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Wednesday, February 23, 2005
 
HEALTH ACCESS UPDATE
Wednesday, February 23rd, 2005

LEGISLATIVE HEARINGS HIGHLIGHT HOSPITAL CONCERNS ABOUT FEDERAL FINANCING CHANGES
  • Also: News on Coverage Expansions for Children, Universal Health Care
  • Also: Legislative Hearings, Advocacy Events
In front of state legislators this week, California safety-net hospitals expressed significant concerns about the current negotiations between the Schwarzenegger Adminstration and the federal government to fundamentally restructure the way public hospitals are financed, as part of the proposed "Medi-Cal redesign."

MEDI-CAL REDESIGN HEARINGS: In the last week, legislative committees of the Senate and the House have held information hearings on the proposed "Medi-Cal redesign." Last Thursday, the Senate Budget Subcommittee on Health, chaired by Senator Denise Ducheny, heard testimony on the many components of Medi-Cal redesign, with the majority of the time on hospital financing, but with panels on mandatory managed care, premium increases, and other proposals.

Earlier today, a joint hearing of the Assembly Health Committee, chaired by Assemblywoman Wilma Chan, and the Assembly Budget Subcommittee on Health, chaired by Assemblyman Hector De La Torre, held a hearing solely on hospital financing. The joint committee will reconvene another HEARING on WEDNESDAY, MARCH 2nd, in the afternoon, to go over other elements of the Administration's Medi-Cal redesign proposal.

NO DEAL YET: While there were significant rumors last week that Governor Schwarzenegger would come back from his Washington, DC, trip with a signed agreement, apparently no deal has been struck yet. The Administration reported today on the status of negotiations with the federal government on the hospital financing waiver. Martin Gallegos of the California Healthcare Association, representing hospitals, stated that the newest concepts revealed today about the proposed waiver "raised as many questions as they answer."

THE CONCEPT: The proposal, which is not explicitly detailed anywhere publicly at this point, would be the "biggest shift in policy" in at least two decades, according to Denny Martin of the California Association of Public Hospitals. As suggested by the Bush Administration, the proposal would move away from a system that provides supplemental funds to public hospitals (funds which are needed to provide care to low-income and uninsured patients) based on "intergovernmental transfers" (IGTs) to a system of reimbursements based on "certifed public expenditures" (CPEs). For a description about the concepts, the Administration has their Medi-Cal Redesign concept paper at: http://www.dhs.ca.gov/mcs/mcpd/MCReform/

THE CONCERNS: Already-strapped safety-net hospitals are concerned about any potential that the waiver would cut or cap the funding they currently get; that whatever money negotiated for the next several years would not be enough for current or future needs; that the proposal would shift the risk and burden of their finances from the state to the counties, and make reimbursement much more unpredictable; that the funding will not be divided among providers appropriately; and many other issues that threaten access to care for millions of Californians.

SAVE THE DATE: Health Access and the California Association of Public Hospitals will be hosting a CONVENING for health advocates to learn more about the hospital financing issue, and to strategize about efforts to ensure access to hospital care for Medi-Cal recipients and the uninsured. The convening will be in Sacramento on the afternoon of MONDAY, MARCH 7th. For more information, contact Jessica Rothhaar at Health Access at jessicar@health-access.org, or 510-873-8787, x107

HEALTH COVERAGE EXPANSIONS UPDATE

CHIRA: This morning, Senator Sheila Kuehl was joined by several of her legislative colleagues, including the chairs of the Assembly and Senate Health Committees, Assemblywomen Wilma Chan and Senator Deborah Ortiz respectively, to announce the formal introduction of her bill, SB 840, the California Health Insurance Reliability Act, which would establish a universal, single-payer health coverage plan. Other legislators present at a spirited rally included Assemblymembers Koretz, Goldberg, and Dymally.

CHILDREN'S COVERAGE: Also this past week, Senator Martha Escutia and Assemblymember Wilma Chan have introduced a “spot bill” intended to serve as the legislative vehicle for a plan to ensure that all children in California have access to health insurance (AB 772 and SB 437).

The sponsors of this effort, including PICO California, the 100% Campaign, and the Californians for Healthy Kids campaign, will host a TOWNHALL MEETING in support of affordable health coverage for all California’s children. It will take place on WEDNESDAY, APRIL 13, from 6:30 to 8:30 PM at the Sacramento Convention Center, Exhibition Hall A, 12th and J St. For more information: Rebecca Stark, at the PICO California Project, at 916-447-7959

ADVOCACY CALENDAR: For more detailed information on these and many other upcoming events, including times and locations, please refer to the Health and Budget Advocacy Calendar at:http://www.health-access.org/calendarhome.htm

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posted by Anthony Wright | Permalink | 12:26 PM


 
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Wednesday, February 09, 2005
 
HEALTH ACCESS UPDATE
Wednesday, February 9th, 2005

PRESIDENT BUSH'S BUDGET CUTS CALIFORNIA HEALTH CARE
  • Deep Cuts to Medicaid: $4.6 Billion in Cuts to Medi-Cal in Next 10 Years
  • Potential Medicaid Changes Could Cap Program
  • Action Needed: Congress to Make Initial Decision in the Next Several Weeks

President George W. Bush released his 2006 budget this past Monday, February 7th. Of note to California health advocates, the budget proposes deep cuts to Medicaid, totaling $60 billion over ten years. This major reduction in funding would shift a huge financial burden to states like California, which are already struggling to pay their share of Medicaid costs, and proposing additional cuts in turn. The budget proposes to spend $15 billion on new proposals related to Medicaid and SCHIP, bringing the net cut to Medicaid at around $45 billion. The budget on health issues is available at the website of the U.S. Department of Health and Human Services, at: http://www.hhs.gov/budget/docbudget.htm

According to Families USA, the cut to Med-Cal, California's Medicaid program that now covers over 6.7 million children, parents, seniors, and people with disabilities, is estimated to be $4.659 billion over 10 years. This proposal comes at a time when Governor Arnold Schwarzenegger has been looking to cut the Medi-Cal program through a "redesign." For more details on the budget, go to the websites of federal advocacy groups, at: FamiliesUSA: http://www.familiesusa.org/site/PageServer?pagename=Budget_Battle_2006_splash

Center for Budget and Policy Priorities: http://www.cbpp.org/budget-series.htm

POTENTIAL CUTS AND CAPS: According to the Center for Budget and Policy Priorities, the Administration’s proposal has two distinct parts. The first part sets forth proposals for deep cuts primarily resulting from changes in the way states finance their share of Medicaid expenditures.

The second part is a plan to “modernize” Medicaid and SCHIP. There is little detail on the Administration’s plans, but the budget documents repeatedly refer to restructuring coverage “among low-income individuals and families without creating additional costs for the federal Government.” The proposal, with its emphasis on “budget neutrality” for the federal government, implies that funding will be capped, even though the budget doesn’t specify this. The budget also states that the Administration will seek reauthorization of the SCHIP program this year, instead of waiting until 2007 when the program’s authorization expires. However, the Administration did not propose to increase SCHIP funding levels beyond the $5.0 billion already planned for FY 2007.

The bottom line of the Bush budget is that it proposes very deep cuts in Medicaid and potentially introduces a cap on federal funding for the program. Moreover, it is possible that Congress will use the $60 billion figure as a starting point, and make even larger cuts. If cuts of this size are included in the Congressional budget resolution, and authorizing committees are instructed to cut $60 billion or more from the program, these cuts may end up being made through a block grant, caps on funding, or other structural changes to the program.

The Administration also proposes significant changes the process by which Congress develops and passes the federal budget. The Administration proposal includes changes that would make it extremely difficult to improve entitlement programs, including Medicaid and SCHIP. Many of the proposals would make it easier to pass tax cuts rather than improve health programs. For example, one proposal would prevent any improvements in Medicare or Medicaid unless a dedicated revenue source was found (not a general fund increase) or cuts could be made in another entitlement program that would provide equivalent savings for the next 75 years.

ACTION NEEDED: The budget is expected to be considered during the week of March 7, we have less than a month to influence the reconciliation instructions that will be given to the Finance Committee. These instructions will dictate the size of the cuts that Finance will have to make.

All California political leaders need to rally against Medicaid cuts and caps. California has the most to lose from changes in Medicaid. Of any state, California has the most number of people on Medicaid, already spends the least per person on the Medicaid program, and has almost the biggest percentage of uninsured people. Any cut or cap on Medicaid would cause disproportionate harm to California, its state budget, its health, and its economy.

Call or write the two Senators from California, and your U.S. Congressional Representative, to urge them to reject Medicaid cuts and caps.
  • Senator Barbara Boxer: 202-224-3553
  • Senator Diane Feinstein: 202-224-3841

Advocates also need to contact Governor Arnold Schwarzenegger, as the most prominent Republican governor in the nation, to use his influence to prevent Medicaid cuts and caps. Medicaid is a central method for states to collect federal funds, but his efforts to increase California's share of dollars from DC will be hampered by this federal budget.

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posted by Anthony Wright | Permalink | 8:28 AM


 
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Thursday, February 03, 2005
 
HEALTH ACCESS UPDATE
Thursday, February 3rd, 2005

NATIONAL, STATE, LOCAL UPDATE
  • State of the Union; Medicaid Cuts Coming
  • New Study on Universal Health Care; Bill to Be Reintroduced Feb 23rd
  • Update on King/Drew in Los Angeles

STATE OF THE UNION: MUM ON MEDICAID

In his State of the Union speech on Wednesday, February 2nd, President George W. Bush focused on his plans for Social Security and national security issues, and largely avoided talking about health care issues. His one paragraph on health issues was a list of the Administration's previous proposals:

"To make our economy stronger and more productive, we must make health care more affordable and give families greater access to good coverage and more control over their health decisions. I ask Congress to move forward on a comprehensive health care agenda, with tax credits to help low-income workers buy insurance, a community health center in every poor county, improved information technology to prevent medical error and needless costs, association health plans for small businesses and their employees, expanded health savings accounts, and medical liability reform that will reduce health care costs and make sure patients have the doctors and care they need."

Consumer groups have raised concerns about many of these proposals, including tax credits, health savings accounts, and association health plans, both about their effectiveness in expanding coverage, and their impact on the health care system on which we all rely. For reports and fact sheets that outline these concerns, go to the Families USA website at http://www.familiesusa.org/.

President Bush did not mention Medicaid, or the rampant speculation that he will be seeking significant cuts and changes in the Medicaid program. He is scheduled to release his federal budget on Monday, February 7th. An analysis will be forthcoming on his proposed changes. California advocates are asking Governor Arnold Schwarzenegger to take a public stance against such Medicaid cuts and caps, given that California would be especially disadvantaged by such proposals.

UNIVERSAL HEALTH CARE STUDY SHOWS SAVINGS

Health care advocates made headlines last week with findings of a new report confirm that California can create a fiscally sound state insurance plan that covers every Californian with a solid, comprehensive health plan, reduces costs and controls health cost inflation.

Senator Sheila Kuehl (D-Los Angeles) has pledged to reintroduce the "California Health Insurance Reliability Act" (formerly SB921) in this new legislative session. The bill, which does not have a bill number yet, is co-authored by both chairs of the legislative Health Committees, Senator Deborah Ortiz (D-Sacramento) and Assemblywoman Wilma Chan (D-Oakland), and also has the support of Speaker Fabian Nunez (D-Los Angeles) and Senate President Don Perata (D-Oakland). The campaign on behalf of this bill will begin with a press conference and lobby day on Wednesday, Feb. 23rd in Sacramento. More information will follow.

Conducted by The Lewin Group, an independent firm with 18 years of experience in healthcare cost analysis, the report finds that a universal program will reduce total health spending in California by $8 billion in the first year, alone. The full report, released by Health Care for All California, is available at http://www.healthcareforall.org/lewin.pdf.

The Lewin report shows that all California residents can have affordable health insurance; and that, on average, individuals, families, businesses and the state of California, all of whom are now burdened with rising insurance costs, will save money. Some highlights include:

SAVINGS OVERALL: The Lewin report model would achieve universal coverage while actually reducing total health spending for California by about $8 billion in the first year alone. Savings would be realized in two ways: 1. The Act would replace the current system of multiple public and private insurers with a single, reliable insurance plan. This saves about $20 billion in administrative costs. 2. California would buy prescription drugs and durable medical equipment (e.g., wheelchairs) in bulk and save about $5.2 billion.

SAVINGS FOR STATE AND LOCAL GOVERNMENTS: In addition, state and local governments would save about $900 million, in the first year, in spending for health benefits provided to state and local government workers and retirees. Aggregate savings to state and local governments from 2006 to 2015 would be about $43.8 billion.

SAVINGS FOR BUSINESSES: Employers who currently offer health benefits would realize average savings of 16% compared to the current system.

SAVINGS FOR FAMILIES: Average family spending for health care is estimated to decline to about $2,448 per family under the Act in 2006, which is an average savings of about $340 per family. Families with under $150,000 in annual income would, on average, see savings ranging between $600 and $3,000 per family under the program in 2006.

COST CONTROLS: By 2015, health spending in California under the Act would be about $68.9 billion less than currently projected. Total savings over the 2006 through 2015 period would be $343.6 billion. Savings to state and local governments over this ten-year period would be about $43.8 billion.

UPDATE ON KING/DREW MEDICAL CENTER

In Los Angeles, a series of crises plaguing Martin Luther King/Drew Medical Center has garnered front-page headlines. Most recently, national organizations have threatened the closure of King/Drew, which would imperil access to health care for the largely low-income African American and Latino population served by the Los Angeles County-owned hospital in Willowbrook, south of Watts. By these news accounts, the hospital has been in a downward spiral due to poor management, neglect, and lack of responsible leadership by the L.A. County Board of Supervisors; as well as the deterioration of the public health care system in CA at large.

As part of a multi-year plan to drastically reduce public health services throughout Los Angeles County, the Board of Supervisors and their Department of Health Services staff took significant steps to reduce the size and scope of services at the hospital, including a decision last November to close King/Drew's trauma center, over opposition of community groups concerned about patient's access to care in the area. The Board has retained Navigant Consulting per a $13.2 million contract to conduct a comprehensive assessment of King/Drew, implement recommendations to improve the hospital, and run its day-to-day operations.

Unfortunately, the Board's interest in King/Drew has come only after intervention by other agencies to address problems at the hospital. The federal CMS (Centers for Medicare & Medicaid Services) recently announced that they may pull the roughly $200 million in federal funding they provide to King/Drew annually to reimburse costs for treating indigent patients. Despite this potential loss of half the hospital's budget, the County is poised to appeal and feels confident that they can reverse CMS's position, after an new inspection in the next few weeks. JCAHO (the Joint Commission on Accreditation of Healthcare Organizations) announced Feb 1 that it has revoked its seal of approval from King/Drew. Again, the County will work toward a reversal of this decision by making the necessary improvements to regain JCAHO accreditation.

In a coordinated effort to stave off any further action by the County to jeopardize King/Drew's viability, a group of health advocacy, community-based and labor organizations have allied to "honor the tradition and shape the future" of King/Drew by promoting a responsible vision for the hospital. They advocate that King/Drew should be restored to an academic medical center with a full range of services such as preventive and primary care, outpatient and inpatient services, and comprehensive specialty services. In addition, King/Drew should continue to play a vital role in the training and placement of physicians who provide care with excellence and compassion for the underserved. Most importantly, the nature and quality of all King/Drew services must be designed to meet the on-going needs of South Los Angeles' culturally and medically diverse communities. For more information on their efforts, please contact Jollene Levid of the Committee for Interns & Residents at 310-632-0111 or Saira Soto of SEIU Local 660 at 213-368-8623.

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posted by Anthony Wright | Permalink | 9:29 AM


 
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Anthony Wright is the executive director,
with a background as a consumer advocate and community organizer on many issues, including health issues for the last ten years in California and New Jersey.


 
Hanh Kim Quach is the policy coordinator; previously serving as
a newspaper reporter covering the Capitol for the Orange County Register and other papers for eight years