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Dept. of Insurance

Friday, June 29, 2007
Our paper on how few assets California families have suggests a broader distinction between health coverage and other types of insurance.

Insurance is typically bought to protect one assets, in case of a flood, fire, earthquake, a lawsuit, car crash, etc. You have an asset, you want to insure it, so if you lose it, you get some money back. When I bought a house, I got insurance so that if we lost it, we could not start from scratch to replace it. I also got life insurance at that time, so that if I died, my family could retain our home without the resource of my income. But typically, people of lower incomes or few assets don't have insurance, not just because they didn't have the money to buy insurance, but because by definition they don't have significant assets to protect.

We appropriately ask much more of health coverage. We ask that it facilitate us to get the care we need, so we can stay healthy, manage chronic conditions, and deal with the sudden emergency. It's different.

That's why the high-deductible coverage doesn't make sense for many, even if it does in other types of insurance, which are geared toward smaller fractions of the population. The oft-made comparison to car insurance misses the point, that it is focused on a self-selected subsection of the population.

posted by Anthony Wright | Permalink | 9:07 PM


We'll always have Paris...

Michael Moore's SiCKO is out today, and many health care activists are leafleting moviegoers at a theater near you. It only adds to the momentum to reform, not just now and its run in theaters, but into the next year, with DVD sales, cable TV showings, etc.

On The Daily Show with Jon Stewart earlier this week, Michael Moore complained that
he was all set to have the hour with Larry King, but then he was bumped for Paris Hilton. For those excited by the power of Moore's fame and media savvy to focus on health care issues, we learn that celebrity-driven attention can cut both ways.

That's the second or third time Paris Hilton has provided a useful lesson in health care politics recently. Earlier, her stint in jail for driving while intoxicated put a spotlight on the personal driving records of LA City Attorney Rocky Delgadillo and his wife, who didn't have car insurance, despite the fact that its mandatory. Just a reminder that a plan with an "individual mandate" isn't universal, just like mandatory care insurance isn't universal, even to a well-educated, top-ranked lawyer.

What else can Paris Hilton teach us? A visit by Paris to Paris to learn more about the French health system? An investigation to whether her family's hotel empire provides coverage to their workers? I see a health policy beat for the tabloids...

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posted by Anthony Wright | Permalink | 8:33 PM


Taking the challenge on high deductibles...

We've gotten good response from our discussion paper about high deductibles... The omnipresent Don McCanne cites it as his Quote of the Day, for example.

The paper was an honest response to a question by Governor Schwarzenegger and others, which is "Isn't a high deductible policy better than nothing?"

For some people, yes, especially if they have significant assets to protect. But usually, those folks also can afford-and choose-comprehensive coverage.

We have talked to many people where an unexpected $5,000 or $10,000 medical expense is the straw that breaks the camel's back in terms of the family finances, with the kind of debt people already carry.

But is that indicative? Our paper suggests it's not just the lowest-incomes, but well into the middle third of the population.

For this middle third, a one-time incidence wipes out the family savings, including the family car (if it is possible to live in CA outside the Bay Area without a car). A chronic condition over even a few years could still lead to bankruptcy. Imagine the heart attack followed by heart disease.

The other problem is the health impacts. A middle-class patient with a high deductible is going to do every possible thing not to go to the emergency room, since even a quick visit, much less being admitted in the hospital, means their savings is gone. One of our uninsured stories we highlighted didn't go to the emergency room, even with a severe stomach ache, fearing the bill. Similar to somebody with a high deductible, he thought the visit would have been in the thousands, but his reluctance to go to the ER led to a ruptured appendix. That cost him his health, his ability to work for a few months, and was far more expensive for not just him, but the health system as a whole.

But given the financial state of his family (and most families), he made an economically rationale decision. The point of health insurance is to change that equation. If it doesn't change, is such a high-deductible plan worth it, regardless of how cheap the premium is?

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posted by Anthony Wright | Permalink | 7:51 PM


Don't take it from us -- here's what others say....

A bunch of interesting public opinion polls have come out recently, so I'll summarize a few of the key points from them here.

PPIC released a poll Thursday showing that 72% of Californians think the state's health care system is in need of major changes. (Take THAT Blue Cross!) Voters, however, are a little less confident that the guv and Legislature will be able to broker a deal (49%).

Another interesting point: 72% of voters support the guv's idea to require residents to have health insurance. From my previous readings, I actually thought voters weren't really hot for such a mandate....but I'm wondering if it's the WAY the question was posed that evoked that response.

The question, verbatim, was: "Would you favor or oppose a plan requiring all Californians to have health insurance, with costs shared by employers, health care providers and individuals?"

Lastly, a SURPRISING number of Californains (73%) said the US should provide health coverage to all children, even if it would require higher taxes. Hopefully Congress and Bush, who are in the process of giving the State Children's Health Insurance Program way too little money hear that.

Poll #2 out of Massachusetts: The Kaiser Family Foundation found that two-thirds of Massachusetts residents polled supported the new law, though support dropped to 57 percent when asked about the individual mandate -- which would penalize those that didn't buy coverage.

The most interesting piece of this poll to me was the part asking about affordability of the plans for people forced to buy coverage on their own without subsidies.

Scenario 1 37-year-old single adult, earning $42,000. The plan:
  • Costs $259 a month
  • Has a $1,500 deductible; $5,000 maximum out-of-pocket
  • Allows 3 doctors visits at $25 a year (the rest would be full-price)
  • After the deductible is met, 20% co-insurance
  • Generic drugs $15, but brand name drugs would be 50% co-insurance.
62% of respondents said this plan was "unfair;'' 58% said it was an unreasonable amount; 62% said this person would remain vulnerable to high medical bills.

The piece about affordability is key as we in California consider what is reasonable and fair for people to pay. The governor's plan requires a $5,000 deductible and $10,000 maximum out-of-pocket for someone earning $26,000. Looking at what people think in Massachusetts, the super-majority of people would say that's unaffordable.

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posted by Hanh Kim Quach | Permalink | 12:02 PM


Comprehensive, not Catastrophic

Thursday, June 28, 2007

Thursday, June 28th, 2007

* New Health Access Paper Calls for Comprehensive Coverage
* Shows “Catastrophic Coverage” Not Meaningful to Majority With Minimal Assets
* Majority of Californians Could Lose All Savings Under Gov’s Minimum Mandated Plan

New on the Health Access WeBlog: Blue Cross Ad; Maternity Coverage; Denied for Heartburn

As the weeklong “Road to Reform” tour wraps up with a major health care rally in Sacramento today, a new report reveals the need for Californians to have comprehensive, rather than catastrophic, coverage. The Health Access Foundation released a paper showing that many middle-income California families, who lack significant assets, would not benefit and possibly be burdened by such high-deductible plans.

The report, “Thin Protections: High Deductible Plans Provide Little Comfort for Asset Poor Middle-Income Families” shows how middle-income Californians are already living on the financial edge. With a high deductible health plan, more than half of the state’s families could still lose all of their life savings in one year, from a single major medical incident.

These findings are central to the discussion on health reform and the inclusion of high-deductible plans. Governor Arnold Schwarzenegger’s plan includes a reliance on high-deductible health plans as a minimum standard, forcing all Californians, even those with employer-based or public coverage, to have at least a plan with a $5,000 deductible and $10,000 out-of-pocket cost maximum. There would be no subsidies for Californians above $25,500/year, or $42,000/year for a family of three.

Proponents of high deductible plans instead tout them as “catastrophic coverage,” as financial security to protect a family’s assets in an emergency.

However, this pre-supposes that the individual or family has assets to protect. This Health Access paper surveys the literature on the savings and debt of California families, and concludes: providing or requiring high deductible health plans does not provide a benefit to a majority of Californians, who have minimal assets to protect.

A review of the literature on Californian's assets and debts reveals:
* 40% of Californians have a net worth of $7,000 or less, including their car, 401(k) plans, savings, although excluding any home equity. An additional 20% have a median net worth of just $12,333.
* This 60% of California would, with a $5,000 deductible and out-of-pocket maximum of $10,000, would likely have to, in the best case scenario, deplete all savings and sell the family car to deal with one major medical incidence in just one year. A chronic condition over several years would bankrupt such families.
* While most people have their savings invested in their home, California ranks 49th in homeownership among the 50 states. In California, a majority of income groups, even up to those who make up to $50,000/year, do not own a home, as is the case with significant percentages of those even above that income (40% of all Californians, and those between $50,000-$75,000/year, also don’t have a home).

Consumer advocates argue that Californians need comprehensive coverage, not the catastrophic coverage that would still leave many middle-class families financially vulnerable. Under a high-deductible plan, many middle-class families would still be wiped out by a one major medical incident, or face bankruptcy if they have an ongoing chronic condition. Advocates state that paying a premium, even a cheaper one, isn’t worth it if the insurance doesn’t provide needed care upfront, or provide financial security after an emergency. For these middle-income families, these high-deductible plans would be a burden, not a benefit.

Health advocates have also attacked high deductible health plans as discouraging the needed care that health coverage is supposed to provide. Compared with the overall population, patients with high deductibles are half as likely to go to the doctor, half as likely to fill a prescription and half as likely to go to an emergency room. While some high deductible plans may provide some limited preventative care upfront, none provides the disease management of chronic conditions that are proven to not only improve health outcomes, but also save health care costs.

The report can also be found at www.health-access.org.

Consumer advocates have argued that any health reform plan should have guarantees of affordability, not just for the premium, but for the deductible and overall out-of-pocket exposure. Health Access will release another paper next week that focuses on defining affordability for consumers.

This message was a theme of the It's Our Healthcare "Road to Reform" tour, a four-day, six-city series of events starting in San Diego on Monday and ending today in Sacramento with a boisterous rally. The public campaign continues to move forward, working to involve regular California consumers in the health care debate, at:

Health Access California's resource page on health reform is at our website at: http://www.health-access.org.

Our blog, updated daily, has other updates on the health reform debate this year:

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posted by Anthony Wright | Permalink | 7:42 PM


This is NOT from Publisher's Clearinghouse..

The lawyer for a deceased client in LA was a little surprised when she opened her client's bill and found a $1 million .... bill.

The hospital bill for $962,120 was 20 times what the lawyer had been told her client owed for her four-day stay at the Glendale Adventist Medical Center falling and suffering minor injuries last year, according to an LA Times story today.

That's right. The bill was 20 times higher than what the hospital quoted as $46,106. And what the hospital quoted was 10 times higher than what the insurance company's rate, which was $4,350.

These numbers, while imposing, are typical -- if you're uninsured. The client HAD insurance, and only had to pay $150.

But uninsured? If you're lucky, you'd get the $46,106 bill. Not? You'd better hope Ed McMahon comes knocking on your door with sweepstakes prizes.

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posted by Hanh Kim Quach | Permalink | 5:53 PM


No maternity! No new drugs! Buy now!

Wednesday, June 27, 2007
It's rare when a company advertises what its products don't do. Except if you are Blue Cross.

Saw another newspaper ad by Blue Cross yesterday trying to place some doubt onto health reform. Oddly, the pitch was the insurer wanted to "continue to provide consumers more choice and flexibility, and keep premiums affordable--for example offering plans without maternity coverage for seniors and plans that cover only generic drugs."

Let's look past the false statement that places their "premiums among the lowest in the country." California actually ranks in the middle of the states in terms of health care costs.

Some of their products may have a lower premium that others, but are we comparing similar products? Is it really a more "affordable" product if it doesn't cover as much, and sticks you with the bill later? So if your next ailment requires a new drug, rather than one where a generic is available, that plan would be immediately unaffordable.

More importantly, by charging some people less, it means that others get charged much more. Blue Cross, who wants to charge women of child-bearing age more than the rest of us, might want to think they get off easy. My wife, who endured a 48-hour labor, might disagree. (The fact that they chose to illustrate this ad with a young mother, father, and baby is even more galling.)

Despite all the carping about the mandated benefits in California, Blue Cross says they specialize in "giving consumers more innovative coverage options than anywhere else in the country." Choice isn't a virtue if the choices are bad ones--and in this situation, for both for the individual consumer and the system as a whole.

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posted by Anthony Wright | Permalink | 5:04 PM


Women and Health and the Glass Ceiling

We all know gender inequality issues still exist in the workplace. Men still get paid more than women. Fewer women are promoted than men.

Another place where gender discrimination is allowed to tacitly continue is in health care. As recently as 2002, women were charged copays of between $500 and $2,000 to deliver babies. Meanwhile (mostly or only men) who had prostate surgery, back surgery, brain surgery, coronary bypass surgery did not have to pay copays.

(Some might argue that maternity costs more. Not so. Average costs for labor and delivery was $1,980 then. Meanwhile, average costs for surgeries for those other procedures ranged from $4,422 to $29,539 -- okay, now i'm really annoyed).

Why am I upset about this now?

Here's the situation: Gov. Arnold Schwarzenegger and Republican cohorts are constantly calling for "flexibility" that would allow insurance companies to offer consumers more "choice'' and more "affordable'' options.

What they really mean is getting rid of a host of "benefits'' that California wrote into the law years ago to make sure health coverage actually covered health care.

Here are some of the benefits they're talking about. (see a full ist of mandates here) California mandates 23 benefits; six directly relate to women. They include coverage for:
  • complications of pregnancy, (for plans that provide maternity benefits);
  • breast cancer screening, diagnosis and treatment;
  • mammograms;
  • cervical cancer screening (if policy includes coverage for treatment/surgery of cervical cancer)
  • prenatal in the Expanded Alpha Feto Protein program, if maternity benefits are included
  • prescription contraceptive methods (if prescription drugs are part of the benefit package)
Two other mandated benefits are "tweeners,'' while they could apply to both genders, I would say they predominantly apply to women:

  • diagnosis, treatment and appropriate management of osteoporosis
  • immediate accident and sickness coverage for each newborn infant and adoptive child.

Of course, the biggest cost for women -- maternity coverage -- is not a mandated benefit and was actually vetoed by Schwarzenegger in 2004 on the grounds that it would make coverage too expensive for everyone. As I pointed out earlier in this post, the collective "we'' pays for a lot of health care that is used primarily by men, including the gov's various heart surgeries.

So don't buy the wrap about "choice,'' "flexibility'' and "affordability.'' It's just another way to help keep women in their place.

Click here for the San Francisco Chronicle's excellent Sunday Op-Ed about women and health care.

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posted by Hanh Kim Quach | Permalink | 1:00 PM


Heartburn by Blue Cross

Tuesday, June 26, 2007
I spoke in front of Congress of California Seniors today at their 30th Anniversary Convention in Long Beach, and got a laugh in my presentation by saying off-hand that "living over 50 is a pre-existing condition." But the truth may be worse...

Last week, in response to my op-ed about young graduates falling off of coverage, I got an E-mail from a 27-year old Ph.D. student denied for Blue Cross' "Tonik" product, because of a high cholesterol test.

Today, health policy-obsessed blogger Ezra Klein posts a letter to Blue Cross by a 28-year old denied for coverage for the pre-existing condition of... heartburn.

(In a similar vein, Lt. Governor John Garamendi also spoke today, and lambasted Blue Cross of California as a "lying bunch of thieves.")

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posted by Anthony Wright | Permalink | 8:03 PM


Gov spends QT with insurers

Monday, June 25, 2007
Gov. Arnold Schwarzenegger told health insurers, "I need you,'' Friday at the industry's convention in Las Vegas.
Noteably, he said he wouldn't support a system where insurers would "go away'' -- a not-so-veiled reference to SB840 (Kuehl), the Legislature's universal, single-payer legislation.

Another thing Arnold said that irks health advocates:
"My plan also reforms some of the state's regulation that now stand in the way of your industry being able to offer lower-cost products to employers and individuals.''
The Translation: Let's get rid of "pesky mandates'' like mammograms and other cancer screenings, preventive care for children, treatment of osteoporosis. If we don't cover health care, health coverage will be cheaper.

The guv also said that while he didn't support "artificial means'' to bring down costs, he believes plans need to play a role in being "efficient, cost-effective, and focused on quality." This emphasis on efficiency and quality -- and insurers reponsibility to assure that -- goes further than what the guv said in January when he unveiled his health reform plan.

Lastly, the guv praised a number of health plans EXCEPT Blue Cross, who are "on board'' with his notion that people shouldn't be denied coverage because of pre-existing conditions. Blue Cross has put $2 million so far into defeating health reform efforts in the state -- which obviously is annoying the gov.

Watch his remarks and read the transcript here.

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


A better deal for employers, part II

Sunday, June 24, 2007
In my last post, I talked about how AB8(Nunez/Perata) was a better deal for employers than 2003's SB2(Burton), less burdensome yet more comprehensive. For those employers that provide coverage, and those that want to, it provides a new, affordable option for them.

How about in comparison with the Governor's proposal? Many reports simply compare the minimum employer contributions in the two plans, 4% in the Governor's plan, 7.5% in the legislative leader's plans. Especially since most employers are spend 8-14% of payroll, it seems superficially that the Governor's plan lets employers off much easier.

But the real question is what employers get in return. As consumer advocates, we just don't argue for the lowest price, but the best value for the dollar.

Under the Governor's plan, those employers that don't provide any health coverage would have to pay a 4% fee. But they wouldn't get any special added value whether they paid the fee or not. The Governor's plan does broadly expand public coverage programs for families up to 250% of the federal poverty level, around $25,000 a year for an individual, or $50,000 for a family of four. For those employers who don't provide coverage and thus pay the fee, their workers over 250% of the poverty level are left to buy coverage on their own.

In contrast, under AB8, the employer who doesn't provide private coverage and pays the 7.5% fee gets to cover his entire workforce (including full-timers and part-timers) through the statewide purchasing pool. That employer gets the benefit of a fully-insured workforce, one that is healthier, more productive, and has less turnover and thus fewer retraining costs.

Most employers have workers at a range of incomes, from entry-level and lower-skill workers to managers and specialists. For these employers, the structure of AB8 seems to be a much better value.

Of course, if the employer doesn't want to provide any coverage, then these details don't matter: they will simply oppose any reform. But for the vast majority of employers that do, or that want to, provide coverage, these different structures of the proposals make a difference, much more than a comparison of 4% and 7.5%.

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posted by Anthony Wright | Permalink | 12:34 PM


The ghost of SB2

Saturday, June 23, 2007
There's still more work to do on the newly revamped AB8(Nunez/Perata). A delegation of top consumer advocates will be meeting with Speaker Nunez and other key legislators on Monday.

But it's important to acknowledge that the proposal has improved, not just from where it is now, but from some past proposals. Many have compared this to 2003's SB2, but this structure is significantly different, at once less less burdensome on the employers impacted, and much more comprehensive for California consumers.

Under the concept of "shared responsibility," AB8 doesn't just set a minimum employer contribution to health care, as some articles have suggested. It includes contributions not just from employers but from individuals, reinvested state dollars, and new federal funds. It expands and streamlines public programs. It has significant reforms on insurers, in general and in particular in the individual market. Any of these provisions, by themselves, would be a major, headline-worthy, health initiative in any other year.

Most employers will not have to make any changes under AB8. And many employers will benefit. They will now have a new, affordable option to cover their workforce, at significantly less than what they pay now, or what is available on that market. Some will be relieved to no longer have to administer a health benefit. The amount, 7.5%, is by definition as a percentage, scaled to the size of payroll, which provides additional benefit to smaller and low-wage firms. Even for those that don't provide coverage now, they will pay a set amount and in return get a healthier, more productive workforce with less turnover and less retraining costs.

Let's contrast that with SB2, which Health Access California strongly supported as a step forward to getting Californians coverage and security. On businesses, SB2 would have simply required that employers have to provide 80% of the cost of a premium for a standard HMO pack. Many employers do that, and many, many employers were neutral on SB2, given that it really wouldn't have impacted them.

Under AB8, most employers also wouldn't have to change a thing. The differences are beneficial to the employer: under AB8, the minimum contribution is 7.5%, which takes into account size of payroll. Paying the fee to have your workers covered in the statewide pool is less than the average 12-14% than employers pay on average now. They have a new affordable option to provide coverage to their workers. If the 7.5% goes up, it does so only after a public process and deliberation--rather than the status quo, which is to have the costs go up automatically as a percent of premium.

This assistance to employers is possible because of public programs and reinvested state dollars, from aggressive use of bringing in California's fair share of federal funds, and by having the statewide purchasing pool bargain for the best rate. There are also several cost containment components of these bills, and more clearly should be done on that front. We would hope that employers, and the groups that represent them, would support many of the efforts that consumer groups have fought for in past year to help control costs.

Some employers are less inclined to provide coverage to their workers, and will oppose any health reform, no matter how litle is required. But for employers that provide coverage, and those that want to provide coverage, AB8 is not a burden, but a benefit.

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posted by Anthony Wright | Permalink | 8:41 AM


Seeing SiCKO Saturday?

Friday, June 22, 2007
Health care activists are putting out the word that Michael Moore's "SiCKO" is playing this Saturday, June 23rd, at key locations around the country. The attendance and response on Saturday may very well have an impact on how wide the movie opens next week, on June 29th. Since many see that the film will propel the health care reform discussion forward, health care activists are urging folks to go see the film, at the following "selected" locations:

Here are the list of theaters in California:
* Pacific ArcLight Cinemas, Hollywood
* AMC Santa Monica 7, Santa Monica
* Edwards University Town Center 6, Irvine
* Pacific Galleria Stadium 16, Sherman Oaks
* Century 9 San Francisco Centre, San Francisco
* AMC Bay Street 16, Emeryville
* Century Stadium 14, Sacramento
* AMC Mission Valley 20, San Diego
* Landmark La Jolla Village Cinemas 4, La Jolla

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posted by Anthony Wright | Permalink | 9:48 AM


Places, everybody. Places... Showtime!

Thursday, June 21, 2007
Thursday, June 21, 2007


* Newly-amended AB8(Nunez/Perata) to be heard on July 11 in Senate Health Committee
* Changes include: No individual mandate; affordable premium guarantee in pool
* Negotiations with Governor still expected into the summer

New on the Health Access WeBlog: Full SiCKO Coverage and Review; White House Hopes for Health Care; State Rankings; Limited Benefit Plans; Graduating into Uninsurance

Assembly Speaker Fabian Nunez and Senate President Pro Tem Don Perata, on Thursday, announced at a Capitol press conference that they would be merging their two health reform bills, AB8 and SB48, respectively into one bill – AB8 (Nunez/Perata).

“This is an expression of faith. This is an expression of real hope and real progress’’ to move the bills forward, Nunez said.

Having passed the full Assembly on June 7th, AB8 (Nunez/Perata) is expected to be heard in Senate Health Committee, chaired by Senator Sheila Kuehl, on July 11th. After the budget deliberations are completed, it is expected that the bill will serve as the basis for negotiations with Governor Schwarzenegger into the summer.


Senator Perata indicated that the leadership proposals were already "90% similar," seeking to provide more security so people can get and keep coverage from their employer, through a public program, or by purchasing it as an individual. It would extend coverage to roughly 70% of the uninsured,and better ensure that the insured will get the coverage they need when they need it.

The previous bills, as well as the new AB8:
• Would require employers to contribute at least 7.5 percent of payroll to their workers' health coverage. Employers would either provide private coverage for their workers, or pay such a fee.
• Would create a state-run purchasing pool, to provide a new, affordable option to cover their full workforce.
• Would expand existing public programs to cover all children, and subsidize coverage for more lower-income parents through this state-run purchasing pool.
• Would draw down new federal funds by bringing in more matching Medicaid money.
• Would also impose some new rules on insurers, including preventing rampant rejection of consumer for "pre-existing'' conditions, and limiting the amount of premium dollars that goes for administration and profit.

The changes announced today did not change that basic framework, but were noteworthy for consumer advocates who were particularly concerned about affordability.

The bill does not include an "individual mandate"--a requirement that Californians, even those without access to public programs or employer-based group coverage, buy coverage on the individual market. “We know there’s a difference of opinion with the Administration. The reason we decided (to take out the individual mandate) is we need more time to figure out whether or no there is an affordable health care product for the average worker,’’ said Nunez. Given the interest by the Governor, and the financing issues, Perata said of the individual mandate, "that's not there, but it's not dead."

Another key provision was a guarantee that workers in the purchasing pool would not have to pay more than 5% of their income for the premium, an important protection for lower-wage workers. Consumer advocates viewed this as an important step, although they will continue to advocate for corresponding guarantees on out-of-pocket costs, like deductibles.

The amendments does not introduce new concepts to the legislation, including ones that have been supported by consumer advocates, such as public review of insurance rates, or additional cost containment provisions. Rather, the amendments largely reconciled differences between the previous bills, and in that regard, most of those amendments made the legislation more favorable to consumers.

With the amendments, AB8:
* Does not contain an mandate on consumers to buy coverage in the individual market (as was required in SB48).
* Assures that premiums do not exceed 5 percent of income for workers earning less than 300% of poverty ($51,510 for a family of three) who are in the statewide purchasing pool.
* Requires all employers to pay at least 7.5 percent of payroll toward the health care for their workers. (Previously, Nunez’ legislation had exempted some businesses)
* Allows MRMIB to adjust employer fees on health coverage.
* Makes Section 125 plans available to all workers, to get a state and federal tax break on health premiums;
* Extends small group insurance rules to mid-size employers from 51-250 employees;
* Allows everyone without serious medical conditions to buy coverage in the individual market. Those with specified medical conditions would go into a high-risk pool, which is funded by an assessment on health plans.

To see the full description of how AB8 and SB48 were merged, click here.


Nunez and Perata fielded a wide range of questions at the press conference. Here are some of their responses:

On AB8’s compliance with the federal ERISA law?

Nunez: “This is a very different approach... nothing that can be compared to Maryland or even the Hawaii case... . We feel very confident, in the face of ERISA, we are going to be very consistent with federal law. The bigger threat, to be honest with you, is with a referendum. We’re being very careful to not make this bill a Christmas tree that includes everything that everyone wants to throw into it... That is the danger of having a bill like this. There might be some that think, OK, this is really going to happen now.... We are thinking about minimizing the potential for a referendum."

What about exemptions for small businesses? Why isn’t it there anymore?

Perata: "We had everyone all in for ours (SB48) because, even though we’ve heard the plight of small businesses, the program simply does not work... and puts the burden and strain on other parts if you take it out.…That's going to be an issue that will be negotiated, I'm sure. We’re still trying to look at the cost pools. If this were easy, it’d be done.... But now there’s a single vehicle, and people will be paying even more attention.

Nunez: With respect to the question about the employer exemption, to be honest with you, so far, I’ve only gotten criticism for it. No one’s come to the table saying they really like that provision. We didn't see a lot of small businesses running to support us. In fact, people said we didn't like this. There didn’t seem to be a lot of support for that provision.

What are the key differences with the governor’s concept of "shared responsibility"?

Nunez: We agree. We all have a role in this, the Governor says it is shared responsibility, that's fine. I think our bill is pretty consistent with shared responsibility. Everbody has a role to play. Everyone has to tighten their belt. The providers, the doctors and hospitals, the insurance industry. Workers got a responsibility. Employers have a responsibility. and state and federal government has a responsibility... Ours is consistent with that value of shared responsibility.

Perata: You also can't expect people to be responsible if you don't offer them the opportunity to be responsible. And there's so many people people shut out of the system right now. Conceptually, there no disagreement at all between the Governor's ideas about health care reform and what this bill does. And we are hoping now we can get even more focused on discussing it. If it goes downstairs, (the bill)’s gotta be something (the governor’s) comfortable signing.


The new amendments do much to help consumers, but health advocates believe that more still needs to be done.

For instance, while the new AB8 caps premiums at 5 percent of income for workers, it does not factor in the costs to use the plans. After paying premiums, consumers still must pay copays, deductibles and out-of-pocket maximums – which in some cases – forces workers to spend as much as 32 percent on health care.

Consumers could also be further protected from price volatility if the state played a greater role in reviewing insurance rate increases and forcing plans to justify when they decide to raise premiums. This could help to mitigate the wild double-digit premium increases that we’ve seen the past decade.

Consumer advocates also remain concerned about workers who may lose coverage when they are between jobs


On July 11, AB8 will receive a thorough review in Sen. Sheila Kuehl’s Health Committee. At some point in July, both leaders will also meet with Gov. Schwarzenegger to try and reach consensus on issues where they do not agree.

Health Access will continue to provide updates as AB8 progresses.


Gov. Arnold Schwarzenegger held a press conference about how the state’s current health care landscape discourages entrepeneurship as people are afraid to light out on their owns and start their own businesses because they would not be able to get job-based health coverage. Watch a webcast of the event on the Governor's website here.

The American Heart Association, the American Lung Association, the American Cancer Society, and PICO California called for an increase its tobacco tax to help fund health care reform, as part of the mix.

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 | 8:01 PM


The three ring circus...

Several health events today...

At 10:00am, Governor Schwarzenegger has a press conference about "job-lock," with people who make career and life decisions in order to get health coverage. It's a big issue: we constantly hear of people who give up their dreams of entrepreneurship for the corporate or government job that will provide health coverage; or the people who unhappily stay in jobs (or marriages) for the health coverage. All this makes the economy less efficient. The solutions? Beyond having a universal system as in SB840(Kuehl), we could at least ensure that all employers are contributing toward their worker's coverage, that our public programs are less restrictive and cover those who need assistance, and that insurers can't deny coverage because of one's health status.

At 10:30am, the American Heart Association, American Lung Association, the American Cancer Society, and PICO California are introducing the notion of a tobacco tax in the debate, as another potential funding source for health reform. Not only would such a proposal continue to decrease smoking and have positive health impacts, but the revenue could fill some gaps in the proposals, to further extend coverage and/or make it more affordable.

At 11:00am, legislative leaders Speaker Fabian Nunez and Senate President Pro Tem Don Perata will be announcing that they are advancing with one bill, rather than the two that are in print today. If there was any doubt, this sets the stage for the next part of the debate in Sacramento. We'll have more of an update later today.

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posted by Anthony Wright | Permalink | 9:55 AM


White House hopes...

Tuesday, June 19, 2007
With all that's going on in California, we haven't covered the presidential candidates and their health care plans too much.

It has been covered by several blogs, including two by independent-minded folks who used to work in the insurance field.

This week, Joe Paduda in Managed Care Matters is at the annual progressive gathering of Campaign for America's Future, Take Back America. He's providing up-to-the-minute reporting of what the candidates are saying about their health plans. So far he's written on Obama, Edwards, and Richardson.

Bob Laszewski at Health Care Policy and Marketplace Review provides a broader context and some insight, wondering where the Republican candidates are on health reform, and noting that the Democratic candidates plan to make health care an issue--but not to distinguish themselves in the primary.


posted by Anthony Wright | Permalink | 2:10 PM


Just above Tennesee and Alabama.

Monday, June 18, 2007
The Commonwealth Fund put out state rankings, based on a Scorecard of Health System Performance. Interesting data.

California's profile is here. And it's not good: 39th overall. 44th in "Access." 50th(!) in "Quality." The national report indicates there's a correlation: "insurance matters." Either way you look at it, there's a lot to work on here.

We do well on the "Healthy Lives" indicator (3rd), although that may be related to the relatively younger mix of California's population.

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posted by Anthony Wright | Permalink | 4:22 PM


Slipping through the net

USA Today last week ran an interesting story about a new breed of health plan that's been hitting the markets: limited medical benefit plans.

Policyholders for these plans pay low premiums to get the illusion of coverage. When an enrollee actually gets sick, they'll find they're insurance to be little more than a bandaid on a broken bone.

Some policies -- such as one offered by Aetna -- cover as little as $2,000 a year. So as long as you have an emergency that doesn't cost more than $2,000 you'll be fine. But other than that....

I bet the premiums paid add up to more than what you actually get out of the coverage.

Seems to me this does exactly the opposite of what a good health coverage policy is supposed to do. We buy health care as a safety net to protect us against financial ruin. But these plans are like a safety net that the rats chewed through.

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posted by Hanh Kim Quach | Permalink | 10:57 AM


Piling on...

Thursday, June 14, 2007
New Health Wonk Review out. Also, Matthew Holt at The Health Care Blog points out that high-deductible and consumer-directed health plans (CHDP) are failing in the market--ironic, since they are often promoted by those who have absolute faith in the market.

He pulls no punches, ending with: "the CDHP is the bastard child of a one night stand between a benefits consultant with nothing to sell and a right-wing think tank that can’t do basic math."

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posted by Anthony Wright | Permalink | 1:07 PM


From "me'' to "we''

A number of users have posted clips on YouTube of Michael Moore's appearance in Sacramento to promote his new movie, SiCKO.

Here's a link to one of them, which will link you up to a whole mess of snippets from his press briefing, rally, legislative briefing and premiere.


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posted by Hanh Kim Quach | Permalink | 12:43 PM


Two thumbs up...

On Tuesday, the festival atmosphere in Sacramento around the movie "Sicko" was the biggest media frenzy since the potent combination of celebrity and politics came together during the recall campaign.

Folks in Sacramento are still talking about the movie, but the focus is on the actual movie. A few reactions.

I don't want to spoil the movie for those who may go see it after it opens on May 29th. So instead of saying what the film is, I'll say what it is not:

It isn't too sad, or too serious: While I have my own critique of Michael Moore's style and politics, I have followed him closely throughout his career, not just Roger & Me and Farenheit 911, but The Big One and Bowling for Columbine, and, most importantly, his TV ventures TV Nation and The Awful Truth--which were precursors to the "fake news" satire now provided by Jon Stewart and Stephen Colbert. Throughout his work--even on a subject like Columbine--there's been a wit and a humor in showing the absurdity of our situation, and that as true with Sicko.

In a film that has wrenching health care horror stories--several people I know in the audience cried--it's punctuated with several laugh-out-loud moments. Some are profound, some are simply silly. For a serious subject, and in a film with deadly serious moments, there is welcome room for levity and fun.

It isn't about the uninsured. The opening credits starts with some examples of uninsured people and the tough choices they have to make. But Moore's narration is clear: the film isn't about them. His focus is on the problems facing the insured, and underinsured, and then an explanation of the health systems of other countries. As a political strategy, it's understandable: over 90% of voters are insured.

This doesn't mean that Moore doesn't believe that insurance doesn't matter. He was clear Tuesday that people should be covered, and that not having coverage has a real cost to people, including in lives. But he also offers a damning indictment of insurance companies.

It really isn't even about health care. As a consumer advocate on health care issues, I tend to stay focused on the topic at hand. Moore, on the other hand, perhaps as he is firmly identified as an icon on the left, deliberately wades indiscriminately into the minefields of recent American politics: President Bush, Soviet-era communism, 9/11, France, Guantanamo Bay, Cuba, Castro, Che Guevara, taxes, and the "nanny" state (literally!) and European-style socialism.

It's the luxury of communicating in a 2-hour movie rather than a 10-second soundbite. But these sojourns aren't digressions from his main point: he ultimately is trying to make a much bigger point about "America's soul." Moore is trying to convince people of something more than just the need for a universal, even single-payer, health care system. He's advocating a different way to view government and society.

He merely uses health care as an example for a much broader discussion, that encompasses education and child care, how we treat the homeless and mentally ill, and about our society focused on "me, not we."

That said, health care is a useful issue to make these points. Health care works best in group coverage, when we share the risk and cost of care, knowing regardless of how healthy we are, that one day, by age or accident, we will need significant care ourselves. Health care works worst--and is most expensive--when the individual is left alone, at the mercy of the big insurers and providers. And that's a lesson for the health reform discussion in both California and the nation.

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posted by Anthony Wright | Permalink | 1:02 AM


Graduating into insecurity...

With Anita Grier, president of the City College of San Francisco, I had an op-ed in the San Francisco Chronicle today on how graduates (and young people in general) are likely to find themselves uninsured... and how health reform options might provide some relief and security.

Young folks know these issues. The young voted overwhelmingly for Proposition 72 in 2004, more than any age group. If they turned out in Californian at the same levels they did nationally, that significant health reform proposal, which got 49.2% of the vote, would have passed. The young have a big stake--and need to have a big impact--in the debate in Sacramento this year. I've reprinted the op-ed below.

New Graduates Fly Without a Safety Net

by Anita Grier and Anthony Wright

Congratulations, grads. Revel in these last few days while you are still cocooned and cared for in your families and school communities. After graduation, your search for the basics to support your life will be more precarious and risky.

That's because graduation also means almost 400,000 of these young adults (younger than 24) will be cut off from health insurance under their parents' plans or from their universities. A report by the Commonwealth Fund (www.commonwealthfund.org) showed that 2 out of 5 college graduates are uninsured after they leave school.

In California, 20-to-29-year-olds make up the largest percentage of uninsured, at 29 percent. Now some critics say that it is their fault. They think young people are slackers, or don't care about their health, or are spending a fortune on the pleasures of the here and now.

They are wrong. Young people tend to pick up coverage at the same rates as other age groups.

For many new grads who are out looking for work, it's an even harder job to find affordable health coverage.

According to the most recent California Health Interview Survey (www.chis.ucla.edu), young adults are four to five times less likely to be eligible for health care on the job, compared with adults in all other age groups. Why? Young people starting their careers now face a changed job market, with an increased reliance on temporary workers, subcontractors, part-time workers and extended probation and waiting periods. What's more, 20-to-29-year-olds are more than twice as likely to be in jobs that don't offer coverage at all.

So what's a young person to do? If you've shopped for insurance as an individual lately, you already know the answer. Insurance companies don't have to sell you coverage, when you're buying on your own. If you've got a "pre-existing" condition, you're out of luck -- and your "condition" could be something as common as ear infections -- when you were a toddler. Of course, if you can find a company that will sell you insurance as an individual, be prepared to take out a health insurance loan (to go with your student loans now coming due). Health insurance for individuals is expensive (when you can find it).

Let's take a typical, healthy 23-year-old with a liberal arts degree (the top degree in the state), with an entry-level position that would earn about $35,000 in San Francisco. The young adult would have 101 plans to choose from: a "typical" low-end plan starting at around $50 a month.

What does $50-a-month buy you? No coverage for primary care visits, no prescription drug coverage (which means no birth control or antidepressants) and no maternity. Women are allowed OB/GYN examinations but must pick up at least 25 percent of the cost of the office visit. So what are you paying for? Coverage that doesn't kick in until you've spent at least $1,500 for a deductible. Deductibles for these "less expensive" plans can be $5,000.

Blue Cross has an entire line of products dedicated to twentysomethings, called "Tonik" with high-deductibles and no coverage for what a young person is most likely to need -- maternity.

By contrast, the average single California worker who receives coverage on the job pays the same amount, but receives more comprehensive benefits -- such as a fixed co-pay for doctor's visits, and prescription drug coverage. Young adults who want traditional, comprehensive plans that many of us get on the job, they would have to pay no less than $90 a month and up to $410 a month. For new graduates beginning their careers with entry-level salaries and loads of student loans, asking them to pay $46 a month for a policy they can't be used until they've spent at least $1,500 is unreasonable. They're practically paying to be uninsured. Blaming their lack of insurance on them because they can't afford a richer plan is unfair.

We should be focused on systemic changes to ensure that we all share the responsibility of making sure that Californians, young and old, get good, affordable health care. Gov. Arnold Schwarzenegger and leaders in the state Legislature have started that process. We need to make sure they follow through with real health-care reform this year.

A long-standing proposal that could help all Californians -- not just young adults -- is SB840 by state Sen. Sheila Kuehl, which would create a universal, single-payer, Medicare-like system in California. The proposals of Assembly Speaker Fabian Nuñez and Senate President Pro Tempore Don Perata make it more likely for young adults to achieve on-the-job coverage by setting a minimum employer contribution of 7.5 percent of payroll on both full-time and part-time workers' health care. Other reforms in the discussion that would help young adults include: reforming the insurance market for people who must buy coverage on their own; expanding public health programs; guaranteeing that coverage is affordable to buy and use; and setting a minimum standard for insurance packages -- rather than promoting and encouraging bare-bones plans.

Policymakers could also take a cue from other states, such as New Jersey and Utah, which require private insurance to cover dependent children up to a higher age -- 25 or 28 years old, as they pursue higher education.

As for this year, no "break a leg" wishes when your senior goes up to get her or his diploma. In the current state of health care, that could be one expensive wish.

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posted by Anthony Wright | Permalink | 12:56 AM


Bundles of $-J-$-O-$-Y-$

Wednesday, June 13, 2007
Kaiser Family Foundation and Georgetown University have a new study about how families enrolled in high-deductible health plans pay more than twice as much for child delivery than families with traditional health coverage.

Well, Duh.

The study shows that the average cost of a normal delivery with a traditional plan is $1,455.
Those with high-deductible plans bought on the job would pay between $3,000 to $7,000 for a normal delivery.

That $3,000 to $7,000 is only if you can get coverage on the job.

If you're buying coverage on your own, high-deductible plans rarely even offer maternity coverage.

Karen Pollitz of Georgetown's Health Policy Institute sums it up in the Washington Post:

"If you are contemplating having a baby or having any kind of big heatlh event, this is not the policy for you.''

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


Moore reporting...

Tuesday, June 12, 2007
Documentary filmmaker Michael Moore today called for insurance company executives to be tried on manslaughter and premeditated murder charges when policyholders were denied care by the companies and die as a result.

Moore, who was in town to promote the release of his new movie SiCKO, testified at a hearing by Sen. Sheila Kuehl, the five-time author of California's universal single-payer health care plan. He was greeted by an enthusiastic crowd of 1,000 nurses, physicians and other supporters of universal health care.

"I’m here,'' with other lawmakers "in the hopes of igniting a movment across California and this country where the people are covered and where profit is no longer the deciding factor'' in getting people healthcare, Moore said.

The primary target of his invective Tuesday was the profit-making companies -- and some non-profit insurers -- who put money-making before patient care.

"My sincere hope is that California will once again lead the way in taking
on the private, profit-making companies that are gouging the citizens of
this state and country to line their pockets at the expense of those who are
sick, who are ill and who need help.''
More explicitly, Moore called such companies "immoral'' and "criminals.''

“There should never be room for the word profit when you’re trying to decide
whether to provide someone care. Our laws state very clearly that they have a
legal, fiduciary responsibility to maximize profits for shareholders. If they
don’t do that, they are required to turn as big a profit as they can. They only
way they can turn a profit is to not provide care.’’

The thrust of Moore's advocacy, however, centered around one state-provided system -- like Medicare or what is supported by Kuehl's legislation -- that would keep administration costs low and provide care to all citizens, not just those who can pay.

Moore's witnesses at the hearing included Andy Bales, CEO of Union Rescue Mission on Skid Row in Los Angeles, where hospitals have been found to dump patients -- in their gowns, IVs and colostomy bags -- who can't pay their bills. Also at the hearing was Dawnelle Keys, whose 18-month-old daughter died hours after being denied treatment at a nearby hospital because it was not affiliated with Kaiser, her insurer.

In addition to Kuehl's hearing, and a rally sponsored by the California Nurses Association -- among the chief proponents of SB840 -- Moore also appeared at a press briefing with Assembly Speaker Fabian Nunez, who supports SB840, and also has his own AB8 health care proposal. Unlike Kuehl's single-payer bill, Nunez' legislation does not get rid of health insurance companies, but does expand public programs and creates a statewide purchasing pool for coverage.

Moore was asked about that legislation, which provides coverage to two-thirds of the uninsured, and other bills in California. He responded "that's the system we all have," and described how he had health plans from Director's, Writer's, and Screen Actors Guilds. "Why should I have three plans and 47 million Americans have no plans?"

Earlier, he said, "Anything that moves toward single payer is a good thing, and I would support that.''

Speaker Nunez, who like many advocates is a supporter of single-payer, said he would change his legislation if he could get two-thirds of the Legislature to support the level of financial investment it would take to fund a more universal system. But the reality is, he said, Republicans won't vote for the bill. In the state Senate, not all Democrats would either. Sen. Lou Correa, D-Anaheim, did not vote for either SB840 or SB48, Sen. Perata's health reform measure.

Moore did, however, give props to Gov. Schwarzenegger, who released his own health reform plan this year. It has not been introduced in legislation, but elements and ideas are embedded in both Nunez and Perata's plan.

“His plan isn't the right plan, but it was very non-traditional Republican thing for him to do, to even say (health care) was a priority,’’ Moore said. “At least Governor Schwarzenegger is saying (health care) is a problem. Recognizing the problem--the old chiche--you're halfway there.’’

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posted by Hanh Kim Quach | Permalink | 3:34 PM


Moore momentum for health reform...

Bill Ainsworth at the San Diego Union-Tribune has a quick report on Michael Moore's day in Sacramento.

Frank Russo at California Progress Report has a more detailed report, with pictures and video.

Juls Rosen at Calitics also has her take.

My colleague Hanh will post additional coverage later.

This is obviously more momentum for health reform, broadly. As the quotes in these press reports indicate, Moore recognized there's no contradiction between full-throated advocacy for universal, single-payer health care as the solution, and recognizing and encouraging progress toward that goal, including covering children, regulating insurers, outlawing and criminalizing certain industry practices, and even acknowledging a Republican Governor for highlighting health care an issue--something, he noted, was not a focus of the presidential candidates in the Republican Party.

The coverage around universal health care was national: I just saw Moore's testimony on CNN.

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posted by Anthony Wright | Permalink | 3:23 PM


Calling in Sicko...

Senator Sheila Kuehl is hosting an informational hearing featuring filmmaker Michael Moore, being carried on the California Channel.

He has a full entourage of TV cameras and photographers following him, as he came from a meeting with Speaker Fabian Nunez. Later, he will go to a rally for SB840 (Kuehl), to create a universal, single-payer health care system.

Previewing the American premiere of his movie later in the day, he did mention that California is featured in the movie, although for the wrong reasons: the film features a case of a hospital dumping a patient on skid row in Los Angeles, and another insured patient who had their coverage rescinded after using it.

More to come...

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posted by Anthony Wright | Permalink | 1:08 PM


The up-to-date bill list...

Monday, June 11, 2007
Monday, June 11, 2007

* Dozens of health-related bills pass full Assembly and Senate, head to second house

New on the
Health Access WeBlog: BlueCross on WallStreet; Recent History of Health Reform; Coverage of Coverage

Bumping up against the June 8 deadline for bills to pass the first of two houses, lawmakers met in all-day sessions this week to ensure their bills advanced to the next level.

In addition to major coverage expansion legislation, AB8 (Nunez), SB48 (Perata) and SB840(Kuehl), which passed both Wednesday and Thursday, a few dozen bills of interest to health advocates also were heard and debated. Following is a list of the bills, the votes, a short description, and the position of Health Access California.

For a handout with this bill list, advocates may also visit the Health Access website, at:

Coverage Expansions

* AB8 (Nunez) -- 47-32 --Would enact several health care reforms to secure and expand coverage for millions of Californians, by setting of a minimum employer contribution for worker healthcare, a statewide purchasing pool, expanded public programs for children and adults, and new rules for insurers, including access for those with "pre-existing conditions." (See previous updates.) Support if amended.
* SB48 (Perata) -- 23-16 --Would enact several health care reforms to secure and expand coverage for millions of Californians, by setting of a minimum employer contribution for worker healthcare, a statewide purchasing pool, expanded public programs for children and adults, and new rules for insurers, including access for those with "pre-existing conditions." (See previous updates.)
* SB840 (Kuehl) -- 23-15 -- Would create a universal, single-payer health care system in California. The bill was passed by the Legislature in 2006 and vetoed by Governor Schwarzenegger. (See previous updates.) Support.

Children's Coverage

* AB1 (Laird/Dymally) – 47-25 – Would allow children in families up to 300% of poverty to enroll in Healthy Families. This is a repeat of the last version of AB772 (Chan), which was vetoed by Gov. Schwarzenegger in 2005. Support.
* SB32 (Steinberg) – 25-32 – Would allow children in families up to 300% of poverty to enroll in Healthy Families. This is a repeat of the last version of AB772 (Chan), which was vetoed by Gov. Schwarzenegger in 2005. Support.

Access to Care

* SB275 (Cedillo) – 24-13 – Would prevent patient dumping by requiring hospitals to have a written policy on discharging patients, and requiring hospitals to appropriately plan post-discharge care with patients. Also prevents hospitals from moving patients to locations, other than their residence, without the consent of the patient.
* SB474 (Kuehl) – 38-0 – Would extend financing for federal hospital waiver and Coverage Initiative. Support.

Legislation Related to Public Programs

* AB2 (Dymally) – 47-32 -- Would reform and restructure the Managed Risk Medical Insurance Program, for the medically uninsurable, who are denied coverage elsewhere because of “pre-existing conditions.’’ This is a repeat of AB1971 (Chan), which did not pass last session. Support.
* AB12 (Beall) – 47-32 – Would create the Adult Health Coverage Expansion Program in Santa Clara County which would be administered by a county or local initiative. Support.
* AB55 (Dymally) – 48-30 – Would increase Medi-Cal eligibility for adults to 133% of poverty. Support.
* AB343 (Solorio) – 47-32 -- Would require the state to disclose names of employers who, rather than providing health coverage, have many of their workers and their families on Medi-Cal and Healthy Families. Gov. Schwarzenegger vetoed a similar bill – AB1840 (Horton) -- last year. Support.
* AB910 (Karnette) – 71-1 – Privately-purchased health coverage for children with ental or physical disabilities would not end at a certain age. Support.
* AB1113 (Brownley) – 50-27 -- Extends and increases eligibility for the Medi-Cal California Working Disabled Program. Support.

Insurance Reforms

* AB1155 (Huffman) – 52-25 -- Allows the Department of Managed Health Care to discipline health plans if they do not pay claims on time.
* AB1324 (De La Torre) – 55-17 -- Would require health plans to justify to DOI or DMHC why they are rescinding health coverage to enrollees. Health plans may not recover costs of care provided to enrollees unless they can prove consumers purposely deceived them. Support.
* AB1554 (Jones) – 42-33 -- Would regulate rates by requiring DMHC/DOI approval before copayments, premiums, coinsurance, deductibles or other out of pocket costs are increased.
* SB350 (Runner) – 38-0 -- Makes technical changes to California ’s landmark legislation last year that bans the practice of hospital overcharging.
* AB423 (Beall) – 47-30 – Would expand Knox Keene to include diagnosis and treatment of mental illnesses. Support.
* SB606 (Scott) – 25-15 – Would require pharmaceutical companies to disclose clinical trial results for drugs sold in the state. Support.

Bills that did not advance to the second house:

* SB1014 (Kuehl) Would impose an additional personal income tax for those earning more than $200,000 to fund a single-payer universal health care system under SB840. Support.
* AB770 (Hernandez) Provides that farmworkers should be offered health coverage. Farmers that provide coverage would be able to lower their total health care costs. Amend.
* AB961 (Hernandez) Would establish that every child born in California to a parent who receives Medi-Cal shall automatically be enrolled in Medi-Cal at birth to address DRA compliance. Support.
* AB1072 (Gaines) Would create the California Health Insurance Exchange within the Managed Risk Medical Insurance Board that would “facilitate’’ the purchase of health insurance. Amend.
* SB982 (Machado) Would establish that statements on applications for insurance that are later found to be false would not bar enrollees from collecting under that policy unless applicants knowingly provided false information.
* AB51 (Dymally) Would create a consumer report card for Medicare Part D plans. This bill was similar to AB2170 (Chan), which was vetoed by Gov. Arnold Schwarzenegger in September 2006. Support.
* AB52 (Dymally) Would require the state to operate a 24-hour, toll-free number for patients to complain about hospital facilities. Support.
* SB389 (Yee) Would prevent providers from directly billing consumers for the balance of bills that insurers don’t pay. Requires insurers to report violations to the Department of Managed Health Care. Support.
* AB368 (Carter) Would require insurers to provide up to $1,000 in hearing aid coverage for enrollees. Support.
* SB623 (Wiggins) Would relieve dually eligible seniors, on Medicare and Medi-Cal, from paying prescription drug copays between $1 and $3, which they were forced to do in 2006 after being shifted to Medicare Part D. Support.

Health Access will continue to update advocates on the status of legislation as it moves through the process.

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posted by Anthony Wright | Permalink | 2:25 PM


Out of the mouths of Blue Cross

In this health reform debate, people have been talking about the term "medical loss ratio," which is the term for how much money is spent on patient care, rather than administration, marketing, and profit. It's clearly a Wall Street term: How much money is "lost" to patient care? It shows the inverted priorities of an unrestrained industry.

It suggests that whatever insurance companies (or other companies) say to regulators, it is also important to see what they say to investors.

So I thank Don McCanne, of California Physicians Alliance and the Physicians for a National Health Plan for pointing the following comments by Wellpoint executives, the owners of Blue Cross of California.

He has for years sent out an invaluable "Quote of the Day" on health policy, along with his own commentary and analysis, all in his admirable and unyielding quest for universal, single-payer health care. And here's just another nugget, which really doesn't need comment:

Bank of America Health Care Conference
June 1, 2007
WellPoint, Inc.

Angela Braly, President and CEO, WellPoint, Inc.:

Let me conclude with a few investment considerations for you to take away from this presentation. Health-care costs continue to rise at a faster pace than overall inflation and are now projected to comprise approximately 20% of the gross domestic product by 2016. We believe that our strategic plan positions us very well to address this continued rise in health-care expenditures as we bring a superior value proposition to the marketplace and a strong voice in the community that helps in advocating a choice-based private health-care market.
The health insurance sector is continuing an era of consolidation. Back in 1995, the ten largest companies enrolled just 27% of the market, whereas today, the ten largest plans have about 52% of the market. Considering the investments required to effectively compete in new areas like consumer-directed health-care and comply with ever-changing regulations, many smaller plans are deciding to leave the industry or partner with larger plans to improve their competitive position.

WellPoint has a consistent track record of delivering on our financial promises to Wall Street and we expect this to continue. With our projected earnings of $5.54 per share for 2007, our compound annual EPS (earnings per share) growth rate will be 22% over a six-year period.
So in summary, we believe that WellPoint is a compelling investment opportunity with strong growth prospects, and I hope that you agree.

Wayne DeVeydt, EVP and CFO, WellPoint, Inc.:

I think one of the questions that I will get from many of you over the near term will be my philosophy, and I want to make sure everybody in this room understands and on the webcast that I’m fully committed to the 15% earnings per share growth and believe that that is sustainable for not only the near term, but the longer term.

Unidentified Participant:

We think it’s a compelling opportunity as well for investment and we appreciate very much you coming out, especially on such short notice. Congratulations on your promotion, both of you.


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posted by Anthony Wright | Permalink | 12:34 PM


It's not a new debate...

Sunday, June 10, 2007
For those who follow health care policy closely, it's a bit jarring to hear the debate in the Assembly and Senate last week, as legislators make floor speeches and speak in very broad terms about the issue.

While several legislators are very well-versed on health issues, most don't necessarily concentrate on the particulars of health policy, having to master a range of other myriad subjects. But part of the reason that Health Access spend the time to report on these legislative debates in committee and floor sessions is because they are instructive of the public discourse around health care, and useful for health care advocates.

For this year, we've had both informational hearings, policy committee hearings, and now floor votes on the various bills and proposals on health reform. Here's a compilation of links to our archived reports for this year:

2007 archived debate on AB8(Nunez), SB48(Perata), and SB840(Kuehl):
Floor debates on AB8, SB48: http://www.health-access.org/2007/06/legislature-goes-on-record-on-key.htm
Floor debate on SB840: http://www.health-access.org/2007/06/going-through-gauntlet-again.htm
Senate committee on SB48: http://www.health-access.org/2007/04/other-shoe-drops.htm
Assembly committee on AB8: http://www.health-access.org/2007/04/steps-forward.htm
Senate committee on SB840: http://www.health-access.org/2007/04/season-has-started.htm
Informational hearing on SB840: http://www.health-access.org/2007/02/gold-standard.htm
Assembly informational hearing: http://www.health-access.org/2007/02/assembly-weighs-in.htm
Senate informational hearing: http://www.health-access.org/2007/02/they-asked-right-questions.htm

Let's remember this isn't the beginning of the debate. It's instructive to see how past legislative sessions have had similar debates on these topics, from an earlier version of single-payer, SB921(Kuehl), to an employer mandate, SB2(Burton), to universal children's coverage, AB772(Chan), to other "individual mandate" proposals and other ideas. Here's some other archived reports that featured hearings and discussion among our policymakers:

2003-4 archived debate on SB2 and SB921

2005-6 archived debate on SB840, AB772 and other proposals

These debates provide a context for the work we do now.

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posted by Anthony Wright | Permalink | 11:10 PM


Coverage of coverage expansions...

Friday, June 08, 2007
In short order, we'll put up a list of health bills and their fates with regard to today's deadline to pass their first floor vote.

Even with all the bills, newspapers covered the passage of the big health reform bills, including Jim Sanders in the Sacramento Bee, Mike Zapler in the Contra Costa Times Jordan Rau in the Los Angeles Times, and Tom Chorneau in the San Francisco Chronicle.

Why was the vote important? I've always said that this debate was five years in the making: that the California legislature has previously voted to expand coverage to workers, to children, and to all Californians. But those all have been in previous terms, with a different list of legislators. With term limits and everything else, it was important for policymakers to come on record endorsing a range of reforms, some new, some old. It provides a baseline for the continuing debate this summer.


posted by Anthony Wright | Permalink | 12:51 PM


The Legislature goes on record on key reforms...

Thursday, June 07, 2007
Thursday, June 7, 2007

* AB8 (Nunez), SB48 (Perata), and SB840(Kuehl) passed on (virtually) party-line votes
* Debate touches on the need for rules in the health care market, expanded coverage
* Over 400 house parties hosted for health reform statewide by Its Our Healthcare coalition
* RSVP to see SiCKO; Full day scheduled for June 12th

New on the Health Access WeBlog: More commentary on floor votes; Past floor debates

The California Legislature's Democratic leaders, Speaker Fabian Nunez and Senate President Pro Tem Don Perata, having passed their health reform bills from their respective houses Thursday, are now looking ahead at trying to meld the two ideas together.


Both passed their respective SB48(Perata) and AB8(Nunez) bills Thursday. Both have similar features, seeking to provide more security so people can get and keep coverage from their employer, through a public program, or by purchasing it as an individual. Both are expected to extend coverage to roughly 70% of the uninsured.

Both bills:
• Would require employers to contribute at least 7.5 percent of payroll to their workers' health coverage, though Nunez does exempt smaller and newer businesses. Employers would either provide private coverage for their workers, or pay such a fee.
• Would create a state-run purchasing pool where workers could get health coverage if their employers don't provide it.
• Would expand existing public programs to cover all children, and move to subsidize coverage for more lower-income adults through this state-run purchasing pool.
• Would draw down new federal funds by bringing in more matching Medicaid money.
• Would also impose some new rules on insurers, including preventing rampant rejection of consumer for "pre-existing'' conditions, and limiting the amount of premium dollars that goes for administration and profit.

One difference between the two plans, though, is that SB48(Perata) would require Californians earning more than 400% of poverty ($40,840 for an individual, $82,600 for a family of four) to have health coverage, with some exemptions.


Senators got right to business Thursday morning and debated SB48 for about 30 minutes before voting 23-16 on the measure, in a near party-line vote. Sen. Mark Ridley-Thomas, D- Los Angeles, was not on the Senate floor when votes were cast. Sen. Lou Correa, D-Anaheim was the only Democrat to vote against the measure. Correa also voted "no" on Wednesday to SB840, Sen. Sheila Kuehl's universal single-payer health care measure.

Perata said this was the year to get something done. "It will not get any better unless we jump in the pool and get wet,'' he said. "When medical costs are going up five, six, seven times inflation, something is fundamentally wrong,'' Perata said. That will mean making tough choices, including the broaching the idea of denying care, for instance a hip replacement to a 90-year-old.

Sen. Tom McClintock, R-Thousand Oaks, warned that every state that has attempted to reform health care has ended up worse off. McClintock prattled off a litany of states, saying, "Every time and every place this concept has been tried, it has consistently produced massive cost overruns for government, massive increases in premiums for consumers, widespread fraud and abuse, and ultimately a deterioration in health care services and a rationing of what remains.''

He mentioned TennCare in particular, which he said resulted in increased taxes to pay for the state's attempt to provide health care to the sickest and most vulnerable. Some advocates who have looked at the TennCare model, which was undone recently, believe that the issue was that the state failed to negotiate lower costs for with insurers and drug companies. McClintock also attacked nationalized systems in other countries. "What makes you think European socialism is going to work any better than it does in Europe?'' asked McClintock, in the face of statistics that show industrialized nations with national health care systems do have better life expectancies and infant mortality rates than the U.S.

Sen. George Runner, R-Palmdale, also spoke. He led a group of senators earlier this year in proposing a smattering of bills that would have encouraged bare-bones, high-deductible plans, among other ideas. Republicans said they see the health care problem in California being more about access to care.

"There are many people around who are carrying around insurance cards to say they're insured (on Medi-Cal). They can't see a doctor. That is coverage with very bad access,'' Runner said. This is a key point that advocates have made in past years in an attempt to increase Medi-Cal reimbursement rates for providers, a move that Republicans have been reluctant to support in the past because it would require finding new money (ie: raising taxes) to pay for the increased reimbursements. Runner later told Sen. Sheila Kuehl (during her speech) that he would vote in the budget to increase reimbursement rates, though did not say anything about finding the money to do it.

Lastly, Runner cautioned that Perata's bill could lead to "rationing'' of health care. "It opens the door to us deciding who's worthy of health care and who isn't,'' Runner said.

Sen. Sheila Kuehl responded: "We have rationing now. Rationing is not going to be imposed in a new plan. It's Darwinian. You have money. You can buy insurance. You have health care. You don't have money. You don't have insurance. You don't have health care,'' she said.

The author of a bill for a universal single-payer system. Kuehl is also co-authoring Perata's bill, and asked Perata if he could also work provisions into SB48 that would ensure that consumers' obligations to pay for health care were capped, just as they are in businesses at 7.5 percent. This is a key advocacy goal for many consumer and community groups, that there are guarantees for affordability for consumers, both to get coverage (the premiums), and to use coverage (deductibles and other out-of-pocket costs).


The Assembly debate on AB8 (Nunez) was considerably longer than the Senate, though the tenor of the debate was much the same.

Republicans, however, began the discussion by attempting to “amend’’ the legislation, some of which had never been heard in committee, into AB8. Their point was that they had 18 bills that they felt could help fix the health system, but that none were advancing to the Senate.

While it is true that the Republican health reform bills were not advancing to the Senate, and eight were voted down in committee, ten never had a hearing because Republicans did not ask for a hearing. Additionally, four bills were scheduled for hearings, but were cancelled by their Republican authors.

Speaker Nunez said it was a shame that California – one of the largest economies in the world – had children who couldn’t see dentists and people who didn’t have medication. “Millions of Californians, most of whom are working hard to support themselves and their families, live in fear of getting sick and missing work. Many families have high rates of chronic diseases such as diabetes, which can lead to blindness and amputation,’’ he said. “….Health care currently is a privilege. Those that can afford to have it have it. From this point forward, health care will be a right that’s afforded to everyone in the state.’’

Assembly Democrats orchestrated a succession of comments that made the point about how AB8 was a sound solution for this year. Assemblyman Merv Dymally, who has served as an elected official since the 1960s, walked the Assembly through the history of health reform in California and the country.

Assemblyman Ed Hernandez, a physician, told a story of a former patient who he had first diagnosed with diabetes, and whose health slowly deteriorated because he could not afford the medication or doctors visits. The patient eventually died – and spurred Hernandez to begin his life as a lawmaker to change the system.

Assemblyman Mark Leno urged his colleagues to look ahead at one disease: diabetes, which now afflicts one in eight Californians. In 20 years, he said, experts predict it will affect one in three Californians, and by 2050, it will affect one in two people, he said. “Do you know what this will do to our economy?’’ Leno asked. Already, he said about 50% of health care costs are spent on diabetes related diseases – and that’s with just 1/8th of the population affected.

Assemblyman Hector De La Torre said his healthy five-year-old daughter would never be able to get insurance in the current system because when she was an infant, she had infant botulism. Such a “pre-existing’’ condition would preclude her from getting coverage on the individual market, in spite of her good health today.

Finally, Assemblywoman Loni Hancock, a strong supporter and co-author of Kuehl’s single-payer measure, said she still pined for SB840, but “I recognize the governor does not support the measure. AB8 represents our best chance to do something real for the millions of California children, and everyone who does not have access to health care now. This bill will reduce the number of uninsured by 70%. That is an enormous step forward so many people will no longer have to fear injury or serious illness.’’

Several Republicans spoke and many repeated the fact that none of 18 Republicans bills were advancing. But Republicans, by and large, admitted that there was a problem with the current way that health care was delivered, characterizing it as “damaged’’ and saying they’d like to see “better care for Californians.’’ That’s a change from previous debates, such as over SB2 (Burton) in 2003, where Republicans denied that there were significant problems with the large number of uninsured.

A number of Republican Assemblymembers challenged AB8 and its legality – particularly with respect to the federal ERISA law, which does not allow states to dictate how employers provide benefits to their workers. Assemblyman Todd Spitzer said AB8 was the “sister’’ legislation to the Maryland so-called “Walmart” bill, that would have forced Walmart to spend 8 percent of it payroll on health care for workers. The Maryland law, however, is quite different from AB8, in that it only affected one company, Wal-Mart, and did not provide choices to employers. (For further distinctions and discussion on this point, visit the Health Access WeBlog here.)

Assemblywoman Audra Strickland, R-Moorpark, called universal healthcare a “Las Vegas buffet,’’ where “everyone eats for the same price; everyone waits in the same long lines. Some of those more sought after foods, -- some people get them, some people don't. Buffet patrons consumer more food. And they waste more food.”

Strickland had a bill, which was rejected, that would have required Medi-Cal patients, the lowest income, to have Health Opportunity Accounts and "shop around’’ for low prices. This is a goal that CalPERS, one of the largest and most sophisticated health buyers in the nation, is having a difficult time negotiating.

In his close, Speaker Nunez directly addressed arguments that Republicans made about allowing the “market’’ to work. He touched upon the need for government rules to be imposed on insurers. Referring to an asthmatic girl who had been denied coverage, Nunez said his message to health plans is, “you’re going to have to do a little bit more to take care of people.’’“If you enter biz of health care, your fundamental responsibility is not how much goes into your back pocket, but to provide adequate health care. We have a responsibility to see that the market works for the people,’’ he said.

AB8 and SB48 will now head to the opposite houses. Sen. Don Perata said it was likely that the bills would, at some point, be combined into one. Frank Russo at the California Progress Report has posted his update of the press conference with both legislative leaders.

Health Access will continue to keep you informed on the status of health reform legislation and debate. For more information, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org.


The passage of SB840 on Wednesday and AB8 and SB48 on Thursday was the perfect kickoff to the It’s Our Healthcare coalition’s weekend of house parties. Beginning Thursday night, more than 400 health activists throughout the state are holding “house parties’’ to help inform friends, family and neighbors about the importance of health reform in California. Activists wrote “get well cards’’ to policymakers to urge action.


Also coming soon, documentarian Michael Moore will be in Sacramento on Tuesday June 12th for the premiere of his movie, SiCKO. He will brief a legislative panel at noon, which will be carried on television feeds in and outside the Capitol. He will also appear at a 2 p.m. rally with the California Nurses Association.

RSVP?: That evening, there will be a screening of SiCKO hosted by Assembly Speaker Fabian Nunez. Those Health Access California members, allies, and friends interested in attending can email Marin Bogema at Health Access at mbogema@health-access.org, who will put your name(s) & organization (if any) on our request list to attend the screening.

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posted by Anthony Wright | Permalink | 11:21 PM


Mergers and negotiations...

After the passage of AB8(Nunez), SB48(Perata), and SB840(Kuehl), Frank Russo at the California Progress Report has a full report on the press conference afterwards by the California legislative leaders.

We'll have more updates later tonight. The floor debate has gotten attention by bloggers Juls Rosen at Working Californians and dday at Calitics, and we'll have more quotes from today.

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posted by Anthony Wright | Permalink | 8:20 PM


Cry me a river

Assembly Republicans on the Assembly floor are opining that nearly all of the 18 bills are not being considered as part of the larger health reform debate.

Well, the public record reflects that 10 of the 18 bills were never heard in committee. That's because the Republicans either didn't ask, or cancelled the bills themselves. Specifically, Roger Niello, Van Tran, Bob Huff and Alan Nakanishi -- who all complained that their bills weren't heard -- actively cancelled scheduled hearings. Van Tran cancelled his hearing twice.

As my colleague Beth Capell said, you can't complain that the girl won't go with you to the dance, if you don't pick up the phone and ask her.

And you certainly can't complain that she stood you up if you cancelled the date!!

Update: The Assembly just passed AB8 (Nunez) on a 47-32 party-line vote. We will have a more complete update later.

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posted by Hanh Kim Quach | Permalink | 12:20 PM


Senate debates, passes SB48 health reform bill

The state Senate just passed SB48 (Perata), the senate president's health reform bill on a nearly party line 23-16 vote. Sen. Lou Correa, D-Anaheim was the only Democrat to vote against the measure. He also was the only Democrat to vote against Sen. Sheila Kuehl's universal health care bill SB840 yesterday.

I will be posting a full report of the debate later today -- along with results from the Assembly side when it takes up Speaker Nunez's AB8, but what really made me spit nails was Sen. George Runner, R-Palmdale's bogeyman warning that health reform proposals being discussed today would lead to rationed care.

"It opens the door to us deciding who's worth of health care and who isn't,'' Runner said.

Thankfully, Sen. Sheila Kuehl weighed in.

"We have rationing now. Rationing is not going to be imposed in a new plan. It's Darwinian. You have money. You can buy insurance. You have health care. You don't have money. You don't have insurance. You don't have health care.''

Well said, Sen. Kuehl!

Stay tuned, we'll give you a full report at the end of today.

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posted by Hanh Kim Quach | Permalink | 10:24 AM


Going through the gauntlet again...

Wednesday, June 06, 2007
Wednesday, June 6, 2007

* SB840(Kuehl) clears Senate on a largely party-line vote
* Legislature slated to vote on leadership-sponsored health reform legislation Thursday
* Michael Moore to be present at Sacramento premier of “SiCKO”

New on the Health Access WeBlog: SCHIP Update; Medi-Cal Documentation Requirements; "Hidden Tax" Research; Businesses for Insurance Reform and Higher Medi-Cal Rates?

SB840, which would establish a single-payer health care system in California , passed the state Senate Wednesday 22-14, a near party-line vote.

Most Democratic Senators were in support. Democratic Senators Denise Ducheny and Mike Machado, both serving on the Budget Conference Committee, were not present when the vote was taken. Lou Correa, D-Anaheim, voted “no’’ on the measure.

It’s the fifth year in a row that Sen. Sheila Kuehl, of Santa Monica , has introduced the measure, which she considers the “gold-standard” for health care reform. While Gov. Arnold Schwarzenegger vetoed the measure last year, she has said she wants to continue to organize the movement, and holds out hope that she can convince him otherwise.


In the staid Senate, there was little debate on the measure. Being its fifth time around the block, Capitol watchers expect nothing other than a party-line (or near party-line) vote on the measure.

However, Sen. Sam Aanestad, R-Grass Valley , did take the opportunity to attack the nationalized health care systems of other countries.

“There’s no question that we have problems with the high cost of health care, but to say we have the lowest standard of health care, or that we’re at the bottom of industrialized nations is not a true statement,’’ Aanestad said.

Contrary to what Aanestad said, though, the U.S. spends more on health care, but gets less, according to the Organization for Economic Cooperation and Development. The latest numbers show that the U.S. spends $7,800 per capita on health care, nearly twice as much as Canada ’s $4,050; the UK spends $3,250. Meanwhile, the US ranks 21st in life expectancy ( Canada ranks 7th and the UK ranks 18th), and 23rd in infant mortality behind Canada and the UK .

Aanestad went on to say that the “the only universal health care ...(seen) in the US is the outmoded and substandard Veterans Administration Health Care system. Do you really want your American health care to end up in the Veterans’ Administration model?”

Lastly, Aanestad proclaimed that “if I needed bypass surgery, I could not get it (in Canada) because I’m over 60 years old and I would be put on a waiting list because I’m too old to qualify for bypass surgery.’’ On the other hand, in the U.S. “If I needed bypass surgery, I’d have it tonight,’’ he said.

Sen. Kuehl contradicted this statement.

“This notion that waiting lists exists somewhere else, but not in America ? Maybe for the privileged few of us who can get right in. But there are a lot of people in my district – the richest district in the state and the one with probably the highest number of people insured – who are still on waiting lists, whether with Kaiser, or with Blue Cross,’’ said Kuehl, who represents Santa Monica.

“You can’t just run right in and get your bypass surgery,’’ Kuehl said.

Sen. Joe Simitian, D-Palo Alto, quoted Walter Cronkite’s description of the “health care system,’’ saying “I don’t know why we call it a health care system. It isn’t healthy. It isn’t caring, and it sure as hell isn’t a system.’’

Simitian stated that he wasn't sure that a single-payer solution was the only or best solution, versus other ideas. But, he said, the author's efforts on SB840 helped bring about this year's focus on health reform, and “whether or not I believe it is the best way or only way, I do believe it’s an important way to get to some meaningful solutions for the 4.5 to 6 million Californians who are without health insurance on any given day.’’

Kuehl closed debate on her bill by referring to “a truly American’’ single-payer system: Medicare.

“If it weren’t for Medicare, a truly American comprehensive system, we would be frightened in my age cohort (she’s 66) and above.’’

That’s because insurance companies have become “very creative in denying care’’ dropping patients when they are sick, or rejecting consumers who apply for policies simply because they’ve had a history of taking certain prescription drugs in a time long ago.

The passage of Kuehl’s bill marks the first of a series of health-reform related bills that must be passed out of the Senate and Assembly this week.


AB8 (Nunez) and SB48 (Perata), which both aim to expand health coverage by relying on the existing system of employer-based insurance, is expected to be heard Thursday. Several other health-related bills must also pass a floor vote by Friday in order to be further considered this year.

The passage of Kuehl’s bill and consideration of the leadership proposals also serve as a prelude to Michael Moore’s new movie SiCKO, about the failures in the American health care system, which is expected to premiere in Sacramento on Tuesday, with the documentary film maker testifying before Kuehl’s committee next week.

Health Access will provide updates on both legislation, Moore ’s testimony and movie in the upcoming days.

For more information, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org.

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posted by Anthony Wright | Permalink | 7:08 PM


Taking the next step...

The Chamber of Commerce's research organization, the California Foundation for Commerce and Education, released a study today on the "hidden tax." It's the second study on the subject from the same Hoover-affliated author, Daniel Kessler, attempting to undermine the rationale for health reform.

While I could question the motive and the substance of the study, it might be a moot point: as we have said before, it seems to me there are more important reasons to support health reform, for employers and employees.

The study states that the cost-shift in the health system is mostly made up of the underpayments to providers by public programs like Medi-Cal, rather than care provided to the uninsured. The first point is not original: the New America Foundation's estimate (which Governor Schwarzenegger uses) is that premiums are 7% higher because of the cost-shift due to California's low Medi-Cal payments, and then another 10% higher because of the cost-shift associated with the uninsured, adding to a grand total of 17%.

So the Chamber thinks Medi-Cal rates are a bigger deal than covering the uninsured. We at Health Access California think both are important, but I'll take the common ground of having the Chamber's implicit support to increase Medi-Cal rates. Those with Medi-Cal coverage have serious issues getting access to providers and services because the rate reimbursement is so low.

What I want to know is, how would the Chamber of Commerce fund a Medi-Cal rate increase? By their own research, their members, especially those that provide coverage, are paying it now through premiums. Will they support a tax or other revenue source to help improve Medi-Cal and the health system as a whole, and lessen that burden on their members?

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posted by Anthony Wright | Permalink | 6:10 PM


Movin' on up....

Sen. Sheila Kuehl's SB840, which would establish a universal health care system such as Medicare in California, passed the full Senate a few minutes ago on a 22-14 vote.

Health reform, and particularly a single-payer system, has become an annual crusade for Kuehl. This is the fifth time she has introduced the bill. Last year, the bill made it to the governor's desk for the first time in history, but was vetoed. This year, health reform is playing on a statewide and national stage -- thanks to the steady drumbeat of crusaders like Kuehl and other health advocates who are highlighting the unfair practices of insurance companies who deny care, change the rules and leave patients to get sicker and die.

SB840's veto, however, was one reason, Republican Sen. Sam Aanestad, an oral surgeon, spoke against the bill. Not only does he not think the legislation is politically feasible, he defendedAmerica's health care system as the best in the world, citing examples of people from countries with nationalized health systems that flee to the US to seek care.

The countries Aanestad referred to were England and Canada, where patients are given medical care based on priority, rather than ability to pay -- which is the system in the United States. According to the Organisation for Economic Cooperation and Development (OECD), both Canada and the UK have higher life expectancies than Americans. Additionally, fewer babies die at birth in those countries than in the U.S. By contrast, the U.S. spends nearly twice as much as these countries on medical care. How does Aanestad explain that?

Sen. Joe Simitian, a Palo Alto Democrat, credited Kuehl with putting health reform at the forefront of the political conversation and voted for the bill, "whether or not I believe it is the best or only way..it’s an important way to advance the solution."

In closing, the ever-eloquent Kuehl challenged assertions made by Aanestad. She cited two studies. One where 98% of Canadians would prefer to seek health care in their own country, rather than the U.S. The other that showed insured white men in England have better health outcomes than insured white men in the U.S.

She also took Aanestad's "America-first'' argument on a different spin: Medicare. Medicare is a single-payer system that is American and provides good and stable care to millions. That, she said, should be the goal.

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posted by Hanh Kim Quach | Permalink | 1:55 PM


Certified, Act III

Tuesday, June 05, 2007
The state Department of Health Services released its All-County Letter on implementing the citizenship verification requirements of the Deficit Reduction Act (DRA).

California tried to make the implementation less onerous than other states, but it's still a deeply flawed law, and will mean that many legal, eligible Californians won't get the care or coverage they need and to which they are entitled.

The new Congress really needs to take another look and fix this action by the old Congress.

(Governor Schwarzenegger hinted at this in his letter today to Congressional leaders urging funding for SCHIP. When it's posted, we'll put up a link.)

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posted by Anthony Wright | Permalink | 3:21 PM


But will they lobby on it?

The National Federation of Independent Businesses (NFIB), which made significant membership gains actively opposing President Clinton's health reforms in the early 1990s, released some responses from a membership survey, which had predictably skewed questions and predictably skewed answers, with a remarkably consistent 68-70% of respondents opposed to anything: HMO consumer protections (called "mandates on small businesses"), an individual mandate, even a subsidized pool for those who can't afford coverage.

The one response that wasn't predictable:

"...on whether or not the state should require health insurers to issue policies regardless of pre-existing medical conditions: A little more than half, 54%, said, ‘Yes,' 32% said ‘No,' and 14% were undecided."

Even this crowd, responding to a less-than-friendly question, thinks that there is a bigger role for the state to oversee the insurers.

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posted by Anthony Wright | Permalink | 12:20 PM


Search by topic!

A little housekeeping...

As we upgrade the website, you'll notice the topic listings on the sidebar. We have labeled our posts for the past month, and are working to categorize the entire archive, but it will take time.

We'll post a broader guide about what the topics means when we are done, but the archive does include all of our Health Access Updates from the last five years. But if you click a topic now, you'll only get some of our past posts on that subject--and you may find in a month, you'll get a whole lot more. We'll let you know when those links will provide a full comprehensive listing.


posted by Anthony Wright | Permalink | 10:25 AM


Floor votes this week...


Monday, June 4, 2007

* Health reform proposals to be considered on Assembly, Senate floors this week
* Ads for and against health reforms take the airwaves
* ACTION ALERT: Still time to
host a house party for health reform this week!

New on the Health Access WeBlog: Sicko; U.S. Ranking; Gruberfest; Chamber's List; Poverty; Is BlueCross Enron?; WWJD?; Guaranteed Issue; Insurance Rules; The Hidden Tax; Budget Conference Commitee; High Deductibles; More Ads and Coalitions; Betty Perry

This week, both houses of the California Legislature will consider significant health reform proposals, and they hit the half-way point of the process, winding their way to the Governor's desk. These bills, and hundreds of others, have a deadline by this Friday to pass their first floor vote, of their "house of origin"

In terms of the major health reform proposals, Assemblymembers will be asked to vote on AB8(Nunez). Senators will consider both SB48(Perata/Kuehl) and SB840(Kuehl).

BILL LIST: A broader list of pending legislation of interest to health advocates is at the Health Access California website (including in online and printable form) at:

WEBLOG: These votes on health reform follow a couple of weeks of significant activity around these proposals, all chronicled on the Health Access WeBlog, including:

* the release of financial details and modeling of the proposals by Speaker Nunez and Senate President Pro Tem Perata, (with a briefing by MIT Professor Jonathan Gruber), which set the stage for the two proposals, along with SB840(Kuehl) to pass out of their respective Appropriations Committees.

* the California health reform conversation making national celebrity news, as Governor Schwarzenegger visits Jay Leno, and filmmaker Michael Moore schedules a premiere of his new movie Sicko in Sacramento on June 12th;

* ads on health reform take to the airwaves, including a TV ad for reform by Together for Health Care, and a print and radio ad against reform by BlueCross of California. The Health Access WeBlog includes responses, fact-checking and commentary on the BlueCross campaign.

HOST A HOUSE PARTY: Later this week, the consumer campaign It's Our Healthcare! will be hosting hundreds of house parties around the state, to inform and interest Californians about the health reform debate this year. To join this exciting activity and volunteer to host a house party, click here.

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posted by Anthony Wright | Permalink | 10:21 AM


SCHIP off the federal block...

Monday, June 04, 2007
Released today is a new California Budget Project Budget Brief, “SCHIP Reauthorization: Congress Can Help California Provide Health Coverage to More Children,” which shows that if Congress does not substantially boost funding, California will not have sufficient funds to cover the 800,000 children who rely on Healthy Families, much less reach more uninsured children.

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posted by Anthony Wright | Permalink | 10:06 AM


Questions for next week...

Friday, June 01, 2007
Two business articles in the LA Times raise more questions than answers:

* So will grocery workers avoid a strike and get better access to health care in this next round of contract negotiations? There's a blackout on negotiations, but the article seems positive. In particular, there seems to be agreement on reducing the waiting times for new hires and their children to get coverage to six months (from the current waiting times as long as 18 or 30 months).

* So what issue caused the finance chief of BlueCross to be dismissed? If someone is whacked on the Sopranos, you kind of wonder if it is for doing something *especially* wrong, or maybe for doing something something right.

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posted by Anthony Wright | Permalink | 11:13 PM


Hail to our Chief!

In all the activity of this week, the highlight was a lovely dinner hosted by state Senator Sheila Kuehl, in honor of Betty Perry.

Betty is a legend around Sacramento and the Capitol, for her long leadership at the Older Women's League of California, where she serves in a volunteer capacity as their public policy director.

It was incredibly sweet of Senator Kuehl to honor her, because these tributes are normally done at retirement partiess, yet Betty "officially" retired a couple of decades ago. He was the guidance counselor at McClatchy High School here in Sacramento, and so knows many of the political class from their childhoods, from Supreme Justice Anthony Kennedy to former state Senator Deborah Ortiz. She recently spoke at the high-profile funeral of Rep. Robert Matsui.

But it's not her connections, it's her heart and values and work ethic and goodness that people appreciate. Nobody questions Betty's motives, even those that question her positions (which I almost never do).

In my toast among many two night ago, I cited my amazement that she works so hard on so many issues, from housing to budget to civil rights. Even in the health care arena, she works consistently on several key issues. She's a tremendous advocate for universal single-payer health care and SB840(Kuehl). She has been very active on Medicare Part D, on health budget cuts, and women's health. These aren't just "me too" positions: Betty Perry and OWL has taken a leadership role on the issue of people being denied for "pre-existing conditions"--working so much on the topic, I noted, that some might wonder if she was dating somebody named MRMIP.

For the past year and a half, she has been the chair of the 26-member board of Health Access California. My board members, from a very diverse range of organizations and positions, all respect her and voted her to the position, and she runs an efficient meeting, and provides good advice in her capacity as my President.

I didn't mention that she is also an excellent representative for Health Access, and she has done so at the highest level, including with Governor Schwarzenegger himself. A couple of year ago, I was in Washington, DC, and could not attend a meeting with the Governor on prescription drugs. In comparison to the former Mr. Universe, I look like the prototypical 90-pound weakling. But he's no match for Betty.

(In this photo of last year's bill signing of the prescription drug discount program, she is on the left, in pink, with a watchful eye on the Governor, and keeping me honest, as always.)

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posted by Anthony Wright | Permalink | 10:40 PM



In an earlier post, we discussed my appreciation that the Democratic legislative leaders were being intellectually honest that their plan was "near-universal," and not fully “universal,” even though they do dramatically expand group coverage to millions of Californians, and provide more security to millions who have it but are concerned it won’t be there for them when they need it.

Universal is the ultimate goal, but let’s be clear that it is hard to get there. The closest way is through a Medicare-like system, where enrollment is simple and required just once in a lifetime, and which is financed through taxes (based on ability to pay). Medicare comes very close, but still falls just short. At the state level, the only bill that can be called "universal" is Senator Kuehl's SB840.

This has come up on the presidential campaign trail, as some critique presidential candidate Barack Obama’s plan for *not* being universal, and while for some that means not being single-payer, for many others that means not having an individual mandate.

I disagree that an “individual mandate” gets you “universal.” Without a truly automatic enrollment and affordable coverage, the enforcement mechanism would have to be pretty punitive, and the publicly-financed subsidies very generous. And even presidential candidate John Edwards’ plan, which does include an individual mandate, has exemptions for those who aren’t able to afford it. However good it is (and I think there are many good things in it), it is not universal either.

Governor Schwarzenegger’s doesn’t have any exemptions to his individual mandate, and the enforcement remains a troubling discussion. He trumpets his proposal as universal, but it is not. The modeling suggests that about a million undocumented adults, and slices of other populations, will remain uninsured.

Yet from some reporters' point of view, his plan is supposedly more “comprehensive” than the others, yet it really doesn’t help more people. Even though roughly a half-million more people are said to be "insured" under the Governor’s plan than the Nunez or Perata plan, those people would not necessarily be better off. These are folks that are not getting coverage on the job, not eligible for public programs, yet are forced to buy individual coverage.

Without any exemption for affordability, many of these folks will be required to pay for a premium, but will only be able to afford a high-deductible product that requires them to spend thousands of dollars out of pocket before care is covered. Is it better for these people to be required to pay a premium for a product many of them won’t be able to afford to use?

So maybe we shouldn’t call these folks newly insured, because that would imply they got a benefit, as opposed to a burden. Here’s where I need your help. What should we call people who are forced to buy a plan that is more than 5% of their income? Forced to buy a high-deductible plan?

The Unafffordables?
The Burdened?
The Forced Underinsured?
TOUGHs? (Tough Option: Uninsured Greater than High-deductibles?)

Defining this group will allow for better apple-to-apples comparisons between the various plans, between the truly insured, and those who are being made to buy a product that doesn’t make sense for them. E-mail your suggestions to awright@health-access.org. I look forward to your replies.

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posted by Anthony Wright | Permalink | 9:59 AM


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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.