Where does our money go?

Friday, June 27, 2008

The most exciting thing this week (other than Health Access' report release) was the release of the California Medical Association's annual "Knox-Keene Health Plan Expenditures Report,'' which replaces my old dog-eared copy from a couple years ago.

The report gathers data reported by health plans to the Department of Managed Health Care to show which ones spend the most on medical services for their enrollees (and which ones spend the most on administration and profit). This is called the "Medical Loss Ratio,'' you know, because plans ''lose'' money when they spend it on health care for you. The percentage of premium dollars spent on patient care is an important (though not the only) measure of a plan’s value.

Sadly, there is not similar data publicly available for PPOs, which are regulated -- more loosely -- by the Department of Insurance. Not having the data on the Department of Insurance side creates a huge hole for advocates, because 40 percent of insured Californians now buy the less robust insurance products regulated by the Department of Insurance. These plans are required to spend 70% of revenues on patient care and are among the worst offenders on the market. Low-value products are marketed to consumers for their low premiums. Patients do not have the actuarial expertise, or information to assess whether a particular low-premium product will actually provide them value – meaning it would pay for physician visits, drugs and other health costs when they need it. Products that have low medical-loss ratios often do not have maternity coverage, do not cover prescription drugs, have high deductibles, high co-insurance, and lack caps on how much consumers need to spend out-of-pocket for their illnesses. Such flimsy coverage causes consumers to defer care, or leaves them saddled with medical debt. Low-value health plans have dedicated as little as 51 cents of every premium dollar toward on what patients need. Meanwhile insurers spend 49 cents of every dollar consumers pay against consumers -- fighting bills for patient services, scouring health records in order to retroactively rescind policies, and other administrative costs—or to the profit of the insurer.

CMA is the sponsor of SB 1440 (Kuehl), which Health Access also supports. The bill would require health plans spend 85 percent of revenues on patient care (also called Medical Loss Ratios -- 'cause to insurers, they ''lose'' money when they have to spend it on you.) That is different from the current law, which only caps administrative costs at 15 percent (which means profits layered on top of that eat into the amount spent on patient care.) A nice feature of the latest version of this bill is that it will require plans to report the Medical Loss Ratio by product, rather than averaging them across the insurer's entire book of business, allowing the really awful products to be lumped in and hide behind better ones.

Okay, on to the report.

For-profit plans that spent the least on patient care in 2007:

1. Great-West Healthcare of California: 69.4% patient care; 11.5% admin; 11.3% profit
2. Blue Cross: 79% patient care; 11.1% admin; 6.1% profit
3. Aetna: 81.4% patient care; 8.7% admin; 6.3% profit
4. Molina Helathcare of California: 84.2% patient care; 15.5% admin; 0.2% profit

Non-profit plans that spent the most on patient care (not including public health plans)

1. Scripps Clinic Health Plan Services: 95.3% patient care: 4.5% admin; 0.1% income
2. Partnership Health Plan: 94% patient care; 6.1% admin; -0.4% income
3. Western Health Advantage: 90.8% patient care; 8.7% admin; 0.6% income
4. Kaiser Foundation Health Plan: 90.6% patient care; 3.6% admin; 5.8% income

Labels: Insurers, Kuehl, Legislation, Research

posted by Hanh Kim Quach | Permalink | 4:24 PM


 

Lots of Key Bills Pass 2nd House Health Committee...

Wednesday, June 18, 2008

HEALTH ACCESS UPDATE
Thursday, June 19th, 2008


BILLS CLEAR HEALTH POLICY COMMITTEES IN OPPOSITE HOUSE
* SB1522 to ban junk insurance passes Assembly Health Committee
* AB1945 would impose new rules on insurers who cancel insurance policies
* AB2967 to collect cost and quality data from medical providers passes

Click Here for What's New on the Health Access WeBlog: Continued Real-Time Budget Conference Committee Reports; A Predictable LAO Analysis on Single-Payer; Following the Bills in Health Committee; Also: Thursday June 19th Events: San Francisco Lunchtime Rally Against AHIP & Insurance Companies; Los Angeles TCE Panel Discussion on Health Reform


Key bills of interest to health advocates were heard in the last two days, in, respectively, the Assembly Health Committee, chaired by Assemblymember Mervyn Dymally, and Senate Health Committee, chaired by Senator Sheila Kuehl.

Hundreds of bills that passed the house where they were introduced must now clear the second house; and the first step of that is to pass policy committees by June 27. A number of bills that would benefit health care consumers were in Assembly and Senate Health committees this week, including a number of key bills that would lay the foundation for comprehensive health reform in the next couple of years. An updated list of bills is available on the Health Access website, at:
http://www.health-access.org/advocating/2008_bills.html

INSURANCE STANDARDS: Among those bills was SB1522 (Steinberg), sponsored by Health Access California, that would weed out junk insurance from the individual insurance market by ensuring that every plan covered doctor, hospital and preventive services. It would also place a cap out-of-pocket costs. The bill would organize the market into five tiers so that consumers could make apples-to-apples comparisons between plans and require that pricing of those plans was consistent with the level of benefits the plans offered.

In an interesting admission, the Association of California Life and Health Insurance Companies noted that "more transparency would be good." This bill passed out of Assembly Health Committee with little debate on a party line vote. It heads next to the Assembly Appropriations Committee.

On Wednesday, the Senate Health Committee heard more bills being tracked by health advocates including:

DEBATE ON ANTI-RESCISSION BILL

AB1945 (De La Torre) would create an INDEPENDENT REVIEW process when an insurer wishes to rescind a consumer’s health insurance policy. The Department of Managed Health Care and Department of Insurance would also have the final say on whether a policy could be rescinded. Lastly, the bill would standardize health plan questionnaires for consumers applying for coverage in the individual market.

The issue of rescissions has received much attention in the past couple of years as the LA Times and other papers have written a number of stories about patients who have had their policies unilaterally cancelled while in the middle of expensive chemotherapy or other medical treatments. Rescissions (or reviews to rescind coverage) have been triggered when a patient begins an expensive course of treatment, and then insurers have allegedly scoured applications looking for a rational to deny their care--any hint that the consumer omitted information about their health status--whether related to the current treatment or not.

Earlier this year, the Department of Managed Health Care had 1,200 policies that were illegally cancelled reinstated. Kaiser, who supported the bill, was one of the insurers that agreed to a settlement with the state to reinstate coverage for rescinded patients. HealthNet--and annoucned earlier today, Pacificare--also reached agreements with the DMHC.

A number of health plans did not oppose, but had concerns about two issues. First, they preferred not to have a uniform questionnaire, but rather a "menu'' of approved questions from which they could pick and choose so they could control the length and scope of the application. Secondly, health plans did not want all rescissions to automatically go to independent review, but rather something that the consumer could opt out of. While some consumer groups, including Health Access California, supported the bill, some organizations raised concerns about the impact on consumers' rights to bring a court proceeding against health plans. The bill heads next to the Senate Judiciary Committee, where some of these questions will be addressed. The bill passed on a bipartisan vote.

DEBATE ON TRANSPARENCY BILL

Another bill heard Wednesday that would help lay the foundation for comprehensive reform in the coming years is aimed at collecting data so that skyrocketing health care costs could be better controlled. Medical errors cost millions annually and result in thousands of unneccessary deaths.

AB 2967 (Lieber) would provide greater TRANSPARENCY AND DISCLOSURE for health care purchasers. The bill would require public reporting of cost and quality by doctors, hospitals HMOs and others in the health care industry. In order to funnel health care dollars more appropriately into treatments that work, the state needs to first gather data. Recognizing that there are many factors that contribute to a patient's health, the data would be adjusted to take into account income, geography, cultural and linguistic issues and other factors.

Collecting data, said author Assemblywoman Sally Lieber, would be "better than driving in the dark with no headlights, which is what we're doing now.''

In an unusual coalition, consumer, labor and business groups all joined together to support this. The California Association of Health Plans were also in Support if amended. Some of the questions that arose came from representation on the baord that collects the information. As constituted in the bill, providers make of half of the board, while consumers, labor and employers make up the other half.

Strong opposition came from the physicians and hospitals, however, who said they did not want "non-scientific people'' collecting data and "releasing it to the public.'' Providers did not trust that data would properly take into account the fact that some patients are poor and have many health issues. Assemblywoman Sally Lieber, however, countered that information to be collected will take into account poverty, health status and cultural issues, which will then be factored in reporting, which can be measured and adjusted. Studies about health disparities that contain this information are regularly published and the data that would be collected through this bill would help the significant work in place now to reduce the health disparities seen in race and income.

Sen. Sheila Kuehl acknowledged the fear that providers had, but said "I like the idea of data collection and knowing to be able to compare.'' The bill passed.

OTHER KEY BILLS: Other bills heard in Assembly or Senate Health Committee this week included the following, listed by bill number (author name) VOTE OUTCOME in Commitee. SHORT DESCRIPTION. Description of Bill. Position of Health Access California:

* SB 1168 (Runner): PASSED Assembly Health. DEPENDENT COVERAGE. Would allow adult dependent children, who are still covered under their parents’ health plan, to stay on that coverage even if the child takes a medically necessary leave of absence from school. Support.
* SB 1633 (Kuehl): PASSED Assembly Health. DENTAL DEBT PROTECTIONS Would prohibit dentists’ offices from offering high-interest loans to patients while they are under the influence of anesthesia. Would also prohibit dental offices from charging lines of credit before services have been rendered. Support.
* SB 1525 (Kuehl): PASSED Assembly Health. MEDICAL NECESSITY. Requires health plans to explain how they determine medical necessity. Also requires health plans to report their rates of denial of care or modifications to care because of medical necessity. Support.
* AB 1203 (Salas) PASSED Senate Health. EMERGENCY ROOM BILLS: Would prevent emergency departments – which do not have a contract with a patient’s insurance company -- from directly billing the patient, requiring the hospital to seek payment directly from insurers. Support
* AB 1887 (Beall) PASSED Senate Health. MENTAL HEALTH PARITY: Would require health plans to provide coverage for all diagnosable mental illnesses. Support.
* AB 1962 (De La Torre) PASSED Senate Health. MATERNITY COVERAGE: Would require all individual insurance policies to cover maternity services. Support.
* AB 2220 (Jones) PASSED Senate Health. BINDING ARBITRATION: Requires providers and health plans to resolve contracting and payment disputes through binding arbitration. More on this legislation must be resolved in the Senate Judiciary Committee. Watch.
* AB 2400 (Price) PASSED Senate Health. HOSPITAL CLOSURES: Would require public notice before closing a hospital. Support
* SB 1096 (Calderon): FAILED Assembly Health. PRESCRIPTION INFORMATION. Would allow pharmacies to send mailers to consumers about the drugs they have been prescribed without the patient’s authorization. Oppose.

A final wave of legislation will be heard next week before the June 27th policy committee deadline. Health Access will keep advocates updated on the progress of consumer-related health bills.

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

Labels: Insurers, Kuehl, Legislation, Updates

posted by Anthony Wright | Permalink | 9:50 PM


 

A predictable answer to the wrong question...

Monday, June 16, 2008

There's bee some buzz about the new analysis by the Legislative Analyst's Office (LAO) of the SB840(Kuehl), the universal, single-payer health care bill, and the companion financing bill, SB1014(Kuehl). SB840 has passed the Senate and is in Assembly Appropriations; SB1014, which contains the financing which requires a two-thirds vote, has stayed in the Senate.

The Sacramento Bee's Dan Weintraub describes the LAO's findings that SB840 and proposed financing would be a "financial train wreck," while Senator Sheila Kuehl disputes that conclusion, but finds affirmation that "a single payer health care system saves money and lowers the rate at which health care costs grow each year."

I haven't had the chance to see the LAO analysis yet, so I can't comment on the specifics. But I predicted a problematic report earlier this year in a blog post. The biggest problem is that it doesn't compare the risks of health reform with the risks of remaining with the status quo (not just risks--the certain problems with letting the health system unravel). The issues raised by the LAO does mean there is more work to do on the financing and policy elements of SB840, but it doesn't undermine the central argument for single-payer reform, that it provides the tools for covering more people and finding savings in the health system.

Why the report predictable? The LAO analysis of AB x1 1 earlier this year (detailed in this Health Access report here) would hinder any health reform, including single-payer. In fact, it says so, with a similar line at the bottom of the LAO single-payer report: "Any plan to reform the state’s health care system, by the nature of its complexity, will involve financial risk over the long term. Many of the fiscal risks discussed in this letter would be shared by a variety of health reform plans."

The LAO report would be less of a problem, frankly, if some single-payer supporters who were opposed to AB x1 1 didn't embrace the LAO analysis so vigorously earlier this year. But there were many SB840 supporters, including Health Access California, who also supported AB x1 1, and who saw and made the case that the LAO's January analysis was being inappropriately used to hinder not just AB x1 1 (a good but imperfect bill) but anything else as well.

There is a crucial role for such financial analysis (both AB x1 1 and SB840 had significant independent modeling and analysis), but the questions should include a comparison with the status quo, and how a proposal can be modified to be fixed. The LAO is basically quantifying a projection of rising health costs: an unknown figure that admittedly is likely to rise. It is also focused on the impact on the state, rather than all Californians, who will bear these costs in one way or another. And it's not like health care costs are going to stay the same if there is no reform.

There is an urgency to health reform. The delay is passing either SB840 or AB x1 1 or any other reform means it just gets harder to do the reform later, for every year the cost of health coverage goes up. That's why we need action ASAP, now and in the future.

We'll have more on the LAO analysis. There's lessons to learn here, from the politics and the policy...

Labels: Kuehl, SB840

posted by Anthony Wright | Permalink | 12:33 PM


 

This year's health reforms...

Tuesday, June 03, 2008

Health reform is alive and well, reports Jordan Rau at the Los Angeles Times.

More than a dozen health bills are advancing through the Legislature, many over the objection of insurers. Some of the proposals were transplanted from the plan that passed the Assembly last year, only to be rejected in the state Senate in January. Other measures are newly devised by the Democrats who control the Legislature.

The bills would require insurers to spend at least 85% of their earnings on patient care; block insurers from canceling policies of patients who need extensive care; and force them to cover more procedures, such as maternity services. Over the
objections of the major doctor and hospital lobbies, the Assembly approved a measure backed by Schwarzenegger that would require medical providers to publicly reveal their costs and medical performance.

In a sign that a desire for piecemeal healthcare changes is strong this election year, some of the Democrats' bills even have picked up votes among Republicans who did not support Schwarzenegger's package.

Many of these are good bills, and would be considered big deals in any other year, if it wasn't in comparison to the huge, comprehensive effort of AB x1 1. But it is important to recognize that they aren't just small pieces: some of the legislative proposals form a foundation for future reforms:

Daniel Zingale, a senior advisor to Schwarzenegger, said the governor favors many of the ideas, if not the exact language, in the bills and plans to add others into the mix in a few weeks. "This year, the first floor of healthcare reform will be built, and it will make current coverage more secure, control costs, promote prevention and end the worst anti-consumer practices by HMOs," Zingale said.

Many of the bills would affect the insurance market for individuals who buy coverage themselves rather than through employers -- now more than 2 million Californians. It is a more lucrative niche for insurers than selling policies through employers because insurers have more leeway to set the terms of individual policies and face fewer regulations about what medical procedures must be covered and which customers must be accepted.

The Senate passed a proposal by the incoming president pro tem, Darrell Steinberg(D-Sacramento), that would make it easier for individual customers to compare competing plans. The bill also would limit maximum out-of-pocket costs for those individuals and force insurers to offer a whole range of policies if they want to do business in the state.

That bill, SB1522(Steinberg), sponsored by Health Access California, is an example of a bill that if implemented, creates a much sounder floor from which to build reform.

Most of note, the article indicates that this agenda to placing greater oversight over the insurance industry is getting bi-partisan support.

Opposition from insurers, however, is not dissuading Republicans -- a traditional ally of the industry -- from supporting some new restrictions. On Thursday, 12 of 32 Assembly Republicans joined Democrats to require insurers to obtain approval from state regulators before canceling coverage for people who have become ill and submitted medical bills. That bill, by Assemblyman Hector De La Torre (D-South Gate) is one of three measures the Assembly has passed to address that practice, which has prompted state investigations of -- and in some cases led to fines for -- many of the state's biggest insurers.

Some GOP lawmakers also are agreeing to expand the type of procedures insurers must cover. Twelve of 15 Republicans joined their Democratic colleagues in the Senate and voted to require insurers to pay for surgery to fix cleft palates, a common birth defect that occurs in one of every 790 babies. A panel of experts said this would add only $146,000 in annual costs to California's $79-billion insurance industry, but insurers are opposing it because they don't want lawmakers limiting the policies they offer.

On the Senate floor in mid-May, five of 15 Republicans ignored industry opposition by voting to compel insurers to reveal how often they rule that procedures are not medically necessary.The bill, by Kuehl, also would force insurers to disclose the medical qualifications of the employees who make those decisions.

That same day, four Republican senators voted to pass another Kuehl bill that would require insurers to offer customers the option of adding, for an additional charge, coverage to include the purchase of wheelchairs, oxygen tanks and other durable medical equipment.

Sen. Sam Aanestad (R-Grass Valley), who voted for the measure, said insurance policies have become too complicated to understand."I've got grown kids who have advanced college degrees, and they're not sure if something's covered or not," he said.

Amen to Dr. Aanestad's comment. If there's a theme to the reforms this year, it's that people are concerned that there coverage will not be there for them when they need it. In some cases, it's because the insurance company rescinds coverage; but in many others, it's because you don't realize what is covered, and not covered, until it is too late.

We can begin to fix that with these bills, as well as with fighting the budget cuts that undermine that security for the millions with public coverage programs.

Labels: Insurers, Kuehl, Legislation, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 11:26 AM


 

The DMHC Oversight Hearing...

Thursday, March 27, 2008

HEALTH ACCESS UPDATE
Friday, March 28th, 2008


SENATE PANEL QUESTIONS HMO REGULATOR
* Lawmakers question Department of Managed Healthcare’s oversight of health insurers
* Inquiry into regulations for timely access, discount plans, rescissions, language access and mental health parity
* Sen. Kuehl sees "pattern" of siding with industry against consumers
* Laws passed more than five years ago still not implemented


Click Here for What's New on the Health Access WeBlog: Health Care Consumers Views; GAO Individual Market Investigation; More Debriefings on California Health Reform; A Health Reform Backlash Against San Francisco Restaurants?; Health Budget Cuts Nationally; Shooting for 60 Votes; 1,000 Posts!; Web Wonkery; McCain's Misstep: Do We Go to the Doctor Frequently?; The Hot Hearing for the Week; Mayor Newsom Suing Sacramento Over Medi-Cal Rates; So-Called Consumer Directed Health Plans; Overseeing the DMHC


SACRAMENTO--At a special hearing of the Senate Health Committee on Thursday, Department of Managed Health Care Director Cindy Ehnes was questioned for over nearly seven hours about her department’s handling of five separate regulations and whether it had met its charge as a consumer protection agency in implementing and enforcing laws to help patients. “This hearing is meant to provide a level of oversight to ensure that legislation that is passed gets implemented in a way that is consistent with the way it was intended,’’ said Sen. Sheila Kuehl, chair of the Senate Health Committee.

At issue were three laws, passed in the late 1990s and earlier this decade, which still have not been put into practice: Timely access to health care, access to health care that is both culturally and linguistically sensitive and mental health parity. Additionally, Ehnes was interrogated about the Department’s rationale for regulations regarding retroactive cancellations of health policies and so-called "discount health cards".

For more detailed information on all these issues, you can visit the Health Access website and blog. As well, the Senator posted a detailed agenda and background papers on her website, at:
www.sen.ca.gov/kuehl


TIMELY ACCESS TO CARE

Background: First on the list was the issue of timely access to care, which were intended to prescribe specific time-elapsed standards for how long it should take patients to get into to see a physicians. The law was passed in 2002, and after many years of hiccups, regulations were on the path to implementation in 2007. The regulations spelled out exactly how quickly patients should be able to get in to see a doctor in certain situations. (I.E. Urgent primary care needs: 24 hours; Routine primary care needs: 10 days; Urgent specialty care: 72 hours; Routine specialty care: 14 days)

But in December, the Department yanked that version, stripped out all specific requirements, and left it up to health plans to determine their own standards, as had been the practice in the years before the law was passed. Health Access California and Western Center for Law and Poverty testified that the law did not meet the legislature's intent in having the Department set clear, prescriptive standards. Last month, the Office of Administrative Law rejected the regulations, saying the department had not allowed enough time for public comment given the dramatic changes in the regulations. To read Health Access' writings on this, click here.
The difference between the August and December versions of the regulations was so stark that Sen. Sam Aanestad, R-Grass Valley, asked, “It looks like the department just punted. What was the amazing turnabout?’’

Department’s take: Ehnes said she felt that the August regulations – 26 pages – were too complicated and would force plans to micromanage physicians they contract with. She said the department focused on the clinical triage via phone, where patients could call in and get a professional to tell them what they needed to do. Health Access’ Beth Capell later said this telephonic triage was available during limited times -- weekdays during work hours.

Legislative comment: “Regulations are supposed to go further than the statute. Sometimes they are going to be very complicated. I would encourage a little more complication,’’ Kuehl said. She urged that the Department set prescriptive, time-elapsed standards when developing new regulations in the new year. Aanestad indicated he thought the Department was "almost there" with previous version of the regulations that had set standards.

DISCOUNT HEALTH CARDS

Background: Discount health cards aren’t health plans, but cards that consumers pay a monthly premium, for access to a list of physicians that will purportedly provide them discounts. The problem is, often, physicians don’t know they’ve been put on a list, and consumers don’t know what the base price off which they receive a discount, making the discounts meaningless. These plans are often marketed toward lower-income or limited-English consumers who believe they are actually buying health coverage, and these plans rely on this confusion to thrive.

The plans have been deemed illegal by the state Attorney General; but there has been confusion about if they should be allowed or licensed and regulated, and even what agency should do the regulating. The DMHC has started a process of developing regulations to license these discount cards, working with the industry. Health Access testified that while the value of these products was questionable, any regulations must at a minimum ensure real discounts to a real network of providers with real notice of what consumers are and are not getting for their money.

Department’s take: The department has investigated 53 discount health plans and ordered cease and desist orders against 7. Ehnes said developing regulations and licensing such products was not meant to be an endorsement, but to try to better understand the products.

Legislative comment: Kuehl asked the department, as it continued its work, to strongly consider whether these products offer any real economic value to consumers.


RESCISSIONS

Background: In the past couple of years, the startling practice of retroactive cancellation of policies by insurers has arrested the public’s attention. Consumers, who have been paying monthly premiums and believed they are insured, receive high-dollar treatments for cancer, heart disease and the like. These expensive treatments often trigger insurance companies to review the enrollees’ initial application and rescind policies, claiming enrollees did not properly disclose pre-existing health conditions. Policies are cancelled, retroactively, as if consumers were never insured. Consumers are then sometimes left with thousands –if not hundreds of thousands of dollars -- in debt for treatments they believed were covered. The courts have determined this practice is illegal unless consumers willfully misrepresent their health status.

Department’s take: Ehnes said the DMHC has been aggressive in investigating plan behavior since the practice came to light. The department, along with the Department of Insurance are developing regulations so that plans do not have the ability to rescind without reason and that consumers can’t misinterpret applications.

Legislative comment: Kuehl’s primary concern was how consumers could obtain coverage after they’ve been cancelled. These cancellations occur on the individual market where consumers are often denied coverage due to pre-existing conditions. Once consumers’ coverage is cancelled, it would be impossible for them to obtain coverage through any carrier.Aanestad believed the department was not properly protecting consumers and making that the focus. “The first priority is to reinstate coverage for consumers. The second priority is to make headlines and change the industry, but it doesn’t sound like that’s really happening.’’


CULTURAL AND LINGUISTIC ACCESS

Background: In 2003, the legislature passed a law, SB853(Escutia), that required health plans to ensure that the consumers who did not speak English as a first language had proper medical interpretation services. Up until then, consumers brought in their children to translate, did not get care, or got the wrong care because they were unable to communicate with their doctors. This is particularly important in California where 55 percent of the population reports not speaking English well. The California Pan-Ethnic Health Network, Latino Issues Forum, and other groups were concerned that the notice about these new rights were left to the industry to determine, without consumer input. Plans have complained it is costing them millions to translate materials.

Department’s take: Ehnes said she was committed to this issue and was attempting to evaluate all aspects, including whether the regulations go beyond the law and whether it will cost too much.

Legislative comment: Kuehl said when the legislature passes something, that’s the rule. “We don’t care what it costs everybody. Cost is important…but that’s not the top consideration. …We really mean it about providing real access to language minorities,’’ said Kuehl, who was also critical about the department’s process in listening to all stakeholders and allowing enough time to comment on regulations. “Please push the envelope on this one, because I know you want to.’’


MENTAL HEALTH PARITY

In 1999, the Legislature passed mental health parity, providing consumers with access to mental health benefits equal to coverage in other health services. But to this day, consumers are still finding it difficult to obtain mental health services they need on the same level as other health services. Timely access to providers remains a problem as well as plans’ treatment and financial obligation toward mental health. The Senators urged the department to be more aggressive about following up on surveys and studies that found consumers lacking access to mental health.

PARTING NOTES

Ehnes said the department would continue to work on these – along with other issues – under the department’s jurisdiction. Kuehl reiterated that the hearing was intended to ensure that laws were actually implemented and not allowed to wither once passed. She also continued to encourage the department to have more open and collaborative process.

For more information, contact Elizabeth Abbott, director of administrative advocacy at Health Access California, at eabbott@health-access.org. Interested organizations can also contact the author of this report, Hanh Kim Quach, policy coordinator at Health Access, at hquach@health-access.org.

Labels: DMHC, Kuehl, LanguageAccess, Sacramento, TimelyAccess, Updates

posted by Anthony Wright | Permalink | 10:12 PM


 

Oversight about oversight...

Victoria Colliver at the San Francisco Chronicle has a preview of today's Senate Health Committee hearing--which is expected to be at least five hours of grilling on a range of meaty issues.

The Senate Health Committee, chaired by Senator Sheila Kuehl, will hold a hearing today on "Consumer Protection under the California Department of Managed Health Care: Adequacy of Implementation and Enforcement," reviewing the DMHC's oversight in five key areas: timely access, language access, so-called discount health plans, retroactive denials of coverage; and mental health.

In all these issues, they strike to the core of whether the coverage is meaningful, and whether the consumer is getting value for what they paid for. And on all these topics, there are pending decisions regarding regulations or implementation issues at the DMHC.

It won't be a surprise to readers of this blog that health and consumer advocates will press for stronger standards and more aggressive oversight for the health insurance industry--and for good reason.

Consumers are increasingly concerned that their coverage won't be there for them when they need it--that they won't be able to get in to see a doctor or specialist, to get a translator if necessary, or even that their coverage will be retroactively rescinded.

In light of these HMO practices, the Department needs to be more--not less--aggressive in protecting patients and investigating the insurance industry.

Yet, the tendency by the Schwarzenegger Administration is to leave the decisions up to the insurers. Recent regulations would let insurers decide their own standards on timely access; to determine their own method of notifying patients about their rights to an interpreter. On new regulations of discount cards, the Department were shaped by the industry they were purporting to regulate-an industry that offers a product of dubious value to consumers.

The regulations to ensure timely access to care has been a particular subject of controversy--and focus for Health Access. For years, the Department of Managed Health Care has had numerous drafts of regulations to implement a 2002 law to establish and enforce standards to ensure access to care within clear timeframes. Yet the most recent draft let the insurers set their own standards. Senator Kuehl recently wrote a letter indicating this conflicted with the intent of the Legislature is passing the bill.

We hope this hearing provides much-needed legislative push to the Department to resolve these issues quickly, and the political cover to prioritize protecting patients, regardless of industry opposition. Consumers want and need more assurances that their coverage will provide the protection that they paid for.

If nothing else, the hearing brings additional *public* scrutiny to these issues--which is important, given the stakes for the average health consumer, but rare, given that DMHC regulations usually get attention from the industry and a handful of consumer advocates.

We have an ongoing interest--Health Access California, the statewide health care consumer advocacy coalition, was the sponsor of the HMO Patient's Bill of Rights in the late 1990s that created the Department of Managed Health Care, to be a stand-alone department with a specific focus on consumer protection. Our group continues to advocate on behalf of consumers at the DMHC on a range of issues. More recently, Health Access was the sponsor of AB2179(Cohn) in 2002, which required the Department to establish and enforce standards for timely access to care; and a strong supporter of SB853(Escutia) to require language access to care.

So we'll be continuing to do our own oversight, over the insurers--and their regulators.

We'll have a report on the hearing later in the day.

Labels: DMHC, Kuehl, Sacramento

posted by Anthony Wright | Permalink | 1:36 AM


 

Back in session... and the hot hearing for the week...

Tuesday, March 25, 2008

The legislators came back to Sacramento this week after spring break... and it's getting frantic, quick. Bills (see the Health Access bill list) introduced this year only have a few weeks to pass their first policy committee.

While the budget and policy committees continue their regular work, the most interesting and high-profile hearing this week will probably be the Senate Health Committee, chaired by Senator Sheila Kuehl, hold a special Thursday session.

The hearing is entitled "Consumer Protection under the California Department of Managed Health Care: Adequacy of Implementation and Enforcement," is expected to take several hours and maybe more.

The issues to be discussed at this informational hearing are meaty, as it asks for reports on the DMHC's implementation of regulatons in many areas of strong interest to consumer advocates, including timely access, so-called "discount health plans," rescissions, language access, and mental health parity.

We're posted some about the pending regulations to ensure patients have timely access to care. A month ago, Senator Kuehl urged the Department to withdraw their proposed regulations, stating that they were not in line with the legislature's intent when passed AB2179. The author, Assemblywoman Rebecca Cohn, has been termed out, but Health Access California was a sponsor, and Senator Kuehl was a member of the Legislature that voted for it.

But it's clear that this hearing is about more than just timely access--or even about the other key issues. It's about being clear that the DMHC should be focused on consumer protection as its core mission--it's the reason that the DMHC was created in the first place. There's too many important issues for anything else to get in the way.

Labels: DMHC, Kuehl, Sacramento, TimelyAccess

posted by Anthony Wright | Permalink | 3:55 PM


 

Pulling on the boxing gloves

Monday, January 28, 2008

The debate over ABx1 1 is being slugged out in today's editorial pages:

In the anti-ABx1 1 corner, we have:

• The California Nurses Association with two op eds, one in the Sacramento Bee and one in the Mercury News, ruing
• The Foundation for Taxpayer and Consumer Rights in the Sacramento Bee, bemoaning the use of an individual mandate and continuing its crusade for rate caps.

In the pro-ABx1 1 corner, we have:

• The American Cancer Society in the Mercury News explaining how fewer people could die of cancer if they were insured
• Assembly Speaker Fabian Nunez rebuts arguments made by Sen. Sheila Kuehl in the LA times last week.
• Finally, the LA Times editorial board encourages the Senate Health Committee to pass ABx1 1

Labels: InTheNews, Kuehl, Legislation, Nunez, Schwarzenegger, YearOfReform

posted by Hanh Kim Quach | Permalink | 10:17 AM


 

Single-payer supporters for strategic steps...

Friday, January 25, 2008

Los Angeles Mayor Antonio Villaraigosa just recently sent a letter to Senator Sheila Kuehl, from the point of view as a fellow supporter of a single-payer solution to health reform, to urge her to support AB x1 1 (Nunez/Perata). Here's a PDF version of that letter:
LAMayorKuehlAB1xSupport.pdf

I was pleased to be a co-signer of a similar letter with over a dozen prominent single-payer supporters, people who I deeply respect and who have dedicated their lives and work toward winning single-payer reforms. This includes activists, academics, and community leaders who led the Proposition 186 campaign, and gave years of their lives and even their bank accounts; and people who worked tirelessly on SB921 and SB840 in recent years, and fought to get it on the Governor's desk in 2006.

We continue to believe that this is not an "either/or" issue, but rather a "yes, and..." More than that, we believe AB x1 1 is the most effective and strategic step to get to single-payer, and that is a motivating factor behind our support.

Far from "settling" for AB x1 1, this is about locking in significant gains for the uninsured as a way to keep the movement and momentum active for broad reforms. Here's the PDF:
SinglePayerSupportABX11-011708.pdf

Here's the full letter:

Thursday, January 17th, 2008

Dear Senator Kuehl, and all legislators who support SB840:

Re: Single-Payer Supporters for Strategic Steps, for AB x1 1

We, the undersigned, write to you as strong supporters of universal health care. We also have a long history of advocacy for single-payer policy proposals. Many of us have been involved in the fight for single-payer health care for as long as two decades. Many of us were active in working for Prop 186 back in 1994, and many of us worked hard over the last few years in support of SB921, and to get SB840 on the Governor's desk in 2006.

As strong supporters of a truly universal health care system, we write to urge you to support AB x1 1 (Nunez), as a significant strategic step toward our shared goal. We strongly believe that health reform need not be an “either/or” situation, and that supporting this reform in front of us is consistent with being whole-hearted supporters of SB840 and single-payer.

We believe that AB x1 1 not only will do no harm — your appropriate minimum test for health legislation — but that AB x1 1 will also do a great deal of good and benefit millions of Californians.

Moreover, we believe that passage and enactment of AB x1 1 will be a strategic advance for the cause of single-payer because it will establish public programs that are the foundation of universal coverage, including a single-payer system.

AB x1 1 embodies policy elements of single-payer. Passage of this law would make it easier to enact truly universal coverage and to pass a single-payer system in the future, since it already includes:

• a major expansion of public program coverage to moderate-income Californians as well as low-income residents, setting the stage for truly universal coverage reforms, including single payer,
• the setting of a minimum employer contribution to health care, which is essential to funding universal coverage and an important part of the financing for SB840,
• the creation of a statewide purchasing pool that could be the beginnings of the huge
purchasing pool that could grow into a single universal system,
• an increase in Medi-Cal rates, helping providers realize that rates could be reasonable under a public program such as a single-payer system.

It also includes additional oversight over insurers. While some have criticized the notion of preserving the role of insurers, the proposal would significantly change the way insurers do business, including having to take all customers on a “guaranteed issue” basis, and having to negotiate with a large purchasing pool to access millions of California customers. The proposal creates a framework where insurers will either have to change their behavior, or face future reforms that impose further oversight on insurers or replace their function.

Like the proposals of the Democratic presidential candidates, AB x 1 1 does not undertake the massive transformation of the health care system that you propose and that we support. But it accomplishes important elements while providing security to those who have good coverage and want to keep it, while creating the framework to take extra steps. Just as passage of family leave legislation created a framework to come back and pass paid family leave, we believe this proposal creates political and policy tools to advance broader reforms.

Some fear that passage of any plan would stall the coming of SB840, as politicians declare their job done. We believe that the opposite is true. Failure begets failure, and if health reform is stalled now, political leaders may be discouraged from supporting any reforms of our health system (and certainly more far-reaching proposals like single-payer). They will likely move on to other issues.

On the other hand, success begets success: Passage and enactment of such a proposal would create a positive environment around health care reform, as politicians will continually seek to raise the bar above the last reform. The people of California are not satisfied with the health care system as it is, and they will want to see it change further to become a health care system worthy of our country and our state. After major reforms in areas like education and global warming, nobody thinks those issues are “done”; instead the interest in pursuing additional reform has stayed strong, and we believe that this will be the same for health care.

The comparison of AB x1 1 should not be with SB840, which we agree is a “gold standard,” but with the status quo in health care, where millions are uninsured, people are denied coverage because of “pre-existing conditions,” low- and moderate-income families face unlimited premiums and unlimited liability, and the situation is only getting worse. Does AB x1 1 provide all the protections we want to see in our health care system? No, but it provides protections that currently do not exist at all:

• it dramatically expands and assures coverage to increasingly desperate families and
individuals,
• it offers protection against the unaffordability of health insurance premiums,
especially for low- and moderate-income families;
• it establishes strong oversight of insurers, and
• it strengthens health care access of insured and uninsured Californians alike by more adequately funding health care providers, especially hospitals and doctors, whose current underpayment threatens their ability to provide emergency services for anyone and their willingness to serve low-income patients.

Under AB x1 1, there are millions of people, especially at the lower end of the income scale but also those with moderate incomes, that would get substantial help in getting the care and coverage they need. We have an obligation to meet their pressing needs. Asking them to wait is asking them to go without the access to care that those of us with insurance have. In addition, the more we can reduce the number of uninsured, the shorter the gap we have to bridge to get to universal coverage and a single-payer system. ABx 1 1 provides a solid foundation on which we can and will continue to advance additional health care reforms.

We will continue to be very active in support of truly universal coverage, but we urge you to consider this as a strategic step needed to win ultimate victory.

Thank you for your consideration.

Sincerely,

E. Richard Brown, PhD
Professor, UCLA School of Public Health

Michael R. Cousineau, PhD
Associate Professor of Research and Director, Center for Community Health Studies, University of Southern California Keck School of Medicine

Sherry Hirota
CEO, Asian Health Services

Henry L. “Hank” Lacayo
State President, Congress of California Seniors

Marty Lynch
CEO, LifeLong Medical Care

Jennifer Reifel Malin, MD
Current Member and Former Board Member, California Physicians’ Alliance

Maryann O’Sullivan
Founding Executive Director, Health Access California

John Roark, MD
Board Member and Past President, California Physicians’ Alliance

Steve Schear
Co-Chair, Universal Health Care Action Network

Joan Pirkle Smith
Chair, Health Committee, Southern California Americans for Democratic Action
Chair, Health Care Legislation Subcommittee, AFTRA

Roy Ulrich
Radio Host and Producer, KPFK

Nora Vargas
Executive Director, Latino Issues Forum, a co-sponsor of SB840,
and convenor of the Latino Universal Health Action Network

Anthony Wright
Executive Director, Health Access California

*All affiliations listed for identification purposes only

Labels: Kuehl, SB840, YearOfReform

posted by Anthony Wright | Permalink | 8:46 AM


 

It's a wrap....

Wednesday, January 23, 2008

Senate Health Committee just adjourned its nearly 11 hour hearing on ABx1 1. I'm pretty amazed at the committee's stamina and feel fortunate that Sen. Kuehl urged committee members to restrain from speechifying until Monday afternoon, when they reconvene to vote on the bill.

Health Access will have our usual update following today's hearing at some point tomorrow or Friday.

To read up on previous analyses of the bill, check out:

http://www.health-access.org/2007/12/first-look-at-new-legislation.htm
and
http://www.health-access.org/2007/12/health-access-update-monday-december-17.htm
and
http://www.health-access.org/2008/01/health-care-hangs-in-balance.htm

Labels: Kuehl, Legislation, YearOfReform

posted by Hanh Kim Quach | Permalink | 7:50 PM


 

Bad Bosses

Sen. Sheila Kuehl just raised a good question, which is how ABx1 1 would handle businesses that "misclassify" or "reclassify" their workers as "independent contractors'' in order to avoid the employer mandate.

This is also known as the underground economy.

SEIU's Beth Capell responded:

Existing law – Unemployment Insurance Code Section 2101 – already addresses issues surrounding the “underground economy.’’ Specifically, the law says businesses cannot “willfully make a false statement or representation’’….that would reduce a worker’s “benefit or payment.’’

An employer that does so, would be fined $20,000 and could spend a year in prison, as provided under UI Code Section 2122.

California’s Economic Development Department has a division specifically dedicated to pursuing and punishing businesses that evade payroll obligations, and in recent months has pursued, arrested, fined, and imprisoned a number of businesses. ABx1 1 would be one of those obligations.

Additionally, Capell added that Kuehl's own SB840 did not include penalty provisions, but would also -- if passed -- be an employer obligation enforceable under this code section.

Labels: Kuehl, Legislation, Nunez, YearOfReform

posted by Hanh Kim Quach | Permalink | 4:29 PM


 

Vote on Monday

After today's LOOOOOONNNNNNNGGGGGG hearing on ABx1 1, Senators will be able to go home, think about the bill, be lobbied, and return on Monday afternoon to vote, Chairwoman Kuehl said.

Labels: Kuehl, Legislation, Nunez, YearOfReform

posted by Hanh Kim Quach | Permalink | 1:37 PM


 

Failure to comply with mandate

Many senators are asking about what would happen to those Californians who fail to -- or are unable to -- comply with the mandate.

It's a good question and it's a concern that has spun many rumors about some faceless bureaucrat -- knocking at your door, garnishing wages, putting liens on your house.

Here's the real scoop: ABx1 1 says nothing about this kind of enforcement. Additionally, such behavior by a state agency (ie. Franchise Tax Board) would not be permitted until

• a) the Legislature approves legislation on that issue and
• b) the Legislature approves funding for enforcement, which is unlikely given the existing funding shortfall.

What ABx1 1 does say is if a person does not have coverage after 62 days, they will be told of different options where they could find coverage (public programs, the state purchasing pool). If the individual does not act, they will be automatically enrolled in the least expensive policy. The state will then recover the costs of that coverage through the Franchise Tax Board, but no additional penalties are exacted.

Labels: IndividualMandate, Kuehl, Legislation, Nunez, YearOfReform

posted by Hanh Kim Quach | Permalink | 1:33 PM


 

"The Status Quo is not an option"

The "most thorough hearing'' on ABX1 1 has begun. You can listen to testimony in the Senate Health Committee throughout the day here, and click on Room 4203.

Secretary of Health and Human Services is now giving her opening remarks on the legislation, following Assembly Speaker Fabian Nunez. Both have emphasized the need to reform the system -- now. Both admit that while this bill may not be perfect, the fall back is the status quo.

"Voting for this bill makes greatly needed progress. Voting against the bill is keeping the status quo,'' Nunez said. "Keeping the status quo does harm. Keeping the status quo tells the uninsured -- who live sicker and die younger -- that they have to wait. Keeping the status quo tells 800,000 kids they have to wait. "

Labels: Kuehl, Legislation, Nunez, Schwarzenegger, YearOfReform

posted by Hanh Kim Quach | Permalink | 9:34 AM


 

Planning for the new year...

Thursday, December 20, 2007

As we plan for the next year, the Senate Health Committee, chaired by the Senator Sheila Kuehl, is planning to meet on January 9th, to consider the following bills. (Letters due January 3rd):

SB 254 (Ashburn) – Emergency medical services: licensure
SB 365 (McClintock) – Out-of-state carriers
SB 389 (Yee) – Health care coverage: claims
SB 891 (Correa) – Health facilities: elective percutaneous coronary intervention pilot program
SB 1000 (Harman) – Substance abuse: adult recovery maintenance facilities
SB 1026 (Calderon) – Personal income and corporation taxes: credit: qualified health care provider

ABX1 1 (Nunez) is scheduled to be heard on January 16th. (Letters due January 10th).

Labels: Kuehl, Legislation

posted by Anthony Wright | Permalink | 10:31 AM


 

In the aftermath --

Friday, October 12, 2007

Gov. Arnold Schwarzenegger just signed SB474 (Kuehl) which will protect patients who live in Los Angeles and would have been impacted by the closure of the Martin Luther King Jr.-Drew Medical Center. It would provide up to $100 million to pay for services that would have otherwise been provided by King-Drew Medical Center, allowing the county to contract with other providers in the area to assure that patients could continue to receive care.

The bill also assures safety net hospitals can continue getting the money they need.

Labels: Kuehl, Legislation, Schwarzenegger

posted by Hanh Kim Quach | Permalink | 1:53 PM


 

The Gov's game show: sign or veto?

Friday, September 21, 2007

HEALTH ACCESS ALERT
Friday, September 21, 2007


HEALTH CONSUMER BILLS ON THE GOVERNOR'S DESK
* Legislature passes a dozen health-related bills of interest to advocates
* ACTION ALERT: Submit letters to Governor’s office to support key bills

New on the Health Access WeBlog: SCHIP Deal in Congress; Timely Access to Care Standards Pending at the DMHC; Jon Stewart on HillaryCare and Health Care; President Bush on Kicking Kids Off Coverage; Will the Governor Release Legislative Language? Special Session Gossip.


Even though most of the focus in the 2007 legislative session focused the prospects of major health reform, health advocates dutifully worked on other bills as well.

In addition to AB8 (Nunez/Perata), several other bills on health issues made it to Gov. Arnold Schwarzenegger’s desk. He has until October 12th to sign or veto the legislation.

While Schwarzenegger has announced he will be vetoing AB8 and working with lawmakers to craft a package in an extraordinary session this fall, many consumer advocacy organizations are still writing the Governor to support the foundation that AB8 sets for negotiations.

Read the Health Access fact sheet on AB8 here.
See Health Access' full list of bills tracked in 2007 here.

Advocates supporting AB8 and other measures should submit letters to:
Gov. Arnold Schwarzenegger
State Capitol Building
Sacramento , CA 95814
FAX: 916.445.2841

Following is the list of bills that health advocates followed this year and their status:

To the Governor’s desk:

* AB8 (Nunez/Perata): Would make coverage more available and affordable through employer benefits, public programs, and the individual market. Creates a statewide purchasing pool for employers purchase health insurance. Sets a minimum employer contribution for health care. Expands Medi-Cal/Healthy Families for children and parents up to 300% federal poverty level. Brings in federal dollars through Medicaid matching funds and Section 125 tax breaks. Reforms the individual insurance market to restrict pre-existing coverage exclusions and require at least 85 cents of each premium dollar be used for patient care. Would lead to coverage of 95% of Californians. SUPPORT
* SB275 (Cedillo): Would prevent patient dumping by requiring hospitals to have a written policy on discharging patients, and requiring hospitals to appropriately plan post-discharge care with patients. Also prevents hospitals from moving patients to locations, other than their residence, without the consent of the patient. SUPPORT
* AB423 (Beall): Would expand Knox-Keene to include diagnosis and treatment of mental illnesses. SUPPORT
* SB474 (Kuehl): Would clarify that hospitals would continue to get paid the same amount under the federal hospital financing waiver and extends the sunset date to the 2007-08 fiscal year. Would also protect patients who live in Los Angeles and will be impacted by the closure of the Martin Luther King Jr.-Drew Medical Center . SB474 would create a special fund that would pay for services that would have otherwise been provided by King-Drew Medical Center . Los Angeles County would contract with other providers in the area to assure that patients could continue to receive care. SUPPORT
* SB472 (Corbett): which would require state Board of Pharmacy to come up with standardized drug labeling for prescription medications. SUPPORT
* AB343 (Solorio): Would require the state to disclose names of employers who, rather than providing health coverage, have many of their workers and their families on Medi-Cal and Healthy Families. (Gov. Schwarzenegger vetoed a similar bill – AB1840 (Horton) -- last year.) SUPPORT
* AB910 (Karnette): Would ensure that privately-purchased health coverage for children with mental or physical disabilities would not end at a certain age. SUPPORT
* AB1113 (Brownley): Would extend and increase eligibility for the Medi-Cal California Working Disabled Program. SUPPORT
* AB1324 (De La Torre): Would require health plans to justify to DOI or DMHC why they are rescinding health coverage to enrollees. Health plans may not recover costs of care provided to enrollees unless they can prove consumers purposely deceived them. SUPPORT

A bill to expand children's coverage, AB1 (Laird/Dymally), passed both the Assembly and the Senate, but was held in the Legislature by the author, at the request of the Schwarzenegger Administration. AB1 would allow children in families up to 300% of poverty to enroll in Healthy Families. This is a repeat of the last version of AB772 (Chan), which was vetoed by Gov. Schwarzenegger in 2005. The Governor has stated he wants children's coverage as part of a broader reform package.

Also of note is SB350 (Runner), which makes technical changes to California' s landmark legislation last year, AB774(Chan) to prevent the practice of hospital overcharging. Health Access California, the sponsor of AB774, is neutral after working with the authors and sponsor. Also of interest to some health advocates is AB12 (Beall), which would create the Adult Health Coverage Expansion Program in Santa Clara County, which would be administered by a county or local initiative.

Bills of interest to health advocates that were not sent to the Governor and will be pending for next year include:

* SB840 (Kuehl): Would establish a universal, single-payer health care system in California that would enable all Californians to have available, affordable, and automatic health coverage. This bill passed the full Legislature for the first time in 2006, but was vetoed by Gov. Schwarzenegger.
* SB1014 (Kuehl): The financing piece of SB840, which would impose an income tax of 3.78 percent for workers earning less than $200,000 annually. Employers would pay 8.14 percent of payroll toward system. Would impose an additional personal income tax for those earning more than $200,000 to fund SB840's single payer system, in lieu of premiums and cost-sharing.
* SB32 (Steinberg): Expands children’s coverage, including the Healthy Families program, to all children in families up to 300% of poverty ($49,800 for a family of 3). Identical to AB1(Laird)
* AB2 (Dymally): Would reform and restructure the Managed Risk Medical Insurance Program, for the medically uninsurable, who are denied coverage elsewhere because of “pre-existing conditions.’’ Also restructures the individual insurance market to assure any Californian who wants coverage can get it. This bill has been reintroduced in special session as ABX1-3 .
* AB51 (Dymally): Would have created a consumer report card for Medicare Part D plans.
* AB52 (Dymally): Would have required the state to operate a 24-hour, toll-free number for patients to register complaints about hospital facilities.
* SB606 (Scott): Would have required pharmaceutical companies to disclose clinical trial results for drugs sold in the state.
* AB1554 (Jones): Would have regulated insurance premium rates by requiring DMHC/DOI approval before copayments, premiums, coinsurance, deductibles or other out-of-pocket costs could be increased.

Updates about the fate of these bills will be posted at the Health Access website, on soon as possible at the Health Access WeBlog at:
http://www.health-access.org/blogger.html
and at the Health Access California legislation webpage, at:
http://www.health-access.org/advocating/2007_bills.html

For more information, contact Hanh Kim Quach, the author of this report, at hquach@health-access.org.

Labels: Kuehl, Legislation, Nunez, Schwarzenegger, YearOfReform