The Senate Budget harms healthcare

Friday, August 29, 2008

Health Access California opposes the Senate Budget Proposal considered the morning of August 29th, 2008, which would significantly harm health care in California, now and in the future.

Here's the health impacts of the Senate Budget Proposal:

* The proposal includes all the cuts agreed to by the Budget Conference Committee (AB1781). In health care, those cuts include more onerous reporting requirement for children's coverage through Medi-Cal, and an increase in Healthy Families premiums, among other reductions. This is expected to deny coverage to over 250,000 children over the next three years.

* The Senate Budget Proposal includes even deeper cuts in health care and other vital services. In health care, this includes a delay in restoring the Medi-Cal provider rates until March of 2009. The Legislature and Governor made 10% cuts to provider rates earlier this year, but proposed to restore them. This would make additional hundreds of millions of dollars of cuts to California's health care providers by delaying that restoration. (This is assuming, of course, that the State is successful in its appeal of a court decision that struck down the cut.)

* The budget relies on a *temporary* 1-cent sales tax, a revenue stream that will expire in three years. Since California's health care needs are expected to grow, not shrink, in three years, this would likely force a budget crisis and additional cuts at that time in three years. At best, this only delays the inevitable decision to either revenues or make cuts permanently.

* Most concerning in the long view, the proposal makes permanent, problematic changes to the state’s budget process in exchange for a temporary tax increase that would leave the state facing significant budget shortfalls in 2011-12, if not sooner, and beyond.

-- The so-called “reserve” that functions as a spending cap that would drain money away from health care, education, and other vital services, locking in inadequate funding levels--California is 51st in the nation in per-patient Medicaid spending---and as health costs rise, forcing additional cuts in the future, especially to health and human services.

-- In particular, the proposal would give the Governor unprecedented power to make unilateral cuts mid-way through the budget year. This and future governors would be given sweeping power to cut payments to families and children, payments to providers of state-funded services, higher education, and other programs based on estimates prepared by the governor’s appointees.

Labels: Budget, MediCal, Perata, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 2:05 PM


 

The wrong direction on kids coverage...

Monday, August 25, 2008

After years of making progress of covering children, California may be going backwards, reports Jordan Rau in Sunday's Los Angeles Times. Actually, it's heartbreaking that there will be kids that are being dropped from coverage, in Alameda County now, and soon statewide.

The budget debate is no longer should kids be discouraged and denied away from coverage, but how many. The Democratic proposal would increase premiums in Healthy Families, and increase reporting in Medi-Cal--both that are expected to decrease enrollment. If we raise less than the $8 billion+ in revenues, then the cuts would need to be even steeper.

Or we can decide covering California kids is a prioirity, and raise the money to finish the job.

Labels: Budget, InTheNews, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 12:08 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


 

Kids losing coverage...

Thursday, July 10, 2008

The most explosive, least reported story of the week--the equivalent of children getting pink slips:

Alameda Alliance for Health to close Healthy Kids Program,
blames state funding woes
San Francisco Business Times

A lack of permanent funding from public and private sources, and the failure of health-care reform in California is forcing the public Alameda Alliance for Health to close its Healthy Kids program, officials said Tuesday.

The closure, which will affect 1,000 poor children in Alameda County, is scheduled to take place Sept 30.

The Alliance is a non-profit, state-licensed health plan that attempts to make high quality health care services "accessible and affordable" to poor residents of the county, officials said, including children from families that don't qualify for other public programs, due to income requirements or residency status.

The Alameda County plan, started in 1996, provides services to 92,000 Alameda County residents through programs such as Medi-Cal, Healthy Families, Alliance Group Care and Alliance CompleteCare.

County officials called the pending closure "an act of last resort" and Lamirault added that some children who are losing their Healthy Kids coverage may be eligible for Kaiser Permanente's Child Health Plan.

The Alliance was one of 10 counties statewide that began its Healthy Kids program in the fall of 2005, officials said. Today 30 counties offer the program, which provides comprehensive health care coverage to more than 80,000 children each year.

Some funds from the nonprofit California Endowment were committed for the older participants, but significant funding from Alameda County's Tobacco Settlement Funds have been "redirected to support other county priorities," due to the state's budget crunch.

Alameda isn't the only county where this will happen. It's a shocking thing, for California counties to drop kids from coverage, but that's exactly what is happening.

Labels: Budget, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 6:17 PM


 

A quarter-million more kids uninsured...

HEALTH ACCESS UPDATE
Wednesday, July 9th, 2008

BUDGET CONFERENCE COMMITTEE WRAP-UP: HEALTH CUTS

* Children's Coverage Gets Cut: More Than a Quarter-Million Kids to Lose Coverage
* Other Devastating Cuts to Eligibility, Benefits, Rates Rejected/Restored for Now
* These/Other Cuts Pending Unless New Taxes and Revenues Approved to Prevent Cuts

Click Here for What's New on the Health Access WeBlog: More on the Budget Cuts; Photos, reports from the Health Care for America Now! launch events; Medicare Bill Passes Senate


SACRAMENTO--The bi-cameral Budget Conference Committee completed work on a legislative budget proposal approved primarily by the four sitting Democrats on the committee, led by budget chairs Denise Ducheny and John Laird.

The Legislative plan for the $101 billion general fund calls for $8.2 billion in additional revenues, including higher income taxes for wealthier couples and higher taxes for businesses. These revenues come on top of the $5.1 billion in lottery revenues and $3.3 billion in deficit bonds proposed in the governor’s budget.

The Budget Conference Committee did reject--for now--many draconian cuts in health care, that would have resulted in over one million more Californians not getting health coverage as a result of the budget, and three and a half million Californians having to pay more and/or get less in terms of care and coverage.

Because no cut or restoration is final until a budget is approved, all cuts are still on the table until both parties in the Legislature can agree on taxes. These cuts are all still pending; the coverage impacts of all the pending cuts is detailed in a recent Health Access report, available on our website:
http://www.health-access.org/preserving/Docs/HACoverageImpactReporto6-25Final.pdf

REAL CUTS, ESPECIALLY TO CHILDREN'S COVERAGE: Yet even under this Democrat-supported budget, children's coverage gets hit hard. Even with the additional revenues raised, more than a quarter-million children are expected to lose coverage if this Democratic version of the budget is fully implemented.

The cuts approved that would impact children's health coverage include:

* Imposing additional paperwork burdens so millions of children need to have their families file reports every six months, rather than annually, to keep their Medi-Cal coverage. It is estimated that such "semi-annual status reports" (SARS) would lead over 250,000 children to fall off coverage under full implementation by 2011. To take action, read the 100% Campaign report on the impacts here.
* Increasing premiums in the Healthy Families program, which not only impose additional costs on hundreds of thousands of families, but likely lead tens of thousands of children to fall off coverage.
* Suspending streamlining and enrollment reforms, which were passed into law two years ago--SB437(Escutia) with fanfare in an attempt to get tens of thousands of more children who are currently eligible but unenrolled into the program.

MAJOR CUTS RESTORED--IF REVENUES PASS: Many of the rest of the big-ticket health care cuts were rejected or partially restored. Assuming the new taxes and revenues, the Budget Conference Committee voted to prevent the:

* Cutting Medi-Cal eligibility for low-income working parents, causing 439,000 adults to lose coverage:
* Cutting vital benefits (like dental coverage) for over 2.5 million parents, seniors and disabled patients on Medi-Cal:
* Cutting rates by 10% for doctors, hospitals and other providers who take patients with Medi-Cal. This cut was approved in February and went into effect last week, but legislators are proposing to restore this cut going forward if the revenues can be raised.

Our Health Care Budget Cuts Scorecard provides a full accounting of all health items that were pending, and how they fared in the Assembly, the Senate, and in Conference Committee. It may also be found on our website:
http://www.health-access.org/preserving/Docs/BudgetScorecard%20070908.pdf.

WHAT’S NEXT

The full houses will need to vote on the budget next – and that could happen as early as next week, though neither house has committed to a date. In order to pass, the budgets would need a two-thirds majority. If all Democrats vote for the budget, which would mean six Assembly Republicans and two Senate Republicans would also need to approve. With the revenue increases included in thie budget, and the many Republicans having signed "no new taxes" pledges, the gridlock in Sacramento may continue into the summer.

Health Access will continue to track budget developments as they occur, including posting fact sheets and materials on our website, at:
http://www.health-access.org/index.htm

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

Labels: Budget, SCHIPHealthyFamilies, Updates

posted by Anthony Wright | Permalink | 12:38 AM


 

Setting the Stage for a Budget Summer

Thursday, July 03, 2008

HEALTH ACCESS UPDATE
Thursday, July 3rd, 2008


BUDGET CONFERENCE COMMITTEE CLOSES OUT MOST HEALTH ITEMS
* Democratic-supported budget would largely restore Medi-Cal rate reductions
* California Discount Prescription Drug Program continues
* Semi-Annual Reports and Healthy Families premium increases still in negotiations
* Conference Committee could close down as early as this Sunday, July 6th

Click Here for What's New on the Health Access WeBlog: More on the Health Care Budget Cuts; the Onion on Kids Coverage; Update on MA; Provider Rates; A Clear, Stark Choice; Missed Budget Deadlines; Reporting "Never Events"; How Many More Uninsured Under the Legislature's Budget?; Where Our Premium Dollars Go; Patients, Not Paperwork; Blog Watch


The Budget Conference Committee, led by Senator Denise Ducheny and Assemblyman John Laird, met this Thursday afternoon and reached agreement on a number of items of note to health advocates.

These decisions largely reflect current agreement between the Democratic majorities in the legislature; no budget decisions are final until the Legislature approves a budget by a two-thirds votes, which requires Republican votes, and the Governor signs the budget. However, these decisions shape the parameters of the budget negotiations this summer. The issues addressed today include:

PRESCRIPTION DRUG DISCOUNTS: The California Prescription Drug Discount Program, AB 2911 (Nunez), supported by Health Access California and a broad "Rx Coalition" of consumer, labor and senior groups, was passed and signed into law in 2006. The program would allow up to five million Californians with no or inadequate prescription drug coverage to buy prescription drug at prices 40 to 60 percent below the sticker price. The discounts would be achieved through contracts with pharmacists and negotiations with drug manufacturers.

The program, though, has not yet been implemented due to budget constraints. The program was in danger of being deferred yet another year until a compromise on the measure was reached Thursday. Under the compromise, the program would be started and implemented in the budget year, but the state would defray the costs to administer the program with a small portion of the manufacturer rebates.

MEDI-CAL RATE REDUCTIONS: The Committee also voted to restore most of the 10 percent rate reductions which took effect two days ago. The higher rates will take effect September 1, 2008. Any services provided between July 1 and August 31 will be reimbursed at the lower rate. The partial rate restorations are all contingent upon a budget agreement that includes revenues.

Following is an accounting of how each individual cut was restored and how the committee votes:

* Providers: Restored most of 10% payment reduction ($158.3 million); Vote: 2-1, 2-1, Republican members voting no
* Pharmacies: restored half (5%) of the payment reduction ($76.3 million); Vote: 2-1, 2-1, Republican members voting no
* Pediatric Sub Acute Care: restored all of payment reduction ($1.8 million); Vote: 2-1, 2-1, Republican members voting no
* Long-term Care: restored half (5%) of the rate restoration ($24.6 million); Vote: 2-1, 2-1, Republican members voting no
* Managed Care rates: restored half (5%) of the payment reduction ($99.2 million); Vote: 2-1, 2-1, Republican members voting no
* Breast and Cervical Cancer treatment: restored full amount of payment reduction ($1.2 million); Vote: 2-1, 2-1, Republican members voting no.
* Non-Contract Hospitals: Compromise would treat small, rural and children’s hospitals as contract hospitals. Vote: 3-0, 3-0

CHILDREN SERVICES: Rates paid under the California Children’s Services (CCS) and Genetically Handicapped Persons Program (GHPP) would be mostly restored by September 1, contingent upon revenues. The governor had originally proposed a 10 percent rate reduction for these programs’ services. In both cases, the vote was 2-1, 2-1, with Republican voting against the partial restorations.

ITEMS REMAINING OPEN: Still in negotiations remain the Semi-Annual Status Reports and additional county administrative funding should those reports be approved. Healthy Families premium increases also remain open. Both would not only place paperwork and additional costs onto families with children on Medi-Cal and Healthy Families coverage, respectively, but would also cause a reduction in enrollment and an increase in California children without coverage.

The children's groups that make up the 100% Campaign are urging health advocates to call members of the Conference Committee to urge them to reject these additional barriers to kids' coverage. Their most recent alert is listed here:
http://www.100percentcampaign.org/resources/updates/2008/update-080624.html

CALENDAR: The Budget Conference Committee is expected to return July 6th, Sunday evening to close out the remaining items. Legislative leaders hope to have a vote on the budget by mid-July.

The Senate plans to hold Appropriations hearing the upcoming week and Monday July 14th and then take summer break until August 4th. The Assembly plans to hold its last Appropriations before break on July 16th before leaving and returning on August 4th.

Health Access will keep advocates abreast of these activities. For information, please contact the author of this report Hanh Kim Quach, policy coordinator, at hquach@health-access.org.

Labels: Budget, Drugs, MediCal, SCHIPHealthyFamilies, Updates

posted by Anthony Wright | Permalink | 9:08 PM


 

A Constituency Against Health Care?

As we await to see what the Budget Conference Committee does about imposing more paperwork burdens to have hundreds of thousands of children fall off coverage, here's something for your holiday weekend amusement. From the Onion News Network, it's the only support I've seen for cutting children's health care:


Study: Most Children Strongly Opposed To Children's Healthcare

Labels: Budget, Funny, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 12:58 AM


 

"The choice is clear..."

Tuesday, July 01, 2008

The Sacramento Bee editorializes and says it well... Read the whole thing, but here's an excerpt:

Editorial: Budget deal will do real damage to health care

The choice is clear: Increase taxes or let the impact fall on children and the elderly

...Faced with a $17 billion deficit, the governor and state lawmakers are considering cuts that would likely drop tens of thousands of children from the Medi-Cal program, the state's version of Medicaid. They also are considering restricting adult eligibility requirements for Medi-Cal, hurting families trying to transition from welfare to work.

Elderly patients would also take a hit. As part of a 10 percent cut scheduled to take effect today, the state plans to reduce payments received by pharmacists who serve Medi-Cal patients. Pharmacists say it would force them to lose money on commonly prescribed drugs, and to choose between taking fewer Medi-Cal patients or cutting staff and limiting hours...

Legislators, particularly Republicans who have taken a vow not to raise taxes under any circumstance, need to consider the consequences.

Start with children. Currently, about 3 million children in California receive health care through Medi-Cal, and eligibility for the program is determined annually. To save $92 million in the budget, Schwarzenegger wants to reinstate a rule that families on Medi-Cal submit paperwork every three months to prove their eligibility, instead of every 12 months.

About 150,000 children are expected to lose coverage this year – and 470,000 eventually – because their families either fail to file the required forms or they can't meet the program's eligibility rules. The quarterly reporting requirement will also add to the burdens of counties, who will have to process all the extra paperwork.

For these reasons and others, the Assembly rejected the administration's proposal, while the Senate has come back with a "compromise" – requiring Medi-Cal recipients to file paperwork twice a year, instead of four times.

This is hardly a compromise. As senators and Schwarzenegger are well aware, kicking poor people out of the Medi-Cal program will only force them to go to the emergency room, or avoid treatment for diabetes, high blood pressure and other chronic diseases.

While campaigning for health care reform last year, Schwarzenegger often talked about the "hidden tax" that uninsured people impose on hospitals, businesses and local governments. It would be revealing for the governor to calculate the hidden tax he will impose on this state if these Medi-Cal cuts are fully enacted.

A better option would be a modest, broadly distributed levy – yes, a tax – to prop up this state's health care program for the poor. Consider it a down payment on a once-and-future goal: a more universal system of health coverage

Labels: Budget, InTheNews, MediCal, SCHIPHealthyFamilies, Schwarzenegger

posted by Anthony Wright | Permalink | 12:43 AM


 

One million more uninsured, just to begin with...

Wednesday, June 25, 2008

Earlier this week, Governor Schwarzenegger called the number of uninsured in California a "moral crisis"--and he was right, both about that and the need for concerted action on health reform.

Unfortunately, the Governor's cuts-only budget goes in completely the opposite direction, making our health care system even more broken, and leaving more people uninsured. Today, we are releasing a report that reveals the full magnitude of the cuts the Governor proposes--with over one million more Californians uninsured. While the Legislature has adopted some of these cuts and rejeced others, all of these proposals are on the table until a budget solution is agreed to. There's early press from Aurelio Rojas at the Sacramento Bee and Jordan Rau of the Los Angeles Times.

HEALTH ACCESS UPDATE
Thursday, June 26th, 2008


New Analysis Reveals Full Impact of Governor’s Health Cuts:
One Million More Californians Would Lose Health Coverage

* Permanent Policy Changes, Not One-Time Cuts, Would Hinder Reform
* Magnitude of Cuts Would Have Ripple Effects Through System
* Health Consumers and Providers Urge Alternative to Cuts-Only Budget

Over one million more Californians would lose health coverage, with significant impacts throughout the state’s health system, if the Governor’s budget and health cuts were passed, according to a new analysis today.

The study, by the health care consumer advocacy group Health Access Foundation, uses information from the Schwarzenegger Administration, but shows a much greater magnitude than earlier estimates, which only looked at the impact of the cuts for less than a year, and not at full implementation.

The report is available on the front page of the Health Access California website, and directly at:
http://www.health-access.org/preserving/Docs/HACoverageImpactReporto6-25Final.pdf

The study shows that these health care budget cuts are of a magnitude that will impact every Californian, as they place huge burdens on the health system we all rely on. These are permanent, not just one-time cuts, to leave more than one million more Californians uninsured, and over three and a half million having to pay more and get less.

Previous summaries of the Governor’s budget proposals, including the May Revision, show the impact of the cuts in only the first year – with tens of thousands losing coverage or being barred from enrollment. But the impact is much greater, in three ways:

• The Governor’s budget is not proposing one-time budget savings, but lasting policy changes and coverage reductions for the health care system.
• A snapshot of the savings in the budget year does not reveal the full impact in the following years, once the reductions have been enacted and all the administrative changes have occurred to continue the reductions.
• Finally, the cumulative impact of all the proposed cuts, when added up together, suggests that the magnitude of the cuts—with more than a million more uninsured—will have impacts not just on specific programs but on the entire health care system on which we all rely.
  

The permanent policy changes reflected in the budget will be in place long after the 2008-09 budget year comes and goes. Of note, these policy changes are contrary to health reform proposals the governor previously put forward.

The cuts include:
* A roll-back of eligibility for basic Medi-Cal coverage for low-income working parents to well below the poverty level. (429,000);
* Additional paperwork burdens for children and adults, requiring reports every three months in order to avoid disenrollment (471,500);
* Suspension of already-passed legislation to streamline child enrollment (97,000)
* Increased premiums for children’s health coverage, leading to decreased enrollment (60,000).

The cuts represent a reversal for the Administration, reducing programs that just a few months ago were being considered for massive expansions to provide coverage to millions more people. Rather than shrinking the number of uninsured, the Schwarzenegger budget would increase the number of uninsured substantially.

The report includes appendices that include:
* a county-by-county breakdown indicated the increase in the uninsured by county by 2010, the last year of the Schwarzenegger Administration;
* a chart comparing the policy changes in the Governor’s budget that would restrict coverage, to the health reform proposal supported by the Governor earlier this year to expand coverage; and
* a further detailing of the populations that under the proposed cuts would be forced to pay more or get less benefits, totaling 3.5 million Californians.

Allowing one million more California children and parents to go uninsured creates ripple effects throughout the entire health care system. It includes:

• an increased burden on “safety net” providers, from emergency rooms to hospitals to community clinics—many of which are dealing with direct cuts of their own;
• a cost-shift, from both the uninsured and reduced Medi-Cal provider payments, to private purchasers of health care—which likely means increased premiums; and
• worse health and economic impacts for California communities, from the destabilizing impact of more children uncovered and getting sicker, to more families facing medical debt and bankruptcy for being uninsured.

As a result, all Californians—not just the million more uninsured—will be impacted these cuts. The report makes clear the stark choice the budget debate this summer presents for California policymakers, between allowing these devastating cuts to move forward and to make these structural policy changes to our health care system, or to find the revenues needed to prevent these cuts.

Labels: Budget, MediCal, Research, SCHIPHealthyFamilies, Uninsured, Updates

posted by Anthony Wright | Permalink | 6:57 PM


 

The budget stage is set.

Sunday, June 01, 2008

HEALTH ACCESS UPDATE
Friday, May 30th, 2008


ASSEMBLY, SENATE BUDGET COMMITTEES VOTE OF PROPOSED CUTS (FOR NOW)

* Assembly and Senate budget committees vote to reject severe cuts to Medi-Cal, including major denials of coverage to working parents & others, elimination of dental & other benefits. Votes would also restore some of the provider rate reductions.
* Significant cuts agreed to by at least one committee include: Cuts to public and private hospitals, counties, health plans; increases in Healthy Families premiums; additional reporting for children; increased premiums for seniors
* Clear choice in budget debate moving forward: Hundreds of thousands of Californians denied coverage & care, or an alternative to a cuts-only budget that includes revenues.

Click Here for What's New on the Health Access WeBlog: Floor Reports on Health Bills Passing This Week; Ongoing Updates from Budget Committees; What Makes Coverage Coverage?; Health Reform in Obama's First 100 Days?; and more...


After a busy week on the floor, Senate and Assembly budget committees topped off the week with simultaneous hearings and votes on outstanding health budget items. A number of items that were left open in previous months while committees vetted the issues were either modified, approved or rejected Friday morning (listing below).

Health Access has posted a Health Care Budget Cuts Scorecard, which details the Governor's proposed cuts, and for each cut, the budget savings, the number of people impacted, and the actions by the Assembly and Senate today. The scorecard is here, at:
http://www.health-access.org/preserving/Docs/Health%20Access%20-%20BudgetScorecard%20053008.pdf

BUDGET BLUES

The Senate Budget Committee, chaired by Senator Denise Ducheny, and the Assembly Budget Subcommittee on Health and Human Services, chaired by Assemblywoman Patty Berg, both voted to approve or reject the many health care cuts proposed by Governor Schwarzenegger in the May Revision of the budget. That budget sought to bridge a $17.2 billion shortfall in a $100 billion general fund budget without raising taxes.

While no action is final until a final budget is approved and signed into law, both the Assembly and Senate committees rejected many of the Medi-Cal cuts to eligibility and benefits as too severe, and both proposed restoring some of the provider rate cuts made earlier in the year.

At the same time, both committees did vote to approve other cuts proposed by the Governor, and other cuts. Cuts approved by at least one committee included cuts to hospitals, cuts to counties, cuts to Healthy Families health plans; caps in benefits; increases in Healthy Families premiums; additional reporting requirements for children; and increased premiums for seniors.

Health Access is posting summaries on its blog, at www.health-access.org/blogger.html.

WHAT’S NEXT

In the Senate, the budget committee’s proposal will head to the floor for a vote. In the Assembly, the full Assembly budget committee will still need to approve each sub-committee’s proposal before being perfunctorily approved by both houses with the intent that the conference committee -- made up three budget committee members from each house – will reconcile differences between each house’s working proposals. The Legislature is supposed to finish working on its budget June 15th, but that has only happened five times in the past 40 years.
The fiscal year begins July 1 – a mere 30 days from now -- and there is no expectation that California will have a budget on time.

ACTIONS TAKEN FRIDAY

Below is a listing of major decisions made by the Assembly Budget Subcommittee on Health and the full Senate Budget Committee. For a full list of actions taken this year, click here.

* Direct denial of coverage to very low income working parents: Would have denied coverage to parents earning wages between $11,000 and $18,000 a year (for a family of three). A parent would need to work fewer than 100 hours a month in order to qualify. REJECTED by both houses.
* Quarterly Status Reports for children and adults: Would have required Medi-Cal recipients to report any changes in their life every three months. Currently, children only have to report annually, and adults every six months. MODIFIED by Senate to require reports every six months for both children and adults. REJECTED by the Assembly.
* Medi-Cal rate reimbursement: Approved earlier this year, will reduce reimbursements to Medi-Cal doctors by 10%. California already ranks near the bottom (43rd) on reimbursements for providers in this program. Both houses sought to restore this already-made cut: REDUCED to 5% reduction by Senate. REVERSED by Assembly.
* Reduced benefits for legal immigrants: Legal immigrants who currently receive comprehensive Medi-Cal benefits would lose all but four services: emergency, pregnancy, some long-term and cancer care. REJECTED by both houses.
* Monthly reporting for immigrants: Would require undocumented immigrants to establish their eligibility for limited emergency Medi-Cal services every month. REJECTED by both houses.
* Elimination of dental benefits for adults on Medi-Cal: Would have eliminated the ability for adults on Medi-Cal to receive cleanings, crowns, filling or other oral surgery unless a physician treated them. REJECTED by both houses.
* Eliminate vital services for Medi-Cal recipients: Adults would no longer be able to see an optometrist, fill eyeglass prescriptions, obtain hearing aids, get speech therapy, treat sores caused by incontinence, see a podiatrist, chiropractor, acupuncturist or psychologist. REJECTED by both houses.
* Require very low-income seniors to pay more for their health care: Would have required seniors who earn $1,100 a month to either pay $100 premium for coverage to see their doctor, or spend half their monthly income on healthcare. MODIFIED by both houses to continue to pay premium for enrollees who do not pay $500 a month for health services.
* Premium increase for some Healthy Families subscribers: Would have increased Healthy Families premiums between 27% and 77% for subscribers between 151 to 250 percent of the poverty level. MODIFIED by both houses to increase premiums by half the amount proposed.
* Co-payment increase for Healthy Families subscribers: Families between 151 to 250% of the poverty level would pay $7.50 (rather than $4) for “non-preventive’’ services, such as prescriptions, some emergency room visits, some doctors visits, eye exams and glasses, therapy and dental work. REJECTED by both houses.
* Capping Healthy Families dental benefit: Would limit dental coverage to $1,000 per enrollee. MODIFIED. Both houses increased the cap to $1,500.
* Shifting money away from public hospitals: Takes federal money used for public hospitals to pay for unrelated programs. REJECTED by the Senate. REJECTED by the Assembly.

No action, including the rejection of cuts in both houses, is final unless the final budget is approved and signed into law by the Governor. However, the actions to reject many of these cuts sets the stage for the budget debate this summer: whether to deny care and coverage to millions of Californians, or whether the state raises the revenue to prevent these cuts. That's the clear choice.

Health Access will continue to track budget actions on the floors and in conference committee during the budget season. For more information, contact the author of this report, Hanh Kim Quach at hquach@health-access.org

Labels: Budget, MediCal, SCHIPHealthyFamilies, Schwarzenegger, Updates

posted by Anthony Wright | Permalink | 1:01 AM


 

Keeping score, even though it's not a game...

Friday, May 30, 2008

A new HEALTH CARE BUDGET CUTS SCORECARD is now available on the Health Access website, at:
http://www.health-access.org/preserving/Docs/Health%20Access%20-%20BudgetScorecard%20053008.pdf

It details the various cuts, the impact on the budget, the number of people impacted, as well as the actions the Legislature took earlier in the year, and what the Assembly and Senate did today in their current deliberations.

We'll keep polishing it, but it's a useful side by side, especially as we head into conference committee and "Big Five" negotiations.

Labels: Budget, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 5:17 PM


 

...but some key cuts made.

The Senate Budget Committee, chaired by Senator Denise Ducheny, rejected the major eligibility cuts to Medi-Cal, and the elimination of benefits. It is adopted semi-annual reporting for children and parents, the increase in premiums and co-payments in Healthy Families, and the cut to Healthy Families plans, and other cuts.

Again, more detail shortly...

Labels: Budget, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 10:51 AM


 

Rejecting the big cuts...

The Assembly Budget Subcommittee on Health and Human Services, chaired by Assemblywoman Berg, has just voted to reject the major eligibility cuts in Medi-Cal, the elimination of optional benefits, and even to restore some of the provider rate cuts made earlier in the year. This is very good, a clear statement that these cuts are too severe... a determination that prior Legislatures made about these same proposed cuts.

There are cuts that they are expected to approve: cuts to public and private hospitals in a couple of ways, county administration, a modified cut on Medicare part B premiums for some seniors, cuts to Healthy Families plan rates, an increase in Healthy Families premiums and co-pays, and a cap on dental coverage in Healthy Families.

More later...

Labels: Budget, MediCal, SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 10:41 AM


 

The Quiet before the Storm

Tuesday, May 13, 2008

There's the steady drone of doom and gloom emanating from the Capitol, but Sacramento is collectively holding its breath, waiting for Gov. Arnold Schwarzenegger to release his updated budget proposal tomorrow in what's known in Capitol parlance as the "May Revise.''

This second version of the budget comes out a month after tax day, when the state has a better idea what kind of income it has to work with the following year ....and by all accounts, it has not been pretty. Estimates of the deficit -- which started at $14.5 billion in January -- are more like $16 billion to $20 billion now.

While the entire state budget is $140 billion -- the general fund, where we have the shortfall -- is $100 billion. That means the deficit is nearly one-fifth of our budget.

Accompanying the bad figures are equally as bad rumors: Cuts, cuts and more cuts. On the flip side, precious little in new income for the state.

For most of this decade, we have grappled with multibillion dollar deficits larger than the entire budgets of many of the states in the US. And what have we done? We've borrowed and cut.

And now, we're down to the bone. Many of you may recall -- and here's a reminder -- that the governor already proposed more than $1.1 billion in health program cuts, which will mean:

• 500,000 children losing health coverage over the next five years because the state will require that their families report every three months any changes in their life.
• People with disabilities, who live on (at most) $997 a month, could develop infections and sores on their body and other sensitive areas because they lose coverage for incontinence creams and washes.
• The poorest adults will lose their dental care -- and many with already poor dental health will not treat their cavities, develop gum disease, abscesses and possibly lose their teeth.

We will all know at 1 p.m. tomorrow what the total damage will be. But this we know -- There are only three ways to cut Medi-Cal:

• Reimbursement rates for providers -- Check. That was already proposed in January and approved by the Legislature months later to go into effect July 1.
• Benefits to recipients -- Check. See a couple of the bullet points above.
• Eligibility -- Quasi - check. Requiring families to justify their income every three months is a passive aggressive way to knock people off of the Medi-Cal rolls. The state is secretly hoping that families will be too overwhelmed, their life in too much chaos, they will lose or somehow fail to complete the form and send it in. Of course, that means 500,000 children won't get health care....

By process of elimination, a direct cut to eligibility is the only thing left for the state to do to the Medi-Cal program.

Let's cry ourselves to sleep and see what's in store for us tomorrow.

Labels: Budget, MediCal, SCHIPHealthyFamilies, Schwarzenegger

posted by Hanh Kim Quach | Permalink | 6:38 PM


 

Bills, bills, bills...

Thursday, April 17, 2008

HEALTH ACCESS UPDATE
Wednesday, April 16th, 2008

BILLS CONSIDERED BY SENATE HEALTH COMMITTEE AS FIRST DEADLINE NEARS
* Bill fails that would license and regulate "discount" health cards
* Panel passes bill to allow local county-run health plans to expand, compete
* Roundup of bills: children's coverage, mandatory Medi-Cal managed care, benefits

Click Here for What's New on the Health Access WeBlog: Health Wonk Review: Drug Co-Payments and Tier 4; Are the Uninsured the Cause of Overcrowded ERs?


The Senate Health Committee heard nearly two dozen bills on Wednesday in the final hearing before Friday’s policy committee deadline to get bills to a fiscal committee. Following is a roundup of the fate of some of the bills of interest to health and consumer advocates:

DISCOUNT CARDS:

SB 1603 (Calderon) would have directed the state Department of Managed Health Care to license and regulate so-called discount health cards, which promise consumers deep (though often unverified) discounts on medical services from a network of providers (also often unverified). Consumers purchase a list of discount providers at a cost of up to $120/month. The state is in the process of promulgating regulations to address these plans, but current state law bans them, even though some currently operate in California.

With bipartisan opposition from committee members, the bill failed in committee. Consumer advocates have long argued that discount medical cards claim "discounts" off a non-public price, rendering the only true value of the card unknown and/or meaningless. Additionally, surveys have shown that medical providers contacted are not even aware that they are included on many discount cards' list. Additionally, the plans often use misleading language to confuse consumers, and rely on the expectation that the consumer will not understand the difference between a discount health card and actual insurance coverage. Consumer advocates would need to see these issues resolved in order to support a regulation that would license these cards and give them the state's seal of approval.

LOCAL INITIATIVE EXPANSION:

SB 1622 (Simitian) would facilitate a statewide public insurer, connecting existing county-based health care plans to be able to offer a broader regional network of providers. This would provide a more options for existing enrollees, especially those who live in one county and work in another, and also allow these local initiatives to better compete with private health care plans. Using economies of scale, this publicly owned health plan would compete with private health plans and provide an affordable alternative for uninsured and small businesses that feel squeezed by insurance costs. This concept was part of ABx1 1 (Nunez), the omnibus health reform legislation that failed in this committee earlier this year. The bill passed.

CHILDREN’S COVERAGE:

SB 1593 (Alquist) passed, which stipulates that children currently covered by county health initiatives would be the first in line to receive Medi-Cal and Healthy Families coverage once those programs are expanded to cover children up to 300% of poverty ($52,800 for a family of three). Currently, only citizen children up to 250% of poverty are covered by the state. Many counties now pick up the population between 250% and 300% of poverty. This measure complements two bills sponsored by the 100% Campaign – SB 32 (Steinberg) and AB 1 (Laird/Dymally) -- that would expand state children's coverage.

SB 1459 (Yee) passed, but with conditions for significant amendments, given the grilling by committee members, and their statements of concern and opposition about elements of the bill. The bill would consolidate both the Healthy Families and Medi-Cal programs under one name “Cal-Health’’ and sought to expand insurance for some children and some adults. Some advocates supported the stated intent to streamline enrollment and extend coverage, but many also raised concerns and/or opposition, with regard to the structure and specific provisions. These included issues about whether it included coverage all or just some children, the proposal's relationship with current child expansion strategies, the interaction with already-passed streamlining efforts, and whether, as written, the proposal would privatize county eligibility workers, divert funding from public providers to private plans, and be a threat to public hospitals.

MANAGED CARE: Another bill that got significant discussion was SB 1332 (Negrete-McLeod), which sets up a a pilot that would mandate that seniors, and people with disabilities in San Bernardino and Riverside counties be required to enroll in Medi-Cal managed care plans. While it passed despite opposition from consumer, low-income, and labor advocates, the chair, Senator Kuehl, admonished the author to address their concerns, about the potential impact of the mandatory enrollment on these vulnerable populations, and the overall safety-net.

BENEFITS: A number of bills dealt with mandated benefits for consumers in insurance plans. Two bills that would guarantee additional benefits passed. One bill that took away benefits failed.

* SB 1198 (Kuehl) would require health plans to offer coverage for durable medical equipment, such as wheelchairs, bath seats and crutches, at the same levels applied to other benefits. Passed on a bipartisan vote.

* SB 1634 (Steinberg) would require the coverage orthodontic services for cleft palate. Passed on a bipartisan vote.

* SB 1669 (McClintock) would have allowed insurance companies to exclude coverage of conditions for which an individual policyholder has received medical advice, a diagnosis, treatment, of prescription drugs at any point in the previous 10 years. Failed with Republicans voting in support and Democrats voting in opposition.

OVERSIGHT: SB 1525 (Kuehl) would require the state to review how health plans decide what services are “medically necessary’’ and should be paid for, and which are not. Passed on a bipartisan vote.

Bills, votes, and analyses are available at the website of the California legislature, at:
http://www.leginfo.ca.gov/

A broader list of pending bills of interest to health and consumer advocates is updated and available at the Health Access website, at:
http://www.health-access.org/advocating/2008_bills.html

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

Labels: Insurers, Legislation, SCHIPHealthyFamilies, Updates

posted by Anthony Wright | Permalink | 2:54 AM


 

They are hearing lots of opposition to the cuts...

Tuesday, April 08, 2008

HEALTH ACCESS UPDATE
Tuesday, April 8th, 2008

SENATE BUDGET SUBCOMMITTEE REVIEWS MEDI-CAL CUTS
* Quarterly Status Reports: hundreds of thousands to ultimately lose coverage
* Proposal to eliminate adult dental care could increase ER use, hurt clinics
* Children on Healthy Families would also face cuts

* Click Here for What's New on the Health Access WeBlog, Updated Daily
* Upcoming: Bill Hearings This Week on Rescissions, Transparency, Individual Market Reform


At a public hearing Monday, the Senate Budget Subcommittee, which oversees state public programs, postponed decisions on a number of Gov. Arnold Schwarzenegger’s proposed cuts to the Medi-Cal and Healthy Families Program. The two programs, along with all state departments, are under pressure to cut 10 percent across-the-board in an effort to close the state’s $14 billion shortfall. The two programs provide coverage to nearly 7 million Californians – nearly 20% of the state.

Monday’s hearing was part of the normal budgeting process for the 2008-09 fiscal year, which begins July 1. Lawmakers prefer to delay decisions on major items until after the governor releases his May revision of the budget, which reflects the latest number on income taxes to the state. The Legislature and Governor have already approved a $1 billion mid-year emergency cuts package in February, which included a 10% rate reduction ($544 million reduction) to Medi-Cal providers.

As lawmakers heard testimony for proposals that raised premiums for the poorest residents in the state and capped their coverages, Sen. Alex Padilla commented on the bad timing and irony: “In tougher economic times, the demand for services and workload goes up and here we are debating cuts to services.’’

BIG CUTS, "BIG MISTAKE"

By far, the biggest ticket items considered by lawmakers was the reinstatement of quarterly status reports for both children and adults on Medi-Cal and the elimination of adult dental benefits from Medi-Cal.

Quarterly Status Reports: The savings behind the increased administrative burden of quarterly status reports (which require recipients to verify income every three months, rather than one year or six months) is that recipients would not return paperwork in time and fall off the rolls, in spite of being eligible. State officials said tactic would save $83.5 million. The cuts would also cause the state to lose an equal amount in federal matching funds.

The state has estimated that approximately 150,000 children and about 14,000 adults would lose coverage through this tactic, though children’s advocates say that twice as many children--nearly 300,000--would lose coverage over a two-year period, when taking into account the cumulative impact.

Advocates also questioned whether that savings could actually be realized given that the it would end up costing more person-hours to reprocess and re-enroll Medi-Cal recipients who fell off and re-applied for coverage.

Dr. Gerry Fairbrother, who has studied the costs of Medi-Cal churning, reported a cost of about $122 per child in paper-pushing costs, on top of higher medical costs that the state would incur because of medical delays that were made more serious. Her estimates are from 2005.

“Quarterly status reports cause eligible children to disenroll. The costs are higher when they come back on and it increases the administrative burden,’’ she said. Others estimated the administrative costs at higher than $200 per person, and did not include an additional $40 to re-enroll people in a managed care plan.

The County Welfare Director’s Association also reviewed statistics on adult disenrollment and found that 70% (and growing) of those disenrolled were re-enrolled in the first year. And 90% of that population that was re-enrolled did so within the first 90 days.

The remaining 30% that did not re-enroll were likely those who had moved or had become not eligible for Medi-Cal, said director Stan Rosenstein, describing the rationale for reinistituting the report. Advocates suggested that even among this group, the issue was more about administrative barriers than not being eligible. Chairwoman Elaine Alquist directed staff to flesh out the numbers.

Elimination of Adult Dental Benefits: The other high-dollar cut proposed was the elimination of adult dental benefits from Medi-Cal, which would save the state $114.9 billion, but also cause the state to lose an equal amount in federal matching dollars. The only services that would not be eliminated included those services that “could be performed by a physician’’ such as extraction.

The department, however, did note that lack of dental treatment did result in higher medical and hospital costs because “people could go to the ER’’ to have dental procedures performed.

HEALTHY FAMILIES CUTS

Following is a rundown of cuts discussed to the Healthy Families program, and some comments offered by committee members to the Managed Risk Medical Insurance Board – which administers the program.

* Increased premium payments: Families between 151% of the poverty level to 250% of the poverty level would see their premiums increased between $4 and $7/month. For those in the lower income brackets, it works out to a 77% increase over what they are paying now. This would reduce state spending by $43.2 million, but would cause the state to lose $78.5 million in matching federal funds. Lawmaker comments: “Given that we are in a recession and given that people are losing jobs and gas is costing a whole lot more, how does the department determine that a 77% increase is appropriate?’’ asked Sen. Elaine Alquist, who also asked about the impact the increase would have on enrollment. MRMIB executive director Leslie Cummings said she would need to report back on that figure.

* Increased co-payments on “non-preventive services.” Families earning more than 150% of poverty ($26,400 for a family of three) would see an increase in copayments from $5 to $7.50. These higher copayments would be applied to emergency room visits, non-preventive doctors visits, prescriptions, eye exams and glasses, various therapies and dental procedures. This would reduce state spending by $3.4 million, but also cause the state to lose $6.2 million in federal matching funds. Lawmaker comments: “I wonder how many of us in this room would consider those non-preventive services. I think your definition is not exactly accurate,’’ Alquist said.

* Limit dental coverage to $1,000 per child. MRMIB contents that only 5 percent of children need more than $1,000 in dental work done from year to year. This would save the state$5.3 million, but cause the loss of $11.4 million in federal matching funds)

* Reduction in in rates to health plans by 5%. This would save the state $22.4 million, but cost $40.7 million in federal funds

OTHER MEDI-CAL CUTS CONSIDERED: The cuts to the Medi-Cal program senators heard included: The cuts to the Medi-Cal program senators heard included:

* County Processing dollars: Reduction in funds sent to counties to process Medi-Cal applications. This reduction would occur at the same time that processing activities increased if Quarterly Status Reports were approved. The reduction was scored as a $71.1 million savings, with an equivalent loss of federal funding.

* Medicare premiums for very low-income seniors: The state currently pays Medicare Part B premiums for some seniors who are dually eligible for Medi-Cal and Medicare. Those with incomes higher than 129% of the poverty level ($1,118 a month) would now be asked to pay approximately $100 a month for their Medicare premium. The state would save $66.5 million.

* Public Hospitals: The state proposes taking $78.8 million in federal dollars from public hospitals, which will see an increasing number of patients who can't afford to pay for medical services, and use it to pay for programs for largely that same population that would be visiting the public hospitals

* Private hospitals: This proposal would reduce by 10 percent what the state pays to private hospitals. This would save $24 million in state dollars, but cause the loss of an equivalent amount in federal dollars.

While no actions were taken to reduce services to recipients, the subcommittee did approve $5 million in cuts in administrative costs to the Medi-Cal program.

Health Access will continue to report on Budget activities. For more information, contact the author of this report, Hanh Kim Quach, policy coordinator, at 916-497-0923, or hquach@health-access.org.

Labels: Budget, MediCal, SCHIPHealthyFamilies, Updates

posted by Anthony Wright | Permalink | 1:03 PM


 

Passing the SCHIPs...

Wednesday, December 19, 2007

Unable to come to an agreement with a veto pen-wielding President, the Congress has passed a short-term extension for SCHIP, the children's coverage program, through March 2009. We understand this postpones a decision by MRMIB to disenroll children because of a lack of federal funds, at least in the near-term.

This doesn't solve the problem in the long term, or for those children who are now uninsured, but that would get health coverage through the proposal health reform proposal. It doesn't address the President's effort to cap any expansions above 250% FPL, just as the Assembly passes a bill that includes an expansion for children up to 300% FPL. But we live to fight another day.

Labels: SCHIPHealthyFamilies

posted by Anthony Wright | Permalink | 8:00 PM


 

Some delays are good...

Monday, December 03, 2007

Good news. The Managed Risk Medical Insurance Board has delayed the decision to start disenrolling children