Archive for the ‘California’ Category
AHL’s TOP STORY: Obama Administration Supports States’ Discretion To Set and Reduce Medicaid Reimbursement Rates
The Obama administration filed a brief yesterday supporting states’ discretion to reduce Medicaid reimbursement rates, the New York Times reports (Pear, New York Times, 2/25).
MEDICAID: Where Each State Stands on the Medicaid Expansion
Click for an interactive map featuring more information about the decisions by states on the Medicaid expansion and type of insurance exchange.
After the U.S. Supreme Court ruled that states can effectively opt out of the Affordable Care Act’s Medicaid expansion without any effect on current funding, state officials now must decide whether to comply. Since the ruling, many governors have made statements in the media and through their press offices indicating their plans about their participation.
American Health Line has compiled available information on where the governors stand. We’ll continue to update this list as information becomes available. Please send news or feedback to: ahleditorial@advisory.com. For details about specific states, click the link below to read the rest of this entry.
[Graphic last updated: May 13, 11:28 a.m. ET // Text last updated: May 17, 11:53 a.m. ET.]
AHL’s TOP STORY: Supreme Court Sends California Medicaid Lawsuit Back to Appellate Court
The Supreme Court yesterday declined to rule on a California lawsuit that could determine whether Medicaid beneficiaries and providers can sue states over reimbursement cuts, the Los Angeles Times reports (Savage/Megerian, Los Angeles Times, 2/23). The justices sent the case back to a lower appellate court, noting the complexity of the case and the fact that some circumstances have changed since it originally was filed (Doyle, Sacramento Bee, 2/23). Read the rest of this entry »
AHL’S TOP STORY: Federal Judge Issues Temporary Injunction on California Medicare Payment Cuts
U.S. District Court Judge Christina Snyder yesterday temporarily blocked a 10% cut to physician reimbursements through Medi-Cal, California’s Medicaid program, saying the cuts would cause “irreparable harm” to beneficiaries, the AP/Sacramento Bee reports (AP/Sacramento Bee, 1/30).
The cuts, which California Gov. Jerry Brown (D) signed last year, were part of the state’s strategy to alleviate its budget constraints (Mieszkowski, Bay Citizen, 1/31). Several California health care organizations filed a lawsuit challenging the payment cuts.
Die Another Day: Drug Shortage Delays Executions
The AP/USA Today reports on a shortage of drugs that are used for lethal injections in 35 states, which already has delayed some executions.
THE FRIDAY RUNDOWN: From the Left Coast to the East Coast and Everywhere in Between
The California Legislature and a Washington, D.C., district court could hardly be farther apart, but that’s where we’ll go to review this week’s biggest health policy stories. The Golden State became the nation’s first to pass legislation to enact the health care exchanges mandated under the federal health reform law. Meanwhile, a judge in the nation’s capitol temporarily banned federal funding for embryonic stem cell research, sending proponents and researchers scrambling for ways to overturn his decision.
Of course, there’s news from middle America — where a pair of farms in Iowa are linked to a salmonella outbreak that forced the FDA to admit it can’t safely oversee the nation’s food supply — and even chain restaurants, where patrons of places like Outback Steakhouse soon will see just how many calories are in that Bloomin’ Onion.
Here’s what you need to know about this week’s five key health policy stories.
CALIFORNIA EXCHANGIN’: The California state Legislature on Wednesday gave final approval to the second of two bills to establish the California Health Benefit Exchange, paving the way for California to become the first state in the nation to create a health insurance exchange under the federal health reform law. The exchanges, which are intended to provide coverage options for individuals and small businesses, are required to be fully operational by January 2011.
Earlier this week, the Legislature approved SB 900, which would set up the state’s insurance exchange to help consumers compare information about insurers before choosing a health plan. The second bill, AB 1602, would delineate the duties of the exchange.
Both measures now go to Gov. Arnold Schwarzenegger (R), who is expected to sign them into law. California’s health benefits exchange is likely to be the largest exchange operated by a single state, with as many as 8.3 million residents expected to be eligible for coverage.
NO FUNDING FOR YOU: U.S. District Court Judge Royce Lamberth on Monday issued a preliminary injunction against President Obama’s March 2009 executive order allowing federal funding for embryonic stem cell research. Lamberth’s ruling also temporarily blocks NIH from providing financial grants for the research under new guidelines by the Obama administration.
A March 2009 executive order by President Obama paved the way for NIH to issue new guidelines for assessing whether newly created embryonic stem cell lines could be used for federally funded research, as well as to clarify how old lines would be evaluated. In December 2009, NIH authorized the first 13 lines of embryonic stem cells under the new guidelines. Since then, a total of 75 stem cell colonies have been approved.
However, in his 15-page ruling, Lamberth said that the Obama administration’s policy to expand federal funding for embryonic stem cell research violated a 1996 law known as the Dickey-Wicker Amendment. Lamberth wrote, “As demonstrated by the plain language of the [1996 law], the unambiguous intent of Congress is to prohibit the expenditure of federal funds on ‘research in which a human embryo or embryos are destroyed.’”
Of course, that’s not the end of it. The Department of Justice on Tuesday said it would appeal the ruling. Obama administration officials warned that if the ruling is upheld, it could eliminate Obama’s executive order and more restrictive rules issued by President George W. Bush. As a result, the ruling could affect embryonic stem cell research and scientific projects exploring novel approaches to vaccines, viruses and other diseases, because cells used in those types of research often are derived from aborted fetuses or destroyed embryos.
Several lawmakers on Tuesday echoed the administration’s concerns and urged Congress to reconsider previously introduced legislation that would have codified ethical restrictions on stem cell research.
HIGHER EGGS-PECTATIONS FOR FDA: A Commissioner Margaret Hamburg on Monday said her agency lacks sufficient oversight authority to prevent salmonella outbreaks similar to the one that caused the recent recall of nearly 500 million eggs. According to Hamburg, FDA needs to be better equipped to implement preventive controls and hold companies accountable for failing to meet safety standards.
Lack of oversight has become increasingly problematic across the last several years as food industries have begun consolidating, a trend that has fostered a market populated with larger businesses that control a majority of the nation’s food supply.
Seeking to bolster FDA’s authority over food safety, the Obama administration in July passed the so-called “egg rule.” The rule requires egg producers to test for salmonella more frequently and take other precautions. However, while Hamburg said FDA is taking the egg recall “very, very seriously,” she urged Congress to pass broader food safety legislation, which would increase the frequency of inspection and allow FDA to issue recalls. Currently, private companies issue recalls voluntarily.
SIMPLIFYING PART D COULD COMPLICATE THINGS: Medicare rule changes intended to make it simpler for beneficiaries to pick prescription drug coverage could cause more than three million beneficiaries to change their plans in 2011, according to an analysis published this week by Avalere Health. When other changes are taken into account, as many as 3.7 million beneficiaries — 20% of the 17.5 million beneficiaries enrolled in stand-alone drug plans — might be forced to switch plans.
The rule changes are intended to decrease duplicative plans offered by the same insurer. Medicare already has notified insurers that they will no longer be permitted to offer more than one “basic” drug plan in a given region, a practice employed by several major prescription plans, including CVS-Caremark and AARP. Eliminating those duplicate plans would result in 2.75 million beneficiaries needing to find new coverage. Another new rule will require insurers that offer multiple enhanced coverage plans to show that they are different. In 2010, almost 1,600 plans were available, many of which lacked significant differences from each other, according to the analysis. Medicare is expected to release its list of drug plans for 2011 in late September. The options available in each state could drop from more than 40 per state to about 30.
Medicare officials disagreed with Avalere’s estimates.
MY BURGER HAS HOW MANY CALORIES?!?!: FDA on Tuesday released draft guidelines for a rule included in the federal health reform law that require restaurants with more than 20 locations and vending machine operators with more than 20 machines to prominently display calorie counts for food choices. The guidelines require calorie information in restaurants to be posted in the same size type as the menu item or price, depending on which is larger. Menus also must include a statement saying, “Additional nutrition information is available on request,” and restaurants will be responsible for providing such details if a customer asks.
FDA has until March 2011 to enforce the rules but the agency will delay implementation for an unspecified time to allow companies to make the necessary changes. FDA asked for public comments on how long it should delay enforcing the rules
By Anthony Wilson, Editor
TELL US WHAT YOU THINK: What will the U.S. courts ultimately rule on the embryonic stem cell issue? Will lawmakers step in to codify the rules for funding such research? What should FDA do to improve food safety? And just how many calories does the Bloomin’ Onion have? Let us know your answers on these questions or what you think about any health policy topics in the comments section below.
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What’s the most-important health care news of the day? Subscribers to First Look find out by 8:30 a.m. ET. Start every morning with First Look, American Health Line’s free roundup of the key policy, strategic and clinical developments shaping health care. See a sample issue or subscribe by clicking HERE.
EXCHANGES: California Legislature Approves Bills Creating Exchange Under Health Reform Law; State First To Do So
The California state Legislature on Wednesday gave final approval to the second of two bills to establish the California Health Benefit Exchange, paving the way for California to become the first state in the nation to create a health insurance exchange under the federal health reform law, the Wall Street Journal reports. The health reform law calls for the creation of insurance exchanges to provide coverage options for individuals and small businesses. The exchanges are required to be fully operational by January 2014 (Wilde Mathews, Wall Street Journal, 8/26).
Earlier this week, the Legislature approved SB 900, by Sen. Elaine Alquist (D-Santa Clara), which would set up the state’s insurance exchange to help consumers compare information about insurers before choosing a health plan. The second bill, AB 1602 by Assembly Speaker John Pérez (D-Los Angeles), would delineate the duties of the exchange (AP/Ventura County Star, 8/24). The Assembly voted 51-27 to approve AB 1602 (AP/San Jose Mercury News, 8/25).
Both measures now go to Gov. Arnold Schwarzenegger (R), who is expected to sign them. If Schwarzenegger signs the legislation, California would be the first state in the nation to establish a health insurance exchange under the reform law.
California’s Exchange To Be Nation’s Largest
California’s health benefits exchange is likely to be the largest exchange operated by a single state, with as many as 8.3 million residents expected to be eligible for coverage.
The exchange will provide consumers with a marketplace of insurance plans through a website that will provide standardized, detailed information about the plans and offer a toll-free number to help consumers understand their options.
The state’s exchange will offer health plans in five categories, ranging from catastrophic coverage for young adults to high-end plans with extensive benefits. The exchange also will provide resources to connect eligible Californians to federal subsidies for health coverage or government programs such as Medicaid. The state plans to authorize a new board to govern its insurance exchange and selectively contract with insurers.
Other States Working Toward Their Own Exchanges
Although California would be the first state to establish a health insurance exchange under the federal health reform law, both Utah and Massachusetts already have pre-existing insurance exchanges. Meanwhile, Iowa is in the process of creating a new information-only exchange (Wall Street Journal, 8/26).
– Ashley Marchand
What’s the most-important health care news of the day? Subscribers to First Look find out by 8:30 a.m. ET. Start every morning with First Look, American Health Line’s free roundup of the key policy, strategic and clinical developments shaping health care. See a sample issue or subscribe by clicking HERE.
MEDICAID: Paterson, Schwarzenegger Criticize Cost of Expansion
Govs. David Paterson (D-N.Y.) and Arnold Schwarzenegger (R-Calif.) have criticized the Senate health care bill (HR 3590) for its plan to expand Medicaid, saying it would create significant burdens for their states which already are in financial straits, Politico reports. The governors say the current bill penalizes states that already have expanded Medicaid coverage — which California and New York have done — by making them pay a disproportionately large share of the costs for expanding coverage in states that currently offer limited Medicaid programs.
Paterson said that New York, which already faces a $6.8 billion budget shortfall, would incur $1 billion in new costs under the proposal. In an opinion piece published in the Buffalo News on Dec. 25, Paterson wrote, “New York taxpayers are being used to pay for handouts to other states.” Similarly, New York City Mayor Michael Bloomberg (I) has called the Senate’s bill a “disgrace” and warned that it could cause several city health clinics to close if it is passed. In a letter to House Speaker Nancy Pelosi (D-Calif.), Schwarzenegger warned that reform legislation could add an additional $3 billion to $4 billion to California’s current $20.7 billion budget deficit.
According to Politico, the governors’ criticisms “are notable because they are distinct from the opposition to the health care bill voiced by many Republican governors,” because both Paterson and Schwarzenegger generally support President Obama’s domestic agenda and neither has opposed Democrats’ health reform efforts. A majority of New York’s congressional delegation supports Paterson’s stance and has asked congressional leaders to solve the Medicaid financing inequities, Politico reports. A spokesperson for Pelosi said the Speaker intends to address Schwarzenegger’s concerns in ongoing negotiations to merge the Senate with the House reform bill (HR 3962) (Isenstadt, Politico, 12/29/09).
– compiled by Zach Swiss
American Health Line’s State Roundup
Welcome to AHL‘s State Roundup, a weekly feature in which we recap news from around the nation.
In the past week, the legal system played a role in a state’s decision to close a dialysis facility, as well as determined how much charity chare a hospital must provide in order to qualify for federal tax exempt status. Also, states expanded coverage through legislation and decided against using stimulus money for a health festival. More after the jump.
In California, Gov. Arnold Schwarzenegger (R) signed a bill (AB 1422) that will maintain coverage for 700,000 children enrolled in Healthy Families, California’s CHIP. The bill, by Assembly Speaker Karen Bass (D-Los Angeles), will raise $196 million to help Healthy Families offset cuts from a July budget revision package. The new funds will allow the program to continue providing health insurance for about 670,000 children scheduled to lose coverage beginning Oct. 1. The bill also will allow Healthy Families to lift an enrollment freeze and begin processing applications to cover more than 80,000 waitlisted children.
Meanwhile, Fulton County, Ga., Superior Court Judge Ural Glanville on Friday ended a restraining order, allowing Grady Memorial Hospital in Atlanta to close its outpatient dialysis clinic. The clinic, which is estimated to lose $2 million in 2009, was the provider of last resort for many uninsured or undocumented immigrant patients. The hospital already had attempted to close the facility but was blocked by the courts. Grady will now close the clinic within one week but will pay for up to three months of dialysis treatments for the 51 patients who will be displaced. In addition, Grady officials said they will continue to help patients to find care in their home countries or in other states where they might qualify for Medicaid coverage.
The Illinois Supreme Court heard arguments regarding how much charity care a hospital must provide in order to receive tax-exempt status. The case began in 2003 when Provena Covenant Medical Center was stripped of its property tax exemption because a local tax board questioned if the hospital was providing enough no-cost care. The state Supreme Court will try to provide clarity on the procedures to which medical facilities in Illinois must adhere to qualify for tax breaks. The ruling could have implications for other not-for-profit hospitals, public officials responsible for tax policies and consumers who could face higher medical costs.
Officials in Baltimore said they will not use federal stimulus funding for the city’s “Fit Family Festival & Rally for Health Babies,” an event that aims to raise awareness of infant mortality, after the officials determined the spending would be inappropriate. The city intended to spend $17,828.50 in federal stimulus funding for the event, which is expected to cost a total of $40,000. The officials reversed their original decision after a newspaper reported on its original intent and said they now are now seeking private donations for the event.
The New York City Planning Commission unanimously approved a proposal that would allow the city to offer zoning and tax incentives to boost the development of full-service grocery stores that include fresh produce and other fresh foods. The proposal is part of a broader effort to fight high rates of diabetes and obesity in areas with high levels of poverty.
New York was busy, as North Shore-Long Island Jewish Health System announced plans to offer its 7,000 affiliated physicians up to $40,000 each in subsidies over five years to adopt electronic health records. The subsidies are in addition to federal support for EHRs, which can total up to $44,000 per physician over five years. The system has made a $400 million commitment to digitize patient records.
by Anthony Wilson, Associate Editor
American Health Line’s State Roundup
Welcome to AHL‘s State Roundup, a weekly feature in which we recap news from around the nation.
California yet again is grabbing most of the attention this week in state news. State Senate President Pro Tempore Darrell Steinberg (D) has announced that he plans to file a lawsuit against Gov. Arnold Schwarzenegger (R) because he said the governor abused his executive powers when he cut an additional $489 million from a budget revision package last month. The line-item vetoes sliced an additional $394 million from health and human services funding, which already faced major cuts under the budget revision package, Steinberg said. If lawsuits weren’t enough, the state’s Managed Risk Medical Insurance Board last week voted to begin disenrolling children from Healthy Families starting Oct. 1. Healthy Families is California’s CHIP. The move to begin dropping enrollees comes despite an announcement that Healthy Families would receive $81.4 million from the First 5 California Commission, which administers the proceeds of a state tobacco tax increase for early childhood health and education programs.
Low-income populations in Pennsylvania also got some bad news last week when Independence Blue Cross — the largest health insurer in the southeastern part of the state — will stop offering two plans, citing cutbacks in federal Medicare funding. The plans — Keystone 65 Complete and Keystone 65 Value — will not be available after Jan. 1, 2010, according to a letter sent to 36,000 subscribers in the two IBC programs. Keystone 65 Complete is a plan for elderly people who qualify for Medicaid, and Keystone 65 Value is designed for seniors with incomes just above the federal poverty line.
Approximately 200,000 people in Michigan might see their insurance premiums go up by about 22% following a tentative agreement between Blue Cross Blue Shield of Michigan and Attorney General Mike Cox (R). Although substantial, the 22% is far less than the 56% originally requested by BCBS. The agreement still needs to be approved by state regulators, and the rate increases would take effect Oct. 1 if the agreement is approved. BCBS and Cox were unable to reach an agreement about a proposed 31% rate increase that would affect 210,000 seniors with supplemental Medicare plans. A hearing before an administrative law judge is scheduled for Sept. 14.
Officials in Connecticut are hoping to address rate increases for individual insurance policies. State Attorney General Richard Blumenthal (D) and Kevin Lembo, the state’s health care advocate, have called for changes in how rate increases are approved for individual health insurance policies. They urged lawmakers to pursue health care reform that includes “reasonable” rate hikes rather than rates that are simply “not excessive,” as the current rule states. State Sen. Joe Crisco (D) and state Rep. Steve Fontana (D) said they would introduce a bill in the next legislative session that would consider affordability, require public hearings and allow officials to intervene. The bill also would require insurers to notify policyholders of all requests for rate hikes and dates of hearings, among other provisions. The comments came about one week after state regulators approved premium increases of up to 20% on individual plans from Anthem Blue Cross and Blue Shield.
Finally, an upturn for a state-run Medicaid program in Alaska. State officials announced that a program that helps the elderly and disabled with bathing, cleaning and meals in their homes can resume services after being closed since June. CMS closed the program because of health and safety concerns, and a review later found that the program was poorly managed. State officials said they must provide additional information to the federal government and then can restart collecting applications.
by Kim Lufkin, Contributing Editor
