Tag Archives: HCR

Legislative Recap on Health: #Health4All; Out-of-Pocket Costs; Medi-Cal, Etc.

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.  

Health Law Doesn’t Protect Californians From Rate Increases

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Reporters largely missed the point of a Commonwealth Fund study released this week, that looked at consumer savings under Obamacare’s 80-20 rule, the rule making insurance companies spend at least 80% of your premiums on health care, not overhead.

The authors started with a fact we already knew — that health insurance companies had to pay $1.1 billion in rebates for missing the MLR requirement in 2011 — and that big shiny number distracted the news media. But the authors zeroed in on a much more important fact. Insurance companies successfully reduced administrative costs by $1.184 billion in 2011, but they used those savings to increase profits instead of passing them on to consumers.

Clearly the 80-20 rule isn’t working to contain profits and hold down premiums, especially in states that don’t have tough regulation of insurance premiums.

California Insurance Commissioner Dave Jones launched an audit this week of the state’s largest health insurers to determine if consumers paid too much when insurers were actually saving money and boosting profits. The Commonwealth study found that in California, insurance companies increased profits for individual plans by $88 per member or about $90 million, even though administrative costs went down and every major insurance company imposed rate increases.

These results are more evidence that states need the ability to say no to rate manipulation. Otherwise, insurance companies will keep premiums artificially high to make sure profit numbers stay high too. As we warned HHS Secretary Sebelius more than two years ago:

“In the same way that a Hollywood agent who gets a 20 percent cut of an actor’s salary has an incentive to seek the highest salary, insurers will have incentive to increase health care costs and raise premiums so that their 15 percent or 20 percent cut is a larger dollar amount.”

As Jones said when announcing the audit:

“I have long pushed for the authority to reject excessive health insurance rate increases and this study provides further evidence of why this change in the law is long overdue in California. Health insurers and HMOs continue to impose double-digit premium increases each year and are making larger profits when selling to individuals and families even during these tough economic times.”

Californians will finally have the chance to stop them, by voting at the next ballot on an initiative measure to require health insurance companies to publicly justify rate increases and get approval before they take effect. Learn more at justifyrates.org

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Posted by Carmen Balber, Washington DC Director for Consumer Watchdog and Consumer Watchdog Campaign

Blue Shield Puts Profits Before People

by California Labor Federation Policy Coordinator Sara Flocks

I have a friend, Patty, who worked as a waitress to pay her way through college. She worked hard and studied hard, so when she got sick and couldn’t get better, she just chalked it up to stress. For two years, Patty was chronically ill with mysterious and debilitating symptoms. She knew she should go to the doctor, but she didn’t have health insurance through work, and she couldn’t afford to buy insurance and pay for rent and tuition at the same time. So she never went to the doctor. Eventually, Patty ended up in the hospital, where she was diagnosed with a thyroid problem. Since she had not gotten care for so long she had to immediately have surgery, which left her with $10,000 in medical debt.

Patty is just one of the 8.4 million Californians who lack health insurance. Californians who don’t have job-based insurance are left to purchase coverage on their own in the individual market—a maze of complicated and overwhelming options hawked by giant health insurance corporations that know how to make a profit. The high cost of health coverage drives many people like Patty into the ranks of the uninsured, because they just can’t afford to buy insurance and pay rent at the same time.

Patty didn’t have health insurance. But even if she did, the rate increases proposed by Blue Shield would have priced her right out of the market. A recent report states that Blue Shield is proposing insurance premium increases as high as 86.5 percent for some policy holders and 45,500 customers will see increases over 50 percent. The total includes three rate increases in the last six months, from October, January and now another one pending in May.

Policy holders were already understandably upset over Blue Shield’s proposed 59 percent increases —so why did that figure jump to 86.5 percent? Turns out, when Blue Shield originally said 59 percent, they neglected to include the October increase in the totals—they only included the two from 2011. Oops, sorry!

Frustrated policy holders have had an ongoing battle with Blue Shield, and now the Department of Insurance has entered the fray. After Blue Shield filed for a rate increase, Insurance Commissioner Dave Jones asked the insurance giant to postpone the planned March 1st increase so the Department could review the rate filing. First Blue Shield refused outright. Then they complied with the request, but thumbed their nose at the Department and released their own study of the rate increase request. To no one’s surprise, Blue Shield found that their rate increase was “reasonable, not excessive.”

Reasonable? Really? Reasonable for whom? I’m sure Blue Shield thinks its ‘reasonable’ to jack up prices during a recession when millions of Californians have lost their jobs, their homes and their savings. But I doubt that the 200,000 Blue Shield policy holders find the increase ‘reasonable.’ I doubt the people who will no longer be able to afford health care and can’t take their kids to the doctor find it ‘reasonable.’ And I highly doubt that the millions of uninsured like Patty find it ‘reasonable’ that even when they work hard at their jobs every day, they will never be able to afford to buy health insurance.

Blue Shield and the other insurance giants who have recently increased health insurance premiums argue that they have to raise prices to cover their costs. They cite soaring medical costs and state and federal mandates, including the federal health reform, as forcing them to raise prices. Yes, medical costs are soaring. But Blue Shield is not exactly a helpless victim in all of this. Insurers play a pivotal role in driving reforms that will reign in costs and make health care more affordable and accessible. They could actually reign in those costs themselves, if they were driven by more than just their own bottom line.

We can no longer afford to pay the skyrocketing price for health insurance. We can no longer afford to have 8.4 million of our fellow Californians go without doctor visits, check-ups, vaccines and basic care because they can’t afford it.

The new federal health care reform law is a step in the right direction, but there is more than needs to be done in order to rein in outrageous premium increases that are forcing more and more Californians into the ranks of the uninsured.

The first step should be to give state health insurance regulators the power to actually regulate the rates health insurers charge. Right now, when Blue Shield files for a rate increase, regulators can make sure that their numbers check out and meet some minimal standards, but they cannot actually stop an insurer from raising rates. Assemblymember Feuer is moving a bill to change that. AB 52 (Feuer) would give the Insurance Commissioner the power to approve rate increases before they go into effect—and to make sure increases are actually reasonable— for people, not just profits. 

Learn more about AB 52.

What Really Happened in MA. Progressives stayed home.

Wanna know what really happened in MA on Tuesday.

The same voters who buried McCain didnt vote this time.

Almost million MORE folks went to the polls in MA in 2008 and all of them voted for Obama.

Scott Brown got the same vote total as McCain, but Coakley got 900k fewer votes.

Dem turnout and independent turnout just disappeared.

MA Election results  

2010 election  

1,168,000 brown  

1,059,000 coakley  

    20,000 others  

2,247,000  total

2008 election  

1,109,000 mccain  

1,904,000 obama  

  100,000 others  

3,113,000 total  

Brown wins with about the same vote as McCain got.  

Where were the 900k or so voters that didnt show up at all and who just a year ago gave Obama the win?

Brown ran identical numbers to McCain, but Coakley drew 900k fewer.  

Dems and independents just didnt turn out. It is as Howard Dean tried to say but then didnt have the data to support it–Progressives are mad at Obama for talking tough on Corporations, HMOs, Big Rx, and Wall Street. But then playing kissy face with them.

There are about 1.5 million Dems, .5 million Goopers, and 2 million no party in MA.  

Healthcare Reform and Workers’ Compensation

(We didn’t get the Kucinich Amendment in the House, but if we did, this would be one more nice side effect of a state single payer program – promoted by Brian Leubitz)

From this morning’s Los Angeles Times:

Steve Poizner on Monday rejected a call from the California Workers’ Compensation Insurance Rating Bureau to hike rates by 22.8% for policies that would be written or renewed after Jan. 1. Poizner also rejected a subsequent recommendation made by a hearing examiner from his department who had reviewed the 22.8% proposal and suggested 15.4% instead.

By law the commissioner’s decision is not binding, but it generally is followed by many leading insurance companies.

In rejecting the recommendations made to him, Poizner cited the weakness of California’s economy and high unemployment.

Because this decision is not binding, it is merely a political act; however, there is little, if any, discussion of the high cost of workers’ compensation on California business when it comes to the health care reform debate. There should be, because relief from workers’ compensation costs would put a very vocal and relatively powerful group behind health care reform: small business. (Or at least eat away at their knee-jerk Chamber of Commerce rejectionism).

For those fuzzy on it, there was a massive reform of California’s workers’ compensation system that was part of Schwarzenegger’s winning platform in 2003. The key aspect of the reform changed what medical treatment was available to workers’ comp claimants, and on what standard medical deicisions would be made, and how compensation would be rated.

This did have the effect of lowering the rates significantly over the last six years, as pointed out by the Times‘s article. I point this out to clarify that it was medical treatment, and not other aspects of workers’ compensation that were at the heart of this reform.

When I brought this up to a number of proponents of the state’s single-payer bill (variously known as SB 810 or SB 840) working for Health Care for All, they confirmed to me that the bills did not include any modification to the workers’ compensation system and that workers’ compensation claims were excluded.

I have not read either bill, so I cannot confirm this personally. But if that is the case, then there is potential in future health care reform that may be necessary at the state level to interface with workers’ compensation.

I have no idea what may come out of the U.S. Senate, but if it is a state-level public option bill, then California may have the chance to work this through. By unifying workers’ compensation claims (to the extent they relate to medical claims) into the larger insurance pool, there should be efficiencies to be gained.

In the future, business might only need to pay for workers’ compensation as a source of disability insurance and rehabilitation insurance. These are significant components, but in my experience, the fighting in administrative courts over workers’ compensation is often over medical treatment. If the state-level plan covered everyone, the dispute resolution system wouldn’t be needed.