HealthCareForAmericaNow - California

By Micah Weinberg | The New Health Dialogue

There were moments during the long national debate on health health reform when California Gov. Arnold Schwarzenegger was critical of the legislation being considered in Washington. That has now changed, and it’s a politically significant shift.

The Republican governor of the largest state in the Union came out forcefully yesterday in favor of marshaling all state resources to quickly and effectively implement federal reform, starting with the high risk pool next month. He promised to call a special session of the legislature if necessary to pass enabling legislation as the state and the country move ahead with health reform implementation.

For those of us in attendance, it was 2007 all over again: here was the governor talking about his positive experience with universal health care in Austria and making a compelling case that health care reform is neither a Democratic or a Republican issue.  “I am a public servant, not a party servant,” he said, when asked whether his decision not to join some fellow Republican governors in filing lawsuits to block national reform could drive a wedge between him and the rest of the Republican party.

He also responded directly to the new concerns that many Republicans are now expressing about the individual mandate.  Gov. Schwarzenegger explained that when people do not have insurance, they are actaully forcing others to pay for their health care when they go to the hospital.  Better, he suggested, for people to be required to have insurance so that they do not shift the costs and make the rest of society subsidize them.

The governor was joined by Kim Belshe, the Secretary of the California Department of Health and Human Services and the person the governor has designated to quarterback the state’s implementation effort.  Sec. Belshe provided a great deal of information in response to questions about, in particular, the implementation of the state’s new high risk pool.  She explained that the pools are the main topic of conversation in the weekly calls with the staff of the federal Department of Health and Human Services and explained how California’s new pool will exist alongside its current pool.

Secretary Belshe will be speaking in greater detail about reform implementation, specifically about how to get Californians a better bang for their healthcare buck at an event that we are hosting in Sacramento on Wednesday, May 5th.  For more information about this event and to RSVP, click here.

HCAN-California’s lead state partner, Health Access, reported Wednesday that the California Senate Health Committee approved a pair of bills authored by Senate Health Committee Chair Elaine Alquist and Senate President Pro Tem Darrell Steinberg setting up a new insurance exchange to help expand health care coverage for Californians.

• SB 900 (Alquist/Steinberg) sets up a new insurance exchange that actively uses its negotiating power to seek out the best deals for individual and small group policyholders.
• SB 890 (Alquist/Steinberg) standardizes and simplifies the health insurance market so that consumers better understand their choices and can make apples-to-apples comparisons.

In introducing her bill, Senator Alquist said, “This establishes the exchange as an active purchaser that will try to get the best possible deal for consumers shopping for individual policies.” She said the exchange would be administered by a board of legislative and gubernatorial appointees that would meet in public every two months. The board will be held accountable for its decisions, Alquist said.

Health Access advocate Beth Capell said it is estimated that between three and nine million Californians would get coverage through the exchange. The exchange will ensure that people are charged for health insurance on a sliding scale, so those who make less will be charged less, and those with higher incomes will pay prices according to a sliding scale as well. It is envisioned that this fundamental building block of health reform in California would be consumer-friendly enough to attract small businesses into the exchange.

Read more at the Health Access blog…

From the California Healthline

On Tuesday, the Assembly Health Committee approved a bill (AB 1602) by Assembly Speaker John Pérez (D-Los Angeles) that would create the California Health Benefit Exchange to allow individuals and small businesses to purchase private health insurance coverage, the San Francisco Chronicle reports (Colliver/Lagos, San Francisco Chronicle, 4/21).

The new national health reform law requires requires such exchanges to be established by Jan. 1, 2014. The law also aims to facilitate participation in the exchanges by providing tax credits to small businesses and federal subsidies to individuals without employer-sponsored coverage (Ferriss, Sacramento Bee, 4/21).

Pérez said state lawmakers will need to pass AB 1602 this year for it to take effect by the deadline. He added that swift passage of the legislation will provide California officials with sufficient time to set up the exchange (San Francisco Chronicle, 4/21).

Exchange Details

Pérez’s bill would direct the Legislature and the governor to appoint an executive board for the exchange (Sacramento Bee, 4/21). The board would administer federal planning money and oversee California’s efforts to establish the health plan marketplace.

In addition, the measure would charge California’s exchange with identifying individuals who qualify for public health insurance and enrolling them in Medi-Cal, Healthy Families or other services. Medi-Cal is California’s Medicaid program and Healthy Families is the state’s Children’s Health Insurance Program.

The exchange also would need to enforce the federal health insurance mandate. State officials would send reports to the U.S. Department of Treasury listing residents who could be exempt from the mandate because of a lack of affordable health care options.

Changes to State Law

In addition to establishing the exchange, Pérez’s bill would modify state law to conform to provisions in the national health reform law that will take effect by the end of 2010, such as:

• Extending coverage for dependents until age 26;
• Eliminating lifetime limits on policy benefits; and
• Prohibiting insurers from denying coverage to children because of pre-existing conditions.

Bill on High-Risk Pools

In related news, the Assembly Health Committee has approved a bill (AB 1887) by Assembly member Mike Villines (R-Clovis) that would establish a high-risk insurance pool for individuals who are unable to obtain private coverage because of a pre-existing condition.

California already has a high-risk insurance pool that covers about 7,000 residents, but it does not meet requirements to qualify for federal subsidies under the new health reform law.

The high-risk pool proposed under AB 1887 would operate along with the state’s current pool until 2014, when insurance companies will be prohibited from denying coverage based on pre-existing conditions (Herdt, Ventura County Star, 4/20).

Residents in California are protesting against Anthem Blue Cross, the largest health care provider in the Golden State, which plans to raise rates for many. Ben Tracy reports from Los Angeles.

Watch CBS News Videos Online

Throughout California – Health Access California, California Partnership and the Alliance of Californians for Community Empowerment as part of Health Care for America Now (HCAN) – the nation’s largest health care campaign – released the following statement after Republican Scott Brown defeated Democrat Martha Coakley in Tuesday’s special election for the Senate seat in Massachusetts:

Patrick Romano, State Campaign Director, Health Care for America NOW-CA:

“The need for good, affordable health care for everyone in the nation – and particularly for Californians – is the same today as it was yesterday. People in California still need to know they will be protected from medical bankruptcy, won’t be denied coverage for pre-existing conditions, and can get good, affordable insurance either through their job or on their own.

Today Californians are more likely to be uninsured, face a higher cost-of-living, are at greater risk to be denied coverage for pre-existing conditions, and less likely to be offered on-the-job coverage. Health reform would particularly benefit Californians by providing new choices for the uninsured, more security for the underinsured, much needed stability for our safety net, and real savings for our state budget.

Health Care for America Now is committed to winning a guarantee of good, affordable health care we all can count on, and we will continue to push aggressively to get the best health care reform bill possible to the President’s desk for his signature as quickly as possible.

Tuesday’s vote was not a referendum on health care reform. It was a referendum on a particular candidate in a climate in which people, hard pressed by the economy, are impatient for change. It is a statement that reflects voters frustration with the lack of boldness displayed in actually making the changes we voted for last year. People are clearly angry and want more change, not less. Congress must keep going and finish health care reform right.

Our nation’s health care crisis is not an incremental problem and cannot be fixed with incremental solutions. In survey after survey, voters continue to voice strong support for forcing health insurers to stop excluding people with pre-existing conditions; a guarantee that everyone has access to good, affordable coverage; and requiring health plans to spend premiums on medical care, not profits. All those popular core elements of reform are tied together, and we cannot do one without the others.

Massachusetts is a model that health reform works, with 98% of people covered and insurers not allowed to deny people based on pre-existing conditions. It’s time for the rest of the country to have the same access to good, affordable care.

We are on track to pass a strong comprehensive bill, and we will stay focused on that until the President signs the health reform bill into law.”

From Anthony Wright, Health Access WeBlog

While vacationing in Hawaii, conservative radio talk show host Rush Limbaugh had chest pains and as a result had a stay at the Queens Medical Center–which is the hospital where Barack Obama was born (as was my wife as well.) But that’s not the only irony.

Right-wing pundit and virulent health reform opponent, Rush Limbaugh

At a press conference talking about his stay, he made comments which were widely interpreted to take a dig at efforts to reform the health care system, saying he was availed of “the best health care the world has to offer.” Limbaugh continued, “Based on what happened here to me, I don’t think there’s one thing wrong with the American health care system. It is working just fine, just dandy.”

I have a post at The New Republic’s The Treatment (which was highlighted by Politico’s LivePulse and Karen Tumulty at Time’s Swampland) which points out that Limbaugh seems to be endorsing the care he got in Hawaii–which has had a version of health reform for the past 35 years!

Many people pointed this out, including Ben Armbruster at ThinkProgress and Paul Abrams at the Huffington Post over the weekend, and others today (after I had submitted my piece to TNR), including the San Francisco Examiner, the Baltimore Sun, and the SEIU Blog–which also points out the hospital was unionized.

My post takes a look at some of the new research about the Hawaii Pre-Paid Health Care Act of 1974, and its central requirement for employers to provide health coverage to their workers: it shows positive results in improving access with no measurable impact on jobs. If Rush Limbaugh is endorsing an employer mandate, the House and Senate leadership may want to take another look at beefing up its requirements.

One lesson from Hawaii beyond Limbaugh’s visit and unintended endorsement of reform I want to spotlight:

* Beyond the level of the assessment, the structure of the employer assessment is key, so there aren’t broad loopholes that allow employers to avoid any contribution whatsoever. In this regard, the Senate’s complicated “free rider” provision needs to be fixed. The House version has a simple test of whether an employer is providing adequate coverage, and the assessment for those that don’t is a percentage of payroll, based on a sliding scale capped at 8%. The Senate is more convoluted, and the most problematic part is that employers could avoid much of the penalty by shifting workers to part-time status.

As Elise Gould and Ken Jacobs writing for the Economic Policy Institute indicate, “Studies of Hawaii’s health insurance mandate have found that the state has a disproportionate number of employees working slightly under 20 hours a week, the number of hours at which that requirement becomes effective. The 30-hour cut-off in the Senate Finance bill is more likely to encourage reductions in work time, since it is easier to restructure work to fewer than 30 hours a week than to fewer than 20 hours a week.” As the researchers note, work shifts in this range are common in the restaurant, retail, and nursing home industries–the very ones that are less likely to provide coverage and leave their workers uninsured. The experience from Hawaii is strong evidence that the final employer responsibility provisions should be closer to the House than the Senate.

This issue of the structure of an employer requirement—and especially how to cover and pay for part-time workers—was a crucial unresolved issue in the California debate around health reform in 2007. The House bill gets this right–and better than what we had in the final Schwarzenegger-Nunez negotiated bill, partially because we didn’t have the constraints of ERISA. The Senate version, however, needs to be fixed in order for it to work as intended.

Last week, Health Care for America Now - California and its partners hosted a special inter-faith procession through the streets of downtown San Francisco.

A very big Thanks to everyone who turned out and helped make this critical event a HUGE success.

Check out the coverage of the event on local SF Bay Area News below:

KGO-TV: Religious leaders march for health care reform

KTVU-TV: SAN FRANCISCO: Silent March Protests Elimination Of Public Option From Health Plan

See more pictures here.

Health Access Organizer, Nancy Gomez appeared on “Al Rojo Vivo con Maria Celeste” last week. The clip aired nationwide and in 15 countries. The piece focused on the Menendez amendment and the possibility of lifting the 5-year ban for legal permanent residents.

Senate Majority Leader Harry Reid on Thursday is expected to announce the Senate’s version of the national health reform bill, aptly titled, “The Patient Protection and Affordable Care Act.”

There’s been a lot of buzz going around about what the bill will include, including this in-depth analysis by the New York Times, which compares the likely Senate Bill to the House’s “Affordable Health Care for America Act.”

According to the most recent information we’ve seen, the Senate Bill will ensure all Americans have access to quality, affordable health care,  as well as creating the necessary transformation within the health care system to help control costs.  The Congressional Budget Office (CBO) recently reported that the Senate Health Reform Bill will provide coverage to more than 94% of Americans while remaining under the previously stipulated $900 billion budget limit - both improving access to quality health care and helping to reduce the Federal deficit over the next 10 years!

Stay tuned for more updates on this exciting development!

The Washington Post’s “Daily Dose” health-reform blog reported Friday that the private health insurance industry is continuing to do everything in its power to derail national health reform.

According to Washington Post reporter Dan Eggen:

The nation’s largest health insurance carrier is urging its employees to lobby the Senate against reform proposals that would hurt the firm’s bottom line, according to copies of e-mails released Thursday by a liberal advocacy group.

UnitedHealth Group, which is based in Minnesota, sent an e-mail message (PDF) to its 75,000 employees on Tuesday asking them to write their senators and local newspapers in opposition to a public insurance option, alleging that “government-run health care” will force “millions of Americans” to drop their current coverage.

The California-based advocacy group, Consumer Watch Dog, published the text of the letters from United Health Group. Check them out here.