Good golly, Miss Molly...

Wednesday, January 31, 2007

Humorist Molly Ivins passed away today, after battling breast cancer. May she rest in peace.

Here's a 2002 column of hers on the need for health reform. And here's a 2000 column that mentions her battle with cancer, as part of a witty but accurate review of what works in health reform, and what doesn't. It also happens to critique President Bush's health care plan, which doesn't seem to have changed in seven years--in fact, it seems to have gotten worse...


Just don't get sick
by Molly Ivins
September 14, 2000

AUSTIN, Texas -- When I was in my 20s, the subject of insurance was so vastly boring that it was a way to describe a bad date: "like talking to an insurance salesman." It's still sort of like your teeth -- something you'd rather not think about but have to take care of -- so let's plunge in.

As Jonathan Cohn pointed out in the May 1 New Republic, the object of health insurance is to get as many people as possible into one big pool, mixing the sick with the healthy. This way, the healthy pay a little more than they otherwise would, but those who get sick pay a lot less.
Since everyone gets sick eventually, if only from old age, it works out fairly. Your chances of never being sick a day in your life and then dropping dead of an undiagnosed heart condition at an early age are less-than-lottery-slim. In most advanced countries, this led logically to national health insurance -- everybody in the same pool, only one administrative agency instead of hundreds...

As a cancer survivor, I am now part of a network regularly called upon to help raise $300,000 to $400,000 for some individual whose insurance company has found a way to drop her. Always a life at stake. The hundreds of thousands of you who have had your HMOs fold under you know how chancy the present system is.

George W. Bush's solution is to promote medical savings accounts -- MSAs. Individuals buy a cheap insurance plan covering only catastrophic illness and then put money aside, tax-free, to cover their medical bills. If there's any left over at the end of the year, they get to keep it. The theory is that this will discourage people from spending frivolously on health care.

"In reality, MSAs simply allow people who expect to be healthy to opt out of larger insurance pools," said Cohn. "Small businesses like the accounts because they transfer the onus for medical coverage more squarely onto individuals. But most experts who have looked at MSAs have concluded that, by further segregating healthy and sick in the health-care market, they make it tougher for people likely to incur high health-care bills to get insurance."

The other piece of the Bush plan is to set up association health plans allowing small businesses to clump together to buy health insurance as cheaply as the big corporations do.

The Catch-22 is that most states already have small businesses clumped together in an insurance pool. The only difference the Bush plan would make would be to exempt those plans from state regulation -- i.e., requirements for minimum benefits like mental-health coverage.
The result would be further segregation of health coverage -- employees healthy, rates go down; a couple of employees get very sick, rates go up; company can no longer afford coverage, drops policy; end result, more uninsured.

Neither move is going to help the 44 million uninsured in this country, and both are likely to increase their number. This is not a solution. For the uninsured, Bush proposes a $2,000 tax credit per family to allow them to buy their own health insurance -- but $2,000 doesn't nearly cover the cost, and nothing is more expensive than buying health insurance as an individual....

For those whose faith in the free market is religious, this is not something to debate. But even Adam Smith admitted that the free market can't take care of everything. And one of the things that no country has yet found a way to make it do is health care. The upside to having government as the only insurer is that it's cheaper because profits don't enter into it.

Worth considering, even if boring.

COPYRIGHT 2000 CREATORS SYNDICATE, INC.

Labels: Bush, ExpandingCoverage, Funny, Insurers, Underinsurance

posted by Anthony Wright | Permalink | 5:47 PM


 

The Senate Republicans take a seat at the table...

Tuesday, January 30, 2007

It's good that the Senate Republicans have put something on the table. (The Assembly Democrats were quick with a statement noting the lack of a plan by the their Republican counterparts.)

The initial take is that it would take us in the wrong direction.

Rather than bringing new resources to improve our health care, the plan proposes to rob Peter to pay Paul: increasing access to some by undermining access to care and coverage for many. For example, it would take money from safety-net hospitals on which we all rely. It would fund children's coverage by taking from other children's programs.

For both public and private coverage, it seeks to increase underinsurance, encouraging high deductibles and scaled-back benefits. And in addition to the problems of what's there, there's also the problem of what's missing: standards for employer-based coverage; better outreach and real streamlining of public programs; more, rather than less, oversight over insurers.

Don't get me wrong: with more legislators at the table, we are still optimistic about the debate and the outcome. The focus on both access and coverage is important, and we support the push for more community clinics...we don't think that should come at the expense of other parts of the health system. And with the other proposals on the table, from the Governor's to Senator Kuehl's, the time is ripe for action.
posted by Anthony Wright | Permalink | 1:46 PM


 

It's really not a choice...

Senate Republicans released their health proposal today with no new surprises. They want high deductible plans, they want Health Savings Accounts. Things we oppose.

But what I found most irksome were the statements about 1 million people who are eligible but not enrolled in Medi-Cal or Healthy Families.

"Many just don't sign up,'' said an incredulous Sen. George Runner, of Palmdale-Lancaster, in spite of the money spent on outreach and education about these programs.

Runner shouldn't be surprised. Each public program has a different "entry point'' making applying to all of them confusing and cumbersome. According to Kaiser Family Foundation, 67% of children who were eligible, but not enrolled had been denied for technical reasons.

Office hours are limited making it difficult for working adults to take the time off. It takes months to be approved. People are randomly dropped off public program rolls.

These should all be familiar issues for Senate Republicans, who would have heard all this in past years when efforts to streamline enrollment wended through the Legislature.

In spite of this not a single Senate Republican voted for last year's SB437 (Escutia) -- which the governor endorsed and encourage -- which makes it easier to enroll (and keep children enrolled) in Medi-Cal and Healthy Families.

Republicans like to complain about all the processes businesses have to go through to keep track of government regulations and rules. I wish they had the same level of empathy for mere mortals.

To see the Republican plan, visit: http://republican.sen.ca.gov/calcare

Health Access will have a more thorough analysis of the Senate Republican plan later today

Labels: Legislation, Republicans, Sacramento, Underinsurance

posted by Hanh Kim Quach | Permalink | 1:04 PM


 

The health of Obama-hype...

Monday, January 29, 2007

posted by Anthony Wright | Permalink | 11:31 PM


 

Spinning the YOYO

Just back from Washington, DC, and saw the discussion on ABC's This Week on the President's health plan.

Apparently, it's in the conservative talking points that George Will was using to simply deny the problem exists, as he and his colleagues also do with global warming. He sought to downgrade the issue of the uninsured, to suggest that since some of the uninsured are only "temporarily" uninsured, it's not much of a problem. I hope he tells that to the folks who have the emergency, the accident, or the ailment while "temporarily" uninsured, and face the hospital bill as a result--perhaps the largest bill that anybody sees in their lifetime.

But even President Bush doesn't deny the problem anymore. Yet his solutions take us in the wrong direction. He adds no new money to deal with these problems, and even when reshuffling the deck of existing funds, he seeks to do so in an inefficient, regressive, and unwise ways.

The Economic Policy Institute appropriately lays out the impacts of the tax change, which is to discourage group coverage (through employers) and shift more people to buy coverage alone as individuals. This not only goes against the notion of insurance as the enterprise of sharing risk, it's also more costly! Rather than expanding public programs (which are far cheaper per person than private coverage) or expanding group health coverage (which enjoy a group discount), he is encouraging people to get coverage in the most expensive way possible.

Most of the articles have been about who is impacted, that those with good health care would be negatively impacted; those who buy health coverage on the individual market would get a decent tax deduction. But the nature of the deduction (rather than a credit, for example) would be regressive, since lower-income folks are in lower tax brackets. The vast majority of Americans who are now uninsured (many low- and moderate-incomes) would not find this helpful, and would not take it up: it would be the equivalent of a three-foot rope to get out of a ten-foot hole.

Kevin Drum at the Washington Monthly and Max Sawicky also make clear this is about the abandonment of group health care. And Ezra Klein and Brad Delong make the excellent point that as health costs rise, the folks who are disadvantaged increase, and the ones who are helped decrease.

Message: You're On Your Own. President Bush would take away the ongoing and open-ended assistance by the federal government for group coverage, and replace it with a fixed assistance to get more expensive private insurance, leaving the individual consumer to face the increating cost of health care all alone.

Labels: Bush

posted by Anthony Wright | Permalink | 1:11 AM


 

"Gold-plated'' vs. tin foil....

Friday, January 26, 2007

I know President Bush's health care proposal is pretty much dead, but I wanted to address his reference to "gold-plated" health plans.

He is actually referring to comprehensive health coverage that could actually provide patients protection from crushing medical bills should they ever get sick, and I suspect we'll hear others begin to characterize health insurance (insurance that actually works, that is) this way too.

"The more expensive the health insurance plan you receive through your employer, the more tax relief you get." (Fact sheet on Bush's 2007 Health Care proposal).

Bush needs a reality check. How many people, when choosing their health plans, look at the list of offerings and say "Which one will give me more tax relief?'' The more relevant questions people ask are: What will my monthly premium payment be? How much will my co-pays/co-insurance be? Is my doctor covered? How much is my deductible?

The truth is, if you can afford it, you choose a plan that you think is going to be a good shield, protecting you against the misfortune of getting sick, getting cancer, having asthma and having flat feet. It also protects you against having to foot the entire bill for having this misfortune.

The kind of coverage President Bush is actually suggesting we get, something that's more "affordable,'' is more like tin foil -- a thin layer of protection that tears easily and exposes us to the elements.

Labels: Bush

posted by Hanh Kim Quach | Permalink | 6:00 AM


 

Walking the halls of Congress...

Thursday, January 25, 2007

Just got back from DC. On the first day, I visited a number of California Congressional offices, along with representatives of the California Pan-Ethnic Health Network and Latino Issues Forum, on the issue of coverage for children.

We got a relatively warm reception at many of the offices, including Democrats and Republicans. But it's going to be a big battle. The State Child Health Insurance Program (SCHIP)--the Healthy Families in California that covers around 800,000 children--is up for reauthorization. The real issue is what level they will fund the renewal at, beyond current levels: enough to keep these children covered? enough to continue enrolling new children? enough to cover all the children in the state? enough to cover their parents as well?

All the health care reform proposals by the Governor and legislative leaders rely on the expansion of Healthy Families to cover all children, but also rely on SCHIP providing a 2-to-1 match. This federal fight is crucial not just in the effort to cover all children, but for health reform in general. We made this point, and many others, to a receptive audience on Capitol Hill.

It was interesting that President Bush's speech, which made a focus on health care, didn't even mention this. Children's coverage will be the focus around health care in Congress, rather than his misguided proposals.

SIDE NOTE: MAYORS! At one of our visits, we walked passed Sacramento Mayor Heather Fargo, doing her own lobbying. Back at the Mayflower Hotel, Oakland Mayor Ron Dellums held court in the lobby area, with his crown of white hair providing him a regal aura. If there were others in town for the Conference of Mayors, I don't think I ran into them.
posted by Anthony Wright | Permalink | 3:56 PM


 

Delayed care often means denied care...

Wednesday, January 24, 2007

Labels: DMHC, Insurers, TimelyAccess

posted by Anthony Wright | Permalink | 3:06 PM


 

President Bush has a Health Plan of his own

HEALTH ACCESS UPDATE
January 24, 2007

PRESIDENT PRESENTS HEALTH PLAN IN STATE OF THE UNION ADDRESS

• Would tax employer-sponsored health benefits for the first time in history
• Would eliminate state consumer protections against insurance companies; would take money from public hospitals
• Ranking members of House Ways and Means committee say proposal is “dead on arrival.”

Now, even President George Bush wants to join the “health reform’’ bandwagon. But rather than seek out more moderate middle ground as he navigates the new Democratic Congress, Bush swings his proposal far to the right.

In his State of the Union address Tuesday evening, Bush unveiled his health care plan, which relies on tax dedcutions to encourage the poor to buy coverage, loosening – or abandoning – consumer protections, and pilfering funds from public hospitals.

House Ways and Means Chairman Charles Rangel (D, New York) and health subcommittee Chairman Pete Stark (D, Fremont, Calif.) have already declared the measure a non-starter.

“President Bush's proposal will make a bad problem worse. I do not intend to consider this particular health care proposal in the Ways and Means Health Subcommittee, but would be happy to meet with the President to consider alternative ideas, starting with the expansion of Medicare,’’ said Stark, a proponent of Medicare for everyone.

TAX DEDUCTIONS KEY IN PRESIDENT’S PLAN

The cornerstone of Bush’s proposal relies on changing how health coverage is taxed. It would impose a new tax on 60% of working families who now receive their benefits through work, thus discouraging the purchase of insurance in a pool where risk is spread across the larger employer group.

Bush’s plan, in turn, would give a $15,000 deduction ($7,500 for an individual) for those who buy their coverage on the more expensive and fickle individual market, where they would bear all the risk.

“Changing the tax code is a vital and necessary step to making health care affordable for more Americans,” Bush said.

Tax deductions, by design, however, favor the wealthy. U.S. Rep. Pete Stark, explains why the plan won’t work.

"The President's so-called health care proposal won't help the uninsured, most of whom have limited incomes and are already in low tax brackets," said Stark. “But it will hurt middle-income Americans, whose employers will shift even more cost and risk to their employees.”

In Bush’s policy papers, the administration claims that his idea would lower health costs because most people are choosing “expensive’’ plans through employers. The President, in turn, attempts to encourage more high-deductible plans, with Health Savings Accounts. Of course, the effect of such a proposal would be to make Americans sicker, as high-deductible plans – forcing patients to delay care rather than shell out thousands in out-of-pocket costs.

OTHER ELEMENTS ALSO PROBLEMATIC

The president also resurrects a plan that failed last year. The proposal, by Sen. Mike Enzi (R, Wyoming), would have allowed businesses to band together across state lines to purchase insurance.

In order to do this, it would lower all insurance regulations to the lowest common denominator, casting away important consumer protections contained in California’s HMO Patient Bill of Rights, such as cancer screening, disease management and the right to a second opinion.

Another feature of the president’s plan would also shift money away from public hospitals – to the tune of $700 million, according to today’s Sacramento Bee.

To see an outline of the president's proposal, click here.

The San Francisco Chronicle, today, also has an analysis of Bush's proposals.

Labels: Bush, Updates

posted by Hanh Kim Quach | Permalink | 10:52 AM


 

D.O.A.

Tuesday, January 23, 2007

Thank God for bi-partisanship, post-partisanship, three branches, checks and balances -- whatever.

Our friend, U.S. Rep Pete Stark (D, Fremont), who believes in Medicare for all, and is the chair of the relevant and powerful House Ways and Means Committee, has proclaimed that the president's health care proposal is dead on arrival.
posted by Hanh Kim Quach | Permalink | 4:51 PM


 

Now that he's eviscerated Iraq....

What voices were whispering in George Bush's head when he drafted the "health proposal'' to be unveiled tonight.

His plan would give families $15,000 tax deduction for having health insurance ($7,500 for a single person) - BUT health insurance through your employer would be considered "taxable income.''

This design would essentially encourage people to pull apart from a buying pool, and take on the risk all by themselves by buying insurance on their own (to take advantage of the tax credit, rather than being taxes. This is exactly the wrong direction we should be going if we really want to hold down costs. We can save money by pooling together, not pulling apart.

And does he really think a family of three making $42,000 a year (in among the lowest tax brackets) needs a tax break for health insurance as they still struggle to pay for basic necessities.
posted by Hanh Kim Quach | Permalink | 1:04 PM


 

Making sure a victory takes hold...

It is true that we all pay a cost for the broken health care system, of having so many uninsured patients. It's one of the reasons why everybody has an interest in covering the uninsured. However, let's not leave the impression that the uninsured get off with free care now.

Far from it. The uninsured often are asked to pay *more* than anybody else in the system, whether for prescription drugs, or for hospital care. The financial repercussions for being uninsured include severe medical debt and personal bankruptcy.

This article in the Sacramento Bee over the holidays shows a case in point. Megan was working but in the waiting period of her job before getting coverage (in her case, a few months, but many employers now make workers or their families wait a year or three being being eligible for coverage). She was riding her bicycle and broke her arm. Like many uninsured patients, she knew the financial hit she was about to take, and took steps--sometimes dangerous to her own health--to avoid expenses. In her case, she explicitly did not call an ambulance, and relied on other ways to get to a hospital. Still, her bill for the hospital visit to get a splint was over $6,000. She incurred other bills from the actual doctors at the hospital, and in follow-up visits, in her path to recovery.

Let's focus on the biggest bill from the hospital. That bill was three or four times larger than insurers get charged for the same service. Insurers have the ability to negotiate down from the "sticker price." Individual consumers, lacking market power, get the main bill.

But that's hopefully going to change. Because of pressure from consumer groups, investigations from Congress, pending legislation in California, and class-action lawsuits, hospitals have begun to change their billing practices, to allow uninsured patients to get a fair price for services.

At the end, Megan was able to pay a rate similar to what Medicare pays for such a service. It's still a lot of money--over $1,500. But for many people, the $5,000 difference is the difference between debt and bankruptcy.

A new law passed this year in California, AB774(Chan), sponsored by Health Access California, to ensure that many uninsured and underinsured patients are not overcharged at hospitals. But as in the case of Megan, it's critical that patients know about their rights and options in the first place. Megan would not have known about the policy at the hospital if she wasn't a friend of mine.

The Office of Statewide Health, Research and Development has a new website about the bill, at:
http://www.oshpd.ca.gov/HID/AboutHID/AB774/AB774.htm

I'm presenting on this landmark bill as part of a panel on medical debt at the Families USA conference in Washington, DC on Thursday. I wouldn't be surprised if you have many states pursuing this type of common-sense remedy.
posted by Anthony Wright | Permalink | 9:27 AM


 

Nunez's take & our goals for 2007

Saturday, January 20, 2007

It's hard to follow any good speaker. It's even harder to follow a person known as "The Speaker." But that was my challenge this week when I presented at the Working Families Summit on Thursday, to describe the Health Access California agenda for 2007.

Speaker Nunez talked at some length about his health reform proposal, which included his commitment to cover *all* children, and to require "fair share" participation from employers as well as employees. At the same time, he expressed his appropriate concern with an "individual mandate" approach, but was interested in Governor Schwarzenegger's proposals to place better rules and oversight over insurers. He ended with his optimism about passing major health reform this year, and asked the audience to keep him and other elected leaders accountable for this goal. We intend to.

The last time I presented at the Summit two years ago, I offered three goals: 1) to protect public health programs from severe budget cuts (Check!), 2) to pass major consumer protections, including to prevent the uninsured from being overcharged, for hospital care or prescription drugs (Check!), or 3) to pass major health reform and expand coverage. (Well, we certainly tried on many fronts, but we had to leave something for this year!)

My presentation complemented the Speaker's comments. A concise paper that describes our recommendations and philsophy for health reform and coverage expansion is now posted on our website, at:
http://www.health-access.org/advocating/policy.htm
posted by Anthony Wright | Permalink | 2:00 AM


 

Unholy Alliance

Friday, January 19, 2007

The big news yesterday was the announcement of a diverse coalition -- which includes Families USA (the national health advocacy organization), U.S. Chamber of Commerce, Kaiser, Blue Cross/Blue Shield, American Medical Association, AARP and others -- that has joined together to unveil an "historic agreement'' to expand healthcare coverage.

I eagerly clicked on the document to see what this unlikely group could have proposed. (link above)

I was disappointed. Don't get me wrong. I really believe that all children should be covered, and the proposal suggests expansion and streamlining of SCHIP and Medicaid (Healthy Families and Medi-Cal, respectively, here in CA), which is a great step towards that goal.

I also like that they it expands Medicaid to really really poor adults (singles making less than $10,000 a year).

But the proposal is a little heavy on tax credits (some advanceable) to help purchase health coverage.

Sure, everyone likes a tax credit. But for the population they're talking about, (300% FPL and below, which is $60,000 for a family of four), what kind of tax credit is going to really help buy good, meaningful coverage that averages about $11,000 a year?

And how many of those that are hovering on the lower end of the income scale are paying high enough levels of taxes to even really feel the impact of a tax credit?

It seems like it'll just cost a lot to give tax credits, but not really spending enough to create anything valueable.

To, look at the coalition's website, visit: www.coalitionfortheuninsured.org
posted by Hanh Kim Quach | Permalink | 10:07 AM


 

Next week: Reports from DC...

Thursday, January 18, 2007

Next week, I go to Washington, DC, to find out what's going on in the other 49 states.

We'll be blogging from the Families USA Health Action conference, which is always informative. We sometimes have policy differences with our colleagues (see yesterday's post), but they are good and friendly folks who have been doing really important work in the last several years, especially defending health care from lots of bad stuff. (Full disclosure: They also presented their Consumer Advocate of the Year award to Health Access California last year, the only organization that has received the award twice.) For the over 60 Californians who will be in attendance, it'll be interesting to see how the conversations go in the new political environment.

Our posts will try to provide some flavor about the DC health reform conversation... We'll probably get a lot of questions about Governor Schwarzenegger and his plan. Lots of DC stars are scheduled to speak, including Senators Kennedy, Brown, Smith, and yes, the star of the moment, Obama. We'll give you the update here...

posted by Anthony Wright | Permalink | 11:39 PM


 

Tigger's response...

Dan Walters at the Sacramento Bee seems to channel Eeyore about the prospect of major health reform, saying that passage of any law would be "a political miracle."

I am a lot more optimistic about getting something done this year. We've had a Legislature for the past four years that has passed fairly significant health legislation and coverage expansions: SB2 (Burton) to cover workers of large employers in 2003; AB772 (Chan) to cover all children in 2005; SB840 (Kuehl) for a universal single-payer health system in 2006. There were major opponents and many of the same issues that Walters raised in these debates as well, yet the political will in the Legislature remained. The major obstacle was the Governor, who has now proposed his own plan, that has significant common ground with these past proposals, but as part of a broader reform package.

So let's look at the landscape: A Legislature that has shown political will to pass major health reform, and has yet to see a legislator lose a race over these votes. A popular Governor with four more years who has laid out a serious proposal and wants a legacy on this issue. Major areas of agreement. A public that wants reform.

The story isn't that health reform might not happen--that's not news--but that there's a once-in-a-generation opportunity for something major to happen here, for California to take control of our health care future, rather than to let our current system erode and ultimately fail for consumers, businesses, and providers alike.

It's not going to be easy, and there's lots of possibilities of this falling apart. At the end of the day, whatever gets passed is going to be different from anything on the table now. So while we have issues with the Governor's proposal, we are optimistic about the process...
posted by Anthony Wright | Permalink | 12:44 AM


 

MD law may need an MD, but CA could have an Rx

Wednesday, January 17, 2007

A federal appeals court Wednesday upheld a lower court's decision that struck down Maryland's so-called Wal-Mart Act.

In 2005, Maryland passed legislation requiring businesses with more than 10,000 employees to spend at least 8 percent of their payroll on health coverage. Only four businesses met the law's description, Johns Hopkins University (which was exempt because it is a non-profit), Giant Food (a union grocery chain which spends more than 8 percent), Northrop Grumman, a defense contracter (which also spends more than the law required because of its high-salaried workers), and Wal-Mart -- ultimately the only target.

After the law passed, retailers sued, claiming -- among other things -- that Maryland could not legally force businesses to spend a certain amount on its "health insurance costs'' because it violated the 1974 federal law that says states can't interfere with businesses' benefit plans. The courts so far have agreed with Wal-Mart.

What implications does this ruling have for an employer requirement in California, in the different variations proposed by Governor Schwarzenegger, Speaker Nunez, or Senate President Perata? Not much.

The courts -- and ERISA -- do not say that state and local governments can't dictate spending on "health care services'' -- just benefits. So -- there is a way for states to make policy in this area without running into the constraints of the federal law.

San Francisco's Health Access Program (no relation), which has created an employer mandate, is believed to have a much stronger legal case to actually get around the federal restrictions.

San Francisco's Health Access Plan requires employers to spend a minimum amount on 'health care services.' Businesses could satisfy this requirement several ways--by providing insurance, contributing to a city pot to cover the uninsured, or reimbursing employees for medical expenses, among other things. The latter two examples would not violate federal law because it has nothing to do with a specific benefit plan.

A second point -- which is mainly just a beef but I'll make it anyway -- is that Maryland's 8 percent threshold would have hardly caused Wal-Mart to make any changes to its workers' health benefits. Wal-Mart testified in court that its coverage spending was between 7-8 percent, already (7.7 percent if their website is to be believed).

For Wal-Mart, that means having to increase its spending on 16,000 Maryland employees, who make an average of $14,400 a year. That means -- at most -- another $2.3 million a year. That doesn't even amount to one-one thousandths of Wal-Marts net profits in 2006.

The passage of the Maryland law was a important signal, after SB2/Prop 72 in California, that other states were looking at the issue of employers scaling back or dropping coverage, and the impacts not just on the uninsured, but on the public programs and thus taxpayers as well.

The concept that everybody--including employers--should pay their "fair share" is an important one. But given how different Maryland's law is from similarly-themed approaches, including those in New York City, Massachusetts, San Francisco, etc, the court ruling will have little actual impact on what has passed in other places, or what is being proposed.

Labels: OtherStates, SanFrancisco

posted by Hanh Kim Quach | Permalink | 10:12 PM


 

Senate Committees Named...

Marty Omoto at the California Disability Community Action Network has posted a list of the new assignments for Senate committees. Of those relevants for health activists:

SENATE BANKING, FINANCE, INSURANCE COMMITTEE
Democratic Members (7) : Mike Machado (Chair), Lou Correa, Dean Florez, Alan Lowenthal, Gloria Romero, Jack Scott and Patricia Wiggins.
Republican Members (4): George Runner (Vice Chair), Dave Cox, Dennis Hollingsworth and Bob Margett

SENATE BUDGET AND FISCAL REVIEW COMMITTEE
Democratic Members (9): Denise Ducheny (Chair), Elaine Alquist, Christine Kehoe, Alan Lowenthal, Mike Machado, Alex Padilla, Jack Scott, Joe Simitian, and Darrell Steinberg
Republican Members (5): Dennis Hollingsworth (Vice Chair), Dave Cogdill, Bob Dutton, Bob Margett, Mark Wyland

Senate Budget Subcommittee #3 on Health, Human Services & Veterans Affairs
Democratic Members (2) : Elaine Alquist (Chair) and Alex Padilla
Republican Member (1): Dave Cogdill

SENATE HEALTH COMMITTEE
Democratic Members (6): Sheila Kuehl (Chair), Elaine Alquist, Gil Cedillo, Gloria Negrete-McLeod, Mark Ridley-Thomas, and Leland Yee
Republican Members (4): Sam Aanestad (Vice Chair), Dave Cox, Abel Maldonado, and Mark Wyland

Labels: Updates

posted by Anthony Wright | Permalink | 8:22 PM


 

"Plastic Safety Net''

Massachusetts-based Access Project has a new report called "Borrowing to Stay Healthy,'' which shows about families who use their credit card to pay health expenses.

In the study, nearly one-third of those with credit card debt said medical expenses contributed to that debt.

Among key finding: those who have medical debt have higher credit card debt ($11,623) related to their medical debt than those without medically-related credit card debt ($7,964).

This problem, of course, will be exacerbated if more low- to middle-income people are foisted into high deductible plans, as Rick Brown from UCLA Center for Health Policy Studies writes in the LA Times today.
posted by Hanh Kim Quach | Permalink | 10:39 AM


 

D for Democrats, D for Part D

Tuesday, January 16, 2007

While we were lost in California-centric discussions about universal coverage, the House on Friday passed a measure to allow the federal government to negotiate drug price directly with pharmaceutical companies, marshalling the buying power of 43 million Medicare enrollees.

Twenty-four Republicans joined Democrats to pass the bill 255-170. Of course, the fearless President Bush has already warned he would veto any such measure and who knows what will happen in the Senate.

Read about the action in the Washington Post and the New York Times.

Labels: Bush

posted by Hanh Kim Quach | Permalink | 9:14 PM


 

Why else would people join Costco?

Monday, January 15, 2007

The Wall Street Journal just published this story about the Bush Administration's nascent plans to boost the use of HSAs and high-deductible plans to make insurance more affordable for low-income workers.

Here's the lead of the story:

With health-care costs emerging as one of voters' biggest domestic concerns, President Bush is considering promoting a tax-code change making it easier for people to buy health insurance for themselves in the open market, rather than relying on employers.

Bush is expected to announce this plan when he releases his budget and state of the union later this month.

Bush, and proponents of HSAs believe that high-deductible plans will make people more cost conscious. Early evidence does show that costs drop -- because people don't go to the doctor. And when you are "low-income" earning $50,000 with two small mouths to feed, it's easy to forgo the doctor.

What gets to me, though, is this idea -- as the Journal article says, that the idea would "make it easier'' for people to buy insurance on their own, rather than relying on their employers.

Why would *anyone,* particularly health policy advisers, think a single person could get a better deal on health coverage than a group?

Society has all kinds of "group'' activities that help people pool together to join risk -- think office lottery pools or a membership to Costco, where you pool together and amass buying power to get lower prices. Maybe you don't need two gallons of Pepto Bismol, but the person that pays the membership fee and uses that Pepto Bismol is also helping you buy your lower priced flat-screen TV.

I have to believe, though, that Bush understands the point of pooling risk, as he said in this 2003 speech where he advocated getting rid of state consumer protections (like the HMO Patients' Bill of Rights) to help small businesses:

Small businesses must be allowed to come together in order to pool risk in order to provide their employees with reasonably priced health care.

So who knows what has spurred this latest Bush boondoggle; maybe it was this cartoon that inspired him.

(PS the Wall Street Journal requires a subscription to read. If you'd like to read the article and you don't have a subscription, email me at hquach@health-access.org and I'll send you a copy)

Labels: Bush

posted by Hanh Kim Quach | Permalink | 8:48 PM


 

Hilarious....but accurate?

Saturday, January 13, 2007

Steve Weigand in the Sacramento Bee sums up -- with humor -- how different sectors are feeling about the gov's healthcare plan.

In other reading, an interesting piece on national interaction with California's health care debate on The Health Care Blog.

Labels: Funny

posted by Hanh Kim Quach | Permalink | 12:10 PM


 

Meanwhile, back at the ranch..

Friday, January 12, 2007

Lost in all the attention about the Governor's announcement on broad health reform was this article by Clea Benson in the Sacramento Bee last Sunday, about what's going on at the Department of Managed Health Care (DMHC).

It spotlights a key member and ally, the California Pan-Ethnic Health Network, and their work to implement a landmark law they co-sponsored to ensure cultural and linguistic access to care.

There's lots of important work going on at the DMHC that needs to be watched, including a process to prevent the practice of balance billing, and the implementation of a law to set standards for timely access to care, which has been delayed, ironically.
posted by Anthony Wright | Permalink | 12:49 AM


 

Blogwatch: The Governor's plan...

Wednesday, January 10, 2007

The online magazine Slate has a rundown of bloggers and their reactions to the Governor's plan. Some rabid response against it, especially from the right; Others acknowledge parts of it; Some are just digesting it.


Two commentators worth noting: Good thinkers at the magazines The New Republic (Jonathan Cohn) and Washington Monthly (Kevin Drum) took a look at the Governor's health care proposal, and like us, found things to like and things not to like. Both are single-payer universal health care supporters, and while they see issues, they acknowledge the significance of the rules on insurers, and of a Republican governor endorsing these ideas. (Kevin then responds to Jonathan here.)


Bob Salladay's Political Muscle investigates the shady outfit that ran a television ad against the Schwarzeneggger plan merely 30 hours after it was announced. No actual stakeholders are involved here. These are consultants wanting a piece of the action, when the opposition develops. They also had an Internet ad against Prop 72, but that never went anywhere. It does show that even though the Governor's plan is a mixed bag, there are formidable opponents for even the modest steps forward in the proposal, including the employer fee.
posted by Anthony Wright | Permalink | 11:41 PM


 

"Angry'' and in pain, governor defends health care proposal

Our update about the state budget is below, but some notes of interest from the press conference:

A tired-looking, beefy Governor, hobbled onstage with crutches, and admitted to reporters that his broken femur has handicapped him, making him "very angry a lot of times'' and causing life to be difficult for him and his wife. Still, the governor fielded questions tangentially related to the budget -- but mainly about his health reform proposal.

Asked about his "evolving definition of taxes,'' he referred to the "dividends'' from having more insured people that doctors and hospitals would get under his health proposal. Schwarzenegger said those parties assessed a fee would benefit from higher revenues and reduce the "hidden taxes'' under his proposal. Therefore, it wouldn't be a tax.

Questioned on whether his reform plan would cover undocumented adult immigrants, the governor reiterated his answer from Monday, saying the state was already required by federal law (EMTALA) to provide emergency care in the emergency room to ALL patients. His health proposal simply would redirect patients to more cost-effective care.
posted by Hanh Kim Quach | Permalink | 10:06 PM


 

Health unscathed.in state budget. But wait for the feds...

HEALTH ACCESS UPDATE
Wednesday, January 10, 2007


GOVERNOR RELEASES "BALANCED" STATE BUDGET
* Health budget escapes unscathed, though social services get cuts
* Health reform plan not included in budget
* New prescription drug & child enrollment efforts get funding for implementation
* Looking ahead to SCHIP reauthorization in Congress and Healthy Families funding
* Visit the Health Access WeBlog: Governor's Q&A, Health Plan Fallout, Media Reaction


Gov. Arnold Schwarzenegger on Wednesday released his fourth state budget, in which he says he eliminates the annual operating deficit, where the state spends more than it takes in. For the budget year, Schwarzenegger has proposed a $143 billion budget that is only 1 percent larger than this year, even though revenues are 7 percent higher.

To view the budget online, visit: http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3519375&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.ebudget.ca.gov%2F&l=2.

HEALTH AND SOCIAL SERVICES AGENCY BUDGET

The Health and Human Services Agency budget will total $76 billion in 07-08 (both state and federal funds). Thats an increase of 3.5 percent over the current year. But that increase isnt felt agencywide. A full summary is available at the Department of Finance website, starting on Page 137, at:
http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3519375&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.ebudget.ca.gov%2Fpdf%2FBudgetSummary%2FFullBudgetSummary.pdf&l=3

The Governor's budget proposal does NOT reflect any of the proposals in the Governor's health proposal, such as the expansion of coverage for all children, as well as adults in poverty, or the shifting of funds away from counties and public hospitals.

Health programs, such as Medi-Cal, Healthy Families and ADAP will see modest increases reflecting standard program growth, but no policy changes are proposed to either cut or expand eligibility. Yet other programs such as CalWORKS and food stamps will suffer cuts, which could cause problems for the same populations served by the public health programs.

Medi-Cal is budgeted at $37.4 billion ($14.6 billion general fund), an increase of $1.9 billion from 2006-07, not reflecting any policy change but increases in caseload and cost per eligible person. The average monthly caseload for Medi-Cal is forecast to be 6.7 million, an increase of 1.6%--but less than the growth of the state as a whole.

Under the Managed Risk Medical Insurance Board, Healthy Families is budgeted at $1.1 billion, ($392 million general fund), an increase of $32 million general fund. The enrollment is expected to rise by 73,900 children, or 8.8 percent, to 915,600. Access for Infants and Mothers (AIM) is expected to increase by 1,815 to 13,912 uninsured pregnant women.

The Governor's Budget includes $40 million for the Managed Risk Medical Insurance Program (MRMIP), which provides coverage for 8,700 "uninsurable" people who have been rejected for coverage by insurers due to "pre-existing conditions." Since the program is capped to the funding provided, there is a waiting list of 80 people. This program and related issues have been the subject of legislative bills for reform last year and this year, and they are addressed in the Governor's health reform proposal.


IMPLEMENTATION OF SIGNED LEGISLATION

The governors write-up on health care spending gives particular focus on legislation passed last year, namely, prescription drugs, and Healthy Families enrollment.

* AB2911 (Nunez/Perata) The California Discount Prescription Drug Program. The governor allotted $8.8 million and 15.2 positions to implement this program next year. This program is expected to allow uninsured Californians to obtain a discount card at a $10 annual fee to purchase prescription drugs that a price negotiated down by using the state's purchasing power.
*AB2877 (Frommer) California Rx Prescription Drug Website. The budget sets aside $96,000 and 1 position to maintain this site, which will help Californians get information on do comparison shopping by price for prescription drugs.
Also on prescription drug prices, the proposal would switch the basis of drug reimbursements on pharmacy claims from Average Wholesale Price (AWP) to Average Manufacturer's Price (AMP). This is seen as closer to the actual cost of the producing the drug, rather than AWP, which is sometimes termed "Ain't What's Paid." This change is expected to result in general fund savings of $44 million.
* SB437 (Escutia) Enrolling children in public programs. The budget includes $16.9 million ($35.9 million state and federal) and 9.4 positions dedicated to finding and enrolling children who are eligible for Medi-Cal and Healthy Families but not yet enrolled. New streamlined programs in the programs could enroll as many as 30,000 children in the budget year; about 447,000 children are eligible, but not enrolled in public health programs.

LOOKING AHEAD: THE FEDERAL BUDGET AND KIDS COVERAGE

As we work with policymakers this next year on universal coverage expansion, one element not to overlook is the reauthorization debate about State Child Health Insurance Program (SCHIP)--called Healthy Families in California--which will be up this year in the federal budget.

President George W. Bush is expected to release this national budget later this month and its expected to be ugly, in attempts to reduce the federal deficit. In spite of the fact that Congress is now controlled by people who are sympathetic to this program, it will be important to impress upon the delegation that California s SCHIP-Healthy Families Program needs significantly more money to continue the rate of growth in the program. Healthy Families currently provides health coverage on a sliding scale to nearly 900,000 children who would otherwise be uninsured.

The California Budget Project estimates the state will need up to $3 billion more in the next five years to keep the program going without having to place children on waiting lists or drop them from coverage. Particularly as Governor Schwarzenegger looks to the Healthy Families program to provide coverage to even more children, continued support from the federal government will be critical.

Health advocates are planning to visit Congressional members in trips to Washington, D.C., later this month and through the year. For more information on these federal issues, contact Elizabeth Abbott or Jessica Rothhaar at Health Access California.

For more information about the budget, contact Hanh Kim Quach, policy coordinator, Health Access California, 916-497-0921, or hquach@health-access.org.

Labels: Bush, Updates