HEALTH ACCESS UPDATE
Saturday, December 30, 2005
2005 YEAR IN REVIEW FOR HEALTH CARE CONSUMERS
- Major Victories in Defeats of Bad Bills, Budget & Ballot Proposals
- Schwarzenegger’s Second Year Slump
- Some Progress on Consumer Protection Efforts, Little on Expanding Health Coverage
- Continued Momentum for Health Care Reform for 2006
California policy and politics in 2005 was dominated by Governor Arnold Schwarzenegger’s call for a special election. Progress on most issues was stalled as the Governor and his opponents campaigned for and against specific initiatives, and the issue of access to health care was no exception.
Yet in what could have been an ugly year for health care, most bad proposals that would have harmed health care were stopped—not just bills, but also at the ballot box, and in the budget. Given the challenges that were presented at the beginning of the year, this is cause for celebration for health care consumers.
While major steps forward were blocked this year in the contentious political environment, some progress was made in key areas, enough to continue the momentum for health care reform.
- Health care advocates were successful in the goal to preserve access to health care at the state level, including preventing the worst of the budget cuts though the bulk of the budget crisis.
- In 2005, we were pleased that the Legislature rejected many of the proposed Medi-Cal Redesign proposals that would have restricted access to care, including imposing premiums on many Medi-Cal patients.
- (For a scorecard on how the various proposals fared, go to: http://www.health-access.org/preserving/docs/MediCalRedesignScorecard2005.doc)
- The attempt to force seniors and people with disabilities in managed care was also defeated, even when policymakers attempted to link it to a controversial “hospital financing” package. Yet it failed as it did not include adequate consumer protections and protections for access to the uninsured to safety-net institutions.
- The fact that the Governor decided not to got forward with more serious health care cuts, as he and his predecessor had proposed in previous years of the budget crisis, indicated the significant support of health care programs have in the Legislature, which had a long record of rejecting severe cuts.
- The most important result for health care from 2005 was the defeat of Proposition 76, which would have given this and future Governors unilateral power to make budget cuts, and would have had profound impacts on health care for generations. Along with the suspension of TABOR in Colorado, voters are rejecting “starve the beast” proposals and appreciating the value of health and other vital services.
- Some health care groups played a significant role in defeating other initiatives, including preserving the right to reproductive health services by defeating Proposition 73, and defeating Proposition 75, preserving the rights of public employees—including nurses, teachers, firefighters, and other health care and service workers—to fully participate in the political process, to advocate for health care for themselves and reform for everyone.
- The fight at the federal level continues. In his budget at the beginning of the year, President George Bush proposed severe cuts to Medicaid, which have been vigorously fought by a largely unified Democratic Congressional caucus and several moderate Republicans, making this a contentious issue despite one-party rule in Washington, DC. (Governor Schwarzenegger was conspicuously silent for most of the year). The cuts to Medicaid and have unfortunately survived a serious of achingly close votes, including most recently a Senate tie that had to be broken by Vice President Dick Cheney. The final vote on “budget reconciliation” had been delayed until a final vote for early next year, providing a final hope to prevent this loss of funding for California health care.
- Consumer advocates did not win many of items they wanted, but they did make progress in ongoing campaigns to provide consumer protections for the insured and uninsured.
- Health Access California, the statewide health care consumer advocacy coalition, was pleased to get some of the bills we sponsored signed into law, including important disclosures for consumers in the individual insurance market (AB356/Chan), and the extension of HMO consumer protections for those in the new prescription drug plans offered in the new Medicare Part D benefit (AB1359/Chan).
- (For a full list of consumer health access bills that were signed and/or vetoed in 2006, visit: http://www.health-access.org/advocating/2005_bills.htm)
- Advocates have been active in other ways in preparing for the new Medicare prescription drug benefit, not only educating seniors and people with disabilities about their options, but organizing them to advocate the fixes and changes need to make it less costly, complex, and confusing. This includes working to protect both low-income “dual-eligibles” and the overall population to ensure they get the drugs they need, despite less than comprehensive coverage.
- Consumer advocates made progress on bills to prevent the overcharging of the uninsured, who end up spending more for health services, than anybody else. This is true especially for hospital care and for prescription drugs.
- This year, the drug industry was forced to admit that drug prices are too high, and yet even with $80 million, the most expensive campaign in the history of the nation, they were not able to convince voters to support Proposition 78, a voluntary proposal without enforcement. The consumer group-backed Proposition 79 was not able to overcome this funding mismatch, but it did provide an opportunity to grow the coalition in support of reform, and the new political environment provides a real opportunity for a legislative compromise that includes some accountability and enforcement.
- (For a full summary of the drug industry’s deception, go to: http://www.health-access.org/providing/docs/PhRMACaseStudySummary.doc)
- The hospital association also had to admit that hospital billing practices should be regulated by law. After years of opposing legislation to provide consumer protections against unfair billing and collections practices (such as the pending AB774/Chan), the hospital association felt compelled, as part of an initiative to fund hospitals, to include consumer protection language. While the original language was a weaker version of what consumer advocates have promoted, it was an acknowledgement that they were afraid of being attacked for their practices of charging uninsured patients multiple times what insurers pay for the same service.
- In December, after a concerted campaign by a coalition of health groups, the hospital association dropped their original, flawed initiative planned for 2006, which would have prevented future attempts to put in place stronger consumer protections, and put in place a funding formula that would have advantaged private hospitals over public and safety-net hospitals that care for the bulk of the uninsured. The hospitals finally came together with other entities on a different tobacco tax proposal for 2006.
- The biggest disappointment has been the lack of significant movement to expand coverage to the uninsured. But the fact that advocates were able to prevent bad proposals to cut health care or further shift the cost and burden of health care to individual patients opens new opportunities in the new year.
- Governor Schwarzenegger has either been focused on other issues, or been a barrier. After campaigning against Proposition 72 in 2004, the Governor vetoed a proposal to expand coverage to all children (AB772/Chan), an expansion of dependent coverage (AB1698/Nunez), and other bills in 2005. He is certainly the most prominent politician, if not the only one, without a health care reform plan.
- The good news is that the health reform debate is still alive and well, as is indicated that such bills made it to the Governor’s desk.
- Children’s coverage proposals are expected to be in the legislature (SB437/Escutia) and on the ballot.
- The Senate passed universal coverage bill, the California Health Insurance Reliability Act (SB840/Kuehl), which is now pending in the Assembly.
- Taking the lead from New York City and Suffolk County on Long Island, San Francisco Supervisor Tom Ammiano has attracted significant support for a county/city-based health requirement so that workers of large employers get coverage.
- Health advocates have also been successful in stopping proposals that take us backward, including a proposal for an “individual mandate” (AB1670/Nation/Richman) and bringing more attention to the pitfalls of so-called “consumer-directed” plans
Health Access and other consumer and health groups will continue to support multiple proposals for expanding coverage, while opposing proposals that simply seek to shift more of the burden, cost and risk of health care onto individuals and families.
With 2006 an election year where policymakers will have to tell voters how they intend to improve the health care system, there is still significant urgency, and well as momentum, for health care reform in the new year.