Health Reform | HealthyCal - Part 2
 

Posts Tagged health reform

  

Republicans will find it harder to repeal health reform than it was to campaign against it

By Daniel Weintraub

Newly ascended Republicans in Congress say one of their first goals will be to repeal the health care reform law Democrats in Congress and President Barack Obama enacted in March.

But that task is likely to prove more difficult than they believe, or at least harder than Republican politicians are letting on to their supporters.

Republican leaders on Wednesday were citing a CBS News exit poll that found nearly half of voters saying they wanted the law repealed. But as Obama pointed out in a post-election press conference, that also means that half of the voters want the law preserved.

Besides, those impressions, especially the negative ones, are based largely on opponents’ characterization of the reform as a federalization of health care, a big-government over-reach that will fundamentally change the way most people get their insurance and their care. Rep. Eric Cantor of Virginia, expected to be the majority leader once Republicans take control of the House, called the law an “abomination” and said he expected to have a bill to repeal it on the floor of the House “right away.”

But Republicans know they have no chance to repeal the entire bill with the Senate still in Democratic hands and Obama in the White House. So they instead will try to chip away at it, piecemeal. But the American public might not be as supportive of that approach, because many of the individual pieces of the plan are far more popular than the concept of a big, comprehensive, government-led overhaul. The parts of this many-faceted law are more popular than the whole.

Republicans, for instance, are unlikely to try to repeal provisions that will prohibit insurance companies from denying coverage to people based on pre-existing conditions, or allow families to keep adult children on their policy until age 26. Both ideas are very popular with the public. Other pieces will make preventive care available without out-of-pocket charges and prevent insurers from using errors in consumers’ applications to justify rescinding coverage to people after they get sick.

GOP lawmakers could try to roll back the bill’s requirement that every individual have insurance, either through an employer or on their own, probably the least popular provision in the bill. But many Americans who have coverage now might see that mandate as a way to get “free riders” to take responsibility for their own care. Also, Republicans know that if they repeal the mandate, they would wreak havoc on the insurance market if they left in place the more popular requirement that insurers sell to all comers, because without the mandate, people would have a big incentive to simply wait until they were sick to buy insurance.

Republicans are also not likely to try to repeal subsidies for small employers to help them buy coverage. They might try to repeal the bill’s subsidies for low-income people, but that’s hardly a huge rallying point for their supporters. In other words, if they can’t repeal the entire program in one swoop, and they can’t, at least until 2012, they will find it very difficult to build broad public support for incremental roll backs.

Obama mentioned some of the more popular parts of the bill in his press conference Wednesday and, while saying he would work with Republicans to tweak it, he all but dared them to try to repeal it.

“I don’t think that you’d have a strong vote for people saying, you know, “Those are provisions I want to eliminate,” the president said.

He added: “Now if the Republicans have ideas for how to improve our health care system, if they want to suggest modifications that would deliver faster and more effective reform to a health care system that, you know, has been wildly expensive for too many families and businesses, and certainly for our federal government, I’m happy to consider some of those ideas.”

 

State opens new plan for people denied health coverage

By Daniel Weintraub

California opened the doors Monday on the first major piece of federal health reform to roll out here, a new state-run insurance pool for people who have been denied or priced out of private coverage because of pre-existing medical conditions.

The Pre-existing Condition Insurance Plan, or PCIP, is subsidized by the federal government and is designed to help provide coverage until 2014, when insurance companies will no longer be allowed to deny coverage due to a person’s medical history.

The $761 million in federal funds coming to California as part of health care reform for this program is expected to help about 23,000 people obtain coverage.

To qualify for the program, a person must have been without coverage for at least six months and have been denied coverage because of a pre-existing condition or offered coverage at rates higher than an existing state program for high-risk consumers.

“Operating the high-risk insurance plan is a win-win for our state,” said Gov. Arnold Schwarzenegger, “because we can maximize federal funds while providing more affordable coverage to individuals who desperately need health insurance.”

Anthony Wright, executive director of Health Access California, said the new program will provide “much-needed relief” for people shut out of the private insurance market.

“It’s not just a better option, it is for many Californians the only option for getting coverage at any price,” Wright said.

To learn more about the program, go to the PCIP website here.

 

Foster kids won’t get same benefits as other young adults through health reform

By Megan Baier
HealthyCal.org correspondent

Parents across the country can put their 20-something kids back on their private health insurance thanks to health reform laws that rolled out last month But thousands of young adults will not have that opportunity: foster children who were raised in the care and custody of the state.

Senator Elaine Alquist, D-San Jose, sponsored SB 771, a bill that would have given foster children the ability to continue to receive health insurance through Medicaid until age 26.

In 2014 federal health reform laws will allow foster youth to stay on Medicaid until age 26. Senator Alquist’s bill aimed to go a step further and enact the law in California early, but it was held up over costs. Although Gov. Arnold Schwarzenegger signed legislation to extend many foster care benefits to youth between the ages of 18 and 21, older former foster kids will still be going without health care.

Sierra Jones grew up in foster care. She recently turned 21 and lost her Medi-Cal benefits. Jones says that now her health care options are limited, and she has to make out of pocket payments at the clinic she can go to.

Jones is pursuing higher education and cannot keep a full time job that would offer health insurance, while other private insurance options are too expensive, leaving her without any coverage.

“If I get sick then I’m just going to have to deal with it,” she said. Even if she needed medical care, she said she would not go to the clinic because of the cost. “It just makes it so much harder now.”

Thousands of young adults who were formerly in foster care are in the same situation as Jones and will not have the same opportunity as children with parents until health reform extends Medicaid in 2014.

Kelly Hardy, associate director of health for Children Now, works in collaboration with the Children’s Defense Fund and the Children’s Partnership on a campaign to win health insurance for all California children.

Hardy calls the state’s refusal to extend Medicaid benefits for foster children “short-term thinking.”

“Unfortunately I think policy makers are just looking at any way to avoid costs, but really you can either pay now or pay later,” Hardy said. “If young adults are not getting the health care that they need, they’re not going to be as productive and healthy later in life.”

“The state is legally the guardian for foster youth and so it’s only fair and equitable for all young adults up to age twenty-six to be able to stay on their guardian’s health insurance plan” Hardy said. “We really need to make sure the most disadvantaged youths are getting all the support that the most advantaged kids are getting.”

According to Senator Alquist, there are about 75,000 children in foster care, but few stay for long periods of time. Typically youth enter the state’s custody in poor health and often have a history of abuse or neglect.

The bill would have extended health insurance to 5,000-10,000 former foster kids between the ages of 21 to 26, costing the state anywhere from $25 million to $50 million a year.

 

Health reform changes rolling out this week

By Daniel Weintraub

Six months after Congress and President Barack Obama overhauled the nation’s health care laws, some of the first major provisions are set to take effect later this week.

The one change the most people will probably notice first is a provision requiring insurers to cover children until the age of 26.

An estimated one million young adults between the ages of 19 and 25 are uninsured in California today, and many of them will be eligible for coverage on their parents’ policies.

And unlike current rules, which require children to be dependents and in school full time in order to stay on their family’s coverage, the new rules will apply to most children whether they are in college or not.

A 25-year-old can be on his or her parents’ plan even if married and living in another state.

The only definite exclusion will be for young adults who are already covered by a plan at their workplace. In addition, insurance companies will still be able to exclude young adults with pre-existing health conditions, or deny them coverage for that condition.

But another change in the law will prevent insurance companies from denying coverage to children under 19 years old because of their health history.

Another change: insurance policies will have to cover a long list of preventive health measures at no out-of-pocket cost to the policyholder. There will be no co-pays or deductibles for check ups, mammograms and the like.

Health insurers will be able to raise premiums to cover these services, and some have said they intend to do so. Some of those costs might be passed on to policyholders through their employers’ benefit plans.

“Most insurers see the value of preventive services and do include them as benefits for their members,” said Gerald Kominski, associate director of the UCLA Center for Health Policy Research. “But many insurers do require co-payments or require that (policyholders) count their preventive care toward their annual deductibles. This will no longer be the case.”

The new law will also prevent insurance companies from retroactively denying coverage to people based on errors in their applications. People will only lose coverage based on outright fraud, not honest mistakes.

Aaron Keshishian, a 25-year-old student at Cal State Northridge, said Monday that he recently had to choose between health coverage and continuing college, because the only health insurance he could find cost about as much as his tuition.

“Up to my 25th birthday I was covered by my mother’s health plan,” he said. But as soon as he turned 25, even as a full-time student, his mother received a letter from the insurance company informing her that he would be dropped from her policy.

“For the past three or four months I have gone without any health insurance” he said. “Thankfully I will be covered by her policy until my 26th birthday.”

 

Local grants will aim to transform communities, improve health

Megan Baier

Megan Baier

By Megan Baier
HealthyCal.org correspondent

A little known part of the federal health reform enacted earlier this year aims to improve health by improving the conditions under which people live. Part of a planned $15 billion investment in prevention programs, community transformation grants will provide money to clean up neighborhoods, rejuvenate neglected parks, and expand access to healthy foods.

The idea behind the grants is to go straight to the source of what ails people, acting on research that shows a connection between where people live and how long, and how well, they live. Many of the medical services to be financed through the health reform wouldn’t be needed if people could prevent illness by living in better conditions and in conditions that encourage them to change unhealthy behavior.

A preview of how that change might look in California is rolling out in Los Angeles, where the county earlier this year was awarded $32 million from the economic stimulus package to undertake projects similar to those that will be financed by the community transformation grants.

Under the supervision of the Los Angeles County Department of Public Health, locally based groups and non-profits, as well as the city and county have began implementing prevention projects.

Alliance for a Better Community (ABC), is working to coordinate joint use agreements between schools and private groups to increase access to safe recreational facilities for community members.

“Our ultimate goal is to increase access to school facilities for physical activities,” said Vanessa Rodriguez, a community health coordinator for ABC.

In Boyle Heights, the local YMCA and Sunrise Elementary have partnered, allowing the YMCA to organize after school exercise programs on school grounds.

The East Theater Company and Esteban Torres High School have established a joint use agreement that allows the theater company to use the school’s outdoor stage for rehearsals and plays.

Joint-use agreements often take many years to establish and ABC is working to simplify and expedite the process.

Instead of creating new parks and facilities, Rodriguez said, working to transform existing parks into safe and active places for the community is more cost effective. It’s a “creative use of spaces,” she said.

Another project is attempting to clean up the alleyways of South Central LA and make them useable for residents. Many of the alleyways in the area are full of trash and residents feel unsafe in them.

Jenny Scanlin, a project coordinator for the Community Redevelopment Agency of the City of Los Angeles (CRA), said CRA is looking to “reuse this dead space” and create a space that fosters health.”

Many of the alleys connect schools, groceries, and parks, so they could provide an opportunity to connect people and places.

CRA is working to create a safe and free space to exercise in the alleys for the residents that live in the surrounding apartments. By installing lighting, permeable roads, benches and even circuit training equipment, residents will be able to exercise in their community.

In addition, CRA is looking to develop gardens and vegetation in the alleys.

Throughout southeast LA, “food deserts” inhibit residents from eating nutritious foods. Convenience stores and liquor stores are in abundance, but grocery stores are often miles away.

The Corner Store Conversion project is working with convenience stores in strategic locations, close to schools, transit, and homes, to bring in refrigeration units and begin carrying fresh and healthy foods.

Another goal of the conversion project is to improve the exterior as well as interior and the lighting of stores to make them more appealing and hopefully increase the number of customers.

Other projects include anti-tobacco campaigns, increasing bike access throughout the county, installing fit zones or places for adults to work out for free in parks, and changing school meals to make them more nutritious.

 

Promotores could see boost from federal health reform

Megan Baier

Megan Baier

By Megan Baier
HealthyCal.org correspondent

California is preparing for a major expansion of support and funding for promotores – grass roots health workers who work within their own communities to reach out to rural, remote and otherwise underserved populations.

The federal health reform enacted earlier this year includes $15 billion over the next ten years for preventive health measures, including promotores. State legislation is pending to enable the Department of Public Health to assess existing promotores organizations here to ready California to compete for the federal grants.

The bill, AB 2354 by Assemblyman V. Manuel Perez of Coachella, would also develop a formal definition of what promotores do. Different from community health workers, promotores are based locally and are affiliated with the community more than health institutions.

Originating in Latin American countries, promotores have increasingly surfaced in the United States over the last 30 years.

Typically promotores serve low-income communities that have less access to health resources. Workers are community members, people who speak the same language, understand the culture, and are familiar with the needs of their neighborhoods.

Promotores may hold paid positions or volunteer. They may work independently, with non-profit agencies, local, county or state governments on prevention, educating communities on health resources, or even policy work.

Those living on low-incomes, people who do not speak English, and those who live in rural or remote areas often do not know what health services and resources are available. Promotores actively work to educate these populations and ensure that they do not go without the health care and preventive services they need.

Last year, for example, when fears about H1N1 flu virus were rampant, the state funded promotores to educate people about the virus and help them get vaccinated.

Because of their unique and effective connections to communities, the promotores model has been chosen by state, county, and non-profit organizations to run preventive campaigns and work from within to create healthier communities.

Poder Popular of the Coachella Valley is a locally based group that provides support, training, and employment opportunities for promotores. Originally funded by the California Endowment, Poder Popular of the Coachella Valley now works with various non-profit groups and foundations to tackle specific problems facing the people of Coachella. (Note: The California Endowment also provided initital funding for this web site, HealthyCal.org.)

Currently Poder Popular is working with residents living in mobile home parks, mostly low-income farm workers, throughout the eastern communities of Coachella. Most of these communities get their water from wells that contain unsafe levels of arsenic, above the federal standard of 10 parts per billion.

“Some of these communities are very remote, rural, and don’t have the resources to fix the water issue,” Ana Lisa Vargas, the executive director of Poder Popular, said. “Currently we work with some of those communities to figure out interim solutions or long term solutions” to ensure people have access to safe drinking water.

Vargas estimates that close to 5,000 people living in mobile home parks throughout the area are affected by unsafe well water.

Poder Popular has provided information to residents about the dangers of arsenic, educated residents on their rights to mobilize, and created community action groups to help residents make changes.

Poder Popular is also beginning to work with the National Latino Research Center in San Diego to use promotores to assess the needs of the community and address them appropriately.

“Whether it’s housing, whether it’s access to health, food,” promotores will be trained on the resources available to address those needs and then go out into the community and try to inform people what resources are available to them, Vargas said.

Maria Lemus the executive director of Vision y Compromiso, said promotores provide a “community solution” to health problems in many communities.

Vision y Compromiso, a statewide organization, works to support promotores across California by providing advocacy, training, education, and workforce development, as well as a network of support and resources. With over 4,000 people in their network, Vision y Compromiso is the largest organization of its kind in the nation.

“There is a lot of infrastructure that goes into promotores programs,” Lemus said. “The training is critical.”

As health reform funding expands and creates new promotores programs it will have to keep that infrastructure intact, Lemus said.

Assemblyman Perez’s bill passed the Assembly and is pending in the Senate Appropriations Committee.

 

High-risk insurance pool to start coverage in September

By Daniel Weintraub

California’s newly expanded program for people who can’t get insurance because of pre-existing medical conditions is about to open for business.

The program, one of the first pieces of federal health reform to be implemented here, is already accepting requests for applications, which will be available later this month. Coverage will begin in September.

“This is an important step in our progress to ensure that many more Californians can
benefit from this important new federal program,” Cliff Allenby, chairman of the 7-
member Managed Risk Medical Insurance Board, said in a statement released by the agency.

Rates under the new program will vary by region and the age of the applicant. The premiums will range from $127 monthly for a child in Southern California to $1003 a month for a 74-year-old person living in the Bay Area.

California will receive $761 million from the federal government to operate the plan through the
end of 2013. After that, new insurance rules will prohibit insurance companies from considering preexisting health conditions in pricing and eligibility.

Currently a state program provides insurance to about 7,100 high risk Californians each month. The federally funded expansion is expected to serve far more people.

To be eligible, a person must be a U.S. must be a citizen, a national or lawfully present in the
United States; must have had no creditable coverage in the six months prior to filing an
application; and must have a preexisting condition and by proof of denial by an insurance
carrier within the past 12 months or an offer of coverage above the premium level of the rates offered by the state’s high-risk program.

Nearly 4,000 people have requested an application for the program from the high-risk insurance board. Anyone who wants an application should submit their name, address, phone number and email
address to PCIP@mrmib.ca.gov.

 

Knitting health reform into the community

By Ronald Fong, MD, MPH

Dr. Ronald Fong

I was privileged and surprised to be invited to Congresswoman Doris Matsui’s inaugural Sacramento Health Care Working Group meeting in early July. Rep. Matsui assembled many of the region’s health care leaders, including Claire Pomeroy, Dean of the School of Medicine at UC Davis; Glennah Trochet, Sacramento County Public Health Officer, CEO’s of medical groups, health directors of community clinics, and others who shape health care delivery in Sacramento.

Rep. Matsui wanted input on how to engage citizens on the implementation of the recently passed federal health reform, known as the Affordable Care Act. During the guest self-introductions, I pondered the weight of my credentials. Immediately, my mind zoomed to the 1992 Vice-Presidential debates where Vice Admiral James Stockdale greeted the American voting public by saying, “Who am I? Why am I here?”

Rep. Matsui promoted constructing a “Sacramento Model” as a paradigm for other cities to institute national policy aligned to local sensibilities. She believed Sacramento’s demographics provided challenges and opportunities that resonate with almost every other region of the country. She cited the 2002 Time Magazine article declaring Sacramento as “America’s Most Diverse City.”

Already, there are institutional responses to the health needs of a varied population. At the UC Davis Medical Center, we have translator services for over 30 languages. The UC Davis School of Medicine sponsors seven student-run clinics that serve communities with histories of limited legislative representation: Paul Hom Asian Clinic [Asian and Pacific Islander]; Clinica Tepati [Latino]; Imani Clinic [African American]; Shifa Clinic [Muslim]; Joan Viteri Memorial Clinic [intravenous drug users, sex workers]; Bayanihan Clinic [World War II veterans and recent immigrants of Filipino descent]; and The Willow Clinic [individuals/families without homes]. The key is how to address diverse health care needs with a coordinated and unified approach.

Rep. Matsui wanted the group to function at the “granular” level, a level where the voices of citizens are the clearest and the loudest. At this point, the clarity of my role and responsibility emerged. My place at the table was due more to my residence than my resume. I grew up in Sacramento and returned to raise my family.

Throughout my childhood, I was the beneficiary of many Sacramentans’ good will, whether it was from neighbors, teachers, or coaches. This social capital was an investment to develop my potential as a future contributor.

My children are experiencing similar blessings from the community. Through her countless hours spent scheduling games, staffing the snack shack and many other duties, fellow Pocket Little League board member Tracy Gee has insured that my sons, along with so many others, will remember their youth baseball experiences fondly.

When the Elk Grove Babe Ruth League was short of managers, they asked Rick Venegas to help. He did so, even though he did not have a son in the league. Rick juggled his schedule and was late for many dinners to teach my son on and off the field and to teach me how to be a better coach.

I thank Howard Liu for his time as principal for the Confucius Chinese School. He provided my children with the skills to help immigrant families find their place in Sacramento, such as my parents did over forty years ago.

I have been witnessing the Sacramento Model in motion for over 40 years. My charge is to weave the Affordable Care Act into the social fabric of the Sacramento community. The Act will be meaningful if it sustains our neighbors’ passions even in the face of illness. While Dr. Fong was invited to the meeting, I believe Coach Ron’s input will be more insightful.


Dr. Fong is director of the UC Davis Family Medicine Residency Network. His opinions are his own and do not represent UC Davis.

 
 
 

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