Thursday, September 18, 2003

[Date]

The Honorable Gray Davis
Governor of California
State Capitol
Sacramento, CA 95814
FAX: 916/445-4633
RE: SB 2 (Burton): SUPPORT

Dear Governor Davis:

I am writing on behalf of [Organization Name] in support of SB 2 (Burton), which would extend health coverage to a million Californian workers. [Organization Description]

We strongly urge to you to sign this bill to help address a growing health care crisis. Over 80% of California’s six million uninsured are in working families, people who work hard, play by the rules, pay their taxes and don’t get health coverage. As a result, they live sicker, die younger, and are one emergency away from financial ruin. Close to half of the uninsured have life-altering medical debt. Nearly half of all personal bankruptcies are because of medical problems and medical bills.

SB 2 would extend coverage to about one million California workers. Employers with less than 50 workers would be totally exempt; those larger employers would pay a fee to a state purchasing pool to cover their workers, or get exempt by the fee—as the vast majority of them do now—by providing health coverage directly. This would provide fairness for the employers that do provide health benefits, but otherwise

SB 2 provides relief to one million uninsured people, security to most of those who have health coverage but are worried about losing it, and new tools to employers that are trying to meet this obligation to their workers.

Given the real need in health care in California, we strongly urge you to sign this important bill. Thank you for your consideration.

Sincerely,

[Your name]
[Your title]


posted by Anthony Wright | Permalink | 8:24 PM


 

HEALTH ACCESS
Thursday, September 18th, 2003

ACTION ALERT: URGE GOVERNOR DAVIS TO SIGN SB 2 (BURTON)

SB 2 (Burton) would extend coverage to up to a million uninsured California
workers, and provide security to millions more working families that get
health coverage through their employer, but are scared about losing it.
While it has passed the California Legislature, Governor Davis has not yet
indicated whether he will sign or veto the measure.

This bill builds upon the current system, by which 18 million Californians
get health coverage through their employer. Small businesses are exempt.
Larger employers of 50 or more workers would pay a fee into a state
purchasing pool to provide health coverage to their workers; they would have
the fee waived if--as over 90% of such employers do--they already provide
health care to their workers. The bill would also create the framework for
additional reforms and expansions in health coverage.

ACTION: Send a letter to Governor Davis ASAP, to urge him to seize this
opportunity to provide relief to the uninsured who now live sicker, die
younger, and are one emergency away from financial ruin; and fairness to the
businesses who currently provide health care to their workers, but have to
compete against those that don't. Contact him at:

The Honorable Gray Davis
Governor of California
State Capitol
Sacramento, CA 95814
FAX: 916/445-4633

Offices: Phone: Fax:
Sacramento: (916)445-2841 (916)445-4633
San Diego: (619)525-4641 (619)525-4640
Los Angeles: (213)897-0322 (213)897-0319
Riverside: (909)680-6860 (909)680-6863
Fresno: (559)445-5295 (559)445-5328
San Francisco: (415)703-2218 (415)703-2803


ATTACHED is a sample letter on SB 2. Please feel free to modify or write
your own in support of this important measure.

Also ATTACHED, for your background, is a three-page set of responses to
common questions regarding SB 2. Additional materials are forthcoming.

--
Anthony E. Wright
Executive Director
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 Anthony Wright | Permalink | 8:23 PM


 

Monday, September 15, 2003

HEALTH ACCESS ALERT
Monday, September 15, 2003

HEALTH BILLS ON GOVERNOR'S DESK
* Alert attached on SB 853 (Escutia), on language access in health plans

The landmark SB 2 (Burton) is accompanied by other health-related bills that passed the Legislature in the last few weeks. Governor Davis has until October 12th to sign (or veto) the bills now on his desk. Health care advocates should call, write, or fax Governor Davis to urge him to sign SB 2 (Burton) and other important legislation.

BELOW and ATTACHED are alerts to support SB 853 (Escutia), to help ensure culturally and linguistically appropriate care. This bill has been supported by a range of advocacy organizations, including California Pan-Ethnic Health Network, Mexican American Legal Defense and Education Fund, Western Center on Law and Poverty, as well as Health Access California.

--

ACTION ALERT!!!
Ask Governor Davis to Sign SB 853 (Escutia): Health Plans and Language Access

Culturally and linguistically competent care is essential for California’s
communities of color. California’s communities becoming increasingly
diverse and integrated. According to 2000 Census data, communities of color
represent 53% of the state’s population. Almost 40% of Californians speak a
language other than English at home.

And yet, there are no specific standards or requirements on commercial
health plans to provide for culturally and linguistically competent care.
Studies show that the lack of language services affects access to health
care services and preventive care, results in greater emergency room use,
impedes patients from comprehending diagnoses and asking questions, and
increases the likelihood of patients missing appointments. Each person’s
health impacts us all, and with culture strongly influencing one’s
perception of disease, prevention, and behavior modification, the need for
culturally and linguistically appropriate health services becomes
imperative.

SB 853 (Escutia) will address this problem. Specifically, the bill will:

· Require the Department of Managed Health Care (DMHC) to develop standards for access to qualified health interpreters for persons who have limited English proficiency and requirements for informing enrollees of the ability to access interpreters.
· Specify the documents that must be translated and specify the formula for determining threshold languages.
· Require that plans report to DMHC on their efforts to improve care to
diverse communities.
· Require DMCH to monitor and enforce compliance.

SB 853 will ensure that people of limited English proficiency have quality
and accessible health care, and that communication and/or language barriers
which compromise health are eliminated. With California’s communities
becoming increasingly diverse and integrated, SB 853 will help to improve
access to needed health care and lead to increased utilization of services.

We need to urge Governor Davis to sign this important bill, which is now on
his desk. Please send letter to the Governor at:

The Honorable Gray Davis
Governor of California
State Capitol
Sacramento, CA 95814
fax: 916/445-4633

For more information on this subject, contact:
Martin Martinez, MPP
Policy Director
The California Pan-Ethnic Health Network
654 Thirteenth St.
Oakland, CA 94612
(510) 832-1160 phone
(510) 832-1175 fax

Labels: Updates

posted by Anthony Wright | Permalink | 8:38 PM


 

Saturday, September 13, 2003

HEALTH ACCESS UPDATE
Friday, September 12th, 2003

SB 2 (BURTON) PASSES THE CALIFORNIA LEGISLATURE
* Landmark Bill Goes to the Governor

Tonight, the California legislature passed SB 2 (Burton), to extend coverage to one million uninsured workers. The unofficial vote count in the Assembly was 46-31, on a strict party-line vote, with Assemblymembers Reyes (D) and Maddox (R) abstaining. The Senate vote was strict party line vote, 25-14. The bill now goes to Governor Davis for his signature.

The legislature also passed companion legislation, AB 1528 (Cohn/Frommer), "the Health Care Quality Improvement and Cost Containment Commission," with bi-partisan support.

Over 18 million Californians get health coverage through their employer; SB 2 would use modest means, using the existing employer-based system and existing agencies and expertise, to expand coverage to up to 1 million more. Employers of 50 or more would be required to pay a user fee into a state health purchasing fund. Employers would get a full credit against the fee if they provide coverage to their workers, as the vast majority do now.

SENATE DEBATE

The California State Senate passed SB 2 (Burton) on a party line vote, 25-14, early in the day. The hour-long debate focused mostly on the potential impact on business, both positive and negative.

AUTHORS: Senate President John Burton began the debate with historical perspective, indicating that "this has been talked about since Earl Warren was Governor." Senator Jackie Speier, co-author of the bill, described how she had been in the emergency room twice that week, once for her father, the other time for her daughter, and had wondered "what if I didn't have health insurance?" She stated that "everybody in this room would be clamoring for this bill if *we* didn't get health insurance through our employer." She was clear that 95% of businesses were exempt from the bill, and there would be significant benefits to businesses.

OPPONENTS: Republican Senators that spoke against included Senator Sam Aanestad, who again stated that this was a "misuse of the power of the state," and asked "what about a food mandate, a housing mandate,... a clothing mandate." Senator Rico Oller called the bill "socialized medicine, while Senator Jeff Denham said that "the timing of this bill is very inappropriate." Senator Tom McClintock, running for the Governor, stated that "every person ought to have access to health care" but proposed his own plan of "pre-paid tax credits." Senator Charles Poochigian claimed that the savings from the worker's comp was "illusory" and that this would further disadvantage business, and Senator Jim Battin agreed.

SUPPORTERS: Democratic Senators that spoke in favor included Senator Deborah Ortiz, who called this a "historic opportunity" and compared it to family leave and the minimum wage. Senator Sheila Kuehl stated that "this is a very good first step," and there was a strong "interest of the state in health care" as a "public issue." She raised her universal health care bill, SB 921, but that was for "another day, another year, another discussion." Senator Dede Alpert stated that while she "struggled with this issue," this is a step to fix the health care problem, and that we have two-three years "to implement this in the fairest possible way."

ASSEMBLY DEBATE

Assemblyman Dario Frommer introduced the bill, stating that "it is not often that we can make history." It "builds on our existing system of employer-based coverage, which now reaches 18 million workers."

SUPPORTERS: Speaking for the measure was Democratic Assemblymembers Goldberg, Cohn, Wiggins, Yee, Lowenthal, Hancock, and Parra. Assemblymember Goldberg talked about the "health care system is in deep trouble... It is literally falling apart." She stated that to get to universal coverage, she supported single-payer plan, other supported other paths, but either way, "I don't think we get there unless we make this start."

Assemblymember Cohn stated that "if health care was a patient, it would be on the critical list," and "it is always the right time to do the right thing." Assemblymember Wiggins also stressed that this is a "step that is long overdue." Assemblyman Yee focused on the "relief for local government" that SB 2 would provide.

Assemblyman Lowenthal asked "if legislators opposed to SB 2 would go without" health insurance themselves. "Do they know where the county hospital is? Do they want to go there? Do they over-utilize the system, as has been implied of the insured?" Assemblywoman Parra made a similar case, that SB 2 would tell "one million Californians they have the same right as everyone of us on this floor" to get care.

OPPONENTS: Speaking against the measure was Republican Assemblymembers Cox, Bogh, Richman, La Suer, Mountjoy, Maze, Campbell, Haynes, Pacheco, Nakanishi, Benoit, Harman, Leslie, Wyland, Samuelian, and Keene. Republican Leader Cox and other opponents cited that the cost of this bill would be $7 billion, a Chamber of Commerce number that has been shown to be widely overblown, double-counting many costs and not taking into account tax breaks and write-offs. (The California Medical Association has the cost estimate at $1.9 billion.)

Assemblyman Richman stated that "SB 2 is the wrong way to go" and warned of "unintended consequences." At least three Assemblymembers called the plan "socialistic," with Assemblyman La Suer saying that "this makes Hillary Care lok like a right-wing conspiracy." Assemblyman Mountjoy stated, wrongly, that "lots of folks don't have insurance, but very few don't get care." Assemblyman Maze was also mistaken when he agreed, "we already heard that people do have access." Assemblyman Maze decried policies that made us similar to "Western Europe. We don't need to go there. We declared our independence."

Assemblyman La Malfa stated this in discussing SB 2 extending health coverage, his wife's stated reaction was "why go to college if you are just going to just give this to anybody with a job?" He himself asked "when did these things like health care become rights?... One small step on business, one giant leap toward Hillarycare." Assemblyman Haynes said that he "was tired of being in the minority," and hoped that a similar political change would occur similar to the one in Washington, DC, after the last attempt at health care reform. Assembly Samuelian said that the California legislature would be "infamous" for passing such a measure.

Assemblyman Pacheco and Harman focused on the fact that its impact would be narrowly targeted, exempting 95% of businesses. Assemblyman Wyland agreed, and gave a more thoughtful opposition than most, suggesting that "if this was done slowly over time, some businesses would adjust" to the requirements.

Assemblyman Frommer closed by countering some of the mistaken numbers used, and by assuring "this is not a reach. This is a common sense approach." In response to the comparison to the Clinton plan, he stated that this was far more similar to the plans of two California Republicans: Governor Earl Warren in 1953, and President Richard Nixon in 1972.

--
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 Anthony Wright | Permalink | 12:49 AM


 

Thursday, September 11, 2003

HEALTH ACCESS CALIFORNIA ALERT
Thursday, September 11, 2003


CALL LEGISLATORS FRIDAY TO SUPPORT SB 2 (BURTON), TO PROVIDE:
* COVERAGE TO ONE MILLION WORKING UNINSURED;
* NEW TOOLS FOR EMPLOYERS PROVIDING HEALTH CARE TO THEIR WORKERS;
* SECURITY FOR WORKING FAMILIES SCARED ABOUT LOSING COVERAGE


After a full year of discussion, SB 2 (Burton), to extend health coverage to
one million uninsured workers, is to be considered and voted on in the last
day of this year's legislative session, Friday, September 12th, 2003. CALLS
ARE NEEDED ON THIS FINAL DAY IN SUPPORT.

Over 18 million Californians get health coverage through their employer; SB
2 would use modest means, using the existing employer-based system and
existing agencies and expertise, to expand coverage to over 1 million more.
Employers of 50 or more would be required to pay a user fee into a state
health purchasing fund. Employers would get a full credit against the fee if
they provide coverage to their workers.

This bill has the unusally broad support of organizations representing
doctors, labor, consumers, hospitals, some insurers, and some employers.
ATTACHED is the letter of support from the sponsors, the California Labor
Federation and the California Medical Association. Health Access California
urges support to provide real relief to a million uninsured Californians
that now live sicker, die younger, and are one emergency away from financial
ruin. Health Access also supports SB 2 as a beginning framework to improve
and expand upon, through implementation and additional legislation, to
finally achieve quality, affordable health care for all.

TO CONTACT YOUR STATE SENATOR AND ASSEMBLYMEMBER:
Go to the website: http://www.leginfo.ca.gov/yourleg.html
Type in your zip code to get the contact information of your legislators.
Call their offices, and urge them to "Vote Yes on SB 2."
Get others to also make calls on Friday!


--
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 Anthony Wright | Permalink | 11:35 PM


 

Wednesday, September 10, 2003

HEALTH ACCESS UPDATE
Tuesday, September 9th, 2003


SB 2 VOTED OUT OF CONFERENCE COMMITTEE
* Major Extension of Health Coverage Heads to Assembly & Senate Floors


SB 2 (Burton), a bill to extend employer-based coverage to over one million working Californians, was voted out of conference committee this evening on a party line vote of 4-2. It now heads to the Assembly and Senate for consideration by the end of legislative session this Friday, September 12th.

Below is a description of the committee discussion, a summary of the changes in the bill since last week, and a revised summary of the key provisions of SB 2, which is also ATTACHED.

Advocates for the bill should immediately generate calls and fax letters to their Assemblymembers and Senators to support SB 2.


COMMITTEE DEBATE:
At the committee, Senator Burton outlined the need for the bill, including the fact that "the uninsured live sicker, die younger" and have dire financial consequences. Committee members made brief statements on the bill. In opposition, Assemblymember Pacheco warned of a challenge under the ERISA law. Senator Sam Aanestad argued against using the "awesome power of the state" to require employers to provide health care to their workers, and warned that "it borders on the immoral." Burton responded later that most employers already do provide coverage, and only through the "long arm of the state" do we have unemployment insurance, the minimum wage, the eight-hour day, and despite protests and predictions of doom, "they end up working all right."

Senator Dede Alpert, sitting in for Senator Jackie Speier who was away for personal reasons, remarked about one of her first experiences 13 years ago first coming to Sacramento was participating in a committee considering health care reforms, including pay-or-play and single-payer bills. Given the lack of progress since then, she is supporting SB 2 as "a good step" to deal with the ongoing health care crisis. She also cited that there was at least two years of implementation time to work out issues with employers and others. Assemblyman Dario Frommer called this a "historic opportunity," and "since it is clear that Washington will never take the step" toward health care reform, California must, especially as it has the third worst rate of residents insured. He stated that the "committee had listened to the concerns" about small business and other issues, and produced a "fair bill."

BILL CHANGES:
After the hearings on Wednesday and Thursday of last week, the conference committee and sponsors took the suggestions and made numerous amendments to the bill. The bill maintain the basic principles and framework as before. Changes are mostly in the details, and include the following:

* The implementation date has been delayed a year. Employers of over 200 workers would be affected January 2006; Employers of over 20 workers would be affected January 2007.
* The provision that the bill will not apply to employers with between 20 and 49 workers without the passage of a 20% tax credit for such employers.
* The creation of premium assistance program and wrap-around benefit for those with employer-provided coverage but that are eligible for Medi-Cal coverage. The wrap-around benefit would cover "any gap between employer-based health care coverage and the benefits provided by the Medi-Cal program," and "pay for any co-payments, deductibles, and other allowable out-of-pocket medical costs." The premium assistance program would provide a Medi-Cal recipient with "his or her share of premium" to "coincide" with required payments to the employer. (Medi-Cal applicants waiting for verification will get "promptly reimbursed.")
* The creation of another premium assistance program with a wraparound benefit for those eligible for Healthy Families that are offered employer-sponsored health coverage.
* The addition of intent language that nothing in the bill should be construed "to diminish or otherwise change existing protections in law" for those eligible for public insurance programs.
* Changes to the insurance underwriting and market reforms.
* Additional language to protect safety-net hospitals and community clinics from negative reimbursement impacts.
* Language changes to deal with legal challenges under ERISA.
* Many technical corrections.
* The shifting of the intent language on "disease management" and "evidence-based medicine" to a companion bill, AB 1528. That bill, which was also voted out of the conference committee on a 6-0 vote, creates a "health care quality improvement and cost containment commission" that looks at these and other ideas to confront cost issues. Language acknowledged the needs of people with disabilities, as well as the need to take into account racial, ethnic, and gender disparities.

---

KEY PROVISIONS OF SB 2 (BURTON):
HEALTH CARE FOR WORKING FAMILIES

Overall Concept
Covered employers required to pay a user fee into a state health purchasing fund. Employers would get a credit against the fee if they provide coverage to their workers. Over 18 million Californians get health coverage through their employer; SB 2 would use modest means, using the existing employer-based system and existing agencies and expertise, to expand coverage to over 1 million more.

Uninsured Covered
§ 1 million-1.5 million workers and their families covered out of 4.5 million uninsured at one time.
§ Half of uninsured workers covered by SB2 if employers of 20 or more.
§ Would cover 20%-25% of uninsured children or about 200,000 children.

Employers Impacted
§ 87.5% of employers have fewer than 20 employees and thus are exempted.
§ Over 80% of California employers with more than 10 employees already provide basic health coverage to their workers, and thus could get a full credit against the fee.
§ Overall, 97.5% of employers could have the fee waived or credited, and thus would not be directly impacted.
§ Only large and medium employers that don’t provide health care to their workers—roughly 2.5% of employers—would be impacted by the new requirements.
§ Net cost to employer per covered worker: $1200-$1300.

Worker Eligibility
§ For employees working for employers with over 200 workers, family coverage.
(January 1, 2006)
§ For employees working for employers with between 20 and 199 employees, worker only coverage. (January 1, 2007)
§ Employers from 20-50 workers exempted from the fee, until a tax credit to provide assistance to such employers is enacted, by 2007.
§ Employers with less than 20 employees are exempted from the fee.
§ Workers must work at least 100 hours per month, for at least 3 months, for one employer.
§ Seasonal worker eligibility being developed.
§ Temporary agencies and farm labor contractors considered employers.

Benefits
§ Anything that meets the requirements of Knox-Keene plus prescription drugs.
§ Any group health insurance policy under DOI that meets PPO standards and covers prescription drugs.
§ Any Taft-Hartley Trust Fund or collectively bargained agreement.
§ Any self-insured group plan with similar benefits.

Governance
§ Creates State Health Purchasing Fund to purchase health coverage.
§ Managed Risk Medical Insurance Board (MRMIB) to set user fee and administer purchasing program for covered employers that pay the user fee.
§ Employment Development Department (EDD) to collect employer user fee in the same manner as it collects UI, SDI, and ETT as well as PIT withholding.

Affordability for employers
§ 80% share of premium paid by employer; employer can choose to pay as much as 100%.
§ Purchasing program will reduce costs for businesses by giving them purchasing leverage similar to CalPERS.
§ Premium savings from reduced unreimbursable costs.
§ Employers can drop coverage for dependents covered by another employer’s coverage.
§ MRMIB authority to develop cost containment measures.

Affordability for workers
§ Maximum contribution of 20% of premium with share of premium capped for low wage workers (below 200% of the Federal Poverty Level) to 5% of their wages.
§ Limits on total co-pays and deductibles, to be determined by MRMIB, for workers covered by the fund and by DMHC and CDI for coverage provided outside.
§ For workers covered by the state fund and eligible, they could enroll in Medi-Cal.
§ For workers eligible for public insurance programs but whose employers choose to purchase coverage directly, Medi-Cal and/or Healthy Families would be available as secondary coverage, just as it is now. A premium assistance program would also be available.

Enforcement
§ Employers cannot designate workers as independent contractors or temporary workers, or reduce worker hours, to evade their obligation.
§ Employers who do not provide coverage as required must pay double the fee they would have owed under this obligation.

State Budget Savings
§ Between 40% and 50% of Medi-Cal enrollees and most Healthy Families enrollees are workers or their children. If their employers pay into the fund, the fund will pay the state share of costs.
§ Estimated to be $620-$900 million in state budget savings.

Safety Net Providers (County Hospitals, Community Clinics)
§ Workers and their families eligible for Medi-Cal will have incentive to sign up, minimizing funding impact for safety net providers.
§ Health care plans shall make every effort to contract with safety net providers

ERISA
§ Covered employer pays user fee to EDD.
§ User fee waived if employer presents proof of coverage.
§ Regulation through insurance products sold, not what employer is required to purchase.

Insurance Market Reform
§ Rules inside and outside of the pool to be similar
§ Generally expands existing small group insurance underwriting law (for 2-50) to covered employers under 200 workers.
§ All HMOs and insurers that offer coverage in the small group market must offer coverage for all covered employers: guaranteed offer and renewal.
§ Restriction of risk categories to age, geographic region and family composition.
§ Specified disease, hospital only, vision only, accident only and other specialized coverage does not count as coverage for purposes of establishing proof of coverage sufficient to have user fee waived.

Security for the Insured
§ 80% of all California workers work for businesses with more than 20 employees.
§ Three quarters of workers work over 25 hours per week.


---
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 Anthony Wright | Permalink | 11:22 AM


 

Thursday, September 04, 2003

HEALTH ACCESS UPDATE
Thursday, September 4th, 2003


SB 2 CONFERENCE COMMITTEE
A Day of Details As Consumers, Safety-Net Providers, and Insurers Testify


The SB 2 (Burton) conference committee continued today, hearing testimony from a range of organizations representating consumers, safety-net providers, and insurers, which mostly were in general support but with various groups offering suggested changes to the details. After going through all the input and suggestions, it is expected that the conference committee will attempt to vote on an amended draft on Monday, September 8th. The bill would then go to the Senate and Assembly floors simultaneously, for an up-or-down vote, before the legislative session ends on September 12th.

CONSUMERS: Most consumer advocates expressed strong support for covering more Californians while offering a variety of specific amendments to improve the measure. Testifiers in support included Health Access, California Council of Churches, Jericho, Older Women's League, Congress of California Seniors, Pacific Institute for Community Organization - California Project, National Organization of Women, Commission on the Status of Women, Gray Panthers, MALDEF, National Council of La Raza, California Immigrant Welfare Collaborative, and others. Some expressed desire for a more expansive bill, or for future reforms that included employers of less than 20 workers, part-time workers, and seasonal workers. Others urged amendments and further work to ensure worker affordability and extent of coverage for low-wage workers, and to make enrollment into public programs as seamless and possible.

SAFETY-NET PROVIDERS: Safety-net providers also supported the measure and sought further amendments to protect county hospitals, community clinics, and other safety net providers. It was clear that any change to the current health care system comes with both concerns and opportunities for those who provide care, and the members seem very sympathatic to those concerns.

INSURERS: Some insurers ranged from "nervously neutral" to "strenuously neutral" to a few being generally supportive. There was no consensus among insurers about the amendments they desired though most sought some changes in the proposed underwriting reforms.

OVERALL: The bill is expected to be amended with some of the suggestions made in the hearings. Many other details and issues are expected to be left to implementation, after passage of the bill, which sets up the framework. Obviously, if this passes, there is significant advocacy work left to do to make this work the best for the insured and uninsured.

So after two days of testimony, only the business community expressed opposition and even though they remain unalterably to all employer mandates (just as they historically opposed minimum wage and even child labor laws), they did not turn out dozens of individual businesses in opposition. Instead, consumers, labor, physicians, hospitals, and many others supported the measure while insurers who have in the past led the effort to defeat such expansions of coverage were neutral or mildly supportive.

ACTION: Those in support of SB 2 have a week to urge their Assemblymember to vote for the bill.

--
Anthony E. Wright
Executive Director
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 Anthony Wright | Permalink | 8:48 PM


 

Wednesday, September 03, 2003

HEALTH ACCESS UPDATE
Wednesday, September 3rd, 2003

CONFERENCE COMMITTEE CONVENES TO CONSIDER SB 2,
TO COVER OVER A MILLION UNINSURED WORKING CALIFORNIANS


A conference committee met today to consider SB 2 (Burton), a bill that would expand health coverage to over a million uninsured working Californians. The bill would require employers of 20 or more workers to pay a fee into a state purchasing pool to cover workers. The fee would be waived for those employers that provide at least basic coverage to their workers--and, for employers with 200 or more workers, their families as well. This would extend coverage to half of all uninsured workers.

The committee started with testimony from labor, medical providers, and employers. Tomorrow, Thursday, September 4th, the committee will hear testimony from representatives of consumers, insurers, safety-net providers, and other advocates. It is likely that a bill may be voted out by Friday, or probably the latest Monday. After passage, it would go to the Senate and Assembly for an up-or-down vote.

ACTION: Advocates for the uninsured are urged to contact members of the conference committee, including Senators John Burton, Jackie Speier, Sam Aanestad, and Assemblymembers Dario Frommer, Rebecca Cohn, and Robert Pacheco. Advocates are requested to:
* state their support for the current version of SB 2,
* thank the legislators for their leadership,
* urge passage of a comprehensive bill out of committee that covers as many as possible,
* and, stress the urgency of addressing the crisis of the uninsured this year.

ACTION: The challenge of getting SB 2 passed is to get this through the Senate and Assembly by next Friday, September 12th. Advocates for the uninsured are urged to contact their Assemblymember ASAP in support of SB 2. Please contact Health Access for bill summaries, fact sheets, and other information.


COMMITTEE TESTIMONY WRAP-UP: The committee started with opening remarks by committee members. Burton stressed the commitment to cover the uninsured. Frommer called this a "historic opportunity," and stressed the opportunities to control costs and remedy unfair cost shifts.

SPONSORS: Art Pulaski of the California Labor Federation and Steve Thompson of the California Medical Association spoke first as representatives of the sponsors of the bill. Pulaski talked about the health care crisis in general, reminding that the greatest cause of personal bankruptcy in medical problems and medical bills. In deference to concerns about not wanting to burden small business, Pulaski reminded the committee of the "extraordinary compromise" in exempting small business with less than 20 employees, which make up 87.5% of businesses in California. Thompson gave a bit of history of the "vexing problem" of health coverage, and urged the committee to seize "a chance to do something important."

LABOR: Representatives from labor testified on the economic benefits of SB 2. SEIU compared SB 2 to a minimum wage for health benefits, a floor that workers could bargain up from, and that employers could go beyond as they do now to attract workers. UFCW complained that employers that provided health coverage were unfairly penalized with competition by employers that don't provide health care to their workers. CFT, representing many teachers who are mostly covered, simply made the point that they would prefer to teach children in healthier, insured families.

MEDICAL PROVIDERS: Groups representing medical providers gave more detailed testimony about specifics in the bill. While the California Healthcare Association, representing hospitals, "enthusiastically support" the bill, they called it "a work in progress" that will need revisiting in the years of implementation. The association representing emergency room doctors talked about the "embarassing" fact that California was losing doctors to Texas, much due to financial issues related the California's high uninsured rate.

EMPLOYERS: The debate heated up with the testimony of representatives of employers. While some, including Genentech, spoke in support of SB 2, most were opposed. The Chamber of Commerce predictably called the bill a "job killer." Assemblyman Frommer and Senator Speier asked repeatedly if their was some way to soften the impact of the bill on employers, but the Chamber stated their unequivocal opposition to all mandates. Frommer responded "either you want to help, or you want to be combative."

Senator Burton had an explosive colliquy with the panel, asking the panel of employer representatives, "Anybody there not get health coverage through your employer?... Anybody dare to not have coverage yourselves?" He suggested that given that most of the Chamber's members are exempt, as well as that most already provide health coverage to their workers, that the Chamber may "have its head in the wrong place and should try to be part of the solution."

One business representative was concerned that "sooner or later" there would be a push to "reduce the threshold" of what businesses are included. The National Federation of Independent Businesses agreed, adding that "100% of our members would love to offer health coverage," but it "has become "unaffordable." Finally, representatives from Wal-Mart defended their company, concerned that they had become the "poster child" for this bill, stating that they do provide health coverage to a majority of their workers.

WHAT'S NEXT: The committee ended their hearing after three hours, around 6:45pm, and stated that they would reconvene tomorrow, Thursday, September 4th at the call of the chair, probably around 1:00pm. They would start with testifiers who had signed up today, including the remainder of representatives of employers, then consumer groups, before going onto insurers, safety-net providers, and other advocates.

--
Anthony E. Wright
Executive Director
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 Anthony Wright | Permalink | 10:18 PM


 

HEALTH ACCESS UPDATE
Monday, September 1, 2003


SB 2 CONFERENCE COMMITTEE:
The conference committee on SB 2 and other bills to expand health coverage is now tentatively set for the afternoon of Wednesday, September 3rd. It is likely that on that day a press event will kick off ten days of activity to win this important advance for California's uninsured.

Letters in support of SB 2 would be appreciated by the committee as soon as possible. Please feel free to use the attached fact sheet as source material. Letters can be addressed to:
The Honorable John Burton
Senate President
State Capitol, Room 205
Sacramento, CA 95814
FAX: (916)445-4722

If possible, please CC: letters of support to Health Access California, at FAX: 916-497-0921, or E-mail at awright@health-access.org.

ATTACHED and BELOW are FACT SHEETS describing the impacts of SB 2, including the impact on health coverage and systems, and on employers and jobs.


ANTI-PROPOSITION 54 PRESS EVENT:
Also on Wednesday, a wide spectrum of the health community will hold a major press conference in opposition to Proposition 54, stating that "The Connerly Initiative is Bad Medicine." The Los Angeles event will be on WEDNESDAY, SEPTEMBER 3RD at 10:30AM at the UCLA Medical Center, and will include the California Medical Association, American Cancer Society, and Kaiser Permanente. Please come and show your support. For more information, contact Marty Martinez at the California Pan-Ethnic Health Network at (510) 832-1160 or mmartinez@cpehn.org


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FACT SHEET: Health Coverage Impacts of SB 2 (Burton)
Sept. 2, 2003

SB 2 (Burton) would extend coverage to over one million California workers and around two hundred thousand of their family members. Rather than creating new bureaucracies, SB 2 would build on the existing health care system and existing programs. More than half of all Californians—more than 18 million—already get health care through an employer.

Not only would SB 2 directly help over a million Californians be healthier and more economically secure, but it would provide benefits for all California, including the state budget, the health system we all depend on, and the economy as a whole.

SB 2 Impact on the Uninsured

SB 2 would extend coverage to 1 million-1.4 million California workers and their families. Over 4.5 million are uninsured at a given point in time. Over six million Californians are uninsured over the course of a year, out of a population of 36 million. (UCLA Center for Health Policy Research) These are families that work hard, play by the rules, pay their taxes, raise their children, yet don’t get basic health coverage.
· The bill would cover about half of uninsured workers covered by SB 2
· The bill would cover 20%-25% of uninsured children—about 200,000 children.

Millions are working but uninsured. SB 2 would extend health coverage to many who don’t have another option.
· Over 80% of the uninsured are in working families, with half of the uninsured being a worker, and over 30% being the dependent of a worker. (UCLA)
· The uninsured are not uninsured by choice. Over 85% of the uninsured are either not offered or not eligible for health insurance from their employer. (UCLA)
· Buying individual coverage is too expensive for the low- and middle-income families that are the vast majority of the uninsured. (Families USA) Coverage simply is not available for many, because of “pre-existing conditions.”

Uninsured families live sicker & die younger. SB 2 fosters healthier lives and communities.
· The uninsured all too often delay or avoid getting the care they need, including screenings and preventative care, ongoing treatments for chronic conditions, and even emergency care, resulting in severe health impacts. (American College of Physicians)
· The uninsured are more likely to die prematurely than insured patients with similar problems, for every type of ailment or problem, from emergency trauma to cancer. (Institute of Medicine)

Uninsured families are one emergency away from financial ruin. SB 2 will help economically strapped families, and prevent personal bankruptcies.
· Nearly half of all uninsured respondents reported having unpaid bills or being in debt to the facility where they received care. (Access Project/Brandeis University).
· Around 40% of uninsured families had to “change their way of life significantly” to pay medical bills. (Commonwealth Fund)
· Nearly half of all personal bankruptcies are the result of health problems or large medical bills. (NYU Law Review)
SB 2 Impact on the Currently Insured

Most workers who are now insured would simply get the security in keeping the health coverage they have, or keeping coverage when they move jobs.
· Most employers—over 80% of those with more than 10 employees—already provide health care to their workers. (Kaiser Family Foundation)
· The bill would require a fee on employers that have 20 or more employees, but those that provide basic health coverage to their workers would have the fee waived. Thus, over 97.5% of employers would not be affected, nor would their employees.
· Even in its modified form, most workers would get the security of having health coverage under SB 2. Almost 80% of California workers work for businesses with more than 20 employees. Three-quarters of workers work over 25 hours per week.
· “Job lock” would be reduced because workers would know that if they found a full-time or nearly full-time job with another employer with over 20 workers, they would still get health benefits.
· As employers are moving to shift the cost of health care onto their employees, SB 2, like the minimum wage, would help the insured maintain a basic level of benefits. This would include keeping worker’s share of premium at or below 20%.

SB 2 Impact on the State Budget

With the state budget crisis, SB 2 has the added benefit of saving the state general fund dollars:
· Between 40% and 50% of Medi-Cal enrollees and most Healthy Families enrollees are workers or their children.
· If their employers pay into the fund, the fund will pay the state share of costs for any worker or dependent that voluntarily enrolls in Medi-Cal or Healthy Families.
· Since employers would serve as a “gateway” to get already-eligible workers and their family member enrolled in public insurance programs, this will bring in Federal matching funds.
· This shift is estimated to save the state budget $700 million- $1 billion.
· The state savings is roughly equivalent to the proposed cuts to Medi-Cal that would deny eligibility and coverage to hundreds of thousands of Californians.

SB 2 Impact on the Health System and Safety Net Providers

· This reform does not make any changes to the current health care delivery system, including our system of doctors, hospitals, clinics, and emergency rooms.
· With more insured people, SB 2 will stabilize the financial health of the emergency rooms and trauma centers on which we all rely.
· Workers and their families eligible for Medi-Cal will have incentive to sign up, minimizing funding impact for safety net providers, including public hospitals and community clinics.
· Under SB 2, health care plans shall make every effort to contract with safety net providers.

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FACT SHEET: Economic Impacts of SB 2 (Burton) September 2, 2003

SB 2 (Burton) would extend coverage to over one million California workers and around two hundred thousand of their family members. Rather than creating new bureaucracies, SB 2 would build on the existing health care system and existing programs. More than half of all Californians—more than 18 million—already get health care through an employer.

Not only would SB 2 directly help over a million Californians be healthier and more economically secure, but it would provide benefits for all California, including the state budget, the health system we all depend on, and the economy as a whole.

SB 2 Impact on Employers
This bill would require a fee on employers that have 20 or more employees. Those that provide basic health coverage to their workers would have the fee waived. Those that pay the fee would receive the benefit of having their workers covered through a state purchasing pool.

Only small percentage of employers would be directly impacted by the fee.
· 87.5% of employers have fewer than 20 employees and thus are exempted. (Employment Development Department)
· Over 80% of California employers with more than 10 employees already provide basic health coverage to their workers, and thus would get a full credit against the fee. (Kaiser Family Foundation)
· Overall, 97.5% of employers could have the fee waived or credited, and thus would not be directly impacted.
· Only large and medium employers that don’t provide coverage to their workers—roughly 2.5% of employers—would be directly impacted by the new requirements.

The fee is modest, and comes with the substantial benefit of an insured workforce.
· The projected cost to this 2.5% of employers would be approximately $1000-$1200 per covered life, after employee contribution and tax business deductions. This does not reflect additional productivity and other economic gains that employers would enjoy by having an insured workforce.
· For this group of larger employers that don’t provide health care to their workers, this would be only a 1-3% increase in the cost of labor, and a less than a 1% increase in their overall costs. (California Establishment Survey)
· This 2.5% of employers would get the tools to meet the requirement, and the direct benefit of an insured, healthier, more economically secure, less transient, and more productive workforce.

The 97.5% of employers that not directly impacted would get economic benefits.
· Large and medium employers which now provide health benefits would no longer be at a competitive disadvantage to those that don’t provide health benefits.
· All business would enjoy a more insured and thus more economically secure customer base. The uninsured often carry significant medical debt, making it harder to pay other bills; half of all personal bankruptcies are due to medical problems and medical bills.
· Large and medium employers would have a tool to help control health care costs, with the option of paying the fee into the state purchasing pool to buy health care.

Surveys of employers indicate that they overwhelmingly want to provide health care to their workers, but they face three barriers: cost, the administration of managing a health benefit, and the fear of agreeing to an ongoing cost that competitors may not be bearing. SB 2 gives employers the tools to overcome these barriers.
· Cost: Employers could pay the fee into a state purchasing pool, which would use the bargaining power to negotiate with insurers for better rates on health insurance that they might be able to get on the open market. This “volume discount” may have effect on lowering the price of health care overall as well.
· Administration: Employers that don’t provide health care to their workers would pay a fee, and workers would get health benefits administered by the Managed Risk Medical Insurance Board (MRMIB), which now runs the Healthy Families program, which would handle negotiating with insurers and other aspects of managing the benefit.
· Competition: Employers would also be secure that their competitors would also have to provide coverage to their workers. Like the minimum wage, it would set a standard that prevents employers that do the right thing from being undercut by competitors that don’t.

SB 2 Impact on Jobs
· More people insured and increased federal matching funds will translate in job increases in the health care sector, already an economic engine in California.
· The impact of SB 2 would be similar to an increase in the minimum wage, a broad-based requirement on all businesses, but that would only affect a small portion of actual businesses and jobs, on the low end of wages and benefits. SB 2 would essentially set a “minimum wage” for health benefits.
· Studies indicate that increases in the minimum wage have not resulted in significant job losses. As a broad-based requirement, businesses absorbed the cost. In fact, the increased spending of these low-income workers may have had a positive economic effect. (Card, 1991; Brown, 1999; Card and Krueger, 1995; Kim and Taylor, 1995)
· Hawaii’s experience with the 1974 Pre-Paid Health Care Act shows little evidence of job loss. (Thurston, Norman. “Labor Market Effects of Hawaii’s Mandatory Employer-Provided Health Insurance,” October 1997, Industrial and Labor Relations Review.)
· When asked directly, employers themselves say they would not reduce jobs. The California Establishment Survey in 2003 asked businesses and nonprofits of five or more employees how they would respond to a hypothetical five percent increase in operating costs that affected all employees in the state.
o Given a range of choices, the two most popular responses were to improve efficiency and to increase prices, totaling 59% of all establishments, and 69% of those that don’t provide health insurance to most of their employees.
o Only 2% said they would relocate outside of California. The jobs that are most likely to relocate, such as in manufacturing, are those that are most likely to already provide health insurance, and thus be unaffected by the bill. Jobs that would be affected most are those least likely to be relocated, such as in retail.
o Only 10% of those that don’t provide health care to most of their workers chose other options that would reduce employment—and this is based on increase in costs greater than those projected for SB 2, and one that did not provide the compensating benefits of SB 2.


--
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 Anthony Wright | Permalink | 10:11 PM


 

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