Upcoming hearings...

Monday, March 31, 2008

While the Capitol is closed today in recognition of Cesar Chavez, the action starts up again tomorrow, in full forse. Some upcoming hearings of note here in Sacramento:

* Assembly Health Committee will meet tomorrow, Tuesday, April 1st--yes, April Fool's Day. What's not a joke is the drug companies' opposition to AB2821 (Feuer), to limit the "gifts" given by drug companies to doctors. And a spirited discussion on AB1945 (De La Torre), on rescissions. Should be an interesting hearing.

* Next Monday, April 7th, the Senate Budget Subcommittee on Health and Human Services will hold a hearing at 10:30 am on some of the proposed cuts to Medi-Cal, like Quarterly Status Reports.

* An important reform of the individual insurance market, AB1522(Steinberg), sponsored by Health Access California, is up in Senate Health Committee on Wednesday, April 9th. The committee starts at 1:30pm. There are other bills of note as well on the docket.

Labels: Drugs, Legislation, MediCal, Sacramento

posted by Anthony Wright | Permalink | 12:13 PM


 

Medical Errors: an issue that's Yours, Mine, and Ours

Friday, March 28, 2008

Sarah Arnquist at The Health Care Blog and Rong-Gong Lin of the Los Angeles Times report from the Association of Health Care Journalists (which I hope bucks the trend of declining membership).


The big news: Actor Dennis Quaid is considering suing Cedars-Sinai Medical Center, which gave their twin newborn babies a massive overdose (1,000 times the prescribed dose) that almost caused their death.

The bigger news: The experience has made Quaid an activist against medical errors. He's set up a organization, The Quaid Foundation, dedicated to patient safety. He's urging Cedars-Sinai and hospitals across the country to implement a bar code system that would ensure that the right drug and dose are provided to patients. It's a worthy cause to highlight: the Insitute of Medicine suggests that there are between 44,000 to 98,000 preventative deaths each year because of medical errors--not to mention the significant costs that could be saved.



There's a lot of policy efforts on the subject. There is Consumers Union's work on hospital infections. There's health reform efforts at transparency of cost and quality data, both last year with AB x1 1, and this year, with bills like AB2967(Lieber).


And there's the question of enforcement. Julie Sevrens Lyons at the San Jose Mercury News reported that some of the first fines allowed under a new law were levied against Cedars-Sinai and 10 other hospitals, for severe--and even lethal--mistakes like the Quaid case. The fine, however, was a mere $25,000--which is the billed charged of only a day or two at a hospital.




Quaid says that Cedars-Sinai at least decided not to send a bill. And some hospitals are adopting the policy of not charging insurers or patients for "never events"--the severe mistakes that lead to injury or worse. So the financial incentives are starting to turn. But the key is to prevent the medical errors in the first place.

Labels: HealthyLiving, Hospitals, InTheNews

posted by Anthony Wright | Permalink | 11:07 PM


 

Corrective Action and Balance Billing

Now that's responsive.

After a nearly seven-hour hearing yesterday in which the Department of Managed Health Care's consumer-protection creds were questioned, the Department has come out swinging (not that kind) on behalf of consumers.

The DMHC today released draft regulations on balance billing -- that practice where consumers get a bill directly from the doctor or hospital for the difference of what is/was/will be paid by the insurance company, and what they charge. This is particularly pervasive in emergency situations where patients are unable to "shop around'' and ensure that the provider they are being driven to is "in-network.''

The language to describe this practice is kind of edgy -- as edgy as one can be in a "Notice of Rulemaking Action.'' From the document:

"Innocent enrollees are routinely leveraged as bargaining chips in an unfair
provider billing pattern, which can lead to detrimental health care decisions by
the enrollee and aggressive collection activities by the provider, with
long-term harm to the enrollee's health, safety, and financial stability.''

Right on. There's more.

"..Providers use unfair and oppressive tactics, holding enrollees as virtual
financial hostages, to pressure health plans to pay their full-billed charges,
irrespective of whether their full-billed charges do, in fact, reflect the
reasonable and customary value of the treatment provided.''

This is a fantastic opening position for advocates to be in on this issue. The comment period for these regulations ends May 12 at 5 p.m, so get letters in!

Labels: BalanceBilling, Schwarzenegger

posted by Hanh Kim Quach | Permalink | 3:30 PM


 

Beyond HillaryCare

Sen. Hillary Clinton said in The New York Times today that she wanted to cap health insurance premiums to no more than 5 or 10 percent of income. The statement gives a bit more specificity to her universal health care plan. Obama has also supported the capping of insurance rates, though without putting a number out.

I like that she is talking about tying the cost of health care to income. As we in the advocacy world know -- and too many consumers have experienced -- health care costs are extremely regressive and it's smart to begin introducing the public to that connection.

That said, we also need to begin introducing the concept of capping out-of-pocket costs as well, something that was not included in the story. Cheap plans that cost about $150/month or less are abundant, meaning coverage would cost about 6% a year ($1,800/year) for a person earning $30,000 a year. The problem is that they cost a lot to use.

Office visits aren't covered until the deductibles are met (or limited office visits are available.)
Prescription drugs aren't covered. If they are, brand name drugs aren't. Neither is maternity. Deductibles range from $2,500 to $5000. Out-of-pocket maximums, for one person, could be up to $8,000.

True, not everyone spends up to the out-of-pocket maximum, but in order to get any kind of value out of health coverage, a person would need to meet the deductible. That would mean that person earning $30,000 a year, who meets their deductible on such a plan would be spending 20% of their income on health care. That's a lot.

What's even worse is if you had an unexpected medical emergency, and had to spend up to the out-of-pocket max, that would be about one-third of a $30,000-a-year income. Not fair.

In California, we have spent a lot of time talking and thinking about the affordability of coverage -- both to buy and to use. In AB8, the legislation that the governor vetoed last fall, the affordability limit that we liked was that families that earned less than 300% of the poverty level ($63,600 for a family of four) would have both premiums and out-of-pocket costs capped at 5%.

For ABx1 1, we took a different approach. Families with incomes up to 400% of poverty ($84,800 for a family of four), would spend no more than 5.5 percent on premium. This premium was pegged to a plan that -- while having a $2,500 deductible -- also included “prescription drugs, physician visits, and preventive services, including the services to manage chronic conditions, outside of the deductible. ''

Increasing health care costs are a real thing and is scary. Ignoring out-of-pocket costs as part of that equation would be ignoring the fastest growing part of health care and that needs to be part of the policy discussions.

Labels: Affordability, InTheNews

posted by Hanh Kim Quach | Permalink | 10:19 AM


 

A balanced approach to the budget...

Thursday, March 27, 2008

Jon Myers at the KQED Capitol Notes blog describes the new PPIC poll that suggests that the public is getting a better sense of the proposed cuts to education, health, and other vital services--and is thus beocming more willing to support alternative solutions--including taxes.

The new poll finds that 56% of voters are “very concerned” about the effects of spending cuts proposed by Schwarzenegger. And only 30% say they support a budget that would be balanced with spending cuts alone.

With that in mind, 42% of voters now favor a mix of tax hikes and cuts to balance the budget… something lobbied for by legislative Democrats. Of course, only 25% of Republicans surveyed favor this option; who said GOP members of the Legislature don’t represent their constituents?

There's some education to do in Republican districts, to be clear that there will be reductions in education (and other key areas.).

Labels: Budget

posted by Anthony Wright | Permalink | 11:50 PM


 

The DMHC Oversight Hearing...

HEALTH ACCESS UPDATE
Friday, March 28th, 2008


SENATE PANEL QUESTIONS HMO REGULATOR
* Lawmakers question Department of Managed Healthcare’s oversight of health insurers
* Inquiry into regulations for timely access, discount plans, rescissions, language access and mental health parity
* Sen. Kuehl sees "pattern" of siding with industry against consumers
* Laws passed more than five years ago still not implemented


Click Here for What's New on the Health Access WeBlog: Health Care Consumers Views; GAO Individual Market Investigation; More Debriefings on California Health Reform; A Health Reform Backlash Against San Francisco Restaurants?; Health Budget Cuts Nationally; Shooting for 60 Votes; 1,000 Posts!; Web Wonkery; McCain's Misstep: Do We Go to the Doctor Frequently?; The Hot Hearing for the Week; Mayor Newsom Suing Sacramento Over Medi-Cal Rates; So-Called Consumer Directed Health Plans; Overseeing the DMHC


SACRAMENTO--At a special hearing of the Senate Health Committee on Thursday, Department of Managed Health Care Director Cindy Ehnes was questioned for over nearly seven hours about her department’s handling of five separate regulations and whether it had met its charge as a consumer protection agency in implementing and enforcing laws to help patients. “This hearing is meant to provide a level of oversight to ensure that legislation that is passed gets implemented in a way that is consistent with the way it was intended,’’ said Sen. Sheila Kuehl, chair of the Senate Health Committee.

At issue were three laws, passed in the late 1990s and earlier this decade, which still have not been put into practice: Timely access to health care, access to health care that is both culturally and linguistically sensitive and mental health parity. Additionally, Ehnes was interrogated about the Department’s rationale for regulations regarding retroactive cancellations of health policies and so-called "discount health cards".

For more detailed information on all these issues, you can visit the Health Access website and blog. As well, the Senator posted a detailed agenda and background papers on her website, at:
www.sen.ca.gov/kuehl


TIMELY ACCESS TO CARE

Background: First on the list was the issue of timely access to care, which were intended to prescribe specific time-elapsed standards for how long it should take patients to get into to see a physicians. The law was passed in 2002, and after many years of hiccups, regulations were on the path to implementation in 2007. The regulations spelled out exactly how quickly patients should be able to get in to see a doctor in certain situations. (I.E. Urgent primary care needs: 24 hours; Routine primary care needs: 10 days; Urgent specialty care: 72 hours; Routine specialty care: 14 days)

But in December, the Department yanked that version, stripped out all specific requirements, and left it up to health plans to determine their own standards, as had been the practice in the years before the law was passed. Health Access California and Western Center for Law and Poverty testified that the law did not meet the legislature's intent in having the Department set clear, prescriptive standards. Last month, the Office of Administrative Law rejected the regulations, saying the department had not allowed enough time for public comment given the dramatic changes in the regulations. To read Health Access' writings on this, click here.
The difference between the August and December versions of the regulations was so stark that Sen. Sam Aanestad, R-Grass Valley, asked, “It looks like the department just punted. What was the amazing turnabout?’’

Department’s take: Ehnes said she felt that the August regulations – 26 pages – were too complicated and would force plans to micromanage physicians they contract with. She said the department focused on the clinical triage via phone, where patients could call in and get a professional to tell them what they needed to do. Health Access’ Beth Capell later said this telephonic triage was available during limited times -- weekdays during work hours.

Legislative comment: “Regulations are supposed to go further than the statute. Sometimes they are going to be very complicated. I would encourage a little more complication,’’ Kuehl said. She urged that the Department set prescriptive, time-elapsed standards when developing new regulations in the new year. Aanestad indicated he thought the Department was "almost there" with previous version of the regulations that had set standards.

DISCOUNT HEALTH CARDS

Background: Discount health cards aren’t health plans, but cards that consumers pay a monthly premium, for access to a list of physicians that will purportedly provide them discounts. The problem is, often, physicians don’t know they’ve been put on a list, and consumers don’t know what the base price off which they receive a discount, making the discounts meaningless. These plans are often marketed toward lower-income or limited-English consumers who believe they are actually buying health coverage, and these plans rely on this confusion to thrive.

The plans have been deemed illegal by the state Attorney General; but there has been confusion about if they should be allowed or licensed and regulated, and even what agency should do the regulating. The DMHC has started a process of developing regulations to license these discount cards, working with the industry. Health Access testified that while the value of these products was questionable, any regulations must at a minimum ensure real discounts to a real network of providers with real notice of what consumers are and are not getting for their money.

Department’s take: The department has investigated 53 discount health plans and ordered cease and desist orders against 7. Ehnes said developing regulations and licensing such products was not meant to be an endorsement, but to try to better understand the products.

Legislative comment: Kuehl asked the department, as it continued its work, to strongly consider whether these products offer any real economic value to consumers.


RESCISSIONS

Background: In the past couple of years, the startling practice of retroactive cancellation of policies by insurers has arrested the public’s attention. Consumers, who have been paying monthly premiums and believed they are insured, receive high-dollar treatments for cancer, heart disease and the like. These expensive treatments often trigger insurance companies to review the enrollees’ initial application and rescind policies, claiming enrollees did not properly disclose pre-existing health conditions. Policies are cancelled, retroactively, as if consumers were never insured. Consumers are then sometimes left with thousands –if not hundreds of thousands of dollars -- in debt for treatments they believed were covered. The courts have determined this practice is illegal unless consumers willfully misrepresent their health status.

Department’s take: Ehnes said the DMHC has been aggressive in investigating plan behavior since the practice came to light. The department, along with the Department of Insurance are developing regulations so that plans do not have the ability to rescind without reason and that consumers can’t misinterpret applications.

Legislative comment: Kuehl’s primary concern was how consumers could obtain coverage after they’ve been cancelled. These cancellations occur on the individual market where consumers are often denied coverage due to pre-existing conditions. Once consumers’ coverage is cancelled, it would be impossible for them to obtain coverage through any carrier.Aanestad believed the department was not properly protecting consumers and making that the focus. “The first priority is to reinstate coverage for consumers. The second priority is to make headlines and change the industry, but it doesn’t sound like that’s really happening.’’


CULTURAL AND LINGUISTIC ACCESS

Background: In 2003, the legislature passed a law, SB853(Escutia), that required health plans to ensure that the consumers who did not speak English as a first language had proper medical interpretation services. Up until then, consumers brought in their children to translate, did not get care, or got the wrong care because they were unable to communicate with their doctors. This is particularly important in California where 55 percent of the population reports not speaking English well. The California Pan-Ethnic Health Network, Latino Issues Forum, and other groups were concerned that the notice about these new rights were left to the industry to determine, without consumer input. Plans have complained it is costing them millions to translate materials.

Department’s take: Ehnes said she was committed to this issue and was attempting to evaluate all aspects, including whether the regulations go beyond the law and whether it will cost too much.

Legislative comment: Kuehl said when the legislature passes something, that’s the rule. “We don’t care what it costs everybody. Cost is important…but that’s not the top consideration. …We really mean it about providing real access to language minorities,’’ said Kuehl, who was also critical about the department’s process in listening to all stakeholders and allowing enough time to comment on regulations. “Please push the envelope on this one, because I know you want to.’’


MENTAL HEALTH PARITY

In 1999, the Legislature passed mental health parity, providing consumers with access to mental health benefits equal to coverage in other health services. But to this day, consumers are still finding it difficult to obtain mental health services they need on the same level as other health services. Timely access to providers remains a problem as well as plans’ treatment and financial obligation toward mental health. The Senators urged the department to be more aggressive about following up on surveys and studies that found consumers lacking access to mental health.

PARTING NOTES

Ehnes said the department would continue to work on these – along with other issues – under the department’s jurisdiction. Kuehl reiterated that the hearing was intended to ensure that laws were actually implemented and not allowed to wither once passed. She also continued to encourage the department to have more open and collaborative process.

For more information, contact Elizabeth Abbott, director of administrative advocacy at Health Access California, at eabbott@health-access.org. Interested organizations can also contact the author of this report, Hanh Kim Quach, policy coordinator at Health Access, at hquach@health-access.org.

Labels: DMHC, Kuehl, LanguageAccess, Sacramento, TimelyAccess, Updates

posted by Anthony Wright | Permalink | 10:12 PM


 

Oversight about oversight...

Victoria Colliver at the San Francisco Chronicle has a preview of today's Senate Health Committee hearing--which is expected to be at least five hours of grilling on a range of meaty issues.

The Senate Health Committee, chaired by Senator Sheila Kuehl, will hold a hearing today on "Consumer Protection under the California Department of Managed Health Care: Adequacy of Implementation and Enforcement," reviewing the DMHC's oversight in five key areas: timely access, language access, so-called discount health plans, retroactive denials of coverage; and mental health.

In all these issues, they strike to the core of whether the coverage is meaningful, and whether the consumer is getting value for what they paid for. And on all these topics, there are pending decisions regarding regulations or implementation issues at the DMHC.

It won't be a surprise to readers of this blog that health and consumer advocates will press for stronger standards and more aggressive oversight for the health insurance industry--and for good reason.

Consumers are increasingly concerned that their coverage won't be there for them when they need it--that they won't be able to get in to see a doctor or specialist, to get a translator if necessary, or even that their coverage will be retroactively rescinded.

In light of these HMO practices, the Department needs to be more--not less--aggressive in protecting patients and investigating the insurance industry.

Yet, the tendency by the Schwarzenegger Administration is to leave the decisions up to the insurers. Recent regulations would let insurers decide their own standards on timely access; to determine their own method of notifying patients about their rights to an interpreter. On new regulations of discount cards, the Department were shaped by the industry they were purporting to regulate-an industry that offers a product of dubious value to consumers.

The regulations to ensure timely access to care has been a particular subject of controversy--and focus for Health Access. For years, the Department of Managed Health Care has had numerous drafts of regulations to implement a 2002 law to establish and enforce standards to ensure access to care within clear timeframes. Yet the most recent draft let the insurers set their own standards. Senator Kuehl recently wrote a letter indicating this conflicted with the intent of the Legislature is passing the bill.

We hope this hearing provides much-needed legislative push to the Department to resolve these issues quickly, and the political cover to prioritize protecting patients, regardless of industry opposition. Consumers want and need more assurances that their coverage will provide the protection that they paid for.

If nothing else, the hearing brings additional *public* scrutiny to these issues--which is important, given the stakes for the average health consumer, but rare, given that DMHC regulations usually get attention from the industry and a handful of consumer advocates.

We have an ongoing interest--Health Access California, the statewide health care consumer advocacy coalition, was the sponsor of the HMO Patient's Bill of Rights in the late 1990s that created the Department of Managed Health Care, to be a stand-alone department with a specific focus on consumer protection. Our group continues to advocate on behalf of consumers at the DMHC on a range of issues. More recently, Health Access was the sponsor of AB2179(Cohn) in 2002, which required the Department to establish and enforce standards for timely access to care; and a strong supporter of SB853(Escutia) to require language access to care.

So we'll be continuing to do our own oversight, over the insurers--and their regulators.

We'll have a report on the hearing later in the day.

Labels: DMHC, Kuehl, Sacramento

posted by Anthony Wright | Permalink | 1:36 AM


 

Smart Business

Wednesday, March 26, 2008

Kiplinger's has a really strange and seemlingly contradictory article about how businesses can tackle their health care costs. One of their top bullets extols to businesses the value of Consumer-Directed Health Plans - which often carry high deductibles and do not have first-dollar coverage for preventive services.

The rest of their bullets outline a series of solutions that encourage preventive health, including free drugs to maintain chronic diseases, paying the full amount of preventive services, and preventive screenings -- pretty much the opposite of what Consumer directed and High Deductible health plans provide.

These bare bones plans are less likely to provide preventive services -- meaning patients would have to pay 100% of the bill for mammograms, colonoscopies, well-visits. Such a requirement makes enrollees in these plans are twice as likely to skip care. If businesses really want to save money in the long term and have a healthier more productive workforce, Consumer-Directed and High-Deductible plans are not the way to go.

Labels: InTheNews, Underinsurance

posted by Hanh Kim Quach | Permalink | 2:03 PM


 

SF Suing Sacramento...

Tuesday, March 25, 2008

San Francisco Mayor Gavin Newsom visited with leaders of the state government in Sacramento today, and announced he was going to sue them. Their decisions are messing up his Healthy San Francisco program, which could provide access to health services to half the city's uninsured population by the end of the year -- granted it gets the money it needs.

Specifically, Newsom (or rather, his city) is seeking an injunction against the 10% reduction in reimbursement rates to providers who take care of Medi-Cal recipients. The yet-to-be-filed lawsuit is seeking a broad coalition of co-plaintiffs to stop the $544 million cut, which takes effect July 1, from going forward.

Newsom's legal action is a criticism of both Gov. Arnold Schwarzenegger and lawmakers -- both Democrat and Republican -- who are seeking to balance the state budget through a cuts-only strategy. The state is facing a $14.5 billion -- and growing state budget deficit. In February, the Legislature and Governor agreed to an approximately $1 billion package of midyear cuts, which included the Medi-Cal rate reduction.

The rate reduction is bad news for Medi-Cal recipients statewide, who already have a hard time finding doctors who'll take them. California ranks 42nd in the nation in provider reimbursement rates; primary care providers are paid between $18 to $24 for seeing patients.

In San Francisco, this rate cut translates to an $8.7 million loss to the city's public health department -- a figure that does not include the network of private practice physicians who also see -- or don't see -- Medi-Cal recipients.


"The impact is already being felt," and some physicians are refusing to take appointments from Medi-Cal patients, Newsom said. That means 123,000 Medi-Cal recipients in San Francisco are going to have a harder time getting health care, and they will suffer. Those who get really, really sick will end up in San Francisco General Hospital's emergency room, which will shift costs to other patients and in other ways to the local economy. It's a burden on everyone, it's unfair and that's what Newsom will argue in court.



I'm a little disappointed, though, that Newsom didn't come out more strongly in favor of a solution--one that includes revenues. He knows one of the problems is that we don't have enough money. The state has chosen to shuffle money hither and yon and enact budgets that slid out of balance the minute they were signed into law.

Given his experience in budgeting with massive deficits ($300 million in SF this year), he knows the need to increase revenues. He admitted that he has raised fees to the hilt and has run out of new fees to increase. Still, he stopped short of supporting higher taxes/fees/revenues, saying tepidly, "I don't believe in a tax-first strategy. But given the magnitude of the problem, it would be wrong not to have revenues on the table."

While taxes and revenues are the long-term solution, the Mayor's announcement is an important immediate tactic, to not take the cuts laying down. In San Francisco, Newsom is actively supporting his Healthy San Francisco program, which he says should be a model for the state. But, he said, "other health care programs will get cut. This money comes from somewhere. Finding a way to get it done will impact other programs in the city. there will be layoffs within the city as a consequence.'

It's nice that there is a high-profile ally who will shed light on budget cuts--he predicts that these cuts will have a big impact on San Francisco--a county that comparatively spends more on health care than others. If that's the impact in SF, how much worse will it be in the rest of the state?

Labels: Budget, SanFrancisco

posted by Hanh Kim Quach | Permalink | 8:36 PM


 

Back in session... and the hot hearing for the week...

The legislators came back to Sacramento this week after spring break... and it's getting frantic, quick. Bills (see the Health Access bill list) introduced this year only have a few weeks to pass their first policy committee.

While the budget and policy committees continue their regular work, the most interesting and high-profile hearing this week will probably be the Senate Health Committee, chaired by Senator Sheila Kuehl, hold a special Thursday session.

The hearing is entitled "Consumer Protection under the California Department of Managed Health Care: Adequacy of Implementation and Enforcement," is expected to take several hours and maybe more.

The issues to be discussed at this informational hearing are meaty, as it asks for reports on the DMHC's implementation of regulatons in many areas of strong interest to consumer advocates, including timely access, so-called "discount health plans," rescissions, language access, and mental health parity.

We're posted some about the pending regulations to ensure patients have timely access to care. A month ago, Senator Kuehl urged the Department to withdraw their proposed regulations, stating that they were not in line with the legislature's intent when passed AB2179. The author, Assemblywoman Rebecca Cohn, has been termed out, but Health Access California was a sponsor, and Senator Kuehl was a member of the Legislature that voted for it.

But it's clear that this hearing is about more than just timely access--or even about the other key issues. It's about being clear that the DMHC should be focused on consumer protection as its core mission--it's the reason that the DMHC was created in the first place. There's too many important issues for anything else to get in the way.

Labels: DMHC, Kuehl, Sacramento, TimelyAccess

posted by Anthony Wright | Permalink | 3:55 PM


 

In McCain's small universe

Monday, March 24, 2008

Kudos to Prof. Tony Sheppard at CSUS, whose careful reading of the newspaper leads us to this story about McCain's recent doctor's visit and cancer screening.

The offending comment:

"Like most Americans, I go see my doctor fairly frequently."

Of course, he can. As a member of Congress, he has access to fancy health coverage through the federal government, which pools together millions of federal workers and provides a really impressive array of options.

For health advocates, though, this off-the-cuff comment belies a deeper concern: Sen. McCain's lack of empathy and understanding for what Americans face is startlingly scary. Because he believes that most have "fairly frequent'' access to the doctor, he sees nothing wrong with his health proposal, a scheme that would cause more people to have worse coverage and bear increasing costs to stay healthy and productive.

For 47 million Americans who lack health insurance and countless others who have inadequate coverage through high-deductible health plans or other products of that ilk, seeing a doctor "fairly frequently'' is a fiction. And given that approximately 2 million more Americans became uninsured annually every year since 2000, we can only expect that number to grow.

If you're uninsured, or have inadequate health coverage, and you're forced to foot 100 percent of the bill to see a doctor - you're not going to go. "I'm healthy; I don't need a mammogram; I don't need a colonoscopy?'' many rationalize. The evidence is there: uninsured patients spend less than *half* the amount that insured people do on health care, according to the Institute on Medicine. Specifically with regard to doctors - 71% of Americans with insurance see a doctor annual, versus 41% of those with no insurance.

Not getting medical care isn't just a problem of the uninsured. Patients who have inadequate coverage are twice as likely to either delay or avoid getting health care because of cost, and far less likely to follow treatments for chronic conditions such as arthritis, high cholesterol or hypertension, according to the 2007 EBRI/Commonwealth Fund survey. Again, specifically with regard to doctor visits -- those with inadequate insurance are nearly twice as likely to avoid seeing a doctor or specialist because of the cost.

This is what we'll be treated to under a McCain health care plan, where employers will be encouraged to dump their workers into a less regulated and less efficient, more expensive individual market to fend for themselves, and where consumers are encouraged to buy high-deductible health plans. Sen. McCain's remark may have been flippant, but shouldn't be ignored.

Labels: InTheNews, Republicans, Underinsurance

posted by Hanh Kim Quach | Permalink | 2:16 PM


 

Looking back, looking forward...

Thursday, March 20, 2008

Steve Wiegand of the Sacramento Bee brings us a fascinating blast from the past, explaining some of the details with Gov. Earl Warren's attempt at health care reform many decades ago. The question is whether the current Republican Governor's second attempt at health reform (he says he's committed) will be more successful...

Lots of posts about state and national health reform in this week's Health Wonk Review, hosted by Joe Paduda at Managed Care Matters. It nicely spotlights our recent post asking what's wrong with the restaurants...

Ground zero in health care reform (at least one of the 'zeros') is San Francisco, perhaps the largest political entity in this country to legislate universal coverage. Anthony Wright finds the most vocal opposition to Healthy San Francisco came not from insurers, or pharma, or physicians or neocons, but restaurants. From his desk, it looks like the restaurant's opposition may be backfiring, as some patrons are happy to pay a surcharge to cover their server's health benefits.

I've always said that given the raw numbers, Los Angeles was the ground zero in the uninsured crisis in the nation--so maybe it's appropriate California offer a ground zero in the solution--hopefully Sacramento will re-establish it's claim to that mantle as well.

Other interesting posts noted include:
* a series on the state of America's health system by Tom Lynch (a four-part post: One, Two, Three and Four), trying to answer the question is our system is the best in the world...
* a Colorado look at a proposal to allow out-of-state plans to offer coverage by Louise Norris--she notes all the problems with such a proposal in terms of undermining state consumer protections and markets; and while these consumer protections are national, I think there's a role for the states in insurance regulation;
* and Jason Shifrin on a minimum benefits requirement for health insurance--an issue we are trying to tackle with SB1522 (Steinberg), which we believe strikes the right balance, allowing lots of choice and variation that is in the insurance market right now, but have some standardization to prevent the "junk" insurance plans that really don't provide even catatrophic coverage, and allow for apples-to-apples comparisons for consumers.

Labels: Insurers, OtherBlogs, SanFrancisco, YearOfReform

posted by Anthony Wright | Permalink | 3:11 PM


 

1,000 posts...

Just recently, we published our 1,000th post on this blog.


Health Access California started putting up our semi-regular E-mail updates and alerts on the web nearly six years ago in May 2002, during a previous budget crisis, when major health reform was not really on the table. On the eve of the "the year of health reform," in November 2006, we started posting daily commentary as well.

We hope this information has been useful: it is the mission of Health Access California to help our member organizations, community leaders, health advocates, and others, by providing them the best information, materials, political advice, and campaign infrastructure, to be the most effective on health care issues, on behalf of their constituencies. We hope this blog has been helpful in providing that information, a link to what's going on in Sacramento, and on health policy in California, so that you (and your organization) can best engage in the policy process--on the variety of issues and in the full range of venues.

Before posting daily to the blog, I've wondered if there would be enough content... but it's clear that there's more than enough going on in health care--even when it's *not* the "Year of Health Reform."

Personally, it's been interesting to also balance blogging with my "day job" being a consumer advocate and an organization director. We've been active in reporting and transcribing many public hearings and events and posting information... while at the same time, to be honest, not sharing strategy secrets or divulging information from private meetings.

We recognize that we are bookmarked by not just both our friends and allies, but by our occassional adversaries in the health indsutry as well. But we welcome their readership as well--maybe we can convince some of them of our position!

Let us know how we can more more helpful, more useful, more relevant for the next 1,000 posts... My E-mail is awright@health-access.org.

Labels: HealthAccessCommunity

posted by Anthony Wright | Permalink | 12:14 AM


 

60 votes!

Wednesday, March 19, 2008

The Take Back America Conference in Washington, DC, had a full panel on health care, focused on the Jacob Hacker proposal, with responses. The video is at the website of the Campaign for America's Future.

Ezra Klein of the American Prospect wrote out his notes beforehand, and does an impressive job predicting what discussion will look like (which is very similar to many discussions of which I have been part)--basically, every speaker goes on to describe their favorite plan, a panelist or two and audience members emphasize single-payer, and the conversation goes back-and-forth.

Instead, Ezra focuses on the politics and one number: 60. That's the number of Senate votes needed to pass any bill, regardless of who the President is.

It's a call for advocates to be flexible given the political realities of next year--which means that reforms will need not just Democratic but Republican votes. But advocates have the opportunity to help shape the political environment of next year. The election matters, and not just the race for the White House.

Labels: Federal, InTheNews

posted by Anthony Wright | Permalink | 12:01 AM


 

It's not just California...

Tuesday, March 18, 2008

Important article by the AP's Sacramento bureau reporter Aaron Davis about the budget crises in the various states across the nation, and many of the cuts being proposed around the nation.

California's proposed cuts, especially to health care, are spotlighted, but in a national context:

An Associated Press review of the budgets in all 50 states reveals coverage would be eliminated for hundreds of thousands of poor children, disabled and the elderly. More than 10 million people would lose dental care, access to specialists, name-brand prescription drugs or other benefits. About 20 million could see their care jeopardized by further cuts to doctors' reimbursements.

Health care is a choice target as governors and legislators confront the worst deficits they've faced in a decade or more, but that's not their only target: They're also considering cuts in aid to schools and universities, shrinking state work forces and even releasing prisoners before their sentences are completed.

It's relevant to know that California is not alone, and other states, from Illinois to New Jersey to Ohio all are struggling as well. The article does a good job of mentioning some of the impact of the cuts, especially for health care:

His medical cuts mark a dramatic turnaround from his failed attempt to create universal health care in California just last year.

He would eliminate dental care for 3 million and restrict access to specialists for 6 million. That includes podiatry care, which is crucial for diabetes patients to detect
infections and avoid amputations.

Schwarzenegger's plan also ends reimbursements for poor patients recovering from cancer and other ailments who require incontinence creams and washes.

To make the case against the Governor's cuts-only budget, we need to be clear about the impacts of these cuts, to health care and other vital services.

Labels: Budget, InTheNews

posted by Anthony Wright | Permalink | 12:45 AM


 

Eating out in San Francisco

Monday, March 17, 2008

Quick. What special interest is the most active opponent against comprehensive health reform?

While many compete for that distinction (insurers, doctors, drug companies, etc.), there's a strong argument that it is... the restaurants.

As the industry perhaps most likely not to provide health coverage to their workers, they have consistently opposed efforts that would require them to contribute a fair share to health care.

* Many have been actively opposed to single-payer at least since the 1994 ballot measure--with some even subjecting patrons to anti-Prop 186 table cards.

* Fast food and chain restaurants were the single largest opponents of SB2 and Prop 72, which would have required large employers to pay for their worker's health care. In fact, fast food and chain restaurants--from McDonald's and KFC to Applebee's and Cheescake Factory--made up over 70% of the opposition fundraising to Prop 72--most of the rest of the employer community stayed on the sidelines. Without the California Restaurant Association, Prop 72-which lost by less than a percetnage point--would have been enacted.

* Despite Governor Schwarzenegger's urging, they ultimately opposed AB x1 1. In opposing an minimum contribution for employers to health care, they graciously offered to support a sales tax--a tax they don't pay, but that their customers and other businesses do.

* In San Francisco, the Golden Gate Restaurant Association--rather than the Chamber of Commerce or broader business interests--has led a lawsuit to overturn Healthy San Francisco. The lawsuit is still pending, although there have been encouraging signs from the Ninth Circuit Court of Appeals and even the Supreme Court (in the most underplayed story of the year).

Marc Lifsher's new Los Angeles Times story places the spotlight on the restaurant's opposition to Healthy San Francisco--an innovative and groundbreaking effort to ensure universal access to care. (See a new one-sheet summary of Healthy San Francisco by the Kaiser Family Foundation.)

The article indicates that dozens of SF restaurants are now placing notices on menus, announcing additional costs--from $1 to $2 dollar flat fees to 1-4% surcharges--to help pay for the new health care requirements.

But the tactic, clearly designed to stoke public opposition to the law, may backfire:

* Of all the things that your dollars, it would seem that San Franciscans might think that a few extra dollars to go to the effort for universal health care is a good thing.

* The beneficiaries of the health care law are not faceless. They are the waiters and waitresses that diners interact with. And even for the kitchen staff--wouldn't you want the people handling your food to have health insurance? Especially since there is a correlation between being insured and health status?

* It's clear that some of the traditional arguments against employer requirements don't apply to San Francisco restaurants--people aren't going to go across the Bay Bridge to get a burger, or a fine dinner, simply to avoid a small surcharge. Rather, the minimum requirement helps level of the playing field between a coffee place that does provide health benefits, and one down the street that doesn't.

* The article quotes at least one patron that didn't mind the surcharge. So, if the surcharge is truly passed on to consumers, this undermines the restaurant's argument that the requirement will put cuts into their profits or put them out of business. They can't have it both ways.

Any health coverage expansions--from employer mandates to single-payer to hybrid "shared responsibility" plans--are going to ask employers who don't cover their workers to contribute more than they do now. It's an issue not just of financing, but of fairness--to the many employers who cover all their workers. It's also a practical issue: without a minimum contribution, policymakers fear "crowd-out," where those employers currently offering coverage drop it so their workers take advantage of a public program expansion.

Fast food and chain restaurants will eventually have to be share in the solution, rather than spending their time raising money against reform, pursuing legal attacks, and even trying to make political points on menus. But it looks like that may be a longer wait than what's at the trendiest San Francisco restaurant.

Labels: Employers, ExpandingCoverage, SanFrancisco

posted by Anthony Wright | Permalink | 10:31 AM


 

Debriefings...

Thursday, March 13, 2008

California's effort at comprehensive health care reform is *still* getting attention, as various experts from California and across the country are weighing in with their analyses, reports, and debriefs from the fight. (This is beyond the initial reactions in the first week, by Health Access and many others, such as editorial boards.)

It's clear the eyes of the nation (or at least health reformers) were on California, and there's a consensus that there are important lessons to learn from our experience: from the policy, from the politics, and the process, as the nation starts to deal with this issue as the federal level. While not endorsing the view of any commentator or author, here's what has come out just recently:

* The New America Foundation has a full report, entitled "Lessons From California's Health Reform Efforts for the National Debate" written by Peter Harbage, Leif Wellington Haase, and Len Nichols.

They also sponsored a forum in Washington, DC, last week, that included Harbage, Haase, and several other Sacramento regulars, including our colleague and board member Betsy Imholz of Consumers Union. A transcript and video of that event is available at the kaisernetwork.org "Healthcast" website.

* The blog of the high profile policy journal Health Affairs has been hosting a forum deconstructing the health debate, between many Californians with different vantage points in the fight. The positings include:
* “California Shelved Health Care Reform,” Rick Curtis and Ed Neuschler, Insitute for Health Policy Solutions
* “Opportunity Lost: The Failure of California’s Health Reform,” Patricia Lynch, Kaiser Permanente
* “The Mandate Wars, In California and Beyond,” Rick Kronick, UC-San Diego
* “California: Negotiating The Intersections of Reform,” Lucien Wulsin, Insure the Uninsured Project.
* “Shared Responsibility: The Better Course,” Curtis/Neuschler
* “Guaranteed Issue? Only With An Individual Mandate,” Lynch
* “Coverage And Cost Containment: Both Are Needed,” Wulsin

* The California Health Care Foundation has a few recent documents on their calhealthreform.org website that reviews the policy developed in AB x1 1. Elliot Wicks of Health Management Associates has a framework assessment from his view in Washington, DC, and Rick Curtis of the Institute for Health Policy Solutions has a summary of technical observations and design issues from being part of developing the proposal.

Mark Smith, the head of the foundation, provided some of his own analysis in his speech to insurers at AHIP in Washington, DC, recently.


There's no less than four more analyses coming out in the next few weeks from various sources--including from ourselves at Health Access, since we have our own thoughts on the subject.

Some initial common themes of many of these pieces include: that the stalling of the bill was a real setback, that there was policy development and components that could serve as models for other states or national reform, that there was breakthrough in terms of the potential coalition that can be built around reform, that there are issues like affordability and cost containment that need to be addressed in future reform efforts, there are reminders about the many political hurdles any reform will face.

Even the distance of a month has been helpful about thinking through some of the issues. This conversation is not over--just like the fight for reform in the first place.

Labels: YearOfReform

posted by Anthony Wright | Permalink | 11:39 PM


 

Wonkery and other links...

I would be remiss in not linking to the new Health Wonk Review, at Workers Comp Insider. Lots of interesting posts.

It pointed me to an Deloitte survey of the attitude "health care consumers" done for corporations and their marketing, but with policy implications: suggesting support for broad health reform, with two-thirds willing to support mandates, and with a majority even willing to consider taxes. As Health Populi reported, they even defined some categories of consumers, based on their frequency of using the system, knowledge, compliance with treatments, focus on cost or quality, and other factors:

* Content & compliant, 29% of Americans
* Sick & savvy, 24%
* Online & onboard, 8%
* Shop & save, 2%
* Out & about, 9%
* Casual & cautious, 28% of the population.

Two other posts I would like to highlight:

Ezra Klein promises a post that is his wonkiest yet, using charts to compare health plans with the goal of system integration.

And Health Care Policy and Marketplace Review reports welcome news that several House Democrats have requested the Goverment Accountability Office (GAO) to report on the state of the individual market. This was prompted, in part, by the rescission controversy in California. It's a much needed investigation.

Labels: OtherBlogs

posted by Anthony Wright | Permalink | 12:12 AM


 

Setting standards for coverage...

Wednesday, March 12, 2008

HEALTH ACCESS ALERT
Thursday, March 13, 2008


NEW LEGISLATION WOULD REFORM INDIVIDUAL INSURANCE MARKET
* Consumers Would Be Able To Price Shop, Do "Apple-to-Apple" Comparisons
* Bill Would Set Standards for Health Insurance Cost-Sharing And Benefits
* ACTION: Letters of Support for SB 1522 (Steinberg) Requested

New on the Health Access WeBlog: More on the McCain Health Plan; Fighting a Cuts-Only Budget; Building a Broad Budget Coalition; Layoffs Means Less Health Coverage by the Media; Legislative Committees Hear LAO Alternative Budget; AHIP Reports; Overtime for Timely Access Regulations;


The fight on health reform in the last year put a spotlight on many of the real issues in the insurance market, and in response, legislators this year have introduced a slew of stand-alone bills designed to set cost and benefit standards for health insurance and otherwise increase oversight of the private insurance industry.

A list of many of these bills is available at the Health Access California website, at:
http://www.health-access.org/advocating/2008_bills.html

SB 1522 (Steinberg), sponsored by Health Access California, would set standards for cost and coverage in the individual insurance market. SB 1522 (Steinberg) would provide immediate help to consumers who have to buy coverage in the individual market, such as the self-employed and those between jobs, while providing a framework for further health reform.

ALERT: Advocates are asked to send an organizational letter of support for SB1522 (Steinberg) to the author by the end of March. Copies to Health Access are always appreciated. For more information, check out the fact sheet and sample letter of support on our website.

THE BILL

SB1522 (Steinberg) organizes the individual insurance market and makes it understandable for consumers. It would allow consumers to see and understand their choices in the individual market, and be better informed about a plan's premium, benefits and cost-sharing. By setting a standard for coverage, it would also effectively weed out a lot of "junk" insurance.

§ Consumers in the individual market would have a better sense of their health coverage choices, since all health plans sold in the individual market would be classified into five "tiers." In this way, consumers would be able to know if a certain plan is a top-tier comprehensive plan, or a bottom-tier catastrophic plan, or something in between, and if one plan from one insuer is roughly comparable with another plan by another insurer. This provides some standardization and simplification of the marketplace, while preserving a wide range of choices for consumers.

§ To allow real price comparison, Insurers would be required to offer five "benchmark" plans, one in each tier. The bill would enable consumers to do cross-insurer price shopping, to make apples-to-apples comparisons, with the confidence of knowing that benchmark plans in a given tier have similar cost-sharing, benefits, and other plan features. The benchmark plan would help define the tier, by being the lowest-price plan in a given tier.

§ The bill would eliminate some "junk" insurance, products that are coverage in name only, that provide such limited benefits or leave consumers so financially exposed, that the product is not of value. Such plans, which deceptively offers "coverage" but leaves consumers facing major gaps in coverage and significant out-of-pocket costs. Insurers would not be able to sell new plans that do not meet the minimum benefit standards.

THE PROBLEM WITH THE STATUS QUO

California consumers who need to buy coverage as individuals face a paralyzing set of confusing and unclear choices.

§ It’s impossible to make cost comparisons, since each plan from each insurer has different deductibles, co-pays, out-of-pocket maximum, benefits, networks, etc.

§ It’s hard to determine what benefits are included or excluded, and how comprehensive any given plan is. Consumers without a college education, elderly consumers and consumers who speak English as a second language are particularly vulnerable in this unstructured market.

§ Consumers are buying "junk" insurance and find out only when it is too late. Some plans are marketed as quality coverage but actually cover only hospitalization, or even only a small fraction of the cost of hospital care. Some plans leave consumers with significant gaps in coverage, sometimes with unlimited exposure to medical bills.

SB 1522 (Steinberg) would provide help for those in the individual market now; a framework to address the growing problem of "underinsurance"; and a foundation for further health reform. This oversight over the health insurance market is a necessary first step in moving to a guaranteed issue market, and an improved marketplace where consumers have confidence in the coverage sold.

ALERT: Insterested supporters are asked to write a letter in support of SB1522 (Steinberg). Send copies to Senator Steinberg, Health Access California, and the Senate Health Committee, chaired by Senator Sheila Kuehl--the first committee that will hear the bill, in the next several weeks. More information is on the Health Access California website, at:
http://www.health-access.org/advocating/docs/SB1522%20Fact%20Sheet.pdf
http://www.health-access.org/advocating/docs/SB1522%20sample%20letter.pdf

If you have questions or need more information, please contact the author of this alert, Jessica Rothhaar, Project Manager at Health Access at jessicar@health-access.org, or (510) 873-8787 ext. 107.

Labels: Insurers, Legislation

posted by Anthony Wright | Permalink | 6:53 PM


 

Bills, bills, bills...

HEALTH ACCESS UPDATE
Monday, March 10th, 2008


2008 LEGISLATION ON HEALTH CONSUMER ISSUES
* Reform efforts continue in 2008 on individual market reform, transparency, etc.
* Consumer protection measures focus on balance billing ,rescissions, etc.
* Health advocates to oppose bills attempt to lower coverage standards


New on the Health Access WeBlog: Mid-Year Budget Cuts; The LAO Alternative Budget; The Jacob Hacker Health Reform Plan; The San Francisco Health Plan at the Supreme Court; HealthNet Fines; DNA Testing; QSR Reports; Cost Containment Revisited; Debating Mandates; Privacy; Timely Access to Care Regulations Withdrawn!; Dale Bonner Confirmation Hearings; Cross Border Coverage; Speaker-elect Karen Bass; Restarting Health Reform; Future Implications of the LAO Health Reform Analysis; Budget Fight-Back


Undaunted by last year's failure to pass comprehensive health reform legislation , health advocates statewide are forging ahead on a three-year effort to win universal health coverage in California.

A number of bills have been introduced this year, which attempt to address various aspects of the health care market, and build upon last year's momentum and policy discussions. Many of the topics will be familiar to advocates who have worked on reform. In fact, many of the ideas being pushed this year were present -- in some form -- in ABx1 1 (Nunez). Those ideas include the disclosure of cost and quality data by health providers, a statewide public insurer to compete with private plans, and the organization of the individual insurance market into tiers and an ultimate ban on "junk" insurance.

In addition to health reform legislation, however, legislators have also introduced hundreds of bills, which will be heard in committee beginning in two weeks. Heath Access has focused the list of hundreds of bills to a couple dozen bills of interest to health consumer advocates.

Below is a list that includes the bill number, a description of the bill, and the position of Health Access California, as the statewide health care consumer advocacy coalition, as approved at a recent board meeting. A printable list can be found on our website.


2008 Bills

HEALTH CARE COVERAGE

Universal Coverage
* SB 840 (Kuehl) Would establish a single-payer health care system in California that would enable all citizens to have health coverage. Support

Children’s Coverage
* AB 1 (Laird/Dymally) and SB 32 (Steinberg) Would expand children’s coverage, including the Healthy Families program, to all children in families up to 300% of poverty ($49,800 for a family of 3). Support
* SB 1168 (Runner) Would allow adult dependent children, who are still covered under their parents’ health plan, to stay on that coverage even if the child takes a medically necessary leave of absence from school. Support

HEALTH INSURANCE INDUSTRY

Oversight & Market Reforms
* SB 1522 (Steinberg) Would sort health insurance policies into five coverage categories, ranging from “comprehensive’’ to “catastrophic.’’ Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing, and assist consumers in making apples-to-apples comparisons between plans. Would weed out “junk’’ insurance by developing minimum benefit standards. Sponsor-Support
* AB 1554(Jones) Would regulate insurance rates. Amend
* AB 2589 (Solorio) Would require insurers who sell to public entities to disclose brokers fees. Support
* SB 1440 (Kuehl) Would require every insurer to spend at least 85 percent of premiums on patient care. Support, seek amendments

Rescissions
* AB 1150 (Lieu) Would outlaw the practice of paying bonuses to insurance company employees when they rescind policies, setting targets for rescinded policies and/or setting financial goals based on savings on health care claims. Support
* AB 1945 (DeLaTorre) Would require approval by Department of Managed Health Care or Department of Insurance for each individual rescission. Support
* AB 2549 (Hayashi) Would impose a six-month time limit in which insurers have to rescind individual health care policies once consumers’ applications are approved. Support

Benefits
* AB1962 (DeLaTorre) Would require all individual insurance policies to cover maternity services. Support
* SB 1553 (Lowenthal) Would address provider concerns and interactions with insurers about California’s existing mental health parity laws. Amend

Insurance Market Options
* AB 2 (Dymally) Would reform the Managed Risk Medical Insurance Program, which provides coverage for “un-insureables” who have “pre-existing conditions.’’ Efforts would make the high risk pool more affordable and available. Support
* Pending SB 1622 (Simitian) Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices. Support

Inadequate Insurance
* AB 2292 (Garrick) Would allow Californians who have Health Savings Accounts, linked to high deductible health plans, to qualify for state personal income tax deduction. Oppose
* SB 972 (McClintock) Would create organizations of small businesses that could purchase unregulated and substandard health insurance products. Oppose
* SB 1669 (McClintock) Would allow insurance companies to exclude coverage of conditions for which an individual policyholder has received medical advice, a diagnosis, treatment, or prescription drugs at any point in the previous 10 years. Oppose
* SB 1603 (Calderon) Would give discount healthcare plans legitimacy in the state by allowing the Department of Managed Health Care to license and regulate such products. Oppose

Health Care Industry

Balance Billing
* AB 1203 (Salas) Would prevent emergency departments – which do not have a contract with a patient’s insurance company -- from directly billing the patient for services, requiring the hospital to seek reimbursement directly from insurers. Support
* SB 981 (Perata) Would prevent emergency physicians – who do not have a contract with a patient’s insurance company -- from directly billing the patient for services, requiring providers to seek reimbursement directly from insurers. Support

Provider Oversight
* AB 2741 (Torrico) Would require non-profit hospital sales to undergo health impact analyses to gauge the transaction’s effects on the affected community, health care services, and the community’s public interest. Support
* Pending AB 2842 (Ma) Would standardize what non-profit hospitals report as “community benefits” to justify their non-profit status. Support
* AB 2821 (Feuer) Would limit drug company gifts to doctors to no more than $250 annually, require disclosure of non-gift payments made to doctors and require annual public disclosure of any gifts higher than $50. Support
* AB 2967 (Lieber) Would require public reporting of cost and quality by doctors, hospitals HMOs and others in the health care industry. Support
* SB 1300 (Corbett) Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contracts between providers and insurers. Support
* SB 1351 (Corbett) Would require Attorney General oversight into transactions involving district hospitals. Support

Underserved Communities
* AB 1472 (Leno) Would establish the California Healthy Places Act, and require diverse state agencies and departments to work together assess and reduce health disparities in underserved communities. Support
* AB 2902 (Swanson) Would require the Office of Multicultural Health to encourage the use of community-based health care workers to help facilitate and coordinate better health outcomes in underserved communities. Support

For more information about legislation, please contact Hanh Kim Quach, policy coordinator, 916.497.0923 x 206 or hquach@health-access.org

Labels: Legislation

posted by Anthony Wright | Permalink | 12:05 AM


 

Overtime for timely access standards...

Monday, March 10, 2008

Aurelio Rojas of the Sacramento Bee had a good Sunday story on the long saga of the timely access to care regulations at the Department of Managed Health Care.

As has been reported on this blog before, after going back-and-forth with specific standards, the DMHC decided a few months ago to simply let the HMOs determine their own standards. As the article indicates, Health Access California and Western Center for Law and Poverty were prepared to go to court, since it's just unacceptable for the DMHC to abdicate their role to insurers, and the regulations simply did not implement the intent of the legislature.

But that was avoided, since the Office of Administrative Law rejected the regulations on a technical process issue. The Bee has a statement by the DMHC:

"With the disapproval of the timely access regulations, we will take the
opportunity to re-examine the concerns of all stakeholders and determine the
best approach going forward."

It would be inappropriate for the DMHC to respond to just the procedural issues and resubmit the same, flawed regulations. We truly hope the Department, in the short winodw of time before they need to resubmit in the next few months, commits to a process that results in clear standards of timely access, standards that consumers can understand and demand the next time they are told they can't see a specialist for two months.

Until such a process is set, the next step is a special oversight hearing by the Senate Health Committee, chaired by Sen. Sheila Kuehl, set for later this month.

Labels: DMHC, InTheNews, TimelyAccess

posted by Anthony Wright | Permalink | 6:41 PM


 

Analyzing the analyst's alternative...

Lots of comments today at the Assembly Budget Subcommittee on Health and Human Services on the LAO Alternative Budget and provider rate reductions. We'll have more...

Labels: Budget

posted by Anthony Wright | Permalink | 5:49 PM


 

Media matters...

I was saddened to hear about the layoffs at the San Jose Mercury News last week.

I was especially concerned to hear that one of the layoffs was Barbara Feder Ostrov, a long-time reporter on the health care beat. She was an excellent reporter, very well-versed in the issues, and not easily spun. I will miss talking to her, and reading her.

It's not possible to replace that expertise and background and experience, and it seems that the newspaper is not going to try. These layoffs, and the larger crisis in the newspaper business, is actually big news for our health care system.

I have written with some alarm and passion before about the precipitous decline in the number of Sacramento bureau reporters covering state government. In this case, not only do we lose a savvy and sage journalist, but one of the few in California that had health care and health policy as a specific beat.

When a newspaper even has a "health reporter," they usually are focused on personal health, providing lifestyle advice about diets and trends in eating and exercise. Some good stuff, probably popular, but not the focus on watching and reporting on the policies and practices of those who provide our health care--doctors, hospitals, insurers, etc.

Some of the remaining reporters who cover health care do it as part of a business beat, reporting how these institutions are doing financially. But what we need more of--and are getting less of--is hard-nosed reporting that really places public oversight on the cost and quality of the care that Californians get.

Health care is too big of an issue for the media to ignore, but even when the big scandal hits, general assignment reporters can only scratch the surface of a complex field, and will miss the big stories. I have talked to very good reporters who need some time just to get up to speed on the basics: the difference between Medicaid and Medicare, an HMO or a PPO, the DMHC and DOI. And given the contraints of electronic media, TV reports never get to that level of detail to start.

There's still some excellent reporting going on, but there's a ton of stories to unveil in our health care system, and it seems some of them will go uncovered.

I have confidence that Barb Feder will land on her feet, but I fear we are all worse off for the layoffs of her and her colleagues.

Labels: InTheNews

posted by Anthony Wright | Permalink | 1:14 PM


 

Coming together...

Saturday, March 08, 2008

I've been getting E-mails in response to today's Sacramento Bee article by Judy Lin, from people wanting to sign up to prevent some of the proposed cuts to schools, parks, health care and other vital services. The article describes the very preliminary conversations among leading organizations spanning a broad range of fields to work together toward a better solution to the budget crisis.

I think it's an indication that California is ready for another solution to the budget crisis, other than cuts, cuts, cuts.

The enthusiasm comes through in our recent work. It comes through in the fact that we have health care organizations and leaders active and ready to go to oppose the cuts to health care.

The energy comes through in the conversations we've been having with groups in completely different sectors. I've been in broad-based campaigns before, but the depth and breadth of interest in stunning, bring together health and social service organizations with environmental groups, the education community, the world of police and public safety, and many others.

The interest comes through in the fact that so much has happened so quickly, as we try to catch up to even get a handle on all the grassroots, spontaneous activity going on, especially at the local level, to fight the cuts and find an alternative. The article was in indication of the great interest, even it is was premature, before this broad umbrella coalition even has a name.

It makes sense for Health Access California to be active in this type of effort for several reasons:
* With the major cuts in health care, in the mid-year cuts already made, and those still pending. You know things are bad when the least of the cuts is denying low-income seniors, people with disabilities, and prostate cancer survivors the basic dignity of incontinence creams and washes. And the cuts get worse from there.
* As a coalition organization, many of Health Access California's member organizations are multi-issue groups representing specific constituencies (seniors, children, workers, communities of color, etc.) They all recognize that it's not enough to say "don't cut health care... cut something else," because cuts in other areas often impact these same Californians in different ways. The children who lose health care are also impacted by cuts in the classsroom and park closings; a senior having their financial assistance cut also loses their Medi-Cal dental coverage and other services. This requires a global solution.

We'll put out more information about this umbrella coalition as soon as we have it.

If we are united and active and vigilant, I am confident: We'll come through.

Labels: Budget

posted by Anthony Wright | Permalink | 6:50 PM


 

The water's fine...

Friday, March 07, 2008

This week, the main event of this year, the budget fight, was given some definition...

The first skirmish was on the terrain of education. That makes sense, given that education is the biggest portion (nearly half) of the state's budget, but it's not the only worthy spending priority. Health advocates should note that health is the second largest portion of the state budget, nearly a third.

So we had several coalition against cuts form, including one headlined with Lt. Gov. Garamendi. We had students stage a mass walk-out of class. And most importantly, we had Senator President Pro Tem Perata, and his successor, Senator Steinberg, make a clear statement at a press conference against the education cuts, and vow the "fight of a lifetime" to prevent those cuts, with a solution that included raising taxes.

Senate President Pro Tem Don Perata was unequivocal about the need for an alternative to the cuts-only budget, in response to a question.: “Raise taxes. That clear enough? Raise taxes.”

Later, he acknowledged this is hard politically even to say, but "now we're wet," presumably as a metaphor.

The Republican legislative leaders put out their own statement, in opposition to any taxes. So we await the Republican legislative caucuses to reveal what cuts that they would take ownership over, and support, and not complain about.

It's fine to for us oppose cuts to schools, parks, hospitals, and other vital services. But we've got to put our money where our mouths are..

Labels: Budget

posted by Anthony Wright | Permalink | 11:54 PM


 

More on the McCain health plan...

Wednesday, March 05, 2008

Well, last night's primaries didn't resolve anything, at least on the Democratic side. Senator Obama has a lead in delegates, while Senator Clinton has new momentum.

The Republican contest was officially resolved, with Senator John McCain taking his party's nominations. In a very timely fashion, Jonathan Cohn at the New Republic investigates McCain's health policy platform.

The title says it all: "Mack the Quack: The disaster that is McCain's health policy."

It actually starts out recognizing that McCain was once "in the vanguard of the health care debate," supporting the HMO Patients' Bill of Rights and importation of cheaper prescription drugs from Canada. "But that debate has changed significantly since then, from simply protecting consumers to overhauling the entire system. So the question is: What type of reform would he be willing to swallow in this much more ambitious moment?"

Unfortunately, McCain's plan could actually have us go backwards--having more people try to get coverage in the individual insurance market, where they have the least bargaining power with the big insurers, and which is as a result the least efficient, most expensive way to get coverage.

As Cohn points out, someone with McCain's medical history would not be able to buy coverage on the individual market, because his skin cancer would be a "pre-existing condition."

Cohn notes that McCain's subsidies don't have any proposed financing to back them up, unlike the Clinton and Obama plans, and makes other comparisons with his likely rivals. He even compares their ideas pay-for-performance plans to improve the quality of care.

One note Cohn doesn't make. One hard-right aspect of McCain's plan (McClintock is sponsoring a similar proposal in the California Senate) that hits home to Californians is to allow insurers to sell across products across state lines. In effect, this eviscerates state consumer protections, including the relatively stronger oversight provided by California, since insurers would all go to sell from a state that provides little or no protections. Imagine trying to complain to the Alabama Department of Insurance about being denied for coverage.

McCain, undoes the goodwill he garnered being supportive of some consumer protections (as Cohn indicates) as a legislator with his proposals of what he would do as an executive.

Labels: InTheNews

posted by Anthony Wright | Permalink | 1:28 PM


 

Spying

Ezra Klein is hanging out at the Association of Health Insurance Plans' National Policy Conference. He's just started posting, but this initial report and take on the insurers' tepid reaction to BIG R, U.S. Rep. Dave Camp (R-Mich.) is fascinating.

I'm interested in seeing what else emerges.

Labels: Insurers, InTheNews

posted by Hanh Kim Quach | Permalink | 10:40 AM


 

Taking the LAO in context, in health reform...

Tuesday, March 04, 2008

One more thing about the LAO, and their role in health reform, in the recent debate, and in the future.

THE LAO'S INFLUENCE: While some have seen the LAO report as a factor in the stalling of AB x1 1 and health reform this year, I think the evidence shows that it was the easy excuse--rather than the actual reason--for the Senate to stop the bill. (For example, one Senator said that the LAO report was determinative in decidng how to vote, even though that Senator had announced opposition to the proposal months earlier.)

In other words, the LAO report, along with other factors, helped create an environment where a "no" vote was acceptable and even easy. The LAO has no formal decision-making power, but it does have influence, and its decisions do have political consequences.

PLACING REFORM AT A DISADVANTAGE: But the issue as we look forward is the approach used by the LAO, and the context of how that report is used by legislators. Health Access put out a full analysis of the LAO's take on AB x1 1. Basically, the LAO gave a report on AB x1 1 that indicated that the plan could pencil out for about five years, but that also:
* indicated and quantified all the costs and potential risks, but did little to put those risks in context, to indicate how real those risks were (which ended up overstating several risks);
* did not quantify a single cent of savings or upside potential;
* did not evaluate the risks of the status quo, or propose alternatives to the proposal.

To be fair, the LAO had very little time for its analysis, and many analysts are more oriented to warning you about potential risks than potential benefits.

But that's when it is important for the Legislature to place such a report in context. Legislators routinely pick-and-choose what they like and do not like about the LAO says about the budget and other policy proposals, and this should have been no exception. The Legislature should have placed this LAO analysis alongside the voluminous analyses done by various independent experts throughout the year.

WHY DOES THIS MATTER? This matters for the future of health reform. Under the approach used by the LAO, given the certainty that some legislators seemed to seek, then no health reform would ever pass in California.

Budgets fluctuate over time: if legislators seek certainty that health care will be adequately funded in perpetuity, then health reform is not possible. This is not a standard that is met in Canada or Great Britain, or indeed in Medicare or Medicaid. The LAO failed to book a single cent of savings, even though we have ample evidence that the power of group purchasing is effective, both in public and private health care purchasing.

THE MIS-ANALYSIS OF SINGLE-PAYER: If the LAO applies the same approach to single-payer, for example, this will be a problem. We and other SB840 supporters believe that single-payer would result in significant savings, from administrative simplicity, global budgeting, cutting out the insurance middleman, a reorienting of the system toward prevention, and more. But if the LAO never quantified any of these savings—if they assumed that health care under a single payer system would cost a similar amount per person per month as the current private system—then their analysis would be that single-payer would be prohibitively expensive. But single payer achieves universal coverage by eliminating of the current private insurance system. That’s the point.

Some might dispute the specifics or the level of the savings—but to quantify *no* savings is not credible. Yet no one questioned very issue, and this very approach, in the AB x1 1 analysis. AB x1 1 was careful to finance itself without taking into account any short-term savings. But if the LAO is going to look out five years, then it seems appropriate to start to measure at least put forward what savings could be generated.

OTHER ISSUES: In a similar vein, the LAO suggested that in spite of decades of experience of the state running public programs and using its significant negotiation power to bargain down the cost of coverage, that the statewide purchasing pool in AB x1 1 was going to have a more expensive cost structure akin to the private marketplace.

FEDERAL APPROVALS: To take another example, any state-level health reform proposal interacts with the federal law and federal programs, such as with ERISA, Medicaid rules and Medi-Cal matching funds. There may be some risk that the federal government may not approve a portion of a proposal; but that doesn't mean California shouldn't try to pursue reform. This is an area where the Legislature should consider these risks in both historical and political context.

In AB x1 1, the LAO admitted that 75% of the federal funds would be practically automatic. What they didn't say that the other 25%, while not totally guaranteed, was a very high probability: that no other states had been denied for that federal money under similar circumstances. In other words, while some made a big deal that the Medi-Cal portions of the proposal were a risk, those federal funds really weren't in danger.

AN ONGOING ISSUE: Speaker Nunez said that he expected SB840 to be evaluted by the LAO if and when it goes to the Governor this year. If so, these same issues with the LAO's method will arise again, and even more severely.

But this isn't only an issue with single-payer, or AB x1 1: the LAO’s approach would be a barrier to all health reform... unless the Legislature does its job, and places any analysis in proper context.

With the rewards of reform, of course there are risks. The key part is that many health experts are convinced that without any reform, the risks of the status quo are much greater, for not just the state budget, but for Californians themselves.

Labels: YearOfReform

posted by Anthony Wright | Permalink | 4:53 PM


 

The role of the LAO...

Monday, March 03, 2008

Conservative blogger Jon Fleischman at the FlashReport has a post attacking the "unelected" Legislative Analyst's Office (LAO) about their "alternative budget" proposal that includes revenue increases, not just cuts. The Sacramento Bee's Dan Weintraub defends the LAO and its role.

There are several issues here: the substance of the LAO's proposal, how the recommendations should be considered by the Legislature, and the LAO's overall role in the budget process.

Weintraub is right that the LAO has put forward policy and budget proposals all the time, but for some reason, probably political, people have invested the office with a more mythic role recently. The LAO has no more power than any other analyst outside the Capitol, does not have make decisions or cast votes, and is not accountable to anybody if it gets things wrong. Fleischman is right that the LAO has no more claim to the truth. Rather, it is there to provide advice to the Legislature, just like other think tanks, consumer groups, and specific interests do.

Sometimes that advice by the LAO is heeded, and sometimes it isn't. Sometimes that information is good and the advice helpful; other times it isn't.
* So when the LAO suggested a potential compromise regarding negotiating prescription drug discounts for the uninsured, it provided a useful frame to break the deadlock after an expensive ballot ballot and for consumer groups to push and for the Legislature and the Governor to agree to the groundbreaking AB2911.
* When the LAO continually recommends the mandatory enrollment of the aged, blind, and disabled into Medi-Cal managed care, the Legislature continually--and appropriately--rejects proposals that to date have not included the appropriate patient protections.

On the budget, the Legislature has often taken the budget recommendations as a buffet, something from which to pick-and-choose. The Legislature appropriately takes the LAO recommendations in context: another perspective, but not the final word. (We were certainly amused/irritated that some legislators that never listened to the LAO before suddenly were taking the analyst as gospel on the issues that the LAO raised regarding health reform.)

So what about the LAO's Alternative Budget?
* It's useful that the LAO has suggested raising revenues as part of the budget mix.
* It's noteworthy that the LAO actually rejected the inclusion of the Medi-Cal provider rates, given the impact it would have on access to care. The Legislature and the Governor, unfortunately, has already made that cut.
* We disagree with the LAO's advice to make even *steeper* cuts to health care in certain areas. In addition to some of the heartbreaking cuts in Medi-Cal benefits, the LAO would potentially triple the cuts to public hospitals, with a rationale that doesn't recognize how care is delivered locally. The LAO would gets rid of continuous eligibility for children, in effect making its harder for many children to get on and stay on medical coverage. The Legislature would be wise to reject these cuts, as they have in previous years.

But the decision on all these matters is up to the Legislature and the Governor, who should then accountable for their actions. We'll support good ideas (such as balancing some of these cuts already made with revenues.) We will provide information to counter the LAO analysis if we see the need. The LAO is doing their job, and their recommendations should be put in context.

Labels: Budget

posted by Anthony Wright | Permalink | 6:10 PM


 

Play ball...

The Health Access California board met on Friday, and provided direction for the year.

Just like baseball's spring training, the season is really just starting in the legislature, and in the new budget process.

It won't be a surprise that the biggest items on our agenda will be the fight-back on budget cuts, and the continuing health reform efforts at the state and federal level over the next three years. The last several years have seen us get come very close to major expansions in health coverage, and just like in previous years where the effort is blocked at some point in the process, we dust ourselves off and continue the fight, and come back stronger.

And now, that effort will be both at the state and federal level. It's clear that health care reform will be a top domestic priority in the 2008 presidential campaign, and likely in many Congressional elections as well. With a new president, health care will rise on the national policy discussion in 2009 and 2010. And back here in our state, rather than simply let the federal debate play out, it's clear that California is more likely to lead than to follow--it's just what we do.

We'll have more about specific legislative efforts and budget activities in upcoming posts. But there's a lot to do!

Labels: HealthAccessCommunity, YearOfReform

posted by Anthony Wright | Permalink | 1:19 AM


 

Did Rush Limbaugh endorse the employer mandate?

 

Catching up...

 

Finish health reform right...

 

Thinking about ten years ago...

 

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

 

Ways to fix the Senate health reform bill...

 

Help us fulfill the promise in 2010...

 

The policy that's fit to print...

 

Christmas Eve comments...

 

Senate Passage! 60!