Health Access WeBlog

Long live the public option...

noreply@blogger.com (Anthony Wright) — Sat, 13 Mar 2010 07:51:00 +0000

Speaker Nancy Pelosi said Friday in a declarative statement that the final health reform bill will not include a "public option."

The public option was an important part of the original proposal, and an important part of our advocacy, even though it wasn't the only important part of health reform--there's still a lot of good element. It's still a shame it's not included--Pelosi and many others had been active warriors for the concept, and our California delegation was united in its active support. Our two Senators, Senator Barbara Boxer and Dianne Feinstein, were supportive early on and are current signatories to a little to include it in the final reconciliation package. In the House delegation, it was a major element of both leadership from California, including Speaker Pelosi and key committee chairs, but other caucus leadership and members of the Progressive and Ethnic Caucuses. Even among our seven Blue Dogs from California, five were early supporters of not just health reform but the public option, and even those that were reluctant on health reform didn't base their qualms on the idea of a public option.

So we in California did our part, but such support for the public option was not uniform across the country, not enough to make it over the hump. Here's Speaker Pelosi:

Speaker Pelosi deserves credit for being straight with us, and she has the credibility to be so candid. As she said, she's a longtime single-payer supporter, and was very active in favor of a public option. I believe that if she says it's not in the cards, then it's not... and I also agree with her other statements that other elements of the health reform--from an active, negotiating exchange to rate review--help ensure the same goal, to prevent individuals from being left alone at the mercy of the big insurers.

Speaker Pelosi has been instrumental in keeping alive health reform as a whole, and she deserves huge credit for that alone.

The passage of health reform then creates an opportunity to revisit the public option in the future. At the state level, there's been an public option bill in the California Legislature, one that would be *much* easier to implement if we had the broader framework of this bill: an exchange, better rules on insurers, etc. After all, a public option in today's marketplace, to survive, would simply have to act like current insurers.

And there may be opportunities at the federal level to revisit the public option... that's why it is good that Senators Boxer and Feinstein and other Senators have made their support known. We won't stop fighting for it, even as we continue to work for health reform.

The immediate benefits of health reform...

noreply@blogger.com (Anthony Wright) — Fri, 12 Mar 2010 18:07:00 +0000

A vote is likely for next week on health reform in the House of Representatives, with votes to reconcile differences and make improvements in the Senate the week after that.

So difference would this reform make? The biggest changes, like the expansion of Medicaid, would not fully kick in until 2014 (these changes take time and some need to be phased in) but there's a lot of immediate benefits in 2010 that we can anticipate:

In 2010, health reform would:

1. Prevent people from being denied coverage based on �pre-existing conditions.�

- Immediately, people who are uninsured due to a pre-existing condition can buy insurance through a special insurance program. Right now, Californians are left in a lurch: our state has a small, underfunded "high-risk pool" that currently has a waiting list--even though it is estimated that over 400,000 have been denied coverage due to health status.
- Within 6 months of passage, no new health plan could discriminate against children with pre-existing conditions.
- In a few years, no insurance plan could deny coverage to anyone for pre-existing conditions.

2. Provide people with more security, by outlawing the worst insurance company abuses. Insurance companies could:

- No longer cancel insurance coverage retroactively when you get sick. Over 6,000 Californians had their coverage rescinded in the past several years, and health reform would end the practice of rescission.
- No longer put lifetime limits on the dollar value of benefits
- No longer place co-payments or cost-sharing on key preventive benefits

3. Provide real relief to young adults and their families, to seniors, and to small businesses. Health reform would:

- Allow young adults up to age 26 to stay covered on their parents� insurance
- Reduces prescription drug costs for seniors. Seniors whose spending falls into Medicare�s prescription drug donut hole will have hundreds of dollars of immediate help and the entire coverage gap will be eliminated over time.
- Gives subsidies to small businesses. Small businesses choosing to offer coverage to workers will receive a tax benefit of up to 35% of premiums.

The popularity of health reform is improving, and these specific & immediate benefits will make it more so, once it is passed.

Getting closer...

noreply@blogger.com (Anthony Wright) — Fri, 12 Mar 2010 05:40:00 +0000

There's a lot going on with health reform, and one of the best updates of the moving parts is by Kate Pickert at Time's Swampland. The Treatment has more, too.

The upshot is we are moving closer to a House vote as early as next week, and Senate votes the week after. The momentum is unmistakable.

One of the ongoing narratives is the opposition to reform of Wellpoint/Anthem Blue Cross. The White House continues to spotlight the company and appropriately rebut its claims. They'v e come a long way since their days as a nonprofit safety-net provider, as public radio's Sarah Varney explains with the help of our colleague Lori Sobel at Consumers Union. Jon Cohn at The New Republic has a similar take. Instead, Anthem Blue Cross has refined a business model based on collecting premiums from the healthy and avoiding the sick, as I wrote on this blog, that has been picked up by the California Progress Report and the new web portal HealthyCal. All of these stories indicate that this is a natural evolution based on our current laws and regulations which allow such practices, and what we need is a reformed system to remove the incentives for insurers' bad behavior.

That's exactly what Congress will be voting on in the next week or two.

Revisiting rescissions...

noreply@blogger.com (Anthony Wright) — Thu, 11 Mar 2010 02:57:00 +0000

Earlier today, the Accountability and Administrative Review Committee, chaired by Assemblyman Hector De La Torre, held a key hearing on the headline-grabbing issue of rescissions.

The hearing usefully sought to follow up on the settlements that regulators got insurers to agree to offer to restore coverage to the 6,000 people who had their coverage yanked from them. Here are reports from the Shaya Tayefe Mohajer at the Associated Press and Daniel Weintraub at Healthy Cal. We'll have more soon.

Some good news from DC...

noreply@blogger.com (Anthony Wright) — Thu, 11 Mar 2010 02:14:00 +0000

A key bill passed the U.S. Senate today...

OK, it's not the big health reform bill, or even a comprehensive jobs bill, but it was a portion of a jobs package that would provide big benefits for health care in California.

One in a series of bills on jobs, this emergency relief package, the �American Workers, State and Business Relief Act,� was approved by a vote of 62-36. Much thanks to Senators Barbara Boxer and Dianne Feinstein for their support. It will go to the House of Representatives, who have passed their own version of a jobs bill, before it goes to the President for his signature.

The legislation, (H.R. 4213), has an extension of unemployment and benefits and contains several health-related provisions that are of particular importance to California, including:
* Extending the COBRA subsidy from the earlier stimulus bill. For unemployed California families, the average monthly COBRA premium is $1,107. The COBRA premium assistance reduced this cost to $388 per month, and without this benefit, unemployed Californians could lose $720 a month.
* Providing help to the state budget through a six month extension of the enhanced Federal Medical Assistance Percentage (FMAP) enacted under the American Recovery and Reinvestment Act, which otherwise would end on December 31, 2010. This extension through June 2011 would provide an increase of $1.5 to $2 billion in federal funding for California's 2010-11 budget.
* Delaying a 21.2 percent cut in payments to physicians who treat California's 4,672,923 Medicare beneficiaries and many TRICARE enrollees in California.

A detailed summary of the benefits for California can be found online at: http://dpc.senate.gov/docs/states-sr-111-2-33/ca.pdf

The COBRA subsidy will be welcome for California, with our high unemployment rate. And the relief for our state budget is crucial, to help close our deficit and prevent much, much worse budget cuts. The House had passed these elements in other bills, but it's very good news that the Senate has finally acted.

Speaker Perez in his own words on health budget cuts...

noreply@blogger.com (Anthony Wright) — Wed, 10 Mar 2010 02:16:00 +0000

Our new California Assembly Speaker John Perez visited the editorial board of the Los Angeles Times late last week.

While acknowledging that he has voted for unthinkable cuts, and that there will be awful cuts going forward, the Speaker showed some impressive knowledge and passion about some of the health care cuts proposed in the past year. He talked personally and policy-wise about proposals to cut kidney dialysis, and about other cuts from AIDS drug assistance, and family planning.

It's worth a listen:
Where to cut $15 billion (5:00)

The big impact of budget cuts...

noreply@blogger.com (Anthony Wright) — Tue, 09 Mar 2010 21:25:00 +0000

Our colleagues at Western Center on Law and Poverty released a report today providing a disturbing view of the dramatic impacts of the Governor's budget proposal.

If California does not get enough money from the federal government, the Governor has proposed to "trigger" a range of cuts and eliminations of programs. The proposal would eliminate the Healthy Families program, and cut Medi-Cal eligibility to the federal Medicaid minimum--a place where no state, no matter how conservative or financially strapped, has gone.
The answer is in the report's title: The Governor�s Proposal to Eviscerate Medi-Cal to the Federal Minimum Would Cut More Than 1.7 Million Poor People From the Medi-Cal Program.

And with the elimination of the Healthy Families program which covers over 900,000 children, and the total who would lose coverage under the Governor's proposal is 2.7 million Californians. It's a staggering impact.

And let's not forget: even with *all* the federal funds the Governor has requested, the Governor's proposal would cut over 300,000 Californians from coverage.

Fired up...

noreply@blogger.com (Anthony Wright) — Tue, 09 Mar 2010 18:54:00 +0000

Earlier today, thousands of people descended on the Ritz-Carlton in Washington, DC, where America's Health Insurance Plans (AHIP), was having its annual conference. They blocked the streets, wrapped the hotel in yellow police crime tape, and sent a powerful message that Congress should listen to us, not the insurers.

The insurers, both as themselves and through the US Chamber of Commerce, announced multi-million dollar ad buys against health reform.

President Obama is amping up the stakes in the last few weeks. In his road show, he's shown sharper language. He again called out California's biggest insurer: "Anthem Blue Cross just jacked up premiums by nearly 40%. 40%! Anyone's paycheck gone up 40%?" He also references his Congressional opposition: "To Republicans: You had 10 years, what happened?"

As the President said, "The U.S. Congress owes the American people an up or down vote on health care. The time for talk is over. We need to see where people stand."

Here's his full rally speech from yesterday:

The Backstory on Anthem BlueCross' Bad Behavior

noreply@blogger.com (Anthony Wright) — Mon, 08 Mar 2010 21:02:00 +0000

It�s true, as Jonathan Cohn points out, that the nation�s largest health insurer, Wellpoint, has been �among the most hostile to reform.� And as unearthed by Ezra Klein, at least one investment bank states the reason clearly: �Should health reform fail, Wellpoint would be a primary beneficiary.�

You may not know Wellpoint�s name, but even if you don�t live in my state, you may have heard of their California subsidiary, Anthem Blue Cross. Their rate hikes have been repeatedly spotlighted by the White House, and have been the subject of over a half-dozen inquiries.

The scrutiny comes with the eye-popping rate hikes, and with being the biggest, both in the nation, and in many states like California. But the scrutiny should go beyond the rate hikes to their overall business practices�and the broken health system that rewards bad behavior. To reinforce Ezra Klein�s point, they have perfected a business model based on collecting premiums from the healthy and avoiding as much as possible actually providing coverage to those who are sick.

It starts with their aggressive denial of people with pre-existing conditions�we have many stories of people being denied not just in their 50s but in their 20s, and even for relatively minor issues like heartburn.

Most controversially, Anthem Blue Cross of California had the most number of rescissions in the state, the odious practice investigating patients after a major claim for the purpose of retroactively cancelling a patient�s coverage--even if they have paid months and months of premiums--if they found an inaccuracy on the patient�s application regarding their medical history. They created even more of an uproar when they sent letters asking doctors to turn their patients about unreported pre-existing conditions.

The company also works to ensure that mostly healthy people come to them in the first place. They specialize in cheaper, �bare-bones� plans with high-deductibles or that leave out key benefits. At a recent Congressional hearing, Chairman Henry Waxman of California grilled Wellpoint executives about why the biggest increases were going to more comprehensive plans, including those with maternity coverage, with an effort to shift people into plans where consumer face more financial risk. As the committee staff report indicates:

"Internal documents suggest that WellPoint�s business plan includes moving consumers into less generous plans. This strategy appears to have three components. First, WellPoint�s highest rate increases seem to apply to their most comprehensive insurance plans. Maternity care is a marker for a more comprehensive package of benefits. A chart of proposed rates shows that WellPoint�s highest rate increases apply to the only two product families regulated by the Department of Insurance with maternity coverage. The chart also shows that for the most part, WellPoint proposed lower increases within specific product lines for the versions with higher deductibles than for the versions with lower deductibles."

Anthem uses benefit design, but also marketing, to avoid older folks and get more than its fair share of young and healthy people�also called �cherry-picking.� A classic example is a product like �Tonik,� which is marketed to 19 to 29 year olds, and has higher cost-sharing and omits maternity coverage�the most likely need for coverage for young women. It was perhaps the only insurance product that has been mocked by The Daily Show.

With this and other strategies, the company has been able to send over $525 million from California policyholders to Wellpoint�s Indiana headquarters in just 2009. Wellpoint got over $4.2 billion in earnings since acquiring Anthem in 2004, according to reporting by Lisa Girion of the LA Times. This is despite an agreement with state regulators that the merger would not siphon California policyholder dollars to the out-of-state . Anthem Blue Cross waited out the three years of the agreement, and sent $950 million to the corporate parent the week after.

These practices, yielding these dollars, are why the company has been on the front lines of opposing health reform.

When Governor Schwarzenegger proposed health reform in California in 2007, other insurers were willing (with caveats) to consider living by new rules, like guaranteed issue. As the biggest player in the market, Anthem Blue Cross of California stood alone apart, investing $2 million in an opposition campaign. (My organization and others launched a counter campaign, www.sickofbluecross.com, which continues today).

In the current federal debate just a few months ago, Anthem Blue Cross took the unusual step of sending misleading E-mails to their subscribers attacking the House health reform bill.

Other insurers have been ambivalent about health reform, which would mean more potential customers--but that includes sicker patients that they would rather not take, and more accountability and oversight over their operations. Health reform would mean a profound transformation for the industry: insurers competing on cost, quality, and customer service, rather than risk selection and avoiding sick people.

Anthem Blue Cross of California, and its parent company Wellpoint, has internalized the perverse and inequitable incentives of the current, broken individual insurance market: it thrives and profits from the status quo. The only surprise in the investment bank�s analysis that Wellpoint would be a primary beneficiary of reform failing was that it was stated so clearly. The rest of us would be a beneficiary of reform passing, changing the system so such bad practices are no longer good business.

Unfair and unbalanced...

noreply@blogger.com (Anthony Wright) — Fri, 05 Mar 2010 09:27:00 +0000

I have been struck that I have been more optimistic about the prospect of health reform that others, and I wonder why. My sense of things is based on my trips to DC, conversations with Hill staffers and stakeholders, etc. I know the pitfalls and policy issues, but also understand the commitment that exists in various quarters to seeing this through.

But there's one advantage I also have: I don't watch a lot of cable news. And this is one area where the more you watch, the less you may know. Unless, of course, you get the perspective of from Comedy Central's Daily Show:

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

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www.thedailyshow.com

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Political Humor

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Wright on Wright on Health...

noreply@blogger.com (Anthony Wright) — Fri, 05 Mar 2010 03:27:00 +0000

This week's right-on Health Wonk Review is by Brad Wright at Wright on Health which includes good links. There's no relation to me, although a post of mine is included in this left-right round-up. It's worth a read.

A Stark choice...

noreply@blogger.com (Anthony Wright) — Fri, 05 Mar 2010 03:04:00 +0000

We in California are blessed to have a lot of leadership in the House of Representatives, starting with Speaker Nancy Pelosi, and including other caucus leaders like Rep. Xavier Becerra.

It was noteworthy that of the three key committees responsible for health care reform, two are headed by Californians: Chairman George Miller of the House Education and Labor Committee, and Chairman Henry Waxman of the House Energy and Commerce Commitee. But as important has been Rep. Pete Stark, Chair of the Health Subcommittee of the House Ways and Means Committee.

Stark was the next senior person in line after Rep. Charlie Rangel stepped aside due to an ethics investigation yesterday, but Stark decided to step aside and allow Rep. Sander Levin to rise to the post today. Stark says he didn't want the job, and wants to continue focusing on health care.

This is described in Josh Richman's Oakland Tribune article, "Why Pete Stark is staying put," which reads:

The Fremont Democrat told Bay Area News Group that he prefers to remain chairman of the Ways and Means Health Subcommittee so he can shepherd and implement health-care reform.
"It seems to me we've got a chance in this Congress � maybe, unfortunately, into the next Congress, but over the next three years � the best chance we've ever had to get decent health care reform, and I've been working on that a long time," said Stark, who has served in the House since 1973.
"Quite honestly, the idea of being chair of Ways and Means and running around the country trying to raise money is the last thing I want to do," he added, calling fundraising on behalf of fellow Democrats for the midterm elections "not exactly my long suit."
Stark, 78, was the next-most-senior Democrat on the tax-writing committee after former Chairman Charlie Rangel, D-N.Y., 79, who temporarily stepped aside Wednesday pending the conclusion of an Ethics Committee probe into his corporate-paid travel. House rules said Stark would automatically take the chair unless he declined, or unless House Democrats voted to pass him over.

For health advocates, it is good that he is staying focused on health care. Rep. Stark and his staff have been absolute champions for health care reform, and for making the reform as good as it can be.

He has been innovative in advancing grand reform ideas, and small changes that make a big difference in people's lives. For example, earlier this year, Rep. Stark was heavily involved in making sure people losing their jobs kept their coverage with the help of a COBRA subsidy.

We are proud to continue to work with him as a pivotal leader on health reform, and much more.

The President's final argument...

noreply@blogger.com (Anthony Wright) — Fri, 05 Mar 2010 00:48:00 +0000

In his speech from the East Room of the White House, President Obama made his final argument for a final comprehensive health reform package. He has distilled his argument as such:

1) consumer protections to end the worst practices of the insurance industry.
2) providing individuals and small businesses seeking health coverage with the choice and purchasing power of large employers and the federal government (like what members of Congress has) through a new Health Insurance Exchange, along with affordability subsidies.
3) helping to control health care costs for everyone, to help our balance our family and federal budgets.

From his speech:

Essentially, my proposal would change three things about the current health care system:

First, it would end the worst practices of insurance companies. No longer would they be able to deny your coverage because of a pre-existing condition. No longer would they be able to drop your coverage because you got sick. No longer would they be able to force you to pay unlimited amounts of money out of your own pocket. No longer would they be able to arbitrarily and massively raise premiums like Anthem Blue Cross recently tried to do in California. Those practices would end.

Second, my proposal would give uninsured individuals and small business owners the same kind of choice of private health insurance that Members of Congress get for themselves. Because if it�s good enough for Members of Congress, it�s good enough for the people who pay their salaries. The reason federal employees get a good deal on health insurance is that we all participate in an insurance marketplace where insurance companies give better rates and coverage because we give them more customers.
This is an idea that many Republicans have embraced in the past. And my proposal says that if you still can�t afford the insurance in this new marketplace, we will offer you tax credits to do so � tax credits that add up to the largest middle class tax cut for health care in history. After all, the wealthiest among us can already buy the best insurance there is, and the least well-off are able to get coverage through Medicaid. But it�s the middle-class that gets squeezed, and that�s who we have to help.

Now, it�s true that all of this will cost money � about $100 billion per year. But most of this comes from the nearly $2 trillion a year that America already spends on health care. It�s just that right now, a lot of that money is being wasted or spent badly. With this plan, we�re going to make sure the dollars we spend go toward making insurance more affordable and more secure. We�re also going to eliminate wasteful taxpayer subsidies that currently go to insurance and pharmaceutical companies, set a new fee on insurance companies that stand to gain as millions of Americans are able to buy insurance, and make sure the wealthiest Americans pay their fair share of Medicare.

The bottom line is, our proposal is paid for. And all new money generated in this plan would go back to small businesses and middle-class families who can�t afford health insurance. It would lower prescription drug prices for seniors. And it would help train new doctors and nurses to provide care for American families.

Finally, my proposal would bring down the cost of health care for millions � families, businesses, and the federal government. We have now incorporated most of the serious ideas from across the political spectrum about how to contain the rising cost of health care � ideas that go after the waste and abuse in our system, especially in programs like Medicare. But we do this while protecting Medicare benefits, and extending the financial stability of the program by nearly a decade.

Our cost-cutting measures mirror most of the proposals in the current Senate bill, which reduces most people�s premiums and brings down our deficit by up to $1 trillion over the next two decades. And those aren�t my numbers � they are the savings determined by the CBO, which is the Washington acronym for the nonpartisan, independent referee of Congress.

Judges rule for and against cuts...

moonriver31@gmail.com (Cynthia Craft) — Thu, 04 Mar 2010 02:11:00 +0000

In the courts, we've won one and lost one.

First, the victory: Kevin Yamamura reports in sacbee.com's Capitol Alert that today the federal appeals court ruled against Governor Schwarzenegger's cuts to health and human services that include Medi-Cal reimbursement rates for hospitals and pharmacists and In-Home Supportive Services wages:

"The Ninth Circuit agreed with lower court decisions that granted preliminary injunctions against the cuts because California did not comply with the federal Medicaid Act. The cuts were contained in budget agreements over the past two years.

The court decisions not only have blocked past budget cuts, but they could also preclude the state from pursuing similar ways of solving its current $19.9 billion budget deficit. Schwarzenegger, for instance, proposed cuts to IHSS to save roughly $950 million in his January budget plan, but court rulings for now suggest that those solutions will be legally difficult to impose.

The court previously determined that under the Medicaid Act the state Department of Health Care Services must set rates "that bear a reasonable relationship to efficient and economical hospitals' costs of providing quality services, unless the Department shows some justification for rates that substantially deviate from such costs.

The Ninth Circuit on Wednesday determined that the state did not conduct the analysis required under the Medicaid Act to consider the impacts of cuts to IHSS wages or reimbursement rates. In the case California Pharmacists v. Maxwell-Jolly, Judge Milan D. Smith wrote that the court now has handed down "multiple decisions" on how to comply with the Medicaid Act.

Schwarzenegger, for instance, proposed cuts to IHSS to save roughly $950 million in his January budget plan, but court rulings for now suggest that those solutions will be legally difficult to impose."

On Tuesday, Yamamura writes of a different outcome in court regarding the governor's cuts: This time a judge ruled Schwarzenegger's line-item vetoes to reduce funding for several programs were constitutional:

"In a 3-0 decision, Justice J. Anthony Kline wrote that the challenge failed to show that Schwarzenegger had overstepped his executive authority in further reducing expenditures during last July's budget revision. The case, St. John's Well Child and Family Center v. Schwarzenegger, called into question seven line-item vetoes worth $288 million, cutting programs ranging from the Office of AIDS to Healthy Families.

Last year's situation was unique because lawmakers and Schwarzenegger approved the budget act in February, four months early. Because of a further drop in revenues and voter rejection of budget solutions, state leaders had to solve for a new $24 billion deficit last summer.

The language of the July budget revision contained reductions of the budget act, whereas normally the summer budget agreement spells out how much money the state will spend on each program. Governors have the ability to use their line-item veto on "appropriations." Democrats and social service groups claimed that the July reductions did not qualify as appropriations."

It's not just Anthem behaving badly...

moonriver31@gmail.com (Cynthia Craft) — Tue, 02 Mar 2010 23:31:00 +0000

It's not just Anthem Blue Cross behaving badly to customers of individual policies in California.

Here's a recent column by David Lazarus of the Los Angeles Times about a 50-year-old father who is a cancer patient who's convinced that his insurance company, Health Net, wants him to die. Health Net paid for the first round of the man's cancer treatment, but when the cancer spread, they declared the company changed its rules and deemed that same treatment "experimental" -- and no longer covered by insurance.

The tale is even more compelling when you hear the patient talk about it in his own words. For the audio version of Lazarus' report, go to KCET's "SoCal Connected."

One thing is true: Evidence of the need for health reform is growing -- case by case, as consumers speak out, one after another.

A perfect storm is headed for Anthem...

moonriver31@gmail.com (Cynthia Craft) — Tue, 02 Mar 2010 22:48:00 +0000

Anthem Blue Cross continues to be in the white hot spotlight over its 39% premium hike.
Just consider the breadth of inquiries closing in on Anthem:

Angry, outspoken consumers. Anthem has about 800,000 individual policy holders in California, many of them now calling for a public option or a consumer walkout on Anthem.
The Assembly Health Committee Chair Dave Jones, who has long pushed a bill to regulate rates for health insurers. Watch for AB 2578 to be heard later this month. Assemblyman Jones is also seeking subpoena power to get more information from Anthem Blue Cross.
Insurance Commissioner Steve Poizner has appointed an independent actuary to evaluate Anthem's premium increases, especially to see if their policies meet minimum loss ratio standards.
Attorney General Jerry Brown has subpoenaed financial records and other documents from Anthem and California's other top health insurers to investigate whether rates are being raised unfairly.
Congressional subcommittee members, including Rep. Henry Waxman (D), held a hearing last week to demand that executives from Anthem's parent corporation, WellPoint Inc., justify the rate increases -- effectively making Anthem Exhibit A for the case for health care reform and insurer regulation.
Consumer Watchdog, which has filed a lawsuit in Ventura, accusing Anthem of closing certain "blocks of health insurance business" to new business without offering comparable options, thereby ensuring that rates rise for those stuck in those policies. Duke Hefland writes in the Los Angeles Times that "plaintiff Randy Freed, 55, of Santa Barbara County, and his wife, Donna, were left with higher premiums and no options to shop around.
President Obama has repeatedly cited the 39% hikes as cause for substantial health reform, kick-starting the health reform legislation in Congress.
And tomorrow, on Wednesday, March 3, U.S. Health and Human Services Secretary Kathleen Sebelius is hosting what she is billing as a conversation with top executives of WellPoint, Aetna, CIGNA and the Health Care Service Corporation. The topic: How do the companies justify their double-digit premium increases and what can be done to keep them in check?

The scrutiny is warranted. The question is what will come of it... both in terms of information, and in terms of reform.

What President Obama got from the summit...

noreply@blogger.com (Anthony Wright) — Tue, 02 Mar 2010 18:19:00 +0000

Health reform is moving forward, with a schedule of the prospective votes: The House may consider the Senate health reform proposal on March 19, along with (or soon afterwards) a package of improvements needed to get the 216 votes. The Senate would consider those changes beginning on March 26, backing up to Easter weekend. (The changes would be through a majority-vote "micro-reconcilation" process--remember the main bill passed by 60 votes, but the budget-related changes needed to reconcile the bills only need 51 votes--just the situations for which the reconcilation process was intended.

That's the process. On the policy, President Obama sent a letter to the Congressional leadership about what he took away from the summit. It continues the commitment to move forward with health reform, but with some nods to the ideas of the Republican opponents:

Dear Speaker Pelosi, Senator Reid, Senator McConnell, and Representative Boehner:

Thank you again for the time, energy, and preparation you invested in last Thursday�s bipartisan meeting on health insurance reform. I have always believed that our legislative process works best when both sides can discuss our differences and common goals openly and honestly, and I�m very pleased that our meeting at Blair House offered the American people and their elected representatives a rare opportunity to explore different health reform proposals in extraordinary depth.
The meeting was a good opportunity to move past the usual rhetoric and sound bites that have come to characterize this debate and identify areas on which we agree and disagree. And one point on which everyone expressed agreement was that the cost of health care is a large and growing problem that, left untended, threatens families, businesses and the solvency of our government itself.
I also left convinced that the Republican and Democratic approaches to health care have more in common than most people think.
For example, we agree on the need to reform our insurance markets. We agree on the idea of allowing small businesses and individuals who lack insurance to join together to increase their purchasing power so they can enjoy greater choices and lower prices. And we agree on the dire need to wring out waste, fraud and abuse and get control of skyrocketing health care costs.
But there were also important areas of disagreement. There was a fundamental disagreement about what role the oversight of the health insurance industry should play in reform. I believe we must insist on some common-sense rules of the road to hold insurance companies accountable for the decisions they make to raise premiums and deny coverage. I don�t believe we can afford to leave life-and-death decisions about health care for America�s families to the discretion of insurance company executives alone.
No matter how we move forward, there are at least four policy priorities identified by Republican Members at the meeting that I am exploring. I said throughout this process that I�d continue to draw on the best ideas from both parties, and I�m open to these proposals in that spirit:
1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.
2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.
3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I�m open to exploring ways to address this issue in a fiscally
responsible manner.
4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers� use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I�m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.
There are provisions that were added to the legislation that shouldn�t have been. That�s why my proposal does not include the Medicare Advantage provision, mentioned by Senator McCain at the meeting, which provided transitional extra benefits for Florida and other states. My proposal eliminates those payments, gradually reducing Medicare Advantage payments across the country relative to fee-for-service Medicare in an equitable fashion (page 8). My proposal rewards high-quality and high-performing plans.
In addition, my proposal eliminates the Nebraska FMAP provision, replacing it with additional federal financing to all states for the expansion of Medicaid.
Admittedly, there are areas on which Republicans and Democrats don�t agree. While we all believe that reform must be built around our existing private health insurance system, I believe that we must hold the insurance industry to clear rules, so they can�t arbitrarily raise rates or reduce or eliminate coverage. That must be a part of any serious reform to make it work for the many Americans who have insurance coverage today, as well as those who don�t.
I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs.
My ideas have been informed by discussions with Republicans and Democrats, doctors and nurses, health care experts, and everyday Americans � not just last Thursday, but over the course of a yearlong dialogue. Both parties agree that the health care status quo is unsustainable. And both should agree that it�s just not an option to walk away from the millions of American families and business owners counting on reform.
After decades of trying, we�re closer than we�ve ever been to making health insurance reform a reality. I look forward to working with you to complete what would be a truly historic achievement.

Sincerely,
President Barack Obama

The new Speaker on reform...

noreply@blogger.com (Anthony Wright) — Mon, 01 Mar 2010 21:20:00 +0000

Assemblyman John Perez of Los Angeles was sworn in as Speaker this afternoon.

His eloquent speech described his journey to be one of the most powerful people in California. It also started to outline procedural reforms, especially around the budget process. It's worth reading:
In addition to focusing on solving our budget crisis and creating jobs, I want this to be a year of reform, real reform!
I envision a three pronged attack.
There are reforms the people in their wisdom must vote on.
For example, I believe that California�s budget should be approved by a simple majority, just like 47 other states and the federal government. As history has shown time and again, if the people lose confidence in the majority party, that party will soon find itself in the minority.
There are reforms the legislature can adopt in a bipartisan, bicameral way�and we will be finalizing some of those proposals in the next couple days.
However some reforms must be made immediately.
I�ve already announced that the budget will not be written behind closed doors in Big 5 meetings. A full budget committee and subcommittee process will ensure all members get to participate and there is time for public input and independent review of the proposals.
Hearings will be held around the state so that everyday Californians have the opportunity to look us in the eye and tell us how our budget proposals will affect their lives. And more importantly, they will have the chance to offer new ideas to us.

We will broadcast our budget hearings and deliberations on the web and where possible on TV. Posting information on the Internet will make it easy for Californians to view the budget, see our proposals for themselves and evaluate the impact on their lives.
Now I�m a big believer in technology, but sometimes we need to limit its reach. Another essential reform we must make immediately is to limit the use of certain technology on the floor and in hearings.
Starting today, text messages from lobbyists are banned while we�re on this floor or in committee doing the people�s business. Californians expect us to pay full attention to the issues and to each other -- and they deserve to know who is involved in the debate. They need not worry that special interest lobbyists are secretly sending messages of opposition or support to us as we deliberate.

At each of these levels � with the voters, with our Senate colleagues and in our own house, we must work together to produce a package of reforms that each and every one of us can be proud of and that allow us to serve our constituents better.

We wish Speaker Perez well in his new position!

Moving forward on multiple tracks...

noreply@blogger.com (Anthony Wright) — Mon, 01 Mar 2010 19:25:00 +0000

As we and others continue to push for health reform at the federal level, Dan Weintraub, now of the New York Times, asks why some California legislators are continuing to also advance a single-payer proposal. But why wouldn't health reform advocates continue to educate people about this reform?

When President Obama signs a health reform package, while it will be a major advancement, it won't end the conversation on health reform, at either the state or federal level.

California OneCare is releasing an ad-a-day for 365 days in support of single-payer and SB810. The first ad features is Senator Mark Leno, continuing this year as the author of SB810, having taken the torch from Senate Sheila Kuehl last year. On the night that Jay Leno returns to the venerable talk show, we're happy to spotlight Senator Mark Leno reiterating his support of the venerable health reform:

We look forward to continuing our efforts, on parallel tracks and multiple ways, to improving the health care system for all Californians.

Anthem Blue Cross and more about health reform...

noreply@blogger.com (Anthony Wright) — Mon, 01 Mar 2010 18:18:00 +0000

HEALTH ACCESS UPDATE
Monday, March 1, 2010

ANTHEM BLUE CROSS RATE HIKES SPUR MOVEMENT ON HEALTH REFORM IN CA AND DC
* Rate Hikes Draw Scrutiny; CA's AB 2578 Rate Regulation Bill Gains Momentum
* Deep Details from D.C. Hearing with Anthem Blue Cross/Wellpoint CEO
* DMHC Holds Hearing on So-Called "Discount Health Card Plans"
* Health Access to Help Represent Consumers at Natl Assn of Insurance Commissioners

* Read Our Health Access Blog! Join Us on Facebook! Follow Us on Twitter!

NEW MOMENTUM FOR HEALTH REFORM: A real life and timely example of what needs fixing--in the form of the actions of Anthem Blue Cross of California--can spur momentum for needed reforms of the broken health care insurance market. In Washington, DC, the rate hikes by California's biggest insurer have become Exhibit A in the fight for comprehensive health reform. President Obama even adopted, as part of his proposed unveiled a week ago Monday, a proposal by California Senator Dianne Feinstein for additional federal rate authority to review and reject increases, where appropriate.

These rates were also brought up in the much-commented on White House bipartisan health reform summit this past Thursday. Legislative leaders, including Speaker Nancy Pelosi of California, continue to press to pass a major reform with the goal of completing work before Easter. This would involve the Senate bill--which had already passed the Senate by a 60-vote supermajority--and some changes and improvements done through "reconciliation," which is the purpose of that majority-vote procedure.

RATE REVIEW TO GET A REVIEW: Back in California at the Assembly Health Committee's informational hearing on the rate increases planned by Anthem Blue Cross, Chair Dave Jones (D) cited Anthem's upcoming premium hike of 39% as reason to move aggressively forward with his AB 2578. The bill would allow the Department of Insurance as well as the Department of Managed Health Care to regulate rate increases. Assemblyman Mark Leno (D) is principal co-author. According to Assembly procedural rules, the first date it can be heard in committee is Tuesday, March 23rd.

CONGRESS RELEASES SOME OF THE ANTHEM DOCUMENTS: The Congressional subcommittee of the House Energy and Commerce Committee (chaired by California Rep. Henry Waxman) holding a hearing last week on Anthem's rate increases released a lot of in-depth financial information about WellPoint, Anthem Blue Cross' parent corporation. We've got links and details on the Health Access blog for the wonkish and curious.

SPEAKING UP FOR CONSUMERS AT THE NAIC: This past week, sixteen consumer representatives were named to regularly attend the National Association of Insurance Commissioners--including Health Access and other state-based consumer organizations throughout the country. Health Access' Elizabeth Abbott, was selected by NAIC as one of the official consumer representatives appointed to advise state insurance commissioners and their national organization on health policy and market regulation. The designation of consumer representatives is designed to ensure consumer protections and good public policy are adopted in regulations and policies drafted by the NAIC which often serve as a template for state regulators. Health Access sees this appointment as particularly well-timed to influence state-based and national health care reform efforts with this influential association, which has some specific tasks under the pending health reforms.

In addition to the four years Ms. Abbott has worked for Health Access, she has considerable experience as a long-time federal employee with the Social Security Administration and most recently as the Centers for Medicare and Medicaid Services (CMS) Regional Administrator for the western states and the Pacific Territories.

CRACKDOWN ON "DISCOUNT" PLANS: Health Access and several of our coalition partners (including the California Pan Ethnic Health Network [CPEHN], Health Rights Hotline, and the Health Consumer Alliance) testified before the Department of Managed Health Care (DMHC) in Oakland on February 22 regarding new regulations concerning so-called Discount Health Plans.

Many consumer advocates generally favor the new DMHC regulations because of the strict new requirements laid out governing the actions of these so-called discount health plans operating in California. DMHC has received over 1,000 consumer complaints regarding the deceptive practices engaged in by more than 150 plans selling what they portray as �comprehensive health insurance.� However, many of these companies do not offer a valid discount off the price from a known network of providers. After consumers buy this �discount card� for $25 to even $100 a month, they find that the doctors do not accept the card, do not provide a discount, or would have granted the same or an even greater discount for free based on other affiliations such as churches, unions, automobile clubs, or fraternal organizations.

DMHC has ordered 8 of these companies to �cease and desist� operations in the state, and are establishing requirements and consumer protections for those companies who want to do business in the state. The discount companies were at the public hearing in force claiming these proposed regulations are an unfair restriction on their ability to do business in California and an infringement of their free speech rights. DMHC will take all comments under advisement and release new regulatory language within the next several months. We urge organizations who have members under this predicament to contact us,

Congratulations, Canada... Til next time...

noreply@blogger.com (Anthony Wright) — Mon, 01 Mar 2010 06:25:00 +0000

Among the many who were transfixed by the 2010 Vancouver Winter Olympics, I even took in the cheesy features celebrating Canadian culture.

Given the debate about health reform here in the states, there is some synergy in having the premier event focused on fitness spotlighted Canada, with their heralded single-payer health system.

The USA-Canada hockey game today, decided in sudden overtime after a literally last-minute goal in regulation time, was amazing. On Twitter, it was also a time for North American trash-talking.

Canadians made their evident pride show, not just about their hockey, but for their health system. An example: "I can't hear you over my free health care." Many American Twitterers were willing to take the Canadian health system, as either the victor's spoils or a consolation prize.

Congratulations to Canada on their win, and to the underdog U.S. team for winning silver and making it a thrilling game. There will be a rematch in four years, in 2014. Coincidentally, that's when the major health coverage expansions are scheduled to take place in the pending federal health reforms. It's a pretty different, uniquely American reform, but it does bring us closer to Canada in dramatically reducing the number of those who find themselves without coverage.

Hopefully, any 2014 rematch of this great Canada-USA hockey game won't feature jibes about our number of uninsured. Hopefully, that rematch will feature *both* countries with near-universal health care.

We'll know soon.

Focusing on the votes from the Valley...

noreply@blogger.com (Anthony Wright) — Sat, 27 Feb 2010 19:51:00 +0000

I just arrived back from Washington, DC, and I have a sober, realistic, and detailed sense that comprehensive health reform can pass in the next several weeks. It's not a forgone conclusion, but it's helpful. Now it's about vote-counting.

The New York Times reported on the task that Speaker Nancy Pelosi has to get the needed 217 votes to pass a final health reform package. It includes this passage about one of our representatives from the Central Valley:

Representative Dennis Cardoza, Democrat of California, typifies the speaker�s challenge. The husband of a family practice doctor, he is intimately familiar with the failings of the American health care system. His wife �comes home every night,� he said, �angry and frustrated at insurance companies denying people coverage they have paid for.�

But as a member of the centrist Blue Dog Coalition, Mr. Cardoza is not convinced that Mr. Obama�s bill offers the right prescription. It lacks anti-abortion language he favors, and he does not think it goes far enough in cutting costs. So while he voted for the House version � �with serious reservations,� he said � he is now on the fence.

�I think we can do better,� Mr. Cardoza said of the president�s proposal.

We were proud that all of the California members of the House Democratic caucus supported the House health reform late last year. But there's a reason, given the particularly acute problems in California's health care system: Fewer employers offering coverage to their workers. Public programs facing budget cuts. And a broken individual market that has been spotlighted in the past few weeks for double digits rate increases and much more.

Nowhere is the health care crisis more severe in California than in the Central Valley, which would benefit most from the proposed reforms, such as the subsidies for low- and moderate-income families to afford health care.

Californians should be clear with our entire Congressional delegation about the desperate need for reform, and work to get every member to vote for the final health reform package.

For health reform talk, click here

moonriver31@gmail.com (Cynthia Craft) — Sat, 27 Feb 2010 00:08:00 +0000

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.

When it comes to getting the news about an event as important as this week's bi-partisan health care summit at Blair House, you might be better off simply watching the whole unfiltered meeting on C-SPAN yourself:
http://www.c-span.org/Topics/Health-Care-Insurance-Reform-Legislation-Town-Hall.aspx

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 Republican Reform: Repeal?

noreply@blogger.com (Anthony Wright) — Fri, 26 Feb 2010 16:57:00 +0000

Yesterday, President Obama's bipartisan health reform White House summit reinforced the need and urgency for health reform, to provide security and stability for those with coverage, and to provide affordable choices for those lack it. We had specific reports and reactions on the Health Access Twitter feed, at www.twitter.com/healthaccess.

The systemic health care problems in California came up repeatedly, showing the need for reform in general, and for stronger oversight and regulation of insurers in particular. This should not be a partisan issue: we were pleased to work with Governor Schwarzenegger on health reform in 2007, especially after we got key protections on affordability and other issues.

So we were disappointed yesterday when so many Republican leaders wanted to delay reform and start from scratch, rather than move ahead with the reforms that Californians desperately need.

We are also dismayed that legislators here in California are seeking to remove existing consumer protections, or repeal regulations even before they are passed.

Two specific efforts were spotlighted in the last 48 hours:

* One bill introduced yesterday would prohibit California from implementing the pending health reform--or any other health reform. It's clearly unconstitional. But on the day of a bipartisan summit to figure out areas of agreement, the amendment vividly portrays the GOP opposition to not just this reform, but any reform. The measure would prevent any regulation of the insurance industry--including preventing denials of coverage for pre-existing conditions.

* The major "reform" that Republicans pushed during the summit and through the year is the concept of selling health insurance across state lines. A California bill on the subject was defeated in committee earlier in the week.

Let's be clear: Allowing insurers across state lines would eviscerate all California consumer protections, allowing insurers from other states with much weaker regulations to sell substandard products.

If an insurer or HMO is licensed in another state and a consumer needs recourse, how would the consumer complain? By calling the insurance commissioner in another state? How would the consumer even know where to call? This measure effectively eliminates all enforcement against health insurers and HMOs.

California provides many consumer protections because of a long history of abuses by HMOs and health insurers. Other states provide few or none. Here's a list of the protections that Californians would likely lose by allowing plans licensed from out-of-state:

California Consumer Protections: Process/Financial

1. Fiscal Solvency Requirements (on Insurers, HMOs, medical groups, etc.)
2. Network Adequacy
3. Independent Medical Review
4. Grievance and Appeal Procedures, including urgent appeals
5. Right to Sue an HMO
6. Standards for Utilization Review
7. Reasonable person standard for emergency care
8. Right to a second opinion
9. Public disclosure of criteria for denial of care
10. Timely Access (48 hours for urgent care, doctor's visit within 10 days, etc)
11. Language Access
12. Continuity of care
13. Protection against balance billing for out of network emergency care
14. HMO Help Line: 24/7, 365 days a year

Which consumer protection should Californians go without? Grievance and appeals procedures? Right to a second opinion? Language access?

California Consumer Protections: Benefit Mandates (partial list)

1. Mental Health Parity (1999)
2. Contraceptive Coverage (1999)
3. Diabetes supplies (1999)
4. Prescription drugs: cover medically necessary drugs if drugs covered
5. Cancer screening: �all generally medically accepted cancer screening tests�
6. Drive-through labor and delivery
7. Same-day mastectomy
8. Prostate screening
9. Cleft palate
10. Pap smears
11. Mammograms
12. Well child care

Which benefit mandate should Californians go without? Mammograms? Well child
care? Cleft palates? Diabetes supplies?

We wish those who support allowing out-of-state insurers to avoid these regulations would be explicit about what existing consumer protections they would like to effectively repeal. Their proposal would effectively eliminate all of them.

The bipartisan health reform summit...

noreply@blogger.com (Anthony Wright) — Thu, 25 Feb 2010 14:00:00 +0000

President Obama is hosting a bipartisan White House summit on health reform today, six hours long to be broadcast on C-SPAN.

Among the participants will be four key California leaders, all Democrats from the House of Representatives: Speaker Nancy Pelosi, Chairman Henry Waxman, Chairman George Miller, and Congressman Xavier Becerra.

Two California-specific notes about the Republican participation in this summit:

* State Senator Tony Strickland will be introducing a bill today to prohibit California from implementing the pending health reform--or any other health reform. It's clearly unconstitional. But on the day of a bipartisan summit to figure out areas of agreement, the amendment vividly portrays the GOP opposition to any reform, including any regulation of the insurance industry, including preventing denials of coverage for pre-existing conditions.

* The major reform that Republicans will push is the concept of selling health insurance across state lines. A California bill on the subject was defeated in committee yesterday. Let's be clear about what such a proposal would do: it would obviate all California consumer protections, allowing insurers from other states with much weaker regulations to sell substandard products.

Hopefully, there will be better ideas, and more willingness to move ahead on desperately-needed health reform, at the summit today.