Early signals on the Budget...

Tuesday, April 27, 2010

HEALTH ACCESS UPDATE
Tuesday, April 27, 2010


ASSEMBLY BUDGET SUBCOMMITTEE REJECTS MANY HEALTH CUTS, FOR NOW
* CA Assembly Budget Subcommittee Responds to Advocates Testimony & Turnout
* Legislators Express Opposition to Governor's "Trigger" Cuts
* Mid-Year Status Reporting for Kids Rejected by Subcommittee
* Tougher Eligibility for Low-Income Folks is Rejected as Violation of Health Reform
* Also Rejected: Additional Medi-Cal Benefit Cuts; Elimination of Coverage for Recent Legal
Immigrants; Sunset of Prescription Drug Discount Program; and More.

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HEALTH CUT PROPOSALS FACE OPPOSITION IN ASSEMBLY BUDGET SUBCOMMITTEE: Gov. Arnold Schwarzenegger’s proposed “trigger” budget cuts got shot down Monday by the Assembly Budget Subcommittee No. 1 on Health and Human Services, which deemed them to be either essential services or violations of federal health reform.

The governor planned to make the drastic round of trigger cuts in the 2010-2011 budget year if his demands for $6.9 billion in added federal funding were not met.

But members of the Assembly Budget Subcommittee rejected the administration’s three worst-case-scenario proposals that are included as part of the Department of Health Care Services budget. The Subcommittee, chaired by Assemblyman Dave Jones (D), voted down three sections of the budget cuts:

* A radical reduction in Medi-Cal eligibility for very low-income Californians, so that Medi-Cal services would be yanked from a total of 2.2 million people. Assembly members noted, however, that all experts were in agreement that this proposal violated provisions of the Patient Protection and Affordable Care Act signed into law by President Obama on March 23, 2010.

* An elimination of Medi-Cal benefits that includes essential durable medical equipment such as wheelchairs, feeding tubes, prosthetics and hearing aids. In addition, this portion of the governor’s trigger proposal would deny low income people medical equipment such as diabetic test strips, wound care supplies, tracheotomy care and more. These cuts would affect more than 223,000 Californians, and would come on top of last year’s elimination of dental care, speech therapy, chiropractic, acupuncture, optician/optical lab services, podiatry, psychology and audiology services. After hearing impassioned testimony from dozens of groups, the subcommittee voted against eliminating the new round of benefits the governor put on the chopping block.

* The Assembly members, who included Wes Chesbro, Jim Beall Jr., Hector De La Torre, Brian Nestande and Bill Emmerson in addition to Chairman Dave Jones, also voted to restore $10 million in funding to community clinics through the Early Access to Primary Care Program. Following the close of budget negotiations, Schwarzenegger unexpectedly stripped that funding from the 2008-2010 budget bill. Among those testifiying as to the illogic of this cutback was Beth Capell of Health Access, who pointed out that California should be ramping up, not shutting down, capacity in anticipation of the year 2014, when health care reform expands access to care.

The subcommittee heard moving testimony from many Californians who had benefited from the access to medical supplies and services through the Medi-Cal program. One woman, Inez Black of Hayward, told the committee she had largely recovered from brain damage thanks to the help of occupational, cognitive and physical therapy provided through Medi-Cal benefits that the governor now wants to cut. “I’m living proof that the therapy works,” Black told lawmakers. Your money is so well spent and I am so grateful.”

STANDING ROOM ONLY: Among those testifying against the cuts were disability rights activists, the California Primary Care Association, the California Immigrant Policy Center, the California Retailers, Rite Aid, Abbott Laboratories, Congress of California Seniors, the California Medical Association, the California Pan-Ethnic Health Network, Children Now, the 100% Campaign, the American Cancer Society, advocates for foster care youth, Planned Parenthood, AARP, the Unitarian Universalist Legislative Ministry and many more.

Even the administration’s representative, Toby Douglas of the Department of Health Care Services, acknowledged the severity of the governor’s “trigger” proposals, saying, “These are terrible proposals…they will have terrible impact on our beneficiaries.” And another administration official was not surprised when mid-year eligibility requirements for children on Medi-Cal was rejected by the subcommittee. The cynical proposal, designed to drop 475,000 low-income children from services because their parents likely would not be able to keep up with the paperwork, likely would have violated "maintenance of effort" requirements in both the economic recovery act and the new federal health reform law.

Still, the governor and legislature do face another massive budget deficit, and some measures to help patch the hole were adopted. The Subcommittee on Monday passed a proposal to extend a Medi-Cal Managed Care Plan fee used to help draw down matching federal funds to support Healthy Families. Without making a final decision, the panel left open for discussion a 10 percent reduction in payments to public and private hospitals in 2010-2011. They also agreed to extend for one more year a delay in California’s discount drug program – while at the same time eliminating a section of the Governor's proposal that would have set a date for a sunset of the program before it ever started.

The subcommittee also rejected the governor’s proposal to eliminate Medi-Cal for legal immigrants who were in California less than five years. Assemblyman Nestande reminded those attending the hearing that “We understand the needs out there but of course we all realize it’s a tough economic environment” for state budgetary purposes.

The subcommittee also [CORRECTION: left open for discussion the Governor's proposal to] ax Medi-Cal Family Planning Services that receive a 9 to 1 federal match, meaning $9 comes back to the state from Washington for every $1 California spends on the program. A UC San Francisco study concluded in 2002 that the Family PACT program had prevented 205,000 unwanted pregnancies.

NEXT STEPS FOR THE BUDGET: However, there’s no guarantee that the full Assembly Budget Committee will follow the recommendations of the subcommittee. No decision on the budget is final until the budget is passed by the Legislature and signed by the Governor.

The governor himself may alter some of his budget and trigger proposals in the May revision that is scheduled to be unveiled on Friday, May 14. Separate hearings will be going on in the state Senate before the two houses join their budget proposals in a conference committee.

Labels: Budget, Updates

posted by Anthony Wright | Permalink | 1:22 PM


 

Healthy Families cuts rejected in subcommittee...

Tuesday, April 20, 2010

HEALTH ACCESS UPDATE
Tuesday, April 19, 2010

FEDERAL HEALTH REFORM TO RESHAPE GOVERNOR'S BUDGET PROPOSAL
* Assembly Budget Subcommittee Hears Testimony Against Cuts to Healthy Families
* Several Testify Against Schwarzenegger's Harshest Scenarios for Children's Health
* New Federal Health Reform Renders Governor's "Trigger" Proposals Illegal

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On Monday, the Assembly Budget Subcommittee on Health and Human Services, chaired by Assemblyman Dave Jones (D), examined the impact federal health reform will have on Governor Arnold Schwarzenegger's state budget proposal.

The subcommittee specifically focused on some of the programs and services Schwarzenegger threatened to eliminate in his "trigger" scenario, a proposal that would be "triggered" should the nearly $7 billion in additional federal funds that the Governor budgeted not materialize.

While agency heads were noncommital about how the governor's budget fits with national health reform, saying they were still studying the matter, advocates stepped up to state clearly where the federal health reform prevents specific cuts.

LAYING DOWN THE LAW: Elizabeth Landsberg of Western Center of Law and Poverty told the subcommittee that, under the new law signed by President Obama, certain programs were protected from being dismantled or scaled back. These include Healthy Families, which insures nearly 1 million children in California from families that pay premiums according to their income, the AIM program for infants and mothers, and even the MRMIP high risk pool health insurance of last resort for those who are denied coverage in the individual insurance market. Beth Capell of Health Access added, "These would plainly violate the MOE," in reference to a "maintenance of effort requirement" included in the new federal law that requires programs to provide the same level of services as before the reform passed into law.

A few weeks ago, Arizona became the first state to shut down its CHIP program -- the same federal-state children's health insurance program as Healthy Famillies -- through state legislation. But Arizona lawmakers overshot their authority. The federal Centers for Medicaid Services "has indicated that this is in violation of federal health care reform," a subcommittee staff report stated.

Amid the analysis of federal health reform requirements, a Department of Finance representative for the Administration suggested that the governor's "trigger" proposals to eliminate these and other programs "are not budget proposals, although they may be in the May revise." Jones indicated that statement was contrary to everything the governor said previously.

Even the Legislative Analyst's Office representative said the trigger proposals "violate federal law." Leslie Cummings, executive director of the Managed Risk Medical Insurance Program, said "there's so much I can't claim to know definitely yet."

The Assembly Budget Subcommittee ended up, by a 4-1 vote (with one not voting), REJECTING the following budget proposals:
* Eliminating the Healthy Families program;
* Reducing eligibility in Healthy Families from 250% to 200% of the federal poverty level;
* Increasing premiums in the Healthy Families program
* Eliminating the vision benefit in Healthy Families
* Eliminating Prop 99 Funding for AIM

Besides running Healthy Families and AIM, the Managed Risk Medical Insurance Board (MRMIB) also administers the Major Risk Medical Insurane Program (MRMIP), the high-risk pool for those denied by private insurers for "pre-existing conditions." Funding proposals were left open, as more information becomes available about the implementation of federal reform in this area.

As always, no budget decision is final until a full a final budget is signed into law.

The hearing focused only on the programs in MRMIB. Next week, Monday, April 26th, at 1:30pm, the Assembly Budget Subcommittee is scheduled to look at proposed Medi-Cal cuts. FYI, Medi-Cal enrollment eligibility has already been protected from cuts under an MOE, as a condition of getting additional Medicaid dollars in the federal recovery act. However, neither the enhanced Medicaid dollars nor federal health reform prevents state governments from cutting certain Medi-Cal benefits or provider rates. The hearing would be a time for health advocates to express their opposition to such Medi-Cal cuts.

Labels: Budget, SCHIPHealthyFamilies, Updates, YearOfReform

posted by Anthony Wright | Permalink | 12:47 PM


 

Senators: Not so fast on California Forward

Monday, April 12, 2010

A lengthy debate over a package of bills encompassing California Forward’s proposal for state budget reform ended Monday with Senator Denise Ducheny (D), chair of the Senate Budget and Fiscal Review Committee, granting the committee a couple of weeks to study the ideas before coming to a decision.

“We need time to process these ideas and see if there are pieces of this we want to put up for a vote on the (Senate) floor,” Ducheny said.

At times during the hours-long hearing, the debate grew lively and informal, with as many as three people – a presenter and two senators -- talking over each other at the same time. There were plenty of opinions and analyses of the proposal.

California Forward, an organization backed by prominent nonprofit foundations in the Golden State, had been working for some time to draw up a package of reforms to help California improve state governance by streamlining the state budget process.

Key parts of the proposal include:

• A reduction of the two-thirds, super-majority requirement needed before the Legislature could pass a budget. (This proposal does not lower the threshold for taxes.) Ducheny and others acknowledged that rounding up two-thirds of the Legislature’s vote was so difficult that it often led to deal-making, trade-offs and budget gimmickry. It also tended to give more power to the hold-outs not in the majority. “It just seems weird that a small number of people can dictate what the larger number of people can do,” Ducheny said.

• A requirement for “pay-go,” or identifying a secure funding source before any new programs are adopted by the Legislature or Administration.

• A requirement that the gubernatorial budget proposal contain more information so Californians would know exactly where their tax dollars are going.

• An option to develop a two-year budget cycle for California, rather than the current one-year budget that doesn't take full account of the impact of actions into the future.

• Financial penalties for legislators for each day the budget is late past a June 25th deadline. Lawmakers would get pay cuts and lose per diem allowances if they don’t agree on a deal by the deadline. Senator Mark Leno (D) warned that the threatened penalties could backfire, encouraging legislators to hastily adopt even less responsible state budgets. Likening the scheme to a “quid pro quo” system, Leno said, “It’s not so much that you vote for this or you won’t get paid. It’s that you vote for this and you will get paid. I think that’s the dynamic that would be in place.”

Several legislators appeared to be in favor of modifying the two-thirds vote requirement that currently exists for a budget to be passed.

Said Leno: “There are 47 states in the nation without this requirement. City councils, boards of supervisors, local school boards – none of them require the supermajority. What is the public policy argument that keeps California from adopting a 60 percent majority vote?”

Ducheny said she favored a 55% majority vote to pass the state budget. “In truth, the two-thirds requirement has caused us to do things in trade-offs that were not sound public policy,” she said. “That’s why we borrowed so much. That’s why we rely on gimmicks so much.”

Senator Robert Dutton (R) of Southern California said tying the Legislature up in knots in state budget negotiations year after year has prevented lawmakers from addressing the true, deep problems that California faces in job loss and loss of competitiveness.

“We’re going to have to do a lot better than we’ve done,” Dutton said, invoking a pet phrase, “We’ve got champagne tastes and a beer pocketbook. There’s not one thing we are doing today to help jobs, the economy and programs.”

Many groups tended to like specific elements of the proposals and but were concerned about other parts. Several conservative-oriented groups--the Howard Jarvis Taxpayers Association, the California Taxpayers Association, the California Manufacturers Technological Association--supported parts of the package.

Among the last to speak on the proposal was Jean Ross, executive director of the California Budget Project. Ross’ assessment was that the proposal was too flawed to go forward, in part because it fostered a lack transparency and accountability, and added additional complexity and constraints to our already confusingly large constitution. “As so many here today have already said,” Ross told the committee, “the devil is in the details.”

Senator Ducheny wondered if some of these reforms had to be written in the state Constitution, rather than done in statute, so as to reform the process without handcuffing future legislatures to respond to unforseen circumstances.

More to come, in just a few weeks...

Labels: Budget

posted by Cynthia Craft | Permalink | 6:26 PM


 

Health care = Jobs

Friday, March 26, 2010

California's unemployment rate stayed flat at a troubling 12.5% in February 2010, according to new data released today.

Our state leaders need to focus on decisions that protect and promote jobs. Unfortunately, the Governor is proposing budget cuts just to health would cost the state’s economy more than 42,000 jobs.

Health Access California released a new report on Thursday detailing the impact on jobs of Governor Schwarzenegger’s 2010-11 proposed budget cuts to health care programs in California. Entitled, “Cuts to Health Care are Bad for the Economy,” the new report demonstrates that sweeping health care cuts in California would cost the state more than 42,000 jobs, at the very minimum.

The job-loss estimate is based on research by the University of California at Berkeley, which calculated that cuts (or investments) to health care services has the biggest "jobs-per-billion" impact than other budget solution, significantly more than tax increases on the high-income earners or an oil severance tax. That research is on the web at:
http://laborcenter.berkeley.edu/californiabudget/budget_solutions_jobs10.pdf

Frankly, there is no place where you get more bang for your buck than investing in health and human services, both because of federal matching funds, and because benefits to low- and moderate-income families get recycled into the economy quickly. Nothing has a worse economic impact than cutting health and human services, which leads to lost federal funds and ripple effects in our health system and economy.

In addition to severe job losses, the Health Access report reveals that California would experience an estimated $2.7 billion loss in business activity across the state, thus further hindering California’s much-needed economic recovery at a time when joblessness is at its worst in decades.

Other findings showed that:
* The Governor’s proposed cuts to Adult Day Health Care would lead to a loss of more than 7,500 jobs across 327 statewide facilities.
* The Governor’s plans to eliminate In-Home Support Services (IHSS) would result in the loss of more than 370,000 home-care jobs across the state – even more than the total number of jobs lost across all sectors from January through December 2009.

Furthermore, the report shows that health care jobs are vital for California’s economic recovery. Not only is the health care industry a major source of jobs in California, with 12 of the 50 largest in-state employers directly involved in healthcare services; but the health care industry (alongside education) was the only industry sector to see an increase in jobs in California – adding nearly 23,000 jobs in 2009 alone.

The Governor’s proposal to slash $6.4 billion from California’s vital safety net couldn’t come at a worse time. When more and more families are struggling to get back on their feet, the Governor’s proposal not only decimates vital services for those Californians currently out of work, but also imposes severe challenges further hindering California’s economic recovery – including cuts to programs that would otherwise contribute desperately-needed Federal funds, such as Medi-Cal and Healthy Families.

A copy of “Cuts to Health Care are Bad for the Economy” is available online.

Labels: Budget, Research

posted by Anthony Wright | Permalink | 12:23 PM


 

The Budget starts to get scrutiny...

HEALTH ACCESS UPDATE
Friday, March 25, 2010


STATE BUDGET STARTS TO GET SCRUTINIZED,
ESPECIALLY IN LIGHT OF HEALTH REFORM

* Federal Health Reform "Reconciliation" Package Passes Both Senate and House
* 2010-2011 State Budget Gets Its First Glances of Scrutiny
* Senate Budget Subcommittee Rejects Harsh Cuts That Go Against Fed Health Reform
* Assembly Budget Subcommittee Grills Adminstration on Impact of Budget Cuts

*** Read Our Health Access Blog! Join Us on Facebook! Follow Us on Twitter!


Yesterday, both the U.S. Senate and House of Representatives took final votes on the on a "reconciliation" package of important improvements to historic health reform legislation signed by the President earlier this week.

THE REFORM IMPROVEMENTS: The new changes would provide more assistance to California's families and small businesses struggling with the cost of coverage, and to the state of California and its budget as well. The changes would:

* increase the financial assistance for low- and moderate-income families to afford insurance premiums, and to protect them against excessive out-of-pocket costs--especially important in a state with a high cost-of-living like California.

* improve drug coverage for seniors by eliminating the Medicare prescription drug coverage "donut hole" that currently leaves some seniors on the hook for thousands of dollars of drug costs.

* improves the financial assistance to states like California and our health system in multiple ways:
* eliminates the special Nebraska provision and instead increases the federal assistance for any expansion of Medicaid, by covering 100% of the cost in the first three years, and at worst in the tenth year, continuing to provide a significant 9:1 federal match. (California's normal matching rate is 1:1.)
* provides resources for a significant increase in Medicaid reimbursement rates for primary care physicians for two years, especially helpful for California that has some of the lowest rates in the nation;
* delays and narrows the excise tax on high-cost health insurance plans, which were more prevalent in California due simply to our high cost-of-living;
* improves the formulas for payments to safety-net (DSH) hospitals.

Although health care for low-income Californians has traditionally been a state and county responsibility, the federal governmet, under health reform with this package of improvements, will provide California with over $70 billion between 2013 and 2019 to subsidize public and private coverage for low- and moderate- income individuals and families. In particularly, the federal government would cover approximately 97% of the costs of expanding Medi-Cal to new populations over that period.

ALERT: As our nation goes forward on coverage expansion, California should not go backward with additional health care cuts that take us and our health system in the wrong direction. California should take advantage of this opportunity to draw down billions in federal funds for our health system and our economy. While health reform helps prevent some eligibility cuts, other programs are left vulnerable to budget cutting.

* CALL YOUR LEGISLATOR to urge them to reject health care cuts, especially to Medi-Cal benefits and other key services. Click here (hyperlink to www.leginfo.ca.gov/yourleg.html) to enter your zip code and find your legislators' phone numbers.

* If you have Medi-Cal and use threatened optional benefits (see below) and are willing to tell us your story to help stop the cuts, please ALSO contact Jessica Rothhaar at jessicar@health-access.org or 510-873-8787 ext. 107 to tell us what it would mean to lose coverage for the products and services you need. Your story can make a difference!

* To join our fight against health care budget cuts, also email jessicar@health-access.org with your city & zip code. We will let you know about upcoming meetings, town halls, rallies and opportunities to meet with your local legislator. Together, we are stronger than we are apart!

BACK IN SACRAMENTO, ACTION STARTS ON 2010-2011 STATE BUDGET -- Already, federal health reform is guiding California’s lawmakers' thinking as they begin the process of considering the next round of state budget cuts to health and human services. Against the backdrop of Congressional action on the historic Patient Protection and Affordable Care Act, legislative subcommittees in both the Assembly and Senate launched their examination of the governor’s proposed 2010-2011 state budget.

SENATE HEARING: On Thursday, a state Senate Budget Subcommittee rejected the harshest of Gov. Arnold Schwarzenegger’s proposals to scale back publicly funded medical services, partially because they did not meet the standards set by the new federal health reform law, finalized by the U.S. House on Thursday.

As we begin a national effort to increase coverage, the new federal law prevents states from undercutting it's effort by reducing eligibility to existing public programs--what’s called “a maintenance of effort.”

Schwarzenegger’s proposed budget threatens to reduce access to health care for nearly 2.7 million people in need, including 875,000 children. This would raise the number of uninsured Californians to more than 10 million.
“The whole thing is nonsensical,” said Sen. Mark Leno (D), chair of the subcommittee. “The concept is to improve access to health care, not to dismantle what the federal government has just achieved.” Under Leno’s leadership, the panel rejected the most devastating cuts, the so-called trigger cuts that Schwarzenegger would “pull the trigger on” if his demands for $6.9 billion in added federal funds is not met. Rejected were:

· The wholesale elimination of the Healthy Families federal-state program that provides low-cost medical coverage to children of low-income families who pay modest premiums. About 1 million children rely on Healthy Families for their health care.

· A stiffening of eligibility requirements for Medi-Cal so that millions of Californians, including working families, children, and the aged, blind and disabled would no longer qualify for public medical care.

· Eliminating nine categories of Medi-Cal benefits – on top of 10 other medical services that Schwarzenegger eliminated last year. The nine are: hearing aids, physical therapy, occupational therapy, orthotics, access to independent rehab facilities, outpatient heroin detoxification, medical supplies, prosthetics, and durable medical equipment such as wheelchairs and oxygen tanks.

· Imposing mandatory co-pays upon Medi-Cal recipients, a move that providers said would create a barrier to access to medical care and could threaten patient flow at vulnerable community clinics. The California Primary Care Association opposed this proposal, reporting that six of its clinics have closed and others statewide suffered a loss of $70 million due to last year’s budget cuts.

· Imposing twice-yearly paperwork requirements on families with young children who receive state-funded health care. The move is designed to reduce the number of children receiving care. A representative from the Department of Health Care Services said an estimated 471,000 children would be dropped from the program because their families expected to fall behind on the twice-yearly paperwork. The subcommittee ordered this proposal rejected and replaced with only annual enrollment paperwork requirements, in keeping with the mandates of the new federal health care law.

Other aspects of the 2010-2011 health and human services budget were put off until the administration provides more detail in the governor’s May revision of his budget package. Ad important as theses votes are, No vote is final unless the entire budget if final and signed.

ASSEMBLY HEARING: Meanwhile, Californians hard-hit by the deep recession are coping with severe cuts from Schwarzenegger’s budget cuts last year. Ten core Medi-Cal services were eliminated last year: dental care, podiatry, chiropractic services, infection-preventing skincare products for the incontinent, optometry, audiology services, optician services, acupuncture, speech therapy and psychological services. In addition, the Healthy Families program was suspended for two months while funding was secured to patch the hole left by the governor’s cuts to the children’s health insurance program.
One consequence to the 2009-2010 budget cuts has been an increase in use of emergency room services, including for emergency dental care.

Another, which Assemblymember Noreen Evans (D) has vowed to reverse, is a six-month freeze of new enrollment in the Every Woman Counts breast cancer early detection and treatment program for low-income women. In addition, the governor unilaterally closed the program to women aged 40 to 50, allowing only women 50 and older to be screened. Evans, a member of the Assembly Budget Subcommittee, which met Wednesday, said the governor took the action against the Legislature’s wishes and she would work to ensure full access to the program is restored.

Other action by the Assembly Budget Subcommittee included fact-finding and questioning administration officials on how many Californians would be affected by proposed health and human services budget cuts. In a majority of cases, administration officials were unable to answer the Assemblymembers’ queries.

Assemblyman Wes Chesbro (D) chastised the administration’s representatives for proposing radical cuts without the data to measure the impact on Californians.

“Our California budget is about real lives and real families and cascading effects of many of the cuts that have occurred,” Chesbro said, stressing that one family in need may suffer multiple cutbacks in multiple health care programs.

Coming up will be an Assembly Budget Subcommittee on the governor's 2010-2011 budget proposal at which the public will be able to testify.

Labels: Budget, MediCal, Updates

posted by Anthony Wright | Permalink | 8:43 AM


 

Some good news from DC...

Wednesday, March 10, 2010

A key bill passed the U.S. Senate today...

OK, it's not the big health reform bill, or even a comprehensive jobs bill, but it was a portion of a jobs package that would provide big benefits for health care in California.

One in a series of bills on jobs, this emergency relief package, the “American Workers, State and Business Relief Act,” was approved by a vote of 62-36. Much thanks to Senators Barbara Boxer and Dianne Feinstein for their support. It will go to the House of Representatives, who have passed their own version of a jobs bill, before it goes to the President for his signature.

The legislation, (H.R. 4213), has an extension of unemployment and benefits and contains several health-related provisions that are of particular importance to California, including:
* Extending the COBRA subsidy from the earlier stimulus bill. For unemployed California families, the average monthly COBRA premium is $1,107. The COBRA premium assistance reduced this cost to $388 per month, and without this benefit, unemployed Californians could lose $720 a month.
* Providing help to the state budget through a six month extension of the enhanced Federal Medical Assistance Percentage (FMAP) enacted under the American Recovery and Reinvestment Act, which otherwise would end on December 31, 2010. This extension through June 2011 would provide an increase of $1.5 to $2 billion in federal funding for California's 2010-11 budget.
* Delaying a 21.2 percent cut in payments to physicians who treat California's 4,672,923 Medicare beneficiaries and many TRICARE enrollees in California.

A detailed summary of the benefits for California can be found online at: http://dpc.senate.gov/docs/states-sr-111-2-33/ca.pdf

The COBRA subsidy will be welcome for California, with our high unemployment rate. And the relief for our state budget is crucial, to help close our deficit and prevent much, much worse budget cuts. The House had passed these elements in other bills, but it's very good news that the Senate has finally acted.

Labels: Budget, Federal

posted by Anthony Wright | Permalink | 6:14 PM


 

Speaker Perez in his own words on health budget cuts...

Tuesday, March 09, 2010

Our new California Assembly Speaker John Perez visited the editorial board of the Los Angeles Times late last week.

While acknowledging that he has voted for unthinkable cuts, and that there will be awful cuts going forward, the Speaker showed some impressive knowledge and passion about some of the health care cuts proposed in the past year. He talked personally and policy-wise about proposals to cut kidney dialysis, and about other cuts from AIDS drug assistance, and family planning.

It's worth a listen:
Where to cut $15 billion (5:00)

Labels: Budget

posted by Anthony Wright | Permalink | 6:16 PM


 

The *big* impact of budget cuts...

Our colleagues at Western Center on Law and Poverty released a report today providing a disturbing view of the dramatic impacts of the Governor's budget proposal.

If California does not get enough money from the federal government, the Governor has proposed to "trigger" a range of cuts and eliminations of programs. The proposal would eliminate the Healthy Families program, and cut Medi-Cal eligibility to the federal Medicaid minimum--a place where no state, no matter how conservative or financially strapped, has gone.
The answer is in the report's title: The Governor’s Proposal to Eviscerate Medi-Cal to the Federal Minimum Would Cut More Than 1.7 Million Poor People From the Medi-Cal Program.

And with the elimination of the Healthy Families program which covers over 900,000 children, and the total who would lose coverage under the Governor's proposal is 2.7 million Californians. It's a staggering impact.

And let's not forget: even with *all* the federal funds the Governor has requested, the Governor's proposal would cut over 300,000 Californians from coverage.

Labels: Budget

posted by Anthony Wright | Permalink | 1:25 PM


 

Judges rule for and against cuts...

Wednesday, March 03, 2010

Labels: Budget, Schwarzenegger

posted by Cynthia Craft | Permalink | 6:11 PM


 

The new Speaker on reform...

Monday, March 01, 2010

Assemblyman John Perez of Los Angeles was sworn in as Speaker this afternoon.

His eloquent speech described his journey to be one of the most powerful people in California. It also started to outline procedural reforms, especially around the budget process. It's worth reading:

In addition to focusing on solving our budget crisis and creating jobs, I want this to be a year of reform, real reform!

I envision a three pronged attack.

There are reforms the people in their wisdom must vote on.

For example, I believe that California’s budget should be approved by a simple majority, just like 47 other states and the federal government. As history has shown time and again, if the people lose confidence in the majority party, that party will soon find itself in the minority.

There are reforms the legislature can adopt in a bipartisan, bicameral way—and we will be finalizing some of those proposals in the next couple days.

However some reforms must be made immediately.

I’ve already announced that the budget will not be written behind closed doors in Big 5 meetings. A full budget committee and subcommittee process will ensure all members get to participate and there is time for public input and independent review of the proposals.

Hearings will be held around the state so that everyday Californians have the opportunity to look us in the eye and tell us how our budget proposals will affect their lives. And more importantly, they will have the chance to offer new ideas to us.

We will broadcast our budget hearings and deliberations on the web and where possible on TV. Posting information on the Internet will make it easy for Californians to view the budget, see our proposals for themselves and evaluate the impact on their lives.

Now I’m a big believer in technology, but sometimes we need to limit its reach. Another essential reform we must make immediately is to limit the use of certain technology on the floor and in hearings.

Starting today, text messages from lobbyists are banned while we’re on this floor or in committee doing the people’s business. Californians expect us to pay full attention to the issues and to each other -- and they deserve to know who is involved in the debate. They need not worry that special interest lobbyists are secretly sending messages of opposition or support to us as we deliberate.

At each of these levels – with the voters, with our Senate colleagues and in our own house, we must work together to produce a package of reforms that each and every one of us can be proud of and that allow us to serve our constituents better.

We wish Speaker Perez well in his new position!

Labels: Budget, Perez

posted by Anthony Wright | Permalink | 1:20 PM


 

A sigh of relief over a bit of good news

Wednesday, February 24, 2010

Back the California Legislature, a collective sigh of relief wafted from around the Capitol this week as the Assembly and Senate wrapped up their work on mid-year budget cuts.

Meeting the deadline for the eighth special session set by Gov. Schwarzenegger -- yes, that was eight in one year -- Assembly members and state senators advanced a range of "budget solutions."

For now, they avoided the uproar that followed the Legislature's acquiescence to Schwarzenegger's harsh budget cuts last year on health and human services programs. Many advocates, commentators and members of the public pointed out that those were exactly the kinds of programs California families need to survive this punishing recession. The Senate and Assembly appropriately delayed discussion of the proposed health and human services cuts and eliminations until June, after the governor's May revision of his proposed budget is released.

Let's hope that come June, their wisdom holds.

For a brief but detailed overview of the mid-year budget cuts that did pass, see the California Budget Project's analysis at http://www.cbp.org/

Labels: Budget, Legislation, Schwarzenegger

posted by Cynthia Craft | Permalink | 7:01 PM


 

Your schedule in conferences...

Friday, February 19, 2010

Two upcoming conferences of note for advocates for health and human services:

The California Working Families Policy Summit 2010, on February 25th, will feature Keynote Speaker Secretary of Labor Hilda L. Solis, a former California Congresswoman and state legislator. It will also include a taped message from First Lady Michelle Obama.

It is free, although there is a charge for the luncheon. You can register for the conference online at http://www.ccrwf.org/ or download the agenda and mailing or faxing it with payment if it applies. The early registration deadline is Friday, February 19 and registration closes on Friday, February 22.

The California Budget Project 2010 Conference, "The 3 Rs: Recession, Recovery, Reform: What's in Store for California?" on March 25th, features the health policy-obsessed Washington Post reporter, commentator and blogger Ezra Klein, a native Californian.

Sign up by February 20 to attend CBP's one-day public policy conference at the early bird price of $90. Sign up online or by faxing or mailing the form in our conference brochure.


While we have presented at past versions of these conferences, we aren't this year, but we encourage your attendance regardless... We are simply posting these because they provide good, solid information, and they are are worth your time.

Labels: Budget, Sacramento

posted by Anthony Wright | Permalink | 6:16 AM


 

More federal help...

Thursday, February 18, 2010

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that states are able to claim enhanced funds for Medicare Part D drug payments. This should allow California to get $680 million additional money from the federal government.

This decision could mean an additional $160 million more if the enhanced Medicaid match--which the states get through December 2010 due to the American Recovery and Reinvestment Act--is extended by Congress for an extra six months. The House has passed such an extension in both its health reform bill and its jobs bill as well.

After some unfair and harsh statements, Governor Schwarzenegger struck an appreciative tone: “Today’s announcement shows that our bipartisan efforts for a more fair and equitable relationship with the federal government are paying off. Together, state legislative leaders and our Congressional delegation, especially Senators Feinstein and Boxer, have been working to bring California more of the federal dollars we are owed. These funds are important, and while we still have more work to do, I appreciate the commitment of the Obama Administration in responding to our requests for these much-needed funds that are owed to our state.”

This doesn't solve our state budget crisis, but it certainly helps.

Labels: Budget, Federal, MediCal, Medicare, Schwarzenegger

posted by Anthony Wright | Permalink | 6:05 PM


 

Assemblymembers on Guv's budget: "Not the wisest thing"

Friday, February 12, 2010

Gov. Arnold Schwarzenegger’s self-described “draconian” budget proposals began sounding a little less inevitable by the end of Thursday’s lengthy Assembly Budget Subcommittee hearing at the Capitol.

A strong showing of citizen-advocates opposed many of the cuts, emphasizing the benefits of threatened health programs ranging from one that provides infected jail inmates with HIV and AIDS drugs to the widely accessed Adult Day Health Care program.

Members of the subcommittee chaired by Assemblyman Jerry Hill (D) noted that if the governor’s proposals were to be adopted, the costs for alternatives would be higher in the long run.

Cases in point:
* The Office of AIDS program buying discounted HIV-AIDS drugs for county jail inmates prevents costly and hazardous outbreaks of disease. The governor would cut the entire $9.5 million portion of the program for counties – and then would also transfer more prison inmates to county jails, which cannot afford the drugs.

* The governor would eliminate vision coverage for kids whose families buy discounted health insurance through the Healthy Families SCHIP program. Lawmakers noted that this move would cost the state uncounted federal dollars by preventing better classroom performance by children who need glasses.

* A proposal to eliminate Adult Day Health Care drew one of the largest crowds of opponents, who testified that the option of long-term housing was unaffordable. Another option, for household members to quit their jobs to care for the participants 24-7 would cost California productive workers and income taxes.

* Administration spokesmen argued that Family Planning Services funded by a 9-to-1 federal match needed to be eliminated because “coming up with 10-cents on the dollar in this environment” was difficult. Legislators questioned that assessment, and suggested the Administration go find even more programs with a $9 federal match for every $1 spent by the state.

Assemblyman Jim Beall Jr. (D) noted that moving ahead with health program cuts would be short-sighted because of the likelihood of federal health reform creating opportunities to restructure delivery of health care in California.

In particular, Beall said, new federal rules about mental health care getting parity with physical health care should pave innovative paths for blending delivery of care.

The final segment of the 6-hour hearing, interrupted by the second Assembly floor vote on Sen. Abel Maldonado’s nomination for lieutenant governor, was dedicated to the last item on the agenda: a proposed shift of at least $1 billion from Proposition 63 Mental Health Services Act dollars to the general fund.

The item brought out perhaps the largest turnout of the day, with advocates from Long Beach to Sonoma lining up to tell stories of how the MHSA saved money, and lives. After a Sacramento woman tallied the cost – over $2 million -- of her mentally ill mother’s numerous hospitalizations, she made the point that early intervention through MHSA-style programs would have led to far less costly, and tragic, outcomes.

Of the proposal to shift MHSA dollars to the general fund, Assemblyman Wesley Chesbro (D) said “The impact of this will be severe if it’s allowed to go forward.”

Following the entire presentation, Hill said, “We fully understand the governor’s request,” regarding the mental health funds. “This is probably not the wisest thing to do.”

Labels: Budget, MediCal, Sacramento, SCHIPHealthyFamilies

posted by Cynthia Craft | Permalink | 4:34 PM


 

Personal testimony...

Below is an account from Nellie Price, a colleague of ours at Health Access, perhaps showing that advocacy runs in the family:



On Tuesday evening, my Aunt called me to let me know she and my Uncle would be in Sacramento the next day visiting with legislative offices and testifying before a committee regarding Adult Day Health Care (ADHC).

My Aunt and Uncle live in Chico, where I grew up. They, along with numerous other members of my family, were born in Chico and have lived there for their entire lives. My Aunt’s sister, who is 70 years old, is schizophrenic, diabetic and an amputee. She lives in Butte County and travels 40 miles Monday through Friday to attend the Peg Taylor ADHC Center. At the center, she is able to receive blood sugar and blood pressure monitoring, care for her amputee stump, monitoring of her diet and her medications.

Just recently, she fell and fractured her left humeral head. After a month at a convalescent hospital, she was released and given physical therapy. The Peg Taylor Center was able to provide the care for her and she currently has full range of motion.

My Aunt and Uncle have both recently retired, and My Aunt’s sister is able to be part of the community and an active part of family activities. But I wonder about people who don’t have these “simple” luxuries. And families who aren’t able to take time to advocate for other family members.

I attended the Assembly Budget Subcommittee on Health and Human Services today with my Aunt and Uncle. It seemed as if the majority of the room was there to testify on behalf of ADHC. The committee had to interrupt the testimonies for an hour to get back to the Assembly to try and reach a verdict on the Maldonado nomination, and then returned. My Aunt was not discouraged, thankfully, and we hurriedly got her back in line to testify in front of the committee.

Though she was briefly cut off with one sentence left, she was able to say exactly what she wanted and felt good about her visit to Sacramento.


After all the other testimonies were heard, the committee had interesting things to say. Assemblyman Hernandez stated he was very unsure that ADHC can be completely eliminated after what he’d heard and the personal visits he’d made to ADHC centers in the area. He thought cuts could possibly be made, but not a complete elimination. Whispers of relief were heard throughout the room.

Assemblyman Chesbro opened a discussion about particular costs, which Assemblyman Beall quickly joined, adding that perhaps we should add up all the costs of people already in ADHC versus those not in ADHC and look at the differences. Assemblyman Beall thought there might be higher costs without ADHC, and more costs of programs in isolation. He also stated this was something to look at within the Waiver, and that we need a more integrated approach to serving people and saving money.

Overall, the process for my Aunt and Uncle was long and exhausting and they learned a lot. They know it is far from over legislatively, but they are not finished either.

Labels: Budget

posted by Anthony Wright | Permalink | 2:16 AM


 

The mid-year budget package comes together...

Thursday, February 11, 2010

The Senate and Assembly are starting to move on mid-year budget package of cuts, as reported by Shane Goldmacher in the Los Angeles Times and Wyatt Buchanan in the San Francisco Chronicle.

The Senate budget committee moved on a mid-year budget package yesterday. The Assembly Budget Subcommittee on Health and Human Services meets this afternoon to consider elements of the Assembly package.

The worst of the health and human service cuts--like cuts to Medi-Cal and Healthy Families eligibility and benefits--look like they are being deferred to the bigger budget fight later this year, in deciding the 2010-11 budget. This doesn't mean these programs are safe, merely that the day of reckoning is delayed for a few months. Health and human service advocates need to stay vigilant through the next week of negotiation around a mid-year package, and need to continue our work through May Revise and the spring-summer negotiations.

We'll keep you posted from today's budget hearing this afternoon.

Labels: Budget, InTheNews

posted by Anthony Wright | Permalink | 10:37 AM


 

Anthem Blue Cross is talk of the town..

Wednesday, February 10, 2010

The plight of millions of Californians who are uninsured was front and center at the annual Insure the Uninsured Project conference held Wednesday in Sacramento, where hundreds of advocates, state officials and health industry professionals gathered to discuss what’s next for federal health reform.

“Timing is everything,” one panelist declared -- and indeed that proved to be the case during talk of industry abuses that continue to underscore the need for rate regulation and broader reform. The recent widely publicized move by Anthem Blue Cross to raise rates by up to 39% on individual policies was cited frequently by speakers as evidence that federal health care reform must move forward.

Anthem Blue Cross has been at the center of a whirlwind of criticism from President Obama on down. On Wednesday, the subsidiary of Indiana-based WellPoint continued to attract sustained attacks at the conference by consumer advocates, state legislators and even industry representatives.

Assembly Health Committee Chair Dave Jones (D) announced a hearing for February 23, saying he would demand justification for the hefty rate increase from executives of Anthem Blue Cross and of the industry in general. Jones noted that WellPoint pulled in $2.4 billion in profits last year, and that the 39% increase follows years of double-digit premium increases by the company.

State Senator Mark Leno (D), who touted his bill for a single-payer system, said he would join Jones in backing legislation to consider imposing disclosure rules and rate regulation on health insurance plans. Jones said he also planned to continue his push for legislation to require more transparency from the industry and place caps on out-of-pocket costs for consumers.

Several panelists spoke of the deep divides between Democrats and Republicans, expressing hopes that those divides could be bridged by reason.

An afternoon panel of stakeholders was tasked with discussing what shape federal health reform may take. Some snippets included:

--John Arensmeyer of Small Business Majority said including provisions to make insurance affordable was absolutely necessary for small businesses to be able to hire quickly.
-- Pat Johnston, head of the California Association of Health Plans, said cost-containment initiatives both on base health costs, and including efforts by health plans to cut back their average 12% overhead costs, would be “a vast improvement over the status quo.”
-- Elizabeth McNeil of the California Medical Association said requiring health reform to offer the same level of benefits that members of Congress have would win over the public.
-- Anthony Wright, executive director of Health Access, advised conferees to offer support to their representatives in Washington and suggested that, with vocal constituent backing, a comprehensive reform package could pass Congress in March, by Easter break.

Judging from reports by several speakers, the death of health reform is way premature, and the discussion was a reminder of its necessity and urgency, given the severity of the health crisis here in California. The Anthem Blue Cross rate hikes is just a symptom of the situation.

Labels: BlueCross, Budget, YearOfReform

posted by Cynthia Craft | Permalink | 8:43 PM


 

A checks-and-balances kind of thing...

Monday, February 08, 2010

Assembly Budget Committee Chair Noreen Evans (D) and others assailed the administration Monday for making cuts to a breast cancer screening program for low-income women against the Legislature’s wishes.

The Department of Public Health in December decided to reduce access to the “Every Woman Counts” early detection program by freezing enrollment until June 2010, and limiting enrollment to only women 50 and older.

For the past decade, the program had offered annual breast cancer screening to low-income women who lacked health insurance and were at least 40 years old. Statewide, 1.2 million are eligible for the program through about 1,000 locations, including community health clinics. The program served 249,000 in fiscal year 2006-2007; 270,000 in fiscal year 2007-2008 and then 310,000 in 2008-2009.

With the demand increasing, however, the Schwarzenegger Administration decided to shift some EWC funding to other programs, thus freeing up some money to help plug the growing budget deficit. This was done even though the Legislature had rejected the cutbacks outlined by the administration during budget negotiations after the governor submitted his May spending-plan revision.

At a hearing well-attended by breast cancer survivors and supporters, an irked Evans told bureaucrats that “It’s unacceptable to me that these screenings won’t take place…In my opinion, we’ve had way too much testosterone in the budget talks….and enough of the macho knife-waving, alpha-male politicians in the process. How many Californians will have to die for budget negotiators to see it’s time for us to grow up?”

Despite having been told by Evans that the planned program cutbacks would not be approved by the Legislature, the Department of Public Health “suddenly and surprisingly changed” the program, Evans said.

Assemblyman Hector de la Torre (D) added, “The administration is not allowed to run around making unilateral decisions. There is a checks-and-balances thing going on here.”

A round of applause broke out in the hearing room after Assemblyman Sandre Swanson (D) said the cutbacks in services would cause greater expenditures in the final analysis, as women get sicker and require extensive treatment. “You’re just shoving these costs off onto other programs – and you are costing lives, too.”

Several medical experts and community providers testified that women who are diagnosed with breast cancer in their 40s are more likely to have aggressive forms of the disease and therefore need early detection to survive. Many also testified that the age-group accessing services through Every Woman Counts are more likely to be women of color with few economic resources.

The hearing came after a bake sale held by Evans, other legislators and breast cancer awareness representatives to raise money and awareness about the program cutbacks. Following the hearing, a large rally was held outside, where several other legislators, including Senate President Pro Tem Darrell Steinberg, declared their opposition to the cuts and support for restoring the program. The rally ended with the Capitol being bathed in pink light, a color of significance for breast cancer survivors. Meanwhile, two bills -- with a third likely to come -- have been proposed to reinstate the program, Evans said.

Labels: Budget, Legislation, Prevention

posted by Cynthia Craft | Permalink | 6:04 PM


 

Budget Burdens from DC to Sacramento...

Thursday, February 04, 2010

HEALTH ACCESS UPDATE
Thursday, February 4, 2010


BUDGET ACTION HEATS UP AT STATE & FEDERAL LEVEL
* Chiang Tells Budget Committee of Cash Crisis, Urges "Credible" Action
* Obama's Federal Budget Includes Health Reform and Help for California
* Other Items: CBP Report on Growing Need for Services; Single-Payer Bill Advances

* Read Our Health Access Blog for updates on state budget, the latest in D.C.
* Join Us on Facebook! Follow Us on Twitter!


ASSEMBLY BUDGET COMMITTEE REVIEWS THE BIG PICTURE: Budget Chair Noreen Evans (D) led committee members Wednesday in a sharply focused Q-and-A with State Controller John Chiang, Legislative Analyst Mac Taylor and representatives with the state Department of Finance.

Not since July 12, 2007, has California actually had cash on hand, Chiang said. Since that date, the Department of Finance has relied on "external borrowing and internal borrowing" from various special funds. In answer to lawmaker's queries, the controller said the state's finance department has identified 710 of the state's 1,000-plus special funds from which it can borrow internally.

Repeatedly, Chiang told legislators that California "needs credible and sustainable budget solutions" that do not include past-year gimmicks such as proposing to sell off the state compensation fund, or EdFund (the state's guarantor of student loans) or the state Lottery -- all of which were said by the administration to be worth far more money than they actually were, and attracted no buyers anyway.

Chiang was firm in telling the budget committee that members needed to make "tough choices" to buck up the state's economic and educational future, as well as to ensure its quality of life does not decline sharply. "We've lost 1 million jobs.... We need to decide what kind of state do we plan to have -- and if we are going to fund essential services, we really need to address the question of revenue."

Both Republicans and Democrats made remarks indicating they've had enough of cutting state services for taxpayers, the disabled, the elderly, and K-12 students as well as university-bound students. Assemblyman Jim Silva (R) said as a teacher he is tired of "seeing students are getting short-changed. I get my back up with I hear that California students are at a disadvantage in getting university educations."

Assemblywoman Diane Harkey (R) noted that she only joined the Legislature about a year ago, but already she'd been through three cycles of closing budget deficits. "We're not just in a budget problem. We are overloaded with debt." Others, including Democrats Jerry Hill and Robert Blumenfield, pointed out that some of the harsh health care service cuts that Gov. Arnold Schwarzenegger is championing will cost the state more money in the long-run as people seek care in emergency rooms or long-term care facilities.

Chiang said Wall Street financial experts do not consider the governor's demand for $6.9 billion from the federal government an intelligent answer to California's perennial deficit woes. "When the governor issued his '6.9 billion solution,' it was not viewed as a totally credible solution, leading Standard & Poors to downgrade California's rating from A to A-."

"We're going to have to educate our students for new economies," Chiang said, "Your actions can make the difference in setting this generation on the right fiscal path. For too long, when people don't make tough choices, students, the aged, disabled and taxpayers all end up suffering."

Evans, the committee chair, said sub-committees will begin meeting next week to scrutinize details of the governor's budget proposal. Regarding an unprecedented Department of Finance letter requesting blanket authority to defer payments to various state creditors, Evans said "I will clean up my language from what I said when I first saw this request for the Department to have legislative authority. I'm extremely skeptical and I suggest you come back with an actual plan." Vice Chair Jim Nielsen (R) joined Republican colleagues in attempting to distance himself from the administration's request for open-ended authority to defer payments. "This is a breath-taking application," Nielsen said. "To just ask us to give you a blank check ... we can't afford that anymore."

PRESIDENT OBAMA PUTS FORWARD FEDERAL BUDGET PROPOSAL: Earlier this week, President Barack Obama released his proposed federal budget. The proposal attempts to balance short-term economic stimulus with long-term efforts at deficit reduction. In attempting to reducing the deficit by $1.25 trillion over 10 years, the proposal lets the Bush-era tax cuts expire, and prioritizes the passage of pending health reforms in Congress. To deal with the immediate recession, the budget proposes a variety of provisions, such as continuing COBRA subsidies to help the unemployed purchase health coverage. It would also extend enhanced Medicaid federal matching funds from the stimulus for six additional months to states, providing $25.5 billion nationally, and at least $1.5 billion to California in the budget year through June 2011.

The Office of Management and Budget has a specific fact sheet on the federal budget and California. Health Access has more about the federal budget on our blog.

CUTS PROPOSED AT TIME OF GROWING NEEDS: The cyclical, seemingly never-ending state budget grind has Gov. Arnold Schwarzenegger stuck in a rut, still swinging away with an ax at the safety net at the time it is needed most. That's the basic message that comes through from a report released Tuesday by the California Budget Project.

California has lost 1,000,000 jobs since the start of the recession, the report says. People need help, families need help, whole communities need help as they scramble against the tide of economic devastation. Cuts, the CBP says, will only further weaken the economy and could impede the national recovery.

The CBP report says that 100 prominent economists of all ideologies recently warned that,"It is economically preferable to raise taxes on those with high incomes than to cut state expenditures [during a recession] ... Steep state budget cuts will exacerbate the economic downturn."

The report noted that California now has 3.6 million more working-age individuals than 10 years ago, but is now down to approximately the same number of jobs as 10 years ago. More than one in five working-age Californians -- or 21.4 percent -- were either unemployed or underemployed in December 2009. (The calculation includes 354,000 jobless people who want and are able to work, but who are left uncounted in official statistics because they have not searched for work in the last month.)

As need grew, California unfortunately responded by cutting off programs -- suspending enrollment in Healthy Families, for example, even though the number of children whose low-income families bought coverage through the program increased steadily by nearly 100,000 kids from July 2007 to July 2009, the report says. To read it and view helpful charts and graphics, go to www.cbp.org.

SINGLE-PAYER, OTHER LEGISLATION STARTS TO MOVE AGAIN: With the new year, bills are starting to move again, including SB 810, the single-payer health reform bill authored by Democratic Senator Mark Leno of San Francisco. That bill looks to be headed to the Governor's desk again this year. It's onto the Assembly after passing the Senate last week, the last week a bill was eligible to pass out of its house of origin. While it still faces the barriers of a two-thirds vote for financing, and a probable gubernatorial veto regardless, it does keep a broad range of health reform options in the policy conversation, and highlights the deteriorating status quo of our health system. If anything, some advocates hope it will provide a lesson from state legislatures to their federal counterparts, that they should not quit just because of a setback.


For more information about anything in this update, contact its author, Cynthia Craft, at ccraft@health-access.org.

Labels: Budget, Federal, Obama, SB840, Updates

posted by Anthony Wright | Permalink | 7:55 AM


 

It's complicated...

Monday, February 01, 2010

Here's the opening of an article by Brian Rokos in the Riverside Press-Enterprise on the potential local impact of Gov. Arnold Schwarzenegger's proposed cuts into programs for individuals and families in need of adult day health care and home-care health services:

"Frail, elderly people and mentally ill adults could be forced into hospitals and nursing homes if day-care services close because of the state's budget cutting, care providers say."

But the article goes on to explain that there's a whole lot more involved than just the black-and-white scenarios: There's a domino effect of consequences should clients lose access to adult day health care. There's also the physical and emotional toll on the elderly and frail. Many may not survive a relocation from their own homes.

And, significantly, there's the stress placed on relatives at home who may have no choice but to restructure their lives to care 24-7 for their loved ones. When adult clients no longer are able to attend day-care health centers, the tasks of providing oversight and activities fall on family members who may have to give up their jobs and free time to provide the care.

The article is illuminating when it comes to explaining this toll on caregivers, some of whom are apparently outlived by the person they attend to, due to the added stress: One man told the Riverside P-E that he grew frustrated reinventing himself as a housewife and a cook and keeping an eye on his wife at all times: "There were times I just wanted to go out and yell," the man said. Without having a day-care health program to take his wife to, "I'd be back to the old daily going crazy." With the service as an option, he's been able to gain some of his free time back -- making life easier on him and his wife.

State budget drafters should always consider the multi-tiered human impacts of cutting deeper and deeper into health and human services programs. Represented on the spreadsheet, the programs may look like numbers yet, in actuality, they represent people. And not just people, but whole neighborhoods, cities and -- in the final analysis -- our level of empathy for fellow Californians.

Labels: Budget

posted by Cynthia Craft | Permalink | 10:23 PM


 

Obama releases his federal budget...

President Obama released his proposed federal budget today.

Here's the Center for Budget and Policy Priorities' inital commentary, which states, "The President’s budget reflects both the short-term priority of boosting the economy and creating jobs and the longer-term priority of bringing deficits under control while meeting important national needs... The budget would reduce deficits by $1.25 trillion over 10 years, compared to what they would be by continuing current policies."

The Office and Management and budget has a specific fact sheet on the federal budget and California.

In the budget, President Obama reiterates that he is “committed to ensuring that every American has access to affordable health care,” and his FY 2011 budget proposal continues investments to this end in the health care of Californians. Specifically, California would receive $29.4 billion to provide health coverage to low-income families [Source: OMB factsheet]. In addition, other funding would be used to improve and increase the public health workforce, encourage health centers and providers to provide care to underserved populations, fund initiatives to achieve higher quality care at lower costs, and strengthen regional and local partnerships in rural areas.

STATE RELIEF FOR MEDI-CAL COSTS

Of particular note to those of us who deal with the state budget, there is some continued state relief through Medicaid.

Under the economic stimulus package (ARRA) passed last year, the federal matching rate for California’s Medi-Cal expenditures was increased from 50 percent to 61.6 percent. This totaled $1,991,907,534 for the two quarters from October 1, 2008 through March 31, 2009. In all, California was allotted $11.23 billion for the increased Medicaid match rate that is set to expire on December 31, 2010. [Source: http://www.statehealthfacts.org/]

President Obama’s FY 2011 budget proposal includes about $25.5 billion to extend the increased Medicaid matching rate for another six months until June 30, 2011 [Source: OMB]. This means California could receive an addition $2 billion to $3 billion in federal Medicaid relief under the President’s proposal, depending on actual expenditures and the formula for apportioning the grants to states.

This six-month extension of enhanced Medicaid matching funds is one of the requests for additional federal funding that Governor Schwarzenegger requested, and one that has also been included in other legislative vehicles, including health reform and jobs. However, Governor Schwarzenegger's state budget requested many other funding increases and policy changes, totaling nearly $7 billion. Given the political and procedural barriers in Washington, DC, some are more likely than others, but getting the enhanced Medicaid matching funds is a good first step.

Labels: Budget, Federal, Obama

posted by Anthony Wright | Permalink | 12:28 PM


 

Deja vu all over again...

Friday, January 29, 2010

It's still worth sharing more tidbits from the Senate Committee on Budget and Fiscal Review, chaired by Sen. Denise Moreno Ducheny, (D) earlier this week. Though the hearing was scheduled to last three hours, it ended up being twice that long -- such was the passion of the stakeholders and the complexity of the fiscal topic.

A few of the governor's proposals were raked over the coals, in some cases because the math didn't add up to equal the level of hardship the administration would impose by cutting crucial programs. Other proposals, glimpsed through the lens of recent history, seemingly deflated on the basis of that historical fact alone.

Consider the governor's persistence on the matters of zapping Proposition 10 and Proposition 63. Remember, these were two propositions placed before the voters in the true Democratic tradition of a) allowing folks to vote yea or nay, and b) tallying up the results and c) committing the results to official record.

Proposition 10, otherwise colloquially known for creating the First Five Commission, established programs that Californians believed were needed to help our kids get the leg-up on a world, not to mention a nation, that has been swiftly overtaking us in educating our next generations. California voters first approved it in 1998, rejected overturning it in 2000, and then later once again reiterated their approval of the program to begin nurturing and schooling children ages birth through age 5 in preparation for a robust education.

Proposition 63, the Mental Health Services Act, was approved by the voters and, then again, last May, was also protected when voters rejected the budget initiative to raid the mental health fund to help cover the general fund deficit.

Certainly, in Yogi Berra's terms, as someone pointed out in committee testimony, the governor's proposals are looking like "deja vu all over again."

County spokespeople testified it cost them $68.1 million to put the budget initiatives on the ballot last May -- only to see voters reaffirm what they said they wanted in the first place. Lo and behold, that $68.1 million has yet to trickle down to the counties as reimbursement from the state for holding the May 2009 special election, though one county spokeswoman testified hopefully, "It's in the governor's budget now. . . for that we are grateful."

Labels: Budget

posted by Cynthia Craft | Permalink | 3:00 PM


 

A big budget turnout...

Wednesday, January 27, 2010

More on the budget hearing from Jessica Rothhaar, who directs our budget organizing for Health Access California:

The hearing room was overflowing with Californians from around the state. The big turnout conveyed the severe impact of the cuts absolutely clear.

Senators Ducheny, Leno and Lowenthal also repeatedly expressed disbelief that the LAO was recommending adoption of the Governor’s cuts without accounting for the additional costs of consequences they admitted would happen, such as additional ER admissions, uncompensated care, homelessness, HIV/AIDS infection rates, etc. or the political impossibility of others, such as the taking of Prop. 10 and Prop. 63 money to backfill other programs. On the flip side, Senator Ducheny did ask several times whether less drastic cuts might be possible to several of the programs under discussion, such as to Healthy Families vision coverage.

Among the groups speaking against the cuts at yesterday's hearing included: AIDS Healthcare Foundation; Alliance of Californians for Community Empowerment (ACCE); AltaMed; Alzheimers Association; The ARC; Asian Pacific American Legal Center (LA); Bayview Adult Day Health Care; CA Alliance of Retired Americans; CA Association of Adult Day Services; CA Association of Family Health Centers; CA Association of Health Plans; CA Association for Health Services at Home; CA Association of Public Hospitals and Health Systems; CA Commission on the Status of Women; CA Disability Community Action Network; CA Hospital Associationl CA Immigrant Policy Center; CA Medical Association; CA Primary Care Association; Casa Pacifico ADHC; Children Now and the 100% Campaign; Children’s Specialty Care Coalition; County Health Directors Association of CA; County Mental Health Directors Association of CA; County Welfare Directors Association of CA (CWDA); Developmental Disabilities Council of Alameda County; Easter Seals; Elderday ADHC; Futures Explored; Graceful Senescence ADHC; Hemophilia Council of CA; Loma Linda University Medical Center; National Alliance for the Mentally Ill; Oral Health Access Council; Para Los Ninos; Placer Independent Resource Services; Planned Parenthood Affiliates of CA; Resources for Independent Living; Sacramento CARES; San Diego Council of Community Clinics; San Francisco AIDS Foundation; United Association of California Care Providers (UACC); and Western Center on Law and Poverty.

There was particularly awesome turnout and testimony organized by the California Association of Adult Day Services, which had members there from just about every district represented on the Budget Committee, including San Diego, San Bernardino, Santa Cruz, San Francisco, Contra Costa and Los Angeles. Let's keep it up!

Labels: Budget, Sacramento

posted by Anthony Wright | Permalink | 3:31 PM


 

Blunt language about a blunt budget...

Tuesday, January 26, 2010

There was no escaping the sharp wit and quick tongue of Sen. Denise Moreno Ducheny (D), chair of the Senate Committee on Budget and Fiscal Review, on Tuesday as the panel heard its first airing of the rationale behind the governor's budget proposals to drastically slash taxpayer-funded health services -- for the second year in a row.

Again and again, Ducheny offered succinct retorts that, in effect, signaled to the admininstration that Gov. Arnold Schwarzenegger's ideas amounted to little more than glasses-half-empty. In nearly every area of cuts described, Ducheny demanded more data before moving forward on the governor's punishing health-care cuts for California's most vulnerable populations at a time when the prolonged recession continues to drag down the state's economy.

More than once, Ducheny and other senators questioned why revenue-raising options were not considered as alternatives to decimating services to taxpaying, lower-income citizens. "Most of these programs were started in the first place with the theory that they would save us Medi-Cal dollars in the long run," Ducheny said, demanding more concrete figures from the administration's Department of Finance as it outlined proposed cuts in adult day health care, Healthy Families coverage for children, mental health programs, HIV-AIDS drug assistance and more.

"It's a pig in a poke, is what it is," Ducheny said, chiding the finance department and the Legislative Analyst's Office representatives for not presenting more details to support the claim of potential savings. "It's a bit of an irony that, if we're the seventh-richest state in the union, why the people who put us there couldn't help us more, by paying a [higher] Vehicle License Fee, for example."

Said Sen. Mark Leno (D-San Francisco): "When the governor talked about 'Sophie's Choices,' he didn't suggest revisiting the tax breaks for revenues. He didn't say that was one of 'Sophie's Choices.'"

Still, time and again, both the LAO and DOF representatives fell short in their explanations of how the puzzle pieces of the governor's proposed budget cuts fit together in a way that made sense in helping Californians weather the tsunami of a persistent recession.

Those offering testimony against the governor's cuts raised the discussion to a blunt level not frequently heard in such a formal setting. They spoke of the elderly and the frail expiring before being able to find a bed in a long-term nursing home. They spoke of children being left behind to fail in classrooms; they spoke of more and more people becoming homeless, hopeless, ailing and unjustly relegated to being second-class citizens. Phrases like "fiscally foolish," "morally reprehensible" and "appalling and horrific" replaced the more polite, mutually beneficial language that advocates typically offer up in legislative hearings.

Regarding the proposal that Healthy Families vision care benefits be dropped for children whose low-income parents pay 150% more in premiums than they did a year ago, Ducheny said, "How are the children going to 'Race to the Top' if they can't read?"

Senator Roderick Wright, a Democrat from Los Angeles, provoked the most heated discussion in dismissing what he called "the euphemisms regarding 'reduction of services.'"

Should the governor's proposals be adopted, Wright said, "We are voting to let people die. If we don't face the consequences of these cuts, if we don't face the fact that we are discussing life or death for some folks. . .we are doing a disservice to the public."

Labels: Budget, Sacramento, Schwarzenegger

posted by Cynthia Craft | Permalink | 9:40 PM


 

"This is a budget with a body count."

Wednesday, January 13, 2010

That's how Assemblywoman Noreen Evans began her statement as chair of the Assembly Budget Committee, as they started deliberation.

She was clear that the budget proposal was not acceptable, that "there was a lot of sacrifice, but it isn't shared." She said that since the Governor's proposal wasn't acceptable, the Legislature would not use the Governor's budget as a framework, and would have to take it upon themselves to craft somthing that then the Governor would respond to.

We'll keep you posted.

Labels: Budget

posted by Anthony Wright | Permalink | 1:44 PM


 

Budget blues...

Tuesday, January 12, 2010

Here's a one-page factsheet on the health care budget cuts, and what is at stake. It's a good companion to our recent report about the past health cuts. As the Los Angeles Times noted this weekend, many of the cuts are to programs that have already been hit hard.

Our Facebook (www.facebook.com/healthaccess) page has some of the many news clips from the eleven events last week from around the state by health and human service advocates.

There will be more to come in the weeks ahead. Budget hearings are starting this week...

Labels: Budget, Research

posted by Anthony Wright | Permalink | 12:33 AM


 

You've Got to Be Kidding...

Friday, January 08, 2010

HEALTH ACCESS UPDATE
Friday, January 8, 2010

GOVERNOR ANNOUNCES BUDGET FOR MORE "MONSTER" FY10-11 CUTS
* Gov. Schwarzenegger Has Budget Proposal Similar--but More Severe--Than Last Year
* Millions of Californians Could Lose Coverage and Care; Dramatic Impacts
* Details Below on $2.9 Billion in Health and Human Services Cuts
* An Additional $3.5 Billion of HHS Cuts Would Be Triggered Without Federal Funds

* For News on the Budget, Read Our Blog! Join Us on Facebook! Follow Us on Twitter!

With California bogged down by a $19.9 billion deficit for the next 18 months, Gov. Arnold Schwarzenegger on Friday once again proposed balancing the state’s budget not with new revenues back with devastating cuts to the state’s least-fortunate -- including up to 6.4 billion dollars of cuts in health and human services. Under the cuts, over 1.5 million Californians, and likely many more, would have their coverage eliminated, other key services would be scaled back, and California would lose jobs and federal matching funds.

As he has in last year's budget cycles, Schwarzenegger proposed severe cuts to health and human service programs, the kinds of safety-net services Californians expect their government to extend to the public in times of deep need, that provide help in getting the state and its people back to work.

In some of the governor’s harshest budget scenarios threatened to shut down altogether a range of existing essential health and human services if the federal government did not respond favorably to his demand for $6.9 billion in federal tax dollars.

“Tough times still lie ahead,” Schwarzenegger proclaimed in announcing a package of budget proposals that included some “monster” cuts that would either lead to “real reform” or a continuation of “the budget roller coaster.” Schwarzenegger said he would declare a fiscal emergency and call a special session of the Legislature so lawmakers would be forced to focus on solutions to the deficit.

Afterwards, Democratic Assembly Speaker Karen Bass succinctly said of the governor’s proposals: “I call this budget a big pile of denial.” Bass said the governor’s budget plan was simply and plainly “a non-starter” because “it’s calling for the virtual elimination of the safety net.” Besides Bass’ comments, early indications were that Schwarzenegger’s plan had fallen flat with the Legislature’s Democratic leadership, whose cooperation the governor will need to adopt the state’s annual budget.

Senate President Pro Tempore Darrell Steinberg opened his statements to reporters with a blunt: “You’ve got to be kidding me.” He later noted that the governor’s budget solutions lacked “creativity.” Senator Denise Ducheny, chair of the Senate Budget Committee, said she saw in the budget “a recycling of exactly the same proposals he’s had before.” The main difference, Ducheny said, was that previously Schwarzenegger tended to blame the Legislature for a lack of fiscal solutions and, on Friday, the governor focused on blaming Washington D.C.

Indeed, Schwarzenegger did everything but identify the federal government as a foe, leaning heavily on the theme of fiscal fairness. This lead Bass to note that the governor struck a nearly inappropriate tone: “Typically he threatens the Legislature. Now he’s threatening the president of the United States.”

The governor pledged to fly to Washington D.C. with all four partisan legislative leaders to demand the $6.9 billion he said the federal government owes California. Schwarzenegger made the case that, for every $1 Californians pay in federal taxes, the state only gets an average of 78 cents back. (Ironically, his cuts would cause California to lose even more in federal matching funds.)

The governor is also seeking more reimbursement funds for Medi-Cal expenses, saying California receives only 50 cents on the dollar, while the average for states is 57 cents.
Chief among the governor’s deep cuts are those that would eliminate coverage and care to millions of Californians, ironically forgoing substantial matching federal fund dollars as a result.

The Governor plans to ask for a $2.9 billion cut in health and human services (including $1.1 billion in Medi-Cal), and an additional $3.5 billion cut in health and human services if California does not get the federal money he seeks.

But even with a massive infusion of federal funds, the Governor would still propose to eliminate coverage to hundreds of thousands of Californians, including children. Health experts say these devastating cuts would further unravel the health care system that we all rely on, where we have already seen services scaled back and full clinics close. Health Access recently released an assessment of the health cuts in the 2009-10 budget, six months in.

THE GOVERNOR'S PROPOSED "TRIGGER" CUTS

The following is a list of proposed cuts and eliminations that the governor proposes to be "triggered" if additional federal funds are not forthcoming:

* Eliminate coverage and benefits for millions in Medi-Cal ($532 million), including:
* Reduce Medi-Cal eligibility to the minimum allowed under current federal law (about 72% of the Federal Poverty Level for most adults and 133% FPL for children and pregnant women). For example, this would reduce eligibility for low-income parents from an income of up to $18,310 for a family of three to around $13,000. While this tightening of eligibility standards would not be allowed under the stimulus package until January 1, 2011, it would eliminate coverage for 250,000 Californians in the first six months, coverage for 450,000 in the year after that, and hundreds of thousands more in future years.
* Eliminate many Medi-Cal programs (including the Family PACT program for family planning services, the CHDP Gateway for transitional children's coverage, Breast and Cervical Cancer Treatment Program, and the Medically Indigent long-term care program).
* Eliminate many remaining optional benefits (including medical supplies like diabetic test strips, prosthetic limbs, orthotics, wheelchairs and other durable medical equipment, hearing aids and other benefits).

* Eliminate the Healthy Families Program, affecting all 874,762 children currently enrolled ($126 million);
* Eliminate various health services programs, (including Access for Infants and Mothers, MRMIP's high-risk pools for those denied coverage for pre-existing conditions, Every Women Counts, Asthma control program, and Expanded Access to Care Program), funded by Proposition 99 (tobacco tax) funds, subject to voter approval ($115 million);
* Eliminate mental health services funded by Proposition 63 (Mental Health Services Act), shifting the $847 million to fund existing mental health services;
* Eliminate CalWORKS, the state's welfare-to-work program ($1.044 billion); and
* Eliminate the In-Home Supportive Services programs that provides home care to those not able to assist themselves. ($495 million)


BASE BUDGET PROPOSAL
(REGARDLESS OF WHETHER FEDERAL DOLLARS ARE FORTHCOMING)

Specifically, as described below, the budget proposal makes a number of cuts to health and human services programs, redirects funding from other sources to health care programs, and relies on significant receipt of federal funds.

Cuts to Medi-Cal:
· $750 million in cuts to Medi-Cal by placing limits on services and applying utilization controls, increasing cost-sharing for Medi-Cal beneficiaries, and making “other programmatic changes,” potentially affecting the 7 million Californians on Medi-Cal;
· $118 million to eliminate Medi-Cal coverage for recent legal immigrants, effective March 1, 2010, affecting about 90,000 legal immigrants;
· $104 million to eliminate the Medi-Cal adult day health care benefit, effective March 1, 2010, affecting about 35,000 frail adults;
· $55 million to delay payment to Medi-Cal institutional providers, requiring doctors and hospitals to “float” the state;
· $26.4 million from aggressive elimination of fraud in Medi-Cal; and
· $28.7 million to rescind a rate increase for Medi-Cal family planning services.

Cuts to the Healthy Families Program:
· $85.3 million (including $10.5 million for the current fiscal year) by tightening eligibility requirements for the Healthy Families Program from 250% of the federal poverty level (FPL) to 200% of the FPL, effective May 1, 2010, affecting roughly 225,000 children, plus an additional corresponding $3.9 million cut to the California Children’s Services program for Healthy Families-eligible children;
· $21.7 million by eliminating vision coverage from the HFP benefit package and increasing monthly premiums in families 151-200% of the FPL, effective July 1, 2010, affecting 167,000 children.

Other cuts to Health and Human Services programs:
· $950.5 million in reducing eligibility, payments and services in the In-Home Support Services (IHSS) program;
· $146.1 million by reducing benefits for CalWORKS recipients;
· $306.9 million by reducing benefits for recipients of SSI/SSP;
· $60 million by eliminating the California Food Assistance Program;
· $200 million by reducing support for Regional Centers;
· $18 million by eliminating the Substance Abuse Offender Treatment Program.

A redirection of funding to avoid more health care cuts:
· Reduce $240 million from children’s health coverage to be replaced by newly enacted hospital fees;
· Reduce $36 million from Medi-Cal to be replaced by one-time Proposition 99 (tobacco tax) reserve funds;
· Reduce $25 million from the Access for Infants and Mothers (AIM) program to be replaced by one-time use Proposition 99 (tobacco tax) reserve funds;
· Reduce $550 million in General Fund expenditures on high-priority health and social programs serving children to be replaced by state and local Proposition 10 (California Children and Families Act) funding, subject to voter approval; and
· Reduce $452.3 million in General Fund expenditures on EPSDT services for children and mental health managed cared to be replaced by Prop 63 (Mental Health Services Act) funding, subject to voter approval.

A reliance on federal funding to avoid more health care cuts:
· $1 billion from federal funds owed to the state for disabled Medicare-eligible individuals and the rate of Medicare Part D coverage
· $1.8 billion from increasing the standard federal matching assistance percentage (FMAP) for Medi-Cal from 50 to 57 percent;
· $1.5 billion from continuation of an increased FMAP (through June 30, 2011) as part of ARRA, the economic recovery act.

Labels: Budget, MediCal, Schwarzenegger, Updates

posted by Anthony Wright | Permalink | 9:35 PM


 

A shocking and severe budget...

Governor Schwarzenegger released his proposed 2010-11 budget today, which includes severe cuts and no new revenues.

As part of the cuts, the Governor proposes a $2.9 billion cut in health and human services (including $1.1 billion in Medi-Cal), and an additional $3.5 billion cut in health and human services if California does not get a major infusion of federal funds.

The Governor proposes shocking cuts eliminating coverage and care for millions of Californians, which will have dramatic impacts on not just these families but on the health system on which we all rely. Even *with* a massive infusion of federal funds, the Governor would still propose to eliminate coverage to hundreds of thousands of Californians, including children.

These devastating cuts would further unravel the health care system that we all rely on, where we have already seen services scaled back and full clinics close. Health Access recently released an assessment of the health cuts in the 2009-10 budget, six months in.

This is an anti-jobs budget that not just harms California families and our healthcare system, but our economic recovery. The most effective way to create jobs is invest in Californians, and in their health and in services to help all of us get through a tough time. This proposal completely undermines our economic recovery efforts.

The economic impacts of these health and human service cuts would be multipled because we would not just lose jobs but billions in federal matching funds.

Labels: Budget, MediCal, SCHIPHealthyFamilies, Schwarzenegger

posted by Anthony Wright | Permalink | 4:50 PM


 

Anthem Blue Cross withdraws rate hikes, for now......

 

The Governor embraces health reform

 

WellPoint, Blue Shield end rescissions

 

The continuing campaign in Congress...

 

Early signals on the Budget...

 

Anthem Blue Cross delays rate hike -- again

 

Bartering and exchanging...

 

Sebelius to WellPoint: Knock it Off!

 

Already, WellPoint is trying to game the system..

 

Anthem Blue Cross dumps breast cancer patients