California Health Report | HealthyCal - Part 56
 

California Health Report

  

New rules require insurers to justify rate increases

Published: December 21, 2010 | No Comments

The Obama Administration has rolled out new rules requiring health insurers to justify any annual rate increases of more than 10 percent.

The proposed regulations, unveiled Tuesday by Health and Human Services Secretary Kathleen Sebelius, represent an escalation of federal involvement in a field historically left to the states.

But the White House said only 26 states have the power to block unreasonable rate increases, and many states lack the resources to effectively police the insurance industry. The new federal rules will come with $250 million set aside in the health reform bill to beef up state regulatory bodies, which will implement the 10 percent rule and examine the insurers’ justification. In states that still cannot handle the increased workload, the federal government will perform the review.

States that don’t now have the power to block rate increases, including California, won’t get that power under the new federal regulations. But they will have the ability to force companies to publicly defend their rates. In theory, that increased level of transparency will lead to smaller increases.

California Gov. Arnold Schwarzenegger signed legislation in October that requires insurance companies to give 60 days public notice before raising rates and to provide more information justifying their rate increases to state regulators.

Here is an HHS statement on the regulation.

–Daniel Weintraub

 

Smoking rate hits record low

Published: December 21, 2010 | No Comments

By Daniel Weintraub

California’s smoking rate dropped to a record low of 13.1 percent in 2009, according to new numbers from the state Department of Public Health. That’s a 42 percent decline since the state’s Tobacco Control Program was established in 1990.

Smoking continues to be correlated with education and income, according to the latest numbers.

Only about 5 percent of college graduates smoke, compared to rates between 12 percent and 15 percent for people with less than a college education.

People with incomes of 150,000 or more smoke at a rate of less than 8 percent. For people with incomes of less than 20,000, the rate is nearly 20 percent.

Men smoke more than women to do. About 16 percent of men and 11 percent of women in California smoke.

Other highlight from the report:

–Californians in rural areas generally smoke more than people in urban areas.

–Californians who smoke are smoking fewer cigarettes than in the past, and far fewer than the national average.

–Smoking rates have declined for all major ethnic groups.

Health and Welfare Secretary Kimberly Belshé said in a statement that she was proud of the “tremendous progress” California has made in the fight against smoking over the past 20 years. But she noted that nearly 4 million Californians still smoke and tobacco remains the number one cause of preventable death and disease in the state.

“Our job is not yet complete,” she said.

The Department of Public Health also released its latest version of anti-tobacco advertising paid for by a tobacco tax passed by voters in 1988.

Download the full report by clicking here.

 

Unemployment steady at 12.4 percent

Published: December 17, 2010 | No Comments

California’s unemployment rate remained unchanged at 12.4 percent in November but the construction industry showed surprising strength for the second consecutive month.

Here is an analysis of the numbers from our friends at Beacon Economics:

* Unemployment Rate Remains Unchanged: California’s unemployment rate remained constant at a seasonally adjusted 12.4% between October and November of 2010, despite a small decrease in the number of employed (-1,800). According to the EDD’s Residential Survey, the number of unemployed Californians increased as many previously discouraged workers who had dropped out of the labor force – and were no longer being counted among the unemployed – returned, expanding the size of the labor force.

* Construction Industry Surprises: California’s industry employment (measured by the Industry Survey) showed gains between October and November with Construction leading the pack. Construction, the sector that was hardest hit by the recession, posted a gain of 7,800 jobs. This is the second consecutive month of employment growth for the Construction sector, but only the fourth month of gains in 2010. Also adding positions were Information (5,200), Professional and Business Services (3,000), Government (3,000), and Education and Health Services (2,900). Many of these gains were offset by losses in sectors such as Retail and Leisure and Hospitality. Overall, California gained 3,500 jobs in farm employment and 1,600 jobs in nonfarm employment.

* Despite the Season Retail Employment Loses As Employers Remain Cautious: California’s Retail industry suffered a significant employment opportunity loss despite the lead up to the holiday season. In non-seasonally adjusted terms, Retail added 26,000 jobs between October and November – a much smaller increase than the average rise at this time of year (looking out over the past 20 years). When seasonally adjusting the data the increase shrinks further, showing a clear loss of job opportunity. These results are surprising because taxable sales have increased considerably and most observers are predicting higher sales this holiday season. Moreover, both Wholesale Trade and Durable Goods Manufacturing added jobs, indicating an increased demand for goods. Retailers have likely increased their efficiency (doing more with less) as they continue to exercise caution in this questionable economy.

 

Low-income Californians more likely to have asthma

Published: December 16, 2010 | No Comments

Californians living in poverty are more likely to be diagnosed with asthma than more affluent people, according to a new report from the UCLA Center for Health Policy Research.

From the Center:

Low-income Californians with asthma experience more frequent symptoms, end up in the emergency room or hospital more often, and miss more days of work and school, researchers found.

Of the more than 600,000 Californians who experience frequent symptoms that can signal uncontrolled asthma, a significant proportion (39.1 percent) earn less than 200 percent of the federal government’s poverty standard (FPL). In 2007, 200 percent of the FPL for a family of four was $41,300. By contrast, 19.3 percent of those with incomes of 400 percent of the FPL or higher suffer frequent symptoms from their asthma.

Analyzing data from the California Health Interview Survey from 2001 to 2007, the report’s authors also found a relationship between poverty and a lack of access to quality health care and repeated exposure to environmental triggers for asthma symptoms, such as smoking and second-hand smoke.

The study calculates the prevalence of asthma among adults and children in California’s counties. Those counties with a high percentage of families living in poverty had some of the highest proportions of people currently suffering from asthma. In all counties, however, poverty was associated with asthma.

“The poorest among us suffer most because they lack quality health care and live in high-risk environments,” said Ying-Ying Meng, a senior research scientist with the Center and co-author of the report. “That disparity also burdens our health system with costly emergency care and hospitalizations and extracts the additional high cost of millions of lost days of work and school.”

 

The link between violence, coercion and unintended pregnancy

Published: December 15, 2010 | No Comments

By Daniel Weintraub

Dr. Elizabeth Miller was working in a family planning clinic in Boston a decade ago when she treated a 15-year-old girl who came in for a pregnancy test. The test was negative, and after a brief conversation about birth control, Miller sent the young patient home with condoms for her partner to use in future sexual encounters.

Two weeks later, the same girl was admitted to a local hospital with a severe head injury. Her boyfriend had pushed her down a flight of stairs. Only then did Miller realize that the girl was in an abusive relationship that included sexual and reproductive coercion.

“I completely missed it,” Miller said Wednesday at the state Capitol.

Since that encounter, Miller has dedicated much of her time as a researcher documenting the extent of partner abuse and its links to sexually transmitted infection and unwanted pregnancy, especially among adolescents. She has also helped devise, and test, a set of simple interventions that she says have proven effective in helping women escape abusive relationships or at least take control of their own reproductive health.

“This is not a marginal phenomenon affecting a small number of women,” said Miller, a UC Davis professor.

Miller’s recently published research (in the journal Contraception) surveyed 900 women in four California family planning clinics.

Fifty-three percent of the women in the study reported having experienced physical or sexual abuse by a partner in their lifetime, and nearly 18 percent reported such violence in the past three months.

Nearly 26 percent of women reported an experience of reproductive coercion, 19 percent reported pregnancy coercion and 15 percent said a partner had sabotaged their birth control.

Pregnancy coercion is defined as threats or pressure to promote pregnancy, or when a partner controls the outcome of a pregnancy. Sexual coercion is defined as intentionally exposing a partner to a sexually transmitted infection, forcing condom non-use, threats or acts of violence related to sexually transmitted infection notification or threats or acts of violence if a woman does not agree to have sex when her partner wants it.

Earlier studies have found that adolescent girls in physically abuse relationships were 3.5 times more likely to become pregnant than non-abused girls, 2.8 times more likely to fear the perceived consequences of negotiating condom use than non-abused girls, and twice as likely to have a second pregnancy within 24 months of giving birth.

The most startling finding in Miller’s research was probably her examination of some simple intervention techniques that clinics can use at little or no cost and which proved to be highly effective.

The program begins with a handful of questions for the patient:

–Does my partner mess with my birth control?

–Does my partner refuse to use condoms when I ask?

–Does my partner make me have sex when I don’t want to?

–Does my partner tell me who I can talk to or where I can go?

Doctors are also encouraged to talk to their patients about birth control options — including some that are invisible or impossible for a partner to sabotage — and to ask their patients if they are worried about how their partner will react if they don’t do what the partner wants with the pregnancy.

Finally, doctors and clinic workers were instructed to refer their patients violence prevention counselors.

After these interventions were tried, Miller found a 71 percent reduction in the odds pregnancy coercion compared to a group of women who were not given this kind of help. Women receiving the intervention were 60 percent more likely to end a relationship because it felt unhealthy or unsafe.

Yali Barr, an independent health care consultant who specializes in family planning, said Miller’s research and other recent studies have shown that reproductive coercion and birth control sabotage are “much more common than we could have thought.”

And with the evidence showing that integrated intervention can dramatically reduce the scope of the problem, Barr said it is time to implement that strategy widely.

“It doesn’t have to cost any more,” she said, mindful of the state’s chronic budget crises.

Miller recently received funding to expand her study to 20 Northern California clinics and 3,000 women.

 

President signs child nutrition bill

Published: December 14, 2010 | No Comments

By Daniel Weintraub

President Barack Obama has signed an extension of the nation’s child nutrition program, including new provisions designed to make school meals healthier for kids.

The bill authorizes the US Department of Agriculture to update the current nutritional standards for school lunches and to set standards for all food sold on school campuses, including vending machines, “a la carte” lines and school stores.

The idea behind the bill is to bringer fresher, healthier food into the schools, replacing processed food with whole foods whenever possible.

The measure will increase reimbursement by about 6 cents per meal for schools that meet the new standards.

The law also tries to encourage schools to adopt “farm to school” networks and school gardens that lead to the use of more locally grown foods in school lunches. And it expands access to drinking water for school children.

The bill is expected to expand access to free school meals to an additional 150,000 children by using the Medicaid eligibility process to directly certify children for the school meal program.

About 31 million children already receive meals through the school meal program.

A “sample menu” released Monday by the White House demonstrates the ambitious nature of the change the bill contemplates.

Instead of hot dogs with ketchup, pizza sticks or bean and cheese burritos, the menu suggests items such as a chef salad, whole wheat spaghetti and a submarine sandwich with low-fat cheese on a whole wheat roll. Instead of applesauce and canned pears, children would get fresh broccoli and cauliflower, baby carrots and kiwi halves.

 

Federal judge rules against Obama health care plan

Published: December 13, 2010 | 1 Comment

A federal judge in Virginia has ruled that it is unconstitutional for the federal government to require people to buy insurance — a crucial piece of the health reform bill passed earlier this year.

Judge Henry Hudson ruled that the so-called individual mandate in the health reform law oversteps the power of Congress to regulate interstate commerce under the Commerce Clause in the US Constitution.

Although the judge’s ruling applies only to the mandate, that provision, scheduled to take effect in 2014, is a key part of the law. Without it, another much more popular provision — the rule prohibiting insurance companies from denying coverage to people with pre-existing conditions — would be difficult to sustain.

If insurance companies must sell policies to anyone, even if they are already sick or injured, and people are not required to buy insurance when they are healthy, consumers would have a strong incentive to not buy coverage until they needed it. That would be like letting people buy fire insurance while their house is on fire.

The idea of the individual mandate is to spread the risk in health insurance as broadly as possible by requiring everyone to have coverage. People who couldn’t afford it would be subsidized by the government.

The case is expected to be appealed, and to eventually reach the US Supreme Court.

But Hudson found that it would be unconstitutional for the federal government to require people to buy a private product — health insurance. He found nothing in the constitution or in case law that allows the government to impose such a requirement. It’s one thing, he said, to regulate economic activity. It’s an entirely different thing to regulate inactivity.

Here is a key paragraph from Hudson’s opinion:

A thorough survey of pertinent constitutional case law has yielded no reported decisions from any federal appellate courts extending the Commerce Clause or General Welfare Clause to encompass regulation of a person’s decision not to purchase a product, notwithstanding its effect on interstate commerce or role in a global regulatory scheme. The unchecked expansion of congressional power to the limits suggested by the Minimum Essential Coverage Provision would invite unbridled exercise of federal police powers.

The Obama Administration had argued that the mandate’s enforcement mechanism, a fine on those who failed to buy coverage, was really a tax, and outside the court’s purview in this case. But the judge said the fine was not a tax — and noted that the Administration said the same thing during the debate over the bill.

One easy fix would be for Congress to impose a health care tax and then offer a credit of an equal amount to anyone who could show proof of coverage. That would have the same effect as the mandate but would clearly rest within the taxing powers of Congress.

That would have been an easy fix, if the Democrats still controlled Congress. But Republicans are not going to pass such a tax, and their opposition will be even greater if it is portrayed as a way to save the reform legislation.

 

Brown hears experts lay out scope of budget problem

Published: December 8, 2010 | 1 Comment

By Daniel Weintraub

Gov.-elect Jerry Brown convened a forum on the California’s budget situation Wednesday, declaring that the state faced a “very serious” crisis that dated to decisions made over the past decade.

“I’m determined to do everything I can to get us back on track,” Brown said.

Brown, who will take office Jan. 3, tried to keep specific solutions off the table Wednesday, instead asking state finance officials to lay out the scope of the problem. He was joined by three legislative leaders and other state officials.

Brown said the state is divided between north and south, Republicans and Democrats, urban and rural areas. To bridge those gaps, he said, people need to have as much information as possible.

“It’s very hard to come to any agreement if there is no consensus on what they underlying facts are,” he said.

Some of the facts highlighted in the forum:

–The state faces a $25 billion gap between projected revenues and spending over the next 18 months. That’s more than the state will spend on higher education and the prisons combined.

–The state is unlikely to grow its way out of the problem. It faces an ongoing $20 billion gap between spending and revenues even if the economy recovers as expected during the next few years.

–The recent recession has meant more than twice as many jobs lost as previous downturns and will require twice as long for the state’s jobs picture to return to its previous peak.

–California is a relatively high tax state, but its government and school payrolls are among the lowest in the nation when measured on a per capita basis.

Senate Leader Darrell Steinberg thanked Brown for beginning what he said he hoped would be “an intelligent conversation” with the people of California about the budget.

“It’s long overdue and it’s absolutely essential,” Steinberg said.

Steinberg said the problem is complex and the solutions can be complicated. But he said it comes down to something much more simple:

“What do we want as a state, and how do we go about paying for it,” he said.

Assembly Republican Leader Connie Conway of Tulare said she was ready to work with Democrats to solve the problem but she cautioned that Republicans would oppose tax increases.

“We can no longer spend what we don’t have,” she said. “There is no doubt tough choices lie ahead.”

 
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