The Riverside Press-Enterprise: Researchers estimate 220,000 to go without coverage

http://www.pe.com/localnews/stories/PE_News_Local_D_study30.3eabb0d.html

June 29, 2011

By LORA HINES

As many as 220,000 California children could be excluded from affordable health care coverage because of restrictions on programs created as a result of federal health care legislation passed last year, according to a study released today.

Researchers at the UCLA Center for Health Policy Research say health care legislation restrictions will exclude many uninsured children — up to 20 percent — who are immigrants or have immigrant parents.

About 40,000 of those children might be eligible for coverage but might not apply because of confusion about rules for the California Health Benefit Exchange, from which coverage will be purchased, and Medi-Cal, researchers found. Medi-Cal is California’s Medicaid program, which covers poor elderly and handicapped residents.

Researchers did not say how many affected children lived in the Inland area.

Federal health care legislation is to be fully implemented by 2014. The law requires health care coverage for all Americans.

“Health care reform restrictions raise some very unpleasant questions about our willingness as a society to let children go without care,” said the study’s lead author, Ninez Ponce, a center faculty associate and associate professor at the UCLA School of Public Health. “And confusion over the rules may result in even eligible children being cut off from coverage.”

The study, which analyzed 2007 state health survey data, estimates that 30,000 undocumented immigrant children will be excluded from the health exchange, which will offer subsidized coverage for low-income Californians.

About 150,000 uninsured children probably will be excluded from Medi-Cal because they are undocumented immigrants or legal immigrants who have lived in the United States fewer than five years, researchers found.

An estimated 40,000 children who are U.S. citizens also might be excluded from health coverage because of confusion over their parents’ citizenship. Noncitizen parents without green cards who are excluded from public programs and the health exchange might believe that their children also would be excluded from coverage, according to the study.

Families without coverage are expected to go to nonprofit community clinics, which typically provide care regardless of immigration status or ability to pay.

“It is neither prudent nor fair to lock immigrants out of purchasing coverage through the exchange,” said Daniel Zingale, senior vice president for The California Endowment, a private statewide health foundation which partly funded the study.

“Everyone needs access, and we know people generally have better access to preventive care when they have health coverage. This helps prevent costly health conditions,” Zingale said.

Legislative Update – New Medicare and Medicaid proposals

062911 Legislative Update – Medicare & Medicaid Proposals

The Sacramento Bee: Budget deal by Brown, Dems scraps tax election, may trigger cuts

http://www.sacbee.com/2011/06/28/3731976/brown-dems-reach-a-deal.html

By Kevin Yamamura

Published Tuesday, Jun. 28, 2011

Gov. Jerry Brown relinquished a cornerstone of his budget plan Monday by forfeiting a 2011 tax election and securing a deal with Democratic lawmakers that shortens the school year if tax revenues fall short of optimistic projections.

After months of seeking GOP votes, Brown decided four days before the new fiscal year that a bipartisan deal was impossible. The Democratic governor wanted Republicans to pass a temporary extension of higher sales and vehicle taxes as a “bridge” to a fall election, but Senate Republicans would not vote for taxes.

“I thought we were getting close, but as I look back on it, there is an almost religious reluctance to ever deal with the state budget in a way that requires new revenues,” Brown said, sitting at the end of a wooden bench in his office with Senate President Pro Tem Darrell Steinberg and Assembly Speaker John A. Pérez.

Republicans said Democrats scuttled the deal because they were unwilling to do enough to make long-term changes to public pensions, institute a tough spending cap and provide regulatory relief for businesses.

With no bipartisan agreement, the state sales tax will drop one percentage point and the vehicle license fee half a percentage point on Friday.

“Republicans listened to the voters and stayed true to the only special interest we represent – California’s taxpayers,” Assembly Republican leader Connie Conway of Tulare said in a statement.

Brown and Democratic leaders hammered out their majority-vote budget over the weekend to bridge California’s remaining $9.6 billion deficit. The governor vetoed legislative Democrats’ first plan June 16, contributing to legislators’ loss of pay. The governor and Democrats have feuded ever since, but they refocused together once Brown gave up on Republicans.

The linchpin of the new deal is a projection that the state will receive another $4 billion in extra revenue in 2011-12 based on strong tax receipts in May and June.

The higher revenue forecast replaces the riskiest items in Democrats’ first budget: a sale of state buildings, a quarter-cent local sales tax increase and taking $1 billion from First 5 commissions.

Lawmakers must approve cuts to education, corrections and safety-net programs that will take effect if revenues fall short of projections. The most visible may be an additional seven-day reduction that state officials will encourage districts to take at the end of the school year if enough revenue doesn’t come in.

Both houses are scheduled to vote this afternoon. Assuming they pass the plan and Brown signs it, the Legislature’s 120 lawmakers would begin receiving pay for work starting today. Controller John Chiang, who blocked their pay, believes he cannot intervene if the governor signs a budget, spokesman Garin Casaleggio said.

Rank-and-file lawmakers will have lost about $4,830 each in 12 days’ worth of pay and personal expenses if the new budget passes today and receives the governor’s signature.

Under the new plan, the University of California and California State University will each absorb additional $150 million reductions, for a total of $650 million apiece. They risk losing another $100 million each if the state falls short of revenues. The university systems already have said they will seek tuition hikes to offset new state reductions.

Since January, Democrats will have solved the state’s original $26.6 billion deficit with $11.8 billion in unexpected revenue, more than $12 billion in cuts and about $3.5 billion in fund shifts and internal borrowing. The budget will include a $500 million reserve.

The $11.8 billion in unexpected revenue is nearly equivalent to Brown’s original tax extensions.

“Going forward, we do expect more revenues in the budget year coming up, but in case we’re over-optimistic, we have severe trigger cuts that will be triggered and go into effect,” Brown said. “Those will be real.”

Outside fiscal experts were doubtful that $4 billion in additional tax revenue would materialize.

“It isn’t as if it’s been a cascade of good news since May,” said Jeff Michael, director of the University of the Pacific’s Business Forecasting Center.

“They’re out of their minds,” said Chris Thornberg of Beacon Economics, a Los Angeles consulting firm.

Brown’s Department of Finance director, Ana Matosantos, will decide in January whether revenues and economic indicators are strong enough to avoid the cuts. State Treasurer Bill Lockyer, who said in May that triggered cuts were necessary for the state to borrow from Wall Street, had no comment Monday.

Sen. Bob Huff, R-Diamond Bar, called the revenue assumption “a wand that Harry Potter would be proud to wield.”

“Senate Republicans call on both the governor and Democrat leaders to return to the bargaining table and take steps to bring about true reform that will put an end to boom/bust budget cycles, rather than rely upon a phantom $4 billion that may never materialize,” Huff said in a statement.

Republicans blocked taxes this year, but they also lost an opportunity to shape pension cuts, a spending cap and regulatory changes. They may instead seek to place a pension measure on the ballot next year by collecting signatures.

That could set up a war of initiatives in 2012. Brown said he is not giving up on his tax vote, while legislative leaders are targeting November 2012 to ask voters for more taxes.

Steinberg said Monday’s deal was the best that could be reached with a majority vote.

“Unfortunately, we were forced to deliver alone,” Steinberg said, “and we used all the tools available to us under the constitution to do just that – deliver.”

COMPARING DEALS

Here’s how the handshake budget deal between Gov. Jerry Brown and Democratic leaders compares to the plan he vetoed nearly two weeks ago:

It adds the following:

• $4 billion in higher projected revenues in 2011-12, with triggered cuts if the money doesn’t come in.

• 1.06 percentage point sales tax swap that redirects money to local governments for Brown’s “realignment” plan rather than to the state. Sales tax rate will fall one percentage point on July 1.

It maintains these provisions:

• $150 million cut each to University of California, California State University

• $150 million cut to state courts

• $200 million in Amazon online tax enforcement

• $2.8 billion in deferrals to K-12 schools and community colleges

• $300 million from $12 increase per vehicle in DMV registration fee

• $50 million from fire fee for rural homeowners

• Higher tax receipts (now worth $1.2 billion for May and June)

It rejects these elements:

• $1.2 billion in revenue from selling state buildings

• $900 million from raising a quarter-cent local sales tax

• $1 billion in revenue shift from First 5 commissions

• $500 million cut in local law enforcement grants

• $540 million deferral to University of California

• $700 million in federal funds for Medi-Cal errors

Los Angeles Times: New website to help patients compare doctors, hospitals

http://www.latimes.com/health/boostershots/la-heb-health-quality-20110628,0,5652444,print.story

June 27, 2011

By Noam N. Levey, Washington Bureau / For the Booster Shots blog

Reporting from Washington

Consumers looking to compare doctors and hospitals are getting a new resource as the Robert Wood Johnson Foundation launches an online state-by-state directory of healthcare providers.

The directory features an interactive map of the 50 states that consumers can click on to access 197 state-level and 27 national quality databases set up by nonprofits, health plans and government agencies nationwide.

Though some of these databases have been available for years, such directories have been proliferating as patient advocates, healthcare leaders and public officials intensify efforts to improve the quality of care that Americans receive.

The new healthcare law that President Obama signed last year includes several initiatives to increase quality reporting by healthcare providers. Some of the data are already available to the public at a Department of Health and Human Services website.

But to date, there has been a lag in public use of online resources to compare providers and choose medical care.

Dr. Michael Painter, a senior program officer at the Robert Wood Johnson Foundation, said that may reflect the relative novelty of such databases.

Like many experts, Painter said the increased transparency can serve as a powerful tool for patients and medical providers. “If you don’t know about the quality of the care you receive, you can’t really improve it,” he said.

The foundation, which has funded several efforts nationwide to improve healthcare quality, excluded databases that do not rely on objective quality measurements or that charge a fee.

Not all of the databases are comprehensive, since some cover only providers that are participating in local quality reporting initiatives.

There are no state-level quality reports in Alabama, Alaska, Hawaii and Idaho.

PEACH Action Alert: Urge your Congressional Representatives to Prevent further Medicaid and Medicare Cuts

June 23, 2011

Memo To:         PEACH Board of Directors & Associates

From:               Catherine K. Douglas

Re:                   Contact Your Congress Members about Medicare & Medicaid Cuts Being Considered as Part of Deficit Reduction

As we have been reporting, the deficit reduction negotiations currently under way in Washington, DC, are clearly targeting additional Medicare and Medicaid reductions (among other things) as major tools to reduce federal spending. Once those talks conclude, a process of transforming them into legislation will begin with the goal of passing legislation by the time the federal government reaches its debt ceiling in early August.

Because of the threat this poses to private safety net hospitals whose primary patient base is dependent upon Medicare and Medicaid, PEACH has been communicating our concerns on a number of fronts including coordinating with AHA and CHA at the federal level to develop a united message, congressional strategy and PEACH specific meetings with our congressional delegation in late May, and numerous follow-up communications.

Yesterday our national affiliate, the National Association of Urban Hospitals (NAUH), contacted every member of congress to ask them to oppose any additional Medicare and Medicaid cuts that would impact private safety net hospitals or the care we provide our patients.  Today PEACH contacted every member of the California congressional delegation with the same message.  CHA has also issued a legislative alert to encourage the California hospital community to communicate with their representatives. Additionally, AHA will hold a congressional action day on July 13, 2011.   

While we encourage you to participate in the AHA/CHA congressional outreach program in Washington, DC, it is critical that you contact your congressional representatives as soon as possible. 

Action Requested:  

1)     Please personalize the attached sample e-mail and send it to both your House and Senate representatives.  

062311 Federal budget cuts sample email final

Please also send a copy of your e-mail to Kate Finkelstein at kate@debrunner.us to assist in PEACH’s follow up with congress members.  

For your assistance in personalizing the attached e-mail, we have also attached a list of estimated Medicare DSH cuts under the Affordable Care Act (ACA). Please contact Kate Finkelstein at kate@debrunner.us or 703-444-4091 with further questions.  

CA ACA Medicare DSH cuts complete PEACH Rpts May 2011

To find your congressional members’ contact information visit:  www.house.gov/writerep

2)     Please also follow up by calling or meeting with your congressional representatives in their district offices. 

House members will be in their districts next week (the week of June 27) and Senators will be back in California the week of July 4).  

Key Messages:

  • You understand that deficit reduction negotiators are talking about more Medicare and Medicaid cuts – cuts above and beyond those you’re already experiencing and the $150 billion hospital-specific reductions that are part of the ACA implementation. 
  • Elaborate on the ACA-related cuts you anticipate, such as Medicare DSH, Medicaid DSH, among other reductions, and how even this level of reduction is not sustainable without dire impacts to your service lines or your hospital viability.  (Include specific examples of the impact on your services, workforce, your hospital’s viability, etc.) 
  • As a result of the talks taking place in Washington, you are also greatly concerned about additional cuts, which may surface as: 

–         Additional Medicare DSH cuts

–         Additional Medicaid DSH cuts

–         Reductions in Medicare bad debt reimbursement

–         Limitations on the use of provider taxes 

  • These potential cuts combined with ongoing losses (such as charity care, Medi-Cal losses, etc.) – and others beyond what you are already experiencing and expecting as part of the ACA – would be detrimental to your community’s access to care and the essential services your hospital provides your entire community – the insured as well as the vulnerable, low-income patients who depend on your hospital. 
  • As members of congress consider ways to reduce future federal spending, urge your representatives to oppose any further cuts in Medicare and Medicaid payments to private safety net hospitals like yours that are a lifeline to essential care for millions of Californians. 

Please act as soon as you can.  This process will start unfolding very quickly and it is essential that your elected officials hear directly from you about the impact of such cuts on your hospital and your community. 

Thank you for your immediate action on this vital issue.

Los Angeles Times: Gov. Jerry Brown sees little progress on budget, but insists ‘I’m not giving up’

As legislative Democrats and Republicans heatedly trade blame for the impasse, Brown says he is still seeking the four GOP votes needed to extend taxes and set a fall referendum.

http://www.latimes.com/news/local/la-me-state-budget-20110624,0,465820,print.story

By Anthony York and Shane Goldmacher, Los Angeles Times

June 24, 2011

Reporting from San Francisco and Sacramento — Gov. Jerry Brown said Thursday he was increasingly skeptical that a tax deal could be struck before the July 1 beginning of the new fiscal year, as Democrats and Republicans heatedly blamed each other for the impasse.

Brown, who issued a historic veto of Democrats’ budget plan a week ago, told a gathering of about 250 apartment owners and developers in San Francisco that he continues to seek GOP support for his budget plan, which includes a tax referendum in the fall.

“I’m not giving up,” Brown said, even if he has grown less sanguine about the prospect of a legislative accord.

Although state Controller John Chiang this week invoked a new law to halt lawmakers’ pay until there’s a budget in place, the renewed commotion in the Capitol has produced little progress.

A critical sticking point is that Brown wants to extend sales and vehicle taxes — which Republicans oppose — until an election can be held. He needs the support of at least four GOP lawmakers for both moves. If he fails, the governor said, he will help gather signatures to place taxes on the ballot next year.

“It will take the use of the initiative, in all probability,” he said, to restore California’s financial health.

With talks slipping and time running out, Republicans held an unusual news conference outside the doors of the governor’s Capitol office to blame Brown and his labor supporters for the lack of progress.

“The public unions and the governor have become the problem in this, not the Republicans,” said Sen. Bob Huff (R-Diamond Bar).

The GOP lawmakers said Brown had failed to deliver sufficiently on the pension and spending policy concessions they have demanded in exchange for supporting an election.

“The reason that there is no budget deal is that the governor and the Democratic majority in the Legislature and their allies refuse to allow the voters the opportunity to reform pensions and control state overspending,” said Senate Minority Leader Bob Dutton (R-Rancho Cucamonga).

Brown retorted that Republicans have adopted “a rejectionist posture.”

The governor said Thursday he was willing to let the stalemate drag on for “the next few weeks.” If no deal is reached, he said, he will call for a budget with deeper spending cuts to make up for the lack of taxes.

Democrats indicated that they have already begun crafting another spending plan without Republican support — one they hope the governor won’t veto. Senate President Pro Tem Darrell Steinberg (D-Sacramento) acknowledged Thursday that such a plan would “have to include more cuts.”

Tensions in the Capitol have risen as lawmakers have contemplated a prolonged standoff without pay. The rank-and-file lose about $400 for each day past the June 15 budget deadline without a balanced spending plan.

Not everyone was complaining, though.

“I think the Legislature is getting paid exactly what it’s worth right now,” said Sen. Sam Blakeslee (R-San Luis Obispo).

Legislative Update – Institute of Medicine recommendations on Geographic Adjustments in Medicare Payments

Legislative Update – IOM Geographic Adjustment recommendations 06-02-2011

PEACH May 2011 Final Congressional Advocacy Program Fact Sheets and Position Papers

May 2011 PEACH Who We Are & Who We Serve

ACO-CMMI Position Paper May 2011 final

Medicare & Medicaid Cuts Position Paper May 2011 final

Medicare DSH Cuts Position Paper May 2011 final

Provider Fee Position Paper May 2011 final

The Sacramento Bee: No deal, but California lawmakers to begin voting on state budget

http://www.sacbee.com/2011/06/10/3690364/no-deal-but-california-lawmakers.html

By Kevin Yamamura

Published Friday, Jun. 10, 2011

Gov. Jerry Brown is still trying to close a bipartisan deal with Republicans to place taxes on the ballot and erase a remaining $9.6 billion deficit, but time is running out.

State lawmakers are staring at a Wednesday constitutional deadline to pass the budget. The full Senate is scheduled to debate today without a handshake deal in place.

We answer some common questions below:

Why does Brown need Republican votes? Didn’t we pass a measure allowing the majority party to approve the budget?

A two-thirds vote is still required to approve taxes, place taxes on the ballot and take money from redevelopment. Brown’s plan to bridge the remaining gap includes all of these items. Republicans say Democrats should solve the budget without more taxes. Democrats say they have already approved more than $10 billion in cuts to universities, health care and welfare.

Besides taxes, what are state leaders discussing?

Republicans are pushing for ballot measures that curtail pension benefits and restrict spending growth. They also want to change some environmental regulations. Democrats are open to these items in exchange for a short-term tax extension and a tax election.

Is an election required to pass taxes?

No. Lawmakers can do so with a two-thirds vote. But Brown promised last year he would not raise taxes without a vote of the people.

I keep hearing lawmakers won’t get paid. True?

Under voter-approved Proposition 25, lawmakers must send the governor a budget by June 15 to continue receiving pay and travel expenses. Controller John Chiang, who issues paychecks, said he will pay lawmakers only if they send the governor a balanced plan.

So if no bipartisan deal emerges by June 15, lawmakers won’t get paid?

They may still. Legislative Democrats could send the governor a balanced budget that relies on additional cuts and accounting maneuvers to eliminate the deficit.

That would meet the pay requirement, but it would risk a gubernatorial veto, given that Brown has said he will not sign a budget that relies on “gimmicks.” Even if Brown vetoes their budget, lawmakers get paid under Proposition 25.

This still seems early. Didn’t the budget impasse last until October last year?

Yes. But several factors make this June crucial.

Besides the new pay threat and majority-vote budget power, new legislative district maps today could push lawmakers one way or the other on the budget.

A recent U.S. Supreme Court ruling has pressured lawmakers to reduce the prison population. Democrats say their budget, with taxes to pay for county jail space, is the best way.

Meanwhile, time is short for Democrats to extend higher taxes on sales and vehicles. The higher rates expire June 30. Should that happen, it will be difficult for Democrats to reinstate higher rates. After June 30, the taxes more clearly become increases rather than extensions. An income tax surcharge that Brown wants to reinstate in 2012 has already expired.

Why does this matter?

Tax extensions fare better than tax increases among voters. Convincing voters to pass tax extensions in a special election will be difficult. Getting them to pass tax increases will be virtually impossible, according to polls.

That’s one reason Brown and Democrats want Republicans to pass a “tax bridge” that maintains the higher sales and vehicle rates until the election. Republicans say they will not do so.

How likely is another long stalemate?

Less likely than before. If Republicans block tax extensions, Democrats can pursue their own budget and stop negotiating with GOP lawmakers. The question then becomes what appetite Brown has for a budget with accounting tricks and deeper cuts.

How can they solve the budget without taxes?

It would require some combination of cuts and one-time solutions, often dubbed gimmicks. The more gimmicks you have, the fewer cuts required, and vice versa. Senate Democrats have said they would have to cut K-12 schools because they have already cut deeply elsewhere.

Assembly Republicans say the state can spare K-12 schools if it pursues other maneuvers like raiding First 5 and mental health accounts, cutting state worker compensation and contracting out to the private sector for services.

What does this mean for my child’s school?

Every district is different, but K-12 schools are on better footing, according to the nonpartisan Legislative Analyst’s Office. The state is projecting $6.6 billion in higher revenue based on early signs of income growth. That makes it less likely that lawmakers will cut deeply into K-12 schools.