Thursday, March 16, 2006

HEALTH ACCESS UPDATE
Thursday, March 16th, 2006


DEBATE ON HIGH DEDUCTIBLE HEALTH PLANS HEATS UP

• California bills would set standards for out-of-pocket costs and high deductible plans
• Other bills would encourage such plans & consumer-opposed Health Savings Accounts
• Assembly Health Committee holds hearings scrutinizing “consumer-directed” plans

The debate over high deductible plans heated up in the last week, as the Assembly Health Committee finished two sessions of hearings on the matter, kicking off a legislative year where multiple bills on the subject will be discussed in the California legislature.

At the same time, the debate over high-deductible plans is getting significant attention at the federal level as well. President George W. Bush, for example, is making a grand push for these so-called “consumer-directed’’ plans in his federal budget, appropriating $11.8 billion in tax incentives (through Health Savings Accounts) per year to encourage their use.

The shift to high-deductible plans are seen to shifting costs onto consumers, cleaving apart the health care market, and forcing consumers to “play doctor’’ and figure out on their own if they should visit a doctor or emergency room.

STATE SOLUTIONS: State legislation that seek to address these problems include:

AB977 (Nava), sponsored by Health Access California, would require regulation of health plans that require high out-of-pocket costs at the state Department of Insurance and Department of Managed Health Care. New health insurance products would be subjected to a public vetting. High-deductible plans could be rejected for reasons such as:

• Excluding certain services, such as preventive care
• Imposing too large a cost burden on enrollee

AB2281 (Chan), supported by Health Access California , would require plans with high deductibles to:

• Cap total out-of-pocket costs to $5,000 for individuals and $10,000 for families
• Include preventive care as a benefit (some high-deductible plans do not pay for preventive care until after the deductible is met)
• Limit the copayment or coinsurance that subscribers pay to no more than 30% of the service
• Include a way for consumers to comparison shop for medical services, via rates and other measures that allow patients to choose high quality providers.
  

OTHER HSA BILLS: On the flip side, four Republican lawmakers are authoring legislation that would provide tax credits to encourage health savings accounts and high deductible plans.

Consumer groups, including Health Access California , oppose these measures, given the many concerns they have with the impact of high-deductible plans and the rise of underinsurance, both on the individual patient, as well as the health system as a whole. Additionally, the money that would the state would lose in taxes would be more effective in increasing access to care by expanding public insurance programs like Medi-Cal and Healthy Families.

The bills opposed by consumer groups include: SB1584 (Runner), SB1639 (Dutton), AB2010(Plescia), and AB 2737 (Nakanishi). The text of all these bills are available at the State Legislative website, at: http://www.leginfo.ca.gov

REPORT FROM ASSEMBLY HEARINGS

The Assembly Health Committee, chaired by Assemblywoman Wilma Chan (D-Alameda), held two hearings on the topic this past month to examine what the state already does to monitor these plans and how laws could be beefed up to ensure consumers are protected.

OVERVIEW: Larry Levitt from Kaiser Family Foundation and Michele Melden, associate professor at Thomas Jefferson School of Law, provided insight into the high-deductible market. A high-deductible plan is one that requires single enrollees to spend at least $1,050 on health care (families must spend at least between $2,100) before the insurance benefits kick in. Three million enrollees reported having such coverage nationally in January 2006, according to the Kaiser Family Foundation.

A person may think they’re “covered’’ by insurance, but they’d still be on the hook for their deductible and out-of pocket costs. Melden testified that she has seen plans with costs as high as $25,000. That often means that patients are paying – whether they can afford to or not – the full price for preventive care (i.e. doctor visits and prescription drugs) unless their plan says otherwise.

Proponents of high deductible health care plans have suggested that these so called consumer-driven health plans could actually help control the fast-escalating costs of health care by causing consumers to have more “skin in the game.’’ By having to pay higher deductibles and higher portions of their health care costs, consumers would ostensibly ‘shop around’ for lower cost services, or go without unnecessary health care services.

OPPOSITION TO HIGH DEDUCTIBLE PLANS: Testimony, including academics and consumer advocates, including from Health Access, Western Center on Law and Poverty, and the Foundation for Taxpayer and Consumer Rights, indicated that these high deductible plans could actually do the opposite of what proponents intend, and cause health care costs to rise:

• Consumers have no way to “shop around’’ prices or quality health care
• Consumers would “play doctor’’ and make their own decisions about which treatments are necessary or not, delaying cost-saving preventive care such as mammograms.
• Separates the market into the “healthy’’ and “less healthy.’’
  

While many of the arguments were that these plans harm the overall health system, there was evidence that they weren't helpful to the consumers who had them, either, who were left underinsured. In one example, Roland Smith, a self-employed videographer in Placer County , would have been better off uninsured, than his high deductible plan from Blue Shield. His policy costed nearly $300 a month, and he still has a bill for over $6,000 for outpatient knee surgery, which has since been sent to collections by Sutter General Hospital .

Insurance Commissioner John Garamendi put out a report earlier in the year on Health Savings Accounts, detailing the problems with high deductible plans. It is available at hi website, at:
http://www.insurance.ca.gov/0400-news/0100-press-releases/0070-2006/release-013-06.cfm

CURRENT STATE OVERSIGHT: Health insurance regulators -- Department of Managed Health Care (DMHC) and Department of Insurance (DOI) – both testified that little data is available on such plans.

DMHC testified to changes in the insurance market where HMOs are following PPOs and requiring deductibles and higher out-of-pocket costs for consumers. Current law, however, only allows DMHC to ensure that co-pays aren’t “objectionable;’’ and ensure disclosures clearly advise consumers which services can be applied to their deductible.

At the DOI, current law does not permit the agency to regulate group policies that employers are offering, which becomes a problem as more employers begin offering high deductible plans. With half of the state’s residents getting coverage through employer, this could leave many consumers vulnerable.

The agency does have more authority to regulate individual policies; however, under “file and use” statutes, policies submitted by insurers are automatically approved in 30 days if the agency fails to act. Additionally, there is no minimum package of benefits and no cap on deductibles.

PROVIDER CONCERNS: The growing popularity of high-deductible plans concerns physician groups and hospitals, which are often left footing the bill when patients are unable to pay for medical services.

The California Hospital Association reported that the number of patients defaulting on their debt is increasing. While no comprehensive survey has been conducted, three southern California hospitals have seen a 50 percent increase in the value of unpaid patient bills, which are ultimately written off. Other hospitals are having an even more difficult time collecting on services. “Trying to keep a hospital viable becomes harder,’’ said Martin Gallegos, for the association.

Physician groups believe high-deductible plans will promote a scattershot approach to health care, where patients will be less likely to involve doctors in important health maintenance decisions. That could ultimately cost the system more money as patients forgo routine and preventive care, and wind up sicker, said Bart Asner, CEO of Monarch Healthcare in Orange County , a 1,900-physician group.

The California Medical Association, however, took a different approach. The association’s Dustin Corcoran said they shouldn’t be ruled out as an option for consumers who could benefit.

INDUSTRY DEFENSE: While insurers did defend their high-deductible product lines, "These plans are not for everybody,'' admitted Charles Bacchi, vice president for the California Association of Health Plans.

Yet employers testified at the hearing that in some cases, employers are not giving employees any choice but to enroll in a high-deductible plan as businesses continue to scale back and cut benefits. Toni Wynn, chief operating officer with Price Associates, reported a spike in the number of companies interested in this type of coverage for their employees.

Secondly, some politicians and policy makers are pushing high-deductibles as one way to control spiraling medical costs. Their lower cost also lures some into purchasing the plans without understanding the financial implications. Wynn says she asks prospective clients, "How do you plan to be sick this year?' Since no one plans to be in a car accident, or get cancer, she thus gets interest in these high deductible plans.

For more information on any of these issues, contact Hanh Kim Quach, Policy Coordinator, Health Access, at 916-497-0923, or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 3:52 PM


 

Wednesday, March 15, 2006

HEALTH ACCESS ALERT
Wednesday, March 15th, 2006
*Ides of March Edition*

ENZI BILL PASSES SENATE COMMITTEE; WOULD GUT CA PROTECTIONS

• State health plan regulations for consumers, providers, employers under attack
• Federal legislation, S. 1955 (Enzi) would have particular impact on California
• Action needed with U.S. Senator Diane Feinstein

California ’s past, current and future efforts to oversee health insurance plans could be rendered moot if new federal legislation, which President George W. Bush supports, were to pass.

ENZI BILL PASSES KEY COMMITTEE: S.1955 by Senator Michael Enzi would eliminate protections that individual states have passed to protect consumers against insurance companies, creating one standard of insurance regulation for all states.

The Enzi bill cleared the Senate Committee on Health, Education, Labor and Pensions on Wednesday on an 11-9 party-line vote, with Republicans supporting the measure, and all Democrats opposing the legislation. It is heading to the Senate Floor.

CALIFORNIA IMPACT: Enzi’s bill is seen to be particularly harmful in California , which has created a regulatory framework that goes beyond that standard and provides greater protections for consumers, health care providers, as well as small businesses that purchase insurance.

Protections for consumers that would be lost in California , with the following results:

• Mandatory and standard benefits, such as maternity care, diabetic equipment, , osteoporosis treatment, mental health services, cancer testing and the ability to seek a second opinion would be lost.
• Access to some specialists, such as optometrists, behavioral therapists or podiatrists could be denied.
• Older workers, or employees with chronic conditions, could be denied coverage through discriminatory pricing and benefit designs.
  

GARAMENDI REPORT: Insurance Commissioner John Garamendi is particularly alarmed by the bill, and released this analysis of its impact on California on Tuesday. Find a full copy of the report, “Bad for Business, Bad for Employees,” which includes full lists of the California protections jeopardized, on his website, at:
http://www.insurance.ca.gov/0400-news/0100-press-releases/0070-2006/upload/BadforBusiness-S1955report.pdf

According to Garamendi’s analysis, the Enzi bill would discriminate against businesses considered “high-risk,’’ had too many older workers, or too many women employees of child-bearing age by making health insurance more difficult to obtain and more expensive. Additionally, this bill would pave the way for more bare-bones health plans to proliferate, without government oversight.

DETAILS: The bill is actually three parts:

1. The creation of “small business health plans,” which are a revised version of “association health plans” (AHPs), which allow employers to offer insurance without state oversight and consumer protections, opening up patients and businesses to fraudulent practices.
2. The elimination of California ’s and other states’ “community rating” rules designed to protect small employers that might be denied the ability to purchase insurance for their workers.
3. An effort at “harmonization” of state consumer protections, setting a process to eliminate such state-based protections and setting a federal ceiling.
   

To read the bill S.1955, visit: http://thomas.loc.gov/

With the bill heading to the full Senate, a range of consumer, health, doctors, patient, and community organizations are asking U.S. Senators to oppose the measure, including U.S. Senators Boxer and Feinstein.

California groups are asked to call, write or fax Senator Diane Feinstein,
The address is: 331 Hart Senate Office Building, Washington DC , 20510 .
The phone is: 202-224-3841
The fax is: 202-228-3954

A sample letter from many national groups is at the website for the National Partnership for Women and Families:

http://www.nationalpartnership.org/portals/p3/library/HealthCareQualityPatientsRights/GroupletterS1955.pdf

For more information, contact Hanh Kim Quach , Policy Coordinator, Health Access, at 916-497-0923, or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 3:47 PM


 

Wednesday, March 01, 2006

HEALTH ACCESS UPDATE
Wednesday, March 1, 2006

CALENDAR OF EVENTS OF INTEREST FOR HEALTH ADVOCATES

• Citizens’ Health Care Working Group: LA this Sat, March 4th; Sac on Wed, April 19th
• Other Forums for National Health Care Reform
• Leg Hearing on High-Deductible Plans, Medi-Cal Anniversary, CPEHN Convenings, etc

While the conversation in Congress is often more about cutting care than expanding coverage, there have been new signs of increased organizing and activity around expanding affordable and high quality health coverage, locally, statewide and nationally. National attention is starting to be focused on major health reform, through a number of different vehicles.

Several events of interest to health advocates are coming up in the next month or so, and listed here are a few highlights. This information, and other events, is listed on the Health and Budget Advocacy Calendar, at the Health Access website at:
http://www.health-access.org/calendarhome.htm


Of particular note is a community meeting this SATURDAY, MARCH 4th:

CITIZENS' HEALTH CARE WORKING GROUP: In January, a panel of 15 federally-appointed members began gathering public input on how to improve the nation’s health care system. Input from community meetings held nationally, from January to April, will serve as a basis for recommendations to decisionmakers in Washington , D.C. on improving the health industry. These forums are interactive, with participants engaging in small group discussions and responding to a series of questions. The process, which is independently administered, will produce recommendations to the Congress and the President, and be the subject of Congressional hearings.

Hundreds of Californians are expected to take part in one of the “signature” events THIS SATURDAY, MARCH 4th, from 8:30am to 4:00pm, at the Los Angeles Convention Center ,
1201 South Figueroa Street, LOS ANGELES. For more information, call 1-800-679-3684, or go to the website at: http://www.citizenshealthcare.gov.

Health advocates and organizations are mobilizing to turn out their members, to involve them in the debate, and help influence the outcome. For more information about these efforts, contact Norma Martinez-HoSang, Health Access, at 213-748-5287, or nmartinez@health-access.org.

A similar hearing will be in SACRAMENTO on WEDNESDAY, APRIL 19th. For information about turnout efforts there, contact Jessica Rothhaar, Health Access, at 510-873-8787 x107, or jessicar@health-access.org.


HEARINGS ON UNIVERSAL HEALTH CARE: Other national efforts are explicit about supporting universal, single-payer health care proposals, such as H.R. 676, by Rep. John Conyers. A series of Citizens’ Congressional Hearings have been organized around the country on this proposal, which have included ones in Marin, Los Angeles , and San Jose , with leadership from California Nurses Association, Health Care for All – California , and others, including Health Access California .

Another such hearing, styled as a “Citizens’ Hearing & Truth Commission on Health Care,” with
Rep. Barbara Lee, is coming to OAKLAND on SATURDAY, MARCH 25th, from 10:00am to 2:00pm at the Forum Building at Laney College, at 900 Fallon Steet (10th Street entrance). For more information, contact Women’s Economic Agenda Project at weap@weap.org.

Such efforts are not only focused on national legislation, but state proposals as well. “Fixing Health Care in California ” is a free public forum on universal health care, with presentations on SB840 by state Senator Sheila Kuehl. The event is also in OAKLAND on THURSDAY, MARCH 16th, at 7:00pm, at the offices of the California Nurses Association, 2000 Franklin at
20th Street. For information call 510-832-8683.


MEDI-CAL 40th ANNIVERSARY: Remembering past efforts at expanding coverage, the California Department of Health Services will be hosting a “celebration” of the Medi-Cal program, which officially started on March 1, 1966. The program in SACRAMENTO features Secretary of Health and Human Services Kim Belshe, DHS Director Sandra Shewry, and Assemblyman Mervyn Dymally. It will be held on TUESDAY, MARCH 14th, at 11:00am-2:00pm (with the program starting at 11:45am), at the Crest Theater at 1013 K St. To RSVP, call 916-440-7737, or e-mail MC40@dhs.ca.gov.


LEGISLATIVE HEARING ON HIGH-DEDUCTIBLE PLANS: Assemblywoman Wilma Chan, Chair of the Assembly Health Committee, will by holding a hearing on high-deductible plans in SACRAMENTO on TUESDAY, MARCH 7th, at 1:30pm. This will include testimony from Health Access, Western Center on Law and Poverty, and others. With President Bush’s push for Health Savings Accounts, and many bills proposed at the state level, this will be a hot topic in policy circles this year.


CPEHN CONVENINGS: The California Pan-Ethnic Health Network (CPEHN) and partners will discuss important issues impacting the health of our communities: reimbursement of interpreter services, obesity and environmental factors impacting health, and children's health insurance coverage. To register go to http://www.cpehn.org/register.php?id=73. For questions please contact (510) 832-1160 or info@cpehn.org. The convenings are at:

• SAN DIEGO, on MARCH 28th, at Malcolm X Branch Library, 5148 Market Street
• FRESNO , on MARCH 30th, UC Center, 550 East Shaw Avenue
• OAKLAND , on APRIL 4th, Nile Hall, Preservation Park , 668 13th Street
• LOS ANGELES, on APRIL 6th, Asian Pacific American Legal Center , 1145 Wilshire Blvd, 2nd Fl.

Labels: Updates

posted by Anthony Wright | Permalink | 6:42 AM


 

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