Bills before break...

Thursday, June 26, 2008

HEALTH ACCESS UPDATE
Thursday, June 25th, 2008

HEALTH BILLS LIVE AND DIE BY THE COMMITTEE
* Health legislation heard in final policy committees before July break
* Bills pass to require 85% of premium to go to patient care; regulate recissions; foster a public insurer; discourage "never events," encourage hospital community benefits.

Click Here for What's New on the Health Access WeBlog: Continued Real-Time Budget Conference Committee Reports; The Perils of "Junk" Insurance; Gender Discrimination in the Individual Insurance Market; The Mortgage Metaphor for SB1522; Improving Medicare with a Phone Call.


With tomorrow's deadline for legislation to have cleared policy committees in the second house, lawmakers heard a battery of bills this past week. Key pieces of legislation of interest to health advocates were also on the agenda. Many of the bills advocates have been tracking passed.

Following is a list of the bills heard this week and the outcome. Additionally, advocates may visit the Health Access website, at http://www.health-access.org/advocating/2008_bills.html for a complete list of bills.

The following bills passed in Assembly Health Committee, chaired by Assemblyman Mervyn Dymally, on Tuesday:

* SB 1198 (Kuehl): DURABLE MEDICAL EQUIPMENT: Would require group health plans and insurers to offer coverage for durable medical equipment, such as wheelchairs and shower seats. Support
* SB 1440 (Kuehl): CAPPING ADMINISTRATION AND PROFIT: Would set a minimum medical loss ratio – requiring every insurer to spend at least 85 percent of premiums on patient care. Would also require plans to report how much they spend on health care versus administration on each single product they offer. Support
* SB 973 (Simitian) PUBLIC INSURER: Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices.
* SB 1300 (Corbett): CONFIDENTIALITY CLAUSES: Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contracts between providers and insurers. Support
* AB 1351 (Corbett): DISTRICT HOSPITAL OVERSIGHT: Would require Attorney General oversight into transactions involving district hospitals. Support

The following bills passed in Senate Health Committee, chaired by Senator Sheila Kuehl, on Wednesday:
* AB 2146 (Feuer): ‘NEVER EVENTS’: Bans providers from billing patients or insurers when they have made an avoidable mistake, such as operating on the wrong person, prescribing the wrong drugs, or leaving foreign objects inside a surgery patient. Support
* AB 2549 (Hayashi) RECISSION TIME LIMIT: Would impose an 18-month time limit in which insurers have to rescind individual health care policies once consumers’ applications are approved. This bill was amended from previous versions, which limited the time frame for rescission to the first six months. Watch, seeking shorter time limit.
* AB 2569 (De Leon) RESCISSION AND BROKER ACCOUNTABILITY: Ensures that family members whose coverage depends on that of the rescinded person may be offered another individual policy. Also requires brokers who take applications to attest, under penalty of perjury, that the information is complete and accurate to the best of their knowledge. Support.
* AB 2697 (Huffman) BOUTIQUE HOSPITALS: Would require so-called “boutique hospitals’’ to asses their impact on a community’s health system annually, specifically whether they siphon doctors, workers, providers from general acute hospitals caring for less affluent populations. Support
* AB 2942 (Ma) COMMUNITY BENEFITS: Would standardize what non-profit hospitals report as “community benefits” to justify their non-profit status. Support

The Legislature will now take a break from committees while budget negotiations are expected to continue throughout July. Both houses will resume committees on August 4. These bills will need to pass fiscal committees by August 15th and the final floor votes by August 31. If they pass through the Legislature, the Governor will have the month of September to decide to sign or veto the bills.

Health Access will continue to track the progress of this legislation in the coming months. For information, please contact the author of this report Hanh Kim Quach at hquach@health-access.org.

Labels: Hospitals, Insurers, Legislation, Updates

posted by Anthony Wright | Permalink | 1:28 AM


 

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


 

Lots of Key Bills Pass 2nd House Health Committee...

Wednesday, June 18, 2008

HEALTH ACCESS UPDATE
Thursday, June 19th, 2008


BILLS CLEAR HEALTH POLICY COMMITTEES IN OPPOSITE HOUSE
* SB1522 to ban junk insurance passes Assembly Health Committee
* AB1945 would impose new rules on insurers who cancel insurance policies
* AB2967 to collect cost and quality data from medical providers passes

Click Here for What's New on the Health Access WeBlog: Continued Real-Time Budget Conference Committee Reports; A Predictable LAO Analysis on Single-Payer; Following the Bills in Health Committee; Also: Thursday June 19th Events: San Francisco Lunchtime Rally Against AHIP & Insurance Companies; Los Angeles TCE Panel Discussion on Health Reform


Key bills of interest to health advocates were heard in the last two days, in, respectively, the Assembly Health Committee, chaired by Assemblymember Mervyn Dymally, and Senate Health Committee, chaired by Senator Sheila Kuehl.

Hundreds of bills that passed the house where they were introduced must now clear the second house; and the first step of that is to pass policy committees by June 27. A number of bills that would benefit health care consumers were in Assembly and Senate Health committees this week, including a number of key bills that would lay the foundation for comprehensive health reform in the next couple of years. An updated list of bills is available on the Health Access website, at:
http://www.health-access.org/advocating/2008_bills.html

INSURANCE STANDARDS: Among those bills was SB1522 (Steinberg), sponsored by Health Access California, that would weed out junk insurance from the individual insurance market by ensuring that every plan covered doctor, hospital and preventive services. It would also place a cap out-of-pocket costs. The bill would organize the market into five tiers so that consumers could make apples-to-apples comparisons between plans and require that pricing of those plans was consistent with the level of benefits the plans offered.

In an interesting admission, the Association of California Life and Health Insurance Companies noted that "more transparency would be good." This bill passed out of Assembly Health Committee with little debate on a party line vote. It heads next to the Assembly Appropriations Committee.

On Wednesday, the Senate Health Committee heard more bills being tracked by health advocates including:

DEBATE ON ANTI-RESCISSION BILL

AB1945 (De La Torre) would create an INDEPENDENT REVIEW process when an insurer wishes to rescind a consumer’s health insurance policy. The Department of Managed Health Care and Department of Insurance would also have the final say on whether a policy could be rescinded. Lastly, the bill would standardize health plan questionnaires for consumers applying for coverage in the individual market.

The issue of rescissions has received much attention in the past couple of years as the LA Times and other papers have written a number of stories about patients who have had their policies unilaterally cancelled while in the middle of expensive chemotherapy or other medical treatments. Rescissions (or reviews to rescind coverage) have been triggered when a patient begins an expensive course of treatment, and then insurers have allegedly scoured applications looking for a rational to deny their care--any hint that the consumer omitted information about their health status--whether related to the current treatment or not.

Earlier this year, the Department of Managed Health Care had 1,200 policies that were illegally cancelled reinstated. Kaiser, who supported the bill, was one of the insurers that agreed to a settlement with the state to reinstate coverage for rescinded patients. HealthNet--and annoucned earlier today, Pacificare--also reached agreements with the DMHC.

A number of health plans did not oppose, but had concerns about two issues. First, they preferred not to have a uniform questionnaire, but rather a "menu'' of approved questions from which they could pick and choose so they could control the length and scope of the application. Secondly, health plans did not want all rescissions to automatically go to independent review, but rather something that the consumer could opt out of. While some consumer groups, including Health Access California, supported the bill, some organizations raised concerns about the impact on consumers' rights to bring a court proceeding against health plans. The bill heads next to the Senate Judiciary Committee, where some of these questions will be addressed. The bill passed on a bipartisan vote.

DEBATE ON TRANSPARENCY BILL

Another bill heard Wednesday that would help lay the foundation for comprehensive reform in the coming years is aimed at collecting data so that skyrocketing health care costs could be better controlled. Medical errors cost millions annually and result in thousands of unneccessary deaths.

AB 2967 (Lieber) would provide greater TRANSPARENCY AND DISCLOSURE for health care purchasers. The bill would require public reporting of cost and quality by doctors, hospitals HMOs and others in the health care industry. In order to funnel health care dollars more appropriately into treatments that work, the state needs to first gather data. Recognizing that there are many factors that contribute to a patient's health, the data would be adjusted to take into account income, geography, cultural and linguistic issues and other factors.

Collecting data, said author Assemblywoman Sally Lieber, would be "better than driving in the dark with no headlights, which is what we're doing now.''

In an unusual coalition, consumer, labor and business groups all joined together to support this. The California Association of Health Plans were also in Support if amended. Some of the questions that arose came from representation on the baord that collects the information. As constituted in the bill, providers make of half of the board, while consumers, labor and employers make up the other half.

Strong opposition came from the physicians and hospitals, however, who said they did not want "non-scientific people'' collecting data and "releasing it to the public.'' Providers did not trust that data would properly take into account the fact that some patients are poor and have many health issues. Assemblywoman Sally Lieber, however, countered that information to be collected will take into account poverty, health status and cultural issues, which will then be factored in reporting, which can be measured and adjusted. Studies about health disparities that contain this information are regularly published and the data that would be collected through this bill would help the significant work in place now to reduce the health disparities seen in race and income.

Sen. Sheila Kuehl acknowledged the fear that providers had, but said "I like the idea of data collection and knowing to be able to compare.'' The bill passed.

OTHER KEY BILLS: Other bills heard in Assembly or Senate Health Committee this week included the following, listed by bill number (author name) VOTE OUTCOME in Commitee. SHORT DESCRIPTION. Description of Bill. Position of Health Access California:

* SB 1168 (Runner): PASSED Assembly Health. DEPENDENT COVERAGE. Would allow adult dependent children, who are still covered under their parents’ health plan, to stay on that coverage even if the child takes a medically necessary leave of absence from school. Support.
* SB 1633 (Kuehl): PASSED Assembly Health. DENTAL DEBT PROTECTIONS Would prohibit dentists’ offices from offering high-interest loans to patients while they are under the influence of anesthesia. Would also prohibit dental offices from charging lines of credit before services have been rendered. Support.
* SB 1525 (Kuehl): PASSED Assembly Health. MEDICAL NECESSITY. Requires health plans to explain how they determine medical necessity. Also requires health plans to report their rates of denial of care or modifications to care because of medical necessity. Support.
* AB 1203 (Salas) PASSED Senate Health. EMERGENCY ROOM BILLS: Would prevent emergency departments – which do not have a contract with a patient’s insurance company -- from directly billing the patient, requiring the hospital to seek payment directly from insurers. Support
* AB 1887 (Beall) PASSED Senate Health. MENTAL HEALTH PARITY: Would require health plans to provide coverage for all diagnosable mental illnesses. Support.
* AB 1962 (De La Torre) PASSED Senate Health. MATERNITY COVERAGE: Would require all individual insurance policies to cover maternity services. Support.
* AB 2220 (Jones) PASSED Senate Health. BINDING ARBITRATION: Requires providers and health plans to resolve contracting and payment disputes through binding arbitration. More on this legislation must be resolved in the Senate Judiciary Committee. Watch.
* AB 2400 (Price) PASSED Senate Health. HOSPITAL CLOSURES: Would require public notice before closing a hospital. Support
* SB 1096 (Calderon): FAILED Assembly Health. PRESCRIPTION INFORMATION. Would allow pharmacies to send mailers to consumers about the drugs they have been prescribed without the patient’s authorization. Oppose.

A final wave of legislation will be heard next week before the June 27th policy committee deadline. Health Access will keep advocates updated on the progress of consumer-related health bills.

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

Labels: Insurers, Kuehl, Legislation, Updates

posted by Anthony Wright | Permalink | 9:50 PM


 

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


 

The budget stage is set.

Sunday, June 01, 2008

HEALTH ACCESS UPDATE
Friday, May 30th, 2008


ASSEMBLY, SENATE BUDGET COMMITTEES VOTE OF PROPOSED CUTS (FOR NOW)

* Assembly and Senate budget committees vote to reject severe cuts to Medi-Cal, including major denials of coverage to working parents & others, elimination of dental & other benefits. Votes would also restore some of the provider rate reductions.
* Significant cuts agreed to by at least one committee include: Cuts to public and private hospitals, counties, health plans; increases in Healthy Families premiums; additional reporting for children; increased premiums for seniors
* Clear choice in budget debate moving forward: Hundreds of thousands of Californians denied coverage & care, or an alternative to a cuts-only budget that includes revenues.

Click Here for What's New on the Health Access WeBlog: Floor Reports on Health Bills Passing This Week; Ongoing Updates from Budget Committees; What Makes Coverage Coverage?; Health Reform in Obama's First 100 Days?; and more...


After a busy week on the floor, Senate and Assembly budget committees topped off the week with simultaneous hearings and votes on outstanding health budget items. A number of items that were left open in previous months while committees vetted the issues were either modified, approved or rejected Friday morning (listing below).

Health Access has posted a Health Care Budget Cuts Scorecard, which details the Governor's proposed cuts, and for each cut, the budget savings, the number of people impacted, and the actions by the Assembly and Senate today. The scorecard is here, at:
http://www.health-access.org/preserving/Docs/Health%20Access%20-%20BudgetScorecard%20053008.pdf

BUDGET BLUES

The Senate Budget Committee, chaired by Senator Denise Ducheny, and the Assembly Budget Subcommittee on Health and Human Services, chaired by Assemblywoman Patty Berg, both voted to approve or reject the many health care cuts proposed by Governor Schwarzenegger in the May Revision of the budget. That budget sought to bridge a $17.2 billion shortfall in a $100 billion general fund budget without raising taxes.

While no action is final until a final budget is approved and signed into law, both the Assembly and Senate committees rejected many of the Medi-Cal cuts to eligibility and benefits as too severe, and both proposed restoring some of the provider rate cuts made earlier in the year.

At the same time, both committees did vote to approve other cuts proposed by the Governor, and other cuts. Cuts approved by at least one committee included cuts to hospitals, cuts to counties, cuts to Healthy Families health plans; caps in benefits; increases in Healthy Families premiums; additional reporting requirements for children; and increased premiums for seniors.

Health Access is posting summaries on its blog, at www.health-access.org/blogger.html.

WHAT’S NEXT

In the Senate, the budget committee’s proposal will head to the floor for a vote. In the Assembly, the full Assembly budget committee will still need to approve each sub-committee’s proposal before being perfunctorily approved by both houses with the intent that the conference committee -- made up three budget committee members from each house – will reconcile differences between each house’s working proposals. The Legislature is supposed to finish working on its budget June 15th, but that has only happened five times in the past 40 years.
The fiscal year begins July 1 – a mere 30 days from now -- and there is no expectation that California will have a budget on time.

ACTIONS TAKEN FRIDAY

Below is a listing of major decisions made by the Assembly Budget Subcommittee on Health and the full Senate Budget Committee. For a full list of actions taken this year, click here.

* Direct denial of coverage to very low income working parents: Would have denied coverage to parents earning wages between $11,000 and $18,000 a year (for a family of three). A parent would need to work fewer than 100 hours a month in order to qualify. REJECTED by both houses.
* Quarterly Status Reports for children and adults: Would have required Medi-Cal recipients to report any changes in their life every three months. Currently, children only have to report annually, and adults every six months. MODIFIED by Senate to require reports every six months for both children and adults. REJECTED by the Assembly.
* Medi-Cal rate reimbursement: Approved earlier this year, will reduce reimbursements to Medi-Cal doctors by 10%. California already ranks near the bottom (43rd) on reimbursements for providers in this program. Both houses sought to restore this already-made cut: REDUCED to 5% reduction by Senate. REVERSED by Assembly.
* Reduced benefits for legal immigrants: Legal immigrants who currently receive comprehensive Medi-Cal benefits would lose all but four services: emergency, pregnancy, some long-term and cancer care. REJECTED by both houses.
* Monthly reporting for immigrants: Would require undocumented immigrants to establish their eligibility for limited emergency Medi-Cal services every month. REJECTED by both houses.
* Elimination of dental benefits for adults on Medi-Cal: Would have eliminated the ability for adults on Medi-Cal to receive cleanings, crowns, filling or other oral surgery unless a physician treated them. REJECTED by both houses.
* Eliminate vital services for Medi-Cal recipients: Adults would no longer be able to see an optometrist, fill eyeglass prescriptions, obtain hearing aids, get speech therapy, treat sores caused by incontinence, see a podiatrist, chiropractor, acupuncturist or psychologist. REJECTED by both houses.
* Require very low-income seniors to pay more for their health care: Would have required seniors who earn $1,100 a month to either pay $100 premium for coverage to see their doctor, or spend half their monthly income on healthcare. MODIFIED by both houses to continue to pay premium for enrollees who do not pay $500 a month for health services.
* Premium increase for some Healthy Families subscribers: Would have increased Healthy Families premiums between 27% and 77% for subscribers between 151 to 250 percent of the poverty level. MODIFIED by both houses to increase premiums by half the amount proposed.
* Co-payment increase for Healthy Families subscribers: Families between 151 to 250% of the poverty level would pay $7.50 (rather than $4) for “non-preventive’’ services, such as prescriptions, some emergency room visits, some doctors visits, eye exams and glasses, therapy and dental work. REJECTED by both houses.
* Capping Healthy Families dental benefit: Would limit dental coverage to $1,000 per enrollee. MODIFIED. Both houses increased the cap to $1,500.
* Shifting money away from public hospitals: Takes federal money used for public hospitals to pay for unrelated programs. REJECTED by the Senate. REJECTED by the Assembly.

No action, including the rejection of cuts in both houses, is final unless the final budget is approved and signed into law by the Governor. However, the actions to reject many of these cuts sets the stage for the budget debate this summer: whether to deny care and coverage to millions of Californians, or whether the state raises the revenue to prevent these cuts. That's the clear choice.

Health Access will continue to track budget actions on the floors and in conference committee during the budget season. For more information, contact the author of this report, Hanh Kim Quach at hquach@health-access.org

Labels: Budget, MediCal, SCHIPHealthyFamilies, Schwarzenegger, Updates

posted by Anthony Wright | Permalink | 1:01 AM


 

Health reform lives on in Sacramento...

Tuesday, May 27, 2008

HEALTH ACCESS UPDATE
Tuesday, May 27th, 2008


KEY HEALTH BILLS PASS FLOOR VOTES IN CALIFORNIA LEGISLATURE
* Senate Passes SB1522 (Steinberg), Standardizing Insurance & Prohibiting "Junk" Coverage
* Assembly Passes AB2967 (Lieber), Providing Transparency on Cost and Quality of Care
* Also: Bills Pass to Regulate Insurers on Rescission, Maternity Coverage, Mental Health Parity, and Requiring 85% of Premium for Patient Care

* More on the Legislative Debate and much more at the Health Access WeBlog (www.health-access.org/blogger.html):


Health reform continues to be a hot topic at the State Capitol. Passing their first floor vote and the half-way point in the California Legislature, key health bills would provide patients with new information and needed consumer protections regarding their care and coverage.

The Assembly and Senate passed several key health care bills, including ones to protect consumers from "junk" insurance; to increase transparency about the cost and quality of care; to regulate the practice of retroactively denying coverage to patients; and to mandate coverage of maternity and mental health services. The health reform conversation is alive and well.


The following bills passed:


INSURER OVERSIGHT

* STANDARDIZING INSURANCE: SB1522(Steinberg), eliminating "junk" insurance and standardizing the insurance market to allow for "apples-to-apples" comparison for consumers. The bill would set a minimum benefit standard for coverage by requiring coverage to have an overall cap on out-of-pocket costs, and cover doctor, hospital, and preventative care. It would sort health insurance policies into five coverage categories, ranging from “comprehensive’’ to “catastrophic." Here's a fact sheet, and a patient story that illustrates the issue.

Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing. The bill would also prevent consumers from not understanding their coverage, or having "junk" coverage where they are paying a premium by are still facing unlimited financial exposure. Sponsored by Health Access California. (Passed by the Senate 22-16 with most Democrats in support; Ducheny and Ridley-Thomas not voting; Correa voting no.)


* MEDICAL LOSS RATIO: SB1440(Kuehl), to require that at least 85% of premium dollars go to patient care, rather than administration, marketing and profit. The proposal seeks to ensure that consumers are getting value for their dollar. (Passed by the Senate 22-16, with most Democrats in support, with Machado and Simitian not voting, and Yee voting no.)

* RESCISSIONS: AB1945(De La Torre), to require insurers to get an independent review before retroactively denying coverage from patients. (Passed the Assembly 57-16, with significant bipartisan support.) Also passing was AB2549(Hayashi) which sets a six-month time limit for insurers to rescind once consumers' applications are approved. (Passed the Assembly 44-26.)

BENEFITS


* MENTAL HEALTH: AB1887(Beall) to expand the requirement on insurers to cover mental health services. (Passed by the Assembly 44-26, with most Democrats in support, and with Arambula, Mullin, Calderon, Galgiani not voting; Soto absent.)

* MATERNITY: AB1962(De La Torre), to require insurers to cover maternity benefits. (Passed the Assembly 44-31, with most Democrats in support; Soto absent; Galgiani not voting; and Calderon and Parra voting no.)


PROVIDER OVERSIGHT

* TRANSPARENCY: AB2967(Lieber), to require better data from health providers and plans to increase the transparency of the cost and quality of care. This effort has yielded one of the most interesting coalitions, with strong support by prominent consumer, labor, and business groups--all purchasers of health care trying to get a better sense of what they are getting for their money. (Passed by the Assembly 41-32, with most Democrats in support but Soto absent; Fuentes, Krekorian, Ruskin, Portantino, Solorio not voting; and Arambula voting no.)

* DISTRICT HOSPITAL TRANSACTIONS: SB1351(Corbett), to require Attorney General oversight over district hospital sales and closures. (Passed the Senate 24-14, with most Democrats in support, and Scott not voting.)

Health Access will continue to track these and other bills on our website, at
http://www.health-access.org/advocating/2008_bills.html

Labels: Hospitals, Insurers, Legislation, Updates, YearOfReform

posted by Anthony Wright | Permalink | 7:46 PM


 

A big week for legislation...

Saturday, May 24, 2008

HEALTH ACCESS ALERT
Saturday, May 24th, 2008


FLOOR VOTES NEXT WEEK FOR KEY HEALTH BILLS
* All bills must clear first floor vote by May 30th--next Friday.
* Action Alert: Letters/Calls Needed ASAP

Click Here for What's New on the Health Access WeBlog: Update on Appropriations Committee; Getting Ready for Reform, Renewed: The American Prospect's Special Edition; MRMIB's Decision on Waiting Lists and Disenrollments; More on the Budget


Enjoy this three-day weekend; next week promises to be a doozy. While budget committees will work away on various budget proposals, the full Assembly and Senate floors will be active. All bills must pass their first floor vote by May 30st. Many bills supported by health consumer advocates will be up for a vote next week.

BELOW is a list of health consumer bills--it will be updated on the Health Access California website as the session continues, at http://www.health-access.org/advocating/2008_bills.html


For every bill, the list includes the bill number (the author) and A SHORT DESCRIPTION IN CAPS: There's also a longer description of the legislation, Health Access California's position on the legislation, and finally, where the legislation is currently pending.

ACTION ALERT: Voice your support. Submit letters to lawmakers on legislation on either the Senate or Assembly Floor.

*Note: Bills in bold and with an asterisk need letters of support. The other bills have already passed the floor vote of the first house, or were stalled and will not be advancing this year. Those that are in bold and with an asterisk are expected to be considered and face this key hurdle in the next week.

BILL LIST

Insurer Regulations

Insurance Oversight & Market Reforms
+ *SB 1522 (Steinberg) INSURANCE MARKET STANDARDS: Would sort health insurance policies into five coverage categories, ranging from “comprehensive’’ to “catastrophic.’’ Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing, and assist consumers in making apples-to-apples comparisons between plans. Would weed out “junk’’ insurance by developing minimum benefit standards. Sponsor-Support. Location: Senate Floor.
+ AB 1554 (Jones) RATE REGULATION: Would regulate insurance rates. Amend. Location: Senate Health.
+ *SB 1440 (Kuehl) CAPPING ADMINISTRATION AND PROFIT: Would set a minimum medical loss ratio – requiring every insurer to spend at least 85 percent of premiums on patient care. Support. Location: Senate Floor


Rescissions
+ AB 1150 (Lieu) BONUSES: Would outlaw the industry practice of paying bonuses to insurance company employees when they rescind policies, for setting targets for rescinded policies and/or setting financial goals based on savings on health care claims. Support. Location: Senate Health.
+ *AB 1945 (De La Torre) INDEPENDENT REVIEW: Would require approval by Department of Managed Health Care or Department of Insurance for each individual rescission. Support. Location: Assembly Floor
+ *AB 2549 (Hayashi) TIME LIMIT: Would impose a six-month time limit in which insurers have to rescind individual health care policies once consumers’ applications are approved. Support. Location: Assembly Floor


Benefit Mandates
+ *AB 1887 (Beall) MENTAL HEALTH PARITY: Would require health plans to provide coverage for all diagnosable mental illnesses Support. Location: Assembly Floor
+ *AB 1962 (De La Torre) MATERNITY COVERAGE: Would require all individual insurance policies to cover maternity services. Support. Location: Assembly Floor
+ SB 1198 (Kuehl) DURABLE MEDICAL EQUIPMENT: Would require group health plans and insurers to offer coverage for durable medical equipment, such as wheelchairs and shower seats. Support. Location: Assembly Health.


Improved Insurance Options
+ AB 2 (Dymally) HIGH RISK POOL: Would reform the Managed Risk Medical Insurance Program, which provides coverage for “un-insureables” who have “pre-existing conditions.’’ Efforts would make the high risk pool more affordable and available. Support Location: Inactive, Senate Floor
+ SB 1622 (Simitian) PUBLIC INSURER: Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices. Support Location: Held in Senate Appropriations Committee.


Health Care Providers

Transparency: Cost and Quality Data
+ *AB 2967 (Lieber) TRANSPARENCY AND DISCLOSURE: Would require public reporting of cost and quality by doctors, hospitals HMOs and others in the health care industry. Support. Location: Assembly Floor.
+ *SB 1300 (Corbett) CONFIDENTIALITY CLAUSES: Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contracts between providers and insurers. Support Location: Senate Floor.
Doctor and Hospital Oversight
+ *AB 2146 (Feuer) ‘NEVER EVENTS’: Bans providers from billing patients or insurers when they have made an avoidable mistake, such as operating on the wrong person, prescribing the wrong drugs, or leaving foreign objects inside a surgery patient. Support. Location: Assembly Floor.
+ *AB 2942 (Ma) COMMUNITY BENEFITS: Would standardize what non-profit hospitals report as “community benefits” to justify their non-profit status. Support. Location: Assembly Floor
+ *SB 1633 (Kuehl) DENTAL PREDATORY LENDING: Would prohibit dentists’ offices from offering high-interest loans to patients while they are under the influence of anesthesia. Would also prohibit dental offices from charging lines of credit before services have been rendered. Support. Location: Senate Floor.


Hospital Transactions
+ AB 2400 (Price) HOSPITAL CLOSURES: Would require public notice before closing a hospital. Support. Location: Senate awaiting committee assignment.
+ AB 2697 (Huffman) BOUTIQUE HOSPITALS: Would require so-called “boutique hospitals’’ to asses their impact on a community’s health system annually, specifically whether they siphon doctors, workers, providers from hospitals caring for less affluent populations. Support. Location: Senate awaiting committee assignment.
+ *AB 2741 (Torrico) HEALTH IMPACT ANALYSIS: Would require for-profit hospital sales to undergo health impact analyses to gauge the transaction’s effects on the affected community, health care services, and the community’s public interest. Support. Location: Assembly Floor.
+ *SB 1351 (Corbett) OVERSIGHT: Would require Attorney General oversight into transactions involving district hospitals. Support. Location: Senate Floor.


Balance Billing
+ AB 1203 (Salas) EMERGENCY ROOM BILLS: Would prevent emergency departments – which do not have a contract with a patient’s insurance company -- from directly billing the patient, requiring the hospital to seek payment directly from insurers. Support. Location: Senate Health.
+ AB 2220 (Jones) BINDING ARBITRATION: Requires providers and health plans to resolve contracting and payment disputes through binding arbitration. Watch. Location: Assembly Floor.
+ SB 981 (Perata) ER DOCTOR BILLS: Would prevent emergency physicians – who do not have a contract with a patient’s insurance company -- from directly billing the patient, requiring providers to seek reimbursement directly from insurers. Support. Location: Assembly Health.


Underserved Communities
+ AB 1472 (Leno) HEALTHY COMMUNITIES: Would establish the California Healthy Places Act, and require diverse state agencies and departments to work together assess and reduce health disparities in underserved communities. Support. Sen Appropriations.
+ *AB 2902 (Swanson) COMMUNITY HEALTH WORKERS: Would require the Office of Multicultural Health to encourage the use of community-based health care workers to help facilitate and coordinate better health outcomes in underserved communities. Support. Location: Assembly Floor.
+ AB 3027 (De Leon) LANGUAGE ACCESS: Would require health plans to translate materials into Medi-Cal threshold languages Support. Location: Held in Assembly Appropriations.
+ *AB 2842 (Berg) MARKETING PROTECTIONS: Would protect Californians from insurance agents trying to sell them private Medicare plans through cold calls and bait-and-switch tactics. Support. Location: Assembly Floor.
+ SB 1332 (Negrete-McLeod) MANDATORY MEDI-CAL MANAGED CARE: Would require seniors and persons with disabilities in Riverside-San Bernardino Counties to enroll in Medi-Cal managed care. Oppose. Location: Held in Senate Appropriations.


Coverage Expansions

Working Disabled
+ AB 851 (Brownley) MEDI-CAL FOR WORKING DISABLED: Increases eligibility for those working with disabilities to buy Medi-Cal coverage through the Medi-Cal California Working Disabled Program. Also extends the program, which will sunset 9/1/08. Support. Location: Senate Health.


Children’s Coverage
+ AB 1 (Laird/Dymally) & SB 32 (Steinberg) UNIVERSAL CHILDREN’S COVERAGE: Would expand children’s coverage, including the Healthy Families program, to all children in families up to 300% of poverty ($49,800 for a family of 3). Support. Location: Assembly and Senate Floors, respectively)
+ SB 1168 (Runner) DEPENDENT CARE: Would allow adult dependent children, who are still covered under their parents’ health plan, to stay on that coverage even if the child takes a medically necessary leave of absence from school. Support. Location: Assembly Health.
+ SB 1593 (Alquist) BRIDGING COVERAGE: Would clarify that children currently covered by county health initiatives would be first in line to receive Medi-Cal and Healthy Families coverage once those programs are expanded. Support. Location: Held in Senate Appropriations.


Universal Coverage
+ SB 840 (Kuehl) SINGLE PAYER: Would establish a single-payer health care system in California that would enable all residents to have health coverage. Support. Location: Assm Appropriations


Health Access will keep advocates updated this next week as bills come up on the floor. Stay tuned. For more information, contact the author of this report, Hanh Kim Quach, Health Care Policy Coordinator at hquach@health-access.org

Labels: Legislation, Updates

posted by Anthony Wright | Permalink | 1:59 AM


 

Getting over a huge hurdle...

Thursday, May 22, 2008

HEALTH ACCESS UPDATE
Thursday, May 22nd, 2008


FISCAL COMMITTEE REPORT: OUTCOME OF KEY HEALTH BILLS
* In budget crisis, only a third of proposed bills pass Appropriations Committee
* Health bills move to standardize insurance, provide transparency, protect consumers
* Deadline to pass full floor vote in the house of origin is Friday, May 31st

Click Here for What's New on the Health Access WeBlog: Budget reactions; The media's miss in reporting the impact of the health budget cuts; Over 1,000 rescinded patients reinstated; the lessons of health reform for the budget, and vice versa; Big balance billing fight; McCain's high-risk pool highjinks from California perspective; Prescription drug discounts in peril


Today was a big day for the fate of many bills of interest to health advocates, which would provide consumer protections and place needed oversight over health insurers and providers.

For those who follow legislation, the Appropriations Committees in both the Assembly and Senate made decisions about whether to let legislation proceed to floor votes, or to hold them in committee, evaluating them on how much the bills will cost the state's general fund.

The Appropriations Committees in both houses considered nearly 600 bills Thursday. Given the state's $17.2 billion -- and growing -- deficit, only one-third passed. In the Assembly, only 79 of 414 bills survived. In the Senate, it was 99 out of 157 bill passing--and of the only $26 million in general fund spending approved, $23 million was in two bills responding to court orders.

Many health consumer bills in committee--many with no general fund cost--cleared this hurdle, however, and will head to the respective houses next week. All bills must pass their respective houses by May 31st. Many bills face difficult floor votes next week.

BELOW is a list of health consumer bills--it will be updated on the Health Access California website as the session continues, at http://www.health-access.org/advocating/2008_bills.html

For every bill, the list includes the bill number (the author) and A SHORT DESCRIPTION IN CAPS: There's also a longer description of the legislation, Health Access California's position on the legislation, and finally, where the legislation is currently pending.

Health Access will send out another list Friday of all bills pending on the Assembly and Senate floors for a vote. Coverage of the floor votes will be available on the Health Access blog, at: http://www.health-access.org/blogger.html


Health Access California -- Selected Bill List

INSURER REGULATIONS

Insurance Oversight & Market Reforms
· PASSED- SB 1522 (Steinberg) INSURANCE MARKET STANDARDS: Would sort health insurance policies into five coverage categories, ranging from “comprehensive’’ to “catastrophic.’’ Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing, and assist consumers in making apples-to-apples comparisons between plans. Would weed out “junk’’ insurance by developing minimum benefit standards. Health Access California is the sponsor. Support. PASSED Senate Appropriations. To Senate Floor.
· PASSED- SB 1440 (Kuehl) CAPPING ADMINISTRATION AND PROFIT: Would set a minimum medical loss ratio – requiring every insurer to spend at least 85 percent of premiums on patient care. Support, seek amendments. PASSED Senate Appropriations. To Senate Floor.

Rescissions
· PASSED- AB 1945 (De La Torre) INDEPENDENT REVIEW: Would require approval by Department of Managed Health Care or Department of Insurance for each individual rescission. Support. PASSED Assembly Appropriations. To Assembly Floor.
· PASSED- AB 2549 (Hayashi) TIME LIMIT: Would impose a six-month time limit in which insurers have to rescind individual health care policies once consumers’ applications are approved. Support. PASSED Assembly Appropriations. To Assembly Floor.

Benefit Mandates
· PASSED- AB 1887 (Beall) MENTAL HEALTH PARITY: Would require health plans to provide coverage for all diagnosable mental illnesses. Support. PASSED Assembly Appropriations. To Assembly Floor.
· PASSED- AB1962 (De La Torre) MATERNITY COVERAGE: Would require all individual insurance policies to cover maternity services. Support. PASSED Assembly Appropriations. To Assembly Floor

Improved Insurance Options
· HELD IN COMMITTEE- SB 1622 (Simitian) PUBLIC INSURER: Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices. Support. HELD. Will not advance this year.

HEALTH CARE PROVIDERS

Transparency
· PASSED- AB 2967 (Lieber) TRANSPARENCY AND DISCLOSURE: Would require public reporting of cost and quality by doctors, hospitals HMOs and others in the health care industry. Support. PASSED Assembly Appropriations. To Assembly Floor.
· PASSED- SB 1300 (Corbett) CONFIDENTIALITY CLAUSES: Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contracts between providers and insurers. Support. PASSED Senate Appropriations. To Senate Floor.

Doctor and Hospital Oversight
· PASSED- AB 2146 (Feuer) ‘NEVER EVENTS’: Bans providers from billing patients or insurers when they have made an avoidable mistake, such as operating on the wrong person, prescribing the wrong drugs, or leaving foreign objects inside a surgery patient. Support. PASSED Assembly Appropriations. To Assembly Floor.
· PASSED- AB 2942 (Ma) COMMUNITY BENEFITS: Would standardize what non-profit hospitals report as “community benefits” to justify their non-profit status. Support. PASSED Assembly Appropriations. To Assembly Floor.

Hospital Transactions
· PASSED- AB 2741 (Torrico) HEALTH IMPACT ANALYSIS: Would require for-profit hospital sales to undergo health impact analyses to gauge the transaction’s effects on the affected community, health care services, and the community’s public interest. Support. PASSED Assembly Appropriations. To Assembly Floor.
· PASSED- SB 1351(Corbett) OVERSIGHT: Would require Attorney General oversight into transactions involving district hospitals. Support. PASSED Senate Appropriations. To Senate Floor.

Balance Billing
· PASSED- AB 2220 (Jones) BINDING ARBITRATION: Requires providers and health plans to resolve contracting and payment disputes through binding arbitration. Watch. PASSED Assembly Appropriations. To Assembly Floor.

UNDERSERVED COMMUNITIES

· PASSED- AB 2902 (Swanson) COMMUNITY HEALTH WORKERS: Would require the Office of Multicultural Health to encourage the use of community-based health care workers to help facilitate and coordinate better health outcomes in underserved communities. Support. PASSED Assembly Appropriations. To Assembly Floor.
· HELD IN COMMITTEE- AB 3027 (De Leon) LANGUAGE ACCESS: Would require health plans to translate materials into Medi-Cal threshold languages. Support. HELD in Assembly Appropriations. Will not advance this year.
· HELD IN COMMITTEE SB 1332 (Negrete-McLeod) MANDATORY MEDI-CAL MANAGED CARE: Would require seniors and persons with disabilities in Riverside-San Bernardino Counties to enroll in Medi-Cal managed care. Oppose. HELD in Senate Appropriations. Will not advance this year.

COVERAGE

· HELD IN COMMITTEE: SB 1593 (Alquist) BRIDGING COVERAGE: Would clarify that children currently covered by county health initiatives would be first in line to receive Medi-Cal and Healthy Families coverage once those programs are expanded. Support. HELD in Senate Appropriations. Will not advance this year.

Labels: Hospitals, Insurers, Legislation, Updates

posted by Anthony Wright | Permalink | 9:35 PM


 

A deeper wound for our health care system...

Wednesday, May 14, 2008

HEALTH ACCESS UPDATE
Wednesday, May 14th, 2008


GOVERNOR'S MAY BUDGET REVISION MAKES DEEPER HEALTH CUTS

* Budget shortfall projected at $17.2 billion; Governor continues "cuts & borrow" approach
* Health cuts keep in place January proposals, goes further in directly denying coverage
* Hundreds of thousands of the poorest working families would lose coverage

Click Here for What's New on the Health Access WeBlog: Much more on the budget cuts; Welcome, Speaker Bass; Bass and health reform; Balance billing; Canadian health care; Underinsurance; Who gets hurt by a cuts-only budget?; High deductible health plans for who?; MRMIP's waiting list; McCain's risky high-risk pool proposal; The new opportunity for health reform; Big Tobacco's track record on reform; More on the McCain health plan.


SACRAMENTO--Gov. Arnold Schwarzenegger released the revised version of his budget proposal today, which makes deeper cuts in health and human services programs in order to address the state’s shortfall, which has grown by nearly $3 billion since he first released the budget in January. Altogether, the $100 billion general fund budget is $17.2 billion short.

“The crisis is very real and it is very serious,’’ the governor said. His proposal would attempt to bring in $11.7 billion in new money ($3.5 billion from deficit bonds of years past), and another $5 billion by selling the lottery’s income to Wall Street. Schwarzenegger would cut an additional $12.5 billion from state programs, on top of the $1 billion that was cut earlier this year to help minimize the deficit.

“We had to make very difficult cuts. No one wanted to do this. But because health and human services was the second largest part of the budget, this is where we had to cut,’’ Schwarzenegger said. Twenty percent of the cuts imposed come from Health and Human services, reported Director of Finance Mike Genest. Deficit aside, Schwarzenegger restored funding to some of his original cut proposals in January and will now keep parks open and will not release inmates nearing their release date early.

View the full May Revision at the website of the Department of Finance here: www.ebudget.ca.gov.

The Health and Human Services Agency has their summary of the health and human services cuts here, at:
http://www.chhs.ca.gov/Documents/HHS%20Budget%20Facts%20Final%205%2008.pdf

THE CUTS

CUTS ALREADY MADE (PROVIDER RATES): Health programs were already dealt a blow earlier this year. Medical providers that treat Medi-Cal recipients will see their reimbursement rates cut by 10% as a result of a budget cut package already approved earlier in the year. Already California ranks near the bottom for reimbursement rates for doctors caring for Medi-Cal patients. That cut -- saving the state $544 million (and losing an equivalent amount in federal matching dollars) -- will begin July 1st.

CUTS ALREADY PROPOSED AND STILL PENDING (MEDI-CAL BENEFITS, QSRs): Still pending from the Governor's January proposal are a range of cuts, such as eliminating benefits for adults on Medi-Cal, including dental coverage, optometry, podiatry, and other services. The pending proposals also included imposing additional paperwork burdens on children and families so hundreds of thousnads enrollees fall off the program (known as quarterly status reports).

NEW MAY REVISE CUTS: The Governor's May revision retain all cuts to health care proposed in January, that would make it harder for the 6.6 million children, parents, seniors and people with disabilities on Medi-Cal to get the care they need--by reducing access to providers, by eliminating benefits, by increasing paperwork so that it is easier to fall off coverage. The May Revision also does the one major type of cut that the January budget did not do--directly deny people coverage by changing eligibility rules. The May revision cuts of interest to health advocates are as follows:

* DENIAL OF COVERAGE TO LOW-INCOME WORKING PARENTS: Parents earning very low wages (roughly between $11,000 and $18,000/year for a family of three) would no longer be eligible for Medi-Cal coverage.

Under the new proposal, a family of three would need to earn even less: $891 a month, and work fewer than 100 hours a month. The cut is expected to reduce spending by $31.2 million this year, but increase to $342.5 annually in three years. In the first year of implementation, 39,000 parents would be denied coverage. After a couple of years of full implementation, over 429,000 Californians would be denied Medi-Cal coverage.

This proposal was also proposed for the 2003-04 budget by then-Gov. Gray Davis, but rejected. Earlier reform expanded coverage to these parents as part of welfare reform, so that families working their way off of welfare would not lose health coverage as they found jobs (that likely did not provide health benefits). If this cut stands, then the potential incentive is to work less, in order to keep coverage.

* CONTINUED BUREAUCRATIC ENROLLMENT PROCEDURES: The Administration, which had championed efforts to make it easier for families to enroll in public programs, is now further seeking to delay the implementation of SB437 (Escutia) of 2006, which would have streamlined and fast-tracked enrollment for children into Healthy Families or Medi-Cal. This delay saves the state $13 million.

* ADDITIONAL BENEFIT CUTS: Qualifying low-income legal immigrants who permanently live in the US will lose various benefits, including prescription drugs and dental coverage, and only get four services: emergency care, pregnancy-related coverage, certain long-term care services, and some cancer treatments. This would be a $86.7 million cut.

* MORE PAPERWORK FOR EMERGENCY SERVICES: The limited emergency services coverage that Medi-Cal provides to undocumented immigrants would be more limited, through the implementation of a monthly eligibility process. The savings would reduce state payments to California health providers by $42 million.

* CUT TO NON-CONTRACTING HOSPITALS: Hospitals that don't contract with Medi-Cal would face a rate cut of either 5% of regional contracted rates, or 90% of cost, whichever is lowest. This would provide $11.2 million in savings.

* COST AND QUALITY DATA: The budget proposes to take money from the state’s Health Data and Planning Fund, which would be used to give consumer a glimpse of providers’ prices, error rates and other key information that would help health care purchasers make informed choices. This cut saves $12 million.

Again, these cuts come on top of more than $1 billion cuts proposed in January. The governor had previously proposed higher premiums and co-pays for Healthy Families enrollees, requiring families to report changes to their income every three months in order to remain on Medi-Cal, and the elimination of essential benefits, such as adult dental care and incontinence creams and washes for aged, blind and disabled Californians.

View the fact sheet and previous reports here and here.

WHAT'S NEXT

With the latest budget figures, the Legislature can now begin making decisions and negotiating on the budget in earnest. Many decisions had been postponed -- in part because it was unclear how much money the state had to work with, and in part, because the cuts were so untenable. Next week, budget subcommittees will continue to hammer out details. Health Access will monitor the status of the health budget proposals and keep advocates informed.

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

Labels: Budget, Schwarzenegger, Updates

posted by Anthony Wright | Permalink | 7:03 PM


 

A bad budget year, indeed...

Tuesday, April 29, 2008

HEALTH ACCESS UPDATE
Tuesday, April 29th, 2008

BUDGET SUBCOMMITTEES CONSIDER, CONTINUE TO HOLD OFF, ON BUDGET CUTS
* Assembly and Senate Budget Subcommittees review cuts to health programs
* Proposals include eliminating various Medi-Cal benefits, like dental
* Also: Cuts to safety-net hospitals, community clinics, and children's enrollment
* Votes will take place after Governor’s May revision
* May budget numbers look grim, Schwarzenegger warns

Click Here for What's New on the Health Access WeBlog: New Field Poll Shows Strong Support for Stalled Health Reform Measure, and Continued Momentum for Reform; A New Window of Opportunity in 2009-10?; The False Choice Between State and Federal Action; Musical Chairs Among the Governor's Health Team; Bush's Medicaid Changes: How They Would Impact California, and How the California Delegation Voted; The World Health Care Congress and the Presidential Plans; Budget Blues Becoming Bigger; The Student Insurance Scam; New Report on QSRs; and more...

Yesterday, both the Senate and Assembly budget subcommittees that oversee the public programs for health coverage reviewed cuts proposed by the Governor. The committees held off on big ticket items pending the May Revision of the budget – which will be released in a couple of weeks.

SENATE BUDGET SUBCOMMITTEE

Sen. Elaine Alquist presaged the Senate budget subcommittee hearing by saying that “all cuts were on the table,’’ even if members of the committee did not like them.

ACTIONS: The Senate subcommittee took actions on three small items, one to increase staffing for HIPPA compliance, and another to cut staffing for the Primary Care and Rural Health Branch.

WORKING DISABLED: Another vote eliminated the sunset on the CA Working Disabled Program, which provides Medi-Cal coverage to people with disabilities who work, as long as their income is below 250% of poverty ($26,000 for an individual). (A related bill is Assemblywoman Julia Brownley’s AB 851.) That action makes this program permanent.

PRESCRIPTION DRUG DISCOUNTS: Another item that had been slated for approval – further delaying the implementation of the CA Discount Prescription Drug Program – was taken off the agenda for day, but may be considered in the future. This program is the result of 2006’s AB 2911, which would allow the state to use its leveraging power to negotiate lower prescription drug prices for millions of California’s uninsured, who currently pay full price for drugs. The program has already been delayed once. The Governor's budget does include its implementation this year.

CHILD ENROLLMENT SELF-CERTIFICATION:The Administration is pushing for the implementation of SB 437 (Escutia) which would allow Santa Clara and Orange Counties to start up a “self-certification’’ pilot program, which would streamline enrollment processes for children enrolling in Healthy Families or Medi-Cal by allowing families could self-certify their income and assets for enrollment in these programs. Like AB 2911, the implementation of this legislation has also been delayed once before. The Administration is asking for $30.9 million to start up this program ($14.4 million from the general fund). The Legislative Analyst's Office has recommended the delay, but health and child advocates, including the 100% Campaign and Health Access California, testified against the cut. Action was "help open."

GOVERNOR'S CUTS STILL PENDING: The following cuts were proposed by the Governor and heard by the Senate Health Committee, but action was "held open," with decisions likely to be made after the Governor's announces the May Revise.

• CLINICS: In the Governor's budget proposal, 400 clinics in the state, providing care to both urban and rural populations, as well as special programs for migrant workers and Native Americans would be reduced by $3.5 million. All told, the funding cut would mean about 120,000 fewer visits to clinics for primary medical care, dental care, tobacco cessation and other health education information.

• CHILD HEALTH & DISABILITY PREVENTION PROGRAM (CHDP): The governor proposes to cut local administrative funding for this program by $1.1 million, though the Department of Health Care Services said it will be up to counties to decide whether this particular program would be cut, or whether they could absorb the cuts elsewhere. Either way, cutting administrative costs for CHDP would make it harder for children – from birth to 21 – to get access to health care through this program.

• CALIFORNIA CHILDREN’S SERVICES: This program would be hit three times, losing a total of $115 million ($51.4 million general fund), in provider reimbursements, case management and administrative costs. Many provider and patient groups testified that CCS saves the state money because it provides case management, care, treatment and therapy for children with medical conditions such as birth defects, chronic illnesses or genetic diseases, such as hemophilia and cystic fibrosis. These children would undoubtedly become more severely ill without these services and wind up needing far more expensive care.

ASSEMBLY BUDGET SUBCOMMITTEE

As in the Senate, the Assembly budget subcommittee did not take votes on any items but did discuss the following proposals:

MEDI-CAL BENEFITS: The Administration has proposed a $19 million cut to services that are not federally mandated by Medicaid--so called "optional" benefits. That includes access to optometrists, podiatrists, therapists, opticians and prescribed creams and washes. In total, these cuts would affect nearly 1 million Medi-Cal recipients who need eyeglasses, mental health therapy, speech therapy after a stroke, creams to avoid bedsores and regular checkups for their chronic diseases.

DENTAL BENEFITS: The biggest chunk of savings from cutting optional benefits comes from the elimination of the adult dental benefit – which would reduce state spending by $115 million, but also cause the state to lose an equivalent amount in federal matching funds. The California Dental Association presented an alternative to a full elimination of the program, which would eliminate specific procedures while retaining the program. The program is already threadbare, with 4,000 dentists serving 6.5 million patients. If it adult dental benefits were eliminated, it could take up to 10 years to rebuild provider networks and infrastructure once money was made available again, the association said.

PUBLIC HOSPITAL FUNDING: The Administration proposes to shift more money from public hospitals, to pay for other health services. All told, the state would siphon $78.8 million from public hospitals in 2008-09. The state would need federal approval to do this, to amend a "hospital financing waiver" agreed to three years ago. Assemblyman Jim Beall suggested the state wait until after the presidential election to see if “we could do better if we had a more cooperative administration’’ to get more federal fund in the first place.

PRIVATE "SAFETY-NET" HOSPITALS: Under this proposal to the "Disproportionate Share Hospitals (DSH)" payments, funding would be reduced by 10%, resulting in a $24 million state savings, but a loss in equivalent federal funds. These funds are used to help private hospitals that see a large number of uninsured and Medi-Cal recipients.

A number of advocates testified against the cuts, including: California Association of Public Hospitals, individual public hospital systems, Western Center on Law and Poverty, Health Access California, Californians for Disability Rights, children’s hospitals and others.

MAY REVISION

The May Revision is expected to be released in the next two weeks. Gov. Arnold Schwarzenegger has projected an even bigger gap than the current $16 billion shortfall.

Health Access will keep advocates up to date on budget issues through these E-mail updates and on our blog. For more information, contact Health Access Policy Coordinator Hanh Kim Quach at hquach@health-access.org.

Labels: Budget, Updates

posted by Anthony Wright | Permalink | 10:08 AM


 

Bills, bills, bills...

Thursday, April 17, 2008

HEALTH ACCESS UPDATE
Wednesday, April 16th, 2008

BILLS CONSIDERED BY SENATE HEALTH COMMITTEE AS FIRST DEADLINE NEARS
* Bill fails that would license and regulate "discount" health cards
* Panel passes bill to allow local county-run health plans to expand, compete
* Roundup of bills: children's coverage, mandatory Medi-Cal managed care, benefits

Click Here for What's New on the Health Access WeBlog: Health Wonk Review: Drug Co-Payments and Tier 4; Are the Uninsured the Cause of Overcrowded ERs?


The Senate Health Committee heard nearly two dozen bills on Wednesday in the final hearing before Friday’s policy committee deadline to get bills to a fiscal committee. Following is a roundup of the fate of some of the bills of interest to health and consumer advocates:

DISCOUNT CARDS:

SB 1603 (Calderon) would have directed the state Department of Managed Health Care to license and regulate so-called discount health cards, which promise consumers deep (though often unverified) discounts on medical services from a network of providers (also often unverified). Consumers purchase a list of discount providers at a cost of up to $120/month. The state is in the process of promulgating regulations to address these plans, but current state law bans them, even though some currently operate in California.

With bipartisan opposition from committee members, the bill failed in committee. Consumer advocates have long argued that discount medical cards claim "discounts" off a non-public price, rendering the only true value of the card unknown and/or meaningless. Additionally, surveys have shown that medical providers contacted are not even aware that they are included on many discount cards' list. Additionally, the plans often use misleading language to confuse consumers, and rely on the expectation that the consumer will not understand the difference between a discount health card and actual insurance coverage. Consumer advocates would need to see these issues resolved in order to support a regulation that would license these cards and give them the state's seal of approval.

LOCAL INITIATIVE EXPANSION:

SB 1622 (Simitian) would facilitate a statewide public insurer, connecting existing county-based health care plans to be able to offer a broader regional network of providers. This would provide a more options for existing enrollees, especially those who live in one county and work i