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In legislative terms, the last two weeks of subcommittee hearings were “lightning quick,” as Jean Ross of the California Budget Project put it.
The Senate and Assembly subcommittees for Health and Human Services listened to presentations and comment on sweeping changes to social service programs. Any one of those changes would normally go through a lengthy review process, but lengthy is a luxury in a budget that needs to be approved by March, just seven weeks after it was proposed.
This week, those subcommittees are expected to wrap up the business of reviewing roughly $12 billion in cuts, about half of that coming from health-related services and programs.
Filling Out the Powerful Exchange Board
The board of the Health Benefit Exchange is going to be small and mighty.
It will be responsible for implementing the first, and probably largest, health insurance exchange in the nation. This exchange will concentrate the health insurance buying power of millions of Californians, and will be the central force in implementing national health care reform in California.
It will be run by five people. Three of the board’s members are in place. Former Governor Schwarzenegger named two of them: his chief of staff Susan Kennedy, and the former Secretary of Health and Human Services, Kim Belshé. The third member, by statute, is the current head of CHHS, Diana Dooley, appointed CHHS secretary two months ago by Governor Brown.
State Budget Plan Is ‘Ugly Beyond Belief’
The annual conference of the Insure the Uninsured Project (“From Reform to Reality: Building Better Systems of Care in California”) was supposed to focus on Medi-Cal expansion, the rollout of the health benefits exchange and how to get insurance coverage for the 6 million Californians who go without it.
But it was pretty hard to ignore the $12 billion in cuts to state programs proposed by Governor Brown — with roughly half of those cuts impacting health services.
The national rancor over the attempt to repeal health care reform slipped into the statewide conference. Orange County is about to announce that it will not be part of the California Health Benefit Exchange.
Seniors Making Noise Over Budget Cuts
They hit Sacramento in force this week, hundreds of seniors and the disabled, milling in front of the Capitol Building with walkers and wheelchairs, chanting about what they want (senior health services) and when they want it (now!).
But most of the political rhetoric in Sacramento has focused on the grim reality of the $25.4 billion deficit and the need to make cuts that no one wants to make.
That includes many health services, from establishing Medi-Cal co-pays and putting a hard cap on the number of provider visits allowed, to eliminating the Adult Day Health Services program and scaling back In-Home Supportive Services. Those latter cutbacks, along with reducing cash benefits from Supplemental Security Income, have incensed and worried seniors, who see a dire future without those services.
Dooley Reacts to Brown’s Speech, Florida Ruling
It has been three weeks since Governor Jerry Brown first floated his ideas for trimming a $25.4 billion deficit, which included roughly $6 billion in cuts to health-related services.
Since then, legislators have listened to hundreds of Californians objecting to those cuts in budget hearings. Diana Dooley has sat in on hearings, talked with the subcommittees and spent a lot of time with legislators and staff to kick around all of the cuts and their possible alternatives.
“I could come up with eight or 10 programs that are [candidates for amending cuts],” Dooley said after Brown’s State of the State speech last night, “but it’s premature to say where there might be modifications.”
How California Progress Fits With Federal Report
A new federal report on lowering health insurance costs has a distinctive California flavor to it.
One of the main points of the report from the Health and Human Services agency is to quantify the savings to families and individuals who participate in a health benefits exchange. Since California is the first in the nation to establish a post-health-reform exchange, this state is a bit of a poster child for how the health reform law will work.
Insurance Commissioner Dave Jones joined national health secretary Kathleen Sebelius in a conference call on Friday to discuss the new federal report.
Pan Named Chair of Health Care Work Force Committee
Richard Pan, a pediatrician newly elected to the Assembly from Natomas (near Sacramento), was named this week to chair the Assembly select committee on health care work force and access to care. It’s a subject the Democrat knows well, since he worked as the director of the pediatric residency program at UC Davis before winning his Assembly seat in November.
The dearth in physicians and other providers in the state is felt particularly strongly in rural and underserved urban areas, he said. The first step to fixing that, he said, may be to have more training and development of health professionals.
“What we want to try to look at is to find effective ways to deal with geographic maldistribution of providers, and to find and leverage funding to enable people to enter health professions,” Pan said.
Budget Subcommittee Gets an Earful
Even before the Senate budget subcommittee started yesterday, chair Mark DeSaulnier (D-Concord) asked the packed chamber for a little indulgence.
“We’re about to have a four-hour hearing on what’s going to be a very difficult subject,” DeSaulnier said.
“So please don’t get cranky with the chair,” he said, “I just want to make sure everyone gets heard.”
Medical Loss Ratio Threshold Goes to 80%
The Department of Insurance already regulates a 70% medical-loss ratio on insurers of individual health plans so it was not a huge leap to bump that limitation to 80%, given the new federal standard at that level, according to Janice Rocco, deputy commissioner of health policy for the DOI.
“We maintain the [current state requirement of a] 70% medical-loss ratio,” she said, “and we also need to comply with the federal 80% ratio, which is calculated in a different way than the state ratio.”
The state Office of Administrative Law agreed, and yesterday granted the Insurance Commissioner and his department the authority to enforce those federal standards.
Health Cuts Raising Seniors’ Hackles
It doesn’t sound like much, the meeting of Senate subcommittee #3.
But tomorrow’s subcommittee hearing is the first time the Legislature will be discussing some of the $1.7 billion in proposed Medi-Cal cuts.
That includes elimination of the Adult Day Health Services program, which Democratic Gov. Jerry Brown hopes would save the state $177 million of general fund money. Lydia Missaelides, executive director of the California Association for Adult Day Services, doesn’t believe it.