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Medical Mercenary or Meathead?

Monday, July 30, 2007
You know you're in trouble when an "occasional'' rabbi from Mormon country sees it as his divine mission to segment the health care market.

"I feel I'm doing God's work switching people from group plans to individual
insurance,'' said Paul Zane Pilzer.

Pilzer, an economist who authors books with titles like "God Wants You to Be Rich,'' and his medical mission are spotlighted on the front page of the Wall Street Journal.

Pilzer's advice is this, according to the Journal: "Employers should stop providing group health insurance and help employees get individual policies instead.''

Never mind, of course, that individual policies are far more expensive and
offer far fewer consumer protections than a person buying through their employer
-- or through a government program.

Never mind, of course, that a huge chunk of people won't be able to get coverage at any price because they're sick.

And never mind that it could be illegal -- discriminating against sicker

What I found interesting/annoying was that he pointed to the shift from pensions to 401ks as a success. (This ignores the fact that workers feel less secure about their financials as they reach their retirement years and businesses are increasingly getting consultants to help employees with their 401ks. If it was such a success, why the insecurity? and why the need for the helping hand?)

Following in the steps of the disappearing pension would be a huge mistake -- as the dreamy Yale economist Jacob Hacker has written of in his Great Risk Shift.

I'm thinking Pilzer might want to take on a different task from God.

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


Going through hoops for health care...

With all this talk of "individual responsibility" and mandates in health care reform, it's sometimes easy to forget that people actually want health coverage. Desperately. If they don't have insurance, they are the ones who face the consequences, which are to live sicker, die younger, and be one emergency away from financial ruin.

The issue isn't that individuals don't want coverage, but that there are barriers to getting it, in each of the three ways that Californians get coverage: through employers, public programs, or the individual market. In each case, health coverage is not always (or even often) available, affordable, or automatic. The point of health reform should be to remove these barriers.

Employer health benefits cover 19 million Californians, just over half of the population.

* Is it available? There are many who simply don't have a connection to the workforce, like early retirees, students, or divorcees. Yet those that do work often find that their employer doesn't offer coverage, or that they (or their family members) are not eligible for it. Over 80% of the uninsured are workers or their family members. Yet more employers are scaling back benefits or dropping it altogether.

* Is it affordable? For most, employers pick up most, if not all, of the tab of the premium. (Economists say that the costs are just made up in foregone wages, but such payments are at least spread thoughout the employer's workforce.) Many employers do require workers to pay some share-of-premium, and a plan that has some cost-sharing, including deductibles and co-payments. As a result, there are some workers, particularly lower-income ones, who decline to pick up coverage because of the cost.

* Is it automatic? One of the reasons that employer-based coverage is so prevalent is that it is pretty automatic: you typically sign up at the workplace, which is most people's main institutional connection to the world around them.

Public programs cover 10 million Californians, around a third of the state, largely though Medicare, Medicaid, and SCHIP. For the purposes of California health reform, let's focus on the state versions of the two latter programs, Medi-Cal (with 6.5 million) and Healthy Families (with 800,000).

* Is it available? At the state level, Medi-Cal covers low-income seniors, people with disabilities, children, and in some cases, their parents. (Healthy Families covers children just above the poverty line.) However, these programs have stringent eligibility requirements, so that they don't cover even the very poor comprehensively. A nonelderly adult without a child at home, even if she is under the poverty level of $10,210/year, would not get Medi-Cal coverage without a disability. Undocumented Californians are largely excluded from these programs. Other restrictions for Medi-Cal include an assets test that prevents people from having any real savings.

* Is it affordable? If you do qualify, the public programs do offer a range of benefits at free or with small co-payments. (Of course, there are always medical expenses that are not reimbursed.) There is limited premiums and cost-sharing in the Healthy Families program.

* Is it automatic? The restrictions listed don't just exclude people who are not eligible for these programs, but many who are eligble as well. Given their complexity, many people don't know if they are eligible or not. Even if they are, the bureaucracy and paperwork to enroll can be substantial and off-putting. Recent efforts have made strides in reducing the paperwork burden, and having children enrolled through schools and other social programs.

The individual insurance market covers under 2 million Californians, less than 5% of the population.

* Is it available? For many, no. Insurers often deny people from coverage because of "pre-existing conditions," which could be health conditions such as diagnosed cancer or diabetes to relatively small diagnoses such as heartburn, childhood asthma, or simply taking a few prescriptions last year.

* Is it affordable? The individual market is the most expensive way to get health coverage, since individual consumers don't have the ability to negotiate with the insurers like large employers and public programs do. Insurers are allowed to charge different rates based on age, health status, gender, and other factors. For many low- and middle-income, as well as older, consumers, the cost of health insurance is prohibitive.

* Is it automatic? Beyond the individual motivation to find health coverage, the individual market is confusing, just to find quality information abuot how to compare plans in a meaningful way. Many find they need to go to a broker to decipher the market.

From a practical perspective, these are the barriers that consumers face trying to get health coverage for themselves and their families. Coming soon: how do the proposed health solutions help remove or reduce these barriers?

posted by Anthony Wright | Permalink | 3:08 PM


Consumer complaints matter...

Friday, July 27, 2007
The fine on Kaiser, as reported on in the San Jose Mercury News and other papers, raises an important issue in the health care reform debate.

How do we handle consumer complaints? Do people know where to go? How are they followed-up and treated?

As a policy advocacy organization, we don't do any individual casework, yet Health Access gets lots of calls of people with all sorts of health care issues and problems. There's not a obvious place to go: The insurer? The hospital? The medical group? The Medical Board? The Department of Managed Health Care's HMO hotline? Department of Insurance? Your employer? Your broker? Your county office?

For Kaiser patients, given that their insurers is also the provider of care, they know to complain to Kaiser. That was small relief, apparently, since Kaiser didn't handle those complaints well. I have a suspicion that this is just the tip of the iceberg in the health system overall...


posted by Anthony Wright | Permalink | 10:27 AM


What price would you pay for health....

Thursday, July 26, 2007
Studies have already shown us that the uninsured live sicker and die younger.

The uninsured pay at least four times as much (in California) -- and sometimes more -- for a visit to the emergency room.
The uninsured pay the highest prices for prescription drugs.
The uninsured delay care because of these costs, resulting in gradually worsening conditions. The uninsured are 25 percent more likely to die then those with insurance.

In addition to all the aforementioned setbacks (including dying), the LA Times yesterday described how the uninsured now have waits of longer than a year for critical services -- such as gallbladder or hernia operations.

"If it's not life-threatening when we start, it certainly could be by the time we finish,'' said Judi Rose, vice president at North Holywood's Valley Community Clinic.

This story is particularly interesting in light of comments made by a number of lawmakers this year about health care -- and rationing. Many have said that a universal health care system would result in long lines -- and people not getting the care they need when they need it.

I wonder what they'd call this.

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posted by Hanh Kim Quach | Permalink | 3:28 PM


It's not just a buzzword...

Wednesday, July 25, 2007
There's a good article today by Timm Herdt of the Ventura County Star on the central debate on "affordability" in health care reform, and I would say that if he didn't quote our Health Access report on high deductible plans.

"Affordability" is not just lowering the cost of overall health care. It's a fundamental change, so that a consumer's health care costs are based on one's ability to pay, rather than the current completely wrong-headed situation, where our costs are based the type of job we have, and how sick we are.

posted by Anthony Wright | Permalink | 9:50 PM


Does St. Mongo's take uninsured wizards?

Tuesday, July 24, 2007
We were up late Friday night, into Saturday morning, to finish what was unresolved, and people around the state wondered what would happen. But by into the day Saturday, it was clear that while some people thought they were finished, others were not there yet.

For me and many people, the big news this weekend was the release of Harry Potter and the Deathly Hallows. For me and a small number of legislators and Capitol watchers, the news was the delay of the California state budget.

California is only one of three states that has a two-thirds vote requirement to pass a state budget, trailer bill, or tax legislation. As a result, we now have a situation where 14 legislators out of 120 are holding up the passage of a budget. The full Assembly has passed a budget that, whatever its flaws, has the support of the Governor, the Assembly Democrats, the Assembly Republicans, and the Senate Democrats, and possibly one Senate Republican. But since we need two thirds of both the Assembly and Senate, we need two Senate Republicans to vote for the budget.

Health and human services are nearly a third of the state budget, and is often held hostage in these negotiations. This has been true more in previous years, but every budget matters to health care. We'll see tomorrow what budget or policy change they are able to get, as they impose the tyranny of the minority.

There's a reason health advocates have consistently supported reforms for the budget process, including lessening the two-thirds vote requirement. Here's to a budget that comes out before the new Harry Potter book hits the big screen.

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posted by Anthony Wright | Permalink | 11:30 PM


All the President's Polyps...

San Francisco physician Margot Kushel delivered this succinct message to President Bush in today's NY Times' Letters to the Editor:

Mr. Bush: one cannot get a preventive colonoscopy in the emergency
In case anyone missed it, earlier this month, the President insensitively remarked:
"I mean, people have access to health care in America. After all, you justgo to
an emergency room." -- President George W. Bush (Cleveland,7/10/07)

Of course. We can't all get presidential health care. But we can get preventive care -- like the President did on Saturday (does that mean it was a house call?) which eventually resulted in the extraction of five (!) polyps.

Well said, Dr. Kushel.

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posted by Hanh Kim Quach | Permalink | 12:36 PM


Blue Cross crossing the line..so doctors are too...

Monday, July 23, 2007
LATimes reveals that Blue Cross has unilaterally reduced reimbursement rates for physicians -- in some cases, even lower than Medicare rates.

Blue Cross calls the rates "sustainable,'' but physicians report it doesn't cover costs. The doctors are at the insurance giant's mercy, though, given the huge number of enrollees Blue Cross brings with them. (I'm surprised none of the doctors took the opportunity to kvetch about the $950 million that the company recently sent to its parent in Indianapolis).

With such aggravating dealings with insurers, its no wonder that some physicians are just bypassing insurance companies altogether, according to this Ventura County Star story.

Two physician groups are asking patients to pay cash and deal with the insurance companies on their own. Patients who can afford it (one woman paid $3,600 out of pocket) think it's worth it.

If Blue Cross keeps it up, they'll end up writing their own obit.

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posted by Hanh Kim Quach | Permalink | 7:43 AM


Jersey Devils...

Friday, July 20, 2007
It's astounding that the debate on the State Child Health Insurance Program (SCHIP) has gotten so polarized, with President Bush campaigning against it. This is a program that has been bipartisan since its beginnings, passing a Republican Congress, including one led by former Speaker of the House Newt Gingrich.

The talking points by President Bush and some Republicans legislative suggest that the program has gone well beyond its original intent, covering children above twice the federal poverty level, and parents as well. Even some supporters of expanded SCHIP tell their conservative colleagues that SCHIP reauthorization is a way to reign in states.

The poster child for this bad behavior is New Jersey, and I now I must confess my role. I ran the state health consumer advocacy coalition when working at New Jersey Citizen Action, when we were able to win expansions of coverage for:
* children up to 350% of the federal poverty level (around $60K for a family of 3), and
* their parents as well, up to 200% of the federal poverty level ($34K for a family of 3).

This goes well beyond what most other states have done, including "left-coast" California, which only covers children up to 250% of the poverty level ($43K for a family of 3), and is currently proposing to go up to 300% ($52K for a family of 3) as part of broader health reform. [California did approve but never implemented a parent expansion.]

But it wasn't just me and the various children's, consumer, and community groups in support of this conspiracy of New Jersey devils toward "government-run health care for every American," according the President Bush.

The New Jersey Legislature that approved these changes was a Republican Assembly and a Republican Senate. The Governor was Christie Todd Whitman, a blue-blood Republican that President Bush thought highly enough of that he included her in his Cabinet the next year.

How times have changed.

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posted by Anthony Wright | Permalink | 12:19 PM


Money Matters: Major Moves in CA & US on Health

Friday, July 20th, 2007

• Bipartisan 17-4 Vote to Expand Children's Coverage, including CA's Healthy Families
• House Expected to Consider Broader Proposal; Bush Threatens Veto
• CA Budget Considered in Full Assembly; Heads to CA Senate

Click Here for What's New on the Health Access WeBlog: More on SCHIP Mark-Up; Will Bush Veto?; Study on Tax Credits and High Deductibles; Grocery Worker Strike Averted; Sicko; Germany's Health System; Language Access Comments Due at Department of Insurance

CA ASSEMBLY PASSES BUDGET: Starting almost at midnight last night and going well into this morning, the California Assembly stayed into the night to consider and pass a proposed deal on the state budget.

In presenting the budget, Budget Conference Committee Chair John Laird stated that "There's a lot to like about this budget," pointing out the many areas that are fully funded. However, he did mention significant reductions, particularly to public transit, and mentioned that "health and human services do suffer cuts." He stated that the goal of the last week of negotiation was to get "a budget that appeals to both sides of the aisle," and as such, mentioned there were "no new social programs."

With the Assembly passing the measure, the hope is that the Senate will consider the measure today, Friday, although the outcome is unclear at this writing. The budget is for the 2007-8 fiscal year that has already started, on July 1, 2007.

Health Access will review the new budget documents, including the health and human services budget trailer bill, and post any health related news on the Health Access WeBlog over the next few days.

US SENATE SCHIP DEAL MOVES AHEAD: Yesterday, in Washington, DC, the U.S. Senate Finance Committee marked up and passed a major bill to reauthorize and expand the State Child Health Insurance Program (SCHIP). This action is an important step for California, which is depending on these deliberations to fund coverage for the over 800,000 children on our state's Healthy Families program, and to help reach the goal of covering all children.

The bill mark-up, which provides for $35 billion in additional funding for SCHIP, was approved by a vote of 17-4. All of the Democrats and 6 Republicans (Grassley, Hatch, Snowe, Smith, Crapo, and Roberts) voted for passage. Lott, Kyl, Ensign, and Bunning were the 4 no votes. It now heads to the Senate floor.

As proposed last week, the bill raises these funds with a 61 cent increase in the national tobacco tax, bringing that tax to a flat $1.00. After the mark-up, the bill now also includes an Express Lane state demonstraton program, mental health parity, and dental health grants. Families USA has a more detailed update, including the full mark-up documents, at their Medicaid Action Center on their website at:

Amendments were suggested to weaken the bill, but they failed, including policies such as allowing premium assistance to be used to purchase high-deductible plans and restricting CHIP eligibility to 300% of poverty. Amendments that would have strengthened the bill (like increasing the funding to $50 billion and adding ICHIA) were withdrawn before a vote, largely because they were unlikely to pass at this time.

In a teleconference call with a California convening, a Democratic staffer for Majority Leader Reid noted that the proposal was not all that Democrats has wanted--including the $50 billion amount that health and children's advocates had pushed--but they needed to get bipartisan support, given that, under Senate rules, any bill needs 60 votes to pass, which means getting all Democratic votes and 10 Republican votes.

HOUSE PLANS: At that same teleconference convening, a staff for Speaker Nancy Pelosi stated that the House hope to pass a broader health care package, also in July, to allow for negotiations over the Congress' August recess to reconcile the measure with the Senate. The desire is to negotiate a final deal for passage in September.

The $100 billion health package is expected to include elements on provider reimbursement, low-income senior assistance, and $50 billion for children's coverage reauthorization and expansion. It would also be funded by a tobacco tax, as well as a readjustment of subsidies to Medicare HMOs.

BUSH'S VETO THREAT: While the Congress is debating how much to expand children's coverage, and how to fund it, President Bush has indicated that he would veto the children's coverage bill passed in the Senate Committee.

Despite his 2004 campaign convention speech promising to enroll more children in SCHIP programs, the President's original budget included only a $5 billion increase, which would force many states, including California, to dump children from the program or have children placed on waiting lists. Bush has repeatedly denounced the bill as a step toward “government-run health care for every American,” describing it as a “massive expansion of the federal role” in health care, financed by “a huge tax increase.”

While SCHIP has traditionally been a program with broad bipartisan support, having originally passed in a Congress headed by former Speaker Newt Gingrich, several Republican Senators used similar talking points in the debate today.

The Center for Budget and Policy Priorities, on their website, has new papers that provide facts disputing these assertions, including addressing the issue of "crowd-out," where an expansion of a public program replaces existing private coverage. These papers are available now, at:

ACTION NEEDED: Contact Senators Boxer and Feinstein, and more urgently, your U.S. Representative, and urge them to support full funding for SCHIP and children's coverage. Families USA is hosting a toll-free line to make this call at 1-800-828-0498, and a website to faciliate E-mails at:

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posted by Anthony Wright | Permalink | 1:01 AM


Drawing the right conclusions...

Thursday, July 19, 2007
I've been looking at the new Health Research and Educational Trust paper released this week, authored by Susan Marquis and others at RAND. The big headline, which got USA Today's attention, is that even reducing premiums for health care by 50% would reduce the uninsured by merely 3%.

Some tried to make this study about the need for an individual mandate, but I don't see anything here that suggests that. I didn't see anything in the paper that suggested that the reason people are uninsured is that they don't want coverage, and other research disputes that notion. As I read the result, a tax credit simply doesn't go far enough for the vast majority of the uninsured: it's a 50-foot rope for someone in a 100-foot hole.

Instead, the vast majority of the dollars from a tax cut or credit to those who are more affluent, including those with insurance.

What can we learn from the study? Funded by the California HealthCare Foundation, this survey of uninsured California families, is a complete and utter smackdown of President Bush and other Republican proposals that suggest that all the uninsured need is a good tax cut. Other studies, even those by business and industry groups, show that such tax credits are far less efficient than expanding public programs and other strategies for health reform.

What the study also does is indicate how people reject plans with high deductibles and other cost sharing. Even when the high deductible plans offers significantly lower premiums, they'd rather go for the higher premium, lower-deductible policies. They don't see the value in the high-deductible plans: What's the point of having health coverage that doesn't provide much coverage?

If anything, the study suggests serious issues with the Governor's proposal, which depends on these high deductible plans, since it requires individuals who aren't eligible for employer-based coverage or public programs to buy coverage in the individual market. For many of these middle-income folks who would be impacted, the only thing they would be able to afford to buy is the minimum coverage of a $5,000 deductible plan. As a result, the plan would force people to get a health care product that many don't find meaningful. For this reason, any affordability standard needs to include both premium and out-of-pocket costs.

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posted by Anthony Wright | Permalink | 11:19 PM


People care....

A slice of life: I was booking a Southwest flight over the phone when the agent, after seeing my E-mail address, awright@health-access.org, asked what I did. I explained that I was a consumer advocate on health care issues at the state legislature.

She said “awesome,” and asked if I had seen SiCKO, and then proceeded to get very excited about my work. She asked me if any of the presidential candidates would propose something like what was in the movie. She did confirm that Southwest did provide coverage, although it is a UnitedHealth HMO, which luckily she hadn’t had to use. She realized she wasn’t in California, but was heartened that somebody was out there fighting for it, and just wished me well with my endeavors, as she continued to take my information.

Why have we (and many other health policy blogs) spent so much time on the movie? Well, it's not everyday there's a feature film on the issues you've spent a career working on. And yes, the movie is having an impact.

posted by Anthony Wright | Permalink | 7:13 PM


If the SCHIP sinks, we all go down....

Just heard a very sobering report from staffers in Congress about the reauthorization of children's insurance this year. We will have a bigger report on it later, but the upshot is this:

The Senate is asking for an additional $35 billion over five years, and that's pretty good. If passed, (and that's a big IF) it would cover an additional 4 million kids.

The House, however, is trying to get $50 billion -- which includes reimbursement for the state of medical care for legal immigrants, and avoids cuts in reimbursements to providers. (Passage of the House bill, however, is an even BIGGER if).

In spite of bipartisan support for children's health insurance and expanding coverage for kids, President Bush is really digging in his heels and has announced his intention to veto these bills. (I mean, really, why doesn't he pick on someone his own size.)

Even though this debate -- nationally -- is primarily about children's insurance, in California, it will be a foundation for larger health reform. That's because we Californians want to cover all children -- and we won't be able to do it without enough money. We're already on very thin financial footing with the proposals on the table....and they're not final until they're final. We can't afford to let this children's money erode as well.

And the hip bone's connected to the knee bone; the knee bone's connected to the... You get the picture.

In a few days, we will have more detailed report on how advocates can get involved in lobbying their Congressional representatives to support health reform.

Stay tuned....

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posted by Hanh Kim Quach | Permalink | 3:21 PM


Health care on aisle 5...

Wednesday, July 18, 2007
The LA Times reports that grocery workers have reached a tentative agreement with Southern California's supermarket chains, avoiding strikes that crippled the industry for 141 days in 2003-04.

While neither side has said what agreements were reached, the Times reports that new workers would not have to wait as long to become eligible for health insurance. During the last contract, new employees had to wait 18 months (and their families nearly three years) before getting health coverage.

The result is that health coverage for workers fell to 54 percent (from 94 percent), according to the UC Berkeley Center for Labor Studies. Turnover also increased to 32 percent (from 19 percent.)

According to the Times, the new waiting period would be 6 months. If this is true, it's a significant step.

Among those who are working and uninsured, 25% are not eligible for coverage by their employers -- either because they are in waiting periods or are a classification of employee that does not qualify for benefits.

Often, these are low-wage workers who would literally have to choose between putting food on the table, paying utilities and rent. There's no way they could afford premiums for coverage purchased on their own -- the most expensive way to buy coverage.

Stay tuned for more details on the grocery worker contract.

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posted by Hanh Kim Quach | Permalink | 10:17 AM


Moore reviews...

Tuesday, July 17, 2007

The Heath Wonk Review, this week hosted by the Colorado Health Insurance Insider, has several good articles of interest about state and federal health policy issues, but it goes absolutely SiCKO (or Wonko?), with several reviews of the Michael Moore documentary.

In other reviews, Maggie Mahar and Matthew Holt state their general praise at The Health Care Blog, even while putting in some caveats and provisos.

Also, former Health Access California board member Sara Nichols has a similar take as mine, loving the film, but wondering if some potential converts might be turned off by all the third rails (Cuba, France, etc) that Moore just doesn't touch but embraces. I think Moore's ambition isn't just universal health care--he could have made that case more easily--but a very different way to view society and government, of which health care is just a example.

How's it doing at the box office? Ask the experts at Variety...

The doctor has given Michael Moore's docu "Sicko" a good bill of health.

Expanding to 756 theaters over the weekend, the Weinstein Co. film made an estimated $2.6 million in its third frame for a total of $15.8 million. That's only a 26% drop from the previous weekend for a per-screen average of $3,505.

"Sicko," a searing indictment of the U.S. healthcare system, stands a strong shot of becoming Moore's highest-grossing film after "Fahrenheit 9/11," whose topic was much broader in appeal.

The Weinstein Co. has been careful to compare "Sicko" to Moore's "Bowling for Columbine," instead of "Fahrenheit," the highest-grossing docu of all time. "Sicko" is already outpacing "Columbine" -- which grossed $21.5 million domestically -- at the same point in the film's run. Last year, "An Inconvenient Truth" made $24.1 million domestically.

"Sicko," distributed by Lionsgate, is one of a handful of niche films performing solidly at the summer box office.

posted by Anthony Wright | Permalink | 9:29 PM


For those moved to comment...

In posting about the need for medical interpretation, I would be remiss if not mentioning an upcoming action item: the Department of Insurance is accepting comments for a 3rd round of changes on its pending language access regulations.

Written comments are now solicited only on the third round of changes, released July 7th. The 15-day public comment period ends on Monday, July 23rd, at 4:00pm, when written, faxed, or E-mailed comments are due. Comments and questions can be submitted to:

Elena Fishman, Senior Staff Counsel
California Department of Insurance
300 Capitol Mall, 17th Floor
Sacramento, CA 95814
(916) 492-3507

George Teekell, Senior Staff Counsel
California Department of Insurance
45 Fremont Street, 21st Floor
San Francisco, CA 94105
(415) 538-4390


posted by Anthony Wright | Permalink | 9:16 PM


How do you say "tetanus shot"?

Monday, July 16, 2007
Correspondent John Oliver at the The Daily Show with Jon Stewart has the definitive take tonight on the need for language access in hospitals and other health care settings.

The segment was directly responding to federal efforts to establish English as the "official language" of the United States, but it looked into the implications of restricting government services from using other languages. Some of the examples was whether the government would be allowed to translate "DANGER" signs and voting pamphlets.

In interviewing an anti-immigration group representative who says that "when it comes to the basic diagnosis, good doctors and good hospitals can do so without any language whatsoever," John Oliver plays along with him, agreeing that someone who doesn't speak English could still point to their heart to indicate a "heart attack," or could point to their arm with a grimace to indicate a broken limb. But then Oliver stumps him, asking for the handsignal to indicate, "I am allergic to penicillin."

This is why the new regulations at the Department of Managed Health Care, and the pending ones at the Department of Insurance, are so important. And why Health Access has been doing a lot on this issue with our Video Medical Interpretation (VMI) Project.

For immigrants or visitors and others who don't speak English fluently, it is impossible to provide quality care without communication between the doctor and patient. If the insurer is to provide meaningful coverage, it needs to include the assurance that appropriate interpretation can take place. Even a comedy show gets it.


posted by Anthony Wright | Permalink | 8:58 PM


What planet is he from?

So apparently President Bush made the following comment at an event last week:

"I mean, people have access to health care in America. After all, you just
go to an emergency room." -- President George W. Bush (Cleveland,

If the president was at all -- even vaguely -- aware of the health care debate, he'd know that the one of the primary issues is that people are going to the emergency room -- too much, because (without health coverage) it's the only place they can see a doctor.

If the president was following the debate, he'd know that going to the emergency room isn't really the best place to get care -- it's expensive, you may/may not get to see a specialist and it if you're there for a minor ailment, it clogs up the ER for truly dire and traumatic events.

And finally, if the president was following the debate, he'd know that a visit to the emergency room costs 3 to 4 times what is billed to insurance companies for the same services.

Brrrrrrr. That just ruffles my feathers.


posted by Hanh Kim Quach | Permalink | 3:02 PM


Over There

I had the opportunity to attend a swanky event hosted by the California HealthCare Foundation with the German Minister of Health, Ulla Schmidt. Through a UN-like interpreter service, Ms. Schmidt described recent reforms that the country has taken to try and control skyrocketing costs.

Unlike some of their European counterparts that have universal healthcare system controlled by a central government entity, Germany’s system is based on coverage through private non-profits that arose out of sickness funds created in the late 1800s, that compensated workers in certain professions (who were required to pay into the system) from losing income when they got sick. Still, with this decentralized (and privatized) healthcare system, the country manages to cover 90 percent of its citizens.

As a result, Germany is struggling with many of the same issues of a private health care system that we are here – including the balance between regulation and encouraging free-market competition.

Perhaps we can borrow from lessons Ms. Schmidt has learned:
“Whoever calls for more competition in health services will usually not want that principle applied to themselves.’’

The system is now a patchwork of 292 sickness funds (down from 1,200 a decade ago) and workers can choose to move between the funds. The funds are required to contract with any applicant (guaranteed issue!). The result has been that younger, healthier and wealthier have fled to “sickness funds’’ that are cheaper (sound familiar?).

The way they’ve chosen to deal with this, Schmidt said, is that just this year, the federal government is starting to pool together all the contributions and distributing to the sickness funds based on the make-up of each funds subscriber base. So if one sickness fund has sicker people, then they’ll get enough money to assure that those people get proper preventive and maintenance care. This, Schmidt hoped, would take away the incentive for sickeness funds to design plans that attracted healthier people – AND reward efficient funds.

Funds that could take care of their members well – keep them healthy with existing dollars – would be rewarded. If they really used their money wisely, then they’d be able to refund subscribers

On the other side, inefficient funds that ran out of money would have to ask their subscribers for additional money. Those subscribers would then become disgruntled and be free to move to another plan.

Additionally laws in Germany require coverage and contribution based on income, mandate a very high level of benefits, and protect consumers from having to pay too much out of pocket already. We don’t have that here. But Schmidt said that’s the role that government plays – to assure those rules are followed.

In a sense, that’s what we’re trying to do this year: create more rules.

It was encouraging to hear from Schmidt, who presented ideas we might be able to borrow from.

Germany, however, has a very strong sense of solidarity among its citizens, that I’m not sure exists in all parts here, that could be more of a barrier for us. “Everybody has to contribute from their income to the health care system. That’s the principle. The healthy pay for the sick. The young pay for the old. The people with no kids pay for people with kids. That is the system.”

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posted by Hanh Kim Quach | Permalink | 2:43 PM


Will he veto?

Really? President Bush might use his first veto of a spending bill on the issue of children's coverage?

Robert Pear at the New York Times and Christopher Lee of the Washington Post report that the Administration has indicated that they would veto the Senate proposal, which would increase tobacco taxes by 61 cents to a flat $1, in order to raise $35 billion for expansion of the State Child Health Insurance Program (SCHIP).

SCHIP is deservedly popular among Democrats and Republicans: it is a major public insurance program, covering millions of children, including 800,000 Californians. Yet, to consumer advocates' chagrin, the structure of the program made concessions to those who critique "big government-run" programs: while providing federal funds, it gives states flexibility in deciding whether to have a program, the eligibility and enrollment rules, and how they implement it; the states mostly negotiate with private insurers to provide the coverage; it is not an entitlement like Medicaid, so when funding runs out, children are left on waiting lists.

Given the Congressional support, the issue was not whether to continue SCHIP, but at what level, and, most importantly, how to pay for it. Frankly, we expected the biggest issue would be the new "pay-as-you-go" rules by the new Democratic leadership, not presidential opposition. They are still working to figure out the money, but could it really face a veto?

With all the other hot-button issues, it still doesn't quite make sense that someone who campaigned as a "compassionate conservative" would choose children's coverage as the issue to draw the line in the sand.

posted by Anthony Wright | Permalink | 10:18 AM


CHIPping away...

Saturday, July 14, 2007
With all the activity about health reform here in California, it might be easy to forget all the drama about SCHIP at the federal level.

The Senate Finance Committee approved a tobacco tax to fund a $35 billion increase in the State Child Health Insurance Program (SCHIP). Robert Pear at The New York Times provides some background.

Politicians of both parties give verbal support for children's coverage, the question is whether they support raising the money needed to fully fund the program, especially under new "pay-go" rules. Some wanted reduce payments to Medicare Advantage HMOs; others wanted to look at other taxes.

What's this mean for California, and Healthy Families, our version of SCHIP? The $35 billion increase is less than the $50 billion increase advocated by many children's, religious, and health groups, which would assured that California could reach its goal of covering all children. This Senate version will need to be reconciled with the House. And whtatever the amount, the other fight is the formula to distribute the funds between states.

In short, the pressure needs to kept up. This campaign is a long ways from over.

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posted by Anthony Wright | Permalink | 12:20 PM


An apple a day...

Thursday, July 12, 2007
Here's the announcement for a panel I am moderating tomorrow on prevention issues in the various health reform proposals. We will be touching on both traditional public health efforts, to how the design of benefits might impact prevention and healthy living...

The California Task Force on Youth and Workplace Wellness invites you to:

How will the health care reform bills keep you healthy?

Please join us for a panel discussion with legislative representatives, followed by a question and answer session. We will focus on the differences between the healthcare reform bills and the prevention components within these bills.

Friday, July 13, 2007
10:30 a.m. - 12:00 p.m.
State Capitol, Room 112

Anthony Wright, Health Access California

Invited Speakers Include
Cindy Ehnes, Department of Managed Care
Sumi Sousa, Assembly Speaker Fabian Núñez
Tim Conaghan, Senate Republican Caucus
Sara Rogers, Senator Sheila Kuehl

See attached flyer for more information. Please contact Leah Cox to RSVP at wellnesstaskforce@yahoo.com, or by calling 916-760-7448 . (RSVP not required.)

posted by Anthony Wright | Permalink | 5:40 PM


Department of Corrections

In our latest long report on the Senate Health hearing, we erroneously said AB55 (Dymally) had passed. AB55 was not heard and has since been amended to relate to the LA Health Authority, not Medi-Cal eligiblity for adults.

We apologize for the error.


posted by Hanh Kim Quach | Permalink | 12:19 PM


A full report on a long hearing on a big topic...

Wednesday, July 11, 2007

* Hundreds of health advocates storm Capitol to support reform efforts this year
* Amendments taken, debated; Many specific issues raised
* Stage set for legislative negotiations with Governor Schwarzenegger
* Other bills of interest to health advocates considered

New on the Health Access WeBlog: New Studies; New Posts; New York and Other States Pursue Reforms; New Website at www.SickOfBlueCross.com

With the deadline for bills to pass committees coming at the end of the week, the Senate Health Committee, chaired by Senator Sheila Kuehl, heard testimony and voted on over two-dozen bills late into Wednesday evening.

The first bill heard was the most far-reaching, AB8(Nunez/Perata), the joint health care reform proposal by legislative leadership, which is expected to be the vehicle for negotiations this summer with Governor Arnold Schwarzenegger, who put forward his own proposal at the beginning of the year.

Speaker Fabian Nunez and Senate President Pro Tem Don Perata presented their new, unified AB8, and as expected, got all seven Democrats on the committee voting for the bill. The bill needed six votes to pass.

Hundreds of health advocates and consumers from the “It’s OUR Healthcare” campaign turned out at Wednesday’s hearing to urge passage of health reform, this year, and also to make press for additional provisions about affordability, cost containment, and other issues.

THE BILL: AB8 would provide more security to those with insurance, and expand coverage to 3.4 million Californians who are uninsured. Nunez described the bill: “It is based on the principle of shared responsibility between government, individuals, and employers. The key components are the following: major reforms for the insurance industry, expansion of public insurance programs, key measures to contain the cost of health care, measures to improve and reward health care quality, and provisions that will improve the private health care market.”

AB8 would expand public insurance programs to children and parents up to 300% of the federal poverty level ($30,000 for an individual, $62,000 for a family of four), and remove many of the administrative barriers to enrollment to Medi-Cal and other programs, such as the assets test, depravation test, and semi-annual status reports.

It would set a minimum employer contribution to health care of 7.5% of payroll, and also provide new option for employers to pay such a fee to a statewide purchasing pool that would provide coverage for all their workers. Such a pool would be funded by employer contributions, worker contributions, reinvested state savings, federal matching funds, and new use of federal and state tax breaks.

The bill would makes reforms to insurance market, including a minimum medical loss ratio so that 85% of premium dollars go to patient care, and more protections for mid-size employers and purchasers. With AB2(Dymally), a companion bill which also passes the committee, the reforms would prevent insurers from denying all but 3-5% of consumers because of their health status, and would fund a high-risk pool to provide better access to coverage for those with “pre-existing conditions.”

Saying he didn’t want to “oversell” the bill, Assembly Speaker Fabian Nunez acknowledged that the bill was still a “work in progress.”

“While this is not a perfect plan, we believe it is a thoughtful plan that will help pave the way for comprehensive reform,’’ he said. “…Clearly there is no greater issue of state interest or urgency that we can be working on today than improving on our fragile health care system. This is a rare opportunity we have….we need to act now. We need to take advantage of the opportunity we have before us.’’

Senate President Don Perata said it was important to move AB8 this year, but indicated that his preference was a national solution. “There’s no doubt that we ought to have a national health care program… It’s scandalous that a country like ours is woeful in the way it treats and responds to people who are in ill health,’’ he said. “Until that day comes, California must provide leadership, not unlike what we did with AB32,” last year’s global warming bill.

AMENDMENTS DEBATED: In preparation for the committee and at the hearing, Speaker Nunez took a range of amendments suggested by Kuehl’s Health Committee. However, Nunez said he could not, at this time, accept the committee suggestion -- which consumer groups supported -- that total health care costs (including premiums, deductibles and other out-of-pocket costs) be limited to 5 percent of a family’s income. Right now, under AB8, only families in the purchasing pool under 300% of poverty ($62,000 for a family of four annually) are guaranteed to not have to pay more than 5% on just their premium.

“We’re still working on many aspects of the bill…that’s not to say that Sen. Perata and I are not committed to making sure that as we more fully develop the bill, that we can allow people to purchase an affordable plan.” he said. “Particularly if you are going to require them to have insurance, we believe it is our obligation and our responsibility to be able to make available to them a health care product that is affordable. Otherwise, it is not good government to impose upon people, to have a requirement, and not be able to provide them with a health insurance premium that when they pay [with] their our-of-pocket share, is [not] going to cost them more that what [they need] to keep a roof over their head.” Nunez later said that while he “would love nothing more” to place a cap on costs for all consumers, he could not commit to it at the moment because he wasn’t sure if there would be enough money to do that.

Kuehl urged that in negotiations with the Governor, to include the concept of “affordability.” She pointed out that Massachusetts did exempt individuals from a requirement to get coverage if that coverage wasn’t “affordable.”

Nunez also did not accept amendments that would have established minimum package of benefits for private group coverage, with regard to preventative care and cost sharing. AB8 does have a basic HMO benefit (Knox/Keene and prescription drugs) in the purchasing pool. Nunez responded that AB8 does establish three standardized products in the overall private market, to help consumers better make comparisons between plans, allowing for “apples to apples” comparisons.


Sen. Elaine Alquist, a proud co-author, started discussion by raising the hope for additional cost containment provisions, to make it easier for purchasers of health care to shop for care based on cost and quality, to make the statewide purchasing pool as big as possible, and to consider allowing county public insurers on the market compete with private plans to help drive down costs.

Assembly Health Committee Chair Merv Dymally also made a quick comment, commenting on eight town hall meetings, where there was support for both AB8 and SB840, Senator Kuehl’s bill. He referred to the long line of Governors since Earl Warren in 1945 that have confronted health care issues, and hoped that this year’s efforts would be more successful.

The committee took nearly an hour of testimony from parties who were watching the bill. Comments on the bill fell into the following categories – Support, Support if amended, No position, and Opposed.

SUPPORT: The 100% Campaign (made up of three children’s groups) and PICO California expressed their support for the measure, as part of their long-standing goal of covering all California ’s children, as well as their support for broader reform.

SUPPORT IF AMENDED: These stakeholders included the California Labor Federation, Health Access California, and the Its Our HealthCare coalition, Western Center on Law and Poverty, Service Employees International Union, Congress of California Seniors, Consumers Union, American Federation of State County and Municipal Employees, National Multiple Sclerosis Society, California Medical Association, Latino Issues Forum and Having Our Say Coalition, Blue Shield of California, Kaiser Permanente, California Primary Care Association, AARP, ACORN, California Black Health Network, California Pan Ethnic Health Network, Jericho, CALPIRG, California Optometric Association, California Chronic Care Coalition, TMJ Society, American Diabetes Association, Alzheimer’s Association, California Academy of Family Physicians, and the American Cancer Society.

Many consumer and community groups appreciated many of the provisions of the AB8, from the statewide purchasing pool to the expanded public programs to the increased access for those with “pre-existing conditions.”

Consumers groups echoed similar requests, asking for assurances about affordability for consumers, both for premiums and out-of-pocket costs, and offered several cost containment suggestions, including oversight of rate increases, creation of public insurers to compete with private plans to drive down costs; bulk purchasing of prescription drugs, and the ability for health purchasers to have more transparency for what they’re paying for. Given the larger role for the Managed Risk Medical Insurance Board (MRMIB), some also asked that lawmakers review how the board is structured and governed.

Other advocates and lobbyists called for coverage and access for childless adults without children at home, due process protections for those in the Medi-Cal expansions, consideration for adequate health care workforce and facilities and primary care capacity, specific provisions on prevention of health problems and medical errors, cultural and linguistic access for patients, and increased Medi-Cal provider reimbursements.

Many patient groups urged full “guaranteed issue,” and some said they would support an individual mandate to reach that goal. Health plans Blue Shield and Kaiser Permanente also announced their tentative support for that position, saying they if they were required to offer coverage to everyone, all Californians should also be required to have coverage.

CONCERN/NEUTRAL: Senator Kuehl allowed brief comments by groups without positions, including the California School Employees Association and California Association for Hospice Care.

OPPOSITION: The list of opponents, both those seeking amendments and those implacable in their position, included the National Federation of Independent Businesses, California Small Business Association, California Hispanic Chamber of Commerce, California Association of Health Plans, California Manufacturers and Technology Association, California Chamber of Commerce, California Farm Bureau Federation, California Restaurant Association, California Association of Health Underwriters, Aetna, Cigna, Protection and Advocacy Inc., National Association of Insurance and Financial Advisors, Association of California Health and Life Insurance Companies, Coalition to Advance Health Care Reform, the California Nurses Association, and a few business owners.

Several business organizations expressed opposition to the minimum employer contribution. NFIB cited a study they released this week that predicted job loss, increased costs, and lost sales. (A study released yesterday by UC-Berkeley debunked that notion, predicting a “net positive” economic impact.) Many opposed the notion that the assessment was a fee, rather than a tax. Others argued for cost containment and “fiscal discipline” measures, and expressed fear that the fee on employers would go up. Restaurant, grocer, and farm representatives argued that their industries would be especially impacted. Some wanted exemptions for small or low-margin businesses.

Health underwriters disputed that a large purchasing pool could bring down costs, and expressed concern on the minimum medical loss ratio. Health plans opposed the insurance market reforms in both the small group and individual markets, and the lack of an individual mandate.

Protection and Advocacy, Inc., representing people with disabilities, was opposed unless amended, expressing concern about a high-risk pool of patients with expensive medical conditions that was separate from the rest of covered Californians. And the California Nurses Association, in their opposition, said health insurance is not health care, and expressed fear that AB8 is, or will be, the Governor’s proposal.


Republican Sen. Sam Aanestad said he was concerned that AB8 was the main vehicle, but with so much contention in opposition, and even supporters seeking amendments, he urged Nunez to take another year. Aanestad said he feared that the legislature was trying to do too much too quickly and might end up fouling up the system – as lawmakers did with electricity deregulation.

Democratic Sen. Darrell Steinberg, however, countered that there was momentum on health care this year. “Sometimes, you just have to capture the moment.” The moment, Steinberg also said, may never come to naysayers who continue to hold reform back year after year. While they profess to want an improved health care system, they are unwilling to support spending money on it. “You either want to get something done or you don’t. It’s not free,” he said.

Republican Sen. Mark Wyland said “this is the sort of bill we should be working on,” but raised concerns. He’s watched over the years as his own businesses started paying less and less for employee health care, and urged more cost containment. He said lawmakers need to consider that not all businesses will be affected the same way. He also said lawmakers needed to think about how to help businesses that must compete on an international level with companies that do not have to factor in environmental quality and health costs.

Sen. Sheila Kuehl joked that she didn’t like AB8 as much as she liked her own bill, SB840, and she thanked Speaker Nunez’s strong support of her proposal. That said, Kuehl acknowledged that in her role as Health Committee Chair, “my responsibility is ‘in the realm of the possible and in the realm of the present.’”

Kuehl said she would vote for AB8 passage out of committee, so that the Legislature needed to have a bill that was “better than the governor’s proposal.’’ But, she said, “my job has been to push as hard as I can on behalf of the people to hammer on the issue of affordability and coverage,” and she urged those principles as touchstones in negotiations with the Governor.
Democratic Sen. Cedillo agreed with Kuehl’s statements and said “if we had a different governor, we might have a different discussion,” citing his support of SB840. But, he also said of AB8, “Frankly, this is a really good bill…. I don’t want to say this is a question of making perfection the enemy of the good, but we have had setbacks,” citing failed efforts at immigration reform recently. “This is a very good bill for a lot of people,’’ Cedillo said.

In closing, Nunez cited his support for Senator Kuehl’s SB840 last year and this year. On his bill, he also acknowledged the opposing viewpoints on his bill, but cautioned, “There are too many problems (in the health care system) for us to wait and come up with a perfect solution that everybody can support…I would argue when you come up with a good solution…you will always have people who oppose it.” He continued, “While it is not a perfect bill, it is a very solid piece of legislation that Senator Perata and I are very proud of… The framework is there…. There are still amendments that we are working on taking.’’

“There is nothing in this bill that will prevent people who like the current system, for those who it works for, to continue to enjoy it... There are 3.4 million who are going to get health care. We’re going to work to improve upon the market and make it more friendly to the ordinary Californian, working California , middle-class California . In the end, it is our goal to expand coverage, improve quality and do no harm,’’ he said.


Health advocates also followed several other bills with high interest, including two other bills that were seen as complementary to AB8: AB2 (Dymally) and AB1554 (Jones).

AB2 (Dymally) would reform the individual insurance market, restricting insurers' practices of denying coverage to consumers with “pre-existing conditions.’’ Instead, the bill places MRMIB in charge of coming up with a standardized questionnaire for insurers to use in determining eligibility for coverage. Those consumers who were denied coverage in the private market would still be able to get coverage through an improved version of the state’s current MRMIP program. That program would no longer have a $75,000 annual cap on benefits, and all California enrollees would pay a small assessment 50 cent to fund the high-risk pool. All Democrats voted in favor of AB2, and no organizations opposed the measure.

AB1554 (Jones) would have regulated insurance rates, requiring health plans to seek permission whenever they wanted rate increases. The bill fell one vote short of passage. Five Democrats voted for the bill, but Sens. Leland Yee and Gloria Negrete McLeod declined to vote for the bill.

OTHER BILLS OF INTEREST TO HEALTH ADVOCATES: With this week being the last that policy committees could hear bills, the health committee busily heard another two dozen bills. Other that are of interest to health advocates included:

* AB1 (Laird) – PASSED – Would allow children in families up to 300% of poverty to enroll in Healthy Families. Support.
* AB12 (Beall) – PASSED – Creates the Adult Health Coverage Expansion Program in Santa Clara County . Support.
* AB55 (Dymally) -- PASSED -- Would increase Medi-Cal eligibility for adults to 133% of poverty. Support.
* AB1113 (Brownley) – PASSED – Extends and increases eligibility for the Medi-Cal California Working Disabled Program. Support.
* AB1472 (Leno) – PASSED – Encourages healthy communities. Support.

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posted by Anthony Wright | Permalink | 12:35 AM


Late breaking...

Wednesday, July 11, 2007
At 8:00pm, Senate Health Committee just wrapped up, and the tallies are officially in.

AB8(Nunez/Perata) passed the Senate Health Committee on a party line vote.

Also passing Senate Health Committee:
* AB2(Dymally) to restrict the ability of insurers to deny people because of "pre-existing conditions," and fund a high-risk pool.
* AB1(Laird) to expand coverage to all children up to 300% of the federal poverty level (FPL).
* AB1113(Brownley) to expand Medi-Cal for working people with disabilities up to 250% FPL.

AB1554(Jones) to provide for rate review and justification failed to get the needed votes, with Democratic Senators Yee and Negrete-McLeod not voting.

We'll have a full report on the debate later.

posted by Anthony Wright | Permalink | 8:02 PM


Studying for finals...

Lots of studies coming out today...

The UCLA Center for Health Policy Research releases its big annual report on the state of health insurance. Based on the data from their California Health Interview Survey (CHIS), the big takeaway is that the main pillar of our health system, employer-based coverage, is eroding. Public programs are partially filling in the gap, but that safety-net is really focused on children, not adults.

The San Diego-based Center for Policy Initiatives also put out a report that focused on employer-based coverage, and really points out the industries and employers less likely to provide health benefits, and the workers that are least able to get coverage on the job are also least able to be able to afford it on their own.

While these reports have implications for the health policy debate, the UC-Berkeley Labor Center has put out an economic analysis of the business impacts of the Governor's proposal and AB8(Nunez/Perata). Not to be confused with the recently-released NFIB study about AB8 which predicts doom-and-gloom, the Labor Center study suggests a "positive net impact on the California economy," with most firms experiencing no or little change, some with modest productivity impacts, and some with modest short-term increases in operating costs.

The studies, as a whole, better illustrate the problem, and provide the fodder for the debate about the solution...

posted by Anthony Wright | Permalink | 12:00 PM


Circling the (profitmaking) wagon....

Calling legislative leader's health bill AB8 (Nunez/Perata) "dangerous legislation,'' insurance brokers are lining up to oppose health reform in California.

Brokers lambast the bill for "prevent(ing) you from providing services to many of your clients.

Since they're brokers, I'm guessing that service would be: selling health insurance so that people can have coverage.

First off, AB8 expands coverage. So if insurance brokers had pure hearts, they'd actually appreciate the fact that Democratic leaders are trying to make sure more people had coverage, right?

The fact is, brokers probably aren't looking out for the uninsured: It's about their ability to make money. For the record, there is nothing in AB8 that specifically prohibits brokers from selling insurance. However, for consumers who get health coverage through the state -- rather than through their employers or on their own -- there would be no broker fee because the state doesn't pay broker fees. (The same situation would exist if we were debating the governor's plan, which also calls for a larger role for the state to provide consumers health insurance.)

Obviously, not getting a broker fee from the state would cut into said broker's profits. But they might see more action from businesses since businesses would be required to offer coverage.

And even if they don't, is it really worth blowing up our chance to try and fix a system that everyone admits is broken?

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posted by Hanh Kim Quach | Permalink | 9:28 AM


The state of the debate...

Tuesday, July 10, 2007
Blogger Ezra Klein has a new piece at Washington Monthly that expresses doubt that state-based health reform will be ultimately successful. It wasn't convincing.

There are certainly arguments about why reform at the federal level is preferable, more sustainable, and even more straightforward policy-wise. He is right, for example, that the federal government is better able to keep programs going during economic downturns, since it has the ability to run deficits, which are more limited at the state level.

But there's clearly opportunities at the state level, including California, so why wait? His examples of failed state efforts lacked the context of comparison with all the failed efforts at the national level, from Teddy Roosevelt to Harry Truman to Richard Nixon to Bill Clinton. The history of health reform has lots of failed attempts at the state *and* federal level, but that's not a reason to stop trying at either level.

And California exceptionalism runs rampant: we think of ourselves as a nation-state anyway, and of DC as a far-away place that take a full day to get there, where people go home at our 2pm.

In bringing up California, he goes astray. (I think he's also mistaken on the Illinois plan, which doesn't have the individual mandate as he said.) His critique of the Schwarzenegger proposal is reliance on federal money, which he is concerned could be rejected or taken away at another time.

But what important to the Governor's plan (and AB8) is that the federal money is simply *matching* money that California is entitled to. California spends the least amount of money per Medicaid patient as any state in the nation, but as a result, we don't get our fair share of federal money. However, if California puts more money on the table, then we get our mandated match from the federal government. For both proposals, the vast majority of money does *not* require federal approval, since it simply is the match that every state is required to get, and is money that frankly California has been leaving on the table for years and years.

Could a future president mess with this? Possibly, but that Congressional fight would not just be with California, but with most states. Now that's a fight that we can win.

posted by Anthony Wright | Permalink | 10:51 PM


If you can make it there...

The state health reform bandwagon is speeding up, with New York setting up to be the next big state to take on the challenge of covering the uninsured. The New York Times reports that Governor Spitzer is have his team of experts come up with proposals for major reforms and expansions.

New York, my home state, would join not just California but Illinois and Pennsylvania where big-state Governors are making health reform a big-ticket issue. This only helps, both to create some self-reinforcing momentum between state efforts, and to compel national action in the presidential campaign and afterwards.

California is a lot more like New York than Massachusetts or any other state in the union, with its size, political profile, the mix of big cities and rural areas, and hyperdiversity aided by large immigrant populations. However, New York has some advantages already: a much more regulated insurance market (guaranteed issue and community rating is just the beginning), and more Medicaid expansions and creative ability to bring in federal matching funds. California has a lot to do just to get to where New York is.

posted by Anthony Wright | Permalink | 10:41 PM


Been Blue Crossed?

It's Our Healthcare campaign is launching a brand new website www.SickofBlueCross.com to combat the largest opponent of health reform.


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


Testing the Tensile Strength of our finances

Monday, July 09, 2007
It seems that health plans are really trying to test the limits of consumer finances. A report released last month from Health Affairs tells how consumers are getting hosed from both directions .... but the moral of the story is, it's still better to buy coverage through a group, than as an individual.

Here are the key points:
  • Between 2003 to 2006, premiums for Small Businesses increased by 53 percent, while those for Individuals increased only 23 percent.
If you were strictly looking at premiums, you'd think the individual market was a good deal. Not so fast.
  • The Average Deductibles among all Small Business plans was $348. Meanwhile, for individuals, its $2,136 -- six times higher!
  • Small business plans cap out-of-pocket costs at $2,000 a year. Individual plans cap it at $4,000.

It also matters whether you're sick or healthy.

  • A patient with Asthma would spend $886 out of pocket if insured through a small business. That person would spend $2,607 if insured on their own.

Policy makers should heed the results of this study as they draft health reform legislation. To wantonly push consumers into an indivdual market where they are not getting much value for their dollar is unfair and may only lead to a need for bigger reforms later. Let's just get it right the first time.

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posted by Hanh Kim Quach | Permalink | 12:08 PM



Sunday, July 08, 2007
This marks the 600th post to the Health Access WeBlog.

For over five years, since 2002, we have posted 300(!) Health Access Updates and Alerts, providing up-to-the-minute reports about what is going on in Sacramento that impacts health care consumers. These E-mailed reports have been a service of Health Access to our member and allied organizations, as well as to hundreds of community leaders, health care advocates and activists across the state, to improve their ability to represent consumers and communities. In particular, our effort is to not just keep our community informed with the inside scoop in Sacramento, but to best faciliate individuals and groups to engage: to make timely and appropriate inteventions to benefit California patients and consumers.

The archives of these posts on the left serve as a full-fledged history of the health reform movement in California, through budget crises, to the first introductions of bills on single-payer, employer contributions to health coverage, children's insurance expansions, and a variety of consumer protections. They are worth checking out.

After the election last year, with another round of reform brewing, we decided to supplement these weekly-ish reports with daily blog posts. In just over eight months, we've also hit an additional 300 blog posts, providing even more quick updates, as well as color commentary and opinion. With the debate on reform, and a host of other activities around health policy, we wanted to make sure our member and allied organizations had a quick resource for up-to-the minute information.

As you can see, we are continuing to add new resources, including searching by topic, a blogroll of other relevant blogs, and other features for your benefit. We would appreciate any feedback that you have as we continue to try to foster increased interest and engagement on health policy issues. Please E-mail for your comments, critiques, suggestions, or other ideas to awright@health-access.org. We look forward to continuing to provide this and other resources in the next months and years...

posted by Anthony Wright | Permalink | 9:30 PM


Reserving my right to critique coverage later...

Wednesday, July 04, 2007
I'll take the opportunity of July 4th to declare my independence from health policy-specific posts for the day.

The most troubling development in state government has not been anything in the State Capitol, but across the street, at 926 J St. That's where most of the state newspapers have their statehouse bureaus, which are quickly being depopulated.

Some reporters have accepted buyouts. Others have been forced to retire. Yet others have simply moved out of town, or to an another career "in the building", but not replaced at the paper. A few have been directly laid off. These are good reporters, senior and experienced journalists.

And the headlines suggest there might be more cuts to come in the newspaper business. This is distressing on several levels, as a colleague, as an advocate, as a reader, and as a citizen.

* It's sad for those personally impacted. I talk to many political, health and general interest reporters, and have befriended many of them. They are smart, articulate, and chose journalism over perhaps more lucrative careers for the right reasons, and now are looking for a Plan B. For those in a noble profession, the morale of those who are left is not high.

* Professionally, it is hard to do my job as a consumer advocate on health issues if newspapers are going to be covering policy and government. Insurers, drug companies, hospitals, and other corporate interests may not care when the San Jose Mercury News axes its Sunday opinion section; they can always buy advertising in different venues to get its message out. Losing the articles and forums that provide equal time to all sides hurts the ability for consumer and community voices to be heard.

* I fear for the quality of the product. I like reading newspapers, both in print and online. My idea of a perfect Sunday includes sitting outside for a couple of hours going through several newspapers, from The New York Times to my local broadsheet. Some papers are getting noticeably thinner, furthering encouraging some to cancel their prescriptions, which would leads to further cuts, less content, and a exacerbated downward spiral.

* My biggest concern is beyond the impacts on my job, my friends and colleagues, or even the newspaper. It's about our democracy, and the need for an informed citizenry, an accountable state government, and a diversity of news outlets and venues for reporting.

When Arnold Schwarzenegger became Governor, some argued that he would bring in a renewed media attention to state government, especially in star-obsessed Los Angeles. After the media frenzy of the recall, it seemed some outlets would have a beefed-up staff.

Alas, even the Terminator's star power didn't convince the entertainment-focused media to stay around in Sacramento and cover deficits, compacts, redistricting, and Medi-Cal. But if anything, it's gotten worse. I was told that the Governor's trip to Canada had a press contingent of exactly one pool reporter.

As the newspapers thin their ranks of reporters, it will be less likely that journalists will have specific beats and specialties, like health care. And yet health care (and other subjects) are getting more complex, not less, and can best be covered by those with a base of knowledge to be able to dig and get at the truth of an issue. I am a better advocate this year with my knowledge and experience on health issues than I was last year, and reporters and their articles benefit from that background and context as well.

So on this July 4th, when we celebrate our nation and our democracy, light a firework for the threatened profession of journalism as well. Our health, and so much more, depends on it.

posted by Anthony Wright | Permalink | 11:37 AM


From small changes to BIG changes...

Wednesday, July 4, 2007

* Organizations line up to support SB840; Partisan debate over merits
* Other health bills on children's coverage & drug trials are voted on in Assembly committees

New on the Health Access WeBlog: More on High Deductible Health Plans; Polling on Health Reform; Paris Hilton Update; International Comparisons; Border Health; San Francisco Starts Enrolling; Bush Opposes SCHIP Expansion; Tom Tomorrow Cartoon; Statehouse Reporters

Tuesday was the last day for Senate health-related bills (aimed to be passed in 2007) to be heard in Assembly Health Committee. The Committee heard testimony into the evening.

SB840: First among the bills considered was SB840, Sen. Shiela Kuehl’s universal, single-payer health reform measure. “If you don’t have single payer, someone is going to get left behind,’’ said Kuehl, in calling on lawmakers to support her legislation.

IN SUPPORT: The Assembly Health Committee approved SB840, but not before the regular stampede of dozens of organizations showed up to support the bill.

Of the many organizations that mentioned their support for SB840 were: California Nurses Association, Western Center on Law and Poverty, Health Access California, California School Employees Association, California Physicians Alliance, City of Berkeley, California Catholic Conference, California Labor Federation, Congress of California Seniors, Gray Panthers, Service Employees International Union, California Faculty Association, Planned Parenthood, Consumer Federation of California, California Federation of Teachers, California Association of Retired Americans, California Professional Firefighters, Health Care for All, California Primary Care Association, United Nurses – AFSCME, Consumers Union, California Senior Legislature, Friends Committee on Legislation, Senior Action Network, United Food and Commercial Worker retirees, Breast Cancer Action, American Association of University Women, California Foundation for Independent Living Centers, Richmond Commission on Aging, City of Berkeley, Wellstone Democratic Club, League of Women Voters, California Teachers Association, Latino Coalition for a Healthy California, California Commission on the Status of Women, CalPIRG, American Medical Students Association, Green Party, and consumers who said they were victims of “insurance company malfeasance.’'

One poignant testimony came from a cancer patient who was about to have her short-term policy run out, and was being denied renewal of that policy, given her condition.

IN OPPOSITION: The usual bevy of insurers and business groups opposed SB840 using some very familiar arguments.

Michael Shaw from the National Federation of Independent Business, a faithful opponent of SB840, said that a single-payer system would mean “government rationing of care’’ and that doctors and hospitals “would not be paid for the services (they) are giving.’’

Shaw’s assertion did not acknowledge the issue of nonpayment in the current system – by health insurance companies. Providers spend about $10 billion a year (nationally) on lawyers trying to recoup costs for services they’ve provided, but health insurance companies have denied. Insurers spend an additional $10 billion on lawyers trying to keep providers from getting their money.

Steve Lindsey from the California Association of Health Underwriters also opposed SB840, making arguments that elicited derision from the audience. “One of the ways single-payer controls costs is by denying care,’’ said Lindsey. Coincidentally on Tuesday, the Los Angeles Times had another article detailing how the Department of Insurance had found that Blue Cross mishandled more than half of the cases in which the company unilaterally cancelled policies on consumers who paid them premiums and expected health coverage.

Lindsey was put on the spot by Assembly Health Committee Chair Mervyn Dymally, who asked him, “Of the top 8 countries, can you name the ones that don’t have a comprehensive health system?” He was forced to response that “America does not have one.’’ “Right,’’ said Assemblyman Dymally, succinctly.

DISCUSSION BY LEGISLATORS: Republicans legislators Nakanishi, Gaines, Huff, and Strickland went through the usual litany of reasons that they do not support a universal, single-payer health care reform: They argued that the US has the best health care in the world, allowing for research and innovation, and any change would harm the good elements of our current system. They said that under such a system, the health care industry will have little incentive to invent new technologies, and countries with single-payer have long lines and care is rationed. They claimed that people from other countries come to the US for care, and that businesses will leave the state. Nakanishi reminded Kuehl that the state has a budget deficit. Huff asked, do you really want the people in charge of DMV or CalTrans running health care?

Assemblywoman Audra Strickland, R-Moorpark, attempted to blame the uninsured for not having coverage, naming undocumented immigrants and those between jobs. Strickland also said that some uninsured “make well over the poverty level’’ and “choose not to buy health insurance.’’

Poverty level is $17,170 for a family of three. While it’s unclear what Strickland meant by “well-over,’’ three times the poverty level is a family of three earning more than $51,510. According to the California Health Interview Survey, only 3.6 percent of individuals earning three times poverty actively decline coverage when it’s offered to them. For the remainder of the 96.4 percent of uninsured, they’re ineligible, not offered, or can’t afford coverage.

A calm Kuehl, in closing, rebutted arguments.

* On the U.S. being the best health care in the world: “We don’t have the health care in the world. It’s ranked 37th by the World Health Organization.’’
* On how single-payer would lead to rationing: “That’s what we’ve got here is rationing.’’
* On long waits: “We have long waits here. I can’t get an MRI tomorrow. I’m told I can get it in four weeks. The waits that people go through are expected. Of course you don’t get into surgery the next day.’’
* On the cost and increased taxes and innovation: “Stop wasting 30% of health care dollars on administration (which insurers use to try and deny care), that money is not going toward innovation. SB840 actually has a much better shot at encouraging innovation because it’s built into the budget.’’

In closing, Kuehl acknowledged that all lawmakers were trying to do something to improve the health care system we have currently. “Let’s talk about humanity. This state and this country is struggling to do what’s right. The reason I think this is the best is because it actually takes into account what people need.’’


Other bills of note to health and consumer advocates were considered in various committees, including Assembly Health Committee, Assembly Judiciary Committee, and Assembly Insurance Committee. They included:
* SB350 (Runner) PASSED. Makes technical amendments to last year’s AB774, which bans hospital overcharging.
* SB32 (Steinberg) PASSED. Would extend Medi-Cal and Healthy Families coverage to all children under 300% of poverty. Support.
* SB474 (Kuehl) PASSED. Technical bill that allows hospitals that receive federal funding for uninsured patients to continue receiving it. Support
* SB606 (Scott) PASSED. Requires drug companies selling products in California to make clinical trial results publicly available. With amendments, this got bipartisan support. Support.
* SB972 (McClintock) FAILED. Would have allowed small employers to create health insurance co-operatives that would have little state oversight, and could have ignored state consumer protections. Oppose.


Wednesday, July 11 will be the last chance for Assembly bills to be heard in the Senate Health Committee. Health Access will provide a full update of the outcome of AB8 (Nunez/Perata) the Democratic leadership’s health reform bill.

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posted by Anthony Wright | Permalink | 2:05 AM


The view from 10,000 feet.

Tuesday, July 03, 2007
As somebody looking at and trying to understand the specific details of the new health reform proposals this year, such as AB8(Nunez/Perata), it is a bit surreal to then hear the kind of very broad debate this afternoon in Assembly Health Committee on SB840(Kuehl).

When the debate over other bills was largely haggling over wording and amendments, the discussion between the Democratic legislators in support of SB840, and the Republican legislators in opposition, was a view from 10,000 feet, strident arguments that resembled this Tom Tomorrow cartoon.

Some might say that SB840 lends itself to this kind of debate, since the Governor has stated his intent to veto the proposal again, yet the Democratic legislators continue to pass the proposal as a statement of their values and goals. But the legislative discussion is similar to that of the many previous debates for this and other health reforms, this year and last.
Perhaps when the ideological issues are so big, the details don't matter. But they do, to the health care consumers who have to live with them. That's the work of this summer.

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posted by Anthony Wright | Permalink | 4:22 PM


A Zen Sen

SB840 was just heard in the Assembly Health Committee a few minutes ago and lots of priceless comments were proferred by opponents of the bill, which we will report on later today. In the face of such attacks on her legislation, though, Sen. Sheila Kuehl remains the picture of composure and thankfully is able to refute the arguments one by one.

But one of the more aggravating statements came from Assemblywoman Audra Strickland, R-Moorpark.

Strickland insists that people would be denied care -- (more than they are now?) -- under a "government run system.'' For instance, a sports athlete with a torn rotator cuff could jump in line ahead an older person who had the same injury.

“Preferential treatment – that’s a big problem that happens when the government gets to decide things,’’ she said. (Of course, I doubt Ms. Strickland would think the Halliburton contracts for the Iraq War were preferential. )

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


Bush Whacking Kids

As many advocates know, 2007 is a crucial year for children's health care. The federal State Children's Health Insurance Program is up for renewal. President Bush has given the program the bare minimum to continue the next five years.

In his latest stunt, George Bush criticized those who would extend State Children's Health Insurance Program to "middle-income'' families. He apparently believes that families earning $35,000 a year can buy "affordable'' health coverage (with high deductibles), wipe out their savings with a health emergency, and be able to hold on to their tenuous spot in the middle class, work three jobs and help keep the economy humming.

George Bush has been resisting the expansion of the program that allows children to get the health care they need -- like filling cavities, getting glasses, seeing a doctor.

In California, 800,000 children are enrolled in Healthy Families and are in families earning up to 2.5 times poverty ($42,925 for a family of three.) Bush wants to change rules allowing only children in families earning less than $34,340 (family of three), which would mean about 170,000 children would be abruptly cut off from coverage.

In the meantime, California politicians -- including Republican Gov. Arnold Schwarzenegger -- want to raise the lid -- allowing more middle-income families to enroll (about 77,000 more chidren). Eighteen other states also allow families earning more than Bush's proposed cap to enroll in this program. Being healthy allows kids to focus on other things, like learning in school (instead of squinting in the back or having a toothache) and being happy, normal children.

The motley bi-partisan National Governors Association doesn't like Bush's proposal much either and has sent numerous letters to the President and Congress about the need for more money and fewer restrictions at the federal level.

Bush, however, somehow believes that expanding SCHIP to more middle income families is a vast left-wing conspiracy to march toward a universal single-payer health system.

Okay, maybe that part's true for some of us, but I doubt that the intention for the insurers and hospitals and other industry types that support SCHIP expansion. Meanwhile, Bush's proposal yanks away health care from the most vulnerable children.

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posted by Hanh Kim Quach | Permalink | 10:59 AM


A San Francisco treat

This weekend got a lot of attention for health care, with the formal adoption of the "individual mandate" in Massachusetts (although enforcement won't kick in until the end of the year). More about that later.

Closer to home, and most importantly, the new Healthy San Francisco plan started limited enrollment, as described in this San Francisco Chronicle article.

It's two key components: setting a minimum employer contribution to health care, and a rethinking of how to provide access to care to the public and private network of San Francisco providers. It's value is not just to expand and secure access to care for San Franciscans, but also to add to the state and national conversation on health reform.


posted by Anthony Wright | Permalink | 10:11 AM


Fireworks of a different kind...

While the rest of the country is thinking toward Independence Day festivities, there's a lot going on today in Sacramento, most notably the Assembly Health Committee meeting to vote on key legislation, including SB840(Kuehl).

As always, we'll have a full report up on this blog later today.

posted by Anthony Wright | Permalink | 9:45 AM


Building a fence at the border for whom...

Monday, July 02, 2007
Crossing the border into Mexico and Canada isn't just a prank that activists and Michael Moore stage to make a point about the expensive U.S. health system. And Americans aren't just buying drugs abroad anymore.

The LA Times today has an interesting story on how growing numbers of Americans (about half a million) are heading across the border -- even to developing countries such as Thailand and India -- to get medical procedures done at a fraction of the cost and often under far more luxurious conditions.

Of course, even though the cost for these procedures is about half what would be paid in the US, it still takes money to do this. It's probably unlikely that many of the 47 million uninsured and living on the edge are taking vacations to Singapore to have surgery.

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posted by Hanh Kim Quach | Permalink | 12:08 PM


International House of Health Care

Sunday, July 01, 2007
My wife and I split up many responsibilities, including newsreading. I handle domestic issues; she follows the international beat. ("Honey, how's the war going?") But she did point me to a fascinating discussion on her favorite website, that of the BBC.

In light of the opening of SiCKO, which favorably compares the health system of Britain and other countries to that of America, the BBC asked what its readers thought of their health systems. Perhaps uniquely, they got hundreds of comments, from not just the U.S. and Great Britain but all over the Europe and the world. Lots of opinions, from all parts of the political spectrum, from a truly international readership.

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posted by Anthony Wright | Permalink | 11:35 PM


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Anthony Wright is the executive director,
with a background as a consumer advocate and community organizer on many issues, including health issues for the last ten years in California and New Jersey.