Busy Day...

Thursday, May 31, 2007

Lots of happenings on health today in Sacramento:

* The Appropriations Committee (Frank Russo gives some flavor here) passed the health care reform plans, as expected.

* More information came out about the release of Sicko, the Michael Moore film, including a premiere that night hosted by Speaker Fabian Nunez in Sacramento on June 12th, as well as a 2p.m. rally that day with Sen. Kuehl and the California Nurses Assocation. (Jon Myers at KQED and Jordan Rau at LA Times have reports).

* On the other side of the spectrum, the Pacific Research Institute hosted a luncheon panel at noon attacking any health care reform, from the Governor Schwarzenegger's proposal to Senator Kuehl's.

* Together for Health Care, a pro-reform coalition that includes California Medical Association, Catholic Healthcare West, California Labor Federation, SEIU, Blue Shield of California, Kaiser Permanente, HealthNet, AARP, Silicon Valley Leadership Group and the California Teachers Association have launched their first ad. The tagline: "If we don't make health care better, it will keep getting worse." Hard to disagree.

The coalition is one of the rash of new health policy coalitions at the state and federal level. (Here's a scorecard.) It's a sign of the times that momentum is gaining on reform, and that is in itself is positive. Yet the diversity of the group (which includes some members and allies as well as sometime and frequent adversaries of Health Access California) means that their agreement is general, not too much beyond broad principles. (Here's one press report.)

Labels: InTheNews, Legislation, Nunez, OtherBlogs, Perata, Sacramento, SB840, YearOfReform

posted by Anthony Wright | Permalink | 6:25 PM


 

What's in the water in Sacramento?

Wednesday, May 30, 2007

With the whales having departed Sacramento (and, it seems, the San Francisco Bay), the focus in the Capitol City comes back to the budget, and health care.

The Budget: The Budget Conference Committee has been named: Assemblymember John Laird (D) will chair, along with his colleagues Mark Leno (D) and Roger Niello (R), and Senators Denise Ducheny (D), Dennis Hollingsworth (R) and Mike Machado (D). You can expect committee hearings shortly, to bridge the differences between the various budget proposal.

Health Proposals: The Appropriations Committee in both houses vote tomorrow, May 31st, to pass out a slew of bills. I don't expect too much trouble from the proposals on the table: AB8 (Nunez), SB48 (Perata), or SB840(Kuehl). This is not just because of the juice of the authors: the committee really focuses on the fiscal impact to the states, and they all have related financing that would not impact the overall budget. (Kuehl's would not be implemented without financing, which is in another bill.)

Passage means that these proposals continue to move to the full legislative chamber of the Assembly or the Senate for their first floor vote in the next few weeks. It will be a whale of a time!

Labels: Budget, Nunez, Perata, Sacramento, SB840, YearOfReform

posted by Anthony Wright | Permalink | 4:14 PM


 

Real stories...

I would be remiss if I didn't point out some articles in the papers. Not because Health Access California is mentioned, but because they offer poignant stories from actual California families about our health system today.

* Bill Ainsworth at the San Diego Union-Tribune features real stories of people dealing with high-deductible plans, and how they would be impacted by an individual mandate, for better and worse. A companion story also documents about how people make tough life decisions simply for the security of health coverage.

* Aurelio Rojas of The Sacramento Bee has the story of Senator Gil Cedillo, not as a legislator, but as a son, dealing with his mother's hospitalization. (Calitics and Working Californians picks up on the story)

That's our organizing is so focused on having California health care consumers simply tell their stories. It is what should inform the current debate on how to make the health system better. (Sometimes, those stories help inform our policy development work. Other times, with the explicit permission of the person, we connect real people with the media, as with the Union-Tribune story. As Victoria Colliver in the San Francisco Chronicle reports, we also did this with Michael Moore's new movie, Sicko.)

Story sharing is the primary work of the Its Our Healthcare! coalition, to make sure that our voices, the voices of California consumers, are front and center in the debate. Check out the constantly-updated website!

Labels: Affordability, InTheNews, OtherBlogs, Underinsurance, YearOfReform

posted by Anthony Wright | Permalink | 1:28 AM


 

The "hidden" reasons for reform...

Tuesday, May 29, 2007

You don't have to be a fan of the New America Foundation to take sides with it over the unabashedly conservative Hoover Institution.

Dan Walters has a questionable column in today's Sacramento Bee that gives way too much credence to a Hoover study trying to downplay the notion of a "hidden tax" in health care.

The "hidden tax" is a phrase Governor uses a lot, to talk about the amount that health premiums are higher because of the uninsured population. The New America Foundation released a study last year often cited by Schwarzenegger. Families USA had a similar conclusion in 2005 with its study documenting "the increased cost of care."

As I have previously said, I don't like the the Governor's rhetoric around a "hidden tax," he tends to blame the victim: the uninsured person who typically is not offered coverage on the job, is not eligible for public programs, and who finds that buying coverage as an individual is either unaffordable or even unavailable, because of "pre-existing conditions." This rhetoric has consequences: if the problem is that people are uninsured, rather than the barriers that lead them to be uninsured, it's no wonder that Schwarzenegger and New America Foundation both see the "individual mandate" as a solution--something we disagree with.

But it is important to acknowledge that our current fragmented health system comes with a cost, to all of us. One of the problems is the lack of fair and equitable financing, with most employers providing coverage to all their workers, but many that don't.

We all pay more when Wal-Mart and McDonald's pay less. It's the same health care system, of doctors and hospitals, and if some manage to not pay their fair share into the system, we all pick up the burden. (Let's remember, the uninsured get it worst, getting charged more than others and facing collections and bankruptcy. But there are costs that are borne in the overall system.)

In some states, they actually have an explicit fee on insurance to help fund the safety-net hospitals and providers that care for the uninsured. So employers and purchasers are able to directly see, on their bill, how much they are paying for a broken health system that leaves people uninsured.

The New America Foundation, in its analysis defending its work, actually pointed out Hoover didn't question the notion of a "hidden tax," just its size. And the New America Foundation makes a credible case that it is bigger than what Hoover estimates.

The thing that rankled me most about the Walters column was the notion that reducing the "hidden tax" was "the most appealing premise" of health care reform. Let's put aside the millions of uninsured who would get coverage, and no longer live sicker, die younger, and be one emergency away from financial ruin. Let's put aside the community, economic, and public health benefits.

It seems to me that there are other reasons why an *insured* person would want a change in our health system:

* SECURITY: Even insured people recognize that they are one job change, one divorce, or other life event, from being uninsured. Reforms could provide more security that they keep the coverage they have now (through an employer or a universal system), are more likely to have coverage at their next job, are more likely to have a safety net if they fall upon hard time, and are more likely to have coverage even if they get sick.

* AFFORDABILITY: Aside from efforts to simply shift the burden of costs onto consumers, most of the ideas to contain costs in the health care system work better when more people are in the system. Whether its information technology, or prevention, or bulk purchasing, or better planning (not to mention fair financing), the cost savings work best in a universal system, rather than our current a fragmented system where it is hard to implement these efforts. For those who are insured, we can best slow the growth in health care costs better if we deal with the uninsured issue as well.

There's no disagreement that there's a cost to the status quo. But let's recognize the other benefits of reform as well.

Labels: Affordability, CostContainment, Employers, IndividualMandate, InTheNews, Research, Sacramento, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 3:56 PM


 

$950 million is real money...

Monday, May 28, 2007

No sooner do we try to tease out the profit motives of BlueCross in opposing new rules and oversight, than we find that the stakes are even higher than we think.

Lisa Girion at the LA Times has the scoop:


State regulators are investigating whether a $950-million dividend Blue Cross of California sent to its Indianapolis-based parent violates an agreement the companies made to limit such payments to keep premiums down and maintain the quality of healthcare benefits, officials said Friday.

Officials said the parent, healthcare giant WellPoint Inc., should have taken no more than $141 million out of California. They called the higher amount excessive, particularly as Blue Cross, which serves more than 7 million state residents, has continued to raise premiums. The state Department of Managed Health Care also is considering expanding its probe to determine whether there are any other potential violations of the three-year agreement, part of a deal to win the agency's approval for a corporate marriage that created the nation's largest health benefits provider.

Cindy Ehnes, director of the Department of Managed Health Care, said she was shocked to learn of the $950-million payday for WellPoint, whose total profit last year was $3.1 billion on $57 billion in revenue.


The merger of Wellpoint and Anthem in 2004, creating the nation's largest health insurer, was controversial, for everything from massive executive payouts, to the question of whether it would truly help patients, not just profits. Then-Insurance Commissioner Garamendi extracted a series of "undertakings," or conditions that the new insurer would have to agree to, in order for the merger to be deemed in the public interest and approved.

The question is whether California BlueCross ratepayers are paying inflated premiums to finance the business expenses and profits of the parent company, Wellpoint.

Normally, the state doesn't look at such information. But the Department of Insurance (and the Department of Managed Health Care) used the merger as a leverage point to place some oversight over BlueCross' behavior. But that authority to keep BlueCross in check has a three-year expiration date.

Let's see how the regulator use this authority. Let's make sure that health reform includes additional oversight over insurers that won't expire.

The undertakings are here. Here's Blue Cross' 2005 report on its compliance with the undertakings.

Labels: BlueCross, CostContainment, Insurers, InTheNews, YearOfReform

posted by Anthony Wright | Permalink | 2:12 PM


 

What is BlueCross afraid of?

Friday, May 25, 2007

More BlueCross blog backlash: Juls Rosen at Working Californians posted her response to the BlueCross ads at dailykos.

At Calitics, dday agrees with our post that there will be a backlash against BlueCross:

"There couldn't be a more reviled corporate entity around these parts than Blue Cross, the team who systematically tried to throw any sick person off their rolls and reduce any effort to get them to actually pay for medical treatment, which after all is their entire job. ... If Blue Cross is the face of health care status quo, I'd say change is a-comin'.

In a comment, Calitics guru Brian Leubitz asks, "WTF are they so scared of?" It's an important question, and the answer suggests that $2 million in opposition might be a down payment.


Blue Cross blues: A review of their "coalition" website is clear about the many reforms that they oppose. The shocking reality is that the practices that consumers hate about insurance companies are actually legal:
* denying to sell people coverage because of their age or health status;
* cherry-picking, using different rates and marketing to avoid people who actually need care;
* diverting premium dollars from patient care to administration, marketing, and profit;
* selling scaled-back plans with limited benefits and high cost-sharing that don't cover much;
* raising rates without explanation or justification.

They are directly attacking the proposals on the table, by the Governor, the Senate President Pro Tem, and the Assembly Speaker, all of which would set new rules and oversight to prevent at least some of these practices.


Health Access California is advocating for new or stronger rules on all these fronts, as well as for SB840, which would radically reduce the role of BlueCross and insurers in general. But even the new rules and reforms that are close to a consensus between the legislative leaders and the Governor would still change the business model that BlueCross relies on.

Two examples:
* The ad directly attacks "guaranteed issue," since BlueCross wants the ability to continue to deny people because of their health status. It's a lot more profitable to sell coverage only to people who won't file claims.
* The website directly attacks setting a "minimum medical loss ratio" meaning that 85% of the premium dollar would go to patient care, rather than adminstration, marketing and profit. The fact that this is a common element of the plans of Schwarzenegger, Nunez, and Perata give BlueCross hearburn: BlueCross HMO has only 78.9% go to patient care; individual who buy the BlueCross PPO only have 51% of their premium dollar go to patient care.


How much money is at stake for BlueCross, the biggest of the California insurers? This San Jose Mercury News article tries to answer (boldface is mine):

How much money Blue Cross makes in California can be difficult to discern, but financial reports that the company files with the state give strong indications about its profitability. In 2005, it sent more than $500 million in profits to parent company WellPoint - the nation's largest health insurer - from its California HMO business alone, which has about 4.5 million members. It reported profits of 10 percent - more than double the HMO profits of HealthNet and Pacificare, Blue Cross' largest for-profit competitors.

Blue Cross' margins on so-called preferred provider plans (or PPOs) - which are subject to less state oversight - are much larger. Documents from a Department of Insurance hearing last year pegged profits for such plans at an average 18 percent, compared with 5 percent for competitor HealthNet. For plans sold to individuals, Blue Cross' profits averaged 27 percent, compared with 15 percent for HealthNet.

No wonder BlueCross likes the status quo, and seeks to block any change, including the ones in discussion now. The comparison to Enron becomes more and more apt.

(Thanks to Matt Ortega at Its Our Healthcare! for re-imagining the BlueCross logo.)

Labels: BlueCross, Insurers, OtherBlogs, YearOfReform

posted by Anthony Wright | Permalink | 2:33 PM


 

The BlueCross backlash begins...

There's a little coverage of Blue Cross firing their first shot at health reform--of the type Blue Cross probably didn't want.

Bill Bradley at New West Notes is dismissive of the ads, and agrees with my assessment not only is the energy analogy wrong, but that the ads may backfire for Blue Cross.

Mike Zapler at the San Jose Mercury News points out the ads were made by the same firm behind the "Harry and Louise" ads of the early 90s. He also reports on the Governor's reaction.

Laura Kurtzman at the AP and Tom Chorneau at the San Francisco Chronicle also report that the response of us at Health Access California was joined by the California Medical Association, calling the ads “abominable.”

Labels: BlueCross, InTheNews, OtherBlogs, YearOfReform

posted by Anthony Wright | Permalink | 10:31 AM


 

More fact-checking, from Fresno to Albany...

Thursday, May 24, 2007

Another study that explodes BlueCross' stunning assertion about the "affordability" of the California individual insurance market.

Bottom line: If you are 20 and never had a health issue ever, you can probably get a good deal in California. But if you are older and/or and in less-than-perfect health, California becomes less "affordable," quickly. In New York, with guaranteed issue, access to coverage is ensured, and the standard rate for a comprehensive package may be more expensive for some, it is less expensive for others.

The study: A national study in 2001 by the Kaiser Family Foundation, authored by Karen Pollitz and Richard Sorian at Georgetown University, and Kathy Thomas, had seven hypothetical applicants, from a 24-year old waitress with hay fever, to a 36-year old with knee surgery 10 years ago, to a 48-year old breast cancer survivor, apply for insurance. They applied to 19 insurers and HMOs in eight markets, including Fresno, California.

The result: Only 10% of application were accepted as "clean" offers--35% were either rejected, and over half (53%) were offered with a premium increase or a benefit limit.

The California conclusion: Carriers in Fresno (and Indiana) had more frequent rejections and premium surcharges than insurers in other markets. On average, applicants were offered coverage only about half of the time in Fresno, compared to about two-thirds of the time in other communities. Applicants in Fresno had surcharges apply 58% of the time, compared to 25%-39% in the other markets.

So any "rate" listed for California ignores how many people are rejected, and how many get a different and higher rate, due to their age and health status.

Comparison with New York: Blue Cross also slams guaranteed issue states, including New York, for having the highest rates in the nation. As a born and bred New Yorker, I hate to break it to them--everything, including insurance, costs more in New York.

But from this study, the hypothetical consumers applied for health insurance in Albany, New York--all got coverage. They all would have been sold a standard policy at a standard rate without any exclusion riders or other coverage penalties for their health conditions. The average premium for our single applicants in Albany was $4,104 per year--only slightly higher than the average premium ($3,996 a year) quoted to many applicants in less regulated markets.

In short, costs in New York, with "guaranteed issue" and "community rating" were similar to those in unregulated states, on average (recognizing that in other states, some paid more and some paid less). But everybody had access to comprehensive coverage, which is not the case in California, despite what BlueCross says.

Labels: BlueCross, GuaranteedIssue, Insurers, OtherStates, Research

posted by Anthony Wright | Permalink | 3:44 PM


 

WWJD? in PA? in CA?

Sometimes, you don't need to comment. The lead of this Pennsylvania Patriot News story is "What would Jesus do about Pennsylvania's health care crisis?"

Labels: InTheNews, OtherStates

posted by Anthony Wright | Permalink | 1:42 PM


 

"Unintended consequences" of BlueCross' ad campaign

In opposing reforms to prevent them from denying Californians coverage, Blue Cross is bringing up the energy crisis, but the analogy might backfire.

Newspapers and even this blog have already chronicled BlueCross' bad behavior in the marketplace, and their overall opposition to any health care reform.

Now they have launched a $2 million-plus ad campaign, under the name "Coalition for Responsible Healthcare Reform." (The LA Times' Political Muscle covers it here.) Blue Cross should be ashamed, spending millions to retain their ability to deny coverage to Californians.

The ads say "Remember how the rash enery deregulation of the energy market in California spawned power outages and soaring rates? Let's not go there again."

But if the energy crisis is the analogy, then Blue Cross is Enron, taking advantage of an unregulated California market and leading to a blackout of coverage for millions. But even the now-disgraced Enron never had the gall to run ads arguing that they should be allowed to continue to manipulate the market.

Because there are so few rules on insurers now, Californians are concerned now they are one job change or life event away from facing a blackout of coverage. We have over 6 million Californians in a coverage blackout. Frankly, we have tolerated deregulation for too long: new and fair rules would increase the security that Californians have now with their coverage, so they are not denied because of their health status.

BlueCross' ad campaign may backfire with the public. They won't believe BlueCross, and they will make it clear to Californians what we can win with health reform.

DOING A FACT CHECK: I think Californians know better than to believe Blue Cross and their misleading statements, especially the absurd notion that buying health coverage as an individual is affordable now. Their ad won't persuade most Californians that individual insurance is affordable now, from a 50-year old woman in the Bay Area, to anybody that takes a handful of prescriptions a year.

Blue Cross' price comparisons matches apples and oranges. It's different products, different people, and different states:
* The list price in many states does not include the significant mark up for age or those who have even minor health issues.
* The states with "guaranteed issue" are Northeast states which started with higher costs of living and higher insurance costs generally.
* Finally, you can't compare a product that actually covers you when you are sick, to one that will not.

We'll have more later in the day.

Labels: Affordability, BlueCross, InTheNews, OtherBlogs, OtherStates, YearOfReform

posted by Anthony Wright | Permalink | 11:01 AM


 

Poverty: It's bad for your health

A big piece of health reform rhetoric -- coming from multimillionaire CEOs -- is the need for personal responsibility and healthy lifestyle choices.

This LA Times story today re-highlights what I thought was a long-established fact, poor women -- many of whom happen to be minorities -- suffer disproportionately from chronic diseases such as diabetes, heart disease, stroke etc.

The study notes that poverty and lack of insurance are complicit in causing these diseases in this population.

As health advocates, we know that the uninsured are twice as likely to forgo medical care and half as likely to fill prescriptions they need, causing their chronic conditions to get worse.

And as members of Congress and various others are learning this week in an empathy exercise, a $3-a-day food stamp allowance that as many as 26 million Americans live on is not enough to live healthy lives. Healthy fresh fruits and vegetables are perishable and more expensive, so what's left is higher sodium, higher sugar, higher calorie foods.

If this emphasis on "healthy lifestyles'' and "healthy choices" really is going to be a part of the reform debate, let's be real about the "choices" that are out there for poor people. Will Safeway stop stocking up on potato chips and candy and offer discounts on fruits and vegetables? Will health insurers start eliminating copays and coinsurance to help people manage their chronic diseases?

Otherwise, there doesn't really seem to be much of a choice.

Labels: HealthyLiving, InTheNews

posted by Hanh Kim Quach | Permalink | 7:39 AM


 

After the slightly off-color joke about Paris Hilton...

Governor Schwarzenegger revisited The Tonight Show last night, where he was introduced as "easily the most popular Republican in the entire country," a phrase that has a bit more edge than Jay Leno is known for.

After suggesting that Jay Leno's proposed 60th birthday idea of having a registered nurse jump out of a bran muffin was "kinky" (will CNA respond?) and admitting to watching all of Paris Hilton's "movies," the Governor talked about health care.

Labels: GuaranteedIssue, IndividualMandate, Insurers, InTheNews, Schwarzenegger

posted by Anthony Wright | Permalink | 12:21 AM


 

Killing jobs? or Killing people?

Wednesday, May 23, 2007

The Chamber of Commerce has just released its annual list of "job-killer'' bills. Among them -- AB8 and SB48, the Legislature's health reform legislation. You'll recall that both bills woudl require businesses to dedicate 7.5 percent of their income to pay for health care for their employees.

(They also opine about "green energy'' and "green building" bills. Maybe global warming doesn't kill jobs.)

Now maybe nobody at the Chamber ever gets sick, but I'm thinking that many of the Chamber's member businesses know better. According the National Committee for Quality Assurance, sicker employees are less productive(Duh) and expensive. Businesses lose about $1.2 billion annually due to heart disease, asthma, hypertension, depression, diabetes, and smoking-related illness. And that 7.5 percent, if anyone up there in the Chamber ivory tower cared to do the math – is less than many businesses pay now for health care.

And, to take the Chamber on its own terms, I can think of no worse "job-killer'' for an employee than being dead. (You think I'm exaggerating, but 18,000 people die a year because they are uninsured making it the sixth leading cause of death in the U.S., according to the Institute of Medicine).


So what do you say?

Will it be a job killer? Or people killer?

Labels: HealthyLiving, Research, Uninsured

posted by Hanh Kim Quach | Permalink | 11:38 AM


 

Need coverage -- and soothsayer

Monday, May 21, 2007

This LA Times story over the weekend helps consumers strategize and build a patchwork health coverage plans for their family, based on what they anticipate their health needs will be.

It's an interesting concept requiring families to look at their past few years of medical bills to determine if they really need a traditional, more comprehensive plan, or can go with a high deductible.

It sounds kind of like looking at a mutual fund's past performance, and anticipating how much it will earn in the future.

The story says that traditional plans, with lower deductibles and good coverage "are still costly"

For a family with a risky medical history, the cost of these policies is
stratospheric.

Uh. Yeah. But a family with a risky medical history is most likely to need good coverage to ensure they don't get sicker.

The story emphasizes the notion that insurance is there to protect assets. But what good is insurance if it deters you from seeing the doctor because of cost. What good is insurance if you have to predict what kinds of services you'll need? You might as well just get a fortune teller to help you plan your child's broken arm and your unexpected heart attack.

Labels: InTheNews, Underinsurance

posted by Hanh Kim Quach | Permalink | 10:34 AM


 

The health debate goes multimedia...

Sunday, May 20, 2007

After a big week, it's time to take a quick check of other blogs and media:

TEXT: There's another edition of Health Wonk Review at Health Care Policy and Marketplace Review blog, which links to several articles of interest, including a conservative critique of the Massachusetts reform, an assessment that highlights the good and the bas about "retail" health clinics, and a detailing of the most recent bad acts by insurance companies.

Of most interest to me was the two links commenting on the new study about the uninsured getting charged multiple times what insurers get charged for the same service. On is at Health Affairs. InsureBlog has a critique that totally misses the point: I would imagine that if hospitals didn't charge such outrageous prices, maybe a few more of the uninsured might actually be able to pay the bill. And regardless, the charged amount--the inflated rate--is the bill that goes to collections and court. The price matters to the person getting the bill.

AUDIO: Back to California politics, KQED's Capitol Notes has now started a weekly podcast of analysis of Sacramento happenings. This week's features the health care, along with the budget and whales(!)

The health care section is amusing. It starts with a negative tone, led by Anthony York playing Eeyore, suggesting all the reasons health reform won't happen this year. But then after ten minutes of conversation, they all seem to come around to the notion that something might happen. (Will business accept a 7.5% minimum employer contribution? Don't most do a lot more now? Aren't some businesses signalling they would support such a standard?... Won't somebody simply put anything that passes on the ballot to kill it? But didn't it come very close time? And wouldn't Schwarzenegger be on the other side of the issue this time?...


VIDEO: Finally, Michael Moore's new film Sicko premiered at Cannes this weekend. It's a comparison of the American health care system with that of other countries. The reports suggests it focus on not just the uninsured but the insured who have issues with our private insurance companies.

Health Access was contacted for stories for the feature, although I hear we were not the only ones: one rumour was that they had hundreds of stories to choose from by the time they were done.

The movie comes out June 29th. It should be interesting to see how it impacts the debate in California and around the nation.

Labels: Hospitals, InTheNews, OtherBlogs, OtherStates

posted by Anthony Wright | Permalink | 10:50 PM


 

Now, is there a return policy on that kidney too?

Friday, May 18, 2007

I always thought it was really screwy that medical professionals could bill patients to correct medical mistakes that the professionals -- not the patients -- made.

Really, we all make mistakes. So the issue really isn't that doctors are making mistakes; it's what they do to make up for them. For most of us, making a mistake is mortifying and often means fixing it -- even if we have to eat the cost.

Unfortunately, that's not always the case in the medical profession. If a mistake is made and a patient ends up back in the hospital/doctor's office, then it means a second or third chance to charge for what should have been done right the first time.

So it really seems like a no-brainer that a Pennsylvania hospital system is providing a warranty for medical care, according to this story in the NY Times.

Already, the Geisinger Health System in Pennsylvania has seen results. Last year, patients who received heart bypass surgeries could return back to the hospital if they had complications -- at no cost to the insurance company.

Well, duh. That seems reasonable. I'd be mad if I had to pay twice.

Since they implemented that policy, the system has found that patients don't return as often, and spend fewer days in the hospital.

Seems like this kind of policy could be a good deal for everyone. No one likes being sick and getting sicker, after you thought you were taken care of, is the worst. And...it's cheaper.

Labels: Hospitals, InTheNews, OtherStates

posted by Hanh Kim Quach | Permalink | 1:27 PM


 

When you come to a fork in the road, take it.

Thursday, May 17, 2007

With all the attention on the financing details of the legislative leader proposals, we shouldn’t ignore the universal health care proposal, SB840(Kuehl), and the attention it has been getting.

There was a good article by Tom Chorneau in the San Francisco Chronicle about the continuing effort. Senator Kuehl says that she plans to put her bill on the Governor’s desk, but it might be in 2008, regardless of what happens this year with the other proposals.

I think Steve Maviglio at the California Majority Report mis-read the article. Kuehl was quoted as saying, "People might say, why are you doing this if we passed that other bill? And I'll say I still think this is the better answer," said Kuehl. "This is will not go away because someone passed a half-assed bill." Unlike Maviglio, I don’t think she was referring to the Nunez bill or the Perata bill--the latter of which she voted for and is a co-author.

She *has* been a critic of the Schwarzenegger proposal--and rightfully so, in our opinion. There are components that don't meet the "do no harm" test that we share with Senator Kuehl. And we agree with her about being vigilant about whatever comes out of the negotiation between the legislative leaders and the Governor.

She is also right that whatever passes and is signed this year--even if it is really good--will probably not be truly universal, and there will be room for improvement. Last year, California passed a global warming bill. It didn’t stop the conversation—it increased interest. There are dozens of new bills on the subject. A health care bill this year—even a good one—will not stop the momentum. (This dday post at Calitics makes the same point.)

Maviglio is right about the opportunity we have this year—to provide security and affordability for those who have coverage, to dramatically expand it for those that don’t, to take several steps toward the goal of universal coverage. Yet he falls into the construct he criticizes.

There’s no conflict between advocating for the vision of a universal single-payer system, and working for positive reforms in this year’s debate--in fact, it is strategic. For the last four years, many advocates and groups have advocated on multiple tracks, supporting a range of health reforms, from expanded children's coverage to an minimum employer contribution to single-payer. There's no need to attack one reform in order to promote another--in fact, it can be counterproductive.

It's good we have an active leader like Senator Kuehl, promoting the vision of a truly universal system. It helps the debate to have SB840 on the table. It's also good that she is supporting and playing an active role in helping shape the legislative leadership proposals to see what we can win this year, toward the goal of quality, affordable health care for all.

Labels: ExpandingCoverage, InTheNews, Kuehl, OtherBlogs, Perata, SB840, YearOfReform

posted by Anthony Wright | Permalink | 5:45 PM


 

Here's something that ruffles my feathers....

It kind of sounds like saline implants for chicken breasts. Whatever it is, it's certainly not "natural."

Apparently, Tyson Foods, Inc. and Pilgrim's Pride Corp. have been calling their chickens -- which are kept moist with injections of a salt water, seaweed concoction and "natural flavor" -- "100% All Natural Marinated Fresh Chicken'' or something like that. (Here's the story in the WSJ.)

Gross.

Their claim is that the chickens have no "artificial ingredients'' because salt and seaweed are both natural. ** So is the saline (sterile salt water) in some breast implants, but no one calls them natural. **

Anyway, this labeling is making real poultry farmers mad because their chickens are really natural.

"Seaweed occurs naturally in the ocean, -- not in chickens,'' said Lampkin Butt, president of Sanderson Farms.

Now, what does this have to do with health reform?

Here's the nexus. Lots of people are suddenly calling for "healthier living,'' which includes healthier eating. All this talk about personal responsibility needs to be coupled with changes in corporate behavior and policy to actually provide healthier choices to begin with.

The problem with the saline-breast chickens is that they contain more sodium than au'naturale chickens. More sodium means "potential health implications,'' according to the American Medical Association. Mr. Butt (his real name) is right.

But the information about the exact "natural'' content of the saline-breast chickens isn't clear unless consumers read the really, really tiny print on the label. Most people don't read the tiny print. They just read the "100% natural" and assume that it's true.

This type of misleading labeling is pervasive in the packaged food industry. The same problem exists for labeling of trans fats, which are bad for reasons I won't go into here. A person should not eat more than 2 grams of trans fats a day.

So, you could feel really virtuous and check the label on everything you eat and think you've hit the target. But if a food item contains less than .5 grams of trans fats, then it can be listed is zero. So if you have six items of food with .4 grams of transfats, you've exceeded your limit.

My rambling point is this, that there is broad complicity in our unhealthy lifestyles. Sure, we need to watch what we eat and exercise, but another part of reform and prevention is also changing the culture that enables companies to dupe consumers -- whether it's about food, or health insurance.

Labels: HealthyLiving, InTheNews

posted by Hanh Kim Quach | Permalink | 12:02 PM


 

Gruberfest

As Jon Myers of KQED's Capitol Notes point out, the buzz yesterday in health reform discussions was MIT professor Jonathan Gruber who held his briefing yesterday to a standing-room only crowd at the State Capitol yesterday. No encores, but you half-expected T-shirts to be sold in the hallway.

The presentation is at the health reform website of the California HealthCare Foundation, which is funding his work. He gave a remarkably matter-of-fact presentation, and answered questions crisply--a surprise for an academic economist. He joked that he would get electro-shocked at any speculation beyond his model and what is backed up from the academic literature.

So for those looking for all the answers, he didn't have them. Some of the assumptions were those given to him by others: for example, the population data was provide by the California Health Interview Survey (CHIS), or the cost of a health product, which was taken from today's market. What he provides is the spreadsheet, which takes this data and makes assumptions about "how individuals and firms react to policy interventions." That enables the estimates about where people will end up, and how much it will cost.

It was interesting--a wonk rock concert, if you will.

Labels: ExpandingCoverage, OtherBlogs, Research, Sacramento, YearOfReform

posted by Anthony Wright | Permalink | 10:24 AM


 

Not suprised....

Wednesday, May 16, 2007

We already knew that the U.S. ranks 21st in life expectancy and 23rd in infant mortality, in spite of spending more than any other industrialized nation on health care, according to OECD stats.

The Commonwealth Fund yesterday just released a report reaffirming that notion.

It's not a surprising revelation for those of us working in health care, but hopefully, it will provide a jolt to those who insist that America has the best health care in the world.

That's not to say the other systems (in Australia, Canada, Germany, NZ and the UK) are perfect -- but they spend about half as much money -- per person -- being imperfect than we do.

Key findings of the report are that the U.S.:

• Is the most inefficient -- costing the most while providing the least.
• Is the most inequitable, leaving low- and middle-income citizens with no health coverage.
• Does poorly on chronic disease management.
• Is behind in adopting information technology to help manage chronic illnesses and see exactly what other treatments any given patient is on before prescribing care.
• Has horrible access because it lacks universal healht coverage.

The only measure that the U.S. does well on is preventive care. But, really, what good is preventive care (discovering you have diabetes) when you can't get your chronic disease managed?

Hopefully, such a report will help convince proud Americans who are convinced that we have the best health care in the world, that while America is great on many things -- it's not really on health care.

Labels: CostContainment, International, Research

posted by Hanh Kim Quach | Permalink | 2:28 PM


 

The money's on the table

Tuesday, May 15, 2007

HEALTH ACCESS UPDATE
Tuesday, May 15, 2007

NEW NUMBERS FOR NUNEZ AND PERATA PLANS ON HEALTH REFORM

* Democratic legislative leaders release financial specifics on health care proposals
* Proposals would cover over two-thirds of uninsured; provide more security for workers
* Momentum for reform prospects, affordability for consumers and employers highlighted

New on the Health Access WeBlog: Theresa Mary Johnson, RIP

Over two-thirds of uninsured Californians would have health coverage under newly fleshed out proposals released by both Assembly Speaker Fabian Nunez and Senate President Pro Tem Don Perata Tuesday.

The new numbers show how each lawmaker’s health expansion plan would be paid for and provide more specifics on how coverage would be provided. Under the notion of "shared responsibility," the proposals would set a minimum contribution for employers at 7.5 percent of wages (for both full- and part-time workers) toward worker health care; would create a statewide purchasing pool as a new option for employers to cover their workers; would expand public programs; would take advantage of federal tax breaks and matching funds; and would place new rules on insurers and reform the insurance market.

This is the first time that the legislative leaders have released the new figures since they both introduced their health coverage proposals in December, which were both aimed at increasing health coverage among California ’s uninsured. The numbers fill in many blanks for AB8(Nunez) and SB48(Perata/Kuehl), and show how their measures would pencil out in the real world.

The Legislative leaders worked with MIT economist John Gruber (who also modeled Gov. Arnold Schwarzenegger’s proposal), funded by the California Health Care Foundation, to run their plans through a computer model, which came up with the numbers that showed the contributions needed in order to make the health plan balance out. Professor Gruber will be presenting his model tomorrow at the State Capitol.

Here's some information about the two plans with some of the new details:

• Coverage expansion to the uninsured: Both cover 3.4 million (69% of uninsured)
• Minimum employer contribution for health expenditures: Both set it at 7.5% of total Social Security wages (capped at $97,500) on health expenditures (for both full time and part-time employees), or pay an equivalent amount into the California Health Trust Fund
• Employers who are exempted:
• SB48(Perata) has no exemptions.
• AB8(Nunez) exempts business operating for fewer than 3 years, with fewer than 2 employees, or with a payroll less than $100,000.
• Number of Californians in statewide purchasing pool:
• AB8(Nunez): Cal-CHIPP – 3.23 million projected to enroll
• SB48(Perata): Connector – 4.1 million projected to enroll (3.6 million adults, 500,000 children.)
• Estimated premium for individuals: For both: Individuals would pay between 0 to 2.8 percent of income for coverage. Families of four (with only one worker): Up to 4.5 percent on income.
• Requirement on individuals:
• AB8(Nunez): Must take up coverage if employer offers coverage, and it’s deemed affordable.
• SB48(Perata): Individual mandate unless income is below 400% of poverty ($40,840 for an individual, $82,600 for a family of four) OR health coverage is more than 5 percent of a person’s income.
• Assistance for low-income families:
• AB8(Nunez): Families and workers below 300% of poverty ($30,630 individual, $61,950 family of four) would receive some relief if they purchased coverage through their employer (through premium assistance), or through Cal-CHIPP.
• SB48(Perata): Families and workers below 300% of poverty would pay a portion of the estimated $224 (per member per month) premium based on a sliding scale.
• Benefits on which estimated are based: Standard coverage, which includes doctors’ visits, hospital coverage, labs and prescription drugs.
  

IMPACT ON WORKERS AND CALIFORNIANS

Under these proposals, most workers would either have their employer provide health coverage, or would get their coverage through a statewide purchasing pool. In the pool, the contribution for workers to pay toward health care would be based on ability to pay. The pool would also use a Section 125 federal tax break to reduce the cost of coverage. Both proposals provide some kind of relief for workers and families who earn less than 300% of poverty.

The following chart shows impacts on both single workers and families.


As the table shows, single workers would spend no more than 2.8 percent of their annual income on coverage; families would spend no more than 4.5 percent on their premiums.

Coverage offered would also be considered comprehensive plans, with "Knox/Keene benefits," which cover doctors, hospital visits, as well as prescription drugs.

Both of these proposals provide a more affordable option for workers than is considered in Gov. Arnold Schwarzenegger’s plan. In Schwarzenegger’s proposal, a worker in the “subsidized” insurance pool person earning between $19,600 to $24,500 (201-250% of poverty) would be asked to spend about 6 percent of their income on premiums alone. That does not include deductibles of $500 and a maximum of $3,000 for the year. In the Schwarzenegger proposal, for families earning more than 250% of poverty, there would be a requirement to buy bare-bones high-deductible plans, with out-of-pocket costs of up to $10,000.

IMPACT ON EMPLOYERS

For many employers, the plans would not have an impact. The plans include a minimum employer contribution of 7.5 percent of wages (for both part- and full-time employees) for health expenses. Assembly Speaker Nunez’ proposal does exempt some smaller businesses. If employers do not wish to spend money on health services themselves, they can contribute an equivalent amount to the statewide purchasing pool, which would use the money to help buy coverage for the workers.

The amount proposed in both plans is far lower than the amount that firms who offer health insurance are already spending for coverage. According to the analyses of both plans, 61.5 percent of businesses already provide health coverage that amounts to an average of 13.8 percent of wages ($79.4 billion total).

However, the Democrat leaders’ proposals require a greater contribution than the 4 percent contribution that was recommended by Gov. Schwarzenegger when he unveiled his plan in January. At that time, the CEO of Safeway, Steve Burd, said the amount was too low. Schwarzenegger also exempted employers with fewer than 10 employees.

OTHER ELEMENTS

Remaining elements that are not addressed here, would remain the same as when introduced initially, such as expansion of Healthy Families to cover all children under 300 percent of poverty, and insurance market reforms to allow people to get coverage regardless of their health status.

WHAT’S NEXT

This is only the first step – of many first steps. Both proposals still must be vetted by each house’s Appropriations committee in the next couple of weeks, which will consider the fiscal implications to the state.

With this financial information, Perata and Nunez’s proposals can be compared alongside two other health reform proposals in the discussion, Gov. Arnold Schwarzenegger’s and Sen Sheila Kuehl’s.

Health Access will continue to provide timely news and analysis as the health reform debate this year continues. For more information, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org.

Labels: Affordability, Employers, Legislation, Nunez, Perata, Research, Updates

posted by Hanh Kim Quach | Permalink | 6:50 PM