It May Be Arcane, But It’s Also Vital
Almost everyone in the health care world knows how important the Medicaid waiver is to California — and really, to the nation.
As the first state to implement national health reform ideals on such a large scale, what happens in California by Oct. 31 with the $10 billion waiver is something that will affect how health care reform is put in place in many other states.
But not everyone in the health care world understands all of the complex give-and-take involved in so many rule changes and manipulations of the health care market.
Hope, Fear in State’s Community Clinics
There are some in the health care world who contend clinics caring for Medi-Cal patients and the uninsured are doomed to failure. Not so, according to a study released yesterday by the California HealthCare Foundation, which publishes California Healthline.
The report, Financial Health of Community Clinics, found that financially stronger clinics serve a high number of low-income patients and manage to have high reimbursement levels compared to financially weaker clinics.
Carmela Castellano-Garcia can explain that one. She’s president and CEO of the California Primary Care Association which represents more than 800 clinics and health centers in the state.
Little Concern About Waiver Timing
When the state Assembly and Senate gather to vote on a budget for California — whenever that may be — members will also vote on the $10 billion Medicaid waiver.
The Medicaid waiver is the plan California has laid out in months of negotiations with CMS to implement the revised Medi-Cal program in California, and to prepare the state for health care reform.
Since California is ahead of the national curve on getting set for the health care reform law, many other states are watching what happens here — which puts additional pressure on federal approval of this large and innovative waiver plan.
The best thing that happened to health insurance rate regulation was the last thing its proponents wanted to see.
When Anthem Blue Cross announced it planned to raise individual rates by as much as 39% back in February, it was the type of steep rate hike regulation proponents had been warning against for many months.
The public scorn and outrage prompted by that rate hike proposal was insurance regulation’s best friend — but, it turned out, was not enough to propel legislation.
Post-Mortem on Physician Hiring Bills
A pilot program that has allowed some direct hiring of physicians in rural areas of California apparently generated a lot of interest in Sacramento. Three different bills were introduced to expand the scope of that pilot program, and all three of those bills failed.
In California, hospitals are not allowed to employ physicians directly, in order to maintain a kind of firewall between hospital administrators and the health care providers who make medical decisions.
But there is also a shortage of primary care physicians in rural areas of the state, so some medical centers were granted an exception to the no-direct-hiring rule, so that they could hire on their own doctor for their own facility. Many hospital administrators felt that suspension of the rule gave them a competitive hiring advantage.
Medicaid Waiver Bills Still in Play at Capitol
The legislative deadline passed more than week ago, but at least two health care bills are still at play in the Legislature.
Not only are two bills dealing with Medi-Cal waiver certain to get a vote when the legislature reconvenes to take up the budget, the legislation has several big factors in favor of its passage, according to health care expert Peter Harbage of Harbage Consulting.
“At the end of the day, the policy changes in the waiver and its funding are too valuable for California to pass up.”
End of Session Winners Wait on Governors Desk
The governor is expected to sign legislation into law that would create the state Health Benefits Exchange legislation. He has till the end of September to make up his mind about the exchange and other health care-related issues.
This is some of what’s pending:
• Seven other bills related to the pending federal health care law and coverage issues are before the governor (in addition to the two exchange bills, SB 900 and AB 1602).
California Set To Insure High-Risk Patients
On April 29, Governor Schwarzenegger signed legislation that established the state’s federally funded high-risk insurance pool. This week that insurance pool is accepting its first enrollee applications.
That means the government set up a complicated government program in about four months. In state bureaucracy terms, that is the blink of an eye.
“We’ve been working nights and weekends trying to make this happen,” Deputy Director for Legislative and External Affairs at the Managed Risk Medical Insurance Board Jeanie Esajian said.
How Budget Morass Could Spring One Bill From Limbo
The Assembly and Senate both passed a bill on the last day of the legislative session, but it ended up being put on hold after Republicans closed ranks and refused to approve it on concurrence.
According to the state’s Chief Clerk, E. Dotson Wilson, it is currently the only bill that could get a re-vote when the Legislature gathers to decide on the budget. AB 1542 by Dave Jones (D-Sacramento) would encourage establishment of patient-centered medical homes.
“Because it has an urgency clause, it is eligible to be taken up again when the legislature votes on the budget,” Wilson said. “There is a window there.”
Single Payer Goes Quietly Into That Last Night
All night long, Assembly watchers waited and wondered: When would the bill be presented to vote on establishing a single payer health system?
The answer was: Not this night. Not in this legislative session.
Political insiders sat around and wondered why Assembly speaker John Perez decided not to present a vote on SB 810 by Mark Leno (D-San Francisco), which had been passed in the legislature twice before, and vetoed twice before by Governor Schwarzenegger.