Killing us softly...

Wednesday, July 02, 2008

NYTimes has a horror story about diabetes and how it creeps up on you and "eat(s) you alive,'' as one doctor described it. In addition to being the leading cause of blindness and amputation, diabetes also affects the afflicted in a myriad other ways from head to toe -- depression, sleep issues, stroke, dental and hearing problems, liver and kidney problems, *paralysis (!)* of the stomach, ulcers, and various sexual problems.

Cases of diabetes are growing -- 8 percent of the US population had it in 2007. And by 2050, it could be 25%, according to the Centers for Disease Control.

I'm fixating on this for two reasons. 1) I'm genetically predisposed to diabetes; my father was diagnosed in his mid-40s. 2) Our insurance coverage trends make it very difficult for people to maintain and keep this perfectly treatable disease at bay.

As more people (not us, mind you) advocate for more stripped down health plans, devoid of disease maintenance, it creates all kinds of barriers to getting the meds and seeing the doctor -- all necessities for a person with diabetes.

I'll do a quick, shameless plug for our SB1522 here, which not only would organize the individual insurance market, but also establish minimum benefits -- such as doctors, hospitals and preventive services. It's one of the ways we could begin to tame the unruly individual insurance market, which has been rapidly degenerating over the past few years.... unless we want a nation of diabetic zombies by 2050.

Labels: Insurers, InTheNews, Legislation, Steinberg, Underinsurance

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


 

So "never events" never happen...

Monday, June 30, 2008

Jordan Rau at the Los Angeles Times has an important article (with lots of links to primary source documents!) on the key issue of "never events"--those things that should never, ever happen when you get care.

It's a list that includes getting severe ulcers from bedsores, having equipment left in a person during surgery, undergoing the wrong surgery or having the wrong limb amputated, or being given the wrong medication or wrong dosage. Unlike other parts of the art of medicine, these are problems that are preventable if the systems are in place.

The number of these adverse events reported is over 1,000 in a 10-month period. It's a wake-up call--Many in the health care community would not have predicted such a large number. These medical errors are serious--in some cases, deadly serious. By definition, these are "never" events--not "sometimes OK" events.

The article highlights AB2146 (Feuer), an important bill supported by many consumer groups like Health Access California, AARP, CALPIRG, Consumers Union, as well as business and labor organizations. It would have California follow the federal government in not paying for these adverse events, as part of a shift to change the financial incentives in this category.

I would also add AB2967 (Lieber), which would add more transparency to the cost and quality of the care being provided in California. This information is valuable in its own right, and will have a impact in getting hospitals to prevent these errors, which will improve health outcomes, and save money too. Information shouldn't be the only tool, but it should be part of more aggressive oversight.

Read the article. It's worth your time.

Labels: Hospitals, InTheNews, Legislation, Prevention, Research

posted by Anthony Wright | Permalink | 1:32 AM


 

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


 

Bills before break...

Thursday, June 26, 2008

HEALTH ACCESS UPDATE
Thursday, June 25th, 2008

HEALTH BILLS LIVE AND DIE BY THE COMMITTEE
* Health legislation heard in final policy committees before July break
* Bills pass to require 85% of premium to go to patient care; regulate recissions; foster a public insurer; discourage "never events," encourage hospital community benefits.

Click Here for What's New on the Health Access WeBlog: Continued Real-Time Budget Conference Committee Reports; The Perils of "Junk" Insurance; Gender Discrimination in the Individual Insurance Market; The Mortgage Metaphor for SB1522; Improving Medicare with a Phone Call.


With tomorrow's deadline for legislation to have cleared policy committees in the second house, lawmakers heard a battery of bills this past week. Key pieces of legislation of interest to health advocates were also on the agenda. Many of the bills advocates have been tracking passed.

Following is a list of the bills heard this week and the outcome. Additionally, advocates may visit the Health Access website, at http://www.health-access.org/advocating/2008_bills.html for a complete list of bills.

The following bills passed in Assembly Health Committee, chaired by Assemblyman Mervyn Dymally, on Tuesday:

* SB 1198 (Kuehl): DURABLE MEDICAL EQUIPMENT: Would require group health plans and insurers to offer coverage for durable medical equipment, such as wheelchairs and shower seats. Support
* SB 1440 (Kuehl): CAPPING ADMINISTRATION AND PROFIT: Would set a minimum medical loss ratio – requiring every insurer to spend at least 85 percent of premiums on patient care. Would also require plans to report how much they spend on health care versus administration on each single product they offer. Support
* SB 973 (Simitian) PUBLIC INSURER: Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices.
* SB 1300 (Corbett): CONFIDENTIALITY CLAUSES: Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contracts between providers and insurers. Support
* AB 1351 (Corbett): DISTRICT HOSPITAL OVERSIGHT: Would require Attorney General oversight into transactions involving district hospitals. Support

The following bills passed in Senate Health Committee, chaired by Senator Sheila Kuehl, on Wednesday:
* AB 2146 (Feuer): ‘NEVER EVENTS’: Bans providers from billing patients or insurers when they have made an avoidable mistake, such as operating on the wrong person, prescribing the wrong drugs, or leaving foreign objects inside a surgery patient. Support
* AB 2549 (Hayashi) RECISSION TIME LIMIT: Would impose an 18-month time limit in which insurers have to rescind individual health care policies once consumers’ applications are approved. This bill was amended from previous versions, which limited the time frame for rescission to the first six months. Watch, seeking shorter time limit.
* AB 2569 (De Leon) RESCISSION AND BROKER ACCOUNTABILITY: Ensures that family members whose coverage depends on that of the rescinded person may be offered another individual policy. Also requires brokers who take applications to attest, under penalty of perjury, that the information is complete and accurate to the best of their knowledge. Support.
* AB 2697 (Huffman) BOUTIQUE HOSPITALS: Would require so-called “boutique hospitals’’ to asses their impact on a community’s health system annually, specifically whether they siphon doctors, workers, providers from general acute hospitals caring for less affluent populations. Support
* AB 2942 (Ma) COMMUNITY BENEFITS: Would standardize what non-profit hospitals report as “community benefits” to justify their non-profit status. Support

The Legislature will now take a break from committees while budget negotiations are expected to continue throughout July. Both houses will resume committees on August 4. These bills will need to pass fiscal committees by August 15th and the final floor votes by August 31. If they pass through the Legislature, the Governor will have the month of September to decide to sign or veto the bills.

Health Access will continue to track the progress of this legislation in the coming months. For information, please contact the author of this report Hanh Kim Quach at hquach@health-access.org.

Labels: Hospitals, Insurers, Legislation, Updates

posted by Anthony Wright | Permalink | 1:28 AM


 

Improving Medicare...

Wednesday, June 25, 2008

According to our collegues at Families USA, we have some good progress on improving Medicare in the U.S. Congress:

On Tuesday, the U.S. House overwhelmingly passed the Medicare Improvements for Patients and Providers Act, H.R. 6331, by a vote of 355-59. They report that the U.S. Senate expects to vote on the House-passed bill as early as Thursday, June 26. An earlier version of this bill was blocked by a Republican filibuster after the President threatened to veto the bill.

The bill also makes needed changes to private Medicare Advantage plans and re-directs funding to Medicare’s doctors and health care providers. This bill makes several important improvements that will help seniors and people with disabilities get the health care they need, including:
* Broader protections for low-income beneficiaries
* Expanded coverage for preventive services
* Reduced cost-sharing for mental health services
* Stronger consumer protections

Families USA is asking health care advocates to call their U.S. Senators, and tell them to support the House-passed version of the Medicare bill -- the Medicare Improvements for Patients and Providers Act (H.R. 6331). You can call 1-800-828-0498 and ask to be connected to your Senator Boxer or Feinstein.

Labels: Bush, Federal, Legislation, Medicare

posted by Anthony Wright | Permalink | 3:28 PM


 

It's called discrimination...

Sunday, June 22, 2008

The scrutiny on the inefficient, iniquitous individual insurance market continues, with David Lazarus' column in the Los Angeles Times.

We've explored before how women get discriminated against in the individual insurance market. They have to pay significant surcharges for maternity coverage. A recent NY Times story spotlighted how a C-section can be classified as a pre-existing condition that leads to higher premiums or a denial of coverage.

But now the California insurance marketplace had come full circle: Lazarus reports that three insurers: Aetna, Blue Cross, and now Blue Shield are charging men and women differently, and others are now looking to go there as well.

Where does it stop? As Lazarus says:

But parsing rates according to gender is a relatively new phenomenon. If women are more expensive than men to insure, and middle-aged women are significantly more expensive than middle-aged men, what about, say, older women with red hair? After all, they have fairer skin and thus are more susceptible to skin cancer.

How about if, statistically speaking, blacks are more expensive to insure than whites? Or Christians more expensive to cover than kosher-observing Jews?

How far will insurers go in determining risks?

This may be a standard insurance practice, but I think the public realizes that this is unacceptable social policy to have such discrimination, against women or any other group.

We should pass bills like AB1962(De La Torre) to require maternity as a basic benefit; institute guaranteed issue in the individual insurance market so that those with "pre-existing conditions" can get coverage; and fundamentally reform the health system to expand group coverage and shrink the individual market--where women and others are subject to discrimination, in multiple ways.

One last point: I keep reading that McCain is interested in appealling to women voters, but how can he explain to them his health plan, which would shift millions into the individual market, where they are likely to be discriminated against?

Labels: Insurers, InTheNews, Legislation

posted by Anthony Wright | Permalink | 4:57 PM


 

Buyer beware, indeed...

Our efforts to reform the individual insurance market got more attention this week, by John Howard in the Capitol Weekly and Aurelio Rojas in the Sacramento Bee, which both profiled SB1522, by Senator Darrell Steinberg, and sponsored by Health Access California.

SB1522 passsed the Assembly Health Committee this week, and is now pending in the Assembly Appropriations Committee.

The Bee has the story of the Mary McCurnin and Ron Bednar of Rancho Cordova, who unwittingly bought a plan that the insurer Mid-West National Life Insurance Company called "definied benefit" coverage.

McCurnin and Bednar said they paid a monthly premium of $600 for what they thought was comprehensive coverage. But in 2002, after she was diagnosed with breast cancer and he had open-heart surgery, they learned otherwise.

Their plan covered only 10 percent of his hospitalization, and the company rescinded her coverage because she didn't disclose on her application that she was given a prescription for an anti-depressant years ago that she never filled.

With more than $250,000 in medical bills, the couple filed for bankruptcy protection and now face the loss of their home.

"Health insurance companies will do everything they can not to cover you," McCurnin said. "Having good (individual) health insurance is a myth."

The wife of the couple was rescinded under that now-infamous practice; the husband got "coverage," but found it covered only 10% of his costs because the benefit was capped. Examples like this inform consumer advocates' deep skepticism about the individual insurance market, and any attempt to expand it, as President Bush and now Senator McCain seek to do.

With little bargaining power, the individual consumer trying to get coverage will be at the mercy of the big insurance companies. SB1522 (Steinberg) tries to set some minimum standards in terms of benefits (doctors, hospitals, preventative care), and to place a cap on out-of-pocket costs. Other bills this year deal with rescission, or making sure than premium dollars go to patient care. All are consumer protections that attempt to make the situation a little more fair in an inherently unfair situation.

Even if all passsed, more reform will be needed. Both stories put this bill in the context of reconstructing health reform.

As the Weekly describes it, "Although the governor's health-care reform plan died this year in the Capitol's political crossfire, critical pieces have been resurrected and are quietly moving through the Legislature. One of the most important--already approved in the Senate and opposed by HMOs--would force health insurers to give consumers uniform, clear and accurate descriptions of their policies to aid comparative shopping."

And in the Bee, Senator Steinberg himself not only makes the clear case for the bill on its merits, and but ends the article making the case that the bill as a foundation for future, and more comprehensive, reform.

"As we move forward to more comprehensive reform in the future, creating confidence that people know what they are buying will be a key element," he said.

Labels: Insurers, InTheNews, Legislation, Steinberg, Underinsurance

posted by Anthony Wright | Permalink | 3:17 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


 

Coming up today...

Tuesday, June 17, 2008

Assembly Health Committee, chaired by Assemblyman Mervyn Dymally, meets later today: SB1522(Steinberg) is up. Hanh will have a report later...

Labels: Legislation

posted by Anthony Wright | Permalink | 1:00 PM


 

Evidence for Reform

Thursday, June 12, 2008

A national report released today confirms what many health advocates already knew: California's individual health insurance market is a big mess.

The individual market is where consumers to go buy health insurance if you don't get it at work (where you have a group going in to buy coverage together and spreading out the risks) or through public programs.

California's feeble -- or lack -- of protections leaves consumers extremely exposed. Here's how we fared:

• Requiring insurers to sell coverage to all applicants (also called guaranteed issue): No Credit.
• Requiring affordable coverage alternatives for uninsureables -- people with pre-existing conditions: Partial Credit. (California has the Managed Risk Medical Insurance Program, which allows this population to buy coverage at above-market rates. Without this program, these consumers would be denied coverage. MRMIP, however, is unable to accommodate all who need coverage. They do not advertise, yet have 8,101 enrollees and 339 applicants on a waiting list.)
• Prohibiting higher premiums based on health status: No Credit.
• Requiring advanced review of proposed premium rates: No Credit.
• Requiring insurers to spend at least 75% of premiums on health care: No Credit. (Actually, HMOs in California are required to spend at least 85% of premiums on health care. PPOs, which are regulated by a different department, are required to spend 70% of premiums on health care, though some insurance products spend as little as 51% on health care)
• Limiting how long coverage can exclude pre-existing conditions: Partial Credit.
• Limiting look-back period: Partial Credit
• Using objective standard to define pre-existing conditions: Full Credit (the first!)
• Requiring medical underwriting to be completed during application: Full Credit (We're not completely convinced this is the case -- otherwise, why the need for some insurers to rescind insurance later?)
• Reviewing insurers' requests to revoke coverage: No Credit (The Department of Managed Health Care Services has restored coverage to more than 1,000 patients and is in the process of reviewing more than 5,000 cases where patients have had their insurance revoked since 2004. )
• Accepting appeals when coverage is revoked: Full Credit
• Reviewing denials for all state-licened carriers: Full Credit
• Making external reviewer decisions binding: Full Credit
• Offering free external reviews regardless of claim size: Full Credit

Pretty sad. But there's hope! Fortunately, we're actually trying to do something about our abysmal performance.

• SB 1522 (Steinberg) INSURANCE MARKET STANDARDS & PREVENTING "JUNK" INSURANCE. The bill would set a minimum benefit standard for coverage, and weed out "junk" insurance that still leaves people exposed to bankruptcy. It would require coverage to have an overall cap on out-of-pocket costs, and cover doctor, hospital, and preventative care. It would sort health insurance policies into five coverage categories, ranging from “comprehensive’’ to “catastrophic.’’ Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing, and assist consumers in making apples-to-apples comparisons between plans.
• SB 1440 (Kuehl) CAPPING ADMINISTRATION AND PROFIT. It would set a minimum medical loss ratio – requiring every insurer to spend at least 85 percent of premiums on patient care.
• AB 1945 (De La Torre) INDEPENDENT REVIEW OF RESCISSIONS. It would require health plans to seek approval by an independent review panel under the Department of Managed Health Care or Department of Insurance for each individual rescission. It would also standard the process and questions used in any underwriting. Also up in the Assembly is AB 2549 (Hayashi) that would impose a six-month time limit in which insurers have to rescind individual health care policies once consumers’ applications are approved.

Labels: GuaranteedIssue, Insurers, Legislation, Rescissions, Research, YearOfReform

posted by Hanh Kim Quach | Permalink | 11:49 AM


 

Jones to be chair of Health Committee...

Thursday, June 05, 2008

Speaker Bass has announced that Assemblyman Dave Jones (D-Sacramento) will be the new chair of Assembly Health Committee. Here's health-specific excerpts from the report by Shane Goldmacher at the Sacramento Bee Capitol Alert:


Jones, a Sacramento Democrat, is currently chairman of the Assembly Judiciary Committee. The new chairmanship is considered higher on the Capitol pecking order, as many influential bills pass through the health panel, particularly as Gov. Arnold Schwarzenegger has said reforming the state's health system remains a top priority.

The current chairman, Assemblyman Mervyn Dymally, D-Compton, is termed out this year...

None of the changes are effective immediately. The new chairs will take over the committees in December.

Here's a recap of... the committee chair and leadership moves Bass has made since her selection as speaker:
Majority leader: Alberto Torrico
Assistant speaker pro tem: Lori Saldaña
Appropriations: Kevin De Leon
Budget: Noreen Evans
Rules: Ted Lieu
Health: Dave Jones

Labels: Bass, Legislation, Sacramento

posted by Anthony Wright | Permalink | 5:52 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


 

Quarterly Status Report Debate

Friday, May 30, 2008

Lots of invective discussion in the Senate Budget Committee this morning on governor's budget proposal to impose Quarterly Status Reports -- which are a passive aggressive way for the state to kick children and adults off of Medi-Cal if they don't return a report form every three months that lets the state know that they're alive, haven't moved and their income hasn't changed.

Some quotes:

Sen. Steinberg: "Let’s be frank. On cost-savings…the motivation of this is not to detect fraud. The motivation is to hope that people won’t show up and therefore lose their eligibility.’’

Sen. Gloria Romero points out that nearly 500,000 children would lose their health coverage once the reports are fully implemented. “That’s not ‘falling through the cracks.’ ….It seems, to me, that the net hope is that these children will just ‘go away’ and that’s the anticipated savings for the state of California. What I’d like to ask is, ‘Are you concerned about this?’’’

Labels: Budget, Legislation, MediCal

posted by Hanh Kim Quach | Permalink | 11:27 AM


 

Two more passed...

Thursday, May 29, 2008

Two more bills of interest to health advocates passed:

AB 2942 (Ma) which would require all hospital (both for- and non-profit) to show how their existence is a community benefit in order to be licensed. That includes providing health services that are important to the community it serves, including care for the most vulnerable. (Passed 43-35.)

SB 1633 (Kuehl) which would protect low-income patients receiving dental work from high-interest credit card schemes promoted by their dentists. (I'll post the vote later)

Labels: Hospitals, Legislation

posted by Hanh Kim Quach | Permalink | 4:58 PM


 

Never-never land...

Wednesday, May 28, 2008

One more bill passed today of interest to health advocates: 2146(Feuer), so that health care providers would not charge for "never events"--events that should never happen. These include surgery performed on the wrong body part; surgery on the wrong patient; deaths from medication errors; etc.

The bill got a 42-21 vote, with most Democrats in support, with Soto absent, and De La Torre, Dymally, Galgiani, Hernandez, Krekorian not voting.

Labels: Hospitals, Legislation

posted by Anthony Wright | Permalink | 6:30 PM


 

Hearings Hearings

Budget hearings in both houses later this week. The Assembly Budget Subcommittee #1 on Health and Human services will review the May Revision to health programs on Thursday (more details on time and place to come).

On Friday morning, the full Senate Budget committee will review health budget changes at 10 a.m. in Room 4203.

Busy busy.

Labels: Budget, Legislation, MediCal

posted by Hanh Kim Quach | Permalink | 5:50 PM


 

What constitutes coverage?

Tuesday, May 27, 2008

As the Democratic presidential candidates debated whether their "universal coverage" plans were "universal"--and what that meant--there wass surprisingly little debate about the definition of "coverage."

What makes "coverage" coverage?

It's a good question, as Florida Governor Charlie Crist just signed a so-called health reform that doesn't expand coverage one bit, but rather strips down the definition of coverage to make the premium cheaper. Critics say that as insurers water down the benefits, at some point the value of the coverage is so little that it's not worth paying premiums for in the first place.

It seems people get coverage to prevent the real health and financial consequences of being uninsured. They literally pay a premium to 1) get the care they need, and 2) not face financial ruin as a result.

There are some products out there that don't meet this basic definition. For example, we've heard of products--some sold by disreputable outfits, sometimes on TV at 3am--that say they provide hospital coverage, but only reimburse $200/day. Only if you've been to a hospital do you know that such a plan doesn't begin to cover an overnight stay, and that such "coverage" from a masssive hospital bill is merely an illusion. It's "junk" insurance.

SB1522(Steinberg), which passed the California Senate Tuesday, would set a minimum standard for coverage as well, in two basic ways:

* It would set an overall cap on out-of-pocket costs, so people paying premiums would not face unlimited financial liability when they get sick or have an emergency. This won't eliminate your standard high-deductible plans, may be a (not great) option for a healthier, wealthier person who wants to save on the premium and who has the ability to self-insure a few thousand dollars of a deductible. But it would eliminate those plans which cover so little or impose so much cost-sharing on the patient that the person continues to be at risk of banktruptcy.

* It would requires that a plan should include doctor, hospital, and preventative care, preventing hospital-only coverage. This would prevent hospital-only plans that leave patients in a situation where cancer isn't covered, since most of the treatment is in a doctor's office, rather than a hospital. Even worse, you don't want an perverse incentive for people to want the more invasive, more expensive hospital treatment unless they need it. Again, these plans often provide a false security to patients--until its too late.

These "junk" plans, because they collect premiums but are far skimpier in paying out benefits, can be very lucrative for the insurers who sell them. But they have the capacity to undermine the very notion coverage altogether. What's the point of paying for coverage, if you still face financial ruin?

People are growing more and more concerned that their coverage will not be there for them when they need it. They are frightened that even if they are insured, there will some loophole or provision that leaves them with significant medical debt. That's why SB1522(Steinberg) and other efforts are so important, to make the definition of coverage mean something. Consumers with coverage deserve some security that with their premium, they will be protected.

Labels: Insurers, Legislation, Steinberg, Underinsurance

posted by Anthony Wright | Permalink | 11:52 PM


 

Health reform lives on in Sacramento...

HEALTH ACCESS UPDATE
Tuesday, May 27th, 2008


KEY HEALTH BILLS PASS FLOOR VOTES IN CALIFORNIA LEGISLATURE
* Senate Passes SB1522 (Steinberg), Standardizing Insurance & Prohibiting "Junk" Coverage
* Assembly Passes AB2967 (Lieber), Providing Transparency on Cost and Quality of Care
* Also: Bills Pass to Regulate Insurers on Rescission, Maternity Coverage, Mental Health Parity, and Requiring 85% of Premium for Patient Care

* More on the Legislative Debate and much more at the Health Access WeBlog (www.health-access.org/blogger.html):


Health reform continues to be a hot topic at the State Capitol. Passing their first floor vote and the half-way point in the California Legislature, key health bills would provide patients with new information and needed consumer protections regarding their care and coverage.

The Assembly and Senate passed several key health care bills, including ones to protect consumers from "junk" insurance; to increase transparency about the cost and quality of care; to regulate the practice of retroactively denying coverage to patients; and to mandate coverage of maternity and mental health services. The health reform conversation is alive and well.


The following bills passed:


INSURER OVERSIGHT

* STANDARDIZING INSURANCE: SB1522(Steinberg), eliminating "junk" insurance and standardizing the insurance market to allow for "apples-to-apples" comparison for consumers. The bill would set a minimum benefit standard for coverage by requiring coverage to have an overall cap on out-of-pocket costs, and cover doctor, hospital, and preventative care. It would sort health insurance policies into five coverage categories, ranging from “comprehensive’’ to “catastrophic." Here's a fact sheet, and a patient story that illustrates the issue.

Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing. The bill would also prevent consumers from not understanding their coverage, or having "junk" coverage where they are paying a premium by are still facing unlimited financial exposure. Sponsored by Health Access California. (Passed by the Senate 22-16 with most Democrats in support; Ducheny and Ridley-Thomas not voting; Correa voting no.)


* MEDICAL LOSS RATIO: SB1440(Kuehl), to require that at least 85% of premium dollars go to patient care, rather than administration, marketing and profit. The proposal seeks to ensure that consumers are getting value for their dollar. (Passed by the Senate 22-16, with most Democrats in support, with Machado and Simitian not voting, and Yee voting no.)

* RESCISSIONS: AB1945(De La Torre), to require insurers to get an independent review before retroactively denying coverage from patients. (Passed the Assembly 57-16, with significant bipartisan support.) Also passing was AB2549(Hayashi) which sets a six-month time limit for insurers to rescind once consumers' applications are approved. (Passed the Assembly 44-26.)

BENEFITS


* MENTAL HEALTH: AB1887(Beall) to expand the requirement on insurers to cover mental health services. (Passed by the Assembly 44-26, with most Democrats in support, and with Arambula, Mullin, Calderon, Galgiani not voting; Soto absent.)

* MATERNITY: AB1962(De La Torre), to require insurers to cover maternity benefits. (Passed the Assembly 44-31, with most Democrats in support; Soto absent; Galgiani not voting; and Calderon and Parra voting no.)


PROVIDER OVERSIGHT

* TRANSPARENCY: AB2967(Lieber), to require better data from health providers and plans to increase the transparency of the cost and quality of care. This effort has yielded one of the most interesting coalitions, with strong support by prominent consumer, labor, and business groups--all purchasers of health care trying to get a better sense of what they are getting for their money. (Passed by the Assembly 41-32, with most Democrats in support but Soto absent; Fuentes, Krekorian, Ruskin, Portantino, Solorio not voting; and Arambula voting no.)

* DISTRICT HOSPITAL TRANSACTIONS: SB1351(Corbett), to require Attorney General oversight over district hospital sales and closures. (Passed the Senate 24-14, with most Democrats in support, and Scott not voting.)

Health Access will continue to track these and other bills on our website, at
http://www.health-access.org/advocating/2008_bills.html

Labels: Hospitals, Insurers, Legislation, Updates, YearOfReform

posted by Anthony Wright | Permalink | 7:46 PM


 

A quick floor report...

Busy and productive day in the Assembly and Senate on many of the key health care bills. The health reform conversation is alive and well...

Here's what passed (partial list--we'll have a fuller update later today):

* SB1522(Steinberg), eliminating junk insurance and standardizing the insurance market to allow for "apples-to-apples" comparison for consumers. (Passed by the Senate 22-16 with Ducheny and Ridley-Thomas not voting; Correa voting no.)

* AB2967(Lieber), to require better data from health providers and plans to increase the transparency of the cost and quality of care. (Passed by the Assembly 41-32. Party line vote with Fuentes, Krekorian, Ruskin, Portantino, Solorio not voting; Soto absent; Arambula voting no.)

* SB1440(Kuehl), to require that at least 85% of premium dollars go to patient care, rather than administration, marketing and profit. (Passed by the Senate 22-16, with Machado and Simitian not voting, and Yee voting no.)

* AB1945(De La Torre), to require insurers to get an independent review before rescinding coverage from patients. (Passed the Assembly 57-16, with significant bipartisan support.) Also passing was AB2549(Hayashi) which sets a time limit for insurers to rescind. (Passed the Assembly 44-26.)

* AB1887(Beall) to expand the requirement on insurer to cover mental health services. (Passed by the Assembly 44-26, with Arambula, Mullin, Calderon, Galgiani not voting, Soto absent.)

* AB1962(De La Torre), to require insurers to cover maternity benefits. (Passed the Assembly 44-31, with Galgiani not voting; Soto absent; and Calderon and Parra voting no.)

* SB1351(Corbett), to require Attorney General oversight over district hospital sales and closures. (Passed the Senate 24-14, with Scott not voting.)

Good things. Good day for consumers.

Labels: Hospitals, Insurers, Legislation

posted by Anthony Wright | Permalink | 5:59 PM


 

The debate on SB1522...

Senator Steinberg just presented SB1522 on the Senate floor. The preliminary count is that it passed, 21-14, largely on party lines.

Senator Cox was the only other speaker, in opposition. An insurance agent, Cox suggested that "Senator Steinberg should find himself a good agent," and that an agent could provide the information to help a consumer decide what coverage to get.

He argued that with the classification of health plans into five tiers, "you've taken away the flexibility" which will lead to a "higher-premium program with fewer enrollees."

In fact, the five tiers allow for lots of variation and flexibility within those tiers. Above some minimum standards (see below), there is total flexibility in benefit design. The tiers will simply provide consumers some guideposts, so they are better be able to make comparisons between insurers.

SB1522 does seek to eliminate some "junk" insurance that leaves patients with unlimited financial exposure, undermining the point of coverage in the first place. Coverage would have to have some overall cap on out-of-pocket costs. The minimum standard for coverage would need to include doctor, hospital, and preventative care, effectively restricting doctor-only or hospital-only health coverage--as if people can guess that not just the type of ailment they will have, but the type of treatment as well.

But other than that, there's lots of flexibility. As Senator Steinberg said in closing, the basic point of the bill is to have clear information. And, he asked, while many people may benefit from "a good broker like Senator Cox," what's the harm in providing everyone as much information as possible? "Information is a good thing, and provides greater flexibility" for consumers.

Labels: Insurers, Legislation, Steinberg, Underinsurance

posted by Anthony Wright | Permalink | 3:43 PM


 

When cancer isn't covered...

SB1522(Steinberg), sponsored by Health Access California, is up for a full Senate vote this week.

The bill would standardize the individual insurance market, so that consumers have a better sense of the coverage they are buying, and allow for "apples-to-apples" comparisons between plans. It would create clear categories so that people would have a better sense of how comprehensive their plan was, and would set a minimum standard for benefits to include doctor, hospital, and preventative care, and have a overall cap on out-of-pocket costs. This would eliminate the "junk" insurance that leaves people to believe they are covered but finding out later they have significant financial exposure.

Below is the testimony of Susan Braig (pictured above, with Senator Darryl Steinberg, author of SB1522). With a limited income to pay premiums, she understood she was buying catastrophic coverage... but not that her "hospital only" plan wouldn't cover the significant costs of being treated for breast cancer, because most of those treatments were not in a hospital.

This is a excerpt of her testimony in the Senate Health Committee earlier this year:

I am a self-employed grant writer, whose Stage 2 Breast Cancer has, thankfully, not metasticized, though my credit card debt has.

In 2001, after a year with no health insurance, my 50th birthday sent me comparison shopping, and I went to Blue Cross. I purchased what I considered to be a “catastrophic” policy, their lowest tier, their BASIC PPO 1000. I thought my out-of-pockets costs would be limited to $3,500, comprised of a $1,000 deductible, plus a $2500 co-payment requirement before full coverage kicks in.

Blue Cross made it clear up front, this plan did not cover doctor visits, tests or prescriptions; I rationalized that, since I was healthy and rarely needed a doctor, why sweat the "small stuff?"

The important thing was, Blue Cross said they would cover 80% the big stuff: surgeries, emergencies, and hospitalizations, and with the big stuff, I would quickly spend $3500, and then Blue Cross would pay 100% of my care for the rest of the year.

Prior to my 2004 diagnosis, I assumed fighting a catastrophic disease like cancer involved the big stuff.

* What I didn’t realize then, but I know now, is that during the next 11 years, most of my medical services I would need in my battle with cancer would involve things not covered—specialist exams, ultrasounds, an $8,000 MRI, lab tests, prescriptions.

Even my chemotherapy treatments were considered doctor visits, unless I had the identical treatments an hour from home in a hospital.

* I also didn’t realize that the way deductibles and co-pays are calculated meant they didn’t count any of these non-hospital expenses to meet my deductible, and I would almost never reach my annual $3500 cap, no matter how much I spent.

It’s true that after I met my deductible, Blue Cross did cover 80% of in-hospital services, such as my Lumpectomy and a 3-day emergency hospitalization in 2004… although by the time I paid off my $1000 deductible, my various 20% co-payments fell $30 short of the $2500 co-payment requirement to get full coverage.
* For a time, due to my low income, I got help with the costs that Blue Cross didn’t cover from the state’s Breast and Cervical Cancer Treatment program. That was a lifesaver—even though I was still paying pre