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Legislative Recap on Health: #Health4All; Out-of-Pocket Costs; Medi-Cal, Etc.

The Senate and Assembly adjourned Thursday, one day ahead of the June 5th deadline to pass all bills out of the first legislative chamber. The good news is that most key bills of interest to health care consumers have passed out of the house of origin, while one bill, opposed by public health groups, was defeated. Bills moving forward deal with limits and protections against unfair out-of-pocket costs; efforts at improving Medi-Cal; and most notably a significant expansion of access to coverage for all regardless of immigration status.

These bills now head to the second half of the legislative process. For details on each bill, see our weekly bill matrix:…

Below the fold, full reports on:

* SB 4 To Take Historic Steps to #Health4All & Cover the Remaining Uninsured

* Patient Protection Bills To Limit Out-of-Pocket Costs

* Additional legislation on transparency, Medi-Cal, tobacco control, and more


The most-watched health bill was SB4, the first bill to pass a state legislative body that would explicitly expand coverage regardless of immigration status. The California Senate passed SB4 on a historic and bipartisan vote, 28-11, with all Democratic senators and 2 Republican senators voting in support. This bill, which continues California’s path to #Health4All, moves on to the Assembly Health Committee for consideration.

With last week’s amendments in the Senate Appropriations Committee, SB 4 would:

* Expand Medi-Cal eligibility to all children regardless of immigration status, as an entitlement;

* Expand coverage for undocumented adults as budget allocations will allow (to be decided each year in the budget, and that enrollment will be capped if funding runs out).

* By way of a Section 1332 waiver (a formal request to the federal government), SB 4 would allow all Californians to purchase coverage through Covered California using their own money.

Senator Ricardo Lara, author of SB 4, called the vote “historic” and one that Senators will remember long after their term is over. “We are talking about our friends, our families, our neighbors. Illness doesn’t care about our immigration status,” said Lara, describing the bill as still “realistic, balanced, and fiscally prudent.”

Several Senators rose to speak during the floor debate. From the opposing side, GOP Senators Jeff Stone, Janet Nguyen, and Bob Huff raised concerns about cost, arguing that expanding Medi-Cal was a “false promise” until the program addresses access issues. Several Democratic Senators responded to that argument, including Senator Richard Pan who stated, “We certainly need to make fixes to Medi-Cal, but certainly being on Medi-Cal is better than being uninsured.” Senator Isadore Hall derided “excuses,” Senator Ben Hueso wanted focus on the issue at hand: “We have a solution on the table, and we should move it forward.” Senator Hernandez rebutted concerns about cost: “The most inefficient way to provide health care is through the emergency room-we all pay for it.”

The most noteworthy speech was by GOP Senator Andy Vidak announcing his support for the bill while also raising the need to address Medi-Cal access issues and federal immigration reform. He and another Central Valley Republican, Senator Anthony Cannella, were the two GOP Senators to vote for the bill. Senator Nguyen abstained, with the rest of the caucus voting no.

This issue is currently pending in Budget Conference Committee as a $40 million item in the Senate’s budget proposal. The next week or two will make a big difference in whether enrollment under SB4 would start in the budget year 2015-16.


Four Health Access-sponsored consumer protection bills to prevent unfair out-of-pocket costs passed out of their “house of origin” this week and are heading to the second half and second legislative chamber in the weeks ahead. The remaining sponsored bill, AB 248 (Hernandez) on large employer junk insurance is further along in the process, having passed out of the Assembly several weeks ago.

* Requiring Accurate Provider Directories: SB 137 (Hernandez) would set standards for provider directories and establish more oversight on accuracy so people know whether their doctor and hospital are in network when they shop for coverage, change coverage, or try to use their coverage. SB 137 passed out of the Senate with bipartisan support. The final vote was 33-0.

* Preventing Surprise Bills: AB 533 (Bonta), which would protect patients from “surprise” bills from out-of-network doctors when they did the right thing by going to an in-network hospital, imaging center, or other facility, passed out of the Assembly with a vote of 74-1.

* Limiting Prescription Drug Cost Sharing: AB 339 (Gordon), which would prevent discrimination against consumers with health conditions by setting standards for cost sharing on prescription drugs passed out of the Assembly with a vote of 48-29.

* Capping Individual Out-of-Pocket Costs: AB 1305 (Bonta) on limitations on cost sharing in family coverage passed out of the Assembly with a vote of 78-0. This bill ensures that the ACA individual out-of-pocket maximum (now $6,600) will apply to individual patients-even if they are in a family plan (which has an overall family out-of-pocket max of $13,200).

* Prohibit Subminimum Coverage: AB 248 (Hernandez), which would prohibit sale of subminimum coverage by insurers to large employers passed out of the Assembly several weeks ago with a vote of 51-27 and will next be heard in Senate Health.


SB546 (Leno) would advance transparency in our health system by extending rate review to large group health coverage. This bill, which requires justification of above-average rate increases, passed out of the Senate with a vote of 23-16.

Other transparency bills faltered earlier this year, including SB 26 (Hernandez), which sought to create a health care cost and quality database, was held in Senate Appropriations Committee amid questions on how to finance it. Earlier in the process, AB 463 by Assemblyman Chiu to facilitate more disclosure on prescription drug costs was stalled in Assembly Health Committee. These efforts will likely be revisited in future years.


Several bills designed to improve the Medi-Cal program, which now covers almost 12 million Californians, advanced out of their house of origin.

* SB 33 (Hernandez), which would limit estate recovery in Medi-Cal to the federally required minimum of long-term care services and eliminate recovery from the estate of a surviving spouse of a deceased beneficiary, passed out of the Senate with a vote of 33-0.

* AB 1231 (Wood), which would facilitate practical access to Medi-Cal specialty care through coverage of nonmedical transportation, also passed out with a vote of 76-0.

* AB 635 (Atkins), which would require the Department of Health Care Services to seek federal funding to establish a program to provide and reimburse for certified medical interpretation services to Medi-Cal beneficiaries with limited English proficiency, passed out of the Senate with a vote of 72-2.

* AB 366 (Bonta), which would require the Department of Health Care Services (DHCS) to report to the Legislature on Medi-Cal access passed out of the Assembly with a vote of 77-0.  Originally introduced as a measure to restore Medi-Cal provider reimbursement rates and bring them up to Medicare levels in future years, this bill came out of the Appropriations Committee’s suspense hearing significantly scaled back in scope. A companion measure SB 243 (Hernandez) was held in Appropriations during the suspense hearing and is not moving forward.


A handful of bills aimed at the negative health impacts of tobacco use passed, including SB 151 (Hernandez) to raise the smoking age from 18 to 21. SB 140 (Leno), which would revise the definition of tobacco products to include e-cigarettes, thus subjecting such products to the same regulations as other tobacco products, passed out of the Senate with a vote of 25-12.  Public health groups, including the Heart Association, Lung Association, and Health Access supported that measure and opposed the related bill SB 24 (Hill), which did not classify e-cigarettes as tobacco. Research suggests that e-cigarettes have much the same negative effect as cigarettes. SB 24 (Hill) failed passage.  


A full matrix of the latest on all active bills supported by Health Access and other health and consumer advocates is available online (here). That list includes ACA implementation legislation like SB 43 (Hernandez), which would extend the sunset date on essential health benefits standards from 2016 to 2018 and incorporate recent changes in federal guidance regarding habilitative care (services that help you keep, learn, or improve skills and functioning for daily living); AB 1117 (Garcia) would help bring more resources to Medi-Cal to improve immunization rates for 2-year-olds and AB 1299 (Ridley-Thomas) seeks to improve the delivery of mental health services for foster youth.


Now that these bills have passed the critical house of origin deadline, they will next be heard in the “other house,” meaning if the bill was introduced in the Assembly, it will be heard in the Senate, and if the bill was introduced in the Senate, it will be heard in the Assembly. Committee hearings will resume on June 8th. Policy committees have until July 17th to meet and report bills out of committee.

This blog entry is cross-posted at It was written by Sawait Hezchias-Seyoum, Health Care Policy Advocate, Health Access. Stay tuned for tools and talking points to bring these bills to the finish line.  

State Budget Preview: Medi-Cal, #Health4All, other health investments needed

The annual state budget process, which began in January, comes into focus later this week when the Governor releases the May Revision of his proposed 2015-16 budget. Health and community advocates are urging the Governor and the Legislature to include funding for critical health programs in upcoming budget negotiations. These investments continue the Affordable Care Act’s momentum by removing barriers to coverage, ensuring those covered in Medi-Cal get access to care along with important benefits, and extending coverage to the remaining uninsured.

The deadline for the Legislature to pass and the Governor to sign a budget is June 15. The Governor’s May Revision sets the stage for a short month of negotiations, shaped by information about how much of a surplus is available given the state revenues that came in during April tax time, and constitutional formulas that limit the use of these funds.

Recent Budget Subcommittee Hearings: Since introducing the budget in January, the legislature’s budget subcommittees have reviewed the Governor’s proposed budget along with budget requests from advocates. In recent days, the Senate and Assembly Budget Subcommittees on Health and Human Services completed their reviews of the Governor’s proposed budget, along with a range of urgent and needed health investments that were not included in the Governor’s proposed budget, from expanding coverage without regard to immigration status to limiting estate recovery in Medi-Cal to restoring Medi-Cal benefits. The subcommittees left most of these items open for further discussions pending the May Revision. Many consumer and community organizations including Health Access California were on hand to strongly support these critical investments.

Immigrant Health Care. Although the Affordable Care Act made health coverage possible for millions of Californians, it excludes undocumented immigrants currently living and working in any state. If and when the President’s executive order on immigration is upheld in court, those newly eligible for deferred action will have access to Medi-Cal. Advocates are proposing to expand that access to all Californians income eligible for Medi-Cal, without regard for immigration status, as proposed in SB 4 (Lara). The cost would be a small fraction of last year’s proposal, amounting to only 2 more cents for every dollar spent on Medi-Cal, but would make a world of difference for not just immigrant families, but for our health system and society.

Estate Recovery. Advocates are also seeking that California limit Medi-Cal estate recovery to costs associated with long term care services and supports, consistent with minimum federal requirements. Last year, the Governor vetoed a bill to limit Medi-Cal estate recovery, arguing the policy change should be considered in the budget instead. Health Access will continue to vigorously advocate for this policy change so that older low-income Californians don’t have to make a trade-off between seeking health care coverage and keeping their family home.

Restore Medi-Cal Benefits Eliminated in the 2009-10 Budget. Major cuts were made during the budget crisis that have yet to be restored, including Medi-Cal rates and benefits, and consumer advocates including Health Access request undoing those cuts. In this part week, the budget subcommittees heard a proposal to restore non-federally mandated yet critical Medi-Cal benefits that were eliminated for budgetary, not policy reasons, in response to the state fiscal crisis. They include, among other things: acupuncture, audiology, chiropractic, podiatry, speech therapy, and full restoration of adult dental coverage. Partial restoration of adult dental was done in the 2013-14 budget, which gives Medi-Cal beneficiaries access to preventative care, restorations, and full dentures. However, important services such as gum treatment and partial dentures or implants are still not covered in Medi-Cal. According to a recent study published in Health Affairs, California emergency departments experienced a spike in visits for dental issues after comprehensive dental benefits for adults were cut from Medi-Cal. The study further found that the lack of adult dental benefits shifts dental care needs to costly emergency departments where dental issues are not adequately addressed.

Medi-Cal Provider Rates. Many providers and consumer groups have sought to rescind the 10 percent Medi-Cal provider rate cut, which will encourage more providers to participate in Medi-Cal and help increase access for Medi-Cal beneficiaries. In fact, California’s Medi-Cal provider reimbursement rates are among the lowest in the nation, making access to doctors, specialists, and beneficiaries harder for some of the 12 million Californians with Medi-Cal coverage.

What’s Next: The Governor is expected to release his May Revision of the budget later this week. The budget subcommittees will then hold hearings to review the May Revision the following week (May 18-22), and the Budget Conference Committee will convene at the end of the month to hash out differences between actions taken by the two houses. A final budget must be passed by June 15th. Stay tuned for updates!

Boxer & Feinstein sign letter in support of a strong public option…

Cross-posted from the Health Access Blog…

Thirty U.S. Senators, including both California Senator Barbara Boxer and Senator Dianne Feinstein have signed a letter to Senate Majority Leader Harry Reid in strong support of a public health insurance option in health reform.

It’s a good letter that was circulated by Senators Brown, Rockfeller and Feingold, and we are proud that our two California Senators have signed on with a majority of the Democratic Caucus for this to be part of health reform.

Over the flip is the letter in full, and status report of where we are in the process of getting health reform this year:

Dear Majority Leader Reid:

We have spent the better part of this year fighting for health reform that would provide insurance access and continuity to every American in a fiscally responsible manner. We are concerned that – absent a competitive and continuous public insurance option – health reform legislation will not produce nationwide access and ongoing cost containment. For that reason, we are asking for your leadership on ensuring that the merged health reform bill contains a public insurance option.

As it stands, the health insurance market is dominated by a handful of for-profit health insurers that are exempt from the anti-trust laws that ensure robust competition in other markets across the United States. Without a not-for-profit public insurance alternative that competes with these insurers based on premium rates and quality, insurers will have free rein to increase insurance premiums and drive up the cost of federal subsidies tied to those premiums. This is simply not fiscally sustainable.

We recognize that the two Committees with jurisdiction over health reform – the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee – have taken two very different approaches with respect to this issue. However, a strong public option has resounding support among Senate Democrats – every Democrat on HELP, three quarters of those on Finance, and what we believe is a majority of the caucus.

The Senate Finance Committee included a cooperative approach to insurance market competition. While promoting more co-ops may be a worthy goal, it is not realistic to expect local co-ops to spring up in every corner of this country. There are many areas of the country where the population is simply too small to sustain a local co-op plan. We are also concerned that the administrative costs associated with financing the start-up of multiple co-op plans would far outstrip the seed money required to establish a public health insurance program.

Opponents of health reform argue that a public option presents unfair competition to the private insurance companies. However, it is possible to create a public health insurance option that is modeled after private insurance – rates are negotiated and providers are not required to participate in the plan. As you know, this is the Senate HELP Committee’s approach. The major differences between the public option and for-profit plans are that the public plan would report to taxpayers, not to shareholders, and the public plan would be available continuously in all parts of the country. The number one goal of health reform must be to look out for the best interests of the American people – patients and taxpayers alike – not the profit margins of insurance companies.

Health reform is about improving access to health care, containing costs, and giving Americans a real choice in the insurance plan best suited to their needs. We urge you to fight for a sustainable health care system that ensures Americans the option of a public plan in the merged Senate bill.

I was in Washington, DC earlier this week, and had lots of conversations about health reform with folks in and out of the Capitol. There’s a long way to go, but it was clear that there’s significant momentum for health reform, and while there are specific and tough issues to work out–details that matter–it was good that the debates were largely over the right issues: affordability, employer responsibility, the structure of insurance regulation and the new exchange, and yes, the need and structure of a public health insurance option.

On the Senate side, the Senate Finance bill is slated to be voted upon next Tuesday. When that happens, all five committees of jurisdiction (3 in the House, 2 in the Senate) will have passed a major health reform bill, all with similar frameworks, even if the details–which are very important–are different. There are already negotiations about the Senate Finance bill’s merger with a more-consumer friendly Senate HELP Committee bill. A combined bill is likely to start being debated on the floor of the Senate the week after that.

We need to continue to advocate with our members of Congress–our two Senators, and our full House delegation–on all these issues.

Let’s Get It Done! Health Reform rallies all this week!

(Events in SF and Modesto today. Details over the flip. – promoted by Brian Leubitz)

Cross-posted from the Health Access Blog

The health care reform story was of the town halls, but it may not be the story you’ve been told. While opponents of health reform certainly did mobilize at the beginning of the month–and got a disproportionate amount of media attention for their disruptive ways, the attention has galvanized supporters.

Getting reports from town halls from Rep. Susan Davis in San Diego to Rep. Pete Stark in the East Bay, supporters are outnumbering opponents. In town halls by Representatives Xavier Becerra, Laura Richardson, Judy Chu, and Diane Watson–opponents didn’t even have a visible presence. As people recognize the stakes, health reform supporters are rallying even in red areas, outnumbering opponents 3-1 in Republican Representative John Campbell’s district, according to the Orange County Register.

Congress goes back to work on September 8th–so this first week of the month is our last chance to make a strong impression as we send our representatives back to DC.

That’s why this week, advocates for health reform, including Health Access California, California ACORN, California Partnership, Organizing for America, MoveOn, and Health Care for America Now (HCAN) – the nation’s largest health care campaign, will have a week-long series of “Let’s Get It Done!” events. With rallies in Fresno, Modesto, San Francisco, and Los Angeles, Californians will come together to rally for health insurance reform now–including one that ensures affordability, and provides a choice of a public health insurance option.

The details, including dates, times, and locations, are below the fold…

The “Let’s Get It Done” rallies in Fresno, Modesto, San Francisco, and Los Angeles, will be one of thousands of events taking place nationwide between now and when legislators head back to Washington, DC on September 8th.  These events involve everything from rallies, town halls, and press conferences to phone banks and canvasses in every state and virtually every Congressional district across the country.

* Tues, Sept 1st: 5:00pm, at the Fresno Amtrak Station, 2650 Tulare Street

* Wed, Sept 2nd: 5:00pm, at the San Francisco City Hall, 1 Dr. Carlton B. Goodlett Pl

* Wed, Sept 2nd: 7:30pm, at the Modesto Office of Rep. Cardoza, 1010 10th Place

* Thur, Sept 3rd: 5:00pm, at the Los Angeles State Park Cornfield, 1245 N. Spring St.

We hope that Californians can come out!


For more information, contact Health Access at, or:

Sacramento · (916) 442-2308 · 1127 11th Street Suite 234 · Sacramento · CA · 95814

Oakland · (510) 873-8787 · 414 13th Street Suite 450 Oakland · CA · 94612

Los Angeles · 1930 Wilshire Blvd, Suite 1210, Los Angeles, CA 90057 (213)413-3587  

Where are we, and CA’s members of Congress, on health reform?

(A great wrap-up of where we stand on federal health care reform and how the California delegation is doing. – promoted by Brian Leubitz)

Edited and updated from the Health Access Blog

Yesterday, Speaker Nancy Pelosi kicked off her August recess by meeting with health care providers and patients at San Francisco General Hospital, to promote President Obama’s health reform effort.

With the passage of H.R.3200 out of Energy and Commerce on Friday, and the other relevant committees earlier in July, she could rightly report historic progress. Such a health reform proposal has now moved farther than any previous attempt in the modern era, and it set the stage for a House vote in September after the August recess.

But health care reform hangs in the balance, with opponents of the President detemined to “rattle” Congressman by disrupting town hall meetings and otherwise create an anti-reform political environment. As has been stated on Calitics before, those who support health reform need to be active NOW AND THROUGH AUGUST, CALLING, WRITING, FAXING, and VISITING our California Congressional Representatives, with a positive message about reform and its various components, from a public health insurance option to minimum benefits standards to affordability subsidies to the financing that allows for the needed upfront investments.

Californians have a particularly important say in health reform in the House of Representatives, from the Speaker to key Committee Chairmen, to Caucus leaders, to the bulk of our 53-member delegation. Health reform supporters can call your member of Congress in support of health reform at 877-264-HCAN, or click here to help pass reform.

Below the fold, we’ll detail more about the bill, the process, and where California’s Congressional representatives have come down on health reform to date:

THE BILL: The House proposal, America’s Affordable Choices Act, H.R.3200, would dramatically secure and expand health coverage:

* making it more likely than people get and keep their on-the-job health benefits;

* improving and expanding public health coverage programs like Medicaid;

* providing significant subsidies for low- and moderate-income families to be able to afford health coverage; and

* placing new rules and oversight over insurers to protect consumers, from prohibiting denial for pre-existing conditions, to limiting out-of-pocket costs; to ensuring a minimum benefit package; to providing a public health insurance option for consumers to choose.

Intertwined in the overall package is a range of efforts to contain rising health care costs, from prevention and public health initiatives to better use of information technology and bulk purchasing.

Especially as this bill gets negotiated with what might come out of the Senate, there will be specific issues and advocacy around affordability, financing, employer responsibility, inclusivity, benefits, and the public health insurance option. But moving the bill is crucial to attain those goals, and the House bill, H.R.3200, is a comprehensive vehicle that is supported by dozens of leading consumer, labor, community, patient, and provider organizations, including Health Access California.

THE AUGUST RECESS AND AFTERWARDS: The August recess, as both Senators and Representatives spend more time in their states and districts, is seen by both supporters and opponents of health reform as a crucial time to sway Congressmembers on the high-profile issue.

In addition to a House vote after the recess, the Senate Finance Committee is planning to unveil and consider its’ version of health reform after the break by September 15th. Under this new timeline, a product from that committee would be joined with the Senate Health Committee passed a few weeks ago, and be considered on the Senate floor soon afterwards.

THE ACTION IN THE HOUSE: The Energy and Commerce Committee passed H.R. 3200 by a vote of 31-28. The vote was supported by all but five Democrats, and included the support of the six California Democrats on the panel: Chairman Henry Waxman, as well as Anna Eshoo, Doris Matsui, Jane Harman, Lois Capps, and Jerry McNerney. All Republicans opposed the measure, including the two California Republicans: George Radanovich and Mary Bono Mack.

This committee was the last of three committees to consider and pass out the historic legislation.

* In the House Education and Labor Committee, all the California Democrats voted for H.R.3200, including Chairman George Miller, as well as Lynn Woolsey, Susan Davis, and Judy Chu. The California Republicans voted against it, including Howard “Buck” McKeon, Tom McClintock, and Duncan Hunter.

* In the House Ways and Means Committee, chaired by Rep Charlie Rangel of New York, all the California Democrats voted for H.R. 3200, including Health Subcommittee Chairman Pete Stark, as well as Xavier Becerra, Mike Thompson, and Linda Sanchez. California Republicans voted against it, including Wally Herger and Devin Nunes.

Health advocates are urging members to THANK the members that voted for the health reform bill.

CALIFORNIANS IN CHARGE: California consumers are uniquely suited to have their voice heard in this debate. In the House of Representatives, California is well represented in this debate, from Speaker Nancy Pelosi, to key members of leadership like Representative Xavier Becerra, on down.

Each of the three committees of jurisdiction for health reform has a senior Californian in a top leadership position: Rep. Henry Waxman chairs the Energy & Commerce Committee; Rep. George Miller chairs the Education & Labor Committee, Representative Pete Stark is the second senior member of the House Ways & Means Committee, and the chairman of the health subcommittee. Given this leadership and authorship, H.R.3200 can be seen as “made in California.”

Californians were also integrally involved in the back-and-forth that led to the final agreement allowing passage from the final committee in the House.

California also has the largest contingent of “Blue Dogs” Democrats, who are self-described as more conservative, and who have been advocating concerns and changes to the health care legislation. However, of the seven California Blue Dogs, five have generally been supportive of health reform. By the beginning of the year, California Representatives Joe Baca, Mike Thompson, Jane Harman, Loretta Sanchez, and Adam Schiff signed on in support of Health Care for America Now! principles, and have been supportive of health reform in general and of the public health insurance option in specific. These five members declined to sign a “Blue Dog” letter that opposed health reform without specific changes.

The two other California “Blue Dogs” are Representatives Jim Costa and Dennis Cardoza, both of the Central Valley , and both signed onto that letter urging changes to the health reform. While neither was on a relevant committee, the signing of the letter gave support to the group that did negotiate for a delay in the house floor vote and that got amendments to the bill, including on the public health insurance option and reducing affordability subsidies. Ultimately, a compromise was reached where some (but not all) of the “Blue Dogs” on the Ways and Means Committee agreed to support the bill.

That compromise was a concern to progressive members, including many Californians. A letter signed by 57 members (14 from California!) of the Progressive Caucus and the Tri-Caucus circulated in the last week gave strong support to health reform but warned “we will not support a weakened public option.” In addition to the leadership of Progressive Caucus Chair Lynn Woolsey, Black Caucus Chair Barbara Lee, and Asian Pacific American Caucus Mike Honda, other California Representatives who signed the letter included Lucille Roybal-Allard, Laura Richardson, Maxine Waters, Judy Chu, Diane Watson, Jackie Speier, Bob Filner, Linda Sanchez, Grace Napolitano, Sam Farr as well as Pete Stark.

Further negotiations ensued between Chairman Waxman, Blue Dogs, and Progressives who were concerned with the Blue Dog compromise, leading to additional “unity amendments” to the bill that sought to bridge the differences, most notably to find savings to maintain the affordability subsidies for low- and moderate-income families.

ACTIONS: Health and consumer advocates, including Health Access California and Health Care for America Now!, are urging Californians to CALL, WRITE, AND VISIT their Congressional representatives this week and through August in support of health reform. Opponents are mobilizing to chip away at the support for health reform, and we need to be clear about the urgency, the need, and the popularity of reform.

Call Congress at 877-264-HCAN, or click here write to help pass reform.

* In particular, Californians should THANK the members of the various committees that voted for H.R.3200, including: Henry Waxman, George Miller, Pete Stark, Xavier Becerra, Anna Eshoo, Doris Matsui, Jane Harman, Lois Capps, Jerry McNerney. Lynn Woolsey, Susan Davis, Judy Chu, Mike Thompson, and Linda Sanchez.

* Californians should THANK the Progressive members that are advocating strongly for a robust public health insurance option and for affordability subsidies for low- and moderate-income Californians, including: Lynn Woolsey, Barbara Lee, Mike Honda, Lucille Roybal-Allard, Laura Richardson, Maxine Waters, Judy Chu, Diane Watson, Jackie Speier, Bob Filner, Linda Sanchez, Grace Napolitano, Sam Farr and Pete Stark.

* Californians should THANK the “Blue Dogs” that have distanced themselves from that caucus to be supportive of health reform, of the Health Care for America Now! principles, and of the public health insurance option, including Joe Baca, Mike Thompson, Jane Harman, Loretta Sanchez, and Adam Schiff.

* Finally, and most importantly, Californians should URGE California Representatives Jim Costa (D-Fresno/Bakersfield) and Dennis Cardoza (D-Merced/Modesto) to come out in support of health reform and H.R.3200. The Blue Dogs got key amendments that should address their concerns, and nowhere in the state or nation is in more need of health reform than the Central Valley of California.

* While you are at it, call California Senators Barbara Boxer and Diane Feinstein in support of health reform as well.

Call your member of Congress at 877-264-HCAN, or click to help pass reform.

The packaging of Prop 1A…

(Health Access has been one of the early leaders in the fight against 1A. – promoted by David Dayen)

Cross posted at the Health Access WeBlog

So much of the campaign around Prop 1A is to package it with the other initiatives, and then sell the entire package as a whole, even though the parts are very different, with different consequences.

The Governor has made two arguments. One is to sell the package as the ultimate solution to our budget crisis: “We have a chance to fix this once and for all.” he told the LA Times. But no one believes that. Not the LAO. Not his own budget crunchers. Not the budget passed earlier this year, nor the pending ballot measures package, solve the fundamental issue of the mismatch between the level of services the state provides and that Californians needs, and the revenues the state brings in. Severe cuts were made, but the revenues are temporary–with or without these initiatives. And even in the short-term, given the extent of the economic crisis, California has a significant deficit on May 20th regardless of the election results on May 19th.

Unable to continue the positive argument with a straight face, there’s a new line. As has been reported here at Calitcs, the new tact has been arguing that the state will fall off a cliff if the package is voted down.

But let’s tease out the package: Proposition 1A will have zero impact on the deficit on May 20th. The impacts of its passage don’t kick in for a few years, whether of additional revenues for 1-2 years in 2011-13, or the long-term constitutional contraints on spending and investment.


The measures that do have an impact on the deficit on May 20th are Propositions 1C, and to a lesser extent, Props 1D & 1E. Proposition 1C would allow the state budgeters to book $5 billion in “budget solutions.” While some may question the wisdom, the policy, the impacts, or even the actual ability of California to “securitize” the lottery, it’s Proposition 1C’s failure that will make the deficit $5 billion bigger.

Similarly, if Props 1D & 1E are voted down, and the general fund is thus not able to take money from voter-approved funds for services for children and the mentally ill, then the general fund deficit is somewhat bigger, but at a smaller scale–less than $1 billion for both measures.

(This is not an argument for 1C, 1D, or 1E, but simply a refutation that 1A has anything to do with impacting our current budget situation.)

It would be more forthright if the proponents, to justify their alarmist rhetoric, at least focused on Proposition 1C, arguing that if that measure goes down, the budget outlook of tough decisions on cuts or taxes would be significantly worse. But they don’t think they can sell it. So they are trying to package it with the other measures, and use the elements of Prop 1A to somehow sell Proposition 1C.

Besides, the Governor in particular sees his legacy in Prop 1A. As he said to the LA Times, “I mean, I’ve been fighting for five years now for budget reform, to put a rainy-day fund aside and to put a certain cap on spending. I wasn’t successful. I tried through the Legislature when I first came into office; I tried in 2005 to go directly to the people, but apparently it wasn’t inclusive enough so that failed — the idea was good but it failed. And so here was our chance again….”

There’s an irony here. The Governor failed in 2005 to pass a spending cap in Proposition 76, which was not popular from the start. Voters didn’t like placing limits on the services they depend on–education, health care, public safety, etc; nor did they like giving the Governor unilateral authority to make certain cuts. (I believe they still don’t.) The opponents used Proposition 76 to help discredit the Governor and the entire package, including other measures that ended up losing by much closer margins.

Now the Governor is trying again with another spending cap proposal, but this time trying to use it to prop up his entire package. But the cap is a fundamentally unpopular proposal to begin with, so I don’t know if it will be successful this time around. It seems to be a strange strategy, given recent history.

The challenge of children’s coverage…

Cross posted at the Health Access WeBlog.

Last week, Families USA released a report, Left Behind: America’s Uninsured Children, which detailed that there are 8.6 million uninsured children in the United States, using 2005-7 averaged numbers from the U.S. Census Bureau.

Over 1.25 million of those uninsured children are in California. There are other estimates, using different definitions, that are a bit lower, but the scale is similar: there are simply too many kids, overwhelmingly with working parents, who are not covered. Not surprisingly, they typically have worse health status. And their parents are one emergency away from financial ruin.

The saddest part is that until recently, California was making real progress on the goal to universal children’s coverage.

(The challenges after the jump…)

While employer-based coverage was being scaled back, especially for dependents (such as spouses and children), public insurance programs like Medi-Cal (Medicaid) and Healthy Families (SCHIP) were more than picking up the slack. In the recent economic downturn, we’ve seen even further increases in enrollment in Medi-Cal, which covers over 6.6 million Californians–about half of them children, and in Healthy Families, which just hit the 900,000 enrollment level. Several counties offer a “Healthy Kids” coverage program with more expansive eligibility rules, to get all kids covered.

But in the last year, California’s effort to cover all children has slipped.

* President Bush vetoed efforts for a full reauthorization of the State Child Health Insurance Program (SCHIP), throwing California’s version of the program, Healthy Families, into some uncertainty. The federal program needs to be reauthorized by March 2009.

* California’s budget crisis has taken its toll: Unless the Legislature intervenes, the board that runs Healthy Families is considering stopping enrollment and creating a waiting list for Healthy Families that would deny coverage to over 160,000 children.

* Yet the Legislature, in an effort a few months ago to make cuts (the alternative of revenues having been blocked by by Republican legislators), has already passed additional burdensome reporting requirements that will have the effect of dropping over 250,000 children off of Medi-Cal coverage. And Governor Schwarzenegger, using his line-item veto, also made it harder for children to get enrolled into coverage in the first place.

* Also, many of the local “Healthy Kids” programs are running out of money as well, and thousands more children may be disenrolled without state assistance.

* Finally, this is in a context of an economic downturn that may mean more children losing private coverage that their families get through an employer or buy directly, and so these cuts come at a time when these public programs are actually in greater demand.

This issue isn’t a tough policy puzzle: we know exactly what we need to do to cover virtually all children; the question is raising the money needed, as part of deciding our priorities and choices as a state. The issue has never lacked for individual champions, whether outgoing Assembly Budget Chair John Laird, or incoming Senate President Pro Tem Darrell Steinberg, or many other legislators past and present.

What we need in these tough times is collective leadership, from the Governor and legislative leaders of both parties, that children’s health coverage is a priority that needs to be preserved despite–actually, especially because of– these tough economic times.

The new legislative session starts today. Children’s coverage is not the only, or even the biggest, health care issue on the agenda, but given the challenges outlined above, it is the most urgent.

Remembering Prop 56 As We Debate the 2/3 Requirement

(Some history worth noting from the last time we tried to fix the 2/3 requirement. – promoted by Brian Leubitz)

Crossposted at the Health Access WeBlog

There’s renewed interest in reforming the budget process, from “consequences” for legislators for not passing a budget (like having them lose their pay for every day the budget is late), to changing the abnormally high 2/3 threshold to pass a budget and taxes (so that a minority of legislators don’t have a veto over the entire process).

As Aurelio Rojas reports in the Sacramento Bee, a previous initiative attempted these and other reforms, but that effort, Proposition 56 in March 2004, only got 36% of the vote. But it is also important to remember context, including a recall election a few months earlier in October 2003 where Californians had a chance to vent their anger and believe that a new Governor was enough to fix the problem, and competing budget initiatives that had bipartisan support, which hindered attempts at making the case for the need of additional reform.

This is not revising history four years later. This is what we wrote the day after that election. (Yes, we were blogging back then!) I added emphasis, in part, to show how much things have, and haven’t changed since March 2004:

While health care was not on the ballot, this past election has significant impact on health care, and the shape of the budget debate moving forward. Propositions 57 & 58 passed by a wide margin, while Proposition 56 failed.

SETBACK ON 56: The defeat of Proposition 56, to be clear, was a setback for health care advocates. The reforms were needed to stop the ongoing cycle of late and irresponsible budgets, and to change the dynamic of the budget process that has gotten us into our current crisis. Advocates will have to find different ways to keep legislators accountable to budget decisions, including decisions to cut health programs. In the long term, the lack of reform continues to make it difficult to win the broad reforms needed to meet the health care needs of all Californians, and the ultimate goal of quality, affordable health care for all.

ELECTION ANALYSIS: A combination of factors conspired against Proposition 56. With no real contest in the presidential primary contest, it was a remarkably low turnout election, with an electorate seemingly exhausted from the historic recall election just a few months ago. The recall and change in Administrations also changed the dynamic of the race: much of the voter demand for change had dissipated. The reform agenda in the Budget Accountability Act was overwhelmed by the focus on Propositions 57 & 58, which were similar sounding and were also billed as the solution to the state’s budget crisis. Among the choices, Proposition 56 was the only initiative that had a funded opposition, which was successful in raising questions about the provisions. When voters are confused about an issue, they tend to vote “no.” And in this case, they felt they did their part to address the budget problem by supporting 57 & 58, something that was supported by most political leaders.

This is not to say that a new effort at budget reform and accountability will be successful, but just to indicate that the results in early 2004 are not predictive: Prop 56 was a victim of uniquely bad timing.

Making the case: putting the economy front and center in the budget debate

Those who believe in investing in health care, education, and other vital services appropriately focus in the budget debate on the devastating impact of the specific budget cuts.

Those who oppose the revenues and taxes that are needed to find those programs generally make a broad anti-tax argument, often with an economic case. Witness many of the Republican Assemblymembers who spoke during the five hour+ debate on Sunday.

But the fact is, it’s the investment that helps the economy, and we should make that case more often. Noted academics Steve Levy and Manuel Pastor had an excellent Sacramento Bee op-ed that makes this very point.

In a recent study “Significant Side Effects: The Economic Impacts of Health Care Cuts in California Communities,” Health Access California (my organization) looked at just the health care cuts: and the comparison is stark. It finds that, due to federal tax deductions and matching Medicaid dollars, preserving California’s health care budget would have three times the positive economic impact as preventing an equivalent amount of increased taxes for upper income Californians.

In fact, the worst thing you could do for an economy is make health care cuts, which means twice the impact just from the lost federal matching funds denied to our economy. There are also economic ripple effects, from lost jobs and wages, increased private health premiums, and more.

Money spent on health care immediately goes into circulation, through wages and vendors, which then gets recycled and multiplied in the economy. In contrast, an upper-income bracket tax impacts money that may be in the economy, or may simply be in the bank. Also, state income taxes are deductible on federal returns, which means that translates to be 35% less to the upper-income family, and in effect, more money in the California economy, courtesy of DC.

We need to forcefully rebut arguments that make economic claims about taxes without considering the economic repercussions of the cuts. Preventing the cuts is not just good for our health, but the health of the economy as well.

Cross-posted at the Health Access WeBlog.

The stakes in the budget debate: 1 million more uninsured, and more…

Cross posted from the Health Access Weblog.

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

Unfortunately, the Governor’s cuts-only budget goes in completely the opposite direction, making our health care system even more broken, and leaving more people uninsured. Today, Health Access California is releasing a report that reveals the full magnitude of the cuts the Governor proposes–with over one million more Californians uninsured. While the Legislature has adopted some of these cuts and rejeced others, all of these proposals are on the table until a budget solution is agreed to.

This has gotten attention in the Sacramento Bee, the Los Angeles Times, and the Contra Costa Times.

Details under the fold…

New Analysis Reveals Full Impact of Governor’s Health Cuts:

One Million More Californians Would Lose Health Coverage

* Permanent Policy Changes, Not One-Time Cuts, Would Hinder Reform

* Magnitude of Cuts Would Have Ripple Effects Through System

* Health Consumers and Providers Urge Alternative to Cuts-Only Budget

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

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

The report is available on the front page of the Health Access California website, and directly at:

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

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

* The Governor’s budget is not proposing one-time budget savings, but lasting policy changes and coverage reductions for the health care system.

* A snapshot of the savings in the budget year does not reveal the full impact in the following years, once the reductions have been enacted and all the administrative changes have occurred to continue the reductions.

* Finally, the cumulative impact of all the proposed cuts, when added up together, suggests that the magnitude of the cuts-with more than a million more uninsured-will have impacts not just on specific programs but on the entire health care system on which we all rely.

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

The cuts include:

* A roll-back of eligibility for basic Medi-Cal coverage for low-income working parents to well below the poverty level. (429,000);

* Additional paperwork burdens for children and adults, requiring reports every three months in order to avoid disenrollment (471,500);

* Suspension of already-passed legislation to streamline child enrollment (97,000)

* Increased premiums for children’s health coverage, leading to decreased enrollment (60,000).

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

The report includes appendices that include:

* a county-by-county breakdown indicated the increase in the uninsured by county by 2010, the last year of the Schwarzenegger Administration;

* a chart comparing the policy changes in the Governor’s budget that would restrict coverage, to the health reform proposal supported by the Governor earlier this year to expand coverage; and

* a further detailing of the populations that under the proposed cuts would be forced to pay more or get less benefits, totaling 3.5 million Californians.

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

* an increased burden on “safety net” providers, from emergency rooms to hospitals to community clinics-many of which are dealing with direct cuts of their own;

* a cost-shift, from both the uninsured and reduced Medi-Cal provider payments, to private purchasers of health care-which likely means increased premiums; and

* worse health and economic impacts for California communities, from the destabilizing impact of more children uncovered and getting sicker, to more families facing medical debt and bankruptcy for being uninsured.

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