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Health Access Weblog
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A Constituency Against Health Care?
Thursday, July 03, 2008
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"The choice is clear..."
Tuesday, July 01, 2008
The Sacramento Bee editorializes and says it well... Read the whole thing, but here's an excerpt: Editorial: Budget deal will do real damage to health care The choice is clear: Increase taxes or let the impact fall on children and the elderly
...Faced with a $17 billion deficit, the governor and state lawmakers are considering cuts that would likely drop tens of thousands of children from the Medi-Cal program, the state's version of Medicaid. They also are considering restricting adult eligibility requirements for Medi-Cal, hurting families trying to transition from welfare to work. Elderly patients would also take a hit. As part of a 10 percent cut scheduled to take effect today, the state plans to reduce payments received by pharmacists who serve Medi-Cal patients. Pharmacists say it would force them to lose money on commonly prescribed drugs, and to choose between taking fewer Medi-Cal patients or cutting staff and limiting hours...
Legislators, particularly Republicans who have taken a vow not to raise taxes under any circumstance, need to consider the consequences.
Start with children. Currently, about 3 million children in California receive health care through Medi-Cal, and eligibility for the program is determined annually. To save $92 million in the budget, Schwarzenegger wants to reinstate a rule that families on Medi-Cal submit paperwork every three months to prove their eligibility, instead of every 12 months. About 150,000 children are expected to lose coverage this year – and 470,000 eventually – because their families either fail to file the required forms or they can't meet the program's eligibility rules. The quarterly reporting requirement will also add to the burdens of counties, who will have to process all the extra paperwork.
For these reasons and others, the Assembly rejected the administration's proposal, while the Senate has come back with a "compromise" – requiring Medi-Cal recipients to file paperwork twice a year, instead of four times. This is hardly a compromise. As senators and Schwarzenegger are well aware, kicking poor people out of the Medi-Cal program will only force them to go to the emergency room, or avoid treatment for diabetes, high blood pressure and other chronic diseases.
While campaigning for health care reform last year, Schwarzenegger often talked about the "hidden tax" that uninsured people impose on hospitals, businesses and local governments. It would be revealing for the governor to calculate the hidden tax he will impose on this state if these Medi-Cal cuts are fully enacted. A better option would be a modest, broadly distributed levy – yes, a tax – to prop up this state's health care program for the poor. Consider it a down payment on a once-and-future goal: a more universal system of health coverage
Labels: Budget, InTheNews, MediCal, SCHIPHealthyFamilies, Schwarzenegger
posted by Anthony Wright |
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12:43 AM
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One million more uninsured, just to begin with...
Wednesday, June 25, 2008
Earlier this week, Governor Schwarzenegger called the number of uninsured in California a "moral crisis"--and he was right, both about that and the need for concerted action on health reform.Unfortunately, the Governor's cuts-only budget goes in completely the opposite direction, making our health care system even more broken, and leaving more people uninsured. Today, we are releasing a report that reveals the full magnitude of the cuts the Governor proposes--with over one million more Californians uninsured. While the Legislature has adopted some of these cuts and rejeced others, all of these proposals are on the table until a budget solution is agreed to. There's early press from Aurelio Rojas at the Sacramento Bee and Jordan Rau of the Los Angeles Times.HEALTH ACCESS UPDATEThursday, June 26th, 2008 New Analysis Reveals Full Impact of Governor’s Health Cuts:One Million More Californians Would Lose Health Coverage* Permanent Policy Changes, Not One-Time Cuts, Would Hinder Reform* Magnitude of Cuts Would Have Ripple Effects Through System* Health Consumers and Providers Urge Alternative to Cuts-Only BudgetOver one million more Californians would lose health coverage, with significant impacts throughout the state’s health system, if the Governor’s budget and health cuts were passed, according to a new analysis today. The study, by the health care consumer advocacy group Health Access Foundation, uses information from the Schwarzenegger Administration, but shows a much greater magnitude than earlier estimates, which only looked at the impact of the cuts for less than a year, and not at full implementation. The report is available on the front page of the Health Access California website, and directly at: http://www.health-access.org/preserving/Docs/HACoverageImpactReporto6-25Final.pdfThe study shows that these health care budget cuts are of a magnitude that will impact every Californian, as they place huge burdens on the health system we all rely on. These are permanent, not just one-time cuts, to leave more than one million more Californians uninsured, and over three and a half million having to pay more and get less. Previous summaries of the Governor’s budget proposals, including the May Revision, show the impact of the cuts in only the first year – with tens of thousands losing coverage or being barred from enrollment. But the impact is much greater, in three ways: - The Governor’s budget is not proposing one-time budget savings, but lasting policy changes and coverage reductions for the health care system.
- A snapshot of the savings in the budget year does not reveal the full impact in the following years, once the reductions have been enacted and all the administrative changes have occurred to continue the reductions.
- Finally, the cumulative impact of all the proposed cuts, when added up together, suggests that the magnitude of the cuts—with more than a million more uninsured—will have impacts not just on specific programs but on the entire health care system on which we all rely.
The permanent policy changes reflected in the budget will be in place long after the 2008-09 budget year comes and goes. Of note, these policy changes are contrary to health reform proposals the governor previously put forward. The cuts include: * A roll-back of eligibility for basic Medi-Cal coverage for low-income working parents to well below the poverty level. (429,000); * Additional paperwork burdens for children and adults, requiring reports every three months in order to avoid disenrollment (471,500); * Suspension of already-passed legislation to streamline child enrollment (97,000) * Increased premiums for children’s health coverage, leading to decreased enrollment (60,000). The cuts represent a reversal for the Administration, reducing programs that just a few months ago were being considered for massive expansions to provide coverage to millions more people. Rather than shrinking the number of uninsured, the Schwarzenegger budget would increase the number of uninsured substantially. The report includes appendices that include: * a county-by-county breakdown indicated the increase in the uninsured by county by 2010, the last year of the Schwarzenegger Administration; * a chart comparing the policy changes in the Governor’s budget that would restrict coverage, to the health reform proposal supported by the Governor earlier this year to expand coverage; and * a further detailing of the populations that under the proposed cuts would be forced to pay more or get less benefits, totaling 3.5 million Californians. Allowing one million more California children and parents to go uninsured creates ripple effects throughout the entire health care system. It includes: - an increased burden on “safety net” providers, from emergency rooms to hospitals to community clinics—many of which are dealing with direct cuts of their own;
- a cost-shift, from both the uninsured and reduced Medi-Cal provider payments, to private purchasers of health care—which likely means increased premiums; and
- worse health and economic impacts for California communities, from the destabilizing impact of more children uncovered and getting sicker, to more families facing medical debt and bankruptcy for being uninsured.
As a result, all Californians—not just the million more uninsured—will be impacted these cuts. The report makes clear the stark choice the budget debate this summer presents for California policymakers, between allowing these devastating cuts to move forward and to make these structural policy changes to our health care system, or to find the revenues needed to prevent these cuts. Labels: Budget, MediCal, Research, SCHIPHealthyFamilies, Uninsured, Updates
posted by Anthony Wright |
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6:57 PM
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The budget stage is set.
Sunday, June 01, 2008
HEALTH ACCESS UPDATEFriday, May 30th, 2008 ASSEMBLY, SENATE BUDGET COMMITTEES VOTE OF PROPOSED CUTS (FOR NOW)* Assembly and Senate budget committees vote to reject severe cuts to Medi-Cal, including major denials of coverage to working parents & others, elimination of dental & other benefits. Votes would also restore some of the provider rate reductions.
* Significant cuts agreed to by at least one committee include: Cuts to public and private hospitals, counties, health plans; increases in Healthy Families premiums; additional reporting for children; increased premiums for seniors
* Clear choice in budget debate moving forward: Hundreds of thousands of Californians denied coverage & care, or an alternative to a cuts-only budget that includes revenues.
Click Here for What's New on the Health Access WeBlog: Floor Reports on Health Bills Passing This Week; Ongoing Updates from Budget Committees; What Makes Coverage Coverage?; Health Reform in Obama's First 100 Days?; and more...
After a busy week on the floor, Senate and Assembly budget committees topped off the week with simultaneous hearings and votes on outstanding health budget items. A number of items that were left open in previous months while committees vetted the issues were either modified, approved or rejected Friday morning (listing below). Health Access has posted a Health Care Budget Cuts Scorecard, which details the Governor's proposed cuts, and for each cut, the budget savings, the number of people impacted, and the actions by the Assembly and Senate today. The scorecard is here, at: http://www.health-access.org/preserving/Docs/Health%20Access%20-%20BudgetScorecard%20053008.pdfBUDGET BLUES
The Senate Budget Committee, chaired by Senator Denise Ducheny, and the Assembly Budget Subcommittee on Health and Human Services, chaired by Assemblywoman Patty Berg, both voted to approve or reject the many health care cuts proposed by Governor Schwarzenegger in the May Revision of the budget. That budget sought to bridge a $17.2 billion shortfall in a $100 billion general fund budget without raising taxes. While no action is final until a final budget is approved and signed into law, both the Assembly and Senate committees rejected many of the Medi-Cal cuts to eligibility and benefits as too severe, and both proposed restoring some of the provider rate cuts made earlier in the year. At the same time, both committees did vote to approve other cuts proposed by the Governor, and other cuts. Cuts approved by at least one committee included cuts to hospitals, cuts to counties, cuts to Healthy Families health plans; caps in benefits; increases in Healthy Families premiums; additional reporting requirements for children; and increased premiums for seniors. Health Access is posting summaries on its blog, at www.health-access.org/blogger.html. WHAT’S NEXT
In the Senate, the budget committee’s proposal will head to the floor for a vote. In the Assembly, the full Assembly budget committee will still need to approve each sub-committee’s proposal before being perfunctorily approved by both houses with the intent that the conference committee -- made up three budget committee members from each house – will reconcile differences between each house’s working proposals. The Legislature is supposed to finish working on its budget June 15th, but that has only happened five times in the past 40 years. The fiscal year begins July 1 – a mere 30 days from now -- and there is no expectation that California will have a budget on time. ACTIONS TAKEN FRIDAY
Below is a listing of major decisions made by the Assembly Budget Subcommittee on Health and the full Senate Budget Committee. For a full list of actions taken this year, click here. * Direct denial of coverage to very low income working parents: Would have denied coverage to parents earning wages between $11,000 and $18,000 a year (for a family of three). A parent would need to work fewer than 100 hours a month in order to qualify. REJECTED by both houses. * Quarterly Status Reports for children and adults: Would have required Medi-Cal recipients to report any changes in their life every three months. Currently, children only have to report annually, and adults every six months. MODIFIED by Senate to require reports every six months for both children and adults. REJECTED by the Assembly. * Medi-Cal rate reimbursement: Approved earlier this year, will reduce reimbursements to Medi-Cal doctors by 10%. California already ranks near the bottom (43rd) on reimbursements for providers in this program. Both houses sought to restore this already-made cut: REDUCED to 5% reduction by Senate. REVERSED by Assembly. * Reduced benefits for legal immigrants: Legal immigrants who currently receive comprehensive Medi-Cal benefits would lose all but four services: emergency, pregnancy, some long-term and cancer care. REJECTED by both houses. * Monthly reporting for immigrants: Would require undocumented immigrants to establish their eligibility for limited emergency Medi-Cal services every month. REJECTED by both houses. * Elimination of dental benefits for adults on Medi-Cal: Would have eliminated the ability for adults on Medi-Cal to receive cleanings, crowns, filling or other oral surgery unless a physician treated them. REJECTED by both houses. * Eliminate vital services for Medi-Cal recipients: Adults would no longer be able to see an optometrist, fill eyeglass prescriptions, obtain hearing aids, get speech therapy, treat sores caused by incontinence, see a podiatrist, chiropractor, acupuncturist or psychologist. REJECTED by both houses. * Require very low-income seniors to pay more for their health care: Would have required seniors who earn $1,100 a month to either pay $100 premium for coverage to see their doctor, or spend half their monthly income on healthcare. MODIFIED by both houses to continue to pay premium for enrollees who do not pay $500 a month for health services. * Premium increase for some Healthy Families subscribers: Would have increased Healthy Families premiums between 27% and 77% for subscribers between 151 to 250 percent of the poverty level. MODIFIED by both houses to increase premiums by half the amount proposed. * Co-payment increase for Healthy Families subscribers: Families between 151 to 250% of the poverty level would pay $7.50 (rather than $4) for “non-preventive’’ services, such as prescriptions, some emergency room visits, some doctors visits, eye exams and glasses, therapy and dental work. REJECTED by both houses. * Capping Healthy Families dental benefit: Would limit dental coverage to $1,000 per enrollee. MODIFIED. Both houses increased the cap to $1,500. * Shifting money away from public hospitals: Takes federal money used for public hospitals to pay for unrelated programs. REJECTED by the Senate. REJECTED by the Assembly. No action, including the rejection of cuts in both houses, is final unless the final budget is approved and signed into law by the Governor. However, the actions to reject many of these cuts sets the stage for the budget debate this summer: whether to deny care and coverage to millions of Californians, or whether the state raises the revenue to prevent these cuts. That's the clear choice. Health Access will continue to track budget actions on the floors and in conference committee during the budget season. For more information, contact the author of this report, Hanh Kim Quach at hquach@health-access.orgLabels: Budget, MediCal, SCHIPHealthyFamilies, Schwarzenegger, Updates
posted by Anthony Wright |
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1:01 AM
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Keeping score, even though it's not a game...
Friday, May 30, 2008
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...but some key cuts made.
The Senate Budget Committee, chaired by Senator Denise Ducheny, rejected the major eligibility cuts to Medi-Cal, and the elimination of benefits. It is adopted semi-annual reporting for children and parents, the increase in premiums and co-payments in Healthy Families, and the cut to Healthy Families plans, and other cuts. Again, more detail shortly... Labels: Budget, MediCal, SCHIPHealthyFamilies
posted by Anthony Wright |
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10:51 AM
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Rejecting the big cuts...
The Assembly Budget Subcommittee on Health and Human Services, chaired by Assemblywoman Berg, has just voted to reject the major eligibility cuts in Medi-Cal, the elimination of optional benefits, and even to restore some of the provider rate cuts made earlier in the year. This is very good, a clear statement that these cuts are too severe... a determination that prior Legislatures made about these same proposed cuts. There are cuts that they are expected to approve: cuts to public and private hospitals in a couple of ways, county administration, a modified cut on Medicare part B premiums for some seniors, cuts to Healthy Families plan rates, an increase in Healthy Families premiums and co-pays, and a cap on dental coverage in Healthy Families. More later... Labels: Budget, MediCal, SCHIPHealthyFamilies
posted by Anthony Wright |
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10:41 AM
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The Quiet before the Storm
Tuesday, May 13, 2008
There's the steady drone of doom and gloom emanating from the Capitol, but Sacramento is collectively holding its breath, waiting for Gov. Arnold Schwarzenegger to release his updated budget proposal tomorrow in what's known in Capitol parlance as the "May Revise.'' This second version of the budget comes out a month after tax day, when the state has a better idea what kind of income it has to work with the following year ....and by all accounts, it has not been pretty. Estimates of the deficit -- which started at $14.5 billion in January -- are more like $16 billion to $20 billion now. While the entire state budget is $140 billion -- the general fund, where we have the shortfall -- is $100 billion. That means the deficit is nearly one-fifth of our budget. Accompanying the bad figures are equally as bad rumors: Cuts, cuts and more cuts. On the flip side, precious little in new income for the state. For most of this decade, we have grappled with multibillion dollar deficits larger than the entire budgets of many of the states in the US. And what have we done? We've borrowed and cut. And now, we're down to the bone. Many of you may recall -- and here's a reminder -- that the governor already proposed more than $1.1 billion in health program cuts, which will mean: - 500,000 children losing health coverage over the next five years because the state will require that their families report every three months any changes in their life.
- People with disabilities, who live on (at most) $997 a month, could develop infections and sores on their body and other sensitive areas because they lose coverage for incontinence creams and washes.
- The poorest adults will lose their dental care -- and many with already poor dental health will not treat their cavities, develop gum disease, abscesses and possibly lose their teeth.
We will all know at 1 p.m. tomorrow what the total damage will be. But this we know -- There are only three ways to cut Medi-Cal: - Reimbursement rates for providers -- Check. That was already proposed in January and approved by the Legislature months later to go into effect July 1.
- Benefits to recipients -- Check. See a couple of the bullet points above.
- Eligibility -- Quasi - check. Requiring families to justify their income every three months is a passive aggressive way to knock people off of the Medi-Cal rolls. The state is secretly hoping that families will be too overwhelmed, their life in too much chaos, they will lose or somehow fail to complete the form and send it in. Of course, that means 500,000 children won't get health care....
By process of elimination, a direct cut to eligibility is the only thing left for the state to do to the Medi-Cal program. Let's cry ourselves to sleep and see what's in store for us tomorrow. Labels: Budget, MediCal, SCHIPHealthyFamilies, Schwarzenegger
posted by Hanh Kim Quach |
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6:38 PM
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Bills, bills, bills...
Thursday, April 17, 2008
HEALTH ACCESS UPDATEWednesday, April 16th, 2008 BILLS CONSIDERED BY SENATE HEALTH COMMITTEE AS FIRST DEADLINE NEARS
* Bill fails that would license and regulate "discount" health cards
* Panel passes bill to allow local county-run health plans to expand, compete
* Roundup of bills: children's coverage, mandatory Medi-Cal managed care, benefits
Click Here for What's New on the Health Access WeBlog: Health Wonk Review: Drug Co-Payments and Tier 4; Are the Uninsured the Cause of Overcrowded ERs?The Senate Health Committee heard nearly two dozen bills on Wednesday in the final hearing before Friday’s policy committee deadline to get bills to a fiscal committee. Following is a roundup of the fate of some of the bills of interest to health and consumer advocates: DISCOUNT CARDS:
SB 1603 (Calderon) would have directed the state Department of Managed Health Care to license and regulate so-called discount health cards, which promise consumers deep (though often unverified) discounts on medical services from a network of providers (also often unverified). Consumers purchase a list of discount providers at a cost of up to $120/month. The state is in the process of promulgating regulations to address these plans, but current state law bans them, even though some currently operate in California. With bipartisan opposition from committee members, the bill failed in committee. Consumer advocates have long argued that discount medical cards claim "discounts" off a non-public price, rendering the only true value of the card unknown and/or meaningless. Additionally, surveys have shown that medical providers contacted are not even aware that they are included on many discount cards' list. Additionally, the plans often use misleading language to confuse consumers, and rely on the expectation that the consumer will not understand the difference between a discount health card and actual insurance coverage. Consumer advocates would need to see these issues resolved in order to support a regulation that would license these cards and give them the state's seal of approval. LOCAL INITIATIVE EXPANSION:
SB 1622 (Simitian) would facilitate a statewide public insurer, connecting existing county-based health care plans to be able to offer a broader regional network of providers. This would provide a more options for existing enrollees, especially those who live in one county and work in another, and also allow these local initiatives to better compete with private health care plans. Using economies of scale, this publicly owned health plan would compete with private health plans and provide an affordable alternative for uninsured and small businesses that feel squeezed by insurance costs. This concept was part of ABx1 1 (Nunez), the omnibus health reform legislation that failed in this committee earlier this year. The bill passed. CHILDREN’S COVERAGE:
SB 1593 (Alquist) passed, which stipulates that children currently covered by county health initiatives would be the first in line to receive Medi-Cal and Healthy Families coverage once those programs are expanded to cover children up to 300% of poverty ($52,800 for a family of three). Currently, only citizen children up to 250% of poverty are covered by the state. Many counties now pick up the population between 250% and 300% of poverty. This measure complements two bills sponsored by the 100% Campaign – SB 32 (Steinberg) and AB 1 (Laird/Dymally) -- that would expand state children's coverage. SB 1459 (Yee) passed, but with conditions for significant amendments, given the grilling by committee members, and their statements of concern and opposition about elements of the bill. The bill would consolidate both the Healthy Families and Medi-Cal programs under one name “Cal-Health’’ and sought to expand insurance for some children and some adults. Some advocates supported the stated intent to streamline enrollment and extend coverage, but many also raised concerns and/or opposition, with regard to the structure and specific provisions. These included issues about whether it included coverage all or just some children, the proposal's relationship with current child expansion strategies, the interaction with already-passed streamlining efforts, and whether, as written, the proposal would privatize county eligibility workers, divert funding from public providers to private plans, and be a threat to public hospitals. MANAGED CARE: Another bill that got significant discussion was SB 1332 (Negrete-McLeod), which sets up a a pilot that would mandate that seniors, and people with disabilities in San Bernardino and Riverside counties be required to enroll in Medi-Cal managed care plans. While it passed despite opposition from consumer, low-income, and labor advocates, the chair, Senator Kuehl, admonished the author to address their concerns, about the potential impact of the mandatory enrollment on these vulnerable populations, and the overall safety-net. BENEFITS: A number of bills dealt with mandated benefits for consumers in insurance plans. Two bills that would guarantee additional benefits passed. One bill that took away benefits failed. * SB 1198 (Kuehl) would require health plans to offer coverage for durable medical equipment, such as wheelchairs, bath seats and crutches, at the same levels applied to other benefits. Passed on a bipartisan vote. * SB 1634 (Steinberg) would require the coverage orthodontic services for cleft palate. Passed on a bipartisan vote. * SB 1669 (McClintock) would have allowed insurance companies to exclude coverage of conditions for which an individual policyholder has received medical advice, a diagnosis, treatment, of prescription drugs at any point in the previous 10 years. Failed with Republicans voting in support and Democrats voting in opposition. OVERSIGHT: SB 1525 (Kuehl) would require the state to review how health plans decide what services are “medically necessary’’ and should be paid for, and which are not. Passed on a bipartisan vote. Bills, votes, and analyses are available at the website of the California legislature, at: http://www.leginfo.ca.gov/A broader list of pending bills of interest to health and consumer advocates is updated and available at the Health Access website, at: http://www.health-access.org/advocating/2008_bills.htmlFor more information on these or other bills, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org. Labels: Insurers, Legislation, SCHIPHealthyFamilies, Updates
posted by Anthony Wright |
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2:54 AM
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They are hearing lots of opposition to the cuts...
Tuesday, April 08, 2008
HEALTH ACCESS UPDATETuesday, April 8th, 2008
SENATE BUDGET SUBCOMMITTEE REVIEWS MEDI-CAL CUTS* Quarterly Status Reports: hundreds of thousands to ultimately lose coverage
* Proposal to eliminate adult dental care could increase ER use, hurt clinics
* Children on Healthy Families would also face cuts
* Click Here for What's New on the Health Access WeBlog, Updated Daily
* Upcoming: Bill Hearings This Week on Rescissions, Transparency, Individual Market Reform
At a public hearing Monday, the Senate Budget Subcommittee, which oversees state public programs, postponed decisions on a number of Gov. Arnold Schwarzenegger’s proposed cuts to the Medi-Cal and Healthy Families Program. The two programs, along with all state departments, are under pressure to cut 10 percent across-the-board in an effort to close the state’s $14 billion shortfall. The two programs provide coverage to nearly 7 million Californians – nearly 20% of the state. Monday’s hearing was part of the normal budgeting process for the 2008-09 fiscal year, which begins July 1. Lawmakers prefer to delay decisions on major items until after the governor releases his May revision of the budget, which reflects the latest number on income taxes to the state. The Legislature and Governor have already approved a $1 billion mid-year emergency cuts package in February, which included a 10% rate reduction ($544 million reduction) to Medi-Cal providers. As lawmakers heard testimony for proposals that raised premiums for the poorest residents in the state and capped their coverages, Sen. Alex Padilla commented on the bad timing and irony: “In tougher economic times, the demand for services and workload goes up and here we are debating cuts to services.’’ BIG CUTS, "BIG MISTAKE"By far, the biggest ticket items considered by lawmakers was the reinstatement of quarterly status reports for both children and adults on Medi-Cal and the elimination of adult dental benefits from Medi-Cal. Quarterly Status Reports: The savings behind the increased administrative burden of quarterly status reports (which require recipients to verify income every three months, rather than one year or six months) is that recipients would not return paperwork in time and fall off the rolls, in spite of being eligible. State officials said tactic would save $83.5 million. The cuts would also cause the state to lose an equal amount in federal matching funds. The state has estimated that approximately 150,000 children and about 14,000 adults would lose coverage through this tactic, though children’s advocates say that twice as many children--nearly 300,000--would lose coverage over a two-year period, when taking into account the cumulative impact. Advocates also questioned whether that savings could actually be realized given that the it would end up costing more person-hours to reprocess and re-enroll Medi-Cal recipients who fell off and re-applied for coverage. Dr. Gerry Fairbrother, who has studied the costs of Medi-Cal churning, reported a cost of about $122 per child in paper-pushing costs, on top of higher medical costs that the state would incur because of medical delays that were made more serious. Her estimates are from 2005. “Quarterly status reports cause eligible children to disenroll. The costs are higher when they come back on and it increases the administrative burden,’’ she said. Others estimated the administrative costs at higher than $200 per person, and did not include an additional $40 to re-enroll people in a managed care plan. The County Welfare Director’s Association also reviewed statistics on adult disenrollment and found that 70% (and growing) of those disenrolled were re-enrolled in the first year. And 90% of that population that was re-enrolled did so within the first 90 days. The remaining 30% that did not re-enroll were likely those who had moved or had become not eligible for Medi-Cal, said director Stan Rosenstein, describing the rationale for reinistituting the report. Advocates suggested that even among this group, the issue was more about administrative barriers than not being eligible. Chairwoman Elaine Alquist directed staff to flesh out the numbers. Elimination of Adult Dental Benefits: The other high-dollar cut proposed was the elimination of adult dental benefits from Medi-Cal, which would save the state $114.9 billion, but also cause the state to lose an equal amount in federal matching dollars. The only services that would not be eliminated included those services that “could be performed by a physician’’ such as extraction. The department, however, did note that lack of dental treatment did result in higher medical and hospital costs because “people could go to the ER’’ to have dental procedures performed. HEALTHY FAMILIES CUTSFollowing is a rundown of cuts discussed to the Healthy Families program, and some comments offered by committee members to the Managed Risk Medical Insurance Board – which administers the program. * Increased premium payments: Families between 151% of the poverty level to 250% of the poverty level would see their premiums increased between $4 and $7/month. For those in the lower income brackets, it works out to a 77% increase over what they are paying now. This would reduce state spending by $43.2 million, but would cause the state to lose $78.5 million in matching federal funds. Lawmaker comments: “Given that we are in a recession and given that people are losing jobs and gas is costing a whole lot more, how does the department determine that a 77% increase is appropriate?’’ asked Sen. Elaine Alquist, who also asked about the impact the increase would have on enrollment. MRMIB executive director Leslie Cummings said she would need to report back on that figure. * Increased co-payments on “non-preventive services.” Families earning more than 150% of poverty ($26,400 for a family of three) would see an increase in copayments from $5 to $7.50. These higher copayments would be applied to emergency room visits, non-preventive doctors visits, prescriptions, eye exams and glasses, various therapies and dental procedures. This would reduce state spending by $3.4 million, but also cause the state to lose $6.2 million in federal matching funds. Lawmaker comments: “I wonder how many of us in this room would consider those non-preventive services. I think your definition is not exactly accurate,’’ Alquist said. * Limit dental coverage to $1,000 per child. MRMIB contents that only 5 percent of children need more than $1,000 in dental work done from year to year. This would save the state$5.3 million, but cause the loss of $11.4 million in federal matching funds) * Reduction in in rates to health plans by 5%. This would save the state $22.4 million, but cost $40.7 million in federal funds OTHER MEDI-CAL CUTS CONSIDERED: The cuts to the Medi-Cal program senators heard included: The cuts to the Medi-Cal program senators heard included: * County Processing dollars: Reduction in funds sent to counties to process Medi-Cal applications. This reduction would occur at the same time that processing activities increased if Quarterly Status Reports were approved. The reduction was scored as a $71.1 million savings, with an equivalent loss of federal funding. * Medicare premiums for very low-income seniors: The state currently pays Medicare Part B premiums for some seniors who are dually eligible for Medi-Cal and Medicare. Those with incomes higher than 129% of the poverty level ($1,118 a month) would now be asked to pay approximately $100 a month for their Medicare premium. The state would save $66.5 million. * Public Hospitals: The state proposes taking $78.8 million in federal dollars from public hospitals, which will see an increasing number of patients who can't afford to pay for medical services, and use it to pay for programs for largely that same population that would be visiting the public hospitals * Private hospitals: This proposal would reduce by 10 percent what the state pays to private hospitals. This would save $24 million in state dollars, but cause the loss of an equivalent amount in federal dollars. While no actions were taken to reduce services to recipients, the subcommittee did approve $5 million in cuts in administrative costs to the Medi-Cal program. Health Access will continue to report on Budget activities. For more information, contact the author of this report, Hanh Kim Quach, policy coordinator, at 916-497-0923, or hquach@health-access.org. Labels: Budget, MediCal, SCHIPHealthyFamilies, Updates
posted by Anthony Wright |
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1:03 PM
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Passing the SCHIPs...
Wednesday, December 19, 2007
Unable to come to an agreement with a veto pen-wielding President, the Congress has passed a short-term extension for SCHIP, the children's coverage program, through March 2009. We understand this postpones a decision by MRMIB to disenroll children because of a lack of federal funds, at least in the near-term. This doesn't solve the problem in the long term, or for those children who are now uninsured, but that would get health coverage through the proposal health reform proposal. It doesn't address the President's effort to cap any expansions above 250% FPL, just as the Assembly passes a bill that includes an expansion for children up to 300% FPL. But we live to fight another day. Labels: SCHIPHealthyFamilies
posted by Anthony Wright |
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8:00 PM
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Some delays are good...
Monday, December 03, 2007
Good news. The Managed Risk Medical Insurance Board has delayed the decision to start disenrolling children from the Healthy Families program for the time being. However, unless the President backs down from his continual veto threat, there's the votes to override the veto, or there's a deal made, children will start to lose coverage, and soon. Here's the post from the MRMIB website: DECEMBER 5TH MEETING CANCELLED
NOTE FROM EXECUTIVE DIRECTOR LESLEY CUMMINGS:
Given anticipated Congressional action, Board Chair Cliff Allenby instructed me to cancel the December 5th Board meeting. To date, Congress has authorized 2008 funding for Healthy Families using 2007 funding levels, providing California funding only through December 14; however, we expect that Congress will address SCHIP funding needs prior to its holiday recess which would change our situation in California. So I recommended that the Board delay consideration of making program reductions at this time. If Congress and the President continue to provide funding at the 2007 funding level, staff will come to the Board at a future meeting with proposals to ensure that the Board meets its fiscal stewardship to manage enrollment to available resources.
To read between the lines: if we only get 2007 level funding, California will still have to disenroll hundreds of thousands of children. We have work to do! Labels: Federal, SCHIPHealthyFamilies
posted by Anthony Wright |
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5:11 PM
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Waiting for January 2009...
Sunday, November 25, 2007
Susan Brink at the LA Times has a lengthy overview of the SCHIP children's coverage crisis, from the point of view of one middle-class family that isn't eligible for children's covearge now, but their kids would be covered under the reform proposals by Governor Schwarzenegger and the legislative leadership, if the federal government gets around to funding the program. More on the political side, there's an important article by Zachery Coile at the San Francisco Chronicle describing the awful choices that California has with regard to the SCHIP discussion: without a resolution in DC, California is on the brink of disenrolling hundreds of thousands of children from the current program. As I point out in the article, this goes beyond the awfulness of denying children coverage for their check-ups and emergencies... this undoes ten years of outreach and enrollment efforts to build the program up to this point, to the 800,000+ children now in CA's SCHIP program, called Healthy Families. This is a betrayal of trust... the whole point of insurance is to provide security, and that security is gone when you yank the insurance away. When the funds eventually come in, will we find those kids again? Why wouldn't those families be skeptical? The only good news is that I think that this problem has a defined end date. * There's a good possibility that a deal could be worked out in the next few months between the President and Congress that provides the needed funds for SCHIP, especially if there's enough heat on the President, Republicans running for re-election, especially 15-or-so Republican Representatives that would provide the margin for a veto override. The closer this gets to the election, the more Congressmembers on the wrong side of this issue may want a deal to protect them from political attack. * In the worst case scenario, the problem goes to January 2009, with a new President. The Democratic candidates have already pledged to support the Congressional policy and level of funding. Frankly, I can't imagine that a new Republican President would want to start his new term with a fight over children's coverage (it's still hard to fathom why President Bush has instigated this issue). And the next President, regardless of party, may not have a choice: a newly-elected Congress with different margins may be able to muster a two-thirds override itself. There's not enough federal money to wait until January 2009. So it's a real, immediate, ugly problem... but one that has a light at the end of the tunnel. Labels: Bush, SCHIPHealthyFamilies
posted by Anthony Wright |
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10:49 AM
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The SCHIPs are down, the kids may be out...
Monday, November 05, 2007
HEALTH ACCESS UPDATE
Monday, November 5, 2007 MRMIB TAKES PRELIMINARY STEP IN DISENROLLING CHILDREN FROM COVERAGE
* MRMIB adopts emergency regulations to allow for waiting periods and disenrollment
* President Bush's SCHIP veto and standoff with Congress creates uncertainty
* CA's Healthy Families program could disenroll children at their annual reviews
* Children could begin losing Healthy Families coverage as early as December 31New on the Health Access Weblog: BREAKING: Summary of Nunez's New Proposal on Health Reform (Analysis Forthcoming); Special Session Update: More Reports from Last Week's Hearing; Text or Treat; More on SCHIP and MRMIB; Sec. Leavitt's Blog; GuilianiCare;In the wake of President Bush's veto of SCHIP and the stalemate over the reauthorization of the federal children's coverage program, board members of California's Managed Risk Medical Insurance Board (MRMIB) on Monday took the first step that would enable the state to put children eligible for Healthy Families on a waitlist, or begin disenrolling eligible children from the program altogether. Emergency Regulations adopted on Monday can be found here. Healthy Families enrolls approximately 830,000 children in families with incomes between 100% and 250% of the federal poverty level ($20,650 to $51,625 for a family of four). MRMIB Executive Director Lesley Cummings first broached the topic of creating waitlists and disenrolling children from the program last month after President Bush vetoed legislation that extended the sunset for the State Children’s Health Insurance Program (SCHIP) and would have provided an additional $35 billion over five years to maintain and expand enrollment. SCHIP expired on September 30. Since then Congress and Bush have been at impasse over the program with lawmakers sending the president a largely similar measure to the previously vetoed legislation last week. The new bill is also expected to be vetoed. Since the September expiration of the SCHIP program, which funds Healthy Families, California has been using up money it has had in reserve from this program. That money, however, runs out on November 16, Cummings said. Healthy Families receives $2 federal dollars for every $1 state dollar put into the program. The 07-08 state budget has appropriated $392 million from the state’s general fund for the program. Cummings said if the board failed to make a decision and continued operating the program as usual, Healthy Families would run out of money and shut down completely from July 2008 through September 2008. She and other board members emphasized, ad nauseum, that Monday’s adoption of emergency regulations did not necessarily mean that waitlists would be established or children would lose coverage. “What we’re talking about today is just the tools to allow MRMIB to take action,’’ said Ruth Liu, who works for Gov. Arnold Schwarzenegger’s administration. ADVOCATES PLEAD FOR MORE TIMEWhile advocates who gave public comments recognized Cummings and her staff for their careful stewardship of the program and acknowledged that the under funding of the Healthy Families Program was a problem created at the federal level, all advocates urged the board to take no action to adopt emergency regulations at this board meeting. Instead, advocates asked that the board wait until the actions of the Congress and the President made the policy options clearer. Their comments centered around the following key points: * All of the speakers acknowledged that they understood that the board’s action would not result in actually invoking waiting lists or disenrollment actions immediately. However, advocates argued that giving MRMIB the capacity to implement those drastic cost-saving measures was premature at this time. They noted that policy and funding negotiations were ongoing in Washington , and while there clearly were uncertainties, there was still hope for a successful veto override vote or broader support for a compromise proposal. * Advocates argued strenuously that this was a policy decision more appropriately made by the legislature and the governor, rather than the MRMIB board and the director. There has been recent precedent for the state to step in with financial assistance when problems arose with a federal program. Both the California legislature and the governor did provide financial aid last year during the first year of Medicare Part D, the prescription drug program. They took action when both the new federal law and the many implementation problems resulted in significant delays in receiving their drugs as well as financial hardships for California ’s most vulnerable seniors and people with disabilities. * Much of the testimony to the board argued for no action until advocates could review the revised emergency regulations. This minor delay would give the director time to consult closely with other states that were facing similar funding shortages regarding their experience. In addition, many felt the board’s decision should at least be delayed until mid-November or preferably the end of the month during a time when the most intense negotiations are being undertaken in Washington which might make these very drastic actions unnecessary. Advocates made several offers to work with MRMIB to pursue additional policy options and remedies to avoid the imposition of waiting lists and disenrollments. Others also pointed out the irony of restricting coverage for children in the same year that the Governor and Legislature are proposing to reform the health system and expand coverage to millions more Californians – including children. “I’m a little confused by this conversation,’’ said Angela Gilliard, advocate with the Western Center on Law and Poverty. “To say that we might have to disenroll and limit enrollment seems like this discussion is taking place outside of the health reform discussion in California where we’re talking about expanding coverage’’ to all children. Board members said they understood angst from advocates, but were torn. “This is the most abhorrent situation for any of us to be in,’’ said board member Sophia Chang, who works for the Senate Rules Committee. But, Chang said, pleas by advocates to delay a decision “It’s a gamble. To ask us to delay could mean that we have to shut down abruptly’’ causing interruptions in coverage in more children’s lives. According to independent analysis, the longer the state waits and continues to spend money on the program without assurance from the federal government for additional funding, the more children will be harmed later. If the President had his way with his proposal: * 260,000 children would have needed to be disenrolled immediately last week (on 11/1), OR, * 433,000 children would need to be disenrolled by 1/1/08; OR, * Healthy Families would shut down, and disenroll all 830,000 children 7/1/08. Deena Lahn from the Children’s Defense Fund and 100% Campaign, said advocates weren’t saying the state should never make a decision. ”We aren’t saying we can wait forever,’’ but Lahn said, “we’ll know more by November 16,’’ and there’s no reason to rush. Since the board’s first meeting on the topic on October 24th, Lahn said MRMIB staff has made positive changes to help clarify the regulations. “There are more improvements to be made,’’ she said. Other advocates who spoke against the emergency regulations included Health Access California and Community Health Councils, Inc. However, after minimal discussion, the chair moved and the board voted to approve the emergency regulations. They did adopt one additional provision to revise the proposed regulation to reinstate previously enrolled children first, before new applicants, when funding was ultimately reauthorized. THE MECHANICS OF WAITLISTING AND DISENROLLING CHILDREN
With Monday’s adoption of emergency regulations, MRMIB can begin as early as December 5, though Executive Director Cummings said any formal actions to constrain enrollment likely wouldn’t start until the end of December. Responding to critiques from the October 24th meeting that the regulations were too vague, MRMIB also drafted more explicit regulations that explained how waitlists and disenrollment were to unfold. If the board does establish that Healthy Families does not have enough money, it would: * First establish a waitlist for new applicants who have not yet been enrolled. * If the waitlist is not enough, then children’s coverage would be terminated in the month of their “Annual Eligibility Review,’’ the anniversary of their enrollment. Once, however, money does become available, children who were disenrolled would be re-enrolled in the program, in the order that they lost coverage. After disenrolled children regained coverage, then children on the waitlist, who had not previously been enrolled in the program, could obtain coverage. For more information, contact the authors of this report, Elizabeth Abbott, project director, at eabbott@health-access.org, or Hanh Kim Quach, policy coordinator, at hquach@health-access.org. Labels: Legislation, SCHIPHealthyFamilies, Updates, YearOfReform
posted by Anthony Wright |
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5:09 PM
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Elections have consequences...
President Bush's veto of SCHIP took one step closer to having a real impact in California today. The Managed Risk Medical Insurance Board (MRMIB) voted today to implement emergency regulations to establish waiting lists and disenrollments of children from California's SCHIP program, called Healthy Families. They aren't kicking off kids coverage yet, but we are getting damn close... We'll have a full report later today. As for why we are in this mess (and to get angry), check out Health and Human Services Secretary Michael Levitt's blog, where he tried to defend the President's decision. He somehow thinks "express lane enrollment" (expediting the application process for children on school lunch programs so they can get coverage) is a secret path to single-payer; and he responds to my Massachusetts' colleagues critique with funny numbers to hide the key fact: President Bush's proposal simply doesn't have the money to keep the currently-enrolled children in California's Healthy Families covered, much less enroll those uninsured-but-eligible California children. Labels: SCHIPHealthyFamilies
posted by Anthony Wright |
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3:03 PM
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Throwing kids overboard?
Friday, November 02, 2007
The Managed Risk Medical Insurance Board on Monday will consider adopting emergency regulations that would enable the state to establish waiting lists and begin disenrolling children from Healthy Families, the state's program for low- and middle-income children, as early as December 5. At the October 24 meeting, board members deferred a decision on the emergency regulations until more information from Washington -- and the reauthorization of the State Children's Health Insurance Program -- was forthcoming. Advocates also offered other options, as spelled out in this report, and pointed out that the Legislature should weigh in before the state begins kicking children off coverage -- particularly during the year of health reform.
The situation on Capitol Hill has been bleak, according to news reports, and the President is expected to veto another bill that would extend the SCHIP. The latest congressional bill would have given California enough money to sustain its Healthy Families program, which enrolls 850,000 children.
According to independent analyses, if the President had his way and funded SCHIP with only the $5 billion increase:
- 260,000 children would need to be disenrolled immediately 11/1 (next week); OR,
- 433,000 children would need to be disenrolled by 1/1/08; OR,
- Healthy Families would shut down, and disenroll all 830,000 children 7/1/08.
To avoid the ensuing calamity, advocates should get their comments into the Managed Risk Medical Insurance Board ASAP! Labels: SCHIPHealthyFamilies
posted by Hanh Kim Quach |
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3:48 PM
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Waiting on waiting lists for kids coverage...
Wednesday, October 24, 2007
HEALTH ACCESS UPDATEWednesday, October 24, 2007 HEALTHY FAMILIES/SCHIP UPDATE: WAITING LIST AUTHORITY DEBATED* Federal dollars for SCHIP will run out Nov 16 without Congressional action
* MRMIB considers emergency regulations to enable agency to disenroll children in Healthy Families (CA's SCHIP), or put new enrollees on waiting lists
* Board will reconsider emergency regulations on November 5
New on the Health Access Weblog: Special Session Halloween Hearing; Corrections and Clarifications; DMHC Updates on Post-Claims Underwriting; HMO Report Card; Doonesbury The Managed Risk Medical Insurance Board (MRMIB), which oversees the Healthy Families program--California's version of the State Child Health Insurance Program--today decided it would wait until at least November 5 to decide whether it should adopt emergency regulations to pave the way for creating wait-lists and disenrolling children from the program. FEDERAL STALEMATE MRMIB executive director Lesley Cummings had recommended the board adopt the emergency regulations in light of the fact that the State Children’s Health Insurance Program (SCHIP) expired on September 30 and Congress and President Bush are still wrangling over how to continue the program – and for how much. Bush had originally allotted $25 billion over five years – which would cause California’s program to fall into deficit by the end of our fiscal year 2008. Meanwhile, Congress has proposed a total of $60 billion over five years, and enable expansions to the program, which the President opposes. The SCHIP legislation managed to obtain a veto-proof majority in the Senate, but failed twice in the House of Representatives – falling less than 20 votes short of 290 votes needed last week -- to override Bush’s veto of the Congressional SCHIP bill. Ronald Springarn from MRMIB said Washington insiders have reported that the Administration and Congressional leaders continue to work toward a compromise to continue the program. Sticking points continue to be whether families above 300% of poverty could be eligible for funding in states that allow it (such as New Jersey); and whether a threshold for low-income children enrolled in SCHIP would have to met before others are enrolled. HEALTHY FAMILIES SITUATION Director Cummings emphasized that the board action did not mean any of the 830,000 children currently enrolled would be kicked off imminently. Nor would it mean the program would institute a waiting list. Cummings said she viewed it as her job to guide the board to be financially responsible in managing the program. “You don’t have a farthing for this program on November 17,’’ she said. Healthy Families receives $2 for every $1 state dollar put into the program. While federal dollars may not come immediately, the 07-08 state budget has appropriated $392 million from the state’s general fund for the program. Other states have the ability to put children on waitlists or disenroll children. California, however, took that provision out of its regulations in 2001 when it sought a waiver to allow the extension of Healthy Families to parents of children in the program. The federal government, at the time, wanted to ensure that children were prioritized in enrollment before parents were covered. The waiver expired this year, and due to budget shortfalls in California reaching $38 billion, no parents were ever enrolled in Healthy Families. Based on analysis performed by Peter Harbage, Cummings layed out the fate of potentially all children currently enrolled in Healthy Families if the President had his way and funded SCHIP with only the $5 billion increase: Director Cummings emphasized that the board action did not mean any of the 830,000 children currently enrolled would be kicked off imminently. Nor would it mean the program would institute a waiting list. Cummings said she viewed it as her job to guide the board to be financially responsible in managing the program.
“You don’t have a farthing for this program on November 17,’’ she said. Healthy Families receives $2 for every $1 state dollar put into the program. While federal dollars may not come immediately, the 07-08 state budget has appropriated $392 million from the state’s general fund for the program.
Other states have the ability to put children on waitlists or disenroll children. California, however, took that provision out of its regulations in 2001 when it sought a waiver to allow the extension of Healthy Families to parents of children in the program. The federal government, at the time, wanted to ensure that children were prioritized in enrollment before parents were covered. The waiver expired this year, and due to budget shortfalls in California reaching $38 billion, no parents were ever enrolled in Healthy Families.
Based on analysis performed by Peter Harbage, Cummings layed out the fate of potentially all children currently enrolled in Healthy Families if the President had his way and funded SCHIP with only the $5 billion increase:
* 260,000 children would need to be disenrolled immediately 11/1 (next week); OR,
* 433,000 children would need to be disenrolled by 1/1/08; OR,
* Healthy Families would shut down, and disenroll all 830,000 children 7/1/08. Cummings said the sooner the state acted, the fewer children would be affected. If and when the board adopts regulations, it will take 32 days before they can act on those regulations. The proposed regulations would allow MRMIB to
* Establish a waitlist;
* Terminate enrollees at their annual eligibility review. Cummings repeatedly emphasized that this did not mean the board would begin taking these actions immediately. MRMIB Chair Cliff Allenby (the former director of the state’s Department of Social Services) said he understood the need to be fiscally responsible with the program, but hoped board members would be able to weigh the regulations in a more “leisurely’’ manner if the federal government took action that would not put California’s program in danger. ADVOCATES OPPOSE EMERGENCY REGULATIONS Children’s and health advocates stood to oppose the adoption of emergency regulations. Deena Lahn of the Children’s Defense Fund and the 100% Percent Campaign said such actions should not be considered an “administrative’’ matter, but something to be vetted by the Legislature. “Healthy Families has reached a peak…To allow disenrollment sends the wrong message,’’ she said. Lahn also suggested that if insufficient federal funding is available, the state should take over full financial responsibility for the 8,000 women enrolled in the Access for Infants and Mothers program, rather than the Healthy Families program. Beth Capell from Health Access California pointed out that the MRMIB board did not have the legal authority to establish emergency regulations based on “speculation” that the federal government may not act. Capell also noted that the regulations were not clear about how and when waiting lists and disenrollments would be unfurled, in what sequence and what would trigger the actions. Other advocates who spoke against the emergency regulations included Community Health Councils, Inc., California Catholic Conference and the California Nurses Association. DEFERRED ACTION UNTIL 11/5 Chairman Allenby motioned for the board to take a deliberative, but prudent process – waiting until November 5 to consider the regulations. In the meantime, he said, the board and MRMIB staff should carefully watch what Congress and the President do on SCHIP. Just as important, he and staff said, was to ensure members of Congress – particularly the California delegation – understands that the Healthy Families program could be in financially dire straits should additional funding not come through. A congressional report optimistically said the state could continue its program until July 1, 2008, but without context that after July1, the program would shut down. Harbage Consulting’s figures reflect the most realistic assessment of California’s program. CALL TO ACTION: The fate of more than 830,000 children is at stake. Advocates need to do two things:
1) Contact your congressional representative and make sure they understand the importance of the SCHIP program to Heatlhy Families. Also make sure they understand that the state’s program runs out of federal dollars in November and state agencies are paving the way to disenroll hundreds of thousands of children.
To find your Congressional Representative, visit: http://www.house.gov/. 2) Write MRMIB and urge them not to allow the board to waitlist or disenroll eligible children from Healthy Families. For information on MRMIB, visit: http://www.mrmib.ca.gov/
For more information, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org.
(Correction: the original UPDATE neglected to mention that MRMIB Chairman Allenby was the *former* director of DSS.) Labels: SCHIPHealthyFamilies
posted by Anthony Wright |
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11:36 PM
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