Jan. 10, 2008

The Honorable Sheila Kuehl, Chair
Senate Health Committee
State Capitol

Sacramento, 95814
Re: SUPPORT -- ABX1-1 (Núñez /Perata)

Dear Senator Kuehl,

CALPIRG is a statewide membership-based public interest group that stands up to powerful interests, working to win concrete results for Californians' health and wellbeing. With researchers, advocates, organizers, and students, we advocate on behalf of consumers and all California's residents.

We were deeply engaged throughout 2007 in the effort to reform California's broken health care system, which fails far too many who cannot get access to quality health insurance at a fair price. We are pleased that now, at the beginning of 2008, we can support ABX1-1, a landmark bill that will catapult California out of the dark ages and towards a nation-leading health care system.

ABX1-1 will expand coverage, contain the skyrocketing costs of health care, and help consumers get a fair shake when buying insurance. Beyond the policy benefits, it also puts health care funding on a secure footing, a goal which is made all the more important by looming deficits. While we request a small number of clarifying amendments to make clear the law's intended function, we strongly urge you to approve ABX1-1 and give California the health care reform it so urgently needs.

Throughout our advocacy, we have focused on four policy areas critical to real reform. ABX1-1 makes great strides in all of them.

1. Giving consumers effective tools to get a fair rate for health insurance
2. Giving all consumers access to health insurance, regardless of whether they are sick or healthy
3. Increasing the number of Californians who have useful health insurance
4. Containing the rising costs of health care

1. GIVING CONSUMERS EFFECTIVE TOOLS TO GET A FAIR RATE FOR HEALTH INSURANCE

Currently, individuals find it next to impossible to get a fair price for health insurance. Alone, they lack any bargaining power, and medical risk is concentrated, rather than spread out over a large population. As a result, insurers are at liberty to present them with take-it-or-leave-it deals and sky-high rates. Californians may spend four times as much for an individual plan as they would have paid for a comparable plan on the group market.¹ And while, on average, small-group plans cover over 80% of enrollees' medical costs, that number is only 54% for those with individual plans.² That's why reform must shrink the number of Californians who buy insurance on their own -- presently 2.6 million, according to recent estimates -- rather than through a group plan.

ABX1-1 goes far to expand group coverage through its creation of the Cal-CHIPP purchasing pool. This pool would provide subsidized coverage to low-income Californians, and also offer unsubsidized coverage, allowing those ineligible for financial assistance to come together and take advantage of the greater bargaining power and riskspreading offered by group coverage. Further, it would increase the competitiveness of the individual market -- viable access to the purchasing pool would give consumers the ability to say no to insurance company offers and hold out for a better deal, forcing insurers to compete for their business.

Unsubsidized coverage through the Cal-CHIPP pool will be open to all those eligible for tax credits -- Californians not offered employer-sponsored coverage with income between 250% and 400% of the federal poverty line -- as well as employees of employers that pay a fee to the state rather than offer coverage themselves, and those of employers that designate the Cal-CHIPP program as the coverage option in their Section 125 plan, allowing employees to pay for their health care with pre-tax dollars. We understand that modeling shows the pool is expected to have three million or more enrollees, meaning that its negotiating clout will be substantial. While we support opening up Cal-CHIPP enrollment further in subsequent legislation, ABX1-1 right now offers millions of Californians access to a fair, group rate for health insurance.

Another strength of the pool's structure is that it gives employees of employers who choose to pay into the pool a real benefit from the choice. Employees of fee-paying employers will see at least 20% of their premium paid for by the employer contribution. Beyond the significant discount the employee receives, this also means that employers who pay the fee see a concrete benefit in the form of a healthier workforce. Businesses, in general, want to cover their workers -- in fact, a recent survey of small business owners found that 80 percent believed that they should pay to provide health care for their employees.³ This link means that both businesses who directly provide coverage and those who pay the fee will contribute to their employees' well-being.

Finally, we note that ABX1-1 sets out a framework under which insurance plans will be categorized into one of five coverage classes. Currently, consumers wishing to buy insurance are confronted with the overwhelming and confusing task of comparing plans from different insurers that can contain wildly different benefits, making it almost impossible to discover the best choice. The new tier system will simplify decisionmaking for consumers, and also allow insurers to experiment with providing a diverse array of choices.

The bill also provides for the setting of a baseline plan within each class of coverage. These clear benchmark plans will allow consumers to make apples-to-apples price and benefit comparisons within and between classes. Insurers would be free to offer other plans equivalent to or better than the benchmark within each tier, meaning that consumer choice and insurer innovation would not be stifled -- but consumers would know what they were buying.

In a well-functioning insurance market, consumers need to be well-informed about what they're buying, and they need to be able to band together to take advantage of riskspreading and greater bargaining strength. ABX1-1 will give consumers the power they need to get a fair price.

2. GIVING ALL CONSUMERS ACCESS TO HEALTH INSURANCE, REGARDLESS OF WHETHER THEY ARE SICK OR HEALTHY

Perhaps the most perverse paradox of our health care system is that those who most need care -- the old and the sick -- find it hardest and most expensive to get. Even where a sick Californian is offered coverage, they can currently expect to pay about three times what their healthy peers are charged.⁴ This problem is especially stark in the individual market, where studies indicate that as many as 90 percent of those seeking coverage may be rejected, charged higher rates, or offered only limited coverage due to pre-existing conditions.⁵ Reform must prevent insurance companies from discriminating against consumers with existing health conditions. The purpose of health insurance is to spread the risks and the costs of poor health among a large pool of people, not to take the healthy and refuse the sick.

ABX1-1 is a huge step forward from the status quo. It requires insurers to offer all of their products to all comers, eliminating insurers' ability to deny coverage for preexisting conditions or other health risks.⁶ It also phases out the power of insurers to charge increased costs based on health status, after four years allowing them to base their rates only on the services provided and the age, family size, and location of the enrollee.

Because insurers can use age as a proxy for health, we are pleased that ABX1-1 eliminates this end-run by setting out a link between the rates charged to older Californians and those charged to those in their 30s -- this means that insurance companies cannot jack up premium costs on the old in an attempt to reverse-compete out of having to provide coverage to them.

These reforms will make a critical difference to the many Californians who lack access to health care because they have the bad luck to need it -- and the many more who fear losing coverage or being charged higher rates if they do become sick.

3. INCREASING THE NUMBER OF CALIFORNIANS WHO HAVE USEFUL HEALTH INSURANCE

California has more uninsured -- 6.7 million at any one time -- than any other state. Thus, expanding coverage is another keystone of reform. Expanding the Medi-Cal and Healthy Families programs will allow more of the neediest Californians to obtain the coverage they need to be healthy. Subsidized coverage through the purchasing pool, combined with tax credits for those making slightly more, will decrease the costs of health insurance for those who are eligible, and also reduce the number of uninsured residents.

As mentioned above, the unsubsidized Cal-CHIPP pool provides another avenue for those otherwise unable to get coverage. Finally, the individual mandate will require all Californians who can afford coverage to buy it. All of these policies will reduce the number of uninsured Californians.

However, it is not simply enough that Californians obtain coverage -- giving the uninsured access to low-quality insurance plans that provide no substantial health benefits and making them insured in name only does little to solve the real problems in our health care system. For this reason, we request that ABX1-1 be clarified to make clear that all plans offered in the Cal-CHIPP pool package should meet the requirements of the Knox-Keene Act, as well as providing prescription drug coverage and promoting prevention.

Similarly, we are pleased that, in line with our previous suggestions, ABX1-1 now sets guidelines for MRMIB's determination of the minimum creditable coverage that individuals must have to satisfy the mandate, requiring that it include coverage for doctor visits, hospital stays, and preventive care. As health care becomes more fairly priced and the insurance market becomes better-regulated, however, the appropriate minimum benefits package may change, so we request that the legislation be clarified to note that MRMIB has the power to revisit the minimum coverage package after it is initially set.

The individual mandate will ensure that those who can afford health coverage obtain it, thereby spreading risk over a larger pool of Californians, reducing rates, and protecting people from unforeseen illness. An appropriate enforcement scheme for the mandate is critically important, however, as too punitive an approach could cause individuals to forego public services and move to the underground economy to avoid the consequences of failure to comply. As such, we welcome ABX1-1's focus on outreach and education in implementing the mandate.

Further, we are pleased that ABX1-1 recognizes the reality that some Californians will simply not be able to afford coverage, given the current scheme of subsidies. Individualized affordability exemptions will allow MRMIB to assess the hardship buying coverage would cause to each particular family who requests an exemption, and also allow regulators to take account of all out-of-pocket costs, rather than just premiums, when making the affordability assessment.

Affordability of coverage is critical to ensuring that ABX1-1 works, and one of the centerpieces of affordability for mid- and lower-income California families is the tax credit that will help those between 250% and 400% of the federal poverty line to pay their premiums. The size of the tax credit is pegged to the cost of a tier-3, midrange product, although consumers may use the credit to assist their purchase of more or less comprehensive plans. We understand that modeling of this provision has assumed that a tier-3 product will include coverage for important primary care outside of any deductible.

Because Californians should know that they will get assistance in buying coverage that will be affordable to use, we request that ABX1-1 be clarified to make clear that the tier- 3 product will include first-dollar coverage for preventive care, doctor visits, and prescription drugs.

4. CONTAINING THE RISING COSTS OF HEALTH CARE

One of the most fundamental difficulties in the effort to reform health care is that prices continue to rise. Slowing this increase is a necessary part of a sustainable program. Fortunately, ABX1-1 contains many provisions that will keep costs under control.

First, it requires insurance companies to allocate significant resources to health care, rather than administrative overhead or excess profits, by mandating them to spend at least 85 percent of premium dollars on patients' health. HMOs are already required to meet this threshold, but currently, some insurers spend as little as 50 cents per premium dollar on health care, contributing to the rising cost of care. We welcome the inclusion of this strong, realistic requirement.

The bill also provides for bulk purchasing of prescription drugs for the Cal-CHIPP pool. Taking advantage of the bargaining power created by Californians coming together is simple common sense, and fully in keeping with free market principles. Similarly, the establishment of a public insurer will promote competition and accountability in the private insurance market. Finally, ABX1-1's robust transparency provisions will help consumers make informed decisions, and ensure that they get the care that they pay for, in addition to promoting high standards of care and efficient best practices.

* * * * * * * * * * *

The current projected $14 billion deficit serves as a stark warning that the best policy package in the world does no good if it is not financially sustainable. Fortunately, ABX1-1 is a responsible way to put our health care system on a secure footing. ABX1-1 brings in new money for health care that could not be used to plug the gap in the general fund, as well as limiting health care costs moving forward. And as the past shows, if it is not passed, short-term budget-balancing cuts without an eye towards systemic reform are likely to increase costs down the road, effectively mortgaging California's health care budget with no end in sight.

ABX1-1's funding mechanisms do not starve the general fund. The bill creates money for health care by opening up new funding sources that would otherwise go untapped. First, it creates a pay-or-play mandate on employers, requiring all business to contribute money to health care, either directly through providing coverage to their workers or by instead paying a fee to the state. The fee will raise approximately $2.5 billion each year, with the size of the contribution scaled to the size of the employer. But the logic of the pay-orplay fee only makes sense in the context of health care; these revenues could only be used for health care.

Similarly, federal matching funds are another major component of ABX1-1's financing. The bill's health care expenditures will draw down $4.4 billion in matching funds from the federal government. Giving employees buying insurance on their own the ability to deduct their health care expenditures from their income tax through Section 125 plans also acts as a de facto injection of federal cash. This money can only be used for health care purposes -- again, failing to pass ABX1-1 leaves money on the table in a time of soaring deficits.

Under ABX1-1, hospitals will pay a fee to the state, which will then return to them in the form of increased Medi-Cal payments. Hospital organizations support the fee, which will generate $2.5 billion for the state, with the corresponding Medi-Cal increases. But again, as a fee, this money would be unavailable to the state for other purposes.

Lastly, a $1.75-per-pack tobacco tax is expected to bring in $1.5 billion for health care. While in theory cigarette taxes can raise money for any purpose, voters have resisted balancing the budget on the backs of smokers, voting for tobacco taxes only where the money raised goes to health and smoking-cessation programs. For example, polling in 2005 showed 37% of voters in favor of using tobacco tax revenue to expand coverage to all children, 32% preferring to spend the money on emergency rooms, and only 15% supporting use of the funds to extend college scholarships, despite 45% thinking such a program was a good idea.⁷

Beyond bringing in new revenue, ABX1-1 will also limit health care costs moving forward. Disease management and prevention programs will reduce the costs of chronic illnesses to the system. Electronic record-keeping and e-prescribing will reduce administrative costs. Transparency and quality programs will ensure that the state, as well as consumers, buys cost-effective care.

Last year's budget fight shows that health care cuts lead to short-term savings with longterm costs. The budget impasse last summer is a preview of what to expect if ABX1-1 doesn't go through -- a future of penny-wise, pound-foolish cuts that balance the budget year to year but only increase the deficit in the long run.

For example, last year the prescription drug negotiation program set out by AB 2911, which aims to save money by helping the state get at least a 40% discount on the prescription drugs it purchases, was left unfunded. Similarly, cuts were made to children's coverage enrollment efforts, leading to more uninsured kids lacking preventive care and higher costs when they do get covered. And community clinics, which act as the front line of the public safety net, were underfunded, forcing overreliance on expensive, inefficient emergency-room-only care.

Finally, it's important to note that ABX1-1 is not a suicide pact, inflexibly chaining the state to billions of spending regardless of facts on the ground. First, the current budgeting packages in $170 million as a reserve against unanticipated cost overruns. But even if there isn't enough revenue to cover all of its programs in a given year, the companion ballot initiative gives the legislature broad authority to balance the books and ensure that the most critical programs are funded without driving the state into the red. Even in this worst-case-scenario, there will still be billions more health-care dollars available to prevent the savage cuts of previous years.

Because ABX1-1 will not go into effect until it is approved by the voters in November, it unfortunately cannot fix this year's deficit. But its package of new revenues and cost containment strategies will relieve pressure on the general fund in the future, by insuring that health care is stable and adequately funded, rather than remaining dependant on adhoc, year-to-year cuts. Fixing the perennial deficits requires the state's spending to be put on a secure footing -- which is exactly what ABX1-1 does for health care.

There are many Californians who either don't have access to or can't afford health insurance today, who would be able to after the bill comes into effect. For those Californians, ABX1-1 is the difference between sickness and health. And for those who do have insurance, ABX1-1 means security from the fear that losing your job or getting divorced or getting sick or old will also mean losing your insurance.

Facing a status quo in which 20% of Californians are uninsured, the public safety net is fraying in the heat of budget woes, and workers are held hostage to the shrinking number of jobs that come with health insurance, it's critical that we get reform now. That is why we support ABX1-1, a fiscally responsible bill that will greatly expand the number of Californians who can get useful coverage at a fair price, enhance their power to make informed choices, and contain the skyrocketing price of coverage.

Sincerely,

Michael Russo
Health Care Advocate and Staff Attorney

California Public Interest Research Group (CALPIRG)
3435 Wilshire Blvd., # 385
Los Angeles, CA 90010
(213)251-3680 x332
www.calpirg.org

Cc: All Senators
Sumi Sousa
David Panush
Herb Schultz

¹ See California Health Care Foundation, SNAPSHOT: HEALTH INSURANCE: CAN CALIFORNIANS AFFORD IT? 2007 EDITION (June 2007), available at http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=133313.
² Id
³ Small Business for Affordable Health Care, CALIFORNIA SMALL BUSINESS HEALTH CARE SURVEY (Aug. 23, 2007), available at http://www.smallbusinessforhealthcare.org/2007_california_healthcare_survey_report.php.
⁴ See California Health Care Foundation, SNAPSHOT: HEALTH INSURANCE: CAN CALIFORNIANS AFFORD IT? 2007 EDITION (June 2007), available at http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=133313.
⁵ See Kaiser Family Foundation, HOW ACCESSIBLE IS INDIVIDUAL HEALTH INSURANCE FOR CONSUMERS IN LESS-THAN-PERFECT-HEALTH? (June 2001), available at http://www.kff.org/insurance/upload/How- Accessible-is-Individual-Health-Insurance-for-Consumers-in-Less-Than-Perfect-Health-Executive- Summary-June-2001.pdf.
⁶ Guaranteed issue coverage is not offered to those who violate the mandate and those exempted from coverage, in order to prevent gaming of the system that would drive up costs for all enrollees. Still, because affordability and hardship exemptions are not automatic, a person must specifically opt in before losing the benefit of guaranteed issue.
Center for Tobacco Control Research and Education, TOBACCO CONTROL IN CALIFORNIA 2003-2007: MISSED OPPORTUNITIES (Oct. 2007), at http://repositories.cdlib.org/ctcre/tcpmus/CA2007/.

January 14, 2008 at 06:15 PM | Permalink | Comments (20) | Trackbacks (0)

January 8, 2008

The Honorable Sheila Kuehl
C hair, Senate Health Committee
State Capitol
Sacramento, CA

Re: SUPPORT -- ABx1 1

Dear Senator Kuehl:

Latino Coalition for a Healthy California (LCHC) is the leading organized voice for policies, services, and conditions to improve the health of Latinos. Founded in 1992 by health care providers, consumers and advocates, LCHC impacts Latino health through enhanced information, policy development and community involvement and represents more than 2,800 community leaders. LCHC supports ABX1 1 because it brings meaningful health access to the millions of uninsured Californians, particularly uninsured Latinos.

Latinos and Health Care Coverage

Because the majority of the uninsured are people of color, the health care system will experience a shift in the demographics of health care consumers: for the first time, the insured population will begin to reflect California's diverse communities.

More than one in four Latinos ages 0-64 in California is uninsured (28% of Latinos compared to 9% of whites) -- the highest rate of uninsurance among all ethnic groups. Latinos represent approximately one in two of the 6.7 million Californians who are uninsured. Latino's high uninsured rate is largely due to the very low rate of health insurance provided by their employers, just 43% compared with 76% for whites.

We support the provisions in ABx1 1 that provide coverage to 75% of the uninsured and expand public programs to all kids up to 300% FPL and citizen/legal resident adults up to 250% FPL. In fact, when implemented, ABx1 1 would be the biggest public program expansion since the creation of Medicare and Medicaid. Further, the provisions regarding the "no wrong door" approach will make it easier for families to get on and stay on health care programs.

Affordability

Because 42% of all insured are low-income (below 300% FPL), it is critical that the state address the unique challenges posed by uninsured communities of color to create a more effective health care system. Latinos' lack of insurance coverage is related to their income and immigration status. The high poverty level among Latinos makes it less likely they will have the resources to purchase health care coverage out of pocket. More than one in three Latinos (35.3%), or 3.2 million, live below the federal poverty level (FPL) in California. Among Latinos ages 0-64 living below poverty, 36.9% are uninsured, with just 13.4% receiving employment- based coverage. Of the approximate 3.0 million non-citizen Latinos under age 65 in California, about one in two, or 47.7 %, is uninsured, again related to low rates of job-based insurance.

We support the provisions in AB 1X that provide tax credits for those 250% - 400% FPL who do not have access to job-based coverage as well as for early retirees over 400%FPL. In addition, we also support the other cost-containment measures like transparency, bulk purchasing of prescription drugs, a purchasing pool with 3-4 million covered lives, and a public insurer.

Employer Contribution

While a majority of Californians continue to get health insurance through their employer or that of a family member, job-based insurance is particularly declining among those living at or below the poverty level. Job-based insurance fell from 19.1% in 2001 to 13.7% in 2005 among the 1.7 million California workers below the federal poverty level, from 42.6% in 2001 to 33% in 2005 for the 2.8 million low-income workers between 100 -- 200% FPL and from 62.1% to 56.6% for the two million moderate-income workers (200-299% of the poverty level). For Latinos, their high uninsured rate is largely due to the very low rate of health insurance provided by their employers, just 43% compared with 76% for whites.

We support the provisions in AB 1X1 that require employers to contribute to health benefits with the contribution scaled from 1% to 6.5%. The creation of a statewide purchasing pool creates a new affordable option for employers to cover their workers.

Much has been said about single payer and how ABx1 1 compares to it. The question should not be about how this measure relates to single payer but rather how this measure compares to the status quo. For the millions of uninsured Californians -- many of whom are LCHC members -- they want health care reform now and believe that ABx1 1 moves us closer to universal health care.

The Board of Directors and I are looking forward to making health care reform a reality and we ask for your support of this measure as its heard in the Senate Health Committee. If you have any questions, please do not hesitate to contact me at (916) 448-3234 or cell (916) 747-5441.

Sincerely,

Lupe Alonzo-Diaz
Executive Director

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January 14, 2008 at 05:44 PM | Permalink | Comments (0) | Trackbacks (0)

January 9, 2008

Honorable Sheila Kuehl
Chair, Senate Health Committee
California State Senate
The Capitol Building
Sacramento CA 95814
RE: ABx1 1 (Nunez/Perata)- Support with clarifying amendments

Dear Senator Kuehl:

Consumers Union, nonprofit publisher of Consumer Reports, writes in support of ABx1 1 with amendments. Since our founding in 1936, Consumers Union has worked to attain universal, affordable, high-quality health coverage for all. Over the past year we have sought to help craft reform that would bring affordable, comprehensive health insurance coverage and high quality care to all Californians, perhaps the most important and complex policy issue facing the State of California and the entire nation.

We supported your universal care bill SB 840, as well as AB 8 (Nunez) in its final amended state. We also believe that ABx1 1 would create a system that would ensure the availability of affordable health care on a scale commensurate with the State of California. We urge your support for this landmark bill.

Our framework for evaluating any proposal for universal health reform rests on three broad principles:

* Fair, adequate financing;

* Access to comprehensive, affordable care;

* Quality, efficiency and cost control.

We find that ABx1 1 creates a framework that meets these principles in large measure and would be a dramatic improvement to the current healthcare system in California. We are in the process of reviewing the terms of the accompanying ballot initiative. Our comments at the end of this letter discuss the clarifying amendments we seek.

A. Fair, adequate financing

Consumers Union agrees that all stakeholders including government, employers, providers, and individuals have a responsibility to contribute their fair share to achieving universal coverage. This bill requires consumers to secure coverage, but contains affordability and hardship exemptions (see further discussion below). Solid financing is needed to assure the long-term stability of the program. The bill sets forth the component parts of the financing structure, and the ballot measure contains the rest. The ballot measure states the intent to finance this reform through a $1.75 per pack tobacco tax, a hospital contribution of 4% of patient revenues, and a scaled employer contribution from 1% (if payroll is $100,000 or less) to 6.5% (with payroll greater than $15 million per year).

The bill and companion initiative provide for bringing in billions of dollars in federal Medicaid matching funds to the California health care system. Together, these pieces, including consumer contributions, appear to create a solid, diversified set of funding streams. We continue to examine the details of the ballot initiative.

B. Realistic access to comprehensive, affordable care

This bill that would widely expand access to insurance through significant public program expansions and simplifications that Consumers Union has long supported. Broadening Medi-Cal and Healthy Families eligibility, including to children regardless of immigration status up to 300% of the federal poverty level (FPL) as well as childless adults up to 250% of the FPL, is to be commended as significant additional help for the poorest Californians.

The mandate to purchase coverage exempts those with income below 250% of the federal poverty level (FPL) who do not qualify for public programs. For those with employer coverage and income between 250 and 400% FPL, coverage would be available under the purchasing pool with a tax credit to assist them in getting coverage. The subsidy available would limit the share paid on premium and the mandate is contingent on subsidies.

The bill also provides that MRMIB shall establish a process for determining "continuing" exemptions when the individual's contributions to health coverage premiums would "interfere with basic necessities of life", as well as temporary exemptions for specific circumstances and conditions such as hardship resulting from natural disasters or changes in family circumstance. These exemptions, to be further defined administratively, go a long way to addressing the concern we have voiced from the outset that consumers not be required to purchase a product they cannot afford.

Individual market reforms including guaranteed issue, phased in community rating, and the requirement that 85% of premium dollars go to patient care, will ameliorate some of the dysfunctionality of the non-employer-based private market. Organizing the individual market into five-tiers of coverage with benchmark plans for each will allow for comparison shopping; and creating a floor on benefits requiring coverage for doctor visits, hospital care and prescription drugs, as well as setting maximum deductibles and out of pocket costs, are important new provisions.

We support the broad outreach and education program about the individual mandate with multiple entry points envisioned in this bill in section 12739.51. Widely publicized, clear information about the mandate and ways to access the right coverage for each consumer's needs will be critically important. And we understand the rationale for defaulting consumers into a plan if they have not obtained minimum creditable coverage on their own: they will have insurance coverage although they did not secure it themselves, and the risk pool and revenue stream will be broadened. Under this bill, methods for collecting premiums from those that have been defaulted into a plan are to be spelled out at a later point.

Section 12739.51 would require a report to the Legislature on intended interagency agreements and enforcement steps to collect from consumers defaulted into a plan. This would give the Legislature a chance to act if it deems the proposed steps unacceptable. We seek the following amendment to clarify in advance that, whatever those future agreements may be, certain protections are in place to ensure that debt collection problems we have seen in the hospital billing realm do not occur here. We suggest the following amendment to 12739.51(e):

Neither the state, its assignees, or agents including collection agencies shall, in carrying out the duties under this section, use wage garnishments or liens on primary residences as a means of collection. No interest shall accrue for individuals who have defaulted into a plan. Collection fees, if any, for individuals shall be reasonable, as determined by MRMIB.

Nothing in this section shall be construed to diminish or eliminate any protections consumers have under existing federal and state debt collection laws, or any other consumer protections available under state or federal law.

C. Quality, Efficiency and Cost Control

This bill contains concrete measures aimed at controlling health care costs, an essential step to ensuring that the reforms enacted are enduring. Given the skyrocketing cost of health care, strong measures are needed to slow that escalation and to sustain any new program for the long-term. There is no silver bullet for containing health care costs, but a constellation of provisions in this bill is targeted at prevention to ensure that chronic conditions and their attendant costs are avoided in the first place or effectively managed, thus saving health care system dollars. These provisions include "Community Makeover Grants," wellness incentives, diabetes management and smoking cessation programs.

The creation of a plan for significantly enhancing our system for collecting and disseminating health care safety, quality and cost information at all levels of the healthcare system as contained in this bill is a critically important step to save health system dollars. The bill's California Health Care Cost and Quality Transparency Committee will develop a plan, to ensure comprehensive and efficient collection of data from physicians, hospitals, and nursing homes to help consumers choose the best-value care and give providers the information and incentives they need to improve their performance.

Public disclosure of safety and quality information, such as mortality rates by hospital, has been shown to instigate concrete, self-improvement by health care providers -- to save lives and also save health system dollars for both public and private payers. Studies repeatedly show that public reporting of medical outcomes leads to improved performance.¹ And improving performance saves lives, while also saving money in the health care system. While there are some voluntary efforts underway to collect data on health care quality and cost, the data are incomplete, inconsistent and hard to compare.

Under ABx1 1, health care providers will have the information they need to evaluate their performance vis a vis their peers and make improvements. Requiring public reporting of key cost drivers such as hospital-acquired infections, as 20 other states do, for example would result in significant savings -- of lives and dollars. The Administration estimates that hospital-acquired infections cost the health care system in California $3 billion per year, and medical errors cost another $1 billion per year. Exposing these outcomes and other federal "Patient Safety Indicators" to the light of day would result in quality improvement and reduced hospital stays.

In addition, the bill's support for the use of e-prescribing, electronic medical records, and personal health records will we believe foster better health, help avert medical errors and achieve long-term systemic savings.

Clarifying amendments requested

* Section 12739.51(e)- Per above draft language, to clarify enforcement shall not include wage garnishment and certain other features.

* Clarify that the benefits provided in the purchasing pool, other than those under the Healthy Families Program, include the covered services required under Knox-Keene plus prescription drugs.

* Section 17052.30- Clarify that the premium on which the tax credit will be based is for a product that provides coverage for physician visits and prescription drugs with no deductible.

Conclusion

Consumers Union appreciates and applauds the deep commitment shown by the Assembly Speaker, President pro Tem, and the Governor to making high quality, affordable health care available to all Californians. We believe that ABx1 1, with the suggested clarifying amendments, would provide an historic step toward comprehensive reform in California. We urge your "aye" vote.

Respectfully submitted,

Elizabeth M. Imholz,
Special Projects Director cc. Members of the Senate Health Committee
Assembly Speaker Fabian Nunez
Senate President pro Tem Don Perata
Governor Arnold Schwarzenegger

¹ See, e.g., "Hospital Performance Reports: Impact on Quality, Market-Share and Regulation",Hibbard, J., Stockard, J., and Tusler, M., Health Affairs (July/August 2005)

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January 14, 2008 at 04:58 PM | Permalink | Comments (0) | Trackbacks (0)

January 9, 2008

The Honorable Sheila Kuehl, Chair
Senate Health Committee
California State Capitol
Room 5108
Sacramento, CA  95814

Re: AB 1X1 (Nunez & Perata) -- Health Care Reform -- SUPPORT IF AMENDED

Dear Senator Kuehl:

On behalf of AARP and its over 3.3 million California members, I urge you to approve AB 1X1 on January 16, after making any adjustments the committee believes necessary. This is an extraordinary opportunity to make vast improvements in the health care system for Californians. We strongly believe that this measure, essentially as it passed the Assembly, should be enacted. Compared to the status quo, this will be a tremendous improvement for our members and Californians of all ages.

Health care is very important to AARP members. While our members 65+ are fortunate to have the security of Medicare, about half of our membership, those 50--64 years old, have far less confidence that they will have the health care they need when they need it. Losing health care coverage at any age can spell disaster, but it is especially problematic in mid-life. In California, it is often impossible to buy affordable health insurance, or any health insurance at all, if ineligible for an employer-sponsored plan. Insurance companies can refuse to sell a person health insurance because of their medical history, or insist on a premium so high that it is unaffordable. People 50+ are much more likely than younger people to have a medical history that causes health insurers to avoid them.

AARP's membership is impacted by virtually every aspect of the health care reform debate. Having access to affordable, quality health care is the bottom line objective, but this cuts across many issues. About half of AARP's membership is still working, so stemming the deterioration of employment--based coverage is important. Requiring insurers to issue policies at reasonable rates to all who apply is important to those without access to employment-based or public program coverage. Children’s coverage is also important to our members, particularly the growing number who are raising their grandchildren. Additionally, spiraling, out-of-control health care costs are straining the budgets of insured individuals and placing health care out of reach of more and more consumers. AB 1X1 (Nunez & Perata) deals with the issues most important to AARP members:

*Guaranteed Issue. Insurers will no longer be able to deny insurance to our members because of their health condition. All Californians will have access to health insurance, in the individual market if they are not eligible for coverage under an employer or public plan.

*Individual Market Reforms. The individual market will be organized and structured so that insurance policies will be priced reasonably, and insurers will compete based on price, quality and service, rather than on risk selection. Insurers will be required to offer benchmark policies defined by the regulators in each of five coverage choice categories, making it much easier for consumers to compare products. Rates will be permitted to vary only on the basis of benefit variation, provider network, geography, family size, and age. The maximum variance based on age will be limited, which is particularly important to AARP members. The office of the patient Advocate will provide information on a website to enable consumers to more easily compare products.

*Cost Containment. Cost containment is threaded throughout this legislation. We are particularly pleased with the provisions which will create the infrastructure to collect and publicly report comprehensive information on the cost and quality of medical services. Providing this basic information to consumers and other purchasers, as well as to providers, is necessary in order to improve the market for medical services, increasing quality and reducing costs. We are also pleased to see the recognition that efforts to improve the health of the population, though interventions to prevent diabetes, obesity, and smoking related illnesses, is a key to long term cost control. The bulk purchasing of drugs and the expansion of local coverage initiatives also has potential to mitigate costs.

*Expanded Public Programs. The expanded public programs will help our members in a variety of ways. Our lower-income, uninsured members will benefit directly though expanded eligibility for public programs, including the new Cal-CHIPP purchasing pool. Our insured members should see far less cost-shifting to the cost of their policies because of the reduction in the uninsured and the increase in Medi--Cal reimbursements to medical service providers.

*Affordability. Affordability has been the issue on which we have most focused over the year and, with one exception, this bill now does a reasonable job of ensuring the cost of coverage that is mandated will be affordable for our members. All uninsured children, and uninsured adults up to 250% of poverty will receive comprehensive coverage with little cost sharing. A tax credit is provided to make coverage more affordable for persons between 250% and 400% of the federal poverty level, and there is expressed intent to also add an early retiree tax credit for persons who have a higher level of income but higher costs due to their age. The one amendment that we need before unconditionally supporting this measure would ensure that individuals, with the tax credit, will be able to afford a policy that provides basic services before any deductible -- doctor visits, drugs, and prevention services, including the management of chronic conditions.

We are comfortable with the structure of the initiative that has been filed to finance this measure, monitor the adequacy of revenues, and to trigger off the individual mandate to buy insurance if the funds necessary to subsidize coverage are not forthcoming.

We believe this is truly a historic opportunity to make significant improvements to the health care and financial security for all Californians, and to show the nation that an issue as difficult as this one can be meaningfully addressed with sufficient effort, determination, and creativity.

AARP strongly urges the Senate Health Committee to make any necessary adjustments to the bill determined necessary, and approve it at the hearing on January 16.

If you have any questions, or would like to discuss AARP’s position, please contact me at (916) 556--3018 or by email at cyoung@aarp.org.

Respectfully,

Casey L. Young
Advocacy Manager  

cc
Members, Senate Health Committee
The Honorable Fabian Nunez
The Honorable Don Perata
Peter Hansel, Consultant, Senate Health Committee
Joe Parra, Consultant, Senate Republican Caucus      
Tom Porter, AARP State Director
Jeannine English, AARP State President      

   

January 14, 2008 at 04:00 PM | Permalink | Comments (0) | Trackbacks (0)

California Health Reform (AB x1 1): WHO GETS WHAT HELP?

January 10, 2008

California is currently considering the Health Care Security and Cost Reduction Act (AB x1 1), a comprehensive health reform effort negotiated by Governor Arnold Schwarzenegger and Speaker Fabian Nunez, and authored by Assembly Speaker Nunez and Senate President Pro Tem Don Perata, in both the state legislature and potentially on the November 2008 ballot.

For many consumers, one test of any health reform and coverage expansion is a very basic one: how does it help me and my family get and afford health care?

The proposal includes a requirement for individuals to have coverage, although that mandate is conditioned on affordability, and allows for exemptions based on affordability or hardship. Some consumer groups have argued that a mandate is unwarranted, since people want coverage: they simply faced barriers to getting coverage. So, the real focus of attention should be on how much help individuals and families get to be able to meet the mandate, to get the coverage that they want and need.

This paper is an analysis of how the current proposal, AB x1 1, would help different populations in getting health coverage in comparison with the status quo, for families in various incomes, for both the uninsured and insured, and for people who are getting coverage through employers, public programs, and the individual market.

FOR THE UNINSURED

Californians are more likely to be uninsured than residents of all but five states. The proposal seeks to cover over two-thirds of the state's uninsured, or over 95% of the state's population as a whole. The vast majority--80%--of the uninsured are workers or their family members, the 5 million Californians who are uninsured at any given time (or the 6.5 million who are uninsured at some point in a given year). The uninsured face health and financial consequences because they go without coverage, even for part of the year. Providing coverage will prevent those who are uninsured from having to live sicker, die younger, and be one emergency away from financial ruin.

And health care is regressive: those who have the lowest incomes pay the most as a share of income in terms of share of premium and out of pocket costs.

All uninsured children up to 300 percent of the federal poverty level (over 800,000 children—very few children are uninsured above 300% FPL, or $62,000 for a family of four) will be eligible and enrolled in the state's Medi-Cal or Healthy Families programs, getting comprehensive coverage with minimal cost-sharing.

* This also includes covering tens of thousands of children now enrolled in county "children's health initiatives" (CHIs). These county efforts are running out of money, and would otherwise have to dis-enroll children if this health reform is not passed and the ballot measure is not successful.

* Families would face very modest cost sharing, with low or no premiums and out of pocket costs limited to $250 a year.

Those uninsured Californian citizens between 0-250 percent of the federal poverty level (3 million people, under $52K for a family of four), or those who fall into that category when they are between jobs, would be eligible for comprehensive coverage like Medi-Cal or Healthy Families.

* those under the poverty level ($21K for a family of four; now around 1.2 million uninsured adults) will have no cost sharing, no premiums and no copays or deductibles.

* Those between the poverty level and 250% of federal poverty level (now around 1.8 million California adults who earn up to $52K for a family of four) would have no or minimal cost sharing, with what people pay scaled from zero to a maximum of 5% for premium and all out of pocket costs.

* If they don't have access to public coverage or employer-based coverage that costs less than 5% of their income for health care expenses, they are exempt from any mandate to have coverage.

For those uninsured from 250-400 percent (estimated to include 600,000 people now, up to 83K for a family of four), there will be help is a couple of different ways.

* Those who buy coverage as individuals will be able to do so on a "guaranteed-issue" basis, so that are not denied because of their "pre-existing conditions." After a four-year phase-in, insurers will no longer be able to charge different rates based on health status, under "modified community rating".

* Many workers are more likely to get an employer contribution toward their health care, due to the minimum employer contribution requirements, where employers will either provide coverage directly, or pay the fee and join the statewide purchasing pool.

* If they don't get coverage from an employer, they can get a subsidy so that a mid-level ("tier 3") coverage product would cost them 5.5 percent of income for premium. Eligible people can use the value of whatever subsidy they get to buy a comprehensive plan for more than 5.5 percent (maybe 8 or 9 percent), or buy a cheaper plan (for maybe 2 or 3 percent) that has a higher deductible or cost-sharing.

* Even those employees that don't need the subsidy would get the ability, under a Section 125 plan, of using pre-tax dollars to pay for their share-of-premium, a 15-40% savings, depending on their tax bracket.

* Those who get the subsidy or the Section 125 tax credit through the purchasing pool would have the benefit of having the pool negotiate the best possible rate on their behalf.

* In summary, these Californians get additional access through guaranteed issue, a subsidy/tax credit they didn't have before, maybe an employer contribution they didn't have before, and a purchasing pool they didn't have before to negotiate on their behalf. And they have a choice of paying a premium much less than 5 percent of income and getting high-deductible coverage, or getting a comprehensive top-tier plan that is still a reasonable percent of income.

For the uninsured over 400 percent of federal poverty level (over $83K for a family of four), there is additional help as well. Of the 2% of Californians that are uninsured and over 400% of the federal poverty level, half (350,000) are under 600% of the federal poverty level, and half are above.)

* A fraction of the uninsured that are over 400 percent are uninsured for more than six months. Those people between jobs would be eligible for subsidized coverage during their period at a lower income.

* Those who buy coverage as individuals will be able to obtain it on a "guaranteed-issue" basis, so that they are not denied health insurance because of their "pre-existing conditions." After a four-year phase-in, insurers will no longer be able to charge different rates based on health status, under "modified community rating."

* Workers also get the Section 125, providing the ability to pay premiums (or share-of-premiums) with pre-tax dollars (which in this income range is probably a 30 percent or more discount.)

* Any uninsured employees in this category are the most likely to get an increased contribution from their employer, under the minimum employer contributions.

* There's also some money booked to provide a subsidy/tax credit for early retirees, who face higher premiums for those over 50. The bill also does give the Department of Insurance and Department of Managed Health Care the ability to set a limit on the difference that people can be charged because of age.

* Finally, for this and other populations, there is an exemption process if needed, so that people can say that they want temporary or long-term exemptions, based on affordability or hardship.

Those left uninsured, such as some visitors to the state, some undocumented, those exempted due to affordability or hardship, and others, would have access to better funded community clinics and public hospitals as a safety-net.

FOR THE INSURED: In general, the benefits for the *insured* are in three categories: DIRECT FINANCIAL ASSISTANCE: Many insured are spending large percentages of their income on health coverage and care. The public program expansions, new subsidies, required employer contributions, and Section 125 benefits would provide additional financial relief for many people, concentrated at the lower-income, but including Californians up and down the income scale.

A BETTER HEALTH CARE SYSTEM: Those who are insured will appreciate the elements of the proposal to improve the health system on which we all rely:
*New Funding: The reform would infuse over $14 billion into our health care system—including billions in new federal matching funds, money that California has been entitled to but has been leaving in Washington because the state has under-invested. This will improve the infrastructure of hospitals, clinics, and health providers that we all use, insured and uninsured.
*Prevention and Cost Containment: While there is more to do, the proposal includes a range of cost containment provisions, including:

* prevention initiatives, like community makeover grants;

* public health efforts on obesity, diabetes, and tobacco use,

* the tobacco tax, which by itself will reduce tobacco use,

* transparency to better track the cost and quality of care,

* information technology and e-prescribing for efficiency,

* new public insurance options for consumers,

* bulk purchasing for prescription drugs, and the ability of the statewide purchasing pool to have bargaining power in negotiating down costs,

* Also, insurance companies will have to spent at least 85% of their premium dollars on care, rather than administration, marketing, and profit.

* Governor Schwarzenegger also talks about removing the "hidden tax" that the insured pay to make up for uncompensated care.

* All these efforts, taken together, can help reduce the cost, and slow the growth, of health care over the long term.

SECURITY: Even those who are insured now are concerned that it won't be there for them when they need it. In the case of a job change, divorce, loss of income, or other change in life circumstance, these reforms make it more likely that a Californians will get the help they need to get the coverage they want -- making coverage more available, affordable and automatic, whether they seek to get coverage through an employer, a public program, or in the individual market. Here's how specific insured populations are impacted: For those who get employer-based coverage now (19 million Californians)

* They would have additional security that their employer won't be able to completely drop coverage altogether, and the likelihood that they can get coverage even after a job change or other life change.

* Even for those who work for employers that do more than required on health benefits, the minimum levels now create a floor from which to bargain up from, as opposed to now, where there is no requirement at all.

* Those with lower-incomes may get a subsidy or improved coverage with less cost-sharing through the public program expansion.

* The cost containment elements may help address rising costs.

For Medi-Cal recipients (6.8 million low-income children, parents, seniors, and people with disabilities)

* They get much better access to doctors, hospitals and other providers, due to increased Medi-Cal reimbursement rates.

* They also get better security to keep their coverage, with the removal of the "asset test" that now prohibits their ability to save.

For Medicare recipients (around 4 million), there's no direct impact, since Medicare, as a federal program, is left untouched.

* However, seniors and people with disabilities are the most frequent users of our health care system, and having an infusion of new money and federal matching funds into our health system will help, as will the cost containment efforts described above.

For Californians who now buy coverage in the individual market (around 2 million now) could get help in several ways.

* Some will find that their employer will now provide coverage.

* Others will find that they are now eligible for public program coverage.

* Those still in the individual market--employed but without an employer contribution--will still get the benefit of a Section 125 plan to use pre-tax dollars to pay for premiums. Some may also get a subsidy for those under 400% (or early retirees above 400%), helping them pay for premiums. These folks also get the benefit of buying coverage through a purchasing pool that can negotiate the best possible rate.

* As those who bear the entire cost of coverage themselves, they would be the consumers most advantaged by the cost containment measures.

* In addition, these folks will have greater security that their premiums can't be increased because of their health status, so people don't have to fear that they would "use it and lose it."

* Since insurers would no longer be able to underwrite and deny people coverage under "guaranteed issue" rules, there would be no cause or ability for insurers to be able to rescind coverage retroactively as well.

* Finally, those buying in the individual market would have a much easier time getting coverage, as the individual market will be "tiered" so people, are able to make apples-to-apples comparisons between plans on both benefits and premiums.

January 14, 2008 at 02:44 PM | Permalink | Comments (0) | Trackbacks (0)

 

On December 17, the California Assembly passed a comprehensive healthcare reform bill, AB x1 1, on a 46-31 vote. Supported by the Governor and the Speaker and a range of labor and consumer groups, the bill expands coverage to 4 million uninsured Californians. It also contains cost control and insurance market reform measures and a requirement that employers contribute. The bill will be heard in the Senate in January. Coalition partners continue to analyze the bill and work on improving it.

Read more from a selection of IOH partners:

California Labor Federation

Health Access

SEIU

December 24, 2007 at 09:04 AM | Permalink

Victoria E. Knight
Wall Street Journal

In an effort to motivate workers to kick unhealthy habits, U.S. companies are hitting them where it hurts: in their wallets.

Employers who provide health insurance often use financial incentives, such as contributions toward premiums, to encourage workers to participate in wellness programs like smoking-cessation courses.

Now some employers are wielding a stick as well as a carrot. Employees at some companies who are overweight, smoke, or have high cholesterol, for instance, and who don't participate in supplementary wellness programs, will pay more for health insurance. In extreme cases, employees' insurance deductibles could rise by $2,000.

Continue reading "Employers Tell Workers to Get Healthy or Pay Up" »

December 4, 2007 at 12:00 AM | Permalink

Aurelio Rojas
Sacramento Bee

For children in low-income families, the state-run Healthy Families program has been a godsend.

The program, which receives $2 from the federal government for every $1 California spends, provides health, dental and vision coverage for roughly 835,000 children whose parents earn more than Medi-Cal allows.

"Without this program we couldn't afford to take the children to a doctor when they get sick," said Juanita Gonzales of Woodland, a stay-at-home mom whose husband does not receive health insurance through his employer and whose sons, 5-year-old Jose and 3-year-old Juan, are covered by Healthy Families.

Continue reading "Children caught in the middle" »

December 3, 2007 at 12:21 PM | Permalink

John Arensmeyer
San Jose Mercury News Editorial

The prospect of relief from the crushing health care burden faced by small businesses has moved closer to reality in the past two weeks, as California's top legislators submitted a compromise health care reform proposal, and Gov. Arnold Schwarzenegger responded with a counterproposal of his own.

California's 3.2 million small-business owners, who employ over 50 percent of the private sector workforce, are fed up with the ever-rising price of health coverage, and in many cases are being completely frozen out of the market for affordable health care. Health insurance costs for small businesses in California have risen 125 percent in the past eight years, with only 39 percent of workers at businesses with less than 100 employees even covered by their company's health insurance plan.

Continue reading "Editorial: Small businesses need health care help" »

December 3, 2007 at 01:36 AM | Permalink

Mary Engel
Los Angeles Times

Illegal immigrants from Mexico and other Latin American countries are 50% less likely than U.S.-born Latinos to use hospital emergency rooms in California, according to a study published Monday in the journal Archives of Internal Medicine. [...]

But the study found that while illegal immigrants are indeed less likely to be insured, they are also less likely to visit a doctor, clinic or emergency room.

"The current policy discourse that undocumented immigrants are a burden on the public because they overuse public resources is not borne out with data, for either primary care or emergency department care," said Alexander N. Ortega, an associate professor at UCLA's School of Public Health and the study's lead author. "In fact, they seem to be underutilizing the system, given their health needs."

Continue reading "Study finds immigrants' use of healthcare system lower than expected" »

November 27, 2007 at 12:00 AM | Permalink

Rong-Gong Lin II and Teresa Watanabe
Los Angeles Times

The case of actor Dennis Quaid's newborn twins, who were reportedly given 1,000 times the intended dosage of a blood thinner at Cedars-Sinai Medical Center, underscores one of the biggest problems facing the healthcare industry: medication errors.

At least 1.5 million Americans a year are injured after receiving the wrong medication or the incorrect dose, according to the Institute of Medicine, part of the National Academies of Science. Such incidents have more than doubled in the last decade.

Continue reading "Hospital drug errors far from uncommon" »

November 22, 2007 at 12:00 AM | Permalink

Victoria Colliver
San Francisco Chronicle

Kent Odell exercises six times a week and eats healthy foods. He is a lean 6-foot-2 and 190 pounds and says he has no known medical conditions. His blood pressure is low, and his cholesterol clocks in well below the recommended level.

But Odell is having trouble getting individual health insurance.

Continue reading "For those 50 and older, health insurance can be hard to come by" »

November 21, 2007 at 12:00 AM | Permalink

Julie Appleby
USA Today

Fewer small employers offered health insurance this year, despite the widespread availability of new, lower-cost high-deductible insurance plans, a survey released today by benefit firm Mercer shows.

Advocates of the high-deductible plans touted them as one solution to the growing number of uninsured, expecting the plans to appeal to small employers, who would continue to offer health insurance as a result.

Continue reading "Fewer small firms offer health insurance" »

November 19, 2007 at 12:00 AM | Permalink

Aurelio Rojas
Sacramento Bee

Gov. Arnold Schwarzenegger declared 2007 the "year of health care reform" in California, but thousands of children could actually lose insurance coverage in the coming months.

Locally financed children's programs are running out of money, a hoped-for increase in federal funding has not materialized, and the state is facing a $10 billion budget deficit.

Moreover, both the Republican governor's and the Democrats' universal health care proposals would not provide coverage until 2010.

Continue reading "Kids' health funding at risk" »

November 18, 2007 at 12:00 AM | Permalink

Bob Herbert
New York Times Editorial

Sandra Hightower never thought of herself as particularly political. She worked, and much of her free time revolved around her daughter, Brittney, a fiercely outgoing teenager with a passion for cheerleading at her high school in Nacogdoches, Tex.

But “after getting slapped in the face with reality,” Ms. Hightower said she’s ready to go to Washington herself if that would help get Congress to do something about the health insurance crisis that is responsible for so much unnecessary suffering and death in the U.S.

The tedious, hair-splitting debates over health care that we’re getting from the presidential candidates — those who talk about health care at all — seem out of sync with the enormity of the problem. For families without the protection of health insurance, the devastating combination of serious illness and imminent financial ruin can be absolutely mind-numbing, stunning in its tragic intensity.

Continue reading "Op-Ed: It’s Not Just the Uninsured" »

November 17, 2007 at 12:00 AM | Permalink

Daniel Costello
Los Angeles Times

The state Thursday slapped a $1-million fine on Health Net Inc., the Woodland Hills-based insurer that acknowledged last week that it set goals for cancellations and paid bonuses in part based on how many policyholders were dropped and how much money was saved.

State officials said they levied the fine after finding that the company misled investigators about such bonuses on two occasions during interviews at the company's headquarters this fall.

Continue reading "Health Net fined for lack of candor" »

November 16, 2007 at 12:00 AM | Permalink

Victoria Colliver
San Francisco Chronicle

State health regulators fined Health Net Inc. $1 million Thursday for lying to investigators about paying employees bonuses based on the number of contracts they canceled after those policyholders got sick.

The penalty was the first levied on a health insurer for withholding information about incentives given to its employees.

Health Net, along with other major health insurers, is being investigated for combing through applications of members after they have filed claims to find mistakes or omissions that would justify revoking policies. Insurers say they resort to rescinding policies only when members lie about their health histories, but consumers say the questionnaires often are vague and misleading.

Continue reading "Health Net punished for lying about contract cancellation bonuses" »

November 16, 2007 at 12:00 AM | Permalink

John Carreyrou
Wall Street Journal

Barbara Calder lives in nearly constant pain. Her limbs dislocate at the slightest movement, even when she turns over in bed at night. She wears her hair short because brushing it hurts too much.

Mrs. Calder suffers from Ehlers-Danlos Syndrome, a rare genetic disorder in which the connective tissue that binds the body together gradually falls apart. But, although she began suspecting she had the disease 16 months ago and had health insurance, she spent a year battling numerous roadblocks just to see a specialist who could diagnose her condition. Now Mrs. Calder says she is left wondering whether she's going to die suddenly because she can't get the test that would tell her whether she has the fatal form of the disease.

Continue reading "How U.S. Health System Can Fail Even the Insured" »

November 16, 2007 at 12:00 AM | Permalink

John Arensmeyer, Small Business Majority
Michael Russo, CalPIRG
San Francisco Chronicle Op-Ed

Almost two months into the special session on health care reform, it has seemed at times as if hopes for change this year were slim, as Gov. Arnold Schwarzenegger and the state Legislature put out different proposals, and critics concentrated on figuring out whom to blame for slow progress. But while the public controversy has thrown out lots of heat, it has shed little light. Now, California's legislative leaders have offered a significant compromise proposal - one that demands a thoughtful response from the governor.

Continue reading "Op-Ed: California Can't Wait for Health Care Reform" »

November 9, 2007 at 12:00 AM | Permalink

Lisa Girion
Los Angeles Times

One of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.

Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.

Continue reading "Health insurer tied bonuses to dropping sick policyholders" »

November 9, 2007 at 12:00 AM | Permalink

San Jose Mercury News Editorial

Maybe Gov. Arnold Schwarzenegger's great health care debate of 2007 will have a Hollywood-style happy ending, after all.

The governor and Assembly Speaker Fabian Núñez, D-Los Angeles, are finally showing a willingness to compromise on the most contentious issues that have hindered progress on significant health care reform for months in Sacramento.

But Californians should hold off on celebrating. Even if the governor and legislative Democrats reach a final accord, voters next November still would have to approve the funding mechanism. Going to the ballot box for financing approval is a daunting and risky notion. But the developments of the past week are positive, and the momentum should continue.

It would be appropriate if history were to record that one of the most decisive moments of this year's health care debate occurred Friday in San Jose.

Throughout the summer and fall, the governor has refused to budge from his notion that businesses not offering health care coverage to employees should be required to pay no more than 4 percent of payroll into a pool to provide coverage for the uninsured. The Democrats' plan calls for employers to contribute 7.5 percent, which the governor said was too much.

Continue reading "Editorial: State political leaders finally ready to compromise on health reform" »

November 7, 2007 at 01:38 AM | Permalink

Aurelio Rojas
Sacramento Bee

Gov. Arnold Schwarzenegger's administration Tuesday called a new universal health care proposal by Democrats a "positive sign," but took issue with the funding, including a proposed $2-per-pack cigarette tax.

The tax would replace Schwarzenegger's plan to sell the rights to run the state's lottery to a private management company and use the proceeds to help finance his proposed $14 billion health plan.

"We still think that's the most viable source of those revenues," Daniel Zingale, one of the Republican governor's top advisers on health care, told reporters a day after Assembly Speaker Fabian Núñez, D-Los Angeles, outlined the Democratic plan.

Continue reading "Health care funding at issue" »

November 7, 2007 at 12:00 AM | Permalink

Sacramento Bee Editorial

With Gov. Arnold Schwarzenegger focused on the southland wildfires and Assembly Speaker Fabian Núñez trying to smother some blazes of his own, neither leader has found much time recently to negotiate a final deal on health care reform. Now the moment appears at hand. On Tuesday, Núñez and Senate leader Don Perata offered up a new proposal that brings them much closer to the framework that Schwarzenegger has proposed all year. If these three leaders can avoid further distractions – whether it be natural disasters or ones of their own making – they could soon come to terms on a historic pact that could expand health coverage to the 6.7 million Californians who are now uninsured.

Continue reading "Editorial: Your Turn, Governor" »

November 7, 2007 at 12:00 AM | Permalink

Associated Press

A spokesman for Assembly Speaker Fabian Nunez says Democratic leaders have agreed to key elements of Gov. Arnold Schwarzenegger's health care reform plan, including mandatory insurance.

They embraced the idea while demanding some exemptions for people who are in financial trouble. Public programs also would expand to cover families earning up to 300 percent of the federal poverty level -- about $62,000 a year for a family of four.

Democrats also lowered the minimum amount employers must spend from their previous health care bill, which Schwarzenegger vetoed.

The new plan has a sliding scale for employers, with a maximum contribution of 6 percent. Spokesman Steve Maviglio said it also raises the tobacco tax by $2 a pack and imposes a tax on hospitals.

Continue reading "State Dems Reach Accord on Healthcare Plan" »

November 5, 2007 at 03:52 PM | Permalink

Aurelio Rojas
Sacramento Bee

Members of the Legislature's African American, Latino and Asian caucuses convened a town hall meeting in a show of solidarity on the eve of last week's hearing into Gov. Arnold Schwarzenegger's universal health care plan.

"We want to deliver a message to the governor (and) to the entirety of the Legislature that any health care discussion, absent the issue of health care disparities, will continue to undermine the quality of care and life expectancy in communities of color," state Sen. Mark Ridley-Thomas said at the outset.

During the past year, the Schwarzenegger administration has held more than 1,000 meetings with stakeholders as it developed its health care plan. But Ridley-Thomas, chairman-elect of the Legislative Black Caucus, said the role of race and ethnicity in the distribution of health care resources has been "conspicuously absent from the discussion."

Continue reading "Legislators decry health care gap" »

November 5, 2007 at 12:00 AM | Permalink

Ezra Klein
The American Prospect

The Commonwealth Fund just released a broad survey collecting health care attitudes and experiences from patients in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Here are summaries of some of the findings:

1. We spend the most. We spend more than any other country in the world. In 2005, our per capita -- so, per person -- spending was $6,697. The next highest in the study was Canada, at $3,326. And remember -- that's "mean" spending, so it's the amount we spend divided by our population. But unlike in Canada, about 16 percent of our population doesn't have insurance, and so often can't use the system. These facts should set the stage for all numbers that come after: Every time you see a data point in which were dead last, or not leading the pack, remember that we spend twice as much as any of our competitors.

2. We don't pay doctors according to the quality of their care. One of the first questions is "percent of primary care practices with financial incentives for quality" -- in other words, how many doctors are paid, in part, according to the quality of the care they deliver. In the United Kingdom, the number is 95 percent. In Australia, it's 72 percent. The U.S. scores lower than anyone else, at 30 percent. Similarly, electronic medical records -- which both increase the quality of care and lower its cost -- have 89 percent penetration in the U.K., 79 percent in Australia, 98 percent in the Netherlands, and 28 percent in America. On both these metrics, we perform miserably.

3. Our wait times are low because many of us aren't getting care at all. It's true, Americans do have short waits for non-elective surgeries. Only 4 percent of us wait more than six months. That's more than in Germany and the Netherlands, but considerably less than the Canadians (14 percent) or the Britons (15 percent). But our high performance on the waiting times only account for individuals who get the care they need. Our advantage dissipates when you see the next question, which asks how many patients skip care due to cost. And here, America is far worse than anywhere else.

In just the past year, a full 25 percent of us didn't visit the doctor when sick because we couldn't afford it. Twenty-three percent skipped a test, treatment, or follow-up recommended by a doctor. Another 23 percent didn't fill a prescription. No other country is even close to this sort of income-based rationing. In Canada, only 4 percent skipped a doctor's visit, and only 5 percent skipped care. In the U.K., those numbers are 2 percent and 3 percent. Few of our countrymen are waiting for the care they need, that much is true. But that doesn't mean they're getting it quickly. Rather, about a quarter of us aren't getting it at all.

Indeed, 19 percent of Americans were unable, or had serious problems, paying medical bills in the last year. Comparatively, no other country was even in the double digits. This is part of why we perform well on the waiting-times metric. In other countries, the disadvantaged wait longer for their care, and so show up in the data tracking wait times. In our country, they disappear from that measure, because they never get the care at all. You don't wait for what you're not receiving. So their wait times show up as "zero," when they should really be something akin to infinite. And would you prefer to wait four months for your surgery, or never get it at all?

4. Most of us don't have a regular physician. One might expect, given what we pay, that our care would at least be more central and convenient. But it's not so. Of everyone surveyed, Americans were the least likely to report a doctor or general practitioner they routinely saw. As a result. Americans are the most likely to say their doctor doesn't know important information about their medical history, which has obvious implications for care quality, medical errors, etc.

5. Our care isn't particularly convenient. Nor is medical service more convenient for Americans to access. On such questions as whether your doctor has early morning hours, evening availability, or weekend slots, we're not trailing the pack, but we're not in the lead, either. On evening hours, for instance, we lag behind Australia, Canada, Germany, and New Zealand. On same day appointments, Only 30 percent of Americans report that they can access a doctor on the very day they need one, as opposed to 41 percent of Britons and 55 percent of Germans. And a full 67 percent of Americans -- more than in any other country -- say it's difficult to get care on nights, weekends, or holidays with resorting to the emergency room, where care is costlier and, if your injury is not grievous, less efficient.

6. Our doctors don't listen to us. But maybe the amount we're paying comes in customer service -- maybe our doctors spend more time with us, are more reassuring, are more attentive to our cases. After all, we basically like the care we get. Our overall self-evaluation of the treatment we receive is solidly in the middle of the pack, with 70 percent expressing satisfaction -- which means we're less satisfied than the Canadians, Australians, and New Zealanders, but 5 percent above the Britons, and well above the Germans or Dutch. But when you ask for specifics, we do a bit worse.

Americans are the least likely to report that their doctors explain things in ways they understand (though the spread on this question is rather small) or say doctors spend enough time with them (56 percent of us say they do, as compared to 70 percent of Germans). We're the most likely to report that test results or medical records were unavailable during our scheduled appointments and, along with the Germans, the most likely to say that our doctors ordered tests that we'd already had done. On the bright side, 78 percent of us say our regular doctor was "informed and up-to-date" about follow-up care after a hospital visit.

7. We have high rates of chronic conditions. Aside from the surprisingly unhealthy Australians, Americans have the highest rate of chronic disease. And this isn't only a comparative problem; our high rates of chronic disease are a massive cost-driver, attributable, according to the research of Ken Thorpe, for about 2/3rds the rise in health spending over the past few decades.

8. … But we're not treating them properly. So given the high prevalence of such diseases, and the pressures they exert on our system, you'd hope our system had evolved so as to treat these diseases more effectively.

Not so. One of the big issues with chronic disease is coordination of care. Illnesses like diabetes and kidney failure have so many manifestations, and require so much maintenance, that it's critical for care providers to have a full picture of what treatments are being received, what the patient's medical history is, what therapies they will and will not follow, etc. And for that reason, it's critical for the patients to have a single medical home – a regular care center where their case is understood, tracked, and treated. Sadly, we're tied with the Canadians for the lowest percentage reporting a single "medical home."

Worse, we're far and away the likeliest to report spending more than $500 out-of-pocket on prescription drugs annually. That's a problem, as higher out-of-pocket costs mean more of us going without prescriptions, which means less maintenance of conditions and, thus, more cost when our chronic illnesses balloon into catastrophic health events. Indeed, 42 percent of Americans with chronic conditions -- the exact same percentage who report paying more than $500 for drugs -- report skipping care, drug doses, or doctor's appointments due to cost. That's cheaper for them in the short-term, as they can spend some of the money on food or rent. It's more expensive for us, however, as we pick up the huge bill when they end up in the hospital in full cardiac arrest.

9. We're frequent victims of medical, medication, and lab errors. Along with Australians, Americans are the most likely to report a medical, medication, or lab error, with 20 percent saying they've experienced one of the above over the past year. For those of us with chronic diseases, the rates are even higher. There are many reasons for this, ranging from our low adoption rate of electronic medical records to our splintered care system. But the effects are bad for our health and, needless to say, bad for our insurance rates. Conservatives make a huge deal out of medical malpractice claims, but studies show that our high rate of lawsuits is due to our high rate of medical error. The crisis isn't just in the courtrooms, it's on the operating tables.

10. Most of us are dissatisfied with our current system. In health polling, happiness with the system is generally measured through a three-answer question: Does your system merely need minor changes, as it works pretty well? Does it need fundamental changes? Or does it need to be rebuilt? Of all the countries surveyed -- including the supposedly dystopic U.K. and Canada -- Americans are the least likely to report relative satisfaction, and the most likely to call for a fundamental rebuilding. Only 16 percent of us are happy. In Canada and the U.K., that number is 26 percent. In the Netherlands, it's 42 percent. Meanwhile, 34 percent of Americas want to completely rebuild. Only 12 percent of Canadians say the same, and only 15 percent of U.K. residents want a new system. So paying more than twice as much as anyone else, we have the lowest satisfaction with our health care system. Lower than the countries with waiting lines. Lower than Germany, and Australia, and New Zealand.

And perhaps this shouldn't be a surprise. Is it any wonder that Americans who have to forgo care are less satisfied than Canadians who simply have to wait for elective surgeries? That our shorter doctor visits, more impersonal caregivers, higher rates of medical errors, and inability to find primary care after 6 P.M. have left us frustrated? And that our sky-high costs have, finally, left us aching for change?

Continue reading "Ten Reasons Why American Health Care Is So Bad" »

November 2, 2007 at 12:00 AM | Permalink

Mike Zapler
San Jose Mercury-News

With Gov. Arnold Schwarzenegger's health care proposal stalled in negotiations and hopes of a breakthrough dimming, Democrats grilled a top administration aide for nearly two hours Wednesday, claiming the governor's reforms would sock middle-class families with insurance costs they can't afford.

Democrats tried to use the legislative hearing to expose what they called flaws in the governor's plan and extract concessions on key sticking points. But time is running short, and it's far from clear that Schwarzenegger can meet the Democrats' demands without alienating the fragile coalition of business and insurance interests he has enlisted as supporters. [...]

Continue reading "Democrats assail health care plan" »

November 1, 2007 at 01:35 AM | Permalink

Aurelio Rojas
Sacramento Bee

Gov. Arnold Schwarzenegger's universal health care plan finally received a hearing in the Legislature on Wednesday – 10 months after he unveiled it amid much pomp – and was greeted with bipartisan skepticism.

Assembly Speaker Fabian Núñez, D-Los Angeles, hailed the hearing before the Assembly Health Committee "as an historic opportunity" to "engage Californians in a more positive attitude about the work that we do."

But the six-hour hearing, which included a two-hour presentation by Kim Belshé, Schwarzenegger's secretary for health and human services, reaffirmed that both Democrats and Republicans remain opposed to major provisions of the plan. [...]

Continue reading "Governor's health care plan receives a checkup" »

November 1, 2007 at 12:08 AM | Permalink

Tom Chorneau
San Francisco Chronicle

After nearly a year of debate and discussion, Gov. Arnold Schwarzenegger's health care reform bill finally goes before a legislative committee Wednesday - on Halloween, which to some legislators is appropriate given its chances for survival. [...]

The two sides have been stuck on the issue of affordability for weeks without any sign of a compromise. In the meantime, the Assembly health committee will hold an informational hearing on the governor's plan today, but it is not expected to move forward in its current form.

Continue reading "Assembly panel gets governor's health care plan" »

October 31, 2007 at 12:00 AM | Permalink

Aurelio Rojas
Sacramento Bee

Cyndi Rose is an administrative assistant at California State University, Sacramento, and hopes to finish her college studies one day.

The 24-year-old Carmichael resident makes $15 an hour, lives with her parents and prays she won't get sick because she says she can't afford health insurance.

Most of her friends, Rose said, are in the same bind. Nearly a third of Californians between the ages of 20 and 29 don't have insurance, the biggest share of any demographic group, according to the California Health Interview Survey, conducted by the UCLA Center for Health Policy Research.

Continue reading "Young pushing change of policy for health insurance" »

October 28, 2007 at 12:21 PM | Permalink

Lisa Girion
Los Angeles Times

State regulators moved Tuesday to limit insurers' ability to cancel medical coverage after patients get sick, proposing that companies be required to check up on an applicant's health before issuing a policy in the first place.

The Department of Managed Health Care, which governs health plans known as HMOs, and the Department of Insurance, which supervises insurance companies, said they would propose rules that reinforced existing laws forbidding rescissions except when they could show a policyholder was at fault. It marked the first time the two agencies had acted in concert on any regulations.

Continue reading "Regulators aim to curb healthcare rescissions" »

October 24, 2007 at 12:00 AM | Permalink

CBS5/KCBS

For 48 hours, beginning Thursday morning in front of Governor Schwarzenegger's San Francisco offices and other locations around the state, advocates will lobby for what they call "real" affordable health care. [...]

There are proposed tax breaks for others, though the plan does have its opponents. The California Labor Federation warns that even a middle class family could potentially wind up paying thousands of dollars in premiums and even more in deductibles. They say affordable health care is legislation that must be passed now and can't wait another year, as Schwarzenegger has proposed.

Continue reading "Vigils Held For Affordable Health Care In State" »

October 19, 2007 at 07:26 AM | Permalink

Lisa Girion
Los Angeles Times

Many Californians enrolled in healthcare plans are receiving inadequate preventive care, a government report said Thursday.

The eight largest plans in the state fail to ensure that their 12 million members are sufficiently tested and treated to prevent and detect major diseases and reduce unnecessary expenses, according to the California Office of the Patient Advocate's report, called the Health Care Quality Report Card.

Continue reading "HMOs not meeting national standards in basic areas, report says" »

October 19, 2007 at 12:00 AM | Permalink

Aurelio Rojas
Sacramento Bee

Prodded by Gov. Arnold Schwarzenegger's veto of a plan backed by Democrats to expand health care coverage, labor unions Wednesday began 48-hour vigils around the state to oppose the Republican governor's proposal.

The vigils, including prayer and fasting, outside the Capitol and the governor's district offices mark a change in what until now has been a behind-the-scenes effort by labor to influence the debate over the 6.7 million Californians without health insurance.

Continue reading "Unions protest health plan" »

October 18, 2007 at 12:00 AM | Permalink

David Lazarus
"Consumer Confidential" column
Los Angeles Times

Healthcare has been much on my mind in recent days as I take my first steps down the lifelong path of dealing with a chronic disease. As I wrote last Sunday, I've been diagnosed with Type 1 diabetes and now rely on five insulin injections daily.

While deeply grateful for all the resources available to me as I learn to manage my condition, I also can't help but fear the possibility of my family being wiped out financially should I ever lose my employer-based insurance.

Continue reading "Medical costs put families on edge" »

October 14, 2007 at 12:00 AM | Permalink

Jamie Court
Los Angeles Times Op-Ed

Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Nuñez claim they are close to a deal on healthcare reform that will require every Californian to prove they have a private health insurance policy -- but does not cap how much insurers can charge for it. Hillary Clinton's health plan, released last week, would require all Americans to have health insurance, also with no cap on premiums. [...]

Health insurance is so unaffordable today precisely because no one is watching costs. With regulation of all medical charges, insurance would be cheaper and people might want to buy it. But Sacramento politicians already refused to standardize what doctors, hospitals, drug companies and insurers charge. [...]

Continue reading "Mandatory insurance isn't reform" »

September 25, 2007 at 12:00 AM | Permalink

Victoria Knight
Wall Street Journal

Health-care premiums of employers and their workers rose by more than twice the rate of inflation in 2007, and cost increases are expected to accelerate next year, with employees picking up a larger slice of the bill, according to a study released Monday by Hewitt Associates, a global human resources company.

The cost of providing health-care benefits to employees rose by 5.3% on average in 2007, down from 7.9% in 2006 and the smallest increase in nine years. However, Hewitt predicts that health-care costs will jump by 8.7% on average in 2008, bringing the average annual premium cost per employee to $8,676 from $7,982 now. [...]

Continue reading "Health-Care Premiums Expected To Jump 8.7% in 2008, Study Says" »

September 24, 2007 at 06:21 PM | Permalink

Karl Vick
Washington Post

[..] "We hope to have a bill very, very soon," the governor's press secretary, Aaron McLear, said Friday. "It's just a matter of closing the last few inches."

Schwarzenegger has invested mightily in the issue, saying California can set a national example on health insurance as it has on energy conservation and other areas. Last week, he called lawmakers back for a special session to find common ground between a Democratic bill and his own proposal to cover about 5 million uninsured Californians.

"The main sticking point, as it always is, is the funding formula, and where is the revenue stream?" said Fabian Nunez, the Democratic speaker of the State Assembly. "When you rely on a free-market health system, and you want everyone to participate, the key issue is affordability."

Continue reading "California Closes In on Universal Health-Care Plan" »

September 24, 2007 at 12:00 AM | Permalink

Tom Chorneau
San Francisco Chronicle

Nine months after unveiling a sweeping plan to bring health care coverage to 6.8 million uninsured Californians, Gov. Arnold Schwarzenegger is close to an agreement with legislative Democratic leadership on a compromise that lawmakers could consider in the coming weeks. [...]

Continue reading "Schwarzenegger, Democratic leaders close to deal on health care reform" »

September 23, 2007 at 12:00 AM | Permalink

Sheryl Gay Stohlberg
New York Times

President Bush, bracing for a series of battles with Congress over spending, threatened on Thursday to veto a bill expanding a popular children’s health insurance program, calling it “a step toward federalization of health care.”

The program expires Sept. 30, and Congress is on the verge of renewing it by providing coverage to an additional 4 million children over the 6.6 million already enrolled — at an additional cost of $35 billion over five years. Mr. Bush says the bill would expand a program aimed at helping the poor beyond its original intent. [...]

Continue reading "Bush Threatens Veto of Child Health Bill" »

September 21, 2007 at 12:00 AM | Permalink

Victoria Colliver
San Francisco Chronicle

It's the children who feel the sting of vaccinations, but it's their parents who can get stuck with a sharp bill for shots they thought their health insurance would cover.

Some pediatricians, faced with a growing number of recommended immunizations and rising prices, are starting to restrict or refuse to administer some vaccines unless patients pay in advance - and the prices can add up to hundreds of dollars.

East Bay Pediatrics Medical Group, for example, which has nine full-time physicians and offices in Berkeley and Orinda, informed its 1,800 Blue Shield of California patients that, as of Aug. 1, physicians would not administer four specific immunizations without payment up front.

Continue reading "Doctor-insurer disputes force parents to pay up front for shots" »

September 21, 2007 at 12:00 AM | Permalink

Mike Zapler
MediaNews

Gov. Arnold Schwarzenegger's self-proclaimed "Year of Health Care Reform" has turned out to be a year of gridlock with the state Legislature. But the ever-optimistic governor is still clinging to his dream of bringing universal health care to California.

The governor has called lawmakers back to town for an overtime shift - formally known as a special session of the Legislature - with the hopes of cutting a deal.

The outline of a possible compromise has already begun to take shape. Schwarzenegger and Democrats would agree on a basic reform package, which the Legislature would approve during the special session. But lacking the votes of Republicans needed to finance it, they would go to voters next year with a ballot initiative seeking billions in new taxes.

Continue reading "Schwarzenegger makes health care push" »

September 17, 2007 at 01:28 AM | Permalink

Susannah Rosenblatt
Los Angeles Times

When Terry Badillo's teenage daughter Denise became pregnant, she didn't know what to do. Badillo's husband had health insurance through his job, but it didn't cover Denise, then 17.

The Monterey Park homemaker, who made call after fruitless call for help, remembers that uncertainty a couple of years ago as "a terrible time."

Badillo eventually learned about Maternal and Child Health Access, a Los Angeles nonprofit agency. There, healthcare outreach workers helped her fill out the complicated forms to enroll her daughter in Medi-Cal. And when Denise started having unexplained seizures six months after giving birth, Badillo was more grateful than ever that her medical expenses were covered.

Continue reading "Healthcare cuts add hurdles for poor families" »

September 14, 2007 at 12:00 AM | Permalink

Kevin Sack
New York Times

Since contracting polio at age 2, Yan Ling Ho has lived with pain for most of her 52 years. After she immigrated here from Hong Kong last year, the soreness in her back and joints proved too debilitating for her to work.

That also meant she did not have health insurance. Not wanting to burden her daughter, who was already paying her living expenses, Ms. Ho delayed doctors’ visits and battled her misery with over-the-counter medications.

“Sometimes the pain was so bad, I would just cry,” she said. “I didn’t know what else to do."

Continue reading "San Francisco to Offer Care for Uninsured Adults" »

September 14, 2007 at 12:00 AM | Permalink

Anthony York
Capitol Weekly

Public schools could wind up as one of the big winners if the governor and legislative leaders can come to an agreement on a health-care overhaul.

Under one of the proposals being discussed at the Capitol, schools could secure as much as $2.2 billion as part of a health-care deal.

The scenario is based on a big hypothetical, but is by no means out of the realm of possibility. Here's how it would work: Among the options being looked at to fund a health-care expansion would be a one-cent increase in the state sales tax. But under Proposition 98, 40 percent of that sales-tax revenue would go directly to schools.

Continue reading "Health-care hypotheticals abound as special session begins" »

September 13, 2007 at 12:00 AM | Permalink

Tom Chorneau
San Francisco Chronicle

Voters may be asked next year to approve funding elements of a health care overhaul and water storage expansion, under a plan outlined Tuesday by legislative leaders and Gov. Arnold Schwarzenegger.

With the regular legislative session set to end Friday, Schwarzenegger called lawmakers into a special session to deal with water and health care - a session that began Tuesday night.

Continue reading "Health care, water issues probably headed to California ballot" »

September 12, 2007 at 04:00 AM | Permalink

Kevin Yamamura
Sacramento Bee

Gov. Arnold Schwarzenegger on Tuesday officially called special sessions on health care and water storage but acknowledged that his long-desired changes on how California draws legislative districts are dead for this year.

The Republican governor and Democratic lawmakers remain at odds over how to pay for a health care solution for the 6.7 million uninsured Californians.

Continue reading "Special sessions ordered" »

September 12, 2007 at 12:38 AM | Permalink

Vanessa Fuhrmans
Wall Street Journal

Health-care premiums of employers and their workers have climbed more than twice as fast as inflation in 2007 -- to about double their cost in 2000 -- and look to rise at a similar or slightly faster clip next year, a pair of nationwide surveys show.

The average family premium has risen 6.1% in 2007, according to an annual study by the Kaiser Family Foundation and the Health Research and Educational Trust. A widely watched barometer of employer health-care costs, the joint survey of 1,997 employers contained a modicum of good news: This is the fourth straight year premiums have decelerated since soaring nearly 14% in 2003.

Continue reading "Health-Care Premiums Climbing Faster Than Inflation, Studies Say" »

September 12, 2007 at 12:00 AM | Permalink

San Francisco Chronicle Editorial

IS THERE any hope for health care reform? The regular legislative session is winding up. Gov. Arnold Schwarzenegger's $12 billion plan - which would require all individuals to purchase coverage and levy a 4 percent tax on employers to help fund coverage for the poor - has yet to garner any Republican support or even make it onto the floor as legislation. The one health care plan that has been signed - a Democratic initiative that would provide coverage to about 70 percent of the state's uninsured, in part through a 7.5 percent payroll tax on employers who don't currently offer employee coverage - is dead in the water, as the governor has promised to veto it.

Continue reading "Editorial: Health-care hope" »

September 12, 2007 at 12:00 AM | Permalink

Molly Selvin and Daniel Costello
Los Angeles Times

The cost of employer-sponsored health insurance continues to outstrip inflation and wages, rising 6.1% this year, according to a closely watched annual report. And workers are bearing more of the burden.

The rate of increase is slower than in previous years, but since 2000, the share paid by the average U.S. worker has doubled. Moreover, the average total cost of healthcare premiums for a family of four, including the share paid by employers, now exceeds the amount a minimum wage worker earns in a year.

Continue reading "Workers paying more for coverage" »

September 12, 2007 at 12:00 AM | Permalink

Tom Chorneau
San Francisco Chronicle

The state Legislature approved an overhaul of California's health care system Monday, but even before the votes were tallied Gov. Arnold Schwarzenegger vowed to veto the bill and call lawmakers into a special session after the current session ends this week.

Schwarzenegger said he would reject AB8, by Speaker Fabian Núñez, D-Los Angeles, because it puts too great a financial burden on employers and does not address the needs of 2.8 million of California's estimated 6.8 million uninsured residents. [...]

Continue reading "Health care bill passes Legislature, but governor says he'll veto it" »

September 11, 2007 at 12:00 AM | Permalink

Associated Press

Gov. Arnold Schwarzenegger said Monday he will call a special session of the state Legislature to deal with health care, as lawmakers considered a Democratic plan he has pledged to veto.

The state Senate passed that plan, known as AB8, on a 22-17 vote and sent it to the Assembly a few hours after the governor announced his intention.

Continue reading " Schwarzenegger To Call Special Session On Health Care" »

September 10, 2007 at 05:18 PM | Permalink

Frank D. Russo
California Progress Report

This afternoon the California State Senate passed AB 8 (Nunez-Perata) on a 22 to 17 vote with only Democrats in support and all Republicans opposed. Democratic Senator Sheil Kuehl, the author of SB 840, a single payor plan, and Senator Lou Correa voted against the bill. Senator Joe Simitian did not vote. The bill now heads to the Assembly, which we have just been advised will be debating it shortly.

Continue reading "California State Senate Passes Nunez-Perata Health Care Bill" »

September 10, 2007 at 04:21 PM | Permalink

Bishop Stephen E. Blaire and Rabbi Alan Henkin
Sacramento Bee Editorial

As religious leaders, our traditions call us to protect the well-being of every human life because we are created in God's image. As a nation, we have failed to meet that duty because we permit people to suffer and die for lack of health care.

We cannot tolerate the injustice that leaves millions of our brothers and sisters without access to health care because they have inadequate insurance or, like over 6.5 million Californians, none at all.

In California, we stand at a crossroads. Here are two truths about health care in California.

Continue reading "Editorial: Our state, national health care failure" »

September 6, 2007 at 12:00 AM | Permalink

Robert K. Ross
San Diego Union-Tribune Editorial

Odds are, you believe our health care system needs fixing. An even safer bet is that you don't think you're going to get it from Sacramento anytime soon.

The latest Field Poll shows that 69 percent of Californians favor health care reform. But the same poll shows just 6 percent of us think we're “very likely” to see reform this year from Sacramento.

Continue reading "Editorial: Health care: A system at the breaking point" »

September 5, 2007 at 12:00 AM | Permalink

Los Angeles Times Editorial

Among the bills Sacramento is scrambling to pass into law by the end of the legislative session on Sept. 11, perhaps none has received as much interest as healthcare reform. With good reason. In recent days, the U.S. Census Bureau estimated that 18.5% of people in the state -- about 6.7 million, more than ever before -- are uninsured, and the Field Poll reported that 69% of Californians are dissatisfied with the state's healthcare system.

Continue reading "Editorial: Compromising on health care" »

September 4, 2007 at 12:00 AM | Permalink

Jordan Rau
Los Angeles Times

With time running out to overhaul California's healthcare system this year, Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Nuñez are fashioning a high-stakes strategy to raise business and hospital taxes through a ballot measure that would circumvent defiant Republican lawmakers.

"I think we're on the verge of doing something huge," Nuñez told The Times' editorial board Friday.

Continue reading "Nuñez, Gov. gamble on healthcare overhaul" »

September 1, 2007 at 12:00 AM | Permalink

John Marelius
San Diego Union-Tribune

Even though the current state legislative session is rapidly drawing to a close, Gov. Arnold Schwarzenegger yesterday expressed optimism that an agreement can be reached on his sweeping health care plan.

“They understand that this is a rare opportunity where we can do this,” he said of the legislators, who are scheduled to adjourn in two weeks.

“They have different ideas, but I tell you there is a willingness to work together to make this work. I can gauge that from the meetings that we have had.”

Continue reading "Governor has hope for his care plan" »

September 1, 2007 at 12:00 AM | Permalink

Tom Chorneau
San Francisco Chronicle

Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Núñez opened a new round of closed-door meetings Thursday on plans to overhaul the state's troubled health care system to offer coverage to a record 6.8 million Californians without health insurance.

The move came after Núñez, D-Los Angeles, withdrew his threat to put the governor's health care plan before the lower house for a vote Thursday, knowing that it would not get much support from Democratic or Republican lawmakers.

Both sides characterized Thursday's talks as productive, but there was no sign of a breakthrough.

Continue reading "The governor and Assembly speaker begin new talks on health care" »

August 31, 2007 at 12:00 AM | Permalink

Jordan Rau
Los Angeles Times

Gov. Arnold Schwarzenegger took a firm stand Wednesday against the Democratic healthcare proposal moving through the Legislature, saying for the first time that he would not support an expansion of medical insurance if it were financed solely by new requirements on employers.

The Democratic proposal would require employers to spend at least the equivalent of 7.5% of their payroll on their workers' health. The governor insisted that the plan also must require all Californians to have insurance, an idea at the core of his January proposal.

Continue reading "Schwarzenegger criticizes Democrats' health plan" »

August 23, 2007 at 12:00 AM | Permalink

Kevin Yamamura
Sacramento Bee

Gov. Arnold Schwarzenegger on Wednesday threatened to veto Democrat-backed health care legislation if it relies solely on employers to pay for coverage, upping the stakes on negotiations to enact controversial fees and require all individuals to obtain coverage.

The Republican governor, meeting with The Bee's editorial board, said he would "absolutely" consider seeking a ballot initiative for a health plan if talks fail in the Legislature. As another option, the Governor's Office indicated Wednesday that he remains open to keeping lawmakers in Sacramento beyond the Sept. 14 close of the session if necessary to reach a health care agreement.

Continue reading "Health care veto is vowed" »

August 23, 2007 at 12:00 AM | Permalink

Tom Chorneau
San Francisco Chronicle

Just one day removed from a near-record state budget impasse caused largely by a dispute with members of his own party, Republican Gov. Arnold Schwarzenegger expressed optimism Wednesday about finding GOP support for health care overhaul legislation this year.

Schwarzenegger, who struggled for 52 days to get two Republican votes in the state Senate to pass the budget, said he still wants a comprehensive overhaul of the state's health care system. That would require support not just from powerful interest groups like doctors, hospitals and consumer groups - but also a two-thirds majority of the Legislature.

Continue reading "Governor optimistic he can get health care overhauled this year" »

August 23, 2007 at 12:00 AM | Permalink

John Meyers
Capitol Notes (KQED)

The fact that only there are only 16 days left on the 2007 legislative calendar has a lot of Capitol watchers wondering whether the year's big policy issue -- health care reform -- can actually be pulled off in time.

Maybe so. But nonetheless, Governor Schwarzenegger told me today he's willing to call the Legislature back into a special session after mid-September, so that legislators could have more time to craft a health care proposal.

Continue reading " Guv Willing To Call Special Health Care Session" »

August 22, 2007 at 12:48 PM | Permalink

Evan Halper
Los Angeles Times

The budget deadlock gripping the Capitol has put Gov. Arnold Schwarzenegger's policy agenda in jeopardy, with prospects for bringing healthcare to all Californians or solving the state's water problems dimming every day that lawmakers fail to pass a spending plan.

The impasse has brought legislative business to a standstill -- from the governor's sweeping proposals to lawmakers' efforts to enhance the quality of life for family pets. It threatens to transform what promised to be one of Sacramento's more productive years into a flop.

"Everything has been put on the sidelines," said Senate Leader Don Perata (D-Oakland). "No one would like to have a healthcare bill more than I would. But if we don't have a budget, nothing else matters."

Continue reading "Budget deadlock stalls Schwarzenegger agenda" »

August 9, 2007 at 12:00 AM | Permalink | Comments (0) | Trackbacks (0)

Gilbert Chan
Sacramento Bee

In re-examining the agreement, Department of Managed Health Care officials spent five hours listening to a parade of speakers praise Blue Cross as a good corporate citizen or lambaste it as an industry powerhouse that puts profits before patient care during a Los Angeles hearing available to media statewide via a conference call.

Consumer activists and doctors accuse Blue Cross of reneging on promises made three years ago to win state approval of the $16.5 billion merger between its corporate parent -- WellPoint Health Networks Inc. -- and Indianapolis-based Anthem Inc.

Continue reading "Fans, foes weigh in on Blue Cross rules" »

August 8, 2007 at 12:00 AM | Permalink

Stephanie Hoops
Ventura County Star

Expressing displeasure that Ehnes was out of the room when he wished to address her, the president of the California Coastal Rural Development Corporation, Herb Aarons, spoke anyway, blaming the state for approving the merger.

He said competition in Monterey County is now limited to two providers.

He described it as a "monopoly situation."

Continue reading "Critics rip Blue Cross at hearing" »

August 8, 2007 at 12:00 AM | Permalink | Comments (0) | Trackbacks (0)

Lisa Girion
Los Angeles Times

Executives and supporters of Blue Cross were on hand to say the company is committed to California and that its policies represent a good deal for members.

Blue Cross said it only made sense that it would receive the most complaints because of its position as the state's No. 1 healthcare plan. The company said that on the whole its members were well served.

But the dominant message was just the opposite from a standing-room-only crowd of more than 200 patients, physicians and hospital operators at the daylong hearing.

Continue reading "Blue Cross undergoes examination" »

August 8, 2007 at 12:00 AM | Permalink | Comments (1) | Trackbacks (0)

Peggy Pico, R.N.
NBC-TV San Diego

Watch video of the report

Dozens of protesters and consumer advocate groups showed up at the hearing, chanting, "Hey Blue Cross you can't hide -- we can see your greedy side."

Steep premium hikes, canceled policies, and decreased reimbursement for doctors are among the 1,600 complaints received by insurance regulators against the HMO in the past three years.

Pediatrician Ron Nagel testified, "Over the past years we've seen Blue Cross reimbursements for pediatricians not keep up with the price of office overhead."

Nagel said he knows insurance is a business but believes "Blue Cross is crossing the line."

Continue reading "State's Largest HMO Under Investigation" »

August 7, 2007 at 04:12 PM | Permalink | Comments (0) | Trackbacks (0)

Victoria Colliver
San Francisco Chronicle

State regulators will hold a public hearing today in Los Angeles to investigate criticisms that have surfaced about Blue Cross of California since the 2004 acquisition of its parent company by a Midwestern health insurer.

Officials from the state Department of Managed Health Care will hear complaints about premium increases, canceled policies, physician reimbursement rates and transfers of money out of California after the $16.4 billion purchase of Blue Cross's parent, WellPoint Health Networks Inc., by Anthem Inc.

Continue reading "State Hearing on Blue Cross" »

August 7, 2007 at 12:00 AM | Permalink | Comments (0) | Trackbacks (0)

Tim Herdt
Ventura County Star

As healthcare reform moved another step forward Wednesday in the Legislature, two new studies were released with findings that bolster the case for action.

Continue reading "Health insurance reforms bolstered" »

July 12, 2007 at 12:00 AM | Permalink

Kevin Yamamura
Sacramento Bee

Legislative Democrats advanced their plan on Wednesday to provide health care for millions of uninsured Californians while admitting it remains a rough draft, setting up summer negotiations with Gov. Arnold Schwarzenegger.

Continue reading "Democrats' health care plan advances" »

July 12, 2007 at 12:00 AM | Permalink

Tom Chorneau and Haley Davies
San Francisco Chronicle

A landmark bill intended to overhaul California's $186 billion health care system won approval Wednesday by a key state Senate committee, setting up a showdown in the coming weeks.

Continue reading "Panel OKs health bill in Senate" »

July 12, 2007 at 12:00 AM | Permalink

Aurelio Rojas
Sacramento Bee

Sixteen months ago, while working as a contract registered nurse in San Francisco, Cynthia Campbell purchased a short-term health insurance policy.

Blue Cross of California refused to extend her policy after she used the plan once for a minor infection, Campbell said, and in a pinch she bought another short-term policy from Blue Shield of California.

Last summer, she worked a Friday shift, got sick over the weekend, and a week later was diagnosed with two aggressive forms of cancer -- rhabdomyosarcoma and adenosarcoma.

On July 20, her health insurance policy runs out and no one will insure her, Campbell told the Assembly Health Committee on Tuesday while testifying in support of Senate Bill 840.

Continue reading "Universal health bill advances -- but faces veto" »

July 4, 2007 at 12:00 AM | Permalink

Brynn Galindo
KGET-TV (NBC)

Watch the video of this report that aired on KGET-TV (NBC).

Local leaders joined your neighbors Wednesday morning on the Road to Reform the state’s health care system.

The goal of the Road to Reform Tour is to influence legislators before they make final negotiations on the state’s health care system.

The reform calls for affordability, cost of containments, and meaningful employer contributions.

Continue reading "Road to Reform Tour rallies healthcare reform support" »

June 28, 2007 at 10:01 PM | Permalink