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Anthem Blue Cross withdraws rate hikes, for now...

Thursday, April 29, 2010
 
California consumers got some relief today. Insurance Commissioner Steve Poizner announced that Anthem Blue Cross of California has withdrawn their rate filings, after a review of an independent actuary has revealed various problems, including arithmetic errors and double-counting.

The rate hikes of up to 39% were controversial, the subject of a white-hot presidential spotlight during the health reform debate.

It's great that California ratepayers got a reprieve from outrageous rate hikes by Anthem Blue Cross of California.

But more than rate relief, this withdrawal of the rate hike proposals show why we need regulators to have active oversight over the insurance industry. This review was done under existing law, which provided very limited authority, and it was still able to find basic problems in arithmetic and double-counting.

Oversight and regulation matter. This shows why more extensive oversight is needed, some of which is in the federal health reform that passed, and additional rate review proposals that are pending at both the state and federal levels.

Federal health reform (and pending state implementation) would create health insurance exchanges, where people buying coverage as individuals could join and benefit from group purchasing to negotiate for better prices and value. There are also pending proposals at both the state and federal levels to have rate review and approval authority, especially in the period before 2014 when the exchange come into full effect.
* At the federal level, California Senator Feinstein has a proposal to regulate rates at the federal level, especially for states that don't have a rate review process.
* California is one of those states that does not have rate review, but there are pending bills. Assemblyman Dave Jones has a rate approval bill, AB2578. State Senator Mark Leno has a bill for insurers to disclose their rate methodology, SB1163.

We need these continued reforms, so when Anthem Blue Cross resubmits rate hike proposals, there's a process to properly review them.

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posted by Anthony Wright | Permalink | 7:39 PM


 
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The Governor embraces health reform

 
Earlier today, Governor Schwarzenegger gave a big speech at UC-Davis Cancer Center here in Sacramento, unveiling his approach to implementing health reform in California.

As we reported on Twitter (at www.twitter.com/healthaccess), he embraced the reform. He called himself a "longtime fan and big believer" in health reform. (Some will remember that hasn't always been the case, but...) He even took credit for health reform (with some justification), saying that his 2007 effort on health reform was "the model" for federal reform. "It is a good law," he said emphatically.



Here's a full fact sheet on what he announced today.

In particular, he wants California to establish a new high-risk pool to cover those denied for pre-existing conditions, alongside our current small and struggling pool, MRMIP, which has a waiting list. Tomorrow is the deadline that Governors had to tell the federal government if they wanted to run their own program or simply let the federal government do it for us.

The Governor also endorsed the implementation of a variety of insurance regulations in the federal law, and the creation of an health insurance exchange. That's notable because despite the fact that it's not a requirement this year, both Assembly Speaker Perez and Senate President Pro Tem Steinberg have bills to create the exchange--which would be good for Californians. Now all the key leaders are endorsing moving ahead, which means the negotiation is really about the details. The Governor also said he is willing to consider a special session to do this work if necessary, although the current bills are all moving along in regular session.

There weren't tons of details--we'll be watching carefully: the news was the Governor's renewed enthusiasm and attitude about implementing health reform. Some outlets have noted the importance of having the nation's most prominent Republican Governor move ahead in this way.

As HHS Secretary Kim Belshe said, "No state is better positioned to make health reform deliver... California is ready to act. This Governor is ready to lead." We look forward to working to fulfill the promise of reform for Californians.

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posted by Anthony Wright | Permalink | 7:18 PM


 
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The continuing campaign in Congress...

Tuesday, April 27, 2010
 
We've blogged a lot about how health reform fight moves to the state. But it continues in Congress as well. In particular, California's two Senators are continuing the fight for rate review.

Senator Feinstein had called on WellPoint/Anthem Blue Cross to drop plans for the rate hike on Californians (one that has been delayed pending an independent investigation for the California Department of Insurance) most recently during a speech on the floor of the U.S. Senate last Friday:




Senator Feinstein also has a scathing essay in the Huffington Post on Anthem Blue Cross' practices as well.

The Health Insurance Rate Authority Act of 2010, authored by Senator Feinstein and co-sponsored by Senator Boxer, would give the U.S. Secretary of Health and Human Services the authority to review and reject unfair premium rate increases in states where Insurance Commissioners do not have the authority or capability to do so. This is especially key for states like California, which do not have rate review, and important for the period between now and 2014, before the exchanges are functional and can use their negotiating power.

This bill is something that Senator Feinstein is looking to move, so stay tuned...

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posted by Anthony Wright | Permalink | 6:27 PM


 
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Bartering and exchanging...

Saturday, April 24, 2010
 
There's been a lot of attention to the comments of Sue Lowden, who is running as the Republican frontrunner for the U.S. Senate seat now held by Senate Majority Leader Harry Reid in Nevada. At a town hall meeting, when describing her alternative to the health reform bill that passed, Lowden talked about going back to the world where patients would "barter" with their doctor. In a follow up interview, she didn't back down from this quaint notion, and in fact talked about "taking a chicken to the doctor."

There have been Jay Leno jokes and other responses, including this video that sets her comments to music...



Beyond the silliness of bartering with a chicken to the doctor, there's also the issue of how many chickens it would take, especially for more advanced procedures. Some websites have been designed to make this point, including one that actually calculates the numbers of chickens various procedures, like a hip replacement, would cost.

But Lowden clearly meant what she said, and deserves the ridicule. But there's a serious debate here that should not be overlooked. One is that some folks really do want to just go back to the good old days, as if medicine hasn't advanced and gotten more complicated and expensive in the process. Harkening back to history isn't a good way to deal with our current and future challenges in health care.

Let's take away the (admittedly humorous) statements about "chickens" and even "bartering." It is equally ridiculous to suggest that individual consumers are in a position to bargain with their doctor. Yet it is an article of faith among some politicians that the real solution to increasing health care costs is to shift the costs onto individuals, have them pay cash, which would "empower" them to bargain for a good price.

For those who raise the fear that reform would make health care like a trip to the DMV, it's strange to argue that health care should really be more like a trip to a used car salesman. Not only would that be needlessly stressful to have to bargain (especially at a time when you were sick), but the individual has little market power. Those who have been the best at negotiating have been large purchasers, like big employers or CALPERS, that negotiate on behalf of hundreds of thousands of people, that have the staff wherewithal to examine the data, make comparisons, and challenge insurer statements.

This is a relevant debate right now. As part of implementating federal health reform, there are bills to set up a new health insurance exchange, AB1602(Perez) and SB900(Alquist/Steinberg), in the California legislature. It is critical that this new exchange use its bulk purchasing power as an "active purchaser," to bargain on behalf of the millions that will get coverage through the exchange, for the best price and value.

So there's two different visions. One is an exchange that negotiates for the best cost and quality. Another is to simply let any insurer sell anything, and let individual consumers fend for themselves, and get deal on their own, with chickens or whatever else--frankly, it's less of a free market than a flea market, letting the buyer beware.

In this continued health reform debate, in Nevada and here in California, we shouldn't be chicken in our efforts to defend consumers.

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posted by Anthony Wright | Permalink | 10:09 PM


 
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The Senate spotlights the new exchange...

Wednesday, April 21, 2010
 
HEALTH ACCESS UPDATE
Thursday, April 22, 2010

SENATE HEALTH COMMITTEE MOVES BILLS
TO LAUNCH STATE'S HEALTH REFORM
* Pair of Bills By Chair Elaine Alquist Allows California to Swiftly Move Forward
* Insurers Urged to Offer More Consumer-Friendly Policies on the Individual Market
* Apples-to-Apples Comparison Shopping in Individual Market is Closer to Reality
* Vice Chair Strickland's Challenge to Expansion of Medi-Cal is Voted Down

Read Our Health Access Blog! Join Us on Facebook! Follow Us on Twitter!

KEY SENATE BILLS PASS SENATE HEALTH COMMITTEE: On Wednesday, California continued its march toward making health reform meaningful here as a pair of bills authored by Senate Health Committee Chair Elaine Alquist and Senate President Pro Tem Darrell Steinberg won committee approval.

These and other key consumer protection measures all passed on a 5-0 vote. Due to sickness and/or scheduling conflicts, all three Republicans and one Democrat on the committee were absent, thus requiring a unanimous vote from the remaining five Democrats in order for bills to proceed.

SB 900 (Alquist/Steinberg) sets up a new insurance exchange that actively uses its negotiating power to seek out the best deals for individual and small group policyholders. SB 890 (Alquist/Steinberg) standardizes and simplifies the health insurance market so that consumers better understand their choices and can make apples-to-apples comparisons.

SB 900 is similar to AB 1602, authored by Speaker John Perez, which the Assembly Health Committee passed on Tuesday. The measures are expected to be reconciled further along the legislative process, as the flagship measures to deliver on federal health reform's promise, and create a fair, consumer-friendly exchange as a market where consumers could shop for the best policies at the best prices would be fulfilled.

In introducing her bill, Senator Alquist said, "This establishes the exchange as an active purchaser that will try to get the best possible deal for consumers shopping for individual policies." She said the exchange would be administered by a board of legislative and gubernatorial appointees that would meet in public every two months. The board will be held accountable for its decisions, Alquist said.

Health Access advocate Beth Capell said it is estimated that between three and nine million Californians would get coverage through the exchange. The exchange will ensure that people are charged for health insurance on a sliding scale, so those who make less will be charged less, and those with higher incomes will pay prices according to a sliding scale as well. It is envisioned that this fundamental building block of health reform in California would be consumer-friendly enough to attract small businesses into the exchange.

An exchange might reduce the number of uninsured in California -- currently estimated at 8.2 million -- to roughly 2-3 million. "We are hopeful that the exchange will help create a real culture of coverage in California," Capell told committee members.

Alquist's SB 890 aims to standardize the range of policies that are available to individual consumers so that "apples-to-apples" comparisons could be made. The bill standardize the market, from the current "confusing maze of over 100 products" where consumers have little ability to determine the differences between plans.

"This would be the first step in beginning to implement health care reform," Alquist said. "We need to restructure for Californians the market in which they buy their own insurance." As many as 2.5 million Californians, or 7% of all Californians, shop and pay for their own insurance in the growing individual market, which has been largely unregulated

SB890 received broad support from a range of stakeholders, including Health Access California, Kaiser Permanente, Congress of California Seniors, California Medical Association, California Hospital Association, and many others.

Insurers and brokers raised concerns with both bills. A common refrain was to wait until the federal government issued more clarifying regulations. An ongoing issue spotlighted by the insurers was about any provision that went beyond the federal law.

Nevertheless, California is moving along at establishing federal health care reform at a quick clip. The state is well-poised to make swift and certain progress at reform, in part due to extensive policy work done in 2007, when California nearly passed its own version of reform before Governor Schwarzenegger's "the Year of Reform" was squelched.

In other important action:

* The Senate Health Committee also passed legislation by Senator Mark Leno (D) to require health plans and insurers to disclose information justifying premium rate hikes and the methodology and frequency of their coverage denials to consumers. Leno's bill, SB 1163, would also require insurers to disclose impending premium increases 180 days before they go into effect -- rather than the 30-day notice current law requires. Leno noted that increases in premiums have far out-paced actual increases in medical costs. In 1960, he said, health insurance premiums made up 5% of the Gross Domestic Product; in 2000, that proportion grew to 13% of the GDP; in 2010, it grew to 17.3% of the GDP; -- and by the year 2025, if that rate of growth were not stopped, health insurance premiums would make up 25% of the GDP. "It is completely unsustainable," the senator said.

* SB 1283, by Senate President Pro Tempore Darrell Steinberg (D) also passed with a 5-0 vote out of committee on Wednesday. The bill would require a closer examination of the Department of Managed Health Care's progress at responding to consumer complaints, grievances and appeals of denial of coverage. A consumer testified that when an autistic child needed prompt medical treatment and was denied it by Blue Shield, the grievance process was so slow and ineffective as to take nine months instead of the legally required seven-day process. Steinberg's bill would allow consumer advocates to examine whether the Department is following the letter of the law of the 1999 Patient Bill of Rights that Health Access and a broad consumer coalition established. Health Access advocate Beth Capell told committee members: "We need to revisit a law we put into place a decade ago and get families the care they need when they need it -- and not see them subjected to Dickensian delays."

* SB 1088, authored by Senator Curren D. Price Jr. (D), was passed by the committee.. The legislation would build a bridge to uninterrupted insurance coverage for young adults up to age 26 who are on their parents' policy as students of a four-year university. Prior to federal health reform, a university graduate would be dropped as a dependant from a policy.

* Another bill by Senator Leno would require insurers to provide timely access to care to children at school. SB 1200 clarifies existing law to make certain that health plans cover children with chronic conditions such as asthma while they are in school.

* During most bill deliberations on Wednesday, lobbyists for the insurance industry were hard-pressed to argue why they might oppose the bills. In the wake of federal health reform, last year's oft-repeated, pro-industry opposing argument -- that any additional mandate would simply add to insurance company costs, and ultimately spread higher costs to all policyholders -- lost its punch. With reforms now the law of the land, the California Association of Health Plans, Health Net, Anthem Blue Cross and industry special interest groups were being very watchful of any changes to the California individuals market.

* And the partisan position that opposed federal health care reform lost ground as well on Wednesday. Senator Mark Wyland, standing in for Vice Chair Tony Strickland (R) presented an opposition bill that protested against the expansion of Medi-Cal -- as called for by federal health reform -- as too costly. But Capell pointed out that allowing people with incomes up to 133% of the poverty level to qualify for Medi-Cal also brought with it the promise of $124 billion in federal funds for California in the next decade. She and other opponents made clear that the the federal government was paying for 100% of the cost of newly eligible patients, and even after some phasing down until 2020, the federal government would provide a higher 9 to 1 marching rate. That pretty much took the steam out of the protest bill, which failed to pass by a 0-5 vote.

Many of these bills are now headed to the relevant Appropriations Committees for review. For more information, contact Health Access California.

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posted by Anthony Wright | Permalink | 11:24 PM


 
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Implementing and improving health reform...

 
HEALTH ACCESS UPDATE
Wednesday, April 20, 2010

ASSEMBLY HEALTH COMMITTEE LAYS CRUCIAL GROUNDWORK
FOR HEALTH REFORM
* CA Assembly Health Moves Several Bills to Line State Up With Federal Health Reforms
* Groundwork is Laid for a State-Run Exchange, Expanded Medi-Cal, High-Risk Pool
* AB 2244 Passes, Protects Kids from Discriminatory Pricing Based on Health Status

* Read our Blog, Join Us on Facebook! Follow Us on Twitter!

In a "deadline" week, the California Assembly Health Committee on Tuesday passed a package of health care consumer protection measures, which lay down some basics for making federal health reform real in California.

CHILDREN FIRST, PLEASE: One prominent bill was AB 2244, by Assemblyman Mike Feuer (D). The bill, sponsored by Health Access on behalf of its coalition members, "phases in several key provisions for children," Feuer told the committee.

The rollout of the Patient Protection and Affordable Care Act signed by President Obama on March 23 begins with children. Insurers will no longer be able to deny coverage to children with pre-existing conditions, and they will also have to rescind pre-existing condition exclusions for children already covered by their family policies.

AB 2244 goes beyond federal law in not just preventing denials, but limiting discriminatory charges for "pre-existing conditions" for children as well. The bill phases in "modified community rating" so that insurers are limited to charging plus or minus 20% for a child's health status. The price difference would be phased to plus or minus 10%, and then to no different charges allowed by 2014.

The bill had the support of the Congress of California Seniors, Consumers Union, the 100% Campaign, the California School Employees Association and others. Speaking out in opposition were the California Association of Health Plans and the California Association of Life and Heallth Insurance Companies, saying they believed AB 2244 was "premature."

The opposition by insurers was not a surprise. Just days after Obama signed the landmark law, insurance companies tried to interpret the new rights for children very narrowly. Not so, said the feds. This woule take the next step. In the Assembly Health Committee, the vote was pretty clear: "11 Ayes" and 6 "Nos". The measure now goes to the Assembly Appropriations Committee.

MAKING MEDI-CAL AVAILABLE TO MORE CALIFORNIANS: AB 1595, authored by Dave Jones (D) lined California's income eligibility requirements right up with the new federal law. Under federal reform by January 2014, Medi-Cal, which is administered by the Department of Health Care Services, will offer Medi-Cal coverage to all adults who earn up to 133% of the federal poverty levels -- even adults without children. The income ceiling would be $14,404 for individuals and $29,326 for a family of four.

Funding for the expansion of Medi-Cal will come from Washington, which will provide 100% of the cost of newly eligible starting in 2014 for the first three years. Then the percentage starts to taper off a bit so that, by 2020, the federal government is sending 90% of the cost of newly-eligible Medi-Cal patients. Health Access is in support of the measure, which passed out of committee with 10 votes. Also in support are the 100% Campaign, the Western Center of Law and Poverty, and the American Federation of State, County and Municipal Employees.

THE CALIFORNIA PATIENT PROTECTION AND AFFORDABLE CARE ACT: Assembly Health Committee members adopted Speaker John A. Perez's central bill, AB 1602, which is more or less the leader of the package. AB1602 "makes several sweeping changes," said Perez (D). Among them are creating the California Health Benefit Exchange, where individuals and small businesses can purchase health care coverage. The measure also prohibits group of individual health care plans from establishing lifetime or unreasonable annual limits of the dollar value of benefits. Carriers will also be required to provide preventative services, outlaws denying people coverage for pre-existing conditions and extends dependent coverage to young adults up to age 26. "Let's be clear," Perez told the committee. "Federal health reform is now the law of the land and California will implement it fully." He described the bill as "by necessity a work in progress as we still need an enormous amount of guidance" on implementation from the U.S. Department of Health and Human Services. The bill won 12 votes in its favor.

MATERNITY COVERAGE, ONCE AGAIN: California insurers have been dropping maternity coverage steadily for years now. Just four or five years ago, 82% of policies [CLARIFIATION: offered in the individual market] included maternity coverage and now only 19% do. Arguing in favor of AB 1825, Assemblywoman Bonnie Lowenthal (D) said, "We can't wait another four years to see what happens." She presented AB 1825 for her colleague, Assemblyman Hector De La Torre, who authored the bill. Health Access, the California Medical Association and many other groups supported the bill, which requires every individual or small group health insurance policy to cover maternity services. Insurers had been dropping the coverage from plans in an effort to make them more affordable and sell more policies. Several organizations, however, have criticized this practice as part of an overall trend of gender discrimination by insurance companies. AB 1825 passed with 12 "aye" votes and 6 "nos."

The Senate Health Committee is due tomorrow with more key bills on health reform. More bills to implement and improve health reform are available for review here.

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posted by Anthony Wright | Permalink | 12:20 PM


 
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Healthy Families cuts rejected in subcommittee...

Tuesday, April 20, 2010
 
HEALTH ACCESS UPDATE
Tuesday, April 19, 2010

FEDERAL HEALTH REFORM TO RESHAPE GOVERNOR'S BUDGET PROPOSAL
* Assembly Budget Subcommittee Hears Testimony Against Cuts to Healthy Families
* Several Testify Against Schwarzenegger's Harshest Scenarios for Children's Health
* New Federal Health Reform Renders Governor's "Trigger" Proposals Illegal

* Read our Blog, Join Us on Facebook! Follow Us on Twitter!

On Monday, the Assembly Budget Subcommittee on Health and Human Services, chaired by Assemblyman Dave Jones (D), examined the impact federal health reform will have on Governor Arnold Schwarzenegger's state budget proposal.

The subcommittee specifically focused on some of the programs and services Schwarzenegger threatened to eliminate in his "trigger" scenario, a proposal that would be "triggered" should the nearly $7 billion in additional federal funds that the Governor budgeted not materialize.

While agency heads were noncommital about how the governor's budget fits with national health reform, saying they were still studying the matter, advocates stepped up to state clearly where the federal health reform prevents specific cuts.

LAYING DOWN THE LAW: Elizabeth Landsberg of Western Center of Law and Poverty told the subcommittee that, under the new law signed by President Obama, certain programs were protected from being dismantled or scaled back. These include Healthy Families, which insures nearly 1 million children in California from families that pay premiums according to their income, the AIM program for infants and mothers, and even the MRMIP high risk pool health insurance of last resort for those who are denied coverage in the individual insurance market. Beth Capell of Health Access added, "These would plainly violate the MOE," in reference to a "maintenance of effort requirement" included in the new federal law that requires programs to provide the same level of services as before the reform passed into law.

A few weeks ago, Arizona became the first state to shut down its CHIP program -- the same federal-state children's health insurance program as Healthy Famillies -- through state legislation. But Arizona lawmakers overshot their authority. The federal Centers for Medicaid Services "has indicated that this is in violation of federal health care reform," a subcommittee staff report stated.

Amid the analysis of federal health reform requirements, a Department of Finance representative for the Administration suggested that the governor's "trigger" proposals to eliminate these and other programs "are not budget proposals, although they may be in the May revise." Jones indicated that statement was contrary to everything the governor said previously.

Even the Legislative Analyst's Office representative said the trigger proposals "violate federal law." Leslie Cummings, executive director of the Managed Risk Medical Insurance Program, said "there's so much I can't claim to know definitely yet."

The Assembly Budget Subcommittee ended up, by a 4-1 vote (with one not voting), REJECTING the following budget proposals:
* Eliminating the Healthy Families program;
* Reducing eligibility in Healthy Families from 250% to 200% of the federal poverty level;
* Increasing premiums in the Healthy Families program
* Eliminating the vision benefit in Healthy Families
* Eliminating Prop 99 Funding for AIM

Besides running Healthy Families and AIM, the Managed Risk Medical Insurance Board (MRMIB) also administers the Major Risk Medical Insurane Program (MRMIP), the high-risk pool for those denied by private insurers for "pre-existing conditions." Funding proposals were left open, as more information becomes available about the implementation of federal reform in this area.

As always, no budget decision is final until a full a final budget is signed into law.

The hearing focused only on the programs in MRMIB. Next week, Monday, April 26th, at 1:30pm, the Assembly Budget Subcommittee is scheduled to look at proposed Medi-Cal cuts. FYI, Medi-Cal enrollment eligibility has already been protected from cuts under an MOE, as a condition of getting additional Medicaid dollars in the federal recovery act. However, neither the enhanced Medicaid dollars nor federal health reform prevents state governments from cutting certain Medi-Cal benefits or provider rates. The hearing would be a time for health advocates to express their opposition to such Medi-Cal cuts.

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posted by Anthony Wright | Permalink | 12:47 PM


 
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What does it mean to repeal health reform?

Monday, April 19, 2010
 
Rather than talking about how to implement and improve health reform, and working so it most benefits Californians, some candidates for U.S. Senate and Governor here in California are talking about repealing it, or legally challenging it, or otherwise.

Speaker Nancy Pelosi's blog has a rejoinder for them and others: So which of these provisions – available to Americans this year – do they want to repeal?

* Do they want to repeal the small business tax credits that will make employee coverage more affordable?
* Or the $250 rebate to America’s seniors who have fallen into the Medicare Part D ‘donut’ hole pay for prescription drug coverage?
* Do they want to repeal the ban on insurance companies dropping people from coverage when they get sick?
* Or the prohibition on insurance companies denying coverage to children with pre-existing conditions?
* Do they want to repeal the ban on insurance companies placing lifetime caps on coverage or the ban on restrictive annual limits on coverage?
* Or the new, independent appeals process that ensures consumers have an avenue to appeal decisions by their health insurance plan?
* Do they want to repeal the temporary high-risk pool that will provide immediate access to Americans who are uninsured because of a pre-existing condition?

* Or do they want to repeal the requirement that health plans allow young people to remain on their parents’ health insurance plan up to their 26th birthday?

Good questions, for reporters to ask all candidates for office this year.

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posted by Anthony Wright | Permalink | 12:04 PM


 
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Cartoon congratulations...

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

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



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

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

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posted by Anthony Wright | Permalink | 4:43 PM


 
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Closing a virtual chapter...

 
I knew this day would come.

No, not the passage of health reform. The end of Jonathan Cohn's blog, The Treatment.

For me and many others, the blog was a go-to source for both the latest update on process and good analysis on substance. As someone who had literally written the book on the health care crisis in America, Jonathan Cohn provided both the knowledge of complicated health policy wonkery, and the savvy of a reporter to decipher and explain the political process--but without the corrosive cynicism so often employed in his profession. He's also just a nice person, with good values and a sense of fairness, even to those with whom he disagrees.

As he describes in his farewell post, his reporting also performed an important function at the magazine The New Republic, exorcising the past mistake of publishing the discredited Betsy McCaughey's false yet devastating attack on the Clinton health reform proposal in 1993. The New Republic's productive role in the past year's health reform debate provided a kind of karmic balance.

I was honored that Jonathan asked me to contribute to the new blog he was starting up a year and a half ago. Beyond this and other blogs that focused on California policy and politics, I appreciated having a forum to weigh in on the federal fight. In my couple-dozen contributions, I tried to speak from experience, and provide a perspective of a Californian, of a veteran of previous reform fights, of an organizer not inside the Beltway echo chamber. I hope I was successful.

I actually am sad that The Treatment won't continue. I know from experience that a blog can be very demanding time-wise, and there's no doubt that with the law's passage, there may be a drop-off in interest.... But there's a lot of work is just beginning, at the Department of Health and Human Services; in 50 state Capitols; at state regulators; in the courts; and in the communities around the country. Here at the Health Access Blog, we'll continue to try to cover some of this here in California, but we have our own time and staff constraints as well.

Until then, thanks to Jonathan for his dogged work and reporting, and his virtual hospitality for my work. Here's a compilation of my TNR reports from how the health care debate was playing out in California:

* More Medicaid Means More Jobs 04/11/2010
* Medicaid: A Bargain, Not a Burden 04/07/2010
* And Now the Real Work Begins 03/24/2010
* More Alarming News from California 03/16/2010
* Would Obamacare Have Prevented the California Mess? 02/15/2010
* This Isn't the End (Trust Me, I've Been There Before) 01/28/2010
* Why Rush Limbaugh Hearts Health Reform 01/04/2010
* On the Job 11/04/2009
* Conflicts of Interest: Who Does the Chamber of Commerce Really Represent? 11/02/2009
* How Conservatives Are Doctoring Insurance Numbers--And Why Obama Needs to Fight Back 09/14/2009
* What Democrats Can Learn From Health Care Battles in Sacramento and Boston 08/28/2009
* How the Media Should Be Covering Town Hall Shenanigans 08/26/2009
* As California Goes, So Goes The Nation Without Reform 07/21/2009
* A Moneyball Approach To Health Reform 07/08/2009
* Are We Asking Too Much Of Employers? Or Too Little? 07/05/2009
* Young And Not So Invincible 06/25/2009
* Taming The Insurance Wilderness 06/05/2009
* How Reform Can Save California (Next Time) 06/02/2009
* Beat The Clock 05/05/2009
* Official State Business: Why Sebelius Makes Sense 04/02/2009
* Is Massachusetts A Model, A Mirage...or Moot? 03/25/2009
* Health Care Reform, A San Francisco Treat 03/12/2009
* Ronald McDonald Is Not Reform's Friend 02/14/2009
* This Cobra Doesn't Bite 02/09/2009
* The Kids Aren't Alright. Neither Are Their Parents. 01/28/2009
* Jump-Starting The Economy--and Health Reform 01/22/2009

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posted by Anthony Wright | Permalink | 5:10 AM


 
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Medicaid matters...

Monday, April 12, 2010
 
Implementation has already begun. On its health reform website, the U.S. Department of Health and Human Services has started today to request comments on key issues, from rate regulation to the setting of medical loss ratios, so that premium dollars do to patient care, rather than administration and profit.


The Obama Administration also today released guidance, through a letter from the Centers for Medicare and Medicaid Services (CMS) to the states, on early expansion of Medicaid. Themore details on the state option to implement a Medicaid program for low-income populations (up to 133% FPL). States can elect to begin covering this population effective April 1, 2010, until 2014 when the requirement for all states will begin.

That's the day when Medicaid expands: January 1, 2014. California should have a goal, that on day one, we get over a million of the newly-eligible onto coverage. With the federal government picking up the full cost for the first three years, there's every reason to maximize those federal dollars to provide the most help for the most people.

We've thought a lot about how to achieve this goal, and wrote a paper on the subject of how to make our Medicaid waiver a bridge to health reform, with a variety of streamlining, early enrollment, and pre-enrollment strategies to get Californians covered on day one.

As I wrote in two posts on The New Republic's The Treatment blog, Our philosophy is that Medicaid is a bargain, not a burden--the opportunity to get many Californians covered at little or no cost to our general fund. Medicaid can also be the centerpiece of a strategy for economic recovery, given the positive jobs impact for coverage.

How do we do it with the deficit in the state general fund? Maybe we don't it this year, but we plan for when the economy comes around between now and 2014. Maybe we look at the county dollars that are now spent on providing care to those under the poverty level, and see if there's a way to have those resources matched by these newly available federal funds.

So even given the severe budget crisis that California is under, we should look at the CMS letter, and see if there are creative ways to bring in dollars and begin to expand coverage, so we can be ready for January 1, 2014.

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posted by Anthony Wright | Permalink | 6:27 PM


 
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Explaining health reform in less than five minutes...

Thursday, April 08, 2010
 
Here's a quick video from the Center for American Progress on how health reform really works. It's gets into the broad architechture of reform (how this impacts consumers in the three ways people get coverage: employer-based health care, public coverage programs like Medicaid and Medicare, and buying insurance as individuals), as well as why it is important and how it is paid for, and all in less than five minutes.

Take a look:



Organizing for America has another snazzy video explaning health reform as well, and you can customize it for California as well.

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posted by Anthony Wright | Permalink | 6:54 PM


 
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Bills to implement and improve reform...

Tuesday, April 06, 2010
 
HEALTH ACCESS ALERT
Tuesday, April 6, 2010

HEALTH REFORM DEBATE SHIFTS TO IMPLEMENTATION BILLS IN CA LEGISLATURE

* California Effort Begins to Implement & Improve Federal Health Reform
* Health Committees in Assembly and Senate to Consider Bills in Next Few Weeks
* Today's Assembly Health Committee to Vote on Bill to Help Kids Stay on Coverage
* Groundwork is Laid for a New Exchange; New Insurer Accountability on Rates; Etc.
* ALERT: Organizational Support Letters Needed to Support Key Reform Bills!

* Read Our Health Access Blog! Join Us on Facebook! Follow Us on Twitter!

HEALTH REFORM HAS JUST BEGUN: Two weeks ago, President Barack Obama signed into law a historic health reform package, one that would reform the worst abuses of the insurance industry, secure coverage for those that have it, and provide new and affordable options for those that don't. One week ago, President Obama approved a "reconciliation" package of improvements to the health reform, the first of many that will be considered in the months and years ahead.

The work to implement and improve health reform at the state level starts today, with state legislation being considered today and over the next few weeks in health policy committees. A series of bills critical to easing California into a smooth transition to health reform is moving through the process.

This afternoon, the Assembly Health Committee, chaired by Assemblyman Bill Monning, will consider several bills, including AB2477 (Jones). The bill will allow for continuous eligibility for children in Medi-Cal, without threatened mid-year status reports that would prevent kids from staying on coverage. This would start to align our eligibility requirements with those of federal health reform.

Most of the other bills are basic consumer protections that would increase accountability for the insurance industry. In some cases, the federal law requires states to act, within certain parameters; other proposals would implement some aspects of health reform early, and in other cases would build on federal health reform but go further. Some bills are up as early as next week in committee, which means organizational letters of support would be due in the next day or two.

One such bill for next week is AB 2042 (Feuer), which would prevent health insurance companies from raising rates more than once per year. This unfair practice is not unheard of. It's bad enough that Anthem Blue Cross refuses to budge on its outrageous up-to-39% annual increase scheduled for May 1, but they also announced that they may increase their rates over the course of the year. The bill would provide ratepayers some security in being able to predict their health care costs over the course of a year.

There are many other bills coming up in the next week, and insurance companies are already sending in their letters of opposition, on everything from rate regulation to limits on charging children with pre-existing conditions.

ALERT: SEND ORGANIZATIONAL LETTERS OF SUPPORT: These bills need organizational letters of support ASAP. Please send letters to the bill's author, the chairs of the relevant Health Committees, Senator Elaine Alquist and/or Assemblyman Bill Monning, and members of the relevant policy committee that will review the legislation.

Insurers have already started to get in their opposition letters, and so we need consumer, community, and constituency organizations to submit their letters in support of these specific bills. Contact Health Access for sample letters on some of these bills; a full list of health reform related bills is listed below.

PENDING BILLS TO IMPLEMENT AND IMPROVE HEALTH REFORM Below is a list of health consumer bills currently in the California State Legislature that are intended to implement and improve certain provisions in the federal health reform law and prepare the state for other provisions contained in the law. This list is regularly updated and can be found at www.health-access.org.Creating a Consumer-Friendly & Transparent Individual Insurance Market & Exchange

* AB 1602 (Bass) CALIFORNIA PATIENT PROTECTION & AFFORDABLE HEALTH CHOICES: Would create the California Cooperative Health Insurance Purchasing Exchange (Cal-CHIPE) and expand dependent coverage in private insurance to age 26.

* SB 900 (Alquist) CREATING A CALIFORNIA HEALTH INSURANCE EXCHANGE: Would establish the California Health Insurance Exchange within the California Health and Human Services Agency to make health coverage available and create the California Health Insurance Exchange Fund to be governed by a board appointed by the Legislature.

* SB 890 (Alquist) IMPLEMENTING FEDERAL HEALTH REFORM: Creates rules in the individual market similar to those for Medi-Gap so that insurers cannot cherry-pick individuals based on health risk status. Sets standard of basic health care services for DOI products as well as DMHC products.

Providing Access for Those with Pre-Existing Conditions

* AB 2244 (Feuer) ASSURING KIDS COVERAGE: Requires guaranteed issue, eliminates all pre-existing condition exclusions and phases in modified community rating for children under age 19 in the individual market.

* AB 2470 (De La Torre) REGULATING RESCISSIONS AND MEDICAL UNDERWRITING: Would require regulations to be created that establish standard information and health history questions used by health insurers on application forms, and required insurers to complete medical underwriting and review for accuracy before issuing an individual a health plan contract or policy.

* SB 227 (Alquist) SECURING FUNDING FOR MRMIP, CA’S “HIGH-RISK” POOL: Creates fee on insurers to support California’s high risk pool for those denied for pre-existing conditions.

Continuing and Expanding Coverage

* SB 1088 (Price) ALLOWING YOUNG ADULTS TO STAY ON THEIR PARENTS’ COVERAGE: Would require group health plans to allow young adults to continue on coverage as a dependent up to age 27, however employers are not required to contribute to the cost of coverage for those dependents 23 or older.

* AB 2477 (Jones) KEEPING CHILDREN ON MEDI-CAL COVERAGE/CONTINUOUS ELIGIBILITY: Would adopt rules to expand continuous eligibility in Medi-Cal to children 19 years of age and younger.

Regulating Insurance Company Rates

* AB 2578 (Jones) REQUIRING APPROVAL FOR RATE HIKES: Would require approval by the Department of Managed Health Care or the Department of Insurance of an increase in the amount of premium, co-payment, coinsurance, deductible or other charges under a health plan.

* SB 1163 (Leno) PROVIDING SUNSHINE ON PRICE GOUGING: Would require health plans to provide, in writing, specific reasons for denial of coverage or for charging higher than the standard rates for coverage.

* SB 316 (Alquist) ENSURING PREMIUM DOLLARS GO TO PATIENT CARE/MEDICAL LOSS RATIO: Would require health plans to provide written disclosure of the medical loss ratio (the ratio of premium costs to health services paid) whenpresenting a plan contract or policy for sale to an individual purchaser or to groups of 50 or fewer individuals.

* AB 2042 (Feuer) PROHIBITING MID-YEAR RATE HIKES: Insurers and HMOs cannot change or increase premiums, cost sharing or benefits more often than once a year.

Setting Minimum Standards

* AB 786 (Jones) SETTING BASIC INSURANCE MARKET STANDARDS: Would sort health insurance policies into a number of categories, based on benefit comprehensiveness and cost-sharing. Would set a minimum standard that requires coverage of doctor and hospital care and an overall limit on out-of-pocket costs, thus eliminating deceptive “junk” insurance.

* AB 1825 (De La Torre) ENSURING MATERNITY CARE: Would require most health plans to cover maternity services.

* AB 1600 (Beall) REQUIRING MENTAL HEALTH PARITY: Would require most health plans to provide coverage for the diagnoses and treatment of a mental illness.

Additional Consumer Protections

* SB 56 (Alquist) FACILITATING A PUBLIC HEALTH INSURANCE OPTION: Would authorize county-organized health plans and other health benefits programs to form joint ventures in order to create integrated networks of public health plans that pool risk and share networks, subject to the requirements of the Knox-Keene Act.

* AB 2110 (De La Torre) PROVIDING PREMIUM GRACE PERIODS: Would extend the grace period for premium payments from 10 or 31 days up to 50 days for most plans regulated by the Department of Insurance.

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posted by Anthony Wright | Permalink | 8:00 AM


 
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Thank you to our national partners...

Monday, April 05, 2010
 
Health Access California has a long and proud tradition as an independent state coalition here in our state, without a national parent. Our policy decisions are made by Californians, for Californians.

But we are pleased to have good, strong connections with national groups that provide useful assistance and resources, including information and linkages with DC-based groups and with other state consumer advocates across the country. During this past health reform effort, these connections were essential in our efforts to integrate the on-the-ground field work with national advocacy.

For example, we were proud to be the lead partner organization in California for the Health Care for America Now! coalition, working with national groups like USAction. We have a long history working with Families USA, co-releasing reports and speaking at their annual DC conference. And we have greatly appreciated the work with Community Catalyst, on both federal health reform, and on projects that we lead in California, the Consumer Voices for Coverage effort and the Hospital Accountability Project. All of these groups are useful resources for us and our partner organizations, and their websites are useful resources for you, too, to find out more about health reform.

We thank these and other national experts, advocates and groups who have helped us in the last two years make a difference in the health reform debate. The Community Catalyst folks sent their own message of appreciation to advocates in the states as well. (I would say it's NSFW, but you would get the wrong idea.) It's even more strange when you know these people. So, with affection:

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posted by Anthony Wright | Permalink | 9:24 PM


 
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WellPoint's CEO gets a humongous raise...

 
"The pay hikes at WellPoint come at a time when overall CEO compensation has been falling slightly amid the recession and a public furor over executive pay levels," notes the Los Angeles Times.

But WellPoint is not known for shrinking back from opportunities to enrich itself and its executives, even when so many Americans -- not to mention its own customers -- struggle around them.

Just last Friday, WellPoint announced it hiked CEO Angela F. Braly's compensation up to $13.1 million, the Times' Duke Helfand and Walter Hamilton reported.

That's 51% in one year. Fifty-one percent -- even as Anthem Blue Cross of California, a subsidiary of WellPoint Inc. of Indianapolis, has refused to back down from a planned May 1 premium increase of up to 39%.

Braly's total compensation shot up to $13.1 million, from $8.7 million a year. earlier, according to a filing with the Securities and Exchange Commission. At least three other WellPoint executives got compensation increases of as much as 75%.

The hefty packages come as Anthem Blue Cross seeks double-digit rate increases for many of its 800,000 members who buy individual policies.

California customers of Anthem Blue Cross said they were shocked by the pay hike, the majority of which came in the form of $6.2 million in restricted stock, up from $2.4 million a year earlier. Braly also got a $1.5-million performance bonus, compared with $73,810 in 2008.

The Times report quotes customer Mark Weiss, a podiatrist whose Anthem policy will increase in cost by 35%, as saying, "It's unconscionable. How much more does somebody need?"

With federal health care reform on the horizon, we'll see how much longer they can get away with this.

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posted by Cynthia Craft | Permalink | 2:22 PM


 
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Chairman Waxman explains the new law...

Saturday, April 03, 2010
 
One of the many heroes of health reform, California Congressman Henry Waxman, chairman of the House Energy and Commerce Committee, provides an easy explanation of the new health reform law in this new five minute video:



His committee has a host of fact sheets at: http://go.usa.gov/igt

Health Access has one fact sheet that's a little more tailored for California, and more coming...

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posted by Anthony Wright | Permalink | 8:40 PM


 
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California's Benefit...

Friday, April 02, 2010
 
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

Read Our Health Access Blog! Join Us on Facebook! Follow Us on Twitter!


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

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posted by Anthony Wright | Permalink | 10:25 AM


 
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For your holiday weekend reading...

Thursday, April 01, 2010
 
It's another edition of the Health Wonk Review, with the "when pigs fly" editionhosted by Rich Elmore at Healthcare Technology News, which includes posts of ours and others.


Kaiser Health News has a useful "true or false" review of seven often-cited issues with health reform, like that the bill does *not* call for 16,000 more IRS agents. Jon Cohn at the The Treatment has one more: Yes, members of Congress will get their health coverage in the exchange with other Americans.

Finally, here's President Obama on the benefits of health reform, this year:

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posted by Anthony Wright | Permalink | 10:27 PM


 
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Rep. Matsui gets thanks and a quilt

 
Congressmember Doris Matsui was losing her voice while addressing nearly 100 supporters who gathered to express appreciation for her leadership on federal health reform on Thursday.

But that didn’t stop the Sacramento congresswoman from getting her message across to the crowd of folks who spent their lunch hour assembling at Trinity Cathedral to say “thanks!!” to one of federal health reforms key supporters.

The room stood to applaud Matsui several times during her remarks. Some wiped their eyes as the Democratic Congresswoman spoke poignantly about the importance of health reform in our nation’s history.

Calling it second-only to the passage of Social Security and Medicare, Matsui declared, “This is a victory for health care, civil rights, human rights and, ultimately, our democracy.”

In her role as a member of the House Energy and Commerce committee, where early versions of the legislation were shaped, Matsui’s commitment was key to ultimately turning a bill into the law of the land.

It was an informative program, with several community leaders and members--including Elizabeth Abbott of Health Access--speaking about various parts of the reform. But it was also touching.

To her supporters, who unveiled and presented Matsui with a handmade health care quilt featuring a patchwork of personal stories and messages of affirmation, the congresswoman, who won the 5th Congressional district after her late husband, Bob, held it for 26 years, offered her own thanks. She also made a point of thanking those whose fight for health care reform preceded hers, saying she was certain they were present in the chapel to help celebrate the historic reform.

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posted by Cynthia Craft | Permalink | 5:18 PM


 
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The benefit to California...

Wednesday, March 31, 2010
 

For the last week, we have stated what seems obvious: that health reform is a huge boon for California, especially given the particularly acute health system crisis our state faces. Given our large uninsured population and other factors, California is likely to disproportionately benefit.

Somehow, Governor Schwarzenegger has been on a different message, and the California Representatives that won this huge benefit aren't pleased with his Administration's misleading characterization of the reform.

Here's the letter recently sent by four leading California members of Congress:

The Honorable Arnold Schwarzenegger, Governor of California
State Capitol Building
Sacramento, CA 95814

Dear Governor Schwarzenegger:

We are writing to explain the benefits of the new health reform legislation for California.

Your Secretary of Health and Human Services estimated this week that the legislation would cost California $2 billion to $3 billion annually. This is an incomplete and misleading assessment because it fails to take into account billions of dollars worth of new federal tax and health care benefits that will go to California's families and small businesses.

We have enclosed an analysis of the many benefits that the health reform law will bring to California and its residents. Over the next ten years, Californians will receive $124 billion in new federal support for health care coverage.

These new benefits include $106 billion in tax credits and other federal funding to pay for health care coverage for California families, $4.3 billion in tax credits to small businesses that purchase health insurance for their employees, and $9.3 billion in federal assistance to California seniors in the Part D drug donut hole. The legislation will also extend health care coverage to 3.8 million uninsured California residents and improve coverage for 21 million residents with employer-based or individual health insurance.

We hope this information is helpful to you as you evaluate the health care reform legislation and its many benefits to the state and California families.

Sincerely,

Rep. Henry A. Waxman, Chairman, Committee on Energy and Commerce
Rep. George Miller, Chairman , Committee on Education and Labor
Rep. Pete Stark, Chairman, Subcommittee on Health,
Committee on Ways and Means
Rep. Zoe Lofgren, Chairman, California Democratic Congressional Delegation

We've been quoted in articles in the Los Angeles Times or San Francisco Chronicle or New America Media rebutting the charges by the Governor, but the headline always favors the Governor's spin. Hopefully this analysis will change the narrative.

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posted by Anthony Wright | Permalink | 7:00 PM


 
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Thank you!

 
The passage of federal health reform has not ended our work... In fact, we've been busier than ever.

We've been in coalition, policy and legislative meetings, starting the full-fledged effort to implement and improve health reform, to fulfill the promise of reform right here in California.

There's a lot of work to do, from re-regulating and re-imagining the individual insurance market, to transforming Medi-Cal to be ready on day one for many newly-eligible Californians.

But we also want to recognize the great work done by the great leaders from the California delegation that made health reform possible. With the Health Care for America Now coalition, we've been doing "Thank You!" events, such as the one pictured above right with Speaker Nancy Pelosi and Representative George Miller in San Francisco this past Monday. We've greeted Representatives Jackie Speier, Lynne Woolsey, and Mike Thompson at the airport with our appreciation.

And we have been part of large constituencies going to visit the offices of our members of Congress, up and down the state. Pictured left is a large delegation (including Health Access organizers Nancy Gomez and Angela Woods, board member Joan Pirkle Smith, and many allies) that crowded into Representative Adam Schiff's office, all there to thank him for his vote for historic health reform.

There's a lot of work to do, but more celebrations are in order as well!

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posted by Anthony Wright | Permalink | 3:52 PM


 
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Things to do in Denver when...

Monday, March 29, 2010
 
Today, we welcomed back Elizabeth Abbott, who spent the last several days in Denver, at the meeting of the National Association of Insurance Commissioners. She represents Health Access California as a consumer representative to this group of insurance regulators that meet quarterly, one of two dozen consumer advocates amidst a sea of insurance industry lobbyists.

One of her fellow NAIC consumer representatives is Wendell Potter, a former CIGNA executive turned whistleblower. He writes his take on the proceedings at the Huffington Post.

We'll be watching closely...

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posted by Anthony Wright | Permalink | 11:57 PM


 
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Onto the next stage...

Thursday, March 25, 2010
 
The House of Representatives just passed, by a vote of 220-207, a package of "reconciliation" improvements to the historic health reform package signed by the President earlier this week.

This was after the Senate passed the package--after hours of brushing back GOP amendments in what was known as vote-a-rama--by 56-41 earlier today.

It now goes to President Obama for his signature. The work on this bill is done.

The work on health reform is just beginning. As I wrote in The New Republic's The Treatment this week:
Instead of being concentrated in Congress for just over a year, health reform will spur frenetic activity over the next five years across the nation, at both the federal and state level, in venues both legislative and regulatory.

The work that needs to be done at the federal level, especially at the Department of Health and Human Services, is immense. But the much of the action will also shift to the states, who have traditionally taken the lead on two central components of health reform: insurance regulation, and the administration of public coverage programs. With federal standards and guidance, each state has a role in everything from expanding and streamlining its Medicaid programs, to setting up the new exchanges which will provide a new, regulated market for consumers to purchase coverage. In essence, the bill spurs 50 different health reforms.

My colleague Richard Kirsch, National Campaign Manager, Health Care for America Now, sounds a similar note and the end of his statement today:

“It’s impossible to overstate the breadth of what our nation’s achieved with the passage of comprehensive health care reform. We have closed the book on decades of struggle to make good, affordable health care a right - and not exclusively a privilege – for America’s families.

We have created a vehicle by which to eliminate insurance industry abuse, to make health care more affordable for working families and small businesses, to close the Medicare “doughnut hole” for seniors, to help young adults maintain coverage as they strike out on their own, and to bring all of us the peace of mind and security of knowing we are no longer just one accident or illness away from bankruptcy.

With the closing of this volume, we also prepare to open another. We will need to continue to hold lawmakers and big insurance accountable and make sure we implement reform in way that truly achieves good, affordable health care for all.”

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posted by Anthony Wright | Permalink | 6:41 PM


 
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Health reform humor...

Wednesday, March 24, 2010
 
Health reform may be historic, but it's also humorous, according to the late night hosts as compiled by The Daily Beast:

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posted by Anthony Wright | Permalink | 9:42 PM


 
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Health reform 2.0 starts at the state level...

 
HEALTH ACCESS UPDATE
Wednesday, March 24, 2010

HISTORY & HELP: OBAMA SIGNS COMPREHENSIVE HEALTH REFORM BILL;
ASSEMBLY MOVES SWIFTLY ON COMPANION HEALTH REFORM BILLS FOR CA


* Historic Bill to Provide Immediate Help to Californians, This Year
* CA Assembly Revives Rate Regulation Bill, With Support from Consumers
* Unfair Practice of Rescissions To Get Independent Review Under Assembly Bill
* Bill to Undo Schwarzenegger Cut of Breast Cancer Program Moves Forward
* Federal Reform Movement Gives New Momentum to Previously Stalled CA Bills

Read Our Health Access Blog! Join Us on Facebook! Follow Us on Twitter!


HISTORY: President Barack Obama signed historic health reform legislation yesterday, legislation that will provide security and stability to those with coverage, and new, affordable options for those that don't. When fully implemented in 2014, the bill has the potential of reducing the number of uninsured Americans by 32 million, and preventing people from becoming uninsured due to a loss of income, being between jobs, or due to health status.

IMMEDIATE HELP: At the signing ceremony, the President emphasized the immediate benefits of the reforms. For Californians in 2010, the health reform will:

1. Prevent people from being denied coverage based on “pre-existing conditions.”

- Soon, people who are uninsured due to a pre-existing condition will be able to buy insurance through a special insurance program. Right now, Californians are left in a lurch: our state has a small, underfunded "high-risk pool" that currently has a waiting list--even though it is estimated that over 400,000 have been denied coverage due to health status.
- Within 6 months of passage, no new health plan will be able to discriminate against children with pre-existing conditions.
- In a few years, no insurance plan will be able to deny coverage to anyone for pre-existing conditions.

2. Provide people with more security, by outlawing the worst insurance company abuses. Insurance companies will:

- No longer be able to cancel insurance coverage retroactively when you get sick. Over 6,000 Californians had their coverage rescinded in the past several years, and health reform would end the practice of rescission.
- No longer be able to put lifetime limits on the dollar value of benefits
- No longer be able to place co-payments or cost-sharing on key preventive benefits

3. Provide real relief to young adults and their families, to seniors, and to small businesses. Health reform will:

- Allow young adults up to age 26 to stay covered on their parents’ insurance
- Reduces prescription drug costs for seniors. Seniors whose spending falls into Medicare’s prescription drug donut hole will have hundreds of dollars of immediate help and the entire coverage gap will be eliminated over time.
- Gives subsidies to small businesses. Small businesses choosing to offer coverage to workers will receive a tax benefit of up to 35% of premiums.

SENATE RECONCILIATION: The effort to improve health reform began today as well, as the Senate start to debate a package of "reconciliation" improvements that were passed by the House of Representatives. They are expected to vote on the package before the end of the Easter recess at the end of the week.

NO MORE EXCESSIVE RATE HIKES: It didn't take long for federal health care reform to spur movement of related, complementary legislation in the California Capitol.
The combination of President Obama signing the historic health care reform bill this morning and, back in California, continuing outrage over Anthem Blue Cross' rate hikes and the company's sending profits to out-of-state corporate parent WellPoint, Inc., provided new momentum to a bill for rate increase reviews.

Assemblyman Dave Jones (D), the previous chair of the Assembly Health Committee, had tried twice before with versions of this bill, AB 2578. Supporters hope the third time is the charm. Under the leadership of new chair Assemblyman William Monning (D), the Assembly Health Committee members moved the bill on to the Assembly Appropriations Committee, the next stop in the legislative process.

It remains to be seen whether the Governor likes the idea of installing rate review on for-profit and non-profit insurers. But one thing is sure: Legislators from all over California have been hearing from plenty of constituents unhappy about the profiteering bad behavior of Anthem Blue Cross and other insurers.

One consumer who attended the hearing just to speak up for himself as an individual testified that his health insurance premium had ballooned from $600 a month to $1,100 a month in just nine months. Such wild rate hikes may be the insurers’ way of purging aging baby boomers and others they calculate may soon need their benefits – and replacing them with new customers buying less generous plans.

AB 2578, co-authored by Assemblyman Mike Feuer (D) and supported by Health Access California, California Labor Federation, Consumer Watchdog, Consumers Union, would extend the kind of regulation that Proposition 103 requires for auto and other policies to health insurance policies.

The bill would fill a need left unfilled by federal health reform. Although Sen. Dianne Feinstein (D) worked with President Obama to try to insert rate regulation in the federal bill, procedural process rules prevented that from happening. Rather, the federal bill requires that insurers spend at least 85% of the consumer’s premium dollar on health and medical expenses, keeping only 15% for administrative expenses.

As it stands now, AB 2578 would trigger a review for rate increases over 7%, conducted by the Department of Insurance or the Department of Maernaged Health Care. In recent years, insurers have imposed double-digit premium increases on consumers annually, so that the average policy in California expanded in cost by 130% since 1999, Jones said.

Speaking out in opposition to the legislation was the Chamber of Commerce, the California Association of Health Plans, the California Medical Association, Health Net and Anthem Blue Cross. Assemblymembers Anthony Adams, Ted Gaines and Audra Strickland voted against the bill.

RESCISSIONS TO GET INDEPENDENT REVIEW UNDER BILL: The Assembly Health Committee also voted in favor of passing AB 2470, authored by Assemblyman Hector De La Torre (D), out of committee.

Though an insurance industry spokesman testified that firms have cleaned up their act since the Los Angeles Times first wrote a series of stories exposing the practice of insurers' rescinding policies once patients incurred medical expenses, De La Torre said the Department of Insurance has been less than forthcoming with information to support that statement.

Insurers also stated that the new federal health reform prohibits rescission immediately, and eventually moves to a guaranteed issue market--and so the bill is unnecessary. De La Torre welcomed the federal law, but said that the bill would provide the regulation to implement the new federal reform. In addition, state regulators have been too slow in coming up with their own regulations that they promised to unveil a year ago this month.

Stalled last year, De La Torre said the bill was needed because consumers were vulnerable to insurance company abuses in the four year window until the federal reform phases out denials for "pre-existing conditions" in the individual market altogether. It is in the individual market that the recissions -- fully 6,000 of them between 2004 and 2009-- took place in California. In only 5% of those cases were consumers compensated, said De La Torre.

Arguing against the bill was the California Association of Health Plans, the Chamber of Commerce, California Life and Health Insurance Companies.

EVERY WOMAN COUNTS, REALLY! -- Assemblywoman Noreen Evans (D), challenging the Schwarzenegger Administration over an unapproved cut of public breast cancer prevention and treatment services, ushered through the committee a bill that states the Legislature's intent to reverse the governor's decision.

Evans, who earlier held a hearing and orchestrated a Capitol steps bakesale to call attention to the cuts and raise money (about $3,800) for the program, reiterated that the Administration was specifically told "no" -- it could not go through with the cutbacks -- but it did so anyway.

The governor needs the Legislature's consent to make the kinds of changes to the program that it did starting in January of 2010. Breast cancer screenings were scaled back to just women 50 and above, eliminating the service for those who previously could access it starting at age 40. Experts testified that many deadly, aggressive breast cancers tend to show up before age 50.

The governor also unilaterally froze enrollment in the "Every Woman Counts" program for the first six months of this year in order to save money. Again, the Legislature had said no to this proposal last June. The bill passed out of Assembly Health on Tuesday, and will pick up details about its funding (through the tobacco tax provided by Proposition 99 ) before it moves to the next commitee, Evans said.

NEW MOMENTUM EVIDENT ON HEALTH INSURANCE REFORM: President Obama's signing of the federal health reform legislation clearly gave a boost to bills to shape up California's insurance industry practices. Supporters spoke about the importance of a fresh era of transparency and consumer protection.

Also speaking in support of AB 2578, Assemblymember Mary Salas (D) said: "This bill is so important at this historic moment."

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posted by Anthony Wright | Permalink | 3:09 AM


 
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Adding rate regulation to reform...

Tuesday, March 23, 2010
 
President Obama today signed comprehensive health care reform into law... and this evening, the Senate is taking up a package of improvements. Hopefully, those improvements will be passed and the President will sign them within the next week.

Here in California, the Assembly Health Committee today was considering important improvements as well.

* The Assembly Health Committee just passed Assembly Bill 2578 (Jones and Feuer). AB 2578 requires that prior approval be obtained before health insurance rates are increased. HMOs and health insurers would need to receive approval from the Department of Managed Health Care (DMHC) or the Department of Insurance for proposed rate increases. Rates requiring approval include premiums, co-payments, and deductibles.

The majority of the committee members voted for the bill, but the vote total is not final, as some Members may add on their votes later in the hearing. AB 2578 is supported by individuals, families and business that have been victims of dramatic health insurance rate increases and organizations such as the California Labor Federation, Consumer Watchdog, Health Access, California Public Interest Research Group (CALPIRG), Consumer Federation of California, and Consumers Union.

* As I write this, the committee is reviewing AB2470 (De La Torre), to regulate the practice of rescissions, the retroactive denial of coverage. This is something that is barred in the national reform signed today, except for proof of fraud and "intentional misrepresentation." Assemblyman De La Torre welcomed the new health reform, but stated there was a need to provide details to how the federal law is implemented, and that's what the law would do.

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posted by Anthony Wright | Permalink | 5:06 PM


 
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Health reform signed into law!

 
In their own words: here's President Obama on signing historic health reform today....



And from this weekend, here's Speaker Pelosi's full speech before the House vote, which is worth seeing in its full three minutes...

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posted by Anthony Wright | Permalink | 4:13 PM


 
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The debate from your laptop...

Monday, March 22, 2010
 
It was a beautiful day, but I mostly was on my couch, watching C-SPAN, and posting commentary on www.twitter.com/healthaccess. The Huffington Post condensed the full floor debate into ten minutes. Below is the video, and some of the quotes from the day, particularly from California Representatives.




* CA Rep Judy Chu talked about Eric, a young member of her staff... Getting chemo, he reached 24 and lost coverage under his parents' plan. He then was denied coverage based on pre-existing conditions. He only had coverage because of the job with the Congresswoman, but this plan would help him, and others like him.
* CA Rep Doris Matsui described her constituents Tim's + Elizabeth's problem with the health system: "If it's not working for them, it's not working for me."
* CA Rep Dennis Cardoza: "My wife has been a doctor for 30 yrs. She tells me every night of stories of patients who get sick, but denied coverage. My wife has to fight with insurers "to let her practice medicine the way she was trained at UC-Davis Med School." "My brother, who owns a small business, saw his premiums are going up 75%.""I am going to vote for this bill, and I am going to vote for it proudly.. "It is desperately needed, desperately long overdue."
* CA Rep Henry Waxman: Health reform "builds on what works today.. and it reforms what doesn't. It fundamentally reforms the practices of insurers."
* MI Rep John Dingell, after being introduced by Rep. Henry Waxman: "Today is a day that is going to rank with the day we passed the Civil Rights bill of 1964... and Social Security..."
* CA Rep Eshoo: I am priviledged to be part of a Congress that votes for this "life affirming" health reform, which will "perfect the union."
* CA Rep Mary Bono Mack's descriptions: "secret deals" "shell game" "does nothing"... She gave the impression she was opposed...
* CA Rep Lois Capps highlighted prevention: after this bill, "no more co-pays for preventative screenings."
* GA Rep John Lewis: "The American people need health care, and they need it now.. Answer the call of history, and pass health care."
* CA Rep Mike Thompson: "I've worked for quality, affordable health care for all for years, since my first campaign." "In my district, 63,000 uninsured residents will have access to coverage"
* CA Rep Devin Nunes: Health reform brings back "ghost of communism," and it "continues failed Soviet socialist experiment".. we should "say no to totalitarianism."
* Vice Chair & CA Rep Xavier Becerra: "Today is a day of history. Today we accomplish what 100 years of Congresses could not."
* MD Rep Van Hollen: "The day after this leg is signed by President Obama, Americans will see the world is not coming to an end."
* CA Rep Lynn Woolsey: "The whole nation needs health reform but no one needs it more than women..." "..being a woman is a pre-existing condition"

Speaker Nancy Pelosi arrived to a standing ovation, to give a speech that journalist Marc Ambinder called "the best speech I've seen her give." She started by stating that we are honoring the vow of our founding fathers, from the Declaration of Independence, for "life, liberty and the pursuit of happiness." This reform will provide healthier lives, and more liberty to pursue happiness. "This is an American proposal..." she emphasized. Citing the linkage with student aid legislation, she said that health reform and education were two issues that were ultimately about opportunity for the American people. "One word: opportunity."

Speaker Pelosi made the link to the economy. "Imagine an economy where people can change jobs or start a business without worrying that they would lose their health coverage." She continued, "The best action to reduce deficit, to improve economy, to create jobs.. ...is to pass health reform." She praised the health reform for emphasizing prevention, wellness, and innovation.. It "will create 4 million jobs.. will save $1.3 trillion from the deficit."

Speaker Pelosi references her predecessor who said "all politics is local," by stating that in fact, especially with health reform, "politics is personal." She recounts, "I saw a grown man cry" when he couldn't pay his medical bills...

She refers to over 350 groups support of health reform: AARP, AMA, Catholic Health Assn, United Methodist Church, Voices for American's Children, and many others. She also pointed out that the bill includes over 200 Republican amendments, and after over a year of debate, it's time to pass it.

Referencing the late Senator Kennedy, Pelosi calls health reform the "great unfinished business" of our society and says the reform will establish health care "is a right and not a privilege."

And after that, the vote tally went up. Like a New Year's Eve countdown, but utterly more rare and consequential, the bill slowly but surely had over 216 votes.

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posted by Anthony Wright | Permalink | 3:02 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.