• Governor Ended Bill Signing Period Saturday
• Landmark Legislation Enacted to Prevent Price-Gouging for Drugs, Hospital Care
• Efforts To Expand Health Coverage Stalled for the Moment

Governor Arnold Schwarzenegger ended his 2006 legislative session Saturday afternoon, announcing his signature and vetoes of key bills. In all, the Governor signed 910 bills and vetoed 262. His legislative announcements are listed at his website, at:
http://gov.ca.gov/archive/press-releases/2006/09

A full list of the chaptered bills, those that have been signed, is available at the Secretary of State's website, at:
http://www.ss.ca.gov/executive/bill_chapters.htm

Highlights for health advocates include the passage and signing of AB2911(Nunez/Perata) and AB774(Chan), which address the unfairness that uninsured patients get charged more for care than anybody else, whether for prescription drugs or hospital services, respectively. The result of multi-year campaigns, these two bills will help many Californians get the care they need, and help prevent needless medical debt and bankruptcy, and help many Californians get the care they need.

The biggest loss was that efforts for major coverage expansions were stalled, most notably with the Governor's veto of SB840(Kuehl), the California Health Insurance Reliability Act. This also includes the lack of action in the budget on expanding children's coverage, although there is still an opportunity this year with Proposition 86 on the ballot. Health advocates are mobilizing their efforts on major health reform, both as a subject of debate in this year's elections, and for next year's legislative session.

Bills supported by health advocates that got signed included ones to better streamline children's coverage programs to better enroll and keep children insured, including SB437(Escutia), AB1948(Montanez), and others; some assistance for those with "pre-existing conditions" who find it hard to purcahse private coverage, in SB1702(Speier) and AB2889(Frommer); and more oversight over Medicare Part D plans, AB2667(Baca).

Disappointing to health advocates were the fate of other bills that were vetoed, including a report card to help seniors choose between those Part D plans, AB2170(Chan), and a bill to disclose the employers who have their workers and their families on public insurance programs, AB1840(Horton).

The status of other health bills of note included the veto of SB1414(Midgen), a bill to require very large employers to dedicate a certain percentage of their payroll for health benefits. Other bills that were signed included SB1312(Alquist), which allows for administrative fines to be levied against hospitals for deficiencies that caused harm to patients; SB1534(Ortiz) to clarify counties' ability to provide health services; and AB2560(Ridley-Thomas) to support school-basec health centers.

A full wrap-up and analysis of the year in health policy will be in a forthcoming Health Access Update.

Here's a cheat sheet for key health consumer bills supported by Health Access California, the statewide health care consumer advocacy coaltion, with bill numbers, descriptions, and whether the Governor has signed or vetoed the measure. It is also available at the Health Access website at:
http://www.health-access.org/advocating/pending2006_bills.htm


Major Health Reform and Coverage Expansion

• Vetoed: SB840 (Kuehl): As the California Health Insurance Reliability Act, creates a universal, publicly-financed (single-payer) health care system, similar to Medicare
  Hospital Overcharging of Uninsured Patients
• Signed: 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.

Affordable Prescription Drugs

• Signed: AB2911 (Nunez/Perata): Allows state to negotiate drug discounts for nearly 6 million Californians. After three years, state can use Medi-Cal purchasing power to encourage deeper discounts.
• Signed: AB2877 (Frommer): Establishes a website providing comparison prices for purchasing more affordable drugs.

Streamlining Children’s Coverage in Public Programs

• Signed: SB437 (Escutia): Streamlines and simplifies enrollment of children in WIC programs to Medi-Cal and Healthy Families.
• Signed: AB1948 (Montanez): Creates a feasibility study on simplifying application for Medi-Cal and Healthy Families using CHDP Gateway and electronic application

Medicare Part D Consumer Protections

• Vetoed: AB2170 (Chan): Creates a consumer report card on Medicare Part D prescription drug plans
• Signed: AB2667 (Baca): Allows the state to monitor Part D prescription drug plans in the same way it monitors health plans

Related Legislation on Access and Coverage

• Vetoed: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
• Signed: AB2889 (Frommer): Prohibits health plans from discriminating against people who have been insured, but who have chronic or serious illnesses in certain instances.
• Signed: SB1448 (Kuehl): Implements “Coverage Initiative’’ using money from state's federal hospital Medicaid waiver
• Signed: SB1702 (Speier): Extends sunset for current Managed Risk Medical Insurance Program (MRMIP)
• Signed: SB1704 (Kuehl): Extends California Health Benefits Review Board to 2011.

Labels: Updates

• Vetoed AB2170 (Chan) Would Have Created Report Card for Part D Plans
• Signed AB2667 (Baca) Will Use State ’s Purchasing To Ensure Oversight Over Part D Plans
• Also: AB2911 (Nunez/Perata) Provides Some Relief to Those in Part D “Donut Hole”
  

As he approaches his final few hours of signing and vetoing bills, Governor Schwarzenegger has announced signing legislation that would provide greater state review over new federal Medicare Part D plans, but also vetoed a report card that would have provided information for seniors and people with disabilities.

For an updated list of health consumer bills signed or vetoed by Governor Schwarzenegger, go to the Health Access website at:
http://www.health-access.org/advocating/pending2006_bills.htm

The Governor's website listing signatures and vetoes is at:
http://gov.ca.gov/archive/press-releases/2006/09

The Medicare Part D bills were designed to allow the state use its authority to place some state oversight over the newly-created prescription drug plans in the program. The signing of the oversight bill, AB2667(Baca), was announced in the veto message of the report card bill, AB2170(Chan):
http://gov.ca.gov/pdf/press/ab_2170_veto.pdf

NO CALIFORNIA REPORT CARD: Because of Governor Schwarzenegger’s veto, those on Medicare will have to make choices about these new prescription drug plans without the benefit of a report card. AB 2170 (Chan) would have compiled information on the performance of prescription drug plans, much the way the state publishes a report card for HMOs.

However, California will have taken two steps toward filling the gaps in the Medicare Part D, providing some benefit to seniors and people with disabilities, due to Governor Schwarzenegger signing the following two bills:

* OVERSIGHT: AB 2667 (Baca) will allow the state to monitor Part D prescription drug plans, and to use the state’s ability as a purchaser to penalize those plans with bad records. Having the state use it authority as a contractor (through Medi-Cal, CALPERS, etc.) can also discourage “bad actors” from coming into California.

* DISCOUNTS FOR THE DONUT HOLE: AB2911(Nunez/Perata) will create a prescription drug discount program. In addition to helping millions of uninsured people, it would also provide a discounts to Medicare recipients who are not covered in the so-called “donut hole” in Part D, when coverage runs out after $2,000 worth of drug costs.

STEPS TOWARD OVERSIGHT OF PART D PLANS: Last year, AB1359(Chan) was enacted, which gave the Department of Managed Health Care explicit authority to license these new private prescription drug plans, although the federal government has broad authority under Part D to pre-empt state action.

Last week, Health Access California released a policy brief about the lack of state or federal oversight over Medicare Part D plans, available at the Health Access website at:
http://www.health-access.org/providing/docs/PartDPolicyBriefFinal9-22-06.doc

OTHER ACTIONS ON PART D: Medicare Part D has gotten a lot of attention from state policymakers, with specific focus on low-income seniors and people with disabilities. This was most notably during the initial implementation after January 1st, when one million vulnerable Californians were automatically swtiched from Medi-Cal drug coverage to the new Medicare Part D private plans. Many of these "dual-eligible" seniors and people with disabilities found significant problems in getting needed medication, and so the legislative leadership passed several bills to provide emergency "coverage of last resort." California has even extended that emergency coverage program through January of 2007, in possible anticipation of problems with new enrollees and changes at the beginning of next year.

However, even with this emergency coverage, these one million "dual-eligibles" are worse off than they were last year, with a more costly, less comprehensive benefit than what they had under Medi-Cal. Senior, health, and low-income advocates argued that Medi-Cal should provide assistance to cover the newly-imposed co-payments for these very low-income seniors and people with disabilities, but this was not included in the final budget.

California senior, health, and low-income advocates will cotninue to pursue efforts to fix the Medicare Part D law at the national level, but also to urge the state take aggressive action on behalf of those with Medicare coverage. For a fact sheet on Medicare Part D and possible solutions, go to the Health Access website at:
http://www.health-access.org/providing/docs/PartDFactSheetwActionSept06.doc

Labels: Updates

• Uninsured Patients No Longer To Be Charged Many Times What Insurers Pay;
• AB774 (Chan) Will Prevent Many Cases of Medical Bankruptcy
• California Joins New York in Prohibiting Unfair Hospital Billing and Collections Practices
  

Tonight, Governor Arnold Schwarzenegger signed into law key consumer protections for self-pay hospital patients, including a ban on the common practice of “hospital overcharging.” California joins New York , which passed a similar law earlier this year, in providing the strongest protections in the nation to prevent abusive hospital billing and collections practices.

AB774(Chan) would ensure that uninsured patients within certain income limits (under 350% of the federal poverty level--$34,300 for a single person, $58,100 for a family of three) would not have to pay more than the Medicare, Medi-Cal or worker’s compensation rate. It would ensure hospital patients get information about the consumer rights and financial options, and place a moratorium on them being sent to collections. Low-income patients will no longer have wage garnishment and liens on primary residences as part of the collections efforts of hospitals.

The Governor's signing statement is on his website, at:
http://gov.ca.gov/pdf/press/ab_774_sign.pdf


THE HISTORY: This bill is a big victory, and the culmination of five years of campaigning by consumer and health advocates, working with Assemblywoman Wilma Chan (D-Oakland), chair of the Assembly Health Committee.

Over the last five years, dozens of Californians have testified and spoken out about their personal experiences going to a hospital, getting care, but then getting a life-changing bill--$3,000, $6,000, or $15,000 for a emergency room visit; $32,000 for a one-night appendectomy; over $250,000 for a two week hospital stay. Many of these patients were willing (and even wanted) to pay something, but were not able to pay the given charge, multiple times what insurers and government programs pay.


With these issues raised by health and consumer advocates, the California Hospital Association adopted a set of "voluntary guidelines" in February 2004 on issues of hospital pricing, billing, collections, and financial assistance.


While vetoing an earlier version of this bill, 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 appropriately 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 indicated 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 2005, 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 results of a 2006 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.

FORCES FOR REFORM: 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 in New York state;
• Congressional hearings and reports on both hospital bills and collections practices and the provision of care to poor patients, by Sen. Charles Grassley (R) and others;
• 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.
  

After opposing the measure for the last five years, the California Hospital Association did work with author and sponsor of the bill, and dropped their opposition in August, moving to a neutral position.

AB774 (Chan) was 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, CALPIRG, California Alliance for Retired Americans, California Church IMPACT, Latino Issues Forum, California Immigrant Welfare Collaborative and many others.

Labels: Updates

• State Would Use Purchasing Power to Negotiate Best Possible Price for Millions
• Drug Industry Spent $80 Million in Ballot Battle Last Year Against Concept
• Also Signed: Website to Assist Comparison Shopping for Affordable Prescription Drugs
• Also Signed: Extensions of MRMIP, CHBRB
  

With less than 48 hours before the deadline, Governor Arnold Schwarzenegger signed into law a landmark prescription drug discount program, AB2911(Nunez/Perata), designed to provide significant savings to millions of Californians without adequate drug coverage.

Schwarzenegger also signed AB2877 (Frommer) that would create a website listing safe places where Californians could purchase safe and affordable prescription drugs. Other bill updates are at the end of this article; for an updated list of health bills and whether they have been signed or vetoed, visit the Health Access website at:
http://www.health-access.org/advocating/pending2006_bills.htm

AB2911's enactment is expected not just to provide relief to seniors and uninsured families, but to have national policy implications, since it allows the state to use its massive purchasing power to negotiate on behalf of eligible Californians for lower drug prices, a much-debated concept in other states and in Washington, DC.

DRUG INDUSTRY'S $80 MILLION INVESTMENT

The prescription drug industry spent $80 million dollars last year to oppose a similar concept in Proposition 79, breaking the record for the most expensive ballot campaign in the nation's history. The drug companies even proposed a competing measure, Proposition 78, which offered a prescription drug program that only provided for voluntary compliance by pharmaceutical manufacturers.

Both measures went down to defeat with voter confusion, but Speaker Fabian Nunez and Senate President Pro Tem Don Perata put forward the framework of this compromise between the two approaches on the ballot.

VERIFIABLE, ENFORCEABLE DISCOUNTS FOR UP TO 6 MILLION

Eligible Californians--those without prescription drug coverage under 300% of the federal poverty level ($60,000 for a family of four), seniors, and those with high health costs--get a discount card for a nominal $10 annual fee. For the first three years, the card provides discounts that are voluntarily provided by the drug companies, allowing them to fulfill their commitments from the campaign.

However, after three years, there is accountability. If the drug companies do not participate or do not provide sufficient discounts, the state has the ability to steer some business (of the $4 billion that Medi-Cal now spends on prescription drugs) to those drug companies that do offer good discounts. This uses the same process the Medi-Cal program now uses to get rebates for the state, but broadens the benefit for the uninsured. The discounts are pegged to be around 40-60%--similar to the discounts that large insurers or the state Medi-Cal program gets.

NATIONAL IMPACT

This action potentially creates the largest prescription drug discount program in the nation. California would follow Maine as the only other state to implement this type of discount program (some states provide full coverage and/or have programs to more specific populations, such as just seniors). Many other states have been considering similar discount programs. Ohio considered such a proposal, but after a launch of lawsuits from the drug industry, they implemented a purely voluntary proposal, but with disappointing results to many consumer advocates. Colorado, for example, recently defeated a purely voluntary proposal proposed by the drug companies earlier this year, and is considering a more ambitious proposal like AB2911.

The impact of the California plan is expected to have implications not just in other states but in the national debate on health reform, prescription drug prices, and in particular about Medicare Part D. For example, the California discount program provides some relief to those seniors who find themselves lacking coverage through the "donut hole." It also promotes the concept of government negotiating for the best possible price, something explicitly--and controversially--prohibited by Part D.

Prescription drug costs have been a major issues, as a recent Kaiser Family Foundation survey indicated that half of adults report taking prescription drugs on a daily basis, and a fifth of California families report not filling a prescribed medication due to cost. More than half of these families reported that their health conditions grew worse as a result.

The signing of the bill was the result of over three years of campaigning, working on bills and ballot measures, by a broad coalition of health, consumer, senior, labor, and patient organizations, including the AIDS Healthcare Foundation, AARP, Breast Cancer Action, CALPIRG, Consumers Union, California Consumers United, Congress of California Seniors, California Alliance for Retired Americans, California Labor Federation, Gray Panthers, Greenlining Institute, Health Access California, Latino Coalition for a Healthy California, MALDEF, Older Women's League, Senior Action Network, and Service Employees International Union.

OTHER BILLS

With just one day left, the governor also signed SB1702 (Speier) extending the sunset for the a part of the state's high risk pool for the uninsurable, Managed Risk Medical Insurance Program until 2008, and SB1704, which extends the California Health Benefits Review Board until 2011.

Schwarzenegger has until midnight, Saturday, September 30th to sign the roughly 400 bills remaining on his desk.

We will update advocates on the outcome of these bills in the coming days.

For information, please call Hanh Kim Quach, policy coordinator at 916.497.0923 x 206 or hquach@health-access.org.

Labels: Updates

PROPOSITION 86 SUPPORT GROWS; BALLOT BATTLE ON TOBACCO TAX

• Tobacco tax would reduce youth smoking, save lives, fund health care
• Money would go to health, including to expand children’s coverage, fund hospital care
• ALERT: Support Proposition 86: http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3437327&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.yesprop86.org&l=1
  

As September winds down, so do the days that Governor Arnold Schwarzenegger has to sign or veto hundreds of bills still on his desk. A list of many bills of interest to health advocates, and their status, is being updated at:
http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3437327&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.health-access.org%2Fadvocating%2Fpending2006_bills.htm&l=2

PROPOSITION 86 TOBACCO TAX: As Californian political watchers turn from legislation to the upcoming elections, one of the ballot measures getting more attention than most is Proposition 86, which would increase tobacco taxes by $2.60 per pack of cigarettes, and fund health programs.

If passed, it would raise California ’s tobacco tax to $3.47, discouraging hundreds of thousands of Californians from smoking, yet raising $2.1 billion raised from the new tax would augment treatment funding and expand health coverage to uninsured children in California .

SUPPORT & OPPOSITION: The measure is supported by a range of groups, with key sponsors including the California division of the American Cancer Society, the American Heart Association, the American Lung Association of California, California Hospital Association, Children Now, PICO California, and the Children’s Partnership. A full list of supporters is at:
http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3437327&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.yesprop86.com%2Fcoalition.asp&l=3

The measure is opposed by the tobacco industry, with over $35 million being spent and growing, run by the same consultants who ran campaigns against other recent health care measures, including Propositions 72 and 79. The tobacco industry has spent several weeks attacking Proposition 86, using a host of arguments with the intent to confuse--including ones on consumer protection issues. In response, consumer advocates such as Health Access California and CALPIRG spotlighted their support for the measure, contrasting their credibility with that of the tobacco companies' credibility on such matters.

MORE INFORMATION: This and other information is available at the independent HealthVote website, at:
http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3437327&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.healthvote.org%2Findex.php%2Fsite%2Fprop_home%2FC37%2F&l=4

Voter pamphlets are being mailed, although the summary, analysis, and arguments for and against Proposition 86 are available at the Secretary of State's website, at:
http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3437327&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.ss.ca.gov%2Felections%2Fvig_06%2Fgeneral_06%2Fpdf%2Fproposition_86%2Fentire_prop86.pdf&l=5

REDUCING SMOKING, SAVING LIVES AND MONEY: A study by the Department of Health Services found Proposition 86 would prevent hundreds of thousands of teenagers from becoming smokers, saving lives and billions in healthcare costs. In particular, it states that:
Prop. 86 would reduce the number of cigarettes consumed in California by more than one quarter (26.3 percent).

• About half a million Californians would quit smoking.
• More than 700,000 children currently under 17 years of age would not become smokers in adulthood.
• The state would take in an additional $2.27 billion in revenues (this estimate is $170 million larger than the Legislative Analyst’s estimate of $2.1 billion).
• Total California tax revenues from cigarettes (excise tax of $3.47 per pack of cigarettes plus five percent sales tax) would increase more than $3 billion a year.
• The state would save more than $16 billion in health care costs.
• About 300,000 fewer premature deaths would occur, including nearly 180,000 deathsdue to smoking among children currently under 17.

The proponents have a summary of the study at their website, at:
http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3437327&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.yesprop86.com%2Fpdf%2FWhat%2520DHS%2520Says.pdf&l=6
http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3437327&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.yesprop86.com%2Fpdf%2FTax_Impact_Exec_Summary.pdf&l=7

EXPANDING CHILDREN’S HEALTH INSURANCE: Health advocates had set 2006 as the year to expand health coverage to the state’s 800,000 remaining uninsured children. Efforts to expand funding for children’s health insurance fell flat during the budget season this year, but Proposition 86 provides revenue for this purpose.
Proposition 86 would ensure that all children under age 19 have access to affordable, comprehensive health insurance. Children in families at or below 300% of poverty ($60,000 a year for a family of 4) and not currently eligible for public programs would become eligible for health insurance through Healthy Families. Additionally, Proposition 86 also makes it easier for families to enroll their children and keep them covered.

More information about Proposition 86, in the context of the campaign to cover all California children, is at the 100% Campaign website, at:
http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3437327&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.100percentcampaign.org%2Fissues%2Fcahealthykids%2Findex.htm%23initiative&l=8

HEALTH PROGRAMS FUNDED: Revenues from Proposition 86 would also go to fund a range of other services, including much-needed funds that would in part assist public hospitals, community clinics, and other safety-net institutions.

• Treatment (53%)
• Hospital emergency care services ($756 million)
• Nurse education ($91 million)
• Community Clinics ($58 million)
• Emergency physicians ($66 million)
• Steve Thompson physician education fund ($8 million)
• Prostate cancer treatment ($18 million)
• Tobacco cessation ($18 million)
• Prevention (42%)
• Children’s health insurance ($367 million)
• Tobacco prevention, education and enforcement programs ($175 million)
• Cancer, heart, asthma and other disease prevention and control programs ($265 million)
• Research (5%)
• Includes tobacco-related disease and cancer research ($95 million)
  

ACTION: SUPPORT PROP 86: For your organization to sign up as a supporter, or to find out ways to help the campaign, visit the Yes on 86 website, at:
http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3437327&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.yesprop86.com%2Fhelp.html&l=9

Labels: Updates