The other big debate in Senate Finance Committee was on amendments by Republican Senators Grassley and Kyl about whether health reform should set a basic minimum for the actuarial value of health insurance plans. This was a big deal discussion that we felt compelled to tweet at www.twitter.com/healthaccess: After wall, if we are going to have "universal coverage," you need to define "coverage" as to be meaningful.
Senator Kyl and Grassley's case was that such a standard would be a government intrusion that would limit choice in the marketplace, including many products that many people have chosen now. Senators Kyl and Grassley indicated how some states have significant percentage of people with plans that have actuarial values of 40%, 50%, 60%--less than the 65% minimum in the Senate Finance Committee bill.
Just to be clear, Kyl sought to allow insurers to continue to sell "junk" plans that cover less than half of the costs that an average patient would incur.
In rebuttal, Senator Baucus called such plans with lower actuarial value of 65% "pseudo-insurance." He said Kyl's amendment is an "amendment for the status quo," since it would allow "terrible plans" in the marketplace, and allow insurers to "take advantage of people."
Frankly, the minimum standard should be higher than 65%, even for the "bronze" plan. Can you imagine paying premiums and still facing 35% of costs after a significant medical incidence and expense?
As described by the Senate Finance Committee staff, there is a need to strike a balance between the affordability of the premium on front end, and meaningful coverage (and signifincant costs) on back end. Some people will want comprehensive coverage *("gold") that covers over 90% of their medical costs, others will save on the premium even if it means taking a risk of larger costs if medicaly expenses are incurred. But at a certain point the premium no longer becomes worth it, and the coverage is just providing a false sense of security.
While that ideal balance is probably closer to 75%, it is important to note, as Senator Grassley did, how much of our current markets are full of these products that provide little value. Think of the plans near the 65% minimum ("bronze") as subprime coverage. The "junk" plans below 65% actuarial value are the predatory lending of health insurance.
Senator Bingaman helpfully brought up the issue of the "underinsured," that the point of the bill was not just to cover the insured but provide greater security and help to the underinsured.
Why is this important? Because so many low- and moderate-income people live paycheck to paycheck, have debt in everything including credit cards and mortgages. As our study from a few years ago indicated, around 1/2 of families have $5-10K or less of assets outside their home (http://bit.ly/10pJz3) So low- and moderate-income families are at risk of bankruptcy and/or losing home if key benefits not covered, or if cost-sharing too much.
If this sounds like the debate here is California around AB786 (Jones), held on the Senate floor until next year, you are right. Even some of the clarifications are the same. For example, Senator Conrad had to correct Kyl, to say: The bill doesn't limit us to only 5 plans, there would be lots of variation within 5 categories. (Like AB786 in CA)
Another side issue was that since the plan wants to allow people to keep the coverage they have, it would grandfather allowing people to keep the plans they have, even if they are under the minimum standard, but that those plans could not be sold to new patients. It's not ideal, but is a start from the sad state of affairs in the current individual market.
Lots of people followed the Senate Finance Committee debate today, which started with a debate on the public health insurance option, and ended with a debate on setting the minimum standards for the value of insurance.
Check out our Twitter feed at www.twitter.com/healthaccess for the blow-by-blow, often retweeting others who were also providing good coverage of the day's deliberations.
The focus was clearly the debate over the public option. Two amendments were extensively debated. Senator Rockefeller's amendment lost five Democratic votes. Senator Schumer's amendment lost three--those of Senator Baucus, Conrad, and Lincoln. In other for it to be accepted, we needed all but one Democrat to vote for the amendment.
Jonathan Cohn at The New Republic says it was predictable, and it was. But regardless of the outcome--either way it went, the fight over the public health insurance wasn't going to end today. Let's remember that of the five committees with jurisdiction on health reform, the other four committees all supported a plan with a public health insurance option. There are at least three other opportunities to improve the Senate Finance proposal, on issues like affordability, employer responsibility, and the public health insurance options, in multiple ways: * when the Senate Finance proposal is merged with the Senate HELP Committee proposal; * on the Senate floor through an amendment; * and in conference committee, when the differences between the Senate and House versions are worked out.
It's clear the public health insurance option doesn't just have the support of a majority of Americans, but a majority (51+) of the Senate. At this moment, it doesn't have 60 votes... which means that the opportunities are there, but it will be a challenge. We need to continue to express the need and urgency for health reform, while at the same time continuing our advocacy for the principles that are necessary.
Here's some reaction from Health Care for America Now!, the national coalition of 1000+ organizations which has been leading the fight for the public health insurance option, and which Health Access is proud to be the lead partner organization in California. Here's the statement by national campaign manager Richard Kirsch:
“Today, a vast majority – more than ¾ - of the Democrats on the Senate Finance Committee joined with all of the Democrats on the Senate HELP Committee to support giving us the choice of a strong public health insurance option. Now four of the five committees that have tackled health care legislation have included a public health insurance option, and the Senate Finance Committee as a whole has proven it’s out of step with the rest of Congress, the President, and a large majority of the American public. As Senators Schumer and Rockefeller said, the public health insurance option is clearly gaining momentum, and we are confident it will be in the final bill that lands on the President’s desk.
The Democratic Senators who spoke out in support of the public health insurance option today made it very clear they understand we cannot leave Americans out in the cold without real choice and competition and at the mercy of the private health insurance companies which will only continue to put their corporate profits before people’s health care needs.”
Even though a lot of health policy is done at the federal level, it is the states that currently regulate insurance companies. Even those federal health reforms pending in Congress that would change the way insurers conduct their business leave an important role for state-based standards.
So it is important that California take advantage of the opportunity to make progress in reforming the ways that health insurers do business. Especially since any federal reform will take years to fully implement.
* AB 119 (Jones): GENDER RATING, to prohibit insurers from charging different premium rates based on gender.
* AB 2 (De La Torre): INDEPENDENT REVIEW, to create an independent review process when an insurer wishes to rescind a consumer's health policy, create new standards and requirements for medical underwriting, and requires state review before plan approval. Also raises the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his health history.
* AB 98 (De La Torre): MATERNITY COVERAGE, to require all individual insurance policies to cover maternity services.
* AB 244 (Beall): MENTAL HEALTH PARITY, to require most health plans to provide coverage for all diagnosable mental illnesses.
These are some of the big hot button issues in health reform. These issues have been cited in the national health reform debate--from the reaction to the policy of rescission, to the debate last Friday on whether maternity coverage is necessary or not. These types of issues--like whether people should be discriminated against based on gender or health status, or what insurers need to include as part of a basic benefit package--are also very much in the discussion in other states as well.
If you have an opinion on whether Governor Schwarzenegger should sign these bills, let him know.
The fight over how people get help in the first place...
As part of the budget agreement, many legislators supported Assembly Bill 7 (Centralized Enrollment for Public Social Services) and the governor enthusiastically signed it into law. Who could be against saving the state millions of dollars by streamlining and automating the process for applying for public social services like Medi-Cal, food stamps, and the temporary assistance to low income families known as CalWORKS? In addition to promising lower costs for the state, the law was heralded as promoting greater efficiency in the application process, more consistency in the eligibility decisions from county to county, and increasing access to these programs for eligible people by making better use of technology.
But hold on... are those claims really true? As the state begins this week to implement this law, the picture is much clearer. Advocates have looked at the experiences in several other large and medium-sized states that have tried to implement similar so-called “reforms.”
The results in these states give California a preview of what we can actually expect: significantly increased costs to the program, less access to benefits especially by seniors and people with disabilities, and substantial loss of health insurance and benefits by eligible people currently enrolled in programs because of new barriers and confusing systems.
Here is what we know now:
Although the new system is advertised as saving California as much as $500 million a year, these savings are not considered likely as a result of these changes. The Administration has failed to factor in the very real start-up costs, the price of new technology, nor evaluated the risk that California may lose the significant reimbursement we currently receive from the federal government utilizing our current application processes.
Other states who have embarked on similar reforms as California have actually incurred increased costs for “contracting out” the application process. Texas, Indiana, Ohio, Wisconsin, and the District of Columbia, among others who have tried to implement a computer-driven application process, have not seen any savings. Instead, they have spent millions of dollars in new contracts, hardware, software, training, and public education campaigns that ultimately were not successful. These states had to respond to these disastrous results by abandoning their “reform” efforts altogether, cancelling expensive contractual arrangements, reconstructing the county and state systems they had just dismantled at great cost, conducting investigations of private contractors, all the while being the subject of scathing reviews by the press and government watchdog organizations. The failures in those states were characterized by independent reviewers as full of “cost overruns and overcharges,” “wasted tax dollars, “and “profiteering at taxpayers’ expense.”
Other states who have tried to move toward a centralized, privatized internet application for public programs have not achieved increased access or better quality and consistency in determinations of eligibility. They have found that too many vulnerable individuals do not have access to the Internet or the capability to use an automated application process. Those states found that they could not achieve significant costs savings by closing county offices. They realized that local in-person access to application assistance remained essential to the viability of their assistance programs and computerized applications should remain an alternative, but not the only way to apply.
Much of the frustration with complex programs such as Medi-Cal should be focused on simplifying the rules for eligibility, not creating barriers by imposing technology. This change is likely to discourage eligible people from applying for public programs without making needed changes to simplify the program rules.
The language in the law calls for a Stakeholders’ Advisory Committee to work with the administration to streamline implementation, keep costs under control, and increase genuine access to public programs. Health Access is committed to working to improve this process and achieve better results with a broad coalition of organizations who serve seniors, people with disabilities, children, labor, low- income families, and others. We will work collectively to ensure that this change brings genuine improvements to the process and does not spend money frivolously on technology that enriches consultants without adding value to consumers and taxpayers.
Stay tuned for developments as this process unfolds.
Earlier this year, John Mackey, the CEO of Whole Foods, wrote an op-ed in the Wall Street Journal, where he opposed the health reform proposals in Congress now. Even more troublesome, he argued for a set of boilerplate deregulatory proposals that would make our health care crisis wrose.
At least one White House official, Ms. DeParle, has gone so far as to make a house call. When Senator Dianne Feinstein, Democrat of California, expressed misgivings about how expanding Medicaid would affect California’s budget, Ms. DeParle gathered some charts and dropped in on a Saturday. They spent nearly three hours talking over coffee in Ms. Feinstein’s den.
That's not a small amount of outreach for a Senator not on a relevant Senate Committee. But when this gets to the floor, every vote will count.
Senator Feinstein has been equivocal in support of health care reform. While many have been disappointed in her lack of championing a public health insurance option, she has been fairly clear in being supportive of the general concept.
But on health reform in general, her tone has been more skeptical than supportive:
Some of the questions she raises are legitimate--from the need for affordability for California's families facing a high cost-of-living, to the impact on our budget to the need to protect our safety-net hospitals--and are appropriate for someone looking out for California's interests and specific needs. There are other concerns that are misguided--for example, the impact on the state budget is inflated--and other points that are contradictory. In another post, we'll go into the Senator's statement in a more detailed way.
It's good that the White House is walking the Senator through the specifics. It's up to Californians to make clear their support for health reform and their sense of urgency in the next few days and weeks.
"This is one for the people," said plaintiff Herbert "Les" Greenberg. The judge "could not understand what Blue Cross did not understand about the law, which is clear on its face."
The award might be small change for Anthem, whose corporate parent, WellPoint Inc., netted $2.5 billion last year.
According to a Times analysis published Feb. 18, Anthem sold thousands of policies that were intended to be safety nets for the sick, jobless and uninsurable at premiums that exceeded state-issued rates. At the time, Anthem said it had erred and pledged to make amends. And Anthem did mail out refund checks. But Greenberg, an investment lawyer, said the $12 check he got fell far short of what he believed he was owed.
It's not easy to get Blue Cross to answer for their policy or their practices. Here's a good video (done by an iPhone) of the San Francisco protest earlier this week, which also got featured with a photo in the New York Times. It features video of Patrick Romano and audio of Linda Leu, both of Health Access California and the national Health Care for America Now campaign.
The Senate Finance Committee, chaired by Senator Max Baucus, has recessed for the weekend and will come back Tuesday morning, where key amendments--like those about the public health insurance option--will be taken up. I expect that there will be lots of staff work over the weekend, maybe even some deals.
The debates are interesting to listen to. Here's one exchange of note, between Senator Stabenow and Senate Kyl, on whether the Secretary of Health and Human Services should be allowed to set a minimum benefit package.
I hope Governor Schwarzenegger is listening to Senator Stabenow. The legislature passed AB 98 (De La Torre): to require all individual insurance policies to cover maternity services, and he has until October 11th to sign or veto it. We have a societal, financial, and familial interest in ensuring that maternity care is part of a basic benefit package. The point of health coverage is that we pool our resources so when we need coverage it is there, whether is is maternity care for some women, or treatment for prostate cancer for some men.
The quiz is important in reminding us not just to look at the bills, but the condition of the current status quo in health care.
At TNR's The Treatment, I joined many much-more disinguished experts in ranking of the Baucus bill. Under the "Truman score" Jon Cohn developed, the Baucus bill got a 6.1 out of 10. In such a life and death issues, my comparison isn't a batting average but a driving test--and 61% is a failing grade in most circumstances. Jon Cohn promises an evaluation of the status quo, which I imagine will get even worse marks. It reminds us why we health reform is so necessary.
Here's a White House video that describes the benefits of health reform in four minutes:
Health Access is giving trainings--longer but more in-depth--around the state to help health reform advocates and community leaders understand the health reform proposals, the "pressure point" issues that are still at issue in the content of the proposals, answer any questions they have, and help them talk about health reform to others. For a training in your area, contact your local Health Access organizer, or Patrick Romano the California campaign director of Health Care for America Now! at email@example.com.
HEALTH ACCESS UPDATE Tuesday, September 22nd, 2009
AS SENATE FINANCE COMMITTEE STARTS TO MARK UP HEALTH REFORM, CALIFORNIANS PROTEST POLICIES/PRACTICES OF ANTHEM BLUE CROSS * Senator Baucus Begins Marathon Sessions to Consider 500+ Amendments to His Proposal * Health Reformers Protest State's & Nation's Biggest Insurer, Wellpoint/Anthem Blue Cross * Wellpoint/Anthem a Major Opponent, But Its Practices Show Need for Health Reform * http://www.sickofbluecross.com/ Relaunched to Spotlight Insurers' Actions
* More Updates on http://blog.health-access.org: AB1422 Signed to Prevent Children From Being Denied Healthy Families Coverage; The Outstanding #Health Reform Issues to Learn and Link About; HCAN on Colbert; New Census Figures to Fight Over; President Obama: It Could Happen to You; We are Number 37!; Hospital Fee Drama; Momentum for Health Reform;
The debate over national health reform is heating up, with the Senate Finance Committee, chaired by Senator Max Baucus (D-Montana), beginning Tuesday to consider, or "mark-up," its version of a health reform bill in marathon session through this week.
Consumer and community advocates are urging several amendments and changes to the proposal, including 1) increasing the financial subsidies for low- and moderate-income families to ensure that coverage is affordable for them, both in premiums and in out-of-pocket costs; 2) improving and changing the structure of the assessment on larger employers which don't provide health coverage to their workers, to provide more security and stability for on-the-job benefits; and 3) including the choice of a public health insurance option for individual who do have to purchase coverage on their own, as a way to provide more choice and competition and to help bring down costs. Other key changes being sought include allowing undocumented immigrants to purchase coverage with their own money and wages (as opposed to using federal funds), to better negotiating drug purchasing savings as to more fully cover seniors for prescriptions
Whatever amendments are taken or not, the health reform proposal is likely to evolve as it goes through the process. Any bill emerging from the Senate Finance Committee will need to be merged with its counterpart in from the Senate Health Committee, previously chaired by the late Senator Ted Kennedy. After such a proposal passes the full Senate, it would need to be reconciled with whatever the House of Representatives passes. Currently, all three House Committees have passed a more generous and ambitious bill, H.R.3200 in July. Only that final product, after going back to the Senate and House for floor votes, then will be able to go to President Obama's desk.
So while health reform has never moved as far in the 40+ years since the passage of Medicare, there's a long process to go, and many organizations and interests, from consumers and community groups, to insurance companies, will have many more opportunities to intervene.
PROTESTS OF WELLPOINT/ANTHEM BLUE CROSS: In that spirit, also on Tuesday, hundreds of customers of Anthem Blue Cross of California , a subsidiary of Wellpoint, protested with California Health Care for America Now partners, including Health Access California, California Partnership, California Labor Federation, California ACORN, MoveOn.org, and SEIU. The protests were held outside the insurance company’s offices in six locations in California, over 100 nationally. They included a rally of 300+ people in downtown Los Angeles and of 250+ people in downtown San Francisco .
In the current national health policy debate, Wellpoint, the largest insurer in the nationa and in California , has emerged as a principle opponent of health reform. Wellpoint’s subsidiary, Anthem Blue Cross of California, sent out communications to both its consumers and its employers with false and misleading attacks against H.R. 3200, the main health reform bill in the House of Representatives.
Health Access and other consumer groups made the point that Anthem Blue Cross of California is not just the main opposition to health reform; it’s the poster child for why we need reform in the first place. It’s their abusive practices that are the very reason for health reform. This soridid history of Anthem Blue Cross's opposition to health reform, and anti-cosnumer protections, are being documents at a newly-relaunched website at http://www.sickofbluecross.com/.
The point of the actions across the nation was to point out that if big insurers profit from the status quo, consumers lose unless we have reform. Anthem Blue Cross has opposed comprehensive health reform in California in 2007, opposes specific bills on the Governor’s desk, and is now aggressively attacking the key legislation moving in Congress.
At these events, consumers and many community organizations rallied in support of the House bill, H.R. 3200, drafted by California committee chairs like Representatives George Miller, Henry Waxman, and Pete Stark, and supported by Health Care for America Now!, which would prohibit many of the anti-consumer practices that Anthem Blue Cross is known for, including rescinding coverage, denying people for pre-existing conditions, and providing inadequate benefits. The bill would also provide a public health insurance option as a choice to compete with private insurers like Anthem Blue Cross.
During the actions, HCAN and partners revealed that the health insurance companies are spending $641,000 a day to oppose reform because they profit by keeping the system exactly the way it is, In these actions, the advocates urged that company to stop it's opposition to health reform, and its practices of those who deny claims; raise premiums, co-pays, and deductibles at will; reject patients based on pre-existing conditions; and refuse to cover the treatments our doctors prescribe.
The crowds gathered before noon at San Francisco, Los Angeles, and other locations, and demanded to see the company’s chief executive to ask her to sign the following pledge:
Stop Denying Our Care!
We are here to demand that CEO Angela Braly of WellPoint, parent company of Anthem Blue Cross of California who made $8.7 million last year to deny care to WellPoint/Anthem Blue Cross of California customers, agree to the following.
1 Anthem Blue Cross of California will not stand between a doctor and a patient when it comes to deciding what care that patient needs. No one at Anthem Blue Cross of California will substitute their judgment for the judgment of the patient’s physician in deciding if care is medically necessary.
2. Anthem Blue Cross of California will not deny coverage or raise rates for individuals or businesses based on a pre-existing medical condition, and will end arbitrary caps on payments for necessary medical care.
3. Anthem Blue Cross of California will terminate any policy or incentive that rewards employees financially or otherwise for denying care and rejecting claims.
4. Anthem Blue Cross of California will not use any resources – including members’ funds, employees, and facilities — to lobby against and oppose any aspect of the health reform proposals supported by President Obama and being considered by members of the United States Congress, including but not limited to a national public health insurance option available on day one.
Events in Los Angeles and San Francisco included testimony from many who have personal experience with Anthem Blue Cross of California’s anti-consumer practices, of having their insurance rescinded when they became sick, of having to fight in ongoing appeals to have prescribed medications covered, of finding their current coverage unaffordable and of being denied coverage due to pre-existing conditions.
Other speakers included doctors and other community and organizational leaders, including California Labor Federation head Art Pulaski of San Francisco . The groups also leafleted passers-by, both to urge them to call their Senator, and to find out more about Anthem Blue Cross’ behavior at the re-launched website http://www.sickofbluecross.com/. The San Francisco event even featured a volunteer in a Sick of Blue Cross costume.
The Los Angeles event also featured state Assemblymember Hector De La Torre, highlighting bills now on the Governor’s desk opposed by Anthem Blue Cross of California.. These bills include his AB 2, to protect consumers against rescission, and will put an end to this shameful practice. Anthem Blue Cross was found to have the most number of rescissions, yet they oppose reform, both the pending state bill, but also the federal reform H.R. 3200, which would completely outlaw the practice.
In California, there were also events as Sacramento, San Jose, Santa Ana and San Diego and hundreds more across the country today, fed up customers and advocates for health care reform held protests and declared, “Big Insurance: Sick of It.” Flagship events in Minneapolis , Indianapolis , Philadelphia , Milwaukee , and Hartford drew thousands of protestors to health insurance company headquarters or to events where they could confront health insurance CEOs.
Health Care for America Now (HCAN) is a national grassroots campaign of more than 1100 organizations representing 30 million people dedicated to winning quality, affordable health care we all can count on in 2009. We are doctors, nurses, community organizations, small business owners, faith-based groups, people of color, seniors, and children’s and women’s rights groups. Founded July 8, 2008, HCAN is the nation’s largest health care campaign fighting to win a guarantee of quality, affordable health care for all with the choice of a strong national public health insurance option in 2009.
Governor Schwarzenegger signed AB1422 today, which along with increased premiums, increased copays, and contributions from First Five provide the resources to prevent loss of Healthy Families coverage for over 900,000 children. Anticipating this signature, the Managed Risk Medical Insurance Board has already started processing the nearly 90,000 children that have been left uninsured on a waiting list for the last month or so. We should have never have been in this situation, but this is good news that such a major crisis was averted.
Health Access California joined the 100% Campaign, the community clinics, Western Center on Law and Poverty, and other organizations in supporting AB1422 by Assembly Speaker Karen Bass which creates a gross premium tax on managed care organizations that can be used to draw down federal match to fund Healthy Families. But it was our frequent adversaries, the HMOs and health insurers themselves, that provided essential support for the bill.
We here at Health Access California go head to head with HMOs and insurers day after day, year after year. HMOs and insurers are among our most frequent adversaries and only rarely on the same side with us. So it is a rare day when we give them credit for helping to get something good done. They had their own interest in supporting the measure, but it still was a good thing to do.
Particular credit is due to John Ramey, who now heads the association that represents the local initiatives, California’s home grown public options for Medi-Cal and Healthy Families. John Ramey was one of the first staff at MRMIB when it was created. We know him more recently from his work with the Chamber of Commerce opposing an employer mandate ballot measure in 2004---and in working with Governor Schwarzenegger for health reform in 2006-07. John was committed to avoiding the destruction of the Healthy Families program as a result of the devastating cuts done in the July budget: he revived the notion of reconfiguring the existing provider fee for HMOs into a gross premiums tax that could draw down federal match.
I know the lobbyists who are on staff with the various insurers and HMOs as well as the trade association lobbyists and the very highly paid contract lobbyists from some of the highest billing lobbying firms in Sacramento. I spend a lot of time in the halls of the Capitol with these folks. The lobbying firms included Lang Hansen O’Malley and Miller as well as Sloat Higgins, both firms that bill a million dollars or more a quarter (http://cal-access.sos.ca.gov/Lobbying/Firms) One of these contract lobbyists once accused me of wanting government-run health care because of the modest reforms to label products in our AB786! So the gulf that exists between their world and mine is not just about who their clients are and how much they charge but their perspective on issues.
I watched over the last few weeks as these lobbyists sweated vote by vote to pull out the victory that looks easy from the vote totals but was very much a day by day effort. These lobbyists assured Republican legislators that there was no official opposition, even from many conservative tax groups, and that at the last critical moment, the Chamber of Commerce senior lobbyist came to lobby on our side of the fight. It is the tradition on the corporate side to hire both conservative Republicans and former Democratic staff: it meant that the face of this fight was often a HMO trade association lobbyist who used to lobby for the Chamber of Commerce or a HMO staff lobbyist that is a former Republican staffer well known for his conservatism.
Credit is also due to Sumi Sousa, Speaker Bass’ staff; David Panush, staff to Pro Tem Steinberg and Jennifer Kent in the Governor’s office. The three of them worked in tandem to make this happen. While their bosses get the public credit (after all Bass, Steinberg and Schwarzenegger were elected, not the staff!), the staff does a lot of the day to day, hour by hour work to get things done.
Of course, thanks are also due to the many advocates who supported this effort as well—but for once, we had the easier assignment.
In a year when we have seen such devastating cuts in health and human services, it is good to have averted the worst of the cuts to Healthy Families.
The Senate Finance Committee is starting its public deliberations on health reform today. If you don't have C-SPAN, you can follow some of the action on Twitter, by journalists and bloggers like @jcohntnr, @ktumulty, @NewHealthDialog and @wonkroom.
We at Health Access (@healthaccess) are following it as well, and will RT (re-tweet) posts from these and other observers, as well as add our own observations. Follow us at @healthaccess!
Schwarzenegger also uses video to display a mischievous side. One in particular landed on national news networks – a 27-second spot of Schwarzenegger waving a giant knife in July before telling followers that they gave him great ideas.
The governor intended for the clip to be humorous, as if the camera caught him in the middle of his everyday big-knife-waving routine.
Of course, critics also use Twitter. Social-services advocates took offense as the video came during tense budget talks in which Schwarzenegger sought deep cuts.
Health Access, which represents low-income Californians, wrote: The video adds insult to injury, literally.
Days later, Schwarzenegger told reporters, "You've got to have a little sense of humor. That's me. You sent a governor to Sacramento, not El Stiffo."
If you live in California, you’re probably familiar with WellPoint, the biggest insurer in the nation, and their California subsidiary, Anthem Blue Cross - the biggest insurer in the state.
Chances are, many of you reading this are also aware of how WellPoint/Anthem Blue Cross have implemented an aggressive policy aimed at covering only the healthy and doing everything in their power to avoid covering those deemed a “high-risk,” because of so-called “pre-existing conditions.”
But did you know that WellPoint and its subsidiary have also been engaged in an aggressive campaign effort to derail national health reform? Just last month, it was reported that Anthem Blue Cross sent an e-mail to millions of their subscribers littered with false information and outright lies about the House Health Reform Bill, H.R. 3200.
The people of California are fed up. We’re tired of the big insurance companies spending big money to undermine the real reform we so desperately need. Join us on Tuesday September 22nd in Los Angeles and San Francisco as we stand up to California’s most notorious private insurance company.
Los Angeles: What: “Big Insurance: Sick of It” Rally Where: Anthem Blue Cross, 801 S. Figueroa St., Los Angeles When: Tuesday, September 22, 2009 at 11:00 am
San Francisco Bay Area: What: “Big Insurance: Sick of It” Rally Where: Anthem Blue Cross - 2 Embarcadero Center, San Francisco, CA When: Tuesday, September 22, 2009 at 11:30 am
Why WellPoint and Anthem Blue Cross? Wellpoint is the biggest insurer in the nation. Anthem Blue Cross of California, its subsidiary, is the biggest insurer in California, with 6.8 million customers relying on it for coverage. Starting with a “robo-call” campaign in April, Anthem Blue Cross urged subscribers into action to help defeat health reform. More recently, Wellpoint called subscribers and urged them to write letters to Congress per instructions on its fake “grassroots” website. Wellpoint has 33.5 million subscribers — who likely are unaware its CEO is on the record as favoring “profits over people.” Wellpoint & its Anthem Blue Cross of California are the insurer most aggressively opposed to health reform:
In just the first six months of 2009, Wellpoint spent nearly $3 million lobbying Capitol Hill against health reform, targeting the public option that would give them competition in the marketplace.
Just last month, Anthem Blue Cross sent E-mails to California subscribers with false information attacking H.R.3200, the House version of health reform.
California’s Attorney General is investigating complaints that Anthem Blue Cross violated labor law in telling their employes to play politics by attending town halls as opponents of health reform — and signing sample letters to their Congressmen urging the defeat of health reform.
This is not a new role for them. In 2007, Anthem Blue Cross & Wellpoint were the leading opponent to the health reform push of Governor Schwarzenegger, spending over $2 million on a deceptive ad campaign against the proposal.
In Sacramento, they consistently oppose not just big comprehensive health reforms, but even small, specific, common-sense bills at the state legislature. They oppose bills to: stop insurers from charging women more than men; require labeling of insurance policies so consumers know what they are buying, stop insurers from the unfair practice of yanking coverage of people who get sick, make maternity coverage standard in policies, and place a limit on out-of-pocket costs for customers.
Wellpoint and Anthem Blue Cross aren’t just the leading opposition to health reform; they and their anti-consumer practices are the reason we need health reform so urgently.
They are one of the most aggressive companies in denying people coverage for so-called “pre-existing conditions.”
They had the largest cases of rescissions, where insurers retroactively yank people’s coverage away from them after medical bills come in. In February 2009, California fined Anthem Blue Cross $1 million for yanking coverage of 2,330 customers who submitted medical bills. It took the $1 million fine to get Anthem Blue Cross to actually cover those medical expenses that customers paid for when they bought coverage.
They hike rates without justification. Some 80% of individual policy subscribers in California got premium increases of up to 39% in the past year — just as the recession was tightening its grip on people’s household budgets. In fact, Anthem Blue Cross has decided to target the “individual” policy market aggressively in California because it is the least regulated and offers the highest profits. More than a third — about 3 million — of its policies sold in California are the less-regulated individual policies.
They aggressively engage in “cherry-picking,” an insurance industry practice that markets coverage to young, healthy people and avoids those who may need medical care. They market “skeleton” or “junk insurance” with bare-bones coverage for consumers, leaving consumers with significant debt, even after paying premiums.
Anthem Blue Cross and Wellpoint choose profits over people. Wellpoint CEO Angela Braley told shareholders, “We will not sacrifice profitability for membership.” Braley’s executive salary? Upwards of $10 million annually, plus stock options and benefits.
Wellpoint and Anthem Blue Cross of California needs to stop using our premium dollars to oppose health reform, and to stop the practices that make health reform so necessary in the first place.
But the big health reform event last week was the release of Senator Max Baucus' "Chairman's Mark," which will be the basis by which the Senate Finance Committee will be considering, and amending, in the next week. Within a familiar framework for those following this debate, there are many issues of significant concern.
Paul Krugman has an apt analysis of the issues in his recent New York Times column--that health reform won't have everything health advocates want, but can still be supportable and even a major improvement over the status quo--but the Baucus plan really need to improved in three big ways: 1) the level of subsidies and assistance to low- and moderate-income families to make coverage affordable; 2) the structure and level of assessment on employers who don't provide coverage to their workers; and 3) the inclusion and structure of the public health insurance option.
Ron Brownstein of The Atlantic, who smart about politics and about health care, makes a point about good aspects of the Baucus plan--but even he agrees that it asks too much of low- and moderate-income families and too little of employers, and that it should be fixed in that regard.
The first step is the process of amending the Baucus proposal in Senate Finance Committee. Many of the issues above, and so many more, are touched on by the 564 amendments proposed. This is the debate of the next week or two.
In a hearing today, the Managed Risk Medical Insurance Board agreed to restart enrolling children in Healthy Families coverage tomorrow, September 17th, after making a formal finding that funding is now sufficient to avoid disenrolling children currently enrolled in the program.
While Governor Schwarzenegger has yet to sign AB1422(Bass), the bill that helps bridge the funding gap by drawing down new federal funds, he has committed he will sign it.
As quoted in their press release, Lesley Cummings, Executive Director to the Board, stated, “Today, the Board was able to make a finding that there are sufficient funds at this time to fully cover estimated expenditures in the Healthy Families Program. I am happy to announce there will be no disenrollments and the program will be open to new enrollment beginning tomorrow. Our administrative vendor, Maximus, has already begun processing applications from the waiting list. The Board’s finding was made possible by three key actions: the passage of AB 1422, program changes to cut expenditures, and the generous commitment from the state First Five Commission to provide funding for children ages 0 to 5 in the program. We are extremely grateful for the huge outpouring of support for the Healthy Families Program and the fact that hundreds of thousands of children in California will have access to health care as a result.”
The "program changes to cut expenditures" were additional costs placed on these low-income families, including increases in subscriber premiums and co-payments for health care services that will save the program approximately $17.5 million this year, effective November 1.
In the short amount of time that enrollment was closed, the waiting list grew to 87,000-plus children. It will take Maximus, the administrative vendor, about 30 days to notify families as to whether their children are eligible and have been enrolled in the program. Actual health care coverage once enrolled begins after 10 days.
All supporters of quality, affordable, health care for all have a tough balancing act: being a clear, strong voice for the urgency and necessity of health reform, while at the same time insisting on the provisions and policies to make it workable and meaningful.
Luckily, we have an example of a very good reform proposal to support with H.R.3200, and to a lesser extent, the version of the Senate bill passes by the Kennedy HELP Committee. These are proposals to rally around.
But the proposal coming out of the Senator Baucus' Senate Finance Committee does raise serious concerns. The framework is similar to the other proposals that we support. But the details matter on key issues on affordability, securing employer-based coverage, and the public health insurance option. And some of those details are very concerning.
Here are some issues of importance, some major, some specific. There's a lot of links below, but they are worth your time--it's my best compilation of the current flashpoints regarding the details in the debate:
We have our work cut out for us not just to pass health reform, but to make it a good health reform. The Senate Finance Committee isn't the end of the process, but a step along the way. If this was easy, it would have been done before.
In his first show after a three week vacation, Stephen Colbert interviewed Richard Kirsch, the national campaign director for Health Care for America Now!, the coalition of over 1,000 organizations working for quality, affordable health care for all, this year. Health Access California is proud to be the lead partner organization for HCAN in California.
I've known Richard for over a decade, as he is on leave from being the longtime executive director of Citizen Action of New York, where I got to know him when I was at New Jersey Citizen Action. He has his own humor, but in these situations, his job was to be the straight man, which he did well despite the grilling by Colbert. Colbert's questions were only slightly more ridiculous than some of the allegations thrown out by right-wing media. Enjoy.
Most estimates of the uninsured are for a specific point in time, or over the course of only one year. When just looking at a two-year period, far more people--nearly 1 in 3--find themselves uninsured, as Families USA has calculated using Census data. And for every day they are uncovered--and most of them are uncovered for more than six months--they are likely to not get care and/or face the risk if not the reality of financial ruin. One trip to the emergency room without coverage can mean thousands of dollars of unexpected bills.
For those who say that two years is too long a period to evaluate, please let our Congress know--as they are busy fretting about the ten-year cost of health reform. If we are going to calculate the ten-year cost, we ought to calculate the ten-year benefit, of how many Americans will be prevented from falling into uninsurance, preventing the gaps that are disruptive to both quality care and a family’s financial stability.
President Obama understands this: This weekend, he cited a new Treasury Department report that indicates about half of non-elderly Americans went uninsured for some portion of 1997-2006. With the continuing erosion of coverage without health reform, the number who would benefit by not having such a gap in coverage over the first ten years of health reform is likely well over half the country. That’s not a problem, or a benefit, to minimize.
My post goes on (and on!) to rebut the range of attacks on the number of 46.5 million uninsured that was recently updated by the U.S. Census Bureau last week. It's a bad sign for the debate when we are arguing about basic facts. But it also shows that health reform opponents don't even have a good sense of the actual problem--much less how H.R.3200 and other health reforms will solve it.
Here's a clip from President Obama's speech to over 15,000 in Minnesota, making the case that the benefits of passing health reform will be felt by millions more than just the uninsured, but also those who might experience a gap in coverage over the next many years.
Young adults from 18 to 34 years old make up more than half of the nation’s uninsured population—largely due to the fact that they tend to have lower incomes. For those in their 20s and 30s who do have health insurance, peace of mind isn't necessarily part of the deal.
Recently, public radio’s Terry Gross interviewed two young women who were diagnosed with cancer in their 20s. The “Fresh Air” segment was planned around the theme of healing through humor and the notion of “cancertainment” becoming popular among young patients.
The conversation turned quite serious, though, when Gross asked her guests -- writers Iva Skoch and Kairol Rosenthal -- about their health insurance.
In short, they said, the hurdles and hassles of dealing with health insurance were so overwhelming they had little time or energy to focus on healing. They had to put their thoughts about having cancer, undergoing treatment, and positive healing, on hold while trying to survive their insurance nightmares.
One ended up rejecting care in the U.S. and seeking cancer treatment in another country – one considered far less advanced than the United States. The other had to muster up super-human strength to fight for her coverage.
Here are some condensed snippets of the interview with Skoch and Rosenthal. It’s worth listening to the entire broadcast -- or reading the transcript -- to get a sense of what these young women have gone through. And yes, parts of the interview are funny – the parts after they talk about insurance. Skoch (pictured at right):“I went to the doctor (in New York) and my diagnosis (of colon cancer) was covered. But I’m originally from Prague, which has socialized medicine, and I decided to go and get treatment there, simply because I honestly was not able to deal with all the billing issues.
Just from the first week after being diagnosed, I had a stack of bills about two inches. I constantly dealt with people from insurance companies, trying to figure out what I have to pay, what I don’t have to pay. I was going through this life-changing experience, and it seemed like all I could focus on was these billing issues. So that was ultimately what made me decide to go back to the Czech Republic and get treatment there.
I got great care. It is different than being treated in the U.S., and I think the biggest difference is that it’s a very efficient kind of care. It’s really all business. So I think that was probably the biggest difference, (no) bedside manners.
And I really did not have to wait…because I think everybody felt that I was young, and they needed to push me ahead. So I really did not have to wait any more than I wait when I go to see my doctor in the U.S.
Part of my treatment was taking Avastin, which is a very new drug, and it’s not actually chemo. It’s a bio-based drug that basically starves your tumors from blood supply. In the U.S. a lot of insurance companies don’t want to cover it because it costs tens of thousands of dollars. (In Prague) it was never an issue of cost. I never got a single bill for anything.”
Rosenthal (pictured at right): “I actually had health insurance the day that I was diagnosed (with thyroid cancer). But when I called to get a second opinion, the nurse said, ‘I’m sorry. You don’t have any health insurance.’ And to me, hearing that I had no health insurance was way more startling than even hearing that I had cancer in the first place.
My employer had forgotten to submit my COBRA paperwork… I was leaving a job, and I had filled out all of the paperwork, and I submitted what I needed to submit, but they didn’t submit what they needed to submit. Now, my problem was, because I had been diagnosed with cancer just a week before, I now had a pre-existing condition, so I was not able to go out and obtain my own health insurance.
It was up to me to spend my time on the phone with the COBRA administration and with the privatized company that was administering the COBRA. That’s what I did for the first month after my diagnosis. I was on the phone Monday through Friday, nine to five, haggling with people. And I ended up sort of weasling my way into getting back on to COBRA.
The image that kept coming to mind over and over again is you hear these legends or myths about children who are trapped underneath a car and their moms are just suddenly empowered with this Herculean strength and they’re able to pick up this massive hunk of mental and get their child out from this trapped situation. And I kept thinking, I feel like the child and the mother at the same time and I am just trapped underneath this incredibly complex and suffocating system of health care and I’m trying to save myself, and I have to use my own energy to do it.
I was constantly on the phone, nine to five. I had to present a good case. But it was really exhausting. So when these phones shut down at nighttime, I was a wreck. I mean, I was hysterical. I was crying all of the time. People think that when you are diagnosed with cancer, it’s about healing, taking a bath, lighting candles. I was utterly exhausted, frustrated and completely freaked out that I might die because I don’t have access to health insurance.”
By the time Kairol Rosenthal won her battle with the bureaucrats, her thyroid cancer had spread to 30 lymph nodes. She’s never been in remission. Iva Skoch’s colon cancer is in remission.
In the last hours of the legislative session, literally between 5:30AM and 6AM Saturday September 12, the California Legislature passed AB1383 by Assemblyman Dave Jones which will create a hospital provider fee that will be used to fund children’s coverage and to improve Medi-Cal reimbursement to hospitals (now 51st in the nation). It passed the Senate 24-5 and the Assembly 52-22 as a fee measure. In the Senate, the vote was party-line, in the Assembly a few Republicans voted in support.
Because the Senate Republicans were blockading all two-thirds vote measures on the last day of the legislative session over un-related budget matters, the bill has been amended to eliminate the urgency clause and to go into effect January 1, 2010 so that it no longer required a two-thirds vote. The amendment also eliminated the appropriation that would have funded the work of the Department of Health Care Services in implementing the measure.
The amendments also included some seemingly minor tweaks to the formula or model that were needed to bring it into compliance with federal requirements for the provider fee.
At this moment, we do not know whether the elimination of the urgency clause means half-year money for the fiscal year 2009-10 or full-year money. Provider fees take months to implement in any case.
Whether it is six months worth of better funding for hospitals and children’s coverage or a full year, Health Access is supportive of the measure.
More importantly, we do not know how the Schwarzenegger Administration will respond to the revised measure. So there is work to do to persuade the Governor to sign the bill.
While we wait for the end-of-session, here's a rock video worth watching, which goes through the list of countries that have better health indicators than the United States--and refers to more recent developments in the health reform debate as well.
The city hall featured is right here in California, in Santa Monica.
The video is so up-to-date it even manages to even get a picture of the now-infamous Rep. Joe Wilson. Amusingly, his opponent has raised over $1 million in the 48 hours since the South Carolina Republican's outburst during the President's speech.
At this moment the California Legislature is still in session: one of the bills they are waiting to pass is AB1383 by Assemblymember Dave Jones, which would bring in $2 billion to California’s health care system including $320 million for children’s coverage.
The log jam we wrote about earlier today has been broken: they are waiting for amendments that would adjust the bill so it does not violate the federal requirements for hospital provider fees. We can only hope that the agreement that was reached this evening did not come too late to be enacted in what are literally the last hours of the legislative session for this year.
LATEST UPDATES at www.twitter.com/healthaccess: @healthaccess With other 2/3 bills, AB1383(Jones) to draw down new fed $ for HC fails in Sen as an urgency measure due to lack of R votes. Being sent back to Senate Rules Com. (2:30am))
Health reform was in the air, and the subject of a (8am!) panel on the subject, moderated by Tom David from Tides, and with Crystal Hayling, President & CEO, Blue Shield of California Foundation, and coming from DC, Roger Hickey, Founder & Co-Director, Campaign for America's Future.
At this moment, AB1383 by Assemblymember Dave Jones--which would create a hospital provider fee, part of which would be used for increased Medicaid reimbursements and for children’s coverage--hangs in the balance. Yesterday Governor Schwarzenegger sent a letter saying he will veto the measure because the model used for the development of the hospital provider fee is fatally flawed.
The California Hospital Association proposal for the hospital provider fee appears to violate the requirements of the federal Centers for Medicare and Medicaid Services for provider fees. These requirements are complicated but not particularly mysterious: more than 30 states, including California, have provider fees for nursing homes and more than 20 states have provider fees for hospitals. It is unfortunate that it is just now in the closing hours of the legislative session the problems with the CHA provider fee proposal have been discovered—and that it puts at risk $320 million in possible funding for protecting and expanding children’s coverage, especially in these tough budget times.
Efforts are underway to find amendments that resolve these difficulties but at this moment it is not at all certain what the outcome will be.
Health Access has been supportive of AB1383—because California needs more children’s coverage, not less and because Medi-Cal reimbursement for hospitals is 51st in the country so it needs to be improved as well.
HEALTH ACCESS UPDATE Thursday, September 10th, 2009
ON PENULTIMATE DAY OF SESSION, ASSEMBLY ADOPTS TWO CRUCIAL HEALTH CARE BILLS FIXING INDIVIDUAL INSURANCE MARKET * AB2, Bill to Provide Regulation on Rescissions of Insurance Policies, Passes Assembly * Assembly Also Passes AB98, Adding Maternity Coverage to Individual Policies * US Census Pegs U.S. Uninsured at 46.3 Million; CA’s Uninsured Rate is 18.5%
* More Updates on blog.health-access.org: The Grim New Census numbers; Liveblogging the Big Speech; Obama’s Big Speech; Last Week of Session; Healthier from Health Reform? Again, Affordability is the Key!; The Full Healthy Families Report, with Updated Info; Gov Will Sign, and No Kids Kicked Off…
* Follow Health Access California on Facebook at www.facebook.com/healthaccess and on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget, bills, and federal health reform. Join our Twitter followers!
SACRAMENTO -- Two Assembly bills to ensure fairness and consumer protection for those who buy individual health insurance policies passed the Assembly on Thursday, heading to the Governor’s desk.
AB2 (De La Torre, D) would provide consumer protection for customers who buy individual insurance policies, seek medical attention and then lose their coverage when insurers rescind the policies to avoid paying medical bills.
Specifically, the bill would establish a new procedure for independent review of such policy rescissions. Insurers would not be allowed to rescind coverage without approval from a regulator. Only if it is determined that a customer willfully held back pertinent information about a relevant pre-existing condition would the rescission stand. Assemblyman De La Torre said that insurers should not be allowed to be judge, jury and executioner in such cases, but that an independent review was needed.
The bill would also reform and standardize the questionaire that people fill out when they apply for coverage, another important reform.
The second bill, AB98 (De La Torre, D) adds maternity coverage to mandated health care services that individual policies must cover. Some Republican lawmakers argued against the measure, saying men should not have to share the cost burden to provide coverage for maternity services. However, De La Torre argued that, currently, women share a cost burden of covering standard services such as prostate cancer coverage and medication for men such as Viagra.
Describing his bill as truly representative of family values – and a “civilized California ” – De La Torre estimated that the added expense to ensure that maternity services were included in all individual coverage plans would cost only an added $7 a month for customers.
Both bills passed the Assembly Thursday on concurrance, having already passed the Senate, and so are heading to the Governor's desk.
Other bills of interest to health advocates (listed on the Health Access website) that passed and are heading to the Governor's desk, also supported by Health Access California, include:
* AB119 (Jones, D), prohibiting gender discrimination in pricing premiums differently based on gender. * AB730 (De La Torre, D), would impose fines on insurers unlawfully engaging in post-claims medical underwriting. * AB108 (Hayashi, D), would impose a 24-month time limit in which insurers have the right to rescind, cancel or limit individual health care policies or charge higher premiums because of fraud once a consumer's application is approved. * AB244 (Beall, D) would require most health plans to provide coverage for all diagnosable mental illnesses. * AB196 (Corbett, D) would require public notice of hospital closure or reduction/elimination of emergency medical services. * AB171 (Jones, D) would prohibit dentists' offices from offering high-interest loans to patients while they are under the influence of anesthesia. Would also prohibit dental offices from charging lines of credit before services have been rendered. * AB1142 (Price, D) would require hospitals, as soon as they have proof of a person's Medi-Cal eligibility, to provide all information regarding that person's Medi-Cal eligibility to all other providers. * AB1269 (Brownley, D) would allow, to the extent that federal financial participation is available, workers with disabilities who are otherwise eligible for Medi-Cal but are temporarily unemployed to elect to remain on Medi-Cal for a period of up to 26 weeks. * AB 23 (Jones, D) was signed by the governor on May 12, 2009. The law requires insurers to provide notice to individuals eligible for Cal-COBRA that federal funds are available to assist with Cal-COBRA premiums.
NEW CENSUS FIGURES: Meanwhile, as the Assembly adopted fixes for those policy holders in the individual market, new figures were released Thursday showing that the number of uninsured people in the United States continues to rise.
The U.S. Census Bureau released its latest count of the nation’s uninsured, putting the number at 46.3 million in 2008. California ’s uninsured are pegged at 6.7 million for the same year – a number greater than the entire population of the state of Indiana.
When updated to reflect 2009 figures, the numbers undoubtedly will grow. Since 2008, several million more people have lost their jobs, and their employer-based coverage. Even before the recession, the number of uninsured was on an upward trajectory as insurance costs continued to rise.
Nationwide, the number of people covered by private health insurance declined from 202 million to 201 million between 2007 and 2008. Meanwhile, those covered by government health insurance rose from 83 million to 87.4 million. And the number of people with job-based insurance dropped from 177.4 million to 176.3 million.
The new figures come the day after President Obama’s address to Congress laying out his health care reform proposal. A CNN/Opinion Research Corp. poll reported a 14-point gain nationally in approval ratings for the President’s health care plans -- 67% of those who watched the speech said afterward that they support the President’s health care proposal.
The new Census data shows renewed urgency for health reform for the country, and California. California continues to have one of the worst uninsured rates (18.5%) in the country, and that doesn't take into account the most recent losses concentrated in California due to the recession, high unemployment, and budget cuts. If anything, the Census numbers underestimate the problem, since they only look at people who are uninsured in a given year, rather than a greater amount of time.
Health insurance reform: The first step in health reform
Earlier this year, I participated on a panel at the conference of the California Pan-Ethnic Health Network, where I, as an advocate for health access and coverage, was supposed to "debate" public health advocates, about which is more important. It was a debate that neither side engaged, because we recognized it to be a false choice: both are important.
That said, I tried to make the point that for those interested in actually improving the health of Californians, health insurance reform wasn't a solution but a necessary foundation. Health insurance reform is more about our families' economic health than their medical health. But if we make the societal commitment to universal health care, and make changes to the incentives in the medical system, then suddenly we have a basis to actually build healthier communities and society.
That’s why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry...
We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care.
The American way of eating has become the elephant in the room in the debate over health care... But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America’s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet...
As things stand, the health care industry finds it more profitable to treat chronic diseases than to prevent them. There’s more money in amputating the limbs of diabetics than in counseling them on diet and exercise.
As for the insurers, you would think preventing chronic diseases would be good business, but, at least under the current rules, it’s much better business simply to keep patients at risk for chronic disease out of your pool of customers, whether through lifetime caps on coverage or rules against pre-existing conditions or by figuring out ways to toss patients overboard when they become ill.
But these rules may well be about to change — and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook — and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change.
The moment these new rules take effect, health insurance companies will promptly discover they have a powerful interest in reducing rates of obesity and chronic diseases linked to diet. A patient with Type 2 diabetes incurs additional health care costs of more than $6,600 a year; over a lifetime, that can come to more than $400,000. Insurers will quickly figure out that every case of Type 2 diabetes they can prevent adds $400,000 to their bottom line. Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits.
When health insurers can no longer evade much of the cost of treating the collateral damage of the American diet, the movement to reform the food system — everything from farm policy to food marketing and school lunches — will acquire a powerful and wealthy ally, something it hasn’t really ever had before.
...But what happens when the health insurance industry realizes that our system of farm subsidies makes junk food cheap, and fresh produce dear, and thus contributes to obesity and Type 2 diabetes? It will promptly get involved in the fight over the farm bill — which is to say, the industry will begin buying seats on those agriculture committees and demanding that the next bill be written with the interests of the public health more firmly in mind....
In the same way much of the health insurance industry threw its weight behind the campaign against smoking, we can expect it to support, and perhaps even help pay for, public education efforts like New York City’s bold new ad campaign against drinking soda...
...All of which suggests that passing a health care reform bill, no matter how ambitious, is only the first step in solving our health care crisis. To keep from bankrupting ourselves, we will then have to get to work on improving our health — which means going to work on the American way of eating.
But even if we get a health care bill that does little more than require insurers to cover everyone on the same basis, it could put us on that course.
For it will force the industry, and the government, to take a good hard look at the elephant in the room and galvanize a movement to slim it down.
* The number of people with health insurance increased from 253.4 million in 2007 to 255.1 million in 2008. * The number of people without health insurance coverage rose from 45.7 million in 2007 to 46.3 million in 2008. * Between 2007 and 2008, the number of people covered by private health insurance decreased from 202.0 million to 201.0 million, while the number covered by government health insurance climbed from 83.0 million to 87.4 million. The number covered by employment-based health insurance declined from 177.4 million to 176.3 million. * The number of uninsured children declined from 8.1 million (11.0 percent) in 2007 to 7.3 million (9.9 percent) in 2008. Both the uninsured rate and number of uninsured children are the lowest since 1987, the first year that comparable health insurance data were collected. * Although the uninsured rate for children in poverty declined from 17.6 percent in 2007 to 15.7 percent in 2008, children in poverty were more likely to be uninsured than all children.
California continues to be in the top ten states with the worst uninsurance rates, at 18.5%.
If President Obama's challenge wasn't clear enough, these new Census numbers clearly indicate we need action on health reform. In addition, these new numbers, which show California with one of the worst uninsured rates in the country, doesn't take into account the most recent losses due to the recession, high unemployment, and budget cuts.
Californians are more likely to become uninsured than residents of all but a handful of states. Californians are less likely to get on-the-job benefits, and are more likely to be denied for pre-existing conditions. The current health reform proposals would fix these problems. If anything, the Census numbers underestimate the problem, since they only look at people who are uninsured in a given year. But we all are one life change--whether a job switch, divorce, graduation, or retirement--away from losing coverage. Those with coverage need security and stability that don't have now to keep their coverage, and those uninsured need more affordable and accesible options--and that's what the current proposals seek to do.
"We have to stop the vicious cycle. When costs go up, more people become uninsured. The more people who are uninsured, the harder it is for our health care system to control costs. We need our elected officials to muster the political will to make health reform happen.
Sacbee.com held a liveblog regarding the President's health reform speech. Here are excerpts by myself and my fellow panelists: Dr. Michael Wilkes, director of global health at the University of California, Davis, who also writes a weekly column for The Bee; and Marjorie Ginsburg, executive director of the Center for Healthcare Decisions in Sacramento. It hopefully has some real-time insights into the speech...
4:59 Linda Gonzales/sacbee.com: Thanks to Anthony and Marge for joining us. Would you two share a little information about your organizations as we get started? 5:00 Marge Ginsburg, Center for Healthcare Decisions: Center for Helathcare Decisions is a non-profit, non-partisan organization that seeks the public's voice in complex healthcare issues. We often focus on areas where there are no easy answers! 5:02 AnthonyWright: Health Access California is the statewide health care consumer advocacy coalition, working for the goal of quality, affordable health care for all. Our website is www.health-access.org. For more info on health reform, visit our daily blog at blog.health-access.org, or follow us on Facebook or Twitter, at @healthaccess. 5:04 AnthonyWright: It's poignant to see Hillary Clinton coming in as a Cabinet Secretary, given her past effort at health reform 5:07 [Comment From Tyler] My child turns 1 soon and will not be eligible for mediCal due to my income. I also was recently married and my new wife is not covered. I have insurance options through my work, but it is not affordable for me to add two dependants to my health coverage at this time. Do I have any options currently besides paying more than I can afford? 5:11 AnthonyWright: Tyler: There are very limited options now. The point of health reform is to increase those options, by expanding coverage at work, through Medicaid and other safety-net programs, and to provided subsidies and help if you have to buy coverage as an individual. 5:12 [Comment From maria] Why are people so afraid of the public option? I understand people are afraid it would eliminate the private insurance companies but if they are so great why would people ditch them? I seem to hear people complaining that they would want to keep their current insurance isn't that the meaning of the "option" part of the public option. I just don't understand the fear behind the public option. If they are afraid of reduced quality of care I would love to tell them my mom has medicare and I buy into a high deductible health plan for myself and my mom has it so much better than me. 5:12 AnthonyWright: Tyler: If you need care or coverage, we have some resources at a nonprofit website we run, at www.hospitalbillhelp.org to help people with big hospital bills, or those who seek care but are uninsured or underinsured. 5:14 [Comment From Tyler] Thanks, Anthony. 5:14 Marge Ginsburg: I think there is unwarranted but pervasive fear of 'big government'...I think it will take a long time for many people to recognize the role the govdrnment has in healthcare today. 5:15 AnthonyWright: Maria: The public health insurance option typically gets 60-75% approval ratings. It's a very American concept to have a public option, whether in our university system, our television stations, our mail delivery, or in other parts of American life. 5:16 AnthonyWright: Here we go... 5:17 [Comment From maria] well that is good to hear! I often keep hearing people against the idea I never knew the approval rating for it was so high. Thanks so much! 5:18 Dr. Michael Wilkes: Good evening everyone. Dr. Wilkes here! 5:19 [Comment From lite_speed] To date, I have experienced the healthcare systems in 3 countries where I have lived and worked for extended periods. The US, by far, is the most expensive. People here fear a govt bureaucrat will somehow make healthcare decisions for them. I am more afraid of an insurance company bureaucrat making that decision and being incented financially to deny coverage. 5:20 AnthonyWright: Actually, he's not going to end the health reform conversation. Even if we pass major health reform, we will need to continue to need to adapt and move forward. But we need to get started. The conversation won't end with the passsage of a bill. 5:22 AnthonyWright: The key point: *It can happen to anyone* 5:23 Marge Ginsburg: It's good to see the Pres. return to why we are tying to tackle this problem in the first place! 5:23 AnthonyWright: Thank you, lite_speed. I think President Obama is making your point about the concern with the current system, including with the current insurance market. 5:26 AnthonyWright: It's not just a slogan: The status quo isn't an option. It's deteriorating. 5:29 AnthonyWright: Minimize disruption, but reform. As @consumersunion is livetweeting: Obama: #healthreform = Build on what works, and fix what doesn't. 5:30 AnthonyWright: Obama is now going through the consumer protections in the bill. When Gov. Schwarzenegger tried health reform in 2007, stopping the denial of pre-existing conditions was his most consistent applause line. It's working for Obama as well. 5:31 Dr. Michael Wilkes: This concept of pre-exisiting condition is crucial as it unfair and will resonate with all Americans. 5:31 AnthonyWright: The protections against "junk" insurance, capping out-of-pocket costs, is huge. "No one should go broke because they get sick."--880,000 Facebook users made that their FB status on last Thursday. 5:33 AnthonyWright: Californians are more likely to be uninsured than residents of all but three other states. That's why it is so critical for our state. 5:33 Dr. Michael Wilkes: Quality is key. Transportability is crucial. Empowerment of the consumer is crucial. Choice is key. 5:34 AnthonyWright: NEW IDEA: low-cost coverage for those denied for pre-existing conditions during the transition 5:34 Marge Ginsburg: These are definitely the messages that people are looking for! 5:35 Dr. Michael Wilkes: Key to see him try to tie this to Republicans! There is credit all around and it is key to let America see this problem is recognized by all. 5:35 AnthonyWright: California's high-risk pool for those denied with pre-existing conditions now has a waiting list. It's very sad. 5:36 AnthonyWright: Laughter at the details "to be ironed out." 5:37 Marge Ginsburg: People hate mandates...but they also hate irresponsible behavior. It's a real balance. 5:41 AnthonyWright: Obama references Wendell Potter. Insurers are rewarded for denying coverage. 5:41 AnthonyWright: I don't want to put them out of business. I want to hold them accountable. 5:42 Dr. Michael Wilkes: Cherry picking is a concept that is essential understand. It implies that insurance companies choose healthy, young people wo are less likely to get sick. It also implies the similar but opposite concept of "dumping". Dumping is the process of trying to get rid of those most like to cost money (elderly, pre-existing conditions, etc.) 5:42 AnthonyWright: Obama defends the public insurance option, says what it is and what it won't be. 5:45 AnthonyWright: Did a member of Congress really yell out "liar" to the President? We've lost some decorum here... 5:46 Dr. Michael Wilkes: Yes, this issue has become very divisive. 5:46 Marge Ginsburg: Providing a choice: magic words! 5:46 Dr. Michael Wilkes: Appealing to fiscal conservatives... 5:47 AnthonyWright: New Idea: Promises spending cuts if the savings aren't realized. (And let's be clear, a lot of the preventative savings aren't being scored) 5:47 Dr. Michael Wilkes: Wow... The President is also stepping into it with digs against the Bush administration. In my opinion, not a wise step. 5:47 AnthonyWright: Obama talks directly to seniors. 5:48 brogonzo:#hc09 Obama is reaching across the aisle to offer olive branches to some, and blacken the eyes of the irresponsible 5:50 AnthonyWright: Just saw CA Sac-area Congressman Tom McClintock not applauding 5:50 AnthonyWright: Obama: I will protect Medicare. 5:52 AnthonyWright: New Idea: Embraces fee on certain insurance policies that is in the Baucus plan 5:52 AnthonyWright: New idea: Obama embraces medical malpractice reform, gets standing O from both sides. Not a "silver bullet." Patient safety first. 5:53 Dr. Michael Wilkes: Malpractice is absolutely essential to improve quality, but it needs to be kept in check to avoid this defensive medicine. 5:53 amorporchoco: Liking the trend towards the center - not sure how the finances balance out, but I do know something needs to change. #hc09 5:53 AnthonyWright: Obama: move forward on malpractice proposals by Bush Admin 5:54 AnthonyWright: $900 million cost: My concern is that it won't provide the help that people need to actually make coverage affordable. 5:54 elleabis:#hc09 malpractice reform is necessary also 5:54 thanasipetridis: He’s making a lot of people happy so far... #hc09 5:55 Dr. Michael Wilkes: elleabis: Reform needs to happen, but MP can't be eliminated as it is an important check on the system. Sure it also has incentives that drive to higher costs and those need to be addressed. 5:56 AnthonyWright: I am also tweeting at @healthaccess. 5:56 AnthonyWright: Important tribute to Ted Kennedy. Panning to Vicky Kennedy, sons. 5:58 AnthonyWright: He's right: this is more than health care. It's about the character of our country. That's why the debate. 5:58 AnthonyWright: Wow. He is going right to the core of the issue. 5:59 Marge Ginsburg: People really do believe that the character of our country is at stake -- it's a message we need to remind them sometimes! 6:00 AnthonyWright: What does it mean to be an American? He is recognizing that the debate is really not about health policy... 6:01 AnthonyWright: "Govt cannot and should not solve every problem... the danger of too much govt is matched by the perils of too little. " 6:02 AnthonyWright: This is Professor Obama, talking to us like adults. 6:03 Marge Ginsburg: And this is what he is particualry skilled at. 6:03 AnthonyWright: "We did not come to fear the future. We came here to shape it." 6:04 Linda Gonzales/sacbee.com: The president's speech has concluded. What did you think? 6:04 AnthonyWright: He didn't go for obvious pandering... 6:05 Dr. Michael Wilkes: Did he succeed in laying out an effective blueprint? Do you now know what his plan will entail? 6:05 Marge Ginsburg: I think he hit a home run...this is an emotional issue, not just a political one. 6:06 AnthonyWright: About five new details, and clarifications about what the President supports. 6:06 Dr. Michael Wilkes: I like the high risk pool, insurance company fees, individual mandate, public option... but the devil is still in the details. Of course he missed a few important areas, although they may opted for simplicity. 6:06 AnthonyWright: He didn't disavow the left, but he focused on the middle, 6:07 Marge Ginsburg: He had no choice but to focus on the middle...that's where most people are. 6:08 Linda Gonzales/sacbee.com: Can anyone speak to the cost of health care under reform plans? 6:08 Linda Gonzales/sacbee.com: The Republican response being televised now is keying on the price of health care, saying costs will rise. 6:08 AnthonyWright: The Republican response is just using talking points that have little reference to the actual bill... 6:10 AnthonyWright: Costs are $900 billion, paid for by savings from the system, employer & individuyal premiums, etc... 6:10 AnthonyWright: The idea to buy insurance across state lines is just a way to eviscerate state consumer protections. If an insurer denied you care, do you want to go to the Delware or Alabama Dept of Insurance? 6:12 [Comment From lite_speed] In a single payer system you would not be denied care. i am surprised that Americans are not embracing that single point. 6:12 AnthonyWright: The R response wasn't truthful. Wouldn't improve the Medicare program? I think seniors in the "donut hole" who have trouble buying Rx drugs would disagree. 6:13 AnthonyWright: KCRA-Sacramento is running a "Prescription for Change" special. I'll be commenting later in the hour. 6:14 AnthonyWright: The President made key points how people would benefit. People get coverage through 1 of 3 ways: through employers, safety-net programs, and buying it as individuals. 6:14 Linda Gonzales/sacbee.com: Dr. Wilkes, along with Shannon Brownlee of the New America Foundation, wrote a column for today's Bee. You can read it here: http://www.sacbee.com/opinion/story/2168499.html 6:14 Dr. Michael Wilkes: In closing the President could have mentioned more about the system being badly broken (besides malpractice). The system isn’t honest with patients, it doesn’t allow doctors or patients the information they need to make choices, it pushes for more treatment instead of better care, it allows pharmaceutical companies to push drugs and advertise treatments for diseases that don’t exist or that aren’t effective treatments. It is all about incentives pushing the system in the wrong direction. We need to re-align incentives for hospitals, doctors, pharmaceutical companies and consumers... 6:15 AnthonyWright: For those with employer-based coverage, it provides stability and security, setting some minimum standards--much like the minimum wage for pay. It would also provide help to small biz. 6:16 Marge Ginsburg: I suspect if he talked too much about improving how healthcare is delivered, it might worry people about gov't intrusion into the doctor-pt. relationship. 6:16 AnthonyWright: For those with Medicaid & Medicare, it would improve & expand coverage: fill the donut hole, increase reimbursement rates, etc. 6:18 AnthonyWright: For those who buy coverage as individual, it would provide new consumer protections, subsidies, and an exchange to buy coverage, including a public health insurance option. 6:18 Linda Gonzales/sacbee.com: Thank you again to our three panelists: Dr. Michael Wilkes, director of global health at the University of California, Davis. Dr. Wilkes also writes a weekly column for The Bee. Marjorie Ginsburg, executive director of the Center for Healthcare Decisions in Sacramento. Anthony Wright, executive director of Health Access California in Sacramento.
President Obama is about to give his speech. I will be liveblogging at www.sacbee.com, and commenting afterwards at KCRA 3 Sacramento. Here are excerpts:
I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.
Our collective failure to meet this challenge - year after year, decade after decade - has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can't get insurance on the job. Others are self-employed, and can't afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.
During that time, we have seen Washington at its best and its worst.
We have seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors' groups and even drug companies - many of whom opposed reform in the past. And there is agreement in this chamber on about eighty percent of what needs to be done, putting us closer to the goal of reform than we have ever been.
But what we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and counter-charges, confusion has reigned.
Well the time for bickering is over. The time for games has passed. Now is the season for action.
Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.
The plan I'm announcing tonight would meet three basic goals:
It will provide more security and stability to those who have health insurance. It will provide insurance to those who don't. And it will slow the growth of health care costs for our families, our businesses, and our government. It's a plan that asks everyone to take responsibility for meeting this challenge - not just government and insurance companies, but employers and individuals.
And it's a plan that incorporates ideas from Senators and Congressmen; from Democrats and Republicans - and yes, from some of my opponents in both the primary and general election.
Here are the details that every American needs to know about this plan:
First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.
What this plan will do is to make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies - because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.
That's what Americans who have health insurance can expect from this plan - more security and stability.
Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange - a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It's how everyone in this Congress gets affordable insurance. And it's time to give every American the same opportunity that we've given ourselves.
This is the plan I'm proposing. It's a plan that incorporates ideas from many of the people in this room tonight - Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.
But know this: I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what's in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.
Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.
That is why we cannot fail. Because there are too many Americans counting on us to succeed - the ones who suffer silently, and the ones who shared their stories with us at town hall meetings, in emails, and in letters.
It's the last week of the legislative year, so there's a mad rush to pass bills before the deadline Friday to send bills to the Governor's desk.
Especially because of the tough budget situation, a number of key health reform bills have been held at various point in the process. For example, AB 1521(Jones), to place limits on how health insurance brokers are compensated by insurers, was held in Senate Appropriations Committee. Another Health Access bill, AB 786(Jones), to better label the individual insurance market and put limits on on-out-pocket costs, is being held on the Senate floor to see what happens with federal health reform. These bills are still alive: as this is the first year of a two-year session, they will be available to move in a few months, as early as January 2010
There are health bills moving. For example, AB 119 (Jones), to prohibit insurers from charging different premium rates based on gender, has already passed both houses of the legislature and is on its way to the Governor. (No word on whether the Governor will sign the bill.)
Of these bills that seek to provide additional oversight on the insurance industry, AB 2 (De La Torre) may be the most contentious in this final week, with consumer groups like Health Access California in support, and the insurance industry in opposition. The bill would create an independent review process when an insurer wishes to rescind a consumer's health policy, create new standards and requirements for medical underwriting, and requires state review before plan approval. It also sets the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his or her health history.
This is not as obvious an answer as you might think. Frankly, health reform is more about improving our economic health, rather than their personal health. Health care and coverage often comes after people are sick... it ensures that people get care but also that they don't fall into medical debt or bankruptcy for seeking such care. The focus of H.R.3200 and other health reform proposals is to provide economic security to families.
That said, the Wall Street Journal Health Blog had a revealing post a few weeks ago that does give a few concrete examples of how these health reforms can actually help our health. They interviewed John Auerbach, the commissioner of Massachusetts’s Department of Public Health. He gave a few indicators he's watching.
In particular, he cites three pieces of data as short-term indicators:
1) Smoking rates: In the first year of the effort that started in 2006 to get all residents insured, there was a surge in people covered by Medicaid, which pays for smoking cessation patches and counseling. Some 11% of smokers on Medicaid choose to take advantage of cessation tools that year. In 2007, Massachusetts saw an 8% drop in adult smokers, its largest dip in 10 years. In addition to having the patches paid for, Auerbach believes that a number of recently insured adults received a physical in that year and discussed smoking cessation with their docs.
2) Colonoscopies: There was a statistically significant increase in age-appropriate colonscopies in the state. “If you’re uninsured, you’re not going to get a colonscopy,” Auerbach said.
3) Flu vaccines: The percentage of adults who received a flu vaccine increased above and beyond the increases the state had been seeing in recent years. The largest percentage of vaccines are given in private doctors’ offices, so it makes sense that if more people are going to their primary care docs, the more likely they would be to receive a flu shot, according to Auerbach.
I have a sense there are many more health benefits to health reform--on top of the economic benefits--especially as time goes on. (And the two are intertwined--in people have less economic anxiety, and are not driven into poverty because of medical costs, that will have health benefits as well.) But those are good initial indicators about why this effort is so important.
While there's been a lot of concern in federal health reform about the public health insurance option, I am more concerned with the possible scaling back of affordability subsidies. Partially because of concern for the size of the number, and partially because some don't want to have to raise the needed revenues, there is talk in the Senate and even in the White House about to make the bill cost less, from about $1 trillion over 10 years to about $700 million.
The cost of the bill is for the subsidies and assistance to low- and moderate-income families to afford health coverage. Do they do enough? Former LA Times Sacramento reporter Jordan Rau at Kaiser Health News reports on this issue with some real examples, no doubt informed by his experience reporting on the California attempt at health reform in 2007-8, as that was the core issue here: what is affordable?
However appealing it sounds, scaling the cost of the bill back is to make low- and moderate-income families pay more in premiums and/or out-of-pocket costs, or get less in terms of benefits. For many, it will still be an improvement over the current status quo, where people struggle to makes ends meet, or simply go uninsured and fully exposed to medical debt and bankruptcy. But as Ezra Klein at the Washington Post indicates, if the bill is scaled back too much, the reform collapses.
Affordability was the issue in *the* key issue in the California debate, it is *the* issue now.
The full Healthy Families report, with updated info...
Here's our full treatment on AB1422 and Healthy Families. We previously reported a preliminary tally. The official tally is 62-5, with the following Republicans in support: Berryhill, Berryhill, Conway, Emmerson, Fletcher, Fuller, Gaines, Garrick, Gilmore, Nestande, Niello, Neilsen, and Villines.
HEALTH ACCESS ALERT Thursday, September 3rd, 2009
ASSEMBLY ADOPTS DEAL TO KEEP HEALTHY FAMILIES GOING * Bi-Partisan Backing of AB1422 (Bass) Leads to a 62-5 Vote For New Tax * Governor Vows to Sign Bill, Pleased No General Funds Involved * AB119 (Jones) Passes, Banning Gender Bias in Health Insurance Pricing
More Updates on the Health Access Blog: Gov will sign, and no kids kicked off, but many cuts continue: Healthy Families: a resurrection; By any legislative means necessary; Public options all over the place; Seeing what the candidates do; Rallies this week for health reform!; New data on debt shows need for action; Get well soon, Rick!; Blue Cross is at it again; Video blogging by Biden; Change the channel and the health reform debate
Follow Health Access on Twitter, at @healthaccess, or www.twitter.com/healthaccess for quick updates on budget and health reform issues. Followers were among the first to find out about key bill passage in the Legislature yesterday and big HCAN rally in LA!
SACRAMENTO -- In what one assemblyman called “our finest moment,” the Assembly on Thursday overcame its partisan differences long enough to pass a bill allowing 600,000 California children to keep their low-cost Healthy Families insurance coverage.
Healthy Families seemed destined for the chopping block before a bi-partisan, two-thirds Assembly majority rescued the program by voting 58-0 for a new tax that everyone -- even those being taxed -- agreed was worth bridging the ideological gulf.
Children’s advocates working to ensure continued coverage for kids in Healthy Families were relieved Thursday at the reprieve negotiated in the Legislature. “The parents of the nearly 1 million children enrolled in the program can sleep better tonight knowing that their kids will have health coverage as the school year starts,” said Children Now’s Tim Morrison.
The legislation likely will reverse a decision by the state’s Managed Risk Medical Insurance Board to begin disenrolling children from the program in a matter of weeks. MRMIB members already voted to begin disenrollment, citing “insufficient funding” but also indicated they were holding out hope for an eleventh-hour funding solution. Now, the board appears to be well-positioned to reverse that vote.
In the Assembly on Thursday, a number of Republicans stood to deliver a series of dramatic, last-minute tributes to AB 1422, (Bass-D), throwing their support behind the measure estimated to generate $97 million. They spoke passionately of the need to preserve the Healthy Families program, the struggles with poverty they see in their districts and the need to provide health care to children vulnerable to the swine flu, already making its rounds through California schools.
The result was surprising, breaking up the partisan iceberg that successfully froze out several proposed budget solutions in the Legislature in the past year. In the Senate, the measure had passed 27-8 on Wednesday, with somewhat less bi-partisan backing. After the vote, Speaker Karen Bass (D), declared, “This is a memorable day when we can cross party lines and stand up for 600,000 California children” who were at risk of being kicked off the program.
Bass also told lawmakers that California’s Taxpayer Association, traditionally an opponent of tax increases, saw enough merit in the deal to take a neutral stance on AB1422, and the California Chamber of Commerce supported the bill.
Gov. Arnold Schwarzenegger, whose severe budget cuts contributed to a $194 million shortfall in the Healthy Families program, said he would sign the bill.
At least three key factors in the AB 1422 deal were instrumental in attracting Republican support: First, the new 2.35 percent tax that AB 1422 imposes is a reduction from the expiring 5.5 percent fee that health plans contracted by the state to manage Medi-Cal and Healthy Families coverage were previously paying. Second: The health plans did not object to paying the new tax, if it drew down federal funding that went back to them to keep Healthy Families going. Third: Families enrolling in the program will share some of the cost burden, allowing a good fit with the Republican tenet of personal responsibility.
Democratic Assemblyman Charles Calderon (D) called the AB1422 proposal “a win-win. They (health plans) get a lower tax and they get the money back in the form of increases or higher payments.” Of the bi-partisanship exhibited by Assembly members, Calderon said, “This is one of our finest hours, if not our finest hour yet.”
Families will be charged nominally higher fees for premiums, ranging from $4 to $7 per child, with very low-income families exempt from the increase. Other cost-sharing will include co-pay increases from $5 to $15 for emergency room visits that do not result in hospitalization and co-pay increases from $5 to $10 for non-preventative health, dental and vision services. In addition, children’s options in choosing dental service providers will be limited.
Still, the increased costs for families are the lesser of several, more expensive options considered by the MRMIB staff. In the final analysis, staff embraced the more moderate proposals, hoping to spare families whose budgets already are stretched more financial pain than necessary.
“This is a high-quality program,” Assemblyman Roger Niello (R) said of Healthy Families, California ’s version of the national children’s insurance program known as SCHIP. “The tax is supported by the industry. I think we can all agree this is a good thing.” Assemblyman Michael Villines (R) noted that the tax is a temporary fix-it, in place until 2010, to keep Healthy Families in operation, and it ends when enhanced federal funds are no longer available.
Part of the purpose of the funds generated by the tax is to secure the increased federal matching funds announced by President Obama last spring -- $2 for every $1 the state spends on Healthy Families.
Republican Assemblyman Danny Gilmore said he had hoped the floor vote would be 80-0 (which would have required participation by all Republicans). “By golly, this is an opportunity where we can come together for the children of our state,” Gilmore said, citing a 40 percent jobless rate in agricultural parts of his district that have been hit severely by drought. “Get over to my district and look at some of those people standing in line waiting for food.”
With passage of AB1422, and the governor’s signature, MRMIB is spared from having to drastically scale back the program -- for this year at least. The children’s health insurance program also is benefiting from a generous boost by the First Five Commission, which committed $81.4 million to cover 200,000 of the kids in Healthy Families, aged 0-5 for one year.
Meanwhile, the demand for Healthy Families coverage has never been higher, with the economic downturn lingering throughout California , and more than 70,000 families placing their children’s names on a waiting list for enrollment. On average, about 3,000 children per work day have been added to the list since MRMIB started taking names instead of enrolling more children in the health insurance program.
Also passing the Legislature on Thursday was AB119 by Assembly Health Committee Chair Dave Jones (D), which prohibits gender discrimination in pricing health care insurance.
Gov will sign, and no kids kicked off, but many cuts continue...
Thursday, September 03, 2009
With the passage of AB1422(Bass) that draws down new federal funds to help prevent children from being disenrolled from health care coverage, consumer, children's, and health advocates breathed a sign of relief.
Governor Arnold Schwarzenegger has committed to sign the bill that was passed today, and so hopefully MRMIB will start enrolling the 70,000+ children on their waiting list as soon as possible. The Governor issued the following statement after the legislature passed AB 1422 by Assembly Speaker Karen Bass (D-Los Angeles):
“The passage of this bipartisan legislation is a great victory for California’s kids. I am very pleased that all parties came together including the legislature, the health plan industry, children’s health advocates, the First Five Commission and others to find a shared solution to fund this important program that ensures not one child will lose their health care coverage - without any new General Fund dollars. Everyone was forced to make very difficult but necessary decisions to balance our budget, and these are the kinds of solutions we should be looking for in this tough economy. I look forward to signing this bill for our kids.”
The good news is that we have averted a massive health and humanitarian crisis, kicking hundreds of thousands of children off coverage. We shouldn't have been facing such an ugly scenario in the first place. And let's remember that while we've prevented the anxiety of families losing coverage for their kids, those lower-income, working families are now facing increased--even doubled--premiums.
The bad news is that other major cuts will continue. This was a unique opportunity to prevent this specific cut: the calvary isn't coming to prevent the devastating impact of other health cuts, from the elimination of dental and other benefits for three million Californians, or the zeroing out of state funding for community clinics. There is no such savior for millions of other of Californians facing such cuts.
In what one assemblyman called “our finest moment,” the Assembly on Thursday overcame its partisan differences long enough to pass a bill allowing 600,000 California children to keep their low-cost Healthy Families insurance coverage.
Healthy Families seemed destined for the chopping block before a bi-partisan, two-thirds Assembly majority rescued the program by voting 58-0 for a new tax that everyone -- even those being taxed -- agreed was worth bridging the ideological gulf.
Children’s advocates were relieved at the reprieve that was negotiated for Healthy Families.
"The parents of the nearly 1 million children enrolled in the program can sleep better tonight knowing that their kids will have health coverage as the school year starts," said Children Now's Tim Morrison.
A number of Republicans stood up on the Assembly floor to deliver a series of dramatic, last-minute statements of support for AB 1422 (Bass-D), throwing their backing to the measure estimated to generate $97 million.
They spoke passionately of the need to preserve the Healthy Families program, the struggles with poverty they see in their districts and the need to provide health care to children vulnerable to the swine flu, already making its rounds through California schools.
The result was surprising, breaking up the partisan iceberg that froze out several proposed budget solutions in the Legislature in the past year. Not a single Republican voted against the measure (although many declined to cast a vote). In the Senate, the measure had passed 27-8 on Wednesday, with somewhat less bi-partisan backing.
After the vote, Speaker Karen Bass (D), declared, “This is a memorable day when we can cross party lines in California and preserve health care for 600,000 children statewide.”
Gov. Arnold Schwarzenegger, whose severe budget cuts contributed to a $194 million shortfall in the Healthy Families program, reportedly said he looked forward to signing the bill.
Three key factors in the AB 1422 deal were instrumental in attracting Republican support:
First, the new 2.35 percent tax that AB 1422 imposes is but half the 5.5 percent fee that health plans contracted by the state to manage Medi-Cal and Healthy Families coverage were previously paying. Second: The health plans did not object to paying the new tax, if it drew down federal funding that went back to them to keep Healthy Families going. Third: A component of the deal was that low to middle-income families enrolling in Healthy Families share some of the cost burden, allowing a good fit with the Republican tenet of personal responsibility.
Families will be charged higher fees for premiums, ranging from $4 to $7 per child, with the lowest-income families exempt from the increase. And, they will pay $5 to $15 dollars more for medical services.
“This is a high-quality program,” Assemblyman Roger Niello (R) said of Healthy Families, California’s version of the national children’s insurance program known as SCHIP. “The tax is supported by the industry. I think we can all agree this is a good thing.”
Assemblyman Michael Villines (R) noted that the tax is a temporary fix-it, in place until 2010, to keep Healthy Families in operation, and it ends when enhanced federal funds are no longer available.
Part of the purpose of the funds generated by the tax is to secure the increased federal matching funds announced by President Obama last spring -- $2 for every $1 the state spends on Healthy Families .
Republican Assemblyman Danny Gilmore said he hoped the floor vote would be 80-0 (which would have required participation by all Republicans).
“By golly, this is an opportunity where we can come together for the children of our state,” Gilmore said, citing a 40 percent jobless rate in agricultural parts of his district that have been hit severely by drought. “Get over to my district and look at some of those people standing in line waiting for food.”
With passage of AB1422, and the governor’s signature, the state’s Managed Risk Medical Insurance Board plan to disenroll children from Healthy Families coverage now appears moot – for this year at least.
The children’s health insurance program also is benefiting from a generous boost by the First Five Commission, which committed $81.4 million to cover 200,000 of the kids in Healthy Families, aged 0-5 for one year.
Meanwhile, the demand for Healthy Families coverage has never been higher, with the economic downturn lingering throughout California, and more than 70,000 families placing their children’s names on a waiting list for enrollment.
If the Democrats want to enact health care reform this year, they appear to have little choice but to adopt a high-risk, go-it-alone, majority-rules strategy....
Superficially seductive calls to scale down the effort until the recession ends or to take time for further deliberations should be ignored. There has been more than enough debate and the recession will almost certainly be over before the major features of reform kick in several years from now. Those who fear that a trillion-dollar reform will add to the nation’s deficit burden should remember that these changes are intended to be deficit-neutral over the next decade.
Delay would be foolish politically. The Democrats have substantial majorities in the House and the Senate this year. Next year, as the midterm elections approach, it will be even harder for legislators to take controversial stands. After the elections, if history is any guide, the Democratic majorities could be smaller....
Mr. Obama should know from sad experience the pitfalls of seeking bipartisan cooperation from a Republican Party that has sloughed off most of its moderates and is dominated by its right wing...
The Democrats are thus well advised to start preparing to use an arcane parliamentary tactic known as “budget reconciliation” that would let them sidestep a Republican filibuster and approve reform proposals by a simple majority.
For those of us in California, this seems like deja vu.
As I wrote in The New Republic's The Treatment this weekend, health reform advocates here in California, as well as in those in Massachusetts, also had to find a way around the political obstacles of supermajority legislative requirements and Republican obstructionism:
Congressional leaders may, according to various reports, split reform into two bills. One would go through the reconciliation process, which is reserved for budget-related items and in which a simple majority can pass legislation, without threat of a filibuster. The rest of the package would go through the standard process, in which legislation effectively needs a supermajority of 60 votes, since that's what it takes to break a filibuster.
It may sound unusual, but such a strategy has been tried before in similar circumstances: Both California and Massachusetts leaders had to resort to similar parliamentary gambits in their health reform discussions, in both cases to overcome intractable Republican opposition to core portions of their agenda.
California is the only state in the country that has the uniquely high requirement that in order to pass a budget or taxes, you need a two-thirds supermajority of the legislature. The Republican minority in the legislature thus have the power to block anything budget-related (which many analysts appropriately blame for our current fiscal woes). Governor Schwarzenegger wanted support from fellow Republicans, but after waiting into September and getting nowhere (sound familiar?), he and Democratic Assembly Speaker Nunez finally devised a way around the obstruction from Republicans. They split the bill in two, with the intent to pass one part by majority-vote in the legislature, but have the second part with the budget-related financing items bypass the legislature altogether and go on the ballot. Unfortunately, health reformers ran out of time to make a deal in the legislature while also meeting the signature-collecting deadlines to make the ballot for the November 2008 election.
What I take away from this is that in order to something of the magnitude of health reform, you need to put all options on the table: splitting the bill in two, reconciliation, and going it alone when the other party decides it's in their best interests to oppose anything at all. Senate Majority Leader Harry Reid said that he hopes to do health reform "by any legislative means necessary."
That's good to hear. Americans will judge this President and this Congress by what happens to their health care: not by the mischaracterizations of the health reform proposal which will never come to pass because they are not true, and not by the process by which a plan passes. The judgement will be if they continue to feel insecure about losing their health coverage due to the lack of action, or if consumers see the benefit of health reform, and see that meaningful and positive change is possible.
Those who support universal single-payer health care point to Medicare as a model, which is provided to those over 65, paid for by a payroll tax. Another analogy of a completely tax-funded service is the fire department or the military--and there is a case to be made that health care is as essential, and there are particularly efficiencies and policy reasons, for funding a universal health coverage through taxes.
But for many political reasons, most particularly that some people are protective of the coverage they have, that's not the emphasis of the health reform policy discussion. The reform would mostly secure and stabilize the coverage that people have through work, and would improve and expand the coverage that others get through Medicaid and Medicare. For those who have to buy as individuals, it would provide new consumer protections, affordability subsidies, and new options--including a public health insurance option.
This "public option" has gotten a disproportionate amount of attention, and it's hard to figure out why. After all, there are many analagous "public options" throughout American life.
In a TV interview last weekend, I was asked if allowing health care consumers the choice of a public health insurance option would overwhelm other private insurers and lead to a “government takeover” of health care. In HR3200 and other plans under consideration, the public health insurance option would be one choice in a new health insurance exchange, competing against many private health plans. Insurers should be worried only if they believe that they cannot be competitive--but there's lots of evidence that public and private options can live side-by-side:
* Postal service: President Obama made the comparison that the public plan is similar to the post office, which offers a basic level of service, but there’s Fedex and UPS doing lots of private business. The Post Office is largely self-funding, but provides a commitment to universal service, to ensure everybody has access can have a letter delivered to nearly everywhere else, for the mere cost of a stamp. Rep. Jesse Jackson, Jr. made a similar point.
* Universities: Senator Charles Schumer made the comparison to the university systems in states like New York, as well as California, which have excellent private and public universities. Our University of California and community college system provides public options, alongside private college options, from Stanford to Occidental.
* Television and radio: NPR and PBS offer public options over the airwaves. Because they have a different mission and structure, they have filled important markets niches—from NPR's in-depth news and reporting, or PBS' children’s educational television programming—that was not well served by the private market. But there activities complemented, rather than supplanted, that of the private industry.
None of these parallels are exact, but it's hard to make a perfect comparison because the exact nature of the proposed "public health insurance option" is in flux, as policymakers struggle about how powerful and effective it is in the first place.
But there are analogies even within the health field, pointed out by California editorial boards:
That's why it's important to promote competition while imposing insurance mandates, starting by creating one-stop shopping exchanges where people can compare and purchase policies that meet a minimum standard for coverage. Although it's a lightning rod for critics, the idea of the government establishing public insurance plans to vie with private ones for subsidized policies is worth exploring. It's a potential counterweight to the power wielded by a single healthcare provider or insurer in too many communities, a recent Urban Institute study contends.
A good model is L.A. Care Health Plan, one of the county-based plans that California created in the early 1990s to manage the care of Medi-Cal patients. Unlike Medicare or Medicaid, which can dictate prices, it has to negotiate rates with doctors and hospitals just as its private competition does. And it's steered by a board of healthcare providers, patients and county officials with a directive to preserve the safety net, which has encouraged it to pursue the best care at the least cost. The new public plans could take on a similar civic mission: to help develop prevention- and wellness-focused approaches to care.
As the politicians in Washington debate the wisdom of a "public option" in health insurance,California has a real-life example of how such a program might work. And oddly enough, Democrats here have voted to sell off a portion of our state-owned insurance company while Republicans are trying to preserve it.
That company is known as State Fund, and it sells workers' compensation insurance – the policies that every California employer must carry to pay for medical care and disability benefits for workers who are injured on the job...
As a nonprofit, the public option provides insurance to employers at cost. The money to pay the medical care and lost wages of injured workers comes exclusively from employer premiums and investment revenue. No money comes from the public purse.
This public option plays a key role in the market, particularly for small businesses, start-up ventures and high-hazard businesses, such as construction and agriculture. As Poizner said Friday, many of these are businesses that "simply cannot get workers' compensation insurance in the private market." For these businesses, State Fund plays a role as an "insurer of last resort."
It also is a long-term, reliable source of insurance in a market that can be volatile especially during economic downturns... More recently, 28 private carriers went under or fled the market between 2001 and 2004, and rates skyrocketed. Many employers saw their premiums double or triple. State Fund provided a stable and affordable option at a time when market conditions had worsened.
As Poizner points out, State Fund "has created healthy competition" between public and private options, resulting in choices for businesses at lower cost. Today, about 200,000 California employers get workers' compensation insurance through State Fund.... State Fund is not without flaws... But through the years, the company has served its purpose as an insurer of last resort that keeps the private market honest.
So throughout American life, and even with our health system, having a "public option" is a key component. So tell me again why there's so much heated opposition? Yeah, there are differences, but there's nothing that make the notion of a "public health insurance option" some foreign, alien concept. If anything, given all these examples, a public option seems awfully American.
We'll see what happens in the legislation in Septmeber.
For the Democratic members of Congress--even the moderate and conservative Democrats--it is unlikely that the screamers at these town halls are voting for them.
As the candidates in today's Congressional contest are suggesting, if you are appealing to the broad range of voters, you need to be on the side of health reform. There have been times when politicians have embraced health issues, and times when they have run. The campaign is a small indicator in just one district, but it's a hint that health reform will happen.
The health care reform story was of the town halls, but it may not be the story you've been told. While opponents of health reform certainly did mobilize at the beginning of the month--and got a disproportionate amount of media attention for their disruptive ways, the attention has galvanized supporters.
Congress goes back to work on September 8th--so this first week of the month is our last chance to make a strong impression as we send our representatives back to DC.
That's why this week, advocates for health reform, including Health Access California, California ACORN, California Partnership, Organizing for America, MoveOn, and Health Care for America Now (HCAN) – the nation’s largest health care campaign, will have a week-long series of “Let’s Get It Done!” events. Starting in Fresno on the evening of Tuesday, September 1st, Californians will come together to rally for health insurance reform now--including one that ensures affordability, and provides a choice of a public health insurance option.
The “Let’s Get It Done” rallies in Fresno, Modesto, San Francisco , and Los Angeles, will be one of thousands of events taking place nationwide between now and when legislators head back to Washington , DC on September 8th. These events involve everything from rallies, town halls, and press conferences to phone banks and canvasses in every state and virtually every Congressional district across the country.
* Tues, Sept 1st: 5:00pm, at the Fresno Amtrak Station, 2650 Tulare Street * Wed, Sept 2nd: 5:00pm, at the San Francisco City Hall, 1 Dr. Carlton B. Goodlett Pl * Wed, Sept 2nd: 7:30pm, at the Modesto Office of Rep. Cardoza, 1010 10th Place * Thur, Sept 3rd: 5:00pm, at the Los Angeles State Park Cornfield, 1245 N. Spring St.