I think it's good news that Speaker Nunez did *not* put up the Governor's plan for a vote, where, as written, it would get few, if any, votes. That simply focuses on the differences, rather than on those items of consensus.
My read is that it's a signal that the Speaker thinks the Governor is actually serious about negotiating, rather than just preparing for a veto.
That's a good sign... and our jobs, as health and consumer advocates, is to create a political environment that anything that comes out of those negotiations has to place affordability for consumers as a central tenet: affordability to get coverage (premiums) and affordability to use coverage (out-of-pocket costs).
What I found interesting/sad about the census report released yesterday is this: While incomes are nudging upwards, the number of people with insurance is falling.
It seems counterintuitive -- that as more people broke into the ranks of middle-income earners, they'd be guaranteed coverage. But in fact, that is what we are fighting now. It's not just low-income who are being left behind, it's the middle-income as well.
Which is why it makes no sense to me that President Bush is trying to deny children in middle-income families ($42,000 for a family of four) coverage.
Which is why it makes no sense to me that Gov. Schwarzenegger's solution is to get middle income famillies ($52,000 for a family of four) to buy coverage that would put 24% of such a family's income on the hook should someone break their arm, or be diagnosed with cancer.
And which is why it makes no sense to me that some lawmakers are saying nothing can be done to help these people this year.
The number one question I get is whether there will be a deal on health care this legislative session. It has been the focus of big, front-page articles in the San Jose Mercury News and the Sacramento Bee--even the Washington Post, just in case we don't think that the whole world is watching.
There are two answers. In the world of politics, I see the Governor threatening a veto of the Speaker's bill; the Speaker threatening to place the Governor's plan to a vote of almost certain defeat; and the Senate President Pro Tem expressing skepticism. Savvy Sacramento folks all think this is just positioning for final negotiations. What do I know?
In the world of policy, I see two plans that are more similar than different. They both include: * a major expansion of coverage for more than two-thirds of the state's uninsured * a minimum employer contribution toward health care * a requirement on most individuals to take up health coverage from employers * major eligibility expansion of public insurance programs for children and parents * significant streamlining of public insurance programs to maximize enrollment * significant draw-down of federal Medicaid funds * new use of federal and state tax breaks, though Section 125 plans, for health coverage * limits on insurers denying people because of pre-existing conditions * a minimum requirement on insurers to spend 85% of premium dollars on patient care * various cost containment efforts, such as on information technology and disease management
In some cases, the proposals are very similar, if not the same. There are differences on some key details. And they matter, a lot. But looking at the policy, it's hard to come away with the notion that a deal isn't just possible, it's likely.
Jon Myers at KQED's Capitol Notes compares this to other "last-minute" deals, for good or ill, and I would argue that this is differnet--we have been having these health care debates for five years, where issues around expanding employer-based coverage, public insurance programs for children and adults, and other reform have been heavily vetted, in bill form and on the ballot.
The main question isn't the policy. It's back to the politics.
How many more reports showing more people becoming uninsured do we need before our elected leaders reform the health system?
The new U.S. Census study shows that 18.5% of Californians were uninsured in 2006, or over 6.6 million people. Nationally, the number of uninsured Americans has now officially released 47 million.
Californians are increasingly more likely to be uninsured than in previous years, and are more likely to be uninsured than resident of all but five states: Texas, New Mexico, Florida, Arizona, and Oklahoma.
Yep, even Mississippi and Arkansas are looking down on us.
While over 75% of Californians get coverage through employer-based coverage or public programs, even those that are insured have reason to be concerned that their coverage won't be there for them when they need it--unless we take steps now to shore up those forms of group coverage. posted by Anthony Wright | Permalink | 5:55 PM
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Moving the finish line...
Monday, August 27, 2007
Apparently Sen. Don Perata, the leader of the Senate, announced today during session that the house would wrap for the year on September 11th - - a full THREE days before the scheduled end of session.
That gives us 10 more work days (15 if you include weekends and holidays) to finalize a health reform package.
So, it's official. If no positive health expansions are passed, Governor Schwarzenegger's "year of health reform" will actually take us backwards in terms of Californians' access to care, given these budget cuts.
In addition to the cuts that we have highlighted here, I would be remiss to not mention the most cruel cut--the $55 million cut to aid the mentally ill homeless, for what all accounts is an effective, humane programs that provides savings in the long term. Both Frank Russo and Bill Bradley point out how the Republican forces this cut while fighting for a $45 million yacht tax credit.
The San Francisco Chronicle also spotlights the cuts to children's health coverage outreach and enrollment efforts. The article spotlights Frances Culp and the work of the Bringing Up Healthy Kids (BUHK) Coalition, which Health Access helped start and coordinate several years ago, but was cut significantly during the last budget crisis. It survived with strong local leadership through the lean times and recently has had great success, especially with the work of the NICOS Chinese Health Coalition. The San Francisco effort has always been a model about how to effectively enroll children and families into coverage and to best stay on and use it effectively... and yet every time it gets on a roll, it faces the budget axe.
This on-again, off-again funding stream is no way to run a health system, especially if the goal is to cover all children, much less all Californians.
There's also good articles on the budget cuts in the San Jose Mercury News and the Sacramento Bee , which also spotlight the zeroing out of the prescription drug discount program for the next budget year. My understanding was that the Department of Health Services already some potential vendors and a few agreements with drug companies in place. We'll have to follow-up on this next week.
Grrr. posted by Anthony Wright | Permalink | 2:30 PM
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Singing the "Blue Pencil" Budget Blues...
Friday, August 24, 2007
HEALTH ACCESS UPDATE Friday, August 24, 2007
GOVERNOR SIGNS BUDGET, BUT WITH HEALTH CUTS * $700 million in cuts is part of agreement with Senate Republican holdouts * Implementation of children’s coverage outreach and drug discount program delayed * Primary care clinics and Medi-Cal managed care also face cuts
New on the Health Access WeBlog: More Budget Update; Small Biz for Health Reform; The Veto Threat; Fact Checking the Gov; MA Redux; What is Universal? What is Covered?; Wonked!; Special Session?; Field Poll Analysis; President Bush Attacks SCHIP; New TV Ads; The Social Security Metaphor; New Report on Individual Market Consumer Protections; The Real Difference Between Nunez and the Gov; California Speaks; Kuehl Speaks; Having Our Say; The 2/3 Vote; Healthy San Francisco; Complaints About Insurers.
Earlier today, Governor Arnold Schwarzenegger signed the 2007-08 Budget, totalling over $145 billion. Due to a standoff by Senate Republicans, the budget was passed on Tuesday, August 21st, over 50 days after the beginning of the budget year. Of particular note was the $703 million in cuts the Governor made using his line-item veto authority.
As the governor and Legislature begin discussions on health care reform, more than half of cuts made in the 54-days-late budget that Gov. Arnold Schwarzenegger signed Friday came from the department of Health and Human Services.
While $332 million of the cuts were simply a re-adjustment in Medi-Cal expectations and will not result in a reduction in services, other cuts would have significant impacts on nascent programs.
Among the cuts:
* PRESCRIPTION DRUG DISCOUNTS:$6.3 million from the California Discount Prescription Drug Program Fund: The Governor zeroed out the money to implement this program that would negotiate with drug companies to provide discounts to uninsured and underinsured Californians. In his veto statement, he directed the Department to identify ways to start the work, but the program is likely to be delayed.
Along with legislation on global warming and minimum wage, the Governor has repeatedly mentioned this program – a result of AB2911 (Nunez/Perata) -- as one of the major successes from 2006, including on multiple appearances on "Meet the Press."
* CHILDREN’S COVERAGE:$66 million to make it easier for children to enroll – and stay enrolled – in the state’s Medi-Cal and Healthy Families Program: There's a range of cuts to children's coverage. This includes cutting the $15.4 million to implement SB437 (Escutia) to streamline enrollment, and also cutting $15 million in funds for county outreach and enrollment efforts. These cuts effectively prevents the state from reaching out to more than 100,000 children who could be enrolled in public programs.
The Governor had a major bill signing ceremony on SB437, and has participated in several events on children's coverage, which remains an element of the Governor's health reform.
* CLINICS:$10 million from the Expanded Access to Primary Care. This cut will decrease access to care for uninsured patients through community clinics.
Providing care through community clinics was something that even legislative Republicans have advocated for in their health reform proposals this year.
* MEDI-CAL MANAGED CARE:$106.3 million in cuts to Medi-Cal Managed Care: While the budget retains $54 million in state dollars for an increase to Medi-Cal HMOs.
Yet the Governor would not draw down $53.1 million in federal matching funds, as part of this reduction to Medi-Cal--at the very time that health reform proposals seek to expand the program.
The Governor announced his anticipated $703 million in line-item budget cuts today, thus ending the sordid budget story. $527 million were cuts to Health and Human Services.
Making cuts to health care is not a good way to start negotiations on health reform.
The Governor's $700 million in line-item veto cuts undermines many of the health care goals that he highlighted and campaigned on just last year.
It also includes our priorities--Health Access California was a co-sponsor, with a broad coalition of senior, consumer, labor, and community groups, of the legislation that established the California Prescription Drug Discount Program, whose implementation is zeroed out in the proposal. The establishment of a prescription drug cost comparison website was also zeroed out.
The line-item veto also includes the zeroing out of implementation of last year's SB437, which would streamline eligibility and enrollment for children's coverage in Medi-Cal and Healthy Families, and would have resulted in more children having health insurance in this budget year.
Other cuts include $10 million from community clinics, out of the "Expanded Access to Primary Care" (EAPC) funds.
Both the prescription drug and children's coverage bills got high-profile signing ceremonies by the Governor last year. Both will now be delayed for another year.
Care delayed is care denied, and because of these cuts, fewer children will be covered, fewer patients will be seen at clinics, and fewer seniors and uninsured will be able to get needed drug discounts. posted by Anthony Wright | Permalink | 1:42 PM
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What it looks like on the other side
As California moves toward health care reform ...oh -- in the next 3 weeks -- we had a visitor from a state that is in the middle of implementing it's health care reform from last year.
Jon Kingsdale, executive director of the Commonwealth Connector, which is the board in Massachusetts that is charged with implementing its health reform, gave us a glimpse of what life would be like once legislation was passed. They're in the first of a three-year process to implement the new law. Kingsdale was in the Capitol today courtesy of the California HealthCare Foundation.
While the most highly publicized part of the Massachusetts reform legislation was the fact that it would require every citizen to purchase health insurance, the pieces of the plan that are furthest along -- at this point -- are the expansions in public programs. More than 70 percent of those that qualify for Medicaid are now enrolled; 75 percent of those qualified for subsidized health coverage have purchased coverage.
That means nearly 3/4 of Massachusetts residents who earn less than $41,000 (a couple) are in some kind of publicly funded program. If we transplant that rate of enrollment success to California, we'd be covering 2.7 million people!
Of course, we can't really compare Massachusetts to California -- on MANY levels.
Population- and coverage-wise:
First, the entire state has 6.2 million people. That's FEWER people than California has in uninsured.
Secondly, only 6 percent of its population was uninsured prior to reform, compared with California's 20 percent.
My colleague Beth has a great one-page fact sheet on how much more robust coverage in Massachusetts was before they began their reform, which includes the fact that more employers were providing coverage before reform (69.4 percent in MA compared with 57.7 percent in CA), and Medicaid spending was higher there ($5,400 per enrollee in MA versus $2,250 in CA)
Market-wise, we're in completely different places, as my colleague Anthony has written about before, MA providing more consumer protections than in CA.
But, in spite of the differences in regulation, population, politics, and coverage, one thing Kingsdale said resonated:
"Nowhere in the country does the non-group market work.''
Translated: the market where poeple must go out and search for coverage on their own without an employer or public group is a wreck, which says to me that any attempts to rely on the individual market to diminish the number of uninsured, or shrink group markets by thrusting people into the individual market is a bad idea.
As a consumer advocate, I've been frustrated over the years about the positions of the lobbying organizations representing businesses, like the Chamber of Commerce and the NFIB.
I think it is a reflexive instinct for an organization to oppose any requirement or tax on their constituency, even if they should be considering the long-term benefits. But these organizations even oppose cost containment measures on insurers, hospitals or drug companies, even though the direct beneficiaries would be employers, as purchasers of health care. A lot more could get done if employers recgonized their interest in promoting some key policies.
Is it that there's a conflict of interest between these business organizations, representing the health industry over their base of employers? Is it ideological?
Regardless, there's a new poll out today that suggests that California small business owners are in a very different place than their representatives about the health reform ideas on the table.
The poll is sponsored by Small Business Majority, and unlike other surveys, it polls small business owners at random, rather than from membership lists of any organization. The ideological spread was broad: Democrat-38%; Republican-30%; Independent-29%; Other-3%. The August survey of over 500 respondents is scientifically significant, with a margin of error of 4%.
Small business owners expressed strong support for a range of the proposal on the table, that are in AB8, the Governor's plan, or otherwise in the conversation:
* 75% favored requiring health insurers to spend at least 85% of their premiums on care -- vs. 8% opposed. * 70% favored offering health insurance regardless of health status – vs. 9% opposed. * 67% favored requiring insurers to offer coverage to small businesses regardless of the workforce’s health status – vs. 10% opposed. * 63% favored a requirement that employers offer Section 125 plans – vs. 11% opposed. * 62% favored requiring insurers and HMO’s to get state approval prior to raising premiums – vs. 15% opposed. * 58% favored expanding current public health programs – vs. 15% opposed. * 56% favored setting a timeline for hospitals and doctors having electronic medical records – vs. 10% opposed.
This is impressive, given that small businesses are portrayed as anti-government zealots, that small businesses see a role for government. What is more remarkable is that employers expressed support for reforms that even required them to contribute:
* 67% felt that employers should be required to pay something to provide healthcare to their employees -- almost four times as many as those who felt that employers should not have to contribute anything (17%). Of those who agreed that employers should contribute, over half felt that they should be required to pay more than 4% of payroll costs.
* Also, 46% were in favor of a one percent sales tax to make healthcare more affordable – vs. 35% who were opposed.
When the poll asked about the three plans on the table, with short descriptions but that seem to include a straight-out statement about the cost to employers, the plans still got a plurality of support. · Governor’s proposal -- 47% in favor; 31% opposed · AB 8 -- 47% in favor; 33% opposed · SB 840 -- 42% in favor; 40% opposed
They seem to be willing to be part of the solution.
Note that they even supported AB 8, proposed by Assembly Speaker Fabian Núńez and Senate President pro Tem Don Perata, at the same level of the plan by Governor Arnold Schwarzenegger, even though it asks for a higher minimum contribution. They seemed to pick up the nuance that employers would get a bigger benefit for that 7.5% amount--the benefit of having all their workers covered. The notion that anything over the Governor's 4% standard is "too much" doesn't seem to be bourne out by the survey.
And despite strong employer opposition over the last five years by business groups, a slim plurality said that they favored the single-payer plan (SB 840) authored by Senator Sheila Kuehl.
One more thing about the Governor's insistence for universal coverage without actually putting forward a plan that gets there.
Let me be clear, AB8(Nunez) isn't universal either. Again, only SB840(Kuehl) offers full universality.
But AB8 still makes major reforms that makes coverage more available, affordable, and automatic for many. So is the Governor's plan *more* universal?
The earlier modeling by Jonathan Gruber at MIT shows that both AB8 and the Governor's plan both would cover the vast majority of the uninsured, although leave some uninsured. The Governor's plan is credited for covering more--on the scale of 700,000 Californians.
It seems that here are two components.
* While both plans expand public program subsidies to children and parents up to 250% of the federal poverty level (AB8 actually goes to 300%), the Governor's plan also requests a federal waiver to also expand coverage to adults without children at home.
This is a group neglected now--right now, a childless adults even under the poverty level has no ability to get Medi-Cal. The challenge here is to raise the money, which might trigger a 2/3 vote issue, and the ability to get federal permission, which requires the ability to show savings in Medi-Cal.
* The other reason for the difference is the individual mandate, requiring people in the individual market to take up coverage, even if they don't get coverage at work or through a public program. There's a question in the modeling about whether the individual mandate would actually bring in the 95% estimated compliance--or how aggressive the enforcement would have to be to get that. Right now, the requirement for car insurance leaves 15% of drivers uncovered.
Regardless, many of the folks impacting by the individual mandate I would *not* classify as "covered," such as those that can only afford to get the $5,000 high-deductible minimum plan. As the Its Our Healthcare ads say, "it's not health care if you can't afford to use it."
Even Massachusetts made the decision to exempt people from the mandate, rather than make them pay for coverage that was both unaffordable to get and to use. Call this group the "overcharged and underinsured." If you can't raise the money to provide adequate subsidies, then politically and morally, the Governor's plan would have to at least provide Massachusetts-like exemptions. That would make the difference between his plan and AB8 even narrower.
Short version: When we describe which plans will cover more people, if matters what we count as coverage. posted by Anthony Wright | Permalink | 2:06 AM
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Fact check #2
Thursday, August 23, 2007
Another point about the Governor's comments to the Sacramento Bee editorial board, where he said he won't sign a less-than-comprehensive bill: "I won't sign it. It won't happen. Because we will never have a chance again to go back and cover the rest."
Does that mean he won't sign his own plan?
The Administration's own modeling, done by MIT Professor Jonathan Gruber, leaves close to a million Californians not covered. There's a vague hope that the counties would cover those Californians, but there's no requirement or proposal for that to happen.
I don't say this as a criticism: it's a major step to expand coverage to millions of the uninsured, and to bolster and secure coverage for the millions who do have coverage, but are concerned it won't be there for them when they need it. But it is simply not universal. Maybe "near-universal" is more appropriate.
If he wants a truly universal, comprehensive plan, he had the framework for that on his desk last year--SB840(Kuehl). So he shouldn't lecture others about wanting a broader, bolder approach.
AB8(Nunez) is an attempt to expand coverage with a bill that requires a majority vote. If the legislative leaders could get two-thirds vote, I imagine they would pass SB840(Kuehl) with the financing.
AB8(Nunez) was heard in Senate Appropriations Committee today, and placed on suspense.
The Governor said to the Sacramento Bee editorial board that he won't sign AB8, or a bill that "has only employer mandate," he said. "I won't sign it. It won't happen. Because we will never have a chance again to go back and cover the rest."
Read the bill, Governor.
The legislative leaders' proposal is more similar than different to the Governor's proposal. The biggest difference between the plans is that AB8(Nunez) requires a majority, rather than a two-thirds, vote to get approved.
AB8(Nunez), like the Governor's plan, includes a minimum employer contribution to health care, but has much more than that. It also includes (as does the Governor's plan): * expansion of public programs for children and parents; * draw-down of significant federal Medi-Cal matching funds; * required individual take-up in employer coverage and the statewide purchasing pool; * rules on insurers requiring 85% of premiums to go to patient care; * limits on insurers denying people because of "pre-existing conditions"; * major expansion of use of federal and state tax breaks for individual premiums; * cost containment provisions on information technology, transparency, and prevention.
AB8(Nunez/Perata) includes financing from several sources, including: * individual contributions, in share of premiums and out-of-pocket costs; * employer contributions, capped at 7.5% of payroll; * reinvested state savings; * federal Medi-Cal matching funds; and * new use of federal and state tax breaks.
The Governor is also apparently wanting a sixth funding source: the provider fees in his proposal, which would in turn fund a Medi-Cal rate increase--a very important and worthy goal.
The issue is, the provide fee requires a two-thirds vote. So he needs to get the legislative Republicans to vote for it--not an easy task, as the last 52 days attests. If he wants that additional funding source, he should be working on the legislative Republicans, not threatening to veto the bill of the legislative leadership.
There's a possibility that the hospitals that would benefit from a Medi-Cal rate increase and expanded coverage would come out for a hospital fee--and be able to get Republicans to vote for it.
There's work being done now. But if it doesn't get done, that shouldn't stop reforms to expand coverage to children, parents, and working families--areas where the Governor and Legislature agree.
So the Guv told John Myers at KQED that he'd be willing to call a special session on health care reform if he and the Legislature can't agree to a plan by September 15 -- the last day of the 2007 session.
In December 2006, 51% of Californians said they were "very satisfied" or "somewhat satisfied" with "the way the health care system is working in California." In August 2007, that number dropped to 27%. Those who were "somewhat dissatisfied" or "very dissatisfied" went from 44 to 69%.
Skeptics can read the question about "preferences about ways to improve the health care system" that there's isn't consensus about how to fix the health care system: one-third (36%) support "a new state government-run system" (getting a big bump from 24% in December), and one-third (33%) support "reform within the framework of current health insurance system... through shared responsibilities" (down from 52% in December.)
First of all, let's be clear that very few (14%, down from 18% in December) chose the "rely on free market competition" option. Yet that's the rhetoric of the legislative Republican proposals here in California, and of President Bush nationally.
Second, the poll forced a false choice: From my review of other polling, I think that both the "single-payer" option and the "shared responsibility" options would get higher percentages--in fact, majorities--if the questions were put one at the time.
The false choice is also in the wording. Senator Kuehl has written eloquently about how her single-payer bill is "shared responsibility," with individuals, employers, and government all paying into a common system, building on current programs like Medicare. And many of those who want to replace the current system would surely support expanding public programs and placing more oversight over insurers.
The Democratic majority in the Legislature has managed to do both, voting this year both for SB840(Kuehl) and AB8(Nunez/Perata). They seem to be representing their state, the combined two-thirds.
In the great health care debate between the YOYO "you're on your own" free-market proposals and expanding group coverage through public programs, employers, or a universal statewide system, it's not a close call. There's a two-thirds majority for reform, for an appropriate government role in the regulation and financing of health care. And Californians' dissatisfaction with the status quo is growing.
It's unclear what cuts Governor Schwarzenegger will make with his "blue pencil" veto authority, and we'll see if those cuts--made as a way to get Republican Senate votes--will include health care items. We'll be watching and reporting...
The implications for health reform are also unclear. After a 52-day standoff on the budget, does he still think he can get the 2/3 vote for health reforms in his proposal? And if not, will that have an impact on what he is willing to sign? Stayed tuned. posted by Anthony Wright | Permalink | 3:57 PM
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Race to the Bottom....
The Wall Street Journal today reports that more insurance companies are jumping into the individual market -- the most expensive and most difficult way to buy health insurance coverage -- and tailoring plans (read skimpy high-deductible health plans -- with no maternity coverage) to the just-beginning-adulthood (who apparently don't think anything they do leads to pregnancy), and just-beginning-seniorhood set.
The illustrative quote that just got my goat: "There is a sizable portion of the population who are not interested in maternity coverage and don't want to pay for this benefit,'' WellPoint spokeswoman Christi Lanier-Robinson told the Journal.
This growing popularity of high-deductible plans could mean that the number of people with Health Savings Accounts (which can only be used if you have a high-deductible plan) may double in the next year from about 4 million now (since their inception in 2004) as more big businesses begin offering them as alternatives to traditional coverage, The Washington Times reports.
While the low premiums for these plans may seem initially alluring -- and HSAs do give some the chance to put money -- that you would have otherwise paid for a more expensive plan for later use -- these stories seem to miss the true detriment of these plans.
Health plans are corralling people into little buckets: young here; healthy here; wealthy here; pregnang here; sick here; old here.
While for some groups -- young and healthy -- it seems okay now when they don't have lots of health expenses -- no diabetes, no high blood pressure medicines, and for one gender -- no expensive babies to pay for.
But what it will eventually mean is that young and healthy mutate into the sick and old (I've heard it happens pretty quickly) , and where will the young and healthy be then?
Today's New York Times has a striking story. On Friday at 7:30pm, the Centers for Medicaid and Medicare Services issues a letter imposing strict rules on states who want to extend their Child Health Insurance Programs to children above 250% of the federal poverty level--around $43,000 for a family of three.
Governor Schwarzenegger and legislative leaders propose to extend our Healthy Families program to 300% FPL--or $52,000 for a family of three. For California do so under these new federal rules, the state would have to prove 95% coverage of children up to 200% FPL in Medicaid or Healthy Families--a standard that no state currently meets. The new rules would also require a one-year waiting period before getting coverage.
California's Medi-Cal Director Stan Rosenstein is quoted:
Stan Rosenstein, the Medicaid director in California, said the federal policy was “highly restrictive, much more restrictive than what we want to do.”
That's not an unintended consequence of President Bush's action. It seems that is the point.
With just four weeks left of the 2007 session, time is slipping away for lawmakers to pass health care reform.
Legislators are back today from summer "recess'' and there's STILL no budget.
The It's OUR Healthcare! coalition today launched two TV ads aimed at getting lawmakers to focus on health care reform (this year) and a number of newspapers printed stories and columns the past few days reminding lawmakers that there's not much time left.
It's not as if any of the concepts around health reform are new. Sheila Kuehl has introduced her single-payer universal health care legislation for five years. Four years ago, then-Gov. Gray Davis signed an employer-mandate that would have forced businesses of a certain size to provide health care for their employees. Public programs have existed for decades. And at its most base -- anyone can understand that health coverage isn't worth anything if you can't afford to use it.
In spite of budget distraction, it's not difficult to understand the core concept that health reform needs to happen this year -- before costs continue to skyrocket, before more people lose health coverage through work or are kicked off.
Click here to find your Senator and Assemblyperson and urge them to support health reform this year!
With the Legislature back in town, the It's Our Healthcare campaign is releasing two television ads, running in the Sacramento market. They spotlight the issue of affordability that even insured Californians face, and end with a strong push to pass healthcare reform now, this year.
Bruce Bodaken, the CEO of Blue Shield, has been a positive voice in the debate on universal health care, even if his company's action have not always been so.
In the San Francisco Chronicle, he uses the analogy of Social Security to make the case for an "individual mandate" to buy his company's product, or those of other health insurers.
I know Social Security. I pay into into Social Security. My parents depend on Social Security. Social Security is my friend.
Blue Shield, you are no Social Security.
Social Security has a defined benefit. Blue Shield does not, and opposes defined benefits. Social Security taxes take into account my ability to pay, since they are based on a percentage of my income. Blue Shield premiums and cost sharing are not. If there are changes to Social Security costs or benefits, they are made in a democratic process. Blue Shield changes their plans' costs and benefits unilaterally, without public oversight.
The larger point is right: Everybody has a part to play to reform our health care system. Everyone should pay in, but the question is, to who? And under what conditions? Whether it is affordable?
Blue Shield suggests one political deal: if everybody is required to take up coverage, insurers should be required to cover everybody. It's an important step for Blue Shield, but the policy of "guaranteed issue" is only one of several consumer protections needed for those buying coverage as individuals, without employer or public program coverage. It doesn't have to be as good an arrangement as Social Security--even in a private pension arrangement, there's a better bargain struck between workers and the employer, especially if the workers have some collective bargaining power.
As a statewide health care consumer group, we are supportive of group coverage, where people have the power of bulk purchasing to get the best possible deal. Blue Shield's belief is not a bargain for consumers.
New Reports Spotlight Several Consumer Protections Missing in California’s “Wild, Wild West” Individual Market
As Lawmakers Refocus on Health Reform and the Individual Market, New National Report Outlines Key Elements to Consider
Comparisons with Massachusetts Market Spotlighted
SACRAMENTO—As lawmakers return from their summer break to focus on health reform, Health Access California and other consumer groups are spotlighting the need for new consumer protections in the California individual insurance market, especially in any consideration of a mandate to buy private coverage without the benefit of employer or public program assistance.
A new report from Community Catalyst, a national consumer health advocacy group, points to the concept of a “Connectors” as a way to improve access to health care coverage, but emphasizes that states should implement strong consumer protections in the use of a “Connector” and as part of any affordable health insurance expansion.
Health Access California also published a comparison chart comparing Governor Schwarzenegger’s health care reform proposal, which includes an individual mandate, to that of Massachusetts, which had a range of consumer protections in place even before last year’s reform and the individual requirement.
“California’s health insurance market is the wild, wild west for individuals--not a friendly place for consumers to have to get coverage. Individuals need not just guaranteed issue and affordability standards, but standardized benefits and group purchasing power. With all the comparisons, it’s important to recognize that that Massachusetts’ individual market had in place more consumer protections in place before their reform, than Governor Schwarzenegger’s plan would have after reform.” said Anthony Wright, executive director, Health Access California, the statewide health care consumer advocacy coalition. “Governor Schwarzenegger’s individual mandate proposal is to the right of Romney. Any requirement on Californians to buy coverage as individuals won’t work without significantly more consumer protections than what is in the discussion now.”
Before their reform package last year, Massachusetts has guaranteed issue, community rating for age, gender, and health status, and a range of mandated benefits. Their reform law, which included an individual mandate, also included affordability and hardship exemptions, tax savings provisions, and a “Connector,” to organize and standardize the marketplace, and also to assist individuals’ ease of signing up for coverage.
“A Connector alone will not increase health insurance coverage for the uninsured or underinsured in any state,” said Michael Miller, Director of Policy at Community Catalyst. “However, with the right framework in place, Connectors can serve as a critical hub for expanding access to health insurance.”
Connectors are an organized marketplace of health plan options and encourage competition between insurers and transparency of benefit information as a way to reduce barriers to acquiring insurance coverage for everyone. The concept of Connectors has existed in state-run purchasing pools since the 1990’s. However, many models now exist, including a Connector like the one recently implemented in Massachusetts, which provides health insurance to everyone statewide and provides state oversight.
In the report, A Consumer Guide to Creating a Health Insurance Connector, Community Catalyst favors a comprehensive model, yet cautions that a Connector cannot reduce the cost of health insurance on its own. The group points to six specific elements that will help provide the base needed to build an effective Connector and to expand access to affordable health care coverage. The Connector should: * Offer a limited number of standardized plans, giving consumers a choice of options with the opportunity to compare like plans and know what benefits are included and excluded; * Subsidize premiums for lower-income people; * Provide outreach and enrollment support.
“What makes the most sense in health reform to secure and expand group coverage, through employers or public programs. In contrast, the individual market is the least efficient, most expensive way to get coverage, where consumer are left to fend for themselves with the big insurers,” said Wright. “Reforms should shrink, not expand, the individual market, and provide more consumer protections for those having to buy coverage by themselves, without the power of group purchasing.”
Many Consumer Protections Needed In the California Individual Market
August 2007 fact sheet
Today in California, consumers trying to buy coverage on the “individual market” face major barriers, of availability, affordability, and administrative hassle. It is the least efficient, most expensive way to get coverage.
Yet Governor Arnold Schwarzenegger’s health reform proposal includes an “individual mandate,” requiring even those without employer-based or public program coverage to buy coverage as an individual. The Governor’s proposal acknowledges that such a mandate to buy coverage in the individual market could not be implemented in the current California market. Most notably, insurers are currently allowed to deny coverage to consumers because of “pre-existing conditions.”
To address this issue, the Governor proposes “guaranteed issue,” to require insurers to provide coverage to all, and other changes. However, he does not propose the full range of consumer protections to make an individual mandate workable, much less fair.
The only state in the nation to pass and individual mandate, Massachusetts, already had stronger-than-California consumer protections in place for over a decade before their reform law in 2006, and was compelled to add additional affordability and consumer protections along with the “individual mandate.”
Unlike those in group coverage, that have the benefit of employers or public programs negotiating for the best deal, individuals have little market power against big insurance companies. Mandates to buy in the individual market take away the one bit of leverage that individuals do have: the ability to say “no.” Any attempt to remove that ability needs to be coupled with a strong, robust oversight and enforcement on the insurance industry.
The need for these consumer protections are even more acute in California than in Massachusetts. Massachusetts has a much greater percentage of people in group coverage, especially employer-based coverage. This means relatively fewer people have to deal with the individual market in the first place.
In the absence of having an employer or public program using its bulk purchasing power, Californians need consumer protections.
Let me be more pointed: The Governor's plan requires a 2/3 vote. The current stalemate proves that we aren't going to get the 2/3 vote for the budget--even one with significant cuts--much less health reforms that the Republicans are on record opposing.
If the Governor wants health reform on his desk, he needs a majority-vote vehicle. AB8 meets the overall "shared responsibility" framework of the Governor's plan--but is different mostly because of the contraints of what is allowed under a "fee" rather than a "tax," rather than any ideological differences.
[In fact, there's lots of elements--such as raising Medi-Cal rates or expanding Medi-Cal for low-income adults who just don't have children at home--that Health Access wants, that the Governor wants, and the authors of AB8 want, but aren't included because it's hard to raise the money without a tax that would require a 2/3 vote. Legislative leaders have said that AB8 would be more expansive, if not for the hurdle of the 2/3 vote requirement.
Some of the differences aren't philosophical, but practical--about what can pass against the Republican blockade against taxes. If the Democratic legislative leaders wanted to put forward a bill with a 2/3 vote, they already did that--SB840 with its financing component.]
So if the Governor wants changes to AB8, he needs to either make sure they are doable under a majority-vote context, or find the six Republican Assemblymembers and two Republican Senators to vote for the overall bill.
[That includes the money for higher Medi-Cal rates or the subsidies to make his individual mandate even remotely workable.]
That's the Governor's choice right now. Will he oppose his fourth health reform and expansion proposal in a row (employer mandate in 2004, children's coverage in 2005, single-payer in 2006, shared responsibility in 2007?), or will he work with the folks that are willing to work with him to pass major health reform, this year? posted by Anthony Wright | Permalink | 6:46 PM
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Kuehl Speaks, Moms Rising, etc...
Lots of new health care stuff on the web:
Senator Kuehl posted on Calitics her report from the rally this weekend, and her own view of the California Speaks event (harsher, but similar themes to mine), and the significant progress being made in the ongoing effort for universal, single-payer health care.
Maybe because the health care crisis is felt across all of California's diverse communities--and disproportionately in communities of color--the benefits of reform would be broadly felt.
But "getting California ready" is an appropriate message: health care reform needs to include, or closely followed by, efforts to make sure that the state's health care system can appropriately welcome and care for the full diversity of the newly insured.
Case in point: Bruce Occena, who runs Health Access' Video Medical Interpretation (VMI) project in San Francisco and Alameda counties, reports that San Francisco is beefing up its language access capabilities in its clinics as part of their health care expansion. It's simply viewed as an essential part of its Healthy San Francisco project, which is starting in Chinatown, and predictably, getting many new enrollees who need interpretation services. This is a benefit to all who use those clinics, not just the newly covered, but its the kind of additional thinking that should be part of the health reform debate, and that this report highlights. posted by Anthony Wright | Permalink | 4:00 PM
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A universal system? I have just the solution...
Bruce Bodaken, CEO of Blue Shield, writes in the San Francisco Chronicle that it's time we make health care universal -- like our national government-run Social Security system.
Bodaken wants everyone to pay so we avoid "freeloaders'' who only pay in when they need coverage. I guess that would mean everyone paying a portion of their income -- let's say 4 percent -- to the state. Their employers would pay too -- let's say 8 percent. And in return, everyone would get health care.
Sound familiar? It is.
SB840 -- Sheila Kuehl's single-payer, state-run universal system that Blue Shield of California has never supported -- until, it seems, now.
The San Francisco Chronicle reports that the city's new health program, Healthy San Francisco, just passed enrolling its 1,000th member. Whie not insurance (enabling enrollees to get coverage outside city borders), these San Franciscans now have a medical home, and can get the care they need an an affordable cost. It's a big deal.
The quick enrollments shows the need, and is remarkable given not just that SF is small, but the the program really only started in two locations, in and around Chinatown. A good start. Hopefully more victories to follow, in the city and statewide...
So there's been a lot of talk about how the budget stalemate is impacting health reform. Even Speaker Nunez was asked about it:
Some folks think, such as the Governor, that the Senate Republicans are trying to run out the clock, and use the budget to black health care reform. I don't know their motives, and the impact may be right: there is still time, but the clock is ticking, and time spent on the budget is less time on health reform.
However, I also think this may backfire on the Senate Republicans, and could help the dynamic for health reform. First of all, there will be an incentive for legislators and the Governor not to end the year on a sour note, and they will want a win on health care.
The more that the budget stalemate disabuses the Governor that he can get the two-thirds vote he needs for his proposal, the more he should look favorably upon AB8(Nunez), which can be passed by a majority vote.
Why give the Senate Republicans, which are holding out on the budget, a second victory, by stalling the health care reforms that they also oppose?
Consumer Reports' latest issue surveys 37,000 readers about their health plans, and finds one in five (20%!) consumers "were sufficiently disappointed with their health-insurance plans and wanted to switch to a new one.''
Consumers were mainly disappointed in the choice of doctors, billing, high cost-sharing and access to care.
The best health care in the world? Not quite.
Reading up on other studies, the magazine also found that 81,000 deaths could be avoided annually (not to mention $3.6 billion in unneccessary hospitalization expenses) if health plans provided the same disease-prevention, wellness and best-practice treatments.
Here's a quick hit list of California health plans and how they fared:
HMOs:
Kaiser Permanente of SoCal -- 82% "reader score,'' with 12% wanting to switch plans
PacifiCare of California -- 78% reader score, 21% of consumers wanting to switch
Blue Shield of California Access + HMO -- 74% reader score, 31% of consumers wanting to switch
Blue Cross of California HMO -- 72% reader score, 34% of consumers wanting to switch
PPOs
Blue Cross of California: 76% readers score, 26% wanting to switch
Blue Shield of California: 73% reader score, 33% wanting to switch
Cigna HealthCare: 72% reader score, 29% wanting to switch
HealthNet: 70% reader score, 35% wanting to switch
At the California Speaks town hall, the first question was "what brought you here today?" I walked around the circular tables to listen to a handful of the several hundred folks in Sacramento (of over 3475 throughout the state). A few had their health care experiences, and had a special interest. But the biggest refrain I heard was best summed up by one man who said, "I feel powerless," and came because he wanted a chance to be heard.
In fact, it was remarkable, as Senator Perata mentioned, for so many to come out for a full Saturday in the summer to talk about health care policy. So in that respect, it was a success and worthwhile. (Add that to the crowds that came out to rally for universal, single-payer health care in Los Angeles, and assorted other campaign activities by Its Our Healthcare and others, and you had a lot of Californians engaging in the health care debate this weekend.)
It was also impressive logistically and technologically, to see the many staff and volunteers, the satellite hook-ups, the touchkey voting, the computer networks, and the mechanisms to translate discussions and opinions into broad themes that can be voted on.
At the same time, there was some things that could have been done better. As an advocate, I have my proposed edits to the discussion guide, about items that were inaccurate or misleading, but they got many of the big issues right.
I certainly have issues with some of the framing of the questions. I think they bought in too much to the Governor's framework of "responsibility" to different "stakeholders," rather than, for example, a consumer-focused frame that works to remove the barriers that people have to health care.
If nothing else, it seemed invert the focus health care reform on the potential burdens on individuals, employers, insurers, rather than the benefits, which then require instituting new rules in order for the benefit to be achieved. Normally, you ask a question like "would you support covering X more California children if it meant raising the tobacco tax by X amount?" Many of the questions asked of the audience asked if folks would support an individual mandate, an employer mandate, etc, without explicitly stating the benefit. For some questions, there wasn't a clear sense of the impacts--both positive and negative--and how they worked together.
But despite this inverted question, people tended to say they would support new responsibilities for employers, government, insurers, and individuals--but under certain conditions. The conditions reflected the concerns and hopes and issues and desires of Californians, and are the nuances that worth thinking about in the next few weeks of this health reform discussion.
There was some wasted potential with the forum. It tried too hard to steer clear of the major ideological battles in health care reform: the one between the philosophy of shared group coverage vs. individual responsibility; the role of government vs. market forces; etc. This is the debate that President Bush brought into stark relief with his opposition to SCHIP renewal. On the flip side, the forums in Humboldt and Oakland almost revolted over the desire to discuss single-payer, and while it was discussed at the end, it should have been placed up front as matter for consideration (as we had advocated with the organizers of the event.) There's no need to sideline SB840 from the discussion; or force a false choice between it and other proposals on the table. In fact, it is a useful standard by which to judge other proposals and how they may get closer or farther to that goal. I also think it would have been useful to also have the audience weigh in with some of the Republican proposals to "increase choice" by eliminating mandated benefits, for example. (The "removing regulation" performed the worst of the cost containment options, however.)
At the same time, the health care debate could have benefited from additional input from the 3500 assembled, around specific key issues, such as what is affordable for an individual?, and what constitutes insurance? These are key issues left to be addressed, and I think Californians would have provided useful insight into the policy discussions now underway.
I wasn't able to go to the big SB840 rally in Los Angeles, but while in Sacramento, I stopped by the CaliforniaSpeaks electronic town hall. I was an official observer, but prevented from interacting with the participants or otherwise expressing an opinion.
Noteworthy was the quick few-minute speeches from the elected leaders, which featured Governor Schwarzenegger in Los Angeles, Senate President Pro Tem Perata in Oakland, Assembly Speaker Fabian Nunez in Los Angeles, and Assembly Republican Leader Villines in Fresno. (Senate Republican Leader Ackerman was invited but did not attend.)
The Governor ticked off several many of the reasons for health reform, "this extremely important discussion" to "fix the broken health care system": 6.5 million uninsured; the "hidden tax" on the insured; health cost increases; overcrowded emergency rooms; "job lock"; financial insecurity, where many are "one long hospital stay away from filing personal bankruptcy." But he said, "I alone cannot do it. This is the year of health care reform, but now we have to work together.... This is not a political issue. It is an issue of what is best for the people."
He warned, in a particularly pointed statement, that "there are people out there, they don't want that to happen, who want to hold on to the status quo. As a matter of fact, there are politicians in Sacramento that are holding up the budget so they don't want to go into health reform... It is inexcusable for someone to hold up the budget in order to make health care reform suffer because of that."
Senator Perata was clear that "we have had many years of discussion... we have done everything but resolve to solve the problem... after today, what we must have is legislative action." He implored that "legislators must hear from you." He said "whether it is AB8 or single-payer, we must act. Inaction is not acceptable. It is the legislature's responsibility to act. If we do not act, we will once again witness in this state an expensive initiative shootout among different interest groups in this state, who will take it upon themselves to do what the legislature should do. If the legislature wants to be relevant, if we are going to provide leadership, we must act by the end of the legislative session, to put a bill on the Governor's desk... to make next year better than this year for those in dire need. Thank you for joining the battle."
Speaker Nunez, in his talk, mentioned that "I think we all can agree that no issue come as close to health care when we look at the needs of Californians." He recounted that "As a young man, I did not have health insurance myself," and how his father, who had two jobs, "if he ever felt ill, he had to figure some home remedy" when he got sick. He said that, "in the absence of real action at the federal government and Congress...we in California are going to stand firm, and are totally committed for delivering health care and reforming health care for each and every Californian in this state." While he mentioned that everyone will "to do their share" including employers and workers, although he said, "I fundamentally believe that I cannot require you to have health care insurance if there isn't a premium out there that is affordable to pay." He also said that "health insurance companies gotta step up... they are the ones that are milking the health care system today." Finally, he committed that "the legislature will agree to a health care package. California deserves nothing less..."
Assemblymember Villines also gave a personal perspective, "I've been a small businessman, that provided health care coverage," and who struggled to pay for it, but continued to do so. He also indicated that, "I've also had a child who had a pre-existing condition," and has to pay for expensive COBRA so that the child didn't lose access to coverage. He also pushed for health reform, "This year, it is a goal... California should do what California always does--lead." He was more specific about this proposals, including those that would "maximize choice", but "without raising taxes, and without a faceless government program that won't be there." He proposed that California's effort won't be like other states, or other countries, but still provide the opportunity to lead.
I'll post more later. To see a little from the electronic town hall, go to a new website that Governor announced today, at: http://www.fixourhealthcare.ca.gov/
That's what yesterday's USA Today article asks, in response to a recent JAMA study finding that underinsured children are vaccinated at lower rates than uninsured children.
For those buying health insurance through a group (such as work), in California, consumer protections guarantee that even flimsy health plans are required to provide preventive care for children following the American Academy of Pediatrics guidelines, which includes immunizations.
However, if you're buying coverage on your own -- it's not only more expensive, but as this study shows, it also doesn't cover the essentials.
The study confronts the insurance company's lines about creating "innovative'' products. Innovation comes at the consumers' expense. They argue that the reason health care is "expensive'' in California is because people have to pay for health coverage they don't need. But without "mandates'' this is what happens -- children don't get properly immunized, cancers don't get discovered, diabetes doesn't get treated.
And I would argue that in California -- the mandates aren't enough -- given that 464,000 children who have insurance in the individual market are not guaranteed proper preventive care in their most formative years.
Department of Managed Health Care scrutinizes Anthem-Wellpoint merger agreement
Consumers, doctors, and health advocates raise issues about Blue Cross' practices
Department will weigh in with final ruling within three months
New on the Health Access WeBlog: SCHIP Reauthorization House and Senate Voter; SCHIP Hypocrisy; Jersey Devils; All the President's Polyps; Budget Battles and Getting Two-Thirds; Uninsured Waits; High Deductibles; Major Kaiser Fine and Consumer Complaints; Coverage: Is It Available, Affordable, and Automatic?; New California Endowment Ads; Affordability; Long Live Prop 56!; New PPO Report Card; Retail vs. Wholesale; More on Blue Cross
A standing room-only crowd crammed into a downtown Los Angeles hearing room on Tuesday to offer more than six hours of testimony about the company and hear Blue Cross of California respond to regulators' questions on whether the company violated any promises the company made when parent Wellpoint Health Systems, Inc. merged with Anthem Inc.
Protestors, including the "Sick of Blue Cross man," demonstrated outside of the Junipero Serra Building before the hearing to call attention to the droves of consumers who have responded to the It’s OUR Healthcare! Campaign’s http://www.sickofbluecross.com/ website.
Blue Cross’ transfer of $950 million to the Indianapolis-based parent company Wellpoint Inc. earlier this year triggered the review of the company’s Undertakings, agreed to three years ago. The Undertakings were intended to protect consumers against the costs associated with merging the insurance giants (including hefty executive salaries and buyouts), meaning that premiums did not increase to cover the merger or that the company spent less money to health care for consumers, that quality of care did not suffer, and the Californians benefited overall from the merger. Regulators hammered on a number of points, including:
Why was Blue Cross’ dividend Wellpoint this year so much higher than in 2005 and 2006?
Why are so many providers threatening to leave Blue Cross of California’s network?
Why is the company aggressively marketing high-deductible plans with fewer benefits, which ask consumers to pay for a larger share of their care, while sending so many dollars out of state?
DEPARTMENT QUESTIONS BLUE CROSS
After a presentation by the Department of Managed Health Care raising questions and reporting on the substance of complaints by consumers and providers, Blue Cross’ California President Brian Sassi first gave a presentation aimed at defending the company’s practices in the three years since the merger.
In a slide that described “What is the value of the merger,’’ Sassi described that Blue Cross has “developed products and services to grow our membership,’’ which now stands at 8.3 million Californians. Those “innovative and cutting edge’’ products Sassi described have attracted 895,000 subscribers in the individual market – the largest share of individual consumers of any other health plan in the state. “We’re working hard to design products for individuals to provide the services they need, without driving up health care costs,” Sassi said.
Blue Cross’ Sassi also defended the company’s $950 million check that was sent to Wellpoint in May, saying that the money was accumulated profits from years “prior’’ to the merger, and because the merger agreement limited the amount of dividends that could be sent to Wellpoint, the company waited until the merger agreement expired. Sassi also boasted that the company spent $11 billion on claims last year and a network of 53,000 physicians and 380 hospitals.
The presentation, however, caused Braulio Montesino, the department’s legal and policy unit chief, to question whether Blue Cross was combining numbers from both their products regulated by Department of Managed Health Care and Department of Insurance. The Department of Managed Health Care, will in a few months, make a final ruling on whether Blue Cross properly followed its merger agreement.
CONSUMERS, ADVOCATES AND PROVIDERS COMMENT
Regulators heard testimony from dozens of members of the public. Physicians talked about the gradual deterioration of Blue Cross’ reimbursement rates – which in many cases are now lower than Medicare rates, which allow providers to break even. While providers acknowledged a tightening of the belt among all insurers, they said Blue Cross was the worst offender.
“The fact is that Blue Cross has crossed through the line,’’ said Ron Nagel, a pediatrician who has been a Blue Cross provider for 20 years. “What message is Blue Cross sending me when the new vaccine reimbursements are barely 10% above my cost. What message is Blue Cross sending me when they reimburse $58 to see a newborn in a hospital and $28 the following day? This is insulting."
Janet Stephens, an Anaheim nurse who spoke at a morning press conference, also told regulators about her struggles with Blue Cross. When she first subscribed, her premiums were $252 a month. Now her premiums are $589 a month for a plan with a $1,500 deductible and a separate $500 prescription drug deductible.
Stephens has cashed in on her home equity and sold household items to help pay off her outstanding $4,000 bill at the pharmacy – whittled down from $8,000. Her co-pays have increased ten-fold.“I’m facing the dire medical and financial consequences as (Blue Cross) seeks to pay for its lucrative merger,’’ she told the Department of Managed Health Care.
Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights questioned both the amount of money that Blue Cross sent out of state and questioned the company’s decisions to retroactively rescind coverage for consumers who made expensive claims.
Anthony Wright of Health Access California questioned statements by Sassi, and challenged that the “innovative’’ product design Blue Cross talked about meant plans with low premiums but skinny benefits. Advocates oppose these plans because they segment the market, driving healthier consumers to lower-priced plans, while driving up the cost of the more comprehensive plans that are used by sicker subscribers.
Advocates also dislike these low-premium, low-benefit plans, because often, consumers believe they are buying coverage, only to find that their coverage scarcely covers their health care needs when they need it. Health Access also advocated that many of the undertakings be extended, and that money be returned to California.
Resoundingly, though, while many who testified spoke of magnitude of Blue Cross’ anti-consumer behavior, the company was not alone. Other insurers were also guilty – to a lesser degree – of denying care, denying claims for reimbursement, promoting low-premium, low-benefit plans and other unseemly practices.
Blue Cross, however, did seem to organize a number of consumers and insurance brokers to testify on their behalf. Consumers in rural counties in the Central Valley commented on how Blue Cross agreed to provide coverage and cultural/linguistic access to their communities when other plans did not. Insurance brokers talked about the popularity of Blue Cross plans and how they have stretched to meet the “needs’’ of consumers.
Regulatory hearings typically last two to three hours at most. Tuesday’s hearing, which was scheduled to run five hours stretched to more than six hours with no breaks in testimony. A retired Wellpoint executive in the audience commented on how he had never seen as much interest from the public on a regulatory hearing.
Read coverage of the hearing in the LA Times here.
It's a big Saturday this weekend for health reform.
The big August 11th event is the major rally in Los Angeles, which will be the culmination of the 365-day OneCare Campaign by Health Care For All, the grassroots group (and Health Access California board member) organizing for universal, single-payer health care.
Staged on the south lawn of LA’s City Hall, at First and Spring Streets, the rally will begin with a procession of “hearses” driving from Santa Monica to LA City Hall representing the Institute of Medicine estimate of 50 persons who die each day in the U.S. because they lack health insurance.
The rally, which starts at 1:00 PM, will feature entertainment with Lily Tomlin, live music, celebrity hosts, victims of the health care crisis, and inspirational talks from California reform leaders. Scheduled speakers include State Senator Sheila Kuehl (author of SB 840), Lieutenant Governor John Garamendi, Dolores Huerta, Maria Elena Durazo, Andrew McGuire of the OneCareNow campaign and others.
It's the place to be in Los Angeles on Saturday! posted by Anthony Wright | Permalink | 8:50 AM
It's a market-based argument: the power relation between the individual and the insurer is inherently unfair. It's only when that individual is represented in a group--most notably a large employer or a public program, does the purchaser get a fair price, and the patient get the protection she needs.
In evaluating California health care plans, the more that a plan expands group coverage--through public programs, employers, or a universal health system--the better it is for consumers. The more it shifts people into the individual market, the more at risk they become. posted by Anthony Wright | Permalink | 6:04 PM
"Maybe uninsured American children who can’t get adequate health care could masquerade as cotton plants or cornstalks. Then the farm bill would shower them with money and care." - New York Times columnist Nicholas Kristof. posted by Anthony Wright | Permalink | 4:00 PM
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Super Sabado!
The other big Saturday event to watch is "CaliforniaSpeaks," a unique all day, electronic town hall, linking thousands of Californians. They will come together on Saturday, August 11th to discuss current health care reform proposals with state leaders, several of whom plan to attend. Satellite link-ups will connect public meetings across eight regions in California (San Diego County, Humboldt County, Fresno County, Los Angeles County, Sacramento County, San Luis Obispo County, Alameda-San Francisco Counties and Riverside-San Bernardino Counties).
CaliforniaSpeaks invited a randomly selected group of thousands of Californians to register to participate in the discussion. Using statistical sampling, the hope was to get a group of Californians that represent the full diversity of the state. Once at the town hall, their opinions will be registered through discussions, voting keypads, and computers. It will be interesting to see how it works just logistically.
We are still recovering from the all-day, standing-room-only hearing yesterday. The LA Times' Lisa Girion stayed through to the bitter end, and provides a report, along with some great pictures.
As part of the It's Our Healthcare campaign's http://www.sickofbluecross.com/ effort, we had a colleague dressed up as "Sick of Blue Cross Guy," complete with fistfulls of (our) cash. Here, an ACORN member leads some chants before the hearing. More to come...
The Department of Managed Health Care will have its hearing later today on the practices of Blue Cross of California, especially after the Anthem-Wellpoint merger in 2004.
With the It's Our HealthCare coalition, we launched www.SickOfBlueCross.com, and collected many consumer stories of BlueCross' bad behavior. At the hearing tomorrow, also working with the Foundation for Taxpayer and Consumer Rights, we'll have some of those stories, at a 9:30am press conference before the hearing.
In order to fix these issues, consumers need to get the attention of both regulators and legislators: regulators, to place oversight over Blue Cross with the rules currently in place, and legislators, to pass health reforms that fundamentally change the system.
We submitted extensive comments last week. We'll give a full report from that press event and from inside the hearing after the festivities.
In 2009, courtesy of the Department of Insurance, California will have the first-in-the-nation PPO Report Card, allowing consumers to see how how well (or not-so-well) their insurance companies perform on key measures -- such as keeping you from getting sick, maintaining your illnesses (like diabetes), and helping you after you get sick. How well health plans respond to complaints and consumer input will also be measured.
(The PPO report card should not be confused with the HMO report card, which is compiled by the Office of the Patient Advocate at the Department of Managed Health Care. )
Being a Consumer Reports junkie, I do think it will be somewhat helpful for consumers to get a glimpse of health quality issues, such as whether the health plan is good at controlling blood pressure, testing for cholesterol in diabetes patients and is responsive to patient concerns. And as more and more consumers defect to PPO plans (30% of the insured are covered by PPOs), it makes sense to have a parallel report card.
But let's not kid ourselves into believing that this will be the tool to help consumers make choices about health coverage. To begin, many consumers don't really have a "choice.'' More than half of Californians receive health coverage through their jobs -- so their "choices'' are limited to whatever their employers offer (so if your employer only offers one plan -- the report card will only tell you how happy or glum you should be about the quality of the insurer).
God help the person who is forced to look for insurance on their own: anyone who has tried to wade through the 109 choices on ehealthinsurance.com knows it's darn near impossible to compare the plans. And if the PPO report card is anything like the HMO report card, it will give very general ratings on how well health plans perform at different measures -- but it's not going to tell you whether Blue Cross PPO 3500-HSA-Compatible is a better plan than Blue Shield's Essential Plan 3000.
This won't help consumers compare provider networks (and the quality of those providers), it won't give a full view of deductibles and other cost-sharing -- all very important factors for consumers.
In the name of consumer friendliness and quality improvement -- this moves us in a good direction, but we're certainly not there yet.
Here's the official list of all the California Representatives that voted no on House CHAMP vote, which would have fully funded SCHIP and also improved Medicare. For the California caucus, it was an exclusively party-line vote. http://clerk.house.gov/evs/2007/roll787.xml
The phone number is in the (202) area code
Brian Bilbray R 225-0508 Dan Lungren R 225-5716 Dana Rohrabacher R 225-2415 Darrell Issa R 225-3906 David Dreier R 225-2305 Devin Nunes R 225-2523 Duncan Hunter R 225-5672 Ed Royce R 225-4111 Elton Gallegly R 225-5811 Gary Miller R 225-3201 George Radanovich R 225-4540 Howard "Buck" McKeon R 225-1956 Jerry Lewis R 225-5861 John Campbell R 225-5611 John Doolittle R 225-2511 Ken Calvert R 225-1986 Kevin McCarthy R 225-2915 Mary Bono R 225-5330 Wally Herger R 225-3076 posted by Anthony Wright | Permalink | 11:38 AM
SB840 (Kuehl) would make coverage more available, affordable, and automatic. It continues to be the gold standard in our advocacy. Available? Every Californian who met the residency requirement would be eligible. Affordable? People would pay through taxes, based on payroll taxes, rather than the costs based on job type or how sick we are. Automatic? By doing the financing through the tax system, and with the simple eligibility, sign-up becomes automatic. Medicare has an easy, one-time sign-up, which gets all but a handful of folks to enroll.
AB8(Nunez/Perata)'s framework would take strides toward removing the barriers to get employer-based coverage, public program coverage, or insurance in the individual market. It has the virtue of building on what works in the current system and not impacting the coverage that people currently have, and avoids some of the political and procedural barriers that SB840 faces, although it doesn't match SB840's scope.
For employer-based coverage: * More Available: A minimum employer contribution toward health coverage would encourage employers to make health benefits more available. So would the new, affordable option for employers of paying a fee to a statewide purchasing pool, which would then make coverage available to all the employer's workers. * More Affordable: The bill does place a limit on the share of premiums for workers under 300% of the federal poverty level to 5% of income. For those who qualify for public programs, they may be able to benefit from "premium assistance" that would make their employer-based coverage more afffordable. And to the extent that any minimum employer contribution is close to the actual cost of care, that provides a floor from which workers can bargain up in terms of benefits. * More Automatic: Employer-based coverage is already pretty automatic for workers, and those workers in the statewide purchasing pool may have the additional benefit of having their coverage be portable if they shift to other employers also paying into the pool.
For public programs: * More Available: The proposal would greatly expand coverage to low-income children and their parents, up to 300% of the federal poverty level. We would have a commitment to finally cover all children, and make coverage much more available for low-income adults, particularly parents. * More Affordable: For those newly eligible for Medi-Cal or Healthy Families, they would get an affordable product, providing more affordable coverage than anything provided privately. For those is subsidized care above the poverty level, there still would be limits on premiums and cost-sharing. * More Automatic: In a major step, the proposal would eliminate the asset tests (which prevented people from having any savings), and effectively scrap the depravation test, and remove semi-annual status reports, all of which were significant adminsitrative barrier to getting on coverage and staying on.
For the individual market: * More available: The companion proposal, AB2, would limit insurers' ability to deny coverage because of pre-existing conditions, so those with relatively minor ailments would now be able to get coverage. That 3-5% of the market that would be denied would then have access to an expanded high-risk pool with an improved benefit than what is now available under MRMIP. * More affordable: While coverage won't be affordable, the proposal would require employers to offer Section 125 plans so that employed Californians could pay their premiums using pre-tax dollars, providing savings at 15-40%. * More automatic: The proposal attempts to place coverage in basic tiers for better comparison's sake, so the confusion in the individual market is not although it still won't be easy to buy coverage, and affordable packages are not expected.
AB8 doesn't remove all these barriers--there would still be issues, and we have sought amendments to go further, especially on affordability. But the framework does, overall, reduce the barriers that impede consumers getting the coverage they want and need.
The budget standoff, which threatens some basic state services, including health care, has placed a renewed spotlight on California's uniquely high threshold for passing a budget. Only 2 other states, Arkansas and Rhode Island, require a 2/3 vote to pass a budget. Because of this, 14 out of 120 legislators can hold up budget for the entire state of California.
Saturday's Sacramento Bee reminded readers that voters had a chance to change these rules in March 2004, and failed to do so. On that ballot, Proposition 56 would have made several changes to the budget process, from denying payment to legislators when a budget isn't completed, to changing the threshold required for passage to 55%. Health Access California was a proud leading sponsor of that effort, and this year's impasse only serves to reinforce our position.
A combination of factors conspired against Proposition 56. With no real contest in the presidential primary contest, it was a remarkably low turnout election, with an electorate seemingly exhausted from the historic recall election just a few months ago. The recall and change in Administrations also changed the dynamic of the race: much of the voter demand for change had dissipated. The reform agenda in the Budget Accountability Act was overwhelmed by the focus on Propositions 57 & 58, which were similar sounding and were also billed as the solution to the state’s budget crisis. Among the choices, Proposition 56 was the only initiative that had a funded opposition, which was successful in raising questions about the provisions. When voters are confused about an issue, they tend to vote “no." And in this case, they felt they did their part to address the budget problem by supporting 57 & 58, something that was supported by most political leaders.
Given the current situation, maybe the Governor is having second thoughts about not supporting Prop 56 back then.
The SCHIP debate is on. A filibuster-proof, veto-proof 68 votes in the Senate! A majority in the House--225 votes!
California advocates need to work on the California Republican delegation, which unanimously voted against the CHAMP Act, voting against the health care of our seniors and children. If those Congressmen actually voted in our state's interest, we could play a major part in getting the veto-proof majority needed.
There's still August recess for the two houses to hammer out differences and send President Bush a renewal for SCHIP that will fully fund the effort to cover all eligible children. Much more work to do, but a strong start.
Ron Brownstein of the LA Times is a smart and insightful columnist, who provides useful political analysis that often distills the issues of a debate in a fair and even-handed manner.
I imagined that it would take a lot to get him riled up, but it is a mark of how incomprehensible the President is with his SCHIP veto threats that Brownstein can't find a reasonable explanation. The headline of the column is "Stealing healthcare from babies," and the text is even more dismissive.
Paul Krugman at the NY Times has also written on the SCHIP issue and health care with passion and verve. But he became disillusioned with the Bush Administration early on, and so for him, this is just the latest outrage among many. Brownstein, even when he disagrees with policymakers, wants to give them the benefit of the doubt, and of their arguments, but he can't bring himself to do so in this case. posted by Anthony Wright | Permalink | 11:10 AM
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Affordability....
The buzzword "affordability" is the focus of a new California Budget Project report coming out today. Their recommendations:
* Fully subsidizing health care coverage for those who make up to 200 percent of the poverty line ($41,300 for a family of four) because the cost of housing, food, and other necessities leaves these families with few or no resources to contribute toward health care costs.
* Providing partial subsidies for families with incomes higher than 300 percent of the poverty line. The report determines that families need incomes near 300 percent of the poverty line ($61,950 for a family of four) just to afford typical health care costs. Because some families face much higher health care costs, the report recommends that policymakers consider providing subsidies for families.
* Limiting families’ out-of-pocket costs. Some insured families have very high health care costs because they have very high copayments, deductibles, or other out-of-pocket costs. Placing limits on out-of-pocket costs is as important as premium subsidies in ensuring affordable health care.
* Taking into account expenses families face, such as housing and child care, when determining how much families can afford to pay for health care. Because families face very different costs, such as housing and child care, income alone is an imprecise measure of what families can afford to spend on health care. posted by Anthony Wright | Permalink | 11:01 AM
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What are we waiting for?
The California Endowment is starting a $6 million advertising campaign today, with a series of television, print, and newspaper ads to run for six weeks, to urge California policymakers to pass major health reform, this year. The ads are available to be viewed at: http://www.cahealthreformnow.org/
The theme is "Californians are waiting for health care reform... What are California's leaders waiting for?" Dr. Robert Ross, the CEO of the Endowment, a private health care foundaion, said they don't have a specific dog in the hunt, between the Governor's proposal, the Nunez/Perata proposal, Kuehl's bill, or other efforts, but they wanted to express the urgency that Californians have on the issue, to "take advantage of an unprecedented opportunity."
While the Endowment has long supported and provided funding to various community and constituency groups that work on health issues (including, in full disclosure, the Health Access Foundation, and many of our member and allied organizations), their direct work has more focused on highlighting children's coverage, until now. This is a significant, important, and welcome commitment. posted by Anthony Wright | Permalink | 10:34 AM
with a background as a consumer advocate and community organizer on many issues, including health issues for the last ten years in California and New Jersey.
