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September 19, 2007

Health care becomes city's cause

As Democratic presidential candidates unveil proposals for universal or near-universal health care for all Americans, San Franciscans already are signing up for a new program that guarantees free or sliding-scale medical care to all uninsured adults.

The program provides a network of care to city residents, regardless of existing medical conditions, immigration status or ability to pay.

For Judy Rees, a 45-year-old part-time home health aide, the program, dubbed Healthy San Francisco, will coordinate treatment for her slipped discs, borderline diabetes and anxiety.

"I've never had insurance," she said as she read a Healthy San Francisco flier in the waiting room at Glide Health Services, a clinic in the impoverished Tenderloin district. "I'd never go to the doctor unless I was deadly sick."

"You never know what's going to happen," said Frederic Tarmis, 38, an uninsured bartender in the Glide waiting room who said he was eager to sign up for the program. "I try not to think about it."

Bill Henry, 63, a part-time gardener, said he'd been navigating the city's free health clinics and San Francisco General Hospital for years and wasn't sure he needed the plan. Then he added, "Once I went to General and didn't know where to ask and I ended up getting bills."

The plan began in pilot form in July. Expanding citywide this week, it is the first attempt by an American city to tackle the health-care crisis, with the assistance of state and federal funds. Unlike other universal health-care plans being proposed, Healthy San Francisco is not insurance -- because health coverage doesn't travel with the individual. Care is provided and paid for only at clinics and hospitals in San Francisco.

"What we're seeing here is the absence of real action at the federal level," said Ken Jacobs, chairman of the University of California, Berkeley, Center for Labor Research and Education. "It certainly sends the message that this is possible."

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Posted by healthinsurance at 04:23 PM | Comments (0)

September 16, 2007

The Health Insurance Enchilada

Given the desperate efforts of California's elected officials to stitch together a vibrant, functioning health insurance plan from the decaying parts of the current system, the surname of the California Medical Association's president-elect may be altogether fitting:

Dr. Frankenstein was one of an impressive group of medical muckety-mucks who gathered around Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Núñez on Friday at the California Hospital Medical Center in downtown Los Angeles.

It was basically a pep rally before the big game. The governor has called the Legislature into special session to try to do in a few weeks what it could not do in the past eight months, which is come up with health care reform that is both effective and politically palatable.

"When we started down this road last December," the governor said, "everyone said health care was too complicated to fix. They said we could never unite all the interest groups with a stake in the issue.

"But look who is standing with us today -- groups that were against us and against each other ... are now standing together for reform."

Despite the guv's upbeat tone, the fact is the state's health care system has actually taken a step or two backward since last December.

For one thing, there are more uninsured California residents. The most-cited estimate then was 6.5 million; now, according to U.S. census figures, it's closer to 6.7 million.

For another, programs in many counties that are designed to cover some of the estimated 800,000 California kids without health insurance are faltering. The programs, funded with money cobbled together from donations by hospitals and medical providers or do-good foundations, are starting to run out of dough.

Moreover, as part of his concessions to holdout Republican legislators during the budget fiasco, Schwarzenegger sliced $28.8 million from programs that would have expanded coverage to 94,000 children and provided grants to counties for kids' health programs.

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Posted by healthinsurance at 01:27 AM | Comments (0)

September 10, 2007

Small Calfornia Firms Struggle to Pay Health Costs

To understand why it is so hard to cover the uninsured in California, consider the case of Brookfields, a small chain of family style restaurants near the state capital.

Profits are low, and the owner, Sam Manolakas, says he cannot afford his workers' rising health care premiums. But since his waitresses, cooks and busboys earn so little, neither can they.

So, like low-wage workers across California and the nation, many of Manolakas' employees are dropping their coverage.

Now, reformers in Sacramento want to reverse this trend, which is a major reason why 6.8 million Californians had no insurance at some point last year.

Gov. Arnold Schwarzenegger says Brookfields' workers should be forced to buy health insurance on their modest wages. Democrats in the state Legislature say Manolakas should bear the burden. They are in intense negotiations to find a compromise in the waning days of the Legislative session.

But, experts say, neither approach has enough subsidies to help Manolakas and his workers afford these proposed mandates, given that medical costs are rising so much faster than inflation.

"Health care is still really expensive," said Marian Mulkey, an analyst with the California Health Care Foundation. "This is shifting the cost but not reducing the cost."

Shifting the cost, of course, is what Manolakas has been doing for years.

He says the insurance premiums for his 250 employees have been rising 10 percent to 20 percent a year, while his profit margin is 3 percent and falling. This year, it is about 1 percent.

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Posted by healthinsurance at 11:01 PM | Comments (0)

September 09, 2007

Despite High Cost, Small Business Says It Supports Universal Health Care

In a recent poll, more than half of small-business owners in California said they are in favor of contributing to a statewide pool that would offer affordable health care insurance for their employees.

Eighty percent of those surveyed also believe that businesses should provide their employees with health care, according to the survey released Aug. 24 by Small Business for Affordable Healthcare, a coalition of the Small Business Majority, a progressive nonprofit organization based in Sausalito.

The San Diego North Chamber of Commerce conducted its own survey to gauge how the local business community felt about Gov. Arnold Schwarzenegger’s health care reform proposal in preparation for his Aug. 31 visit.

Of the 112 people surveyed, 38 percent agreed that every resident in California should have health insurance and nearly 60 percent agreed to increase Medi-Cal reimbursements to doctors and hospitals, according to a statement from Gary Powers, chief executive officer of the chamber.

Under the governor’s plan, employers who have “10 or more employees would be required to spend 4 percent of Social Security wages on health care expenditures for employees or pay an equal amount to fund a statewide purchasing pool,” according to the California Hospital Association.

“It (the chamber survey) also showed that the majority of businesses should share the responsibility,” said Kamal Muilenburg, executive director of the San Diego Business Healthcare Connection. “We support the notion of health care’s shared responsibility.”

The nonprofit organization provides no-cost assistance for county businesses seeking health care.

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Posted by healthinsurance at 04:52 PM | Comments (0)

September 06, 2007

California, not Congress, is in driver's seat on health care

The number of Americans without insurance continues to rise, but Congress likely will let states and presidential candidates take the lead on health care reform for now.

The Census Bureau reported Aug. 28 that 47 million Americans lacked health insurance in 2006, up 2.2 million from 2005. Many of these uninsured Americans work for small businesses, so these firms will play a major role in any initiative to cover more people.

The health care issue facing Congress is whether to expand a government program covering children. Both the House and Senate have voted to make more children eligible for the State Children's Health Insurance Program, but they disagree on how to pay for it.

President Bush, meanwhile, favors modest expansion of SCHIP and has threatened to veto either bill. He says the legislation would be costly and encourage people to turn to the government instead of private insurers.

Once the SCHIP battle is resolved, Congress will have little time -- and probably little appetite -- for bigger health care reforms.

"What we're hoping for is a very small incremental piece that will get us some relief for a few years," said Amanda Austin, a lobbyist for the National Federation of Independent Business.

This could take the form of health care purchasing pools for small businesses -- a longtime priority for NFIB -- or tax breaks to help small employers afford insurance, she said.

The chairman of the Senate Finance Committee, Max Baucus, D-Mont., has said that he plans to put together a small business health care package this fall. But, Austin said, "I don't know when he'll have time to do it."

All eyes are on California, not Congress, in the health care reform fight.

Republican Gov. Arnold Schwarzenegger wants to require businesses to offer health insurance if they have 10 or more employees. Otherwise, they would have to pay 4 percent of their payroll into a state fund that would cover uninsured individuals. Doctors and hospitals also would have to pay new fees to help finance coverage for the uninsured. All would be required to have insurance.

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Posted by healthinsurance at 02:13 PM | Comments (0)

September 04, 2007

Children’s Health Coverage Seen at Risk

At a time when several states and both houses in Congress are pushing to expand a children’s health-insurance program partially financed by the federal government, the Bush administration’s new guidelines restricting enrollment have drawn criticism from school officials and health advocates, who warn that children will lose access to insured medical care.

The $25 billion-a-year State Children's Health Insurance Program, or SCHIP, is intended for children in families that earn too much to be eligible for Medicaid but may find it hard to afford private health insurance.

The U.S. Department of Health and Human Services, in an Aug. 17 letter, told states that they cannot enroll children from higher-income families—those with income above 250 percent of the federal poverty line—unless the states can prove that 95 percent of their poorest children are already covered through Medicaid or SCHIP.

Though the letter is described as clarifying existing regulations, some state officials see it as new policy and an attempt to circumvent the efforts by states and Congress to expand the program. The 95 percent enrollment target for the state’s poorest children is impossible to meet, they contend.

As a result, many children will remain uninsured, school health officials argue—and that could affect schools by weakening student preparedness for learning and increasing the need for services.

“The more kids that are covered, the more kids are likely to come to school without chronic health-care problems and ready to learn,” said Bruce Hunter, the associate executive director for public policy for the Arlington, Va.-based American Association of School Administrators, whose organization supports the congressional proposals to expand SCHIP coverage.

Without insurance of their own, many families also come to rely on schools for services, said Donna Mazyck, the president of the National Association of School Nurses, based in Silver Spring, Md. “School nurses are sometimes the only health-care provider a student regularly sees,” she said. “We definitely see the importance of students’ having a regular primary- care provider.”

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Posted by healthinsurance at 12:02 PM | Comments (0)