California Frets Over Funding After Congress Misses Health Care Deadlines
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CEO of California-Based Health Insurer Says Obamacare Just Needs a Tune-Up
Glaring Disparities in Health Plan Benefits Persist Despite Federal and State Efforts
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Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.","avatar":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twitter":"adembosky","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"April Dembosky | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/adembosky"},"cfeibel":{"type":"authors","id":"11314","meta":{"index":"authors_1591205172","id":"11314","found":true},"name":"Carrie Feibel","firstName":"Carrie","lastName":"Feibel","slug":"cfeibel","email":"cfeibel@KQED.org","display_author_email":false,"staff_mastheads":[],"title":"KQED Contributor","bio":"Carrie Feibel is a former health editor at KQED, where she has also reported for radio and online. Her stories have appeared on the national NPR shows \u003cem>Morning Edition\u003c/em>, \u003cem>All Things Considered\u003c/em>, and \u003cem>Here & Now\u003c/em>, and on the national website, Kaiser Health News. Her print career included stints at the \u003cem>Houston Chronicle\u003c/em>, \u003cem>The (Bergen) Record,\u003c/em> and the Associated Press in New York City. A native of St. Louis, Feibel attended Cornell University, and earned a master's in journalism from Columbia University.","avatar":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twitter":"KQEDHealth","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"stateofhealth","roles":["administrator"]}],"headData":{"title":"Carrie Feibel | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/cfeibel"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_361316":{"type":"posts","id":"stateofhealth_361316","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361316","score":null,"sort":[1507164500000]},"guestAuthors":[],"slug":"california-frets-over-funding-after-congress-misses-health-care-deadlines","title":"California Frets Over Funding After Congress Misses Health Care Deadlines","publishDate":1507164500,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>More than a million California children get their health insurance from the Children's Health Insurance Program, also know as \"CHIP.\" Like they do with Medicaid, states split the costs for CHIP with the federal government. But Congress missed an Oct. 1 deadline to renew CHIP funding -- a lapse that many blame on the drawn-out effort to repeal the Affordable Care Act. That fight put other health care priorities on the back burner, and anxiety is growing about when -- or if -- Congress will reauthorize the money to pay for them.\u003c/p>\n\u003cp>\u003cem>What exactly is CHIP?\u003c/em>\u003c/p>\n\u003cp>CHIP is a little-known program but very important. Everyone knows about Medi-Cal, which covers lots of low-income children (and many adults as well), but CHIP is for children whose parents make too much money to qualify them for Medi-Cal, but don't have insurance through their jobs.\u003c/p>\n\u003cp>\"It saddens me because, I mean, they're children. Children should not be politicized,\" said Dr. Porshia Mack, chief medical officer at the \u003ca href=\"http://www.tvhc.org/Home.aspx\" target=\"_blank\" rel=\"noopener\">Tiburcio Vasquez Health Center\u003c/a> in Hayward.\u003c/p>\n\u003cp>A lot of people agree with Mack. CHIP has never been a controversial program, unlike the Affordable Care Act. It's always had bipartisan support since its start in 1997. Everyone professes a desire to insure children, and kids are relatively cheap to insure, compared to adults and seniors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cem>So what happened?\u003c/em>\u003c/p>\n\u003cp>Congress simply missed the deadline to renew the funding. In September, the Senate decided to try yet again to repeal and replace the Affordable Care Act, and it was so busy that CHIP was one of many programs that just didn't get voted on in time.\u003c/p>\n\u003cp>This week, Congress is starting to discuss reauthorizing the money for CHIP, but some of the ideas include ratcheting down the funding amounts. In recent years, CHIP funding had gotten a financial boost from the Affordable Care Act. Right now, California's share of CHIP's costs amount to $364 million a year, but some of the new funding proposals being floated in Congress would increase California's CHIP contribution to $1.5 billion a year.\u003c/p>\n\u003cp>California's CHIP program does have enough money to keep going through the end of 2017, according to the state's Medicaid director, Mari Cantwell. If the federal funding does not come back by January, the state could face some difficult decisions. Cantwell said most children won't actually be kicked off of their insurance, but California would have to pay much more to move them into Medi-Cal plans to keep them insured.\u003c/p>\n\u003cp>\u003cem>What else has been put on the back burner while Congress debated the Affordable Care Act?\u003c/em>\u003c/p>\n\u003cp>There were a number of health programs that also had funding deadlines of Sept. 30. One \u003ca href=\"https://khn.org/news/congress-cold-shoulder-sends-shivers-through-community-health-centers/\" target=\"_blank\" rel=\"noopener\">program\u003c/a> provides federal funding for community health clinics like Tiburcio Vasquez in Hayward. These are safety-net clinics that typically treat low-income people on Medi-Cal, and also provide a last resort for uninsured or undocumented people who have no other options. In California, the federal funding for these clinics came to $1.6 billion over the past five years. Clinic directors in California have been \u003ca href=\"https://www.sfccc.org/blog/2017/9/19/time-to-fight-back-against-graham-cassidy-repeal-bill-and-health-center-funding-cliff\" target=\"_blank\" rel=\"noopener\">vocal\u003c/a> about the importance of this money over the past few weeks, and are especially anxious now that the deadline has been missed. They're saying Congress really has to act soon.\u003c/p>\n\u003cp>\u003cem>What about the future of Obamacare itself? It seems to be very unclear about which direction it's heading.\u003c/em>\u003c/p>\n\u003cp>The repeal efforts seem to have stopped for now, or at least for 2017. But there was also a separate bill to fix one of the chief problems plaguing Obamacare, and that has also been delayed. The bill would have stabilized the individual insurance markets in the states by locking in funding that the Trump administration has threatened to cut. As a result of the ongoing uncertainty, some insurance companies have dropped out of the markets, and some have raised premiums for 2018.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Some states are waiting to see if that bill gets passed, and there is \u003ca href=\"http://thehill.com/policy/healthcare/353671-gop-willing-to-give-ground-on-obamacare-subsidies\" target=\"_blank\" rel=\"noopener\">movement\u003c/a> this week to revive it. But others have already announced that the premiums are going to increase. In Georgia, for example, premiums are set to go up by 50 percent for 2018 -- all because Congress hasn't yet fixed this funding gap. California still hasn't released the rates for Covered California plans for 2018, but they will have to do that soon, because open enrollment for 2018 starts on Nov. 1.\u003c/p>\n\n","blocks":[],"excerpt":"A program that covers more than a million children is in funding limbo. Community clinics and Covered California are also waiting on Congress to take action. ","status":"publish","parent":0,"modified":1507250658,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":753},"headData":{"title":"California Frets Over Funding After Congress Misses Health Care Deadlines | KQED","description":"A program that covers more than a million children is in funding limbo. Community clinics and Covered California are also waiting on Congress to take action. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California Frets Over Funding After Congress Misses Health Care Deadlines","datePublished":"2017-10-05T00:48:20.000Z","dateModified":"2017-10-06T00:44:18.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"361316 https://ww2.kqed.org/stateofhealth/?p=361316","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/10/04/california-frets-over-funding-after-congress-misses-health-care-deadlines/","disqusTitle":"California Frets Over Funding After Congress Misses Health Care Deadlines","path":"/stateofhealth/361316/california-frets-over-funding-after-congress-misses-health-care-deadlines","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than a million California children get their health insurance from the Children's Health Insurance Program, also know as \"CHIP.\" Like they do with Medicaid, states split the costs for CHIP with the federal government. But Congress missed an Oct. 1 deadline to renew CHIP funding -- a lapse that many blame on the drawn-out effort to repeal the Affordable Care Act. That fight put other health care priorities on the back burner, and anxiety is growing about when -- or if -- Congress will reauthorize the money to pay for them.\u003c/p>\n\u003cp>\u003cem>What exactly is CHIP?\u003c/em>\u003c/p>\n\u003cp>CHIP is a little-known program but very important. Everyone knows about Medi-Cal, which covers lots of low-income children (and many adults as well), but CHIP is for children whose parents make too much money to qualify them for Medi-Cal, but don't have insurance through their jobs.\u003c/p>\n\u003cp>\"It saddens me because, I mean, they're children. Children should not be politicized,\" said Dr. Porshia Mack, chief medical officer at the \u003ca href=\"http://www.tvhc.org/Home.aspx\" target=\"_blank\" rel=\"noopener\">Tiburcio Vasquez Health Center\u003c/a> in Hayward.\u003c/p>\n\u003cp>A lot of people agree with Mack. CHIP has never been a controversial program, unlike the Affordable Care Act. It's always had bipartisan support since its start in 1997. Everyone professes a desire to insure children, and kids are relatively cheap to insure, compared to adults and seniors.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>So what happened?\u003c/em>\u003c/p>\n\u003cp>Congress simply missed the deadline to renew the funding. In September, the Senate decided to try yet again to repeal and replace the Affordable Care Act, and it was so busy that CHIP was one of many programs that just didn't get voted on in time.\u003c/p>\n\u003cp>This week, Congress is starting to discuss reauthorizing the money for CHIP, but some of the ideas include ratcheting down the funding amounts. In recent years, CHIP funding had gotten a financial boost from the Affordable Care Act. Right now, California's share of CHIP's costs amount to $364 million a year, but some of the new funding proposals being floated in Congress would increase California's CHIP contribution to $1.5 billion a year.\u003c/p>\n\u003cp>California's CHIP program does have enough money to keep going through the end of 2017, according to the state's Medicaid director, Mari Cantwell. If the federal funding does not come back by January, the state could face some difficult decisions. Cantwell said most children won't actually be kicked off of their insurance, but California would have to pay much more to move them into Medi-Cal plans to keep them insured.\u003c/p>\n\u003cp>\u003cem>What else has been put on the back burner while Congress debated the Affordable Care Act?\u003c/em>\u003c/p>\n\u003cp>There were a number of health programs that also had funding deadlines of Sept. 30. One \u003ca href=\"https://khn.org/news/congress-cold-shoulder-sends-shivers-through-community-health-centers/\" target=\"_blank\" rel=\"noopener\">program\u003c/a> provides federal funding for community health clinics like Tiburcio Vasquez in Hayward. These are safety-net clinics that typically treat low-income people on Medi-Cal, and also provide a last resort for uninsured or undocumented people who have no other options. In California, the federal funding for these clinics came to $1.6 billion over the past five years. Clinic directors in California have been \u003ca href=\"https://www.sfccc.org/blog/2017/9/19/time-to-fight-back-against-graham-cassidy-repeal-bill-and-health-center-funding-cliff\" target=\"_blank\" rel=\"noopener\">vocal\u003c/a> about the importance of this money over the past few weeks, and are especially anxious now that the deadline has been missed. They're saying Congress really has to act soon.\u003c/p>\n\u003cp>\u003cem>What about the future of Obamacare itself? It seems to be very unclear about which direction it's heading.\u003c/em>\u003c/p>\n\u003cp>The repeal efforts seem to have stopped for now, or at least for 2017. But there was also a separate bill to fix one of the chief problems plaguing Obamacare, and that has also been delayed. The bill would have stabilized the individual insurance markets in the states by locking in funding that the Trump administration has threatened to cut. As a result of the ongoing uncertainty, some insurance companies have dropped out of the markets, and some have raised premiums for 2018.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Some states are waiting to see if that bill gets passed, and there is \u003ca href=\"http://thehill.com/policy/healthcare/353671-gop-willing-to-give-ground-on-obamacare-subsidies\" target=\"_blank\" rel=\"noopener\">movement\u003c/a> this week to revive it. But others have already announced that the premiums are going to increase. In Georgia, for example, premiums are set to go up by 50 percent for 2018 -- all because Congress hasn't yet fixed this funding gap. California still hasn't released the rates for Covered California plans for 2018, but they will have to do that soon, because open enrollment for 2018 starts on Nov. 1.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361316/california-frets-over-funding-after-congress-misses-health-care-deadlines","authors":["11314"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_3175","stateofhealth_2808","stateofhealth_2845","stateofhealth_2519"],"featImg":"stateofhealth_361343","label":"stateofhealth"},"stateofhealth_337900":{"type":"posts","id":"stateofhealth_337900","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"337900","score":null,"sort":[1496454967000]},"guestAuthors":[],"slug":"california-senate-passes-single-payer-health-care-bill-despite-missing-financial-details","title":"California Senate Passes Single-Payer Health Care Bill, Despite Missing Financial Details","publishDate":1496454967,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>State senators voted mostly along party lines, 23-14, to pass a bill that would create a state-managed health care system for all 39 million Californians – even though the bill was missing key details, namely, how to pay for it.\u003c/p>\n\u003cp>Opponents of the “Healthy California Act” repeatedly drew comparisons to the rushed Republican House bill to repeal and replace the Affordable Care Act in Washington, DC. They said state Democrats were guilty of the same tactics, pushing their bill on a single payer health system without a funding mechanism.\u003c/p>\n\u003cp>“It’s not cooked,” Sen. Jeff Stone, R-Temecula, said of the bill. “It’s raw meat.”\u003c/p>\n\u003cp>Senate Bill 596 would upend the state’s employer-based health insurance system and replace it with a “Medicare-for-all” single payer system run by the state.\u003c/p>\n\u003cp>Supporters admitted that the bill is a work in progress, but urged passage as a way to continue the debate, especially in light of uncertainty around billions of dollars in federal funding tied to the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The message to those people who say we’re irresponsible, I tell you, do not don’t judge us based upon a vote in a day,” said Sen. Bob Hertzberg, D-Los Angeles. “Judge us based upon our work at the end of the day.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz.\"\u003cbr>\n\u003ccite>Sen. John Moorlach, R-Costa Mesa\u003c/cite>\u003c/aside>\n\u003cp>How to pay for the new system – estimated to cost $400 billion a year – was the main point of contention, with several lawmakers arguing the state’s finances were already strapped.\u003c/p>\n\u003cp>\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz,\" said Sen. John Moorlach, R-Costa Mesa.\u003c/p>\n\u003cp>No specific funding plan was included in the bill, but an economic analysis by the University of Massachusetts-Amherst, commissioned by the bill’s sponsors, assumed two-thirds of the funding would come from existing federal and state funds that currently pay for Medicare and Medi-Cal, and the rest would come from either a payroll tax, or a combination of a 2.3 percent gross receipts tax on business revenue above $2 million and a 2.3 percent sales tax.\u003c/p>\n\u003cp>The health insurance industry criticized the financial assumptions in the report as “overly optimistic.\" Business groups called the taxes a “job killer” and lawmakers raised concerns on the Senate floor that the Trump administration would not allow the state, which has identified itself as a part of the Trump resistance, to re-apply those funds to a single payer system.\u003c/p>\n\u003cp>“We’re going to kick the crap out of Trump day in and day out on this floor, then we’re going to go beg him for a couple hundred billion dollars?” said Sen. Tom Berryhill, R-Twain Harte. “Should be an interesting ask.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“They are fighting to limit care and we’re fighting to expand it.”\u003cbr>\n\u003ccite>Sen. Ricardo Lara, D-Bell Gardens \u003c/cite>\u003c/aside>\n\u003cp>The bill’s primary author, Sen. Ricardo Lara, D-Bell Gardens, thanked his colleagues for a robust debate. He took copious notes, and even accepted critics’ comparison to him pushing his unfinished bill with the Republicans’ hasty passage of the repeal and replace Obamacare bill.\u003c/p>\n\u003cp>“But there is one fundamental difference,” Lara said. “They are fighting to limit care and we’re fighting to expand it.”\u003c/p>\n\u003cp>Because the bill is on a two-year legislative cycle, Lara has another year and half to work out the details of the funding plan. Getting it passed through the Senate gives him extra momentum to bring other stakeholders in on the debate, including, perhaps, Gov. Jerry Brown, who has indicated he would veto a single payer bill.\u003c/p>\n\u003cp>Lara vowed to work with lawmakers on both sides of the aisle going forward, and committed to having a transparent debate.\u003c/p>\n\u003cp>“For the countless people that still do not have access to care, and are still making the decision about putting food on their table or buying prescription drugs because they cannot afford them, we are going to put our minds together to ensure that we bring back a product that is fiscally prudent and sustainable.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"Legislative approval means more time to work out details for funding government-sponsored health plan","status":"publish","parent":0,"modified":1496455647,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":753},"headData":{"title":"California Senate Passes Single-Payer Health Care Bill, Despite Missing Financial Details | KQED","description":"Legislative approval means more time to work out details for funding government-sponsored health plan","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California Senate Passes Single-Payer Health Care Bill, Despite Missing Financial Details","datePublished":"2017-06-03T01:56:07.000Z","dateModified":"2017-06-03T02:07:27.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"337900 https://ww2.kqed.org/stateofhealth/?p=337900","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/02/california-senate-passes-single-payer-health-care-bill-despite-missing-financial-details/","disqusTitle":"California Senate Passes Single-Payer Health Care Bill, Despite Missing Financial Details","path":"/stateofhealth/337900/california-senate-passes-single-payer-health-care-bill-despite-missing-financial-details","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>State senators voted mostly along party lines, 23-14, to pass a bill that would create a state-managed health care system for all 39 million Californians – even though the bill was missing key details, namely, how to pay for it.\u003c/p>\n\u003cp>Opponents of the “Healthy California Act” repeatedly drew comparisons to the rushed Republican House bill to repeal and replace the Affordable Care Act in Washington, DC. They said state Democrats were guilty of the same tactics, pushing their bill on a single payer health system without a funding mechanism.\u003c/p>\n\u003cp>“It’s not cooked,” Sen. Jeff Stone, R-Temecula, said of the bill. “It’s raw meat.”\u003c/p>\n\u003cp>Senate Bill 596 would upend the state’s employer-based health insurance system and replace it with a “Medicare-for-all” single payer system run by the state.\u003c/p>\n\u003cp>Supporters admitted that the bill is a work in progress, but urged passage as a way to continue the debate, especially in light of uncertainty around billions of dollars in federal funding tied to the Affordable Care Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The message to those people who say we’re irresponsible, I tell you, do not don’t judge us based upon a vote in a day,” said Sen. Bob Hertzberg, D-Los Angeles. “Judge us based upon our work at the end of the day.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz.\"\u003cbr>\n\u003ccite>Sen. John Moorlach, R-Costa Mesa\u003c/cite>\u003c/aside>\n\u003cp>How to pay for the new system – estimated to cost $400 billion a year – was the main point of contention, with several lawmakers arguing the state’s finances were already strapped.\u003c/p>\n\u003cp>\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz,\" said Sen. John Moorlach, R-Costa Mesa.\u003c/p>\n\u003cp>No specific funding plan was included in the bill, but an economic analysis by the University of Massachusetts-Amherst, commissioned by the bill’s sponsors, assumed two-thirds of the funding would come from existing federal and state funds that currently pay for Medicare and Medi-Cal, and the rest would come from either a payroll tax, or a combination of a 2.3 percent gross receipts tax on business revenue above $2 million and a 2.3 percent sales tax.\u003c/p>\n\u003cp>The health insurance industry criticized the financial assumptions in the report as “overly optimistic.\" Business groups called the taxes a “job killer” and lawmakers raised concerns on the Senate floor that the Trump administration would not allow the state, which has identified itself as a part of the Trump resistance, to re-apply those funds to a single payer system.\u003c/p>\n\u003cp>“We’re going to kick the crap out of Trump day in and day out on this floor, then we’re going to go beg him for a couple hundred billion dollars?” said Sen. Tom Berryhill, R-Twain Harte. “Should be an interesting ask.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“They are fighting to limit care and we’re fighting to expand it.”\u003cbr>\n\u003ccite>Sen. Ricardo Lara, D-Bell Gardens \u003c/cite>\u003c/aside>\n\u003cp>The bill’s primary author, Sen. Ricardo Lara, D-Bell Gardens, thanked his colleagues for a robust debate. He took copious notes, and even accepted critics’ comparison to him pushing his unfinished bill with the Republicans’ hasty passage of the repeal and replace Obamacare bill.\u003c/p>\n\u003cp>“But there is one fundamental difference,” Lara said. “They are fighting to limit care and we’re fighting to expand it.”\u003c/p>\n\u003cp>Because the bill is on a two-year legislative cycle, Lara has another year and half to work out the details of the funding plan. Getting it passed through the Senate gives him extra momentum to bring other stakeholders in on the debate, including, perhaps, Gov. Jerry Brown, who has indicated he would veto a single payer bill.\u003c/p>\n\u003cp>Lara vowed to work with lawmakers on both sides of the aisle going forward, and committed to having a transparent debate.\u003c/p>\n\u003cp>“For the countless people that still do not have access to care, and are still making the decision about putting food on their table or buying prescription drugs because they cannot afford them, we are going to put our minds together to ensure that we bring back a product that is fiscally prudent and sustainable.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/337900/california-senate-passes-single-payer-health-care-bill-despite-missing-financial-details","authors":["3205"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_3112","stateofhealth_2808","stateofhealth_3110","stateofhealth_2874","stateofhealth_2845","stateofhealth_2519","stateofhealth_365","stateofhealth_3048","stateofhealth_3111"],"featImg":"stateofhealth_338275","label":"stateofhealth"},"stateofhealth_337364":{"type":"posts","id":"stateofhealth_337364","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"337364","score":null,"sort":[1496318421000]},"guestAuthors":[],"slug":"single-payer-economics-one-health-plan-two-new-taxes-three-ways-to-save","title":"Single Payer Economics: One Health Plan, Two New Taxes, Three Ways to Save","publishDate":1496318421,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>A new outside analysis claims a \"single payer\" health system for California would cost $330 billion a year, not $400 billion, the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\" target=\"_blank\" rel=\"noopener noreferrer\">initial price tag \u003c/a>announced last week in a legislative report.\u003c/p>\n\u003cp>The financial analysis also proposed two new taxes to pay for the system: an excise tax and a sales tax. That's in contrast to the 15 percent payroll tax proposed in last week's report.\u003c/p>\n\u003cp>The analysis was produced by a team of economists at the University of Massachusetts-Amherst, and paid for by the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">California Nurses Association\u003c/a>, a key leader in the movement to establish a universal health care system in California.\u003c/p>\n\u003cp>Supporters of a single-payer plan have promised these details for months, ever since two Democrats from southern California, state senators Ricardo Lara and Toni Atkins, introduced Senate Bill 562, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">\"The Healthy California Act.\" \u003c/a>The full Senate must vote on the bill by Friday for it to move forward in the legislative process.\u003c/p>\n\u003cp>Here's your takeaway:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>One Health Plan:\u003c/strong> Say goodbye to your employer-sponsored health plan, with its deductible, co-pays and co-insurance. Say goodbye to Medicare and its part B premium. Everyone would be moved into the still-unnamed, state-administered plan. The new plan would also completely absorb anyone now covered by Medi-Cal or Covered California. The seven percent of Californians who are still uninsured -- including undocumented residents -- would be brought into the fold as well.\u003c/p>\n\u003cp>The economists argue that a single payer plan, by eliminating private, for-profit insurers in California, and by pooling together public funds from Medicare and Medi-Cal, would create a stream-lined system with lots of bargaining power.\u003c/p>\n\u003cp>\"The good news is that California can get a lot more for our money,\" said State Senator Lara after unveiling the analysis on Wednesday at the state Capitol. \"When the legislature passes the Healthy California Act, we will actually spend less than we do now on health care.\"\u003c/p>\n\u003cp>\u003cstrong>Two New Taxes: \u003c/strong>The analysis assumes California would successfully obtain permission from the federal government -- not a given under a Trump administration -- to continue drawing down federal money for Medicare and Medi-Cal patients, but divert the funds into a single-payer system instead. That would take care of two-thirds of the annual cost.\u003c/p>\n\u003cp>Then, California could raise the remaining $106 billion by taxing consumers and business. Specifically, the analysis proposes:\u003c/p>\n\u003cul>\n\u003cli>A new 2.3 percent sales tax, except on basic living expenses such as housing, groceries, and utilities.\u003c/li>\n\u003cli>A new 2.3 percent excise tax on gross business receipts (the first $2 million in receipts are exempted).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Three Ways to Save:\u003c/strong> A single-payer plan would actually cost 10 percent less than the current system, the analysis claims. How would this savings of $38 billion be achieved?\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Overhead:\u003c/strong> Having only one insurer, California, eliminates the need to make a profit or spend money on marketing and sales. The health care \"providers\" (doctors, nurses, hospitals, nursing homes, etc.), would also save money because they wouldn't have to pay people to administer different insurance contracts and navigate multiple payment systems.\u003c/li>\n\u003cli>\u003cstrong>Medical Salaries and Drug Prices:\u003c/strong> As the only entity paying for healthcare, California could negotiate lower reimbursement rates for some services. The state plan could also pressure drug companies to lower prices as a condition of having their drugs included in the state-run \u003ca href=\"https://www.healthcare.gov/glossary/formulary/\" target=\"_blank\" rel=\"noopener noreferrer\">formulary.\u003c/a>\u003c/li>\n\u003cli>\u003cstrong>More Efficient Treatment from Cradle to Grave:\u003c/strong> In a single, streamlined system, doctors won't have to duplicate tests. A unified system of electronic health records could also help identify risk factors for illness, or prompt patients to get necessary vaccines and screenings.\u003c/li>\n\u003c/ul>\n\u003cp>The new report was received skeptically by Charles Bacchi, who leads the industry trade group for private insurers, the \u003ca href=\"http://California%20Association%20of%20Health%20Plans\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. Bacchi predicted the plan would be \"incredibly disruptive\" and \"unaffordable,\" and implied that doctors might leave the state.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They assume that every doctor is going to still be here in California providing coverage under this proposal,\" he said. \"And, you know, who knows? Something like this creates a lot of uncertainty.\"\u003c/p>\n\n","blocks":[],"excerpt":"New economic analysis lowers final price tag to $330 billion a year. ","status":"publish","parent":0,"modified":1496298197,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":693},"headData":{"title":"Single Payer Economics: One Health Plan, Two New Taxes, Three Ways to Save | KQED","description":"New economic analysis lowers final price tag to $330 billion a year. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Single Payer Economics: One Health Plan, Two New Taxes, Three Ways to Save","datePublished":"2017-06-01T12:00:21.000Z","dateModified":"2017-06-01T06:23:17.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"337364 https://ww2.kqed.org/stateofhealth/?p=337364","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/01/single-payer-economics-one-health-plan-two-new-taxes-three-ways-to-save/","disqusTitle":"Single Payer Economics: One Health Plan, Two New Taxes, Three Ways to Save","path":"/stateofhealth/337364/single-payer-economics-one-health-plan-two-new-taxes-three-ways-to-save","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new outside analysis claims a \"single payer\" health system for California would cost $330 billion a year, not $400 billion, the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\" target=\"_blank\" rel=\"noopener noreferrer\">initial price tag \u003c/a>announced last week in a legislative report.\u003c/p>\n\u003cp>The financial analysis also proposed two new taxes to pay for the system: an excise tax and a sales tax. That's in contrast to the 15 percent payroll tax proposed in last week's report.\u003c/p>\n\u003cp>The analysis was produced by a team of economists at the University of Massachusetts-Amherst, and paid for by the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">California Nurses Association\u003c/a>, a key leader in the movement to establish a universal health care system in California.\u003c/p>\n\u003cp>Supporters of a single-payer plan have promised these details for months, ever since two Democrats from southern California, state senators Ricardo Lara and Toni Atkins, introduced Senate Bill 562, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">\"The Healthy California Act.\" \u003c/a>The full Senate must vote on the bill by Friday for it to move forward in the legislative process.\u003c/p>\n\u003cp>Here's your takeaway:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>One Health Plan:\u003c/strong> Say goodbye to your employer-sponsored health plan, with its deductible, co-pays and co-insurance. Say goodbye to Medicare and its part B premium. Everyone would be moved into the still-unnamed, state-administered plan. The new plan would also completely absorb anyone now covered by Medi-Cal or Covered California. The seven percent of Californians who are still uninsured -- including undocumented residents -- would be brought into the fold as well.\u003c/p>\n\u003cp>The economists argue that a single payer plan, by eliminating private, for-profit insurers in California, and by pooling together public funds from Medicare and Medi-Cal, would create a stream-lined system with lots of bargaining power.\u003c/p>\n\u003cp>\"The good news is that California can get a lot more for our money,\" said State Senator Lara after unveiling the analysis on Wednesday at the state Capitol. \"When the legislature passes the Healthy California Act, we will actually spend less than we do now on health care.\"\u003c/p>\n\u003cp>\u003cstrong>Two New Taxes: \u003c/strong>The analysis assumes California would successfully obtain permission from the federal government -- not a given under a Trump administration -- to continue drawing down federal money for Medicare and Medi-Cal patients, but divert the funds into a single-payer system instead. That would take care of two-thirds of the annual cost.\u003c/p>\n\u003cp>Then, California could raise the remaining $106 billion by taxing consumers and business. Specifically, the analysis proposes:\u003c/p>\n\u003cul>\n\u003cli>A new 2.3 percent sales tax, except on basic living expenses such as housing, groceries, and utilities.\u003c/li>\n\u003cli>A new 2.3 percent excise tax on gross business receipts (the first $2 million in receipts are exempted).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Three Ways to Save:\u003c/strong> A single-payer plan would actually cost 10 percent less than the current system, the analysis claims. How would this savings of $38 billion be achieved?\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Overhead:\u003c/strong> Having only one insurer, California, eliminates the need to make a profit or spend money on marketing and sales. The health care \"providers\" (doctors, nurses, hospitals, nursing homes, etc.), would also save money because they wouldn't have to pay people to administer different insurance contracts and navigate multiple payment systems.\u003c/li>\n\u003cli>\u003cstrong>Medical Salaries and Drug Prices:\u003c/strong> As the only entity paying for healthcare, California could negotiate lower reimbursement rates for some services. The state plan could also pressure drug companies to lower prices as a condition of having their drugs included in the state-run \u003ca href=\"https://www.healthcare.gov/glossary/formulary/\" target=\"_blank\" rel=\"noopener noreferrer\">formulary.\u003c/a>\u003c/li>\n\u003cli>\u003cstrong>More Efficient Treatment from Cradle to Grave:\u003c/strong> In a single, streamlined system, doctors won't have to duplicate tests. A unified system of electronic health records could also help identify risk factors for illness, or prompt patients to get necessary vaccines and screenings.\u003c/li>\n\u003c/ul>\n\u003cp>The new report was received skeptically by Charles Bacchi, who leads the industry trade group for private insurers, the \u003ca href=\"http://California%20Association%20of%20Health%20Plans\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. Bacchi predicted the plan would be \"incredibly disruptive\" and \"unaffordable,\" and implied that doctors might leave the state.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They assume that every doctor is going to still be here in California providing coverage under this proposal,\" he said. \"And, you know, who knows? Something like this creates a lot of uncertainty.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/337364/single-payer-economics-one-health-plan-two-new-taxes-three-ways-to-save","authors":["11314"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_2746","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_2808","stateofhealth_2845","stateofhealth_2519","stateofhealth_3048"],"featImg":"stateofhealth_337507","label":"stateofhealth"},"stateofhealth_314323":{"type":"posts","id":"stateofhealth_314323","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"314323","score":null,"sort":[1492002017000]},"guestAuthors":[],"slug":"while-washington-fiddles-california-leaders-forge-ideas-for-universal-health-care","title":"While Washington Fiddles, California Leaders Forge Ideas for Universal Health Care","publishDate":1492002017,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>As the nation’s Republican leaders huddle to reconsider their plans to “repeal and replace” the nation’s health law, advocates for universal health coverage press on in California, armed with renewed political will and a new set of proposals.\u003c/p>\n\u003cp>Organized labor and two lawmakers are leading the charge for a single, government-financed program for everyone in the state. Another legislator wants to create a commission that would weigh the best options for a system to cover everyone. And Democratic Lt. Gov. Gavin Newsom, who hopes to become the next governor, has suggested building on employer-based health care to plug holes in existing coverage.\u003c/p>\n\u003cp>The proposals are fueled both by a fear of losing gains under the Affordable Care Act and a sense that the law doesn’t go far enough toward covering everyone and cutting costs.\u003c/p>\n\u003cp>But heath policy experts say that creating any type of universal health plan would face enormous political and fiscal challenges — and that if it happens at all, it could take years.\u003c/p>\n\u003cp>“There are different ways to get there,” says Jonathan Oberlander, professor of social medicine and health policy at the University of North Carolina. “None of them is easy.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The most specific California proposal comes from state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), co-authors of legislation that would take steps toward creating one publicly financed “single-payer” program.\u003c/p>\n\u003cp>The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB562\" target=\"_blank\">bill\u003c/a>, co-sponsored by the California Nurses Association, would aim for something like a system of “Medicare for all” in which the government, not insurers, provides payments and sets coverage rules.\u003c/p>\n\u003cp>\"It's the right moral thing to do,\" Lara says. \"We live in the United States of America. We live in the most powerful state in the union. It is the right thing for us to make sure that we fight to ensure that everyone has coverage.”\u003c/p>\n\u003cp>Lara’s bill contains a long \u003ca href=\"http://sd33.senate.ca.gov/news/2017-02-17-californians-healthy-california-act-seeks-one-plan-more-choice-residents\" target=\"_blank\">list of benefits \u003c/a>the statewide program would cover. Not just doctors and hospitals, but also prescriptions, vision and dental care, hospice and rehabilitative therapies, and more.\u003c/p>\n\u003cp>California Health and Human Services Secretary, \u003ca href=\"http://www.chhs.ca.gov/Pages/Secretary-Diana-S.-Dooley.aspx\" target=\"_blank\">Diana Dooley\u003c/a>, understands the appeal.\u003c/p>\n\u003cp>“I think in California there continues to be a great deal of interest and enthusiasm around single payer,\" she says. \"It is very easy to talk about and it certainly takes advantage of the anxiety people have about health insurance companies.”\u003c/p>\n\u003cp>Lara’s plan does away with premiums, deductibles, co-pays — all those pesky out-of-pocket expenses. So where would the state get the money? Past proposals – here and in states like Vermont and Colorado – have suggested new payroll taxes.\u003c/p>\n\u003cp>\"We know that single payer will be expensive,\" says Assemblyman Jim Wood, chairman of the Health Committee. \"Some estimates from a few years ago, the analysis showed $200 billion plus.\"\u003c/p>\n\u003cp>\"I believe in universal coverage and I’d love to see that happen in the future, but the devils in the details,” he added.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/317282377\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" target=\"_blank\">Roughly half of coverage\u003c/a> in California is sponsored by employers.\u003c/p>\n\u003cp>If “you’re going to take health insurance largely out of the market, you’re going to disconnect it from employers,” Oberlander says.\u003c/p>\n\u003cp>Currently, premiums paid by both employer and employee fund private health insurance plans. Single-payer would change that: instead of paycheck deductions for premiums, workers would see new taxes on their wages to pay for the state plan. It would be controversial and disruptive, Oberlander says. \"A lot of people are satisfied with what they have.\"\u003c/p>\n\u003cp>But Lara thinks it can be done, slowly and methodically. He is traveling this week in Canada, along with Bay-Area state senators Nancy Skinner and Scott Wiener. They’ll be learning about Canadian medical care and how it’s financed.\u003c/p>\n\u003cp>Lara takes heart from the fact that Canada’s system began in just one province, and then spread to others. It did so despite resistance, over many years.\u003c/p>\n\u003cp>\"We envision California being the first state to implement a universal healthcare program, and then having that then be the model for the rest of the other states.”\u003c/p>\n\u003cp>Lara says everyone should withhold judgment until he can provide more detailed funding plans in a month or two. His goal is to get the bill at least through the Senate this year, and then push it farther forward in 2018.\u003c/p>\n\u003cp>The trade group for insurers in California does not support the single-payer idea.\u003c/p>\n\u003cp>“A single-payer system would make the quality of our health care worse, not better,” says Charles Bacchi, president and CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>. “We’ve made substantial progress in expanding and increasing access to and quality of care — this step backwards would be particularly devastating for Californians.”\u003c/p>\n\u003cp>Many conservatives oppose the single-payer approach. “We have come to value and expect a health care system that has private-sector market elements,” said \u003ca href=\"http://www.hoover.org/profiles/lanhee-j-chen\" target=\"_blank\">Lanhee Chen,\u003c/a> a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.\u003c/p>\n\u003cp>A single-payer system would need federal approval, essentially giving California permission to take the money meant for Medicare and Medicaid, and distribute those funds in a totally new way.\u003c/p>\n\u003cp>\"I’m not sure under what construct that could even occur,\" says \u003ca href=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" target=\"_blank\">Jennifer Kent\u003c/a>, director of the Department of Health Care Services, which operates the state’s Medicaid program, known as Medi-Cal.\u003c/p>\n\u003cp>\"The federal government would have to essentially turn those funds over to a state,\" she says.\u003c/p>\n\u003cp>As it stands, \u003ca href=\"http://californiahealthline.org/news/single-payer-health-care-bill-to-be-introduced-in-california-senate/\">no state has a single-payer system\u003c/a>. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn’t figure out how to finance it.\u003c/p>\n\u003cp>Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks.\u003c/p>\n\u003cp>One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program \u003ca href=\"http://www.lao.ca.gov/2008/hlth/sb840/SB840_analysis.pdf\" target=\"_blank\">costing \u003c/a> $200 billion a year or more. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.\u003c/p>\n\u003cp>Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C.\u003c/p>\n\u003cp>“The ACA created more familiarity with being insured,” said Kuehl. “They’ve recognized the value.”\u003c/p>\n\u003cp>Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say.\u003c/p>\n\u003cp>“California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA,” said Jerry Kominski, director of the UCLA Center for Health Policy Research. “It would take decades to get back to where we are now,” he said.\u003c/p>\n\u003cp>In an interview with California Healthline, California Gov. Jerry Brown emphasized that financing a single-payer system would be a major challenge. Although he said he would entertain a conversation about a single-payer system, he did not say whether he would endorse creating one.\u003c/p>\n\u003cp>For one thing, it would require a new tax, which would have to be approved either by a two-thirds majority vote in the state Legislature or a simple-majority popular vote, he said. Even with the current Democratic supermajority, Brown said, there are always a few “outliers” who wouldn’t support raising new revenues.\u003c/p>\n\u003cp>Brown leaves office in 2018, however, and Newsom, who hopes to succeed him, is looking into a creating a plan for universal coverage that would be an alternative to a single-payer system.\u003c/p>\n\u003cp>One option, according to Newsom’s office, would be to use as a model the Healthy San Francisco program he introduced in 2007 as mayor. The city has used a combination of public money and contributions from employers and enrollees to plug holes in coverage and make primary care accessible to nearly everyone.\u003c/p>\n\u003cp>Newsom has acknowledged, however, that the San Francisco approach \u003ca href=\"https://www.thenation.com/article/can-california-achieve-universal-health-care-in-the-age-of-trump/\">would not necessarily work in every county\u003c/a>, and said he is open to other possibilities.\u003c/p>\n\u003cp>Using that model to expand health care statewide has some political advantages, Oberlander said, because it builds on the “status quo rather than radically restructuring” the current system.\u003c/p>\n\u003cp>Another California lawmaker proposes to keep the conversation going about universal health care, at least, by creating a commission that would make various recommendations to policymakers.\u003c/p>\n\u003cp>“We have to be able to move on multiple tracks at once,” said Assemblyman Rob Bonta (D-Oakland), who is carrying the bill to create the Health Care for All commission, which would convene in 2018.\u003c/p>\n\u003cp>The debate in Washington could actually produce some surprising opportunities for California and other states. The feds might, for instance, approve waivers to allow other types of experimentation within states. \u003ca href=\"http://healthaffairs.org/blog/2017/01/24/aca-replacement-bill-from-cassidy-and-colleagues-offers-state-options-roth-hsas/\">Some Republicans\u003c/a> favor an approach in which each state decides on its own coverage system, within certain limits.\u003c/p>\n\u003cp>That could mean a retraction of coverage in some states, but in California it might open the door to a new model.\u003c/p>\n\u003cp>“It is possible that some liberal-leaning states are going to do things that we didn’t think possible before,” Oberlander said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"But it could take years and billions of dollars to achieve coverage for everyone — if it happens at all.","status":"publish","parent":0,"modified":1492017675,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":49,"wordCount":1672},"headData":{"title":"While Washington Fiddles, California Leaders Forge Ideas for Universal Health Care | KQED","description":"But it could take years and billions of dollars to achieve coverage for everyone — if it happens at all.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"While Washington Fiddles, California Leaders Forge Ideas for Universal Health Care","datePublished":"2017-04-12T13:00:17.000Z","dateModified":"2017-04-12T17:21:15.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"314323 https://ww2.kqed.org/stateofhealth/?p=314323","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/04/12/while-washington-fiddles-california-leaders-forge-ideas-for-universal-health-care/","disqusTitle":"While Washington Fiddles, California Leaders Forge Ideas for Universal Health Care","nprByline":"\u003ca href=\"http://khn.org/news/author/pauline-bartolone/\">\u003cstrong>Pauline Bartolone,\u003c/strong>\u003c/a> California Healthline, and \u003cstrong>Carrie Feibel,\u003c/strong> KQED","path":"/stateofhealth/314323/while-washington-fiddles-california-leaders-forge-ideas-for-universal-health-care","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>As the nation’s Republican leaders huddle to reconsider their plans to “repeal and replace” the nation’s health law, advocates for universal health coverage press on in California, armed with renewed political will and a new set of proposals.\u003c/p>\n\u003cp>Organized labor and two lawmakers are leading the charge for a single, government-financed program for everyone in the state. Another legislator wants to create a commission that would weigh the best options for a system to cover everyone. And Democratic Lt. Gov. Gavin Newsom, who hopes to become the next governor, has suggested building on employer-based health care to plug holes in existing coverage.\u003c/p>\n\u003cp>The proposals are fueled both by a fear of losing gains under the Affordable Care Act and a sense that the law doesn’t go far enough toward covering everyone and cutting costs.\u003c/p>\n\u003cp>But heath policy experts say that creating any type of universal health plan would face enormous political and fiscal challenges — and that if it happens at all, it could take years.\u003c/p>\n\u003cp>“There are different ways to get there,” says Jonathan Oberlander, professor of social medicine and health policy at the University of North Carolina. “None of them is easy.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The most specific California proposal comes from state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), co-authors of legislation that would take steps toward creating one publicly financed “single-payer” program.\u003c/p>\n\u003cp>The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB562\" target=\"_blank\">bill\u003c/a>, co-sponsored by the California Nurses Association, would aim for something like a system of “Medicare for all” in which the government, not insurers, provides payments and sets coverage rules.\u003c/p>\n\u003cp>\"It's the right moral thing to do,\" Lara says. \"We live in the United States of America. We live in the most powerful state in the union. It is the right thing for us to make sure that we fight to ensure that everyone has coverage.”\u003c/p>\n\u003cp>Lara’s bill contains a long \u003ca href=\"http://sd33.senate.ca.gov/news/2017-02-17-californians-healthy-california-act-seeks-one-plan-more-choice-residents\" target=\"_blank\">list of benefits \u003c/a>the statewide program would cover. Not just doctors and hospitals, but also prescriptions, vision and dental care, hospice and rehabilitative therapies, and more.\u003c/p>\n\u003cp>California Health and Human Services Secretary, \u003ca href=\"http://www.chhs.ca.gov/Pages/Secretary-Diana-S.-Dooley.aspx\" target=\"_blank\">Diana Dooley\u003c/a>, understands the appeal.\u003c/p>\n\u003cp>“I think in California there continues to be a great deal of interest and enthusiasm around single payer,\" she says. \"It is very easy to talk about and it certainly takes advantage of the anxiety people have about health insurance companies.”\u003c/p>\n\u003cp>Lara’s plan does away with premiums, deductibles, co-pays — all those pesky out-of-pocket expenses. So where would the state get the money? Past proposals – here and in states like Vermont and Colorado – have suggested new payroll taxes.\u003c/p>\n\u003cp>\"We know that single payer will be expensive,\" says Assemblyman Jim Wood, chairman of the Health Committee. \"Some estimates from a few years ago, the analysis showed $200 billion plus.\"\u003c/p>\n\u003cp>\"I believe in universal coverage and I’d love to see that happen in the future, but the devils in the details,” he added.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/317282377&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/317282377'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" target=\"_blank\">Roughly half of coverage\u003c/a> in California is sponsored by employers.\u003c/p>\n\u003cp>If “you’re going to take health insurance largely out of the market, you’re going to disconnect it from employers,” Oberlander says.\u003c/p>\n\u003cp>Currently, premiums paid by both employer and employee fund private health insurance plans. Single-payer would change that: instead of paycheck deductions for premiums, workers would see new taxes on their wages to pay for the state plan. It would be controversial and disruptive, Oberlander says. \"A lot of people are satisfied with what they have.\"\u003c/p>\n\u003cp>But Lara thinks it can be done, slowly and methodically. He is traveling this week in Canada, along with Bay-Area state senators Nancy Skinner and Scott Wiener. They’ll be learning about Canadian medical care and how it’s financed.\u003c/p>\n\u003cp>Lara takes heart from the fact that Canada’s system began in just one province, and then spread to others. It did so despite resistance, over many years.\u003c/p>\n\u003cp>\"We envision California being the first state to implement a universal healthcare program, and then having that then be the model for the rest of the other states.”\u003c/p>\n\u003cp>Lara says everyone should withhold judgment until he can provide more detailed funding plans in a month or two. His goal is to get the bill at least through the Senate this year, and then push it farther forward in 2018.\u003c/p>\n\u003cp>The trade group for insurers in California does not support the single-payer idea.\u003c/p>\n\u003cp>“A single-payer system would make the quality of our health care worse, not better,” says Charles Bacchi, president and CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>. “We’ve made substantial progress in expanding and increasing access to and quality of care — this step backwards would be particularly devastating for Californians.”\u003c/p>\n\u003cp>Many conservatives oppose the single-payer approach. “We have come to value and expect a health care system that has private-sector market elements,” said \u003ca href=\"http://www.hoover.org/profiles/lanhee-j-chen\" target=\"_blank\">Lanhee Chen,\u003c/a> a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.\u003c/p>\n\u003cp>A single-payer system would need federal approval, essentially giving California permission to take the money meant for Medicare and Medicaid, and distribute those funds in a totally new way.\u003c/p>\n\u003cp>\"I’m not sure under what construct that could even occur,\" says \u003ca href=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" target=\"_blank\">Jennifer Kent\u003c/a>, director of the Department of Health Care Services, which operates the state’s Medicaid program, known as Medi-Cal.\u003c/p>\n\u003cp>\"The federal government would have to essentially turn those funds over to a state,\" she says.\u003c/p>\n\u003cp>As it stands, \u003ca href=\"http://californiahealthline.org/news/single-payer-health-care-bill-to-be-introduced-in-california-senate/\">no state has a single-payer system\u003c/a>. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn’t figure out how to finance it.\u003c/p>\n\u003cp>Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks.\u003c/p>\n\u003cp>One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program \u003ca href=\"http://www.lao.ca.gov/2008/hlth/sb840/SB840_analysis.pdf\" target=\"_blank\">costing \u003c/a> $200 billion a year or more. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.\u003c/p>\n\u003cp>Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C.\u003c/p>\n\u003cp>“The ACA created more familiarity with being insured,” said Kuehl. “They’ve recognized the value.”\u003c/p>\n\u003cp>Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say.\u003c/p>\n\u003cp>“California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA,” said Jerry Kominski, director of the UCLA Center for Health Policy Research. “It would take decades to get back to where we are now,” he said.\u003c/p>\n\u003cp>In an interview with California Healthline, California Gov. Jerry Brown emphasized that financing a single-payer system would be a major challenge. Although he said he would entertain a conversation about a single-payer system, he did not say whether he would endorse creating one.\u003c/p>\n\u003cp>For one thing, it would require a new tax, which would have to be approved either by a two-thirds majority vote in the state Legislature or a simple-majority popular vote, he said. Even with the current Democratic supermajority, Brown said, there are always a few “outliers” who wouldn’t support raising new revenues.\u003c/p>\n\u003cp>Brown leaves office in 2018, however, and Newsom, who hopes to succeed him, is looking into a creating a plan for universal coverage that would be an alternative to a single-payer system.\u003c/p>\n\u003cp>One option, according to Newsom’s office, would be to use as a model the Healthy San Francisco program he introduced in 2007 as mayor. The city has used a combination of public money and contributions from employers and enrollees to plug holes in coverage and make primary care accessible to nearly everyone.\u003c/p>\n\u003cp>Newsom has acknowledged, however, that the San Francisco approach \u003ca href=\"https://www.thenation.com/article/can-california-achieve-universal-health-care-in-the-age-of-trump/\">would not necessarily work in every county\u003c/a>, and said he is open to other possibilities.\u003c/p>\n\u003cp>Using that model to expand health care statewide has some political advantages, Oberlander said, because it builds on the “status quo rather than radically restructuring” the current system.\u003c/p>\n\u003cp>Another California lawmaker proposes to keep the conversation going about universal health care, at least, by creating a commission that would make various recommendations to policymakers.\u003c/p>\n\u003cp>“We have to be able to move on multiple tracks at once,” said Assemblyman Rob Bonta (D-Oakland), who is carrying the bill to create the Health Care for All commission, which would convene in 2018.\u003c/p>\n\u003cp>The debate in Washington could actually produce some surprising opportunities for California and other states. The feds might, for instance, approve waivers to allow other types of experimentation within states. \u003ca href=\"http://healthaffairs.org/blog/2017/01/24/aca-replacement-bill-from-cassidy-and-colleagues-offers-state-options-roth-hsas/\">Some Republicans\u003c/a> favor an approach in which each state decides on its own coverage system, within certain limits.\u003c/p>\n\u003cp>That could mean a retraction of coverage in some states, but in California it might open the door to a new model.\u003c/p>\n\u003cp>“It is possible that some liberal-leaning states are going to do things that we didn’t think possible before,” Oberlander said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/314323/while-washington-fiddles-california-leaders-forge-ideas-for-universal-health-care","authors":["byline_stateofhealth_314323"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_2845","stateofhealth_2519","stateofhealth_365","stateofhealth_3048"],"featImg":"stateofhealth_316319","label":"stateofhealth"},"stateofhealth_294589":{"type":"posts","id":"stateofhealth_294589","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"294589","score":null,"sort":[1487325652000]},"guestAuthors":[],"slug":"ceo-of-california-based-health-insurer-says-obamacare-just-needs-a-tune-up","title":"CEO of California-Based Health Insurer Says Obamacare Just Needs a Tune-Up","publishDate":1487325652,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Some large health insurance companies have suffered losses under the Affordable Care Act, leading to a couple high-profile exits from the health exchanges – Humana was the latest. But one smaller, Long Beach-based insurer has done OK: Molina Healthcare.\u003c/p>\n\u003cp>“We understood the demographics of the people that we’re serving a little better, ” said J. Mario Molina, CEO of Molina Healthcare, \"because we’ve been doing it for so long,\"\u003c/p>\n\u003cp>Molina’s father, David, founded Molina Healthcare in 1980, after a career as a doctor. Sometimes his patients couldn’t pay, so they would barter, or they gave him items from their homes instead: a glass decanter, a pipe organ, even the family dog.\u003c/p>\n\u003cp>“My father was old-fashioned,” recalled the younger Molina. “He believed doctors had an obligation to take care of patients, and that the primary issue was not how they were going to get paid.”\u003c/p>\n\u003cfigure id=\"attachment_294594\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-294594\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/015-800x623.jpg\" alt=\"C. David Molina reviewing medical records\" width=\"800\" height=\"623\">\u003cfigcaption class=\"wp-caption-text\">C. David Molina reviewing medical records \u003ccite>(Courtesy of Molina Healthcare)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The elder Molina opened a network of medical clinics serving low-income patients, and then later, started a health insurance company focused on customers with Medicaid, government coverage for the poor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That is what positioned the company to move into the Obamacare marketplaces so smoothly, Mario Molina explained, because most people who signed up for Obamacare plans are low-income.\u003c/p>\n\u003cp>“It’s a different population most insurance companies haven’t been interested in,” he said.\u003c/p>\n\u003cp>For example, transportation is an issue for their customers, Molina said. They often take the bus to medical appointments, so they’d much rather see a doctor close to home, not someone at a fancy academic hospital 30 miles away.\u003c/p>\n\u003cp>“We don’t contract with every hospital and every doctor,” he said. “It’s not everyone, but it’s enough so that you can find a doctor and the hospital and the services you need.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/308218361\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Having fewer doctors in their network means lower costs for Molina. And that means the company was able to earn some modest profits -- roughly 1 percent in the first couple years of Obamacare.\u003c/p>\n\u003cp>But some big name commercial insurers are used to creating health plans for employers, who often want more doctors and more benefits to attract better employees. Plans like that cost more.\u003c/p>\n\u003cp>“They’re looking at things sort of from the top down, and we’re looking at things from the bottom up,” Molina said.\u003c/p>\n\u003cp>He’s used to running a low-cost, low-margin business. Those big guys aren’t. Industry analysts say that’s why some of them lost money with Obamacare.\u003c/p>\n\u003cp>“It’s easier to work up from a low-cost position than it is to work down from a higher-cost position,” said Josh Weisbrod, a health care consultant with Bain and Company. “For an insurer that is used to selling employer plans with rich benefit designs and broad networks, it is difficult for them to transition that to a narrow network of lower cost providers.”\u003c/p>\n\u003cp>But Molina says there’s been a serious downside to his company’s success: a provision of the Affordable Care Act known as “risk transfer.” The program was designed to help insurance companies cover losses, if they ended up with a lot of really sick, expensive patients. The way it works: companies with fewer sick patients pay some of their revenues to the companies that have more.\u003c/p>\n\u003cp>It was a fine idea, Molina said, but the formula lawmakers came up with to calculate risk was all wrong.\u003c/p>\n\u003cfigure id=\"attachment_294593\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-294593\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/MARIO-MOLINA_FINAL1-800x532.jpg\" alt=\"Mario Molina, CEO of Molina Healthcare\" width=\"800\" height=\"532\">\u003cfigcaption class=\"wp-caption-text\">Mario Molina, CEO of Molina Healthcare \u003ccite>(Courtesy of Molina Healthcare)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Let’s put it this way: currently Molina Healthcare is returning 25 percent of our premiums to the government, which are then distributed to our competitors,” he said. “So we are really subsidizing our competitors and helping them, rather than forcing them to compete.”\u003c/p>\n\u003cp>And that hit Molina’s bottom line in 2016, resulting in much lower profits than originally projected. Molina said the risk formula factors in the average cost of premiums in the state, which seems to punish efficiency rather than help those who had some bad luck.\u003c/p>\n\u003cp>“I think it was done by well-meaning people who had a theoretical knowledge, but not a practical knowledge of insurance,” he said.\u003c/p>\n\u003cp>Still, Molina remains a fan of the Affordable Care Act overall. His company operates in 12 states and Puerto Rico, and he hopes Congress will consult with him and other insurers as it debates the future of the health law.\u003c/p>\n\u003cp>“It doesn’t need to be scrapped and replaced,” he said. “It needs a tune-up.”\u003c/p>\n\u003cp>He added that if lawmakers need guidance on how to fix Obamacare, they should look at one state that really got it right: California.\u003c/p>\n\u003cp>California insurance regulators \"forced everyone to really compete. and that made everyone kind of sharpen their pencils and do a better job,” he said. “It’s kept everyone on their toes, and, as a result, I think there’s been more stability in the marketplace.”\u003c/p>\n\u003cp>There’s also more predictability. California may have more business regulations than other states, but Molina believes that’s created a level playing field.\u003c/p>\n\u003cp>“The state doesn’t make arbitrary decisions. We can plan from year to year. We understand the rules,” he said. “Imagine if you’re trying to play a game and the rules change in every quarter.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Molina is hoping the newly-elected rule makers at the federal level take this to heart.\u003c/p>\n\n","blocks":[],"excerpt":"Mario Molina, head of Molina Healthcare, says his insurance company understands the Obamacare consumer.","status":"publish","parent":0,"modified":1487355937,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":29,"wordCount":1001},"headData":{"title":"CEO of California-Based Health Insurer Says Obamacare Just Needs a Tune-Up | KQED","description":"Mario Molina, head of Molina Healthcare, says his insurance company understands the Obamacare consumer.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"CEO of California-Based Health Insurer Says Obamacare Just Needs a Tune-Up","datePublished":"2017-02-17T10:00:52.000Z","dateModified":"2017-02-17T18:25:37.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"294589 https://ww2.kqed.org/stateofhealth/?p=294589","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/02/17/ceo-of-california-based-health-insurer-says-obamacare-just-needs-a-tune-up/","disqusTitle":"CEO of California-Based Health Insurer Says Obamacare Just Needs a Tune-Up","path":"/stateofhealth/294589/ceo-of-california-based-health-insurer-says-obamacare-just-needs-a-tune-up","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some large health insurance companies have suffered losses under the Affordable Care Act, leading to a couple high-profile exits from the health exchanges – Humana was the latest. But one smaller, Long Beach-based insurer has done OK: Molina Healthcare.\u003c/p>\n\u003cp>“We understood the demographics of the people that we’re serving a little better, ” said J. Mario Molina, CEO of Molina Healthcare, \"because we’ve been doing it for so long,\"\u003c/p>\n\u003cp>Molina’s father, David, founded Molina Healthcare in 1980, after a career as a doctor. Sometimes his patients couldn’t pay, so they would barter, or they gave him items from their homes instead: a glass decanter, a pipe organ, even the family dog.\u003c/p>\n\u003cp>“My father was old-fashioned,” recalled the younger Molina. “He believed doctors had an obligation to take care of patients, and that the primary issue was not how they were going to get paid.”\u003c/p>\n\u003cfigure id=\"attachment_294594\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-294594\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/015-800x623.jpg\" alt=\"C. David Molina reviewing medical records\" width=\"800\" height=\"623\">\u003cfigcaption class=\"wp-caption-text\">C. David Molina reviewing medical records \u003ccite>(Courtesy of Molina Healthcare)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The elder Molina opened a network of medical clinics serving low-income patients, and then later, started a health insurance company focused on customers with Medicaid, government coverage for the poor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That is what positioned the company to move into the Obamacare marketplaces so smoothly, Mario Molina explained, because most people who signed up for Obamacare plans are low-income.\u003c/p>\n\u003cp>“It’s a different population most insurance companies haven’t been interested in,” he said.\u003c/p>\n\u003cp>For example, transportation is an issue for their customers, Molina said. They often take the bus to medical appointments, so they’d much rather see a doctor close to home, not someone at a fancy academic hospital 30 miles away.\u003c/p>\n\u003cp>“We don’t contract with every hospital and every doctor,” he said. “It’s not everyone, but it’s enough so that you can find a doctor and the hospital and the services you need.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/308218361&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/308218361'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Having fewer doctors in their network means lower costs for Molina. And that means the company was able to earn some modest profits -- roughly 1 percent in the first couple years of Obamacare.\u003c/p>\n\u003cp>But some big name commercial insurers are used to creating health plans for employers, who often want more doctors and more benefits to attract better employees. Plans like that cost more.\u003c/p>\n\u003cp>“They’re looking at things sort of from the top down, and we’re looking at things from the bottom up,” Molina said.\u003c/p>\n\u003cp>He’s used to running a low-cost, low-margin business. Those big guys aren’t. Industry analysts say that’s why some of them lost money with Obamacare.\u003c/p>\n\u003cp>“It’s easier to work up from a low-cost position than it is to work down from a higher-cost position,” said Josh Weisbrod, a health care consultant with Bain and Company. “For an insurer that is used to selling employer plans with rich benefit designs and broad networks, it is difficult for them to transition that to a narrow network of lower cost providers.”\u003c/p>\n\u003cp>But Molina says there’s been a serious downside to his company’s success: a provision of the Affordable Care Act known as “risk transfer.” The program was designed to help insurance companies cover losses, if they ended up with a lot of really sick, expensive patients. The way it works: companies with fewer sick patients pay some of their revenues to the companies that have more.\u003c/p>\n\u003cp>It was a fine idea, Molina said, but the formula lawmakers came up with to calculate risk was all wrong.\u003c/p>\n\u003cfigure id=\"attachment_294593\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-294593\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/MARIO-MOLINA_FINAL1-800x532.jpg\" alt=\"Mario Molina, CEO of Molina Healthcare\" width=\"800\" height=\"532\">\u003cfigcaption class=\"wp-caption-text\">Mario Molina, CEO of Molina Healthcare \u003ccite>(Courtesy of Molina Healthcare)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Let’s put it this way: currently Molina Healthcare is returning 25 percent of our premiums to the government, which are then distributed to our competitors,” he said. “So we are really subsidizing our competitors and helping them, rather than forcing them to compete.”\u003c/p>\n\u003cp>And that hit Molina’s bottom line in 2016, resulting in much lower profits than originally projected. Molina said the risk formula factors in the average cost of premiums in the state, which seems to punish efficiency rather than help those who had some bad luck.\u003c/p>\n\u003cp>“I think it was done by well-meaning people who had a theoretical knowledge, but not a practical knowledge of insurance,” he said.\u003c/p>\n\u003cp>Still, Molina remains a fan of the Affordable Care Act overall. His company operates in 12 states and Puerto Rico, and he hopes Congress will consult with him and other insurers as it debates the future of the health law.\u003c/p>\n\u003cp>“It doesn’t need to be scrapped and replaced,” he said. “It needs a tune-up.”\u003c/p>\n\u003cp>He added that if lawmakers need guidance on how to fix Obamacare, they should look at one state that really got it right: California.\u003c/p>\n\u003cp>California insurance regulators \"forced everyone to really compete. and that made everyone kind of sharpen their pencils and do a better job,” he said. “It’s kept everyone on their toes, and, as a result, I think there’s been more stability in the marketplace.”\u003c/p>\n\u003cp>There’s also more predictability. California may have more business regulations than other states, but Molina believes that’s created a level playing field.\u003c/p>\n\u003cp>“The state doesn’t make arbitrary decisions. We can plan from year to year. We understand the rules,” he said. “Imagine if you’re trying to play a game and the rules change in every quarter.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Molina is hoping the newly-elected rule makers at the federal level take this to heart.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/294589/ceo-of-california-based-health-insurer-says-obamacare-just-needs-a-tune-up","authors":["3205"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_2845","stateofhealth_3047","stateofhealth_2519"],"featImg":"stateofhealth_294591","label":"stateofhealth"},"stateofhealth_234725":{"type":"posts","id":"stateofhealth_234725","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"234725","score":null,"sort":[1473355848000]},"guestAuthors":[],"slug":"glaring-disparities-in-health-plan-benefits-persist-despite-federal-and-state-efforts","title":"Glaring Disparities in Health Plan Benefits Persist Despite Federal and State Efforts","publishDate":1473355848,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Tracey Stahl lost part of a leg to bone cancer last fall, and she has to wince through bouts of crippling pain from an ill-fitting artificial limb because of a strange health insurance limit: Her plan covers just one limb per lifetime.\u003c/p>\n\u003cp>She now has to weigh whether to dump the nearly $9,000 cost of a new leg on her credit card as she fights her insurance company over the restriction. \"I feel — it's embarrassing to say — paralyzed about what to do,\" said Stahl, from her home in Penfield, New York.\u003c/p>\n\u003cp>Caiti Riley's left leg was amputated below the knee at age 4 due to a rare birth defect. The San Antonio resident is 31 now and covered by the best insurance she's ever had. Her plan is paying most of the roughly $5,000 bill for a new running leg to complement the one she uses every day.\u003c/p>\n\u003cp>\"I work out every day, there's nothing really that I can't do now,\" she said.\u003c/p>\n\u003cp>Glaring differences in insurance coverage persist for amputees, children with autism and others in need of certain expensive treatments even after the Affordable Care Act set new standards as part of its push to expand and improve coverage, and despite efforts by states to mandate coverage for some treatments.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These differences don't develop simply because some people pay more for better coverage. Instead, they stem from random factors like what state someone lives in or who happens to provide their coverage — and often people can do nothing about it. The federal health care law largely leaves decisions on what actually gets covered up to states or employers who provide insurance for their workers.\u003c/p>\n\u003cp>These gaps can bury patients in debt or force them to skip care. And they may become more common as health care costs continue to rise and insurers and employers look for ways to control that expense.\u003c/p>\n\u003cp>Researcher Sabrina Corlette thinks nothing short of federal action can close these coverage gaps, and she doesn't see that happening anytime soon.\u003c/p>\n\u003cp>\"I think you would need to see Congress say, 'Ok, we need more uniformity here,'\" said Corlette, a Georgetown Health Policy Institute professor. \"And I just don't see this Congress or any near-term Congress stepping in and wanting to do that.\"\u003c/p>\n\u003cp>States have passed about 1,800 mandates requiring the coverage of various treatments or conditions, according to the National Conference of State Legislatures. But those mandates don't extend beyond state borders, and they don't apply to the self-funded coverage offered by nearly all large employers.\u003c/p>\n\u003cp>North Carolina, for example, recently became one of 44 states to require coverage of autism treatments — and it won't help Iris Castillo one bit.\u003c/p>\n\u003cp>The Raleigh, North Carolina, resident said it felt like a cold bucket of water had been tossed on her when she learned that insurance from her new job won't cover applied behavior analysis therapy for her 9-year-old son, Alex.\u003c/p>\n\u003cp>Hours of this daily therapy, which is a standard treatment for autistic children, have helped Alex learn simple tasks like how to brush his teeth or say hi to another kid. Castillo worries that her son will regress if treatment stops. But it can cost more than $40,000 a year, far beyond what Castillo's family can afford.\u003c/p>\n\u003cp>\"You don't feel like you're in control,\" she said.\u003c/p>\n\u003cp>Her employer's coverage is self-funded, which means it pays its own health care bills instead of buying coverage from an insurer. That also means it doesn't have to comply with most state coverage mandates.\u003c/p>\n\u003cp>Employers have been slowly switching to this type of coverage for several years to help control what has become one of their largest expenses and to avoid some of the requirements imposed by the ACA, said Robert Laszewski, a health care consultant and former insurance executive. He expects gaps or differences in coverage to become more common as health expenses grow.\u003c/p>\n\u003cp>Insurers and employers routinely cover organ transplants, heart procedures and other expensive surgeries. But coverage still varies widely for a range of patients that also includes people recovering from eating disorders like anorexia and women who need breast reduction surgery to ease back pain.\u003c/p>\n\u003cp>The cost of a particular treatment, the need for it in a covered population and lingering disagreements over necessity help explain some coverage differences.\u003c/p>\n\u003cp>Bariatric surgery, which can improve the health of obese patients by limiting food intake, can cost $7,000 to $30,000. Coverage is improving, and Dr. John Morton estimates that about 75 percent of patients who need the surgery have some insurance for it.\u003c/p>\n\u003cp>But the quality of that coverage varies widely, according to the Stanford School of Medicine surgeon. Some plans only cover the procedure for severely obese patients, while others may charge deductibles of around $10,000, which can dissuade many from having surgery.\u003c/p>\n\u003cp>An annual survey of large employers by the benefits firm Mercer found that 40 percent offered no coverage for infertility treatment last year. Some companies don't view it as essential to a person's health, while others with an eye toward attracting and keeping good workers, have started offering the coverage to help LGBT patients conceive.\u003c/p>\n\u003cp>\"We see a lot of variation between employers, and it's extremely confusing to the consumer,\" said Dr. David Kaplan, a senior partner at Mercer.\u003c/p>\n\u003cp>Tracey Stahl, who lost her leg to cancer, got a prosthesis in January, but her leg shrank so the artificial limb no longer fits. This forces her to use crutches or a wheelchair when she has to walk more than a short distance. If the pain grows too intense, she retreats to bed and keeps her leg elevated.\u003c/p>\n\u003cp>She bought her coverage on New York's public insurance exchange. Her insurer, Excellus BlueCross BlueShield, said the coverage it sells there follows a model set by the state. The insurer rejected Stahl's claim for a new limb in May and then rejected her appeal in July.\u003c/p>\n\u003cp>In Texas, Caiti Riley said her previous insurance capped limb coverage at $2,500 every four years, which she likened to \"a smack in the face.\" Now her coverage is so good she says she almost feels bad about it.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I know what the challenges are,\" she said. \"If you go out and get in a car accident and lose your leg, you're not going to be prepared for something like this.\"\u003c/p>\n\n","blocks":[],"excerpt":"Differences in coverage stem from factors like what state someone lives in or who happens to provide their health plan.","status":"publish","parent":0,"modified":1473355848,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":1094},"headData":{"title":"Glaring Disparities in Health Plan Benefits Persist Despite Federal and State Efforts | KQED","description":"Differences in coverage stem from factors like what state someone lives in or who happens to provide their health plan.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Glaring Disparities in Health Plan Benefits Persist Despite Federal and State Efforts","datePublished":"2016-09-08T17:30:48.000Z","dateModified":"2016-09-08T17:30:48.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"234725 http://ww2.kqed.org/stateofhealth/?p=234725","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/09/08/glaring-disparities-in-health-plan-benefits-persist-despite-federal-and-state-efforts/","disqusTitle":"Glaring Disparities in Health Plan Benefits Persist Despite Federal and State Efforts","nprByline":"Tom Murphy, Associated Press ","path":"/stateofhealth/234725/glaring-disparities-in-health-plan-benefits-persist-despite-federal-and-state-efforts","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tracey Stahl lost part of a leg to bone cancer last fall, and she has to wince through bouts of crippling pain from an ill-fitting artificial limb because of a strange health insurance limit: Her plan covers just one limb per lifetime.\u003c/p>\n\u003cp>She now has to weigh whether to dump the nearly $9,000 cost of a new leg on her credit card as she fights her insurance company over the restriction. \"I feel — it's embarrassing to say — paralyzed about what to do,\" said Stahl, from her home in Penfield, New York.\u003c/p>\n\u003cp>Caiti Riley's left leg was amputated below the knee at age 4 due to a rare birth defect. The San Antonio resident is 31 now and covered by the best insurance she's ever had. Her plan is paying most of the roughly $5,000 bill for a new running leg to complement the one she uses every day.\u003c/p>\n\u003cp>\"I work out every day, there's nothing really that I can't do now,\" she said.\u003c/p>\n\u003cp>Glaring differences in insurance coverage persist for amputees, children with autism and others in need of certain expensive treatments even after the Affordable Care Act set new standards as part of its push to expand and improve coverage, and despite efforts by states to mandate coverage for some treatments.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>These differences don't develop simply because some people pay more for better coverage. Instead, they stem from random factors like what state someone lives in or who happens to provide their coverage — and often people can do nothing about it. The federal health care law largely leaves decisions on what actually gets covered up to states or employers who provide insurance for their workers.\u003c/p>\n\u003cp>These gaps can bury patients in debt or force them to skip care. And they may become more common as health care costs continue to rise and insurers and employers look for ways to control that expense.\u003c/p>\n\u003cp>Researcher Sabrina Corlette thinks nothing short of federal action can close these coverage gaps, and she doesn't see that happening anytime soon.\u003c/p>\n\u003cp>\"I think you would need to see Congress say, 'Ok, we need more uniformity here,'\" said Corlette, a Georgetown Health Policy Institute professor. \"And I just don't see this Congress or any near-term Congress stepping in and wanting to do that.\"\u003c/p>\n\u003cp>States have passed about 1,800 mandates requiring the coverage of various treatments or conditions, according to the National Conference of State Legislatures. But those mandates don't extend beyond state borders, and they don't apply to the self-funded coverage offered by nearly all large employers.\u003c/p>\n\u003cp>North Carolina, for example, recently became one of 44 states to require coverage of autism treatments — and it won't help Iris Castillo one bit.\u003c/p>\n\u003cp>The Raleigh, North Carolina, resident said it felt like a cold bucket of water had been tossed on her when she learned that insurance from her new job won't cover applied behavior analysis therapy for her 9-year-old son, Alex.\u003c/p>\n\u003cp>Hours of this daily therapy, which is a standard treatment for autistic children, have helped Alex learn simple tasks like how to brush his teeth or say hi to another kid. Castillo worries that her son will regress if treatment stops. But it can cost more than $40,000 a year, far beyond what Castillo's family can afford.\u003c/p>\n\u003cp>\"You don't feel like you're in control,\" she said.\u003c/p>\n\u003cp>Her employer's coverage is self-funded, which means it pays its own health care bills instead of buying coverage from an insurer. That also means it doesn't have to comply with most state coverage mandates.\u003c/p>\n\u003cp>Employers have been slowly switching to this type of coverage for several years to help control what has become one of their largest expenses and to avoid some of the requirements imposed by the ACA, said Robert Laszewski, a health care consultant and former insurance executive. He expects gaps or differences in coverage to become more common as health expenses grow.\u003c/p>\n\u003cp>Insurers and employers routinely cover organ transplants, heart procedures and other expensive surgeries. But coverage still varies widely for a range of patients that also includes people recovering from eating disorders like anorexia and women who need breast reduction surgery to ease back pain.\u003c/p>\n\u003cp>The cost of a particular treatment, the need for it in a covered population and lingering disagreements over necessity help explain some coverage differences.\u003c/p>\n\u003cp>Bariatric surgery, which can improve the health of obese patients by limiting food intake, can cost $7,000 to $30,000. Coverage is improving, and Dr. John Morton estimates that about 75 percent of patients who need the surgery have some insurance for it.\u003c/p>\n\u003cp>But the quality of that coverage varies widely, according to the Stanford School of Medicine surgeon. Some plans only cover the procedure for severely obese patients, while others may charge deductibles of around $10,000, which can dissuade many from having surgery.\u003c/p>\n\u003cp>An annual survey of large employers by the benefits firm Mercer found that 40 percent offered no coverage for infertility treatment last year. Some companies don't view it as essential to a person's health, while others with an eye toward attracting and keeping good workers, have started offering the coverage to help LGBT patients conceive.\u003c/p>\n\u003cp>\"We see a lot of variation between employers, and it's extremely confusing to the consumer,\" said Dr. David Kaplan, a senior partner at Mercer.\u003c/p>\n\u003cp>Tracey Stahl, who lost her leg to cancer, got a prosthesis in January, but her leg shrank so the artificial limb no longer fits. This forces her to use crutches or a wheelchair when she has to walk more than a short distance. If the pain grows too intense, she retreats to bed and keeps her leg elevated.\u003c/p>\n\u003cp>She bought her coverage on New York's public insurance exchange. Her insurer, Excellus BlueCross BlueShield, said the coverage it sells there follows a model set by the state. The insurer rejected Stahl's claim for a new limb in May and then rejected her appeal in July.\u003c/p>\n\u003cp>In Texas, Caiti Riley said her previous insurance capped limb coverage at $2,500 every four years, which she likened to \"a smack in the face.\" Now her coverage is so good she says she almost feels bad about it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I know what the challenges are,\" she said. \"If you go out and get in a car accident and lose your leg, you're not going to be prepared for something like this.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/234725/glaring-disparities-in-health-plan-benefits-persist-despite-federal-and-state-efforts","authors":["byline_stateofhealth_234725"],"categories":["stateofhealth_2442"],"tags":["stateofhealth_38","stateofhealth_2885","stateofhealth_2887","stateofhealth_2886","stateofhealth_2808","stateofhealth_2845","stateofhealth_2519"],"featImg":"stateofhealth_234726","label":"stateofhealth"},"stateofhealth_223727":{"type":"posts","id":"stateofhealth_223727","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"223727","score":null,"sort":[1470926452000]},"guestAuthors":[],"slug":"insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment","title":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment","publishDate":1470926452,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Twice a day, Angela and Nate Turner of Greenwood, Ind., put tiny strips that look like tinted tape under their tongues.\u003c/p>\n\u003cp>“They taste disgusting,” Angela says.\u003c/p>\n\u003cp>But the taste is worth it to her. The dissolvable strips are actually a drug called Suboxone, which helps control an opioid user’s cravings for the drug. The married couple both got addicted to prescription painkillers following injuries several years ago, and they decided to go into recovery this year. With Suboxone, they don’t have to worry about how they’ll get drugs, or how sick they’ll feel if they don’t.\u003c/p>\n\u003cp>“You can function, but you’re not high,” Angela says. “It’s like a miracle drug. It really is.”\u003c/p>\n\u003cp>A body of evidence now shows that medications such as Suboxone are effective in putting the brakes on opioid use disorder, when used in conjunction with counseling. For the Turners, the treatment means Angela can take care of their 3-year-old and Nate can hold down a job.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But because of some companies’ insurance rules, getting started on Suboxone — and staying on it — can be difficult.\u003c/p>\n\u003cp>Angela says after her doctor wrote her a prescription, she had to wait three days to get it filled. She spent those days in bed with nausea, diarrhea and muscle cramps — the intense symptoms of opioid withdrawal. For Nate, the wait was five days. On Day 3, he relapsed and used heroin.\u003c/p>\n\u003cp>“I just thought it was over, that I wasn’t going to make it back to the program,” he says.\u003c/p>\n\u003cp>Suboxone is covered through the Turners’ health plan, which is part of Indiana’s Medicaid expansion, the Healthy Indiana Plan. But before the couple’s insurance company, Managed Health Services, will pay for the drug treatment, their doctor has to get approval from the insurer — known as a prior authorization.\u003c/p>\n\u003cp>The prior authorization process adds work for doctors and their staff, said Dr. Andrew Chambers, a psychiatrist and addiction specialist in Indianapolis. With the phone calls, faxing and other paperwork, he said, three of his nurses spend about 30 hours a week going back and forth with the insurance companies.\u003c/p>\n\u003cp>“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Chambers said.\u003c/p>\n\u003cp>Getting a prior authorization to prescribe one of these medications can take days or weeks, said Sam Muszynski, director of health care systems and financing with the American Psychiatric Association. He said the delays leave patients vulnerable to relapse.\u003c/p>\n\u003cp>“You may lose that opportunity right then and there,” he said. “They may never come back.”\u003c/p>\n\u003cp>Muszynski and policy analysts with the federal Substance Abuse and Mental Health Services Administration say requiring prior authorizations from insurers for addiction medication is a widespread practice in the U.S.\u003c/p>\n\u003cp>As of 2013, Medicaid in 48 states required a prior authorization for buprenorphine, the active ingredient in Suboxone. Chris Carroll, director of health care financing at SAMHSA, said that number likely has not changed much since 2013. He said treatment limitations like prior authorizations are part of “the dark shadows of the insurance industry.”\u003c/p>\n\u003cp>Prior authorizations are one way insurers limit what they pay for, Muszynski said, and they use prior authorizations more often with mental health and addiction treatments, compared to other medical treatments. That’s despite the 2008 passage of a federal law called the Mental Health Parity and Addiction Equity Act, which was supposed to end unequal insurance coverage for mental illness as compared to physical illness.\u003c/p>\n\u003cp>For instance, under the Turners’ plan, insulin treatments for diabetes don’t require a prior authorization. But Suboxone does.\u003c/p>\n\u003cp>“It’s just totally unfair,” Muszynski said. “There’s a continuing pattern of discrimination, which results in reduced access to people who need opioid addiction treatment.”\u003c/p>\n\u003cp>Prior authorization requirements can also pressure doctors to change how they prescribe a drug such as Suboxone. Sometimes an insurer will push for a lower dosage than the doctor wants, or it will require a patient to start tapering the use of a medication even when the doctor thinks the patient needs more time.\u003c/p>\n\u003cp>“These rules and regulations for us completely block the correct provision of care,” says Chambers. “And that’s crazy.”\u003c/p>\n\u003cp>For some insurers, a prior authorization expires after just a few months, forcing everyone involved to go back through the process of reauthorizing. In some cases, Chambers said, patients will even run out of medicine before a new prescription can be approved, which can force them into withdrawal.\u003c/p>\n\u003cp>Indiana Medicaid said it has started to allow some doctors to skip that initial back-and-forth with the insurance company. But Chambers said the changes haven’t helped him much yet.\u003c/p>\n\u003cp>Clare Krusing, press secretary with the trade association America’s Health Insurance Plans, said that prior authorizations are not in place to limit treatment for patients with opioid addiction. Rather, she said, they’re meant to ensure that patients receive proper care.\u003c/p>\n\u003cp>“Prior authorization is not just arbitrarily applied,” she said. “Plans look at what the clinical guidelines are. A plan is going to make sure that before a drug is prescribed, the patient meets those guidelines.”\u003c/p>\n\u003cp>Krusing added that the prior authorizations in place for buprenorphine don’t violate the parity law, because the treatment plan for addiction is different from the treatment plan for other chronic illnesses, such as diabetes.\u003c/p>\n\u003cp>Nate Turner has managed to stay in treatment despite the prior authorization process. He says there’s an irony here. He started taking opioids without a prior authorization — in fact, on his plan, the pain pills he used to be addicted to require no prior authorization. He says that sort of gatekeeping paperwork shouldn’t be a stumbling block when he’s trying to quit his opioid habit.\u003c/p>\n\u003cp>“I can assure you, if I were on regular pain medicine, I’d be able to get them, no problem,” he says. “No questions asked.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Red tape makes it hard for patients to get started on recovery drug and stay on it.\r\n","status":"publish","parent":0,"modified":1470926658,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1082},"headData":{"title":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment | KQED","description":"Red tape makes it hard for patients to get started on recovery drug and stay on it.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment","datePublished":"2016-08-11T14:40:52.000Z","dateModified":"2016-08-11T14:44:18.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"223727 http://ww2.kqed.org/stateofhealth/?p=223727","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/11/insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment/","disqusTitle":"Insurance Rules Put Up Roadblocks to Opioid Addiction Treatment","nprByline":"Jake Harper\u003cbr />\u003ca href=\"http://sideeffectspublicmedia.org/\">Side Effects Public Media\u003c/a>","path":"/stateofhealth/223727/insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Twice a day, Angela and Nate Turner of Greenwood, Ind., put tiny strips that look like tinted tape under their tongues.\u003c/p>\n\u003cp>“They taste disgusting,” Angela says.\u003c/p>\n\u003cp>But the taste is worth it to her. The dissolvable strips are actually a drug called Suboxone, which helps control an opioid user’s cravings for the drug. The married couple both got addicted to prescription painkillers following injuries several years ago, and they decided to go into recovery this year. With Suboxone, they don’t have to worry about how they’ll get drugs, or how sick they’ll feel if they don’t.\u003c/p>\n\u003cp>“You can function, but you’re not high,” Angela says. “It’s like a miracle drug. It really is.”\u003c/p>\n\u003cp>A body of evidence now shows that medications such as Suboxone are effective in putting the brakes on opioid use disorder, when used in conjunction with counseling. For the Turners, the treatment means Angela can take care of their 3-year-old and Nate can hold down a job.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But because of some companies’ insurance rules, getting started on Suboxone — and staying on it — can be difficult.\u003c/p>\n\u003cp>Angela says after her doctor wrote her a prescription, she had to wait three days to get it filled. She spent those days in bed with nausea, diarrhea and muscle cramps — the intense symptoms of opioid withdrawal. For Nate, the wait was five days. On Day 3, he relapsed and used heroin.\u003c/p>\n\u003cp>“I just thought it was over, that I wasn’t going to make it back to the program,” he says.\u003c/p>\n\u003cp>Suboxone is covered through the Turners’ health plan, which is part of Indiana’s Medicaid expansion, the Healthy Indiana Plan. But before the couple’s insurance company, Managed Health Services, will pay for the drug treatment, their doctor has to get approval from the insurer — known as a prior authorization.\u003c/p>\n\u003cp>The prior authorization process adds work for doctors and their staff, said Dr. Andrew Chambers, a psychiatrist and addiction specialist in Indianapolis. With the phone calls, faxing and other paperwork, he said, three of his nurses spend about 30 hours a week going back and forth with the insurance companies.\u003c/p>\n\u003cp>“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Chambers said.\u003c/p>\n\u003cp>Getting a prior authorization to prescribe one of these medications can take days or weeks, said Sam Muszynski, director of health care systems and financing with the American Psychiatric Association. He said the delays leave patients vulnerable to relapse.\u003c/p>\n\u003cp>“You may lose that opportunity right then and there,” he said. “They may never come back.”\u003c/p>\n\u003cp>Muszynski and policy analysts with the federal Substance Abuse and Mental Health Services Administration say requiring prior authorizations from insurers for addiction medication is a widespread practice in the U.S.\u003c/p>\n\u003cp>As of 2013, Medicaid in 48 states required a prior authorization for buprenorphine, the active ingredient in Suboxone. Chris Carroll, director of health care financing at SAMHSA, said that number likely has not changed much since 2013. He said treatment limitations like prior authorizations are part of “the dark shadows of the insurance industry.”\u003c/p>\n\u003cp>Prior authorizations are one way insurers limit what they pay for, Muszynski said, and they use prior authorizations more often with mental health and addiction treatments, compared to other medical treatments. That’s despite the 2008 passage of a federal law called the Mental Health Parity and Addiction Equity Act, which was supposed to end unequal insurance coverage for mental illness as compared to physical illness.\u003c/p>\n\u003cp>For instance, under the Turners’ plan, insulin treatments for diabetes don’t require a prior authorization. But Suboxone does.\u003c/p>\n\u003cp>“It’s just totally unfair,” Muszynski said. “There’s a continuing pattern of discrimination, which results in reduced access to people who need opioid addiction treatment.”\u003c/p>\n\u003cp>Prior authorization requirements can also pressure doctors to change how they prescribe a drug such as Suboxone. Sometimes an insurer will push for a lower dosage than the doctor wants, or it will require a patient to start tapering the use of a medication even when the doctor thinks the patient needs more time.\u003c/p>\n\u003cp>“These rules and regulations for us completely block the correct provision of care,” says Chambers. “And that’s crazy.”\u003c/p>\n\u003cp>For some insurers, a prior authorization expires after just a few months, forcing everyone involved to go back through the process of reauthorizing. In some cases, Chambers said, patients will even run out of medicine before a new prescription can be approved, which can force them into withdrawal.\u003c/p>\n\u003cp>Indiana Medicaid said it has started to allow some doctors to skip that initial back-and-forth with the insurance company. But Chambers said the changes haven’t helped him much yet.\u003c/p>\n\u003cp>Clare Krusing, press secretary with the trade association America’s Health Insurance Plans, said that prior authorizations are not in place to limit treatment for patients with opioid addiction. Rather, she said, they’re meant to ensure that patients receive proper care.\u003c/p>\n\u003cp>“Prior authorization is not just arbitrarily applied,” she said. “Plans look at what the clinical guidelines are. A plan is going to make sure that before a drug is prescribed, the patient meets those guidelines.”\u003c/p>\n\u003cp>Krusing added that the prior authorizations in place for buprenorphine don’t violate the parity law, because the treatment plan for addiction is different from the treatment plan for other chronic illnesses, such as diabetes.\u003c/p>\n\u003cp>Nate Turner has managed to stay in treatment despite the prior authorization process. He says there’s an irony here. He started taking opioids without a prior authorization — in fact, on his plan, the pain pills he used to be addicted to require no prior authorization. He says that sort of gatekeeping paperwork shouldn’t be a stumbling block when he’s trying to quit his opioid habit.\u003c/p>\n\u003cp>“I can assure you, if I were on regular pain medicine, I’d be able to get them, no problem,” he says. “No questions asked.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/223727/insurance-rules-put-up-roadblocks-to-opioid-addiction-treatment","authors":["byline_stateofhealth_223727"],"categories":["stateofhealth_2442"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2845","stateofhealth_2519","stateofhealth_2656"],"featImg":"stateofhealth_223728","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. 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