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"content": "\u003cp>Doctors who are on probation after being disciplined by state regulators would have to share that information with patients before providing care under a bill making its way through the state Senate.\u003c/p>\n\u003cp>The measure, which would apply to physicians, podiatrists, acupuncturists and chiropractors, was passed by the Senate Business, Professions and Economic Development Committee this week.\u003c/p>\n\u003cp>About 600 of the 137,000 licensed physicians in California are on probation for serious offenses, including sexual misconduct involving patients or treatment and prescription errors that harmed patients.\u003c/p>\n\u003cp>The Medical Board of California in November voted down \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/29/in-california-doctors-on-probation-not-required-to-tell-you-should-they/\" target=\"_blank\">a similar proposal\u003c/a> that would have required doctors on probation to tell their patients verbally and in writing, saying it was too onerous and unnecessary because the information is posted on the board’s website.\u003c/p>\n\u003cp>In California, physicians on probation are already required to report the disciplinary status to their malpractice insurers and hospitals where they work, yet there is no rule requiring proactive notifications of patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Doctors on probation are not necessarily admitting they violated ethics rules. Some do it to avoid lengthy and costly legal battles.\u003c/p>\n\u003cp>While on probation, they may be temporarily barred from performing specific procedures or prescribing certain medicines. They might have to take classes or be supervised. In some cases it means a physician disciplined for sexual misconduct must be chaperoned in the exam room.\u003c/p>\n\u003cp>Patient advocate Tina Minasian, of Roseville, Calif., said such a law would have prevented her much pain and misery.\u003c/p>\n\u003cp>“Nearly 14 years after my botched surgery, I still suffer from the lingering effects with excruciating pain, spitting sutures, gaping holes, disfigurement and a mutilated body,” she said in written testimony to the committee. “I will be forever reminded of the harm this doctor caused me and how the Medical Board of California allowed him to destroy my body, my self-confidence and my womanhood. I know many patients who were victims of this same physician while he was on probation, in fact, some have died.”\u003c/p>\n\u003cp>Minasian, who works as an advocate with Consumer’s Union California Safe Patient Project, told the committee that, unbeknownst to her, Brian West, operated on her while on probation for alcohol abuse. She said his license was revoked seven years after her surgery.\u003c/p>\n\u003cp>The California Medical Association, which opposes the bill, said requiring doctors to inform patients directly would take up valuable time in which care could be provided, in a letter filed with the committee.\u003c/p>\n\u003cp>But advocacy groups like Consumers Union and Consumer Watchdog say it’s important for doctors to tell patients about their disciplinary status so patients can make informed choices about their own care.\u003c/p>\n\u003cp>“This is the kind of information every patient deserves to know about their doctor before they receive medical care,” Consumer Watchdog wrote in a letter to the committee. “The patients of these doctors deserve to be notified proactively.”\u003c/p>\n\u003cp>The bill needs to be passed by the appropriations committee and then by the full state Senate by June 3 in order to proceed to the Assembly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Doctors who are on probation after being disciplined by state regulators would have to share that information with patients before providing care under a bill making its way through the state Senate.\u003c/p>\n\u003cp>The measure, which would apply to physicians, podiatrists, acupuncturists and chiropractors, was passed by the Senate Business, Professions and Economic Development Committee this week.\u003c/p>\n\u003cp>About 600 of the 137,000 licensed physicians in California are on probation for serious offenses, including sexual misconduct involving patients or treatment and prescription errors that harmed patients.\u003c/p>\n\u003cp>The Medical Board of California in November voted down \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/29/in-california-doctors-on-probation-not-required-to-tell-you-should-they/\" target=\"_blank\">a similar proposal\u003c/a> that would have required doctors on probation to tell their patients verbally and in writing, saying it was too onerous and unnecessary because the information is posted on the board’s website.\u003c/p>\n\u003cp>In California, physicians on probation are already required to report the disciplinary status to their malpractice insurers and hospitals where they work, yet there is no rule requiring proactive notifications of patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Doctors on probation are not necessarily admitting they violated ethics rules. Some do it to avoid lengthy and costly legal battles.\u003c/p>\n\u003cp>While on probation, they may be temporarily barred from performing specific procedures or prescribing certain medicines. They might have to take classes or be supervised. In some cases it means a physician disciplined for sexual misconduct must be chaperoned in the exam room.\u003c/p>\n\u003cp>Patient advocate Tina Minasian, of Roseville, Calif., said such a law would have prevented her much pain and misery.\u003c/p>\n\u003cp>“Nearly 14 years after my botched surgery, I still suffer from the lingering effects with excruciating pain, spitting sutures, gaping holes, disfigurement and a mutilated body,” she said in written testimony to the committee. “I will be forever reminded of the harm this doctor caused me and how the Medical Board of California allowed him to destroy my body, my self-confidence and my womanhood. I know many patients who were victims of this same physician while he was on probation, in fact, some have died.”\u003c/p>\n\u003cp>Minasian, who works as an advocate with Consumer’s Union California Safe Patient Project, told the committee that, unbeknownst to her, Brian West, operated on her while on probation for alcohol abuse. She said his license was revoked seven years after her surgery.\u003c/p>\n\u003cp>The California Medical Association, which opposes the bill, said requiring doctors to inform patients directly would take up valuable time in which care could be provided, in a letter filed with the committee.\u003c/p>\n\u003cp>But advocacy groups like Consumers Union and Consumer Watchdog say it’s important for doctors to tell patients about their disciplinary status so patients can make informed choices about their own care.\u003c/p>\n\u003cp>“This is the kind of information every patient deserves to know about their doctor before they receive medical care,” Consumer Watchdog wrote in a letter to the committee. “The patients of these doctors deserve to be notified proactively.”\u003c/p>\n\u003cp>The bill needs to be passed by the appropriations committee and then by the full state Senate by June 3 in order to proceed to the Assembly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Gov. Brown Signs Bill Increasing Paid Family Leave Benefits",
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"content": "\u003cp>Gov. Jerry Brown signed a bill \u003cspan class=\"aBn\">\u003cspan class=\"aQJ\">Monday\u003c/span>\u003c/span> that increases the amount of pay employers must give workers who take time off to care for their family.\u003c/p>\n\u003cp>Brown said he wants to create a \"more decent and empathetic kind of community.\"\u003c/p>\n\u003cp>Californians can take up to six weeks off work to bond with a new child or care for sick family members and receive 55 percent of their wages.\u003c/p>\n\u003cp>The measure increases the pay to 60 percent of wages starting in 2018 and creates a new classification for low-income workers to receive 70 percent of their pay.\u003c/p>\n\u003cp>There was little opposition voiced in the state Legislature. Last week Brown signed legislation boosting California's minimum wage to $15 an hour by 2022.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>San Francisco recently approved full pay during family leave and New York state extended partial pay from six weeks to 12.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gov. Jerry Brown signed a bill \u003cspan class=\"aBn\">\u003cspan class=\"aQJ\">Monday\u003c/span>\u003c/span> that increases the amount of pay employers must give workers who take time off to care for their family.\u003c/p>\n\u003cp>Brown said he wants to create a \"more decent and empathetic kind of community.\"\u003c/p>\n\u003cp>Californians can take up to six weeks off work to bond with a new child or care for sick family members and receive 55 percent of their wages.\u003c/p>\n\u003cp>The measure increases the pay to 60 percent of wages starting in 2018 and creates a new classification for low-income workers to receive 70 percent of their pay.\u003c/p>\n\u003cp>There was little opposition voiced in the state Legislature. Last week Brown signed legislation boosting California's minimum wage to $15 an hour by 2022.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>San Francisco recently approved full pay during family leave and New York state extended partial pay from six weeks to 12.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California's Dire Shortage of Hospital Beds for Patients in Psychiatric Crisis",
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"content": "\u003cp>When \u003ca href=\"http://californiahealthline.org/news/saving-amanda-one-familys-struggle-to-deal-with-a-daughters-mental-illness/\" target=\"_blank\">Pam Lipp’s 18-year-old daughter Amanda\u003c/a> needed to be admitted to a psychiatric hospital in 2010, she thought it would be easy to find her a bed.\u003c/p>\n\u003cp>Instead, Lipp says, “It was a nightmare.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'If I hadn’t done what I did, our daughter would most likely have been discharged, back on the street with nowhere to go.'\u003cbr>\n\u003ccite> Pam Lipp\u003c/cite>\u003c/aside>\n\u003cp>Her daughter had been admitted to a psychiatric crisis center during an episode of psychosis but she could only stay there for 72 hours. Lipp asked the crisis center for help finding her a bed and was told she was on her own.\u003c/p>\n\u003cp>So Lipp plugged her phone into the wall in the waiting room and started calling one hospital after the next. They were all full. They wouldn’t reserve a spot when a bed opened, nor would they call to let her know. So she called each one every half hour to check. After eight hours, she found her daughter an open bed near their home in Fair Oaks, California.\u003c/p>\n\u003cp>Usually, it’s an emergency room staff or medical providers making such calls, rather than a patient or caregiver. The result, however, is the same: Finding an available inpatient psychiatric bed in the state of California can be extremely difficult. Many patients with acute psychiatric conditions spend days \u003ca href=\"http://www.npr.org/2011/04/13/135351760/mentally-ill-languish-in-hospital-emergency-rooms\" target=\"_blank\">deteriorating in hospital emergency departments\u003c/a> while they wait.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But how exactly to solve the problem has become a controversy in Sacramento.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB2743\" target=\"_blank\">An Assembly bill \u003c/a>backed by the California Psychiatric Association and the Steinberg Institute, a mental health policy organization, seeks to improve the process by establishing an online registry to collect and display information to help medical providers find psychiatric beds. But the California Hospital Association is staunchly opposed, saying that finding the right placement for a patient is much more complex than identifying an empty bed, and a registry could actually hinder efforts to get patients appropriate treatment.\u003c/p>\n\u003cp>The Assembly’s Committee on Health plans to hold the first hearing on the bill on April 12.\u003c/p>\n\u003cp>[contextly_sidebar id=\"3DVVdSD0eUzVhPbKvw2SFfjlfM0rBqT8\"]Under the proposed legislation, AB2743, facilities with psychiatric beds would be required to update the registry as the beds became available, and emergency medical providers would be able to log on to search for openings.\u003c/p>\n\u003cp>“A bed registry would eliminate the need for rounds and rounds of calls over hours and hours. Why not just cut that time out and go straight to the source?” asks Anna Hasselblad, public policy director at the Steinberg Institute.\u003c/p>\n\u003cp>California is facing a serious shortage of psychiatric beds, said Randall Hagar, director of government affairs for the California Psychiatric Association. As of 2013, there were 6,680 beds in the state — about 17 per 100,000 residents, according to a \u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/6_-_psychbeddata.pdf\" target=\"_blank\">report from the hospital association\u003c/a>. Psychiatric experts recommend a minimum of 50 beds per 100,000. In 25 counties in the state, there were no psychiatric beds at all.\u003c/p>\n\u003cp>Adding beds is a long-term goal for many mental health advocates, but it’s a huge task that could take years.\u003c/p>\n\u003cp>“We have to use the beds we do have and we have to know where they are. It can be a hit or miss process. It needs to be more reliable,” said Hagar. “We’ve heard instances where people were told there were no beds when in fact it turns out later that there were. An online registry would fix that issue.”\u003c/p>\n\u003cp>It would also provide data on exactly what types of additional beds are needed and where, he said.\u003c/p>\n\u003cp>The hospital association is not convinced it would work.\u003c/p>\n\u003cp>“On first blush, if you are not in the trenches, it seems like the best and easiest solution in the entire world. But the reality is that the bill will really increase the amount of time and the frustration people have trying to locate psychiatric acute-levels of care in our state,” said Sheree Lowe, the hospital association’s vice president of behavioral health.\u003c/p>\n\u003cp>Beyond finding an open bed, staffers must also factor in the age, gender, illness and acuity of the patient.\u003c/p>\n\u003cp>“You have to take under consideration your staffing needs, the needs of the other patients, and the therapeutic milieu for the safety of all patients and all staff. And that’s not something you can put into a drop-down menu,” said Lowe.\u003c/p>\n\u003cp>Requiring hospital staffers to report all those changing dynamics in an online registry, she added, would be yet another administrative burden that could cut into hands-on patient care.\u003c/p>\n\u003cp>\u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/6_-_psychbeddata.pdf\" target=\"_blank\">Many states \u003c/a>have some sort of computerized tracking system for psychiatric beds, but few are mandatory. Lowe points to a recent effort in Virginia to create a mandatory registry similar to the one being proposed in California as evidence that they don’t work.\u003c/p>\n\u003cp>In January, the \u003ca href=\"https://osig.virginia.gov/media/5277/2016-bhds-001-acute-psychiatric-and-community-services-board-bed-registry.pdf\" target=\"_blank\">Virginia state inspector general reported \u003c/a>that more than half of users of the online registry said it takes longer to find a bed for a patient than it did before the registry was established, in part because hospitals were not accurately updating information about their beds.\u003c/p>\n\u003cp>Hasselblad of the Steinberg Institute, however, said the issues with the Virginia system “is a little bit of a self-fulfilling prophesy. We have to get the buy-in from the people who will be updating the registry, because if you don’t believe it’s going to be useful to you, it’s not going to be useful to you.”\u003c/p>\n\u003cp>One solution, she said, would be to include a fine in the bill for hospitals that do not keep the registry updated. “Hospitals aren’t going to do this unless they’re absolutely mandated to.”\u003c/p>\n\u003cp>Despite the opposition of the hospital association, the emergency room doctors who staff their facilities are generally supportive of the bill. Holding psychiatric patients for days in the emergency department is “a worst case scenario for everyone involved,” said Elena Lopez-Gusman, executive director of the California chapter of the American College of Emergency Physicians.\u003c/p>\n\u003cp>And she said the hospitals with psychiatric beds may be making the problem worse by trying to reserve beds for patients with private insurance.\u003c/p>\n\u003cp>“Our physician members have reported a significant level of difficulty in getting what they feel is an accurate assessment of bed availability,” said Lopez-Gusman. “They might call the same facility in a short time for two different patients with different types of insurance, and get different answers on whether or not there’s a bed available. So our thought is that more transparency reduces the hospitals’ ability to hide available beds.”\u003c/p>\n\u003cp>Lowe of the hospital association denies that psychiatric hospitals are holding beds, which would be a violation of federal law.\u003c/p>\n\u003cp>Assemblymember Susan Talamantes Eggman, the Stockton Democrat who wrote the bill, said she believes the bill has a good chance of passing.\u003c/p>\n\u003cp>“We are very hopeful. There’s a good coalition, and everyone is talking about mental health these days,” she said. “This is a practical, small step we can take. It’s hard to argue against it.”\u003c/p>\n\u003cp>Pam Lipp, who struggled to find a bed for her daughter, said the idea of establishing a registry is “absolutely phenomenal.”\u003c/p>\n\u003cp>“Our situation is exactly the kind of situation that hopefully this bill will help,” she said.\u003c/p>\n\u003cp>“If I hadn’t done what I did, our daughter would most likely have been discharged, back on the street with nowhere to go, and we would have just repeated the cycle again. Maybe she wouldn’t have survived.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org\" target=\"_blank\">Kaiser Family Foundation.\u003c/a>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When \u003ca href=\"http://californiahealthline.org/news/saving-amanda-one-familys-struggle-to-deal-with-a-daughters-mental-illness/\" target=\"_blank\">Pam Lipp’s 18-year-old daughter Amanda\u003c/a> needed to be admitted to a psychiatric hospital in 2010, she thought it would be easy to find her a bed.\u003c/p>\n\u003cp>Instead, Lipp says, “It was a nightmare.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'If I hadn’t done what I did, our daughter would most likely have been discharged, back on the street with nowhere to go.'\u003cbr>\n\u003ccite> Pam Lipp\u003c/cite>\u003c/aside>\n\u003cp>Her daughter had been admitted to a psychiatric crisis center during an episode of psychosis but she could only stay there for 72 hours. Lipp asked the crisis center for help finding her a bed and was told she was on her own.\u003c/p>\n\u003cp>So Lipp plugged her phone into the wall in the waiting room and started calling one hospital after the next. They were all full. They wouldn’t reserve a spot when a bed opened, nor would they call to let her know. So she called each one every half hour to check. After eight hours, she found her daughter an open bed near their home in Fair Oaks, California.\u003c/p>\n\u003cp>Usually, it’s an emergency room staff or medical providers making such calls, rather than a patient or caregiver. The result, however, is the same: Finding an available inpatient psychiatric bed in the state of California can be extremely difficult. Many patients with acute psychiatric conditions spend days \u003ca href=\"http://www.npr.org/2011/04/13/135351760/mentally-ill-languish-in-hospital-emergency-rooms\" target=\"_blank\">deteriorating in hospital emergency departments\u003c/a> while they wait.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But how exactly to solve the problem has become a controversy in Sacramento.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB2743\" target=\"_blank\">An Assembly bill \u003c/a>backed by the California Psychiatric Association and the Steinberg Institute, a mental health policy organization, seeks to improve the process by establishing an online registry to collect and display information to help medical providers find psychiatric beds. But the California Hospital Association is staunchly opposed, saying that finding the right placement for a patient is much more complex than identifying an empty bed, and a registry could actually hinder efforts to get patients appropriate treatment.\u003c/p>\n\u003cp>The Assembly’s Committee on Health plans to hold the first hearing on the bill on April 12.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Under the proposed legislation, AB2743, facilities with psychiatric beds would be required to update the registry as the beds became available, and emergency medical providers would be able to log on to search for openings.\u003c/p>\n\u003cp>“A bed registry would eliminate the need for rounds and rounds of calls over hours and hours. Why not just cut that time out and go straight to the source?” asks Anna Hasselblad, public policy director at the Steinberg Institute.\u003c/p>\n\u003cp>California is facing a serious shortage of psychiatric beds, said Randall Hagar, director of government affairs for the California Psychiatric Association. As of 2013, there were 6,680 beds in the state — about 17 per 100,000 residents, according to a \u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/6_-_psychbeddata.pdf\" target=\"_blank\">report from the hospital association\u003c/a>. Psychiatric experts recommend a minimum of 50 beds per 100,000. In 25 counties in the state, there were no psychiatric beds at all.\u003c/p>\n\u003cp>Adding beds is a long-term goal for many mental health advocates, but it’s a huge task that could take years.\u003c/p>\n\u003cp>“We have to use the beds we do have and we have to know where they are. It can be a hit or miss process. It needs to be more reliable,” said Hagar. “We’ve heard instances where people were told there were no beds when in fact it turns out later that there were. An online registry would fix that issue.”\u003c/p>\n\u003cp>It would also provide data on exactly what types of additional beds are needed and where, he said.\u003c/p>\n\u003cp>The hospital association is not convinced it would work.\u003c/p>\n\u003cp>“On first blush, if you are not in the trenches, it seems like the best and easiest solution in the entire world. But the reality is that the bill will really increase the amount of time and the frustration people have trying to locate psychiatric acute-levels of care in our state,” said Sheree Lowe, the hospital association’s vice president of behavioral health.\u003c/p>\n\u003cp>Beyond finding an open bed, staffers must also factor in the age, gender, illness and acuity of the patient.\u003c/p>\n\u003cp>“You have to take under consideration your staffing needs, the needs of the other patients, and the therapeutic milieu for the safety of all patients and all staff. And that’s not something you can put into a drop-down menu,” said Lowe.\u003c/p>\n\u003cp>Requiring hospital staffers to report all those changing dynamics in an online registry, she added, would be yet another administrative burden that could cut into hands-on patient care.\u003c/p>\n\u003cp>\u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/6_-_psychbeddata.pdf\" target=\"_blank\">Many states \u003c/a>have some sort of computerized tracking system for psychiatric beds, but few are mandatory. Lowe points to a recent effort in Virginia to create a mandatory registry similar to the one being proposed in California as evidence that they don’t work.\u003c/p>\n\u003cp>In January, the \u003ca href=\"https://osig.virginia.gov/media/5277/2016-bhds-001-acute-psychiatric-and-community-services-board-bed-registry.pdf\" target=\"_blank\">Virginia state inspector general reported \u003c/a>that more than half of users of the online registry said it takes longer to find a bed for a patient than it did before the registry was established, in part because hospitals were not accurately updating information about their beds.\u003c/p>\n\u003cp>Hasselblad of the Steinberg Institute, however, said the issues with the Virginia system “is a little bit of a self-fulfilling prophesy. We have to get the buy-in from the people who will be updating the registry, because if you don’t believe it’s going to be useful to you, it’s not going to be useful to you.”\u003c/p>\n\u003cp>One solution, she said, would be to include a fine in the bill for hospitals that do not keep the registry updated. “Hospitals aren’t going to do this unless they’re absolutely mandated to.”\u003c/p>\n\u003cp>Despite the opposition of the hospital association, the emergency room doctors who staff their facilities are generally supportive of the bill. Holding psychiatric patients for days in the emergency department is “a worst case scenario for everyone involved,” said Elena Lopez-Gusman, executive director of the California chapter of the American College of Emergency Physicians.\u003c/p>\n\u003cp>And she said the hospitals with psychiatric beds may be making the problem worse by trying to reserve beds for patients with private insurance.\u003c/p>\n\u003cp>“Our physician members have reported a significant level of difficulty in getting what they feel is an accurate assessment of bed availability,” said Lopez-Gusman. “They might call the same facility in a short time for two different patients with different types of insurance, and get different answers on whether or not there’s a bed available. So our thought is that more transparency reduces the hospitals’ ability to hide available beds.”\u003c/p>\n\u003cp>Lowe of the hospital association denies that psychiatric hospitals are holding beds, which would be a violation of federal law.\u003c/p>\n\u003cp>Assemblymember Susan Talamantes Eggman, the Stockton Democrat who wrote the bill, said she believes the bill has a good chance of passing.\u003c/p>\n\u003cp>“We are very hopeful. There’s a good coalition, and everyone is talking about mental health these days,” she said. “This is a practical, small step we can take. It’s hard to argue against it.”\u003c/p>\n\u003cp>Pam Lipp, who struggled to find a bed for her daughter, said the idea of establishing a registry is “absolutely phenomenal.”\u003c/p>\n\u003cp>“Our situation is exactly the kind of situation that hopefully this bill will help,” she said.\u003c/p>\n\u003cp>“If I hadn’t done what I did, our daughter would most likely have been discharged, back on the street with nowhere to go, and we would have just repeated the cycle again. Maybe she wouldn’t have survived.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org\" target=\"_blank\">Kaiser Family Foundation.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In a small room at a neighborhood clinic in Sacramento, a handful of hepatitis C patients wait to see their physician, hoping they’ll be found sick enough to be approved for a cure.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There are very few tools in our toolbox” to control pharmaceutical spending\u003ccite>Diana Dooley, secretary of California’s Health and Human Services\u003c/cite>\u003c/aside>\n\u003cp>The low-income patients hope to be prescribed new breakthrough drugs, such as Sovaldi or Harvoni, which offer cures with almost no side effects. But treating the virus comes with a high price tag: at least $84,000 for a course of treatment. Getting Medi-Cal to pay for such drugs can involve a long, arduous process of tests and paperwork to prove infection has progressed to liver damage.\u003c/p>\n\u003cp>“If you’re practically dead … they’ll approve you,” said Laura Castillo, 54, who has been navigating the Medi-Cal system for four months to get Sovaldi. The former legal clerk said she contracted the virus from a blood transfusion in the early 1980s. Patients can live for years symptom free with hepatitis C, but left untreated, it can eventually lead to liver disease and death. Castillo has waited for treatment with substantial liver damage, which burdens her with overwhelming fatigue, depression and what she describes as a “brain fog.”\u003c/p>\n\u003cp>“It’s very, very frustrating, knowing that you have an illness and there is a cure, and you can’t do anything about it,” Castillo said.\u003c/p>\n\u003cp>Castillo’s physician, Dr. Catherine Moizeau, says she treats hundreds of Medi-Cal patients who wait months to get approval for the hepatitis C drugs. Moizeau says health plans, under state guidelines, are rationing the drugs because of the high cost. But Medi-Cal officials say patients receive the treatments based on medical necessity, not on cost.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hepatitis C drugs are not the only part of California’s troubling drug spending picture. Despite recent cost-cutting measures, such as putting tighter controls on which patients get coverage for which drugs and when, California’s spending on pharmaceuticals has gone up, and so has the number of pricey drugs it is covering. It’s not clear state agencies have the means to balance drug cost pressures in a way that serves the best interests of patients, taxpayers and public health.\u003c/p>\n\u003cp>“There are very few tools in our toolbox” to control pharmaceutical spending, said Diana Dooley, secretary of California’s Health and Human Services. She says high prescription drug costs are a problem across California’s public and private health insurance, and should be addressed on a national level.\u003c/p>\n\u003cp>Drug price concerns will also be a matter of public policy debate this year. California voters are expected to decide in November on a measure to put a ceiling on what the state pays for drugs, and lawmakers have proposed drug price transparency requirements on pharmaceutical manufacturers and health insurers.\u003c/p>\n\u003cp>“We all have to do everything we can to try to control these drug costs,” Dooley said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"kO3lkbe6TLc7SIMiuJ3FinItNEnjyfYz\"]A CALmatters analysis found that state prisons, a California public pension system, and one subset of the Medi-Cal program spent $600 million more on pharmaceuticals in 2014 than in 2012. That does not include the Medi-Cal population in a health plan, nor does it account for discounts the state may have received from drugmakers.\u003c/p>\n\u003cp>Over the past decade, Medi-Cal has seen a 57 percent increase in the drugs it covers that cost $600 or more per prescription. And when it comes to hepatitis C drugs alone, Medi-Cal estimates it will spend almost $482 million over this fiscal year and last. As of September 2015, only 4,200 Medi-Cal patients had received the drugs in that time period, out of 237,000 who are estimated to have the disease.\u003c/p>\n\u003cp>These cost trends exist despite new protocols various state agencies have introduced to tamp down on pharmaceutical spending, which include stricter controls on which patients get which prescription drugs and how.\u003c/p>\n\u003cp>“The people that pay for health care, be it the government or employers, are asking for more prior authorization because we’re having to scrutinize every penny we spend now,” said Steve Miller, chief medical officer at Express Scripts, which manages pharmacy benefits for health plans nationally, including 7.5 million Californians.\u003c/p>\n\u003cp>Miller said involvement from the payer is meant to get “the right patient, the right drug, at the right dose.” But the process, can be “clunky” and cause delays and frustrations for patients like Castillo.\u003c/p>\n\u003cp>Drugmakers say the value of the new hepatitis C drugs, the first of which hit the market at the end of 2013, is worth the cost, and in the long term, may eventually even bring savings to the health system.\u003c/p>\n\u003cp>The new hepatitis C drugs involve only a few months of treatment, and produce a cure in about 90 percent of patients. The older generation of treatments are cheaper, but are also about half as effective, and have side-effects that resemble the flu.\u003c/p>\n\u003cp>“These patients are now healthier. They’re more productive. They’re functioning,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA).\u003c/p>\n\u003cp>“You’re going to have less people who need long-term medication therapy for their hep C, they’re not going to need liver transplants, they’re not going to need significant hospitalizations,” VanderVeer said.\u003c/p>\n\u003cp>Health consumer advocates and economists argue that paying a lot for some drugs that only treat a limited population may not serve larger public health interests, or be the best use of taxpayer dollars.\u003c/p>\n\u003cp>For example, if the cost of the new hepatitis C drugs were cheaper, the hundreds of millions of dollars spent on treating just a few thousand patients could have been spent to help eradicate the disease, says Anthony Wright, executive director of Health Access, an advocacy group.\u003c/p>\n\u003cp>“You could imagine a strategy to provide this cure in a much more broad population strategy,” Wright said.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-170763 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/DrugsOver600-400x828.png\" alt=\"DrugsOver600\" width=\"400\" height=\"828\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600-400x828.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600.png 550w\" sizes=\"(max-width: 400px) 100vw, 400px\">Specialty drugs, which the federal government defines as costing $600 or more a month, are raising concern among health insurers and state agencies. In CalPERS, for instance, specialty drugs are taking up a larger share of total drug expenditures, despite the fact that they account for a small percentage of prescriptions.\u003c/p>\n\u003cp>Drugmakers are investing more in these types of drugs, said Joel Hay, a pharmaceutical economist at the University of Southern California, because “the profits are very high.”\u003c/p>\n\u003cp>But paying a high price for drugs that treat a small number of patients raises an equity question, Hay said. It may not be fair to the larger patient population for a health system to pay a high price for cancer drugs that extend a patient’s life by three weeks.\u003c/p>\n\u003cp>“You can get a lot more lives saved if you take that budget and put it into colon cancer screening or any number of other more efficient, more effective interventions,” Hay said.\u003c/p>\n\u003cp>The cost pressure from specialty drugs may not go away soon. Pharmaceutical benefits manager Express Scripts estimates that this class of drugs will continue to grow in Medicaid programs by 13.6 percent over the next three years.\u003c/p>\n\u003cp>“Are we going to have a sustainable (pharmaceutical) industry where we are making sure the drug companies make enough money where they can bring great new products to the marketplace, yet we control cost well enough that people –- all people, even the most vulnerable -- have access to the drugs they need?” asked Miller.\u003c/p>\n\u003cp>State Medi-Cal administrators say it’s too soon to assess the sustainability of current prescription drug spending trends. Meantime, their guidelines about which patients can get covered by new hepatitis C drugs has recently loosened up. As of July 2015, patients with a less advanced stage of liver disease can get covered for the drugs, as well as IV drug users and women who want to get pregnant.\u003c/p>\n\u003cp>Castillo got her medication in March, after an attorney helped her challenge denied coverage for Sovaldi through a health insurance regulator. Castillo says she’s glad she’s in treatment now, but she doesn’t know why her Medi-Cal health plan made it so hard for her to get the medicine.\u003c/p>\n\u003cp>“They need to get it together,” she said. “It’s our health and our life that they’re messing with.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CALmatters data reporter Matt Levin contributed to this article. \u003c/em>\u003ca href=\"https://calmatters.org/\" target=\"_blank\">\u003cem>CALmatters\u003c/em>\u003c/a>\u003cem> is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\">\u003cem>California Data\u003c/em>\u003c/a> \u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" target=\"_blank\">\u003cem>Fellowship,\u003c/em>\u003c/a>\u003cem> a program of the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">\u003cem>Center for Health Journalism\u003c/em>\u003c/a>\u003cem> at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a small room at a neighborhood clinic in Sacramento, a handful of hepatitis C patients wait to see their physician, hoping they’ll be found sick enough to be approved for a cure.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There are very few tools in our toolbox” to control pharmaceutical spending\u003ccite>Diana Dooley, secretary of California’s Health and Human Services\u003c/cite>\u003c/aside>\n\u003cp>The low-income patients hope to be prescribed new breakthrough drugs, such as Sovaldi or Harvoni, which offer cures with almost no side effects. But treating the virus comes with a high price tag: at least $84,000 for a course of treatment. Getting Medi-Cal to pay for such drugs can involve a long, arduous process of tests and paperwork to prove infection has progressed to liver damage.\u003c/p>\n\u003cp>“If you’re practically dead … they’ll approve you,” said Laura Castillo, 54, who has been navigating the Medi-Cal system for four months to get Sovaldi. The former legal clerk said she contracted the virus from a blood transfusion in the early 1980s. Patients can live for years symptom free with hepatitis C, but left untreated, it can eventually lead to liver disease and death. Castillo has waited for treatment with substantial liver damage, which burdens her with overwhelming fatigue, depression and what she describes as a “brain fog.”\u003c/p>\n\u003cp>“It’s very, very frustrating, knowing that you have an illness and there is a cure, and you can’t do anything about it,” Castillo said.\u003c/p>\n\u003cp>Castillo’s physician, Dr. Catherine Moizeau, says she treats hundreds of Medi-Cal patients who wait months to get approval for the hepatitis C drugs. Moizeau says health plans, under state guidelines, are rationing the drugs because of the high cost. But Medi-Cal officials say patients receive the treatments based on medical necessity, not on cost.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hepatitis C drugs are not the only part of California’s troubling drug spending picture. Despite recent cost-cutting measures, such as putting tighter controls on which patients get coverage for which drugs and when, California’s spending on pharmaceuticals has gone up, and so has the number of pricey drugs it is covering. It’s not clear state agencies have the means to balance drug cost pressures in a way that serves the best interests of patients, taxpayers and public health.\u003c/p>\n\u003cp>“There are very few tools in our toolbox” to control pharmaceutical spending, said Diana Dooley, secretary of California’s Health and Human Services. She says high prescription drug costs are a problem across California’s public and private health insurance, and should be addressed on a national level.\u003c/p>\n\u003cp>Drug price concerns will also be a matter of public policy debate this year. California voters are expected to decide in November on a measure to put a ceiling on what the state pays for drugs, and lawmakers have proposed drug price transparency requirements on pharmaceutical manufacturers and health insurers.\u003c/p>\n\u003cp>“We all have to do everything we can to try to control these drug costs,” Dooley said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>A CALmatters analysis found that state prisons, a California public pension system, and one subset of the Medi-Cal program spent $600 million more on pharmaceuticals in 2014 than in 2012. That does not include the Medi-Cal population in a health plan, nor does it account for discounts the state may have received from drugmakers.\u003c/p>\n\u003cp>Over the past decade, Medi-Cal has seen a 57 percent increase in the drugs it covers that cost $600 or more per prescription. And when it comes to hepatitis C drugs alone, Medi-Cal estimates it will spend almost $482 million over this fiscal year and last. As of September 2015, only 4,200 Medi-Cal patients had received the drugs in that time period, out of 237,000 who are estimated to have the disease.\u003c/p>\n\u003cp>These cost trends exist despite new protocols various state agencies have introduced to tamp down on pharmaceutical spending, which include stricter controls on which patients get which prescription drugs and how.\u003c/p>\n\u003cp>“The people that pay for health care, be it the government or employers, are asking for more prior authorization because we’re having to scrutinize every penny we spend now,” said Steve Miller, chief medical officer at Express Scripts, which manages pharmacy benefits for health plans nationally, including 7.5 million Californians.\u003c/p>\n\u003cp>Miller said involvement from the payer is meant to get “the right patient, the right drug, at the right dose.” But the process, can be “clunky” and cause delays and frustrations for patients like Castillo.\u003c/p>\n\u003cp>Drugmakers say the value of the new hepatitis C drugs, the first of which hit the market at the end of 2013, is worth the cost, and in the long term, may eventually even bring savings to the health system.\u003c/p>\n\u003cp>The new hepatitis C drugs involve only a few months of treatment, and produce a cure in about 90 percent of patients. The older generation of treatments are cheaper, but are also about half as effective, and have side-effects that resemble the flu.\u003c/p>\n\u003cp>“These patients are now healthier. They’re more productive. They’re functioning,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA).\u003c/p>\n\u003cp>“You’re going to have less people who need long-term medication therapy for their hep C, they’re not going to need liver transplants, they’re not going to need significant hospitalizations,” VanderVeer said.\u003c/p>\n\u003cp>Health consumer advocates and economists argue that paying a lot for some drugs that only treat a limited population may not serve larger public health interests, or be the best use of taxpayer dollars.\u003c/p>\n\u003cp>For example, if the cost of the new hepatitis C drugs were cheaper, the hundreds of millions of dollars spent on treating just a few thousand patients could have been spent to help eradicate the disease, says Anthony Wright, executive director of Health Access, an advocacy group.\u003c/p>\n\u003cp>“You could imagine a strategy to provide this cure in a much more broad population strategy,” Wright said.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-170763 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/DrugsOver600-400x828.png\" alt=\"DrugsOver600\" width=\"400\" height=\"828\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600-400x828.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600.png 550w\" sizes=\"(max-width: 400px) 100vw, 400px\">Specialty drugs, which the federal government defines as costing $600 or more a month, are raising concern among health insurers and state agencies. In CalPERS, for instance, specialty drugs are taking up a larger share of total drug expenditures, despite the fact that they account for a small percentage of prescriptions.\u003c/p>\n\u003cp>Drugmakers are investing more in these types of drugs, said Joel Hay, a pharmaceutical economist at the University of Southern California, because “the profits are very high.”\u003c/p>\n\u003cp>But paying a high price for drugs that treat a small number of patients raises an equity question, Hay said. It may not be fair to the larger patient population for a health system to pay a high price for cancer drugs that extend a patient’s life by three weeks.\u003c/p>\n\u003cp>“You can get a lot more lives saved if you take that budget and put it into colon cancer screening or any number of other more efficient, more effective interventions,” Hay said.\u003c/p>\n\u003cp>The cost pressure from specialty drugs may not go away soon. Pharmaceutical benefits manager Express Scripts estimates that this class of drugs will continue to grow in Medicaid programs by 13.6 percent over the next three years.\u003c/p>\n\u003cp>“Are we going to have a sustainable (pharmaceutical) industry where we are making sure the drug companies make enough money where they can bring great new products to the marketplace, yet we control cost well enough that people –- all people, even the most vulnerable -- have access to the drugs they need?” asked Miller.\u003c/p>\n\u003cp>State Medi-Cal administrators say it’s too soon to assess the sustainability of current prescription drug spending trends. Meantime, their guidelines about which patients can get covered by new hepatitis C drugs has recently loosened up. As of July 2015, patients with a less advanced stage of liver disease can get covered for the drugs, as well as IV drug users and women who want to get pregnant.\u003c/p>\n\u003cp>Castillo got her medication in March, after an attorney helped her challenge denied coverage for Sovaldi through a health insurance regulator. Castillo says she’s glad she’s in treatment now, but she doesn’t know why her Medi-Cal health plan made it so hard for her to get the medicine.\u003c/p>\n\u003cp>“They need to get it together,” she said. “It’s our health and our life that they’re messing with.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>CALmatters data reporter Matt Levin contributed to this article. \u003c/em>\u003ca href=\"https://calmatters.org/\" target=\"_blank\">\u003cem>CALmatters\u003c/em>\u003c/a>\u003cem> is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\">\u003cem>California Data\u003c/em>\u003c/a> \u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" target=\"_blank\">\u003cem>Fellowship,\u003c/em>\u003c/a>\u003cem> a program of the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">\u003cem>Center for Health Journalism\u003c/em>\u003c/a>\u003cem> at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Medi-Cal Expands to Undocumented Children. Here's How It Works",
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"content": "\u003cp>\u003cem>Lea este artículo en español : \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/04/22/medi-cal-se-expande-para-los-ninos-inmigrantes-asi-es-como-funciona/\" target=\"_blank\">“Medi-Cal se expande para los niños inmigrantes. Así es como funciona”\u003c/a>\u003c/em>\u003c/p>\n\u003cp>In a few months, California will begin providing full Medi-Cal coverage to all low-income children — regardless of their immigration status.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/02/09/states-medi-cal-bill-for-undocumented-children-could-go-up/\" target=\"_blank\">Depending on whom you ask\u003c/a>, anywhere from 170,000 to \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/covers/undocumented%20children%20transition%20memo%20final%20101615.pdf\" target=\"_blank\">250,000\u003c/a> children who live in California and are in the country illegally will qualify.\u003c/p>\n\u003caside class=\"pullquote alignright\">Take action now, sign up today, say health advocates\u003c/aside>\n\u003cp>If you think your child will, or know a parent whose child will, state officials and health care advocates have a simple message for you: Take action now. “Sign up today,” says Rachel Vizcarra, a program assistant with the \u003ca href=\"http://www.ufwfoundation.org/\" target=\"_blank\">UFW Foundation\u003c/a> in Bakersfield, which is helping families pre-enroll. “If you do, your kids will be automatically enrolled into the program.”\u003c/p>\n\u003cp>State officials expect coverage to start May 16. But because the policy shift requires complex programming changes to state and county computer systems, implementation may be delayed, says Tony Cava of the \u003ca href=\"http://www.dhcs.ca.gov/Pages/default.aspx\" target=\"_blank\">state Department of Health Care Services\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>No matter when it occurs, eligible children will gain coverage retroactive to the first day of that month, he says. For example, if the change takes place on May 16, coverage will extend back to May 1.\u003c/p>\n\u003cp>Carolina Moran of Canoga Park looks forward to taking her 14-year-old daughter Lizeth to the doctor once she becomes eligible for full Medi-Cal benefits.\u003c/p>\n\u003cp>A concussion on the soccer field sent Lizeth to the emergency room in January, but she couldn’t see a doctor for a follow-up visit because “we couldn’t afford it. We would have to pay out of pocket,” Moran says.\u003c/p>\n\u003cp>The first thing Moran will do is take Lizeth for a physical “and make sure her vaccinations are up to date,” she says. “She also needs fillings for five cavities.”\u003c/p>\n\u003cp>Medi-Cal eligibility is based on household income, and children under the age of 19 qualify at a higher income level than adults. They’re eligible for Medi-Cal if the family’s household income is less than 266 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\">Federal Poverty Level\u003c/a>, or about $53,600 for a family of three and $75,650 for a family of five.\u003c/p>\n\u003cp>Currently, children and adults in the country illegally qualify for limited Medi-Cal coverage, called restricted-scope, which covers emergency and pregnancy-related services.\u003c/p>\n\u003cp>Though this may sound counter-intuitive, health care advocates and the state want you to sign your kids up for restricted Medi-Cal now in preparation for the availability of full Medi-Cal benefits.\u003c/p>\n\u003caside class=\"pullquote alignright\">Be warned: the Medi-Cal application is long and complicated, but free help is available to help with enrollment\u003c/aside>\n\u003cp>The idea is that when the change occurs, qualified children \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_EE_Plan_032116_Final.PDF\" target=\"_blank\">will automatically transition\u003c/a> into full-scope Medi-Cal “within a few days” and without an additional application, Cava says.\u003c/p>\n\u003cp>The state estimates that there are about 115,000 unauthorized immigrant children who already have restricted Medi-Cal.\u003c/p>\n\u003cp>If your child is uninsured, sign up for restricted-scope Medi-Cal now. Even if your child has coverage through another existing program — such as Kaiser Permanente’s \u003ca href=\"http://info.kaiserpermanente.org/html/child_health_plan/index.html\" target=\"_blank\">Child Health Program\u003c/a> or county-based health coverage — you should still sign your child up for restricted Medi-Cal now, says Mark Diel, CEO of \u003ca href=\"http://cchi4families.org/\" target=\"_blank\">California Coverage & Health Initiatives\u003c/a> (CCHI), a statewide outreach and enrollment network.\u003c/p>\n\u003cp>That’s because those kids will eventually become ineligible for those programs after they become eligible for full Medi-Cal, he says. (Don’t drop out of another program until you confirm that your child’s full-scope Medi-Cal has been approved, he says.)\u003c/p>\n\u003cp>But be warned: The Medi-Cal application is long and complicated. To complete it, you’ll need to provide a birth certificate, proof of local address, proof of identity and income information, Vizcarra says. Foreign passports and birth certificates can be used.\u003c/p>\n\u003cp>“Work with a local enroller instead of trying to do it on your own,” Diel says. “You’re much more likely to get the application approved.”\u003c/p>\n\u003cp>Help from local health clinics and community groups is free. Online, visit \u003ca href=\"http://www.cchi4families.org/find-help\" target=\"_blank\">www.cchi4families.org/find-help\u003c/a> for local resources.\u003c/p>\n\u003cp>Advocates and state officials also want you to know that enrolling your kids shouldn’t lead to negative immigration consequences for you — or other members of your family — who may not have legal status.\u003c/p>\n\u003cp>“None of the information being collected is shared with immigration authorities,” says Maria Romero-Mora of CCHI.\u003c/p>\n\u003cp>Once you get your kids into restricted-scope Medi-Cal, and eventually into full Medi-Cal, you’ll need to take action.\u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SB75_FAQ_1.aspx\" target=\"_blank\"> Look for letters in the mail\u003c/a> before and after the transition explaining your options.\u003c/p>\n\u003cp>\u003cstrong>CHOOSE A PLAN\u003c/strong>: Once the transition to full Medi-Cal occurs, you will have 60 days to choose a managed care health plan for children already enrolled in restricted-scope Medi-Cal. If you don’t choose a plan, the state will assign one, Cava says.\u003c/p>\n\u003cp>Parents of kids who are not in restricted-scope Medi-Cal at the time of the change and who enroll them afterward will have 30 days to choose a plan, he says.\u003c/p>\n\u003cp>If you live in one of 22 counties where Medi-Cal managed care is operated by a single \u003ca href=\"http://www.healthconsumer.org/092914-ManagedCareinCaliforniaSeries-3-COHSMediCalPlans.pdf\" target=\"_blank\">County Organized Health System\u003c/a>, children will be automatically enrolled in that plan, Cava says.\u003c/p>\n\u003cp>In all cases, until a plan is chosen — or assigned — children will receive coverage through Medi-Cal’s fee-for-service program.\u003c/p>\n\u003cp>\u003cstrong>PAY PREMIUMS\u003c/strong>: Medi-Cal is premium-free for kids up to 160 percent of the Federal Poverty Level, but you will owe a premium if your family income falls between 160 percent and 266 percent. The premium is $13 a month for each child, with a $39 family maximum.\u003c/p>\n\u003cp>Children in Medi-Cal plans don’t have co-payments for medical care.\u003c/p>\n\u003cp>\u003cstrong>RENEW\u003c/strong>: You will need to participate in Medi-Cal’s annual renewal process to ensure your children remain eligible and enrolled.\u003c/p>\n\u003cp>Finally, if you don’t sign your child up for restricted Medi-Cal before the change, you can apply for full benefits afterward — anytime of year — at your county human services office, through a community organization or via the \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> website, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">www.CoveredCA.com\u003c/a>.\u003c/p>\n\u003cp>In Canoga Park, Moran says getting Lizeth on Medi-Cal will give her family greater financial security. Lizeth agrees.\u003c/p>\n\u003cp>“I worry that if I have to go to a checkup, it’s going to cost my parents money, and sometimes they don’t have the money to pay for it,” the ninth-grader says.\u003c/p>\n\u003cp>\u003cem>This story is part of California Healthline's \u003ca href=\"http://californiahealthline.org/news/author/emily-bazar/\" target=\"_blank\">Ask Emily\u003c/a>, a series of Q&A columns answering consumers’ questions about California’s new medical world. It was produced by Kaiser Health News which publishes California Healthline, a service of the California Health Care Foundation.”\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Send questions for Emily to AskEmily@kff.org\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Lea este artículo en español : \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/04/22/medi-cal-se-expande-para-los-ninos-inmigrantes-asi-es-como-funciona/\" target=\"_blank\">“Medi-Cal se expande para los niños inmigrantes. Así es como funciona”\u003c/a>\u003c/em>\u003c/p>\n\u003cp>In a few months, California will begin providing full Medi-Cal coverage to all low-income children — regardless of their immigration status.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/02/09/states-medi-cal-bill-for-undocumented-children-could-go-up/\" target=\"_blank\">Depending on whom you ask\u003c/a>, anywhere from 170,000 to \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/covers/undocumented%20children%20transition%20memo%20final%20101615.pdf\" target=\"_blank\">250,000\u003c/a> children who live in California and are in the country illegally will qualify.\u003c/p>\n\u003caside class=\"pullquote alignright\">Take action now, sign up today, say health advocates\u003c/aside>\n\u003cp>If you think your child will, or know a parent whose child will, state officials and health care advocates have a simple message for you: Take action now. “Sign up today,” says Rachel Vizcarra, a program assistant with the \u003ca href=\"http://www.ufwfoundation.org/\" target=\"_blank\">UFW Foundation\u003c/a> in Bakersfield, which is helping families pre-enroll. “If you do, your kids will be automatically enrolled into the program.”\u003c/p>\n\u003cp>State officials expect coverage to start May 16. But because the policy shift requires complex programming changes to state and county computer systems, implementation may be delayed, says Tony Cava of the \u003ca href=\"http://www.dhcs.ca.gov/Pages/default.aspx\" target=\"_blank\">state Department of Health Care Services\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>No matter when it occurs, eligible children will gain coverage retroactive to the first day of that month, he says. For example, if the change takes place on May 16, coverage will extend back to May 1.\u003c/p>\n\u003cp>Carolina Moran of Canoga Park looks forward to taking her 14-year-old daughter Lizeth to the doctor once she becomes eligible for full Medi-Cal benefits.\u003c/p>\n\u003cp>A concussion on the soccer field sent Lizeth to the emergency room in January, but she couldn’t see a doctor for a follow-up visit because “we couldn’t afford it. We would have to pay out of pocket,” Moran says.\u003c/p>\n\u003cp>The first thing Moran will do is take Lizeth for a physical “and make sure her vaccinations are up to date,” she says. “She also needs fillings for five cavities.”\u003c/p>\n\u003cp>Medi-Cal eligibility is based on household income, and children under the age of 19 qualify at a higher income level than adults. They’re eligible for Medi-Cal if the family’s household income is less than 266 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\">Federal Poverty Level\u003c/a>, or about $53,600 for a family of three and $75,650 for a family of five.\u003c/p>\n\u003cp>Currently, children and adults in the country illegally qualify for limited Medi-Cal coverage, called restricted-scope, which covers emergency and pregnancy-related services.\u003c/p>\n\u003cp>Though this may sound counter-intuitive, health care advocates and the state want you to sign your kids up for restricted Medi-Cal now in preparation for the availability of full Medi-Cal benefits.\u003c/p>\n\u003caside class=\"pullquote alignright\">Be warned: the Medi-Cal application is long and complicated, but free help is available to help with enrollment\u003c/aside>\n\u003cp>The idea is that when the change occurs, qualified children \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_EE_Plan_032116_Final.PDF\" target=\"_blank\">will automatically transition\u003c/a> into full-scope Medi-Cal “within a few days” and without an additional application, Cava says.\u003c/p>\n\u003cp>The state estimates that there are about 115,000 unauthorized immigrant children who already have restricted Medi-Cal.\u003c/p>\n\u003cp>If your child is uninsured, sign up for restricted-scope Medi-Cal now. Even if your child has coverage through another existing program — such as Kaiser Permanente’s \u003ca href=\"http://info.kaiserpermanente.org/html/child_health_plan/index.html\" target=\"_blank\">Child Health Program\u003c/a> or county-based health coverage — you should still sign your child up for restricted Medi-Cal now, says Mark Diel, CEO of \u003ca href=\"http://cchi4families.org/\" target=\"_blank\">California Coverage & Health Initiatives\u003c/a> (CCHI), a statewide outreach and enrollment network.\u003c/p>\n\u003cp>That’s because those kids will eventually become ineligible for those programs after they become eligible for full Medi-Cal, he says. (Don’t drop out of another program until you confirm that your child’s full-scope Medi-Cal has been approved, he says.)\u003c/p>\n\u003cp>But be warned: The Medi-Cal application is long and complicated. To complete it, you’ll need to provide a birth certificate, proof of local address, proof of identity and income information, Vizcarra says. Foreign passports and birth certificates can be used.\u003c/p>\n\u003cp>“Work with a local enroller instead of trying to do it on your own,” Diel says. “You’re much more likely to get the application approved.”\u003c/p>\n\u003cp>Help from local health clinics and community groups is free. Online, visit \u003ca href=\"http://www.cchi4families.org/find-help\" target=\"_blank\">www.cchi4families.org/find-help\u003c/a> for local resources.\u003c/p>\n\u003cp>Advocates and state officials also want you to know that enrolling your kids shouldn’t lead to negative immigration consequences for you — or other members of your family — who may not have legal status.\u003c/p>\n\u003cp>“None of the information being collected is shared with immigration authorities,” says Maria Romero-Mora of CCHI.\u003c/p>\n\u003cp>Once you get your kids into restricted-scope Medi-Cal, and eventually into full Medi-Cal, you’ll need to take action.\u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SB75_FAQ_1.aspx\" target=\"_blank\"> Look for letters in the mail\u003c/a> before and after the transition explaining your options.\u003c/p>\n\u003cp>\u003cstrong>CHOOSE A PLAN\u003c/strong>: Once the transition to full Medi-Cal occurs, you will have 60 days to choose a managed care health plan for children already enrolled in restricted-scope Medi-Cal. If you don’t choose a plan, the state will assign one, Cava says.\u003c/p>\n\u003cp>Parents of kids who are not in restricted-scope Medi-Cal at the time of the change and who enroll them afterward will have 30 days to choose a plan, he says.\u003c/p>\n\u003cp>If you live in one of 22 counties where Medi-Cal managed care is operated by a single \u003ca href=\"http://www.healthconsumer.org/092914-ManagedCareinCaliforniaSeries-3-COHSMediCalPlans.pdf\" target=\"_blank\">County Organized Health System\u003c/a>, children will be automatically enrolled in that plan, Cava says.\u003c/p>\n\u003cp>In all cases, until a plan is chosen — or assigned — children will receive coverage through Medi-Cal’s fee-for-service program.\u003c/p>\n\u003cp>\u003cstrong>PAY PREMIUMS\u003c/strong>: Medi-Cal is premium-free for kids up to 160 percent of the Federal Poverty Level, but you will owe a premium if your family income falls between 160 percent and 266 percent. The premium is $13 a month for each child, with a $39 family maximum.\u003c/p>\n\u003cp>Children in Medi-Cal plans don’t have co-payments for medical care.\u003c/p>\n\u003cp>\u003cstrong>RENEW\u003c/strong>: You will need to participate in Medi-Cal’s annual renewal process to ensure your children remain eligible and enrolled.\u003c/p>\n\u003cp>Finally, if you don’t sign your child up for restricted Medi-Cal before the change, you can apply for full benefits afterward — anytime of year — at your county human services office, through a community organization or via the \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> website, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">www.CoveredCA.com\u003c/a>.\u003c/p>\n\u003cp>In Canoga Park, Moran says getting Lizeth on Medi-Cal will give her family greater financial security. Lizeth agrees.\u003c/p>\n\u003cp>“I worry that if I have to go to a checkup, it’s going to cost my parents money, and sometimes they don’t have the money to pay for it,” the ninth-grader says.\u003c/p>\n\u003cp>\u003cem>This story is part of California Healthline's \u003ca href=\"http://californiahealthline.org/news/author/emily-bazar/\" target=\"_blank\">Ask Emily\u003c/a>, a series of Q&A columns answering consumers’ questions about California’s new medical world. It was produced by Kaiser Health News which publishes California Healthline, a service of the California Health Care Foundation.”\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Send questions for Emily to AskEmily@kff.org\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Denti-Cal Program 'Dysfunctional' Says Scathing Bipartisan Report",
"title": "Denti-Cal Program 'Dysfunctional' Says Scathing Bipartisan Report",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>The State of California’s dental health system for the poor is “dysfunctional” according to a \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\" target=\"_blank\">scathing report\u003c/a> issued Friday by a bipartisan oversight commission.\u003c/p>\n\u003cp>The program, Denti-Cal, “ranks among state government’s greatest deficiencies,” said the report by the \u003ca href=\"http://www.lhc.ca.gov/about/about.html\" target=\"_blank\">Little Hoover Commission\u003c/a>, a statutorily independent oversight agency.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In California we have kids’ teeth rotting out of their heads.'\u003ccite> Pedro Nava, Chairman, Little Hoover Commission \u003c/cite>\u003c/aside>\n\u003cp>The state bureaucracy that runs Denti-Cal draws only part of the blame. The legislature, the governor’s office, and the political culture of California share culpability for decades of neglect and strategic misdirection, the commission says.\u003c/p>\n\u003cp>The program falls “disastrously short in providing dental care to a third of California’s population and more than half of its children.”\u003c/p>\n\u003cp>A more vivid description comes from Pedro Nava, the commission’s chairman:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“In California we have kids’ teeth rotting out of their heads,” he says. “That’s utterly inexcusable.”\u003c/p>\n\u003cp>\u003cb>Dental Profession 'Thoroughly Alienated'\u003c/b>\u003c/p>\n\u003cp>The report makes grim reading. California faces an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches, whole counties have no Denti-Cal providers and families don’t understand basic preventative dental care,” it said.\u003c/p>\n\u003cp>Meanwhile, Denti-Cal has “thoroughly alienated the dental profession” with tangles of red tape and “reimbursement rates among the nation’s lowest,” the report said.\u003c/p>\n\u003cp>In sum, the commission said it’s time to “reboot” Denti-Cal.\u003c/p>\n\u003cp>[contextly_sidebar id=\"MvOmIplCazK7Ew4ddY2etXumhgCTSgzr\"]The program is run by the state Department of Health Care Services, which oversees Medi-Care, California’s version of Medicaid.\u003c/p>\n\u003cp>The department released a \u003ca href=\"https://californiahealthline.files.wordpress.com/2016/04/californiahealthline-denti-cal-040116.pdf\" target=\"_blank\">lengthy prepared response to questions\u003c/a> from CHL, which includes this statement:\u003c/p>\n\u003cp>“DHCS is strongly committed to providing access to quality dental care for our millions of Medi-Cal members, and Director Jennifer Kent has publicly stated that improving the Denti-Cal program is one of her top priorities.”\u003c/p>\n\u003cp>Nava has heard it before. “I have been completely underwhelmed by the response of the department,” he said. “Their efforts have been far too little and far too late.”\u003c/p>\n\u003cp>It’s not just the department though. Acccording to the report, “Blame goes so much deeper.”\u003c/p>\n\u003cp>“Successive legislatures and administrations,” the commission said, “have underfunded the Denti-Cal program and slashed reimbursement rates for dental providers to national lows. The state has historically lacked any strategy to prevent dental disease among its neediest populations.”\u003c/p>\n\u003cp>Evidence is widespread that bad dental health can seriously affect general health, making more people sick and driving health costs even higher.\u003c/p>\n\u003cp>But in California, there is a Denti-Cal dentist shortage.\u003c/p>\n\u003cp>Many dentists say they lose money on state-funded patients, so caring for them becomes a form of charity work.\u003c/p>\n\u003cp>John Blake is a dentist who gave up a private practice in Long Beach to run the Children’s Dental Health Clinic in Long Beach, where about 85 percent of patients are on Denti-Cal.\u003c/p>\n\u003cp>Blake said he just wants to break even — the business is a non-profit — 25 percent of his overhead is paid for through donations and fund-raising events. It’s impossible to cover costs with the low payments from the state, he said.\u003c/p>\n\u003cp>“A lot of my colleagues used to take Denti-Cal, but it’s not just the low rates, it’s that the hassle of the system is so much worse than reimbursement. The hassle factor just got to be too much,” Blake said. “They just gave up.”\u003c/p>\n\u003cp>Little Hoover more formally addressed the hassle factor, noting that copious pre-authorizations for basic procedures are a major hassle, never mind a a clunky billing system, much of it still paper-based, and a 22-page application form just to participate in the program.\u003c/p>\n\u003cp>Camille Nishikawa is a dentist in Los Angeles who doesn’t have those problems. She runs the QueensCare mobile dental clinic in partnership with USC Medical Center, which travels to the poorest parts of LA to take care of kids’ teeth. The mobile dental van is funded by grants; it doesn’t accept any money from patients or from Denti-Cal.\u003c/p>\n\u003cp>\u003cstrong>Children 'Suffer in Pain'\u003c/strong>\u003c/p>\n\u003cp>Organizational dysfunction is only part of the problem with Denti-Cal, Nishikawa said. Many poor people who are eligible for the program’s benefits don’t even know about them.\u003c/p>\n\u003cp>“A lot of the community isn’t aware of what they’re entitled to,” she said. “And if they do, they don’t know where to go to find a dentist.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"YqwmVIo7HQrzTrqAnpvYUxl7c1QcyMYV\"]Ruth Sandoval is one of those low-income people, a mostly Spanish-speaking mother of two in Los Angeles. She said she had no idea she and her two children could even get dental care as part of their Medi-Cal program. “It has been hard to find a dentist; it’s very hard to find one,” Sandoval said.\u003c/p>\n\u003cp>She went to a clinic in LA for a different health problem and discovered a dentist on staff. She’s grateful for that, she said, because she wouldn’t have a dentist otherwise. “It’s so important to us, we were so happy to find her there,” Sandoval said.\u003c/p>\n\u003cp>Most low-income Californians aren’t that lucky. Only about half of the children eligible for dental coverage actually see a dentist, said Jenny Kattlove of the Santa Monica-based Children’s Partnership advocacy group.\u003c/p>\n\u003cp>She said the severity of the dental problem was accurately outlined in the Little Hoover report, saying it lays out “an ambitious but necessary path” toward revamping the entire low-income dental system.\u003c/p>\n\u003cp>People think of dental care as just getting a teeth-cleaning, and that it’s not seen as a health issue.\u003c/p>\n\u003cp>“Look, when children don’t get the oral health care they need, they suffer in pain,” she said. “Untreated dental problems actually can lead to death, I don’t know what’s more health-related than that.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Nava said access problems may only get worse as more Californians are added to the Medi-Cal rolls. In mid-May, an estimated 170,000 undocumented children will become eligible for full Medi-Cal benefits, including dental care, and Nava worries that they won’t get it.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The State of California’s dental health system for the poor is “dysfunctional” according to a \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\" target=\"_blank\">scathing report\u003c/a> issued Friday by a bipartisan oversight commission.\u003c/p>\n\u003cp>The program, Denti-Cal, “ranks among state government’s greatest deficiencies,” said the report by the \u003ca href=\"http://www.lhc.ca.gov/about/about.html\" target=\"_blank\">Little Hoover Commission\u003c/a>, a statutorily independent oversight agency.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In California we have kids’ teeth rotting out of their heads.'\u003ccite> Pedro Nava, Chairman, Little Hoover Commission \u003c/cite>\u003c/aside>\n\u003cp>The state bureaucracy that runs Denti-Cal draws only part of the blame. The legislature, the governor’s office, and the political culture of California share culpability for decades of neglect and strategic misdirection, the commission says.\u003c/p>\n\u003cp>The program falls “disastrously short in providing dental care to a third of California’s population and more than half of its children.”\u003c/p>\n\u003cp>A more vivid description comes from Pedro Nava, the commission’s chairman:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“In California we have kids’ teeth rotting out of their heads,” he says. “That’s utterly inexcusable.”\u003c/p>\n\u003cp>\u003cb>Dental Profession 'Thoroughly Alienated'\u003c/b>\u003c/p>\n\u003cp>The report makes grim reading. California faces an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches, whole counties have no Denti-Cal providers and families don’t understand basic preventative dental care,” it said.\u003c/p>\n\u003cp>Meanwhile, Denti-Cal has “thoroughly alienated the dental profession” with tangles of red tape and “reimbursement rates among the nation’s lowest,” the report said.\u003c/p>\n\u003cp>In sum, the commission said it’s time to “reboot” Denti-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The program is run by the state Department of Health Care Services, which oversees Medi-Care, California’s version of Medicaid.\u003c/p>\n\u003cp>The department released a \u003ca href=\"https://californiahealthline.files.wordpress.com/2016/04/californiahealthline-denti-cal-040116.pdf\" target=\"_blank\">lengthy prepared response to questions\u003c/a> from CHL, which includes this statement:\u003c/p>\n\u003cp>“DHCS is strongly committed to providing access to quality dental care for our millions of Medi-Cal members, and Director Jennifer Kent has publicly stated that improving the Denti-Cal program is one of her top priorities.”\u003c/p>\n\u003cp>Nava has heard it before. “I have been completely underwhelmed by the response of the department,” he said. “Their efforts have been far too little and far too late.”\u003c/p>\n\u003cp>It’s not just the department though. Acccording to the report, “Blame goes so much deeper.”\u003c/p>\n\u003cp>“Successive legislatures and administrations,” the commission said, “have underfunded the Denti-Cal program and slashed reimbursement rates for dental providers to national lows. The state has historically lacked any strategy to prevent dental disease among its neediest populations.”\u003c/p>\n\u003cp>Evidence is widespread that bad dental health can seriously affect general health, making more people sick and driving health costs even higher.\u003c/p>\n\u003cp>But in California, there is a Denti-Cal dentist shortage.\u003c/p>\n\u003cp>Many dentists say they lose money on state-funded patients, so caring for them becomes a form of charity work.\u003c/p>\n\u003cp>John Blake is a dentist who gave up a private practice in Long Beach to run the Children’s Dental Health Clinic in Long Beach, where about 85 percent of patients are on Denti-Cal.\u003c/p>\n\u003cp>Blake said he just wants to break even — the business is a non-profit — 25 percent of his overhead is paid for through donations and fund-raising events. It’s impossible to cover costs with the low payments from the state, he said.\u003c/p>\n\u003cp>“A lot of my colleagues used to take Denti-Cal, but it’s not just the low rates, it’s that the hassle of the system is so much worse than reimbursement. The hassle factor just got to be too much,” Blake said. “They just gave up.”\u003c/p>\n\u003cp>Little Hoover more formally addressed the hassle factor, noting that copious pre-authorizations for basic procedures are a major hassle, never mind a a clunky billing system, much of it still paper-based, and a 22-page application form just to participate in the program.\u003c/p>\n\u003cp>Camille Nishikawa is a dentist in Los Angeles who doesn’t have those problems. She runs the QueensCare mobile dental clinic in partnership with USC Medical Center, which travels to the poorest parts of LA to take care of kids’ teeth. The mobile dental van is funded by grants; it doesn’t accept any money from patients or from Denti-Cal.\u003c/p>\n\u003cp>\u003cstrong>Children 'Suffer in Pain'\u003c/strong>\u003c/p>\n\u003cp>Organizational dysfunction is only part of the problem with Denti-Cal, Nishikawa said. Many poor people who are eligible for the program’s benefits don’t even know about them.\u003c/p>\n\u003cp>“A lot of the community isn’t aware of what they’re entitled to,” she said. “And if they do, they don’t know where to go to find a dentist.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Ruth Sandoval is one of those low-income people, a mostly Spanish-speaking mother of two in Los Angeles. She said she had no idea she and her two children could even get dental care as part of their Medi-Cal program. “It has been hard to find a dentist; it’s very hard to find one,” Sandoval said.\u003c/p>\n\u003cp>She went to a clinic in LA for a different health problem and discovered a dentist on staff. She’s grateful for that, she said, because she wouldn’t have a dentist otherwise. “It’s so important to us, we were so happy to find her there,” Sandoval said.\u003c/p>\n\u003cp>Most low-income Californians aren’t that lucky. Only about half of the children eligible for dental coverage actually see a dentist, said Jenny Kattlove of the Santa Monica-based Children’s Partnership advocacy group.\u003c/p>\n\u003cp>She said the severity of the dental problem was accurately outlined in the Little Hoover report, saying it lays out “an ambitious but necessary path” toward revamping the entire low-income dental system.\u003c/p>\n\u003cp>People think of dental care as just getting a teeth-cleaning, and that it’s not seen as a health issue.\u003c/p>\n\u003cp>“Look, when children don’t get the oral health care they need, they suffer in pain,” she said. “Untreated dental problems actually can lead to death, I don’t know what’s more health-related than that.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nava said access problems may only get worse as more Californians are added to the Medi-Cal rolls. In mid-May, an estimated 170,000 undocumented children will become eligible for full Medi-Cal benefits, including dental care, and Nava worries that they won’t get it.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Francisco, Oakland Working to Put Soda Tax Before Voters",
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"content": "\u003cp>Berkeley was the trend setter in 2014 when voters there approved the first a soda tax in the U.S. with a resounding 75 percent of the vote.\u003c/p>\n\u003cp>That same year San Francisco voters rejected a soda tax. But supporters were not deterred. Now, new efforts have resumed in San Francisco and in Oakland to move through a tax with a goal of fighting the obesity and diabetes epidemic. Both cities seem to be applying lessons from the Berkeley playbook to see the taxes through.\u003c/p>\n\u003cp>First, a bit of review: in 2014 San Franciscans considered a dedicated tax, one that would be earmarked to fund specific health programs. That kind of earmarked tax needs a two-thirds supermajority approval to become law. With 55 percent of the vote, it fell short of the threshhold.\u003c/p>\n\u003cp>Berkeley, meanwhile, had pursued a different path, one where the proceeds of a tax would go toward the city's general fund. But the law called for the creation of a health panel to advise the Berkeley City Council on appropriate programs to fund. This approach requires only a simple majority -- 50 percent plus one vote -- to pass.\u003c/p>\n\u003cp>Backers of the Berkeley soda tax also cultivated a \u003ca href=\"http://www.berkeleyvsbigsoda.com/supporters\" target=\"_blank\">long list of supporters,\u003c/a> including health organizations and grassroots groups.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That's where Oakland and San Francisco are today -- both proposals are remarkably similar to the Berkeley approach:\u003c/p>\n\u003cul>\n\u003cli>a penny per ounce fee on sugar-sweetened beverages\u003c/li>\n\u003cli>a dedicated health panel to advise city or county officials on spending\u003c/li>\n\u003cli>plenty of grassroots support\u003c/li>\n\u003cli>levied on distributors (in Berkeley much of the tax is passed through to consumers)\u003c/li>\n\u003c/ul>\n\u003cp>“We’re building a much stronger community coalition,\" says San Francisco Supervisor Malia Cohen, one of the sponsors of the 2014 effort and a backer of the current move. \"We’re taking a much more thoughtful and grassroots focused effort this time around. We have learned from errors.\"\u003c/p>\n\u003cp>Cohen says 10,000 signatures are needed by a July deadline to place the item on the San Francisco ballot. Nine-thousand people have already signed and she expects the remainder by late May, well in advance of the deadline.\u003c/p>\n\u003cp>The Oakland City Council, meanwhile, is weighing whether to directly place a soda tax on the ballot. The proposed measure will be heard in committee this Thursday. If it passes there, it goes before the full board. Adam Simons, chief of staff for City Council Member Annie Campbell Washington, one of the proponents of the ordinance, said he expects it will be approved for the November ballot.\u003c/p>\n\u003cp>\"We're feeling very confident it will move through,\" he says.\u003c/p>\n\u003cp>\u003cstrong>Mexico Was First\u003c/strong>\u003c/p>\n\u003cp>Globally, the first soda tax was in Mexico. Its tax took effect in January, 2014 -- 11 months before the Berkeley and San Francisco votes. Consumption of sugary drinks dropped 6-12 percent in the year after it was implemented and raised millions for the Mexican government.\u003c/p>\n\u003cp>More recently, the British Parliament \u003ca href=\"http://www.vox.com/2016/3/17/11256594/jamie-oliver-soda-tax\" target=\"_blank\">passed a soda tax\u003c/a> just last month. \u003ca href=\"http://www.nbcphiladelphia.com/news/politics/Mayor-Jim-Kenney-Philadelphia-Soda-Tax-371956832.html\" target=\"_blank\">Philadelphia's mayor \u003c/a>has pitched a three-cents-per-ounce tax. The \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/03/09/soda-tax-is-again-before-california-legislators/\" target=\"_blank\">California legislature\u003c/a> is considering a two-cents-per-ounce tax. But multiple attempts at a tax or even a warning label have failed at the state level in recent years.\u003c/p>\n\u003cp>The taxes achieve multiple goals, advocates say, not just the obvious one to reduce consumption of sugar-sweetened beverages. The effect of a tax to \u003ca href=\"http://soda%20tax%20what%20a%20penny%20can%20do%20kqed\" target=\"_blank\">get people to switch to healthier beverages is, at best, modest\u003c/a>.\u003c/p>\n\u003cp>But the taxes also raise money and awareness. In just over a year, Berkeley's tax has already \u003ca href=\"http://www.berkeleyvsbigsoda.com/faq\" target=\"_blank\">generated more than $1.5 million \u003c/a>for nutrition and health programs.\u003c/p>\n\u003cp>[contextly_sidebar id=\"yZpoYrRYKbFsAhYAGSb8bRQ4dqMRfrax\"]Harold Goldstein, executive director of the California Center for Public Health Advocacy, has long worked on educating the public about the harms of sugar-sweetened beverages. He says \"soda tax's time has come.\"\u003c/p>\n\u003cp>\"We're at the point of no return where soda taxes are going to be sweeping the country and sweeping the world,\" he says.\u003c/p>\n\u003cp>Sugary drinks -- sodas, energy drinks and fruit-flavored beverages -- are the number one source of added sugar in the American diet. A 12-ounce can of Coke, for example, has more than nine teaspoons of added sugar. Health advocates argue that these beverages and their so-called empty calories put people at higher risk of type 2 diabetes and obesity.\u003c/p>\n\u003cp>\"So taxing soda to raise a lot of money to solve this problem is it,\" says Goldstein. \"They are a product that should be taxed so you have the revenue to solve the problem that they are causing.\"\u003c/p>\n\u003cp>The beverage industry fires back that obesity and diabetes are far more complicated problems than can be solved by taxing a single product. And the tax is regressive, they say, hitting poor people hardest. The American Beverage Association spent $9.1 million defeating the San Francisco tax and another $2.4 million fighting the Berkeley measure in 2014.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/10/15/election-2014-san-francisco-berkeley-consider-soda-taxes/\" target=\"_blank\">Some voters in Berkeley voted against the tax\u003c/a> because they did not trust city government to spend the money on health programs. Since the tax is not earmarked, governments can allocate the money however they like.\u003c/p>\n\u003cp>In Berkeley, diet drinks with very low calories, 100 percent fruit juice and most milk products are exempt from the tax. Infant formulas are exempt.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Sports drinks like Gatorade, energy drinks, sweetened teas, fruit-flavored drinks and sodas sold both in bottles and cans as well as fountain drinks are taxed.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Berkeley was the trend setter in 2014 when voters there approved the first a soda tax in the U.S. with a resounding 75 percent of the vote.\u003c/p>\n\u003cp>That same year San Francisco voters rejected a soda tax. But supporters were not deterred. Now, new efforts have resumed in San Francisco and in Oakland to move through a tax with a goal of fighting the obesity and diabetes epidemic. Both cities seem to be applying lessons from the Berkeley playbook to see the taxes through.\u003c/p>\n\u003cp>First, a bit of review: in 2014 San Franciscans considered a dedicated tax, one that would be earmarked to fund specific health programs. That kind of earmarked tax needs a two-thirds supermajority approval to become law. With 55 percent of the vote, it fell short of the threshhold.\u003c/p>\n\u003cp>Berkeley, meanwhile, had pursued a different path, one where the proceeds of a tax would go toward the city's general fund. But the law called for the creation of a health panel to advise the Berkeley City Council on appropriate programs to fund. This approach requires only a simple majority -- 50 percent plus one vote -- to pass.\u003c/p>\n\u003cp>Backers of the Berkeley soda tax also cultivated a \u003ca href=\"http://www.berkeleyvsbigsoda.com/supporters\" target=\"_blank\">long list of supporters,\u003c/a> including health organizations and grassroots groups.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That's where Oakland and San Francisco are today -- both proposals are remarkably similar to the Berkeley approach:\u003c/p>\n\u003cul>\n\u003cli>a penny per ounce fee on sugar-sweetened beverages\u003c/li>\n\u003cli>a dedicated health panel to advise city or county officials on spending\u003c/li>\n\u003cli>plenty of grassroots support\u003c/li>\n\u003cli>levied on distributors (in Berkeley much of the tax is passed through to consumers)\u003c/li>\n\u003c/ul>\n\u003cp>“We’re building a much stronger community coalition,\" says San Francisco Supervisor Malia Cohen, one of the sponsors of the 2014 effort and a backer of the current move. \"We’re taking a much more thoughtful and grassroots focused effort this time around. We have learned from errors.\"\u003c/p>\n\u003cp>Cohen says 10,000 signatures are needed by a July deadline to place the item on the San Francisco ballot. Nine-thousand people have already signed and she expects the remainder by late May, well in advance of the deadline.\u003c/p>\n\u003cp>The Oakland City Council, meanwhile, is weighing whether to directly place a soda tax on the ballot. The proposed measure will be heard in committee this Thursday. If it passes there, it goes before the full board. Adam Simons, chief of staff for City Council Member Annie Campbell Washington, one of the proponents of the ordinance, said he expects it will be approved for the November ballot.\u003c/p>\n\u003cp>\"We're feeling very confident it will move through,\" he says.\u003c/p>\n\u003cp>\u003cstrong>Mexico Was First\u003c/strong>\u003c/p>\n\u003cp>Globally, the first soda tax was in Mexico. Its tax took effect in January, 2014 -- 11 months before the Berkeley and San Francisco votes. Consumption of sugary drinks dropped 6-12 percent in the year after it was implemented and raised millions for the Mexican government.\u003c/p>\n\u003cp>More recently, the British Parliament \u003ca href=\"http://www.vox.com/2016/3/17/11256594/jamie-oliver-soda-tax\" target=\"_blank\">passed a soda tax\u003c/a> just last month. \u003ca href=\"http://www.nbcphiladelphia.com/news/politics/Mayor-Jim-Kenney-Philadelphia-Soda-Tax-371956832.html\" target=\"_blank\">Philadelphia's mayor \u003c/a>has pitched a three-cents-per-ounce tax. The \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/03/09/soda-tax-is-again-before-california-legislators/\" target=\"_blank\">California legislature\u003c/a> is considering a two-cents-per-ounce tax. But multiple attempts at a tax or even a warning label have failed at the state level in recent years.\u003c/p>\n\u003cp>The taxes achieve multiple goals, advocates say, not just the obvious one to reduce consumption of sugar-sweetened beverages. The effect of a tax to \u003ca href=\"http://soda%20tax%20what%20a%20penny%20can%20do%20kqed\" target=\"_blank\">get people to switch to healthier beverages is, at best, modest\u003c/a>.\u003c/p>\n\u003cp>But the taxes also raise money and awareness. In just over a year, Berkeley's tax has already \u003ca href=\"http://www.berkeleyvsbigsoda.com/faq\" target=\"_blank\">generated more than $1.5 million \u003c/a>for nutrition and health programs.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Harold Goldstein, executive director of the California Center for Public Health Advocacy, has long worked on educating the public about the harms of sugar-sweetened beverages. He says \"soda tax's time has come.\"\u003c/p>\n\u003cp>\"We're at the point of no return where soda taxes are going to be sweeping the country and sweeping the world,\" he says.\u003c/p>\n\u003cp>Sugary drinks -- sodas, energy drinks and fruit-flavored beverages -- are the number one source of added sugar in the American diet. A 12-ounce can of Coke, for example, has more than nine teaspoons of added sugar. Health advocates argue that these beverages and their so-called empty calories put people at higher risk of type 2 diabetes and obesity.\u003c/p>\n\u003cp>\"So taxing soda to raise a lot of money to solve this problem is it,\" says Goldstein. \"They are a product that should be taxed so you have the revenue to solve the problem that they are causing.\"\u003c/p>\n\u003cp>The beverage industry fires back that obesity and diabetes are far more complicated problems than can be solved by taxing a single product. And the tax is regressive, they say, hitting poor people hardest. The American Beverage Association spent $9.1 million defeating the San Francisco tax and another $2.4 million fighting the Berkeley measure in 2014.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/10/15/election-2014-san-francisco-berkeley-consider-soda-taxes/\" target=\"_blank\">Some voters in Berkeley voted against the tax\u003c/a> because they did not trust city government to spend the money on health programs. Since the tax is not earmarked, governments can allocate the money however they like.\u003c/p>\n\u003cp>In Berkeley, diet drinks with very low calories, 100 percent fruit juice and most milk products are exempt from the tax. Infant formulas are exempt.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Sports drinks like Gatorade, energy drinks, sweetened teas, fruit-flavored drinks and sodas sold both in bottles and cans as well as fountain drinks are taxed.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Tucked in \u003ca href=\"http://www.11alive.com/news/full-transcript-president-obama-at-atlanta-heroin-summit/108944462\" target=\"_blank\">remarks\u003c/a> the president made Tuesday on the opioid epidemic was his announcement of a new \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/03/29/presidential-memorandum-mental-health-and-substance-use-disorder-parity\" target=\"_blank\">task force on mental health parity\u003c/a> — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.\u003c/p>\n\u003caside class=\"pullquote alignright\">Advocates say parity has long been an 'empty phrase' and it has taken the administration far too long to address the problem.\u003c/aside>\n\u003cp>Despite a landmark \u003ca href=\"https://www.cms.gov/Regulations-and-Guidance/Health-Insurance-Reform/HealthInsReformforConsume/downloads/MHPAEA.pdf\" target=\"_blank\">2008 law\u003c/a> intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.\u003c/p>\n\u003cp>“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”\u003c/p>\n\u003cp>Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them.\u003c/p>\n\u003cp>“It’s better late than never, and you can’t not be grateful for the fact that we’re finally implementing a law that was passed nearly a decade ago,” said former congressman Patrick Kennedy, one of the authors of the parity law. “But it’s troubling that it’s occurring in the last year of the presidency, and that it took the administration this long to address a problem that’s been with us for many years.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In \u003ca href=\"http://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">a 2015 survey\u003c/a> by the National Alliance on Mental Illness, an advocacy group for people with mental illness and their families, many patients said they were denied payment because treatment was deemed “not medically necessary” twice as often for mental health as for other medical conditions. Only \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\" target=\"_blank\">a handful of states, including California\u003c/a> and New York, have been investigating whether insurers are complying with the parity law. Meanwhile, the federal government has taken few if any public enforcement actions, as \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\" target=\"_blank\">Kaiser Health News reported\u003c/a> last year.\u003c/p>\n\u003cp>For years, Kennedy has been traveling the country speaking about the lack of enforcement of the federal mental health parity law he helped create. One problem, he has said repeatedly, is that the administration has been hesitant to enforce a law against insurers, who were a key partner in implementing the Affordable Care Act.\u003c/p>\n\u003cp>“Even this administration, which is pro-consumer and liberal, has a tough time doing anything but dancing around issues of enforcing the law because they’re afraid to step on the insurers’ toes,” Kennedy said.\u003c/p>\n\u003cp>Tuesday’s announcement, he said, was also meager. “If the administration really wanted to be front and center on this they could have done it at the White House at a summit that would have gotten all kind of attention.”\u003c/p>\n\u003cp>Instead, he said, it was buried in an announcement of new programs and funding for opioid addiction. Also announced Tuesday were \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-03-29.html\" target=\"_blank\">the final parity rules\u003c/a> for patients with coverage under Medicaid and the Children’s Health Insurance Program (CHIP).\u003c/p>\n\u003cp>Despite the complaints of advocates and patients, insurers argue they have long been complying with parity.\u003c/p>\n\u003cp>“Our industry has long supported mental health parity and implementation of those requirements so that consumers have access to care when they need it,” Clare Krusing, a spokesperson for America’s Health Insurance Plans, the industry’s main trade group, said in a written statement. “Suggesting that coverage decisions drive the mental health challenges we face does a disservice to the ongoing efforts to improve the country’s health system for those who need behavioral health care.”\u003c/p>\n\u003cp>The interagency task force, which will be chaired by the White House’s \u003ca href=\"https://www.whitehouse.gov/administration/eop/dpc\" target=\"_blank\">Domestic Policy Council\u003c/a>, will aim to identify and promote best practices for state and federal agencies to ensure that insurers are complying with the parity law. It will consist of heads of the departments of Treasury, Justice, Labor and Health and Human Services, among others, and will be responsible for delivering a report to the President by October 31, 2016.\u003c/p>\n\u003cp>“I think anything the White House does to acknowledge the obstacles to treatment of mental illness is a step in the right direction. But frankly, another task force is a far cry from much-needed enforcement,” said Meiram Bendat, a Los Angeles-based lawyer who has filed several lawsuits against insurers alleging violations of the parity law.\u003c/p>\n\u003cp>People with mental illness and their advocates have long been aware of exactly what the problems are, he said. But rooting them out will require the task force to be “keenly attuned to social and institutional bias against patients with behavioral health problems. And that bias frequently takes the form of insurance companies effectively limiting care only to crisis and refusing to acknowledge the pervasive and long-term nature of these disorders.”\u003c/p>\n\u003cp>Provider groups widely applauded the creation of the task force.\u003c/p>\n\u003cp>“What we’re hoping is that the task force will increase the visibility of the issue and highlight its significance,” said Dr. Renée Binder, president of the American Psychiatric Association, which has identified wide variation in how well insurers are complying with the law.\u003c/p>\n\u003cp>“We would welcome the opportunity to meet with the task force as part of its outreach charge,” she said.\u003c/p>\n\u003cp>But even if parity is successfully implemented, Benjamin Miller, director of the health policy center at the University of Colorado School of Medicine, said it may be “too little, too late.”\u003c/p>\n\u003cp>“It’s simply not enough to have mental health parity – even with this change in law, there will still be access issues for patients.”\u003c/p>\n\u003cp>That’s because mental health providers often don’t have appointments readily available or won’t accept these patients’ insurance coverage, he said.\u003c/p>\n\u003cp>“While mental health parity rights a wrong, it does not change the fundamental delivery of care, which is sorely needed for increasing access to mental health,” Miller said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent project of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tucked in \u003ca href=\"http://www.11alive.com/news/full-transcript-president-obama-at-atlanta-heroin-summit/108944462\" target=\"_blank\">remarks\u003c/a> the president made Tuesday on the opioid epidemic was his announcement of a new \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/03/29/presidential-memorandum-mental-health-and-substance-use-disorder-parity\" target=\"_blank\">task force on mental health parity\u003c/a> — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.\u003c/p>\n\u003caside class=\"pullquote alignright\">Advocates say parity has long been an 'empty phrase' and it has taken the administration far too long to address the problem.\u003c/aside>\n\u003cp>Despite a landmark \u003ca href=\"https://www.cms.gov/Regulations-and-Guidance/Health-Insurance-Reform/HealthInsReformforConsume/downloads/MHPAEA.pdf\" target=\"_blank\">2008 law\u003c/a> intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.\u003c/p>\n\u003cp>“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”\u003c/p>\n\u003cp>Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them.\u003c/p>\n\u003cp>“It’s better late than never, and you can’t not be grateful for the fact that we’re finally implementing a law that was passed nearly a decade ago,” said former congressman Patrick Kennedy, one of the authors of the parity law. “But it’s troubling that it’s occurring in the last year of the presidency, and that it took the administration this long to address a problem that’s been with us for many years.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In \u003ca href=\"http://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">a 2015 survey\u003c/a> by the National Alliance on Mental Illness, an advocacy group for people with mental illness and their families, many patients said they were denied payment because treatment was deemed “not medically necessary” twice as often for mental health as for other medical conditions. Only \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\" target=\"_blank\">a handful of states, including California\u003c/a> and New York, have been investigating whether insurers are complying with the parity law. Meanwhile, the federal government has taken few if any public enforcement actions, as \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\" target=\"_blank\">Kaiser Health News reported\u003c/a> last year.\u003c/p>\n\u003cp>For years, Kennedy has been traveling the country speaking about the lack of enforcement of the federal mental health parity law he helped create. One problem, he has said repeatedly, is that the administration has been hesitant to enforce a law against insurers, who were a key partner in implementing the Affordable Care Act.\u003c/p>\n\u003cp>“Even this administration, which is pro-consumer and liberal, has a tough time doing anything but dancing around issues of enforcing the law because they’re afraid to step on the insurers’ toes,” Kennedy said.\u003c/p>\n\u003cp>Tuesday’s announcement, he said, was also meager. “If the administration really wanted to be front and center on this they could have done it at the White House at a summit that would have gotten all kind of attention.”\u003c/p>\n\u003cp>Instead, he said, it was buried in an announcement of new programs and funding for opioid addiction. Also announced Tuesday were \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-03-29.html\" target=\"_blank\">the final parity rules\u003c/a> for patients with coverage under Medicaid and the Children’s Health Insurance Program (CHIP).\u003c/p>\n\u003cp>Despite the complaints of advocates and patients, insurers argue they have long been complying with parity.\u003c/p>\n\u003cp>“Our industry has long supported mental health parity and implementation of those requirements so that consumers have access to care when they need it,” Clare Krusing, a spokesperson for America’s Health Insurance Plans, the industry’s main trade group, said in a written statement. “Suggesting that coverage decisions drive the mental health challenges we face does a disservice to the ongoing efforts to improve the country’s health system for those who need behavioral health care.”\u003c/p>\n\u003cp>The interagency task force, which will be chaired by the White House’s \u003ca href=\"https://www.whitehouse.gov/administration/eop/dpc\" target=\"_blank\">Domestic Policy Council\u003c/a>, will aim to identify and promote best practices for state and federal agencies to ensure that insurers are complying with the parity law. It will consist of heads of the departments of Treasury, Justice, Labor and Health and Human Services, among others, and will be responsible for delivering a report to the President by October 31, 2016.\u003c/p>\n\u003cp>“I think anything the White House does to acknowledge the obstacles to treatment of mental illness is a step in the right direction. But frankly, another task force is a far cry from much-needed enforcement,” said Meiram Bendat, a Los Angeles-based lawyer who has filed several lawsuits against insurers alleging violations of the parity law.\u003c/p>\n\u003cp>People with mental illness and their advocates have long been aware of exactly what the problems are, he said. But rooting them out will require the task force to be “keenly attuned to social and institutional bias against patients with behavioral health problems. And that bias frequently takes the form of insurance companies effectively limiting care only to crisis and refusing to acknowledge the pervasive and long-term nature of these disorders.”\u003c/p>\n\u003cp>Provider groups widely applauded the creation of the task force.\u003c/p>\n\u003cp>“What we’re hoping is that the task force will increase the visibility of the issue and highlight its significance,” said Dr. Renée Binder, president of the American Psychiatric Association, which has identified wide variation in how well insurers are complying with the law.\u003c/p>\n\u003cp>“We would welcome the opportunity to meet with the task force as part of its outreach charge,” she said.\u003c/p>\n\u003cp>But even if parity is successfully implemented, Benjamin Miller, director of the health policy center at the University of Colorado School of Medicine, said it may be “too little, too late.”\u003c/p>\n\u003cp>“It’s simply not enough to have mental health parity – even with this change in law, there will still be access issues for patients.”\u003c/p>\n\u003cp>That’s because mental health providers often don’t have appointments readily available or won’t accept these patients’ insurance coverage, he said.\u003c/p>\n\u003cp>“While mental health parity rights a wrong, it does not change the fundamental delivery of care, which is sorely needed for increasing access to mental health,” Miller said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Most women seeking an abortion were not deterred by a Utah law requiring a 72-hour waiting period before having the procedure, according to a recent study by the University of California, San Francisco.\u003c/p>\n\u003cp>The 2012 law requires a 72-hour waiting period and at least two medical visits before an abortion. It was the first such law in the nation, and researchers found that it added financial costs and increased logistical hassles and anxiety for the women.\u003c/p>\n\u003cp>Most women were certain in their decision to have an abortion, so the law was “unnecessary,” researchers said. It would be more appropriate to offer individual counseling for the women who were conflicted about the decision, they said.\u003c/p>\n\u003cp>“The policy just created hardship for the women, most of whom had already made decision to have an abortion,” said lead author Sarah Roberts, assistant professor at UCSF and the Advancing New Standards in Reproductive Health. “I’m a researcher, and I believe policy should be based available evidence. I hope policymakers considering waiting periods in their states will pay attention to these findings.”\u003c/p>\n\u003cp>Four other states, Missouri, Oklahoma, South Dakota, and North Carolina, enacted 72-hour requirements. Twenty-seven states have shorter waiting periods and 13 states require two visits before having an abortion, the study noted.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At four family planning facilities in Utah in 2013-2014, the researchers recruited 500 women who, as required, attended the information visit before seeking an abortion. The women completed initial surveys on an iPad.\u003c/p>\n\u003cp>Of the 309 women who also completed a follow-up survey by phone three weeks later, 86 percent went through with having an abortion, 8 percent were no longer seeking an abortion, 3 percent miscarried or discovered they had not been pregnant, and 2 percent were still seeking an abortion. One woman was undecided, and the waiting period pushed another woman beyond her abortion provider’s gestational limit so the pregnancy continued, according to the study published in the March 24 issue of \u003cem>\u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1363/48e8216/abstract\" target=\"_blank\">Perspectives on Sexual and Reproductive Health\u003c/a>\u003c/em>.\u003c/p>\n\u003cp>Utah state Rep. Steve Eliason, who sponsored the 72-hour waiting period bill, said the study’s findings did not make him question the need for the law.\u003c/p>\n\u003cp>“Nobody ever thought that everybody would change their mind,” Eliason said. “What about the some women who did? Even if it’s effective for a handful of people, what’s the rush?”\u003c/p>\n\u003cp>He questioned the validity of the study for reasons including the unidentified source of funding. Roberts said funding came from an anonymous foundation that complied with UCSF’s grant policies and that the organization was not involved at all in conducting, reviewing, writing or publishing the study.\u003c/p>\n\u003cp>Eliason said he disagreed with the study’s conclusion.\u003c/p>\n\u003cp>“The study’s ultimate conclusion is that it is unnecessary,” Eliason said. “They can have that opinion. The objective was why don’t we give women in a difficult position, sufficient time they can use to consider the facts. We will have multiple extra kindergarten classes as a result.”\u003c/p>\n\u003cp>Most of the women who changed their minds about having an abortion reported being conflicted at the initial information visit. Only 2 percent of those women said they were not conflicted at the information visit but later decided against having an abortion, the study said.\u003c/p>\n\u003cp>Even though the waiting period was 72 hours, the women had to wait much longer to have the procedure -- about eight days after their initial information visit, the study said. The delay was caused mostly by appointment availability and personal logistics.\u003c/p>\n\u003cp>The increased wait time also cost women privacy. Six percent of the women said they had to disclose that they were seeking an abortion to additional people in their lives because of the extra time and logistics involved in getting the procedure, the study said.\u003c/p>\n\u003cp>Women had to pay 10 percent more for an abortion because of the additional wait and having to make two visits, the study said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Financially, it was just hard,” a 30-year-old Idaho woman who went to Utah for the procedure wrote in the survey. “I have three children, so I couldn’t stay there during the waiting period,\" she said. “I had to make the trip, come back home and do the regular stuff, and then plan another trip.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Most women seeking an abortion were not deterred by a Utah law requiring a 72-hour waiting period before having the procedure, according to a recent study by the University of California, San Francisco.\u003c/p>\n\u003cp>The 2012 law requires a 72-hour waiting period and at least two medical visits before an abortion. It was the first such law in the nation, and researchers found that it added financial costs and increased logistical hassles and anxiety for the women.\u003c/p>\n\u003cp>Most women were certain in their decision to have an abortion, so the law was “unnecessary,” researchers said. It would be more appropriate to offer individual counseling for the women who were conflicted about the decision, they said.\u003c/p>\n\u003cp>“The policy just created hardship for the women, most of whom had already made decision to have an abortion,” said lead author Sarah Roberts, assistant professor at UCSF and the Advancing New Standards in Reproductive Health. “I’m a researcher, and I believe policy should be based available evidence. I hope policymakers considering waiting periods in their states will pay attention to these findings.”\u003c/p>\n\u003cp>Four other states, Missouri, Oklahoma, South Dakota, and North Carolina, enacted 72-hour requirements. Twenty-seven states have shorter waiting periods and 13 states require two visits before having an abortion, the study noted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At four family planning facilities in Utah in 2013-2014, the researchers recruited 500 women who, as required, attended the information visit before seeking an abortion. The women completed initial surveys on an iPad.\u003c/p>\n\u003cp>Of the 309 women who also completed a follow-up survey by phone three weeks later, 86 percent went through with having an abortion, 8 percent were no longer seeking an abortion, 3 percent miscarried or discovered they had not been pregnant, and 2 percent were still seeking an abortion. One woman was undecided, and the waiting period pushed another woman beyond her abortion provider’s gestational limit so the pregnancy continued, according to the study published in the March 24 issue of \u003cem>\u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1363/48e8216/abstract\" target=\"_blank\">Perspectives on Sexual and Reproductive Health\u003c/a>\u003c/em>.\u003c/p>\n\u003cp>Utah state Rep. Steve Eliason, who sponsored the 72-hour waiting period bill, said the study’s findings did not make him question the need for the law.\u003c/p>\n\u003cp>“Nobody ever thought that everybody would change their mind,” Eliason said. “What about the some women who did? Even if it’s effective for a handful of people, what’s the rush?”\u003c/p>\n\u003cp>He questioned the validity of the study for reasons including the unidentified source of funding. Roberts said funding came from an anonymous foundation that complied with UCSF’s grant policies and that the organization was not involved at all in conducting, reviewing, writing or publishing the study.\u003c/p>\n\u003cp>Eliason said he disagreed with the study’s conclusion.\u003c/p>\n\u003cp>“The study’s ultimate conclusion is that it is unnecessary,” Eliason said. “They can have that opinion. The objective was why don’t we give women in a difficult position, sufficient time they can use to consider the facts. We will have multiple extra kindergarten classes as a result.”\u003c/p>\n\u003cp>Most of the women who changed their minds about having an abortion reported being conflicted at the initial information visit. Only 2 percent of those women said they were not conflicted at the information visit but later decided against having an abortion, the study said.\u003c/p>\n\u003cp>Even though the waiting period was 72 hours, the women had to wait much longer to have the procedure -- about eight days after their initial information visit, the study said. The delay was caused mostly by appointment availability and personal logistics.\u003c/p>\n\u003cp>The increased wait time also cost women privacy. Six percent of the women said they had to disclose that they were seeking an abortion to additional people in their lives because of the extra time and logistics involved in getting the procedure, the study said.\u003c/p>\n\u003cp>Women had to pay 10 percent more for an abortion because of the additional wait and having to make two visits, the study said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Financially, it was just hard,” a 30-year-old Idaho woman who went to Utah for the procedure wrote in the survey. “I have three children, so I couldn’t stay there during the waiting period,\" she said. “I had to make the trip, come back home and do the regular stuff, and then plan another trip.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California plans to delay state-required warnings on metal cans lined with the chemical BPA, arguing too-specific warnings could scare stores and shoppers in poor neighborhoods away from some of the only fruits and vegetables available — canned ones, officials said Thursday.\u003c/p>\n\u003cp>The decision and rationale of the California Environmental Protection Agency are angering some community and public-health groups.\u003c/p>\n\u003cp>It's \"ridiculous. It's paternalistic,\" said Martha Dina Arguello, executive director of Physicians for Social Responsibility-Los Angeles. \"I just can't imagine that it's a better idea not to let us know what's in our food.\"\u003c/p>\n\u003cp>The warnings are coming on line in California under the state's Proposition 65, a measure approved by voters in 1986 that requires businesses to notify the public about high levels of chemicals in products or places.\u003c/p>\n\u003cp>California officials decided last year to add BPA, or bisphenol A, to the list of about 800 other chemicals requiring Proposition 65 notices. Manufacturers use BPA in epoxy liners of some cans, bottles and jars.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The state based its action on a 2008 finding by the National Toxicology Program, which determined the chemical was an estrogen-like substance that could harm the female reproductive system at high levels.\u003c/p>\n\u003cp>That 2015 decision by California is controversial. The U.S. Food and Drug Administration banned BPA from baby bottles and sippy cups in 2012, but it says the level of BPA that leeches into food is safe otherwise. The federal agency also is awaiting the results of more studies.\u003c/p>\n\u003cp>Ordinarily, the state would either require manufacturers to put those warnings on the cans, or make grocers post signs on canned-goods shelves specifically warning that \"Brand X tomato sauce, Brand Y green beans\" have the targeted chemical in the can, said Allan Hirsch, chief deputy director of the state EPA's Office of Environmental Health Hazard Assessment.\u003c/p>\n\u003cp>For BPA, though, \"we think that would be kind of chaotic,\" the state official said. \"Retailers might react ... by just pulling canned and bottled foods off their shelves entirely,\" which would be bad news in neighborhoods without good grocery stores.\u003c/p>\n\u003cp>\"We would want to make sure that people, especially in low-income communities, still have access to canned fruits and vegetables. That's certainly better than not having access to them,\" the state official said.\u003c/p>\n\u003cp>Hirsch also acknowledged hearing \"some concern from retailers\" about how the warning is going to work.\u003c/p>\n\u003cp>Kathleen Roberts, executive director of the can industry's North American Metal Packaging Alliance, said Thursday that confusion \"from these warning signs could further limit healthy choices, particularly for low-income families in inner-city neighborhoods and rural communities.\"\u003c/p>\n\u003cp>Rather than require warnings for specific cans and other goods when the warning-requirement kicks in in May, the state plans to make merchants place general notices saying some cans for sale in the store have BPA.\u003c/p>\n\u003cp>State officials foresee requiring more specific notices after perhaps a year. That would give can manufacturers more time to label their cans and to see what ongoing medical studies find regarding safe and unsafe levels of the chemicals, Hirsch said.\u003c/p>\n\u003cp>It's the state's arguments about BPA and canned vegetables in so-called food deserts — neighborhoods too poor to attract top grocery chains — that offend the community groups.\u003c/p>\n\u003cp>\"California is willingly putting out the language ... excluding a whole sub-population of people from protection,\" said Jose T. Bravo, executive director of Just Transition Alliance, an environmental health and labor coalition in San Diego.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The community representatives say they plan to file protests before a final decision by another state agency that approves such regulatory changes.\u003c/p>\n\n",
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"content": "\u003cp>Have you ever gone in for a medical procedure you knew was covered by your health plan, only to be hit weeks later by a large, unexpected bill from a doctor whose name you didn’t even recognize?\u003c/p>\n\u003cp>If so, you’re not alone. More than one in five Californians with private health insurance reported receiving “surprise” medical bills at least once over the previous two years, according to a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\">2015 Consumer Reports survey\u003c/a>.\u003c/p>\n\u003cp>Today in Sacramento, consumer advocates will launch a campaign they hope will eliminate such surprises. Legislation introduced last year by Assembly member Rob Bonta, D-Oakland, is back, after falling just three Assembly votes short of passage in 2015.\u003c/p>\n\u003cp>The California Medical Association is fighting Bonta’s bill, and it is busy preparing a plan of its own with a different approach to the problem — one that puts more of the financial onus on insurers and gives doctors a better deal.\u003c/p>\n\u003cp>At issue: the practice at many hospitals and outpatient surgery centers of using doctors not covered by a patient’s insurance plan — specialists such as anesthesiologists, pathologists and radiologists — for procedures that are otherwise covered.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Because health plans typically pay a small fraction of the charges by these “out of network” specialists, consumers get saddled with their bills. And what they charge is often a lot more than what the insurers pay their in-network docs.\u003c/p>\n\u003cp>Under Bonta’s proposal, health plans would pay these specialists more or less what they pay their covered physicians for similar care. The specialists would accept that level of payment and stop sending big bills to patients.\u003c/p>\n\u003cp>The CMA says this plan would put too big a squeeze on doctors’ pocketbooks. Instead, the association wants to set the payments in line with what the doctors charge.\u003c/p>\n\u003cp>Michael Dondero of Long Beach has experienced the unsettling feeling of coming home to a large, unexpected medical bill. He had hernia surgery last year that was pre-approved by his health plan, held in a hospital covered under the plan and performed by a physician who was also part of the covered network.\u003c/p>\n\u003cp>“And yes, it went fantastic,” Dondero said. “I’m feeling a lot better now.”\u003c/p>\n\u003cp>But about a month after the surgery, Dondero received something that didn’t make him feel so good: an unexpected bill for $771. It turned out the anesthesiologist on duty during his procedure was not covered by his insurance.\u003c/p>\n\u003cp>“To me it was a real eye-opener,” Dondero said. “I just assumed an in-network procedure at an in-network hospital would be covered. But you know what happens when we assume.”\u003c/p>\n\u003cp>Dondero appealed to his insurance company, and after a month of back and forth letters and phone calls, he ended up paying a much smaller amount.\u003c/p>\n\u003cp>Both the Bonta bill and the proposal being drafted by the physicians’ association share the goal of ensuring that patients won’t get the kind of unwanted surprise that landed in Dondero’s mailbox.\u003c/p>\n\u003cp>But after that, the plans diverge. Bonta’s plan is more palatable to the health plans than the one being crafted by the medical association, which would claw back the financial advantage for specialist doctors.\u003c/p>\n\u003cp>Many specialists say the benchmark established by Bonta’s bill is far too low, claiming it would cut physician compensation by two-thirds.\u003c/p>\n\u003cp>In Bonta’s plan, physicians who think they were underpaid can appeal through an independent review.\u003c/p>\n\u003cp>Still, the medical association argues that the bill essentially penalizes doctors for insurer networks that are too small to meet the needs of patients. Doctors should not be forced to pick up the slack when health plans don’t have enough specialists to perform the medical services they’ve promised to cover, the association says.\u003c/p>\n\u003cp>Janus Norman, a senior vice president of the CMA, says the Bonta bill would create a disincentive for health plans to negotiate reasonable rates with providers.\u003c/p>\n\u003cp>The crux, Norman said, is whether surprise bills are ultimately the responsibility of the health plans or the doctors who generate them.\u003c/p>\n\u003cp>Bonta said the argument is not that simple, and that he has spent a year trying to find the middle ground between insurers and physicians.\u003c/p>\n\u003cp>“The challenge has always been getting reimbursed appropriately, and that’s where the fight has been,” Bonta said. “It’s not fully within the ambit of plans to determine who’s in the network, and it’s not fully in the ambit of providers to determine that.”\u003c/p>\n\u003cp>But one thing is clear, he said: “You can’t punish the patient if they do everything right. They schedule it in advance; it’s in the network. It’s not on the patient to find out which providers that day are in the network or not.”\u003c/p>\n\u003cp>Health Access California, a consumer advocacy group based in Sacramento that is sponsoring the Bonta bill, expects to announce today that the California Labor Federation has signed on as co-sponsor. Anthony Wright, executive director of Health Access, said he hopes this expanded support will help tip the scale in favor of the bill’s passage.\u003c/p>\n\u003cp>Wright argued that physicians bear a substantial share of responsibility for the surprise bill problem, and that they have stood in the way of fixing it. So now they should be willing to work out an arrangement that suits everyone, he said.\u003c/p>\n\u003cp>“We are working to end surprise billing, yet the California Medical Association has delayed and held that process hostage for a year to demand high reimbursement rates for its members,” Wright said. “We’ve put a lot of options on the table, and CMA has rejected all of them.”\u003c/p>\n\u003cp>Norman countered that doctors do want to fix the problem, but that the cause of it is the increasingly restricted choice of providers offered by health plans.\u003c/p>\n\u003cp>The medical association’s plan to get higher rates for doctors, based on an average of what similar physicians charge, is a method already employed in other states, including New York and Connecticut.\u003c/p>\n\u003cp>Bill Barcellona, chief lobbyist at the California Association of Provider Groups, which represents physicians that negotiate with insurance companies, said the proposal could throw the payment system out of whack, with some physicians receiving rates “200 percent higher” than what they currently get.\u003c/p>\n\u003cp>Bonta said he hopes to negotiate a compromise but won’t tolerate an attempt by the medical association to push its own agenda at the risk of undermining the main objective of eliminating surprise bills for consumers.\u003c/p>\n\u003cp>He said he is prepared to counter the competing proposal from the association, if necessary, by pushing his own bill through quickly — possibly as early as April.\u003c/p>\n\u003cp>“It isn’t my preference to push this over the finish line, but we will do that if we’re pushed,” he said.\u003c/p>\n\u003cp>Dondero said his surprise bill blindsided him a little, but that in retrospect it shouldn’t have. He urged others to contest such bills, like he did.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I think usually when other people get that bill, they just pay it,” he said. “But you can fight it. The thing is, you don’t take ‘no’ for an answer the first go-round.”\u003c/p>\n\n",
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"excerpt": "Legislation fell three votes short last year. New push pits consumer advocates and health plans against major doctors' group.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Have you ever gone in for a medical procedure you knew was covered by your health plan, only to be hit weeks later by a large, unexpected bill from a doctor whose name you didn’t even recognize?\u003c/p>\n\u003cp>If so, you’re not alone. More than one in five Californians with private health insurance reported receiving “surprise” medical bills at least once over the previous two years, according to a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/07/nearly-1-in-4-californians-hit-by-surprise-medical-bills/\" target=\"_blank\">2015 Consumer Reports survey\u003c/a>.\u003c/p>\n\u003cp>Today in Sacramento, consumer advocates will launch a campaign they hope will eliminate such surprises. Legislation introduced last year by Assembly member Rob Bonta, D-Oakland, is back, after falling just three Assembly votes short of passage in 2015.\u003c/p>\n\u003cp>The California Medical Association is fighting Bonta’s bill, and it is busy preparing a plan of its own with a different approach to the problem — one that puts more of the financial onus on insurers and gives doctors a better deal.\u003c/p>\n\u003cp>At issue: the practice at many hospitals and outpatient surgery centers of using doctors not covered by a patient’s insurance plan — specialists such as anesthesiologists, pathologists and radiologists — for procedures that are otherwise covered.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Because health plans typically pay a small fraction of the charges by these “out of network” specialists, consumers get saddled with their bills. And what they charge is often a lot more than what the insurers pay their in-network docs.\u003c/p>\n\u003cp>Under Bonta’s proposal, health plans would pay these specialists more or less what they pay their covered physicians for similar care. The specialists would accept that level of payment and stop sending big bills to patients.\u003c/p>\n\u003cp>The CMA says this plan would put too big a squeeze on doctors’ pocketbooks. Instead, the association wants to set the payments in line with what the doctors charge.\u003c/p>\n\u003cp>Michael Dondero of Long Beach has experienced the unsettling feeling of coming home to a large, unexpected medical bill. He had hernia surgery last year that was pre-approved by his health plan, held in a hospital covered under the plan and performed by a physician who was also part of the covered network.\u003c/p>\n\u003cp>“And yes, it went fantastic,” Dondero said. “I’m feeling a lot better now.”\u003c/p>\n\u003cp>But about a month after the surgery, Dondero received something that didn’t make him feel so good: an unexpected bill for $771. It turned out the anesthesiologist on duty during his procedure was not covered by his insurance.\u003c/p>\n\u003cp>“To me it was a real eye-opener,” Dondero said. “I just assumed an in-network procedure at an in-network hospital would be covered. But you know what happens when we assume.”\u003c/p>\n\u003cp>Dondero appealed to his insurance company, and after a month of back and forth letters and phone calls, he ended up paying a much smaller amount.\u003c/p>\n\u003cp>Both the Bonta bill and the proposal being drafted by the physicians’ association share the goal of ensuring that patients won’t get the kind of unwanted surprise that landed in Dondero’s mailbox.\u003c/p>\n\u003cp>But after that, the plans diverge. Bonta’s plan is more palatable to the health plans than the one being crafted by the medical association, which would claw back the financial advantage for specialist doctors.\u003c/p>\n\u003cp>Many specialists say the benchmark established by Bonta’s bill is far too low, claiming it would cut physician compensation by two-thirds.\u003c/p>\n\u003cp>In Bonta’s plan, physicians who think they were underpaid can appeal through an independent review.\u003c/p>\n\u003cp>Still, the medical association argues that the bill essentially penalizes doctors for insurer networks that are too small to meet the needs of patients. Doctors should not be forced to pick up the slack when health plans don’t have enough specialists to perform the medical services they’ve promised to cover, the association says.\u003c/p>\n\u003cp>Janus Norman, a senior vice president of the CMA, says the Bonta bill would create a disincentive for health plans to negotiate reasonable rates with providers.\u003c/p>\n\u003cp>The crux, Norman said, is whether surprise bills are ultimately the responsibility of the health plans or the doctors who generate them.\u003c/p>\n\u003cp>Bonta said the argument is not that simple, and that he has spent a year trying to find the middle ground between insurers and physicians.\u003c/p>\n\u003cp>“The challenge has always been getting reimbursed appropriately, and that’s where the fight has been,” Bonta said. “It’s not fully within the ambit of plans to determine who’s in the network, and it’s not fully in the ambit of providers to determine that.”\u003c/p>\n\u003cp>But one thing is clear, he said: “You can’t punish the patient if they do everything right. They schedule it in advance; it’s in the network. It’s not on the patient to find out which providers that day are in the network or not.”\u003c/p>\n\u003cp>Health Access California, a consumer advocacy group based in Sacramento that is sponsoring the Bonta bill, expects to announce today that the California Labor Federation has signed on as co-sponsor. Anthony Wright, executive director of Health Access, said he hopes this expanded support will help tip the scale in favor of the bill’s passage.\u003c/p>\n\u003cp>Wright argued that physicians bear a substantial share of responsibility for the surprise bill problem, and that they have stood in the way of fixing it. So now they should be willing to work out an arrangement that suits everyone, he said.\u003c/p>\n\u003cp>“We are working to end surprise billing, yet the California Medical Association has delayed and held that process hostage for a year to demand high reimbursement rates for its members,” Wright said. “We’ve put a lot of options on the table, and CMA has rejected all of them.”\u003c/p>\n\u003cp>Norman countered that doctors do want to fix the problem, but that the cause of it is the increasingly restricted choice of providers offered by health plans.\u003c/p>\n\u003cp>The medical association’s plan to get higher rates for doctors, based on an average of what similar physicians charge, is a method already employed in other states, including New York and Connecticut.\u003c/p>\n\u003cp>Bill Barcellona, chief lobbyist at the California Association of Provider Groups, which represents physicians that negotiate with insurance companies, said the proposal could throw the payment system out of whack, with some physicians receiving rates “200 percent higher” than what they currently get.\u003c/p>\n\u003cp>Bonta said he hopes to negotiate a compromise but won’t tolerate an attempt by the medical association to push its own agenda at the risk of undermining the main objective of eliminating surprise bills for consumers.\u003c/p>\n\u003cp>He said he is prepared to counter the competing proposal from the association, if necessary, by pushing his own bill through quickly — possibly as early as April.\u003c/p>\n\u003cp>“It isn’t my preference to push this over the finish line, but we will do that if we’re pushed,” he said.\u003c/p>\n\u003cp>Dondero said his surprise bill blindsided him a little, but that in retrospect it shouldn’t have. 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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"meta": {
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"id": "fresh-air",
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"hidden-brain": {
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"how-i-built-this": {
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"hyphenacion": {
"id": "hyphenacion",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
},
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},
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"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"meta": {
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"rss": "https://rss.art19.com/masters-of-scale"
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},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. 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": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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},
"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. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
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"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
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"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. 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. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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},
"link": "/radio/program/on-the-media",
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"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
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},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
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},
"link": "/radio/program/pbs-newshour",
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"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
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"officialWebsiteLink": "/perspectives/",
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"source": "kqed",
"order": 14
},
"link": "/perspectives",
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"npr": "https://www.npr.org/podcasts/432309616/perspectives",
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"planet-money": {
"id": "planet-money",
"title": "Planet Money",
"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
"officialWebsiteLink": "https://www.npr.org/sections/money/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/planet-money",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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"rss": "https://feeds.npr.org/510289/podcast.xml"
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},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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