Assemblymembers on Guv's budget: "Not the wisest thing"
Friday, February 12, 2010
Gov. Arnold Schwarzenegger’s self-described “draconian” budget proposals began sounding a little less inevitable by the end of Thursday’s lengthy Assembly Budget Subcommittee hearing at the Capitol.
A strong showing of citizen-advocates opposed many of the cuts, emphasizing the benefits of threatened health programs ranging from one that provides infected jail inmates with HIV and AIDS drugs to the widely accessed Adult Day Health Care program.
Members of the subcommittee chaired by Assemblyman Jerry Hill (D) noted that if the governor’s proposals were to be adopted, the costs for alternatives would be higher in the long run.
Cases in point: * The Office of AIDS program buying discounted HIV-AIDS drugs for county jail inmates prevents costly and hazardous outbreaks of disease. The governor would cut the entire $9.5 million portion of the program for counties – and then would also transfer more prison inmates to county jails, which cannot afford the drugs.
* The governor would eliminate vision coverage for kids whose families buy discounted health insurance through the Healthy Families SCHIP program. Lawmakers noted that this move would cost the state uncounted federal dollars by preventing better classroom performance by children who need glasses.
* A proposal to eliminate Adult Day Health Care drew one of the largest crowds of opponents, who testified that the option of long-term housing was unaffordable. Another option, for household members to quit their jobs to care for the participants 24-7 would cost California productive workers and income taxes.
* Administration spokesmen argued that Family Planning Services funded by a 9-to-1 federal match needed to be eliminated because “coming up with 10-cents on the dollar in this environment” was difficult. Legislators questioned that assessment, and suggested the Administration go find even more programs with a $9 federal match for every $1 spent by the state.
Assemblyman Jim Beall Jr. (D) noted that moving ahead with health program cuts would be short-sighted because of the likelihood of federal health reform creating opportunities to restructure delivery of health care in California.
In particular, Beall said, new federal rules about mental health care getting parity with physical health care should pave innovative paths for blending delivery of care.
The final segment of the 6-hour hearing, interrupted by the second Assembly floor vote on Sen. Abel Maldonado’s nomination for lieutenant governor, was dedicated to the last item on the agenda: a proposed shift of at least $1 billion from Proposition 63 Mental Health Services Act dollars to the general fund.
The item brought out perhaps the largest turnout of the day, with advocates from Long Beach to Sonoma lining up to tell stories of how the MHSA saved money, and lives. After a Sacramento woman tallied the cost – over $2 million -- of her mentally ill mother’s numerous hospitalizations, she made the point that early intervention through MHSA-style programs would have led to far less costly, and tragic, outcomes.
Of the proposal to shift MHSA dollars to the general fund, Assemblyman Wesley Chesbro (D) said “The impact of this will be severe if it’s allowed to go forward.”
Following the entire presentation, Hill said, “We fully understand the governor’s request,” regarding the mental health funds. “This is probably not the wisest thing to do.”
California’s performance ranking in five key areas, including health care, dropped a grade on the annual report card issued by Children Now, leaving the Golden State with its most tarnished marks in the 20-year history of the advocacy group’s rating system.
Due mainly to brutal cuts in the state’s FY09-10 budget by the Legislature and the governor in children’s programs, California “earned the worst grades ever” for 2009, said Ted Lempert, president of Children Now. Lempert, a former state legislator, summed up the state’s dire performance during a legislative briefing held in the Capitol on Monday afternoon for staff members of the Legislature.
Still, Lempert, joined by vice president Wilma Chan and Kelly Hardy, associate director of health policy for Children Now, tried to emphasize the possibilities for improvement in coming budget discussions. “There are lots of opportunities to move forward this year on children’s health,” Hardy told the group. The silver lining in getting California’s children through the tough budget cuts last year came in the form of an unprecedented financial boost from the federal government.
The increase in federal matching funds did not pull California out of its economic doldrums, however; it merely helped keep pace somewhat with the increased need brought about by the loss of job-based health coverage as more and more parents became unemployed, Hardy said. The areas in which California performed worse than in previous years were:
Children’s oral health: the state’s marks dropped from a “C to a D” Infant health: the state’s marks dropped from a “B- to a C+” Adolescent health: the state dropped from a “B- to a C+” K-12 education: the state dropped from a “C- to a D” Integrated services: the state dropped from a “D+ to a D”
In response to legislative staff questions about the methodology of Children Now’s assessment, Lempert responded that the organization examined statistics, policy program decisions and also took a broad view of the outlook for the 9.4 million children currently living in California. In the final analysis, he said, “The methodology was similar to the academic grading process in that it was somewhat subjective.”
There was widespread recognition in the room that things will not become rosier overnight. “We know this is going to be another bad year for children in the California budget,” Chan said. “But people in this building have to make kids a higher priority – so our children and our economic future won’t become sicker.” The report card can be found online at the Children Now website, reports and research section.
Governor Schwarzenegger released his proposed 2010-11 budget today, which includes severe cuts and no new revenues.
As part of the cuts, the Governor proposes a $2.9 billion cut in health and human services (including $1.1 billion in Medi-Cal), and an additional $3.5 billion cut in health and human services if California does not get a major infusion of federal funds.
The Governor proposes shocking cuts eliminating coverage and care for millions of Californians, which will have dramatic impacts on not just these families but on the health system on which we all rely. Even *with* a massive infusion of federal funds, the Governor would still propose to eliminate coverage to hundreds of thousands of Californians, including children.
This is an anti-jobs budget that not just harms California families and our healthcare system, but our economic recovery. The most effective way to create jobs is invest in Californians, and in their health and in services to help all of us get through a tough time. This proposal completely undermines our economic recovery efforts.
The economic impacts of these health and human service cuts would be multipled because we would not just lose jobs but billions in federal matching funds.
2010: THE NEW YEAR BRINGS MORE CUTS TO CONTEST * Gov. Schwarzenegger To Unveil FY10-11 Budget Proposal on Friday, 11:30 a.m. * Health Access Reveals "The Damage Already Done" Six Months Into 2009-10 Budget * Stakeholders Meet for First Medi-Cal Waiver Committee Meeting
* 2010 Promises to be a Big Year! Join Us on Facebook! Follow Us on Twitter!
BUDGET TO BE ANNOUNCED FRIDAY: California Governor Arnold Schwarzenegger announces the release of his new FY2010-2011 budget around 11:30 a.m. on Friday. All expectations are that the budget proposal will include more painful cuts in programs vital to California's health and struggling economy. Health Access will review and report later tomorrow on the proposal's impact on health and human services, with quick reactions on our blog and on Twitter.
ASSESSING "THE DAMAGE ALREADY DONE" BY CUTS BEFORE CONTINUING: In anticipation of that announcement, Health Access California today released a new report detailing the six-month impact of nearly $2 billion in cuts already made to the state’s healthcare system in the current budget year. Entitled “The Damage Already Done: A Report on the Impacts of the 2009 Health Care Budget Cuts, Six Months In,” the report documents many of the effects these cuts have had on individual patients, families, health providers, and our economy.The finding? Just six months into the 2009 budget, hundreds of thousands of Californians have been denied care or coverage for key services, and we see indications of the health system we all rely on is crumbling, with five clinics closing. These cuts are starting to ripple through the health system and our economy, as we lose health jobs and federal matching funds, and people don’t get the help they need to get through these tough times. Six months into those cuts, families are suffering harmful impacts of being denied access to a range of critical services such as dental care, basic prevention and affordable health care options. We hope this assessment informs the discussion about whether the state can afford to cut more.
THE GOVERNOR'S ANTI-JOBS, ANTI-HEALTHCARE STATE OF THE STATE: But the indications are not positive. Yesterday, the Governor presented his State of the State address. The Governor focused on jobs, but by suggesting tax breaks and credits that would only make the deficit bigger and force additional cuts. He conveyed that the budget will include painful cuts, but did not acknowledge the lost jobs and lost federal funds that would result.
The Governor took the opportunity to oppose the health reform proposals in Congress, completely contrary to the health plan he supported merely two years ago. Health Access believes his reasoning is based on faulty assumptions, and has very different numbers of the fiscal impact of Medicaid expansions in health reform on California. Beyond that, California--with its large percentage of uninsured people and low-wage workers--is likely to disproportionately benefit from the billions of federal dollars to help families and small business, and the state, afford coverage.
MEDI-CAL WAIVER STAKEHOLDER PROCESS STARTS: In this busy week, Thursday marked the first gathering of the stakeholder committee appointed to help guide the state Department of Health Care Services in its 1115 Medi-Cal federal waiver process. The renegotiation of our state's Medi-Cal waiver with the federal government will provide challenges and opportunities regarding the Medi-Cal coverage of 7 million California children, parents, seniors, and people with disabilities. More information is at the Department of Health Care Services website.
A REQUEST FOR THE NEW YEAR: From fighting budget cuts to fulfilling the promise of health reform, 2010 will be a very busy year. We’ll need your help, so resolve to join and contribute: Consider contributing to the Health Access Foundation!
Word has come that the federal government will permit, for a limited time, California to take advantage existing federal rules to implement AB1422 (Bass) which would help to fund the Healthy Families program.
This is a great relief. Until now, we heard very discouraging words from those in DC about the prospects for approval of federal matching funds through the extension of the gross premiums tax to Medi-Cal managed care plans.
As you may recall, the health coverage of almost a million children was put at risk as a result of the budget adopted by the Legislature and the further line item vetoes by the Governor back in July. AB1422 was a last ditch effort supported by both the insurers and the advocates to find a way to end the waiting lists and avoid disenrollment of hundreds of thousands of children in the midst of the great economic downturn.
When we learned of the difficulties at the federal level, in a matter of days, an impressive coalition of 20 California groups signed a letter of support for the implementation of AB1422 for Obama Administration.
The federal Centers for Medicare and Medicaid Services will pursue a formal rule making process that is likely completed in June 2011 or later.
Nobody wants a lump of coal in their stocking, least of all the children of California---and in the land of sunshine and oranges, every kid should have health care—and now a million of them will have that chance.
The story notes that kids are not especially likely to be hospitalized and that most kids who are recover and that is all good.
But here is what is really appalling: the study period is 1988 to 2005—and for the last half of that period the Children’s Health Insurance Program (known as Healthy Families in California) was in effect—meaning that most low and moderate income children in this country had access to affordable coverage. Yet there are still seven million children uninsured in this country, including over 600,000 in California.
Study after study has demonstrated that uninsured children are less likely to get treatment for serious conditions like asthma and diabetes, conditions that can be managed with good care but that without it can be literally life-threatening. Now we have a study that documents what policy types had suspected: uninsured children are more likely to die than children with health insurance.
Before Healthy Families was created, health care costs were the most common cause of homelessness among families—a family would literally spend next month’s rent to get a kid seen in the emergency room. Any parent can imagine what that choice feels like: spend next month’s rent or face the risk that your child will be one of the 1,000 a year who die after hospitalization because you waited too long.
As we look forward to the week’s debate over the proposals in Congress, we agree with many who say that the proposals could be improved but we also remember that parent in the middle of the night making the choice between homelessness and a child’s life. No one should face that choice.
Health Access attended the Managed Risk Medical Insurance Board (MRMIB) board meeting on Thursday in particular because we were interested in the status of how California's children were faring under the Healthy Families Program now that the eligibility restrictions have been removed. On July 17 the state reluctantly established a waiting list of eligible children for the state children's health insurance program due to funding shortfalls. After short-term rescue strategies were cobbled together this fall to provide additional money to fund the program, everyone at the meeting was anxious for news about how quickly eligible children's applications were being processed. Here's what we learned at the public board meeting:
Although the state discontinued the waiting list on September 16, families were still receiving incorrect notices for another week that they were being put on a waiting list.
As of September 30 Healthy Families enrollment had fallen from over 920,000 to 871,335.
Advocates were very disappointed to learn how slowly the administrative vendor was working down the waiting list. They have processed only about one-quarter of the wait-listed children's applications. They anticipate that they will process the remaining applications by mid-November, but hope to have the bulk of them reviewed by the end of this month.
MRMIB is projecting much higher retention rates of new applicants because of the worsening economy, and the slowness of the job recovery picture (because employer-based health insurance for families is often offered to new employees.)
Although everyone voiced this concern at the outset, we should remember how long it takes to fix the administrative actions that were undertaken to limit enrollment in public programs. We should not undertake these restrictions lightly. Healthy Families is experiencing resurgent enrollment for this program and the families who are enrolled are expected to remain eligible for a longer period of time due to the economy. In addition to the new influx of applications, Healthy Families must institute an expedited processing of wait-listed children that built up during the time when enrollment was limited due to uncertain financing. In addition, they have to correct the confusion that has resulted from the off-again/on-again status of enrollment in the program which may have deterred some eligible families from even applying.
Even though we have endured these restrictions on enrollment, longer-term financing for children's health insurance is far from assured--and the rules may be changing under several scenarios for health care reform. It is important to remember that we should place restrictions on enrollments for public programs only in the most extreme financial circumstances because the process of undoing the limits put in place takes way longer than anyone wants it to!
posted by Elizabeth C Abbott | Permalink | 1:35 PM
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Some kudos for keeping kids on coverage...
Tuesday, September 22, 2009
Governor Schwarzenegger signed AB1422 today, which along with increased premiums, increased copays, and contributions from First Five provide the resources to prevent loss of Healthy Families coverage for over 900,000 children. Anticipating this signature, the Managed Risk Medical Insurance Board has already started processing the nearly 90,000 children that have been left uninsured on a waiting list for the last month or so. We should have never have been in this situation, but this is good news that such a major crisis was averted.
Health Access California joined the 100% Campaign, the community clinics, Western Center on Law and Poverty, and other organizations in supporting AB1422 by Assembly Speaker Karen Bass which creates a gross premium tax on managed care organizations that can be used to draw down federal match to fund Healthy Families. But it was our frequent adversaries, the HMOs and health insurers themselves, that provided essential support for the bill.
We here at Health Access California go head to head with HMOs and insurers day after day, year after year. HMOs and insurers are among our most frequent adversaries and only rarely on the same side with us. So it is a rare day when we give them credit for helping to get something good done. They had their own interest in supporting the measure, but it still was a good thing to do.
Particular credit is due to John Ramey, who now heads the association that represents the local initiatives, California’s home grown public options for Medi-Cal and Healthy Families. John Ramey was one of the first staff at MRMIB when it was created. We know him more recently from his work with the Chamber of Commerce opposing an employer mandate ballot measure in 2004---and in working with Governor Schwarzenegger for health reform in 2006-07. John was committed to avoiding the destruction of the Healthy Families program as a result of the devastating cuts done in the July budget: he revived the notion of reconfiguring the existing provider fee for HMOs into a gross premiums tax that could draw down federal match.
I know the lobbyists who are on staff with the various insurers and HMOs as well as the trade association lobbyists and the very highly paid contract lobbyists from some of the highest billing lobbying firms in Sacramento. I spend a lot of time in the halls of the Capitol with these folks. The lobbying firms included Lang Hansen O’Malley and Miller as well as Sloat Higgins, both firms that bill a million dollars or more a quarter (http://cal-access.sos.ca.gov/Lobbying/Firms) One of these contract lobbyists once accused me of wanting government-run health care because of the modest reforms to label products in our AB786! So the gulf that exists between their world and mine is not just about who their clients are and how much they charge but their perspective on issues.
I watched over the last few weeks as these lobbyists sweated vote by vote to pull out the victory that looks easy from the vote totals but was very much a day by day effort. These lobbyists assured Republican legislators that there was no official opposition, even from many conservative tax groups, and that at the last critical moment, the Chamber of Commerce senior lobbyist came to lobby on our side of the fight. It is the tradition on the corporate side to hire both conservative Republicans and former Democratic staff: it meant that the face of this fight was often a HMO trade association lobbyist who used to lobby for the Chamber of Commerce or a HMO staff lobbyist that is a former Republican staffer well known for his conservatism.
Credit is also due to Sumi Sousa, Speaker Bass’ staff; David Panush, staff to Pro Tem Steinberg and Jennifer Kent in the Governor’s office. The three of them worked in tandem to make this happen. While their bosses get the public credit (after all Bass, Steinberg and Schwarzenegger were elected, not the staff!), the staff does a lot of the day to day, hour by hour work to get things done.
Of course, thanks are also due to the many advocates who supported this effort as well—but for once, we had the easier assignment.
In a year when we have seen such devastating cuts in health and human services, it is good to have averted the worst of the cuts to Healthy Families.
In a hearing today, the Managed Risk Medical Insurance Board agreed to restart enrolling children in Healthy Families coverage tomorrow, September 17th, after making a formal finding that funding is now sufficient to avoid disenrolling children currently enrolled in the program.
While Governor Schwarzenegger has yet to sign AB1422(Bass), the bill that helps bridge the funding gap by drawing down new federal funds, he has committed he will sign it.
As quoted in their press release, Lesley Cummings, Executive Director to the Board, stated, “Today, the Board was able to make a finding that there are sufficient funds at this time to fully cover estimated expenditures in the Healthy Families Program. I am happy to announce there will be no disenrollments and the program will be open to new enrollment beginning tomorrow. Our administrative vendor, Maximus, has already begun processing applications from the waiting list. The Board’s finding was made possible by three key actions: the passage of AB 1422, program changes to cut expenditures, and the generous commitment from the state First Five Commission to provide funding for children ages 0 to 5 in the program. We are extremely grateful for the huge outpouring of support for the Healthy Families Program and the fact that hundreds of thousands of children in California will have access to health care as a result.”
The "program changes to cut expenditures" were additional costs placed on these low-income families, including increases in subscriber premiums and co-payments for health care services that will save the program approximately $17.5 million this year, effective November 1.
In the short amount of time that enrollment was closed, the waiting list grew to 87,000-plus children. It will take Maximus, the administrative vendor, about 30 days to notify families as to whether their children are eligible and have been enrolled in the program. Actual health care coverage once enrolled begins after 10 days.
In the last hours of the legislative session, literally between 5:30AM and 6AM Saturday September 12, the California Legislature passed AB1383 by Assemblyman Dave Jones which will create a hospital provider fee that will be used to fund children’s coverage and to improve Medi-Cal reimbursement to hospitals (now 51st in the nation). It passed the Senate 24-5 and the Assembly 52-22 as a fee measure. In the Senate, the vote was party-line, in the Assembly a few Republicans voted in support.
Because the Senate Republicans were blockading all two-thirds vote measures on the last day of the legislative session over un-related budget matters, the bill has been amended to eliminate the urgency clause and to go into effect January 1, 2010 so that it no longer required a two-thirds vote. The amendment also eliminated the appropriation that would have funded the work of the Department of Health Care Services in implementing the measure.
The amendments also included some seemingly minor tweaks to the formula or model that were needed to bring it into compliance with federal requirements for the provider fee.
At this moment, we do not know whether the elimination of the urgency clause means half-year money for the fiscal year 2009-10 or full-year money. Provider fees take months to implement in any case.
Whether it is six months worth of better funding for hospitals and children’s coverage or a full year, Health Access is supportive of the measure.
More importantly, we do not know how the Schwarzenegger Administration will respond to the revised measure. So there is work to do to persuade the Governor to sign the bill.
At this moment, AB1383 by Assemblymember Dave Jones--which would create a hospital provider fee, part of which would be used for increased Medicaid reimbursements and for children’s coverage--hangs in the balance. Yesterday Governor Schwarzenegger sent a letter saying he will veto the measure because the model used for the development of the hospital provider fee is fatally flawed.
The California Hospital Association proposal for the hospital provider fee appears to violate the requirements of the federal Centers for Medicare and Medicaid Services for provider fees. These requirements are complicated but not particularly mysterious: more than 30 states, including California, have provider fees for nursing homes and more than 20 states have provider fees for hospitals. It is unfortunate that it is just now in the closing hours of the legislative session the problems with the CHA provider fee proposal have been discovered—and that it puts at risk $320 million in possible funding for protecting and expanding children’s coverage, especially in these tough budget times.
Efforts are underway to find amendments that resolve these difficulties but at this moment it is not at all certain what the outcome will be.
Health Access has been supportive of AB1383—because California needs more children’s coverage, not less and because Medi-Cal reimbursement for hospitals is 51st in the country so it needs to be improved as well.
The full Healthy Families report, with updated info...
Friday, September 04, 2009
Here's our full treatment on AB1422 and Healthy Families. We previously reported a preliminary tally. The official tally is 62-5, with the following Republicans in support: Berryhill, Berryhill, Conway, Emmerson, Fletcher, Fuller, Gaines, Garrick, Gilmore, Nestande, Niello, Neilsen, and Villines.
HEALTH ACCESS ALERT Thursday, September 3rd, 2009
ASSEMBLY ADOPTS DEAL TO KEEP HEALTHY FAMILIES GOING * Bi-Partisan Backing of AB1422 (Bass) Leads to a 62-5 Vote For New Tax * Governor Vows to Sign Bill, Pleased No General Funds Involved * AB119 (Jones) Passes, Banning Gender Bias in Health Insurance Pricing
More Updates on the Health Access Blog: Gov will sign, and no kids kicked off, but many cuts continue: Healthy Families: a resurrection; By any legislative means necessary; Public options all over the place; Seeing what the candidates do; Rallies this week for health reform!; New data on debt shows need for action; Get well soon, Rick!; Blue Cross is at it again; Video blogging by Biden; Change the channel and the health reform debate
Follow Health Access on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget and health reform issues. Followers were among the first to find out about key bill passage in the Legislature yesterday and big HCAN rally in LA!
SACRAMENTO -- In what one assemblyman called “our finest moment,” the Assembly on Thursday overcame its partisan differences long enough to pass a bill allowing 600,000 California children to keep their low-cost Healthy Families insurance coverage.
Healthy Families seemed destined for the chopping block before a bi-partisan, two-thirds Assembly majority rescued the program by voting 58-0 for a new tax that everyone -- even those being taxed -- agreed was worth bridging the ideological gulf.
Children’s advocates working to ensure continued coverage for kids in Healthy Families were relieved Thursday at the reprieve negotiated in the Legislature. “The parents of the nearly 1 million children enrolled in the program can sleep better tonight knowing that their kids will have health coverage as the school year starts,” said Children Now’s Tim Morrison.
The legislation likely will reverse a decision by the state’s Managed Risk Medical Insurance Board to begin disenrolling children from the program in a matter of weeks. MRMIB members already voted to begin disenrollment, citing “insufficient funding” but also indicated they were holding out hope for an eleventh-hour funding solution. Now, the board appears to be well-positioned to reverse that vote.
In the Assembly on Thursday, a number of Republicans stood to deliver a series of dramatic, last-minute tributes to AB 1422, (Bass-D), throwing their support behind the measure estimated to generate $97 million. They spoke passionately of the need to preserve the Healthy Families program, the struggles with poverty they see in their districts and the need to provide health care to children vulnerable to the swine flu, already making its rounds through California schools.
The result was surprising, breaking up the partisan iceberg that successfully froze out several proposed budget solutions in the Legislature in the past year. In the Senate, the measure had passed 27-8 on Wednesday, with somewhat less bi-partisan backing. After the vote, Speaker Karen Bass (D), declared, “This is a memorable day when we can cross party lines and stand up for 600,000 California children” who were at risk of being kicked off the program.
Bass also told lawmakers that California’s Taxpayer Association, traditionally an opponent of tax increases, saw enough merit in the deal to take a neutral stance on AB1422, and the California Chamber of Commerce supported the bill.
Gov. Arnold Schwarzenegger, whose severe budget cuts contributed to a $194 million shortfall in the Healthy Families program, said he would sign the bill.
At least three key factors in the AB 1422 deal were instrumental in attracting Republican support: First, the new 2.35 percent tax that AB 1422 imposes is a reduction from the expiring 5.5 percent fee that health plans contracted by the state to manage Medi-Cal and Healthy Families coverage were previously paying. Second: The health plans did not object to paying the new tax, if it drew down federal funding that went back to them to keep Healthy Families going. Third: Families enrolling in the program will share some of the cost burden, allowing a good fit with the Republican tenet of personal responsibility.
Democratic Assemblyman Charles Calderon (D) called the AB1422 proposal “a win-win. They (health plans) get a lower tax and they get the money back in the form of increases or higher payments.” Of the bi-partisanship exhibited by Assembly members, Calderon said, “This is one of our finest hours, if not our finest hour yet.”
Families will be charged nominally higher fees for premiums, ranging from $4 to $7 per child, with very low-income families exempt from the increase. Other cost-sharing will include co-pay increases from $5 to $15 for emergency room visits that do not result in hospitalization and co-pay increases from $5 to $10 for non-preventative health, dental and vision services. In addition, children’s options in choosing dental service providers will be limited.
Still, the increased costs for families are the lesser of several, more expensive options considered by the MRMIB staff. In the final analysis, staff embraced the more moderate proposals, hoping to spare families whose budgets already are stretched more financial pain than necessary.
“This is a high-quality program,” Assemblyman Roger Niello (R) said of Healthy Families, California ’s version of the national children’s insurance program known as SCHIP. “The tax is supported by the industry. I think we can all agree this is a good thing.” Assemblyman Michael Villines (R) noted that the tax is a temporary fix-it, in place until 2010, to keep Healthy Families in operation, and it ends when enhanced federal funds are no longer available.
Part of the purpose of the funds generated by the tax is to secure the increased federal matching funds announced by President Obama last spring -- $2 for every $1 the state spends on Healthy Families.
Republican Assemblyman Danny Gilmore said he had hoped the floor vote would be 80-0 (which would have required participation by all Republicans). “By golly, this is an opportunity where we can come together for the children of our state,” Gilmore said, citing a 40 percent jobless rate in agricultural parts of his district that have been hit severely by drought. “Get over to my district and look at some of those people standing in line waiting for food.”
With passage of AB1422, and the governor’s signature, MRMIB is spared from having to drastically scale back the program -- for this year at least. The children’s health insurance program also is benefiting from a generous boost by the First Five Commission, which committed $81.4 million to cover 200,000 of the kids in Healthy Families, aged 0-5 for one year.
Meanwhile, the demand for Healthy Families coverage has never been higher, with the economic downturn lingering throughout California , and more than 70,000 families placing their children’s names on a waiting list for enrollment. On average, about 3,000 children per work day have been added to the list since MRMIB started taking names instead of enrolling more children in the health insurance program.
Also passing the Legislature on Thursday was AB119 by Assembly Health Committee Chair Dave Jones (D), which prohibits gender discrimination in pricing health care insurance.
Gov will sign, and no kids kicked off, but many cuts continue...
Thursday, September 03, 2009
With the passage of AB1422(Bass) that draws down new federal funds to help prevent children from being disenrolled from health care coverage, consumer, children's, and health advocates breathed a sign of relief.
Governor Arnold Schwarzenegger has committed to sign the bill that was passed today, and so hopefully MRMIB will start enrolling the 70,000+ children on their waiting list as soon as possible. The Governor issued the following statement after the legislature passed AB 1422 by Assembly Speaker Karen Bass (D-Los Angeles):
“The passage of this bipartisan legislation is a great victory for California’s kids. I am very pleased that all parties came together including the legislature, the health plan industry, children’s health advocates, the First Five Commission and others to find a shared solution to fund this important program that ensures not one child will lose their health care coverage - without any new General Fund dollars. Everyone was forced to make very difficult but necessary decisions to balance our budget, and these are the kinds of solutions we should be looking for in this tough economy. I look forward to signing this bill for our kids.”
The good news is that we have averted a massive health and humanitarian crisis, kicking hundreds of thousands of children off coverage. We shouldn't have been facing such an ugly scenario in the first place. And let's remember that while we've prevented the anxiety of families losing coverage for their kids, those lower-income, working families are now facing increased--even doubled--premiums.
The bad news is that other major cuts will continue. This was a unique opportunity to prevent this specific cut: the calvary isn't coming to prevent the devastating impact of other health cuts, from the elimination of dental and other benefits for three million Californians, or the zeroing out of state funding for community clinics. There is no such savior for millions of other of Californians facing such cuts.
In what one assemblyman called “our finest moment,” the Assembly on Thursday overcame its partisan differences long enough to pass a bill allowing 600,000 California children to keep their low-cost Healthy Families insurance coverage.
Healthy Families seemed destined for the chopping block before a bi-partisan, two-thirds Assembly majority rescued the program by voting 58-0 for a new tax that everyone -- even those being taxed -- agreed was worth bridging the ideological gulf.
Children’s advocates were relieved at the reprieve that was negotiated for Healthy Families.
"The parents of the nearly 1 million children enrolled in the program can sleep better tonight knowing that their kids will have health coverage as the school year starts," said Children Now's Tim Morrison.
A number of Republicans stood up on the Assembly floor to deliver a series of dramatic, last-minute statements of support for AB 1422 (Bass-D), throwing their backing to the measure estimated to generate $97 million.
They spoke passionately of the need to preserve the Healthy Families program, the struggles with poverty they see in their districts and the need to provide health care to children vulnerable to the swine flu, already making its rounds through California schools.
The result was surprising, breaking up the partisan iceberg that froze out several proposed budget solutions in the Legislature in the past year. Not a single Republican voted against the measure (although many declined to cast a vote). In the Senate, the measure had passed 27-8 on Wednesday, with somewhat less bi-partisan backing.
After the vote, Speaker Karen Bass (D), declared, “This is a memorable day when we can cross party lines in California and preserve health care for 600,000 children statewide.”
Gov. Arnold Schwarzenegger, whose severe budget cuts contributed to a $194 million shortfall in the Healthy Families program, reportedly said he looked forward to signing the bill.
Three key factors in the AB 1422 deal were instrumental in attracting Republican support:
First, the new 2.35 percent tax that AB 1422 imposes is but half the 5.5 percent fee that health plans contracted by the state to manage Medi-Cal and Healthy Families coverage were previously paying. Second: The health plans did not object to paying the new tax, if it drew down federal funding that went back to them to keep Healthy Families going. Third: A component of the deal was that low to middle-income families enrolling in Healthy Families share some of the cost burden, allowing a good fit with the Republican tenet of personal responsibility.
Families will be charged higher fees for premiums, ranging from $4 to $7 per child, with the lowest-income families exempt from the increase. And, they will pay $5 to $15 dollars more for medical services.
“This is a high-quality program,” Assemblyman Roger Niello (R) said of Healthy Families, California’s version of the national children’s insurance program known as SCHIP. “The tax is supported by the industry. I think we can all agree this is a good thing.”
Assemblyman Michael Villines (R) noted that the tax is a temporary fix-it, in place until 2010, to keep Healthy Families in operation, and it ends when enhanced federal funds are no longer available.
Part of the purpose of the funds generated by the tax is to secure the increased federal matching funds announced by President Obama last spring -- $2 for every $1 the state spends on Healthy Families .
Republican Assemblyman Danny Gilmore said he hoped the floor vote would be 80-0 (which would have required participation by all Republicans).
“By golly, this is an opportunity where we can come together for the children of our state,” Gilmore said, citing a 40 percent jobless rate in agricultural parts of his district that have been hit severely by drought. “Get over to my district and look at some of those people standing in line waiting for food.”
With passage of AB1422, and the governor’s signature, the state’s Managed Risk Medical Insurance Board plan to disenroll children from Healthy Families coverage now appears moot – for this year at least.
The children’s health insurance program also is benefiting from a generous boost by the First Five Commission, which committed $81.4 million to cover 200,000 of the kids in Healthy Families, aged 0-5 for one year.
Meanwhile, the demand for Healthy Families coverage has never been higher, with the economic downturn lingering throughout California, and more than 70,000 families placing their children’s names on a waiting list for enrollment.
This report, prepared as the last week for fiscal committees to take action is winding down, is by Health Access advocate Beth Capell:
Today, the Senate Appropriations Committee took action on numerous important health measures; some of the news is good, some of it is bad.
In a very difficult state budget year in the midst of the worst economic downturn since the 1930s, it is not surprising that Appropriations members would be cautious about letting out measures that increase cost. Still the bad news is never pleasant.
Good news: bills that passed....
AB786 (Jones-D), the Health Access-sponsored bill to provide consumer protections in the individual market.
AB2 (DeLaTorre-D) on independent review of rescinded policies.
AB98 (DeLaTorre-) on maternity coverage for products regulated by the Department of Insurance.
AB108 (Hayashi-D) limiting the period in which rescissions may take place to 24 months.
AB1142 (Price-D) on minimizing balance billing of Medi-Cal patients by requiring hospitals to notify doctors if patients have Medi-Cal coverage.
AB1269 (Brownley-D) on working disabled adults being covered by Medi-Cal, although implementation was delayed until 2011.
Bad news: bills that were held....
AB1521 (Jones-D) on health insurance agents, Health Access sponsored.
AB730 (DeLaTorre-D) fines for rescission of policies.
For Healthy Families: Some possible good news, some troublesome choices....
This morning, MRMIB acted by emergency regulations to increase co-pays for children on Healthy Families, for everything from doctor's visits to prescription drugs to emergency room visits.
Based on the savings from the increased co-pays and the funding from the First Five commission that will help to cover children ages 0-5, MRMIB voted to delay disenrollment from October 1 to November 1, with notices going out to families deferred from September 1 to October 1.
Sadly, the waiting list has now grown to 70,780 children as enrollment remains closed.
Within the hour of MRMIB's action, the Senate Appropriations Committee voted on AB1422 by Assembly Speaker Karen Bass (D). This measure reconfigures an assessment on Medi-Cal HMOs from a provider fee to a smaller gross premium tax that will be used to draw down federal funds to restore Medi-Cal rate cuts to Medi-Cal HMOs and to provide funding for the Healthy Families program. This is an urgency measure that requires a two-thirds vote.
AB1422 will also increase premiums for the low-income children who depend on the Healthy Families program. The combined actions of MRMIB and the provisions of AB1422 will increase costs for low-income families through both premiums and copays.
The effort to enact AB1422 has been led by the HMOs that serve Healthy Families enrollees. It is also supported by Health Access, the 100% Campaign, California Primary Care Association and others.
AB1422 has had cautious bi-partisan support in the three committees that have now heard the measure: Senate Revenue and Taxation as well as Senate Health yesterday and Senate Appropriations today.
In agreeing to vote for the measure today, Senate Appropriations Vice-Chair Dave Cox (R) said he was willing to vote for the measure because of the increased premiums, increased cost sharing and the commitment by the First Five Commission to help fund to Healthy Families coverage for children ages 0-5.
Cox also noted that given the threat of H1N1 virus at the start of the school year, he was not willing to take the risk to the health of the community by having 600,000 children losing health coverage. But again, he said that his vote was only good for this committee and he had further concerns that needed to be resolved.
Five Senate Republicans have now supported AB1422: Roy Ashburn, Cox, Jeff Denham, Abel Maldonaldo and Mark Wyland. The only "No" vote so far has been Senator Mimi Walters, R-Tustin.
Seeing a slightly brighter financial picture on the horizon, the Managed Risk Medical Insurance Board on Thursday postponed for one month the process of kicking kids out of the Healthy Families program.
Disenrollment will begin with notices mailed to families on October 1, instead of September 1 as originally planned.
Board members and staff voiced hope that, somehow, more funds will surface to save them from having to follow through with the disenrollment plan, adopted by voice vote earlier this month.
Perhaps coincidentally, the 30-day reprieve came as the nation marked the death of Senator Edward Kennedy, an original author of the nationwide children’s health insurance program, or SCHIP, which in California is known as Healthy Families.
President Obama’s ARRA economic stimulus initiative called for an expansion of SCHIP, pledging beefed-up funding of $2 in federal matching funds for every $1 that states invest in the program.
While at least a dozen states have managed to use the added federal funds to grow their SCHIP programs to cover more children than ever, California’s stubborn budgetary problems due to the lingering recession has led to cutbacks -- and less services for fewer children.
The final version of the state budget crafted by the Legislature and Governor Arnold Schwarzenegger targeted Healthy Families with $194 million in cuts.
That amounted to a substantial financial blow to the program for low-income, working, taxpaying families in California – those whose income is too high to qualify for Medi-Cal and too low to afford health insurance for their kids on the open market.
Still, the blow was softened greatly by an $81.4 million commitment from the voter-approved First Five Commission, which pitched in funds to cover about 200,000 children ages 0 to 5 for one year.
Childrens’ advocacy groups and coalitions such as Children Now, The 100% Campaign and the Children’s Health Initiative have been persistent in urging MRMIB to tread cautiously while implementing program cutbacks due to insufficient funds.
One advocate stood up from her seat in the MRMIB auditorium Thursday upon hearing the board discuss delaying disenrollment. Called on by a puzzled Chair Cliff Allensby, the advocate blurted out: “Thanks. I just wanted to say ‘thanks.’’’
Meanwhile, the number of children whose names have been added to a waiting list for access to Healthy Families coverage has grown to 70,788, following a consistent trend of an 11 percent increase since the last count was released on August 20.
Most of the children seeking access to Healthy Families live in Southern California, the board’s staff reported, where population density necessitates greater services than elsewhere in the state. More than half of the children signed up on the waiting list reside in five Southern California counties.
A portion of the brighter financial picture for Healthy Families comes from higher fees to be paid by the families served. Generally, co-pays that were $5 for services will rise to $10 -- or up to $15, in the case of paying for prescription name-brand drugs when a generic version is available.
Visits to the emergency room will result in a co-pay hike from $5 to $15 whenever hospitalization is not required.
Premiums for those families with incomes that are 150% to 200% of the federal poverty level will increase from a family maximum of $36 to $48.
Premiums for families earning from 200% to 250% of the federal poverty level will rise from a family maximum of $51 to $72.
The changes seem bound to remain in place even if more funding is found, something that staff told board members is almost certain to materialize through an anticipated "complicated array of solutions.”
Tough times = 63,000 kids wishing, waiting for health care
Thursday, August 20, 2009
Continuing its trajectory of growth, the waiting list for Healthy Families has reached 62,955 California children whose families are seeking affordable health care coverage for their kids.
The list has grown by about 3,000 children per work day since the state’s Managed Risk Medical Insurance Board started taking names instead of enrollees July 17 because of state budget cuts.
The new tally was announced Thursday at a MRMIB meeting, one of a series held to consider cost-cutting options for its insurance programs of last resort for low-income, working Californians unable to afford health care coverage on the open market.
The meeting took a somber tone as MRMIB, its staff and children’s advocates continued with their task of doing the least harm to their programs while following the mandate of Governor Schwarzenegger to “live within our means,” through severe state budget cuts.
For every dollar in state general funds denied to Healthy Families, at least $2 in federal matching funds is lost. Schwarzenegger and the Legislature slashed $194 million from the children’s health care program in the last round of budget cuts.
No one in the MRMIB auditorium on Thursday seemed eager to embrace the brutal consequences of drastic program cutbacks looming on the horizon.
Nonetheless, the staff of MRMIB made several recommendations, mainly embracing the least onerous cutbacks or cost-sharing proposals that require families to pay more out-of-pocket -- or lose coverage for certain health care services. The board was reminded that, although they must ultimately vote to recommend changes, they “are not the deciders.” Only after statutes are approved by the Legislature would any changes get enacted. Among the recommendations the board must ultimately make are:
Come October 1st, continuing with plans to disenroll children from Healthy Families, barring a miracle of additional funds being pledged. Already, the First Five Commission has offered up $81.4 million to cover an estimated 200,000 children up to age 5 for a year. On Thursday, it was clear that many people still held out hope that an angel funder will yet surface – whether from the public or private sector.
Placing tens of thousands of children – and likely more – on the bulging waiting list during the fiscal year that ends July 1, 2010.
Imposing higher co-pays and premium payments on families lucky enough to have their children still covered, for now, by Healthy Families program. Board staff on Thursday recommended that, for emergency room visits, co-pays rise from $5 to $15, a proposed hike that is less severe than those earlier considered. Co-pays for non-preventative health, dental and vision would increase from $5 to $10, and co-pays for brand name prescription drugs would increase from $10 to $15, with generic drugs increasing from $5 to $10. Staff recommended against increasing subscriber premiums, saying the hike was “a bit too much in this economic environment.”
Eliminating whole categories, or levels, of health care services for current enrollees. Staff recommended rejecting proposals to eliminate vision, mental health and substance abuse treatment. Dental services would be cut back to a level consistent with what state employees get.
Freezing new enrollment in the Access for Mothers and Infants, or AIM, program for pregnant women receiving prenatal care. It turns out that, because fewer women have enrolled in the program, the date to freeze pregnant women out has been delayed from January 1, 2010 to March 1, 2010. And, babies born to women in the program would be guaranteed coverage in Healthy Families for their first year of life.
Pulling funding from Rural Health Demonstration Projects underway in a number of counties. So far, seven dental care programs and two health care programs have been cut.
Several children’s groups urged the board and its staff to approach program cutbacks so that those who most need the health care services get top priority. A letter from the California Children’s Health Initiatives asked the board “find solutions that do the least harm to vulnerable children and those needing care.” Krystal Moreno Lee of Children Now told the board, “The clock is ticking. We hope you look at and exhaust every avenue available to avoid disenrolling children from the program.”
Even with the legislature back in session, budget-related action this week will be at the Managed Risk Medical Insurance Board this Thursday, and for the next couple of Thursdays.
This small board (pictured in this somewhat outdated photo), which directs a relatively small staff, has the privilege (or burden) of running three health care programs--all of which are closing their doors to new enrollment.
The cuts have been made by the Governor and the Legislature. For AIM for pregnant mothers, MRMIP for those denied by private insurers for "pre-existing conditions," or Healthy Families for low-income children, the question is now *how* these are made. It involves some ugly choices. In order to save some money to keep some more kids covered, do they cut benefits for all remaining children? Do they terminate coverage for some kids immediately, or wait--with the risk they will have to kick off more kids as a result?
For the biggest of the programs, Healthy Families, they should hold off and see if the last month of the legislative session yields some assistance that might prevent some more children from being kicked off coverage. The calvary needs to come.
We'll twitter from the MRMIB meeting any news at @healthaccess, or www.twitter.com/healthaccess and also blog here later in the day to keep you up-to-date.
The good news for the Healthy Families program on Thursday was an $81.4 million commitment from the First Five Commission to keep 200,000 children ages 0-5 enrolled in the program for the remainder of the fiscal year.
The bad news? Despite at first seeming to want to delay the decision, the Managed Risk Medical Insurance Board, or MRMIB, voted to begin kicking kids off the health care program this fall.
On advice of staff, MRMIB declared that insufficient funding forced the board to prepare to disenroll children from Healthy Families beginning October 1.
Families with kids getting health care through the program – those who don’t benefit from the First Five funding, that is -- will get 30-day disenrollment notices as their annual re-enrollment dates approach. Those children can then be added to the end of a long wait list to get re-enrolled if the program’s finances improve.
Since the list was established July 17, an average of more than 3,000 children per work day have been signed up for the waiting list. Currently the list stands at 55,202 children of working families that can’t afford health insurance, but whose household incomes are higher than the threshold for MediCal.
Health care under the program is not free. The taxpaying, working families pay co-payments for services and prescriptions, as well as premiums to get their kids in Healthy Families, known nationally as SCHIP, a program expanded by President Obama earlier this year.
As California watched its fortunes dwindle this year, the Legislature and Governor Schwarzenegger ordered severe cutbacks in health and human services. Meanwhile, at least a dozen other states have managed to take the $2 in federal matching funds for every state dollar spent and use the augmentation to grow and expand their SCHIP programs.
Counting the forgone federal matching funds, California’s health care economy, not to mention children’s care, is losing a total of $533.4 million – thanks to the cuts made by the governor and Legislature.
This has left Healthy Families with a $194 million funding deficiency, staff members told the board, as well as an inability to continue serving the bulk of the program’s 921,787 child clients.
Even with the First Five’s $81.4 million, the California Budget Project estimates that nearly 800,000 kids will lose access to affordable health care because of Healthy Family’s decline. The cutbacks could not come at a worse time for working Californians trying to weather the persistent recessionary storm clouds that linger over the state.
Children’s advocates applauded and praised the generosity of the First Five Commission, which at first was expected to allocate around $30 million to help keep Healthy Families alive for kids through age 5. As it is, the much larger gift will allow for coverage of 200,000 children only through June 2010.
Wendy Lazarus, director of the Children’s Partnership, urged MRMIB members to exercise caution in making decisions about the future of the program.
“I ask that you consider that the next 45 days are going to be critical,” Lazarus said. “You’re going to have to look at what is safe, and what is riskier for children. At this point, we think that fewer kids will be served by the program than you do.”
Pending are lawsuits filed by several parties that specifically challenge the legality of the governor's deep cuts, made through line-item vetoes after a budget deal was already negotiated with the Legislature. MRMIB announced it will meet again August 20th, and August 27th. Among the decisions to be taken up is how much more money to charge families whose kids remain in Healthy Families, and what medical services can be eliminated or pared back.
The options currently before them are less severe than those listed as possibilities during last month’s MRMIB meeting. They now include:
• Increasing family co-pay maximums from $250 to $300. • Increasing program co-pays for health services, drugs, dental services and vision care from $5 to $10 for non-preventative services. • Increasing co-pays for name-brand drugs (when a generic version is available) to $10 to $15. The standard co-pay for generics would remain at $10. • Increasing co-pays for emergency room visits from $5 to $25 unless hospitalization is required. • Increasing subscriber premiums to $20 per child, with a maximum of $60 per family whose income falls within 150-200 percent of the federal poverty level. • Increasing subscriber premiums to $30 per child, with a maximum of $90 per family whose income falls within 200-250 percent of the federal poverty level. • Eliminating vision benefits. • Eliminating mental health and substance abuse benefits. • Scaling back dental benefit coverage. • Eliminating benefits for biofeedback, acupuncture or chiropractic care.
Senator Steinberg announced that using his campaign funds, he would personally sue Governor Schwarzenegger over the additional $500 million in blue-pencil line-items cuts.
Lots of groups impacted were interested in suing, but they were, by definition, the folks hard-pressed to find the resources to sue: community clinics, AIDS services providers, battered women's shelters, low-income families with uninsured children, etc.
It raises troubling questions about the power and purview of the governor and about whether he can take for himself some of the authority to impose midyear spending cuts that he has tried, and failed, to win at the ballot box. California needs to know the answers.
Remember that the Legislature passed, and the governor signed, a budget in February... Last month, lawmakers sent Schwarzenegger a package of appropriations and cuts, and no one disputes the governor's power to veto any of the appropriations. But he also vetoed some of the cuts, not to reject them but to deepen them -- to, in effect, use the opportunity presented by the Legislature's majority-vote cuts to reopen appropriations that the Legislature made, and that he signed, in February. But if an appropriation requires a two-thirds vote, and if a cut is adopted on a simple majority, how can it be deemed an appropriation?
California vests lawmaking power in the Legislature and properly limits the executive by allowing him to veto appropriations, line-by-line if he likes, but not to unilaterally alter those already on the books.
Human services providers want to restore some of the cuts that never got legislative approval, and it's hard to blame them. But there's an even more important reason to subject the vetoes to scrutiny: They amount to a power shift -- one that may well be outside the lines of the state Constitution and beyond the principle of separation of powers.
While the Governor’s vetoes provide a stark reminder of the scope and magnitude of the reductions in the recent budget agreement, they represent a tiny fraction – just 3.0 percent – of the total cuts in the July package. The $50 million “blue penciled” from the Healthy Families Program, for example, is less than the $124 million cut approved by the Legislature. Debate over the legality of the Governor’s vetoes shouldn’t divert attention from the underlying fact that absent additional revenues, future budgets will continue to erode the quality of public services that Californians and the future of the state’s economy depend on.
As the Sacramento Bee's Kevin Yamamura, quoting Assemblyman John A. Perez, it's up to those impacted to file suit against the cuts. But the cruel irony is that the legal and financial burden to file suit is on the very underfunded, struggling families and service providers--community clinics, battered women's shelters, low-income families with uninsured children, maternal and child health providers--they are so negatively impacted by the Governor's draconian cuts.
The Governor should not add insult to injury with regard to these immoral and illegal cuts. The Governor should not wait for a lawsuit... With this decision, he should agree to withdraw the cuts unilaterally, just as he made them.
One person who has taken on that tough job is journalist Joe Matthews, who recently had a post on a conservative website pretending to reveal what's going on in "Arnold's Brain." This isn't as much of a conceit as it may seem: as someone who has literally written a book on Schwarzenegger, many of Matthews' musings seem to come from the Governor, or at least his inner circle. Beyond his sources, he also seems sympathetic to Schwarzenegger, trying to give the Governor the benefit of the doubt. Earlier this year, he was on a radio program suggesting that the Governor's proposals to eliminate major programs like Healthy Families was simply a way to build the case for revenues--something that certainly never panned out. His recent entry, in the voice of Arnold, also seeks to put a positive spin to defend the indefensible cuts he has made:
My personality and celebrity is so big that the media, or what’s left of it, is missing the real story.
Here’s the tale in a nutshell: I tried to give Democrats what they say they want–universal health care and higher taxes. I did this at huge political cost to myself. And they said no...
You’ll forgive me for not committing political suicide a third time. The foreheads say I went back to the right in the last two months. Excuse me, but what other choice did they leave me?
And so now, when we get this terrible budget, full of health cuts that I hate (remember: I’m the guy who put my neck on the line for universal coverage), this is somehow my fault? You want someone to blame, foreheads? Try a f-----g mirror.
According to this take, the Governor really wants to do good and is really opposed to cutting children's coverage, he's just misunderstood. Matthews uses two examples that Health Access California was intimately familiar with: health reform in 2007 (which we ultimately were in support of the Governor's effort with AB x1 1), and Proposition 1A in the May 19th special election (which we were in early opposition).
The broad brush that this voice of "Arnold" uses for "liberals" makes little sense, since there was a diverse response on both issues: I know that for both issues, our Health Access California coalition vote was not unanimous, and we had good friends and allies on both sides of both issues. This is true of legislators as well: much to our chagrin, the Senate Democrats that helped kill health reform in 2007 were his strongest supporters for Proposition 1A in 2009. But this voice of "Arnold" seems to forget some things as well:
* As someone who supported AB x1 1, I agree with the assessment that California lost an opportunity when health reform stalled here, not just to raise revenues for expanded health coverage, but also to influence the national debate in a positive direction. But the Governor does bear some responsibility of his own, for example by delaying negotiations until key initiative and legislative deadlines passed. And by driving such a hard bargain on key affordability issues, he splintered the coalition that was needed to win in the legislature and on the ballot. He deserves some credit for coming to the issue, but shouldn't escape all blame.
* Proposition 1A presented health and human service advocates with the option of temporary taxes and revenues for only two additional years, but at the price of a permanent spending cap. Some proponents may have characterized it as a "soft" spending cap, but many others had different analyses--as is shown by the current debate over whether the Governor had authority to make additional cuts last week. Prop 1A was much less about increasing revenues than his second attempt at the legacy of a spending cap, in the rhetoric of "live within your means."
The main problem with Matthews' piece is he uses only two data points. As the San Jose Mercury News editorial board pointed out, the Governor's history on the issue of children's coverage--to take just one example--is far more spotty. "What other choice did I have?" can be answered with a long litany of his actions or inactions, from his very first budget proposal to a veto of AB772(Chan/Escutia) in 2005, a universal children's coverage bill, to his stance on Proposition 86--which was within 2 percentage points of passing:
Schwarzenegger came into office promising to make universal coverage for children a priority. Instead, he tried to cap Healthy Families in his first year in Sacramento and opposed Proposition 86 in 2006, which would have insured children through an increase in the tobacco tax...
Matthews' piece seems ill-timed, since it was only a few days before another, devastating data point: the Governor chose to unilaterally take another $50 million out of Healthy Families, on top of another $144 million cut he insisted on. So he has been far more consistent in seeking to cut children's coverage, and opposing taxes and revenues that would sustain such cuts.
What's the explanation for the latest cut? Willie Brown wrote in the San Francisco Chronicle, "I suspect his final cuts to children's health care and AIDS programs were made more out of anger at Democrats than sound thinking. They will haunt him for the remainder of his term."
Steve Harmon and Mike Zapler of MediaNews (such as the Oakland Tribune) notes that he seems to enjoy his role of budget slasher: "Gov. Arnold Schwarzenegger seemed to relish the task of reining in government spending, almost as if it was another cinematic role in which to star. With gusto, he launched blistering attacks against fraud in the welfare system, demanding that those abusing the system be kicked out. He unwaveringly stood his ground on taxes, never allowing Democrats to seriously consider including them in negotiations...." Let's not even get into the whole thing with him waving around a knife.
As the Los Angeles Times editorial board puts it, "Funny, isn't it, that when the governor scours the state budget for waste, fraud and abuse, he only seems to find it in programs for the old, the young, the poor and others unable to raise campaign funds or muster political opposition."
Matthews attempted to find a unified theory of Schwarzenegger, but there's an easier narrative available: as a down-the-line corporate conservative who has consistently gotten high marks vetoing proposals the Chamber of Commerce doesn't like throughout his service, but who had a moderate moment right before and after his re-election campaign. He toned down his rhetoric after being pushed back by the legislature from budget proposals to cut everything from the Lanternman Act to Healthy Families, and then after being rejected by the electorate on a budget spending cap and other efforts in a special election. After accolades for his 2006 pre-election concessions on global warming, minimum wage, and prescription drugs (that last reform for which we applauded him for signing and yet has never been implemented), the Governor sought a continuation of that national attention, and health reform was merely the means to that end. The budget crisis has allowed him cover to impose the conservative agenda that in any other time would be politically impossible.
I have no idea if that's a correct analysis of the Governor. But at some level, it doesn't matter. What the Governor thinks in his brain or feels in his heart doesn't matter. It is what he does and doesn't do.
And right now, his Administration is beginning to deny hundreds of thousands of children health coverage, among many other things. He had other options and choices from day one to the present. He still does, and maybe we'll see yet another version of our Governor in his remaining time. For the sake of California, I hope so.
Here's a report by Cynthia Craft, communicatin & policy coordinator at Health Access, from the MRMIB meeting on Thursday:
Disclosing that it likely will have to purge some children from the Healthy Families Program, the Managed Risk Medical Insurance Board, or MRMIB, reported Thursday that the wait list for the program, which froze enrollment July 1, had grown to 33,146 children in just two weeks.
The number was higher than anyone had imagined, and it reflects the bitter irony of cutting health care assistance for kids of low-income, tax-paying, legal residents at a recessionary time when they most need help.
As it now stands, the Healthy Families Program has lost funds that total $533.4 million, including federal matching funds no longer available due to the $194 million cuts made by the Legislature and Gov. Schwarzenegger. The federal government returns $2 of taxpayer funds to Healthy Families for every $1 the state dedicates to the program.
Advocates laid blame at the feet of both the governor and the Legislature for the choices they made in balancing the state budget.
“This is really a dark hour in California, when we are jettisoning children over other interests,” said Steve Barrow of the California Premature Infant Coalition, which strives to reduce the statewide 10% premature birthrate.
The outlook for California’s children in this down economy is likely to get bleaker, still. MRMIB announced it was setting a public meeting date of August 13th to discuss disenrollment, or kicking currently enrolled kids out of the program.
Several health care advocates testifying before MRMIB warned of “dire consequences” if children lost continuity of care, particularly in the case of cancer treatments.
Nearly every one of the two dozen or so who testified spoke of collaborating to find help from outside funders to prop up the Healthy Families program until its financial outlook improves.
Already, the First 5 Commission passed a resolution to help fill the gap for Healthy Families. Kris Perry, executive director of First 5, said it “pledged to provide, with some of the others, some of the funds” for children up to five years old. It was clear that the First 5 Commission was in the position to assist – but only to a point.
Nevertheless, Cliff Allenby, the chair of MRMIB, told Perry, “Needless to say, we appreciate your efforts since we are clearly in a large hole.”
Many held out hope that legislators would be motivated to successfully challenge the cuts upon reconvening after summer recess Aug. 17th.
Healthy Families was established by the federal government for low-income working families to provide health care for their children. State budget cuts made it necessary to establish a wait list for new enrollees July 17, and 14,000 children signed up the first week. Those who are bumped from the program through the anticipated disenrollment would go to the end of the list.
Earlier this year, President Obama announced an expansion of Healthy Families, known in Washington as the SCHIP program, funded by tobacco tax money. The President heralded the move as an important step in his larger goal of reform aimed at extending coverage to the nation’s 42 million uninsured adults. During the previous administration, former President George W. Bush vetoed legislation expanding the program to cover more children.
But California’s troubles, which attendees at the hearing said included a void of “emboldened leadership” on the state level, led to the opposite of what Obama intended. Now, health care coverage is less accessible and less affordable for low-income, working families in California – at a time when several other states managed to cover more children.
Even for families fortunate enough to remain in the much-smaller Healthy Families Program, keeping their children covered will become increasingly difficult financially. MRMIB plans to shift more out-of-pocket costs on to families enrolled in the program. Some of the cost-shifting suggestions read aloud by a staff member Thursday were drastic enough to make audience members audibly gasp.
The proposals, which staff and MRMIB said had yet to be thoroughly analyzed, include:
* Paying for eye exams, but not for glasses. * Eliminating vision benefits altogether. * Rescinding a new rate increase to insurers such as Anthem Blue Cross. * Increasing medical co-pays, such as: -- Physician visits would rise from $5 to $10. -- Name-brand prescriptions would rise from $5 to $10. -- Inpatient hospitalization would rise from $0 to $250. -- Outpatient hospital services would rise from $5 to 20% of the service cost. -- Emergency room services would rise from $5 to $50 unless hospitalized. -- Medical transportation would rise from $0 to 20%. -- Durable medical equipment would rise from $0 to 20%. -- Basic outpatient mental health services would rise from $5 to $10. -- Inpatient alcohol and drug treatment would rise from $0 to $250 per admission. -- Outpatient alcohol and drug treatment would rise from $5 to $10. -- Eye exams, if not eliminated, would go from $5 to $25. -- Subscriber premiums would go from $20 per child to a maximum of $60, in the income range from 150%-200% of the federal poverty level. -- Subscriber premiums would go from $30 per child to a maximum of $90 for families in the range of 200%-250% of the federal poverty level.
As of June 2009, Healthy Families served 920,000 children. In recent months, the program has accepted 29,000 new enrollees monthly.
On Thursday, MRMIB members mostly sat silent while listening to input from the community. Those testifying with concerns about children’s health included Beth Capell, the advocate for Health Access California, who noted that health care costs were the major cause of homelessness for families prior to the launch of Healthy Families.
“We are about to return to those dark days,” Capell said, noting that the governor’s “blue pencil” cuts also obliterated funding for community health clinics.
Capell also pointed out that the number of children at risk of not having coverage in California is greater than the population of 40 states including Massachusetts.
Also testifying in support of children’s health care were representatives from Children Now, the 100% Coalition, the California Teachers Association, the American Academy of Pediatrics, Local Health Plans of California, California Children’s Hospital Association, the Children’s Coalition, PICO, California Primary Care Association, Santa Clara Health Plans and the Community Health Council.
That's a high bar: last month, they closed the door to new enrollments, instituted a "waiting list" which is really just a euphemism for denying coverage to 350,000 children over the next year.
But this meeting will be even tougher. With a $194 million shortfall due to the budget signed by Governor Arnold Schwarzenegger Tuesday (which includes $50 million that he did through a controversial line-item veto), the board may have to take even more drastic steps--to kick hundreds of thousands of children off of coverage.
It is projected that over 900,000 children would be denied coverage--doubling the number of uninsured children in California, undoing a decade of progress.
The San Jose Mercury News editorial board sums up the issues with appropriate disdain. The Governor and Legislature appropriately criticized insurers from rescinding coverage from patients, but their action here is as bad, yanking coverage during a bad economic time when such coverage is probably needed most. Coverage that won't be there during when you need it is no longer coverage. If Healthy Families starts disenrolling children from coverage, it fundamentally alters the program forever.
MRMIB will review options, including if any money can come from other sources like the First Five Commission, or from insurers who participate in the program. But the outlook is grim.
GOVERNOR'S LINE-ITEM CUTS DEVASTATE CALIFORNIA HEALTH CARE * $50 Million More in Cuts to Healthy Families; Over 900,000 Kids to Be Denied Coverage
* Additional cuts to HIV/AIDS Care, Community Clinic Funding, Maternal/Child Health Programs, Medi-Cal County Administration, and Key Human Services
* Shocking, Large, Outrageous Cuts Will Deny Coverage & Care to Hundreds of Thousands of Californians, Impact Health System On Which We All Rely, and Hurt Our Economy
* More Updates on blog.health-access.org: Are These Cuts Legal?; Updates on Federal Health Reform; Wonkery on the Weekend; The Challege of August Recess for Reform; Governor Schwarzenegger's Knife; Reaction to the Passage of a Budget; The President Lays Our What's In It For You; The Governor's Budget "Reforms" of Medi-Cal; and much more...
Governor Arnold Schwarzenegger today signed a budget reduction package today, including an additional $600+ million in unilateral and controversial cuts, largely to health and human services.
BACKGROUND: In February 2009, the Governor signed a budget for the current fiscal year that included $15 billion in spending cuts to health and other vital services, as well as a spending cap plus five other proposals that voters rejected in a special election on May 19, 2009.
With the economy worsening, the Governor and the Budget Conference Committee proposed solutions to fill the growing budget deficit, a final budget was passed last week that was largely negotiated by the Governor and legislative leaders. Combined, the February and July solutions signed by the Governor, close a $60 billion budget gap in the state’s General Fund.
Governor Arnold Schwarzenegger today signed the budget that was passed last week, but not before making $650 million in additional "blue pencil" reductions. Over $516 million were in specific line-item veto cuts, with over $400 million of those to health and human services. The added cuts were jaw-dropping to many advocates for health and human services.
The Governor has zeroed out some programs, such as some state funding for community clinics, and others were preserved in name only. Healthy Families, which has grown over a decade to cover nearly one million children, will not be the same program, as it is now shuttered and will likely be actively kicking kids off coverage.
THE ADDITIONAL CUTS made unilaterally by Governor Schwarzenegger today include:
* An additional $50 million cut to Healthy Families, raising the total shortfall for the program to $194 million, well over half the program's state funding. As a result, Healthy Families will likely deny coverage for over 900,000 children, including actively disenrolling hundreds of thousands of kids, yanking their coverage away. This one budget cut would double the number of uninsured children in the state of California, undoing a decade of progress.
* Additional cuts of $52 million to programs under the Office of AIDS Prevention and Treatment, including education and prevention, therapeutic monitoring, counseling and testing, early intervention, home and community-based care, and housing.
* An additional $25 million cut that would eliminate state funding for community clinics, including Expanded Access to Primary Care. This is especially devastating when the number of uninsured are increasing, partially due to other cuts.
* An additional $12 million in cuts to Maternal, Child and Adolescent Health local assistance programs, including the Adolescent Family Life Program and the Black Infant Health program.
* An additional $60 million in Medi-Cal county administration, making it harder for California children, parents, seniors and people with disabilities to get on and stay on Medi-Cal coverage.
Other human services cuts include:
* An additional $80 million cut to funding for the Child Welfare Services Program, which responds to reports of abuse and neglect. * An additional $50 million cut to funding for Regional Center services for children up to age 5 who have developmental disabilities. * An additional $40 million in cuts to In-Home Support Services (IHSS) home care, further reducing eligibility. * An additional $16 million in cuts to domestic violence programs, largely battered women's shelters.
Consumer and community groups point out that California has better choices than to deny coverage to hundreds of thousands of children, or to make such devastating cuts to the health system on which we all rely. Check the Health Access website (http://www.health-access.org) and blog (http://blog.health-access.org) for the most up-to-date information.
THE OVERALL HEALTH BUDGET signed today, including the cuts made today, include the following cuts to health care:
* Denying hundreds of thousands of children health coverage. The Healthy Families program current covers nearly one million low-income children between 100-250% of the federal poverty level. The proposed cut of $194 million in state dollars (well above the recommendation of the Budget Conference Committee) would deny over 900,000 children coverage. First, the newly-imposed wait list would deny over 350,000 children over the course of the budget year. Second, the size of cut would force California to actively disenroll over 500,000 additional children--based on an assumption that the children would be kicked off during the time of annual renewal. depending on when they are disenrolled. In addition, for every dollar we cut in Healthy Families, we are losing two dollars in federal matching funds for our health system, and our economy.
* Making severe cuts to prevention-oriented and core health programs. While rejecting outright eliminations, the Budget Conference Committee made drastic cuts to a series of health care programs and services. The budget also includes:
o Cutting mental health, including reducing by $92 million of funds for the Mental Health Managed Care Services, and the Early and Periodic Screening, Diagnosis and Treatment program. A $14 million cut would eliminate state money for ancillary health services in Institutions for Mental Disease. o Cutting HIV/AIDS care, reducing funding by $85 million.
o Cutting Adult Day Health Care, limiting it three days a week and other changes, a $26.8 million cut o Cutting hospitals, taking $23 million from the Distressed Hospital Fund o Cutting funding for community clinics, zeroing state general fund support for programs like Expanded Access to Primary Care, (with cuts also to the Rural Health Services, Seasonal Migratory Worker and the Indian Health Program).
o Cutting maternal and child health care significantly, including the Black Infant Health Program; Adolescent Family Life Program, and others. o Cutting last-option health coverage for those rejected for “pre-existing conditions”, reducing the Major Risk Medical Insurance Program by $6.6 million. MRMIP already has a waiting list, with 7,100 enrollees, despite estimates of over 400,000 eligible “uninsurables.” o Cutting health coverage for mothers and newborns babies to get prenatal and post-natal care, reducing the Access for Infants and Mother program by $4.9 million. The cut would force a waiting list, basically denying care to pregnant women.
o Cutting all of the Immunization Program, for $18 million. o Cutting community application assisters that help enrollment in public coverage like Medi-Cal and Healthy Families, for $3 million. o Suspending a children’s dental disease prevention program, for $3 million.
* Advancing controversial Medi-Cal proposals that would make it harder for patients to get the care they need.
* One provision would seek to privatize county eligibility workers for Medi-Cal and other human services. As reported in the media, the legislative leaders agreed to a process to consider the Governor’s recent proposal to privatize and replace the current county workers who assist Californians enrolling in Medi-Cal and other social services with a private contractor like Maximus or Halliburton. The reports indicate that the consideration would allow stakeholders to vet the proposal and requires legislative approval. * Another provision would mandate managed care for seniors and disabilities on Medi-Cal. Consumer advocates have been long concerned about the impact on patients and their access to care and specialists, as well as funding impacts to safety-net institution.
It’s important to note that these and other cuts are on top of the cuts made in February 2009. Those cuts included the elimination of 10 benefits, including dental coverage, for the nearly 3 million adults (parents, seniors, and people with disabilities) with Medi-Cal coverage. Those went into effect recently on July 1, 2009.
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.
