Wednesday, May 31, 2006

ASSEMBLY FINISHES FIRST HALF OF SESSION

• Lawmakers reject proposal to cap annual out-of-pocket costs on high-deductible plans
• Republican effort to provide tax breaks for Health Savings Accounts also defeated
• Other bills pass on prescription drugs, other issues
• ACTION ITEM: Call Budget conferees to urge expansion of children’s coverage

The state Assembly met late into the night Wednesday to finish hearing hundreds of bills before the constitutional deadline for their passage to the state Senate. The Assembly finished their work, adjourning until next Thursday, June 8th (after the primary election), for the second half of this year's legislative session. In session today, the Assemblymembers approved out several items of interest to health consumer advocates, but with one major exception.

FINANCIAL PROTECTIONS AGAINST HIGH OUT-OF-POCKET COSTS FAILS FOR NOW

AB2281 (Chan) died, failing to get the 41 votes needed for passage before the Assembly adjourned. The bill would have capped annual out-of-pocket costs, providing security for "underinsured" against severe medical bankruptcy.

THE VOTE: An unofficial tally at the end of session indicated a 38-36 vote, largely along party lines. While most Democrats voted for the measure, four joined Republicans in voting "no": Assemblymembers Barbara Matthews, Nicole Parra, Gloria Negrete-McLeod, and Lois Wolk. Several other Democratic Assemblymembers abstained, dooming the bills chances, including: Juan Arambula, Ed Chavez, Juan Vargas, Ron Calderon, Rebecca Cohn, Joe Canciamilla.

THE BILL: The bill would have capped annual out-of-pocket costs at $5250 for an individual, and $10,500 for a family. Without AB2281, consumers with high-deductible health plans often are decieved that they’re coverage will kick in after they meet their deductible – sometimes as high as $5,000. But in reality, after the $5,000 deductible is met, the costs just start. Patients often must pay co-insurance and co-pays that can add up to tens of thousands of dollars. Without AB2281, there is no cap on the out-of-pocket costs that can be shifted to the individual consumer.

Insurance companies, however, had made AB2281 their top priority bill to kill. Many consumer, health, community of color, patient, labor, and other groups supported the measure.

HSAs: The debate on the Assembly floor started with an attempt by Republican Assemblymember Greg Aghazarian, who is Vice-Chair of the Assembly Health Committee, to substantially amend the bill. His amendments would have dramatically changed the bill to provide state tax breaks for Health Savings Accounts. While the amendments were defeated on a party line vote, the debate did show the stark difference on health care issues.

The Chan bill would have placed limits on new "skeleton" plans that leave many Californians underinsured, by providing some consumer protections against ongoing medical debt, that would be crushing to low and moderate income families. The Agharzarian amendments would have used state tax policy to actually encourage people to be underinsured, providing tax benefits primarily to the healthiest and wealthiest. Both approaches failed today.

DEBATE: Assemblywoman Chan opened by talking about the bill as a "modest regulation of a new product" that requires "higher consumer cost sharing," plans that are "on sale in California with no regulation and no consistent information for consumers."

Assemblyman Russ Bogh, an Inland-Empire Republican, mistakely said AB2281 would deny thousands of workers Health Savings Accounts because employers “wouldn’t’’ be able to buy them. “This bill would deny them of that,’’ he said. He supported HSAs, saying that it was better to "have people pay for their health care... to better control costs."

This was refuted by Democratic Assemblywomen Goldberg and Berg, who pointed out that the bill still allowed high deductible plans and Health Savings Accounts to exist, as they do now, but simply "put a reasonable limit on how much a family would have to pay," as Assemblywoman Berg said, to prevent medical debt and bankruptcy.

Notoriously conservative Assemblyman Ray Haynes, of Murrieta, said high-deductible plans are a good idea because “it teaches people how to take care of themselves and not have government bureaucracy do it.’’ He argued that they allow patients "to control the cost, by dealing directly with the doctor." He opposed "foolish mandates like these" that he states would drive up the cost of health insurance and lead to more uninsured. He ended about "why this bill is so evil," stating that it would "start us down the road to regulation of Health Savings Accounts, start us down the road to government health insurance," and to more uninsured.

While many of the Republican opponents spoke on their preference of having "consumers and families choose, rather than government bureaucrats," it was unclear what they were speaking about with regard to the bill. The bill would have actually required the insurers to provide consumers with more information to make better choices.

NEXT STEPS: The effort on these issues around the value and cost of health coverage is not dead. Another bill, AB977(Nava), sponsored by Health Acceszs California, would seek to create a public review of out-of-pocket costs at the Department of Managed Health Care. It is pending in June in the Senate Insurance Committee.

On a related matter, tomorrow, Thursday, June 1st, Insurance Commissioner John Garamendi is holding an investigatory hearing on "the profitability of health insurance products" in Los Angeles. It starts at 9:00am at the Ronald Reagan State Building at 300 South Spring Street, and will consider regulations setting standards for medical loss ratios for health plans.

UPDATE ON OTHER BILLS ON PRESCRIPTION DRUGS

Several bills of concern to health advocates did pass, including on the subject of prescription drugs.

• Uninsured and underinsured Californians may see a discount drug program this year. AB2911 by Assembly Speaker Fabian Nunez and Senate Leader Don Perata passed the Assembly with little fanfare, on a (unofficial) 45-29 vote tally.
• Assemblyman Frommer passed his bill, AB2877, which would set up a website to facilitate reimportation of safe and affordable prescription drugs from other countries.
• Also passing was Assemblywoman Chan's bill, AB2170, to create a consumer report card for Medicare Part D prescription drug plans.
  

A full report on the status of bills of interest to health advocates, and actions of the Budget Conference Committee, will be prepared by Health Access at the end of the week. For more information on any of these issues, contact Hanh Kim Quach, Policy Coordinator, at hquach@health-access.org, or 916-497-0923.

ACTION ITEM: SUPPORT EXPANDING KIDS’ COVERAGE

The six-member Budget Conference Committee, chaired by Assemblyman John Larid and Senator Wes Chesbro, is expected to wrap up reconciling the two houses’ budgets on Friday by midnight, earlier than in recent years.

The most high-profile health item is items around expanding coverage to children.

Child, faith, and health advocates are urging the Conference Committee to adopt the Assembly’s version of the children’s coverage proposal, which is more expansive than the Senate version. It includes some of the provisions in SB 437, including assistance to local Children’s Health Initiatives. For this issue, the Subcommittee specified $40 million in bridge funding so that these county efforts can cover all the uninsured children now on waiting lists. These proposals are geared toward the eventual goal of covering all California's children. For more information, view the campaign updates of the 100 Percent Campaign website at:
http://www.100percentcampaign.org/resources/updates/index.htm

These health items are likely to be heard tomorrow, Thursday, June 1st. Please attend the hearings in Capitol Room 4202 and/or contact the six members of the conference committee. More information is available below:
http://www.senate.ca.gov/ftp/sen/committee/JOINT/BUDGET/_home1/PROFILE.HTM

For questions or more information, please contact Hanh Kim Quach, policy coordinator. 916.497-0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 10:28 AM


 

Wednesday, May 24, 2006

HIGH-DEDUCTIBLE PLAN BILL IN THE BULL’S EYE

• We need your help NOW!
• Business Democrats targeted.
• ACTION ITEM: Call business-oriented Democrats and urge passage of AB2281.

Insurers have made killing AB2281 (Chan) their TOP PRIORITY and are aggressively lobbying business-friendly Democrats.

The bill could come up for a vote on the Assembly Floor as early as THURSDAY, May 25th.

AB2281 would restrict annual out-of-pocket expenses on high-deductible insurance plans to $5,250 a year for individuals, $10,500 for families.

Without these restrictions, Blue Cross admits 1.5 million Blue Cross members would continue to face unlimited out-of-pocket costs, even AFTER their deductible is met.

Don’t delay.

Call up moderately minded Democrats in your area that are top targets of business lobbyists and urge passage of AB2281.

For questions or more information on AB2281, please contact Hanh Kim Quach, policy coordinator. 916.497-0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 9:01 AM


 

Monday, May 22, 2006

BOTH HOUSES FAIL TO COVER CO-PAYS FOR POOREST SENIORS AND PEOPLE WITH DISABILITIES AS HEALTH BUDGET IS COMPLETED

For the second year in a row, both the Assembly and Senate budget subcommittees have failed to provide funding for Medicare Part D co-payments paid by low income seniors and persons with disabilities.

• No money included by either house to help the state’s poorest seniors and people with disabilities afford their medications
• Patients with monthly incomes of less than $850 could be forced to pay $40 or $50 out-of-pocket for medications
• ACTION ITEM: Call Legislative leaders and budget committee members to express your discontent and urge reconsideration of this issue
• Assembly Budget Subcommittee rejects governor’s modest proposal to cover uninsured children in favor of Assembly version to phase-in coverage for all children below 300%FPL.

Among the top priorities for advocates this year was to fix problems associated with the complicated and confusing federal Medicare Part D program. In addition to the disastrous implementation problems, advocates sought to protect the lowest income patients in California, who faced out-of-pocket co-payments for the first time under the new plan.

COPAYS WILL NOT BE COVERED FOR STATE’S POOREST RESIDENTS

Lawmakers have decided not to spend one thin dime to help the state’s most vulnerable residents pay for their medications.

The Senate shut down its health budget subcommittee on Friday with nary a mention of the $76 million it could cost to cover the co-pays of seniors and disabled people who are enrolled in both Medi-Cal and Medicare.

In the Assembly, subcommittee chairman Hector DeLaTorre heard testimony about the issue two weeks ago and seemed sympathetic. But DeLaTorre closed the book on the health portion of the budget without a single penny going to cover the co-pays.

In California, 1.1 million seniors and people with disabilities were enrolled in both Medi-Cal and Medicare. When Medicare Part D took effect in January, these dually eligible patients found they were worse off. The patients, who live on $834 a month, were unceremoniously shifted into the program on January 1, 2006 and forced to come up with $1 to $5 co-pays for each medication. If they did not have the money, a pharmacy could refuse to fill their prescription.

Previously, Medi-Cal covered the full cost of their drugs with no co-pays. These dually eligible seniors use an average of 10 medications a month and can least afford $10, let alone $50 for their medications to stay alive.

Because neither house has included this funding in their budget, it means the issue is effectively dead for the year. Because neither subcommittee included any funding, this item will not be heard in the budget conference committee.

For action to occur this year, legislation would require a two-thirds vote in both houses and the signature of the Governor in order to appropriate funds. The four legislative caucuses, the four legislative leaders, and the governor would need to agree—as yet, none of them, not one leader, not the Governor, has supported this effort.

In light of the unexpected $7.5 billion revenue windfall the state received, it is hard to believe that the resources could not be found to support a $76 million budget proposal to pay for co-payments.

With $65 million earmarked for Medi-Cal HMOs, many health advocates are deeply troubled by the actions of the federal government and lack of action by state government that leave the most vulnerable Californians are now worse off than they were just five months ago under Medi-Cal.

ACTION ITEM: Express your discontent. Urge reconsideration.

Let Legislative leaders know how their inaction will affect the most vulnerable in California.

Assembly Speaker Fabian Nunez
California State Assembly
State Capitol, Room 219
Sacramento, CA 95814
Phone: 916.319.2046, Fax: 916.319.2146

The Honorable John Laird
Assembly Budget Chairman
California State Assembly
State Capitol, Room 6026
Sacramento, CA 95814
Phone: 916.319.2027, Fax: 916.319.2127

The Honorable Hector DeLaTorre
Chair, Assembly Budget Subcommittee #1
California State Assembly
State Capitol, Room 4162
Sacramento, CA 95814
Phone: 916.319.2050, Fax: 916.319.2150

Senate President Pro Tem Don Perata
California State Senate
State Capitol, Room 205
Sacramento, CA 95814
Phone: 916.651.4009, Fax: 913.327.1997

Senator Wes Chesbro
Chair, Senate Budget Committee
State Capitol, Room 5035
Sacramento, CA 95814
Phone: 916.651.4002, Fax: 913.323.6958

Senator Denise Ducheny
Chair, Senate Budget Subcommittee #3
State Capitol, Room 4081
Sacramento, CA 95814
Phone: 916.651.4040, Fax: 913.327.3522

The remaining alternative is to draft a bill requiring action on co-payments, but this measure would need to reach the high bar of a 2/3 vote in both the Assembly and the Senate and the signature of the governor.

ASSEMBLY BUDGET SUBCOMMITTEE REJECTS GOVERNOR’S MODEST PLAN TO COVER UNINSURED CHILDREN; RETAIN THEIR PROPOSAL OF NEARLY TWICE THE AMOUNT

Also on Monday, members of the Assembly budget subcommittee rejected Gov. Arnold Schwarzenegger’s plan to spend $23 million to cover 24,000 currently uninsured children who are on waiting lists for coverage at County Health Initiatives.

The Assembly budget subcommittee had earlier this month approved a proposal that would give the counties $40 million to cover uninsured children at up to 300 percent of the federal poverty level. The Assembly plan also directed the state to begin administrative efforts to cover all California’s 800,000 uninsured children by 2008.

DeLaTorre said their action would retain the earlier proposal.

Advocates have not yet seen the specific language adopted by the Assembly. It will differ in some details from the proposed initiative pending for the November 2006 ballot.

Since the Senate budget subcommittee adopted the Governor’s proposal to fund the waiting list in the CHIs, this issue goes to conference committee and to the Big Five (the Governor and the four legislative leaders) for resolution.

It is important to remember that in presenting the May Revise, Governor Schwarzenegger took pains to note that he would not support the November 2006 ballot measure on children’s coverage because he does not support tax increases.

When Schwarzenegger first ran for office in 2003, he said he supported every child having insurance. In spite of that campaign rhetoric, Schwarzenegger vetoed the earlier measure, AB772 Chan/Escutia because it lacked funding.

Advocates look forward to his next statement on children’s health insurance: perhaps the next step for Schwarzenegger will the dedication of funding for health insurance for every child below 300% of poverty.

OTHER BUDGET ITEMS

The Assembly budget subcommittee on Monday also:

• Intervenor funds: Extended a program that allows consumer groups to be paid for their work advocating Department of Managed Health Care regulatory proceedings. The “intervenor funding’’ mirrors what is available to consumer advocates at the Public Utilities Commission and provides health care advocates with up to $350,000 a year until 2012 to continue fighting for consumer protections at the agency level.
• Managed care rate increase: Approved Medi-Cal rate increase for certain managed care plans. The committee also reversed a five percent rate reduction imposed on all plans in 2004.
• Provider rate increase: Approved $5 million in rate increases for other providers, such as physicians, labs, pharmacies, ambulances and dentists, who served Medi-Cal beneficiaries.
• Medi-Cal documentation requirements: Approved tentative language that allows the state to follow federal guidelines in requiring documentation of legal citizenship status – using a passport, or birth certificate and photo ID -- as a condition of receiving Medi-Cal.
• This language was accepted on the condition that the Department of Health Services continued to find solutions that would ensure Medi-Cal recipient services would not be interrupted.
• Advocates and the state Department of Health Services are in agreement that the new federal guidelines places a significant burden on many CITIZENS of the U.S. who may not have a passport, photo ID or birth certificate.

For questions or more information on any of these issues, please contact Hanh Kim Quach, policy coordinator. 916.497-0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 8:38 AM


 

Saturday, May 20, 2006

FINAL ACTIONS TAKEN BY SENATE BUDGET SUBCOMMITTEE

• Action not taken: Senate committee fails to include ANY funding for Medicare Part D copay
• Assembly Budget Subcommittee to take final actions Monday 5/22/06
• ACTION ITEM: Urge Nunez, Laird, DeLaTorre, Hancock and Mullin to include $76 million funding for Medicare Part D copes in budget. • Tentatively approves state interpretation of new federal rules on documentation for Medi-Cal beneficiaries
• Approves governor’s plan to cover some uninsured children
• Approves plan allowing state and advocates to continue hammering out new Medi-Cal documentation requirements
• ACTION ITEM: Urge your Assemblymember to support AB2281 on high-deductible health plans by May 25

Budget subcommittees are winding up their work for the year. The Senate budget subcommittee on health finished up on Friday, May 19, 2006. The Assembly subcommittee is expected to finish on Monday, May 22, 2006.

That means Monday is the last chance for advocates to have money put into the budget for their priorities in order for the topics to advance to conference committee, when both houses convene to reconcile differences in their budgets.

LAST CHANCE TO FIGHT FOR MEDICARE PART D

The Senate subcommittee on health Friday did not include any mention of funding that would cover Medicare Part D copes for dual eligible seniors and people with disabilities.

Such a decision could devastate the 1.1 million Californians who were enrolled in both Medi-Cal and Medicare. In January, these so-called “Medi-Medis” were shifted to Medicare Part D and forced to come up with $1-$5 co-pays for each medication, or a pharmacy can refuse to fill their medications.

Previously Medi-Cal covered the full cost of their drugs, with no copays.These are the poorest and most vulnerable seniors and people with disabilities who live on $834 a month or less and who can ill afford to pay $20, $30 or $50 a month for prescriptions.

ACTION ITEM: Monday, the Assembly subcommittee on Health wraps up its work. It’s imperative that funding for Medi-Cal co-pays be included in at least this initial version of the budget so discussions may continue.

Please urge the following key members for support in providing co-pays for dual-eligible seniors and people with disabilities:

Assembly Speaker Fabian Nunez
State Capitol
Sacramento, CA 95814
Phone: 916.319. 2050. Fax: 916.319.2150

The Honorable John Laird
Chair, Assembly Budget Committee
State Capitol
Sacramento, CA 95814
Phone: 916.319. 2027. Fax: 916.319.2127

The Honorable Hector DeLaTorre
Chair, Assembly Budget Subcommittee #1
State Capitol
Sacramento, CA 95814
Phone: 916.319. 2050. Fax: 916.319.2150

The Honorable Loni Hancock
Member, Assembly Budget Subcommittee #1
State Capitol
Sacramento, CA 95814
Phone: 916.319. 2014. Fax: 916.319.2114

The Honorable Gene Mullin
Member, Assembly Budget Subcommittee #1
State Capitol
Sacramento, CA 95814
Phone: 916.319. 2019. Fax: 916.319.2119

SENATORS AGREE TO PALTRY HEALTH COVERAGE EXPANSION

The health budget subcommittee Friday also approved Gov. Arnold Schwarzenegger’s proposal to give $23 million to extend county health coverage to up to 24,000 children on waiting lists to receive services.

While the governor’s proposal would cover only 3 percent of the uninsured children, advocates agree it’s a small, but good first step.

This item will likely come in the budget conference committee later this month. The Assembly budget committee approved a slightly more generous proposal, which would give counties $40 million.

Additionally, the Assembly budget proposal instructs the state to begin work to cover all of California’s 800,000 children, at 300% of federal poverty or below by July 2008.

Sen. Dave Cox, a Republican from Fair Oaks, complained that such an expense would amount to a continuing expense for the state, with no guarantee that Google executives will continue to cash out their stocks. Such reliance on one-time funds is what lead the state into deficit in recent years.

Sen. Wes Chesbro, a Democrat from Arcata, countered however, that “sick kids make for big deficits too.’’

ADVOCATES FIGHT TO ENSURE MEDI-CAL RECIPIENTS RECEIVE UNINTERRUPTED SERVICES

Among the most difficult issues Friday was how California would implement a provision in the federal Deficit Reduction Act, aimed at weeding out undocumented immigrants from using public services.

As a condition of receiving aid, the provision requires that recipients present either a passport, or a birth certificate combined with a photo ID.

Ironically the proposal is expected to have the greatest impact on U.S. citizens, particularly those born prior to World War II when birth certificates were not universal or those born outside the US (to American parents) in countries where it may be difficult to obtain documentation. It will also affect children and persons with disabilities who have had no reason to obtain a photo ID.

Advocates fear that families who don’t have passports and cannot locate birth certificates would lose benefits, putting millions at risk. A group of advocates met with the Department of Health Services on Monday to discuss how the federal law would be implemented here.

The state agrees that the new federal law will create problems for existing Medi-Cal recipients. However, the state could also risk losing $15 billion (the federal Medicaid match) if it doesn’t follow new federal guidelines, which take effect July 1, 2006.

The Senate subcommittee voted on placeholder language that would enable the state and advocates to continue exploring how to implement the new law, while doing the least harm.

Remedies being considered include:

• DHS automatically crosschecking eligibility in other programs such as SSI and CalWorks that already require proof of citizenship.
• Allowing parents, who are citizens, to vouch for their children.
• Keep children in the program on a provisional basis if parents can show they’re trying to obtain their birth certificates from out of state.
• Work with other states to share documents

Those who have been actively involved in monitoring the Deficit Reduction Act documentation requirements include: Children’s Defense Fund, Western Center on Law and Poverty, Children NOW, California Pan-Ethnic Health Network, California Budget Project, California Medical Association, Center for Budget and Policy Priorities, Latino Coalition for a Healthy California, The Children’s Partnership, County Welfare Directors’ Association, Health Access, Latino Issues Forum, Planned Parenthood, National Health Law Program, California Primary Care Association, The California Partnership, California Immigrant Welfare Collaborative and Asian Pacific Islander American Health forum.

For questions or information on this issue, please contact Elizabeth Abbott, project director at Health Access. 916.497.0924 x 201 or eabbott@health-access.org

OTHER BUDGET ITEMS

Senators also:

• Approved Schwarzenegger’s proposal to repay $65 million to managed care plans, which had endured a 5 percent rate cut earlier this year.
• Doubled to $50 the payment made to application takers to successfully enroll a recipient onto Healthy Families or Medi-Cal.
• Rejected an additional $25 incentive to encourage application takers to use an electronic application.

ALSO NEXT WEEK: As early as Thursday, May 25, the full Assembly could take up AB2281, which would restrict annual out-of-pocket costs to $5,250 for an individual.

• ACTION ITEM: Please contact your Assemblymember and encourage them to support this legislation.

For information or questions about state budget, legislative issues, or a sample letter of AB2281, please contact Hanh Kim Quach, Policy Coordinator, 916.497.0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 10:04 AM


 

Wednesday, May 17, 2006

HIGH DEDUCTIBLE PLAN PROTECTIONS HEADS TO ASSEMBLY FLOOR

• AB2281, to cap annual out-of-pocket costs, passes Assembly Appropriations
• Medicare Part D Update: Emergency Extension signed; AB2667 passes Assembly

The debate over high deductible health plans is heating up, as key legislation hotly opposed by the insurance industry is heading toward the Assembly floor.

This week has also been a big week for Medicare Part D, as well as for efforts to reform the program and fill in some of the gaps it leaves.

HIGH DEDUCTIBLE HEALTH PLANS HEADS TO FULL ASSEMBLY

Annual out of pocket costs for high-deductible health plans would be capped at $5,000 for individuals, and deductibles would not apply for covered preventive care under AB2281 by Assemblywoman Wilma Chan, which passed out of the Assembly Appropriations Committee Wednesday on a party line vote, with Democrats voting for it.

While the bill would allow Californians to couple a high deductible health plan with a tax-sheltering Health Savings Account., AB2281 would ensure that consumers weren’t annually on the hook for thousands more than their deductible. “These products are here and they’re going to be around for some time to come,’’ Chan said. “This bill sets outer limits. Without this bill, the Department of Insurance has no way to regulate these plans at all.”

Chan took three amendments that focused the bill, including one that conformed the caps on out of pocket costs to federal IRS guidelines, and also indexes the cap to annual inflation rates.

Several organizations spoke in support of Chan’s measure, including: Health Access, California School Employees Association, SEIU, Older Women’s League, California Labor Federation, Western Center on Law and Poverty, Foundation for Taxpayer and Consumer Rights, the Office of Insurance Commissioner John Garamendi, AFSCME and United Nurses Association of California.

The insurance industry lined up a parade of opposition. Anne Eowan, speaking for the Association of California Life and Health Insurance opposed to AB2281 because they claimed it would make premiums more expensive. “Folks who are buying these found a price point they can afford,’’ said Eowan. “With preventive care, they might not be able to afford it.’’ As part of their lobbying, Blue Cross’ Armand Feliciano produced for Chan, the bill’s author, and Assemblywoman Judy Chu, the chairwoman of Appropriations, how many of their constituents with Blue Cross plans would be affected by AB2281.

Advocates for the bill argued that affordability of premiums is a secondary concern if the product doesn't not provide coverage or value, and still leaves the patient at risk for financial ruin. Even if consumers can pay the monthly bill to the insurance company, they may not be able to pay the bill for the doctor’s office, or the prescription drugs, or the hospital bill.

The bill now heads directly for the Assembly floor, where the bill needs 41 votes to pass, and could be heard as early as next week.

ACTION NEEDED: The insurance industry has reportedly made AB2281 (Chan) their top priority bill to kill this year. With that kind of lobbying fervor and financial backing opposed, health advocates are organizing to contact legislators about their support. CALLS AND FAXES TO LEGISLATORS ARE NEEDED.

The mailing address for lawmakers is:

State Capitol
Sacramento , CA 95814

For a sample letter of support for AB2281, please email or call Hanh Kim Quach, Health Care Policy Coordinator at Health Access: hquach@health-access.org or 916.497.0923 x 206.

DECISION WEEK ON MEDICARE PART D

It was a big week for the Medicare Part D prescription drug benefit.

SIGN-UP DEADLINE: Monday was the deadline for seniors and people with disabilities to sign up and select a plan under Medicare Part D for the year. That means those who have not yet enrolled would now face a penalty of 1 percent each month to their premiums. On top of that, consumers who did not sign up by Monday cannot do so until November, with coverage beginning in Janury 2007. When enrolled, they will face a 7% additional penalty for life.

PROPOSAL TO PREVENT PENALTY: To remedy this, a bipartisan group of U.S. Senators Charles Grassley (R-IA), Max Baucus (D-MT), Bill Nelson (D-FL), and Mike DeWine (R-OH) indicated that they will work together to waive the Medicare Part D late enrollment penalty. President George W. Bush had previously rejected calls to delay the deadline, and hence the penalty.

EMERGENCY COVERAGE EXTENDED: In California , Gov. Arnold Schwarzenegger on Tuesday signed AB813 (Perata/Nunez), which would extend until January 2007 the emergency drug coverage for seniors and people with disabilities when they have problems with their Medicare Part D plan. Earlier this year, the state authorized emergency coverage for this population, when many found that drug plans had no record of their enrollment or Medicare lost their information, among other problems. The extension allows this "coverage of last resort" to continue through the beginning of next year, when confusion and complicaties are expected as the private prescription drug plans either change formularies or leave the program altogether.

ASSEMBLY PASSES BACA BILL: Also this week, the full Assembly passed AB2667 (Baca) by a wide margin. The bill, by Assemblyman Joe Baca, which would allow the state to use its full regulatory authority to provide additional oversight to prescription drug plans with a history of bad behavior in other states.

COVERING CO-PAYS: An issue that will be decided in the next week is whether California will cover the newly-imposed costs on the one million "dual-eligible" seniors and people with disabilities made worse off by Medicare Part D.

Senior, health and low-income advocates are urging the Budget Subcommittees that oversee the health budget, to allocate the $76 million price tag to provide assistance to all seniors and people with disabilities who previously had Medi-Cal coverage for their drugs, but now must use part of their $825 a month income to stay alive. These dual eligibles use an average of 10 medications a month.

Please call and write to:

Assemblyman Hector De La Torre
Chair, Assembly Budget Subcommittee #1
State Capitol
Sacramento, CA 95814 .
The phone number is 916.319.2050; fax: 916.319.2150.

The Honorable Denise Moreno Ducheny, Chair
Chair, Senate Budget & Fiscal Review Subcommittee #3
Health and Human Services
State Capitol
Sacramento , CA 95814
The phone number is 916.651.4040; fax: 916.327.3522

For a sample letter on copay coverage for dual eligibles, please contact Elizabeth Abbott, Project Director at Health Access at eabbott@health-access.org.

For questions about state health policy issues, please call Hanh Kim Quach, Policy Coordinator, 916.497.0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 9:56 AM


 

Friday, May 12, 2006

GOVERNOR RELEASES MAY BUDGET REVISION

• Extra $7.5 billion over 2 years flows to state coffers, directed to deficit and education
• No health cuts; No significant health care expansions; Missed health opportunities
• National Update: Enzi bill defeated that would have negated state protections
  

There’s nothing like an extra $7.5 billion over two years that won’t boost anyone’s spirits – or popularity. A grinning Gov. Arnold Schwarzenegger glowed as he unveiled his $131.1 billion May Budget Revision. Two-thirds of the extra money will be used to pay down debt and put in a rainy day account. Education will also get significant funding restored. The full budget proposal is available on the Department of Finance's website, at:
http://www.ebudget.ca.gov/

As a rule, the Governor stressed that he was "committed to fiscal discipline." In spite of the happy turn in economic news, little of the largesse will be falling to issues important to health advocates. The chapter of the budget summary on health issues is available at:
http://www.ebudget.ca.gov/pdf/Revised/BudgetSummary/HealthandHumanServices.pdf

Most of the focus of the budget was on education, infrastructure, and non-health related items. In the health budget, the county children's coverage was highlighted, along with emergency preparedness, and other issues.

What is most noteworthy is what isn't in the health budget. With no major expansions, Health Access California and other advocates noted the opportunities missed to make relatively small investments in health that would have a big impact on children, seniors, and the health system as a whole. The budget does not include proposals for covering all children, helping low-income seniors with newly-imposed co-payments under Medicare Part D, or raising Medi-Cal provider rates.

BUDGET BATTLE BEGINS ON CHILDREN’S COVERAGE

As Secretary Kim Belshe announced Thursday, Schwarzenegger’s May revision includes $23 million to cover 24,000 children--which is approximately 3 percent of the currently 800,000 uninsured children in the state. The money would flow to 18 county "Healthy Kids" programs which have waiting lists through the 2006-07 year, with no guarantee that the funding would be continued the following year.

This $23 million is on top of $35 million (general fund) that Schwarzenegger dedicated in January for Healthy Families and Medi-Cal outreach and retention efforts. At his budget press conference today, the Governor was asked about the tobacco tax measure pending for the November ballot that would cover children's coverage, he stated, "I don't support any initiatives to increase taxes." He did express pride in the "public/private partnership" effort to outreach to more children. "We want to make sure every child is eventually insured; we are working toward that goal."

However, the governor’s efforts fall short of his 2003 campaign promise to “cover all children’’ in the state. As Schwarzenegger seeks re-election this year, Democrats in both houses pounced on that promise.

Sen. Wes Chesbro, chairman of the Senate Budget Committee, juxtaposed the priority given to an avian flu pandemic--$400 million--with the amount being spent on the basic need to increase children’s coverage.

Assembly Democratic Caucus leader Dario Frommer said Democrats were “disappointed that this governor has still not fulfilled his campaign promise to provide health insurance for every child.’’ Frommer added that health care for children “should be a priority.... We look forward to working with the governor to helping him fulfill his campaign promise."

For their part, Assembly Democrats have proposed a plan that would put the state on track to cover all children by July 2008. Earlier this week, the Assembly Budget Committee on health approved $50 million – twice the amount that Schwarzenegger has proposed. About $40 million would go to the counties’ Healthy Kids programs and another $5 million would begin the administrative process of expanding overage to the remaining 800,000 uninsured children in Healthy Families and Medi-cal programs.

The Democrats’ plan would increase the income ceiling for Healthy Families from 250 percent of poverty to 300 percent. It would also expand Medi-Cal’s income ceiling to 133 percent. Currently, children older than 5 were not eligible for Medi-Cal if their families earned above 100 percent of poverty. In effect, the changes would allow for universal coverage of ALL under 300 percent of the federal poverty level, which is $60,000 for a family of four.

SOME HELP FOR MEDI-CAL MANAGED CARE; NONE FOR MEDI-CAL PROVIDERS

The May Revision also contains $33 million (general fund) to eliminate a previous 5 percent provider rate reduction on Medi-Cal managed care plans, starting January 1, 2007. This would allow continued access to care for 3.2 million California in such Medi-Cal managed care plans.

Specific rate increases, totalling $30 million (general fund), will be granted in for plans in specific counties, including: Central Coast Alliance for Health, Community Health Group, Contra Costa Health Plan, Health Plan of San Mateo, Partnership Health Plan of California, and Santa Barbara Regional Health Authority.

So while there are some increases for Medi-Cal managed care plans, the budget does not include any increases in Medi-Cal provider rates. Such provider rates have not been increased since 2000, and are among the worst in the nation. Adjusted for inflation, the value of the Medi-Cal reimbursement rate has declined by 54 percent since 1985. Low reimbursement rates affect access to care, with fewer doctors willing and able to afford to care for the state’s poorest patients, including children, seniors, and people with disabilities.

NO HELP FOR LOW-INCOME SENIORS WITH NEW DRUG CO-PAYS

The budget does not include help dual-eligible seniors and people with disabilities – who previously did not have co-pays --cover their newly-imposed costs for prescription drugs under Medicare Part D. These seniors and people with disabilities who survive on less than $825 a month, who qualify for both Medi-Cal and Medicare. These "dual-eligibles" were made worse off this year in the implementation of Medicare Part D, which forced them to pay co-pays for the many needed prescription drugs they take monthly.

Even though Schwarzenegger does not mention this item in his May Revision, advocates are attempting to keep the issue alive in budget negotiations and legislation. Assemblywoman Wilma Chan made a presentation before the budget subcommittee on health this week.

ADVOCATES NATIONWIDE DEFEAT ENZI LEGISLATION

In other news, S. 1955 (Enzi), which would have jeopardized over twenty of California's consumer health insurance protections, was stopped in the U.S. Senate Thursday evening. Supporters needed 60 votes to bring the measure to a vote, but only got 55 votes in support, mostly from Republicans; 43 Senators voted against it, including both California Sens. Dianne Feinstein and Barbara Boxer.

The bill, by Wyoming Republican Sen. Michael Enzi, would have evicerated state insurance consumer oversight, under the guise of allowing small businesses to pool with other businesses across state lines and negotiate for lower insurance rates. The bill would have required standardizing state insurance regulations, including consumer protections that states have passed, and preventing future state efforts. By eliminating community rating laws, it would have also had the effect of increasing rates for businesses that employ an older workforce or women of child bearing age.

For information on the budget, federal health legislation, or other issues, please contact Hanh Kim Quach, Policy Coordinator, Health Access, at hquach@health-access.org, or (916) 497-0923 x 206.

Labels: Updates

posted by Anthony Wright | Permalink | 8:39 PM


 

Thursday, May 11, 2006

GOVERNOR ANNOUNCES SOME FUNDING OF COUNTY CHILDREN'S COVERAGE;
NO EXPANSION OF STATE HEALTH PROGRAMS; MAY REVISE RELEASED TOMORROW

• May Revise to spend $23 million to cover 24,000 kids on County Health Initiative (CHI) waiting lists
• No expansion of state programs, or further assistance for the rest of the 800,000 uninsured kids
• Senate passes extension of emergency Rx coverage for low-income seniors and others
• Action Item: Advocacy needed on Medicare emergency coverage, co-payments coverage

April showers at the Capitol typically spring May leaks–especially the week leading up to the governor’s May budget revision, which will be released tomorrow, Friday, May 12th.

At an orchestrated “leak’’ to health and Capitol reporters Thursday, Health and Human Services Secretary Kim Belshe announced that in the context of a budget that will "hold the line on spending in public programs," one of the governor’s spending priorities this year would be to expand coverage to more uninsured children, by funding county programs that currently have waiting lists.

While 90% of California's children are insured, about 800,000 children in California remain uninsured. About half of these children actually qualifies for Medi-Cal or Healthy Families, but are not enrolled. The other half are not eligible for any program.

The governor’s proposal would spend $23 million, to cover just a 3 percent sliver of the uninsured population – 24,000 children currently on waiting lists at County Health Initiatives. The governor’s new proposal supplements the $70 million Gov. Arnold Schwarzenegger already appropriated in his January budget proposal reach out and cover children eligible for Healthy Families and Medi-Cal.

“We believe this is a prudent and responsible initiative,’’ Belshe said.

Schwarzenegger’s new proposal, however, is less than half the amount that Assembly Democrats approved this week for County Health Initiatives for children's coverage. Last Monday, the Assembly Budget Subcommittee on Health and Human Services approved a more ambitious effort on children's coverage: it included a $5 million for the 2006-07 budget year to start the administrative process of expanding coverage to the remaining 800,000 uninsured children in Healthy Families and Medi-Cal. The proposal also allocated $40 million--about twice what Governor Schwarzenegger proposed--to go to county "Healthy Kids" programs to allow them to enroll more children now on waiting lists.

The overall Assembly proposal, which would not be implemented until July 2008, would raise the income ceiling for Healthy Families from 250 percent of poverty to 300 percent. It would also expand Medi-Cal's income ceiling for Medi-Cal to 133 percent. Previously, children older than 5 were ineligible for Medi-Cal if their families earned above 100 percent of poverty. In effect, the changes would allow for universal coverage of *all* children under 300% of the federal poverty level, which is $49,800 for a family of three.

Both proposals would require additional funds in the 2007-2008 budget year. They could come from the general fund, or from other revenues, such as the tobacco tax that is pending for the November 2006 election. Secretary Belshe in fact mentioned the Schwarzenegger proposal as a "bridge" or "transition" proposal until the voters decide on that pending initiative.

The Governor's proposal has no such planned expansion of eligibility for state public insurance programs.

California has 18 County Health Initiatives, toward the goal of covering *all* children. In most cases, they cover children:

• Living in families with incomes up to 300 percent FPL
• Up to 18 years old.
• Otherwise ineligible for Healthy Families or Medi-Cal.

San Mateo County covers children up to 400 percent FPL; meanwhile Kern and Stanislaus only cover children up to age 5.

For more information on any of these issues, contact Hanh Kim Quach, Policy Coordinator, Health Access California, at 916-497-0923 x206 or hquach@health-access.org.

EMERGENCY DRUG COVERAGE TO HEAD TO ASSEMBLY MONDAY

AB813 by Senate Leader Don Perata and Assembly Speaker Fabian Nunez cleared the state Senate Thursday. AB813 would extend emergency coverage for Californians dually eligible for Medicare and Medi-Cal until January 31, 2007.

This extension is needed for the federal government and insurers to sort out problems for this population, which comprises the poorest, frailest seniors and people with disabilities.

The length of the emergency extension was hotly contested, but was agreed that this “coverage of last resort’’ should exist during November open enrollment period and the beginning of next year, when many prescription drug plans are expected to change their formularies or pull out of the market altogether, creating even more problems.

In order to prevent inappropriate usage of the $120 million maximum allocation, AB 813 also provides more restrictions on state coverage than the current emergency coverage. For example, in many circumstances it requires doctors and pharmacists to go through a prior authorization process before providing emergency drug benefits to dual eligible beneficiaries, to ensure that they truly are unable to obtain drug benefits from his or her Medicare Drug Plan.

AB813 will be considered in the Assembly on Monday, in order to get the bill to the Governor's desk on late Monday or Tuesday, in time for a gubernatorial signature before the expiration of the program on Tuesday, May 16th.

ACTION NEEDED: Legislators from both parties need to be urged to protect these dual-eligible seniors and people with disabilities, to ensure that they get the drugs they need. Health advocates are urging their memebers and allies to call their Assemblymembers and Senators to:

• Support AB813 (Perata/Nunez) to allow the state to continue emergency drug coverage for seniors and persons with disabilities so they get needed prescription drugs when Medicare Part D fails, including for the expected problems and prescription drug plan changes at the beginning of 2007.
• Support a budget item that has the state, in the budget process, agree to cover the newly imposed co-payments for low income senior and disabled people living on fixed incomes, so they are not worse off than they were last year.

For more information on Medicare Part D, contact Elizabeth Abbott, Project Director, Health Access California, at 916-497-0923 x201, or eabbott@health-access.org. On all these issues, contact Hanh Kim Quach, Policy Coordinator, Health Access California, at 916-497-0923 x206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 1:49 PM


 

SENATE HEALTH COMMITTEE APPROVES EXTENSION OF EMERGENCY PRESCRIPTION DRUG COVERAGE FOR MEDICARE PART D PROBLEMS

• Emergency coverage expires May 16th; AB813(Perata/Nunez) would extend "last resort" drug coverage for low-income seniors and people with disabilities; Length of extension disputed.
• Congress urged to extend deadline for seniors who have not yet chosen a prescription drug plan.
• Federal funds for medical interpreter services sought.
• Action Item: Advocacy needed on Medicare emergency coverage, co-payments coverage

The next few days feature a series of key days and deadlines for the seniors and people with disabilities, impacting their ability to get the drugs they need, through the Medicare Part D program.

• On Friday, May 12th, the Governor will release the "May Revise" of the state budget, where he will announce if he supports the state covering the newly-imposed co-payments on one million low-income seniors and people with disabilities.
• Monday, May 15th is the last day that seniors and people with disabilities can sign up for a Part D prescription drug plan before facing a lifetime penalty. About 1 million low-income seniors and people with disabilities in California are dually eligible for Medicare.
• And Tuesday, May 16th is when the California’s emergency “safety-net” coverage program will expire, if the legislature does take quick action in the next few days. This "coverage of last resort" was instituted with bipartisan support, in response to major failures in the implementation of Part D, to ensure that low-income seniors and people with disabilities that were automatically enrolled in the program continued to get needed medications. The problems were plentiful: Some patients could not be found in the system, others were paying exorbitant co-pays. The state initially approved this emergency coverage in January, allowing for up to $150 million to cover these costs. The state covered hundreds of thousands of drugs, which was reimbursed by the federal government through March. Since then, around $20 million has been spent.

This past Wednesday, the Senate Health Committee heard a handful of bills, but the one that got the most attention was the debate about whether to extend this emergency coverage, and how to do it.

EMERGENCY COVERAGE EXTENSION CONSIDERED

AB813 by Senate President Pro Tem Don Perata and Assembly Speaker Fabian Nunez would extend this emergency coverage through March 31, 2007. The ten month extension is intended to give the government and insurers time to sort out problems for this vulnerable "dual-eligible" population, which uses an average of at least ten prescription drugs a month, according to some estimates. The extension would allow this "coverage of last resort" to be in place during the transition to the second year of the program, when many prescription drug plans are expected to change their formularies or pull out of the market altogether, causing confusion and potential problems.

All Democrats on the Senate Health Committee, chaired by Sen. Deborah Ortiz, voted in favor of the measure. The measure got testimony in support from a wide range of representatives of seniors, consumers, low-income families, health groups, pharmacists, retailers, people with disabilities, medical providers, communities of color, and other organizations. There was no organized opposition.

Senate Republicans abstained, and noted that they had concerns, especially about the length of the extension. The reason, they said, is that the state should not be in the business of dealing with "federal issues." This development does raise alarms: the bill will need Republican votes in order to get the two-thirds votes needed to pass in the next few days as an emergency measure.
California has one million low-income seniors and people with disabilities that are under both Medicare and Medi-Cal, which account for over 14 percent of the "dual eligibles" in the country. Even as the problems have lessened, the emergency programs still pays for thousands of prescriptions a day, that without this program, many of which would either go unfilled, or place a financial burden on this low-income and frail population.

ACTION NEEDED: Legislators from both parties need to be urged to protect these dual-eligible seniors and people with disabilities, to ensure that they get the drugs they need. Health advocates are urging their memebers and allies to call their Assemblymembers and Senators to:

• Support AB813 (Perata/Nunez) to allow the state to continue emergency drug coverage for seniors and persons with disabilities so they get needed prescription drugs when Medicare Part D fails, including for the expected problems and prescription drug plan changes at the beginning of 2007.
• Support a budget item that has the state, in the budget prcess, agree to cover the newly imposed co-payments for low income senior and disabled people living on fixed incomes, so they are not worse off than they were last year.

STATE APPEALS TO CONGRESS FOR DEADLINE DELAY

The Senate Health Committee also took up other issues, including another Medicare Part D issue. Democrats on the committee also approved AJR 40 by Assemblywoman Wilma Chan, a resolution to urge Congress to allow seniors extra time to make adjustments to and enroll in a Medicare Part D prescription drug plan.

The cut-off date for seniors and people with disabilities to decide on whether to enroll in the federal program and select a plan is Monday, May 15th. There is a 1% surcharge added each month to the premium for those who do not select a plan before May 15. Consumers who miss the deadline cannot then sign up until November with coverage beginning in January 2007. Legislation, such as H.R. 3861(Stark) is pending to extent this deadline, and the Bush Administration has such authority for “exceptional circumstances.”

The problem is manifold. First, the calamitous start to Medicare Part D has discouraged the enrollment of many seniors. Additionally, materials remain complicated and confusing, and recent surveys found Medicare's website and toll-free line to provide inaccurate, incomplete, or inappropriate information. In California, there are 47 different stand alone Medicare prescription drug plans.

Therefore, AJR40 urges Congress to amend the Part D program so that seniors not be punished for the federal government-wrought confusion.

Rather:

• The deadline for enrolling in a program should be extended to December 31, 2006.
• Medicare beneficiaries should be allowed to change plans once in 2006 without penalty if they feel they’ve made a poor decision.
• Retirees with health benefits should not lose them because they signed up for Medicare Part D.
• Legislation, such as H.R. 3861(Stark), is pending in Congress to extend this deadline and take these actions. The Bush Administration has such “exceptional circumstances” authority to make these changes. At this point, it has not chosen to do so.

LANGUAGE ACCESS DISCUSSED

On another important topic, the Senate Health Committee approved SB1405 (Soto), which would require the state to set up a task force to actively seek federal matching funds to pay for medical interpretation services. The bill is co-sponsored by the Asian Pacific Islander American Health Forum, the California Pan-Ethnic Health Network, the California Primary Care Association, and the Latino Coalition for a Healthy California.

California has both the largest number and highest percentage of immgrants of any state in the nation. Census data estimates that 25 percent of the California population is foreign born. Twenty percent of the state’s population has limited English proficiency. That makes visiting the physician to explain ailments, or even for routine checkups, an extremely intimidating process.
Children are used as interpreters. Cultural barriers prevent parents from explaining to their children intimate and embarrassing details of their ailments. Or, a visit is reduced to a game of pointing and charades.

In 2003, SB853 (Escutia) required the Department of Managed Health Care to establish standards for health plans to provide enrollees with language assistance. Those regulations are currently pending at the Department of Managed Health Care.

However, providers and advocates argue that money is needed to provide adequate interpreter services by people trained in the appropriate medical . The bill begins to explore an important solution to ensure the health of California ’s communities.

Labels: Updates

posted by Anthony Wright | Permalink | 1:36 PM


 

Monday, May 08, 2006

BUDGET COMMITTEES DEBATE MEDICARE DRUG CO-PAYS, CHILDREN'S COVERAGE

• Assembly subcommittee proposes all remaining uninsured children be covered by public programs
• Assemblywoman Chan and advocates urge covering Medicare Part D co-pays for "dual-eligibles"
• Senate and Assembly subcommittees weight other health budget items
• Action Item: Advocacy needed on Medicare emergency coverage, co-payments coverage
  

Governor Arnold Schwarzenegger’s May Revision is just a few days away, and various groups are jockeying to spend the over $4 billion that has flowed into state coffers over what was projected in January. What the governor decides to do won’t be revealed until Friday, May 12, but the Legislature stepped up pressure Monday to use a small portion of the increase to provide better access and coverage to health care for California's most vulnerable.

The Assembly Budget Subcommittee on Health and Human Services, chaired by Assemblyman Hector De La Torre (D-South Gate), approved a proposal that would cover all California’s children, and weighed a $76 million proposal to cover the co-pays for dual-eligibles who are now forced to pay for their medications under the new Medicare Part D. These budget items must still jump significant hurdles in order to be included in the final budget.

CHILDREN’S COVERAGE

The Assembly Budget Subcommittee on Health and Human Services approved $5 million for the 2006-07 budget year to start the administrative process of expanding coverage to the remaining 800,000 uninsured children in Healthy Families and Medi-Cal.

The proposal, which would not be implemented until July 2008, would raise the income ceiling for Healthy Families from 250 percent of poverty to 300 percent. It would also expand Medi-Cal's income ceiling for Medi-Cal to 133 percent. Previously, children older than 5 were ineligible for Medi-Cal if their families earned above 100 percent of poverty. In effect, the changes would allow for universal coverage of *all* children under 300% of the federal poverty level, which is $49,800 for a family of three.

Under this proposal, additional funds would be needed in the 2007-2008 budget year. They could come from the general fund, or from other revenues, such as the tobacco tax that is pending for the November 2006 election.

To simplify the application process and increase the number of children enrolled in Healthy Families and Medi-Cal, the committee also:

• Rejected the Administration's proposal to cut funds for county eligibility operations, as well as to hold counties financially responsible for federal Medi-Cal penalties.
• Rejected the Administration's proposal to fund a media campaign on enrollment, the effectiveness of which was questioned by the Legislative Analysts Office (LAO) and advocates.
• Held open proposals around outreach and increasing incentives for Certified Application Assisters (CAAs).
• Approved the Administration’s proposal not to require families to pay premiums up front, or choose a health plan, before they are enrolled and know exactly what program they qualify for.
• Approved the Administration’s proposal to hasten enrollment for eligible infants born to mothers in the Access for Infant Mothers (AIM) program, although families may have to prepay two months of premiums.

The Senate Budget Subcommittee on Health, chaired by Senator Denise Ducheny, also heard a range of issues earlier today. They also heard and rejected the Governor's proposed to cut county eligibility operations, as did the Assembly. The Senate also approved a $21.1 million increase in Medi-Cal, in expectation of having 27,672 Medi-Cal recipients stay enrolled, as a result of simplifying the redetermination form.

LOW-INCOME SENIORS IN MEDICARE PART D

CO-PAYMENT COVERAGE CONSIDERED: The Assembly heard testimony – though delayed a vote – on a $76 million proposal that would cover the co-pays that low-income seniors must pay as part of the new Medicare Part D prescription drug plan.

Previously, low-income seniors and people with disabilities had their prescription drugs covered under the state Medicaid (Medi-Cal) program, which had broad coverage with no costs. But when this population was entirely shifted over to Medicare Part D, these seniors ended up with less comprehensive, most costly coverage.

These seniors have to now deal with newly-imposed co-payments, even though they live on less than $825 a month and on average, use more than 10 prescription drugs on a regular basis.

Assemblywoman Wilma Chan, chair of the Assembly Health Committee, made the case before the budget subcommittee for the state to cover these co-payments. She indicated that the Medicare Part D program left California's most vulnerable worse off, and that the state should not allow these Californians to suffer under a policy than the state would not have approved.

The committee held the item open, and is expected to revisit the issue next week, after the Governor's May Revise announcement.

MEDICARE EMERGENCY COVERAGE: In addition to urging the state to cover the co-payments for "dual-eligibles," senior, health, and low-income advocates are urging state policymakers to extend the "emergency coverage" to ensure that these seniors and people with disabilities get needed medications despite any ongoing problems and glitches in the Medicare Part D program.

Governor Schwarzenegger and legislative leaders passed emergency legislation earlier this year, to allow the Medi-Cal program to serve as coverage of last resort, when these low-income seniors and people with disabilities were denied drug coverage. That coverage runs out next week, on May 16th. While the scale of the issues have decreased, some problems remain, and there is concern that new ones may re-appear as the program continues its first year of operation, with new populations being enrolled, and later in the year, when some prescription drug plans are expected to leave the program.

AB 813 (Perata/Nunez) was recently amended to extend emergency coverage to "dual eligible" seniors and people with disabilities from May 17, 2006 until March 31, 2007. AB 813 provides that the state Medi-Cal program will pay for prescription drugs when Medicare Part D fails. Pharmacists are required to use good faith efforts to bill Medicare Part D before using the state system. In addition, pharmacists are required to sign claims under penalty of perjury that efforts to bill Medicare Part D have been used.

Governor Schwarzenegger's Administration has not yet announced whether it will support extending the emergency coverage, and nor have Republican legislative leaders. Their support will be critical to pass this legislation by two-thirds, which is needed to do it in the short time frame needed.

ACTION NEEDED: Legislators from both parties need to be urged to protect these dual-eligibles, and ensure that get the drugs they need. Health advocates are urging their members and allies to call their Assemblymembers and Senators to:

• Support AB813(Perata/Nunez), to allow the state to continue emergency drug coverage for seniors and persons with disabilities so they get needed prescription drugs if Medicare Part D fails.
• Support a budget item that has the state, in the budget process, agree to cover the newly-imposed co-payments for low income senior and disabled people, living on fixed incomes.

Labels: Updates

posted by Anthony Wright | Permalink | 9:22 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...