Overexposure to policy-speak can make one’s eyes glaze over and one’s thoughts wander far, far off. (Think Aruba.) Surely by the time Washington settles on a health-care fix, much of the public will have absorbed more than it ever imagined of geeky chatter on cost-shifting, co-ops, capitation and more.
We hope, however, that the continued drumbeat of cable TV’s wonky discourse, or the tsunami of health care blogs multiplying like guppies in a fish tank won’t inundate people with so much policy detail as to turn them off.
It’s really very important that Americans remain open to learning and reading and talking and hearing about even the finer points of health care reform. After all, health care is an essential humanitarian service that’s projected to cost families in the neighborhood of $30,000-a-year in a mere 10 years. Sustainable? No way.
And, we’re pretty sure that whatever compromise deal is hatched by Washington probably won’t be – how shall we put this? -- the “perfect” that is the enemy of the good.
So we’ve got to stay interested, engaged and involved – because this health care delivery system is as broken as the levies of the Ninth Ward at the height of Katrina. Regardless of what comes out of Washington, the American people themselves will still need to press on for improvements. We will still need to care.
Luckily, some media outlets are going out of their way to help us care by framing and presenting the topic in a refreshing, inventive way that encourages the public to stay with the debate. (And we’re not talking about the lazy-bones media who report the story in the context of Dems-vs.-Reps, conservatives-vs.-liberals, he-said-vs-she-said, as if that framing had anything to do with truly illuminating the debate.)
The good news starts with a two-part, two-hour series aired on “This American Life,” the public radio program hosted by Ira Glass. Glass and the show’s producers decided to employ NPR’s crack team of financial reporters, Planet Money, to explain the complex web of factors that got us where we are today with our health care delivery system. If you’ve ever heard their unorthodox hour-long take on derivatives and the mortgage meltdown, you’ll know what a Planet Money treatment delivers – hear the podcasts for yourself: "More is Less" and "Someone Else's Money." They're fun, spunky and – most important – highly accessible and informative.
The intriguing feature is that the boxes change size -- along with the number of tiny simulated people standing around chatting inside them -- according to the volume of reader comments submitted on various aspects of the health care debate.
The interactive graphic features 21 boxes for 21 health-care-reform related topics: the newly released House health care bill, the public option, a single-payer system, drug costs, exchanges and co-ops, the Massachusetts model, medical malpractice and tort reform, competition among insurers, illegal immigrants, Medicare and the elderly, health care abroad, women and health care, the generation gap, moral and spiritual considerations, nursing home and end-of-life care, taxes and the national deficit, insurance and affordability, employers and insurance, abortion, and lifestyle and preventative care.
Today, as House bill was released, that box (along with the public option box) were the largest and had the biggest gathering of simulated chatterers.
With the 21 choices, there's something for everyone. The topics serve as prompts to readers, beckoning them to the conversation on health care reform. (We recommend scanning the "health care abroad" topic box -- it's fascinating to learn of other people's experiences seeking medical care outside of the U.S. and their comparisons with our homegrown system.)
If more media outlets make efforts to stretch their boundaries of imagination, creativity and resources as did “This American Life” and the New York Times – more members of the public will stay engaged in the debate.
The result, in the final analysis, could be better outcomes for overhaul. A well-informed public coaxed into staying with the debate over the long haul will keep our elected leaders responsive and focused on the end goal: affordable, accessible, quality health care for all.
Rep. Miller comment on the challenge of putting this bill together, and the future obstacles. While most press reports indicate that the bill is a merger between the three committee versions, the most important change was meeting President Obama's requirements during his speech to Congress: that the bill be in the range of $900 billion over 10 years, and that it be paid for not just in the first decade but in the future beyond that. These were laudable goals, but they put a significant crimp in the effort to make sure the bill provides enough help to low- and moderate-income families to afford coverage--the crux of this entire enterprise. But the House leaders were able to find ways to find new savings (like expanding Medicaid even moreto 150% of the poverty level, which is cheaper than private coverage).
But as we go through it, there's a lot of good stuff here.
Rep. Miller's website also has lots of fact sheets on the new House. Here are some key ones:
It is with great pride and with great humility that we come before you to follow in the footsteps of those who gave our country Social Security and then Medicare and now universal, quality, affordable health care for all Americans...
But I am very grateful for the cross-section of members that we have -- generationally, geographically, philosophically, in every way, from all of the committees of jurisdiction that worked on this legislation and also members of the caucus who participated over and over again under the leadership of our chairman, John Larson, and our vice chair, Xavier Becerra.
So here we are. For nearly a century -- it's really over a century -- leaders of all political parties, starting over a century ago with President Theodore Roosevelt, have called and fought for health care and health insurance reform.
Today we are about to deliver on the promise of making affordable, quality health care available for all Americans, laying the foundation for a brighter future for generations to come.
The Affordable Health Care for America Act is founded on key principles of American success: opportunity, choice, competition and innovation. We have listened to the American people, we are putting forth a bill that reflects our best values and addresses our greatest challenges. And we are putting it online for all Americans to see.
Here's what our health insurance reform legislation will mean to American families, workers and the economy. This is why this legislation is important: affordability for our middle class. It lowers costs for every patient, reins in premiums, copays and deductibles, limits out-of-pocket costs, and lifts the cap on what insurance companies cover each year.
Affordability for the middle class, security for (inaudible) seniors: by strengthening Medicare secures the financial stability and solvency of Medicare for years to come, provides seniors with better benefits and guaranteed access to their doctors. And in this legislation, we will immediately begin to close the doughnut hole.
Affordability to the middle class, security for our seniors, responsibility to our children. It reduces the deficit, meets President Obama's call to keep the cost under $900 billion over 10 years, and it insures 36 million more Americans -- 36 million more.
As I said, the bill is fiscally sound, will not add one dime to the deficit, as it expands coverage, implements key insurance reforms and promotes prevention and wellness across the health system.
The bill will expand coverage, including a public option to boost choice and competition in the health insurance reform (sic).
It covers 96 percent of all Americans, and it puts affordable coverage in reach for millions of uninsured and underinsured families, lowering health care costs for all of us.
One other very important feature is that it will end discrimination for preexisting medical conditions.
It opens doors to quality medical care to those who are shut out of the system for far too long. And because of the work of our members and -- meetings across the country, we know that prevention and wellness are an important part of this legislation. It puts a major new emphasis on preventative care, expands access to screenings and other treatments to keep Americans healthy and promote workplace wellness.
The drive for health care reform is moving forward. The Affordable Health Care Act will ensure, again, affordability for the middle class, security for our seniors, and responsibility to our children.
As we consider -- continue to move through the legislative process, it is critical to remember what this means to the American people. Today we will hear stories that serve as our inspiration. We will listen to people whose hopes are our motives for action.
Our president has said our success will be -- our progress will be measured by the success of America's families in making progress for themselves. And so these stories are a place that need our attention, will have our action, and we look forward to hearing them.
Here's the comments from the press conference from California Congressman Xavier Becerra. Health Access California, Health Care for America Now! and many other groups will be helping host a town hall in Los Angeles with Rep. Becerra this Saturday, October 31st.
He's a member of leadership, and provided some historical context as he introduced Rep. John Dingell, the long-serving dean of the House, and long-time champion for universal health care.:
In 1935, Franklin Delano Roosevelt stood up and fought for Social Security. There were many who said no, but he had the courage to stand up.
In 1965, Lyndon Baines Johnson stood up and had the courage to say yes to Medicare, despite the fear that was shouted out by many along with their no.
And today all of us here gather together to say yes to America, because we have heard you, we see it in your eyes. You are telling us it is time to reform our health care system for all of our families; not tomorrow, not in 40 years, but today. And we hear you loud and clear.
We know that you have fought to keep your children insured. We know that you have fought against those insurance bureaucrats who deny you care. We know that you scramble to find the money to pay that monthly premium. And we know that you would not go one day without doing everything you could to help your child or your spouse or your parent have access to the quality affordable care that we all deserve.
We will be with you because it is time for quality health care we know exists in this country.
Earlier this week the Governor sent a letter to Congress asking them to support health reform but noting that the cost of Medi-Cal expansions could be as much as $1 billion. To his credit, unlike earlier estimates, the Governor noted that this estimate did not include offsetting cost savings to California.
Health Access has done an estimate of the estimate of the Medi-Cal/Healthy Families impacts of health reform based on our best understanding of the national reform proposals that were in print until today.
The bottom line is that we estimate that the net impact of the Senate Finance Mark for California state government would be costs of about $750 million annually plus a loss of $550 million in DSH funding while HR3200 would cost California about $200 million annually plus a loss of $330 million in DSH funding.
We will revise it again once we have read the House bill that was released this morning! Preliminary information indicates that a larger Medicaid expansion is included in the new House bill: that will be a good thing in terms of affordability and benefits for those covered though a challenge in terms of assuring adequate access to physicians.
Health Access has supported the earlier version of HR3200 for many reasons—the impact on California’s budget is on the long list of good things about the earlier House proposal.
There wasn't much new. It wasn't even his first letter to Congress on health reform this year. Also, given that the Governor has been all over the place on health reform, being at different times both for the expansion of key health coverage programs and for their elimination, for employer mandates to provide coverage and against them, and for new regulations on insurers and against them, the question is not so much where the Governor is but where he is *now* on some of the vital health policy questions.
Either way, both men shared the view that the rising cost of insurance to small business is simply not sustainable – not for the small business owner, not for the employees, not for the community as a whole.
Valentino is co-owner of a landscaping firm in the Central Valley and he has strong beliefs about people taking personal responsibility for leading healthy and fulfilling lives. He also believes the whole workforce will be more stable and productive if employers are able to provide affordable health care. Embrace it as a business strategy; embrace it as the right thing to do – but do embrace it.
Especially in California, where the entrepreneur’s spirit runs high and small businesses are a good chunk of the economy, affordable health care is key to recovery and growth.
In his radio address, President Obama gave voice to the frustration of business people trying to get a new venture off the ground. “Many entrepreneurs can’t get financing to start a small business in the first place,” the president said. “And many more are discouraged from even trying because of the crushing costs of health care – costs that have forced too many small businesses to cut benefits, shed jobs or shut their doors for good.”
That’s the sound of small businesses -- like Valentino's in the Central Valley -- being listened to. posted by Cynthia Craft | Permalink | 11:48 PM
Autism is a difficult condition to treat but there are at least some treatments, including intensive behavioral therapy, that increase the odds that a child will be able to lead a more normal and productive life. Intensive behavioral therapy such as applied behavioral analysis is no picnic for either the child or the parents and demands extensive efforts on the part of parents as well as skilled intervention of certified practitioners.
We have been troubled about how DMHC has handled autism claims: a number of cases were referred to independent medical review and the independent medical reviewers found that peer-reviewed science justified the treatment as medically necessary. HMOs than asserted that the care was being denied because it was not a covered benefit rather than on grounds of medical necessity.
Independent medical review was one of the victories consumers won in the HMO Patient Bill of Rights, sponsored by Health Access California and signed into law in 1999. Consumers who are denied care on the grounds that it is not medically necessary can appeal to an independent panel of medical experts who determine whether the science and the particular circumstances of the patient justify the care. (Some treatments work but not for the particular patient.)
There are some flaws in California law with respect to independent medical review. One of them is made obvious by the autism case: independent medical review deals only with determinations of medical necessity, not with whether something is a covered benefit. In some instances whether something is a covered benefit is clear: the coverage does not include durable medical equipment so wheelchairs are not covered. But other times the line between a covered benefit and a determination of medical necessity is murkier: does someone need more than the normal regimen of physical therapy after breaking a leg either because the injury is worse than usual or the individual has diabetes so recovery is delayed? Are the additional physical therapy visits a covered benefit question or a medical necessity determination? The autism question falls into this category as well: the HMOs allege that it is not a covered benefit; the consumer side said the care is medically necessary and a denial violated the Mental Health Parity Act.
Another flaw in the California law with respect to independent medical review is that appeals are not automatic: consumers must push forward at each step, first filing a grievance, then seeking an independent medical review. In this case, a number of very determined parents pushed even further---by filing a lawsuit with the help of Consumer Watchdog. It is an important case and one we will watch carefully as it progresses.
The big news today is that Senator Majority Leader Harry Reid is moving forward with a merged bill that includes a public health insurance option (with a provision for states to "opt-out" of having one if they choose).
I am well aware that the issue of the public option has been a source of great discussion in recent weeks. I have always been a strong supporter of the public option. While the public option is not a silver bullet, I believe it is an important way to ensure competition and to level the playing field for patients.
As we’ve gone through this process, I’ve concluded, with the support of the White House and Senators Baucus and Dodd, that the best way forward is to include a public option with an opt-out provision for states. Under this concept, states will be able to determine whether the public option works well for them and will have the ability to opt-out. I believe that a public option can achieve the goal of bringing meaningful reform to our broken system.
It will protect consumers, keep insurers honest and ensure competition and that’s why we intend to include it on the bill that will be submitted to the Senate for consideration. We have spent countless hours over the last few days in consultation with Senators who have shown a genuine desire to see reform succeed, and I believe there is strong consensus to move forward in this direction.Today’s developments bring us another step closer to achieving our goal of passing a bill this year that lowers costs, preserves choice, creates competition and improves quality of care.
Some other points from the 10-minute press conference:
* Reid said he had the votes to "move to this bill & start legislating." That suggests that he has 60 votes on motion to proceed--but he gave no guarantee he can break a filibuster.
* Reid's best line was that he was "always looking for Republicans [to vote with us].. there're just a little hard to find.. [The number of] moderate Republicans are extremely limited.. I can count them on 2 fingers."
* When he was asked about affordability and subsidies, Reid said the bill was a meld of the HELP and Finance proposals.
* Sen. Reid didn't mention, and not one reporter asked, about merged bill's reqs for employer-based coverage--which is how half of US gets coverage now. There's concern that the Senate version is leaning toward the Finance "free rider" proposal rather than the much better HELP version.
Have you ever had to squint at the tiny print on a prescription label or have to give advice to an elderly family member to interpret their instructions for taking pills? California is in the process of helping to take some of the guesswork--and potential danger--out of deciphering those labels for seniors, people with disabilities, and patients with low English-language proficiency.
California's Board of Pharmacy held a public hearing on Thursday to consider how to implement a new law that requires patient-centered prescription drug labels. This new law requires the instructions to be in a larger font (type-size), and, upon request from the patient, contain instructions in several other threshold languages for people with low English language proficiency. Here is some of the testimony the Board heard:
One consumer advocate described an Asian senior client whose doctor had prescribed low-dose aspirins (81 milligrams) for her heart. Upon returning home and looking at the confusing English-language prescription label, she did not recognize any of the words. The only thing she could read was the number "81." So she carefully counted out 81 aspirin tablets and took them all that evening. When she was found later by her family, she was rushed to the emergency room for expensive life-saving treatment.
Another senior who spoke to the Board through an interpreter described how confused she was by the ten bottles of different medicines that her doctor had been prescribed for her. She had received an oral consultation from the pharmacist, but all she could remember when she got home was that she was supposed to "take one tablet each day." As a result, because she couldn't read the prescription label, she lined up the bottles and took one pill from the first bottle on the first day, one pill from the second bottle on the second day, and so on. When she returned to her doctor for follow-up treatment several weeks later, the doctor was puzzled that she had experienced no improvement in her condition. She assured the doctor she had been taking her medicine faithfully, but it eventually took him several more visits to determine why the prescriptions were so ineffective and why there had been such a delay in her treatment.
Having a more patient-centered prescription drug label would have helped in those situations and others described at the hearing by consumers, health professionals, and advocates.
In contrast, the retail pharmacy industry testified that this law was too difficult and expensive to implement. However, several individual pharmacists expressed commitment to assist their patients and a willingness to work with the Board to find solutions regarding container size, the pharmacist's liability concerns, and other technology/printing issues.
To the Board's credit, they voted to enter the next formal regulatory step in the process and announced they will schedule another public hearing in January. The Board also hopes to take advantage of special financial and linguistic support offered by a California foundation to translate the most commonly used instructions, such as "take one pill with food" into several non-English languages for general use by pharmacies that operate in the state.
So despite the threats that "all medication will have to be dispensed in mayonaise jars so people can read the labels," we are hopeful that "help really is on the way."
Luba Taylor pressed the letter almost to her nose, close enough to read through thick glasses that she was losing her "optional" vision benefits from state Medi-Cal.
Taylor, 54, saw the words but couldn't believe them. After all, a brain tumor left her legally blind — even when wearing glasses — and unable to work. Last week, months after receiving the letter, reality set in when her glasses broke.
She called for an appointment with her low-vision specialist in Fullerton and was told she lost her coverage July 1.
"I don't understand how ruthless this society is," Taylor said. "My glasses are very expensive because I'm very low vision — 20/200. I'm going to just have to get Scotch tape and tape them up. I have no spending money."
By eliminating vision and dental coverage for most adults receiving Medi-Cal, including roughly 181,000 in Orange County, the state saved $122 million. Other health cuts in late July would follow to help close California's massive $26 billion deficit, including $86 million for AIDS prevention and services, and $28 million to reduce day care for adults with dementia and other disabilities...
The article goes on to detail other cuts, like the elimination of dental coverage for the nearly 3 million adults (mostly parents, seniors, and people with disabilities) with Medi-Cal coverage:
In Orange County, the cuts have resulted in layoffs at nonprofit community dental clinics and longer wait times as former Denti-Cal patients compete for time in the dentist's chair with the growing numbers of uninsured.
Six out of 14 nonprofits providing dental care have cut back their hours, said Isabel Becerra, executive director of the Orange County Coalition of Community Clinics. The nonprofit clinic system sees about 200,000 patients a year, with 40 percent of them needing a cavity filled or a cleaning.
"Their care is being delayed out 6 to 9 months," Becerra said. "The patients are not being turned away. That's the hallmark of the community clinics. They just won't be able to see you as quickly as they once were."...
Besides pain, lack of dental care is also associated with respiratory disease, diabetes, stroke, heart disease and premature and low birth weight deliveries.
"It's not just Orange County, but pretty much everywhere you go, the first impression is very important," said the clinic's dental director Dr. Jila Nikkhah. "If you don't have front teeth, if you don't look presentable, you probably won't get the job."
Other budget cuts--choices made rather than raising (or even restoring) revenues--were to prevention programs, which has significant consequences for both the patients directly, but our health care system as a whole:
Sariah Gonzalez isn't the condom lady anymore.
After nine years with AIDS Services Foundation Orange County, she was laid off last month and other programs were scaled back after the nonprofit lost $105,000 in prevention funds. Orange County lost about $1.8 million for AIDS services and prevention.
Gonzalez worked with Spanish-speaking Latina women — a high-risk group because their partners might have unprotected sex with men. Gonzalez said that because of cultural stigma, some men keep their bisexuality a secret, which puts their wives at risk.
Latinos represent about one-third of Orange County's population, but last year, they accounted for 52 percent of diagnosed AIDS cases, according to the county's Health Care Agency....
Some cuts that were made were avoided--either by legislative action, as with the severe cuts to Healthy Families or domestic violence shelters that were lessened, or by court order, as with the proposals on adult day health centers. But it's important to remember that many cuts continued. The article details just some of the impact in Orange County, but these are stories that are going on in every community in California.
While the anti-reform protestors got attention by shouting at town halls, some of the most memorable pro-reform protests have been by singing, from the "Billionaires for Wealthcare" that were featured at our Health Care for America Now! events in Los Angeles and San Francisco to the "Hey Mackey!" flashmob at a Whole Foods in Oakland.
While the U.S. Senate tries to merge the HELP and Finance measures and the House tries to blend the products of three committees (Ways and Means, Education and Labor, and Energy and Commerce), we have been looking at what we would need to do here in California to implement health reform if it is enacted at the federal level.
While the proposals differ in specifics, all of them have an important role for the states in continuing to regulate key aspects of health insurance as well as having either the option or the obligation to operate an “exchange” at the state level.
In particular, as we read the Senate Finance proposal, we were struck by the repeated reliance on the National Association of Insurance Commissioners (NAIC). California is unique in having two regulators for health insurance: the Insurance Commissioner and the Department of Managed Health Care. It is the Insurance Commissioner, currently Steve Poizner, who participates in NAIC, not the DMHC.
Yet most of health insurance in California is regulated by the Department of Managed Health Care. The numbers vary year by year but roughly out of the approximately 20 million Californians with private health insurance, about 80% have products regulated by DMHC and about 20% by DOI. For the 2-2.5 million who buy insurance as individuals, the split is closer: it is usually 60/40, with DMHC sometimes having the majority and other years DOI having the majority of covered lives.
As readers of this blog know from our fights to improve health insurance for those Californians who buy their own coverage, DOI products are much less comprehensive than DMHC products. Insurers regulated by DOI sell hospital-only coverage or coverage that covers three doctor visits, two days in the hospitals, and a few generic drugs and that counts as health insurance at DOI. Of course, the premiums are lower for such junk than for real insurance that actually covers basic health services.
In the real world of the politics of protecting consumers, what does it mean that California has two regulators? Well, it depends. When Pete Wilson was governor vetoing HMO consumer protections left and right, we were grateful to have Insurance Commissioner John Garamendi for four of those years. When Gray Davis signed the 21 bills that made up the HMO Patient Bill of Rights and created the Department of Managed Health Care, headed by Daniel Zingale, while Insurance Commissioner Chuck Quackenbush was taking questionable contributions from insurers, we thought more fondly of DMHC than DOI.
The two departments try to work together—and as would be expected, sometimes and on some issues that works better than other times and other issues.
If health reform is enacted at the national level, and we are doing everything in our power to make that happen, then implementation will occur under a new Governor and new Insurance Commissioner—so it is hard to say whether we will be happy or sad about the prospects for implementation. But what is certain is that winning health reform at the national level is only the first step in making sure that consumers are protected.
Lots of movement in the last few days on health care reform, in both the Senate and the House of Representatives. There's been a clear back-and-forth in both houses, focused on the public health insurance option, and on the savings it generates that allows for better affordability subsidies for low- and moderate-income families.
The general gist is that Speaker Pelosi, representing California well, is working to see if she has the votes to have a health reform that includes a strong public health insurance option (which would start off-the-bat paying providers at 5% higher than Medicare rates)--which in turns allow the reform to provide more financial assistance to low- and moderate-income families. It's important that our Congressmembers hear from constituents that that's the option they want to vote on in the next week or so.
In the Senate, Senate Pro Tem Harry Reid is seeing if he can pass health reform (which means not have a Democratic-caucusing Senator vote to filibuster the bill) include a version of the public health insurance option at all, as he seeks to merge the Senate HELP bill, which has one, with the Senate Finance version, which doesn't. The kind of compromise that has been talked about is an "opt-out" version where a national plan starts on day one, but states can opt-out of it.
Of course, anything in these bills will eventually need to be negotiated between the House and the Senate, so what we are really arguing about is the contours of the final discussion, rather than the final product.
If employers avoid their responsibility, taxpayers pay...
Wednesday, October 21, 2009
More on the lack of employer responsibility and the "free rider" provision of the Senate Finance Committee proposal...
As employers restructure work for low- and moderate-income employees to avoid paying the free rider penalty, the taxpayer ends up footing the bill for health benefits for employees of some very large employers that rely on low and moderate income workforces.
CBO in its analysis assumes that every dollar not spent on health benefits by an employer will translate into wages. Is this really true for low and moderate wage employees? By definition, these employees lack bargaining power in the labor market: their wages are below the median wage. Will it be possible for employers to avoid paying the credit and fail to increase wages? For employers with workforces that are predominantly below the median wage, the answer could be a resounding yes.
Widespread restructuring of employment by employers with predominantly low and moderate income employees could blow up CBO’s conclusion that Social Security and income taxes will increase because wages will increase if health benefits are not paid by employers. CBO may be right about this in the aggregate and certainly for higher wage employees and even higher wage workforces but is this correct for low/moderate wage workforces? Or will employers with predominantly low/moderate wage workforces simply restructure work so that the employer avoids the free rider provision? Is the free rider provision a free pass for employers?
Contrast this with HR3200 which requires employers to provide benefits or pay 8% of payroll per hour worker for each employee. Here there is no incentive to restructure work to be less than a certain number of hours per week. If the nature of the work requires part-time employment (a school bus driver, a restaurant that is only open at lunch) or part-year employment (residential construction, the Christmas season in retail), the employer is only on the hook for the hours worked. But there is no incentive to restructure the work so that low and moderate wage workers work less than 30 hours per week.
Even the Senate HELP bill is better than Senate Finance: at least it requires a modest payment for part-time workers as well as a proportional payment for part-year employees.
The evidence from Hawaii is somewhat mixed—but there the threshold was 20 hours per week. While it is relatively easy to restructure employment from 40 hours per week to 30 hours per week for an employer with 50 or more employees, it is tougher to restructure work to be less than 20 hours per week. Shifts of seven hours or six hours four days per week are easy to arrange: getting under 20 hours per week is tougher.
Indiana's generally well-regarded Republican governor who formerly served as President George Bush's Director of Management and Budget, pulled the plug on October 16 on their effort to "modernize" the state's system of delivering welfare services. This was a similar result in Indiana to an effort to privatize welfare in the state of Texas which was a failure, and was cancelled in 2007 after a huge expenditure of Texas state funds.
The Indiana governor acknowledged that he continued to favor privatization of some state government functions. However, the systems changes he implemented resulted in too many errors and left too many deserving people waiting for too long for help they desperately needed. State legislators were inundated with complaints from their constituents. Eligible applicants suffered nightmarish consequences that affected their health coverage and their health status. In fact, Indiana is facing increased criticism and oversight from the federal government over their error rate. State hearings on this debacle are under consideration by the Indiana legislature.
Indiana expected significant cost savings by directing applicants to apply for benefits by calling customer service centers staffed by contractor employees or by having the public file for benefits using a computer. Now that the governor has cancelled the $1.34 billion contract, applicants will return to applying for public services as part of face-to-face interviews with state workers in local county offices. The governor admitted in his public statements that it wasn't the resources the state devoted to this endeavor or the amount of effort, but that it was "a flawed concept that simply did not work out in practice."
So, why are these experiences in Texas and Indiana so relevant to California? As my mother would say: "It is a cautionary tale." The California legislature passed, and the governor signed, AB 7 Centralized Enrollment for Public Social Services that purports to streamline and automate the process for applying for public social services like Medi-Cal, food stamps, and CalWORKS. The benefits of this law are reputed to be greater access to benefits by having the public apply over a computer, greater consistency in eligibility determinations from county to county, and significantly lower administrative costs for the state.
As the state prepares to implement this law in the coming months, it will face many of the same problems and criticisms experienced by these other states. California will doubtless incur tremendous costs (and will be unlikely to realize any savings) while exposing eligible Californians to significant delays and real adverse health consequences from what other states are calling "a failure."
The question to ask is: Can we learn from their mistakes?
The free rider provision is easily evaded by precisely those employers who are most likely to have employees using the exchange, to wit, employers with workforces that are disproportionately low and moderate income.
Here’s why: the free rider provision only applies to employees who work more than 30 hours per week. It is entirely possible for employers to restructure work so that most low and moderate wage jobs are less than 30 hours per week while supervisors, managers, professional and even long-time employees work more than 30 hours per week. Indeed, this is already the structure of employment in large segments of retail and fast food.
And employers will figure out pretty quickly that the way to avoid paying the credit is to restructure work to be less than 30 hours per week. They will have a considerable incentive to do so: the first employee that goes into the exchange will cost them $5000 for that employee---or $400 for every employee. That is a considerable marginal increment, as the economists say, or a pretty big whack as the rest of us would say.
Is it bad for the employees? They will be eligible for the credit or perhaps Medicaid, even if they work multiple jobs, none of which provide benefits. The credit is not as generous as good employee health benefits provided by employers with high wage workforces but still the credit or Medicaid are substantially better than nothing which is all that too many low and moderate income employees have now.
But what about the taxpayer? The taxpayer will end up footing the bill for the lack of employer-paid benefits. Employers who systematically restructure low and moderate income jobs to be less than 30 hours per week will shift the costs to Medicaid and the exchange—to the taxpayer.
Today was a major day of action for health reform, with well over 100,000 calls made to Congress, and events around the country. This included several cities in California, from an overnight vigil in front of the federal building in Sacramento, to a "Rolling Caravan for Health Care Reform" in Los Angeles. Below, pictured with HCAN organizers Mari Lopez of the California Partnership and Nancy Gomez of Health Access California, is the flatbed truck that circulated through LA with over 150+ people at various stops, with the theme "The Clock is Ticking." Other events were all over the place, from San Diego to Modesto.
Another fellow "judge" on the Truman panel with myself is erstwhile Californian and health policy consultant Peter Harbage, who has an important post on the need to not just make coverage affordable and accessible, but administratively simply, if not automatic. He's right: the recent conversation on penalties from the individual mandate is missing the point: after all, people overwhelmingly want coverage. (Even with auto insurance, the coverage required is for the person you may run into, not yourself.) The key is removing the barriers for people to get coverage in the first place.
Before I joined Health Access in January 2006, I worked for the federal government in a variety of jobs. I began my career when I was hired to take applications for retirement, survivor's and disability insurance benefits for the Social Security Administration and ultimately worked in 17 Social Security offices across the U.S. I also served as the Regional Administrator for the Centers for Medicare and Medicaid Services (CMS), formerly HCFA, in San Francisco. The regional office was responsible for Medicare and Medicaid in the four western states (including California) and the Pacific Territories. While these programs are complex, they remain important and are widely respected.
Government programs have many detractors. All programs have coverage gaps and other flaws because of the compromises that arise out of the legislative process. In addition, agencies can have imperfect administration, due to inadequate funding or for other reasons. However, I had the good fortune to work on those programs (Social Security, Medicare, and Medicaid) that are esteemed by Congress and the public as National Treasures to this day. They are consistently admired as having a strong programmatic purpose, an unwavering commitment to beneficiaries, and consistent, professional, and relatively low-cost administration.
So, as we approach a new chapter in the current health care reform debate, it is interesting to look back at the legislative history leading up to the passage of Social Security and Medicare/Medicaid. Since our Congressional representatives all point to those programs as hallmarks of our social fabric and essential to our financial underpinnings, it is interesting to see if those revered programs passed Congress with virtually monolithic, or at least bi-partisan support. Not so much. The Social Security Act of 1935 passed with overwhelming Democratic support, but only 16 Republicans voted for it in the Senate. The Medicare/Medicaid legislation in 1965 similarly had broad support among Democrats in the Senate, but only 13 Republican Senators voted for its passage. While these programs remain part of our foundation, and few legislators would vote for their repeal today, they had little support across the political spectrum at the time they were signed into law.
However, as we attempt to build on their foundation for health care reform, no one remembers the fierce opposition those programs encountered, and the fairly one-sided and sometimes grudging support they received in their day. These days legislators from both political parties acknowledge the critical importance of these programs to the American people. So, let's hope as we re-examine our commitment to passing health care, we continue to go about the business of building on these National Treasures.
Health Access attended the Managed Risk Medical Insurance Board (MRMIB) board meeting on Thursday in particular because we were interested in the status of how California's children were faring under the Healthy Families Program now that the eligibility restrictions have been removed. On July 17 the state reluctantly established a waiting list of eligible children for the state children's health insurance program due to funding shortfalls. After short-term rescue strategies were cobbled together this fall to provide additional money to fund the program, everyone at the meeting was anxious for news about how quickly eligible children's applications were being processed. Here's what we learned at the public board meeting:
Although the state discontinued the waiting list on September 16, families were still receiving incorrect notices for another week that they were being put on a waiting list.
As of September 30 Healthy Families enrollment had fallen from over 920,000 to 871,335.
Advocates were very disappointed to learn how slowly the administrative vendor was working down the waiting list. They have processed only about one-quarter of the wait-listed children's applications. They anticipate that they will process the remaining applications by mid-November, but hope to have the bulk of them reviewed by the end of this month.
MRMIB is projecting much higher retention rates of new applicants because of the worsening economy, and the slowness of the job recovery picture (because employer-based health insurance for families is often offered to new employees.)
Although everyone voiced this concern at the outset, we should remember how long it takes to fix the administrative actions that were undertaken to limit enrollment in public programs. We should not undertake these restrictions lightly. Healthy Families is experiencing resurgent enrollment for this program and the families who are enrolled are expected to remain eligible for a longer period of time due to the economy. In addition to the new influx of applications, Healthy Families must institute an expedited processing of wait-listed children that built up during the time when enrollment was limited due to uncertain financing. In addition, they have to correct the confusion that has resulted from the off-again/on-again status of enrollment in the program which may have deterred some eligible families from even applying.
Even though we have endured these restrictions on enrollment, longer-term financing for children's health insurance is far from assured--and the rules may be changing under several scenarios for health care reform. It is important to remember that we should place restrictions on enrollments for public programs only in the most extreme financial circumstances because the process of undoing the limits put in place takes way longer than anyone wants it to!
Today several Democratic Senators said that the AHIP report released on the eve of the critical vote in Senate Finance makes the case for health insurance reform, pointing to the need for the public option and for the insurance market reforms.
We agree—and point to p. 13 of the study by PriceWaterhouseCoopers paid for by AHIP. It shows that the almost all of the alleged increase in premiums would result from the health insurance reforms. Why? Two reasons: first, because insurers would be required to sell insurance to everyone, including people who actually need health care, and second, because insurers would be required to cover most of the cost of care (AHIP uses an average or “actuarial value” of 65%).
In California, more than 2 million individuals buy health insurance as individuals---but we estimate that as many as 400,000 are denied coverage because of medical underwriting. And one individual can pay 15 or 20 times as much for the same health insurance product as someone who is younger and healthier---if the older, less healthy individual can get coverage at all.
Shockingly, in many states, individuals are sold so-called insurance where more than half the premium dollar goes to overhead and profits—and less than half goes to paying for health care. This was the case in California until former Insurance Commissioner John Garamendi pushed through regulations supported by Health Access requiring that health insurance products spend at least 70 cents out of every premium dollar on health care. This eliminated a number of insurance products in the California market of minimal value.
The AHIP study ignores the affordability provisions of Senate Finance proposal: Jon Gruber, MIT, who did the modeling for California health reform, offers an insightful perspective---with the subsidies provided in Senate Finance, almost everyone who gets insurance as an individual would spend less on premiums and get more in terms of health benefits than in the current market.
We still have lots of worries about affordability in the Senate Finance proposal—we have supported HR 3200 in part because HR3200 does a job of assuring affordability and decent benefits. But the bill that was voted out of Senate Finance today is a better bill than what they started with. And there is more to do...
The big news was the historic passage of the health reform from the Senate Finance Committee, the fifth of five committees. We covered it, including the 14-9 bipartisan vote, on our Twitter feed at www.twitter.com/healthaccess
President Obama has a way of trying to ensure fidelity from partisan opposites once they've voiced early ideological support for the initiatives he was elected to achieve.
In very public speeches, he singles them out by name and elevates them as leaders who are standing up to do right by America. Today, he did so for Maine Sen. Olympia Snowe in a shout-out during a serious Rose Garden speech after which he took no questions.
Obama made it clear that Snowe deserved recognition for being first to break the partisan barrier when she threw her vote behind the 14-9 passage of the Senate Finance Committee version of the health care bill. In making his remarks, Obama was also sending a message: he is statesman enough to give credit where credit is due.
Conceivably, this praise strategy can either bring a politician deeper into the fold, or provide a the public record for a flip-flop, should one be gathering on the horizon. Think Iowa Sen. Chuck Grassley, during the kookiness of August's town-hall season.
And while Snowe, reportedly irked by an ill-timed, deceptive 11th-hour insurance industry blitz against her committee's bill, voted for the bill today, she also made it clear that no one should take her future support for granted:
"When history calls, history calls," Snowe announced in the Senate Finance Committee. Wrapping up, she added, "Finally I say that my vote today is my vote today. It doesn't indicate what my vote will be tomorrow."
Here's hoping the senator will continue to see the greater value in voting for the goal of making health care affordable in America.
Obama was clear today about what's at stake: "As a result of these efforts we are now closer than ever before to getting health reform passed."
As the Senate Finance Committee is set to vote today on health reform, there's some assurance it will passs the committee. The only question is whether Senators Rockefeller, Wyden, and Snowe will be among the "Yes" votes. Stay tuned...
The passage of reform from the fifth of five Congressional committees of jurisdiction certainly gives momentum to health reform efforts, and President Obama highlights this in his weekly address:
Much has been made of the insurance industry's ostensible support for the concept of health reform, but these tensions have been present. They have always been actively opposed to the public health insurance option. They were reluctant to embrace some regulations, like modified community rating, and still opposed others, like minimum medical loss ratios.
In California in 2007, their ambivalence was clearer, since it showed in the different plan's positioning: we had our biggest health insurer, Anthem Blue Cross of California (owned by Wellpoint), actively opposing health reform--as the company has been doing this year as well. But there seemed to be possibility that the industry was split, and some insurers--like HealthNet, or California-based nonprofit plans like Kaiser and BlueShield--were willing to live under another set of rules, and to be supportive of health reform.
But it was always a stretch to call them the "good guys," because even with these plans, what they wanted for their support was so much, it was less than helpful. In return for getting rid of underwriting and screening people for "pre-existing conditions," they wanted an individual mandate, so people wouldn't wait until needing care to buy coverage. It's a revolutionary change to their business model, and fair in concept.
But their demands were a problem: they wanted a strict mandate. This means they wanted no or little exemptions, and a strict enforcement mechanism. They opposed not just the public plan option, but additional regulation.
In order to do away with denying people for "pre-exisitng conditions," the insurers want virtually everyone to get covered to best share the risk and costs of health care. In order to do that, Governor Schwarzenegger proposed a mandate but with not anemic help for people to afford their coverage. While fine for those insurers willing to be supportive, that obviously was a problem for consumer, labor, and community groups, which were successful in increasing the financial assistance that low- and moderate-income families would get--although some differed on whether it was enough.
The insurers tried to be helpful in arguing for more resources--but not at all in recognizing other trade-offs. When the level of subsidies is capped, either explicitly (President Obama has a target costs for health reform around $900 billion over 10 years) or implicitly by the amount of money that it is politically feasible to raise, then they need to recognize that there needs to be some additional security that consumers aren't forced to buy a product that is too expensive: exemptions, more stringent oversight and regulation, and/or competition from a public health insurance option. They oppose those elements, however. As Ezra Klein notes, they aren't even willing to support taxes to help fund the subsidies to buy their product.
The notion that they are willing to abandon their business model is significant--it's one of the truly revolutionary aspects of health reform, that we will move to a system where not only can you not be denied for a pre-existing conditions, but people start to pay based on what they can afford, rather than how sick they are. And insurers would then compete on cost and quality, rather than how effectively they acan avoid sick people. That said, even those insurers willing to play ball have really offered the bare minimum of what the new rules they are willing to play by are.
I hope the AHIP effort does encourage policymakers to increase subsidies so more people can get the coverage they need and want--but that it also strengthens the spine of policymakers' anti-AHIP efforts at greater insurer oversight, cost containment, the public health insurance option, and other important elements that should be included in health reform.
The Governor's legislative actions on health, in full...
Monday, October 12, 2009
HEALTH ACCESS UPDATE Monday, October 12, 2009
HEALTH BILL ROUNDUP: GOV SIGNS KEY MEDI-CAL IMPROVEMENTS, VETOES MOST CONSUMER PROTECTIONS AND INSURER REGS * Signed Bill To Draw Down Over $2.3 Billion in Federal Matching Funds for CA Hospitals and Children’s Coverage; Additional Legislation Needed
* Signed Measure To End Gender Discrimination in Premium Pricing
* Vetoed Bills Would Have Prevented Rescissions; Require Maternity, Mental Health Services; Give Communities Notice Before ER Closures
Governor Arnold Schwarzenegger signed and vetoed over 700 bills yesterday, including several of interest to California's health care consumers.
Governor Schwarzenegger’s actions on end-of-year legislation was mixed for health care consumers. He signed some key proposals to maintain and improve the Medi-Cal program, from getting more federal funds to improving hospital reimbursements, to helping prevent balance billing of Medi-Cal patients, to extending a program for people with disabilities who are working.
But the Governor sided with the insurance industry to veto most of the consumer protections before him. He did sign a key measure to stop women from being charged more than men for premiums, but vetoed other insurance regulation measures to prevent coverage from being rescinded, and ensure that key services, like maternity, mental health and other treatments, are covered.
Here are some of the highlights of the health bills. All bulleted bills were supported by Health Access California.:
MEDI-CAL IMPROVEMENTS, INCLUDING MORE FEDERAL FUNDS
Perhaps the biggest health news was the Governor’s signing of a measure to draw down $2.3 billion in federal funds to increase Med-Cal reimbursement rates as well as support children’s coverage.
* AB 1383 (Jones): HOSPITAL DIVIDEND FEE: would, per federal approval, impose a coverage dividend fee on hospitals for the purpose of drawing down federal funds for increased reimbursement and children’s coverage expansion. SIGNED.
With a tough budget year, a struggling health care system, and Medi-Cal rates that are some of the lowest in the nation, AB1383(Jones) is especially urgent given the enhanced match under the economic stimulus period of the American Recovery and Reinvestment Act.
Other bills that improved the Medi-Cal program included:
* AB 1142 (Price): PROOF OF ELIGIBILITY: To prevent "balance billing" of Medi-Cal patients, 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. SIGNED.
* AB 1269 (Brownley): DISABLED WORKERS: 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 up to 26 weeks. SIGNED.
KEY CONSUMER PROTECTIONS
The Governor vetoed most of the key health care bills on the Governor's desk would provide consumer protections for patients and needed oversight over health insurers, but signed some notable exceptions.
The biggest surprise was the Governor's signing of AB119(Jones), to ban gender discrimination in the pricing of health policies.
Bills that were vetoed included regulations of insurer rescissions, and mandating key benefits like maternity care and mental health services. These were high-profile issues that have been significantly discussed in the national health reform debate, and included in the major health reform proposals in Congress, like H.R. 3200. The bills included:
* AB 119 (Jones): GENDER RATING: to prohibit insurers from charging different premium rates based on gender. SIGNED
A few bills addressed the controversial insurance company practices of retroactively denying coverage, or rescissions.
* AB 2 (De La Torre): INDEPENDENT REVIEW OF RESCISSIONS, 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. VETOED (See attached veto message) * AB 730 (De La Torre): POSTCLAIMS UNDERWRITING PENALTIES: Would increase and direct fines on insurers unlawfully engaging in rescissions and post-claims medical underwriting. VETOED (See attached veto message) * AB 108 (Hayashi): RECISSION TIME LIMIT: Would make clear a 24-month time limit in which insurers have to rescind, cancel, or limit individual health care policies or charge higher premiums because of fraud once a consumer’s application is approved. SIGNED (See attached signing message)
The Governor largely vetoed virtually all the bills that required that health insurance include key benefits, so patients who have been paying premiums don’t find themselves without needed coverage or care. They included:
* AB 98 (De La Torre): MATERNITY COVERAGE, to require all individual insurance policies to cover maternity services. VETOED (See attached veto message)
* AB 244 (Beall): MENTAL HEALTH PARITY, to require most health plans to provide coverage for all diagnosable mental illnesses. VETOED (See attached veto message)
Other pending consumer protections regarding providers included:
* AB 171 (Jones), on DENTAL CREDIT CARDS - 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. SIGNED
* SB 196 (Corbett): HOSPITAL/ER CLOSURE NOTICE: Requires public notice of hospital closure or reduction/elimination of emergency medical services. VETOED (See attached veto message)
Here's a quick overview of the bills supported by Health Access California, and whether they signed and vetoed by Governor Schwarzenegger yesterday...
Insurance Oversight & Market Reforms
AB 119 (Jones): GENDER RATING: Would prohibit insurers from charging different premium rates based on gender. SIGNED
AB 2 (De La Torre): INDEPENDENT REVIEW OF RESCISSIONS: 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. Also raises the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his health history. VETOED
AB 730 (De La Torre): POSTCLAIMS UNDERWRITING: Would impose fines on insurers unlawfully engaging in post-claims medical underwriting. VETOED
AB 108 (Hayashi): RESCISSION TIME LIMIT: Would impose a 24-month time limit in which insurers have to rescind, cancel, or limit individual health care policies or charge higher premiums because of fraud once a consumer’s application is approved. SIGNED
Insurance Benefit Mandates
AB 98 (De La Torre): MATERNITY COVERAGE: Would require most health plans to cover maternity services. VETOED
AB 244 (Beall): MENTAL HEALTH PARITY: Would require most health plans to provide coverage for all diagnosable mental illnesses. VETOED
Medi-Cal Reimbursement, Eligibility & Retention
AB 1383 (Jones): HOSPITAL COVERAGE DIVIDEND FEE: Would, per federal approval, impose a coverage dividend fee on hospitals for the purpose of drawing down federal funds for increased reimbursement and children’s coverage expansion. SIGNED
AB 1142 (Price): PROOF OF ELIGIBILITY: 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. SIGNED
AB 1269 (Brownley): DISABLED WORKERS: 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 up to 26 weeks. SIGNED
AB 171 (Jones) CONSUMER PROTECTIONS: 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. SIGNED SB 196 (Corbett): HOSPITAL CLOSURES: Requires public notice of hospital closure or reduction/elimination of emergency medical services. VETOED
Governor Schwarzenegger has released a first batch of the hostage bills, but is still promising to blanket veto a whole bunch more depending on the negotiations on unrelated water issues.
In the first batch, there's not a lot of health stuff signed. The big news is that virtually all of the requirements on insurance companies to cover certain benefits--from maternity (AB98) to mental health services(AB244)--were vetoed. Not a surprise that the Governor sided with the insurance industry on these issues, but still a disappointment to patients who find out after the fact that the treatment and services they need are not actually covered.
It's the Governor's deadline day for signing or vetoing bills, and crucial health reform bills are being held hostage under a veto threat over the unrelated issue of water.
Several key health measures hang in the balance today, Sunday, October 11th, the deadline for Governor Arnold Schwarzenegger to sign or veto over 700 bills on his desk. The legislature considered many bills of importance to health care consumers this year (a full list is available at http://www.health-access.org/item.asp?id=158), and many of them made it to the Governor's desk.
It's outrageous that the Governor is taking bills on health and other key areas as hostages in order to extract concessions on unrelated water issues. California consumer and patients will literally pay a price if the Governor follows through on his veto threat. One measure would draw down over $2 billion in desperately needed federal funds for California 's hospitals and children's coverage. Other consumer protection bills would stop women from being charged more than men, help prevent coverage from being rescinded, and ensure that key services, like maternity and mental health are covered.
We'll see what happens later today. Here are some of the highlights of the health bills on the Governor's desk.
FEDERAL FUNDS FOR CALIFORNIA :
With a tough budget year, a struggling health care system, and Medi-Cal rates that are some of the lowest in the nation, there’s an opportunity to draw down over $2 billion in federal matching funds. AB1383(Jones) is especially urgent given the enhanced match under the economic stimulus period of the American Recovery and Reinvestment Act. A veto of this act would be a direct loss of money for both California ’s hospitals and for children’s coverage.
* AB 1383 (Jones): HOSPITAL COVERAGE DIVIDEND FEE - Would, per federal approval, impose a coverage dividend fee on hospitals for the purpose of increased reimbursement and children's coverage expansion.
KEY CONSUMER PROTECTIONS:
Several important health care bills on the Governor's desk would provide key consumer protections for patients and needed oversight over health insurers. These are high-profile issues that have been significantly discussed in the national health reform debate, and included in the major health reform proposals in Congress, like H.R. 3200 which also prevents rescission of coverage, gender discrimination, or coverage that doesn't include such basic benefits as maternity care and mental health.
But any reform measure that emerge from Congress will take years to implement -- and California has the opportunity to provide this relief to consumers quickly, and to start the transition to a reformed and improved health system.
Four selected consumer protection bills awaiting the Governor's action are:
* AB 119 (Jones): GENDER RATING, to prohibit insurers from charging different premium rates based on gender. * AB 2 (De La Torre): INDEPENDENT REVIEW OF RESCISSIONS, 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.
EVEN CONSENSUS BILLS:
While some of these bills are contentious, there are some consumer protections that have a clear consensus and yet still face a veto—for a second year in the row. AB 171 (Jones), to prevent growing abuses of dental credit cards, passed with unanimous bipartisan votes in the Senate and Assembly, and with the support of both consumer advocates and the California Dental Association. Last year, an earlier version of this bill was blanket-vetoed by the Governor in a similar fashion, over unrelated budget issues, despite the bills’ broad support.
* AB 171 (Jones), on DENTAL CREDIT CARDS - 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.
This could be the second year in a row that this common sense consensus measure is vetoed over unrelated issues.
All the bills on this list are supported by Health Access California and other consumer and community organizations, and will be updated regularly and available at www.health-access.org. We'll post a report, on the blog, Twitter, Facebook, etc, when we know what happens...
Our need for health care coverage that doesn’t vanish when the jobs vanish becomes ever clearer each month, as the number of newly unemployed piles up. Given the mounting jobless toll – and subsequent swelling of the uninsured population -- it’s a wonder that debate lives on over whether reform is needed.
Surely, by now we all know someone who has been stripped of their livelihood in this recession. Surely, by now most of us feel that, there but for the grace of God, go I.
Yet Congress members are willing to entertain scaling back health care reform’s figurative big tent of coverage, accepting that millions more than first envisioned may be left out in the cold, uninsured.
Moved by helping care for his ailing elderly father, Olbermann deemed it flat-out unfair that those with means -- like himself – had access to quality care, while others without means were shut out of access. The episode is worth watching, if only to witness the passion of his argument.
Meanwhile, matters are worsening in real time, as joblessness continues to broaden the problem Congress is trying to solve. The elephant in the room is getting bigger by the day, so to speak.
A new report by Families USA calculates the impact of the economy’s double whammy on the workforce. Titled “One-Two Punch: Unemployed and Uninsured,” the report seeks to update U.S. Census Bureau figures from 2008 that were recently released and widely reported:
“Given the close link between unemployment and uninsurance, and given the marked increase in the unemployment rate between 2008 and 2009, we estimate that the number of uninsured working-age adults (19-64) today is substantially higher than the Census Bureau’s 2008 estimate.”
In California, the number of uninsured working-age adults in 2008 was 5.4 million, or 24.3 percent of the population. Families USA expects that number to rise to 6.1 million, or 26.7 percent, when 2009’s job-shedding is taken into account.
The new report says California’s unemployment rate has already grown 4 percent, from 7.2 percent in 2008 to 11.3 percent through August 2009 (the 2009 figure is calculated by averaging the jobless rate from January through August.)
By the end of 2009, California will have “suffered the largest numerical loss in health coverage among working-age adults” of all the states, Families USA says. The organization projects that loss at 661,600 adults. Texas is second-worst with a loss estimated at 396,900, and Florida has the third-worst loss, with 297,600 losing coverage.
That elephant in the room? Families USA projects that by the end of the year, the uninsured ranks nationwide will plump up from 46.3 million to 50 million. Pity Congress: It’s not easy to negotiate a solution to a problem that continues to expand as compromises are being crafted.
It's a good letter that was circulated by Senators Brown, Rockefeller and Feingold, and we are proud that our two California Senators have signed on with a majority of the Democratic Caucus for this to be part of health reform. Here is the letter in full:
Dear Majority Leader Reid:
We have spent the better part of this year fighting for health reform that would provide insurance access and continuity to every American in a fiscally responsible manner. We are concerned that – absent a competitive and continuous public insurance option – health reform legislation will not produce nationwide access and ongoing cost containment. For that reason, we are asking for your leadership on ensuring that the merged health reform bill contains a public insurance option.
As it stands, the health insurance market is dominated by a handful of for-profit health insurers that are exempt from the anti-trust laws that ensure robust competition in other markets across the United States. Without a not-for-profit public insurance alternative that competes with these insurers based on premium rates and quality, insurers will have free rein to increase insurance premiums and drive up the cost of federal subsidies tied to those premiums. This is simply not fiscally sustainable.
We recognize that the two Committees with jurisdiction over health reform – the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee – have taken two very different approaches with respect to this issue. However, a strong public option has resounding support among Senate Democrats – every Democrat on HELP, three quarters of those on Finance, and what we believe is a majority of the caucus.
The Senate Finance Committee included a cooperative approach to insurance market competition. While promoting more co-ops may be a worthy goal, it is not realistic to expect local co-ops to spring up in every corner of this country. There are many areas of the country where the population is simply too small to sustain a local co-op plan. We are also concerned that the administrative costs associated with financing the start-up of multiple co-op plans would far outstrip the seed money required to establish a public health insurance program.
Opponents of health reform argue that a public option presents unfair competition to the private insurance companies. However, it is possible to create a public health insurance option that is modeled after private insurance – rates are negotiated and providers are not required to participate in the plan. As you know, this is the Senate HELP Committee’s approach. The major differences between the public option and for-profit plans are that the public plan would report to taxpayers, not to shareholders, and the public plan would be available continuously in all parts of the country. The number one goal of health reform must be to look out for the best interests of the American people – patients and taxpayers alike – not the profit margins of insurance companies.
Health reform is about improving access to health care, containing costs, and giving Americans a real choice in the insurance plan best suited to their needs. We urge you to fight for a sustainable health care system that ensures Americans the option of a public plan in the merged Senate bill.
I was in Washington, DC earlier this week, and had lots of conversations about health reform with folks in and out of the Capitol.
There's a long way to go, but it was clear that there's significant momentum for health reform, and while there are specific and tough issues to work out--details that matter--it was good that the debates were largely over the right issues: affordability, employer responsibility, the structure of insurance regulation and a new exchange, and yes, the public health insurance option. We need to continue to advocate with our members of Congress--our two Senators, and our full House delegation--on all these issues.
URGE GOV. SCHWARZENEGGER TO SIGN CRUCIAL HEALTH REFORM BILLS * Bills Include Measure to Protect Women from Being Charged More Than Men for Coverage * Another Bill Would Place Burden of Proof on Insurers Before Rescission of Coverage * Yet Another Would Require Maternity Medical Services to be Standard in Policies
* More Updates on blog.health-access.org: Speaking Truth to the Power of Insurers; Valuing Value: The Practices and Policies of Wellpoint/Anthem Blue Cross; Pass the Garlic; Pick Up A Good Book; The Arguments Against Reform; The Value of Coverage, Literally; Long Live the Public Option!; Will the Governor Sign on to Greater Insurer Oversight?
Governor Arnold Schwarzenegger has until October 11th, THIS SUNDAY, to sign into law the bills on his desk. He is threatening to veto them based on the unrelated issue of water.
The legislature considered many bills of importance to health care consumers this year (a full list is available at www.health-access.org), and many of them made it to the Governor's desk.
Four important health care bills on the Governor's desk would provide key consumer protections for patients and needed oversight over health insurers. All four have already undergone intense scrutiny in the Legislature and passed, as California's state representatives heeded constituents' demands for tougher regulation of health insurance companies.
With federal health reform discussions progressing in Washington, D.C., this is the perfect time for the Governor to model proactive leadership by signing these consumer protection measures. The major health reform proposals in Congress, like H.R. 3200, address these issues as well, whether preventing rescission of coverage, gender discrimination, or coverage that doesn't include such basic benefits as maternity care and mental health.
But any reform measure that emerge from Congress will take years to implement -- and California has the opportunity to provide this relief to consumers quickly, and to start the transition to a reformed and improved health system. Our state should embrace these same reform goals that are encapsulated by both the national proposals and California bills.
Tell the Governor You Want California to Lead, not Lag Behind, the Movement to Reform the Health Insurance Martket -- and Help Californians Be Healthy!
Call and fax the Governor's office before Sunday's deadline for him to sign the bills!:
PHONE: 916-445-2841 FAX: 916-445-4633
The crucial bills awaiting the Governor's action are: * AB 119 (Jones): GENDER RATING, to prohibit insurers from charging different premium rates based on gender. * AB 2 (De La Torre): INDEPENDENT REVIEW OF RESCISSIONS, 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.
Tell Governor Schwarzenegger he should sign these bills... PHONE: 916-445-2841 FAX: 916-445-4633
Yesterday, it was amusing to see colleagues in person, and on Twitter and blogs, in a anxious waiting game. For Senator Max Baucus and others, it probably was like a colleage applicant getting SAT scores.
There was good summaries and reactions by good commentators, bloggers, and others. The score was that it is paid for and actually reduces the deficit over 10 years; that it expands coverage but does not get everybody covered, not providing the assistance needed to be fully universal.
The Senate Finance bill is slated to be voted upon next Tuesday. When that happens, all five committees of jurisdiction will have passed a major health reform bill, all with similar frameworks, even if the details--which are important--are different. There are already negotiations about a merger with a more-consumer friendly Senate Health Committee bill. A combined bill is likely to start being debated on the floor of the Senate the week after that.
It’s heart-wrenching to see the long scars, some still deep red, crisscrossing the scalp of 19-year-old Penelope DeMeerleer, who has half a head of thick blond hair and the other half practically mapping out her medical history of 44 brain surgeries.
But don’t feel sorry for Penelope. That’s not what she’s after today at Tuesday’s Health Care for America Now protest in Sacramento. Today, she’s taking on the role of an articulate, proud, sign-waiving activist for real, meaningful health care reform in one of HCAN’s rallies against the insurance industry’s heavy-handed influence on health reform in Washington.
Hundreds of people supporting strong health care reform showed up for protests and “die-ins” in Sacramento, San Francisco, Los Angeles, Santa Ana and San Diego. Some even staged a “crime scene” with actors and yellow tape (saying “It’s a crime to deny care”) to illustrate the raw mortality statistics: In the U.S., one uninsured person dies every 12 minutes, and 45,000 uninsured die every year.
In Sacramento, across from the State Capitol, Penelope doesn’t play the part of a victim. Except for the dire financial consequences, hers is a story of triumph over insurance executives who tried to screen her out as a hopeless, helpless case – in effect, rationing care by insisting she’d never be able to walk or talk and would likely live life “as a vegetable,” she says.
But Penelope’s mother found a doctor who believed she’d improve and wanted to make her better. So in a way, Penelope illustrates what happens when the insurance companies don’t win after deeming patients’ medical conditions too grave (and expensive) to treat.
Penelope was born with a rare congenital disease called hydrocephalus, characterized by the inability of spinal fluids to drain properly. The way it usually works is that spinal fluid moves up the spine, to the brain, and drains back down. In Penelope’s case, the fluid travels up to the brain, and gathers there, causing swelling.
She needs a surgically implanted cerebral shunt to help the fluid drain back down and regular monitoring to make sure it is working properly. Such shunts are a medical device not much improved since their development in the 1960s, and about half of all shunts fail within two years, requiring further surgery to replace them.
In the last quarter-century, the survival rate for people with Penelope’s condition has improved dramatically, to 95 percent. Intellectual disabilities related to hydrocephalus have dropped significantly – by half. Penelope is a bright, well-spoken young woman who understands and accepts her need for continued care, but she does not accept the financial burden insurance companies put on her family.
Holding a hand-lettered sign that said, “We have insurance and jobs and we still can’t afford our co-pays!” Penelope and her mother said her insurance cost $700 a month when she was a baby, and then went up to $1,200 a month, roughly equal to a mortgage payment.
Penelope’s mother, Pam Tuohy-Novinsky, says: “We pay our co-pays, we pay taxes, we are middle-class, hard-working people. But for 19 years, we’ve been getting deeper in debt to insurance companies just to keep her alive.”
And Tuohy-Novinsky’s convinced that keeping Penelope alive was not what the insurance company had in mind. “In the beginning, Blue Cross-Blue Shield said they expected her to die. They seemed to want her to die…,” Tuohy-Novinsky said, as other activists milled around with signs, buttons, petitions and banners demanding insurance reform. “I believe health care is a civil right -- and this is a civil rights protest.”
The practices and policies of Wellpoint/Anthem BlueCross...
Today, Tuesday, October 6th, Californians will protest the practices of Anthem Blue Cross of California, owned by Wellpoint.
Along with over 100 events around the country, these protests are escalating. The California events will be in front of their offices right before or around lunchtime in Los Angeles, San Francisco, Sacramento, Santa Ana, and San Diego. There's more information at the California website at Health Care for America Now!, at http://hcanca.org/
This short video on Wellpoint, produced by www.SickForProfit.com, features a California woman who is denied care by the health insurer, and also focuses on a Wellpoint court case against the entire state of Maine:
Thousands of people are sending twitters to House Republican leader John Boehner, at @GOPLeader.
He said, remarkably, "I'm still trying to find the first American to talk to who's in favor of the public option, other than a member of Congress or the administration." Really? He probably doesn't get out much.
So folks on the internet are actively introducing themselves, and expressing their support for the public option.
But he also said: "This is about as unpopular as a garlic milkshake."
Politico asked, "Isn't a garlic milkshake healthy?" to which he replied, "I don't know I haven't tried it." Politico noted that SurveyUSA poll showing three-quarters of Americans backing a public option choice.
Dissing garlic is a big deal for California, and especially Gilroy, the garlic Capitol of the world, which hosts an impressive garlic festival every year.
Gilroy's Congressman, California Representative Mike Honda (who is also chair of the Asian Pacific American Caucus), defended both garlic and the public health insurance action. As the Sacramento Bee has the story, as does the Angry Asian Man blog:
After hearing Boehner's comments, Congressman Mike Honda felt compelled to act. A recent New York Times/CBS poll found broad support, over 65%, for the public option across the nation. But wait, did Boehner just talk some smack about garlic?
Congressman Honda represents California's 15th District, which he says is rich not only in its support for the public option, but also rich in its garlic production. Gilroy, the garlic capital of the world, is home to the world-famous Gilroy Garlic Festival.
To inform Mr. Boehner of his mistake, Congressman Honda hand-delivered him a basket of California garlic, and a limerick illustrating America's desperate need for health care, and the public option:
Two things make for a strong healthy heart. Gilroy garlic, for one, a good start. Public option? Also high, In the American eye, 65 percent n'er want it to part.
Let's hope the prospects of the public health insurance option are better than the doggerel.
One of the benefits of living in these times is that information flows so freely. As a nation, we really cannot be hoodwinked unless we choose to.
Those who want to expand their fact-based understanding of the need for health care reform can find a number of reliable, unbiased news sites to visit online, such as the Washington, D.C.,-based independent Kaiser Health News and California Healthline, an aggregate site produced by the California HealthCare Foundation.
And then, there's the bookshelf as well. I recently picked up a copy of longtime Washington Post reporter T.R. Reid's "The Healing of America: a Global Quest for Better, Cheaper, and Fairer Health Care." (I know, I know...it's not exactly the blogosphere, but it is bound in an old-fashioned way with 277 pages -- and oh soportable!)
Published in 2009 by The Penguin Press, the book offers a refreshing bird's-eye view of what the world has to offer in terms of health care delivery systems. Reid's travels and reportage pivot around his search for treatment of a bum shoulder; he'd badly injured his right shoulder decades ago, and the effectiveness of the initial fix -- surgery and steel screws --has long since worn off, leaving him with pain and stiffness (albiet not disability) and in search of quality, affordable care.
From India to Japan, from France to Taipei, from Britain to Canada and beyond, Reid roams the continents, checking out his options.
That's after starting in the United States, where his visit to "a brilliant American orthopedist" results in a proposed surgical intervention that Reid says reflects the (flawed) "high-tech ethos of American contemporary medicine."
In other words, a solution that involves what seems like the most complicated, space-aged, super-techno, state-of-the-art, expensive, over-the-top procedure possible. The author writes:
"This operation -- it is known as total shoulder arthroplasty, Procedure No. 080.81 on the National Center for Health Statistics' roster of 'clinical modifications' -- would require the orthopedist to take a surgical saw, cut off the shoulder joint that God gave me, and replace it with a man-made contraption of silicon and titanium. This new arthroplastic joint would be hammered into my upper arm and then cemented to my clavicle.... I had serious reservations about Procedure No. 080.81. The saws and hammers and glue made the procedure sound rather drastic. It would cost tens of thousands of dollars (like most major medical procedures in the United States, the exact price was veiled in mystery). The best prognosis I could get was that the operation might or might not give me more shoulder movement...A certain skepticism crept into my soul about this high-tech medical intervention. I departed my American surgeon's office and took my aching shoulder to other doctors, doctors all over the globe. Over the next year or so, I had my blood pressure and temperature taken in ten different languages...."
Reid admits the shoulder wasn't really all that bad, but his condition did provide a way in the door to medical offices worldwide. His thesis? "We can bring about fundamental change by borrowing ideas from foreign models of health care."
He pooh-poohs the notion that anybody who dares say that other countries could offer lessons to America is unpatriotic or anti-American.... "The real patriot, the person who genuinely loves his country, or college, or company, is the person who recognizes its problems and tries to fix them. Often, the best way to solve a problem is to study what other colleges, companies, or countries have done."
And why not? Take Japan, for one. Japan has the oldest population in the world, and the Japanese go to the doctor on average 14 times per year, compared to an average of 5 times for an American. The U.S. average expenditure per capita is $7,000 on health care; Japan spends about $3,000.
Surely, we can still learn a lot from other nations older and more experienced than ours. Reid's book provides plenty of mind-expanding experiences and ideas in a fairly breezy voice, neither leaden with policy nor politics.
A New York Times online book review concludes with the line: "Evidently, when it comes to health care, America is exceptional only in that it’s a rich country with a poor country’s approach to taking care of people."