Still waiting...

Thursday, November 30, 2006

Our colleagues and allies at the 100% Campaign, PICO California, and other groups held a press conference earlier today urging the Governor to prioritize covering all children as part of his health plan. Here's the release:
http://www.100percentcampaign.org/newsroom/releases/2006/pr-061130.htm

One particular effort is a new website, Fulfill the Pledge, to keep the Governor to his word.
http://www.fulfillthepledge.org/

It's notable that while Governor Schwarzenegger made this promise in his first campaign for Governor three years ago, he has yet to even provide a plan to get there, much less implement it. And he has opposed other opportunities, whether by bill or ballot measure, to achieve the goal.

Will he cover all kids? As he prepares his broader health care plan, it's the very least he can do.
posted by Anthony Wright | Permalink | 7:08 PM


 

She was even willing to provide an early photo for the cause...

The California Progress Report has a great report on Assemblywoman Wilma Chan's last press conference in that position.
http://www.californiaprogressreport.com/2006/11/assemblymember_7.html

It's hard to describe how much of an impact she has had, both on actual health care policy to help consumers, as well as on the debate as a whole. She's been a warrior, a leader, a champion for health care consumers. Health Access California has been the sponsor of many of her bills that became law, including to prevent hospitals from overcharging the uninsured, which she highlighted in her interview, but also to better regulate Medicare Part D plans, and to provide consumer protections and information to those who buy insurance as individuals. But she's also been a leader on the effort to cover all kids, to fight health care budget cuts, to lower prescription drug prices, to help seniors choose drug plans, to provide access to those with "pre-existing conditions," to limit out-of-pocket costs and high deductibles, and many other worthy goals.

She's accomplished a lot, and for the unfinished fights, we'll continue the effort. While there's good allies left in the legislature, we'll really miss her (and other key termed-out legislators) in the coming health care discussion next year.
posted by Anthony Wright | Permalink | 4:16 PM


 

HSAs in Aisle 12

Wednesday, November 29, 2006

Gov. Arnold Schwarzenegger has on several occasions mentioned that he is looking for guidance from the business community on how to resolve the health care problem. In particular, Schwarzenegger is looking to Safeway CEO Steve Burd, who has been proselytizing his own brand of health care.

This year, Burd offered a $2,000 deductible plan, with a $1,000 HSA contribution to the 30,000 managers.

Burd's main thrust, however, is "personal responsibility.''

“When we discovered this behavioral stuff,'' he said. "I felt it was the Holy Grail.''

"It’s where the money is. It’s where the change takes place,'' he said.

People need to quit smoking, lose weight and exercise. (All noble goals, but if you're among the working poor, with two jobs to make ends meet, I'm not sure where you'd find time to exercise or take a smoking cessation class)

Additionally, he says, too many people don't comply with regimens to maintain diabetes, hypertension and other chronic disease. They need to be responsible. (True, but for Health Access, part of being able to maintain your health is having health care so your disease does not become a financial burden.)

Burd's emphasis on "personal responsibility'' is particularly attractive to Schwarzenegger, who has repeated this mantra several times in his ideas about reform.

It is particularly troubling, though, for advocates. It gives people a way to "blame'' others as "irresponsible.'' As we know, the uninsured are 25% more likely to die from their ailments than insured people because they lack health insurance. They are twice as likely to put off care, skip medications, skip doctor visits because of cost -- because they lack health insurance. A high-deductible plan will not help, but may make matters worse if a person is already ill, as Jonathan Gruber explains in his report.

Here is Burd's address to the U.S. Chamber of Commerce on September 7. Health Access has listened to the hourlong webcast and is providing a rough transcription here.
posted by Hanh Kim Quach | Permalink | 10:21 PM


 

Jobs and healthcare

The California Employer Health Benefits Survey 2006 was released today and has some new interesting factoids. Among them, that the number of plans that have no out-of-pocket limit grew from 5% to 16% over six years.
posted by Hanh Kim Quach | Permalink | 9:49 PM


 

Like high school dating...

posted by Anthony Wright | Permalink | 1:01 PM


 

Health issues explode in old *and* new media

HEALTH ACCESS UPDATE
Wednesday, November 29th, 2006


HEALTH CARE DEBATE HEATS UP
* Schwarzenegger Reiterates Health Care Goals, But No Details Yet; Significant Press Focus
* New Web Debate on Health Care Hosted by the Sacramento Bee
* New on Health Access Weblog: Gossip on the Gov's Plans; Congress on Drugs; Admin Staff Change


This weekend on NBC's Meet the Press, Governor Arnold Schwarzenegger reiterated his goals for 2007 of covering all Californians, and reducing health care costs. Yesterday, the Administration held a press briefing reiterating these goals, and promising that the Governor would unveil his health care plan in 41 days--at the State of the State on January 9th, 2007.

These developments have led to more intense press scrutiny of the health care crisis, Governor Schwarzenegger's record to date on health coverage issues, and speculation about his plans for next year. According to these statements, there are no announced details yet with regard to his plan--or even whether he will introduce a specific plan.

On the new Health Access Weblog, at http://www.health-access.org/blogger.html, we have spotlighted and commented on recent editorials and press accounts. BELOW is a catalog of recent articles in the last two weeks that report on what is known, and what is not known, about Schwarzenegger's health care plans for 2007. For those wanting to track this renewed debate, they are worth reading:

Recent Articles:
Sacramento Bee 11/27: http://www.sacbee.com/111/story/83351.html
San Jose Mercury News 11/27: http://www.mercurynews.com/mld/mercurynews/news/16106382.htm
San Francisco Chronicle 11/27: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/11/27/BAGBPMKDT11.DTL&hw=health+schwarzenegger&sn=002&sc=831
California Healthline 11/27: http://www.californiahealthline.org/index.cfm?action=dspItem&itemid=127547
Los Angeles Times 11/25: http://www.latimes.com/news/health/la-fi-health25nov25,1,6558256.story
Sacramento Bee 11/19: http://www.sacbee.com/296/story/79527.html
Los Angeles Times 11/19: http://www.latimes.com/news/la-me-health19nov19,1,4969121.story
San Francisco Chronicle 11/18: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/11/18/BAGVAMFAO91.DTL&hw=health+schwarzenegger&sn=007&sc=337
Sacramento Bee 11/15: http://www.sacbee.com/111/story/77205.html

Recent Editorials:
San Franscisco Chronicle: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/11/28/EDGIHMKRSI1.DTL&hw=health+schwarzenegger&sn=001&sc=1000
San Jose Mercury News: http://www.mercurynews.com/mld/mercurynews/news/opinion/16088129.htm
Sacramento Bee: http://www.sacbee.com/110/story/83298.html
Contra Costa Times: http://www.contracostatimes.com/mld/cctimes/news/editorial/16101974.htm

The New Blog Debate:
The Sacramento Bee is hosting a new online forum, Crossroads, starting first with the renewed health care debate. Daniel Weintraub, the moderator and libertarian-leaning blog veteran, has invited various health care policy people to contribute initial op-ed style pieces, and then allow them, and the public, to comment and discuss health reform amongst one another.

Health Access California executive director Anthony Wright was invited to put the first article up, which already got a quick response from Dr. James Knight, a conservative proponent of Health Savings Accounts. You can read the debate and participate in it here, at:
http://www.sacbee.com/static/weblogs/crossroads/healthcare/

BELOW is the full article posted, which provides a framework for thinking about the renewed debate this year. We invite your responses, both directly at awright@health-access.org, and on the blog.


ANXIOUS FOR ACTION
Anthony Wright, executive director, Health Access California

Too often debates about health care in Sacramento or DC turn into fights among industries: hospitals vs. insurers, doctors vs. medical groups, HMOs vs. drug companies, etc. As the director of Health Access California, the statewide coalition representing health care consumers, I welcome broadening this debate to include those who our health care system is supposed to serve: the patient and the public. But it is no longer good enough to have the debate; it is time for action.

CALIFORNIANS MORE LIKELY TO BE UNINSURED: For California patients and families, health care is a deeply personal and important issue, that goes directly to one’s life and livelihood. Californians are more likely to be uninsured than those in 45 other states. Over six million Californians are uninsured—80% are workers or their family members—and many more are underinsured. Many with insurance at the moment fear that it won’t be there for them when they need it.

THE CONSEQUENCES OF UNINSURANCE: Why should we care? Those who are uninsured live sicker, die younger, and are one emergency away from financial ruin. They don’t get needed care, including preventative screenings, ongoing treatment for chronic conditions, and emergency care, resulting in worse health outcomes, for them and the community at large. The uninsured are more likely to die prematurely than insured patients with similar problems. Financially, nearly half of the uninsured reported having unpaid bills or being in debt to a health provider. In fact, medical problems and bills are a leading cause of personal bankruptcy.

A MANDATE FOR CHANGE: So it is good news that both major gubernatorial candidates made health care affordability and coverage expansion a major priority for next year, and that the re-elected Governor Schwarzenegger stated that 2007 will be the year of “health care, health care, health care.”

Our health system is at a crossroads, and action is needed just to preserve the level of health security we have today.

TWO PILLARS OF OUR HEALTH SYSTEM: Of 36 million Californians, 19 million get health coverage through employers, and another 10 million get coverage through public insurance programs like Medicaid (Medi-Cal in California) and Medicare. The common theme is that we come together to share the risk and cost of health care, either at the worksite, or through a public program.

WHAT DOESN’T WORK: In contrast, relatively few Californians—1-2 million—get coverage in the private marketplace, because it is either unaffordable, or unavailable, due to so-called “pre-existing conditions.” As individuals, consumers don’t have a chance against big insurance companies, who actively try to avoid covering those who actually need care. Together, we know it is more affordable and efficient to get insurance in a larger group—and the larger the group, the more effectively we can spread risk, and the better we can bargain for fair rates.

THE CHALLENGE: Yet the two key pillars of our health system on which most of us rely, employer-based coverage and public insurance programs, are under attack. Employers are scaling back health benefits or dropping them altogether—which places an additional burden on public programs. Yet some politicians have proposed cuts or caps on Medicaid and Medicare coverage, even though they have proven more cost-effective than the private insurance-even at taking care of the oldest, sickest, and frailest amongst us.

THE POLITICAL WILL: The best solutions are to fortify these key pillars, building on what works to both protect the coverage that people have and extend coverage further. In the past four years, the California legislature has tried to do just that. To bolster private coverage, it set a standard for employers to provide health benefits to their workers, much like the minimum wage does for pay (SB2 in 2003); it passed an expansion of public insurance programs to cover all California children (AB772 in 2005); and this year, it passed a reform that would bring all Californians together under a universal health care system (SB840 in 2006). Each of these efforts were opposed by Governor Schwarzenegger, either in ballot campaign or by a veto.

FIFTH YEAR’S THE CHARM?: So 2007 should not be seen as the beginning of a health care debate in California, but the culmination. We’ve been having this debate in our state for four years; it’s now time for action.

THE RISKS OF INACTION: Without positive action, the health care system is deteriorating, and individual patients and families are being forced to take on the risk, burden, and cost of health care.

What’s worse, some so-called policy solutions actually encourage this trend, toward what economist Jared Bernstein calls YOYO, or “you’re on your own.” Such YOYO ideas include using the tax system (through so-called Health Savings Accounts) to encourage underinsurance and high-deductible plans, where consumers bear the risk for most medical expenses; and imposing an “individual mandate,” forcing consumers to purchase unaffordable coverage in the broken individual insurance market.

THE CHOICE: That’s the choice we have. If the health care system continues down the current path, you’re on your own to deal with your next major medical emergency. But the Governor and the Legislature can actually come together, to bring Californians together, we all will be healthier for it.

We look forward to the debate, but we are anxious for some action.

Labels: Updates

posted by Anthony Wright | Permalink | 12:24 AM


 

Whitewashing Wal-Mart

Tuesday, November 28, 2006

This story in the Sacramento Bee today hails the arrival of Wal-Mart's $4-a-prescription that "sets the stage for a generic drug price war in the state'' listing other retail giants, such as Target and Raley's who are poised to meet their low prices.

To parade Wal-Mart as the Pied Piper of cheaper drug prices, when the Wal-Mart is the beacon for what is wrong with corporate health practices in America, is completely absurd.

Legislation to enact "fair share'' benefits were inspired by the company, which has among the most abominable practices in the U.S.

Wal-Mart:

• Insures fewer than half (46%) of its employees.
• Carries only high-deductible plans -- $1,000 for an individual and $3,000 for a family.
• Pays low wages -- an average $10.50 wage (in California).
• Imposes a six-month waiting period for full-time employees to become eligible for benefits. (Most large businesses have a three-month wait.)

Wal-Mart's stingy benefits has already inspired Target to follow suit earlier this year. Other large employers are also eyeing high-deductible plans, in what my colleague, Beth Capell calls "a race to the bottom."

In this paper from the UC Berkeley Labor Center, Wal-Mart workers who enroll in public assistance programs cost California taxpayers $86 million annually. The report also says that "if other large California retailers adopted Wal-Mart's wage and benefits standards, it would cost taxpayers an additional $410 million a year in public assistance to employees.''

It doesn't have to be that way. Costco, another large discount retailer, provides health insurance to more than 80% of its employees and has a three-month waiting period. Employees have a choice between a traditional managed care plan and "freedom of choice plan.''

The practice, unfortunately, does ding Costco on Wall Street.

posted by Hanh Kim Quach | Permalink | 11:21 AM


 

The Renewed Debate: to Bee, or not to Bee?

Monday, November 27, 2006

The Sacramento Bee is hosting a new online forum, Crossroads, on the renewed health care debate. Dan Weintraub, the moderator and blog veteran, has invited various health care policy people to contribute initial op-ed style pieces, and then allow them, and the public, to comment and discuss health reform amongst one another. My article is first up, posted here:http://www.sacbee.com/static/weblogs/crossroads/healthcare/

The Sacramento Bee editorial board gets in on the discussion too, responding to its own article about the Administration considering scaling back mandates and other consumer protections on insurers. The editorial is right to warn against so-called reforms that simply seek to shift the risk and cost of health care to individual consumers and families. They don't make the obvious point: removing the mandates won't actually save any real money, even as they dramatically increase the burdens of specific consumers, while causing worse health outcomes and necessitating more expensive treatments later.
posted by Anthony Wright | Permalink | 10:09 PM


 

Meet the Russert

Sunday, November 26, 2006

Governor Schwarzenegger was on Meet the Press this morning. It wasn't Tim Russert's toughest interview, with very few of his trademark"gothcha" questions, and more about his advice for Republicans in D.C.

On health care, it was notable that he spotlighted his work on prescription drug prices twice, along with the minimum wage, global warming, and infrastructure. The full transcript is available at MSNBC's website, at:
http://www.msnbc.msn.com/id/3032608/

Whlie he didn't go into detail, he did make some comments about health care of note. While he reiterated statements made previously, he made the stakes clear, especially on the goal of covering all Californians, " fixing our health care problems to insure everybody that is uninsured." It's a good, clear statement to hold him to in the next year.

"This year is the year where we go—this coming year—where Democrats and Republicans are going to work together to fix our health care problem. First of all, we have to bring down the health care costs, we have to make it more affordable to provide health care. Number two, we’ve got to insure everybody, because we have 6.7 million people that are uninsured, and we’re working right now on the various different ideas, we’re going to bring those ideas together, I’m going to present this in my State of the State address. But this is the next big challenge. Look, if we could face the challenge and fix our infrastructure problem and approve a $37 billion infrastructure package, we can also solve the health care problem. We’re going to solve all of those things. Democrats and Republicans are very determined in California to say, “We have certain problems that have been problems for decades, and we’re going to go out now and fix it.” And that is what is so wonderful about it, bringing both of the parties together.

He did not say how he would acheive this goal, but he might want to be more flexible than his other statements. He noted that the voters opposed the various initiatives that included a tax, including, he mentioned in a gratuitous remark, the measure by the California Nurses Association. Yet in the same interview, the Governor stated that when voters rejected his initiatives, it wasn't that the content was bad... it was "the approach." Most analysts concluded the determining factor was that every initiative with a funded opposition lost.

In fact, the closest measure was the tobacco tax, which got 48% despite $60 million spent against it, and whose opposition campaign didn't even oppose the notion of a tax, but rather focused on ancillary provisions for hospitals that were portrayed as anti-consumer (such as an anti-trust exemption). If the Governor is trying to read the mood of the public about revenues for health care, he may want to take a closer look at the election results.
posted by Anthony Wright | Permalink | 10:14 PM


 

Congress on drugs...

Saturday, November 25, 2006

The wave of prescription drug price reform that started in California this year is heading toward Washington, DC.

Several articles, such as in the New York Times ("Drug Industry Is On the Defensive"), Wall Street Journal ("Why Medicare Drugs May Be Sticking Point"), and even the London Times ("Big PHRMA on a Mission to Woo Democrats", courtesy of Consumers Union's blog) in the past several days detail the drug companies bracing for the Congressional control to switch to Democrats, who ran on issues such as allowing reimportation of drugs from Canada, and for allowing Medicare to negotiate for the lowest possible price.

The fact that such negotiation was prohibited in the Medicare Part D law was part of the reason that consumer, health, and senior advocates focused at the state level for relief for Californians without prescription drug coverage, including seniors. This led to the epic Prop 78/79 ballot battle last year, where the drug companies spent a record-breaking $80 million, and consumer advocates were left with grassroots tactics up and down the state, including driving an ambulance (above. in Sacramento) and wearing a giant prescription drug costume, (right, at Venice Beach).

But nevertheless, Californians won a landmark prescription drug discount program with AB2911, allowing California to use it purchasing power to negotiate lower prices for up to six million uninsured and underinsured.

The drug companies seem determined not to have this happen in DC. The articles bring up all sorts of tactics to "buy their way out" of this problem, as health care blogger Matthew Holt succintly summarizes it, from hiring key Democratic consultants and staffers, to crafting messages to confuse the issue. Another New York Times article details the close relationships that drug companies cultivate with advocacy and disease groups.

But that doesn't mean the drug companies will win. The drug companies pulled every trick in the book here in California, as detailed in this Health Access report. Yet we were ultimately able to pass something meaningful here. But it's a good reminder that they don't go down without a fight...
posted by Anthony Wright | Permalink | 6:35 PM


 

Mercy Mercy Me

Businesses are already beginning to kvetch about potential costs associated with Gov. Arnold Schwarzenegger's plan to cover the state's uninsured, the Los Angeles Times writes today.

Small-business owners, who say they can't afford to offer health insurance, gripe that they could be forced out of business if hit with an expensive mandate.

Large corporations, which are providing increasingly costly health benefits, contend that they shouldn't ante up even more in subsidies. And unions adamantly oppose raising employee co-payments and deductibles.

But Bill Dombrowski, president and chief executive of the California Retailers Assn., said that "everybody has got to step up to the plate" if California wants to expand healthcare.

"Employers recognize that they are going to have to play a role," Dombrowski said. "But there's still a question about what the individuals and the healthcare systems will contribute."

I don't understand why businesses keep saying individuals don't contribute. Individuals already pay premiums and are being asked to shoulder more out-of-pocket costs -- without any input. There seems to be no question that individuals are going to contribute.

One county, though, offers a look at how government, businesses and individuals can come together and create a health system. The plan, spelled out in Friday's San Jose Mercury News would expand the use of Santa Clara County's existing infrastructure for indigent adults (county clinics, hospitals and cadre of physicians) to small businesses that employ low wage workers. The employers and workers would each pay into the system. The state would also pitch in.

The jury is still out on whether a plan like this -- or San Francisco's recently passed Health Access Plan will work, but both serve as models for how the disparate communities can come to a workable agreement.
posted by Hanh Kim Quach | Permalink | 10:43 AM


 

Taking and not giving

Friday, November 24, 2006

The Sacramento Bee has an interesting story about the Bush administration's reticence to release a study on farmworker health and access to care.

The study, which was commissioned four years ago, was intended to help national policymakers plan for better health care for three million migrant farmworkers who are the backbone of our food supply.

The nation's estimated 3 million migrant and seasonal farmworkers are generally poor. Three out of four earn less than $10,000 a year.

Few are insured. By some estimates, only about 5 percent are covered by employer-provided health insurance. Their work is dangerous.

Thirteen percent of U.S. occupational deaths during the 1990s occurred in farming, though farmworkers made up only 2 percent of the nation's work force.

...

"Oftentimes if we can catch their illnesses early, we can actually save society a great deal of money," then-Rep. Mark Foley, R-Fla., declared during brief House debate. "The sicker a person becomes ... the more expensive it is and typically will be treated in an emergency room where the cost is that much greater for Medicaid."

The issue will be a thorny one for state lawmakers and Gov. Arnold Schwarzenegger, too, as many of these farmworkers are also undocumented immigrants. This past year, efforts by Gov. Schwarzenegger and Democrats to expand coverage to all children was thwarted by Republican legislators, who objected that some of those children would be undocumented.

It will be interesting to see how the release of such a study will affect the debate in California.

Labels: Bush

posted by Hanh Kim Quach | Permalink | 11:31 AM


 

Something not to give thanks for

Thursday, November 23, 2006

Actors and artists will see health care premiums increase by as much as 254 percent next year, according to this Los Angeles Times story.

"We have a right to raise their rates, and we have the right to raise their rates based on experience," Cigna's Gwyn Dilday said. "They are a large group, and their rates are based on the claims experience of the group."

Regulators said this week that they were looking into the increases, but their hands may be tied. With the exception of the so-called small-group market, health insurers in California are largely free to set premiums as they see fit.

Something we should all watch as the health care debate next year takes shape.
posted by Hanh Kim Quach | Permalink | 11:59 AM


 

Be thankful if you are healthy...

Wednesday, November 22, 2006

As Ezra Klein at The American Prospect points out, the Kaiser Family Foundation put out a sobering study about how cancer has an impact not just on the health of the diagnosed individual, but on the broader family. It has troubling information about the impact of a major disease on a family's finances, especially if they are uninsured--but even if they are insured:

From the KFF press release:

The survey found that one in four families affected by cancer say the experience led the person with the disease to use up all or most of their savings, and one in eight say they borrowed money from relatives. The illness also made it harder for some to find and keep health insurance – with about one in 10 saying they couldn’t buy health insurance because they had been diagnosed with cancer, and 6% saying they lost their coverage as a result of the disease.

Having health insurance at all times during treatment helped to limit the financial consequences of a cancer diagnosis, but even those with consistent coverage faced difficulties – one in five used up all or most of their savings, one in 10 borrowed money from relatives and 9% were contacted by a collection agency.

Among those who did not have health insurance consistently during their illness, the financial burden was even greater. More than one in four said that they delayed or decided not to get treatment because of its cost – five times the rate reported by those who had health insurance consistently. Nearly half used all or most of their savings; four in 10 were unable to pay for basic necessities; one in three sought the aid of a charity or public assistance program; and 6% filed for personal bankruptcy.

“This is one of the most disturbing of the hundreds of surveys we have done,” said Kaiser Family Foundation President and CEO Drew E. Altman, Ph.D. “When people with cancer are deferring care and experiencing such serious financial hardships because of inadequate insurance or because they have no health insurance, it casts a new light on the need to address our nation’s health insurance problems.”

Lots of implications for the California health debate...
posted by Anthony Wright | Permalink | 7:08 PM


 

Mother knows best...

Two more points about the Sacramento Bee story this weekend about the Administration considering removing requirements on insurers to provide certain services.

* With all the talk of Massachusetts, let's be clear: that state has more mandates for what constitutes minimum coverage, yet also has nearly half the percentage of uninsured as California. As other states show, we can clearly expand coverage without sacraficing these consumer protections. (In fact, it is likely that more people are insured in Massachusetts because they have *more* oversight over insurers and their practices, not less.)

* The new study about what a "basic benefits" pacakge looks like, by Sacramento HealthCare Decisions, funded by the California HealthCare Foundation, adds an interesting counterpoint to the Bee article. As my colleague Hanh pointed out, the business representative made the case against mandating maternity coverage, even though it is actually not a benefit required in California. (Governor Schwarzenegger vetoed a bill to do that a couple of years ago.) Yet what benefit do the most people of those surveyed consider essential? Maternity coverage, with 99%.
posted by Anthony Wright | Permalink | 1:22 AM


 

Changing of the guard...

Tuesday, November 21, 2006

The press has made a lot about the turnover in the Governor's office, with major figures leaving such as press secretary Margita Thompson and legislative director Richard Costigan. Costigan's departure matters in next year's health reform debate, given his history on the issue: In 2003, he was the Chamber of Commerce's top lobbyist and the main opponent of SB2(Burton), the bill to expand employer-based coverage.

Under the radar for the mainstream press, but hugely important for health policy, is the just announced departure of Stan Rosenstein, the Director of Medi-Cal (California's version of the federal Medicaid program). In a thoughtful E-mail, Stan reports he is retiring from state service after three decades--and in Executive positions under four Governors. He reports that he will "establish a Sacramento office for one of the nation’s leading healthcare consulting firms, Health Management Associates, and will start work on January 15, 2007."

In his long history, there certainly have been many times when we as health and consumer advocates have strenously disagreed with Stan's positions and statements, but let me simply point our three positive and memorable events from just this year.

* Stan had a big role in a celebration of Medi-Cal's 40th anniversary, but even for that event it was hard to overstate how important the program is, providing coverage for over 6.8 million Californians--many seniors, people with disabilities, children & many of their parents, and providing significant funding for the health system on which we all rely. He was appropriately proud of the program, and at the celebration, Medi-Cal adopted a logo that represented these patients, as well as all the California counties that are important participants. All year, I never have seen Stan without the new Medi-Cal lapel pin, or without one of his trademark purple ties.

* When the initial implementation of Medicare Part D was clearly faltering, Stan was seen as taking an active role in having California adopt emergency "coverage of last resort," to ensure that low-income seniors and people with disabilities got their medications until the problems were fixed. While advocates have an unfinished agenda in preventing these "dual-eligibles" from being worse off under Part D, these quick actions may have saved lives.

* The last time I saw Stan was at the signing ceremony for AB2911 (Nunez/Perata), the much-discussed prescription drug discount bill, an issue he was involved in for many years. [Here is a picture from the ceremony, from left to right, of Stan, Assembly Speaker Nunez, myself, and Governor Schwarzenegger.] The Governor (wearing a matching pink tie to Stan's purple tie) made an explicit point of ensuring that Stan got one of the signed copies of the bill. Maybe he knew something that we didn't?
posted by Anthony Wright | Permalink | 11:52 PM


 

Cheaper for whom?

The San Francisco Chronicle today details an emerging behavior by employers trying to trim costs: go for cheaper high-deductible plans. Premiums on these coverage options cost less, for the employer and employee at the front end.


BUT if you happen to get sick, need surgery, have chronic pain that doctors can't seem to diagnose, it'll end up costing you far more for doctor's visits, drugs, etc.

Some people seem to believe higher deductibles will cause patients to become more cost conscious and "shop around'' for care. NOT. ...But not for lack of trying. There simply isn't enough information out there on cost and quality.

When was the last time you tried to "shop around'' for a pap smear, prostate exam, blood test. The information simply isn't out there and isn't easy to get. And if you're in an ambulance, suffering from a heart attack, there's really not enough time to do the research.

The Employer Benefit Research Institute and The Commonwealth Fund both have relatively recent reports on consumers, high deductible health plans and their accompanying Health Savings Accounts.

The evidence, so far, shows that while these plans may be more affordable for employers -- it means employees will be paying more.
posted by Hanh Kim Quach | Permalink | 4:14 PM


 

Why a Blog?

Monday, November 20, 2006

HEALTH ACCESS UPDATE
Tuesday, November 21, 2006


EXPANDED BLOG FOR EXPANDED DEBATE ON HEALTH REFORM
* Updated Daily With Latest Developments on California Health Policy
* Latest Reports About Governor’s Plans for 2007 Health Reform


Health Access, the statewide health care consumer advocacy coalition, is pleased to announce that we are expanding the blog on our website to feature commentary, action alerts, and breaking news on a daily basis. In addition to these E-mail updates and alerts, we hope this provide real-time insight on the renewed health reform discussion in Sacramento, just as it heats up leading into 2007 and beyond.

In the past few days, we have just posted some reactions to what the several newspapers are reporting that Governor Schwarzenegger may be considering to unveil in a health proposal, including a Los Angeles Times overview, a San Francisco Chronicle article about prevention strategies, and a Sacramento Bee report about a potential attack on the HMO Patients' Bill of Rights. We invite you to visit the blog, on a regular basis, at:
http://www.health-access.org/blogger.html

BLOG BACKGROUND: For the last five years, Health Access has produced the E-mail alerts and updates like the one you are reading now, reporting in a timely way the happenings in Sacramento regarding the health policy debate. Our purpose is not just to inform, but to provide a resource to help take action to help preserve and expand access to care for Californians. We hope they have been useful to your work.

These posts have gone to hundreds of staff members of coalition allies and membership organizations, community leaders, public policy experts, key activists, and others interested in working toward the goal of quality, affordable health care for all. They have also been archived on a blog at the Health Access website, at:
http://www.health-access.org/Sac_archives.htm

These posts document an important time in the debate over health policy, spanning over a major budget crisis as well as two gubernatorial elections, a recall election, a presidential election, and a special election. It saw the beginning of a debate over major health reform several years ago, which has continued to the present day. This debate has led to the passage of major bills that would have expanded coverage to workers and their families (SB2 in 2003), children (AB772 in 2005) and all Californians (SB840 in 2006), only to see them blocked by a Governor’s veto or at the ballot box. The archives detail many of the specific committee hearings, floor debates, and votes taken.

With this expanded blog, we are still committed to continue to send out these updates on a regular basis, to report on committee hearings, the progress of legislation or the budget, or other full-fledged updates. To sign up to get these E-mails, you can subscribe right from the Health Access website home page:
http://www.health-access.org/

THE NEW COMMENTARY: But in addition to these updates, we want to be able to share real-time information, the latest wonkish gossip going around the Capitol, to the reaction from the story in the morning paper, to highlighting a new study that provides new perspective on the debate of the moment. We want to help California organizations and individuals be engaged in this campaign for health care reform, and we hope to provide the tools to help.

As the statewide health care consumer advocacy coalition, our goal is to assist organizations in advocating for health care reform on behalf of their constituency. Some groups are focused on many other issues; others are local and are less familiar with the ways of Sacramento . Our hope will be to make the process transparent, and give the best sense of what the discussion is, and most importantly, where is there an opportunity for input and intervention. The point is not just to educate, but to activate.

We are unabashed in our perspective as advocates for health care consumers--the uninsured, insured, and underinsured--not from the health providers, insurers, or others from the health industry, or even that of a dispassionate observer. That's our position as consumer advocates, as a coalition of community groups which have won the HMO Patient’s Bill of Rights to this years’ passage of bills to stop hospital overcharging and implement a prescription drug discount program. Our interest for this blog will be the same: How will these policy changes impact the patient, and the public?

YOUR HOSTS: The blog will be hosted by two Health Access staff members: Hanh Kim Quach, policy coordinator, as well as Anthony Wright, executive director. Hanh has extensive experience working for years as a newspaper reporter, most recently for a major daily covering the Statehouse, before joining Health Access. We expect she will use her journalism expertise to provide fresh insights and new information to the health policy debate, and most of all do so in a way that is understandable to those not immersed in the field. Anthony will bring his experience as a consumer advocate and organizer in California and other states, on health care and other issues.

As we develop the blog and our website further, we expect that we will have contributions from other Health Access staff, and guest blogs from our board members, and staff of member and allied organizations. We would love your input. Feel free to contact Hanh Kim Quach at hquach@health-access.org, or Anthony Wright at awright@health-access.org, with suggestions, ideas, or other thoughts.

NAME CONTEST: As we expand the blog, we are looking for a name for it, beyond the rather boring “Health Access Weblog.” Please send suggestions to hquach@health-access.org. The winning entry will get an as-to-be-determined prize, and the thanks of a grateful blogger.

Labels: Updates

posted by Anthony Wright | Permalink | 6:10 PM


 

Cards on the table...

As Hanh has indicated here earlier, the speculation in Sacramento is rampant about what the Governor is considering for his health proposal. Jordan Rau in the LA Times lays out some of the history and provides a good sense of the dynamics...

But back to the recent story in the Sacramento Bee by Aurelio Rojas, which says the Governor is considering rolling back the HMO Patients' Bill of Rights (which Health Access California sponsored). The press spin was as follows:

"Right now, the administration is combing through hundreds of ideas and concepts," said Adam Mendelsohn, the governor's communications director. "No idea is in, no idea is out, and there is no specific plan developed."

But that's plainly not true. The Governor has already ruled lots of things off the table, most notably with his veto of SB840, Senator Sheila Kuehl's California Health Insurance Reliability Act. That's off the table, but somehow a huge gift to the HMOs--repealing managed care consumer protections--is on the table?
posted by Anthony Wright | Permalink | 4:13 PM


 

No Man is an Island

Sunday, November 19, 2006

Today’s Sacramento Bee story highlights an option that the administration is looking at to try and trim health care costs. The method essentially involves getting rid of some of the state's 23 health plan benefits that are mandated by law. These hard fought patient protections range from cancer screening, to diabetes maintenance and treatment of mental illnesses.

One of the advocates of this idea is Michael Shaw, assistant director for the National Federation of Independent Business:

First of all, Shaw needs to do his homework. California does not mandate maternity coverage and many small group plans don’t offer it – or if they do, it’s only after thousands in deductibles have been met.

Secondly, helping to shoulder the cost for maternity coverage is really the least young, single, virile men could do.

The substance of Shaw's argument troubles me, though. He is essentially arguing that there is not public good in pooling together to collectively shoulder costs.

If you look at the state's list of mandated benefits -- with the exception of some of the family-planning benefits -- none of the conditions are within a person's control. You have it -- or you don't.

Shaw is saying that if you are unlucky enough to have -- say -- Alzheimer's disease, osteoporosis or a mental illness, you're on you're own, because the healthy crowd doesn't believe it should have to take care of you.

But what happens when someone who is healthy suddenly becomes unhealthy -- and gets -- say, prostate cancer. Then what happens?

Under Shaw's idea, you pay for it yourself, or you don't and face the consequences.

The lesson under this model: Pray that you never get sick.

Here is a listing of California’s 23 mandated benefits. All may be found in the state’s Insurance Code. (A similar list exists in the Health and Safety Code for HMOs regulated by the Department of Managed Health Care.)

1. 10119(b): Mandated benefit granting immediate accident and sickness coverage to each newborn infant and adoptive child.
2. 10119.5: Mandated benefit for involuntary complications of pregnancy, at regular policy benefits. Limited to those policies which provide maternity benefits.
3. 10119.7: Mandated benefit for diethylstilbestrol (DES) conditions or exposure
4. 10119.9: Mandated benefit for general anesthesia for dental procedures performed in a hospital or surgery center on patients under age seven, the developmentally disabled and certain other patients.
   
5. 10123.21: Mandated benefit for surgical procedures for jawbone conditions (TMJ).
6. 10123.5: Mandated benefits for comprehensive preventive care for children age 16 and under in accord with certain guidelines established by the American Academy of Pediatrics (applies to group policies only)
7. 10123.8: Mandated benefit for breast cancer screening, diagnosis and treatment, including prosthetic devices and reconstructive surgery.
8. 10123.81: Mandated benefit for mammograms.
9. 10123.82: Mandated benefit for prosthetic devices to restore a method of speaking incidental to a laryngectomy.
10. 10123.83: Mandated benefit for prostate cancer screening/diagnosis
11. 10123.88: Mandated benefit for reconstructive surgery, as defined.
12. 10123.16: Mandated benefit requiring any policy providing coverage for long-term care facility services or home-based care to cover persons with certain degenerative illnesses, including Alzheimer’s disease (except for pre-existing conditions.)
13. 10123.18: Mandated benefit for annual cervical cancer screening test if policy includes coverage for treatment/surgery of cervical cancer.
14. 10123.20: Mandated benefit for all generally medically accepted cancer screening tests.
15. 10123.68: Mandated benefit for a second opinion when requested by insured or health professional treating an insured.
16. 10123.89: Mandated benefit for testing and treatment, including formulas and special food products, of phenylketonuria (PKU)
17. 10123.184: Mandated benefit, in certain policies which provide maternity benefit, for participation in the Expanded Alpha Feto Protein (AFP) prenatal testing program.
18. 10123.185: Mandated benefit for services related to diagnosis, treatment, and appropriate management of osteoporosis.
19. 10123.195: Mandated benefit requiring any policy providing prescription drugs to cover drugs, which are prescribed for a use that is different from the use for which the drug has been approved by the FDA.
20. 10123.195: Mandated benefit requiring any policy providing prescription drugs to cover a a variety of FDA approved prescription contraceptive methods.
21. 10144.5: Mandated benefit for diagnosis/treatment of severe mental illnesses (adults and children) and serious emotional disturbances of children.
22. 10145.4: Mandated benefit for routine patient care costs related to cancer clinical trials.
23. 10176.61: Mandated benefit for equipment, supplies (including prescriptions if prescription coverage is included), and self management training for the management and treatment of diabetes.

posted by Hanh Kim Quach | Permalink | 1:07 PM


 

A Fat Smokescreen

Saturday, November 18, 2006

My head spun when I read today’s San Francisco Chronicle article describing
Gov. Arnold Schwarzenegger’s plan to promote “personal responsibility” and
healthy living as part of his health care reform.

“From too much junk food and too little exercise to missed doctor visits,
Schwarzenegger wants to get serious about shaping up California.

Although debate continues internally about how the administration would
encourage participation, officials said Friday that Schwarzenegger wants his
health care agenda to address not just cost and coverage issues but also
disease prevention.

The article goes on to focus mostly on obesity.

Don’t get me wrong. I don’t think people should gorge on Big Macs, French fries and not exercise.

But I believe the Governor's focus on this could be a red herring that fails to help people understand the systemic failures that have lead to the nation’s increasing obesity and declining health.

To truly engage in prevention – and maintenance of chronic diseases – one needs insurance. Real insurance.

Not the kind that gives you one free mammogram a year and one free "routine'' visit and
pats itself on the back. Not the kind that requires you to pay thousands out of pocket for the maintenance of your diabetes, high blood pressure or heart
disease.

Meaningful insurance is insurance that will really cover the times when you have indescribable
symptoms that doctors can’t seem to diagnose.

Meaningful insurance is insurance that will ensure you don’t hold off on going to the doctor because you'd rather save money and wait out stabbing pain in your side, hoping will go away.


Let’s get back, though, to dissect the issue of obesity:

In 2005, 14.2 percent of teens were obese. That’s nearly 500,000 overweight
teens, according to the latest California Health Interview Survey. Adults
fare worse, with 5.6 million – or 21.2 percent of the state’s adult
population.

• Why are people obese?

The Centers for Disease Control blames the prevalence of “abundant, but
nutritionally poor food’’ combined with limited physical activity.

• Why are people eating nutritionally poor food?

It’s cheaper and it’s abundantly available.

• Why is nutritionally poor food abundantly available – and cheap?

Well, authors Greg Critser and Michael Pollan believe it's because of the ubiquity of high-fructose corn syrup, which flavors everything from soda to fruit juices to granola bars to ketchup.Nutritionists blame high-fructose corn syrup for the rise in obesity.(Read more about this here and here.

• Where do you start?

Is the Governor willing to talk Safeway CEO Steve Burd (whose health plan
for managers is serving as a model for the administration) into banning the unhealthy
snacks aisle in his stores?

Is the Governor asking Carl's Jr. to stop serving over-sized portions of
high sugar/high fat food?

If Schwarzenegger is unable to see that we are living in a system that has created an unhealthy environment, I can’t see the administration getting very far in his attempts for health reform focused on prevention.

To read the SF Chronicle article that set me off, click here.
posted by Hanh Kim Quach | Permalink | 2:44 PM


 

A game of Clue

Friday, November 17, 2006

The Sacramento Bee reported about the Governor's comments, stating a goal of reducing the rate of uninsurance in the state by half.
http://www.sacbee.com/391/story/77205.html

After statements that focused on other aspects of health reform, it's good he is still talking about expanding coverage. It's an important statement, a benchmark to hold him to. However, no word on what approach he will take....

The game is Sacramento right now is to guess what the Governor might come out with. Less attention is being paid to the (probably multiple) proposals the Legislature might produce, even though both the Governor and the Legislature are vital to getting something passed.

The Legislature, however, has previously shown the political will to pass major health expansions, to working families (in 2003), children (in 2005), and all Californians (in 2006). Those will be back in the mix in some way, regardless of what the Governor does. More speculation to come...
posted by Anthony Wright | Permalink | 10:44 AM


 

A kid at 25 -- a good thing

Monday, November 13, 2006

A tidbit buried in a Tuesday (11/14) Wall Street Journal Story:

"...Health insurance...is ''at the top of the list'' of workers' problems. (An) idea is to offer government coverage for everyone under a certain age -- say 18, or even 25 -- as part of reauthorizing the current federal program for covering low-income children.

"That would be my wildest dream,'' said Rep. Forney "Pete" Stark of California, a prime sponsor of the idea.''

http://online.wsj.com/article/SB116346456714722160.html?mod=home_whats_news_us (subscription only)

If such legislation passes, California could reduce its uninsured population by another 1.1 million, (CHIS 2003). The most recent study by the California HealthCare Foundation shows that the population between ages 21-24 were the most likely to be uninsured last year.
http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=126257

Why aren't young people insured?

Well -- think back to your first job. You're 21; you're not making a lot of money. You're either just starting your career -- or not on a career path yet. Maybe you're working part-time at a couple places. Maybe you're an intern. Maybe you've just been hired full-time, but are in a probationary period.
That means your employer:

1. Isn't offering benefits - especially if you're part-time.
2. Offers benefits, but to full-time employees who have been working there for a while. (That means not you -- at least right away).

Knowing that, advocates have tried to extend coverage to young adults through their parents' health insurance in past years. In California, Gov. Arnold Schwarzenegger vetoed AB1698 (Nunez) in 2005, which would have extended dependent coverage until age 26.

Should Stark's proposal