(Cross posted from the Health Access WeBlog)

The news coverage of the budget, if anything, has downplayed the impact of the budget on health care. Let me focus on what we consider is the biggest of the cuts newly announced yesterday, that would impact the most number of people.

The San Francisco Chronicle mentions that the Medi-Cal eligibility cut would mean that “40,000 poor working parents, who now receive comprehensive Medi-Cal coverage, would have their benefits reduced if they earn more than about $12,000 for a family of three.”

Actually, these parents, who would make roughly $10,736-$17,600/year for a family of three, would lose access to Medi-Cal coverage. Some might be eligible for other programs, but many would simply become uninsured.

More to the point, the 39,000 people impacted in the first year is only the beginning. In a few years, after full implementation, the cut would deny coverage to 439,000 Californians.

The Los Angeles Times described it in this way, that the budget would “Deny thousands of impoverished parents healthcare coverage that they now have through the state’s Medi-Cal program. Under the change, a single parent with one child who earns more than $8,540 a year would no longer be eligible.” Tha was correct, but downplayed the massive scale of the cut–that the impact was eventually deny hundreds of thousands of Californians.

The Sacramento Bee has an article that doesn’t go into the specific horror of the cuts.

The sidebar that describes the budget “highlights” doesn’t even mention this cut to Medi-Cal eligibility–even though it is the health cut with the biggest impact in the May Revise. That sidebar does list some of the bad cuts, but also neglects to mention a major-dollar proposed cut from January, that would also eliminate key benefits, like dental, optometry, and podiatry, for millions of adults on coverage. It’s unclear why some cuts were included and other, bigger cuts were not.

Let’s hope that future coverage of the budget goes into the full implications of what is being proposed here. The cuts are bad enough that they don’t need embellishment, but they do need coverage, so Californians can understand the stark choices, and how they would impact our fellow citizens and our health system.

Los Angeles Mayor Antonio Villaraigosa just recently sent a letter to Senator Sheila Kuehl, from the point of view as a fellow supporter of a single-payer solution to health reform, to urge her to support AB x1 1 (Nunez/Perata). Here’s a PDF version of that letter:

LAMayorKuehlAB1xSupport.pdf

I was pleased to be a co-signer of a similar letter with over a dozen prominent single-payer supporters, people who I deeply respect and who have dedicated their lives and work toward winning single-payer reform. This includes respected activists, academics, and community leaders who led the Proposition 186 campaign, and gave years of their lives and even their bank accounts; and people who worked tirelessly on SB921 and SB840 in recent years, and fought to get it on the Governor’s desk in 2006.

There’s obviously some single-payer supporters that take an “all-or-nothing” approach. There are others who decide simply to focus their energies on legislation like SB840, or HR676, rather than to attack other efforts in the health care arena.

We continue to believe that this is not an “either/or” issue, but rather a “yes, and…” More than that, we believe AB x1 1 is the most effective and strategic step to get to single-payer, and that is a motivating factor behind our support.

Far from “settling” for AB x1 1, this is about locking in significant gains for the uninsured as a way to keep the movement and momentum active for broad reforms. Here’s the PDF:

SinglePayerSupportABX11-011708.pdf

The full letter is over the jump:

Thursday, January 17th, 2008

Dear Senator Kuehl, and all legislators who support SB840:

Re: Single-Payer Supporters for Strategic Steps, for AB x1 1

We, the undersigned, write to you as strong supporters of universal health care. We also have a long history of advocacy for single-payer policy proposals. Many of us have been involved in the fight for single-payer health care for as long as two decades. Many of us were active in working for Prop 186 back in 1994, and many of us worked hard over the last few years in support of SB921, and to get SB840 on the Governor’s desk in 2006.

As strong supporters of a truly universal health care system, we write to urge you to support AB x1 1 (Nunez), as a significant strategic step toward our shared goal. We strongly believe that health reform need not be an “either/or” situation, and that supporting this reform in front of us is consistent with being whole-hearted supporters of SB840 and single-payer.

We believe that AB x1 1 not only will do no harm – your appropriate minimum test for health legislation – but that AB x1 1 will also do a great deal of good and benefit millions of Californians.

Moreover, we believe that passage and enactment of AB x1 1 will be a strategic advance for the cause of single-payer because it will establish public programs that are the foundation of universal coverage, including a single-payer system.

AB x1 1 embodies policy elements of single-payer. Passage of this law would make it easier to enact truly universal coverage and to pass a single-payer system in the future, since it already includes:

• a major expansion of public program coverage to moderate-income Californians as well as low-income residents, setting the stage for truly universal coverage reforms, including single payer,

• the setting of a minimum employer contribution to health care, which is essential to funding universal coverage and an important part of the financing for SB840,

• the creation of a statewide purchasing pool that could be the beginnings of the huge

purchasing pool that could grow into a single universal system,

• an increase in Medi-Cal rates, helping providers realize that rates could be reasonable under a public program such as a single-payer system.

It also includes additional oversight over insurers. While some have criticized the notion of preserving the role of insurers, the proposal would significantly change the way insurers do business, including having to take all customers on a “guaranteed issue” basis, and having to negotiate with a large purchasing pool to access millions of California customers. The proposal creates a framework where insurers will either have to change their behavior, or face future reforms that impose further oversight on insurers or replace their function.

Like the proposals of the Democratic presidential candidates, AB x 1 1 does not undertake the massive transformation of the health care system that you propose and that we support. But it accomplishes important elements while providing security to those who have good coverage and want to keep it, while creating the framework to take extra steps. Just as passage of family leave legislation created a framework to come back and pass paid family leave, we believe this proposal creates political and policy tools to advance broader reforms.

Some fear that passage of any plan would stall the coming of SB840, as politicians declare their job done. We believe that the opposite is true. Failure begets failure, and if health reform is stalled now, political leaders may be discouraged from supporting any reforms of our health system (and certainly more far-reaching proposals like single-payer). They will likely move on to other issues.

On the other hand, success begets success: Passage and enactment of such a proposal would create a positive environment around health care reform, as politicians will continually seek to raise the bar above the last reform. The people of California are not satisfied with the health care system as it is, and they will want to see it change further to become a health care system worthy of our country and our state. After major reforms in areas like education and global warming, nobody thinks those issues are “done”; instead the interest in pursuing additional reform has stayed strong, and we believe that this will be the same for health care.

The comparison of AB x1 1 should not be with SB840, which we agree is a “gold standard,” but with the status quo in health care, where millions are uninsured, people are denied coverage because of “pre-existing conditions,” low- and moderate-income families face unlimited premiums and unlimited liability, and the situation is only getting worse. Does AB x1 1 provide all the protections we want to see in our health care system? No, but it provides protections that currently do not exist at all:

• it dramatically expands and assures coverage to increasingly desperate families and

individuals,

• it offers protection against the unaffordability of health insurance premiums,

especially for low- and moderate-income families;

• it establishes strong oversight of insurers, and

• it strengthens health care access of insured and uninsured Californians alike by more adequately funding health care providers, especially hospitals and doctors, whose current underpayment threatens their ability to provide emergency services for anyone and their willingness to serve low-income patients.

Under AB x1 1, there are millions of people, especially at the lower end of the income scale but also those with moderate incomes, that would get substantial help in getting the care and coverage they need. We have an obligation to meet their pressing needs. Asking them to wait is asking them to go without the access to care that those of us with insurance have. In addition, the more we can reduce the number of uninsured, the shorter the gap we have to bridge to get to universal coverage and a single-payer system. ABx 1 1 provides a solid foundation on which we can and will continue to advance additional health care reforms.

We will continue to be very active in support of truly universal coverage, but we urge you to consider this as a strategic step needed to win ultimate victory.

Thank you for your consideration.

Sincerely,

E. Richard Brown, PhD, Professor, UCLA School of Public Health

Michael R. Cousineau, PhD, Associate Professor of Research and Director, Center for Community Health Studies, University of Southern California Keck School of Medicine

Sherry Hirota, CEO, Asian Health Services

Henry L. “Hank” Lacayo, State President, Congress of California Seniors

Marty Lynch, CEO, LifeLong Medical Care

Jennifer Reifel Malin, MD, Current Member and Former Board Member, California Physicians’ Alliance

Maryann O’Sullivan, Founding Executive Director, Health Access California

John Roark, MD, Board Member and Past President, California Physicians’ Alliance

Steve Schear, Co-Chair, Universal Health Care Action Network

Joan Pirkle Smith, Chair, Health Committee, Southern California Americans for Democratic Action, & Chair, Health Care Legislation Subcommittee, AFTRA

Roy Ulrich, Radio Host and Producer, KPFK

Nora Vargas, Executive Director, Latino Issues Forum, a co-sponsor of SB840, and convenor of the Latino Universal Health Action Network

Anthony Wright, Executive Director, Health Access California

*All affiliations listed for identification purposes only

(Perhaps this will shed a bit more light than heat on the issues around health care reform.  Play nice in the comments, people   – promoted by jsw)

A new comparative analysis shows that the pending California Health Security and Cost Reduction Act, AB x1 1, takes major steps in health reform far beyond the much-discussed Massachusetts reform of 2006. A full copy of the 8-page analysis is available HERE at the Health Access website.

The analysis, entitled “Health Reform in California and Massachusetts: Different from Start to Finish,” concludes that AB x1 1 would provide a broader benefit to California consumers than what was passed in Massachusetts. The report lists “top ten” major differences between the California ‘s AB x1 1, and the health reform law, Chapter 58, passed in 2006. In contrast with Massachusetts, the California proposal includes:

1) New, Broader Financing, including a Tobacco Tax

2) A More Meaningful Employer Contribution

3) General Fund Protection

4) Significant Cost Containment

5) Subsidies up to and above 400% of the federal poverty level

6) Key Differences in the Individual Mandate, Affordability and Enforcement

7) A Transition to Guaranteed Issue

8) Medical Loss Ratios and Increased Insurer Oversight

9) Not Just a Connector, but a Negotiator

10) New and Improved Public Health Care Options

WHERE ADVOCATES STARTED IN MA: Probably most interesting to the progressive readers of Calitics is the comparison of AB x1 1, not with what passed in Massachusetts, but with advocates first proposed. Many consumer and community groups (www.massact.org) originally proposed a 5-page ballot measure as leverage to force health reform, and to influence its content. They collected all the signatures needed, but they ultimately decided not to file, given the deal passed in the legislature.

Their ballot measure included subsidies for not just low-income but middle-income families up to 400% FPL, financed by minimum contributions for large employers of 5-7% of payroll, and a 60-cent tobacco tax–none of which made it in the final Massachusetts package, but is included (if not more robustly) in the pending California plan.

More…

WHERE CA IS NOW: California advocates ended up where Massachusetts advocates started–although now we have to wage the ballot campaign those in Massachusetts didn’t. At the same time, if the effort succeeds, then California will have a reform that goes further and is much better financed and stable over the long term.

The conclusion of the report is that Massachusetts and California start from different places, and the plans are different enough, that they will end up having different results. Critiques of the Massachusetts plan simply do not apply to California’s effort.

But it’s notable that the California conversation has been largely been about doing more than MA, rather than doing less. That’s positive momentum for the national reform effort.