain why Mr. Obama was willing to spend so much political capital on the issue, even though it did not appear to be his top priority as a presidential candidate. Beyond the health reform’s effect on the medical system, it is the centerpiece of his deliberate effort to end what historians have called the age of Reagan...
The bill is the most sweeping piece of federal legislation since Medicare was passed in 1965. It aims to smooth out one of the roughest edges in American society — the inability of many people to afford medical care after they lose a job or get sick. And it would do so in large measure by taxing the rich.
A big chunk of the money to pay for the bill comes from lifting payroll taxes on households making more than $250,000. On average, the annual tax bill for households making more than $1 million a year will rise by $46,000 in 2013, according to the Tax Policy Center, a Washington research group. Another major piece of financing would cut Medicare subsidies for private insurers, ultimately affecting their executives and shareholders.
The benefits, meanwhile, flow mostly to households making less than four times the poverty level — $88,200 for a family of four people. Those without insurance in this group will become eligible to receive subsidies or to join Medicaid. (Many of the poor are already covered by Medicaid.) Insurance costs are also likely to drop for higher-income workers at small companies.
Finally, the bill will also reduce a different kind of inequality. In the broadest sense, insurance is meant to spread the costs of an individual’s misfortune — illness, death, fire, flood — across society. Since the late 1970s, though, the share of Americans with health insurance has shrunk. As a result, the gap between the economic well-being of the sick and the healthy has been growing, at virtually every level of the income distribution.
The health reform bill will reverse that trend. By 2019, 95 percent of people are projected to be covered, up from 85 percent today (and about 90 percent in the late 1970s). Even affluent families ineligible for subsidies will benefit if they lose their insurance, by being able to buy a plan that can no longer charge more for pre-existing conditions.
The article goes on to talk about the last 30 years of rising economic inequality, abetted by the Reagan-era policies of "tax cuts, light regulation, a patchwork safety net." In Washington, this debate continues, and the efforts to change direction, however ambitiously or modestly (health reform, financial regulation), are hotly contested, with all of the President's challengers seeking to reverse them.
Among the many issues it raises, the Occupy movement should include defending recent progress, like the Affordable Care Act, in addition to the broader and necessary efforts for a fairer tax system, additional reforms in health, and more oversight in making banks, insurers, and other financial institutions accountable.
The board of the California Health Benefits Exchange met today, both fully showcasing the new executive director, Peter Lee, and his vision for operating the Exchange, and thanking Pat Powers in her final meeting officially with the Exchange, where she served as the interim director during its startup.
As chair of the board of the Exchange, HHS Secretary proposed a resolution in the middle of the meeting to thank Pat Powers for her service, and mulitple board members provided words of appreciation, crediting her with significant progress and keeping California's leadership role in implementing the new health law. The motion passed unanimously. The new Director, Peter Lee, also thanked her and the legacy she provided.
This was Peter Lee's second meeting in his new role, and he used his report to put his own strong stamp, as a full-time, ongoing director, on how the Exchange would be run.
* On public testimony, the Exchange piloted a 2-minute limit for public testimony (per item). Lee used his iPad to display a countdown clock, and he mentioned that the Board will pilot, at the next meeting, the ability to take off-site testimony.
* Lee highlighted background materials, including submitted comments by Health Access, Western Center on Law and Poverty, and a report by the Greenlining Institute on the opportunities and challenges of implementing health reform for California's diverse communities.
* Through a Powerpoint, Lee stated that the Exchange will use "evidence based policymaking," factoring in legal scope, California facts, stakeholder views, options & recommendations, budget & timeline, and other data.
* Lee outlined the multiple contracts expected to be granted in the next year. He also reported that in closed session this morning, the Exchange Board authorized six contracts: research & analysis, stakeholder engagement, health plan management, SHOP, support for board mtgs, etc. As they do this, they are developing a standard procurement process for this contracting.
* That said, there was recognition that the contract for information technology for the Exchange was much bigger, and more foundational--and so the Exchange board will take comments on the RFP. However, given the timeline, the process will be condensed. For the planning purposes for health wonks, the comment period for IT RFP will be short and over the holidays. Final adoption will be mid-January.
* On the personnel front, Lee introduced five new staff people, including Katie Marcellus who is switching over from CA HHS. Lee also presented a new proposed Exchange organizational structure, including a chief medical officer, as well as executives for legal issues, health plan contracting, actuarial work and research, etc. In closed session, the board authorized new senior executive positions (IT, operations, communications, chief actuary, etc.) Lee also said that the Exchange will soon announce three senior hires (many from civil service) in the next week.
After these multiple reports by Lee, he asked staff to provide reports on relevant signed health reform implementation bills, AB922 on consumer assistance, and AB1296 on eligibility and enrollment, as well as on the Supreme Court decision to hear the constitutional challenge to the ACA.
The rest of the meeting was a presentation by Terri Shaw on the UX2014 project, to develop a "first class user experience" in enrolling people in the Exchange. She is coordinating a project that provides the design of a framework of a user experience that should provide end-to-end eligibility, enrollment, plan comparison, premium payment, and retention services. The design should help enroll people in all coverage programs, as well as be linked to other human services, with a uniform application that is tailored for the individual (for example, asking only for needed data).
Shaw stated that the UX2014 project learning from analogues, from travel sites (which features complex choices) and online dating (which users need to trust with personal info). Responding to a Q by board member Kim Belshe, Shaw stated that an (ambitious) goal of UX2014 would be to make getting health insurance, usually a complex chore, as close to "fun" as possible. The presentation engendered much public discussion--although it was clear that the finished product was merely a design that states and Exchanges across the nation could draw from, but was not a finished product, source code, or a recommendation with the imprimatur of state or federal policymakers.
The Exchange ended their meeting, but with a fuller understanding of the tasks that lie ahead. As always, you can follow these meetings live on Twitter at www.twitter.com/healthaccess or from our friends at Consumers Union http://twitter.com/RX_4CalChange, using the hashtag #CaHBEx.
We agree with some of the GOP presidential candidates on at least one thing: it's nearly impossible to convey a coherent policy position on health reform (and what they would "replace" the Affordable Care Act with) in 30 seconds.
That said, my guess is that they are actually helped by the reduced time. I would imagine that after a few minutes, the limits of their "markets good, government bad" rhetoric would be clear. Health care in particular is full of market failures that need to be remedied by public policy.
The Department of Health and Human Services will be hosting a listening session on the topic of Minimum Essential Benefits, the baseline of benefits that all insurance plans must cover on November 21st. This is a great opportunity for consumers and advocates to share our needs.
YOU MUST RSVP IN ADVANCE by emailing your name, title, organization, and email address to region9ord@hhs.gov.
Please see details below:
Region 9 Listening Session: San Francisco
November 21, 2011 3 - 5 PM Location: 90 Seventh Street, Suite 5-100 San Francisco, CA 94103 RSVP to region9ord@hhs.gov
To register for the event, please send an email with your name, organization, title, email address and phone number to the email address above. (NOTE: In some locations, RSVPs are needed for building security and will be accepted on a first come, first serve basis)
The Affordable Care Act ensures Americans have access to quality, affordable health insurance. To achieve this goal, the law ensures plans offered in the new Affordable Insurance Exchanges offer a package of essential health benefits, which are to be defined by the Department of Health and Human Services (HHS).
The statute directs the Secretary to consider the scope of benefits provided under a typical employer plan in defining essential health benefits. To inform the Department, HHS received a survey of employer-sponsored coverage conducted by the Department of Labor as well as recommendations from the Institute of Medicine on the criteria and methods for defining and updating essential health benefits.
HHS is committed to receiving broad public input on essential health benefits from all stakeholders, including States, patients, providers,employers, legislators, insurers, and all other interested Americans.
To that end, we are pleased to invite you to comment sessions for regional, state, and local stakeholders on essential health benefits. Senior HHS officials will be in attendance to listen to stakeholder feedback.
If you plan to attend the session, we ask that you consider these questions in preparing your comments:
·In keeping with the title of the Institute of Medicine report "Essential Health Benefits-Balancing Coverage and Cost", how can the Department best meet the dual goals of balancing the comprehensiveness of coverage included in essential health benefits and affordability?
·How might the Department ensure that essential health benefits reflect an appropriate balance among the categories so that they are not unduly weighted toward any category?
·What policy principles and criteria should be taken into account to prevent discrimination against individuals because of their age, disability status, or expected length of life as the Affordable Care Act requires?
·What models should HHS consider in developing essential health benefits?
·What criteria should be used to update essential health benefits over time and what should the process be for their modification?
Two or three years ago, there was never even a question about the constitutionality of the so-called "individual mandate," the requirement that people should have health insurance. There were (and remain) political and policy questions. In the debate over Governor Schwarzenegger's proposal in 2007-8, and in the federal reform discussion, we had questions about its workability and feasibility, and importantly its affordability. But the consensus among legal scholars was that it was well within constitutional grounds.
Opponents of health reform in general highlighted a constitutional critique, and with the political debate becoming so polarized, it perhaps shouldn't have been a surprise that Republican-appointed judges started ruling against the individual mandate (and in one case, against the law as a whole). But it's still strange, given that the policy was something that the very conservative Heritage Foundation supported not too long ago.
Today's ruling is noteworthy because it's another conservative justice supporting the individual mandate's constitutionality. It's becoming more likely that the Supreme Court not only affirms the Affordable Care Act (as now many appeals and district courts have done), but that the vote won't be a 5-4 close call but a more comfortable margin.
Anything is possible, especially in a polarized political environment, but things are looking more positive on the legal front.
Herman Cain, the NRA, and Bill Clinton on health reform...
Monday, November 07, 2011
The frontrunning GOP presidential candidate Herman Cain has gotten a lot of attention today, and in the last week, for his alleged actions in the 1990s.
Perhaps this will also increase the scrutiny of Cain's *official* actions as head of the National Restaurant Association during that time. The NRA (not the gun lobby but the trade association of fast-food and chain restaurants) was a big opponents of health reform back then, and through the years.
As Wendell Potter noted in a recent article, the NRA actively lobbied against the Clinton health reform effort, in alliance with the insurance industry. Cain came to prominence during this anti-health reform effort. His campaign even highlighted a dialogue with President Clinton during a town hall meeting, even though the most striking thing about the clip is how much lower health costs were back then--suggesting that the lack of reform hasn't done any favors to restaurants or other workers.
The other notable fact is that back then, Godfather's Pizza only provided 17% of his workers health coverage. And so his business model--and that of many fast-food and chain restaurants--is to let their workers go uninsured, or to fall onto publicly-financed insurance programs. It's not surprising that any attempt to reform this system would face opposition from these businesses.
The restaurant association has also played that role here in California, as the lead opponent against SB2 in 2003 and Prop 72 in 2004, the California expansion of employer-based health coverage. Some employers were supportive, others were neutral, others (including the Chamber of Commerce) were opposed, but it was the California Restaurant Association that was the main financial backer of the referendum of that law--along with their members like McDonald's, as well as Outback Steakhouse and other fast-food and chain restaurants.
In San Francisco, the Golden Gate Restaurant Association played that role again, leading the opposition politically the Healthy San Francisco plan, even as other employers and employer organizations stayed neutral or in support. They didn't stop after the law was signed, becoming the lead plaintiff in the lawsuit to overturn the San Francisco ordinance, all the way to the Supreme Court--which they lost. They continue to
As the GOP politicians try to outdo themselves to position themselves as which one is more anti-health reform, having a presidential candidate from the NRA is a perfect distillation of that opposition. But is what is good for the Restaurant Association good for America?
The good news: Insurers will continue to have to spend over 80% of their premiums on patient care, or rebate the money to consumers, under the medical loss ratio (MLR) rules in the Affordable Care Act.
The DC-area meeting of the National Association of Insurance Commissioners came and went without a vote on a controversial proposal to weaken those consumer protections.
The bad news: Those who proposed to weaken the MLR rules, by exempting broker and agent commissions from the calculations, will come back again. Soon. So consumer advocates need to continue to be vigilant.
But until then, let's continue to spotlight the benefit of this policy, and why it shouldn't be undone.
Our colleague Beth Abbott is currently in Washington, DC, as a designated consumer representative at the National Association of Insurance Commissioners meeting, where she is fighting a surprise proposal to undermine a key consumer protection. While California Insurance Commissioner Dave Jones has spoken against the change, it is unclear how the body will act as a whole.
The proposal would weaken the medical loss ratio rule-which requires that at least 80% of a health insurance premium goes to patient care rather than administration and profit--by removing broker commissions from the calculation. The last-minute announced resolution urging Congress and HHS to take agents and brokers out of the medical loss ratio (MLR) equation is being circulated at the NAIC meeting in Washington and could come to a vote this weekend.
The NAIC's own figures estimate health insurance customers would miss out on over $1 billion in rebates. Last June, when the NAIC took up a similar recommendation, more than 10,000 consumers wrote to their insurance commissioner expressing disappointment and opposing the effort.
The MLR rule, designed to rein in health insurance premiums, is already working. Earlier this year, Aetna announced that it would reduce premiums for Connecticut policy holders by 10% on average, citing the MLR rule.
Complaints that the rule is forcing brokers and agents out of business are simply not substantiated by the facts. According to the NAIC's own study, states that already have high MLR requirements have reported no impact on the availability of agents or brokers.
California was allocated $761 million in federal funding to run the program through 2013--until the new federal law requires insurers to take all comers, regardless of health status. The Managed Risk Medical Insurance Board (MRMIB) runs the program in California, along with a longtime state "high-risk" pool, the Major Risk Medical Insurance Program (MRMIP), which is capped at 7,000 enrollees.
It's good news that PCIP is picking up steam, and Calfornians are starting to get the benefits.
"I think we are largely in desperate need of revolutionary change in the way our mindset is. Our priority is fame, and people's wellness is way low. I saw this knowing full well that I'm a part of the problem. I'm playing the game, though I am trying to reroute. Anyway, not to get all politically divulging and introspective, but the fact that America doesn't have free health care drives me fucking absolutely crazy, and is so wrong."
After volunteering at the huge CareNow "free clinic" held at the Los Angeles Coliseum a few weeks ago, TV's Dr. Oz has a powerful new editorial out in Time Magazine. He recounts the stories of some of the patients he saw, and the problems they dealt with becasue they lacked coverage and care.
At what point, I wondered that day and still wonder now, will we finally say enough? The medically underserved are, most commonly, the medically uninsured, and they number in the tens of millions. Many don’t have jobs, but just as many do. Their companies may not offer health insurance, or they simply may not be able to afford the monthly payroll deductions that would be required to enroll. Since we held our first clinic in October 2009, federal health care reform was enacted to address this. The law is challenged in many states and ultimately will be decided by the Supreme Court within the next year. I don’t underestimate the complexities of implementing a health care reform law that we can all live with. As with most entitlement programs since the Great Depression, we will have to perfect health care reform over time, just as Social Security, Medicare, veterans’ benefits and others were.
But we’re not perfecting the law; we’re fighting over it. Politicians dither and people die. Lawyers argue the merits of this or that technical point, and more blameless Americans grow sick and slip away. This isn’t just a failure of politics and policy; it’s a failure of basic morality...
This is a powerful statement, and noteworthy because it is not without risk for Dr. Oz, who hosts a syndicated television show. The safe thing would be not to touch a politically sensitive subject, or to stay "above the fray." He did that when Governor Schwarzenegger invited him to host a health reform summit in 2006, and then again another forum in Los Angeles in 2009. After reform passed, the California Endowment had him do a television ad after the election to help people enroll in some of the new law's benefits.
But for perhaps the nation's most trusted doctor, this is the most forceful statement yet, that we need have to get back to the work of improving our health system, rather than just fighting about it.
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.
