Building blocks ...

Monday, April 30, 2007

Even though President George Bush only wants to provide health coverage to the poorest families, many states are planning to extend coverage to an increasingly middle-income population, according to an Associated Press story today.

Under current law, only children in families up to 200% of poverty ($41,300 for a family of four) could qualify for the program.

But 18 states, including California, allow children to qualify if the family income is higher than 200%. (In California, children in families at 250% of the poverty level could qualify, though many proposals in the Legislature -- including Gov. Arnold Schwarzenegger's -- would increase that to 300% of poverty - $51,510 for a family of four).

New York state just expanded its program to include children in families earning up to $82,600 a year -- or four times the poverty level.

This irritates the Bush administration, which opined that if everyone followed NY's lead, then 71% of children in the country would be covered through public programs.

Now, that doesn't seem like such a bad thing.

Labels: Bush, Federal, InTheNews, OtherStates, SCHIPHealthyFamilies

posted by Hanh Kim Quach | Permalink | 10:48 AM


 

For our mothers and fathers, grandmothers and grandfathers

Friday, April 27, 2007

There's a common perception out there that seniors are "taken care of'' when it comes to health care. But many adults between the ages of 55 and 64 are increasingly filing for bankruptcy as a result -- partially -- of higher health care costs, according to this LA Times article.

when you think about it, though, it's no surprise. Medicare benefits don't begin until 65. By the time you're 55, you've got a good history of pre-existing conditions, making it more expensive to cover you. And employers are looking for younger, cheaper workers -- because you cost too much in more ways than one.

More reason for us to get on the ball and do something this year.

Labels: InTheNews, MedicalDebt, Medicare

posted by Hanh Kim Quach | Permalink | 11:22 AM


 

Conan (the Barbarian)

Thursday, April 26, 2007

From Conan O'Brien last night:

"Wal-Mart has begun opening 400 health clinics in their stores. Wal-Mart says the clinics are important because 50% of the people they will treat there won't have health insurance. Those people are called Wal-Mart employees."

Future "Tonight Show" host O'Brien is broadcasting from San Francisco next week. Bets on what California politicians might visit the show? Maybe talk about health reform?

Labels: Employers, Funny, InTheNews

posted by Anthony Wright | Permalink | 1:32 AM


 

How to control costs, and more...

Some laughter at an unexpected part of the conversation at the hearing yesterday... Senator Perata was detailing the various measures in his bill intended to control costs. For example, he stated that "we are in the freaking stone age in terms of medical records," and said that we "are killing people" by not using modern electronic technology to deal with medical records.

Beyond his own bill, he went on a short rant about prescription drug advertising, and the large amount of money spent on the television commercials for "the little blue pill," and the impact it has on health costs in general. He was very skeptical that as a patient he should be asking his doctor about any medication beyond aspirin. "What the heck do I know?" he inquired, wondering why he should be pestering his doctor about drugs, rather than the other way around.

He said if one looks at the sports show, all the advertisements are for "beer, cars, and pills--and not in that order." With a bemused smile, we commented on all TV commercials "and all those smiling men."

Not finished, he even interjected "you don't see the women smiling, only the men."

And then the conversation went back to health reform.

On a more serious note, one way to deal with the issue of prescription drug advertising is at the federal level, in a bill by California Congressman Henry Waxman, as described in this blog post by Steve Blackledge of CALPIRG. Not so seriously, he managed to invoke a comparison to Steve Martin in The Jerk.

Labels: CostContainment, Drugs, Federal, Funny, Legislation, OtherBlogs, Perata, YearOfReform

posted by Anthony Wright | Permalink | 1:20 AM


 

The other shoe drops...

HEALTH ACCESS UPDATE
Thursday, April 26th, 2007


SEN. PERATA'S HEALTH REFORM LEGISLATION CLEARS HEALTH COMMITTEE
* Senate Leader Don Perata’s “pragmatic’’ reform bill clears committee
* Senators urge more work to guarantee affordability
* ROUNDUP: Other bills in Senate Health Commitee

New on the Health Access WeBlog: Additional leg reports; "Near-universal?"; 500th post coming!


A day after his Assembly counterpart passed his health reform legislation in Assembly Health Committee, Senate Leader Don Perata presented his health reform legislation, SB48, for the first time Wednesday in Senate Health. As expected, the bill passed on a party line vote, with Chair of the Senate Health Committee Sheila Kuehl and other Democrats voting to move the measure.

No Republicans voted to move the bill forward, and they did not ask questions, even though the Senate President Pro Tem explicitly stated that "we must have Republicans actively engaged in the discussion. Saying this issue need full debate and should be a "full contact, participant sport," Perata urged lawmakers of both parties to keep working with him on the bill: “While we differ on approach, we all agree something must be done.”

Bluntly saying the bill is "not finished," he also stated that by the time the bill goes to Appropriations in a couple of weeks, the bill will be more fleshed out with specific numbers that can be openly debated, to weigh the trade-offs.

“SHARED RESPONSIBILITY’’ IS THEME AMONG REFORM PROPOSALS

Like Assembly Speaker Fabian Nunez’s AB8, Governor Schwarzenegger’s proposal, and Senator Kuehl's SB840, Perata’s plan relies rhetorically on the notion of “shared responsibility.’’

SB8 would:
• Require every Californian earning more than 400% poverty to have health insurance, or lose personal tax deductions
• Expand coverage to *all* children up to 300% of federal poverty;
• Require employers to spend a percentage of payroll on health care for both full- and part-time workers and their families, or pay an equivalent amount into a state fund that could help fund health care for workers.
• Create a state-run insurance “connector’’ that would negotiate rates and create coverage standards for employers to buy into.
• Require insurers to sell at least one approve plan to any applicant, regardless of health status.
• Combine small group and mid-size group insurance markets.
• Require health plans to spend at least 85 cents for every premium dollar on health care.

Unlike the Nunez and Schwarzenegger proposals, expansions and the “connector’’ purchasing pool would primarily cover workers and their families.

“SB48 is a huge leap to extending coverage to the uninsured, but it does not cover everyone,’’ admitted Perata. “It is shy of universal coverage, but it is a plan that is pragmatic and affordable.”

DISCUSSION ON AFFORDABILITY AND QUALITY

Democratic senators Mark Ridley-Thomas, Darryl Steinberg, Gil Cedillo, and Kuehl, along with advocates weighed in with concerns about whether the plan would actually be “pragmatic’’ for Californians if they could not afford health coverage, yet were forced to buy it.

“This is a very good attempt to cover working people. But our concern is that single people at 400% would have to buy coverage on the market if they are making over $39,000 a year,’’ said Kuehl. She cited that after she is termed out in 2008, she may have this experience herself, perhaps being self-employed or otherwise without employer-based coverage and ineligible for a public program, and just finding it unaffordable to get coverage.

Ridley-Thomas also was concerned that Californians who were not working – for instance, retired or between jobs – would not be able to get insurance through the “connector’’ pool that was negotiated by the state.

Perata said he would continue working on the issue of affordability – and also ensuring that plans met some kind of minimum standards.

STAKEHOLDER TESTIMONY

As with the Nunez bill, groups either gingerly supported or opposed the measure, or even were, as Perata dubbed them, "tweeners."

Supporters, including those seeking amendments, included the 100% Campaign, PICO California, the California Association of Public Hospitals, and AARP, which called health reform a "top priority." The California chapter of the American College of Emergency Physicians said any coverage expansion would help, since the uninsured account for 20% of emergency room visits, and since they don't often get reimbursed, those costs are borne by those with private insurance.

While supporting, the Califormia Medical Association and the association of county health executives urged a Medi-Cal rate increase. Kaiser Permanente was supportive but wanted the "guaranteed issue" requirements to be tied to only the population impacted by the individual mandate--not everybody. Blue Shield argued that the employer fee should not be allowed to be adjusted by regulation.

Some groups that were following the debate did not take position on the Perata bill at the committee hearing. Some groups testified even though not formally stating a support or oppose issue. Health Access California, the California Labor Federation, and SEIU stated their support of several elements but could not support the bill as a whole because of the individual mandate provisions. Health Access appreciated amendments that sought to protect lower-wage Californians and to include consideration for consumers' ability to pay, but such amendments were not applied broadly. The California Labor Federation echoed the concerns about the practical impact of the individual mandate, as well as the message it sends about shifting responsibility away from the collective and onto the individual.

Other groups were opposed, including the California Chamber of Commerce, which said it was concerned about the employer mandate and affordability of coverage for businesses. Other business opponents included the California Manufacturers and Technology Association, the California Restaurant Association. The California Association of Health Underwriters raised concerns from the employer mandate, as well as issues arising from non-compliance. The California Nurses Association also opposed the continued use of insurance companies. A Christian Science organization sought a religious exemption from the individual mandate.

WHY THIS BILL? WHY NOW?

This past week, Capitol watchers have seen a flurry of activity on health reform – nearly six months after Gov. Arnold Schwarzenegger declared 2007 to be the “Year of Health Reform.’’

“The stars and the planets may be aligning in a way to allow us to get something substantial done to improve health access and cost.’’ Perata said. "We have a historic opportunity and a responsibility to get it right."

In addition to Tuesday’s passage of AB8, last week, Sen. Sheila Kuehl’s single payer legislation, SB840, cleared her committee. “You know what I think the perfect bill is,’’ said Kuehl, referring to her SB840. “I don’t think this is the perfect, but it’s got some reality base. I see it happening. I see the job of this committee to try and getting it stronger.’’

"I think of your bill and the Speaker's bill as attempting to move us…(toward) extended coverage for some people in California, and attempting to move it in a way that does no harm,'' she said.

She appreciated Perata's willingness to work on further expanding coverage and making sure that coverage is affordable. Kuehl said that once all is said and done, Californians shouldn't be saying, "Why did they do this to me?'' Kuehl continued, "We may find them saying, 'Why didn't they do more for me?,' which is a different question.''

Perata agreed to work with the committee on these issues and reminded lawmakers to be practical about their approach. “Everyone here has one thing in common – they have health insurance. There is a danger of this becoming an academic exercise,’’ said Perata. But there are people without coverage, he said. “That’s the reason SB48 is here – and I’m still supporting SB840,’’

“Why this year? Why this bill? I know the perfect, the better,’’ said Sen. Perata referring to SB840. “But if we can’t do something for someone now, then shame on us.”

OTHER BILLS

Also in committee on Wednesday:
* SB32 (Steinberg) would expand Healthy Families to children in families up to 300% of poverty. An identical bill, AB1 (Laird) passed Tuesday. PASSED
* SB365 (McClintock) would have allowed out-of-state insurers to sell plans in California without abiding by California’s mandates and regulations. FAILED
* SB893 (Cox) would divert First Five tobacco tax dollars to pay to provide health coverage for low-income children. FAILED

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

Labels: Affordability, ExpandingCoverage, Kuehl, Legislation, Perata, Sacramento, Updates, YearOfReform

posted by Anthony Wright | Permalink | 1:16 AM


 

We're rollin' on reform....

Wednesday, April 25, 2007

It's been a busy week in health reform. Today, the last of three health reform bills – SB48 (Perata) – was heard and passed out of Senate Health Committee.

The bill – jointly authored by Senate President Pro Tem Don Perata and Sen. Sheila Kuehl – attacks health reform in the "shared responsibility'' fashion that the Governor and AB8 by Assembly Speaker Nunez do. Kuehl, however, has her own single-payer proposal SB840, which passed last week.

Perata's bill has a little of this and a little of that:

• Requiring employers to contribute to employee health plans or pay a fee.
• Reining in the insurance company practice of discriminating against people with "pre-existing" conditions.
• Expanding public programs, such as Medi-Cal and Healthy Families.
• And requiring that every Californian earning more than $41,000 (individual) to have health insurance – whether you're offered it on the job or not.

(Read the full text of the bill here.)

What was interesting about the debate, to me, was the sense that despite concerns about specific issues, all parties acknowledge that this was the year to get something done.

Sen. Sheila Kuehl, a strong advocate for consumers and considered a rock star in health policy circles for her persistence in getting a single-payer system in California, said she is often asked why she is co-authoring SB48.

"I think of your bill and the Speaker's bill as attempting to move us…(toward) extended coverage for some people in California, and attempting to move it in a way that does no harm,'' she said. "It's a good attempt to cover working people.''

But, Kuehl admonished, she would be extremely sensitive to any proposals that leave Californians worse off than they are now.

She appreciated Perata's willingness to work on further expanding coverage and making sure that coverage is affordable, saying that once all is said and done, Californian's shouldn't be saying, "Why did they do this to me?''

While they may be saying, "Why didn't they do more for me,'' Kuehl said, that's a different question.

Sen. Perata agreed with Kuehl.

"Why this year? Why this bill? I know the better [bill],'' said Sen. Perata referring to SB840, which would be vetoed – again – by Gov. Schwarzenegger if it landed on his desk. "But if we can't do something for someone now, then shame on us."

Labels: ExpandingCoverage, Kuehl, Legislation, Perata, YearOfReform

posted by Hanh Kim Quach | Permalink | 6:19 PM


 

Steps forward...

HEALTH ACCESS UPDATE
Wednesday, April 25, 2007


SUPER TUESDAY: ASSEMBLY HEALTH COMMITTEE CONSIDERS 37 BILLS;
PASSES SPEAKER'S HEALTH REFORM BILL

* Speaker’s bill (AB8) on health reform expands coverage, set rules on insurers, etc.
* Other bills: Health plans would need to follow stricter rules before rescinding coverage
* Roundup of other bills of interest to health advocates

New on the Health Access Weblog: Blog Update, Gov's Proposal, Medicaid Grades


With one week left before bills need to be out of policy committees, the Assembly Health Committee was a flurry of activity on Tuesday. Of highest interest to many health advocates was AB8 (Nunez), getting its first legislative hearing this year.

While AB8 was heard for the first time Tuesday, it’s not on the only health reform proposal on the table. Gov. Arnold Schwarzenegger started the year by unveiling his proposal and a declaration that 2007 would be the “Year of Health Reform.’’ Last week, the Senate Health Committee passed SB840 (Kuehl), which would create a universal single-payer health system in California, which has been vetted for the last five years. Senate President Pro Tem Don Perata will have to present his health reform measure today at 1:30 in the Senate Health Committee.

AB8 (Nunez)

AB8 passed on a 10-5 votes (unofficial tally). Assembly Speaker Fabian Nunez started by saying "there is no greater state interest or urgency this year than strengthening our fragile health care system." He characterized the bill as a "very broad approach to reforming our broken health care system." He admitted that his bill “is not the finished product’’ but said it was thoughtful and sound and urged fellow lawmakers to work with him on improving the measure. “This year we have a rare opportunity. A chance to act. I don’t think that we can miss this opportunity,’’ Nunez said. “This system is going to fall on us if we don’t fix it.’’

Speaker Nunez had several Assembly Democrats present on different parts of the bill.

* Assemblywoman Karen Bass talked about expanding and simplifying public programs:
* Increasing eligibility for public programs such as Healthy Families and Medi-Cal, for children, as well as many parents;
* Creating a premium assistance program for low-income families;
* Streamlining enrollment in these programs, including elimination of the asset test in Medi-Cal;

* Assemblyman Hector De La Torre described the insurance market reforms, including new rules for government and insurers:
* Imposing rules on health insurers so that relatively minor ailments are no longer grounds for denying coverage;
* Extending protections in the small group market to the mid-size insurers;
* Requiring insurers to dedicate at least 85 cents on every premium dollar toward patient care, rather than administration and profit;

* Assemblyman Ed Hernandez talked personally, from his experience as a optometrist dealing with patients who had diabetes, about the focus on prevention. This includes the creation of uniform benefit standards that include preventative care and disease management.

* Assemblyman Kevin de Leon presented on cost containment issues, such as:
* The use of Section 125 plans to allow health premiums to be paid for with pre-tax dollars;
* The creation of the state purchasing pool to bargain rates, as well the creation of uniform benefit plans to allow for better price comparison by health purchasers;
* Promoting health information technology;
* The savings yielded by covering the uninsured, reducing the estimated 10% cost shift.

* Speaker Nunez finished on the financial aspects, including the drawing down of new federal funds, and issues of employer and employee responsibility. That includes the option for businesses to contribute money toward coverage or pay a fee. (The exact level of the fee was unspecified, as the modeling of the proposal is continuing).

Read full text of the bill here.

Assemblyman Nakanishi, Republican vice-chair of the committee, started off the discussion by saying that while they agreed with the concern, the Republicans were "vehemently against the approach" of the bill.

Assemblyman Bob Huff, R-Diamond Bar, said he did not believe Nunez was approaching the problem correctly and “stifling choice.’’He said the health care system “is not broken. People come here from countries with socialized medicine for cutting edge treatments.’’ The problem, he said, “”It’s not an equally distributed health care system.’’ Huff said he believed that Nunez’ attempts to fix the system would “kill the baby while trying to save it.’’ Rather, Huff is supportive of the Assembly Republican assortment of health care legislation that focuses on “increased choice’’ that allows for “incentive- and market-based’’ reforms.

Assemblywoman Audra Strickland, R-Thousand Oaks, took issue with the part of Nunez’ proposal that would eliminate the Medi-Cal asset test. “We are opening our doors to the world…offering “Cadillac Coverage” to anyone who sets foot here,’’ she said. She also said she believed that taking away insurers’ ability to discriminate against people who had illnesses – major or minor – was a losing proposition, “increasingi premiums and deductibles’’ in other states. Nunez clarified that his bill would create a high-risk pool for consumers who had more serious illnesses, but that his bill simply prevented insurance companies from denying policies for ailments such as bunions or ear infections. “I believe the healthcare insurance industry has got to step up to the table,’’ he said.

Assemblyman Ted Gaines, R-Roseville, said he resisted the mandates in the bill, and would argue to even remove the mandates in the current law. “Maybe you don’t need ‘bells and whistles’ on a catastrophic health policy,’’ he said.

A handful of groups, such as the 100% Campaign of Children Now, Children's Defense Fund, and Children's Partnership, as well as the NAACP and PICO California, supported the measure outright. Many expressed general support but had suggested amendments including the California Labor Federation, California Medical Association, Health Access California, Consumers Union, SEIU, Teamsters, AARP, AFSCME, California Association of Public Hospitals, California Federation of Teachers, CALPIRG, Congress of California Seniors, Jericho, said they would support the measure if amended. Also in the same position of seeking amendments was the California Association of Health Underwriters, Kaiser Permanente and Blue Shield, the latter saying that the bill "does not go easy on health plans," and while they have concerns, they recognize they need to be part of the "shared responsibility."

See Health Access California’s position letter on AB8 here.

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 %20
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Assemblywoman%20Strickland%20jumped%20on%20that%20notion%20as%20well.

De%20La%20Torre%20reiterated%20several%20times%20that%20the%20bill%20would%20not%20force%20health%20plans%20to%20pay%20for%20consumers%20that%20werenâ??t%20paying%20their%20premiums.%20It%20only%20addressed%20the%20narrow%20issue%20of%20health%20plans%20canceling%20coverage%20when%20it%20turned%20out%20consumers%20needed%20coverage.

ROUNDUP%20OF%20BILLS%20COMMITTEE%20VOTED%20ON%20TUESDAY

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â?¢Â   %20AB1468%20(Garrick)%20FAILED.%20Would%20require%20hospitals%20to%20collect%20and%20report%20information%20on%20how%20much%20care%20they%20provide%20to%20uninsured%20patients%20â??%20particularly%20undocumented%20immigrants%20â??%20and%20how%20much%20of%20that%20care%20is%20uncompensated.%20(Health%20Access%20position:%20Oppose)%20
�   %20AB1312%20(Emmerson)%20SUPPORT. %20Would%20increase%20Medi-Cal%20reimbursement%20rates%20to%20near%20Medicare%20levels. %20(Health%20Access%20position:%20Support)%20
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Opponents included the business groups largely opposed to the employer mandate, with the Chamber of Commerce and others citing their concern about health costs rising higher than the rate of inflation. The California Restaurant Association testified that there was "much to applaud" in the measure, but was concerned about the mandate on "labor intensive, low-margin businesses." Other opponents included the National Federation of Independent Businesses, California Manufacturers Association, and the Automotive Business Association. The California Nurses Association also opposed, saying "health insurance isn't health care," suggesting amendments to only expand coverage to children, as a "bridge" to SB840.

Nunez responded to the various questions by Republican Assemblymembers, arguing that his proposal "expands access to health care, improves quality of health care... and provides the opportunity to put a hold on the cost of health care."


HEALTH PLANS WOULD BE BANNED FROM RESCINDING POLICIES WHEN CONSUMERS USE COVERAGE

In a victory for consumers Tuesday, the Health Committee also passed AB1324 (De La Torre), which re-states and re-emphasizes California’s law prohibiting health insurers for canceling coverage consumers if they turn out to be sick.

The bill comes about after several high profile cases in which several insurers such as Blue Cross of California rescinded coverage – retroactively – from policyholders after expensive claims were made. Consumers were left with hundreds of thousands of dollars in bills after the insurer refused to pay the bills incurred during the time patients believed they were insured. Blue Cross alleges that the patients knowingly lied about their health status on their applications for coverage, triggering the cancellation. Since then, policyholders filed hundreds of lawsuits against Blue Cross. Physicians and hospitals have also joined with consumers.

Insurers opposed AB1324, but attacked it on unrelated issues regarding the bill's overall scope. For instance, the California Association of Health Plans, said they were concerned insurers would have to continue to cover patients even if premium payments had not been made for the patient.

De La Torre reiterated several times that the bill would not force health plans to pay for consumers that weren’t paying their premiums. It only addressed the narrow issue of health plans canceling coverage when it turned out consumers needed coverage.


ROUNDUP OF BILLS COMMITTEE VOTED ON TUESDAY

* AB1 (Laird) PASSED. Would allow children in families up to 300% of poverty to enroll in Healthy Families. This bill is similar to AB772 (Chan), which was vetoed by Gov. Schwarzenegger in 2005. (Health Access position: Support)

Several bills that were part of the Assembly Republican health package were considered as well:

* AB1468 (Garrick) FAILED. Would require hospitals to collect and report information on how much care they provide to uninsured patients – particularly undocumented immigrants – and how much of that care is uncompensated. (Health Access position: Oppose)
* AB1312 (Emmerson) SUPPORT. Would increase Medi-Cal reimbursement rates to near Medicare levels. (Health Access position: Support)
* AB1572 (DeVore) FAILED. Would require conversion foundations that administer grants to spend 90 percent of those dollars providing direct medical services.
* AB1072 (Gaines) PASSED. Would create the California Health Insurance Exchange within MRMIB that would “facilitate” the purchase of health insurance.

Labels: ExpandingCoverage, Insurers, Legislation, Nunez, Sacramento, Updates, YearOfReform

posted by Anthony Wright | Permalink | 1:37 AM


 

Legislation? What legislation?

Monday, April 23, 2007

Bill Bradley at New West Notes puts forward his own prognosis for health care reform this year. He's off on some things (like the exact content of the legislative proposals), but gets the history with SB2(Burton) right.

One thing I'll disagree with him on is the significance of the Governor not having an authored bill: Health underwriter Alan Katz comments in his blog that it doesn't matter if the Governor doesn't have a bill: by virtue of pen and veto stamp, he is able to influence the process. But at the same time, he can only sign the bills the Legislature place on his desk. It's up to us to get the legislature to put a bills that provides benefits, not burdens, to health care consumers.

Some have cited models from last year: global warming, minimum wage, prescription drugs. As we start in the next two days with committee hearings on the proposals by Speaker Nunez and Senate President Pro Tem Perata, that's the type of process we might be looking at.

Labels: Legislation, OtherBlogs, Sacramento, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 9:54 PM


 

Grading on a curve

Saturday, April 21, 2007

Public Citizen put out a report last week ranking each state's Medicaid programs, based on the question, if you were poor and/or sick, how well could you get the care that you need?

Especially after fighting all the proposals to cut Medi-Cal during the last budget crisis, there should be some pride in California's ranking of 14, although it's sobering how restrictive Medicaid can be in other states. California did better than others: California didn't top the list in any category, but is better is eligibility and benefits than many states, and near the bottom of the pack in paying providers, which has an impact on these 6.8 million children, seniors and people with disabilities being able to access a provider. It does show that California can do more, and the report recognizes the health reform conversation we are having now.

The report does provide a useful reminder about how important and foundational the Medicaid program is for all of us. Page 61 focuses specifically on California.

Labels: MediCal, OtherStates, Research, YearOfReform

posted by Anthony Wright | Permalink | 11:14 AM


 

Blue Cross in more hot water

Friday, April 20, 2007

Lisa Girion at the LA Times writes that doctors and hospitals are now joining the patient lawsuit against Blue Cross when the giant health insurer retroactively rescinded patient's policies after they received treatments and refused to pay out claims.

Assemblyman Hector De La Torre is hoping to curb the practice with his AB1324.

Labels: BlueCross, InTheNews, Legislation, Sacramento

posted by Hanh Kim Quach | Permalink | 12:21 PM


 

The season has started...

Thursday, April 19, 2007

HEALTH ACCESS UPDATE
Wednesday, April 19, 2007


SB840(KUEHL) PASSES BEFORE PACKED HOUSE
· Overflow crowds show support as SB840 passes Senate Health Committee
· Update on week's health legislative activity; preview of next week


New on the Health Access WeBlog: Medicare Drug Negotiations; Hospital Fair Pricing; Prague Spring and ERISA; Schwarzenegger in San Diego; It's Our Healthcare; Wonks, Hacks and Flacks; The Connector and The Terminator; Blue Cross' Bad Behavior; Book Club


Sen. Sheila Kuehl, standing before her own Senate Health Committee, presented (for a fifth year in a row) her legislation that would establish a universal single-payer health system in California .

Since 2003, Kuehl has carried this legislation. And since 2003, a growing legion of supporters makes the pilgrimage to the fourth floor Capitol hearing rooms to advocate for this universal system.

“Californians have been left helplessly stranded,’’ said Kuehl in her opening statements, detailing how health care costs have steadily risen, while quality and access has steadily declined. She cited a study, published this week by the online medical journal Open Medicine, which concluded that Canada’s single-payer health care system “produces health benefits similar or perhaps superior, to those of the US health system, but at a much lower cost.’’

SB840 passed on a party line vote, 6-5. Democratic Senator Gloria Negrete-McLeod, D-Chino, was not present when the vote was taken.

Kuehl said she continues to author the measure because she believes that the legislative system works. Since introducing her bill, it has gone through many changes – and gotten better, in her view. On why she keeps pushing the proposal in the legislative process, she said: “It’s better than backroom deals. It’s better than the ballot – where it’s a ‘take it or leave it’ situation,’’ she said. “This bill has been vetted and vetted."

DEBATE

Since Kuehl first introduced her single-payer measure, the debate has shifted significantly, and steadily picked up more supporters. A full description of the atmosphere of the hearing is at the California Notes blog.

Opponents continued to argue against the bill, but their comments – compared with past years – were more tempered, perhaps in deference to the Kuehl's new position as chair of the Senate Health Committee. The lobbyist for the Association of California Life and Health Insurance Companies, went to great lengths on Wednesday to “respectfully’’ oppose Kuehl’s measure, saying “We don’t agree that government would be the best’’ at running a health care system.

The Chamber said it disagreed, in principle, with the annihilation of the health insurance industry, (“We don’t support the banning of an industry because they’re not living up to your standards.”), and said it would be difficult to get Californians to agree to higher taxes to fund the system (even, as supporters argue, that those increased taxes would be lower than what we currently in premiums.)

Sen. Darrell Steinberg, D-Sacramento, asked the Chamber of Commerce representative whether business “had a position on the declining quality of health care, and increasing premiums.’’

The Chamber representative conceded that business was, in fact, struggling with the health care system. But then noted that the problem is partially due to the fact that California’s current health care “system’’ is actually a “cadre of systems” (public and private) that have been forced to work together without much consistency. The Chamber representative, however, questioned whether SB840, which would supplant the existing “systems’’ with a new and different one would succeed.

THE MARCH CONTINUES

Sen. Sam Aanestad, R-Grass Valley , asked Kuehl why she continued to introduce her bill when it appeared as if Gov. Arnold Schwarzenegger would veto it – as he did in 2006.

Kuehl’s response: “I’m not sure I do expect a different result this year. But I do expect a different result eventually.’’

About 50 groups announced their support for SB840 at the hearing; 84 organizations have submitted letters of support. Meanwhile, 15 organizations – including business and insurers and providers – opposed the measure.

WEEK IN REVIEW

As the deadline for bills to pass policy committees loom, other bills of note that were up this week included:
* AB2 (Dymally) - Reforms and restructures the Managed Risk Medical Insurance Program for the medically uninsurable who are denied care by health plans because of "pre-existing conditions.'' Passed.
* AB1554 (Jones) - Would regulate health coverage rates by requiring state approval before premiums, deductibles or other out-of-pocket costs are changed. Passed.
* SB350 (Runner) - Makes technical changes to last year's landmark AB774 (Chan) which bans hospital overcharging, enabling patients who are uninsured or underinsured to pay the same rates as public programs or insurance companies. Passed.
* SB1014 (Kuehl) Establishes a financing mechanism and tax for SB840, the single payer system. Passed.

Also this week, the Senate Budget Subcommittee on Health also heard from health plans about the need to increase their reimbursement rates for their Medi-Cal enrollees. Health plans said the state's low reimbursement rates made it difficult for them to adequately pay providers to care for Medi-Cal recipients. The committee left the item open until after the governor releases his May Revision.


NEXT WEEK

Stay tuned next week as the health reform debate continues.
· AB8 (Nunez) – The Speaker’s health reform proposal will be in Assembly Health Committee on April 24th
· AB1 (Laird) – to provide universal children’s coverage will be in Assembly Health Committee on April 24th.
· SB48 (Perata/Kuehl) – Senate Leader Perata’s health reform proposal will be in the Senate Health Committee on April 25th.
· SB32 (Steinberg) – to provide universal children’s coverage will be in Senate Health Committee on April 25th.

Labels: Kuehl, Legislation, Sacramento, SB840, Updates

posted by Anthony Wright | Permalink | 9:51 PM


 

Fair is fair. Not charity.

California enacted landmark legislation this year that would allow uninsured -- and underinsured -- hospital patients negotiate fair rates from hospitals.

As many are well aware, if you're uninsured and end up in the emergency room, you're often charged many times what insurance companies pay for the same procedures. Patients have reported visits that cost thousands of dollars per minute. Others have gone into bankruptcy as a result of needing health care at a time they were not insured.

As a result of these unfair and aggressive billing practices by hospitals, the Legislature passed (and governor signed) AB774 (Chan) last year, which would allow uninsured and underinsured patients to pay the same rates at Medicare.

Sen. George Runner, R-Antelope Valley, this year, is authoring a bill to clarify that law. Health Access is working with Sen. Runner's office to ensure that this effort is a technical clean-up. We appreciated his public commitment at Senate Health Committee yesterday to not move the bill unless it is something that stakeholders like us agree to. We want to ensure the hard-won consumer protections stay strong and that patients are not overcharged and thrown into financial turmoil because they had the misfortune to get sick.

But one clarification of our own: in yesterday's hearing, Runner repeatedly referred to the practice of "fair hospital pricing'' as "charity care.''

The law that Senator Runner is attempting to amend is not about "charity care.'' It shouldn't be considered "charity'' if you are simply paying the same price as public programs and big insurer.

Labels: Hospitals, Legislation, MedicalDebt, Sacramento

posted by Hanh Kim Quach | Permalink | 2:59 PM


 

This is our political system on drugs...

Wednesday, April 18, 2007

Here in Sacramento, SB840(Kuehl) passed out of Senate Health Committee this evening, along a party line vote with six "aye" votes. (State Senator Negrete-McLeod was not present during the vote.)

But the issue of "single-payer" health coverage was invoked in Washington, DC, as well.

In a blow to seniors, the federal budget, and common sense, several U.S. Senators blocked a attempt to pass a bill to allow the federal government to use its purchasing power under Medicare to negotiate for prescription drugs. While most Democrats (including California's Boxer and Feinstein) and even six Republicans voted for the measure, totalling 55 votes, it was not enough to get the supermajority 60 votes needed to actually get it passed.

I was curious about the argument quoted in the New York Times write-up:


Senator John Cornyn, Republican of Texas, denounced the bill as “a step down the road to a single-payer government-run health care system.”

Democrats said they were merely trying to untie the hands of the secretary of health and human services so he could negotiate on behalf of 43 million Medicare beneficiaries.

“The Department of Veterans Affairs is able to negotiate for lower-priced drugs,” said the Senate majority leader, Harry Reid, Democrat of Nevada. “H.M.O.’s can negotiate. Wal-Mart can negotiate. Why in the world shouldn’t Medicare be able to do that?”

A 2003 law prohibits Medicare from negotiating or setting drug prices or establishing a uniform list of covered drugs, or formulary.


More than a handful of Republican Senators don't think they are endorsing single-payer health care when simply supporting the common-sense notion of the Medicare program using its purchasing power. The notion of a "bulk discount" is market-oriented, after all.

But it seem Senator Cornyn's argument only makes sense if he thinks the bill will actually be effective--that it will actually provide medicines at lower prices for seniors and Medicare. If it worked, it would spur other reforms... but that wouldn't be a bad thing.

Labels: Drugs, Federal, InTheNews, Medicare, SB840

posted by Anthony Wright | Permalink | 9:32 PM


 

The dreamers, the lawyers, and me...

I am disappointed that the LA Times/Political Muscle's Bob Salladay didn't challenge the San Diego Union-Tribune's Chris Reed when repeating his assertions that health reform at the state level is not legal.

I'm not a lawyer, but given all the activity at the state level across the country, it doesn't seem many agree with him. His entire argument is based on a split ruling by the most conservative appeal circuit in the nation, about a specific law in Maryland that is structured differently than the proposals in California, which is in a different circuit anyway.

It's true that Maryland decided earlier this week not to appeal the court decision against their infamous "Wal-Mart law" to require the large retailer to spend at least 8% on health benefits. Reed compares the court decision--and I am not kidding or embellishing--to the Soviet tanks rolling into Prague as a final act against state health reform efforts.

We could get into the details of the federal ERISA law, but let's quote the actual decisions:

* The lower trial court: "Of course, I am expressing no opinion on whether legislative approaches taken by other States to the problems of health care delivery and its attendant costs would be preempted by ERISA. For example, the Commonwealth of Massachusetts has recently enacted legislation that addresses health care issues comprehensively and in a manner that arguably has only incidental effects upon ERISA plans. In light of what is generally perceived as a national health care crisis, it would seem that to the extent ERISA allows, it is strongly in the public interest to permit states to perform their traditional role of serving as laboratories for experiment in controlling the costs and increasing the quality of health care for all citizens." (From footnote 15)

* Characterizing and quoting the appeals court, the Center for Policy Alternatives writes: "The majority (2-1) opinion was written by a very conservative Reagan and Bush Sr.-appointed judge and was based on the assertion that "the Fair Share Act leaves employers no reasonable choices except to change how they structure their employee benefit plans…", an assertion that is simply false (as the dissenting judge pointed out).

* From the the dissenting appeals judge's statement: "Maryland is being buffeted by escalating Medicaid costs. The [Maryland] Act is a permissible response to the problem. Because a covered employer has the option to comply with the Act by paying an assessment — a means that is not connected to an ERISA plan — I would hold that the Act is not preempted."

It's about choices: The basis of the decision by the appeal court was that while there was technically an "option" for employers, it wasn’t "meaningful." Their ruling was based on the notion that no employer would choose to pay the 8% assessment to the state, for which they or their workers get no benefit, rather than directly provide coverage to their workers.

In San Francisco, and to various extents in Massachusetts and Vermont, and what is being debated in various states including California by our Governor and legislative leaders, the employers who pay the fee get the benefit of a workforce with access to health care, a workforce that is healthy, more productive, and has less turnover and training costs. For example, the "pay or play" models give employers "reasonable" and "meaningful" choices to benefit their workers, and thus themselves. Employers have options to comply with these local proposals without impacting their national ERISA health plans.

On Reed's challenge: Reed make a big deal that he can't find a ERISA lawyer to endorse Schwarzenegger's health plan. But lawyers are notorious about not giving a straight answer: most wouldn't endorse an Arbor Day resolution without five caveats.

But to say that you can't do state health reforms? I can find several through Google. Reed may be admitting he didn't read the court decision: I quoted above the dissenting judge who is undoubtedly a lawyer, who seemed OK with Maryland's law, even with its structure. Reed himself cites Pat Butler and other authors of various papers. And he mentioned that several states (Illinois, Pennsylvania, etc) have come out with their own proposals since the court decisions, and they all have their own legislators and lawyers in support.


California dreaming: Finally, Reed compares health reformers to the Dreamers during the Prague Spring, a time of creativity, liberalization, and openness before the Iron Curtain fell over Czechoslovakia.

But in the end, didn't the Iron Curtain fall? Didn't a playwright become president? Didn't the Dreamers ultimately win?

Labels: Employers, Federal, OtherBlogs, OtherStates, Research, SanFrancisco, YearOfReform

posted by Anthony Wright | Permalink | 6:49 PM


 

Big Action Day

In another inspiring day at the Capitol, hundreds of supporters packed hallways and overflowed hearing rooms -- for the second time this year -- in support of Sen. Sheila Kuehl's SB840, which would create a single-payer health system in California.

This is the fifth year that Kuehl has introduced the measure and support has snowballed.

In addition to the standing-room only crowd, who needed to be told not to cheer in the hearing room, more than four dozen supporters lined up to annouce their support for the bill to lawmakers. This strong showing nearly drowned out the seven sheepish opposing voices coming from business, health insurers and medical providers.

Last year, for the first time, Kuehl's SB840 passed both houses of the Legislature and landed on the governor's desk. It was the first time a single-payer measure has ever made it that far in California. Schwarzenegger vetoed the bill.

Asked whether she believed the governor would "realistically'' sign the bill this year in light of last year's veto.

"I'm not sure I do expect a different result this year. But I do expect a
different result eventually,'' Kuehl said.

Eventually is too long for some Californians to wait. Urge your lawmakers to support health reform now!

Labels: ExpandingCoverage, Kuehl, Sacramento, SB840, YearOfReform

posted by Hanh Kim Quach | Permalink | 2:24 PM


 

Patients spotlight affordability

Here's a section of the press "pool report" by Keith Darce, San Diego Union Tribune, covering the Governor's visit to the emergency department of Scripps Mercy Hospital in San Diego. You can link to the article he wrote, but this is the background he wrote for use for other reporters:

The emergency department was crowded with doctors, nurses and other hospital workers. About 40 patients were in the department, most of them hidden from sight behind drawn privacy curtains.

Schwarzenegger met with three patients, all of whom have health insurance. The governor was quickly ushered to the bedside of Evelyn Hare, 81, of San Diego, who had arrived an hour and a half earlier after suffering side effects from medication.

"Good to see you," Schwarzenegger said. "How are you feeling?"

"I'm feeling much better," Hare replied.

"I wish I could live to 81. You look really great," the Governor said....

Next, Schwarzenegger visited Ivy Harris, who lives in southeastern San Diego. She was making her second visit to the emergency department since Friday due to complications from a March 20 surgery to remove intestinal blockage.

"The hospital is taking good care of me," Harris told the Governor. She questioned Schwarzenegger about how his health care insurance reform plan might affect unmarried women such as herself, and she noted that her out-of-pocket costs for health care have increased substantially in recent years....

Just a reminder that real people are concerned about rising out-of-pocket costs like co-pays and deductibles, and health care reform needs to address the issue, not just the affordability of the premium.

Labels: Affordability, Schwarzenegger, Underinsurance, YearOfReform

posted by Anthony Wright | Permalink | 10:28 AM


 

Our Voice, Our Healthcare...

Yesterday, Health Access California joined with the California Labor Federation and many other organizations in events around the state for a formal launch of the Its Our Healthcare! campaign, and particularly, the effort to raise the voice of consumers, workers, and families, and get us to tell the health care stories we all have.

The event at Capitol Park in Sacramento had signs all around, with people's pictures and stories posted, including uninsured, insured, underinsured... but all who have issues with the health care system and want major reform. More information from these events is at the campaign website (where we will also be posting on that blog), at:
http://www.itsourhealthcare.org/

UPDATE: The Bayne of Blog covered the rally yesterday, complete with pictures:
http://bayneofblog.blogspot.com/

Labels: OtherBlogs, Sacramento, YearOfReform

posted by Anthony Wright | Permalink | 12:18 AM


 

Wonks, Flacks, and Hacks

Tuesday, April 17, 2007

One last comment on the TPMCafe Book Club on the new Jonathan Cohn book Sick. The discussion was useful in moving beyond the debate among progressives about what specific proposal to support, and focusing on the hard work at hand. In the last four years in California, we've shown that we can successfully advocate for different proposals at the same time, from setting standards for on-the-job benefits to expanding children's coverage to creating a universal single-payer systemmm, and each effort can build momentum for one another. There's more focus on health care this year because of all these efforts complementing each other.

One correction: Robin Podolsky wants it clarified that she wrote that she copped to being a "flak," not a "hack," as I mistakenly wrote. She was originally objecting to the term "wonk." I'll claim all three descriptions for myself...

That reminds me that I never linked to the newest version of Health Wonk Review, at the Health Affairs blog, which is chock full 'o interesting posts and analyses, about the national health policy debate. There's a reading list on lessons learned from the Clinton-era efforts; comments on the Democratic presidential candidate's plans, Massachusetts, single-payer, and other ideas, issues raised about transparency, and even a April Fool's post...

Labels: Kuehl, OtherBlogs, OtherStates, SB840, YearOfReform

posted by Anthony Wright | Permalink | 4:42 PM


 

The Connector vs. The Terminator

To inform our debate about "individual responsibility" in California, let's be clear that the only state in the nation to even try an individual mandate has last week allowed for broad "affordability" exemptions, for 20% of the uninsured. These folks are likely not offered public subsidies or affordable employer-based coverage, yet were facing the penalty of enforcement.

Under the Massachusetts plan, staying uninsured was the least worst option for these uninsured folks: the other option is to be forced to buy a coverage product that they don't have the money for, and given the deductibles and cost-sharing, may not be of particular use or value to them. Under the exemption, it's not great that they stay uninsured, but at least it meets the "first, do no harm" policy test.

I post this schedule not to endorse these standards, but to show that even proponents of the individual mandate need to recognize its problems. The Governor's proposal does not have any exemptions or considerations in this regard.


From "The Connector" in Massachusetts:

An example of what monthly premiums are deemed affordable, based on income under the recommended schedule, is set forth below. As an example, a single individual earning under $15,315 who is not eligible for Commonwealth Care because he or she is eligible for employer-sponsored insurance would not be penalized for passing up the employer-sponsored insurance offer unless it were free. At the other end of the income scale, a single individual earning between $40,001 and $50,000 would not be penalized for passing up the offer if the monthly premium were more than $300.

Singles ---------------------- Couples -------------------- Families w/Children
$0 - $15,315 ($0) ----------- $0 - $20,535 ($0) ----------$0 - $25,755 ($0)
$15,316 - $20,420 ($35) ---- $20,536 - $27,380 ($70) --- $25,756 – $34,340 ($70)
$20,421 – $25,525 ($70) ---- $27,381 - $34,225 ($140) -- $34,341 - $42,925 ($140)
$25,526 – $30,630 ($105) -- $34,225 - $41,070 ($210) -- $42,926 - $51,510 ($210)
$30,631 - $35k ($150) ------ $41,071 - $50k ($270) ----- $51,511 - $70k ($320)
$35,001 - $40k ($200) ----- $50,001 - $60k ($360) ----- $70,001 - $90k ($500)
$40,001 - $50k ($300) ----- $60,001 - $80k ($500) ----- $90,001 - $110k ($720)

Labels: Affordability, IndividualMandate, OtherStates, Schwarzenegger, Uninsured

posted by Anthony Wright | Permalink | 3:46 PM


 

What can you do for health care?

Monday, April 16, 2007

HEALTH ACCESS ALERT
Monday, April 16, 2007

ACTIONS ON HEALTH CARE THIS WEEK: RALLIES, HEARINGS, CALLS
* "It’s Our Healthcare!" Rally: Tuesday, April 17th
* Senate Health Committee considers SB840 (Kuehl): Wednesday, April 18th
* Call Congress on drug negotiation; SCHIP and covering legal immigrant children
* Health reform and children’s coverage measures up next week

The last two weeks of April promise to be eventful for health care activists in Sacramento, with many activities and committee hearings.

HEALTH REFORM RALLY TUESDAY APRIL 17

Tomorrow, a broad range of consumer, community, consumer, and labor groups will convene on the east side of the Capitol to kick off a major effort to engage Californians to tell their health care stories. These stores will help to remind decision makers at the Capitol that the reason that the health system needs to be reformed is to protect consumers.

The rally on Tuesday, sponsored by the It’s Our Healthcare! Campaign and the California Labor Federation, will feature Californians who have had a hard time getting health care they need when they need it, or ended up with mountains of medical debt when they sought medical help for their ailments. Photos and the stories of victims of the health care system will be featured in Capitol Park .

Who: More than 200 members of community organizations, unions, and senior groups statewide
What: Rally for Health Care. Launch of statewide story collection efforts.
When: 12noon, Tuesday, April 17th
Where: East lawn (between 12th and N streets) facing the east side of the Capitol.


SB840 (KUEHL) IN COMMITTEE ON WEDNESDAY

Sen. Sheila Kuehl will present her universal, single-payer legislation before her own Senate Health Committee on Wednesday, April 18th.

This is the fifth year in a row that Kuehl has authored a version of this bill. Last year, it made it to Gov. Arnold Schwarzenegger’s desk – for the first time in history – but was vetoed. Kuehl hopes to continue to refine the bill and advance it through the legislative process, as an important part of the health reform bill this year.

When: 1:30 p.m.
Where: State Capitol, Room 4203
Listen on the Web: http://www.senate.ca.gov/htbin/testbin/noframe_raudio/


CONGRESS TO VOTE ON MEDICARE DRUG NEGOTIATION

Back in Washington, DC, the U.S. Senate is expected to consider the Medicare Prescription Drug Price Negotiation Act soon. Currently, the government is prohibited from using the bargaining power of 43 million Americans in Medicare to negotiate with pharmaceutical companies for lower drug prices. Earlier this year, the House of Representatives passed a bill to give the government the option to do just that.

National consumer groups have set up a TOLL-FREE HOTLINE FOR TODAY to urge our Senators to vote YES on this important legislative. The number is 1-800-828-0498.


HEALTH CARE FOR (LEGAL) IMMIGRANT CHILDREN, TOO!

The U.S. Congress is also deliberating the extension and reauthorization of the State Child Health Insurance Program, also known as Healthy Families in California.

One potential change as part of this debate would significantly help California draw down federal dollars for children's coverage. California currently provides coverage for some qualified children who are here legally but have not been here for five years--but the state does not get federal matching funds for this, as we get for other programs.

The Legal Immigrant Children’s Health Improvement Act (ICHIA) (S. 764, H.R. 1308) would allow and reimburse states to enroll these children in those programs. If this law passed, it would go a long way toward helping to cover all children nationally, and help California get its fair share of federal financing. It would also create a more solid foundation for the state’s efforts this year to provide universal health care to all