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CaliforniACA September Newsletter

The California Health Benefit Exchange
September Board Meeting Covers Stakeholder Consultation, Consumer Assistance, SHOP and Service Center Models

During the September Exchange board meeting, staff presented onnaming/tagline updatesoutreach and education grant program concepts,stakeholder engagement plansconsumer assistance/ombudsman optionscontracting options for the administration of the Small Business Health Options Program (SHOP)qualified health plan solicitation timelines, and a service center update on options to refer Medi-Cal eligible consumers to county offices.  All meeting materials are available online, and more information on this meeting can be found here.  The next meeting has been rescheduled to October 30, and will be held in Sacramento.

Governor Brown Signs Health-Related Measures Into Law
Gov. Brown has signed several health-related bills into law:

  • AB 1453 (Monning)/SB 951 (Hernandez): Requires health plans to cover a set of minimum essential health benefits to be at least equivalent to the Kaiser small group HMO
  • AB 472 (Ammiano): Exempts residents from prosecution in overdose cases if they seek medical assistance
  • AB 1731 (Block): Requires infants to be tested for congenital heart disease before leaving the hospital
  • AB 1301 (Hill): Requires state to suspend a store’s tobacco license for 45 days if it has 3 violations for selling tobacco to minors within 5 years; the state must permanently revoke the store’s license if it has 5 violations in 5 years
  • SB 623 (Kehoe): Extends until Jan 1, 2014 a pilot program to evaluate safety and effectiveness of allowing nurse practitioners, physician assistants and midwives to provide non-surgical abortions
  • AB 1569 (Allen): Extends Laura’s Law until 2017, which allows courts to mandate treatment for residents with severe mental health conditions and a history of violence or hospitalization
  • AB 2348 (Mitchell): Allows registered nurses to distribute and administer birth control according to a standard procedure outlined by a physician or surgeon.
  • SB 1538 (Simitian): Requires women who receive mammograms to be informed if they have dense breast tissue

Governor Vetoes Health Reform Bills
The following health implementation bills were vetoed Sunday night:

  • AB 1461 (Monning)/SB 961 (Hernandez): Prevents insurers from discriminating against pre-existing conditions in the individual market
  • SB 970 (De Leon): Integrates health enrollment with human services

These issues, along with eligibility and enrollment rules, Medicaid expansion and the Basic Health Plan, are expected to be addressed during the special session of the legislature, which will begin in December.

Slight Majority of Likely Voters Support Prop 30, Support Higher Among Wealthier Residents
A recent poll by the Public Policy Institute of CA (PPIC) found that a slight majority (52%) of likely voters supported Proposition 30, with 40% against and 8% undecided.  Support was higher among Democrats (73%), women (59%), Latinos (66%) and voters under the age of 35 (72%).  Another survey by the Field Poll and The Institute of Governmental Studies at UC Berkeley found that 51% of all respondents were in favor of Proposition 30, but 59% of voters with household incomes over $100,000 supported the Governor’s tax plan.  A USC Dornsife/Los Angeles Times poll found that support has slipped from 55% of registered voters from 59% in May; voters may be leery of tax hikes in the wake of a financial scandal at the parks department and increasing costs for a high-speed rail project that would link North and Southern California.

Medi-Cal Pilot Program Cuts Hospital Stays for Children
A UCLA study found that children with life-threatening illnesses enrolled in Partners for Children spent less time in the hospital and had 11% lower health care costs than before they joined the program.  Partners for Children is a Medi-Cal pilot program for individuals under the age of 21 with life-threatening illnesses, like cystic fibrosis, cancer, neuromuscular and cardiac disorders; it provides participants’ families with care coordination and 24-hour access to a nurse familiar with the child’s condition.  The pilot is set to end this year, but will likely be renewed as a 5-year program that could be expanded to cover 25 counties.

Medi-Cal Managed Care Transition Facing Problems
A report by the California HealthCare Foundation found that the state encountered problems during its efforts to transition 240,000 Medi-Cal beneficiaries from fee-for-service into managed care plans.  Caregivers and other respondents said that “the managed care system was not prepared” to address beneficiaries’ needs, which involved mental illness, developmental disabilities and homelessness.  The report also found that health plans did not offer information and care coordination early enough in the process; beneficiaries struggled to understand complex written materials they received; and beneficiaries “experienced anxiety due to confusion and concern over whether or not they would still be able to see their current primary care physician, specialists and mental health care providers.”  The authors recommend allowing more than 7 months to expand managed care to seniors and persons with disabilities (SPD), while also establishing simple and clear policies for Medical Exemption Requests (MER), continuity of care, and notification of disruption in the provision of pharmaceuticals and durable medical equipment.

Information Technology
>UC-Davis Health System to Lead Data Sharing Program
The UC-Davis Health System will lead the California Health eQuality (CHeQ) initiative that will electronically link CA hospitals, emergency departments and physicians by 2014.  The project received a 4-year $38.8M grant in 2010 through the federal stimulus package.  State and CHeQ officials plan to hold a stakeholder summit in Sacramento on November 1-2.

CA Health Providers Received $743M for EHR Use
About 18,000 CA health providers have received a combined $743 million in federal incentive payments for using electronic health records (EHR).  Under the federal economic stimulus package, providers who demonstrated meaningful use of certified EHR systems could qualify for Medicaid and Medicare incentive payments.

Outreach and Enrollment Critical to Minimize Remaining Uninsured Post-Reform
According to a report by the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research, while health coverage will significantly expand with ACA reforms, up to 4 million Californians will remain uninsured in 2019.  Almost 75% of this population are projected to be US citizens or lawfully present immigrants, and half will be eligible for Medi-Cal or Exchange subsidies but not enroll due to lack of awareness, difficulties in enrolling, or inability to afford subsidized coverage; authors of the study predict that a more robust outreach effort could increase Medi-Cal/subsidized Exchange enrollment by an additional 800,000.  Due to the high numbers of remaining uninsured, researchers believe the state will still have a great need for a strong safety net.

CA Uninsured Rates Among Highest in US
New data from the Census Bureau found that the rate of California residents without health insurance in 2011 was among the highest in the US.  The national rate decreased from 16.3% in 2010 to 15.7% in 2011.  In California, however, the rate increased slightly from 19.4% in 2010 to 19.7% in 2011, which was the fifth highest rate in the nation.  Additionally, the number of CA residents who lived in poverty increased for the fifth straight year to almost 6.4 million.

Obesity Rate to Double by 2030
A report by the Robert Wood Johnson Foundation and the Trust for America’s Health found that CA’s obesity rate is expected to increase from 23.8% in 2011 to 46.6% in 2030 if current trends continue.  If CA residents lost an average of 5% of their body weight, the state would save almost $82 billion and prevent 800,000 cases of diabetes.  The report also found that every state is projected to have an obesity rate higher than 44% by 2030.

ACO Saved CalPERS $37M over Two Years
An accountable care organization pilot led by Blue Shield of California, which serves thousands of CalPERS beneficiaries in Sacramento, saved the agency $37million in 2010 and 2011, according to a report published in Health Affairs.  It found that health care costs per CalPERS beneficiary declined by 1.6% to $393 monthly during the first year, while the average cost for beneficiaries outside the ACO increased by 10% to nearly $436 monthly during the same period.  The report also found that the number of inpatient days and hospital readmissions decreased by 15% in the first year, and the number of hospital stays lasting longer than 20 days decreased by 50% during that time.

NCQA Report Card On Medicare, Medicaid and Private Plans Released
The National Committee for Quality Assurance (NCQA) has released their annual Health Plan Report Card for Medicare and Medicaid plans.  Two of California’s Medicare plans ranked among the best in the nation, with Kaiser Foundation Health Plan of Southern California ranking 1st and Northern California ranking 3rd out of 395 plans; no other CA Medicare plan ranked higher than 102.  CA’s Medicaid plans did not fare well, with no Medicaid plan ranked higher than 70 out of 115 plans.  Among 473 private plans, California had two plans in the top 10, with Kaiser Foundation Health Plan of Northern California ranking 8th, and its Southern California counterpart ranking 10th.

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