HEALTH ACCESS

HEALTH CARE CUTS ALERT

June 5, 2002

CONFERENCE COMMITTEE ON HEALTH CARE: The Conference Committee started Wednesday, June 5th, considering health care issues. Long story short: the committee left open most of the items of greatest concern to health care advocates. SEE the UPDATED LEGISLATIVE SCORECARD off the link from our homepage. The discussion did give some clues as to the committee’s direction.

In this first stage of their deliberations, they are going through the differences between the Assembly and Senate versions of the budget, as is traditional. But given this is an “open” conference, they will go over ALL items, including those where the Assembly and Senate agree (1931b eligibility, county administration, quarterly status reports, etc.). We expect those conversations on those cuts to come up in the future. There will also be a “Member’s Day” on Friday where legislators can advocate for additional cuts and/or additional ways to raise revenues. The committee is expected to meet on the weekend.

The Conference Committee includes: Senate Budget Chair Steve Peace (D), Senate Budget Vice Chair Dick Ackerman (R), Senator Wes Chesbro (D), Assembly Budget Chair Jenny Oropeza (D), Assembly Budget Vice Chair John Campbell (R), and Assemblymember Darrell Steinberg (D).

CHDP: In approving language to approve an evaluation of the new CHDP gateway, Assemblymember Campbell (R), in a surprise move, made a motion to eliminate the Child Health and Disability Prevention Program entirely. (The Governor originally proposed CHDP elimination in the January budget, but after soliciting input from a range of organizations, providers, and advocates, the May Revise instead recommended developing CHDP into a “gateway” to get children enrolled in the more comprehensive Medi-Cal and Healthy Families programs.) The motion failed, but Assemblymember Campbell continued to suggest elimination of CHDP as a way to generate savings to preserve other items.

CHDP PERIODICITY: The committee considered the Senate proposal to include another $2 million into the CHDP program to increase the number of “comprehensive health assessments” a child could get under the program, to make it consistent with Medi-Cal and Healthy Families. After Senator Chesbro’s presentation that it was simply an equity issue, Assemblymember Steinberg moved the Senate proposal, which also got support from Assemblymember Oropeza. Senator Peace, who had the vote to carry the motion, placed the measure on call, saying that he would have “an argument with myself” and vote later. Depending on his decision, the issue will either be approved, or left open.

DSH: Assemblymembers Campbell and Steinberg wanted more information about the individual impact on hospitals, and how this would affect those folks who depend on safety-net hospitals. Senator Peace also stated that he was inclined to support the Assembly proposal to reject the Governor’s additional $31 million cut to Medi-Cal Disproportionate Share Hospitals (DSH). The committee left the item open.

TRAUMA: The committee left the item open, after not getting enough votes to either renew or not renew the $25 million for trauma centers.

EXPRESS LANE ELIGIBILITY: The committee requested more information on what school districts would start the program under the Assembly version. The item was left open.

PROVIDER RATE REDUCTIONS: Senator Peace made clear that he believed that provider rates are “ridiculously low,” but that since there was no money, he was inclined to support the rate reductions, and even seek additional cuts in this area if necessary. Assemblymember Campbell expressed concerns, including on the size of the cut, which would be 33% for California Children’s Services, 10% for Home Health Services, etc. Assemblymember Steinberg talked about the specialists needed for certain areas. Senator Ackerman suggested a proposal to cut all the proposed provider cuts except those to California Children’s Services. Attempts to pass either the Senate or Assembly version failed. The item was left open.

DENTAL SERVICES: In a discussion that was ostensibly about limiting Medi-Cal adults to one dental visit per year, Assemblymember Campbell attacked all Medi-Cal dental coverage. He was “outraged” that there are a “vast number of employees” who “don’t get anywhere near the benefits” than those on Medi-Cal. These families who “pay taxes and work for a living and are buying Chevrolets,” while others “are getting Cadillacs on the dole.” He made a motion to agree with the Governor’s proposal to eliminate adult dental coverage in Medi-Cal, which would save $210 million. (This full item was not on the agenda, since both house subcommittees rejected the proposal.) This engendered a broad conversion about the state of the health care system today, and the value of covering the uninsured, and the associated costs and opportunities. Senator Peace sarcastically suggested that he might agree with the notion, to further the deterioration of a health care system gone wrong. Senator Chesbro offered that the health care system didn’t need the extra push. Assemblymember Oropeza and Senator Peace offered that the uninsured get the care and we pay for it in more expensive ways, in our taxes and premiums, if maybe not directly in this year’s budget. Assemblymember Steinberg stated that in fact some people simply don’t get care, but there are other costs. One fact that was not raised was that a majority of Medi-Cal recipients are in working families.

CO-PAYS: After some discussion on who bears the burden of the co-payments, including that it ends up being another cut to providers to care for Medi-Cal patients, the committee left the item open.

OUTREACH: Assemblymember Oropeza gave a spirited defense of the money for school and community based outreach programs, stating the goal of enrolling as many children as possible in the Medi-Cal and Healthy Families programs. Assemblymember Campbell questioned the outreach program’s effectiveness. Senator Chesbro defended the Senate subcommittee’s action in cutting the programs, putting his priority on core services. Senator Peace expressed his skepticism at “professional outreachers” and questioned where the money would come from, also preferring direct services. The item was left open.

HEALTHY FAMILIES PARENT EXPANSION: The committee had some discussion on the preferred date of the Healthy Families expansion, with the Administration, Assembly and Senate agreeing on the expansion as a priority, but having different notions of when to start it. While the Administration proposed a start date of July 2003, it pointed out that it could not start any expansion before a budget was approved, and so a July 2002 start date as proposed by some might be optimistic. This and related items were left open.

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