Health Access WeBlog

But what kind of change?

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

Republican legislators are viewing President Obama's invitation to the White House with skepticism. I don't doubt the President's sincerity in wanting to take into consideration and even adopt their best ideas. As frustrating as that may be to some of his supporters, he is a consensus builder and organizer, and that is who he is.

But that doesn't mean the Republicans shouldn't be worried. Because I don't think the President is going to give up on his proposals. And because the Congressional Republican leadership doesn't have a comprehensive solution to the health care crisis. The spotlight that the President has put on alternative reforms has shown them to be ineffective, but ones that provide less security and stability, not more.

Change can be scary, especially when there's an entire political party feeding that fear and mistrust. Consumers don't like the status quo, but it can be seen to be comforting compared to the unknown.
If it's a fight between a complex reform with both benefits and burdens (and any reform of health care is going to be complex) with the status quo, the status quo has a distinct advantage.

President Obama wants to make this a fight between the change you want, versus the change you don't. Reformers make the point--correctly--that the status quo isn't an option, since the current health system is unravelling.

The summit will counterpose not change vs. the status quo, but what kind of change is appropriate. And the comparison isn't close:
* Jonathan Cohn of the New Republica analyzes the Republican plan for health reform in their �Roadmap for America's Future,� a much more radical privatization of Medicare than people realize.
* Ezra Klein of the Washington Post examines the Republican ideas that are already in the health reform bills
* Greg Sargent at the Plum Line shows how the GOP response so far is a rejection of bald-faced rejection of any negotiation or compromise.

Other links of note for health advocates:

* E.J. Dionne in the Washington Post reports how Rep. Inslee (D-WA) has advice to Democrats to "finish the kitchen."

* Duke Helfand at the Los Angeles Times explores the scam of so-called "discount health plans" and new efforts (which we at Health Access California are active in) to regulate them. This was one of several articles that led the LA Times Blog to wonder if any coverage will be there for you when you need it.

* Dean Baker at Talking Points Memo breaks down the initiative victory in Oregon that passed progressive taxes in order to prevent significant budget cuts.

FYI, I'll be on a panel at the Insure the Uninsured Project conference this Wednesday, February 10th, in Sacramento. Should be an interesting conference, with the mix of anticipation and uncertainty around reform right now.

Sebelius writes Anthem Blue Cross of CA...

noreply@blogger.com (Anthony Wright) — Mon, 08 Feb 2010 21:42:00 +0000

Maybe this is how we get some rate review after all.

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today sent a letter to Anthem Blue Cross of California urging it to publicly justify its premium hikes for its California individual market customers--hikes that are as much as 39 percent.

Here's the letter:?

February 8, 2010

Leslie Margolin
President, Anthem Blue Cross

Dear Ms. Margolin,

One of the biggest pressures facing families, businesses and governments at every level are skyrocketing health insurance costs. With so many families already affected by rising costs, I was very disturbed to learn through media accounts that Anthem Blue Cross plans to raise premiums for its California customers by as much as 39 percent. These extraordinary increases are up to 15 times faster than inflation and threaten to make health care unaffordable for hundreds of thousands of Californians, many of whom are already struggling to make ends meet in a difficult economy.

Your company's strong financial position makes these rate increases even more difficult to understand. As you know, your parent company, WellPoint Incorporated, has seen its profits soar, earning $2.7 billion in the last quarter of 2009 alone.

I believe Anthem Blue Cross has a responsibility to provide a detailed justification for these rate increases to the public. Additionally, you should make public information on the percent of your individual market premiums that is used for medical care versus the percent that is used for administrative costs. Policy holders in the individual market deserve to know if their premium increases would be invested in better medical care or insurance company overhead costs like salaries, profits, and advertising. I am aware that the State of California is investigating this matter, and urge Anthem Blue Cross to cooperate fully. In the meantime, I will be closely monitoring the situation.

At a time when health care costs are a critical threat to families as well as the nation's economy, I hope you appreciate the urgent nature of this request. I look forward to your prompt reply.

Sincerely,
Kathleen Sebelius
Secretary of Health and Human Services

If you have been impacted by this premium increase, visit www.sickofbluecross.com, and tell your story to us...

The time for consumer protections

moonriver31@gmail.com (Cynthia Craft) — Mon, 08 Feb 2010 19:57:00 +0000

An article by Tom Kisken in the Ventura County Star explores how doctors' offices, HMOs and PPOs are preparing to implement the new "timely access" state regulations requiring providers to see patients within a reasonable amount of time.

Meanwhile, advocates for health care reform are not sitting back and waiting passively for the logjam to break in Washington. A big push -- with public events and rallies -- is being launched nationwide on February 17th. Keep an eye out for events scheduled in your area, and add your voice to the masses demanding change.

Health reform continues, at federal and state level...

noreply@blogger.com (Anthony Wright) — Mon, 08 Feb 2010 16:19:00 +0000

HEALTH ACCESS UPDATE
Monday, February 8, 2010

PRESIDENT OBAMA RECOMMITS TO HEALTH REFORM, SCHEDULES BIPARTISAN SUMMIT
* In Renewed Push, Obama To Host GOP at White House on CSPAN on February 25th
* President Cites Anthem Blue Cross of California Increasing Premiums up to 39%
* New Process Launched for Medi-Cal Federal Waiver Input
* Other Items: Some State and Federal Budget Dispatches on our Health Access Blog.
* Join Us on Facebook! Follow Us on Twitter!

PRESIDENT OBAMA RENEWS HEALTH REFORM EFFORTS: This weekend, President Obama made a couple of pronouncements renewing his call to pass comprehensive health reform. At a meeting of Democrats in a snow-bound Washington, DC, he said, "Let me be clear: I am not going to walk away from health reform," bringing the audience in the hotel ballroom to their feet. "We can't return to the dereliction of duty," Obama said. "America can't afford to wait, and we can't look backward."

On Sunday, he indicated in an CBS interview before the Super Bowl that he would be inviting leaders from both parties to the White House on February 25th to go over the "best ideas" on health reform, to inform the final negotiations in reconciling the House and Senate bills. The meeting, to be televised on C-SPAN, will likely provide a forum for Republican opponents of the current health reform proposals to provide their alternatives, and to point to parts of the proposals where Republican input has already been taken. Under this schedule laid out by President Obama, the expectation of action on health reform would be possibly in March.

ANTHEM BLUE CROSS HIKES PREMIUMS: In stressing the need for reform, President Obama cited the reasons why the status quo is unsustainable, including the premium increases by Anthem Blue Cross in California, the state's largest insurer. The Los Angeles Times, in an article by Duke Hefland, reports that Anthem Blue Cross -- a subsidiary of Wellpoint in Indianapolis -- is increasing premiums 30% to 39% for the second year in a row for California customers of its individual policies.

Increases are set to take effect March 1, policyholders learned last week. In the Feller household in San Rafael, for instance, that makes the family's health care policy more expensive than their mortgage payment. The Fellers will pay 39% more, driving their annual premium up to $19,896; and then there's a 38% increase for their 26-year-old daughter, adding another $1,572 a year to the Feller's bill.

The letter detailing the increase hints at more hikes to come. It says: "Anthem Blue Cross will usually adjust rates every 12 months; however, we may adjust more frequently in accordance with the terms of your health benefit plan."

If you've got a story about your health insurance premium increases, Health Access would love to hear it. Please contact us directly, or visit www.sickofbluecross.com

SHOULD WE PAY FOR PROBLEMS?: In this memorable past week, we found out that health care spending accounted for more than 17% of the nation's gross national product.

Alan Weil, the executive director of the National Academy for State Health Policy, argues that we can bring down the costs of health care through common sense: Simply pay providers less when they mess up. Weil was in Sacramento for a policy discussion sponsored by the Center for Health Improvement and the California HealthCare Foundation. He argues that providers should face monetary penalties not just for so-called "never" events (mistakes "that should never happen") but for mistakes that are perhaps less drastic such as hospital-acquired infections. Weil calls these "a shouldn't-happen-very-often-event."

It makes us think of a recent article by HealthLeaders Media that began with the question, 'Why do hospital teams unintentionally leave more than 30 types of surgical tools or other items inside their patients, a category of hospital error that California officials say is the second most common preventable adverse event in acute care?"

The Legislature is scheduled to consider launching a study of the phenomena later this year. Either way, the Center for Medicare and Medicaid Services plans to no longer reimburse hospitals for the cost of caring for a patient's injuries, such as hospital-acquired infections, resulting from a "retained foreign object."

GETTING THE BALL ROLLING WITH STAKEHOLDER INPUT ON THE MEDI-CAL WAIVER: The process continues to develop a renewal for California's Medicaid waiver with the federal government. This past week saw the beginning of "technical workgroups" with some stakeholders set to give their input to the California Department of Health Care Services on proposed changes to Medi-Cal, which covers 7 million Californians.

With a focus on ensuring that consumer protections are in place for the Medi-Cal patients affected by the federal waiver request, Health Access is one of several organizations represented, with our Executive Director Anthony Wright (awright@health-access.org) sitting on two stakeholder groups: one on local coverage initiatives, the other on the changes to coverage for seniors and persons with disabilities.

These workgroups and a broader stakeholder advisory committee will consider these issues as the state moves toward submitting a final waiver request to the federal government this coming fall. We'll post more on our blog in the near future.

Got suggestions for future Health-Access Update news items, or notes? Please feel free to send them to updates@health-access.org

The coach calls the play...

noreply@blogger.com (Anthony Wright) — Mon, 08 Feb 2010 02:16:00 +0000

This past year's health reform debate went through major holidays, so it isn't a surprise that news is made on the secular holiday of Super Sunday.

In an interview with Katie Couric before the Super Bowl, they talked health care:

Politico has the story. The White House will host a meeting on February 25th, televised, with both Democratic and Republican leaders of Congress to discuss their best ideas on health reform. It's not an attempt to start over, the White House says, but to incorporate the best thoughts a final agreement. It'll be one more proof that the President has tried to pursue a bipartisan course, only to face solid opposition.

Jon Cohn and Ezra Klein have the early analysis.

Lots of people may have thoughts, but one thing is sure: this kind of high-profile effort isn't what a President or Congressional leaders do if they are seeking to drop the issue.

Update: Why won't President Obama walk away from health reform? He cited the increases by Anthem Blue Cross of California in his answer:

Watch CBS News Videos Online

Those with the least pay the most...

noreply@blogger.com (Anthony Wright) — Fri, 05 Feb 2010 23:46:00 +0000

Without bulk purchasing power, individuals are the most disadvantaged in the current health care system.

The most recent example Anthem Blue Cross is raising its rates in the individual market, as reported by Duke Helfand in the Los Angeles Times today. It's a Commonwealth Fund study further explores the difficulties with the current individual market.

I make a similar point in the post highlighted in this week's Health Wonk Review hosted by Joe Paduda at Managed Care Matters. When individuals are self-pay patients, they get charged more than insurers for the same level of care.

That's why the crux of health reform is to make sure individuals (and small businesses) have the benefits and bargaining power of large purchasers.

Today's headlines just emphasize the point.

Anthem Blue Cross seizes the political moment

moonriver31@gmail.com (Cynthia Craft) — Fri, 05 Feb 2010 17:43:00 +0000

It's not like Captain Renault is going to burst into Anthem Blue Cross' boardroom and announce he's "shocked!...shocked!" to see more consumer-gouging taking place.

We doubt that anyone is surprised to see Anthem Blue Cross seizing the day and aggressively hiking fees in California -- again -- for individual policy holders.

Never mind that containing costs of health coverage has been a major part of the national conversation for a year now. What matters to Anthem's parent corporation, Wellpoint, located in Indiana, is that the conversation is now down to a hushed whisper, thanks to the Party of No in Washington D.C.

And when it comes to reading political tea leaves, "no" means "yes" to Anthem Blue Cross, which for the second year in a row is increasing premiums by 30 to 39 percent. For Century City podiatrist Mark Weiss, 63, that means his and his wife's annual health insurance bill rises from $20, 184 to $27,336. Wow.

Weiss, who has been a member of Blue Cross for 30 years now, thinks "it's just unconscionable." So do a whole lot of other people -- who need to continue speaking up about it.

Read all about it in an article by Duke Hefland in the Los Angeles Times. Also, go to sickofbluecross.com to register your opinions and tell your story about being price-gouged by Anthem Blue Cross.

Budget Burdens from DC to Sacramento...

noreply@blogger.com (Anthony Wright) — Thu, 04 Feb 2010 15:55:00 +0000

HEALTH ACCESS UPDATE
Thursday, February 4, 2010

BUDGET ACTION HEATS UP AT STATE & FEDERAL LEVEL
* Chiang Tells Budget Committee of Cash Crisis, Urges "Credible" Action
* Obama's Federal Budget Includes Health Reform and Help for California
* Other Items: CBP Report on Growing Need for Services; Single-Payer Bill Advances

* Read Our Health Access Blog for updates on state budget, the latest in D.C.
* Join Us on Facebook! Follow Us on Twitter!

ASSEMBLY BUDGET COMMITTEE REVIEWS THE BIG PICTURE: Budget Chair Noreen Evans (D) led committee members Wednesday in a sharply focused Q-and-A with State Controller John Chiang, Legislative Analyst Mac Taylor and representatives with the state Department of Finance.

Not since July 12, 2007, has California actually had cash on hand, Chiang said. Since that date, the Department of Finance has relied on "external borrowing and internal borrowing" from various special funds. In answer to lawmaker's queries, the controller said the state's finance department has identified 710 of the state's 1,000-plus special funds from which it can borrow internally.

Repeatedly, Chiang told legislators that California "needs credible and sustainable budget solutions" that do not include past-year gimmicks such as proposing to sell off the state compensation fund, or EdFund (the state's guarantor of student loans) or the state Lottery -- all of which were said by the administration to be worth far more money than they actually were, and attracted no buyers anyway.

Chiang was firm in telling the budget committee that members needed to make "tough choices" to buck up the state's economic and educational future, as well as to ensure its quality of life does not decline sharply. "We've lost 1 million jobs.... We need to decide what kind of state do we plan to have -- and if we are going to fund essential services, we really need to address the question of revenue."

Both Republicans and Democrats made remarks indicating they've had enough of cutting state services for taxpayers, the disabled, the elderly, and K-12 students as well as university-bound students. Assemblyman Jim Silva (R) said as a teacher he is tired of "seeing students are getting short-changed. I get my back up with I hear that California students are at a disadvantage in getting university educations."

Assemblywoman Diane Harkey (R) noted that she only joined the Legislature about a year ago, but already she'd been through three cycles of closing budget deficits. "We're not just in a budget problem. We are overloaded with debt." Others, including Democrats Jerry Hill and Robert Blumenfield, pointed out that some of the harsh health care service cuts that Gov. Arnold Schwarzenegger is championing will cost the state more money in the long-run as people seek care in emergency rooms or long-term care facilities.

Chiang said Wall Street financial experts do not consider the governor's demand for $6.9 billion from the federal government an intelligent answer to California's perennial deficit woes. "When the governor issued his '6.9 billion solution,' it was not viewed as a totally credible solution, leading Standard & Poors to downgrade California's rating from A to A-."

"We're going to have to educate our students for new economies," Chiang said, "Your actions can make the difference in setting this generation on the right fiscal path. For too long, when people don't make tough choices, students, the aged, disabled and taxpayers all end up suffering."

Evans, the committee chair, said sub-committees will begin meeting next week to scrutinize details of the governor's budget proposal. Regarding an unprecedented Department of Finance letter requesting blanket authority to defer payments to various state creditors, Evans said "I will clean up my language from what I said when I first saw this request for the Department to have legislative authority. I'm extremely skeptical and I suggest you come back with an actual plan." Vice Chair Jim Nielsen (R) joined Republican colleagues in attempting to distance himself from the administration's request for open-ended authority to defer payments. "This is a breath-taking application," Nielsen said. "To just ask us to give you a blank check ... we can't afford that anymore."

PRESIDENT OBAMA PUTS FORWARD FEDERAL BUDGET PROPOSAL: Earlier this week, President Barack Obama released his proposed federal budget. The proposal attempts to balance short-term economic stimulus with long-term efforts at deficit reduction. In attempting to reducing the deficit by $1.25 trillion over 10 years, the proposal lets the Bush-era tax cuts expire, and prioritizes the passage of pending health reforms in Congress. To deal with the immediate recession, the budget proposes a variety of provisions, such as continuing COBRA subsidies to help the unemployed purchase health coverage. It would also extend enhanced Medicaid federal matching funds from the stimulus for six additional months to states, providing $25.5 billion nationally, and at least $1.5 billion to California in the budget year through June 2011.

The Office of Management and Budget has a specific fact sheet on the federal budget and California. Health Access has more about the federal budget on our blog.

CUTS PROPOSED AT TIME OF GROWING NEEDS: The cyclical, seemingly never-ending state budget grind has Gov. Arnold Schwarzenegger stuck in a rut, still swinging away with an ax at the safety net at the time it is needed most. That's the basic message that comes through from a report released Tuesday by the California Budget Project.

California has lost 1,000,000 jobs since the start of the recession, the report says. People need help, families need help, whole communities need help as they scramble against the tide of economic devastation. Cuts, the CBP says, will only further weaken the economy and could impede the national recovery.

The CBP report says that 100 prominent economists of all ideologies recently warned that,"It is economically preferable to raise taxes on those with high incomes than to cut state expenditures [during a recession] ... Steep state budget cuts will exacerbate the economic downturn."

The report noted that California now has 3.6 million more working-age individuals than 10 years ago, but is now down to approximately the same number of jobs as 10 years ago. More than one in five working-age Californians -- or 21.4 percent -- were either unemployed or underemployed in December 2009. (The calculation includes 354,000 jobless people who want and are able to work, but who are left uncounted in official statistics because they have not searched for work in the last month.)

As need grew, California unfortunately responded by cutting off programs -- suspending enrollment in Healthy Families, for example, even though the number of children whose low-income families bought coverage through the program increased steadily by nearly 100,000 kids from July 2007 to July 2009, the report says. To read it and view helpful charts and graphics, go to www.cbp.org.

SINGLE-PAYER, OTHER LEGISLATION STARTS TO MOVE AGAIN: With the new year, bills are starting to move again, including SB 810, the single-payer health reform bill authored by Democratic Senator Mark Leno of San Francisco. That bill looks to be headed to the Governor's desk again this year. It's onto the Assembly after passing the Senate last week, the last week a bill was eligible to pass out of its house of origin. While it still faces the barriers of a two-thirds vote for financing, and a probable gubernatorial veto regardless, it does keep a broad range of health reform options in the policy conversation, and highlights the deteriorating status quo of our health system. If anything, some advocates hope it will provide a lesson from state legislatures to their federal counterparts, that they should not quit just because of a setback.

For more information about anything in this update, contact its author, Cynthia Craft, at ccraft@health-access.org.

Obama to Senate: Finish the job on health care...

noreply@blogger.com (Anthony Wright) — Wed, 03 Feb 2010 19:46:00 +0000

President Obama spoke with the Senate Democratic retreat this morning. He had a clear message:

A Report from DC: Don't believe the hype...

noreply@blogger.com (Anthony Wright) — Wed, 03 Feb 2010 07:05:00 +0000

The media still is debating the question of whether health reform is dead or alive. Some publications predict its demise one day, and then get another headline the next line proclaiming its resurrection. It's appropriate today is Groundhog day, given the regularity of this pattern.

Several dozen health advocates were in Washington, DC, last week, and I think many of us come away with the feeling of that comprehensive health reform will happen. Democratic Congressional Representatives and their Hill staffers were depressed, but committed. With the loss of the 60th vote in the Senate, it took some time to figure out a procedural path to passage--and it still is. Congressional leadership stepped up and Speaker Pelosi has made sure it will continue. At the annual conference of Families USA, many of us watched President Obama's State of the Union speech, which further energized all of us in the rooom.

The House of Representatives isn't going to pass the Senate version as is, but will require changes to be made by the Senate through the budget reconciliation process. Some things can be changed, others can't. But with President Obama, Speaker Pelosi, and Senate Majority Leader Reid, there seems to be movement forward. Let's keep the pressure on them!

It's complicated...

moonriver31@gmail.com (Cynthia Craft) — Tue, 02 Feb 2010 06:23:00 +0000

Here's the opening of an article by Brian Rokos in the Riverside Press-Enterprise on the potential local impact of Gov. Arnold Schwarzenegger's proposed cuts into programs for individuals and families in need of adult day health care and home-care health services:

"Frail, elderly people and mentally ill adults could be forced into hospitals and nursing homes if day-care services close because of the state's budget cutting, care providers say."

But the article goes on to explain that there's a whole lot more involved than just the black-and-white scenarios: There's a domino effect of consequences should clients lose access to adult day health care. There's also the physical and emotional toll on the elderly and frail. Many may not survive a relocation from their own homes.

And, significantly, there's the stress placed on relatives at home who may have no choice but to restructure their lives to care 24-7 for their loved ones. When adult clients no longer are able to attend day-care health centers, the tasks of providing oversight and activities fall on family members who may have to give up their jobs and free time to provide the care.

The article is illuminating when it comes to explaining this toll on caregivers, some of whom are apparently outlived by the person they attend to, due to the added stress: One man told the Riverside P-E that he grew frustrated reinventing himself as a housewife and a cook and keeping an eye on his wife at all times: "There were times I just wanted to go out and yell," the man said. Without having a day-care health program to take his wife to, "I'd be back to the old daily going crazy." With the service as an option, he's been able to gain some of his free time back -- making life easier on him and his wife.

State budget drafters should always consider the multi-tiered human impacts of cutting deeper and deeper into health and human services programs. Represented on the spreadsheet, the programs may look like numbers yet, in actuality, they represent people. And not just people, but whole neighborhoods, cities and -- in the final analysis -- our level of empathy for fellow Californians.

Obama releases his federal budget...

noreply@blogger.com (Anthony Wright) — Mon, 01 Feb 2010 20:28:00 +0000

President Obama released his proposed federal budget today.

Here's the Center for Budget and Policy Priorities' inital commentary, which states, "The President�s budget reflects both the short-term priority of boosting the economy and creating jobs and the longer-term priority of bringing deficits under control while meeting important national needs... The budget would reduce deficits by $1.25 trillion over 10 years, compared to what they would be by continuing current policies."

The Office and Management and budget has a specific fact sheet on the federal budget and California.

In the budget, President Obama reiterates that he is �committed to ensuring that every American has access to affordable health care,� and his FY 2011 budget proposal continues investments to this end in the health care of Californians. Specifically, California would receive $29.4 billion to provide health coverage to low-income families [Source: OMB factsheet]. In addition, other funding would be used to improve and increase the public health workforce, encourage health centers and providers to provide care to underserved populations, fund initiatives to achieve higher quality care at lower costs, and strengthen regional and local partnerships in rural areas.

STATE RELIEF FOR MEDI-CAL COSTS

Of particular note to those of us who deal with the state budget, there is some continued state relief through Medicaid.

Under the economic stimulus package (ARRA) passed last year, the federal matching rate for California�s Medi-Cal expenditures was increased from 50 percent to 61.6 percent. This totaled $1,991,907,534 for the two quarters from October 1, 2008 through March 31, 2009. In all, California was allotted $11.23 billion for the increased Medicaid match rate that is set to expire on December 31, 2010. [Source: http://www.statehealthfacts.org/]

President Obama�s FY 2011 budget proposal includes about $25.5 billion to extend the increased Medicaid matching rate for another six months until June 30, 2011 [Source: OMB]. This means California could receive an addition $2 billion to $3 billion in federal Medicaid relief under the President�s proposal, depending on actual expenditures and the formula for apportioning the grants to states.

This six-month extension of enhanced Medicaid matching funds is one of the requests for additional federal funding that Governor Schwarzenegger requested, and one that has also been included in other legislative vehicles, including health reform and jobs. However, Governor Schwarzenegger's state budget requested many other funding increases and policy changes, totaling nearly $7 billion. Given the political and procedural barriers in Washington, DC, some are more likely than others, but getting the enhanced Medicaid matching funds is a good first step.

Deja vu all over again...

moonriver31@gmail.com (Cynthia Craft) — Fri, 29 Jan 2010 23:00:00 +0000

It's still worth sharing more tidbits from the Senate Committee on Budget and Fiscal Review, chaired by Sen. Denise Moreno Ducheny, (D) earlier this week. Though the hearing was scheduled to last three hours, it ended up being twice that long -- such was the passion of the stakeholders and the complexity of the fiscal topic.

A few of the governor's proposals were raked over the coals, in some cases because the math didn't add up to equal the level of hardship the administration would impose by cutting crucial programs. Other proposals, glimpsed through the lens of recent history, seemingly deflated on the basis of that historical fact alone.

Consider the governor's persistence on the matters of zapping Proposition 10 and Proposition 63. Remember, these were two propositions placed before the voters in the true Democratic tradition of a) allowing folks to vote yea or nay, and b) tallying up the results and c) committing the results to official record.

Proposition 10, otherwise colloquially known for creating the First Five Commission, established programs that Californians believed were needed to help our kids get the leg-up on a world, not to mention a nation, that has been swiftly overtaking us in educating our next generations. California voters first approved it in 1998, rejected overturning it in 2000, and then later once again reiterated their approval of the program to begin nurturing and schooling children ages birth through age 5 in preparation for a robust education.

Proposition 63, the Mental Health Services Act, was approved by the voters and, then again, last May, was also protected when voters rejected the budget initiative to raid the mental health fund to help cover the general fund deficit.

Certainly, in Yogi Berra's terms, as someone pointed out in committee testimony, the governor's proposals are looking like "deja vu all over again."

County spokespeople testified it cost them $68.1 million to put the budget initiatives on the ballot last May -- only to see voters reaffirm what they said they wanted in the first place. Lo and behold, that $68.1 million has yet to trickle down to the counties as reimbursement from the state for holding the May 2009 special election, though one county spokeswoman testified hopefully, "It's in the governor's budget now. . . for that we are grateful."

Any front we can...

noreply@blogger.com (Anthony Wright) — Fri, 29 Jan 2010 07:01:00 +0000

When we get health reform, Speaker Nancy Pelosi of California will be a major reason. The New Republic's Joanthan Cohn commented that she "has been nothing short of heroic over the past week" on keeping health reform alive as legislators remembers that despite a special election in a specific state, the need and urgency and political imperative of passing health reform has fundamentally not changed.

As reported by Carolyn Lochhead of the San Francisco Chronicle, Pelosi had strong words today keeping the momentum up. She said that while some parts of health care reform may be done piecemeal, but "That doesn't mean that is a substitute for doing comprehensive. It means we will move on many fronts, any front we can."

"We will go through the gate. If the gate is closed, we will go over the fence. If the fence is too high, we will pole vault in. If that doesn't work, we will parachute in. But we are going to get health care reform passed for the American people for their own personal health and economic security and for the important role that it will play in reducing the deficit."

On Cohn's blog, here's my take about why Californians should feel some deja vu, and why we are far from the end of the process.

President Obama on health care & more: "We don't quit."

noreply@blogger.com (Anthony Wright) — Thu, 28 Jan 2010 06:17:00 +0000

Health reform is alive. Speaker Pelosi has indicated she can pass the Senate bill in the House with the appropriate Senate changes through budget reconciliation. But President Obama set the new tone tonight at the State of the Union:

Now let�s be clear � I did not choose to tackle this issue to get some legislative victory under my belt. And by now it should be fairly obvious that I didn�t take on health care because it was good politics.

I took on health care because of the stories I�ve heard from Americans with pre-existing conditions whose lives depend on getting coverage; patients who�ve been denied coverage; and families � even those with insurance � who are just one illness away from financial ruin.

After nearly a century of trying, we are closer than ever to bringing more security to the lives of so many Americans. The approach we�ve taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market. It would require every insurance plan to cover preventive care. And by the way, I want to acknowledge our First Lady, Michelle Obama, who this year is creating a national movement to tackle the epidemic of childhood obesity and make our kids healthier.

Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office � the independent organization that both parties have cited as the official scorekeeper for Congress � our approach would bring down the deficit by as much as $1 trillion over the next two decades.

Still, this is a complex issue, and the longer it was debated, the more skeptical people became. I take my share of the blame for not explaining it more clearly to the American people. And I know that with all the lobbying and horse-trading, this process left most Americans wondering what�s in it for them.

But I also know this problem is not going away. By the time I�m finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans, and neither should the people in this chamber.

As temperatures cool, I want everyone to take another look at the plan we�ve proposed. There�s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here�s what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people.

A big budget turnout...

noreply@blogger.com (Anthony Wright) — Wed, 27 Jan 2010 23:31:00 +0000

More on the budget hearing from Jessica Rothhaar, who directs our budget organizing for Health Access California:

The hearing room was overflowing with Californians from around the state. The big turnout conveyed the severe impact of the cuts absolutely clear.

Senators Ducheny, Leno and Lowenthal also repeatedly expressed disbelief that the LAO was recommending adoption of the Governor�s cuts without accounting for the additional costs of consequences they admitted would happen, such as additional ER admissions, uncompensated care, homelessness, HIV/AIDS infection rates, etc. or the political impossibility of others, such as the taking of Prop. 10 and Prop. 63 money to backfill other programs. On the flip side, Senator Ducheny did ask several times whether less drastic cuts might be possible to several of the programs under discussion, such as to Healthy Families vision coverage.

Among the groups speaking against the cuts at yesterday's hearing included: AIDS Healthcare Foundation; Alliance of Californians for Community Empowerment (ACCE); AltaMed; Alzheimers Association; The ARC; Asian Pacific American Legal Center (LA); Bayview Adult Day Health Care; CA Alliance of Retired Americans; CA Association of Adult Day Services; CA Association of Family Health Centers; CA Association of Health Plans; CA Association for Health Services at Home; CA Association of Public Hospitals and Health Systems; CA Commission on the Status of Women; CA Disability Community Action Network; CA Hospital Associationl CA Immigrant Policy Center; CA Medical Association; CA Primary Care Association; Casa Pacifico ADHC; Children Now and the 100% Campaign; Children�s Specialty Care Coalition; County Health Directors Association of CA; County Mental Health Directors Association of CA; County Welfare Directors Association of CA (CWDA); Developmental Disabilities Council of Alameda County; Easter Seals; Elderday ADHC; Futures Explored; Graceful Senescence ADHC; Hemophilia Council of CA; Loma Linda University Medical Center; National Alliance for the Mentally Ill; Oral Health Access Council; Para Los Ninos; Placer Independent Resource Services; Planned Parenthood Affiliates of CA; Resources for Independent Living; Sacramento CARES; San Diego Council of Community Clinics; San Francisco AIDS Foundation; United Association of California Care Providers (UACC); and Western Center on Law and Poverty.

There was particularly awesome turnout and testimony organized by the California Association of Adult Day Services, which had members there from just about every district represented on the Budget Committee, including San Diego, San Bernardino, Santa Cruz, San Francisco, Contra Costa and Los Angeles. Let's keep it up!

Blunt language about a blunt budget...

moonriver31@gmail.com (Cynthia Craft) — Wed, 27 Jan 2010 05:40:00 +0000

There was no escaping the sharp wit and quick tongue of Sen. Denise Moreno Ducheny (D), chair of the Senate Committee on Budget and Fiscal Review, on Tuesday as the panel heard its first airing of the rationale behind the governor's budget proposals to drastically slash taxpayer-funded health services -- for the second year in a row.

Again and again, Ducheny offered succinct retorts that, in effect, signaled to the admininstration that Gov. Arnold Schwarzenegger's ideas amounted to little more than glasses-half-empty. In nearly every area of cuts described, Ducheny demanded more data before moving forward on the governor's punishing health-care cuts for California's most vulnerable populations at a time when the prolonged recession continues to drag down the state's economy.

More than once, Ducheny and other senators questioned why revenue-raising options were not considered as alternatives to decimating services to taxpaying, lower-income citizens. "Most of these programs were started in the first place with the theory that they would save us Medi-Cal dollars in the long run," Ducheny said, demanding more concrete figures from the administration's Department of Finance as it outlined proposed cuts in adult day health care, Healthy Families coverage for children, mental health programs, HIV-AIDS drug assistance and more.

"It's a pig in a poke, is what it is," Ducheny said, chiding the finance department and the Legislative Analyst's Office representatives for not presenting more details to support the claim of potential savings. "It's a bit of an irony that, if we're the seventh-richest state in the union, why the people who put us there couldn't help us more, by paying a [higher] Vehicle License Fee, for example."

Said Sen. Mark Leno (D-San Francisco): "When the governor talked about 'Sophie's Choices,' he didn't suggest revisiting the tax breaks for revenues. He didn't say that was one of 'Sophie's Choices.'"

Still, time and again, both the LAO and DOF representatives fell short in their explanations of how the puzzle pieces of the governor's proposed budget cuts fit together in a way that made sense in helping Californians weather the tsunami of a persistent recession.

Those offering testimony against the governor's cuts raised the discussion to a blunt level not frequently heard in such a formal setting. They spoke of the elderly and the frail expiring before being able to find a bed in a long-term nursing home. They spoke of children being left behind to fail in classrooms; they spoke of more and more people becoming homeless, hopeless, ailing and unjustly relegated to being second-class citizens. Phrases like "fiscally foolish," "morally reprehensible" and "appalling and horrific" replaced the more polite, mutually beneficial language that advocates typically offer up in legislative hearings.

Regarding the proposal that Healthy Families vision care benefits be dropped for children whose low-income parents pay 150% more in premiums than they did a year ago, Ducheny said, "How are the children going to 'Race to the Top' if they can't read?"

Senator Roderick Wright, a Democrat from Los Angeles, provoked the most heated discussion in dismissing what he called "the euphemisms regarding 'reduction of services.'"

Should the governor's proposals be adopted, Wright said, "We are voting to let people die. If we don't face the consequences of these cuts, if we don't face the fact that we are discussing life or death for some folks. . .we are doing a disservice to the public."

The one true path...

noreply@blogger.com (Anthony Wright) — Wed, 27 Jan 2010 04:13:00 +0000

We'll have more reports about health reform from DC through the week. But one message: this is *totally* doable.

There is a path for health reform. Some call it "two-step," others call it "Senate plus reconciliation." But it's the same path, and perhaps the only path: The House passes the Senate bill, and a package of improvements that would be passed by the Senate through a limited budget reconciliation process. This still takes two final floor votes, needing 218 votes in the House, and 51 in the Senate.

Two good write-ups of the process are at Time.com's Swampland and at Talking Points Memo.

This is a situation where the best policy and best politics align.

We need comprehensive health reform, and failure to pass such a broad reform (or passing a dramatically scaled back version of reform) won't begin to solve basic issues: getting insurers to compete based on cost and quality, rather than avoiding sick people; having people pay for coverage based on what they can afford, rather than how sick they are.

But other options are also politically problematic. Small reforms and/or starting anew wouldn't work, would not provide the necessary political benefit, and would bring up all sorts of new issues, new opponents, and take much more time and effort.

That's the procedural path is clear. The only question is the political will.

Does Limbaugh want everyone to be uninsured & overcharged? Like him?

noreply@blogger.com (Anthony Wright) — Wed, 27 Jan 2010 03:45:00 +0000

The latest Health Wonk Review highlights our comments about Rush Limbaugh�s short stay at a Hawaii hospital. His endorsement of its quality provided a moment to spotlight the success of the Aloha state�s thirty-year old health reforms, especially in the area of ensuring employer-based health coverage.

As policymakers consider the fate of health reform, it's worth considering what is the alternative that the opponents propose.

Let's start with Rush Limbaugh, from his his first day back on the radio, his response to such commentary.

He noted he is uninsured�by choice. And that he is concerned about the waste and barriers to coverage by insurance companies�and he may have been overcharged�all issues addressed in the health reform bills. Rush said:

I'm not gonna get health insurance. I'm not going to inflate my bill by 35%. This cost me 30% less than had insurance been involved here. There was not one bureaucrat determining whether or not I was gonna get treatment. There wasn't a death panel here.

He seems to be referring that a lot of insurance premium dollars go to costs beyond patient care. That�s why the health reform bills set minimum medical loss ratios�the industry�s term for the money that is �lost� to care, rather than administration, marketing, and profit.

He also seems concerned about insurance bureaucrats denying care. The health reforms also include independent medical review�a component of a patient�s bill of rights package that has been passed in many states but stalled at the national level until now�so that if an insurer does deny coverage for medically necessary care, patients have the ability to get a third party to review, and possibly overturn, the decision.

His solution to insurance industry abuses is to not get insurance. As a multi-millionaire, Limbaugh had the ability to pay, as he said, just using a credit card.

But for the rest of us, health coverage is not just a good idea, it is essential. It's not an option to be on the hook for thousands (or possibly tens or hundreds of thousands of dollars) if we get sick.

How much did he pay for his short stay? He indicates it�s around the price of a car.

In the first place, you don't need to make $33 million a year or $50 million to afford what happened. I'll put it to you this way. My expenses were less than the cheapest car that you will go out and buy today other than one of these little bubble smart cars. It was five figures less than the average car. Yet for some reason it's immoral for people to have to pay for that. I don't have insurance. "I'm sure he has insurance." No. I pay cash for it and it was less than the price of a car. And just as is the case with a car you could finance your health care coverage. You don't have to come up with the whole lump sum, hospitals, doctors, work with you on this.

As someone who is uninsured, self-pay patient, Limbaugh probably gets charged on average of three times what insurers and public programs pay, for exactly the same service.

That�s because hospitals have a �chargemaster,� or sticker price, for their services that are inflated well beyond the actual cost of providing care. Insurers and public programs, with their market power, have the ability to negotiate the rate down. The uninsured, without that bargaining power, are stuck with the inflated rate.

The cruel irony of our health care system is those with the least are charged the most. In California, the average hospital charge is four times what most insurers pay. I�ve worked with patients who a 3-hour visit to the ER cost $12K; a one-night stay for an appendectomy cost $26K; and people who have racked up six figures in debt. These are the kinds of numbers that force regular middle-income people�however responsible they are�into collections and bankruptcy.

There have been class-action lawsuits about these unfair billing practices, and California and a few other states now cap how much hospitals can charge uninsured within certain incomes. (We have a website, www.hospitalbillhelp.org, to help Californians struggling with high hospital bills.) The Senate health reform places some oversight over hospital pricing policies, which has been a longtime interest of Senator Grassley.

But the ultimate way to prevent this practice of overcharging is to get people into group coverage, where they have the purchasing power to negotiate the best rate. Coverage provides a way for people to share in the risk and cost of health care: even if you are healthy today, you have financial security when (not if) those chest pains, or another ailment, comes upon you, you don�t have the additional shock of a huge bill. And that�s the heart of health reform.

So Rush�s alternative to health reform seems radical: he's not just against health insurance reform, but against health insurance. For most people who can�t absorb a five or six-figure trip to the hospital, that�s a prescription for financial ruin�or worse.

A lot of people say, "Rush, you're really running a risk here of sounding out of touch when you talk about how you can pay for this.�

Yep. Before we agree with those opposing health reform, we should understand what their proposal is.

Do California leaders need to stay after school?

moonriver31@gmail.com (Cynthia Craft) — Tue, 26 Jan 2010 03:05:00 +0000

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.

Not going down without a fight...

noreply@blogger.com (Anthony Wright) — Mon, 25 Jan 2010 04:58:00 +0000

California health reform advocates have seen health reform proposals die, whether by a veto or a vote. This just doesn't seem to be one of those times.

Some breathlessly predicted health reform's collapse, but the next day the very same Politico reported that Speaker Nancy Pelosi and Senate Majority Leader Harry Reid are negotiating the obvious path forward: The House passes the Senate bill, with the agreement to make the appropriate changes through the budget process--which take 51, rather than 60, votes in the Senate.

The only other path, short of complete abdication, is a drastically scaled back, unrecognizable proposal that would reopen all sorts of difficult conversations, and may provide some help to specific folks but no one would call it close to health reform.

This week, many of us will be in Washington, DC, and may have additional insights into what is going on. As always, we'll have reports on health reform and the California budget, from DC and Sacramento.

Given the circumstances, our posts recently have focused on the politics, rather than policy. If you are loking for your health policy fix, here's a link to the latest Health Wonk Review, hosted this week by the Disease Management Care Blog.

Show your support for health reform in SF & LA:

noreply@blogger.com (Anthony Wright) — Sat, 23 Jan 2010 17:32:00 +0000

This morning, Saturday, Janaury 23rd, at 11:00am, keep the push on for health reform!

IN SAN FRANCISCO:
San Francisco Federal Building, 90 7th St., San Francisco 94103 (Meet at 7th and Mission)

Californians will hold umbrellas � rain or shine � to illustrate the need for better coverage and honk for health care signs calling on Members of Congress not to leave consumers at the mercy of the insurance industry.

IN LOS ANGELES:
Clinica Romero, 2032 Marengo St., Los Angeles, CA 90033

Los Angeles community members performing street theatre to illustrate abuses by insurance companies and why health care reform efforts are needed to be to assure affordable, secure health coverage for all.

What Speaker Pelosi actually said today...

noreply@blogger.com (Anthony Wright) — Fri, 22 Jan 2010 07:26:00 +0000

Some have interpreted Speaker Nancy Pelosi's remarks as a signal that health reform is dead. Here's a transcript of some of her statements today, where she expresses the need and urgency for health reform. She's says her caucus can't pass the Senate bill as is. But it seems like it's a path for moving forward, but with changes. One way is to use the budget reconciliation process to make amendments. Read it for yourself:

PELOSI: Many of you have asked many questions about where we go from here. Let me congratulate the new Senator, Senator Brown from Massachusetts. While the results of the Massachusetts election may have diminished by one in the number of Senators in the Senate, last year this time there were 58 Senators, I remind you, 58 Democratic Senators, now there are 59. It has not diminished the need for affordable quality health care reform and for health care to be available to all Americans. As a right not a privilege.

The need for us to address health insurance reforms to end discrimination based on preexisting conditions, to stop rescissions, that when people are sick even though they have health insurance their policy has a rescission, to say that if you pay your premiums and do so on time and you get sick your plan will not -- your insurance will not be canceled. The list goes on and on. The idea of medical loss ratio that insurance companies should pay five percent of the premiums they collect on benefits. These and other issues to hold the insurance companies accountable. The McCarran-Ferguson, repealed McCarran-Ferguson exemption to the antitrust laws for the insurance company. As I say, these and other needs are still there.

There are still 30 million people in our country without health insurance. But the most important point I think is that the present system is unsustainable. We can not afford an upward spiral of cost. Families can't, businesses can't, our economy can't in terms of our international competitiveness, and certainly the Federal budget cannot. So we are going to have to continue to go in a forward direction to lower cost, to hold the insurance companies accountable, to make sure what we do is affordable to the middle class and to -- as we expand access to quality affordable health care. It is still a very exciting initiative, ranks right up there with Social Security and Medicare. And we are meeting with our Members on every level -- as a Caucus, in different groups of the Caucus, to hear how they perceive as the best way to go, how they would prefer to go forward, but we will go forward.

QUESTION: Madam Speaker, given the fact that there seems to be widespread unease in your Caucus about taking up the Senate bill and passing it and fixing it, is that option being discarded at this point?

PELOSI: Nothing is discarded, everything is on the table. You characterize it correctly; "unease" would be a gentle word in terms of the attitude of my colleagues toward certain provisions of the Senate bill. Let me remind you that over 80 percent of that bill, our two bills, are similar. So there are important initiatives in the Senate bill. But there are certain things that members just cannot support. For example, the Nebraska piece of it. And so what they would want to see fixed is that there be equity among states, more fairness, and that that policy shouldn't be made on the basis of one Senator, but on the basis of one country for -- to name one example. There has always been unrest in our Caucus about the excise tax on so called Cadillac benefits and so, you know, just to name a few.

So in its present form without any change, I don't think it is possible to pass the Senate bill in the House. There is some part of our Caucus that would say let's just take these pieces. We recognize health care has to be done -- health care reform has to be done, let's take some pieces of it and go forward. Others are saying let's just get it done and move on. But everybody recognizes that something needs to be done.

QUESTION: Madam Speaker, does that mean the Senate bill in its present form you will not pass?

PELOSI: I don't see the votes for it at this time, no. I mean, the Members have been very clear in our Caucus about the fact that they didn't like it before it had the Nebraska provision and some of the other provisions that are unpalatable to them. But there is a recognition that there is a foundation in that bill that is important. So one way or another, those areas of agreement that we have will have to be advanced, whether it is by passing the Senate bill with any changes that can be made or just taking pieces of the bill. But everything is on the table. In other words, what we are doing now is very calm, we have to get a bill passed. We know that, that is a predicate that we all subscribe to. We have to pass legislation.

QUESTION: But passing the Senate bill and then trying to fix it later is not an option?

PELOSI: There are some fundamentals in there that that make it problematic for our Members. And some Members say, and I respect this, some of the concerns that were expressed in Massachusetts were about certain provision of the Senate bill. We want obviously to hear and heed what was said there and what is said across the country. What was said in Massachusetts was not news to anyone, it was just expressed in an election. But it is hard it say, well, we don't like the special provision for [Nebraska] -- and that had a lot of resonance around the country, again most recently expressed in Massachusetts. So they don't see why something that wasn't even a fundamental part of the bill to begin with, that has been rejected by the American people is something they should be called upon to vote for. That doesn't sound like they heard the message of Massachusetts.

QUESTION: Just to be clear on that, you are ruling out passing the Senate bill unchanged, but are you not...

PELOSI: We are not ruling out anything. I am saying to you we are ruling out -- everything is on the table and everything, every decision that we have to make -- now we are legislating here now, so this may be more on the subject than you want to know. But in legislating, we have to know what our possibilities are, and that means in both Houses and with the White House. And every time you make a decision, you have to make a choice; you don't like this but is it better than that. I am saying to you right now that the Members -- in every meeting that we have had there would be nothing to give me any thought that that bill could pass right now the way it is.

QUESTION: You mentioned that as an option, the pieces. Given the unease among your Members about the Senate bill and trying to fix that, is that a more likely option?

PELOSI: Well, I don't think anybody disagrees with, "Let's pass the popular part of the bill," but some of that popular part of the bill is the engine that drives some of the rest of it. But again, we are not in a big rush; pause, reflect upon what our possibilities are, see what the support is in the Caucus. We have to always go where we can build consensus. So certainly there would be great consensus to take the most popular part of the bill and advance it, but I don't know what -- and that would be positive, but we have serious other structural things that have to be done, systemic changes that have to happen to again hold the insurance companies accountable. [Sound of clock chiming.] Have we, did we get a new clock? Or have we not been here at this time of day? Oh, it is 10 o'clock? It must be Eastern time, Western, some time, other time.

But again, however we achieve it we must arrive at accountability of the insurance companies, and I talked about that package earlier, any discrimination of preexisting conditions, no rescissions, stopping them from canceling policies even though people have paid their premiums but because they get sick their policies cancel. The list goes on, medical loss ratio, McCarran-Ferguson, repealing the exemption that they have to antitrust laws. Again in the Senate bill good language that talks about if the insurance companies raise rates in this next couple of years before the exchanges are established, then they would not be able to participate in the exchange. You know, those kinds of things -- accountability. Affordability is very important. Affordability for the middle class. That is one of the main purposes of bill is to make it affordable to the middle class. And so to the extent that any one of these initiatives, or the decision may be to proceed with the full bill, I don't know, but there isn't a market right now for proceeding with the full bill unless some changes are made in the Senate.

Getting perspective...

noreply@blogger.com (Anthony Wright) — Thu, 21 Jan 2010 05:35:00 +0000

President Barack Obama was interviewed by ABC News today. He made clear that he heard the anger of Massachusetts votes, but he didn't back away from health reform. In fact, he made the case for continuing the effort. Neither is Speaker Nancy Pelosi backing away:

The need and urgency for health reform that was true last year and last week is still true today and this week and this year. Families continue to wonder if their coverage is going to be there for them if they need it.

The urgency for health reform does not change because of one special election in the state where health reform least mattered, since they already adopted many of reform's benefits, from regulating insurers so there are no denials for pre-existing conditions, to providing subsidies to low and moderate income families to afford coverage. Even the candidate opposed to national health reform did not oppose the policies in Massachusetts once they were adopted.

Given the extent of California's health crisis, Californians need health reform more than ever, and to pass a final proposal quickly. Californians are more likely to be uninsured, face a higher cost-of-living, are at greater risk to be denied for coverage for pre-existing conditions, and are less likely to be offered on-the-job coverage. Health reform would disproportionately help Californians, providing new choices for the uninsured, more security for the underinsured, stability for our safety net, and savings for our state budget.

We thank the President and Speaker Pelosi for her leadership in continuing the effort to solve the pressing problems that patients face. We look forward to working with them, especially our California Congressional delegation led by Speaker Pelosi, to pass health reform and to continue to improve our health system in the months and years to come.

HCAN on moving forward...

noreply@blogger.com (Anthony Wright) — Wed, 20 Jan 2010 10:13:00 +0000

Here's a statement by Richard Kirsch, National Campaign Manager, Health Care for America Now:
�Health Care for America Now is committed to winning a guarantee of good, affordable health care we all can count on, and we will continue to push aggressively to get the best health care reform bill possible to the President�s desk for his signature as quickly as possible.

Tuesday�s vote was not a referendum on health care reform. It was a referendum on a particular candidate in a climate in which people, hard pressed by the economy, are impatient for change. When it comes to the need to make good health care affordable, nothing is different today than it was yesterday. Congress must keep going and finish reform right.

Fixing health care now is vital to fixing our economy. In survey after survey, voters continue to voice strong support for forcing health insurers to stop excluding people with pre-existing conditions, guaranteeing everyone has access to good, affordable coverage, and requiring health plans to spend premiums on medical care, not profits.

The people of Massachusetts already have benefit from health care reform. It�s time the rest of the country had the same access to good, affordable care.

We are on track to pass a strong bill, and we will stay focused on that until the President signs the bill into law.�

I would add that we at Health Access are pleased by Speaker Pelosi's continued leadership on this issue. And maybe that comes from the fundamentals: After all, the need and urgency for health reform from last year and last week didn't change this week and this year, because of a single result of a special election in a specific state. The election in question was in the state where health reform least mattered--as opposed to California, where it matters possibly most of all, given our large percentages of uninsured, lower-wage workers, people at risk of being denied for pre-existing conditions, etc. Even in Massachusetts, the candidate in opposition to national health reform did not dare oppose the identical state reforms already in place.

And that's the lesson. Pass a bill--a good bill--and health reform won't be the political issue it is now.