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


 

Single-payer in committee...

Wednesday, July 16, 2008

After a long pause, SB840(Kuehl) was heard in Assembly Appropriations Committee today, it's first committee hearing since late year, where the bill went through much of the legislative process already. Rather than have the bill simply go to the Governor's desk for a certain veto, Senator Kuehl wanted to keep the bill alive and continue the organizing in support of the bill, and the concept.

Now in the second year of a two-year session, it is continuing down the legislative path. The bill attracted an unusually large number of backers--including Health Access California--for an Appropriations Committee, which is really focused on the financing of bills rather than the policy, and where authors often provide abbreviated testimony or even waive presentations altogether. It was predictable opposed by many the insurer and employer groups.

As expected, the bill was placed on suspense, with a final determination about if it will be released for a floor vote in a few weeks. The bill does not include financing: a companion bill with financing was stalled in the first policy committee last year, and would need to be updated anyway. Rather, the bill puts forward the concept, and would set in motion a process to determine the financing.

The reason for moving the bill is to keep the commitment to health reform alive, to keep SB840 in the policy discussion, and to advance the elements of single-payer--from group purchasing to public program coverage to progressive financing--in the health debate in the state and nation. Let's keep the mometum...

Labels: Kuehl, Sacramento, SB840

posted by Anthony Wright | Permalink | 11:20 PM


 

A inclusive strategy to win...

Friday, July 11, 2008

Paul Krugman of The New York Times talks about the prospect of health reform, and how the dramatic Medicare vote in the US Senate bodes well for the fight--as does the new Health Care for America Now! (HCAN) effort.

Both Jonathan Cohn at The New Republic and Ezra Klein at the blog of the American Prospect report on how the HCAN principles are inclusive of a single-payer solution, and how they advance the single-payer cause strategically. The opportunity to advance elements of a single-payer solution--greatly expanded public coverage; defined benefits; group purchasing power; costs based on what patients can afford rather than how sick they are--is there, if we take advantage of it.

Labels: Federal, InTheNews, SB840, YearOfReform

posted by Anthony Wright | Permalink | 6:23 PM


 

The insurance companies come to town...

Wednesday, June 18, 2008

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 (map)

More information is available at:
http://singlepayernow.net/

My only question is: what were they thinking? To come to the state where their notoriety has only increased with the rescission issue, where a single-payer bill is moving in the Legislature, where policymakers of both parties want to place new rules over their behavior... it just seems masochistic.

It's a good opportunity to put the spotlight on the problems with insurance companies practices in general, and to voice support for single-payer health care (including SB840 and HR676) in specific. Especially if you are in the Bay Area, it's worth your lunch hour and afternoon.

Labels: Insurers, SanFrancisco, SB840

posted by Anthony Wright | Permalink | 3:55 PM


 

A predictable answer to the wrong question...

Monday, June 16, 2008

There's bee some buzz about the new analysis by the Legislative Analyst's Office (LAO) of the SB840(Kuehl), the universal, single-payer health care bill, and the companion financing bill, SB1014(Kuehl). SB840 has passed the Senate and is in Assembly Appropriations; SB1014, which contains the financing which requires a two-thirds vote, has stayed in the Senate.

The Sacramento Bee's Dan Weintraub describes the LAO's findings that SB840 and proposed financing would be a "financial train wreck," while Senator Sheila Kuehl disputes that conclusion, but finds affirmation that "a single payer health care system saves money and lowers the rate at which health care costs grow each year."

I haven't had the chance to see the LAO analysis yet, so I can't comment on the specifics. But I predicted a problematic report earlier this year in a blog post. The biggest problem is that it doesn't compare the risks of health reform with the risks of remaining with the status quo (not just risks--the certain problems with letting the health system unravel). The issues raised by the LAO does mean there is more work to do on the financing and policy elements of SB840, but it doesn't undermine the central argument for single-payer reform, that it provides the tools for covering more people and finding savings in the health system.

Why the report predictable? The LAO analysis of AB x1 1 earlier this year (detailed in this Health Access report here) would hinder any health reform, including single-payer. In fact, it says so, with a similar line at the bottom of the LAO single-payer report: "Any plan to reform the state’s health care system, by the nature of its complexity, will involve financial risk over the long term. Many of the fiscal risks discussed in this letter would be shared by a variety of health reform plans."

The LAO report would be less of a problem, frankly, if some single-payer supporters who were opposed to AB x1 1 didn't embrace the LAO analysis so vigorously earlier this year. But there were many SB840 supporters, including Health Access California, who also supported AB x1 1, and who saw and made the case that the LAO's January analysis was being inappropriately used to hinder not just AB x1 1 (a good but imperfect bill) but anything else as well.

There is a crucial role for such financial analysis (both AB x1 1 and SB840 had significant independent modeling and analysis), but the questions should include a comparison with the status quo, and how a proposal can be modified to be fixed. The LAO is basically quantifying a projection of rising health costs: an unknown figure that admittedly is likely to rise. It is also focused on the impact on the state, rather than all Californians, who will bear these costs in one way or another. And it's not like health care costs are going to stay the same if there is no reform.

There is an urgency to health reform. The delay is passing either SB840 or AB x1 1 or any other reform means it just gets harder to do the reform later, for every year the cost of health coverage goes up. That's why we need action ASAP, now and in the future.

We'll have more on the LAO analysis. There's lessons to learn here, from the politics and the policy...

Labels: Kuehl, SB840

posted by Anthony Wright | Permalink | 12:33 PM


 

Oh, Canada!

Friday, February 08, 2008

Sara Robinson at the Campaign for America's Future blog has a much heralded post that provides a fair comparison of Canadian and American health care. It's fair, and not sugar coated one way or another, but is aggressive in its "myth busting" of some of the common misperceptions.

And there's a new edition of Health Wonk Review at Health Business Blog, with lots of links...

Labels: International, SB840

posted by Anthony Wright | Permalink | 10:31 PM


 

Single-payer supporters for strategic steps...

Friday, January 25, 2008

Los Angeles Mayor Antonio Villaraigosa just recently sent a letter to Senator Sheila Kuehl, from the point of view as a fellow supporter of a single-payer solution to health reform, to urge her to support AB x1 1 (Nunez/Perata). Here's a PDF version of that letter:
LAMayorKuehlAB1xSupport.pdf

I was pleased to be a co-signer of a similar letter with over a dozen prominent single-payer supporters, people who I deeply respect and who have dedicated their lives and work toward winning single-payer reforms. This includes activists, academics, and community leaders who led the Proposition 186 campaign, and gave years of their lives and even their bank accounts; and people who worked tirelessly on SB921 and SB840 in recent years, and fought to get it on the Governor's desk in 2006.

We continue to believe that this is not an "either/or" issue, but rather a "yes, and..." More than that, we believe AB x1 1 is the most effective and strategic step to get to single-payer, and that is a motivating factor behind our support.

Far from "settling" for AB x1 1, this is about locking in significant gains for the uninsured as a way to keep the movement and momentum active for broad reforms. Here's the PDF:
SinglePayerSupportABX11-011708.pdf

Here's the full letter:

Thursday, January 17th, 2008

Dear Senator Kuehl, and all legislators who support SB840:

Re: Single-Payer Supporters for Strategic Steps, for AB x1 1

We, the undersigned, write to you as strong supporters of universal health care. We also have a long history of advocacy for single-payer policy proposals. Many of us have been involved in the fight for single-payer health care for as long as two decades. Many of us were active in working for Prop 186 back in 1994, and many of us worked hard over the last few years in support of SB921, and to get SB840 on the Governor's desk in 2006.

As strong supporters of a truly universal health care system, we write to urge you to support AB x1 1 (Nunez), as a significant strategic step toward our shared goal. We strongly believe that health reform need not be an “either/or” situation, and that supporting this reform in front of us is consistent with being whole-hearted supporters of SB840 and single-payer.

We believe that AB x1 1 not only will do no harm — your appropriate minimum test for health legislation — but that AB x1 1 will also do a great deal of good and benefit millions of Californians.

Moreover, we believe that passage and enactment of AB x1 1 will be a strategic advance for the cause of single-payer because it will establish public programs that are the foundation of universal coverage, including a single-payer system.

AB x1 1 embodies policy elements of single-payer. Passage of this law would make it easier to enact truly universal coverage and to pass a single-payer system in the future, since it already includes:

• a major expansion of public program coverage to moderate-income Californians as well as low-income residents, setting the stage for truly universal coverage reforms, including single payer,
• the setting of a minimum employer contribution to health care, which is essential to funding universal coverage and an important part of the financing for SB840,
• the creation of a statewide purchasing pool that could be the beginnings of the huge
purchasing pool that could grow into a single universal system,
• an increase in Medi-Cal rates, helping providers realize that rates could be reasonable under a public program such as a single-payer system.

It also includes additional oversight over insurers. While some have criticized the notion of preserving the role of insurers, the proposal would significantly change the way insurers do business, including having to take all customers on a “guaranteed issue” basis, and having to negotiate with a large purchasing pool to access millions of California customers. The proposal creates a framework where insurers will either have to change their behavior, or face future reforms that impose further oversight on insurers or replace their function.

Like the proposals of the Democratic presidential candidates, AB x 1 1 does not undertake the massive transformation of the health care system that you propose and that we support. But it accomplishes important elements while providing security to those who have good coverage and want to keep it, while creating the framework to take extra steps. Just as passage of family leave legislation created a framework to come back and pass paid family leave, we believe this proposal creates political and policy tools to advance broader reforms.

Some fear that passage of any plan would stall the coming of SB840, as politicians declare their job done. We believe that the opposite is true. Failure begets failure, and if health reform is stalled now, political leaders may be discouraged from supporting any reforms of our health system (and certainly more far-reaching proposals like single-payer). They will likely move on to other issues.

On the other hand, success begets success: Passage and enactment of such a proposal would create a positive environment around health care reform, as politicians will continually seek to raise the bar above the last reform. The people of California are not satisfied with the health care system as it is, and they will want to see it change further to become a health care system worthy of our country and our state. After major reforms in areas like education and global warming, nobody thinks those issues are “done”; instead the interest in pursuing additional reform has stayed strong, and we believe that this will be the same for health care.

The comparison of AB x1 1 should not be with SB840, which we agree is a “gold standard,” but with the status quo in health care, where millions are uninsured, people are denied coverage because of “pre-existing conditions,” low- and moderate-income families face unlimited premiums and unlimited liability, and the situation is only getting worse. Does AB x1 1 provide all the protections we want to see in our health care system? No, but it provides protections that currently do not exist at all:

• it dramatically expands and assures coverage to increasingly desperate families and
individuals,
• it offers protection against the unaffordability of health insurance premiums,
especially for low- and moderate-income families;
• it establishes strong oversight of insurers, and
• it strengthens health care access of insured and uninsured Californians alike by more adequately funding health care providers, especially hospitals and doctors, whose current underpayment threatens their ability to provide emergency services for anyone and their willingness to serve low-income patients.

Under AB x1 1, there are millions of people, especially at the lower end of the income scale but also those with moderate incomes, that would get substantial help in getting the care and coverage they need. We have an obligation to meet their pressing needs. Asking them to wait is asking them to go without the access to care that those of us with insurance have. In addition, the more we can reduce the number of uninsured, the shorter the gap we have to bridge to get to universal coverage and a single-payer system. ABx 1 1 provides a solid foundation on which we can and will continue to advance additional health care reforms.

We will continue to be very active in support of truly universal coverage, but we urge you to consider this as a strategic step needed to win ultimate victory.

Thank you for your consideration.

Sincerely,

E. Richard Brown, PhD
Professor, UCLA School of Public Health

Michael R. Cousineau, PhD
Associate Professor of Research and Director, Center for Community Health Studies, University of Southern California Keck School of Medicine

Sherry Hirota
CEO, Asian Health Services

Henry L. “Hank” Lacayo
State President, Congress of California Seniors

Marty Lynch
CEO, LifeLong Medical Care

Jennifer Reifel Malin, MD
Current Member and Former Board Member, California Physicians’ Alliance

Maryann O’Sullivan
Founding Executive Director, Health Access California

John Roark, MD
Board Member and Past President, California Physicians’ Alliance

Steve Schear
Co-Chair, Universal Health Care Action Network

Joan Pirkle Smith
Chair, Health Committee, Southern California Americans for Democratic Action
Chair, Health Care Legislation Subcommittee, AFTRA

Roy Ulrich
Radio Host and Producer, KPFK

Nora Vargas
Executive Director, Latino Issues Forum, a co-sponsor of SB840,
and convenor of the Latino Universal Health Action Network

Anthony Wright
Executive Director, Health Access California

*All affiliations listed for identification purposes only

Labels: Kuehl, SB840, YearOfReform

posted by Anthony Wright | Permalink | 8:46 AM


 

When you come to a fork in the road...

Monday, January 14, 2008

Here's an important post on the California Progress Report, an argument about why supporters of single-payer should support AB x1 1 (Nunez).

It's written by Steve Schear, who is a long-time single-payer activist, active in the fight for Proposition 186, one of several founders of Health Access California 20 years ago, and until recently served on our board. He helped create the notion of the Health Care Options Project effort, which helped jump-start the current effort. He is still active, and currently co-chairs the Universal Health Care Action Network, a national group.

His arguments make sense to me, and mirror some of my thinking. Even though we work on a wide range of health issues, Health Access is a long-time, avowed single-payer organization, from developing the proposal that eventually became Proposition 186 15 years ago, to most recently in 2006, when we devoted our field organizing staff full-time to getting SB840 on Governor Schwarzenegger's desk, and continuing to be active this year, in keeping SB840 in the conversation.

I recognize that the notion that AB x1 1 is a strategic step toward single payer may be a selling point for some, but not for others. But here's the point: if I am hitchhiking from Bakersfield to Sacramento, and there's a vehicle that will take me to Fresno, I'm taking it. The vehicle might stop in Fresno, or maybe I can convince the driver along the way to go further, to Stockton, or all the way to Sacramento. Maybe not, and we will decide at Modesto to go our separate ways. The goal is still Sacramento, but it's better to get moving, rather than the status quo of staying in Bakersfield. (No offense to those in Kern County.)

Steve isn't alone on this one.

Labels: SB840, YearOfReform

posted by Anthony Wright | Permalink | 1:01 AM


 

Before the budget battles begin...

Wednesday, January 09, 2008

So tomorrow, this year's budget battles win begin in earnest. And they will be ugly.

But before the budget battles begin, I would like to respond to those who question why we support a single-payer health care system and public program expansions, at the very same time we are actively engaged in fight over the bad decisions and priorities that elected officials sometimes make with regard to public health programs.

The question is comical, since it pre-supposes that we are naive, thinking somehow that everything that government does is right. That's far from the truth.

The answer is in the process we are about to go through. By all accounts, Governor Schwarzenegger will propose ugly cuts tomorrow. And he will propose those cuts rather than put forward a balanced approach that includes fighting for additional taxes and revenues to prevent the worst of those cuts.

But then these cuts will be evaluated in a public process, analyzed, considered by a legislature, and negotiated throughout. Various constituency groups will make their points about the impact of the cuts. And however, tough and ugly the budget process will be, there will be a resolution.

We may or may not like the final result. (In previous budget efforts, we've won some and lost some.) But at least there was public discussion and oversight.

In health care, what's the alternative? For those not on public programs, consumers have their premiums increased, their benefits cut, deductibles raised, their choices restricted and they often have no say. Those decisions are made by employers and insurers, in private boardrooms and executive suites. Not in public, not by elected leaders who are accountable for their decisions.

Many who support single-payer believe that if everybody is in the same health system, the public pressure will be there for a system to balance keeping cost-sharing low but quality high. In countries with universal health care systems, this is a active issues: In Canada, Britain, or elsewhere, elected officials compete on how they will improve their health systems.

Reforms like AB x1 1 place more public oversight over health insurers and the health sector, so that some issues, such as what a minimum benefit should include, are debated and decided in public, rather than in private. That's much better than the status quo.

So even when Health Access and other groups are fighting budget cuts, don't be mistaken: we support a system that allows us to have the fight in the first place.

And that's why we'll also fight some of the so-called budget reforms, to allow unilateral or automatic cuts, that seek to remove that public process. That's a consistent principle through all our work.

Labels: Budget, SB840

posted by Anthony Wright | Permalink | 10:13 PM


 

A universal system? I have just the solution...

Thursday, August 16, 2007

Bruce Bodaken, CEO of Blue Shield, writes in the San Francisco Chronicle that it's time we make health care universal -- like our national government-run Social Security system.

Bodaken wants everyone to pay so we avoid "freeloaders'' who only pay in when they need coverage. I guess that would mean everyone paying a portion of their income -- let's say 4 percent -- to the state. Their employers would pay too -- let's say 8 percent. And in return, everyone would get health care.

Sound familiar? It is.

SB840 -- Sheila Kuehl's single-payer, state-run universal system that Blue Shield of California has never supported -- until, it seems, now.

Bruce...you shouldn't have.

Labels: Insurers, Kuehl, SB840, YearOfReform

posted by Hanh Kim Quach | Permalink | 11:31 AM


 

From small changes to BIG changes...

Wednesday, July 04, 2007

HEALTH ACCESS UPDATE
Wednesday, July 4, 2007


ASSEMBLY HEALTH COMMITTEE PASSES SB840 AND OTHER MEASURES
* Organizations line up to support SB840; Partisan debate over merits
* Other health bills on children's coverage & drug trials are voted on in Assembly committees

New on the Health Access WeBlog: More on High Deductible Health Plans; Polling on Health Reform; Paris Hilton Update; International Comparisons; Border Health; San Francisco Starts Enrolling; Bush Opposes SCHIP Expansion; Tom Tomorrow Cartoon; Statehouse Reporters


Tuesday was the last day for Senate health-related bills (aimed to be passed in 2007) to be heard in Assembly Health Committee. The Committee heard testimony into the evening.

SB840: First among the bills considered was SB840, Sen. Shiela Kuehl’s universal, single-payer health reform measure. “If you don’t have single payer, someone is going to get left behind,’’ said Kuehl, in calling on lawmakers to support her legislation.

IN SUPPORT: The Assembly Health Committee approved SB840, but not before the regular stampede of dozens of organizations showed up to support the bill.

Of the many organizations that mentioned their support for SB840 were: California Nurses Association, Western Center on Law and Poverty, Health Access California, California School Employees Association, California Physicians Alliance, City of Berkeley, California Catholic Conference, California Labor Federation, Congress of California Seniors, Gray Panthers, Service Employees International Union, California Faculty Association, Planned Parenthood, Consumer Federation of California, California Federation of Teachers, California Association of Retired Americans, California Professional Firefighters, Health Care for All, California Primary Care Association, United Nurses – AFSCME, Consumers Union, California Senior Legislature, Friends Committee on Legislation, Senior Action Network, United Food and Commercial Worker retirees, Breast Cancer Action, American Association of University Women, California Foundation for Independent Living Centers, Richmond Commission on Aging, City of Berkeley, Wellstone Democratic Club, League of Women Voters, California Teachers Association, Latino Coalition for a Healthy California, California Commission on the Status of Women, CalPIRG, American Medical Students Association, Green Party, and consumers who said they were victims of “insurance company malfeasance.’'

One poignant testimony came from a cancer patient who was about to have her short-term policy run out, and was being denied renewal of that policy, given her condition.

IN OPPOSITION: The usual bevy of insurers and business groups opposed SB840 using some very familiar arguments.

Michael Shaw from the National Federation of Independent Business, a faithful opponent of SB840, said that a single-payer system would mean “government rationing of care’’ and that doctors and hospitals “would not be paid for the services (they) are giving.’’

Shaw’s assertion did not acknowledge the issue of nonpayment in the current system – by health insurance companies. Providers spend about $10 billion a year (nationally) on lawyers trying to recoup costs for services they’ve provided, but health insurance companies have denied. Insurers spend an additional $10 billion on lawyers trying to keep providers from getting their money.

Steve Lindsey from the California Association of Health Underwriters also opposed SB840, making arguments that elicited derision from the audience. “One of the ways single-payer controls costs is by denying care,’’ said Lindsey. Coincidentally on Tuesday, the Los Angeles Times had another article detailing how the Department of Insurance had found that Blue Cross mishandled more than half of the cases in which the company unilaterally cancelled policies on consumers who paid them premiums and expected health coverage.

Lindsey was put on the spot by Assembly Health Committee Chair Mervyn Dymally, who asked him, “Of the top 8 countries, can you name the ones that don’t have a comprehensive health system?” He was forced to response that “America does not have one.’’ “Right,’’ said Assemblyman Dymally, succinctly.

DISCUSSION BY LEGISLATORS: Republicans legislators Nakanishi, Gaines, Huff, and Strickland went through the usual litany of reasons that they do not support a universal, single-payer health care reform: They argued that the US has the best health care in the world, allowing for research and innovation, and any change would harm the good elements of our current system. They said that under such a system, the health care industry will have little incentive to invent new technologies, and countries with single-payer have long lines and care is rationed. They claimed that people from other countries come to the US for care, and that businesses will leave the state. Nakanishi reminded Kuehl that the state has a budget deficit. Huff asked, do you really want the people in charge of DMV or CalTrans running health care?

Assemblywoman Audra Strickland, R-Moorpark, attempted to blame the uninsured for not having coverage, naming undocumented immigrants and those between jobs. Strickland also said that some uninsured “make well over the poverty level’’ and “choose not to buy health insurance.’’

Poverty level is $17,170 for a family of three. While it’s unclear what Strickland meant by “well-over,’’ three times the poverty level is a family of three earning more than $51,510. According to the California Health Interview Survey, only 3.6 percent of individuals earning three times poverty actively decline coverage when it’s offered to them. For the remainder of the 96.4 percent of uninsured, they’re ineligible, not offered, or can’t afford coverage.

A calm Kuehl, in closing, rebutted arguments.

* On the U.S. being the best health care in the world: “We don’t have the health care in the world. It’s ranked 37th by the World Health Organization.’’
* On how single-payer would lead to rationing: “That’s what we’ve got here is rationing.’’
* On long waits: “We have long waits here. I can’t get an MRI tomorrow. I’m told I can get it in four weeks. The waits that people go through are expected. Of course you don’t get into surgery the next day.’’
* On the cost and increased taxes and innovation: “Stop wasting 30% of health care dollars on administration (which insurers use to try and deny care), that money is not going toward innovation. SB840 actually has a much better shot at encouraging innovation because it’s built into the budget.’’

In closing, Kuehl acknowledged that all lawmakers were trying to do something to improve the health care system we have currently. “Let’s talk about humanity. This state and this country is struggling to do what’s right. The reason I think this is the best is because it actually takes into account what people need.’’

OTHER BILLS

Other bills of note to health and consumer advocates were considered in various committees, including Assembly Health Committee, Assembly Judiciary Committee, and Assembly Insurance Committee. They included:
* SB350 (Runner) PASSED. Makes technical amendments to last year’s AB774, which bans hospital overcharging.
* SB32 (Steinberg) PASSED. Would extend Medi-Cal and Healthy Families coverage to all children under 300% of poverty. Support.
* SB474 (Kuehl) PASSED. Technical bill that allows hospitals that receive federal funding for uninsured patients to continue receiving it. Support
* SB606 (Scott) PASSED. Requires drug companies selling products in California to make clinical trial results publicly available. With amendments, this got bipartisan support. Support.
* SB972 (McClintock) FAILED. Would have allowed small employers to create health insurance co-operatives that would have little state oversight, and could have ignored state consumer protections. Oppose.

WHAT’S NEXT

Wednesday, July 11 will be the last chance for Assembly bills to be heard in the Senate Health Committee. Health Access will provide a full update of the outcome of AB8 (Nunez/Perata) the Democratic leadership’s health reform bill.

Labels: International, Kuehl, Legislation, Sacramento, SB840, Updates

posted by Anthony Wright | Permalink | 2:05 AM


 

The view from 10,000 feet.

Tuesday, July 03, 2007

As somebody looking at and trying to understand the specific details of the new health reform proposals this year, such as AB8(Nunez/Perata), it is a bit surreal to then hear the kind of very broad debate this afternoon in Assembly Health Committee on SB840(Kuehl).

Labels: Funny, Legislation, Sacramento, SB840, YearOfReform

posted by Anthony Wright | Permalink | 4:22 PM


 

A Zen Sen

SB840 was just heard in the Assembly Health Committee a few minutes ago and lots of priceless comments were proferred by opponents of the bill, which we will report on later today. In the face of such attacks on her legislation, though, Sen. Sheila Kuehl remains the picture of composure and thankfully is able to refute the arguments one by one.

But one of the more aggravating statements came from Assemblywoman Audra Strickland, R-Moorpark.

Strickland insists that people would be denied care -- (more than they are now?) -- under a "government run system.'' For instance, a sports athlete with a torn rotator cuff could jump in line ahead an older person who had the same injury.

“Preferential treatment – that’s a big problem that happens when the government gets to decide things,’’ she said. (Of course, I doubt Ms. Strickland would think the Halliburton contracts for the Iraq War were preferential. )

Labels: Kuehl, Republicans, SB840

posted by Hanh Kim Quach | Permalink | 2:48 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 importance of health reform in California. Activists wrote “get well cards’’ to policymakers to urge action.

SiCKO

Also coming soon, documentarian Michael Moore will be in Sacramento on Tuesday June 12th for the premiere of his movie, SiCKO. He will brief a legislative panel at noon, which will be carried on television feeds in and outside the Capitol. He will also appear at a 2 p.m. rally with the California Nurses Association.

RSVP?: That evening, there will be a screening of SiCKO hosted by Assembly Speaker Fabian Nunez. Those Health Access California members, allies, and friends interested in attending can email Marin Bogema at Health Access at mbogema@health-access.org, who will put your name(s) & organization (if any) on our request list to attend the screening.

Labels: ExpandingCoverage, Kuehl, Legislation, Nunez, Perata, Sacramento, SB840, SCHIPHealthyFamilies, Updates, YearOfReform

posted by Anthony Wright | Permalink | 11:21 PM


 

Going through the gauntlet again...

Wednesday, June 06, 2007

HEALTH ACCESS UPDATE
Wednesday, June 6, 2007


SENATOR KUEHL'S UNIVERSAL HEALTH CARE BILL PASSES STATE SENATE
* SB840(Kuehl) clears Senate on a largely party-line vote
* Legislature slated to vote on leadership-sponsored health reform legislation Thursday
* Michael Moore to be present at Sacramento premier of “SiCKO”

New on the Health Access WeBlog: SCHIP Update; Medi-Cal Documentation Requirements; "Hidden Tax" Research; Businesses for Insurance Reform and Higher Medi-Cal Rates?


SB840, which would establish a single-payer health care system in California , passed the state Senate Wednesday 22-14, a near party-line vote.

Most Democratic Senators were in support. Democratic Senators Denise Ducheny and Mike Machado, both serving on the Budget Conference Committee, were not present when the vote was taken. Lou Correa, D-Anaheim, voted “no’’ on the measure.

It’s the fifth year in a row that Sen. Sheila Kuehl, of Santa Monica , has introduced the measure, which she considers the “gold-standard” for health care reform. While Gov. Arnold Schwarzenegger vetoed the measure last year, she has said she wants to continue to organize the movement, and holds out hope that she can convince him otherwise.

DEBATE

In the staid Senate, there was little debate on the measure. Being its fifth time around the block, Capitol watchers expect nothing other than a party-line (or near party-line) vote on the measure.

However, Sen. Sam Aanestad, R-Grass Valley , did take the opportunity to attack the nationalized health care systems of other countries.

“There’s no question that we have problems with the high cost of health care, but to say we have the lowest standard of health care, or that we’re at the bottom of industrialized nations is not a true statement,’’ Aanestad said.

Contrary to what Aanestad said, though, the U.S. spends more on health care, but gets less, according to the Organization for Economic Cooperation and Development. The latest numbers show that the U.S. spends $7,800 per capita on health care, nearly twice as much as Canada ’s $4,050; the UK spends $3,250. Meanwhile, the US ranks 21st in life expectancy ( Canada ranks 7th and the UK ranks 18th), and 23rd in infant mortality behind Canada and the UK .

Aanestad went on to say that the “the only universal health care ...(seen) in the US is the outmoded and substandard Veterans Administration Health Care system. Do you really want your American health care to end up in the Veterans’ Administration model?”

Lastly, Aanestad proclaimed that “if I needed bypass surgery, I could not get it (in Canada) because I’m over 60 years old and I would be put on a waiting list because I’m too old to qualify for bypass surgery.’’ On the other hand, in the U.S. “If I needed bypass surgery, I’d have it tonight,’’ he said.

Sen. Kuehl contradicted this statement.

“This notion that waiting lists exists somewhere else, but not in America ? Maybe for the privileged few of us who can get right in. But there are a lot of people in my district – the richest district in the state and the one with probably the highest number of people insured – who are still on waiting lists, whether with Kaiser, or with Blue Cross,’’ said Kuehl, who represents Santa Monica.

“You can’t just run right in and get your bypass surgery,’’ Kuehl said.

Sen. Joe Simitian, D-Palo Alto, quoted Walter Cronkite’s description of the “health care system,’’ saying “I don’t know why we call it a health care system. It isn’t healthy. It isn’t caring, and it sure as hell isn’t a system.’’

Simitian stated that he wasn't sure that a single-payer solution was the only or best solution, versus other ideas. But, he said, the author's efforts on SB840 helped bring about this year's focus on health reform, and “whether or not I believe it is the best way or only way, I do believe it’s an important way to get to some meaningful solutions for the 4.5 to 6 million Californians who are without health insurance on any given day.’’

Kuehl closed debate on her bill by referring to “a truly American’’ single-payer system: Medicare.

“If it weren’t for Medicare, a truly American comprehensive system, we would be frightened in my age cohort (she’s 66) and above.’’

That’s because insurance companies have become “very creative in denying care’’ dropping patients when they are sick, or rejecting consumers who apply for policies simply because they’ve had a history of taking certain prescription drugs in a time long ago.

The passage of Kuehl’s bill marks the first of a series of health-reform related bills that must be passed out of the Senate and Assembly this week.

OTHER HEALTH BILLS AND EVENTS

AB8 (Nunez) and SB48 (Perata), which both aim to expand health coverage by relying on the existing system of employer-based insurance, is expected to be heard Thursday. Several other health-related bills must also pass a floor vote by Friday in order to be further considered this year.

The passage of Kuehl’s bill and consideration of the leadership proposals also serve as a prelude to Michael Moore’s new movie SiCKO, about the failures in the American health care system, which is expected to premiere in Sacramento on Tuesday, with the documentary film maker testifying before Kuehl’s committee next week.

Health Access will provide updates on both legislation, Moore ’s testimony and movie in the upcoming days.

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

Labels: ExpandingCoverage, Kuehl, Legislation, SB840, Updates, YearOfReform

posted by Anthony Wright | Permalink | 7:08 PM


 

Movin' on up....

Sen. Sheila Kuehl's SB840, which would establish a universal health care system such as Medicare in California, passed the full Senate a few minutes ago on a 22-14 vote.

Health reform, and particularly a single-payer system, has become an annual crusade for Kuehl. This is the fifth time she has introduced the bill. Last year, the bill made it to the governor's desk for the first time in history, but was vetoed. This year, health reform is playing on a statewide and national stage -- thanks to the steady drumbeat of crusaders like Kuehl and other health advocates who are highlighting the unfair practices of insurance companies who deny care, change the rules and leave patients to get sicker and die.

SB840's veto, however, was one reason, Republican Sen. Sam Aanestad, an oral surgeon, spoke against the bill. Not only does he not think the legislation is politically feasible, he defendedAmerica's health care system as the best in the world, citing examples of people from countries with nationalized health systems that flee to the US to seek care.

The countries Aanestad referred to were England and Canada, where patients are given medical care based on priority, rather than ability to pay -- which is the system in the United States. According to the Organisation for Economic Cooperation and Development (OECD), both Canada and the UK have higher life expectancies than Americans. Additionally, fewer babies die at birth in those countries than in the U.S. By contrast, the U.S. spends nearly twice as much as these countries on medical care. How does Aanestad explain that?

Sen. Joe Simitian, a Palo Alto Democrat, credited Kuehl with putting health reform at the forefront of the political conversation and voted for the bill, "whether or not I believe it is the best or only way..it’s an important way to advance the solution."

In closing, the ever-eloquent Kuehl challenged assertions made by Aanestad. She cited two studies. One where 98% of Canadians would prefer to seek health care in their own country, rather than the U.S. The other that showed insured white men in England have better health outcomes than insured white men in the U.S.

She also took Aanestad's "America-first'' argument on a different spin: Medicare. Medicare is a single-payer system that is American and provides good and stable care to millions. That, she said, should be the goal.

Labels: ExpandingCoverage, Kuehl, Legislation, Sacramento, SB840, YearOfReform

posted by Hanh Kim Quach | Permalink | 1:55 PM


 

Floor votes this week...

Tuesday, June 05, 2007

HEALTH ACCESS UPDATE
Monday, June 4, 2007


HEALTH REFORM PLANS HIT HALF-WAY POINT
* Health reform proposals to be considered on Assembly, Senate floors this week
* Ads for and against health reforms take the airwaves
* ACTION ALERT: Still time to host a house party for health reform this week!

New on the Health Access WeBlog: Sicko; U.S. Ranking; Gruberfest; Chamber's List; Poverty; Is BlueCross Enron?; WWJD?; Guaranteed Issue; Insurance Rules; The Hidden Tax; Budget Conference Commitee; High Deductibles; More Ads and Coalitions; Betty Perry


This week, both houses of the California Legislature will consider significant health reform proposals, and they hit the half-way point of the process, winding their way to the Governor's desk. These bills, and hundreds of others, have a deadline by this Friday to pass their first floor vote, of their "house of origin"

In terms of the major health reform proposals, Assemblymembers will be asked to vote on AB8(Nunez). Senators will consider both SB48(Perata/Kuehl) and SB840(Kuehl).

BILL LIST: A broader list of pending legislation of interest to health advocates is at the Health Access California website (including in online and printable form) at:
http://www.health-access.org/advocating/2007_bills.html

WEBLOG: These votes on health reform follow a couple of weeks of significant activity around these proposals, all chronicled on the Health Access WeBlog, including:

* the release of financial details and modeling of the proposals by Speaker Nunez and Senate President Pro Tem Perata, (with a briefing by MIT Professor Jonathan Gruber), which set the stage for the two proposals, along with SB840(Kuehl) to pass out of their respective Appropriations Committees.

* the California health reform conversation making national celebrity news, as Governor Schwarzenegger visits Jay Leno, and filmmaker Michael Moore schedules a premiere of his new movie Sicko in Sacramento on June 12th;

* ads on health reform take to the airwaves, including a TV ad for reform by Together for Health Care, and a print and radio ad against reform by BlueCross of California. The Health Access WeBlog includes responses, fact-checking and commentary on the BlueCross campaign.


HOST A HOUSE PARTY: Later this week, the consumer campaign It's Our Healthcare! will be hosting hundreds of house parties around the state, to inform and interest Californians about the health reform debate this year. To join this exciting activity and volunteer to host a house party, click here.

Labels: Kuehl, Legislation, Nunez, Perata, SB840, Updates, YearOfReform

posted by Anthony Wright | Permalink | 10:21 AM


 

Hail to our Chief!

Friday, June 01, 2007

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

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

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

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

In my toast among many two night ago,