Health Access WeBlog

HEALTH ACCESS UPDATE
Friday, April 2, 2010

HEALTH REFORM'S BENEFITS FOR CALIFORNIA
* Californians Thank Their Congressional Representatives for Health Reform
* Federal Health Reform "Reconciliation" Package Signed Into Law Earlier This Week
* Health Reform Would Significantly Benefit California and Californians

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Up and down the state, Californians this week have been meeting legislators at airports as they arrive home from Washington, DC, visiting Congressional offices, and attending town halls, all to thank their Representatives for voting for and passing health reform.

From Speaker Nancy Pelosi in San Francisco to Rep. Doris Matsui in Sacramento, Congressional leaders are in turn reaching out to their constituents to tell them about the significant benefits of health reform for their districts and the state of California. As our state has one of the highest rates of uninsured, low-wage families who need help to afford coverage, workers who don't get coverage on the job, and people denied for pre-existing conditions, Californians would especially benefit from this health reform that directly addresses these issues.

On Tuesday, President Obama signed a "reconciliation" package of improvements to the base health reform proposal he approved last week. That package improved the measure for California, increasing aid to the state budget of California and improving subsidies for low- and moderate-income families to afford coverage in this high cost-of-living state.

From the House Energy and Commerce Committee and other sources, here's some analysis of the benefits of the health reform bill to California:

The law prevents the worst abuses of the insurance industry, installing consumer protections that will provide more security to all Californians. It also provide specific help to many Californians. Health reform will:
* Extend health coverage to 3.8 million uninsured Californians and improve coverage for 21 million Californians with employer-based or individual health insurance, ultimately extending coverage to 94% of the population.
* Guarantee that 800,000 Californians with pre-existing conditions can obtain coverage.
* Protect 66,000 California families from bankruptcy due to unaffordable health care costs.
* Allow 3.2 million young adults in California to obtain coverage on their parents’ insurance plans.

Over the next ten years, the state and its residents will receive new federal support for health care worth approximately $124 billion. In California, the law will:
* Provide families with tax credits to purchase health care coverage and other federal health care benefits worth $106 billion.
* Provide small businesses with $4.3 million worth of health care tax credits.
* Fill the donut hole, saving seniors $9.3 billion in drug costs.
* Provide $1.4 billion in new funding to community health centers.
* Reduce uncompensated care costs for California health care providers by $2.6 billion.

**Affordability Assistance Through Middle Class Tax Credits and Medi-Cal

California residents that do not receive health care coverage through their employer will be able to purchase coverage at group rates through the new health insurance exchange.

To make this insurance affordable, the new health care reform law provides middle class families with incomes up to $88,000 for a family of four with tax credits to help pay for coverage in the exchange, so that coverage is not more than a certain (sliding scale) percentage of income.

For a family of four making $50,000, the average tax credit will be approximately $5,800. There are 7.2 million households in California that could qualify for these credits if they purchase health insurance through the exchange or, in the case of households with incomes below 133% of poverty, receive coverage through Medi-Cal. These families will receive $106 billion in tax credits and other federal health care assistance over the next decade.

** Support for Small Business to Help Purchase Coverage for Their Workers

Small businesses with 25 employees or less and average wages of less than $50,000 will qualify for tax credits of up to 50% of the costs of providing health insurance. There are approximately 775,000 small businesses in California that could qualify for tax credits for providing coverage. These businesses will receive $4.6 billion in tax cuts over the next decade.

** Help for Seniors Who Now See a Part D Donut Hole in Their Drug Coverage

There are 465,000 California seniors who have their Medicare Part D prescription drug coverage "run out" each year, dealing with a "donut hole" in their coverage. Under the new law, these beneficiaries will receive a $250 rebate in 2010, 50% discounts on brand name drugs beginning in 2011, and complete closure of the donut hole within a decade. A typical beneficiary who enters the donut hole will see savings of over $700 in 2011 and over $3,000 by 2020. Over the next decade, seniors in California who hit the donut hole will save a total of $9.3 billion.

** New Funds for Community Health Centers

There are almost 1,100 community health centers in California that provide health care to the poor and medically underserved. Nationwide, the legislation would provide $11 billion in new funding for these centers. If the community health centers in the state receive the average level of support, the 1,100 centers will receive $1.4 billion in new assistance.

** Reducing the Cost of Uncompensated Care

California hospitals and health providers incur billions of dollars in uncompensated costs for providing health care for individuals without health insurance or with inadequate insurance. By providing quality, affordable health care coverage for almost every American, the new health care reform law will reduce the costs of uncompensated care for California health care providers by $2.6 billion over the next decade.

For more information, visit the Health Access California website, at www.health-access.org, A quick one-page factsheet on the benefit of the health reform bill to Californians is available on the website, at:
http://www.health-access.org/files/expanding/Health%20Reform%20Impact%2003-29-10.pdf

Labels: Obama, Research, Updates, YearOfReform

posted by Anthony Wright | Permalink | 10:25 AM

California's unemployment rate stayed flat at a troubling 12.5% in February 2010, according to new data released today.

Our state leaders need to focus on decisions that protect and promote jobs. Unfortunately, the Governor is proposing budget cuts just to health would cost the state’s economy more than 42,000 jobs.

Health Access California released a new report on Thursday detailing the impact on jobs of Governor Schwarzenegger’s 2010-11 proposed budget cuts to health care programs in California. Entitled, “Cuts to Health Care are Bad for the Economy,” the new report demonstrates that sweeping health care cuts in California would cost the state more than 42,000 jobs, at the very minimum.

The job-loss estimate is based on research by the University of California at Berkeley, which calculated that cuts (or investments) to health care services has the biggest "jobs-per-billion" impact than other budget solution, significantly more than tax increases on the high-income earners or an oil severance tax. That research is on the web at:
http://laborcenter.berkeley.edu/californiabudget/budget_solutions_jobs10.pdf

Frankly, there is no place where you get more bang for your buck than investing in health and human services, both because of federal matching funds, and because benefits to low- and moderate-income families get recycled into the economy quickly. Nothing has a worse economic impact than cutting health and human services, which leads to lost federal funds and ripple effects in our health system and economy.

In addition to severe job losses, the Health Access report reveals that California would experience an estimated $2.7 billion loss in business activity across the state, thus further hindering California’s much-needed economic recovery at a time when joblessness is at its worst in decades.

Other findings showed that:
* The Governor’s proposed cuts to Adult Day Health Care would lead to a loss of more than 7,500 jobs across 327 statewide facilities.
* The Governor’s plans to eliminate In-Home Support Services (IHSS) would result in the loss of more than 370,000 home-care jobs across the state – even more than the total number of jobs lost across all sectors from January through December 2009.

Furthermore, the report shows that health care jobs are vital for California’s economic recovery. Not only is the health care industry a major source of jobs in California, with 12 of the 50 largest in-state employers directly involved in healthcare services; but the health care industry (alongside education) was the only industry sector to see an increase in jobs in California – adding nearly 23,000 jobs in 2009 alone.

The Governor’s proposal to slash $6.4 billion from California’s vital safety net couldn’t come at a worse time. When more and more families are struggling to get back on their feet, the Governor’s proposal not only decimates vital services for those Californians currently out of work, but also imposes severe challenges further hindering California’s economic recovery – including cuts to programs that would otherwise contribute desperately-needed Federal funds, such as Medi-Cal and Healthy Families.

A copy of “Cuts to Health Care are Bad for the Economy” is available online.

Labels: Budget, Research

posted by Anthony Wright | Permalink | 12:23 PM

As reported by Duke Helfand of the LA Times, there's shocking figures about a *huge* increase in the uninsured. Nearly 2 million Californians lost their health insurance from 2007 to 2009, largely due to a deep recession and mass layoffs.

New estimates from the UCLA Center for Health Policy Research show a 25 percent increase in the number of uninsured since 2007, when 6.4 million Californians lacked insurance, according to the authors of the new policy brief, Number of Uninsured Jumped to More Than Eight Million from 2007 to 2009.

The shocking increase in people losing insurance spotlights the problem that even for those of us who are insured, coverage may not be there for us when we need it.

Today, nearly one-quarter of all adult Californians lack coverage and the number of uninsured increased among all age groups, even among children, despite their better access to public health insurance safety-net programs. The hardest hit, however, were California's working adults. The recession of 2008-09 reduced those percentage of those getting job-based coverage to less than 50 percent for all Californians under 65.

Although public coverage among Californians increased slightly from 15% in 2007 to 16% in 2009, this did not offset the decline in employment-based insurance, as public programs had in previous years, especially for children. Yet the situation could get worse: the Governor’s budget proposes to eliminate coverage for hundreds of thousands --and without federal reform and resources, over two and a half million more Californians.

The overall UCLA report is shocking and sobering, and should be required reading, especially for any Representative thinking about voting against health reform this week.

Labels: Research, YearOfReform

posted by Anthony Wright | Permalink | 11:26 PM

A new Robert Wood Johnson Foundation (RWJF) report today projects that if significant reform efforts are not enacted, by 2015 there could be as many as 59.7 million people uninsured nationwide – and further estimates that the number could swell to 67.6 million by 2020 – with middle-income families hardest hit. An estimated 49.4 million individuals were without health coverage in 2010. The report, conducted by researchers from the Urban Institute, was released today as a part of Cover the Uninsured Week. For more information, see http://www.covertheuninsured.org/

The analysis, conducted by the Urban Institute, shows that the middle class would suffer most without reform. The uninsured rate for middle-class families earning 200-399 percent of the federal poverty level (FPL) – roughly $40,000-$75,000 a year – would rise by nine percentage points, from 19 percent to 28 percent over the next 10 years. Overall, the share of the uninsured from all families with incomes higher than about $40,000 would rise from 44 percent to 53 percent in 2020.

For employers who continued to offer health insurance benefits, an increasing amount of the costs would likely be passed on to workers. At the same time, individuals and families would face higher out-of-pocket costs for premiums and health care services. Spending for families and individuals would jump by 34 percent in 2015 and by 79 percent in 2020.

Families in California can’t afford to see our health care costs rise by more than a third in five short years. Already there are over million people in our state who lack health coverage and do not get the care they need. These individuals are forced to gamble every day that they won’t get sick or injured. Our businesses are struggling under the weight of ever increasing health care costs.

Now more than ever, we must make significant changes to our health care system to decrease costs and ensure that all Americans have quality, affordable care to keep our families healthy and financially secure.

Federal health reform legislation would benefit California immensely, by providing new and affordable choices for the uninsured, more security for the underinsured, much needed stability to our safety net, and real savings for our state budget. California needs real solutions to our health care crisis, and without reform, the future health and security of California’s families are at stake.

Labels: Research, YearOfReform

posted by Anthony Wright | Permalink | 2:16 PM

California’s performance ranking in five key areas, including health care, dropped a grade on the annual report card issued by Children Now, leaving the Golden State with its most tarnished marks in the 20-year history of the advocacy group’s rating system.

Due mainly to brutal cuts in the state’s FY09-10 budget by the Legislature and the governor in children’s programs, California “earned the worst grades ever” for 2009, said Ted Lempert, president of Children Now. Lempert, a former state legislator, summed up the state’s dire performance during a legislative briefing held in the Capitol on Monday afternoon for staff members of the Legislature.

Still, Lempert, joined by vice president Wilma Chan and Kelly Hardy, associate director of health policy for Children Now, tried to emphasize the possibilities for improvement in coming budget discussions. “There are lots of opportunities to move forward this year on children’s health,” Hardy told the group. The silver lining in getting California’s children through the tough budget cuts last year came in the form of an unprecedented financial boost from the federal government.

The increase in federal matching funds did not pull California out of its economic doldrums, however; it merely helped keep pace somewhat with the increased need brought about by the loss of job-based health coverage as more and more parents became unemployed, Hardy said.
The areas in which California performed worse than in previous years were:

Children’s oral health: the state’s marks dropped from a “C to a D”
Infant health: the state’s marks dropped from a “B- to a C+”
Adolescent health: the state dropped from a “B- to a C+”
K-12 education: the state dropped from a “C- to a D”
Integrated services: the state dropped from a “D+ to a D”

In response to legislative staff questions about the methodology of Children Now’s assessment, Lempert responded that the organization examined statistics, policy program decisions and also took a broad view of the outlook for the 9.4 million children currently living in California. In the final analysis, he said, “The methodology was similar to the academic grading process in that it was somewhat subjective.”

There was widespread recognition in the room that things will not become rosier overnight. “We know this is going to be another bad year for children in the California budget,” Chan said. “But people in this building have to make kids a higher priority – so our children and our economic future won’t become sicker.” The report card can be found online at the Children Now website, reports and research section.

Labels: Research, SCHIPHealthyFamilies

posted by Cynthia Craft | Permalink | 7:05 PM

As Governor Schwarzenegger is poised to release his proposal for next year’s state budget, the proposal is expected to include a slew of additional cuts to health and human services.

In anticipation of that announcement, Health Access California today released a new report detailing the six-month impact of nearly $2 billion in cuts already made to the state’s healthcare system in the current budget year. Entitled “The Damage Already Done: A Report on the Impacts of the 2009 Health Care Budget Cuts, Six Months In,” the report documents many of the effects these cuts have had on individual patients, families, health providers, and our economy.

The finding? Just six months into the 2009 budget, hundreds of thousands of Californians have been denied care or coverage for key services, and we see indications of the health system we all rely on is crumbling, with five clinics closing. These cuts are starting to ripple through the health system and our economy, as we lose health jobs and federal matching funds, and people don’t get the help they need to get through these tough times. We deserve a budget that supports, not undercuts, the health of our communities.

Since the Governor signed the budget in July 2009, slashing nearly $2 billion from the health care system, some cuts have been partially averted through various actions. The delay and uncertainty, however, have generated grave consequences. In many cases, cuts were made, resulting in very real human hardships and economic impacts for Californians.

Those impacts include:

* Almost three million low-income adults have lost ten important benefits, such as dental care, vision care, speech therapy, and psychological services – in the last six months, over 450,000 Californians in poverty have either had to forego or pay for dental care; another 240,000 have lost coverage for prescriptions eyeglasses;
* About 93,000 children waited uninsured for Healthy Families coverage until the cut was averted by non-government donations and higher cost sharing for 269,000 children on the program;
* Five community clinics in the state have already been forced to shut down and hundreds of workers have been laid off, an additional 10 clinics are on the brink of closure;
* Thousands of AIDS/HIV patients have been denied access to needed services and affordable medications they rely on;
* About 300,000 low-income women no longer have access to life-saving breast cancer screenings;
* Six domestic violence shelters were temporarily closed while the Legislature passed a bill to find ways to keep shelters open, and even afterwards, most have been forced to reduce services;

The ripple effects of these cuts will continue beyond these short six months, as we see more layoffs and closures of services, and the impacts of people not getting care or preventative services comes to back to haunt us.

“The Damage Already Done” will be distributed at multiple press conferences this week held to address the broader topic of health and human service cuts. Events are scheduled for San Francisco, San Bernardino, and Sacramento this Thursday morning as well as Bakersfield, San Diego, Los Angeles, Fresno, and Modesto on Friday, January 8th.

Labels: Budget, MediCal, Research

posted by Anthony Wright | Permalink | 10:10 AM

Under all versions of health reform currently pending in Congress, millions of Californians would get significant help in affording their coverage and/or in improving the comprehensiveness of their coverage, according to three new studies just released by UC-Berkeley and the University of Chicago. The studies also indicate the important differences between the House and Senate versions, as they head into conference committee.

The data puts into context the millions of Californians who would get help under health reform--and not just the uninsured. Many who have coverage would get more stability and security.

Here are some of the key findings from these three important studies that have been just released about the impact of health reform on California.

* Californians' Access to Coverage under the Health Reform Proposals
This data brief finds that nearly 4 million Californians who are without health insurance, covered in the individual market or enrolled in unaffordable job-based coverage, would be eligible for Medicaid or subsidized coverage under the national health reform proposals. The brief analyzes both the House and Senate legislation to compare how they differ in their impacts on Californians.
* Close to 2 million Californians who were uninsured, in the individual market or had unaffordable employer sponsored insurance in 2007 would qualify for Medicaid under the House bill, compared to 1.74 million under the Senate bill.
* 1.93 million Californians would be eligible for subsidies in the exchange under the House bill and 2.19 million in the Senate.
* 95 percent of California businesses, employing 44 percent of all workers would be eligible to purchase coverage through an exchange by 2015.
* One out of five businesses would be eligible for tax credits towards the purchase of that coverage.

* National Health Reform Requirements and California Employers
This issue brief analyzes the impact that the House and Senate health reform proposals would have on the 18.4 million Californians who are enrolled in employer-based insurance. While the vast majority of employees work for firms that currently comply with most of the new requirements for employer-based insurance included in the bills, reform legislation, if passed, would increase protection for many insured workers and their families in California. Many workers would have their coverage improved under these bills. They include those who's coverage now is less than comprehensive:
* 23 percent of workers with employer-based insurance are enrolled in a plan either without an out-of-pocket limit or a limit exceeding $5,000.
* Over 40 percent of insured employees are enrolled in a plan with a lifetime limit.
* About 10 percent of California insured workers are enrolled in a plan where preventive benefits are subject to a deductible.

* How Would Health Care Reforms Change the Spending of California Families Without an Employer Plan?
This report uses simulated claims data to project out of pocket costs at different cost sharing subsidy levels for the House and Senate bills, and provide a comparison to costs in the current individual market in California. Among the findings:
* Californians with an income of $16,245 a year would save $5,053 on average on premiums and out-of-pocket costs under the House bill compared to what they would spend in the current individual market; they would save $4,116 under the Senate bill.
* Those with an income of $43,320 a year would save $838 a year under both plans compared to what they would spend in the current individual market.
* California families of three with typical health care use earning less than $59,000 would spend significantly less under the House bill than the Senate bill, while those earning between $59,000 and $73,240 would spend less under the Senate bill.

Labels: Research, YearOfReform

posted by Anthony Wright | Permalink | 4:39 PM

Much more has been written on the new CBO report on whether premiums will go up or down under health reform. I won't go into all the details, but a few points.

It's hard to make broad statements about whether premiums go up or down, because so many people are in such different circumstances, and people changes those circumstances frequently. The person getting great coverage heavily subsidized by their employer today may be unemployed tomorrow, paying 100% of a very high premium, if not denied for pre-existing conditions. A young person in the individual market could find his specific policy getting marked up significantly, even if the overall market is not a problem.

That said, it makes some key points: Even without taking into consideration a range of cost saving mechnisms (prevention, payment reforms, etc), premiums will go down for many people, especially low- and moderate-income folks who have the toughest time affording coverage, and who will get subsidies to help pay for coverage.

Even many of those who are not subsidized will have their coverage go down. For those who don't, it largely because they will be getting better, more comprehensive policies. These are folks who are largely underinsured, who now will be fully insured. So when opponents talk about some who may see an increase in premiums, they are not doing an apples-to-apples comparison. The minimum benefit standards are a feature, not a bug, in that people won't be suckered into "junk" coverage that leaves them in a lurch when they actually get sick.

For most people, the big takeaway is that for the vast majority of people, they will get a guarantee that health premiums for meaningful coverage won't be more than a certain percentage of their income. Because we will subsidize low-and-moderate income families based on their income, we will fundamentally change the regressive nature of health insurance. Under health reform, we will move toward a system where we pay premiums based on how much we can afford, rather than how sick we are--which is our current practice.

Labels: Research, YearOfReform

posted by Anthony Wright | Permalink | 11:51 PM

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

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

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

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

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

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

Labels: InTheNews, Research, SCHIPHealthyFamilies, YearOfReform

posted by Beth Capell | Permalink | 8:29 PM

Today was a major day of action for health reform, with well over 100,000 calls made to Congress, and events around the country. This included several cities in California, from an overnight vigil in front of the federal building in Sacramento, to a "Rolling Caravan for Health Care Reform" in Los Angeles. Below, pictured with HCAN organizers Mari Lopez of the California Partnership and Nancy Gomez of Health Access California, is the flatbed truck that circulated through LA with over 150+ people at various stops, with the theme "The Clock is Ticking." Other events were all over the place, from San Diego to Modesto.

There's also been some good research and posts of note. The UCLA Center for Health Policy Research put out a fact sheet on the many Californians that would potentially benefit and get coverage due to health reform.

Henry Stern at InsureBlog has the new edition of Health Wonk Review, which is chock full of interesting health policy posts.

Jon Cohn at The New Republic's The Treatment has the new "Truman Score" for the Senate HELP health reform bill, which is appropriated judged as better than the Senate Finance bill which has gotten much of the recent attention, and which it needs to be combined with.

Another fellow "judge" on the Truman panel with myself is erstwhile Californian and health policy consultant Peter Harbage, who has an important post on the need to not just make coverage affordable and accessible, but administratively simply, if not automatic. He's right: the recent conversation on penalties from the individual mandate is missing the point: after all, people overwhelmingly want coverage. (Even with auto insurance, the coverage required is for the person you may run into, not yourself.) The key is removing the barriers for people to get coverage in the first place.

Labels: OtherBlogs, Research, YearOfReform

posted by Anthony Wright | Permalink | 4:32 PM

How many uninsured are there?

Maybe we are asking the wrong question. Here's a better question: How many people will experience uninsurance in the future?

We need to be thinking of uninsurance as a condition--one that can (and will) impact us all--as opposed to a population--one that can be minimized and marginalized.

In my commentary at today's The New Republic's The Treatment,
Most estimates of the uninsured are for a specific point in time, or over the course of only one year. When just looking at a two-year period, far more people--nearly 1 in 3--find themselves uninsured, as Families USA has calculated using Census data. And for every day they are uncovered--and most of them are uncovered for more than six months--they are likely to not get care and/or face the risk if not the reality of financial ruin. One trip to the emergency room without coverage can mean thousands of dollars of unexpected bills.

For those who say that two years is too long a period to evaluate, please let our Congress know--as they are busy fretting about the ten-year cost of health reform. If we are going to calculate the ten-year cost, we ought to calculate the ten-year benefit, of how many Americans will be prevented from falling into uninsurance, preventing the gaps that are disruptive to both quality care and a family’s financial stability.

President Obama understands this: This weekend, he cited a new Treasury Department report that indicates about half of non-elderly Americans went uninsured for some portion of 1997-2006. With the continuing erosion of coverage without health reform, the number who would benefit by not having such a gap in coverage over the first ten years of health reform is likely well over half the country. That’s not a problem, or a benefit, to minimize.

My post goes on (and on!) to rebut the range of attacks on the number of 46.5 million uninsured that was recently updated by the U.S. Census Bureau last week. It's a bad sign for the debate when we are arguing about basic facts. But it also shows that health reform opponents don't even have a good sense of the actual problem--much less how H.R.3200 and other health reforms will solve it.

Labels: OtherBlogs, Research

posted by Anthony Wright | Permalink | 12:25 PM

The U.S. Census Bureau came out today with the 2008 version annual report on income, poverty and health insurance. Some findings:

* The number of people with health insurance increased from 253.4 million in 2007 to 255.1 million in 2008.
* The number of people without health insurance coverage rose from 45.7 million in 2007 to 46.3 million in 2008.
* Between 2007 and 2008, the number of people covered by private health insurance decreased from 202.0 million to 201.0 million, while the number covered by government health insurance climbed from 83.0 million to 87.4 million. The number covered by employment-based health insurance declined from 177.4 million to 176.3 million.
* The number of uninsured children declined from 8.1 million (11.0 percent) in 2007 to 7.3 million (9.9 percent) in 2008. Both the uninsured rate and number of uninsured children are the lowest since 1987, the first year that comparable health insurance data were collected.
* Although the uninsured rate for children in poverty declined from 17.6 percent in 2007 to 15.7 percent in 2008, children in poverty were more likely to be uninsured than all children.

California continues to be in the top ten states with the worst uninsurance rates, at 18.5%.

If President Obama's challenge wasn't clear enough, these new Census numbers clearly indicate we need action on health reform. In addition, these new numbers, which show California with one of the worst uninsured rates in the country, doesn't take into account the most recent losses due to the recession, high unemployment, and budget cuts.

Californians are more likely to become uninsured than residents of all but a handful of states. Californians are less likely to get on-the-job benefits, and are more likely to be denied for pre-existing conditions. The current health reform proposals would fix these problems. If anything, the Census numbers underestimate the problem, since they only look at people who are uninsured in a given year. But we all are one life change--whether a job switch, divorce, graduation, or retirement--away from losing coverage. Those with coverage need security and stability that don't have now to keep their coverage, and those uninsured need more affordable and accesible options--and that's what the current proposals seek to do.

"We have to stop the vicious cycle. When costs go up, more people become uninsured. The more people who are uninsured, the harder it is for our health care system to control costs. We need our elected officials to muster the political will to make health reform happen.

Labels: Federal, Research, YearOfReform

posted by Anthony Wright | Permalink | 2:44 PM

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...

Labels: MedicalDebt, Research, Underinsurance

posted by Anthony Wright | Permalink | 3:38 PM

Today, the UCLA Center for Health Policy Research put out its biannual report compiling data from the California Health Interview Survey (CHIS), the most comprehensive look at health coverage and issues in our state. It's a seminal source of information for health policymakers and advocates, and we'll have a lot to say and post about its findings--especially about the new and disturbing information about medical debt--in the next few days and months.

But we should take a moment to send not just our congratulations but our good wishes to E. Richard Brown, UCLA Professor in the School of Public Health, the Director of the Center for Health Policy Research, and the Principal Investigator for CHIS. Beyond being one of California's foremost academic experts on health policy, he's been a good resource, friend, and colleague of Health Access over many years.

On August 10th, Rick had the unfortunate opportunity to experience the health care system first hand when a brain aneurysm ruptured. The good news is that we have heard he has just recently been transferred out of the ICU to a regular hospital bed at UCLA.

We wish him the best for a safe and speedy recovery, and our thoughts are with him. He's an important and valued member in the health policy and advocacy communities, and we look forward to working with him soon!

Labels: HealthAccessCommunity, Research

posted by Anthony Wright | Permalink | 1:22 PM

In case you missed it, the good folks at University of California-Berkeley has an important op-ed in the New York Times over the weekend. It shows that the implementation of Healthy San Francisco holds some important insight into the federal health reform debate. Here's extended snippet, with emphasis added:

TWO burning questions are at the center of America’s health care debate. First, should employers be required to pay for their employees’ health insurance? And second, should there be a “public option” that competes with private insurance?

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

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

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

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

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

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

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

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

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

Labels: Employers, InTheNews, Research, SanFrancisco, YearOfReform

posted by Anthony Wright | Permalink | 9:54 PM

The Census Bureau came out with new data today, and it's not pretty. California jumps from the 7th highest in the nation in uninsured rate--to 4th. Here's Sacramento Bee's Capitol Alert:

The new data, based on a 2006 survey, indicate that California has the nation's fourth lowest level of medical insurance, with 21.3 percent of its residents under 65 years old lacking coverage - and recent reductions in Healthy Families and other state-sponsored medical care programs will, authorities say, push that number higher...

Only Florida, Louisiana and Texas have lower levels of health insurance, with Texas last at 27.6 percent uninsured. The Census Bureau data, which confirm earlier estimates by state officials and health care advocates, found that 6.8 million Californians lacked health insurance in 2006 out of 32 million Californians under 65. (Those over 65 are not counted because it's presumed they have Medicare coverage.)

At the other end of the scale, just 9.4 percent of under-65 residents of Minnesota, 9.6 percent of those in Massachusetts, 9.8 percent of Hawaiians and 9.9 percent of Wisconsinites lack insurance.

Our uninsured rate will only get worse: these numbers don't take into account the projected 500,000+ people who have lost coverage related to the recession in its first 18 months, nor the impact of the more recent budget cuts, including the closure of Healthy Families enrollment, denying coverage to up tp 900,000 children.

We need federal health reform, and fast.

Labels: Research, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 8:32 PM

Rep. Michael Honda stood with Health Care for America Now, Health Access California, and other groups this morning in San Jose, to releasee new California-specific report today today showing that racial and ethnic disparities in health outcomes constitute a crisis, one that requires the attention of health care providers, policymakers, and communities alike. As the study shows, in California, communities of color and immigrants face barriers in accessing health care including lack of insurance coverage, limits to geographic access, and cultural and linguistic challenges.

“Since the publication of the momentous 2002 Institute Of Medicine study confirming the depth and breadth of disparities in health care faced by racial and ethnic minorities in the United States, I have worked tirelessly with my colleagues to reform our health care system to correct these inequities” said Representative Mike Honda (D – San Jose), chair of the Congressional Asian Pacific American Caucus. “Children should not have to translate complicated medical information for their parents, patients should have access to quality, affordable care regardless of the language they speak, the color of their skin, or where they live. The public option within health reform is a singular opportunity to both expand competition in the health care industry and rectify injustices faced by too many in our communities.”

This took on special emphasis this week because the Congressional TriCaucus - comprised of the Congressional Black Caucus (chaired by CA Rep. Barbara Lee), the Congressional Hispanic Caucus and the Congressional Asian Pacific American Caucus (chaired by CA Rep. Honda) – and the Congressional Progressive Caucus (chaired by CA Rep. Lynn Woolsey) -- altogether 120 House and Senate Members -- will hold a news conference on Wednesday, June 24 at 10 am expressing unprecedented, united, and strong support for comprehensive healthcare reform, of which the cornerstone must be a robust public health insurance option.

At the press conference this morning, Honda joined Health Care for America Now (HCAN); Asian Americans for Community Involvement (AACI); Asian Immigrant Women Advocates (AIWA); California Immigrant Policy Center (CIPC); California Pan Ethnic Health Network (CPEHN); the Having Our Say Coalition; Health Access California, and Services, Immigrant Rights, and Education Network (SIREN) in highlighting the specific needs of our communities and calling upon Congressional leaders to include them in the Health Reform Debate. The report is available at:
http://www.health-access.org/files/expanding/Ideas%20in%20Action%20The%20Heatlh%20Equity%20Challenge%20CA%206-20-09.pdf

"As three-quarters of the uninsured in this state, communities of color have the most at stake in health reform” according to Martin Martinez, Policy Director at the California Pan Ethnic Health Network. “If the United States is going to be positioned for a successful future, we need to make sure that everyone has access to affordable, comprehensive, and culturally and linguistically appropriate health care. We urge Congress to act this year to enact meaningful reform that addresses these inequalities in health."

The debate over health reform in Washington DC represents a historic opportunity to achieve quality and affordable health care for all; it is critical that reform efforts take into account the specific needs of immigrants and communities of color. We must expand and simplify public programs to cover all low-income individuals, and give everyone the option of buying into a public plan. We must also invest in building healthy communities to address the underlying causes of the obesity and chronic disease epidemics that are disproportionately affecting communities of color.

The time is now.

Labels: Research, YearOfReform

posted by Anthony Wright | Permalink | 12:20 PM

Californians really want health reform. The Field Poll that came out today reaffirms that.

Californians know that we need major health reform, and we need it urgently. The problems in the health system are significantly bigger in California, and it's not a surprise that our condition has translated into such overwhelming support for broad health reforms.

What is noteworthy is that what may be controversial in Washington, DC, is not in California, given the level of our crisis, and our elected leaders in Congress should take note. Californians support a range of provisions that are now being debated in DC. They include:

* 85% of Californians support "the choice of a public health insurance option, that can compete with the private insurers and make sure they play by the rules."
* 81% of Californians support "requiring health insurance companies to offer coverage to anyone without regard to their health condition."
* 70% of Californians support "expanding state government programs for low-income people, such as Medi-Cal and the State Child Health Insuance Program."
* 69% of Californians support "requiring employers to offer health insurance to their workers or pay money into a government fund that will pay to cover" their workers. also support requiring employers to help provide health coverage to their workers. These are critical components that should be in any health reform package."

On the public health insurance option, there's been concerted effort to ensure that is included in health reform by coalitions like Health Care for America Now.

Another effort has been the Stand with Dr. Dean campaign. They have urged blog readers and others to write their Senators to get specific answers to specific questions about their support for a public health insurance option.

Let's keep up the pressure!

Labels: Research, YearOfReform

posted by Anthony Wright | Permalink | 1:45 PM

As insurance company executives from around the nation congregate to San Diego on Wednesday June 3rd, 2009, Health Access, as part of the Health Care for America Now campaign, released a new report today showing that consolidation in the private health insurance industry is creating skyrocketing premiums for both patients and employers. In California , the state and most metropolitan areas are considered “highly concentrated” under U.S. Department of Justice guidelines. This kind of concentration means that an insurer can, without minimal consequence, raise premiums and/or reduce the variety of plans or quality of services offered to customers.

Health insurance premiums for California working families have increased 96 percent from 2000 to 2007. At the same time, the median earnings of California workers increased 19 percent from $25,740 to $30,702. That means health insurance premiums for California working families have risen five times faster than wages.

Wihle not the only cause of rising health premiums, one factor is the marked concentration in the health insurance market. In virtually every area of California, the new report shows that just a couple of companies have over half the health insurance market. Individual consumers and small businesses have no market power against the Blue Cross and other big insurers, who can set the premiums and the benefits

Consumer groups argued that these finding show it’s time for real comprehensive health reform that includes regulation and the choice of a public health insurance plan so patients are no longer at the mercy of the private health insurers in California. At the state level, they also support AB786(Jones), providing standards for coverage, up in the California Assembly today.

“For too long, insurance companies have competed based on dropping the sick, rather than through lowered costs and higher quality. Now this new research shows that they haven’t even been competing much at all!” said Michael Russo, health care advocate and staff attorney for CalPIRG. “The choice of a public health insurance plan will give consumers better options – and will keep insurers honest.”

The American Medical Association reports that the health insurance marketplace is dangerously concentrated with 94 percent of local markets in the United States currently considered highly concentrated. And contrary to what the health insurance industry claims, these mergers have undermined market efficiency. Premiums nationwide have gone up an average of more than 87 percent over the past six years.

“There is no real choice or competition in the private health insurance market, and only giving everyone the option of a public health insurance plan will guarantee we get quality, affordable health care we all can count on this year,” said Marty Martinez, policy director for the California Pan-Ethnic Health Network. “A public health insurance option will force private health insurance companies to control cost, guarantee quality, stop hiding what they will and won’t cover, and put people’s health before corporate profit.”

Some facts about the insurance industry in California:

* Anthem Blue Cross, a subsidiary of WellPoint Inc. and the state’s largest insurer, controlled 30 percent of the California market in 2008. Together Wellpoint, with Kaiser Permanente, they hold 58 percent of the California market.

* California insurance markets are concentrated. The top two insurers in the Los Angeles metro area control over 60 percent of the market. (The report details similar levels of concentration in most California metro areas.)

* Such consolidation is especially true in smaller markets. By itself, WellPoint, Inc. (Anthem Blue Cross) holds 60 percent of the market in Salinas and more than 50 percent of the markets in San Luis Obispo and Redding .

* Health insurance premiums for California working families skyrocketed by 96 percent from 2000 to 2007.

* For family health coverage in California during that time, the average annual combined premium for employers and employees rose from $6,227 to $12,194.

* For family health coverage in California , the average employer’s portion of annual premiums rose 91 percent, while the average worker’s share grew by 111 percent.

On the conference call releasing the report was Linda Jackson, of Grass Valley , CA , who has experienced the problems in this concentrated and confusing health insurance market. They lost their coverage after being laid off by Formica after 34 years of working there. She and her husband, in their late 50s, now pay over $1100/month, even though they are relatively healthy. They have been shopping around for coverage but their options are limited, and she is worried about getting any new coverage she gets may not be comparable to her current coverage in terms of benefits.

The concentration in the health insurance market is seen not just impacting premiums, but the quality of the health policies and the benefits they provide. The lack of competition is further exacerbated by a confusing and unstructured marketplace, where consumers find it impossible to compare plans. At the federal level, health reform proposals offer a “health insurance exchange” that would standardize and set basic benefit levels, and a public health insurer as a new, affordable option for people to secure basic coverage.

At the state level, AB786(Jones) would set basic health insurance standards to allow for better “apples-to-apples” comparisons, and limit “junk” insurance. Health Access California, the sponsor of AB786, argues that consumers need health reforms that provide greater oversight and standards for the insurance industry, who right now dictate the terms of coverage with their market power. The bill is scheduled to be voted on in the California Assembly today, Wednesday, June 3rd, 2009.

The report is also being released as insurance companies executives from across the nation are coming to San Diego , California , for the annual conference of their trade association, America ’s Health Insurance Plans (AHIP). The report is being release in advance of a Rally for Health Reform, on Thursday, 8-10am, in front of the AHIP conference at the San Diego Conference Center , 111 W. Harbor Drive.

The report was prepared by Health Care for America Now - the nation's largest health care campaign - is made up of more than 1000 organizations representing more than 30 million people nationwide. President Obama and more than 190 Members of Congress support HCAN’s principles for health care reform. All across the country, HCAN supporters are organized and mobilized to stress the urgent need for health care reform in 2009 -- reform that finally puts our health care needs before insurance company profits.

Labels: IndividualMarket, Insurers, Legislation, Research, YearOfReform

posted by Anthony Wright | Permalink | 8:37 AM

The California Health Care Foundation is hosting an important briefing this Friday, May 15. In a talk entitled "Health Insurance When It Counts -- What Does It Cover?", leading health academics Karen Pollitz and Eliza Bangit of Georgetown University's Health Policy Institute will present research findings on a comparison of cost-sharing and coverage associated with the design of California health insurance products in the individual and small group market. The researchers explored three health conditions -- breast cancer, heart attack, and diabetes.

When purchasing health insurance, consumers often don't have a sense of what will be covered in the event of a serious illness. That's why Health Access California is sponsoring AB786(Jones), to set some standards so consumers know what they are buying, can so some comparion shopping, and can have confidence that their coverage will at least cover both doctor and hospital bills, and have an out-of-pocket cost maximum. Without knowing all the findings, we think such a research project like this was long overdue, and hopefully it will help spark the discussion abotu the needed policy remedies.

The event is Friday, May 15th, 10:30AM - 12:00PM, at the California State Capitol, Room 112, Sacramento. More information is on the California Health Care Foundation's website. To RSVP , contact Danny Sandoval at dsandoval@chcf.org or 916.329.4542.

Labels: Insurers, Research

posted by Anthony Wright | Permalink | 3:46 AM

The number of Americans paying more for health insurance policies that cover less has increased 60 percent since 2003, a troubling trend that is exacerbated by and contributing to the economic crisis according to a national report released today by Community Catalyst in collaboration with Health Access California and Consumers Union.

“When Coverage Fails: Causes and Remedies for Inadequate Health Insurance” can be found at www.communitycatalyst.org/assets/pdfs/WhenCoverageFails.pdf. It outlines the implications of a growing “underinsurance” problem and urges government leaders to act to ensure families who purchase insurance get the coverage they need.

At a press conference this morning, Assemblymember Dave Jones (D-Sacramento), Chairman of the Assembly Health Committee, said “Consumers should know that their health insurance coverage will be there for them when they need it. Increasingly expensive health insurance policies that don’t cover the basic needs of policyholders threaten the financial and physical well being of California families. The medical debt incurred by many who purchase these policies harms our already weakened economy. We need common-sense protections that limit the financial risk to families and give them the tools to make good decisions. My bill, AB786, would set standards so that consumers could make apples-to-apples comparisons and it would limit the sale of “junk” insurance."

Approximately 6 million Californians —one in five insured adults—are underinsured, a problem that is made worse by the down economy. Many insurance plans are marketed as financial protection in case of major medical needs, but have such extreme gaps in coverage that consumers are effectively paying to be uninsured. Some plans that are marketed as “catastrophic” coverage, but which only pay for care delivered on an inpatient basis, even though 80% of medical procedures, including surgery, chemotherapy and dialysis, are now done in outpatient settings. Other forms of "junk" insurance include plans that do not cover hospital care, or that cover only a tiny fraction of the cost of hospital care, which can easily run to $5,000 a day.

That is what happened to Laura Burwell, a small business owner in Chico, who spoke this morning. When Laura retired from her corporate job of 30 years and became part owner of a small wine shop, she purchased health coverage through a broker, who promised that her new coverage was comparable to the comprehensive plan she had had through her employer. In 2008, Laura was bitten on the finger by a rattlesnake while weeding in her backyard, and spent twenty-nine hours in the local Intensive Care Unit. Her bill came to for over $73,000. Her insurance covered just $3,000 of that bill, leaving Laura in significant debt.

Most people who are underinsured don’t know they’re underinsured until they’re in debt, said Laurie Sobel, Senior Attorney for Consumers Union, the publisher of Consumer Reports magazine. “Many people who think they have adequate health insurance actually have coverage so riddled with loopholes, limits, exclusions, and gotchas that it won’t come close to covering their expenses if they fall seriously ill,” Sobel said. The May 2009 issue of Consumer Reports includes an investigation into junk insurance, and identifies seven warning signs that a plan might be junk. “7 Signs a Health Plan Might Be Junk,” can be found at www.consumerreports.org/health

Small business owners face a high risk of being underinsured, said John Karatzas, California Project Director of Small Business Majority, which is supporting AB786. “Small business owners are the ones out there trying to buy coverage in the individual market,” said Karatzas. “They know how to crunch numbers better than most, and even they can’t figure out what their options are, because different plans have different deductibles, co-pays, out-of-pocket maximums, benefits, and networks. AB786 is a commonsense reform that will help small business.”

Assemblyman Jones’s bill, AB 786, would:

· Require all health plans to be classified into five tiers. Consumers would be able to know if a certain plan is a top-tier comprehensive plan, or a bottom-tier “bare bones” plan, or something in between.

· Require insurers to offer one “benchmark” plan in each tier. Consumers would be able to make cross-insurer,apples-to-apples price comparisons with the confidence of knowing that benchmark plans in a given tier have similar cost-sharing and benefits. The benchmark plan would be the lowest-price plan in each tier.

· Weed out “junk” insurance. The bill would require all plans, including bare-bones plans, to at least cover doctors’ visits, hospital and preventive services; no more “hospital only” plans could be sold. The bill would also direct state regulators to set overall limits on out-of-pocket costs.

In addition to its work at the state level with AB786(Jones), Health Access California is working with the national Health Care for America Now! campaign for federal health reform that provides for quality and affordable coverage for all Americans. As several speakers said, individual consumers should not be left all alone at the mercy of the big insurance companies. Health reform needs to include strong oversight of the insurers to ensure basic standards of coverage.

Labels: Insurers, Legislation, Research

posted by Anthony Wright | Permalink | 12:42 PM

Two California-specific reports came out this week on the uninsured, as noted by the Sacramento Bee and other papers, and they are sobering.

Families USA came out with a California-specific report, Americans at Risk, that showed a new light to the regular uninsured numbers. It's commonly understood that the number of uninsured is in the 5-7 million range in California, 44-46 million nationally. But those numbers seem to imply that the uninsured are a self-contained, even if large, population--rather than the reality than being uninsured is a condition that anybody can fall into.

In fact, Californians are more likely to become uninsured than residents of all but a few other states. The studies looks at the uninsured over two years, and finds that over 12 million Californians, or 37% of Californians under 65, have been uninsured at some point in 2007-08. More about the research is reported by the Los Angeles Times, as well as public radio.

The UC Berkeley Labor Center also released a new health care study this past week: “No Recovery in Sight: Health Coverage for Working-Age Adults in the United States and California.” As reported in the Sacramento Business Journal article, the UC-Berkeley researchers calculated how many people in California have lost their health insurance during the current recession--500,000.

Even more distressing is that the researchers projected what would happen to health coverage rates as the economy recovers, and they found that even when the economy recovers from the recession, the number of people who are uninsured will continue to grow.

Certainly a compelling context for the Forum on Health Reform Monday, in Los Angeles, which is ground zero for the uninsured crisis nationally.

Labels: Research, Uninsured

posted by Anthony Wright | Permalink | 12:36 AM

With all the back and forth about health reform in Washington, DC, California will get a little bit of the spotlight in the next week.

On Monday, April 6th, Governor Schwarzenegger, along with Washington Governor Christine Gregoire and a representative of the Obama Administration will host a Western Regional White House Forum on Health Reform, which will be held at The California Endowment in downtown Los Angeles. It will be a short hour-and-a-half event, with participation from satellite-linked events in San Diego, Oakland, and Clovis. But it will focus high-profile attention on the issue of our broken health care system, and the need for reform.

Tomorrow, we'll be co-releasing a new California-specific report from Families USA that indicates that the number of people who have been uninsured over the past two years is actually larger than you might realize--uninsurance is not contained within a small population, but is something than many of us experience at some point. The report, based on data from the Census Bureau and the Agency for Healthcare Research and Quality, reveals that, nationally, one out of every three non-elderly people, or 86.7 million Americans, were uninsured during 2007-08. The report will have California-specific numbers and demographic information.

California has a more significant health crisis than the nation as a whole, and so the attention is needed.

Labels: Research, YearOfReform

posted by Anthony Wright | Permalink | 11:37 AM

To add insult to injury, the Governor also eliminated funding for the UC Berkeley Labor Center. It was the only line item veto in the UC budget. The Governor did this even though his Administration relied on the work of the Labor Center in doing health reform in 2007. The UC Labor Center did numerous publications on health care which all of us who struggled with health reform rely upon, publications on the impact of an employer mandate and important work done jointly with UCLA on affordability for individuals that separated out those who are in the individual market from those who are employees. (No surprise: those who are in the individual market suffer from lack of affordability much more than those who get coverage on the job.) You can find these publications at www.laborcenter.berkeley.edu.

I guess we should not be surprised: a Governor who would once again delay funding for one of his own signature programs, the prescription drug discount program for the uninsured, and who would toss a quarter million kids or more off Medi-Cal, is the kind of Governor who would single out a research effort that had worked with his Administration on health reform. Of course, he did not veto funding for any of the business schools on the various UC campuses.

Speaker Bass in her media release said it well:

“The Governor has also broken his promise, again, to fund the Miguel Contreras
Labor Institute. I am deeply disappointed in his actions today, and they set the
stage for yet another difficult budget in the year ahead.”

Labels: Bass, Budget, Research, Schwarzenegger

posted by Beth Capell | Permalink | 7:27 AM

There's been lots of quotes regarding the latest Census data, including our comments in Victora Colliver's article in the San Francisco Chronicle.

But the one that has gotten the most attention are those of John Goodman, speaking to the Dallas Morning News.

California still has the highest number – not percentage – of uninsured residents at 6.7 million, compared with 5.7 million Texans. The Texas number is up from 5.5 million in 2006.
But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain's health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)
"So I have a solution. And it will cost not one thin dime," Mr. Goodman said. "The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.
"So, there you have it. Voila! Problem solved."

Amazing...a McCain advisor wanting to simply define away the uninsured... in a just world, that should get a public rebuke worse than Sen. Gramm suggesting that America was only going through a "mental recession."

Some commentators have already pounced, including Ezra Klein and Joe Klein (no relation).

But even these rebukes don't actually explicitly refute the misconception that Goodman's comments are based on--so I will. Yes, Health Access California was founded 20-years ago, from a coalition working for a law that people are not turned away from emergency rooms based on insurance status. The eventually-passed federal version of that law, EMTALA, is important, but let's be clear what it does, and doesn't do:

* The law only requires emergency rooms to stabilize patients, not treat them. If you just had a car crash or heart attack, they will treat you, but if have cancer, asthma, diabetes, or any other long-term illness, there's no obligation by the hospital.

* Even in an emergency situation, there's no prohibition on what the hospital can charge. And in fact, the uninsured is often charged 2-4 times what insurance companies and public programs pay for the exact same service. That's the bill they get.

So even our EMTALA law does not ensure access to care, and certainly not *coverage* for care. People need care, and they need coverage to pay the bills. And the Census figures show a staggering number of people who have neither.

The irony is that the Census figures do have a "voila" moment. It shows that policy matters: states like Hawaii, Massachusetts, and Minnesota--that have set standards for employer based coverage, or have expanded public programs--have significantly lower uninsured rates in comparison to other states.

We know what we need to do to say "Problem solved!" But it's not by sweeping it under the rug.

Labels: Federal, Research, Uninsured

posted by Anthony Wright | Permalink | 3:25 PM

It's useful context to look at the broad numbers:

Out of nearly 300 million Americans, 253.4 million (85%) have coverage, nearly 45.7 million (15%) do not. 202 million (67.5%) have private coverage: About 177.2 million (59%) have employer-based coverage, and a relatively small 26.7 million (9%) buy coverage as individuals. 83 million (28%) have coverage through public programs: 39.6 million (13%) have Medicaid, 41.3 million (14%) have Medicare, and 11 million (4%) have coverage through the military.

California's uninsured rate inched up, to a 3-year average of 18.6%, up from 18.4% and 18.5% earlier in the decade. The Census figure pinpoints the number at 6.7 million uninsured. There are other figures, such as those from the California Health Interview Survey of the UCLA Center for Health Policy Research, which have different survey technique, and ask some different questions (Are you uninsured now? vs. Have you been uninsured in the past year?) Even with those differences, the Census data is important to indicate scale, trends, and baseline comparisons with other states.

Only six states have a higher percentage of uninsured residents than California: Texas, New Mexico, Florida, Arizona, Louisiana, and Mississippi.

The states with the lowest rate of uninsured are Massachusetts, Hawaii, and Minnesota, which suggests that state policy matters: you can you could look to the policies and reforms in the states to see how they have been able to reduce the uninsured rates.

Labels: Research, Uninsured

posted by Anthony Wright | Permalink | 10:17 AM

Steve Lawrence at the Associated Press writes about the new, troubling unemployment numbers released yeaterday. There was an attempt to make a connection with the budget, but some legislators came to the wrong conclusion.

Republicans said the jobless figures provided more evidence that lawmakers shouldn't consider tax increases to help eliminate a $15.2 billion state budget deficit.

"Our unemployment rate will grow far worse and more Californians will lose their jobs if we pass a budget that increases taxes," said Assembly Minority Leader Mike Villines, R-Clovis.

But health care advocates said state budget cuts would also lead to more job losses, partly because the state would be unable to put up seed money needed to attract hundreds of millions of dollars in federal aid. "The worst thing you can do for the economy is make cuts, especially to health care," said Anthony Wright, executive director of the nonprofit advocacy group Health Access California. "I think it's very clear that health care cuts specifically would have three times as great an economic impact as an increase of taxes on the upper income."

That's the conclusion of the two studies Health Access released yesterday, as evidenced by headlines like "Health Care Cuts May Hurt Economy" in the Stockton Record, and "Medi-Cal Cuts Hurt Everyone, Not Just the Poor, Study Says" in the Bakerfield Californian.

The Bakersfield Californian also has a quote from a Republican Senator, one we wholeheartedly agree with.

“Reductions in Medi-Cal causes increases in costs in other places,” said Sen. Roy Ashburn, R-Bakersfield, who wants the 10 percent cuts restored in the budget. “The fact is that the state underfunds the program.”

By raising the revenues needed to prevent cuts to health care, legislators can BOTH restore crucial funding to our health care system, and help stimulate our economy.

The two reports, "Adverse Reaction: Proposed Health Budget Cuts Would Lead to Increased Health Insurance Premiums" and "Significant Side Effects: The Economic Impacts of Health Care Cuts in California Communities" are available on the front page of the Health Access website.

Labels: Budget, MediCal, Research

posted by Anthony Wright | Permalink | 3:40 PM

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.

Labels: MedicalDebt, Research, Underinsurance

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

High gas prices, a sputtering economy, global food shortages the obesity epidemic and countless other apocryphal trends make the headlines and have spurred interest in locally grown goods, farmers markets and "Slow Food" (I'm still trying to figure out what the heck that is.)

I really love food. I love the farmers' market. I plan my weeks and weekends around the farmers market. I feel really fancy, wholesome and healthy buying my food directly from the Hmong and Latino farmers, and I prefer the taste of farmers' market food to Safeway (sorry, Steve Burd.) But the small family farmers who are raising goats, planting tomatoes and picking cherries are doing this at risk to their own financial well being and health. The Boston-based Access Project recently published a paper about the health care burdens that California's farmers face.

Farmers tend to be wealthier than the average citizen and are more likely to be insured. On average, they spent nearly $9,000 annually on premiums and out-of-pocket expenses, which constitutes between 9 and 44 percent of the family's income. High health care expenses:

Made it hard for farmers to pay other bills;
Meant farmers delayed investments in their farm;
Took time off farming/ranching.

According to the report author, Carol Pryor, "The survey shows that most farmers and ranchers are trying to do the right thing by getting coverage, but they aren't finding products in the (individual) market that are affordable and that provide them with financial protection if they get sick. This is a case of product failure.''

If not for moral reasons, wouldn't the like-minded food obsessed want to keep our farmers healthy?

I'll do a quick shameless plug for a few of our bills here that would start us down the track of easing health care burdens for farmers:

SB 1522 (Steinberg) would organize the individual insurance market, where family farmers need to buy their coverage, and establish a minimum benefit package that includes doctors visits, hospitals and preventive care;
AB 2967 (Lieber) woudl require insurers and healthcare providers to provide better data on the cost and quality of care, and create pressure to drive down rapidly escalating health care costs;
SB 973 (Simitian) would create a public insurer that would enable farmers to buy in to a system that is publicly run and competes with private insurers;
Rescission bills (AB 1945, AB 1150, AB 2549 and AB 2569) rein in the insidious insurer practice of retroactively cancelling coverage of people who have been paying premiums and believed they were covered.

Labels: ExpandingCoverage, Research, Underinsurance, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 11:32 AM

Health Access Blog

California's Benefit...

Friday, April 02, 2010

Health care = Jobs

Friday, March 26, 2010

Shocking Numbers: 8.2 Million Uninsured in CA!

Monday, March 15, 2010

The cost of not fixing our health system...

Do California leaders need to stay after school?

Monday, January 25, 2010

Budget blues...

Tuesday, January 12, 2010

The Damage Already Done by the 2009-10 Health Cuts...

Thursday, January 07, 2010

New facts about why health reform is needed in CA...

Thursday, December 17, 2009

You get what you pay for...

Monday, November 30, 2009

With children, tough choices...

Sunday, November 01, 2009

It's time to deliver...

Tuesday, October 20, 2009

Uninsurance--it's bigger--not smaller--than you think.

Monday, September 14, 2009

The grim new Census numbers...

Thursday, September 10, 2009

New data on debt shows need for action...

Monday, August 31, 2009

Get well soon, Rick!

Facts from San Francisco...

Monday, August 24, 2009

It just gets worse... We're #4!

Monday, August 03, 2009

Major congressional caucuses push health reform...

Monday, June 22, 2009

The public is for the public health insurance option...

Thursday, June 18, 2009

New report details lack of competition in CA...

Wednesday, June 03, 2009

What you get coverage for...

Wednesday, May 13, 2009

Watching where the premium dollar goes...

Tuesday, May 05, 2009

New info and efforts on underinsurance...

Wednesday, April 15, 2009

When things get worse...

Sunday, April 05, 2009

Watching the West Coast...

Wednesday, April 01, 2009

Bit by COBRA....

Friday, January 16, 2009

How bad is it?

Monday, December 08, 2008

Further sad economic news that will get even worse..

Thursday, September 25, 2008

What was that for?

Wednesday, September 24, 2008

"Voila! Problem solved!"

Thursday, August 28, 2008

Getting a sense of the landscape...

Tuesday, August 26, 2008

Go Medicaid....(!?!)

Quotes from Republican legislators...

Saturday, August 16, 2008

Lots of Studying Going on

Wednesday, August 13, 2008

Slowing, but still increasing

Tuesday, August 12, 2008

Another reason to pick on HSAs ...

Wednesday, August 06, 2008

Healthy Food

Tuesday, July 29, 2008