Mapping Out Future for Rural Health Care
The problems faced by rural health providers go far beyond whether or not patients have insurance coverage, according to Danny Fernandez, legislative advocate for the National Rural Health Association, who spoke at the 10th annual conference of the California State Rural Health Association this week in Sacramento .
“At some point, ‘national health reform’ morphed into ‘national health insurance reform,’ ” Fernandez said. But it’s not just about making sure everyone’s insured, he said. “Our overall message to Capitol Hill was, if you don’t have access to a provider, then it doesn’t matter if you do or don’t have insurance coverage.”
That is probably the number one problem in rural areas throughout the state and nation, he said, along with a general lack of funding for rural health care. National health care reform, Fernandez said, might be able to address both concerns — by increasing funds through better insurance, and by offering incentives and programs to get medical providers into rural areas.
Rural Health Clinics Getting Short-Changed?
There was an interesting moment at this week’s annual conference of the California State Rural Health Association. During one of the presentations, a sit-down with two state Assembly members — V. Manuel Perez (D-Coachella) and recently elected Linda Halderman (R-Fresno) — the conversation seemed to veer away from rural health issues.
After hearing about high unemployment, the icy regulatory climate, too much government and arsenic contamination of water supplies, host Steve Barrow gently redirected the conversation.
“You know, rural [medicine] gets lost a lot in the Capitol,” he said. “We care about clean water, and cultural issues, and economic issues — but if we’re talking about economics in rural California, 11 percent of the rural economy is health care. Health care is a big part of economics in rural areas.”
If E-Prescribing’s So Great, Why Is It So Difficult?
Some people might think that since California has such a big head start on the rest of the nation in some arenas of health care reform, that it would also be taking a lead role in launching a program for e-prescribing — the electronic communication of prescriptions between physicians and pharmacists.
But those people would be wrong.
“California is 45th in the nation,” Ned Hanson, director of formulary management at Health Net Pharmaceutical Services, said. “We’ve been looking at anywhere from 8 to 10 percent adoption.”
Overuse of Health Services May Be a Myth
This week, at the annual meeting of the American Public Health Association in Denver, researchers analyzed survey data from California — investigating the concern that immigrants are a major drain on health care services.
“People looked at immigrants and undocumented workers and their use of emergency services and preventive care, and found that those groups are actually less likely than other groups to use health care services,” according to David Grant, director of the California Health Interview Survey.
“The data show [lower usage] of emergency services, as well as lower usage of preventive medicine, even among immigrants who have insurance,” he said.
Healthy Interest in Reform from Small Businesses
California’s small businesses are embracing the tenets of health care reform, according to John Arensmeyer, CEO of the Small Business Majority.
“The more people learn about it, particularly about the tax credits [offered by the Affordable Care Act], the more interested they are,” Arensmeyer said. “The real problem is that it’s a little unknown, so it’s important to get people to understand what’s in it.
According to a recent report by Bernstein Research in New York, more small-business employers — those with three to nine workers — are offering health insurance this year. Nationally, the number of small businesses offering insurance increased by 13 percentage points in a year, from 46% to 59%.
Primary Care Might Get its Due With Health Reform
It’s hard to delineate the possible progress being made in fixing the primary care problem in California and the nation, without first looking at how bad that problem is, according to Kevin Grumbach of the UCSF Department of Family and Community Medicine, who addressed an audience of health professionals at UC Davis Medical Center in Sacramento this week.
“Health systems and regions built with primary care have better outcomes, better quality of care, lower costs and more equitable care,” Grumbach said.
“The trouble is, we’re finding that the whole foundation of primary care is crumbling.”
New Commissioner Eager To Get Started
The role of California’s insurance commissioner will change quite a bit during the current term. It’s a job that oversees a huge agency, with 1,300 employees charged with evaluating, regulating and policing the home, car and other insurance industries in California. Its approach to health care insurers, though, historically has been different than its authority over other insurance industries. That is about to change and expand in several ways.
After Tuesday’s election, the new commissioner, Dave Jones, said he is “eager and excited” to oversee those changes.
“I’m looking forward to all of it,” Jones said. “I’m excited at the prospect of making this office the state’s most important consumer protection agency. And I’m excited at the prospect of playing a leadership role in implementing health care reform in California.”
New Waiver Sets Bar High for Other States
“It was a long wait,” Norman Williams of the state’s Department of Health Care Services said with a slight sigh. “But it was worth it. This is a good day for California.”
Williams is talking about the Medicaid waiver, which sets the structure and facilitation requirements for California’s Medi-Cal program. The waiver is worth up to $2 billion a year in federal funding to California for the next five years. This waiver is a huge accomplishment, Williams said, because it takes all the elements of national health care reform, and puts them into practical use.
“This is such an important step,” Williams said, “because it allows us to completely restructure California’s health care system, and to rein in costs in Medi-Cal.”
Insurance Commissioner Race Generates Direct, Indirect Funding
So far, the two main candidates for insurance commissioner in California have spent a total of about $4 million in direct money on this campaign, according to the Secretary of State’s office, with another estimated $3 million coming from independent expenditures, or IEs — ads produced independently but that support a specific candidate or attack his opponent.
According to government expenditure records, Republican Mike Villines, a member of the Assembly from Clovis, has about $850,000 to spend on this election. He also has benefited from about $2.2 million in spending by JobsPAC, the political action committee of the California Chamber of Commerce.
In contrast, the campaign of Democrat Dave Jones, Assembly member from Sacramento, has raised almost $3 million. He has received another $590,000 in spending by various special interest groups, mostly labor and law interests, with most of it coming from the California Alliance.
Friday Is New Deadline for Waiver
State health officials get another few days to fine-tune the complex and multi-faceted Medicaid waiver, a plan that is expected to revamp and expand California’s Medi-Cal program. The waiver is worth about $10 billion in federal money over the next five years.
On Friday, CMS granted the extension in a letter to California’s Department of Health Care Services, saying that the agreement was close to finalization and that the extra few days are necessary to finish the “Bridge to Reform” demonstration.
“With these extra few days, we are confident we can finalize the documentation and provide the State with an approval of the Demonstration,” the extension letter said.