Progress report

Wednesday, July 02, 2008

Ezra Klein has a good update on what's going on with the Massachusetts plan here.

Labels: OtherStates

posted by Hanh Kim Quach | Permalink | 12:57 PM


 

Healthy blogging...

Sunday, June 01, 2008

Those interested in health policy should be subscribed to the news summary that the Kaiser Family Foundation puts out on a daily basis. Now, those summaries will often include a health policy blog roundup, which will be another way to keep up-to-date. Here's several gold nuggets they found from panning the blogosphere about McCain's health plan:

Joe Paduda of Managed Care Matters examines presumptive Republican presidential nominee Sen. John McCain's (Ariz.) health care plan and whether it could increase the number of uninsured residents by destabilizing the employer-based health care system. Robert Laszewski of Health Care Policy and Marketplace Review builds off of Paduda's post to argue that McCain's market-based plan reforms might work well for some voters, as long as advisers present certain changes carefully. Bob Vineyard of Insure Blog reacts to a Slate article and discusses McCain's proposal to allow individuals to purchase insurance across state lines. Peter Harbage from the Wonk Room Blog discusses a new Center for American Progress Action Fund paper about McCain's health care plan and administrative costs.

Really good stuff there.

Don't forget the biweekly Health Wonk Review, which this week is hosted by Hank Stern at InsureBlog. We are listed in there with over a dozen interesting posts from around the web.

Finally, for those who prefer to read offline, our state-based colleagues at the Connecticut Health Policy Project have a blog of interest, CT Health Notes Blog, and have a recommended booklist for your summer reading.

Labels: OtherBlogs, OtherStates, PresidentialCandidates

posted by Anthony Wright | Permalink | 1:10 AM


 

Overcoming California's unique health reform hurdles...

Monday, January 28, 2008

Part of last week I was with many of my fellow health and consumer advocates in Washington, DC. I learned about all the good and promising efforts they were embarking on in states like Minnesota, Oregon, Ohio, Colorado, Illinois, Maryland, Pennsylvania, Washington, Maine, Vermont, and yes, my previous home states in New York and New Jersey.

They were using the progress that we made in California in their own efforts. In one blue state, advocates are pushing the most progressive legislator in their StateHouse to improve his nascent proposal on the employer contribution, to be more like what was agreed to by Assembly Speaker Nunez and Governor Schwarzenegger.

Our efforts, in short, have already been helpful to my colleagues in other states. I know other states are already borrowing some of the policy elements that were developed in this exhaustive process.

But it's cold comfort for Californians, now that the bill has stalled. What is the implication for my colleagues in other states?

With apologies to my New York background, if we could have made it here, we could made it anywhere. It would have been a boon to efforts around the country and in DC.

But there's reasons why the opposite is not true.

California has all the obstacles that seem to frustrate federal reform, but without the flexibility or financing ability.

* National health reform is hard because health care has an enormous number of stakeholders that are impacted by any change, and it's hard to get a consensus, especially in a country so large and diverse, both in terms of the on-the-ground infrastructure, and in terms of ideology. On health care, Washington, DC has been polarized on any solution (see the SCHIP debate), which has resulted in either neglect or gridlock.

* It is because of this gridlock that the states have taken the lead with their own efforts. And while states have clear jurisdiction and responsibilities in many health areas, state health reform is hard because there's contraints in policy and process: Medicaid rules, ERISA, and the biggest of all, the ability to finance the system overall. States have balanced budget requirements and it's harder to raise revenues. (Among other things, we don't have a Bush tax cut to repeal, as is the suggestion of many Democratic presidential candidates.)

A nation-sized state, California has the size and diversity that makes consensus hard (think Berkeley and Bakersfield, Orange County and Oakland), and has one of the worst problems, with Californians more likely to be uninsured than in all but five states. As we have said before, Massachusetts, with 10% uninsured, had to close a gap; California, with nearly 20% uninsured, has to jump a chasm.

So California has all the obstacles at the federal level, with all the obstacles at the state level, plus some of California's very own--in particular the 2/3 vote rule to pass any revenues in a legislators (a threshold only Arkansas and Rhode Island share) that empowers a solid Republican blockade against taxes; and the ballot-box culture of initiatives and referendum.

Yet in spite of all this--look how far we have come.

In the past five years, the legislature has passed four measures to dramatically expand health coverage--SB2; AB772; SB840; AB8. Until recently, it was the Governor that was the obstacle. The Assembly and the Governor agreed on a fifth proposal, AB x1 1, and now it's the Senate.

Despite all the obstacles, it's clear that political will can make it happen, from Senate President John Burton in 2003 to Assembly Speaker Fabian Nunez and Governor Arnold Schwarzenegger in this special session.

We just don't yet have the needed political will. But that is something we can build, and change, and make happen.

I cringed when some Democratic Senators in committee made comments about the Legislature--talking about themselves!--being unable to functionally monitor and make adjustments to a health reform if they are needed. There are clearly constraints with health reform, but that sounded like abdicating leadership. Finding an excuse, rather than solving a problem.

If I learned anything in the past five years, it is that reform in California is possible, but that it takes political will and leadership from multiple sources, a major effort to engage and mobilize Californians to demand and expect results, and that it also takes multiple efforts and time to make it happen.

This wasn't the first year of health reform, and it won't be the last. We'll see to it.

Labels: OtherStates, YearOfReform

posted by Anthony Wright | Permalink | 7:20 PM


 

More on Massachusetts, and comparing to California...

Tuesday, January 15, 2008

HEALTH ACCESS UPDATE
Tuesday, January 15, 2007

NEW ANALYSIS: PENDING CA HEALTH REFORM WOULD GO WELL BEYOND MA
* Fundamentally Different in Financing, Cost Containment, and Other Concepts
* Broader Benefit in Providing Premium Relief, Insurance Market Reform
* California's Proposals Learns Some of the Lessons from Massachusetts
* Senate Health Committee to Hear AB x1 1(Nunez) Next Wed, Jan 23rd, 9am

New on the Health Access WeBlog: LAO on the Budget; California in Health Wonk Review; A Single-Payer Supporter for AB x1 1; More on the SF Court Case; U.S. Health Rankings;


The Senate Health Committee, chaired by Senator Sheila Kuehl, has postponed the hearing considering AB x1 1 (Nunez), the current health reform proposal negotiated with Governor Schwarzenegger, as they await the analysis by the Legislative Analyst's Office. The hearing will now be next Wednesday, January 23rd, starting at 9:00am and is expected to last all day. The deadline for letters of support or opposition on the measure are due this Wednesday.

NEW MODEL: As the Senate Health Committee awaits a financial analysis, the California Health Care Foundation has released another analysis, showing the results of modeling of AB x1 1 and the related ballot measure. The report, by MIT Professor Jonathan Gruber, shows how 3.6 million Californians would have coverage under the proposal, mostly through expanded public programs, a new subsidized purchasing pool, and greater availability of on-the-job coverage. The report is at the Cal Health Reform website, at:
http://www.calhealthreform.org/pdf/GruberAnalysis011108.pdf

NEW ANALYSIS: Health Access is also releasing a new analysis today, comparing AB x1 1 (Nunez) with the recent reform in Massachusetts . This new comparative analysis shows that the pending California Health Security and Cost Reduction Act, AB x1 1 (Nunez), takes major steps in health reform far beyond the much-discussed Massachusetts reform of 2006.

A full copy of the 8-page analysis is available at the Health Access website, at: http://www.health-access.org/advocating/docs/2008CA-MAReformComparison%2001%2014%2008.pdf

The analysis, entitled "Health Reform in California and Massachusetts : Different from Start to Finish," concludes that AB x1 1 would provide a broader benefit to California consumers than what was passed in Massachusetts . In addition, the California proposal has a much more stable financing structure of significant new dollars to improve the state's health care system, and goes far beyond Massachusetts in trying to control health care costs.

The report lists "top ten" major differences between the California 's AB x1 1, and the health reform law, Chapter 58, passed in 2006. In contrast with Massachusetts, the California proposal includes:
1) New, Broader Financing, including a Tobacco Tax
2) A More Meaningful Employer Contribution
3) General Fund Protection
4) Significant Cost Containment
5) Subsidies up to and above 400% of the federal poverty level
6) Key Differences in the Individual Mandate, Affordability and Enforcement
7) A Transition to Guaranteed Issue
8) Medical Loss Ratios and Increased Insurer Oversight
9) Not Just a Connector, but a Negotiator
10) New and Improved Public Health Care Options

The report shows that while there are similarities in the framework, California's pending proposal goes far beyond Massachusetts in numerous areas. At the same time, even with their more limited reform, Massachusetts has taken the major step of covering over half of uninsured--over 300,000 people through public program expansions--in a short amount of time, and is on path to close the gap further. The biggest critique is that this success in signing up patients quickly has led to higher-than-expected general fund costs.

The report explains how the Massachusetts plan never raised significant new revenue--it mostly redistributed existing state and federal funds, and relied on new funding from the general fund. In stark contrast, the California proposal would raise $15 billion in new funding, to be in a lock-box protected from the general fund, and vice versa. The new funds raised are from a much more meaningful employer contribution, individual contribution, a hospital fee, significant new federal matching funds, reinvested savings from county and state governments, and a tobacco tax.

In fact, research into the history of the Massachusetts law shows the California's proposal is much more like the ballot measure originally proposed by the consumer and community advocates, which included significant employer contributions, middle-income subsidies up to 400% FPL, and a tobacco tax--none of which made it in the final Massachusetts package, but is included in the pending California plan. The study goes into the details of the different iterations of these measures.

The conclusion of the report is that Massachusetts and California start from different places, and the plans are different enough, that they will end up having different results. Critiques of the Massachusetts plan simply do not apply to California 's reform.

Again, a full copy of the 8-page analysis is available at the Health Access website, at: http://www.health-access.org/advocating/docs/2008CA-MAReformComparison%2001%2014%2008.pdf

To view other resources from the Year of Health Reform, visit our website,at:
http://www.health-access.org/advocating/2007_healthdebate.html.

CALL TO ACTION: With the new hearing time, letters are due into the Senate Health Committee TOMORROW, Wednesday, January 16th, in order to be included in the committee analysis.

Health Access California has sent a letter expressing support, while also seeking amendments to get clarifications on affordability and benefits. The letter is available on our website. Letters of support should be sent to the Senate Health Commitee at:

The. Hon Sheila Kuehl
Chair, Senate Health Committee
State Capitol, Room 2191
Sacramento , CA 95814
FAX: 916-324-0384

Advocates should also write letters to the individual members of the Senate Health Committee:

Senator Sheila Kuehl (Chair); Senator Samuel Aanestad (Vice Chair); Senator Elaine Alquist; Senator Gilbert Cedillo; Senator Dave Cox; Senator Abel Maldonado; Senator Gloria Negrete McLeod; Senator Mark Ridley-Thomas; Senator Darrell Steinberg; Senator Mark Wyland; Senator Leland Yee

Health Access will continue to provide updates on ABx1 1, the initiative and other health reform efforts, including late-breaking developments that will be posted on our blog, at:http://www,health-access.org/blogger.html

To view other resources from the Year of Health Reform, visit our website, at:http://www.health-access.org/advocating/2007_healthdebate.html.

This includes a new analysis, "Who Gets What Help?" so that California consumers can find out how they would be helped under the proposal in getting health coverage.
http://www.health-access.org/advocating/docs/ABx1%201%20Who%20Gets%20Help.pdf

Labels: OtherStates, YearOfReform

posted by Anthony Wright | Permalink | 10:37 AM


 

Mid-terms for Massachusetts...

Saturday, December 22, 2007

Community Catalyst, a national consumer advocacy organization we work with, published an end-of year analysis of the much-discussed Massachusetts reform, which provides a direct look and the successes and the shortfalls of that effort.

Entitled "Revisiting Massachusetts Health Reform: 18 Months Later," the report comes out just as the state has indicated that 300,000 people got covered--half of the state's uninsured. At the same time, it acknowledges some of the issues, including their lack of meaningful employer contribution and other questions about long-term financing.

While Massachusetts largely redistributed existing funding, California's proposed AB x1 1 raises significant new resources, so perhaps we've learned some lessons already. Health Access California will be putting out an analysis comparing the two state and the two plans in short order.

Labels: OtherStates, YearOfReform

posted by Anthony Wright | Permalink | 6:22 PM


 

We're not alone...

Sunday, November 25, 2007

The Kaiser Family Foundation has a new interactive map showing what other states are doing on health reform. It's a far cry from when California started this conversation in 2003, where only Maine was having a similar conversation...

Some quibbles: the description of California is short, and neglects key pieces of history and policy. And the map classifies the reforms in Massachusetts, Maine, and Vermont as "universal," which I understand has come to be shorthand for any sort of comprehensive reform package, but I don't think advocates in those states would say their plans are fully universal.

Still, it's useful to get a sense of what is being discussed around the nation...

Labels: OtherStates, YearOfReform

posted by Anthony Wright | Permalink | 8:43 PM


 

Getting educated from the Commonwealth...

Sunday, October 28, 2007

So I have a love/hate relationship with Massachusetts.

I am a Bronxite who roots for the Yankees, and I'm beside myself that the Red Sox are up 3-0 in the World Series. (Go Rockies!) But I have fond memories goingt to college at Amherst, and loved the formal close of our Commencement, with the banging of a large staff and the pronouncement: "God save the Commonwealth of Massachusetts."

On health policy, I was happy that Massachusetts helped focus attention on state reforms for expanding coverage, although I remind folks that California was one percentage point away a few years earlier, in 2003, with SB2 and Prop 72.

On the actual reform plan, it's not our place to support or oppose the MA plan, but we have produced both discussion papers and fact sheets that discuss the various provisions, and to make clear the major differences between our two states.

Even so, there is lots to learn from the discussion going on in Massachusetts. Our colleagues from Health Care for All Massachusetts (not affiliated with our board member Health Care for All California) have been liveblogging the deliberations of their "Connector" board, which makes for interesting, although wonky, reading. As expected, there's things that are working, and things that aren't.

It's odd that the Governor's health proposal seems oblivious to these discussions, especially with regard to the individual mandate (whatever you think of the concept). No condition or exemption based on affordability and availability? No simplification/standardization of the individual market that we are requiring people to go into? Exempting employer-based coverage from what constitutes "minimum coverage" for the mandate?

The Governor's proposal would benefit from a closer look at the consumer protections in the Massachusetts market (Health Access prepared a chart), and learning from their deliberations of what is working and what isn't...

Labels: IndividualMandate, OtherStates, YearOfReform

posted by Anthony Wright | Permalink | 9:40 AM


 

SCHIP Impacts in California...

Tuesday, October 02, 2007

Two good stories over the weekend spotlight the impact of the President's SCHIP veto to California. Bill Ainsworth in the San Diego Union-Tribune and Barbara Anderson in the Fresno Bee report that potentially hundreds of thousands of children wil lose coverage, as well as the wrench it throws into our health care reform debate.

Beyond making clear the scale of the disruption, I tried to make the point in my quotes in these articles that there should be political ramifications, especially for the 18 California Congressional Representatives from California that voted against SCHIP.

Today, according to the San Jose Mercury News and the Washington Post, California is joining several other states, including New York and New Jersey, in suing the Bush Administration about their unilateral efforts to restrict SCHIP.

Labels: Federal, InTheNews, OtherStates, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 10:26 AM


 

Who fought for their state?

Tuesday, September 25, 2007

It's disappointing SCHIP didn't get a veto proof majority. It's even more disappointing how little California was able to get there, compared to other similar states.

In the SCHIP battle, a few states have been targeted, namely New York, New Jersey, and California, as states that expanded their state child health insurance programs above the norm of twice the poverty level. All three started their programs under Republican Governors (Pataki, Whitman, and Wilson, respectively). And all three have lots of children on the program now, have a high cost-of-living and are thus justified in a higher eligibility level, and recognize that SCHIP reauthorization is a big deal for the state to draw down federal funds--not to mention the benefit of providing health coverage to the children of the state.

So how did we do compared to the other states that are particularly targeted? In comparison, California did poorly in getting our House Representatives to vote for the interests of their state.

Of our 19 California House Republicans, only one--Mary Bono--voted for the measure. (Another did not vote.)

In comparison, New Jersey had 3 out of 6 Republicans in a 13-member delegation vote for SCHIP. New York both had 4 out of 6 House Republicans in a 29-member delegation vote the interest of their state over their President. (To complete the tri-state area, Connecticut also meets the criteria above, and has only one Republican Congressman out of a 5-member delegation, and yes, he voted for SCHIP.)

For whatever reason, our counterparts in the Mid-Atlantic did a much better job in getting their Representatives to represent them, in bringing in federal funds and extending coverage to children. As a result of California's inability to produce the votes, we may have to have hundreds of thousands of children disenrolled from California's Healthy Families program shortly.

One would have hoped that the broad support of Republican Governors--including Governor Schwarzenegger--would have made more of an impact on the Republican Congressional Representatives. New York and New Jersey actually have Democratic Governors now, but they still were able to have some sway with their Representatives. So what's wrong with our delegation?

Labels: Federal, OtherStates, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 11:16 PM


 

What it looks like on the other side

Friday, August 24, 2007

As California moves toward health care reform ...oh -- in the next 3 weeks -- we had a visitor from a state that is in the middle of implementing it's health care reform from last year.

Jon Kingsdale, executive director of the Commonwealth Connector, which is the board in Massachusetts that is charged with implementing its health reform, gave us a glimpse of what life would be like once legislation was passed. They're in the first of a three-year process to implement the new law.
Kingsdale was in the Capitol today courtesy of the California HealthCare Foundation.

While the most highly publicized part of the Massachusetts reform legislation was the fact that it would require every citizen to purchase health insurance, the pieces of the plan that are furthest along -- at this point -- are the expansions in public programs. More than 70 percent of those that qualify for Medicaid are now enrolled; 75 percent of those qualified for subsidized health coverage have purchased coverage.

That means nearly 3/4 of Massachusetts residents who earn less than $41,000 (a couple) are in some kind of publicly funded program. If we transplant that rate of enrollment success to California, we'd be covering 2.7 million people!

Of course, we can't really compare Massachusetts to California -- on MANY levels.

Population- and coverage-wise:

• First, the entire state has 6.2 million people. That's FEWER people than California has in uninsured.
• Secondly, only 6 percent of its population was uninsured prior to reform, compared with California's 20 percent.

My colleague Beth has a great one-page fact sheet on how much more robust coverage in Massachusetts was before they began their reform, which includes the fact that more employers were providing coverage before reform (69.4 percent in MA compared with 57.7 percent in CA), and Medicaid spending was higher there ($5,400 per enrollee in MA versus $2,250 in CA)

Market-wise, we're in completely different places, as my colleague Anthony has written about before, MA providing more consumer protections than in CA.

But, in spite of the differences in regulation, population, politics, and coverage, one thing Kingsdale said resonated:

"Nowhere in the country does the non-group market work.''

Translated: the market where poeple must go out and search for coverage on their own without an employer or public group is a wreck, which says to me that any attempts to rely on the individual market to diminish the number of uninsured, or shrink group markets by thrusting people into the individual market is a bad idea.

Labels: OtherStates

posted by Hanh Kim Quach | Permalink | 11:39 AM


 

Jersey Devils...

Friday, July 20, 2007

It's astounding that the debate on the State Child Health Insurance Program (SCHIP) has gotten so polarized, with President Bush campaigning against it. This is a program that has been bipartisan since its beginnings, passing a Republican Congress, including one led by former Speaker of the House Newt Gingrich.

The talking points by President Bush and some Republicans legislative suggest that the program has gone well beyond its original intent, covering children above twice the federal poverty level, and parents as well. Even some supporters of expanded SCHIP tell their conservative colleagues that SCHIP reauthorization is a way to reign in states.

The poster child for this bad behavior is New Jersey, and I now I must confess my role. I ran the state health consumer advocacy coalition when working at New Jersey Citizen Action, when we were able to win expansions of coverage for:
* children up to 350% of the federal poverty level (around $60K for a family of 3), and
* their parents as well, up to 200% of the federal poverty level ($34K for a family of 3).



This goes well beyond what most other states have done, including "left-coast" California, which only covers children up to 250% of the poverty level ($43K for a family of 3), and is currently proposing to go up to 300% ($52K for a family of 3) as part of broader health reform. [California did approve but never implemented a parent expansion.]

But it wasn't just me and the various children's, consumer, and community groups in support of this conspiracy of New Jersey devils toward "government-run health care for every American," according the President Bush.

The New Jersey Legislature that approved these changes was a Republican Assembly and a Republican Senate. The Governor was Christie Todd Whitman, a blue-blood Republican that President Bush thought highly enough of that he included her in his Cabinet the next year.

How times have changed.

Labels: Federal, OtherStates, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 12:19 PM


 

Just above Tennesee and Alabama.

Monday, June 18, 2007

The Commonwealth Fund put out state rankings, based on a Scorecard of Health System Performance. Interesting data.

California's profile is here. And it's not good: 39th overall. 44th in "Access." 50th(!) in "Quality." The national report indicates there's a correlation: "insurance matters." Either way you look at it, there's a lot to work on here.

We do well on the "Healthy Lives" indicator (3rd), although that may be related to the relatively younger mix of California's population.

Labels: OtherStates, Research

posted by Anthony Wright | Permalink | 4:22 PM


 

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

Thursday, May 24, 2007

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

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

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

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

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

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

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

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

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

Labels: BlueCross, GuaranteedIssue, Insurers, OtherStates, Research

posted by Anthony Wright | Permalink | 3:44 PM


 

WWJD? in PA? in CA?

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

Labels: InTheNews, OtherStates

posted by Anthony Wright | Permalink | 1:42 PM


 

"Unintended consequences" of BlueCross' ad campaign

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

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

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

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

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

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

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

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

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

We'll have more later in the day.

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

posted by Anthony Wright | Permalink | 11:01 AM


 

The health debate goes multimedia...

Sunday, May 20, 2007

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

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

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

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

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


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

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

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

Labels: Hospitals, InTheNews, OtherBlogs, OtherStates

posted by Anthony Wright | Permalink | 10:50 PM


 

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

Friday, May 18, 2007

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

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

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

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

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

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

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

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

Labels: Hospitals, InTheNews, OtherStates

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


 

Arnold's day...

Tuesday, May 01, 2007

We hear that now that the prison issue has come to some resolution, the Governor is re-focusing on health care reform.

John Myers at KQED Capitol Notes suggests his day today has a significant health care theme:


Fly On The Wall: Most political reporters would love to be at two unusual events today on Governor Schwarzenegger's schedule... both of which are private meetings.

This afternoon, the guv is speaking to a meeting of the California Restaurant Association and, we're told, taking questions from those in attendance. The topic: Schwarzenegger's health care reform ideas. That's a proposal about which the restaurant industry has been quite vocal about its unhappiness, especially on the governor's call for new health care mandates on employers.


Let's remember that it was the fast-food and chain restaurants (McDonald's, Yum Brands, Outback Steakhouse, etc.) that were the bulk of the opposition to Proposition 72, raising around 70% of the funds against that proposal.

But also check out the other item on the Gov's agenda:


Later this afternoon, the governor is scheduled to meet here in Sacramento with GOP presidential candidate Mitt Romney. While the two have spoken on the phone before, the governor's aides say this is their first face-to-face chat. Romney has been working hard in recent weeks to plant his flag on the conservative side of the GOP universe for the coming primary... a place that Schwarzenegger seems to have taken off his political map. By the way, Schwarzenegger is also scheduled to attend Thursday afternoon's GOP presidential debate at the Ronald Reagan Library in Simi Valley.


Gov. Mitt Romney was supposed to be at Gov. Schwarzenegger's "Health Care Summit" last year to present the plan he signed (and partially vetoed). He couldn't make it, and he sent his Secretary of Health (who I sat next to). You would imagine health reform would be a big discussion point for their first meeting. But since then, Gov. Romney has been suspiciously quiet about health reform in his home state during his presidential campaign.

He doesn't want to own the individual mandate, nor the costs of the private market plans, nor other elements he insisted on. Yet he also doesn't want to highlight what many would consider the good aspects of the Massachusetts plan, including more than a 100,000 people getting coverage--through the expansion of public programs.

Maybe they will talk about the weather.

Labels: Employers, OtherBlogs, OtherStates, Schwarzenegger

posted by Anthony Wright | Permalink | 5:32 PM


 

Building blocks ...

Monday, April 30, 2007

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

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

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

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

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

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

Labels: Bush, Federal, InTheNews, OtherStates, SCHIPHealthyFamilies

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


 

Grading on a curve

Saturday, April 21, 2007

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

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

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

Labels: MediCal, OtherStates, Research, YearOfReform

posted by Anthony Wright | Permalink | 11:14 AM


 

The dreamers, the lawyers, and me...

Wednesday, April 18, 2007

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

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

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

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

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

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

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

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

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

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

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


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

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

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

posted by Anthony Wright | Permalink | 6:49 PM


 

Wonks, Flacks, and Hacks

Tuesday, April 17, 2007

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

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

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

Labels: Kuehl, OtherBlogs, OtherStates, SB840, YearOfReform

posted by Anthony Wright | Permalink | 4:42 PM


 

The Connector vs. The Terminator

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

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

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


From "The Connector" in Massachusetts:

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

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

Labels: Affordability, IndividualMandate, OtherStates, Schwarzenegger, Uninsured

posted by Anthony Wright | Permalink | 3:46 PM


 

Health Care for children

Sunday, April 15, 2007