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The challenge of children's coverage...

Sunday, November 30, 2008
Last week, Families USA released a report, Left Behind: America's Uninsured Children, which detailed that there are 8.6 million uninsured children in the United States, using 2005-7 averaged numbers from the U.S. Census Bureau.

Over 1.25 million of those uninsured children are in California. There are other estimates, using different definitions, that are a bit lower, but the scale is similar: there are simply too many kids, overwhelmingly with working parents, who are not covered. Not surprisingly, they typically have worse health status. And their parents are one emergency away from financial ruin.

The saddest part is that until recently, California was making real progress on the goal to universal children's coverage.

While employer-based coverage was being scaled back, especially for dependents (such as spouses and children), public insurance programs like Medi-Cal (Medicaid) and Healthy Families (SCHIP) were more than picking up the slack. In the recent economic downturn, we've seen even further increases in enrollment in Medi-Cal, which covers over 6.6 million Californians--about half of them children, and in Healthy Families, which just hit the 900,000 enrollment level. Several counties offer a "Healthy Kids" coverage program with more expansive eligibility rules, to get all kids covered.

But in the last year, California's effort to cover all children has slipped.
* President Bush vetoed efforts for a full reauthorization of the State Child Health Insurance Program (SCHIP), throwing California's version of the program, Healthy Families, into some uncertainty. The federal program needs to be reauthorized by March 2009.
* California's budget crisis has taken its toll: Unless the Legislature intervenes, the board that runs Healthy Families is considering stopping enrollment and creating a waiting list for Healthy Families that would deny coverage to over 160,000 children.
* Yet the Legislature, in an effort a few months ago to make cuts (the alternative of revenues having been blocked by by Republican legislators), has already passed additional burdensome reporting requirements that will have the effect of dropping over 250,000 children off of Medi-Cal coverage. And Governor Schwarzenegger, using his line-item veto, also made it harder for children to get enrolled into coverage in the first place.
* Also, many of the local "Healthy Kids" programs are running out of money as well, and thousands more children may be disenrolled without state assistance.
* Finally, this is in a context of an economic downturn that may mean more children losing private coverage that their families get through an employer or buy directly, and so these cuts come at a time when these public programs are actually in greater demand.

This issue isn't a tough policy puzzle: we know exactly what we need to do to cover virtually all children; the question is raising the money needed, as part of deciding our priorities and choices as a state. The issue has never lacked for individual champions, whether outgoing Assembly Budget Chair John Laird, or incoming Senate President Pro Tem Darrell Steinberg, or many other legislators past and present.

What we need in these tough times is collective leadership, from the Governor and legislative leaders of both parties, that children's health coverage is a priority that needs to be preserved despite--actually, especially because of-- these tough economic times.

The new legislative session starts tomorrow. Children's coverage is not the only, or even the biggest, health care issue on the agenda, but given the challenges outlined above, it is the most urgent.

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posted by Anthony Wright | Permalink | 7:47 PM


Let the Sunshine in...

Friday, November 28, 2008
Speaking of assembling a health care team, many have overlooked the appointment of Peter Orzag as the director of the Office of Management and Budget (OMB), which is a big-deal position. Orzag was the well-respected head of the Congressional Budget Office (CBO), and actually ran a well-regarded blog where he posted on key issues, especially health care.

Ezra Klein at the American Prospect says this bodes well for the prospects health reform, given his clear views about how the federal budget and economy is simply unsustainable in the absence of health reform, and his significant knowledge about the medicine and economics.

But the flip side is that Orzag's former position at CBO was as crucial to the success of health reform. In the early 1990s, many people thought that one of the main obstacles to reform was the way that the CBO at the time "scored" the Clinton health plan, a detachment fromt he process, and the reticence to book savings. Here in California, the CBO-equivalent Legislative Analyst's Office (LAO) has come up with controversial analyses of health reform proposals, from single-payer to the ABx1 1, helping to stall the latter. The analyses, from a place of detachment, tended to overstate the risks of reform, while not making a comparison to the risks of inaction. The LAO only answered what was asked, but under the criteria used, no reform was possible.

Health reformers was heartened that Orzag would not fall into these problems at the CBO, with his efforts to be transparent about assumptions, and his knowledge about the value of prevention and systems reforms and attempts to quantify realistic savings from such efforts. Most of all, Orzag would include in any analysis a comparison with the problems of the status quo.

So it's good that Orzag will be helping craft, rather than simply evaluate, the health care proposal. But then who replaces him? The Acting CBO Director is now Robert A. Sunshine. Orzag beefed up the CBO health staff from 30 to 50 FTEs, and perhaps provided a perspective and direction into the next year. Will Sunshine continue this ray of hope? Or even the blog?

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posted by Anthony Wright | Permalink | 1:23 AM


The team, coming together...

Thursday, November 27, 2008
Some of the players of the federal health reform effort are coming together:

A new health reform policy team was announced by President-elect Obama earlier this week, getting good reviews from Jonathan Cohn at The New Republic.

Congressman Dingell might still be a player on health reform, looking at the subcommittee that oversees health care. Either way, any proposal coming out of the House of Representatives will be heavily influences by Californians: Speaker Pelosi; Chairmen Miller, Stark, and Waxman; and many members on key committees, or in leadership positions of key caucuses.

In the Senate, our California Senators Boxer and Feinstein tend to specialize on other issues, so the leadership will come from Senate Majority Leader Reid, Chairmen Baucus and Kennedy, as well as others. The chairmen met together with key other Senators to commit to working on health care, including Democratic Senators Rockefeller and Dodd, and interestingly, Republican Senators Enzi and Hatch. Senators Harkin and Mikulski (and Clinton, although she is presumed to start another role outside the Senate) have taken up task forces to work with Kennedy.

The Senate is being watched carefully, because of the requirement to need 60 votes to pass most legislation. While there are exceptions that might allow for a simple majority, some observers believe for something so major as health care, you need even more votes. I may disagree with such a high bar, but clearly, there will be a challenge to get some Republicans and even conservative Democrats.

That's why Senator Wyden's bill, as controversial as elements of it are, still gets attention, given its bipartisan support, from Democratic Senators Carper, Nelson, Stabenow, Landrieu, Inouye, Cantwell, but also Senator Lieberman and Republican Senators Bennett, Alexander, Gregg, Grassley, Coleman, Crapo, Smith, and Corker.

While there's overlap, that's not the obvious list of more "moderate" Republican Senators, or even those from "Obama" states, like Collins and Snowe from Maine, Specter from Pennsylvania, Voinovich from Ohio, Lugar from Indiana, Grassley from Iowa, Burr from North Carolina, Martinez from Florida, Ensign from Nevada, and Gregg from New Hampshire.

We still have yet to see if Democrats have 58-60 seats, with Senate seats in Minnesota and Georgia still undecided. And then there's Senator McCain, who was willing to support some health reforms earlier in his career, on prescription drug reimportation and HMO consumer protections, but never comprehensive reform, and he in fact ran for President on a plan that went in the complete opposite direction. He didn't even join many of these other Republicans in support of SCHIP expansion last year. It will be interesting to see where he ends up in this debate.

Some of these folks, Republicans and even conservative Democrats, have been supportive of issues like SCHIP expansions. But the debate to come is another matter: Getting them to support other health reform components, such as aggressive oversight on the insurance industry, or setting a minimum standard for employer-based benefits, will be the challenge.

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posted by Anthony Wright | Permalink | 11:32 AM


Sine Die -- for real this time

Tuesday, November 25, 2008
The Assembly adjourned today -- again -- for the last time this legislative session without having passed any kind of interim budget package to address the gaping and growing budget deficit. The Senate will also adjourn momentarily *hopefully*.

The next time we see these guys -- on Monday -- it will be a new year. Sadly, it will not necessarily mean a new conversation.

We will still face a $28 billion deficit, which seems to be growing. Numbers thrown out today were as high as $34 billion.

We will face a new crop of legislators -- and on the Republican side, all but three of them have signed Grover Norquists' "no tax increase'' pledges.

And by the sounds of today, we face a more acrimonious Legislature.

Incoming Senate Leader Darrell Steinberg threw down the gauntlet. He spoke slowly, clearly – and somewhat loudly.

“We need to make a choice. We need to make a series of choices. We are willing to engage you (Republicans) anywhere, any time, in any manner to try to resolve this situation because the alternative of doing nothing is not an option.’’

Outgoing Sen. Sheila Kuehl assailed the past several years of free market policies as a failure and Senate Republican Leader Dave Cogdill complained that raising taxes at a time of economic uncertainty was exactly the opposite of what everyone else was doing.

So in the end (and as expected) there were not enough votes for the $8.1 billion in additional taxes, thus, the $8.1 billion in spending cuts also will not take effect.

See you next year/week.


posted by Hanh Kim Quach | Permalink | 6:00 PM


California held hostage, continued...

Both the Assembly and Senate are currently debating a budget package of $8.1 billion in cuts, $8.1 billion in revenues.

There are big cuts in education, community colleges, higher education, local government and transportation. Core health services like Medi-Cal, which got some big cuts just a few months ago, does not have major changes proposed. In human services, the cuts include a reduction of SSI/SSP grants, suspend a cost-of-living increase for CALWORKS, and a reduction in regional center for people with developmental disabilities.

It's good that some legislators are willing to support revenues to prevent worst cuts, including indexing personal income tax brackets and restoring the vehicle license fee.

But the state continues to be held hostage by Republican legislators beholden to a "no taxes" pledge, which has forced California to make over $10 billion in cuts in just the past few months.

It would have been better if the legislature passed $10 billion in revenues to match the cuts already made, before proposing additional cuts. But even this package, with its significant cuts and some revenues, is being opposed by Republican legislators, as the state budget hole gets deeper and deeper.


posted by Anthony Wright | Permalink | 4:23 PM


Clarity among the chaos...

Monday, November 24, 2008
Legislators are flying back in tomorrow (Tuesday) to vote on a budget proposal before the Thanksgiving holiday, and the end of the current, lame-duck legislative session.

What that budget proposal includes is unclear.

Rumors include possible revenues (the vehicle license fee?), but also significant cuts (but unclear in what areas or programs) and a spending cap proposal.

What is clear is our advocacy against the cuts:
* Further cuts to health care, like those the Governor has proposed, would not only directly deny coverage to hundreds of thousands of Californians, but harm the health system on which we all rely.
* In addition, the vast majority of proposed health care cuts would have a disproportionate impact on the economy, since California would be forgoing federal matching funds. In an economic recession, health care spending should increase, both to meet an increased need by California families, and because no other spending gives you an immediate doubling of economic stimulus.
* California has already made over $10 billion in cuts just this year; it is time to raise the revenues needed to match those cuts before going further. Further cuts to health and other vital services have been previously--and appropriately--rejected as too severe.

We also oppose a spending cap that would starve our health system, or prevent our state from meeting the health needs of Californians.

We'll see what they do tomorrow.

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posted by Anthony Wright | Permalink | 11:03 PM


The mustache of justice

Saturday, November 22, 2008
Whatever the competing records on environmental issues, Congressman John Dingell was a champion on core health care issues. But here's a Washington Post op-ed by California journalist/editor Harold Meyerson about why Congressman Henry Waxman's new chairmanship is such a boon for the cause of health reform, detailing some of Waxman's unique skills and history on Medicaid and other health issues.

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posted by Anthony Wright | Permalink | 6:09 PM


From insurers? Read the fine print...

Among the positive signs for health reform this week was a New York Times article by Robert Pear, entitled "Health Insurers Offer to Accept All Applicants, on Condition."

The news: the main insurance industry lobby is willing to support "guaranteed issue"--that everybody gets access to coverage--as long as there is an "enforceable individual mandate"--that everybody has to get coverage.

This isn't a foreign concept to California health reformers: last year, most insurers were willing to consider such new rules for the individual market. But our biggest insurer, BlueCross (Wellpoint/Anthem), was opposed to any change. That the two trade groups, America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, have made this statement, etiher suggests there is movement... or they are trying a different tactic.

Some, like Jonathan Cohn of The New Republic and Ezra Klein of The American Prospect, say that guaranteed issue also needs to include community rating: the notion that insurers cannot just deny you for your health status, but cannot charge you differently either. It's an important point, and AHIP is silent, at best, on the issue.

Health Care for America Now makes a broader point:
"The leading insurance industry representative, America's Health Insurance Plans, came out and said they would stop denying people coverage due to pre-existing conditions. Of course, what they didn't say tells the real story:
* They said nothing about lowering their prices so working families can afford their insurance.
* They said nothing about reigning in their bureaucracy, designed to find ways to deny you the care you've paid for.
* They said nothing about cutting the multi-million dollar salaries they pay their
CEOs, while they charge working families skyrocketing premiums.
Click to send a message to AHIP.

To reemphasize the point: During our health reform debate in California last year, we recognized in order to force consumers, even a small percentage, to buy in the individual market, you needed to do a lot more than guaranteed issue to make that situation hospitable for consumers.

We actually issued a short chart, called "Beyond Guaranteed Issue: Many Consumer Protections Needed in the California Individual Insurance Market," showing what protections Massachusetts already had in place, and some they needed to add, and California frankly needed even additional reforms. From rate oversight to better defined benefits, from a medical loss ratio to a public plan option, there's a lot more to do to make the individual market even workable enough for consumers. And AHIP seems to be still opposed to those reforms.

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posted by Anthony Wright | Permalink | 9:29 AM


Arguing fat falls flat

Friday, November 21, 2008
A bunch of CEOs met this week and decided that one of the most pressing health care issues that needed to be dealt with was obesity. Now, I'm as obsessive as anybody about obesity -- mainly forestalling my own -- but their comments just drove me up the wall. Especially vis-a-vis this story today in the LA Times about how more and more seniors are approaching senior-hood with a litany of chronic diseases.

It's true that obesity is the root cause of some chronic diseases for some people. And chronic diseases then cause the rapid escalation in medical care costs to treat these diseases. But the way that "obesity'' is often framed in the health care context is "individual responsibility,'' especially when spoken of by CEOs, who seem to exist in a different plane -- literally. Usually, when CEOs think about obesity and health policy, they want everyone to go to the gym and take their medicine when they're supposed to and walk around rather than drive a car.

Obesity lies at the intersection of so many different areas of social policy. Obesity disproportionately affects low-income, communities of color, who -- as the story says - live in neighborhoods to dangerous to walk around in. Or you live in neighborhoods -- like mine in Downtown Sacramento -- where the most affordable gym (if you can afford one) is one where there is algae growing at the bottom of the pool and was actually the site of drowning.

Some people can't just go to a doctor and take meds for chronic diseases -- possibly caused by obesity -- when instructed because many are in jobs that don't offer health benefits, or don't offer very good ones if they do, making health services cost prohibitive.

Current food policies and subsidies contribute to the availability of cheap bad food (McDonald's and Taco Bell), versus expensive good food (like cauliflower) -- which, in turn, causes obesity. Cauliflower is expensive: $5 for a head -- at least that's what it cost the last time I bought it. It's really expensive when you consider that a head of cauliflower could be a side dish, but that an entire meal at McDonald's -- the meat, the cheese, the "vegetable" -- is less than $5.

I'm not saying obesity isn't an important thing to tackle. But it's just so annoying and tone deaf for CEOs to address what has been the effect of our entire social policy, rather than the cause.

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posted by Hanh Kim Quach | Permalink | 1:25 PM


Big changes at the state level, too...

Major staff changes aren't just happening at the federal level.

Governor Schwarzenegger has announced big news on health care, effective December 19th.
* Sandra Shewry is leaving her position as the director of the Department of Health Care Services (DHCS), to be replaced by David Maxwell-Jolly, PhD.
* Stan Rosenstein is leaving his position as deputy director of DHCS, which includes responsibility for the hugely important Medi-Cal program, to be replaced by Toby Douglas.

This is a big deal. Sandra and Stan have long histories in California health agencies, not just during the whole of the Schwarzenegger era, but previous Administrations as well. Along with Secretary of Health and Human Services Kim Belshe, these are the folks that run Medi-Cal, which provides health coverage to over 6.5 million Californians , and is an integral part of the heath care system on which we all rely.

We wish Sandra and Stan the best in their new endeavors.

We congratulate David Maxwell-Jolly and Toby Douglas on their promotions. Some might question, given the bleak budget times, whether congratulations are in order. But we need people in government who can make the case for the value of these programs and services, as economic and political forces determine whether we have the resources to sustain and expand them. And so despite the bad budget situation, we hope that David and Toby will have the opportunity to make progress, as the conversation on federal and state health reform continues. We've worked with them in the past, and look forward to doing so in their new roles.

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posted by Anthony Wright | Permalink | 11:29 AM


Progress on Balance Billing!

It is ironic, on the day Health Access celebrated its founding 20 years ago, a founding that started out of a consumer victory against the California Medical Association (CMA) and other providers, we get word of a new victory in a fight that has Health Access on one side and doctors on the other.

The big news: A court sent out its preliminary decision against CMA and other providers, denying their efforts to stop new regulations on “balanced billing” at the Department of Managed Health

Insured patients can breathe easier that if they get needed care in an emergency situation, they will not be billed unnecessarily and used as a pawn in a contractual dispute between insurers and providers.

The practice of balanced billing, where insured patients are sent the bill when a provider has a billing dispute with the insurer, is a significant problem for consumers. Patients get sent to collections, and have their entire credit history ruined---when legally they owe nothing and have done nothing wrong, except get the care they need.

We are pleased the courts sided with the Department of Managed Health Care (DMHC), and against the CMA’s lawsuit. There’s more work to do on this subject, but this is good news for patients.

Two final notes on the ruling, from my colleague and legislative advocate, Beth Capell:

* First, it is evident from the court’s ruling that the case made by the California Medical Association, the California Hospital Association and other providers ignored the economic impact on consumers and focused only on the economic impact on providers. While it is reasonable for provider trade associations to represent their members, we are weary of these same organizations claiming that they care deeply for consumers when they oppose consumer measures time and again... it is plain that their pocketbooks are their primary concern.

* Second, the court’s ruling rests on the plain language of the law which states that a “unfair billing pattern” means engaging in a demonstrable and unjust pattern of nbundling of claims, upcoding of claims, or other demonstrable and unjustified billing patterns, as defined by the department.

Put simply, DMHC defined balance billing as an “unfair billing pattern”, the court found that the law permits it to do so and the providers are squawking because they thought “unfair billing pattern” only applied to provider-plan disputes with consumers as collateral damage.

Here’s excerpts from the case, below:

The following shall constitute the Court's tentative ruling on the Petition for Writ of Mandate and Complaint for Declaratory and Injunctive Relief filed by Petitioners California Medical Association, California Hospital Association, California Chapter of the American College of Emergency Physicians, California Orthopeadic Association, California Radiological Society, and California Society of Anesthesiologists, set for hearing in Department 31 on Friday, November 21, 2008 at 9:00 a.m.

II. Background

This case challenges DMHC’s promulgation of 28 CCR § 1300.71.39 (the “Balance Billing Regulation”). The Balance Billing Regulation was enacted under the authority purportedly granted to DMHC by provisions in the Knox-Keene Act, Health and Safety Code §§ 1340 et seq., in which the Legislature delegated certain regulatory authority with regard to health care service plans (“HMOs”) to DMHC. Of particular interest here is Health and Safety Code § 1371.39, which was added to the Act as part of Assembly Bill 1455 (Scott, 2000). Among other things, § 1371.39 allows HMOs to report “instances in which the plan believes a provider is engaging in an unfair billing pattern” to DMHC.

The Balance Billing Regulation defines “unfair billing pattern” to include a practice known as “balance billing” when that practice is engaged in with respect to emergency care recipients who are enrollees in a health care service plan (an “HMO”). Balance billing occurs when a provider receives less than the total amount billed from a patient’s HMO and subsequently bills the unpaid balance directly to the patient. The Balance Billing Regulation provides:

(a) Except for services subject to the requirements of Section 1367.11 of the Act, “unfair billing pattern” includes the practice, by a provider of emergency services, including but not limited to hospitals and hospital-based physicians such as radiologists, pathologists, anesthesiologists, and on-call specialists, of billing an enrollee of a health care service plan for amounts owed to the provider by the health care service plan or its capitated provider for the provision of emergency services.

Petitioners contend that DMHC acted unlawfully in promulgating the Balance Billing Regulation and seek a writ of mandate (under CCP § 1085) ordering DMHC to repeal the Balance Billing Regulation, a declaration that the Balance Billing Regulation is invalid, and an injunction stopping DMHC from implementing and enforcing the Balance Billing Regulation.

III. Analysis

A. Standard of Review.
In reviewing the legality of a regulation adopted pursuant to a delegation of legislative authority, the Court’s inquiry is limited to three questions: (1) whether the regulation is within the agency’s delegated authority; (2) whether the regulation is reasonably necessary to effectuate and not in conflict with the purposes of the statute being implemented; and (3) whether the regulation was promulgated pursuant to proper procedure. (Moore v. Cal. State Bd. of Accountancy (1992) 2 Cal.4th 999, 1014-15; Cal. Gov’t Code §§ 11342.1, 11342.2, 11350(b).) The Court accords the regulation a strong presumption of regularity, and Petitioners bear the burden of showing its invalidity. (Moore, 2 Cal.4th at 1014-15; Credit Ins. Gen’l Agents Ass’n v. Payne (1976) 16 Cal.3d 651, 657.)
B. Discussion.

Petitioners challenge the Balance Billing Regulation under each of the three areas of Court review listed above, and additionally challenge the regulation as unconstitutionally vague. Petitioners’ many arguments can be organized into the following categories: (1) that the regulation was not within DMHC’s delegated authority to enact; (2) that DMHC did not follow proper procedures under the California Administrative Procedure Act in promulgating the regulation because its economic impact statement conflicts with substantial record evidence; (3) that the record lacks substantial evidence that the Balance Billing Regulation was reasonably necessary to effectuate the statutory purpose; (4) that the regulation conflicts with the Knox-Keene Act’s purpose that contracts between HMOs and providers be “fair and reasonable to ensure adequate networks”; and (5) that the regulation violates due process because it is overly vague. The Court will address each category of argument in turn.

* The DMHC Acted Within Its Delegated Authority in Promulgating the Balance Billing Regulation....
a. Health and Safety Code § 1371.39(b)(1) Plainly Authorizes DMHC to Define Unfair Billing Practices....
b. Health and Safety Code § 1371.39(b)(1) Authorizes DMHC to Regulate Providers With Regard to Unfair Billing Practices.
c. DMHC’s Determination that Balance Billing Can Constitute a Billing Pattern is Reasonable..
* The DMHC’s Economic Impact Statement Does Not Conflict with Substantial Record Evidence.
* The DMHC’s Conclusion that the Balance Billing Regulation Was Reasonably Necessary Is Supported by Substantial Evidence.
* The Balance Billing Regulation Does Not Conflict with the Knox-Keene Act’s Requirements for HMO-Provider Contracts.
* The Balance Billing Regulation Is Not Unconstitutionally Vague.

IV. Disposition
The petition is denied. The requests for declaratory and injunctive relief are denied. DMHC, as the prevailing party, is directed to prepare a formal order, incorporating the Court's ruling herein verbatim or attaching it as an Exhibit, and a judgment consistent with the ruling; submit them to opposing counsel for approval as to form; and thereafter submit them to the Court for signature and entry of judgment in accordance with Rules of Court 3.1312 and 3.1590.

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posted by Anthony Wright | Permalink | 7:37 AM


20th Anniversary thoughts...

Thursday, November 20, 2008
We'll post more in the next few days about our 20th Anniversary event.

Some quick highlights: Incoming Assembly Health Committee chair Dave Jones reported on a long list of issues he's interested in tackling, from continuing comprehensive health reform, to specific reforms on both coverage and care. Incoming Senate President Pro Tem Darrell Steinberg also put forward some lessons he learned from last year's health reform effort, and stated the beginnings of a plan to make progress on the issue.

Despite the deficit and other issues, the panel and speakers conveyed a sense of optimism in the air. In one word: Obama.

Not just the man, but the moment and all it represents. The mandate he has on health care, after spending over $150 million in ads on the health care issue alone. The fact that people are "paying attention" to health care issues. The renewed sense that government has an important role, to act as a regulator. The potential appointment of former Senator Tom Daschle as HHS Secretary, with his interest and skills in passing reform. The campaign infrastructure and organizing energy to continue beyond the election. The reception on Capitol Hill, with expanded Democratic majorities, and the support already signalled by everyone from conservative Senator Max Baucus, chair of the Senate Finance Committee, to California's Congressman Henry Waxman, the newly-minted chair of the House Energy and Commerce Committee. The notion that health care reform can and should be seen as economic relief during tough times. The belief that the federal government will be a partner to state reform efforts, rather than an obstacle.

I was also pleased that we were able to honor our past founders and directors of the organization. I am the fifth executive director of this organization, and recognize I am holding, in trust, an organization built by many before me. I was glad we were able, as a community, to recognize some of those past leaders: Lois Salisbury, Maryann O'Sullivan, Bruce Livingston, and Melinda Paras.

I loved that given the chance to ask the incoming Senate President Pro Tem a question, it was these honorees who seized the opportunity to ask the question.

We'll post more specifics from the speakers and discussions in the next few days.

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posted by Anthony Wright | Permalink | 10:53 PM


Congratulations, Chairman Waxman!

California Congressman Henry Waxman, a longtime expert and champion of health care issues, was elected today as the new Chairman of the House Energy and Commerce Committee.

With Californians in key leadership and committee posts, our state is poised to lead the nation in the fight for quality, affordable health care for all.

Chairman Waxman has long been an expert and champion on health care issues, from defending Medicaid and Medicare from cuts, to protecting consumers from insurance industry practices. His new committee has key jurisdiction on health reform, and he has shown the knowledge, skills, and values to use that power well.

Most recently, this past July, Congressman Waxman held oversight hearings on the practice, in California and elsewhere, on insurers retroactively denying patients and terminating their coverage.

Californians know the urgent need for health reform in our state: Even more than most Americans, Californians are more likely to be uninsured, less likely to get coverage on the job, more likely to be denied for pre-existing conditions, and most at risk from budget cuts.

Health Access California and the national Health Care for America Now! (HCAN) campaign sent out statements of congratulations to Congressman Waxman today. We look forward to working with Congressman Waxman, who was the first member of the House to support the HCAN principles for comprehensive health care reform.

In addition to Chairman Waxman, President-elect Obama, Vice President-elect Biden, Incoming White House Chief of Staff Congressman Emanuel - along with more than 150 other Members of the 111th Congress - have all signed onto Health Care for America Now's principles since mid-August. California members who have signed include Congressional Representatives Joe Baca, Lois Capps, Susan Davis, Bob Filner, Michael Honda, Barbara Lee, Loretta Sanchez, Adam Schiff, Brad Sherman, Hilda L. Solis, Jackie Speier, Pete Stark, Henry Waxman, and Lynn Woolsey.

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posted by Anthony Wright | Permalink | 11:18 AM


The best of times, the worst of times...

The Sacramento Bee's Capitol Alert is always a treat to read in the morning, and so we appreciated the notice of our 20th Anniversary Event at 2pm at the Sacramento Convention Center.

Given the budget crisis over the past many years, it's probably accurate that despite the consumer protections won and the reform battles fought, Health Access is best known as "a group dedicated to staving off such spending reductions." But does it have to be in such a downer of an update?

Here's the grim news, in their words:

The Legislative Analyst's Office will release a new report today analyzing the woeful state of California's finances. It will flesh out last week's estimate that the state faces a $27.8 billion deficit over the next 19 months.

But a new report from Beacon Economics predicts things will look even glummer in the future:
* Labor markets are showing increased signs of stress.
* There is little sign of a recovery in housing, and foreclosure rates are growing worse by the day.
* Consumer markets have fallen off a cliff.
* Corporate profits are taking a serious beating.

The report commissioned by California Forward, the nonpartisan government reform group, describes itself as "decidedly more pessimistic" than the LAO or Schwarzenegger administration projections, largely due to lower projections for corporate taxes.

The report also predicts the first year-over-year decline in statewide property taxes "since the Great Depression," according to Fred Silva, fiscal policy adviser to California Forward. "Our forecast implies that we are quite literally on the edge of a fiscal cliff," the report says, rather bluntly.

Then there is this gem of analysis: "At the moment, California's budget strategy seems to adhere to a slightly different logic, one that might be summed up as: Hope for the best and ignore the obvious."

And they write that as if it's a bad thing.

In her visit with the Capitol Bureau on Wednesday, Assembly Speaker Karen Bass gave her own take on the role of partisanship, ideology and political futures on the budgetary stalemate: "One of the reasons why it's hard for my Republican colleagues to vote for revenue -- more important than their tax pledge -- is their next primary," Bass said.

"If they vote for revenue, then they're going to be easily challenged in another primary. But the Democrats face the same thing: If we vote for deep, permanent cuts in health and human services, then we have to face our next primary, too."

Bass said putting aside self-interest would be key to break the logjam. "When you're in the middle of a national and international meltdown, you have to get beyond your career."

Speaking of deep cuts to health care, Health Access, a group dedicated to staving off such spending reductions, celebrates its 20th year of existence today with an event at the Sacramento Convention Center.

Among the speakers set for the event are Sacramento reps Darrell Steinberg and Dave Jones, the incoming pro tem and chair of the health panel, respectively.

Not bad allies to have in these times...

Hopefully, we'll balance the bad news with the good news this afternoon at the event.

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posted by Anthony Wright | Permalink | 10:26 AM


Kudos to the California Congressional Caucus

Wednesday, November 19, 2008
As the various caucuses at the U.S. House of Representatives make their decisions, California is showing a lot of leadership, and is poised to show more leadership on health care

California Congresswoman Lynn Woolsey maintains her position as co-chair of the Congressional Progressive Caucus.

Her co-chair for the past session, California Congresswoman Barbara Lee, is now the new chair of the Congressional Black Caucus.

In the past Congress, California had Congressman Michael Honda as chair of the Congressional Asian Pacific American Caucis, and Joe Baca as chair of the California Hispanic Caucus. California Congresswoman Hilda Solis, who was chair of the Tri-Caucus (representing Asian, Hispanic, and Black Caucuses), will serve as second vice-chair of the California Hispanic Caucus.

We don't think it is a coincidence that all these members are early supporters of the Health Care for America Now! campaign, supporting the HCAN princples, rather than so-called reforms that leave consumers alone at the mercy of the insurance industry. Over 150 members already support the principles, and more are signing up every day, and the session hasn't started yet.

California Congressional representatives sign on because they know health care reform is a huge priority for the state of California: Californians are signficantly less likely to have coverage, less likely to get coverage on the job, more lilkely to be denied for pre-existing conditions, than Americans as a whole.

Congressional leaders representing communities of color know how much the health care crisis impacts *all* of California's diverse communities, and how these communities of color have the most at stake in the health care debate. A month ago, Health Access California and key other groups representing communities of color spotlighted these issues at press events in both Northern and Southern California.

At Asian Health Services in Oakland, and the Japanese American National Museum in Los Angeles, health advocates and experts spotlighted the urgent need for health reform throughout California’s diverse communities, as evidenced by the leadership of our Representatives, who chair the major Congressional caucuses that represent communities of color.

Responding to growing disparities in rates for chronic diseases, clinical outcomes, and health care coverage, their early leadership shows the urgency that health reform has in California’s communities of color. The "Which Side Are You On?" statement that the Congressional leaders signed is online here: (pdf) http://hcfan.3cdn.net/517370ec1fddf45044_vbm6ivw3d.pdf

As our colleague Ellen Wu, executive director of the California Pan-Ethnic Health Network said, “Our current health care system is failing our diverse communities. With communities of color making up more than 70% of California’s uninsured, we need our leaders to fight for health care options that place our collective well-being ahead of profits for the insurance industry” Other speakers at the events included Mari Lopez of the California Partnership; Reshma Shamasunder of the California Immigrant Policy Center; Dong Suh, Associate Director, Asian Health Services; myself, and others.

We are pleased that our Congressional delegation will continue to be in the lead on these issues.

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posted by Anthony Wright | Permalink | 10:28 PM


Cutting off kids for Christmas?

Wednesday, November 19th, 2008

* Could California close doors to coverage at time children need it most?
* Over 900,000 kids now on program; Coverage for over 160,000 children at stake
* Advocates make the care against waitlist; Decision pending for June board meeting

Click for What's New on the Health Access WeBlog: Daschle at HHS!; Open (Enrollment) Season; Keeping Obama's Promise(s); Senators Step Up for Health Reform; Health Wonk Review; Response to the Baucus Plan; A Health Access Homecoming...

Last Reminder: Health Access' 20th Anniversary Forum & Reception with Sen. Steinberg, Assemblyman Jones, and an All-Star Panel:Thurs, November 20th, 2pm-6pm, Sacramento Convention Center.

Advocates and enrolled families flocked to the Managed Risk Medical Insurance Board (MRMIB) meeting today in Sacramento (it was literally “standing room only”) to give testimony to the Board in support of California’s State Children’s Health Insurance Program. The health insurance program covers children of working families of modest means who do not qualify for Medicaid, known as Medi-Cal in California . The MRMIB board believes they must decide whether to impose a freeze on enrollment to California ’s program, known as Healthy Families, in response to the state’s budget shortfall and uncertain federal funding.

Although the board did not take a vote on imposition of a freeze at their meeting today, they are planning to render their decision at December’s board meeting. The Board is considering placing eligible children on a waiting list for up to six months, or possibly even longer until the financial picture in the state and federal funding commitment is clearer. This contemplated action is particularly unfortunate because it coincides with increased enrollment to Healthy Families of approximately 27,125 children each month and reaching a milestone with its highest enrollment ever, exceeding 900,000 children. In fact, California has the highest enrollment in the nation; more children are enrolled in California ’s Healthy Families Program than the second, third, and fourth states combined.

Unfortunately, the worsening financial situation nationally and the state’s budget problems make the continuation of enrollment in Healthy Families essential for families during any economic downturn. Families are facing the loss of jobs and health insurance, increased out-of-pocket health insurance costs, and many families face loss of their homes and retirement savings due to mortgage and credit difficulties. Consequently, they should not also face a freeze on enrollment in Healthy Families during this same period of time.

In addition, President George Bush twice vetoed the extension of the State Children’s Health Insurance program nationally, despite strong bi-partisan support in the U.S. House and Senate. However, President-elect Obama and the new Congress indicate that they would support re-authorization of the S-CHIP program nationally early in the new administration.

Every single speaker at the MRMIB Board hearing today urged the board to explore other alternatives, and to delay any freeze in Healthy Families enrollment and impose it if necessary only as the very last resort. Many argued that the harm to the program could be irrevocable because of the gap in health insurance coverage has real health consequences for children.

Also, the confusion surrounding off-and-on-again enrollment in the program does not convey the stability and accessibility of treatment for chronic conditions such as asthma, diabetes, and obesity. One community clinic advocate described how Florida never returned to their previous enrollment level attained before freezing enrollment because of the uncertainty it created for families even after lifting their waiting list requirement.

The most compelling testimony at the Board Meeting by far came from families enrolled in Healthy Families. They spoke about the impact the program had had on the lives of their children and the piece of mind it gave them to have a stable health resource and access to diagnostic tests and specialty care.

Advocates, providers, associations, and families all implored the Board not to take this action at all or at least not prematurely Here is a sampling:

* Cliff Sarkin, representing the Children’s Defense Fund, PICO, and the 100% Campaign, spoke on behalf of California ’s children and many children’s organizations. He emphasized the importance of maintaining a strong safety net like Healthy Families during a period of an economic downturn. He urged the Board to explore other scenarios and not to let California become the only state to establish a waiting list.

* David Ford from the California Medical Association argued that the Board should explore other options during the remaining month before they feel they have to make a decision. He predicted that families without health insurance coverage would either go without care until their health status worsened or would go to emergency rooms (either of which are more costly alternatives.)

* Leona Butler representing the Local Health Plans of California urged the Board to explore unconventional funding sources such as the possibility of using First Five funding to cover costs for Healthy Family enrollees up to age 5 to defer some costs. She also said that the Healthy Family providers she represents might even be willing to take a 5% cut in reimbursement to avoid the cap on enrollment.

* Bonnie Ferreira from the Children’s Health Care Initiative also counseled about the negative spillover effect and confusion that the waiting lists would have on this and other public health programs.

* Dr. Richard Penn, representing The Academy of Pediatrics, testified that many families would not seek care without health coverage and we would lose any of the gains we have made in health status by taking advantage of opportunities for preventative care.

* Al Hernandez from Latino Coalition for a Healthy California also emphasized the huge impact this program has for the largest ethnic group of enrollees, Hispanic children.

* Elizabeth Abbott from Health Access stressed the importance of the higher federal funding match rate for Healthy Families—which should make this the very last program that should be frozen. She also highlighted the efforts in the U.S. Congress to temporarily increase the federal matching share payments to the states and the hopeful signs that there would be a stimulus package that would provide some additional money to fill the state funding gap. These actions at the federal level might make freezing enrollment unnecessary, delay the implementation of a freeze, or cause any cap on enrollment to be in effect for a shorter period of time.

It is anticipated that the board will vote on this at their next board meeting on December 17, 2008 in Sacramento .

ACTION: Please contact your state Assemblymember and state Senator and urge them to support finding money in the state budget to fund Healthy Families, one of the most successful health programs for children in the nation. We cannot think of decision less in keeping with the holidays to freeze enrollment for Healthy Families in December.

For more information, contact the author of this article, Elizabeth Abbott, at eabbott@health-access.org.

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posted by Anthony Wright | Permalink | 10:19 PM


'Tis the Season

It's open enrollment!

You know, that one month in the year when you get to swap out the health plan you may have wrongly chosen last year before you knew better?

Sadly, for many workers, the choices are shrinking. As reported in this NYT story a couple days ago a growing number of companies are offering *only* high deductible health plans....take it - or leav it. And that includes big companies, like Nissan and Delta Airlines.

The reason: skyrocketing premiums, and the underlying fast pace of health care inflation is making health coverage unaffordable for businesses to offer as well, according to this WSJ article. So businesses are trying to tamp down their costs by passing it along to their workers.

Some workers may find themselves *completely* without the option of health insurance. In that case, they're at the mercy of the individual insurance market. If they're not turned down for "pre-existing conditions'' like earaches, or something, then workers may be able to find coverage. But there, the average monthly premium for an individual was $158 with a deductible of $1,972, according to a study of 227,000 policies purchased through www.ehealthinsurance.com. For families, the figure is worse -- $366 for a $2,610 deductible.

Happy holidays?

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


Daschle at HHS?

Politico reports that former Senate Majority Leader Tom Daschle will be nominated to be the next Secretary of Health and Human Services, with an eye toward significant Congressional negotiations on health reform. Daschle was one of the earliest Washington insiders to encourage President-elect Obama to run, and helped staff his Senate office, and his campaign.

Suddenly, look for Daschle's book, Critical: What We Can Do About the Health Care Crisis, to increase in sales, and in actual people picking it up and reading it.
UPDATE: Here's a blog link that links to other blogs and reactions about Daschle.

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posted by Anthony Wright | Permalink | 10:27 AM


Keeping Obama's promise(s)...

Tuesday, November 18, 2008
As this TV ad is being run in the Washington, DC, area, we're happy to be part of the Health Care for America Now! campaign's effort to keep President-elect Obama to his promise, and his promises:

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posted by Anthony Wright | Permalink | 8:44 PM


Lots of linkage...

Lots about federal health reform and commentary (including ours) at this week's Health Wonk Review, hosted by Louise Norris at Colorado Health Insurance Insider.

Lots of responses (including ours) to Senator Baucus' health plan are offered at the Kaiser Family Foundation Blog Roundup. Another California perspective is at the Alan Katz Health Reform Blog. Lots worth reading, all around.

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posted by Anthony Wright | Permalink | 7:52 PM


The U.S. Senate lines up...

This has gotten lots of attention from a variety of places, mostly because of the speculation about Sen. Hillary Clinton's future:


Washington, DC— Senator Edward M. Kennedy, Chairman of the Senate Committee on Health, Education, Labor and Pensions, today established three working groups of the committee to deal with critical issues of health reform.

Under Senator Kennedy’s direction, the working groups will concentrate on three areas essential to comprehensive reform: (1) prevention and public health, (2) improvements in the quality of care, and (3) insurance coverage. Senator Tom Harkin will lead the working group on prevention and public health, Senator Barbara Mikulski will lead the working group on improvements in quality, and Senator Hillary Clinton will lead the working group on insurance coverage.

What it does mean is that we are getting more serious about federal reform, and more and more Senators are getting invested: Kennedy, Baucus, Wyden, Clinton, Harkin, Mikulski to start, and we've not started the legislative session yet (or even decided certain races). Change is coming.

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posted by Anthony Wright | Permalink | 7:42 PM


A Health Access homecoming, with an All-Star team...

Monday, November 3rd, 2008

Learned Lessons, Future Prospects for State and Federal Reform

* "Many Paths, One Goal: Toward Quality, Affordable Health Care for All Californians."
* State Reform Prospects from Incoming Sen. Pres. Steinberg, Assm. Health Chair Jones
RSVP for Nov. 20th Forum with All-Stars of Seasoned Vets, Obama Advisors
* Tickets Available; Comped Tickets Available for Health Advocates, Community Groups

* Panel includes: Rick Brown, Wilma Chan, Jacob Hacker, Larry Levitt, and Robert Phillips
* Reception to Honor Past Leaders & History of Health Access and CA health advocacy
* Honorees: Lois Salisbury, Maryann O'Sullivan, Bruce Livingston, Melinda Paras

Click Here for What's New on the Health Access WeBlog: Healthy Families Up for a Waiting List; The Economic Impact of Bad Budget Cuts; Obama's Health Reform Mandate; Dr. Stephen Colbert on Drug Costs; New Info on the Baucus Plan; Kennedy Moves on Federal Health Reform

There's lots going on with federal health reform: Senator Ted Kennedy has returned to the Hill, vowing to work on health reform; Senate Finance Committee Chairman Max Baucus released the outlines of a health reform plan; and President-elect Obama has reiterated his commitment. At the state level, there's significant health care cuts on the table, and increased calls for federal help, whether through increased Medicaid matching funds or increased SCHIP funds.

To celebrate 20 years of health advocacy and, more importantly, prepare for these challenges and new opportunities of the next few years, Health Access will be hosting a forum and reception on Thursday, November 20th, in Sacramento. With an election that has opened up new possibilities for health reform and more, we will seek to honor the history of health reform in California and learn its lessons, but also get the latest from top experts about the propects for state and federal reform.

We invite you to join us at our 20th Anniversary Event, on Thursday, Thursday, November 20th, at the Sacramento Convention Center, starting with a 2pm forum and a 4:30pm reception. You can buy tickets with the official form on our website.

Health advocates and community organizations can get comped tickets, by request, to Marin Nakasone, mbogema@health-access.org.

The program, entitled “Many Paths, One Goal: Moving Toward Quality Affordable Health Care for All Californians" starts at 2pm, with an impressive program of speakers, including incoming Senate President Pro Tem Darrell Steinberg, and incoming Assembly Health Committee Chair Dave Jones, who may share their future goals.

A panel of distinguished California-based experts with national reputations will speak, including UCLA professor Rick Brown; former Assemblywoman Wilma Chan of Children Now; UC-Berkeley professor Jacob Hacker; Larry Levitt of the Kaiser Family Foundation, and Robert Phillips of The California Endowment. Some have advised President-elect Obama on health issues, others were advisors of President Clinton during his effort, and all are veterans of past health reform efforts, and expected to be active participants in the upcoming state and national debates.

Afterwards, we will have a reception that will honor past heads of our organization, including Lois Salisbury, Maryann O’Sullivan, Bruce Livingston, and Melinda Paras, leaders who helped nurture and build Health Access as an organization, and the broader health reform movement, and who each have had broader careers advancing social justice in multiple ways. A full program is available on the Health Access website, as well as a form to buy tickets.

Beyond recognizing the past work of the organization and the broader health advocacy community, our discussion will restart efforts at the state and federal level around the budget, consumer protections, and comprehensive health reform. Please join us.

Many Paths, One Goal:
Moving Toward Quality, Affordable Health Care for All Californians

Date: November 20, 2008
Location: Sacramento Convention Center
1400 J Street, Sacramento CA
Ballroom 314-315

2PM – 4PM
A discussion about the future of health care reform in California and the nation

Featured Speakers:

The Honorable Darrell Steinberg
Senate President pro Tempore-elect

The Honorable Dave Jones
Prospective Chair, California State Assembly Committee on Health

Guest Panelists:
E. Richard Brown, Ph.D.
Director, UCLA Center for Health Policy Research;
Professor, UCLA School of Public Health;
Principle Investigator, California Health Interview Survey

Wilma Chan
Vice President, Policy, Children Now;
Former Chair of the California State Assembly Committee on Health

Jacob Hacker, Ph.D.
Professor of Political Science, UC Berkeley;
Author, The Great Risk Shift

Larry Levitt
Vice President, Media and Public Education,
The Henry J. Kaiser Family Foundation; Editor-in-chief, kaisernetwork.org

Robert Phillips, M.P.A., M.P.H.
Senior Program Officer, The California Endowment

4:30PM – 6PM
Honoring past leaders of Health Access including

Lois SalisburyHealth Access Founding Chair
Director of the Children, Families, and Communities Program,
The David & Lucille Packard Foundation

Maryann O’Sullivan - Health Access Founding Executive Director, 1987-93
Founder, Preschool California
Independent Consultant

Bruce Livingston - Health Access Executive Director, 1995 –99
Executive Director, Marin Institute

Melinda Paras - Health Access Executive Director, 1999 –2002
President and CEO, Paras and Associates Interpreter Systems

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posted by Hanh Kim Quach | Permalink | 4:13 PM


The Promised Land if you're Chronically Ill

The Netherlands!

According to the latest Health Affairs web issue, a Commonwealth Fund study of seven industrialized nations reveals -- once again -- that the US is dead last when it comes to quality and cost, particularly as it relates to caring for people with chronic conditions: diabetes, heart disease, arthritis, depression, etc.

The US spends the most ($7k per capita versus about $3k), and in spite of that more than half (54%) of patients end up skipping drugs, doctors visits, etc. because it's too darned expensive. Patients in the US are least likely to have a regular doctor, among the least able to see a doctor the same day when sick, and more likely to report that recommended treatments were unhelpful or that medical care was poorly organized.

Meanwhile, other countries, like the Netherlands, Canada, the UK or France, place strong emphasis on medical homes and chronic disease maintenance and don't require any co-pays, co-insurance for the maintenance of these conditions. In Germany, coinsurance is limited to 1% to 2% of income.

While there's quicker access to specialists in the US, the same can be said of the Netherlands, where requests to see a specialist are usually met in fewer than four weeks.

Here's a NY Times editorial on it.

In the meantime, diabetes cost the US $217.5 billion in 2007, according to the National Diabetes Economic Barometer study, by the Lewin Group. Perhaps other models worth a view.

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posted by Hanh Kim Quach | Permalink | 1:34 PM


A glimpse into the future

Monday, November 17, 2008
This LA Times story about the call to overhaul 401 (k) plans piqued my interest this weekend. It was nearly 30 years ago that businesses began the migration from defined benefit pensions to defined contribution 401 (k) plans, with the idea that workers should manage their retirement. Now, as a generation prepares to retire, relying largely on 401 (k)s, we're learning a couple things -- 1) that this recent monkey business with the stock market is really a disaster for those close to retirement and that's totally unfair, and 2) that people are consumed with life and can't be stock porfolio managers and properly manage their accounts. Here's a telling statement:
.. even Nobel Prize-winning economists have admitted that they don't closely monitor their 401(k) statements -- allowing an initially well-balanced portfolio to become dangerously overexposed to stocks as those investments grow faster than bonds.

So, the reason I call attention to this: the trend in health insurance has long been heading in the direction of 401 (k)s. Marketers alluringly suggest that people need to "take control'' of their health care management and they know "what's best'' for themselves. And voila, we have "consumer-directed health care.''

It all sounds very frontier-ish and exciting and no-nonsensey and take-the-bull-by-the-hornsy. That is, until you have to start calling the insurance company to see if your mammogram is covered, or prenatal care, or orthotics -- then you realize just how very, very small and very, very insignificant -- and very, very alone you are navigating phone trees and call centers in India. And all you really want to know is if you should really worry about that lump in your breast.

Anyway, now, there is serious clamoring for a re-look at the 401 (k). The cows are already out of the barn on that one. We know what happened. We're starting to see the consequences of underinsurance now... So let's not let the same thing happen to health care.

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posted by Hanh Kim Quach | Permalink | 2:35 PM


So much for pledges.,,

Saturday, November 15, 2008
Just in the last year, California has made cuts of over $10 billion to education, health and other vital services. No real revenues were raised, as Republicans held to a "no new taxes" pledge.

As a result, we now have a $11 billion deficit in the current year, and a projected deficit in the budget year for as much as $28 billion... a truly staggering figure.

The Governor has proposed to make cuts and, finally, raise revenues to bridge the gap. But the revenues he proposed doesn't begin to match the $10 billion in severe cuts that have already been made. We need to raise the taxes need to prevent further cuts and maintain the education, health and other key services all Californians depend on.

As the Republican blockade on taxes doesn't just dig us deeper in a hole... it just shifts the burden elsewhere. As a resident of Davis, California, I joined nearly three-fourths of my neighbors to vote for an increase in my taxes or $120/year in order to maintain school funding, in light of the cuts at the state level.

Regarding health care, that "no new taxes" pledge is also meaningless to the families who have to pay more in Healthy Families premiums in order to have the children covered, or those children's families who face huge medical bills after losing Medi-Cal coverage.

That pledge will be laughable if the additional cuts proposed by Schwarzenegger go through, for example, to the hundreds of thousands of seniors who will have to pay significantly more for health coverage.

So what is the point of the "no new taxes" pledge? The result, whether in health, education, or elsewhere, is that Californians are still paying more, but just getting less.

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posted by Anthony Wright | Permalink | 10:03 PM


Dr. Colbert, DFA, with the diagnosis...

The recent Jupiter clincial trial revealing that statins like Crestor may help prevent heart attacks, even for folks who would not ordinarily be prescribed the cholesterol-lowering drug, got front-page news.

While this could be an important breakthrough in science, medicine, and health, there are some concerns, encouraged by the . Leave it to Comedy Central's The Colbert Report to provide a counterpoint:

Colbert brings up some of the legitimate critique of PhRMA: that their research is focused more on finding a steady income stream from existing drugs than on new discoveries. “This is a great breakthrough in the battle to find things to prescribe to people who don’t need them...True, the drug costs $100 a month... But that is a small price to pay to not have the heart attack that there’s no way of knowing that you would have had.”

After a clip of Stanford cardiologist Mark Hlatky urging caution, Colbert quipped, “sounds like someone hasn’t gotten enough free Crestor pens.” Health Access California, CALPIRG, California Labor Federation and other senior and consumer groups supported a bill earlier this year to place limits on the drug company giveaways to medical providers, but the active opposition of PhRMA blocked it. Maybe now that the issue has gotten the famous "Colbert bump" (along with the city of Sacramento), we can be more successful in the future.

The Colbert piece led Scientific American and the Wall Street Journal Health Blog to (in jest?) encourage Colbert’s name be added to the list of candidates for FDA Commissioner as President Obama selects a new administration.

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posted by Anthony Wright | Permalink | 11:22 AM


Bleak Budget: Cuts & Caps Considered...

Friday, November 14, 2008
Friday, November 14th, 2008

* Schwarzenegger proposes significant midyear cuts in health, other vital services
* Legislative Analyst predicts $28 billion shortfall without corrections
* Assembly Budget Committee holds hearings on proposals
* MRMIB/Healthy Families considers waitlist for eligible children

Click for What's New on the Health Access WeBlog: More on today's budget hearing; Assemblyman Dave Jones gets more facts; How SCHIP votes impacted the election; President-elect Obama on the false choice of economic reform vs. health reform; Unhealthy Healthy Families Proposals; Responses to the Baucus plan; Federal health reform gets serious!

Get Tickets for Health Access' 20th Anniversary Forum & Reception, Thurs, November 20th

Less two months after Gov. Arnold Schwarzenegger signed an overdue and painful budget, significant budget cuts are back in discussion, with the threat of denying care and coverage to hunderds of thousands of Californians.

GOVERNOR'S MID-YEAR BUDGET PROPOSAL: Last week, in light of an $11.2 billion gap in income (partially a fallout from the global financial crisis), Schwarzenegger put forth a proposal for additional cuts this year and a tax increase. The additional cuts come on top of more than $10 billion in cuts already enacted in the 2008-09 budget.

The proposal includes cuts to health services of $141.9 million in the current year, but would quickly grow to nearly a billion in future years as the policy changes get implemented, denying nearly a half-million low-income Californians coverage, and eliminating benefits and/or raising costs for over 2.5 million parents, seniors, and people with disabilities. A detailing these cuts is available on the Health Access website, at:

LAO PROJECTIONS: The indepdent Legislative Analyst weighed in this week with their assessment of the problem: an estimated $28 billion deficit at the end of the year if lawmakers and the governor do not act soon to close part of the budget. The Schwarzenegger administration did not dispute those numbers, and added that the hole could be bigger, given that more people must rely on state programs during an economic slump because they have lost jobs, benefits, etc. and that would, in turn, increase state spending.

ASSEMBLY HEARING: The Assembly Budget Committee held a hearing on the mid-year proposal Friday.

“There’s no way we can solve this budget problem with just cuts or just revenues,’’ cautioned outgoing Assembly Budget Committee Chair John Laird. “People on all sides will resist one or the other. I urge anyone to avoid any lines in the sand….” including “avoid(ing) taking any pledges.’’

Yet nearly all Republicans have signed a no-tax pledge.

Roger Niello, the Republican vice chair of the budget committee, said in his opening statements, “It makes no sense to begin immediately talking about increased taxes, when we haven’t done everything we possibly can to eliminate ineffective programs.’’

The legislative analyst said eliminating waste, fraud and abuse would not resolve our near-term budget problems, though ideas would be worth a second look.

Assemblyman Dave Jones said he wanted to see more analysis of how the economy would respond if services were cut versus the avoidance of a tax increase – particularly an upper income tax.

“A lot is being asked of poor Californians,’’ said Jones. “We need to ask everyone to participate in this problem,’’ he said, including wealthier Californians. (Health Access did an analysis earlier this year reviewing the economic impact and the coverage impact of the cuts contained in the May Revision.)

Schwarzenegger was hoping that with the election over, and about one-third turnover in the Legislature, the current lawmakers whose terms expire November 30th, would have more freedom to approve the 1.5-cent sales tax increase that he has proposed (yielding $4.5 billion), in conjunction with an equivalent amount in cuts.

Without corrective action, the state will be operating on dangerously thin margins in December, and will have insufficient funds in February and March if lawmakers don’t act, the administration and legislative analyst reported. Additionally, the state’s ability to borrow money would also be compromised. The state Treasurer would be unable to sell California deficit bonds if Wall Street does not perceive that Sacramento has a strategy to rectify its now-perennial budget problem.

“We’re in a new ballgame now,’’ said new Legislative Analyst Mac Taylor. Taylor says this is the worst fiscal situation he’s seen in his 30 years analyzing the budget. “It’s imperative to act early.’’

DEADLINE LOOMS: The governor and legislative leaders have been meeting throughout the past week, but a breakthrough does not seem imminent. The current legislative session expires on November 30th, although some speculation suggests lawmakers would need to vote on some kind of package by next Friday, November 21st – maybe Nov. 26th, right before Thanksgiving, at the latest -- in order to allow the Legislature’s computer system to be changed over to be ready for the swearing-in of the new legislative session beginning December 1.


In related news, the Managed Risk Medical Insurance Board, which administers the Healthy Families children's coverage program, will be considering on Wednesday – November 19th – the institution of a wait list for eligible children who apply, beginning in mid-December.

The reason: the program is currently operating at a deficit, albeit a small one, projected at $17 million.

This is, in part, due to the economic recession and increased demand from Californians: Healthy Families reports enrolling more children than ever, with 27,000 new children signing up per month. Currently, there are 900,000 children enrolled in the program, the most ever since it began in the late-1990s.

If a waitlist is imposed, then MRMIB estimates that 162,750 children would be on that waitlist within six months. Even more starkly, enrollment is estimated to drop from 904,000 in November to 787,000 in June 2009.

Incoming Senate Pro Tempore Darrell Steinberg urged the board, which will make a decision in December, to not rush into anything. Steinberg told the Sacramento Bee: "I would urge (the Managed Risk Medical Insurance Board) to hold up on such a vote…There are a lot of moving parts, including a new administration in Washington and a Congress committed to putting children's health at or near the top of the agenda."

In particular, Congress could consider a stimulus package before the end of the year that could increase the federal matching rates for Medicaid, which could provide potentially $2 billion in assistance for California's health programs. Additionally, Congress needs to renew the State Child Health Insurance Program (SCHIP) before March 2009, when its current authorization expires. SCHIP is what funds Healthy Families with a $2 –to-$1 (state dollar) match.

OPPORTUNITIES FOR ACTION: A full update and alert on this issue is available at the website of the 100% Campaign coalition of children's advocates, at:

In particular, child and health advocates are:
1) urging MRMIB, at the Wednesday, November 19th public hearing and in other venues, not to impose the wait list on children's coverage;
2) urging state legislative leaders and Governor Schwarzenegger to keep Healthy Families funded, and direct MRMIB not to go forward with the wait list;
3) urging federal legislators to include and maximize state assistance to Medicaid ("increased FMAP") in any economic stimulus package as soon as possible, and to prioritize SCHIP funding and reauthorization.

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

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posted by Anthony Wright | Permalink | 9:47 PM


Ask and you shall receive

I'm watching the Assembly Budget hearing on the governor's mid-year cuts proposal. Assemblyman Dave Jones has just asked for a report on the economic impact of the cuts proposed.

Department of Finance has not done the analysis yet. ...but we have!

Specific to health care cuts, the governor proposes $141.9 billion in reductions, which would result in about 400,000 adults being denied Medi-Cal even though they would ordinarily qualify. It includes eliminating dental benefits, podiatry benefits and other vital services for those making about $1,000 a month.

Health Access did such an analysis of the ripple effects based on the May Revise budget earlier this year.

Here is our take on the current proposals:

2008-09 impact of proposed cuts
  • 08-09 state funds saved: $141.9 million
  • 08-09 federal funds lost: $93.4 million
  • NOTE: This is on top of enacted budget which reduced general fund by $443 million, and lost $357.7 million in federal funds.

Economic impact

  • $235.3 million in business activity lost (multiplier effect)
  • 1,853 jobs lost
  • $84 million in lost wages

2009-10 impact of proposed cuts

  • 09-10 general fund saved: $714.7 million
  • 09-10 federal funds lost: $442.6 million

Economic Impact:

  • $1.12 billion in business activity lost (multiplier effect)
  • 8,781 jobs lost
  • $398.3 million in lost wages

All of these figures come on top of the losses already sustained this year.

  • $901.4 million in business activity (multiplier effect)
  • 7,097 jobs lost
  • $321.9 million in lost wages


posted by Hanh Kim Quach | Permalink | 11:49 AM


For the children ...

Thursday, November 13, 2008
Politico compiled a list of 10 Republican Congressmembers who lost their seats when they opposed expansion to the State Children's Health Insurance Program/Healthy Families. A reconsideration and reauthorization of SCHIP is among the first things on Congress' and Obama's agenda come 2009 -- and not a moment too soon.

Next month, California is expected to institute a waitlist for eligible children applying for Healthy Families. Advocates will speak out against the proposal at the November 19th Managed Risk Medical Insurance Board hearing. The response is ill-timed and ironic. More children than ever are applying for coverage monthly (27,000, reports the executive director Lesley Cummings), and Healthy Families enrolls 900,000 children now -- the highest in its 11-year history. Add to that, an expected increase in unemployment in the next year -- driving more families to public programs.

UPDATE: In this letter to its board, MRMIB shows what will happen to Healthy Families with a waitlist:

November 2008 enrollment = 904,389
June 2009 enrollment= 786,719

That's 117,670 children who would actually *lose* coverage -- not to mention the countless others (estimates are between 100,000 - 162,000 children) who would be placed on a waiting lists, even though they would otherwise qualify.

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posted by Hanh Kim Quach | Permalink | 12:58 PM


Roundup of News on Federal Health Reform

I'm just going to cut and paste this great compendium of clips about the Baucus white paper, and PriceWaterhouseCoopers report on health reform (signs are encouraging). More later..

  • Congressional Quarterly: Baucus Outlines Health Care Plan The first step would almost certainly be the expansion of federally funded children's health insurance, known as SCHIP. ... Many parts of Baucus' plan were intentionally left vague, according to Baucus policy aides. Absent, for example, are politically sensitive details on how large a fine would be levied on large employers who do not provide health insurance, how many children would be covered under SCHIP, or even what the plan would cost or how those costs would be offset - all questions that will create fights among lawmakers and interest groups.... It does seem certain, though, that the plan would not fully comply with pay-as-you-go budget rules, which require any new spending to be offset. "We're not going to fully offset the cost of the plan in the early years," said the aide.
  • Wall Street Journal Blogs Why Sen. Baucus Didn't Wait for Obama On Health Reform For yesterday, at least, everybody was making nice. Kennedy called Baucus's proposal a "major contribution to the debate on health reform." Sen. Ron Wyden (D., Ore.), another big health thinker, praised Baucus too, saying he "couldn't be happier than to see Chairman Baucus make health care such a priority for the next Congress."
  • LA TIMES: Congress isn't waiting for Obama"Much of what's here dovetails with the president-elect's own health plan," Baucus said. "And where we differ, I have committed to work with him to find a consensus."
  • Reuters: Healthcare reform gets backing in Congress"He has rightly sounded the urgent plea to get comprehensive reform done early in the next Congress and recognizes that the failure to act has dire and unacceptable consequences for working families, businesses and our national economy," AFL-CIO President John Sweeney said in a statement.
  • PricewaterhouseCoopers Issues Report On What Obama Presidency Means for Health Industry"The financial crisis could accelerate health reform rather than be a roadblock to it," said David Levy, MD, prin cipal of PricewaterhouseCoopers' health industries advisory practice. "Right now, we have an historic opportunity to fix our broken health system as many forces converge around bringing better value for patients, and those forces could become unleashed by a new President who has pledged to make healthcare reform a priority of his administration." A full copy of the report Healthcare Policy in an Obama Administration: Delivering on the Promise of Universal Coverage is available for download at www.PwC.com/obamahealthreport.
  • Reuters: Obama health plan to cost $75 billion: analysis President-elect Barack Obama's plans to overhaul the U.S. healthcare system would cost the federal government $75 billion the first year but would provide health insurance for 95 percent of Americans, consulting firm PriceWaterhouseCoopers said on Wednesday.
  • Forbes Ahead of the Bell: Health care hearing House lawmakers on Thursday are slated to examine the impact the hemorrhaging economy has had on health care coverage for Americans. The Energy and Commerce Committee's health subcommittee plans to look at the state of federal health care programs, including Medicaid, which has been hurt by state budget shortfalls.
  • Think Progress: The Baucus Health Plan & The Tax Incentive Tweak During the presidential campaign, progressives criticized Sen. John McCain (R-AZ) for dismantling the employer-based health insurance system by exposing employee tax benefits to income taxes. This morning, Sen. Max Baucus (D-MT) proposed financing his comprehensive health reform plan by reforming the tax incentives for employer coverage.
  • Ezra Klein: THE BAUCUS WHITE PAPER: THE PLAN. I'm going to split my commentary on Max Baucus's policy paper (pdf) into two posts: The plan and the politics. First, the plan.

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posted by Hanh Kim Quach | Permalink | 12:52 PM


Health reform to the Max...

Wednesday, November 12, 2008
Senator Max Baucus, Chairman of the Senate Finance Committee, unveiled his "Call to Action" today. The 89-page white paper is on Committee's website, here:

Ezra Klein at the American Prospect has been doing some heavy blogging on the politics and the policy of the plan, with Matt Yglesias at the Center for American Progress collecting other comments from Paul Krugman, Jonathan Cohn, and others.

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posted by Hanh Kim Quach | Permalink | 12:37 PM


The federal reform push starts...

Senator Max Baucus of Montana, Chair of the Senate Finance Committee, is slated to release a concept paper around health reform today

Laura Meckler at The Wall Street Journal, Jonathan Cohn at The New Republic, and Robert Pear of the New York Times have some of the outline. We should see more of the details tomorrow.

If the articles (and our sources of information) are right, we start from a vastly improved place from the Clinton era. The then-Chair of the Senate Finance Committee, Daniel Patrick Moynihan, wass openly dismissive of the need for health reform, much less the framework. In contrast, Senator Baucus is proposing a framework very similar to the plan that President Obama ran on, and poured well over $100 million in campaign TV ads promoting.

Both Obama and Baucus plans appropriately focus on expanding group coverage, including expanding public programs for lower-income children and adults, and employer-based coverage in general. It would offer purchasing pools and public coverage options. Both would institute a variety of cost-control measures, and new regulations on insurers--particular preventing them to deny people for "pre-existing conditions." That's good stuff, and a strong platform to start.

Much will be made about the notion of an individual mandate, which was a debating point between Senator Clinton and Senator Obama during the primaries. Clinton was for it; Obama said he wanted to ensure affordability before considering the requirement for adults as well (his plan includes a requirement for children, ). Many have argued that the issue was overblown.

We at Health Access have been skeptical of the individual mandate, but not opposed to the notion that we all--sick and healthy--should contribute to health coverage (as many health reforms, including single-payer, include). Rather, our issues were more about the problems in the inefficient and inequitable individual insurance market that some may be forced into. It was only in the context of expanding group coverage, shrinking the individual market, and placing new subsidies and restrictions, that we and other consumer groups supported AB x1 1, the negotiated deal between Governor Schwarzenegger and Speaker Nunez.

So the real question, in the Baucus plans and others that may come out, is: what help does it provide? Will it leave consumers are the mercy of the private insurers, of the individual insurance market?

In addition to supporting the concept and urgency of health reform, we as consumer advocates can push to ensure that we institute new rules for the private insurers, especially with regard to allowing them to pick and choose who they cover; that we offer new purchasing pools so individuals and employers can better negotiate for the best deal; and provide new public coverage options, as a competitive choice.

Let's look at the details when they come out, but that's what I will be looking for.

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posted by Anthony Wright | Permalink | 12:05 AM


What does Obama think? In his own words...

Tuesday, November 11, 2008
Lots of commentators, stakeholder groups, and bloggers are debating whether President-elect Barack Obama has the interest in, or the mandate for, comprehensive health reform.

Some are arguing that economic priorities must come first, that we can’t afford to fix our health care system until later.

Candidate Obama directly addressed this question on October 4th, just one month before the election:

”Now I know that at this moment, when we stand in the midst of a serious economic crisis, some might ask how we can afford to focus on health care. Well, let’s be clear: the rescue package we just passed in Congress isn’t the end of what we need to do to fix our economy – it’s just the beginning. Because the fundamentals of our economy are still not strong – contrary to what Senator McCain says. And we’ve got to address those fundamentals – and address them right now.

In other words, the question isn’t how we can afford to focus on health care – but how we can afford not to. Because in order to fix our economic crisis, and rebuild our middle class, we need to fix our health care system too.… So it’s clear that the time has come – right now – to solve this problem: to cut health care costs for families and businesses, and provide affordable, accessible health insurance for every American.”

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posted by Hanh Kim Quach | Permalink | 12:40 PM


More misery

The Legislative Analysts Office just told us to expect next year's deficit to be in the $22 to $28 billion range.

We're now approaching Gray Davis-Recall-catastrophe levels... (In 2003, the administration's projected deficit was $38 billion, LAO said it was $30 billion. And that, famously, was the beginning of the end....)


posted by Hanh Kim Quach | Permalink | 12:26 PM


Healthy Families during an Unhealthy Economy

Friday, November 07, 2008
The good news: With the economy quickly spiraling down the toilet, California's Healthy Families program is enrolling more children than ever, reports the executive director of board running Healthy Families, Lesley Cummings. They're now enrolling 28,000 children a month -- and just enrolled its 900,000 child (!). It's additional proof of the sucess of public programs.

The bad news: Sadly, ironically and when it's needed most, the program will need to be cut. It's short $17 million ( about .017% of the state general fund). The Managed Risk Medical Insurance Board will meet November 19th (10 days) to discuss whether they should begin putting new applicants on waitlists.

A decision will be made sometime in December.

With jobless rates rising -- as reported today -- and thousands more losing health coverage through work, either because a loss of jobs, or cutbacks on benefits by companies, the state is the last stop for these children. This is the worst time (not that there is a best time ) that the state should contemplate denying children who are eligible for coverage.

We will keep advocates abreast of news to come. Here, also, is the MRMIB agenda where the cuts will be discussed and instructions for how to comment and help prevent these cuts.

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posted by Hanh Kim Quach | Permalink | 5:44 PM


A taxing perspective

A colleague in a meeting yesterday said succinctly what many of us have been thinking for a while: Why is it that tax increases are temporary, while cuts are permanent?

The current 2008-09 budget makes about $10 billion in permanent cuts, yet only $18 million (yes, Million) in permanent tax increases. The big-ticket tax increases, denying businesses the ability to claim losses or credits, are temporary. After they expire, businesses will collectively make back their losses within two to four years.
And if Gov. Arnold Schwarzenegger's proposal goes through as suggested, unequal treatment of cuts versus taxes will happen again. To fix our gaping and growing shortfall -- now pegged at $11 billion -- Gov. Arnold Schwarzenegger proposed a 1.5-cent sales tax increase that would expire in three years. Meanwhile, the $4.5 billion in cuts will go on indefinitely. For health care, it means $150 million in reduced services this year, which grows to $1 billion in future years. (on top of more than $600 million already cut this year. )

How is this fair?


posted by Hanh Kim Quach | Permalink | 2:01 PM


The November budget fight...

Thursday, November 6th, 2008


* Gov. Schwarzenegger calls a “lame duck” Legislature back into special session
* Proposes $4.5 billion in cuts, on top of $10 billion already made in 2008-09 budget
* Proposes $141.9 million in health cuts in 08-09, which grow to $1 billion/year in out years
* Proposes 1.5-cent sales tax increasem, other revenues

* Click here for a look at what's new on the Health Access Weblog: Budget misery, the presidential election, the prospects of health reform under President Obama.
* Get Tickets, Ads, Sponsors for
Health Access' 20th Anniversary Celebration, November 20th

Gov. Arnold Schwarzenegger today called lawmakers back to Sacramento to help close a new and growing deficit of $11 billion. The governor said he was driven to re-open the budget, which was signed into law just six weeks ago, because Californians “don’t have the luxury of waiting until January’’ when governor’s typically introduce the first draft of their spending proposals.
“We have a dramatic situation that requires a dramatic solution," said Schwarzenegger, citing the 20 percent drop in the country’s stock market.

To bridge the gap, Schwarzenegger has proposed $4.5 billion in cuts – including $141.9 million in health care cuts this year alone. The cuts grow in future years, as would impact on families needing health care services.

The Republican governor has also proposed a temporary 1.5-cent sales tax increase, along with elevating vehicle registration fees by about $23 per vehicle. The revenue increases are expected to raise $4.4 billion.

Health and other advocates appreciate that the Governor is supporting specific taxes to prevent even worse cuts, and rejecting a cuts-only approach to find a budget solution. However, the revenues proposed don't match the cuts that have already been made in the past few months and years, much less the new, additional cuts proposed today.

It is unclear, however, whether the governor will be able to garner enough Republican votes to pass these increases, to get the needed 2/3 of the legislature. He was unable to convince his fellow party members earlier this year.


The health cuts proposed by Schwarzenegger revisit familiar territory from previous budget fights, including the most recent. These are largely cuts that have been rejected by the Legislature as too severe, earlier this year and in previous years.

The proposed health cuts would mean hundreds of thousands of Californians would lose coverage, and millions would lose dental, vision, podiatry, and other vital benefits. There are specific cuts to seniors, immigrants, public hospitals, and other groups. These cuts will also mean California will lose federal matching funds, further harm our already broken health system, and our economy.

Two specific cuts of note:

* Denying low-income working parents Medi-Cal coverage, by lowering the eligibility from 100% to 72% of poverty level, cutting off eligbility for parents in families of three making more than $13,000. The cut would be $8.6 million in 2008-09; $109 million in 2009-10, and $342 million in 2011-12, ultimately impacting over 429,000 California parents.

* Eliminating dental, vision, podiatry and several other benefits for the three million parents, seniors, and people with disabilities on Medi-Cal coverage. The cut would be $41 million in 2008-09, and $129.9 million in 2009-10.

Other cuts would increase health costs with seniors, limit benefits for legal immigrants, and shift funds away from public hospitals.

For a complete list of mid-year health-related budget-reduction proposals, visit our website:

For a list of the final budget cuts sustained for the enacted 2008-09 budget, visit our website: http://www.health-access.org/preserving/Docs/BudgetScorecard%20092608.pdf.

Because one-third of the fiscal year is already over, cuts to health care in the 2008-09 fiscal year, which include sharp cuts to eligibility and benefits for the lowest income Californians, are relatively modest at $142 million. Cuts actually grow in their impact, to over $700 million in 2009-10, and to nearly $1 billion in out years.

These cuts come on top of $615 million in reductions already made to health care services earlier this year.


Schwarzenegger is hoping lawmakers act fast. The current batch of legislators will see their terms expire on November 30th. While some will undoubtedly return December 1, there will be 24 brand new Assembly members, who have never been immersed in state budget complexities. Senate President Pro Tempore Don Perata applauded the governor’s quick action, but said he was unwilling to make deeper cuts.

“Over the summer, Democrats agreed to $10 billion in deep cuts, and we have cut all the way to the bone,’’ said Perata in a statement. “…the Governor’s plan to slash assistance to the poor and the needy while raising their taxes is an unacceptable double blow to California’s most vulnerable citizens.’’

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posted by Anthony Wright | Permalink | 8:10 AM


First look.... It's ugly...

Thursday, November 06, 2008
The quick headlines on the Governor's budget:
* Hundreds of Thousands Would Lose Coverage; 3 Million Would Lose Dental, Other Benefits
* Cuts Would Harm California's Coverage, Health System, Economy; Lost Federal Funds
* More Revenues Needed Just to Match Cuts of Previous Year, Not Including New Cuts

The proposed health cuts would mean hundreds of thousands of Californians would lose coverage, and millions would lose dental, vision, podiatry, and other vital benefits. These cuts will also mean California will lose federal matching funds, further harm our already broken health system, and our economy.

Two specific cuts of note:
* Denying low-income working parents Medi-Cal coverage, by lowering the eligibility from 100% to 72% of poverty level, cutting off eligbility for parents in families of three making more than $13,000. The cut would be $8.6 million in 2008-09; $109 million in 2009-10, and $342 million in 2011-12, ultimately impacting over 429,000 California parents.
* Eliminating dental, vision, podiatry and several other benefits for the three million parents, seniors, and people with disabilities on Medi-Cal coverage

We appreciate the Governor is supporting specific taxes to prevent even worse cuts, and rejects a cuts-only approach to find a budget solution. However, the revenues proposed don't match the cuts that have already been made in the past few months and years, much less the new, additional cuts proposed today.

Health Access California, the statewide health care consumer advocacy coalition, has a quick one-sheet detailing the health cuts, on our website:

Health Access also has earlier studies, about how these cuts impact health coverage:

More later...

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posted by Anthony Wright | Permalink | 1:00 PM


More cuts on the way

Gov. Arnold Schwarzenegger currently announced at a press conference that the state will have to cut another $4.5 billion from the budget to staunch the bleeding. In the 2008-09 budget year, signed less than two months ago, we are already facing a $11 billion shortfall. The balance of the shortfall will be filled in with revenues -- such as a 1.5 cent sales tax increase.

more to come.


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


Blogging the budget...

Wednesday, November 05, 2008
Governor Schwarzenegger is set to release tomorrow the figures about the scale of the deficit for this year, and next, as well as his proposals for briding the gap, through both mid-year cuts and revenues.

We'll post as soon as we can on the content, including the proposed health cuts. Stay tuned.

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posted by Anthony Wright | Permalink | 11:34 PM



It's been a historic night. Now, the real work begins. But here's a few thoughts, and then more after some sleep.

For the cause of major health reform and coverage expansions, the election of President-elect Barack Obama makes me very hopeful:

1) He and Senator Biden endorsed the Health Care for America Now! principles, in support of a guarantee of quality affordable health coverage, and against leaving consumers alone at the mercy of private health insurers. Along with over 125 members of Congress, he has committed to make health reform a top priority, and under the right principles.

2) He put his money where his mouth is, spending over $110 million of his campaign resources on advertisements around health care issues. When voters gave him this mandate, they did so partially because they support health reform, and the type that Obama was talking about.

3) Health care is so important to consumers that any major change in our health system requires a certain level of trust that reform is possible, and positive. In a post-Katrina world, Obama's core message, against cynicism and the appeal that we all have a shared future, together, is as important for the cause of health reform as any policy detail.

4) The increased margins of his party in the House and Senate will help. So will his impressive showing in previous "red" states, giving him strength and leverage with moderate Democrats and Republicans. For example, he won Iowa easily and came excruciatingly close in Montana--the home states of the two leaders of the Senate Finance Committee (Grassley and Baucus)--perhaps the most important hurdle for health reform in the legislative process. He can use his mandate for health reform in those states.

5) Finally, we now have the ability to pursue reform not just at the state, but federal level. And for those of us committed to state-level reforms, it looks like we will have a partner, rather than an obstacle, at the federal level.

Also, FYI, in other good news, Arizona narrowly defeated Prop 101 (50-50, by only a few thousand votes) the anti-universal health care intiative, that would have prohibited health reforms like that of Obama, Schwarzenegger-Nunez, or single-payer. But that's too close.


posted by Anthony Wright | Permalink | 1:26 AM


Vote today.

Tuesday, November 04, 2008
It matters.

posted by Anthony Wright | Permalink | 2:24 PM


You are invited...

Monday, November 03, 2008
Monday, November 3rd, 2008

AFTER THE ELECTION: Health Access 20th Anniversary Forum THURS, NOV. 20th

* "
Many Paths, One Goal: Moving Toward Quality, Affordable Health Care for All Californians."

Nov. 20th Post-Election Forum to Preview Renewed Efforts, Share Lessons on Reform
* Key Elected Leaders to Speak, Provide Insight on Prospects for State and Federal Efforts
* Reception to Honor Past Leaders & History of Health Access and CA health advocacy

* NEEDED: Please
Consider Tickets, Sponsorships, Program Book Advertising

Click Here for What's New on the Health Access WeBlog: Vote!; Arizona's Anti-Health Reform Measure; Severe Budget Cuts Sought in Special Session; Montana in the Middle; Living Wage, and Benefits; California's High-Risk Pool; Debating Why the Young are Uninsured in Swampland; McCain's October Surprise; The Multi-Pronged Budget Fight After the Election; The Big Event; Obama's Investment in Campaign Ads on Health Issues; LA Times on the Individual Insurance Market; Baseball's Beane on Health Data; Health Wonk Reviews; Campaign Ads; Budget

The election tomorrow brings with it new opportunities and challenges. We are pleased that soon afterwards, Health Access will be hosting our 20th Anniversary Event, not just to celebrate our past but to prepare for the future, whether the immediate budget crisis that threatens additional cuts to California health reform in the next few days, or the camapign to win comprehensive health reform at the federal level next year.

We invite you to join us on Thursday, Thursday, November 20th, at the Sacramento Convention Center, starting with a 2pm forum and a 4:30pm reception. You can buy tickets, as well program book advertisements and sponsorships, with the official form on our website.

The program, entitled “Many Paths, One Goal: Moving Toward Quality Affordable Health Care for All Californians" starts at 2pm, with a program of speakers, including incoming Senate President Pro Tem Darrell Steinberg, incoming Assembly Health Committee Chair Dave Jones, and distinguished leaders in state and federal health policy and health reform.

Afterwards, we will have a reception that will honor past heads of our organization, including Lois Salisbury, Maryann O’Sullivan, Bruce Livingston, and Melinda Paras. A full program is available on the Health Access website, as well as a form where you can buy ads celebrating our honorees and the organization.

Beyond recognizing the past work of the organization and the broader health advocacy community, our discussion will restart efforts at the state and federal level around the budget, consumer protections, and comprehensive health reform.

Many Paths, One Goal:
Moving Toward Quality, Affordable Health Care for All Californians

Date: November 20, 2008
Location: Sacramento Convention Center
1400 J Street, Sacramento CA
Ballroom 314-315

2PM – 4PM
A discussion about the future of health care reform in California and the nation

Featured Speakers:
The Honorable Darrell Steinberg
Senate President pro Tempore-elect

The Honorable Dave Jones
Prospective Chair, California State Assembly Committee on Health

Guest Panelists:
E. Richard Brown, Ph.D.
Director, UCLA Center for Health Policy Research;
Professor, UCLA School of Public Health;
Principle Investigator, California Health Interview Survey

Wilma Chan
Vice President, Policy, Children Now;
Former Chair of the California State Assembly Committee on Health

Jacob Hacker, Ph.D.
Professor of Political Science, UC Berkeley;
Author, The Great Risk Shift

Larry Levitt
Vice President, Media and Public Education,
The Henry J. Kaiser Family Foundation; Editor-in-chief, kaisernetwork.org

Robert Phillips, M.P.A., M.P.H.
Senior Program Officer, The California Endowment

4:30PM – 6PM
Honoring past leaders of Health Access including:

Lois Salisbury, J.D. – Health Access Founding Chair
Director of the Children, Families, and Communities Program,
The David & Lucille Packard Foundation

Maryann O’Sullivan, J.D. - Health Access Founding Executive Director, 1987-93
Founder, Preschool California
Independent Consultant

Bruce Livingston, M.P.P. - Health Access Executive Director, 1995 –99
Executive Director, Marin Institute

Melinda Paras - Health Access Executive Director, 1999 –2002
President and CEO, Paras and Associates Interpreter Systems

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posted by Anthony Wright | Permalink | 6:02 PM


What if?

As folks consider their election day decisions tomorrow, here's a link to reports we've issued about the presidential candidates' health plans.

There's lots of races, from the presidential to Congressional, in state Senate to Assembly seats, where health care issues loom large. It could have been much more so.

Let's remember that the stalling of AB x1 1 earlier this year, in January, was not the final hurdle. Even if the negotiated health reform plan between Governor Schwarzenegger and Assembly Speaker Nunez had passed the legislature, it was entirely contingent on a companion ballot measure with the passing on the ballot... tomorrow.

How would that measure, which included the financing for the health reform, have fared? It's hard to tell.

Some believed this was the best opportunity in a generation to have health reform up on the ballot, given the record turnout expected tomorrow, especially with younger, lower-income, community of color, and first-time voters. All these groups went strongly for Prop 72 in 2004.

There's also the notion that AB x1 1 had a similar framework to the Obama plan (although there are differences in the details). The case could have been made to the majority of California voters expected to vote for Obama to also vote for his health plan.

At the same time, the ballot measure to fund AB x1 1 would have had lots of well-funded opponents, from Blue Cross to the California Restaurant Association. Both sides could claim credible spokespeople within the health care world, and would attempt to use the budget deficit and economic recession in their talking points, for and against the measure. It is a crowded ballot, with other measures (like Props 4 & 8)--not to mention the Obama campaign--getting lots of attention from voters, volunteers, and contributors.

It's unclear what the fate of a health reform proposition would have been. What I do know is that the last two efforts to expand coverage on the California ballot have both gotten within two percentage points: the expansion of employer-based coverage, Prop 72 in 2004, at 49.2%, and a tobacco tax to fund children's coverage and other care, Prop 86 in 2006, at 48.2%. The results in these recent contests were too close not to think there won't be new attempts in the future.


posted by Anthony Wright | Permalink | 1:47 PM


On another ballot....

Sunday, November 02, 2008
There's lots of important ballot measures on the California ballot, but one for health advocates to watch is in Arizona.

In Arizona, there's Proposition 101, which would block future universal health coverage efforts in that state, according to Jacob Goldstein of the Wall Street Journal Health Blog.

The initiative, as a constitutional amendment, states that it would:
"Prohibits laws that: restrict person's choice of private health care systems or private plans; interfere with person's or entity's right to pay directly for lawful medical services; impose a penalty or fine for choosing to obtain or decline health care coverage or for participating in any health care system or plan."
While phrased as "choice," in actuality it would prohibit even basic regulation of private insurers, including most efforts to control costs in the health care system. The proponents are candid in their desire to have this amendment in order to prevent various broad health reforms, from the creation of a single-payer proposal, a "pay-or-play" policy, an individual mandate, or other ideas.

Supporting are conservative doctors and anti-tax groups, while there's an interesting coalition in opposition from health advocates to chambers of commerce to hospitals and health providers to childrens and senior groups to Gov. Janet Napolitano.

The proponents talk about "choice," but actually don't acknowledge that the current health system is what restricts choice: people don't get coverage because they are denied for pre-existing conditions, or are denied because it is unaffordable. The point of reform is to provide those new choices, including public--not just private--coverage options, that many don't have now.

Regardless, Proposition 101 is one of many monkey wrenches that will be thrown at health reformers in the next few years. Let's see how Arizona deals with it this week.

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posted by Anthony Wright | Permalink | 9:29 PM


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Anthony Wright is the executive director,
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