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"content": "\u003cp>Modoc County, in the northeast corner of California, is roughly the size of Connecticut. It's so sparsely populated, the entire county has just one stoplight. The nearest Wal-Mart is more than an hour's drive, across the Oregon border. Same with hospitals that deliver babies.\u003c/p>\n\u003cp>Greta Elliott runs a tiny health \u003ca href=\"http://canbyclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">clinic\u003c/a> in Canby, on the edge of the national forest. \"Rural\" doesn’t begin to describe the area, she says. This is \"the frontier.\"\u003c/p>\n\u003cp>“There are more cows in Modoc than there are people,” Elliott says.\u003c/p>\n\u003cp>There's a frontier mentality, too. People take care of each other, and they take care of themselves. They don’t like being told what to do. Being forced to buy insurance made Obamacare a dirty word.\u003c/p>\n\u003cp>Even Elliott, the head of a health clinic, decided against buying coverage for herself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It's too expensive,” she says. “I choose to put my money back into paying the bills of the whole family.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-28a-tcr.mp3\" Image=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/03/BloodPressure-768x512.jpg\" Title=\"Obamacare Inspires Unlikely Political Action in Red California\" program=\"The California Report\"]\u003c/p>\n\u003cp>Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents.\u003c/p>\n\u003cp>“The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That’s the irony,” says Dean Germano, CEO of the \u003ca href=\"https://www.shastahealth.org\" target=\"_blank\" rel=\"noopener noreferrer\">Shasta Community Health Center\u003c/a>. “These are places that voted much more heavily for Donald Trump.”\u003c/p>\n\u003cp>In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.\u003c/p>\n\u003cp>But now a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of clinics from across the Northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend Obamacare.\u003c/p>\n\u003cp>And the right-leaning Shasta County Board of Supervisors took them up on it.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Nl4j8x6j7iRmpWflZsVooGaqsbbbOLuA\"]\u003c/p>\n\u003cp>“We thought ‘Whoa! That is really bold,’” Germano says. “I was surprised.”\u003c/p>\n\u003cp>The board sent a letter to the local Republican congressman, \u003ca href=\"https://lamalfa.house.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Doug La Malfa\u003c/a>, asking him to vote against the initial GOP repeal and replace bill, because it would hurt local people.\u003c/p>\n\u003cp>“We have an obligation to say something,” says Supervisor David Kehoe. “And if it may be mildly offensive from a political standpoint for some, well, we’re not going to be intimidated by politics.”\u003c/p>\n\u003cp>But Congressman La Malfa still voted in favor of dismantling Obamacare.\u003c/p>\n\u003cp>La Malfa didn't return calls and emails for this story, but, in May, \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">he told KQED\u003c/a> that skyrocketing premiums were the main driver behind his vote.\u003c/p>\n\u003cp>\"Unfortunately, the reality is that too many young and healthy individuals are deciding they’d rather pay the penalty than sign up for care, citing financial barriers and lack of choice,\" he said in a statement. \"A 28 year old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.\"\u003c/p>\n\u003cp>When clinic representatives met with La Malfa's staffers, they were told the Congressman's office was flooded with calls like this.\u003c/p>\n\u003cp>But poor folks on Medi-Cal didn’t call to say how much they appreciate that program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.\u003c/p>\n\u003cp>“They feel like it's a handout and they're too proud, they don’t want to,” says Carol Morris, an enrollment counselor for the \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys\u003c/a> health clinics in Shasta county.\u003c/p>\n\u003cp>One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">\"Partnership Health Plan\" \u003c/a>and may not realize they’re actually covered by a government program.\u003c/p>\n\u003cp>“It feels like it's more of an insurance,” Morris says. “It’s like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card.”\u003c/p>\n\u003cp>One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.\u003c/p>\n\u003cp>“It did me good,” she says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"swxoiuaBwIFNHC8PbxRB3kfDYxOKFLOH\"]\u003c/p>\n\u003cp>Now she has a subsidized commercial plan through Covered California, with modest premiums and co-pays, and she likes that, too.\u003c/p>\n\u003cp>“It’s okay. 'Cause I’m at the doctor’s at least once a month,” she says.\u003c/p>\n\u003cp>But when asked what she thinks of Obamacare overall, she says she doesn’t like it.\u003c/p>\n\u003cp>“Because of Obama himself,” she says with a laugh. “I rest my case.”\u003c/p>\n\u003cp>The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.\u003c/p>\n\u003cp>“People just don't understand the different names,” she says. “But, of course, it's the same thing.”\u003c/p>\n\u003cp>Morris has seen the difference Obamacare has made for people in the region. She’s seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn’t have gotten.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Those patients won’t fight for Obamacare, Morris says, so that’s why the clinics have to.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents.\u003c/p>\n\u003cp>“The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That’s the irony,” says Dean Germano, CEO of the \u003ca href=\"https://www.shastahealth.org\" target=\"_blank\" rel=\"noopener noreferrer\">Shasta Community Health Center\u003c/a>. “These are places that voted much more heavily for Donald Trump.”\u003c/p>\n\u003cp>In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.\u003c/p>\n\u003cp>But now a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of clinics from across the Northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend Obamacare.\u003c/p>\n\u003cp>And the right-leaning Shasta County Board of Supervisors took them up on it.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“We thought ‘Whoa! That is really bold,’” Germano says. “I was surprised.”\u003c/p>\n\u003cp>The board sent a letter to the local Republican congressman, \u003ca href=\"https://lamalfa.house.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Doug La Malfa\u003c/a>, asking him to vote against the initial GOP repeal and replace bill, because it would hurt local people.\u003c/p>\n\u003cp>“We have an obligation to say something,” says Supervisor David Kehoe. “And if it may be mildly offensive from a political standpoint for some, well, we’re not going to be intimidated by politics.”\u003c/p>\n\u003cp>But Congressman La Malfa still voted in favor of dismantling Obamacare.\u003c/p>\n\u003cp>La Malfa didn't return calls and emails for this story, but, in May, \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">he told KQED\u003c/a> that skyrocketing premiums were the main driver behind his vote.\u003c/p>\n\u003cp>\"Unfortunately, the reality is that too many young and healthy individuals are deciding they’d rather pay the penalty than sign up for care, citing financial barriers and lack of choice,\" he said in a statement. \"A 28 year old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.\"\u003c/p>\n\u003cp>When clinic representatives met with La Malfa's staffers, they were told the Congressman's office was flooded with calls like this.\u003c/p>\n\u003cp>But poor folks on Medi-Cal didn’t call to say how much they appreciate that program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.\u003c/p>\n\u003cp>“They feel like it's a handout and they're too proud, they don’t want to,” says Carol Morris, an enrollment counselor for the \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys\u003c/a> health clinics in Shasta county.\u003c/p>\n\u003cp>One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">\"Partnership Health Plan\" \u003c/a>and may not realize they’re actually covered by a government program.\u003c/p>\n\u003cp>“It feels like it's more of an insurance,” Morris says. “It’s like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card.”\u003c/p>\n\u003cp>One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.\u003c/p>\n\u003cp>“It did me good,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Now she has a subsidized commercial plan through Covered California, with modest premiums and co-pays, and she likes that, too.\u003c/p>\n\u003cp>“It’s okay. 'Cause I’m at the doctor’s at least once a month,” she says.\u003c/p>\n\u003cp>But when asked what she thinks of Obamacare overall, she says she doesn’t like it.\u003c/p>\n\u003cp>“Because of Obama himself,” she says with a laugh. “I rest my case.”\u003c/p>\n\u003cp>The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.\u003c/p>\n\u003cp>“People just don't understand the different names,” she says. “But, of course, it's the same thing.”\u003c/p>\n\u003cp>Morris has seen the difference Obamacare has made for people in the region. She’s seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn’t have gotten.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Those patients won’t fight for Obamacare, Morris says, so that’s why the clinics have to.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>People in the state’s health industry, from advocates to clinic directors, were left reeling by the new CBO report, which estimated the Senate Republican health plan would create an additional 22 million uninsured Americans by 2026.\u003c/p>\n\u003cp>“Nowhere are the dangers greater than in California, where our Medicaid program (Medi-Cal) covers more than one in three state residents,” said Sandra R. Hernández, president and CEO of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation.\u003c/a>\u003c/p>\n\u003cp>The Republican bill would radically cut federal funding for Medicaid, even more deeply than what was proposed in the House bill. It would also decrease subsidies for Americans who buy their own insurance on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>, but that’s a smaller group, about 1.7 million residents, compared to the 13.5 million residents covered by Medi-Cal.\u003c/p>\n\u003cp>“More Californians will likely delay or defer necessary care, and when they show up at clinics and emergency rooms, they will likely be sicker and costlier to treat,” Hernandez predicted.\u003c/p>\n\u003cp>“States, communities, and families will be forced to make unthinkable choices about providing necessary care for their loved ones,\" she added.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under the Senate plan, most consumers who shop for subsidized plans on Covered California would see their out-of-pocket costs rise, while also receiving less financial assistance to compensate. In San Francisco, a 60-year-old who earns $30,000 a year would be facing an out-of-pocket premium of $5,570 a year, more than double what she paid under the Affordable Care Act, according to an \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> by the Kaiser Family Foundation.\u003c/p>\n\u003cp>But a 27-year-old in San Francisco making $40,000 a year would see premiums decrease by 12 percent.\u003c/p>\n\u003cp>In general, older consumers would pay more under the Senate plan, because the bill allows insurers to charge them five times as much as younger people, but also because the subsidy they get decreases by almost $1,000 a year.\u003c/p>\n\u003cp>When it comes to the impacts on Medi-Cal, which covers the lower-income residents, people with disabilities, and many seniors, rural California would bear the brunt, said Doreen Bradshaw, executive director of a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of health clinics in northern California.\u003c/p>\n\u003cp>“If you look at a map, 44 out of 58 counties in California are rural,” she said. “We need to maintain [Medicaid] for rural America. This has the potential to be very devastating.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The state’s rural counties provide food, timber, and water for the rest of California and the rest of the country. Bradshaw said cutting health care for rural California workers would have a negative ripple effect on the national economy.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>People in the state’s health industry, from advocates to clinic directors, were left reeling by the new CBO report, which estimated the Senate Republican health plan would create an additional 22 million uninsured Americans by 2026.\u003c/p>\n\u003cp>“Nowhere are the dangers greater than in California, where our Medicaid program (Medi-Cal) covers more than one in three state residents,” said Sandra R. Hernández, president and CEO of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation.\u003c/a>\u003c/p>\n\u003cp>The Republican bill would radically cut federal funding for Medicaid, even more deeply than what was proposed in the House bill. It would also decrease subsidies for Americans who buy their own insurance on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>, but that’s a smaller group, about 1.7 million residents, compared to the 13.5 million residents covered by Medi-Cal.\u003c/p>\n\u003cp>“More Californians will likely delay or defer necessary care, and when they show up at clinics and emergency rooms, they will likely be sicker and costlier to treat,” Hernandez predicted.\u003c/p>\n\u003cp>“States, communities, and families will be forced to make unthinkable choices about providing necessary care for their loved ones,\" she added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under the Senate plan, most consumers who shop for subsidized plans on Covered California would see their out-of-pocket costs rise, while also receiving less financial assistance to compensate. In San Francisco, a 60-year-old who earns $30,000 a year would be facing an out-of-pocket premium of $5,570 a year, more than double what she paid under the Affordable Care Act, according to an \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> by the Kaiser Family Foundation.\u003c/p>\n\u003cp>But a 27-year-old in San Francisco making $40,000 a year would see premiums decrease by 12 percent.\u003c/p>\n\u003cp>In general, older consumers would pay more under the Senate plan, because the bill allows insurers to charge them five times as much as younger people, but also because the subsidy they get decreases by almost $1,000 a year.\u003c/p>\n\u003cp>When it comes to the impacts on Medi-Cal, which covers the lower-income residents, people with disabilities, and many seniors, rural California would bear the brunt, said Doreen Bradshaw, executive director of a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of health clinics in northern California.\u003c/p>\n\u003cp>“If you look at a map, 44 out of 58 counties in California are rural,” she said. “We need to maintain [Medicaid] for rural America. This has the potential to be very devastating.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The state’s rural counties provide food, timber, and water for the rest of California and the rest of the country. Bradshaw said cutting health care for rural California workers would have a negative ripple effect on the national economy.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "CHART: Who Wins, Who Loses With Senate Health Care Bill",
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"content": "\u003cp>Senate Republicans on Thursday \u003ca href=\"https://apps.npr.org/documents/document.html?id=3872487-SenateHCBill\">unveiled their plan\u003c/a> to repeal and replace the Affordable Care Act — also known as Obamacare. The long-awaited plan marks a big step toward achieving one of the Republican Party's major goals. (Story continues below chart.)\u003c/p>\n\u003cp>[ACACompare]\u003c/p>\n\u003cp>The Senate proposal is broadly similar to the bill passed by House Republicans last month, with a few notable differences. Senate Majority Leader Mitch McConnell, who has been criticized for drafting the bill in secret with just a dozen Republican Senate colleagues, says the proposal — which he calls a discussion draft — will stabilize insurance markets, strengthen Medicaid and cut costs to consumers.\u003c/p>\n\u003cp>\"We agreed on the need to free Americans from Obamacare's mandates. And policies contained in the discussion draft will repeal the individual mandates so Americans are no longer forced to buy insurance they don't need or can't afford,\" McConnell said.\u003c/p>\n\u003cp>Instead, the bill entices people to voluntarily buy a policy by offering them tax credits based on age and income to help pay premiums.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This bill is better designed than the House version, according to \u003ca href=\"https://medium.com/@avik\">Avik Roy\u003c/a>, founder of the Foundation for Research on Equal Opportunity, because it offers more help to older people who can't afford insurance while making coverage cheaper for young healthy people.\u003c/p>\n\u003cp>\"The bill will encourage a lot more of those individuals to buy health insurance,\" Roy says. \"That, in turn, will make the risk pool much healthier, which will also lower premiums. And the tax credits in the bill will also be better-designed.\"\u003c/p>\n\u003cp>But Caroline Pearson, a senior vice president at the consulting firm Avalere Health, says the bill bases its tax credits on lower-quality insurance.\"If you're paying a similar percentage of income, you're getting a less generous product under this new plan,\" she says.\u003c/p>\n\u003cp>The plan keeps some popular parts of Obamacare. It allows parents keep their children on their policies until age 26 and requires insurers to cover people with pre-existing conditions.\u003c/p>\n\u003cp>But it then allows states to opt out of that requirement.\u003c/p>\n\u003cp>\"The protections around pre-existing conditions are still in place in the Senate bill, but the waiver authority gives states options that could include limiting coverage for people with pre-existing conditions,\" says Pearson.\u003c/p>\n\u003cp>Those waivers would allow state to drop benefits \u003ca href=\"https://www.healthcare.gov/coverage/what-marketplace-plans-cover/\">required by Obamacare\u003c/a>, such as maternity coverage, mental health care and prescription drug coverage.\u003c/p>\n\u003cp>Both bills would eliminate most of the taxes imposed by the Affordable Care Act.\u003c/p>\n\u003cp>And they would bar people from using tax credits to buy policies that pay for abortion and also block Planned Parenthood from getting any money from Medicaid for a year.\u003c/p>\n\u003cp>Perhaps the most sweeping move, however, is that the Senate plan follows the House lead in completely changing how the government pays for health care for the poor and the disabled — and goes even further.\u003c/p>\n\u003cp>Today, Medicaid pays for all the care people need, and state and federal governments share the cost.\u003c/p>\n\u003cp>But Medicaid has been eating up an ever-larger share of federal spending. The Senate Republicans' plan puts a lid on that by rolling back the Obama-era expansion of the program and then granting states a set amount of money for each person enrolled. Republicans also want to change the way the federal government calculates payments to the states starting in 2025, reducing the federal government's contribution to the states.\u003c/p>\n\u003cp>\"The Medicaid cuts are even more draconian that the House bill was, though they take effect more gradually than the House bill did,\" Pearson says. \"So we're going to see very significant reductions in coverage in Medicaid and big cuts in federal funding that will result in significant budget gaps for states.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Several Republican senators have already said they oppose the bill, at least as of now. Senate leaders are aiming for a vote before July 4.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CHART%3A+Who+Wins%2C+Who+Loses+With+Senate+Health+Care+Bill&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Senate Republicans on Thursday \u003ca href=\"https://apps.npr.org/documents/document.html?id=3872487-SenateHCBill\">unveiled their plan\u003c/a> to repeal and replace the Affordable Care Act — also known as Obamacare. The long-awaited plan marks a big step toward achieving one of the Republican Party's major goals. (Story continues below chart.)\u003c/p>\n\u003cp>[ACACompare]\u003c/p>\n\u003cp>The Senate proposal is broadly similar to the bill passed by House Republicans last month, with a few notable differences. Senate Majority Leader Mitch McConnell, who has been criticized for drafting the bill in secret with just a dozen Republican Senate colleagues, says the proposal — which he calls a discussion draft — will stabilize insurance markets, strengthen Medicaid and cut costs to consumers.\u003c/p>\n\u003cp>\"We agreed on the need to free Americans from Obamacare's mandates. And policies contained in the discussion draft will repeal the individual mandates so Americans are no longer forced to buy insurance they don't need or can't afford,\" McConnell said.\u003c/p>\n\u003cp>Instead, the bill entices people to voluntarily buy a policy by offering them tax credits based on age and income to help pay premiums.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This bill is better designed than the House version, according to \u003ca href=\"https://medium.com/@avik\">Avik Roy\u003c/a>, founder of the Foundation for Research on Equal Opportunity, because it offers more help to older people who can't afford insurance while making coverage cheaper for young healthy people.\u003c/p>\n\u003cp>\"The bill will encourage a lot more of those individuals to buy health insurance,\" Roy says. \"That, in turn, will make the risk pool much healthier, which will also lower premiums. And the tax credits in the bill will also be better-designed.\"\u003c/p>\n\u003cp>But Caroline Pearson, a senior vice president at the consulting firm Avalere Health, says the bill bases its tax credits on lower-quality insurance.\"If you're paying a similar percentage of income, you're getting a less generous product under this new plan,\" she says.\u003c/p>\n\u003cp>The plan keeps some popular parts of Obamacare. It allows parents keep their children on their policies until age 26 and requires insurers to cover people with pre-existing conditions.\u003c/p>\n\u003cp>But it then allows states to opt out of that requirement.\u003c/p>\n\u003cp>\"The protections around pre-existing conditions are still in place in the Senate bill, but the waiver authority gives states options that could include limiting coverage for people with pre-existing conditions,\" says Pearson.\u003c/p>\n\u003cp>Those waivers would allow state to drop benefits \u003ca href=\"https://www.healthcare.gov/coverage/what-marketplace-plans-cover/\">required by Obamacare\u003c/a>, such as maternity coverage, mental health care and prescription drug coverage.\u003c/p>\n\u003cp>Both bills would eliminate most of the taxes imposed by the Affordable Care Act.\u003c/p>\n\u003cp>And they would bar people from using tax credits to buy policies that pay for abortion and also block Planned Parenthood from getting any money from Medicaid for a year.\u003c/p>\n\u003cp>Perhaps the most sweeping move, however, is that the Senate plan follows the House lead in completely changing how the government pays for health care for the poor and the disabled — and goes even further.\u003c/p>\n\u003cp>Today, Medicaid pays for all the care people need, and state and federal governments share the cost.\u003c/p>\n\u003cp>But Medicaid has been eating up an ever-larger share of federal spending. The Senate Republicans' plan puts a lid on that by rolling back the Obama-era expansion of the program and then granting states a set amount of money for each person enrolled. Republicans also want to change the way the federal government calculates payments to the states starting in 2025, reducing the federal government's contribution to the states.\u003c/p>\n\u003cp>\"The Medicaid cuts are even more draconian that the House bill was, though they take effect more gradually than the House bill did,\" Pearson says. \"So we're going to see very significant reductions in coverage in Medicaid and big cuts in federal funding that will result in significant budget gaps for states.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Several Republican senators have already said they oppose the bill, at least as of now. Senate leaders are aiming for a vote before July 4.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CHART%3A+Who+Wins%2C+Who+Loses+With+Senate+Health+Care+Bill&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
"title": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
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"content": "\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>State senators voted mostly along party lines, 23-14, to pass a bill that would create a state-managed health care system for all 39 million Californians – even though the bill was missing key details, namely, how to pay for it.\u003c/p>\n\u003cp>Opponents of the “Healthy California Act” repeatedly drew comparisons to the rushed Republican House bill to repeal and replace the Affordable Care Act in Washington, DC. They said state Democrats were guilty of the same tactics, pushing their bill on a single payer health system without a funding mechanism.\u003c/p>\n\u003cp>“It’s not cooked,” Sen. Jeff Stone, R-Temecula, said of the bill. “It’s raw meat.”\u003c/p>\n\u003cp>Senate Bill 596 would upend the state’s employer-based health insurance system and replace it with a “Medicare-for-all” single payer system run by the state.\u003c/p>\n\u003cp>Supporters admitted that the bill is a work in progress, but urged passage as a way to continue the debate, especially in light of uncertainty around billions of dollars in federal funding tied to the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The message to those people who say we’re irresponsible, I tell you, do not don’t judge us based upon a vote in a day,” said Sen. Bob Hertzberg, D-Los Angeles. “Judge us based upon our work at the end of the day.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz.\"\u003cbr>\n\u003ccite>Sen. John Moorlach, R-Costa Mesa\u003c/cite>\u003c/aside>\n\u003cp>How to pay for the new system – estimated to cost $400 billion a year – was the main point of contention, with several lawmakers arguing the state’s finances were already strapped.\u003c/p>\n\u003cp>\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz,\" said Sen. John Moorlach, R-Costa Mesa.\u003c/p>\n\u003cp>No specific funding plan was included in the bill, but an economic analysis by the University of Massachusetts-Amherst, commissioned by the bill’s sponsors, assumed two-thirds of the funding would come from existing federal and state funds that currently pay for Medicare and Medi-Cal, and the rest would come from either a payroll tax, or a combination of a 2.3 percent gross receipts tax on business revenue above $2 million and a 2.3 percent sales tax.\u003c/p>\n\u003cp>The health insurance industry criticized the financial assumptions in the report as “overly optimistic.\" Business groups called the taxes a “job killer” and lawmakers raised concerns on the Senate floor that the Trump administration would not allow the state, which has identified itself as a part of the Trump resistance, to re-apply those funds to a single payer system.\u003c/p>\n\u003cp>“We’re going to kick the crap out of Trump day in and day out on this floor, then we’re going to go beg him for a couple hundred billion dollars?” said Sen. Tom Berryhill, R-Twain Harte. “Should be an interesting ask.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“They are fighting to limit care and we’re fighting to expand it.”\u003cbr>\n\u003ccite>Sen. Ricardo Lara, D-Bell Gardens \u003c/cite>\u003c/aside>\n\u003cp>The bill’s primary author, Sen. Ricardo Lara, D-Bell Gardens, thanked his colleagues for a robust debate. He took copious notes, and even accepted critics’ comparison to him pushing his unfinished bill with the Republicans’ hasty passage of the repeal and replace Obamacare bill.\u003c/p>\n\u003cp>“But there is one fundamental difference,” Lara said. “They are fighting to limit care and we’re fighting to expand it.”\u003c/p>\n\u003cp>Because the bill is on a two-year legislative cycle, Lara has another year and half to work out the details of the funding plan. Getting it passed through the Senate gives him extra momentum to bring other stakeholders in on the debate, including, perhaps, Gov. Jerry Brown, who has indicated he would veto a single payer bill.\u003c/p>\n\u003cp>Lara vowed to work with lawmakers on both sides of the aisle going forward, and committed to having a transparent debate.\u003c/p>\n\u003cp>“For the countless people that still do not have access to care, and are still making the decision about putting food on their table or buying prescription drugs because they cannot afford them, we are going to put our minds together to ensure that we bring back a product that is fiscally prudent and sustainable.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>State senators voted mostly along party lines, 23-14, to pass a bill that would create a state-managed health care system for all 39 million Californians – even though the bill was missing key details, namely, how to pay for it.\u003c/p>\n\u003cp>Opponents of the “Healthy California Act” repeatedly drew comparisons to the rushed Republican House bill to repeal and replace the Affordable Care Act in Washington, DC. They said state Democrats were guilty of the same tactics, pushing their bill on a single payer health system without a funding mechanism.\u003c/p>\n\u003cp>“It’s not cooked,” Sen. Jeff Stone, R-Temecula, said of the bill. “It’s raw meat.”\u003c/p>\n\u003cp>Senate Bill 596 would upend the state’s employer-based health insurance system and replace it with a “Medicare-for-all” single payer system run by the state.\u003c/p>\n\u003cp>Supporters admitted that the bill is a work in progress, but urged passage as a way to continue the debate, especially in light of uncertainty around billions of dollars in federal funding tied to the Affordable Care Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The message to those people who say we’re irresponsible, I tell you, do not don’t judge us based upon a vote in a day,” said Sen. Bob Hertzberg, D-Los Angeles. “Judge us based upon our work at the end of the day.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz.\"\u003cbr>\n\u003ccite>Sen. John Moorlach, R-Costa Mesa\u003c/cite>\u003c/aside>\n\u003cp>How to pay for the new system – estimated to cost $400 billion a year – was the main point of contention, with several lawmakers arguing the state’s finances were already strapped.\u003c/p>\n\u003cp>\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz,\" said Sen. John Moorlach, R-Costa Mesa.\u003c/p>\n\u003cp>No specific funding plan was included in the bill, but an economic analysis by the University of Massachusetts-Amherst, commissioned by the bill’s sponsors, assumed two-thirds of the funding would come from existing federal and state funds that currently pay for Medicare and Medi-Cal, and the rest would come from either a payroll tax, or a combination of a 2.3 percent gross receipts tax on business revenue above $2 million and a 2.3 percent sales tax.\u003c/p>\n\u003cp>The health insurance industry criticized the financial assumptions in the report as “overly optimistic.\" Business groups called the taxes a “job killer” and lawmakers raised concerns on the Senate floor that the Trump administration would not allow the state, which has identified itself as a part of the Trump resistance, to re-apply those funds to a single payer system.\u003c/p>\n\u003cp>“We’re going to kick the crap out of Trump day in and day out on this floor, then we’re going to go beg him for a couple hundred billion dollars?” said Sen. Tom Berryhill, R-Twain Harte. “Should be an interesting ask.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“They are fighting to limit care and we’re fighting to expand it.”\u003cbr>\n\u003ccite>Sen. Ricardo Lara, D-Bell Gardens \u003c/cite>\u003c/aside>\n\u003cp>The bill’s primary author, Sen. Ricardo Lara, D-Bell Gardens, thanked his colleagues for a robust debate. He took copious notes, and even accepted critics’ comparison to him pushing his unfinished bill with the Republicans’ hasty passage of the repeal and replace Obamacare bill.\u003c/p>\n\u003cp>“But there is one fundamental difference,” Lara said. “They are fighting to limit care and we’re fighting to expand it.”\u003c/p>\n\u003cp>Because the bill is on a two-year legislative cycle, Lara has another year and half to work out the details of the funding plan. Getting it passed through the Senate gives him extra momentum to bring other stakeholders in on the debate, including, perhaps, Gov. Jerry Brown, who has indicated he would veto a single payer bill.\u003c/p>\n\u003cp>Lara vowed to work with lawmakers on both sides of the aisle going forward, and committed to having a transparent debate.\u003c/p>\n\u003cp>“For the countless people that still do not have access to care, and are still making the decision about putting food on their table or buying prescription drugs because they cannot afford them, we are going to put our minds together to ensure that we bring back a product that is fiscally prudent and sustainable.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A new outside analysis claims a \"single payer\" health system for California would cost $330 billion a year, not $400 billion, the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\" target=\"_blank\" rel=\"noopener noreferrer\">initial price tag \u003c/a>announced last week in a legislative report.\u003c/p>\n\u003cp>The financial analysis also proposed two new taxes to pay for the system: an excise tax and a sales tax. That's in contrast to the 15 percent payroll tax proposed in last week's report.\u003c/p>\n\u003cp>The analysis was produced by a team of economists at the University of Massachusetts-Amherst, and paid for by the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">California Nurses Association\u003c/a>, a key leader in the movement to establish a universal health care system in California.\u003c/p>\n\u003cp>Supporters of a single-payer plan have promised these details for months, ever since two Democrats from southern California, state senators Ricardo Lara and Toni Atkins, introduced Senate Bill 562, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">\"The Healthy California Act.\" \u003c/a>The full Senate must vote on the bill by Friday for it to move forward in the legislative process.\u003c/p>\n\u003cp>Here's your takeaway:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>One Health Plan:\u003c/strong> Say goodbye to your employer-sponsored health plan, with its deductible, co-pays and co-insurance. Say goodbye to Medicare and its part B premium. Everyone would be moved into the still-unnamed, state-administered plan. The new plan would also completely absorb anyone now covered by Medi-Cal or Covered California. The seven percent of Californians who are still uninsured -- including undocumented residents -- would be brought into the fold as well.\u003c/p>\n\u003cp>The economists argue that a single payer plan, by eliminating private, for-profit insurers in California, and by pooling together public funds from Medicare and Medi-Cal, would create a stream-lined system with lots of bargaining power.\u003c/p>\n\u003cp>\"The good news is that California can get a lot more for our money,\" said State Senator Lara after unveiling the analysis on Wednesday at the state Capitol. \"When the legislature passes the Healthy California Act, we will actually spend less than we do now on health care.\"\u003c/p>\n\u003cp>\u003cstrong>Two New Taxes: \u003c/strong>The analysis assumes California would successfully obtain permission from the federal government -- not a given under a Trump administration -- to continue drawing down federal money for Medicare and Medi-Cal patients, but divert the funds into a single-payer system instead. That would take care of two-thirds of the annual cost.\u003c/p>\n\u003cp>Then, California could raise the remaining $106 billion by taxing consumers and business. Specifically, the analysis proposes:\u003c/p>\n\u003cul>\n\u003cli>A new 2.3 percent sales tax, except on basic living expenses such as housing, groceries, and utilities.\u003c/li>\n\u003cli>A new 2.3 percent excise tax on gross business receipts (the first $2 million in receipts are exempted).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Three Ways to Save:\u003c/strong> A single-payer plan would actually cost 10 percent less than the current system, the analysis claims. How would this savings of $38 billion be achieved?\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Overhead:\u003c/strong> Having only one insurer, California, eliminates the need to make a profit or spend money on marketing and sales. The health care \"providers\" (doctors, nurses, hospitals, nursing homes, etc.), would also save money because they wouldn't have to pay people to administer different insurance contracts and navigate multiple payment systems.\u003c/li>\n\u003cli>\u003cstrong>Medical Salaries and Drug Prices:\u003c/strong> As the only entity paying for healthcare, California could negotiate lower reimbursement rates for some services. The state plan could also pressure drug companies to lower prices as a condition of having their drugs included in the state-run \u003ca href=\"https://www.healthcare.gov/glossary/formulary/\" target=\"_blank\" rel=\"noopener noreferrer\">formulary.\u003c/a>\u003c/li>\n\u003cli>\u003cstrong>More Efficient Treatment from Cradle to Grave:\u003c/strong> In a single, streamlined system, doctors won't have to duplicate tests. A unified system of electronic health records could also help identify risk factors for illness, or prompt patients to get necessary vaccines and screenings.\u003c/li>\n\u003c/ul>\n\u003cp>The new report was received skeptically by Charles Bacchi, who leads the industry trade group for private insurers, the \u003ca href=\"http://California%20Association%20of%20Health%20Plans\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. Bacchi predicted the plan would be \"incredibly disruptive\" and \"unaffordable,\" and implied that doctors might leave the state.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They assume that every doctor is going to still be here in California providing coverage under this proposal,\" he said. \"And, you know, who knows? Something like this creates a lot of uncertainty.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new outside analysis claims a \"single payer\" health system for California would cost $330 billion a year, not $400 billion, the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\" target=\"_blank\" rel=\"noopener noreferrer\">initial price tag \u003c/a>announced last week in a legislative report.\u003c/p>\n\u003cp>The financial analysis also proposed two new taxes to pay for the system: an excise tax and a sales tax. That's in contrast to the 15 percent payroll tax proposed in last week's report.\u003c/p>\n\u003cp>The analysis was produced by a team of economists at the University of Massachusetts-Amherst, and paid for by the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">California Nurses Association\u003c/a>, a key leader in the movement to establish a universal health care system in California.\u003c/p>\n\u003cp>Supporters of a single-payer plan have promised these details for months, ever since two Democrats from southern California, state senators Ricardo Lara and Toni Atkins, introduced Senate Bill 562, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">\"The Healthy California Act.\" \u003c/a>The full Senate must vote on the bill by Friday for it to move forward in the legislative process.\u003c/p>\n\u003cp>Here's your takeaway:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>One Health Plan:\u003c/strong> Say goodbye to your employer-sponsored health plan, with its deductible, co-pays and co-insurance. Say goodbye to Medicare and its part B premium. Everyone would be moved into the still-unnamed, state-administered plan. The new plan would also completely absorb anyone now covered by Medi-Cal or Covered California. The seven percent of Californians who are still uninsured -- including undocumented residents -- would be brought into the fold as well.\u003c/p>\n\u003cp>The economists argue that a single payer plan, by eliminating private, for-profit insurers in California, and by pooling together public funds from Medicare and Medi-Cal, would create a stream-lined system with lots of bargaining power.\u003c/p>\n\u003cp>\"The good news is that California can get a lot more for our money,\" said State Senator Lara after unveiling the analysis on Wednesday at the state Capitol. \"When the legislature passes the Healthy California Act, we will actually spend less than we do now on health care.\"\u003c/p>\n\u003cp>\u003cstrong>Two New Taxes: \u003c/strong>The analysis assumes California would successfully obtain permission from the federal government -- not a given under a Trump administration -- to continue drawing down federal money for Medicare and Medi-Cal patients, but divert the funds into a single-payer system instead. That would take care of two-thirds of the annual cost.\u003c/p>\n\u003cp>Then, California could raise the remaining $106 billion by taxing consumers and business. Specifically, the analysis proposes:\u003c/p>\n\u003cul>\n\u003cli>A new 2.3 percent sales tax, except on basic living expenses such as housing, groceries, and utilities.\u003c/li>\n\u003cli>A new 2.3 percent excise tax on gross business receipts (the first $2 million in receipts are exempted).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Three Ways to Save:\u003c/strong> A single-payer plan would actually cost 10 percent less than the current system, the analysis claims. How would this savings of $38 billion be achieved?\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Overhead:\u003c/strong> Having only one insurer, California, eliminates the need to make a profit or spend money on marketing and sales. The health care \"providers\" (doctors, nurses, hospitals, nursing homes, etc.), would also save money because they wouldn't have to pay people to administer different insurance contracts and navigate multiple payment systems.\u003c/li>\n\u003cli>\u003cstrong>Medical Salaries and Drug Prices:\u003c/strong> As the only entity paying for healthcare, California could negotiate lower reimbursement rates for some services. The state plan could also pressure drug companies to lower prices as a condition of having their drugs included in the state-run \u003ca href=\"https://www.healthcare.gov/glossary/formulary/\" target=\"_blank\" rel=\"noopener noreferrer\">formulary.\u003c/a>\u003c/li>\n\u003cli>\u003cstrong>More Efficient Treatment from Cradle to Grave:\u003c/strong> In a single, streamlined system, doctors won't have to duplicate tests. A unified system of electronic health records could also help identify risk factors for illness, or prompt patients to get necessary vaccines and screenings.\u003c/li>\n\u003c/ul>\n\u003cp>The new report was received skeptically by Charles Bacchi, who leads the industry trade group for private insurers, the \u003ca href=\"http://California%20Association%20of%20Health%20Plans\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. Bacchi predicted the plan would be \"incredibly disruptive\" and \"unaffordable,\" and implied that doctors might leave the state.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They assume that every doctor is going to still be here in California providing coverage under this proposal,\" he said. \"And, you know, who knows? Something like this creates a lot of uncertainty.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It would cost the state of California an estimated $400 billion per year to cover all of its 39 million residents, according to a staff analysis by the state's Senate Appropriation Committee. That's more than twice the state's total annual budget of $180 billion.\u003c/p>\n\u003cp>But the main legislative advocate for single-payer, \u003ca href=\"http://sd33.senate.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Senator Ricardo Lara\u003c/a> (D-Bell Gardens), explained the state could get access to half of that amount, $200 billion, by shifting over what it already spends on Medicare, Medi-Cal and other state-run health services. That assumes the federal government would agree to let California re-route federal funds in that way.\u003c/p>\n\u003cp>\"The fiscal estimates are subject to enormous uncertainty,\" said Nick Louizos, vice president of legislative affairs for the \u003ca href=\"http://www.calhealthplans.org/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. \"If a combination of assumptions don't come through, this could be even more expensive than we even think.\"\u003c/p>\n\u003cp>To raise the other $200 billion, the state could implement a 15 percent payroll tax, according to the analysis, which was released Monday during a Senate Appropriations Committee in Sacramento. It's unclear how that tax might be split between the employer and the employee.\u003c/p>\n\u003cp>\"Given this picture of increasing costs, health care inefficiency, and the uncertainty created by Republicans in Congress, it is critical that California chart our own path,\" said Lara at the committee hearing.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It will eliminate the need for insurance companies and their administrative costs and profits,\" he added. \"Doctors and hospitals will no longer need to negotiate rates and deals with insurance companies to seek reimbursement.\"\u003c/p>\n\u003cp>At the hearing, Kyle Thayer, a paramedic who works in San Diego, urged the legislators to move forward with the plan.\u003c/p>\n\u003cp>“I see every single day the people that don’t have health coverage and the things that happen. Often they choose between one medicine and another, and end up in the back of my ambulance for something as simple as high-blood pressure medication,\" said Thayer, a resident of Carlsbad.\u003c/p>\n\u003cp>His concerns were personal as well as professional, he said.\u003c/p>\n\u003cp>“My fiancee’s mother was trying to manage her blood pressure, and for a time wasn’t taking her medication, and she ended up with a stroke in the emergency room,\" said Thayer. \"It cost them all kinds of money.”\u003c/p>\n\u003cp>Opponents of the plan also spoke, including Karen Sarkissian from the California Chamber of Commerce, who called the 15 percent payroll tax a \"job killer,\" and a line of representatives from private health insurance companies. These companies would see their business model collapse in California in the face of a single-payer plan, which would be state-administered and not-for-profit.\u003c/p>\n\u003cp>“We don’t need to go backwards and start from scratch. This bill could have catastrophic implications for the health care system in our state,” said Teresa Stark, the chief lobbyist for Kaiser Permanente in California, which covers 8.5 million Californians.\u003c/p>\n\u003cp>\"We share the goal of health care for all,\" she explained, but added that a single-payer system would \"dismantle Kaiser Permanente as we know it.\"\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[docCloudTestLPW]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>April Dembosky contributed reporting.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It would cost the state of California an estimated $400 billion per year to cover all of its 39 million residents, according to a staff analysis by the state's Senate Appropriation Committee. That's more than twice the state's total annual budget of $180 billion.\u003c/p>\n\u003cp>But the main legislative advocate for single-payer, \u003ca href=\"http://sd33.senate.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Senator Ricardo Lara\u003c/a> (D-Bell Gardens), explained the state could get access to half of that amount, $200 billion, by shifting over what it already spends on Medicare, Medi-Cal and other state-run health services. That assumes the federal government would agree to let California re-route federal funds in that way.\u003c/p>\n\u003cp>\"The fiscal estimates are subject to enormous uncertainty,\" said Nick Louizos, vice president of legislative affairs for the \u003ca href=\"http://www.calhealthplans.org/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. \"If a combination of assumptions don't come through, this could be even more expensive than we even think.\"\u003c/p>\n\u003cp>To raise the other $200 billion, the state could implement a 15 percent payroll tax, according to the analysis, which was released Monday during a Senate Appropriations Committee in Sacramento. It's unclear how that tax might be split between the employer and the employee.\u003c/p>\n\u003cp>\"Given this picture of increasing costs, health care inefficiency, and the uncertainty created by Republicans in Congress, it is critical that California chart our own path,\" said Lara at the committee hearing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It will eliminate the need for insurance companies and their administrative costs and profits,\" he added. \"Doctors and hospitals will no longer need to negotiate rates and deals with insurance companies to seek reimbursement.\"\u003c/p>\n\u003cp>At the hearing, Kyle Thayer, a paramedic who works in San Diego, urged the legislators to move forward with the plan.\u003c/p>\n\u003cp>“I see every single day the people that don’t have health coverage and the things that happen. Often they choose between one medicine and another, and end up in the back of my ambulance for something as simple as high-blood pressure medication,\" said Thayer, a resident of Carlsbad.\u003c/p>\n\u003cp>His concerns were personal as well as professional, he said.\u003c/p>\n\u003cp>“My fiancee’s mother was trying to manage her blood pressure, and for a time wasn’t taking her medication, and she ended up with a stroke in the emergency room,\" said Thayer. \"It cost them all kinds of money.”\u003c/p>\n\u003cp>Opponents of the plan also spoke, including Karen Sarkissian from the California Chamber of Commerce, who called the 15 percent payroll tax a \"job killer,\" and a line of representatives from private health insurance companies. These companies would see their business model collapse in California in the face of a single-payer plan, which would be state-administered and not-for-profit.\u003c/p>\n\u003cp>“We don’t need to go backwards and start from scratch. This bill could have catastrophic implications for the health care system in our state,” said Teresa Stark, the chief lobbyist for Kaiser Permanente in California, which covers 8.5 million Californians.\u003c/p>\n\u003cp>\"We share the goal of health care for all,\" she explained, but added that a single-payer system would \"dismantle Kaiser Permanente as we know it.\"\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[docCloudTestLPW]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>April Dembosky contributed reporting.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Closures and consolidations have been increasing among community clinics that provide reproductive health services.\u003c/p>\n\u003cp>Two beloved women’s clinics in San Francisco are consolidating with outside partners in order to keep operating. Another two, in Santa Rosa and Sacramento, have shut their doors. All four were unintended casualties of the Affordable Care Act, which shifted payments and changed incentives throughout California's health industry.\u003c/p>\n\u003cp>Because of the health law, more women in California have coverage for a full range of health services through Medi-Cal. As a result, many of those women are now going to a regular doctor or primary care center for their family planning needs, instead of a dedicated women’s clinic. In addition, the state is paying these clinics \u003ca href=\"http://audio.californiareport.org/archive/R201401031630/c\">less money under Obamacare\u003c/a>.\u003c/p>\n\u003cp>“Of course, I love the Affordable Care Act, but it was very harmful to reproductive health clinics,” said \u003ca href=\"https://obgyn.ucsf.edu/san-francisco-general-hospital/rebecca-jackson-md\" target=\"_blank\" rel=\"noopener noreferrer\">Dr. Rebecca Jackson\u003c/a>, director of New Generation, a teen clinic in San Francisco's Mission neighborhood. New Generation announced last spring it would have to close, but then UCSF agreed to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/05/11/uc-san-francisco-drops-plans-to-close-mission-clinic/\">fund it one more year\u003c/a>.\u003c/p>\n\u003cp>This week, managers announced the next steps to ensure the clinic's ongoing survival. New Generation will move into a smaller, shared office; partner with the city’s Department of Public Health to cover administrative costs such as billing and medical records; and continue intensive and urgent fund-raising efforts in the private sector.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“That allows us to get long-term sustainability that we didn't have as a free-standing clinic,” Jackson said.\u003c/p>\n\u003cp>In Sacramento, \u003ca href=\"https://www.womenshealthspecialists.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Women’s Health Specialists\u003c/a> couldn’t get the numbers to work and shut down last month. Their Santa Rosa location closed two years ago. Outgoing director Shauna Heckert warned the same could happen to the three remaining clinics in Grass Valley, Chico, and Redding if the state doesn’t increase Medi-Cal reimbursements. That's something Governor Jerry Brown has \u003ca href=\"http://audio.californiareport.org/archive/R201509020850/b\">refused to do for years\u003c/a>.\u003c/p>\n\u003cp>“Number one, raising rates for poor people's health care is not popular,” Heckert explained. “Number two, raising rates for reproductive health — that includes abortion and chlamydia [and] gonorrhea — is certainly not something people even feel comfortable talking about.”\u003c/p>\n\u003cp>Women’s clinics are now lobbying state lawmakers, asking them to direct some of the revenues from the newly-passed tobacco tax specifically to them. The Legislature must pass the state budget by June 15th.\u003c/p>\n\u003cp>But the Women’s Community Clinic in San Francisco couldn’t wait to see what might happen with the state budget. The clinic, which had \u003ca href=\"http://womenscommunityclinic.org/who-we-are/history/\" target=\"_blank\" rel=\"noopener noreferrer\">previously suffered\u003c/a> a temporary closure and re-organization in 1999, announced a merger this week with\u003ca href=\"https://www.healthright360.org/\" target=\"_blank\" rel=\"noopener noreferrer\"> HealthRight360\u003c/a>, a statewide nonprofit health system.\u003c/p>\n\u003cp>Carlina Hansen, the clinic's executive director, explained that the Women’s Community Clinic had lost some federal grants. But she noted that the merger with HealthRight360 will also benefit her patients: in addition to family planning, they'll be able to access primary care, mental health services and addiction treatment.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It was not all about money,” said Hansen, who will step down from running the clinic after 17 years. “It was really also about adapting, to do better for our clients in the future.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Closures and consolidations have been increasing among community clinics that provide reproductive health services.\u003c/p>\n\u003cp>Two beloved women’s clinics in San Francisco are consolidating with outside partners in order to keep operating. Another two, in Santa Rosa and Sacramento, have shut their doors. All four were unintended casualties of the Affordable Care Act, which shifted payments and changed incentives throughout California's health industry.\u003c/p>\n\u003cp>Because of the health law, more women in California have coverage for a full range of health services through Medi-Cal. As a result, many of those women are now going to a regular doctor or primary care center for their family planning needs, instead of a dedicated women’s clinic. In addition, the state is paying these clinics \u003ca href=\"http://audio.californiareport.org/archive/R201401031630/c\">less money under Obamacare\u003c/a>.\u003c/p>\n\u003cp>“Of course, I love the Affordable Care Act, but it was very harmful to reproductive health clinics,” said \u003ca href=\"https://obgyn.ucsf.edu/san-francisco-general-hospital/rebecca-jackson-md\" target=\"_blank\" rel=\"noopener noreferrer\">Dr. Rebecca Jackson\u003c/a>, director of New Generation, a teen clinic in San Francisco's Mission neighborhood. New Generation announced last spring it would have to close, but then UCSF agreed to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/05/11/uc-san-francisco-drops-plans-to-close-mission-clinic/\">fund it one more year\u003c/a>.\u003c/p>\n\u003cp>This week, managers announced the next steps to ensure the clinic's ongoing survival. New Generation will move into a smaller, shared office; partner with the city’s Department of Public Health to cover administrative costs such as billing and medical records; and continue intensive and urgent fund-raising efforts in the private sector.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“That allows us to get long-term sustainability that we didn't have as a free-standing clinic,” Jackson said.\u003c/p>\n\u003cp>In Sacramento, \u003ca href=\"https://www.womenshealthspecialists.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Women’s Health Specialists\u003c/a> couldn’t get the numbers to work and shut down last month. Their Santa Rosa location closed two years ago. Outgoing director Shauna Heckert warned the same could happen to the three remaining clinics in Grass Valley, Chico, and Redding if the state doesn’t increase Medi-Cal reimbursements. That's something Governor Jerry Brown has \u003ca href=\"http://audio.californiareport.org/archive/R201509020850/b\">refused to do for years\u003c/a>.\u003c/p>\n\u003cp>“Number one, raising rates for poor people's health care is not popular,” Heckert explained. “Number two, raising rates for reproductive health — that includes abortion and chlamydia [and] gonorrhea — is certainly not something people even feel comfortable talking about.”\u003c/p>\n\u003cp>Women’s clinics are now lobbying state lawmakers, asking them to direct some of the revenues from the newly-passed tobacco tax specifically to them. The Legislature must pass the state budget by June 15th.\u003c/p>\n\u003cp>But the Women’s Community Clinic in San Francisco couldn’t wait to see what might happen with the state budget. The clinic, which had \u003ca href=\"http://womenscommunityclinic.org/who-we-are/history/\" target=\"_blank\" rel=\"noopener noreferrer\">previously suffered\u003c/a> a temporary closure and re-organization in 1999, announced a merger this week with\u003ca href=\"https://www.healthright360.org/\" target=\"_blank\" rel=\"noopener noreferrer\"> HealthRight360\u003c/a>, a statewide nonprofit health system.\u003c/p>\n\u003cp>Carlina Hansen, the clinic's executive director, explained that the Women’s Community Clinic had lost some federal grants. But she noted that the merger with HealthRight360 will also benefit her patients: in addition to family planning, they'll be able to access primary care, mental health services and addiction treatment.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It was not all about money,” said Hansen, who will step down from running the clinic after 17 years. “It was really also about adapting, to do better for our clients in the future.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Fearing Deportation, Parents Worry About Enrolling Undocumented Kids In Medi-Cal",
"title": "Fearing Deportation, Parents Worry About Enrolling Undocumented Kids In Medi-Cal",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>Luz felt relieved and grateful when she learned that her 16-year-old son qualified for full coverage under Medi-Cal. Now, she worries that the information she provided to the government health program could put her family at risk of deportation.\u003c/p>\n\u003cp>Luz’s son is one of nearly 190,000 children who have enrolled in Medi-Cal since California opened it to undocumented children last year. Luz, her husband and her son came to Merced, California, from Mexico without papers about 10 years ago. Luz asked that the family’s last name not be used, for fear of being identified by federal immigration authorities.\u003c/p>\n\u003cp>In the current political climate, immigration and health advocates worry that children, like Luz’s son, will drop out of Medi-Cal and that new kids won’t enroll out of concern that personal information may be used to deport families.\u003c/p>\n\u003cp>Luz would need to renew her son’s coverage in October, but she remains undecided even though the program paid for his hospital visit when he injured a foot. “I’m still thinking about it,” she said.\u003c/p>\n\u003cp>Last May, the state Department of Health Care Services (DHCS) implemented the new “Health For All Kids” law allowing California children under 19 to receive full Medi-Cal benefits, including dental care and mental health, regardless of their immigration status. Previously, undocumented children could receive only emergency care through Medi-Cal.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California followed Illinois, Massachusetts, New York, Washington and the District of Columbia in offering state-supported health coverage to children in the country illegally.\u003c/p>\n\u003cp>Medi-Cal is California’s version of the federal Medicaid program for people with low incomes. The federal government pays for a significant portion of the California program, as it does for all states. But coverage for undocumented kids is entirely funded by the state.\u003c/p>\n\u003cp>From last May to through April 6, 189,434 undocumented children signed up for the program, according to the most recent state data. The health care services department estimates that another 61,000 children are eligible but not enrolled. Advocates say now is the time for a push to sign up these “harder-to-reach” children and to encourage those already in the program to stay.\u003c/p>\n\u003cp>Immigrant families have become more reluctant to share personal information with government programs because of the Trump administration’s planned changes in health care and immigration policies, according to a \u003ca href=\"https://www.childrennow.org/files/6714/9374/6391/H4AK-SurveyUPDATE_4_25_17FINAL.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">recent survey\u003c/a> of 62 individuals working for pediatric practices, community clinics, local public health departments and hospitals serving immigrant communities throughout the state.\u003c/p>\n\u003cp>Immigrants are also increasingly skipping doctor appointments because of similar concerns, according to the survey, conducted in March by the advocacy group Children Now.\u003c/p>\n\u003cp>Kelly Hardy, Children Now’s managing director of health policy, said some families even have \u003ca href=\"http://californiahealthline.org/news/some-immigrants-fearful-of-political-climate-shy-away-from-medi-cal/\" target=\"_blank\" rel=\"noopener noreferrer\">sought to withdraw\u003c/a> their children from the Medi-Cal program because they fear that their immigration status might be shared with immigration officials.\u003c/p>\n\u003cp>“Holding on to the kids who have recently enrolled is going to become critically important,” Hardy said. She said she hopes families will see that the coverage is a boon to their health and will not be scared away.\u003c/p>\n\u003cp>In an email last week, the DHCS reiterated to California Healthline that an applicant’s immigration status is “only used for the purposes of determining Medi-Cal eligibility.”\u003c/p>\n\u003cp>But that doesn’t eliminate the worry for some parents.\u003c/p>\n\u003cp>“This fear is horrible. We don’t know who to trust,” Luz said.\u003c/p>\n\u003cp>Before the coverage-for-all law took effect last year, undocumented children could get coverage through the Healthy Kids insurance program in some California counties. However, many of those children have been transferred to Medi-Cal, and the Healthy Kids programs are closing down.\u003c/p>\n\u003cp>Carlos Jimenez, a health policy advocate at the Mixteco Community Organizing Project in Oxnard, Calif., said the nonprofit doubled its enrollment assistance efforts after the law was implemented.\u003c/p>\n\u003cp>Community health educators known as \u003cem>promotoras\u003c/em>, spread word about the new law in farm fields, in front of supermarkets and outside churches. Last year, enrollment counselors saw up to 400 people a month who had questions about Medi-Cal, the majority looking to enroll their children, Jimenez said.\u003c/p>\n\u003cp>But after the November presidential election, enrollment counselors at Mixteco saw the number of people seeking help drop by nearly half, Jimenez said. Staffers had expected more inquiries about renewals by now, he said.\u003c/p>\n\u003cp>Most people ask whether enrolling an undocumented child would bring any problems with the U.S. Immigration and Customs Enforcement agency, Jimenez said. “We tell them their information is safe. But even then, they’re afraid.”\u003c/p>\n\u003cp>The Children Now survey showed that participants had questions about the future of Medi-Cal for undocumented children — in particular, whether it would continue if the Affordable Care Act were replaced.\u003c/p>\n\u003cp>In an \u003ca href=\"http://californiahealthline.org/news/qa-efforts-to-extend-health-coverage-to-undocumented-immigrants/\" target=\"_blank\" rel=\"noopener noreferrer\">interview\u003c/a> with California Healthline in February, Sen. Ricardo Lara (D-Bell Gardens), who authored the Health for All Kids law, said there was no reason for people to be concerned about the program’s durability.\u003c/p>\n\u003cp>Democratic Gov. Jerry Brown continues to make this program a priority, Lara said, noting that California is spending \u003ca href=\"http://www.ebudget.ca.gov/2017-18/pdf/GovernorsBudget/4000/4260.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$279.5 million\u003c/a> to continue benefits for undocumented kids this year. That’s up from the $188 million it provided for the program last year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Health advocates in California are hoping to extend the program to young adults. Earlier this month, the California Immigrant Policy Center and Health Access California, launched an online \u003ca href=\"https://act.myngp.com/Forms/7315664987463485440\" target=\"_blank\" rel=\"noopener noreferrer\">petition\u003c/a> requesting that full Medi-Cal benefits be made available to people ages 19 to 26.\u003c/p>\n\n",
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"excerpt": "A 2016 California law allowed children without papers to sign up for full Medi-Cal benefits. More than 189,000 children have been covered, but some families now fear renewing coverage or signing up their kids for the first time.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Luz felt relieved and grateful when she learned that her 16-year-old son qualified for full coverage under Medi-Cal. Now, she worries that the information she provided to the government health program could put her family at risk of deportation.\u003c/p>\n\u003cp>Luz’s son is one of nearly 190,000 children who have enrolled in Medi-Cal since California opened it to undocumented children last year. Luz, her husband and her son came to Merced, California, from Mexico without papers about 10 years ago. Luz asked that the family’s last name not be used, for fear of being identified by federal immigration authorities.\u003c/p>\n\u003cp>In the current political climate, immigration and health advocates worry that children, like Luz’s son, will drop out of Medi-Cal and that new kids won’t enroll out of concern that personal information may be used to deport families.\u003c/p>\n\u003cp>Luz would need to renew her son’s coverage in October, but she remains undecided even though the program paid for his hospital visit when he injured a foot. “I’m still thinking about it,” she said.\u003c/p>\n\u003cp>Last May, the state Department of Health Care Services (DHCS) implemented the new “Health For All Kids” law allowing California children under 19 to receive full Medi-Cal benefits, including dental care and mental health, regardless of their immigration status. Previously, undocumented children could receive only emergency care through Medi-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California followed Illinois, Massachusetts, New York, Washington and the District of Columbia in offering state-supported health coverage to children in the country illegally.\u003c/p>\n\u003cp>Medi-Cal is California’s version of the federal Medicaid program for people with low incomes. The federal government pays for a significant portion of the California program, as it does for all states. But coverage for undocumented kids is entirely funded by the state.\u003c/p>\n\u003cp>From last May to through April 6, 189,434 undocumented children signed up for the program, according to the most recent state data. The health care services department estimates that another 61,000 children are eligible but not enrolled. Advocates say now is the time for a push to sign up these “harder-to-reach” children and to encourage those already in the program to stay.\u003c/p>\n\u003cp>Immigrant families have become more reluctant to share personal information with government programs because of the Trump administration’s planned changes in health care and immigration policies, according to a \u003ca href=\"https://www.childrennow.org/files/6714/9374/6391/H4AK-SurveyUPDATE_4_25_17FINAL.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">recent survey\u003c/a> of 62 individuals working for pediatric practices, community clinics, local public health departments and hospitals serving immigrant communities throughout the state.\u003c/p>\n\u003cp>Immigrants are also increasingly skipping doctor appointments because of similar concerns, according to the survey, conducted in March by the advocacy group Children Now.\u003c/p>\n\u003cp>Kelly Hardy, Children Now’s managing director of health policy, said some families even have \u003ca href=\"http://californiahealthline.org/news/some-immigrants-fearful-of-political-climate-shy-away-from-medi-cal/\" target=\"_blank\" rel=\"noopener noreferrer\">sought to withdraw\u003c/a> their children from the Medi-Cal program because they fear that their immigration status might be shared with immigration officials.\u003c/p>\n\u003cp>“Holding on to the kids who have recently enrolled is going to become critically important,” Hardy said. She said she hopes families will see that the coverage is a boon to their health and will not be scared away.\u003c/p>\n\u003cp>In an email last week, the DHCS reiterated to California Healthline that an applicant’s immigration status is “only used for the purposes of determining Medi-Cal eligibility.”\u003c/p>\n\u003cp>But that doesn’t eliminate the worry for some parents.\u003c/p>\n\u003cp>“This fear is horrible. We don’t know who to trust,” Luz said.\u003c/p>\n\u003cp>Before the coverage-for-all law took effect last year, undocumented children could get coverage through the Healthy Kids insurance program in some California counties. However, many of those children have been transferred to Medi-Cal, and the Healthy Kids programs are closing down.\u003c/p>\n\u003cp>Carlos Jimenez, a health policy advocate at the Mixteco Community Organizing Project in Oxnard, Calif., said the nonprofit doubled its enrollment assistance efforts after the law was implemented.\u003c/p>\n\u003cp>Community health educators known as \u003cem>promotoras\u003c/em>, spread word about the new law in farm fields, in front of supermarkets and outside churches. Last year, enrollment counselors saw up to 400 people a month who had questions about Medi-Cal, the majority looking to enroll their children, Jimenez said.\u003c/p>\n\u003cp>But after the November presidential election, enrollment counselors at Mixteco saw the number of people seeking help drop by nearly half, Jimenez said. Staffers had expected more inquiries about renewals by now, he said.\u003c/p>\n\u003cp>Most people ask whether enrolling an undocumented child would bring any problems with the U.S. Immigration and Customs Enforcement agency, Jimenez said. “We tell them their information is safe. But even then, they’re afraid.”\u003c/p>\n\u003cp>The Children Now survey showed that participants had questions about the future of Medi-Cal for undocumented children — in particular, whether it would continue if the Affordable Care Act were replaced.\u003c/p>\n\u003cp>In an \u003ca href=\"http://californiahealthline.org/news/qa-efforts-to-extend-health-coverage-to-undocumented-immigrants/\" target=\"_blank\" rel=\"noopener noreferrer\">interview\u003c/a> with California Healthline in February, Sen. Ricardo Lara (D-Bell Gardens), who authored the Health for All Kids law, said there was no reason for people to be concerned about the program’s durability.\u003c/p>\n\u003cp>Democratic Gov. Jerry Brown continues to make this program a priority, Lara said, noting that California is spending \u003ca href=\"http://www.ebudget.ca.gov/2017-18/pdf/GovernorsBudget/4000/4260.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$279.5 million\u003c/a> to continue benefits for undocumented kids this year. That’s up from the $188 million it provided for the program last year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Health advocates in California are hoping to extend the program to young adults. Earlier this month, the California Immigrant Policy Center and Health Access California, launched an online \u003ca href=\"https://act.myngp.com/Forms/7315664987463485440\" target=\"_blank\" rel=\"noopener noreferrer\">petition\u003c/a> requesting that full Medi-Cal benefits be made available to people ages 19 to 26.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The Senate is negotiating its own legislation to repeal and replace much of the Affordable Care Act in secret talks with senators hand-picked by party leaders and with no plans for committee hearings to publicly vet the bill.\u003c/p>\n\u003cp>\"I am encouraged by what we are seeing in the Senate. We're seeing senators leading,\" said Sen. Ted Cruz, R-Texas, one of the 13 Republicans involved in the private talks. \"We're seeing senators working together in good faith. We're not seeing senators throwing rocks at each other, either in private or in the press.\"\u003c/p>\n\u003cp>Senate Democrats have a different take. \"Your morning reminder that under the cloud cover of the FBI story, 13 GOP Senators are still secretly writing a bill to destroy the ACA,\" Sen. Chris Murphy, D-Conn., \u003ca href=\"https://twitter.com/ChrisMurphyCT/status/864089871270457345\">tweeted\u003c/a> Monday morning.\u003c/p>\n\u003cp>Senate Republicans have shrugged away criticism about their decision to avoid action in committees in favor of closely guarded meetings in the U.S. Capitol to craft legislation to repeal and replace key pillars of President Barack Obama's health care law and reshape Medicaid.\u003c/p>\n\u003cp>The working group has met four times, and it plans to continue to meet every Tuesday and Thursday. So far, its strategy appears to be selectively suggesting potential provisions of the legislation to the media.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For instance, Sen. John Thune, R-S.D., has \u003ca href=\"http://www.politico.com/story/2017/05/12/senate-obamacare-repeal-tax-credits-238290\">floated\u003c/a> pegging tax credits to help Americans buy health insurance to their income instead of their age like it does in the House version of the bill.\u003c/p>\n\u003cp>While the fallout over President Trump's decision to fire FBI Director James Comey consumes the news cycle, it has not had an impact on Republicans' health care talks. A GOP aide for a senator involved in the talks said it has even given the Senate some breathing room to negotiate with so much attention focused elsewhere.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell formed the negotiating team to take the lead on crafting health care legislation that can ultimately win the support of at least 50 of the chamber's 52 Republicans. No Democrats are expected to support any potential GOP health care bill. The legislation is moving under special budget rules known as reconciliation, which means it is not subject to usual filibuster rules and cannot be blocked by the minority party.\u003c/p>\n\u003cp>Republicans ditched the House-passed bill in pursuit of their own legislation, although the two chambers share the broad goals of repealing the ACA's individual mandates and taxes, restricting access to abortion services and overhauling the Medicaid system from an open-ended federal guarantee that covers costs to a system that gives states more flexibility to spend an allotted amount of money.\u003c/p>\n\u003cp>Conservatives like Cruz are also laying down what they say is a key marker for whether a bill can pass the Senate: \"Do premiums go up, or do they go down?\" Cruz said.\u003c/p>\n\u003cp>Sen. Ron Johnson, R-Wis., told reporters last week that Republicans are still in the early planning phase of crafting a bill. \"We still need to agree on those goals and find out what's achievable,\" he said. Like Cruz, Johnson said for him lowering premiums is a top goal and he wants to repeal as much of the ACA as possible under the Senate's more strict budget rules.\u003c/p>\n\u003cp>Early talks suggest Republicans are optimistic they can ultimately pass a bill by the August recess. \"We've got a group of 52 Republican senators, all of us want to get to 'yes,'\" Johnson said.\u003c/p>\n\u003cp>Sens. Susan Collins, R-Maine, and Bill Cassidy, R-La., have introduced their own health care plan, and they have been prominent voices in the debate, but they were excluded from the health care working group.\u003c/p>\n\u003cp>Republicans were roundly criticized for not including any women in their core group, but the Republican women in the Senate who were asked about the omission said they didn't mind. \"It doesn't bother me, the leaders have the right to choose whoever they wish,\" said Collins. \"It doesn't mean that I'm not going to work on health care.\"\u003c/p>\n\u003cp>Cassidy and Collins have been moderating voices in the health care debate, and their support or opposition could be critical to Republicans' success.\u003c/p>\n\u003cp>The Cassidy-Collins proposal would let states keep the ACA, also known as Obamacare, in place if they wanted to, and it leaves in place the ACA's taxes and fees to have revenue streams to pay for their health care overhaul. However, their plan doesn't enjoy support among conservatives who don't believe it goes far enough to repeal and replace Obamacare — the party's signature campaign pledge.\u003c/p>\n\u003cp>The duo has been reaching out to Democrats, but Cassidy said his efforts have been rejected. Democrats see no policy or political upside to working with Republicans to dismantle the ACA. \"Let me phrase this carefully. I've had seven or eight meetings with Democrats either in their office, maybe once my office or on the floor, and that was the consistent message I got,\" Cassidy said.\u003c/p>\n\u003cp>Most Republicans see no political advantage to attempting to craft bipartisan legislation that could aid vulnerable Red State Senate Democrats heading in to the midterm elections. In other words, there is mutual disinterest in bipartisanship when it comes to the fundamentals of Obamacare.\u003c/p>\n\u003cp>The GOP health care talks are expected to roll through the summer months in the Senate. The long-term strategy — according to senior GOP aides in both the House and Senate — is to pass a Senate bill and send it back to the House for an up-or-down vote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While House passage of their bill was hailed by the president in an unusual Rose Garden ceremony earlier this month, Republicans are still a long way away from fulfilling their campaign promises on health care. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Secret+Republican+Senate+Talks+Are+Shaping+Health+Care+Legislation&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is negotiating its own legislation to repeal and replace much of the Affordable Care Act in secret talks with senators hand-picked by party leaders and with no plans for committee hearings to publicly vet the bill.\u003c/p>\n\u003cp>\"I am encouraged by what we are seeing in the Senate. We're seeing senators leading,\" said Sen. Ted Cruz, R-Texas, one of the 13 Republicans involved in the private talks. \"We're seeing senators working together in good faith. We're not seeing senators throwing rocks at each other, either in private or in the press.\"\u003c/p>\n\u003cp>Senate Democrats have a different take. \"Your morning reminder that under the cloud cover of the FBI story, 13 GOP Senators are still secretly writing a bill to destroy the ACA,\" Sen. Chris Murphy, D-Conn., \u003ca href=\"https://twitter.com/ChrisMurphyCT/status/864089871270457345\">tweeted\u003c/a> Monday morning.\u003c/p>\n\u003cp>Senate Republicans have shrugged away criticism about their decision to avoid action in committees in favor of closely guarded meetings in the U.S. Capitol to craft legislation to repeal and replace key pillars of President Barack Obama's health care law and reshape Medicaid.\u003c/p>\n\u003cp>The working group has met four times, and it plans to continue to meet every Tuesday and Thursday. So far, its strategy appears to be selectively suggesting potential provisions of the legislation to the media.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For instance, Sen. John Thune, R-S.D., has \u003ca href=\"http://www.politico.com/story/2017/05/12/senate-obamacare-repeal-tax-credits-238290\">floated\u003c/a> pegging tax credits to help Americans buy health insurance to their income instead of their age like it does in the House version of the bill.\u003c/p>\n\u003cp>While the fallout over President Trump's decision to fire FBI Director James Comey consumes the news cycle, it has not had an impact on Republicans' health care talks. A GOP aide for a senator involved in the talks said it has even given the Senate some breathing room to negotiate with so much attention focused elsewhere.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell formed the negotiating team to take the lead on crafting health care legislation that can ultimately win the support of at least 50 of the chamber's 52 Republicans. No Democrats are expected to support any potential GOP health care bill. The legislation is moving under special budget rules known as reconciliation, which means it is not subject to usual filibuster rules and cannot be blocked by the minority party.\u003c/p>\n\u003cp>Republicans ditched the House-passed bill in pursuit of their own legislation, although the two chambers share the broad goals of repealing the ACA's individual mandates and taxes, restricting access to abortion services and overhauling the Medicaid system from an open-ended federal guarantee that covers costs to a system that gives states more flexibility to spend an allotted amount of money.\u003c/p>\n\u003cp>Conservatives like Cruz are also laying down what they say is a key marker for whether a bill can pass the Senate: \"Do premiums go up, or do they go down?\" Cruz said.\u003c/p>\n\u003cp>Sen. Ron Johnson, R-Wis., told reporters last week that Republicans are still in the early planning phase of crafting a bill. \"We still need to agree on those goals and find out what's achievable,\" he said. Like Cruz, Johnson said for him lowering premiums is a top goal and he wants to repeal as much of the ACA as possible under the Senate's more strict budget rules.\u003c/p>\n\u003cp>Early talks suggest Republicans are optimistic they can ultimately pass a bill by the August recess. \"We've got a group of 52 Republican senators, all of us want to get to 'yes,'\" Johnson said.\u003c/p>\n\u003cp>Sens. Susan Collins, R-Maine, and Bill Cassidy, R-La., have introduced their own health care plan, and they have been prominent voices in the debate, but they were excluded from the health care working group.\u003c/p>\n\u003cp>Republicans were roundly criticized for not including any women in their core group, but the Republican women in the Senate who were asked about the omission said they didn't mind. \"It doesn't bother me, the leaders have the right to choose whoever they wish,\" said Collins. \"It doesn't mean that I'm not going to work on health care.\"\u003c/p>\n\u003cp>Cassidy and Collins have been moderating voices in the health care debate, and their support or opposition could be critical to Republicans' success.\u003c/p>\n\u003cp>The Cassidy-Collins proposal would let states keep the ACA, also known as Obamacare, in place if they wanted to, and it leaves in place the ACA's taxes and fees to have revenue streams to pay for their health care overhaul. However, their plan doesn't enjoy support among conservatives who don't believe it goes far enough to repeal and replace Obamacare — the party's signature campaign pledge.\u003c/p>\n\u003cp>The duo has been reaching out to Democrats, but Cassidy said his efforts have been rejected. Democrats see no policy or political upside to working with Republicans to dismantle the ACA. \"Let me phrase this carefully. I've had seven or eight meetings with Democrats either in their office, maybe once my office or on the floor, and that was the consistent message I got,\" Cassidy said.\u003c/p>\n\u003cp>Most Republicans see no political advantage to attempting to craft bipartisan legislation that could aid vulnerable Red State Senate Democrats heading in to the midterm elections. In other words, there is mutual disinterest in bipartisanship when it comes to the fundamentals of Obamacare.\u003c/p>\n\u003cp>The GOP health care talks are expected to roll through the summer months in the Senate. The long-term strategy — according to senior GOP aides in both the House and Senate — is to pass a Senate bill and send it back to the House for an up-or-down vote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While House passage of their bill was hailed by the president in an unusual Rose Garden ceremony earlier this month, Republicans are still a long way away from fulfilling their campaign promises on health care. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Secret+Republican+Senate+Talks+Are+Shaping+Health+Care+Legislation&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"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.",
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"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>",
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"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?",
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"tagline": "Politics from a personal perspective",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"radiolab": {
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"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
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"info": "",
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"tech-nation": {
"id": "tech-nation",
"title": "Tech Nation Radio Podcast",
"info": "Tech Nation is a weekly public radio program, hosted by Dr. Moira Gunn. Founded in 1993, it has grown from a simple interview show to a multi-faceted production, featuring conversations with noted technology and science leaders, and a weekly science and technology-related commentary.",
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"ted-radio-hour": {
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"title": "TED Radio Hour",
"info": "The TED Radio Hour is a journey through fascinating ideas, astonishing inventions, fresh approaches to old problems, and new ways to think and create.",
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