Policy

Actions by people in power – lawmakers, regulators and the like – can make a difference to your health, for better or for worse. We keep you informed

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Spike in ER, Hospitalization Use Short-Lived After Medicaid Expansion

(Getty Images)

(Getty Images)

While the Medicaid expansion may lead to a dramatic rise in emergency room use and hospitalizations for many of the previously uninsured, that increase is largely temporary and should not lead to a dramatic impact on state budgets, according to a new analysis from the UCLA Center for Health Policy Research released Wednesday.

Researchers reviewed two years of claims data from nearly 200,000 Californians who had enrolled in public programs in advance of the expansion of Medi-Cal, the state’s version of Medicaid, in January. These programs were designed to ease the expansion of Medicaid by providing insurance to low-income adults who were not eligible for Medi-Cal at that point but would be when the health law’s expansion went into effect earlier this year.

Researchers then divided the group into four categories, based on the researchers’ assessment of each group’s pent-up demand for health care.

In July, 2011, after being enrolled in California’s Low Income Health Program, the so-called “bridge to reform,” the group with the highest pent-up demand had a rate of costly emergency room visits triple — or more — that of the other groups. But from 2011 to 2013, that high rate dropped by more than two-thirds and has remained “relatively constant,” according to the analysis. Continue reading

Ebola Now an Issue in Nurses’ Contract Bargaining

(Centers for Disease Control via Getty Images)

(Centers for Disease Control via Getty Images)

Nurses’ calls for better hospital preparation around Ebola have landed on the bargaining table. California’s powerful nurses’ union has been bargaining with Kaiser Permanente for months over a new contract, and is now adding to its list of demands better training, protection, and insurance coverage for nurses who may treat patients infected with Ebola.

Diane McClure, a nurse at Kaiser’s South Sacramento facility, says nurses still had no meaningful training more than a month after a patient was admitted to the hospital for a potential Ebola infection, though he later tested negative for the virus.

“Kaiser felt all they had to do was pull up some CDC flyers and put them on the lunchroom tables or up in the bathrooms,” she says. Continue reading

Prop. 45 Fight Worthy of Television Drama

Kevin Spacey stars as Frank Underwood in the Netflix series "House of Cards." (Kevin Winter/Getty Images)

Kevin Spacey stars as Frank Underwood in the Netflix series “House of Cards.” (Kevin Winter/Getty Images)

The power play behind Proposition 45 could be fodder for an episode of House of Cards:

Dave Jones might not like this comparison, but he’s the Frank Underwood in this fight.

“Power is a lot like real estate. It’s all about location, location, location. The closer you are to the source, the higher your property value,” so goes protagonist Frank Underwood, who plays the menacing House majority whip scheming to get closer to the president.

You’d never think there’d be such positioning over who gets to regulate health insurance.

But this is California. And no less than three state agencies want to have a say in this one. Continue reading

Darrell Steinberg, Termed Out, Leaves Health Care Legacy in California

Sen. Darrel Steinberg has served in the California legislature for 14 years. (Lorie Shelley, Senate Photographer)

Sen. Darrell Steinberg has served in the California legislature for 14 years, including six years as president pro tem. (Lorie Shelley, Senate Photographer)

By David Gorn, California Healthline

It only seems like Darrell Steinberg (D) has been in the California Legislature forever. Really, forever has just been 14 years.

The senator had made mental health issues a priority.

For health care advocates, Steinberg’s presence has cast the longest shadow in the 21st century, helping advance health causes on multiple fronts — including autism care, mental health services, foster care and homeless services.

Steinberg was elected to the Assembly in 1998, the Senate in 2006 and became Senate President Pro Tempore in 2008. In that 16-year span, he took a two-year break from the Legislature, from 2004 to 2006. He built a reputation as a deal-maker, a horse trader, a broker of political compromises.

Along the way, he helped shape and muscle into existence some of the cornerstone mental health laws in the state. In 2004, Steinberg wrote and backed the voter-approved California Mental Health Services Act, passed in 2004 as Proposition 63. Continue reading

Poll: Majority of California Voters Support Health Coverage for Undocumented Immigrants

(Getty Images)

(Getty Images)

A majority of the state’s voters support extending current health insurance programs to all low-income Californians, including undocumented immigrants, according to a new statewide poll released Monday.

The poll was commissioned by The California Endowment, a foundation that has been actively working to expand health insurance access to all people, regardless of immigration status. The Affordable Care Act expressly bars undocumented immigrants from receiving any of its benefits, including subsidies to purchase health insurance.

In the poll, 54 percent of those surveyed said they support covering the undocumented. Support was strongest among younger voters as well as Latino respondents and African Americans.

Continue reading

More Than Half of California’s Hospitals Dinged for Readmissions

Chinese Hospital in San Francisco received the second-highest fine of any hospital statewide. (m./Flickr)

Chinese Hospital in San Francisco received the second-highest fine of any hospital statewide. (m./Flickr)

The federal government is fining 64 percent of California hospitals for having too many Medicare patients return to the hospital within a month of being discharged, according to an analysis of Medicare data by Kaiser Health News.

Sutter Surgical Hospital North Valley in Yuba City was the only facility in the state that received the maximum 3 percent fine. Chinese Hospital in San Francisco received the second highest fine: 2.16 percent of all Medicare billings in the coming year.

“Any little bit hurts. We will definitely feel it,” says Peggy Cmiel, chief nursing officer at Chinese Hospital.

The fines are meant to encourage hospitals to do a better job of caring for patients after they’re released. In the past, many hospitals benefited if a patient returned after surgery – more treatment meant more money. Now, the Medicare program that pays for those treatments wants to reverse the trend by fining hospitals that don’t do a good enough job transitioning patients out of the hospital. Continue reading

Early Elective Deliveries Down in California, Still More Work to be Done

(Getty Images)

Doctors, advocates also working to reduce rates of babies born by caesarian-section. (Getty Images)

By Brittany Patterson

In California, about 500,000 babies are born every year. Statewide efforts to reduce early deliveries and maternal death have netted improvements, but more work is still to be done, said advocates who gathered this week to share notes on how to improve maternal and child health across the state.

One specific bright spot was reduction of early elective deliveries — where a woman chooses to deliver her baby early, defined as between 36 and 39 weeks. These are scheduled deliveries that are not medically necessary. But babies born before 39 weeks are more likely to have feeding and breathing problems, trouble keeping themselves warm, and infections.

In 2010, 14.7 percent of births in California were scheduled before 39 weeks. Today, in-part because of intense campaigning, that rate has dropped to less than three percent of total births at about half of the state’s hospitals. The effort to decrease the practice was spearheaded by the March of Dimes, but strengthened by data collected and synthesized by the California Maternity Data Center. Continue reading

California Catholic Leadership Challenges State Abortion Order

 Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)

Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores in July. (Chip Somodevilla/Getty Images)

Associated Press — California’s Catholic leadership has filed a federal civil rights complaint over a state requirement that health insurance cover abortions.

The California Catholic Conference, which represents the state’s bishops and archbishops, sent a letter Tuesday to the U.S. Department of Health and Human Services. It contends that California’s Department of Managed Health Care discriminated against those morally opposed to abortion and requests an investigation.

The complaint is under review, said Rachel Seeger, spokeswoman for the federal agency’s Office for Civil Rights.

The state agency didn’t immediately comment. Continue reading

Why Advocates Say Brown’s Veto of Livestock Antibiotics Bill is a Good Thing

(iStock/Getty Images)

(iStock/Getty Images)

By Joe Rubin

Senate Bill 835 was crafted as a measure aimed at limiting antibiotic use in livestock. To those concerned about the growing problem of antibiotic resistance, it might seem surprising that Gov. Jerry Brown vetoed the bill earlier this week. Yet advocates believe that in striking down the bill, California is poised to take a leading role on the issue.

‘The governor sent a message that he isn’t going to accept fig-leaf solutions to tackle this problem.’ — Natural Resources Defense Council spokesman    

Here’s why: Critics had assailed the bill as too industry-friendly and unlikely to make much impact on antibiotic resistance.

SB835 would have codified a recent Food and Drug Administration voluntary ban on the use of antibiotics for growth-promoting purposes. The measure had sailed through the Legislature. But a coalition, including the Natural Resources Defense Council (NRDC), Consumers Union and several leading medical experts on antibiotic resistance, quietly created a campaign urging the governor to veto the bill. Continue reading

Brown Vetoes Adult Day Health Bill; Future of Program Unknown

There is a 45% increased risk of death in people who are lonely compared to not lonely, according to a UCSF study.

The state has tried to eliminate adult day health care in the past.  (Photo: Getty Images)

By David Gorn, California Healthline

On Monday, Gov. Jerry Brown vetoed a bill to codify Community Based Adult Services as a Medi-Cal benefit and continue offering it as a benefit into the future.

“It puts everything up for grabs. It’s a real step backward.”
The state has attempted to eliminate adult day health care in the past. The CBAS program, serving some of the oldest, most frail Californians on Medi-Cal, is the result of a 2011 settlement of a lawsuit challenging the state the last time the state tried to cut the program.

The veto Monday of AB1552 by Assemblywoman Bonnie Lowenthal (D-Long Beach) leaves an uncertain future for CBAS. The agreement in the 2011 settlement expired at the end of August, but CBAS is included as a Medi-Cal benefit in a proposed amendment of the state’s Medicaid waiver and is included in the Coordinated Care Intitiative. CMS is expected to approve the amendment by the end of this month. Continue reading