Young folks: I want my MTV coverage!

Friday, March 30, 2007

New York magazine has a must-read article for anybody over 30 (and a great read for those under 30).

Labels: YoungAndUninsured

posted by Anthony Wright | Permalink | 5:48 PM


 

Googling benefits...

Wednesday, March 28, 2007

Earlier this month, there was a front page New York Times article on Google, and in particular the lavish benefits that workers get:

The perks of working at Google are the envy of Silicon Valley. Unlimited amounts of free chef-prepared food at all times of day. A climbing wall, a volleyball court and two lap pools. On-site car washes, oil changes and haircuts, not to mention free doctor checkups.

I was reminded of the article when I had a newspaper reporter ask me last week if our employer-based health care system is dead.

As more and more employers either scale back or drop coverage altogether, I do worry about the 19 million Californians who get their health coverage through an employer. I do worry that we may reach a dangeous tipping point, when enough employers in an industry drop coverage, causing all their competitors to follow suit, in a disastrous race to the bottom.

But that's simply not going to happen with certain types of jobs for certain highly-skilled, highly-competitive jobs. Google wants to attract key engineers and programming specialists, and they do so partially with an attractive health benefits package.

There will always be some employers who offer a health benefit to attract key talent, regardless of what our health system looks like: whether in the best case of universal system (on top of what is offered by the single-payer system), in the worst case of an everybody-for-themselves system of individual vouchers or HSAs, or even in a pay-or-play-type system where employers have a choice of providing it directly, or buying from a common pool even is that plan is attractive.

The question is what happens for everbody else: The new trend is that not just low-income workers are finding themselves without benefits: it's middle-income families, it's the jobs that are becoming more prevalent in our economy. Unless you are in a highly-specialized, highly-sought-after field, you could be one job away from being uninsured. And even many in Silicon Valley are very aware of this.

But my point is this: even if the employer-based health care system collapsed tomorrow, it would go from covering over 50% of the population now to 10-20%, and there would probably still be several million people with employer-provided health benefits.

But right now, there's around 5%--a little over one million people--who buy coverage as individuals.

The real question should be: is the individual insurance system dead?
posted by Anthony Wright | Permalink | 2:13 PM


 

Red-handed and Red-faced

Tuesday, March 27, 2007

The Assembly Health Committee just passed AB343 (Solorio), which would require the state to list the names of businesses who have more than 25 employees are enrolled in public programs such as Healthy Families, Access for Infants and Mothers, and Medi-Cal.

In other words, if you are a business and at least 25 of your workers are enrolled in public programs, the state will publish:

• your business name
• address
• the number of employees (and their dependents) are on public programs
• How much it costs the state (and taxpayers) to provide health care to your employees, and their families.

The California Chamber of Commerce and WalMart opposed the bill, citing veto messages of previous efforts that said it would do nothing to lessen the number of uninsured in the state.

On the contrary, though, while it may not directly provide coverage to the uninsured, it would essentially allow the public to see how much taxpayer money is being spent to provide healthy workers, who inturn help private companies make money.

The Employer Development Department is already collecting all the data anyway -- so why not crunch it in a different way.

Businesses frequently opine about California's unfriendly climate for businesses. A study such as suggested in Solorio's bill could either prove their case (showing that CA taxpayers don't give a dime to providing health coverage to workers), as I suspect, blow their cover, showing that huge amounts of taxpayer dollars go to help workers to enroll in public programs.

As Assemblymember Mary Salas said, if businesses are not ashamed of the way they are conducting business, why not let this report become public?

posted by Hanh Kim Quach | Permalink | 2:48 PM


 

National Public Radio's latest story in its series on health care details a family doctor's plight against insurance companies.

Because insurance companies watch costs aggressively, Jaffe says she has to
fight to get her patients the care they need. On two occasions, insurers told
her they would pay less for an immunization than it would cost her to buy the
vaccine, let alone administer it.

...Jaffe says she wishes she could be practicing medicine, rather than
searching for ways to pay for it. At the end of the day, once her patients have
gone home, she is left with mounds of paperwork.

...Jaffe says that the time that she spends on paperwork is time that could
have been spent with patients.

The Wall Street Journal last month went into more detail in this article, explaining how doctors are spending lots of time and money to recover money that insurers are denying. (WSJ requires a subscription, but I can send you a copy of the article if you email me at hquach@health-access.org).

Doctors increasingly complain that the insurance industry uses complex, opaque
claims systems to confound their efforts to get paid fairly for their work.
Insurers say their systems are designed to counter unnecessary charges and help
keep down soaring health-care costs. Like many tug-of-wars over the health-care
money pot, the tension has spawned a booming industry of intermediaries.

It's called "denial management." Doctors, clinics and hospitals are
investing in software systems costing them each hundreds of thousands of dollars
to help them navigate insurers' systems and head off denials.

The imbroglio is costing medical providers and insurers around $20 billion
-- about $10 billion for each side -- in unnecessary administrative
expenses, according to a 2004 report by the Center for Information
Technology Leadership, a nonprofit health-technology research group based in
Boston. (Emphasis mine)

The upshot of these two stories: that administrative hassles with insurance companies all come at a cost. For a small one-doctor clinic, with limited administrative staff, like Rebecca Jaffe in the NPR story -- it means patients will get worse care -- or less care. For the larger physician group, like the ones in the WSJ story, it means more money that could either be dedicated to patient care or costs that wouldn't eventually be billed to patients.

Combine the administrative costs of providers with the 30% administrative costs of insurance companies (as this article revealed) and we find consumers paying more money -- and getting less health care.

These administrative fights weigh heavily on the consumers. If the energy dedicated to denying and recovering costs could be redirected to providing health care, we might have a few million more people with health coverage.
posted by Hanh Kim Quach | Permalink | 11:19 AM


 

Last year's legislation are this year's budget items...

Monday, March 26, 2007

HEALTH ACCESS UPDATE
Tuesday, March 27th, 2007


SENATE BUDGET SUBCOMMITTEE REVIEWS FIRST HEALTH ITEMS
* Implementation of new drug discount program for Californians underway
* New efforts to streamline enrollment into Healthy Families and Medi-Cal begins

New on the Health Access Weblog: Presidential Forum; The Illusion of Coverage; Weekend Care; Blue Cross' Bad Behavior; Tonik; International Update; Rush and Arnold; Etc...


The first layer of decision-makers -- among many -- took a first look at the 2007-08 health budget on Monday, where Senate Budget Subcommittee members focused this hearing on programs under the Managed Risk Medical Insurance Board (MRMIB) as well as a few Medi-Cal items.

NEW PRESCRIPTION DRUG LAW ON TRACK TO BEGIN IN 2008

The Senate Budget Subcommittee on Health and Human Services, chaired by Senator Elaine Alquist, approved the full budget the state requested to implement AB2911 (Nunez/Perata), the landmark drug discount legislation, that will provide more affordable prescription medications to as many as 6 million uninsured or underinsured Californians without comprehensive drug coverage.

The Department of Health Services reported that it was in the process of negotiating with drug companies, and of hiring an independent contractor to help the state implement its program on time by January 2008. Senator Alex Padilla, of Los Angeles , questioned why department staff could not do it. Due to the complexity of the first-of-its kind program in California , and the short time frame to get it going, the Department of Health Services said it was crucial that the state contract out core functions of the program to begin the process, as well as have some added staff positions to manage the program.

Ultimately, the panel approved $8.8 million to hire 16 new positions, which was the request of the Department, but one more than what the Legislative Analyst's Office recommended. Consumer advocacy groups that testified supported the full funding for the implementation.

ENROLLING CHILDREN IN COVERAGE

The committee also approved $29.3 million in additional funding to help counties reach out to families whose children are eligible but not yet enrolled in either Healthy Families or Medi-Cal. While the amount is a bit less than the state had originally requested, the extra money would specifically help counties comply with streamlined processes passed in SB437 (Escutia) last year that aim to make it easier for children to become enrolled and stay enrolled, in a coverage program.

In California 428,000 children are poor enough and qualify for Healthy Families or Medi-Cal, but currently are not enrolled.

Specifically, the new rules under SB437 would allow some families to verify – on their own – that their incomes meet eligibility requirements for these programs, rather than having to submit proof of income. It also automatically enrolls children, who are no longer eligible for Medi-Cal, into Healthy Families, until the state decides whether or not they qualify or not. The new program would also automatically enroll children into public programs if they are receiving help from the federal Women, Infant and Children supplemental food program.

The committee, however, held off discussion of additional positions to help implement the new law until more is known about the federal government’s intentions to reauthorize the State Children’s Health Insurance Program (SCHIP), and at what funding level. SCHIP, which is called Healthy Families in California , is set to expire this year unless it is reauthorized.

While President Bush has announced his intention to continue the program, the funding level he has proposed -- $5 billion a year – ($25 billion over 5 years) was stated to be too low. If Bush’s proposal becomes law, more than 400,000 California children could lose coverage next year.

Advocates are hoping that Congress will increase reauthorize at a level closer to $85 billion over five years.

With regular caseload growth, including the streamlining procedures outlined in SB437, Healthy Families is budgeted by the Schwarzenegger Administration to grow to a total enrollment of 915,598 children as of June 30, 2008, an 8.8% increase of 73,870 over current year levels.

OTHER ISSUES

The budget subcommittee also took the following actions:

* Agreed to fund 4 new positions for the Department of Health Services as it attempts to implement the new requirements under the 2005 Deficit Reduction Act.
* Approved $138.7 million for the Access for Infants and Mothers (AIM) Program
* Discussed the Managed Risk Medical Insurance Program (MRMIP), which provides some coverage to those who are "uninsurable" because of "pre-existing conditions."

For more information, please contact the author of this report, Hanh Kim Quach, policy coordinator, Health Access, at 916.497.0923 x 206 or hquach@health-access.org

Labels: Updates

posted by Anthony Wright | Permalink | 11:21 PM


 

Take a bite out of....

Insurers are taking a bite out of our health care. A big bite. According to PNC Financial Services Group, it's an average of 30 cents on every premium dollar for administration ALONE.

That does not include profits.

The numbers closely mirror what the Department of Insurance found last year as it held hearings on Preferred Provider Organizations (PPO plans).

In California, HMO administration and profits is limited to 15 percent of the premium dollar. However, PPO products -- which are regulated by the state Department of Insurance -- have no such cap.

The state Department of Insurance last year reported that the average of all Blue Cross' PPO policies were 24% profit and administration. However, for policies on the individual market -- where people aren't buying through an employer or government pool -- profits can be 27 percent and administration another 9 percent.

For these products, as little as 51 cents for every premium dollar actually goes to health care. The amount of money that insurance companies must spend to provide health care to enrollees to coldly called a "medical loss ratio,'' meaning they're losing money on you.

Let's reverse this trend and take a bite out of administration -- and profits.
posted by Hanh Kim Quach | Permalink | 10:36 AM


 

Voters and values: it'll be an interesting discussion...

HEALTH ACCESS UPDATE
Monday, March 26, 2007


INVITATION: HERNDON ALLIANCE BRIEFING ON FRAMING AND VALUES
* Tuesday, April 3rd at the Sacramento Convention Center, 9:30am-1:30pm


Health Access California member and allied organizations are invited to send staff and leaders to a briefing by the Herndon Alliance, where they will discuss their work around framing and values research on the issue of health care reform, which has attracted attention around the nation.

The Herndon Alliance is a national coalition of seventy minority, faith, labor, advocacy, and provider organizations—both national and state—advocating for a health justice movement. Their goal is to achieve quality, affordable health care accessible to all by expanding the base of people supporting universal health care and increasing the breadth and depth of voices working and/or speaking out for health care reform. The beginning focus of the Herndon Alliance--tentatively named for the site of its first meeting--was a project to do an in-depth study to map the underlying values held by various groups of Americans, identify constituencies that are potential allies, and explore initiatives that connect those constituencies with our goals.

This Sacramento briefing, sponsored along with National Council of La Raza, Catholic Healthcare West, The California Endowment, and Health Access California, will report on the findings to date of the Herndon Alliance.

Date: April 3, 2007
Time: 9:30 am to 1:30 pm
Location: Sacramento Convention Center
1030 Fifteenth Street, Room 204
Sacramento , California

The featured speakers will be Michael Shellenberger from American Environics and David Mermin from Lake Research Partners, who will discuss the findings from the past year of work around values, toward the goal of expanding the base of voters in support of health care reform. These presenters will also provide advice on how to apply their research. A reactor panel, including Anthony Wright, Health Access California; Wade Rose, Catholic Healthcare West; Katrina Mendiola, National Council of La Raza; and Michael Shellenberger, American Environics, will discuss how to use this research in a California context.

Lunch will be provided.

Please RSVP by E-mailing Gwen, gwen@herndonalliance.org, to let her know if you or others from your organization plan to attend the meeting.

Labels: Updates

posted by Anthony Wright | Permalink | 12:22 AM


 

The Big Three

Saturday, March 24, 2007

Not the automakers -- but the three frontrunners for the Democratic nomination for president in 2008 -- gave their take on health care reform for the next presidential term(s).

With the exception of Sen. John Edwards, who released his plan in February, none really had a solid plan, but echoed common principles. (The other two I refer to are Barack Obama and Hillary Clinton).

All tapped into the notion of shared responsibility and building on the existing system of employer-based coverage, while also trying to expand government-purchased health care as a stepping stone to a Medicare-for-all like system in the future.

It's pretty encouraging when everyone's talking about the same thing.

It was noted that Republicans were invited to talk about health care by the Center of American Progress, University of Nevada and Las Vegas, and Service Employees International Union, but none responded.

Labels: Federal, PresidentialCandidates

posted by Hanh Kim Quach | Permalink | 11:06 AM


 

Blue Cross' bad behavior deserves it own blog...

Friday, March 23, 2007

The Department of Managed Health Care fined Blue Cross of California $1 million for rescinding policies of almost 100 patients without rationale or due process.

It's outrageous that Blue Cross has been dropping coverage for patients who actually seek care. California needs strong rules to stop this 'use it and lose it' practice.

More than that, the Department of Managed Health Care findings provide perspective in the health reform debate in Sacramento: While Blue Cross' practices have been found illegal, this finding brings into question why we allow insurers to deny Californians coverage because of their health status at all.

We support the portions of the health reform proposals by the Governor and legislative leaders seek to prevent insurers from discriminating against those Californians with "pre-existing conditions."

But these practices are also a case study about why any reform should not leave individuals alone and powerless at the mercy of big insurers--to pick and choose among us, to deny us coverage at their whim. In contrast, any reforms should focus on expanding group coverage instead, where we have the power of group purchasing.

This case study amplifies a report Health Access California co-released yesterday with The Access Project, The Illusion of Coverage: How Health Insurance Fails to Protect People When They Get Sick, available at www.accessproject.org. The report indicated the need for strong standards for insurers and employers about what "coverage" is.

We've complained about high-deductible, bare-bones products like Tonik in the market offered only to healthy people, all to avoid actually paying claims for care. This finding about Blue Cross simply takes this logic to the extreme: to rescind the policy if they actually need care. Remarkable.
posted by Anthony Wright | Permalink | 5:34 PM


 

Running Men (and Woman)

Thursday, March 22, 2007

This Saturday (March 24th), the Democratic presidential candidates will be talking about Health Reform in Las Vegas. You'll be able to watch a live webcast and ask questions.

Here's a link to the event.

The participants include:

• Sen. Hillary Clinton
• Sen. Chris Dodd
• Sen. John Edwards
• Sen. Mike Gravel
• Rep. Dennis Kucinich
• Sen. Barack Obama
• Gov. Bill Richardson

posted by Hanh Kim Quach | Permalink | 5:57 PM


 

Product failure

When you pay for something, you expect it to work – especially if you’re forking over lots of money.

But as some of us know, procedures we thought were covered – in my case, a blood test -- can end up costing us a lot more than we bargained for.

A new report, “The Illusion of Coverage: How Health Insurance Fails People When They Get Sick” is being released by the Boston-based Access Project today. (Read the report at http://www.accessproject.org/). The report details the stories of real people who have struggled with their insurance companies – and why.

One woman, who was diagnosed with multiple sclerosis, was denied coverage to go to a rehabilitation hospital. Instead, she got a walker. Naturally, she thought the walker was covered. It was not. She later received a bill for the walker as well.

One California man is struggling paying off a $150,000 equity loan that was used to pay for his late wife’s bypass surgery and pacemaker.

Reading through the report, you really get the sense of helplessness that an individual feels battling doctors, hospitals, collection companies and insurance companies all at the same time – while they’re recovering.

What gets me, though, is how many individuals blame themselves when they get into this situation. I had interviewed this California man with the $150,000 debt. At the time, he told me “Maybe we should have read the fine print,’’ and found out ahead of time about the $100,000 lifetime cap on his wife’s insurance. Or, he said, maybe she should have taken better care of herself.

Others have echoed the same things: “I wasn’t taking very good care of my weight,’’

When you buy a car, and your car doesn’t work, you don’t blame yourself for being too hard on the car or driving poorly. You drive straight back to the dealer and demand that it be fixed.

Many stores and companies stand behind their products and will refund your money or exchange the product.

But for some reason, insurance and health aren't the same.

When health coverage doesn’t work, people end up with more hassles, more headaches – and debt. And many blame themselves.

The truth is, as the report details, the policies are written in confusing language, and often change from year to year. Employers and insurers don’t educate consumers about changes, leaving many in the dark about what exactly their policies cover.

Just as government steps in to protect consumers against “lemon’’ vehicles, we need the government to step in and protect consumers against “lemon’’ insurance policies.

Labels: Affordability, Research, Underinsurance

posted by Hanh Kim Quach | Permalink | 4:36 PM


 

Rush and Arnold debate health care...

Wednesday, March 21, 2007

Bob Salladay at the LA Times' Political Muscle has the transcript. Sometimes, this work is just surreal.
posted by Anthony Wright | Permalink | 4:58 PM


 

Planning a heart attack? Make sure it's Monday through Friday

If you're having a heart attack on a Saturday, driving to your nearest hospital might not save your life.

A new article in the New England Journal of Medicine this week shows that people who have heart attacks on weekends are more likely to die than those who suffer the attacks on weekdays.

Why?

Because not all hospitals are equipped with the right staff at all times who are equipped to open up your chest and perform an emergency coronary angioplasty. In fact, the Journal's data of heart attack patients over 16 years in 38 New Jersey hospitals found that weekend patients were 25% as likely to have a life-saving invasive procedure as a weekday patient.

The health care system's patchwork of public and private hospitals, with little planning and coordination, is one of the reasons for this problem.

A better planned and coordinated system (one of the suggestions Health Access makes in this fact sheet) -- where everyone knows where the trauma specialists and coronary specialists are -- could save money and lives.

Labels: Hospitals

posted by Hanh Kim Quach | Permalink | 11:39 AM


 

Who is getting the subsidies?

Monday, March 19, 2007

The more I think about my conversation with the Blue Cross broker, the more upset I get. I'm not attacking her. She was just doing her job.

But really, the conversation just highlighted how businesses manages to double-dip and finagle subsidies from government.

The essence of my conversation with her was this: She sold a 22-year-old restaurant worker an $80-a-month high-deductible policy. If this restaurant worker got pregnant, she would first be rolled into a higher-deductible plan, and ultimately referred to a public program -- Access for Infants and Mothers, which caps the cost of pregnancy-only coverage at 1.5 percent of an individual's income. Read the full blog here.

What this really means is that Blue Cross would have been able to collect the $80-a-month premium for the young person buying the high-deductible coverage. But when time came to pay out -- someone who is too poor to afford the $3,000 or $5,000 deductibles (mostly likely someone young and in the restaurant business who had no businesses buying the plan in the first place) -- would be referred to the state -- who would shoulder the cost and risk of pregnancy and child birth.

That would give Blue Cross a subsidy of tens of thousands of dollars because the company -- which paid its executives millions in salary and bonuses during its merger with Wellpoint -- would be free of having to pay for their enrollee's pregnancy.

This is not the only way that businesses tacitly receive subsidies from the government.

Consider another conversation I had last week with a county welfare director in a nearby rural county. One of his new county supervisors, a farmer, takes a very dim view of all the 'socialized programs' that the county runs and essentially would rather see them go away.

This county welfare director then asked his boss:

"Do any of your seasonal workers use Medi-Cal or food stamps?"

Well, the farmer/supervisor said, I don't know?

Well, the welfare director said, if they do, then we (the county) provide those services to them.

Let me point out here, that that means part-time, seasonal workers for this farmer (who makes money off their labor) receives benefits through public programs.

The staff at this county office also took the supervisor on a tour showing him exactly the services they provide and who they help. The workers in this county office say they have now planted enough questions in the mind of this supervisor to force him to admit that their county needs a "safety net'' for workers who don't earn much money and don't receive much from their employers (like himself).

What the farmer/supervisor isn't willing to admit yet, though, that this safety net is subsidizing his business. for him to have healthy workers who can buy enough food to feed themselves, they need social programs -- such as Medi-Cal or food stamps. Without these social programs helping these workers, they wouldn't have the wherewithal to work for him.

Don't get me wrong. I think Access for Infants and Mothers is a wonderful program. It saves new mothers tons of heartache and ensure their babies are healthy. It also saves the state money by ensuring poor women can get prenatal care and have healthy babies (which are less expensive to care for.) I also think Medi-Cal and Healthy Families and all public programs need to be expanded.

In addition to helping millions stay healthy, we also need to be honest and acknowledge how they keep businesses, such as Blue Cross, farmers, anyone whose workforce depends on public programs (That means you too, WalMart, Safeway and Target with your high-deductible plans and waiting periods)-- healthy as well.
posted by Hanh Kim Quach | Permalink | 1:17 PM


 

Health Access: international edition

From around the globe:

Steven Greenhut at Orange Punch gloats that the Swiss rejected a health reform initiative last week. Does that mean he is endorsing the current Swiss health system?

Another blogger, Ezra Klein, took the time to seriously consider what other countries (including Germany, Japan, France, Great Britain, Canada, and others) are doing in health policy, in his Health of Nations series (recently referred to by Calitics.)

Massachussetts' A Healthy Blog takes a look at the health system in Israel.

Finally, Peru just put in place a universal health care policy... "why can't we?" asks The Health Care Blog.
posted by Anthony Wright | Permalink | 11:46 AM


 

Spring redecorating...

Readers of this blog are noticing some changes to the format...

Don't worry, our commitment to providing daily commentary about the health care policy debate here in Sacramento is the same. We are simply experimenting with some better ways of presenting the information and analysis, making it easier to read, providing more resources and links, etc.

This will be an ongoing process, as we try to improve our ability to help California consumers and the organizations that represent them be part of this conversation.

Labels: HealthAccessCommunity

posted by Anthony Wright | Permalink | 11:38 AM


 

Would Blue Cross' Tonik cover ass herpes?

Friday, March 16, 2007

Ed Helms from the Daily Show has the scoop.

Labels: BlueCross, Funny, Underinsurance, YoungAndUninsured

posted by Hanh Kim Quach | Permalink | 9:47 AM


 

Where are we going?

I attended the always-informative California Budget Project conference yesterday, where Alissa Anderson Garcia, an analyst there, shared her study of where California industry, wages and benefits are headed. The information was fascinating.

First off, higher paying jobs WITH benefits -- such as manufacturing and the information sector -- are on the decline. These jobs average $51,215 annually.

They are being replaced by lower-paying jobs WITHOUT benefits, such as construction and service industry jobs, where the pay is $44,057.

Garcia analysis showed that if the new jobs provided health care at the same rate as the old jobs, 600,000 more workers would have coverage.

Instead, these low-wage workers are either uninsured -- and paying for it through poorer health and higher medical expenses -- or enrolled in public programs, which means the taxpayers are taking care of the private sector's workers.

These workers need to be covered. It helps everyone if they have health coverage because they are healthier and it will give them an opportunity propel themselves and their families into a higher income bracket. It helps everyone because they will not be delaying their medical needs because they're afraid of the expense, ultimately costing everyone more money.

This means two things, in my view.
1) Require employers to provide health coverage or 2) Provide substantial enough subsidies for these workers to get adequate and meaningful coverage.

Labels: Sacramento, Uninsured

posted by Hanh Kim Quach | Permalink | 8:37 AM


 

Tonik or Snake Oil?

Thursday, March 15, 2007

My colleague Hanh's post about the 22-year old restaurant worker who spoke at the Assembly Republican press conference on health reform has gotten some attention, on blogs such as the California Progress Report and Working Californians and others.

Labels: YoungAndUninsured

posted by Anthony Wright | Permalink | 11:04 AM


 

March Madness: the brackets are now filled in by the "big four"...

HEALTH ACCESS UPDATE
Thursday, March 15, 2007


ASSEMBLY REPUBLICANS ROUND OUT HEALTH REFORM PROPOSALS
• Focus on high-deductible plans, Health Savings Accounts, tax credits
• Medi-Cal & "uninsurable" recipients would receive bare bones coverage
• Proposal would undermine 23 mandates like cancer screenings & second opinions

New on the Health Access WeBlog: Certified Rules; A Tale of Two States; The New 300; Rationing; LA Story; Paying to Be Uninsured; A Tonik for Young People


Assembly Republicans stood before Mercy General Hospital in Sacramento Wednesday and unveiled a package of 18 proposals that they believed could help resolve a growing health care crisis by “maximizing choice, reducing cost, increasing access.’’ Read a copy of the Assembly Republican press release here.

The plan relies heavily on the “market’’ to hold down health care costs and ensure that more people receive coverage. Assembly Republican Leader Mike Villines, R-Fresno, said that while other proposals for “socialized medicine’’ were “well-intentioned,’’ they wouldn’t work because the proposals would cost too much and lead to increased taxes.

The proposal was welcomed into the year's health care debate, in hopes that the Assembly Republicans would engage rather than simply oppose health reform measures. However, consumer advocates generally opposed many of the proposals, although there were items of potential consensus.

HIGHLIGHTS OF THE PLAN

A complete list of the Republican bills can be found here, but some of the foundational bills seek to reduce cost by reducing care or coverage. The plan features tax credits and eliminating state oversight and consumer protections, generally watering down coverage by either reducing benefits, or increasing deductibles.

? Health Savings Accounts and High Deductible Plans. Many proposals would conform state law to federal law and allow employers and individuals to receive tax credits for contributing to Health Savings Accounts. Health Savings Accounts, by definition, are only available to those with High-Deductible Plans, so such a tax credit would be using public money to encourage underinsurance. Consumer advocates believe these plan do not control costs, but merely create financial barriers and shift costs to individuals.

* AB84 (Nakanishi) – HSA tax credits for individuals
* AB85 (Nakanishi) – HSA tax credits for businesses
* AB245 (Devore) -- HSA tax credits for individuals
* AB1377 (Nakanishi) – directs CalPERS to offer high-deductible plans and HSAs for public employees and retirees
* AB1635 (Strickland) – health opportunity accounts for Medi-Cal enrollees
* AB1378 (Nakanishi) -- HSAs and high-deductible plans for those with "pre-existing conditions."

Other tax break bills include AB1040 (Duvall) to expand state tax deductions for health care, dental and vision expenses, and AB1592 (Huff) to create a new tax credit for doctors who provide charity care. There were no details on how any of these proposals would be paid for in the budget.

? Relaxing Insurance Protections and Oversight. One proposal would allow insurers to sell products across state lines, and thus avoiding strong California consumer protections, such as the right to appeal HMO decisions to deny care. Another bill is more explicit in simply allowing insurers to offer products that do not include some of all of the 23 required benefits, such as coverage of cancer screenings, pap smears, or diabetic care. Such bills would limit government regulation on health plans, exposing consumers to an uncontrolled marketplace that could further shift costs and risks on individuals.

* AB1214 (Emmerson) --allowing insurers to ignore minimum benefit rules
* AB1644 (Niello) -- allowing out-of-state insurers in without a California license and outside California consumer protections

There was no claim that any of these proposals would significantly reduce the number of uninsured. No public programs would be expanded. Employers would continue to not have any obligation to provide any kind of coverage to their employees – leaving workers in the lowest paid positions to hunt for health insurance in the most expensive way, on the individual insurance market with no guarantee that coverage will be affordable or available if they have a “pre-existing condition.”

A TOUGH CHOICE FOR MEDI-CAL PATIENTS

One spotlighted idea by the Assembly Republicans is AB1635 by Audra Strickland (R-Moorpark), which would give Medi-Cal recipients the choice to have a health savings account and a bare-bones high-deductible plan combination to “put them in charge of their own health care decision making and lower costs for taxpayers.’’

A family of three living on $1,430 a month would be asked to make decisions between food, rent, utilities, or health care. Even if Medi-Cal provides an initial deposit in these savings accounts for these families, the impact could mean both health and financial consequences, especially when they need care, for diabetes, asthma, or a medical emergency. Research indicates that forcing people to place financial decisions before health concerns means that patients are half as likely to see the doctor, half as likely to get the care they need, and half as likely to fill their prescriptions.

Consumers who are asked to triage their own health care also do not always make the best medical choices – leading them to get sicker and wind up needed more expensive care. This is a cost – not a savings.

The Center for Budget and Policy Priorities has a paper on so-called “Health Opportunity Accounts’’ for Medicaid enrollees here.

AREAS FOR AGREEMENT: Republicans, however, did offer one concept that advocates could support. AB1312 by Bill Emmerson would increase Medi-Cal provider reimbursements to Medicare levels – an issue that does not seem to be in contention. There was no clear indication of how that increase would be funded.

THE STORY BEHIND THE STORY: Additionally, the “real person’’ who spoke at the press conference that Assembly Republicans touted as someone who could benefit from their plan – a 22-year-old restaurant worker – turned out to be a poster child for standards for employer-based coverage, minimum benefit mandates, and expanded public programs. (She doesn’t receive health care through her job; her insurance broker who sold her a high-deductible plan suggested that if she got pregnant, there’s a state program called AIM – Access for Infants and Mothers, that would take care of her so her insurance would not have to.) Read about the background of person at the Health Access WeBlog here.

ALL PROPOSALS NOW ON THE TABLE: Reports indicated it was unlikely that many of these bills will pass the state Legislature with the Democratic majorities. But discussion of these ideas – particularly high-deductible plans and Health Savings Accounts--will be part of the debate about the plans of Gov. Arnold Schwarzenegger and others.

For more information, contact the author of this report, Hanh Kim Quach, policy coordinator, Health Access California, hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 10:43 AM


 

Paying to be Uninsured

Wednesday, March 14, 2007

YI just got back from the press conference held by Assembly Republicans to unveil their health proposal, where they showed how their plans would help small businesses and young people.

The young person featured was a nice 22-year-old named Suzanne Hernandez who is enrolled in Blue Cross' "Part-Time Daredevil" Tonik plan, which has a $3,000 deductible.

Miss Hernandez doesn't get coverage through her employer -- Lucille's Smokehouse BBQ in Rocklin. The restaurant industry, she explained, often does not offer benefits and most employees don't work full-time, which means they wouldn't qualify for benefits anyway.

(First off, the solution here would be to require businesses to provide coverage to both full- and part-time workers. Then, Miss Hernandez wouldn't be on her own.)

The Tonik plan, she said, gives her 4 doctors visits a year for a $30 co-pay. That's what she needs ....for now.

As a young woman, though, she might need maternity, I said. What would happen if she got pregnant?

Her broker stepped in and said Blue Cross actually allows Tonik enrollees to roll into a higher deductible plan -- $5,000 a year -- which includes maternity. And childbirth, the broker said, costs a lot more than $5,000.

But $5,000 on a part-time job at a restaurant still seems kind of expensive, I said.

Well, said the broker, there's social programs for that, called AIM -- Access for Infants and Mothers.

That's right -- a person that doesn't have adequate insurance through Blue Cross should enroll in Access for Infants and Mothers -- a state program for low-income women who have deductibles that are too high, the broker said.

The last time I looked, Access for Infants and Mothers was a government program -- the kind that Assembly Republicans said today they didn't really think would work.

I wonder what they would think if they knew that part of this Blue Cross business model -- as advised by the broker -- relied on social programs to provide the rest of the health coverage that the insurance company itself does not provide.

Labels: Insurers, Sacramento, Underinsurance, YearOfReform, YoungAndUninsured

posted by Hanh Kim Quach | Permalink | 1:29 PM


 

First take on the Assembly Republican proposal...

It’s good that the Assembly Republicans have agreed there’s a need to fix the problems in health care, even if we disagree with many of the solutions. Some of their proposals—like raising Medi-Cal rates—make sense and are necessary. But many of the proposals would serve to undermine consumer protections and ultimately take the health out of health insurance.

We need to reduce costs, but not at the price of reducing care and coverage. As even insured Californians grow concerned that their coverage won’t be there when they need it, these proposal go in the wrong direction, providing less security for families.

The entire section on “maximizing choice” is focused on offering what many would consider a bad choice: watering down coverage by either reducing benefits or increasing deductibles. They find an impressive number of ways to accomplish the goal:

On benefits, one proposal would allow out-of-state plans, not subject to California’s consumer protection laws, to be able to operate here unregulated. (Would you like a plan regulated by the Alabama Department of Insurance?) Or they would allow plans sold without any minimum benefit standards, without covering cancer screenings, pap smears, or diabetic supplies. (The point of insurance is not having to guess what disease or ailment you might have, but to be covered regardless.)

They also have several bills to encourage high-deductible plans, through tax credits for Health Savings Accounts (which can only be used with plan of $5,000 deductibles or more). While even some proponents have said that such plans only work for the “healthy and wealthy” (and opponents sometimes question that, these proposals would encourage such “underinsurance” for public employees (through CALPERS), low-income families (through Medi-Cal), and even more stunningly, those with “pre-existing conditions.” This would actually serve to make coverage worse for many Californians.

There are other ways to contain costs, other than simply shifting them to consumers. Here’s a whole list, on the Health Access website…

There are things worth looking at in the Assembly Republican proposal, even if one or two of them seem to already be in existing law. For example, allowing small businesses to band together to get better rates on coverage makes sense: California had a purchasing pool for small employers, unfortunately this privatized program shut down last summer with little notice and less explanation. Similarly, increasing the number of nurses is a good idea: there have been several efforts to do this but more could be done. And there are things worth exploring like allowing employers to buy coverage that is both health insurance and the medical side of workers compensation.

And while we don’t think that high deductible plans make much sense for most people with pre-existing medical conditions, we agree that guaranteeing coverage is available for people with health conditions is the right step to take.

So we welcome the Assembly Republicans to the debate, even if consumer group disagree on key points.

Labels: YoungAndUninsured

posted by Anthony Wright | Permalink | 8:32 AM


 

400 is the new 300

Tuesday, March 13, 2007

When health care policy types talk about "300," they aren't talking about the new hit Spartan war movie with gruesome and ultraviolent battle scenes and homoerotic tones.

We wonks usually are referring to 300% of the federal poverty level, which is $30,630/year for an individual, and $51,510/year for a family of three. Even though this is literally three times the poverty level, this isn't a lot of money, especially in a high cost-of-living state like California. Housing and other expenses in the San Diego, Los Angeles, the Bay Area, and elsewhere don't leave a lot for other necessities, including health care.

Some of the health care proposals out there recognize this, to a point. For example, Governor Schwarzenegger, Speaker Nunez, and Senate President Pro Tem Perata all propose to expand public programs to children in families up to 300% of the poverty level. Several counties already go up beyond the 250% of poverty ($25, 525 for an individual, $42,925 for a family of three) -- the upper limit of Healthy Families eligibility now.

The Governor doesn't go so far for adults, proposing subsidized coverage for adults up to 250%, even though he would still impose an "individual mandate" on those above that amount, who get no financial assistance to help meet that requirement. Even the plan in Massachusetts provides subsidized coverage for families up to 300%.

But now there is a greater recognition that help is needed for the middle-income families, up to 400%. Illinois Governor Rod Blagojevich has proposed his own health reform plan, which provides subsidies for families up to 400%. Presidential candidate Hillary Clinton and key Congressional leader John Dingell have proposed reauthorizing the children's coverage program (SCHIP, Healthy Families here in CA) to cover all children up to 400%. New York Governor Eliot Spitzer has proposed the same for children's coverage in his state.

Health care is getting costly enough that help is needed for both low- and moderate-income families. Some will argue that such ambitious proposals are harder to pass and to fund. But the recognition that health care is a middle-class issue might be the very reason health care reform is getting such attention from political leaders in the first place.

Labels: OtherStates

posted by Anthony Wright | Permalink | 10:38 PM


 

The table is now set...

Tomorrow (Wednesday), the Assembly Republicans will announce their health care plan at a press conference at a Sacramento-area hospital. We'll have quick analysis here tomorrow...
posted by Anthony Wright | Permalink | 7:47 PM


 

We don't even have socialized medicine....

Monday, March 12, 2007

The Wall Street Journal (subscription required) this weekend had a story about the United Network for Organ Sharing is revising its kidney transplant policies -- favoring young patients over old, rather than the length of time on a waiting list.

This change in how kidneys are currently rationed, naturally, has stirred up the age-old debate over whose life should hold more value; who deserves to live and who will die waiting for care?

What's interesting to me, is that without this suggested policy change, there has been virtually no furor over medical rationing in the U.S. Fear of rationing occurs in discussions over "socialized systems'' such as those in Canada or the U.K. that will result in lines and rationing.

But we DO have medical rationing in the U.S. And people die at the rate of 18,000 a year because health care is rationed, according to the Institute of Medicine, making uninsurance the sixth leading cause of death in the United States.

The United States' method of rationing, however, is largely invisible to the middle and upper classes, because they have insurance.

The U.S. medical system current rations care based on who can afford to pay. If you can afford to pay, you see a doctor. If you can't afford to pay, you wait, you get sicker. You might see a doctor -- at an exhorbitant price -- and you are 25 percent more likely to die because of the lack of care you receive.

That's not to say other systems are perfect. In the U.K, for instance, waiting times for elective procedures (such as hip replacements) can be long. On the flip side, waits to see a primary care physician can be shorter than the waits in the U.S., according to an analysis of four countries' health systems.

The United Network for Organ Sharing is heading into a ideological and emotional storm and all new policies must be approved by the U.S. Department of Health and Human Services. These are difficult decisions to make and one could argue that none of us is qualified to judge who is deserving of life or not.

But let's not kid ourselves, just because our policies don't explicitly make those judgements, that rationing is happening today, and it's happening in the U.S.

Labels: ExpandingCoverage, International, InTheNews, TimelyAccess

posted by Hanh Kim Quach | Permalink | 10:58 AM


 

A tale of two states...