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

Wednesday, June 25, 2008

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

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

HEALTH ACCESS UPDATE
Thursday, June 26th, 2008


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

posted by Anthony Wright | Permalink | 6:57 PM


 

An Unhealthy Trend

Tuesday, June 10, 2008

75 million adults -- that's 42% of working age adults in the US -- had no insurance or really bad insurance (the kind that makes you pay up the nose anytime you sneeze) in 2007.

That's up from 35% of working age adults that were uninsured or underinsured in 2003, the first time Health Affairs did this analysis. A new analysis -- out today!-- updates the study from five years ago.

Among the findings:

• 25 million people who were technically "insured'' actually have really crappy insurance (that amounts to one-fifth of the entire "insured'' population)
• The number of adults earning between $40k and $60k who were underinsured nearly tripled from 5% to 13%.
• The number of adults earning more than $100k and were underinsured (meaning that they spent more than 10% of their income on out-of-pocket medical expenses) increased from 1% to 7%.

The series of studies is important because until recently, most analyses only tracked the number of people without coverage and how lack of coverage impacts a person's ability to stay healthy. Just as important now, though, is this tracking the number of people with inadequate insurance. High deductibles, high co-pays, high co-insurance and high out-of-pocket costs cause patients to behave in similar ways to a person who is uninsured -- they forgo care because of the expense.

Insurance companies like to argue that these low-quality, low-premium plans are at least a backstop to keep people from going into bankruptcy. But as our previous study has shown, people don't have much in the way of assets -- and a $5,000 deductible would wipe out the savings of 40% of Americans. Health Affairs (obviously a nerd's must-read publication) also recently published a study that showed uninsured families earning more than 300% of the poverty level had less than $4,000 in liquid assets. (Here's our blog post on that study).
From our perspective, being underinsured means you're paying premiums to be functionally uninsured. All in all, we don't really buy the insurance company logic on this and think they should be labeled and limited (and the most egregious ones banned) -- as SB 1522 would do.

Labels: Research, Underinsurance, Uninsured

posted by Hanh Kim Quach | Permalink | 11:32 AM


 

Dressing up the Individual (Market)

Monday, June 09, 2008

As we continue to struggle with how to get more people coverage, I'd suggest a look at this Kaiser Family Foundation report from February. The study looks at people who can't get public coverage and aren't offered insurance through their jobs.

Among the findings:

• At 400% of poverty, the outer limit of an income that could qualify for subsidies in California (under last year's health reform discussions), only 25% of family purchased coverage on the individual market.
• At 1000% of poverty, fewer than half (49%) of families purchased coverage.

Self-employed families, who receive tax credits on the premiums took up coverage at ever-so-slightly higher rates:

• At 400% of poverty, about 30% purchased coverage
• At 1000% of poverty, 58% took up coverage

The study, however, did not take into consideration the regulatory atmosphere -- whether individuals *wanted* to buy coverage, but were denied because of pre-existing conditions, or priced out because of their health histories -- all important factors as we go forward.

So the upshot is this: health coverage on the individual market isn't that attractive to lots of people and policymakers are going to have to find a way to make it more so, including subsidies that "may need to extend higher up the income scale than some policymakers may prefer.''

Labels: Affordability, Insurers, Research, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 11:46 AM


 

We knew her when...

Sunday, June 01, 2008

The effort to win national health care reform is heating up: lots of planning meeting and activities to ensure that there is a mandate for a new President and Congress to take this issue on, and to be ready to roll in 2009.

Consumers Union (a Health Access California board member) is spearheading a Cover America Tour: an RV that will criss-cross the country for four months, collecting stories about the issues that people have with the broken health care system.

The effort has a website and blog of interest, which includes a video of the launch of the Cover America Tour from Consumers Union's Yonkers headquarters, being cheered by staffers from the labs that test all those products that are evaluated in Consumer Reports. It should be an interest and informative trip, that I urge folks to follow along on the web.

The video prominently features the energetic Meg Bohne (pictured above, crouching), a Health Access alumnus, who has told me she give us partial credit (or blame) for her current assignment. On the website page that describes the whole enterprise, Meg Bohne cites her experience as a "a seasoned community activist, advocate and organizer, Meg has come to specialize in on-the-road campaigns in vehicles that have spanned a bus, an ambulance and, now, an RV." At left is the ambulance she drove up and down the state of California for Health Access, in the cause of lower prescription drug prices.

We wish Meg and the whole crew at Consumers Union luck in their trip and their effort. We look forward to hearing the stories, the personal health care experiences, and the adventures on the road!

Labels: ExpandingCoverage, Federal, HealthAccessCommunity, Underinsurance, Uninsured

posted by Anthony Wright | Permalink | 2:02 AM


 

Why today matters...

Friday, May 30, 2008

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

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

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

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

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

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

Labels: Budget, MediCal, Uninsured

posted by Anthony Wright | Permalink | 9:44 AM


 

The new/renewed conversation on health reform...

Friday, May 23, 2008

“When you come to a fork in the road, take it,” said Yogi Berra.

It’s a lesson that health reformers can take to heart after reading the May issue of The American Prospect, which has a special section on “the path to universal health care.” The articles reflect heated debates, some spanning decades, on the preferred type of health reform; the best strategies and messaging; whether to pursue reform at the state or federal level; and how prevention can be a cornerstone for reform. My sense is we need all of the above: multiple efforts on different tracks and different venues—to meet this challenge.

There’s agreement on a couple of things, including the absolute urgency for reform. Many people are uninsured, or concerned their coverage won’t be there for them when they need it. Lack of adequate health coverage has direct health and financial consequences. The uninsured—and underinsured—live sicker, die younger, and are one emergency away from financial ruin.

A couple of the articles debate the kind of health reform to pursue and point out issues with experiments like the Massachusetts reform and Medicare. I was privileged to contribute an article on some of the lessons learned from the debate in California, and about how we can be ready for the next round.

We have a new window of opportunity in 2009 to confront these issues, with a new President and new Congress. While California had a health reform effort stall recently, there is enough support and momentum that the window for comprehensive reform will re-open at the state level as well, with new legislative leaders and a Governor who still wants to pursue big reform in his last two years. In California we have an opportunity to pursue state reform, to both bolster and shape federal efforts, alongside our own direct pursuit of a national solution.

So will we be ready? Yes, if we learn lessons from our multiple-year experience in California, and help educate our friends around the nation. We Californians have much to tell: no other state has had such a robust discussion of health reforms in the past five years. Our legislature has advanced multiple reforms—expansions of job-based coverage, universal children’s coverage, a single-payer system, and a comprehensive “shared responsibility” approach—and all these ideas are still on the table.

To be ready, we need to lay the foundation this year. Proposed budget cuts would take us backwards in terms of access to health care. The budget—and current programs like Medi-Cal and Healthy Families--are the foundation on which health expansions will be built. While shoring up the budget with new revenues, we can also pass other policy reforms that are building blocks toward universal coverage.

Most of all, we need to plan and prepare for the next stage of the great health debate—as previewed in The American Prospect. We have a real opportunity in the next year or two and we need to take it.

(Cross-posted at Bob's Blog, as a guest post on the new and renewed conversation on health reform, at the website of The California Endowment, an important funder for the Health Access Foundation and many key health programs and organizations in our state.)

Labels: InTheNews, OtherBlogs, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 12:11 PM


 

Senate Committee says No to Prescription Drugs

Wednesday, May 21, 2008

The Senate budget subcommittee that oversees the state's health budget voted to eliminate funding that would have implemented the California Discount Prescription Drug Program.

As many may recall, health advocates went through a bruising battle against Big PhRMA in 2005 ($80 million spent against us) on the ballot, and then won a year later when Gov. Arnold Schwarzenegger signed the bill and even had a fancy signing ceremony in the Capitol Rotunda.

The discount drug program would have allowed the state to negotiate discounted drug prices from pharmaceutical company, helping approximately 5.4 million uninsured families -- the people who now pay FULL PRICE for prescription drugs -- buy drugs at fairer prices. If drug companies did not give satisfactory discounts, then the state could have used the purchasing power of Medi-Cal to leverage lower prices.

Californians below 300% of poverty ($63,600 for a family of four) would have been able to buy drugs at 40-60% off the sticker price. While that's still more than many of us pay for our drugs (insured Californians often pay a fixed co-pay), it's still a lot less than what they pay without the program.

So that means middle-income and low-income Californians, who are already seeing the substantial reductions in their health benefits through public programs for their children, and schools, will now have to pay more for drugs.

Labels: Budget, Drugs, Schwarzenegger, Uninsured

posted by Hanh Kim Quach | Permalink | 11:22 AM


 

Find the solutions, not blaming the victim...

Tuesday, April 15, 2008

"Don't Blame Crowded ERs on the Uninsured" is the pitch-perfect headline of an article by Suzanne Bohan in the San Mateo County Times and other papers.

The articles reports on a UC-San Francisco study that reports that asks "Are the Uninsured Responsible for the Increase in Emergency Department Visits in the United States?" and answers "no." In fact, the "proportion of adult ED visits by persons without insurance was stable across the decade," roughly in the 14-15% range.

Despite the belief that the uninsured are the majority of those crowded in our emergency rooms, I note that this figure is a bit lower than the overall percentage of uninsured people in the country, which is around 16%.

This is consistent with other findings, such as a 2004 Urban Institute report by researchers Zuckerman and Shen on ocassional and frequent ER users. That paper concludes, in part, "The uninsured and the privately insured adults have the same risk of being frequent users... It seems hard to blame the overcrowding of EDs on the uninsured."

MISSING THE MESSAGE: Some conservative commentators will use this research to attack the notion that of a "hidden tax" that we all pay in our premiums for having such a large uninsured population, and to attack the notion of health reforms and coverage expansion generally. I get a very different lesson from the study.

I too have been a skeptic of the Governor Schwarzenegger's "hidden tax" rhetoric, because it led people to blame the uninsured for high health costs, rather than the reverse.

If the uninsured go to the emergency room, they have only a right to be stabilized. But even then, they get a bill--typically the biggest bill they will see in their lives, and often one that is inflated well above what an insurer would pay for the same service. No wonder they may actually go to the ER less.

LOTS OF FACTORS: That said, there's nothing inconsistent with saying that the uninsured, when they finally do go to get care, are in a worse condition since they let their conditions linger and mestatisize, costing the health system more money in the long run. Or that the uninsured get the bill, but some face bankruptcy not being able to pay, and as a result leave the hospital unpaid.

In other words, I think the real world in health care is more complicated than one cause. Some uninsured get the care they need. Others go without and simply die. And in between, some uninsured wait until the problem gets worse. And some of these factors end up costing the health system. So reforming health and increasing coverage is needed and urgent, even for the regular, insured California.

SOLUTIONS: So how much is the "hidden tax?" I don't know, but it's real. But I think the focus should be on fixing the system, not the victims of that system:

* We all pay when McDonald's, Wal-Mart, or Applebee's don't, when some employers don't pay their fair share. Those who are uninsured are those who fall through our health system that relies on voluntary employer contributions.

* We should ensure that those who are uninsured are not overcharged and thus discouraged from getting needed care. California passed a fair hospital pricing law in 2006, and other protections would be helpful.

* We who are *insured* would not go to the emergency room as much if we had the ability to get timely access to care to primary care and specialists. There's pending regulations for insurers and providers at the California Department of Managed Health Care.

Our health care system doesn't have just one problem, and doesn't have just one solution. The new research helps us understand that.

Labels: ExpandingCoverage, Hospitals, Research, TimelyAccess, Uninsured

posted by Anthony Wright | Permalink | 10:45 PM


 

Fake Plans

Monday, April 14, 2008

One of the bills Health Access is watching that's up in Senate Health Committee this week is SB1603 (Calderon), which would authorize the state to license and regulate so-called discount health cards.

We question the very existence of these things. Not only do they annoyingly clog up the fax machine (you've seen those strange health "insurance'' offers), but they rely on consumer naivete to make money.

Their sin is that they're incredibly deceptive and provide questionable -- if any -- value to consumers. Discount health plans entice consumers with words like "no pre-authorization,'' "no pre-existing condition denial,'' and "no waiting period." They exaggerate their value, promising low prices -- discounts of as much as 80% -- at a vast "network'' of providers.

But often, neither is true. Consumers have no idea what the price for which the "discount'' is based on, rendering the discounts essentially meaningless -- and often, they could have received the discount anyway if they told the provider they were uninsured.

Mila Kofman, health policy expert formerly of Georgetown University, also tested out some cards and found that nearly three-quarters of providers contacted did not even realize they were part of the "provider'' network. Complaints filed against these cards in California show a similar patern.

Kofman's research also finds that the monthly cost for the identical card can range from $54.95 to $120 because of the pyramid-esque marketing for these products. Cancelling the cards can also be tricky, as many continue to charge a former subscriber's credit card even after they consumer quit the service.

Sadly, SB1603 would create a way to allow these fake plans to operate legally and continue to bilk consumers.

Boo.

Labels: Insurers, Underinsurance, Uninsured

posted by Hanh Kim Quach | Permalink | 10:27 AM


 

Only in LA?

Friday, April 11, 2008

For those who were not able to witness Senate Health Committee in person, this week, it's not always as boring as you might think.

Committee Chair Sheila Kuehl and Sen. Dave Cox had an interesting exchange during testimony of our bill SB1522, which would help organize the individual insurance market and place caps on out-of-pocket costs. Most importantly, it would help weed out junk coverage and require at least mimimum coverage of doctor's office visits and preventive care.

Kuehl shared a story of a caller on a radio show who had ambulance workers lay a bill on her chest as she was being wheeled into the hospital emergency room.

"Surely,'' snorted Sen. Dave Cox, R-Fair Oaks, "they would do no such thing.''

Responded Kuehl: "Yes, Sen. Cox. And a hospital in LA would surely not dump patients on Skid row in the middle of the night.''

"Well...'' grunted Cox. "Maybe in Los Angeles.''

Labels: Legislation, MedicalDebt, Underinsurance, Uninsured

posted by Hanh Kim Quach | Permalink | 2:12 PM


 

Consequences

Tuesday, April 08, 2008

An interesting comment from Medi-Cal director Stan Rosenstein at the budget subcommittee hearing yesterday on the elimination of adult dental benefits for Medi-Cal recipients.

“…People could go to the emergency room if they’ve got dental pain,’’ he
said.

And they will.

Is that really the best place for a toothache?

Labels: Budget, MediCal, Uninsured

posted by Hanh Kim Quach | Permalink | 9:56 AM


 

Dying for Coverage

Thursday, April 03, 2008

California likes to be first at everything. Unfortunately, according to a new series of state-by-state reports by Families USA, we're also first when it comes to deaths due to uninsurance. You can find this sinister stat at Dying for Coverage in California.

They show that:

• Every day, more than eight Californias die due to lack of coverage;
• In 2006, 3,100 uninsured Californians died;
• Between 2000 and 2006, 19,900 uninsured Californians died.

Other macabre findings include the fact that twice as many people died because they were uninsured than died from homicide. The study augments an early report by the Institute of Medicine, which found 18,000 Americans die annually because of uninsurance.

Why do people die for lack of insurance? Let's see -- in a generic nutshell: They're afraid to go to the doctor because it will cost money. They don't get the proper tests done to make sure they don't have cancer or chronic disease. They don't get the proper prescriptions filled for asthma or diabetes. They get sicker. They feel awful, but are too afraid to seek help because of the cost...then it's too late.

So what to do about this?

Well -- first, we wait about 10 months, according to U.S. Representative Pete Stark of California on a conference call releasing the report this morning. Specifically, we wait 291 days give or take a few hours and minutes to be exact for the departure of our sitting president, who Stark says is the “one individual in the U.S. who has done more to disadvantage people …particularly those with low incomes.’’ Specifically, with respect to regulations on who can qualify for Medicaid (Medi-Cal), expansions of children’s insurance, government negotiation for prescription drugs – you name it.

Next, we laud the seating of either (in no particular order) him or her. And then we see if the federal goverment stops being a hindrance to state efforts to provide universal coverage to children and expanded access to low-income families and adults. We'll have issues with him and particularly his health plan, which would atomize the health insurance market and to essentially raise taxes -- against his promise to do such -- for every American who receives coverage through work.

Then, we get back to work.

Labels: PresidentialCandidates, Research, Uninsured

posted by Hanh Kim Quach | Permalink | 11:05 AM


 

Coverage matters...

Wednesday, April 02, 2008

There are real health consequences to being uninsured.

Because it's in the Metro Section, this article by Steven Magagnini of the Sacramento Bee might be overlooked, but it shouldn't be.

It makes the point by focusing on the death of Melelea Tausinga, a leader in Sacramento's Tongan community, who was uninsured and didn't get the care she needed.

"People who do not have health insurance delay much needed medical care, are more likely to forgo care because of costs, and when they do finally show up for care the conditions they have are often far more severe," James said. "They are more likely to show up with late stage cancer."

That's what happened to Tausinga, said her husband, Tevita Tausinga...

Melelea Tausinga, mother of four and grandmother of seven, not only gave herself to her community, she worked for more than 10 years as motel maid, then as teaching assistant at Susan B. Anthony Elementary, where her granddaughters attend. Neither job provided health insurance.

She kept working even after she started complaining five years ago about severe pain. "She told me to touch her stomach," her husband said.

"It was something like a stone but it was little. The main thing is, we didn't have money. She finally went to a doctor last May after we got Medi-Cal."

The doctor told her she had a cancerous tumor, but it took three months before her daughter-in-law Brianna Tausinga lined up a surgeon who would take Medi-Cal.
"They pretty much said we caught it too late," said Brianna Tausinga

The article further talks of the lack of health coverage in California's growing Asian-American community, referring to a new report by the Kaiser Family Foundation and the Asian Pacific Islander American Health Forum, an important ally and Health Access California board member.

The issue of uninsurance is acute for Latinos and Asian-Americans--but it's a big issue for all of us.

Labels: InTheNews, Research, Uninsured

posted by Anthony Wright | Permalink | 10:57 PM


 

New Paper. Old Problem.

Wednesday, February 06, 2008

Health Affairs has a new report this week about how hospitals recover a higher percentage of their charges from uninsured patients than those on Medicare.
On average, the prices uninsured patients paid in California, from 2004-05, were 20% more than Medicare.

Of course, advocates have tried to deal with this issue in past years -- in 2005 securing a signature on AB774 (Chan), which, among other goals, essentially bans overcharging of the uninsured and ties their rates to Medicare.

It will be interesting to see an update on this study looking at rates after the law's implementation in 2006. We're getting mixed reports from the field about whether hospitals are properly advising uninsured (and underinsured) patients of their rights to apply for discounted rates, and whether information about the policies are properly posted. We also have no idea if patients are getting the reduced rates.

In the meantime, also because of AB774, the Office of Statewide Health Planning and Development (yes, it's a mouthful) has launched its own website on hospital fair pricing. (and yes, we know the URL is really awful and makes no sense) that allows consumers to search hospital discount policies in their area.

Labels: InTheNews, Research, Underinsurance, Uninsured

posted by Hanh Kim Quach | Permalink | 3:30 PM


 

Charmingly Third World

Wednesday, January 09, 2008

I know we have very talented smart, physicians, scientists and researchers in this country that make America's health care system the greatest. But it's a total waste to have an amazing arsenal of doctors if the people who need to see them can't.

A new article in Health Affairs this month says the US is dead last among industrialized nations in preventing deaths from amenable diseases (those illnesses that can resolved with good healthcare, such as whooping cough, tuberculosis, treatable cancers, diabetes, bacterial infections, etc.)

For a full list of what's considered an "amenable illness," click here. My personal favorite is euphemistic "misadventures to patients during surgical and medical care."

Some interesting stats:

• In 1997, the US ranked 15th among OECD countries in amenable mortality, with a rate of 114.7 deaths out of 100,000
• In 1997, the US fared better than Finland, Portugal, UK and Ireland.
• In 2002-03, the US ranked last (19TH) among OECD countries in amenable mortality, though our rate improved to 109.7 deaths per 100,000
• Other countries improved their rates by up to 20%, while US improved by only 4%

There are many reasons people die from diseases and illnesses that are treatable, but one of those reasons is lack of insurance -- people deferring or skipping care until it's too late and the cancer as spread, etc.

Perhaps most interesting is the number of preventable deaths annually. IF the US achieved the same mortality rate as other industrialized nations, between 75,000 and 101,000 Americans would survive annually. That's at least four times higher than the figure we often cite from the Institute of Medicine, which describes how 18,000 people die annually due to uninsurance.

Ironically, we also learned this week that the amount the US spends per capita has increased to $7,026 -- a collective $2 trillion plus annually -- more than any other industrialized nation.

So WHAT exactly are we getting with our money?

Labels: International, InTheNews, Uninsured

posted by Hanh Kim Quach | Permalink | 5:00 PM


 

Balancing roles...

Tuesday, December 18, 2007

All year, we at Health Access have been balanced multiple goals in the "Year of Health Reform."

The first is to provide the information, the reporting, and the policy analysis to help our member and allied organizations be involved in the health policy debate. A primary role is to provide the best possible resources so that groups can most effectively advocate for their members and constituencies. This blog has been part of that effort, and we hope advocates and activists have found it useful, in addition to our direct work to influence policy, as organizers and advocates.

The other balancing act has been to be *for* reform and keep the momentum for reform up through the course of the year, while at the same time being vigilant in our consumer advocacy role of protecting our constituency from--which are all of California's health care consumers--all 36 million of them.

The Governor's original plan made that a significant challenge, since it included some good reform elements but with untenable burdens on some consumers, and other issues of concern.

I am far more enthusiastic about AB x1 1 as a framework, but we will continue to solicit assurances as we move forward, not just to clarify policies for consumers, but to assure voters at the polls, which will be very important.

Our continued advocacy on specific issues like affordability is in the context of actively supporting the overall reform, and moving it forward--the sad and sagging shape of the status quo demands it. But this means our work isn't done. Not by a long shot.

Labels: ExpandingCoverage, Legislation, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 1:58 AM


 

Those with the least get charged the most...

Saturday, December 08, 2007

For years, we've made the case that the uninsured actually get charged *more* than anybody else in the health care system. Because they don't have the group purchasing power of an insurer or a public program, those typically with the least get charged the most--the "sticker price" which the insurers and public programs always pay less than.

Our advocacy over the past few years has been to correct this with regard to drugs (last year's AB2911) and hospital bills (last year's AB774). And now there is some movement on doctor's visits. Barbara Feder at the San Jose Mercury News reports on a new lawsuit against ER doctors.

When we did our work against hospital overcharging, we found that uninsured patients would typically get several bills from an emergency room visit, not just from the hospital but from the ER doctor, any specialist that was involved in the care provided, the ambulance company, etc. While the hospital bill was by far the biggest bill (and because these smaller providers seem to be more aggressive in billing and collections), patients were likely to pay the smaller bills first, without realizing it was also inflated.

Lieff Cabraser, the law firm, had done some of the previous class actions against hospital chains like Sutter and Catholic Healthcare West, which resulted in settlements for consumers. So this is no frivolous lawsuit.

Labels: Hospitals, Uninsured

posted by Anthony Wright | Permalink | 5:49 PM


 

Willing, but Unable....

Tuesday, November 27, 2007

An article in this month's Health Affairs (subscription required) breaks down why the U.S. Census Bureau's statistic pointing out that one-third of "higher income'' Americans is uninsured is misleading. The Census statistics are an important source for health coverage data and is also used by the federal government to allocate funds.

In 2006, according to Census statistics, more than one in every three Americans (37.8%) lived in a household with income higher than $50,000.

But, the Health Affairs article points out"...many of the uninsured who live in higher income households do not fit a profile of "financially able but unwilling.''

Moments when income is "high" could be a temporary, as with self-employed or transient workers. So are moments of uninsurance, when a person is between jobs.

Additionally, "households'' does not equal "one family.'' Many of these "households" have many generations living under one roof: adult children at home who are contributing to the family income, but are not allowed to glom onto their parents' policy; parents living with their adult children, who need to purchase separate policies. Adults in "high income'' households could also be in roomate situations, and therefore need separate policies. So if you separate out the individual family units, earnings are far below the $50,000 to $75,000 mark.

That's why the debate about affordability of health care in this year's reform efforts is so essential. Policymakers need to find a way to help this middle-income group, sandwiched between super-poor and super-rich find affordable and meaningful health coverage.

As the report shows, being uninsured is not a symptom of being "young, invincible'' and brazen as many would like to believe, but more because insurance simply costs too much for people who are trying to survive by pooling their resources and huddling under one roof.

Labels: Affordability, InTheNews, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 8:00 AM


 

Reason #6,089 to reform health care -- this year

Monday, November 26, 2007

The California HealthCare Foundation released its annual "Snapshot: California's Uninsured" today and it's grim.

Middle-income families are becoming uninsured faster than any other income-bracket in the state, the report says. Since the beginning of the decade, the number of families earning between $50,000-$75,000 and are uninsured has increased by 3.1%.


This is a really important point because $75,000 is between 350% to 450% of poverty (depending on family size) -- the level at which policymakers are discussing cutting off eligibility for tax credits to help keep the cost of health care affordable. The guv wants he cut-off at 350%, the Democrat leaders want it at 450%. This latest information, to me, makes a convincing argument for the higher threshhold. If the trend continues, as we expect it to, we can only expect more and more middle-income people to be uninsured in future years if something is not done.

Other interesting -- and sobering factoids:

• Since the beginning of the decade, 5.9% fewer Californains are getting their health coverage through work. Instead, they're getting it primarily from really expensive individual policies (up 2.6%), Medi-Cal (up 2.1%), Medicare or are uninsured.
• Young adults -- ages 25-34 -- experienced the biggest jump in uninsurance since 2000.
• Latinos are three ties as likely as whites to be uninsured.

Labels: Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 12:03 PM


 

What's he been doing all month?

Monday, October 08, 2007

So the governor's finally gotten moving on the bill signings, with less than a week left and 596 bills to swipe his pen across.

In today's list, we have SB350 (Runner), requested by debt collectors, which makes minor technical changes to the landmark AB774 (Chan) anti-hospital overcharging bill last year. Health Access, Consumers Union and Western Center on Law and Poverty closely monitored the bill to make sure the new law, AB774, was not diluted in any way. Health Access took a neutral position on the bill.

As many may recall, consumer advocates scored a major victory -- after five years -- last year when Gov. Arnold Schwarzenegger signed legislation that would ban hospitals from charging uninsured and underinsured patients thousands and tens of thousands of dollars for services that they charged insurance companies just a fraction (like 25% of what the uninsured paid). Uninsured and underinsured patients can now pay the same rate as Medicare.

To read more about AB774, click here.

Labels: MedicalDebt, Underinsurance, Uninsured

posted by Hanh Kim Quach | Permalink | 5:08 PM


 

More than you think...

Thursday, September 20, 2007

How many people are uninsured? The answer depends on the question. Typically, the established Census number for California is around 6.5 million. That's what came a few weeks ago

There's also the California Health Interview Survey from UCLA: they have a similar number for those who are uninsured at some point in a given year. The modelers, however, use a different number from that data: 5 million, or the number who are uninsured at any given time.

But how many people experience uninsurance over the course of two years? In fact, it's a much bigger number. As my colleague Hanh indicates, Families USA and the Lewin Group put out a report today, using Census data, that shows that nearly 13 million Californians had a gap in coverage over the past two years.

The highlights:
* 40.5% of Non-Elderly Californians Were Uninsured During 2006-2007
* 12,987,000 Californians Were Uninsured At Some Point Over the Past Two Years
* Two-Thirds (65%)-8,557,000--Were Uninsured for Six Months or More

This study is unique in that it quantifies the people who experience uninsurance over two years, rather than one year, or at a single point in time. In this way, it shows how our current health system leaves many more people at risk than is commonly assumed--and that there is potentially a bigger base for reform.

This study shows why even people with coverage are concerned it is not going to be there for them when they need it. That's why expanding health coverage is so important: Many of the reforms on the table here in California would reduce these gaps, and provide more security, by expanding group coverage, and reforming the individual market.

Labels: Research, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 11:25 AM


 

A nudge/shove to get something done...

National health advocacy organization, Families USA released a report today entitled "Wrong Direction: One Out of Three Americans are Uninsured,'' which features California in fourth place for the highest percentage of uninsured in a two-year period.

Specifically, in the 2006-07 time frame, 13 million Californians are likely to be uninsured at some point in time. This jives with the 6.5 million uninsured at some point annually.

That means 40.5 percent of Californians under 65 find themselves without health coverage at some point during a two-year period. Could be a month. Could be three months. Or, for 8.6 million, it's longer than 6 months, the study finds.

This number has grown since the beginning of the decade, when 11 million were uninsured over a two-year period (or 35 percent of the population).

Why is this happening? Why are the ranks of uninsured growing? Simple.

* Health insurance is more expensive.
* Fewer employers are offering coverage.
* There's less money for public programs to cover the poor or near-poor.

That's why it's a good thing that we're all still ready *i hope* to keep talking about health care this year. At least 13 million are ready.

Labels: HealthAccessCommunity, InTheNews, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 11:18 AM


 

Diverging paths

Wednesday, August 29, 2007

What I found interesting/sad about the census report released yesterday is this: While incomes are nudging upwards, the number of people with insurance is falling.

It seems counterintuitive -- that as more people broke into the ranks of middle-income earners, they'd be guaranteed coverage. But in fact, that is what we are fighting now. It's not just low-income who are being left behind, it's the middle-income as well.

Which is why it makes no sense to me that President Bush is trying to deny children in middle-income families ($42,000 for a family of four) coverage.

Which is why it makes no sense to me that Gov. Schwarzenegger's solution is to get middle income famillies ($52,000 for a family of four) to buy coverage that would put 24% of such a family's income on the hook should someone break their arm, or be diagnosed with cancer.

And which is why it makes no sense to me that some lawmakers are saying nothing can be done to help these people this year.

Labels: Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 7:28 AM


 

What price would you pay for health....

Thursday, July 26, 2007

Studies have already shown us that the uninsured live sicker and die younger.

The uninsured pay at least four times as much (in California) -- and sometimes more -- for a visit to the emergency room.
The uninsured pay the highest prices for prescription drugs.
The uninsured delay care because of these costs, resulting in gradually worsening conditions. The uninsured are 25 percent more likely to die then those with insurance.

In addition to all the aforementioned setbacks (including dying), the LA Times yesterday described how the uninsured now have waits of longer than a year for critical services -- such as gallbladder or hernia operations.

"If it's not life-threatening when we start, it certainly could be by the time we finish,'' said Judi Rose, vice president at North Holywood's Valley Community Clinic.

This story is particularly interesting in light of comments made by a number of lawmakers this year about health care -- and rationing. Many have said that a universal health care system would result in long lines -- and people not getting the care they need when they need it.

I wonder what they'd call this.

Labels: Hospitals, Underinsurance, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 3:28 PM


 

Health care on aisle 5...

Wednesday, July 18, 2007

The LA Times reports that grocery workers have reached a tentative agreement with Southern California's supermarket chains, avoiding strikes that crippled the industry for 141 days in 2003-04.

While neither side has said what agreements were reached, the Times reports that new workers would not have to wait as long to become eligible for health insurance. During the last contract, new employees had to wait 18 months (and their families nearly three years) before getting health coverage.

The result is that health coverage for workers fell to 54 percent (from 94 percent), according to the UC Berkeley Center for Labor Studies. Turnover also increased to 32 percent (from 19 percent.)

According to the Times, the new waiting period would be 6 months. If this is true, it's a significant step.

Among those who are working and uninsured, 25% are not eligible for coverage by their employers -- either because they are in waiting periods or are a classification of employee that does not qualify for benefits.

Often, these are low-wage workers who would literally have to choose between putting food on the table, paying utilities and rent. There's no way they could afford premiums for coverage purchased on their own -- the most expensive way to buy coverage.

Stay tuned for more details on the grocery worker contract.

Labels: Employers, Uninsured

posted by Hanh Kim Quach | Permalink | 10:17 AM