2009 Year in Review: The Best & Worst of Times…

Wednesday, December 30, 2009

* The Hope of Federal Health Reform: Further Than We’ve Been Before
* California’s Budget Blues: Medi-Cal Benefits Eliminated, Clinic Funding Zeroed
* Some Progress on State Consumer Protections…

* Much To Do for 2010: Join Us on Facebook! Follow Us on Twitter!
Include Health Access Foundation in Your Year-End Giving!

For health care in California, the year 2009 was the best of times, and the worst of times.

The year began with the hope and excitement of new Obama Administration—especially, for health advocates, for a new president that made health reform a central part of his campaign. The good news from Washington, DC, started quickly, with the reauthorization of the SCHIP program that covers low-income children, which had been vetoed in previous years.

But the California budget crisis loomed, with nothing more symbolically showing the disconnect between the federal possibilities and state problems than Governor Schwarzenegger’s budget proposal to eliminate the state’s SCHIP coverage for a million low-income children in its entirety—and actually have that program, Healthy Families, close enrollment and be a week away from sending out hundreds of thousands of disenrollment notices. That roller coaster continued as the same Governor and Legislature that approved steep cuts in the program earlier in the year then passed a fix to temporarily prevent kids from being kicked off coverage—and then wait with concern about federal approval. Given everything, it’s gratifying that at year’s end, Healthy Families’ waiting list has been cleared and children are being covered and enrolled—even if some families are now paying more, and future funding in uncertain.

The work started in 2009 is not yet finished, but here are some other highlights:

HEALTH REFORM: It’s not done, but comprehensive health reform has never made it so far in the legislative process, going through five policy committees and full floor votes in both the House of Representatives and the Senate. It’s not finished, but the final product is likely to provide more security and stability for people with health coverage, and include be the biggest expansion of health coverage (both public and private) ever, to around 30 million Americans—and nearly 4 million Californians.

Health advocates, including the state’s Health Care for America Now! campaign, succeeded in having our two Senators be champions on key issues, and getting all Democratic Representatives from our 53-member House delegation—including all 7 “Blue Dogs”—to vote for the House version of reform. With the exception of the anti-abortion Stupak amendment, the House reform is a very strong bill that meets consumer advocacy principles, from affordability and employer responsibility to providing a public health insurance option. Californians took the lead in the House, and were in leadership positions—Chairmen Miller, Waxman, and Stark—in each of the three House committees of jurisdiction. From Speaker Pelosi to the chairs of the key Asian, Black, and Progressive caucuses, the House did its job and is looking to make final bill better than what passed the Senate, which needs improvement in key areas.

The work for health advocates now is to help our sizable California House and Senate members improve the final bill while passing it in early 2010, and then begin the longer effort to implement and improve it here at the state level, through legislation and regulation.

CALIFORNIA’S BUDGET CRISIS: In both February and July, the Legislature passed and the Governor signed two budget packages to solve a combined $60 billion deficit—with many cuts, including to health care—for the year-and-a-half period of January 2009-June 2010.

The first February package of $42 billion included significant health and human service cuts that were “triggered”—including the full elimination of ten benefits for three million adults with Medi-Cal coverage, including dental, vision, podiatry, speech therapy—as well as some temporary taxes. The package also placed six propositions on the May ballot, including a spending cap (and two others to divert funding away from mental health services and health and social services for young children). The only one that passed was to prevent increases legislator salaries in deficit years.

A July package was needed to address over $20 billion more in deficits, and that led to even steeper health and human services cuts, and no new revenue. The reductions in health included cuts to coverage, hospitals, AIDS and mental health programs, and the zeroing out of state funding for community clinics.

For 2010, a new $20 billion hole is projected for the next year-and-a-half. Health Access plans to release a report next week, “The Damage Already Done,” to start to document the effect of the cuts in just six months. This will be part of sustained coalition efforts this year to detail the impact of these budget choices on California families, on our health system, and on our economy.

STATE CONSUMER PROTECTIONS: Regarding consumer protections, the year 2009 started with a significant Supreme Court ruling prohibiting the practice of “balance billing.” It ended on a position note with the Department of Managed Health Care about to announce newly-finalized, first-in-the-nation rules on insurers to require timely access to care. Mid-year, Health Access introduced a new website to help patients with their hospital bills.

As for state legislation that was considered, the budget did take up much of the attention and energy. Key legislation was passed and signed into law, attempting bring in more federal money for children’s coverage, hospital Medi-Cal reimbursement, and individual’s COBRA coverage.

Some consumer protection bills were vetoed, on issues like insurers rescinding coverage, and proposals to mandate key benefits, from maternity coverage to mental health parity. But a few good bills were passed and signed into law, including a prohibition on gender rating—which will stop insurers from charging men and women differently.

In 2010, there are existing bills that will start moving again, from SB810, Senator Leno’s single-payer legislation, to bills like Assemblyman Jones’ bill on better labeling coverage and limiting “junk” insurance, AB786, and Assemblyman Lieu’s bill on prohibiting patient overcharging in the emergency room, AB1503. New bills are expected that will seek to start the implementation of federal health reform. A related effort is the renegotiation of our state’s Medi-Cal waiver with the federal government, which provides challenges and opportunities regarding the Medi-Cal coverage of 7 million California children, parents, seniors, and people with disabilties.

AN END-OF-YEAR INVITATION: There’s no shortage of work. To prevent the worst in budget cuts, and organize for the best in terms of health reform, 2010 will be a very busy year. We’ll need your help, so resolve to join and contribute:
* Join Health Access on Facebook: (www.facebook.com/healthaccess)
* Follow Health Access on Twitter: (www.twitter.com/healthaccess)
* Consider Health Access Foundation in your end-of-year giving!

Thank you for your support and consideration, and have a healthy and happy new year!

Health Access California promotes quality, affordable health care for all Californians.
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