Thursday, August 31, 2006

LEGISLATURE SENDS BILL TO BAN HOSPITAL OVERCHARGING TO GOVERNOR

• Assembly ratifies pact with hospitals to ban practice of gouging uninsured patients;
• Health advocates score other major wins this year, including universal health care;
• Full list of bills of interest to health advocates to come Friday, September 1.

In the waning and dizzying hours of the 2005-06 session, lawmakers approved a number of major health reforms, including a prohibition against the hospitals for charging low-income patients prices four times higher than what insurance companies pay.

AB774 (Chan) passed on a party-line vote, 41-25 in the preliminary tally, with five hours to spare before the close of session. The bill had cleared the Senate earlier today, with a 22-13 preliminary tally.

The issue has been in the making for five years as lawmakers and advocates have sought to relieve uninsured and underinsured patients from taking on crushing debt, avoiding medical care and getting sicker.

Earlier this week, negotiations broke through with hospitals who had been opposing the bill. The California Hospital Association on Tuesday declared it was neutral on AB774, paving the way for it to pass.

“We’ve worked on this issue for a long time. Hospital bills are the leading cause of bankruptcy. We negotiated what I think is a fair bill,’’ said author Wilma Chan.

While this issue has prompted Congressional hearings, voluntary guidelines by hospitals, class-action lawsuits and multi-million dollar settlements, and national media attention, only New York has passed a similar measure, earlier this year.

AB774 would provide self-pay hospital patients a range of consumer protections, most notably that for families whose income is less than 350% of the federal poverty level ($34,300 for an individual; $58,100 for a family of three), they would not have to pay more for hospital care than the Medi-Cal, Medicare, or worker's compensation rate. Hospitals would also need to provide notice about their rights and the hospital’s financial policies for uninsured and underinsured. Patients would be given 150 days to negotiate payments and payment plans before their bills are sent to collections.

While nothing in the bill requires hospitals to provide free care, it does ensure than Californians get a fair price; Previously, uninsured patients had gotten hospital bills that were multiple times what insurance companies or government programs paid for exactly the same service.

This victory is the result of a five year campaign by many consumer, health, low-income and community advocacy organizations. AB774 is sponsored by Health Access California and has been strongly supported by a wide range of organizations representing health care consumers, including Consumers Union, Western Center for Law and Poverty, ACORN, Latino Coalition for a Healthy California, California Alliance for Retired Americans, California Church IMPACT, Latino Issues Forum, California Immigrant Welfare Collaborative and many others.

The California Hospital Association had adopted a set of "voluntary guidelines" in February 2004 on issues of hospital pricing, billing, collections, and financial assistance. When vetoing an earlier version of this bil, SB379(Ortiz) later that year, Governor Arnold Schwarzenegger stated that “the voluntary guidelines must be given time to be implemented and reviewed.” In his veto message, the Governor left open the possibility of revisiting legislation if the guidelines were not followed, saying, “Nevertheless, it is my expectation that all hospitals in the state uphold their important commitment to the voluntary guidelines and that they are applied evenly, consistently and without hesitation.”

Studies indicate that the guidelines have not been followed. In late 2004, Health Access worked with volunteers and community organizations to survey 40 hospitals around the state, and found only one hospital met all the criteria; just half met the modest effort of posting a sign in the emergency room to alert patients to the possibility of financial assistance.

Late last year, the independent California HealthCare Foundation reported on the result of its broader and more comprehensive "mystery shopper" survey, entitled “Price Check: The Mystery of Hospital Pricing.” Among the findings, over half the hospitals (57%) did not have a sign in the emergency room about financial assistance policies, as described in the hospitals guidelines adopted nearly two years ago. Only 7.3 percent of "mystery shoppers" were offered written information about financial assistance policies.
The preliminary results of a study by the Western Center for Law and Poverty found that fewer than half of 137 hospital sites visited had notices about their discount policies posted in either the administration area or emergency room

In addition to these studies, the issue of hospital billing and collections has received renewed attention in recent months, with:

• Passage of a similar law to AB774(Chan) in New York state;
• Congressional and IRS scrutiny of nonprofit hospitals’ tax status;
• Settlement of class-action lawsuits against two California hospital corporations, Catholic Healthcare West and Sutter Health. Both hospital systems were ordered to reimburse patients for hundreds of millions of dollars in refunds or bill adjustments.

The bill now goes to the Governor's desk.


UNIVERSAL HEALTH CARE HEADED TO GOVERNOR

As reported earlier, Sen. Sheila Kuehl sent SB840, her single-payer, publicly funded health care system bill to the governor’s desk earlier Thursday. In an historic vote, the California Senate falling along party lines, voted 24-12 to support SB840, the California Health Insurance Reliability Act (CHIRA), to guarantee health coverage to all Californians, with comprehensive benefits, and the right to choose one's own doctor, and save on health care costs.


UPDATE ON OTHER HEALTH BILLS TO COME FRIDAY

The Legislature is expected to continue meeting and voting on bills until midnight Thursday – or later. Health Access will provide a roundup of all bills of interest to health advocates and their fate in this last week of the legislature, for tomorrow, Friday, September 1st.

Labels: Updates

posted by Anthony Wright | Permalink | 8:30 PM


 

LEGISLATURE SENDS BILL TO BAN HOSPITAL OVERCHARGING TO GOVERNOR

• Assembly ratifies pact with hospitals to ban practice of gouging uninsured patients;
• Health advocates score other major wins this year, including universal health care;
• Full list of bills of interest to health advocates to come Friday, September 1.

In the waning and dizzying hours of the 2005-06 session, lawmakers approved a number of major health reforms, including a prohibition against the hospitals for charging low-income patients prices four times higher than what insurance companies pay.

AB774 (Chan) passed on a party-line vote, 41-25 in the preliminary tally, with five hours to spare before the close of session. The bill had cleared the Senate earlier today, with a 22-13 preliminary tally.

The issue has been in the making for five years as lawmakers and advocates have sought to relieve uninsured and underinsured patients from taking on crushing debt, avoiding medical care and getting sicker.

Earlier this week, negotiations broke through with hospitals who had been opposing the bill. The California Hospital Association on Tuesday declared it was neutral on AB774, paving the way for it to pass.

“We’ve worked on this issue for a long time. Hospital bills are the leading cause of bankruptcy. We negotiated what I think is a fair bill,’’ said author Wilma Chan.

While this issue has prompted Congressional hearings, voluntary guidelines by hospitals, class-action lawsuits and multi-million dollar settlements, and national media attention, only New York has passed a similar measure, earlier this year.

AB774 would provide self-pay hospital patients a range of consumer protections, most notably that for families whose income is less than 350% of the federal poverty level ($34,300 for an individual; $58,100 for a family of three), they would not have to pay more for hospital care than the Medi-Cal, Medicare, or worker's compensation rate. Hospitals would also need to provide notice about their rights and the hospital’s financial policies for uninsured and underinsured. Patients would be given 150 days to negotiate payments and payment plans before their bills are sent to collections.

While nothing in the bill requires hospitals to provide free care, it does ensure than Californians get a fair price; Previously, uninsured patients had gotten hospital bills that were multiple times what insurance companies or government programs paid for exactly the same service.

This victory is the result of a five year campaign by many consumer, health, low-income and community advocacy organizations. AB774 is sponsored by Health Access California and has been strongly supported by a wide range of organizations representing health care consumers, including Consumers Union, Western Center for Law and Poverty, ACORN, Latino Coalition for a Healthy California, California Alliance for Retired Americans, California Church IMPACT, Latino Issues Forum, California Immigrant Welfare Collaborative and many others.

The California Hospital Association had adopted a set of "voluntary guidelines" in February 2004 on issues of hospital pricing, billing, collections, and financial assistance. When vetoing an earlier version of this bil, SB379(Ortiz) later that year, Governor Arnold Schwarzenegger stated that “the voluntary guidelines must be given time to be implemented and reviewed.” In his veto message, the Governor left open the possibility of revisiting legislation if the guidelines were not followed, saying, “Nevertheless, it is my expectation that all hospitals in the state uphold their important commitment to the voluntary guidelines and that they are applied evenly, consistently and without hesitation.”

Studies indicate that the guidelines have not been followed. In late 2004, Health Access worked with volunteers and community organizations to survey 40 hospitals around the state, and found only one hospital met all the criteria; just half met the modest effort of posting a sign in the emergency room to alert patients to the possibility of financial assistance.

Late last year, the independent California HealthCare Foundation reported on the result of its broader and more comprehensive "mystery shopper" survey, entitled “Price Check: The Mystery of Hospital Pricing.” Among the findings, over half the hospitals (57%) did not have a sign in the emergency room about financial assistance policies, as described in the hospitals guidelines adopted nearly two years ago. Only 7.3 percent of "mystery shoppers" were offered written information about financial assistance policies.
The preliminary results of a study by the Western Center for Law and Poverty found that fewer than half of 137 hospital sites visited had notices about their discount policies posted in either the administration area or emergency room

In addition to these studies, the issue of hospital billing and collections has received renewed attention in recent months, with:

Passage of a similar law to AB774(Chan) in New York state;

• Congressional and IRS scrutiny of nonprofit hospitals’ tax status;
• Settlement of class-action lawsuits against two California hospital corporations, Catholic Healthcare West and Sutter Health. Both hospital systems were ordered to reimburse patients for hundreds of millions of dollars in refunds or bill adjustments.

The bill now goes to the Governor's desk.

UNIVERSAL HEALTH CARE HEADED TO GOVERNOR

As reported earlier, Sen. Sheila Kuehl sent SB840, her single-payer, publicly funded health care system bill to the governor’s desk earlier Thursday. In an historic vote, the California Senate falling along party lines, voted 24-12 to support SB840, the California Health Insurance Reliability Act (CHIRA), to guarantee health coverage to all Californians, with comprehensive benefits, and the right to choose one's own doctor, and save on health care costs.


UPDATE ON OTHER HEALTH BILLS TO COME FRIDAY

The Legislature is expected to continue meeting and voting on bills until midnight Thursday – or later. Health Access will provide a roundup of all bills of interest to health advocates and their fate in this last week of the legislature, for tomorrow, Friday, September 1st.

Labels: Updates

posted by Anthony Wright | Permalink | 8:21 PM


 

HISTORIC MOMENT: Landmark Universal Health Care bill heads to California Governor's Desk for the first time; Senate bans Hospitals from overcharging uninsured patients

• Senate takes final vote on SB840 to create a publicly financed health care system.
• Senators pass AB774 to prevent hospital overcharging.
• 10 hours remain until session ends...

In a historic vote, the California Senate voted on a party line vote, 24-12, to support a universal, public-financed health care system, the California Health Insurance Reliability Act (CHIRA), to guarantee health coverage to all Californians, with comprehensive benefits, and the right to choose one's own doctor, and save on health care costs.

Four years later...

"Willie Brown used to tell me never fall in love with your bill. Well, I broke the cardinal rule and I fell in love with this one,'' said Sen. Sheila Kuehl, who has worked four years to pass this legislation.

The plan would be funded by drawing in current public spending and replacing all premiums, co-pays and deductibles paid to insurance companies with premiums paid to the system. As amended, the bill creates a blue ribbon panel of health, finance and technical experts to lay out the mechanics for an affordable premium structure using information gathered in available funding studies. Because this structure, the bill needed a majority vote to pass, not the two-thirds vote needed for fiscal measures.

Supporters of the plan argued that SB 840 saves the state of California, businesses and working families nearly $8 billion in the first year, through a streamlined claims and reimbursement system reducing administrative costs, and using the state's combined purchasing power to negotiate better rates for prescription drugs and durable medical equipment.

The Governor is expected to veto it, although hundreds of advocates stormed the Capitol Wednesday chanting "Sign this bill'' outside the governor's offices.

Despite the potential veto by Governor Schwarzenegger, the vote is historic in having the full California legislature go on record in support of a universal healthcare system, and for the desired direction of our health care system.

The California legislature has voted on and passed other major health care coverage expansions in recent years, most notably with an expansion of employer-based coverage in 2003 (SB2) which was narrowly repealed by referendum and a full expansion of coverage to nearly all children in 2005 (SB774), which was vetoed. With the vote on SB840, the California legislature has continued to make health care coverage a priority, puts forward a vision, and sets an even higher marker for the coming debate next year.

Uninsured patients would receive greater protections in when visiting hospitals

Minutes ago, the state Senate passed 22-13 legislation that would protect uninsured patients from getting gouged when they visit the hospital.

AB774 (Chan) would ensure that patients with inadequate insurance and earning less than 350 percent poverty ($60,000 for a family of four) would be charged no more than what Medi-Cal or other government programs pay for procedures at hospitals.

Hospitals would also be required to advise patients of discount options and give patients 150 days to negotiate a payment plan before sending them to collections.

This bill has been a work in progress for five years. It does not require hospitals provide free care -- just a fair price for medical servicse.

The state Assembly now much concur in amendments by midnight tonight.

Session nears end

With less than 10 hours remaining until the session ends, Health Access will keep advocates apprised of bill passage as information becomes available. We will provide a fuller accounting of bills of interest to health advocates Friday, September 1 after the dust has settled.

For more information, contact Hanh Kim Quach, hquach@health-access.org, or 916-497-0923.

Labels: Updates

posted by Anthony Wright | Permalink | 2:20 PM


 

END OF SESSION COUNTDOWN: Major bills pass; 25 hours to go...

• Prescription drug discount bill heads to governor
• Bill to ease children's enrollment in health programs passes Assembly
• Supporters of universal health care storm Capitol, Los Angeles
• UPDATE: Where are bills in the Legislature?

Health care issues continued to loom large in the Legislature as session nears a close. Rallies to shame Wal-Mart and urge signature on universal health care convened on Capitol steps Wednesday. And lawmakers continued to shuffle through hundreds of bills still on file.

Lawmakers passed bills that would make it easier for children to obtain health coverage and sent a bill to the Governor to provide discount prescription drug discounts to six million Californians. A fuller description of key health consumer bills pending in the Legislature follows.

Tomorrow, Thursday, August 31st is the last day of the legislative session. The California constitution requires that the legislature adjourn by midnight of August 31st of even-numbered years. Any measure considered after midnight requires a two-thirds vote. Yet key bills are still pending in this last day of action.

LEGISLATURE SENDS PRESCRIPTION DRUG DISCOUNT BILL TO GOVERNOR

Despite the drug companies' spending of $80 milion last year, and an army of slick, PhRMA suits that blanketed the Capitol, the California legislature passed a major prescription drug discount plan to benefit uninsured, underinsured, low-income, seniors, and other Californians.

The state Assembly Wednesday voted 46-28 to pass AB2911 (Nunez/Perata), giving the state authority to negotiate discount prices for 6 million Californians who now pay more for prescription drugs than anybody else in the world. (An identical bill, SB1702 (Perata/Nunez) no longer needs to be passed, as AB2911 has cleared both houses.) The bill now heads to the governor’s desk for signature. Gov. Schwarzenegger, who joined with Democratic leaders in the Legislature on this issue, is expected to sign the measure.

“The important thing here is to look at what pharmaceutical companies have said all along, which is, given the opportunity – on a voluntary basis – they would provide discounts,’’ said Assembly Speaker Fabian Nunez. “Under this bill, we’d give them three years to (provide discounts) voluntarily.’’

After three years, the state would be permitted to steer some of the state's $4 billion Medi-Cal purchasing away from companies who did not provide sufficient discounts. Assemblymembers Merv Dymally and Jackie Goldberg expressed their support for the bill, but stated their hope that Medi-Cal patients would be unaffected. "This is a big step forward," said Goldberg, but she urged future legislators to watch that "if and when there are companies that don't [participate], there is a timely response to Medi-Cal recipients" in getting the drug they need. "They all know they'll get the help they need," she said, but some are concerned about the speed of the bureacracy.

In a strange political twist, Republican Assemblymen Greg Aghazarian and Keith Richman also cited the same concerns for Medi-Cal recipients. “This hammer will have one effect. It uses the poorest, most vulnerable in society as hostages – as pawns – in a chess game to try and leverage and extort drug companies,’’ Aghazarian said. Despite the stated concerns, neither legislator has supported repealing the existing system of "prior authorization" in Medi-Cal--a process that AB2911 does not change--or the current mechanism that the state uses to win rebates from the drug companies. The bill does not change the access of Medi-Cal recipient to medications, but simply broadens the benefit of the existing Medi-Cal drug purchasing system to help the uninsured get fairer prices.

Democratic Assemblywoman Wilma Chan also pointed out that "as long as the drug companies provide discounts" that they promised, there's no use of enforcement, and Maine's program hasn't had to even use their Medicaid's purchasing power to get discounts. Assemblymember Dario Frommer argued this was a reasonable compromise, after many years of working on the issue.

In another critique, Republican Assemblymember Chuck DeVore argued that "we are putting price controls on an industry that will result in less money for research and development."

In closing remarks, Nunez contrasted groups on either side of the bill. “I don’t know a pharmaceutical company in the country that’s filing for bankruptcy,’’ he said. “But I know a lot of poor people that don’t have any food – or enough money to put food on the table. If you really care about poor people, you are going to cast an ‘aye’ vote for the 6 million people who are going to benefit from this bill,’’ he said.

The bill passed on a straight party line vote, with Gloria Negrete McLeod being the only Democrat who abstained. Republicans abstaining included Lynn Daucher, Bonnie Garcia and Shirley Horton, according to the preliminary tally.

The bill now goes to Governor Schwarzenegger for his signature. Advocates hope this help influence the national debate on health reform, and encourage the principle--in Medicare and elsewhere--that government can negotiate for the best possible price for prescription drugs and other health care.

AMENDED BILL TO STREAMLINE CHILD HEALTH ENROLLMENT PASSES ASSEMBLY

The state Assembly Wednesday evening passed SB437, which would streamline the process for poor children to seek medical attention and coverage through the state's Medi-Cal or Healthy Families programs.

SB437(Escutia), supported by Governor Schwarzenegger, jockeyed by Assemblymember Cindy Montanez, passed 47-14 with mostly Democratic votes and four Republican Assemblymembers voting for the bill, including Lynn Daucher, Shirley Horton, Tim Leslie and Keith Richman.

This bill has been amended significantly, but would make enrollment easier through a WIC Gateway, and by expanding pre-enrollment for Healthy Families for county applications. It will also seek to keep more children retained on the program by simiplying annual renewals to allow self-certification of income for Healthy Families, and creating a pilot for self-certification in Medi-Cal.

While SB437 is expected to make it easier for low-income children to become enrolled in state programs, it is a far cry from the bill's original intent -- which was to provide full health coverage to the 800,000 California children who remain uninsured, bemoaned Assemblymembers Wilma Chan and Dario Frommer.

They cited the recent history, that Gov. Arnold Schwarzenegger and Democratic leaders withdrew a proposal earlier this year to provide an additional $23 million in the state budget to enroll 18,000 children -- both documented and undocumented -- in county health initiatives, often called Healthy Kids. When it became apparent that legislative Republicans, whose votes were needed to pass the budget, refused to support the proposal because it would have helped undocumented immigrants, Gov. Schwarzenegger and Democrats agreed to strip the funding from the budget and address the issue in August before the session ended. With hours left before the Legislature leaves for the year, "the money was not put back,'' Chan said.

Frommer reminded lawmakers of the Schwarzenegger’s 2003 campaign promise during the recall – to provide health coverage to all children. “What we have at the last hour of this session is a bill that he’s sponsoring that makes a few good technical improvements to programs, but does not meet his pledge to the children and families of California to provide health care to all children’’ Frommer said.


In spite of SB437's modest goals, Republican Sen. Ray Haynes said its intentions were too grandiose, likening its goal to "lining the street with gold.'' He stated that, "we have made it so easy to sign up for government programs,'' Haynes said. If children remain uninsured, "they’re uninsured because they want to be uninsured. If they don’t have it, they don’t want it. The problem isn’t that we’re not doing enough. It’s that they don’t want it.''

Frommer refuted Haynes' argument and asked the governor to make good on his campaign promise. "I would really hope Governor that you would keep your promise to California children, who, Mr. Haynes, cannot make decisions about whether they get health care or not. They get born into whatever life they're born into,'' Frommer said. “Every child should be able to see a doctor if they are sick,'' he said. "That should be a right.’’

OTHER MEASURES OF NOTE

The Senate passed a measure, AB1971(Chan), to extend the state's high-risk pool so those with "pre-existing conditions" can get some coverage. It is pending in the Assembly.

One measure that faced significant debate was SB1534(Ortiz), a new measure to clarify counties' ability to provide care to undocumented Californians, which passed the Assembly floor and Senate Health Committee.

Another measure was SB1414(Migden), to require employers of 10,000 or more to pay into a fund if they do not spend a minimum level on health benefits. That measure, which generated a lot of discussion about Wal-Mart and the benefits the company does or does not provide, is up for reconsideration.

Finally, SB1312(Alquist) as part of licensing reform, would allow hospitals to be fined for patient car violations, in a manner similar to nursing homes. That measure passed the Assembly 49-28, and is heading toward the Senate.

RALLIES REV HEALTH ADVOCATES

Celebrating the first time a single-payer health system legislation has ever made it to the governor’s desk, a boisterous crowd of 400 participants chanted “Sign this bill’’ outside Gov. Arnold Schwarzenegger’s Capitol office suite in support of SB840.

Speaker Fabian Nunez and Sen. Sheila Kuehl, the bill’s author, both addressed sign-toting crowd of advocates, thanking volunteers and advocates for the countless hours spent working on behalf of the bill.


The noon rally in support of Sen. Sheila Kuehl’s SB840 was the second health-related gathering of the day in Sacramento . That morning, hundreds of labor, health, and community advocates also gathered to shame Wal-Mart to do better for its workers, including to provide better health benefits.

UPDATE: Where the bills are.

Voted on Assembly Floor (Needs 41 votes to pass)

• AB2911 (Nunez/Perata) PASSED 46-28. Allows the state of California to use its Medi-Cal purchasing power to negotiate discounted prescription drug prices for uninsured and underinsured Californians. To the Governor.
• SB437 (Escutia) PASSED 47-14. Streamlines enrollment into children's insurance programs. Back to the Senate.

Pending on the Assembly Floor

• SB452 (Alarcon) Requires Medi-Cal to report to Governor on whether Medi-Cal prices are higher than prices for federal programs. (Reconsideration. Failed passage Tuesday on 35-37 vote)
• AB2889 (Frommer) Concurrence. Allows patients in the individual market to transfer to similar health plans without underwriting that would lead to denial of coverage based on "pre-existing conditions."
• AB1948 (Montanez) Concurrence. Creates a feasibility study on simplifying application for Medi-Cal and Healthy Families using CHDP Gateway and electronic application.

Voted on Senate Floor Tuesday: (Needs 21 votes to pass)

• AB1971 (Chan) PASSED 21-13. Extends the sunset for the Managed Risk Medical Insurance Program (MRMIP), which covers patients with "pre-existing conditions" unable to get coverage elsewhere. Pending in Assembly.

Still pending on Senate Floor:

• 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.
• AB2667 (Baca) Allows the state to monitor Part D prescription drug plans in the same way it monitors health plans. (Reconsideration. Failed passage 17-10 on Wednesday night. Needs advocacy.)
• AB2877 (Frommer) Establishes a website listing sources that are safe for purchasing more affordable drugs from other countries. (Reconsideration. Failed passage 15-14 on Wednesday night. Needs advocacy.)
• SB840 (Kuehl) Concurrence. Called the California Health Insurance Reliability Act, creates a universal, publicly financed (single-payer) health care system for the state similar to Medicare.
• SB1405 (Soto) Concurrence. Creates a Task Force on Reimbursement for Language Services to recommend actions for achieving linguistic access to care.

For more information, contact Hanh Kim Quach, hquach@health-access.org, or 916-497-0923 x 206.

Labels: Updates

posted by Anthony Wright | Permalink | 8:10 AM


 

Tuesday, August 29, 2006

CENSUS: CALIFORNIA UNINSURED RATE RISING: 2 Days Left in Legislative Session

• New Census data: California uninsured rate rises to 19%; CA among "top 5" worst states
• State Senate passes AB2911(Nunez/Perata) to negotiate drug discounts
• UPDATE: Some health bills pass, fail: Report on bills' status in the Legislature

With the legislative session for 2005-06 approaching its final deadline, health care continues to be in the spotlight, with pending bills on everything from universal coverage to hospital overcharging.

On prescription drugs, a major bill to negotiate lower, fairer prices for millions of uninsured, AB2911(Nunez/Perata) passed the full Senate on a straight party line vote and now heads to the Assembly. Some other bills on prescription drug issues, including AB71(Chan) and SB452(Alarcon) both failed. But other health-related measures, including AB1840(Horton) and SB1704(Kuehl) passed and headed to the Governor's desk.

A fuller description is below. Many of these bills are attempts to help the uninsured, and today there was new information about the extent of the health care crisis in California.

NEW CENSUS DATA: MORE AMERICANS & CALIFORNIANS UNINSURED

New census data released Tuesday showed the number of uninsured in 2005 rising in the United States, and in California specifically. Of particular note, California was one of eight states to see the proportion of uninsured rise. The likelihood a Californian is uninsured rose to 19 percent of the population, from 18.5 percent in 2004.

That means nearly 1 in every 5 Californians finds themselves uninsured.

With these new numbers, California is in the "top 5" states with the worst rate of residents with health coverage. Only Texas (24.5%), New Mexico (20.6%), Florida (20.3%) have higher rates of uninsured: Oklahoma and California are tied at 19%.

On the national front, the number of Americans without health coverage rose to 46.6 million. The proportion of Americans with employer-based coverage went down to 59.5%, which, according to the Census report, "essentially explains the decrease in total private health insurance coverage, from 68.2% to 67.7%." While public insurance programs did pick up some of the slack, it was not enough to prevent more people from becoming uninsured.

Other Census numbers for the United States as a whole:

Number of Americans without health coverage
2004: 45.3 million
2005: 46.6 million

Proportion of Americans who receive health benefits from their employer
2004: 59.8%
2005: 59.5%

Number of people covered by government programs
2004: 79.4 million
2005: 80.2 million

Number of people born in the U.S. who were uninsured
2004: 13.1%
2005: 13.4%

Uninsured Whites
2004: 11.2%
2005: 11.3%

Uninsured Blacks
2004: 19.3%
2005: 19.6%

Uninsured Latinos
2004: 32.3%
2005: 32.7%

Uninsured Asians
2004: 16.5%
2005: 17.9%

In this context, the California legislature is set to pass major legislation to assist the growing uninsured population in the next week, and send those bills to Governor Arnold Schwarzenegger. The bills include the landmark SB840(Kuehl), the California Health Insurance Reliability Act, to extend coverage to all Californians through a universal, publicly financed health care system.

Among the financial consequences of being uninsured is that the lack of negotiating power, which means the uninsured end up paying signfiicantly more for care--including prescription drugs and hospital care--than anybody else. The legislature is set to pass major legislation to remedy thig issue:

• AB774(Chan) would prohibit hospitals from charging more than the Medi-Cal, Medicare, or worker's compensation rate for hospital care, and provide other consumer protections against abusive billing and collections practices.
• AB2911(Nunez/Perata) and SB1702 (Perata/Nunez) would create a prescription drug discount program, eventually allowing the state to use its purchasing power to negotiate discounts for the uninsured and underinsured.

PRESCRIPTION DRUG LEGISLATION


In fact, California state senators voted 25-12 to give the state authority to negotiate discounted and fair prescription drug prices for uninsured Californians. All Democrats in the Senate voted for AB2911 (Nunez/Perata).

The bill, which now heads to the Assembly, authorizes the state to negotiate for the best possible price for up to 6 million Californians. The first three years, the program is voluntary, allowing the drug companies to fulfill their promises made last year to make a voluntary program work. However, after August 1, 2010, if drug companies are not participating or their discounts are still insufficient, the state may use the purchasing power of its Medi-Cal program to steer some business away from drug companies that give insufficient discounts.

Senator Perata opened the floor debate by describing the measure as a compromise, after the "shootout on the ballot" last year between Propositions 78 & 79. He cited the potential benefits to millions of uninsured Californians, for discounts of 40-60%.

Senator Ortiz, who proposed a voluntary drug discount program last year, announced that she would vote for the bill, but raised issues about the use of Medi-Cal's bargaining power to negotiate discounts, fearing it might make it harder for some Medi-Cal recipients to get authorization for the medicines they need. While there are several protections in existing law and in the bill to ensure that all Medi-Cal recipients get access to drugs they need, she asked that future legislators work to ensure protections for Medi-Cal patients.

Republican Sen. Dave Cox called AB2911 and attempt to impose "price caps'' on drug companies. "I don't have to stand here very long to tell you that price caps haven't worked in the past. the reason we don't do that is because they don't work,'' Cox said. While AB2911 attempts to achieve up to 60 percent discount off generic drugs and 40 percent off brand name drugs, using verifiable benchmarks such as the best price Medicaid pays, the discounts will be based on the negotiations between the state and the drug companies.

Sen. Jackie Speier, a Democrat, rose to support the bill. Speier had authored the "Golden Bear'' program in 2001, which asked drug companies to voluntarily provide discounts for uninsured Californians. "Guess what happened?'' she asked. "Nothing.'' The Golden Bear program folded for lack of drug company participation. Nothing is going to happen without the use of the state's purchasing power, which this bill provides, she said. "This is too big a market for them."

The program would be available for 5-6 million Californians who earn less than 300 percent of the federal poverty level ($60,000 for a family of four); or who have high un-reimbursed medical expenses and incomes below the state's median family income ($68,310 for a family of four); or whose drugs are not covered by Medicare may qualify.

In anticipation of this week's vote, a giant, walking pill bottle and volunteers from Gray Panthers, Older Women's League, Congress of California Seniors, Latino Coalition for a Healthy California, Health Access, California Alliance for Retired Americans, Consumers' Union, AIDS Healthcare Foundation and Health Care for All distributed more than 1,000 pro-prescription drug leaflets to Capitol staff, lawmakers and lobbyists arriving at work Monday morning and leaving for lunch on Tuesday.


BILL UPDATE: WHERE ARE HEALTH BILLS NOW?

Bills headed to the Governor:

• AB1840 (Horton) PASSED. 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.
• SB1704 (Kuehl) PASSED. Extends the sunset for the existing California Health Benefits Review program to 2011.

Voted on Assembly Floor Tuesday: (Need 41 votes to pass)

• SB452 (Alarcon) FAILING. 34-37. Requires Medi-Cal to report to Governor on whether Medi-Cal prices are higher than prices for federal programs. (Democrats voting against the bill included: Ed Chavez, La Puente; Jerome Horton, Los Angeles; Ted Lieu, El Segundo; Barbara Matthew, Tracy; Nicole Parra, Bakersfield; Leland Yee, San Francisco. Democrats abstaining or absent at voting time included: Ron Calderon, Montebello; Joe Canciamilla, Martinez; Paul Koretz, Hollywood; Gene Mullin, South San Francisco; Gloria Negrete-McLeod, Cino; Alberto Torrico, Newark; and Lois Wolk, Davis.)

Pending on the Assembly Floor

• SB437 (Escutia) Streamlines enrollment into children's insurance programs. This bill has been amended significantly, but would make enrollment easier through a WIC Gateway, and by expanding pre-enrollment for Healthy Families for county applications. It will also seek to keep more children retained on the program by simiplying annual renewals to allow self-certification of income for Healthy Families, and creating a pilot for self-certification in Medi-Cal.
• AB2889 (Frommer) Concurrence. Allows patients in the individual market to transfer to similar health plans without underwriting that would lead to denial of coverage based on "pre-existing conditions."
• AB1948 (Montanez) Concurrence. Creates a feasibility study on simplifying application for Medi-Cal and Healthy Families using CHDP Gateway and electronic application.

Voted on Senate Floor Tuesday: (Needs 21 votes to pass)

• AB71 (Chan/Frommer) FAILED 18-18. Establishes a clearinghouse for information about the safety and effectiveness of prescription drugs that are advertised on television. (Democrats voting against the bill included: Denise Ducheny, San Diego; Dean Florez, Fresno; Mike Machado, Stockton; Ed Vincent, Los Angeles. Democrats abstaining or absent were: Christine Kehoe, San Diego; Kevin Murray, Los Angeles).
• AB2911 (Nunez/Perata) PASSED 25-15. Allows the state of California to use its Medi-Cal purchasing power to negotiate discounted prescription drug prices for uninsured and underinsured Californians.

Still pending on Senate Floor:

• 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 sunset for the Managed Risk Medical Insurance Program (MRMIP), which covers patients with "pre-existing conditions" unable to get coverage elsewhere.
• AB2667 (Baca) Allows the state to monitor Part D prescription drug plans in the same way it monitors health plans.
• AB2877 (Frommer) Establishes a website listing sources that are safe for purchasing more affordable drugs from other countries.
• SB840 (Kuehl) Concurrence. Called the California Health Insurance Reliability Act, creates a universal, publicly financed (single-payer) health care system for the state similar to Medicare.
• SB1405 (Soto) Concurrence. Creates a Task Force on Reimbursement for Language Services to recommend actions for achieving linguistic access to care.

For more information, contact Hanh Kim Quach, hquach@health-access.org, or 916-497-0923.

Labels: Updates

posted by Anthony Wright | Permalink | 10:26 PM


 

Monday, August 28, 2006

FOUR DAYS LEFT TO PASS MAJOR REFORMS & PROTECTIONS FOR UNINSURED

• Governor, Legislative leaders reach agreement on prescription drug discount program
• Bill for consumer protections against "hospital overcharging" to come up soon
• California Health Insurance Reliability Act up for landmark vote this week
• UPDATE: Where in the process are bills of interest to health advocates?

Lawmakers have four more days to sort through a dizzying number of bills before midnight on Thursday. One bill, to create a report card for Medicare Part D prescription drug plans, is already headed to the Governor's desk. Health advocates still have over a dozen bills in the legislative mix. Momentum is picking up on legislation for discounted prescription drug prices, a ban on hospital overcharging, and other consumer protection measures, as well as a major vote on a universal, single-payer health care system.

Prescription Drug Discounts Deal

Gov. Arnold Schwarzenegger, Speaker Fabian Nunez, and Senate President Pro Tem Don Perata announced Thursday, August 24th that they had come to an agreement on a prescription drug discount program, which will allow California to use its volume purchasing power to wrestle discounts from drug companies. Read the press release here:
http://gov.ca.gov/index.php/press-release/3650/

An additional information sheet is at:
http://www.stayhealthycalifornia.com/

The Governor has agreed with the framework proposed in two bills, AB2911(Nunez/Perata) and SB1702(Perata/Nunez), and the agreement reflects some amendments to the legislation. The prescription drug discount program is seen as a reasonable compromise between the competing proposals of last year, including Proposition 79, supported by consumer groups, and Proposition 78, supported by the drug industry.

After both measures were defeated, the many senior, health, and consumer groups supporting Proposition 79 indicated they were willing to compromise, but they also wanted to ensure that key criteria were met, elements that make up the new AB2911/SB1702:

• Verifiable discounts: Authorizes the state to negotiate for the best possible price, and to consider three benchmarks in negotiations with drug manufacturers: Medicaid Best Price, lowest price offered to private payers and average manufacturer's price minus 15 percent.
• Enforceability: The first three years, the program is voluntary, allowing the drug companies to fulfill their promises made last year to make a voluntary program work. However, after August 1, 2010, if drug companies are not participating or their discounts are still insufficient, the state may use the purchasing power of its Medi-Cal program to steer some business to those drug companies that do participate.
<>Broad eligibility: The program would be available for 5-6 million Californians who earn less than 300 percent of the federal poverty level ($60,000 for a family of four); or who have high un-reimbursed medical expenses and incomes below the state's median family income ($68,310 for a family of four); or whose drugs are not covered by Medicare may qualify.


AB2911/SB1702 would help up to 5-6 million low-income uninsured and underinsured Californians who currently pay the most in the world for their medications; yet Medi-Cal patients would continue to have the same access to the drugs they need as well.

Having spent $80 million in opposition to Proposition 79 last year, the drug companies are continuing to work in opposition to the bill.

Contact Hanh Kim Quach, policy coordinator, for a sample floor alert for your organization, or to sign on to a floor alert with other advocates. hquach@health-access.org or 916.497.0923 x 206.

Ban on Hospital Overcharging Up For Vote

Prescription drugs are not the only treatments where the uninsured get charged more than everybody else. Hospitals also charge self-pay patients more than insurers for exactly the same service. An important bill, AB774(Chan), would ban the practice of overcharging low-income patients.

After five years, the issue has come under increased scrutiny in recent months, in part, because of court multi-million court settlements by Catholic HealthCare West and Sutter Health to reimburse and forgive low-income and uninsured patients who had been overcharged. The Sacramento Bee wrote a story on the issue this week: http://www.sacbee.com/content/politics/story/14306199p-15189746c.html.

Advocates for the uninsured are hoping this is the year for action, and that California follow New York in passing these consumer protections.

Please contact Hanh Kim Quach, policy coordinator at Health Access, for a sample floor alert to send to lawmakers: 916.497.0923 x 206 or hquach@health-access.org.


Universal Healthcare System Proposal Up In Assembly

SB840 (Kuehl), the California Health Insurance Reliability Act (CHIRA) which would create a universal publicly-financed health care system in California, is expected to have an Assembly vote. Despite Governor Schwarzenegger's likely opposition, the very act of having this major bill passing the full legislature would send a strong signal about the need for health reform, and the direction of how to cover all Californians and provide some costs savings.. This is the culmination of years of hard work by organizations across the state.

ACTION ITEM: Advocates for SB840(Kuehl) are planning a rally at noon Wednesday August 30 at the State Capitol, Sacramento.

BILL UPDATE

Below is a list of bill of interest to health advocates, including their current location:

Headed for the Governor's Desk

• AB2170 (Chan) Creates a consumer report card on Medicare Part D prescription drug plans.

Assembly Floor

• 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. ( on concurrence)
• SB437 (Escutia) Streamlines enrollment into children's insurance programs. Support local children's health insurance programs and expansions.
• SB452 (Alarcon) Requires Medi-Cal to report to Governor on whether Medi-Cal prices are higher than prices for federal programs.
• SB840 (Kuehl) Called the California Health Insurance Reliability Act, creates a universal, publicly financed (single-payer) health care system for the state similar to Medicare.
• SB1405 (Soto) Creates a Task Force on Reimbursement for Language Services to recommend actions for achieving linguistic access to care.

Senate Floor

• AB71 (Chan/Frommer) 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.
• AB1948 (Montanez) Creates a feasibility study on simplifying application for Medi-Cal and Healthy Families using CHDP Gateway and electronic application.
• 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.
• AB2667 (Baca) Allows the state to monitor Part D prescription drug plans in the same way it monitors health plans.
• AB2877 (Frommer) Establishes a website listing sources that are safe for purchasing more affordable drugs from other countries.
• 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) Allows the state of California to use its Medi-Cal purchasing power to negotiate discounted prescription drug prices for uninsured and underinsured Californians.

For more information, contact Health Access:

Sacramento · (916) 442-2308 · 1127 11th Street Suite 234 · Sacramento · CA · 95814
Los Angeles · (213) 748-5287 · 3655 South Grand Avenue Suite 220 · Los Angeles · CA · 90007
Oakland · (510) 873-8787 · 414 13th Street Suite 450 · Oakland · CA · 94612

Labels: Updates

posted by Anthony Wright | Permalink | 10:14 AM