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Young folks: I want my MTV coverage!

Friday, March 30, 2007
 
New York magazine has a must-read article for anybody over 30 (and a great read for those under 30).
There's only one problem: the title.
The article is heartbreaking in describing the problem: young people who are students, part-time workers, just starting their careers, who are not offered employer-based coverage, don't qualify for public programs, and with low-incomes and high rents can't afford to buy it as individuals.
The situation seem particular acute for places like New York and California. This statement could just as easily be about the Golden State:
“A lot of the professions that draw young people to New York—everything from retail to the arts to restaurants to software development—tend to have spottier coverage,” says James R. Tallon, the president of the United Hospital Fund, a health-care think tank. Even large corporations are increasingly reluctant to offer coverage. (At a company like MTV, for instance, many full-time employees work in a nebulous state of hourly wages and no benefits, an arrangement that can last years.)
But while the article describes all these situations where the current system places young people in these no-win situations, the piece is entitled, "The Young Invincibles," using the insurance industry term, and accepting their premise. With those three words, it suggests that folks "choose" to be uninsured.
If people actually read the text, you have Andrew Kuo, a 29-year old painted who "made a vow to be insured by the time he turned 30."
And here's one anecdote:
Nichole Schulze, a 31-year-old former publicist and current student at the Fashion Institute of Technology, was quick to rattle off a battery of quasi-logical preventive measures: “You won’t see me snowboarding or mountain biking or even jaywalking. My friends think I’m a freak because I’m the only person in New York who actually waits until the light changes to cross the street. Oh, and I eat a kiwi every morning because I read somewhere that they contain twice the vitamin C of oranges. And if it’s snowing? I’m the one walking on the inside of the sidewalk, just in case a cab decides to swerve and hop the curb.” Should any of these methods fail? “I carry an expired Blue Cross card in my wallet. You never know, maybe they’ll think I have insurance and I’ll get better care.”
Doesn't sound like they feel invincible to me.

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posted by Anthony Wright | Permalink | 5:48 PM


 
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Googling benefits...

Wednesday, March 28, 2007
 
Earlier this month, there was a front page New York Times article on Google, and in particular the lavish benefits that workers get:

The perks of working at Google are the envy of Silicon Valley. Unlimited amounts of free chef-prepared food at all times of day. A climbing wall, a volleyball court and two lap pools. On-site car washes, oil changes and haircuts, not to mention free doctor checkups.

I was reminded of the article when I had a newspaper reporter ask me last week if our employer-based health care system is dead.

As more and more employers either scale back or drop coverage altogether, I do worry about the 19 million Californians who get their health coverage through an employer. I do worry that we may reach a dangeous tipping point, when enough employers in an industry drop coverage, causing all their competitors to follow suit, in a disastrous race to the bottom.

But that's simply not going to happen with certain types of jobs for certain highly-skilled, highly-competitive jobs. Google wants to attract key engineers and programming specialists, and they do so partially with an attractive health benefits package.

There will always be some employers who offer a health benefit to attract key talent, regardless of what our health system looks like: whether in the best case of universal system (on top of what is offered by the single-payer system), in the worst case of an everybody-for-themselves system of individual vouchers or HSAs, or even in a pay-or-play-type system where employers have a choice of providing it directly, or buying from a common pool even is that plan is attractive.

The question is what happens for everbody else: The new trend is that not just low-income workers are finding themselves without benefits: it's middle-income families, it's the jobs that are becoming more prevalent in our economy. Unless you are in a highly-specialized, highly-sought-after field, you could be one job away from being uninsured. And even many in Silicon Valley are very aware of this.

But my point is this: even if the employer-based health care system collapsed tomorrow, it would go from covering over 50% of the population now to 10-20%, and there would probably still be several million people with employer-provided health benefits.

But right now, there's around 5%--a little over one million people--who buy coverage as individuals.

The real question should be: is the individual insurance system dead?

posted by Anthony Wright | Permalink | 2:13 PM


 
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Red-handed and Red-faced

Tuesday, March 27, 2007
 
The Assembly Health Committee just passed AB343 (Solorio), which would require the state to list the names of businesses who have more than 25 employees are enrolled in public programs such as Healthy Families, Access for Infants and Mothers, and Medi-Cal.

In other words, if you are a business and at least 25 of your workers are enrolled in public programs, the state will publish:
  • your business name
  • address
  • the number of employees (and their dependents) are on public programs
  • How much it costs the state (and taxpayers) to provide health care to your employees, and their families.

The California Chamber of Commerce and WalMart opposed the bill, citing veto messages of previous efforts that said it would do nothing to lessen the number of uninsured in the state.

On the contrary, though, while it may not directly provide coverage to the uninsured, it would essentially allow the public to see how much taxpayer money is being spent to provide healthy workers, who inturn help private companies make money.

The Employer Development Department is already collecting all the data anyway -- so why not crunch it in a different way.

Businesses frequently opine about California's unfriendly climate for businesses. A study such as suggested in Solorio's bill could either prove their case (showing that CA taxpayers don't give a dime to providing health coverage to workers), as I suspect, blow their cover, showing that huge amounts of taxpayer dollars go to help workers to enroll in public programs.

As Assemblymember Mary Salas said, if businesses are not ashamed of the way they are conducting business, why not let this report become public?


posted by Hanh Kim Quach | Permalink | 2:48 PM


 
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National Public Radio's latest story in its series on health care details a family doctor's plight against insurance companies.

Because insurance companies watch costs aggressively, Jaffe says she has to
fight to get her patients the care they need. On two occasions, insurers told
her they would pay less for an immunization than it would cost her to buy the
vaccine, let alone administer it.

...Jaffe says she wishes she could be practicing medicine, rather than
searching for ways to pay for it. At the end of the day, once her patients have
gone home, she is left with mounds of paperwork.

...Jaffe says that the time that she spends on paperwork is time that could
have been spent with patients.



The Wall Street Journal last month went into more detail in this article, explaining how doctors are spending lots of time and money to recover money that insurers are denying. (WSJ requires a subscription, but I can send you a copy of the article if you email me at hquach@health-access.org).

Doctors increasingly complain that the insurance industry uses complex, opaque
claims systems to confound their efforts to get paid fairly for their work.
Insurers say their systems are designed to counter unnecessary charges and help
keep down soaring health-care costs. Like many tug-of-wars over the health-care
money pot, the tension has spawned a booming industry of intermediaries.

It's called "denial management." Doctors, clinics and hospitals are
investing in software systems costing them each hundreds of thousands of dollars
to help them navigate insurers' systems and head off denials.

The imbroglio is costing medical providers and insurers around
$20 billion
-- about $10 billion for each side -- in unnecessary administrative
expenses
, according to a 2004 report by the Center for Information
Technology Leadership, a nonprofit health-technology research group based in
Boston.
(Emphasis mine)

The upshot of these two stories: that administrative hassles with insurance companies all come at a cost. For a small one-doctor clinic, with limited administrative staff, like Rebecca Jaffe in the NPR story -- it means patients will get worse care -- or less care. For the larger physician group, like the ones in the WSJ story, it means more money that could either be dedicated to patient care or costs that wouldn't eventually be billed to patients.

Combine the administrative costs of providers with the 30% administrative costs of insurance companies (as this article revealed) and we find consumers paying more money -- and getting less health care.

These administrative fights weigh heavily on the consumers. If the energy dedicated to denying and recovering costs could be redirected to providing health care, we might have a few million more people with health coverage.

posted by Hanh Kim Quach | Permalink | 11:19 AM


 
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Last year's legislation are this year's budget items...

Monday, March 26, 2007
 
HEALTH ACCESS UPDATE
Tuesday, March 27th, 2007


SENATE BUDGET SUBCOMMITTEE REVIEWS FIRST HEALTH ITEMS
* Implementation of new drug discount program for Californians underway
* New efforts to streamline enrollment into Healthy Families and Medi-Cal begins

New on the
Health Access Weblog: Presidential Forum; The Illusion of Coverage; Weekend Care; Blue Cross' Bad Behavior; Tonik; International Update; Rush and Arnold; Etc...


The first layer of decision-makers -- among many -- took a first look at the 2007-08 health budget on Monday, where Senate Budget Subcommittee members focused this hearing on programs under the Managed Risk Medical Insurance Board (MRMIB) as well as a few Medi-Cal items.

NEW PRESCRIPTION DRUG LAW ON TRACK TO BEGIN IN 2008

The Senate Budget Subcommittee on Health and Human Services, chaired by Senator Elaine Alquist, approved the full budget the state requested to implement AB2911 (Nunez/Perata), the landmark drug discount legislation, that will provide more affordable prescription medications to as many as 6 million uninsured or underinsured Californians without comprehensive drug coverage.

The Department of Health Services reported that it was in the process of negotiating with drug companies, and of hiring an independent contractor to help the state implement its program on time by January 2008. Senator Alex Padilla, of Los Angeles , questioned why department staff could not do it. Due to the complexity of the first-of-its kind program in California , and the short time frame to get it going, the Department of Health Services said it was crucial that the state contract out core functions of the program to begin the process, as well as have some added staff positions to manage the program.

Ultimately, the panel approved $8.8 million to hire 16 new positions, which was the request of the Department, but one more than what the Legislative Analyst's Office recommended. Consumer advocacy groups that testified supported the full funding for the implementation.

ENROLLING CHILDREN IN COVERAGE

The committee also approved $29.3 million in additional funding to help counties reach out to families whose children are eligible but not yet enrolled in either Healthy Families or Medi-Cal. While the amount is a bit less than the state had originally requested, the extra money would specifically help counties comply with streamlined processes passed in SB437 (Escutia) last year that aim to make it easier for children to become enrolled and stay enrolled, in a coverage program.

In California 428,000 children are poor enough and qualify for Healthy Families or Medi-Cal, but currently are not enrolled.

Specifically, the new rules under SB437 would allow some families to verify – on their own – that their incomes meet eligibility requirements for these programs, rather than having to submit proof of income. It also automatically enrolls children, who are no longer eligible for Medi-Cal, into Healthy Families, until the state decides whether or not they qualify or not. The new program would also automatically enroll children into public programs if they are receiving help from the federal Women, Infant and Children supplemental food program.

The committee, however, held off discussion of additional positions to help implement the new law until more is known about the federal government’s intentions to reauthorize the State Children’s Health Insurance Program (SCHIP), and at what funding level. SCHIP, which is called Healthy Families in California , is set to expire this year unless it is reauthorized.

While President Bush has announced his intention to continue the program, the funding level he has proposed -- $5 billion a year – ($25 billion over 5 years) was stated to be too low. If Bush’s proposal becomes law, more than 400,000 California children could lose coverage next year.

Advocates are hoping that Congress will increase reauthorize at a level closer to $85 billion over five years.

With regular caseload growth, including the streamlining procedures outlined in SB437, Healthy Families is budgeted by the Schwarzenegger Administration to grow to a total enrollment of 915,598 children as of June 30, 2008, an 8.8% increase of 73,870 over current year levels.

OTHER ISSUES

The budget subcommittee also took the following actions:

* Agreed to fund 4 new positions for the Department of Health Services as it attempts to implement the new requirements under the 2005 Deficit Reduction Act.
* Approved $138.7 million for the Access for Infants and Mothers (AIM) Program
* Discussed the Managed Risk Medical Insurance Program (MRMIP), which provides some coverage to those who are "uninsurable" because of "pre-existing conditions."

For more information, please contact the author of this report, Hanh Kim Quach, policy coordinator, Health Access, at 916.497.0923 x 206 or hquach@health-access.org

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posted by Anthony Wright | Permalink | 11:21 PM


 
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Take a bite out of....

 
Insurers are taking a bite out of our health care. A big bite. According to PNC Financial Services Group, it's an average of 30 cents on every premium dollar for administration ALONE.

That does not include profits.

The numbers closely mirror what the Department of Insurance found last year as it held hearings on Preferred Provider Organizations (PPO plans).

In California, HMO administration and profits is limited to 15 percent of the premium dollar. However, PPO products -- which are regulated by the state Department of Insurance -- have no such cap.

The state Department of Insurance last year reported that the average of all Blue Cross' PPO policies were 24% profit and administration. However, for policies on the individual market -- where people aren't buying through an employer or government pool -- profits can be 27 percent and administration another 9 percent.

For these products, as little as 51 cents for every premium dollar actually goes to health care. The amount of money that insurance companies must spend to provide health care to enrollees to coldly called a "medical loss ratio,'' meaning they're losing money on you.

Let's reverse this trend and take a bite out of administration -- and profits.

posted by Hanh Kim Quach | Permalink | 10:36 AM


 
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Voters and values: it'll be an interesting discussion...

 
HEALTH ACCESS UPDATE
Monday, March 26, 2007


INVITATION: HERNDON ALLIANCE BRIEFING ON FRAMING AND VALUES
* Tuesday, April 3rd at the Sacramento Convention Center, 9:30am-1:30pm


Health Access California member and allied organizations are invited to send staff and leaders to a briefing by the Herndon Alliance, where they will discuss their work around framing and values research on the issue of health care reform, which has attracted attention around the nation.

The Herndon Alliance is a national coalition of seventy minority, faith, labor, advocacy, and provider organizations—both national and state—advocating for a health justice movement. Their goal is to achieve quality, affordable health care accessible to all by expanding the base of people supporting universal health care and increasing the breadth and depth of voices working and/or speaking out for health care reform. The beginning focus of the Herndon Alliance--tentatively named for the site of its first meeting--was a project to do an in-depth study to map the underlying values held by various groups of Americans, identify constituencies that are potential allies, and explore initiatives that connect those constituencies with our goals.

This Sacramento briefing, sponsored along with National Council of La Raza, Catholic Healthcare West, The California Endowment, and Health Access California, will report on the findings to date of the Herndon Alliance.

Date: April 3, 2007
Time: 9:30 am to 1:30 pm
Location: Sacramento Convention Center
1030 Fifteenth Street, Room 204
Sacramento , California

The featured speakers will be Michael Shellenberger from American Environics and David Mermin from Lake Research Partners, who will discuss the findings from the past year of work around values, toward the goal of expanding the base of voters in support of health care reform. These presenters will also provide advice on how to apply their research. A reactor panel, including Anthony Wright, Health Access California; Wade Rose, Catholic Healthcare West; Katrina Mendiola, National Council of La Raza; and Michael Shellenberger, American Environics, will discuss how to use this research in a California context.

Lunch will be provided.

Please RSVP by E-mailing Gwen, gwen@herndonalliance.org, to let her know if you or others from your organization plan to attend the meeting.

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posted by Anthony Wright | Permalink | 12:22 AM


 
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The Big Three

Saturday, March 24, 2007
 
Not the automakers -- but the three frontrunners for the Democratic nomination for president in 2008 -- gave their take on health care reform for the next presidential term(s).

With the exception of Sen. John Edwards, who released his plan in February, none really had a solid plan, but echoed common principles. (The other two I refer to are Barack Obama and Hillary Clinton).

All tapped into the notion of shared responsibility and building on the existing system of employer-based coverage, while also trying to expand government-purchased health care as a stepping stone to a Medicare-for-all like system in the future.

It's pretty encouraging when everyone's talking about the same thing.

It was noted that Republicans were invited to talk about health care by the Center of American Progress, University of Nevada and Las Vegas, and Service Employees International Union, but none responded.

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posted by Hanh Kim Quach | Permalink | 11:06 AM


 
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Blue Cross' bad behavior deserves it own blog...

Friday, March 23, 2007
 
The Department of Managed Health Care fined Blue Cross of California $1 million for rescinding policies of almost 100 patients without rationale or due process.

It's outrageous that Blue Cross has been dropping coverage for patients who actually seek care. California needs strong rules to stop this 'use it and lose it' practice.

More than that, the Department of Managed Health Care findings provide perspective in the health reform debate in Sacramento: While Blue Cross' practices have been found illegal, this finding brings into question why we allow insurers to deny Californians coverage because of their health status at all.

We support the portions of the health reform proposals by the Governor and legislative leaders seek to prevent insurers from discriminating against those Californians with "pre-existing conditions."

But these practices are also a case study about why any reform should not leave individuals alone and powerless at the mercy of big insurers--to pick and choose among us, to deny us coverage at their whim. In contrast, any reforms should focus on expanding group coverage instead, where we have the power of group purchasing.

This case study amplifies a report Health Access California co-released yesterday with The Access Project, The Illusion of Coverage: How Health Insurance Fails to Protect People When They Get Sick, available at www.accessproject.org. The report indicated the need for strong standards for insurers and employers about what "coverage" is.

We've complained about high-deductible, bare-bones products like Tonik in the market offered only to healthy people, all to avoid actually paying claims for care. This finding about Blue Cross simply takes this logic to the extreme: to rescind the policy if they actually need care. Remarkable.

posted by Anthony Wright | Permalink | 5:34 PM


 
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Running Men (and Woman)

Thursday, March 22, 2007
 
This Saturday (March 24th), the Democratic presidential candidates will be talking about Health Reform in Las Vegas. You'll be able to watch a live webcast and ask questions.

Here's a link to the event.

The participants include:
  • Sen. Hillary Clinton
  • Sen. Chris Dodd
  • Sen. John Edwards
  • Sen. Mike Gravel
  • Rep. Dennis Kucinich
  • Sen. Barack Obama
  • Gov. Bill Richardson

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


 
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Product failure

 
When you pay for something, you expect it to work – especially if you’re forking over lots of money.

But as some of us know, procedures we thought were covered – in my case, a blood test -- can end up costing us a lot more than we bargained for.

A new report, “The Illusion of Coverage: How Health Insurance Fails People When They Get Sick” is being released by the Boston-based Access Project today. (Read the report at http://www.accessproject.org/). The report details the stories of real people who have struggled with their insurance companies – and why.

One woman, who was diagnosed with multiple sclerosis, was denied coverage to go to a rehabilitation hospital. Instead, she got a walker. Naturally, she thought the walker was covered. It was not. She later received a bill for the walker as well.

One California man is struggling paying off a $150,000 equity loan that was used to pay for his late wife’s bypass surgery and pacemaker.

Reading through the report, you really get the sense of helplessness that an individual feels battling doctors, hospitals, collection companies and insurance companies all at the same time – while they’re recovering.

What gets me, though, is how many individuals blame themselves when they get into this situation. I had interviewed this California man with the $150,000 debt. At the time, he told me “Maybe we should have read the fine print,’’ and found out ahead of time about the $100,000 lifetime cap on his wife’s insurance. Or, he said, maybe she should have taken better care of herself.

Others have echoed the same things: “I wasn’t taking very good care of my weight,’’

When you buy a car, and your car doesn’t work, you don’t blame yourself for being too hard on the car or driving poorly. You drive straight back to the dealer and demand that it be fixed.

Many stores and companies stand behind their products and will refund your money or exchange the product.

But for some reason, insurance and health aren't the same.

When health coverage doesn’t work, people end up with more hassles, more headaches – and debt. And many blame themselves.

The truth is, as the report details, the policies are written in confusing language, and often change from year to year. Employers and insurers don’t educate consumers about changes, leaving many in the dark about what exactly their policies cover.

Just as government steps in to protect consumers against “lemon’’ vehicles, we need the government to step in and protect consumers against “lemon’’ insurance policies.

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posted by Hanh Kim Quach | Permalink | 4:36 PM


 
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Rush and Arnold debate health care...

Wednesday, March 21, 2007
 
Bob Salladay at the LA Times' Political Muscle has the transcript. Sometimes, this work is just surreal.

posted by Anthony Wright | Permalink | 4:58 PM


 
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Planning a heart attack? Make sure it's Monday through Friday

 
If you're having a heart attack on a Saturday, driving to your nearest hospital might not save your life.

A new article in the New England Journal of Medicine this week shows that people who have heart attacks on weekends are more likely to die than those who suffer the attacks on weekdays.

Why?

Because not all hospitals are equipped with the right staff at all times who are equipped to open up your chest and perform an emergency coronary angioplasty. In fact, the Journal's data of heart attack patients over 16 years in 38 New Jersey hospitals found that weekend patients were 25% as likely to have a life-saving invasive procedure as a weekday patient.

The health care system's patchwork of public and private hospitals, with little planning and coordination, is one of the reasons for this problem.

A better planned and coordinated system (one of the suggestions Health Access makes in this fact sheet) -- where everyone knows where the trauma specialists and coronary specialists are -- could save money and lives.

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posted by Hanh Kim Quach | Permalink | 11:39 AM


 
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Who is getting the subsidies?

Monday, March 19, 2007
 
The more I think about my conversation with the Blue Cross broker, the more upset I get. I'm not attacking her. She was just doing her job.

But really, the conversation just highlighted how businesses manages to double-dip and finagle subsidies from government.

The essence of my conversation with her was this: She sold a 22-year-old restaurant worker an $80-a-month high-deductible policy. If this restaurant worker got pregnant, she would first be rolled into a higher-deductible plan, and ultimately referred to a public program -- Access for Infants and Mothers, which caps the cost of pregnancy-only coverage at 1.5 percent of an individual's income. Read the full blog here.

What this really means is that Blue Cross would have been able to collect the $80-a-month premium for the young person buying the high-deductible coverage. But when time came to pay out -- someone who is too poor to afford the $3,000 or $5,000 deductibles (mostly likely someone young and in the restaurant business who had no businesses buying the plan in the first place) -- would be referred to the state -- who would shoulder the cost and risk of pregnancy and child birth.

That would give Blue Cross a subsidy of tens of thousands of dollars because the company -- which paid its executives millions in salary and bonuses during its merger with Wellpoint -- would be free of having to pay for their enrollee's pregnancy.

This is not the only way that businesses tacitly receive subsidies from the government.

Consider another conversation I had last week with a county welfare director in a nearby rural county. One of his new county supervisors, a farmer, takes a very dim view of all the 'socialized programs' that the county runs and essentially would rather see them go away.

This county welfare director then asked his boss:
"Do any of your seasonal workers use Medi-Cal or food stamps?"

Well, the farmer/supervisor said, I don't know?

Well, the welfare director said, if they do, then we (the county) provide those services to them.

Let me point out here, that that means part-time, seasonal workers for this farmer (who makes money off their labor) receives benefits through public programs.

The staff at this county office also took the supervisor on a tour showing him exactly the services they provide and who they help. The workers in this county office say they have now planted enough questions in the mind of this supervisor to force him to admit that their county needs a "safety net'' for workers who don't earn much money and don't receive much from their employers (like himself).

What the farmer/supervisor isn't willing to admit yet, though, that this safety net is subsidizing his business. for him to have healthy workers who can buy enough food to feed themselves, they need social programs -- such as Medi-Cal or food stamps. Without these social programs helping these workers, they wouldn't have the wherewithal to work for him.

Don't get me wrong. I think Access for Infants and Mothers is a wonderful program. It saves new mothers tons of heartache and ensure their babies are healthy. It also saves the state money by ensuring poor women can get prenatal care and have healthy babies (which are less expensive to care for.) I also think Medi-Cal and Healthy Families and all public programs need to be expanded.

In addition to helping millions stay healthy, we also need to be honest and acknowledge how they keep businesses, such as Blue Cross, farmers, anyone whose workforce depends on public programs (That means you too, WalMart, Safeway and Target with your high-deductible plans and waiting periods)-- healthy as well.

posted by Hanh Kim Quach | Permalink | 1:17 PM


 
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Health Access: international edition

 
From around the globe:

Steven Greenhut at Orange Punch gloats that the Swiss rejected a health reform initiative last week. Does that mean he is endorsing the current Swiss health system?

Another blogger, Ezra Klein, took the time to seriously consider what other countries (including Germany, Japan, France, Great Britain, Canada, and others) are doing in health policy, in his Health of Nations series (recently referred to by Calitics.)

Massachussetts' A Healthy Blog takes a look at the health system in Israel.

Finally, Peru just put in place a universal health care policy... "why can't we?" asks The Health Care Blog.

posted by Anthony Wright | Permalink | 11:46 AM


 
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Spring redecorating...

 
Readers of this blog are noticing some changes to the format...

Don't worry, our commitment to providing daily commentary about the health care policy debate here in Sacramento is the same. We are simply experimenting with some better ways of presenting the information and analysis, making it easier to read, providing more resources and links, etc.

This will be an ongoing process, as we try to improve our ability to help California consumers and the organizations that represent them be part of this conversation.

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posted by Anthony Wright | Permalink | 11:38 AM


 
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Would Blue Cross' Tonik cover ass herpes?

Friday, March 16, 2007
 
Ed Helms from the Daily Show has the scoop.

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posted by Hanh Kim Quach | Permalink | 9:47 AM


 
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Where are we going?

 
I attended the always-informative California Budget Project conference yesterday, where Alissa Anderson Garcia, an analyst there, shared her study of where California industry, wages and benefits are headed. The information was fascinating.

First off, higher paying jobs WITH benefits -- such as manufacturing and the information sector -- are on the decline. These jobs average $51,215 annually.

They are being replaced by lower-paying jobs WITHOUT benefits, such as construction and service industry jobs, where the pay is $44,057.

Garcia analysis showed that if the new jobs provided health care at the same rate as the old jobs, 600,000 more workers would have coverage.

Instead, these low-wage workers are either uninsured -- and paying for it through poorer health and higher medical expenses -- or enrolled in public programs, which means the taxpayers are taking care of the private sector's workers.

These workers need to be covered. It helps everyone if they have health coverage because they are healthier and it will give them an opportunity propel themselves and their families into a higher income bracket. It helps everyone because they will not be delaying their medical needs because they're afraid of the expense, ultimately costing everyone more money.

This means two things, in my view.
1) Require employers to provide health coverage or 2) Provide substantial enough subsidies for these workers to get adequate and meaningful coverage.

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posted by Hanh Kim Quach | Permalink | 8:37 AM


 
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Tonik or Snake Oil?

Thursday, March 15, 2007
 
My colleague Hanh's post about the 22-year old restaurant worker who spoke at the Assembly Republican press conference on health reform has gotten some attention, on blogs such as the California Progress Report and Working Californians and others.

It's an important story: Here's a young woman who wants to be insured (so much for the "young immortal" myth), but has barriers in her way. She doesn't get health coverage at the job (and thus would be helped by some standard for employer-based coverage). To get coverage, she has no other choice but to go into the open market, and her broker steers her to Tonik, a Blue Cross product. You can find out more about the product at the marketing website, here:

It is a controversial product. It markets to young, healthy people, has aggressive underwriting to weed out anybody who might be sick, offers them a high deductible plan with skimpy benefits. Blue Cross gets to collect premiums without paying out very much in health care services. It's a great deal for them, but what about for the young consumer? Are they truly getting value for their dollar? When he was Insurance Commissioner, Lt. Gov. Garamendi spotlighted the plan for criticism in his 2005 report, "Priced Out: Health Care in California." On page 27, he talked about the exclusion of maternity coverage, and specifically mentioned that it would be "predictable" that these premium-paying people would end up on Medi-Cal or Access to Infants and Mothers (AIM):

So the most likely reason that a 22-year old woman might visit a hospital--pregnancy--won't be covered by this plan. (It seems she would benefit from a minimum benefit standard.)

This plan is so silly it was featured on The Daily Show with Jon Stewart. I wish I could link to the Ed Helms segment, but copyright issues have taken it off the Internet. It makes fun of an attempt of a big insurance company to clumsily cater to young people--but also makes an important point about why young people are--or are not--uninsured.
It had the best health care policy chart that I have ever seen, which indicated the reasons that young people are uninsured. One half of the pie chart read "TOO POOR"; the other half read "TOO SICK"--a short ways to talk about "pre-existing conditions." A small sliver in the middle simply read, "TOO EXTREME"--the apparent target audience for this product.
It 's both silly and sad at the same time.

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posted by Anthony Wright | Permalink | 11:04 AM


 
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March Madness: the brackets are now filled in by the "big four"...

 
HEALTH ACCESS UPDATE
Thursday, March 15, 2007


ASSEMBLY REPUBLICANS ROUND OUT HEALTH REFORM PROPOSALS
• Focus on high-deductible plans, Health Savings Accounts, tax credits
• Medi-Cal & "uninsurable" recipients would receive bare bones coverage
• Proposal would undermine 23 mandates like cancer screenings & second opinions


New on the Health Access WeBlog: Certified Rules; A Tale of Two States; The New 300; Rationing; LA Story; Paying to Be Uninsured; A Tonik for Young People


Assembly Republicans stood before Mercy General Hospital in Sacramento Wednesday and unveiled a package of 18 proposals that they believed could help resolve a growing health care crisis by “maximizing choice, reducing cost, increasing access.’’ Read a copy of the Assembly Republican press release here.

The plan relies heavily on the “market’’ to hold down health care costs and ensure that more people receive coverage. Assembly Republican Leader Mike Villines, R-Fresno, said that while other proposals for “socialized medicine’’ were “well-intentioned,’’ they wouldn’t work because the proposals would cost too much and lead to increased taxes.

The proposal was welcomed into the year's health care debate, in hopes that the Assembly Republicans would engage rather than simply oppose health reform measures. However, consumer advocates generally opposed many of the proposals, although there were items of potential consensus.

HIGHLIGHTS OF THE PLAN

A complete list of the Republican bills can be found here, but some of the foundational bills seek to reduce cost by reducing care or coverage. The plan features tax credits and eliminating state oversight and consumer protections, generally watering down coverage by either reducing benefits, or increasing deductibles.

? Health Savings Accounts and High Deductible Plans. Many proposals would conform state law to federal law and allow employers and individuals to receive tax credits for contributing to Health Savings Accounts. Health Savings Accounts, by definition, are only available to those with High-Deductible Plans, so such a tax credit would be using public money to encourage underinsurance. Consumer advocates believe these plan do not control costs, but merely create financial barriers and shift costs to individuals.

* AB84 (Nakanishi) – HSA tax credits for individuals
* AB85 (Nakanishi) – HSA tax credits for businesses
* AB245 (Devore) -- HSA tax credits for individuals
* AB1377 (Nakanishi) – directs CalPERS to offer high-deductible plans and HSAs for public employees and retirees
* AB1635 (Strickland) – health opportunity accounts for Medi-Cal enrollees
* AB1378 (Nakanishi) -- HSAs and high-deductible plans for those with "pre-existing conditions."

Other tax break bills include AB1040 (Duvall) to expand state tax deductions for health care, dental and vision expenses, and AB1592 (Huff) to create a new tax credit for doctors who provide charity care. There were no details on how any of these proposals would be paid for in the budget.

? Relaxing Insurance Protections and Oversight. One proposal would allow insurers to sell products across state lines, and thus avoiding strong California consumer protections, such as the right to appeal HMO decisions to deny care. Another bill is more explicit in simply allowing insurers to offer products that do not include some of all of the 23 required benefits, such as coverage of cancer screenings, pap smears, or diabetic care. Such bills would limit government regulation on health plans, exposing consumers to an uncontrolled marketplace that could further shift costs and risks on individuals.

* AB1214 (Emmerson) --allowing insurers to ignore minimum benefit rules
* AB1644 (Niello) -- allowing out-of-state insurers in without a California license and outside California consumer protections

There was no claim that any of these proposals would significantly reduce the number of uninsured. No public programs would be expanded. Employers would continue to not have any obligation to provide any kind of coverage to their employees – leaving workers in the lowest paid positions to hunt for health insurance in the most expensive way, on the individual insurance market with no guarantee that coverage will be affordable or available if they have a “pre-existing condition.”

A TOUGH CHOICE FOR MEDI-CAL PATIENTS

One spotlighted idea by the Assembly Republicans is AB1635 by Audra Strickland (R-Moorpark), which would give Medi-Cal recipients the choice to have a health savings account and a bare-bones high-deductible plan combination to “put them in charge of their own health care decision making and lower costs for taxpayers.’’

A family of three living on $1,430 a month would be asked to make decisions between food, rent, utilities, or health care. Even if Medi-Cal provides an initial deposit in these savings accounts for these families, the impact could mean both health and financial consequences, especially when they need care, for diabetes, asthma, or a medical emergency. Research indicates that forcing people to place financial decisions before health concerns means that patients are half as likely to see the doctor, half as likely to get the care they need, and half as likely to fill their prescriptions.

Consumers who are asked to triage their own health care also do not always make the best medical choices – leading them to get sicker and wind up needed more expensive care. This is a cost – not a savings.

The Center for Budget and Policy Priorities has a paper on so-called “Health Opportunity Accounts’’ for Medicaid enrollees here.

AREAS FOR AGREEMENT: Republicans, however, did offer one concept that advocates could support. AB1312 by Bill Emmerson would increase Medi-Cal provider reimbursements to Medicare levels – an issue that does not seem to be in contention. There was no clear indication of how that increase would be funded.

THE STORY BEHIND THE STORY: Additionally, the “real person’’ who spoke at the press conference that Assembly Republicans touted as someone who could benefit from their plan – a 22-year-old restaurant worker – turned out to be a poster child for standards for employer-based coverage, minimum benefit mandates, and expanded public programs. (She doesn’t receive health care through her job; her insurance broker who sold her a high-deductible plan suggested that if she got pregnant, there’s a state program called AIM – Access for Infants and Mothers, that would take care of her so her insurance would not have to.) Read about the background of person at the Health Access WeBlog here.

ALL PROPOSALS NOW ON THE TABLE: Reports indicated it was unlikely that many of these bills will pass the state Legislature with the Democratic majorities. But discussion of these ideas – particularly high-deductible plans and Health Savings Accounts--will be part of the debate about the plans of Gov. Arnold Schwarzenegger and others.

For more information, contact the author of this report, Hanh Kim Quach, policy coordinator, Health Access California, hquach@health-access.org.

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posted by Anthony Wright | Permalink | 10:43 AM


 
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Paying to be Uninsured

Wednesday, March 14, 2007
 
YI just got back from the press conference held by Assembly Republicans to unveil their health proposal, where they showed how their plans would help small businesses and young people.

The young person featured was a nice 22-year-old named Suzanne Hernandez who is enrolled in Blue Cross' "Part-Time Daredevil" Tonik plan, which has a $3,000 deductible.

Miss Hernandez doesn't get coverage through her employer -- Lucille's Smokehouse BBQ in Rocklin. The restaurant industry, she explained, often does not offer benefits and most employees don't work full-time, which means they wouldn't qualify for benefits anyway.

(First off, the solution here would be to require businesses to provide coverage to both full- and part-time workers. Then, Miss Hernandez wouldn't be on her own.)

The Tonik plan, she said, gives her 4 doctors visits a year for a $30 co-pay. That's what she needs ....for now.

As a young woman, though, she might need maternity, I said. What would happen if she got pregnant?

Her broker stepped in and said Blue Cross actually allows Tonik enrollees to roll into a higher deductible plan -- $5,000 a year -- which includes maternity. And childbirth, the broker said, costs a lot more than $5,000.

But $5,000 on a part-time job at a restaurant still seems kind of expensive, I said.

Well, said the broker, there's social programs for that, called AIM -- Access for Infants and Mothers.

That's right -- a person that doesn't have adequate insurance through Blue Cross should enroll in Access for Infants and Mothers -- a state program for low-income women who have deductibles that are too high, the broker said.

The last time I looked, Access for Infants and Mothers was a government program -- the kind that Assembly Republicans said today they didn't really think would work.

I wonder what they would think if they knew that part of this Blue Cross business model -- as advised by the broker -- relied on social programs to provide the rest of the health coverage that the insurance company itself does not provide.

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posted by Hanh Kim Quach | Permalink | 1:29 PM


 
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First take on the Assembly Republican proposal...

 
It’s good that the Assembly Republicans have agreed there’s a need to fix the problems in health care, even if we disagree with many of the solutions. Some of their proposals—like raising Medi-Cal rates—make sense and are necessary. But many of the proposals would serve to undermine consumer protections and ultimately take the health out of health insurance.

We need to reduce costs, but not at the price of reducing care and coverage. As even insured Californians grow concerned that their coverage won’t be there when they need it, these proposal go in the wrong direction, providing less security for families.

The entire section on “maximizing choice” is focused on offering what many would consider a bad choice: watering down coverage by either reducing benefits or increasing deductibles. They find an impressive number of ways to accomplish the goal:

On benefits, one proposal would allow out-of-state plans, not subject to California’s consumer protection laws, to be able to operate here unregulated. (Would you like a plan regulated by the Alabama Department of Insurance?) Or they would allow plans sold without any minimum benefit standards, without covering cancer screenings, pap smears, or diabetic supplies. (The point of insurance is not having to guess what disease or ailment you might have, but to be covered regardless.)

They also have several bills to encourage high-deductible plans, through tax credits for Health Savings Accounts (which can only be used with plan of $5,000 deductibles or more). While even some proponents have said that such plans only work for the “healthy and wealthy” (and opponents sometimes question that, these proposals would encourage such “underinsurance” for public employees (through CALPERS), low-income families (through Medi-Cal), and even more stunningly, those with “pre-existing conditions.” This would actually serve to make coverage worse for many Californians.

There are other ways to contain costs, other than simply shifting them to consumers. Here’s a whole list, on the Health Access website…

There are things worth looking at in the Assembly Republican proposal, even if one or two of them seem to already be in existing law. For example, allowing small businesses to band together to get better rates on coverage makes sense: California had a purchasing pool for small employers, unfortunately this privatized program shut down last summer with little notice and less explanation. Similarly, increasing the number of nurses is a good idea: there have been several efforts to do this but more could be done. And there are things worth exploring like allowing employers to buy coverage that is both health insurance and the medical side of workers compensation.

And while we don’t think that high deductible plans make much sense for most people with pre-existing medical conditions, we agree that guaranteeing coverage is available for people with health conditions is the right step to take.

So we welcome the Assembly Republicans to the debate, even if consumer group disagree on key points.

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posted by Anthony Wright | Permalink | 8:32 AM


 
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400 is the new 300

Tuesday, March 13, 2007
 
When health care policy types talk about "300," they aren't talking about the new hit Spartan war movie with gruesome and ultraviolent battle scenes and homoerotic tones.

We wonks usually are referring to 300% of the federal poverty level, which is $30,630/year for an individual, and $51,510/year for a family of three. Even though this is literally three times the poverty level, this isn't a lot of money, especially in a high cost-of-living state like California. Housing and other expenses in the San Diego, Los Angeles, the Bay Area, and elsewhere don't leave a lot for other necessities, including health care.

Some of the health care proposals out there recognize this, to a point. For example, Governor Schwarzenegger, Speaker Nunez, and Senate President Pro Tem Perata all propose to expand public programs to children in families up to 300% of the poverty level. Several counties already go up beyond the 250% of poverty ($25, 525 for an individual, $42,925 for a family of three) -- the upper limit of Healthy Families eligibility now.

The Governor doesn't go so far for adults, proposing subsidized coverage for adults up to 250%, even though he would still impose an "individual mandate" on those above that amount, who get no financial assistance to help meet that requirement. Even the plan in Massachusetts provides subsidized coverage for families up to 300%.

But now there is a greater recognition that help is needed for the middle-income families, up to 400%. Illinois Governor Rod Blagojevich has proposed his own health reform plan, which provides subsidies for families up to 400%. Presidential candidate Hillary Clinton and key Congressional leader John Dingell have proposed reauthorizing the children's coverage program (SCHIP, Healthy Families here in CA) to cover all children up to 400%. New York Governor Eliot Spitzer has proposed the same for children's coverage in his state.

Health care is getting costly enough that help is needed for both low- and moderate-income families. Some will argue that such ambitious proposals are harder to pass and to fund. But the recognition that health care is a middle-class issue might be the very reason health care reform is getting such attention from political leaders in the first place.

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posted by Anthony Wright | Permalink | 10:38 PM


 
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The table is now set...

 
Tomorrow (Wednesday), the Assembly Republicans will announce their health care plan at a press conference at a Sacramento-area hospital. We'll have quick analysis here tomorrow...

posted by Anthony Wright | Permalink | 7:47 PM


 
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We don't even have socialized medicine....

Monday, March 12, 2007
 
The Wall Street Journal (subscription required) this weekend had a story about the United Network for Organ Sharing is revising its kidney transplant policies -- favoring young patients over old, rather than the length of time on a waiting list.

This change in how kidneys are currently rationed, naturally, has stirred up the age-old debate over whose life should hold more value; who deserves to live and who will die waiting for care?

What's interesting to me, is that without this suggested policy change, there has been virtually no furor over medical rationing in the U.S. Fear of rationing occurs in discussions over "socialized systems'' such as those in Canada or the U.K. that will result in lines and rationing.

But we DO have medical rationing in the U.S. And people die at the rate of 18,000 a year because health care is rationed, according to the Institute of Medicine, making uninsurance the sixth leading cause of death in the United States.

The United States' method of rationing, however, is largely invisible to the middle and upper classes, because they have insurance.

The U.S. medical system current rations care based on who can afford to pay. If you can afford to pay, you see a doctor. If you can't afford to pay, you wait, you get sicker. You might see a doctor -- at an exhorbitant price -- and you are 25 percent more likely to die because of the lack of care you receive.

That's not to say other systems are perfect. In the U.K, for instance, waiting times for elective procedures (such as hip replacements) can be long. On the flip side, waits to see a primary care physician can be shorter than the waits in the U.S., according to an analysis of four countries' health systems.

The United Network for Organ Sharing is heading into a ideological and emotional storm and all new policies must be approved by the U.S. Department of Health and Human Services. These are difficult decisions to make and one could argue that none of us is qualified to judge who is deserving of life or not.

But let's not kid ourselves, just because our policies don't explicitly make those judgements, that rationing is happening today, and it's happening in the U.S.

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posted by Hanh Kim Quach | Permalink | 10:58 AM


 
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A tale of two states...

 
Clea Benson in the Sacramento Bee touches on some of the debate that the Massachusetts health reform has sparked in that state, and the implications for California.

So how is the Massachusetts reform going? My take: It is the best of times; it is the worst of times.

It's not a surprise that of the mix of policy changes, some are working, others are not: A useful guide to see what we want to pick and choose here.

The best of times: The expansion of public programs there has enabled over 100,000 uninsured folks to get coverage, moving Massachusetts to have the lowest rate of uninsurance of any state in the country, alongside Hawaii and Minnesota. Appropriately, the help is greatest where the need is greatest, with low-income individuals and families. These sort of expansions of proven public programs are what work in our health system, and that's why we support similar proposals here in California, to expand Medi-Cal and Healthy Families.

Let's also remember context: MA was already 6th lowest uninsured before their reform. CA is on the other end of the spectrum, with the 5th highest uninsured. So we have a longer ways to go.

The worst of times: The idea that consumer advocates have been most alarmed about, the "individual mandate," is raising alarms there, too, as they approach the July 1 date for its implementation. The problem is that for many, the coverage that is available is simply too expensive for those with middle-class incomes. Policymakers are trying deciding between an unaffordable premium, or an unaffordable benefit, one that either has too high cost-sharing or that doesn't cover key services, like prescription drugs. And for that latter choice, what's the point of having coverage if it doesn't cover what you need, or is too expensive to use?

This debate is being well-documented by the MA consumer group, Health Care for All. Massachusetts does has an escape valve, stating that the individual mandate does not apply if coverage is "unaffordable," so it is likely that some category of individuals above $30K/year or families of four over $60K/year--who won't get subsidized coverage--will simply be exempt from the plan. (FYI, Governor Schwarzenegger's individual mandate proposal does not include any exemption whatsoever.)

For these Massachusetts individuals that don't have the benefit of employer based coverage (and the MA plan does virtually nothing to help them get it, and Governor Schwarzenegger's plan won't help most), the *best* case scenario is that they stay uninsured--and face the health and financial consequences of being uninsured. The *worst* case scenario is that they are forced to spend an unaffordably large percentage of their income to get stripped-down and/or high out-of-pocket cost coverage that will not be useful to them.

And that would be Dickensian, indeed.

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posted by Anthony Wright | Permalink | 1:56 AM


 
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Certified, Part II: Waterloo Edition

Sunday, March 11, 2007
 
Last week, I described how much a pain it was to get a original birth certificate for my newborn son, even for me, as a well-educated, middle-class, bureaucracy-savvy Californian who has a car, sets his own schedule at work, and still lived in the county of the birth in question, which was recent.

Well, enough about me. What about him?


Robert Pear of the The New York Times has a gut-wrenching story about how the introduction of the new and onerous citizenship documentation requirements in Medicaid has led to tens of thousands of people losing coverage in each of the following states mentioned in the article: Florida, Kansas, Louisiana, New Mexico, Ohio and Virginia.

If that's the scope of the impact in those smaller state, then the damage in California, where we are just about to implement this new federal law, will certainly be in the six figures. Despite the attempts of California to ease the impact, hundreds of thousands of California citizens--yes, citizens--are likely to be denied health coverage because our national political leaders intentionally burdened them with paperwork.

Here's the money quote, by Kevin W. Concannon, director of the Department of Human Services in Iowa, where the number of Medicaid recipients dropped by 5,700 in the second half of 2006, to 92,880, after rising for five years.

“We have not turned up many undocumented immigrants receiving Medicaid in Waterloo, Dubuque or anywhere else in Iowa.”

posted by Anthony Wright | Permalink | 10:00 PM


 
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What's poverty?

Friday, March 09, 2007
 
The Illinois governor is also talking about a health coverage expansion that would extend to one-third of the state's uninsured population (1.4 million).

Like Schwarzenegger's plan, it would extend its Medicaid (Medi-Cal, here) to adults without children living below poverty. Unlike California, though, the plan would extend subsidized coverage to families with uncome up to 400 percent of poverty ($82,600 for a family of four in 2007). Under the California Governor's plan, the subsidies only extend to families up to 250 percent of poverty ($51,625 for a family of four).

It's definitely something to look at, especially considering that Illinois and Caifornia's median income are roughly the same, $70,558 and $69,377 per family of four, respectively.

posted by Hanh Kim Quach | Permalink | 12:34 PM


 
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It's enough to get you certified...

 

Earlier this week, I went to get my baby son’s birth certificate. About four months late.

When little Jefferson Wright was born, the hospital gave me the paperwork, sure. But I misplaced it, then it just lay on the dining room table as I dealt with other life crisis.

It involved paying $17 to get the birth certificate. And it wasn’t something that I could just send away for while paying my bills. I needed a notarized signature on the forum. I vaguely remember that there are some Notary Publics in town, but not exactly where.

So then I decided it would be easier to just go to the county office, than to go someplace to get the notarized signature and then have to mail the form. But the hours of the Yolo County Health Department are pretty much during business hours, and so this waited for several weeks until I found a morning that I wasn’t booked at my job.

I finally took an hour to drive to Woodland, find the county health department (actually they recently moved, so I needed to go to another building), and submit the form. I also needed to go to the ATM, since I needed cash, since they wouldn’t take a credit card.

Once there, there was no line, the staff was friendly and courteous, and I got the birth certificates there, on the spot.


Why do I go into detail about this? Because this was enough of a hassle and expense for me, as an able-bodied, well-educated professional that schedules his own hours. Yet under the citizenship documentation requirements of the Deficit Reduction Act passed by the previous Congress and signed into law by President Bush, we are asking hundreds of thousands of low-income seniors, parents, and people with disabilities to go through such a process: to get original birth certificates (photocopies not allowed) in order to get Medi-Cal health coverage.

I admit that if my health coverage was riding on this, I probably would have tried to act sooner. But as an adult looking for my own certificate, I wouldn’t have had the form so easily from the hospital; In fact, I may very well have been across the country from the county with my birth records, if I even remembered the location. I might not have been born in a hospital, so such documentation may be hard if not impossible to track down. I might have had a job where it would be harder to take the time to get this done. I might not have had a car to go driving around Woodland.

This is why we think that many thousands, if not tens or hundreds of thousands of Californians, will lose their coverage under this law. (NEW NOTE: California has worked to ease the impact, with electronic data matching for those recently born in the state. But out-of-staters, or those who were born a while ago, will have to find a way to get their original copy manually!)

It’s annoying to face bureaucratic hurdles. But it makes me angry when those burdens are imposed for no real reason, for the express purpose of placing barriers in people’s way. There are some policies in place to intentionally discourage some from getting the services to which they are entitled.

Hopefully Congress will take another look at changing or just discarding these requirements this year.

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posted by Anthony Wright | Permalink | 1:41 AM


 
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LA Story...

Thursday, March 08, 2007
 
On Wednesday, I visited Health Access' new offices in Los Angeles. We are on the other side of the freeway from downtown, on Wilshire, across the street from un centro medico (there's an MRI trailer in the parking lot!). The new address:

Health Access California
Los Angeles Office
1930 Wilshire Blvd, Suite 1210
Los Angeles, CA 90057
(213)413-3587

I like the neighborhood, a few blocks from MacArthur Park. I joined our staff to lunch at Mama's Hot Tamales Cafe, across the street from the park, which is also a nonprofit "neighborhood revitalization experience." It's also pretty yummy.

For many years, we had a small closet/office at El Mercado La Paloma, across the hall from ACORN and appreciated the community there. We were one of the first tenants, as one of the nonprofits housed above a community marketplace and eatery. But we needed more space, and now actually cohabitate with our friends at Latino Issues Forum. We are still setting up furniture, phones, and the other basics, so the main treat is the view.

Health Access is a small organization with not many staff, but has for much of its history maintained a office in Los Angeles--ground zero for the uninsured problem nationally. It's just too important not to have somebody on the ground, with the population base of people (and voters), and the mix of health care issues, from the rates of uninsurance to the preservation of the public hospitals there. We're happy to continue our commitment to Southern California.

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posted by Anthony Wright | Permalink | 10:27 PM


 
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The waiting game...

 
HEALTH ACCESS UPDATE
Friday, March 9th, 2007


TIMELY ACCESS TO CARE STANDARDS DEBATED AT DMHC
* Lack of timely medical appointments a major consumer complaint & health obstacle
* Health plans and providers testify that providing timely appointments “very burdensome”
* Need for strong and clear time-elapsed standards debated
* False “choice” posed, between timely access and linguistic access to health care


The Department of Managed Health Care (DMHC) held a hearing on this past Monday, March 5, 2007 in Sacramento to seek public comment on their proposed new regulation governing timely access to care.

This long-delayed regulation is based on AB2179(Cohn) sponsored by Health Access and passed in 2002. For the last thirty years, since the Knox-Keene Act was passed in 1975, HMOs have been required to provide timely access to care and have filed their own self-imposed standards saying that patients should be able to see doctor within so many days, etc. And for decades neither the HMOs nor the department in charge of overseeing them bothered to check if consumers got care when they needed it. So five years ago, the Legislature acted to required specific, uniform and enforceable standards for timely access to care.

The regulations to implement the law are not just a boon for patients seeking to get a phone call answered, or get an appointment quickly. They are also seen as a way to gauge netowrk adequacy, to ensure that an insurer has enough doctors and specialists in their network. FInally, such regulations are expected to have a positive impact on the issues of emergency room overcrowding and rising health care costs: many Californians now wind up in the emergency rooms with worse conditions because they are unable to get a timely appointment with a provider, in what is a more appropriate and less costly setting.

INDUSTRY OPPOSITION: The health plans, providers, and their associations all spoke against the Department’s regulation as written. They expressed their clear dislike for time-elapsed standards. DMHC wrote these regulations to require that consumers must be able to see a physician within certain prescribed time frames. Some examples of the time frames specified in the regulation require that consumers:
* see a primary care physician for urgent care within 24 hours,
* get an appointment for routine care with a primary care physician within 10 days, or
* be referred to a specialist for urgent care within 72 hours.

The provider community emphasized that this would result in “chaos in the delivery of health care in California ” and would be “very burdensome to administer.” One executive testified that she had “no difficulty getting a prompt appointment with her doctor.” One plan representative asserted that the Department should put forward a very minimal regulation because “nothing they would do would improve the timeliness of access to care” rather than the “rigid” standards currently proposed.

CONSUMER GROUP SUPPORT: Consumer advocates, from Health Access California, Western Center on Law and Poverty, and Health Care Rights Hotline, countered these claims at the hearing. They emphasized that this law was passed five years ago and, because of the delay in drafting the regulation, plans and providers had plenty of time to prepare for their implementation. They argued that the best way to measure that consumers were afforded timely access to care was to measure how long it took to get a necessary health care appointment. Advocates urged that it was now time to move forward and were generally supportive of the regulation as written.

But plans also expressed surprise that time-elapsed standards were being imposed because the law does allow for some alternative standards. However, in the five years since passage of the law, the plans and providers had not experimented with other ways to gauge if timely access to care is being delivered, nor have they developed any alternative way to assess if appointments are being offered on a timely basis.

REPORTING: Health plans and providers also expressed objections to any monitoring by the plans or the Department of this regulation. They stated the regulation would lead to higher administrative costs, claiming that the rules would require extensive record-keeping, including tracking every phone call received at the expense of actually providing care. Consumer advocates refuted such statements, and suggested several mechanisms for cost-effective monitoring of this regulation to ensure compliance. Theu argued the regulations allowed for flexibility for the plans without requiring burdensome record-keeping. They also proposed that the ability to provide timely access to care beyond these standards could even be an important way for consumers to differentiate between providers and/or plans in making health care choices.

EXEMPTION FOR LANGUAGE ACCESS?: The Department raised one disturbing question during the course of the hearing. DMHC asked several testifiers if it would be acceptable for consumers if they had to forego any entitlement to timely access to care if they required language assistance. This is especially troublesome since the Department finalized their Cultural and Linguistic Access to Care regulation on February 23, 2007. This landmark regulation guaranteed low English proficient consumers the right to have health care delivered in a language they understood and written documents provided in multiple languages. Consumer advocates resoundingly affirmed at the hearing that consumers should not be required to make a “choice” between receiving health care in a language they understood and receiving health care on a timely basis (nor should providers be permitted to make that choice for their patients.) The impact of being forced to make such a decision would be clearly discriminatory.

ACTION: Consumer advocates are awaiting the Department’s decision whether to make the regulation final as written or to invite another round of comments. All interested parties should check the Department’s website at www.dmhc.ca.gov for announcements regarding the finalization of the regulation or the scheduling of another public hearing on timely access to care. If DMHC undertakes a revision of the regulation, consumer advocates should be prepared to testify and/or provide written comments against the weakening of the proposed standards.

Questions and requests for more information should be referred to Elizabeth Abbott, Project Director, Health Access, at (916) 497-0923, ext. 201, or by email to eabbott@health-access.org

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posted by Anthony Wright | Permalink | 9:56 PM


 
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A new kind of patient dumping

 
The Hill reports on a federal investigation into how one insurance company diverted sicker, more prescription-drug dependent customers (Translation: more expensive) to a competitor.

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posted by Hanh Kim Quach | Permalink | 7:21 AM


 
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Consumer-driven trend

 
I just wanted to flag an investigation by a Congressional committee of fees that cause workers to lose billions a year in 401(k) retirement funds. The Washington Post and LA Times wrote about a hearing on the issue yesterday.

From the Washington Post story, the problem is this:

Mutual funds and other professional investment firms often charge fees totaling 3 percent to 5 percent of the assets they manage, when 1.5 percent would be more appropriate, Matthew D. Hutcheson, an independent consultant on pension fees, told the House Education and Labor Committee.

An excess charge of just 1 percent can seriously erode retirement money, retirement planner Stephen J. Butler testified. A couple investing $10,000 a year over 30 years and earning 10 percent, for example, would have more than $1.9 million for retirement at the end of that time. But that sum would be reduced by $355,395 -- to just under $1.6 million -- if that money earned one percentage point less, or 9 percent a year.

This has been able to happen because "fees often are scattered across written materials, or sometimes not reported at all, making it difficult for employers and consumers to comparison shop, according to testimony from Hutcheson and others, including an official from the Government Accountability Office, the research arm of Congress.''

It's been about two decades since pension annuities -- pooled retirement funds -- started eroding as a benefit in favor of individualized 401(k)s -- where workers could "take control'' of their own nest eggs. It was also cheaper for employers to give workers a set amount to invest up front, rather than being responsible for a regular check after workers retired until they died (and sometimes beyond).

It's only now that lawmakers are beginning to probe the opaque practices of these 401(k)s and bringing them into public view.

In health care, the rising popularity of Health Savings Accounts and consumer-driven plans to allow consumers to "take control" of their health care holds the same kinds of warning signs to me. These individualized plans are being pushed as an alternative to traditional comprehensive insurance -- pooling people together to spread risk.

Sound familiar?

At this point, the health industry is far too opaque for consumers -- and employers -- to get an accurate read on what it is they are paying for or to comparison shop. Even more opaque than the 401(k) managers who are required by law to disclose certain information just now being investigated.

No laws require the disclosure of price information for consumers.

To have to wait two decades for a congressional committee to begin opening up investigations on practices behind the health care curtain could be far too late for some consumers, who could get sicker and die while waiting.

posted by Hanh Kim Quach | Permalink | 6:58 AM


 
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Can California Kids' Coverage Continue?

Wednesday, March 07, 2007
 
HEALTH ACCESS UPDATE
March 7th, 2007

FOCUS ON FEDERAL FUNDING FIGHT FOR CHILDREN'S COVERAGE
  • Children's coverage is a key foundation for universal expansion
  • California children at risk without a national allocation of at least $60 billion in new funding
  • Alert: Call-In Day for the Campaign for Children's Coverage: 1-800-828-0498
  • Also: Assembly Health votes on first bills of session: Part D Report, Medi-Cal Expansion

While we debate huge, systemic reforms to the health system statewide – and even nationwide – we cannot forget the federal fight for funding children's coverage. The biggest debate in Congress this year is over the extent of children’s coverage, and getting full funding for children's coverage will be foundational to health reform efforts and the push for universal coverage.

ALERT: Today and tomorrow are national CALL-IN DAYS to call your Congressional Representatives and urge them to fully fund children's health coverage, with at least $60 billion in new federal funds. A TOLL-FREE line has been established for March 6-8th, at 1-800-828-0498.

BACKGROUND: Since its inception in 1997, the State Children’s Health Insurance Program (the Healthy Families Program in California) has been hugely successful, helping to decrease the ranks of uninsured children from nearly 23 percent to 15 percent, in spite of a decline in employer-based coverage that otherwise would have swelled the ranks of uninsured children. As a result of this progra, hundreds of thousands of children are getting neededpreventive care and leading healthier lives.

In its tenth year, SCHIP is up for reauthorization this year. Fortunately, the question is not – “Should we reauthorize it?” The explosive increase in children who have insurance and are leading healthier lives because of it is reason enough to continue to fund it. The question, though, is how much?

BUSH'S PROPOSAL: President Bush has decided that SCHIP will not grow at all in the next five years – in either enrollment or health inflation. So, he’s authorized the exact same amount -- another $5 billion a year for five years. Even with a meager $5 billion more, that’s abysmally low. Health inflation alone will gobble up chunks of money throwing out children already in the program. California alone needs an additional $2 to $3 billion over the next few years to ensure the 750,000 children currently enrolled don’t drop off.

CHILDREN DENIED COVERAGE?: Bush’s proposal is so low, that it means about a dozen other states, including California would need to scale back their children’s coverage programs to meet that level. California provides coverage to children in families with incomes up to 250% of poverty ($42,925 for a family of three). Bush would allow only children in families up to 200% of poverty ($34,340 for a family of three) to receive coverage. That would abruptly force 170,000 California children off Healthy Families.

The effects are longstanding too. Under the President’s budget, with even just moderate growth assumptions for SCHIP programs in California, it means 775,000 otherwise eligible kids would either be kicked off or forced to wait for another child to drop off the rolls before they could be added to Healthy Families. The money simply would not be there, according to an analysis by Peter Harbage for the California Health Care Foundation. His study will be featured today at the regular Sacramento meeting of the Managed Risk Medical Insurance Board (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.mrmib.ca.gov&l=2), which oversees the Healthy Families program. The agenda for today's meeting is here:
http://www.mrmib.ca.gov/MRMIB/Agenda.html

THE NEED: To adequately fund children’s health care – national advocacy groups such as Families USA and ACORN – are requesting an new, additional $60 billion.SCHIP has been the most significant health coverage expansion in the U.S. the past decade and it can’t be lost – particularly as we debate expanding coverage beyond children. Securing the additional funding needs to be a priority for all health advocates this year – as part of the larger conversation about health coverage. If children’s coverage retreats, so will our foundation for expanding coverage. All of the proposal here in California for reforming health coverage and expanding coverage would benefit from full federal funding for children.

Nationally, the Campaign for Children's Health has a petition to support augmenting children's health coverage. (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.childrenshealthcampaign.org%2F&l=4).

In California, the triumvirate of children's groups (Children Now, Children's Defense Fund and Children's Partnership), also direct action through their 100% Campaign (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.100percentcampaign.org&l=5.)

To read analysis of the children’s health coverage issue, visit:

• Center of Budget and Policy Priorities (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.cbpp.org&l=6)

• Managed Risk Medical Insurance Board (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.mrmib.ca.gov&l=7)

• Families USA (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.familiesusa.org%2F&l=8)

• California Budget Project (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.cbp.org&l=9)

For more information, contact Health Access at 916-497-0923, including policy coordinator Hanh Kim Quach, the author of this report, at hquach@health-access.org, or project director Elizabeth Abbott, who is tracking the SCHIP debate, at eabbott@health-access.org.

ASSEMBLY HEALTH VOTES FOR FIRST TIME THIS SESSION

The Assembly Health Committee convened its first hearing where they voted on bills Tuesday; two bills of interest to health advocates passed:

• AB51 (Dymally) would require the Department of Managed Health Care to develop a report card for Medicare Part D plans in the same way it grades other health plans. A previous bill, AB2170 (Chan) was vetoed by Gov. Arnold Schwarzenegger last year.

• AB55 (Dymally) would increase the eligibility for Medi-Cal for some adults to 133% of the federal poverty level.

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posted by Hanh Kim Quach | Permalink | 1:46 PM


 
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Cart before the horse.

Tuesday, March 06, 2007
 
The California HealthCare Foundation today unveiled a free-to-the-public hospital report card at www.CalHospitalCompare.org.

I took it for a quick spin and now feel thankful that I live in Sacramento, where two of the hospitals near me are "superior" and three are "average." By comparison, Bakersfield's best hospital is "below average," while the rest are "poor." San Francisco, on the other hand, has four of 11 hospitals rated "superior."

I can see this being helpful if I was planning a heart bypass surgery, child birth, or looking around to see which hospital would best treat my pneumonia. But if I was having a heart attack (assuming it was bad enough that i couldn't drive myself) I don't think I could be aware enough to tell the ambulance driver -- from the stretcher -- that Hospital X has a "poor" rating, please take me to Hospital Y.

Moreover, if I am really expected to shop for "cost,'' as well as quality as consumer-driven plan boosters would like, I can't. That comparative information doesn't exist.

Don't misread my fussiness. I think CHCF has done a huge public service and went through considerable effort to achieve this. Here's the eye-crossing account of what they went through to get these ratings:



The investigative phase of the CHART project, led by researchers at the
University of California, San Francisco's Institute for Health Policy Studies
and supported by the California HealthCare Foundation, ran from May 2004 to July 2005. A broad group of stakeholders, working collaboratively, served as a
steering committee and participated in advisory groups. Participants included
representatives from hospitals, health plans, health care purchasers and the
business community, consumers, the research community, and government. To
support their work, especially the selection of complex quality measures, a
number of smaller workgroups were also formed.
What strikes me is that this -- and other quality measures (available in the "Resources and Tools" section of their website) have all only recently come available and are all extremely nascent.

Consumer-driven health care, however, has been around for about a half-dozen years (tax-free Health Savings Accounts were created in 2003 and had precursors in HRAs). The premise of these plans was to put consumers in the driver's seat. But if it took teams of researchers with lots of letters behind their names 13 months, plus lots of stakeholders and lots of meetings to get this level of detail, what was a consumer to do during the interim?

And even now that some tools are beginning to be available, I would argue that it's hardly enough.

Government sites assume you have some knowledge about what is supposed to happen the moment you get to the hospital. (unless you've already had a heart attack and you know what the drill is.) Another site gives most hospitals the "Gold Seal of Approval" including those that CalHospitalCompare said were "below average.'' All this could be confusing and a huge turnoff to consumers embarking on their first consumer-directed health shopping.

The efforts that have been made are extremely important for health shoppers. The more information consumers can get, the better. And I assume this is just version 1 of many comparison sites to come.

But at this point, it's still a little premature for policy makers to really rely on the consumer-driven approach to provide the savings and change people's care-seeking habits, based on a scattering of spare websites.

That's putting the cart WAAAAYY before the horse.

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


 
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Which Part D plans get a "D"?

 
The Assembly Health Committee, chaired by Assemblyman Mervyn Dymally, meets today. The big news item will be the debate on trans-fats in restaurants.

There's a couple of bills that Health Access California will be supporting, including an expansion of Medi-Cal of seniors and people with disabilities. I would like to spotlight another bill, AB51 (Dymally), about Medicare Part D.

It's a simple bill, to have California create a report card for the new private Medicare Part D prescription drug plans. Right now, there's very little oversight over these plans. A Health Access report last year found that some of these plans are not being watched at even the state or federal level.

The problem is that seniors have little ability to compare plans, yet they are forced to choose on a yearly basis. The state has a model for a solution: the HMO report card, which reports on a variety of factors. The bill proposes expanding that report to include Part D plans.

Governor Schwarzenegger vetoed a similar bill last year authored by Assemblywoman Chan, and sponsored by Health Access California. We hope to figure something out this year, working with groups like Congress of California Seniors, California Pan-Ethnic Health Network, and Senior Action Network.

posted by Anthony Wright | Permalink | 10:51 AM


 
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The (ideological) war at home...

Monday, March 05, 2007
 
You would imagine that the scandalous conditions at Walter Reed would be an indictment of incompetence, of misplaced prioirities, of past and proposed budget cuts, of the Army management, or of the current political leadership.

Not to some. In a short post, Steven Greenhut at the Orange Punch blog of the OC Register manages to make several leaps of logic: "Wonder why health care at Walter Reed is so horrible? Wonder why VA hospitals are so terrible? This is socialized health care in action. Coming to a hospital near you if our policy makers get their way."

Where to begin?

First: what policy makers? There is no proposal on the table, in California or in Congress--including Senator Sheila Kuehl's universal, single-payer proposal--that plans to takeover hospitals under government control, or to change the mix of public and private hospitals, or how they operate. The comment attacks a straw-man.

The folks at The Health Care Blog are actively discussing the news, with Maggie Mahar providing some useful context, as are Matthew Holt and John Irvine:

* Privatization may be one of the causes of the problem, according to an internal Army memo cited in a letter by California Rep. Henry Waxman: "the Army’s decision to privatize support services at Walter Reed Army Medical Center was causing an exodus of ‘highly skilled and experienced personnel,’” the committee’s letter states. “According to multiple sources, the decision to privatize support services at Walter Reed led to a precipitous drop in support personnel at Walter Reed.” The letter said Walter Reed also awarded a five-year, $120-million contract to IAP Worldwide Services, which is run by Al Neffgen, a former senior Halliburton official. (Irvine)

* Walter Reed is run by the Army, not the Veterans Administration, so it is unfair to lump them together, as many are attempting to do. (Mahar)

* Independent and private reviewers give the VA high grades, compared with private facilities:

+ BusinessWeek said, “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 treatments to the percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers.” (Mahar)

+ "A string of studies published in medical journals back up these claims. For the full story of the VA's transformation. see Philip Longman's "The Best Care Anywhere" in Washington Monthly, January 2007." (Mahar)

+ "Those in the private sector appeared to be convinced by the turnaround in its clincal quality indicators. Or at least Managed Care Magazine has been fooled into thinking that..." (Holt)


The problems at Walter Reed need to be investigated and corrected, and it looks like that will be done now.

If this spurs a new effort at improving care for soldiers and veterans more broadly, even better. But let's remember: there are things to improve in the Veterans Administration, but there's things to learn from it as well.

posted by Anthony Wright | Permalink | 2:44 PM


 
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Let's not repeat history

 
The Boston Globe today reveals how the state is considering high deductible plans in order to make premiums for the mandated insurance more affordable -- but not without peril:

"...Research shows high deductibles deter people from getting needed treatment,
including preventive care, and can plunge those without savings into debt.

Those who have been following Massachusetts' process to implement its new health reform law also know that they're considering whether plans should have drug coverage -- or not.

Before we get to the point where we're debating whether drugs should be an integral part of insurance, and whether a $2,000 deductible is affordable for a single adult earning $26,000 a year (not including the premium), let's aim to define what value consumers will be getting for their dollars.

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


 
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Like Jeopardy!, looking for the right questions...

Sunday, March 04, 2007
 
The California Budget Project came out with a three page paper, asking questions about the Governor's health care proposal. These are important questions, and we are trying to get the answers. At the same time, we shouldn't let those questions get in the way of full-throated advocacy for the reforms we want and need this year.

CBP's conference is next week, and the headliner is Jacob Hacker, the author of The Great Risk Shift. It's one of those important books that come along every couple of years that puts everything in perspective about several different policy debates, not just health care but the fight over Social Security, bankruptcy reform, pensions, etc.



People try to boil the health care conversation to money and "who pays?" and while that's an important question, the more fundamental question is, "who bears the risk?" I've heard everybody from Sen. Darrell Steinberg to Schwarzenegger chief of staff Susan Kennedy ask this question. It gives me some hope that if we are asking the right questions, we might get to the right answer this year.



Jacob Hacker describes why the question is so important, and gives his own answer. To get a taste, view this YouTube clip:
http://www.youtube.com/watch?v=_N7Q_IYDWkQ



I look forward to seeing and hearing him in California next week.

posted by Anthony Wright | Permalink | 10:21 AM


 
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The uninsured face enough penalties...

Saturday, March 03, 2007
 
I actually responded to the Governor's comments on the individual mandate at the National Press Club when I was debating gubernatorial aide Daniel Zingale on the LA Times online opinion blog "Dust-Up."


Regarding the "individual mandate" described today, my concern is with the policy and with the rhetoric. With all this talk about the hidden tax, the Governor comes dangerously close to blaming the victim.

We reject reforms that send the message to patients and consumers, "It's your fault," especially when it is not.

With all the problems and players in the health care system—with insurers who profit by denying care, drug companies that price-gouge, employers who don't offer coverage, and others—can it be true that the Governor's "individual mandate" proposal places the harshest punishment not on those interests but on uninsured Californians?

Who are the uninsured? More than 80% are workers, or family members of workers. The vast majority are citizens and legal residents. (Let's be clear: we have a legal and public health obligation to provide care to all Californians, but even if we didn't have a single immigrant in the state, we would still have a major health crisis to fix.)

The uninsured are not so by choice—they want coverage, but are largely not eligible for on-the-job benefits or public programs, and find buying coverage unaffordable or unavailable, because of "pre-existing conditions." The notion of "individual responsibility" is felt now by uninsured families that face the real health and financial consequences.

It's just incorrect that uninsured people simply get "free care." Even when they go to the emergency room, they get a bill. In fact, Governor Schwarzenegger signed two bills we sponsored last year to try to rectify the longstanding problem that uninsured working families often get charged more for care (for hospital care or prescription drugs) than anybody else in the system, because they don't have an insurer or public program to bargain for them. As a result, many uninsured face medical debt and bankruptcy.

An individual mandate only makes sense if you think the problem is that people don't want health coverage. But we know that if people are eligible for employer-based coverage or public programs, they overwhelmingly take them up. The Health Access California website features a paper [PDF] opposing the individual mandate: the subtitle is "Unwarranted, unworkable, and unwise."

The question by our Dust-Up moderators suggest that the problem is the so-called "young immortals," those 20-something Californians supposedly too hip to have insurance. While young people are disproportionately uninsured, the reason is not their youth, but their lower incomes and job type.

The difference is entirely explained by the fact that they are more likely to work at McDonald's or Wal-Mart, at lower-income jobs that are less likely to provide health coverage. If offered coverage, they overwhelmingly take it up, just like older people. They just are more likely to have to wait 20 months to get coverage, yet the Governor's plan would force this $28,000 entry-level worker to buy coverage without any help from her employer or elsewhere.

Young people aren't shunning health care. In fact, given their past voting records, I would argue that if we win health reform this year, it will be because of the support of young Californians.

So I don't disagree with the Governor's point about the "hidden tax," that having so many uninsured creates a strain on the health system as a whole, and that we all have a stake in health reform. But don't think the uninsured don't want coverage, or that they get off with free care and without consequence.


One last thing: he cited opposition to the "individual mandate" as a "Democratic" concern. But last time I checked, I didn't see support for this particular component from the Republican side either. Maybe it is a truly "post-partisan" idea...

posted by Anthony Wright | Permalink | 11:57 PM


 
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He said he went for the mug and windbreaker...

 
The Governor's address to the National Press Club in Washington, DC, was broadcast on C-SPAN this weekend. It mostly got comments and rebuttals to the notion of his "post-partisan" philosophy, but his comments on the health care debate in specific are worth quoting:

One big issue we’re trying to address is health care. The problem is so pressing we got together and said, “We can’t wait for the federal government anymore. Let’s do it ourselves.”

We’re in the middle of that process right now. Here are the politics of the situation.
Part of the plan that I put on the table provides coverage for children of undocumented immigrants. My fellow Republicans oppose this, and I totally understand their opposition. After all, doesn’t it encourage people to come here illegally and stick Californians with their medical bills?

The fact is: we have no choice about paying the medical bills of people who are in California illegally. Federal law requires us to treat anyone who shows up at an emergency room in need of care. We have no choice. None.

So the real question is, do we treat them in emergency rooms at three or four times the cost of a doctor’s office or health clinic? Or do we treat them more efficiently? I say, let’s recognize the reality of the situation and deal with it practically. My Republican colleagues are having real trouble with this.

Now, here’s what the Democrats don’t like about my plan. It provides individual mandates, which require personal responsibility. I believe part of the health care answer is mandatory medical insurance, just like you have mandatory car insurance.

A lot of Democrats say that individual mandates are unfair. My position is that people who don’t take responsibility for themselves end up costing everyone else money. Not everyone can afford healthcare and government should help.

So, these are the kinds of things we’re trying to work out and I’m confident that we will. So far, everyone has maintained a good attitude. No one is calling each other names. That itself is progress.

But this is the dynamic I’m trying to encourage in California on a range of issues—the environment, health care, infrastructure, prison reform, energy and water supply and so forth.

This was from the prepared text. He also took several questions on his health care proposal, asking about the status of the proposal, about the notion of the "individual mandate" (insurers should not be allowed to "pick and choose" who they cover, but "we need to be fair to the insurers" to have "a larger risk pool..."), about regulating health insurance rates ("if there is a problem with it, we can go in that direction..."), and about why he opposes a single-payer system.

posted by Anthony Wright | Permalink | 11:38 PM


 
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All the Polls That Are Fit to Blog...

Friday, March 02, 2007
 
Trying to figure out why health care is such a hot topic on the presidential campaign trail, the New York Times has a new poll out, showing the renewed support for universal health care:
http://www.nytimes.com/2007/03/02/washington/02poll.html?_r=1&oref=slogin

It's not a wishy-washy question, since it actually asks if people would be willing to raise their taxes to have such a health system. The result:

The poll found Americans across party lines willing to make some sacrifice to ensure that every American has access to health insurance. Sixty percent, including 62 percent of independents and 46 percent of Republicans, said they would be willing to pay more in taxes. Half said they would be willing to pay as much as $500 a year more.

Nearly 8 in 10 said they thought it was more important to provide universal access to health insurance than to extend the tax cuts of recent years; 18 percent said the tax cuts were more important.



Among domestic issues, health care is listed by a majority of respondents (55%) as a top priority for the President and Congress to concentrate on right now, beating immigration, values, and other issues.

Several months ago, I was fielding questions from reporters about a PPIC poll that listed health care in the low single digits, asking why people didn't care about health care. I knew that for whatever reason, that poll was an aberration: health care is often in the top tier of issues, along with education and the economy. But this result is much stronger than what I have typically seen in the past. The momentum builds!

posted by Anthony Wright | Permalink | 4:31 PM


 
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Without a translator, a doc might as well be a vet...

Thursday, March 01, 2007
 
Earlier today, my Health Access colleagues Elizabeth Abbott and Bruce Occena attended a press conference at UCDavis Medical Center in Sacramento, to spotlight the new Department of Managed Health Care regulations on cultural and linguistic access to health care.

It's hard to overstate the importance of these regulations, which implement a bill by Sen. Escutia a few years ago. With a state as diverse as California, and with many people who don't speak English well or at all, you can't have access to health care with language access. Health care is all about that doctor-patient communication, and you can't have communcation with translation.

Working with groups like the California Pan-Ethnic Health Network and many others, we have been working for policies to ensure language access to health services.

Health Access has also been pioneering a Video Medical Interpretation (VMI) technology, to use the power of videoconferencing to cost-effectively and efficiently provide translation services. The Health Access VMI project working in Alameda and San Francisco counties has helped use the economies of scale through this technology to radically reduce waiting times for translation service, and provide a broader range of languages to patients. More information is available at:
http://www.health-access.org/providing/docs/VMIProject.pdf

The next challenge, however, is to make sure that HMO patients know about their rights to get translation services. Spread the word!

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posted by Anthony Wright | Permalink | 8:32 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.