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:

http://www.health-access.org/i…

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

SB4, THE FRAMEWORK FOR #HEALTH4ALL REGARDLESS OF IMMIGRATION STATUS

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.

BILLS LIMITING OUT-OF-POCKET COSTS

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.

TRANSPARENCY

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.

MEDI-CAL

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.

TOBACCO CONTROL

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.  

OTHER KEY CONSUMER BILLS

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.

WHAT’S NEXT?

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 http://blog.health-access.org. 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.  

Another rod fails testing

by Brian Leubitz

When you spend $6.5 billion on something, you expect it to last a few years, even if it is one of the world’s widest bridges. (That $6B+ price tag also set a Guinness record!)

Caltrans officials downplayed the failure, stressing that 99 percent of the 407 rods that underwent testing passed, and said that the cause will need to be determined by further tests in a materials lab. But the failure of a second rod leaves the possibility that more rods could eventually fail.

“Hydrogen embrittlement and corrosion occurs over time,” said Steve Heminger, executive director of the Metropolitan Transportation Commission and one of three people on a committee overseeing the east span construction. “They could last 20 years or 50 years, but with this bridge, we want 150 years.” …

“This bridge is safe, and it’s going to perform well in a major seismic event,” he said. “The engineers are saying it’s terrific.”

Some independent experts are not convinced, however.

“That would suggest it did not strip, but that it fractured,” said Bernard Cuzzillo, a Berkeley mechanical engineer. “Because a fracture results in a sudden release of elastic energy, which causes a pop or a bang sound. Stripping is a slower failure and typically does not result in an audible sound.” (SF Gate)

Tollpayers will now be paying for a few million dollars worth of additional testing to give us all confidence, but doubt abounds. The rods are intended to grant additional stability during a seismic event, so perhaps it is natural that even one failure brings about a little nervousness in drivers using the bridge.

But the one certainty we have with the new eastern span is that this won’t be the last we hear about corrosion and botched grouting.  

By Kathryn Slater-Carter and Jon Youngdahl

News headlines often depict the growing economic divide in our nation as a tug of war between workers and business, but in one critical sector of our economy – franchise enterprises — entrepreneurs and workers are both being pushed into economic peril.  Workers and franchise business owners are both being squeezed by giant corporations like McDonald’s, having critical decisions that affect their livelihoods and their dignity forced on them by a faceless corporate headquarters.  Workers and franchise owners alike face retaliation and the loss of their income if they speak out.  For these reasons, both workers and franchise owners are coming together to fight for AB 525 (Holden), a bill that protects jobs by giving franchisees a fair shake so they can keep and grow the businesses they’ve nurtured.

A generation ago, McDonald’s valued its franchisees as partners who built the strength of the brand in communities across the country.  Now, McDonald’s and other corporations built on the franchising model have gone the way of so many other industries that look to post short-term gains rather than build real value, even if it means driving franchise owners and workers into poverty.

Today, franchise agreements are so one-sided, franchisees have virtually no say in the businesses they’ve risked their life savings and dedicated years of their lives to build.  Corporate headquarters control nearly every aspect of the business, can force new and unexpected costs onto franchise owners, and franchise owners can be punished for speaking out or joining with other franchise owners to improve business conditions.  Franchises can even be shut down for arbitrary reasons, as Kathryn Slater-Carter experienced firsthand after working 30 years to build her Bay Area McDonald’s franchise.  

A survey of 1,100 franchise owners released in April found Kathryn’s case is far from an isolated incident.  Dissatisfaction with franchisors — the parent corporations of franchise businesses – is widespread, and retaliation against franchise owners who speak out about problems is frequent.   More than half of franchisees say they can’t earn a living from their business.  Four in 10 reported threats of having their franchise agreements terminated for taking actions they thought were appropriate for their business, and nearly 20% said their franchisor increased the frequency of inspections after the franchisee raised questions or spoke out about problems.

California franchisees and workers are both striving to be a part of California’s economic future and AB 525 brings us one step closer to stabilizing small businesses so they can continue serving the needs of California’s communities and strengthen the jobs that build our economy and provide for families.  

The bill, the Small Business Investment Protection Act, would significantly expand the rights of franchisees and establish stronger protections against unfair termination or nonrenewal of contracts by franchisors.  California workers support the bill because they know when franchisees can make decisions that are in the best interest of their businesses, they can invest in their employees.

Franchise owners and workers want the same thing – a fair shot at the American Dream.  That’s why we’ve formed an unlikely alliance to support AB 525.  By ensuring franchisees have a fair shot at surviving as corporations squeeze more and more from franchisees and workers, AB 525 protects California small businesses and jobs.

Kathryn Slater-Carter was a McDonald’s franchise owner for more than 30 years.  Jon Youngdahl is the Executive Director of the Service Employees International Union (SEIU) California, which includes 700,000 private and public sector workers as members.

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!

Pundits already discounting the failed Senate candidate

by Brian Leubitz

It is never good when an officer in your own party in your home state says this about your candidacy:

California GOP Vice Chairwoman Harmeet Dhillon said Monday she could envision Fiorina’s campaign propelling her to a cabinet post or even a vice-presidential nomination.

“But I don’t know a single person who thinks she’ll be our presidential nominee,” Dhillon said. (Josh Richman/BANG)

Perhaps she is using the campaign as a way to elevate her national profile for a cabinet gig. But that seems an awfully expensive and laborious task just to raise one’s profile.

She’s failed at HP, though I do give her credit for um, reducing costs while she was there. She’s a failed Senate candidate here in California, and now she is looking to also become a failed presidential candidate as well?

You have to admire her tenacity against all the odds in this somewhat quixotic run, but at least I have high hopes for more Demon Sheep videos:

by Carolyn Constantino

A new website reveals that Enron-billionaire John Arnold has spent up to $50 million of his own fortune to dismantle retirement plans for firefighters, nurses, teachers and other public employees.

The website – Truth About John Arnold – is sponsored by the National Public Pension Coalition (NPPC) and Californians for Retirement Security and traces the wide financial influence that one billionaire has on public pension fights. John Arnold amassed his fortune as an Enron trader, where he earned an $8 million bonus as the company’s collapse decimated $1.5 billion in public pension assets. Arnold turned his $8 million into billions as a Wall Street hedge fund manager.

Dave Low, California School Employees Association (CSEA) Executive Director and Chairman of Californians for Retirement Security explains,

“John Arnold is the second youngest billionaire in America. John Arnold has decided to spend his billions to take hard earned retirement benefits away from school bus drivers, teachers, nurses, firefighters and other public employees. What is in the heart of someone who, having become one of the richest people on the planet, decides to use that wealth to undermine the retirement security of working class Americans who have dedicated their entire careers to public service?”

Arnold’s spending has touched every facet of anti-retirement campaigning, including tainted research, political advocacy organizations, ballot initiatives, journalism, and the campaign coffers of extreme politicians. He is involved in battles to limit retirement security across the country through his foundation, the Laura and John Arnold Foundation, and his political PAC, Action Now.

“Lawmakers, workers, and the public at large deserve to know that the funding to dismantle retirement security for firefighters, nurses, teachers and other public employees across the country can be traced back to one source – Enron-billionaire John Arnold,” said Bailey Childers, Executive Director of NPPC.

The truth about John Arnold:

– In 2013, Arnold was the leading financier of former San Jose Mayor Chuck Reed’s failed effort to put a statewide pension-gutting initiative on the ballot.

– Arnold was the lead financier ($150,000) of an effort to end public pensions in Ventura County. A judge declared the effort unconstitutional.

– Arnold spent more than $1 million dollars on a ballot initiative in Phoenix to close the pension system. That effort was defeated by voters in 2014.

– The Laura and John Arnold Foundation underwrote a PBS series called “Pension Peril.” The PBS Ombudsman declared the $3.5 million contribution inappropriate. The grant was returned and the series pulled from the air.

– Arnold underwrites Pew Charitable Trusts’ pension work with a $4.85 million contribution.

Learn more about John Arnold here.

Cross-posted from CSEA.