Saturday session...

Saturday, August 30, 2008

The debate on SB1522(Steinberg) is reported in today in The Los Angeles Times by Nancy Vogel, along with other bills of note.

It's getting attention online as well: Frank Russo at the California Progress Report, without our urging, spotlights SB1522 (Steinberg), which is up for reconsideration today.

The argument that insurers are using is that the bills would eliminate low-cost products. That's untrue--it leaves lots of options, including high deductible products in place: in fact, the bill explicitly categorizes plans into five tiers, expectation that their will be continue to be a wide variation and range in insurance products. But it better labels those products so people are clear what they are getting.

But in doing that categorization, there some choices that may provide so little coverage that even the lowest rating isn't appropriate. Requiring hospital, doctor, and preventative care is a pretty low standard--but would phase out only a handful of products that are "hospital-only coverage."

But is it really "health coverage" if it doesn't cover 80% of all surgeries? Yet that's what hospital-only coverage does (or doesn't) do. This may have made sense 30 years ago, when the vast majority of care was inpatient. But medicine has changed, most surgeries and other care is outside of a hospital. People pay premiums but only get a false sense of security.

Does anybody benefit from such a policy that covers so little care, other than the insurer that collects the premium? We wouldn't allow car insurance to cover only accidents with red cars. Why certify coverage that only covers patients in one setting, but not another?

That's why the bill is actively supported by prominent groups representing low-income families, like ACORN, Western Center on Law and Poverty, and Having Our Say, a coalition of groups representing communities of color, including California Pan-Ethnic Health Network, Latino Issues Forum, and others. It's these groups, not the insurers, that are looking out for low-income and Latino Californians, by supporting SB1522(Steinberg).

Labels: Insurers, Legislation, Steinberg, Underinsurance

posted by Anthony Wright | Permalink | 12:21 PM


 

Votes on the Assembly floor...

Friday, August 29, 2008

After a debate that we have mostly seen before in the state Legislature, SB840(Kuehl) to create a universal single-payer system, got a 44-31 vote in the Assembly today. It was a party line debate and vote, with Republicans voting against, and most Democrats voting for it, except for Parra and Galgiani--who voted No--and Nunez not voting. (Soto was an excused absence.) It now goes to the Senate for concurrence.


The insurers' top legislative priority to kill was actually SB1522(Steinberg), to provide consumer information and protections and set standards in the individual insurance market. It started and ended the day in the Assembly, and got 36 votes, short of the 41 votes needed for passage. That was also a mostly party-line vote, with Democrats generally in support.

Republicans voted with Blue Cross and some other insurers and against the bill, joined by Democratic Assemblymembers Fuentes, Parra, Solorio, and Torrico, all voting No. Not voting was Assemblymembers Calderon, De Leon, Galgiani, Furutani, Mendoza, Nunez, and Portantino. (Soto is an excused absence.) The bill is up for reconsideration.

More commentary about the debate upcoming...

Labels: Insurers, Kuehl, Legislation, Steinberg, YearOfReform

posted by Anthony Wright | Permalink | 6:34 PM


 

Whose side are you on: consumers or insurers?

Friday, August 22, 2008

While Senator Steinberg was being sworn in as the new President Pro Tem on the Senate side, and calling for “health access for every Californian,” insurance company lobbyists were actively attacking Senator Steinberg’s health care bill, SB1522, on the Assembly side.

Without a strong case to make, they are resorting to mischaracterizations of the bill, hoping nobody pays attention to the facts in the heated last days of session.

The bill is modest but meaningful. It would ensure that consumers have more confidence in their coverage, and that they know what they are getting when buying coverage as individuals.

Right now:
· It’s impossible to make price comparisons, since each plan from insurer has different deductibles, co-pays, out-of-pocket maximum, benefits, or networks.
· It’s hard to know what a plan covers, or doesn’t cover, or how comprehensive any given plan is.
· Some consumers think they are well covered, and find out they are not only when it is too late. Some plans are marketed as quality coverage but actually cover only hospitalization, but not surgeries, outpatient treatments, or doctor’s visits. (It would be like having car insurance, but only for accidents with red vehicles.) Some plans leave consumers with significant gaps in coverage, sometimes with unlimited exposure to medical bills.

SB1522 (Steinberg) does the following:
* Requires health insurance to cover doctors, hospitals, and preventive care
* Requires all health insurance to have a maximum out of pocket cost.
* Categorizes all health insurance into five categories so that consumers can know whether they are buying comprehensive coverage with low cost sharing or a high deductible, catastrophic policy. It allows for "apples to apples" comparison.

Contrary to the misrepresentations of Blue Cross and other insurers, here is what SB1522(Steinberg) does NOT do:
- SB1522 (Steinberg) does NOT eliminate so-called “low cost”, low premium products with high deductibles. In fact, that’s why there are five categories, so that those products are better labeled.
- SB1522 (Steinberg) does NOT require all health insurance to cover specific benefits. There are other bills: AB1962 DeLaTorre requires maternity coverage, for example.
- SB1522 (Steinberg) does NOT force people to leave the coverage they have. Anybody with a current plan can renew it indefinitely.

These mischaracterizations and misrepresentations show why we need the bill: Just as consumers are rightfully skeptical about their insurance policies and what’s in the fine print, legislators should be skeptical of the claims of the insurance companies. The point of this bill is to give consumers more confidence that their coverage will be there for them when they need it. I am not sure there’s a legislative remedy for the representations of insurers in the halls of the Capitol.

Assemblymembers should join key organizations, including Health Access California, AARP California, ACORN California, AFSCME, CALPIRG, California Teachers Association, Congress of California Seniors, Community Health Councils, Consumers Union, Having Our Say, Jericho, Latino Issues Forum, MALDEF, MS Society, Planned Parenthood, SEIU, Small Business Majority, and Western Center on Law & Poverty in supporting SB1522(Steinberg).

Labels: Insurers, Legislation, Steinberg, Underinsurance

posted by Anthony Wright | Permalink | 8:41 AM


 

Even better than the "mensch" award I saw him get...

Thursday, August 21, 2008

Senator Darrell Steinberg was officially sworn in to be Senate President Pro Tem today, in a touching ceremony on the Senate floor this afternoon. With the current Senate President Pro Tem Don Perata making the motion, and the current Republican leader Dave Cogdill seconding the motion, it was approved unanimously by voice vote.


He also gave a speech that seemed to counter the cynicism about public service and government these days, which seems especially ripe right now because of the budget standoff. He talked about the advances made in some areas, whether infrastructure, stem cell research, or mental health, and suggested that progress could be made in other areas as well. As Shane Goldmacher at the Sacramento Bee reports:

Labels: Sacramento, Steinberg, Year of Reform

posted by Anthony Wright | Permalink | 11:50 PM


 

Killing us softly...

Wednesday, July 02, 2008

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

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

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

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

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

Labels: Insurers, InTheNews, Legislation, Steinberg, Underinsurance

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


 

Buyer beware, indeed...

Sunday, June 22, 2008

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

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

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

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

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

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

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

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

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

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

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

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

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

Labels: Insurers, InTheNews, Legislation, Steinberg, Underinsurance

posted by Anthony Wright | Permalink | 3:17 PM


 

What constitutes coverage?

Tuesday, May 27, 2008

As the Democratic presidential candidates debated whether their "universal coverage" plans were "universal"--and what that meant--there wass surprisingly little debate about the definition of "coverage."

What makes "coverage" coverage?

It's a good question, as Florida Governor Charlie Crist just signed a so-called health reform that doesn't expand coverage one bit, but rather strips down the definition of coverage to make the premium cheaper. Critics say that as insurers water down the benefits, at some point the value of the coverage is so little that it's not worth paying premiums for in the first place.

It seems people get coverage to prevent the real health and financial consequences of being uninsured. They literally pay a premium to 1) get the care they need, and 2) not face financial ruin as a result.

There are some products out there that don't meet this basic definition. For example, we've heard of products--some sold by disreputable outfits, sometimes on TV at 3am--that say they provide hospital coverage, but only reimburse $200/day. Only if you've been to a hospital do you know that such a plan doesn't begin to cover an overnight stay, and that such "coverage" from a masssive hospital bill is merely an illusion. It's "junk" insurance.

SB1522(Steinberg), which passed the California Senate Tuesday, would set a minimum standard for coverage as well, in two basic ways:

* It would set an overall cap on out-of-pocket costs, so people paying premiums would not face unlimited financial liability when they get sick or have an emergency. This won't eliminate your standard high-deductible plans, may be a (not great) option for a healthier, wealthier person who wants to save on the premium and who has the ability to self-insure a few thousand dollars of a deductible. But it would eliminate those plans which cover so little or impose so much cost-sharing on the patient that the person continues to be at risk of banktruptcy.

* It would requires that a plan should include doctor, hospital, and preventative care, preventing hospital-only coverage. This would prevent hospital-only plans that leave patients in a situation where cancer isn't covered, since most of the treatment is in a doctor's office, rather than a hospital. Even worse, you don't want an perverse incentive for people to want the more invasive, more expensive hospital treatment unless they need it. Again, these plans often provide a false security to patients--until its too late.

These "junk" plans, because they collect premiums but are far skimpier in paying out benefits, can be very lucrative for the insurers who sell them. But they have the capacity to undermine the very notion coverage altogether. What's the point of paying for coverage, if you still face financial ruin?

People are growing more and more concerned that their coverage will not be there for them when they need it. They are frightened that even if they are insured, there will some loophole or provision that leaves them with significant medical debt. That's why SB1522(Steinberg) and other efforts are so important, to make the definition of coverage mean something. Consumers with coverage deserve some security that with their premium, they will be protected.

Labels: Insurers, Legislation, Steinberg, Underinsurance

posted by Anthony Wright | Permalink | 11:52 PM


 

The debate on SB1522...

Senator Steinberg just presented SB1522 on the Senate floor. The preliminary count is that it passed, 21-14, largely on party lines.

Senator Cox was the only other speaker, in opposition. An insurance agent, Cox suggested that "Senator Steinberg should find himself a good agent," and that an agent could provide the information to help a consumer decide what coverage to get.

He argued that with the classification of health plans into five tiers, "you've taken away the flexibility" which will lead to a "higher-premium program with fewer enrollees."

In fact, the five tiers allow for lots of variation and flexibility within those tiers. Above some minimum standards (see below), there is total flexibility in benefit design. The tiers will simply provide consumers some guideposts, so they are better be able to make comparisons between insurers.

SB1522 does seek to eliminate some "junk" insurance that leaves patients with unlimited financial exposure, undermining the point of coverage in the first place. Coverage would have to have some overall cap on out-of-pocket costs. The minimum standard for coverage would need to include doctor, hospital, and preventative care, effectively restricting doctor-only or hospital-only health coverage--as if people can guess that not just the type of ailment they will have, but the type of treatment as well.

But other than that, there's lots of flexibility. As Senator Steinberg said in closing, the basic point of the bill is to have clear information. And, he asked, while many people may benefit from "a good broker like Senator Cox," what's the harm in providing everyone as much information as possible? "Information is a good thing, and provides greater flexibility" for consumers.

Labels: Insurers, Legislation, Steinberg, Underinsurance

posted by Anthony Wright | Permalink | 3:43 PM


 

Joe the Plumber...

 

Credit where credit is do to protect credit...

 

Healthy lifestyles and health care

 

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Going uncovered...

 

An unspoken, untrue consensus...

 

McCain's Plan IS a Tax Increase on the Middle Clas...

 

Big differences between them, and bigger impacts i...

 

Job Killer? No!

 

Feint Faint