SENATE HEALTH COMMITTEE MOVES BILLS TO LAUNCH STATE'S HEALTH REFORM * Pair of Bills By Chair Elaine Alquist Allows California to Swiftly Move Forward * Insurers Urged to Offer More Consumer-Friendly Policies on the Individual Market * Apples-to-Apples Comparison Shopping in Individual Market is Closer to Reality * Vice Chair Strickland's Challenge to Expansion of Medi-Cal is Voted Down
KEY SENATE BILLS PASS SENATE HEALTH COMMITTEE: On Wednesday, California continued its march toward making health reform meaningful here as a pair of bills authored by Senate Health Committee Chair Elaine Alquist and Senate President Pro Tem Darrell Steinberg won committee approval.
These and other key consumer protection measures all passed on a 5-0 vote. Due to sickness and/or scheduling conflicts, all three Republicans and one Democrat on the committee were absent, thus requiring a unanimous vote from the remaining five Democrats in order for bills to proceed.
SB 900 (Alquist/Steinberg) sets up a new insurance exchange that actively uses its negotiating power to seek out the best deals for individual and small group policyholders. SB 890 (Alquist/Steinberg) standardizes and simplifies the health insurance market so that consumers better understand their choices and can make apples-to-apples comparisons.
SB 900 is similar to AB 1602, authored by Speaker John Perez, which the Assembly Health Committee passed on Tuesday. The measures are expected to be reconciled further along the legislative process, as the flagship measures to deliver on federal health reform's promise, and create a fair, consumer-friendly exchange as a market where consumers could shop for the best policies at the best prices would be fulfilled.
In introducing her bill, Senator Alquist said, "This establishes the exchange as an active purchaser that will try to get the best possible deal for consumers shopping for individual policies." She said the exchange would be administered by a board of legislative and gubernatorial appointees that would meet in public every two months. The board will be held accountable for its decisions, Alquist said.
Health Access advocate Beth Capell said it is estimated that between three and nine million Californians would get coverage through the exchange. The exchange will ensure that people are charged for health insurance on a sliding scale, so those who make less will be charged less, and those with higher incomes will pay prices according to a sliding scale as well. It is envisioned that this fundamental building block of health reform in California would be consumer-friendly enough to attract small businesses into the exchange.
An exchange might reduce the number of uninsured in California -- currently estimated at 8.2 million -- to roughly 2-3 million. "We are hopeful that the exchange will help create a real culture of coverage in California," Capell told committee members.
Alquist's SB 890 aims to standardize the range of policies that are available to individual consumers so that "apples-to-apples" comparisons could be made. The bill standardize the market, from the current "confusing maze of over 100 products" where consumers have little ability to determine the differences between plans.
"This would be the first step in beginning to implement health care reform," Alquist said. "We need to restructure for Californians the market in which they buy their own insurance." As many as 2.5 million Californians, or 7% of all Californians, shop and pay for their own insurance in the growing individual market, which has been largely unregulated
SB890 received broad support from a range of stakeholders, including Health Access California, Kaiser Permanente, Congress of California Seniors, California Medical Association, California Hospital Association, and many others.
Insurers and brokers raised concerns with both bills. A common refrain was to wait until the federal government issued more clarifying regulations. An ongoing issue spotlighted by the insurers was about any provision that went beyond the federal law.
Nevertheless, California is moving along at establishing federal health care reform at a quick clip. The state is well-poised to make swift and certain progress at reform, in part due to extensive policy work done in 2007, when California nearly passed its own version of reform before Governor Schwarzenegger's "the Year of Reform" was squelched.
In other important action:
* The Senate Health Committee also passed legislation by Senator Mark Leno (D) to require health plans and insurers to disclose information justifying premium rate hikes and the methodology and frequency of their coverage denials to consumers. Leno's bill, SB 1163, would also require insurers to disclose impending premium increases 180 days before they go into effect -- rather than the 30-day notice current law requires. Leno noted that increases in premiums have far out-paced actual increases in medical costs. In 1960, he said, health insurance premiums made up 5% of the Gross Domestic Product; in 2000, that proportion grew to 13% of the GDP; in 2010, it grew to 17.3% of the GDP; -- and by the year 2025, if that rate of growth were not stopped, health insurance premiums would make up 25% of the GDP. "It is completely unsustainable," the senator said.
* SB 1283, by Senate President Pro Tempore Darrell Steinberg (D) also passed with a 5-0 vote out of committee on Wednesday. The bill would require a closer examination of the Department of Managed Health Care's progress at responding to consumer complaints, grievances and appeals of denial of coverage. A consumer testified that when an autistic child needed prompt medical treatment and was denied it by Blue Shield, the grievance process was so slow and ineffective as to take nine months instead of the legally required seven-day process. Steinberg's bill would allow consumer advocates to examine whether the Department is following the letter of the law of the 1999 Patient Bill of Rights that Health Access and a broad consumer coalition established. Health Access advocate Beth Capell told committee members: "We need to revisit a law we put into place a decade ago and get families the care they need when they need it -- and not see them subjected to Dickensian delays."
* SB 1088, authored by Senator Curren D. Price Jr. (D), was passed by the committee.. The legislation would build a bridge to uninterrupted insurance coverage for young adults up to age 26 who are on their parents' policy as students of a four-year university. Prior to federal health reform, a university graduate would be dropped as a dependant from a policy.
* Another bill by Senator Leno would require insurers to provide timely access to care to children at school. SB 1200 clarifies existing law to make certain that health plans cover children with chronic conditions such as asthma while they are in school.
* During most bill deliberations on Wednesday, lobbyists for the insurance industry were hard-pressed to argue why they might oppose the bills. In the wake of federal health reform, last year's oft-repeated, pro-industry opposing argument -- that any additional mandate would simply add to insurance company costs, and ultimately spread higher costs to all policyholders -- lost its punch. With reforms now the law of the land, the California Association of Health Plans, Health Net, Anthem Blue Cross and industry special interest groups were being very watchful of any changes to the California individuals market.
* And the partisan position that opposed federal health care reform lost ground as well on Wednesday. Senator Mark Wyland, standing in for Vice Chair Tony Strickland (R) presented an opposition bill that protested against the expansion of Medi-Cal -- as called for by federal health reform -- as too costly. But Capell pointed out that allowing people with incomes up to 133% of the poverty level to qualify for Medi-Cal also brought with it the promise of $124 billion in federal funds for California in the next decade. She and other opponents made clear that the the federal government was paying for 100% of the cost of newly eligible patients, and even after some phasing down until 2020, the federal government would provide a higher 9 to 1 marching rate. That pretty much took the steam out of the protest bill, which failed to pass by a 0-5 vote.
Many of these bills are now headed to the relevant Appropriations Committees for review. For more information, contact Health Access California.
ASSEMBLY HEALTH COMMITTEE LAYS CRUCIAL GROUNDWORK FOR HEALTH REFORM * CA Assembly Health Moves Several Bills to Line State Up With Federal Health Reforms * Groundwork is Laid for a State-Run Exchange, Expanded Medi-Cal, High-Risk Pool * AB 2244 Passes, Protects Kids from Discriminatory Pricing Based on Health Status
In a "deadline" week, the California Assembly Health Committee on Tuesday passed a package of health care consumer protection measures, which lay down some basics for making federal health reform real in California.
CHILDREN FIRST, PLEASE: One prominent bill was AB 2244, by Assemblyman Mike Feuer (D). The bill, sponsored by Health Access on behalf of its coalition members, "phases in several key provisions for children," Feuer told the committee.
The rollout of the Patient Protection and Affordable Care Act signed by President Obama on March 23 begins with children. Insurers will no longer be able to deny coverage to children with pre-existing conditions, and they will also have to rescind pre-existing condition exclusions for children already covered by their family policies.
AB 2244 goes beyond federal law in not just preventing denials, but limiting discriminatory charges for "pre-existing conditions" for children as well. The bill phases in "modified community rating" so that insurers are limited to charging plus or minus 20% for a child's health status. The price difference would be phased to plus or minus 10%, and then to no different charges allowed by 2014.
The bill had the support of the Congress of California Seniors, Consumers Union, the 100% Campaign, the California School Employees Association and others. Speaking out in opposition were the California Association of Health Plans and the California Association of Life and Heallth Insurance Companies, saying they believed AB 2244 was "premature."
The opposition by insurers was not a surprise. Just days after Obama signed the landmark law, insurance companies tried to interpret the new rights for children very narrowly. Not so, said the feds. This woule take the next step. In the Assembly Health Committee, the vote was pretty clear: "11 Ayes" and 6 "Nos". The measure now goes to the Assembly Appropriations Committee.
MAKING MEDI-CAL AVAILABLE TO MORE CALIFORNIANS: AB 1595, authored by Dave Jones (D) lined California's income eligibility requirements right up with the new federal law. Under federal reform by January 2014, Medi-Cal, which is administered by the Department of Health Care Services, will offer Medi-Cal coverage to all adults who earn up to 133% of the federal poverty levels -- even adults without children. The income ceiling would be $14,404 for individuals and $29,326 for a family of four.
Funding for the expansion of Medi-Cal will come from Washington, which will provide 100% of the cost of newly eligible starting in 2014 for the first three years. Then the percentage starts to taper off a bit so that, by 2020, the federal government is sending 90% of the cost of newly-eligible Medi-Cal patients. Health Access is in support of the measure, which passed out of committee with 10 votes. Also in support are the 100% Campaign, the Western Center of Law and Poverty, and the American Federation of State, County and Municipal Employees.
THE CALIFORNIA PATIENT PROTECTION AND AFFORDABLE CARE ACT: Assembly Health Committee members adopted Speaker John A. Perez's central bill, AB 1602, which is more or less the leader of the package. AB1602 "makes several sweeping changes," said Perez (D). Among them are creating the California Health Benefit Exchange, where individuals and small businesses can purchase health care coverage. The measure also prohibits group of individual health care plans from establishing lifetime or unreasonable annual limits of the dollar value of benefits. Carriers will also be required to provide preventative services, outlaws denying people coverage for pre-existing conditions and extends dependent coverage to young adults up to age 26. "Let's be clear," Perez told the committee. "Federal health reform is now the law of the land and California will implement it fully." He described the bill as "by necessity a work in progress as we still need an enormous amount of guidance" on implementation from the U.S. Department of Health and Human Services. The bill won 12 votes in its favor.
MATERNITY COVERAGE, ONCE AGAIN: California insurers have been dropping maternity coverage steadily for years now. Just four or five years ago, 82% of policies [CLARIFIATION: offered in the individual market] included maternity coverage and now only 19% do. Arguing in favor of AB 1825, Assemblywoman Bonnie Lowenthal (D) said, "We can't wait another four years to see what happens." She presented AB 1825 for her colleague, Assemblyman Hector De La Torre, who authored the bill. Health Access, the California Medical Association and many other groups supported the bill, which requires every individual or small group health insurance policy to cover maternity services. Insurers had been dropping the coverage from plans in an effort to make them more affordable and sell more policies. Several organizations, however, have criticized this practice as part of an overall trend of gender discrimination by insurance companies. AB 1825 passed with 12 "aye" votes and 6 "nos."
* In their rhetoric, more legislators are using the concern about rising health care costs to make their arguments on pending bills. Sen. Mark Leno (D) presented a bill Wednesday that would require youths through age 18 to wear sports safety helmets on ski and snowboard slopes. Serious head injuries are expensive and can require lenghty hospitalization, he said, and, yes, those big hospital bills will somehow get spread around into everyone's health insurance premiums.
A witness testifying in favor of the bill, SB 880, authored by Sen. Yee, described how, as an 18-year, she went at a smallish snowboard jump at too slow of a speed and her board flew up in the air and crashed down on her head, knocking her unconscious. She was in a coma on life support for three-and-a-half weeks, lost sensation on her left side and needed years of therapy to recover. Now she visits schools to share her story as a cautionary tale.
Leno told his colleagues: "One-half of all skiing deaths are caused by head injuries. If we pass this bill and require safety helmets, we will decrease the number of expensive serious head injuries, thereby reducing health care premiums for everyone."
SB 880 passed, 6 to 2, and heads now to the appropriations committee.
* In the same Senate Health Committee hearing Wednesday, Sen. Dave Cox (R) argued in favor of SB 1109, which would go after tobacco tax funds for preschool activities for children ages 0 to 5. Cox passionately declared that the Proposition 10 revenue would be better spent on anything but the "First Five" programs for California preschoolers that the voters approved.
His strongest argument? "If kids don't have health care, the music circles and play groups won't make much difference," Cox said. "Circle time, movie nights, yoga, play groups...none of that makes sense. Not when the money could be used for health care."
His bill failed, however, due to strong opposition testimony as to the benefits California's little ones are getting firing up their synapses with the lessons that the First Five programs provide.
* Sen. Alan Lowenthal (D) was presenting his bill, SB 1169, a simple one, to require insurance companies to give tracking numbers to treatment authorizations for mental health. The idea is to make it easier for people and providers to settle claims by making them easier to track through the insurance system.
"Tracking is not a revolutionary idea," said a supporter of the bill. "If we make a hotel reservation, we get a confirmation number in case the hotel clerk says you have no room reserved. UPS uses tracking numbers...."
Insurance lobbyists, however, gave their usual objection: If you impose any more bureaucratic or paperwork requirements , the costs will end up going up for consumers. In other words, premiums will rise for everyone.
But Lowenthal backed the insurers into a corner, figuratively, by revealing he knew insurers already had a tracking number system. The hitch was that the companies wanted that tracking system to be internal -- not known to anyone outside the firm.
Why not share? asked Lowenthal. If you do, he said, then you can't go on saying "'Things get lost...we can't find your claim or authorization.' That won't have to happen anymore."
If you can believe it, the health insurance industry's argument Tuesday against restricting rate hikes to once a year was that an incremental sprinkling of increases every few months would help consumers deal with sticker shock.
Of AB 2042, a bill to limit insurance companies to just one premium increase annually, a lobbyist for health plans said: "This only ensures that consumers will receive a bigger rate increase once a year." In his view, multiple "adjustments" in a year's time -- that is, in addition to "the one-time annual global increase in our premiums" -- would serve to soften the blow.
Members of the Assembly Health Committee, chaired by Assemblyman Bill Monning, weren't buying the upside-down logic. AB 2042 by Assemblyman Mike Feuer (D) passed out of the committee on Tuesday on a 10-5 vote.
"There ought not be frequent increases in the course of a year," Feuer told his colleagues. "Once is enough." Another argument was that consumers need predictability in their premiums, that it's impossible to plan an annual family budget if the rates go up mid-year.
The measure applies to policies sold on the individual market to people without group coverage or job-based coverage. In California, the individual market has been especially lucrative and is growing as more people lose benefits stability in these recessionary times.
Anthem Blue Cross dominates the individual market in California, with about 800,000 customers and little regulation. The insurance company's recent notice to policy holders of an impending 39% rate hike gained notoriety as national health reform picked up speed and became the law of the land.
“This measure complements the recent federal health reforms by ensuring that health insurers are prohibited from raising their rates multiple times per year," said Feuer. "If insurers raise rates when their subscribers aren’t expecting an increase, cash-strapped families could be forced to give up their coverage.”
Feuer announced the bill after the Assembly Health Committee held an oversight hearing examining the proposed rate increases of several health insurers. In addition to Anthem Blue Cross' 39% hike scheduled to go into effect May 1, it was learned that several other health insurers have raised their subscribers’ premium rates in the 30 to 40 percent range.
With public outrage growing over the practice, consumers began speaking up about having to endure premium hikes two/three times a year or more in the individual policy market.
Consumers Union's Betsy Imholz testified in favor of AB 2042, on Tuesday and Health Access is a sponsor of the legislation. Labor groups also back the measure.
California families need reform not just at the federal but at the state level. Given these tough economic times, we can't let insurers jack up health premiums whenever they feel like it.
ASSEMBLY HEALTH COMMITTEE PASSES BILLS ALIGNING STATE WITH HEALTH REFORM * CA Assembly Health: Kids in Medi-Cal Won't Be Forced to Re-Enroll Every 6 Months * Hospital Fee Funding Deal to Draw Down More Federal Funds Seeks an Extension * Mental Health Parity Bill Passes in CA Assembly Health -- as It Already Has in DC
HEALTH REFORM CONTINUES IN THE STATE CAPITOL: The California Assembly Health Committee on Tuesday passed a number of measures that align the state's policies closer with provisions outlined in the landmark federal health reform law.
CONTINUOUS KIDS COVERAGE: Foremost, the committee, chaired by William Monning (D), voted to pass AB 2477 to allow children on Medi-Cal to stay covered for a year before their families would have to renew eligibility paperwork. A proposal by the Governor would have required families to renew their children's coverage every six months, with the impact that some parents would miss their deadlines and the children would no longer be covered. The proposal is one of the governor's ideas for saving the state money--at the expense of the health of Californians.
Assemblyman Dave Jones (D), sponsor of AB 2477, a bill supported by Children Now and the 100% Campaign, Health Access, and other coalition partners, wrapped up his arguments in favor of the measure by saying simply, "Vote for our kids!"
Since the historic federal law signed by President Obama requires states to maintain the same level of eligibility they had before the federal reform passed, California risked losing substantial federal funds if it adopted Schwarzenegger's proposal. Semi-annual eligibility review would have posed an unfair burden on families struggling in the recession, frequently on the move and working primarily to put food on the table, Jones said.
With the committee in agreement, AB 2477 now moves to the Assembly Appropriations Committee, where its fiscal impact on the state will be assessed.
MENTAL HEALTH PARITY: Assembly Health Committee members also voted to pass a bill by Assemblyman Jim Beall (D) to require health plans to cover mental illness as they do physical illness. Current California law dictates that only serious mental illnesses be covered, and Beall's AB 1600 extends coverage to other mental illnesses as well.
Again, the provision mirrors what President Obama signed into law. Beall argued that failing to cover mental conditions, including substance abuse and drinking alcohol to excess, cost California's health care system, government and industry too much money in lost productivity and late intervention.
Beall said the bill will also correct some of the discriminatory practices of health insurance companies, which argued that AB 1600 would cost too much money. Health Access' legislative advocate said the bill is consistent with federal health reform, which would also extend mental health parity to the small group market and the individual insurance market by 2014. AB 1600 heads next to the Assembly appropriations committee.
EXTENSION OF PROVIDER TAX ON HOSPITALS TO DRAW DOWN MORE FEDERAL FUNDS: The Assembly Health Committee also considered a measure, AB1653 (Jones), to extend for another six months a three-year deal struck with hospitals through which they pay fees in order to draw down additional matching federal funds.
Lawmakers voted in favor of the measure, which was supported by several hospital associations and is needed to help hospitals cover the voluminous cost of caring for the uninsured in emergency rooms.
The current hospital fee arrangement, which is still pending at the federal level, would collect $2.3 billion a year in order to attract $1.1 billion in matching funds from Washington. Noone spoke up in opposition to the measure, which will next go before the Assembly Appropriations Committee.
KEEP UP THE FIGHT: Many other bills are scheduled for votes in the next week, and insurance companies are already sending in their letters of opposition, on everything from rate regulation to limits on charging children with pre-existing conditions.
ALERT: SEND YOUR ORGANIZATIONAL LETTERS OF SUPPORT: These bills need organizational letters of support ASAP. Please send letters to the bill's author, the chairs of the relevant Health Committees, Senator Elaine Alquist and/or Assemblyman Bill Monning, and members of the relevant policy committee that will review the legislation.
Insurers are sharing their wish-lists with the Legislature, and so we need consumer, community, and constituency organizations to voice the people's view. Submit letters in support of these specific bills, listed on our website. Contact Health Access for sample letters on some of these bills.
HEALTH REFORM DEBATE SHIFTS TO IMPLEMENTATION BILLS IN CA LEGISLATURE
* California Effort Begins to Implement & Improve Federal Health Reform * Health Committees in Assembly and Senate to Consider Bills in Next Few Weeks * Today's Assembly Health Committee to Vote on Bill to Help Kids Stay on Coverage * Groundwork is Laid for a New Exchange; New Insurer Accountability on Rates; Etc. * ALERT: Organizational Support Letters Needed to Support Key Reform Bills!
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HEALTH REFORM HAS JUST BEGUN: Two weeks ago, President Barack Obama signed into law a historic health reform package, one that would reform the worst abuses of the insurance industry, secure coverage for those that have it, and provide new and affordable options for those that don't. One week ago, President Obama approved a "reconciliation" package of improvements to the health reform, the first of many that will be considered in the months and years ahead.
The work to implement and improve health reform at the state level starts today, with state legislation being considered today and over the next few weeks in health policy committees. A series of bills critical to easing California into a smooth transition to health reform is moving through the process.
This afternoon, the Assembly Health Committee, chaired by Assemblyman Bill Monning, will consider several bills, including AB2477 (Jones). The bill will allow for continuous eligibility for children in Medi-Cal, without threatened mid-year status reports that would prevent kids from staying on coverage. This would start to align our eligibility requirements with those of federal health reform.
Most of the other bills are basic consumer protections that would increase accountability for the insurance industry. In some cases, the federal law requires states to act, within certain parameters; other proposals would implement some aspects of health reform early, and in other cases would build on federal health reform but go further. Some bills are up as early as next week in committee, which means organizational letters of support would be due in the next day or two.
One such bill for next week is AB 2042 (Feuer), which would prevent health insurance companies from raising rates more than once per year. This unfair practice is not unheard of. It's bad enough that Anthem Blue Cross refuses to budge on its outrageous up-to-39% annual increase scheduled for May 1, but they also announced that they may increase their rates over the course of the year. The bill would provide ratepayers some security in being able to predict their health care costs over the course of a year.
There are many other bills coming up in the next week, and insurance companies are already sending in their letters of opposition, on everything from rate regulation to limits on charging children with pre-existing conditions.
ALERT: SEND ORGANIZATIONAL LETTERS OF SUPPORT: These bills need organizational letters of support ASAP. Please send letters to the bill's author, the chairs of the relevant Health Committees, Senator Elaine Alquist and/or Assemblyman Bill Monning, and members of the relevant policy committee that will review the legislation.
Insurers have already started to get in their opposition letters, and so we need consumer, community, and constituency organizations to submit their letters in support of these specific bills. Contact Health Access for sample letters on some of these bills; a full list of health reform related bills is listed below.
PENDING BILLS TO IMPLEMENT AND IMPROVE HEALTH REFORM Below is a list of health consumer bills currently in the California State Legislature that are intended to implement and improve certain provisions in the federal health reform law and prepare the state for other provisions contained in the law. This list is regularly updated and can be found at www.health-access.org.Creating a Consumer-Friendly & Transparent Individual Insurance Market & Exchange
* AB 1602 (Bass) CALIFORNIA PATIENT PROTECTION & AFFORDABLE HEALTH CHOICES: Would create the California Cooperative Health Insurance Purchasing Exchange (Cal-CHIPE) and expand dependent coverage in private insurance to age 26.
* SB 900 (Alquist) CREATING A CALIFORNIA HEALTH INSURANCE EXCHANGE: Would establish the California Health Insurance Exchange within the California Health and Human Services Agency to make health coverage available and create the California Health Insurance Exchange Fund to be governed by a board appointed by the Legislature.
* SB 890 (Alquist) IMPLEMENTING FEDERAL HEALTH REFORM: Creates rules in the individual market similar to those for Medi-Gap so that insurers cannot cherry-pick individuals based on health risk status. Sets standard of basic health care services for DOI products as well as DMHC products.
Providing Access for Those with Pre-Existing Conditions
* AB 2244 (Feuer) ASSURING KIDS COVERAGE: Requires guaranteed issue, eliminates all pre-existing condition exclusions and phases in modified community rating for children under age 19 in the individual market.
* AB 2470 (De La Torre) REGULATING RESCISSIONS AND MEDICAL UNDERWRITING: Would require regulations to be created that establish standard information and health history questions used by health insurers on application forms, and required insurers to complete medical underwriting and review for accuracy before issuing an individual a health plan contract or policy.
* SB 227 (Alquist) SECURING FUNDING FOR MRMIP, CA’S “HIGH-RISK” POOL: Creates fee on insurers to support California’s high risk pool for those denied for pre-existing conditions.
Continuing and Expanding Coverage
* SB 1088 (Price) ALLOWING YOUNG ADULTS TO STAY ON THEIR PARENTS’ COVERAGE: Would require group health plans to allow young adults to continue on coverage as a dependent up to age 27, however employers are not required to contribute to the cost of coverage for those dependents 23 or older.
* AB 2477 (Jones) KEEPING CHILDREN ON MEDI-CAL COVERAGE/CONTINUOUS ELIGIBILITY: Would adopt rules to expand continuous eligibility in Medi-Cal to children 19 years of age and younger.
Regulating Insurance Company Rates
* AB 2578 (Jones) REQUIRING APPROVAL FOR RATE HIKES: Would require approval by the Department of Managed Health Care or the Department of Insurance of an increase in the amount of premium, co-payment, coinsurance, deductible or other charges under a health plan.
* SB 1163 (Leno) PROVIDING SUNSHINE ON PRICE GOUGING: Would require health plans to provide, in writing, specific reasons for denial of coverage or for charging higher than the standard rates for coverage.
* SB 316 (Alquist) ENSURING PREMIUM DOLLARS GO TO PATIENT CARE/MEDICAL LOSS RATIO: Would require health plans to provide written disclosure of the medical loss ratio (the ratio of premium costs to health services paid) whenpresenting a plan contract or policy for sale to an individual purchaser or to groups of 50 or fewer individuals.
* AB 2042 (Feuer) PROHIBITING MID-YEAR RATE HIKES: Insurers and HMOs cannot change or increase premiums, cost sharing or benefits more often than once a year.
Setting Minimum Standards
* AB 786 (Jones) SETTING BASIC INSURANCE MARKET STANDARDS: Would sort health insurance policies into a number of categories, based on benefit comprehensiveness and cost-sharing. Would set a minimum standard that requires coverage of doctor and hospital care and an overall limit on out-of-pocket costs, thus eliminating deceptive “junk” insurance.
* AB 1825 (De La Torre) ENSURING MATERNITY CARE: Would require most health plans to cover maternity services.
* AB 1600 (Beall) REQUIRING MENTAL HEALTH PARITY: Would require most health plans to provide coverage for the diagnoses and treatment of a mental illness.
Additional Consumer Protections
* SB 56 (Alquist) FACILITATING A PUBLIC HEALTH INSURANCE OPTION: Would authorize county-organized health plans and other health benefits programs to form joint ventures in order to create integrated networks of public health plans that pool risk and share networks, subject to the requirements of the Knox-Keene Act.
* AB 2110 (De La Torre) PROVIDING PREMIUM GRACE PERIODS: Would extend the grace period for premium payments from 10 or 31 days up to 50 days for most plans regulated by the Department of Insurance.
The House of Representatives just passed, by a vote of 220-207, a package of "reconciliation" improvements to the historic health reform package signed by the President earlier this week.
This was after the Senate passed the package--after hours of brushing back GOP amendments in what was known as vote-a-rama--by 56-41 earlier today.
It now goes to President Obama for his signature. The work on this bill is done.
Instead of being concentrated in Congress for just over a year, health reform will spur frenetic activity over the next five years across the nation, at both the federal and state level, in venues both legislative and regulatory.
The work that needs to be done at the federal level, especially at the Department of Health and Human Services, is immense. But the much of the action will also shift to the states, who have traditionally taken the lead on two central components of health reform: insurance regulation, and the administration of public coverage programs. With federal standards and guidance, each state has a role in everything from expanding and streamlining its Medicaid programs, to setting up the new exchanges which will provide a new, regulated market for consumers to purchase coverage. In essence, the bill spurs 50 different health reforms.
My colleague Richard Kirsch, National Campaign Manager, Health Care for America Now, sounds a similar note and the end of his statement today:
“It’s impossible to overstate the breadth of what our nation’s achieved with the passage of comprehensive health care reform. We have closed the book on decades of struggle to make good, affordable health care a right - and not exclusively a privilege – for America’s families.
We have created a vehicle by which to eliminate insurance industry abuse, to make health care more affordable for working families and small businesses, to close the Medicare “doughnut hole” for seniors, to help young adults maintain coverage as they strike out on their own, and to bring all of us the peace of mind and security of knowing we are no longer just one accident or illness away from bankruptcy.
With the closing of this volume, we also prepare to open another. We will need to continue to hold lawmakers and big insurance accountable and make sure we implement reform in way that truly achieves good, affordable health care for all.”
HISTORY & HELP: OBAMA SIGNS COMPREHENSIVE HEALTH REFORM BILL; ASSEMBLY MOVES SWIFTLY ON COMPANION HEALTH REFORM BILLS FOR CA
* Historic Bill to Provide Immediate Help to Californians, This Year * CA Assembly Revives Rate Regulation Bill, With Support from Consumers * Unfair Practice of Rescissions To Get Independent Review Under Assembly Bill * Bill to Undo Schwarzenegger Cut of Breast Cancer Program Moves Forward * Federal Reform Movement Gives New Momentum to Previously Stalled CA Bills
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HISTORY: President Barack Obama signed historic health reform legislation yesterday, legislation that will provide security and stability to those with coverage, and new, affordable options for those that don't. When fully implemented in 2014, the bill has the potential of reducing the number of uninsured Americans by 32 million, and preventing people from becoming uninsured due to a loss of income, being between jobs, or due to health status.
IMMEDIATE HELP: At the signing ceremony, the President emphasized the immediate benefits of the reforms. For Californians in 2010, the health reform will:
1. Prevent people from being denied coverage based on “pre-existing conditions.”
- Soon, people who are uninsured due to a pre-existing condition will be able to buy insurance through a special insurance program. Right now, Californians are left in a lurch: our state has a small, underfunded "high-risk pool" that currently has a waiting list--even though it is estimated that over 400,000 have been denied coverage due to health status. - Within 6 months of passage, no new health plan will be able to discriminate against children with pre-existing conditions. - In a few years, no insurance plan will be able to deny coverage to anyone for pre-existing conditions.
2. Provide people with more security, by outlawing the worst insurance company abuses. Insurance companies will:
- No longer be able to cancel insurance coverage retroactively when you get sick. Over 6,000 Californians had their coverage rescinded in the past several years, and health reform would end the practice of rescission. - No longer be able to put lifetime limits on the dollar value of benefits - No longer be able to place co-payments or cost-sharing on key preventive benefits
3. Provide real relief to young adults and their families, to seniors, and to small businesses. Health reform will:
- Allow young adults up to age 26 to stay covered on their parents’ insurance - Reduces prescription drug costs for seniors. Seniors whose spending falls into Medicare’s prescription drug donut hole will have hundreds of dollars of immediate help and the entire coverage gap will be eliminated over time. - Gives subsidies to small businesses. Small businesses choosing to offer coverage to workers will receive a tax benefit of up to 35% of premiums.
SENATE RECONCILIATION: The effort to improve health reform began today as well, as the Senate start to debate a package of "reconciliation" improvements that were passed by the House of Representatives. They are expected to vote on the package before the end of the Easter recess at the end of the week.
NO MORE EXCESSIVE RATE HIKES: It didn't take long for federal health care reform to spur movement of related, complementary legislation in the California Capitol. The combination of President Obama signing the historic health care reform bill this morning and, back in California, continuing outrage over Anthem Blue Cross' rate hikes and the company's sending profits to out-of-state corporate parent WellPoint, Inc., provided new momentum to a bill for rate increase reviews.
Assemblyman Dave Jones (D), the previous chair of the Assembly Health Committee, had tried twice before with versions of this bill, AB 2578. Supporters hope the third time is the charm. Under the leadership of new chair Assemblyman William Monning (D), the Assembly Health Committee members moved the bill on to the Assembly Appropriations Committee, the next stop in the legislative process.
It remains to be seen whether the Governor likes the idea of installing rate review on for-profit and non-profit insurers. But one thing is sure: Legislators from all over California have been hearing from plenty of constituents unhappy about the profiteering bad behavior of Anthem Blue Cross and other insurers.
One consumer who attended the hearing just to speak up for himself as an individual testified that his health insurance premium had ballooned from $600 a month to $1,100 a month in just nine months. Such wild rate hikes may be the insurers’ way of purging aging baby boomers and others they calculate may soon need their benefits – and replacing them with new customers buying less generous plans.
AB 2578, co-authored by Assemblyman Mike Feuer (D) and supported by Health Access California, California Labor Federation, Consumer Watchdog, Consumers Union, would extend the kind of regulation that Proposition 103 requires for auto and other policies to health insurance policies.
The bill would fill a need left unfilled by federal health reform. Although Sen. Dianne Feinstein (D) worked with President Obama to try to insert rate regulation in the federal bill, procedural process rules prevented that from happening. Rather, the federal bill requires that insurers spend at least 85% of the consumer’s premium dollar on health and medical expenses, keeping only 15% for administrative expenses.
As it stands now, AB 2578 would trigger a review for rate increases over 7%, conducted by the Department of Insurance or the Department of Maernaged Health Care. In recent years, insurers have imposed double-digit premium increases on consumers annually, so that the average policy in California expanded in cost by 130% since 1999, Jones said.
Speaking out in opposition to the legislation was the Chamber of Commerce, the California Association of Health Plans, the California Medical Association, Health Net and Anthem Blue Cross. Assemblymembers Anthony Adams, Ted Gaines and Audra Strickland voted against the bill.
RESCISSIONS TO GET INDEPENDENT REVIEW UNDER BILL: The Assembly Health Committee also voted in favor of passing AB 2470, authored by Assemblyman Hector De La Torre (D), out of committee.
Though an insurance industry spokesman testified that firms have cleaned up their act since the Los Angeles Times first wrote a series of stories exposing the practice of insurers' rescinding policies once patients incurred medical expenses, De La Torre said the Department of Insurance has been less than forthcoming with information to support that statement.
Insurers also stated that the new federal health reform prohibits rescission immediately, and eventually moves to a guaranteed issue market--and so the bill is unnecessary. De La Torre welcomed the federal law, but said that the bill would provide the regulation to implement the new federal reform. In addition, state regulators have been too slow in coming up with their own regulations that they promised to unveil a year ago this month.
Stalled last year, De La Torre said the bill was needed because consumers were vulnerable to insurance company abuses in the four year window until the federal reform phases out denials for "pre-existing conditions" in the individual market altogether. It is in the individual market that the recissions -- fully 6,000 of them between 2004 and 2009-- took place in California. In only 5% of those cases were consumers compensated, said De La Torre.
Arguing against the bill was the California Association of Health Plans, the Chamber of Commerce, California Life and Health Insurance Companies.
EVERY WOMAN COUNTS, REALLY! -- Assemblywoman Noreen Evans (D), challenging the Schwarzenegger Administration over an unapproved cut of public breast cancer prevention and treatment services, ushered through the committee a bill that states the Legislature's intent to reverse the governor's decision.
Evans, who earlier held a hearing and orchestrated a Capitol steps bakesale to call attention to the cuts and raise money (about $3,800) for the program, reiterated that the Administration was specifically told "no" -- it could not go through with the cutbacks -- but it did so anyway.
The governor needs the Legislature's consent to make the kinds of changes to the program that it did starting in January of 2010. Breast cancer screenings were scaled back to just women 50 and above, eliminating the service for those who previously could access it starting at age 40. Experts testified that many deadly, aggressive breast cancers tend to show up before age 50.
The governor also unilaterally froze enrollment in the "Every Woman Counts" program for the first six months of this year in order to save money. Again, the Legislature had said no to this proposal last June. The bill passed out of Assembly Health on Tuesday, and will pick up details about its funding (through the tobacco tax provided by Proposition 99 ) before it moves to the next commitee, Evans said.
NEW MOMENTUM EVIDENT ON HEALTH INSURANCE REFORM: President Obama's signing of the federal health reform legislation clearly gave a boost to bills to shape up California's insurance industry practices. Supporters spoke about the importance of a fresh era of transparency and consumer protection.
Also speaking in support of AB 2578, Assemblymember Mary Salas (D) said: "This bill is so important at this historic moment."
President Obama today signed comprehensive health care reform into law... and this evening, the Senate is taking up a package of improvements. Hopefully, those improvements will be passed and the President will sign them within the next week.
Here in California, the Assembly Health Committee today was considering important improvements as well.
* The Assembly Health Committee just passed Assembly Bill 2578 (Jones and Feuer). AB 2578 requires that prior approval be obtained before health insurance rates are increased. HMOs and health insurers would need to receive approval from the Department of Managed Health Care (DMHC) or the Department of Insurance for proposed rate increases. Rates requiring approval include premiums, co-payments, and deductibles.
The majority of the committee members voted for the bill, but the vote total is not final, as some Members may add on their votes later in the hearing. AB 2578 is supported by individuals, families and business that have been victims of dramatic health insurance rate increases and organizations such as the California Labor Federation, Consumer Watchdog, Health Access, California Public Interest Research Group (CALPIRG), Consumer Federation of California, and Consumers Union.
* As I write this, the committee is reviewing AB2470 (De La Torre), to regulate the practice of rescissions, the retroactive denial of coverage. This is something that is barred in the national reform signed today, except for proof of fraud and "intentional misrepresentation." Assemblyman De La Torre welcomed the new health reform, but stated there was a need to provide details to how the federal law is implemented, and that's what the law would do.
CALIFORNIANS HAVE CAUSE TO CELEBRATE WITH PASSAGE OF HISTORIC HEALTH REFORM IN THE HOUSE OF REPRESENTATIVES
* All House Democrats from California Supported Health Reform; All Republicans Opposed * Major Victory for California Leaders, Starting with Speaker Pelosi, Key Chairmen * Consumer and Community Groups Cheer Passage of Health Reform
* Reform Will Provide Immediate Relief for Children, Seniors & Small Businesses * Crucial Package of "Reconciliation" Improvements Head to Senate * Work Begins to Implement and Improve at the Federal & State Level
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HISTORY: On Sunday evening, the House of Representatives, by a vote of 219-212, voted to pass a comprehensive and historic health reform package that would provide more security and stability for those who have coverage, and new, affordable choices for those that don't. It would prevent the worst abuses of the insurance industry, expand coverage to 32 million uninsured, and put in place the tools to control health care costs.
The House passed two measures: the health reform bill passed by the Senate late last year, which heads to President Barack Obama for his signature Tuesday; and a "reconciliation" package of changes and improvements, that will be considered by the Senate within the next week, under a budget process that requires a straight majority of 51 Senators for passage.
HOW IT HELPS: The bill was mainly a victory for health care consumers, for both the insured, and the uninsured--both who benefit. Under the proposal, most consumers will be required to have coverage, but with that requirement comes signficant reforms and relief to help people meet that requirement.
IF YOU ARE INSURED, nothing requires you to change your coverage; but it will make your coverage more secure and stable: * It makes it more likely your employer continues to offer coverage, and set minimum standards for such coverage. * It improves Medicare; It expands and streamlines Medicaid. * It fixes the “individual market," giving individuals the bulk purchasing power of large purchasers, preventing "junk" insurance, and stopping denials for health status. * It provides the foundation to bring down the overall costs of health care.
IF YOU ARE UNINSURED OR UNDERINSURED, you will need to get coverage, but there will be new help and new options to ensure coverage is: * AVAILABLE: No denials or different rates for pre-existing conditions. * AFFORDABLE: Subsidies/affordability credits for low- & mid-income families, so you don’t have to pay more than a percentage of their income (based on a sliding scale up to 9.5%). * ADEQUATE: Minimum benefit standards and a cap on out-of-pocket costs, so no one goes into significant debt or bankruptcy. * ADMINISTRATIVELY SIMPLE: The Exchange provides choice and convenience, making it easy to sign up for and compare plans. * ALSO: Other efforts attempt to bring down the cost of coverage.
THE SUPPORTERS: The passage of health reform also is a win for many who supported it, starting with President Obama and Speaker Nancy Pelosi of San Francisco, who is widely credited with keeping health reform alive even when others believed the effort to be dead. Other Californian House members of note were key leaders like Democratic Caucus Vice Chair Xavier Becerra; Education and Labor Committee Chairman George Miller; Energy and Commerce Committee Chairman Henry Waxman; Way and Means Committee member Pete Stark, who chaired the Health Subcommittee; and many others, including leaders of key caucuses.
All California House Democrats voted for health reform; all California Republicans voted against it. The supporters included several members from more competitive districts--including Representatives Dennis Cardoza, Jim Costa, Jerry McNerney, and Loretta Sanchez--that decided in the last several days, especially after a Congressional Budget Office analysis showed that the reform would actually reduce the deficit in the first ten years by over $130 billion, and reduce the deficit in the second ten years by over $1.2 trillion.
Appreciation also goes to many health advocates from around the state. This includes the many organizations that are part of Health Care for America Now, which Health Access California leads in California, working with the Alliance of Californians for Community Empowerment and the California Partnership. This broad coalition started an aggressive field operation in July of 2008 to both push for health reform and for key principles.
THE ELEMENTS: What did health and consumer advocates win? Here's a top ten list:
* Near-universal coverage for all, largely through group coverage and its purchasing power. * New consumer protections: New rules and oversight on insurers that include the abolition of underwriting and limits on age-based rates and on premiums dollars going to administration and profit. * The biggest expansion of Medicaid since its creation 45 years ago, completing a commitment for millions in and near poverty. * Sliding scale subsidies tied to income: Consumers will pay for coverage not based on how sick they are, but what they can afford. * The end of most junk insurance and bankruptcies due to medical bills, with a cap on out-of-pocket costs. * Fair share financing, including an employer assessment as important in concept as the minimum wage was for pay * Assistance for small business, and their low-wage workers to be able to afford coverage. * More sustainability and improvements for existing public programs, filling the donut hole in Medicare & simplifying Medicaid. * The tools for cost containment and quality improvement in health care generally, from prevention to IT to bulk purchasing. * Momentum to do more in the future, politically and policy-wise, in health care and beyond
NEXT STEPS: But to fulfill the promise of health reform, the work to implement and improve it begins today.
The Senate needs to pass the package of House-passed improvements this week. The reforms are crucial, including greater affordability subsidies for low- and moderate-income families; the closing of the donut hole in the Medicare prescription drug coverage for seniors; greater consumer protections; the narrowing and delay of an excise tax on high-cost health plans; and more assistance to states like California for its Medicaid program.
Even after passage of the reconciliation package, the work to implement and improve health reform will continue at the federal level, and explode at the state level. Many items that were not included in this round of reform at the federal level--like rate regulation and the public health insurance option--already are pending as state legislation. The state's plans to renegotiate its Medicaid waiver will need to be rethought with the goals of health reform in mind. California will need to set up a new health insurance exchange. And the campaign efforts will need to continue, not just to defend health reform from the continued attacks, but to make sure it is implemented correctly.
That's the challenge of the next week, the next months, the next years, and the next decade. For more information about how to stay involved, become a member, visit our blog, join our E-mail list, Twitter feed, and Facebook page, and continue to be involved with Health Access California and Health Care for America Now--California.
California especially benefits from health reform...
Sunday, March 21, 2010
Given the extent of our state’s health care crisis, California would especially benefit from health reform:
EXPANDED COVERAGE: California has one of the worst insurance rates in the country. Health reform would cover most Californians, reducing the uninsured by roughly two-thirds. According to researchers at UC-Berkeley, close to 4 million Californians who were uninsured, in the individual market or had unaffordable employer sponsored insurance in 2007 would qualify for Medicaid or subsidized coverage in the exchange. This would provide relief to our beleaguered health system and safety-net.
STABILIZED EMPLOYER-BASED COVERAGE: California has one of the worst rates of employers offering coverage. Health reform would provide over $4 billion in new tax credits for California small business in the next ten years to help them provide coverage.
SUBSIDIES FOR LOW-WAGE WORKERS: California has a disproportionately large percentage of low-income workers. Health reform would expand Medi-Cal to individuals and families below 133% of the poverty level (over 2 million Californians will be newly covered), and provide significant subsidies to families under 400% FPL. Californians with an income of $14,404 a year would save $5,159 on average on premiums and out-of-pocket costs under the proposal compared to what they would spend in the current individual market. Those with an income of $43,320 a year would save $904 a year under the proposal. No one will have to pay more than a percentage of their income, on a sliding scale basis, for an insurance premium.
A BETTER WAY TO BUY COVERAGE: California’s individual insurance market is the biggest in the nation, but leaves Californians at most risk of being denied for “pre-existing conditions,” rescissions, and other insurer abuses. Health reform provides a new Health Insurance Exchange where insurers can’t rescind or deny coverage for “pre-existing conditions,” there are standards to prevent “junk” insurance, and consumers can make better comparisons between plans.
RECOGNITION OF OUR DIVERSE POPULATION: Health reforms recognizes the growing diversity of California and the nation, and the need for investment in language access; workforce development; and other provisions for our diverse population.
This Saturday morning, the House Rules Committee will meet at 10am (7am Pacific).
Both Congresswoman Doris Matsui (D-Sacramento) and Congressman Dennis Cardoza (D-Stockton-Modesto-Fresno) serve on the powerful House Rules Committee, which will vote on the key "reconciliation" package, so that it is considered Sunday by the full House, alongside the health reform proposal passed in the Senate by supermajority late last year. The reform effort will not proceed without passage in the Rules Committee.
(A multi-ethnic, multi-generational range of organizations will react to the House Rules Committee vote this afternoon at a press conference at Sacramento State, hopefully thanking our area Representatives.)
The Rules Committee will also vote on what if any amendments go to the floor. Here's a list of proposed amendments. The vote today otherwise sets up a historic vote on the House floor for Sunday, expected around 2pm (11am Pacific), with some speeches and debate beforehand.
We in California are blessed to have a lot of leadership in the House of Representatives, starting with Speaker Nancy Pelosi, and including other caucus leaders like Rep. Xavier Becerra.
It was noteworthy that of the three key committees responsible for health care reform, two are headed by Californians: Chairman George Miller of the House Education and Labor Committee, and Chairman Henry Waxman of the House Energy and Commerce Commitee. But as important has been Rep. Pete Stark, Chair of the Health Subcommittee of the House Ways and Means Committee.
Stark was the next senior person in line after Rep. Charlie Rangel stepped aside due to an ethics investigation yesterday, but Stark decided to step aside and allow Rep. Sander Levin to rise to the post today. Stark says he didn't want the job, and wants to continue focusing on health care.
The Fremont Democrat told Bay Area News Group that he prefers to remain chairman of the Ways and Means Health Subcommittee so he can shepherd and implement health-care reform.
"It seems to me we've got a chance in this Congress — maybe, unfortunately, into the next Congress, but over the next three years — the best chance we've ever had to get decent health care reform, and I've been working on that a long time," said Stark, who has served in the House since 1973.
"Quite honestly, the idea of being chair of Ways and Means and running around the country trying to raise money is the last thing I want to do," he added, calling fundraising on behalf of fellow Democrats for the midterm elections "not exactly my long suit."
Stark, 78, was the next-most-senior Democrat on the tax-writing committee after former Chairman Charlie Rangel, D-N.Y., 79, who temporarily stepped aside Wednesday pending the conclusion of an Ethics Committee probe into his corporate-paid travel. House rules said Stark would automatically take the chair unless he declined, or unless House Democrats voted to pass him over.
For health advocates, it is good that he is staying focused on health care. Rep. Stark and his staff have been absolute champions for health care reform, and for making the reform as good as it can be.
He has been innovative in advancing grand reform ideas, and small changes that make a big difference in people's lives. For example, earlier this year, Rep. Stark was heavily involved in making sure people losing their jobs kept their coverage with the help of a COBRA subsidy.
We are proud to continue to work with him as a pivotal leader on health reform, and much more.
As we and others continue to push for health reform at the federal level, Dan Weintraub, now of the New York Times, asks why some California legislators are continuing to also advance a single-payer proposal. But why wouldn't health reform advocates continue to educate people about this reform?
When President Obama signs a health reform package, while it will be a major advancement, it won't end the conversation on health reform, at either the state or federal level.
California OneCare is releasing an ad-a-day for 365 days in support of single-payer and SB810. The first ad features is Senator Mark Leno, continuing this year as the author of SB810, having taken the torch from Senate Sheila Kuehl last year. On the night that Jay Leno returns to the venerable talk show, we're happy to spotlight Senator Mark Leno reiterating his support of the venerable health reform:
We look forward to continuing our efforts, on parallel tracks and multiple ways, to improving the health care system for all Californians.
I just arrived back from Washington, DC, and I have a sober, realistic, and detailed sense that comprehensive health reform can pass in the next several weeks. It's not a forgone conclusion, but it's helpful. Now it's about vote-counting.
Representative Dennis Cardoza, Democrat of California, typifies the speaker’s challenge. The husband of a family practice doctor, he is intimately familiar with the failings of the American health care system. His wife “comes home every night,” he said, “angry and frustrated at insurance companies denying people coverage they have paid for.”
But as a member of the centrist Blue Dog Coalition, Mr. Cardoza is not convinced that Mr. Obama’s bill offers the right prescription. It lacks anti-abortion language he favors, and he does not think it goes far enough in cutting costs. So while he voted for the House version — “with serious reservations,” he said — he is now on the fence.
“I think we can do better,” Mr. Cardoza said of the president’s proposal.
We were proud that all of the California members of the House Democratic caucus supported the House health reform late last year. But there's a reason, given the particularly acute problems in California's health care system: Fewer employers offering coverage to their workers. Public programs facing budget cuts. And a broken individual market that has been spotlighted in the past few weeks for double digits rate increases and much more.
Nowhere is the health care crisis more severe in California than in the Central Valley, which would benefit most from the proposed reforms, such as the subsidies for low- and moderate-income families to afford health care.
Californians should be clear with our entire Congressional delegation about the desperate need for reform, and work to get every member to vote for the final health reform package.
Back the California Legislature, a collective sigh of relief wafted from around the Capitol this week as the Assembly and Senate wrapped up their work on mid-year budget cuts.
Meeting the deadline for the eighth special session set by Gov. Schwarzenegger -- yes, that was eight in one year -- Assembly members and state senators advanced a range of "budget solutions."
For now, they avoided the uproar that followed the Legislature's acquiescence to Schwarzenegger's harsh budget cuts last year on health and human services programs. Many advocates, commentators and members of the public pointed out that those were exactly the kinds of programs California families need to survive this punishing recession. The Senate and Assembly appropriately delayed discussion of the proposed health and human services cuts and eliminations until June, after the governor's May revision of his proposed budget is released.
Let's hope that come June, their wisdom holds.
For a brief but detailed overview of the mid-year budget cuts that did pass, see the California Budget Project's analysis at http://www.cbp.org/
Assembly Budget Committee Chair Noreen Evans (D) and others assailed the administration Monday for making cuts to a breast cancer screening program for low-income women against the Legislature’s wishes.
The Department of Public Health in December decided to reduce access to the “Every Woman Counts” early detection program by freezing enrollment until June 2010, and limiting enrollment to only women 50 and older.
For the past decade, the program had offered annual breast cancer screening to low-income women who lacked health insurance and were at least 40 years old. Statewide, 1.2 million are eligible for the program through about 1,000 locations, including community health clinics. The program served 249,000 in fiscal year 2006-2007; 270,000 in fiscal year 2007-2008 and then 310,000 in 2008-2009.
With the demand increasing, however, the Schwarzenegger Administration decided to shift some EWC funding to other programs, thus freeing up some money to help plug the growing budget deficit. This was done even though the Legislature had rejected the cutbacks outlined by the administration during budget negotiations after the governor submitted his May spending-plan revision.
At a hearing well-attended by breast cancer survivors and supporters, an irked Evans told bureaucrats that “It’s unacceptable to me that these screenings won’t take place…In my opinion, we’ve had way too much testosterone in the budget talks….and enough of the macho knife-waving, alpha-male politicians in the process. How many Californians will have to die for budget negotiators to see it’s time for us to grow up?”
Despite having been told by Evans that the planned program cutbacks would not be approved by the Legislature, the Department of Public Health “suddenly and surprisingly changed” the program, Evans said.
Assemblyman Hector de la Torre (D) added, “The administration is not allowed to run around making unilateral decisions. There is a checks-and-balances thing going on here.”
A round of applause broke out in the hearing room after Assemblyman Sandre Swanson (D) said the cutbacks in services would cause greater expenditures in the final analysis, as women get sicker and require extensive treatment. “You’re just shoving these costs off onto other programs – and you are costing lives, too.”
Several medical experts and community providers testified that women who are diagnosed with breast cancer in their 40s are more likely to have aggressive forms of the disease and therefore need early detection to survive. Many also testified that the age-group accessing services through Every Woman Counts are more likely to be women of color with few economic resources.
The hearing came after a bake sale held by Evans, other legislators and breast cancer awareness representatives to raise money and awareness about the program cutbacks. Following the hearing, a large rally was held outside, where several other legislators, including Senate President Pro Tem Darrell Steinberg, declared their opposition to the cuts and support for restoring the program. The rally ended with the Capitol being bathed in pink light, a color of significance for breast cancer survivors. Meanwhile, two bills -- with a third likely to come -- have been proposed to reinstate the program, Evans said.
“Health Care for America Now is committed to winning a guarantee of good, affordable health care we all can count on, and we will continue to push aggressively to get the best health care reform bill possible to the President’s desk for his signature as quickly as possible.
Tuesday’s vote was not a referendum on health care reform. It was a referendum on a particular candidate in a climate in which people, hard pressed by the economy, are impatient for change. When it comes to the need to make good health care affordable, nothing is different today than it was yesterday. Congress must keep going and finish reform right.
Fixing health care now is vital to fixing our economy. In survey after survey, voters continue to voice strong support for forcing health insurers to stop excluding people with pre-existing conditions, guaranteeing everyone has access to good, affordable coverage, and requiring health plans to spend premiums on medical care, not profits.
The people of Massachusetts already have benefit from health care reform. It’s time the rest of the country had the same access to good, affordable care.
We are on track to pass a strong bill, and we will stay focused on that until the President signs the bill into law.”
I would add that we at Health Access are pleased by Speaker Pelosi's continued leadership on this issue. And maybe that comes from the fundamentals: After all, the need and urgency for health reform from last year and last week didn't change this week and this year, because of a single result of a special election in a specific state. The election in question was in the state where health reform least mattered--as opposed to California, where it matters possibly most of all, given our large percentages of uninsured, lower-wage workers, people at risk of being denied for pre-existing conditions, etc. Even in Massachusetts, the candidate in opposition to national health reform did not dare oppose the identical state reforms already in place.
And that's the lesson. Pass a bill--a good bill--and health reform won't be the political issue it is now.
In order to secure stimulus funds from Washington, D.C., the Senate Health Commitee, chaired by Sen. Elaine Alquist (D), voted on Wednesday to advance a bill to officially undo the state's requirement for semi-annual reporting for Medi-Cal.
As a condition of receiving enhanced federal funds, states must refrain from efforts at reducing Medicaid enrollment, such as using semi-annual reporting, which has been shown to create a barrier for people trying to access the state-and-federally funded program.
"It makes sense to support this common-sense measure to keep 174,000 kids covered with health insurance, " Elizabeth Landsberg of the Western Center on Law & Poverty told committee members.
Also speaking in favor of the bill was Beth Capell for Health Access California, the California Medical Association, Molina Health Care of California, and advocates for the disabled and children's access to health care.
The bill must pass the full Senate by the end of the month to advance to the Assembly. Committee member Sen. Dave Cox (R ), was the only one to vote against it, while Vice Chair Tony Strickland (R ) joined Democrats in voting to pass the bill.
In other action, the Senate Health Committee also voted to send SB270 (Alquist) along to the Appropriations Committee. The measure would create a health information technology advisory panel to advise the Governor and the Legislature on health information technology in California.
Back in DC, legislative leaders from both the House and Senate have been in long negotiations at the White House for over five hours. There's a rumor that President Obama has urged them to stay in until the framework of a bicameral health reform deal is agreed to.
If we had our druthers, the House would prevail in most of the differences. I participated with a panel of experts, convened by Jonathan Cohn of The New Republic, that came up with the same result. Cohn has also been busy explaining the negotiation to "Fresh Air" public radio listeners.
Fingers crossed on our Congressional leaders coming to a good and equitable resolution. Many of my thoughts on federal health reform have found a forum on Cohn's blog at The New Republic, called The Treatment. I have appreciated having the platform on national health policy issues (and the editing), and have now posted there 20 times in the past year. Here are the posts, many of which are still very relevant to the current debate:
Senator Mark Leno, the current author of the bill, was joined at the rally by its previous author, Senator Sheila Kuehl. Other speakers included Jim Kahn, President of the California Physicians Alliance, labor leaders, and others.
The bill, SB810 (Leno) is expected to come up for a full Senate vote this month.
On the Health Committee, there are 9 members, 6 Democrats. This means that if a bill is to pass Health Committee, and all Republicans oppose it, it can't lose more than one of the Democratic votes.
There's lots of charts on the web comparing the House and Senate bills. But not only is this one (posted by Politico) really good and detailed (11 pages!), it is written by the House staffers of the three committees of jurisdiction. That means these are the folks who worked to write the House version, and know why they made the choices they did when crafting it. It gives some hints about what the negotiators are thinking about what they are looking to improve the Senate version.
Since the Senate is seen as a more delicate compromise, some people think the final product would look much closer to the Senate version. While it is important to be realistic, I think there will be some significant improvements from the Senate. There are some compromises that have been made which were very contentious, and probably won't get reopened. But as the opponents tell us, it is a 2,000+ page bill, so there lots of opportunity for improvements in other areas. The House, which by passing their version earlier already exerted some influence on the Senate bill, has a political imperative to put its stamp on the final bill. Also, the House version didn't pass with lots of extra votes, and their members are all up for re-election next year, so they have as much reason to ask for adjustments.
* Affordability, Affordability, Affordability: Required insurance could still be too expensive for many. Both bills require many Americans to have insurance. In the Senate bill, the caps on how much we're expected to pay are too high, and the subsidies for working families are too low. Many are working to fix this, but it's going to be a significant fight.
* Employer responsibility: The Senate bill’s requirement on employers has major loopholes for large employers who don’t provide coverage to their workers. Also, this complex and confusing “free rider” provision has potentially negative workforce impacts, encouraging part-time rather than full-time work. The Senate also needs to apply basic benefit standards to all employers, including large ones. The House bill has simple standard for large employers, who would either provide coverage to their workers, or pay a flat percentage (sliding scale up to 8%).
* Progressive Financing: Though the House bill is financed through progressive options like a surcharge on wealth individuals and families, the Senate bill includes an excise tax on high-cost health plans. We advocate a variety of progressive revenue options to offset a repeal or narrowing of the excise tax.
* Immigrant inclusivity: While both bills prohibit the use of federal funds to fund coverage of undocumented workers, the Senate bill excludes undocumented workers from using their own wages and money from being able to buy coverage in the national insurance exchange. Another issue is that the bills continue a 5 year waiting period for recent legal residents who would otherwise be eligible for Medicaid. We are urging Senators to support an amendment being offered by NJ’s Senator Menendez to lift this restriction.
* Abortion: While both bills adopt the current law that federal funds not be used for abortion coverage, the House bill goes beyond that in restricting reproductive rights. The Stupak provision House bill virtually prohibits anyone purchasing insurance in the Exchange from buying a plan that covers abortion—even if paid for with their own money. The Senate leaves the issues to the states. We need to work against a rollback of reproductive rights.
* State consumer protections: The new Senate bill did remove the permission of "nationwide plans" that seriously threatened state-based consumer protections. However, both bills do allow "interstate compacts," where states can allow insurance plans from another state without having to abide by their consumer protection laws. We are advocating for this provision to be removed.
* Public health insurance option: While the House passed health care with a public option, the Senate does not include one. We need to continue to advocate for a public health insurance option. The public option would provide competition for private insurance—and we need to continue to support its inclusion, even after a bill is signed into law.
We have watched much but not all of the Senate floor debate on health reform. We enjoyed Roland Burris' version of the Night Before Christmas, which closed with "health care for all, even our friends on the right".
But I was most taken aback to hear Sen. John Ensign (R-Nevada) cite favorably a US Supreme Court case that overturned child labor laws as the constitutional basis for opposing health reform. This is like citing Plessy v. Ferguson, the case in which the Supreme Court upheld state laws on segregation, as a justification for opposing Medicaid and Medicare, saying that the states should be responsible for health care for the poor and seniors just as the Supreme Court allowed states to set their own standards for segregation.
Overturn child labor laws? Eliminate the minimum wage? Why? Because the federal government should not interfere in the rights of the states to regulate the right of children to work or minimum wage. This parallels one of the fundamental arguments that is made by the opposition to health reform: the federal government should stay out of health care--except of course for Medicare (which Chuck Grassley and John Ensign now claim to support).
Just as it seems presposterous to think that the federal government cannot prohibit child labor or set a minimum wage, it should be preposterous to think that the federal government cannot reform health insurance. After all, regulation of insurance is a right reserved to the states under federal law, now long uncontested, the McCarran Ferguson Act. And if the federal government gave states the right to regulate insurance, then Congress and the President can act to change that.
But it gives us a glimpse into the world that the opponents of health reform seek--a world where there are no child labor laws to kill jobs for children, where there is no minimum wage to deny low-wage workers the chance to compete for the lowest wage, where there is no guaranteed Social Security benefit so seniors and the disabled live on whatever their family can help with. Today this is the world of the uninsured who are entitled to just as much health care as they can afford out of their own pocket.
We have written lots (and will write more) about how the health reform proposals now pending in Congress can be improved but here's what we know: if we do health reform right, it is the equivalent of creating Social Security for retirement, the minimum wage for wages and yes, child labor laws to protect the most vulnerable among us.
And what we also know is that the fight still goes on to protect Social Security, to increase the minimum wage and yes, even more sadly but thank goodness more rarely, to protect children from being forced to work. Americans have a right to Social Security, they have a right to a minimum wage, and children have a right to go to school, not to work--and we should have a right to health care. So we agree with Senator Ensign that the fight for health reform is like the fight to outlaw child labor---but we think the federal government should outlaw child labor and he apparently does not.
As we have written previously, the manager's amendment to the Senate bill that was adopted earlier today makes a number of changes to the Senate bill.
Our California Senator Barbara Boxer, as well as Senator Dianne Feinstein, won a significant improvement for California as well as six or seven other states, including Idaho, North Carolina and Michigan.
It is easy to figure out that Nebraska (and Hawaii) got something in the Medicaid provisions because those two states are mentioned by name.
We guessed that California met the following: "If the State is not a low DSH State described in (5) (B) and has spent more than 99.90 percent of the DSH allotments for the State on average for the period of fiscal years 2004 through 2008, as of September 30, 2009, the applicable percentage is 35 percent."
What is that and why do we care? DSH or Disproportionate Share Hospital funding is a key part of Medicaid funding for hospitals. In some states, DSH helps to make up for low Medicaid reimbursement rates. In other states, including California, DSH helps to cover the cost of care by hospitals for the uninsured as well as improving low Medicaid rates.
DSH is a big deal in California both because we are 51st in Medicaid reimbursement and because we have such a high proportion of uninsured.
So what did our Senators win for us? The earlier version of the Senate bill cut DSH funding in half once the rate of uninsurance drops. The new version would cut DSH funding by only 35%.
This moves the Senate bill much closer to the House version in terms of the DSH cut, at least for California, Idaho, North Carolina, Michigan and several other states.
With those changes, Senator Ben Nelson of Nebraska announced his support for the health reform proposal. This means that barring a surprise, the Senate Democrats have the 60 votes necessary to pass the bill off the floor and into conference committee. Given the wide ideological spectrum in the Democratic Party, this is a significant feat--and a bill that is necessarily a compromise.
Here's a list from Senator Reid's office of the components of the manager's amendment, with editorial comments from HCAN's Blog:
* Stronger medical loss ratios. Health insurers will be required to spend more of their premium revenues on clinical services and quality activities, with less going to administrative costs and profits - or else pay rebates to policyholders. These stricter limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans. (Ed note: Reportedly, these require group insurance plans to pay 85% of premiums to health care, and individual plans to pay 80%. These would go into effect in 2011. In 2012, the ratios would be based on the average medical loss ratio in the Exchange.) * Accountability for excessive rate increases. A health insurer's participation in the Exchanges will depend on its performance. Insurers that jack up their premiums before the Exchanges begin will be excluded - a powerful incentive to keep premiums affordable. * Immediate ban on pre-existing condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage of pre-existing conditions for children. Patient protections. Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care. * Ensuring access to needed care. The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014. * Guaranteed opportunity to appeal coverage denials. All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable. * Multi-state option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be non-profit, and the plans will be available nationwide. This will promote competition and choice. (Ed note: At least two plans will have to be offered, one of which must be non-profit. OPM can negotiate medical loss ratio, profits, premiums and other terms.) * Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan. * Children's health. Support will be extended for the Children's Health Insurance Program and the adoption tax credit. Foster care children aging out of Medicaid will be able to retain its comprehensive coverage. * Rural and underserved communities. Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers. * Revised abortion language, including state opt-out of abortion coverage (Ed note: details here)
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.
