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.

The Future of Universal Health Care: Is San Francisco Leading the Way?

Four years ago, the city of San Francisco launched Healthy San Francisco, a pioneering plan to bring universal health care to residents through a network of community clinics and hospitals. SFMS has been a long supporter of the program and even participated in legal defenses to preserve this plan.

In an election year in which health reform is on the political front burner, what lessons can the nation learn from San Francisco’s experiment? Will preventive care save or cost more money in the long run? What are the potential long-term policy implications for patients and health care providers? What other cities might have the answers?

Listen to diverse perspectives from a distinguished panel of public health planners, care providers, patients and journalists—and share your own health care experiences.

Wednesday, February 29, 2012

5:00pm – 6:30 pm

Glide Health Services

330 Ellis Street (Freedom Hall), San Francisco, CA 94102

 

• Moderator: Barbara Grady, reporter, San Francisco Public Press
• Tangerine Brigham, director, Healthy San Francisco program
• William Dow, researcher, UC Berkeley School of Public Health
• Pat Dennehy, director, Glide Health Services
• Karen Hill, clinic manager Glide Health Services
• Abbie Yant, vice president of Mission, Advocacy and Community Health at Saint Francis Memorial Hospital… and a Healthy S.F. patient

Admission is free to the community. Healthy snacks and beverages will be provided. The facility is wheelchair accessible.

Click here for more information.

This event is sponsored by The San Francisco Public Press, Glide Foundation, Glide Health Services, UC Berkeley of Public Health.

Value-Based Insurance Design

“Value” is gaining clout in the health care industry.

The Patient Protection and Affordable Care Act is set to test whether value-based insurance design (VIBD) can be a viable tool for aligning out-of-pocket costs and the value of medical services.

National reform will further encourage value-based insurance design in 2014, when it allows employers to reimburse employees up to 30% of health insurance costs if workers meet health and wellness goals. The current reimbursement rate is 20%.

“As we move away from a one-size-fits-all, cost-sharing model to VBID, we are removing barriers to accessing high-value care and at times, creating disincentives to deter care of little value,” said A. Mark Fendrick, director of the Center for Value-Based Insurance Design at the University of Michigan.

Value-based insurance adjusts out-of-pocket costs based on an assessment of the clinical benefit value—not simply the cost—to a specific patient population. Simply put, value equals the clinical benefit achieved for the money spent.

The Pacific Business Group on Health, an employer purchasing coalition based in San Francisco, takes a broader approach to value-based insurance design. Moving beyond just copayment or coinsurance reductions, the model should include shared decision-making, network design, incentive design and disease management, said PBGH Director Emma Hoo.

VBID Makes Inroads

In California, Blue Shield of California and SeeChange Health are working on value-based plans with options that offer members a chance to put money back in their pockets by engaging in healthy behaviors.

Two other California-based entities—CalPERS and Safeway—have introduced “reference pricing,” which establishes a standard price for a medication, procedure or service and requires members to pay any charges beyond the price.

Blue Shield Develops Three-Tiered Plan

Blue Shield of California developed Blue Groove, a three-tiered, value-based program for large employer groups to be piloted in the Sacramento area beginning in 2012. Participants will use the services of Hill Physicians.

The three levels—basic, main, and care+ groove—provide a range of health and wellness benefits, opportunities to earn incentives and lower out-of-pocket payments.

Participants who achieve healthy parameters can earn up to $500 in cash deposited into a health reimbursement account and/or receive a discount on premiums. They must comply with evidence-based protocols outlined in a customized care plan.

Blue Shield anticipates Blue Groove will reduce the premium for employers by 10% to 15% in the first year and significantly improve members’ health.

Blue Groove builds on the infrastructure of the plan’s successful two-year, accountable care organization pilot with the CalPERS.

Source: California Healthline, January 9, 2012.

Quick (and fun!) Summary About Health Reform and the Affordable Care Act

Confused about how the new health reform law really works? This short, animated movie — featuring the “YouToons” — explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014.