Judging from some surprised E-mails that I have received, there are some needed corrections and clarifications to Dan Walters' recent Sacramento Bee column on health care policies and politics. He mentions "health-access advocates" but has never called anyone at our organization, so perhaps he's reporting third- or fourth-hand.
The biggest misrepresentation is his declaration of an "unspoken consensus is to wait to see what Congress and the next president, whoever he may be, can devise before taking up the Sacramento battle again with a new governor."
It's unspoken because it's untrue. There's lots of conversations about how to proceed at the state level, through bills, budget efforts, or ballot measures, and how to integrate state and federal efforts for reform. The political and policy landscape is changing, and we all need to adapt to it, but the planning is actively going on: the notion that any health stakeholders are in a "wait and see" is simply wrong.
Walters has been wrong before, having written several articles hostile to health reform over the last few years, much of the time declaring that that any health reform was doomed to be pre-empted by the federal ERISA law. He has stated that these reform proposals that included a required employer contribution to health coverage "illegal," that a previous court decision on ERISA was "a potentially fatal blow," and that elected leaders attempting reform were "in denial."
Yet last week, the Ninth Circuit Court of Appeals upheld the Healthy San Francisco plan which included just such a employer contribution component. This was predicted by many health reform supporters, but never fully acknowledged as a possibility by Walters in his reporting, until this article. And he characterizes the unanimous decision as "seemingly daring the Supreme Court to take up health care," rather than just ruling on the merits of the case. He doesn't acknowledge that the Supreme Court already had a chance to weigh in regarding an injunction of the SF law, and Justice Anthony Kennedy declined.
There's a lot of avenues to pursue health reform, at the local level, state, and federal level, and through various venues and strategies. But it's not an either/or proposition.
Big differences between them, and bigger impacts in California
Friday, October 10, 2008
HEALTH ACCESS CALIFORNIA ALERT Friday, October 10, 2008
HEALTH PLANS OF PRESIDENTIAL CANDIDATE WOULD HAVE SIGNIFICANT IMPACTS ON CALIFORNIANS' COVERAGE
* Under McCain Health Plan, Over 2.4 Million Californians Would Lose On-the-Job Health Benefits
* New reports reveal McCain's plan that would strip away consumer protections, raise taxes, and leave many California families to fend for themselves at mercy of insurers * New chart shows Obama’s framework similar to Nunez/Schwarzenegger proposal, with expansion of employer coverage, public programs, and insurer oversight
California, because of its specific demographics and policies, will be more acutely impacted by the health proposals of the two presidential candidates, according to new information released today by Health Access California, the statewide health care consumer advocacy coalition, and Health Care for America Now!, a national campaign to win quality, affordable health care for all Americans.
Risks of the McCain Plan:Health Access California and Health Care for America Now released two new reports from the Center for American Progress Action Fund and the Economic Policy Institute which find that 2.4 million Californians would lose employer-sponsored health insurance under the McCain health care plan. The reports conclude that McCain’s health care plan would accelerate the deterioration of employer-sponsored benefits by both removing current tax incentives and, at the same time, taxing employee benefits as if they were salary.
In California , Senator McCain’s plan would: * Threaten the coverage of over 17 million people in California who receive health benefits through work. The Economic Policy Institute projects as many as 2.4 million could lose their job-based coverage. McCain’s plan eliminates the employer health care tax benefits that enable many businesses, especially small businesses, to provide group insurance to their employees. * Put at special risk coverage for the 6.2 million non-elderly people in California struggling with diseases like cancer and diabetes who are now covered through their jobs. Under McCain’s plan, insurance companies would be free to “cherry pick” only those individuals for coverage who do not have costly health conditions and avoid state regulations that keep health care accessible and affordable. * Raise taxes on the health insurance benefits paid by millions of California families. A typical California family could pay almost $1,300 more in taxes by 2013 if McCain imposes both income and payroll taxes on their health coverage.
At least one in 13 people would lose his/her employer-sponsored health insurance benefits and be forced out into the private insurance market where premiums are more expensive and coverage is less comprehensive. Anyone with a pre-existing condition – as defined by the insurers themselves – could be denied coverage altogether.
Comparison with California Proposals: Some of the provisions of the plans of the two presidential candidates, Senator Barack Obama and Senator John McCain, have been extensively discussed in California . As indicated by a chart prepared by Health Access California, Senator Obama’s plan follows a very similar framework as AB x1 1, a plan negotiated between Speaker Nunez and Governor Schwarzenegger, and the plan’s antecedents in the legislature.
The provisions of Senator McCain’s plan has gotten less state-level attention, except for one bill, SB x1 16 by state Senator Tom McClintock, to allow insurers to sell across state-lines, and thus avoid state oversight and consumer protections.
California Consumer Impacts: In each of the three ways that consumers get coverage, the McCain and Obama plans have radically different strategies, each on with significantly different results:
* On Employer-Based Coverage: Just around half of Californians (nearly 18 million) have employer-based coverage, but Californians are less likely to get job-based benefits than in the rest of the country. · The McCain plan would tax health benefits offered by employers, and offer a tax credit instead for those on the, individual health projects. This would result in the 1.3 to 3.3 million Californians losing their health coverage through work, according to EPI. · Given the lower expectation of on-the-job benefits in California , there is fear that the state is reaching a “tipping point” in some industries, where if more leading employers drop coverage due to different tax incentives, that would force all competitors to follow. · The Obama plan would bolster on-the-job benefits by setting an as-yet-determined minimum requirement for employers to contribute to health care for their workers, and also provide financial assistance to small business, and new purchasing pool options for all employers. * On Public Programs: Under a third of Californians--over 10 million--have public program coverage: over 6.6 million low-income children, parents, seniors and people with disabilities through Medicaid (Medi-Cal in California ), and another remaining 4 million seniors and people with disabilities in Medicare. There is another 800,000 children in SCHIP (Healthy Families in California ). * The McCain campaign recently changed the health plan, saying it would require a $1.3 trillion cut to Medicaid and Medicare. (This was prompted by the McCain’s plan shift, in saying that the plan would eliminate only some, rather than all, of the tax deductions for employer-based care.) * Such a cut to Medicare and Medicaid would mean significant reductions in benefits or access to medical providers for these children, seniors, and people with disabilities. It also would force additional cuts at the state level. California has already made significant cuts to Medicaid due to the current budget crisis, and such a cut at the federal level would compound the budget problem. * The Obama plan would fund and expand programs like Medicaid and SCHIP: California would be first “in line” to take advantage of resources that might be available, especially since our state and county efforts already have more expansive eligibility. In short, public program expansions at the federal level will allow California to claim additional federal marching funds.
* On the Individual Insurance Market: Roughly 2 million Californians-- less than 10 percent—buy coverage as individuals, but it is a bigger share of the population than other states. As a result, Californians are more likely to be denied for “pre-existing conditions.” Unlike some states, California does not have “guaranteed issue” and in fact has had many cases of rescission, where patients are denied for coverage retroactively. For those who are denied, California has a small and underfunded high-risk pool that currently has a waiting list. In terms of benefits and other policies, California has stronger consumer protections compared to other states. * Senator McCain’s health care plan would expand the individual market, and more Californians would be at risk for being denied for “pre-existing conditions.” Senator McCain’s plan would ask patients who are denied to rely on the state’s “high-risk” pool, but the pool is inadequate for the existing population, much less a greatly expanded individual market. * Senator McCain’s plan would also strip away consumer protections by allowing insurers to sell across state lines, avoiding California ’s existing consumer protections. According to CAPAF, insurers could avoid over 40 benefit requirements and other state laws. These laws currently require insurance companies to cover benefits like breast cancer and cervical cancer screenings and to ensure other consumer protections, from fiscal solvency standards, to providing the opportunity for an independent medical review. California consumers who want a second opinion about the denial of a treatment might not be able to go to the California Department of Managed Health Care, as is their right now, but to the insurance commissioner of another state. * Senator Obama’s plan would institute additional insurance oversight and consumer protections, including “guaranteed issue,” and keep existing state protections, like independent medical review.
Again, the chart and reports are available at the Health Access California website, at: http://www.health-access.org
Health Care for America Now is a national grassroots campaign currently asking Members of Congress, “Which Side Are You On? – the side of quality, affordable health care for all or the side of leaving us alone to fend for ourselves in the bureaucratic, unregulated insurance market? HCAN’s Statement of Common Purpose includes 10 principles the campaign believes will lay the foundation for effective, comprehensive health care reform in 2009.
Health Access California (www.health-access.org) is the statewide health care consumer advocacy coalition, working for the goal of quality, affordable health care for all. Health Access California was the sponsor of the many HMO consumer protection bills passed in the past decade, including the creation of the Department of Managed Health Care and independent medical review. Health Access has also been actively involved in supporting numerous coverage expansion efforts, through bills and ballot measures. Health Access is a lead partner organization in California for the Health Care for America Now! campaign.
Health Care for America Now is made up of millions of individuals and more than 275 organizations nationwide. It’s steering committee includes ACORN, AFSCME, Americans United for Change, Campaign for America’s Future, Center for American Progress Action Fund, Center for Community Change, MoveOn.org, National Education Association, National Council of La Raza, National Women’s Law Center, Planned Parenthood, SEIU, UFCW, and USAction.
Health Care for America Now and Health Access California are both section 501(c)(4) issue advocacy organizations, HCAN and each of its members conducts and funds only activities appropriate to its tax and election law status. This statement was not funded or endorsed by HCAN’s 501(c)(3) members. ###
In the long run, this court decision trumps all the unfortunate vetoes made in the past week in importance, in terms of the boost that the decision provides to state health reform around the country. It was a tough week here in California, but the court decisions makes it easier to do reform in Sacramento and around the country, and that's a positive outcome amidst the negativity. So the issue for state health reform refocuses on being able to pass a proposal, rather than to defend it in court.
Ezra Klein at The American Prospect said "Joe Biden just offered the most lucid and concise demolition of McCain's health care plan that I've heard. He hit the taxation of employer benefits, the fact that 20 million would lose their health coverage, the failures of the individual market, and all the rest. It was [beautifully] put."
Marie Cocco at the Washington Post, perhaps watching a different debate than Ezra, said that "Biden countered with a convoluted explanation of how that $5,000 wouldn’t be enough to purchase what is now a policy costing about $12,000, and which is subsidized with tax breaks for employers. That’s about as far as it went, and it’s not nearly far enough. "
Cocco continued,"In fact, McCain’s health insurance proposal would eliminate tax benefits employers now get for offering health insurance to their workers. This would effectively end the work-based health insurance system. Families would be left to purchase policies on their own, those who are sick would face much higher premiums, and the number of uninsured would rise, rather than fall, according to independent analyses."
Merrill Goozner at GoozNews goes deeper into the substance of the debate, trying to take seriously aspects of the McCain plan--perhaps more seriously than McCain seems to take them.
Some make a case that the tax deduction for employer-based benefits can be better structured to be more efficient and equitable. But in the current system, removing this tax benefit would be a takeaway for both employers and employees, and give a significant push for at least some employers to drop coverage of their workers.
What workers would get in return is nothing close: a tax break that may or may not be of a similar dollar amount, but almost certainly not of the same value. For those workers swtiched from the employer-based coverage to the individual market, they not only lose the employer contribution, but the efficiency and bargaining power of group purchasing. Even with the same dollar amount in tax benefit, whatever they buy in the individual market will be a much more scaled back, less valuable plan, on average.
And for some with "pre-existing conditions," they lose the ability to get insurance in the first place. McCain's policy people said he would boost state high-risk pools, like California's MRMIP. As we said with the recent veto of AB2 here in California, such efforts are deserving but too small and inadequate as a fix for the problem... and by shifting the tax burden to shift people out of group coverage in the individual market, the plan actually makes the problem worse.
It's not just a tax increase, as the commentators indicate... It's a tax increase that leads to a further unravelling of our health system.
There's lots of talk about how the economic crisis (and the bailout, still in flux) will impact the prospects of major health reform in 2009.
There are some who think hopes for reform are scotched, including Robert Laszewski at the Health Care Marketplace and Policy Review, and Jeff Goldsmith at The Health Care Blog. And maybe Jim Lehrer, given the implications of his question that the candidates will have to "give up" portions of their plans. A down economy (and/or a bailout) would dry up the money that would be needed to pass health reform.
Parts of the counter-argument are made by Jane Sarasohn-Kahn at The Health Care Blog, and Ezra Klein at the American Prospect, and others. They argue that the economic times would create the political will and need for health reform, both from the public, and from the government that needs to find structural ways to address the issues in the existing health programs.
I would also say that this past week re-asserted a key concept in our political discourse: that government matters. Regardless of what you think of the substance of the bailout, or even the final outcome, there was bipartisan agreement that government action on big issues are possible and in fact necessary, that there are some things that only government can do. And if Congress can consider a $700 billion rescue of our financial markets, the leap for health reform is no longer so radical.
We should remember that the major social programs and leaps--Social Security, Medicare--happened during similarly tumultuous times. And to those who argue that a new President will have other issues on his plate (two wars, the economy, housing, energy, etc) to worry about, let's also remember that transformational moments in American history are not single-issue events. The New Deal, the Great Society did not only focus on one issue. When we argue that health reform needs to be a priority, it is not at the exclusion of other issues: rather, the change that comes will be on several fronts. It is our job to insure that health care is part of that wave.
The Governor's vetoes actively harm California health care consumers. * Over one thousand consumers will continue be uninsured and uninsurable at any price, on a waiting list, without the reforms the Governor vetoed. * Patients will be retroactively denied coverage by their insurer with no independent review. * Insured consumers will be balance billed after going to an emergency room, with their credit and financial future at risk. * All consumers will continue to wonder if their premiums are going to profit and overhead, rather than patient care.
In addition, we vehemently disagree with the Governor's opposition to a starting the process to create universal, single-payer health care system, or with bills that would set basic benefits for insurance coverage. But many of these vetoes were unexpected, and go against the themes and policies that the Governor had advocated earlier in the year.
The Governor's stubborn approach to health care has meant that California has actually taken big steps backward, away from the goals of health reform. With his vetoes and combined with his action on the budget, the Governor has made health care less available, less affordable, and less secure for California consumers.
The United States Court of Appeal for the Ninth Circuit ruled today for the City and County of San Francisco, and against the Golden Gate Restaurant Association, which had sued to block the new Healthy San Francisco program, and particularly, the employer contribution provisions.
According to Judges Alfred T. Goodwin, Stephen Reinhardt, and William A. Fletcher: "We hold that ERISA does not preempt the Ordinance."
Many opponents of health reform, including SB2, Prop 72, SB840, AB8, AB x1 1, and other efforts, have cited the ERISA bogeyman. This decision is the highest and most affirmative ruling yet that there are ways for states and localities to address health reform, including employer-based coverage, without being preempted by the federal ERISA law.
Once again, California leads the way. More to come!
If there's one thing you read about the presidential election related to all the happenings on Wall Street, take a look at Ron Brownstein in the National Journal. It makes the link between the financial sector crisis and policy on retirement, health care, and other hot-button issues. He quotes Jacob Hacker, author of the The Great Risk Shift, and soon-to-be-professor at UC-Berkeley, about the fundamental question in this election. Read the whole thing, but's here's a few paragraphs:
Although neither McCain nor Obama has framed the situation this way, their reactions to this transfer of risk and responsibility represent a fundamental dividing line between them. Like President Bush, who touted an "ownership society," McCain has welcomed these shifts of responsibility as giving individuals more control over their financial future. On several fronts, McCain in fact wants to accelerate these trends.
Today, most Americans still receive their health insurance through group coverage (either from government or employers) that shares risk and cost between the healthy and the sick. Relatively few obtain insurance in the individual market, which exposes consumers to much wider variations in cost and coverage depending on their health. McCain's proposal would push more people toward the individual market (perhaps 20 million more, according to an independent study released this week) by replacing the tax break that promotes employer-based coverage with an individual tax credit....
Obama, by contrast, wants to strengthen the institutions that promote the sharing of risk. His health care plan aims to buttress group-based coverage, either through employers or new government-sponsored purchasing networks. He adamantly opposes private accounts under Social Security and would instead offer tax incentives for workers to invest for retirement in accounts intended to supplement Social Security's guaranteed benefits.
In all these respects, the McCain-Obama contest represents a fork in the road that will likely determine whether the nation continues to shift more financial responsibility to individuals, or seeks opportunities to restore more sharing of risk. This week's chaos on Wall Street, which rattled millions of workers relying on the markets to fund a decent retirement, shows how much average Americans have at stake in that choice. "This is a critical watershed moment," Hacker correctly notes, "because it really captures in sharp relief both the stakes and what the core of this debate is."
Brownstein overlooks that Obama did explicitly counter the "you're on your own" philosophy of the so-called "ownership society" in his convention speech, which didn't get much attention because of the announcement of Sarah Palin's selection the next day.
In Washington, they call this the Ownership Society, but what it really means is - you're on your own. Out of work? Tough luck. No health care? The market will fix it. Born into poverty? Pull yourself up by your own bootstraps - even if you don't have boots. You're on your own.
But the rest of the analysis by Brownstein and Hacker is spot-on. This debate is bigger than all of us, including Obama and McCain.
The individual market makeover: mend it, end it, or both?
Wednesday, September 17, 2008
Last week, I attended a conference with fellow state-based health consumer advocates and now-notorious "community organizers," and was impressed by the range in activity around the country.
Even as we see what is likely at the federal level next year with a new President and reconfigured Congress, state legislators and advocates are not waiting around: they are actively pursuing health reforms, from Albany to Harrisburg, from Augusta to Springfield, from Trenton to Salem.
Much of that advocacy has traditionally focused on expanding public coverage programs like Medicaid and SCHIP. Yet I spoke on a panel on private coverage--which states are currently in charge of regulating--and that leads us to the current policy debate in DC and elsewhere.
There's big divide in health policy: One mainstream, proven way is to provide for subsidized group coverage, whether through an employer (how most get coverage now), a public program (how nearly a third get coverage), or even a universal single-payer system.
Another theory is to switch people into a more functional individual market. For example, President Bush (and now, Senator McCain as a candidate) would shift tax policy to discourage employers from providing coverage, and rather encourage people to buy coverage on their own. These proposals are obviously flawed, because they don't even attempt to fix the most glaring problem in the individual market: that insurers can deny patients for "pre-existing conditions" which would amazingly (and ironically, if it wasn't so sad) leave the sick out of their health coverage.
But there are more reasoned, thought-through proposals that at least try to take an individual market approach seriously, that recognize the flaws of the individual market, but seek to remake the market as they expand it. This includes relatively progressive legislators at the state and federal level, including Senator Ron Wyden of Oregon, who has an ambitious proposal, and Governor Schwarzenegger, based on his original proposal in January 2007. These efforts include significant regulation of the insurance industry and changing the way they do business. To be serious, they at least include guaranteed issue--that insurers must take all patients, regardless of health status--and some form of community rating--restricting variation in what is charged between patients.
My take? I still remain skeptical. As the least efficient, most expensive way to get coverage, the individual market seems a poor platform from which to rebuild a health system. Individual consumers simply don't have the group purchasing power of large employers or public programs, and are simply at the mercy of the big insurers. It's confusing and complex, and hard to compare and to sign-up for coverage.
When debating health reform last year in California, Health Access detailed a chart ofwhat would be consumer advocates would want "Beyond Guaranteed Issue," from subsidies to standards, minimum benefits to easy enrollment, rate regulation to medical loss ratios. The chart looks at what regulations exist in California and Massachusetts--where more still needs to be done.
Some of the real problems and provisions to address them included in the negotiated agreement of AB x1 1, and also discussed this year in SB1522 (Steinberg), to standardize the individual market. What we learned in this debate even makes me more alarmed, that consumers are getting a raw deal, paying premiums without proper protections in place.
Some of the bills that were passed this year, from AB1945 (De La Torre) to AB2 (Dymally) deal with other issues in the individual market, from rescissions to what happens after people are denied for "pre-existing conditions." But there's so much more to do.
My overall takeaway is that I would focus efforts at reform on expanding group coverage, which is thankfully where Senator Obama is (and where Senators Clinton and Edwards previously were), where Jacob Hacker and other academics are, and even where Rep. Conyers and other single-payer advocates are.
In virtually all reforms, an ancillary market of individual coverage will exist (like in the current "system"), and such regulations, oversight, and consumer protections are, and will be, desperately needed. I absolutely believe that we can improve the individual market; I appreciate those with the confidence to remake it altogether. I'm not sure we can fix everything about the individual market--it requires a lot more than guaranteed issue. As a consumer advocate, I am hesistant to shift people there wholesale unless we can prove that it can work. It's one of the main policy debates of the next few months.
Lots in the news about the Presidential candidates respective health plans today.
Health Affairs has just published an analysis of Obama's and McCain's health plans. Ezra Klein has done his own summary of the Health Affairs' take on the Obama and McCain plans. Bob Herbert of the New York Times talks about McCain's awful health agenda. Wall Street Journal (!) also has an op ed on why Obama's plan is better.
McCain's plan, according to health policy academics, would result in more than 20 million people losing their work-sponsored health coverage -- leaving them to fend for themselves in the individual insurance market. I'm not sure how this improves anyone's lot -- especially in a state like California, where it would be an exagerration to say the individual market was regulated.
Meanwhile, the critiquers of the Obama plan (which includes an adviser to the McCain campaign), opine that it amounts to more regulation (because deregulation works sooooo well) and more spending (duh, it's expensive to pay for health care.)
Today, over 250 house parties in 38 states in over 120 cities were held around the nation, by volunteers and leaders of the Health Care for America Now! campaign--which included house parties by Health Access California, California ACORN, and other partners hear in the Golden State.
The point is to get Americans to contact their Congressional representatives, to urge them to make health reform a top priority in 2009, and to commit to a reform that places consumers' interest first. The Health Care for America Now! website has the Statement of Common Purpose, which outlines the direction health reform should go, and a "Which Side Are You On?" statement, asking Representatives where they stand on the central debates in health policy.
Here's the trailer for the video shown at the house parties... We have a chance to make history on health reform, but only if we do this right...
Healthy San Francisco gets the full treatment in a paper by Community Catalyst. "Healthy San Francisco: A Case Study of City-Level Health Reform" is a description of the politics and policy of the groundbreaking effort, written for health advocates in other states and nationally to learn lessons and take inspiration for their efforts.
Even in tough week, we see that California can lead the way. It's up to us not to give up...
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.
I love the Divided We Fail/AARP commercials that are running during the Democratic National Convention that highlight how financially devastating the current health care system is to the 1.85 million Americans who must declare bankruptcy annually.
He's been involved in every major debate around health reform over the past half-century (even ones that he is not publicly involved, such as the fight for SB2/Prop 72 in California). He believes that a President Obama will provide him a final opportunity to bring everything he has learned, all his legislative experience and background and relationships and institutional memory, to the cause of passing health reform.
A lot of our coalition work this year, such as working with Health Care for America Now!, is trying to ensure there is a Congressional commitment to major health reform next year, but it looks like there will be a home grown push as well. Good. We need both.
A month or so ago, America's Health Insurance Plans, representing the insurance industry, launched a "listening tour," as part of their campaign to organize 100,000 people who are satisfied with their health coverage--and presumably to stop many of the health reforms that are being proposed. Many suspect that's the actual goal of their Campaign for an American Solution.
The insurers probably were spooked by the protest by Health Care for America Now and local health consumer and constituency organizations in Columbus, Ohio during their first "listening tour" stop. But if they are serious about listening, that means listening to their critics--and having . Otherwise, it's just PR.
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.
Consumers Union staff, including former Health Access staffer Meg Bohne (pictured), had driven an RV over 12,000 miles before coming to Sacramento, talking with health care consumers and videotaping their stories with the health care system. Among their stops on the way back to the East Coast will be Denver and Minneapolis, as they make the case to elected leaders of all parties and political stripes of the need for health care reform next year.
But the RV stop in Sacramento also focused on what we in California can do--not just next year, but in the next few days and weeks.
Health care reform may have stalled earlier this year, but there are pending bills in the California legislature that can help our state move down the road to reform, that can help Californians have more confidence in the quality of their care and their coverage.
Those bills include:
* HOSPITAL INFECTIONS: SB 1058 (Alquist) and SB 158 (Florez), geared to reducing hospital acquired infections. SB 1058 would mandate public disclosure of hospital acquired infection rates, and require hospitals to screen high risk patients to identify those colonized with methicillin-resistant Staphylococcus aureus (MRSA) bacteria, and to take special precautions with those who test positive to prevent its spread to other patients. SB 158 gives the Department of Health Services additional authority to investigate infection outbreaks and complaints about lax infection control practices. The Department of Health Services estimates that as many as 9,600 Californians die from hospital infections annually, and it is esimated that hospital infections add a staggering $3 billion to California’s health care bill every year.
Speaking at the press conference was Cindy Gaston of Elverta (pictured speaking), who developed a serious MRSA infection following the C-section delivery of her child. She had to be rushed back to the hospital a few days after giving birth when her surgical incision burst open and it became clear that she was very sick. She required multiple surgeries to clean out the infection and ended up staying another ten days in the hospital while undergoing IV antibiotic treatments. Cindy was surprised by the sometimes poor infection control practices she observed at the hospital and how little information she was provided about how to prevent the spread of her infection to others. She has had three outbreaks of her antibiotic-resistant infection since she was discharged from the hospital and hopes that she won’t become sick again.
* TRANSPARENCY: AB 2967 (Lieber) would require public reporting of information about the cost and quality of care delivered by health care providers in the state. It would establish the Health Care Cost and Quality Transparency Committee to develop a plan for making cost and quality data available to the public. The goal is to provide the public and purchasers with data to seek more cost effective care that improves patient outcomes and to enable hospitals and other care providers to compare themselves with their peers and identify areas where improvement is needed.
* HEALTH INSURANCE STANDARDS: SB 1522 (Steinberg) would set standards to help consumers compare health insurance products and weed out “junk” insurance plans.
Under existing California law, health insurers can sell products characterized as health insurance that cover only hospitals or only physicians. Health insurers can sell products that have no maximum out of pocket cap, exposing consumers to hundreds of thousands of dollars in out of pocket costs in the case of catastrophic illness. Insurers can sell health insurance that covers only a small fraction of the actual cost of care.
SB 1522 would help eliminate “junk” insurance by requiring health insurance to cover doctors, hospitals, preventive care, and any existing statutory mandates, and to have a cap on out-of-pocket expenses. The bill also requires the Department of Insurance and the Department of Managed Care to create five coverage categories that would help organize the insurance market so that consumers can shop more knowledgably. Insurers would be required to offer benchmark plans to assist with apples to apples comparisons.
Senator Elaine Alquist (pictured above and left), who is on the Senate Health Committee, also spoke on her hospital infection bill, as well as the need for health care reform in general.
In an "MTV:Cribs" moment (see picture left), the Senator also toured the RV, as did Daniel Zingale and Richard Figueroa, who both work in the Governor's office and advice the him on health policy, and who came by to watch the press conference.
These bills are up for final floor votes in the California Legislature in the next week and a half. If they pass that final legislative hurdle, then their fate will be in Governor Schwarzenegger's hands, where he can sign the bills, help consumers and help lay a better foundation for health reform--or just leave us with the deteriorating status quo in California.
As the different accounts indicate, there was a successful push to include a greater emphasis to "guarantee accessible health care for all," from supporters of Senator Clinton, who urged an "individual mandate" approach in the primaries, and health care activist focused on a single-payer solution. Obama's plan is neither, but embodies similar principles and goals.
While the platform states that "there are different approaches within the Democratic Party about how best to achieve the commitment of universal coverage," there's a lot of similarity of these approaches: an emphasis on group coverage, rather than the individual market; the use of purchasing pools for bulk purchasing and other efficiencies; fair financing, where people pay based on what they can afford rather than how sick they are; the expansion of public insurance programs and coverage options; and a healthy distrust of the insurance industry, by increasing insurer oversight and offering alternatives to private coverage.
If anybody reading this is going to Denver (and there are some in Sacramento who don't know yet, because of the prolonged budget debate), there's going to be a forum at the Democratic Convention, entitled, "Winning Health Care Reform in 2009." The Wednesday, August 27th, forum is billed to include "congressional leaders, committee chairs, governors leading state health reform, and many others—in this historic effort to win health care reform."
The invite list includes key Californians, including House Speaker Nancy Pelosi and Representative George Miller, as well as Senator Edward Kennedy, Senator Hillary Clinton, Senate Majority Leader Harry Reid, Kansas Govenor Kathleen Sebelius, Senator Max Baucus, Senator Ken Salazar, Representative Charles Rangel, Massachusetts Governor Deval Patrick, Representative John Dingell, Ohio Governor Ted Strickland, Pennsylvania Governor Edward G. Rendell, Representative Artur Davis, Former Senator Tom Daschle and others. It's a good starting list of the players that will make health reform either happen or not next year.
The event will be held starting at 9:30am in the Seawall Ballroom, at the Denver Center for the Performing Arts, right next door to the Convention Center, with views of the Rockies. Might be a good place to recover from a late night.
It is a good, comprehensive report about several consumer protections moving through the Legislature and to the Governor's desk, which would in particular help those who don't have group coveragae through an employer or public program, and have to buy coverage as an individual. The Governor is currently negotiating with the legislators about the final contents--from SB1522(Steinberg), our bill to better standardize the insurance market, to SB1440(Kuehl), which would ensure a percentage of premiums go to patient care.
It's critical to future efforts around health reform: if people don't have confidence in the value of coverage, then they are less enthused about expanding that coverage.
The National Federation of Independent Business this week unveiled their campaign to promote health reform from a business perspective. What I really liked was their "Faces of the Healthcare Crisis,'' a compilation of stories/testimonials of small businesses struggling with health care costs. The stories, not surprisingly, sound a lot like some of the consumer stories we get.
One guy, whose employees largely receive health care through their spouses, did not have insurance of his own. When he had chest pains, he delayed going to the ER. When the pain became excruciating, he finally relented and found he was having a heart attack, leaving him with $200,000 in hospital bills.(!!) Sounds like something out of our story database: uninsured, delayed care, high hospital bill.
We certainly empathize with many of the small businesses who want, very badly, to provide health care for their workers. It's expensive, and we have bills that can help:
Transparency (a la AB 2967 - Lieber, and which NFIB is supporting) allows health care buyers can gravitate toward providers that are effective and efficient.
Standardizing and organizing the individual market, a la SB 1522 (Steinberg), would cap out-of-pocket costs, ensure that every plan has doctors, hospitals, and preventive care. This would help give small businesses, who are worried about how much their workers can afford, more peace of mind.
Public insurer (SB 973 - Simitian) would allow small businesses to buy coverage from a public system that competes for business with private companies.
Anti-rescission (AB 1945 (De La Torre) and various other bills) would make harder for insurance companies to yank coverage from paying policy holders willy nilly.
Of course, (here's our 'I told you so' moment) what would have *really* helped was the 1993 Clinton Health plan, which was defeated with lots of help from NFIB. Through Clinton's plan, smaller businesses would have only had to pay up to 3.5 percent of payroll costs toward healthcare rather than the 20-plus percent they are now paying in a virtually unregulated market.
High gas prices, a sputtering economy, global food shortages the obesity epidemic and countless other apocryphal trends make the headlines and have spurred interest in locally grown goods, farmers markets and "Slow Food" (I'm still trying to figure out what the heck that is.)
I really love food. I love the farmers' market. I plan my weeks and weekends around the farmers market. I feel really fancy, wholesome and healthy buying my food directly from the Hmong and Latino farmers, and I prefer the taste of farmers' market food to Safeway (sorry, Steve Burd.) But the small family farmers who are raising goats, planting tomatoes and picking cherries are doing this at risk to their own financial well being and health. The Boston-based Access Project recently published a paper about the health care burdens that California's farmers face.
Farmers tend to be wealthier than the average citizen and are more likely to be insured. On average, they spent nearly $9,000 annually on premiums and out-of-pocket expenses, which constitutes between 9 and 44 percent of the family's income. High health care expenses:
Made it hard for farmers to pay other bills;
Meant farmers delayed investments in their farm;
Took time off farming/ranching.
According to the report author, Carol Pryor, "The survey shows that most farmers and ranchers are trying to do the right thing by getting coverage, but they aren't finding products in the (individual) market that are affordable and that provide them with financial protection if they get sick. This is a case of product failure.''
If not for moral reasons, wouldn't the like-minded food obsessed want to keep our farmers healthy?
I'll do a quick shameless plug for a few of our bills here that would start us down the track of easing health care burdens for farmers:
SB 1522 (Steinberg) would organize the individual insurance market, where family farmers need to buy their coverage, and establish a minimum benefit package that includes doctors visits, hospitals and preventive care;
AB 2967 (Lieber) woudl require insurers and healthcare providers to provide better data on the cost and quality of care, and create pressure to drive down rapidly escalating health care costs;
SB 973 (Simitian) would create a public insurer that would enable farmers to buy in to a system that is publicly run and competes with private insurers;
Rescission bills (AB 1945, AB 1150, AB 2549 and AB 2569) rein in the insidious insurer practice of retroactively cancelling coverage of people who have been paying premiums and believed they were covered.
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