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Blue Cross puts the squeeze on docs

Wednesday, April 07, 2010
Tuesday's hearing of the Assembly Health Committee gave a glimpse into the ways Anthem Blue Cross not only squeezes consumers, but providers as well.

We've all heard by now that Anthem Blue Cross of California has in its hip pocket a double-digit premium hike to whip out for individual-policy holders come May 1. And that Anthem's parent, WellPoint Inc. of Indianpolis, blessed its CEO, Angela Braly, with a 51% raise in compensation (with some lesser execs getting up to 75% boosts). That was just last Friday.

We can't say we're surprised -- though we are amazed at the utter brazenness of it all.

The other half of the financial equation that fattens Anthem and WellPoint at the expense of consumers and corporate responsibility is revealed by how they manage to collect money by shorting providers -- doctors and others who provide medical care.

Members of the Assembly Health Committee got their glimpse of Anthem Blue Cross' methodology on Tuesday when Dr. Marsha McKay, of the modest Sonora Pass town of Twain Harte, explained to committtee members how she can no longer provide treatment to all of her patients because Blue Cross fails to reimburse her even for the cost of supplies.

Take vaccinations, for example. An MMR vaccine costs Dr. McKay $59 to buy for her patients. Blue Cross refuses to reimburse her more than $57.61 for that same vaccine, nickle-and-diming her practice. The doctor charges a $25 fee to administer the vaccine, and Blue Cross only reimburses her $11. She can get another $3 from Medicare, but .... well, add up the math. She says she falls up short.

A combination DTaP vaccine that covers diphtheria, tetanus and pertussis costs Dr. McKay $40.90 to buy for her patients. It's given to kids 11 and up to boost the immunity of vaccines given in early childhood. Blue Cross pays her only $28 for this $40.90 vaccine. The IPV is an injected polio vaccine. Dr. McKay buys it at a price of $31.80; Blue Cross reimburses her $29.50 per dose.

Dr. McKay told Assembly members that Tuolumne County is an underserved area. Recently there was a small pertussis outbreak in Twain Harte, a place with a healthy dose of historical literary value but little widespread wealth. "I wonder if lack of access to vaccines was a contributing factor," Dr. McKay told lawmakers.

She's taken to sending her young patients in need of vaccination to the local health department. Because she can no longer afford to allow Blue Cross to add to her pile of medical debt. That's the local doctor's pile of medical debt -- not the usual, by now legendary, consumer medical debt we are used to hearing about.

Anthem Blue Cross, the middleman between care and coverage, is making a game of squeezing both sides. They have only a short amount of time to keep this game going. We should all look forward to the day when federal health care reform starts to put a stop to this egregious practice.

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posted by Cynthia Craft | Permalink | 4:34 PM


New accountability for so-called discount health plans: Key hearing in Oakland on Monday!

Thursday, February 18, 2010
Friday, February 19, 2010

* CA Department of Managed Health Care cracks down on wild west of unlicensed products
* Discount health plans are not health insurance, but some pay premiums thinking they are.
* Many provide less benefit than a pizza coupon: illusory discounts with phantom providers
* Health Access argues in favor of real discounts, real networks, and real notices

* DMHC HEARING on new consumer protections: MONDAY, February 22nd, in Oakland

* Other Items: Updates on Federal Health Reform, Anthem Blue Cross rate hikes,
State Budget Issues, and much more on our Health Access
* Join Us on
Facebook! Follow Us on Twitter!

The California Department of Managed Health Care has now embarked on the formal process to regulate so-called "discount health plans." This will begin with a public hearing at the Elihu Harris State Building, 1515 Clay Street in Oakland at 11:30 am on Monday, February 22, 2010 and it is expected that industry representatives, advocates, and consumers will all give testimony on this regulation. The specific language can be seen at DMHC’s website at http://www.dmhc.ca.gov/. Interested persons or organizations may also submit written comments to the Department on their website by 5:00 pm on Monday, February 22.

The Department has reacted to many industry abuses where so-called discount health plans marketed a discount health card as real, comprehensive health insurance—which it is not. Some of the documented abuses are:

* Consumers are charged high fees and co-payments by discount health plans ($25 to over $1000 per month) which are of questionable value for that money

* Discount health plans advertise what turns out to be a phantom network of doctors, hospitals, and clinics that allegedly offer discounts to cardholders. However, these providers often are unaware they are part of discount health network and are reluctant to provide services.

* Consumers pay a monthly premium for a discount health card that is billed as a dollar deduction or “percentage off”—but is often no more than or even as great as other discounts commonly given to consumers for free, such as AAA, religious groups, or fraternal organizations.

* In most cases in health care, the value of the discount is illusory because there's no set price of the service to begin with. Many "billed charges" for doctor and hospital care are multiple times what insurers and government programs pay, so a discount off that "sticker price" is still inflated.

* However, the most insidious impact on these consumers is that they believe they have purchased true health insurance that provides some peace of mind; however, they find they are spending good money for a largely worthless product.

DMHC has undertaken to put discount health plans through a rigorous licensing process to establish requirements and test screening and oversight guidelines to separate what may be legitimate businesses from outright fraud artists. They have, for example,
· Prohibited from marketing as health insurance
· Required the discount health plan to maintain a public website with a complete and accurate directory of all providers by specialty and geographic location
· Required plans to provide a toll-free customer assistance call center number and disclose availability of interpretation services for languages other than English where calls must be answered within 5 minutes
· Required to offer bona fide discounts tied to the established Medicare fee schedule

Health Access has previously supplied significant policy guidance to the Department in drafting the language of this regulation. Consequently, with some changes, consumer advocates generally support the language in this version of the regulation.

Health Access and many of consumer allies will be present at the upcoming public hearing to support the Department’s strong language to rein in the most egregious abuses in this industry. ORGANIZATIONS AND INDIVIDUALS ARE INVITED TO JOIN US IN SUPPORT OF THE REGULATIONS AT THE MONDAY FEB 22nd OAKLAND HEARING.

If you have questions, or need further information, please contact Elizabeth Abbott at Health Access at (916) 497-0923 or via email at eabbott@health-access.org.

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posted by Anthony Wright | Permalink | 7:01 PM


Medical bankruptcies are rising....

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

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posted by Cynthia Craft | Permalink | 10:40 AM


Speaking truth to the power of insurers...

Tuesday, October 06, 2009
It’s heart-wrenching to see the long scars, some still deep red, crisscrossing the scalp of 19-year-old Penelope DeMeerleer, who has half a head of thick blond hair and the other half practically mapping out her medical history of 44 brain surgeries.

But don’t feel sorry for Penelope. That’s not what she’s after today at Tuesday’s Health Care for America Now protest in Sacramento. Today, she’s taking on the role of an articulate, proud, sign-waiving activist for real, meaningful health care reform in one of HCAN’s rallies against the insurance industry’s heavy-handed influence on health reform in Washington.

Hundreds of people supporting strong health care reform showed up for protests and “die-ins” in Sacramento, San Francisco, Los Angeles, Santa Ana and San Diego. Some even staged a “crime scene” with actors and yellow tape (saying “It’s a crime to deny care”) to illustrate the raw mortality statistics: In the U.S., one uninsured person dies every 12 minutes, and 45,000 uninsured die every year.

In Sacramento, across from the State Capitol, Penelope doesn’t play the part of a victim. Except for the dire financial consequences, hers is a story of triumph over insurance executives who tried to screen her out as a hopeless, helpless case – in effect, rationing care by insisting she’d never be able to walk or talk and would likely live life “as a vegetable,” she says.

But Penelope’s mother found a doctor who believed she’d improve and wanted to make her better. So in a way, Penelope illustrates what happens when the insurance companies don’t win after deeming patients’ medical conditions too grave (and expensive) to treat.

Penelope was born with a rare congenital disease called hydrocephalus, characterized by the inability of spinal fluids to drain properly. The way it usually works is that spinal fluid moves up the spine, to the brain, and drains back down. In Penelope’s case, the fluid travels up to the brain, and gathers there, causing swelling.

She needs a surgically implanted cerebral shunt to help the fluid drain back down and regular monitoring to make sure it is working properly. Such shunts are a medical device not much improved since their development in the 1960s, and about half of all shunts fail within two years, requiring further surgery to replace them.

In the last quarter-century, the survival rate for people with Penelope’s condition has improved dramatically, to 95 percent. Intellectual disabilities related to hydrocephalus have dropped significantly – by half. Penelope is a bright, well-spoken young woman who understands and accepts her need for continued care, but she does not accept the financial burden insurance companies put on her family.

Holding a hand-lettered sign that said, “We have insurance and jobs and we still can’t afford our co-pays!” Penelope and her mother said her insurance cost $700 a month when she was a baby, and then went up to $1,200 a month, roughly equal to a mortgage payment.

Penelope’s mother, Pam Tuohy-Novinsky, says: “We pay our co-pays, we pay taxes, we are middle-class, hard-working people. But for 19 years, we’ve been getting deeper in debt to insurance companies just to keep her alive.”

And Tuohy-Novinsky’s convinced that keeping Penelope alive was not what the insurance company had in mind. “In the beginning, Blue Cross-Blue Shield said they expected her to die. They seemed to want her to die…,” Tuohy-Novinsky said, as other activists milled around with signs, buttons, petitions and banners demanding insurance reform. “I believe health care is a civil right -- and this is a civil rights protest.”

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posted by Cynthia Craft | Permalink | 5:57 PM


New data on debt shows need for action...

Monday, August 31, 2009
With new data being published about health coverage and medical debt, it's clear we need state and federal action to prevent Californians from falling into uninsurance and underinsurance.

More than 2.2 million California adults report having medical debt, and two-thirds of those incurred the debt while insured, according to the authors of "The State of Health Insurance in California (SHIC)" a comprehensive new report from the UCLA Center for Health Policy Research.

Here's a report by Victoria Colliver at the San Francisco Chronicle, and here's some key findings from UCLA:

In total, nearly one in seven non-elderly adults in California (13 percent) have some kind of medical debt...

In addition, Californians with medical debt were much more likely than those without debt to delay getting the care they needed. Those with debt were twice as likely to report delays in care: 32.3 percent reported delays in getting needed care, compared with 16.1 percent of those without medical debt...

Also, medical debt can lead to loans and bankruptcy: Among those with medical debt, more than half (55.4 percent) reported financial consequences ranging from an inability to pay for basic necessities to credit card debt to a declaration of bankruptcy.

The study shows that Californians are appropriately concerned about the cost of getting needed care--even when they have coverage. We need action on health reform so we are not at such high risk of losing coverage, and to ensure that such coverage is comprehensive. When people pay a premium, they shouldn't then be saddled with debt for simply getting the care they need.

Here's two pieces of legislation to address the issues, both state and federal, and specific and comprehensive:

* AB786(Jones) would better label insurance products and ensure that all health insurance plans had a cap on out-of-pocket costs, so no plan left premium-paying patients with unlimited financial risk. The bill was approved by the Senate Appropriations Committee last week and is scheduled to be voted on by the full Senate next week.

* H.R. 3200, the comprehensive health reform package in the U.S. House of Representatives, would not only secure, stabilize, and expand health coverage for nearly all Americans, but it would also cap out-of-pocket costs. It would set minimum benefit standards and abolish "caps" on benefits that leave insured people with significant medical bills. The bill has passed the three committees of jurisdiction and is expected to get a vote on the House floor in September.

Another reason to work for health reform...

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posted by Anthony Wright | Permalink | 3:38 PM


Unprotected while paying premiums

Friday, June 05, 2009
It's incredibly hard to buy health coverage as an individual, and it's harder to figure out what you actually are covered for, reports Anna Wilde Matthews at the Wall Street Journal in "The Importance of Deciphering Your Insurance." She reports on the problems, and also cites California's AB786(Jones)--which just passed the Assembly this week--as part of efforts around the country:

Lawmakers and regulators in states including Texas, Vermont and New York are pushing new efforts to make health insurers' consumer communications clearer, though many states already have some requirements on their books. Rhode Island's health insurance commissioner wants to make insurers write all documents at an eighth-grade level. A California bill would classify insurance plans by their levels of coverage.

My post today at TNR's The Treatment also touches on this theme, referencing both AB786(Jones) and provisions of national health reform that would help consumers better to comparison shop, and fundamentally understand what they are buying. Consumers aren't actuaries, and don't know the general costs of ailments and injuries they haven't yet had.

Why is this important? The new study from earlier this week on personal bankruptcies makes the point: Over 60% of bankruptcies involve medical bills as a factor, and around 75% of those bankruptcies are people with health coverage. In many cases, their coveraeg has let them down. At a minimum, people expect health coverage to prevent them from going into bankruptcy. If it doesn't do that, then it doesn't deserve to be called coverage.

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posted by Anthony Wright | Permalink | 3:18 PM


Medi-Cal Reforms, Fair Pricing Bill Advances

Wednesday, April 22, 2009
Wednesday, April 21st, 2009


* Bipartisan Vote to Ensure Fair Pricing by Emergency Room Doctors
* Process Begins on Renegotiating California's Hospital Financing Waiver
* Other Medi-Cal Changes Also Pass Committee

More Updates on the Health Access WeBlog: Health Reform Hearings in the House; The Timetable for Federal Reform; Gender Discrimination; Honoring Frank Russo; The Packaging of Prop 1A; Married for Health Coverage?

In a hearing lasting over four hours, the Assembly Health Committee, chaired by Assemblyman Dave Jones (D-Sacramento), considered several bills that would impact California health care consumers. Some of the highlights include:

Self-Pay Patients To Get Help on ER Doctor Bills

AB 1503, Lieu (D) would require emergency room physicians to charge rates to lower-income patients who do not have health insurance. Currently, uninsured individuals treated in emergency rooms are frequently charged three to four times more what insurers pay for exactly the same service. The measure specifies that ER doctors would have to offer eligible patients rates that are no higher than those paid by Medicare, Medi-Cal or similar government programs. Physicians also would have to offer payment plans, rather than submit unpaid bills to collection agencies.

The measure prohibits wage garnishments or liens, and prohibits the forced sale of a patient’s home as a means of collecting the debt. These consumer protections already apply to hospital billing under AB774(Chan) of 2006, and in this bill would be extended to individual ER physician billing. As of 2007, about 6.5 million Californians were without health insurance. Research pinpoints medical debt as the leading cause of personal bankruptcy in the United States . The bill got support from Health Access California, ACORN, Western Center for Law and Poverty, Congress of California Seniors, Jericho, and others. The bill won unanimous bipartisan support in committee, and AB 1503 advances to the Assembly Appropriations Committee.

Key Medi-Cal Reforms Pass

Hospital Financing Waiver Process Starts: AB 342, Bass (D) and Jones (D),
a companion bill to its Senate counterpart, SB 208 (Steinberg), lays the groundwork for the state to negotiate a new Medicaid waiver from the federal government, a crucial component of financing for the state's public and safety-net hospitals, and for the health system as a whole. Specifically, the bill gives the go-ahead for the state to draft a comprehensive waiver from federal Medicaid rules, with an eye toward preserving and strengthening safety-net providers and maximizing federal funds. The measure is not fully detailed, but sets the stage for negotiations with stakeholders, many of whom testified with their interests and concerns as part of the process in developing this plan. AB 342 overwhelmingly won passage to the Assembly Appropriations Committee.

Fewer Payment Hassles for Medi-Cal Enrollees: AB 1142, Price (D), would reduce unnecessary headaches for Medi-Cal beneficiaries by requiring hospitals and providers to make an extra effort to bill the program, instead of unnecessarily sending the bill to the patient. The bill calls for a series of actions following patient care to ensure Medi-Cal consumers are not wrongfully pursued for debt that the program would cover. It would require hospitals to share eligibility status with hospital-based providers, ambulance services and other appropriate professionals. Fines up to three times the amount of the Medi-Cal payment would result if the provider has proof of Medi-Cal eligibility but pursues collection from the patient instead, resulting in a negative credit report. AB 1142 got support from Western Center on Law and Poverty, and children's, labor, low-income, and consumer organizations, including Health Access California. The bill advanced the Assembly Appropriations Committee on a strict party-line vote, with Republicans voting “nay.”

Extended Medi-Cal Coverage for Disabled Workers: AB 1269, Brownley (D), would make health coverage more affordable for many working people who are disabled. Specifically, it would extend eligibility for Medi-Cal under the California Working Disabled Program for 26 weeks effective March 1, 2010. Groups representing people with disabilities, health providers, and consumers, including Health Access California, supported AB 1269. The bill advanced, with voting along party lines, to the Assembly Appropriations Committee.

Less Bureaucracy, Duplication for Medi-Cal Enrollees: AB 963, Ammiano (D), would lessen paperwork for low-income individuals and families who apply for food stamps, also streamlining their applications for Medi-Cal eligibility. It would require stakeholder groups, the Department of Social Services, counties and the Statewide Automated Welfare System to coordinate efforts in a collaboration to update data sharing, technology and administrative procedures to ensure continued health coverage for eligible people whose status in other programs changes. The measure, which advanced to the Assembly Appropriations Committee, prohibits the Department of Health Care Services from imposing duplicative and burdensome paperwork requirements. Health Access California is in support of AB 963.

Some Bills Stall

The committee passed most bills it considered, with the exception of a ten percent fee on alcohol to fund alcohol and drug programs, and a measure to require disclosure of employer's claims data. AB 562, Cook (D), failed to pass when lawmakers’ concerns about ensuring employee privacy trumped the bill author’s call for greater transparency. The stated purpose of the bill was to give mid-sized small business employers more information about where their health care dollars are going while they shop for policies. Insurance underwriters testifying in favor of the measure said business owners who pay a portion of their workers’ premiums should be able to discern what costs lie behind their investment when negotiating with insurers. The bill was opposed by both health insurers and privacy advocates, and some Health Committee members expressed concern that too close a look at the health care costs would expose employees to discrimination, termination or simply compromise their privacy. The bill failed to advance out of committee, and is up for reconsideration. (Health Access California did not take a position on the measure.)

Given the length of the hearing, some bills were "put over" to be considered during next week's hearing. All bills need to pass policy committees by April 30. Health Access will continue to provide updates on actions taken in the Legislature. For a broader list of interest to health advocates and Health Access California , check out the bill list on our website.

For more reports on legislation, visit the Health Access WeBlog, at http://www.health-access.org/blogger.html

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posted by Anthony Wright | Permalink | 2:42 AM


Back at it: Some good bills get over the first hurdle...

Wednesday, April 01, 2009
It is the legislative season. This week saw the Assembly and Senate Health committees beginning to vote on legislation. Next week is spring recess and then there will be three weeks of intensive legislative action running up to the deadline on April 30 for all bills to pass the first policy committee in the first house.

This week both the Assembly and Senate Health Committees passed AB119 (Jones) and SB54 (Leno) respectively which would prohibit insurers from rating premiums based on gender, thus adding gender to a long list of prohibited conditions that already includes race, ethnicity, religion, marital status and sexual orientation. If it is wrong to discriminate based on race and religion, it should be wrong to discriminate based on gender. It is true that women use more health care—but it is equally true that there are racial disparities in health care needs. Neither is an excuse for discrimination in pricing. Both passed on party-line votes.

Assembly Business and Professions Committee also passed unanimously AB171 (Jones) which would regulate dental credit cards---for example, prohibiting the practice of getting patients to sign up while they are under anesthesia.

Today, Senate Health Committee also passed SB316 (Alquist) which would require HMOs and insurers to spend at least 85 cents out of every premium dollar on health care instead of profit and overhead. An identical bill by Senator Kuehl was vetoed by the Governor last year even though the same language had been in his own health reform proposal. Senators Alquist, Cedillo, DeSaulnier, Leno, Pavley and Wolk voted. Senator Negrete McLeod failed to vote, which has the same effect as a No vote. Senators Strickland, Aanestad, Cox, and Maldonaldo voted No.

SB196 by Senator Corbett, a re-introduction of SB1300 also by Senator Corbett, also passed on a party-line vote. Supported by Health Access California, this bill provides modest disclosure of cost and quality measures. It is opposed by the California Medical Association and the California Hospital Association.

Also today the Assembly Appropriations Committee passed unanimously AB24 by Assemblymembers Jones and Fletcher, the chair and vice-chair of Assembly Health Committee. This bill implements the state law changes needed to provide the 65% COBRA subsidy included in the federal stimulus package.

Health Access California supported all of these bills. A broader bill list is on the front page of our website. We'll be tracking them all year on the list, and on this blog...

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posted by Beth Capell | Permalink | 10:16 PM


Notes and news about nonprofit hospitals...

Tuesday, January 27, 2009
In California, about 10% of hospitals are for-profit while over two-thirds are non-profit entities.

Non-profit hospitals, like other non-profits, pay no property tax and no corporate income and they even get a special deal on unemployment insurance taxes. For-profit, private hospitals pay property taxes, corporate income taxes, unemployment insurance taxes, the Employment Training Tax and other taxes just like any other business. Yet, in the words of Bill Leonard, a conservative Republican member of the Board of Equalization, “when I drive past a hospital, I can’t tell the difference” between a non-profit hospital and a for-profit hospital.

Last week the Board of Equalization met and considered a proposal by Board Member Betty Yee to obtain information from non-profit hospitals regarding what in tax lingo is called the “welfare exemption”, meaning their non-profit tax status. Ms. Yee has been working on this for some time: last year she proposed requiring non-profit hospitals to spend 5% of revenue on charity care in return for their non-profit tax status. That proposal was not favorably received by the Board. Last week, Ms. Yee had a better day.

The California Hospital Association challenged the authority of the Board to collect the desired information and CHA also said that some of the information was duplicative and some information was impossible to provide.

The attorney for the Board and all five members of the Board of Equalization, including the representative of State Controller John Chiang, were unequivocal in asserting their right to collect the information they deemed necessary in order to determine whether any entity, including a hospital, could be a non-profit in the eyes of the State of California.

The Board decided to embark on a stakeholder process to refine the proposal to collect the information.

The information desired by Ms. Yee (available online at www.boe.ca.gov) includes such basic information as how much charity care hospitals provide as well as whether liens on primary residences are levied on consumers.

In addition, Ms. Yee wanted to know whether non-profit hospitals had revenues in excess of expenditures (otherwise known as profits) of more than 10% and if so, what the hospitals spent the money on. There is existing case law in California (the Rideout case) that allows hospitals to have excess profits and still be non-profit so long as they put the money back into the hospital, rather than taking it out in profits.

We know that when Senators Baucus (D-Montana) and Grassley (R-Iowa) investigated hospitals, a bipartisan effort that has spanned the change in control of the US Senate, they were dismayed to discover excessive CEO compensation, overcharging of the uninsured, and various other bad behavior by hospitals benefitting from not paying taxes.

Given the bipartisan support in Congress for efforts that have resulted in the IRS revising the reporting for non-profit hospitals, perhaps we should not have been surprised that the California Board of Equalization voted unanimously on a bipartisan vote to support the concept of collecting the information by May 2009. But I certainly was. Bill Leonard said plainly that if a non-profit hospital is acting like a for-profit, it should lose its non-profit tax status.

For those of you who are wondering what in the blazes the Board of Equalization is, you should know that you have the opportunity to elect its members every four years. Among those who currently serve on the Board of Equalization is Judy Chu, former Chair of Assembly Appropriations, as well as Betty Yee, State Controller John Chiang, Bill Leonard, and Michelle Steel (verify). The Board of Equalization is a key tax agency responsible for determining the equity of taxes across counties as well as whether entities are worthy of non-profit tax status. Its hearing room was as crowded as any legislative hearing for that reason.

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posted by Beth Capell | Permalink | 8:23 PM


Tough cookies...

Monday, December 08, 2008
The Wall Street Journal today reports of the twin devastation of abruptly losing a job and health insurance. Not that losing both at once isn't bad enough, but it's especially awful when the company goes bankrupt because employees -- make that "former employees" -- are asked to foot medical bills accrued when they thought they had insurance. (Here is the NY Times story on the same thing)

Archway & Mother's Cake and Cookie Co. (aren't they the makers of those cute pink and white sprinkled animal cookies) abruptly closed its doors in October laying off all 673 employees. What ensued was a mad dash to get medical procedures done before insurance ran dry:

...A pregnant employee had labor induced before her due date. Another worker bought a $6,000 insulin pump for her diabetic daughter. "I called my doctor at home and said, 'I need to have my gallbladder removed this weekend,'" recalls Janet Esbenshade, a 37-year-old mother of two who lost her job packing cookies.

What employees didn't know was the company was self-insured, meaning that it paid for medical expenses itself, but using a health insurer to administer the program. For employees, that meant once the company declared bankruptcy, announcing to the world it could no longer pay its bills, the medical bills fell back to the employees -- tens of thousands of dollars worth of medical bills.

Some medical services rendered in September -- the month before the company went belly up -- are also becoming the responsibility of employees.

Archway isn't the only company declaring bankruptcy and leaving employees adrift in Dante's world. Bankruptcy filings among companies are surging.

Reading stories like this, you wonder, why the heck do we have an employer-based system anyway?

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posted by Hanh Kim Quach | Permalink | 12:25 PM


Flying without a parachute

Wednesday, October 29, 2008
The San Jose City Council will soon consider a "living wage'' that would increase wages for airport workers. For those with health benefits, the wage would be $12.83 an hour. For those without benefits, the wage would be $14.03 an hour.

The difference, then, between having benefits and going without is $1.20 an hour. Over the course of a year, that's an extra $2,400 in your pocket, assuming employees work 2,000 hours. That's $200 extra dollars a month. But that also means that a worker would have to go out and find insurance on their own.

Airport workers, the ones that push wheelchairs and check baggage, are not young. In a Google search, I find that in Dallas, the average age of an airport worker is 45, so I'm going to use that for my illustration.

It is possible to find an individual health insurance plan for a 45-year-old woman in San Jose for less than $200 a month. However, it also means
  • paying deductibles ranging from $500 to $5,000;
  • paying high co-pays for limited doctor's visits (and for a 45-year-old with a physically taxing job, that may not be a wise choice. Not to mention the regular health needs of a 45-year-old woman.);
  • having *only* generic prescription drug coverage;
  • paying the full cost of labs and X-rays until the deductible is met;
These are bills that make your stomach ache. They're not fun to pay, but you need to pay them because you need to stay healthy. And for a person earning about $28,060 a year, these costs represent, proportionally, an even bigger financial sacrifice. The premium alone is 9.5 percent of wages.

Of course, the big question, is whether a person $28,060 can really afford -- with housing, food and gas expenses -- to spend another $200 a month on a skimpy health care plan.

The answer, most likely, is no.

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posted by Hanh Kim Quach | Permalink | 8:55 AM


Registering my praise for ACORN...

Sunday, October 19, 2008
Tomorrow, Monday, October 20th is the deadline to register to vote in California.

If you are not registered, do so today.

If you are, find at least one person who may not be registered (for example, someone who recently turned 18, or moved, or just a politically disconnected friend), and make sure they are. Send them the link to the California Secretary of State's office:

Why does this matter for health care?

Key issues will be decided about the future of the health care system in the next few years, at the state and federal levels, and all citizens need to be involved in choosing a direction. California's debate on health reform has been hindered by the fact that the voting electorate differs from the actual population.

The Public Policy Institute of California has a report a couple of years back called "California's Exclusive Electorate," indicating "the likely voters who decide who's elected and the fate of the state's many ballot initiatives, but who do not represent the size, the makeup, or the preferences of the state's adult population."

That's why I'm stunned by the attacks on ACORN this political season for its voter registration effort, to bring over 1.3 million citizens around the country into the political process. In an effort that big, there's bound to be problems: applications not properly filled out (and state law appropriately requires even those to be turned in.) As impartial observers point out, there's no evidence that these errors translate to fraudulent or inappropriate voting. (After all, "Mickey Mouse" is not showing up at a polling place on Election Day.)

I can't claim any direct knowledge about any issues with ACORN's voter registration effort, but I know its incredibly important. And so while I can't say I know all their activities and policy positions, I know that ACORN, with their representation of low-income communities, is an important voice in health care. Many of their members are uninsured, underinsured, and otherwise exactly the folks that need to be part of the deliberations on health reform.

I am proud to have ACORN on the Health Access California board, as one of twenty-five member consumer and constituency organizations that direct our public policy agenda. In recent years, ACORN had increased their attention on health care issues, responding to their members. We have worked with them on the issue of prescription drug prices, medical debt, and particularly around hospital overcharging issues, with local campaigns around inappropriate billing practices of specific hospitals. They have been a key ally for coverage expansions and health care reform in the last few years, both at the state and federal level.

It is absurd that an association with ACORN is somehow an issue. And we shouldn't let those trying to undermine important voter registration work succeed. So let's all make sure their work continues.

So for our health, as well as the health of our democracy, make one last push to help get all citizens in Californians registered.

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posted by Anthony Wright | Permalink | 12:40 PM


Dept. of Stupid Vetoes...

Saturday, September 27, 2008
The Governor today vetoed SB 1633 by Senator Sheila Kuehl (D-Santa Monica), a bill sponsored by Western Center for Law and Poverty (WCLP), and supported by Health Access California, Consumers Union, and many other consumer groups working together against medical debt.

This consumer protection bill attempted to remedy a growing problem, as identified by legal services advocates around the state. Some dentists signing people up for credit to pay for their treatment, but a few are charging them (with interest!) before the patients gets the service, or other dubious practices (signing people up under anathesia!). With the good work of Elizabeth Landsberg and others at WCLP, a compromise was reached with the dentists association, it had Republican Senator Sam Aanestad, a dentist, as a co-author, and it passed the Senate 35-3, and the Assembly 79-0. Arbor Day legislation doesn't get votes like that.

So what was the problem? Here's the veto message.

The historic delay in passing the 2008-2009 State Budget has forced me to prioritize the bills sent to my desk at the end of the year’s legislative session. Given the delay, I am only signing bills that are the highest priority for California. This bill does not meet that standard and I cannot sign it at this time.

That's the weakest excuse I've ever heard. The budget delay made me do it? What an abdication of responsibility.

What's the real reason? Pique? Politics? Phooey.

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posted by Anthony Wright | Permalink | 8:23 PM


Further sad economic news that will get even worse..

Thursday, September 25, 2008
More deflating news. The NY Times reports on how unpaid medical bills are creating more of a strain for families, according to a new study from the Center for Studying Health System Change.

The study shows a striking increase in the number of families with medical debt. Here are the highlights:
  • 57 million Americans were in families that had problems paying medical bills last year -- a 33% increase from five years ago;
  • 75% of people with medical debt *had* health insurance;
  • 20% of those with medical bill problems considered filing bankruptcy. About 4% followed through with it (2.2 million Americans).

This study comes out as we see that health care premiums continue to outpace our stagnant wages. Health care, sadly, is becoming a luxury.

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posted by Hanh Kim Quach | Permalink | 1:33 PM


Another economic indicator...

Americans - feeling poorer and dejected -- are cutting health care out of their budgets for the first time in a decade. The article was in the Wall Street Journal this week.

Here's a striking paragraph:

The number of prescriptions filled in the U.S. fell 0.5% in the first quarter and a steeper 1.97% in the second, compared with the same periods in 2007 -- the first negative quarters in at least a decade, according to data from market researcher IMS Health. Despite an aging and growing U.S. population, the number of physician office visits also has been declining since the end of 2006. Between July 2007 and 2008, the most recent month for which data are available, visits fell 1.2%, according to IMS.

And that survey only counts the first six months of this year. I can only imagine how the numbers will slide after the economic mayhem of this quarter.
In a survey by the National Association of Insurance Commissioners last month,
22% of 686 consumers said that economy-related woes were causing them to go
to the doctor less often. About 11% said they've scaled back on prescription
drugs to save money. Some of the areas being hit include hip and knee
replacements, mammograms, and visits to the emergency room, according to a
survey conducted by D2Hawkeye Inc., a Waltham, Mass., medical data analytics
firm, on behalf of The Wall Street Journal.
Unfortunately, health care reform will become a casualty of the current banking crisis at the national level, and has already become a casualty of state and local budget crises -- at a time when public options for health care and more efficient, quality and affordable health care are needed most.

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posted by Hanh Kim Quach | Permalink | 11:15 AM


It's not a joke....

Tuesday, September 23, 2008
This story from the satirical newspaper, The Onion, is actually supposed to be a joke -- but really, it's dead on:

After years of battling crippling premiums and agonizing deductibles, local resident Michael Haige finally succumbed this week to the health insurance policy that had ravaged his adult life. Haige, who had suffered from limited medical coverage for nearly a decade, passed away early Monday morning. According to sources, the 46-year-old was laid to rest at Fairplains cemetery, surrounded by friends, family members, and more than $300,000 of mounting debt.

According to an independent study released last month by the Mayo Clinic, health insurance is the nation's No. 2 cause of death, claiming the lives of some 400,000 Americans each year. A silent killer, health insurance often strikes without warning, its harmful and profit-based policies avoiding detection until it is far too late. Although the cruel bureaucratic disorder does not discriminate, statistics have shown that senior citizens, young dependents, and those woefully underemployed are most at risk.

Actually, there is a statistic, which relates to the uninsured. According to the Institute of Medicine, it's more like 18,000 annually who die from lack of insurance, making it the sixth most common cause of death

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posted by Hanh Kim Quach | Permalink | 8:30 AM


I'm loving it...

Wednesday, August 27, 2008
I love the Divided We Fail/AARP commercials that are running during the Democratic National Convention that highlight how financially devastating the current health care system is to the 1.85 million Americans who must declare bankruptcy annually.

AARP has this really cool website on the stories.

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posted by Hanh Kim Quach | Permalink | 11:17 AM


A step forward! NOT a stumble...

Friday, August 22, 2008
The Riverside Press-Enterprise this week had an editorial called "Health Stumble'' bemoaning Sen. Sheila Kuehl's SB1440, which would require all health insurance offered in the state to spend at least 85% premiums on providing health care -- that is physical exams, surgery, mammograms -- you name it. SB1440 is now awaiting concurrence on the Senate Floor -- thank goodness.

They cite a Rand Corp. study which *only* looked at health plans regulated by the Department of Managed Health Care. Those health plans are not allowed to spend more than 15% on administration (of course, that doesn't count profit, but at least it's a target). But, as we know, health insurance plans in California are regulated by two agencies -- DMHC *and* the Department of Insurance.

Until a couple of years ago, some plans at the Department of Insurance (ahem, Blue Cross) spent as little as 51 cents for ever premium dollar on health care. (This we gleaned from a DOI powerpoint presentation at a public hearing). Meanwhile the company would spend 23 cents of every dollar consumers pay to use against consumers -- fighting bills for patient services, scouring health records in order to retroactively rescind policies, and other administrative costs. The remaining 27 cents is reserved for profit and executive bonuses.

That was changed and the DOI now requires that health plans spend at least 70% of their premiums on providing health care -- but that's still far short of 85%.

The Press-Enterprise argues that "medical loss ratios'' don't really tell us much about the plan's efficiency or quality of care. True -- but right now, we have *nothing*.

In an information void, such as the one we have now, the percentage of premium dollars spent on patient care is an important (though not the only) measure of a plan’s value. Unfortunately, low-value products (like the ones offered at DOI) are marketed to consumers for their low premiums. Patients do not have the actuarial expertise, or information to assess whether a particular low-premium product will actually provide them value – meaning it would pay for physician visits, drugs and other health costs when they need it.

Products that have low medical-loss ratios often:
  • do not have maternity coverage,
  • do not cover prescription drugs,
  • have high deductibles,
  • high co-insurance, and
  • lack caps on how much consumers need to spend out-of-pocket for their illnesses.

Such flimsy coverage causes consumers to deter care, or leaves them saddled with medical debt. And that's a stumble.

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posted by Hanh Kim Quach | Permalink | 1:48 PM


Radio break...

Tuesday, August 19, 2008
Okay. I'm not as savvy as Anthony and can't figure out how to embed this funny Onion Radio piece onto the blog, so here it is:

Republican Enjoys Paying Huge Health Insurance Premiums

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posted by Hanh Kim Quach | Permalink | 10:19 AM


Coast to coast consumer protections...

Tuesday, August 12, 2008
Congratulations to New Jersey Governor Jon Corzine, who just signed a law to prevent hospitals overcharging the uninsured. Previously in 2006, both California and New York passed comprehensive legislation to prohibit hospitals from overcharging those who don't have an insurer or government program to negotiate for them, and as a result, get charged more 3-4 times or more of what insurance companies or public program pay for the exact same service.

The New Jersey bill, described by ace health reporter Lindy Washburn of the Bergen Record, would limit charges to 15% above Medicare rates.

More information about the California law--AB774 (Chan)--is on the Health Access website. We continue to be active in making sure the law is enforced, that patients know about their rights, and to work in the policy arena against overcharging and medical debt. (Watch for more announcements this fall.) It's good to see New Jersey and other states looking at this issue, so that the consumer protections can be more widespread.

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posted by Anthony Wright | Permalink | 3:30 PM


Another reason to pick on HSAs ...

Wednesday, August 06, 2008
Proponents of these deplorable Health Savings Accounts say they like them because consumers can take matters into their own hands in lots of ways: you can "shop around'' for care (although, I'm not sure how we do this when we don't have cost and quality transparency, yet) and you can save for health expenses in retirement.

A new EBRI study takes on the latter point head-on. Their research shows that consumers contributing the maximum to their HSAs (plus catch-up) will only have saved between 16 percent and 33 percent of what they will *actually* need in retirement to cover health expenses.

The study assumes that Medicare will cover half of what a person needs in retirement (about $376,000). With an HSA, an individual would accumlate $59,000 over 10 years (with the catch-up deposits).

A man with average health expenses and an average life span would need to have saved $132,000 to cover drugs, premiums and other out-of-pocket expenses in retirement. That's more than twice what could be saved under the HSA. And that's assuming he's average and dies on time. If he lives longer, he'd need $266,000 -- 4.5 times more than is in the HSA. In the most expensive scenario, he lives a long time with LOTS of health care needs -- he'd need $555,0000.

Women have it even worse since we live longer. A retiring woman would need $181,000 to cover drugs, premiums and other out-of-pocket expenses in retirement. A woman who lives beyond the average life span, and incurs higher than average health costs needs $654,000. Add to this the gender wage gap and......

It's unclear to me whether the savings projections EBRI takes into account the fact that consumes with HSAs will likely be using a chunk of the money they invest in the account because a prerequisite to having and HSA is being underinsured. Bush Administration rules require that consumers must be insured only by a high-deductible health plan (a deductible of *at least* $1,100) in order to open such an account. You also can't save more than the deductible, so......

Seems like a bad deal all around:
* You can't shop around
* You have a crummy health plan
* You're *still* broke in retirement.

Don't sign me up for that one.

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posted by Hanh Kim Quach | Permalink | 12:21 PM


When medical debt attacks...

Wednesday, June 04, 2008
If you want to know more about the financial consequences of being uninsured, read yesterday's Wall Street Journal article by Sara Rubenstein.
In a move that consumer groups say could increase pressure on people with unpaid medical bills, some hospitals are trying out a new tactic to recoup patients' debts: They're auctioning the debt online.

Hospitals have long relied on outside collection agencies to go after debtors. Under traditional arrangements, these agencies receive a percentage of any money they get from a debtor; the more they collect, the more they earn.

Now, some of the same collection agencies, as well as other firms that purchase debt outright, have begun participating as bidders in online auctions, in which they buy the debt or provide guaranteed payments to hospitals for access to the unpaid accounts. Some experts say this gives them more reason to aggressively pursue patients in arrears. Auctions can drive up the amount paid for debt, meaning a collector must recoup more money from patients to cover its initial investment and turn a profit. And the winning bidders often get to keep all the money they collect on the auctioned debt.
Health Access California has talked to lots of Californians with medical debt, as we worked to pass AB774(Chan), to prevent hospitals from overcharging the uninsured. Invariably, the experience of these patients in dealing with the bill was worse after the bill was referred to collections, and much worse after the debt was sold. That's why AB774 included a moratorium on patients being sent to collections. There are other existing consumer protections against aggressive collections practices, but is it enough?

Winning bidders may "have to work harder" to make a profit from auctioned debt, says Michael Klozotsky, an analyst at Kaulkin Ginsberg Co., a collections-industry strategic-advice company. "Working harder means sometimes using strategies that are more aggressive.

"Many of the auctions of hospital debt have been done through Web site ARxChange.com1 -- shorthand for "accounts receivable exchange" -- owned by TriCap Technology Group. Another site is medipent.com2, run by Medipent LLC. The auction-site owners, both small companies based in New York, say their systems create safeguards that protect patients from potential abuse. Collection firms are vetted for their tactics and approach to patient needs and concerns before they are allowed to participate in auctions, the site owners say. The site owners also try to ensure that collectors comply with hospital rules -- whether they must record phone calls, for instance, or get the hospital's permission before initiating a lawsuit against a patient. Hospitals have final say over who bids on their accounts, and, on ARxChange.com, don't necessarily award the contract to the highest bidder.

Consumer advocates say patients are less likely to successfully dispute bills or negotiate them downward if they are dealing with a third-party collector rather than a hospital directly. Collectors also are further removed from hospitals' financial-assistance policies."The hospital is an institution in the community, has a reputation, in many cases has a nonprofit mission to uphold," says Anthony Wright, executive director of the consumer-advocacy coalition Health Access California. "Once it goes to collections, that starts a process that can get a lot more antagonistic, a lot more aggressive, and a lot more damaging to a family's credit history and financial future."

The federal Fair Debt Collection Practices Act and some state laws govern how debt collectors can treat consumers. For instance, debt collectors aren't allowed to harass consumers or make false statements, including implying they will sue if they don't intend to do so. Consumer groups say calling the medical provider or your insurer could help clarify any confusion about what you owe. The hospital also could provide information about financial assistance or charity-care.

A hospital bill is typically the biggest bill a person gets in their entire life. The first goal is to prevent these situations from happening in the first place: to make sure people are covered, or have other financial options that can help pay the bill. But in any case, patients with medical debt should have basic consumer protections. We don't want people to not go to the hospital for fear of the bill, or those who come to collect it.

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posted by Anthony Wright | Permalink | 10:59 AM


Healthcare Armageddon

Tuesday, May 06, 2008
The New York Times had an excellent article this weekend about workers, who have health coverage through work, feeling financially strained.

The reason: businesses - unable to absorb higher health care costs - have decided that workers need to absorb more of these costs. Businesses are buying crappier coverage (this doesn't mean cheaper premiums, just cheaper than more comprehensive plans, but still expensive) and asking workers to pay a greater share of the premium. So not only are premiums for workers increasing, but the plans that they are getting are getting worse, which means higher copays, deductibles, and less coverage.

It used to be that worrying about how to pay for health care happened mostly if you didn't have insurance. Then, it started creeping into the ranks of the insured -- but only those who bought insurance on their own, without the benefit of a group buying in bulk to negotiate lower rates. Now, though, health cost worries are hitting the employer market -- where most Americans get their coverage.

One *insured* worker said he was losing the equivalent of a month's worth of pay with the higher premium and deductibles. That's in addition to the fact that the coverage isn't very good.
Another *insured* worker, who has diabetes, doesn't monitor her blood sugar regularly and can't afford to see an eye doctor on top of other normal everyday expenses.

The Times characterized these plans as "health insurance in name only.'' I like that: essentially people are paying to be uninsured under these plans.

My health plan colleagues would argue that having some kind of coverage is better than being uninsured. No?

But is it really? At what point does debt become so crushing that it doesn't matter if the number is $60,000 or $200,000 in debt, and accruing interest. Especially considering that families that are insured, earning more than 300% of the poverty level actually have negative (-$600) net financial assets according to the latest study by Health Affairs. On an annual income of $60,000, either way, you're screwed.

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posted by Hanh Kim Quach | Permalink | 2:01 PM


On top of student loans...

Sunday, April 20, 2008
We are coming close to high school and college graduations, so it's a good time to spotlight this post by Henry Stern on InsureBlog on student insurance.

The young are the most likely to be uninsured, and what is offered to them isn't a very good value. The post spotlights a very typical student policy that will leave some students will have significant medical debt even before graduation.

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posted by Anthony Wright | Permalink | 2:38 PM


Only in LA?

Friday, April 11, 2008
For those who were not able to witness Senate Health Committee in person, this week, it's not always as boring as you might think.

Committee Chair Sheila Kuehl and Sen. Dave Cox had an interesting exchange during testimony of our bill SB1522, which would help organize the individual insurance market and place caps on out-of-pocket costs. Most importantly, it would help weed out junk coverage and require at least mimimum coverage of doctor's office visits and preventive care.

Kuehl shared a story of a caller on a radio show who had ambulance workers lay a bill on her chest as she was being wheeled into the hospital emergency room.

"Surely,'' snorted Sen. Dave Cox, R-Fair Oaks, "they would do no such thing.''

Responded Kuehl: "Yes, Sen. Cox. And a hospital in LA would surely not dump patients on Skid row in the middle of the night.''

"Well...'' grunted Cox. "Maybe in Los Angeles.''

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posted by Hanh Kim Quach | Permalink | 2:12 PM


Enabling My Mother

Tuesday, January 29, 2008
Here's reason #6,782 that the status quo just isn't working -- and it's purely personal.

My mother, a Buddhist in name only, cannot help but worry about everything. She worries that my 17-year-old geeky, mute brother will join an Asian gang. She worries my sister, an engineer, spent too much on a couch. And she worries I'll die commuting to work on my bike.

Now, she's worried that her retiree insurance coverage won't pay my father's recent hospital bill.

The hospital has sent a bill for about $90,000.
The anesthesiologist sent an $8,000 bill.
The physician's assistant another $1,200.

And they keep rolling in.....

She's not asking for free health care. In fact, her deductible is $1,500 with an out-of-pocket maximum of $4,000. She and my father are willing to pay every dime of that -- and continue paying the $650 a month for coverage, as long as she can be assured that the coverage actually works.

I'm sure she'll be okay, but for once, I can't say I blame her for worrying. Ordinarily, (or knowing her, maybe not) I'm not sure my mother would necessarily fret over these bills. But stories in recent years about rescissions, denial of claims, and people hitting their lifetime limits has left her feeling very unsure about whether the insurance she has will be there when she needs it. Sadly, that's how many Americans feel today.

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


Falling off a cliff

Thursday, December 13, 2007
The Department of Insurance has accused Blue Shield of illegally rescinding coverage for more than 200 Californians, according to a Los Angeles Times today. Insurance Commissioner Steve Poizner is seeking a $12.6 million fine.

The other insurance regulator -- Department of Managed Health Care -- is still reviewing Blue Shield's cancellation practices. If violations are found, DMHC could impose additional fines on the company.

This is the third health insurer in the past year found to have improperly rescinded policies of their enrollees. The practice involves insurers retroactively cancelling policies on patients, who seek treatment for illnesses believing they are covered. After their policies are cancelled, patients and providers are on the hook for hundreds of thousands in unpaid medical expenses.

Blue Cross and Health Net were other insurers, either fined by the state, pursued in lawsuits, or both. Court documents showed Health Net was able to avoid nearly $36 million in medical expenses, and gave bonuses to those who helped the company avoid paying to treat patients' illnesses.

I wouldn't be surprised if more big insurers were nailed to the wall for this practice in the coming months, year.

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posted by Hanh Kim Quach | Permalink | 11:19 AM


What's he been doing all month?

Monday, October 08, 2007
So the governor's finally gotten moving on the bill signings, with less than a week left and 596 bills to swipe his pen across.

In today's list, we have SB350 (Runner), requested by debt collectors, which makes minor technical changes to the landmark AB774 (Chan) anti-hospital overcharging bill last year. Health Access, Consumers Union and Western Center on Law and Poverty closely monitored the bill to make sure the new law, AB774, was not diluted in any way. Health Access took a neutral position on the bill.

As many may recall, consumer advocates scored a major victory -- after five years -- last year when Gov. Arnold Schwarzenegger signed legislation that would ban hospitals from charging uninsured and underinsured patients thousands and tens of thousands of dollars for services that they charged insurance companies just a fraction (like 25% of what the uninsured paid). Uninsured and underinsured patients can now pay the same rate as Medicare.

To read more about AB774, click here.

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posted by Hanh Kim Quach | Permalink | 5:08 PM


Spins a web...

Tuesday, May 08, 2007
The Health Affairs study on hospital overcharging that Hanh describes got national attention, including in the blogosphere from everybody from Juls Rosen to Ezra Klein.

The issue has been a focus and passion of Health Access California for five years, and its not a surprise that California, with one of the biggest problems, was one of the first and most ambitious in passing a law to solve it. AB774(Chan) was a big victory that will help many people avoid bankruptcy, but there's more work to do: hospital charges need to become transparent to relate to actual cost; and nobody should be left alone without group coverage.

While with Ezra, check out his review of Spider-Man 3. He gives it thumbs down for dialogue, but manages to see the movie as a message for universal health care. Given how many people saw it, hopefully others see it that way as well...

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posted by Anthony Wright | Permalink | 4:06 PM


Soaking the poor...

Health Affairs' new issue, today, contains an excellent examination of hospital overcharging practices nationwide. (The study is summarized in these LA Times and SF Chronicle articles).

Essentially, it confirms what we advocates already knew: that hospital are routinely charging uninsured patients at least 2.5 times what Medicare and insurance companies pay for the same exact procedures.

In California, it's worse, with hospitals charging 4 times what Medicare allows, making it the third most egregious state in hospital overcharging. The results are similar to a Health Access investigation in 2004 called "Your Money or Your Health", that examined one hospital chain's pricing practices by looking at bankruptcy records.

What really blows is this: When the hospitals increase what they "charge'' it means that insurers can negotiate bigger discounts -- so insurers aren't paying higher rates.
"When the hospital increases its charges,...only self-pay (uninsured or
underinsured) patients are expected to pay the higher charges.''

And really, if someone is uninsured, it's most likely because they can't afford insurance in the first place. So how on earth could they afford the highest rates? The study finds that the collection rate from the uninsured is only about 10 percent.

Basically, this practice just means huge amounts of stress for patients who must deal with their illnesses, bills, and aggressive, name-calling debt collectors banging on their doors.

Now, the Health Affairs study looks at 2004 rates. That's two years before California passed AB774(Chan), sponsored by Health Access California, which took effect on January 1 of this year. It prevents this sort of overcharging for patients who are underinsured or earn less than 350% of poverty ($35,735 for an individual). Things should be a bit better for uninsured and underinsured patients now, as Anthony said in the SF Chronicle article:
"The ER visit that might have cost thousands of dollars may now cost several
hundred or a thousand dollars, which is still a lot of money, especially for
lower-income patient," he said. "But the patient at least has a fighting chance
to pay."

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posted by Hanh Kim Quach | Permalink | 11:25 AM


For our mothers and fathers, grandmothers and grandfathers

Friday, April 27, 2007
There's a common perception out there that seniors are "taken care of'' when it comes to health care. But many adults between the ages of 55 and 64 are increasingly filing for bankruptcy as a result -- partially -- of higher health care costs, according to this LA Times article.

when you think about it, though, it's no surprise. Medicare benefits don't begin until 65. By the time you're 55, you've got a good history of pre-existing conditions, making it more expensive to cover you. And employers are looking for younger, cheaper workers -- because you cost too much in more ways than one.

More reason for us to get on the ball and do something this year.

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posted by Hanh Kim Quach | Permalink | 11:22 AM


Fair is fair. Not charity.

Thursday, April 19, 2007
California enacted landmark legislation this year that would allow uninsured -- and underinsured -- hospital patients negotiate fair rates from hospitals.

As many are well aware, if you're uninsured and end up in the emergency room, you're often charged many times what insurance companies pay for the same procedures. Patients have reported visits that cost thousands of dollars per minute. Others have gone into bankruptcy as a result of needing health care at a time they were not insured.

As a result of these unfair and aggressive billing practices by hospitals, the Legislature passed (and governor signed) AB774 (Chan) last year, which would allow uninsured and underinsured patients to pay the same rates at Medicare.

Sen. George Runner, R-Antelope Valley, this year, is authoring a bill to clarify that law. Health Access is working with Sen. Runner's office to ensure that this effort is a technical clean-up. We appreciated his public commitment at Senate Health Committee yesterday to not move the bill unless it is something that stakeholders like us agree to. We want to ensure the hard-won consumer protections stay strong and that patients are not overcharged and thrown into financial turmoil because they had the misfortune to get sick.

But one clarification of our own: in yesterday's hearing, Runner repeatedly referred to the practice of "fair hospital pricing'' as "charity care.''

The law that Senator Runner is attempting to amend is not about "charity care.'' It shouldn't be considered "charity'' if you are simply paying the same price as public programs and big insurer.

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posted by Hanh Kim Quach | Permalink | 2:59 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.