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Good riddance...

Monday, January 19, 2009
Now that it is ending, an assessment on George W. Bush's presidency on health care is due, but it would be too depressing to write.

The writer would be have a tough decision about whether to focus on inaction--the lack of health reform, coverage expansion, or even a national HMO Patients Bill of Rights that he promised--or on what he did do--from the SCHIP vetoes, to the attacks on Medicaid through the waiver process, to the major subsidies to promote HSAs and high-deductible plans. The President claims Medicare Part D as a success, and while it has helped some seniors, other low-income seniors on Medicare actually pay more now, and there were too many bad policies and precedents to balance out, from the provisions with the purpose of privatizing Medicare, to the explicit bar on negotiating with the drug companies for a better price. It's certainly a open field of work for President-elect Obama.

There should be a special part of the report that would focus on what he actually wanted to do, bu didn't get around to. His broader plan to move people away from group coverage and into the an even-more-deregulated individual market was astonishingly adopted by Senator McCain as a whole, and served a ripe target for the Obama campaign. Hopefully some of those ideas ended with the McCain campaign, and now with the Bush presidency.

We'll see.

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posted by Anthony Wright | Permalink | 10:51 PM


Deficit Reduction Act? Yeah Right.

Friday, September 05, 2008
A special Blog post from our Director of Administrative Advocacy, Beth Abbott:

I attended a forum on Thursday to evaluate the effectiveness of requiring applicants and current beneficiaries to prove their U.S. citizenship and identity to receive Medicaid (Medi-Cal in California) under the federal Deficit Reduction Act. The U.S. Congress, operating on the speculation that many illegal immigrants in the U.S. were claiming to be citizens to become eligible for Medi-Cal, proposed this provision into the eligibility requirements for Medicaid for all states in 2005.

The Government Accountability Office (GAO) did a study to evaluate that premise. Their study found no evidence to support that undocumented people falsely asserted that they were citizens, and there was no basis for establishing a requirement to prove citizenship or identity when applying for Medicaid. Congress was undeterred and inserted this provision in the law affecting all states effective July 1, 2006.

This forum in Sacramento showcased the experience of California’s Department of Health Care Services (who lay out the rules for Medi-Cal in California), California counties (who implement these new rules throughout the state), as well as the experience of other states, foundations, and public policy institutes.

The Good: Our state and counties were consistently complimented about their thoughtful and even-handed implementation of this onerous law. California sought input from a wide variety of stakeholders to minimize the harm of these requirements, communicate as clearly as possible about the complexities of the law, and build into the state rules as much flexibility as they were able to get.

The Bad: California and the counties said:
• They had not uncovered any fraudulent attempts to claim U.S. citizenship.
• The state admitted that so far they had spent about $80 million dollars to implement this new law. (This is serious money!)
• The counties had not included the costs to pay for training, longer interviews, additional computer coding or file documentation, or help obtaining proofs.
• Although this law affects only U.S. citizens, it has had a chilling effect and these additional administrative hurdles discourage applicants.

The Ugly: Based on the first two years of its implementation, many attendees believed this was evidence of a misguided, but costly attempt to deal with U.S. immigration problems through the back door, to the detriment of our citizens. However, if this early experience were not enough, Congress is considering expanding this requirement to such programs as Healthy Families, CAL-Works, and others. The consensus was that these requirements did nothing to contribute to the expansion of public health programs, streamline efficiency of the administration of government programs, or add meaningful deterrents to fraud or abuse in public benefits.

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posted by Hanh Kim Quach | Permalink | 1:15 PM



Wednesday, July 16, 2008
I would be remiss if I didn't mention the big victory--not by the American League in the All-Star Game, but by seniors and doctors in the big Medicare showdown.

The U.S. House of Representatives and the U.S. Senate both voted overwhelmingly to override President Bush's veto of the Medicare bill, which reverses a cut to doctor's reimbursement rates in Medicare, pays for it with cut to overpayments to private insurers, and also installs some new consumer improvements for seniors. It was backed by consumer groups like AARP and Families USA, as well as the key doctors' lobby, the American Medical Association.

Some blogs that have good analysis include Managed Care Matters, Health Beat Blog, and the Health Care Policy and Marketplace Review. As the latter stated in an early post: "This vote was not about the doc cuts. It was about Medicare and its future." It's a big deal, for Medicare, and for the prospects of health reform.

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posted by Anthony Wright | Permalink | 11:39 PM


Improving Medicare...

Wednesday, June 25, 2008
According to our collegues at Families USA, we have some good progress on improving Medicare in the U.S. Congress:

On Tuesday, the U.S. House overwhelmingly passed the Medicare Improvements for Patients and Providers Act, H.R. 6331, by a vote of 355-59. They report that the U.S. Senate expects to vote on the House-passed bill as early as Thursday, June 26. An earlier version of this bill was blocked by a Republican filibuster after the President threatened to veto the bill.

The bill also makes needed changes to private Medicare Advantage plans and re-directs funding to Medicare’s doctors and health care providers. This bill makes several important improvements that will help seniors and people with disabilities get the health care they need, including:
* Broader protections for low-income beneficiaries
* Expanded coverage for preventive services
* Reduced cost-sharing for mental health services
* Stronger consumer protections

Families USA is asking health care advocates to call their U.S. Senators, and tell them to support the House-passed version of the Medicare bill -- the Medicare Improvements for Patients and Providers Act (H.R. 6331). You can call 1-800-828-0498 and ask to be connected to your Senator Boxer or Feinstein.

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posted by Anthony Wright | Permalink | 3:28 PM


Adding fuel to the fire...

Friday, April 25, 2008
Earlier today, Families USA released a short report about the proposed Medicaid rule changes put in place by the Bush Administration. They are projected to cost California more than $10.8 billion in federal funds over the next five years.

The report suggests that the cut in federal funding will, in fact, act like a giant anti-stimulus package. Those lost Medicaid funds will eliminate an estimated 46,700 jobs and an accompanying $1.9 billion in wages, and, even worse, cost the state an estimated $5.4 billion in lost business activity.

Virtually all that economic pain comes in the first year of implementation, when California would fail to receive approximately $2.2 billion in Medicaid payments. Titled “Bad Medicine,” the report analyzed the economic impact of seven new Medicaid regulations that were issued in 2007.

“The devastation caused by the Administration’s cuts will affect millions of people who rely on Medicaid for their health lifeline. This will be tragic for their families,” Ron Pollack, Executive Director of Families USA, said today.

“Additionally, these cuts will harm state budgets at the worst possible time. These cuts in federal Medicaid payments will have a ripple effect through state economies that are already struggling during this economic downturn. This economic harm will increase the number of people who may need Medicaid, as tens of thousands of Californians see their paychecks being cut or their jobs being eliminated.

“This lost business activity in California will hurt business and industry, and it will force governors and state legislators to make increasingly difficult choices about providing state services,” Pollack said. “This Bush Administration’s decision is ill-timed and ill-considered, and it should be reversed by Congress.”
There was also comments from our state's Medicaid director.
“The proposed changes to the Medicaid program would result in a significant and potentially devastating shift of costs to California taxpayers,” Stan Rosenstein, chief deputy director, California Department of Health Care Services, said today. “Our state would be saddled with an estimated $12 billion financial burden resulting from such a drastic change in how the federal government supports the Medicaid program. The Governor strongly believes that such changes should undergo further evaluation and a full congressional review before being implemented."

The seven regulation changes issued by the Bush Administration in 2007 – and imposed on states without congressional review or debate – restrict funding for a variety of Medicaid services, including rehabilitation services, school-based transportation, as well as Medicaid administrative services, such as outreach, enrollment, and case management. The seven rule changes are now either under a congressional moratorium or awaiting implementation.

Just a comment: On top of proposed cuts at the state level, these federal cuts by the Bush Administration would be a 1-2 punch for California patients, our health system, and our economy. These cuts would add fuel to the fire of our deteriorating economy, and our deteriorating health system, one that we all rely on.

We are happy that most (but not all) of our California Congressional delegation voted to delay these regulations, as Hanh reported below. These is the exact wrong direction for California and for health care.

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posted by Anthony Wright | Permalink | 5:06 PM


Congressional Republicans join in to stop Bush Administration cuts

Wednesday, April 23, 2008
The House voted 349-62 today to extend the existing moratoria on Bush's Medicaid regulations that would have hurt low-income children and people with disabilities the hardest. (read more about the bad regs here and here.)

Besides the huge human impact state's would have lost LOTS of money -- like $50 billion in federal matching funds. California's share was $2.2 billion in the first year of implementation.

Given that we're facing our own budget crisis, let's thank California's members of Congress who continue to block these regulations. Here is the full roll call from today's vote.

VOTING YES: All the Democrats, and Republicans Brian Billbray, Mary Bono, Ken Calvert, David Dreier, Elton Gallegly, Duncan Hunter, Jerry Lewis, Dan Lungren, Kevin McCarthy, Gary Miller, Devin Nunes, George Radanovich, and Dana Rohrabacher.

VOTING NO: Out of 19 Republicans in California's Congressional delegation, only four voted no, which would allowed the Bush Administration cuts to go forward. Republican No votes were: Wally Herger, Darrell Issa, John Doolittle and Buck McKeon.

NOT VOTING: Republicans John Campbell and Ed Royce. Maxine Waters, a Democrat also did not vote.

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posted by Hanh Kim Quach | Permalink | 3:42 PM


Bush vs. San Francisco...

Thursday, April 17, 2008
As if San Francisco didn't need more bad press this week, the Bush Administration is weighing in against Healthy San Francisco in court today, reports Bob Egelko of the San Francisco Chronicle.

Here's some previous posts on the background of the Healthy San Francisco effort, including the legal ERISA challenge to the San Francisco program, to strike down the policy of getting employers to contribute to the health care of their workers.

There's a hearing today at the Ninth Circuit Court of Appeals. Given that effort around Healthy San Francisco came about in part because of federal inaction on health reform, it's disappointing that the White House couldn't stay out of it, and allow state and local groups to proceed with their own reforms.

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posted by Anthony Wright | Permalink | 8:03 AM


Subprime Monday...

Monday, February 04, 2008
What comes between Super Sunday and Super Tuesday?

Subtraction Monday.

The California Senate Budget Committee held a umpteen-hour hearing on the health care budget cuts, the last hearing on specific cuts before putting together a mid-year cuts package. Hanh will have a full report later today.

President Bush put out his new budget today, and it's also not pretty.

For starters, he proposes $560 billion in cuts from Medicare over the next decade. Here's Families USA:

Following up on his indefensible veto of the kids' health bill, President Bush proposed inadequate funding for the State Children's Health Insurance Program (SCHIP). Under the President's proposal, the program could not even continue to serve the children currently eligible for the program. The President also proposes drastic cuts to Medicare and Medicaid. These public programs offer health security for many families and are more important than ever when we face hard economic times.

The President's solutions for the rising cost of health insurance and the growing numbers of uninsured follow three simplistic principles:
* Ask people to pay more out of their own pockets for health care;
* Create tax breaks that provide little or no help to low-income families;
* Provide no government oversight of the behavior of insurance companies.

This budget, like many over the last seven years, offers clear insight into the Bush Administration's priorities for our health care system — priorities that place working Americans at risk.

Here's the Center for Budget and Policy Priorities, from their budget brief, well worth reading in full:

The President's budget would provide more tax cuts heavily skewed to the most well-off while cutting vital services for low- and moderate-income Americans, generating large deficits, and increasing the strain on states already confronting budget problems as a result of the economic downturn. The budget reflects misguided priorities that would leave the American people more vulnerable in a number of ways....

MEDICAID: In addition, the budget would cut federal Medicaid expenditures by $18.2 billion over five years (with $17.4 billion in reductions from legislative changes and another $800 million from regulatory changes). These “savings”
would primarily be achieved not by lowering health care costs, but rather by shifting costs to the states.

MEDICARE: In addition to the Medicaid cuts, the budget includes $556 billion in Medicare reductions over ten years. Many of the proposed cuts go well beyond the reductions that MedPAC, Congress’ expert advisory commission on Medicare payments, recommended and considers safe. These reductions could drive some health care providers to limit the number of Medicare patients they see or drop out of the program entirely. That, in turn, would jeopardize health care for significant numbers of people who are elderly or have serious disabilities... At the same time, the Administration rejected MedPAC’s call to curb the tens of billions of dollars of overpayments being made to private insurance companies that serve some Medicare beneficiaries through the Medicare Advantage program.

SCHIP: The budget includes what it describes as a $19.7 billion increase in funding for the State Children’s Health Insurance Program (SCHIP). This would not, however, allow states to cover more uninsured children, millions of whom are eligible for SCHIP and Medicaid but unenrolled. States need an increase of approximately $21.5 billion over the next five years simply to maintain their current programs. This is because the budget “baseline” for SCHIP includes no adjustment for health care inflation in coming years; the baseline actually assumes a reduction in SCHIP funding for 2009. Under the Administration’s funding level, therefore, states would be required to scale back their SCHIP programs modestly unless they were able to increase their own funding.

We have a lot of work to do in the new year, at both the state and federal levels...

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posted by Anthony Wright | Permalink | 9:24 PM


Waiting for January 2009...

Sunday, November 25, 2007
Susan Brink at the LA Times has a lengthy overview of the SCHIP children's coverage crisis, from the point of view of one middle-class family that isn't eligible for children's covearge now, but their kids would be covered under the reform proposals by Governor Schwarzenegger and the legislative leadership, if the federal government gets around to funding the program.

More on the political side, there's an important article by Zachery Coile at the San Francisco Chronicle describing the awful choices that California has with regard to the SCHIP discussion: without a resolution in DC, California is on the brink of disenrolling hundreds of thousands of children from the current program.

As I point out in the article, this goes beyond the awfulness of denying children coverage for their check-ups and emergencies... this undoes ten years of outreach and enrollment efforts to build the program up to this point, to the 800,000+ children now in CA's SCHIP program, called Healthy Families. This is a betrayal of trust... the whole point of insurance is to provide security, and that security is gone when you yank the insurance away. When the funds eventually come in, will we find those kids again? Why wouldn't those families be skeptical?

The only good news is that I think that this problem has a defined end date.

* There's a good possibility that a deal could be worked out in the next few months between the President and Congress that provides the needed funds for SCHIP, especially if there's enough heat on the President, Republicans running for re-election, especially 15-or-so Republican Representatives that would provide the margin for a veto override. The closer this gets to the election, the more Congressmembers on the wrong side of this issue may want a deal to protect them from political attack.

* In the worst case scenario, the problem goes to January 2009, with a new President. The Democratic candidates have already pledged to support the Congressional policy and level of funding. Frankly, I can't imagine that a new Republican President would want to start his new term with a fight over children's coverage (it's still hard to fathom why President Bush has instigated this issue). And the next President, regardless of party, may not have a choice: a newly-elected Congress with different margins may be able to muster a two-thirds override itself.

There's not enough federal money to wait until January 2009. So it's a real, immediate, ugly problem... but one that has a light at the end of the tunnel.

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posted by Anthony Wright | Permalink | 10:49 AM


Zonker would know what to do...

Tuesday, October 23, 2007
Doonesbury takes on the SCHIP issue, and the attack on the 12-year old...

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posted by Anthony Wright | Permalink | 9:40 PM



Wednesday, October 03, 2007
Health and consumer advocates should keep the pressure on U.S. House members about the possibility of an override of the President's veto of children's health coverage, which he did today.

We need 25 more votes from last week's House vote to override the veto. There's a handful of Democrats who didn't think it went far enough, or who had other issues. (For example, California Rep. Diane Watson voted "present.") Presumably, they can be convinced that they made their point, and to vote to override the President and get coverage to children.

So theoretically, the California delegation could make the remaining difference itself, if all of the 18 California Republicans vote in the interest of their Republican Governor, their state, and the children of their district. Rep. Wally Herger did not vote, and so maybe that's a signal that he would vote for the override. Maybe not all of them are able to be convinced, but California could make a big difference in putting this over the top. It's essential.

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posted by Anthony Wright | Permalink | 10:27 AM


All SCHIP, all the time.

Tuesday, October 02, 2007
HHS Secretary Mike Leavitt posted his defense of the President's SCHIP veto at *his* blog.

Hat tip to John McDonough at A Healthy Blog. I posted a comment to rebut only a few of the clearly inaccurate statements... maybe others can take on some of the others.

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posted by Anthony Wright | Permalink | 12:33 PM


How times change...

Thursday, September 27, 2007
...from election years.

Here's an excerpt from President Bush's 2004 speech at the Republican National Convention:

"America's children must also have a healthy start in life. In a new term, we will lead an aggressive effort to enroll millions of poor children who are eligible but not signed up for the government's health insurance programs. We will not allow a lack of attention, or information, to stand between these children and the health care they need. (Applause.)"

Oh, well.

In fairness, here's the White House's website response on SCHIP.

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posted by Anthony Wright | Permalink | 1:36 PM


Roll Call on SCHIP

Tuesday, September 25, 2007
A victory, but a defeat.

The SCHIP Reauthorization Bill, H.R. 976, passed in a broad bipartisan vote of 265-159, with 1 Representative saying "present" and 9 not voting.

The problem is that the two-thirds vote needed to override a veto is 290 votes. So while the bill has a veto-proof majority in the Senate, and even though SCHIP got more House Republican votes than expected, we are 25 votes shy in the House.

President Bush can veto the bill, as he has promised, and it will stick.

All but 12 Democrats voted for the bill. Of the Republicans, 45 voted for it. From the California Republican delegation, it seems only Rep. Mary Bono saw fit to vote with Governor Schwarzenegger and the interest of California children.

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posted by Anthony Wright | Permalink | 8:44 PM


The SCHIP Showdown Today...

Tuesday, September 25, 2007

* State Child Health Insurance Program (SCHIP) expires in five days
* President Bush has vowed to veto legislation to extend the program
* California's Healthy Families may have to disenroll hundreds of thousands of children
* Compromise $35 billion bill would cover one-half of remaining uninsured children
* ACTION ITEM: Contact your member of Congress today, to support SCHIP expansion

New on the Health Access WeBlog: SCHIP Deal; New Language Access to Care Standards at the Department of Insurance; How Close to a Deal on Health Care? Special Session Gossip.

The U.S. House of Representatives is set to vote TODAY, Tuesday, September 25th, on the extension and expansion of the popular State Child Health Insurance Program. The vote will determine the future of the federal program, and of children's health coverage in general.

California's version of the program, Healthy Families, now covers 850,000 children. With extended federal funding, the program has the potential to meet its promise to cover the rest of California's uninsured children.

Unfortunately, the big vote today could send also signal of the reverse, and force the program to consider disenrolling hundreds of thousands of Californians children.

To avoid this, CALL YOUR CONGRESSIONAL REPRESENTATIVE TODAY, and urge them to support of SCHIP expansion, and to support an override of President Bush. To call the Capitol swtichboard using a toll-free number, call: 1-800-828-0498.


Hundreds of thousands of children enrolled in Healthy Families could be abruptly dropped from health coverage as early as mid-November, unable to see a doctor, go to the hospitals and get medical treatments they need, if Congress does not vote to continue the State Children’s Health Insurance Program today with large margins.

Sen. Sherrod Brown, D-Ohio, spoke eloquently on the Senate Floor about the importance of extending SCHIP on Monday, pointing out that private insurance is prohibitively expensive for many Americans, “These families are uninsured because they have no choice and their children have no choice.’’ Extending the SCHIP program, he said, could give those families necessary health coverage.

BUSH'S VETO THREAT AND IMPACT: Yet President George W. Bush has threatened to veto the proposal, suggesting such an expansion would lead to a federal system of "government-run health care." If there is no extension is granted by the start of the federal fiscal year, federal money will run out for the program by mid-November, according to independent estimates.

Mindful of the deadline, he suggested that Congress extend the program at current funding levels. Because California is using federal dollars saved from earlier years of low enrollment, an extension on current levels would not be enough to even keep the children covered who are currently enrolled, much less accept new enrollment. Such a proposal, as proposed by Rep. Barton, would force California to have to dis-enroll hundreds of thousands of children from the Healthy Families program, according to estimated commissioned by The California HealthCare Foundation. The choice for California would be cruel: either to continue to cover all the children in the program until the money runs out in summer 2007, potentially leaving all the children without coverage; or to immediately disenroll around 250,000 children in October.

VOTES FOR AN OVERRIDE? The Senate has already voted for this extension with a veto-proof 2/3 majority. In order to show President Bush that they can override his veto, the U.S. House of Representatives would need 290 votes in support of the SCHIP reauthorization bill--including all Democrats, and 57 Republicans in Congress.

California has 53 Congressional representatives that could make the difference, especially the Republican ones, who have the choice between loyalty to the President, or representation the best interest of their state and its children.

CONTACT YOUR CONGRESSIONAL REPRESENTATIVE TODAY. Click here for a list of California Congressional offices and contact information, including phone numbers.

BACKGROUND: SCHIP's SUCCESS: The SCHIP program has been largely successfully since it passed 10 years ago with bipartisan support, enrolling 6.6 million children nationwide at a time when private health coverage through employers has been declining. In California, 850,000 children receive benefits from the Healthy Families Program.

STATES SEEK TO EXPAND: Coinciding with efforts to re-authorize SCHIP, many states, including California are looking to expand the number of children who are eligible for SCHIP/Healthy Families. Gov. Arnold Schwarzenegger, in his January health reform proposal, suggested that families earning up to 300 percent of poverty ($61,950 for a family of four), should be able to obtain coverage through this program.

Currently, in California, families earning up to 250 percent of poverty ($51,000 for a family of four) qualify. A few other states have more more generous expansions for families earning 300 or 350 percent of poverty. New York recently sought to expand coverage to 400%, but was rejected by the Bush Administration a few weeks ago.

AN EXTENSION TO MEET THE NEED: Ironically, in the same year that health reform and reducing the number of uninsured has come into national focus, President Bush has taken a stand to do the opposite.

As SCHIP ticks toward its September 30th expiration, the president has declared he would veto legislation that would allow it to continue and expand coverage to about 4 million more children, halving the number of uninsured children. Estimates are that the bill Congress is considering now could help as many as 650,000 additional children in California.

BUSH'S PROPOSALS: Bush favors funding the program at only $5 billion more over the current level over the next five years – rather than the additional $35 billion proposed. Such a proposal would force California to create a waiting list for children wanting to get coverage, and probably disenroll some already on the program.

Additionally, Bush proposes to scale back eligibility – only allowing those who earn 200 percent of poverty ($41,300 for a family of four) or less to qualify. That would reverse gains made in 18 states, including California, who have eligibility limits higher than the 200 percent of poverty threshold. In California, that would mean 190,000 children would lose coverage. Failure to extend and expand the SCHIP program could also endanger California's efforts to pass a health reform and provide near universal coverage this year.

ACTION ITEM: Please call your Representatives and urge them to support the compromise measure allocating an additional $35 billion for children and families over the next five years. To find your representatives, visit www.house.gov.

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posted by Anthony Wright | Permalink | 12:41 AM


A compromise on kids...

Friday, September 21, 2007
The two houses of the U.S. Congress came together on a proposal to extend and re-authorize SCHIP, the State Child Health Insurance Program, called Healthy Families in California.

The compromise attempts to bridge the differences between the House and Senate versions, maintain the bipartisan support, including that of Republican Senators, in the hope of getting a veto-proof majority. The proposal also attempts to address the issues--however specious--raised by President Bush.

That said, the deal in uncertain to give California all the resources it need to continue its gradual increase in children's enrollment... that depends on how the formula works out. Also, the deal does make harder California's efforts to further expand coverage to middle-income children, and to parents.

Yet it is likely, even expected, that Bush will veto. That's why we need the full California delegation--Republicans and Democrats--in support, since the alternative is to start kicking kids off coverage.

Here's the press release from the Congress:


Bipartisan, bicameral coalition ready to move on full reauthorization of vital

Washington, D.C. – A bipartisan coalition of Senate and House leaders today announced a bicameral agreement to reauthorize the Children’s Health Insurance Program (CHIP) for an additional five years. CHIP provides health coverage to American children whose parents do not qualify for Medicaid, but can’t afford private insurance. The $35 billion agreement struck by House and Senate negotiators will bring health coverage to approximately ten million children in need – preserving coverage for all 6.6 million children currently covered by CHIP, and reaching millions more low-income, uninsured American children in the next five years.

Below is an outline of the agreement, which is designed to target specifically the lowest-income uninsured American children for outreach and enrollment. The agreement does not call for CHIP coverage for children in families at higher income levels. Instead, it reduces Federal matching funds for future coverage of children at higher income levels, and provides incentives to cover the lowest-income children instead. CHIP coverage of childless adults and parents will be phased out to maintain the program’s focus on kids.

Investing $35 Billion in New Funding for CHIP. The agreement reauthorizes the Children’s Health Insurance Program, investing an additional $35 billion over five years to strengthen CHIP’s financing, increase health insurance coverage for low-income children, and improve the quality of health care children receive.

Lowering the rate of uninsured low-income children. The agreement will provide health coverage to millions of low-income children who are currently uninsured. The bill also ensures that the 6.6 million children who currently participate in CHIP continue to receive health coverage. Pending final Congressional Budget Office estimates, the reduction in the number of uninsured children will approach four million children.

Improving Access to Benefits for Children (Dental Coverage/Mental Health Parity/EPSDT). Under the agreement, quality dental coverage will be provided to all children enrolled in CHIP. The agreement also ensures states will offer mental health services on par with medical and surgical benefits covered under CHIP, and protects medically necessary benefits (EPSDT) for low-income children.

Prioritizing children’s coverage. The agreement makes several modifications as it relates to populations eligible for CHIP.

Pregnant Women: The agreement provides coverage to pregnant women as a new state option as well as preserving the options to cover them through a state waiver or through regulation.

Parents: The agreement prohibits any new waivers to cover parents in the CHIP program. States that have received waivers to cover low-income parents under CHIP will be allowed to transition parents into a separate block grant. The federal match for services to parents covered through CHIP will be reduced.

Childless Adults: The agreement retains the current law prohibition of waivers to allow coverage of childless adults. Currently covered childless adults will transition off CHIP. For states that have received CHIP waivers to cover childless adults, the agreement terminates those waivers after a one-year period, provides temporary Medicaid funding for already-enrolled adults, and allows states to apply for a Medicaid waiver for coverage.

Providing states with incentives to lower the rate of uninsured low income children. Under the financing structure, states will receive state-based allotments that are responsive to state demographic and national spending trends and allow additional up-front funding for states planning improvements. States that face a funding shortfall and meet enrollment goals will receive an adjustment payment to ensure that no child who is eligible for Medicaid or CHIP is denied coverage or placed on a waiting list. The formula also sets in place new overall caps on federal funding to ensure the program’s expenditures do not exceed the amounts authorized. The agreement provides incentives for states to lower the rate uninsured children by enrolling eligible children in CHIP or Medicaid.

Agreement Replaces CMS August 17th Letter to States. The Congress agrees with the President on the importance of covering low-income children have health coverage while taking steps to address crowd-out and prioritize coverage of lower income children. The agreement replaces the flawed CMS August 17th letter to
states with a more thoughtful and appropriate approach. In place of the CMS letter, the agreement gives states time and assistance in developing and implementing best practices to address crowd out. The agreement also puts the lowest income children first in line by phasing in a new requirement for coverage of low-income children as a condition of receiving CHIP funding for coverage of children above 300 percent of the poverty level.

Improving Outreach Tools to Simplify and Streamline Enrollment of Eligible Children. The agreement provides $100 million in grants for new outreach activities to states, local governments, schools, community-based organizations, safety-net providers and others.

Improving the Quality of Health Care for Low-Income Children. The agreement establishes a new quality child health initiative to develop and implement quality measures and improve state reporting of quality data.

Improving Access to Private Coverage Options. The agreement expands on current premium assistance options for states. The agreement allows states to offer a premium assistance subsidy for qualified, cost-effective employer-sponsored coverage to children eligible for CHIP and who have access to such coverage. It also changes the federal rules governing employer-sponsored insurance to make it easier for states and employers to offer premium assistance programs.

Legislative language is currently being finalized, and will be available Monday. The House of Representatives will likely vote on legislation implementing this agreement on Tuesday of next week. The Senate will take up the measure shortly thereafter, to deliver a full renewal of the Children’s Health Insurance Program to the President for signature into law before CHIP’s current authorization expires on September 30.

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posted by Anthony Wright | Permalink | 3:13 PM


Kicking kids off coverage...

Thursday, September 20, 2007
The New York Times reports on a press conference this morning by President Bush, again threatening a veto on extension and expansion of the State Child Health Insurance Program.

He's right about the philosophical divide:

"What I'm describing here is a philosophical divide that exists in Washington over the best approach for health care. Democratic leaders in Congress want to put more power in the hands of government by expanding federal health care programs. Their S-CHIP plan is an incremental step toward the goal of government-run health care for every American."

Instead, President Bush is seeking to disenroll children and leave them uninsured.
"Congress must pass a clean, temporary extension of the current S-CHIP program that I can sign by September the 30th. And that's the date when the program expires."
If there's a flat extension, without any increase in funding, California will have to disenroll children in Healthy Families, our SCHIP program. In recent years, we've been using SCHIP funds that we had saved during the earlier years, when we had low enrollments.

If we just got the federal allotment we got last year, it doesn't just mean that Healthy Families has to install a waiting list. It means actively kicking kids off coverage. If this impass lasts the entire year, we are talking of hundreds of thousands of children.

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posted by Anthony Wright | Permalink | 2:47 PM



Saturday, August 04, 2007
The SCHIP debate is on. A filibuster-proof, veto-proof 68 votes in the Senate! A majority in the House--225 votes!

California advocates need to work on the California Republican delegation, which unanimously voted against the CHAMP Act, voting against the health care of our seniors and children. If those Congressmen actually voted in our state's interest, we could play a major part in getting the veto-proof majority needed.

There's still August recess for the two houses to hammer out differences and send President Bush a renewal for SCHIP that will fully fund the effort to cover all eligible children. Much more work to do, but a strong start.

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posted by Anthony Wright | Permalink | 9:17 PM


All the President's Polyps...

Tuesday, July 24, 2007
San Francisco physician Margot Kushel delivered this succinct message to President Bush in today's NY Times' Letters to the Editor:

Mr. Bush: one cannot get a preventive colonoscopy in the emergency
In case anyone missed it, earlier this month, the President insensitively remarked:
"I mean, people have access to health care in America. After all, you justgo to
an emergency room." -- President George W. Bush (Cleveland,7/10/07)

Of course. We can't all get presidential health care. But we can get preventive care -- like the President did on Saturday (does that mean it was a house call?) which eventually resulted in the extraction of five (!) polyps.

Well said, Dr. Kushel.

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posted by Hanh Kim Quach | Permalink | 12:36 PM


Money Matters: Major Moves in CA & US on Health

Friday, July 20, 2007
Friday, July 20th, 2007

• Bipartisan 17-4 Vote to Expand Children's Coverage, including CA's Healthy Families
• House Expected to Consider Broader Proposal; Bush Threatens Veto
• CA Budget Considered in Full Assembly; Heads to CA Senate

Click Here for What's New on the Health Access WeBlog: More on SCHIP Mark-Up; Will Bush Veto?; Study on Tax Credits and High Deductibles; Grocery Worker Strike Averted; Sicko; Germany's Health System; Language Access Comments Due at Department of Insurance

CA ASSEMBLY PASSES BUDGET: Starting almost at midnight last night and going well into this morning, the California Assembly stayed into the night to consider and pass a proposed deal on the state budget.

In presenting the budget, Budget Conference Committee Chair John Laird stated that "There's a lot to like about this budget," pointing out the many areas that are fully funded. However, he did mention significant reductions, particularly to public transit, and mentioned that "health and human services do suffer cuts." He stated that the goal of the last week of negotiation was to get "a budget that appeals to both sides of the aisle," and as such, mentioned there were "no new social programs."

With the Assembly passing the measure, the hope is that the Senate will consider the measure today, Friday, although the outcome is unclear at this writing. The budget is for the 2007-8 fiscal year that has already started, on July 1, 2007.

Health Access will review the new budget documents, including the health and human services budget trailer bill, and post any health related news on the Health Access WeBlog over the next few days.

US SENATE SCHIP DEAL MOVES AHEAD: Yesterday, in Washington, DC, the U.S. Senate Finance Committee marked up and passed a major bill to reauthorize and expand the State Child Health Insurance Program (SCHIP). This action is an important step for California, which is depending on these deliberations to fund coverage for the over 800,000 children on our state's Healthy Families program, and to help reach the goal of covering all children.

The bill mark-up, which provides for $35 billion in additional funding for SCHIP, was approved by a vote of 17-4. All of the Democrats and 6 Republicans (Grassley, Hatch, Snowe, Smith, Crapo, and Roberts) voted for passage. Lott, Kyl, Ensign, and Bunning were the 4 no votes. It now heads to the Senate floor.

As proposed last week, the bill raises these funds with a 61 cent increase in the national tobacco tax, bringing that tax to a flat $1.00. After the mark-up, the bill now also includes an Express Lane state demonstraton program, mental health parity, and dental health grants. Families USA has a more detailed update, including the full mark-up documents, at their Medicaid Action Center on their website at:

Amendments were suggested to weaken the bill, but they failed, including policies such as allowing premium assistance to be used to purchase high-deductible plans and restricting CHIP eligibility to 300% of poverty. Amendments that would have strengthened the bill (like increasing the funding to $50 billion and adding ICHIA) were withdrawn before a vote, largely because they were unlikely to pass at this time.

In a teleconference call with a California convening, a Democratic staffer for Majority Leader Reid noted that the proposal was not all that Democrats has wanted--including the $50 billion amount that health and children's advocates had pushed--but they needed to get bipartisan support, given that, under Senate rules, any bill needs 60 votes to pass, which means getting all Democratic votes and 10 Republican votes.

HOUSE PLANS: At that same teleconference convening, a staff for Speaker Nancy Pelosi stated that the House hope to pass a broader health care package, also in July, to allow for negotiations over the Congress' August recess to reconcile the measure with the Senate. The desire is to negotiate a final deal for passage in September.

The $100 billion health package is expected to include elements on provider reimbursement, low-income senior assistance, and $50 billion for children's coverage reauthorization and expansion. It would also be funded by a tobacco tax, as well as a readjustment of subsidies to Medicare HMOs.

BUSH'S VETO THREAT: While the Congress is debating how much to expand children's coverage, and how to fund it, President Bush has indicated that he would veto the children's coverage bill passed in the Senate Committee.

Despite his 2004 campaign convention speech promising to enroll more children in SCHIP programs, the President's original budget included only a $5 billion increase, which would force many states, including California, to dump children from the program or have children placed on waiting lists. Bush has repeatedly denounced the bill as a step toward “government-run health care for every American,” describing it as a “massive expansion of the federal role” in health care, financed by “a huge tax increase.”

While SCHIP has traditionally been a program with broad bipartisan support, having originally passed in a Congress headed by former Speaker Newt Gingrich, several Republican Senators used similar talking points in the debate today.

The Center for Budget and Policy Priorities, on their website, has new papers that provide facts disputing these assertions, including addressing the issue of "crowd-out," where an expansion of a public program replaces existing private coverage. These papers are available now, at:

ACTION NEEDED: Contact Senators Boxer and Feinstein, and more urgently, your U.S. Representative, and urge them to support full funding for SCHIP and children's coverage. Families USA is hosting a toll-free line to make this call at 1-800-828-0498, and a website to faciliate E-mails at:

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posted by Anthony Wright | Permalink | 1:01 AM


Drawing the right conclusions...

Thursday, July 19, 2007
I've been looking at the new Health Research and Educational Trust paper released this week, authored by Susan Marquis and others at RAND. The big headline, which got USA Today's attention, is that even reducing premiums for health care by 50% would reduce the uninsured by merely 3%.

Some tried to make this study about the need for an individual mandate, but I don't see anything here that suggests that. I didn't see anything in the paper that suggested that the reason people are uninsured is that they don't want coverage, and other research disputes that notion. As I read the result, a tax credit simply doesn't go far enough for the vast majority of the uninsured: it's a 50-foot rope for someone in a 100-foot hole.

Instead, the vast majority of the dollars from a tax cut or credit to those who are more affluent, including those with insurance.

What can we learn from the study? Funded by the California HealthCare Foundation, this survey of uninsured California families, is a complete and utter smackdown of President Bush and other Republican proposals that suggest that all the uninsured need is a good tax cut. Other studies, even those by business and industry groups, show that such tax credits are far less efficient than expanding public programs and other strategies for health reform.

What the study also does is indicate how people reject plans with high deductibles and other cost sharing. Even when the high deductible plans offers significantly lower premiums, they'd rather go for the higher premium, lower-deductible policies. They don't see the value in the high-deductible plans: What's the point of having health coverage that doesn't provide much coverage?

If anything, the study suggests serious issues with the Governor's proposal, which depends on these high deductible plans, since it requires individuals who aren't eligible for employer-based coverage or public programs to buy coverage in the individual market. For many of these middle-income folks who would be impacted, the only thing they would be able to afford to buy is the minimum coverage of a $5,000 deductible plan. As a result, the plan would force people to get a health care product that many don't find meaningful. For this reason, any affordability standard needs to include both premium and out-of-pocket costs.

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posted by Anthony Wright | Permalink | 11:19 PM


If the SCHIP sinks, we all go down....

Just heard a very sobering report from staffers in Congress about the reauthorization of children's insurance this year. We will have a bigger report on it later, but the upshot is this:

The Senate is asking for an additional $35 billion over five years, and that's pretty good. If passed, (and that's a big IF) it would cover an additional 4 million kids.

The House, however, is trying to get $50 billion -- which includes reimbursement for the state of medical care for legal immigrants, and avoids cuts in reimbursements to providers. (Passage of the House bill, however, is an even BIGGER if).

In spite of bipartisan support for children's health insurance and expanding coverage for kids, President Bush is really digging in his heels and has announced his intention to veto these bills. (I mean, really, why doesn't he pick on someone his own size.)

Even though this debate -- nationally -- is primarily about children's insurance, in California, it will be a foundation for larger health reform. That's because we Californians want to cover all children -- and we won't be able to do it without enough money. We're already on very thin financial footing with the proposals on the table....and they're not final until they're final. We can't afford to let this children's money erode as well.

And the hip bone's connected to the knee bone; the knee bone's connected to the... You get the picture.

In a few days, we will have more detailed report on how advocates can get involved in lobbying their Congressional representatives to support health reform.

Stay tuned....

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posted by Hanh Kim Quach | Permalink | 3:21 PM


What planet is he from?

Monday, July 16, 2007
So apparently President Bush made the following comment at an event last week:

"I mean, people have access to health care in America. After all, you just
go to an emergency room." -- President George W. Bush (Cleveland,

If the president was at all -- even vaguely -- aware of the health care debate, he'd know that the one of the primary issues is that people are going to the emergency room -- too much, because (without health coverage) it's the only place they can see a doctor.

If the president was following the debate, he'd know that going to the emergency room isn't really the best place to get care -- it's expensive, you may/may not get to see a specialist and it if you're there for a minor ailment, it clogs up the ER for truly dire and traumatic events.

And finally, if the president was following the debate, he'd know that a visit to the emergency room costs 3 to 4 times what is billed to insurance companies for the same services.

Brrrrrrr. That just ruffles my feathers.


posted by Hanh Kim Quach | Permalink | 3:02 PM


Bush Whacking Kids

Tuesday, July 03, 2007
As many advocates know, 2007 is a crucial year for children's health care. The federal State Children's Health Insurance Program is up for renewal. President Bush has given the program the bare minimum to continue the next five years.

In his latest stunt, George Bush criticized those who would extend State Children's Health Insurance Program to "middle-income'' families. He apparently believes that families earning $35,000 a year can buy "affordable'' health coverage (with high deductibles), wipe out their savings with a health emergency, and be able to hold on to their tenuous spot in the middle class, work three jobs and help keep the economy humming.

George Bush has been resisting the expansion of the program that allows children to get the health care they need -- like filling cavities, getting glasses, seeing a doctor.

In California, 800,000 children are enrolled in Healthy Families and are in families earning up to 2.5 times poverty ($42,925 for a family of three.) Bush wants to change rules allowing only children in families earning less than $34,340 (family of three), which would mean about 170,000 children would be abruptly cut off from coverage.

In the meantime, California politicians -- including Republican Gov. Arnold Schwarzenegger -- want to raise the lid -- allowing more middle-income families to enroll (about 77,000 more chidren). Eighteen other states also allow families earning more than Bush's proposed cap to enroll in this program. Being healthy allows kids to focus on other things, like learning in school (instead of squinting in the back or having a toothache) and being happy, normal children.

The motley bi-partisan National Governors Association doesn't like Bush's proposal much either and has sent numerous letters to the President and Congress about the need for more money and fewer restrictions at the federal level.

Bush, however, somehow believes that expanding SCHIP to more middle income families is a vast left-wing conspiracy to march toward a universal single-payer health system.

Okay, maybe that part's true for some of us, but I doubt that the intention for the insurers and hospitals and other industry types that support SCHIP expansion. Meanwhile, Bush's proposal yanks away health care from the most vulnerable children.

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posted by Hanh Kim Quach | Permalink | 10:59 AM


Certified, Act III

Tuesday, June 05, 2007
The state Department of Health Services released its All-County Letter on implementing the citizenship verification requirements of the Deficit Reduction Act (DRA).

California tried to make the implementation less onerous than other states, but it's still a deeply flawed law, and will mean that many legal, eligible Californians won't get the care or coverage they need and to which they are entitled.

The new Congress really needs to take another look and fix this action by the old Congress.

(Governor Schwarzenegger hinted at this in his letter today to Congressional leaders urging funding for SCHIP. When it's posted, we'll put up a link.)

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posted by Anthony Wright | Permalink | 3:21 PM


I expected a little more...

Thursday, May 03, 2007
An article in the Wall Street Journal today titillates us with talk of a "rift'' between Republicans in Congress and the Bush Administration over money for children's health insurance.

Republicans and Republican candidates are representing states that have acknowledged that more needs to be done to cover middle income children. These states are applying for waivers that will allow them to include more children beyond the ceiling set by the federal governmnet at 200% of poverty level -- $34,340 for a family of three. (California is one of those Republican-led states that is seeking to expand its children's coverage program).

But none (except former Arkansas Gov. Mike Huckabee) is taking the President's meager allotment for the program to task. They're not even really inquiring about it.

The president has proposed to fund the State Children's Health Insurance Program at a piddling $5 billion over the next five years, which would leave many states -- including California -- woefully short of the amount they need. Advocates believe the amount should be an additional $65 billion over the next five years. Democrats are fighting for another $50 billion.

If health care reform is going to happen, funding children's coverage a cornerstone to that plan. All elected leaders -- Democrats and Republicans alike -- need to be pressuring the administration to increase those costs.

That will definitely involve more direct confrontation than what is going on now.

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posted by Hanh Kim Quach | Permalink | 11:02 AM


Building blocks ...

Monday, April 30, 2007
Even though President George Bush only wants to provide health coverage to the poorest families, many states are planning to extend coverage to an increasingly middle-income population, according to an Associated Press story today.

Under current law, only children in families up to 200% of poverty ($41,300 for a family of four) could qualify for the program.

But 18 states, including California, allow children to qualify if the family income is higher than 200%. (In California, children in families at 250% of the poverty level could qualify, though many proposals in the Legislature -- including Gov. Arnold Schwarzenegger's -- would increase that to 300% of poverty - $51,510 for a family of four).

New York state just expanded its program to include children in families earning up to $82,600 a year -- or four times the poverty level.

This irritates the Bush administration, which opined that if everyone followed NY's lead, then 71% of children in the country would be covered through public programs.

Now, that doesn't seem like such a bad thing.

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posted by Hanh Kim Quach | Permalink | 10:48 AM


Children's Crusade

Monday, April 02, 2007
The New York Times yesterday reported that the Bush administration said it would "strenuously resist" plans to expand the State Children's Health Insurance Program, which funds California's Healthy Families.

They annoyingly "expressed concern about a sharp increase in the proportion of children covered by public programs in the last decade.''


If businesses wouldn't keep dropping family coverage or making it harder for workers to cover their families, then maybe fewer children would need to be enrolled in public programs.

During the economic downturn, from 2000 to 2002, the number of businesses covering children dropped by 2.5 percent. In the same period, state and federal government saw a 2.9 percent increase in children enrolling in public programs. In spite of this administration -- and their friends in the business community, these programs have continued to grow.

Now, Bush is unwisely trying to restrict growth in these programs by reauthorizing the bare minimum ($30 billion over five years) for SCHIP, and making fewer children eligible. Meanwhile he's doing nothing to encourage more coverage on the other end.

Advocates, on the other hand, say we need about $85 billion over the next five years to do a good job. Surely, we can find $17 billion A YEAR for children's coverage if we've been able to find $413 billion for war the past five years. According to this fun calculator, we could have covered about 250 million kids by now.

It'll be interesting to see where the presidential candidates fall on this as we debate the issue over the next few months.

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posted by Hanh Kim Quach | Permalink | 5:36 PM


It's enough to get you certified...

Friday, March 09, 2007

Earlier this week, I went to get my baby son’s birth certificate. About four months late.

When little Jefferson Wright was born, the hospital gave me the paperwork, sure. But I misplaced it, then it just lay on the dining room table as I dealt with other life crisis.

It involved paying $17 to get the birth certificate. And it wasn’t something that I could just send away for while paying my bills. I needed a notarized signature on the forum. I vaguely remember that there are some Notary Publics in town, but not exactly where.

So then I decided it would be easier to just go to the county office, than to go someplace to get the notarized signature and then have to mail the form. But the hours of the Yolo County Health Department are pretty much during business hours, and so this waited for several weeks until I found a morning that I wasn’t booked at my job.

I finally took an hour to drive to Woodland, find the county health department (actually they recently moved, so I needed to go to another building), and submit the form. I also needed to go to the ATM, since I needed cash, since they wouldn’t take a credit card.

Once there, there was no line, the staff was friendly and courteous, and I got the birth certificates there, on the spot.

Why do I go into detail about this? Because this was enough of a hassle and expense for me, as an able-bodied, well-educated professional that schedules his own hours. Yet under the citizenship documentation requirements of the Deficit Reduction Act passed by the previous Congress and signed into law by President Bush, we are asking hundreds of thousands of low-income seniors, parents, and people with disabilities to go through such a process: to get original birth certificates (photocopies not allowed) in order to get Medi-Cal health coverage.

I admit that if my health coverage was riding on this, I probably would have tried to act sooner. But as an adult looking for my own certificate, I wouldn’t have had the form so easily from the hospital; In fact, I may very well have been across the country from the county with my birth records, if I even remembered the location. I might not have been born in a hospital, so such documentation may be hard if not impossible to track down. I might have had a job where it would be harder to take the time to get this done. I might not have had a car to go driving around Woodland.

This is why we think that many thousands, if not tens or hundreds of thousands of Californians, will lose their coverage under this law. (NEW NOTE: California has worked to ease the impact, with electronic data matching for those recently born in the state. But out-of-staters, or those who were born a while ago, will have to find a way to get their original copy manually!)

It’s annoying to face bureaucratic hurdles. But it makes me angry when those burdens are imposed for no real reason, for the express purpose of placing barriers in people’s way. There are some policies in place to intentionally discourage some from getting the services to which they are entitled.

Hopefully Congress will take another look at changing or just discarding these requirements this year.


posted by Anthony Wright | Permalink | 1:41 AM


Can California Kids' Coverage Continue?

Wednesday, March 07, 2007
March 7th, 2007

  • Children's coverage is a key foundation for universal expansion
  • California children at risk without a national allocation of at least $60 billion in new funding
  • Alert: Call-In Day for the Campaign for Children's Coverage: 1-800-828-0498
  • Also: Assembly Health votes on first bills of session: Part D Report, Medi-Cal Expansion

While we debate huge, systemic reforms to the health system statewide – and even nationwide – we cannot forget the federal fight for funding children's coverage. The biggest debate in Congress this year is over the extent of children’s coverage, and getting full funding for children's coverage will be foundational to health reform efforts and the push for universal coverage.

ALERT: Today and tomorrow are national CALL-IN DAYS to call your Congressional Representatives and urge them to fully fund children's health coverage, with at least $60 billion in new federal funds. A TOLL-FREE line has been established for March 6-8th, at 1-800-828-0498.

BACKGROUND: Since its inception in 1997, the State Children’s Health Insurance Program (the Healthy Families Program in California) has been hugely successful, helping to decrease the ranks of uninsured children from nearly 23 percent to 15 percent, in spite of a decline in employer-based coverage that otherwise would have swelled the ranks of uninsured children. As a result of this progra, hundreds of thousands of children are getting neededpreventive care and leading healthier lives.

In its tenth year, SCHIP is up for reauthorization this year. Fortunately, the question is not – “Should we reauthorize it?” The explosive increase in children who have insurance and are leading healthier lives because of it is reason enough to continue to fund it. The question, though, is how much?

BUSH'S PROPOSAL: President Bush has decided that SCHIP will not grow at all in the next five years – in either enrollment or health inflation. So, he’s authorized the exact same amount -- another $5 billion a year for five years. Even with a meager $5 billion more, that’s abysmally low. Health inflation alone will gobble up chunks of money throwing out children already in the program. California alone needs an additional $2 to $3 billion over the next few years to ensure the 750,000 children currently enrolled don’t drop off.

CHILDREN DENIED COVERAGE?: Bush’s proposal is so low, that it means about a dozen other states, including California would need to scale back their children’s coverage programs to meet that level. California provides coverage to children in families with incomes up to 250% of poverty ($42,925 for a family of three). Bush would allow only children in families up to 200% of poverty ($34,340 for a family of three) to receive coverage. That would abruptly force 170,000 California children off Healthy Families.

The effects are longstanding too. Under the President’s budget, with even just moderate growth assumptions for SCHIP programs in California, it means 775,000 otherwise eligible kids would either be kicked off or forced to wait for another child to drop off the rolls before they could be added to Healthy Families. The money simply would not be there, according to an analysis by Peter Harbage for the California Health Care Foundation. His study will be featured today at the regular Sacramento meeting of the Managed Risk Medical Insurance Board (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.mrmib.ca.gov&l=2), which oversees the Healthy Families program. The agenda for today's meeting is here:

THE NEED: To adequately fund children’s health care – national advocacy groups such as Families USA and ACORN – are requesting an new, additional $60 billion.SCHIP has been the most significant health coverage expansion in the U.S. the past decade and it can’t be lost – particularly as we debate expanding coverage beyond children. Securing the additional funding needs to be a priority for all health advocates this year – as part of the larger conversation about health coverage. If children’s coverage retreats, so will our foundation for expanding coverage. All of the proposal here in California for reforming health coverage and expanding coverage would benefit from full federal funding for children.

Nationally, the Campaign for Children's Health has a petition to support augmenting children's health coverage. (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.childrenshealthcampaign.org%2F&l=4).

In California, the triumvirate of children's groups (Children Now, Children's Defense Fund and Children's Partnership), also direct action through their 100% Campaign (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.100percentcampaign.org&l=5.)

To read analysis of the children’s health coverage issue, visit:

• Center of Budget and Policy Priorities (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.cbpp.org&l=6)

• Managed Risk Medical Insurance Board (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.mrmib.ca.gov&l=7)

• Families USA (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.familiesusa.org%2F&l=8)

• California Budget Project (http://click.icptrack.com/icp/relay.php?r=1012041699&msgid=3586388&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.cbp.org&l=9)

For more information, contact Health Access at 916-497-0923, including policy coordinator Hanh Kim Quach, the author of this report, at hquach@health-access.org, or project director Elizabeth Abbott, who is tracking the SCHIP debate, at eabbott@health-access.org.


The Assembly Health Committee convened its first hearing where they voted on bills Tuesday; two bills of interest to health advocates passed:

• AB51 (Dymally) would require the Department of Managed Health Care to develop a report card for Medicare Part D plans in the same way it grades other health plans. A previous bill, AB2170 (Chan) was vetoed by Gov. Arnold Schwarzenegger last year.

• AB55 (Dymally) would increase the eligibility for Medi-Cal for some adults to 133% of the federal poverty level.

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posted by Hanh Kim Quach | Permalink | 1:46 PM


Attack of the Governors...

Monday, February 26, 2007
Robert Pear of the New York Times has this article about Governors of both parties splitting with the White House over child health coverage:

Key graphs:

WASHINGTON, Feb. 26 — Governors clashed with the White House on Monday over the future of the popular Children’s Health Insurance Program, an issue that some members of both parties said was as important as money for the Iraq war.

Governors said the Clinton and Bush administrations had encouraged them to expand children’s coverage and had granted waivers allowing them to cover parents and even some childless adults.

Having successfully expanded the health insurance programs in their states, some governors now suggest that the Bush administration is pulling the safety net out from under many children....

And yes, the last paragraph...

Gov. Arnold Schwarzenegger of California, a Republican, said federal aid was essential to his $12 billion plan for universal health coverage. Mr. Schwarzenegger said that in a private meeting he told the president, “We need the federal government’s help.” He did not say whether he got a commitment.


posted by Anthony Wright | Permalink | 10:19 PM


SCHIPS without Ponch and Jon

Saturday, February 24, 2007
On Friday, the California HealthCare Foundation held a convening on SCHIP (State Child Health Insurance Program) reauthorization--the technical term for the Congressional debate this year on how much money should be allocated to the federal program that funds 2/3 of California's Healthy Families program. HHS Secretary Kim Belshe and MRMIB Director Lesley Cummings were there, as were policy wonks and advocates.

As Belshe said, this is the biggest health care policy issue on the federal agenda this year. She not only extolled the program's worthy goal of covering children, but also its "operational success"--an important part of the case for additional funding is the fact that it works, and that it has actually served to decrease the number of uninsured children. We'll report on this issue more throughout the year, but a few quick points from the meeting:

* Cummings stated that the next few years will be the first real test of the "block grant" nature of the program; up until now, it has been sufficiently funded, but some states have started to run out of funds, and depending on the funding debate this year, California may follow, with creating waiting lists or even dropping children off of coverage.

* The President's proposal is woefully inadequate: $25 billion over the next 5 years would mean hundreds of thousands of California children being dropped from coverage. In the choice between having stable funding or increased funding to keep up with growing demand, President Bush took the third and worst option, which is to under-fund children's coverage.

* The SCHIP reauthorization can't be less than $60 billion over the next 5 years, in order to have the funds to meet the goal of covering all California children. The policy people are still refining the numbers, in order to account for variables such as different formulas to distribute funds between the states, or the impact of declining employer-based coverage, or different take-up rates. But that's the general figure.

My comments at the forum focused on how this fits into the broader policy debate.

* First, those of us who will advocate for $60 billion or more to fund children's coverage will also need to take another step, to support the revenues or offsets needed. Under the new "paygo" rules, where both tax cuts and new spending need to be balanced with other budget items, the proposal by Rep. Rahm Emmanuel and others to do more in collecting capitol gains taxes is welcome, as a way to show that children's coverage is important enough that we have to pay for it. There's lots of ways to raise the money we need: we just need to provide support for those who properly prioritize children's coverage, and who take the harder but necessary step of finding the money.

* Secondly, this debate is fundamental to the broad conversation on health reform here in California. Whether you support the Governor's plan, or the ones by the Speaker, the Senate President Pro Tem, or Senator Kuehl, they all would be better financed and more feasible and workable with full SCHIP funding. The less funds there are for kids, the harder it is to find the resources to cover their parents.

* Third, all these debates are intertwined. SCHIP is a key priority, but not the only one for the cause of children's coverage. For example, there's been a big drop in employer-based coverage for children, as employers start scaling back benefits with dependent coverage. The recent report on Safeway shows that for new employees, the waiting periods to get individual coverage is 18 months, and for family coverage it's 30 months. That's a trend, especially at big fast-food and chain restaurants and many retailers. Healthy Families was wildly successful at picking up the slack and preventing a dip in the rates of children's coverage, but broader reforms will be needed to truly get universal children's coverage.

We'll be talking about SCHIP reauthorization throughout the year here on this blog.


posted by Anthony Wright | Permalink | 12:40 AM


Bush's Budget: Cuts for California Care

Tuesday, February 06, 2007
Monday, February 5, 2007

· Children would be kicked off Healthy Families
· Steep cuts to Medicaid; Public hospitals would take $500 million cut
· More Medicare recipients would pay higher premiums

President George W. Bush released his seventh budget proposal Monday – a $2.9 trillion spending plan which he states "protects the American people.’’ He increases total defense spending to $625 billion from $600 billion last year. That's an increase of 4.1 percent, which includes more money for Iraq and the global war on terrorism.

Many advocates and legislators stated that a closer examination of Bush’s plan shows that it leaves the most vulnerable Americans exposed to ill health and little protection. In particular, the proposal takes a hatchet to domestic spending areas, and health care in particular. The President's proposal cuts Medicare by $252 billion, asking recipients to pick up the slack. He also cuts Medicaid by $26 billion over 5 years.

And in spite of the promises he has made in the 2004 campaign and other times to ensure children have adequate health coverage, the budget would barely maintain enough money to keep children currently enrolled. It would also force 18 states – including California – to cut children out of the program.

The budget also includes other proposals unveiled at his State of the Union two weeks ago, which would leave more Americans uninsured by discouraging employer-based coverage, and shifting funds away from public hospitals on which we all rely, further weakening the safety net for the nation’s most vulnerable.

Look at actual budget documents here.


Bush's budget puts him directly at odds with California efforts for health reform, including those by Gov. Arnold Schwarzenegger, and legislative leaders, both Democratic and Republican.

Gov. Arnold Schwarzenegger, Democrats, and Democratic leaders want to increase eligibility to allow children in families earning $51,500 (family of 3) to enroll in Healthy Families. Bush wants to restrict eligibility, to cut it off at $34,000.

Schwarzenegger wants to expand Medi-Cal to low-income, childless adults. Bush wants to make it harder for the people already on it to stay on.

Several members of Congress have expressed their dismay at the lopsidedness of the Bush Budget and have until October to craft a new one. But with promises on all sides to reduce the long-term federal deficit, it's unclear how health care might shake out.


Advocates this year were preparing to fight for the reauthorization of the State Children's Health Insurance Program. SCHIP, which expires this year, provides health coverage to 10 million children nationwide, including 750,000 children in California. But to ensure that children can keep coverage through Healthy Families (California's SCHIP program), Congress should not merely reauthorize the program -- it would also have to increase its allotment.

In order to ensure children don't get kicked off, California by itself would need an additional $2 to $3 billion over the next five years, according to the California Budget Project.

While Bush proposes to reauthorize SCHIP, he would make a cut in the first year, forcing children to lose coverage, and he would only increase spending by $5 billion over five years for the entire nation--well short of the over $40 billion needed to maintain current enrollment growth.

In California , the outlook is worse.

Bush’s plan would encourage states to cut children in families whose income exceed 200% of poverty ($34,340 for a family of three.) California ’s cutoff is 250% ($42,925 for a family of three).
That would mean approximately 170,000 children would abruptly lose Healthy Families Coverage.

The plans of the Governor and the Legislature would actually increase eligibility to 300% ($51,510 for a family of three,) to cover another 77,000 children in California, but that would also be endangered by the President's plan .


The reductions in Medicaid include an adminstrative rule change that would take a $500 million chunk out of California ’s already cash-starved public hospital system, according to the California Association of Public Hospitals. In Los Angeles County , home to one of the busiest trauma centers in the nation, it would mean a $200 million cut.

The Bush plan also proposes to:
* Prohibit federal Medicaid funds for Graduate Medical Education, which trains medical professionals and allows them to treat low-income patients
* Use electronic financial records to ensure Medi-Cal patients are eligible. (The reverse--to ensure patients who are eligible may be enrolled--is not done.)
* Deny people, whose home equity is higher than $500,000, to be eligible for Medicaid long-term care services. In California , where home values are high, this new rule would have a major impact for patients who have few other assets.


Because California is also a high-income state, Bush’s proposed changes to Medicare would also disproportionately impact seniors here. Right now, recipients who earn more than $80,000 a year must pay higher premiums. That income cut-off, though, rises with inflation.

Bush’s budget would freeze the cut-off at $80,000, meaning more and more people would then need to pay premiums.


Some helpful budget analyses may also be found at the following links:
* Families USA, for more specific health-related news
* Center for Budget and Policy Priorities, for a national look at economic issues and implications with an eye toward low- and moderate-income families.
* California Institute, an affiliate of Public Policy Institute of California, for implications in California .
* House Budget Committee’s Democratic Staff analysis of past Bush budgets

For more information, contact Hanh Kim Quach, policy coordinator, Health Access California, at 916-497-0923, or hquach@health-access.org.

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posted by Anthony Wright | Permalink | 9:39 AM


Good golly, Miss Molly...

Wednesday, January 31, 2007
Humorist Molly Ivins passed away today, after battling breast cancer. May she rest in peace.

Here's a 2002 column of hers on the need for health reform. And here's a 2000 column that mentions her battle with cancer, as part of a witty but accurate review of what works in health reform, and what doesn't. It also happens to critique President Bush's health care plan, which doesn't seem to have changed in seven years--in fact, it seems to have gotten worse...

Just don't get sick
by Molly Ivins
September 14, 2000

AUSTIN, Texas -- When I was in my 20s, the subject of insurance was so vastly boring that it was a way to describe a bad date: "like talking to an insurance salesman." It's still sort of like your teeth -- something you'd rather not think about but have to take care of -- so let's plunge in.

As Jonathan Cohn pointed out in the May 1 New Republic, the object of health insurance is to get as many people as possible into one big pool, mixing the sick with the healthy. This way, the healthy pay a little more than they otherwise would, but those who get sick pay a lot less.
Since everyone gets sick eventually, if only from old age, it works out fairly. Your chances of never being sick a day in your life and then dropping dead of an undiagnosed heart condition at an early age are less-than-lottery-slim.
In most advanced countries, this led logically to national health insurance -- everybody in the same pool, only one administrative agency instead of hundreds...

As a cancer survivor, I am now part of a network regularly called upon to help raise $300,000 to $400,000 for some individual whose insurance company has found a way to drop her. Always a life at stake. The hundreds of thousands of you who have had your HMOs fold under you know how chancy the present system is.

George W. Bush's solution is to promote medical savings accounts -- MSAs. Individuals buy a cheap insurance plan covering only catastrophic illness and then put money aside, tax-free, to cover their medical bills. If there's any left over at the end of the year, they get to keep it. The theory is that this will discourage people from spending frivolously on health care.

"In reality, MSAs simply allow people who expect to be healthy to opt out of larger insurance pools," said Cohn. "Small businesses like the accounts because they transfer the onus for medical coverage more squarely onto individuals. But most experts who have looked at MSAs have concluded that, by further segregating healthy and sick in the health-care market, they make it tougher for people likely to incur high health-care bills to get insurance."

The other piece of the Bush plan is to set up association health plans allowing small businesses to clump together to buy health insurance as cheaply as the big corporations do.

The Catch-22 is that most states already have small businesses clumped together in an insurance pool. The only difference the Bush plan would make would be to exempt those plans from state regulation -- i.e., requirements for minimum benefits like mental-health coverage.
The result would be further segregation of health coverage -- employees healthy, rates go down; a couple of employees get very sick, rates go up; company can no longer afford coverage, drops policy; end result, more uninsured.

Neither move is going to help the 44 million uninsured in this country, and both are likely to increase their number. This is not a solution. For the uninsured, Bush proposes a $2,000 tax credit per family to allow them to buy their own health insurance -- but $2,000 doesn't nearly cover the cost, and nothing is more expensive than buying health insurance as an individual....

For those whose faith in the free market is religious, this is not something to debate. But even Adam Smith admitted that the free market can't take care of everything. And one of the things that no country has yet found a way to make it do is health care. The upside to having government as the only insurer is that it's cheaper because profits don't enter into it.

Worth considering, even if boring.


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posted by Anthony Wright | Permalink | 5:47 PM


Spinning the YOYO

Monday, January 29, 2007
Just back from Washington, DC, and saw the discussion on ABC's This Week on the President's health plan.

Apparently, it's in the conservative talking points that George Will was using to simply deny the problem exists, as he and his colleagues also do with global warming. He sought to downgrade the issue of the uninsured, to suggest that since some of the uninsured are only "temporarily" uninsured, it's not much of a problem. I hope he tells that to the folks who have the emergency, the accident, or the ailment while "temporarily" uninsured, and face the hospital bill as a result--perhaps the largest bill that anybody sees in their lifetime.

But even President Bush doesn't deny the problem anymore. Yet his solutions take us in the wrong direction. He adds no new money to deal with these problems, and even when reshuffling the deck of existing funds, he seeks to do so in an inefficient, regressive, and unwise ways.

The Economic Policy Institute appropriately lays out the impacts of the tax change, which is to discourage group coverage (through employers) and shift more people to buy coverage alone as individuals. This not only goes against the notion of insurance as the enterprise of sharing risk, it's also more costly! Rather than expanding public programs (which are far cheaper per person than private coverage) or expanding group health coverage (which enjoy a group discount), he is encouraging people to get coverage in the most expensive way possible.

Most of the articles have been about who is impacted, that those with good health care would be negatively impacted; those who buy health coverage on the individual market would get a decent tax deduction. But the nature of the deduction (rather than a credit, for example) would be regressive, since lower-income folks are in lower tax brackets. The vast majority of Americans who are now uninsured (many low- and moderate-incomes) would not find this helpful, and would not take it up: it would be the equivalent of a three-foot rope to get out of a ten-foot hole.

Kevin Drum at the Washington Monthly and Max Sawicky also make clear this is about the abandonment of group health care. And Ezra Klein and Brad Delong make the excellent point that as health costs rise, the folks who are disadvantaged increase, and the ones who are helped decrease.

Message: You're On Your Own. President Bush would take away the ongoing and open-ended assistance by the federal government for group coverage, and replace it with a fixed assistance to get more expensive private insurance, leaving the individual consumer to face the increating cost of health care all alone.


posted by Anthony Wright | Permalink | 1:11 AM


"Gold-plated'' vs. tin foil....

Friday, January 26, 2007
I know President Bush's health care proposal is pretty much dead, but I wanted to address his reference to "gold-plated" health plans.

He is actually referring to comprehensive health coverage that could actually provide patients protection from crushing medical bills should they ever get sick, and I suspect we'll hear others begin to characterize health insurance (insurance that actually works, that is) this way too.

"The more expensive the health insurance plan you receive through your employer, the more tax relief you get." (Fact sheet on Bush's 2007 Health Care proposal).
Bush needs a reality check. How many people, when choosing their health plans, look at the list of offerings and say "Which one will give me more tax relief?'' The more relevant questions people ask are: What will my monthly premium payment be? How much will my co-pays/co-insurance be? Is my doctor covered? How much is my deductible?

The truth is, if you can afford it, you choose a plan that you think is going to be a good shield, protecting you against the misfortune of getting sick, getting cancer, having asthma and having flat feet. It also protects you against having to foot the entire bill for having this misfortune.

The kind of coverage President Bush is actually suggesting we get, something that's more "affordable,'' is more like tin foil -- a thin layer of protection that tears easily and exposes us to the elements.


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


President Bush has a Health Plan of his own

Wednesday, January 24, 2007
January 24, 2007

  • Would tax employer-sponsored health benefits for the first time in history
  • Would eliminate state consumer protections against insurance companies; would take money from public hospitals
  • Ranking members of House Ways and Means committee say proposal is “dead on arrival.”

Now, even President George Bush wants to join the “health reform’’ bandwagon. But rather than seek out more moderate middle ground as he navigates the new Democratic Congress, Bush swings his proposal far to the right.

In his State of the Union address Tuesday evening, Bush unveiled his health care plan, which relies on tax dedcutions to encourage the poor to buy coverage, loosening – or abandoning – consumer protections, and pilfering funds from public hospitals.

House Ways and Means Chairman Charles Rangel (D, New York) and health subcommittee Chairman Pete Stark (D, Fremont, Calif.) have already declared the measure a non-starter.

“President Bush's proposal will make a bad problem worse. I do not intend to consider this particular health care proposal in the Ways and Means Health Subcommittee, but would be happy to meet with the President to consider alternative ideas, starting with the expansion of Medicare,’’ said Stark, a proponent of Medicare for everyone.


The cornerstone of Bush’s proposal relies on changing how health coverage is taxed. It would impose a new tax on 60% of working families who now receive their benefits through work, thus discouraging the purchase of insurance in a pool where risk is spread across the larger employer group.

Bush’s plan, in turn, would give a $15,000 deduction ($7,500 for an individual) for those who buy their coverage on the more expensive and fickle individual market, where they would bear all the risk.

“Changing the tax code is a vital and necessary step to making health care affordable for more Americans,” Bush said.

Tax deductions, by design, however, favor the wealthy. U.S. Rep. Pete Stark, explains why the plan won’t work.

"The President's so-called health care proposal won't help the uninsured, most of whom have limited incomes and are already in low tax brackets," said Stark. “But it will hurt middle-income Americans, whose employers will shift even more cost and risk to their employees.”

In Bush’s policy papers, the administration claims that his idea would lower health costs because most people are choosing “expensive’’ plans through employers. The President, in turn, attempts to encourage more high-deductible plans, with Health Savings Accounts. Of course, the effect of such a proposal would be to make Americans sicker, as high-deductible plans – forcing patients to delay care rather than shell out thousands in out-of-pocket costs.


The president also resurrects a plan that failed last year. The proposal, by Sen. Mike Enzi (R, Wyoming), would have allowed businesses to band together across state lines to purchase insurance.

In order to do this, it would lower all insurance regulations to the lowest common denominator, casting away important consumer protections contained in California’s HMO Patient Bill of Rights, such as cancer screening, disease management and the right to a second opinion.

Another feature of the president’s plan would also shift money away from public hospitals – to the tune of $700 million, according to today’s Sacramento Bee.

To see an outline of the president's proposal, click here.

The San Francisco Chronicle, today, also has an analysis of Bush's proposals.

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posted by Hanh Kim Quach | Permalink | 10:52 AM


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Anthony Wright is the executive director,
with a background as a consumer advocate and community organizer on many issues, including health issues for the last ten years in California and New Jersey.