Friday, August 30, 2002

8/29/02 11:48 PM

To: Health Access Interested Parties
From: Beth Capell, Health Access advocate
Re: Legislative Session: 48 hours left

FINAL DAYS
Today the Legislature passed one key HMO reform bill. Others hang in the balance in the Senate in the last hours of the legislative session.

BUDGET RUMORS ABOUND

Budget rumors are flying. It is apparent from the rumors and the activity that there are serious efforts to resolve the state budget prior to the scheduled adjournment at midnight, Saturday, August 31.

It is possible that any final deal will involve a different revenue package than previously enacted by the Senate—and it is likely that any final deal will involve more cuts in health care.

If I had the faintest idea what the proposed cuts were, we would mobilize you to fight them. However, as is traditional when a deal finally comes down, it is being held very close and few know its contents---if indeed they are knowable at this moment. It is likely that no final decisions have been made.

It remains possible and perhaps even likely that no deal will be reached on the budget in the next 48 hours. If that occurs, the last date to adopt a budget under the California Constitution is November 15. However, the state will run out of cash to pay bills before then. When that will happen and who will be first in line to suffer is the subject of much speculation and little hard information.

Anything that has ever been on a list to be cut remains vulnerable—and there are probably some nasty things that could happen that have not been on any list up till now.

Remember—the Governor can item-veto or blue-pencil an amount and reduce it but the Governor cannot increase amounts. So a cut made by the Legislature is probably final (so long as it complies with any federal requirements). Also, some cuts require legislative action and some do not: for those that do (such as quarterly status reports), the Governor cannot reduce the funding. Other items can be reduced or eliminated by the Governor without further legislative action (such as trauma funding). See the Health Access budget cuts scorecard, at www.health-access.org, to distinguish what falls into which category.

As we say in the halls of the Capitol, it is a long time till Saturday.


MANAGED CARE REFORM

Two key bills progressed today:

AB2179(Cohn) which requires real and enforceable standards for timely access to health care passed the Assembly 60-0 today (Thursday, 8/28) after passing the Senate 21-13 on a party line vote yesterday (Wednesday 8/27). AB2179 now goes to the Governor for a probable signature. A fact sheet and sample letter will follow: we need organizations to support this measure.

SB842(Speier), which regulates prescription drug coverage by HMOs, passed the Assembly tonight with 44 aye votes. It was hung up for numerous hours even though all opposition had been removed. Let this be a lesson to us that the memory of HMO reform has come and gone in California---more than a third of the Assembly was not here in 1999 when the HMO Patient Bill of Rights was enacted. Next year, the proportion will exceed two thirds. SB842 proceeds to the Senate for a vote either Friday, 8/30 or Saturday, 8/31. Since this measure is supported by the Davis Administration, it is expected to be signed if it passes the Senate.

Continuity of Care: AB1522(Thomson) and SB103(Speier): As predicted, agreement was not reached and neither measure proceeded to the Governor. This issue awaits further action next year, when Helen Thomson will no longer be in the Legislature, although Jackie Speier is expected to continue as chair of Senate Insurance.

Medical group negotiations: AB1600(Keeley): Also as predicted, this measure failed to proceed due to lack of agreement.

posted by Kristin | Permalink | 10:21 AM


 

Tuesday, August 27, 2002

HEALTH ACCESS ALERT
Tuesday, August 27th, 2002

END-OF-SESSION LEGISLATIVE UPDATE ON HMO PATIENTS RIGHTS: Attached is a quick update, by Health Access legislative advocate Beth Capell, on the status of key legislation regarding managed care consumer protections, which continues the work around the passage of the California HMO Patients' Bill of Rights in 2000.

There are other bills of note, but we wanted to get out information quickly on specific legislation that our allies have been following. In particular, we would appreciate any support on the following bills still in play (more info in attachment):

· SB842(Speier), prescription drug coverage for HMO enrollees, hangs in the balance at this writing, on its way to an uncertain fate on the Assembly floor.
· AB2179(Cohn), timely access to care, is awaiting Senate action before returning to the Assembly for final action.

For a recent version of our more comprehensive bill list, visit our web site, at www.health-access.org.
----------------------------
MANAGED CARE UPDATE: FIRST PARTTuesday, August 27, 2002
Beth Capell, Health Access Advocate.

As the legislative session winds down, key HMO reform legislation hangs in the balance. However, the outcome of several measures has already been determined. Further updates will follow.

Continuity of Care: AB1522 (Thomson) and SB103 (Speier): In late 2000, many consumers had their care disrupted because of a bitter contract dispute between Sutter Health and Blue Cross. Relationships with physicians were abruptly terminated often with only a few weeks notice. In another instance where a medical group went bankrupt, the medical records, including thousands of mammogram films, were held by the group and not released to either affected consumers or the HMOs legally responsible for handling the transfer of the consumers to other physicians.

Health Access and other consumer organizations supported efforts to obtain continuity of care for up to a year after contracts between HMOs and provider groups were terminated. This would allow consumers who have an open enrollment period to take advantage and others who are in the midst of a course of treatment or who have conditions that require multiple doctors sufficient time to make a change. The DMHC in the Davis Administration has supported consumers.

Physicians and medical groups have fought to limit continuity of care to six months. In stunning testimony, the California Medical Association said that disrupting the doctor-patient relationship was a mere “inconvenience” to the consumer and that the important continuity was between the physician and the contract. Senator Speier, chair of the Senate Insurance Committee, has sided with the physicians in advocating for six months of continuity rather than a full year.

Because of this, continuity of care legislation has been stalled in a conference committee for over a year. As of today, Tuesday, August 27, the deadline for conference committees to act, this complicated measure is not in shape to move forward and is unlikely to do so, leaving consumers at the mercy of contract disputes between HMOs and providers for another year.

Medical Group Negotiations: AB1600 (Keeley): This bill, which in some of its many versions was opposed by Health Access as well as many labor organizations, would have voided anti-trust protections to allow medical groups and medical associations to negotiate to set prices with HMOs. These medical groups are often large businesses with hundreds and even thousands of doctors represented. AB1600 was opposed by Health Access because it allowed prices to be negotiated in secret between two groups of businesses (the medical groups and the HMOs) with no role for the consumer or the purchaser, little or no public scrutiny, and dramatic potential to drive up premiums without necessarily improving quality or even compensation of individual physicians.

Health Access supported the right of consumers to sue to enforce the Knox-Keene Act and has also supported regulation of HMO rates if it is done through a regulator with a public process that includes consumer scrutiny and involvement.

AB1600, which had been stalled for almost a year in the Assembly on concurrence in Senate amendments, has failed to proceed to the Governor and is dead for this year.

More to come:
·SB842(Speier), prescription drug coverage for HMO enrollees, hangs in the balance at this writing, on its way to an uncertain fate on the Assembly floor. Health Access and other consumer and constituent organizations will be fighting for its passage.

·AB2179(Cohn), timely access to care, is awaiting Senate action before returning to the Assembly for final action. Little active opposition to this measure remains, except that of the medical group associations, which fear that their organizations will fail to meet standards of timeliness, whatever those may be. The DMHC is continuing to prepare for implementation of the measure and will hold a public meeting on this subject on Tuesday, Sept. 3 in Los Angeles. For details see their website at www.hmohelp.ca.gov.

--
Anthony E. Wright
Health Access
1127 11th St., #234, Sacramento, CA 95814
Ph: 916-442-2308, Fx: 916-497-0921
awright@health-access.org

Labels: Updates

posted by Kristin | Permalink | 11:21 AM


 

HEALTH ACCESS UPDATE
Budget Cuts Update
Monday, August 26, 2002

Still no budget, but negotiations continue and are moving quickly. Here's an update from weekend developments, as of mid-day Monday:

* DEMOCRATIC PROPOSAL FOR BUDGET COMPROMISE: So far unable to get the support of four Assembly Republicans to pass a budget, Speaker Herb Wesson put forward a compromise proposal on the budget over the weekend to the entire Republican Caucus. The proposal included an additional $200 million cut from the Senate-passed budget, and a spending cap for the 2003 fiscal year.

Details have not been specified at the time of this writing. A $200 million cut (or another additional cut of a higher amount) would most likely involve health care cuts beyond the Senate-passed budget (see scorecard at http://www.health-access.org/scorecard.htm). Given this direction, all proposed cuts in health care and other areas are still on the table, and "in play."

The Assembly Republicans have stated that they will put forward a counter proposal, but have not done so today. They indicated that they will not propose something different from what they have advocated in the past, including an opposition to all tax increases--necessitating nearly $4 billion in additional cuts.

* EMERGENCY SPENDING GAMESMANSHIP: In an attempt to deflect pressure after weeks of newspaper articles detailing the plight of vendors, service agencies, and individuals adversely affected by the lack of a budget, Assembly Republican Leader Dave Cox proposed an "emergency spending" measure to "allow the state to pay bills for critical health services and education grants."

When discussed on the Assembly floor, it was amended by the Democratic majority led by Assemblyman Marco Firebaugh to include all departments and services, and passed with support from both parties. The bill was referred to the Assembly Budget Committee, which has yet to meet, or to schedule a meeting time.

The Assembly Republicans held a press conference Monday morning to call for passage of this emergency spending measure. Several senior, religious, health care, and labor organizations sent representatives to respond and point out the irony (if not hypocrisy) of these legislators, who are responsible for the budget being held up in the first place, and whose actions would lead to severe cuts in health care, education, and other services.

Labels: Updates

posted by Kristin | Permalink | 9:24 AM


 

Tuesday, August 13, 2002

HEALTH ACCESS UPDATE
Budget Cuts Update
Friday, August 9th, 2002

* NEW BUDGET CUTS SCORECARD: Given the new parameters of the budget debate, we have a new and expanded Legislative Scorecard, detailing the proposed cuts to health care, and the current status of those proposals. View this at http://www.health-access.org/scorecard.htm
* The new scorecard now includes not only those proposed cuts from the May Revise, but the explicit cut proposals by the Assembly Republicans.
* It also has new columns to follow the next phases of the budget battle, including whatever the Assembly budget would look like, and the Governor's options, if and when a budget reaches his desk.
* The scorecard is now 3 pages. We are working on producing a simpler one-pager for general, grassroots distribution.
* While the scorecard shows that the Senate budget largely rejects the worst of the proposed cuts to health care, since it raises the revenues needed to restore funding, it is clear that until a budget is passed by both houses and signed by the Governor, our work is not over. Then there's next year...

* TOBACCO TAX PUSH CONTINUES: Assembly Speaker Herb Wesson continues to focus on his proposal to significantly raise the tobacco tax. On Monday, August 12th at 10am, he will host a press conference with health care professionals and providers to show support for this tax. His office is interested in working with advocacy and constituency groups on other events, efforts, and ideas.

* THE RICH AND FAMOUS FOR REVENUES: Over 85 high-income earners released an open letter in support of revenues, particularly upper tax bracket restoration. BELOW is the article from the Los Angeles Times.

----

http://www.latimes.com/news/local/la-me-budget8aug08.story?coll=la%2Dheadlines%2Dcalifornia

THE STATE

WEALTHY RESIDENTS URGE HIGHER TAXES ON RICH

Budget: Group says state needs the money to balance this year's and future spending plans and preserve vital services like health care.

By JULIE TAMAKI
TIMES STAFF WRITER

August 8, 2002

SACRAMENTO -- It's a rare day when people ask the government to tax them more, but that's exactly what dozens of California's wealthiest residents are urging state leaders to do as a battle heats up over a new state budget.

Concerned about proposed trims to health care and other vital services, 88 of California's high-income earners, including actors Ed Asner and Richard Lewis, are releasing a letter today asking Gov. Gray Davis and legislative leaders to reinstate top income-tax brackets to help balance this year's budget and future ones.

"This is about the devastation to needed services in the state and thinking about something other than your own wallet," said signatory Roy Ulrich, a Santa Monica attorney and president of the California Tax Reform Assn.

"It makes me sleep better at night," he said.

If revenue is not found to reverse proposed cuts, Ulrich warned, all Californians will be affected.

"We may be separated by neighborhoods, but we are not separated in terms of a failed health-care system," he said. "We all use trauma- care centers."

The letter comes as Democrats who control the Assembly struggle to pass a $99-billion spending package that cleared the state Senate on June 29.

Republicans are blocking the plan due to its reliance on more than $4 billion in new taxes and revenue, in part by raising the state cigarette tax to $3 per pack.

The tax package failed to clear the Assembly on Wednesday on a 50-20 vote after several hours of particularly bombastic oratory.

At one point, Assemblyman Ken Maddox (R-Garden Grove) compared the budget to a giant mosquito carrying the West Nile virus.

To balance the spending plan, Davis and his fellow Democrats have proposed a combination of new taxes, spending cuts, borrowing and fund transfers.

Their approach is similar to one used by former Gov. Pete Wilson when he faced a $14-billion hole during the recession of the early 1990s.

Even with those steps, state analysts predict that California will face five more years of shortfalls.

Assemblywoman Helen Thomson (D-Davis) is among the Assembly Democrats who have publicly supported taxing top earners to prevent health-care programs and other key state services from being diminished.

"To make the kinds of cuts that Republicans are proposing we would have so little left in terms of health care, parks and education," Thomson said.

"We don't need to make such draconian cuts that it puts California behind such states as Missouri and Georgia," she said.

Senate Leader John Burton (D-San Francisco) previously proposed increasing the highest individual tax brackets from 9.3% by adding 10% and 11% brackets.

Estimates of the revenue that would be generated by his plan range from $2.7 billion to $3.3 billion.

The Burton plan died, however, after it failed to garner the single Republican vote necessary to pass the budget out of the Senate.

Davis, who believes that the state has become too reliant on personal income tax revenues, also opposes the proposal.

Nonetheless, advocates for the poor have continued to push for higher taxes on the rich.

Anthony Wright, organizing director of the health-reform group Health Access, said proposed cuts have put access to health insurance for hundreds of thousands of Californians at risk in addition to hospitals and trauma centers.

Labels: Updates

posted by Kristin | Permalink | 9:22 AM


 

Friday, August 09, 2002

HEALTH ACCESS UPDATE
Wednesday, August 7th, 2002

BUDGET DEBATE HEATS UP
Additional Cuts Debated and Rejected; Increased Tobacco Tax In Play

ATTACHED:
* Memo by Senate Secretary on Budget Timing
* Alert by Speaker Wesson on Tobacco Tax

THE STORY SO FAR: The Senate came back into session after a month-long recess this past Monday, August 5th, but it was the Assembly that restarted serious debate and discussion on the budget. The Senate went into recess in late June after passing their budget plan, which raised the tobacco tax and restored part of the vehicle license fee, and thus was able to prevent the worst of the proposed cuts to health care and other services. The Assembly stayed in session throughout July, but was unable to get the 2/3 majority needed to pass the Senate budget. No Assembly Republicans voted for the budget, due to their opposition to increased revenues.

CUTS PRESENTED AND REJECTED: On Monday, Assembly Democratic leaders called the bluff of those not voting for the budget. The Assembly debated and voted on a plan that did not increase revenues, and thus made the additional cuts necessary to balance the budget. The presented cuts were steep in every area, including cuts of $1.5 billion cut to public schools and community colleges, $1.16 billion in health care, more than $422 million to social services, $240.6 million to universities, $215.8 million to environmental protection, and $164.6 million to public safety. In health care, the cuts included not only all of the Governor's proposed cuts from the May Revise, but additional cuts that Assembly Republicans have proposed in recent months, such as the elimination of the Child Health and Disability Prevention program. Yet the Assembly Republicans voted with the Democrats against these cuts, and the proposal got zero votes.

NEW PROPOSAL ON TOBACCO TAX: On Tuesday, the debate moved onto an alternative approach to raise revenues. Since the Assembly Republicans have refused to vote for a partially-restored vehicle license fee, or even a plan that included cuts that they had previously proposed, Assembly Speaker Herb Wesson put forward a third approach. SB 1849 would, in lieu of the vehicle license fee restoration, increase the tobacco tax by $2.13, to a total in taxes of $3.00 a pack. On Wednesday afternoon, this new budget plan was voted on, 49-20, failing to get the 54 needed votes. ATTACHED is a flyer from the Speaker's Office with talking points, urging people to support SB 1849. Assembly leadership believes that this is the proposal that could eventually win the votes needed to pass a budget.

OTHER ALTERNATIVES: To present yet another alternative to devastating cuts, Assemblywoman Helen Thomson will host a press conference on Thursday morning at 9:00am in the Governor's Press Room 1190 in the Capitol. She will release an open letter signed by over 85 high-income earners who support restoring the upper tax brackets in order to prevent severe cuts, and will be joined by some of the signatories.

Health Access continues to be against cuts that would devastate our health care system, and is in active support for increased revenues that serve prevent such cuts. Our coalition supports a range of solutions, that includes tobacco taxes, vehicle license fee restoration, upper tax bracket restoration, and/or a combination thereof, to prevent cuts not only this year, but in future years when budget deficits loom.

TIMELINE: How long can this budget crisis go on? ATTACHED is a memo by the Secretary of the Senate, which summarizes: "Bottom line: a budget bill may be taken up and passed any time after August 31 but no later than November 15 without any need for a special session. Urgency bills may be taken up. Tax levies may be taken up." With the budget now late by over a month, Health Access urges passage of a budget well before November 15th.

------------------------------
HERB J. WESSON, JR.
SPEAKER OF THE CALIFORNIA STATE ASSEMBLY

ALERT: TOBACCO TAX VOTE IN STATE ASSEMBLY

Support SB 1849

·Assembly Speaker Herb J. Wesson has proposed a new tax on cigarettes to help cover the state budget shortfall.

·Instead of increasing the car tax (The Vehicle License Fee) his plan will increase the cost of cigarettes by $2.13—to a total in taxes of $3 a pack.

·The new cigarette tax will help prevent the draconian cuts in health programs proposed in the Governor’s budget and the Republicans’.

·All studies show that with every increase in tobacco taxes-people quit smoking and fewer people start.

·One out of every 10 eighth graders smoke—one of every four high school kids smoke—we’ve got to help them stop.

·No one can now deny that smoking kills. This new tax is the only tax that will save lives.

·And this is the only tax that is voluntary—if you don’t smoke, you won’t pay.

·Call your State Legislator today. Tell them to Support SB 1849. Tell them this is a fair tax, it will save important government services and IT WILL SAVE LIVES.

Tell Your Legislator to Support the Only Tax that SAVES LIVES
SB 1849

-------------------------
Date: August 9, 2002

TO: All Senate Offices

FROM: Greg Schmidt, Secretary Of The Senate

RE: End of Session
_____________________________________________________________

In these perilous times, a number of people have made inquiries regarding the end of the session and what may or may not be done after the August 31 adjournment date. The following is provided for your edification.

The actual day the 2001-02 Session ends is November 30, 2002. That is the date of adjournment sine die. The August 31 date is set by Joint Rule 51(b) (3) as the beginning of the Final Recess.

The August 31 date is set to accommodate the provisions of the Constitution which give the Governor one month to sign bills and the public 90 days to review them, for purposes of potential referendum, prior to their January 1, 2003, effective date. All regular bills, therefore, must be passed by August 31. Urgency bills, statutes calling elections, tax levies, or “appropriations for the usual current expenses of the state,” can be taken up and passed after the August 31 deadline because they go into effect immediately and are not subject to referendum. However, they must be sent to the Governor by November 15, providing twelve days for him to sign or veto and three days for the Legislature to consider an override.

Bottom line: a budget bill may be taken up and passed any time after August 31 but no later than November 15 without any need for a special session. Urgency bills may be taken up. Tax levies may be taken up.

And if, after all this, everyone decides that enough is enough, special elections may be called as necessary.

Any questions, please feel free to call.

Labels: Updates

posted by Kristin | Permalink | 10:02 AM


 

Digging a bigger whole for reform...

 

Scoring at home...

 

We are hiring, to make a difference...

 

Field Poll: strong opposition to the health cuts.....

 

An Unhealthy Trend

 

Dressing up the Individual (Market)

 

A great debate on the great divide...

 

Jones to be chair of Health Committee...

 

Bass on the budget...

 

Pretty soon, the insureable will be a pretty exclu...