We live to fight another day for drug discounts...

Friday, May 23, 2008

Wednesday morning, without taking testimony, the Senate Budget Subcommittee chaired by Senator Elaine Alquist, with Senator Alex Padilla concurring, voted to eliminate funding for the drug discount program.

At noon time, I came back to the office and looked at the blog post by my colleague, Hanh Quach, with that wonderful picture of Governor Schwarzenegger signing the bill, framed on either side by supporters including Anthony Wright, Health Access executive director, and Assembly Speaker Fabian Nunez, who stepped down from that position a week ago yesterday.

I found it hard to believe that only a week after Nunez had stepped down as Speaker, the Assembly would just agree with the Senate and eliminate funding for the drug discount program that every article on his tenure as Speaker cited as one of his major accomplishments.

At 1:30pm, I found out I was wrong. The Assembly Budget Subcommittee convened and we discovered that they too planned to eliminate funding, in the technical language of the legislature, “conforming” to the Senate action. Things can move quickly around the Capitol.

I noticed that somehow the drug companies had found out that they were about to win a delay in this program that they had fought so hard to stop—I saw several of their lobbyists in the back of the hearing room.

Fortunately, the Assembly Budget Subcommittee allowed public testimony. Bill Powers, advocate for California Alliance of Retired Americans (CARA), and I spoke. I pointed out that Health Access had sponsored a ballot measure that Pharma spent $80 million to defeat and that the law was a compromise based on the Legislative Analyst Office (LAO). Consumers and labor supported the law, Pharma bitterly opposed. I said we strongly opposed not funding the program.

Bill Powers spoke about the travesty of the Medicare drug program where Medicare cannot negotiate prices with the drug companies. He pointed out that the State of California negotiates with drug companies for both Medi-Cal and for this new program for the uninsured. Medi-Cal gets very good prices from the drug companies—that is why they opposed this new discount program. If we don’t get the new program, Bill said, we will never know for sure how much we can benefit the uninsured.

And rare in what all too often feels pre-scripted, Assemblymember Patty Berg, the Budget Sub chair, moved to hold the item open, postponing action to another day. The Democrats present, Assemblymembers Jim Beall and Ed Hernandez, concurred. I was so relieved I forgot to notice what the Republicans did.

So we still have a chance to win. But it is a slim one. At any time, the Assembly could agree with the Senate and consumers will be out of luck on drug discounts and the drug companies will have won through the backdoor because of the bad budget year. It seems a poor tribute to the work Speaker Emeritus Nunez has done on health care.

Labels: Budget, Drugs, Nunez, Perata, Schwarzenegger

posted by Beth Capell | Permalink | 10:13 AM


 

A coda on confirmation...

Wednesday, February 27, 2008

By the way, Secretary Dale Bonner was confirmed today by the Senate Rules Committee.

But not before several Senators asked a series of tough questions about his oversight over the Department of Managed Health Care. This was part of a wide-ranging hearing that reflected the broad scope of the department, from housing to transportation issues as well.

Senator Padilla asked about the level of fines levied at Blue Cross and other insurers over rescissions, and said he's "not convinced [they] get to the level of deterrence needed" and that he's thinks that "all of the players have not gotten the message." After being asked about how the Department is made aware of consumer complaints, Bonner stated "I don't think [the Department] is sufficiently pro-active."

Senator Padilla also asked about the letter by Senate Health Committee Chair Kuehl expressing concern that the timely access regulations adopted are not reflecting the will of the legislature. He ask about the Department's adoption of new regulation that allow the health plans to set their own standards: "that sounds a little permissive to me." He made the argument for such clear, enforceable standards. "We know that justice delayed is justice denied. Well, health care delayed is health care denied," and he pointed out the additional costs and burdens that such delays place on emergency rooms. Padilla also asked about the implementation of language access regulations. Bonner stated that he thought the implementation of language access is "all over the map," and that "I don't believe we have enough coherency" with regard to the goal of language access.

Senator Ashburn asked about the appropriateness of Blue Cross' letter to get doctors to reveal information to the insurer that would get patients retroactively denied. Bonner stated that he didn't read the infamous letter himself, but that he recognized "the discomfort in anything that interferes in the doctor-patient relationship," and he thought Blue Cross' restraction of the letter "confirms that there was a serious problem." asked more specifically about the actions that Bonner took with regard to the issue, including any conversations with DMHC Director Cindy Ehnes. He said he hadn't spoken with her directly, but did through staff, and was satisfied that there was a investigation underway. Later, Senator Perata followed up Ashburn's scolding, saying "you should have seen the letter, and you should have been all over it."

Senator Perata also agreed about the need for more responsive DMHC. "This isn't an academic exercise, for those who are in trouble with their HMO, someone who is being horsed around." Senator Perata also urged higher fines: "you have to put a sharper point on it," he said, and later, "fines are a real attention getter." Senator Perata even asked if the DMHC should be in his far-flung Business, Transportation, and Housing Agency. Bonner indicated that it should, given the kind of expertise it regarding business oversight and solvency issues.

Consumers groups like Health Access California and Western Center on Law and Poverty were there, not to oppose Bonner's confirmation, but to make clear our concerns about how the Department is abdicating their responsibilities to the industry they are supposed to be overseeing.

Senator Cedillo followed up on the language access issue and making sure people have notice of their rights under the law, saying "this is an absurdity. You don't know you have a right unless someone communiciates it to you. If you don't know it, it doesn't exist.... It's the law. The Escutia law is the law." Senator Perata suggested that Bonner didn't want former Senator Escutia coming back to ask questions.

Secretary Bonner was confirmed, but promised to reach out to stakeholders, including consumer groups, to deal with these issues and the other issues presented.

Labels: DMHC, Perata, TimelyAccess

posted by Anthony Wright | Permalink | 8:44 PM


 

Condolence of sorts

Monday, January 28, 2008

Sen. Perata has posted a letter on his website on his house' decision.

Labels: Perata, YearOfReform

posted by Hanh Kim Quach | Permalink | 3:54 PM


 

Creeping Costs....

Tuesday, September 18, 2007

Lots of press last week made a big deal of the fact that health care premiums were inching up 6.1 percent, rather than the usual gazillion percent of years past. Some even gave passing mention to how consumers were paying more out-of-pocket.

But a close look at the KFF-HRET 2007 Employer Health Benefits Survey gives us a good view of exactly how much out-of-pocket costs are creeping upward.

Many, rightly, fixate on deductibles. For instance, in 2000, only 1 percent of workers had deductibles higher than $1,000; now 10% of workers have deductibles at that level.

Deductibles are part of the picture, but not the whole thing.

This year, for instance, the survey started tracking separate "hospital'' deductibles that consumers would have to pay, on TOP of their regular deductibles. More than half of plans are now imposing those fees. Some plans have also started imposing separate prescription drug deductibles, but that's not reflected in this year's survey -- yet.

Another interesting finding -- we're getting nickled and dimed to death by co-pays. Just three short years ago (2004), 68% of patients had copays of less than $15; now 45% have copays at that level. Meanwhile, in the same period, the number of people paying between $20-$25 per visit nearly doubled.

As we head into Round two of health reform in California, let's not forget about these pesky out-of-pocket costs. Assembly Speaker Fabian Nunez and Senate Leader Don Perata wisely added -- at the last minute -- language in their AB8 that would limit consumers' out-of-pocket costs. Let's make sure it stays that way.

(And 'Hi.' I've been neglecting this for a bit, but now I'm back on.)

Labels: Affordability, InTheNews, Nunez, Perata, Underinsurance, YearOfReform

posted by Hanh Kim Quach | Permalink | 2:33 PM


 

Fact Check on AB8

Monday, September 10, 2007

The state Senate just concluded debate on AB8, which passed 22-17.

(Aside: All Republicans and Sens. Lou Correa, D-Anaheim, and Sheila
Kuehl, D-Santa Monica voted against the bill. Correa is the only Democratic
lawmaker to oppose any health reform measures this year.)

The bill now heads to the Assembly, where I'm sure all 80 lawmakers will want to get up and speak. Lest they planned to crib from Senators, I wanted to set the record straight on some of the erroneous statements made by their colleagues in the red-wing of the Capitol.

Myth: "I cannot remember a bill -- either minor or major -- that comes before the Legislature without any organization in complete support,'' (Sen. Sam Aanestad, R-Grass Valley)

Fact: Last week, AB8 underwent substantial amendments that dealt with controlling the rapidly increasing health care costs, and affordability of health coverage for consumers. After amendments on both those issues surfaced, a number of strong consumer voices -- such as Consumers' Union, Health Access, CalPIRG, AARP, Congress of California Seniors, Service Employees International Union, California Labor Federation, AAFSME and ACORN and other groups moved to support the bill.

Myth: "This plan does nothing to contain costs.'' (Aanestad). Sen. Dave Cox, R-Fair Oaks, also alluded to this.

Fact: Amendments added to the bill last Wednesday directly address the issue of cost containment -- something that the It's OUR Healthcare coalition has been asking for all year. We recognize that without without controlling costs, any health reform efforts would collapse under the weight of increasing health care expenses.
Cost containment provisions include:

• Preventing Californians from getting sicker by helping patients to affordably control chronic diseases. Asthma, diabetes and heart disease are among the biggest cost drivers in health care. Preventing and maintaining these diseases keep patients from getting sicker, and costing more money to treat. This means reducing co-pays and cost-sharing for doctor’s visits, lab tests and medications. High cost-sharing deters patients from seeking the necessary treatment and care for their diseases, causing their conditions to worsen.
• Requiring public reporting on health care costs, and the quality of services. By publicly reporting how well – or poorly – doctors, hospitals and other providers perform health care procedures, providers would be driven to improve quality, thereby saving lives and saving health system dollars. Better information on quality and cost can allow purchasers and consumers effectively purchase care that gives them value for each dollar they spend.
• Requiring the adoption of health information technology. Electronic records could help reduce costly errors due to poor handwriting, unclear instructions and other human errors. Technology could also help cut down on administrative costs.
• Reining in prescription drug costs. Prescription drug costs climbed an average three times higher than the rate of inflation from 1994 to 2006. AB8 allows the state to combine with other public entities and trust funds to create a purchasing program for prescription drugs, using the power of a larger group to help leverage lower prices for prescription drugs.
• Creating a public insurer that would compete for business with private insurers to help drive down costs. The public insurer, built on the foundations of California’s existing local initiatives, county-organized health systems, public hospitals and community clinics, would give Californians the option to obtain coverage from a publicly owned entity, such as a municipal utility.

Myth: Sen. Aanestad, in his speech on the Senate floor opposing AB8, also said the bill was "modeled on the Massachusetts plan.''

Fact: While AB8 certainly share certain features with the Massachusetts plan, one missing provision is glaringly obvious: the absence of an individual mandate. AB8 does not require anyone to have coverage if they can't afford it.
Here's how it would work: workers would be required to take up health coverage IF their employer pays for it and IF -- BIG IF, HERE -- the cost of health care (that includes premiums and out-of-pockets costs) does NOT exceed five percent of a worker's wages. That means a worker earning $41,000 a year would not have to pay more than $2,050 in premiums, co-pays, co-insurance and deductibles.

Labels: CostContainment, InTheNews, Perata, Republicans, YearOfReform

posted by Hanh Kim Quach | Permalink | 3:19 PM


 

The news from the Capitol...

Assembly Speaker Fabian Nunez and Senate President Don Perata announced at a news conference today that they planned to take up the newly amended AB8 -- which Health Access supports -- on both floors today.

Stay tuned for a long session. My colleague Anthony posted details of the new amendments on Friday and attempts to dispel some of the misinformation that is floating around out there about the new AB8. ..

Labels: InTheNews, Nunez, Perata, YearOfReform

posted by Hanh Kim Quach | Permalink | 11:03 AM


 

Liveblogging legislative leaders...

Saturday, August 11, 2007

I wasn't able to go to the big SB840 rally in Los Angeles, but while in Sacramento, I stopped by the CaliforniaSpeaks electronic town hall. I was an official observer, but prevented from interacting with the participants or otherwise expressing an opinion.

Noteworthy was the quick few-minute speeches from the elected leaders, which featured Governor Schwarzenegger in Los Angeles, Senate President Pro Tem Perata in Oakland, Assembly Speaker Fabian Nunez in Los Angeles, and Assembly Republican Leader Villines in Fresno. (Senate Republican Leader Ackerman was invited but did not attend.)

The Governor ticked off several many of the reasons for health reform, "this extremely important discussion" to "fix the broken health care system": 6.5 million uninsured; the "hidden tax" on the insured; health cost increases; overcrowded emergency rooms; "job lock"; financial insecurity, where many are "one long hospital stay away from filing personal bankruptcy." But he said, "I alone cannot do it. This is the year of health care reform, but now we have to work together.... This is not a political issue. It is an issue of what is best for the people."

He warned, in a particularly pointed statement, that "there are people out there, they don't want that to happen, who want to hold on to the status quo. As a matter of fact, there are politicians in Sacramento that are holding up the budget so they don't want to go into health reform... It is inexcusable for someone to hold up the budget in order to make health care reform suffer because of that."

Senator Perata was clear that "we have had many years of discussion... we have done everything but resolve to solve the problem... after today, what we must have is legislative action." He implored that "legislators must hear from you." He said "whether it is AB8 or single-payer, we must act. Inaction is not acceptable. It is the legislature's responsibility to act. If we do not act, we will once again witness in this state an expensive initiative shootout among different interest groups in this state, who will take it upon themselves to do what the legislature should do. If the legislature wants to be relevant, if we are going to provide leadership, we must act by the end of the legislative session, to put a bill on the Governor's desk... to make next year better than this year for those in dire need. Thank you for joining the battle."

Speaker Nunez, in his talk, mentioned that "I think we all can agree that no issue come as close to health care when we look at the needs of Californians." He recounted that "As a young man, I did not have health insurance myself," and how his father, who had two jobs, "if he ever felt ill, he had to figure some home remedy" when he got sick. He said that, "in the absence of real action at the federal government and Congress...we in California are going to stand firm, and are totally committed for delivering health care and reforming health care for each and every Californian in this state." While he mentioned that everyone will "to do their share" including employers and workers, although he said, "I fundamentally believe that I cannot require you to have health care insurance if there isn't a premium out there that is affordable to pay." He also said that "health insurance companies gotta step up... they are the ones that are milking the health care system today." Finally, he committed that "the legislature will agree to a health care package. California deserves nothing less..."

Assemblymember Villines also gave a personal perspective, "I've been a small businessman, that provided health care coverage," and who struggled to pay for it, but continued to do so. He also indicated that, "I've also had a child who had a pre-existing condition," and has to pay for expensive COBRA so that the child didn't lose access to coverage. He also pushed for health reform, "This year, it is a goal... California should do what California always does--lead." He was more specific about this proposals, including those that would "maximize choice", but "without raising taxes, and without a faceless government program that won't be there." He proposed that California's effort won't be like other states, or other countries, but still provide the opportunity to lead.

I'll post more later. To see a little from the electronic town hall, go to a new website that Governor announced today, at:
http://www.fixourhealthcare.ca.gov/

Labels: Legislation, Nunez, Perata, Sacramento, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 10:44 AM


 

A full report on a long hearing on a big topic...

Thursday, July 12, 2007

HEALTH ACCESS UPDATE
Wednesday, July 11, 2007


AB8 (NUNEZ/PERATA) DEBATED, PASSED IN SENATE HEALTH COMMITTEE
* Hundreds of health advocates storm Capitol to support reform efforts this year
* Amendments taken, debated; Many specific issues raised
* Stage set for legislative negotiations with Governor Schwarzenegger
* Other bills of interest to health advocates considered

New on the Health Access WeBlog: New Studies; New Posts; New York and Other States Pursue Reforms; New Website at www.SickOfBlueCross.com


With the deadline for bills to pass committees coming at the end of the week, the Senate Health Committee, chaired by Senator Sheila Kuehl, heard testimony and voted on over two-dozen bills late into Wednesday evening.

The first bill heard was the most far-reaching, AB8(Nunez/Perata), the joint health care reform proposal by legislative leadership, which is expected to be the vehicle for negotiations this summer with Governor Arnold Schwarzenegger, who put forward his own proposal at the beginning of the year.

Speaker Fabian Nunez and Senate President Pro Tem Don Perata presented their new, unified AB8, and as expected, got all seven Democrats on the committee voting for the bill. The bill needed six votes to pass.

Hundreds of health advocates and consumers from the “It’s OUR Healthcare” campaign turned out at Wednesday’s hearing to urge passage of health reform, this year, and also to make press for additional provisions about affordability, cost containment, and other issues.

THE BILL: AB8 would provide more security to those with insurance, and expand coverage to 3.4 million Californians who are uninsured. Nunez described the bill: “It is based on the principle of shared responsibility between government, individuals, and employers. The key components are the following: major reforms for the insurance industry, expansion of public insurance programs, key measures to contain the cost of health care, measures to improve and reward health care quality, and provisions that will improve the private health care market.”

AB8 would expand public insurance programs to children and parents up to 300% of the federal poverty level ($30,000 for an individual, $62,000 for a family of four), and remove many of the administrative barriers to enrollment to Medi-Cal and other programs, such as the assets test, depravation test, and semi-annual status reports.

It would set a minimum employer contribution to health care of 7.5% of payroll, and also provide new option for employers to pay such a fee to a statewide purchasing pool that would provide coverage for all their workers. Such a pool would be funded by employer contributions, worker contributions, reinvested state savings, federal matching funds, and new use of federal and state tax breaks.

The bill would makes reforms to insurance market, including a minimum medical loss ratio so that 85% of premium dollars go to patient care, and more protections for mid-size employers and purchasers. With AB2(Dymally), a companion bill which also passes the committee, the reforms would prevent insurers from denying all but 3-5% of consumers because of their health status, and would fund a high-risk pool to provide better access to coverage for those with “pre-existing conditions.”

Saying he didn’t want to “oversell” the bill, Assembly Speaker Fabian Nunez acknowledged that the bill was still a “work in progress.”

“While this is not a perfect plan, we believe it is a thoughtful plan that will help pave the way for comprehensive reform,’’ he said. “…Clearly there is no greater issue of state interest or urgency that we can be working on today than improving on our fragile health care system. This is a rare opportunity we have….we need to act now. We need to take advantage of the opportunity we have before us.’’

Senate President Don Perata said it was important to move AB8 this year, but indicated that his preference was a national solution. “There’s no doubt that we ought to have a national health care program… It’s scandalous that a country like ours is woeful in the way it treats and responds to people who are in ill health,’’ he said. “Until that day comes, California must provide leadership, not unlike what we did with AB32,” last year’s global warming bill.

AMENDMENTS DEBATED: In preparation for the committee and at the hearing, Speaker Nunez took a range of amendments suggested by Kuehl’s Health Committee. However, Nunez said he could not, at this time, accept the committee suggestion -- which consumer groups supported -- that total health care costs (including premiums, deductibles and other out-of-pocket costs) be limited to 5 percent of a family’s income. Right now, under AB8, only families in the purchasing pool under 300% of poverty ($62,000 for a family of four annually) are guaranteed to not have to pay more than 5% on just their premium.

“We’re still working on many aspects of the bill…that’s not to say that Sen. Perata and I are not committed to making sure that as we more fully develop the bill, that we can allow people to purchase an affordable plan.” he said. “Particularly if you are going to require them to have insurance, we believe it is our obligation and our responsibility to be able to make available to them a health care product that is affordable. Otherwise, it is not good government to impose upon people, to have a requirement, and not be able to provide them with a health insurance premium that when they pay [with] their our-of-pocket share, is [not] going to cost them more that what [they need] to keep a roof over their head.” Nunez later said that while he “would love nothing more” to place a cap on costs for all consumers, he could not commit to it at the moment because he wasn’t sure if there would be enough money to do that.

Kuehl urged that in negotiations with the Governor, to include the concept of “affordability.” She pointed out that Massachusetts did exempt individuals from a requirement to get coverage if that coverage wasn’t “affordable.”

Nunez also did not accept amendments that would have established minimum package of benefits for private group coverage, with regard to preventative care and cost sharing. AB8 does have a basic HMO benefit (Knox/Keene and prescription drugs) in the purchasing pool. Nunez responded that AB8 does establish three standardized products in the overall private market, to help consumers better make comparisons between plans, allowing for “apples to apples” comparisons.

STAKEHOLDER VIEWPOINTS

Sen. Elaine Alquist, a proud co-author, started discussion by raising the hope for additional cost containment provisions, to make it easier for purchasers of health care to shop for care based on cost and quality, to make the statewide purchasing pool as big as possible, and to consider allowing county public insurers on the market compete with private plans to help drive down costs.

Assembly Health Committee Chair Merv Dymally also made a quick comment, commenting on eight town hall meetings, where there was support for both AB8 and SB840, Senator Kuehl’s bill. He referred to the long line of Governors since Earl Warren in 1945 that have confronted health care issues, and hoped that this year’s efforts would be more successful.

The committee took nearly an hour of testimony from parties who were watching the bill. Comments on the bill fell into the following categories – Support, Support if amended, No position, and Opposed.

SUPPORT: The 100% Campaign (made up of three children’s groups) and PICO California expressed their support for the measure, as part of their long-standing goal of covering all California ’s children, as well as their support for broader reform.

SUPPORT IF AMENDED: These stakeholders included the California Labor Federation, Health Access California, and the Its Our HealthCare coalition, Western Center on Law and Poverty, Service Employees International Union, Congress of California Seniors, Consumers Union, American Federation of State County and Municipal Employees, National Multiple Sclerosis Society, California Medical Association, Latino Issues Forum and Having Our Say Coalition, Blue Shield of California, Kaiser Permanente, California Primary Care Association, AARP, ACORN, California Black Health Network, California Pan Ethnic Health Network, Jericho, CALPIRG, California Optometric Association, California Chronic Care Coalition, TMJ Society, American Diabetes Association, Alzheimer’s Association, California Academy of Family Physicians, and the American Cancer Society.

Many consumer and community groups appreciated many of the provisions of the AB8, from the statewide purchasing pool to the expanded public programs to the increased access for those with “pre-existing conditions.”

Consumers groups echoed similar requests, asking for assurances about affordability for consumers, both for premiums and out-of-pocket costs, and offered several cost containment suggestions, including oversight of rate increases, creation of public insurers to compete with private plans to drive down costs; bulk purchasing of prescription drugs, and the ability for health purchasers to have more transparency for what they’re paying for. Given the larger role for the Managed Risk Medical Insurance Board (MRMIB), some also asked that lawmakers review how the board is structured and governed.

Other advocates and lobbyists called for coverage and access for childless adults without children at home, due process protections for those in the Medi-Cal expansions, consideration for adequate health care workforce and facilities and primary care capacity, specific provisions on prevention of health problems and medical errors, cultural and linguistic access for patients, and increased Medi-Cal provider reimbursements.

Many patient groups urged full “guaranteed issue,” and some said they would support an individual mandate to reach that goal. Health plans Blue Shield and Kaiser Permanente also announced their tentative support for that position, saying they if they were required to offer coverage to everyone, all Californians should also be required to have coverage.

CONCERN/NEUTRAL: Senator Kuehl allowed brief comments by groups without positions, including the California School Employees Association and California Association for Hospice Care.

OPPOSITION: The list of opponents, both those seeking amendments and those implacable in their position, included the National Federation of Independent Businesses, California Small Business Association, California Hispanic Chamber of Commerce, California Association of Health Plans, California Manufacturers and Technology Association, California Chamber of Commerce, California Farm Bureau Federation, California Restaurant Association, California Association of Health Underwriters, Aetna, Cigna, Protection and Advocacy Inc., National Association of Insurance and Financial Advisors, Association of California Health and Life Insurance Companies, Coalition to Advance Health Care Reform, the California Nurses Association, and a few business owners.

Several business organizations expressed opposition to the minimum employer contribution. NFIB cited a study they released this week that predicted job loss, increased costs, and lost sales. (A study released yesterday by UC-Berkeley debunked that notion, predicting a “net positive” economic impact.) Many opposed the notion that the assessment was a fee, rather than a tax. Others argued for cost containment and “fiscal discipline” measures, and expressed fear that the fee on employers would go up. Restaurant, grocer, and farm representatives argued that their industries would be especially impacted. Some wanted exemptions for small or low-margin businesses.

Health underwriters disputed that a large purchasing pool could bring down costs, and expressed concern on the minimum medical loss ratio. Health plans opposed the insurance market reforms in both the small group and individual markets, and the lack of an individual mandate.

Protection and Advocacy, Inc., representing people with disabilities, was opposed unless amended, expressing concern about a high-risk pool of patients with expensive medical conditions that was separate from the rest of covered Californians. And the California Nurses Association, in their opposition, said health insurance is not health care, and expressed fear that AB8 is, or will be, the Governor’s proposal.

LEGISLATIVE DEBATE

Republican Sen. Sam Aanestad said he was concerned that AB8 was the main vehicle, but with so much contention in opposition, and even supporters seeking amendments, he urged Nunez to take another year. Aanestad said he feared that the legislature was trying to do too much too quickly and might end up fouling up the system – as lawmakers did with electricity deregulation.

Democratic Sen. Darrell Steinberg, however, countered that there was momentum on health care this year. “Sometimes, you just have to capture the moment.” The moment, Steinberg also said, may never come to naysayers who continue to hold reform back year after year. While they profess to want an improved health care system, they are unwilling to support spending money on it. “You either want to get something done or you don’t. It’s not free,” he said.

Republican Sen. Mark Wyland said “this is the sort of bill we should be working on,” but raised concerns. He’s watched over the years as his own businesses started paying less and less for employee health care, and urged more cost containment. He said lawmakers need to consider that not all businesses will be affected the same way. He also said lawmakers needed to think about how to help businesses that must compete on an international level with companies that do not have to factor in environmental quality and health costs.

Sen. Sheila Kuehl joked that she didn’t like AB8 as much as she liked her own bill, SB840, and she thanked Speaker Nunez’s strong support of her proposal. That said, Kuehl acknowledged that in her role as Health Committee Chair, “my responsibility is ‘in the realm of the possible and in the realm of the present.’”

Kuehl said she would vote for AB8 passage out of committee, so that the Legislature needed to have a bill that was “better than the governor’s proposal.’’ But, she said, “my job has been to push as hard as I can on behalf of the people to hammer on the issue of affordability and coverage,” and she urged those principles as touchstones in negotiations with the Governor.
Democratic Sen. Cedillo agreed with Kuehl’s statements and said “if we had a different governor, we might have a different discussion,” citing his support of SB840. But, he also said of AB8, “Frankly, this is a really good bill…. I don’t want to say this is a question of making perfection the enemy of the good, but we have had setbacks,” citing failed efforts at immigration reform recently. “This is a very good bill for a lot of people,’’ Cedillo said.

In closing, Nunez cited his support for Senator Kuehl’s SB840 last year and this year. On his bill, he also acknowledged the opposing viewpoints on his bill, but cautioned, “There are too many problems (in the health care system) for us to wait and come up with a perfect solution that everybody can support…I would argue when you come up with a good solution…you will always have people who oppose it.” He continued, “While it is not a perfect bill, it is a very solid piece of legislation that Senator Perata and I are very proud of… The framework is there…. There are still amendments that we are working on taking.’’

“There is nothing in this bill that will prevent people who like the current system, for those who it works for, to continue to enjoy it... There are 3.4 million who are going to get health care. We’re going to work to improve upon the market and make it more friendly to the ordinary Californian, working California , middle-class California . In the end, it is our goal to expand coverage, improve quality and do no harm,’’ he said.

OTHER HEALTH LEGISLATION

Health advocates also followed several other bills with high interest, including two other bills that were seen as complementary to AB8: AB2 (Dymally) and AB1554 (Jones).

AB2 (Dymally) would reform the individual insurance market, restricting insurers' practices of denying coverage to consumers with “pre-existing conditions.’’ Instead, the bill places MRMIB in charge of coming up with a standardized questionnaire for insurers to use in determining eligibility for coverage. Those consumers who were denied coverage in the private market would still be able to get coverage through an improved version of the state’s current MRMIP program. That program would no longer have a $75,000 annual cap on benefits, and all California enrollees would pay a small assessment 50 cent to fund the high-risk pool. All Democrats voted in favor of AB2, and no organizations opposed the measure.

AB1554 (Jones) would have regulated insurance rates, requiring health plans to seek permission whenever they wanted rate increases. The bill fell one vote short of passage. Five Democrats voted for the bill, but Sens. Leland Yee and Gloria Negrete McLeod declined to vote for the bill.

OTHER BILLS OF INTEREST TO HEALTH ADVOCATES: With this week being the last that policy committees could hear bills, the health committee busily heard another two dozen bills. Other that are of interest to health advocates included:

* AB1 (Laird) – PASSED – Would allow children in families up to 300% of poverty to enroll in Healthy Families. Support.
* AB12 (Beall) – PASSED – Creates the Adult Health Coverage Expansion Program in Santa Clara County . Support.
* AB55 (Dymally) -- PASSED -- Would increase Medi-Cal eligibility for adults to 133% of poverty. Support.
* AB1113 (Brownley) – PASSED – Extends and increases eligibility for the Medi-Cal California Working Disabled Program. Support.
* AB1472 (Leno) – PASSED – Encourages healthy communities. Support.

Labels: Kuehl, Legislation, Nunez, Perata, Updates, YearOfReform

posted by Anthony Wright | Permalink | 12:35 AM


 

Circling the (profitmaking) wagon....

Wednesday, July 11, 2007

Calling legislative leader's health bill AB8 (Nunez/Perata) "dangerous legislation,'' insurance brokers are lining up to oppose health reform in California.

Brokers lambast the bill for "prevent(ing) you from providing services to many of your clients.

Since they're brokers, I'm guessing that service would be: selling health insurance so that people can have coverage.

First off, AB8 expands coverage. So if insurance brokers had pure hearts, they'd actually appreciate the fact that Democratic leaders are trying to make sure more people had coverage, right?

The fact is, brokers probably aren't looking out for the uninsured: It's about their ability to make money. For the record, there is nothing in AB8 that specifically prohibits brokers from selling insurance. However, for consumers who get health coverage through the state -- rather than through their employers or on their own -- there would be no broker fee because the state doesn't pay broker fees. (The same situation would exist if we were debating the governor's plan, which also calls for a larger role for the state to provide consumers health insurance.)

Obviously, not getting a broker fee from the state would cut into said broker's profits. But they might see more action from businesses since businesses would be required to offer coverage.


And even if they don't, is it really worth blowing up our chance to try and fix a system that everyone admits is broken?

Labels: Nunez, Perata, Sacramento, YearOfReform

posted by Hanh Kim Quach | Permalink | 9:28 AM


 

A better deal for employers, part II

Sunday, June 24, 2007

In my last post, I talked about how AB8(Nunez/Perata) was a better deal for employers than 2003's SB2(Burton), less burdensome yet more comprehensive. For those employers that provide coverage, and those that want to, it provides a new, affordable option for them.

How about in comparison with the Governor's proposal? Many reports simply compare the minimum employer contributions in the two plans, 4% in the Governor's plan, 7.5% in the legislative leader's plans. Especially since most employers are spend 8-14% of payroll, it seems superficially that the Governor's plan lets employers off much easier.

But the real question is what employers get in return. As consumer advocates, we just don't argue for the lowest price, but the best value for the dollar.

Under the Governor's plan, those employers that don't provide any health coverage would have to pay a 4% fee. But they wouldn't get any special added value whether they paid the fee or not. The Governor's plan does broadly expand public coverage programs for families up to 250% of the federal poverty level, around $25,000 a year for an individual, or $50,000 for a family of four. For those employers who don't provide coverage and thus pay the fee, their workers over 250% of the poverty level are left to buy coverage on their own.

In contrast, under AB8, the employer who doesn't provide private coverage and pays the 7.5% fee gets to cover his entire workforce (including full-timers and part-timers) through the statewide purchasing pool. That employer gets the benefit of a fully-insured workforce, one that is healthier, more productive, and has less turnover and thus fewer retraining costs.

Most employers have workers at a range of incomes, from entry-level and lower-skill workers to managers and specialists. For these employers, the structure of AB8 seems to be a much better value.

Of course, if the employer doesn't want to provide any coverage, then these details don't matter: they will simply oppose any reform. But for the vast majority of employers that do, or that want to, provide coverage, these different structures of the proposals make a difference, much more than a comparison of 4% and 7.5%.

Labels: Employers, ExpandingCoverage, Legislation, Nunez, Perata, Schwarzenegger, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 12:34 PM


 

The ghost of SB2

Saturday, June 23, 2007

There's still more work to do on the newly revamped AB8(Nunez/Perata). A delegation of top consumer advocates will be meeting with Speaker Nunez and other key legislators on Monday.

But it's important to acknowledge that the proposal has improved, not just from where it is now, but from some past proposals. Many have compared this to 2003's SB2, but this structure is significantly different, at once less less burdensome on the employers impacted, and much more comprehensive for California consumers.

Under the concept of "shared responsibility," AB8 doesn't just set a minimum employer contribution to health care, as some articles have suggested. It includes contributions not just from employers but from individuals, reinvested state dollars, and new federal funds. It expands and streamlines public programs. It has significant reforms on insurers, in general and in particular in the individual market. Any of these provisions, by themselves, would be a major, headline-worthy, health initiative in any other year.

Most employers will not have to make any changes under AB8. And many employers will benefit. They will now have a new, affordable option to cover their workforce, at significantly less than what they pay now, or what is available on that market. Some will be relieved to no longer have to administer a health benefit. The amount, 7.5%, is by definition as a percentage, scaled to the size of payroll, which provides additional benefit to smaller and low-wage firms. Even for those that don't provide coverage now, they will pay a set amount and in return get a healthier, more productive workforce with less turnover and less retraining costs.

Let's contrast that with SB2, which Health Access California strongly supported as a step forward to getting Californians coverage and security. On businesses, SB2 would have simply required that employers have to provide 80% of the cost of a premium for a standard HMO pack. Many employers do that, and many, many employers were neutral on SB2, given that it really wouldn't have impacted them.

Under AB8, most employers also wouldn't have to change a thing. The differences are beneficial to the employer: under AB8, the minimum contribution is 7.5%, which takes into account size of payroll. Paying the fee to have your workers covered in the statewide pool is less than the average 12-14% than employers pay on average now. They have a new affordable option to provide coverage to their workers. If the 7.5% goes up, it does so only after a public process and deliberation--rather than the status quo, which is to have the costs go up automatically as a percent of premium.

This assistance to employers is possible because of public programs and reinvested state dollars, from aggressive use of bringing in California's fair share of federal funds, and by having the statewide purchasing pool bargain for the best rate. There are also several cost containment components of these bills, and more clearly should be done on that front. We would hope that employers, and the groups that represent them, would support many of the efforts that consumer groups have fought for in past year to help control costs.

Some employers are less inclined to provide coverage to their workers, and will oppose any health reform, no matter how litle is required. But for employers that provide coverage, and those that want to provide coverage, AB8 is not a burden, but a benefit.

Labels: Employers, ExpandingCoverage, Nunez, Perata, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 8:41 AM


 

Places, everybody. Places... Showtime!

Thursday, June 21, 2007

HEALTH ACCESS UPDATE
Thursday, June 21, 2007


ASSEMBLY AND SENATE LEADERSHIP UNIFIED ON HEALTH REFORM PROPOSAL

* Newly-amended AB8(Nunez/Perata) to be heard on July 11 in Senate Health Committee
* Changes include: No individual mandate; affordable premium guarantee in pool
* Negotiations with Governor still expected into the summer

New on the Health Access WeBlog: Full SiCKO Coverage and Review; White House Hopes for Health Care; State Rankings; Limited Benefit Plans; Graduating into Uninsurance


Assembly Speaker Fabian Nunez and Senate President Pro Tem Don Perata, on Thursday, announced at a Capitol press conference that they would be merging their two health reform bills, AB8 and SB48, respectively into one bill – AB8 (Nunez/Perata).

“This is an expression of faith. This is an expression of real hope and real progress’’ to move the bills forward, Nunez said.

Having passed the full Assembly on June 7th, AB8 (Nunez/Perata) is expected to be heard in Senate Health Committee, chaired by Senator Sheila Kuehl, on July 11th. After the budget deliberations are completed, it is expected that the bill will serve as the basis for negotiations with Governor Schwarzenegger into the summer.

CHANGES FOR CONSUMERS

Senator Perata indicated that the leadership proposals were already "90% similar," seeking to provide more security so people can get and keep coverage from their employer, through a public program, or by purchasing it as an individual. It would extend coverage to roughly 70% of the uninsured,and better ensure that the insured will get the coverage they need when they need it.

The previous bills, as well as the new AB8:
• Would require employers to contribute at least 7.5 percent of payroll to their workers' health coverage. Employers would either provide private coverage for their workers, or pay such a fee.
• Would create a state-run purchasing pool, to provide a new, affordable option to cover their full workforce.
• Would expand existing public programs to cover all children, and subsidize coverage for more lower-income parents through this state-run purchasing pool.
• Would draw down new federal funds by bringing in more matching Medicaid money.
• Would also impose some new rules on insurers, including preventing rampant rejection of consumer for "pre-existing'' conditions, and limiting the amount of premium dollars that goes for administration and profit.

The changes announced today did not change that basic framework, but were noteworthy for consumer advocates who were particularly concerned about affordability.

The bill does not include an "individual mandate"--a requirement that Californians, even those without access to public programs or employer-based group coverage, buy coverage on the individual market. “We know there’s a difference of opinion with the Administration. The reason we decided (to take out the individual mandate) is we need more time to figure out whether or no there is an affordable health care product for the average worker,’’ said Nunez. Given the interest by the Governor, and the financing issues, Perata said of the individual mandate, "that's not there, but it's not dead."

Another key provision was a guarantee that workers in the purchasing pool would not have to pay more than 5% of their income for the premium, an important protection for lower-wage workers. Consumer advocates viewed this as an important step, although they will continue to advocate for corresponding guarantees on out-of-pocket costs, like deductibles.

The amendments does not introduce new concepts to the legislation, including ones that have been supported by consumer advocates, such as public review of insurance rates, or additional cost containment provisions. Rather, the amendments largely reconciled differences between the previous bills, and in that regard, most of those amendments made the legislation more favorable to consumers.

With the amendments, AB8:
* Does not contain an mandate on consumers to buy coverage in the individual market (as was required in SB48).
* Assures that premiums do not exceed 5 percent of income for workers earning less than 300% of poverty ($51,510 for a family of three) who are in the statewide purchasing pool.
* Requires all employers to pay at least 7.5 percent of payroll toward the health care for their workers. (Previously, Nunez’ legislation had exempted some businesses)
* Allows MRMIB to adjust employer fees on health coverage.
* Makes Section 125 plans available to all workers, to get a state and federal tax break on health premiums;
* Extends small group insurance rules to mid-size employers from 51-250 employees;
* Allows everyone without serious medical conditions to buy coverage in the individual market. Those with specified medical conditions would go into a high-risk pool, which is funded by an assessment on health plans.

To see the full description of how AB8 and SB48 were merged, click here.

QUESTIONS FROM PRESS

Nunez and Perata fielded a wide range of questions at the press conference. Here are some of their responses:

On AB8’s compliance with the federal ERISA law?

Nunez: “This is a very different approach... nothing that can be compared to Maryland or even the Hawaii case... . We feel very confident, in the face of ERISA, we are going to be very consistent with federal law. The bigger threat, to be honest with you, is with a referendum. We’re being very careful to not make this bill a Christmas tree that includes everything that everyone wants to throw into it... That is the danger of having a bill like this. There might be some that think, OK, this is really going to happen now.... We are thinking about minimizing the potential for a referendum."

What about exemptions for small businesses? Why isn’t it there anymore?

Perata: "We had everyone all in for ours (SB48) because, even though we’ve heard the plight of small businesses, the program simply does not work... and puts the burden and strain on other parts if you take it out.…That's going to be an issue that will be negotiated, I'm sure. We’re still trying to look at the cost pools. If this were easy, it’d be done.... But now there’s a single vehicle, and people will be paying even more attention.

Nunez: With respect to the question about the employer exemption, to be honest with you, so far, I’ve only gotten criticism for it. No one’s come to the table saying they really like that provision. We didn't see a lot of small businesses running to support us. In fact, people said we didn't like this. There didn’t seem to be a lot of support for that provision.

What are the key differences with the governor’s concept of "shared responsibility"?

Nunez: We agree. We all have a role in this, the Governor says it is shared responsibility, that's fine. I think our bill is pretty consistent with shared responsibility. Everbody has a role to play. Everyone has to tighten their belt. The providers, the doctors and hospitals, the insurance industry. Workers got a responsibility. Employers have a responsibility. and state and federal government has a responsibility... Ours is consistent with that value of shared responsibility.

Perata: You also can't expect people to be responsible if you don't offer them the opportunity to be responsible. And there's so many people people shut out of the system right now. Conceptually, there no disagreement at all between the Governor's ideas about health care reform and what this bill does. And we are hoping now we can get even more focused on discussing it. If it goes downstairs, (the bill)’s gotta be something (the governor’s) comfortable signing.


ADVOCATES STILL HOPING FOR MORE CHANGE

The new amendments do much to help consumers, but health advocates believe that more still needs to be done.

For instance, while the new AB8 caps premiums at 5 percent of income for workers, it does not factor in the costs to use the plans. After paying premiums, consumers still must pay copays, deductibles and out-of-pocket maximums – which in some cases – forces workers to spend as much as 32 percent on health care.

Consumers could also be further protected from price volatility if the state played a greater role in reviewing insurance rate increases and forcing plans to justify when they decide to raise premiums. This could help to mitigate the wild double-digit premium increases that we’ve seen the past decade.

Consumer advocates also remain concerned about workers who may lose coverage when they are between jobs

WHAT HAPPENS NEXT

On July 11, AB8 will receive a thorough review in Sen. Sheila Kuehl’s Health Committee. At some point in July, both leaders will also meet with Gov. Schwarzenegger to try and reach consensus on issues where they do not agree.

Health Access will continue to provide updates as AB8 progresses.

ALSO ON THURSDAY….

Gov. Arnold Schwarzenegger held a press conference about how the state’s current health care landscape discourages entrepeneurship as people are afraid to light out on their owns and start their own businesses because they would not be able to get job-based health coverage. Watch a webcast of the event on the Governor's website here.

The American Heart Association, the American Lung Association, the American Cancer Society, and PICO California called for an increase its tobacco tax to help fund health care reform, as part of the mix.

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

Labels: Legislation, Nunez, Perata, Updates, YearOfReform

posted by Anthony Wright | Permalink | 8:01 PM


 

The three ring circus...

Several health events today...

At 10:00am, Governor Schwarzenegger has a press conference about "job-lock," with people who make career and life decisions in order to get health coverage. It's a big issue: we constantly hear of people who give up their dreams of entrepreneurship for the corporate or government job that will provide health coverage; or the people who unhappily stay in jobs (or marriages) for the health coverage. All this makes the economy less efficient. The solutions? Beyond having a universal system as in SB840(Kuehl), we could at least ensure that all employers are contributing toward their worker's coverage, that our public programs are less restrictive and cover those who need assistance, and that insurers can't deny coverage because of one's health status.

At 10:30am, the American Heart Association, American Lung Association, the American Cancer Society, and PICO California are introducing the notion of a tobacco tax in the debate, as another potential funding source for health reform. Not only would such a proposal continue to decrease smoking and have positive health impacts, but the revenue could fill some gaps in the proposals, to further extend coverage and/or make it more affordable.

At 11:00am, legislative leaders Speaker Fabian Nunez and Senate President Pro Tem Don Perata will be announcing that they are advancing with one bill, rather than the two that are in print today. If there was any doubt, this sets the stage for the next part of the debate in Sacramento. We'll have more of an update later today.

Labels: Nunez, Perata, Sacramento, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 9:55 AM


 

Moore reporting...

Tuesday, June 12, 2007

Documentary filmmaker Michael Moore today called for insurance company executives to be tried on manslaughter and premeditated murder charges when policyholders were denied care by the companies and die as a result.

Moore, who was in town to promote the release of his new movie SiCKO, testified at a hearing by Sen. Sheila Kuehl, the five-time author of California's universal single-payer health care plan. He was greeted by an enthusiastic crowd of 1,000 nurses, physicians and other supporters of universal health care.

"I’m here,'' with other lawmakers "in the hopes of igniting a movment across California and this country where the people are covered and where profit is no longer the deciding factor'' in getting people healthcare, Moore said.

The primary target of his invective Tuesday was the profit-making companies -- and some non-profit insurers -- who put money-making before patient care.

"My sincere hope is that California will once again lead the way in taking
on the private, profit-making companies that are gouging the citizens of
this state and country to line their pockets at the expense of those who are
sick, who are ill and who need help.''

More explicitly, Moore called such companies "immoral'' and "criminals.''

“There should never be room for the word profit when you’re trying to decide
whether to provide someone care. Our laws state very clearly that they have a
legal, fiduciary responsibility to maximize profits for shareholders. If they
don’t do that, they are required to turn as big a profit as they can. They only
way they can turn a profit is to not provide care.’’

The thrust of Moore's advocacy, however, centered around one state-provided system -- like Medicare or what is supported by Kuehl's legislation -- that would keep administration costs low and provide care to all citizens, not just those who can pay.

Moore's witnesses at the hearing included Andy Bales, CEO of Union Rescue Mission on Skid Row in Los Angeles, where hospitals have been found to dump patients -- in their gowns, IVs and colostomy bags -- who can't pay their bills. Also at the hearing was Dawnelle Keys, whose 18-month-old daughter died hours after being denied treatment at a nearby hospital because it was not affiliated with Kaiser, her insurer.

In addition to Kuehl's hearing, and a rally sponsored by the California Nurses Association -- among the chief proponents of SB840 -- Moore also appeared at a press briefing with Assembly Speaker Fabian Nunez, who supports SB840, and also has his own AB8 health care proposal. Unlike Kuehl's single-payer bill, Nunez' legislation does not get rid of health insurance companies, but does expand public programs and creates a statewide purchasing pool for coverage.

Moore was asked about that legislation, which provides coverage to two-thirds of the uninsured, and other bills in California. He responded "that's the system we all have," and described how he had health plans from Director's, Writer's, and Screen Actors Guilds. "Why should I have three plans and 47 million Americans have no plans?"

Earlier, he said, "Anything that moves toward single payer is a good thing, and I would support that.''

Speaker Nunez, who like many advocates is a supporter of single-payer, said he would change his legislation if he could get two-thirds of the Legislature to support the level of financial investment it would take to fund a more universal system. But the reality is, he said, Republicans won't vote for the bill. In the state Senate, not all Democrats would either. Sen. Lou Correa, D-Anaheim, did not vote for either SB840 or SB48, Sen. Perata's health reform measure.

Moore did, however, give props to Gov. Schwarzenegger, who released his own health reform plan this year. It has not been introduced in legislation, but elements and ideas are embedded in both Nunez and Perata's plan.

“His plan isn't the right plan, but it was very non-traditional Republican thing for him to do, to even say (health care) was a priority,’’ Moore said. “At least Governor Schwarzenegger is saying (health care) is a problem. Recognizing the problem--the old chiche--you're halfway there.’’

Labels: ExpandingCoverage, Kuehl, Nunez, Perata, Republicans, Sacramento, Uninsured

posted by Hanh Kim Quach | Permalink | 3:34 PM


 

It's not a new debate...

Sunday, June 10, 2007

For those who follow health care policy closely, it's a bit jarring to hear the debate in the Assembly and Senate last week, as legislators make floor speeches and speak in very broad terms about the issue.

While several legislators are very well-versed on health issues, most don't necessarily concentrate on the particulars of health policy, having to master a range of other myriad subjects. But part of the reason that Health Access spend the time to report on these legislative debates in committee and floor sessions is because they are instructive of the public discourse around health care, and useful for health care advocates.

For this year, we've had both informational hearings, policy committee hearings, and now floor votes on the various bills and proposals on health reform. Here's a compilation of links to our archived reports for this year:

2007 archived debate on AB8(Nunez), SB48(Perata), and SB840(Kuehl):
Floor debates on AB8, SB48: http://www.health-access.org/2007/06/legislature-goes-on-record-on-key.htm
Floor debate on SB840: http://www.health-access.org/2007/06/going-through-gauntlet-again.htm
Senate committee on SB48: http://www.health-access.org/2007/04/other-shoe-drops.htm
Assembly committee on AB8: http://www.health-access.org/2007/04/steps-forward.htm
Senate committee on SB840: http://www.health-access.org/2007/04/season-has-started.htm
Informational hearing on SB840: http://www.health-access.org/2007/02/gold-standard.htm
Assembly informational hearing: http://www.health-access.org/2007/02/assembly-weighs-in.htm
Senate informational hearing: http://www.health-access.org/2007/02/they-asked-right-questions.htm

Let's remember this isn't the beginning of the debate. It's instructive to see how past legislative sessions have had similar debates on these topics, from an earlier version of single-payer, SB921(Kuehl), to an employer mandate, SB2(Burton), to universal children's coverage, AB772(Chan), to other "individual mandate" proposals and other ideas. Here's some other archived reports that featured hearings and discussion among our policymakers:

2003-4 archived debate on SB2 and SB921
http://www.health-access.org/2003/04/health-access-update-wednesday-april.htm
http://www.health-access.org/2003/07/health-access-alert-tuesday-july-1.htm
http://www.health-access.org/2003/09/health-access-update-wednesday.htm
http://www.health-access.org/2003/09/health-access-update-thursday.htm
http://www.health-access.org/2003/09/health-access-update-tuesday-september.htm
http://www.health-access.org/2003/09/health-access-update-friday-september.htm
http://www.health-access.org/2004/06/health-access-update-tuesday-june-22nd.htm

2005-6 archived debate on SB840, AB772 and other proposals
http://www.health-access.org/2005/04/health-access-update-special-edition.htm
http://www.health-access.org/2005/04/health-access-update-wednesday-april_06.htm
http://www.health-access.org/2005/05/health-access-alert-tuesday-may-31st.htm
http://www.health-access.org/2006/04/assembly-health-committee-passes-key.htm
http://www.health-access.org/2006/06/budget-conference-committee-approves.htm
http://www.health-access.org/2006/06/bill-to-protect-consumers-against-high.htm
http://www.health-access.org/2006/08/sb840kuehl-passes-assembly-legislative.htm

These debates provide a context for the work we do now.

Labels: ExpandingCoverage, Kuehl, Legislation, Nunez, Perata, Sacramento, Updates, YearOfReform

posted by Anthony Wright | Permalink | 11:10 PM


 

The Legislature goes on record on key reforms...

Thursday, June 07, 2007

HEALTH ACCESS UPDATE
Thursday, June 7, 2007


HEALTH REFORM MEASURES PASS FIRST FLOOR VOTES
* AB8 (Nunez), SB48 (Perata), and SB840(Kuehl) passed on (virtually) party-line votes
* Debate touches on the need for rules in the health care market, expanded coverage
* Over 400 house parties hosted for health reform statewide by Its Our Healthcare coalition
* RSVP to see SiCKO; Full day scheduled for June 12th

New on the Health Access WeBlog: More commentary on floor votes; Past floor debates


The California Legislature's Democratic leaders, Speaker Fabian Nunez and Senate President Pro Tem Don Perata, having passed their health reform bills from their respective houses Thursday, are now looking ahead at trying to meld the two ideas together.

REFRESHER

Both passed their respective SB48(Perata) and AB8(Nunez) bills Thursday. Both have similar features, seeking to provide more security so people can get and keep coverage from their employer, through a public program, or by purchasing it as an individual. Both are expected to extend coverage to roughly 70% of the uninsured.

Both bills:
• Would require employers to contribute at least 7.5 percent of payroll to their workers' health coverage, though Nunez does exempt smaller and newer businesses. Employers would either provide private coverage for their workers, or pay such a fee.
• Would create a state-run purchasing pool where workers could get health coverage if their employers don't provide it.
• Would expand existing public programs to cover all children, and move to subsidize coverage for more lower-income adults through this state-run purchasing pool.
• Would draw down new federal funds by bringing in more matching Medicaid money.
• Would also impose some new rules on insurers, including preventing rampant rejection of consumer for "pre-existing'' conditions, and limiting the amount of premium dollars that goes for administration and profit.

One difference between the two plans, though, is that SB48(Perata) would require Californians earning more than 400% of poverty ($40,840 for an individual, $82,600 for a family of four) to have health coverage, with some exemptions.

THE DEBATE: SB48 (PERATA)

Senators got right to business Thursday morning and debated SB48 for about 30 minutes before voting 23-16 on the measure, in a near party-line vote. Sen. Mark Ridley-Thomas, D- Los Angeles, was not on the Senate floor when votes were cast. Sen. Lou Correa, D-Anaheim was the only Democrat to vote against the measure. Correa also voted "no" on Wednesday to SB840, Sen. Sheila Kuehl's universal single-payer health care measure.

Perata said this was the year to get something done. "It will not get any better unless we jump in the pool and get wet,'' he said. "When medical costs are going up five, six, seven times inflation, something is fundamentally wrong,'' Perata said. That will mean making tough choices, including the broaching the idea of denying care, for instance a hip replacement to a 90-year-old.

Sen. Tom McClintock, R-Thousand Oaks, warned that every state that has attempted to reform health care has ended up worse off. McClintock prattled off a litany of states, saying, "Every time and every place this concept has been tried, it has consistently produced massive cost overruns for government, massive increases in premiums for consumers, widespread fraud and abuse, and ultimately a deterioration in health care services and a rationing of what remains.''

He mentioned TennCare in particular, which he said