The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Posts Tagged ‘The Health Care Security and Cost Reduction Act’

California Health Care Reform Initiative Timing

Posted by Alan on December 24, 2007

The Health Care Security and Cost Containment Act, ABX1-1, can become effective only if voters approve a ballot measure providing financing for the health care reform package. Supporters of ABX1-1 are hoping to place that funding initiative on the November 2008 ballot. As posted earlier, a Field Poll released Friday shows strong support for the measure, although the survey failed to probe for reactions to arguments likely to be made by opponents.

Contrary to the impression folks might have from the large number of initiatives California voters face every year, qualifying a ballot measure takes time, money and perseverance. While every aspect of the qualification process is challenging, the biggest obstacle facing supporters of the Health Care Security and Cost Containment Act is time.

That’s why Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez are pushing so hard on Senate President Pro Tem Don Perata to have his house consider the legislation sooner rather than later. The Senate can — and should — make changes to ABX1-1. Without knowing what these changes are, drafting the initiative is challenging.

If the Governor and Speaker had their way, the Senate would convene this week and pass the bill as is. Senator Perata says he won’t call the Senate into session until January 7th. And he won’t bring ABX1-1 up for consideration until the Legislative Analyst has had a chance to evaluate it’s impact on California’s budget. Realistically, that means a vote is unlikely before January 15.

Will that leave enough time for the qualification process to begin?

According to an excellent post on the Sacramento Bee’s CapitolAlert web site by Shane Goldmacher, the answer is “probably not.” This is a post well worth reading.  Go there, I’ll wait.

For those looking for solely the bottom line …

It is virtually impossible to gather enough signatures to qualify a ballot measure in less than 30 days. That’s the key stat. Before the signature gathering can start, however, the Attorney General has to do some paperwork. That can take weeks. If the Senate takes until January 15th to pass the legislation and the Governor and Speaker wait until then to submit the initiative to the Attorney General, there will be virtually no chance to meet the deadlines for the November ballot. It’s not impossible, but the chances are slim. We’re talking really, really slim here.

To get the full story, check out Mr. Goldmacher’s post. And I suggest you read it before time runs out.


Posted in California Health Care Reform, Health Care Reform, Healthcare Reform | Tagged: , | Comments Off on California Health Care Reform Initiative Timing

California Health Care Reform Needs a Better Name

Posted by Alan on December 21, 2007

OK. I know a rose by any other name would smell as sweet. And that a rose is a rose is a rose.

I get it. Names aren’t everything. The debate should focus on a piece of legislation’s substance.

Fine. But after nearly a year of debate and negotiations, couldn’t someone have come up with a better name for California’s comprehensive health care reform package than the “Health Care Security and Cost Reduction Act?” 

What were they thinking? Don’t they realize that every name over three syllables gets reduced to an acronym? When Congress the Health Insurance Portability and Accountability Act in 1996 they gave us HIPAA (“Hip Ahh”). That’s an acronym that works. When they passed the Consolidated Omnibus Budget Reconciliation Act of 1985, they result was “COBRA.” An A+ acronym. And the list goes on.

The Health Care Security and Cost Reduction Act? No one is going to take the twenty five minutes required to say all that. It cries out for an acronym. But come on, “HCSCRA?” How do we pronounce that? “Hick Scraw?” “H C Scray?” “Hic Sic Ra?” Anyway you work it, it sounds like an insult. There’ll be fist fights in the parking lot over this one.

While waiting for the Legislative Analyst to determine if ABX1-1 insults the state’s budget, negotiators need to meet around the clock until they come up with a better name for the legislation. If necessary, they should head down to Hollywood. There’s a lot of good writers there with time on their hands. Maybe they could come up with something that works.

But I don’t think they need outside help. The folks working on California’s health care reform plan are smart. They’re creative. They’re talented. Surely they can come up with something that doesn’t sound like a slur.

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Another California Health Care Reform Round-up

Posted by Alan on December 20, 2007

A couple of days ago I provided links to documents, articles and web sites describing the Health Care Security and Cost Reduction Act passed by the Assembly on December 17th. Those were predominately focused on the facts surrounding ABX1-1. Now that folks have had a few days to look things over, opinions about the compromise health care reform package pulled together by Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez are emerging. Here’s a round-up of some of the more interesting ones:

Los Angeles Times columnist George Skelton writes about the need for policy makers to heed the forthcoming review of the financial impact ABX1-1 will have on the state’s finances being prepared by the Legislative Analyst, Elizabeth Hill, and her staff.

Anthony York, over at the Capitol Weekly web site dissects some of the politics behind the Assembly’s mostly party-line vote on ABX1-1. Not to give away the ending, but he suspects the motivation might have something to do with an issue that rhymes with “germ inhibits.” The nature of political give-and-take is further examined in a Los Angeles Timesarticle written by Michael Rothfeld. It seems some last minute amendments to the health care reform package benefited unions which, in a coincidence of timing, poured $1 million into the “Yes” on Proposition 93, the germ inhibits — I mean, term limits — initiative.

Sacramento Bee columnist Daniel Weintraub wrote an interesting piece on how the Governor and others are insisting the Health Care Security and Cost Reduction Act is in keeping with Republican Party principles. He even offers polling to support the claim. GOP Assemblyman Chuck DeVore, writing in the Orange County Register, would, I believe, beg to differ (Note: this article was cited in the previous California Health Care Reform Round-up).

The San Jose Mercury News editorial board likes much of what they’re reading in ABX1-1, but thinks Senate President Pro Temp Don Perata is right to make sure the state can afford the plan. The Contra Costa Times editorial board agrees and is willing to have the financing initiative targeted for the November 2008 ballot if that’s what it takes to assure the Health Care Security and Cost Reduction Act won’t break the state’s piggy bank.

As I wrote about earlier today, the Los Angeles Times editorial board’s endorsement of ABX1-1 would make Alfred E. Neuman proud. The editorial board at the Los Angeles Daily News concludes ABX1-1 is the best comprehensive health care reform package California is going to see for awhile, so they’re hoping it moves forward.

I’m sure there will be more opinion pieces worth reading, but hopefully this is a helpful start.


Posted in California Health Care Reform, Health Care Reform, Healthcare Reform, Politics | Tagged: , | 1 Comment »

The Alfred E. Neuman Approach to Health Care Reform

Posted by Alan on December 20, 2007

The Los Angeles Times ran a surprising editorial in support of the health care reform package cobbled together by California Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez. That the Times is supporting the reform package isn’t the surprise, it’s the reasoning.

The editorial, published on Wednesday and entitled simply “California’s healthcare plan” accurately noted that there is much to like in Assembly Bill X1-1, the Health Care Security and Cost Reduction Act. And they assume Governor Schwarzenegger will make “a reasonable case that there will be adequate funding [for the reform package] — and that there’s a backup plan in place should finances fall short ….”

So, there’s some good things in the bill. The Governor is bound to make a “reasonable” case it won’t bankrupt the state. That’s enough for an Alfred E. Neuman worthy endorsement by the Times: “Why not give it a chance?”

Well, gee. Let’s think.

First, the history of state health care reform is littered with the wreckage from “What, me worry? reforms. As described in one of yesterday’s post, Washington State and Tennessee had to roll back their reforms. New York and New Jersey consumers pay on average twice what Californians do for individual health insurance thanks to their reforms. In fact, there’s no example of state health care reform inspiring confidence that the challenges facing our health care system can be resolved at the state level.

Second, while there’s a lot to applaud about the compromise legislation, it may contain serious flaws, too.* The reality is the Health Care Security and Cost Reduction Act has not been thoroughly vetted. The bill that passed out of the Assembly Health Committee was far different than that put before the Assembly Appropriations Committee. And what the Appropriations Committee and the full Assembly passed was made available to them the day of the vote. There was no way this complex, 200+ page bill was thoroughly reviewed before its passage. The staffs of the Governor and the Speaker are very good. They are very well intentioned. And they are very human. The odds of the bill being ready for prime time are small.

Senate President Pro Temp Don Perata is to be commended for slowing down the reform juggernaut until the Legislative Analyst’s office can estimate the impact of ABX1-1 on the state’s rapidly worsening budget. The Senate should also use this time to thoroughly review details of the bill and fix what’s flawed.

Even Alfred E. Neuman should be worried about the impact of a defective health care reform package on California.

* Note: In the original post I outlined one such serious flaw, the lack of enforcement of the mandate for residents to have coverage. Mike Russo at CALPIRG posted a comment leeting me know I missed a provision that allows carriers to exclude coverage on existing health conditions for up to 12 months on “late enrollees.” In the interest of accuracy, and out of fear I missed something else, I deleted that discussion from this blog. As pennance for missing this major element of the bill the first time, I’m going to re-read the bill again to see what else I might have missed the first time. My thanks to Mike for the correction.
Alan – December 20th, noon.

Posted in Arnold Schwarzenegger, California Health Care Reform, Health Care Reform, Healthcare Reform, Politics, State Health Care Reform | Tagged: , , , , , | 3 Comments »

A Long 10 Months

Posted by Alan on December 19, 2007

It could be a long 10 months. If California enacts ABX1-1, the health care reform compromise worked out by Governor Arnold Schwarzenegger and Speaker Fabian Nunez, we’re in for a public relations war that will start out nasty and get worse from there.

ABX1-1, the Health Care Security and Cost Reduction Act, is a framework for health care reform, bereft of funding. It will take effect only if voters approve a financing initiative supporters will seek to qualify for the November 2008 ballot. When it comes to health care reform, passions run deep. Many participants in the debate have a near religious belief in the rightness of their cause. And health care itself is an emotional issue. Taken together, these factors will tempt partisans on both sides to make bold, dramatic and emotional attacks on their opponents.

In fact, it’s already started. Daniel Weintraub, posted a story on the Sacramento Bee’s CapitolAlert web site concerning the California Nurses Association plans to march on offices of Cigna in protest of the company’s denial of a liver transplant for a critically ill 17 year old. The nurses see this as proof that ABX1-1 is fatally flawed as it fails to address the problem of denial of care. However, after being challenged for claiming the denial was made based on the cost of the transplant, the Nurses Association now admits the transplant was denied because Cigna considered it experimental and, consequently, not covered. (Cigna’s conclusion will be examined under the state’s independent medical review system.)

What’s hypocritical about the California Nurses Association protest is that their preferred solution, a state-run single payer health care system would be no better. Instead of an administrator who works for a health plan deciding whether the treatment is experimental, the decision would be made by an administrator working for the government. As Mr. Weintraub notes, “It’s misleading for the nurses to imply that their plan somehow would give every patient every treatment they requested. It wouldn’t.”

The plight of this teenager is sad. Manipulating her situation to support misleading attacks proved too tempting for the California Nurses Association to resist. That’s sad, too. Unfortunately, while they were the first to succumb to this enticement, they won’t be the last.

Note added December 21, 2007: A few hours after Cigna agreed to cover the transplant, the teenager passed away. While Cigna normally does not cover experimental treatment, the company made an exception in this case. Doctors at UCLA, where she was being treated, said patients in situations similar to Nataline’s who undergo transplants have a six-month survival rate of about 65 percent. My condolences and sympathy to her family.

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