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WellPoint, Blue Shield end rescissions

Wednesday, April 28, 2010
It's often said that sunshine is the best disinfectant -- and that may well be the case regarding this surprise development: Lisa Girion of the Los Angeles Times reports that two of the nation's largest insurers -- WellPoint and Blue Shield of California -- have agreed to end the practice of rescission.

WellPoint is the Indiana-based parent corporation of Anthem Blue Cross of California, which has grown notorious lately for its proposed 39% rate increase for individual policyholders, and for a story reported last week by Reuters that WellPoint had systematically targeted breast cancer patients for investigations of fraud, and subsequent rescissions.

Some breast cancer patients had their policies yanked from them, or rescinded, as they were mid-treatment.

The announcements also come as Congress and the Obama administration prepare to crack down on rescissions. Said Angela Braly, CEO of WellPoint, the "goal is to make reform work for our members and for the country."

Since 2004, the LA Times says, at least 5,000 Californians had their insurance policies rescinded by the state's five largest health insurers — Anthem Blue Cross, Blue Shield, Health Net, Kaiser and PacifiCare. That includes about 3,500 policies regulated by the Department of Managed Health Care and another 1,600 policies regulated by the Department of Insurance.

With all the attention on the practice in the last few years, those rescissions have already slowed to a trickle. So the announcement may be more about public relations, especially given another recent LA Times headline highlighting a 51% jump in profits for WellPoint.

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posted by Cynthia Craft | Permalink | 11:12 AM


Sebelius to WellPoint: Knock it Off!

Friday, April 23, 2010
HHS Secretary Kathleen Sebelius wasted no time in sharply admonishing the CEO of WellPoint Inc. for the insurers' practice of dumping breast cancer patients, and refusing to pay for their care.

In a letter sent to CEO Angela Braly, Sebelius reminded the highly compensated executive ($13-plus million last year) that this sort of practice is soon to be outlawed by the new federal health reform law.

"I hope you will consider these women and their families as you work to end this harmful practice," Sebelius wrote.

Read the release and the letter here. WellPoint and Anthem Blue Cross' scheme was disclosed in an exclusive report by Murray Haas published by Reuters yesterday. Hundreds of concerned and outraged women have reacted to the report on website comment pages. Wellpoint is the parent company of Anthem Blue Cross of California.

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posted by Cynthia Craft | Permalink | 4:31 PM


Already, WellPoint is trying to game the system..

"Hold onto your health plans," writes the San Francisco Chronicle editorial page editors. Because apparently we consumers are in for a wild ride -- one in which health plans try everything under the sun to boost their profits under the new rules.

Right away, the Chron fingers WellPoint, the parent company of Anthem Blue Cross of California, as an example of insurers likely to commit bad behavior:

"One of the earliest offenders was WellPoint, one of the country's largest insurance companies. Under the new health care law, insurers must spend 80 percent of premium dollars on medical care. In January - well ahead of the reform's passage - WellPoint began reclassifying some of their administrative expenses as "medical spending." The company even bragged about it to its investors.

Meanwhile, the Department of Health and Human Services and the National Association of Insurance Commissioners haven't even finished writing the definition of "medical spending" as it will exist under the health care reforms. So this is clearly a pre-emptive move by WellPoint, to make its own classification. It's unfair and unseemly. And if WellPoint's allowed to get away with it, every other health insurer will do the same."

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posted by Cynthia Craft | Permalink | 3:12 PM


Cartoon congratulations...

Tuesday, April 13, 2010
Californian Mark Fiore won the Pulitzer Prize yesterday for editorial cartooning, for online animated cartoons that appeared on http://www.sfgate.com/, the website of the San Francisco Chronicle.

Many of his biting videos were about the health reform debate. Here's one:

You can visit his archive of videos, his website at http://www.markfiore.com/, and here are links to others that are specifically health reform-related:

Healthy -- SF Gate, 07/22/09
Reform Madness -- SF Gate, 08/13/09
Plummeting Death Reform -- SF Gate, 03/03/10

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posted by Anthony Wright | Permalink | 4:43 PM


Unfair and unbalanced...

Friday, March 05, 2010
I have been struck that I have been more optimistic about the prospect of health reform that others, and I wonder why. My sense of things is based on my trips to DC, conversations with Hill staffers and stakeholders, etc. I know the pitfalls and policy issues, but also understand the commitment that exists in various quarters to seeing this through.

But there's one advantage I also have: I don't watch a lot of cable news. And this is one area where the more you watch, the less you may know. Unless, of course, you get the perspective of from Comedy Central's Daily Show:

The Daily Show With Jon StewartMon - Thurs 11p / 10c
Anchor Management
Daily Show
Full Episodes
Political HumorHealth Care Reform

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posted by Anthony Wright | Permalink | 1:27 AM



Monday, February 22, 2010
There's a lot going on, from the President releasing a new health reform proposa, to the investigations on Anthem Blue Cross, to the state budget, to the action at adminstrative agencies like the Department of Managed Health Care and the Board of Pharmacy.

Here's a quick snippet of some must-read links:

* The President announced his compromise health plan today. Here's the link to the plan. More analysis to come.

* Josh Richman at the Contra Costa Times makes a stand-out case for reconciliation to pass health reform, and calls out Tom Campbell for his hypocrisy in opposing the move.

* An LA Times article by Shane Goldmacher about the Governor making last minute appointments to the Board of Pharmacy to help gut drug labeling regulations.

* More on the bad behavior of Anthem Blue Cross of California:
* Duke Helfand at the LA Times on Commissioner Poizner finding over 700 violations by Anthem Blue Cross.
* Lisa Girion at the LA Times reports that Anthem Blue Cross of California has provided more than $4.2 billion in profit to its parent, Wellpoint.

More commentary to come...

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posted by Anthony Wright | Permalink | 10:36 PM


Blue Cross backs off, but only a bit...

Saturday, February 13, 2010
As we followed on Twitter today, Anthem Blue Cross agreed to delay their controversial and large rate increases in the California individual market for two months, from March 1st to May 1, 2010.

This was in response to California Insurance Commissioner Steve Poizner, who asked for the delay to allow time for an outside actuary to review Anthem Blue Cross' rates.

Anthem remains defiant and unapologetic about the rate increase, and says the rates will ultimately be approved.

They may be right. As pointed out in Marc Lifsher in the Los Angeles Times, the only real authority the Commissioner has is on an related issue, which is whether Anthem Blue Cross was abiding by a 70% "medical loss ratio" requirement--whether 70% of premium dollars were going to patient care, rather than administration and profit. (That requirement was increased from 50% to 70% by former Insurance Commissioner John Garamendi in his last year before becoming Lt. Governor. Federal health reform would increase that requirement to around 85%.)

If nothing else, the delay provides two months of rate relief for many California consumers. Hopefully, the inquiry and attention will provide more information about how Wellpoint and Anthem Blue Cross determines their rates. As the blogger Karoli has noted, increases by Anthem Blue Cross at this level are not uncommon--what is new is that the rates are spotlighting the need for reform, showing their need to be stronger oversight on insurers at exactly the time we are debating what rules they should be under.

But even today's events just reinforce the need for health reform--both the federal health reform bills, and state legislation to put in place more insurance oversight and rate review. Anthem Blue Cross' behavior continues to be the clearest case for why such reforms are needed (more is available at http://www.sickofbluecross.com/).

Here's the statement from Anthem Blue Cross executive Brian A. Sassi:
“Earlier today, Anthem Blue Cross agreed to a request by the California Department of Insurance to postpone a rate adjustment for individual members in California by two months to allow the Department additional time for review. To avoid confusion for our members, this delay will impact all Anthem individual members regulated at either the state Department of Insurance or the Department of Managed Health Care. We welcome the regulatory review and are confident that our rates reflect anticipated medical costs.

“Anthem filed these rates with the appropriate regulators in November of 2009. They are actuarially sound and in full compliance with all requirements in the law. The rate adjustments have been reviewed by an independent expert.

“Our decision to agree to postpone the rate adjustment does not change the underlying issue. All health plans are in the same situation in trying to deal with the steadily increasing medical costs in the delivery system, which are not sustainable. We are also experiencing a higher proportion of healthy individuals choosing not to enroll, leaving an insured pool that utilizes significantly more services. We need to refocus the health care reform debate toward steps that will improve quality and control the underlying medical costs, which is driving the high cost of coverage.

“We understand the impact any rate adjustment has on our members and their ability to continue to carry health insurance. And we are committed to driving quality and reducing costs in the health care system and improving the lives of the Californians we serve and the health of communities all across the state. Members will be receiving a letter shortly that describes these changes in detail and whom to contact for additional information.”

Anthem makes the point that this is a "re-review" of rates filed in November 2009. But that only points out that we need more aggressive rate review to start with, like the legislation that Assemblyman Dave Jones and others have advanced in the legislature in recent years.

Anthem also continues to make the two-point justification of their rates, that it reflects medical costs the impacts from the economy. It's not clear that's the whole story. Medical inflation has only been around 9% this year, nowhere near there 25-39% increases.

And while it may be true that people are dropping coverage, leaving a smaller--and typically sicker--pool to cover, that's something that would be addressed by health reform. After all, health reform would provide subsidies so premiums would not go above a percentage of a family's income; so if you lost a job or income, you wouldn't lose coverage. That not only helps the family, but prevents the adverse selection that leads to higher premiums.

Even if the rate increase is ultimately approved, the next two months can be useful in getting a better and deeper understanding of the issues involved, and what new rules need to be put in place, especially in the individual insurance market.

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posted by Anthony Wright | Permalink | 2:12 PM


The mid-year budget package comes together...

Thursday, February 11, 2010
The Senate and Assembly are starting to move on mid-year budget package of cuts, as reported by Shane Goldmacher in the Los Angeles Times and Wyatt Buchanan in the San Francisco Chronicle.

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

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

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

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posted by Anthony Wright | Permalink | 10:37 AM


The world watches Anthem Blue Cross...

Wednesday, February 10, 2010
We've long had issues with Anthem Blue Cross of California--both their practices and policy positions. That's why we launched http://www.sickofbluecross.com/, to document these issues and collect stories of aggrieved Californians.

Anthem Blue Cross of California has gotten lots of attention in the past few days, due to its controversial increases of up to 39% for their customers in the individual insurance market, as first reported by Duke Helfand of the Los Angeles Times, who has followed up with reporting the fallout.

* President Obama cited--multiple times!--these rate increases on California consumers as one reason why he is continuing to pursue comprehensive health reform.

* HHS Secretary Kathleen Sebelius wrote to the CEO of Anthem Blue Cross of California, our state's largest insurer, asking them to justify their increases of up to 39% for consumers in the individual insurance market.

* Insurance Commissioner Steve Poizner is investigating the increases, according to the Sacramento Bee. It's indicative of how little oversight California currently places on these rates that the Insurance Commissioner is going to contract with an outside actuary to see if Anthem Blue Cross is complying with existing law.

* Congress is investigating as well. Energy and Commerce Committee Chairman Henry Waxman (D-CA) has requested Wellpoint's testimony on the subject of the rate increases. They are seeking documents as well as CEO Angela Braly's presence at a February 24th Congressional hearing.

* California's two Senators have weighed in as well, urging action and review at the state level. As the San Francisco Chronicle reports, Senator Boxer urged state Attorney General Jerry Brown to investigate the proposed rate increases and Feinstein asked state Sen. President Pro-Tem Darrell Steinberg, D-Sacramento, to introduce legislation to regulate rates.

* Assemblyman Dave Jones, the chair of the Assembly Health Committee and someone who has long carried a bill on rate regulation, is holding his own hearing on health insurance rates on February 23rd.

* Others, like Jonathan Cohn at the New Republic, have refuted Anthem's explanations on the large increases, and explained why this situation would be prevented--or at least ameliorated--under health reform.

All of these government officials are right to question the premium spikes by California's largest insurer. While we know health costs grow at a rate higher than inflation, they are not growin anywhere near 20%, 30%, or 39% in the past year. However good it is to have this scrutiny now, the point is we need this oversight on a regular basis, and that's why we need health reform.

Anthem has been a longstanding opponent of health reform. Just a few months ago, Anthem Blue Cross was sending anti-health reform messages to their customers. Their new notices--about their premium increases--is the strongest message to date about why we urgently need health reform.

Consumers who buy coverage as individuals have no bargaining power, and are at the mercy of the big insurance companies. The benefits of health reform is to provide consumers with the power of group purchasing, so we all can get better rates for health coverage. Health reform would also put in place rate review, so insurers would have to justify their rate increases much more than they do now in California.

Health Access California will continue to host www.sickofbluecross.com, that contains more background of Anthem Blue Cross of California's anti-consumer record, and is collecting stories of people's experience with the insurer.

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posted by Anthony Wright | Permalink | 12:52 AM


Those with the least pay the most...

Friday, February 05, 2010
Without bulk purchasing power, individuals are the most disadvantaged in the current health care system.

The most recent example Anthem Blue Cross is raising its rates in the individual market, as reported by Duke Helfand in the Los Angeles Times today. It's a Commonwealth Fund study further explores the difficulties with the current individual market.

I make a similar point in the post highlighted in this week's Health Wonk Review hosted by Joe Paduda at Managed Care Matters. When individuals are self-pay patients, they get charged more than insurers for the same level of care.

That's why the crux of health reform is to make sure individuals (and small businesses) have the benefits and bargaining power of large purchasers.

Today's headlines just emphasize the point.

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posted by Anthony Wright | Permalink | 3:46 PM


Catching up...

Monday, January 04, 2010
For those who stopped paying attention since the Senate passed its version of health reform on Christmas Eve, here's some links of articles to catch up:

On the process from here, the likelihood in that the House and Senate do not go into a formal conference--which would simply let the Republican opposition put up more procedural roadblocks. Instead, the House and Senate leadership would hold informal negotiations, and they would amend an existing bill to be a final compromise to then get the two final floor votes--the 218 votes in the House and the 60 votes in the Senate. Jon Cohn at The New Republic has more about this game of "ping pong," and David Dayen of FireDogLake (formerly of Calitics) has a detailed report and quotes from CA Representative and House Energy and Commerce Chairman Henry Waxman.

Other articles of note, that were also spotlighted on our Twitter feed at www.twitter.com/healthaccess:

On health reform:
* I had a post on Calbuzz urging advocates to stay active in the health reform fight--that there is still lots to win and lots to lose, and we can't let our frustration with the procedural barriers get in the way of an analysis and strategy for winning health reform.. and a good health reform at that.
* Hanh Kim Quach at the California Budget Project describes the affordability issues in the health reform bills that need to be addressed.
* Former Sacramentan Jordan Rau and others at Kaiser Health News breaks down how the health reform proposal would affect you.
* Bobby Calvan at the Sacramento Bee writes about how health reform can help improve healthy living.
* The Kaiser Family Foundation has a side-by-side comparison of the House and Senate bills
* We posted some of the ways to fix the Senate health reform bill.

On the budget crisis:
* Kevin Yamamura of the Sacramento Bee looks at the lawsuits stemming from state budget decisions.
* Judy Lin at the Associated Press previews the awful state budget that looms, and the fights that are expected, given the procedural barriers.

And on both:
* Ezra Klein in the Washington Post suggests that California's budget woes are really political woes, and will soon be the nation's.
* Dick Flacks, UC-Santa Barbara sociology professor emeritus, has trenchant commentary about both health reform and California's budget woes.
* Jon Cohn at The New Republic spotlights a California story and suggests some medical providers--including ones in California--that may be worthy of support.

At this blog, we posted a year in review and thoughts about how things have changed, and didn't in the last decade.

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posted by Anthony Wright | Permalink | 6:00 AM


The policy that's fit to print...

Sunday, December 27, 2009
For the holiday season, the Prescriptions Blog of the New York Times hosted a doggerel contest, about who could adapt the classic poem "Twas the Night Before Christmas" to describe the health reform debate-taking inspiration from Senator Roland Burris' floor statement.

In the middle of this contentious and sometimes confusing debate, the series on health reform by the New York Times editorial page that has been generally good on policy and consistently clear in prose in explaining health reform.

Today's editorial is typically good in detailing many of the differences between the House and Senate health reform proposals--and their preferences for which should prevail.

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posted by Anthony Wright | Permalink | 5:25 PM


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

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

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

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

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

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

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

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

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posted by Anthony Wright | Permalink | 11:41 PM


With children, tough choices...

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

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

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

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

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

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

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posted by Beth Capell | Permalink | 8:29 PM


The medium is the message...

Thursday, October 29, 2009
Overexposure to policy-speak can make one’s eyes glaze over and one’s thoughts wander far, far off. (Think Aruba.) Surely by the time Washington settles on a health-care fix, much of the public will have absorbed more than it ever imagined of geeky chatter on cost-shifting, co-ops, capitation and more.

We hope, however, that the continued drumbeat of cable TV’s wonky discourse, or the tsunami of health care blogs multiplying like guppies in a fish tank won’t inundate people with so much policy detail as to turn them off.

It’s really very important that Americans remain open to learning and reading and talking and hearing about even the finer points of health care reform. After all, health care is an essential humanitarian service that’s projected to cost families in the neighborhood of $30,000-a-year in a mere 10 years. Sustainable? No way.

And, we’re pretty sure that whatever compromise deal is hatched by Washington probably won’t be – how shall we put this? -- the “perfect” that is the enemy of the good.

So we’ve got to stay interested, engaged and involved – because this health care delivery system is as broken as the levies of the Ninth Ward at the height of Katrina. Regardless of what comes out of Washington, the American people themselves will still need to press on for improvements. We will still need to care.

Luckily, some media outlets are going out of their way to help us care by framing and presenting the topic in a refreshing, inventive way that encourages the public to stay with the debate. (And we’re not talking about the lazy-bones media who report the story in the context of Dems-vs.-Reps, conservatives-vs.-liberals, he-said-vs-she-said, as if that framing had anything to do with truly illuminating the debate.)

The good news starts with a two-part, two-hour series aired on “This American Life,” the public radio program hosted by Ira Glass. Glass and the show’s producers decided to employ NPR’s crack team of financial reporters, Planet Money, to explain the complex web of factors that got us where we are today with our health care delivery system. If you’ve ever heard their unorthodox hour-long take on derivatives and the mortgage meltdown, you’ll know what a Planet Money treatment delivers – hear the podcasts for yourself: "More is Less" and "Someone Else's Money." They're fun, spunky and – most important – highly accessible and informative.

As for encouraging online conversations on health care reform, the New York Times deserves notice for its interactive graphic that simulates a salon-like discussion among readers. A graphic of Mondrian-like boxes fit together like puzzle pieces on the computer screen – some of them large, some medium, some small.

The intriguing feature is that the boxes change size -- along with the number of tiny simulated people standing around chatting inside them -- according to the volume of reader comments submitted on various aspects of the health care debate.

The interactive graphic features 21 boxes for 21 health-care-reform related topics: the newly released House health care bill, the public option, a single-payer system, drug costs, exchanges and co-ops, the Massachusetts model, medical malpractice and tort reform, competition among insurers, illegal immigrants, Medicare and the elderly, health care abroad, women and health care, the generation gap, moral and spiritual considerations, nursing home and end-of-life care, taxes and the national deficit, insurance and affordability, employers and insurance, abortion, and lifestyle and preventative care.

Today, as House bill was released, that box (along with the public option box) were the largest and had the biggest gathering of simulated chatterers.

With the 21 choices, there's something for everyone. The topics serve as prompts to readers, beckoning them to the conversation on health care reform. (We recommend scanning the "health care abroad" topic box -- it's fascinating to learn of other people's experiences seeking medical care outside of the U.S. and their comparisons with our homegrown system.)

If more media outlets make efforts to stretch their boundaries of imagination, creativity and resources as did “This American Life” and the New York Times – more members of the public will stay engaged in the debate.

The result, in the final analysis, could be better outcomes for overhaul. A well-informed public coaxed into staying with the debate over the long haul will keep our elected leaders responsive and focused on the end goal: affordable, accessible, quality health care for all.

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posted by Cynthia Craft | Permalink | 8:31 PM


Seeing the consequences of cuts...

Monday, October 26, 2009
Courtney Perkes at the Orange County Register has a compelling story about the fall out from some of the budget cuts made just a few months ago.

Luba Taylor pressed the letter almost to her nose, close enough to read through thick glasses that she was losing her "optional" vision benefits from state Medi-Cal.

Taylor, 54, saw the words but couldn't believe them. After all, a brain tumor left her legally blind — even when wearing glasses — and unable to work. Last week, months after receiving the letter, reality set in when her glasses broke.

She called for an appointment with her low-vision specialist in Fullerton and was told she lost her coverage July 1.

"I don't understand how ruthless this society is," Taylor said. "My glasses are very expensive because I'm very low vision — 20/200. I'm going to just have to get Scotch tape and tape them up. I have no spending money."

By eliminating vision and dental coverage for most adults receiving Medi-Cal, including roughly 181,000 in Orange County, the state saved $122 million. Other health cuts in late July would follow to help close California's massive $26 billion deficit, including $86 million for AIDS prevention and services, and $28 million to reduce day care for adults with dementia and other disabilities...

The article goes on to detail other cuts, like the elimination of dental coverage for the nearly 3 million adults (mostly parents, seniors, and people with disabilities) with Medi-Cal coverage:

In Orange County, the cuts have resulted in layoffs at nonprofit community dental clinics and longer wait times as former Denti-Cal patients compete for time in the dentist's chair with the growing numbers of uninsured.

Six out of 14 nonprofits providing dental care have cut back their hours, said Isabel Becerra, executive director of the Orange County Coalition of Community Clinics. The nonprofit clinic system sees about 200,000 patients a year, with 40 percent of them needing a cavity filled or a cleaning.

"Their care is being delayed out 6 to 9 months," Becerra said. "The patients are not being turned away. That's the hallmark of the community clinics. They just won't be able to see you as quickly as they once were."...

Besides pain, lack of dental care is also associated with respiratory disease, diabetes, stroke, heart disease and premature and low birth weight deliveries.

"It's not just Orange County, but pretty much everywhere you go, the first impression is very important," said the clinic's dental director Dr. Jila Nikkhah. "If you don't have front teeth, if you don't look presentable, you probably won't get the job."

Other budget cuts--choices made rather than raising (or even restoring) revenues--were to prevention programs, which has significant consequences for both the patients directly, but our health care system as a whole:
Sariah Gonzalez isn't the condom lady anymore.

After nine years with AIDS Services Foundation Orange County, she was laid off last month and other programs were scaled back after the nonprofit lost $105,000 in prevention funds. Orange County lost about $1.8 million for AIDS services and prevention.

Gonzalez worked with Spanish-speaking Latina women — a high-risk group because their partners might have unprotected sex with men. Gonzalez said that because of cultural stigma, some men keep their bisexuality a secret, which puts their wives at risk.

Latinos represent about one-third of Orange County's population, but last year, they accounted for 52 percent of diagnosed AIDS cases, according to the county's Health Care Agency....

Some cuts that were made were avoided--either by legislative action, as with the severe cuts to Healthy Families or domestic violence shelters that were lessened, or by court order, as with the proposals on adult day health centers. But it's important to remember that many cuts continued. The article details just some of the impact in Orange County, but these are stories that are going on in every community in California.

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posted by Anthony Wright | Permalink | 1:32 AM


Seeing what the candidates do...

Tuesday, September 01, 2009
In all the talk about where the voters are on health reform, one indicator is to look at where politicians running for office are.

Today is election day for a contested race to fill the seat of moderate Democrat Ellen Tauscher, who left to work as high-level State Department official.

As I write this, polls are still open and the results are unknown, but one winner was the cause of health reform. As the New York Times observes from a distance, it is the central issue of the campaign, as the Democrats scramble to take the lead on the issue.

For the Democratic members of Congress--even the moderate and conservative Democrats--it is unlikely that the screamers at these town halls are voting for them.

As the candidates in today's Congressional contest are suggesting, if you are appealing to the broad range of voters, you need to be on the side of health reform. There have been times when politicians have embraced health issues, and times when they have run. The campaign is a small indicator in just one district, but it's a hint that health reform will happen.

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posted by Anthony Wright | Permalink | 6:38 PM


RIP Senator Ted Kennedy

Tuesday, August 25, 2009
With the passing of Senator Ted Kennedy, much will be made of his famous family, and his longstanding efforts to pass comprehensive health reform and universal coverage, including taking a major leadership role this year, despite his brain cancer.

He did sponsor various efforts at health reform in previous years and era. In our national rememberance, it should not go unnoticed the bills he did help pass into law, that make a difference in people's lives today: Sen. Kennedy led efforts to pass COBRA and HIPAA so those leaving job-based coverage could keep it, the Ryan White AIDS Care Act, the Mental Health Parity Act, and the State Child Health Insurance Program (SCHIP) to cover low-income kids.

There's a historic picture in my colleague Beth Abbott's office of President Johnson signing Medicare over 40 years ago, with an elderly President Truman, who had championed universal health care a generation earlier, looking on. It is sad that Senator Kennedy won't join President Clinton when President Obama signs health reform this year.

Health reform can and should pass on its own merits, not to eulogize anyone. But Senator Kennedy's career is a testament that such reforms can have direct, powerful, meaningful improvements in people's lives.

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posted by Anthony Wright | Permalink | 11:19 PM


Facts from San Francisco...

Monday, August 24, 2009
In case you missed it, the good folks at University of California-Berkeley has an important op-ed in the New York Times over the weekend. It shows that the implementation of Healthy San Francisco holds some important insight into the federal health reform debate. Here's extended snippet, with emphasis added:
TWO burning questions are at the center of America’s health care debate. First, should employers be required to pay for their employees’ health insurance? And second, should there be a “public option” that competes with private insurance?

Answers might be found in San Francisco, where ambitious health care legislation went into effect early last year...

The early results are in. Today, almost all residents in the city have affordable access to a comprehensive health care delivery system through the Healthy San Francisco program...

Although not formally insurance, the program is tantamount to a public option of comprehensive health insurance, with the caveat that services are covered only in the city of San Francisco. Enrollees with incomes under 300 percent of the federal poverty level have heavily subsidized access, and those with higher incomes may buy into the public program at rates substantially lower than what they would pay for an individual policy in the private-insurance market.

To pay for this, San Francisco put into effect an employer-health-spending requirement, akin to the “pay or play” employer insurance mandates being considered in Congress. Businesses with 100 or more employees must spend $1.85 an hour toward health care for each employee. Businesses with 20 to 99 employees pay $1.23 an hour, and businesses with 19 or fewer employees are exempt. These are much higher spending levels than mandated in Massachusetts, and more stringent than any of the plans currently under consideration in Congress. Businesses can meet the requirement by paying for private insurance, by paying into medical-reimbursement accounts or by paying into the city’s Healthy San Francisco public option.

There has been great demand for this plan. Thus far, around 45,000 adults have enrolled, compared to an estimated 60,000 who were previously uninsured. Among covered businesses, roughly 20 percent have chosen to use the city’s public option for at least some of their employees. But interestingly, in a recent survey of the city’s businesses, very few (less than 5 percent) of the employers who chose the public option are thinking about dropping existing (private market) insurance coverage. The public option has been used largely to cover previously uninsured workers and to supplement private-coverage options.

Through our experience working on health-care-reform efforts in California and Washington (one of us worked for President George W. Bush’s Council of Economic Advisers), we have seen how concern over employer costs can be a sticking point in the health care debate, even in the absence of persuasive evidence that increased costs would seriously harm businesses. San Francisco’s example should put some of those fears to rest. Many businesses there had to raise their health spending substantially to meet the new requirements, but so far the plan has not hurt jobs.

As of December 2008, there was no indication that San Francisco’s employment grew more slowly after the enactment of the employer-spending requirement than did employment in surrounding areas in San Mateo and Alameda counties. If anything, employment trends were slightly better in San Francisco. This is true whether you consider overall employment or employment in sectors most affected by the employer mandate, like retail businesses and restaurants...

The San Francisco experiment has demonstrated that requiring a shared-responsibility model — in which employers pay to help achieve universal coverage — has not led to the kind of job losses many fear. The public option has also passed the market test, while not crowding out private options. The positive changes in San Francisco provide a glimpse of what the future might look like if Washington passes substantial health reform this year.

We need to ensure that the California delegation takes these lessons from San Francisco back into the debate in DC.

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posted by Anthony Wright | Permalink | 9:54 PM


Predicting health reform's impact?

Friday, August 21, 2009
We often hear predictions about the dire consequences if health reform passes. When Healthy San Francisco was passed a few years ago, opponents from a portion of the business community--largely fast food and chain restaurants that don't provide coverage to their workers-- foretold of awful job losses as a result.

Healthy San Francisco has been a success in reducing the number of uninsured by 75%, but what about article in the San Francisco Chronicle by Healther Knight, entitled "Study finds SF health plan didn't hurt jobs," says it (emphasis added):

San Francisco's first-of-its-kind universal health care program and its mandate that employers provide health care has not resulted in feared job losses, according to a new study by a UC Berkeley researcher.

Crunching quarterly data from the U.S. Labor Department, the researcher found that since the inception of Healthy San Francisco's employer mandate in 2008, the city's growth rate across all employment sectors was similar to or better than other Bay Area counties. While San Francisco saw its employment rate shrink due to the struggling economy, it actually shrank less than other counties.

This held true in retail, food service, restaurants and hotels, the sectors most strongly impacted by the health care ordinance because they traditionally have a lot of low-income workers and aren't as likely to offer health insurance as higher-paying industries.

"The San Francisco experiment is working, and it's working well," said Ken Jacobs, chair of the university's Center for Labor Research and Education. "There's no evidence of any impact of the ordinance on employment in San Francisco."

The statistics were unveiled Thursday as part of a push by big-name labor leaders and Mayor Gavin Newsom to hype Healthy San Francisco as a public option that's working - and that could be a model for the rest of the country as it remains mired in a heated debate over health care reform.

"The sky has not fallen - the world as we know it did not come to an end," said Newsom, adding the controversial policy didn't prompt businesses to leave, bureaucracies to sprout up or the city's economy to crater.

For those who predict gloom-and-doom with health reform, the real question should be what does the world look if there is no reform. The status quo isn't an option--the situation on health care will get worse.

We see this everyday in California, as Timm Herdt of the Ventura County Star explains:
Not much has changed, that is, except for these two things: Group health insurance premiums have gone up another 11 percent, more than double the rate of inflation, and about 1 million more Californians have lost their insurance because they were either laid off or their employers dropped coverage.

Those two developments alone ought to be enough to cause any mortal to demand that Congress not blow this latest opportunity to fix a badly broken system.

They show that the existing system is not really a system at all, doesn’t work and is getting worse.

In 1999, as data collected by the Kaiser Family Foundation show, the average group health insurance premium for a family of four, was $5,791. By 2008, the cost had more than doubled to $12,680.

In four of those nine years, there were double-digit annual percentage increases. In none of those years was the increase less than 5.5 percent.

Employers have been squeezed, hospitals have bled red ink, doctors have been pinched and ordinary folks have seen their healthcare costs soar. The employee share of costs for employer-based policies shot up 117 percent from 1999 to 2008, from $1,543 to $3,354, and that added cost was compounded by higher deductibles and copays.

Through it all, health-insurance companies have largely remained profitable.

But this annual process of raising premiums by twice or three times the rate of inflation cannot go on forever, or even much longer.

Look at that figure of the average cost of a group health plan for a family of four —$12,680 — and ask yourself this: At what price will your employer be forced to throw in the towel? Will it be when a family policy costs $15,000? $20,000? $25,000?

With prices that high, how can anyone feel secure that he or she will have health insurance next year or the year after that?

Having closely followed the health-reform efforts in California two years ago, I know that it is complicated stuff. There are a lot of moving, interrelated parts: providers, private insurers, consumers, employers, labor unions — and not even all the players in the same categories have the same interests.

But while health reform is complicated, it’s not rocket science.

A system built on shared risk cannot work unless everyone, or nearly everyone, is sharing the risks — and it doesn’t work now because about one in five Americans does not have insurance. That’s why the failed California bill, the bill now in the House and the bill now in the Senate have as their principal focus the goal of getting everyone insured.

Each includes a mandate that everyone have insurance, a requirement that all employers either provide a policy to workers or pay a fee, a framework of subsidies to make sure everyone who is forced to buy insurance can afford it, and a requirement that insurance companies respond to a universal-coverage mandate by making their products universally available.

And there is one other common element: an attempt to force price discipline on an insurance industry that will be handed millions of new customers as a result of the mandates...

If the momentum for reform is squandered this time, all America will look back two years from now and see the same price for failure that Californians have seen: 6,380 people losing their health coverage every week and the cost of a family policy marching relentlessly upward toward a day when the private insurance system will collapse under the weight of its own expense.

Without health reform, we didn't just get stuck with the broken status quo. It got worse, just like everyone predicted.

So which predictions should we listen to this time: the unfounded, unsupported warning of those opposed to reform, or the real consequences if we do nothing?

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posted by Anthony Wright | Permalink | 10:24 AM


Coverage at the county level...

Tuesday, August 18, 2009
Plenty has changed since 2006, the latest year that the uninsured of California was counted by the U.S. Census. But even then, many months before the current recession hit, the percentage of people living without health insurance in our state was startling.

This week, the Sacramento Bee laid out the statistics, finding quite a disparity between those with health insurance and those without. Just in the five-county region The Bee covers, Yolo County posted an uninsured rate of 22 percent of people under 65, while the more prosperous Placer County -- with more employment-based coverage -- posted a 13.7 percent rate.

That's quite a disparity, and the article by Phillip Reese and Anna Tong is worth reading. But the Bee doesn't limit information to its circulation area, it also posts online a comprehensive rundown of each of California's 58 counties' uninsured rate, along with an interactive map of the state and rollover charts.

Here's a sampling of what the authors wrote:

"The uninsured present an immense fiscal and public health challenge: 18,000 Americans die each year because they aren't covered, according to the Institute of Medicine, a nonprofit research organization. This is because having insurance is closely tied to health outcomes: The uninsured won't see a doctor regularly, and if they seek care it is likely to be inadequate or too late.

Moreover, the uninsured are a cost for society: One economist recently estimated the tab at $56 billion per year, 75 percent of which is paid by governments. In cash-strapped California, that cost is critical: 6.6 million residents went uninsured in 2007, more than in any other state, according to the California Healthcare Foundation."

You can bet that, with massive layoffs and small businesses closing since that Census count, the number of those among us -- members of our communities -- who are going without health insurance is a great deal larger. Factor in the Governor and Legislature's cuts in health and insurance programs for lower-income Californians, their children and the elderly, and you get an unimaginable sum of fellow Californians without access to affordable, quality health care -- notably, preventative health care, with better outcomes.

This is what the conversation about health care reform boils down to, not pumped-up talking points and hyper-emotive protests based on misinformation. This is not a partisan issue. It is a people issue. And the bottom line is that the majority of Americans have already voted -- for substantive change for a better future for our country.

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posted by Cynthia Craft | Permalink | 8:31 PM


Don Draper's health reform...

Monday, August 17, 2009
The big TV event this weekend was the season premiere of Mad Men, the AMC show that depicts the life of New York advertising executives and their families in the early 1960s.

It is smartly written and filmed to highlight the differences in everything from fashion to gender relations. Guest New York Times columnist Timothy Egan made a fascinating contribution about the changes in public health:

My parents and their friends were nicotine fiends, the women smoking even during late pregnancy. The high point of tobacco addiction was around 1964, when 42 percent of adults smoked. Today, the figure is less than 20 percent — a modern low.

I remember rattling around inside a station wagon filled with secondhand smoke. No seat belts, of course. And after the ride, we 6-year-olds reeked of Lucky Strikes.

Now, smokers are such pariahs that the actors on the set of “Mad Men” can’t even puff real cigarettes; they have to use herbal ones, or run afoul of the law.

If a driver of that station wagon had a drink or two before getting behind the wheel, so what? Drunken driving was a respected social skill. Last year, 11,773 Americans died in accidents involving drunken driving — tragically high, but down by more than 50 percent from a generation ago.

Roger Sterling, the silver-haired sybarite in the “Mad Men” ad agency, suffered a major heart attack, telegraphed from his first three-martini lunch. Today, coronary heart disease is still the leading cause of mortality in the United States, but the death rate from heart attacks is down 72 percent since 1960.

The brooding, unfathomable ad man at the center of the show, Don Draper, has high blood pressure. When his doctor asks how much he’s boozing, he admits, after some hesitation, to five drinks a day. He also has sexual problems, unable to match the passion of his stunning wife, a Grace Kelly look-alike who is a shrink session away from going full Betty Friedan.

...Is all of this progress, a march toward a more tolerant, equitable, less socially inauthentic society? Sure. Plus, Don Draper would have Lipitor for his heart and Viagra for his sexual troubles.

For a show in the 1960s, explicit politics and policy is only in the background on the show--in the premiere on Sunday, the only reference was to an ad executive bemoaning the 60%+ upper-income tax brackets of the day. And the serious health care issues that led to the passsage of Medicare and Medicaid in the late 60s are not shown.

But there's a lot here to inform our health reform debate. It's a useful reminder about the significant progress that there has been in not just sexual politics, but in the realm of prevention and public health:

* Tobacco control, which has included taxation, limiting its use in public spaces, medical research, educating young children, litigation, major public awareness efforts, and the overall changing of social mores.

* Drunk driving reductions through changes in law and increases in penalties and enforcement, as well as a major public education effort that includes changing its social acceptability.

* Seat belts took a combination of ensuring that they were provided as standard in cars, and then a variety of public education strategies to get people to use them.

These things, by themselves, have saved untold lives and increased are life expectancy. Like the cause of gender and racial equality, these didn't happen overnight or without struggle. Each of these efforts were long, concerted, multi-year, multi-pronged campaigns by many players. And it's not over yet: For example, while the three martini lunch may not be as prevalent, we may not have some to terms with the full health impact of alcohol, so there is more work to do for groups like the Marin Institute.

The current conversation on health insurance reform, as the President not calls it, is less about people's health, and more about the health of their finances, and the health of the economy. That's not a bad thing: it's essential to prevent people who go bankrupt for medical reasons, or to remove the economic insecurity that so many people feel when they need care, either for age or accident.

There are elements of the reform bills that focus on prevention, doing more research, focusing on public health efforts, and making sure that there are no financial barriers to screening and preventative care. Here's a prevention fact sheet on H.R.3200:

Beyond the policy specifics, my hope is that once we finally make a public policy commitment for quality, affordable health care for all, that such a changes creates a platform and investment to move toward a healthier environment and society.

So I can imagine another form of entertainment 50 years from now, where our current technology looks quaint, our fashion looks sophisticated, our music is nostalgic, and some of our current diet and lifestyle choices, as well as current policies and industry practices, look as unhealthy and silly as the smoking and drunk driving scenes in Mad Men today.

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posted by Anthony Wright | Permalink | 11:38 PM


Health reform isn't rocket science...

Reformers typically must wage battle on two front: one against the opponents who argue the facts, and those who do so with confusion, lies, and mistruths. Defenders of the status quo don't have an easier job: they don't necessarily have to make a cogent argument against reform, or for an alternative. They merely have to sow enough confusion, distrust and doubt to get people to fear the unknown.

Health reform can be legitimately complicated, and so it is particularly vulnerable to this kind of attack. But health reform doesn't have to be complicated. Like an iPod, it can be complicated on the inside, but reasonable easy to understand for the regular user.

So here's some resources that show it's easy.

Alex MacGillis of the Washington Post has a handy health care sheet that explains the bill.

Nick Beaudrot of Donkeylicious has a flowchart that shows how easy it really is for families to figure out how it impacts them, in three easy steps.

And on the sillier side...

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posted by Anthony Wright | Permalink | 7:17 PM


Can you talk about cuts without talking about them?

Saturday, August 15, 2009
The Bee editorial board this Saturday bemoans that "after months of haggling... the two most powerful men in California government are still not on the same page." Yet its condemnation is not for Governor Schwarzenegger, who unilaterally cut another half-billion dollars in vital services, beyond his agreement with legislative leaders.

Their misplaced scolding is for Senator President Pro Tem Steinberg, who is suing (as are several groups) over the Governor's authority to make such cuts.

What's remarkable about the editorial is that it makes no attempt to acknowledge the serious constitutional issues about unchecked gubernatorial power to cut outside the once-a-year budget, without legislative approval or oversight. Voters rejected "spending cap" proposals that included similar power grabs (although with differences in the details) in both 2005 and earlier this year. Yet the Governor is assuming this power anyway.

What's misleading about the editorial is that it treats the legislature as a monolith. It says the legislature rejected over $1 billion in budget solutions, without specifying it was, by many accounts, specifically the Assembly Republicans who balked. Instead, the Governor didn't punish them, but rewarded them with cuts to the safety-net that they had sought, with the fallout on the vulnerable Californians who rely on the services he cut.

And yes, what's most shameful about the editorial is that nowhere does it mention the actual substance of the cuts, mostly to health and human services. How can these cuts be discussed without even mentioning what they are, and their impacts--such as zeroing out state funding for community clinics and battered women's shelters, or additional, steep cuts to maternal and child health, AIDS and HIV treatment and prevention, and children's health insurance.

The legislature had already agreed to cuts that were beyond the pale, for example forcing California to actively kick children off of Healthy Families coverage--but the Governor's additional cuts threaten the viability of the program as a whole. The Budget Conference Committee spent several weeks to be deliberate in making cuts, and all that was undone by the Governor's veto pen. If anything, the legislature already had went too far, too deep, and we--and particular our children--will suffer the consequence.

These would be inconvenient facts to mention in the editorial's desire to be "safely beyond the budget debate." Whether those that directly are served by these programs, or for all Californians who rely on our health system, the rest of us are hardly beyond the debate, but are going to start feeling it first hand.

Those who are suing the Governor--which includes but is not limited to Senator Steinberg, since several health provider, social service, and other community groups are as well--are right to do so, both to preserve check-and-balances, and on the sheer human impact of the cuts. Too bad the Bee didn't want to even tell it readership what we were talking about.

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posted by Anthony Wright | Permalink | 9:23 PM


Will health reform get the Colbert bump?

Wednesday, August 12, 2009
The Colbert Report last night featured an interview with Jonathan Cohn of The New Republic (who edits the blog The Treatment where I contribute occasionally) making the case for health reform against the host, who in his wacky way was actually was more reasonable than the current opposition arguments.

The Colbert ReportMon - Thurs 11:30pm / 10:30c
Jonathan Cohn
Colbert Report Full EpisodesPolitical HumorMeryl Streep

Cohn makes the important case for reform, and refutes one of the worst myths out there, that somehow everybody already has access to healthcare. He points out that access to the emergency room isn't the same: in the best case scenario, we want people to have access to care so they don't need to go to the ER later.

But he points out not just the health but financial consequence of being uninsured: when you go to the emergency room, you get a bill. If anything he understates it, since that bill is likely to be 3-4 times what an insurer pays for exactly the same service.

This points out the reason for the Hospital Fair Pricing Act and the new www.HospitalBillHelp.Org website that we unveiled today, which informs people of their consumer rights and financial options.

But given that those options are often limited and inadequate, it also spells out the desperate need for health reform.

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posted by Anthony Wright | Permalink | 9:57 PM


If you go to one hearing today...

Thursday, July 30, 2009
Today, the Managed Risk Medical Insurance Board will hold the saddest of its monthly public meetings.

That's a high bar: last month, they closed the door to new enrollments, instituted a "waiting list" which is really just a euphemism for denying coverage to 350,000 children over the next year.

But this meeting will be even tougher. With a $194 million shortfall due to the budget signed by Governor Arnold Schwarzenegger Tuesday (which includes $50 million that he did through a controversial line-item veto), the board may have to take even more drastic steps--to kick hundreds of thousands of children off of coverage.

It is projected that over 900,000 children would be denied coverage--doubling the number of uninsured children in California, undoing a decade of progress.

The San Jose Mercury News editorial board sums up the issues with appropriate disdain. The Governor and Legislature appropriately criticized insurers from rescinding coverage from patients, but their action here is as bad, yanking coverage during a bad economic time when such coverage is probably needed most. Coverage that won't be there during when you need it is no longer coverage. If Healthy Families starts disenrolling children from coverage, it fundamentally alters the program forever.

MRMIB will review options, including if any money can come from other sources like the First Five Commission, or from insurers who participate in the program. But the outlook is grim.

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posted by Anthony Wright | Permalink | 12:22 AM


Waiting for the knife to come out again.

Tuesday, July 28, 2009
Right now, we're waiting for the Governor to announce his signing of the state budget at 11:00am. Kevin Yamamura of the Sacramento Bee has more details. Part of the question is what authority does the Governor actually have to make additional "blue pencil" cuts, given that this isn't actually a budget--that was passed in February--but a mid-year budget cuts package.

When we find out about the Governor's added cuts, we'll put our first report out via Twitter, at @healthaccess or www.twitter.com/healthaccess. (There's a Twitter feed on our homepage as well.)

But as always, we'll try to post information and analysis on this blog as soon as possible.

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posted by Anthony Wright | Permalink | 10:17 AM


California's shame...

Sunday, July 19, 2009
"Embarassing" was a frequent comment I heard when I was in DC earlier this week, made by various legislative staff of California lawmakers. The subject was the new waiting list, reported by the Sacramento Bee (source of the photo) and elsewhere, in Healthy Families program which has begun denying children the health coverage they need.

Our delegation worked really hard to pass the reauthorization of the state Child Health Insurance Program--which provides 2/3 of the funding for Healthy Families--and to make sure that the reauthorization was favorable for California. And now, that work may be for naught--given the Governor's proposal to end the program altogether, and even the likelihood that we would freeze enrollment and leave hundreds of millions of federal dollars back in DC.

Even in bad economic times, there are choices. And the shameful decision of California leaders, starting with Governor Schwarzenegger, is in stark contrast to many other states.

Kevin Sack has the top story in today's New York Times, which should be the shame of every California policymaker (emphases mine):

Despite budgets ravaged by the recession, at least 13 states have invested millions of dollars this year to cover 250,000 more children with subsidized government health insurance.

The expansions have come in the five months since Congress and
President Obama used the reauthorization of the Children’s Health Insurance Program to vastly increase its funding and encourage states to increase enrollment. Although the federal government covers the vast majority of the cost, states set their own eligibility levels and must decide whether to spend state money in order to draw even more from Washington.

The states’ willingness to spend, even under excruciating budget pressures, is a measure of the support for expanding health care coverage to the uninsured as Congress and the administration intensify their negotiations over a new federal health care bill.

But a number of states decided that their depleted coffers did not allow them to insure additional children, even as a minority partner.

...in California, where Democratic legislators and Gov.
Arnold Schwarzenegger, a Republican, are struggling to close the country’s largest budget gap, the state on Friday imposed a freeze on new enrollments.

California officials estimate that up to 350,000 eligible children may be relegated to a waiting list, and that attrition could lower enrollment by 250,000 by June. If money is not found, the losses there might overwhelm the cumulative gains in other states.

Health and Human Services Secretary
Kathleen Sebelius said the potential for major reductions in California was “a huge concern.”

But over all, she said, the Obama administration was “very pleased that even in what are some of the worst budget times in a very long time, children’s health insurance continues to be an absolute top priority.”

The Children’s Health Insurance Program, known as CHIP, has been politically popular since its enactment in 1997 because it primarily benefits working families that earn too much to qualify for
Medicaid but too little to afford private insurance.

In many states, eligibility expansions have passed with solid bipartisan support. In one of her final acts as governor of Kansas in April, Ms. Sebelius, a Democrat, signed a two-year expansion worth $4.4 million that had been approved by her overwhelmingly Republican Legislature...

Forty-eight states faced budget shortfalls this year,
totaling $121.2 billion, according to the National Conference of State Legislatures. But in those that have managed to expand eligibility, governors and legislators said they viewed CHIP as a cost-effective investment.

“In a downturn, the number of people who need the safety net increases,” said Gov. Bill Ritter Jr. of Colorado, a Democrat, whose state levied $600 million in fees on hospitals, some of which will be used to cover an additional 21,000 children.

In Alabama, Democratic legislators overrode the veto of Gov. Bob Riley, a Republican, to extend coverage to 14,000 children at an additional cost to the state of $8 million.“Our economy is tough here,” said State Senator Roger H. Bedford Jr., a Democrat. “But our decision was to fund the health care needs of our children because a healthy child learns better and they don’t show up at the emergency room needing acute care.”

Other states expanding eligibility include Arkansas, Indiana, Iowa, Montana, Nebraska, North Dakota, Oklahoma, Oregon and West Virginia. Ohio passed a budget last week that includes an expansion, but its financing depends on the resolution of a court case.

Illinois, New York and Wisconsin, which had been paying for expansions with state money, are now applying for federal matching funds. And many states are enacting measures to make it easier for children to enroll and stay enrolled, steps encouraged by the federal legislation. Officials in those states and others said they had little choice but to leave federal money on the table.

In California, the Legislature beat back Mr. Schwarzenegger’s proposal to eliminate CHIP altogether but seems to have accepted the enrollment freeze.

“It is heartbreaking,” said Ginny S. Puddefoot, deputy director of the agency that administers the program there. “For those of us involved with children’s health care, this is just something we never imagined we would see.”

California's financial woes are bigger than most, but these other states have their own fiscal crises as well. And yet they are deciding where their priorities are. And right now, for children and health care, Alabama has better priorities than California.

Just shameful.

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posted by Anthony Wright | Permalink | 12:12 PM


Even Wall Street agrees...

Monday, July 13, 2009
Wall Street’s analysts met with health care policy wonks in Washington July 8 for a conference organized by the Center for Studying Health System Change, which was funded by the Robert Wood Johnson Foundation.

An industry newsletter called Healthcare BS reports that everyone agreed the flawed health care system is costing too much of our economic resources – estimated at 16.7 % of gross domestic product.

Here are some of the findings on dollars-and-cents issues:

  • “Cost trends have ticked up, and so pricing is up about 1% on average in the individual and small-group market in 2009. This means higher deductibles and out-of-pocket costs -- all of which are expected to filter into the large-group market this year as employers set their benefits for 2010.”

  • "Premium increases and benefit changes stem from two primary causes: medical spending inflation and cost shifting, panelists said. As hospitals’ payments from government insurance plans are cut, they pass along more costs to private insurance carriers, and in turn, employers are passing along their cost increases to their employees in higher premium contributions, copays and out-of-pocket maximums."

  • "The analysts noted that insurance brokers generally earn hefty commissions of between 20% and 25% of the premium in the first year and then half that amount in each renewal year, adding substantially to the cost of individual insurance. "

  • "At the end of the day, everyone expressed a sincere desire to see the creation of an integrated health care delivery system that provides better care to more people at lower costs."

And these were the money guys talking.

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posted by Cynthia Craft | Permalink | 1:59 PM


Newspapers go on the record...

Tuesday, July 07, 2009
The Sacramento Bee opinion section had a package on health reform, and included elements of our fact sheet about how Californians are uniquely impacted by the health care crisis.

They had a follow-up editorial today correctly citing the need to pay for reform. National health reform is going to need up-front investments. But we disagree with the second part of the statement that "Insuring more people might be good policy, but it will not save money." Bringing everybody into the health system not only allows for cost-saving preventative care, but gives policymakers the tools to drive payment and system changes to encourage the best quality and low-cost care. It is a result of our fragmented non-system that our level of spending does not have any correlation to the quality of care. And health reform includes key components, from the public health insurance option to comparative effectiveness research, that can have an impact to.

The Los Angeles Times had a long editorial as well on health reform, with several key points we agree with mostly, but not entirely. Here are snippets of interest:

Access to affordable healthcare in the United States is an entitlement, a perquisite or a fantasy, depending on a seemingly arbitrary matrix of factors. Government insurance programs are available for the elderly, the permanently disabled, people with failing kidneys, the impoverished and children from low-income families. But how poor one has to be to qualify varies from state to state and from year to year. Employees at most large companies and many small ones can take advantage of group insurance plans negotiated by their employers. But millions of people who work in low-paying service, retail or contracting jobs have to seek individual insurance policies, which may be unaffordable or unavailable because of their medical histories. Others obtain insurance with deductibles so high or coverage limits so low that one bad accident or illness could bankrupt them.

It's an irrational system with inhumane and costly results that extend beyond the 47 million uninsured. According to the
Kaiser Family Foundation, more than half of the adults without insurance have "no regular source of healthcare" other than an emergency room. They are more than four times as likely as the insured to delay a trip to the doctor, and six to eight times as likely not to get treatment because of the cost. The consequences for the uninsured include more serious ailments and a higher premature death rate; for everyone else, the consequences include the loss of productivity attributable to worker illness, a higher risk of infectious disease and about $50 billion in medical bills passed along by those who couldn't pay them.

Most important, the large and growing number of uninsured Americans make it well-nigh impossible to overhaul the healthcare system to improve quality and control cost. Bringing those people in from the fringes is crucial to changing the system's incentives, shifting from a model that relies on sickness to one that promotes prevention and wellness, increases the supply of primary care and improves coordination among its many elements...

Washington can't order people to buy insurance without helping millions of them pay for policies they couldn't otherwise afford. Kaiser estimates that almost 40% of the uninsured in 2007 had family incomes at or below the federal poverty level, and another 29% had incomes less than twice the poverty level.
Typical group policies cost $12,200 on average for a family of four in 2007 -- more than a full-time minimum-wage worker earned that year. Even at twice the poverty level, the average premium for a group policy would devour 20% or more of the family's income. Any individual mandate would have to be accompanied by subsidies for those who make too much to qualify for Medicaid but too little to afford a standard insurance plan...

It's legitimate to ask why some employers -- or more accurately, their workers -- shoulder the cost of the healthcare system when others do not. That's why a limited mandate, scaled to the size of the business and its payroll, may be in order. If a company can't afford the extra cost, it could opt out by paying a tax based on the size of its payroll.

Bringing the uninsured and underinsured completely into the system will set the table for reforms that improve care and save money for everyone. The Commonwealth Fund
recently estimated that the cumulative savings from these reforms could be $1.2 trillion to $3 trillion by 2020. But those savings don't represent actual reductions in the cost of healthcare; they represent how much less those costs are expected to increase. Similarly, providing insurance for millions of low-income Americans should drive down inefficiency and cost-shifting within the system; instead of getting much of their treatment in expensive emergency rooms and passing the costs on to people with private insurance, they can get more routine and preventive care paid for by their own policies. But taxpayers will have to bear much of the cost of providing that coverage, which the Congressional Budget Office has estimated to be at least $1 trillion over the next decade.

In short, shifting to universal coverage will generate a mix of costs and benefits, with some segments of the economy taking on more of the burden and others less. The biggest potential winners would be healthcare providers, whose services would be in greater demand from the newly insured, and private insurers, who stand to pick up millions of new, federally subsidized customers.

In fact, the expansion could yield a windfall for insurers or healthcare providers that dominate a market. That's why it's important to promote competition while imposing insurance mandates, starting by creating one-stop shopping exchanges where people can compare and purchase policies that meet a minimum standard for coverage.

Although it's a
lightning rod for critics, the idea of the government establishing public insurance plans to vie with private ones for subsidized policies is worth exploring. It's a potential counterweight to the power wielded by a single healthcare provider or insurer in too many communities, a recent Urban Institute study contends.

A good model is L.A. Care Health Plan, one of the county-based plans that California created in the early 1990s to manage the care of Medi-Cal patients. Unlike Medicare or Medicaid, which can dictate prices, it has to negotiate rates with doctors and hospitals just as its private competition does. And it's steered by a board of healthcare providers, patients and county officials with a directive to preserve the safety net, which has encouraged it to pursue the best care at the least cost. The new public plans could take on a similar civic mission: to help develop prevention- and wellness-focused approaches to care.

We can't kid ourselves: Expanding insurance coverage is expensive. It also raises thorny questions about how far to go, including whether to cover illegal immigrants and how to enforce the individual mandate. But the payoff is a real one, with the benefits mounting over the long term in the form of a rational healthcare system that delivers increasing value for the money. It's a price worth paying.

These editorial boards have opposed some previous efforts at health reform in the past, so the fact that there's an endorsement of employer responsibility and a public health insurance option--albeit weaker versions of what we recommend and advocate--it shows a critical consensus is forming.

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posted by Anthony Wright | Permalink | 12:03 AM


This week in health reform...

Thursday, July 02, 2009
The federal health reform debate continues full steam ahead.

The Kaiser Family Foundation has a useful chart of the three leadership measures, the one "discussion draft" proposal in the House of Representatives, and the two others--which are in various forms of public release--in the Senate.

There are other proposals, both big and small floating around Capitol Hill(from single-payer and the Wyden-Bennett bills, to specific legislation on specific issues), but they will largely serve as ideas that will influence the three leadership bills are the main vehicles being authored by the key committees that have jurisdiction.

Due to the pace of Congressional discussions, the attached chart does not capture some of the more recent revisions we’ve heard about. For instance, just yesterday, the Senate HELP Committee released more details of their bill, including a public plan option and an employer mandate for employers with more than 25 employees, which has been scored at $611.4 billion (not including Medicaid) and is stated to cover over 97 percent of Americans. And Senate Finance Committee members continue to work on the cost of their bill, in part by tinkering with the level of subsidies.

We'll have more analysis--much more--in the next few days.

The picture above is of Representative Xavier Becerra, a key member of the leadership of the House of Representatives, who appeared at a packed Health Care for America Now town hall this Monday. He is pictured with leaders from California Partnership, Children's Defense Fund - California, and Health Access California.

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posted by Anthony Wright | Permalink | 5:41 PM


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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.