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A native of St. Louis, Feibel attended Cornell University, and earned a master's in journalism from Columbia University.","avatar":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twitter":"KQEDHealth","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"stateofhealth","roles":["administrator"]}],"headData":{"title":"Carrie Feibel | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/cfeibel"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_362850":{"type":"posts","id":"stateofhealth_362850","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362850","score":null,"sort":[1520240430000]},"guestAuthors":[],"slug":"to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing","title":"To Screen or Not to Screen? Doctors Debate Post Partum Depression Testing","publishDate":1520240430,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Lawmakers will begin debate next month on a bill that would require doctors to screen new moms for mental health problems – once while they’re pregnant and again, after giving birth.\u003c/p>\n\u003cp>But a lot of doctors don’t like the idea. Many obstetricians and pediatricians are afraid to screen new moms for depression and anxiety.\u003c/p>\n\u003cp>“What are you going to do with those people who screen positive?” said Laura Sirott, an OB/GYN who practices in Pasadena. “Some providers have nowhere to send them.”\u003c/p>\n\u003cp>Of women who screen positive for postpartum depression, 78 percent don’t get mental health treatment, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618720/\" target=\"_blank\" rel=\"noopener\">2015 study review\u003c/a> published in the journal \u003cem>Obstetrics & Gynecology\u003c/em>. Dr. Sirott’s patients have told her the range of reasons why they don’t take her up on a referral to a psychologist.\u003c/p>\n\u003cp>“Oh, they don’t take my insurance. Or my insurance pays for three visits. I can’t take time off of work to go to those visits. It’s a three-month wait to get in to that person,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And, it’s hard to find a psychiatrist who is trained in the complexities of prescribing medications to pregnant or breastfeeding women, and who is willing to treat them, especially in rural areas.\u003c/p>\n\u003cp>“So it’s very frustrating to ask patients about a problem and then not have any way to solve that problem,” Sirott said.\u003c/p>\n\u003cp>But moms are frustrated, too. After the baby comes, no one asks about them anymore. Wendy Root Askew struggled for years to get pregnant, and when she finally did, her anxiety got worse. She couldn’t stop worrying that something would go wrong.\u003c/p>\n\u003cp>“And then after I had my son, I would have these dreams where someone would come to the door and they would say ‘Well, you know, we’re just going to wait two weeks to see if you get to keep your baby or not,’” she said. “And it really impacted my ability to bond with him.”\u003c/p>\n\u003cp>She likes the bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB2193\" target=\"_blank\" rel=\"noopener\">AB 2193\u003c/a>, because it goes beyond mandated screening. It requires health insurance companies to set up case management programs to help moms find a therapist, and to connect obstetricians or pediatricians with a psychiatric expert.\u003c/p>\n\u003cp>“Just like we have case management programs for patients who have diabetes or sleep issues or back pain, a case management program requires the insurance company to take some ownership of making sure their patients are getting the treatment they need to be healthy,” said Root Askew, who is now advocating for the bill on behalf of the group \u003ca href=\"https://www.2020mom.org/\" target=\"_blank\" rel=\"noopener\">2020 Mom\u003c/a>.\u003c/p>\n\u003cp>Health insurance companies haven’t taken a position on the legislation. It’s unclear how much it will cost them to comply, because some already have infrastructure in place for case management programs and some don’t. But there is consensus among insurers and health advocates that such programs save money in the long run.\u003c/p>\n\u003cp>“The sooner that you can get good treatment for a mom, the less expensive that condition will be to manage over the course of the woman’s life and over the course of that child’s life,” Root Askew said.\u003c/p>\n\u003cp>Doctors still have their objections. Under the bill, they could be disciplined for not screening. And screening takes time. Sometimes a doctor asks a mom how she’s sleeping, and she’s in tears for the next 30 minutes.\u003c/p>\n\u003cp>The health care system, and the incentives, aren’t set up for this, said Dr. Sirott.\u003c/p>\n\u003cp>“Currently, I get six dollars for screening a patient,” she said. “By the time I put it on a piece of paper and print it, it’s not worth it.”\u003c/p>\n\u003cp>And it’s not clear it’s worth it to the patients either. Four other states – Illinois, Massachusetts, New Jersey, and West Virginia – have tried mandated screening, and it made no difference in patient outcomes, according to \u003ca href=\"https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201300505?code=ps-site\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> published in \u003cem>Psychiatric Services\u003c/em> in 2015.\u003c/p>\n\u003cp>Even with California’s extra requirements on insurance companies to facilitate care, women could still face high co-pays or limits on therapy sessions. Or, they’re so overwhelmed caring for a newborn, they never leave the house.\u003c/p>\n\u003cp>What does seem to work, according to the study, is when nurses or mental health providers visit new moms at home.\u003c/p>\n\u003cp>“Despite abundant good will, there is no evidence that state policies are addressing this great need,” the study authors wrote.\u003c/p>\n\u003cp>But supporters of the proposed bill say doctors need to start somewhere. Screening is the first step in recognizing the full scope of the problem, said Mountain View psychiatrist \u003ca href=\"https://www.elcaminohospital.org/doctors/nirmaljit-dhami\" target=\"_blank\" rel=\"noopener\">Nirmaljit Dhami\u003c/a>, adding that women should be screened on an ongoing basis throughout pregnancy and for a year after birth, not just once or twice as the bill requires.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I often tell doctors that if you don't know that somebody is suicidal it doesn't mean that their suicidality will go away,” she said. “If you don't ask, the risk is the same.”\u003c/p>\n\n","blocks":[],"excerpt":"A proposed bill would require doctors to screen new moms for depression, and require health insurers to help them get care.","status":"publish","parent":0,"modified":1521474114,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":891},"headData":{"title":"To Screen or Not to Screen? Doctors Debate Post Partum Depression Testing | KQED","description":"A proposed bill would require doctors to screen new moms for depression, and require health insurers to help them get care.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"To Screen or Not to Screen? Doctors Debate Post Partum Depression Testing","datePublished":"2018-03-05T09:00:30.000Z","dateModified":"2018-03-19T15:41:54.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"362850 https://ww2.kqed.org/stateofhealth/?p=362850","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/03/05/to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing/","disqusTitle":"To Screen or Not to Screen? Doctors Debate Post Partum Depression Testing","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/03/MandatedPostPartumScreeningDembosky.mp3","path":"/stateofhealth/362850/to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lawmakers will begin debate next month on a bill that would require doctors to screen new moms for mental health problems – once while they’re pregnant and again, after giving birth.\u003c/p>\n\u003cp>But a lot of doctors don’t like the idea. Many obstetricians and pediatricians are afraid to screen new moms for depression and anxiety.\u003c/p>\n\u003cp>“What are you going to do with those people who screen positive?” said Laura Sirott, an OB/GYN who practices in Pasadena. “Some providers have nowhere to send them.”\u003c/p>\n\u003cp>Of women who screen positive for postpartum depression, 78 percent don’t get mental health treatment, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618720/\" target=\"_blank\" rel=\"noopener\">2015 study review\u003c/a> published in the journal \u003cem>Obstetrics & Gynecology\u003c/em>. Dr. Sirott’s patients have told her the range of reasons why they don’t take her up on a referral to a psychologist.\u003c/p>\n\u003cp>“Oh, they don’t take my insurance. Or my insurance pays for three visits. I can’t take time off of work to go to those visits. It’s a three-month wait to get in to that person,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And, it’s hard to find a psychiatrist who is trained in the complexities of prescribing medications to pregnant or breastfeeding women, and who is willing to treat them, especially in rural areas.\u003c/p>\n\u003cp>“So it’s very frustrating to ask patients about a problem and then not have any way to solve that problem,” Sirott said.\u003c/p>\n\u003cp>But moms are frustrated, too. After the baby comes, no one asks about them anymore. Wendy Root Askew struggled for years to get pregnant, and when she finally did, her anxiety got worse. She couldn’t stop worrying that something would go wrong.\u003c/p>\n\u003cp>“And then after I had my son, I would have these dreams where someone would come to the door and they would say ‘Well, you know, we’re just going to wait two weeks to see if you get to keep your baby or not,’” she said. “And it really impacted my ability to bond with him.”\u003c/p>\n\u003cp>She likes the bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB2193\" target=\"_blank\" rel=\"noopener\">AB 2193\u003c/a>, because it goes beyond mandated screening. It requires health insurance companies to set up case management programs to help moms find a therapist, and to connect obstetricians or pediatricians with a psychiatric expert.\u003c/p>\n\u003cp>“Just like we have case management programs for patients who have diabetes or sleep issues or back pain, a case management program requires the insurance company to take some ownership of making sure their patients are getting the treatment they need to be healthy,” said Root Askew, who is now advocating for the bill on behalf of the group \u003ca href=\"https://www.2020mom.org/\" target=\"_blank\" rel=\"noopener\">2020 Mom\u003c/a>.\u003c/p>\n\u003cp>Health insurance companies haven’t taken a position on the legislation. It’s unclear how much it will cost them to comply, because some already have infrastructure in place for case management programs and some don’t. But there is consensus among insurers and health advocates that such programs save money in the long run.\u003c/p>\n\u003cp>“The sooner that you can get good treatment for a mom, the less expensive that condition will be to manage over the course of the woman’s life and over the course of that child’s life,” Root Askew said.\u003c/p>\n\u003cp>Doctors still have their objections. Under the bill, they could be disciplined for not screening. And screening takes time. Sometimes a doctor asks a mom how she’s sleeping, and she’s in tears for the next 30 minutes.\u003c/p>\n\u003cp>The health care system, and the incentives, aren’t set up for this, said Dr. Sirott.\u003c/p>\n\u003cp>“Currently, I get six dollars for screening a patient,” she said. “By the time I put it on a piece of paper and print it, it’s not worth it.”\u003c/p>\n\u003cp>And it’s not clear it’s worth it to the patients either. Four other states – Illinois, Massachusetts, New Jersey, and West Virginia – have tried mandated screening, and it made no difference in patient outcomes, according to \u003ca href=\"https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201300505?code=ps-site\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> published in \u003cem>Psychiatric Services\u003c/em> in 2015.\u003c/p>\n\u003cp>Even with California’s extra requirements on insurance companies to facilitate care, women could still face high co-pays or limits on therapy sessions. Or, they’re so overwhelmed caring for a newborn, they never leave the house.\u003c/p>\n\u003cp>What does seem to work, according to the study, is when nurses or mental health providers visit new moms at home.\u003c/p>\n\u003cp>“Despite abundant good will, there is no evidence that state policies are addressing this great need,” the study authors wrote.\u003c/p>\n\u003cp>But supporters of the proposed bill say doctors need to start somewhere. Screening is the first step in recognizing the full scope of the problem, said Mountain View psychiatrist \u003ca href=\"https://www.elcaminohospital.org/doctors/nirmaljit-dhami\" target=\"_blank\" rel=\"noopener\">Nirmaljit Dhami\u003c/a>, adding that women should be screened on an ongoing basis throughout pregnancy and for a year after birth, not just once or twice as the bill requires.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I often tell doctors that if you don't know that somebody is suicidal it doesn't mean that their suicidality will go away,” she said. “If you don't ask, the risk is the same.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362850/to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing","authors":["3205"],"categories":["stateofhealth_2442","stateofhealth_3012","stateofhealth_14"],"tags":["stateofhealth_3067","stateofhealth_2582","stateofhealth_2947","stateofhealth_2808","stateofhealth_28","stateofhealth_3229","stateofhealth_3212","stateofhealth_68","stateofhealth_3230","stateofhealth_2519","stateofhealth_3228"],"featImg":"stateofhealth_362852","label":"stateofhealth"},"stateofhealth_362035":{"type":"posts","id":"stateofhealth_362035","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362035","score":null,"sort":[1511212646000]},"guestAuthors":[],"slug":"health-giant-sutter-destroys-evidence-in-crucial-antitrust-case-over-high-prices","title":"Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices","publishDate":1511212646,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.\u003c/p>\n\u003cp>In a \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">ruling this week\u003c/a>, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”\u003c/p>\n\u003cp>Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.\u003c/p>\n\u003cp>Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.\u003c/p>\n\u003cp>Employers and policymakers across the country are closely watching this legal fight amid growing concern about the financial implications of industry consolidation. Large health systems are gaining market clout and the ability to raise prices by acquiring more hospitals, outpatient surgery centers and physician offices.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s stunning what Sutter did to cover up incriminating documents in this case,” said Richard Grossman, the lead plaintiffs’ lawyer representing a class of more than 1,500 employer-funded health plans.\u003c/p>\n\u003cp>In April 2014, a grocery workers’ health plan sued Sutter and alleged it was violating antitrust and unfair competition laws. The plaintiffs began requesting documents related to contracting practices, such as “gag clauses” that prevent patients from seeing negotiated rates and choosing a cheaper provider and “all-or-nothing” terms that require every facility in a health system to be included in insurance networks \u003c/p>\n\u003cp>Sutter disputes the broader allegations in the lawsuit over its market conduct and said its charges are in line with its competitors’.\u003c/p>\n\u003cp>The judge said that in 2015 \u003ca href=\"https://www.youtube.com/watch?v=hLtEtJgW7no\">Melissa Brendt\u003c/a>, Sutter’s chief contracting officer in the managed-care department, and an assistant general counsel, Daniela Almeida, authorized Brendt’s executive assistant to destroy 10 years’ worth of managed-care documents going back to 1995. The company earlier had scheduled the documents to be destroyed in 2035 — 20 years later.\u003c/p>\n\u003cp>The executive assistant, Sina Santagata, testified in a deposition she wasn’t aware of any other time in her 17 years at Sutter when the managed-care department destroyed records held in storage.\u003c/p>\n\u003cp>In his \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">Nov. 13 ruling\u003c/a> against Sutter, the judge singled out an email by Santagata as “particularly noteworthy.”\u003c/p>\n\u003cp>The executive assistant emailed Brendt, the chief contracting officer, on July 30, 2015, after sending the order to destroy the records. She wrote, “I’ve pushed the button … if someone is in need of a box between 3/15/95 & 11/23/05 … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.”\u003c/p>\n\u003cp>The Federal Trade Commission (FTC) enforces antitrust laws in health care to prevent hospitals, drugmakers and other industry players from engaging in anti-competitive behavior that could harm consumers.\u003c/p>\n\u003cp>Santagata testified that she was being “sarcastic” in her email, and Sutter told the judge that the FTC reference was just a “joke.”\u003c/p>\n\u003cp>Karnow saw no humor in it. “There are infinite topics for jokes, and the choice of this one is strong evidence” in the plaintiffs’ favor, he wrote in his order Monday.\u003c/p>\n\u003cp>As part of his sanctions against Sutter, the judge ordered the health system to examine \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/plaintiffs-motion-for-sutter-sanctions.pdf\">email\u003c/a> backup tapes covering 2002 through 2005 to search for documents on some of the same topics as the destroyed records. Also, Karnow said he will consider a plaintiffs’ motion for issuing jury instructions that are adverse to Sutter in light of the document destruction. The trial is scheduled for June 2019.\u003c/p>\n\u003cp>“The record shows that Sutter’s conduct was more than just an inadvertent error,” Karnow wrote.\u003c/p>\n\u003cp>Sutter spokeswoman Karen Garner said the incident was a “mistake made as part of a routine destruction of old paper records” and the Sacramento-based health system disclosed the error as soon as it was discovered.\u003c/p>\n\u003cp>“We regret that as part of a routine archiving process we failed to preserve some boxes of decades-old hard-copy documents,” Garner said.\u003c/p>\n\u003cp>The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014. The joint employer-union health plan represents more than 60,000 employees, dependents and retirees. The court certified the case as a class action in August, allowing hundreds of other employers and self-funded health plans to potentially benefit from the litigation.\u003c/p>\n\u003cp>In addition to its 24 hospitals, Sutter’s nonprofit health system has 35 surgery centers and more than 5,000 physicians in its network. It reported $11.9 billion in revenue last year and income of $554 million.\u003c/p>\n\u003cp>Grossman, the plaintiffs’ counsel, said he welcomed the judge’s ruling. But he said much of the evidence is irreplaceable, particularly handwritten notes from negotiating sessions and meetings involving key Sutter executives.\u003c/p>\n\u003cp>He said those records covered a critical period in the early 2000s when there was a “sea change in Sutter’s contracting strategy” and it implemented provisions that insulated the health system from price competition.\u003c/p>\n\u003cp>“This was groundbreaking in the industry,” Grossman said. “Until we address the anti-competitive behavior of entities like Sutter, we will not solve the problem of high costs in health care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The plaintiffs are seeking to recover hundreds of millions of dollars from Sutter from what it claims are illegally inflated prices. The lawsuit alleges that an overnight hospital stay at Sutter hospitals in San Francisco or Sacramento costs at least 38 percent more than a comparable stay in the more competitive Los Angeles market.\u003c/p>\n\n","blocks":[],"excerpt":"\"Fingers crossed,\" a staffer wrote after destroying the documents. Sutter, which owns 24 hospitals, says the destruction was a mistake.","status":"publish","parent":0,"modified":1511212646,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1018},"headData":{"title":"Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices | KQED","description":""Fingers crossed," a staffer wrote after destroying the documents. Sutter, which owns 24 hospitals, says the destruction was a mistake.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices","datePublished":"2017-11-20T21:17:26.000Z","dateModified":"2017-11-20T21:17:26.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"362035 https://ww2.kqed.org/stateofhealth/?p=362035","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/11/20/health-giant-sutter-destroys-evidence-in-crucial-antitrust-case-over-high-prices/","disqusTitle":"Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices","nprByline":"\u003cb>Chad Terhune\u003c/b>, Kaiser Health News","path":"/stateofhealth/362035/health-giant-sutter-destroys-evidence-in-crucial-antitrust-case-over-high-prices","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.\u003c/p>\n\u003cp>In a \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">ruling this week\u003c/a>, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”\u003c/p>\n\u003cp>Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.\u003c/p>\n\u003cp>Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.\u003c/p>\n\u003cp>Employers and policymakers across the country are closely watching this legal fight amid growing concern about the financial implications of industry consolidation. Large health systems are gaining market clout and the ability to raise prices by acquiring more hospitals, outpatient surgery centers and physician offices.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s stunning what Sutter did to cover up incriminating documents in this case,” said Richard Grossman, the lead plaintiffs’ lawyer representing a class of more than 1,500 employer-funded health plans.\u003c/p>\n\u003cp>In April 2014, a grocery workers’ health plan sued Sutter and alleged it was violating antitrust and unfair competition laws. The plaintiffs began requesting documents related to contracting practices, such as “gag clauses” that prevent patients from seeing negotiated rates and choosing a cheaper provider and “all-or-nothing” terms that require every facility in a health system to be included in insurance networks \u003c/p>\n\u003cp>Sutter disputes the broader allegations in the lawsuit over its market conduct and said its charges are in line with its competitors’.\u003c/p>\n\u003cp>The judge said that in 2015 \u003ca href=\"https://www.youtube.com/watch?v=hLtEtJgW7no\">Melissa Brendt\u003c/a>, Sutter’s chief contracting officer in the managed-care department, and an assistant general counsel, Daniela Almeida, authorized Brendt’s executive assistant to destroy 10 years’ worth of managed-care documents going back to 1995. The company earlier had scheduled the documents to be destroyed in 2035 — 20 years later.\u003c/p>\n\u003cp>The executive assistant, Sina Santagata, testified in a deposition she wasn’t aware of any other time in her 17 years at Sutter when the managed-care department destroyed records held in storage.\u003c/p>\n\u003cp>In his \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">Nov. 13 ruling\u003c/a> against Sutter, the judge singled out an email by Santagata as “particularly noteworthy.”\u003c/p>\n\u003cp>The executive assistant emailed Brendt, the chief contracting officer, on July 30, 2015, after sending the order to destroy the records. She wrote, “I’ve pushed the button … if someone is in need of a box between 3/15/95 & 11/23/05 … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.”\u003c/p>\n\u003cp>The Federal Trade Commission (FTC) enforces antitrust laws in health care to prevent hospitals, drugmakers and other industry players from engaging in anti-competitive behavior that could harm consumers.\u003c/p>\n\u003cp>Santagata testified that she was being “sarcastic” in her email, and Sutter told the judge that the FTC reference was just a “joke.”\u003c/p>\n\u003cp>Karnow saw no humor in it. “There are infinite topics for jokes, and the choice of this one is strong evidence” in the plaintiffs’ favor, he wrote in his order Monday.\u003c/p>\n\u003cp>As part of his sanctions against Sutter, the judge ordered the health system to examine \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/plaintiffs-motion-for-sutter-sanctions.pdf\">email\u003c/a> backup tapes covering 2002 through 2005 to search for documents on some of the same topics as the destroyed records. Also, Karnow said he will consider a plaintiffs’ motion for issuing jury instructions that are adverse to Sutter in light of the document destruction. The trial is scheduled for June 2019.\u003c/p>\n\u003cp>“The record shows that Sutter’s conduct was more than just an inadvertent error,” Karnow wrote.\u003c/p>\n\u003cp>Sutter spokeswoman Karen Garner said the incident was a “mistake made as part of a routine destruction of old paper records” and the Sacramento-based health system disclosed the error as soon as it was discovered.\u003c/p>\n\u003cp>“We regret that as part of a routine archiving process we failed to preserve some boxes of decades-old hard-copy documents,” Garner said.\u003c/p>\n\u003cp>The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014. The joint employer-union health plan represents more than 60,000 employees, dependents and retirees. The court certified the case as a class action in August, allowing hundreds of other employers and self-funded health plans to potentially benefit from the litigation.\u003c/p>\n\u003cp>In addition to its 24 hospitals, Sutter’s nonprofit health system has 35 surgery centers and more than 5,000 physicians in its network. It reported $11.9 billion in revenue last year and income of $554 million.\u003c/p>\n\u003cp>Grossman, the plaintiffs’ counsel, said he welcomed the judge’s ruling. But he said much of the evidence is irreplaceable, particularly handwritten notes from negotiating sessions and meetings involving key Sutter executives.\u003c/p>\n\u003cp>He said those records covered a critical period in the early 2000s when there was a “sea change in Sutter’s contracting strategy” and it implemented provisions that insulated the health system from price competition.\u003c/p>\n\u003cp>“This was groundbreaking in the industry,” Grossman said. “Until we address the anti-competitive behavior of entities like Sutter, we will not solve the problem of high costs in health care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The plaintiffs are seeking to recover hundreds of millions of dollars from Sutter from what it claims are illegally inflated prices. The lawsuit alleges that an overnight hospital stay at Sutter hospitals in San Francisco or Sacramento costs at least 38 percent more than a comparable stay in the more competitive Los Angeles market.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362035/health-giant-sutter-destroys-evidence-in-crucial-antitrust-case-over-high-prices","authors":["byline_stateofhealth_362035"],"categories":["stateofhealth_2442","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_3201","stateofhealth_2808","stateofhealth_28","stateofhealth_2519","stateofhealth_3200"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_169744","label":"stateofhealth_3007"},"stateofhealth_360417":{"type":"posts","id":"stateofhealth_360417","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360417","score":null,"sort":[1501719537000]},"guestAuthors":[],"slug":"feinstein-deeply-concerned-with-anthem-rollback-of-coverage","title":"Feinstein 'Deeply Concerned' With Anthem Rollback of Coverage","publishDate":1501719537,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>California Senator Diane Feinstein said Wednesday that she was \"deeply concerned\" by Anthem Blue Cross’s decision to reduce individual health plan coverage for some 150,000 Californians.\u003c/p>\n\u003cp>\"I’m unhappy, at first blush, and at second blush, I don’t understand it,\" she said in an interview with KQED.\u003c/p>\n\u003cp>Anthem said it will withdraw from 16 of the 19 California regions it covers. This means \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/08/01/health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california/\" target=\"_blank\" rel=\"noopener noreferrer\">more than half of Californians\u003c/a> with an Anthem plan through the individual market -- or 153,000 people -- will have to find a new option.\u003c/p>\n\u003cp>In an email to KQED, Anthem Blue Cross representatives said the shrinking individual market and changes in federal guidance were the reasons behind its decision to cover fewer Californians this year. These changes will not impact Californians with Anthem plans through Medicare, Medi-Cal and their employer, or plans purchased before March 2010 -- which are grandfathered in.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Anthem representatives also said they'd \"continue to advocate solutions that will stabilize the market to allow us to return to a more robust presence in the future.\"\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Feinstein said the change came as a surprise and she's puzzled by the insurer opting out of the large California market. \"I'm really surprised to see this and deeply concerned.\"\u003c/p>\n\u003cp>Anthem's announcement came as Covered California -- the state's health care marketplace -- on Tuesday released the 11 participating \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">health insurers and its 2018 rates\u003c/a>.\u003c/p>\n\u003cp>Covered California said the average health premium would increase 12.5 percent next year -- but could double if the federal government stops providing key cost-sharing subsidies that help low-income consumers. Covered California said it needs to finalize rates by Aug. 31.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lawmakers in Congress have temporarily abandoned their efforts to repeal and replace the Affordable Care Act, or Obamacare, despite President Trump's urging them to keep working on legislation.\u003c/p>\n\n","blocks":[],"excerpt":"Sen. Feinstein said the change came as a surprise and she's puzzled by the insurer opting out of the large California market. ","status":"publish","parent":0,"modified":1501781657,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":10,"wordCount":324},"headData":{"title":"Feinstein 'Deeply Concerned' With Anthem Rollback of Coverage | KQED","description":"Sen. Feinstein said the change came as a surprise and she's puzzled by the insurer opting out of the large California market. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Feinstein 'Deeply Concerned' With Anthem Rollback of Coverage","datePublished":"2017-08-03T00:18:57.000Z","dateModified":"2017-08-03T17:34:17.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"360417 https://ww2.kqed.org/stateofhealth/?p=360417","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/02/feinstein-deeply-concerned-with-anthem-rollback-of-coverage/","disqusTitle":"Feinstein 'Deeply Concerned' With Anthem Rollback of Coverage","path":"/stateofhealth/360417/feinstein-deeply-concerned-with-anthem-rollback-of-coverage","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Senator Diane Feinstein said Wednesday that she was \"deeply concerned\" by Anthem Blue Cross’s decision to reduce individual health plan coverage for some 150,000 Californians.\u003c/p>\n\u003cp>\"I’m unhappy, at first blush, and at second blush, I don’t understand it,\" she said in an interview with KQED.\u003c/p>\n\u003cp>Anthem said it will withdraw from 16 of the 19 California regions it covers. This means \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/08/01/health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california/\" target=\"_blank\" rel=\"noopener noreferrer\">more than half of Californians\u003c/a> with an Anthem plan through the individual market -- or 153,000 people -- will have to find a new option.\u003c/p>\n\u003cp>In an email to KQED, Anthem Blue Cross representatives said the shrinking individual market and changes in federal guidance were the reasons behind its decision to cover fewer Californians this year. These changes will not impact Californians with Anthem plans through Medicare, Medi-Cal and their employer, or plans purchased before March 2010 -- which are grandfathered in.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Anthem representatives also said they'd \"continue to advocate solutions that will stabilize the market to allow us to return to a more robust presence in the future.\"\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Feinstein said the change came as a surprise and she's puzzled by the insurer opting out of the large California market. \"I'm really surprised to see this and deeply concerned.\"\u003c/p>\n\u003cp>Anthem's announcement came as Covered California -- the state's health care marketplace -- on Tuesday released the 11 participating \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">health insurers and its 2018 rates\u003c/a>.\u003c/p>\n\u003cp>Covered California said the average health premium would increase 12.5 percent next year -- but could double if the federal government stops providing key cost-sharing subsidies that help low-income consumers. Covered California said it needs to finalize rates by Aug. 31.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lawmakers in Congress have temporarily abandoned their efforts to repeal and replace the Affordable Care Act, or Obamacare, despite President Trump's urging them to keep working on legislation.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360417/feinstein-deeply-concerned-with-anthem-rollback-of-coverage","authors":["8648"],"categories":["stateofhealth_1"],"tags":["stateofhealth_2698","stateofhealth_368","stateofhealth_3144","stateofhealth_28","stateofhealth_2865"],"featImg":"stateofhealth_360435","label":"stateofhealth"},"stateofhealth_360160":{"type":"posts","id":"stateofhealth_360160","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360160","score":null,"sort":[1501633399000]},"guestAuthors":[],"slug":"health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california","title":"Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California","publishDate":1501633399,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>More than half of the Californians who have an individual health insurance policy from Anthem Blue Cross will have to shop for a new plan next year.\u003c/p>\n\u003cp>The company is pulling out of the individual market in all but three regions of the state, abandoning 153,000 of its customers. Of those, 30,000 will be left with just one plan on offer through Covered California.\u003c/p>\n\u003cp>But the former Anthem customers who do have a choice of plans will be able to find reasonable alternatives.\u003c/p>\n\u003cp>“In a number of areas where consumers in Anthem will now be forced to shop, they will find much more cost-competitive options,” said Peter Lee, executive director of Covered California.\u003c/p>\n\u003cp>Statewide, premium rates will go up an average 12.5 percent in 2018 in the state’s Affordable Care Act marketplace. But in San Francisco, the average premium increase will be just 6.6 percent. In Fresno, Kings, and Madera counties, the average increase will be 4.7 percent.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Anthem customers can keep their plan if they live in the far rural northern part of the state, parts of the Central Valley, and Santa Clara County. But in areas where Anthem is one of only two plans offered for sale – like Modoc, Lassen, and Siskiyou counties in the far north – customers will pay as much as 54 percent more for their Anthem plan. The alternative, Blue Shield, will charge up to 24 percent more next year.\u003c/p>\n\u003cp>In a statement, Anthem said its price increases and partial departure from the market are due largely to federal changes and uncertainty around the future of the Affordable Care Act.\u003c/p>\n\u003cp>“Planning and pricing for ACA-compliant health plans has become increasingly difficult,” it said, because of “continual changes in federal operations, rules and guidance.”\u003c/p>\n\u003cp>The overall lack of predictability “simply does not provide a sustainable path forward to providing affordable plan choices for all California consumers,” the company said.\u003c/p>\n\u003cp>Uncertainty also affected the prices the remaining marketplace insurers plan to charge next year. Of the overall 12.5 percent average increase, 3 percent is due to uncertainty alone, Lee said.\u003c/p>\n\u003cp>Lee warned that some plans will see an additional 12 percent surcharge, on top of the 12.5 percent average increase, if President Trump makes good on his threat to stop so-called \"Cost-Sharing Reduction\" payments to insurers. These CSR payments help insurers provide discounts on co-pays and deductibles for low-income consumers, as they are required to do by the Affordable Care Act.\u003c/p>\n\u003cp>But even if the Trump administration withdraws the money, and insurers add the surcharge to premiums, Lee says most Californians won’t feel it, because the federal subsidy will also go up in kind, covering most of the premium increase.\u003c/p>\n\u003cp>“We do not want to implement this workaround,” Lee said. “It will cause unnecessary confusion, and ultimately cost the federal government billions of dollars more than they would have spent by [just] making the CSR payments directly to health plans.”\u003c/p>\n\u003cp>Covered California submitted \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_CL_2018_Rates-HHSLetter.pdf\">a letter\u003c/a> to federal health officials, saying there's an urgent need to get clarity on the future of the cost-sharing reduction payments. California will have to decide by the end of August whether to add the surcharge to monthly premiums or not. After that, it cannot make changes to \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\">2018 rates\u003c/a>.\u003c/p>\n\u003cp>\"I'm expecting to be dealing with a lot of angry and frustrated consumers as we head into 2018 open enrollment,\" said Jonathan Greer, a health insurance broker with Rockridge Health Benefits in Oakland. \"Unfortunately, many consumers will experience sticker shock this year, especially if the Trump Administration stops making the cost-sharing payments.\"\u003c/p>\n\u003cp>Insurers are also worried that the federal government will make changes to the Affordable Care Act in the middle of next year, after rates are locked in. In addition to the CSR payments, they are concerned the IRS will stop enforcing the individual mandate, the ACA's requirement that almost all Americans buy insurance. The mandate helps balance insurance \"risk pools\" by ensuring young, healthy people also buy policies, to help cover the costs of care for the sick.\u003c/p>\n\u003cp>Covered California had to fend off requests for premium increases well beyond the 12.5 percent average because of these fears.\u003c/p>\n\u003cp>“One of the things that many of the health plans said to us is ‘What if policies change mid-year? Our actuaries are saying, ‘Be really conservative and bump rates a boatload,’” Peter Lee said, recalling the tensions underlying the negotiations. “We said, ‘Take a deep breath. Before you bump up rates a boatload, instead, what can we do to help you plan over the long term?’”\u003c/p>\n\u003cp>The agency convinced insurers to keep the increases in check by drafting a plan that would allow them to make up for any 2018 losses in subsequent years. This backup plan, which still has to be approved by state regulators, wouldn’t cost the state money, Lee said. But it would allow insurers to shift costs internally so they could replenish the coffers in later years.\u003c/p>\n\u003cp>But Lee predicts the state probably won’t have to implement the backup plan. By keeping increases relatively low this year, more people will sign up for health plans, which will give insurers the stability they need to keep prices low in 2019 and beyond.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"Uncertainty around the Affordable Care Act is pushing rates higher in California and has Anthem scaling back coverage.","status":"publish","parent":0,"modified":1501635400,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":922},"headData":{"title":"Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California | KQED","description":"Uncertainty around the Affordable Care Act is pushing rates higher in California and has Anthem scaling back coverage.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California","datePublished":"2017-08-02T00:23:19.000Z","dateModified":"2017-08-02T00:56:40.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"360160 https://ww2.kqed.org/stateofhealth/?p=360160","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/01/health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california/","disqusTitle":"Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California","path":"/stateofhealth/360160/health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than half of the Californians who have an individual health insurance policy from Anthem Blue Cross will have to shop for a new plan next year.\u003c/p>\n\u003cp>The company is pulling out of the individual market in all but three regions of the state, abandoning 153,000 of its customers. Of those, 30,000 will be left with just one plan on offer through Covered California.\u003c/p>\n\u003cp>But the former Anthem customers who do have a choice of plans will be able to find reasonable alternatives.\u003c/p>\n\u003cp>“In a number of areas where consumers in Anthem will now be forced to shop, they will find much more cost-competitive options,” said Peter Lee, executive director of Covered California.\u003c/p>\n\u003cp>Statewide, premium rates will go up an average 12.5 percent in 2018 in the state’s Affordable Care Act marketplace. But in San Francisco, the average premium increase will be just 6.6 percent. In Fresno, Kings, and Madera counties, the average increase will be 4.7 percent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Anthem customers can keep their plan if they live in the far rural northern part of the state, parts of the Central Valley, and Santa Clara County. But in areas where Anthem is one of only two plans offered for sale – like Modoc, Lassen, and Siskiyou counties in the far north – customers will pay as much as 54 percent more for their Anthem plan. The alternative, Blue Shield, will charge up to 24 percent more next year.\u003c/p>\n\u003cp>In a statement, Anthem said its price increases and partial departure from the market are due largely to federal changes and uncertainty around the future of the Affordable Care Act.\u003c/p>\n\u003cp>“Planning and pricing for ACA-compliant health plans has become increasingly difficult,” it said, because of “continual changes in federal operations, rules and guidance.”\u003c/p>\n\u003cp>The overall lack of predictability “simply does not provide a sustainable path forward to providing affordable plan choices for all California consumers,” the company said.\u003c/p>\n\u003cp>Uncertainty also affected the prices the remaining marketplace insurers plan to charge next year. Of the overall 12.5 percent average increase, 3 percent is due to uncertainty alone, Lee said.\u003c/p>\n\u003cp>Lee warned that some plans will see an additional 12 percent surcharge, on top of the 12.5 percent average increase, if President Trump makes good on his threat to stop so-called \"Cost-Sharing Reduction\" payments to insurers. These CSR payments help insurers provide discounts on co-pays and deductibles for low-income consumers, as they are required to do by the Affordable Care Act.\u003c/p>\n\u003cp>But even if the Trump administration withdraws the money, and insurers add the surcharge to premiums, Lee says most Californians won’t feel it, because the federal subsidy will also go up in kind, covering most of the premium increase.\u003c/p>\n\u003cp>“We do not want to implement this workaround,” Lee said. “It will cause unnecessary confusion, and ultimately cost the federal government billions of dollars more than they would have spent by [just] making the CSR payments directly to health plans.”\u003c/p>\n\u003cp>Covered California submitted \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_CL_2018_Rates-HHSLetter.pdf\">a letter\u003c/a> to federal health officials, saying there's an urgent need to get clarity on the future of the cost-sharing reduction payments. California will have to decide by the end of August whether to add the surcharge to monthly premiums or not. After that, it cannot make changes to \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\">2018 rates\u003c/a>.\u003c/p>\n\u003cp>\"I'm expecting to be dealing with a lot of angry and frustrated consumers as we head into 2018 open enrollment,\" said Jonathan Greer, a health insurance broker with Rockridge Health Benefits in Oakland. \"Unfortunately, many consumers will experience sticker shock this year, especially if the Trump Administration stops making the cost-sharing payments.\"\u003c/p>\n\u003cp>Insurers are also worried that the federal government will make changes to the Affordable Care Act in the middle of next year, after rates are locked in. In addition to the CSR payments, they are concerned the IRS will stop enforcing the individual mandate, the ACA's requirement that almost all Americans buy insurance. The mandate helps balance insurance \"risk pools\" by ensuring young, healthy people also buy policies, to help cover the costs of care for the sick.\u003c/p>\n\u003cp>Covered California had to fend off requests for premium increases well beyond the 12.5 percent average because of these fears.\u003c/p>\n\u003cp>“One of the things that many of the health plans said to us is ‘What if policies change mid-year? Our actuaries are saying, ‘Be really conservative and bump rates a boatload,’” Peter Lee said, recalling the tensions underlying the negotiations. “We said, ‘Take a deep breath. Before you bump up rates a boatload, instead, what can we do to help you plan over the long term?’”\u003c/p>\n\u003cp>The agency convinced insurers to keep the increases in check by drafting a plan that would allow them to make up for any 2018 losses in subsequent years. This backup plan, which still has to be approved by state regulators, wouldn’t cost the state money, Lee said. But it would allow insurers to shift costs internally so they could replenish the coffers in later years.\u003c/p>\n\u003cp>But Lee predicts the state probably won’t have to implement the backup plan. By keeping increases relatively low this year, more people will sign up for health plans, which will give insurers the stability they need to keep prices low in 2019 and beyond.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360160/health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california","authors":["3205"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_38","stateofhealth_368","stateofhealth_2808","stateofhealth_28","stateofhealth_2519","stateofhealth_365","stateofhealth_3143"],"featImg":"stateofhealth_360144","label":"stateofhealth"},"stateofhealth_353504":{"type":"posts","id":"stateofhealth_353504","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"353504","score":null,"sort":[1499897934000]},"guestAuthors":[],"slug":"cheat-sheet-how-would-the-republican-health-plan-affect-me","title":"Cheat Sheet: How Would the Republican Health Plan Affect Me?","publishDate":1499897934,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"Will it change my job-based coverage? What about my pre-existing condition? Will it cover mental illness? Does it cover abortion? This searchable FAQ has answers.","status":"publish","parent":0,"modified":1499897934,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":5,"wordCount":114},"headData":{"title":"Cheat Sheet: How Would the Republican Health Plan Affect Me? | KQED","description":"Will it change my job-based coverage? What about my pre-existing condition? Will it cover mental illness? Does it cover abortion? This searchable FAQ has answers.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Cheat Sheet: How Would the Republican Health Plan Affect Me?","datePublished":"2017-07-12T22:18:54.000Z","dateModified":"2017-07-12T22:18:54.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"353504 https://ww2.kqed.org/stateofhealth/?p=353504","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/07/12/cheat-sheet-how-would-the-republican-health-plan-affect-me/","disqusTitle":"Cheat Sheet: How Would the Republican Health Plan Affect Me?","nprByline":"Gisele Grayson and Nancy Shute","nprImageAgency":"NPR","nprStoryId":"535851043","nprApiLink":"http://api.npr.org/query?id=535851043&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you?ft=nprml&f=535851043","nprRetrievedStory":"1","nprPubDate":"Tue, 11 Jul 2017 12:07:00 -0400","nprStoryDate":"Mon, 10 Jul 2017 06:00:00 -0400","nprLastModifiedDate":"Tue, 11 Jul 2017 14:41:51 -0400","path":"/stateofhealth/353504/cheat-sheet-how-would-the-republican-health-plan-affect-me","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/353504/cheat-sheet-how-would-the-republican-health-plan-affect-me","authors":["byline_stateofhealth_353504"],"categories":["stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_294","stateofhealth_3120","stateofhealth_28","stateofhealth_2519","stateofhealth_365"],"featImg":"stateofhealth_353505","label":"stateofhealth"},"stateofhealth_348224":{"type":"posts","id":"stateofhealth_348224","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"348224","score":null,"sort":[1498603938000]},"guestAuthors":[],"slug":"californias-leaders-warn-health-bill-remains-a-dangerous-threat","title":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan","publishDate":1498603938,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n","blocks":[],"excerpt":"Though Senate Republicans have delayed a vote on their health bill, California Dems are urging people to keep up the pressure.","status":"publish","parent":0,"modified":1498611249,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":452},"headData":{"title":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan | KQED","description":"Though Senate Republicans have delayed a vote on their health bill, California Dems are urging people to keep up the pressure.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan","datePublished":"2017-06-27T22:52:18.000Z","dateModified":"2017-06-28T00:54:09.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"348224 https://ww2.kqed.org/stateofhealth/?p=348224","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/27/californias-leaders-warn-health-bill-remains-a-dangerous-threat/","disqusTitle":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan","path":"/stateofhealth/348224/californias-leaders-warn-health-bill-remains-a-dangerous-threat","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/348224/californias-leaders-warn-health-bill-remains-a-dangerous-threat","authors":["11314"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_28","stateofhealth_99","stateofhealth_218","stateofhealth_2519","stateofhealth_2865","stateofhealth_365"],"featImg":"stateofhealth_348225","label":"stateofhealth"},"stateofhealth_346757":{"type":"posts","id":"stateofhealth_346757","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"346757","score":null,"sort":[1498162582000]},"guestAuthors":[],"slug":"analysis-why-senate-health-bill-is-even-meaner-for-california","title":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California","publishDate":1498162582,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"Five takeaways from the new draft bill, and why it's not really 'repeal and replace.'","status":"publish","parent":0,"modified":1498253090,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":887},"headData":{"title":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California | KQED","description":"Five takeaways from the new draft bill, and why it's not really 'repeal and replace.'","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California","datePublished":"2017-06-22T20:16:22.000Z","dateModified":"2017-06-23T21:24:50.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"346757 https://ww2.kqed.org/stateofhealth/?p=346757","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/22/analysis-why-senate-health-bill-is-even-meaner-for-california/","disqusTitle":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California","path":"/stateofhealth/346757/analysis-why-senate-health-bill-is-even-meaner-for-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/346757/analysis-why-senate-health-bill-is-even-meaner-for-california","authors":["11314"],"categories":["stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_38","stateofhealth_3117","stateofhealth_2808","stateofhealth_28","stateofhealth_99","stateofhealth_218","stateofhealth_2519","stateofhealth_2865","stateofhealth_365"],"featImg":"stateofhealth_346802","label":"stateofhealth"},"stateofhealth_337321":{"type":"posts","id":"stateofhealth_337321","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"337321","score":null,"sort":[1496264630000]},"guestAuthors":[],"slug":"californias-new-single-payer-proposal-based-on-costly-old-ways","title":"California’s New Single-Payer Proposal Based On Costly Old Ways","publishDate":1496264630,"format":"standard","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>Three of the dirtiest words in health care are “fee for service.”\u003c/p>\n\u003cp>For years, U.S. officials have sought to move Medicare away from paying doctors and hospitals for each task they perform, a costly approach that rewards the quantity of care over quality. State Medicaid programs and private insurers are pursuing similar changes.\u003c/p>\n\u003cp>Yet the \u003ca href=\"http://californiahealthline.org/news/tab-for-single-payer-proposal-in-california-could-run-400-billion/\">$400 billion single-payer proposal\u003c/a> that’s advancing in the California legislature would restore fee-for-service to its once-dominant perch in California.\u003c/p>\n\u003cp>A \u003ca href=\"https://assets.documentcloud.org/documents/3728610/SB-0562.pdf\">state Senate analysis\u003c/a> released last week warned that fee-for-service and other provisions in the legislation would “strongly limit the state’s ability to control costs.” Cost containment will be key in persuading lawmakers and the public to support the increased taxes that would be necessary to finance this ambitious, universal health care system for 39 million Californians.\u003c/p>\n\u003cp>Several health experts expressed skepticism about the bill’s prospects in its current form.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Single-payer has its pros and cons, but if it’s built on the foundation of fee-for-service it will be a disaster,” said Stephen Shortell, dean emeritus of the School of Public Health at the University of California-Berkeley. “It would be a huge step backwards in delivering health care.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"TJaQ7ImJONsaQhBNKC359DYzk8X4H5t4\"]\u003c/p>\n\u003cp>Paul Ginsburg, a health economist and professor at the University of Southern California, agreed and said the legislation reads like something out of the 1960s in terms of how it wants to reimburse providers.\u003c/p>\n\u003cp>“There’s broad consensus we ought to go from volume to value. This bill ignores all the signs pointing to progress and advocates a system that failed,” he said.\u003c/p>\n\u003cp>Backers of the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Healthy California proposal\u003c/a> are pushing for a vote in the Senate by Friday so the legislation can go to the state Assembly and remain in play for this year’s session.\u003c/p>\n\u003cp>The authors say that their single-payer proposal won’t rely entirely on old-fashioned fee-for-service and that there’s plenty of time for the bill to be amended. According to the authors, some of the criticism in the legislative analysis reflects a misreading of the bill: It would, they say, include some use of managed care.\u003c/p>\n\u003cp>In managed care organizations such as HMOs, providers receive a lump sum every month based on how many people they have enrolled. The idea is to encourage providers to offer preventive care and to scrutinize every test or treatment, since they bear the losses if they go over budget.\u003c/p>\n\u003cp>More than other states, California embraced this approach. In its Medicaid program, about 80 percent of enrollees are in managed care.\u003c/p>\n\u003cp>Michael Lighty, director of public policy for the California Nurses Association/National Nurses United, the lead sponsor of the California bill said “it will be a mixed-payment approach. Per capita payments are envisioned in this system.”\u003c/p>\n\u003cp>“We want to address how different payment methodologies work before mandating specifics in the bill,” he added.\u003c/p>\n\u003cp>Lighty said more provisions to curtail costs will be added shortly.\u003c/p>\n\u003cp>As opposition builds over congressional efforts to dismantle the Affordable Care Act, progressives in California and New York have responded to the ACA repeal threat by \u003ca href=\"http://nymag.com/daily/intelligencer/2017/05/new-york-and-california-consider-single-payer-health-care.html?mid=twitter-share-di\">crafting proposals\u003c/a> for universal coverage. (Such efforts failed earlier in Vermont and Colorado.)\u003c/p>\n\u003cp>Single-payer supporters are tapping into Americans’ deep dissatisfaction with the high costs and red tape embedded in the current hodgepodge of private insurance and public programs. But some defenders of the existing national health law say single-payer proposals are a costly distraction from the immediate fight in Washington over the health care safety net that millions of Americans rely on.\u003c/p>\n\u003cp>The California legislation, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Senate Bill 562\u003c/a>, requires that payments to providers be made on a “fee-for-service basis unless and until another payment methodology is established by the [Healthy California] board,” according to the bill.\u003c/p>\n\u003cp>It says health care delivery systems can choose to be paid on a capitated basis. But the analysis by the state Senate Appropriations Committee said it may be difficult for the single-payer program to establish such a payment system because of other features in the law, such as patients’ ability to see any provider with no referral necessary. A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201720180SB562\">report in April\u003c/a> from the state Senate Health Committee made a similar determination, saying multiple provisions in this bill “would make cost control unlikely to occur.”\u003c/p>\n\u003cp>The bill doesn’t address other innovative approaches being rolled out across California and the country. For instance, Medicare and private insurers are shifting to “bundled payments” for knee and hip surgeries, in which providers are paid a set fee for all treatment. More physician groups and hospitals are forming accountable care organizations (ACOs), which try to coordinate care within a budget.\u003c/p>\n\u003cp>While fee-for-service medicine can lead to excessive spending, Lighty said, ACOs and other “pay-for-performance” initiatives haven’t been entirely effective at reining in costs either.\u003c/p>\n\u003cp>The California bill faces another daunting challenge: coming up with the estimated $400 billion annually required to pay for universal coverage. Existing government money used for health care could cover half of that amount, but the other half may need to come from payroll taxes on workers and employers — not a politically palatable prospect. (The taxes could be offset in some measure by reduced health spending by employers and workers.)\u003c/p>\n\u003cp>Every Californian, regardless of age, employment or immigration status, would be eligible for coverage and there would be no premiums, copayments or deductibles. In addition, patients could see any willing provider without a referral and receive any service deemed medically appropriate.\u003c/p>\n\u003cp>Those factors would make it difficult for the program to use “drug formularies, prior authorization requirements or other utilization management tools,” the Senate analysts wrote. As a result, they estimated that health care utilization may increase by 10 percent compared to fee-for-service in Medi-Cal, the state’s Medicaid program.\u003c/p>\n\u003cp>At a hearing May 22, state Sen. Jim Nielsen (R-Tehama) said the single-payer proposal appears to invite patients to “come in for what’s almost like a blank check.”\u003c/p>\n\u003cp>State Sen. Ricardo Lara (D-Bell Gardens), a chief sponsor of the bill, acknowledged the concern and said he’s looking at what single-payer systems outside the U.S. do to contain costs.\u003c/p>\n\u003cp>The bill’s sponsors are opposed to the proliferation of narrow insurance networks that exclude providers to keep costs down. But the Senate analysis said that approach means the state couldn’t use potential exclusion from the single-payer system as a means of negotiating favorable prices, as health insurers often do.\u003c/p>\n\u003cp>Lighty said significant costs can be pared from the current system in other ways. For instance, consumers will no longer subsidize lavish salaries for hospital CEOs and excessive profits because reimbursements will be tied to “efficiently providing health care services.”\u003c/p>\n\u003cp>Lara said eliminating the middleman role of health insurers and consolidating the state’s purchasing power would lead to huge savings. “By pooling health care funds in a publicly run fund, we get the bargaining power of the seventh-largest economy in the world,” he said.\u003c/p>\n\u003cp>Insurers and brokers in California and nationwide oppose single-payer proposals because they could literally put them out of business. And legislative analysts and health policy experts question whether California would be able to exert sufficient bargaining power. They noted the political constraints that Medicare has faced in flexing its market power on prices.\u003c/p>\n\u003cp>“Our system of government may mean single-payer is much less successful than in other countries,” Ginsburg said. “We are so open to lobbying it means we can’t count on some of the very strong actions other countries have taken to keep costs down.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"Health experts say California shouldn't roll out universal health care unless there are limits on doctor and hospital fees.","status":"publish","parent":0,"modified":1496275443,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":1386},"headData":{"title":"California’s New Single-Payer Proposal Based On Costly Old Ways | KQED","description":"Health experts say California shouldn't roll out universal health care unless there are limits on doctor and hospital fees.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California’s New Single-Payer Proposal Based On Costly Old Ways","datePublished":"2017-05-31T21:03:50.000Z","dateModified":"2017-06-01T00:04:03.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"337321 https://ww2.kqed.org/stateofhealth/?p=337321","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/05/31/californias-new-single-payer-proposal-based-on-costly-old-ways/","disqusTitle":"California’s New Single-Payer Proposal Based On Costly Old Ways","nprByline":"\u003cstrong>\u003ca href=\"http://khn.org/news/author/chad-terhune/\">Chad Terhune\u003c/a>\u003c/strong>","path":"/stateofhealth/337321/californias-new-single-payer-proposal-based-on-costly-old-ways","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three of the dirtiest words in health care are “fee for service.”\u003c/p>\n\u003cp>For years, U.S. officials have sought to move Medicare away from paying doctors and hospitals for each task they perform, a costly approach that rewards the quantity of care over quality. State Medicaid programs and private insurers are pursuing similar changes.\u003c/p>\n\u003cp>Yet the \u003ca href=\"http://californiahealthline.org/news/tab-for-single-payer-proposal-in-california-could-run-400-billion/\">$400 billion single-payer proposal\u003c/a> that’s advancing in the California legislature would restore fee-for-service to its once-dominant perch in California.\u003c/p>\n\u003cp>A \u003ca href=\"https://assets.documentcloud.org/documents/3728610/SB-0562.pdf\">state Senate analysis\u003c/a> released last week warned that fee-for-service and other provisions in the legislation would “strongly limit the state’s ability to control costs.” Cost containment will be key in persuading lawmakers and the public to support the increased taxes that would be necessary to finance this ambitious, universal health care system for 39 million Californians.\u003c/p>\n\u003cp>Several health experts expressed skepticism about the bill’s prospects in its current form.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Single-payer has its pros and cons, but if it’s built on the foundation of fee-for-service it will be a disaster,” said Stephen Shortell, dean emeritus of the School of Public Health at the University of California-Berkeley. “It would be a huge step backwards in delivering health care.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Paul Ginsburg, a health economist and professor at the University of Southern California, agreed and said the legislation reads like something out of the 1960s in terms of how it wants to reimburse providers.\u003c/p>\n\u003cp>“There’s broad consensus we ought to go from volume to value. This bill ignores all the signs pointing to progress and advocates a system that failed,” he said.\u003c/p>\n\u003cp>Backers of the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Healthy California proposal\u003c/a> are pushing for a vote in the Senate by Friday so the legislation can go to the state Assembly and remain in play for this year’s session.\u003c/p>\n\u003cp>The authors say that their single-payer proposal won’t rely entirely on old-fashioned fee-for-service and that there’s plenty of time for the bill to be amended. According to the authors, some of the criticism in the legislative analysis reflects a misreading of the bill: It would, they say, include some use of managed care.\u003c/p>\n\u003cp>In managed care organizations such as HMOs, providers receive a lump sum every month based on how many people they have enrolled. The idea is to encourage providers to offer preventive care and to scrutinize every test or treatment, since they bear the losses if they go over budget.\u003c/p>\n\u003cp>More than other states, California embraced this approach. In its Medicaid program, about 80 percent of enrollees are in managed care.\u003c/p>\n\u003cp>Michael Lighty, director of public policy for the California Nurses Association/National Nurses United, the lead sponsor of the California bill said “it will be a mixed-payment approach. Per capita payments are envisioned in this system.”\u003c/p>\n\u003cp>“We want to address how different payment methodologies work before mandating specifics in the bill,” he added.\u003c/p>\n\u003cp>Lighty said more provisions to curtail costs will be added shortly.\u003c/p>\n\u003cp>As opposition builds over congressional efforts to dismantle the Affordable Care Act, progressives in California and New York have responded to the ACA repeal threat by \u003ca href=\"http://nymag.com/daily/intelligencer/2017/05/new-york-and-california-consider-single-payer-health-care.html?mid=twitter-share-di\">crafting proposals\u003c/a> for universal coverage. (Such efforts failed earlier in Vermont and Colorado.)\u003c/p>\n\u003cp>Single-payer supporters are tapping into Americans’ deep dissatisfaction with the high costs and red tape embedded in the current hodgepodge of private insurance and public programs. But some defenders of the existing national health law say single-payer proposals are a costly distraction from the immediate fight in Washington over the health care safety net that millions of Americans rely on.\u003c/p>\n\u003cp>The California legislation, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Senate Bill 562\u003c/a>, requires that payments to providers be made on a “fee-for-service basis unless and until another payment methodology is established by the [Healthy California] board,” according to the bill.\u003c/p>\n\u003cp>It says health care delivery systems can choose to be paid on a capitated basis. But the analysis by the state Senate Appropriations Committee said it may be difficult for the single-payer program to establish such a payment system because of other features in the law, such as patients’ ability to see any provider with no referral necessary. A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201720180SB562\">report in April\u003c/a> from the state Senate Health Committee made a similar determination, saying multiple provisions in this bill “would make cost control unlikely to occur.”\u003c/p>\n\u003cp>The bill doesn’t address other innovative approaches being rolled out across California and the country. For instance, Medicare and private insurers are shifting to “bundled payments” for knee and hip surgeries, in which providers are paid a set fee for all treatment. More physician groups and hospitals are forming accountable care organizations (ACOs), which try to coordinate care within a budget.\u003c/p>\n\u003cp>While fee-for-service medicine can lead to excessive spending, Lighty said, ACOs and other “pay-for-performance” initiatives haven’t been entirely effective at reining in costs either.\u003c/p>\n\u003cp>The California bill faces another daunting challenge: coming up with the estimated $400 billion annually required to pay for universal coverage. Existing government money used for health care could cover half of that amount, but the other half may need to come from payroll taxes on workers and employers — not a politically palatable prospect. (The taxes could be offset in some measure by reduced health spending by employers and workers.)\u003c/p>\n\u003cp>Every Californian, regardless of age, employment or immigration status, would be eligible for coverage and there would be no premiums, copayments or deductibles. In addition, patients could see any willing provider without a referral and receive any service deemed medically appropriate.\u003c/p>\n\u003cp>Those factors would make it difficult for the program to use “drug formularies, prior authorization requirements or other utilization management tools,” the Senate analysts wrote. As a result, they estimated that health care utilization may increase by 10 percent compared to fee-for-service in Medi-Cal, the state’s Medicaid program.\u003c/p>\n\u003cp>At a hearing May 22, state Sen. Jim Nielsen (R-Tehama) said the single-payer proposal appears to invite patients to “come in for what’s almost like a blank check.”\u003c/p>\n\u003cp>State Sen. Ricardo Lara (D-Bell Gardens), a chief sponsor of the bill, acknowledged the concern and said he’s looking at what single-payer systems outside the U.S. do to contain costs.\u003c/p>\n\u003cp>The bill’s sponsors are opposed to the proliferation of narrow insurance networks that exclude providers to keep costs down. But the Senate analysis said that approach means the state couldn’t use potential exclusion from the single-payer system as a means of negotiating favorable prices, as health insurers often do.\u003c/p>\n\u003cp>Lighty said significant costs can be pared from the current system in other ways. For instance, consumers will no longer subsidize lavish salaries for hospital CEOs and excessive profits because reimbursements will be tied to “efficiently providing health care services.”\u003c/p>\n\u003cp>Lara said eliminating the middleman role of health insurers and consolidating the state’s purchasing power would lead to huge savings. “By pooling health care funds in a publicly run fund, we get the bargaining power of the seventh-largest economy in the world,” he said.\u003c/p>\n\u003cp>Insurers and brokers in California and nationwide oppose single-payer proposals because they could literally put them out of business. And legislative analysts and health policy experts question whether California would be able to exert sufficient bargaining power. They noted the political constraints that Medicare has faced in flexing its market power on prices.\u003c/p>\n\u003cp>“Our system of government may mean single-payer is much less successful than in other countries,” Ginsburg said. “We are so open to lobbying it means we can’t count on some of the very strong actions other countries have taken to keep costs down.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/337321/californias-new-single-payer-proposal-based-on-costly-old-ways","authors":["byline_stateofhealth_337321"],"categories":["stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_28","stateofhealth_2519","stateofhealth_3048"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_337325","label":"stateofhealth_3036"},"stateofhealth_333573":{"type":"posts","id":"stateofhealth_333573","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"333573","score":null,"sort":[1495483865000]},"guestAuthors":[],"slug":"single-payers-price-tag-in-california-400-billion-a-year","title":"Single-Payer Plan's Price Tag in California: $400 Billion Per Year","publishDate":1495483865,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>It would cost the state of California an estimated $400 billion per year to cover all of its 39 million residents, according to a staff analysis by the state's Senate Appropriation Committee. That's more than twice the state's total annual budget of $180 billion.\u003c/p>\n\u003cp>But the main legislative advocate for single-payer, \u003ca href=\"http://sd33.senate.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Senator Ricardo Lara\u003c/a> (D-Bell Gardens), explained the state could get access to half of that amount, $200 billion, by shifting over what it already spends on Medicare, Medi-Cal and other state-run health services. That assumes the federal government would agree to let California re-route federal funds in that way.\u003c/p>\n\u003cp>\"The fiscal estimates are subject to enormous uncertainty,\" said Nick Louizos, vice president of legislative affairs for the \u003ca href=\"http://www.calhealthplans.org/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. \"If a combination of assumptions don't come through, this could be even more expensive than we even think.\"\u003c/p>\n\u003cp>To raise the other $200 billion, the state could implement a 15 percent payroll tax, according to the analysis, which was released Monday during a Senate Appropriations Committee in Sacramento. It's unclear how that tax might be split between the employer and the employee.\u003c/p>\n\u003cp>\"Given this picture of increasing costs, health care inefficiency, and the uncertainty created by Republicans in Congress, it is critical that California chart our own path,\" said Lara at the committee hearing.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It will eliminate the need for insurance companies and their administrative costs and profits,\" he added. \"Doctors and hospitals will no longer need to negotiate rates and deals with insurance companies to seek reimbursement.\"\u003c/p>\n\u003cp>At the hearing, Kyle Thayer, a paramedic who works in San Diego, urged the legislators to move forward with the plan.\u003c/p>\n\u003cp>“I see every single day the people that don’t have health coverage and the things that happen. Often they choose between one medicine and another, and end up in the back of my ambulance for something as simple as high-blood pressure medication,\" said Thayer, a resident of Carlsbad.\u003c/p>\n\u003cp>His concerns were personal as well as professional, he said.\u003c/p>\n\u003cp>“My fiancee’s mother was trying to manage her blood pressure, and for a time wasn’t taking her medication, and she ended up with a stroke in the emergency room,\" said Thayer. \"It cost them all kinds of money.”\u003c/p>\n\u003cp>Opponents of the plan also spoke, including Karen Sarkissian from the California Chamber of Commerce, who called the 15 percent payroll tax a \"job killer,\" and a line of representatives from private health insurance companies. These companies would see their business model collapse in California in the face of a single-payer plan, which would be state-administered and not-for-profit.\u003c/p>\n\u003cp>“We don’t need to go backwards and start from scratch. This bill could have catastrophic implications for the health care system in our state,” said Teresa Stark, the chief lobbyist for Kaiser Permanente in California, which covers 8.5 million Californians.\u003c/p>\n\u003cp>\"We share the goal of health care for all,\" she explained, but added that a single-payer system would \"dismantle Kaiser Permanente as we know it.\"\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[docCloudTestLPW]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>April Dembosky contributed reporting.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"It would cost the state of California more than twice the state's total annual budget.","status":"publish","parent":0,"modified":1495675006,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":538},"headData":{"title":"Single-Payer Plan's Price Tag in California: $400 Billion Per Year | KQED","description":"It would cost the state of California more than twice the state's total annual budget.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Single-Payer Plan's Price Tag in California: $400 Billion Per Year","datePublished":"2017-05-22T20:11:05.000Z","dateModified":"2017-05-25T01:16:46.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"333573 https://ww2.kqed.org/stateofhealth/?p=333573","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/","disqusTitle":"Single-Payer Plan's Price Tag in California: $400 Billion Per Year","path":"/stateofhealth/333573/single-payers-price-tag-in-california-400-billion-a-year","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>It would cost the state of California an estimated $400 billion per year to cover all of its 39 million residents, according to a staff analysis by the state's Senate Appropriation Committee. That's more than twice the state's total annual budget of $180 billion.\u003c/p>\n\u003cp>But the main legislative advocate for single-payer, \u003ca href=\"http://sd33.senate.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Senator Ricardo Lara\u003c/a> (D-Bell Gardens), explained the state could get access to half of that amount, $200 billion, by shifting over what it already spends on Medicare, Medi-Cal and other state-run health services. That assumes the federal government would agree to let California re-route federal funds in that way.\u003c/p>\n\u003cp>\"The fiscal estimates are subject to enormous uncertainty,\" said Nick Louizos, vice president of legislative affairs for the \u003ca href=\"http://www.calhealthplans.org/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. \"If a combination of assumptions don't come through, this could be even more expensive than we even think.\"\u003c/p>\n\u003cp>To raise the other $200 billion, the state could implement a 15 percent payroll tax, according to the analysis, which was released Monday during a Senate Appropriations Committee in Sacramento. It's unclear how that tax might be split between the employer and the employee.\u003c/p>\n\u003cp>\"Given this picture of increasing costs, health care inefficiency, and the uncertainty created by Republicans in Congress, it is critical that California chart our own path,\" said Lara at the committee hearing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It will eliminate the need for insurance companies and their administrative costs and profits,\" he added. \"Doctors and hospitals will no longer need to negotiate rates and deals with insurance companies to seek reimbursement.\"\u003c/p>\n\u003cp>At the hearing, Kyle Thayer, a paramedic who works in San Diego, urged the legislators to move forward with the plan.\u003c/p>\n\u003cp>“I see every single day the people that don’t have health coverage and the things that happen. Often they choose between one medicine and another, and end up in the back of my ambulance for something as simple as high-blood pressure medication,\" said Thayer, a resident of Carlsbad.\u003c/p>\n\u003cp>His concerns were personal as well as professional, he said.\u003c/p>\n\u003cp>“My fiancee’s mother was trying to manage her blood pressure, and for a time wasn’t taking her medication, and she ended up with a stroke in the emergency room,\" said Thayer. \"It cost them all kinds of money.”\u003c/p>\n\u003cp>Opponents of the plan also spoke, including Karen Sarkissian from the California Chamber of Commerce, who called the 15 percent payroll tax a \"job killer,\" and a line of representatives from private health insurance companies. These companies would see their business model collapse in California in the face of a single-payer plan, which would be state-administered and not-for-profit.\u003c/p>\n\u003cp>“We don’t need to go backwards and start from scratch. This bill could have catastrophic implications for the health care system in our state,” said Teresa Stark, the chief lobbyist for Kaiser Permanente in California, which covers 8.5 million Californians.\u003c/p>\n\u003cp>\"We share the goal of health care for all,\" she explained, but added that a single-payer system would \"dismantle Kaiser Permanente as we know it.\"\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[docCloudTestLPW]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>April Dembosky contributed reporting.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/333573/single-payers-price-tag-in-california-400-billion-a-year","authors":["11314"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_28","stateofhealth_2519","stateofhealth_3048"],"featImg":"stateofhealth_316319","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. 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