It's OUR Healthcare http://itsourhealthcare.org/ The Campaign for Quality, Affordable Healthcare for All Californians. en Copyright 2008 Mon, 14 Jan 2008 18:15:00 -0800 http://www.sixapart.com/movabletype/?v=3.2ysb5-20051201 http://blogs.law.harvard.edu/tech/rss CALPIRG supports AB X1 1
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/.
]]> http://itsourhealthcare.org/blog1/news/calpirg_supports_ab_11.html http://itsourhealthcare.org/blog1/news/calpirg_supports_ab_11.html News Mon, 14 Jan 2008 18:15:00 -0800 Latino Coalition for a Healthy California supports ABX1 1
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

Download the pdf file

]]> http://itsourhealthcare.org/blog1/news/latino_coalition_for_a_healthy_2.html http://itsourhealthcare.org/blog1/news/latino_coalition_for_a_healthy_2.html News Mon, 14 Jan 2008 17:44:09 -0800 Consumers Union Favors ABX1 1
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)

Click here for the pdf version ]]> http://itsourhealthcare.org/blog1/news/consumers_union_favors_ab_1x1.html http://itsourhealthcare.org/blog1/news/consumers_union_favors_ab_1x1.html News Mon, 14 Jan 2008 16:58:39 -0800 Read the AARP's Letter to State Senator Kuehl on AB 1X1 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      

   
]]> http://itsourhealthcare.org/blog1/news/read_the_aarps_letter_to_state.html http://itsourhealthcare.org/blog1/news/read_the_aarps_letter_to_state.html News Mon, 14 Jan 2008 16:00:19 -0800 Read Health Access' ABX1 1 Summary
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.
]]> http://itsourhealthcare.org/blog1/news/read_health_access_abx1_1_summ.html http://itsourhealthcare.org/blog1/news/read_health_access_abx1_1_summ.html News Mon, 14 Jan 2008 14:44:18 -0800 Comprehensive Healthcare Legislation Passes CA Assembly  

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

]]> http://itsourhealthcare.org/blog1/news/comprehensive_healthcare_legis.html http://itsourhealthcare.org/blog1/news/comprehensive_healthcare_legis.html News Mon, 24 Dec 2007 09:04:50 -0800 SEIU California State Council Supports New Version of Healthcare Reform Bill, ABx1 1 The Largest and Fastest-Growing Labor Union in the State and the Largest Union of Healthcare Workers Says Proposal Provides the Framework Needed to Fix Healthcare

SEIU Press Release
December 17, 2007

(SACRAMENTO) -- The California State Council of the Service Employees International Union (SEIU) commended the Governor and the Speaker of the Assembly, Fabian Núñez, for the landmark health care reform proposal in ABx1 1.

"Our healthcare has been deteriorating," said Annelle Grajeda, president of both the SEIU California State Council and SEIU Local 721, "and individuals and families are being hit hard from all sides. We can pass this proposal and make our healthcare more secure and accessible, or do nothing and watch our coverage crumble even more. On behalf of the millions of Californians who can't afford to wait any longer, SEIU locals in California yesterday voted unanimously to support AB x1 1."

Grajeda pointed to the fundamental trends in healthcare that need to be fixed:

* Having a job and working hard no longer guarantees healthcare. Over 80% of California's 6.5 million uninsured are members of working families.
* Businesses are struggling to provide healthcare and many are dropping coverage. According to the UC Labor Center, only 57% of the population received coverage through their employers in 2004, down from 59% in 2000.
* Costs keep increasing. According to the Kaiser Family Foundation, healthcare costs increased 123% between 1990 and 2004, far more than inflation, economic growth, or wages.
* Preventive care is eroding as more people are forced into high-deductible, catastrophic plans and can't afford to take care of basic health needs.
* As individuals and businesses struggle, drug companies and some insurance giants like Blue Cross spend millions to stop reform because they profit from our current, flawed system.

SEIU leaders in California unanimously agreed that the health care reform proposal in ABx 1 1 is a solid foundation for fixing our healthcare.

"This proposal marks the most significant effort to secure our healthcare since Medicare and Medicaid were established in the 1960's," said Sal Rosselli, President of SEIU UHW (United Healthcare Workers-West). "It provides a strong foundation for fixing fundamental problems with healthcare that affect us all, whether we have insurance or whether we're among the millions who will gain coverage through this plan."

In making their decision to support AB x1 1, SEIU leaders highlighted the proposal's scope, ambition, and many strengths:

* First and foremost, AB x1 1 would expand coverage to nearly three quarters of California's uninsured -- 95% of Californians would be insured.
* With a sliding scale employer contribution between and 1 and 6.5%%, depending on the size of payroll, AB x1 1 establishes a minimum standard for employer-based health coverage, as historic and significant as the creation of the minimum wage.
* AB x1 1 helps make healthcare affordable for low and moderate-income Californians (up to 400% of poverty, around $82,000 for a family of four) and for early retirees above 400% between ages 50 and 64. It also includes hardship exemptions.
* AB x1 1 launches fundamental reforms to control costs, including:
    * Public disclosure by health insurers, hospitals, doctors and nursing homes of information on costs and quality
    * Bulk purchasing of drugs
    * Limits on insurance company profits and overhead
    * A new statewide purchasing pool with purchasing power 3-4 times as large as Cal-PERS
    * New prevention and wellness initiatives

"Years from now, we may identify this as the pivotal moment in the fight to transform our nation's health care system," said Andy Stern, International President of SEIU. "California is proving that it is possible, when we all work together, to make real change happen. If the most populous, most diverse state in the country can make health care happen, so can the rest of the country."

The proposal will face both a Senate vote in the near future and a popular vote in November 2008. SEIU continues to work with the Governor and legislative leaders on the legislation and the accompanying ballot measure.

"Families are struggling with serious and growing financial, emotional, and health problems as our healthcare system spins out of control," said Grajeda. "We urge the Assembly to seize this opportunity as an important first step towards achieving comprehensive healthcare reform this year. We can't afford to wait"

###

SEIU California State Council coordinates the state-level political and legislative efforts of California's largest union, SEIU, the Service Employees International Union. 650,000 members strong in California, we make our voices heard on issues that matter to working families: health care, living wages, secure retirement, safe staffing in hospitals, quality long-term care, ensuring that all children have a chance to succeed, and much more.

]]> http://itsourhealthcare.org/blog1/press_releases/seiu_california_state_council_1.html http://itsourhealthcare.org/blog1/press_releases/seiu_california_state_council_1.html press releases Mon, 17 Dec 2007 09:24:36 -0800 Employers Tell Workers to Get Healthy or Pay Up 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.

]]> http://itsourhealthcare.org/blog1/news/employers_tell_workers_to_get.html http://itsourhealthcare.org/blog1/news/employers_tell_workers_to_get.html News Tue, 04 Dec 2007 00:00:00 -0800 A Big, Unfortunate and Expensive Illustration for Health Reform By Hanh Kim Quach
Health Access California

The Wall Street Journal had this tragic story last week about a Merced man -- who was insured -- but still socked with a $1.2 million hospital bill (not counting thousands in doctor's office bills also).

What happened to Jim Dawson, of Merced, that landed with debt that could bankrupt him is a textbook example of what health consumer advocates have been fighting to reform for years.

Dawson had a good job with Valero Energy Corp., a big oil refinery. He had Valero-sponsored comprehensive health insurance policy, and a regular primary care physician who knew his medical history, *should* not have been vulnerable to medical-financial angst. That's at least what many think. But Dawson's story shows how anyone can be vulnerable.

]]> http://itsourhealthcare.org/blog1/blog/_a_big_unfortunate_and_expensi.html http://itsourhealthcare.org/blog1/blog/_a_big_unfortunate_and_expensi.html Blog Mon, 03 Dec 2007 13:36:05 -0800 Children caught in the middle 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.

]]> http://itsourhealthcare.org/blog1/news/children_caught_in_the_middle.html http://itsourhealthcare.org/blog1/news/children_caught_in_the_middle.html News Mon, 03 Dec 2007 12:21:49 -0800 Editorial: Small businesses need health care help 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.

]]> http://itsourhealthcare.org/blog1/news/small_businesses_needs_healthcare_help.html http://itsourhealthcare.org/blog1/news/small_businesses_needs_healthcare_help.html News Mon, 03 Dec 2007 01:36:37 -0800 At the Call of the Speaker By Hanh Kim Quach
Health Access California

Shane Goldmacher at Capitol Alert has the scoop on the most recent developments:

The Assembly sessions for December 5th and 6th are now postponed. There was an issue that they conflicted with retreats with the Assembly and Senate Republican caucuses, and it seems they need more time in negotiating on health reform.

We've heard from various Assembly offices that the Speaker has asked members to be available within 24 hours notice.

]]> http://itsourhealthcare.org/blog1/blog/at_the_call_of_the_speaker.html http://itsourhealthcare.org/blog1/blog/at_the_call_of_the_speaker.html Blog Thu, 29 Nov 2007 17:15:35 -0800 Not Just a Word, But a Challenge

By Anthony Wright
Executive Director
Health Access California

As health reform negotiations go on, I continue to be puzzled why the Governor has yet to publicly budge on having some--any--affordability standard for individuals in the context of a mandate. Any other politician, concerned about voter reaction, would not just include affordability in their plan, but lead with it. The presidential Democratic candidates, like Clinton, Obama, and Edwards, both provide assurances to voters than coverage will be affordable, both in terms of costs (tied to a percentage of their income), or in terms of benefits (for example, saying that people should have access to coverage as good as what Congress gets).

Some, like healthcare blogger Alan Katz, have criticized the notion of an affordability exemption--saying it undermines the point of a mandate. The Governor's team asks, "don't you want universal coverage?" Of course, but I think they misunderstand the point.

]]> http://itsourhealthcare.org/blog1/blog/not_just_a_word_but_a_challeng.html http://itsourhealthcare.org/blog1/blog/not_just_a_word_but_a_challeng.html Blog Wed, 28 Nov 2007 10:36:38 -0800 Study finds immigrants' use of healthcare system lower than expected 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."

]]> http://itsourhealthcare.org/blog1/news/study_finds_immigrants_use_of.html http://itsourhealthcare.org/blog1/news/study_finds_immigrants_use_of.html News Tue, 27 Nov 2007 00:00:00 -0800 Hospital drug errors far from uncommon 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.

]]> http://itsourhealthcare.org/blog1/news/hospital_drug_errors_far_from.html http://itsourhealthcare.org/blog1/news/hospital_drug_errors_far_from.html News Thu, 22 Nov 2007 00:00:00 -0800