Trying to stay informed on the progress of health care reform can be a tricky. Even a consumer of mainstream media must be saavy enough to figure out which talking heads or commentators are biased -- and then figure out how to block that bias.
That's the only way to really obtain a true picture of what transpired. And if you want, you can declare the winners and losers yourself -- if that's your game.
But if you're lacking the time to view a replay of the summit, and want a straight-forward analysis of what actually transpired -- beyond the talking points of each caucus and the obvious props of the Republicans --here's a good place to go: Paul Krugman's column in the New York Times.
The big news was the historic passage of the health reform from the Senate Finance Committee, the fifth of five committees. We covered it, including the 14-9 bipartisan vote, on our Twitter feed at www.twitter.com/healthaccess
President Obama has a way of trying to ensure fidelity from partisan opposites once they've voiced early ideological support for the initiatives he was elected to achieve.
In very public speeches, he singles them out by name and elevates them as leaders who are standing up to do right by America. Today, he did so for Maine Sen. Olympia Snowe in a shout-out during a serious Rose Garden speech after which he took no questions.
Obama made it clear that Snowe deserved recognition for being first to break the partisan barrier when she threw her vote behind the 14-9 passage of the Senate Finance Committee version of the health care bill. In making his remarks, Obama was also sending a message: he is statesman enough to give credit where credit is due.
Conceivably, this praise strategy can either bring a politician deeper into the fold, or provide a the public record for a flip-flop, should one be gathering on the horizon. Think Iowa Sen. Chuck Grassley, during the kookiness of August's town-hall season.
And while Snowe, reportedly irked by an ill-timed, deceptive 11th-hour insurance industry blitz against her committee's bill, voted for the bill today, she also made it clear that no one should take her future support for granted:
"When history calls, history calls," Snowe announced in the Senate Finance Committee. Wrapping up, she added, "Finally I say that my vote today is my vote today. It doesn't indicate what my vote will be tomorrow."
Here's hoping the senator will continue to see the greater value in voting for the goal of making health care affordable in America.
Obama was clear today about what's at stake: "As a result of these efforts we are now closer than ever before to getting health reform passed."
The Senate Health Committee, chaired by Senator Elaine Alquist, met today. Our colleague Cynthia Craft provides the background on the most radical bill on the agenda:
S.B. 92 (Aanestad, R) was a proverbial everything-but-the-kitchen sink, 34-point partisan pitch in the form of a bill that, in the end, only one soul voted for: the author Senator Sam Aanestad himself. Even fellow Republican Senator Tony Strickland asked that his earlier “yea” vote be changed to “no” at the end of the day. And Republican Dave Cox stayed altogether mum.
Representing the bill as a product of the entire Republican Senate Caucus, Aanestad affectionately called the massive package by its apparently GOP caucus-designated nickname, “The Beast.” S.B. 92 would have offered a “free market” alternative to health reform, particularly another single-payer legislative push that Sen. Aanestad suggested was likely to earn another veto from the Governor.
But opponents, including Health Access California, spotlighted just a few of the conservative ideological statements embedded in the bill’s nearly three dozen provisions: an anti-illegal immigrant tax on remittances sent out of the country via Western Union, a swipe at organized labor with flexible work schedules; and an attempt to allow out-of-state unregulated insurers to come into California to do business, without having to abide by California consumer protections. And those were just three of the 34 points that sunk S.B. 92.
Even more than last year's version, the bill was an impressive compendium of proposals that Health Access California opposes, from allowing insurers to provide coverage that excludes certain ailments and body parts, allowing for limb-by-limb coverage, to the promotion of Health Savings Accounts, which are ways to promote high-deductible health plans.
Senator Aasnestad made the final plea to allow a vehicle for health reform to proceed. He said he expected that the Governor may have his own health reform proposal this year, but as of now, ther only comprehensive approach is a single-payer bill that he had new assurances would be vetoed. Senator Alquist corrected him, and referred to her own SB56(Alquist) as a vehicle for comprehensive reform. Again, the bill stalled with only one vote in support.
Senate Budget Subcommittee on Health is meeting this morning. Republican Sen. Roy Ashburn just chastised Democrats, specifically Sen. Elaine Alquist. Alquist had asked how plausible it was to expect aged, blind and disabled individuals, with incomes of about $870 could possible pay for rent and food on top of $270 for medical care.
“I only ask for real choices…and I don’t hear an answer on how this is really doable,’’ she had said.
Ashburn shot back that he was fed up with this type of examination of social programs. “If that is going to be the reaction, then there are some in this committee that are not going to go for cut. And there are some who recognize the dire situation,’’ he said.
“I’m not advocating that we be heartless or harsh. But we can’t balance this budget if the answer is going to be ‘no.’’’ said Ashburn, who has signed the American’s for Tax Reform “no tax’’ pledge.
Legislative leaders and the governor have reached a newbudget deal and boy is it a stinker.
Lawmakers gave in to the governor's demand that would make it harder to draw on money locked away in a rainy day fund. Effectively, it means it will be harder to pay for health, education, social services, transporation -- all the things we pay the state to take care of.
Additional cuts will also be coming. If this budget passes (as it is expected to tomorrow) and is sent to the governor, Gov. Schwarzenegger still has the ability to use his line-item veto power to reduce spending even further. Watch out everyone (!) -- especially in light of the fact that lawmakers caved to businesses and ix-nayed a tax amnesty program that would have forced thousands of businesses delinquent on their taxes to pay up.
Of course, we have no *additional* permanent sources of revenue, which means we'll be fighting this same thing again in a few months.
I ran into a former Republican staffer today who opined that Republicans had "warned '' of this kind of death and destruction five years ago.... Would that have been the five years ago when a $6 billion hole was blown in the budget because the Vehicle License Fee was reversed?
I'm going to re-emphasize what Anthony was saying in his latest post just because I'm really *really* grouchy about the state of our budget. In the latest iteration of a budget deal, legislative leaders are crowing about the fact that there are no taxes raised, no more *additional* borrowing.
They're crowing about how there are no cuts to health care "beyond the Conference Committee'' budget, which already (as my colleague Anthony points out) leaves more than a quarter-million children without health coverage, increases Healthy Families premiums and continues the paycut to Medi-Cal healthcare providers through next year even while the cut continues to be litigated.
All this leaves me in a foul mood. Why? Because they'll be at it again next year and they *know* it. We have gone through this exercise nearly every year of this decade and every year we end up in worse shape. The gimmicks allow them to *pretend* to balance the budget in 08-09, but opens up an equivalent (and often larger) hole in 09-10. What's even more harmful, is it's a huge distraction that keeps policymakers from advancing the state's goals.
It means that next year, we're going to be fighting the same fight -- REconvincing lawmakers that trying to take away podiatry services and eyeglasses for people earning $1,000-a-month is a really dumb idea, leaving people sicker and less able to independent. It means we're going to have to re-remind them that, No, $18,000-a-year income is not enough to allow a person to go buy health insurance on the private market. Yes, it's actually a really big pain-in-the-ass burden for people whose lives are in constant flux to have to re-convince the State of California that they are still eligible for Medi-Cal every 90 days. Heck - it's annoying enough to have to renew my driver's license every five years.
For every minute that we are fighting back those cuts, it's another minute that we cannot work to advance real health reform -- health reform we desperately need that would help all families, by allowing them financial and health security. For every shred of emotional and intellectual energy that we have to use preventing the budget from rolling backwards, it's energy that we can't divert to moving our state forward.
Grump, grump, grump. And now for a Dan Walters Column that says it better than I did.
After a few hours of "debate" the Senate just voted down the Republican version of the budget 15-21. It was no big surprise since it mainly consisted of cuts and borrowing. In health services, the Republican version made an additional $43.2 million in cuts beyond the governor's $830 million cuts to health care services.
The zinger, though, in the Republican cuts is $30.3 million for family planning services, such as contraceptive care, counseling cancer and STD screening and annual exams. That cut would have resulted in $272.7 million in lost federal dollars (The federal government gives $9 for every $1 the state spends on certain family planning services.)
Should a Republican budget be enacted (thankfully not) it would result in a loss of more than $1.7 billion in federal matching dollars -- all dollars that would go to other states....
A special Blog post from our Director of Administrative Advocacy, Beth Abbott:
I attended a forum on Thursday to evaluate the effectiveness of requiring applicants and current beneficiaries to prove their U.S. citizenship and identity to receive Medicaid (Medi-Cal in California) under the federal Deficit Reduction Act. The U.S. Congress, operating on the speculation that many illegal immigrants in the U.S. were claiming to be citizens to become eligible for Medi-Cal, proposed this provision into the eligibility requirements for Medicaid for all states in 2005.
The Government Accountability Office (GAO) did a study to evaluate that premise. Their study found no evidence to support that undocumented people falsely asserted that they were citizens, and there was no basis for establishing a requirement to prove citizenship or identity when applying for Medicaid. Congress was undeterred and inserted this provision in the law affecting all states effective July 1, 2006.
This forum in Sacramento showcased the experience of California’s Department of Health Care Services (who lay out the rules for Medi-Cal in California), California counties (who implement these new rules throughout the state), as well as the experience of other states, foundations, and public policy institutes.
The Good: Our state and counties were consistently complimented about their thoughtful and even-handed implementation of this onerous law. California sought input from a wide variety of stakeholders to minimize the harm of these requirements, communicate as clearly as possible about the complexities of the law, and build into the state rules as much flexibility as they were able to get.
The Bad: California and the counties said: • They had not uncovered any fraudulent attempts to claim U.S. citizenship. • The state admitted that so far they had spent about $80 million dollars to implement this new law. (This is serious money!) • The counties had not included the costs to pay for training, longer interviews, additional computer coding or file documentation, or help obtaining proofs. • Although this law affects only U.S. citizens, it has had a chilling effect and these additional administrative hurdles discourage applicants.
The Ugly: Based on the first two years of its implementation, many attendees believed this was evidence of a misguided, but costly attempt to deal with U.S. immigration problems through the back door, to the detriment of our citizens. However, if this early experience were not enough, Congress is considering expanding this requirement to such programs as Healthy Families, CAL-Works, and others. The consensus was that these requirements did nothing to contribute to the expansion of public health programs, streamline efficiency of the administration of government programs, or add meaningful deterrents to fraud or abuse in public benefits.
The Wall Street Journal today contains an analysis of Rep. Veep candidate Sarah Palin's policy record. Here are the relevant health portions:
Gov. Palin didn't make health care one of her top priorities, but where she did take a strong stand on health, it was for the free market.
"Health care must be market- and business-driven, rather than restricted by government," her office said in a January statement.
Her overall approach is much like Sen. McCain's -- loosen government regulations to allow for greater competition, along with more information for patients to make good choices.
Addressing the uninsured was less of an issue for Gov. Palin, much as it is less significant for Sen. McCain. She was reluctant to support a significant expansion of the state's version of the Children's Health Insurance Program, called Denali KidCare. She signed a bill that raised eligibility to allow families with incomes up to 175% of the poverty level -- stingy compared with other states.
Great. So she doesn't *really* think addressing the uninsured is an issue. Yet, Alaska, according to the latest Census Report, her state (and it's teeny tiny population of 664,000) has nearly the same proportion of uninsured as California -- 17.3 percent (to our 18.6 percent). The number of uninsured in her state could populate the entire town of Costa Mesa -- home to South Coast Plaza and 113,955 Orange Countians. (AK's uninsured is 115,000).
The state budget impasse is nearing the end of its second month and shows no signs of abating. For every day that California goes without a budget, we get anxious because it means that more cuts are possible.
The May Revise budget contained nearly $1 billion in cuts to health services, which would have translated to more than one million additional uninsured Californians by the end of the Schwarzenegger administration. The Conference Committee restored many cuts, but the Conference Committee budget would result in the loss of health coverage for nearly 300,000 children by the the Schwarzenegger administration. The LA Times had a story this weekend.
As the budget debate drags on, and Republicans refuse to agree to increased revenues to fund our state's basic needs, more lives will be on the line. There have been rumored mutterings of more cuts -- meaning more children will be unable to get eyeglasses, teeth cleanings and basic health services that would keep them healthy and in school for years to come.
Gov. Arnold Schwarzenegger scolded lawmakers via Capitol press conference today, saying both sides (especially Republicans) needed to stop being stubborn sticks-in-the-mud and grow up, and that the Republican idea to paper over our budget gap sucks. (That's not a quote, I'm paraphrasing).
"Let us get together and let us work this out. Don't come to the table with the same stubborn position. The Republican came in and said 'No taxes. No taxes. No taxes. ' The Democrats say 'No cuts. No cuts. No cuts,'''' the governor said at today's press conference.
He looked pretty annoyed that the whole thing wasn't done with already. I'm not sure how a public scolding is going to help matters, but I did want to point out one thing: We've taken our lumps. The budget has been cut already and we can't take anymore.
Setting aside the Medi-Cal reimbursement issue -- which was just blocked by a federal judge yesterday -- California's services will be cut no matter which budget we're talking about -- the May Revision or Conference Committee. In health services, we anticipate nearly 300,000 children to lose coverage because of burdensome paperwork requirements and increased premiums for Healthy Families and community clinics will lose some sources of funding.
It's unfair to go back and ask for more...we've done our part. Let the others do theirs.
On Day 42 of the budget impasse, I guess I find it somewhat encouraging that Senate Republican Leader Dave Cogdill said over the weekend he didn't believe we could have a cuts only budget. Republicans, so far (and as in previous years), have rejected the Conference Committee proposal which balances cuts against taxes. The Legislature needs a two-thirds vote to pass a budget, which means getting Republican support for the budget.
Cogdill has instead said he'd rather borrow money and repay it with lottery proceeds. But after the borrowing this year, what happens next year?
Of course, Cogdill and his Republican colleagues in the past have derided bonds and borrowing as mortgaging our children's future. Really, though, will there be any future for some children if their schools aren't properly funded, they can't see a doctor and can't afford a public university education.
For us, the May Revise Budget means 1 million more uninsured over the next three years. It means seniors and disabled Californians who live on fewer than $1,000 a month will have to spend their meager allowances paying for -- or going without -- eyeglasses, dental exams even incontinence creams and washes. Is this the kind of state we are?
Ed Mendel at the San Diego Union Tribune reports that our protracted, though expected, budget stalemate is leaving lots of rural hospitals in a bind. Many of these hospitals, which run on really thin margins as it is, are having to seek emergency loans from banks, which are also stretched thin because of larger economic issues -- like that mortage thing.
To exacerbate health care access, beginning next week, the state will not be paying Medi-Cal to the state's 600 community clinics. The clinics, which serve 3.6 million people annually, are the most efficient way to deliver regular preventive care to the Medi-Cal and uninsured population.
Ironically, the rural areas that are experiencing the most immediate problems are represented by Republicans, who have talked about how they don't want to cut provider rates and make sure health care access is preserved, but in conference committee voted against all of the rate reimbursement increases for providers who care for Medi-Cal recipients.
The Legislative Budget Conference Committee just approved Semi-Annual reporting for children on Medi-Cal.
Right now, children renew their eligibility annually, and adults twice a year. But periodic status reporting is a *passive aggressive* way for the state to reduce the number of people in Medi-Cal by hoping they don't "report'' their status on time. Under Gov. Arnold Schwarzenegger's original -- more draconian -- proposal requiring reporting every three months, the administration assumed 471,500 children (a drop off of 24%) would be eliminated from the rolls.
We don't have officials numbers yet on how many children would lose coverage under semi-annual reporting. But let's just slice the Quarterly number in half -- just to give us a working number -- and say about 235,750 children would lose coverage under semi-annual reporting.
The compromise attempts to soften the blow by saying the semi-annual status reports will sunset (for children only, adults will continue to be semi-annual) by December 31, 2011. But what does the sunset really mean for the child who needs asthma inhalers this year. Who falls of his bike, next year. Who gets pneumonia, in two years?
They'd be in line, to get back on Medi-Cal. Long-suffering counties, who will not receive extra funding to process the additional paperwork as a result of Semi-Annual Status Reports, will have a hard time handling the extra load, meaning it will be harder for kids to get coverage.
Assemblyman John Laird, who sadly will be departing the Legislature this year, gave a fantastic speech about how he hated having to support this compromise.
"I'm extremely unhappy about this...it's not the right direction to go....I'm kicking and screaming, but going to vote for this. But, if there is a hint that people want to move toward something more draconian, I will wage a full-pitched fight and advocate to go back to where it is now (annual reporting.)"
Soon-to-be Sen. Mark Leno reiterated Laird's position also.
"I think we need to be honest about this. We're shifting the responsibilities of children to county hospitals and emergency rooms. It's not an efficient way to have health care provided."
Also part of the compromise: an assessment on the effects of semi-annual status reporting. But we won't get to see the results of it until December, 2010 -- when we have just a year left until the sunset.
Republicans got to dodge a vote. They wanted more kids to drop off rolls with quarterly status reports.
Overall, this is a really profoundly troubling budget and a really pathetic statement of our priorities when we let more than 200,000 children -- who otherwise would be eligible for coverage -- just fall off and go without healthcare.
And it's really sad that the choice had to come between cutting already inadequate Medi-Cal reimbursement rates for doctors who care for these kids -- or letting really low-income kids (living in families that earn less than $17,600 a year for three) go without health insurance.
This should not be the choice... of worse and worse. This should not be the state we are fighting for.
Sen. Denise Ducheny corrected Assemblyman Niello's assertion that the budget debate has not included all the ways Medi-Cal could be reduced. The problem is, she said, cuts to benefits save so little.
Sen. Bob Dutton, R-Inland Empire, had a few interesting comments that I hope he'll remember in the future:
"I don't want to cut things that are going to get matching dollars from the federal government.'' In the Medi-Cal program, the federal government matches eligible expenses dollars for dollar. It means that for every dollar California cuts, we lose an additional dollar in federal investment. Duh. This logic should be applied anytime he looks at a Medi-Cal cut.
Dutton also made a logical argument for why provider rates ought not be cut: because it would discourage providers from taking more patients in certain areas and drive patients to the emergency room. Bingo.
Assemblyman Roger Niello suggests in conference committee during debate on 10% provider rate reduction that the state is not applying cuts to Medi-Cal in a way that attacks all "three legs'': Eligibility, provider rates and benefits.
That's just wrong.
The budget does all three.
RATES:
10% rate reduction for providers. (-$614 million)
BENEFITS
Elimination of Adult Dental (-$73.8 million)
Other benefits, such as podiatristrists, eyeglasses and incontinence creams and washes (-$11.6 million)
ELIGIBILITY
Quarterly Status Reports. (-$43.3 million): a passive agressive way for the state to eliminate Medi-Cal recipients by blaming their disenrollment on the recipients' failure to report their income every three months.
Direct denial of low-income working adults (-$31.2 million): which would tell parents earning between $11,000 and $18,000 that they earn too much to qualify for Medi-Cal.
Congressional Republicans join in to stop Bush Administration cuts
Wednesday, April 23, 2008
The House voted 349-62 today to extend the existing moratoria on Bush's Medicaid regulations that would have hurt low-income children and people with disabilities the hardest. (read more about the bad regs here and here.)
Besides the huge human impact state's would have lost LOTS of money -- like $50 billion in federal matching funds. California's share was $2.2 billion in the first year of implementation.
Given that we're facing our own budget crisis, let's thank California's members of Congress who continue to block these regulations. Here is the full roll call from today's vote.
VOTING YES: All the Democrats, and Republicans Brian Billbray, Mary Bono, Ken Calvert, David Dreier, Elton Gallegly, Duncan Hunter, Jerry Lewis, Dan Lungren, Kevin McCarthy, Gary Miller, Devin Nunes, George Radanovich, and Dana Rohrabacher.
VOTING NO: Out of 19 Republicans in California's Congressional delegation, only four voted no, which would allowed the Bush Administration cuts to go forward. Republican No votes were: Wally Herger, Darrell Issa, John Doolittle and Buck McKeon.
NOT VOTING: Republicans John Campbell and Ed Royce. Maxine Waters, a Democrat also did not vote.
Assemblyman Ted Gaines today said he was concerned that insurers did not like a bill -- AB1945 (De La Torre) -- that would restrict their ability to profit, i mean, prevent insurers from retroactively canceling patients' policies.
“I’m concerned about the insurance industry and want to make sure they’re on board. …I just want to make sure it works from both ends of the spectrum,'' Gaines said.
I'd like to see Assemblyman Gaines mediate that discussion.
On one end is the consumer, who wants reliable health coverage that they're not afraid to use for fear that it might get canceled.
On the other end is the insurer, who, on the one hand, does not want standardized applications to be too long (and inconvenience the consumer) but does not want the applications to be too vague, either, "so that they (insurers can) do reasonable underwriting up front.'' (That means they want to be able to deny you for pre-existing conditions -- that saves them the later step of retroactively canceling coverage.)
Also during yesterday's Medi-Cal budget subcommittee Sen. Mark Wyland, R-Escondido, made an unseemly and untimely remark.
It was during discussion about the governor's proposal to stop paying the $100/month Medicare Part B (drs offfice visits) premium for seniors who earn at least $13,416 a year. Here's how the math works out: It means that seniors who receive $1,118 a month would now have to dedicate $100 of their paltry monthly earnings to be able to see a doctor.
Asked whether any lawmakers had questions about the cut, Wyland piped up:
"Just to say, Madam Chair, we do support the governor's proposals."
I have no idea what inspired Wyland to be so enthusiastic about this cut -- particularly after a string of witnesses explained the hardship this population already endures. Or why he thought this was a particularly useful insight that added value to the conversation -- right then.
Kudos to Prof. Tony Sheppard at CSUS, whose careful reading of the newspaper leads us to this story about McCain's recent doctor's visit and cancer screening.
The offending comment:
"Like most Americans, I go see my doctor fairly frequently."
Of course, he can. As a member of Congress, he has access to fancy health coverage through the federal government, which pools together millions of federal workers and provides a really impressive array of options.
For health advocates, though, this off-the-cuff comment belies a deeper concern: Sen. McCain's lack of empathy and understanding for what Americans face is startlingly scary. Because he believes that most have "fairly frequent'' access to the doctor, he sees nothing wrong with his health proposal, a scheme that would cause more people to have worse coverage and bear increasing costs to stay healthy and productive.
For 47 million Americans who lack health insurance and countless others who have inadequate coverage through high-deductible health plans or other products of that ilk, seeing a doctor "fairly frequently'' is a fiction. And given that approximately 2 million more Americans became uninsured annually every year since 2000, we can only expect that number to grow.
If you're uninsured, or have inadequate health coverage, and you're forced to foot 100 percent of the bill to see a doctor - you're not going to go. "I'm healthy; I don't need a mammogram; I don't need a colonoscopy?'' many rationalize. The evidence is there: uninsured patients spend less than *half* the amount that insured people do on health care, according to the Institute on Medicine. Specifically with regard to doctors - 71% of Americans with insurance see a doctor annual, versus 41% of those with no insurance.
Not getting medical care isn't just a problem of the uninsured. Patients who have inadequate coverage are twice as likely to either delay or avoid getting health care because of cost, and far less likely to follow treatments for chronic conditions such as arthritis, high cholesterol or hypertension, according to the 2007 EBRI/Commonwealth Fund survey. Again, specifically with regard to doctor visits -- those with inadequate insurance are nearly twice as likely to avoid seeing a doctor or specialist because of the cost.
This is what we'll be treated to under a McCain health care plan, where employers will be encouraged to dump their workers into a less regulated and less efficient, more expensive individual market to fend for themselves, and where consumers are encouraged to buy high-deductible health plans. Sen. McCain's remark may have been flippant, but shouldn't be ignored.
Sen. Dave Cox just complained that ABx1 1 did not meet Knox Keene requirements because it did not include brand name prescription drug coverage.
First of all -- Knox Keene, the state's mandated guarantee of "basic health care'' -- does not provide any prescription drugs. Just doctors, hospitals, diagnostic and preventive health.
BUT -- we'd LOOOOVVVVVEEE to see prescription drugs guaranteed in that.
Do I hear a "mandated benefit'' coming from Sen. Cox -- demanding brand-name prescription drug coverage in California? This is only really funny because Sen. Cox and his Republican compatriots have repeatedly attempted to UNDO mandated benefits and kvetched ad nauseum about the state's "mandates'' that require health plans to cover childhood immunizations and cancer screening.
The Senate Health Committee heard a number of Republican bills on Wednesday. All but one failed. The special session bills were resurrected from 2007, where many either failed or were not heard in committee. Following is a list of the bills, purpose, and outcome:
SBx1 5 (Cox): Would redirect First Five tobacco tax funds to pay for health care services. FAILED
SBx1 9 (Runner): Directs state to issue licenses to open more clinics, including in retail locations. FAILED.
SBx1 10 (Maldonado): Would create a tax credit for those who have Health Savings Accounts, which are used with high-deductible health plans. Efforts to conform state and federal tax laws on Health Savings Accounts have failed the past two years because tax credits through them are predicated on the fact that individuals are underinsured. FAILED
SBx1 16 (McClintock): Allows out-of-state insurers to offer health coverage in California, essentially negating the voter-approved HMO Patients Bill of Rights guaranteeing 23 protections such as cancer screening and children’s immunizations. FAILED
SBx1 21 (Cogdill): Creates a tax credit for providers practicing in rural areas. FAILED
SBx1 23 (Ashburn): Creates a tax credit for businesses that set up a Section 125 account for their employees, which enables use of pre-tax dollars for health expenses. PASSED
The state Senate just concluded debate on AB8, which passed 22-17.
(Aside: All Republicans and Sens. Lou Correa, D-Anaheim, and Sheila Kuehl, D-Santa Monica voted against the bill. Correa is the only Democratic lawmaker to oppose any health reform measures this year.)
The bill now heads to the Assembly, where I'm sure all 80 lawmakers will want to get up and speak. Lest they planned to crib from Senators, I wanted to set the record straight on some of the erroneous statements made by their colleagues in the red-wing of the Capitol.
Myth: "I cannot remember a bill -- either minor or major -- that comes before the Legislature without any organization in complete support,'' (Sen. Sam Aanestad, R-Grass Valley)
Fact: Last week, AB8 underwent substantial amendments that dealt with controlling the rapidly increasing health care costs, and affordability of health coverage for consumers. After amendments on both those issues surfaced, a number of strong consumer voices -- such as Consumers' Union, Health Access, CalPIRG, AARP, Congress of California Seniors, Service Employees International Union, California Labor Federation, AAFSME and ACORN and other groups moved to support the bill.
Myth: "This plan does nothing to contain costs.'' (Aanestad). Sen. Dave Cox, R-Fair Oaks, also alluded to this.
Fact: Amendments added to the bill last Wednesday directly address the issue of cost containment -- something that the It's OUR Healthcare coalition has been asking for all year. We recognize that without without controlling costs, any health reform efforts would collapse under the weight of increasing health care expenses. Cost containment provisions include:
Preventing Californians from getting sicker by helping patients to affordably control chronic diseases. Asthma, diabetes and heart disease are among the biggest cost drivers in health care. Preventing and maintaining these diseases keep patients from getting sicker, and costing more money to treat. This means reducing co-pays and cost-sharing for doctor’s visits, lab tests and medications. High cost-sharing deters patients from seeking the necessary treatment and care for their diseases, causing their conditions to worsen.
Requiring public reporting on health care costs, and the quality of services. By publicly reporting how well – or poorly – doctors, hospitals and other providers perform health care procedures, providers would be driven to improve quality, thereby saving lives and saving health system dollars. Better information on quality and cost can allow purchasers and consumers effectively purchase care that gives them value for each dollar they spend.
Requiring the adoption of health information technology. Electronic records could help reduce costly errors due to poor handwriting, unclear instructions and other human errors. Technology could also help cut down on administrative costs.
Reining in prescription drug costs. Prescription drug costs climbed an average three times higher than the rate of inflation from 1994 to 2006. AB8 allows the state to combine with other public entities and trust funds to create a purchasing program for prescription drugs, using the power of a larger group to help leverage lower prices for prescription drugs.
Creating a public insurer that would compete for business with private insurers to help drive down costs. The public insurer, built on the foundations of California’s existing local initiatives, county-organized health systems, public hospitals and community clinics, would give Californians the option to obtain coverage from a publicly owned entity, such as a municipal utility.
Myth: Sen. Aanestad, in his speech on the Senate floor opposing AB8, also said the bill was "modeled on the Massachusetts plan.''
Fact: While AB8 certainly share certain features with the Massachusetts plan, one missing provision is glaringly obvious: the absence of an individual mandate. AB8 does not require anyone to have coverage if they can't afford it. Here's how it would work: workers would be required to take up health coverage IF their employer pays for it and IF -- BIG IF, HERE -- the cost of health care (that includes premiums and out-of-pockets costs) does NOT exceed five percent of a worker's wages. That means a worker earning $41,000 a year would not have to pay more than $2,050 in premiums, co-pays, co-insurance and deductibles.
SB840 was just heard in the Assembly Health Committee a few minutes ago and lots of priceless comments were proferred by opponents of the bill, which we will report on later today. In the face of such attacks on her legislation, though, Sen. Sheila Kuehl remains the picture of composure and thankfully is able to refute the arguments one by one.
But one of the more aggravating statements came from Assemblywoman Audra Strickland, R-Moorpark.
Strickland insists that people would be denied care -- (more than they are now?) -- under a "government run system.'' For instance, a sports athlete with a torn rotator cuff could jump in line ahead an older person who had the same injury.
“Preferential treatment – that’s a big problem that happens when the government gets to decide things,’’ she said. (Of course, I doubt Ms. Strickland would think the Halliburton contracts for the Iraq War were preferential. )
Documentary filmmaker Michael Moore today called for insurance company executives to be tried on manslaughter and premeditated murder charges when policyholders were denied care by the companies and die as a result.
Moore, who was in town to promote the release of his new movie SiCKO, testified at a hearing by Sen. Sheila Kuehl, the five-time author of California's universal single-payer health care plan. He was greeted by an enthusiastic crowd of 1,000 nurses, physicians and other supporters of universal health care.
"I’m here,'' with other lawmakers "in the hopes of igniting a movment across California and this country where the people are covered and where profit is no longer the deciding factor'' in getting people healthcare, Moore said.
The primary target of his invective Tuesday was the profit-making companies -- and some non-profit insurers -- who put money-making before patient care.
"My sincere hope is that California will once again lead the way in taking on the private, profit-making companies that are gouging the citizens of this state and country to line their pockets at the expense of those who are sick, who are ill and who need help.''
More explicitly, Moore called such companies "immoral'' and "criminals.''
“There should never be room for the word profit when you’re trying to decide whether to provide someone care. Our laws state very clearly that they have a legal, fiduciary responsibility to maximize profits for shareholders. If they don’t do that, they are required to turn as big a profit as they can. They only way they can turn a profit is to not provide care.’’
The thrust of Moore's advocacy, however, centered around one state-provided system -- like Medicare or what is supported by Kuehl's legislation -- that would keep administration costs low and provide care to all citizens, not just those who can pay.
Moore's witnesses at the hearing included Andy Bales, CEO of Union Rescue Mission on Skid Row in Los Angeles, where hospitals have been found to dump patients -- in their gowns, IVs and colostomy bags -- who can't pay their bills. Also at the hearing was Dawnelle Keys, whose 18-month-old daughter died hours after being denied treatment at a nearby hospital because it was not affiliated with Kaiser, her insurer.
In addition to Kuehl's hearing, and a rally sponsored by the California Nurses Association -- among the chief proponents of SB840 -- Moore also appeared at a press briefing with Assembly Speaker Fabian Nunez, who supports SB840, and also has his own AB8 health care proposal. Unlike Kuehl's single-payer bill, Nunez' legislation does not get rid of health insurance companies, but does expand public programs and creates a statewide purchasing pool for coverage.
Moore was asked about that legislation, which provides coverage to two-thirds of the uninsured, and other bills in California. He responded "that's the system we all have," and described how he had health plans from Director's, Writer's, and Screen Actors Guilds. "Why should I have three plans and 47 million Americans have no plans?"
Earlier, he said, "Anything that moves toward single payer is a good thing, and I would support that.''
Speaker Nunez, who like many advocates is a supporter of single-payer, said he would change his legislation if he could get two-thirds of the Legislature to support the level of financial investment it would take to fund a more universal system. But the reality is, he said, Republicans won't vote for the bill. In the state Senate, not all Democrats would either. Sen. Lou Correa, D-Anaheim, did not vote for either SB840 or SB48, Sen. Perata's health reform measure.
Moore did, however, give props to Gov. Schwarzenegger, who released his own health reform plan this year. It has not been introduced in legislation, but elements and ideas are embedded in both Nunez and Perata's plan.
“His plan isn't the right plan, but it was very non-traditional Republican thing for him to do, to even say (health care) was a priority,’’ Moore said. “At least Governor Schwarzenegger is saying (health care) is a problem. Recognizing the problem--the old chiche--you're halfway there.’’
Assembly Republicans on the Assembly floor are opining that nearly all of the 18 bills are not being considered as part of the larger health reform debate.
Well, the public record reflects that 10 of the 18 bills were never heard in committee. That's because the Republicans either didn't ask, or cancelled the bills themselves. Specifically, Roger Niello, Van Tran, Bob Huff and Alan Nakanishi -- who all complained that their bills weren't heard -- actively cancelled scheduled hearings. Van Tran cancelled his hearing twice.
As my colleague Beth Capell said, you can't complain that the girl won't go with you to the dance, if you don't pick up the phone and ask her.
And you certainly can't complain that she stood you up if you cancelled the date!!
Update: The Assembly just passed AB8 (Nunez) on a 47-32 party-line vote. We will have a more complete update later.
Senate Republicans released their health proposal today with no new surprises. They want high deductible plans, they want Health Savings Accounts. Things we oppose.
But what I found most irksome were the statements about 1 million people who are eligible but not enrolled in Medi-Cal or Healthy Families.
"Many just don't sign up,'' said an incredulous Sen. George Runner, of Palmdale-Lancaster, in spite of the money spent on outreach and education about these programs.
Runner shouldn't be surprised. Each public program has a different "entry point'' making applying to all of them confusing and cumbersome. According to Kaiser Family Foundation, 67% of children who were eligible, but not enrolled had been denied for technical reasons.
Office hours are limited making it difficult for working adults to take the time off. It takes months to be approved. People are randomly dropped off public program rolls.
These should all be familiar issues for Senate Republicans, who would have heard all this in past years when efforts to streamline enrollment wended through the Legislature.
In spite of this not a single Senate Republican voted for last year's SB437 (Escutia) -- which the governor endorsed and encourage -- which makes it easier to enroll (and keep children enrolled) in Medi-Cal and Healthy Families.
Republicans like to complain about all the processes businesses have to go through to keep track of government regulations and rules. I wish they had the same level of empathy for mere mortals.
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.
