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More federal help...

Thursday, February 18, 2010
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that states are able to claim enhanced funds for Medicare Part D drug payments. This should allow California to get $680 million additional money from the federal government.

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

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

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

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posted by Anthony Wright | Permalink | 6:05 PM


The Medicare Buy-In Option

Monday, December 14, 2009
The other night on the PBS Newshour, our colleague Jacob Hacker, who was briefly at UC Berkeley and has now returned to Yale, said that the Senate compromise on the public option was a bit Dickensian, a tale of two public options, the best of times and the worst of times---that is a public option that was an expansion of Medicare to a new population, those aged 55 to 64 was the best of the public option while he was disappointed by the trigger on a public option available in the exchange. (He's also not impressed with another part of the deal, national nonprofit plans offered by the Office of Personnel Management.)

What would a Medicare buy-in mean for California? Courtesy of www.chis.ucla.edu, we took a look at how many Californians might benefit. Of the 3.7 million Californians ages 55-64, almost 12% are uninsured and another 7% buy their own insurance. That means that almost 20% of Californians aged 55-64 might benefit from a Medicare buy-in, especially if (or when) affordability credits are made available to help them afford that coverage.

This is a very big deal for those aged 55-64. In the current individual insurance market, these are exactly the people that are all too often uninsurable—precisely because by that age, most people have one chronic condition or another or have had an illness or surgery that made them uninsurable. And while 65% of those aged 55-64 have employment-based coverage, losing that coverage is a devastating life event at an age when most people expect to need health care. The Medicare buy-in would eliminate that fear.

We are somewhat bemused by the reaction of doctors and hospitals to the expansion of Medicare. The 4 million Californians who rely on Medicare today seem to have ready access to doctors and hospitals. Would an increase from 4.1 million Californians with Medicare coverage to 4.8 million undermine the ability of doctors and hospitals to provide care? The protests seem especially odd to us when a majority of those who might benefit from a Medicare buy-in are uninsured.


posted by Beth Capell | Permalink | 2:21 AM


National treasures...

Friday, October 16, 2009
Before I joined Health Access in January 2006, I worked for the federal government in a variety of jobs. I began my career when I was hired to take applications for retirement, survivor's and disability insurance benefits for the Social Security Administration and ultimately worked in 17 Social Security offices across the U.S. I also served as the Regional Administrator for the Centers for Medicare and Medicaid Services (CMS), formerly HCFA, in San Francisco. The regional office was responsible for Medicare and Medicaid in the four western states (including California) and the Pacific Territories. While these programs are complex, they remain important and are widely respected.

Government programs have many detractors. All programs have coverage gaps and other flaws because of the compromises that arise out of the legislative process. In addition, agencies can have imperfect administration, due to inadequate funding or for other reasons. However, I had the good fortune to work on those programs (Social Security, Medicare, and Medicaid) that are esteemed by Congress and the public as National Treasures to this day. They are consistently admired as having a strong programmatic purpose, an unwavering commitment to beneficiaries, and consistent, professional, and relatively low-cost administration.

So, as we approach a new chapter in the current health care reform debate, it is interesting to look back at the legislative history leading up to the passage of Social Security and Medicare/Medicaid. Since our Congressional representatives all point to those programs as hallmarks of our social fabric and essential to our financial underpinnings, it is interesting to see if those revered programs passed Congress with virtually monolithic, or at least bi-partisan support. Not so much. The Social Security Act of 1935 passed with overwhelming Democratic support, but only 16 Republicans voted for it in the Senate. The Medicare/Medicaid legislation in 1965 similarly had broad support among Democrats in the Senate, but only 13 Republican Senators voted for its passage. While these programs remain part of our foundation, and few legislators would vote for their repeal today, they had little support across the political spectrum at the time they were signed into law.

However, as we attempt to build on their foundation for health care reform, no one remembers the fierce opposition those programs encountered, and the fairly one-sided and sometimes grudging support they received in their day. These days legislators from both political parties acknowledge the critical importance of these programs to the American people. So, let's hope as we re-examine our commitment to passing health care, we continue to go about the business of building on these National Treasures.

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posted by Elizabeth C Abbott | Permalink | 3:33 PM


It's ALL bad....

Tuesday, October 07, 2008
I missed this story yesterday, but the Wall Street Journal reported that we've got it all wrong -- McCain's plan wouldn't tax the health care benefits we get from our jobs. Wouldn't think about it! And in fact, Obama is lying about it!

(By the way: McCain didn't seem to contest the idea that he was taxing employer-sponsored coverage when it was brought up by others, such as the Commonwealth Fund in their January 2008 analysis, this story in the New York Times from May 2008, or this description of his plan from his own website from February 2008, (which I handily printed out at the time, made into a pdf and highlighted for relevant comparisons). I noticed on his current website, he actually uses slightly different phraseology so he doesn't mention the 'bias toward employer-sponsored health insurance' that he previously references.)

Here's a quick summary:

McCain's health care plan is based on the idea that individuals should have more "choices" when choosing their health insurance, so he gives everyone a $2,500 tax credit ($5,000 for families). That way, people can "choose'' which plans work best, thus "fostering competition and innovation.'' But analyses have revealed that the tax credits would cost $3.6 billion, after he claimed it wouldn't cost the government anything at all (leading many to surmise that the money came from the tax he would impose on employer-sponsored coverage). Forward to this past week, when Obama has begun hitting hard with ads like this against McCain's health plan, and that makes him really mad. So that's what leads to his policy director saying McCain would not tax the middle class. Instead -- McCain's campaign says it wants to target and reduce Medicare (and the 41 million seniors on it) and Medicaid (with its 60 million enrollees).

Is that supposed to make it better?

So basically, rather than tax middle-class Americans -- we're weakening the system that the parents of working middle class Americans rely on? On top of that, we're weakening the safety net that millions of children, disabled, seniors also rely on.


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posted by Hanh Kim Quach | Permalink | 10:54 AM


A fighter throughout...

Thursday, July 24, 2008

Our wishes go out to Joan Lee,who has been in the hospital for a few weeks now, battling cancer.

We at Health Access California have worked with Joan closely in her leadership role with the Gray Panthers, on everything from fighting budget cuts to fighting the price-gouging of prescription drug companies. Health Access has had a joint project with her and the Gray Panthers, along with other senior groups, around the implementation of Medicare Part D, and a broader range of senior health policy issues. She's been active in Democratic circles, and in building bridges between the senior and disability communities.

She was cited last year as a California Senior Leader by the UC-Berkeley School of Public Health, which described her as "a convenor of the Gray Panthers of Sacramento, national Gray Panther board member, and Vice President of the Congress of California Seniors, to name but a few. Joan Lee is well known in the State Legislature, and in Washington DC, as an articulate voice for better transportation, improving Medicare Part D, and policies to help prevent elder abuse. Returning to college to get a degree in Gerontology in her mid 50’s, she has fought for the rights of older adults on many fronts, including creating an innovative long term care program in Northern California and successfully advocating for medical schools to have required courses in gerontology."

We're pulling for her. Wishes can be sent to her and her husband Arnie at: Joan B. Lee (patient), c/o Kaiser Hospital , 2025 Morse Avenue, Sacramento, CA 95825.

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posted by Anthony Wright | Permalink | 11:09 PM



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

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

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

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posted by Anthony Wright | Permalink | 11:39 PM


Medicare bill passes... with Kennedy's vote!

Wednesday, July 09, 2008
The Medicare bill passed the Senate a few hours ago! This is a good thing: it prevents a rate cut to doctors with Medicare patients--and do it by using savings creating by leveling the playing field between the basic Medicare program and private Medicare health plans. It would also provide new consumer protections and improvements in the Medicare program.

It got overwhelming bipartisan support in the House of Representatives, but there was some drama in the Senate before the July 4th holiday. The bill got 59 votes--one shy of being able to break a potential filibuster and advance.

The bill had unanimous Democratic support, and some Republican support--although not of Sen. John McCain, who was not present. The only Democratic vote that was not present was Sen. Ted Kennedy, ailing from his recent cancer diagnosis.

So it's a fitting moment when Sen. Kennedy, a champion on health care, made a rare appearance since his own health crisis to ensure this health reform passes.

Ultimately, he wasn't the swing vote: The final vote was 69 in favor: Enough to override President Bush's threatened veto!

It's good to see that *some* progress is possible in Congress...

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posted by Anthony Wright | Permalink | 4:30 PM


Improving Medicare...

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

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

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

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

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posted by Anthony Wright | Permalink | 3:28 PM


Did he really need to announce that?

Tuesday, April 08, 2008
Also during yesterday's Medi-Cal budget subcommittee Sen. Mark Wyland, R-Escondido, made an unseemly and untimely remark.

It was during discussion about the governor's proposal to stop paying the $100/month Medicare Part B (drs offfice visits) premium for seniors who earn at least $13,416 a year. Here's how the math works out: It means that seniors who receive $1,118 a month would now have to dedicate $100 of their paltry monthly earnings to be able to see a doctor.

Asked whether any lawmakers had questions about the cut, Wyland piped up:

"Just to say, Madam Chair, we do support the governor's proposals."

I have no idea what inspired Wyland to be so enthusiastic about this cut -- particularly after a string of witnesses explained the hardship this population already endures. Or why he thought this was a particularly useful insight that added value to the conversation -- right then.

It was very very strange.

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posted by Hanh Kim Quach | Permalink | 10:13 AM


Hail to our Chief!

Friday, June 01, 2007
In all the activity of this week, the highlight was a lovely dinner hosted by state Senator Sheila Kuehl, in honor of Betty Perry.

Betty is a legend around Sacramento and the Capitol, for her long leadership at the Older Women's League of California, where she serves in a volunteer capacity as their public policy director.

It was incredibly sweet of Senator Kuehl to honor her, because these tributes are normally done at retirement partiess, yet Betty "officially" retired a couple of decades ago. He was the guidance counselor at McClatchy High School here in Sacramento, and so knows many of the political class from their childhoods, from Supreme Justice Anthony Kennedy to former state Senator Deborah Ortiz. She recently spoke at the high-profile funeral of Rep. Robert Matsui.

But it's not her connections, it's her heart and values and work ethic and goodness that people appreciate. Nobody questions Betty's motives, even those that question her positions (which I almost never do).

In my toast among many two night ago, I cited my amazement that she works so hard on so many issues, from housing to budget to civil rights. Even in the health care arena, she works consistently on several key issues. She's a tremendous advocate for universal single-payer health care and SB840(Kuehl). She has been very active on Medicare Part D, on health budget cuts, and women's health. These aren't just "me too" positions: Betty Perry and OWL has taken a leadership role on the issue of people being denied for "pre-existing conditions"--working so much on the topic, I noted, that some might wonder if she was dating somebody named MRMIP.

For the past year and a half, she has been the chair of the 26-member board of Health Access California. My board members, from a very diverse range of organizations and positions, all respect her and voted her to the position, and she runs an efficient meeting, and provides good advice in her capacity as my President.

I didn't mention that she is also an excellent representative for Health Access, and she has done so at the highest level, including with Governor Schwarzenegger himself. A couple of year ago, I was in Washington, DC, and could not attend a meeting with the Governor on prescription drugs. In comparison to the former Mr. Universe, I look like the prototypical 90-pound weakling. But he's no match for Betty.

(In this photo of last year's bill signing of the prescription drug discount program, she is on the left, in pink, with a watchful eye on the Governor, and keeping me honest, as always.)

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posted by Anthony Wright | Permalink | 10:40 PM


Fighting to the end, may she rest in peace.

Tuesday, May 15, 2007
Sad news: Theresa Mary Johnson, president of the Older's Women League of California, passed away this weekend.

A mother of nine (!) children, she was a spirited and forceful advocate for social justice and universal health care. Her death was a shock to many of us, as she was active as ever, just last week presiding over OWL's annual Mother Day's event. She recently testified before the California legislature's health committees in favor of SB840(Kuehl), and other bills. This and last January, we went as a group to Washington, DC, and visited several Capitol Hill offices on Medicare Part D issues, where she made strong points to key Congressional staffers.

Betty Perry, OWL's public policy director and chair of the Health Access California board, greatly appreciated her leadership and partership with the advocacy work. We will miss Theresa Mary, and offer condolences to Betty and the rest of the OWL and senior advocacy community.

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posted by Anthony Wright | Permalink | 11:04 AM


A senior moment...

Friday, May 04, 2007
I've been on the road speaking a lot. Yesterday, I presented on the health reform debate to a conference on Healthy Aging.

My message to them, not shockingly: seniors need to be engaged in this health reform and coverage expansion discussion. In part, I wanted to blow up the myth that seniors and their concerns aren't relevant because they largely have coverage through Medicare and Medi-Cal.

1) In fact, it is because they do have such coverage that they need to pay attention. Every time there is a recession or a deficit, we face calls to cut these programs. As health and consumer advocates, we argue that the increases in these programs are actually less than the overall private market, which leads us to conclude: We don't have a Medicare problem, We don't have a Medicaid problem, we have a health care problem.

And unless we fix the overall health care system problems, cutting Medicare or Medi-Cal isn't going to help. At the same time, Medicare and Medi-Cal will also be targeted for cuts until we get a handle on the overall system.

2) Medicare is a model, for those of us who support a universal, single-payer plan (like SB840), and related plans. Senator Kennedy and Representative Dingell just introduced a "Medicare for All" bill last week, allowing people to buy-in to Medicare. Professor Jacob Hacker calls his proposal "Medicare for Many." Introducing younger, healthier populations into Medicare, which right now is by definition older and sicker, could actually help the long-term financial picture for the program.

3) Many seniors rely on Medi-Cal, which could in store for major improvements. On the table are major Medi-Cal rate increases, which could increase access to care for many seniors, children, and people with disabilities. This also includes Medi-Cal expansions, not just for children but for low-income parents and adults without children at home: that's a big hole in our current system now, one that a lot who are in the 50-65 year old range fall through.

4) Speaking of the 50-65 year olds, they have perhaps the most to gain from comprehensive health reforms. Many are in the types of jobs that don't provide health coverage, and would benefit from an expansion of employer-based health coverage. Early retirees and others often find it impossible to buy coverage as an individual, either because it is unaffordable or unavailable, because of "pre-existing conditions" that virtually anybody who has lived sevreal decade has. Reforms on the table include prohibitions for insurers to deny or discriminate against consumers because of their health status.

5) Seniors are the biggest users of health care. Any effort to change or improve health care will naturally have a disproportionate impact on those who interact with the system the most.

6) Everybody has an intergenerational stake. Seniors also care about their own care, but that of their children and grandchildren. They want their family to have the social compact they had, where if they worked and paid taxes, they would have the security of health coverage. But they recognize that wihout action, that compact is unravelling.

Seniors can be an important voting block and political constituency, and so the success of reform, both in terms of if something gets passed and what gets passed, could hinge on the senior community.

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posted by Anthony Wright | Permalink | 7:14 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


This is our political system on drugs...

Wednesday, April 18, 2007
Here in Sacramento, SB840(Kuehl) passed out of Senate Health Committee this evening, along a party line vote with six "aye" votes. (State Senator Negrete-McLeod was not present during the vote.)

But the issue of "single-payer" health coverage was invoked in Washington, DC, as well.

In a blow to seniors, the federal budget, and common sense, several U.S. Senators blocked a attempt to pass a bill to allow the federal government to use its purchasing power under Medicare to negotiate for prescription drugs. While most Democrats (including California's Boxer and Feinstein) and even six Republicans voted for the measure, totalling 55 votes, it was not enough to get the supermajority 60 votes needed to actually get it passed.

I was curious about the argument quoted in the New York Times write-up:

Senator John Cornyn, Republican of Texas, denounced the bill as “a step down the road to a single-payer government-run health care system.”

Democrats said they were merely trying to untie the hands of the secretary of health and human services so he could negotiate on behalf of 43 million Medicare beneficiaries.

“The Department of Veterans Affairs is able to negotiate for lower-priced drugs,” said the Senate majority leader, Harry Reid, Democrat of Nevada. “H.M.O.’s can negotiate. Wal-Mart can negotiate. Why in the world shouldn’t Medicare be able to do that?”

A 2003 law prohibits Medicare from negotiating or setting drug prices or establishing a uniform list of covered drugs, or formulary.

More than a handful of Republican Senators don't think they are endorsing single-payer health care when simply supporting the common-sense notion of the Medicare program using its purchasing power. The notion of a "bulk discount" is market-oriented, after all.

But it seem Senator Cornyn's argument only makes sense if he thinks the bill will actually be effective--that it will actually provide medicines at lower prices for seniors and Medicare. If it worked, it would spur other reforms... but that wouldn't be a bad thing.

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posted by Anthony Wright | Permalink | 9:32 PM


After today, the deluge

Wednesday, April 11, 2007
After a burst of health-related activity in January and February, the 2007 session has been relatively quiet -- until now.

This week, advocates saw debate on several bills, including two of note:
  • AB1635 (Strickland) would have allowed Medi-Cal recipients to voluntarily enroll in high-deductible plans, and use HSA-like "Health Opportunity Accounts.'' Health Access California opposed the measure as did Western Center on Law and Poverty. The bill died on Tuesday.
  • SB623 (Wiggins) would relieve seniors who are eligible for both Medi-Cal and Medicare to have co-pays for their prescription drugs paid for by Medi-Cal. Last year, when Medicare Part D went into effect, one million of the state's lowest income seniors (earning about $800 a month) were made worse off when they were shifted into the federal program, and required to pay copays on their multiple prescriptions. Under Medi-Cal, they did not have to pay. An effort to ensure these seniors could continue to get their medications without paying last year failed. Wiggins bill passed Senate Health on Wednesday.
The next two weeks, health committees in the Assembly and Senate will be bursting with activity. Health reform proposals by Assembly Speaker Fabian Nunez are expected to be heard on Tuesday, April 17. Sen. Sheila Kuehl's single payer measure, SB840, will be up the next day.

Senate President Don Perata's health reform bill will be up the following Wednesday April 25. And universal children's coverage bills will be up the 24th and 25th also.

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posted by Hanh Kim Quach | Permalink | 11:56 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.