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You get what you pay for...

Monday, November 30, 2009
Much more has been written on the new CBO report on whether premiums will go up or down under health reform. I won't go into all the details, but a few points.

It's hard to make broad statements about whether premiums go up or down, because so many people are in such different circumstances, and people changes those circumstances frequently. The person getting great coverage heavily subsidized by their employer today may be unemployed tomorrow, paying 100% of a very high premium, if not denied for pre-existing conditions. A young person in the individual market could find his specific policy getting marked up significantly, even if the overall market is not a problem.

That said, it makes some key points: Even without taking into consideration a range of cost saving mechnisms (prevention, payment reforms, etc), premiums will go down for many people, especially low- and moderate-income folks who have the toughest time affording coverage, and who will get subsidies to help pay for coverage.

Even many of those who are not subsidized will have their coverage go down. For those who don't, it largely because they will be getting better, more comprehensive policies. These are folks who are largely underinsured, who now will be fully insured. So when opponents talk about some who may see an increase in premiums, they are not doing an apples-to-apples comparison. The minimum benefit standards are a feature, not a bug, in that people won't be suckered into "junk" coverage that leaves them in a lurch when they actually get sick.

For most people, the big takeaway is that for the vast majority of people, they will get a guarantee that health premiums for meaningful coverage won't be more than a certain percentage of their income. Because we will subsidize low-and-moderate income families based on their income, we will fundamentally change the regressive nature of health insurance. Under health reform, we will move toward a system where we pay premiums based on how much we can afford, rather than how sick we are--which is our current practice.

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posted by Anthony Wright | Permalink | 11:51 PM


A new week...

To provide the latest information about health policy and politics, from the California budget to the federal health reform debate, Health Access is piloting a new format to our regular Health Access Update, highlighting resources on our website, blog, Twitter feed, Facebook page, coalition partners, and elsewhere. Sign up by typing your E-mail address on the front page of our website. Please let us know what you think. Here's this week's update:

SENATE VOTES TO START FLOOR DEBATE ON HEALTH REFORM: The U.S. Senate will come back from Thanksgiving today and start floor debate on health reform, after a crucial vote before the break. If you follow us on Twitter, you'd have gotten the real-time updates as Senators voted affirmatively, 60-39, on a "motion to proceed" to debate health reform. The House of Representatives passed their own version of health reform three weeks ago.

Health advocates thanked California's Sen. Barbara Boxer and Sen. Dianne Feinstein for voting, with all Democrats and independents, to move health reform to the next stage.

The next day, on Sunday, Senator Feinstein went on to appear on NBC's Meet the Press, where she made strong points on the urgency of reform, the problem with our for-profit insurance industry, and the fabrication of opposition facts. Watch it and read about it on our blog.

Much more to come in the next few weeks, as Senate leadership hopes to finish debate and get the necessary 60 votes to stop debate before Christmas.

NEW BUDGET FIGURES SPARK SPECULATION ABOUT ADDITIONAL CUTS: Due to the economic downturn, things were decidedly less promising in California, where we were busy explaining, explaining, and explaining in the media that any additional budget cuts in health and human services would be beyond brutal in terms of their impact on individuals and families, on our economy, and on the health system on which we all rely. A fact sheet of the health budget cuts in the current budget is available on our website.

Governor Schwarzenegger is expected to release in January both a mid-year cuts package and a 2010-11 proposed budget. Many crucial health program are expected to be in jeopardy, as elected leaders seek to address another massive anticipated shortfall of upwards of $20 billion for the next year-and-a-half. Health Access will be actively organizing to prevent the worst of these cuts, and to advocate for the revenues that are needed prevent the cuts and sustain these programs.

MEDICAID WAIVER GETS LEGISLATIVE HEARING: Meanwhile, an administration proposal for a federal Medi-Cal waiver was given a hearing by the Senate Health Committee. This process would reshape for the next five years the Medi-Cal program, which provides coverage to seven million low-income Californians, largely children, parents, seniors and people with disabilities, and provides core funding to safety-net hospitals and other providers.

The Assembly Health Committee is expected to have its own informational hearing on Thursday, December 10th. Health Access' new paper discussed how the waiver may offer a bridge to health reform.

HOLIDAY PARTY: There's lots going on during December, but if you are in the Bay Area, take the time to join Health Access California and the California Pan-Ethnic Health Network for a holiday celebration in the Bay Area. Health Access and CPEHN are hosting our annual holiday celebration in Oakland on Wednesday, December 9.

The location is Max's of Oakland, 500 12th Street, at the Oakland City Center. (12th Street BART). Here's a map. It'll be from 4 p.m. to 7 p.m. Please RSVP to Pam Flood at pflood@cpehn.org. Hope to see you there!

Any suggestions about the new update format, or questions about its content, should be directed to Cynthia Craft at Health Access, at ccraft@health-access.org.

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posted by Anthony Wright | Permalink | 6:44 AM


Medical bankruptcies are rising....

Wednesday, November 25, 2009
Even as reform makes its way through Congress, medical bankruptcies -- a term hardly known 20 years ago -- appear to be on the rise, says the New York Times.

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posted by Cynthia Craft | Permalink | 10:40 AM


Is Lieberman arguing against Big Bird?

Tuesday, November 24, 2009
Senator Joe Lieberman's latest argument against the public health insurance option struck me strange:
"This is a radical departure from the way we've responded to the market in America in the past," Lieberman said Sunday on NBC's "Meet The Press." "We rely first on competition in our market economy. When the competition fails, then what do we do? We regulate or we litigate. ... We have never before said, in a given business, we don't trust the companies in it, so we're going to have the government go into that business."

Ezra Klein of the Washington Post thought that was a wierd comment, too:
"What does he think Social Security is? Or Medicare? Or public fire departments?"

To be fair, his list includes responsibilities that the private industry largely shuns (there's no market for private fire protection), or which the government is the main provider and private industry is a structured alternative (Medicare Advantage) or a supplement (private retirement plans).

The model for the public health insurance option is one where the government isn't the sole provider, but is one among a range of options. One analogy used by Senator Schumer is public universities, UC-Berkeley being an excellent option alongside private colleges like Stanford. But even there, the public health insurance option is not going to be subsidized like the UC system (although less so, as the protests this week show), nor as dominant in terms of being the real and only option for so many Californians.

Maybe a better analogy for Senator Lieberman is public broadcasting, which he has strongly supported over his years (at least when he was a Democrat). Public radio and television stands alongside traditional private radio and television stations as one of several options. Yes, public broadcasting gets a small subsidy, but it's tiny compared to its overall budget. It has been structured with different incentives, and thus has been able to respond to market failures: for example, specializing in educational children's television programming and informational documentaries all of which were unique until the explosion of cable channels; even now, it is an important launching pad for programs. In radio, it has focused on in-depth news, and there's nothing like it on the dial.

There's been a lot of online commentary about how the public health insurance option, given all the compromises to come and already made, may not be worth it. We need to still advocate for a public option that has strong negotiating power, that is national in scope, and begins on day one. But even if it is not available to everybody on day one, or doesn't save all the money that a stronger version does, I do think there are other reasons for it. With a different structure and accountability that the private insurers, it has the real potential to innovate in areas of market failures: Maybe it specializes in really doing the best possible treatment and management of asthma, diabetes, and obesity. Maybe it figures out new ways to provide access to rural populations. Maybe it is just a "safe harbor" for people against continued abuses by private insurers--much like PBS is a safe harbor for parents against TV commercials.

There are many other important issues as well in the health reform debate, from affordability to employer responsibility. But the public health insurance option continues to be a key concept worth fighting for, even with some of the compromises made.

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posted by Anthony Wright | Permalink | 1:02 PM


Senator Feinstein Meets the Press

Sunday, November 22, 2009
Fresh from voting to begin debate on health reform, California Senator Dianne Feinstein was on NBC's Meet The Press this morning. (We tweeted her comments at @healthaccess on Twitter.)

Earlier this year, Senator Feinstein’s comments on health reform were noncommittal and even skeptical. She had a website post that indicated her “concerns” with health reform. But as she’s focused on the problem and the solution, she has become more convinced of the urgency of the need, as she stated the urgency of the problem: "The time has come to really see that people who have no insurance can get insurance."

She also seems to have more appreciation for the solution proposed. Always a moderate at heart, she described the bill as “incremental,” in a positive way. "The good part about this bill is that it is structured so it is phased in, so over time we can watch it, we can change it." She cited that some help comes early, like small business tax credits, and coverage for those denied for pre-existing condition,. Other changes, like setting up the exchange and the public option, come online in 2014, and she seemed comforted that it would give us time for adjustments if needed.

As she indicated in a new health reform statement on her website last month, Senator Feinstein was clearly influenced by the T.R. Reid book that compared health systems from around the world. A conclusion of the book is that while several countries have different systems, the U.S. stands out, and not in a good way. As Senator Feinstein said on Meet the Press, "America has serious problems with respect to health care. Virtually every other developed country has a better system than we do. Ours is costly, in places it is ineffective, it's deeply troubled."

But then Feinstein went further, showing that her centrism is not incompatible with a strong critique of insurance companies and our current for-profit system: "No developed country on Earth has a huge for-profit medical insurance industry that we have: 480% profit in 8 years. Premiums skyrocketing." She described that she had five California Daughters of Charity hospitals come to her, and talk about how they face a 17% in premium hike for their 6,000 workers, yet only got back 5% in rate reimbursement. The premium increase wiped out their operating capital for 2009. She argued strongly for a public health insurance option, and for a rate regulation authority.

She also pushed back against the wild falsehoods by the opposition. "I looked at the Republican talking points on the 2.5 trillion figure that is their cost [for health reform]. There's no substantiation for that... What [the CBO] does say: The deficit savings is $170 billion."

Senator Feinstein did Californians right with her vote to move health reform forward, and in her comments on health reform this morning.

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posted by Anthony Wright | Permalink | 9:47 AM


Senate votes to move forward on health reform!

Saturday, November 21, 2009
Earlier tonight, the U.S. Senate voted on a "motion to proceed" to begin debate on a historic comprehensive health reform proposal, by a vote of 60-39. (All Democrats and Independents voting yes, all Republicans voting no, with GOP Senator George Voinovich not present.)

We thank California Senators Boxer and Feinstein for voting to move forward on the debate for desperately needed comprehensive health reform. Given the extent of California's health crisis, we need to move this bill, and work on the Senate floor to make it better.

The bill would provide stability and security for those who have coverage, and that would extend affordable coverage to those who don't. Californians are concerned that coverage won't be there for them when they need it, and this bill provides our families with much needed security from financial ruin.

Californians have a particular interest in this debate. Californians are more likely to be uninsured, face a higher cost-of-living, are at greater risk to be denied for coverage for pre-existing conditions, and are less likely to be offered on-the-job coverage.The Senate bill would provide crucial financial assistance to small businesses and low- and moderate-income families, expand our safety net, provide key consumer protections against insurance company abuses, and provide the choice of a public health insurance option.

There are areas where we will push to improve the bill, closer to where the House bill is in affordability, inclusivity, and employer responsibility. We need to do better to ensure affordable and meaningful coverage both in terms of what low- and moderate-income families pay in premiums, and in out-of-pocket costs. We need to do better secure on-the-job coverage for working families. We need to remove unnecessary paperwork and prohibitions for people to use the new health insurance exchange. But despite these details, this is a good framework for moving forward.

What we needed tonight was to move the bill foward. We are proud that California's Senators did the right thing for our state. We look forward to them taking quick action so that this legislation can become final law.

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posted by Anthony Wright | Permalink | 5:23 PM


C-SPAN Saturday night!

Friday, November 20, 2009
The U.S. Senate is currently debating health reform, and California Senator Barbara Boxer just announced on Twitter that she will be speaking on the floor at 6pm Eastern, 3pm Pacific.

We are leading up to a key vote Saturday night, 5pm Pacific. C-SPAN will be broadcasting it live.

In the arcane rules of the Senate, 60 votes are needed--given the united Republican opposition, that means all Democratic-caucusing Senators--just to begin the debate in the Senate.

For more information on the Senate bill, here's two central hubs of fact sheets, video clips, and information:

Here's a specific link for many fact sheets on lots of specifics about the Senate bill:

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posted by Anthony Wright | Permalink | 1:55 PM


The California budget mess continues...

The budget news got worse this week with a new LAO report: "California's Fiscal Outlook: The 2010-11 Budget." It states:

Our forecast of California’s General Fund revenues and expenditures shows that the state must address a General Fund budget problem of $20.7 billion between now and the time the Legislature enacts a 2010–11 state budget plan. The budget problem consists of a $6.3 billion projected deficit for 2009–10 and a $14.4 billion gap between projected revenues and spending in 2010–11. Addressing this large shortfall will require painful choices—on top of the difficult choices the Legislature made earlier this year.

Readers of this blog will know the painful cuts already made, but here's a Health Access handout that includes a full list of the health cuts made in just the last year, from the elimination of dental and 10 other benefits for adults in Medi-Cal, to the zeroing out of state funding for community clinics.

It's hard to imagine the severity of the cuts that are left, a point I make in this Sacramento Bee article by Kevin Yamamura. Do we go back to eliminating the Healthy Families program that covers 900,000 children, a mere few weeks after a big-deal signing ceremony trumpeting the saving of the program? What else?

Jean Ross of the California Budget Project is right that we need to raise revenues, and start with repealing the corporate tax breaks that were granted in the last budget. The LAO agrees that the budget needs to include revenues, not just cuts.

Much more to come...


posted by Anthony Wright | Permalink | 12:12 AM


U.S. Senate releases its bill...

Wednesday, November 18, 2009
Senate Majority Leader Harry Reid unveiled the new Senate health reform proposal today, a merger of the bills produced by the Senate HELP Committee and the Senate Finance Committee.

All 2074 pages of the bill, H.R. 3590, are available here, at http://democrats.senate.gov/.

There's been some quick responses on Twitter and blogs like The Treatment and the Wonkroom.

California blogger David Dayen live-blogged the press conference, and posted this video:

The immediate drama is whether Democrats will be able to get the 60 votes (requiring all Democratic-caucusing members) to start the debate on the measure later this week. Senator Baucus is in Montana with a family emergency; there's about 3-5 conservative Democrats whose vote is a question, both for the first vote to start the debate, and the vote to end the debate and allow the bill to be voted on.

Republican Senators have sought to delay the bill as much as possible. Senator Coburn is potentially going to force a full reading of the bill, a procedural stalling tactics. The best Twitter conversation was who could be made to do the reading, with suggestions including uninsured Americans to Christopher Walken to William Shatner.

As details come out about the bill, we'll continue to post more info here, and on our Twitter account, at www.twitter.com/healthaccess

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posted by Anthony Wright | Permalink | 6:57 PM


Senate Health hears Medi-Cal waiver ideas...

The Senate Health Committee, chaired by Sen. Elaine Alquist, met Wednesday to hear panels of experts share ideas for how the state’s Medi-Cal program could be restructured through the development of a Medicaid waiver.

The waiver that California hopes to obtain from the federal government next year would allow the state to stretch the boundaries of Medicaid’s current rules. Administration officials, including David Maxwell-Jolly, Director of the CA Department of Health Care Services, argued that the proposed changes would help the state’s Medi-Cal program save money and improve coverage for California’s most vulnerable citizens. The focus of their talk, and a concept paper that was released a few weeks ago, was finding savings and in organizing and coordinating care of patients, especially those with chronic conditions.

The restructured health care delivery system would seek to do more with less, saving the state money in the long run. The informational hearing came as the Legislative Analyst’s Office predicted that California’s revenue shortfall will balloon to $20.7 billion in 2010.

Several advocates and health policy experts expressed hope that the state will pump any savings resulting from the waiver program back into health care services to prepare the state for a smooth transition into national health care reform, should federal legislation pass.

Proposed health care reform legislation in Congress would go into effect in 2013, midway into the five-year waiver period that the state hopes to begin in September of 2010.

Health Access California’s Beth Capell offered suggestions as to how the state could take advantage of the timing and dovetail into the rollout of federal reform by, for example, simplifying eligibility requirements before 2013.

“We’ll have to be ready to go from zero to sixty on January 1, 2013,” Capell told the committee, recommending that existing programs prepare auto-enrollment processes. That way, California would be poised to get as many Californians enrolled on day one, and take advantage of federal dollars for a reformed health care delivery system right from the start. These ideas were also explained in a Health Access Medi-Cal waiver paper released this week.

Several panel members fielded questions from the Health Committee members regarding the best methods of care in California.

Among those testifying about best practices and enhanced outcomes were a few administrators of a few spotlighted "medical home" and managed care systems already in place in 26 counties. They reported that their coordinated care systems led to fewer emergency room visits, greater attention to “whole body” wellness, better preventative care and more attention to co-occuring mental health and substance abuse cases. In addition, these counties were able to attract some uninsured Californians who had been putting off medical care, a practice that could lead to higher medical bills in the long run.

But Senator Alquist also raised questions to Administration officials, including whether all existing managed care plans actually did care coordination, and whether they were ready to take the responsibility to provide quality care and coordination in accordance with the special needs of seniors and people with disabilities in Medi-Cal.

Saying the hearing had proved informative, Senator Alquist said, “There’s no reason why we can’t produce a better product at a reduced cost.”

Western Center on Law and Poverty legislative advocate Elizabeth Landsberg expressed concerns about mandatory managed care, but supported a “medical home" model, as did several testifiers. The medical home model has a lot in common with managed care plans in that it serves as a hub of coordinated care for patients. Beneficiaries would have a practitioner who serve as their “medical home,” a source from which all medical and behavior care, diagnostic tests, medications -- and so on -- can be linked and coordinated.

There was some questions as to whether individual physicians would be prepared to serve as a medical home model, and if the Administration's proposal was simply to shift many seniors and people with disabilities into existing managed care plans.

The Department of Health Care Services is leading the waiver development, and plans to convene a panel of stakeholders as well as technical committees for input and feedback.

Alquist asked DHCS administrators to be prepared to report back to the committee with more details as the process progressed.

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posted by Cynthia Craft | Permalink | 5:16 PM


A bridge to health reform?

Lots going on today. At 2pm Pacific, Senate Majority Leader Reid will unveil the new, combined version of a health reform proposal to his Democratic Senate colleagues, thus starting weeks of debate on the measure. The drama is whether all 60 Democratic-caucusing Senators will vote to allow such a debate to take place, in order to prevent a Republican filibuster. It's an important next step in getting health reform passed.

Back here in California, health reform will be front and center in its own way. At 1:30pm, the Senate Health Committee, chaired by Senator Elaine Alquist, will hold an informational hearing on "Redesigning California's Medi-Cal Program: Examining the Potential for Cost Savings and Program Improvements."

As we have reported before, California's Medi-Cal waiver agreement with the federal government is up for renewal next year. A new waiver would set the rules for the program, which now covers 7 million Californians, mostly low-income children, parents, seniors, and people with disabilities, for the next five years.

Those next five years would take us into the full implementation of health reform, should any of the pending proposals in Congress pass. The waiver process poses a challenge, since consumer advocates are always wary of changes that might undermine patients' rights or access to care. But it can be a significant opportunity to increase access to care and coverage and transition Medi-Cal to a newly reformed system.

We'll have a full report on the hearing later, but here's our new paper by Health Access California on a new Medi-Cal waiver for California, about what we see is the potential, and concerns, in a new waiver.

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posted by Anthony Wright | Permalink | 9:27 AM


So it's come to this....

Tuesday, November 17, 2009
I had to laugh out loud in my sedan while listening to the local NPR affiliate station recently. Think of it as an absurd, tragic-comic commentary on the present state of our health care delivery system. It was a blurb of no more than 5-10 seconds paid for by the underwriter of the local broadcast. A prominent managed health care plan touted its name, followed by a marketing slogan intended to attract more consumers:

". . . where doctors take extra time to get to know each patient."

In our current health care system, that's not standard, that's a selling point.

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posted by Cynthia Craft | Permalink | 5:35 PM


Some reading on the House reform bill...

Monday, November 16, 2009
As we start the Senate debate on health reform, some key items about the health reform that passed the House of Representatives:

Politico's Jonathan Allen and Patrick O'Connor has the scoop on some of the behind-the-scenes back-and-forth around the House of Representatives, which highlights at least three California Representatives, starting with Representative Dennis Cardoza. The article points out an interesting footnote, that the last two Democratic votes for the bill were Californians, Rep. Maxine Waters (who waited to be the deciding vote #218) and afterwards, Rep. Loretta Sanchez.

The House bill is the focus of this week's Health Wonk Review, hosted by Louise Norris at Colorado Health Insurance Insider, which features some of our posts, here and elsewhere.

Health Access supports H.R.3962, as we wrote in our letter supporting the health reform measure. Our letter does mention areas that we agree, and areas where it could improve. What it doesn't mention is the anti-abortion Stupak amendment, which was added on the day of the vote. It's an overreach, going beyond extending the current federal prohibition against federal funding of abortions, to impact any private health plans offered in the exchange.

The amendment is bad in its policy, but also in its politics. The House bill was a very good bill, in most cases better than in Senate counterpart. But the Stupak amendment is a major exception to that rule, and this makes it harder to rally aggressive support for the other House provisions.

There are other issues with the House bill that need to be worked out in a conference committee. Lisa Girion at the Los Angeles Times has an important story about how provisions in health reform might undermine state-based consumer protections. Health Access, which sponsored many of those HMO patients' rights in the past two decades, is working with Senators and members of Congress to point out the issues, so that national health reform serves as a floor, not a ceiling, for consumer protections. Luckily, as the article indicates, some of our members of Congress, from Susan Davis to Jackie Speier to John Garamendi, were heavily involved in the state passage or implementation of those protections, and so have a base of knowledge and passion on this issue.

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posted by Anthony Wright | Permalink | 9:17 PM


From a Central Valley Congressman to another...

Today, with Senate debate on health care reform gearing up for action, former Congressman Richard Lehman, of the Central Valley town of Sanger, had words of support for his House successors, U.S. Rep Dennis Cardoza and U.S. Rep Jim Costa.

Lehman penned an opinion piece published in the Fresno Bee, voicing his appreciation of the votes in favor of health care reform that Cardoza and Costa cast in the House:

"One can demonstrate true leadership and advocate for your district, as Costa and Cardoza have done, and try to address the difficult challenges facing us. Costa and Cardoza have demonstrated once again their choice to take the political hard road and advocate for one of the poorest regions of the country and try to improve our health care system."

Representatives Costa and Cardoza were the subject of major efforts to urge them to support health reform, as among the last to commit to vote for the reform. They did vote for the bill, and there were lots of reasons for them to do so. Health reform will be a major assist to the Central Valley, which needs the help.

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posted by Cynthia Craft | Permalink | 4:03 PM


Cooking the books...

We knew that the opponents of health reform will attempt to manufacture research findings against the pending proposals. Ken Jacobs at UC-Berkeley earlier offered here a point-by-point takedown about some citations made on the House floor about the supposed negative economic impacts of health reform--statistics that were not just inflated, but basically made up.

Now Michael Schear at the Washington Post has obvious evidence of this, as it has obtained an E-mail from the Chamber of Commerce's senior health policy manager soliciting funds from business lobbies for a study about the jobs impact of health reform. The E-mail states: "We are seeking 4-5 other groups to contribute $5k so that we can move forward as soon as possible, especially considering that Leader Reid has filed a rule 14 to begin debate as early as Tuesday.. The longer we wait, the less chance we have of influencing the debate... If you know of any other trade associations we should approach, please let me know."

They plan to use the money to hire a "respected economist" to produce a study. Then, "The economist will then circulate a sign-on letter to hundreds of other economists saying that the bill will kill jobs and hurt the economy. We will then be able to use this open letter to produce advertisements, and as a powerful lobbying and grass-roots document."

We suspected as much from the opposition, but never had the process of manufacturing data laid out before us so clearly.

Even with this evidence, the Post article tries to be even-handed: "The proposed economic study by the Chamber is the latest example of attempts by advocates and opponents of health-care reform to influence the debate with economic studies whose authenticity is later questioned by their adversaries." But what if one side is just much, much more willing to make stuff up?

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posted by Anthony Wright | Permalink | 11:09 AM


On jobs impact, more untruthful than just making it up...

Wednesday, November 11, 2009
At the New Republic's The Treatment, I recently wrote about the need for the employer responsibility provisions in order to secure on-the-job coverage, and about where business is regarding health reform.

Those who oppose an employer requirement, and health reform in general, have been making wild claims about the supposed negative impact. To fact-check these claims, here's a guest commentary by Ken Jacobs, Chair of the UC-Berkeley Center for Labor Research and Education:

Over the last few months, we have heard any number of outrageous claims about the potential impacts of the proposed health care bills (death panels, end to private insurance, etc.). Still, the claim made by Republican speaker after speaker during Saturdays House debate that the bill would result in a loss of 5.5 million jobs stands out. They even go so far as to say (see House Republican Leader John Boehner’s website), that the research was based on a methodology developed by Dr. Christina Romer, Chair of the Council of Economic Advisors, and Jared Bernstein, the Vice President’s Chief Economist. What’s going on here?

The Economic Policies Institute’s Josh Bevans pointed me to
Politifact, which does a good job of debunking the claim. It turns out that the number comes from Republican staff of the House Weighs and Means Committee.

They started with an estimated tax increase on employers from the play or pay provision of $300 billion. It is not clear where this number comes from; the CBO estimate is $163 billion over ten years. They treat that number as though it is a direct reduction in GDP for a single year, thereby increasing the projected impact tenfold. To get the total impact on GDP they use a multiplier from a 2007 paper by Christina Romer which explicitly states that the analysis in the paper pertains to tax increases or cuts that change the total spending in the economy. This would be the case, for example, for a tax increase to fund the deficit where there is no corresponding increase in government spending, or for a tax cut to stimulate the economy that was not balanced by a reduction in spending. The paper is very clear that the analysis would not apply to a social insurance program where the increased tax is balanced by an equal increase in output—as with the healthcare act. Finally, the minority committee staff applied a ratio of changes in GDP to job losses or gains from the stimulus analysis by Romer and Bernstein to reach a number of lost jobs.

So to reiterate—they:
* use a methodology that is clearly inappropriate for the case at hand
* start with a cost to employers that is nearly double that of the CBO projections
* inexplicably multiply the results by ten.

Then they claim that the analysis was done with a methodology from the Counsel of Economic Advisors—one Congressman actually directly attributed the estimates to the CEA—even as it directly contradicts what Romer wrote in the paper they cite. Amazing.

So, what does the academic literature tell us about pay or play provisions and job losses? Studies on
Hawaii and San Francisco, which both have employer requirements, have found no measurable impacts on employment. Most economists believe that for workers above the minimum wage the costs of health insurance are passed on to workers over time in the form of lower compensation. The impact of a health requirement of the size under consideration would be equivalent to a modest increase in the minimum wage. Drawing on the minimum wage and health mandate literature, Philip Cryan found that the job impacts of an employer requirement of 8 percent of payroll, with no exemptions or subsidies for small businesses, would be in the range of 166,000 jobs lost to 55,000 jobs gained.

This is before taking into account the many positive impacts of health reform on jobs, small businesses and the economy as a whole. The biggest “job-killer” would be a failure to act.

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posted by Anthony Wright | Permalink | 1:35 PM


It's a matter of timeline...

Tuesday, November 10, 2009
Even as federal health care reform is inching forward, and change of some sort seems perched on the horizon, there's still plenty of opportunity to grasp the full context of its place in history.

The New England Journal of Medicine has an interactive timeline online that allows us to do just that -- with ease, and without a lot of online searching. The timeline starts with 1912 and the involvement of Theodore Roosevelt and the Progressive Party, and brings the health care reform movement all the way up to the present legislative process.

It's a clean, inviting informational graphic that depicts dozens of factors and events that helped shape the system of health care delivery in the United States. A simple rollover of the mouse gives greater detail to the events on the timeline -- and as a bonus, cites New England Journal of Medicine articles on the events as far back as 1916. We recommend it.

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posted by Cynthia Craft | Permalink | 2:23 PM


A television thank you...

Monday, November 09, 2009
Health Access California, as part of Health Care for America Now (HCAN) – the nation’s largest health care campaign – launched a new television ad today to publicly thank Representative Jerry McNerney (CA-D) for his historic ‘yes’ vote on the House of Representatives’ health care bill – the Affordable Health Care for America Act (H.R. 3962).

The ad titled “About More” will air for a week on San Francisco Bay Area cable. The ad is one of more than twenty airing nationwide to show appreciation to Members of Congress who have done the right thing in voting ‘yes’ to pass health care legislation through the House and to emphasize the importance of Members continuing to hold strong as health insurance lobbyists and other opponents of meaningful reform are sure to ramp up their attacks in the coming weeks.

California HCAN partners visited Congressman McNerney’s office (and those of several other health reform-supporting Representatives) on Monday morning at 11am to deliver chocolates and a “health care hero” media to make sure Rep. McNerney knows how much his constituents appreciate his voting to make quality care affordable to families and businesses in Nevada and to let her know they will continue to stand with her until health care reform gets signed into law.

“We’re very proud of Congressman McNerney and all the Democrats in the California delegation for standing up to the health insurance industry and other special interests and doing what’s right for California. His historic vote to pass health care legislation through the House means we are one step closer to having good health care we can afford,” said Anthony Wright, executive director, Health Access California. “With his vote, Congressman McNerney has said yes to lower health care costs, yes to a guarantee of good, affordable coverage, yes to stopping health insurance companies from denying care, and yes to the real choice and competition we’ll get with a new national public health insurance option.”

Here's a television advertisement starting to run today by Health Care for America Now! in the district of Rep. Jerry McNerney, thanking him for voting for the historic health reform bill this weekend.


Small floating SUPER: For Congressman Jerry McNerney, it’s about more than just health care.
Small business owners happily running their business. SUPER: Helping small businesses
SUPER: Growing the economy

Skyscrapers. SUPER: Taking on insurance companies.

Middle class couple looking over bills at kitchen table. SUPER: Making health care affordable.

Patient in waiting room looking worried. SUPER: No more denying coverage

Middle aged woman speaking with doctor in a doctor’s office. SUPER: Medical decisions in the hands of you and your doctor.

Still of Congressman w/ SUPER: Thank You Congressman McNerney for fighting for us. 1-877-264-4226


For Congressman Jerry McNerney, it’s about more than just health care.

It’s about helping small businesses survive and growing the economy.
Source: Affordable Health Care for America Act, H.R. 3962, 111th Cong (2009). Accessed at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3962ih.txt.pdf

It’s about taking on the insurance companies.
Source: Affordable Health Care for America Act, H.R. 3962, 111th Cong (2009). Accessed at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3962ih.txt.pdf

Making health care affordable for our families.
Source: Affordable Health Care for America Act, H.R. 3962, 111th Cong (2009). Accessed at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3962ih.txt.pdf

No more denying coverage if you’re sick.
Source: Affordable Health Care for America Act, H.R. 3962, 111th Cong (2009). Accessed at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3962ih.txt.pdf

And putting medical decisions back in the hands of you and your doctor.
Source: Affordable Health Care for America Act, H.R. 3962, 111th Cong (2009). Accessed at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3962ih.txt.pdf

Call Congressman McNerney, say thank you for standing up to the insurance companies and fighting for us.
Source: Affordable Health Care for America Act, H.R. 3962, 111th Cong (2009). Accessed at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3962ih.txt.pdf

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posted by Anthony Wright | Permalink | 7:42 PM


How they voted...

Now that the House has cast its vote for health care reform, it can be interesting to go back and see who voted for it, and who didn’t.

Of those who didn’t support reform, one might assume it may have been because few people in their districts were uninsured, and thus health care reform was not a priority.

Of course, it's not that simple.

Take U.S. Rep. Devin Nunes (R), whose district, including Visalia and Clovis, has an uninsured population rate of 23.8% -- nearly 1 in 4 people. He voted “no.”

Or U.S. Rep. Mary Bono Mack (R), with 24% of the population in her Palm Springs area district uninsured. She voted “no” as well.

The district with the highest rate of uninsured Californians – a whopping 42.4% -- is represented by U.S. Rep. Xavier Becerra (D). He voted “yes” for health care reform.

To see how all the California representatives have voted, the uninsured rate in their districts, and an accounting of health industry contributions to the Congress members, visit this graphic on the Washington Post site.

You'll also note that newly sworn-in U.S. Rep John Garamendi (D) managed his transition swiftly enough to have his say on the historic reform proposal -- voting "yes," as promised during the campaign.

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posted by Cynthia Craft | Permalink | 3:52 PM


Get your online education here

Feel like you’re ready to buckle down and review the basics of the process here on out regarding health care reform in the comfort of your own home or office?

Like you ought to be taking this policy shift seriously, because everyone, including the President, describes it as history in the making? Something you’ll want to tell the grandkids about some day? There are plenty of blogs and news stories and informal conversations online, where you can pick up bits and pieces of the process of health care reform.

But if you want to feel like you’ve attended a real, buttoned-down, online university mini-course, try this one at Kaiser.edu.org, a project of the Kaiser Family Foundation. It’s got to be in the Ivy League of online overview slideshow/seminars.

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posted by Cynthia Craft | Permalink | 1:30 PM


History in the House!

Saturday, November 07, 2009
Earlier tonight, the U.S. House of Representatives passed H.R.3962, a historic comprehensive health reform proposal, by a vote of 220-215.

We thank ALL of California's Democratic Congressional Representatives for voting for this desperately needed comprehensive health reform. Given California's health crisis, it's appropriate that the House of Representatives, led by Californians like Speaker Pelosi, Chairmen Miller, Waxman, and Stark, and many others, took the lead in crafting this historic bill.

The bill would provide stability and security for those who have coverage, and that would extend affordable coverage to those who don't. Californians are concerned that coverage won't be there for them when they need it, and this bill provides our families with much needed security from financial ruin.

Californians have a particular interest in this vote. California has more uninsured, a higher cost-of-living, more denials of coverage for pre-existing conditions, and fewer workers offered on-the-job coverage.The House bill would help people keep their on-the-job coverage and expand our safety net. It would provide consumer protections against insurance company abuses, and provide the choice of a public health insurance option.

This is the equivalent of passing Social Security or the minimum wage in the 1930s, or the passage of Medicare or civil rights legislation in the 1960s.

This is not the end of the process, but it moves the process forward. The Senate should take quick action the conference committee to meld the two bills can start its work can begin as soon as possible.

We will look to conference committee to change the one unfortunate development from today's debate, which was the adoption of the Stupak anti-abortion amendment. The main bill had already prohibited federal funds to be used for abortion. The amendment provides for an unwarranted extension that would place anti-abortion restrictions on private plans offered in the new health insurance exchange. While over 190 Democrats voted against the amendment, it's unfortunate that over 60 Democrats--including California Representatives Joe Baca, Dennis Cardoza, and Jim Costa--joined all Republicans in voting for this amendment. This issue needs to be fixed in conference.

Aside from the abortion issue, the House bill is a very good bill--and superior to the Senate versions, especially on key issues like affordability, employer responsibility, the public health insurance option, inclusivity, the bargaining power of the exchange, limits on out-of-pocket costs, financing, and several other issues.

So there's a lot of work to do, but let's remember the importance of this vote. It moves the process forward. And this process has now moved farther than any other previous effort in over 100 years of effort, with an entire body of Congress endorsing a proposal. Let's keep the focus on passing reform, while working to make the reform better.

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posted by Anthony Wright | Permalink | 9:55 PM


A historic day...

We are following the House health reform debate on Twitter. Follow us at www.twitter.com/healthaccess

As I write this, Speaker Nancy Pelosi spoke on the House floor. "This is an historic moment," and said, in a strong voice, "Today we will pass" health reform. "Today, we answer the call" of history. She talked of three pillars: Innovation, Competition, and Prevention. She talked about the benefits of reform for consumers, including that "there's a cap on what you pay in, but there's no cap on what you receive." She gave a long series of bullet points of what "no longer" will happen under the bill, with the biggest applause when she said, "No longer will being a woman be a pre-exisiting condition." At the end, Speaker Pelosi invokes Rep. John Dingell's long fight the health reform, as well as the quote from the late Senator Kennedy: "What is at stake is the character of our country."

There's been other poignant speeches by Californians, including Education and Labor Chairman George Miller's statement focusing on preventing financial insecurity for families. "We cannot ask American families to continue to live on the edge of insecurity..today, we deliver security... A small event, because of lack of healthcare, can explode into the life of a family, the life of a community. That's not going to happen again" under this bill.

Progressive Caucus Chair Rep. Lynn Woolsey explained how she worried about her three children's health when they were uninsured, and no mother will have to now.

The debate is expected to go into this evening.

There will be tough amendments on abortion and immigration before the day is done.
* An amendment by Bart Stupak would limit abortion coverage for even *private* health coverage offered through the health insurance exchange.
* A Republican amendment would limit undocument immigrants from *using their own money* to buy coverage in the health insurance exchange.

So if you can, keep calling your Congressmembers TODAY (Saturday) 1-877-264-4226.

Health Access California is opposed to the amendments, but strongly for the main bill, H.R. 3962.

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posted by Anthony Wright | Permalink | 2:39 PM


More supporters for H.R.3962

Friday, November 06, 2009
Major endorsements today for the House health reform proposal, from AARP to the American Cancer Society to the American Medical Association.

Earlier in the week, other supporters included Consumers Union, the publisher of the Consumer Reports magazine (and a Health Access California board member)

Here's an even broader list of supporters of H.R. 3962, and Health Access California is proud to be on that list.

Here's a quick fact sheet about it's impact on California families.

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posted by Anthony Wright | Permalink | 4:26 PM


Join the Frisco brigade for children's health care...

Thursday, November 05, 2009
One of the activist events rippling across the country is coming to San Francisco on Sunday -- and Champions for Children's Health is calling on people to participate to send a strong message to Congressional leaders that, when all is said and done in Washington, children should have equitable, accessible, affordable health care.

The event is the Champions for Children's Health Stroller Brigade, and participants will be pushing strollers en masse to demonstrate the need for kids' coverage. Supporters without strollers are welcome, too.

Folks should gather at San Francisco City Hall at 2 p.m. Sunday, November 8, to join in the brigade, which the Children's Defense Fund is organizing to send a strong message to Speaker Nancy Pelosi, Senator Barbara Boxer and Senator Diane Feinstein.

The message? Children need their leadership to ensure they are better off after health care reform is done.

Here's the Children's Defense Fund California website for details and more information on who, what, when, where, how, and why.

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posted by Cynthia Craft | Permalink | 7:32 PM


A very good House health reform bill....

Wednesday, November 04, 2009

As the vote near on the House health reform bill, it is easy to sink into the specifics of the bill, be obsessed by the debate on key details, and mourn amendments that we really wanted but that weren't included.

But we should look at this bill in its totality, and appreciate how signficant it is, and how much help it would provide if it passes. Here's my top ten reasons why this is an impressive bill:

1) Near-universal coverage for all, largely through group coverage with its efficiencies and purchasing power to get the best price.
2) The biggest expansion of Medicaid since its creation 40 years ago, completing a unfulfilled commitment for millions in and near poverty.
3) Sliding scale subsidies tied to income: Consumers will pay for coverage not based on how sick they are, but what they can afford.
4) The end of "junk" insurance, and bankruptcies due to medical bills, with a cap on out-of-pocket costs, and even no cost-sharing for preventative services.
5) Fair share financing that is progressive and pays for itself (in fact, it decreases the deficit), including an employer assessment as important as setting the minimum wage for pay back in the 1930s.
6) New consumer protections: New rules & oversight on insurers that include the abolition of underwriting and "pre-existing conditions," minimum benefit standards, limits on age-based rates and on premiums dollars going to administration and profit.
7) A public health insurance option to provide choice, competition, and offer a safe haven against private insurer abuses.
8) The tools for cost containment and quality improvement in health care generally, from health information technology to transparency of cost and quality to a strong emphasis on prevention.
9) More sustainability and improvements for existing programs--like filling the donut hole in Medicare and streamlining Medicaid paperwork.
10) Momentum to do more in the future, politically and policy-wise, in health care and beyond.

Yes, it still needs to be merged with the Senate, which shares many but unfortunately not all of these characteristics. But for the House of Representatives to pass this proposal, and move us closer to these multiple victories, would be a historic achievement.

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posted by Anthony Wright | Permalink | 3:17 PM


Congratulations, Congressman Garamendi!

The headlines from the elections last night was clearly about the two gubernatorial races, but there were other news as well.

Health advocates across the nation can take some solace that TABOR (so-called "Taxpayor Bill of Rights") spending cap initiatives were defeated in Maine and Washington states. California voters have defeated spending caps twice in the past five years, and hopefully steam is running out of these artificial attempts to handcuff government's ability to meet the needs of its citizens.

In the House of Representatives, Speaker Nancy Pelosi will on Thursday have two more votes for the health reform proposal that is up for a vote Saturday or Monday. New York's 23rd district is sending new Congressman Owens, and California's 10th district has our newly minted Congressman John Garamendi.

Garamendi, Lt. Governor for one more day until he takes his seat, is a advocate for consumers and a verified health policy wonk, as a former Insurance Commissioner who was very active and influential in the health reform debates in the early 1990s. (Update: Ezra Klein and Jon Cohn have more on his health wonk ways.) Last year, he helped us launch the Health Care for America Now campaign in Los Angeles in July 2008 (see photo), and became then the first elected politician nationally to sign the HCAN Statement of Principles. It is totally appropriate that his first act in Congress will likely to be to vote for the historic health reform package.

We've been sending some real health care champions and experts to DC recently. Earlier this year, Congresswoman Judy Chu was elected, like Garamendi, to replace another Obama appointee, and arrived just in time to provide a historic vote. A fighter for health care as chari of the budget subcommittee on health when in the Assembly, she quickly filled former Rep. Hilda Solis' shoes on the U.S. House Education and Labor Committee as it passed health reform out of committee on her first day.

And last year, a San Francisco district elected Rep. Jackie Speier, who was a longtime chair of the Insurance Committee when in the state Senate, and co-author of SB2, the expansion of employer-based coverage that passed in 2003.

The seniority system of Congress suggests they won't necessarily be out front, but they will play a key role. It's heartwarming to know we have such good people who are so knowledgeable and passionate about health care entering Congress from California, augmenting the leadership of Californians like Speaker Pelosi, George Miller, Henry Waxman, Pete Stark, Xavier Becerra, Lois Capps, and others.

For this round of health reform and into the future, Californians will be the movers and shakers.


posted by Anthony Wright | Permalink | 11:05 AM


72 hours...

While the rest of the political class has focused on the elections Tuesday evening, Speaker Nancy Pelosi has introduced the "manager's amendment" for the House health reform bill. This is the final amendment the House leadership plans on making to the main bill before full passage. She promised that she would allow 72 hours before introducing the final bill before a full vote. Consider this your 72 minute warning.

The amendment is not major. It does not include amendments sought--by the right and left--on hot-button issues like abortion, the public health insurance option, allowing states to adopt single-payer, or other changes to the base bill introduced in its new form last week. They are going to the vote with the bill largely as it is.

Here's her statement:

"Tonight, we have filed a manager's amendment to the Affordable Health Care for America Act, which is the next critical step toward comprehensive health insurance reform that ensures affordability for the middle class, provides security for our seniors, and protects our children's future by not adding to our deficit. Our bill covers 96 percent of Americans, makes coverage more affordable for all, and creates new consumer protections that will end discrimination by insurance companies against the sick and cap what Americans pay out-of-pocket.

"Building on the legislation House Democrats introduced last week, this manager's amendment includes these key improvements to the bill:
· providing $1 billion in new resources to states to rein in price gouging by insurance companies,
· excluding insurers who put profits over patients from an affordable marketplace that will serve tens of millions of Americans,
· expanding on the provision that removed insurance companies' anti-trust exemption and strengthening it to further promote competition and bring down costs for Americans; and
· expanding oversight to further prevent waste, fraud, and abuse.
"Americans are ready for comprehensive health insurance reform, and the House will soon act."

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posted by Anthony Wright | Permalink | 12:56 AM


Who does the Chamber represent?

Tuesday, November 03, 2009
I refer a little to recent health policy history here in California when I ask the question at the website of The New Republic: When the Chamber of Commerce opposes health reform, who are they representating?

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posted by Anthony Wright | Permalink | 11:25 PM


Dear Patient...

This story’s a shocker – a sad, tragic shocker. Again, it’s from the Central Valley. Again, the money-maker in our health care system comes across as the bad guy.

The Sacramento Bee’s Sam Stanton reports on a heinous billing mistake that sent the parents of a deceased 23-year-old Sacramento college student into a devastating emotional tailspin. You’ll have to read it to believe it.

Less than two weeks after their son was brutally beaten to death in his dorm room, the bill from UC Davis Medical Center arrived. Addressed “Dear Patient,” it was the sort of “Dear John” letter the hospital sends to indigent patients who go to the emergency room because they don’t have insurance.

Trouble is, the family had insurance – and had just lost their son.

When you read the story you’ll be horrified at the letter’s clinical, uncaring language – not to mention its message.

The dollar-amount of the bill raises questions as well. For a 5-minute (unsuccessful) attempt at resuscitating the young man, UCDavis charged $29,186.50.

Even if this was a mistake, patients get horrendously huge hospital bills every day in California. There were some protections that were put in place in 2006, that are detailed at our newest website, www.HospitalBillHelp.org, that provides some step-by-step assistance to families in this predicament.

But the story makes you wonder about our health system in general. And when you think about what the UCDavis medical system represents – that it’s really part of California’s public universities – questions about accessibility, accountability and morals arise, too.

We need health reforms where families don't face such financial pain, especially at the same time that they are going through such stress and grief that led them to the hospital in the first place.

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posted by Cynthia Craft | Permalink | 9:17 PM


Fresno County workers see coverage hikes...

In yet another sign that affordability needs to be front-and-center in health care reform, the Fresno Bee has a story titled “Valley Workers feel pain of costlier coverage.”

Not too many years ago, Fresno County workers received their medical coverage for free as a benefit for working for the county. Now, the Bee says, these county workers will likely dig deeper into their slim pockets for another 9% to 19% to cover the costlier premiums.

Workers across California are expected to see coverage increases this open-enrollment season. It makes you wonder how the state’s economy is ever supposed to recover when people have less and less money in their paychecks to cover the basics.

It’s the proverbial vicious cycle: Businesses are selling fewer goods and services because consumers have less money to spend. Premium hikes from our ever-more-expensive current health care system come along, and consumers have even less to spend. Businesses suffer even greater losses and...well, you get the picture.

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posted by Cynthia Craft | Permalink | 7:25 PM


The future of Medi-Cal, part 1...

Monday, November 02, 2009
The state Department of Health Care Services had its first official public forum today on a new Medi-Cal "waiver," which will determine the funding and structure of the program for the next five years. They reviewed a draft concept paper, released on October 19th, that includes at its core a shift of many Medi-Cal beneficiaries to mandatory managed health care plans or other "medical homes" as a way to slow the continued growth of Medi-Cal costs.

The plan, under which the state will seek a waiver from the federal government from certain rules guiding Medi-Cal spending, was developed by the department at the behest of the Governor and the Legislature. More information on the Medi-Cal waiver is on the Department's website, at:

As part of the 2009-2010 budget deal, the Legislature had passed AB xxxx 6, which Governor Schwarzenegger signed, requiring the DHCS to embark on a process for a renewed waiver from the federal government for our Medi-Cal program, with a goal to achieve long-term cost savings.

The restructuring entails securing a waiver from Washington in order to continue receiving matching federal dollars for public health care. It comes as Congress is closer than it ever has been to paving the way to national health care reform.

Department executives said a waiver would allow the Medi-Cal program to operate more efficiently to achieve long-term cost savings while continuing coverage for California’s older adults and chronically ill. This is the costliest population medically because of its ongoing need for health care.

Should health care reform emerge from Washington in a form that would expand Medi-Cal coverage to insure more Californians, an expansion likely would not occur for several years. This waiver for the next five years has the opportunity to be a bridge to that reformed health care system.

Monday’s hearing on the waiver demonstration project marked the first public hearing on the proposal. Dozens of advocates representing patients, hospitals, care providers, community clinics, the uninsured and others – including Health Access California – pressed DHCS for detailed answers to their questions about the proposal.

Stakeholders have until November 14th to submit their comments, positions and suggestions to DHCS officials. The department will convene a stakeholder committee and a panel of technical advisors to examine the waiver proposal closely and suggest any changes.

DHCS said its goal is to present proposed milestones for the waiver demonstration project to the Centers for Medicare & Medicaid Services by August 2010. Officials admitted that they did not have an exact date for when changes take place, should the waiver be approved as proposed.

Health Access will have more written materials about the substance of the draft waiver concept paper shortly.

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posted by Cynthia Craft | Permalink | 6:29 PM


Where no vote and a no vote are the same...

Sunday, November 01, 2009
I was puzzled about the front-page Sacramento Bee article Sunday, which was making a arguable point but doing so in a fundamentally deceiving way.

The news analysis was that individual Democrats in the California Legislature voted with the majority of their party or abstained 99 times out of 100 this session. Republicans, on average, voted with the majority of their party or abstained 96 out of every 100 times."

The above statistic is just misleading, since it groups together "yes" votes and abstentions--which are fundamentally different in impact and intent.

In the California legislature, bills only pass when they get 50%+1--not of those present, but of the full voting body, regardless of whether members are there or not. In this scenario, not voting is the same as voting "no."

So in the 40-member Senate, a regular bill needs 21 "yes" votes on the floor. If the 15 Republicans stick together in voting "no," and 5 of the 25 Democrats are sick, not present, or abstain, the bill fails. There invariably is a member or two that may not be present, which means the margin to pass bills is actually pretty thin. When conservative Democrats oppose a measure, they typically just don't vote, and the lack of a majority stops the bill.

So an abstention isn't a sign of agreement--it's the reverse. And so there is nothing to be learned from an analysis that groups them together--its mush. It's not just a wrong conclusion, but does a disservice to readers.

The overall point may or may not be true. There's no doubt that the California legislature--with representatives from Berkeley and Bakersfield--is significantly polarized. But the article confuses, rather than illuminates, the issue.

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posted by Anthony Wright | Permalink | 11:41 PM


With children, tough choices...

The New York Times reports on a study that found that children without health insurance who are hospitalized are much more likely to die—how much more likely? Well, almost half the kids who died after hospitalization were uninsured, far out of proportion to their numbers in the general population. http://prescriptions.blogs.nytimes.com/2009/10/30/lacking-insurance-hospitalized-children-more-likely-to-die/?hpw

The story notes that kids are not especially likely to be hospitalized and that most kids who are recover and that is all good.

But here is what is really appalling: the study period is 1988 to 2005—and for the last half of that period the Children’s Health Insurance Program (known as Healthy Families in California) was in effect—meaning that most low and moderate income children in this country had access to affordable coverage. Yet there are still seven million children uninsured in this country, including over 600,000 in California.

Study after study has demonstrated that uninsured children are less likely to get treatment for serious conditions like asthma and diabetes, conditions that can be managed with good care but that without it can be literally life-threatening. Now we have a study that documents what policy types had suspected: uninsured children are more likely to die than children with health insurance.

Before Healthy Families was created, health care costs were the most common cause of homelessness among families—a family would literally spend next month’s rent to get a kid seen in the emergency room. Any parent can imagine what that choice feels like: spend next month’s rent or face the risk that your child will be one of the 1,000 a year who die after hospitalization because you waited too long.

As we look forward to the week’s debate over the proposals in Congress, we agree with many who say that the proposals could be improved but we also remember that parent in the middle of the night making the choice between homelessness and a child’s life. No one should face that choice.

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posted by Beth Capell | Permalink | 8:29 PM


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Anthony Wright is the executive director,
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