Post-Election Health Reform Round-Up…


Tuesday, November 30th, 2010


* AP Declares Congressmen Costa and McNerney Winners, All CA Representatives Who Voted for Health Reform Were Re-Elected; Results Provide Momentum for Implementation

* Bad Budget News, with Initiative Results and $25 Billion Deficit; Special Session Dec 6th
* California Gets New Medicaid Waiver; Starts Up New Option for Pre-Existing Conditions
* DMHC Fines Insurers on Provider Payments; CDI Gives Poor Grades to PPOs
* HHS Releases New Regulations on Medical Loss Ratios

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While the November election has passed a few weeks ago, the results are now just being finalized. Over the Thanksgiving holiday, the Associated Press called the Congressional races still outstanding in California, declaringvictories for Congressmen Jim Costa (Fresno) and Jerry McNerney (Stockton) in those very close races.

For California health care and consumer advocates, this means that every California member of Congress that voted for the new federal health law–33 Representatives and our 2 Senators–was re-elected.

Californians also elected a Senator who championed the law in Barbara Boxer and a Governor who pledged to implement it in Jerry Brown, against candidates who held “repeal and replace positions. These results, along with the election of several pro-reform candidates for key statewide positions, like Dave Jones for Insurance Commissioner and Kamala Harris for Attorney General, provides strong momentum for an aggressive effort to implement and improve the new federal health law in California.

Around the country, the health care issue was sometimesa subject of television ads, but exit polls suggested that health care was a distant second to the economy. Regardless of calls to repeal by some politicians, the law is the law. As Dr. Oz said in a post-election television ads sponsored by the California Endowment, it time to “get on with it” and take advantage of the “historic opportunity” to “make health care better for millions of Californians, to make health care better and more affordable for you.”

The Health Access blog, at, has been reporting on many developments related to fulfilling the promise of reform. Here are other highlights:* The election results in California were decidedly mixed with regard topropositions, with good and bad news regarding the state budget. While the passage of Proposition 25 will improve the budget process by allowing a majority-vote budget, that victory is outweighed by the passage of Propositions 22 & 26, which blew billion-dollar holes in current and future budgets, and making it harder to impose fees to get corporations to remedy the health and environmental harm they cause.

* The budget news got even worse when the Legislative Analysts Office released projections–partially due to those and other ballot results–that the 2011-2012 budget would see a $25 billion deficit of more than $6 billion in the current year (2010-2011) and more than $19 billion for 2011-2012. A special session on the budget is expected to start next Monday, December 6th.

* On election day, Governor Schwarzenegger announced the finalization of the Medicaid waiver agreement between the State of California and the federal government. The waiver determines the future of the Medicaid program for the next five years, and as such has been cast as a “bridge to health reform,” especially since it includes the ability of counties to get federal matching funds to expand coverage to low-income Californians in advance of the federal expansions in 2014.

* California’s efforts to take advantage of the opportunities under the new federal health law has been compared as the “Dr. Jekyll and Mr. Hyde” in relation to Texas, whose leaders are musing as whether to withdraw from the Medicaid program–although it’ll be clear that such a move would be disastrous for their citizens and their health system.

* In late October, California began another benefit of the new federal health law, in earnest providing a new option to those denied private health coverage because of their health status. This new, federal funded “Pre-Existing Condition Insurance Plan” (PCIP), run by the California Major Risk Medical Insurance Board (MRMIB), now has over 600 enrollees in its first couple of weeks of operation, but is the last and only option for tens of thousands of Californians until the new federal law prohibits insurers for denying people for pre-existing conditions in 2014.

* California regulators continued their consumer protection and oversight work keeping insurers and health plans accountable. The California Department of Insurance released a new report card that gave poor consumer service and satisfaction marks to PPOs. The California Department of Managed Health Care announced nearly$5 million in fines on insurers dur to problems in paying health providers.

* The U.S. Department of Health and Human Services recently released a new regulation on medical-loss ratios, to ensure than at least 80% (and in many cases more) of our premium dollars go to patient care, rather than administration and profit. This was result of months of negotiations at the National Association of Insurance Commissioners (NAIC), last-minute attempts by the industry to weaken the regulations, resulting in dramatic votes that had the suspense of a World Series game.

* While her Department cranks out new regulations and rulemakings, Health and Human Services Secretary Kathleen Sebelius recognizes that the action on implementing the new health law is at the state level, as she met with a select group of state-based consumer advocates, including Health Access California, to discuss the work ahead to fulfill the promise of reform at the state level.

* Finally, in order to remind us the importance of health reform and the need to do even more, the LA Times reported on a new study that reminded us of the problems with high deductible plans. These health plans impose deductibles of more than $5,000 and may cause members to delay care, putting people in financial jeopardy.

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

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