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Still waiting...

Thursday, November 30, 2006

Our colleagues and allies at the 100% Campaign, PICO California, and other groups held a press conference earlier today urging the Governor to prioritize covering all children as part of his health plan. Here's the release:

One particular effort is a new website, Fulfill the Pledge, to keep the Governor to his word.

It's notable that while Governor Schwarzenegger made this promise in his first campaign for Governor three years ago, he has yet to even provide a plan to get there, much less implement it. And he has opposed other opportunities, whether by bill or ballot measure, to achieve the goal.

Will he cover all kids? As he prepares his broader health care plan, it's the very least he can do.

posted by Anthony Wright | Permalink | 7:08 PM


She was even willing to provide an early photo for the cause...

The California Progress Report has a great report on Assemblywoman Wilma Chan's last press conference in that position.

It's hard to describe how much of an impact she has had, both on actual health care policy to help consumers, as well as on the debate as a whole. She's been a warrior, a leader, a champion for health care consumers. Health Access California has been the sponsor of many of her bills that became law, including to prevent hospitals from overcharging the uninsured, which she highlighted in her interview, but also to better regulate Medicare Part D plans, and to provide consumer protections and information to those who buy insurance as individuals. But she's also been a leader on the effort to cover all kids, to fight health care budget cuts, to lower prescription drug prices, to help seniors choose drug plans, to provide access to those with "pre-existing conditions," to limit out-of-pocket costs and high deductibles, and many other worthy goals.

She's accomplished a lot, and for the unfinished fights, we'll continue the effort. While there's good allies left in the legislature, we'll really miss her (and other key termed-out legislators) in the coming health care discussion next year.

posted by Anthony Wright | Permalink | 4:16 PM


HSAs in Aisle 12

Wednesday, November 29, 2006
Gov. Arnold Schwarzenegger has on several occasions mentioned that he is looking for guidance from the business community on how to resolve the health care problem. In particular, Schwarzenegger is looking to Safeway CEO Steve Burd, who has been proselytizing his own brand of health care.

This year, Burd offered a $2,000 deductible plan, with a $1,000 HSA contribution to the 30,000 managers.

Burd's main thrust, however, is "personal responsibility.''

“When we discovered this behavioral stuff,'' he said. "I felt it was the Holy Grail.''

"It’s where the money is. It’s where the change takes place,'' he said.

People need to quit smoking, lose weight and exercise. (All noble goals, but if you're among the working poor, with two jobs to make ends meet, I'm not sure where you'd find time to exercise or take a smoking cessation class)

Additionally, he says, too many people don't comply with regimens to maintain diabetes, hypertension and other chronic disease. They need to be responsible. (True, but for Health Access, part of being able to maintain your health is having health care so your disease does not become a financial burden.)

Burd's emphasis on "personal responsibility'' is particularly attractive to Schwarzenegger, who has repeated this mantra several times in his ideas about reform.

It is particularly troubling, though, for advocates. It gives people a way to "blame'' others as "irresponsible.'' As we know, the uninsured are 25% more likely to die from their ailments than insured people because they lack health insurance. They are twice as likely to put off care, skip medications, skip doctor visits because of cost -- because they lack health insurance. A high-deductible plan will not help, but may make matters worse if a person is already ill, as Jonathan Gruber explains in his report.

Here is Burd's address to the U.S. Chamber of Commerce on September 7. Health Access has listened to the hourlong webcast and is providing a rough transcription here.

posted by Hanh Kim Quach | Permalink | 10:21 PM


Jobs and healthcare

The California Employer Health Benefits Survey 2006 was released today and has some new interesting factoids. Among them, that the number of plans that have no out-of-pocket limit grew from 5% to 16% over six years.

posted by Hanh Kim Quach | Permalink | 9:49 PM


Like high school dating...

John Myers of KQED at his blog (http://www.kqed.org/weblog/capitalnotes/blog.jsp) continues his good reporting on health issues, detailing an Administration briefing yesterday about their health reform plans. No details, but the Administration made a deal about meeting with “hundreds” of groups and soliciting their input.

As it happens, I was in one of those meetings yesterday, along with several other consumer groups. Other representatives of Health Access California, and many of our organizational members and allies, have also met with Administration officials in the last few months, in some cases several times. I would not be writing about this if I were betraying a confidence, but there was little information to betray. It is still unclear what the plan will be or even what direction the Administration is considering.

While the time is appreciated, there isn’t a dialogue. The Administration officials certainly take notes, but there’s no give-and-take. Yes, they ask what we would support or oppose, but that’s something they could get from our website. It’s not like we’ve been shy about what we support: in just his first three-year term, Governor Schwarzenegger got and opposed multiple proposals that Health Access and many other organizations have supported, to expand coverage to workers, children, and even all Californians. These weren’t just ideas, but fully-fleshed out legislation, with all the details and back-and-forth accommodations it takes to make it through the entire legislative process.
So when the Governor’s staff asks for our input, and that of others, including the Legislature, it's a bit of a tease. It’s sort of like high school dating. You ask the girl to go out to the movies, she says no; you ask her out to go roller-skating, she says no; you ask her out to dinner, she says no. At this point, she needs to take the initiative and suggest something, to restart the conversation. Maybe she suggest something completely different, but there’s a limit to the options. She might reconsider some of the previous options: maybe she likes ice-skating rather than roller-skating. Or only dinner with a movie. But there needs to be a sign that she’s actually interested in going out.

As with the dating scene, maybe the dynamic will shift. The Governor will need the Legislature to get something—anything—passed. The Legislature is expected to provide their own ideas and suggestions, with their own bills. Then the negotiations will really get started.

posted by Anthony Wright | Permalink | 1:01 PM


Health issues explode in old *and* new media

Wednesday, November 29th, 2006

* Schwarzenegger Reiterates Health Care Goals, But No Details Yet; Significant Press Focus
* New Web Debate on Health Care Hosted by the Sacramento Bee
* New on
Health Access Weblog: Gossip on the Gov's Plans; Congress on Drugs; Admin Staff Change

This weekend on NBC's Meet the Press, Governor Arnold Schwarzenegger reiterated his goals for 2007 of covering all Californians, and reducing health care costs. Yesterday, the Administration held a press briefing reiterating these goals, and promising that the Governor would unveil his health care plan in 41 days--at the State of the State on January 9th, 2007.

These developments have led to more intense press scrutiny of the health care crisis, Governor Schwarzenegger's record to date on health coverage issues, and speculation about his plans for next year. According to these statements, there are no announced details yet with regard to his plan--or even whether he will introduce a specific plan.

On the new Health Access Weblog, at http://www.health-access.org/blogger.html, we have spotlighted and commented on recent editorials and press accounts. BELOW is a catalog of recent articles in the last two weeks that report on what is known, and what is not known, about Schwarzenegger's health care plans for 2007. For those wanting to track this renewed debate, they are worth reading:

Recent Articles:
Sacramento Bee 11/27: http://www.sacbee.com/111/story/83351.html
San Jose Mercury News 11/27: http://www.mercurynews.com/mld/mercurynews/news/16106382.htm
San Francisco Chronicle 11/27: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/11/27/BAGBPMKDT11.DTL&hw=health+schwarzenegger&sn=002&sc=831
California Healthline 11/27: http://www.californiahealthline.org/index.cfm?action=dspItem&itemid=127547
Los Angeles Times 11/25: http://www.latimes.com/news/health/la-fi-health25nov25,1,6558256.story
Sacramento Bee 11/19: http://www.sacbee.com/296/story/79527.html
Los Angeles Times 11/19: http://www.latimes.com/news/la-me-health19nov19,1,4969121.story
San Francisco Chronicle 11/18: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/11/18/BAGVAMFAO91.DTL&hw=health+schwarzenegger&sn=007&sc=337
Sacramento Bee 11/15: http://www.sacbee.com/111/story/77205.html

Recent Editorials:
San Franscisco Chronicle: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/11/28/EDGIHMKRSI1.DTL&hw=health+schwarzenegger&sn=001&sc=1000
San Jose Mercury News: http://www.mercurynews.com/mld/mercurynews/news/opinion/16088129.htm
Sacramento Bee: http://www.sacbee.com/110/story/83298.html
Contra Costa Times: http://www.contracostatimes.com/mld/cctimes/news/editorial/16101974.htm

The New Blog Debate:
The Sacramento Bee is hosting a new online forum, Crossroads, starting first with the renewed health care debate. Daniel Weintraub, the moderator and libertarian-leaning blog veteran, has invited various health care policy people to contribute initial op-ed style pieces, and then allow them, and the public, to comment and discuss health reform amongst one another.

Health Access California executive director Anthony Wright was invited to put the first article up, which already got a quick response from Dr. James Knight, a conservative proponent of Health Savings Accounts. You can read the debate and participate in it here, at:

BELOW is the full article posted, which provides a framework for thinking about the renewed debate this year. We invite your responses, both directly at awright@health-access.org, and on the blog.

Anthony Wright, executive director, Health Access California

Too often debates about health care in Sacramento or DC turn into fights among industries: hospitals vs. insurers, doctors vs. medical groups, HMOs vs. drug companies, etc. As the director of Health Access California, the statewide coalition representing health care consumers, I welcome broadening this debate to include those who our health care system is supposed to serve: the patient and the public. But it is no longer good enough to have the debate; it is time for action.

CALIFORNIANS MORE LIKELY TO BE UNINSURED: For California patients and families, health care is a deeply personal and important issue, that goes directly to one’s life and livelihood. Californians are more likely to be uninsured than those in 45 other states. Over six million Californians are uninsured—80% are workers or their family members—and many more are underinsured. Many with insurance at the moment fear that it won’t be there for them when they need it.

THE CONSEQUENCES OF UNINSURANCE: Why should we care? Those who are uninsured live sicker, die younger, and are one emergency away from financial ruin. They don’t get needed care, including preventative screenings, ongoing treatment for chronic conditions, and emergency care, resulting in worse health outcomes, for them and the community at large. The uninsured are more likely to die prematurely than insured patients with similar problems. Financially, nearly half of the uninsured reported having unpaid bills or being in debt to a health provider. In fact, medical problems and bills are a leading cause of personal bankruptcy.

A MANDATE FOR CHANGE: So it is good news that both major gubernatorial candidates made health care affordability and coverage expansion a major priority for next year, and that the re-elected Governor Schwarzenegger stated that 2007 will be the year of “health care, health care, health care.”

Our health system is at a crossroads, and action is needed just to preserve the level of health security we have today.

TWO PILLARS OF OUR HEALTH SYSTEM: Of 36 million Californians, 19 million get health coverage through employers, and another 10 million get coverage through public insurance programs like Medicaid (Medi-Cal in California) and Medicare. The common theme is that we come together to share the risk and cost of health care, either at the worksite, or through a public program.

WHAT DOESN’T WORK: In contrast, relatively few Californians—1-2 million—get coverage in the private marketplace, because it is either unaffordable, or unavailable, due to so-called “pre-existing conditions.” As individuals, consumers don’t have a chance against big insurance companies, who actively try to avoid covering those who actually need care. Together, we know it is more affordable and efficient to get insurance in a larger group—and the larger the group, the more effectively we can spread risk, and the better we can bargain for fair rates.

THE CHALLENGE: Yet the two key pillars of our health system on which most of us rely, employer-based coverage and public insurance programs, are under attack. Employers are scaling back health benefits or dropping them altogether—which places an additional burden on public programs. Yet some politicians have proposed cuts or caps on Medicaid and Medicare coverage, even though they have proven more cost-effective than the private insurance-even at taking care of the oldest, sickest, and frailest amongst us.

THE POLITICAL WILL: The best solutions are to fortify these key pillars, building on what works to both protect the coverage that people have and extend coverage further. In the past four years, the California legislature has tried to do just that. To bolster private coverage, it set a standard for employers to provide health benefits to their workers, much like the minimum wage does for pay (SB2 in 2003); it passed an expansion of public insurance programs to cover all California children (AB772 in 2005); and this year, it passed a reform that would bring all Californians together under a universal health care system (SB840 in 2006). Each of these efforts were opposed by Governor Schwarzenegger, either in ballot campaign or by a veto.

FIFTH YEAR’S THE CHARM?: So 2007 should not be seen as the beginning of a health care debate in California, but the culmination. We’ve been having this debate in our state for four years; it’s now time for action.

THE RISKS OF INACTION: Without positive action, the health care system is deteriorating, and individual patients and families are being forced to take on the risk, burden, and cost of health care.

What’s worse, some so-called policy solutions actually encourage this trend, toward what economist Jared Bernstein calls YOYO, or “you’re on your own.” Such YOYO ideas include using the tax system (through so-called Health Savings Accounts) to encourage underinsurance and high-deductible plans, where consumers bear the risk for most medical expenses; and imposing an “individual mandate,” forcing consumers to purchase unaffordable coverage in the broken individual insurance market.

THE CHOICE: That’s the choice we have. If the health care system continues down the current path, you’re on your own to deal with your next major medical emergency. But the Governor and the Legislature can actually come together, to bring Californians together, we all will be healthier for it.

We look forward to the debate, but we are anxious for some action.


posted by Anthony Wright | Permalink | 12:24 AM


Whitewashing Wal-Mart

Tuesday, November 28, 2006
This story in the Sacramento Bee today hails the arrival of Wal-Mart's $4-a-prescription that "sets the stage for a generic drug price war in the state'' listing other retail giants, such as Target and Raley's who are poised to meet their low prices.

To parade Wal-Mart as the Pied Piper of cheaper drug prices, when the Wal-Mart is the beacon for what is wrong with corporate health practices in America, is completely absurd.

Legislation to enact "fair share'' benefits were inspired by the company, which has among the most abominable practices in the U.S.


  • Insures fewer than half (46%) of its employees.
  • Carries only high-deductible plans -- $1,000 for an individual and $3,000 for a family.
  • Pays low wages -- an average $10.50 wage (in California).
  • Imposes a six-month waiting period for full-time employees to become eligible for benefits. (Most large businesses have a three-month wait.)

Wal-Mart's stingy benefits has already inspired Target to follow suit earlier this year. Other large employers are also eyeing high-deductible plans, in what my colleague, Beth Capell calls "a race to the bottom."

In this paper from the UC Berkeley Labor Center, Wal-Mart workers who enroll in public assistance programs cost California taxpayers $86 million annually. The report also says that "if other large California retailers adopted Wal-Mart's wage and benefits standards, it would cost taxpayers an additional $410 million a year in public assistance to employees.''

It doesn't have to be that way. Costco, another large discount retailer, provides health insurance to more than 80% of its employees and has a three-month waiting period. Employees have a choice between a traditional managed care plan and "freedom of choice plan.''

The practice, unfortunately, does ding Costco on Wall Street.

posted by Hanh Kim Quach | Permalink | 11:21 AM


The Renewed Debate: to Bee, or not to Bee?

Monday, November 27, 2006
The Sacramento Bee is hosting a new online forum, Crossroads, on the renewed health care debate. Dan Weintraub, the moderator and blog veteran, has invited various health care policy people to contribute initial op-ed style pieces, and then allow them, and the public, to comment and discuss health reform amongst one another. My article is first up, posted here:http://www.sacbee.com/static/weblogs/crossroads/healthcare/

The Sacramento Bee editorial board gets in on the discussion too, responding to its own article about the Administration considering scaling back mandates and other consumer protections on insurers. The editorial is right to warn against so-called reforms that simply seek to shift the risk and cost of health care to individual consumers and families. They don't make the obvious point: removing the mandates won't actually save any real money, even as they dramatically increase the burdens of specific consumers, while causing worse health outcomes and necessitating more expensive treatments later.

posted by Anthony Wright | Permalink | 10:09 PM


Meet the Russert

Sunday, November 26, 2006
Governor Schwarzenegger was on Meet the Press this morning. It wasn't Tim Russert's toughest interview, with very few of his trademark"gothcha" questions, and more about his advice for Republicans in D.C.

On health care, it was notable that he spotlighted his work on prescription drug prices twice, along with the minimum wage, global warming, and infrastructure. The full transcript is available at MSNBC's website, at:

Whlie he didn't go into detail, he did make some comments about health care of note. While he reiterated statements made previously, he made the stakes clear, especially on the goal of covering all Californians, " fixing our health care problems to insure everybody that is uninsured." It's a good, clear statement to hold him to in the next year.

"This year is the year where we go—this coming year—where Democrats and Republicans are going to work together to fix our health care problem. First of all, we have to bring down the health care costs, we have to make it more affordable to provide health care. Number two, we’ve got to insure everybody, because we have 6.7 million people that are uninsured, and we’re working right now on the various different ideas, we’re going to bring those ideas together, I’m going to present this in my State of the State address. But this is the next big challenge. Look, if we could face the challenge and fix our infrastructure problem and approve a $37 billion infrastructure package, we can also solve the health care problem. We’re going to solve all of those things. Democrats and Republicans are very determined in California to say, “We have certain problems that have been problems for decades, and we’re going to go out now and fix it.” And that is what is so wonderful about it, bringing both of the parties together.

He did not say how he would acheive this goal, but he might want to be more flexible than his other statements. He noted that the voters opposed the various initiatives that included a tax, including, he mentioned in a gratuitous remark, the measure by the California Nurses Association. Yet in the same interview, the Governor stated that when voters rejected his initiatives, it wasn't that the content was bad... it was "the approach." Most analysts concluded the determining factor was that every initiative with a funded opposition lost.

In fact, the closest measure was the tobacco tax, which got 48% despite $60 million spent against it, and whose opposition campaign didn't even oppose the notion of a tax, but rather focused on ancillary provisions for hospitals that were portrayed as anti-consumer (such as an anti-trust exemption). If the Governor is trying to read the mood of the public about revenues for health care, he may want to take a closer look at the election results.

posted by Anthony Wright | Permalink | 10:14 PM


Congress on drugs...

Saturday, November 25, 2006
The wave of prescription drug price reform that started in California this year is heading toward Washington, DC.

Several articles, such as in the New York Times ("Drug Industry Is On the Defensive"), Wall Street Journal ("Why Medicare Drugs May Be Sticking Point"), and even the London Times ("Big PHRMA on a Mission to Woo Democrats", courtesy of Consumers Union's blog) in the past several days detail the drug companies bracing for the Congressional control to switch to Democrats, who ran on issues such as allowing reimportation of drugs from Canada, and for allowing Medicare to negotiate for the lowest possible price.

The fact that such negotiation was prohibited in the Medicare Part D law was part of the reason that consumer, health, and senior advocates focused at the state level for relief for Californians without prescription drug coverage, including seniors. This led to the epic Prop 78/79 ballot battle last year, where the drug companies spent a record-breaking $80 million, and consumer advocates were left with grassroots tactics up and down the state, including driving an ambulance (above. in Sacramento) and wearing a giant prescription drug costume, (right, at Venice Beach).

But nevertheless, Californians won a landmark prescription drug discount program with AB2911, allowing California to use it purchasing power to negotiate lower prices for up to six million uninsured and underinsured.

The drug companies seem determined not to have this happen in DC. The articles bring up all sorts of tactics to "buy their way out" of this problem, as health care blogger Matthew Holt succintly summarizes it, from hiring key Democratic consultants and staffers, to crafting messages to confuse the issue. Another New York Times article details the close relationships that drug companies cultivate with advocacy and disease groups.

But that doesn't mean the drug companies will win. The drug companies pulled every trick in the book here in California, as detailed in this Health Access report. Yet we were ultimately able to pass something meaningful here. But it's a good reminder that they don't go down without a fight...

posted by Anthony Wright | Permalink | 6:35 PM


Mercy Mercy Me

Businesses are already beginning to kvetch about potential costs associated with Gov. Arnold Schwarzenegger's plan to cover the state's uninsured, the Los Angeles Times writes today.

Small-business owners, who say they can't afford to offer health insurance, gripe that they could be forced out of business if hit with an expensive mandate.

Large corporations, which are providing increasingly costly health benefits, contend that they shouldn't ante up even more in subsidies. And unions adamantly oppose raising employee co-payments and deductibles.

But Bill Dombrowski, president and chief executive of the California Retailers Assn., said that "everybody has got to step up to the plate" if California wants to expand healthcare.

"Employers recognize that they are going to have to play a role," Dombrowski said. "But there's still a question about what the individuals and the healthcare systems will contribute."
I don't understand why businesses keep saying individuals don't contribute. Individuals already pay premiums and are being asked to shoulder more out-of-pocket costs -- without any input. There seems to be no question that individuals are going to contribute.

One county, though, offers a look at how government, businesses and individuals can come together and create a health system. The plan, spelled out in Friday's San Jose Mercury News would expand the use of Santa Clara County's existing infrastructure for indigent adults (county clinics, hospitals and cadre of physicians) to small businesses that employ low wage workers. The employers and workers would each pay into the system. The state would also pitch in.

The jury is still out on whether a plan like this -- or San Francisco's recently passed Health Access Plan will work, but both serve as models for how the disparate communities can come to a workable agreement.

posted by Hanh Kim Quach | Permalink | 10:43 AM


Taking and not giving

Friday, November 24, 2006
The Sacramento Bee has an interesting story about the Bush administration's reticence to release a study on farmworker health and access to care.

The study, which was commissioned four years ago, was intended to help national policymakers plan for better health care for three million migrant farmworkers who are the backbone of our food supply.

The nation's estimated 3 million migrant and seasonal farmworkers are generally poor. Three out of four earn less than $10,000 a year.

Few are insured. By some estimates, only about 5 percent are covered by employer-provided health insurance. Their work is dangerous.

Thirteen percent of U.S. occupational deaths during the 1990s occurred in farming, though farmworkers made up only 2 percent of the nation's work force.


"Oftentimes if we can catch their illnesses early, we can actually save society a great deal of money," then-Rep. Mark Foley, R-Fla., declared during brief House debate. "The sicker a person becomes ... the more expensive it is and typically will be treated in an emergency room where the cost is that much greater for Medicaid."
The issue will be a thorny one for state lawmakers and Gov. Arnold Schwarzenegger, too, as many of these farmworkers are also undocumented immigrants. This past year, efforts by Gov. Schwarzenegger and Democrats to expand coverage to all children was thwarted by Republican legislators, who objected that some of those children would be undocumented.

It will be interesting to see how the release of such a study will affect the debate in California.


posted by Hanh Kim Quach | Permalink | 11:31 AM


Something not to give thanks for

Thursday, November 23, 2006
Actors and artists will see health care premiums increase by as much as 254 percent next year, according to this Los Angeles Times story.

"We have a right to raise their rates, and we have the right to raise their rates based on experience," Cigna's Gwyn Dilday said. "They are a large group, and their rates are based on the claims experience of the group."

Regulators said this week that they were looking into the increases, but their hands may be tied. With the exception of the so-called small-group market, health insurers in California are largely free to set premiums as they see fit.
Something we should all watch as the health care debate next year takes shape.

posted by Hanh Kim Quach | Permalink | 11:59 AM


Be thankful if you are healthy...

Wednesday, November 22, 2006
As Ezra Klein at The American Prospect points out, the Kaiser Family Foundation put out a sobering study about how cancer has an impact not just on the health of the diagnosed individual, but on the broader family. It has troubling information about the impact of a major disease on a family's finances, especially if they are uninsured--but even if they are insured:

From the KFF press release:

The survey found that one in four families affected by cancer say the experience led the person with the disease to use up all or most of their savings, and one in eight say they borrowed money from relatives. The illness also made it harder for some to find and keep health insurance – with about one in 10 saying they couldn’t buy health insurance because they had been diagnosed with cancer, and 6% saying they lost their coverage as a result of the disease.

Having health insurance at all times during treatment helped to limit the financial consequences of a cancer diagnosis, but even those with consistent coverage faced difficulties – one in five used up all or most of their savings, one in 10 borrowed money from relatives and 9% were contacted by a collection agency.

Among those who did not have health insurance consistently during their illness, the financial burden was even greater. More than one in four said that they delayed or decided not to get treatment because of its cost – five times the rate reported by those who had health insurance consistently. Nearly half used all or most of their savings; four in 10 were unable to pay for basic necessities; one in three sought the aid of a charity or public assistance program; and 6% filed for personal bankruptcy.

“This is one of the most disturbing of the hundreds of surveys we have done,” said Kaiser Family Foundation President and CEO Drew E. Altman, Ph.D. “When people with cancer are deferring care and experiencing such serious financial hardships because of inadequate insurance or because they have no health insurance, it casts a new light on the need to address our nation’s health insurance problems.”

Lots of implications for the California health debate...

posted by Anthony Wright | Permalink | 7:08 PM


Mother knows best...

Two more points about the Sacramento Bee story this weekend about the Administration considering removing requirements on insurers to provide certain services.

* With all the talk of Massachusetts, let's be clear: that state has more mandates for what constitutes minimum coverage, yet also has nearly half the percentage of uninsured as California. As other states show, we can clearly expand coverage without sacraficing these consumer protections. (In fact, it is likely that more people are insured in Massachusetts because they have *more* oversight over insurers and their practices, not less.)

* The new study about what a "basic benefits" pacakge looks like, by Sacramento HealthCare Decisions, funded by the California HealthCare Foundation, adds an interesting counterpoint to the Bee article. As my colleague Hanh pointed out, the business representative made the case against mandating maternity coverage, even though it is actually not a benefit required in California. (Governor Schwarzenegger vetoed a bill to do that a couple of years ago.) Yet what benefit do the most people of those surveyed consider essential? Maternity coverage, with 99%.

posted by Anthony Wright | Permalink | 1:22 AM


Changing of the guard...

Tuesday, November 21, 2006
The press has made a lot about the turnover in the Governor's office, with major figures leaving such as press secretary Margita Thompson and legislative director Richard Costigan. Costigan's departure matters in next year's health reform debate, given his history on the issue: In 2003, he was the Chamber of Commerce's top lobbyist and the main opponent of SB2(Burton), the bill to expand employer-based coverage.

Under the radar for the mainstream press, but hugely important for health policy, is the just announced departure of Stan Rosenstein, the Director of Medi-Cal (California's version of the federal Medicaid program). In a thoughtful E-mail, Stan reports he is retiring from state service after three decades--and in Executive positions under four Governors. He reports that he will "establish a Sacramento office for one of the nation’s leading healthcare consulting firms, Health Management Associates, and will start work on January 15, 2007."

In his long history, there certainly have been many times when we as health and consumer advocates have strenously disagreed with Stan's positions and statements, but let me simply point our three positive and memorable events from just this year.

* Stan had a big role in a celebration of Medi-Cal's 40th anniversary, but even for that event it was hard to overstate how important the program is, providing coverage for over 6.8 million Californians--many seniors, people with disabilities, children & many of their parents, and providing significant funding for the health system on which we all rely. He was appropriately proud of the program, and at the celebration, Medi-Cal adopted a logo that represented these patients, as well as all the California counties that are important participants. All year, I never have seen Stan without the new Medi-Cal lapel pin, or without one of his trademark purple ties.

* When the initial implementation of Medicare Part D was clearly faltering, Stan was seen as taking an active role in having California adopt emergency "coverage of last resort," to ensure that low-income seniors and people with disabilities got their medications until the problems were fixed. While advocates have an unfinished agenda in preventing these "dual-eligibles" from being worse off under Part D, these quick actions may have saved lives.

* The last time I saw Stan was at the signing ceremony for AB2911 (Nunez/Perata), the much-discussed prescription drug discount bill, an issue he was involved in for many years. [Here is a picture from the ceremony, from left to right, of Stan, Assembly Speaker Nunez, myself, and Governor Schwarzenegger.] The Governor (wearing a matching pink tie to Stan's purple tie) made an explicit point of ensuring that Stan got one of the signed copies of the bill. Maybe he knew something that we didn't?

posted by Anthony Wright | Permalink | 11:52 PM


Cheaper for whom?

The San Francisco Chronicle today details an emerging behavior by employers trying to trim costs: go for cheaper high-deductible plans. Premiums on these coverage options cost less, for the employer and employee at the front end.

BUT if you happen to get sick, need surgery, have chronic pain that doctors can't seem to diagnose, it'll end up costing you far more for doctor's visits, drugs, etc.

Some people seem to believe higher deductibles will cause patients to become more cost conscious and "shop around'' for care. NOT. ...But not for lack of trying. There simply isn't enough information out there on cost and quality.

When was the last time you tried to "shop around'' for a pap smear, prostate exam, blood test. The information simply isn't out there and isn't easy to get. And if you're in an ambulance, suffering from a heart attack, there's really not enough time to do the research.

The Employer Benefit Research Institute and The Commonwealth Fund both have relatively recent reports on consumers, high deductible health plans and their accompanying Health Savings Accounts.

The evidence, so far, shows that while these plans may be more affordable for employers -- it means employees will be paying more.

posted by Hanh Kim Quach | Permalink | 4:14 PM


Why a Blog?

Monday, November 20, 2006
Tuesday, November 21, 2006

* Updated Daily With Latest Developments on California Health Policy
* Latest Reports About Governor’s Plans for 2007 Health Reform

Health Access, the statewide health care consumer advocacy coalition, is pleased to announce that we are expanding the blog on our website to feature commentary, action alerts, and breaking news on a daily basis. In addition to these E-mail updates and alerts, we hope this provide real-time insight on the renewed health reform discussion in Sacramento, just as it heats up leading into 2007 and beyond.

In the past few days, we have just posted some reactions to what the several newspapers are reporting that Governor Schwarzenegger may be considering to unveil in a health proposal, including a Los Angeles Times overview, a San Francisco Chronicle article about prevention strategies, and a Sacramento Bee report about a potential attack on the HMO Patients' Bill of Rights. We invite you to visit the blog, on a regular basis, at:

BLOG BACKGROUND: For the last five years, Health Access has produced the E-mail alerts and updates like the one you are reading now, reporting in a timely way the happenings in Sacramento regarding the health policy debate. Our purpose is not just to inform, but to provide a resource to help take action to help preserve and expand access to care for Californians. We hope they have been useful to your work.

These posts have gone to hundreds of staff members of coalition allies and membership organizations, community leaders, public policy experts, key activists, and others interested in working toward the goal of quality, affordable health care for all. They have also been archived on a blog at the Health Access website, at:

These posts document an important time in the debate over health policy, spanning over a major budget crisis as well as two gubernatorial elections, a recall election, a presidential election, and a special election. It saw the beginning of a debate over major health reform several years ago, which has continued to the present day. This debate has led to the passage of major bills that would have expanded coverage to workers and their families (SB2 in 2003), children (AB772 in 2005) and all Californians (SB840 in 2006), only to see them blocked by a Governor’s veto or at the ballot box. The archives detail many of the specific committee hearings, floor debates, and votes taken.

With this expanded blog, we are still committed to continue to send out these updates on a regular basis, to report on committee hearings, the progress of legislation or the budget, or other full-fledged updates. To sign up to get these E-mails, you can subscribe right from the Health Access website home page:

THE NEW COMMENTARY: But in addition to these updates, we want to be able to share real-time information, the latest wonkish gossip going around the Capitol, to the reaction from the story in the morning paper, to highlighting a new study that provides new perspective on the debate of the moment. We want to help California organizations and individuals be engaged in this campaign for health care reform, and we hope to provide the tools to help.

As the statewide health care consumer advocacy coalition, our goal is to assist organizations in advocating for health care reform on behalf of their constituency. Some groups are focused on many other issues; others are local and are less familiar with the ways of Sacramento . Our hope will be to make the process transparent, and give the best sense of what the discussion is, and most importantly, where is there an opportunity for input and intervention. The point is not just to educate, but to activate.

We are unabashed in our perspective as advocates for health care consumers--the uninsured, insured, and underinsured--not from the health providers, insurers, or others from the health industry, or even that of a dispassionate observer. That's our position as consumer advocates, as a coalition of community groups which have won the HMO Patient’s Bill of Rights to this years’ passage of bills to stop hospital overcharging and implement a prescription drug discount program. Our interest for this blog will be the same: How will these policy changes impact the patient, and the public?

YOUR HOSTS: The blog will be hosted by two Health Access staff members: Hanh Kim Quach, policy coordinator, as well as Anthony Wright, executive director. Hanh has extensive experience working for years as a newspaper reporter, most recently for a major daily covering the Statehouse, before joining Health Access. We expect she will use her journalism expertise to provide fresh insights and new information to the health policy debate, and most of all do so in a way that is understandable to those not immersed in the field. Anthony will bring his experience as a consumer advocate and organizer in California and other states, on health care and other issues.

As we develop the blog and our website further, we expect that we will have contributions from other Health Access staff, and guest blogs from our board members, and staff of member and allied organizations. We would love your input. Feel free to contact Hanh Kim Quach at hquach@health-access.org, or Anthony Wright at awright@health-access.org, with suggestions, ideas, or other thoughts.

NAME CONTEST: As we expand the blog, we are looking for a name for it, beyond the rather boring “Health Access Weblog.” Please send suggestions to hquach@health-access.org. The winning entry will get an as-to-be-determined prize, and the thanks of a grateful blogger.


posted by Anthony Wright | Permalink | 6:10 PM


Cards on the table...

As Hanh has indicated here earlier, the speculation in Sacramento is rampant about what the Governor is considering for his health proposal. Jordan Rau in the LA Times lays out some of the history and provides a good sense of the dynamics...

But back to the recent story in the Sacramento Bee by Aurelio Rojas, which says the Governor is considering rolling back the HMO Patients' Bill of Rights (which Health Access California sponsored). The press spin was as follows:

"Right now, the administration is combing through hundreds of ideas and concepts," said Adam Mendelsohn, the governor's communications director. "No idea is in, no idea is out, and there is no specific plan developed."

But that's plainly not true. The Governor has already ruled lots of things off the table, most notably with his veto of SB840, Senator Sheila Kuehl's California Health Insurance Reliability Act. That's off the table, but somehow a huge gift to the HMOs--repealing managed care consumer protections--is on the table?

posted by Anthony Wright | Permalink | 4:13 PM


No Man is an Island

Sunday, November 19, 2006
Today’s Sacramento Bee story highlights an option that the administration is looking at to try and trim health care costs. The method essentially involves getting rid of some of the state's 23 health plan benefits that are mandated by law. These hard fought patient protections range from cancer screening, to diabetes maintenance and treatment of mental illnesses.

One of the advocates of this idea is Michael Shaw, assistant director for the National Federation of Independent Business:

Shaw, whose organization represents 35,000 employers in the state, said that because group insurance plans are required to provide more benefits than individual plans, many small business have been priced out of the market.

"So we want to create a set of rules for all plans that treat individuals equally but do not cost people the ability to afford health care," he said.

Shaw said single men, for example, should not be forced to pay for maternity care "simply because the state determined that it should be part of health coverage."

First of all, Shaw needs to do his homework. California does not mandate maternity coverage and many small group plans don’t offer it – or if they do, it’s only after thousands in deductibles have been met.

Secondly, helping to shoulder the cost for maternity coverage is really the least young, single, virile men could do.

The substance of Shaw's argument troubles me, though. He is essentially arguing that there is not public good in pooling together to collectively shoulder costs.

If you look at the state's list of mandated benefits -- with the exception of some of the family-planning benefits -- none of the conditions are within a person's control. You have it -- or you don't.

Shaw is saying that if you are unlucky enough to have -- say -- Alzheimer's disease, osteoporosis or a mental illness, you're on you're own, because the healthy crowd doesn't believe it should have to take care of you.

But what happens when someone who is healthy suddenly becomes unhealthy -- and gets -- say, prostate cancer. Then what happens?

Under Shaw's idea, you pay for it yourself, or you don't and face the consequences.

The lesson under this model: Pray that you never get sick.

Here is a listing of California’s 23 mandated benefits. All may be found in the state’s Insurance Code. (A similar list exists in the Health and Safety Code for HMOs regulated by the Department of Managed Health Care.)

  1. 10119(b): Mandated benefit granting immediate accident and sickness coverage to each newborn infant and adoptive child.
  2. 10119.5: Mandated benefit for involuntary complications of pregnancy, at regular policy benefits. Limited to those policies which provide maternity benefits.
  3. 10119.7: Mandated benefit for diethylstilbestrol (DES) conditions or exposure
  4. 10119.9: Mandated benefit for general anesthesia for dental procedures performed in a hospital or surgery center on patients under age seven, the developmentally disabled and certain other patients.
  5. 10123.21: Mandated benefit for surgical procedures for jawbone conditions (TMJ).
  6. 10123.5: Mandated benefits for comprehensive preventive care for children age 16 and under in accord with certain guidelines established by the American Academy of Pediatrics (applies to group policies only)
  7. 10123.8: Mandated benefit for breast cancer screening, diagnosis and treatment, including prosthetic devices and reconstructive surgery.
  8. 10123.81: Mandated benefit for mammograms.
  9. 10123.82: Mandated benefit for prosthetic devices to restore a method of speaking incidental to a laryngectomy.
  10. 10123.83: Mandated benefit for prostate cancer screening/diagnosis
  11. 10123.88: Mandated benefit for reconstructive surgery, as defined.
  12. 10123.16: Mandated benefit requiring any policy providing coverage for long-term care facility services or home-based care to cover persons with certain degenerative illnesses, including Alzheimer’s disease (except for pre-existing conditions.)
  13. 10123.18: Mandated benefit for annual cervical cancer screening test if policy includes coverage for treatment/surgery of cervical cancer.
  14. 10123.20: Mandated benefit for all generally medically accepted cancer screening tests.
  15. 10123.68: Mandated benefit for a second opinion when requested by insured or health professional treating an insured.
  16. 10123.89: Mandated benefit for testing and treatment, including formulas and special food products, of phenylketonuria (PKU)
  17. 10123.184: Mandated benefit, in certain policies which provide maternity benefit, for participation in the Expanded Alpha Feto Protein (AFP) prenatal testing program.
  18. 10123.185: Mandated benefit for services related to diagnosis, treatment, and appropriate management of osteoporosis.
  19. 10123.195: Mandated benefit requiring any policy providing prescription drugs to cover drugs, which are prescribed for a use that is different from the use for which the drug has been approved by the FDA.
  20. 10123.195: Mandated benefit requiring any policy providing prescription drugs to cover a a variety of FDA approved prescription contraceptive methods.
  21. 10144.5: Mandated benefit for diagnosis/treatment of severe mental illnesses (adults and children) and serious emotional disturbances of children.
  22. 10145.4: Mandated benefit for routine patient care costs related to cancer clinical trials.
  23. 10176.61: Mandated benefit for equipment, supplies (including prescriptions if prescription coverage is included), and self management training for the management and treatment of diabetes.

posted by Hanh Kim Quach | Permalink | 1:07 PM


A Fat Smokescreen

Saturday, November 18, 2006
My head spun when I read today’s San Francisco Chronicle article describing
Gov. Arnold Schwarzenegger’s plan to promote “personal responsibility” and
healthy living as part of his health care reform.

“From too much junk food and too little exercise to missed doctor visits,
Schwarzenegger wants to get serious about shaping up California.

Although debate continues internally about how the administration would

encourage participation, officials said Friday that Schwarzenegger wants his
health care agenda to address not just cost and coverage issues but also
disease prevention.

The article goes on to focus mostly on obesity.

Don’t get me wrong. I don’t think people should gorge on Big Macs, French fries and not exercise.

But I believe the Governor's focus on this could be a red herring that fails to help people understand the systemic failures that have lead to the nation’s increasing obesity and declining health.

To truly engage in prevention – and maintenance of chronic diseases – one needs insurance. Real insurance.

Not the kind that gives you one free mammogram a year and one free "routine'' visit and
pats itself on the back. Not the kind that requires you to pay thousands out of pocket for the maintenance of your diabetes, high blood pressure or heart

Meaningful insurance is insurance that will really cover the times when you have indescribable
symptoms that doctors can’t seem to diagnose.

Meaningful insurance is insurance that will ensure you don’t hold off on going to the doctor because you'd rather save money and wait out stabbing pain in your side, hoping will go away.

Let’s get back, though, to dissect the issue of obesity:

In 2005, 14.2 percent of teens were obese. That’s nearly 500,000 overweight
teens, according to the latest California Health Interview Survey. Adults
fare worse, with 5.6 million – or 21.2 percent of the state’s adult

  • Why are people obese?
The Centers for Disease Control blames the prevalence of “abundant, but
nutritionally poor food’’ combined with limited physical activity.
  • Why are people eating nutritionally poor food?
It’s cheaper and it’s abundantly available.

  • Why is nutritionally poor food abundantly available – and cheap?
Well, authors Greg Critser and Michael Pollan believe it's because of the ubiquity of high-fructose corn syrup, which flavors everything from soda to fruit juices to granola bars to ketchup.Nutritionists blame high-fructose corn syrup for the rise in obesity.(Read more about this here and here.

  • Where do you start?
Is the Governor willing to talk Safeway CEO Steve Burd (whose health plan
for managers is serving as a model for the administration) into banning the unhealthy
snacks aisle in his stores?

Is the Governor asking Carl's Jr. to stop serving over-sized portions of
high sugar/high fat food?

If Schwarzenegger is unable to see that we are living in a system that has created an unhealthy environment, I can’t see the administration getting very far in his attempts for health reform focused on prevention.

To read the SF Chronicle article that set me off, click here.

posted by Hanh Kim Quach | Permalink | 2:44 PM


A game of Clue

Friday, November 17, 2006
The Sacramento Bee reported about the Governor's comments, stating a goal of reducing the rate of uninsurance in the state by half.

After statements that focused on other aspects of health reform, it's good he is still talking about expanding coverage. It's an important statement, a benchmark to hold him to. However, no word on what approach he will take....

The game is Sacramento right now is to guess what the Governor might come out with. Less attention is being paid to the (probably multiple) proposals the Legislature might produce, even though both the Governor and the Legislature are vital to getting something passed.

The Legislature, however, has previously shown the political will to pass major health expansions, to working families (in 2003), children (in 2005), and all Californians (in 2006). Those will be back in the mix in some way, regardless of what the Governor does. More speculation to come...

posted by Anthony Wright | Permalink | 10:44 AM


A kid at 25 -- a good thing

Monday, November 13, 2006
A tidbit buried in a Tuesday (11/14) Wall Street Journal Story:

"...Health insurance...is ''at the top of the list'' of workers' problems. (An) idea is to offer government coverage for everyone under a certain age -- say 18, or even 25 -- as part of reauthorizing the current federal program for covering low-income children.

"That would be my wildest dream,'' said Rep. Forney "Pete" Stark of California, a prime sponsor of the idea.''

http://online.wsj.com/article/SB116346456714722160.html?mod=home_whats_news_us (subscription only)

If such legislation passes, California could reduce its uninsured population by another 1.1 million, (CHIS 2003). The most recent study by the California HealthCare Foundation shows that the population between ages 21-24 were the most likely to be uninsured last year.

Why aren't young people insured?

Well -- think back to your first job. You're 21; you're not making a lot of money. You're either just starting your career -- or not on a career path yet. Maybe you're working part-time at a couple places. Maybe you're an intern. Maybe you've just been hired full-time, but are in a probationary period.
That means your employer:
  1. Isn't offering benefits - especially if you're part-time.
  2. Offers benefits, but to full-time employees who have been working there for a while. (That means not you -- at least right away).
Knowing that, advocates have tried to extend coverage to young adults through their parents' health insurance in past years. In California, Gov. Arnold Schwarzenegger vetoed AB1698 (Nunez) in 2005, which would have extended dependent coverage until age 26.

Should Stark's proposal pass, allowing young adults to receive coverage through Healthy Families, it would be a huge boon to expansion efforts nationally.

(Those who'd like me to email a copy of the WSJ article can contact me at hquach@health-access.org and i will be happy to send it your way.)

posted by Hanh Kim Quach | Permalink | 5:57 PM


Little Hoover takes on big issue...

Monday, November 13th, 2006

* Little Hoover Commission studies strategies to address state’s health needs
* Report from Sacramento hearing, field visit to Los Angeles hospital

The state’s Little Hoover Commission, a quasi-governmental, bipartisan oversight commission that makes recommendations to improve efficiency in state government, has recently turned its focus to health care.

While they don't have an specific authority to implement any recommendations, they have had impact on debates on government reorganizations to specific issues. As Gov. Arnold Schwarzenegger announces his intention to make 2007 the "Year of Health Reform'' and advocates plot a 2007-08 expansion, the Commission's recommendations -- expected to be released next year -- will be timely.

In the past month, the panel has toured public hospitals and community clinics in Contra Costa County and Los Angeles County. The panel also held its first public hearing on the matter to give the seven citizen members of the 11-member commission a better foundation on problems plaguing the health care system. Of particular concern, noted Chairman Michael Alpert, the fact that public coffers will contribute $73 billion in health programs, yet six million Californians remain uninsured. (Counting private insurance dollars, the number spent toward health care in California is actually $180 billion).

To see documents the commission has been collecting for its health care project, visit the Little Hoover website:


The Little Hoover Commission has not traditionally followed health care issues, and so their early explorations have revisited issues that have been discussed in the recent past. Even though the commission is intended to be bi-partisan (six Republicans, four Democrats and one insurance executive who is a "declined to state''), the nature of the conversation has focused more on cost-cutting measures, rather than on expanding access or dealing with other reforms.

The Commission has not produced any recommendations yet, but Commissioners have been asking questions, at hearings and field visits. This report merely details the types of questions they are asking, as they explore health issues.

INDIVIDUAL MANDATE: For instance, Commissioner Daniel Hancock, a Democrat from San Ramon and father of young adults, noted at the hearing that “some of them (young adults) want to be uninsured. They’re 23 years old. They feel bullet proof.’’

He asked whether the state should impose an “individual mandate’’ that would require every person to have health insurance, just as every driver is required to have health insurance.
Massachusetts , others noted, just imposed that requirement as part of its larger near-universal coverage package.

While it is true that young adults under 30 are the largest demographic of uninsured, it is not because they don't want to be insured. These young adults are also most likely to be in low-wage jobs where health benefits are unavailable, or not eligible for public programs because they are childless, and they can ill afford to spend meager incomes on increasingly expensive health care products.
Consumer advocates in California have been wary of the “individual mandate’’ concept successfully opposing bills in the past two years – that would have fined or criminalized people for not having insurance – even if they were denied coverage because of pre-existing conditions, or even if it is unaffordable. Unlike Massachusetts , California also does not have laws requiring insurers to sell policies to people on the individual market – meaning consumers could find it nearly impossible to obtain insurance if they’ve ever experienced seemingly innocuous ailments such as ear infections, bladder infections or more than three doctor visits in the last year. And even they can, it might not be affordable – a dictate under Massachusetts ’ new laws in order for the individual mandate to be imposed.
MANDATORY MANAGED CARE: Commissioners grappled with the state’s growing spending on health care for those who need it most. It has been cited as a problem that Medi-Cal has grown about 8.5 percent per year, outpacing the state general fund’s growth of 6 percent per year. It was not mentioned that Medi-Cal costs are growing at a slower rate than health care in general, and the private health insurance in particular.

Commisioner Loren Kaye, a Republican from Sacramento , questioned why the state did not shift fee-for-service Medi-Cal recipients, which include the disabled and seniors. But the population being cared for under the fee-for-service program has higher health care needs. Gov. Arnold Schwarzenegger attempted to do this in 2003, his first year in office, but the Legislature and advocates fought the proposal and defeated it. Seniors and the disabled may voluntarily choose to be in managed care, but are not required.

Stan Rosenstein, head of the state’s Medi-Cal said this population is generally fearful that HMOs would restrict services to save money, or they would disrupt their care by switching doctors, who have not cared for their complicated health conditions.

SCALING BACK MEDICAID: Commissioner Stanley Zax, who is president of Zenith National Insurance, which provides workers’ compensation insurance, hammered away on the issue of waste, fraud and abuse and whether the state was doing enough to prevent money from falling into undeserving hands. Medi-Cal is among the only programs in the nation that audits itself and has an error rate of about 8 percent, reported Rosenstein.

With relatively little savings to be harnessed there, Zax began another inquiry – saving money by restricting services. California ’s Medi-Cal offers the richest package of “optional benefits"--even though those items considered "optional" include prescription drugs, prosthetics, orthotics and dental services for adults. Medi-Cal also provides these benefits to populations not required by federal.

In spite of its richer benefits and higher eligility, Medi-Cal is also one of the most efficient systems in the nation, insuring more people at less cost per person than any other state program and obtaining the best prices for prescription drugs, second only to the VA system, according to Rosenstein.

The most unconventional idea aired was the suggestion by Hancock, who is a Democrat. Hancock suggested that Medi-Cal patients be “timed out’’ of their entitlement benefits, as welfare recipients were put on a five-year lifetime limit during the national welfare overhaul in 1996.

One response was that about 2 million of Medi-Cal enrollees are seniors or people with disabilities – on respirators, wheelchairs or other devices that help them live day to day. Stan Rosenstein, who runs the state’s Medi-Cal program, said the reason Medi-Cal (Medicaid) was exempted from the welfare reform laws of a decade ago was because many of the recipients “can’t work and can’t be insured by anyone.’’

Additionally, he noted there are large numbers of people joining Medi-Cal is because they can’t get coverage at work. “If people have a choice, they don’t want to be on Medi-Cal. It’s not a glamour program.’’ Also important to point out is that half of Medi-Cal’s 6.5 recipients are children and children are required to be in school and are barred by federal laws from working, so that they can earn money to pay or qualify for health coverage.


At a tour of Los Angeles County-USC hospital in southern California, Commissioners Mitch Mitchell and Hancock were able to witness innovations that keep the second-busiest emergency room in the nation running. Patients are diverted daily. The Intensive Care Unit is running at 107 percent capacity annually.

The county, through its Public Private Partnership, is able to provide access to preventive care through a network of about 200 doctors in the community for people with incomes less than 200 percent of poverty ($33,200 for a family for three). Through the hospital's Camino de Salud Network, it makes sure that "frequent users'' of the hospital emergency room receive extra preventive and chronic maintenance attention. COPE Health Solutions also supplements county services by providing a team of about 40 case managers who are responsible for about 30 patients apiece. These case managers make follow up calls to make sure that patients understand doctor's instructions and take their medications.

In spite of the Los Angeles County's innovations, the majority of residents still aren't able to get adequate chronic disease maintenance because of gaps in the state and federal financing system.

Mitchell drew some conclusions from the visit, including that patients needed "catastrophic coverage.'' For consumer advocates, "catastrophic coverage'' would not prevent medical debt, and would serve as a perverse disincentive for patients to avoid preventive care that prevents visits to the ER, and instead encouraged people to wait until illnesses were "catastrophic."

To couple with his "catastrophic plan,'' Mitchell suggested that patients needed to be "reconditioned'' to visit community clinics for preventive medicine, rather than the emergency room. Particularly troubling to Mitchell was the fact that patients could receive a shot that cost the county $12,000 in the Emergency room, but only $100 through a clinic. To Mitchell, patients were wasting money by going to the Emergency Room. Mitchell said several times that coverage should also encourage "preventive'' care.

In Los Angeles county, partnerships and other programs have already increased patient access to "preventive'' care. The problem is that once patients learn, through their preventive visits, that they have a chronic disease, such as hypertension, diabetes or asthma, they don't know how to care for it -- and there is no coverage for it. For advocates, policy makers need to be equally as focused on opening access for maintenance of chronic disease.

Mitchell seemed impressed with Los Angeles County's innovation and Camino de Salud concept, which tracks the frequent emergency room users. At several points, Mitchell said "The state is in the way'' of such innovations really taking hold. Dr. Alan Kurd, medical director for Los Angeles County, however, said it was important for commissioners to understand that local governments need to be incentivized to innovate -- that not all counties would take steps that Delgado did at Los Angeles County -USC hospital.


The commission is expected to have two more hearings before its report is released. Health Access will continue to monitor the commissions' meetings and update advocates on the status and dates of those hearings so that advocates may help provide input to commissioners.

For more information, contact Hanh Kim Quach, Health Access policy coordinator, who wrote this report, at hquach@health-access.org.


posted by Anthony Wright | Permalink | 3:54 PM


Bush & Dems spar over Medicare Part D & drugs

With Bush's "thumpin''' now nearly a week behind us, and the obligatory handshakes and conciliatory platitudes checked off, flash points between the newly empowered Democratic Congress and Bush Administration are again emerging.

Today's New York Times reveals that HHS secretary Michael Levitt sees "no prospect of compromise'' on the Democrat's plan to revise Medicare Part D to allow the government to negotiate lower drug prices. The savings garnered from the government's negotiation of drugs would go to cover seniors in the so-called "doughnut hole,'' the period when seniors are responsible for 100 percent of their drug costs -- even as they continue to pay their drug plan premiums.

The administration vehemently believes that the current private, competitive market structure of prescription drug plans is the best answer. Read the NYT story here (login required):

I'm not sure the "best answer for whom?'' The recent Families USA study on prescription drug plans revealed that fewer and fewer of these private plans are offering doughnut hole coverage that would actually cover the majority of drugs seniors use most. Read the Families USA study here:

The administration's ideological inflexibility is baffling in the face of government successes, such as the Veteran's Administration, which Business Week hailed as the best run, most efficient and highest quality health system in America (and which we featured in this blog as a tribute to Veteran's Day. ) To look at the story again, here's the link:

Finally, the national press is starting to notice that California is leading the way on this prescription debate. Here's a Boston Globe story that starts with the Medicare Part D debate, but then focused on what California did last year:


posted by Hanh Kim Quach | Permalink | 10:56 AM


Health issues back on the DC agenda

Sunday, November 12, 2006
Sunday's New York Times goes a little further about the new members entering Congress next year. We mentioned in our post-election analysis several days ago how the biggest change for health policy would be not what get moved to the front burner, but what goes to the back burner: pre-emption of state consumer protections, cuts and caps to Medicaid and Medicare, Health avings Accounts, etc.

However, the article does suggest that many of these new members have a populist streak with a commitment especially on health care. Here's the link:

Here's the most relevant paragraphs for health advocates:

Bob Casey, who overwhelmingly defeated Senator Rick Santorum of Pennsylvania, said he looked forward to “a really intensive focus on health care that I hope to be a part of.”

That economic populism extends, for many candidates, to a new emphasis on expanding health coverage. Congressional Democrats who lived through the Clinton administration’s failed effort to create a national health insurance plan, which many believe was a crucial factor in the Democrats’ losses in 1994, have been wary of broad health legislation for years. (And being in the minority, they were unable to do much about it, regardless.) But the class of ’06 is adamant that something major can, and will, be done.

Dave Loebsack, a political science professor in Iowa who unseated the veteran Republican moderate, Representative Jim Leach, said he intended to sign on to proposed legislation to create a single-payer, national health insurance program “as one of the first things I will do when I get to Congress."

“I have no idea where it’s going to go next year,” Mr. Loebsack said, “but at least we can give it a fair hearing.”

Steven Kagen, an allergist who won a Wisconsin district that has been represented by a Republican for much of the past 30 years, campaigned on a “No Patient Left Behind” plan. Mr. Kagen won despite doubters who called it “the Hillary hot potato,” a reference to the first lady turned New York senator who was the architect of the Clinton plan.

“This issue has blurred the lines between the two parties,” Mr. Kagen said. “You don’t have to be a Republican or a Democrat to be ill, and to understand that the health care system doesn’t work.”

Mr. Kagen is one of several new House members urging a renewed commitment to the more than eight million uninsured children in the United States, an issue that will move to the forefront when the State Children’s Health Insurance Program comes up for renewal next year.

Most of these new Democrats said they were also committed to changes in the new Medicare prescription drug program; in fact, giving the government the power to negotiate prices with drug companies is one of the first items of business in the Democrats’ “Six for ’06 Agenda.” The agenda also includes an increase in the minimum wage and expansion of embryonic stem cell research.

Ron Klein, a state senator who defeated the veteran Representative E. Clay Shaw Jr. of Florida, said he had often heard both from retirees who fell into the gaps of the new Medicare drug plan and from “taxpayers who were really put off that this was something that could have been done a lot better.”

Democrats, of course, had their chance to resolve the prescription drug problem in the past — their party held the Senate for a brief period in 2001-02 — and few issues have been more divisive on Capitol Hill.

But the new Democrats say they have high hopes of building bipartisan coalitions for these changes in Medicare, for expanding embryonic stem cell research, and for other parts of their agenda. “I’m still scratching my head” over Mr. Bush’s veto of last year’s stem cell bill, said Ed Perlmutter, a former state senator who won a House district in the Denver suburbs.

Representative Sherrod Brown, who is moving to the Senate from the House after beating Senator Mike DeWine of Ohio, argued: “Tell me a whole lot of Republicans won’t work with us on finding a way for middle-class kids to get a college education, to vote for embryonic stem cell research, to raise the minimum wage. John McCain is already out there talking about prescription drug issues.”

Senator Brown will be a major champion for health consumers, as will some of these other new members. As the article stated, there first opportunity will be to fix the Medicare Part D benefit, and to reauthorize the State Child Health Insurance Program to accomodate the growth in the program, so that we can truly cover all children...


posted by Anthony Wright | Permalink | 8:09 PM


Veterans leading the way

Friday, November 10, 2006
As we salute those who served our country for Veteran's Day, I am reminded of a must-read article in BusinessWeek this summer:


I am proud that our veterans get "The Best Medical Care in the U.S.," as the article is titled. They deserve it. But it suggests we don't need to look to other countries to figure out how the health system for the rest of us could be better: we have American know-how and expertise providing a home-grown example to show us the way.

The article states that contrary to some might think, "a nationwide health system that is run and financed by the federal government provides the best medical care in America. But it's true -- if you want to be sure of top-notch care, join the military. The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatment to percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers. " By all accounts, it does this cost-effectively as well.

Hopefully, the veterans can lead the way again...

posted by Anthony Wright | Permalink | 11:08 PM


Co-pay, Schmo-pay. Why they matter.

Thursday, November 09, 2006
I just finished reading a new analysis of the decades old RAND Health Insurance Experiment by Jonathon Gruber at MIT. The report has the scintillating, no-nonsense title, “The Role of Consumer Copayments for Health Care: Lessons from the RAND Health Insurance Experiment and Beyond.’’

As a newbie to the world of health care policy, I found it extremely helpful in summarizing why we get so many disparate views of what the HIE proved with respect to copayments – and what it actually did prove.

Gruber's take:

  1. Coinsurance Leads to declines in overall health spending.
    1. Usage falls as Co-insurance increases
    1. Inpatient care, however, shows less fluctuation within co-insurance levels.
  2. Coinsurance causes equal declines in all kinds of care – effective and ineffective care.
    1. ER use is higher when co-insurance is required, than with free care.
    1. Coinsurance means reductions in preventive care
  3. Most people, who are ‘typically healthy to start’ aren’t negatively affected (healthwise) by co-insurance – whether they are rich or poor.
  4. If a person is sick, though, coinsurance has a bad effect. Particularly if they are sick and poor.
    1. Poor children suffer a larger reduction in effective care than in ‘ineffective care’ when co-insurance is imposed.
    2. Those with bad health to start with were at significantly higher risk of dying if they had a coinsurance plan.

Gruber does note, however that the study doesn’t factor in the more recent phenomenon of uninsurance. The people who were part of this study had maximum out-of-pocket limits – so there was a limit to how much their pocketbooks would bleed. Unfortunately, Gruber says there is no apples-to-apples study that looks at the current health care schema. To the extent that people have studied it, the most recent data doesn’t measure – as the HIE did – whether the types of care that are skipped with these higher deductible plans are “effective’’ or “ineffective.’’

Our take

Clinical care changes a lot in 35 years: Ask yourself how different things were in 1935 than in 1971? No polio vaccine; No antibiotics. Is the degree of difference between 1971 and 2006 as great? In terms of major conditions, such as asthma and diabetes, yes. What we do know, though, is that when the RAND study was done in the 1970s – thirty years ago – clinical care was very different. This is an important point. Gruber mentions the changes in clinical care but does not dwell on them. We now know that effective management of asthma, diabetes, high blood pressure, heart disease and some other chronic diseases reduces avoidable and expensive visits to the doctor or emergency room. Let’s also not forget that it also keeps people healthier, longer.

Gruber's lessons

As a starting point, Gruber takes these lessons from the HIE study on coinsurance:

  • High Deductible health plans don’t really get anyone to a good co-insurance model because it applies the same deductible to all income types.
  • Out-of-pocket limits need to be related to income.
  • Co-insurance should be targeted to places where care is least effective so as not to discourage patients from maintaining their chronic diseases.

Health Access' lessons

For us, Gruber's last point is particularly salient. Most patients call “disease management’’ of chronic conditions “preventive care’’ – because their doctor told them to observe a regimen that would prevent them from getting sicker.

Maintenance of these diseases requires many steps – prescription drugs, labs, follow-up doctor visits. Insurance plans, which require co-insurance and co-pays at each point, deter patients from properly maintaining their regimens. It interferes with them taking drugs regularly, from getting follow-up tests, from seeing their physicians for follow-up care. Those who can’t afford the asthma meds, diabetes tests, lab co-pays, heart meds or postpone their follow-up visits, and delay their care because of cost have demonstrably worse outcomes and use more expensive care down the road.

posted by Hanh Kim Quach | Permalink | 6:04 PM


Welcome to Health Access' New Blog

Thanks for reading.

Beginning today, Health Access will be filling this space with a blog to be updated daily with interesting tidbits and information about health reform efforts in California and across the nation.

A bit about myself: I’m new to the world of advocacy and to health.

I joined Health Access in February after being a reporter for the Orange County Register, covering the Capitol for six years. Before that, I worked two years at The Fresno Bee covering general assignment and education.

I left journalism because I wanted to be more of an actor than an observer. People often ask if I miss being a reporter – especially a political reporter during exciting and tumultuous times.

To be honest: no. I don’t miss it one bit.

As a reporter, I felt I had limited ability to really reach and engage people. Even though a newspaper's circulation may be large, the number of people who are actually moved by your story is small. As an advocate – particularly on health care – I felt I had more ability to affect people directly.

That’s not to say the transition has been easy.

I’m still trying to absorb all the complexities of health policy. I’m learning that a movement could take years to complete – not a few weeks, as expected by a newspaper.

I will be blogging here regularly with my colleagues at Health Access. I’m hoping you all will feel comfortable emailing me with tips and suggestions: hquach@health-access.org.

Until next time.

posted by Hanh Kim Quach | Permalink | 3:10 PM


What Now? What Next? A Post-Election Outlook...

Wednesday, November 08, 2006
  • Prop 86 Defeated in Close Vote In Face of Massive Spending by Big Tobacco
  • Gov. Schwarzenegger, Commissioner Poizner; Other State Offices Go Dem
  • Major Health Debate Expected, With Similar Margins for Dem Legislature
  • Dramatic Change Nationally with Democratic Takeover in House & Senate
  • Medicare Part D Fixes; Children’s Coverage Funding on National Agenda
  • Expanded Health Access Blog for an Expanded Discussion on Health Reform

The 2006 election results dramatically impact the prospects for change in health policy, with many new opportunities, particularly at the national level.


The question on the ballot most directly dealing with the issue of access to health care was Proposition 86, a $2.60 tobacco tax that would have raised significant funding for emergency rooms, expanded children’s coverage, anti-smoking activities, medical research, and other health programs.

CLOSE VOTE: Prop 86 received 48% of the vote, making it the closest statewide contest of the night, despite over $60 million spent by tobacco companies against the measure. On Proposition 86, health advocates can correctly point out that not only did the tobacco companies needed to spend eye-popping amounts in order to beat the measure by such a small margin, but the campaign was waged on issues unrelated to the provisions around expanding access.
The measure started with significant support, particularly as a way to discourage smoking and save lives. The tobacco companies successfully were able to spotlight specific provisions in the initiative included by the hospital industry, and thus reframed the debate as merely one special interest fighting another. A tobacco tax measure was also defeated in Missouri , but another passed in South Dakota.

CHILDREN’S COVERAGE CAMPAIGN CONTINUES: Especially given that the campaign did not focus on universal children’s coverage or the broad issue of access to health care, the result should not change the momentum for those goals. In past years, health advocates have had initiatives on both HMO reform and prescription drug prices go down to defeat on the ballot, only to win those issues subsequently in the legislature. Expanding coverage for all children is likely to appear next year as part of the broad statewide debate on health reform.

Governor Schwarzenegger was opposed to Prop 86, despite his many statements in support of expanding coverage for all children. The passage of Prop 86 would have helped him meet this promise, and yet his position and the outcome now places him in a more difficult position of having to find another way to meet this outstanding commitment.

OTHER MEASURES: Another watched ballot measure on health-related matters, Proposition 85, which would have required parental notification and thus impacted access to abortion for teenagers, also was defeated. This was a victory for Planned Parenthood and several other groups, as it was with last year’s Proposition 73. The campaign finance measure Proposition 89, sponsored by the California Nurses Association, was also defeated. In other state news on initiatives, proposals for a “taxpayer bill of rights” to restrict spending for health and other services were defeated in Maine , Oregon , and Nebraska .


The wide margin for the re-election of Governor Arnold Schwarzenegger was widely predicted, but what was noteworthy about the gubernatorial race was that both major candidates made health care an important part of their platforms, promising major action next year.

HEALTH CARE AS NEXT YEAR’S FOCUS: Governor Schwarzenegger has said that next year will be focused on “health care, health care, health care,” and that he will present a major health reform plan in his January 2006 State of the State. This goal was set during a health care summit that he held this past summer; and was reinforced in his campaign commercials—which placed health care as a top issue, along with education and the environment. The Governor's campaign commercials even chastised his opponent on health care issues. For a Governor that rarely talked about health issues in the beginning of his term, 2006 was a year that he prioritized the issue.

What the campaign did not reveal was what Governor Schwarzenegger would do on health care. His statements were vague, talking about “affordability, shared responsibility, and the promotion of healthy living,” even while opposing proposals that seemed to meet those goals, such as Senator Kuehl’s SB840 universal health care bill. Future updates will go into more detail about what we might expect from the Governor. While his proposal won't be the only one, it will be an indication of the parameters of the health care debate California is about to have.


Next year’s health care debate will include many proposals and many players, most notably many members of the newly re-elected Democratic Legislature, led by Speaker Fabian Nunez and Senate President Pro Tem Don Perata. The Democrats maintained strong majorities in the Assembly and Senate, and any health care reform will need to go through the legislative process.
SIMILAR BREAKDOWN, NEW FACES: The partisan breakdown has not changed in the Assembly, with 48 Democrats and 32 Republicans, despite close races in Kern and Imperial counties. However, because of term limits, nearly half—36—of the Assemblymembers will be new to the Assembly, which provides a challenge for health advocates to educate them about the specifics of health policy and work with them on health reform.

The Senate is likely to have a similar breakdown as last session, 25-15, with the possibility of the Republicans picking up one seat. Republican Lynn Daucher is leading Democrat Lou Correa by a handful of votes, with a recount likely. While there are many new Senators as well, many are legislative veterans; Democratic Los Angeles councilman Alex Padilla is the only Senator-elect without Assembly experience.

Some of the most active legislators on health care issues were termed out, such as Assemblymembers Chan, Chu , Cohn, and Frommer, and Senators Ortiz, Speier, and Chesbro, but others remain, such as Assemblymembers Dymally, De La Torre and Laird, and Senators Kuehl and Ducheny.


Governor Schwarzenegger’s landslide victory did not seem to indicate any coattails, as Democrats won tight contests for Secretary of State, Controller, and in particular Lieutenant Governor, which was won by Insurance Commissioner John Garamendi, long-time advocate on health care issues, who is likely to continue to be active in the issue.

NEW INSURANCE COMMISSIONER: Replacing Garamendi will be Steve Poizner, a multi-millionaire businessman and the only other Republican besides the Governor to win statewide. While most Californians are covered under plans regulated by the Department of Managed Health Care rather than the Department of Insurance, the Insurance Commissioner does have authority over some health insurers, and so is relevant in health policy. For example, Garamendi is finishing up regulations on ensuring that certain amount of premiums go to medical care, and that language access to care is provided. Poizner has no previous experience in elected office, and so there is no record to go by to know what to expect of his tenure.

OTHER GOVERNORS: California ’s debate on health care reform will also be informed by what goes on in other states. It was noteworthy that Governors that took on health reform, including Gov. John Baldacci (D) in Maine , and Gov. Rod Blagojevich (D) in Illinois , were re-elected. The much-discussed reform in Massachussetts, which left much to implementation, will have much of that implementation done under a new Governor, Democrat Deval Patrick. This may change the nature of that reform from the characterization by Governor Romney (R), who was not up for re-election. Finally, many new Governors made health care reform a major priority, suggesting that California ’s health care debate will take place with efforts in other states.


The biggest national news is the change of the U.S. House of Representatives and probably the Senate as well in Democratic control, new opportunities open up with regard to the national debate on health care. The most immediate changes in national health policy is likely to be on changes to Medicare Part D, and the reauthorization of the State Child Health Insurance Program, but it has implications for broader reform, and the 2008 presidential election.

NEW DEMOCRATIC MAJORITIES: As of this writing, Democrats are likely to have at least 229 seats in the House of Representatives and maybe as many as 234, more than the 218 needed for a majority. This includes one change in California , with Jerry McNerney (D) defeating Rep. Richard Pombo (R) in Northern California .
In the Senate, Democrats held onto seats in New Jersey , Maryland , Washington , and Minnesota and other states, while picking up seats in Pennsylvania , Ohio , Rhode Island , Montana , Missouri . If Democrats maintain their lead in Virginia , they will have the 51 votes to be in the majority.

NEW CALIFORNIA LEADERS: The new majorities will bring new California Representatives into key positions to impact health reform. First and foremost is Rep. Nancy Pelosi, who is expected to become Speaker of the House, third in line in presidential succession. Longtime leaders on health issues Rep. Pete Stark and Rep. Henry Waxman, both of California, are in line to chair vital committees, and to thus put forward proposals and shape the national conversation on health policy.

HEALTH CARE AS AN ISSUE: After corruption, Iraq , and the economy, health care was in the mix of issues in the national Congressional elections. The controversial structure of Medicare Part D and prescription drug prices was a big part of specific races, such as those that led to the defeat of Reps. Nancy Johnson (R-CT) and Clay Shaw (R-FL).

MEDICARE PART D: In their campaign document “A New Direction for America ,” the Democratic congressional campaign pledged “Six in ‘06”, six measures to pass immediately: one of those plank was: “Affordable Health Care: Life Saving Medicine. Fix the Medicare prescription drug benefit by putting seniors first by negotiating lower drug prices and ending wasteful giveaways to drug companies and HMOs.” Pelosi has stated that changes to the Medicare Part D law, including allowing the government to negotiate for lower prescription drug prices, would be a top priority for passage in the first 100 hours of her Speakership.

CHILDREN’S COVERAGE: Another issue slated to come up is the reauthorization of the State Child Health Insurance Program (SCHIP), which provide around 2/3 of the funding for California ’s Healthy Families program. Health advocates have been concerned if the renewal of SCHIP will provide sufficient funds for the ongoing growth of programs like Healthy Families. This will be a major focus for health advocates nationally, even in the new political environment.

BAD ITEMS TABLED?: The most meaningful change for the new majorities is not what might get passed, but what doesn’t. The margins in the House and Senate are thin, and President Bush would still have the authority to veto proposals. However, the switch in power in Congress makes it less likely to see proposals that were slated to come up, and that were debated in the last few years. This includes proposals to cap, block-grant, or privatize the Medicaid or Medicare programs; tax cuts that would further pressure cuts in the health and other vital services; or legislation to pre-empt state consumer protections, or encourage high-deductible health plans. All these ideas were clearly on the agenda in Congress before the power shift, and their prospects have decreased, even though health advocates need to continue to be vigilant.

SETTING THE 2008 AGENDA: While having a majority in the House and Senate does not automatically translate to passing legislation, it does allow political leaders to help set an agenda, to hold hearings, to develop proposals. While major health reform is not likely for the immediate future, it allows the new party in power to float ideas, in time for the 2008 presidential campaign. After years when major expansions of health coverage were only discussed at the state level, in California and a handful of other states, we can expect that there will be a new conversation nationally on health reform.


This election dramatically sets the landscape for a major discussion of health reform, both statewide and nationally. Health Access California looks forward to the debate. As part of this effort, we are expanding the blog on the Health Access website to include more daily, real-time updates about health reform, in addition to the regular E-mail Health Access Updates that have been archived there for the past several years.

For those who want the latest on the health care debate in Sacramento and around California , visit the Health Access blog at:

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posted by Anthony Wright | Permalink | 3:30 PM


Monday, November 06, 2006


  • Proposition 86 Would Reduce Smoking, Fund Health Care, Cover All Children
  • New "Yes on 86" Ads Airing Statewide
  • ACTION ITEM: Voter Registration Deadline Fast Approaching
  • Get Involved: Phone Banking Opportunities

Election Day is only 19 days away and California voters will have the opportunity to vote on a measure that would expand health coverage to all children, as well as reduce smoking and fund other key health care services.

NEW REPORT: A new paper by the UCLA Center for Health Policy Research reports on the status of children's health coverage, and shows how Prop. 86 would cover 85 percent of uninsured children currently not eligible for any other program.

The report shows that currently,

  • California has 763,000 uninsured children.
  • Of those, around half, 447,000 are eligible for either Healthy Families or Medi-Cal, but the other half are not.
  • The report indicates that an additional 97,000 were eligible for county-based Healthy Kids program, although many of these program have unstable funding or already have waiting lists. 219,000 children were even eligible for any public programs.

If Prop. 86 passes,

  • 269,000 children would become eligible for Healthy Families.
  • Other children who live in families with incomes above 300% of poverty could qualify for a “pilot’’ Healthy Families program.
  • In addition to direct benefits of expanding eligibility, health advocates have argued that the best way to make enroll already-eligible (but hard to reach) children is as part of a comprehensive push for universal coverage. The experience in the county programs is that an expansion to "all kids" makes outreach and enrollment efforts easier and ultimately, more successful.

To read the report, visit:

NEW “Yes on Prop 86” COMMERCIALS

Two new “Yes on 86” ads are currently airing throughout the state and will continue to run until November 7th. The ads are viewable at YouTube, at:

These ads are also running on the home page of the “Yes on Prop 86” Web site, rotating spots every two days. Visit:


Make sure you and your friends, family and colleagues are registered to vote. The deadline to register to vote in California is this Monday, October 23. For more information and instructions on registering to vote, visit


Join the phone banking effort and encourage fellow voters to support Prop. 86. Visit the website to find a phone banking site in your area.


posted by Anthony Wright | Permalink | 1:30 PM


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Anthony Wright is the executive director,
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.