Going uncovered...

Saturday, October 11, 2008

Health Access has never endorsed a candidate in our 20-year history, and as a nonpartisan organization, I am refraining from posting some of the health-related ads from the presidential campaign.

I will say that I am pleased that there *are* health care ads, and that health care is an active point of discussion in the campaign.

But this ad is from a Kansas Senate race, that we here in California can only sit and watch, and chuckle:

Labels: ExpandingCoverage, Funny, PresidentialCandidates

posted by Anthony Wright | Permalink | 5:57 PM


 

Healthy Food

Tuesday, July 29, 2008

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


 

We knew her when...

Sunday, June 01, 2008

The effort to win national health care reform is heating up: lots of planning meeting and activities to ensure that there is a mandate for a new President and Congress to take this issue on, and to be ready to roll in 2009.

Consumers Union (a Health Access California board member) is spearheading a Cover America Tour: an RV that will criss-cross the country for four months, collecting stories about the issues that people have with the broken health care system.

The effort has a website and blog of interest, which includes a video of the launch of the Cover America Tour from Consumers Union's Yonkers headquarters, being cheered by staffers from the labs that test all those products that are evaluated in Consumer Reports. It should be an interest and informative trip, that I urge folks to follow along on the web.

The video prominently features the energetic Meg Bohne (pictured above, crouching), a Health Access alumnus, who has told me she give us partial credit (or blame) for her current assignment. On the website page that describes the whole enterprise, Meg Bohne cites her experience as a "a seasoned community activist, advocate and organizer, Meg has come to specialize in on-the-road campaigns in vehicles that have spanned a bus, an ambulance and, now, an RV." At left is the ambulance she drove up and down the state of California for Health Access, in the cause of lower prescription drug prices.

We wish Meg and the whole crew at Consumers Union luck in their trip and their effort. We look forward to hearing the stories, the personal health care experiences, and the adventures on the road!

Labels: ExpandingCoverage, Federal, HealthAccessCommunity, Underinsurance, Uninsured

posted by Anthony Wright | Permalink | 2:02 AM


 

Find the solutions, not blaming the victim...

Tuesday, April 15, 2008

"Don't Blame Crowded ERs on the Uninsured" is the pitch-perfect headline of an article by Suzanne Bohan in the San Mateo County Times and other papers.

The articles reports on a UC-San Francisco study that reports that asks "Are the Uninsured Responsible for the Increase in Emergency Department Visits in the United States?" and answers "no." In fact, the "proportion of adult ED visits by persons without insurance was stable across the decade," roughly in the 14-15% range.

Despite the belief that the uninsured are the majority of those crowded in our emergency rooms, I note that this figure is a bit lower than the overall percentage of uninsured people in the country, which is around 16%.

This is consistent with other findings, such as a 2004 Urban Institute report by researchers Zuckerman and Shen on ocassional and frequent ER users. That paper concludes, in part, "The uninsured and the privately insured adults have the same risk of being frequent users... It seems hard to blame the overcrowding of EDs on the uninsured."

MISSING THE MESSAGE: Some conservative commentators will use this research to attack the notion that of a "hidden tax" that we all pay in our premiums for having such a large uninsured population, and to attack the notion of health reforms and coverage expansion generally. I get a very different lesson from the study.

I too have been a skeptic of the Governor Schwarzenegger's "hidden tax" rhetoric, because it led people to blame the uninsured for high health costs, rather than the reverse.

If the uninsured go to the emergency room, they have only a right to be stabilized. But even then, they get a bill--typically the biggest bill they will see in their lives, and often one that is inflated well above what an insurer would pay for the same service. No wonder they may actually go to the ER less.

LOTS OF FACTORS: That said, there's nothing inconsistent with saying that the uninsured, when they finally do go to get care, are in a worse condition since they let their conditions linger and mestatisize, costing the health system more money in the long run. Or that the uninsured get the bill, but some face bankruptcy not being able to pay, and as a result leave the hospital unpaid.

In other words, I think the real world in health care is more complicated than one cause. Some uninsured get the care they need. Others go without and simply die. And in between, some uninsured wait until the problem gets worse. And some of these factors end up costing the health system. So reforming health and increasing coverage is needed and urgent, even for the regular, insured California.

SOLUTIONS: So how much is the "hidden tax?" I don't know, but it's real. But I think the focus should be on fixing the system, not the victims of that system:

* We all pay when McDonald's, Wal-Mart, or Applebee's don't, when some employers don't pay their fair share. Those who are uninsured are those who fall through our health system that relies on voluntary employer contributions.

* We should ensure that those who are uninsured are not overcharged and thus discouraged from getting needed care. California passed a fair hospital pricing law in 2006, and other protections would be helpful.

* We who are *insured* would not go to the emergency room as much if we had the ability to get timely access to care to primary care and specialists. There's pending regulations for insurers and providers at the California Department of Managed Health Care.

Our health care system doesn't have just one problem, and doesn't have just one solution. The new research helps us understand that.

Labels: ExpandingCoverage, Hospitals, Research, TimelyAccess, Uninsured

posted by Anthony Wright | Permalink | 10:45 PM


 

Eating out in San Francisco

Monday, March 17, 2008

Quick. What special interest is the most active opponent against comprehensive health reform?

While many compete for that distinction (insurers, doctors, drug companies, etc.), there's a strong argument that it is... the restaurants.

As the industry perhaps most likely not to provide health coverage to their workers, they have consistently opposed efforts that would require them to contribute a fair share to health care.

* Many have been actively opposed to single-payer at least since the 1994 ballot measure--with some even subjecting patrons to anti-Prop 186 table cards.

* Fast food and chain restaurants were the single largest opponents of SB2 and Prop 72, which would have required large employers to pay for their worker's health care. In fact, fast food and chain restaurants--from McDonald's and KFC to Applebee's and Cheescake Factory--made up over 70% of the opposition fundraising to Prop 72--most of the rest of the employer community stayed on the sidelines. Without the California Restaurant Association, Prop 72-which lost by less than a percetnage point--would have been enacted.

* Despite Governor Schwarzenegger's urging, they ultimately opposed AB x1 1. In opposing an minimum contribution for employers to health care, they graciously offered to support a sales tax--a tax they don't pay, but that their customers and other businesses do.

* In San Francisco, the Golden Gate Restaurant Association--rather than the Chamber of Commerce or broader business interests--has led a lawsuit to overturn Healthy San Francisco. The lawsuit is still pending, although there have been encouraging signs from the Ninth Circuit Court of Appeals and even the Supreme Court (in the most underplayed story of the year).

Marc Lifsher's new Los Angeles Times story places the spotlight on the restaurant's opposition to Healthy San Francisco--an innovative and groundbreaking effort to ensure universal access to care. (See a new one-sheet summary of Healthy San Francisco by the Kaiser Family Foundation.)

The article indicates that dozens of SF restaurants are now placing notices on menus, announcing additional costs--from $1 to $2 dollar flat fees to 1-4% surcharges--to help pay for the new health care requirements.

But the tactic, clearly designed to stoke public opposition to the law, may backfire:

* Of all the things that your dollars, it would seem that San Franciscans might think that a few extra dollars to go to the effort for universal health care is a good thing.

* The beneficiaries of the health care law are not faceless. They are the waiters and waitresses that diners interact with. And even for the kitchen staff--wouldn't you want the people handling your food to have health insurance? Especially since there is a correlation between being insured and health status?

* It's clear that some of the traditional arguments against employer requirements don't apply to San Francisco restaurants--people aren't going to go across the Bay Bridge to get a burger, or a fine dinner, simply to avoid a small surcharge. Rather, the minimum requirement helps level of the playing field between a coffee place that does provide health benefits, and one down the street that doesn't.

* The article quotes at least one patron that didn't mind the surcharge. So, if the surcharge is truly passed on to consumers, this undermines the restaurant's argument that the requirement will put cuts into their profits or put them out of business. They can't have it both ways.

Any health coverage expansions--from employer mandates to single-payer to hybrid "shared responsibility" plans--are going to ask employers who don't cover their workers to contribute more than they do now. It's an issue not just of financing, but of fairness--to the many employers who cover all their workers. It's also a practical issue: without a minimum contribution, policymakers fear "crowd-out," where those employers currently offering coverage drop it so their workers take advantage of a public program expansion.

Fast food and chain restaurants will eventually have to be share in the solution, rather than spending their time raising money against reform, pursuing legal attacks, and even trying to make political points on menus. But it looks like that may be a longer wait than what's at the trendiest San Francisco restaurant.

Labels: Employers, ExpandingCoverage, SanFrancisco

posted by Anthony Wright | Permalink | 10:31 AM


 

Balancing roles...

Tuesday, December 18, 2007

All year, we at Health Access have been balanced multiple goals in the "Year of Health Reform."

The first is to provide the information, the reporting, and the policy analysis to help our member and allied organizations be involved in the health policy debate. A primary role is to provide the best possible resources so that groups can most effectively advocate for their members and constituencies. This blog has been part of that effort, and we hope advocates and activists have found it useful, in addition to our direct work to influence policy, as organizers and advocates.

The other balancing act has been to be *for* reform and keep the momentum for reform up through the course of the year, while at the same time being vigilant in our consumer advocacy role of protecting our constituency from--which are all of California's health care consumers--all 36 million of them.

The Governor's original plan made that a significant challenge, since it included some good reform elements but with untenable burdens on some consumers, and other issues of concern.

I am far more enthusiastic about AB x1 1 as a framework, but we will continue to solicit assurances as we move forward, not just to clarify policies for consumers, but to assure voters at the polls, which will be very important.

Our continued advocacy on specific issues like affordability is in the context of actively supporting the overall reform, and moving it forward--the sad and sagging shape of the status quo demands it. But this means our work isn't done. Not by a long shot.

Labels: ExpandingCoverage, Legislation, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 1:58 AM


 

Inches?

Monday, September 24, 2007

There's been a spate of articles in the San Francisco Chronicle and the Washington Post about an apparent deal between the Governor and the Legislative leaders. The Governor's press aide is quoted that they are "inches" apart.

Inches? I've always said that the plans were more alike than they were different, and that previous obituaries were way premature. I do think there's a place for agreement. But inches?

It seems there are substantive issues still left to decide. And once those issues are sorted out, there's the details that make the plan work. Rather than inches, I'd say we're miles apart, but with a roapmap on how to make the connection. It's still driving distance: no getting on a plane or a boat, but there's still some travel time.

Labels: ExpandingCoverage, InTheNews, Nunez, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 9:45 PM


 

A compromise on kids...

Friday, September 21, 2007

The two houses of the U.S. Congress came together on a proposal to extend and re-authorize SCHIP, the State Child Health Insurance Program, called Healthy Families in California.

The compromise attempts to bridge the differences between the House and Senate versions, maintain the bipartisan support, including that of Republican Senators, in the hope of getting a veto-proof majority. The proposal also attempts to address the issues--however specious--raised by President Bush.

That said, the deal in uncertain to give California all the resources it need to continue its gradual increase in children's enrollment... that depends on how the formula works out. Also, the deal does make harder California's efforts to further expand coverage to middle-income children, and to parents.

Yet it is likely, even expected, that Bush will veto. That's why we need the full California delegation--Republicans and Democrats--in support, since the alternative is to start kicking kids off coverage.

Here's the press release from the Congress:

SENATE, HOUSE ANNOUNCE AGREEMENT TO RENEW, IMPROVE
CHILDREN’S HEALTH INSURANCE PROGRAM NOW

Bipartisan, bicameral coalition ready to move on full reauthorization of vital
program

Washington, D.C. – A bipartisan coalition of Senate and House leaders today announced a bicameral agreement to reauthorize the Children’s Health Insurance Program (CHIP) for an additional five years. CHIP provides health coverage to American children whose parents do not qualify for Medicaid, but can’t afford private insurance. The $35 billion agreement struck by House and Senate negotiators will bring health coverage to approximately ten million children in need – preserving coverage for all 6.6 million children currently covered by CHIP, and reaching millions more low-income, uninsured American children in the next five years.

Below is an outline of the agreement, which is designed to target specifically the lowest-income uninsured American children for outreach and enrollment. The agreement does not call for CHIP coverage for children in families at higher income levels. Instead, it reduces Federal matching funds for future coverage of children at higher income levels, and provides incentives to cover the lowest-income children instead. CHIP coverage of childless adults and parents will be phased out to maintain the program’s focus on kids.

Investing $35 Billion in New Funding for CHIP. The agreement reauthorizes the Children’s Health Insurance Program, investing an additional $35 billion over five years to strengthen CHIP’s financing, increase health insurance coverage for low-income children, and improve the quality of health care children receive.

Lowering the rate of uninsured low-income children. The agreement will provide health coverage to millions of low-income children who are currently uninsured. The bill also ensures that the 6.6 million children who currently participate in CHIP continue to receive health coverage. Pending final Congressional Budget Office estimates, the reduction in the number of uninsured children will approach four million children.

Improving Access to Benefits for Children (Dental Coverage/Mental Health Parity/EPSDT). Under the agreement, quality dental coverage will be provided to all children enrolled in CHIP. The agreement also ensures states will offer mental health services on par with medical and surgical benefits covered under CHIP, and protects medically necessary benefits (EPSDT) for low-income children.

Prioritizing children’s coverage. The agreement makes several modifications as it relates to populations eligible for CHIP.

Pregnant Women: The agreement provides coverage to pregnant women as a new state option as well as preserving the options to cover them through a state waiver or through regulation.

Parents: The agreement prohibits any new waivers to cover parents in the CHIP program. States that have received waivers to cover low-income parents under CHIP will be allowed to transition parents into a separate block grant. The federal match for services to parents covered through CHIP will be reduced.

Childless Adults: The agreement retains the current law prohibition of waivers to allow coverage of childless adults. Currently covered childless adults will transition off CHIP. For states that have received CHIP waivers to cover childless adults, the agreement terminates those waivers after a one-year period, provides temporary Medicaid funding for already-enrolled adults, and allows states to apply for a Medicaid waiver for coverage.

Providing states with incentives to lower the rate of uninsured low income children. Under the financing structure, states will receive state-based allotments that are responsive to state demographic and national spending trends and allow additional up-front funding for states planning improvements. States that face a funding shortfall and meet enrollment goals will receive an adjustment payment to ensure that no child who is eligible for Medicaid or CHIP is denied coverage or placed on a waiting list. The formula also sets in place new overall caps on federal funding to ensure the program’s expenditures do not exceed the amounts authorized. The agreement provides incentives for states to lower the rate uninsured children by enrolling eligible children in CHIP or Medicaid.

Agreement Replaces CMS August 17th Letter to States. The Congress agrees with the President on the importance of covering low-income children have health coverage while taking steps to address crowd-out and prioritize coverage of lower income children. The agreement replaces the flawed CMS August 17th letter to
states with a more thoughtful and appropriate approach. In place of the CMS letter, the agreement gives states time and assistance in developing and implementing best practices to address crowd out. The agreement also puts the lowest income children first in line by phasing in a new requirement for coverage of low-income children as a condition of receiving CHIP funding for coverage of children above 300 percent of the poverty level.

Improving Outreach Tools to Simplify and Streamline Enrollment of Eligible Children. The agreement provides $100 million in grants for new outreach activities to states, local governments, schools, community-based organizations, safety-net providers and others.

Improving the Quality of Health Care for Low-Income Children. The agreement establishes a new quality child health initiative to develop and implement quality measures and improve state reporting of quality data.

Improving Access to Private Coverage Options. The agreement expands on current premium assistance options for states. The agreement allows states to offer a premium assistance subsidy for qualified, cost-effective employer-sponsored coverage to children eligible for CHIP and who have access to such coverage. It also changes the federal rules governing employer-sponsored insurance to make it easier for states and employers to offer premium assistance programs.

Legislative language is currently being finalized, and will be available Monday. The House of Representatives will likely vote on legislation implementing this agreement on Tuesday of next week. The Senate will take up the measure shortly thereafter, to deliver a full renewal of the Children’s Health Insurance Program to the President for signature into law before CHIP’s current authorization expires on September 30.

Labels: Bush, ExpandingCoverage, Federal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 3:13 PM


 

Next step in negotiations...

Wednesday, September 19, 2007

So now we are in special session. What's the next step?

When the special session was announced, both the Speaker and the Senate President made the case that the Governor needed to produce language to negotiate about.

As an advocate, it's been frustrating that the Governor's proposal has not evolved, in detail or in policy, from the 10-page concept paper introduced in January. Health Access' preliminary analysis still applies, ten months later. The lack of movement also stops the conversation: a policy change in one area has implications in other areas, that then need to be explored in a new light.

It's also part of negotiations. For years, the Legislature has passed (and Health Access and other consumer groups have supported) reform measures, including an employer mandate, children's coverage, and single-payer, but the Governor said "no." In January, the Governor put forward his proposal, of what he would say "yes" to. It borrowed a lot from the previous proposals, but he combined them together with his own details.

So it was the Legislature's turn. The legislature advanced a single-payer proposal again, not giving up on that framework and keeping the momentum for that alive... but if that was the only thing that they placed on his desk, the Governor would say, with reason, that the legislative leaders were not working in good faith, since he already rejected that proposal.

The legislative leaders also advanced and placed on his desk a comprehensive bill, AB8, that was similar to the Governor's proposal, but made changes that fixed objectionable parts and made improvements, especially on affordability and cost containment. In fact, the major differences between AB8 and the Governor's plan were due not to ideology, but to the practicality of needing to pass a financed bill on a majority-vote basis. (The need for a 2/3 vote to raise revenues--and the resulting need to get recalcitrant Republicans--remains a roadblock for both single-payer and the Governor's plan.)

The Governor says he'll veto AB8. So now it's his turn. The Governor needs to show his language of what he wants, that he thinks will pass. Then we'll see if he and his team listened to the concerns about affordability, about the need for the consumer protections that come with expanding group coverage, rather than relying on the individual market.

The rumour mill has that the Governor will introduce legislative language soon, for the special session. It'll be good to see the details, and if there's been any movement. Then we can have a real--special--discussion.

Labels: ExpandingCoverage, Nunez, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 10:30 AM


 

A San Francisco treat...

Thursday, August 16, 2007

The San Francisco Chronicle reports that the city's new health program, Healthy San Francisco, just passed enrolling its 1,000th member. Whie not insurance (enabling enrollees to get coverage outside city borders), these San Franciscans now have a medical home, and can get the care they need an an affordable cost. It's a big deal.

The quick enrollments shows the need, and is remarkable given not just that SF is small, but the the program really only started in two locations, in and around Chinatown. A good start. Hopefully more victories to follow, in the city and statewide...

Labels: ExpandingCoverage, InTheNews, SanFrancisco

posted by Anthony Wright | Permalink | 11:00 AM


 

The benefits in the bills on the table...

Sunday, August 05, 2007

So now that we established the barriers for individuals to get available, affordable, and automatic health care coverage in a previous post, let's look at the various legislative proposals, and how they have remove or at least lessen those barriers.

SB840 (Kuehl) would make coverage more available, affordable, and automatic. It continues to be the gold standard in our advocacy.
Available? Every Californian who met the residency requirement would be eligible.
Affordable? People would pay through taxes, based on payroll taxes, rather than the costs based on job type or how sick we are.
Automatic? By doing the financing through the tax system, and with the simple eligibility, sign-up becomes automatic. Medicare has an easy, one-time sign-up, which gets all but a handful of folks to enroll.

AB8(Nunez/Perata)'s framework would take strides toward removing the barriers to get employer-based coverage, public program coverage, or insurance in the individual market. It has the virtue of building on what works in the current system and not impacting the coverage that people currently have, and avoids some of the political and procedural barriers that SB840 faces, although it doesn't match SB840's scope.

For employer-based coverage:
* More Available: A minimum employer contribution toward health coverage would encourage employers to make health benefits more available. So would the new, affordable option for employers of paying a fee to a statewide purchasing pool, which would then make coverage available to all the employer's workers.
* More Affordable: The bill does place a limit on the share of premiums for workers under 300% of the federal poverty level to 5% of income. For those who qualify for public programs, they may be able to benefit from "premium assistance" that would make their employer-based coverage more afffordable. And to the extent that any minimum employer contribution is close to the actual cost of care, that provides a floor from which workers can bargain up in terms of benefits.
* More Automatic: Employer-based coverage is already pretty automatic for workers, and those workers in the statewide purchasing pool may have the additional benefit of having their coverage be portable if they shift to other employers also paying into the pool.

For public programs:
* More Available: The proposal would greatly expand coverage to low-income children and their parents, up to 300% of the federal poverty level. We would have a commitment to finally cover all children, and make coverage much more available for low-income adults, particularly parents.
* More Affordable: For those newly eligible for Medi-Cal or Healthy Families, they would get an affordable product, providing more affordable coverage than anything provided privately. For those is subsidized care above the poverty level, there still would be limits on premiums and cost-sharing.
* More Automatic: In a major step, the proposal would eliminate the asset tests (which prevented people from having any savings), and effectively scrap the depravation test, and remove semi-annual status reports, all of which were significant adminsitrative barrier to getting on coverage and staying on.

For the individual market:
* More available: The companion proposal, AB2, would limit insurers' ability to deny coverage because of pre-existing conditions, so those with relatively minor ailments would now be able to get coverage. That 3-5% of the market that would be denied would then have access to an expanded high-risk pool with an improved benefit than what is now available under MRMIP.
* More affordable: While coverage won't be affordable, the proposal would require employers to offer Section 125 plans so that employed Californians could pay their premiums using pre-tax dollars, providing savings at 15-40%.
* More automatic: The proposal attempts to place coverage in basic tiers for better comparison's sake, so the confusion in the individual market is not although it still won't be easy to buy coverage, and affordable packages are not expected.

AB8 doesn't remove all these barriers--there would still be issues, and we have sought amendments to go further, especially on affordability. But the framework does, overall, reduce the barriers that impede consumers getting the coverage they want and need.

Labels: ExpandingCoverage, Kuehl, Legislation, Nunez, YearOfReform

posted by Anthony Wright | Permalink | 1:44 AM


 

CHIPping away...

Saturday, July 14, 2007

With all the activity about health reform here in California, it might be easy to forget all the drama about SCHIP at the federal level.

The Senate Finance Committee approved a tobacco tax to fund a $35 billion increase in the State Child Health Insurance Program (SCHIP). Robert Pear at The New York Times provides some background.

Politicians of both parties give verbal support for children's coverage, the question is whether they support raising the money needed to fully fund the program, especially under new "pay-go" rules. Some wanted reduce payments to Medicare Advantage HMOs; others wanted to look at other taxes.

What's this mean for California, and Healthy Families, our version of SCHIP? The $35 billion increase is less than the $50 billion increase advocated by many children's, religious, and health groups, which would assured that California could reach its goal of covering all children. This Senate version will need to be reconciled with the House. And whtatever the amount, the other fight is the formula to distribute the funds between states.

In short, the pressure needs to kept up. This campaign is a long ways from over.

Labels: ExpandingCoverage, Federal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 12:20 PM


 

Don't take it from us -- here's what others say....

Friday, June 29, 2007

A bunch of interesting public opinion polls have come out recently, so I'll summarize a few of the key points from them here.

PPIC released a poll Thursday showing that 72% of Californians think the state's health care system is in need of major changes. (Take THAT Blue Cross!) Voters, however, are a little less confident that the guv and Legislature will be able to broker a deal (49%).

Another interesting point: 72% of voters support the guv's idea to require residents to have health insurance. From my previous readings, I actually thought voters weren't really hot for such a mandate....but I'm wondering if it's the WAY the question was posed that evoked that response.

The question, verbatim, was: "Would you favor or oppose a plan requiring all Californians to have health insurance, with costs shared by employers, health care providers and individuals?"

Lastly, a SURPRISING number of Californains (73%) said the US should provide health coverage to all children, even if it would require higher taxes. Hopefully Congress and Bush, who are in the process of giving the State Children's Health Insurance Program way too little money hear that.

Poll #2 out of Massachusetts: The Kaiser Family Foundation found that two-thirds of Massachusetts residents polled supported the new law, though support dropped to 57 percent when asked about the individual mandate -- which would penalize those that didn't buy coverage.

The most interesting piece of this poll to me was the part asking about affordability of the plans for people forced to buy coverage on their own without subsidies.

Scenario 1 37-year-old single adult, earning $42,000. The plan:

• Costs $259 a month
• Has a $1,500 deductible; $5,000 maximum out-of-pocket
• Allows 3 doctors visits at $25 a year (the rest would be full-price)
• After the deductible is met, 20% co-insurance
• Generic drugs $15, but brand name drugs would be 50% co-insurance.

62% of respondents said this plan was "unfair;'' 58% said it was an unreasonable amount; 62% said this person would remain vulnerable to high medical bills.

The piece about affordability is key as we in California consider what is reasonable and fair for people to pay. The governor's plan requires a $5,000 deductible and $10,000 maximum out-of-pocket for someone earning $26,000. Looking at what people think in Massachusetts, the super-majority of people would say that's unaffordable.

Labels: Affordability, ExpandingCoverage, IndividualMandate, Schwarzenegger, Underinsurance

posted by Hanh Kim Quach | Permalink | 12:02 PM


 

A better deal for employers, part II

Sunday, June 24, 2007

In my last post, I talked about how AB8(Nunez/Perata) was a better deal for employers than 2003's SB2(Burton), less burdensome yet more comprehensive. For those employers that provide coverage, and those that want to, it provides a new, affordable option for them.

How about in comparison with the Governor's proposal? Many reports simply compare the minimum employer contributions in the two plans, 4% in the Governor's plan, 7.5% in the legislative leader's plans. Especially since most employers are spend 8-14% of payroll, it seems superficially that the Governor's plan lets employers off much easier.

But the real question is what employers get in return. As consumer advocates, we just don't argue for the lowest price, but the best value for the dollar.

Under the Governor's plan, those employers that don't provide any health coverage would have to pay a 4% fee. But they wouldn't get any special added value whether they paid the fee or not. The Governor's plan does broadly expand public coverage programs for families up to 250% of the federal poverty level, around $25,000 a year for an individual, or $50,000 for a family of four. For those employers who don't provide coverage and thus pay the fee, their workers over 250% of the poverty level are left to buy coverage on their own.

In contrast, under AB8, the employer who doesn't provide private coverage and pays the 7.5% fee gets to cover his entire workforce (including full-timers and part-timers) through the statewide purchasing pool. That employer gets the benefit of a fully-insured workforce, one that is healthier, more productive, and has less turnover and thus fewer retraining costs.

Most employers have workers at a range of incomes, from entry-level and lower-skill workers to managers and specialists. For these employers, the structure of AB8 seems to be a much better value.

Of course, if the employer doesn't want to provide any coverage, then these details don't matter: they will simply oppose any reform. But for the vast majority of employers that do, or that want to, provide coverage, these different structures of the proposals make a difference, much more than a comparison of 4% and 7.5%.

Labels: Employers, ExpandingCoverage, Legislation, Nunez, Perata, Schwarzenegger, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 12:34 PM


 

The ghost of SB2

Saturday, June 23, 2007

There's still more work to do on the newly revamped AB8(Nunez/Perata). A delegation of top consumer advocates will be meeting with Speaker Nunez and other key legislators on Monday.

But it's important to acknowledge that the proposal has improved, not just from where it is now, but from some past proposals. Many have compared this to 2003's SB2, but this structure is significantly different, at once less less burdensome on the employers impacted, and much more comprehensive for California consumers.

Under the concept of "shared responsibility," AB8 doesn't just set a minimum employer contribution to health care, as some articles have suggested. It includes contributions not just from employers but from individuals, reinvested state dollars, and new federal funds. It expands and streamlines public programs. It has significant reforms on insurers, in general and in particular in the individual market. Any of these provisions, by themselves, would be a major, headline-worthy, health initiative in any other year.

Most employers will not have to make any changes under AB8. And many employers will benefit. They will now have a new, affordable option to cover their workforce, at significantly less than what they pay now, or what is available on that market. Some will be relieved to no longer have to administer a health benefit. The amount, 7.5%, is by definition as a percentage, scaled to the size of payroll, which provides additional benefit to smaller and low-wage firms. Even for those that don't provide coverage now, they will pay a set amount and in return get a healthier, more productive workforce with less turnover and less retraining costs.

Let's contrast that with SB2, which Health Access California strongly supported as a step forward to getting Californians coverage and security. On businesses, SB2 would have simply required that employers have to provide 80% of the cost of a premium for a standard HMO pack. Many employers do that, and many, many employers were neutral on SB2, given that it really wouldn't have impacted them.

Under AB8, most employers also wouldn't have to change a thing. The differences are beneficial to the employer: under AB8, the minimum contribution is 7.5%, which takes into account size of payroll. Paying the fee to have your workers covered in the statewide pool is less than the average 12-14% than employers pay on average now. They have a new affordable option to provide coverage to their workers. If the 7.5% goes up, it does so only after a public process and deliberation--rather than the status quo, which is to have the costs go up automatically as a percent of premium.

This assistance to employers is possible because of public programs and reinvested state dollars, from aggressive use of bringing in California's fair share of federal funds, and by having the statewide purchasing pool bargain for the best rate. There are also several cost containment components of these bills, and more clearly should be done on that front. We would hope that employers, and the groups that represent them, would support many of the efforts that consumer groups have fought for in past year to help control costs.

Some employers are less inclined to provide coverage to their workers, and will oppose any health reform, no matter how litle is required. But for employers that provide coverage, and those that want to provide coverage, AB8 is not a burden, but a benefit.

Labels: Employers, ExpandingCoverage, Nunez, Perata, Uninsured, YearOfReform

posted by Anthony Wright | Permalink | 8:41 AM


 

Moore reporting...

Tuesday, June 12, 2007

Documentary filmmaker Michael Moore today called for insurance company executives to be tried on manslaughter and premeditated murder charges when policyholders were denied care by the companies and die as a result.

Moore, who was in town to promote the release of his new movie SiCKO, testified at a hearing by Sen. Sheila Kuehl, the five-time author of California's universal single-payer health care plan. He was greeted by an enthusiastic crowd of 1,000 nurses, physicians and other supporters of universal health care.

"I’m here,'' with other lawmakers "in the hopes of igniting a movment across California and this country where the people are covered and where profit is no longer the deciding factor'' in getting people healthcare, Moore said.

The primary target of his invective Tuesday was the profit-making companies -- and some non-profit insurers -- who put money-making before patient care.

"My sincere hope is that California will once again lead the way in taking
on the private, profit-making companies that are gouging the citizens of
this state and country to line their pockets at the expense of those who are
sick, who are ill and who need help.''

More explicitly, Moore called such companies "immoral'' and "criminals.''

“There should never be room for the word profit when you’re trying to decide
whether to provide someone care. Our laws state very clearly that they have a
legal, fiduciary responsibility to maximize profits for shareholders. If they
don’t do that, they are required to turn as big a profit as they can. They only
way they can turn a profit is to not provide care.’’

The thrust of Moore's advocacy, however, centered around one state-provided system -- like Medicare or what is supported by Kuehl's legislation -- that would keep administration costs low and provide care to all citizens, not just those who can pay.

Moore's witnesses at the hearing included Andy Bales, CEO of Union Rescue Mission on Skid Row in Los Angeles, where hospitals have been found to dump patients -- in their gowns, IVs and colostomy bags -- who can't pay their bills. Also at the hearing was Dawnelle Keys, whose 18-month-old daughter died hours after being denied treatment at a nearby hospital because it was not affiliated with Kaiser, her insurer.

In addition to Kuehl's hearing, and a rally sponsored by the California Nurses Association -- among the chief proponents of SB840 -- Moore also appeared at a press briefing with Assembly Speaker Fabian Nunez, who supports SB840, and also has his own AB8 health care proposal. Unlike Kuehl's single-payer bill, Nunez' legislation does not get rid of health insurance companies, but does expand public programs and creates a statewide purchasing pool for coverage.

Moore was asked about that legislation, which provides coverage to two-thirds of the uninsured, and other bills in California. He responded "that's the system we all have," and described how he had health plans from Director's, Writer's, and Screen Actors Guilds. "Why should I have three plans and 47 million Americans have no plans?"

Earlier, he said, "Anything that moves toward single payer is a good thing, and I would support that.''

Speaker Nunez, who like many advocates is a supporter of single-payer, said he would change his legislation if he could get two-thirds of the Legislature to support the level of financial investment it would take to fund a more universal system. But the reality is, he said, Republicans won't vote for the bill. In the state Senate, not all Democrats would either. Sen. Lou Correa, D-Anaheim, did not vote for either SB840 or SB48, Sen. Perata's health reform measure.

Moore did, however, give props to Gov. Schwarzenegger, who released his own health reform plan this year. It has not been introduced in legislation, but elements and ideas are embedded in both Nunez and Perata's plan.

“His plan isn't the right plan, but it was very non-traditional Republican thing for him to do, to even say (health care) was a priority,’’ Moore said. “At least Governor Schwarzenegger is saying (health care) is a problem. Recognizing the problem--the old chiche--you're halfway there.’’

Labels: ExpandingCoverage, Kuehl, Nunez, Perata, Republicans, Sacramento, Uninsured

posted by Hanh Kim Quach | Permalink | 3:34 PM


 

It's not a new debate...

Sunday, June 10, 2007

For those who follow health care policy closely, it's a bit jarring to hear the debate in the Assembly and Senate last week, as legislators make floor speeches and speak in very broad terms about the issue.

While several legislators are very well-versed on health issues, most don't necessarily concentrate on the particulars of health policy, having to master a range of other myriad subjects. But part of the reason that Health Access spend the time to report on these legislative debates in committee and floor sessions is because they are instructive of the public discourse around health care, and useful for health care advocates.

For this year, we've had both informational hearings, policy committee hearings, and now floor votes on the various bills and proposals on health reform. Here's a compilation of links to our archived reports for this year:

2007 archived debate on AB8(Nunez), SB48(Perata), and SB840(Kuehl):
Floor debates on AB8, SB48: http://www.health-access.org/2007/06/legislature-goes-on-record-on-key.htm
Floor debate on SB840: http://www.health-access.org/2007/06/going-through-gauntlet-again.htm
Senate committee on SB48: http://www.health-access.org/2007/04/other-shoe-drops.htm
Assembly committee on AB8: http://www.health-access.org/2007/04/steps-forward.htm
Senate committee on SB840: http://www.health-access.org/2007/04/season-has-started.htm
Informational hearing on SB840: http://www.health-access.org/2007/02/gold-standard.htm
Assembly informational hearing: http://www.health-access.org/2007/02/assembly-weighs-in.htm
Senate informational hearing: http://www.health-access.org/2007/02/they-asked-right-questions.htm

Let's remember this isn't the beginning of the debate. It's instructive to see how past legislative sessions have had similar debates on these topics, from an earlier version of single-payer, SB921(Kuehl), to an employer mandate, SB2(Burton), to universal children's coverage, AB772(Chan), to other "individual mandate" proposals and other ideas. Here's some other archived reports that featured hearings and discussion among our policymakers:

2003-4 archived debate on SB2 and SB921
http://www.health-access.org/2003/04/health-access-update-wednesday-april.htm
http://www.health-access.org/2003/07/health-access-alert-tuesday-july-1.htm
http://www.health-access.org/2003/09/health-access-update-wednesday.htm
http://www.health-access.org/2003/09/health-access-update-thursday.htm
http://www.health-access.org/2003/09/health-access-update-tuesday-september.htm
http://www.health-access.org/2003/09/health-access-update-friday-september.htm
http://www.health-access.org/2004/06/health-access-update-tuesday-june-22nd.htm

2005-6 archived debate on SB840, AB772 and other proposals
http://www.health-access.org/2005/04/health-access-update-special-edition.htm
http://www.health-access.org/2005/04/health-access-update-wednesday-april_06.htm
http://www.health-access.org/2005/05/health-access-alert-tuesday-may-31st.htm
http://www.health-access.org/2006/04/assembly-health-committee-passes-key.htm
http://www.health-access.org/2006/06/budget-conference-committee-approves.htm
http://www.health-access.org/2006/06/bill-to-protect-consumers-against-high.htm
http://www.health-access.org/2006/08/sb840kuehl-passes-assembly-legislative.htm

These debates provide a context for the work we do now.

Labels: ExpandingCoverage, Kuehl, Legislation, Nunez, Perata, Sacramento, Updates, YearOfReform

posted by Anthony Wright | Permalink | 11:10 PM


 

The Legislature goes on record on key reforms...

Thursday, June 07, 2007

HEALTH ACCESS UPDATE
Thursday, June 7, 2007


HEALTH REFORM MEASURES PASS FIRST FLOOR VOTES
* AB8 (Nunez), SB48 (Perata), and SB840(Kuehl) passed on (virtually) party-line votes
* Debate touches on the need for rules in the health care market, expanded coverage
* Over 400 house parties hosted for health reform statewide by Its Our Healthcare coalition
* RSVP to see SiCKO; Full day scheduled for June 12th

New on the Health Access WeBlog: More commentary on floor votes; Past floor debates


The California Legislature's Democratic leaders, Speaker Fabian Nunez and Senate President Pro Tem Don Perata, having passed their health reform bills from their respective houses Thursday, are now looking ahead at trying to meld the two ideas together.

REFRESHER

Both passed their respective SB48(Perata) and AB8(Nunez) bills Thursday. Both have similar features, seeking to provide more security so people can get and keep coverage from their employer, through a public program, or by purchasing it as an individual. Both are expected to extend coverage to roughly 70% of the uninsured.

Both bills:
• Would require employers to contribute at least 7.5 percent of payroll to their workers' health coverage, though Nunez does exempt smaller and newer businesses. Employers would either provide private coverage for their workers, or pay such a fee.
• Would create a state-run purchasing pool where workers could get health coverage if their employers don't provide it.
• Would expand existing public programs to cover all children, and move to subsidize coverage for more lower-income adults through this state-run purchasing pool.
• Would draw down new federal funds by bringing in more matching Medicaid money.
• Would also impose some new rules on insurers, including preventing rampant rejection of consumer for "pre-existing'' conditions, and limiting the amount of premium dollars that goes for administration and profit.

One difference between the two plans, though, is that SB48(Perata) would require Californians earning more than 400% of poverty ($40,840 for an individual, $82,600 for a family of four) to have health coverage, with some exemptions.

THE DEBATE: SB48 (PERATA)

Senators got right to business Thursday morning and debated SB48 for about 30 minutes before voting 23-16 on the measure, in a near party-line vote. Sen. Mark Ridley-Thomas, D- Los Angeles, was not on the Senate floor when votes were cast. Sen. Lou Correa, D-Anaheim was the only Democrat to vote against the measure. Correa also voted "no" on Wednesday to SB840, Sen. Sheila Kuehl's universal single-payer health care measure.

Perata said this was the year to get something done. "It will not get any better unless we jump in the pool and get wet,'' he said. "When medical costs are going up five, six, seven times inflation, something is fundamentally wrong,'' Perata said. That will mean making tough choices, including the broaching the idea of denying care, for instance a hip replacement to a 90-year-old.

Sen. Tom McClintock, R-Thousand Oaks, warned that every state that has attempted to reform health care has ended up worse off. McClintock prattled off a litany of states, saying, "Every time and every place this concept has been tried, it has consistently produced massive cost overruns for government, massive increases in premiums for consumers, widespread fraud and abuse, and ultimately a deterioration in health care services and a rationing of what remains.''

He mentioned TennCare in particular, which he said resulted in increased taxes to pay for the state's attempt to provide health care to the sickest and most vulnerable. Some advocates who have looked at the TennCare model, which was undone recently, believe that the issue was that the state failed to negotiate lower costs for with insurers and drug companies. McClintock also attacked nationalized systems in other countries. "What makes you think European socialism is going to work any better than it does in Europe?'' asked McClintock, in the face of statistics that show industrialized nations with national health care systems do have better life expectancies and infant mortality rates than the U.S.

Sen. George Runner, R-Palmdale, also spoke. He led a group of senators earlier this year in proposing a smattering of bills that would have encouraged bare-bones, high-deductible plans, among other ideas. Republicans said they see the health care problem in California being more about access to care.

"There are many people around who are carrying around insurance cards to say they're insured (on Medi-Cal). They can't see a doctor. That is coverage with very bad access,'' Runner said. This is a key point that advocates have made in past years in an attempt to increase Medi-Cal reimbursement rates for providers, a move that Republicans have been reluctant to support in the past because it would require finding new money (ie: raising taxes) to pay for the increased reimbursements. Runner later told Sen. Sheila Kuehl (during her speech) that he would vote in the budget to increase reimbursement rates, though did not say anything about finding the money to do it.

Lastly, Runner cautioned that Perata's bill could lead to "rationing'' of health care. "It opens the door to us deciding who's worthy of health care and who isn't,'' Runner said.

Sen. Sheila Kuehl responded: "We have rationing now. Rationing is not going to be imposed in a new plan. It's Darwinian. You have money. You can buy insurance. You have health care. You don't have money. You don't have insurance. You don't have health care,'' she said.

The author of a bill for a universal single-payer system. Kuehl is also co-authoring Perata's bill, and asked Perata if he could also work provisions into SB48 that would ensure that consumers' obligations to pay for health care were capped, just as they are in businesses at 7.5 percent. This is a key advocacy goal for many consumer and community groups, that there are guarantees for affordability for consumers, both to get coverage (the premiums), and to use coverage (deductibles and other out-of-pocket costs).

THE DEBATE: AB8 (NUNEZ)

The Assembly debate on AB8 (Nunez) was considerably longer than the Senate, though the tenor of the debate was much the same.

Republicans, however, began the discussion by attempting to “amend’’ the legislation, some of which had never been heard in committee, into AB8. Their point was that they had 18 bills that they felt could help fix the health system, but that none were advancing to the Senate.

While it is true that the Republican health reform bills were not advancing to the Senate, and eight were voted down in committee, ten never had a hearing because Republicans did not ask for a hearing. Additionally, four bills were scheduled for hearings, but were cancelled by their Republican authors.

Speaker Nunez said it was a shame that California – one of the largest economies in the world – had children who couldn’t see dentists and people who didn’t have medication. “Millions of Californians, most of whom are working hard to support themselves and their families, live in fear of getting sick and missing work. Many families have high rates of chronic diseases such as diabetes, which can lead to blindness and amputation,’’ he said. “….Health care currently is a privilege. Those that can afford to have it have it. From this point forward, health care will be a right that’s afforded to everyone in the state.’’

Assembly Democrats orchestrated a succession of comments that made the point about how AB8 was a sound solution for this year. Assemblyman Merv Dymally, who has served as an elected official since the 1960s, walked the Assembly through the history of health reform in California and the country.

Assemblyman Ed Hernandez, a physician, told a story of a former patient who he had first diagnosed with diabetes, and whose health slowly deteriorated because he could not afford the medication or doctors visits. The patient eventually died – and spurred Hernandez to begin his life as a lawmaker to change the system.

Assemblyman Mark Leno urged his colleagues to look ahead at one disease: diabetes, which now afflicts one in eight Californians. In 20 years, he said, experts predict it will affect one in three Californians, and by 2050, it will affect one in two people, he said. “Do you know what this will do to our economy?’’ Leno asked. Already, he said about 50% of health care costs are spent on diabetes related diseases – and that’s with just 1/8th of the population affected.

Assemblyman Hector De La Torre said his healthy five-year-old daughter would never be able to get insurance in the current system because when she was an infant, she had infant botulism. Such a “pre-existing’’ condition would preclude her from getting coverage on the individual market, in spite of her good health today.

Finally, Assemblywoman Loni Hancock, a strong supporter and co-author of Kuehl’s single-payer measure, said she still pined for SB840, but “I recognize the governor does not support the measure. AB8 represents our best chance to do something real for the millions of California children, and everyone who does not have access to health care now. This bill will reduce the number of uninsured by 70%. That is an enormous step forward so many people will no longer have to fear injury or serious illness.’’

Several Republicans spoke and many repeated the fact that none of 18 Republicans bills were advancing. But Republicans, by and large, admitted that there was a problem with the current way that health care was delivered, characterizing it as “damaged’’ and saying they’d like to see “better care for Californians.’’ That’s a change from previous debates, such as over SB2 (Burton) in 2003, where Republicans denied that there were significant problems with the large number of uninsured.

A number of Republican Assemblymembers challenged AB8 and its legality – particularly with respect to the federal ERISA law, which does not allow states to dictate how employers provide benefits to their workers. Assemblyman Todd Spitzer said AB8 was the “sister’’ legislation to the Maryland so-called “Walmart” bill, that would have forced Walmart to spend 8 percent of it payroll on health care for workers. The Maryland law, however, is quite different from AB8, in that it only affected one company, Wal-Mart, and did not provide choices to employers. (For further distinctions and discussion on this point, visit the Health Access WeBlog here.)

Assemblywoman Audra Strickland, R-Moorpark, called universal healthcare a “Las Vegas buffet,’’ where “everyone eats for the same price; everyone waits in the same long lines. Some of those more sought after foods, -- some people get them, some people don't. Buffet patrons consumer more food. And they waste more food.”

Strickland had a bill, which was rejected, that would have required Medi-Cal patients, the lowest income, to have Health Opportunity Accounts and "shop around’’ for low prices. This is a goal that CalPERS, one of the largest and most sophisticated health buyers in the nation, is having a difficult time negotiating.

In his close, Speaker Nunez directly addressed arguments that Republicans made about allowing the “market’’ to work. He touched upon the need for government rules to be imposed on insurers. Referring to an asthmatic girl who had been denied coverage, Nunez said his message to health plans is, “you’re going to have to do a little bit more to take care of people.’’“If you enter biz of health care, your fundamental responsibility is not how much goes into your back pocket, but to provide adequate health care. We have a responsibility to see that the market works for the people,’’ he said.

AB8 and SB48 will now head to the opposite houses. Sen. Don Perata said it was likely that the bills would, at some point, be combined into one. Frank Russo at the California Progress Report has posted his update of the press conference with both legislative leaders.

Health Access will continue to keep you informed on the status of health reform legislation and debate. For more information, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org.


YEAR OF HEALTH REFORM CONTINUES

The passage of SB840 on Wednesday and AB8 and SB48 on Thursday was the perfect kickoff to the It’s Our Healthcare coalition’s weekend of house parties. Beginning Thursday night, more than 400 health activists throughout the state are holding “house parties’’ to help inform friends, family and neighbors about the importa