Mari Edlin

Expanding Medicaid Called ‘Right Thing To Do’

The CEO of a trade group representing safety net health plans in 26 states hopes other states follow California’s example and make plans now to expand Medicaid.

“The Supreme Court’s ruling on the expansion of Medicaid is unlikely to materially affect the efforts of health plans in California since the state has indicated that it would participate in the expansion,” said Margaret Murray, CEO of the Association for Community Affiliated Plans, which represents 59 non-profit safety net health plans in 26 states.

“We hope other states do likewise. Approving the expansion of coverage to working families with low incomes is the right thing to do,” she said.  “Many of our plans in California have discussed the possibility of participating in the health insurance exchanges set forth in the Affordable Care Act, along with the Basic Health Program, should the state move forward with that option.”

State Officials Applaud Rulings, Add: ‘We Need To Be Ready’

California officials who said they’d push forward with health care reform no matter what the Supreme Court ruled are pushing today with much less resistance after the Affordable Care Act rulings announced yesterday.

Sen. Ed Hernandez (D-West Covina), who chairs the Senate Health Committee, said he was “surprisingly excited. We can take a deep breath now that we don’t have to worry about Californians having access to health care.”  He admits, however, there is much more that California needs to do before 2014.

“The ruling establishes a legal foundation for our vision,” said Hernandez’s counterpart in the Assembly, Bill Monning (D-Carmel), who chairs the Assembly Committee on Health and is a strong advocate of preventive care.

Health Programs Take a Hit in Legislature

The California Legislature yesterday passed two budget trailer bills calling for relatively rapid changes in California’s Healthy Families program.

Although many organizations and health advocates opposed the two bills, most Democratic legislators voted for them. The bills call for a four-phase, one-year transition of enrollees in the Healthy Families Program to Medi-Cal managed care plans. Children’s health advocates lobbied unsuccessfully for a slower transition.

The Healthy Families changes are part of the state’s plan to cut more than $1 billion from health related programs to pare down a $15.7 billion deficit.

Autism Task Force Bill Moves to Assembly Health Committee

State Sen. Elaine Alquist’s (D-Santa Clara) bill to establish a telehealth task force for autism passed the Assembly’s Human Services Committee yesterday with a unanimous vote. Both Republican committee members — Brian Jones (Santee) and Shannon Grove (Bakersfield) — abstained.

Having received bipartisan support in the Senate before reaching the Human Services Committee, the bill by the Santa Clara Democrat has now been double- referred to the Assembly Health Committee.

SB 1050 establishes a telehealth task force under the State Department of Developmental Services to develop evaluation and diagnostic procedures for autism and other autistic spectrum disorders.  It is sponsored by The Children’s Partnership, a national nonprofit, non-partisan, child advocacy group with offices in Santa Monica and Washington, D.C.

Making Budget Pill Easier To Swallow

If you were to say last week’s California State Legislature trailer bills on health care were pulling a large load, you might be accused of putting the cart before the horse. The cart, in this case, is orchestrating cuts and ways to preserve health care programs before voting on the final state budget, which — to carry the analogy — would be the horse.

Having been approved by both houses and ready for Gov. Jerry Brown’s (D) signature, the Senate and Assembly budget proposals include enough money for the state In-Home Supportive Services program to remain in operation, helping to keep aged, blind and disabled persons living at home instead of being institutionalized.

Part of the fiscal maneuvering to keep the program alive is a little-talked-about provision — the Medication Dispensing Pilot Project slated to launch July 1.

What About Docs’ Side of Drug Kickbacks?

Insurance Commissioner Dave Jones’ pursuit of a whistle-blower lawsuit against Bristol-Myers Squibb, which allegedly offered kickbacks to physicians to increase its drug sales in California, raises a related question: What about all those physicians — 15,000 gifts have been reported between 1999 and 2005 — who took the bait?

That bait includes sports tickets, expensive meals, all-expense paid trips and honoraria for speakers who sometimes didn’t even show up.

While a code of conduct for physicians is not written in stone, the American Medical Association’s policies usually hold weight with its members. In essence, AMA’s guidelines say that individual gifts of minimal value are permissible as long as the gifts are related to the physician’s work. We’re talking pens and notepads. No gifts should be accepted if there are strings attached, according to AMA. In other words, don’t accept gifts in return for prescribing a manufacturer’s drugs.

New High-Risk Rates Welcomed

When California’s Managed Risk Medical Insurance Board decided to create a state-run, pre-existing condition insurance plan in October, 2010 instead of using the “federal fallback” program, it didn’t mean complete autonomy for California officials.

The high-risk insurance program is funded through 2013 by a $761 million allotment from the federal government and federal officials have some guidelines about how that money is spent.

To entice more enrollees, the federal HHS lowered premiums on the pre-existing condition plans in states using the federal fall-back program. HHS requested that all plans, including state-sponsored ones, create a new child-only age band, moving it from birth to 14-years-old to include children up to 18. Secondly, HHS reinterpreted the payment plans for subscribers in each of the nation’s PCIP — or pre-existing condition insurance plan — regions.

Blue Shield’s Rate Motives Explained

Could Blue Shield of California’s motivation for making an about face on its proposed May 1 rate increase have anything to do with California’s new Health Benefits Exchange, slated to launch in 2014?

Blue Shield officials say no. 

However, whether intended or not, the decision probably won’t hurt the company’s relationship with the state’s Department of Insurance. Legislation creating California’s new exchange grants the state insurance commissioner authority to recommend insurers to the exchange based on the equity of their rate increases.

Blue Shield officials said retreating from the proposed rate hikes will allow the company to more freely address issues causing medical costs to rise.

Fearer Ready To Get To Work on Benefit Exchange Board

Paul Fearer, senior executive vice president and director of human resources for Union Bank in San Francisco, brings a rich background in health care purchasing to the penultimate seat on the California Health Benefit Exchange board. Now he and his three colleagues are waiting for the fifth and final appointee so the board can set policy in motion in preparation for the exchange’s start-up in 2014.

He joins California Health and Human Services Secretary Diana Dooley, former California HHS Secretary Kim Belshé and former Schwarzenegger administration chief of staff Susan Kennedy on the exchange board.

“We may look at different ways to reach solutions, but we are aligned in our mission to achieve affordable, quality and accessible health care,” Fearer said.

Regional Meetings Focus on Work Force Shortages

By the time the California Office of Statewide Health Planning and Development completes a series of regional focus groups, it should have a good handle on creating a robust health care work force. The 10th meeting is scheduled this week in Ontario.

Regional leaders have been charged with offering suggestions on training, recruiting and retaining quality health care workers, while buttressing the impact of reform.

The Patient Protection and Affordable Care Act is bolstering efforts to increase the work force through a variety of provisions addressing the primary care system.