We in California are blessed to have a lot of leadership in the House of Representatives, starting with Speaker Nancy Pelosi, and including other caucus leaders like Rep. Xavier Becerra.
It was noteworthy that of the three key committees responsible for health care reform, two are headed by Californians: Chairman George Miller of the House Education and Labor Committee, and Chairman Henry Waxman of the House Energy and Commerce Commitee. But as important has been Rep. Pete Stark, Chair of the Health Subcommittee of the House Ways and Means Committee.
Stark was the next senior person in line after Rep. Charlie Rangel stepped aside due to an ethics investigation yesterday, but Stark decided to step aside and allow Rep. Sander Levin to rise to the post today. Stark says he didn't want the job, and wants to continue focusing on health care.
The Fremont Democrat told Bay Area News Group that he prefers to remain chairman of the Ways and Means Health Subcommittee so he can shepherd and implement health-care reform.
"It seems to me we've got a chance in this Congress — maybe, unfortunately, into the next Congress, but over the next three years — the best chance we've ever had to get decent health care reform, and I've been working on that a long time," said Stark, who has served in the House since 1973.
"Quite honestly, the idea of being chair of Ways and Means and running around the country trying to raise money is the last thing I want to do," he added, calling fundraising on behalf of fellow Democrats for the midterm elections "not exactly my long suit."
Stark, 78, was the next-most-senior Democrat on the tax-writing committee after former Chairman Charlie Rangel, D-N.Y., 79, who temporarily stepped aside Wednesday pending the conclusion of an Ethics Committee probe into his corporate-paid travel. House rules said Stark would automatically take the chair unless he declined, or unless House Democrats voted to pass him over.
For health advocates, it is good that he is staying focused on health care. Rep. Stark and his staff have been absolute champions for health care reform, and for making the reform as good as it can be.
He has been innovative in advancing grand reform ideas, and small changes that make a big difference in people's lives. For example, earlier this year, Rep. Stark was heavily involved in making sure people losing their jobs kept their coverage with the help of a COBRA subsidy.
We are proud to continue to work with him as a pivotal leader on health reform, and much more.
As we and others continue to push for health reform at the federal level, Dan Weintraub, now of the New York Times, asks why some California legislators are continuing to also advance a single-payer proposal. But why wouldn't health reform advocates continue to educate people about this reform?
When President Obama signs a health reform package, while it will be a major advancement, it won't end the conversation on health reform, at either the state or federal level.
California OneCare is releasing an ad-a-day for 365 days in support of single-payer and SB810. The first ad features is Senator Mark Leno, continuing this year as the author of SB810, having taken the torch from Senate Sheila Kuehl last year. On the night that Jay Leno returns to the venerable talk show, we're happy to spotlight Senator Mark Leno reiterating his support of the venerable health reform:
We look forward to continuing our efforts, on parallel tracks and multiple ways, to improving the health care system for all Californians.
I just arrived back from Washington, DC, and I have a sober, realistic, and detailed sense that comprehensive health reform can pass in the next several weeks. It's not a forgone conclusion, but it's helpful. Now it's about vote-counting.
Representative Dennis Cardoza, Democrat of California, typifies the speaker’s challenge. The husband of a family practice doctor, he is intimately familiar with the failings of the American health care system. His wife “comes home every night,” he said, “angry and frustrated at insurance companies denying people coverage they have paid for.”
But as a member of the centrist Blue Dog Coalition, Mr. Cardoza is not convinced that Mr. Obama’s bill offers the right prescription. It lacks anti-abortion language he favors, and he does not think it goes far enough in cutting costs. So while he voted for the House version — “with serious reservations,” he said — he is now on the fence.
“I think we can do better,” Mr. Cardoza said of the president’s proposal.
We were proud that all of the California members of the House Democratic caucus supported the House health reform late last year. But there's a reason, given the particularly acute problems in California's health care system: Fewer employers offering coverage to their workers. Public programs facing budget cuts. And a broken individual market that has been spotlighted in the past few weeks for double digits rate increases and much more.
Nowhere is the health care crisis more severe in California than in the Central Valley, which would benefit most from the proposed reforms, such as the subsidies for low- and moderate-income families to afford health care.
Californians should be clear with our entire Congressional delegation about the desperate need for reform, and work to get every member to vote for the final health reform package.
Back the California Legislature, a collective sigh of relief wafted from around the Capitol this week as the Assembly and Senate wrapped up their work on mid-year budget cuts.
Meeting the deadline for the eighth special session set by Gov. Schwarzenegger -- yes, that was eight in one year -- Assembly members and state senators advanced a range of "budget solutions."
For now, they avoided the uproar that followed the Legislature's acquiescence to Schwarzenegger's harsh budget cuts last year on health and human services programs. Many advocates, commentators and members of the public pointed out that those were exactly the kinds of programs California families need to survive this punishing recession. The Senate and Assembly appropriately delayed discussion of the proposed health and human services cuts and eliminations until June, after the governor's May revision of his proposed budget is released.
Let's hope that come June, their wisdom holds.
For a brief but detailed overview of the mid-year budget cuts that did pass, see the California Budget Project's analysis at http://www.cbp.org/
Assembly Budget Committee Chair Noreen Evans (D) and others assailed the administration Monday for making cuts to a breast cancer screening program for low-income women against the Legislature’s wishes.
The Department of Public Health in December decided to reduce access to the “Every Woman Counts” early detection program by freezing enrollment until June 2010, and limiting enrollment to only women 50 and older.
For the past decade, the program had offered annual breast cancer screening to low-income women who lacked health insurance and were at least 40 years old. Statewide, 1.2 million are eligible for the program through about 1,000 locations, including community health clinics. The program served 249,000 in fiscal year 2006-2007; 270,000 in fiscal year 2007-2008 and then 310,000 in 2008-2009.
With the demand increasing, however, the Schwarzenegger Administration decided to shift some EWC funding to other programs, thus freeing up some money to help plug the growing budget deficit. This was done even though the Legislature had rejected the cutbacks outlined by the administration during budget negotiations after the governor submitted his May spending-plan revision.
At a hearing well-attended by breast cancer survivors and supporters, an irked Evans told bureaucrats that “It’s unacceptable to me that these screenings won’t take place…In my opinion, we’ve had way too much testosterone in the budget talks….and enough of the macho knife-waving, alpha-male politicians in the process. How many Californians will have to die for budget negotiators to see it’s time for us to grow up?”
Despite having been told by Evans that the planned program cutbacks would not be approved by the Legislature, the Department of Public Health “suddenly and surprisingly changed” the program, Evans said.
Assemblyman Hector de la Torre (D) added, “The administration is not allowed to run around making unilateral decisions. There is a checks-and-balances thing going on here.”
A round of applause broke out in the hearing room after Assemblyman Sandre Swanson (D) said the cutbacks in services would cause greater expenditures in the final analysis, as women get sicker and require extensive treatment. “You’re just shoving these costs off onto other programs – and you are costing lives, too.”
Several medical experts and community providers testified that women who are diagnosed with breast cancer in their 40s are more likely to have aggressive forms of the disease and therefore need early detection to survive. Many also testified that the age-group accessing services through Every Woman Counts are more likely to be women of color with few economic resources.
The hearing came after a bake sale held by Evans, other legislators and breast cancer awareness representatives to raise money and awareness about the program cutbacks. Following the hearing, a large rally was held outside, where several other legislators, including Senate President Pro Tem Darrell Steinberg, declared their opposition to the cuts and support for restoring the program. The rally ended with the Capitol being bathed in pink light, a color of significance for breast cancer survivors. Meanwhile, two bills -- with a third likely to come -- have been proposed to reinstate the program, Evans said.
“Health Care for America Now is committed to winning a guarantee of good, affordable health care we all can count on, and we will continue to push aggressively to get the best health care reform bill possible to the President’s desk for his signature as quickly as possible.
Tuesday’s vote was not a referendum on health care reform. It was a referendum on a particular candidate in a climate in which people, hard pressed by the economy, are impatient for change. When it comes to the need to make good health care affordable, nothing is different today than it was yesterday. Congress must keep going and finish reform right.
Fixing health care now is vital to fixing our economy. In survey after survey, voters continue to voice strong support for forcing health insurers to stop excluding people with pre-existing conditions, guaranteeing everyone has access to good, affordable coverage, and requiring health plans to spend premiums on medical care, not profits.
The people of Massachusetts already have benefit from health care reform. It’s time the rest of the country had the same access to good, affordable care.
We are on track to pass a strong bill, and we will stay focused on that until the President signs the bill into law.”
I would add that we at Health Access are pleased by Speaker Pelosi's continued leadership on this issue. And maybe that comes from the fundamentals: After all, the need and urgency for health reform from last year and last week didn't change this week and this year, because of a single result of a special election in a specific state. The election in question was in the state where health reform least mattered--as opposed to California, where it matters possibly most of all, given our large percentages of uninsured, lower-wage workers, people at risk of being denied for pre-existing conditions, etc. Even in Massachusetts, the candidate in opposition to national health reform did not dare oppose the identical state reforms already in place.
And that's the lesson. Pass a bill--a good bill--and health reform won't be the political issue it is now.
In order to secure stimulus funds from Washington, D.C., the Senate Health Commitee, chaired by Sen. Elaine Alquist (D), voted on Wednesday to advance a bill to officially undo the state's requirement for semi-annual reporting for Medi-Cal.
As a condition of receiving enhanced federal funds, states must refrain from efforts at reducing Medicaid enrollment, such as using semi-annual reporting, which has been shown to create a barrier for people trying to access the state-and-federally funded program.
"It makes sense to support this common-sense measure to keep 174,000 kids covered with health insurance, " Elizabeth Landsberg of the Western Center on Law & Poverty told committee members.
Also speaking in favor of the bill was Beth Capell for Health Access California, the California Medical Association, Molina Health Care of California, and advocates for the disabled and children's access to health care.
The bill must pass the full Senate by the end of the month to advance to the Assembly. Committee member Sen. Dave Cox (R ), was the only one to vote against it, while Vice Chair Tony Strickland (R ) joined Democrats in voting to pass the bill.
In other action, the Senate Health Committee also voted to send SB270 (Alquist) along to the Appropriations Committee. The measure would create a health information technology advisory panel to advise the Governor and the Legislature on health information technology in California.
Back in DC, legislative leaders from both the House and Senate have been in long negotiations at the White House for over five hours. There's a rumor that President Obama has urged them to stay in until the framework of a bicameral health reform deal is agreed to.
If we had our druthers, the House would prevail in most of the differences. I participated with a panel of experts, convened by Jonathan Cohn of The New Republic, that came up with the same result. Cohn has also been busy explaining the negotiation to "Fresh Air" public radio listeners.
Fingers crossed on our Congressional leaders coming to a good and equitable resolution. Many of my thoughts on federal health reform have found a forum on Cohn's blog at The New Republic, called The Treatment. I have appreciated having the platform on national health policy issues (and the editing), and have now posted there 20 times in the past year. Here are the posts, many of which are still very relevant to the current debate:
Senator Mark Leno, the current author of the bill, was joined at the rally by its previous author, Senator Sheila Kuehl. Other speakers included Jim Kahn, President of the California Physicians Alliance, labor leaders, and others.
The bill, SB810 (Leno) is expected to come up for a full Senate vote this month.
On the Health Committee, there are 9 members, 6 Democrats. This means that if a bill is to pass Health Committee, and all Republicans oppose it, it can't lose more than one of the Democratic votes.
There's lots of charts on the web comparing the House and Senate bills. But not only is this one (posted by Politico) really good and detailed (11 pages!), it is written by the House staffers of the three committees of jurisdiction. That means these are the folks who worked to write the House version, and know why they made the choices they did when crafting it. It gives some hints about what the negotiators are thinking about what they are looking to improve the Senate version.
Since the Senate is seen as a more delicate compromise, some people think the final product would look much closer to the Senate version. While it is important to be realistic, I think there will be some significant improvements from the Senate. There are some compromises that have been made which were very contentious, and probably won't get reopened. But as the opponents tell us, it is a 2,000+ page bill, so there lots of opportunity for improvements in other areas. The House, which by passing their version earlier already exerted some influence on the Senate bill, has a political imperative to put its stamp on the final bill. Also, the House version didn't pass with lots of extra votes, and their members are all up for re-election next year, so they have as much reason to ask for adjustments.
* Affordability, Affordability, Affordability: Required insurance could still be too expensive for many. Both bills require many Americans to have insurance. In the Senate bill, the caps on how much we're expected to pay are too high, and the subsidies for working families are too low. Many are working to fix this, but it's going to be a significant fight.
* Employer responsibility: The Senate bill’s requirement on employers has major loopholes for large employers who don’t provide coverage to their workers. Also, this complex and confusing “free rider” provision has potentially negative workforce impacts, encouraging part-time rather than full-time work. The Senate also needs to apply basic benefit standards to all employers, including large ones. The House bill has simple standard for large employers, who would either provide coverage to their workers, or pay a flat percentage (sliding scale up to 8%).
* Progressive Financing: Though the House bill is financed through progressive options like a surcharge on wealth individuals and families, the Senate bill includes an excise tax on high-cost health plans. We advocate a variety of progressive revenue options to offset a repeal or narrowing of the excise tax.
* Immigrant inclusivity: While both bills prohibit the use of federal funds to fund coverage of undocumented workers, the Senate bill excludes undocumented workers from using their own wages and money from being able to buy coverage in the national insurance exchange. Another issue is that the bills continue a 5 year waiting period for recent legal residents who would otherwise be eligible for Medicaid. We are urging Senators to support an amendment being offered by NJ’s Senator Menendez to lift this restriction.
* Abortion: While both bills adopt the current law that federal funds not be used for abortion coverage, the House bill goes beyond that in restricting reproductive rights. The Stupak provision House bill virtually prohibits anyone purchasing insurance in the Exchange from buying a plan that covers abortion—even if paid for with their own money. The Senate leaves the issues to the states. We need to work against a rollback of reproductive rights.
* State consumer protections: The new Senate bill did remove the permission of "nationwide plans" that seriously threatened state-based consumer protections. However, both bills do allow "interstate compacts," where states can allow insurance plans from another state without having to abide by their consumer protection laws. We are advocating for this provision to be removed.
* Public health insurance option: While the House passed health care with a public option, the Senate does not include one. We need to continue to advocate for a public health insurance option. The public option would provide competition for private insurance—and we need to continue to support its inclusion, even after a bill is signed into law.
We have watched much but not all of the Senate floor debate on health reform. We enjoyed Roland Burris' version of the Night Before Christmas, which closed with "health care for all, even our friends on the right".
But I was most taken aback to hear Sen. John Ensign (R-Nevada) cite favorably a US Supreme Court case that overturned child labor laws as the constitutional basis for opposing health reform. This is like citing Plessy v. Ferguson, the case in which the Supreme Court upheld state laws on segregation, as a justification for opposing Medicaid and Medicare, saying that the states should be responsible for health care for the poor and seniors just as the Supreme Court allowed states to set their own standards for segregation.
Overturn child labor laws? Eliminate the minimum wage? Why? Because the federal government should not interfere in the rights of the states to regulate the right of children to work or minimum wage. This parallels one of the fundamental arguments that is made by the opposition to health reform: the federal government should stay out of health care--except of course for Medicare (which Chuck Grassley and John Ensign now claim to support).
Just as it seems presposterous to think that the federal government cannot prohibit child labor or set a minimum wage, it should be preposterous to think that the federal government cannot reform health insurance. After all, regulation of insurance is a right reserved to the states under federal law, now long uncontested, the McCarran Ferguson Act. And if the federal government gave states the right to regulate insurance, then Congress and the President can act to change that.
But it gives us a glimpse into the world that the opponents of health reform seek--a world where there are no child labor laws to kill jobs for children, where there is no minimum wage to deny low-wage workers the chance to compete for the lowest wage, where there is no guaranteed Social Security benefit so seniors and the disabled live on whatever their family can help with. Today this is the world of the uninsured who are entitled to just as much health care as they can afford out of their own pocket.
We have written lots (and will write more) about how the health reform proposals now pending in Congress can be improved but here's what we know: if we do health reform right, it is the equivalent of creating Social Security for retirement, the minimum wage for wages and yes, child labor laws to protect the most vulnerable among us.
And what we also know is that the fight still goes on to protect Social Security, to increase the minimum wage and yes, even more sadly but thank goodness more rarely, to protect children from being forced to work. Americans have a right to Social Security, they have a right to a minimum wage, and children have a right to go to school, not to work--and we should have a right to health care. So we agree with Senator Ensign that the fight for health reform is like the fight to outlaw child labor---but we think the federal government should outlaw child labor and he apparently does not.
As we have written previously, the manager's amendment to the Senate bill that was adopted earlier today makes a number of changes to the Senate bill.
Our California Senator Barbara Boxer, as well as Senator Dianne Feinstein, won a significant improvement for California as well as six or seven other states, including Idaho, North Carolina and Michigan.
It is easy to figure out that Nebraska (and Hawaii) got something in the Medicaid provisions because those two states are mentioned by name.
We guessed that California met the following: "If the State is not a low DSH State described in (5) (B) and has spent more than 99.90 percent of the DSH allotments for the State on average for the period of fiscal years 2004 through 2008, as of September 30, 2009, the applicable percentage is 35 percent."
What is that and why do we care? DSH or Disproportionate Share Hospital funding is a key part of Medicaid funding for hospitals. In some states, DSH helps to make up for low Medicaid reimbursement rates. In other states, including California, DSH helps to cover the cost of care by hospitals for the uninsured as well as improving low Medicaid rates.
DSH is a big deal in California both because we are 51st in Medicaid reimbursement and because we have such a high proportion of uninsured.
So what did our Senators win for us? The earlier version of the Senate bill cut DSH funding in half once the rate of uninsurance drops. The new version would cut DSH funding by only 35%.
This moves the Senate bill much closer to the House version in terms of the DSH cut, at least for California, Idaho, North Carolina, Michigan and several other states.
With those changes, Senator Ben Nelson of Nebraska announced his support for the health reform proposal. This means that barring a surprise, the Senate Democrats have the 60 votes necessary to pass the bill off the floor and into conference committee. Given the wide ideological spectrum in the Democratic Party, this is a significant feat--and a bill that is necessarily a compromise.
Here's a list from Senator Reid's office of the components of the manager's amendment, with editorial comments from HCAN's Blog:
* Stronger medical loss ratios. Health insurers will be required to spend more of their premium revenues on clinical services and quality activities, with less going to administrative costs and profits - or else pay rebates to policyholders. These stricter limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans. (Ed note: Reportedly, these require group insurance plans to pay 85% of premiums to health care, and individual plans to pay 80%. These would go into effect in 2011. In 2012, the ratios would be based on the average medical loss ratio in the Exchange.) * Accountability for excessive rate increases. A health insurer's participation in the Exchanges will depend on its performance. Insurers that jack up their premiums before the Exchanges begin will be excluded - a powerful incentive to keep premiums affordable. * Immediate ban on pre-existing condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage of pre-existing conditions for children. Patient protections. Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care. * Ensuring access to needed care. The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014. * Guaranteed opportunity to appeal coverage denials. All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable. * Multi-state option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be non-profit, and the plans will be available nationwide. This will promote competition and choice. (Ed note: At least two plans will have to be offered, one of which must be non-profit. OPM can negotiate medical loss ratio, profits, premiums and other terms.) * Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan. * Children's health. Support will be extended for the Children's Health Insurance Program and the adoption tax credit. Foster care children aging out of Medicaid will be able to retain its comprehensive coverage. * Rural and underserved communities. Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers. * Revised abortion language, including state opt-out of abortion coverage (Ed note: details here)
Two years ago today, December 17, 2007, there was an Assembly vote on a comprehensive health reform in California, the result of a year-long negotiation between then-Assembly Speaker Nunez and Governor Schwarzenegger. The bill went on to defeat in the state Senate.
There was a debate about whether the bill was worthy of support. Many consumer and constituency groups supported it, but some didn't.
The political situation before us is both strikingly similar, and radically different. Same goes for the policy proposal itself.
One big difference is that the bill in 2007 was a final product, in more ways than one. A companion ballot measure had been filed, and so the Senate was being asked to ratify it without changes. Were the ballot measure to pass, key parts would not be easily changeable.
The situation now is different--the bill is still in flux, and there are things to win, and to lose: the next week the Senate is considering to move an amended health reform bill, to go to a conference committee. It will need to be melded with a House bill, which is a very good bill, before final votes in the House and Senate in January. Even after passage, there will be opportunities to improve the bill in the years ahead, at both the federal and state level.
My take: we only lose when we give up. And we shouldn't give up. Others who have concerns with the Senate bill are echoing similar themes.
So I am concerned that some seem to be giving up on the current process. There's been a back-and-forth on the positioning of the Senate health reform bill, where Nate Silver of FiveThirtyEight has asked "20 Questions" for those who would kill the Senate health reform proposal; bloggers at DailyKos and FireDogLake have responded; and FiveThirty Eight followed up.
There's been a lot of commentary in the last 24-48 hours about the fate of the public health insurance option, and/or the idea of a Medicare buy-in. Health Care for America Now details the often-shifting positions of Senator Joe Lieberman, who has opposed the public health insurance option with at least three Democratic Senators. Nate Silver at Five Thirty Eight reminds us of how hard the challenge was and far far the idea came, even getting a majority of Senators on board. We'll have more analysis and commentary once we see where the dust settles.
Ezra Klein of the Washinton Post has a post that details the situation, and especially the timing moving forward: Votes starting as soon as Thursday lead to a timetable that extends to Christmas just to report the bill off the Senate floor.
And then there's conference committee, with a House bill that is superior in many ways.
That's the one thing I want to emphasize tonight. This is not the time for the final evaluation of the bill, for taking a step back, for either giving up or going along. There's still work to do! The health reform fight isn't over..
There's lots of fights on very important provisions still left to be won or lost in Senate and in conference committee. We need to continue to advocate on the very crucial issue of affordability, and on issues like employer responsibility, insurer regulations and oversight, inclusivity, financing, as well as continuing to look for opportunities to include public health insurance options.
The fight isn't over to make it the best bill it can be--or to prevent it from getting worse. We still have work to do.
My colleague, Beth Capell, has already posted her impressions from the National Association of Insurance Commissioners (NAIC) meeting that we attended last week in San Francisco. It was so not what I expected that I thought I would add my reaction as well.
During my federal career at The Centers for Medicare and Medicaid Services and the Social Security Administration, I was responsible for holding public hearings on public policy issues according to federal requirements. The NAIC meeting had no resemblance to any official public hearing that I've ever attended. The entire premise is that a public hearing is designed to be a venue for informed expert testimony, but also a forum for probing follow-up questions of the policy experts by the Commisioners and an opportunity for public comment. A federal hearing must meet several criteria:
The hearing must be announced 3 weeks in advance in The Congressional Record and must be held in a public setting with access for persons with disabilities
There should be no admission charge whatsoever, offer free/reduced rate parking, and the location be accessible by public transportation
The sponsoring organization must transcribe the entire hearing and distribute it to all Commissioners and also take meticulous notes that are made available to the public
They must hold the hearing for a sufficient duration of time to allow for questions from the audience for the experts giving testimony and for the Commissioners
. . .And more
You get the picture. Although the NAIC "public hearing" met some of the above criteria, it was by no means free ($650 fee for each of us to attend just this one session, although they allowed how they would not charge us if we returned our badges.) I thought it had the closest resemblance to a "show hearing" (where they could say they held hearings outside of Washington, DC, but it did not provide any opportunity for new information or a dialogue between the panels of experts, the audience, and the Commissioners.
I was struck by the time constraints of the hearing. In a world where the health care dialogue occupies such a significant amount of time and includes many complicated policy issues, this felt very abbreviated. Out of a week-long conference, it allowed for 3 hours for panels to give testimony (and pretty much stuck to that.) I guess it is easier to shoehorn testimony into that block of time if you don't have to make allowances for pesky questions from the audience--or much engagement from the Commissioners themselves. Three hours for a fulsome discussion of the most significant changes to health care delivery in 45 years--since the enactment of Medicare and Medicaid--seems way not enough time. This is particularly true when by many versions of health care reform legislation under consideration, significant policy pieces will be developed by NAIC and or be delegated to them to enforce. And what about consideration of whether and how is it effective to delegate regulatory functions to a non-governmental entity like NAIC? This was not discussed at all.
Two consumer organizations gave testimony at the hearing and raised some significant issues for consideration, including AARP and Consumers Union, the publisher of Consumer Reports. (The third "consumer voice" at the table was represented by The Hemophilia Association, but their spokesperson was the former Insurance Commissioner from Indiana, so I'm not exactly sure that counts.) In addition, each of the consumer organizations were asked to truncate their testimony because of time constraints (although no similar request was made of other testifiers, such as the doctor speaking on behalf of the American Medical Association. He was able to expound at length about how underpaid doctors are.) I found it curious that although some of the consumer testimony ran counter to accepted orthodoxy at NAIC, it did not generate substantive questions of the consumer panel or an engagement by the Commissioners in any meaningful dialogue.
And, you may ask, how about the showing of California's contingent at this NAIC meeting on our home turf? What probing questions did our Insurance Commissioner ask? What leadership did he demonstrate among his peers after California's recent foray into enacting health care reform here? Mr. Poizner was not in attendance. Although he may have directed some of his staff to attend, they were in no way visible at this hearing. There were insurance commissioners from other states in attendance who raised issues from a protection-of-consumers perspective or discussed challenges they had faced in their states. Honorable mention goes to the insurance commissioners from PA, OK, and RI who added to the content of the hearing.
There was one distinct highlight of this hearing--that I would say could have taken the place of several so-called experts who were given equal time. That was Jon Kingsdale, who is the Director of the Massachusetts Connector and has the closest thing to real experience in what may be part of our new health care reality. He talked about the technology challenges he faced, how he staffed the health care exchange with real talent from public service and the private sector, how they rank on the report card from Bay Staters, and how he publicized the individual responsibility with the cooperation of the Boston Red Sox and CVS Pharmacy and got 98.9% compliance (and, as he acknowledged, that he "just didn't send all of the outlaws to New Hampshire!")
So, on balance, it was worth attending, and it was educational for us, but I have to admit it was a particularly mediocre cookie for my (hope I don't really have to pay) $650.
posted by Elizabeth C Abbott | Permalink | 10:12 AM
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Steps forward and back on the most contentious issues...
Tuesday, December 08, 2009
Earlier today, California Senators Diane Feinstein and Barbara Boxer joined the majority of their colleagues to table an anti-abortion Nelson/Hatch amendment, 54-45. They argued the amendment, which mirrored the Stupak amendment in the House bill, would go beyond the three decade-old Hyde amendment that prohibits federal funds to be used for abortions, which continues to be encoded in the main Senate bill. The amendment was opposed by most Democrats and the two female Republican Senators from Maine, Snowe and Collins.
They made the case that the amendment would prohibit women from using their own dollars to have private plans that cover abortion services. While Senator Boxer, who managed debate for the opposition, was successful, the issue continues. Senate Nelson of Nebraska, whose vote is crucial, may require other changes. And there remains a negotiation with the House bill, which does include the Stupak amendment.
In other news... ten Senators, five progressives and five moderates & conservatives, have come up with a potential deal on the "public option." What is it? No one knows for sure.
“This has been a long journey. We have confronted many hurdles, and tonight I believe we have overcome yet another one.
I asked Senators Schumer and Pryor to work with some of the most moderate and most progressive members of our diverse caucus, and tonight they have come to a consensus.
It is a consensus that includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices.
I know not all 10 Senators in the room agree on every single detail of this, nor will all 60 members of my caucus. But I know we all appreciate the hard work that these progressives and moderates have done to move this historic debate forward.
I want to thank Senators Schumer, Pryor, Brown, Carper, Feingold, Harkin, Landrieu, Lincoln, Nelson and Rockefeller for working together for the greater good and never losing sight of our shared goal: making it possible for every American to afford to live a healthy life.
As is long-standing practice, we do not disclose details of any proposal before the Congressional Budget Office has a chance to evaluate it. We will wait for that to happen, but in the meantime, tonight we are confident.
Over the weekend and today, CA Senators Boxer and Feinstein voted with the majority when amendments came up for a vote: * for a Stabenow amendment to assure that Medicare Advantage plans continue to include core Medicare benefits; * for a Kerry amendment on home care; * against Johanns amendment to send the bill back to committee; * for a Lincoln amendment to limit tax break for insurance CEO compensation; * against an Ensign amendment to limit the lawyer fees of medical malpractice victims; * for a Pryor amendment to survey patients in the exchange about their satisfaction; and * against a Gregg amendment to prohibit program expansions funded by Medicare savings.
Only the Kerry and Pryor amendments got the needed 60 votes for passage; the rest failed.
Debates are continuing as we speak, including on an amendment by Senator Ben Nelson to include the anti-abortion language similar to the Stupak amendment in the House bill. The debate continues...
The U.S. Senate is in full debate on health reform, and they started voting on some amendments in the last few days, despite various efforts by the GOP opposition to slow the debate down even more.
I've been in DC this week, and so have not been posting as much. Despite all the negotiations about amendments, you do get a sense that we are nearing a major advance. Beyond my Hill visits, my hope is to go see a little of the Senate floor debate in person, to say I saw a piece of history.
California's two Senators are actively participating in the floor debate as well. Here's some clips to give you a sense of what they are saying. Here is Senator Barbara Boxer, on women's health issues, from just a few days ago:
Here's a longer clip from Senator Feinstein from about a month ago, about the history of health insurance in this country:
The report, by the consumer health organization Families USA and co-released by the statewide health consumer coalition Health Access California, states that the subsidies – which were started last March by the American Recovery and Reinvestment Act (ARRA), but were made available for only nine months – have enabled millions of laid-off workers and dependents to afford so-called “COBRA” premiums needed to continue health coverage from their previous employer.
Under the ARRA, the federal subsidies pay 65 percent of the cost of COBRA premiums. In California, the federal subsidies for COBRA family coverage average $720 per month.
Without subsidies, the report finds, COBRA premiums for family health coverage will cost laid-off California workers, on average, $1,107 per month – 82.1 percent of the average ($1,349) monthly Unemployment Insurance checks they receive.
For the first recipients, who began receiving subsidies in March, the subsidies will expire on November 30. For those who started receiving subsidies after March, the expiration will be nine months after their start-up date.
For millions of laid-off workers and their families, the federal COBRA subsidies have been described as a health-coverage lifeline. Health advocates are arguing that new jobs legislation extends those subsidies.
Health and consumer advocates noted that pending health reform legislation would provide a permanent source of help to laid off workers. The health reform bills pending in Congress would enable laid-off workers and their families to obtain health coverage through a newly created marketplace, called an “exchange,” and families with low incomes would receive tax-credit subsidies to help pay the premiums.
Health advocates are urging Congress to extend the COBRA subsidy as a much-needed measure in the present to protect recently laid-off workers and their families. But, they say, this issue shows the dire need for health reform moving forward, so nobody loses health coverage when he or she switches jobs or becomes unemployed looking for work.
The Congressional Budget Office and Joint Tax Committee estimated that approximately 7 million adults and dependent children would receive the COBRA subsidy in 2009. The Treasury Department is compiling data about how many workers received the subsidy, but a count of the people benefiting from the subsidy is not yet available.
The data for the Families USA report were derived from federal sources in the Departments of Labor and Health and Human Services. A more detailed description of the sources of the data is set forth in the report’s methodology section.
Fresh from voting to begin debate on health reform, California Senator Dianne Feinstein was on NBC's Meet The Press this morning. (We tweeted her comments at @healthaccess on Twitter.)
Earlier this year, Senator Feinstein’s comments on health reform were noncommittal and even skeptical. She had a website post that indicated her “concerns” with health reform. But as she’s focused on the problem and the solution, she has become more convinced of the urgency of the need, as she stated the urgency of the problem: "The time has come to really see that people who have no insurance can get insurance."
She also seems to have more appreciation for the solution proposed. Always a moderate at heart, she described the bill as “incremental,” in a positive way. "The good part about this bill is that it is structured so it is phased in, so over time we can watch it, we can change it." She cited that some help comes early, like small business tax credits, and coverage for those denied for pre-existing condition,. Other changes, like setting up the exchange and the public option, come online in 2014, and she seemed comforted that it would give us time for adjustments if needed.
As she indicated in a new health reform statement on her website last month, Senator Feinstein was clearly influenced by the T.R. Reid book that compared health systems from around the world. A conclusion of the book is that while several countries have different systems, the U.S. stands out, and not in a good way. As Senator Feinstein said on Meet the Press, "America has serious problems with respect to health care. Virtually every other developed country has a better system than we do. Ours is costly, in places it is ineffective, it's deeply troubled."
But then Feinstein went further, showing that her centrism is not incompatible with a strong critique of insurance companies and our current for-profit system: "No developed country on Earth has a huge for-profit medical insurance industry that we have: 480% profit in 8 years. Premiums skyrocketing." She described that she had five California Daughters of Charity hospitals come to her, and talk about how they face a 17% in premium hike for their 6,000 workers, yet only got back 5% in rate reimbursement. The premium increase wiped out their operating capital for 2009. She argued strongly for a public health insurance option, and for a rate regulation authority.
She also pushed back against the wild falsehoods by the opposition. "I looked at the Republican talking points on the 2.5 trillion figure that is their cost [for health reform]. There's no substantiation for that... What [the CBO] does say: The deficit savings is $170 billion."
Senator Feinstein did Californians right with her vote to move health reform forward, and in her comments on health reform this morning.
The U.S. Senate is currently debating health reform, and California Senator Barbara Boxer just announced on Twitter that she will be speaking on the floor at 6pm Eastern, 3pm Pacific.
We are leading up to a key vote Saturday night, 5pm Pacific. C-SPAN will be broadcasting it live.
In the arcane rules of the Senate, 60 votes are needed--given the united Republican opposition, that means all Democratic-caucusing Senators--just to begin the debate in the Senate.
For more information on the Senate bill, here's two central hubs of fact sheets, video clips, and information: dpc.senate.gov/reform
Senate Majority Leader Harry Reid unveiled the new Senate health reform proposal today, a merger of the bills produced by the Senate HELP Committee and the Senate Finance Committee.
The immediate drama is whether Democrats will be able to get the 60 votes (requiring all Democratic-caucusing members) to start the debate on the measure later this week. Senator Baucus is in Montana with a family emergency; there's about 3-5 conservative Democrats whose vote is a question, both for the first vote to start the debate, and the vote to end the debate and allow the bill to be voted on.
Republican Senators have sought to delay the bill as much as possible. Senator Coburn is potentially going to force a full reading of the bill, a procedural stalling tactics. The best Twitter conversation was who could be made to do the reading, with suggestions including uninsured Americans to Christopher Walken to William Shatner.
As details come out about the bill, we'll continue to post more info here, and on our Twitter account, at www.twitter.com/healthaccess
Earlier tonight, the U.S. House of Representatives passed H.R.3962, a historic comprehensive health reform proposal, by a vote of 220-215.
We thank ALL of California's Democratic Congressional Representatives for voting for this desperately needed comprehensive health reform. Given California's health crisis, it's appropriate that the House of Representatives, led by Californians like Speaker Pelosi, Chairmen Miller, Waxman, and Stark, and many others, took the lead in crafting this historic bill.
The bill would provide stability and security for those who have coverage, and that would extend affordable coverage to those who don't. Californians are concerned that coverage won't be there for them when they need it, and this bill provides our families with much needed security from financial ruin.
Californians have a particular interest in this vote. California has more uninsured, a higher cost-of-living, more denials of coverage for pre-existing conditions, and fewer workers offered on-the-job coverage.The House bill would help people keep their on-the-job coverage and expand our safety net. It would provide consumer protections against insurance company abuses, and provide the choice of a public health insurance option.
This is the equivalent of passing Social Security or the minimum wage in the 1930s, or the passage of Medicare or civil rights legislation in the 1960s.
This is not the end of the process, but it moves the process forward. The Senate should take quick action the conference committee to meld the two bills can start its work can begin as soon as possible.
We will look to conference committee to change the one unfortunate development from today's debate, which was the adoption of the Stupak anti-abortion amendment. The main bill had already prohibited federal funds to be used for abortion. The amendment provides for an unwarranted extension that would place anti-abortion restrictions on private plans offered in the new health insurance exchange. While over 190 Democrats voted against the amendment, it's unfortunate that over 60 Democrats--including California Representatives Joe Baca, Dennis Cardoza, and Jim Costa--joined all Republicans in voting for this amendment. This issue needs to be fixed in conference.
Aside from the abortion issue, the House bill is a very good bill--and superior to the Senate versions, especially on key issues like affordability, employer responsibility, the public health insurance option, inclusivity, the bargaining power of the exchange, limits on out-of-pocket costs, financing, and several other issues.
So there's a lot of work to do, but let's remember the importance of this vote. It moves the process forward. And this process has now moved farther than any other previous effort in over 100 years of effort, with an entire body of Congress endorsing a proposal. Let's keep the focus on passing reform, while working to make the reform better.
As I write this, Speaker Nancy Pelosi spoke on the House floor. "This is an historic moment," and said, in a strong voice, "Today we will pass" health reform. "Today, we answer the call" of history. She talked of three pillars: Innovation, Competition, and Prevention. She talked about the benefits of reform for consumers, including that "there's a cap on what you pay in, but there's no cap on what you receive." She gave a long series of bullet points of what "no longer" will happen under the bill, with the biggest applause when she said, "No longer will being a woman be a pre-exisiting condition." At the end,Speaker Pelosi invokes Rep. John Dingell's long fight the health reform, as well as the quote from the late Senator Kennedy: "What is at stake is the character of our country."
There's been other poignant speeches by Californians, including Education and Labor Chairman George Miller's statement focusing on preventing financial insecurity for families. "We cannot ask American families to continue to live on the edge of insecurity..today, we deliver security... A small event, because of lack of healthcare, can explode into the life of a family, the life of a community. That's not going to happen again" under this bill.
Progressive Caucus Chair Rep. Lynn Woolsey explained how she worried about her three children's health when they were uninsured, and no mother will have to now.
The debate is expected to go into this evening.
There will be tough amendments on abortion and immigration before the day is done. * An amendment by Bart Stupak would limit abortion coverage for even *private* health coverage offered through the health insurance exchange. * A Republican amendment would limit undocument immigrants from *using their own money* to buy coverage in the health insurance exchange.
So if you can, keep calling your Congressmembers TODAY (Saturday) 1-877-264-4226.
Health Access California is opposed to the amendments, but strongly for the main bill, H.R. 3962.
As the vote near on the House health reform bill, it is easy to sink into the specifics of the bill, be obsessed by the debate on key details, and mourn amendments that we really wanted but that weren't included.
But we should look at this bill in its totality, and appreciate how signficant it is, and how much help it would provide if it passes. Here's my top ten reasons why this is an impressive bill:
1) Near-universal coverage for all, largely through group coverage with its efficiencies and purchasing power to get the best price. 2) The biggest expansion of Medicaid since its creation 40 years ago, completing a unfulfilled commitment for millions in and near poverty. 3) Sliding scale subsidies tied to income: Consumers will pay for coverage not based on how sick they are, but what they can afford. 4) The end of "junk" insurance, and bankruptcies due to medical bills, with a cap on out-of-pocket costs, and even no cost-sharing for preventative services. 5) Fair share financing that is progressive and pays for itself (in fact, it decreases the deficit), including an employer assessment as important as setting the minimum wage for pay back in the 1930s. 6) New consumer protections: New rules & oversight on insurers that include the abolition of underwriting and "pre-existing conditions," minimum benefit standards, limits on age-based rates and on premiums dollars going to administration and profit. 7) A public health insurance option to provide choice, competition, and offer a safe haven against private insurer abuses. 8) The tools for cost containment and quality improvement in health care generally, from health information technology to transparency of cost and quality to a strong emphasis on prevention. 9) More sustainability and improvements for existing programs--like filling the donut hole in Medicare and streamlining Medicaid paperwork. 10) Momentum to do more in the future, politically and policy-wise, in health care and beyond.
Yes, it still needs to be merged with the Senate, which shares many but unfortunately not all of these characteristics. But for the House of Representatives to pass this proposal, and move us closer to these multiple victories, would be a historic achievement.
While the rest of the political class has focused on the elections Tuesday evening, Speaker Nancy Pelosi has introduced the "manager's amendment" for the House health reform bill. This is the final amendment the House leadership plans on making to the main bill before full passage. She promised that she would allow 72 hours before introducing the final bill before a full vote. Consider this your 72 minute warning.
The amendment is not major. It does not include amendments sought--by the right and left--on hot-button issues like abortion, the public health insurance option, allowing states to adopt single-payer, or other changes to the base bill introduced in its new form last week. They are going to the vote with the bill largely as it is.
"Tonight, we have filed a manager's amendment to the Affordable Health Care for America Act, which is the next critical step toward comprehensive health insurance reform that ensures affordability for the middle class, provides security for our seniors, and protects our children's future by not adding to our deficit. Our bill covers 96 percent of Americans, makes coverage more affordable for all, and creates new consumer protections that will end discrimination by insurance companies against the sick and cap what Americans pay out-of-pocket.
"Building on the legislation House Democrats introduced last week, this manager's amendment includes these key improvements to the bill: · providing $1 billion in new resources to states to rein in price gouging by insurance companies, · excluding insurers who put profits over patients from an affordable marketplace that will serve tens of millions of Americans, · expanding on the provision that removed insurance companies' anti-trust exemption and strengthening it to further promote competition and bring down costs for Americans; and · expanding oversight to further prevent waste, fraud, and abuse. "Americans are ready for comprehensive health insurance reform, and the House will soon act."
I was puzzled about the front-page Sacramento Bee article Sunday, which was making a arguable point but doing so in a fundamentally deceiving way.
The news analysis was that individual Democrats in the California Legislature voted with the majority of their party or abstained 99 times out of 100 this session. Republicans, on average, voted with the majority of their party or abstained 96 out of every 100 times."
The above statistic is just misleading, since it groups together "yes" votes and abstentions--which are fundamentally different in impact and intent.
In the California legislature, bills only pass when they get 50%+1--not of those present, but of the full voting body, regardless of whether members are there or not. In this scenario, not voting is the same as voting "no."
So in the 40-member Senate, a regular bill needs 21 "yes" votes on the floor. If the 15 Republicans stick together in voting "no," and 5 of the 25 Democrats are sick, not present, or abstain, the bill fails. There invariably is a member or two that may not be present, which means the margin to pass bills is actually pretty thin. When conservative Democrats oppose a measure, they typically just don't vote, and the lack of a majority stops the bill.
So an abstention isn't a sign of agreement--it's the reverse. And so there is nothing to be learned from an analysis that groups them together--its mush. It's not just a wrong conclusion, but does a disservice to readers.
The overall point may or may not be true. There's no doubt that the California legislature--with representatives from Berkeley and Bakersfield--is significantly polarized. But the article confuses, rather than illuminates, the issue.
Rep. Miller comment on the challenge of putting this bill together, and the future obstacles. While most press reports indicate that the bill is a merger between the three committee versions, the most important change was meeting President Obama's requirements during his speech to Congress: that the bill be in the range of $900 billion over 10 years, and that it be paid for not just in the first decade but in the future beyond that. These were laudable goals, but they put a significant crimp in the effort to make sure the bill provides enough help to low- and moderate-income families to afford coverage--the crux of this entire enterprise. But the House leaders were able to find ways to find new savings (like expanding Medicaid even moreto 150% of the poverty level, which is cheaper than private coverage).
But as we go through it, there's a lot of good stuff here.
Rep. Miller's website also has lots of fact sheets on the new House. Here are some key ones:
The House is expected to vote on the full bill before Veterans' Day. And as Rep. Miller indicates, he expects that the whole effort is done, and a bill is on the President's desk, by Christmas.
It is with great pride and with great humility that we come before you to follow in the footsteps of those who gave our country Social Security and then Medicare and now universal, quality, affordable health care for all Americans...
But I am very grateful for the cross-section of members that we have -- generationally, geographically, philosophically, in every way, from all of the committees of jurisdiction that worked on this legislation and also members of the caucus who participated over and over again under the leadership of our chairman, John Larson, and our vice chair, Xavier Becerra.
So here we are. For nearly a century -- it's really over a century -- leaders of all political parties, starting over a century ago with President Theodore Roosevelt, have called and fought for health care and health insurance reform.
Today we are about to deliver on the promise of making affordable, quality health care available for all Americans, laying the foundation for a brighter future for generations to come.
The Affordable Health Care for America Act is founded on key principles of American success: opportunity, choice, competition and innovation. We have listened to the American people, we are putting forth a bill that reflects our best values and addresses our greatest challenges. And we are putting it online for all Americans to see.
Here's what our health insurance reform legislation will mean to American families, workers and the economy. This is why this legislation is important: affordability for our middle class. It lowers costs for every patient, reins in premiums, copays and deductibles, limits out-of-pocket costs, and lifts the cap on what insurance companies cover each year.
Affordability for the middle class, security for (inaudible) seniors: by strengthening Medicare secures the financial stability and solvency of Medicare for years to come, provides seniors with better benefits and guaranteed access to their doctors. And in this legislation, we will immediately begin to close the doughnut hole.
Affordability to the middle class, security for our seniors, responsibility to our children. It reduces the deficit, meets President Obama's call to keep the cost under $900 billion over 10 years, and it insures 36 million more Americans -- 36 million more.
As I said, the bill is fiscally sound, will not add one dime to the deficit, as it expands coverage, implements key insurance reforms and promotes prevention and wellness across the health system.
The bill will expand coverage, including a public option to boost choice and competition in the health insurance reform (sic).
It covers 96 percent of all Americans, and it puts affordable coverage in reach for millions of uninsured and underinsured families, lowering health care costs for all of us.
One other very important feature is that it will end discrimination for preexisting medical conditions.
It opens doors to quality medical care to those who are shut out of the system for far too long. And because of the work of our members and -- meetings across the country, we know that prevention and wellness are an important part of this legislation. It puts a major new emphasis on preventative care, expands access to screenings and other treatments to keep Americans healthy and promote workplace wellness.
The drive for health care reform is moving forward. The Affordable Health Care Act will ensure, again, affordability for the middle class, security for our seniors, and responsibility to our children.
As we consider -- continue to move through the legislative process, it is critical to remember what this means to the American people. Today we will hear stories that serve as our inspiration. We will listen to people whose hopes are our motives for action.
Our president has said our success will be -- our progress will be measured by the success of America's families in making progress for themselves. And so these stories are a place that need our attention, will have our action, and we look forward to hearing them.
Here's the comments from the press conference from California Congressman Xavier Becerra. Health Access California, Health Care for America Now! and many other groups will be helping host a town hall in Los Angeles with Rep. Becerra this Saturday, October 31st.
He's a member of leadership, and provided some historical context as he introduced Rep. John Dingell, the long-serving dean of the House, and long-time champion for universal health care.:
In 1935, Franklin Delano Roosevelt stood up and fought for Social Security. There were many who said no, but he had the courage to stand up.
In 1965, Lyndon Baines Johnson stood up and had the courage to say yes to Medicare, despite the fear that was shouted out by many along with their no.
And today all of us here gather together to say yes to America, because we have heard you, we see it in your eyes. You are telling us it is time to reform our health care system for all of our families; not tomorrow, not in 40 years, but today. And we hear you loud and clear.
We know that you have fought to keep your children insured. We know that you have fought against those insurance bureaucrats who deny you care. We know that you scramble to find the money to pay that monthly premium. And we know that you would not go one day without doing everything you could to help your child or your spouse or your parent have access to the quality affordable care that we all deserve.
We will be with you because it is time for quality health care we know exists in this country.
The big news today is that Senator Majority Leader Harry Reid is moving forward with a merged bill that includes a public health insurance option (with a provision for states to "opt-out" of having one if they choose).
I am well aware that the issue of the public option has been a source of great discussion in recent weeks. I have always been a strong supporter of the public option. While the public option is not a silver bullet, I believe it is an important way to ensure competition and to level the playing field for patients.
As we’ve gone through this process, I’ve concluded, with the support of the White House and Senators Baucus and Dodd, that the best way forward is to include a public option with an opt-out provision for states. Under this concept, states will be able to determine whether the public option works well for them and will have the ability to opt-out. I believe that a public option can achieve the goal of bringing meaningful reform to our broken system.
It will protect consumers, keep insurers honest and ensure competition and that’s why we intend to include it on the bill that will be submitted to the Senate for consideration. We have spent countless hours over the last few days in consultation with Senators who have shown a genuine desire to see reform succeed, and I believe there is strong consensus to move forward in this direction.Today’s developments bring us another step closer to achieving our goal of passing a bill this year that lowers costs, preserves choice, creates competition and improves quality of care.
Some other points from the 10-minute press conference:
* Reid said he had the votes to "move to this bill & start legislating." That suggests that he has 60 votes on motion to proceed--but he gave no guarantee he can break a filibuster.
* Reid's best line was that he was "always looking for Republicans [to vote with us].. there're just a little hard to find.. [The number of] moderate Republicans are extremely limited.. I can count them on 2 fingers."
* When he was asked about affordability and subsidies, Reid said the bill was a meld of the HELP and Finance proposals.
* Sen. Reid didn't mention, and not one reporter asked, about merged bill's reqs for employer-based coverage--which is how half of US gets coverage now. There's concern that the Senate version is leaning toward the Finance "free rider" proposal rather than the much better HELP version.
Indiana's generally well-regarded Republican governor who formerly served as President George Bush's Director of Management and Budget, pulled the plug on October 16 on their effort to "modernize" the state's system of delivering welfare services. This was a similar result in Indiana to an effort to privatize welfare in the state of Texas which was a failure, and was cancelled in 2007 after a huge expenditure of Texas state funds.
The Indiana governor acknowledged that he continued to favor privatization of some state government functions. However, the systems changes he implemented resulted in too many errors and left too many deserving people waiting for too long for help they desperately needed. State legislators were inundated with complaints from their constituents. Eligible applicants suffered nightmarish consequences that affected their health coverage and their health status. In fact, Indiana is facing increased criticism and oversight from the federal government over their error rate. State hearings on this debacle are under consideration by the Indiana legislature.
Indiana expected significant cost savings by directing applicants to apply for benefits by calling customer service centers staffed by contractor employees or by having the public file for benefits using a computer. Now that the governor has cancelled the $1.34 billion contract, applicants will return to applying for public services as part of face-to-face interviews with state workers in local county offices. The governor admitted in his public statements that it wasn't the resources the state devoted to this endeavor or the amount of effort, but that it was "a flawed concept that simply did not work out in practice."
So, why are these experiences in Texas and Indiana so relevant to California? As my mother would say: "It is a cautionary tale." The California legislature passed, and the governor signed, AB 7 Centralized Enrollment for Public Social Services that purports to streamline and automate the process for applying for public social services like Medi-Cal, food stamps, and CalWORKS. The benefits of this law are reputed to be greater access to benefits by having the public apply over a computer, greater consistency in eligibility determinations from county to county, and significantly lower administrative costs for the state.
As the state prepares to implement this law in the coming months, it will face many of the same problems and criticisms experienced by these other states. California will doubtless incur tremendous costs (and will be unlikely to realize any savings) while exposing eligible Californians to significant delays and real adverse health consequences from what other states are calling "a failure."
The question to ask is: Can we learn from their mistakes?
posted by Elizabeth C Abbott | Permalink | 3:01 PM
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The Governor's legislative actions on health, in full...
Monday, October 12, 2009
HEALTH ACCESS UPDATE Monday, October 12, 2009
HEALTH BILL ROUNDUP: GOV SIGNS KEY MEDI-CAL IMPROVEMENTS, VETOES MOST CONSUMER PROTECTIONS AND INSURER REGS * Signed Bill To Draw Down Over $2.3 Billion in Federal Matching Funds for CA Hospitals and Children’s Coverage; Additional Legislation Needed
* Signed Measure To End Gender Discrimination in Premium Pricing
* Vetoed Bills Would Have Prevented Rescissions; Require Maternity, Mental Health Services; Give Communities Notice Before ER Closures
Governor Arnold Schwarzenegger signed and vetoed over 700 bills yesterday, including several of interest to California's health care consumers.
Governor Schwarzenegger’s actions on end-of-year legislation was mixed for health care consumers. He signed some key proposals to maintain and improve the Medi-Cal program, from getting more federal funds to improving hospital reimbursements, to helping prevent balance billing of Medi-Cal patients, to extending a program for people with disabilities who are working.
But the Governor sided with the insurance industry to veto most of the consumer protections before him. He did sign a key measure to stop women from being charged more than men for premiums, but vetoed other insurance regulation measures to prevent coverage from being rescinded, and ensure that key services, like maternity, mental health and other treatments, are covered.
Here are some of the highlights of the health bills. All bulleted bills were supported by Health Access California.:
MEDI-CAL IMPROVEMENTS, INCLUDING MORE FEDERAL FUNDS
Perhaps the biggest health news was the Governor’s signing of a measure to draw down $2.3 billion in federal funds to increase Med-Cal reimbursement rates as well as support children’s coverage.
* AB 1383 (Jones): HOSPITAL DIVIDEND FEE: would, per federal approval, impose a coverage dividend fee on hospitals for the purpose of drawing down federal funds for increased reimbursement and children’s coverage expansion. SIGNED.
There is more work to do on this issue. In the Governor’s signing message, he indicated the need for additional legislation to implement the change.
With a tough budget year, a struggling health care system, and Medi-Cal rates that are some of the lowest in the nation, AB1383(Jones) is especially urgent given the enhanced match under the economic stimulus period of the American Recovery and Reinvestment Act.
Other bills that improved the Medi-Cal program included:
* AB 1142 (Price): PROOF OF ELIGIBILITY: To prevent "balance billing" of Medi-Cal patients, would require hospitals, as soon as they have proof of a person’s Medi-Cal eligibility, to provide all information regarding that person's Medi-Cal eligibility to all other providers. SIGNED.
* AB 1269 (Brownley): DISABLED WORKERS: Would allow, to the extent that federal financial participation is available, workers with disabilities who are otherwise eligible for Medi-Cal but are temporarily unemployed to elect to remain on Medi-Cal for a period up to 26 weeks. SIGNED.
KEY CONSUMER PROTECTIONS
The Governor vetoed most of the key health care bills on the Governor's desk would provide consumer protections for patients and needed oversight over health insurers, but signed some notable exceptions.
The biggest surprise was the Governor's signing of AB119(Jones), to ban gender discrimination in the pricing of health policies.
Bills that were vetoed included regulations of insurer rescissions, and mandating key benefits like maternity care and mental health services. These were high-profile issues that have been significantly discussed in the national health reform debate, and included in the major health reform proposals in Congress, like H.R. 3200. The bills included:
* AB 119 (Jones): GENDER RATING: to prohibit insurers from charging different premium rates based on gender. SIGNED
A few bills addressed the controversial insurance company practices of retroactively denying coverage, or rescissions.
* AB 2 (De La Torre): INDEPENDENT REVIEW OF RESCISSIONS, to create an independent review process when an insurer wishes to rescind a consumer's health policy, create new standards and requirements for medical underwriting, and requires state review before plan approval. Also raises the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his health history. VETOED (See attached veto message) * AB 730 (De La Torre): POSTCLAIMS UNDERWRITING PENALTIES: Would increase and direct fines on insurers unlawfully engaging in rescissions and post-claims medical underwriting. VETOED (See attached veto message) * AB 108 (Hayashi): RECISSION TIME LIMIT: Would make clear a 24-month time limit in which insurers have to rescind, cancel, or limit individual health care policies or charge higher premiums because of fraud once a consumer’s application is approved. SIGNED (See attached signing message)
The Governor largely vetoed virtually all the bills that required that health insurance include key benefits, so patients who have been paying premiums don’t find themselves without needed coverage or care. They included:
* AB 98 (De La Torre): MATERNITY COVERAGE, to require all individual insurance policies to cover maternity services. VETOED (See attached veto message)
* AB 244 (Beall): MENTAL HEALTH PARITY, to require most health plans to provide coverage for all diagnosable mental illnesses. VETOED (See attached veto message)
Other coverage benefit mandates that were vetoed included SB 158 (Wiggins), for cervical cancer screening of the human papillomavirus vaccination (See attached veto message); AB 56 (Portantino) for mammographies (See attached veto message), and AB 513 (de León) for breast-feeding consultation (See attached veto message). One insurer benefit mandate that was signed was SB 630 (Steinberg) for cleft palate reconstructive surgery.
Other pending consumer protections regarding providers included:
* AB 171 (Jones), on DENTAL CREDIT CARDS - Would prohibit dentists' offices from offering high-interest loans to patients while they are under the influence of anesthesia. Would also prohibit dental offices from charging lines of credit before services have been rendered. SIGNED
* SB 196 (Corbett): HOSPITAL/ER CLOSURE NOTICE: Requires public notice of hospital closure or reduction/elimination of emergency medical services. VETOED (See attached veto message)
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.
