Wednesday, June 28, 2006

BUDGET PASSES LEGISLATURE; BILLS IN ASSEMBLY HEALTH COMMITEE

• Budget Passes Before Deadline: Important Health Items Not Included
• Assembly Committee Passes Bills on Drugs, Language Access; Rejects Insurer Oversight

Late tonight, the state legislature approved a $131 billion state budget. The Assembly voted 54-22, and the Senate voted 30-10. Democrats were unanimous in support of the budget, AB1801 (Laird), with the support of some Republicans to get the needed 2/3 vote, including leaders Senator Dick Ackerman and Assemblyman George Plescia.

The health trailer bill, AB1807, was passed along with other budget trailer bills. This bills includes implementing language on a range of health-related issues, including those dealing with Medi-Cal and Healthy Familes.

Despite a continued multi-billion structural deficit, the budget process was smoothed because of $8 billion more in revenues than was expected. However, despite this windfall, the budget does not include the key items for which health groups advocated, suggesting more work is needed:

• The budget does not include any expansion of child health coverage, either for county programs or the statewide Healthy Families program. Legislative leaders did indicate that they intended to revisit the issue in legislation. Child and faith-based advocates have been advocating for SB437(Escutia) as part of this effort, as well as a tobacco tax initiative this November.
• The budget does not include coverage of newly-imposed prescription drug co-payments for "dual-eligible" seniors and people with disabilities. Senior, low-income and health advocates have just introduced SB503(Figueroa) to continue their effort in this regard.
• The budget also does not include any increase in Medi-Cal reimbursement rates for providers.

ASSEMBLY HEALTH COMMITTEE REPORT

On Tuesday, in a long Assembly Health Committee, the final one chaired by Assemblywomen Wilma Chan, who is termed out, several key bills were considered.

Those that passed included:

• SB452 (Alarcon), sponsored by the AIDS Healthcare Foundation and supported by a range of senior, health and consumer groups, which requires Medi-Cal to report to Governor on whether Medi-Cal prices are higher than prices for federal programs.
• SB1405 (Soto), which creates a Task Force on Reimbursement for Language Services to recommend actions for achieving linguistic access to care. Sponsored by Asian Pacific Islander American Health Forum, California Pan-Ethnic Health Network, California Primary Care Association, and Latino Coalition for a Healthy California, eighteen groups tesified in favor of this effort.
• SB1622 (Escutia), sponsored by the Mexican American Legal Defense and Education Fund, which would give employers a notice to be passed along to employees, advising them of the availability of Healthy Families and Medi-Cal.
• SB1702 (Perata/Nunez), supported by a range of senior, health, and consumer groups, which would allow California to use its purchasing power to negotiate discounts for prescription drugs for uninsured and underinsured Californians.

Health insurers were able to defeat two bills sponsored by the California Medical Association, and supported by consumer groups. Neither bill got the needed 8 votes from the committee:

• SB1591(Kuehl) would have allowed the Insurance Commissioner to turn down health insurance products that did not provide economic value to consumers, such as with unacceptable medical loss ratios. The bill got 7 votes from Democratic Assemblymembers, but did not get the votes of Democratic Assemblymembers Frommer, Montanez, and Negrete-McLeod or any Republican.
• SB1804 (Florez) would have required health insurers to disclose the number of physicians accespting patients on a county-by-county basis. The measure only got 6 votes.

Labels: Updates

posted by Anthony Wright | Permalink | 9:38 PM


 

Tuesday, June 27, 2006

SAN FRANCISCO ANNOUNCES HEALTH EXPANSIONS

• Ammiano Ordinance Would Require Employer Contribution to Coverage
• Newsom Proposal Would Set Up Health Access Program

This past week, the City and County of San Francisco announced pending policy changes that would expand access to health care to 82,000 uninsured residents. However, crucial elements have yet to be finalized, with major actions anticipated in the next few weeks.

While the conversation about expanding health care coverage seems stalled at the federal level, it is active at the state level with live proposals on everything from expanding children’s coverage programs to establishing a universal system in California . There is also strong support for health reform at the local level.

Because San Francisco voted over 70% for Proposition 72 in 2004, which would have expanded employer-based coverage, local consumer, community and labor activists have been pressing for universal coverage in that county.

The San Francisco effort includes two distinct components:

OF WORKER HEALTH CARE SECURITY ORDINANCE: The effort to expand health coverage in San Francisco actually started last year, when Supervisor Tom Ammiano proposed a employer mandate to provide health coverage to their workers, and community advocates started to consider a county ballot measure, given the success of Proposition 72.

Supervisor Ammiano’s "Worker Health Care Security Ordinance" is seen by advocates as an essential complement to the Health Access Program (described below). Similar to Proposition 72, Supervisor Ammiano’s ordinance would set a dollar standard for health benefits on the job, just as the minimum wage does for pay. This standard would require businesses to pay a percentage of the cost of health care coverage. It would apply to businesses with 20 or more workers, or nonprofits with 50 or more workers, and would expand coverage to over 16,000 San Franciscans, while also protecting the coverage of San Franciscans who already depend on employment based coverage.

SF HEALTH ACCESS PROGRAM: Mayor Gavin Newsom announced the "San Francisco Health Access Program" a week ago, unveiling the work of an over 40-member Universal Healthcare Council that had been meeting for the last several month. Administered by the existing San Francisco Health Plan, this new program is available for all uninsured SF residents, regardless of income, immigration status, or pre-existing conditions. People would join through their employer, or as individuals. In this way, it would be one of several options for employers that fall under the Worker Health Care Security Ordinance.

It is not traditional health insurance--and it does not guarantee "all medically necessary care," but would still provide a comprehensive set of benefits, including preventative, inpatient and outpatient services, prescription drugs, and other treatments. These benefits would provide a medical home, but would only be provided in San Francisco , through San Francisco 's public health infrastructure and other participating San Francisco health providers.

(This San Francisco effort is not related to the consumer advocacy group Health Access California, other than that the advocacy group has been a supporter, working alongside key local groups such as Senior Action Network, the San Francisco Central Labor Council, ACORN, San Francisco Organizing Project, California Women's Agenda, and many others.)

COMPLEMENTARY EFFORTS: If these elements come together in the next few weeks, the combination of the two efforts would give uninsured San Franciscans access to a broad range of primary, preventive and inpatient health services at a lower cost than they would otherwise pay, while giving employers a more affordable option for providing access for their workers.

All San Francisco workers would get more security with regard to their coverage, some would have new coverage, and all San Franciscans would have better access to health care services. The package could also provide a funding source to reimburse city clinics and hospitals for care they are already providing to the working uninsured, thereby shoring up the City’s health care safety net.

UNIQUE CIRCUMSTANCES: This activity in San Francisco has been possible due to several factors, some unique to San Francisco . This includes the political environment in the city, including the support for Proposition 72, and the leadership of key political and community leaders. The fact that San Francisco is both a city and a county has permitted consideration of a range of policy options that are not easily accomplished in other localities.

Most importantly, San Francisco has a public health infrastructure, including hospitals, clinics, and other health providers, that has substantial public support and that is better funded proportionately than the county hospitals and clinics in most other California counties. Because San Francisco has invested in health care, it is easier to build on previous policies, such as San Francisco ’s program to cover all children. It also provides the economic basis for the policy change: given that San Francisco has already made the commitment to provide care to the uninsured through public health providers (rather than letting them go without care), it makes financial sense to provide better coordination of care.

MOMENTUM: San Francisco ’s action should provide momentum to efforts—in other counties, cities, and the state—in the area of health reform and expanding access to care. Already, the City of Oakland and the County of San Mateo are investigating what health reforms they might pursue. With recent employer requirements passed in other localities around the country (most recently in New York City and neighboring Suffolk County ), it helps advance the national discussion. It will help frame the emerging debate in California ’s gubernatorial race on health reform.

ACTIONS: The votes on these items will be held in short order. Health, community, and labor groups are urging CALLS TO MAYOR GAVIN NEWSOM, 554-6141 or 554-7111 to support the Worker Ordinance. (Also E-mail at gavin.newsom@sfgov.org) While nine Supervisors have expressed their support for the measure, calls to express support would also be appreciated.

There was a hearing yesterday, Monday, June 26th, but a committee vote is expected next week.

For more information, feel free to call Pilar Schiavo at the San Francisco Central Labor Council for more information at (415) 440-4809.

CALENDAR:

• Monday, July 5th: Vote and Final Report on both the Health Access Program and the Worker Healthcare Security Ordinance, by the Budget and Finance Committee, at the Board Chambers in San Francisco City Hall .
• Tuesday, July 11th: First vote by County Supervisors .
• Tuesday, July 18th: Second vote by County Supervisors
• Friday, July 28st: Deadline for the Mayor to sign or veto the measures.

Labels: Updates

posted by Anthony Wright | Permalink | 9:31 PM


 

Monday, June 26, 2006

BUDGET WRITERS NIX CHILDREN’S COVERAGE EXPANSION

• Republican legislators win in removing extra dollars for children’s coverage
• Key bills of interest to health advocates in committees this week

Legislative leadership and Governor Arnold Schwarzenegger, announced earlier today that they had come to a deal on a state budget. Eager to pass a budget on time this year, they gave up on the fight to expand children’s coverage, one of the sticking points with Republican legislators. Since a budget requires a two-thirds vote, Republican legislators were able to hold up the budget on this issue.

A budget vote is expected as early as Tuesday, June 27th.

Republicans from both houses had been fuming over $23 million, which had been added by Gov. Arnold Schwarzenegger in his May Revise, to cover about 24,000 children who were awaiting coverage through their local county "Healthy Kids" initiatives. This money is no longer is the budget.

Last week, Republicans had succeeded in getting Democrats to abandon a plan that would have expanded Healthy Families to *all* children living in families with incomes below 300 percent FPL ($60,000 for a family of four) beginning in 2008. Also opposed by Governor Schwarzenegger, that plan was slated to cost $1.8 million this year and expand over the next few years. Both efforts included covering all children, including undocumented children, which make up around 12% of the uninsured children in the state.

Legislative leaders said they would try to revisit the issue of children's coverage when the Legislature returns from its July recess.

KEY BILLS UP THIS WEEK

Committees will be packed again this week before lawmakers skip town for their summer break.

Below is a listing of bills that are supported by Health Access California and many other health and consumer advocates, and the support in before and during the hearings are crucial. This includes bills on hospital overcharging, prescription drugs, language access, Medicare Part D, health insurance access, and other key issues.

ASSEMBLY HEALTH COMMITTEE, TUESDAY, 6/27/06

• SB452 (Alarcon): Requires Medi-Cal to report to Governor on whether Medi-Cal prices are higher than prices for federal programs.
• SB1405 (Soto): Creates a Task Force on Reimbursement for Language Services to recommend actions for achieving linguistic access to care.
• SB1591(Kuehl): Allows Insurance Commissioner to turn down health insurance products with unacceptable medical loss ratios.
• SB1622 (Escutia): Gives employees a notice to be passed along to employees, advising them of the availability of Healthy Families and Medi-Cal.
• SB1702 (Perata/Nunez): Establishes a prescription drug discount program.
• SB1804 (Florez): Requires health insurers to disclose the number of physicians accespting patients on a county-by-county basis.

SENATE HEALTH COMMITTEE, WEDNESDAY, 6/28/06

• AB71 (Chan): Establishes a clearinghouse for information about the safety and effectiveness of prescription drugs that are advertised on television.
• AB774 (Chan): Provides consumer protections against abusive hospital billing and collections practices, including those that charge uninsured patients multiple times what insurers pay for the same service.
• AB1971(Chan): Extends the MRMIP program for uninsurable Californians with "pre-existing conditions."
• AB2170 (Chan): Creates a consumer report card on Medicare Part D prescription drug plans.
• AB2377 (Chan): Assists counties in extending health coverage to children.
• AB2667 (Baca): Allows the state to monitor Part D prescription drug plans in the same way it monitors health plans.
• AB2889 (Frommer): Prohibits health plans from discriminating against people who have been insured, but who have chronic or serious illnesses in certain instances.
• AB2911 (Nunez/Perata): Establishes a program to allow the state to negotiate for prescription drug discounts for uninsured and underinsured Californians.

For information on the state budget or legislation, please contact Hanh Kim Quach, policy coordinator, Health Access 916.497.0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 9:21 PM


 

Wednesday, June 21, 2006

BILL TO PROTECT CONSUMERS AGAINST HIGH DEDUCTIBLE PLANS FAILS

• Senate committee fails to place oversight over high-deductible plans
• Children’s coverage still at issue in budget talks
• Other updates on: coverage for those with "pre-exisitng conditions", clinical trials, Part D

It’s been a busy and disappointing week for health advocates in the Legislature as the fiscal year draws near – with still no resolution on the budget – and lawmakers’ summer break looming. Many bills on health coverage, Medicare Part D, prescription drugs, and other matters passed. However, two significant consumer-oriented bills: one on out-of-pocket costs, another on disclosure of clinical trials for prescription drugs, failed in committee.

SENATE COMMITTEE KILLS KEY CONSUMER PROTECTION BILL

Senators in the Banking, Finance and Insurance committee today failed to pass AB977, which would have limited annual out-of-pocket expenses and created a stricter approval process for new health coverage plans.

The bill received only two votes, from Sens. Gloria Romero and Dean Florez. The remaining members of the caucus abstained, including Chairwoman Jackie Speier, Sens. Alan Lowenthal, Mike Machado, Kevin Murray, Gloria Romero and Jack Scott. Republicans Senators voted no.

The bill was heavily opposed by the HMOs and insurance industry. Lawmakers seriously considered the insurance industry’s warnings. The top argument circulated by insurers was that tighter scrutiny of new health coverage products would “limit consumer choice’’ and leave more people uninsured because coverage would be unaffordable.

From a consumer advocate’s perspective, though, without AB977 consumers are condemned to a “choice’’ of bad products.

Consumer advocates argued that high-deductible plans hardly undergo any public scrutiny, as do other policies that impose significant out-of-pocket costs on consumers. While the premiums on these plans may be less expensive than comprehensive coverage, they are expensive to use – requiring high deductibles, with co pays and co-insurance. For practical purposes, it’s not really insurance if enrollees are afraid to use their health plan because of the costs, if the patient doesn't get the care they need, if the family is still at risk of bankruptcy.

Sen. Kevin Murray stated that "I don't know that I have a problem with the ability of someone to offer that [high-deductible] product." Sen. Jack Scott said he didn't like the idea of ceding any regulatory control or authority to the Department of Managed Health Care, which he argued was notoriously slow at enacting laws. Such inaction amounts to no improvement.

Committee chairwoman Jackie Speier suggested that more information was needed, and suggested that Assemblyman Pedro Nava convert his legislation to a “study’’ of all the plans Department of Insurance and Department of Managed Health Care has approved, including the amounts of co-pays, deductibles and other out-of-pocket costs. Such information is hard to obtain. Incidentally, Health Access sponsored such a bill in 2004 – AB2289 by Assemblywoman Wilma Chan. That bill was vetoed by Gov. Arnold Schwarzenegger.

As more and more Californians become underinsured, finding themselves with more out-of-pocket costs shifted to them by employers and insurers, this will continue to be an issue.

HIGH-RISK POOL BILL MOVES ON, BUT MORE DEBATE TO COME

The Senate Insurance Committee cautiously agreed today to pass AB1971 (Chan), which would extend the Managed Risk Medical Insurance Program (MRMIP), which covers patients with “pre-existing conditions’’ unable to get coverage elsewhere. Saying that much more work needed to be done, Sen. Jackie Speier urged that a conference committee to continue work on the bill.

The Graduate Insurance Program pilot allows Californians with “pre-existing conditions’’ who have been insured by the state to move off the state MRMIP program to a private insurer. The program currently enrolls about 12,000 patients.

But one of big problems is that many more Californians--possibly ten times or more--need such coverage. Additionally, the coverage is capped at $75,000 a year.

Blue Cross has also opined that it insures a disproportionate number of the difficult-to-insure in this program, losing $13 million a year. (While Blue Cross is correct that it has largest share of this market, it should be noted that former CEO Leonard Shaeffer reportedly received $330 million from the Wellpoint-Anthem merger – enough to cover this loss for 25 years.) In some other states, insurers pay a tax that helps to subsidize the high-risk patients that live in the state.

Insurers uniformly opposed AB1971, which would extend the program, and require those insurers that do not offer plans without regard to pre-existing conditions--known as "guaranteed issue"--to pay a fee to support this program. All insurers were opposed to the bill, but they did not agree on one alternative.

They agreed that this program needs to be fixed, and many admitted they needed to pay some assessment. Questions remain include: How much is the insurer assessment? How is it determined? What segments of the market will the assessment be levied on -- just individual insurance? Or large and small group markets as well?
While the Senate Insurance committee passed AB1971 Wednesday, the bill will likely return for conference committee hearings in August to answer these questions.

BILL REQUIRING PUBLIC DISCLOSURE OF CLINICAL TRIALS FAILS

The Assembly Health Committee yesterday killed SB163 (Scott), which would require drug companies to make results of their clinical trials publicly available.
Assemblymembers Juan Vargas of San Diego and Leland Yee of San Francisco did not vote for the measure, which would have forced Merck to disclose the dangers of its drug Vioxx, which has since been pulled off the market.

OTHER KEY HEALTH BILLS PASS KEY COMMITTEES

Despite some setbacks, other key bills passes important policy committees, although some of these bill are double-referred, and will be considered in other policy committees in the next week or so. Those bills heard and passed today included:

• AB1840 (Horton): Requires the state to disclose names of employers who, rather than providing health coverage, have many of their workers and their families on Medi-Cal and Healthy Families. Despite opposition from the Restaurant Association and the Agua Caliente tribe, labor and consumer groups were able to pass this measure in Senate Insurance.
• AB2877 (Frommer): Establishes a website listing sources that are safe for purchasing more affordable drugs from other countries. Despite opposition from the drug companies, this measure passed Senate Health.
• AB2377(Chan): Assists counties in extending coverage to children. Passed Senate Insurance.
• AB1948 (Montanez): Simplifies the application for Medi-Cal and Healthy Families using the CHDP Gateway and electronic applications. Passed Senate Health.
• AB2889 (Frommer): Prohibits health plans from discriminating against people who have been insured, but who have chronic or serious illnesses. Passed Senate Insurance.
• AB2667 (Baca): Allows the state to monitor prescription drug coverage plans in the same way it monitors health plans and weed out bad apples. Passed Senate Insurance.
• AB2170 (Chan): Creates a consumer report card on Medicare Part D prescription drug plans. Passed Senate Insurance.

EXPANSION OF CHILDREN’S COVERAGE CAUGHT IN POLITICS

Hopes of a smooth budget passage this year were abruptly dashed when Republicans raised issue with $24 million – about .02 percent of the entire state spending plan.

The piece that most ignited Republican anger was a lean $1.8 million – added in by Assembly Democrats – that would start the process of expanding the Healthy Families program to children in families earning less than 300 percent federal poverty level beginning 2008.

On Monday, at the Sacramento Press Club lunch, Senate President Pro Tem Don Perata announced that Senate Democrats would concede the $1.8 million in the budget to expand Healthy Families. He promised to have the issue dealt with in legislation, and noted that a statewide child coverage expansion will be considered this fall on the ballot, as one part of a pending tobacco tax initiative. That initiative was officially qualified yesterday, which would raise the tobacco tax by $2.60 and use the money, among other things, to fund a statewide expansion of health coverage to all children.

Howeber, upon further inspection, Republicans also decided they didn’t like the $22 million originally proposed by the governor. In his May Revise, Gov. Arnold Schwarzenegger augmented spending by County Health Initiatives, which provide health care to children who otherwise wouldn’t qualify for Medi-Cal or Healthy Families. These children are in families earning up to 300 percent of poverty ($60,000 for a family of four) and may or may not be citizens.

Schwarzenegger has already said – on several occasions – he believes *all* children need health coverage, whether they are legal or illegal. This directly contradicts the position of Legislative Republicans.

As of this writing, a range of advocates representing children, people of faith, business, and others are continuing to urge legislators, Democrats and especially Republicans, to support this "bridge" funding for these county efforts.

THE WEEK AHEAD

Next week also promises to be a busy week in the Legislature. While not a comprehensive list, bills to be heard include:

IN ASSEMBLY HEALTH ON TUESDAY, JUNE 27TH

• SB1591: Would set rules on the profit and overhead for health insurers.
• SB452: Requires Medi-Cal to report to Governor on whether Medi-Cal prescription drug prices are higher than prices for federal programs.
• SB1622: Gives employers a notice to be passed along to employees, advising them of the availability of Healthy Families and Medi-Cal.
• SB1405: Creates a Task Force on Reimbursement for Language Services to recommend actions for achieving linguistic access to care
• SB1702: Establishes a discount prescription drug program.
• SB1804: Requires health insurers to disclose the number of physicians accepting new patients on a county-by-county basis

IN SENATE HEALTH ON WEDNESDAY, JUNE 28TH

• AB2607: Provides consumer protections if seniors and people with disabilities in Medi-Cal are placed into managed care.
• AB2911: Establishes a discount prescription drug program.
• AB71: Establishes a clearinghouse for information about the safety and effectiveness of prescription drugs that are advertised on television
• AB774: Provides consumer protections against abusive hospital billing and collections practices, including those that charge uninsured patients multiple times what insurers pay for the same service.

For information on any of these bills or topics, please contact Hanh Kim Quach, policy coordinator, at hquach@health-access.org or (916)497-0923 x 206.

Labels: Updates

posted by Anthony Wright | Permalink | 9:02 PM


 

Friday, June 16, 2006

BUDGET BLUES: CHILDREN'S COVERAGE IN SPOTLIGHT

• Republicans legislators hold up state budget over funding to insure children.
• ACTION ITEM: AB977 to limit out-of-pocket expenses on health insurance to be heard next week.

The predictions were too good to be true: an extra $7.5 billion, an on-time budget. June 15th, the constitutional deadline for the Legislature to pass a budget, has come and gone without one.

CHILDREN’S HEALTH COVERAGE

Since the budget needs to be passed by a two-thirds vote, it is often the case that the budget is held up. Even if the Democratic majorities are unanimous in their support, the budget would still require two Republican Senators and six Republican Assemblymembers for passage. Often, the Republicans hold out their votes for changes to the final document.

Republicans, this year, say they cannot support the budget because of a provision that amounts to .02 percent of the entire state spending plan.

Their beef: $1.8 million that would go toward the goal of providing health coverage to all California ’s children. That includes children of undocumented immigrants.

The specific proposal includes $23 million that Gov. Arnold Schwarzenegger set aside in his May Revise to provide coverage to 24,000 children on waiting lists at County Health Initiatives, often called Healthy Kids programs.

The additional proposal, which has Republicans up in arms, is $1.8 million that would fund seven state staff members to work toward the goal covering all children under the statewide Healthy Families program.

Beginning July 1 2007, children in families with incomes of up to 275 percent FPL ($55,000 for a family of four) would be qualified for Healthy Families. The following year, children in families earning up to 300 percent FPL ($60,000 for a family of four) would qualify for the state subsidized health program.

At issue is that toward the goal of covering *all* children, this may include children that are undocumented. Of the nearly 800,000 uninsured children, roughly 88% are citizens or holders of green cards.

Many of the statements critiquing this proposal are simply false. Sen. Dennis Hollingsworth is quoted in a press release as saying that the proposal would “ultimately provide comprehensive health insurance for all illegal immigrants…."

The truth is, both the governor’s original $23 million proposal, and the Healthy Families extension applies to only children, a fraction of whom may be undocumented.

While Schwarzenegger Republican colleagues blast coverage for undocumented children, the governor has, himself, supported the idea--even if he didn't want to fund it.

KQED reporter Jon Myers asked Schwarzenegger Thursday about the issue of undocumented children, to which Schwarzenegger responded:

"For me, we should not politicize the children," he said, as reported by Myers in his blog. But then, he went further. "Every child, if they are here legally or illegally, every child should have the right to some health care and to schooling. That's where I'm coming from."

He did however, state that he did not support the $1.7 million to start a full Healthy Families, because of budget concerns, despite his campaign pledge. When running for governor during the recall election in 2003, Schwarzenegger said, "We have to make sure that every child in California is insured. That is the most important thing."

The status of the budget, and the children's coverage provisions, are uncertain as of this writing.


ROUND TWO FOR AB977 – BILL TO LIMIT OUT-OF-POCKET COSTS AND ROGUE "BARE BONES" PLANS IN SENATE COMMITTEE NEXT WEEK

A recently strengthened AB977 (Nava) will be vetted in the Senate Banking, Finance and Insurance Committee on Wednesday, June 21st.

As recently amended, AB977 would require that health plans have overall limits on annual out-of-pocket costs. Additionally, it would create a new process for obtaining state approval for health coverage plans, and their out-of-pocket cost strutures.

This is an attempt to have some public oversight over the trend of insurers and employers continuing to shift the cost and burden of health care to patients and families. Insurers are attempting to shift more costs onto their policyholders, leaving patients at financial risk. Consumers need public oversight to prevent health plans for imposing so many costs that people are not able to get the care they need. It's not insurance if you can't get the care you need. It's not insurance if you still end up going bankrupt.

Under the bill, the Department of Insurance and Department of Managed Health Care would need to come up with five standardized health benefit plans, so that purchasers can better compare what is available to them. Insurers who wish to submit products that match one of these health benefit plans would go through a predictable regulatory process.

However, insurers who want to alter these plans -- or create their own -- would need to seek a higher level of approval. That would include a 60-day public comment period, during which there could be hearings. Additionally, regulators would review and could deny certain plans as they consider the plan's out-of-pocket costs and their impact on:

• Bankruptcy
• Homelessness
• Increased cost to public programs;
• High out-of-pocket costs;
• An enrollee delaying care;
• An enrollee becoming sicker because of delayed care;
• An enrollee’s ability to obtain timely care.

ACTION ITEM: Contact members of the Senate Banking, Finance and Insurance Committee and urge their support on AB977.

For sample letters, fact sheets, talking points or other materials on AB977, please contact Hanh Kim Quach, policy coordinator at Health Access, 916.497.0923 x 206 or hquach@health-access.org.

Members on the Senate Banking, Finance and Insurance committee include:

Sen. Jackie Speier, Chair
Senate Banking, Finance and Insurance Committee
State Capitol, Room 2032
Sacramento , CA 95814
916.651.4008; Fax: 916.327.2186

Sen. Dave Cox, Vice-Chair
Senate Banking, Finance and Insurance Committee
State Capitol, Room 2068
Sacramento , CA 95814
916.651.4001; Fax: 916.324.2680

Sen. Dean Florez
Senate Banking, Finance and Insurance Committee
State Capitol, Room 5061
Sacramento , CA 95814
916.651.4016; Fax: 916.327.5989

Sen. Alan Lowenthal
Senate Banking, Finance and Insurance Committee
State Capitol, Room 3048
Sacramento , CA 95814
916.651.4027; Fax: 916.327.9113

Sen. Mike Machado
Senate Banking, Finance and Insurance Committee
State Capitol, Room 5066
Sacramento , CA 95814
916.651.4005; Fax: 916.323.2304

Sen. Kevin Murray
Senate Banking, Finance and Insurance Committee
State Capitol, Room 5050
Sacramento , CA 95814
916.651.4026; Fax: 916.445.8899

Sen. Gloria Romero
Senate Banking, Finance and Insurance Committee
State Capitol, Room 313
Sacramento , CA 95814
916.651.4024; Fax: 916.445.0485

Sen. Jack Scott
Senate Banking, Finance and Insurance Committee
State Capitol, Room 2082
Sacramento , CA 95814
916.651.4021; Fax: 916.324.7543

For information on the state budget or AB977, please contact Hanh Kim Quach, policy coordinator, Health Access 916.497.0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 10:48 AM


 

Monday, June 12, 2006

KEY HEALTH BILLS HEAD TO POLICY COMMITTEES IN NEXT FEW WEEKS

• Bill Hearings Scheduled for Bills to Limit Hospital Overcharging, Out-of-Pocket Costs, Drug Prices

Health advocates are actively working on the following bills, which includes efforts to expand health care coverage and provide consumer protections for patients.

Also listed is where the bills are in the process and the position of Health Access California, the statewide health consumer advocacy coalition working for the goal of quality, affordable health care for all.

Health Care Coverage

Major Coverage Expansions

• SB437 (Escutia) Expands Public insurance programs to provide comprehensive health coverage to ALL children. Strong Support. On Assembly Floor
• SB840 (Kuehl) As the California Health Insurance Reliability Act, creates a universal, publicly-financed (single-payer) health care system, similar to Medicare. Strong Support. Awaiting Assembly Committee assignment.

Related Legislation on Access and Coverage

• AB1840 (Horton) Requires the state to disclose names of employers who, rather than providing health coverage, have their workers and their families on Medi-Cal and Healthy Families. Support. Awaiting Senate committee assignment
• AB1948 (Montanez) Creates a feasibility study on simplifying application for Medi-Cal and Healthy Families using CHDP Gateway and electronic application. Support. Awaiting Senate committee assignment
• AB1971 (Chan) Extends the sunset for the Managed Risk Medical Insurance Program (MRMIP), which covers patients with “pre-existing conditions” unable to get coverage elsewhere. Support. Awaiting Senate committee assignment.
• AB2889 (Frommer) Prohibits health plans from discriminating against people who have been insured, but who have chronic or serious illnesses in certain instances. Support. Awaiting Senate committee assignment.
• SB1448 (Kuehl) Expands coverage using money from state's federal hospital waiver. Support. Assembly Health 6/20/06
• SB1622 (Escutia) Gives employers a notice to be passed along to employees, advising them of the availability of Healthy Families and Medi-Cal. Support. Awaiting Assembly committee assignment.

Consumer Protections Against Medical Debt

Hospital Overcharging of Uninsured Patients

• AB774 (Chan) Provides consumer protections against abusive hospital billing and collections practices, including those that charge uninsured patients multiple times what insurers pay for the same service. Support/Sponsor. Senate Health 6/21/06

Underinsurance and High-Deductible Health Plans

• AB977 (Nava) Allows the state to regulate out-of-pocket costs for consumers covered by HMOs and health insurers. Support/Sponsor. Senate Banking 6/21/06

Affordable Prescription Drugs

• AB75 (Frommer) Would establish a prescription drug discount program, to use the purchasing power of the state of California (through its Medi-Cal program) to negotiate the best possible drug prices for 8-10 million Californians who are uninsured or underinsured. Support. Senate Health (no hearing set)
• AB2911 (Nunez/Perata) Establishes a prescription drug discount program. Support. Awaiting Senate committee assignment.
• SB1702 (Perata/Nunez) Establishes a prescription drug discount program. Support. Awaiting Assembly committee assignment.
• AB2877 (Frommer) Establishes a website listing sources that are safe for purchasing more affordable drugs from other countries. Support. Awaiting Senate committee assignment.
• SB452 (Alarcon) Requires Medi-Cal to report to Governor on whether Medi-Cal prices are higher than prices for federal programs. Support. Assembly Health 6/13/06.

Patient Protections

Prescription Drug Safety

• AB71 (Chan/Frommer) Establishes a clearinghouse for information about the safety and effectiveness of prescription drugs that are advertised on television. Support. Senate Health 6/14/06.
• SB163 (Scott) to require pharmaceutical companies to report the results of their clinical trials. Support. Assembly Business and Professions 6/20/06.

Medicare Part D Consumer Protections

• AB2170 (Chan) Creates a consumer report card on Medicare Part D prescription drug plans. Support/Sponsor. Awaiting Senate committee assignment
• AB2667 (Baca) Allows the state to monitor prescription drug coverage plans in the same way it monitors health plans. Support/Sponsor. Senate Banking 6/13/06.

Insurance Oversight and Other Patient Protections

• SB1405 (Soto) Creates a Task Force on Reimbursement for Language Services to recommend actions for achieving linguistic access to care. Support. Awaiting Assembly committee assignment
• SB1591 (Kuehl) Would limit profit and overhead for health insurers. Would also penalize those that went above the limits. Support. Awaiting Assembly committee assignment.
• SB1704 (Kuehl) Extends the sunset for the existing California Health Benefits Review program to 2010. Support. Awaiting Assembly Committee assignment.
• SB1804 (Florez) Requires health insurers to disclose the number of physicians accepting new patients on a county-by-county basis. Support. Awaiting Assembly committee assignment.

Bills that died

While most bills survived, health advocates lost two significant pieces of legislation this year.

• AB2281 (Chan) Would have limited annual out-of-pocket expenses to $5,250 for an individual and $10,500 for family. It died on the Assembly floor on a 38-36 vote.
• SB1683 (Scott) Would have required pharmaceutical companies to report the results of their clinical trials. This did not make it off the Senate suspense calendar.

Below are other bills that were opposed by health advocates did not move, including bills that would have threatened consumer health coverage. Those bills are:

• AB1952 (Nation) Would have required individuals and employers to purchase health coverage.
• AB2450 (Richman) Would have obligated every Californian to purchase a skeletal health coverage plan.
• AB2473 (Wyland) Would have required personal identification for any kind of state-funded health care benefit.
• AB2855 (Parra) Would have allowed fraudulent “discount health plans” to operate without consumer protections.
• AB2010 (Plescia) Would have allowed holders of Health Savings Accounts to receive a tax credit in California .
• AB2737 (Nakanishi) Would have given businesses tax breaks if they contribute to employees’ Health Savings Accounts.
• SB1584 (Runner/Ackerman) Would have allowed holders of Health Savings Accounts to receive a tax credit in California .
• SB1639 (Dutton) Would have given businesses tax breaks if they contribute to employees’ Health Savings Accounts.

For more info, go to the Health Access webpage at http://www.health-access.org.

For questions or an updated list, contact our policy coordinator Hanh Kim Quach, at 916-497-0923 ext. 206, hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 10:35 AM


 

Sunday, June 11, 2006

BUDGET CONFERENCE COMMITTEE APPROVES KEY CHILD COVERAGE EXPANSIONS

• County programs for children's coverage funded for waiting lists; Goal of universal coverage by 2008
• Other items: $10 million for trauma care; some language on new Medicaid documentation
• Not in budget: provide rate increase, Part D co-payments, etc.

The Budget Conference Committee, chaired by Senator Wes Chesbro and Assemblyman John Laird, is finished up its final meeting, closing out its work crafting the state budget for 2006-07. Of particular note, the conference committee voted to include funds to expand county programs for children's coverage, and to start the administrative actions needed to expand state programs to cover all children up to 300% of the federal poverty level by 2008.

CHILDREN'S COVERAGE APPROVED, DEBATED

Assemblyman John Laird described a compromise between the Assembly and Senate budgets with regards to children's coverage. "Basically, the compromise sets a goal for 2008 in funding health insurance for all kids in California... For this year, except for a small amount of money to help the Administration set up some of the infrastructure, this basically takes the Governor's proposal of the $22 million to support the existing counties in their programs." The Senate originally only had the Governor's proposal; the Assembly had budgeted twice as much for county programs, and included money to start planning an expansion to all children.

In addition to $22,783,000 to fund the exisiting county "Healthy Kids" programs, the Conference Committee compromise proposal does fund seven administrative positions, at $1,880,000, to start the implementation of a full Healthy Families expansion. It would extend eligibility to *all* children up to 275% of the federal poverty level effective July 1, 2007, and up to 300% (roughly $49,800 for a family of three) effective July 1, 2008.

Assemblyman Laird also explained that "there's also a mechanism in this that if the voters approve the tobacco tax measure, it stands back... and defers to that measure." A $2.60 tobacco tax measure is slated for the November 2006 ballot that would fund universal children's coverage, among other health items.

The Republicans on the committee both raised objections. Assemblyman Rick Keene urged that this item not be considered in the conference committee, given the policy issues, "Are we going to start providing health care for children of illegal immigrants, and are we going to provide health care for people that are in that wage rate[$40-50K] and above? Those are very serious policy concerns."

Assemblyman Laird responded: "We are talking about the fundamental point, that right now we budget for a whole host of health programs in this state... It is appropriate for us budgetarily to be prudent and rearrange the money; if providing every kid with health care means we spend less on emergency room visits or ongoing care because prevention is done, that over time that might be the cheaper thing... but that might also the most humane thing."

Republican Senator Hollingsworth raised his concerns more directly, saying that this is "an another incentive for illegal immigration... you need to know that this is a very large issues for our caucues. This was not the same as the Governor's May Revise proposal; that was bad enough. This is [a] much larger issue, much larger cost, and just not the right thing to do."

Assemblyman Laird also responded, focusing on the fact that the proposal was geared to cover *all* children. "If the facts were as Mr. Hollingsworth described, I might have trouble with the program: This does not single out only illegal immigrants for health insurance, it applies to anybody [up to] 300% of the federal poverty level."

The Conference Committee approved the compromise language on a 2-1, 2-1 vote, with Democrats supporting and Republicans opposing. Governor Schwarzenegger's Administration also indicated that they did not support the compromise, prompting Budget Committee Chair Wes Chesbro to comment that "we have more work to do." It is likely this item will continue to be a discussion point as the budget moves through the process.

OTHER ITEMS DISCUSSED

Other actions by the Budget Conference Committee of note for health advocates:
* TRAUMA CARE: The committee funded trauma care by $10 million, a compromise between the Senate and Assembly, on a party line vote. The item includes budget trailer bill language that the money goes away if the above-mentioned tobacco tax measure is passed (which would provide greater funds for hospitals in general).
* MEDI-CAL MANAGED CARE RATES: The committee approved $48 million for Medi-Cal managed care rate adjustments, taking the more generous Assembly proposal, with some budget trailer bill language.
* HEALTH-E-APP INCENTIVE: Another compromise between the Senate and Assembly on children's coverage was on Healthy Families outreach and enrollment, allowing a $10 additional incentives (from $50 to $60) for certified application assisters (CAAs) who use the Health-E-App program.

ITEMS NOT DISCUSSED

DOCUMENTATION REQUIREMENTS: While it was not discussed, the conference committee is expected to include trailer bill language with regard to the new federal Medicaid documentation requirements. New guidance from the federal Centers for Medicare and Medicaid Services has just been released to implement these new provisions from the Deficit Reduction Act (DRA) passed earlier this year by Congress. The documentation requirements are seen as major barrier to coverage to the millions of both current and prospective Medicaid enrollees who are eligible, but simply may not be able to produce the documents required.

The state budget trailer bill language attempts to mitigate some but not all of the barriers raised by the federal requirements, allowing counties and others to provide leeway and assistance to those who will have trouble producing birth certificates, etc, especially where federal funds are available. However, the budget does not provide state funds to continue to cover these people who may be unfairly restricted from needed coverage or care because of this federal issue.

PART D CO-PAYS: The budget also does not include another major priority of health advocates, to cover the newly-imposed prescription drug co-payments on one million "dual-eligible" seniors and people with disabilities. These vulnerable patients, who are both Medi-Cal and Medicare, often taken 10 or more drugs, and are finding these co-payments a major cost on their very limited income. Neither the Assembly or the Senate responded to calls to cover these costs, and so it was not an item for discussion in the conference committee.

Another issue for health consumer advocates--increasing Medi-Cal provider rates, which are among the lowest in the nation--was also not in either budget and not discussed in conference committee.

NEXT STEPS

The Conference Committee approved a final budget, 2-1, 2-1, on a party line vote. The budget still needs to be approved by the full Assembly and Senate, by a two-thirds vote, and all items are still subject to change in that process. When a budget reaches the Governor's desk, he also has the ability to line-item veto budget items.

The Conference Committee's action is closing down their work is part of an effort to get the budget done "early" this year, attempting to make the June 15th deadline for the Legislature to pass a budget, a deadline that was last met two decades ago in 1986.

Labels: Updates

posted by Anthony Wright | Permalink | 10:32 AM


 

Wednesday, June 07, 2006

A POST-PRIMARY LOOK AT THE PROSPECTS FOR HEALTH REFORM

• Democratic nominee Angelides highlights health care in acceptance speech, goes after "HMO profiteers" and the goal to "extend coverage to every Californian."
• Governor Schwarzenegger speaks in rare comments on health issues during Q & A; commits to work for "health care for every citizen" as "the challenge for me for next year"
• Stark contrast on health reform issues for November
• Comments wanted: National citizens' working group preliminary recommendations

The race for governor now shifts to the November ballot, now that the primaries behind us. Both candidates, Gov. Arnold Schwarzenegger and Treasurer Phil Angelides, have mentioned health care reform is among the top priorities in the state. Both of their comments suggest a vigorous debate on health issues this fall, leading to major debate in 2007 about comprehensive health reform.

Health and consumer advocates, grassroots activists, and community members have been active in getting both statewide and legislative candidates to talk about health care issues. Below is a list from Health Access California of six suggested questions to ask any and all candidates running for office on key health issues:
http://www.health-access.org/advocating/healthqs.htm

A PRIMARY GOAL: ANGELIDES ON HEALTH
The primary campaign for the Democratic nomination focused more on negative attacks than on much on substantive issues. Education, taxes, and the environment gained more prominence than health care in the primary campaign debate.

That said, health care was not ignored. State Treasurer Phil Angelides stated that the uninsured need to be covered, and even supported the concept of a universal, single-payer system. In separate speeches to delegates at the Democratic convention and the California Chamber of Commerce, Angelides highlighted the importance of universal health care. Here’s what he told the Chamber of Commerce:

“I’m going to ask you to join me in forging a comprehensive health care plan for our state. Together, we’ve got to cover all children, so they go to school healthy and ready to learn; we’ve got to crack down on the HMO profiteering that jacks up premiums for businesses and workers; and we’ve got to move toward a universal health care plan that controls costs and makes us competitive in the global economy.”

Angelides also mentioned health care as an important issue Tuesday night in his victory speech, saying he would to go after "the HMO profiteers" and extend coverage to every Californians, as part of his vision of the "California Dream."

To see Angelides’ health care platform, click here:
http://www.angelides.com/issues/health.html

SCHWARZENEGGER SPEAKS ON HEALTH ISSUES

In contrast, Governor Schwarzenegger does not mention health care reform among the key issues that are part of his "vision" on his campaign website. He does list some health care items under his "good government" record, mostly spotlighting his work on obesity:
http://www.joinarnold.com/site/c.owL2KgN3LxH/b.1727873/k.741D/The_Record_Good_Government.htm

Yet there are signs that the Governor has begun to think about health issues seriously. Last week, Schwarzenegger told Sacramento State University students, at the end of a question-and-answer session, that his goal for 2007 (if re-elected) would be “to create health care for every citizen.” For a someone who has spoken very rarely on health issues, he showed surprising aptitude by noting that California was different than Massachusetts , especially in terms of the scale of the crisis with regard to the number of uninsured.

Here is a transcript of what the Governor Schwarzenegger said in response to a question on students graduating and needing health coverage, on the recently-passed Massachusetts proposal, and on state-based universal health care:

A. Well, as you know, it has been a huge struggle for years to get that done. And there have been different versions introduced, and it never got done because they were always maybe too extreme, one was too extreme in one way and one in another way. I think that's why when I came into office I said the most important thing, while we are debating that issue, the most important thing is that our children ought to be insured. That's why we expanded on the Healthy Families, we put more money into the Healthy Families program to reach out to kids. And that's why this year even, we put an extra 70 million plus into the budget to start a program where we can reach the other 400,000 kids that are eligible for the program to be insured, but we haven't reached yet, because for various different reasons. And so we are now trying to go out and reach those kids.

But while we are doing that, this year we are studying and working together with all the different groups in order to create health care, because I want to really go after that. This is the challenge for me for next year, to create health care for every citizen, because we still have 6.5, 7 million people in this state that are uninsured, and I think that we have to insure them. And I think that it's a big challenge, it's not going to be as easy as Massachusetts , because Massachusetts only had 700,000 uninsured, so we have 10 times as many.

But I think that we can really conquer that problem once and for all if everyone works together. It means that the employers have to put money in, I think that the employees have to put money in, and I think that the government has to put money in. I think that is those three entities work together I think that we can solve this problem.

Okay. Thank you very much, everyone, for listening. Thank you. (Applause)

These comments were first highlighted last week by KQED reporter John Myers in his "Capital Notes" blog, where he noted "The governor said he was currently studying the issue. And while it sounded like he favors something akin to an employer mandate program, it's important to remember that Schwarzenegger campaigned against a 2004 ballot measure that would have required large businesses to provide health insurance." The blog report is at:
http://www.kqed.org/weblog/capitalnotes/2006/05/guest-lecturer-schwarzenegger.jsp

A STARK CONTRAST

The Governor did actively campaign against Proposition 72, which resulted in the repeal of requirements for employer coverage, which would have expanded insurance to 1 million uninsured Californians and protected the coverage of millions more. In contrast, Treasurer Angelides actively supported and campaigned for Proposition 72.

Treasurer Angelides' website mentions other health issues that make a distinction between the two candidates. The Treasurer cites his opposition to the Governor's original 2003 budget proposals to cut access to health care for 100,000 California children, and the Administration's approval of a Wellpoint/BlueCross-Anthem merger, with including "excessive and obscene" executive bonuses.

Despite the clear record on health issues, Governor Schwarzenegger's comments last week suggested that the health care debate may get more interesting between the two candidates.

It is up to Californians who care about health care to insist that both candidates offer their detailed views on health reform, by asking questions in candidate forums, writing letters to the editor, and otherwise insisting that they address this urgent issue.

NATIONAL EFFORTS TOWARD UNIVERSAL HEALTH CARE

The effort to bring about a robust conversation on health care is not just at the state level. The Citizens’ Health Care Working Group, which has held forums across the country and solicited comments about health coverage, has released its interim recommendations. The six recommendations include:

1. That all Americans have affordable health care. This embraces the notion that increased taxes may have to be a part of the solution.
2. Defining a “core’’ benefit package, that includes preventive services, primary care, acute care, prescription drugs, education and disease management. Includes both physical, mental and dental health.
3. Guaranteeing protection against high health care costs – particularly high out-of-pocket costs.
4. Supporting integrated community health networks.
5. Promoting efforts to improve quality of care and efficiency.
6. Restructure end-of-life services are financed and provided.

To read more, pleave visit: http://www.citizenshealthcare.gov/recommendations/interim_recommendations.pdf

The public has until August 31st to comment on the interim recommendations. Public comments will be accepted online via email: citizenshealth@ahrq.gov, or snail mail at:

Citizen’s Health Care Working Group
Attn. Interim Recommendations
7201 Wisconsin Ave., Room 575
Bethesda , MC 20814

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 | 10:40 AM


 

Friday, June 02, 2006

BUDGET & LEGISLATIVE UPDATE: Conference Committee Reviews Proposed Health Budget

• Children’s health coverage and application reimbursements remain unresolved.
• Medi-Cal provider reimbursement rates stays the same; study to confirm insufficiency of CA rates
• BUDGET ACTION: Urge Conferees to support Assembly’s expansion of children’s coverage
• LEGISLATIVE UPDATE: Bill wrap-up as first half of session is over

The bicameral Budget Conference Committee Thursday made a first pass through the health items.

In contrast to earlier years during the height of the budget crisis, few health items are in conference committee this year since many were either resolved earlier in the budget subcommittees or were routed in the normal legislative process for policy bills. The discussion is described below, courtesy of Beth Capell, legislative advocate, Health Access California.

CHILDREN’S COVERAGE

The major health item discussed Thursday was children’s health coverage. While the committee has yet to act on the major elements, the debate helped shed further light on the thinking of the various parties involved. The Conference Committee is expected to take final action next week.

Assembly Budget Chair Laird, the major proponent of children’s coverage in the budget, explained how the Assembly proposal would expand Healthy Families to 300% FPL in three steps:

• First, in 06-07, it would do the administrative work necessary to support future expansions as well as both funding backlogs at the county level and allowing new counties to start up.
• In 07-08, it would expand eligibility to 275% FPL.
• In 08-09, it would complete the expansion by expanding eligibility to 300% FPL.

The Assembly proposal would NOT eliminate the existing provision that children ages 6-18 over 100% are covered by Healthy Families while those under age 6 are covered by Medi-Cal up to 133% FPL. Nor does the proposal implement the CHDP Gateway or the bridge.

It would cost about $300 million annually when fully implemented, but much less in the first year.

The proposal prompted a lively discussion.

The Legislative Analyst Office now maintains that we should “maintain the county obligation” to fund coverage and require counties to match any state or other dollars. No conferee concurred.
Assm. Keene said that this proposal should go through the normal policy process (neglecting to note that he had voted no on a prior policy bill, AB774 Chan/Escutia). Keene said that the proposal did two things he opposed: make eligible families making more than $60,000 a year and cover kids who are here illegally. He said these were policy issues where both sides felt passionately and had a right to be heard. Because of that, he felt uncomfortable taking action in the budget. While Keene several times referred to “illegal” kids, he was very careful to be respectful of those who support coverage for them.

From Laird’s perspective, though, it is absurd that children aren’t all covered yet, in light of the fact that California is "the wealthiest state in the wealthiest nation in the world." He also corrected Keene ’s misimpression that the Assembly Democratic proposal covered kids in families with incomes over 300% FPL. Laird said this was "a targeted investment" of eventually $300 million in $100 billion budget – approximately 3/10ths of one percent of California ’s budget -- that would save money on emergency rooms and preventive care and allow children to learn better.

Chesbro agreed that this was an investment and he said that in his district many parents cannot afford coverage and people with chronic conditions are often unable to obtain affordable coverage at any premium because of high out of pocket costs.

With that, the various items associated with this proposal were left open to be reconciled at a later time.

ACTION: Support Children’s Health Coverage in the State Budget Now!

Child and health advocates are urging the Conference Committee members to pass the Assembly version of the budget on children's coverage, especially the $5 million to start the administrative process to phase in coverage for all children. Please call the committee members (listed below) to ask them to support health insurance for California ’s kids:

• Support the Assembly version of Department of Health Services and Managed Risk Medical Insurance Board (MRMIB) issue #160, which would provide state resources to begin establishing a comprehensive health care program for children in families with incomes at or below 300% of the poverty level. The Senate took no action on this item.
• Support the Assembly version of MRMIB issue #128, which would provide a total of $40 million for local Children’s Health Initiative programs. This proposal was adopted as part of the health care coverage for all low-income children program. The Senate approved the Governor’s proposal of $22.8 million for these programs to enroll 24,000 children in 2006-07 with priority on programs that have established a waiting list to serve children.
  

Members of the Budget Conference Committee include:

• Senator Wesley Chesbro (D – Humboldt, Lake, Mendocino, Napa, Solano, & Sonoma counties), 916-651-4002
• Senator Denise Moreno Ducheny (D – Imperial, parts of San Diego & Riverside counties), 916-651-4040
• Senator Dennis Hollingsworth (R – parts of Riverside & San Diego counties), 916-651-4036

• Assemblymember John Laird (D – Santa Cruz ), 916-319-2027
• Assemblymember Judy Chu (D – Monterey Park (in LA County)), 916-319-2049
• Asemblymember Rick Keene (R – Chico ), 916-319-2003

Other legislators we urge you to contact on these issues include:

• Senate Democratic Leader Don Perata ( Oakland ), 916-651-4009
• Senate Republican Leader Dick Ackerman ( Irvine ), 916-651-4033

• Asembly Speaker Fabian Núñez ( Los Angeles ), 916-319-2046
• Assembly Democratic Floor Leader Dario Frommer ( Glendale ), 916-319-2043
• Assembly Republican Leader Plescia ( San Diego ), 916-319-2075

CERTIFIED APPLICATION ASSISTANTS: E-APPLICATIONS

The conferees had a lively discussion of whether those who use E-App should be paid an additional $25 per enrollee. The Assembly, LAO and Finance all supported doing so.

Sen. Ducheny said it was not fair to application assisters who did not have computers or were not on the internet. Sen. Ducheny also thought that if it were so much more efficient, then CAAs would use simply to do higher volume. The item was left open for the moment.

MEDI-CAL RATES: PROVIDER REIMBURSEMENT, MANAGED CARE RATES

On a number of other minor issues in which the Assembly had augmented in excess of the Senate, the conference committee adopted the Senate action. They also discussed one major issue, physician fees for service compensation which the Assembly had proposed to increase by $15 million.

Conferees had a lively discussion in which Keene pointed out that, taken in isolation, this was an important problem to correct, but that the problem needed to be looked at more broadly. (It was not entirely clear whether he was referring to Medi-Cal, health care or the budget more generally).

Sen. Ducheny responded that she and Sen. Cox had agreed to hold hearings in the fall on the larger issue of Medi-Cal funding in which she said California is 51st in the nation.

Conferees repeatedly expressed their frustration with low rates of Medi-Cal reimbursement for providers. Only Keene posed improving provider reimbursement as a tradeoff for limiting expansions of eligibility. In the end, the doctors did not get additional dollars but language requiring a study by DHS and a report back.

In a particularly memorable exchange Dept. of Finance cited the approximate backlog of 10,000 providers seeking Medi-Cal provider certifications as proof of physician interest in caring for Medi-Cal patients.

Sen. Ducheny on behalf of the six conferees retorted that she knew of no legislator who believed that physicians were happily accepting Medi-Cal reimbursement as adequate and Sen. Chesbro recounted how some physicians were forgoing Medi-Cal reimbursement entirely and just taking patients referred by a schoolteacher or a Catholic priest. Assemblymember Keene noted that physician reimbursement under Medi-Cal is less than their overhead.

On Medi-Cal managed care rates, most of these items were left open. Conferees expressed frustration about the existing rate setting process and the need to improve it. This will be a major focus in next year’s budget. Health Access and other advocates will also raise issues around access for enrollees and quality of care under Medi-Cal managed care. As those of us with commercial HMOs frequently experience lack of timely access, those covered by Medi-Cal have even greater difficulties.

LEGISLATIVE WRAP-UP FOR FIRST HALF OF YEAR

Both houses rushed to get bills out of their own houses by the constitutional deadline this week, passing many bills of interest to health advocates. Yet health advocates also lost some battles in the budget and legislature this year, including $76 million that would have provided 1.1 dually eligible seniors with coverage of their newly-imposed co-payments.
Below is a list of the status of key bills of interest to health consumer advocates. It includes the bill number, the bull author, whether it passed (and is alive, pending) or failed in the first house, the position of Health Access California, and a description of the measure:

Those bills that PASSED the first house this year, or are PENDING after having passed last year, now have to be heard in the second house. Most of these bills are up in policy committee in the next few weeks.

Health Care Coverage

Major Coverage Expansions

• SB437/ Escutia. PENDING. Strong Support. Expands public insurance programs to provide comprehensive health coverage to *all* children
• SB840/ Kuehl: PENDING. Strong Support. As the California Health Insurance Reliability Act, creates a universal, publicly-financed (single-payer) health care system, similar to Medicare

Related Legislation on Access and Coverage

• AB1840/Horton. PASSED. Support. Requires the state to disclose names of employers who, rather than providing health coverage, have many of their workers and their families on Medi-Cal and Healthy Families
• AB1948/Montanez. PASSED. Support. Simplifies application for Medi-Cal and Healthy Families using CHDP Gateway and electronic application
• AB1971/Chan. PASSED. Support. Extends sunset for Managed Risk Medical Insurance Program, which covers patients who are unable to get coverage elsewhere
• AB2889/Frommer. PASSED. Support. Prohibits health plans from discriminating against people who have been insured, but who have chronic or serious illnesses
• SB1448/Kuehl: PASSED. Support. Expands coverage using money from state's federal hospital waiver
• SB1622/Escutia. PASSED Support. Gives employers a notice to be passed along to employees, advising them of the availability of Healthy Families and Medi-Cal

• AB1952/Nation. FAILED. Oppose Unless Amended. Repeals HMO reform, while forcing businesses to provide health coverage and individuals to purchase it
• AB2450/Richman. FAILED. Oppose. Obligates every Californian to purchase skeleton health coverage.
• AB2473/Wyland. FAILED. Oppose. Intends to require personal identification for any kind of state-funded health care benefits.

Consumer Protections Against Medical Debt

• AB774/Chan. PENDING. Support-Sponsor. Provides consumer protections against abusive hospital billing and collections practices, including those that charge self-pay patients multiple times what insurers pay for the same service.
• AB977/Nava. PASSED. Support-Sponsor. Allows the state to monitor and determine the fairness of out-of-pocket costs permitted by health plans

• AB2281/Chan. FAILED. Strong Support. Provides information and protections to consumers with high-deductible health plans
• AB2010/Plescia FAILED. Oppose. Allows holders of Health Savings Accounts to receive a tax credit in California
• SB1584/ Runner-Ackerman. FAILED. Oppose. Allows holders of Health Savings Accounts to receive a tax credit in California .
• AB2737/Nakanishi. FAILED. Oppose. Gives businesses tax breaks if they contribute to employees' Health Savings Accounts
• SB1639/Dutton. FAILED Oppose. Gives businesses tax breaks if they contribute to employees' Health Savings Accounts

Affordable Prescription Drugs

• AB75/Frommer: PENDING. Support.Would establish a prescription drug discount program, to use the purchasing power of the state of California (through its Medi-Cal program) to negotiate the best possible drug prices for 8-10 million Californians who are uninsured or underinsured
• AB2911/Nunez-Perata. PASSED. Support. Establishes a prescription drug discount program
• SB1702/Perata-Nunez: PASSED. Support. Establishes a prescription drug discount program
• AB2877/Frommer: PASSED. Support. Establishes a website listing sources that are safe for purchasing more affordable drugs from other countries.
• SB452/Alarcon: PENDING. Support. Requires Medi-Cal contracts with drug manufacturers to be disclosed to the chairs of relevant legislative committees

Patient Protections

Prescription Drugs

• AB71/Chan-Frommer: PENDING. Support. Establishes a clearinghouse for information about the safety and effectiveness of prescription drugs that are advertised on television.
• SB1683/Scott: FAILED. Support. Requires pharmaceutical companies to report the results of all their clinical trials.

Medicare Part D

• AB2170/Chan: PASSED. Support-Sponsor. Creates a consumer report card on Medicare Part D prescription drug plans
• AB2667/Baca: PASSED. Support-Sponsor. Allows the state to monitor prescription drug coverage plans in the same way it monitors health plans
• AJR40/Chan-Berg: PASSED. Support Calls on federal government to make changes to the Medicare Part D prescription drug plans, including extending the deadline for it.

Insurance Oversight and Other Patient Protections

• SB1405/Soto: PASSED. Support. Creates a Task Force on Reimbursement for Language Services to recommend actions for achieving linguistic access to care
• SB1704/Kuehl: PASSED. Support. Extends the sunset for the existing California Health Benefits Review program to 2010.
• SB1804/Florez: PASSED. Support. Requires health insurers to disclose the number of physicians accepting new patients on a county-by-county basis.
• AB2855/Parra: FAILED. Oppose. Allows fraudulent "discount health plans'' without needed consumer protections
  

For information on these 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 | 10:30 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...