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.

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