A Constituency Against Health Care?

Thursday, July 03, 2008

As we await to see what the Budget Conference Committee does about imposing more paperwork burdens to have hundreds of thousands of children fall off coverage, here's something for your holiday weekend amusement. From the Onion News Network, it's the only support I've seen for cutting children's health care:


Study: Most Children Strongly Opposed To Children's Healthcare

Labels: Budget, Funny, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 12:58 AM


 

Provider rate cuts put in place today...

Tuesday, July 01, 2008

As July 1st, today got a lot of attention for being the start of the state's fiscal new year... and get another year where the budget is not done on time.

Presumably, a budget will be agreed to and signed into law later this summer. What's more important is that this is the first day that the 10% Medi-Cal provider rate cuts go into effect.

This doesn't just impact doctors, hospitals, and other providers. It hurt patients who find it harder to get a doctor, or specialist. (One study indicated that more than half of California doctors don't take Medi-Cal.) It is a major cut to the health care system on which we all rely. And unlike the delay in the budget, it is permanent, unless the Legislature reverses the cuts.

Let's be clear: the Democratic majorities are offering to restore these cuts. But that won't happen unless the Democrats in the Legislature are able to get their fellow Republican legislators to support the taxes needed to restore those cuts. And until such a decision is made, patients and providers will have to suffer with the cut and its consequences.

Labels: Budget, MediCal

posted by Anthony Wright | Permalink | 11:49 PM


 

"The choice is clear..."

The Sacramento Bee editorializes and says it well... Read the whole thing, but here's an excerpt:

Editorial: Budget deal will do real damage to health care

The choice is clear: Increase taxes or let the impact fall on children and the elderly

...Faced with a $17 billion deficit, the governor and state lawmakers are considering cuts that would likely drop tens of thousands of children from the Medi-Cal program, the state's version of Medicaid. They also are considering restricting adult eligibility requirements for Medi-Cal, hurting families trying to transition from welfare to work.

Elderly patients would also take a hit. As part of a 10 percent cut scheduled to take effect today, the state plans to reduce payments received by pharmacists who serve Medi-Cal patients. Pharmacists say it would force them to lose money on commonly prescribed drugs, and to choose between taking fewer Medi-Cal patients or cutting staff and limiting hours...

Legislators, particularly Republicans who have taken a vow not to raise taxes under any circumstance, need to consider the consequences.

Start with children. Currently, about 3 million children in California receive health care through Medi-Cal, and eligibility for the program is determined annually. To save $92 million in the budget, Schwarzenegger wants to reinstate a rule that families on Medi-Cal submit paperwork every three months to prove their eligibility, instead of every 12 months.

About 150,000 children are expected to lose coverage this year – and 470,000 eventually – because their families either fail to file the required forms or they can't meet the program's eligibility rules. The quarterly reporting requirement will also add to the burdens of counties, who will have to process all the extra paperwork.

For these reasons and others, the Assembly rejected the administration's proposal, while the Senate has come back with a "compromise" – requiring Medi-Cal recipients to file paperwork twice a year, instead of four times.

This is hardly a compromise. As senators and Schwarzenegger are well aware, kicking poor people out of the Medi-Cal program will only force them to go to the emergency room, or avoid treatment for diabetes, high blood pressure and other chronic diseases.

While campaigning for health care reform last year, Schwarzenegger often talked about the "hidden tax" that uninsured people impose on hospitals, businesses and local governments. It would be revealing for the governor to calculate the hidden tax he will impose on this state if these Medi-Cal cuts are fully enacted.

A better option would be a modest, broadly distributed levy – yes, a tax – to prop up this state's health care program for the poor. Consider it a down payment on a once-and-future goal: a more universal system of health coverage

Labels: Budget, InTheNews, MediCal, SCHIPHealthyFamilies, Schwarzenegger

posted by Anthony Wright | Permalink | 12:43 AM


 

Follow along...

Sunday, June 29, 2008

Our report revealing the full magnitude of the health care budget cuts got lots of good response and press attention (such as from the Contra Costa Times, Ventura County Star, New America Media, and others) earlier this week.

For those following the budget, we have one-sheet on the proposed health cuts in the 2008-09 Health Care Budget on our home page.

The Budget Conference Committee is expected to come back on Monday, and perhaps close out in this week. Our website also has an often-updated Budget Cuts Scorecard where you can follow along to see--item by item--what the Assembly has done, what the Senate has done, and what the Conference Committee had done on a specific cut.

The scorecard answers the relevant question: where is the Legislature on the proposals that would deny coverage to one million Californians?

Our report details four cuts that lead one million Californians to be denied:
* One of the biggest and most direct cuts, to directly close eligibility for 430,000 low-income working parents, has been rejected by both the Senate and the Assembly.
* Two of the smaller cuts have been accepted by both the Senate and Assembly: the increase in premiums for Healthy Families, and the suspension of key reforms to streamline eligibility for children. Together, that potentially would prevent as many as 160,000 children (and some parents) from getting coverage.
* The Assembly rejected the other big cut, to impose paperwork requirements through quarterly status reports, which would by 2010 deny coverage to 470,000 children. The Senate, however, is looking at imposing the additional paperwork every six months, which would have from a third to half the impact, but it would still be significant. We'll see what they decide.

In short, the Legislature has indicated that, in the best case scenario, the budget will contain health cuts to leave roughly 150,000 more Californians without coverage. The Conference Committee will determine if that number could go to 300,000 or more... and if the "Big 4" negotiations between the Democrats and Republicans don't yield the necessary revenues to prevent these cuts, the number of uninsured Californians could grow by over one million.

Let's also not forget two other major categories of cuts: the provider rates, which were cut 10% and the Legislature is considering making some restorations; and the proposed elimination of dental and other key benefits to Medi-Cal patients, the impacts of which are detailed in this fact sheet, entitled "Vital Medi-Cal Benefits on the Chopping Block ".

Decisions made in the next weeks will determine the fate of care and coverage for hundreds of thousands, if not millions. The stakes are high.

Labels: Budget, InTheNews, MediCal, Research, Schwarzenegger

posted by Anthony Wright | Permalink | 1:37 PM


 

Patients, not paperwork!

Friday, June 27, 2008

Great editorial in the LA Times today: should we spend on healthcare, or on paperwork? That's the proposal in the Governor's budget, and while the Assembly rejected it, the Senate is still considering a modified version of the proposal. Read the whole thing, but here's the final paragraph:

The semiannual applications are projected to save California $25.6?million while taking medical coverage away from tens of thousands of children. Meanwhile, the costs of doubling the paperwork would erase much of the savings. The health of poor children is a vital social interest; more paperwork is not.

Labels: Budget, InTheNews, MediCal

posted by Anthony Wright | Permalink | 10:18 AM


 

One million more uninsured, just to begin with...

Wednesday, June 25, 2008

Earlier this week, Governor Schwarzenegger called the number of uninsured in California a "moral crisis"--and he was right, both about that and the need for concerted action on health reform.

Unfortunately, the Governor's cuts-only budget goes in completely the opposite direction, making our health care system even more broken, and leaving more people uninsured. Today, we are releasing a report that reveals the full magnitude of the cuts the Governor proposes--with over one million more Californians uninsured. While the Legislature has adopted some of these cuts and rejeced others, all of these proposals are on the table until a budget solution is agreed to. There's early press from Aurelio Rojas at the Sacramento Bee and Jordan Rau of the Los Angeles Times.

HEALTH ACCESS UPDATE
Thursday, June 26th, 2008


New Analysis Reveals Full Impact of Governor’s Health Cuts:
One Million More Californians Would Lose Health Coverage

* Permanent Policy Changes, Not One-Time Cuts, Would Hinder Reform
* Magnitude of Cuts Would Have Ripple Effects Through System
* Health Consumers and Providers Urge Alternative to Cuts-Only Budget

Over one million more Californians would lose health coverage, with significant impacts throughout the state’s health system, if the Governor’s budget and health cuts were passed, according to a new analysis today.

The study, by the health care consumer advocacy group Health Access Foundation, uses information from the Schwarzenegger Administration, but shows a much greater magnitude than earlier estimates, which only looked at the impact of the cuts for less than a year, and not at full implementation.

The report is available on the front page of the Health Access California website, and directly at:
http://www.health-access.org/preserving/Docs/HACoverageImpactReporto6-25Final.pdf

The study shows that these health care budget cuts are of a magnitude that will impact every Californian, as they place huge burdens on the health system we all rely on. These are permanent, not just one-time cuts, to leave more than one million more Californians uninsured, and over three and a half million having to pay more and get less.

Previous summaries of the Governor’s budget proposals, including the May Revision, show the impact of the cuts in only the first year – with tens of thousands losing coverage or being barred from enrollment. But the impact is much greater, in three ways:

• The Governor’s budget is not proposing one-time budget savings, but lasting policy changes and coverage reductions for the health care system.
• A snapshot of the savings in the budget year does not reveal the full impact in the following years, once the reductions have been enacted and all the administrative changes have occurred to continue the reductions.
• Finally, the cumulative impact of all the proposed cuts, when added up together, suggests that the magnitude of the cuts—with more than a million more uninsured—will have impacts not just on specific programs but on the entire health care system on which we all rely.
  

The permanent policy changes reflected in the budget will be in place long after the 2008-09 budget year comes and goes. Of note, these policy changes are contrary to health reform proposals the governor previously put forward.

The cuts include:
* A roll-back of eligibility for basic Medi-Cal coverage for low-income working parents to well below the poverty level. (429,000);
* Additional paperwork burdens for children and adults, requiring reports every three months in order to avoid disenrollment (471,500);
* Suspension of already-passed legislation to streamline child enrollment (97,000)
* Increased premiums for children’s health coverage, leading to decreased enrollment (60,000).

The cuts represent a reversal for the Administration, reducing programs that just a few months ago were being considered for massive expansions to provide coverage to millions more people. Rather than shrinking the number of uninsured, the Schwarzenegger budget would increase the number of uninsured substantially.

The report includes appendices that include:
* a county-by-county breakdown indicated the increase in the uninsured by county by 2010, the last year of the Schwarzenegger Administration;
* a chart comparing the policy changes in the Governor’s budget that would restrict coverage, to the health reform proposal supported by the Governor earlier this year to expand coverage; and
* a further detailing of the populations that under the proposed cuts would be forced to pay more or get less benefits, totaling 3.5 million Californians.

Allowing one million more California children and parents to go uninsured creates ripple effects throughout the entire health care system. It includes:

• an increased burden on “safety net” providers, from emergency rooms to hospitals to community clinics—many of which are dealing with direct cuts of their own;
• a cost-shift, from both the uninsured and reduced Medi-Cal provider payments, to private purchasers of health care—which likely means increased premiums; and
• worse health and economic impacts for California communities, from the destabilizing impact of more children uncovered and getting sicker, to more families facing medical debt and bankruptcy for being uninsured.

As a result, all Californians—not just the million more uninsured—will be impacted these cuts. The report makes clear the stark choice the budget debate this summer presents for California policymakers, between allowing these devastating cuts to move forward and to make these structural policy changes to our health care system, or to find the revenues needed to prevent these cuts.

Labels: Budget, MediCal, Research, SCHIPHealthyFamilies, Uninsured, Updates

posted by Anthony Wright | Permalink | 6:57 PM


 

Live-blogging the conference committee...

Sunday, June 15, 2008

HEALTH ACCESS UPDATE
Saturday, June 14th, 2008


BUDGET CONFERENCE COMMITTEE DEBATES HEALTH ITEMS
* Budget Conference Committee attempts to reconcile Assembly, Senate decisions
* Drug discount program, QSRs, and provider rates debated; Most items left open.
* These and other cuts dependent on final budget resolution and revenues

Click Here for What's New on the Health Access WeBlog: Healthy Blogging; Consumers Union's Cover America Tour; the LA Times on This Year's Health Reform; Hospitals Auctioning Medical Debt; C-Section as a Pre-Existing Condition; Speaker Bass on the Budget; Jones to be Health Chair; the Health Divide Between Obama and McCain; the Individual Market; High Deductible Plans; the Field Poll on Health Cuts; Health Access is Hiring; Budget Resources; the Biggest Threat to Health Reform: the Budget Cuts; New Families USA Report Grading California's Consumer Protections; Taking Consumer Representation Seriously; and Full Real-Time Budget Conference Committee Reports!


Budget season is in full swing as the bi-cameral Budget Conference Committee began meeting this past Thursday.

The conference committee is made up of six members -- three from the Assembly and three from the Senate. The Senate conferees are Senators Denise Ducheny (the chair), Bob Dutton, and Mike Machado. The Assembly conferees are Assemblymen John Laird (the vice-chair), Mark Leno and Roger Niello. Together, their task is to pore through a 439-page agenda contains all the differences between the Senate and Assembly version of the budget and reconcile them.

Health programs sit right in the middle of that agenda and came up Saturday afternoon. Health Access tracked discussions on the health budget on our blog in real time at:
www.health-access.org/blogger.html.

For people tracking this issue, here's a scorecard of all the proposed cuts, including those accepted, rejected, and those where there is disargeement between the two houses:
http://www.health-access.org/preserving/Docs/BudgetScorecard%20061408.pdf

Some of the most severe cuts, like direct cuts to Medi-Cal eligibility for working parents, were rejected by both the Assembly and Senate majorities and those are not "in conference." However, the legislators again repeated today that those cuts are still pending, unless the budget includes revenues to offset those cuts.

The conference committee focused on items where the Assembly and the Senate took different actions. That includes:
* the start of the California Discount Prescription Drug Program, where the Senate voted to defund the program and delay the start of it for a year, and the Assembly (along with the Governor) allowing the program to get underway, to start negotiating with drug companies.
* the question of imposing additional paperwork burdens for children on Medi-Cal, through quartely status reports. the Assembly voted against the proposal; the Senate put forward a modified proposal to have children's families renew their coverage every six months, rather than on an annual basis.
* the biggest dollar amounts considered were whether to restore the 10% provider rate cut made this February for doctors, hospitals and others who care for patients with Medi-Cal coverage.

Most items heard today, including these three areas, remained open while lawmakers directed staff to work out compromises or gather more information about the programs. Before leaving the items "open," lawmakers debated quarterly status reporting for children and adults, and the 10% rate cut for providers, as well as the frustration that many of these cuts mean losing federal matching dollars as well.

"We can talk about all we want to about restoring cuts, or we can defer the consideration of cuts, but until we can put focus as to where we are going to go with revenues, we are creating a false document,'' said Sen. Mike Machado, urging lawmakers to look realistically at the state's fiscal problems. "I think it's very difficult to talk about this if we're not going to talk about the revenue side. We're creating a budget in a vacuum.''

One cut that was made was to accept the Governor's proposed reduction to hospitals who do not contract with Medi-Cal.

The committee ended Saturday afternoon on an up note, with some federal funds identified that could be applied to California Children's Services, which pays for medical care for children with chronic illnesses and disabilities. The committee approved a compromise measure between the two houses on this issue.

Again, no decisions are final until a final budget is passed and signed into law.

Health Access will continue to track the Budget Conference Committee, which will resume Monday, June 16th at noon to continue discussion of health-related items, including to clinics and the Healthy Families program.

In the meantime, Health Access keeps a scorecard of items of interest to health advocates. For more information, contact Hanh Kim Quach, the author of this report, at hquach@health-access.org.

Labels: Budget, MediCal, Sacramento, Updates

posted by Anthony Wright | Permalink | 12:25 PM


 

More on Provider Rate Reductions

Saturday, June 14, 2008

Sen. Denise Ducheny corrected Assemblyman Niello's assertion that the budget debate has not included all the ways Medi-Cal could be reduced. The problem is, she said, cuts to benefits save so little.

Sen. Bob Dutton, R-Inland Empire, had a few interesting comments that I hope he'll remember in the future:

"I don't want to cut things that are going to get matching dollars from the federal government.'' In the Medi-Cal program, the federal government matches eligible expenses dollars for dollar. It means that for every dollar California cuts, we lose an additional dollar in federal investment. Duh. This logic should be applied anytime he looks at a Medi-Cal cut.

Dutton also made a logical argument for why provider rates ought not be cut: because it would discourage providers from taking more patients in certain areas and drive patients to the emergency room. Bingo.

Labels: Budget, MediCal, Republicans

posted by Hanh Kim Quach | Permalink | 1:58 PM


 

Plain Wrong

Assemblyman Roger Niello suggests in conference committee during debate on 10% provider rate reduction that the state is not applying cuts to Medi-Cal in a way that attacks all "three legs'': Eligibility, provider rates and benefits.

That's just wrong.

The budget does all three.

RATES:

• 10% rate reduction for providers. (-$614 million)

BENEFITS

• Elimination of Adult Dental (-$73.8 million)
• Other benefits, such as podiatristrists, eyeglasses and incontinence creams and washes (-$11.6 million)

ELIGIBILITY

• Quarterly Status Reports. (-$43.3 million): a passive agressive way for the state to eliminate Medi-Cal recipients by blaming their disenrollment on the recipients' failure to report their income every three months.
• Direct denial of low-income working adults (-$31.2 million): which would tell parents earning between $11,000 and $18,000 that they earn too much to qualify for Medi-Cal.
  

For updated information, visit our budget resource page.

Labels: Budget, MediCal, Republicans

posted by Hanh Kim Quach | Permalink | 1:03 PM


 

Digging a bigger hole for reform...

Wednesday, June 11, 2008

As the Budget Conference Committee in the California Legislature is about to begin its deliberations, a couple of reminders.

1) The cuts being discussed are ugly. The proposed cuts by the Governor would deny coverage to over a million Californians, and reduce access to care and coverage to millions more, and defund and undermine the health system on which we all rely.

For six and a half million children, parents, seniors, and people with disabilities, their Medi-Cal coverage will be harder to get, harder to stay on, and for those who keep it, they will have reduced ability to get the benefits and access to the providers they need.

2) The decisions around the budget will have a decisive impact on health reform, at the state level, and even at the national level. These proposed health cuts would go in the exact opposite direction of the policy reforms our broken health care system needs. If adopted, the Governor's proposed cuts take us further from the goal of health reform: it digs a bigger hole, that will need to be filled before embarking on additional expansions.

Medicaid and SCHIP (Medi-Cal and Healthy Families in California) are the groundwork for health reform, on which additional expansions are built--but that only works their funding is strong and sustainable.

Regarding of the plan, from single-payer to a Massachusetts-style proposal to any public program expansion to anything else, any health reform and coverage expansion presupposes that we will need significant subsidies for lower-income families, who simply won't be able to afford coverage by themselves. Yet by significantly cutting public programs that exist now--which are incomplete in policy and practice already--we have less to work with.

If these cuts are made, reformers will have to raise all those additional resources elsewhere--a major task indeed. In the effort for universal health care:
* For every dollar cut from the health care budget by California and other states, that's a dollar that we will have to raise later.
* For every child or parent that loses coverage, that's a child or parent that we are going to have to re-find and enroll later.
* For every policy change to place more administrative barriers to getting care and coverage, that's just more we have to do later.

In other words, the greatest threat to health reform in 2009 may not be the insurance industry or even voter distrust (although they are significant obstacles as well), but the budget crisis and the state Governors and legislators who are making these health care budget cuts around the nation, and are undermining the foundation on which we need to build.

Labels: Budget, MediCal, YearOfReform

posted by Anthony Wright | Permalink | 1:48 AM


 

Scoring at home...

The Budget Conference Committee will start their marathon sessions with a meeting tomorrow, Thursday, to reconcile the differences between the Assembly and the Senate versions. You can follow along with our handy, newly-updated Health Care Budget Cuts Scorecard, featured on our website's front page. which shows the Governor's proposed cuts, and their status. We also have recent fact sheets on the cuts in general, and the Medi-Cal benefits cuts in specific.

Follow along! There's a column so fill in to see what the Conference Committee might do...

Labels: Budget, MediCal

posted by Anthony Wright | Permalink | 1:29 AM


 

Field Poll: strong opposition to the health cuts...

Tuesday, June 10, 2008

The coverage of today's Field Poll is broadly about the budget, but has lots of specific information on health care.

On the broad take, it's clear that the voters' top two priorities in the budget are education ("the public schools") and health care, with 80% and 77% of the public opposing to making cuts in these areas. The budget reflects the will of the voters: around half of the budget is education, and a third is health and human services.

The terrifically high support for health care could actually be an underestimate, given the question (about making cuts to "health care programs for low-income Californians and the disabled.") It's true that Medi-Cal, the main health program, serves 6.5 million low-income children, parents, seniors, and people with disabilities. It's also true that Medi-Cal is an essential funding base for the entire health care system on which we all rely.

The poll in fact did ask about specific health areas: here are the proportions reporting being very or somewhat concerned about each of the five health program areas measured.
• hospital emergency rooms and trauma centers (86%)
• health care programs for low income Californians and the disabled, like Medi-Cal (80%)
• staffing for nursing homes (76%)
• immunizations and prenatal care (72%)
• public health and bio-terrorism preparedness (60%)

The public is clear about rejecting these health care cuts. The polls also tests a range of taxes to prevent those cuts, with some getting majority support, and some not. It's up to our elected leaders to figure out exactly the mix of revenues to prevent these cuts. But that's the job of our leaders now.

Labels: Budget, MediCal, Research

posted by Anthony Wright | Permalink | 11:52 AM


 

The budget stage is set.

Sunday, June 01, 2008

HEALTH ACCESS UPDATE
Friday, May 30th, 2008


ASSEMBLY, SENATE BUDGET COMMITTEES VOTE OF PROPOSED CUTS (FOR NOW)

* Assembly and Senate budget committees vote to reject severe cuts to Medi-Cal, including major denials of coverage to working parents & others, elimination of dental & other benefits. Votes would also restore some of the provider rate reductions.
* Significant cuts agreed to by at least one committee include: Cuts to public and private hospitals, counties, health plans; increases in Healthy Families premiums; additional reporting for children; increased premiums for seniors
* Clear choice in budget debate moving forward: Hundreds of thousands of Californians denied coverage & care, or an alternative to a cuts-only budget that includes revenues.

Click Here for What's New on the Health Access WeBlog: Floor Reports on Health Bills Passing This Week; Ongoing Updates from Budget Committees; What Makes Coverage Coverage?; Health Reform in Obama's First 100 Days?; and more...


After a busy week on the floor, Senate and Assembly budget committees topped off the week with simultaneous hearings and votes on outstanding health budget items. A number of items that were left open in previous months while committees vetted the issues were either modified, approved or rejected Friday morning (listing below).

Health Access has posted a Health Care Budget Cuts Scorecard, which details the Governor's proposed cuts, and for each cut, the budget savings, the number of people impacted, and the actions by the Assembly and Senate today. The scorecard is here, at:
http://www.health-access.org/preserving/Docs/Health%20Access%20-%20BudgetScorecard%20053008.pdf

BUDGET BLUES

The Senate Budget Committee, chaired by Senator Denise Ducheny, and the Assembly Budget Subcommittee on Health and Human Services, chaired by Assemblywoman Patty Berg, both voted to approve or reject the many health care cuts proposed by Governor Schwarzenegger in the May Revision of the budget. That budget sought to bridge a $17.2 billion shortfall in a $100 billion general fund budget without raising taxes.

While no action is final until a final budget is approved and signed into law, both the Assembly and Senate committees rejected many of the Medi-Cal cuts to eligibility and benefits as too severe, and both proposed restoring some of the provider rate cuts made earlier in the year.

At the same time, both committees did vote to approve other cuts proposed by the Governor, and other cuts. Cuts approved by at least one committee included cuts to hospitals, cuts to counties, cuts to Healthy Families health plans; caps in benefits; increases in Healthy Families premiums; additional reporting requirements for children; and increased premiums for seniors.

Health Access is posting summaries on its blog, at www.health-access.org/blogger.html.

WHAT’S NEXT

In the Senate, the budget committee’s proposal will head to the floor for a vote. In the Assembly, the full Assembly budget committee will still need to approve each sub-committee’s proposal before being perfunctorily approved by both houses with the intent that the conference committee -- made up three budget committee members from each house – will reconcile differences between each house’s working proposals. The Legislature is supposed to finish working on its budget June 15th, but that has only happened five times in the past 40 years.
The fiscal year begins July 1 – a mere 30 days from now -- and there is no expectation that California will have a budget on time.

ACTIONS TAKEN FRIDAY

Below is a listing of major decisions made by the Assembly Budget Subcommittee on Health and the full Senate Budget Committee. For a full list of actions taken this year, click here.

* Direct denial of coverage to very low income working parents: Would have denied coverage to parents earning wages between $11,000 and $18,000 a year (for a family of three). A parent would need to work fewer than 100 hours a month in order to qualify. REJECTED by both houses.
* Quarterly Status Reports for children and adults: Would have required Medi-Cal recipients to report any changes in their life every three months. Currently, children only have to report annually, and adults every six months. MODIFIED by Senate to require reports every six months for both children and adults. REJECTED by the Assembly.
* Medi-Cal rate reimbursement: Approved earlier this year, will reduce reimbursements to Medi-Cal doctors by 10%. California already ranks near the bottom (43rd) on reimbursements for providers in this program. Both houses sought to restore this already-made cut: REDUCED to 5% reduction by Senate. REVERSED by Assembly.
* Reduced benefits for legal immigrants: Legal immigrants who currently receive comprehensive Medi-Cal benefits would lose all but four services: emergency, pregnancy, some long-term and cancer care. REJECTED by both houses.
* Monthly reporting for immigrants: Would require undocumented immigrants to establish their eligibility for limited emergency Medi-Cal services every month. REJECTED by both houses.
* Elimination of dental benefits for adults on Medi-Cal: Would have eliminated the ability for adults on Medi-Cal to receive cleanings, crowns, filling or other oral surgery unless a physician treated them. REJECTED by both houses.
* Eliminate vital services for Medi-Cal recipients: Adults would no longer be able to see an optometrist, fill eyeglass prescriptions, obtain hearing aids, get speech therapy, treat sores caused by incontinence, see a podiatrist, chiropractor, acupuncturist or psychologist. REJECTED by both houses.
* Require very low-income seniors to pay more for their health care: Would have required seniors who earn $1,100 a month to either pay $100 premium for coverage to see their doctor, or spend half their monthly income on healthcare. MODIFIED by both houses to continue to pay premium for enrollees who do not pay $500 a month for health services.
* Premium increase for some Healthy Families subscribers: Would have increased Healthy Families premiums between 27% and 77% for subscribers between 151 to 250 percent of the poverty level. MODIFIED by both houses to increase premiums by half the amount proposed.
* Co-payment increase for Healthy Families subscribers: Families between 151 to 250% of the poverty level would pay $7.50 (rather than $4) for “non-preventive’’ services, such as prescriptions, some emergency room visits, some doctors visits, eye exams and glasses, therapy and dental work. REJECTED by both houses.
* Capping Healthy Families dental benefit: Would limit dental coverage to $1,000 per enrollee. MODIFIED. Both houses increased the cap to $1,500.
* Shifting money away from public hospitals: Takes federal money used for public hospitals to pay for unrelated programs. REJECTED by the Senate. REJECTED by the Assembly.

No action, including the rejection of cuts in both houses, is final unless the final budget is approved and signed into law by the Governor. However, the actions to reject many of these cuts sets the stage for the budget debate this summer: whether to deny care and coverage to millions of Californians, or whether the state raises the revenue to prevent these cuts. That's the clear choice.

Health Access will continue to track budget actions on the floors and in conference committee during the budget season. For more information, contact the author of this report, Hanh Kim Quach at hquach@health-access.org

Labels: Budget, MediCal, SCHIPHealthyFamilies, Schwarzenegger, Updates

posted by Anthony Wright | Permalink | 1:01 AM


 

Keeping score, even though it's not a game...

Friday, May 30, 2008

A new HEALTH CARE BUDGET CUTS SCORECARD is now available on the Health Access website, at:
http://www.health-access.org/preserving/Docs/Health%20Access%20-%20BudgetScorecard%20053008.pdf

It details the various cuts, the impact on the budget, the number of people impacted, as well as the actions the Legislature took earlier in the year, and what the Assembly and Senate did today in their current deliberations.

We'll keep polishing it, but it's a useful side by side, especially as we head into conference committee and "Big Five" negotiations.

Labels: Budget, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 5:17 PM


 

Quarterly Status Report Debate

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


 

...but some key cuts made.

The Senate Budget Committee, chaired by Senator Denise Ducheny, rejected the major eligibility cuts to Medi-Cal, and the elimination of benefits. It is adopted semi-annual reporting for children and parents, the increase in premiums and co-payments in Healthy Families, and the cut to Healthy Families plans, and other cuts.

Again, more detail shortly...

Labels: Budget, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 10:51 AM


 

Rejecting the big cuts...

The Assembly Budget Subcommittee on Health and Human Services, chaired by Assemblywoman Berg, has just voted to reject the major eligibility cuts in Medi-Cal, the elimination of optional benefits, and even to restore some of the provider rate cuts made earlier in the year. This is very good, a clear statement that these cuts are too severe... a determination that prior Legislatures made about these same proposed cuts.

There are cuts that they are expected to approve: cuts to public and private hospitals in a couple of ways, county administration, a modified cut on Medicare part B premiums for some seniors, cuts to Healthy Families plan rates, an increase in Healthy Families premiums and co-pays, and a cap on dental coverage in Healthy Families.

More later...

Labels: Budget, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 10:41 AM


 

Why today matters...

Later today, both the Assembly and Senate budget committees will be considering and making decisions on many of the health care cuts proposed by Governor Schwarzenegger. And with that, the budget debate goes into full gear.

This is still an early stage: any decision made at this point can still be reversed. Given the massive deficit, and the major effort it will take to raise revenues, it is likely that cuts that the both the Assembly and the Senate agree with the Governor on are close to final. Yet the rejection of those cuts does not mean we can breath easy. Unless there are revenues or taxes to fill the gap, those cuts still loom as possibilities. So this is a day where we can't win, but we can surely lose.

However, while these are not final decisions, the actions made today in the Assembly and Senate are hugely important. The decision to reject health care cuts will set the stage for the budget negotiations. It will send the clear signal: some cuts are too severe, and we need to raise revenues to prevent those cuts. And then we have the debate, with those legislators who want a cuts-only budget, rather than a budget solution that includes some revenues or taxes.

It's important that the majority of legislators make this stand, so that the choice is clear, between denying children and parents health coverage, defunding doctors and hospitals, eliminating dental and other benefits, etc... and raising the revenues needed to prevent those cuts.

To follow along, here's a health budget cuts scorecard, which details the cuts impacting access to health care, and what their status is with the Governor, the Assembly, and the Senate. We'll update it after today.

We'll be posting through the day on the action.

Labels: Budget, MediCal, Uninsured

posted by Anthony Wright | Permalink | 9:44 AM


 

Hearings Hearings

Wednesday, May 28, 2008

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


 

By The Numbers

Wednesday, May 14, 2008

Gov. Arnold Schwarzenegger's budget will impact tens of thousands of Californians. Here's a compilation of the cuts and lives affected:

• Quarterly-status reports: 160,000 children; 15,000 adults impacted in 2008-09. Two-year total is 300,000 children impacted. Five-year total is 471,000 impacted. Requires families to justify every three months that their income has not changed. If they fail to do so, they would be dropped from Medi-Cal.
• Elimination of essential benefits, such as dental, speech therapy, eyeglasses and optometrist services and incontinence creams and washes.

1. Dental: 900,000
2. Optometrists: 214,000
3. Eyeglasses and Contact lenses: 457,000
4. Podiatrists: 85,000
5. Incontinence creams and washes: 66,000
6. Acupuncture: 33,000
7. Hearing aids: 28,000

• Seniors and Medicare premiums: Requiring some low-income seniors (earning, at most, $1,100 a month) to pay $97-a-month co-pay on for their Medicare coverage for doctors visits. 57,000 seniors affected.
• Low-income working families: Would deem families earning very meager wages ($1,500 a month for three people) too wealthy to qualify for Medi-Cal. Such a family would need to drop its income to $895 a month -- and work no more than 100 hours a month -- in order to qualify. Numbers of people affected by this are unclear. We do know that 429,000 adults with children are on Medi-Cal now. About one-third of those are single moms.

Labels: Budget, MediCal, Schwarzenegger

posted by Hanh Kim Quach | Permalink | 5:16 PM


 

The Quiet before the Storm

Tuesday, May 13, 2008

There's the steady drone of doom and gloom emanating from the Capitol, but Sacramento is collectively holding its breath, waiting for Gov. Arnold Schwarzenegger to release his updated budget proposal tomorrow in what's known in Capitol parlance as the "May Revise.''

This second version of the budget comes out a month after tax day, when the state has a better idea what kind of income it has to work with the following year ....and by all accounts, it has not been pretty. Estimates of the deficit -- which started at $14.5 billion in January -- are more like $16 billion to $20 billion now.

While the entire state budget is $140 billion -- the general fund, where we have the shortfall -- is $100 billion. That means the deficit is nearly one-fifth of our budget.

Accompanying the bad figures are equally as bad rumors: Cuts, cuts and more cuts. On the flip side, precious little in new income for the state.

For most of this decade, we have grappled with multibillion dollar deficits larger than the entire budgets of many of the states in the US. And what have we done? We've borrowed and cut.

And now, we're down to the bone. Many of you may recall -- and here's a reminder -- that the governor already proposed more than $1.1 billion in health program cuts, which will mean:

• 500,000 children losing health coverage over the next five years because the state will require that their families report every three months any changes in their life.
• People with disabilities, who live on (at most) $997 a month, could develop infections and sores on their body and other sensitive areas because they lose coverage for incontinence creams and washes.
• The poorest adults will lose their dental care -- and many with already poor dental health will not treat their cavities, develop gum disease, abscesses and possibly lose their teeth.

We will all know at 1 p.m. tomorrow what the total damage will be. But this we know -- There are only three ways to cut Medi-Cal:

• Reimbursement rates for providers -- Check. That was already proposed in January and approved by the Legislature months later to go into effect July 1.
• Benefits to recipients -- Check. See a couple of the bullet points above.
• Eligibility -- Quasi - check. Requiring families to justify their income every three months is a passive aggressive way to knock people off of the Medi-Cal rolls. The state is secretly hoping that families will be too overwhelmed, their life in too much chaos, they will lose or somehow fail to complete the form and send it in. Of course, that means 500,000 children won't get health care....

By process of elimination, a direct cut to eligibility is the only thing left for the state to do to the Medi-Cal program.

Let's cry ourselves to sleep and see what's in store for us tomorrow.

Labels: Budget, MediCal, SCHIPHealthyFamilies, Schwarzenegger

posted by Hanh Kim Quach | Permalink | 6:38 PM


 

A cuts-only budget harm knows no party...

Monday, May 05, 2008

The California Budget Project has an excellent resource on its website, showing the local impact of proposed budget cuts by county and by legislative district.

The county numbers are interesting, but you need to know the context of how big/small the counties are to begin with. (Alpine County has only 160 Medi-Cal recipients, and 2 children on Healthy Families; Los Angeles has 2.2 million on Medi-Cal, 250,000 kids on Healthy Families).

The legislative districts numbers are interesting because they are more comparable, having similar (although not the same) numbers in each district.

TOP FIVE DISTRICTS IMPACTED BY MEDI-CAL RATE CUTS: Five Senators have more than a quarter of a million constituents on Medi-Cal coverage--largely children, parents, seniors, and people with disabilities--who would lose access to key doctors and hospitals as a result of the proposed Medi-Cal provider rate cuts already adopted. These Senators would have hospitals and doctors in their districts lose over $50 million dollars in Medi-Cal funds.

These five (of 40 total) Senators are:
1) Florez (D-Fresno/Bakersfield): 306,820 on Medi-Cal; $62 million lost funding
2) Vincent (D-Los Angeles): 290, 260 on Medi-Cal; $59 million lost funding
3) Cedillo (D-Los Angeles): 278,180 on Medi-Cal; $56 million lost funding
4) Cogdill (R-Fresno/Ripon): 270,320 on Medi-Cal; $55 million lost funding
5) Ashburn (R-Bakersfield): 253,190 on Medi-Cal; $51 million lost funding

What's interesting about the list is the diversity. We have some districts from inner-city Los Angeles, but also the rural areas of the Central Valley. These districts are represented by Latino, African-American, and white legislators. And they are three Democrats and two Republicans: these budget cuts impact Republican and Democratic areas alike.

While California Republican legislators insist on a cuts-only budget, there are certainly many whose communities will be severely hurt by such a resolution to this budget crisis.

Republican Senators Denham and Runner also have lots of impacted constituents, with over 200,000 people on Medi-Cal in their districts. Of the eighteen (out of 80) Assemblymembers with more than 110,000 constituents with Medi-Cal coverage, eight are Republicans, including La Malfa, Aghazarian, Villines, Fuller, Maze, Runner, Adams, and Garcia.

TOP TEN DISTRICTS ON CHILDREN LOSING COVERAGE: So, as a result of the proposal to increase paperwork and administration burdens on Medi-Cal, here would be the top ten legislative districts that have the biggest number of children fall off coverage by 2010 and become uninsured: Florez (14,420); Vincent (14, 300); Cedillo (14,150); Calderon (11,760); Romero (11, 640); Cogdill (11,570); Ridley-Thomas (10,820); Ashburn (10,510); Padilla (10,490); Correa: (10,280). Again, a diverse crew in region, ethnicity, party, and ideology.

Unlike the other 3/4 of the Senate, these legislators each have over 10,000 children losing coverage as a result of the so-called "quarterly status reports." Sens. Denham and Battin also have high number of impacted children as well; in the Assembly, the list includes Berryhill, Aghazarian, Villines, Maze, Runner, and Garcia, who would have over 2,500 children lose coverage.

MAY REVISE AND BUDGET NEGOTIATIONS APPROACH. The California Budget Project has similar numbers for education, child care, and other programs. I haven't looked closely at those reports, but I imagine that my takeaway would still hold:

The budget crisis knows no bounds. Californians in both "red" and "blue" areas will get hit in a big way, whether cuts to schools, to child care, or to health care--where thousands and thousands of children and adults will have reduced access to doctors and hospitals, if not lose coverage altogether.

We need to come together to find an alternative to a cuts-only budget that would force such cuts.

Labels: Budget, MediCal, Research

posted by Anthony Wright | Permalink | 3:50 PM


 

Adding fuel to the fire...

Friday, April 25, 2008

Earlier today, Families USA released a short report about the proposed Medicaid rule changes put in place by the Bush Administration. They are projected to cost California more than $10.8 billion in federal funds over the next five years.

The report suggests that the cut in federal funding will, in fact, act like a giant anti-stimulus package. Those lost Medicaid funds will eliminate an estimated 46,700 jobs and an accompanying $1.9 billion in wages, and, even worse, cost the state an estimated $5.4 billion in lost business activity.

Virtually all that economic pain comes in the first year of implementation, when California would fail to receive approximately $2.2 billion in Medicaid payments. Titled “Bad Medicine,” the report analyzed the economic impact of seven new Medicaid regulations that were issued in 2007.

“The devastation caused by the Administration’s cuts will affect millions of people who rely on Medicaid for their health lifeline. This will be tragic for their families,” Ron Pollack, Executive Director of Families USA, said today.

“Additionally, these cuts will harm state budgets at the worst possible time. These cuts in federal Medicaid payments will have a ripple effect through state economies that are already struggling during this economic downturn. This economic harm will increase the number of people who may need Medicaid, as tens of thousands of Californians see their paychecks being cut or their jobs being eliminated.

“This lost business activity in California will hurt business and industry, and it will force governors and state legislators to make increasingly difficult choices about providing state services,” Pollack said. “This Bush Administration’s decision is ill-timed and ill-considered, and it should be reversed by Congress.”

There was also comments from our state's Medicaid director.

“The proposed changes to the Medicaid program would result in a significant and potentially devastating shift of costs to California taxpayers,” Stan Rosenstein, chief deputy director, California Department of Health Care Services, said today. “Our state would be saddled with an estimated $12 billion financial burden resulting from such a drastic change in how the federal government supports the Medicaid program. The Governor strongly believes that such changes should undergo further evaluation and a full congressional review before being implemented."

The seven regulation changes issued by the Bush Administration in 2007 – and imposed on states without congressional review or debate – restrict funding for a variety of Medicaid services, including rehabilitation services, school-based transportation, as well as Medicaid administrative services, such as outreach, enrollment, and case management. The seven rule changes are now either under a congressional moratorium or awaiting implementation.

Just a comment: On top of proposed cuts at the state level, these federal cuts by the Bush Administration would be a 1-2 punch for California patients, our health system, and our economy. These cuts would add fuel to the fire of our deteriorating economy, and our deteriorating health system, one that we all rely on.

We are happy that most (but not all) of our California Congressional delegation voted to delay these regulations, as Hanh reported below. These is the exact wrong direction for California and for health care.