Live-blogging the conference committee...

Sunday, June 15, 2008

HEALTH ACCESS UPDATE
Saturday, June 14th, 2008


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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

Labels: Budget, MediCal, Sacramento, Updates

posted by Anthony Wright | Permalink | 12:25 PM


 

Our big day is tomorrow!

Friday, June 13, 2008

The latest news is that the Budget Conference Committee will begin on health issues tomorrow morning -- that's right, Saturday -- around 10 a.m.

See you then....

UPDATE: They stopped tonight on page 170 -- California Integrated Waste Management Board. We begin on page 208. The committee plans to meet from 10-1 Saturday (men do not need to wear ties.) They will break on Sunday for Father's Day and resume Monday, tentatively, from noon to 3.

Labels: Budget, Sacramento

posted by Hanh Kim Quach | Permalink | 6:09 PM


 

Conference Committee

For those of you following, the Legislative Budget Conference committee began yesterday and has been meeting all day today. They resume again at 4:30 p.m. with Department of Fish and Game. On the agenda, they are about 70 pages away from Department of Health Care Services issues. (So far they've gone through 133 pages in 1.5 days to give you an idea of the pace)

It's unclear if they will get to our issues tonight, or if they will address them tomorrow.

We'll keep you updated.

Labels: Budget, Sacramento

posted by Hanh Kim Quach | Permalink | 4:07 PM


 

Jones to be chair of Health Committee...

Thursday, June 05, 2008

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


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

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

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

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

Labels: Bass, Legislation, Sacramento

posted by Anthony Wright | Permalink | 5:52 PM


 

The stars aligning again...

Wednesday, April 30, 2008

All week, we've seen signs that while health reform stalled, the need and the urgency--and the opportunity--has not.

* We have had a Field Poll showing broad support for the proposed California legislation that did stall, and even the broad provisions that any major reform is going to need to do.

* A Kaiser Family Foundation poll showed health as a major election issue this year, outpacing many other pocketbook issues--and the startling factoid, picked up by Ricardo Alonso-Zaldivar of the LA Times, that 7% of Americans said they made a decision about marriage based on the need for health coverage.

* A Robert Wood Johnson study, as reported by Lisa Girion in the Los Angeles Times, that laid out the bare facts about the rise in health care costs and the decrease in the number of jobs that now come with health benefits. Yes, the worry that the polls found is based on real trends-- people are appropriately more concerned about the status quo than the needed reforms.

* The playing field is set, the public is there, and so are many of the politicians. Governor Schwarzenegger made a strong commitment to revisit health care reform in the remaining years in his term.

The editorial board of the San Jose Mercury News may have cracked even the cynics, with their opinion piece today:

By all appearances, Gov. Arnold Schwarzenegger's plan for health care reform died an ugly death on the floor of the Legislature in January.

But as Billy Crystal's Miracle Max cracked in "The Princess Bride": "There's a big difference between mostly dead and all dead. Mostly dead is slightly alive."

Besides a great movie reference, the Mercury News also provided another key element to a new possibility: the need to get legislation passsed this year, to set the stage for 2009. We appreciate their spotlight on the Health Access California-sponsored SB1522 (Steinberg), and there are other key bills that can provide real help for people and patients as soon as possible, and lay the foundation for further reform.

It's not too late to resurrect the governor's plan. And even though it might take a miracle to reform health care in California, it's worth a shot in 2009.

That doesn't mean the subject can be ignored this year. The Legislature has work to do now to set the stage.

Next year Karen Bass will be Assembly speaker, Darrell Steinberg will lead the Senate and someone other than George Bush will be in the White House. If public support for reform remains strong, the stars will be aligned for the governor to make another run at passing his comprehensive package.

According to a Field Poll released Monday, a whopping 72 percent of voters said they generally favor Schwarzenegger's plan. And the need for reform continues to grow. Some 6.6 million Californians, 19 percent, are uninsured, and that number is certain to increase as the economy worsens. A Kaiser Family Foundation poll released Monday showed that every 1 percent jump in U.S. unemployment would cause the number of uninsured to rise by 1.1 million nationwide.

Two bills before the Legislature may give an early indication of the prospects for reform in 2009.

The first, Steinberg's SB 1522, would set up what consumer advocates call an apples-to-apples comparison for individuals seeking private insurance coverage. It's sure to draw intense interest from insurance companies, and it will test the governor's willingness to collaborate across party lines.

The second, Sen. Sheila Kuehl's SB 1440, would require insurance companies to spend a minimum of 85 percent of premium dollars on health care expenses. That's a concept from the earlier reform package that insurance companies hoped was more than "mostly dead."

Calling Miracle Max.

With all this momentum, I don't think we need a miracle to get comprehensive health reform in 2009-10, just our work and commitment. It would help to have some movement, as the editorial points out, by putting some of the legislative building blocks in place.

Labels: InTheNews, Sacramento, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 9:44 PM


 

Budget hearings and benefits...

Monday, April 28, 2008

Lots of budget hearings for health advocates today.

The Senate Budget Subcommittee on Health, chaired by Senator Alquist, met this morning. It heard several proposed cuts. It did *not* take action on a proposal to delay the state's prescription drug discount program, and similarly held open other proposals to cut community clinics, and various other efforts to get care for children and vulnerable patients.

The Assembly Budget Subcommittee on Health, chaired by Assemblywoman Berg, is meeting this afternoon. The big topic is the elimination of Medi-Cal "optional" benefits, especially dental coverage.

My colleague Hanh will have a full report later.

Also: Stan Rosenstein was also finally confirmed by the Senate today for his position today at the Department of Health Care Services.

Labels: Budget, Sacramento

posted by Anthony Wright | Permalink | 4:04 PM


 

Health Care Musical Chairs in the Administration

Thursday, April 24, 2008

Big changes on health care in the Governor’s office: Ana Matasantos, legislative deputy extraordinaire and health reform maven, has moved on up – to be deputy director of Department of Finance. A big job given our BIG deficit, and we’re lucky to have someone who comes from and understands the health and public program world occupying that spot.

Filling the legislative position in the Governor's office will be Jennifer Kent, formerly of Department of Health Care Services, and most recently at Health and Human Services Agency. Jennifer was instrumental in drafting and negotiating the transparency/price and quality disclosure language in ABx1 1 (Nunez), which has since been dropped into AB 2967 (Lieber). Jennifer can be reached at Jennifer.Kent@gov.ca.gov.

The legislative position in the Governor’s office was formerly held by Richard “Fig” Figueroa, in a prior Administration, who is now staffing the Governor’s cabinet on health and human services.

Congrats to all.

Labels: HealthAccessCommunity, Sacramento, Schwarzenegger

posted by Hanh Kim Quach | Permalink | 2:34 PM


 

More on rescissions

Friday, April 18, 2008

I wanted to follow up on Anthony's post with some more details about what Gov. Schwarzenegger's administration has laid out as his goals, this year, to tackle the rescission problem.

A quick recap: The state ordered the immediate reinstatement of health coverage for 26 enrollees who had their health policies retroactively cancelled in the past four years by Kaiser, Blue Cross or Blue Shield. Thousands more policies of consumers insured by the three named insurers, Health Net and Pacificare, could also be reinstated after review by an independent arbiter. These retroactive cancellations typically occured after a consumer started using lots of expensive health services -- triggering a second and very, very close look at their application by insurers.

As the system is now, said Daniel Zingale, one of the governor's health policy advisors, "If you use it, you lose it,'' of health coverage. To change this, the governor is supporting the following guidelines and principles to protect consumers:

1) A clear application process, which could help prevent mistakes and omissions
2) If there is no evidence of "willful misrepresentation,'' a policy cannot be rescinded
3) Plans must give adequate notice to consumers about the fact that they are investigating their applications. There would also be an established appeals process for consumers.
4) A prohibition on bonuses, quotas and other incentives for insurance company employees to rescind.

Of course, Zingale pointed out -- and we wholeheartedly agree -- this would all be moot had we passed ABx1 1. With health reform, we would have:

• Guaranteed issue: everyone receives coverage, regardless of pre-existing conditions,
• Guaranteed that everyone was paying into the system so insurers didn't go nuts about NOT being able exclude the really sick and expensive people,
• And guaranteed affordable health coverage and/or subsidies to purchase health coverage for 4 million Californians.

In the absence of that, though, this is a great place to focus reforms that would begin to help consumers feel more secure about the coverage they have.

Labels: BlueCross, Insurers, InTheNews, Rescissions, Sacramento

posted by Hanh Kim Quach | Permalink | 1:18 PM


 

The Big Five on the Budget changes...

Assemblywoman Karen Bass will take the reins of the Assembly and assume the Speakership in mid-May, right at the time the budget negotiations get going with the unveiling of the Governor's May Revise. Those Big Five meetings will also include Sen. Dave Cogdill, representing the Senate Republicans, who takes over this week. Marty Omoto at the California Disability Community Action Network has the update at the California Progress Report.

Labels: Budget, Sacramento

posted by Anthony Wright | Permalink | 10:25 AM


 

Upcoming hearings...

Monday, March 31, 2008

While the Capitol is closed today in recognition of Cesar Chavez, the action starts up again tomorrow, in full forse. Some upcoming hearings of note here in Sacramento:

* Assembly Health Committee will meet tomorrow, Tuesday, April 1st--yes, April Fool's Day. What's not a joke is the drug companies' opposition to AB2821 (Feuer), to limit the "gifts" given by drug companies to doctors. And a spirited discussion on AB1945 (De La Torre), on rescissions. Should be an interesting hearing.

* Next Monday, April 7th, the Senate Budget Subcommittee on Health and Human Services will hold a hearing at 10:30 am on some of the proposed cuts to Medi-Cal, like Quarterly Status Reports.

* An important reform of the individual insurance market, AB1522(Steinberg), sponsored by Health Access California, is up in Senate Health Committee on Wednesday, April 9th. The committee starts at 1:30pm. There are other bills of note as well on the docket.

Labels: Drugs, Legislation, MediCal, Sacramento

posted by Anthony Wright | Permalink | 12:13 PM


 

The DMHC Oversight Hearing...

Thursday, March 27, 2008

HEALTH ACCESS UPDATE
Friday, March 28th, 2008


SENATE PANEL QUESTIONS HMO REGULATOR
* Lawmakers question Department of Managed Healthcare’s oversight of health insurers
* Inquiry into regulations for timely access, discount plans, rescissions, language access and mental health parity
* Sen. Kuehl sees "pattern" of siding with industry against consumers
* Laws passed more than five years ago still not implemented


Click Here for What's New on the Health Access WeBlog: Health Care Consumers Views; GAO Individual Market Investigation; More Debriefings on California Health Reform; A Health Reform Backlash Against San Francisco Restaurants?; Health Budget Cuts Nationally; Shooting for 60 Votes; 1,000 Posts!; Web Wonkery; McCain's Misstep: Do We Go to the Doctor Frequently?; The Hot Hearing for the Week; Mayor Newsom Suing Sacramento Over Medi-Cal Rates; So-Called Consumer Directed Health Plans; Overseeing the DMHC


SACRAMENTO--At a special hearing of the Senate Health Committee on Thursday, Department of Managed Health Care Director Cindy Ehnes was questioned for over nearly seven hours about her department’s handling of five separate regulations and whether it had met its charge as a consumer protection agency in implementing and enforcing laws to help patients. “This hearing is meant to provide a level of oversight to ensure that legislation that is passed gets implemented in a way that is consistent with the way it was intended,’’ said Sen. Sheila Kuehl, chair of the Senate Health Committee.

At issue were three laws, passed in the late 1990s and earlier this decade, which still have not been put into practice: Timely access to health care, access to health care that is both culturally and linguistically sensitive and mental health parity. Additionally, Ehnes was interrogated about the Department’s rationale for regulations regarding retroactive cancellations of health policies and so-called "discount health cards".

For more detailed information on all these issues, you can visit the Health Access website and blog. As well, the Senator posted a detailed agenda and background papers on her website, at:
www.sen.ca.gov/kuehl


TIMELY ACCESS TO CARE

Background: First on the list was the issue of timely access to care, which were intended to prescribe specific time-elapsed standards for how long it should take patients to get into to see a physicians. The law was passed in 2002, and after many years of hiccups, regulations were on the path to implementation in 2007. The regulations spelled out exactly how quickly patients should be able to get in to see a doctor in certain situations. (I.E. Urgent primary care needs: 24 hours; Routine primary care needs: 10 days; Urgent specialty care: 72 hours; Routine specialty care: 14 days)

But in December, the Department yanked that version, stripped out all specific requirements, and left it up to health plans to determine their own standards, as had been the practice in the years before the law was passed. Health Access California and Western Center for Law and Poverty testified that the law did not meet the legislature's intent in having the Department set clear, prescriptive standards. Last month, the Office of Administrative Law rejected the regulations, saying the department had not allowed enough time for public comment given the dramatic changes in the regulations. To read Health Access' writings on this, click here.
The difference between the August and December versions of the regulations was so stark that Sen. Sam Aanestad, R-Grass Valley, asked, “It looks like the department just punted. What was the amazing turnabout?’’

Department’s take: Ehnes said she felt that the August regulations – 26 pages – were too complicated and would force plans to micromanage physicians they contract with. She said the department focused on the clinical triage via phone, where patients could call in and get a professional to tell them what they needed to do. Health Access’ Beth Capell later said this telephonic triage was available during limited times -- weekdays during work hours.

Legislative comment: “Regulations are supposed to go further than the statute. Sometimes they are going to be very complicated. I would encourage a little more complication,’’ Kuehl said. She urged that the Department set prescriptive, time-elapsed standards when developing new regulations in the new year. Aanestad indicated he thought the Department was "almost there" with previous version of the regulations that had set standards.

DISCOUNT HEALTH CARDS

Background: Discount health cards aren’t health plans, but cards that consumers pay a monthly premium, for access to a list of physicians that will purportedly provide them discounts. The problem is, often, physicians don’t know they’ve been put on a list, and consumers don’t know what the base price off which they receive a discount, making the discounts meaningless. These plans are often marketed toward lower-income or limited-English consumers who believe they are actually buying health coverage, and these plans rely on this confusion to thrive.

The plans have been deemed illegal by the state Attorney General; but there has been confusion about if they should be allowed or licensed and regulated, and even what agency should do the regulating. The DMHC has started a process of developing regulations to license these discount cards, working with the industry. Health Access testified that while the value of these products was questionable, any regulations must at a minimum ensure real discounts to a real network of providers with real notice of what consumers are and are not getting for their money.

Department’s take: The department has investigated 53 discount health plans and ordered cease and desist orders against 7. Ehnes said developing regulations and licensing such products was not meant to be an endorsement, but to try to better understand the products.

Legislative comment: Kuehl asked the department, as it continued its work, to strongly consider whether these products offer any real economic value to consumers.


RESCISSIONS

Background: In the past couple of years, the startling practice of retroactive cancellation of policies by insurers has arrested the public’s attention. Consumers, who have been paying monthly premiums and believed they are insured, receive high-dollar treatments for cancer, heart disease and the like. These expensive treatments often trigger insurance companies to review the enrollees’ initial application and rescind policies, claiming enrollees did not properly disclose pre-existing health conditions. Policies are cancelled, retroactively, as if consumers were never insured. Consumers are then sometimes left with thousands –if not hundreds of thousands of dollars -- in debt for treatments they believed were covered. The courts have determined this practice is illegal unless consumers willfully misrepresent their health status.

Department’s take: Ehnes said the DMHC has been aggressive in investigating plan behavior since the practice came to light. The department, along with the Department of Insurance are developing regulations so that plans do not have the ability to rescind without reason and that consumers can’t misinterpret applications.

Legislative comment: Kuehl’s primary concern was how consumers could obtain coverage after they’ve been cancelled. These cancellations occur on the individual market where consumers are often denied coverage due to pre-existing conditions. Once consumers’ coverage is cancelled, it would be impossible for them to obtain coverage through any carrier.Aanestad believed the department was not properly protecting consumers and making that the focus. “The first priority is to reinstate coverage for consumers. The second priority is to make headlines and change the industry, but it doesn’t sound like that’s really happening.’’


CULTURAL AND LINGUISTIC ACCESS

Background: In 2003, the legislature passed a law, SB853(Escutia), that required health plans to ensure that the consumers who did not speak English as a first language had proper medical interpretation services. Up until then, consumers brought in their children to translate, did not get care, or got the wrong care because they were unable to communicate with their doctors. This is particularly important in California where 55 percent of the population reports not speaking English well. The California Pan-Ethnic Health Network, Latino Issues Forum, and other groups were concerned that the notice about these new rights were left to the industry to determine, without consumer input. Plans have complained it is costing them millions to translate materials.

Department’s take: Ehnes said she was committed to this issue and was attempting to evaluate all aspects, including whether the regulations go beyond the law and whether it will cost too much.

Legislative comment: Kuehl said when the legislature passes something, that’s the rule. “We don’t care what it costs everybody. Cost is important…but that’s not the top consideration. …We really mean it about providing real access to language minorities,’’ said Kuehl, who was also critical about the department’s process in listening to all stakeholders and allowing enough time to comment on regulations. “Please push the envelope on this one, because I know you want to.’’


MENTAL HEALTH PARITY

In 1999, the Legislature passed mental health parity, providing consumers with access to mental health benefits equal to coverage in other health services. But to this day, consumers are still finding it difficult to obtain mental health services they need on the same level as other health services. Timely access to providers remains a problem as well as plans’ treatment and financial obligation toward mental health. The Senators urged the department to be more aggressive about following up on surveys and studies that found consumers lacking access to mental health.

PARTING NOTES

Ehnes said the department would continue to work on these – along with other issues – under the department’s jurisdiction. Kuehl reiterated that the hearing was intended to ensure that laws were actually implemented and not allowed to wither once passed. She also continued to encourage the department to have more open and collaborative process.

For more information, contact Elizabeth Abbott, director of administrative advocacy at Health Access California, at eabbott@health-access.org. Interested organizations can also contact the author of this report, Hanh Kim Quach, policy coordinator at Health Access, at hquach@health-access.org.

Labels: DMHC, Kuehl, LanguageAccess, Sacramento, TimelyAccess, Updates

posted by Anthony Wright | Permalink | 10:12 PM


 

Oversight about oversight...

Victoria Colliver at the San Francisco Chronicle has a preview of today's Senate Health Committee hearing--which is expected to be at least five hours of grilling on a range of meaty issues.

The Senate Health Committee, chaired by Senator Sheila Kuehl, will hold a hearing today on "Consumer Protection under the California Department of Managed Health Care: Adequacy of Implementation and Enforcement," reviewing the DMHC's oversight in five key areas: timely access, language access, so-called discount health plans, retroactive denials of coverage; and mental health.

In all these issues, they strike to the core of whether the coverage is meaningful, and whether the consumer is getting value for what they paid for. And on all these topics, there are pending decisions regarding regulations or implementation issues at the DMHC.

It won't be a surprise to readers of this blog that health and consumer advocates will press for stronger standards and more aggressive oversight for the health insurance industry--and for good reason.

Consumers are increasingly concerned that their coverage won't be there for them when they need it--that they won't be able to get in to see a doctor or specialist, to get a translator if necessary, or even that their coverage will be retroactively rescinded.

In light of these HMO practices, the Department needs to be more--not less--aggressive in protecting patients and investigating the insurance industry.

Yet, the tendency by the Schwarzenegger Administration is to leave the decisions up to the insurers. Recent regulations would let insurers decide their own standards on timely access; to determine their own method of notifying patients about their rights to an interpreter. On new regulations of discount cards, the Department were shaped by the industry they were purporting to regulate-an industry that offers a product of dubious value to consumers.

The regulations to ensure timely access to care has been a particular subject of controversy--and focus for Health Access. For years, the Department of Managed Health Care has had numerous drafts of regulations to implement a 2002 law to establish and enforce standards to ensure access to care within clear timeframes. Yet the most recent draft let the insurers set their own standards. Senator Kuehl recently wrote a letter indicating this conflicted with the intent of the Legislature is passing the bill.

We hope this hearing provides much-needed legislative push to the Department to resolve these issues quickly, and the political cover to prioritize protecting patients, regardless of industry opposition. Consumers want and need more assurances that their coverage will provide the protection that they paid for.

If nothing else, the hearing brings additional *public* scrutiny to these issues--which is important, given the stakes for the average health consumer, but rare, given that DMHC regulations usually get attention from the industry and a handful of consumer advocates.

We have an ongoing interest--Health Access California, the statewide health care consumer advocacy coalition, was the sponsor of the HMO Patient's Bill of Rights in the late 1990s that created the Department of Managed Health Care, to be a stand-alone department with a specific focus on consumer protection. Our group continues to advocate on behalf of consumers at the DMHC on a range of issues. More recently, Health Access was the sponsor of AB2179(Cohn) in 2002, which required the Department to establish and enforce standards for timely access to care; and a strong supporter of SB853(Escutia) to require language access to care.

So we'll be continuing to do our own oversight, over the insurers--and their regulators.

We'll have a report on the hearing later in the day.

Labels: DMHC, Kuehl, Sacramento

posted by Anthony Wright | Permalink | 1:36 AM


 

Back in session... and the hot hearing for the week...

Tuesday, March 25, 2008

The legislators came back to Sacramento this week after spring break... and it's getting frantic, quick. Bills (see the Health Access bill list) introduced this year only have a few weeks to pass their first policy committee.

While the budget and policy committees continue their regular work, the most interesting and high-profile hearing this week will probably be the Senate Health Committee, chaired by Senator Sheila Kuehl, hold a special Thursday session.

The hearing is entitled "Consumer Protection under the California Department of Managed Health Care: Adequacy of Implementation and Enforcement," is expected to take several hours and maybe more.

The issues to be discussed at this informational hearing are meaty, as it asks for reports on the DMHC's implementation of regulatons in many areas of strong interest to consumer advocates, including timely access, so-called "discount health plans," rescissions, language access, and mental health parity.

We're posted some about the pending regulations to ensure patients have timely access to care. A month ago, Senator Kuehl urged the Department to withdraw their proposed regulations, stating that they were not in line with the legislature's intent when passed AB2179. The author, Assemblywoman Rebecca Cohn, has been termed out, but Health Access California was a sponsor, and Senator Kuehl was a member of the Legislature that voted for it.

But it's clear that this hearing is about more than just timely access--or even about the other key issues. It's about being clear that the DMHC should be focused on consumer protection as its core mission--it's the reason that the DMHC was created in the first place. There's too many important issues for anything else to get in the way.

Labels: DMHC, Kuehl, Sacramento, TimelyAccess

posted by Anthony Wright | Permalink | 3:55 PM


 

Congratulations...

Thursday, February 28, 2008

to the Speaker-elect of the California Assembly, Karen Bass.

She has familiarity with health care issues, serving on the Assembly Health Committee and being part of Speaker Nunez's leadership team on health reform in the past year. Prior to her election to the Assembly, she founded and created the well-regarded Community Coalition, and so is steeped in her experience in community organizing, and in needs of the neighborhoods of Los Angeles, for health care and otherwise.

Assemblyman Mark Ridley-Thomas and others have their assessments and reactions.

Labels: Sacramento

posted by Anthony Wright | Permalink | 9:11 PM


 

Legislative leadership...

Friday, February 08, 2008

From all the reports on the various political blogs, it seems that both Speaker Fabian Nunez and Senate President Pro Tem Don Perata will hold their leadership posts for the remainder of the legislative year.

In terms of afterwards, there's lots of possibilities for the race to replace the Assembly Speaker, but there will be a first vote on March 11th.

Congratulations to Senator Darrell Steinberg on being the next choice of Senate President Pro Tem. Folks in health advocacy are very familiar with him for his authorship of the universal children's coverage bill; his leading advocacy on mental health issues, and his leadership on budget and appropriations committees, of which health care issues always loom large.

Labels: Sacramento

posted by Anthony Wright | Permalink | 12:10 AM


 

The hearing on health cuts...

Monday, February 04, 2008

HEALTH ACCESS UPDATE
Tuesday, February 5, 2008

SENATE PANEL WEIGHS PROPOSED BUDGET CUTS
• More than $1.6 billion in general fund cuts to the neediest families
• Senate Budget Committee reviews provider rate cuts, QSRs, cuts of "optional" benefits
• Absent health reform, senators reflect on sinking status quo
• ALSO: President Bush unveils federal budget; Reminder: VOTE TODAY

More on the Health Access WeBlog: More on the State Budget Cuts and Committee Hearing; Analysis on President Bush's Budget and Proposed Cuts to Medicare, Medi-Cal and SCHIP; The Presidential Candidates and their Experience with Health Issues; Dusting Off After California's AB x1 1 Stalls; Post-Mortems Galore for Health Reform;


The Senate Budget Committee met Monday to comb through $1.6 billion in proposed health budget cuts, which would force the state’s poorest residents to overcome bureaucratic burdens to keep their coverage, and leave many residents without access to eyeglasses, hearing aids, teeth cleaning or incontinence creams and ointments. And that's not including the biggest cuts aimed at the health providers on which all Californians rely.

Some cuts, Chairwoman Denise Ducheny classified as “knee-jerk” policies, and lamented that “some of these savings are so small, we’re spending more time talking about them than what they’re worth,’’ specifically in that instance referring to the $251,000 to be saved (out of a $141 billion budget) by eliminating adult psychology services.

CALIFORNIA’S BUDGET BLUES

Lawmakers need to make big decisions about these and other programs by March in order to avoid a statewide financial catastrophe, such as defaulting on loans, on July 1. The state is short about $14.5 billion.

California’s perennial budget problem is particularly acute this year because the state has papered over its budget deficits for most of the past decade – borrowing internally from funds it shouldn’t have, deferring payments – several times – that were later ruled illegal, selling bonds to pay off its debt, and reversing the Vehicle License Fee. The latter two make up $9 billion of the $14.5 billion deficit.

Gov. Arnold Schwarzenegger proposed a budget that cuts spending by 10% across the board. See Health Access’ Fact Sheet on the proposed budget cuts at our website, or view the Senate Budget Committee’s analysis of budget impact here:
http://www.senate.ca.gov/ftp/SEN/COMMITTEE/STANDING/BFR/_home/20408SbfrAgenda.pdf

Medi-Cal, whose recipients earn less than approximately $17,600 annually for a family of three, would weather the bulk of health reductions -- $1.1 billion -- for the current and 2008-09 fiscal year. The biggest ticket cuts in health services are:

* Rate reductions for providers who care for Medi-Cal recipients; California already ranks 41st out of 50 states in reimbursement rates.
* Elimination of certain benefits for roughly 3 million adults with Medi-Cal coverage, such as eyeglasses, incontinence creams and dental coverage;
* Reinstatement of quarterly status reports for Medi-Cal, forcing children and adults to renew their coverage and justify their income and eligibility every three months.

Healthy Families enrollees would also face higher co-pays and restrictions on their dental benefits.

WHAT KIND OF STATE DO WE WANT?

Budget Committee Chairwoman Denise Ducheny and other lawmakers shook their heads, muttered under their breaths and interrupted the Administration’s staff with questions and assertions, during the afternoon hearing that stretched late into the evening.

Some cuts seemed antithetical -- such as eliminating optometry services (but not more expensive opthamology services), and eliminating eyeglass and contact lens benefits for those who obtain the more-expensive eye-prescriptions from opthamologists.

According to some Senators, some cuts just seemed wrong. At one point, a dejected Sen. Joe Simitian after hearing about rashes, lesions and other discomfort resulting from not having incontinence creams, said, “Every now and again, we have to stop ourselves and say, ‘What have we come to?' We’re talking about people in need. This is just to save $4.7 million. At some point, you just need to stop yourself and to say, ‘What the hell have we come to? Is this really what we aspire to be as a state?’’’

The state that California would become, if the budget cuts are enacted, is the kind that would kick 160,000 children off Medi-Cal because their parents did not, for some reason, submit the proper paperwork every three months.

During one exchange about quarterly status reports, lawmakers hammered staff about the true intent of such a policy.

“Do you have evidence that things like that change on a quarterly basis?’’ Ducheny asked.“We do have evidence that it changes the enrollment,’’ responded administration staff impassively.

“That’s not the question,’’ quipped Ducheny. “The question is, ‘How likely is it that people’s status is actually changing versus ‘Sure, it changes the enrollment because someone didn’t turn in a piece of paper.’’’

Sen. Darrell Steinberg summarized: “We need to be clear about what is happening. [Quarterly status reports] are a pretext for hoping that adults, who may be confused, disabled, or unable to figure it out will not fill out the paperwork and that thei children will suffer.’’

“On it’s face, [filling out the paperwork] is not an unreasonable thing. But when you know that it will lead to children being thrown of the rolls, that’s not the right policy.’’

SPECTER OF HEALTH REFORM RESURFACES

Monday’s health budget hearing came one week after Senate Health Committee members – of which two budget committee members also participate – failed to pass comprehensive health reform, which would have injected the state with approximately $14 billion in new money, allowed the state to avoid cuts to health programs, and expanded health coverage to nearly three-quarters of the uninsured.

ABx1 1 garnered one “aye’’ vote, while three Democrats voted ‘no’ and three abstained. All Republicans rejected the measure. Lawmakers cited budget and economic concerns as the reason they could not push the proposal forward.

Sen. Alex Padilla, after nearly two hours of testimony, urged his colleagues to view health reform and its connection to the budget. “The critique of the financing of that bill didn’t make a whole lot of sense when put up against the proposed cuts in the budget,’’ he said. “By the same token, the proposed cuts don’t make sense, if indeed, we’re going to pursue and achieve an improvement in the healthcare system. As much as people would like to suggest they’re not linked, in fact, they are.’’

LEGIONS OPPOSE CUTS

Several dozen recipients and beneficiaries of the state’s programs, as well as advocates and various consumer and professional organizations, stepped forward to oppose the cuts.

Patients spoke of the need for podiatrists to monitor diabetes patients, adults to continue to receive preventive dental cleaning and procedures, and dually eligible Medi-Cal/Medicare recipients to have their $96-a-month Medicare premiums paid for through Medi-Cal.

Lawmakers on the panel were particularly impressed with one witness, who communicated by typing words into a computer, and allowing the computer to “read’’ what he had “said.’’ Such speech therapy equipment would be unavailable under the proposed cuts.

“These ‘optional’ benefits aren’t really ‘optional’ for everybody,’’ Ducheny acknowledged.

The committee on Monday heard testimony about the cuts, but will not make a decision until later this spring.

Health Access will continue to provide updates on budget negotiations throughout the year.

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

Labels: Budget, Sacramento, Updates

posted by Anthony Wright | Permalink | 11:58 PM


 

Subprime Monday...

What comes between Super Sunday and Super Tuesday?

Subtraction Monday.

The California Senate Budget Committee held a umpteen-hour hearing on the health care budget cuts, the last hearing on specific cuts before putting together a mid-year cuts package. Hanh will have a full report later today.

President Bush put out his new budget today, and it's also not pretty.

For starters, he proposes $560 billion in cuts from Medicare over the next decade. Here's Families USA:

Following up on his indefensible veto of the kids' health bill, President Bush proposed inadequate funding for the State Children's Health Insurance Program (SCHIP). Under the President's proposal, the program could not even continue to serve the children currently eligible for the program. The President also proposes drastic cuts to Medicare and Medicaid. These public programs offer health security for many families and are more important than ever when we face hard economic times.

The President's solutions for the rising cost of health insurance and the growing numbers of uninsured follow three simplistic principles:
* Ask people to pay more out of their own pockets for health care;
* Create tax breaks that provide little or no help to low-income families;
* Provide no government oversight of the behavior of insurance companies.

This budget, like many over the last seven years, offers clear insight into the Bush Administration's priorities for our health care system — priorities that place working Americans at risk.

Here's the Center for Budget and Policy Priorities, from their budget brief, well worth reading in full:

The President's budget would provide more tax cuts heavily skewed to the most well-off while cutting vital services for low- and moderate-income Americans, generating large deficits, and increasing the strain on states already confronting budget problems as a result of the economic downturn. The budget reflects misguided priorities that would leave the American people more vulnerable in a number of ways....

MEDICAID: In addition, the budget would cut federal Medicaid expenditures by $18.2 billion over five years (with $17.4 billion in reductions from legislative changes and another $800 million from regulatory changes). These “savings”
would primarily be achieved not by lowering health care costs, but rather by shifting costs to the states.

MEDICARE: In addition to the Medicaid cuts, the budget includes $556 billion in Medicare reductions over ten years. Many of the proposed cuts go well beyond the reductions that MedPAC, Congress’ expert advisory commission on Medicare payments, recommended and considers safe. These reductions could drive some health care providers to limit the number of Medicare patients they see or drop out of the program entirely. That, in turn, would jeopardize health care for significant numbers of people who are elderly or have serious disabilities... At the same time, the Administration rejected MedPAC’s call to curb the tens of billions of dollars of overpayments being made to private insurance companies that serve some Medicare beneficiaries through the Medicare Advantage program.

SCHIP: The budget includes what it describes as a $19.7 billion increase in funding for the State Children’s Health Insurance Program (SCHIP). This would not, however, allow states to cover more uninsured children, millions of whom are eligible for SCHIP and Medicaid but unenrolled. States need an increase of approximately $21.5 billion over the next five years simply to maintain their current programs. This is because the budget “baseline” for SCHIP includes no adjustment for health care inflation in coming years; the baseline actually assumes a reduction in SCHIP funding for 2009. Under the Administration’s funding level, therefore, states would be required to scale back their SCHIP programs modestly unless they were able to increase their own funding.

We have a lot of work to do in the new year, at both the state and federal levels...

Labels: Budget, Bush, Sacramento

posted by Anthony Wright | Permalink | 9:24 PM


 

Hot off the Presses -- For the Nerdiest in Nerdland

Tuesday, January 22, 2008

Exciting news. The Federal Register today released its 2008 Poverty Level Guidelines. For most people, this means nothing. But for those who work with/around public programs, these numbers dictate who's in and who's out for Medicaid, SCHIP, food stamps, and other public programs.

Find them here: http://aspe.hhs.gov/poverty/08poverty.shtml

Also, Health Access likes to do a spreadsheet that shows annual and monthly income at different levels, which you can find here.

Our lobbyist Beth Capell likes to carry a miniature version in her wallet for quick reference, and has trained me to do the same.

Labels: Research, Sacramento

posted by Hanh Kim Quach | Permalink | 3:21 PM


 

Expected but disappointing....

Friday, October 12, 2007

It's not often that any Governor has a chance to help millions of Californians with a stroke of the pen, but he just missed that opportunity minutes ago with the veto of AB8.

With his pen, he could have made coverage more available and affordable for millions of Californians, whether through on-the-job benefits, through public programs, or the individual insurance market. We'll see what he is willing to put in its place.

This is the fourth time in four years that the Governor Schwarzenegger has blocked a major health care reform that would have significantly expanded health coverage for over a million Californians:

* the Governor campaigned against Prop 72 to expand worker coverage in 2004;
* he vetoed AB772 to expand children's coverage in 2005;
* he vetoed SB840 to expand coverage to all Californians through a single-payer system in 2006; and now
* he vetoed AB8 that would have comprehensively expanded health coverage and that included financing in 2007.

With his history of vetoes on health, the Governor needs to show flexibility and not just keep proposing what he set out in January.

WORDS VS. ACTIONS: He says he wants reform, but vetoes the bills that pass the Legislature.

He says he only will sign a universal coverage proposal, but his proposal is neither universal nor coverage—it doesn’t even define what coverage is. He says he wants only comprehensive reform, but he sets a standard that his own proposal doesn’t meet.

He says he is willing to negotiate and be flexible, yet ten months into the process, he has just put out language, and it doesn’t move much from his January proposal.

AB8 DESCRIPTION: AB8(Nunez/Perata) was a comprehensive health reform package that would expand health coverage to over 95 percent of Californians in the state -- and would be the most sweeping coverage expansion in four decades.

Unlike the Governor's plan, which requires a 2/3 vote or a ballot measure, AB8 can be passed and financed as a majority vote, allowing it to get to the Governor's desk.

AB8 would have made significant strides toward universal health coverage. Once enacted, 95 percent of Californians would have health coverage.

* The full text of the bill is here,
* Health Access’ comprehensive fact sheet on AB8 is here.
* Health Access' analysis of the current barriers for consumers in getting coverage, and how AB8 (and SB840) would have addressed those issues, is available on our website, here.
* Health Access letter to the governor on AB8 is here.

KEY PROVISIONS: The high points of AB8 include:
· Expands Medi-Cal and Healthy Families to cover all children, and most parents, who are citizens/legal residents up to 300%FPL.
· Creates a statewide purchasing pool initially for employees and dependents of employers that choose to use the purchasing pool. A new, affordable option for employers to cover their entire workforce, the purchasing pool would cover an estimated three to four million people.
· Establishes a minimum employer contribution to spend 7.5% of payroll on health benefits, either by paying into the purchasing pool or buying health insurance or other health benefits.
· Establishes a ceiling – at 5 percent of income - for what consumers are required to pay annually for health costs (including premiums and out-of-pocket costs).
· Reforms the individual insurance market so that coverage is available to anyone who wishes to purchase, by limiting insurers ability to deny people based on “pre-existing conditions,” and providing better funding coverage for those that are denied.
· Brings in new federal dollars to California ’s health system, through these expansions of public programs and employer contributions.
· Offers workers tax savings, by providing the ability to pay premiums, or share-of-premiums, with pre-tax dollars, for a savings of 15-40%.
· Places other rules and oversight on insurers, including limiting the percentage of premium dollars that go to administration and profit, rather than patient care.
· Provides modest reforms of job-based coverage to make it more accessible and affordable for employers.
· Encourages use of health information technology and disease management.
· Encourages cost savings through a bulk purchasing of prescription drugs, transparency of medical cost and quality information and creates a public insurer option to compete with private insurers to help keep premiums low.

AB8 SETS A GOOD FOUNDATION

AB8 (Nunez/Perata) is a comprehensive approach to both expand health coverage, and to secure coverage for those who have it, but are concerned that it won’t be there for them when they need it.

It seeks to make health coverage more available, affordable, and automatic in each of the three ways that consumers now get coverage: through employer health benefits, public coverage programs, and the individual market.

Passage and enactment of AB8 would have been historic, as it would be the biggest health care expansion of since the creation of Medicare 40 years ago; it would set a minimum employer contribution for health care, as significant as the establishment of the minimum wage 70 years ago.

The proposal includes “shared responsibility” financing from employers, workers, state and federal government, and insurers. As a majority vote bill, it can be enacted into law with simply the Governor’s signature, without the need for additional financing or special federal waivers.

If the governor wants something different or include different elements that would improve the bill, such as the Medi-Cal rate increase (and related hospital), he should start with the framework of AB8 and add to that.

Labels: Legislation, Sacramento, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 5:00 PM


 

Governor introduces health reform language....

Tuesday, October 09, 2007

After 10 months, Gov. Arnold Schwarzenegger released the highly anticipated legalese to accompany his 10-page health reform concept paper released in January. This 220-page draft seems to have grown since last week, when a 195-page version was circulating for comments. My colleague Anthony posted comments and analysis about last week's language -- which was not claimed by the governor -- here and here and remains relevant to the latest document.

Here's a quick take on some of the new elements of the plan:

One new wrinkle: All employers -- not just those with more than 10 workers -- would be required to contibute to employee health care. Businesses would be asked to contribute, based on a sliding scale, of between 1 and 4 percent. AB8 (Nunez/Perata), which is the Legislative leaders' proposal, requires a 7.5 percent minimum contribution from employers. Ken Jacobs at the UC Berkeley Labor Center explains in this Sacramento Bee editorial why that 7.5 percent figure is important. (Essentially, businesses in the state already contribute an average of 8 percent and we shouldn't lower the bar and allow businesses to abrogate their current responsibilities.)

Another new thing this week seems to be the addition of revenues from the state lottery. The governor's idea is to lease the operation of the lottery to a private company (though he specified that the concept did not involve privatizing the lottery), which would -- i suppose -- sell more tickets and make more money? This idea, Schwarzenegger said, is meant to supplant talk of a sales tax increase.

Lastly, Bill Ainsworth at the San Diego Union Tribune asked the governor about affordability. Under this plan, Californians earning more than 350% of poverty ($72,275 for a family of four), would be responsible for buying their own coverage without any help at all (either subsidies or tax breaks). Such a family -- in today's insurance market -- could spend nearly $7,000 a year on premiums alone. The premiums alone are nearly 10 percent of the family income. And that's for coverage that isn't that great ($3,000 deductible, $500 prescription drug deduction, and $10,000 out-of-pocket maximum).

The governor conceded that affordability was an issue, "We need to help people especially if it costs more than 5 percent'' of their income. All the figures in the current bill, he said, are up for negotiations.

Stay tuned for more....

Labels: Affordability, Legislation, Sacramento, Schwarzenegger, YearOfReform

posted by Hanh Kim Quach | Permalink | 10:32 PM


 

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."