Tag Archives: Medi-Cal

Pushback: SEIU Potential Walk-Out, Corporate Tax Cut Repeal, Court Overturns Medi-Cal Cuts

Rumors ran rampant yesterday that state employees, pushed too far by yet another salary cut (totaling 20% over the course of the year), would potentially strike.

Doug Crooks, Director of Communications with the Service Employees International Union’s local 1000, which represents more than 95,000 state employees, declined to confirm the rumor but said any decision would be made by the employees through an authorization vote.

“In the first place, that decision hasn’t been made yet,” said Crooks about the plan to strike. “That decision hasn’t been made yet. We are definitely going to strongly oppose and do everything we can to prevent the governor from imposing a fourth furlough day. But check back with me Monday.”

“The bottom line is we negotiated with this governor in good faith and we agreed on a contract that would save $340 million dollars immediately, and if applied to all state employees it would save the state a billion dollars. That’s billion with a ‘B.’ And for the governor to undermine that contract now is beyond irresponsible. He’s made the state employee a pawn” in the state budget negotiations.

“Well actually, it’s a five percent cut on top of those three furlough days,” explained Alicia Trost, a spokesperson for Senate leader Darrell Steinberg. “It’s simply a scare tactic by the governor, yet another, and we feel the state workforce has already paid their fair share. What’s worse is that it would have a horrible effect on the economy if state workers were to lose up to 20 percent of their buying power.”

By the way, Mr. Stogie just lost a furlough case, with a judge tentatively ruling that he cannot furlough  the legal staff of the State Compensation Insurance Fund, which has emboldened the larger pool of workers in SEIU.  But more to the point, in the world of Arnold Antionette and the Yacht Party, workers making a median income getting 20% salary cuts while the largest corporations doing business in the state get a massive corporate tax break is considered “everyone paying their fair share.”

Speaking of which, Lenny Goldberg offers the text of an initiative to repeal the negotiated-in-secret corporate tax cuts and save the state $2.5 billion dollars a year.  Opponents typically respond with race-to-the-bottom rhetoric about businesses leaving the state, which isn’t true, by the way.

UPDATE: Here’s a study out TODAY from the PPIC confirming that the whole “the rich are leaving California” line is a flat-out lie.

Finally, a federal appeals court ruled that California cannot cut Medi-Cal reimbursements, in an opinion written by a George W. Bush appointee.  The familiar pattern of breaking the law to cut the budget often runs up against judicial review, and so the criminals in Sacramento – considering what they’re attempting, I don’t consider that hyperbole – will have to try something else to achieve their long-sought destruction of the social safety net.  

The Story of the Governor And IHSS

As the budget talks stall, let’s bore in on what new items the Governor has recently proposed.  Out of nowhere last week, he called for policy changes as a condition for agreeing to covering the full budget deficit.  He can call them budget-related, or part of the “reform” agenda, but that’s a lie.  He added new issues into the negotiations, and Karen Bass was right to call him out for it.

Among those new items was this call to “root out fraud” in several programs, including IHSS, Cal-Works and Medi-Cal.  The Governor claims that implementing programs to end this fraud would save the state $500 million dollars a year – meaning it would take 14-16 years for this program fix to cover the wasted money caused by his intransigence in refusing the stop-gap fix last week, which lead to the issuance of IOUs.  On top of that, those numbers are overstated, and changing eligibility standards is a complex, costly process that will neither improve customer service or even reduce an already-low error rate.

The Governor’s response to these comments is that Democrats are somehow protecting union allies and the status quo.  If that’s the case, what to make of this fact:

In April of THIS YEAR, Democrat Bonnie Lowenthal introduced AB682, which would investigate fraud in the IHSS program.  Here’s the analysis of the bill:

1) Requires that, beginning January 1, 2010, DSS dedicate two positions to evaluate implementation of five specific anti-fraud provisions of the Welfare and Institutions Code related to the IHSS program and authorizes DSS to fill the positions either by using existing resources or, if an appropriation is provided for that purpose, by adding new positions.

2) Requires DSS, in consultation with the state Department of Health Care Services, the district attorney in the county with the largest caseload, and stakeholders, including IHSS consumers and providers, to provide a report to the Legislature by December 31, 2010, which shall do all of the following with respect to IHSS-related fraud:

a) Identify the magnitude of fraud in terms of the total dollars inappropriately spent or removed from the program, and the number of consumers harmed or placed at risk of harm as a result of fraudulent activity, through instances resulting in a fraud conviction between January 1, 2005 and January 1, 2010;

b) Identify the number of people involved in fraud for each of the following categories:  IHSS providers, IHSS consumers, state workers, county workers, and others.  In the case of “others,” the report shall describe the function of the persons committing fraud with specificity but without revealing personal identifying information; and,

c) Provide recommendations on the best means to combat IHSS fraud.

It may interest you to know how the Assembly voted on the bill.  In the Human Services Committee, the Democrats voted yes, the Republicans NO.  In Appropriations, all Democrats voted yes, all Republicans NO.  The final floor vote went 49-28, with three abstentions.  EVERY SINGLE REPUBLICAN VOTED NO except for Paul Cook, who abstained.

The ostensible reason for the Yacht Party united front against the bill?  It costs $350,000 to hire two new employees at the Department of Social Services, and give them a budget to look into fraud at the IHSS.  To pursue fraud that the Governor says would save the state $500 million a year.

This is basically what you do in government.  You learn of a problem, you study it, and then you implement potential fixes for the problem.  IHSS fraud was brought up as a problem in April, and Bonnie Lowenthal sought to fix it.  The Governor waited around for a few months, then barged in and said Democrats, who were taking the steps to fix the problem, were safeguarding public employees, and that anti-fraud measures must be taken immediately in conjunction with an unrelated budget deficit.

The only fraud here is the Governor.  He’s tried to cut IHSS funding since the day he entered office.  The Assembly passed a “quality assurance” provision in 2004 to ensure that the program ran smoothly, and the county investigations were kicked up to the state, and then the Governor NEVER FUNDED THE NEW POSITIONS for investigators to look over the county referrals.  Small wonder a lot of cases with no action ensued.

In the final analysis, the Governor is doing what he has done multiple times in the past – attempting to cheat the needy out of lawful care and services instead of doing the politically unpalatable work of cutting programs.  He’d rather reduce costs by making it virtually impossible for enrollees to stay eligible.  It’s cowardly and craven.

That’s our Arnold.

Stimulus Funds Held Back By The Yacht Party Dam

(Assembly Bill 23xxx, the employment benefits extension bill, passed the Assembly. I added the Speaker’s video discussing it. – promoted by Brian Leubitz)

There are two bills likely to come up for vote this week that would allow California to receive billions in stimulus funding, both of which have been subject to Yacht Party obstruction thus far of the Mark Sanford, Sarah Palin variety.

First up is the unemployment benefits extension bill which Republicans rejected last week.  There are actually two separate measures, one which would extend benefits and one which would increase the pool of people eligible for those benefits, but the extension is the one that will be voted on as soon as today.  Kudos to the SacBee for noting that the Governor has taken no position on these bills, despite the bromance rhetoric about the President and the stimulus.

The Assembly is expected to vote this week, probably today, on a bill that would pave the way for California to extend its lifeline for out-of-work residents by five months at federal expense.

The measure would ensure an extra $2.5 billion to $3 billion in federal funds for emergency benefits at a time when California is mired in recession, with an unemployment rate above 10 percent.

Passage would mean $6,140 in additional benefits for an out-of-work person receiving the state’s average benefit of $307 per week. Benefits range from $65 to $475, based on previous income earned […]

Gov. Arnold Schwarzenegger supports both concepts but has not taken a position on specific legislation, aides said.

Schwarzenegger has “no position” because the Chamber of Commerce doesn’t like anything that could lead to higher corporate taxes, and they hold the puppet strings on our last action hero.  The vote on this has yet to be recorded in the Assembly, so we shall see what the Yacht Party decides.

The second bill, currently in the State Senate, concerns Medi-Cal eligibility requirements that would open up even more federal funding.

Although California is slated to receive more than $31 billion in federal money, a change in eligibility rules for Medi-Cal made as part of this year’s budget prevents California from qualifying for more than 25 percent of those  federal funds.

In order to do so, the state must have the same Medi-Cal eligibility rules today as those in place July 1, 2008.

The problem was caused by an attempt to save $70 million by changing eligibility rules for children receiving care from Medi-Cal was contained in the 85-day record late budget signed by Gov. Arnold Schwarzenegger last September.

Under the change, children must fill out a report every six months confirming their continuing eligibility along with their parents who were already required to fill out such a report prior to the change in law.

Critics of the requirement say that most of the children who lose eligibility do so because they forget to turn in the paperwork, not because they actually lose eligibility. Sorting out such issues increases Medi-Cal costs to counties, who administer the program locally.

To get the federal money, the state must change the law before July 1, 2009 so that kids don’t need to fill out the report. The bill would do that.

Let’s be entirely clear – the Administration was banking on oversights from poor families who qualify for Medi-Cal to save the state money.  That’s borderline immoral and it ought to be addressed.  Elaine Alquist is carrying the bill in the Senate, and on this one, Schwarzenegger has seen the error of his ways and promises to sign it.  Will the Yacht Party follow suit, or prefer budgeting by forcing bureaucratic red tape on the poor?

Yeah, We’re Still Well And Truly Screwed

There’s a very pernicious habit in California of turning away from budget issues once a crisis is averted, in a show of relief that we will at least get a small reprieve from having to deal with the contentious battles for a period of time.  This false sense of security is bad enough in regular years, when the budget is cobbled together through borrowing against the future and no long-term solutions are implemented.  In this dynamic economic crisis, when rosy outlooks can darken in a matter of days, it’s downright foolhardy.

Greg Lucas at California’s Capitol has been one of the louder voices in insisting that the budget crisis is not at all over.  According to Controller John Chiang, revenue in February was $900 million dollars below estimates.  Now, if you extrapolate that out, we’ll be in a $10-$12 billion dollar budget hole by the end of the year just if things remain at the same level.  This is of course unlikely, as the February national job numbers showed.  So much of the tax increases passed in the February 19 budget solution are tied to employment – an increase in the income tax, and sales tax increases that of course rely on residents having purchasing power.  In addition, these lean economic times will push more people into needing state services, like unemployment and Medi-Cal.  Then there are the counter-cyclical increases and cuts that are working against what the economic recovery is attempting at the federal level.

In addition, many of the spending and taxation decisions made in the recent budget cancel out some of the benefits to California of the American Recovery and Reinvestment Act.

The federal package provides an estimated $13.1 billion in refundable income tax credits for middle to low-income Californians at the same time the state budget includes $12.2 billion in tax increases, only some of which are deductible. And only half of taxpayers deduct.

The federal bill includes a one-time $250 payment to the state’s aged, blind and disabled poor at the same time the state is reducing the maximum grant for an individual by $37 a month, $444 annually.

“California is roughly an eighth of the nation. The impact of this is sufficiently large that it could affect the prospects of recovery for the nation as a whole,” said Jean Ross, director of the California Budget Project, who has been examining how the state’s budget interacts with the federal stimulus package.

The biggest short-term issue is cash.  Lucas did an interview with John Chiang where he admitted that we will still need to borrow against the anticipation of future revenue as early as April, to the probable tune of $1.5 billion.  Because the budget deal was completed too late to include changes to the income tax code, those revenues will not come in until the following tax year.  The sales tax will go up April 1, but that will not be enough to cover expenses.

CC: Is February a big month for obligations?

JC: No. April is the real difficult month. If we don’t get that RAN, we’re $636 million in the red. But then the bigger issue is July. When we walk into the next fiscal year we will need a massive cash infusion.

CC: How come?

JC: We always borrow at the beginning of the year, 25 out of the last 26 anyway and then in April we make up the difference. But this year we walk in with weakness into the next fiscal year. There are less tools in the tool kit.  We’ll need a massive RAN or RAW (Revenue Anticipation Warrant).

Remember these last budgets borrow $16.5 billion from (state) special funds to backfill the general fund. So if we have any emergency in the state requiring aid from one of those special fund departments, the state is in trouble. Over 1,100 special funds in the state and we borrowed from over 650 of them. Part of this last budget solution gives us the ability to borrow another $2 billion more. The governor’s budget has us borrowing $11 billion from special funds over the next 18 months.

So we’re going to have to do some outside borrowing for the next fiscal year. Period.

And of course, there’s very little anticipation of the worsening economic picture in the budget, meaning that we’ll be in unquestionably worse shape by summer.  And the cash crisis, forcing short-term borrowing, really impacts selected projects that go out into the bond market, for example infrastructure like the high speed rail project, which will basically have to shut down if there isn’t a quick infusion of cash.  Keep in mind that California has the worst bond rating in the country and the credit markets are still not that friendly to the state.

Another pressing matter is the determination of how much money from the federal stimulus will be available to the state to fill budget holes.  There is a “trigger” in the state budget that would actually reduce some cuts – most of them the worst of the worst, particularly in health care for the needy – as well as reverse increases to the income tax, if at least $10 billion dollars in federal money hits the state budget.  It’s not just that money comes in, it’s that it has to go toward general fund relief in order to contribute to the trigger.  And Mike Genest, the Governor’s finance director, has a preliminary estimate up showing that the state will come up short.  This is insanity.  As the California Budget Project noted on a conference call today, there will be many billions above the trigger number available to the state, the legislature need only craft the receipt of that money in such a way to hit the trigger.  Otherwise, they are raising taxes and cutting services, and needlessly so.  One such bill would change Medi-Cal eligibility requirements to free up as much as $11.23 billion over 27 months.  That should happen ASAP.  Democrats are trying to write this as a special session bill and ensure that it requires only a majority vote.

The main point here is that we remain in crisis mode with the state budget, and will continue for years upon years until we stop putting off the fundamental, structural solutions the way we constantly do.  For example, the prison system remained virtually untouched during the budget crisis, despite being both crippling to the bottom line and unconstitutional in its overcrowding and inability to provide health care.  We desperately need structural changes with how the state budgets, and those will only be accomplished by demolishing the conservative veto over the process and repealing the 2/3 rule.

UPDATE: Here’s a link to the CBP study of the American Recovery and Reinvestment Act, identifying as much as $50 billion dollars available to the state in funding.  Surely the legislature can figure out how to capture 20% of that and set off the budget trigger.

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.

Movement on Health Care – Thanks To The Courts and State Agencies

At this point the judiciary is pretty much the only government entity in this state I have a modicum of belief in; they aren’t hamstrung by ridiculous rules that make it impossible to function, so they can simply follow the law.  State agencies, when properly run, also can exhibit some independence.  Lately, there have been several cases ruled in favor of reformers at the expense of malign protectors of the health care status quo.

After a series of investigations from the California Department of Public Health, 18 hospitals have been fined for substandard care.

Violations included an improperly inserted catheter, a ventilator that was not turned on and surgical tools left inside patients after operations […]

The hospitals were fined $25,000 for each violation – the latest of dozens of penalties the state has issued in recent years to more than 40 hospitals.

“The number of penalties will decrease and the quality of care will dramatically improve as hospitals take action to improve,” said Kathleen Billingsley, director of the health department’s Center for Healthcare Quality. “The entire intent of these fines is to improve the overall quality of care in California.”

As care is improved, so must access for treatment.  The proposed cuts to Medi-Cal by the governor would have decimated the ability for the poor to find a doctor.  The cuts never made it through district court.

A federal judge has ordered a temporary halt in the state’s 10 percent reduction in Medi-Cal reimbursement rates, improving access to care for 6.5 million low-income patients but throwing a new wrench in already difficult budget negotiations.

The U.S. District Court decision forces the state to reimburse most Medi-Cal providers at rates prior to the 10 percent cut, which lawmakers and Gov. Arnold Schwarzenegger made effective July 1 as a cost-cutting measure to help resolve a $15.2 billion budget shortfall this year.

The move increases reimbursement rates the state pays to doctors, dentists, pharmacists, adult day-care centers and other providers who serve Medi-Cal patients. It excludes some hospitals who do not contract with the state and do not provide emergency care.

This just shows the fallacy of a cuts-only budget, which runs into all kinds of voter mandates and constitutional demands.  The good news here is that reimbursement rates will be sustained, albeit at a level low enough that half of the state’s doctors will still probably reject Medi-Cal patients.  The Democratic budget would also have rescinded the Medi-Cal rate cuts.

In a separate decision in the State Supreme Court, the justices ruled that doctors cannot deny care to gays and lesbians based on moral objections.

Justice Joyce Kennard wrote that two Christian fertility doctors who refused to artificially inseminate a lesbian have neither a free speech right nor a religious exemption from the state’s law, which “imposes on business establishments certain antidiscrimination obligations.”

In the lawsuit that led to the ruling, Guadalupe Benitez, 36, of Oceanside said that the doctors treated her with fertility drugs and instructed her how to inseminate herself at home but told her their beliefs prevented them from inseminating her. One of the doctors referred her to another fertility specialist without moral objections, and Benitez has since given birth to three children.

Nevertheless, Benitez in 2001 sued the Vista-based North Coast Women’s Care Medical Group. She and her lawyers successfully argued that a state law prohibiting businesses from discriminating based on sexual orientation applies to doctors.

Of course, we cannot rely on the courts to shape public policy.  But they set the boundaries – the lines that lawmakers cannot cross.  And those boundaries are leading to increased access and improved care.

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:

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.

Lawsuits, Lawsuits, Lawsuits

There’s a confluence of high-profile laswsuits against the state today, on big topics with far-reaching consequences.  First, the medical community is suing over Medi-Cal payments:

Doctors, hospitals and health care providers filed a class-action lawsuit Monday seeking to block the state from cutting payments to them for treating the poor.

The lawsuit argues that an upcoming 10 percent rate cut to Medi-Cal — the state-run health insurance program serving 6.5 million low-income residents — will exacerbate a shortage of doctors, dentists and pharmacists willing to treat poor patients because payments are so low.

“Medi-Cal already doesn’t cover the cost of providing care,” said Dr. Richard Frankenstein, president of the California Medical Association, which led the lawsuit. “If these cuts take effect, Medi-Cal patients will be forced to seek care in already overcrowded hospital emergency rooms, which undermines access to care for all Californians.”

The suit, filed in Los Angeles Superior Court on Monday, seeks an immediate injunction to block the reduction from taking effect July 1.

San Francisco mayor Gavin Newsom has been at the forefront of criticizing these payment cuts, and when he talked to bloggers at the CDP convention he predicted this lawsuit would be successful.  The future of emergency room care and Medi-Cal really hangs in the balance: if the payments are inadequate, hospitals and doctors might turn these patients away, straining the ER system and increasing the crisis in health care access.

In a separate lawsuit, a taxpayer group is suing to block $12 billion in prison construction bonds.

Even though the state is facing a $20 billion dollar deficit and our high schools, colleges, universities, health care facilities, and food banks alike are threatened with billions of dollars of reduced funding, the Governor and our Legislative leaders want to build 53,000 new prison and jail beds. We already have 170,000 prisoners in California. We don’t need more prison beds — we need sentencing reform and better support in the community for recovering drug addicts, people with mental illness, and parolees.

That’s why we are filing our lawsuit today to stop the Governor from borrowing $7.4 billion in lease revenue bonds to build new prison beds, at a total cost of over $12 billion including interest payments. Operating these new prison beds will cost at least $1.5 billion each year, or a staggering total of $37 billion over the next 25 years. Our lawsuit argues that the $7.4 billion in lease revenue bonds violates the requirement in the California Constitution that all significant long term debts be approved by the voters. The lawsuit aims to force the state to ask its voters whether they want to build the 53,000 prison and jail beds proposed in AB 900. The New York Times has dubbed AB 900 as “the single largest prison construction program in the history of the US.” Not only is AB 900 a tremendous waste of government resources, it also threatens the very premise of democracy by shutting voters off from their constitutional rights.

Desperate times call for desperate measures.  And considering that a year after passage of AB 900, not one bed has been constructed, I’d say that this is a money pit and taxpayers need to step in to stop the digging.  We have better solutions in the way of sentencing reform, and while Democrats in both chambers of the legislature play politics over which sentencing bill will become the primary one (Sen. Romero’s clearly should, IMO), the crisis grows.  And given that these construction bonds are little more than a boondoggle, California will probably end up following the lead of several states and release a mass of inmates early.  There are real solutions to be had here, but pissing away $12 billion dollars is not one of them.

As if the state didn’t have enough problems…  

SF to sue the state over Medi-Cal reimbursements

San Francisco mayor announced yesterday that SF will be suing the state over Medi-Cal reimbursements.  Just so you know, under the new fee schedule primary care providers would get either $18 or $24 per visit. That’s hardly enough to make it worth hiring somebody to fill out the forms, let alone pay rent, buy equipment, etc. Of course, part of this is a failure at the state level for allowing these cuts, part of this is a federal problem, with federal rates too low. But, to be clear here, the federal government provides a 1:1 match for increased reimbursements, so we are leaving a lot on the table here.

Hanh Quach at Health Access says that she likes the start, but more can be done:

It’s nice that there is a high-profile ally who will shed light on budget cuts–he predicts that these cuts will have a big impact on San Francisco–a county that comparatively spends more on health care than others. If that’s the impact in SF, how much worse will it be in the rest of the state?

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I’m a little disappointed, though, that Newsom didn’t come out more strongly in favor of a solution–one that includes revenues. He knows one of the problems is that we don’t have enough money. The state has chosen to shuffle money hither and yon and enact budgets that slid out of balance the minute they were signed into law.

Really, it’s all part of the Norquistian strategy to remove the social safety net that was built under FDR through LBJ. Brick by brick, the conservatives are demolishing it. We are finally beginning to wake up to that, but far too late.

Incidentally, the press folks, especially Dan Walters, seemed to be most interested in whether the Mayor was running for governor.