Tag Archives: health

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:

http://www.health-access.org/preserving/Docs/HACoverageImpactReporto6-25Final.pdf

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.

Endorsements in the CA-08 Assembly Primary Race – Healthcare Proxy Battle?

The California Nurses’ Association called today about the Yamada campaign, and it piqued my interest enough to check out Mariko Yamada and Christopher Cabaldon’s respective endorsement lists. While doing that, one noteworthy pair of endorsements for Yamada came from the California Nurses Association and SEIU United Healthcare Workers West, two unions who have not only been aggressive in pushing for a single payer health care plan for California, but who also stood up against Schwarzeneggar and the 2005 special election boondoggle back when the CA Democratic party was content to sit back and let Arnold run the state unimpeded.

On the issue of health care reform, the candidates are close but not identical. In a recent debate, Yamada backed Sheila Kuhl’s single payer health insurance plan pretty strongly, while Cabaldon gave it lip service, but like the CA Democratic leadership in last year’s health insurance negotiations, also left himself open to a compromise that fell short of single payer. As the Davis Vanguard reported at the time: [emphasis mine]

For Christopher Cabaldon he suggested that everyone is paying for the uninsured, even when we do not see it. He favors the Sheila Kuehl single payer health system as the ideal. However, he then argued that we must do something even it is not a single payer system. We cannot allow the perfect to be the enemy of the possible. Finally he argued that cuts in Medi-Cal are taking us in the wrong direction and it will make it impossible to find Medi-Cal providers who cover the disadvantaged. Mariko Yamada was also supportive of the Kuehl Bill and argued that if her supporter, Phil Angelides had been elected Governor, we would have it as law now. She is also willing to consider others but not as enthusiastically. Talked about the fact that social workers have supported single payer health system going back 50 years, back then, she quipped they were called Communists but now normal people also support such a system.

While Cabaldon has his fair share of union endorsements, the presence of that 2005 special election coalition of SEIU-UHWW, CNA, firefighters, police and teachers’ unions on Yamada’s endorsement list suggests that those unions don’t trust Cabaldon, even though he’s the front runner and as such would be easy enough to endorse. It’s not a matter of liberal versus conservative – both candidates are fairly liberal Democrats, well in the mainstream for the blue 8th AD – but it suggests that the battle over the shape of health care reform between establishment accommodationists and single payer advocates that scuttled the compromise last year is still simmering under the surface, and that CNA and SEIU-UHWW are doing some quiet primary work to try and actually get single payer passed as more than a symbolic bill, should the Democrats get a big enough majority in November to pass it over the governor’s veto.

Or maybe I’m just seeing things.

originally at surf putah

LA Health Care–Waste $$ Here, Close another Hospital over there…

Well, the depth of LA’s Hospital mess keeps getting clearer–now the LA Times is reporting that the construction of the new County-USC Medical Center is exploding, and will now be 22% over the original estimates.  Oh yeah, the project is now 1 year overdue and the clock keeps ticking.  (http://www.latimes.c…)

The sadest part of this is that this hospital is not really what LA needs: the county has long had too many hospital beds and not enough local clinics to meet pressing community needs.  Most recently, the Board of Supervisors and the mis-managed County government allowed the vital resource that is (was!) King-Drew Medical Center to die.  Or rather, they lynched it through years of incompetence–with the effect that thousands of residents in the most impacted communities of LA will now not have health care resources they need. 

Why would the Supervisors back such a nonsensical policy?  Because they see Hospitals as Politically beneficial–lots of union votes and contributions to support their uncontested elections, and the opportunity to grandstand around big buildings, rather than doing the tawdry work needed to actually lead or even just manage the nation’s largest local government. 

Equally important, not all Supevisors are created equally.  While Yvonne Burke snoozes in her Brentwood Hills condo, Gloria Molina, Mike Antonovich and Don Knabe have grabbed all the loot they think they can for their districts.  And Zev Yaroslavsky just waves his arms around, like “what can I do about it?”.  What a mess!

What is the solution?  Not only do we need to through these bums out, we need to change the way LA County is run.  We need a single, clearly accountable County Executive, balanced by a large, part-time County Legislature.  Until then, the self-serving Supes will just keep rolling over the same terrible decisions.

Tri-Caucus Minority Health Summit this Weekend in San Diego

(Great to see Rep. Solis, one of the most progressive members of Congress, posting here. Come back often! – promoted by dday)

Hello to my friends at Calitics! 

The 5th Annual Congressional Tri-Caucus Minority Health Summit will be held this weekend in San Diego.  This year’s Summit is being hosted by the Community Clinic Association of Los Angeles County, with support from The California Endowment and others.  At least twelve members of the Congressional Hispanic, Black, and Asian Pacific American Caucuses are scheduled to attend, including Reps. John Conyers (MI-14), Raul Grijalva (AZ-7), and Mike Honda (CA-15).

Five years ago, I conceived the idea of the Tri-Caucus Minority Health Summit as a forum for members of Congress to hear firsthand about the health challenges facing communities of color and innovative solutions to address them.  Indeed, the need to reduce health disparities is great.  Despite recent gains in health care, disparities related to race, ethnicity, and socioeconomic status remain prevalent.  For example, more than 70% of Latinos across the country are considered overweight or obese, including 25% of Latino children.  In 2005, 86% of babies born with HIV and AIDS were of color. 

The Summit will cover topics such as SCHIP, homelessness, tobacco cessation, veterans’ health, and HIV/AIDS.  It also will include discussion of H.R. 3014, comprehensive, bi-partisan legislation I introduced last week with Congresswomen Donna Christensen (Virgin Islands) and Madeleine Bordallo (Guam) to reduce racial and ethnic health disparities.  H.R. 3014 has 70 original co-sponsors, including House Majority Whip Jim Clyburn (SC-6).

Over 200 people are expected to attend this weekend’s Summit in San Diego.  As Chair of the Hispanic Caucus’ Task Force on Health and a member of the House Health Subcommittee, I look forward to hearing from the panelists and attendees and to sharing the information I gather at the Summit with organizations in my district and with my colleagues in Congress.

For more information about the Summit, visit www.ccalac.org.

Congresswoman Hilda Solis
www.house.gov/solis
www.youtube.com/rephildasolis

A “Far-Left” Manifesto for Yolo County

(Surf Putah, which you will find in the California friends of our blogroll, is a great site for Yolo Cty. politics. – promoted by Brian Leubitz)

Well, I’ve made the cut, having been linked in the “Yolo Blogs” category over at Republican Yolo County Supervisor Matt Rexroad’s new website (which looks quite nice, really). Along with the link (a good web resource for Yolo County in its own right), Rexroad gave this site this little introduction:

If you want to know what the people at the far end of the spectrum in Davis are doing….surf Putah.  I really can’t explain this stuff. Generally, if you find an opinion expressed here Matt Rexroad will be on the other side.

Since I’ve been identified as the far end of the spectrum, I figure that it’s as good a time as any to lay out what us inexplicable far-out Davisites are thinking about Yolo County. Ironically enough, I find myself to the center, or at least in a slightly different direction, from many self-defined “progressives” here in Davis, especially on the issue of development, the axis which city politics seems, rightly or wrongly, to revolve around. Mostly, though, I find that the perpetual battle over political labels to be a fairly useless one, since it assumes a coherent binary political debate, when in fact things tend to be far more complex in real life. I believe that governments ought to balance their budgets responsibly, instead of borrowing and spending with bond measures; am I a conservative? I believe that people generally ought to mind their own business, and that government and religious beliefs are best kept separate where neither can mess the other up; am I a liberal? I believe that all people are created equal, and ought to be treated as such; am I a progressive?

So for the benefit of both Rexroad and those who might follow his link to my site I’ll toss out where this inexplicable far-left blogger would like to see Yolo County headed:

1. Making it possible for Yolo farmers and ranchers to make a decent living, so that they can grow crops instead of subdivisions. The reasons why it is getting harder and harder for small farmers and ranchers to get by are complex, and the roots of the problem more often than not lie well outside of Yolo County. And yet, preserving a healthy and locally-rooted agricultural industry is something that should be central to any vision of a future Yolo County. Protecting farmland from development by easements, or buyouts is one way to help curb development pressure on productive ag land, but it is perhaps more important to ease the market pressures of falling agricultural commodity prices and rising fuel and other operating costs. Encouraging fuel-intensive or alternate fuel usage, aided by ag research over at UC Davis, might help to insulate Yolo agriculture from rising gas prices. Requiring school lunches to preference local farmers and ranchers might help to provide more demand for those products. Teaching gardening in elementary school, as they do at Fairfield Elementary school out in the county, might help to diminish the urban-rural split as well, and give our kids more appreciation for the folks who grow their food.Encouraging new agricultural industries in the county to replace the loss of all those closed tomato canneries in the past decade would help too.

Ultimately, reversing the decades-long national policy of free trade deals that flood domestic markets with foreign imports, and national policies that encourage overproduction are the real key to saving the family farm. Food is one thing, like military technology, that is a bad idea to rely on foreign imports for. We shouldn’t be flying walnuts in all the way from China when we can grow them out perfectly well in Winters.

2. Keeping development off the floodplain, and strengthening the flood control measures where we have already built close to rivers. The Yolo Bypass is a sound approach to the long-term pressures of river systems and seasonal flooding, and Yolo County has been smarter than many counties in this regard. Woodland desperately needs some way of guarding against winter flooding on Cache Creek, and hopefully some hydraulically sound solution will be found in the next couple of years, whether it be stronger levees or some bypass channel upstream of town. While the pressure for more housing is and will continue to be acute because of population growth (more on that below), we need to be steadfast about avoiding Natomas-style floodplain sprawl, because the moment any houses are built there we will collectively be liable for paying for their protection, indefinitely. In places such as West Sacramento, where flooding will always be a problem, we need to make sure that their levees are hardened to withstand severe flooding.

3. Providing adequate housing so that the children of Yolo residents can afford to actually live in their hometowns. This is one area where I part ways with many Davis progressives, in that I do not believe that a no growth or even slow growth model is either smart or just. When a town limits its housing stock like Davis has done, it might preserve the population size of ther town, but the nature of the community cannot but change with the skyrocketing housing prices. As long as people continue to have children, as long as the university increases its student and professorial population (which it will, since it is tied to state demographic growth), and as long as people want to move into this county of ours, we are going to have to have reasonable housing options. Yolo County has both one of the higher rates of growth in the state as well as one of the higher birthrates. All those people are going to have to find somewhere to live.

My sense is that we’d be better off encouraging the cities of Yolo county to start urbanizing in their downtown cores, close to the highways and train stations, to at bare minimum a level of density that our cities reached at the turn of the 19th century (the tallest buildings in most Yolo towns are perversely often the oldest ones). Build up a couple stories, get some people in those downtowns, and then get the downtowns built up along walkable, new urbanist lines, so that people don’t have to drive everywhere just to go about everyday life. This will allow more housing to be efficiently defended by floodwalls where floods threaten, and it should make room for many Yoloites who are currently priced out of even renting here anymore, let alone own houses. Additionally, when suburban housing is built, aim for smaller lots and smaller two story houses the way you used to see in the 20s and 30s, instead of the spread-out ranch tract housing that uses land as if it’s still cheap. Land is expensive, and denser housing makes better and more economical use of that land. And enough already with the huge luxury mcmansion developments for out of towners.

4. Support more small businesses to fulfill city needs, avoid big box megastores. As I wrote during the Measure K debate last November, there is a need for more and better retail in Yolo County, especially here in luxury boutique-saturated downtown Davis, but that we ought to be encouraging small and locally owned businesses to fulfill those needs rather than inviting big box retailers in to suck up the whole market, and siphon that revenue out of the county to some out of state corporate headquarters. Far too often it is posed as a false choice between the status quo and big box megastores, when in fact a third way is possible. One of the problems is that commercial rent is far too high in Davis, but as best as can be done, the city governments and county government should work to ease whatever barriers to starting businesses exist for small local businesses.

5. While this might be seen by some as working at cross-purposes to #4, we really need a living wage for the county, to say nothing of the über-expensive city of Davis as well. People who work in town ought to be able to afford to live in the same communities, or failing that, in the county. While the statewide minimum wage hike of $7.50 goes partway, a hike to a living wage of $10 or higher would help a great deal, and lessen the class segregation that we get when rents get so rediculously high. Living wage ordinances in other towns have shown that they don’t destroy the local economy as predicted, and that the recipients of those wages tend to plough most of that money back into the local economy, creating a virtuous economic cycle. Finally, a living wage is simply the right thing to do, since anybody who works hard every day at a job, any job, deserves the dignity of being able to make ends meet.

6. Along with this, since the National and State governments seem incapable of getting universal health insurance passed, we need to find some way of at least covering children, from prenatal through delivery and child medical care. A significant number of the working poor in Yolo County either are children or have children, and helping to cover the often exorbitant costs of child healthcare would not only go a long way towards lessening that burden on those families (in effect, a net wage raise), it would also help to guarantee that those children got adequate health care, immunizations and so on. This in turn helps to limit problems for the county down the road dealing with epidemics and overtaxed emergency rooms. Disease does not recognize any difference between rich or poor, insured or uninsured, citizen or immigrant; we’ve all seen how quickly a cold or flu can move through an elementary school or a daycare.

Anyone who claims to be in favor of family values ought to be willing to help make sure that people don’t get bankrupted by the costs of giving birth, let alone raising a kid. It is in our best interest personally as well as as a societally to make sure that these kids are covered, at least until the state and federal government get their acts together and get something funded. Since Yolo is a fairly poor county government-wise, this will have to be a fairly bare bones plan without accompanying state funding, not unlike any serious levee solutions. Assemblywoman Wolk, we’re counting on you to help talk some sense into the Governor.

7. More state parks. We have in this county both beautiful hiking up in the hills to the west of us, as well as a beautiful river to the east. Why there aren’t more state parks or recreational infrastructure helping people to get to them is beyond me.

8. The reestablishment of the old interurban train network in the Central Valley. The Capitol Corridor has been a great success since its inception a decade ago, but relatively little work has been done to apply the same logic to the Valley itself, and try and link the cities and towns of the Sacramento Valley together like they once were abnout a century ago, before the rise of auto-fueled sprawl. The old train lines are still there, connecting most cities up and down the valley to Sacramento, and yet they sit virtually unused for commuter traffic. Fixing them up a bit and running basic commuter lines on them would help to take traffic pressure off the highway system, and help us to accomodate what population growth the region will see in the decades to come. It also uses a lot more fuel, which brings us to the next point:

9. Countywide efforts at conservation and alternative energy. As our populations grow, and global warming gives us hotter, dryer summers, we will see increased stresses on our water and electric usage. As peak oil runs hard into increasing global demands for fuel, gasoline and natural gas are going to persistantly rise in price, hurting commuters, farmers and businesses alike. We should be getting ahead of the curve by working to lower our communities’ water and energy footprints, and thus our exposure to price increases and shortages. Having UCD’s stellar environmental engineering research at the ready is a huge advantage; let’s take advantage of it.

10. A justice system that treats all Yolo residents as equal members of their communities, that serves and protects Black and Latino citizens as well as White citizens. Doug Paul Davis over at the Davis Vanguard has done such great reporting on this issue that I won’t try to duplicate it, but rest assured our police forces and justice system need serious revamping on the issues of racial profiling and how we combat crime in general. While gang violence is real, criminalizing an entire neighborhood, as was done in West Sacramento, seems to me to violate the rights of the very citizens that our justice system is ostensibly supposed to protect. Likewise, while out of towners commit crimes in town, treating huge swathes of our community as perpetual suspects does real and lasting harm to the community as a whole. We can do better.

—–

So there you have it, one Yoloite’s “far-left” take on things. While I expect that Matt and I disagree on several of these issues, i’m not sure that he and I are diametrically opposed on all of them. Statewide and nationally, however, I suspect that our political differences are clearer and less common ground possible to reach. I leave the question of whether the above opinions are way off the end of the spectrum up to the reader.

(originally posted at surf putah