Latest California Healthline Stories
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.
Agreement Expected Today on Medicaid Waiver
The formal deadline for wrapping up negotiations on the federal Medicaid waiver for California is Oct. 31, and state officials say it might go right up to the deadline. But since that deadline is on Sunday, health care policy experts are expecting an agreement to be formalized and announced two days earlier than that — by today.
The Medicaid waiver is a complex and multipronged plan to revise the state’s Medi-Cal program and prepare California to implement national health care reform.
California stands to receive about $2 billion a year in federal money over the next five years in the agreement. Roughly half of that is in new money — money beyond what the federal government currently pays per year to help fund Medi-Cal, California’s Medicaid program.
More Oversight Ordered for California’s Nursing Homes
California is going to get 70 more investigators to monitor conditions at nursing facilities around the state, according to state officials.
The Department of Public Health, along with the state legislature, has made an increasing push to raise levels of monitoring and enforcement for California nursing facilities.
From the legislative side, recent passage of SB 853 (a trailer bill passed during budget finalization and recently signed by the governor) pushes for more nursing home inspections.
Ripple Effect Might Hit Non-Medicare Patients
The poll numbers were not good. About 67% of physicians in America said they’ll likely see fewer Medicare patients, and well over half of American physicians said they intend to cut administrative or clinical staff, if the roughly 30% cut in Medicare reimbursement goes through at the end of this year.
That’s according to a national report this week from the Medical Group Management Association.
“I think you’d find similar answers in California,” Andrew LaMar of the California Medical Association said. “Physicians will be in tough financial straits if they have to take a 30% cut in Medicare. And it will have a huge effect on access to care in California.”
Coverage Begins for High-Risk Enrollees
After setting an ambitious timetable for startup and then hitting delays for almost a month after its scheduled launch, the state’s Pre-Existing Condition Insurance Plan officially started enrolling patients yesterday.
The program will use $761 million in federal money to help insure Californians who cannot get health insurance coverage because of pre-existing conditions. So PCIP helps provide coverage to people who would not otherwise get it.
“We’re very happy for the people of California who need this,” Jeanie Esajian of the state’s Managed Risk Medical Insurance Board said yesterday.
Mental Health Advocates Sue Over Governor’s Cuts
Before the governor signed the state budget, he cut about $1 billion from it. One of those line-item vetoes trims $133 million from mental health services spending for children.
According to advocates who filed a lawsuit Friday to stop it, those cuts are illegal.
“Only the state Legislature has the authority to reverse the mandate to provide these services,” Jim Preis of Mental Health Advocacy Services said.
Exchange Passage Raises Question: Now What?
When you’re the first to launch a new program, it is often greeted with a measure of fear and suspicion, according to Jon Kingsdale, former executive director of the Commonwealth Health Insurance Connector Authority in Massachusetts.
And one of the common misconceptions about the exchange in Massachusetts and the exchange-to-be in California, he said, has been the worry that somehow the exchange will be constantly at odds with health insurance companies.
“As a non-regulatory marketplace for insurance, with a mandate to serve the public, there is a strong interest in having long-term, value-based relations with health plans,” Kingsdale said. “Meaning, we want them to make a little money.”
Senate Probes Reasons for Adverse Hospital Events
They are events that leave patients worse off than when they first come to the hospital — from “never events” such as leaving surgical devices in a patient after an operation, to the acquisition of MRSA (methicillin-resistant Staphylococcus aureus), a highly resistant bacterial infection.
“I believe that the DPH (California’s Department of Public Health) has not been actively pursuing the reporting of adverse events within the five days required by statute,” Senate member Elaine Alquist (D-Santa Clara) said. “Now, I don’t know if we’re talking fines or not, but I do know the system is not working.”
Alquist is chair of the Senate panel that convened yesterday and gathered representatives from state health agencies, hospital associations and patient advocate groups to discuss reporting and preventing adverse events in California hospitals.
California Exchange Compared to its Predecessors
California is the first in the nation to pass legislation to create a health benefit exchange in response to the national health care reform law. But that doesn’t mean it’s the first exchange in the nation.
Four other states implemented some kind of exchange ahead of the national reform law — Massachusetts, Connecticut, Utah and the newest exchange recently established in Washington state.
“In Utah, it’s more of a clearinghouse model,” according to Julie Sonier, deputy director of the University of Minnesota’s SHADAC (the State Health Access Data Assistance Center). “And Connecticut is different, in that it’s entirely a private model. It’s less like an exchange, and more like a set of insurance products for their members. They’re not trying to organize the market.”