David Gorn

Similar Procedures, Different Prices at California Hospitals

The cost of many hospital services varies widely across the state — with some facilities charging two or three times as much for a similar procedure, according to a report released yesterday by the California Public Interest Research Group.

Higher cost at one hospital doesn’t necessarily mean higher quality, according to Pedro Morillas, CalPIRG’s legislative director.

“Just because a specific hospital charges an arm and a leg doesn’t mean you’ll get better care there,” Morillas said. “Cost is not a corollary for better quality.”

Rural Clinics Hope DHCS Email Will Turn Tide in Medi-Cal Benefits Lawsuit

The Department of Health Care Services has been accused of withholding information in a court case — information that has the potential to change the reimbursement status of rural health centers and federally qualified health centers in California, according to court documents filed Monday in the U.S. Court of Appeals Ninth Circuit by the California Association of Rural Health Clinics.

Officials from DHCS could not comment on the lawsuit, according to Norman Williams, deputy director of public affairs for DHCS.

“As this matter is in active litigation, DHCS will provide its response to CARHC’s recent motion in an upcoming court filing,” Williams said.

Capitol Reacts to Budget, Reform Ruling

Health care issues took center stage in California for the past month — first, when budget pushback focused on health-related programs, and more recently, when the Supreme Court took a stand on legality of the federal health care reform law.

Here’s a taste of what California had to say about it all, culled from interviews, releases and a variety of media outlets:

What Food Issues Mean to Health Care

A new policy brief from the UCLA Center for Health Policy Research found that 3.8 million Californians in 2009 had times during the year when they could not afford food.

Based on data from the California Health Interview Survey, the new study of showed a marked rise from the 2.5 million Californians with food insecurity eight years before, in 2001. That’s an increase of about half (49%), during a time period where California’s population grew by about 10%.

“The numbers are quite striking,” said UCLA researcher Gail Harrison. “We knew what the trend was going to be, but this was a much more striking increase than I thought there would be.”

Kaiser, State Close on Healthy Families Pact

Officials from Kaiser Permanente and the state Department of Health Care Services are finalizing a deal to enable Kaiser’s participation in the state’s planned elimination of the Healthy Families program.

That is welcome news for the 193,000 Kaiser-enrolled children in Healthy Families — almost one-fourth of all children in the program. Up till now, it looked like the state and Kaiser were at an impasse over Kaiser’s participation in the conversion of Healthy Families to Medi-Cal managed care.

“Earlier it appeared we would not be able to include Kaiser,” said Norman Williams, deputy director of public affairs for DHCS. “But we have made some significant progress, and now it looks like they will be included.”

Committee Moves Stop-Loss Bill Forward

Stop-loss health insurance is a way for small-business employers to offer a form of health care insurance to employees while limiting risk. The trouble with that, according to Senate member Kevin De León (D-Los Angeles), is that the low risk incurred by stop-loss insurers could mean higher rates for the rest of California.

“Here’s the problem,” De León said this week before the Assembly Committee on Health. “Any increase in stop-loss coverage insurance … could lead to a significant exodus of small employers … especially employers with young employees, leaving behind a smaller-group insurance pool subject to skyrocketing premiums.”

Basically, stop-loss coverage allows insurers to cherry-pick or adversely select the youngest and healthiest consumers with low rates, which makes rates rise for everyone else, De León said.

Health Reform Bills Move Through Committee

State Senator Ed Hernandez (D-West Covina) had a busy day. At Tuesday’s hearing of Assembly Committee on Health, Hernandez had seven different bills heard and approved — including two of the highest profile health care reform bills in California.

One of them, SB 951, would set the essential health benefits for California under the Affordable Care Act and the other, SB 961, would reform individual coverage in the state.

“Last week the Supreme Court appropriately said the ACA is here to stay,” Hernandez said, when introducing the latter bill. “This bill reforms the individual market … to improve access to health coverage in California.”

Bill Would Create Office of Oral Health

Dental providers are united in their intention to address the poor quality of dental care for California children, but are divided about the best way to do that.

Legislators at last week’s Assembly Committee on Health decided to put aside the disagreement and rancor over the best method to deal with the problem and voted unanimously to approve SB 694 by Alex Padilla (D-Pacoima).

The main component of the bill was never questioned in the health committee hearing — that is, to establish a statewide Office of Oral Health and to have a high-level director of that office. According to bill author Padilla, that new office taps no state funds.

CO-OP Program Moves Forward in Senate

California took a small step toward instituting a new type of health insurance plan in the state — a not-for-profit, member-governed plan dubbed the Consumer Operated and Oriented Plan, or CO-OP.

The new bill was introduced to the Senate in last week’s Senate Committee on Health hearing. AB 1846 by Assembly member Rich Gordon (D-Menlo Park) would pave the way for California to apply for some of the $3.8 billion the federal government is planning to loan to states to start CO-OPs. So far, 12 states have started the process.

“It’s a new type of health insurance, intended to offer affordable, consumer- friendly coverage … in the individual and small group market,” Gordon said. “This bill streamlines the licensure process, and allows California to take part in this program, and tap federal dollars.”

Heat Over Healthy Families Compromise Plan

Yesterday’s state budget compromise between legislative leaders and the governor includes a provision that 880,000 children in the Healthy Families program will complete the shift to Medi-Cal managed care within a year, beginning Jan. 1. State officials, who had been using an enrollment figure of 875,000, now say the Healthy Families programs serves 880,000 California children.

The timing of the shift ticks off Suzie Shupe, executive director of California Coverage and Health Initiatives (formerly known as the Children’s Health Initiative).

“We are really outraged over this deal that was struck,” Shupe said. “Despite both houses of the Legislature supporting the notion of transitioning just the bright-line kids, I can’t believe they decided to eliminate a popular and successful program in one fell swoop like this.”