Category Archives: News

SFMS Unveils New Website, Interactive Blog

SFMS now has a new presence on the Internet with the newly revamped www.sfms.org.

The new site features:

  • Physician finder tool and customizable physician page for each SFMS member
  • New Advocacy section that includes regional, state, and national updates on priority bills and key wins
  • More robust Membership section with full integration with SFMS’ member database to enable online application, renewal, event registration, and member information updates
  • Commenting capability on the newly integrated SFMS blog to promote two-way communication and better user engagement
  • Integration with Issuu to read San Francisco Medicine journal in e-magazine format

SFMS will be phasing out our blog on WordPress and posting new and pertinent health care news and events at the SFMS blog on our website, http://www.sfms.org/NewsPublication/SFMSBlog.aspx. Subscribers can also sign up for an RSS feed by visiting sfms.org and clicking on the “Get Aggregated RSS” link at the bottom of the page.

Essential Health Benefit Bill Clears Committee

Bill Monning, chair of the Assembly Committee on Health, knew the moment was a big one.

Monning introduced AB 1453, which laid out a plan for what essential benefits will be covered in California under the Affordable Care Act. The proposed set of benefits is modeled on the Kaiser small group HMO plan.

“This is one of the most important bills you will face this year,” Beth Capell of Health Access California told the committee.

The federal government requires states to choose essential benefits in 10 broad categories. In California, that process looked daunting because of the many health care mandates passed by the Legislature, including coverage of autism.

This package includes all current California mandates—including autism coverage—and everything in the package fits the federal profile as well, which means there would be no extra mandate costs to the state, Monning said.

The Kaiser small group plan covers reproductive services, acupuncture, prescription drugs and all of California’s current mandates, Monning said. “And best of all, it is affordable,” he said.

There was no stated opposition to the bill, but Nick Louizos of the California Association of Health Plans said his organization has some reservations about the bill. He was pleased, he said, to see the legislative discussion focus on selection of the benchmark plan.

The bill passed committee, and now heads to Appropriations.

Source: California Healthline, April 11, 2012.

HealthShare Bay Area Founding Members to Form Health Information Exchange

Eighteen Bay Area health care organizations will be founding members of the region’s first community health information exchange (HIE) program, HealthShare Bay Area (HSBA).

The founding 18:

  • Alameda-Contra Costa Medical Association
  • Alameda County Community Health Center Network
  • Alameda County Medical Center
  • Brown & Toland Physicians
  • California Pacific Medical Center
  • Glide Health Services
  • Haight Ashbury-Walden House
  • Hill Physicians Medical Group
  • John Muir Health
  • John Muir Physician Network
  • Lyon-Martin Health Services
  • Mission Neighborhood Health Center
  • North East Medical Services
  • St. Anthony Medical Clinic
  • San Francisco Department of Public Health
  • San Francisco Medical Society
  • South of Market Health Center
  • Women’s Community Clinic

The HealthShare Bay Area HIE will provide a secure, safe, and interoperable method for exchanging patient health information among providers of care and patients in the San Francisco Bay Area.

In the coming weeks, the founding members will form a governing board for the HIE. The board will then contract with a vendor that will provide the technical infrastructure for the exchange. The chosen technology will operate according to robust data privacy and security standards.

The governing board will also be tasked with securing additional funding for HSBA. The HIE’s four-year, $11 million startup and operating cost will come primarily from the founding members’ participation fees. Additional federal and private grants will be sought to supplement expenses as HSBA develops. New members joining the exchange in the coming months will provide additional revenue.

HealthShare Bay Area began as a grass-roots community initiative. In August of 2009, the California eHealth Collaborative brought together various San Francisco parties interested in creating a HIE within the city. This meeting was precipitated in large part by the passing of the American Reinvestment and Recovery Act (ARRA), which allocated $20 billion for the deployment of health information technology. The ARRA also calls for medical organizations to participate in HIEs.

In March of 2010, a governing committee was formed under the auspices of the San Francisco Medical Society Community Service Foundation. A similar movement was also underway in the East Bay – the Alameda-Contra Costa Health Information Organization, fostered by the Alameda-Contra Costa Medical Association. That fall, the San Francisco and East Bay groups joined forces. In April of 2011, the effort officially became HealthShare Bay Area.

California State Officials Consider Ways to Continue Health Reform

The Los Angeles Times reports California state officials are considering strategies for continuing health reform efforts if the U.S. Supreme Court strikes down the federal health reform law.

State lawmakers already have developed legislation to further implement the federal law, and the proposals could serve as a vehicle for statewide health reforms if the court strikes down the federal overhaul.

State health reform supporters say that lawmakers must enact an individual insurance mandate requiring all residents to purchase health coverage to spread risk and lower health costs.

Assembly member Bill Monning (D-Carmel)—chair of the state Assembly Health Committee—said he would support the individual mandate if federal funds still are available to support residents buying health insurance.

According to the Times, California nearly approved an individual mandate in 2008.

Meanwhile, health policy experts said California could consider other options to encourage healthy residents to join insurance pools. They said the state could impose an open enrollment period for health plans and incorporate penalties for people who sign up later.

California insurance industry representatives have said they will fight efforts to force insurers to accept sick residents without a requirement that healthy Californians participate in the market as well. Insurers said that premiums would rise substantially without healthy residents in the market, which could cause even more people to drop their coverage.

Source: California Healthline, April 2, 2012.

Supreme Court Concludes Hearings on Federal Health Reform Law Case

The U.S. Supreme Court concluded three days of oral arguments in the lawsuit challenging the federal health reform law yesterday.

Wednesday’s hearings consisted of a morning session on the severability of the law’s individual mandate and an afternoon session on the overhaul’s Medicaid expansion.

Audio and written transcripts of the morning session and the afternoon session are available from the Supreme Court’s website.

Wednesday’s afternoon session ended more than six hours of oral arguments over three days. The high court is expected to release its decision in late June (Bloomberg, 3/28).

Severability of Individual Mandate

In the morning session of Wednesday’s arguments, some of the justices seemed open to allowing the remainder of the overhaul to stand even if the individual mandate is deemed unconstitutional. Some observers noted that the justices’openness to allowing other provisions to stand could indicate that they have accepted that the individual mandate will be struck down.

According to AP, three liberal justices—Rth Bader Ginsburg, Elena Kagan,and Sonia Sotomayor—asked questions that intimated they believe the law can stand without the minimum coverage requirement. Meanwhile, Chief Justice John Roberts and Justice Antonin Scalia—both conservatives—also asked questions that suggest they were leaning the same way. Roberts noted that the law includes measures—such as a provision related to Native American health care—that are unrelated to the individual mandate.

Uncertainty Among Justices

While most of the justices seemed opposed to eliminating the entire law, they also “were clearly worried about the consequences if they pull out pieces of the law and that throws the rest of the health care system into chaos” (Gerstein/Budoff Brown, Politico, 3/28).

Ginsburg said that if portions of the overhaul needed to be changed as a result of the high court’s decision, “Congress can take care of it” rather than the courts. Kagan noted that it would represent a “revolution” for the court to guess which provisions Congress would have approved without the individual mandate.

Scalia said it is “totally unrealistic” for the court to comb through the 2,700 pages in the health reform law. “My approach would be to say that if you take the heart of the statute”—referring to the individual mandate—“the statute’s gone.”

Justice Anthony Kennedy, a likely swing vote, said it would be “more extreme” for the court to attempt to piece together the remaining parts of the overhaul. If they were to do that, “we would have a new regime that Congress did not order.”

Implications for California

The Kaiser Family Foundation has estimated that California could receive an additional $45 billion to $55 billion in federal funds between 2014 and 2019 if the reform law is upheld.

A friend of the court brief filed by California Attorney General Kamala Harris and attorneys general in 11 other states estimates that the law’s Medicaid expansion could extend health care to 11.2 million U.S. residents, including 1.9 million Californians.

Source: California Healthline, March 29, 2012.