Final floor votes...

Tuesday, August 19, 2008

HEALTH ACCESS UPDATE
Wednesday, August 20th, 2008


HEALTH LEGISLATION UP FOR FINAL VOTES

* Handful of consumer bills on the line, including single-payer, insurance standards, medical loss ratios, recission review, coverage for those with "pre-existing conditions."
* Budget remains unresolved: negotiations continue on cuts, revenues, and caps.

Click for What's New on the Health Access WeBlog: More on Budget Negotiations; The Return of Harry & Louise; How to Improve the Economy; The Insurance Companies "Listening Tour"; HSAs; The Folly of a Spending Cap; The Consumers Union Cover America Tour RV Comes to Sacramento; New Studies; NJ Prohibits Hospital Overcharging; Premiums Going Up; The DNC Platform on Health Reform; Preparing for Denver; ER Overcrowding and Timely Access to Care; Ups and Downs of the Budget Fights; MegaLife and Mega Problems


The 2007-08 Legislative Session is fast coming to a close. Bills are up for final floor votes in the next several days--the last chance for health care advocates to weigh in with legislators about pending legislation is now.

While midnight August 31st is the deadline for bills to pass, legislative leaders have, at times, indicated they wanted to end session sooner – as early as this Friday, August 22nd. It is unclear whether either house will actually complete their legislative work at the end of this week, given that a state budget still has not passed. While both have national party conventions to attend over the next two weeks, the budget may keep the legislators in town through the 31st, and perhaps later. Adding to the uncertainty, Gov. Arnold Schwarzenegger has vowed to veto any and all bills that land on his desk if a state budget is not passed.

Regardless of the exact last day of session, legislation will be considered in the next several days that will have a major impact on health care consumers, from those trying to compare and purchase insurance, to those denied for "pre-existing conditions."

Health Access continues to track a number of health consumer-related bills. Several bills work to ensure that consumer have more confidence that there coverage will be there for them when they need it. More information is available on the Health Access website, at:
http://www.health-access.org/advocating/2008_bills.html

Here's a selected list of pending legislation that Health Access California, the statewide health care consumer advocacy coalition, supports:

ON ASSEMBLY FLOOR

* INSURANCE MARKET STANDARDS: SB 1522 (Steinberg) Would provide standards for health insurance policies in the individual market. This would weed out "junk" insurance and sort policies into five coverage categories, ranging from “comprehensive’’ to “catastrophic," to enable consumers to better track premium, benefits and cost-sharing. Benchmark policies would assist consumers in making apples-to-apples comparisons between plans. SUPPORT/SPONSOR
* SINGLE PAYER: SB 840 (Kuehl) Would establish the framework for a universal, single-payer health care system in California that would enable all residents to have health coverage. SUPPORT
* HOSPITAL DISTRICT ASSET TRANSFERS: SB 1351 (Corbett) Would require Attorney General oversight into transactions involving district hospitals. SUPPORT
* INSURANCE COMPANY FINES: SB 1379 (Ducheny) Would use millions in fines levied on insurance companies for improperly rescinding coverage to fund two programs: high-risk pool for those rejected by insurance companies because of "pre-existing conditions"--which has a waiting list of nearly 1,000 Californians and financial aid program for physicians who serve in underserved areas. SUPPORT
* PREDATORY DENTAL PRACTICES: SB 1633 (Kuehl) Would prohibit dentists’ offices from offering high-interest loans to patients while they are under the influence of anesthesia. Would also prohibit dental offices from charging lines of credit before services have been rendered. SUPPORT
* UNFAIR BUSINESS PRACTICES: AB 2842 (Berg) Would protect Californians from insurance agents trying to sell them private Medicare plans through cold calls and bait-and-switch tactics. SUPPORT
* HOSPITAL CLOSURES: AB 2400 (Price) Would require public notice before closing a hospital. SUPPORT

ON SENATE FLOOR

* HIGH-RISK POOL: AB 2 (Dymally) Would reform the Managed Risk Medical Insurance Program, which provides coverage for “un-insureables” who have “pre-existing conditions.’’ Would institute reforms and generate revenues through fees to make the high risk pool more affordable and available. SUPPORT
* BALANCE BILLING IN EMERGENCY ROOMS: AB 1203 (Salas) Would prohibit balance billing by doctors and hospitals for care received after an emergency patient is stable enough to be transferred to a contracting hospital or released. SUPPORT
* MENTAL HEALTH PARITY: AB 1887 (Beall) Would require health plans to provide coverage for all diagnosable mental illnesses. SUPPORT
* LIMITING RESCISSIONS: AB 1945 (De La Torre) Would create an independent DMHC/DOI review if an insurer wants to rescind coverage, and raises the standard in existing law so that coverage can only be rescinded if a consumer willfully misrepresents his health history. SUPPORT
* BROKER ACCOUNTABILITY AND FAMILY COVERAGE AFTER RESCISSION: AB 2569 (De Leon) Would require brokers who take applications to attest that the information is complete and accurate to the best of their knowledge. Also ensures that family members whose coverage depends on that of the rescinded person may be offered another individual policy. SUPPORT
* PUBLIC INSURER: SB 973 (Simitian) Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices. SUPPORT
* DURABLE MEDICAL EQUIPMENT: SB 1198 (Kuehl) Would require group health plans and insurers to offer coverage for durable medical equipment, such as wheelchairs and shower seats. SUPPORT
* CONFIDENTIALITY CLAUSES: SB 1300 (Corbett) Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contracts between providers and insurers. SUPPORT
* CAPPING ADMINISTRATION AND PROFIT: SB 1440 (Kuehl) Would set a minimum medical loss ratio – requiring every insurer to spend at least 85 percent of premiums on patient care. SUPPORT
* FREQUENT ER USE: SB 1738 (Steinberg) Would continue pilot program in six counties that has provided frequent emergency room users with more cost-effective preventive care and disease maintenance through clinics and other resources. SUPPORT

HEADING TO GOVERNOR’S DESK

* MATERNITY COVERAGE: AB 1962 (De La Torre) Would require all individual insurance policies to cover maternity services. SUPPORT
* BOUTIQUE HOSPITALS: AB 2697 (Huffman) Would require so-called “boutique hospitals’’ to asses their impact on a community’s health system annually, specifically whether they siphon doctors, workers, providers from hospitals caring for less affluent populations. SUPPORT
* DEPENDENT CARE: SB 1168 (Runner) Would allow adult dependent children, who are still covered under their parents’ health plan, to stay on that coverage even if the child takes a medically necessary leave of absence from school. SUPPORT

For more information, contact the author of this report, Hanh Kim Quach, policy coordinator at Health Access California, at hquach@health-access.org.

Labels: Insurers, Legislation, Sacramento

posted by Anthony Wright | Permalink | 6:03 PM


 

Harry & Louise returns...

Harry and Louise, the couple that helped take down health care reform, are back... but this time on the opposite side.

There's a new ad, being run during the political conventions, that feature the same actors from a decade-and-a-half ago:
http://www.harryandlouisereturn.com/

The sponsors include groups in support of reform, from Families USA to the American Hospital Association and the American Cancer Society, and also on group that vocally opposed reform--the National Federation of Independent Buisnesses.

Here's the "making of" video:


For a blast from the past, here's the original ad attacking the Clinton health care plan. It's a sobering reminder of the attacks that any reform with come under by insurers and other opponents:

Labels: Federal, Insurers, Year of Reform

posted by Anthony Wright | Permalink | 10:51 AM


 

Getting in gear on health reform...

Wednesday, August 13, 2008

Consumer Reports Health’s Cover America Tour, a nationwide road trip chronicling the difficulties many American families face getting affordable, high quality health care, rolled into Sacramento Tuesday, with a message around state and federal reform.

Labels: Federal, Hospitals, Insurers, Legislation, SCHIPHealthyFamilies, YearOfReform

posted by Anthony Wright | Permalink | 11:39 AM


 

Slowing, but still increasing

Tuesday, August 12, 2008

Insurance brokerage giant Aon Corporation released a study today showing that even though health care premiums next year will still outpace inflation by more than 3.6 times, at least it's slowing. In the next year, health premiums are expected to increase approximately 10.6 percent. It's been going down steadily since 2002, when increases hovered around 16 percent.

The San Francisco Chronicle also reports on the study.


One of the reasons for the slowed increase, the study director says in the SF Chronicle, is that businesses are being much better about ensuring their workers stay well -- through disease management programs -- and attacking underlying reasons for increased costs rather than purely making workers pay more, but allowing them to live less healthy and medically expensive lives.

What I found interesting was the rate of increase for a managed-care plan and consumer-directed plan (many of which are low-premium, low-value, high-deductible and intended to save money by allowing consumers to take control) were approximately the same -- 10.5 and 10.5, respectively.


Here's a related report from PriceWaterhouseCoopers

Labels: Insurers, InTheNews, Research

posted by Hanh Kim Quach | Permalink | 1:06 PM


 

Key bills move to the next step...

Thursday, August 07, 2008

Assembly Appropriations Committee, chaired by Assemblyman Mark Leno, is meeting as we speak. Here's some of the bill that are being passed, and are heading to their second floor vote:

* SB840(Kuehl), to establish a single-payer universal health care system, and set up a commission to work out the financing, was passed, with amendments to adjust timing issues.

Other bills passed include:
* SB973(Simitian) to facilitate county-based public health insurers to work together;
* SB981(Perata) to prevent balance billing;
* SB1198(Kuehl) to require insurers to offer coverage of durable medical equipment;
* SB1440(Kuehl) to require a minimum level of premium dollars to go to patient care;
* SB1522(Steinberg) to provide standards for individual insurance products;

More information to come...

Labels: BalanceBilling, Insurers, Legislation, SB840, Underinsurance

posted by Anthony Wright | Permalink | 3:10 PM


 

Making coverage matter...

Monday, August 04, 2008

Health reform continues, and the first job is to make coverage provide the security for which people get insurance in the first place. That's the upshot of the front-page article today by Jordan Rau of the Los Angeles Times.

It is a good, comprehensive report about several consumer protections moving through the Legislature and to the Governor's desk, which would in particular help those who don't have group coveragae through an employer or public program, and have to buy coverage as an individual. The Governor is currently negotiating with the legislators about the final contents--from SB1522(Steinberg), our bill to better standardize the insurance market, to SB1440(Kuehl), which would ensure a percentage of premiums go to patient care.

It's critical to future efforts around health reform: if people don't have confidence in the value of coverage, then they are less enthused about expanding that coverage.

Labels: Insurers, Legislation, Schwarzenegger, Underinsurance, YearOfReform

posted by Anthony Wright | Permalink | 1:46 PM


 

A novel concept

Wednesday, July 23, 2008

The NYTimes had a story this week about paying doctors more so they can do more preventive maintenance for their patients.

What a concept.

It seems that we learn really basic concepts at a very early age: that often (not 100% of the time, but frequently) you get what you pay. If you want higher quality, you pay more. We also learned that if you do things right and carefully the first time, you won't have to redo it later (I admit, this is a lesson I'm STILL trying to master).

The trend for our medical system, however, has been the opposite, leading to what we have now, which is harried doctors rushing from patient to patient paying a few minutes of attention.

But the NYTimes story points out that insurers are now applying these adages to medicine (as is Medicaid and Medicare). Higher compensation enables doctors to hire more staff to follow up with patients, answer questions when they call/e-mail and make sure they're up to date on tests.

It seems funny to say this is an innovation (because it seems like common sense to focus on wellness up front before patients get too sick after receiving episodic or inattentive care)....but hope the trend continues

Labels: Insurers, InTheNews, Prevention

posted by Hanh Kim Quach | Permalink | 10:53 AM


 

Blue Shield and Blue Cross settle on rescissions...

Thursday, July 17, 2008

Big day on rescissions. I was in Los Angeles, testifying before the LA County Commission on Insurance in support of SB840, health reform, and specific pending legislation on recissions--after all there are no less than four bills, sponsored by Assemblymembers De La Torra, Deleon, Hayashi, and Lieu, that include a number of reforms.

I thought I was providing the most up-to-date information, but a lot happened.

The Capitol Weekly and The Los Angeles Times reports on two major settlements, with Blue Shield to restore coverage to 450 rescinded patients and pay a $3 million fine, and Blue Cross to restore coverage to 1770 patients and pay a $10 million fine. Earlier settlements were already reached with Kaiser, HealthNet, and Pacificare, albeit with smaller fines and numbers of people impacted, given their market share.

We'll need to watch over the Department and the insurers to ensure their goals are reached for these consumers:"guaranteed issue coverage, a process for full monetary losses and no back premiums owed," as Department of Managed Health Care Director Cindy Ehnes had identified in the LA Times.

It's good that there has been a focus on getting these folks coverage as soon as possible, even as other court and other proceedings continue. The question is what laws can help moving forward so we radically reduce or eliminate these practices once and for all. The ideas pending include:
* providing a independent review of all rescission cases;
* standardizing the underwriting proccedings;
* shortening the time frame where a patient can be rescinded;
* eliminating bonuses paid to employees who rescind more patients;
* protecting family members' coverage when a family member is rescinded; and
* setting standards for brokers due diligence.

Finally, at the federal level, Congressman Henry Waxman and the House Committee on Oversight and Government Reform held a hearing on the subject, featuring testimony from several rescinded patients, a representative of the insurers, and from California, Secretary Dale Bonner, which oversees the DMHC. It put a federal spotlight on the issues, hopefully helped in getting some attention on these issues in a new light, maybe helped serve as an impetus for these settlements, and sets what being "a regular" may mean.

Labels: BlueCross, DMHC, GuaranteedIssue, Insurers

posted by Anthony Wright | Permalink | 10:53 PM


 

More Blues for Blues

The LA Times today reveals that LA City Attorney Rocky Delgadillo is suing Blue Shield (for once, we're not picking on Blue Cross) for rescissions.

The featured story is this poor Portuguese couple, left with $60,000 in medical bills after Blue Shield retroactively cancelled their coverage. The insurer scrutinized the family's applications after the wife needed emergency surgery to remove her gall bladder. They couldn't find anything wrong with her application, so they mined her husband's application and VOILA -- he had a high cholesterol reading he had not disclosed: cancel!

Turns out, the poor man didn't even *realize* he had high cholesterol. He took Lipitor, but he was told by his doctor that "men his age often needed it.'' He doesn't speak English well. The agent filled out the application for them.

I always get nervous when I read these stories because it helps to illustrate exactly how vulnerable each and every one of us really is. This story, though, particularly touching because I have immigrant parents and my immigrant mother misunderstands things all the time -- *ALL* the time. She doesn't get jokes, and she can't tell stories without getting at least three facts wrong.

So, if she were ever at the mercy of the individual insurance market (if the myriad pre-existing conditions she and my father have don't already disqualify them from coverage), I would be reading about her rescinded coverage in the LA Times. Thank God for the retiree health care she has -- for now.....

Labels: Insurers, InTheNews, Rescissions

posted by Hanh Kim Quach | Permalink | 11:07 AM


 

High-Risk policies, indeed...

Monday, July 14, 2008

Last week, one aspect of the McCain health plan was highlighted by Kevin Sack of the New York Times , in an article entitled, "McCain Plan to Aid States on Health Could Be Costly." It lays out the problem:

"If Senator John McCain’s radical plan for remaking American health care is to work, he will have to find a way to cover people like Chaim Benamor, 52, a self-employed renovator in this Baltimore suburb.... After being rejected by a number of commercial carriers, he turned to the Maryland Health Insurance Plan, one of 35 state programs for high-risk applicants whom no private company is willing to insure."

The McCain plan would eliminate the tax benefits for employer-based coverage, and thus push people from on-the-job group coverage into the individual market, where consumers (except in a few states) can be denied for "pre-existing conditions."

So what happens if one is denied? In California, your only option is the state's "high-risk" pool, MRMIP, the Major Risk Medical Insurance Program... but that now has a waiting period of over 1,000 patients!

And that's a program that has never been advertised, that's more expensive premiums than already-expensive market rates, and that caps annual benefits at a mere $75,000--less than a week in many hospitals.

Even though we suspect that the number of willing-to-pay-but-"uninsurable" customers are in the hundreds of thousands, the McCain plan would make this worse. And his only solution is to provide some federal assistance to plans like MRMIP. The question is: will it be enough?

With the new attention on the individual insurance market and "high-risk" pools, the Kaiser Family Foundation is hosting an "Ask the Experts" webcast tomorrow (Tuesday) at 10am Pacific Time on the subject. One of the experts is California's own Lesley Cummings, executive director of the MRMIB, which runs MRMIP. It should be interesting to hear her answers to question coming from a national perspective.

Don't get me wrong: MRMIP needs help and resources as soon as possible--AB2(Dymally) is a longstanding pending bill on this subject that Health Access California supports.

But the real solution is to reduce the number of people denied by insurance companies in the first place, either through the market power of group coverage, or by significantly regulating the individual market. Even in the context of health reform that does both, like in AB x1 1, it made sense to maintain and improve the high-risk pool to make sure the safety net was in place and strengthened for those who fall through the cracks.

What makes no sense is to make the problem worse, and pretend these already struggling problems are the solution.

Labels: Federal, GuaranteedIssue, Insurers, InTheNews

posted by Anthony Wright | Permalink | 7:02 PM


 

You really had to be there...

Saturday, July 05, 2008

So this blogger walks into a bar...

At least that the premise of a recent post by Julie Barnes at the New America Foundation's New Health Dialogue Blog, talking about a performance by comdian Jake Johannsen:

When we saw him, he was on a "How The Man Sticks It To The Little Guy" run when he used health insurance as an example. First, he mentioned how lucky most of us feel if we can buy insurance through our employers (unspoken subtext: because if we get health insurance at work, we don't have to worry about being denied coverage because of preexisting conditions). But then we don't feel so lucky if we get sick and, even with coverage, get a pretty big bill. At least then, Jake joked, we could complain about how our boss was "sticking it to us." But some of us have to purchase our own insurance directly, so, he deadpanned: "I end up sticking it to myself! That doesn't seem right."

Then, in surprisingly fluent health insurance-speak, Jake went off about how he could barely keep up when his insurance broker was trying to explain his policy choices: an HMO, an HMO with a POS, a PPO, and variances between the deductible, premiums, co-pays, co-insurance and out-of-pocket maximums.

Jake asked "but which one is best" and the broker replied "it depends on the individual." And Jake, being a comedian, said: "Let's say, hypothetically, that the individual is me." The broker responded: "You have to make your own decision about what's best for you." At which point, Jake made a funny face that meant "You've got to be kidding" and the audience responded with gales of laughter.

Ha ha. To be honest, the retelling doesn't seem that funny... it just seems sad because it's so true. Some have argued that we don't need reforms to standardize the individual insurance market--like the pending SB1522(Steinberg)--because people have access to brokers. If you are lost (as many consumers are), it is useful to ask for directions, and it is useful to have a map. One doesn't obviate the need for the other. Both are helpful.

The blogger from the centrist New American Foundation agrees that the humor doesn't quite translate:

As things currently stand, no one (not even those of us who work on health policy for a living!) can make truly informed decisions about which health care policy is best for us. It is difficult to determine whether paying more up-front or taking the risk of paying more later or having more or less provider choice is the way to go. This kind of confusion is not funny, which is why transparency and consumer-friendly decision support tools (real ones, that real people can understand) must be part of any health reform.

Labels: Funny, Insurers, Legislation

posted by Anthony Wright | Permalink | 3:01 PM


 

Killing us softly...

Wednesday, July 02, 2008

NYTimes has a horror story about diabetes and how it creeps up on you and "eat(s) you alive,'' as one doctor described it. In addition to being the leading cause of blindness and amputation, diabetes also affects the afflicted in a myriad other ways from head to toe -- depression, sleep issues, stroke, dental and hearing problems, liver and kidney problems, *paralysis (!)* of the stomach, ulcers, and various sexual problems.

Cases of diabetes are growing -- 8 percent of the US population had it in 2007. And by 2050, it could be 25%, according to the Centers for Disease Control.

I'm fixating on this for two reasons. 1) I'm genetically predisposed to diabetes; my father was diagnosed in his mid-40s. 2) Our insurance coverage trends make it very difficult for people to maintain and keep this perfectly treatable disease at bay.

As more people (not us, mind you) advocate for more stripped down health plans, devoid of disease maintenance, it creates all kinds of barriers to getting the meds and seeing the doctor -- all necessities for a person with diabetes.

I'll do a quick, shameless plug for our SB1522 here, which not only would organize the individual insurance market, but also establish minimum benefits -- such as doctors, hospitals and preventive services. It's one of the ways we could begin to tame the unruly individual insurance market, which has been rapidly degenerating over the past few years.... unless we want a nation of diabetic zombies by 2050.

Labels: Insurers, InTheNews, Legislation, Steinberg, Underinsurance

posted by Hanh Kim Quach | Permalink | 10:34 AM


 

Deadbeat Insurers

Tuesday, July 01, 2008

David Lazarus at the LA Times had an excellent column last weekend about health insurers charging men and women different rates. When Blue Shield and other insurers admit they're charging women higher premiums because they are higher "risks'' (Read: more expensive), they're coming clean about the industry's already discriminatory practices against women. Though, in doing so, it further widens the gap between what women and men pay for health care. Women will wind up spending more, not only to *buy* care, but also to *use* care, as has been the case.

Since the steady increase of high-deductible health plans (and in the absence of stronger consumer protections such as community rating and minimum benefit standards) insurers have been permitted to passive aggressively charge women more based on the fact that women are trying to be conscientious about their health.

A Harvard Medical School study last year found women ages 18-64 with consumer-directed health policies wound up spending 218% more on health care than men. "High-deductible plans punish women for having breasts and uteruses and having babies,'' said Dr. Steffie Woolhandler, one of the authors of the study.

We require various gynecological exams. We need birth control pills (as a result of co-activities with men). Sometimes we have babies (as a result of said co-activities) -- though high-deductible plans don't cover maternity anyway. We go to the doctor when we hurt. We generally seek more preventive care than men. Hmmmm. And I thought I was just being responsible.

A world that allows high-deductible plans to proliferate -- as envisioned by John McCain -- is essentially a world that legitimizes deadbeat insurers, who want to thrust more and more costs onto women in the name of keeping prices low. But for whom?

Labels: Affordability, Insurers, InTheNews, Underinsurance

posted by Hanh Kim Quach | Permalink | 12:00 PM


 

Where does our money go?

Friday, June 27, 2008

The most exciting thing this week (other than Health Access' report release) was the release of the California Medical Association's annual "Knox-Keene Health Plan Expenditures Report,'' which replaces my old dog-eared copy from a couple years ago.

The report gathers data reported by health plans to the Department of Managed Health Care to show which ones spend the most on medical services for their enrollees (and which ones spend the most on administration and profit). This is called the "Medical Loss Ratio,'' you know, because plans ''lose'' money when they spend it on health care for you. The percentage of premium dollars spent on patient care is an important (though not the only) measure of a plan’s value.

Sadly, there is not similar data publicly available for PPOs, which are regulated -- more loosely -- by the Department of Insurance. Not having the data on the Department of Insurance side creates a huge hole for advocates, because 40 percent of insured Californians now buy the less robust insurance products regulated by the Department of Insurance. These plans are required to spend 70% of revenues on patient care and are among the worst offenders on the market. Low-value products are marketed to consumers for their low premiums. Patients do not have the actuarial expertise, or information to assess whether a particular low-premium product will actually provide them value – meaning it would pay for physician visits, drugs and other health costs when they need it. Products that have low medical-loss ratios often do not have maternity coverage, do not cover prescription drugs, have high deductibles, high co-insurance, and lack caps on how much consumers need to spend out-of-pocket for their illnesses. Such flimsy coverage causes consumers to defer care, or leaves them saddled with medical debt. Low-value health plans have dedicated as little as 51 cents of every premium dollar toward on what patients need. Meanwhile insurers spend 49 cents of every dollar consumers pay against consumers -- fighting bills for patient services, scouring health records in order to retroactively rescind policies, and other administrative costs—or to the profit of the insurer.

CMA is the sponsor of SB 1440 (Kuehl), which Health Access also supports. The bill would require health plans spend 85 percent of revenues on patient care (also called Medical Loss Ratios -- 'cause to insurers, they ''lose'' money when they have to spend it on you.) That is different from the current law, which only caps administrative costs at 15 percent (which means profits layered on top of that eat into the amount spent on patient care.) A nice feature of the latest version of this bill is that it will require plans to report the Medical Loss Ratio by product, rather than averaging them across the insurer's entire book of business, allowing the really awful products to be lumped in and hide behind better ones.

Okay, on to the report.

For-profit plans that spent the least on patient care in 2007:

1. Great-West Healthcare of California: 69.4% patient care; 11.5% admin; 11.3% profit
2. Blue Cross: 79% patient care; 11.1% admin; 6.1% profit
3. Aetna: 81.4% patient care; 8.7% admin; 6.3% profit
4. Molina Helathcare of California: 84.2% patient care; 15.5% admin; 0.2% profit

Non-profit plans that spent the most on patient care (not including public health plans)

1. Scripps Clinic Health Plan Services: 95.3% patient care: 4.5% admin; 0.1% income
2. Partnership Health Plan: 94% patient care; 6.1% admin; -0.4% income
3. Western Health Advantage: 90.8% patient care; 8.7% admin; 0.6% income
4. Kaiser Foundation Health Plan: 90.6% patient care; 3.6% admin; 5.8% income

Labels: Insurers, Kuehl, Legislation, Research

posted by Hanh Kim Quach | Permalink | 4:24 PM


 

Bills before break...

Thursday, June 26, 2008

HEALTH ACCESS UPDATE
Thursday, June 25th, 2008

HEALTH BILLS LIVE AND DIE BY THE COMMITTEE
* Health legislation heard in final policy committees before July break
* Bills pass to require 85% of premium to go to patient care; regulate recissions; foster a public insurer; discourage "never events," encourage hospital community benefits.

Click Here for What's New on the Health Access WeBlog: Continued Real-Time Budget Conference Committee Reports; The Perils of "Junk" Insurance; Gender Discrimination in the Individual Insurance Market; The Mortgage Metaphor for SB1522; Improving Medicare with a Phone Call.


With tomorrow's deadline for legislation to have cleared policy committees in the second house, lawmakers heard a battery of bills this past week. Key pieces of legislation of interest to health advocates were also on the agenda. Many of the bills advocates have been tracking passed.

Following is a list of the bills heard this week and the outcome. Additionally, advocates may visit the Health Access website, at http://www.health-access.org/advocating/2008_bills.html for a complete list of bills.

The following bills passed in Assembly Health Committee, chaired by Assemblyman Mervyn Dymally, on Tuesday:

* SB 1198 (Kuehl): DURABLE MEDICAL EQUIPMENT: Would require group health plans and insurers to offer coverage for durable medical equipment, such as wheelchairs and shower seats. Support
* SB 1440 (Kuehl): CAPPING ADMINISTRATION AND PROFIT: Would set a minimum medical loss ratio – requiring every insurer to spend at least 85 percent of premiums on patient care. Would also require plans to report how much they spend on health care versus administration on each single product they offer. Support
* SB 973 (Simitian) PUBLIC INSURER: Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices.
* SB 1300 (Corbett): CONFIDENTIALITY CLAUSES: Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contracts between providers and insurers. Support
* AB 1351 (Corbett): DISTRICT HOSPITAL OVERSIGHT: Would require Attorney General oversight into transactions involving district hospitals. Support

The following bills passed in Senate Health Committee, chaired by Senator Sheila Kuehl, on Wednesday:
* AB 2146 (Feuer): ‘NEVER EVENTS’: Bans providers from billing patients or insurers when they have made an avoidable mistake, such as operating on the wrong person, prescribing the wrong drugs, or leaving foreign objects inside a surgery patient. Support
* AB 2549 (Hayashi) RECISSION TIME LIMIT: Would impose an 18-month time limit in which insurers have to rescind individual health care policies once consumers’ applications are approved. This bill was amended from previous versions, which limited the time frame for rescission to the first six months. Watch, seeking shorter time limit.
* AB 2569 (De Leon) RESCISSION AND BROKER ACCOUNTABILITY: Ensures that family members whose coverage depends on that of the rescinded person may be offered another individual policy. Also requires brokers who take applications to attest, under penalty of perjury, that the information is complete and accurate to the best of their knowledge. Support.
* AB 2697 (Huffman) BOUTIQUE HOSPITALS: Would require so-called “boutique hospitals’’ to asses their impact on a community’s health system annually, specifically whether they siphon doctors, workers, providers from general acute hospitals caring for less affluent populations. Support
* AB 2942 (Ma) COMMUNITY BENEFITS: Would standardize what non-profit hospitals report as “community benefits” to justify their non-profit status. Support

The Legislature will now take a break from committees while budget negotiations are expected to continue throughout July. Both houses will resume committees on August 4. These bills will need to pass fiscal committees by August 15th and the final floor votes by August 31. If they pass through the Legislature, the Governor will have the month of September to decide to sign or veto the bills.

Health Access will continue to track the progress of this legislation in the coming months. For information, please contact the author of this report Hanh Kim Quach at hquach@health-access.org.

Labels: Hospitals, Insurers, Legislation, Updates

posted by Anthony Wright | Permalink | 1:28 AM


 

Mortgage metaphor...

Tuesday, June 24, 2008

How confusing and complicated is the individual insurance market? It makes the much-maligned mortgage industry look clear and simple in comparison.

I was reading a recent study in the Journal of Insurance Regulation (Winter 2007) conducted by Michael Wroblewski during his time at Consumers Union, and the comparison came up. From the article:

“The question remains how consumers choose individual health insurance when they are required to assemble the information on the relevant attributes themselves, because they do not have employers or unions acting as intermediaries for this purpose. And, unlike other financial decisions consumers make, such as mortgage products in which the market provides consistent information for standard products (e.g. 30-year mortgages), standardized information for individual health insurance products does not exist; hence, comparative cost, coverage and benefit data is much more difficult to come by.”

Our individual insurance market is like trying to figure out to compare mortgages where different companies had different terms and lengths, and its impossible to compare, with one company selling 27- and 32-year mortgages, another selling 31.5- and 26-year mortgages.

Contrary to those who mis-characterize the bill, SB1522 doesn’t prohibit the equivalent of a 28.5-year mortgage, if some insurer wanted to provide that “creative” product; it just requires that the insurance company offers a standard product—the equivalent of the 30-year mortgage—as a benchmark.

My hope with SB1522 is that we at least get to the place where people have a standard loan that they can compare between plans, that they are appropriately alerted when purchasing “subprime” insurance, and that we set a minimum standard to prevent the “junk” products that are the insurance version of predatory lending.

Obviously, with everything going on in the mortgage and housing crisis, there’s renewed attention whether those disclosures and consumer protections are enough. Yet it would be a major step to even get those basic protections in the individual insurance market.

Labels: Insurers, Underinsurance

posted by Anthony Wright | Permalink | 11:00 PM


 

It's called discrimination...

Sunday, June 22, 2008

The scrutiny on the inefficient, iniquitous individual insurance market continues, with David Lazarus' column in the Los Angeles Times.

We've explored before how women get discriminated against in the individual insurance market. They have to pay significant surcharges for maternity coverage. A recent NY Times story spotlighted how a C-section can be classified as a pre-existing condition that leads to higher premiums or a denial of coverage.

But now the California insurance marketplace had come full circle: Lazarus reports that three insurers: Aetna, Blue Cross, and now Blue Shield are charging men and women differently, and others are now looking to go there as well.

Where does it stop? As Lazarus says:

But parsing rates according to gender is a relatively new phenomenon. If women are more expensive than men to insure, and middle-aged women are significantly more expensive than middle-aged men, what about, say, older women with red hair? After all, they have fairer skin and thus are more susceptible to skin cancer.

How about if, statistically speaking, blacks are more expensive to insure than whites? Or Christians more expensive to cover than kosher-observing Jews?

How far will insurers go in determining risks?

This may be a standard insurance practice, but I think the public realizes that this is unacceptable social policy to have such discrimination, against women or any other group.

We should pass bills like AB1962(De La Torre) to require maternity as a basic benefit; institute guaranteed issue in the individual insurance market so that those with "pre-existing conditions" can get coverage; and fundamentally reform the health system to expand group coverage and shrink the individual market--where women and others are subject to discrimination, in multiple ways.

One last point: I keep reading that McCain is interested in appealling to women voters, but how can he explain to them his health plan, which would shift millions into the individual market, where they are likely to be discriminated against?

Labels: Insurers, InTheNews, Legislation

posted by Anthony Wright | Permalink | 4:57 PM


 

Buyer beware, indeed...

Our efforts to reform the individual insurance market got more attention this week, by John Howard in the Capitol Weekly and Aurelio Rojas in the Sacramento Bee, which both profiled SB1522, by Senator Darrell Steinberg, and sponsored by Health Access California.

SB1522 passsed the Assembly Health Committee this week, and is now pending in the Assembly Appropriations Committee.

The Bee has the story of the Mary McCurnin and Ron Bednar of Rancho Cordova, who unwittingly bought a plan that the insurer Mid-West National Life Insurance Company called "definied benefit" coverage.

McCurnin and Bednar said they paid a monthly premium of $600 for what they thought was comprehensive coverage. But in 2002, after she was diagnosed with breast cancer and he had open-heart surgery, they learned otherwise.

Their plan covered only 10 percent of his hospitalization, and the company rescinded her coverage because she didn't disclose on her application that she was given a prescription for an anti-depressant years ago that she never filled.

With more than $250,000 in medical bills, the couple filed for bankruptcy protection and now face the loss of their home.

"Health insurance companies will do everything they can not to cover you," McCurnin said. "Having good (individual) health insurance is a myth."

The wife of the couple was rescinded under that now-infamous practice; the husband got "coverage," but found it covered only 10% of his costs because the benefit was capped. Examples like this inform consumer advocates' deep skepticism about the individual insurance market, and any attempt to expand it, as President Bush and now Senator McCain seek to do.

With little bargaining power, the individual consumer trying to get coverage will be at the mercy of the big insurance companies. SB1522 (Steinberg) tries to set some minimum standards in terms of benefits (doctors, hospitals, preventative care), and to place a cap on out-of-pocket costs. Other bills this year deal with rescission, or making sure than premium dollars go to patient care. All are consumer protections that attempt to make the situation a little more fair in an inherently unfair situation.

Even if all passsed, more reform will be needed. Both stories put this bill in the context of reconstructing health reform.

As the Weekly describes it, "Although the governor's health-care reform plan died this year in the Capitol's political crossfire, critical pieces have been resurrected and are quietly moving through the Legislature. One of the most important--already approved in the Senate and opposed by HMOs--would force health insurers to give consumers uniform, clear and accurate descriptions of their policies to aid comparative shopping."

And in the Bee, Senator Steinberg himself not only makes the clear case for the bill on its merits, and but ends the article making the case that the bill as a foundation for future, and more comprehensive, reform.

"As we move forward to more comprehensive reform in the future, creating confidence that people know what they are buying will be a key element," he said.

Labels: Insurers, InTheNews, Legislation, Steinberg, Underinsurance

posted by Anthony Wright | Permalink | 3:17 PM


 

Lots of Key Bills Pass 2nd House Health Committee...

Wednesday, June 18, 2008

HEALTH ACCESS UPDATE
Thursday, June 19th, 2008


BILLS CLEAR HEALTH POLICY COMMITTEES IN OPPOSITE HOUSE
* SB1522 to ban junk insurance passes Assembly Health Committee
* AB1945 would impose new rules on insurers who cancel insurance policies
* AB2967 to collect cost and quality data from medical providers passes

Click Here for What's New on the Health Access WeBlog: Continued Real-Time Budget Conference Committee Reports; A Predictable LAO Analysis on Single-Payer; Following the Bills in Health Committee; Also: Thursday June 19th Events: San Francisco Lunchtime Rally Against AHIP & Insurance Companies; Los Angeles TCE Panel Discussion on Health Reform


Key bills of interest to health advocates were heard in the last two days, in, respectively, the Assembly Health Committee, chaired by Assemblymember Mervyn Dymally, and Senate Health Committee, chaired by Senator Sheila Kuehl.

Hundreds of bills that passed the house where they were introduced must now clear the second house; and the first step of that is to pass policy committees by June 27. A number of bills that would benefit health care consumers were in Assembly and Senate Health committees this week, including a number of key bills that would lay the foundation for comprehensive health reform in the next couple of years. An updated list of bills is available on the Health Access website, at:
http://www.health-access.org/advocating/2008_bills.html

INSURANCE STANDARDS: Among those bills was SB1522 (Steinberg), sponsored by Health Access California, that would weed out junk insurance from the individual insurance market by ensuring that every plan covered doctor, hospital and preventive services. It would also place a cap out-of-pocket costs. The bill would organize the market into five tiers so that consumers could make apples-to-apples comparisons between plans and require that pricing of those plans was consistent with the level of benefits the plans offered.

In an interesting admission, the Association of California Life and Health Insurance Companies noted that "more transparency would be good." This bill passed out of Assembly Health Committee with little debate on a party line vote. It heads next to the Assembly Appropriations Committee.

On Wednesday, the Senate Health Committee heard more bills being tracked by health advocates including:

DEBATE ON ANTI-RESCISSION BILL

AB1945 (De La Torre) would create an INDEPENDENT REVIEW process when an insurer wishes to rescind a consumer’s health insurance policy. The Department of Managed Health Care and Department of Insurance would also have the final say on whether a policy could be rescinded. Lastly, the bill would standardize health plan questionnaires for consumers applying for coverage in the individual market.

The issue of rescissions has received much attention in the past couple of years as the LA Times and other papers have written a number of stories about patients who have had their policies unilaterally cancelled while in the middle of expensive chemotherapy or other medical treatments. Rescissions (or reviews to rescind coverage) have been triggered when a patient begins an expensive course of treatment, and then insurers have allegedly scoured applications looking for a rational to deny their care--any hint that the consumer omitted information about their health status--whether related to the current treatment or not.

Earlier this year, the Department of Managed Health Care had 1,200 policies that were illegally cancelled reinstated. Kaiser, who supported the bill, was one of the insurers that agreed to a settlement with the state to reinstate coverage for rescinded patients. HealthNet--and annoucned earlier today, Pacificare--also reached agreements with the DMHC.

A number of health plans did not oppose, but had concerns about two issues. First, they preferred not to have a uniform questionnaire, but rather a "menu'' of approved questions from which they could pick and choose so they could control the length and scope of the application. Secondly, health plans did not want all rescissions to automatically go to independent review, but rather something that the consumer could opt out of. While some consumer groups, including Health Access California, supported the bill, some organizations raised concerns about the impact on consumers' rights to bring a court proceeding against health plans. The bill heads next to the Senate Judiciary Committee, where some of these questions will be addressed. The bill passed on a bipartisan vote.

DEBATE ON TRANSPARENCY BILL

Another bill heard Wednesday that would help lay the foundation for comprehensive reform in the coming years is aimed at collecting data so that skyrocketing health care costs could be better controlled. Medical errors cost millions annually and result in thousands of unneccessary deaths.

AB 2967 (Lieber) would provide greater TRANSPARENCY AND DISCLOSURE for health care purchasers. The bill would require public reporting of cost and quality by doctors, hospitals HMOs and others in the health care industry. In order to funnel health care dollars more appropriately into treatments that work, the state needs to first gather data. Recognizing that there are many factors that contribute to a patient's health, the data would be adjusted to take into account income, geography, cultural and linguistic issues and other factors.

Collecting data, said author Assemblywoman Sally Lieber, would be "better than driving in the dark with no headlights, which is what we're doing now.''

In an unusual coalition, consumer, labor and business groups all joined together to support this. The California Association of Health Plans were also in Support if amended. Some of the questions that arose came from representation on the baord that collects the information. As constituted in the bill, providers make of half of the board, while consumers, labor and employers make up the other half.

Strong opposition came from the physicians and hospitals, however, who said they did not want "non-scientific people'' collecting data and "releasing it to the public.'' Providers did not trust that data would properly take into account the fact that some patients are poor and have many health issues. Assemblywoman Sally Lieber, however, countered that information to be collected will take into account poverty, health status and cultural issues, which will then be factored in reporting, which can be measured and adjusted. Studies about health disparities that contain this information are regularly published and the data that would be collected through this bill would help the significant work in place now to reduce the health disparities seen in race and income.

Sen. Sheila Kuehl acknowledged the fear that providers had, but said "I like the idea of data collection and knowing to be able to compare.'' The bill passed.

OTHER KEY BILLS: Other bills heard in Assembly or Senate Health Committee this week included the following, listed by bill number (author name) VOTE OUTCOME in Commitee. SHORT DESCRIPTION. Description of Bill. Position of Health Access California:

* SB 1168 (Runner): PASSED Assembly Health. DEPENDENT COVERAGE. Would allow adult dependent children, who are still covered under their parents’ health plan, to stay on that coverage even if the child takes a medically necessary leave of absence from school. Support.
* SB 1633 (Kuehl): PASSED Assembly Health. DENTAL DEBT PROTECTIONS Would prohibit dentists’ offices from offering high-interest loans to patients while they are under the influence of anesthesia. Would also prohibit dental offices from charging lines of credit before services have been rendered. Support.
* SB 1525 (Kuehl): PASSED Assembly Health. MEDICAL NECESSITY. Requires health plans to explain how they determine medical necessity. Also requires health plans to report their rates of denial of care or modifications to care because of medical necessity. Support.
* AB 1203 (Salas) PASSED Senate Health. EMERGENCY ROOM BILLS: Would prevent emergency departments – which do not have a contract with a patient’s insurance company -- from directly billing the patient, requiring the hospital to seek payment directly from insurers. Support
* AB 1887 (Beall) PASSED Senate Health. MENTAL HEALTH PARITY: Would require health plans to provide coverage for all diagnosable mental illnesses. Support.
* AB 1962 (De La Torre) PASSED Senate Health. MATERNITY COVERAGE: Would require all individual insurance policies to cover maternity services. Support.
* AB 2220 (Jones) PASSED Senate Health. BINDING ARBITRATION: Requires providers and health plans to resolve contracting and payment disputes through binding arbitration. More on this legislation must be resolved in the Senate Judiciary Committee. Watch.
* AB 2400 (Price) PASSED Senate Health. HOSPITAL CLOSURES: Would require public notice before closing a hospital. Support
* SB 1096 (Calderon): FAILED Assembly Health. PRESCRIPTION INFORMATION. Would allow pharmacies to send mailers to consumers about the drugs they have been prescribed without the patient’s authorization. Oppose.

A final wave of legislation will be heard next week before the June 27th policy committee deadline. Health Access will keep advocates updated on the progress of consumer-related health bills.

For more information, please call the author of this report Hanh Kim Quach, policy coordinator at Health Access, at hquach@health-access.org.

Labels: Insurers, Kuehl, Legislation, Updates

posted by Anthony Wright | Permalink | 9:50 PM


 

The insurance companies come to town...

America's Health Insurance Plans (AHIP) is having its conference this weekend, starting tomorrow, Thursday, at the Moscone Center in San Francisco.

Healthcare activists both in-state and nationally are hosting a rally for a "Health Insurance DAY OF ACTION." It is:

Thursday, June 19
12pm – 1:30pm (Pacific Time)
4th and Howard Streets, San Francisco (