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"content": "\u003cp>By Alvin Tran and Sarah Barr,\u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/20/bodaken-q-and-a.aspx\" target=\"_blank\"> Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_4301\" class=\"wp-caption alignleft\" style=\"max-width: 272px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/BruceBodakenHeadShot_03262012_COurtesy_BlueShield.jpg\">\u003cimg class=\"size-medium wp-image-4301\" title=\"Bruce Bodaken is CEO of Blue Shield of California. (Photo Courtesy of Blue Shield)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/BruceBodakenHeadShot_03262012_COurtesy_BlueShield-300x330.jpg\" alt=\"Bruce Bodaken is CEO of Blue Shield of California. (Photo Courtesy of Blue Shield)\" width=\"272\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Bruce Bodaken is CEO of Blue Shield of California. (Photo Courtesy of Blue Shield)\u003c/figcaption>\u003c/figure>\n\u003cp>As chairman and CEO, Bruce Bodaken led Blue Shield of California to become one of the fastest growing health plans in the state -- it currently has more than three million members. But after 12 years of service, the 61-year-old recently announced his plans to retire at the end of 2012.\u003c/p>\n\u003cp>Bodaken's successor, Paul Markovich (the chief operating officer), may not have an easy time of it. He’ll have to implement provisions of the federal health law while trying to keep costs as low as possible. \"That will be the biggest challenge that I think any health plan CEO will face over the next several years,\" Bodaken said.\u003c/p>\n\u003cp>Bodaken's views on the health law and the current state of the insurance industry were among the many topics during a recent interview with Kaiser Health News. Here are edited excerpts:\u003c/p>\n\u003cp>\u003cstrong>Q. \u003c/strong>\u003cstrong>Why retire now?\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A. One thing I told my board when I first came on, after a decade or so, you need to think about changing your CEO as a policy matter. There is a time for these things for any corporation, for any person. I’ve been doing this for 12 years. I don’t see this retirement as me dropping out of sight.\u003c/p>\n\u003cp>\u003cstrong>Q. \u003c/strong>\u003cstrong>What do you think insurers will have to contend with as they head to 2014, when the federal health law will fully kick in?\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>A. One of the biggest challenges will just be incorporating all of the new regulations in such a short period of time -- and putting those into effect in complex organizations with multiple products with different geographies. Those regulations impact eligibility, they impact how we interact with providers, they impact how we interact with the [health insurance] exchange.\u003c/p>\n\u003cp>And, of course, we're not just talking about federal regulations; we're talking about regulations in California that are peculiar to our state. If you look at all of that, I think one of the biggest challenges will be all of the health plans, providers, everyone in the industry being able to get this right with such complex, in some cases, not-clear regulation.\u003c/p>\n\u003cp>Early on, I gave (the federal) HHS great credit in that they issued regulations very quickly. Of course it closed down over the election and I think that was expected. But it was a bad time for us to be slowing down because we only have really a few months left before we have to submit to the federal government the outline of our plan.\u003c/p>\n\u003cp>\u003cstrong>Q. \u003c/strong>\u003cstrong>But Blue Shield of California won’t have to worry because you’re only in California, right?\u003c/strong>\u003c/p>\n\u003cp>A. We think we would worry if other competitors are gaining ground as part of a large association of [multi-state] plans. We want it to be sustainable.\u003c/p>\n\u003cp>\u003cstrong>Q. \u003c/strong>\u003cstrong>Are there challenges that are specific to California's exchange?\u003c/strong>\u003c/p>\n\u003cp>A. A small employer should make a choice about which plans are available to the employees. If each employee is able to make a choice between carriers, it’s going to be very complex and difficult from both a ratings standpoint and for making sure that we have a cohesive group that we can rate against. [If] each member of the group can have a different choice, it’s not clear to us how that works.\u003c/p>\n\u003cp>\u003cstrong>Q. \u003c/strong>\u003cstrong>There’s been some talk about whether the premium subsides for low income-people offered through the health insurance exchanges could be changed as part of a deal to solve the national \"fiscal cliff\" predicament. Would that be problematic?\u003c/strong>\u003c/p>\n\u003cp>A. Changing the subsidies would be problematic in that this is a bill about expanding coverage for the people who have been least able to afford it. And the impact that the subsidies have on a group that will not be eligible for Medi-Cal or Medicaid is profound. So, in general we would not want to see those subsidies cut back.\u003c/p>\n\u003cp>I’m a realist and understand that there’s going to be a lot of different issues that are going to be part of any grand deal, any grand bargain, if this is one that has to be modified to address that, I hope it is not too significant. And I hope that it’s clear so that we can get it into place immediately because right now we’re dealing with the current expectations of the current law. If that were to change, it needs to change quickly.\u003c/p>\n\u003cp>\u003cstrong>Q. \u003c/strong>\u003cstrong>The health law calls for the establishment of ACOs -- accountable care organizations -- so that providers will coordinate care for patients. Do you have any suggestions about what should happen at the federal level to encourage their success?\u003c/strong>\u003c/p>\n\u003cp>A. At the federal level, what would be helpful again would be to not be too prescriptive in the area of accountable care organizations. There are principles that we’re using to organize and I think we’ve developed the greatest number in California of any of the plans there at this point. We have led the field on actual signed contracts that are organized with global reimbursement arrangements.\u003c/p>\n\u003cp>Watching a thousand flowers bloom I think is a good thing across the states -- and even across products, commercial products and Medicare products. We think (ACOs) are going to make a real difference in cost. They’re going to make a real difference in quality and the biggest challenge that we will face are having enough seasoned and experienced medical directors and physician leaders. Physician leadership on the ground makes the difference.\u003c/p>\n\u003cp>\u003cstrong>Q. \u003c/strong>\u003cstrong>Why do you think the public is still split on the federal health law?\u003c/strong>\u003c/p>\n\u003cp>A. The health care law has many pieces to it. The consumer protections that have been put in early on, I think, are well regarded. I think everyone agrees that it is time to get away from a system of determining a person’s health insurance by virtue of their health status. And so, doing away with preexisting conditions was overdue.\u003c/p>\n\u003cp>Any change is scary until you put it in place and then it seems like it was the natural thing to do two years later.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This law will continue to go through some changes, I’m sure. There’s a lot we’re going to have to experiment with and I hope we’ll be encouraging HHS and the government to allow states to experiment. If we get only the people that need care in the system, it’s obvious that premiums will go up beyond what anyone can pay and that won’t be a success or sustainable. So, while we think it is something that over time people could accept, we need to do this in stages.\u003c/p>\n\n",
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But it was a bad time for us to be slowing down because we only have really a few months left before we have to submit to the federal government the outline of our plan.\u003c/p>\n\u003cp>\u003cstrong>Q. \u003c/strong>\u003cstrong>But Blue Shield of California won’t have to worry because you’re only in California, right?\u003c/strong>\u003c/p>\n\u003cp>A. We think we would worry if other competitors are gaining ground as part of a large association of [multi-state] plans. We want it to be sustainable.\u003c/p>\n\u003cp>\u003cstrong>Q. \u003c/strong>\u003cstrong>Are there challenges that are specific to California's exchange?\u003c/strong>\u003c/p>\n\u003cp>A. A small employer should make a choice about which plans are available to the employees. If each employee is able to make a choice between carriers, it’s going to be very complex and difficult from both a ratings standpoint and for making sure that we have a cohesive group that we can rate against. 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"content": "\u003cp>By Jenny Gold, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/18/Mental-Health-Insurance-Coverage-Questions-After-Shooting.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_9564\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PresObamaNewtownOlivier-DoulieryGetty-Images.1.jpg\">\u003cimg class=\"size-full wp-image-9564\" title=\"President Obama Visits Newtown, CT, Consoles Families Of Shooting Victims\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PresObamaNewtownOlivier-DoulieryGetty-Images.1.jpg\" alt=\"President Obama speaks at an interfaith vigil for the shooting victims at Sandy Hook Elementary School (Olivier Douliery-Pool/Getty Images).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">President Obama speaks at an interfaith vigil for the shooting victims at Sandy Hook Elementary School (Olivier Douliery-Pool/Getty Images).\u003c/figcaption>\u003c/figure>\n\u003cp>On Monday White House spokesman Jay Carney pointed to the federal health law as evidence that the administration has already started to tackle the issue. Mental health issues are \"clearly a factor that needs to be addressed in some of these cases of horrific violence,\" Carney said. \"Obamacare, if you will, has ensured that mental health services are a part of the services\" provided under the health law.\u003c/p>\n\u003cp>While the Affordable Care Act, along with the Mental Health Parity Act of 2008, go a long way toward assuring coverage for most Americans, some gaps remain.\u003c/p>\n\u003cp>Here are some answers to frequently asked questions about mental health coverage:\u003c/p>\n\u003cp>\u003cstrong>Didn't the Mental Health Parity Act already guarantee coverage for Americans with insurance?\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The \u003ca href=\"http://www.kaiserhealthnews.org/features/insuring-your-health/mental-health-coverage.aspx\" target=\"_self\">Mental Health Parity and Addiction Equity Act\u003c/a>, signed into law in 2008, \u003ca href=\"http://archpsyc.jamanetwork.com/article.aspx?articleid=208673\" target=\"_blank\">made a big dent\u003c/a> in the problem of mental health coverage. But it depends on how you get your insurance\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Large Employers (more than 50 workers): \u003c/strong>If large companies include mental health services in their insurance plans, they must cover those services at same or higher level as other medical conditions. That means that the plans could not provide fewer inpatient hospital days or require higher out-of-pocket costs, more cost sharing or separate deductibles for mental health conditions. But Paul N. Samuels, director and president of the Legal Action Center, says that some people still aren't receiving equal coverage, and the law is not always enforced. \"That's a problem we're really concerned about,\" he says. Note that large employers are not \u003cem>required \u003c/em>to offer mental health insurance, but most do.\u003c/li>\n\u003cli>\u003cstrong>Small Business/Individual Plans: \u003c/strong>Not included in the Parity Act.\u003c/li>\n\u003c/ul>\n\u003cp>In short, whether you have mental health coverage in an employer-sponsored insurance plan depends on where you work.\u003c/p>\n\u003cp>\u003cstrong>What if I don't have mental health coverage in my employer’s insurance plan? Will the ACA change that?\u003c/strong>\u003c/p>\n\u003cp>Small group and individual plans will be required to offer the coverage in 2014 through health exchanges created under the law. But employers with 50 or more workers can continue to not offer the benefits.\u003c/p>\n\u003cp>\u003cstrong>I'm planning to buy an insurance plan through one of the new exchanges. What kind of mental health coverage will I have?\u003c/strong>\u003c/p>\n\u003cp>Again, as noted above, all plans sold in the exchanges \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/18/www.ncsl.org/documents/health/MHparity&mandates.pdf%20\">will be required\u003c/a> to provide coverage for mental health and substance abuse. The exchanges will be open to individuals and small businesses.\u003c/p>\n\u003cp>The same rules will apply to small group and individual plans purchased outside of the exchange.\u003c/p>\n\u003cp>In other words, beginning in 2014, if you (or your small employer) are purchasing any new insurance plan, coverage will include mental health benefits on par with any other medical condition.\u003c/p>\n\u003cp>\u003cstrong>I'll be covered under the Medicaid expansion authorized by the law. What kind of mental health coverage will I get?\u003c/strong>\u003c/p>\n\u003cp>If you earn less than 138 percent of the federal poverty level (about $32,809 for a family of four), you may be newly eligible for Medicaid coverage in 2014. Like people who purchase coverage through the exchange, new Medicaid beneficiaries will receive mental health benefits on par with other medical or surgical needs.\u003c/p>\n\u003cp>\u003cstrong>What problems might arise?\u003c/strong>\u003c/p>\n\u003cp>While the ACA \"provides enormous potential and opportunity to make sure than many millions more Americans obtain the services they need,\" says Samuels, \"that will only happen if the implementation of those reforms is effective.\" Samuels worries that the rules from HHS will not be clear or strong enough to make the parity laws meaningful. He also worries about getting everyone who is eligible for coverage enrolled, particularly those with severe mental health disorders who be may homeless or living on the fringes of society.\u003c/p>\n\u003cp>Access to treatment will likely also remain a serious stumbling block. As many as 30 million people are expected to gain insurance coverage beginning in 2014. Of those, the U.S. Substance Abuse and Mental Health Services Administration \u003ca href=\"http://www.samhsa.gov/samhsanewsletter/Volume_18_Number_5/HealthReform.aspx\">estimates that 6 to 10 million will have untreated mental illnesses\u003c/a> or addiction, adding additional demands to a system that is already overwhelmed. Patients may experience long wait times to see a psychiatrist, for example, and may require additional investments to expand the mental health workforce.\u003c/p>\n\u003cp>\u003cstrong>Learn More: KQED Forum \u003ca href=\"http://www.kqed.org/a/forum/R201212171000\" target=\"_blank\">Shooting Puts Spotlight on Mental Health\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201212171000.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201212171000.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "In his speech at the memorial service for the Newtown victims, President Obama included mental health in calling for a national response to the massacre, a conversation that so far has focused on gun control. \"I will use whatever power this office holds to engage my fellow citizens -- from law enforcement to mental health professionals to parents and educators -- in an effort aimed at preventing more tragedies like this,\" the president said.\r\n\r\nOn Monday White House spokesman Jay Carney pointed to the federal health law as evidence that the administration has already started to tackle the issue. Mental health issues are \"clearly a factor that needs to be addressed in some of these cases of horrific violence,\" Carney said. \"Obamacare, if you will, has ensured that mental health services are a part of the services\" provided under the health law.",
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"description": "In his speech at the memorial service for the Newtown victims, President Obama included mental health in calling for a national response to the massacre, a conversation that so far has focused on gun control. "I will use whatever power this office holds to engage my fellow citizens -- from law enforcement to mental health professionals to parents and educators -- in an effort aimed at preventing more tragedies like this," the president said.\r\n\r\nOn Monday White House spokesman Jay Carney pointed to the federal health law as evidence that the administration has already started to tackle the issue. Mental health issues are "clearly a factor that needs to be addressed in some of these cases of horrific violence," Carney said. "Obamacare, if you will, has ensured that mental health services are a part of the services" provided under the health law.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Jenny Gold, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/18/Mental-Health-Insurance-Coverage-Questions-After-Shooting.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_9564\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PresObamaNewtownOlivier-DoulieryGetty-Images.1.jpg\">\u003cimg class=\"size-full wp-image-9564\" title=\"President Obama Visits Newtown, CT, Consoles Families Of Shooting Victims\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PresObamaNewtownOlivier-DoulieryGetty-Images.1.jpg\" alt=\"President Obama speaks at an interfaith vigil for the shooting victims at Sandy Hook Elementary School (Olivier Douliery-Pool/Getty Images).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">President Obama speaks at an interfaith vigil for the shooting victims at Sandy Hook Elementary School (Olivier Douliery-Pool/Getty Images).\u003c/figcaption>\u003c/figure>\n\u003cp>On Monday White House spokesman Jay Carney pointed to the federal health law as evidence that the administration has already started to tackle the issue. Mental health issues are \"clearly a factor that needs to be addressed in some of these cases of horrific violence,\" Carney said. \"Obamacare, if you will, has ensured that mental health services are a part of the services\" provided under the health law.\u003c/p>\n\u003cp>While the Affordable Care Act, along with the Mental Health Parity Act of 2008, go a long way toward assuring coverage for most Americans, some gaps remain.\u003c/p>\n\u003cp>Here are some answers to frequently asked questions about mental health coverage:\u003c/p>\n\u003cp>\u003cstrong>Didn't the Mental Health Parity Act already guarantee coverage for Americans with insurance?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The \u003ca href=\"http://www.kaiserhealthnews.org/features/insuring-your-health/mental-health-coverage.aspx\" target=\"_self\">Mental Health Parity and Addiction Equity Act\u003c/a>, signed into law in 2008, \u003ca href=\"http://archpsyc.jamanetwork.com/article.aspx?articleid=208673\" target=\"_blank\">made a big dent\u003c/a> in the problem of mental health coverage. But it depends on how you get your insurance\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Large Employers (more than 50 workers): \u003c/strong>If large companies include mental health services in their insurance plans, they must cover those services at same or higher level as other medical conditions. That means that the plans could not provide fewer inpatient hospital days or require higher out-of-pocket costs, more cost sharing or separate deductibles for mental health conditions. But Paul N. Samuels, director and president of the Legal Action Center, says that some people still aren't receiving equal coverage, and the law is not always enforced. \"That's a problem we're really concerned about,\" he says. Note that large employers are not \u003cem>required \u003c/em>to offer mental health insurance, but most do.\u003c/li>\n\u003cli>\u003cstrong>Small Business/Individual Plans: \u003c/strong>Not included in the Parity Act.\u003c/li>\n\u003c/ul>\n\u003cp>In short, whether you have mental health coverage in an employer-sponsored insurance plan depends on where you work.\u003c/p>\n\u003cp>\u003cstrong>What if I don't have mental health coverage in my employer’s insurance plan? Will the ACA change that?\u003c/strong>\u003c/p>\n\u003cp>Small group and individual plans will be required to offer the coverage in 2014 through health exchanges created under the law. But employers with 50 or more workers can continue to not offer the benefits.\u003c/p>\n\u003cp>\u003cstrong>I'm planning to buy an insurance plan through one of the new exchanges. What kind of mental health coverage will I have?\u003c/strong>\u003c/p>\n\u003cp>Again, as noted above, all plans sold in the exchanges \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/December/18/www.ncsl.org/documents/health/MHparity&mandates.pdf%20\">will be required\u003c/a> to provide coverage for mental health and substance abuse. The exchanges will be open to individuals and small businesses.\u003c/p>\n\u003cp>The same rules will apply to small group and individual plans purchased outside of the exchange.\u003c/p>\n\u003cp>In other words, beginning in 2014, if you (or your small employer) are purchasing any new insurance plan, coverage will include mental health benefits on par with any other medical condition.\u003c/p>\n\u003cp>\u003cstrong>I'll be covered under the Medicaid expansion authorized by the law. What kind of mental health coverage will I get?\u003c/strong>\u003c/p>\n\u003cp>If you earn less than 138 percent of the federal poverty level (about $32,809 for a family of four), you may be newly eligible for Medicaid coverage in 2014. Like people who purchase coverage through the exchange, new Medicaid beneficiaries will receive mental health benefits on par with other medical or surgical needs.\u003c/p>\n\u003cp>\u003cstrong>What problems might arise?\u003c/strong>\u003c/p>\n\u003cp>While the ACA \"provides enormous potential and opportunity to make sure than many millions more Americans obtain the services they need,\" says Samuels, \"that will only happen if the implementation of those reforms is effective.\" Samuels worries that the rules from HHS will not be clear or strong enough to make the parity laws meaningful. He also worries about getting everyone who is eligible for coverage enrolled, particularly those with severe mental health disorders who be may homeless or living on the fringes of society.\u003c/p>\n\u003cp>Access to treatment will likely also remain a serious stumbling block. As many as 30 million people are expected to gain insurance coverage beginning in 2014. Of those, the U.S. Substance Abuse and Mental Health Services Administration \u003ca href=\"http://www.samhsa.gov/samhsanewsletter/Volume_18_Number_5/HealthReform.aspx\">estimates that 6 to 10 million will have untreated mental illnesses\u003c/a> or addiction, adding additional demands to a system that is already overwhelmed. Patients may experience long wait times to see a psychiatrist, for example, and may require additional investments to expand the mental health workforce.\u003c/p>\n\u003cp>\u003cstrong>Learn More: KQED Forum \u003ca href=\"http://www.kqed.org/a/forum/R201212171000\" target=\"_blank\">Shooting Puts Spotlight on Mental Health\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201212171000.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201212171000.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Prepares for Children's Dental Insurance Mandate",
"title": "California Prepares for Children's Dental Insurance Mandate",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cem>By Laird Harrison\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_6734\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Child-at-dentist.jpg\">\u003cimg class=\"size-medium wp-image-6734 \" title=\"More people may get dental care in Calfornia when the Affordable Care Act is implemented. (heraldpost/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Child-at-dentist-300x271.jpg\" alt=\"More people may get dental care in Calfornia when the Affordable Care Act is implemented. (heraldpost/Flickr)\" width=\"300\" height=\"271\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">More people may get dental care in Calfornia when the Affordable Care Act is implemented. (heraldpost/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>If you know anything about the Affordable Care Act -- otherwise known as Obamacare -- you know that it will require everyone to get medical coverage by January 1, 2014.\u003c/p>\n\u003cp>But did you know that the act could also require millions of families to buy dental benefits for their children?\u003c/p>\n\u003cp>The dental mandate, if you want to call it that, is indirect and incomplete. Parents who are determined to avoid it can find loopholes. And much depends on regulations that state and federal authorities are still hashing out.\u003c/p>\n\u003cp>But preliminary estimates show that some five million children nationwide and as many as 1.5 million Californians could gain extensive new dental benefits.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Starting in 2014, the Affordable Care Act says, all medical plans sold to small groups (100 people or fewer) or individuals must include a set of “essential benefits,” and these benefits must include “pediatric services, including oral and vision care.”\u003c/p>\n\u003cp>In California, the benefits will be pretty extensive. The state has decided to base them on its \u003ca href=\"http://www.healthyfamilies.ca.gov/HFProgram/Summary_of_Benefits.aspx#dental\">Healthy Families dental program\u003c/a>.\u003c!--more-->\u003c/p>\n\u003cp>Here is where the law gets tricky. The law says that dental plans and medical plans can be sold separately. While the Affordable Care Act imposes a penalty on people who don’t have medical insurance, it does \u003cem>not\u003c/em> say what happens if someone doesn’t get dental coverage for their kids.\u003c/p>\n\u003cp>I called the U.S. Health and Human Services Department, which has so far remained silent on that question. A spokesperson said told me no one would be available for an interview, and instead issued this statement: \"The department will issue further guidance on essential health benefits through the rulemaking process.\" (They've been issuing \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/10/feds-to-states-on-medicaid-expand-fully-or-no-new-funding/\" target=\"_blank\">a lot of guidance\u003c/a> lately, just not on this issue.)\u003c/p>\n\u003cp>Evelyn Ireland, executive director of the National Association of Dental Plans says that federal regulators have told her the question may be left up to individual states. I then called the California Health Benefit Exchange, but was told that no one would be available to comment until next week.\u003c/p>\n\u003cp>Even if most parents do sign up for the coverage, the NADP is warning of another potential problem. It says new fees charged to insurers -- along with the cost of expanding the benefits -- will make children’s dental plans more expensive than what is currently on the market for small groups and individuals. Instead of about $21 per child per month, the cost could go up to $28 or even $36, depending on copayments, the organization says.\u003c/p>\n\u003cp>If you’re below 400 percent of the federal poverty level ($92,000 for a family of four) and spend more than 9.5 percent of your income on health insurance, the Affordable Care Act provides a \u003ca href=\"http://www.kff.org/healthreform/upload/7962-02.pdf\">subsidy\u003c/a> to help you pay for these benefits. But even so, the NADP estimates that nationwide as many as 11 million adults who have dental benefits will decide they can’t afford benefits for both themselves and their kids, and will drop their own benefits. “The entire landscape is changing,” says Jeff Album, vice president of public and government affairs for Delta California.\u003c/p>\n\u003cp>Not everyone agrees with that prediction. The California Dental Association is confident that the new exchange will keep dental benefit costs under control. CDA President Lindsey Robinson praised California's choice to use the extensive dental benefits in the Healthy Families program. “It has a proven track record of meeting the oral health needs of California standards and meets the professional standards of dentists who are taking care of children,” she said.\u003c/p>\n\u003cp>Robinson is also hopeful that the state has enough dentists to cover all the children who might gain benefits under the new law.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>All that remains to be seen is how many parents will sign up.\u003c/p>\n\n",
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"excerpt": "If you know anything about the Affordable Care Act -- otherwise known as Obamacare -- you know that it will require everyone to get medical coverage by January 1, 2014.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>By Laird Harrison\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_6734\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Child-at-dentist.jpg\">\u003cimg class=\"size-medium wp-image-6734 \" title=\"More people may get dental care in Calfornia when the Affordable Care Act is implemented. (heraldpost/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Child-at-dentist-300x271.jpg\" alt=\"More people may get dental care in Calfornia when the Affordable Care Act is implemented. (heraldpost/Flickr)\" width=\"300\" height=\"271\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">More people may get dental care in Calfornia when the Affordable Care Act is implemented. (heraldpost/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>If you know anything about the Affordable Care Act -- otherwise known as Obamacare -- you know that it will require everyone to get medical coverage by January 1, 2014.\u003c/p>\n\u003cp>But did you know that the act could also require millions of families to buy dental benefits for their children?\u003c/p>\n\u003cp>The dental mandate, if you want to call it that, is indirect and incomplete. Parents who are determined to avoid it can find loopholes. And much depends on regulations that state and federal authorities are still hashing out.\u003c/p>\n\u003cp>But preliminary estimates show that some five million children nationwide and as many as 1.5 million Californians could gain extensive new dental benefits.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Starting in 2014, the Affordable Care Act says, all medical plans sold to small groups (100 people or fewer) or individuals must include a set of “essential benefits,” and these benefits must include “pediatric services, including oral and vision care.”\u003c/p>\n\u003cp>In California, the benefits will be pretty extensive. The state has decided to base them on its \u003ca href=\"http://www.healthyfamilies.ca.gov/HFProgram/Summary_of_Benefits.aspx#dental\">Healthy Families dental program\u003c/a>.\u003c!--more-->\u003c/p>\n\u003cp>Here is where the law gets tricky. The law says that dental plans and medical plans can be sold separately. While the Affordable Care Act imposes a penalty on people who don’t have medical insurance, it does \u003cem>not\u003c/em> say what happens if someone doesn’t get dental coverage for their kids.\u003c/p>\n\u003cp>I called the U.S. Health and Human Services Department, which has so far remained silent on that question. A spokesperson said told me no one would be available for an interview, and instead issued this statement: \"The department will issue further guidance on essential health benefits through the rulemaking process.\" (They've been issuing \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/10/feds-to-states-on-medicaid-expand-fully-or-no-new-funding/\" target=\"_blank\">a lot of guidance\u003c/a> lately, just not on this issue.)\u003c/p>\n\u003cp>Evelyn Ireland, executive director of the National Association of Dental Plans says that federal regulators have told her the question may be left up to individual states. I then called the California Health Benefit Exchange, but was told that no one would be available to comment until next week.\u003c/p>\n\u003cp>Even if most parents do sign up for the coverage, the NADP is warning of another potential problem. It says new fees charged to insurers -- along with the cost of expanding the benefits -- will make children’s dental plans more expensive than what is currently on the market for small groups and individuals. Instead of about $21 per child per month, the cost could go up to $28 or even $36, depending on copayments, the organization says.\u003c/p>\n\u003cp>If you’re below 400 percent of the federal poverty level ($92,000 for a family of four) and spend more than 9.5 percent of your income on health insurance, the Affordable Care Act provides a \u003ca href=\"http://www.kff.org/healthreform/upload/7962-02.pdf\">subsidy\u003c/a> to help you pay for these benefits. But even so, the NADP estimates that nationwide as many as 11 million adults who have dental benefits will decide they can’t afford benefits for both themselves and their kids, and will drop their own benefits. “The entire landscape is changing,” says Jeff Album, vice president of public and government affairs for Delta California.\u003c/p>\n\u003cp>Not everyone agrees with that prediction. The California Dental Association is confident that the new exchange will keep dental benefit costs under control. CDA President Lindsey Robinson praised California's choice to use the extensive dental benefits in the Healthy Families program. “It has a proven track record of meeting the oral health needs of California standards and meets the professional standards of dentists who are taking care of children,” she said.\u003c/p>\n\u003cp>Robinson is also hopeful that the state has enough dentists to cover all the children who might gain benefits under the new law.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>All that remains to be seen is how many parents will sign up.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Expanding Medi-Cal Caseload Leaves State Concerned About Cost",
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"content": "\u003cfigure id=\"attachment_9457\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/CapitalBldg_DarylHunt_flickr.jpg\">\u003cimg class=\"size-medium wp-image-9457\" title=\"(Daryl Hunt/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/CapitalBldg_DarylHunt_flickr-300x225.jpg\" alt=\"(Daryl Hunt/Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Daryl Hunt/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"line-height: 24px\">The Affordable Care Act calls for an expansion of Medicaid -- or Medi-Cal in California. Last week the feds were clear that states must expand to the mandated 138 percent of poverty\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/10/feds-to-states-on-medicaid-expand-fully-or-no-new-funding/\" target=\"_blank\"> in order to get federal funds\u003c/a>. Feds have promised to pick up 100 percent of the costs of these new enrollees for the first three years. \u003c/span>Expanding to 138 percent of poverty means another 1.5 million Medi-Cal recipients.\u003c/p>\n\u003cp>So now we know who will receive Medi-Cal benefits, but California's Secretary of Health and Human Services, Diana Dooley has already signaled concern about being \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/05/affordable-care-act-in-california-getting-to-the-nitty-gritty-now/\" target=\"_blank\">on the hook for promising things we can't deliver\u003c/a>.\"\u003c/p>\n\u003cp>In other words, the Administration is looking at limiting benefits as KPCC's \u003ca href=\"http://www.californiareport.org/archive/R201212130850/a\" target=\"_blank\">Julie Small reported\u003c/a> this morning on The California Report. For starters, after the three years of federally-funded Medi-Cal expansion, states must pick up 10 percent of the tab -- or an estimated $6 billion within the next decade, according to the Kaiser Family Foundation. While California is committed to expanding Medi-Cal, the prospect of limited benefits is a concern to advocates, including Vanessa Cajina with the Western Center on Law and Poverty. From Small's report:\u003c/p>\n\u003cblockquote>\u003cp>\"We want to provide coverage for people that they can afford and that’s accessible and still having the question open is disconcerting at this point,\" Cajina said.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Democratic lawmakers agree. San Gabriel Valley Senator Ed Hernandez -- a former optometrist who chairs the Senate Health Committee -- told advocates at [a recent] symposium he’s pushing to get California to offer the maximum benefits to the new group of people who qualify for Medi-cal.\u003c/p>\n\u003cp>\"I have every intention to make sure that every single person has the fullest amount of benefits available and draw down as many federal dollars as we possible can,\" Hernandez said.\u003c/p>\n\u003cp>Hernandez thinks California should also raise the rates the state pays providers for treating Medi-Cal patients. California ranks 47th in the nation for the lowest rates -- so low that many physicians refuse to participate.\u003c/p>\n\u003cp>Democrats also want to reinstate some benefits cut in recent years, like dental coverage for adults. Patients can now get covered for a tooth extraction, but not for dentures.\u003c/p>\u003c/blockquote>\n\u003cp>Some Democrats believe they should use their new super-majority status in both houses to reinstate some of these benefits. Small reports that Republicans could get behind some of these ideas -- but only \"if lawmakers rein in Medi-Cal's administrative costs.\"\u003c/p>\n\u003cp>A special legislative session about the Affordable Care Act -- and the Medi-Cal expansion -- is expected in January.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Listen to Julie Small's piece:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201212130850a.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201212130850a.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "The Affordable Care Act calls for an expansion of Medicaid -- or Medi-Cal in California. Last week the feds were clear that states must expand to the mandated 138 percent of poverty in order to get federal funds. Feds have promised to pick up 100 percent of the costs of these new enrollees for the first three years. Expanding to 138 percent of poverty means another 1.5 million Medi-Cal recipients.\r\n\r\nSo now we know who will receive Medi-Cal benefits, but California's Secretary of Health and Human Services, Diana Dooley has already signaled concern about being \"on the hook for promising things we can't deliver.\"",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9457\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/CapitalBldg_DarylHunt_flickr.jpg\">\u003cimg class=\"size-medium wp-image-9457\" title=\"(Daryl Hunt/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/CapitalBldg_DarylHunt_flickr-300x225.jpg\" alt=\"(Daryl Hunt/Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Daryl Hunt/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"line-height: 24px\">The Affordable Care Act calls for an expansion of Medicaid -- or Medi-Cal in California. Last week the feds were clear that states must expand to the mandated 138 percent of poverty\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/10/feds-to-states-on-medicaid-expand-fully-or-no-new-funding/\" target=\"_blank\"> in order to get federal funds\u003c/a>. Feds have promised to pick up 100 percent of the costs of these new enrollees for the first three years. \u003c/span>Expanding to 138 percent of poverty means another 1.5 million Medi-Cal recipients.\u003c/p>\n\u003cp>So now we know who will receive Medi-Cal benefits, but California's Secretary of Health and Human Services, Diana Dooley has already signaled concern about being \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/05/affordable-care-act-in-california-getting-to-the-nitty-gritty-now/\" target=\"_blank\">on the hook for promising things we can't deliver\u003c/a>.\"\u003c/p>\n\u003cp>In other words, the Administration is looking at limiting benefits as KPCC's \u003ca href=\"http://www.californiareport.org/archive/R201212130850/a\" target=\"_blank\">Julie Small reported\u003c/a> this morning on The California Report. For starters, after the three years of federally-funded Medi-Cal expansion, states must pick up 10 percent of the tab -- or an estimated $6 billion within the next decade, according to the Kaiser Family Foundation. While California is committed to expanding Medi-Cal, the prospect of limited benefits is a concern to advocates, including Vanessa Cajina with the Western Center on Law and Poverty. From Small's report:\u003c/p>\n\u003cblockquote>\u003cp>\"We want to provide coverage for people that they can afford and that’s accessible and still having the question open is disconcerting at this point,\" Cajina said.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Democratic lawmakers agree. San Gabriel Valley Senator Ed Hernandez -- a former optometrist who chairs the Senate Health Committee -- told advocates at [a recent] symposium he’s pushing to get California to offer the maximum benefits to the new group of people who qualify for Medi-cal.\u003c/p>\n\u003cp>\"I have every intention to make sure that every single person has the fullest amount of benefits available and draw down as many federal dollars as we possible can,\" Hernandez said.\u003c/p>\n\u003cp>Hernandez thinks California should also raise the rates the state pays providers for treating Medi-Cal patients. California ranks 47th in the nation for the lowest rates -- so low that many physicians refuse to participate.\u003c/p>\n\u003cp>Democrats also want to reinstate some benefits cut in recent years, like dental coverage for adults. Patients can now get covered for a tooth extraction, but not for dentures.\u003c/p>\u003c/blockquote>\n\u003cp>Some Democrats believe they should use their new super-majority status in both houses to reinstate some of these benefits. Small reports that Republicans could get behind some of these ideas -- but only \"if lawmakers rein in Medi-Cal's administrative costs.\"\u003c/p>\n\u003cp>A special legislative session about the Affordable Care Act -- and the Medi-Cal expansion -- is expected in January.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Listen to Julie Small's piece:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201212130850a.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201212130850a.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Children and the Health Care Overhaul: Where is Coverage Best?",
"title": "Children and the Health Care Overhaul: Where is Coverage Best?",
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"content": "\u003cp>\u003cem>Editor's note: this post was updated to clarify benefits available to children who receive Medi-Cal and benefits available in the new Health Insurance Exchange.\u003c/em>\u003c/p>\n\u003cp>\u003cem>By Elaine Korry\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_9421\" class=\"wp-caption alignleft\" style=\"max-width: 287px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PediatricianPorshiaMack_SaniaBettancourt_ElaineKorry_KQED.jpg\">\u003cimg class=\"size-medium wp-image-9421\" title=\"Pediatrician Porshia Mack examines 3-year-old Sania Bettancourt at Richmond LifeLong community health clinic. (Photo:Elaine Korry)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PediatricianPorshiaMack_SaniaBettancourt_ElaineKorry_KQED-300x313.jpg\" alt=\"Pediatrician Porshia Mack examines 3-year-old Sania Bettancourt at Richmond LifeLong community health clinic. (Photo:Elaine Korry)\" width=\"287\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pediatrician Porshia Mack examines 3-year-old Sania Bettancourt at Richmond LifeLong community health clinic. (Photo:Elaine Korry)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"http://keck.usc.edu/About/Administrative_Offices/Office_of_Public_Relations_and_Marketing/News/Detail/2012__pr_and_marketing__fall__cousineau_chcf_111412\" target=\"_blank\">More than a million California children\u003c/a> who currently lack health insurance will qualify for coverage under the Affordable Care Act. When the health care overhaul goes into effect in 2014, more children from poor families will qualify for Medi-Cal, and other children will get subsidies for private low-cost insurance through the new state Exchange, Covered California. But children’s advocates are concerned that some kids won’t get the best coverage.\u003c/p>\n\u003cp>The nation’s pediatricians devised a gold standard of care. The name is a mouthful -- the \u003ca href=\"EARLY%20AND%20PERIODIC%20SCREENING,%20DIAGNOSTIC,%20AND%20TREATMENT%20SERVICES\" target=\"_blank\">Early and Periodic Screening, Diagnostic and Treatment Services\u003c/a>, or EPSDT for short. It's a standard to meet kids' medical needs -- and it's the standard of care at the Richmond LifeLong Medical Care, a community clinic in San Francisco's East Bay that serves low-income families.\u003c/p>\n\u003cp>On a recent visit, Dr. Porshia Mack, head of pediatrics at the clinic, treated 3-year-old Sania Bettancourt. Dr. Mack listened to Sania's lungs, checked her heartbeat, and peered into her throat and ears. Mack told Sania’s mother that all seemed well except for one recurring problem. Sania’s mild anemia was back, so Mack prescribed a multi-vitamin.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dr. Mack has treated Sania since she was a baby and knew her well enough to realize that this bout of anemia was not serious. But she said that wouldn’t necessarily be the case for kids who aren’t covered for early pediatric care. “It could be a sign of something more ominous than it is, and we wouldn’t know that unless I saw her on a regular interval,” says Mack. “The AAP, the American Academy of Pediatrics, recommends certain lab tests drawn at certain intervals so we can catch these things.”\u003c/p>\n\u003cp>Under the Affordable Care Act, children who are on Medi-Cal, like Sania, will continue to have the full range of coverage recommended by the AAP. Children whose families have slightly more income and qualify for coverage under the new insurance Exchange will likely get significantly better benefits than they have now, but those benefits may not be equal to those under Medi-Cal.\u003c/p>\n\u003cp>The federal law outlines the so-called \u003ca href=\"http://www.healthcare.gov/glossary/e/essential.html\" target=\"_blank\">essential health benefits\u003c/a> that insurers in the state Exchanges must cover. Each state must pick an existing insurance plan as a model -- a plan that has \u003ca href=\"http://aspe.hhs.gov/health/reports/2011/MarketComparison/rb.shtml\" target=\"_blank\">equivalent benefits to a \"typical\" employer plan\u003c/a>. California was among the first states to pick its model benchmark.\u003c/p>\n\u003cp>“It’s a huge step forward for children’s health,” says Kelly Hardy, director of health policy at Children Now, a statewide advocacy group. California chose as its benchmark a Kaiser Small Group plan. That is the baseline plan, and there will be more expensive plans to trade up to, if people want to pay for more benefits. Although Kelly rejects the idea of one-size-fits-all insurance, she says state lawmakers did expand on the Kaiser plan to meet some of children’s needs.\u003c/p>\n\u003cp>“We’re really pleased that the legislature chose to add strong vision and comprehensive dental benefits for children,” says Kelly. “Those are two additions that are really important.\" (By comparison, people with employer-based health insurance often have separate insurance plans for dental and vision coverage.)\u003c/p>\n\u003cp>Yet children’s advocates like Hardy did not get everything they hoped for. Most importantly, she says, they did not convince state lawmakers to adopt the EPSDT for children insured through the state's Exchange. Hardy says that wasn’t practical to include for all kids because it’s simply too expensive. She also noted that many private plans, employer-based health insurance plans included, may not meet that standard.\u003c/p>\n\u003cp>Many pediatricians say that in reality, even the AAP standard is minimal coverage, especially for children with special needs such as asthma, Down syndrome or heart disease. As east bay physician Dr. Thomas Long puts it, “Is it the floor or is it the ceiling? We think it’s the floor, and the least we can do for all children.”\u003c/p>\n\u003cp>Dr. Long is an expert on child health financing with the American Academy of Pediatrics. He says the new Exchange’s standard of care falls short on things like mental health benefits, access to pediatric specialists and other needed coverage.\u003c/p>\n\u003cp>Insurers respond that the Exchange benefits package is broad enough -- and is certainly an improvement for children who have no or very limited insurance now. Charles Bacci, with the California Association of Health Plans, says there’s always a tradeoff between coverage and cost. “The more broad the benefit package, the more expensive your healthcare premiums are,” says Bacci. “The more narrow the benefit, the more affordable your premiums are.”\u003c/p>\n\u003cp>So the irony is that children on Medi-Cal, including half a million new enrollees under the Affordable Care Act, may have the broadest coverage, while children from slightly higher income families in the Exchange, may have at least somewhat narrower benefits. But, says Bacci, if the half-million new kids in the Exchange were also guaranteed the best coverage, healthcare costs would explode.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Support for this report came from the\u003ca href=\"http://www.reportingonhealth.org/fellowships/seminars/lucile-packard-foundation-childrens-health-journalism-fund\" target=\"_blank\"> Lucile Packard Foundation for Children’s Health Journalism Fund\u003c/a>, a program of the USC Annenberg School of Journalism’s California Endowment Health Journalism Fellowships.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor's note: this post was updated to clarify benefits available to children who receive Medi-Cal and benefits available in the new Health Insurance Exchange.\u003c/em>\u003c/p>\n\u003cp>\u003cem>By Elaine Korry\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_9421\" class=\"wp-caption alignleft\" style=\"max-width: 287px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PediatricianPorshiaMack_SaniaBettancourt_ElaineKorry_KQED.jpg\">\u003cimg class=\"size-medium wp-image-9421\" title=\"Pediatrician Porshia Mack examines 3-year-old Sania Bettancourt at Richmond LifeLong community health clinic. (Photo:Elaine Korry)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PediatricianPorshiaMack_SaniaBettancourt_ElaineKorry_KQED-300x313.jpg\" alt=\"Pediatrician Porshia Mack examines 3-year-old Sania Bettancourt at Richmond LifeLong community health clinic. (Photo:Elaine Korry)\" width=\"287\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pediatrician Porshia Mack examines 3-year-old Sania Bettancourt at Richmond LifeLong community health clinic. (Photo:Elaine Korry)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"http://keck.usc.edu/About/Administrative_Offices/Office_of_Public_Relations_and_Marketing/News/Detail/2012__pr_and_marketing__fall__cousineau_chcf_111412\" target=\"_blank\">More than a million California children\u003c/a> who currently lack health insurance will qualify for coverage under the Affordable Care Act. When the health care overhaul goes into effect in 2014, more children from poor families will qualify for Medi-Cal, and other children will get subsidies for private low-cost insurance through the new state Exchange, Covered California. But children’s advocates are concerned that some kids won’t get the best coverage.\u003c/p>\n\u003cp>The nation’s pediatricians devised a gold standard of care. The name is a mouthful -- the \u003ca href=\"EARLY%20AND%20PERIODIC%20SCREENING,%20DIAGNOSTIC,%20AND%20TREATMENT%20SERVICES\" target=\"_blank\">Early and Periodic Screening, Diagnostic and Treatment Services\u003c/a>, or EPSDT for short. It's a standard to meet kids' medical needs -- and it's the standard of care at the Richmond LifeLong Medical Care, a community clinic in San Francisco's East Bay that serves low-income families.\u003c/p>\n\u003cp>On a recent visit, Dr. Porshia Mack, head of pediatrics at the clinic, treated 3-year-old Sania Bettancourt. Dr. Mack listened to Sania's lungs, checked her heartbeat, and peered into her throat and ears. Mack told Sania’s mother that all seemed well except for one recurring problem. Sania’s mild anemia was back, so Mack prescribed a multi-vitamin.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. Mack has treated Sania since she was a baby and knew her well enough to realize that this bout of anemia was not serious. But she said that wouldn’t necessarily be the case for kids who aren’t covered for early pediatric care. “It could be a sign of something more ominous than it is, and we wouldn’t know that unless I saw her on a regular interval,” says Mack. “The AAP, the American Academy of Pediatrics, recommends certain lab tests drawn at certain intervals so we can catch these things.”\u003c/p>\n\u003cp>Under the Affordable Care Act, children who are on Medi-Cal, like Sania, will continue to have the full range of coverage recommended by the AAP. Children whose families have slightly more income and qualify for coverage under the new insurance Exchange will likely get significantly better benefits than they have now, but those benefits may not be equal to those under Medi-Cal.\u003c/p>\n\u003cp>The federal law outlines the so-called \u003ca href=\"http://www.healthcare.gov/glossary/e/essential.html\" target=\"_blank\">essential health benefits\u003c/a> that insurers in the state Exchanges must cover. Each state must pick an existing insurance plan as a model -- a plan that has \u003ca href=\"http://aspe.hhs.gov/health/reports/2011/MarketComparison/rb.shtml\" target=\"_blank\">equivalent benefits to a \"typical\" employer plan\u003c/a>. California was among the first states to pick its model benchmark.\u003c/p>\n\u003cp>“It’s a huge step forward for children’s health,” says Kelly Hardy, director of health policy at Children Now, a statewide advocacy group. California chose as its benchmark a Kaiser Small Group plan. That is the baseline plan, and there will be more expensive plans to trade up to, if people want to pay for more benefits. Although Kelly rejects the idea of one-size-fits-all insurance, she says state lawmakers did expand on the Kaiser plan to meet some of children’s needs.\u003c/p>\n\u003cp>“We’re really pleased that the legislature chose to add strong vision and comprehensive dental benefits for children,” says Kelly. “Those are two additions that are really important.\" (By comparison, people with employer-based health insurance often have separate insurance plans for dental and vision coverage.)\u003c/p>\n\u003cp>Yet children’s advocates like Hardy did not get everything they hoped for. Most importantly, she says, they did not convince state lawmakers to adopt the EPSDT for children insured through the state's Exchange. Hardy says that wasn’t practical to include for all kids because it’s simply too expensive. She also noted that many private plans, employer-based health insurance plans included, may not meet that standard.\u003c/p>\n\u003cp>Many pediatricians say that in reality, even the AAP standard is minimal coverage, especially for children with special needs such as asthma, Down syndrome or heart disease. As east bay physician Dr. Thomas Long puts it, “Is it the floor or is it the ceiling? We think it’s the floor, and the least we can do for all children.”\u003c/p>\n\u003cp>Dr. Long is an expert on child health financing with the American Academy of Pediatrics. He says the new Exchange’s standard of care falls short on things like mental health benefits, access to pediatric specialists and other needed coverage.\u003c/p>\n\u003cp>Insurers respond that the Exchange benefits package is broad enough -- and is certainly an improvement for children who have no or very limited insurance now. Charles Bacci, with the California Association of Health Plans, says there’s always a tradeoff between coverage and cost. “The more broad the benefit package, the more expensive your healthcare premiums are,” says Bacci. “The more narrow the benefit, the more affordable your premiums are.”\u003c/p>\n\u003cp>So the irony is that children on Medi-Cal, including half a million new enrollees under the Affordable Care Act, may have the broadest coverage, while children from slightly higher income families in the Exchange, may have at least somewhat narrower benefits. But, says Bacci, if the half-million new kids in the Exchange were also guaranteed the best coverage, healthcare costs would explode.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Support for this report came from the\u003ca href=\"http://www.reportingonhealth.org/fellowships/seminars/lucile-packard-foundation-childrens-health-journalism-fund\" target=\"_blank\"> Lucile Packard Foundation for Children’s Health Journalism Fund\u003c/a>, a program of the USC Annenberg School of Journalism’s California Endowment Health Journalism Fellowships.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_9368\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sebelius-KHN_-300.jpg\">\u003cimg class=\"size-full wp-image-9368\" title=\"HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sebelius-KHN_-300.jpg\" alt=\"HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The Obama Administration handed down a key rule Monday on its health care overhaul having to do with Medicaid, or Medi-Cal in California. States must expand to the federally mandated 138 percent of poverty in order to receive matching funds for those newly eligible for the program.\u003c/p>\n\u003cp>Because the\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/28/supreme-court-health-care-decision/\" target=\"_blank\"> Supreme Court ruling in June\u003c/a> had struck down the requirement that states participate or lose existing match funds, some states thought there might be flexibility in the expansion. But the answer to that question is a clear \"no\" as Secretary of Health and Human Services Kathleen Sebelius explained in a\u003ca href=\"http://cciio.cms.gov/resources/files/gov-letter-faqs-12-10-2012.pdf\" target=\"_blank\"> letter to governors\u003c/a>.\u003c/p>\n\u003cp>In a briefing last week, California's Health and Human Services Secretary Diana Dooley \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/05/affordable-care-act-in-california-getting-to-the-nitty-gritty-now/\" target=\"_blank\">indicated she was waiting for guidance\u003c/a> from the feds about the Medicaid expansion and might not expand to the full 138 percent limit.\u003c/p>\n\u003cp>In an email, a spokesperson for the state's department of health and human services said staff is currently evaluating the new information and declined to comment further at this time.\u003c/p>\n\u003cp>Consumer advocates said it was good to have the matter settled. \"We thought that it was the case,\" Anthony Wright, Executive Director of Health Access told me in a phone call, \"but it's good for the federal government to provide clarity and hopefully this allows the states to move forward with all deliberate speed.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It's expected that more than four million Californians will be newly eligible for Medi-Cal. Under the Affordable Care Act, the federal government will pay 100 percent of the cost of those new eligibles from 2014 to 2017. After that, the match will phase down to 90 percent by 2020.\u003c/p>\n\n",
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"excerpt": "The Obama Administration handed down a key rule Monday on its health care overhaul having to do with Medicaid, or Medi-Cal in California. States must expand to the federally mandated 138 percent of poverty in order to receive matching funds for those newly eligible for the program.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9368\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sebelius-KHN_-300.jpg\">\u003cimg class=\"size-full wp-image-9368\" title=\"HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sebelius-KHN_-300.jpg\" alt=\"HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The Obama Administration handed down a key rule Monday on its health care overhaul having to do with Medicaid, or Medi-Cal in California. States must expand to the federally mandated 138 percent of poverty in order to receive matching funds for those newly eligible for the program.\u003c/p>\n\u003cp>Because the\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/28/supreme-court-health-care-decision/\" target=\"_blank\"> Supreme Court ruling in June\u003c/a> had struck down the requirement that states participate or lose existing match funds, some states thought there might be flexibility in the expansion. But the answer to that question is a clear \"no\" as Secretary of Health and Human Services Kathleen Sebelius explained in a\u003ca href=\"http://cciio.cms.gov/resources/files/gov-letter-faqs-12-10-2012.pdf\" target=\"_blank\"> letter to governors\u003c/a>.\u003c/p>\n\u003cp>In a briefing last week, California's Health and Human Services Secretary Diana Dooley \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/05/affordable-care-act-in-california-getting-to-the-nitty-gritty-now/\" target=\"_blank\">indicated she was waiting for guidance\u003c/a> from the feds about the Medicaid expansion and might not expand to the full 138 percent limit.\u003c/p>\n\u003cp>In an email, a spokesperson for the state's department of health and human services said staff is currently evaluating the new information and declined to comment further at this time.\u003c/p>\n\u003cp>Consumer advocates said it was good to have the matter settled. \"We thought that it was the case,\" Anthony Wright, Executive Director of Health Access told me in a phone call, \"but it's good for the federal government to provide clarity and hopefully this allows the states to move forward with all deliberate speed.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It's expected that more than four million Californians will be newly eligible for Medi-Cal. Under the Affordable Care Act, the federal government will pay 100 percent of the cost of those new eligibles from 2014 to 2017. After that, the match will phase down to 90 percent by 2020.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Fiscal Cliffnotes: If Medicare Eligibility Age Goes Up, People of Color Hit Hardest",
"title": "Fiscal Cliffnotes: If Medicare Eligibility Age Goes Up, People of Color Hit Hardest",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>While we all wait to see if President Obama and House Speaker John Boehner will \u003ca href=\"http://www.npr.org/blogs/thetwo-way/2012/12/10/166860670/can-a-fiscal-cliff-deal-be-both-in-and-out-of-reach-yes\" target=\"_blank\">hash out a deal \u003c/a>on the fiscal cliff, one item getting a lot of discussion is \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/07/fiscal-cliffnotes-what-are-the-trade-offs-in-raising-medicares-eligibility-age/\" target=\"_blank\">raising the Medicare eligibility age\u003c/a>, as I wrote about on Friday. Today, I was checking out \u003ca href=\"https://twitter.com/sarahkliff\" target=\"_blank\">Sarah Kliff's twitter feed\u003c/a>, and she pointed to UC Berkeley grad student \u003ca href=\"http://owenzidar.wordpress.com/2012/12/09/the-medicare-eligibility-age-impacts-on-health-behavior-and-outcomes/\" target=\"_blank\">Owen Zidar's blog\u003c/a>. Zidar's post includes some eye-opening charts from economists David Card, Carlos Dobkin and Nicole Maestas writing in the \u003ca href=\"http://www.aeaweb.org/articles.php?doi=10.1257/aer.98.5.2242\" target=\"_blank\">American Economic Review\u003c/a>.\u003c/p>\n\u003cp>Embedded in these wonky charts is an illustration of disparity:\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Screen-Shot-2012-12-10-at-11.31.44-AM.png\">\u003cimg class=\"aligncenter size-large wp-image-9352\" title=\"Screen Shot 2012-12-10 at 11.31.44 AM\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Screen-Shot-2012-12-10-at-11.31.44-AM-620x396.png\" alt=\"\" width=\"620\" height=\"396\">\u003c/a>\u003c/p>\n\u003cp>And that disparity plays out in people not getting health care because of cost. Another snapshot of disparity:\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Screen-Shot-2012-12-10-at-11.39.44-AM.png\">\u003cimg class=\"aligncenter size-large wp-image-9355\" title=\"Screen Shot 2012-12-10 at 11.39.44 AM\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Screen-Shot-2012-12-10-at-11.39.44-AM-620x424.png\" alt=\"\" width=\"620\" height=\"424\">\u003c/a>This data was compiled before the Affordable Care Act was passed. We'll have to wait and see how coverage and access change once the ACA is fully implemented in 2014.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "While we all wait to see if President Obama and House Speaker John Boehner will hash out a deal on the fiscal cliff, one item getting a lot of discussion is raising the Medicare eligibility age, as I wrote about on Friday. Today, UC Berkeley grad student Owen Zidar points to some very eye-opening charts from economists David Card, Carlos Dobkin and Nicole Maestas writing in the American Economic Review.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>While we all wait to see if President Obama and House Speaker John Boehner will \u003ca href=\"http://www.npr.org/blogs/thetwo-way/2012/12/10/166860670/can-a-fiscal-cliff-deal-be-both-in-and-out-of-reach-yes\" target=\"_blank\">hash out a deal \u003c/a>on the fiscal cliff, one item getting a lot of discussion is \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/07/fiscal-cliffnotes-what-are-the-trade-offs-in-raising-medicares-eligibility-age/\" target=\"_blank\">raising the Medicare eligibility age\u003c/a>, as I wrote about on Friday. Today, I was checking out \u003ca href=\"https://twitter.com/sarahkliff\" target=\"_blank\">Sarah Kliff's twitter feed\u003c/a>, and she pointed to UC Berkeley grad student \u003ca href=\"http://owenzidar.wordpress.com/2012/12/09/the-medicare-eligibility-age-impacts-on-health-behavior-and-outcomes/\" target=\"_blank\">Owen Zidar's blog\u003c/a>. Zidar's post includes some eye-opening charts from economists David Card, Carlos Dobkin and Nicole Maestas writing in the \u003ca href=\"http://www.aeaweb.org/articles.php?doi=10.1257/aer.98.5.2242\" target=\"_blank\">American Economic Review\u003c/a>.\u003c/p>\n\u003cp>Embedded in these wonky charts is an illustration of disparity:\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Screen-Shot-2012-12-10-at-11.31.44-AM.png\">\u003cimg class=\"aligncenter size-large wp-image-9352\" title=\"Screen Shot 2012-12-10 at 11.31.44 AM\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Screen-Shot-2012-12-10-at-11.31.44-AM-620x396.png\" alt=\"\" width=\"620\" height=\"396\">\u003c/a>\u003c/p>\n\u003cp>And that disparity plays out in people not getting health care because of cost. Another snapshot of disparity:\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Screen-Shot-2012-12-10-at-11.39.44-AM.png\">\u003cimg class=\"aligncenter size-large wp-image-9355\" title=\"Screen Shot 2012-12-10 at 11.39.44 AM\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Screen-Shot-2012-12-10-at-11.39.44-AM-620x424.png\" alt=\"\" width=\"620\" height=\"424\">\u003c/a>This data was compiled before the Affordable Care Act was passed. We'll have to wait and see how coverage and access change once the ACA is fully implemented in 2014.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cfigure id=\"attachment_9251\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr1.jpg\">\u003cimg class=\"size-medium wp-image-9251\" title=\"(seliaymiwell/flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr1-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>More than 200 people filled a Sacramento hotel meeting room yesterday to celebrate the 25th anniversary of Health Access, the consumer health advocacy group. But it wasn't all party -- the event featured a four-hour symposium with speakers including Diana Dooley, secretary of the state Health and Human Services agency; key legislators who chair health committees; and long time health advocates.\u003c/p>\n\u003cp>And everyone was focused on one thing: implementation of the Affordable Care Act.\u003c/p>\n\u003cp>After joking that \"I quake in my boots\" over the amount of work that needs to be done between now and January 1, 2014, Secretary Dooley sounded a distinctly cautionary note of what to expect as the rollout of Obamacare progresses in California. \"It's going to take years to make this work,\" she told the crowd. \"There are going to be fits and starts, speed bumps that we'll have to get over.\"\u003c/p>\n\u003cp>She talked about her concerns around affordability and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/29/california-faces-headwinds-in-easing-doctor-shortages/\" target=\"_blank\">capacity\u003c/a>. Then she reminded the crowd of the wait for more information from the feds. For example, the Affordable Care Act promises to fund 100 percent of those newly eligible for Medicaid. But in an acknowledgement to the \"fiscal cliff\" discussions in Washington, she said it's unclear if some of that money may be pulled back.\u003c!--more-->\u003c/p>\n\u003cp>\"We're not going to extend benchmark coverage beyond what is sustainable,\" Dooley said, \"because we cannot take it back. ... I don't want to be on the hook for promising things we can't deliver.\" She added that she wants to build on a stable foundation and maintain California's position as the \"lead car\" among states implementing the ACA, but added, \"I want to be honest with our partners about where the challenges are.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>With that, she had to leave, and three legislators took the podium with a decidedly different view of how the ACA should progress. Assemblymember Holly Mitchell argued that she felt it was a time to be \"bold ... You heard from the representative of the administration who has a much narrower view than I see,\" she said. \"We have another branch of government ... clearly we have work to do to create policy and create legislation that can get a signature out of the governor.\"\u003c/p>\n\u003cp>Ed Hernandez, chair of the Senate Health Committee, pointed specifically to bills he plans to introduce during the special legislative session expected to begin in early January. The Medicaid expansion bill is among them, he explained, saying the state should \"draw down every federal dollar we can.\" Assemblymember Richard Pan, who chairs the Assembly Health Committee, echoed a desire to get \"as close as we can to universal coverage.\"\u003c/p>\n\u003cp>Just before taking the podium for the last panel of the day, Ellen Wu, Executive Director of the California Pan-Ethnic Health Network, expressed a level of frustration with Dooley's remarks, especially Dooley's concerns about the cost of Medicaid expansion -- and an apparent suggestion that California might not implement the expansion as fully as advocates would like. \"We helped with Prop 30,\" she said, referring to health advocates' work on behalf of the passage of the governor's education proposition. Communities of color \"are 60 percent of California ... and now we're going to turn down federal dollars? It doesn't make sense.\" She said people of color feel they're \"getting the short end of the stick, always getting left behind.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In that last panel of the day, Health Access Executive Director Anthony Wright pointed to the \"10 short months we have until October, 2013\" when the new exchange will begin selling insurance. \"The final obstacle is the clock. That should not curtail our ambition.\"\u003c/p>\n\n",
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"excerpt": "More than 200 people filled a Sacramento hotel meeting room yesterday to celebrate the 25th anniversary of Health Access, the consumer health advocacy group. But it wasn't all party -- the event featured a four-hour symposium with speakers including Diana Dooley, secretary of the state Health and Human Services agency; key legislators who chair health committees; and long time health advocates.\r\n\r\nAnd everyone was focused on one thing: implementation of the Affordable Care Act.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9251\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr1.jpg\">\u003cimg class=\"size-medium wp-image-9251\" title=\"(seliaymiwell/flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr1-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>More than 200 people filled a Sacramento hotel meeting room yesterday to celebrate the 25th anniversary of Health Access, the consumer health advocacy group. But it wasn't all party -- the event featured a four-hour symposium with speakers including Diana Dooley, secretary of the state Health and Human Services agency; key legislators who chair health committees; and long time health advocates.\u003c/p>\n\u003cp>And everyone was focused on one thing: implementation of the Affordable Care Act.\u003c/p>\n\u003cp>After joking that \"I quake in my boots\" over the amount of work that needs to be done between now and January 1, 2014, Secretary Dooley sounded a distinctly cautionary note of what to expect as the rollout of Obamacare progresses in California. \"It's going to take years to make this work,\" she told the crowd. \"There are going to be fits and starts, speed bumps that we'll have to get over.\"\u003c/p>\n\u003cp>She talked about her concerns around affordability and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/06/29/california-faces-headwinds-in-easing-doctor-shortages/\" target=\"_blank\">capacity\u003c/a>. Then she reminded the crowd of the wait for more information from the feds. For example, the Affordable Care Act promises to fund 100 percent of those newly eligible for Medicaid. But in an acknowledgement to the \"fiscal cliff\" discussions in Washington, she said it's unclear if some of that money may be pulled back.\u003c!--more-->\u003c/p>\n\u003cp>\"We're not going to extend benchmark coverage beyond what is sustainable,\" Dooley said, \"because we cannot take it back. ... I don't want to be on the hook for promising things we can't deliver.\" She added that she wants to build on a stable foundation and maintain California's position as the \"lead car\" among states implementing the ACA, but added, \"I want to be honest with our partners about where the challenges are.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>With that, she had to leave, and three legislators took the podium with a decidedly different view of how the ACA should progress. Assemblymember Holly Mitchell argued that she felt it was a time to be \"bold ... You heard from the representative of the administration who has a much narrower view than I see,\" she said. \"We have another branch of government ... clearly we have work to do to create policy and create legislation that can get a signature out of the governor.\"\u003c/p>\n\u003cp>Ed Hernandez, chair of the Senate Health Committee, pointed specifically to bills he plans to introduce during the special legislative session expected to begin in early January. The Medicaid expansion bill is among them, he explained, saying the state should \"draw down every federal dollar we can.\" Assemblymember Richard Pan, who chairs the Assembly Health Committee, echoed a desire to get \"as close as we can to universal coverage.\"\u003c/p>\n\u003cp>Just before taking the podium for the last panel of the day, Ellen Wu, Executive Director of the California Pan-Ethnic Health Network, expressed a level of frustration with Dooley's remarks, especially Dooley's concerns about the cost of Medicaid expansion -- and an apparent suggestion that California might not implement the expansion as fully as advocates would like. \"We helped with Prop 30,\" she said, referring to health advocates' work on behalf of the passage of the governor's education proposition. Communities of color \"are 60 percent of California ... and now we're going to turn down federal dollars? It doesn't make sense.\" She said people of color feel they're \"getting the short end of the stick, always getting left behind.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In that last panel of the day, Health Access Executive Director Anthony Wright pointed to the \"10 short months we have until October, 2013\" when the new exchange will begin selling insurance. \"The final obstacle is the clock. That should not curtail our ambition.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Five New Obamacare Regulations Just Out",
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"content": "\u003cfigure id=\"attachment_1157\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/12/230136_President-Obama-signs-Health-Reform-Law1.jpg\">\u003cimg class=\"size-medium wp-image-1157\" title=\"President Obama signs health care reform law. (Photo: White House)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/12/230136_President-Obama-signs-Health-Reform-Law1-300x200.jpg\" alt=\"President Obama signs health care reform law. (Photo: White House)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">President Obama signs health care reform law. (Photo: White House)\u003c/figcaption>\u003c/figure>\n\u003cp>The Department of Health and Human Services issued a whole slew of long-awaited regulations Tuesday about the Affordable Care Act. They are important to consumers because they have to do with both cost and (loosely) what must be covered. States have some latitude in the coverage area, more on that in a moment.\u003c/p>\n\u003cp>Friendly reminder that most of what the feds released are for the new state based exchanges. Individuals and small businesses will be able to buy insurance through the state's exchange, \u003ca href=\"http://www.cahba.com/exchange/covered-california.htm\" target=\"_blank\">Covered California\u003c/a>. If you get insurance through your employer, you will continue to do so.\u003c/p>\n\u003col>\n\u003cli>\u003cstrong>Guaranteed issue and renewal:\u003c/strong> you no longer can be denied getting insurance due to a pre-existing condition. Insurance companies can no longer jack up rates or drop you completely when it's time to renew. They may only raise rates annually (on your birthday!) and only by a set amount.\u003c/li>\n\u003cli>\u003cstrong>Fair premiums: \u003c/strong>premiums can only differ based on age, family size, tobacco use and where you live. Adults will be within a 3:1 ratio. In other words, a premium for a 63-year-old can be a maximum of three times the rate of a 21-year-old. Everyone over age 63 is in the same rate band. Women can no longer be charged more than men.\u003c!--more-->\u003c/li>\n\u003cli>\u003cstrong>Young adults special option: \u003c/strong>Younger people tend to be healthier than older people. But, as noted above, older adults are capped at paying a max of three times the premium of a 21-year-old. There was concern that this would mean high premiums for 20-somethings. The new rules allow for catastrophic health insurance plans -- plans with lower premiums and higher deductibles for those generally health younger adults.\u003c/li>\n\u003cli>\u003cstrong>What's covered:\u003c/strong> The feds have \u003ca href=\"http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html\" target=\"_blank\">already detailed\u003c/a> that each state must offer coverage within ten categories. States have some latitude in exactly what they'll put in their plans. But one question had been around prescription drugs. The federal government had initially indicated that plans need only cover one prescription drug per category in a policy's \"formulary\" -- which could be problematic for the millions of people with chronic illnesses who take more than one drug. There were concerns that only one drug would be covered in a huge category, such as diabetes for example. The new rules today say that insurance sold in the exchange must match the benefits of the most popular small group health plan in the state (the \"benchmark plan\"). In other words, in all likelihood, more than one prescription drug will be covered in each category.\u003c/li>\n\u003cli>\u003cstrong>Wellness programs: \u003c/strong>A new rule encourages employers to offer a new kind of wellness program. If employers participate, people who receive insurance through their employer will be able to participate in enhanced wellness programs. Specifically, they can win a reward (real money here, folks: discount on premium or co-pay, for example) if they meet a specific health target: reduce or quit smoking; lower cholesterol; weight loss, etc.\u003c/li>\n\u003c/ol>\n\u003cdiv>\u003cstrong>What happens next\u003c/strong>\u003c/div>\n\u003cdiv>\u003c/div>\n\u003cdiv>\n\u003cp>These federal rules are in the 30-day public comment period. Then the rules will be finalized. 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On a conference call with reporters today, Gary Cohen, acting director of the Center for Consumer Information and Insurance Oversight, said, \"We're working hard to get everything out as fast as we can.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>Kaiser Health News:\u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/November/20/administration-releases-new-rules-for-health-law.aspx\" target=\"_blank\"> Administration Releases New Health Law Rules for Insurers, Employers\u003c/a>\u003c/p>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "The Department of Health and Human Services issued a whole slew of long-awaited rules Tuesday about the Affordable Care Act. The rules are important to consumers because they have to do with both cost and (loosely) what must be covered. States have some latitude in the coverage area, more on that in a moment.\r\n\r\nFriendly reminder that most of these rules are for the new state based exchanges. Individuals and small businesses will be able to buy insurance through the state's exchange, Covered California. If you get insurance through your employer, you will continue to do so.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_1157\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/12/230136_President-Obama-signs-Health-Reform-Law1.jpg\">\u003cimg class=\"size-medium wp-image-1157\" title=\"President Obama signs health care reform law. (Photo: White House)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2011/12/230136_President-Obama-signs-Health-Reform-Law1-300x200.jpg\" alt=\"President Obama signs health care reform law. (Photo: White House)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">President Obama signs health care reform law. (Photo: White House)\u003c/figcaption>\u003c/figure>\n\u003cp>The Department of Health and Human Services issued a whole slew of long-awaited regulations Tuesday about the Affordable Care Act. They are important to consumers because they have to do with both cost and (loosely) what must be covered. States have some latitude in the coverage area, more on that in a moment.\u003c/p>\n\u003cp>Friendly reminder that most of what the feds released are for the new state based exchanges. Individuals and small businesses will be able to buy insurance through the state's exchange, \u003ca href=\"http://www.cahba.com/exchange/covered-california.htm\" target=\"_blank\">Covered California\u003c/a>. If you get insurance through your employer, you will continue to do so.\u003c/p>\n\u003col>\n\u003cli>\u003cstrong>Guaranteed issue and renewal:\u003c/strong> you no longer can be denied getting insurance due to a pre-existing condition. Insurance companies can no longer jack up rates or drop you completely when it's time to renew. 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The new rules today say that insurance sold in the exchange must match the benefits of the most popular small group health plan in the state (the \"benchmark plan\"). In other words, in all likelihood, more than one prescription drug will be covered in each category.\u003c/li>\n\u003cli>\u003cstrong>Wellness programs: \u003c/strong>A new rule encourages employers to offer a new kind of wellness program. If employers participate, people who receive insurance through their employer will be able to participate in enhanced wellness programs. Specifically, they can win a reward (real money here, folks: discount on premium or co-pay, for example) if they meet a specific health target: reduce or quit smoking; lower cholesterol; weight loss, etc.\u003c/li>\n\u003c/ol>\n\u003cdiv>\u003cstrong>What happens next\u003c/strong>\u003c/div>\n\u003cdiv>\u003c/div>\n\u003cdiv>\n\u003cp>These federal rules are in the 30-day public comment period. Then the rules will be finalized. 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"disqusTitle": "Missive From Massachusetts: Addressing Health Care Costs",
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"content": "\u003cp>\u003cem>Editor's note: The Massachusetts health care overhaul has been a model for the federal plan. The state has reached near-universal access, but that's only one piece (albeit a big one) of health care reform. Another big piece is cost, which the state is now addressing.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Martha Bebinger,\u003c/strong>\u003cem> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/November/19/stuart-altman-massachusetts-health-costs.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/em>\u003c/p>\n\u003cdiv>\n\u003cfigure id=\"attachment_8916\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/BostonSkyline_Nietnagel_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8916\" title=\"Boston, as seen from Boston harbor. (Nietnagel/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/BostonSkyline_Nietnagel_Flickr-300x199.jpg\" alt=\"Boston, as seen from Boston harbor. (Nietnagel/Flickr)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The skyline of Boston, Massachusetts. (Nietnagel/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Massachusetts is the first state to say that health care costs must stop increasing faster than that of most other goods and services. Prof. Stuart Altman, \u003ca href=\"http://heller.brandeis.edu/facultyguide/person.html?emplid=cf63e5b429988290b1667469d90e9f9ae4eefe8a\" target=\"_blank\">a Brandeis economist\u003c/a> who \u003ca href=\"http://www.kaiserhealthnews.org/stories/2009/september/03/nixon-proposal.aspx\" target=\"_blank\">advised President Richard Nixon\u003c/a> on health policy and \u003ca href=\"http://rs9.loc.gov/medicare/index.html\" target=\"_blank\">President Bill Clinton on Medicare\u003c/a>, has responsibility for helping the state achieve that goal.\u003c/p>\n\u003cp>Gov. Deval Patrick recently named Altman to chair the Health Policy Commission, the new board overseeing the sweeping cost-control law. The board, whose other members were \u003ca href=\"http://www.boston.com/whitecoatnotes/2012/11/15/member-health-policy-commission-begin-work-friday/oJENRradgJutBRLkXz1d7H/story.html\" target=\"_blank\">announced last week\u003c/a>, will monitor progress toward keeping health care spending in line with state economic growth overall. While he’s \"hopeful\" the state can meet this goal, Altman notes that many attempts have failed over the years. Here is an edited transcript of my interview with Altman about the challenge facing Massachusetts:\u003c/p>\n\u003cp>\u003cstrong>How do you see this new role?\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">\"[Historically,] I’ve seen both the private sector fall apart and the government sector fall apart. Now, I think what’s being done is smarter.\"\u003c/aside>\n\u003cp> Massachusetts has put together the best kind of balanced program that I could think of in the country, where it is relying at one level on the many changes that are going on in the private sector. But it also has put together an overarching public assessment of what’s going on to make sure that it works, and it actually brings cost down without hurting quality.\u003c/p>\n\u003cp>If the changes that are currently in place don’t do that, this commission is responsible for giving an early warning sign. So we don’t have direct regulatory power to force the system to change, but we do have a monitoring role to make sure that it is working. If it’s not, [we would] first direct the delivery system and the payers to change, and if that doesn’t work, we could also recommend back to the legislature that the state needs more authority.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>What is your sense going in about whether things will proceed without too much intervention, or whether you will need to be directive?\u003c/strong>\u003c/p>\n\u003cp>On one level I’m pretty optimistic. The level of changes that are occurring in the state are really very substantial. And I would say that the delivery systems, including our very big delivery systems, they really are seriously trying to restructure to live within a tighter budget than they had in the past. And the payers too -- Blue Cross, Tufts and Harvard also -- are tightening up the reins and not giving big increases.\u003c/p>\n\u003cp>But I’ve been around a long time and I’ve seen other years and other decades when after a while the cost-containment mechanisms in place began to fall apart, and did fall apart. So while I’m going into this quite optimistic, I also have a degree of skepticism so I’m going to be watching it pretty closely.\u003c/p>\n\u003cp>\u003cstrong>You have seen interest in reining in costs wax and wane. How do you rank this period?\u003c/strong>\u003c/p>\n\u003cp>If we look back in history we had very strong government regulation environment in the early and middle 1970s, actually put forward by a Republican administration. It looked like the government was going to be a very strong regulator of growing health care spending. We had wage and price controls from ’71 to ’74. We created health planning agencies all over the country. We had tough certificate-of-need laws.\u003c/p>\n\u003cp>And then as we move through the '70s we gradually dismantled it all and by the end of the '70s, it was all gone. Then we had a very brief period when the providers had what we called a “voluntary effort” to control their spending. All that fell apart and we had the biggest growth in our history in the 1980s.\u003c/p>\n\u003cp>Then we introduced managed care, which was extremely effective in slowing the growth in spending, but it was perceived by the patients — and the beneficiaries and the press — as a system that was holding back access and quality. We had this strong backlash and we essentially destroyed managed care by the end of the ‘90s. So I’ve seen both the private sector fall apart and the government sector fall apart.\u003c/p>\n\u003cp>Now, I think what’s being done is smarter, and not quite as aggressive as the ‘90s, which I think is a good thing. If you’re too aggressive you’re going to get a lot of backlash too quickly. So I give it a higher probability of success than either the ‘90s or the ‘70s, and I am hopeful.\u003c/p>\n\u003cp>\u003cstrong>What’s your main worry?\u003c/strong>\u003c/p>\n\u003cp>There are two:\u003c/p>\n\u003cp>Ultimately the constraints begin to hurt certain segments of the provider community, [and they] begin to put out statements to the patients that they’re being denied needed care and we begin to develop a new backlash. So I think patients need to be part of this equation and we need to be balancing their needs with the people that pay the bills, so that’s one side.\u003c/p>\n\u003cp>Massachusetts can only be so far ahead of the rest of the country. If inflation really begins to rear its head again in the rest of the country, the likelihood that Massachusetts would be able to really have a significantly lower level of spending growth is hard to hold on to. I’m going to be very conscious of trying to minimize any backlash and I’ll also be watching what’s going on in the rest of the country.\u003c/p>\n\u003cp>\u003cstrong>For patients, are things moving along now in terms of communicating clearly with patients as you think they should?\u003c/strong>\u003c/p>\n\u003cp>No. I don’t think patients really understand these limited networks and tiered networks and ACOs and the like. I think there needs to be an expanded consumer education program. Also I think we need to do it smarter. You don’t force a patient into any one delivery system, you just make it more expensive if they jump out of one to the other, which continues to gives them the choice. What happened in the ‘90s is that often they had no choice, they had to be at a particular network and they couldn’t jump out.\u003c/p>\n\u003cp>So I think we’ve learned something in the last 20 years. If we’re going to ask organizations to have responsibility for total spending of a particular patient population, [the patients] need to know they’re in a particular group, but they also need to have the flexibility if for some reason they want to get out. I think we need to better educate our consumers and patients, but I think we’ve also learned from the ‘90s, so I’m hopeful.\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership that includes \u003ca href=\"http://commonhealth.wbur.org/\">WBUR\u003c/a>, \u003ca href=\"http://www.npr.org/\" target=\"_blank\">NPR\u003c/a> and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cdiv>\u003cem>\u003cbr>\n\u003c/em>\u003c/div>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor's note: The Massachusetts health care overhaul has been a model for the federal plan. The state has reached near-universal access, but that's only one piece (albeit a big one) of health care reform. Another big piece is cost, which the state is now addressing.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Martha Bebinger,\u003c/strong>\u003cem> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2012/November/19/stuart-altman-massachusetts-health-costs.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/em>\u003c/p>\n\u003cdiv>\n\u003cfigure id=\"attachment_8916\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/BostonSkyline_Nietnagel_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8916\" title=\"Boston, as seen from Boston harbor. (Nietnagel/Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/BostonSkyline_Nietnagel_Flickr-300x199.jpg\" alt=\"Boston, as seen from Boston harbor. (Nietnagel/Flickr)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The skyline of Boston, Massachusetts. (Nietnagel/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Massachusetts is the first state to say that health care costs must stop increasing faster than that of most other goods and services. Prof. Stuart Altman, \u003ca href=\"http://heller.brandeis.edu/facultyguide/person.html?emplid=cf63e5b429988290b1667469d90e9f9ae4eefe8a\" target=\"_blank\">a Brandeis economist\u003c/a> who \u003ca href=\"http://www.kaiserhealthnews.org/stories/2009/september/03/nixon-proposal.aspx\" target=\"_blank\">advised President Richard Nixon\u003c/a> on health policy and \u003ca href=\"http://rs9.loc.gov/medicare/index.html\" target=\"_blank\">President Bill Clinton on Medicare\u003c/a>, has responsibility for helping the state achieve that goal.\u003c/p>\n\u003cp>Gov. Deval Patrick recently named Altman to chair the Health Policy Commission, the new board overseeing the sweeping cost-control law. The board, whose other members were \u003ca href=\"http://www.boston.com/whitecoatnotes/2012/11/15/member-health-policy-commission-begin-work-friday/oJENRradgJutBRLkXz1d7H/story.html\" target=\"_blank\">announced last week\u003c/a>, will monitor progress toward keeping health care spending in line with state economic growth overall. While he’s \"hopeful\" the state can meet this goal, Altman notes that many attempts have failed over the years. Here is an edited transcript of my interview with Altman about the challenge facing Massachusetts:\u003c/p>\n\u003cp>\u003cstrong>How do you see this new role?\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">\"[Historically,] I’ve seen both the private sector fall apart and the government sector fall apart. Now, I think what’s being done is smarter.\"\u003c/aside>\n\u003cp> Massachusetts has put together the best kind of balanced program that I could think of in the country, where it is relying at one level on the many changes that are going on in the private sector. But it also has put together an overarching public assessment of what’s going on to make sure that it works, and it actually brings cost down without hurting quality.\u003c/p>\n\u003cp>If the changes that are currently in place don’t do that, this commission is responsible for giving an early warning sign. So we don’t have direct regulatory power to force the system to change, but we do have a monitoring role to make sure that it is working. If it’s not, [we would] first direct the delivery system and the payers to change, and if that doesn’t work, we could also recommend back to the legislature that the state needs more authority.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>What is your sense going in about whether things will proceed without too much intervention, or whether you will need to be directive?\u003c/strong>\u003c/p>\n\u003cp>On one level I’m pretty optimistic. The level of changes that are occurring in the state are really very substantial. And I would say that the delivery systems, including our very big delivery systems, they really are seriously trying to restructure to live within a tighter budget than they had in the past. And the payers too -- Blue Cross, Tufts and Harvard also -- are tightening up the reins and not giving big increases.\u003c/p>\n\u003cp>But I’ve been around a long time and I’ve seen other years and other decades when after a while the cost-containment mechanisms in place began to fall apart, and did fall apart. So while I’m going into this quite optimistic, I also have a degree of skepticism so I’m going to be watching it pretty closely.\u003c/p>\n\u003cp>\u003cstrong>You have seen interest in reining in costs wax and wane. How do you rank this period?\u003c/strong>\u003c/p>\n\u003cp>If we look back in history we had very strong government regulation environment in the early and middle 1970s, actually put forward by a Republican administration. It looked like the government was going to be a very strong regulator of growing health care spending. We had wage and price controls from ’71 to ’74. We created health planning agencies all over the country. We had tough certificate-of-need laws.\u003c/p>\n\u003cp>And then as we move through the '70s we gradually dismantled it all and by the end of the '70s, it was all gone. Then we had a very brief period when the providers had what we called a “voluntary effort” to control their spending. All that fell apart and we had the biggest growth in our history in the 1980s.\u003c/p>\n\u003cp>Then we introduced managed care, which was extremely effective in slowing the growth in spending, but it was perceived by the patients — and the beneficiaries and the press — as a system that was holding back access and quality. We had this strong backlash and we essentially destroyed managed care by the end of the ‘90s. So I’ve seen both the private sector fall apart and the government sector fall apart.\u003c/p>\n\u003cp>Now, I think what’s being done is smarter, and not quite as aggressive as the ‘90s, which I think is a good thing. If you’re too aggressive you’re going to get a lot of backlash too quickly. So I give it a higher probability of success than either the ‘90s or the ‘70s, and I am hopeful.\u003c/p>\n\u003cp>\u003cstrong>What’s your main worry?\u003c/strong>\u003c/p>\n\u003cp>There are two:\u003c/p>\n\u003cp>Ultimately the constraints begin to hurt certain segments of the provider community, [and they] begin to put out statements to the patients that they’re being denied needed care and we begin to develop a new backlash. So I think patients need to be part of this equation and we need to be balancing their needs with the people that pay the bills, so that’s one side.\u003c/p>\n\u003cp>Massachusetts can only be so far ahead of the rest of the country. If inflation really begins to rear its head again in the rest of the country, the likelihood that Massachusetts would be able to really have a significantly lower level of spending growth is hard to hold on to. I’m going to be very conscious of trying to minimize any backlash and I’ll also be watching what’s going on in the rest of the country.\u003c/p>\n\u003cp>\u003cstrong>For patients, are things moving along now in terms of communicating clearly with patients as you think they should?\u003c/strong>\u003c/p>\n\u003cp>No. I don’t think patients really understand these limited networks and tiered networks and ACOs and the like. I think there needs to be an expanded consumer education program. Also I think we need to do it smarter. You don’t force a patient into any one delivery system, you just make it more expensive if they jump out of one to the other, which continues to gives them the choice. What happened in the ‘90s is that often they had no choice, they had to be at a particular network and they couldn’t jump out.\u003c/p>\n\u003cp>So I think we’ve learned something in the last 20 years. If we’re going to ask organizations to have responsibility for total spending of a particular patient population, [the patients] need to know they’re in a particular group, but they also need to have the flexibility if for some reason they want to get out. I think we need to better educate our consumers and patients, but I think we’ve also learned from the ‘90s, so I’m hopeful.\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership that includes \u003ca href=\"http://commonhealth.wbur.org/\">WBUR\u003c/a>, \u003ca href=\"http://www.npr.org/\" target=\"_blank\">NPR\u003c/a> and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cdiv>\u003cem>\u003cbr>\n\u003c/em>\u003c/div>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Health Clinics Continue Growing -- and Preparing -- for January 2014",
"title": "Health Clinics Continue Growing -- and Preparing -- for January 2014",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>By Lauren Whaley, \u003ca title=\"http://centerforhealthreporting.org/blog/clinics-will-continue-surging-prepping-january-20141022\" href=\"http://centerforhealthreporting.org/blog/clinics-will-continue-surging-prepping-january-20141022\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8908\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/CommunityHealthCenterSign_LaurenWhaley_CHCFCenterForHealthReporting.jpg\">\u003cimg class=\"size-medium wp-image-8908\" title=\"(LaurenWhaley/CHCF Center for Health Reporting)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/CommunityHealthCenterSign_LaurenWhaley_CHCFCenterForHealthReporting-300x224.jpg\" alt=\"\" width=\"300\" height=\"224\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(LaurenWhaley/CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Paul Gregerson says November 7, the day after the election, was a “very good day in my life.”\u003c/p>\n\u003cp>“The Obama election is very good news, let me tell you,” he says. “I couldn’t be happier.”\u003c/p>\n\u003cp>Gregerson’s joy -- and relief -- stems from his role as chief medical officer at the \u003ca href=\"http://jwchinstitute.org/\" target=\"_blank\">John Wesley Community Health Institute\u003c/a> in Los Angeles. Gregerson sees patients daily at the Institute’s \u003ca href=\"http://jwchinstitute.org/primary-medical-care/cch-downtown/\" target=\"_blank\">clinic in downtown LA’s Skid Row\u003c/a> neighborhood.\u003c/p>\n\u003cp>He sees Obamacare (and \u003ca href=\"http://centerforhealthreporting.org/article/%E2%80%98last-distraction%E2%80%99-removed-california-moves-ahead-health-reform1015\">California’s full-steam ahead movement on it\u003c/a>) as a way to increase quality health care to his patients. About 20 percent of them are currently enrolled in Medi-Cal. Come January 2014, when the president’s Affordable Care Act goes into full effect, about 80 percent will qualify, he says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under the new law, the clinic will get reimbursed for more of the patients it already sees -- and for many of the new patients it expects to see. About a million more Angelenos are expected to get health insurance. Studies show that people visit the doctor more often when they’re insured. Community health centers have been planning for an explosion of new patients for several years.\u003c!--more-->\u003c/p>\n\u003cp>With more reimbursements for newly insured patients, Gregerson and his team will be able to hire more employees, which, in turn, will allow his clinic to serve more patients. He also expects clinics to deliver a higher level of service and higher quality of care because of increased competition for patients.\u003c/p>\n\u003cp>“For the health center, the things that we’ve already put in motion will continue to run the course,” he says. “The creating of new programs, money that’s been spent on remodeling and hiring new people, will move forward and will even accelerate.”\u003c/p>\n\u003cp>As I reported in a story for \u003ca href=\"http://centerforhealthreporting.org/article/community-health-centers-rise-california1011\">KPCC Southern California Public Radio\u003c/a>, Federally-Qualified Health Centers (FQHCs) like this one have already been ramping up their services and sites. They have become the darlings of the Affordable Care Act, with their \u003ca href=\"http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx\" target=\"_blank\">patient-centered medical home\u003c/a> team approach.\u003c/p>\n\u003cp>“It improves their attachment to the clinic because they’re not only attaching to a physician, they’re attaching to a whole team,” says Al Ballesteros, CEO at \u003ca href=\"http://jwchinstitute.org/about-us/\" target=\"_blank\">JWCH Institute\u003c/a>. “Their mental health, physical health, their nursing needs, their laboratory needs, their specialty referral needs, their needs for benefits, their needs for housing access, (are) all handled by a team.”\u003c/p>\n\u003cp>Ballesteros says community health centers help monitor chronic diseases, focus on preventive care and keep people away from expensive emergency room visits.\u003c/p>\n\u003cp>The JWCH Institute hasn’t been the only FQHC ramping up. Advocates say that the recession has introduced middle class Americans to community health centers.\u003c/p>\n\u003cp>In California, the number of patients seen at FQHCs rose from \u003ca href=\"http://www.nachc.com/client/documents/Primary_Care_Revolution_Final_8_16.pdf\" target=\"_blank\">2.7 million in 2009\u003c/a> to \u003ca href=\"http://www.nachc.com/client/2012%20Key%20data.pdf\" target=\"_blank\">3.1 million in 2011\u003c/a>.\u003c/p>\n\u003cp>Nationwide, patient numbers are expected to jump from the current \u003ca href=\"http://www.nachc.com/client/HCR_New_Patients_Final.pdf\" target=\"_blank\">20 million to 40 million by 2015\u003c/a>.\u003c/p>\n\u003cp>As for JWCH, its centers have been bombarded. In 2009, JWCH clinics provided 59 thousand primary care visits. They expect to have almost twice that number by year’s end.\u003c/p>\n\u003cp>“We started out here eight years ago with a clinic down here,” says Gregerson of the Skid Row location. “And just because of the demand, we’ve added a clinic in Bell Gardens, in Norwalk, in Lynwood. We just opened one in Bellflower about six or eight months ago.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We’re all human,” he says. “Everybody deserves to be taken care of.”\u003c/p>\n\n",
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"excerpt": "Dr. Paul Gregerson says November 7, the day after the election, was a “very good day in my life.”\r\n\r\n“The Obama election is very good news, let me tell you,” he says. “I couldn’t be happier.”\r\n\r\nGregerson’s joy -- and relief -- stems from his role as chief medical officer at the John Wesley Community Health Institute in Los Angeles. Gregerson sees patients daily at the Institute’s clinic in downtown LA’s Skid Row neighborhood.",
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"title": "Health Clinics Continue Growing -- and Preparing -- for January 2014 | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Lauren Whaley, \u003ca title=\"http://centerforhealthreporting.org/blog/clinics-will-continue-surging-prepping-january-20141022\" href=\"http://centerforhealthreporting.org/blog/clinics-will-continue-surging-prepping-january-20141022\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8908\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/CommunityHealthCenterSign_LaurenWhaley_CHCFCenterForHealthReporting.jpg\">\u003cimg class=\"size-medium wp-image-8908\" title=\"(LaurenWhaley/CHCF Center for Health Reporting)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/CommunityHealthCenterSign_LaurenWhaley_CHCFCenterForHealthReporting-300x224.jpg\" alt=\"\" width=\"300\" height=\"224\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(LaurenWhaley/CHCF Center for Health Reporting)\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Paul Gregerson says November 7, the day after the election, was a “very good day in my life.”\u003c/p>\n\u003cp>“The Obama election is very good news, let me tell you,” he says. “I couldn’t be happier.”\u003c/p>\n\u003cp>Gregerson’s joy -- and relief -- stems from his role as chief medical officer at the \u003ca href=\"http://jwchinstitute.org/\" target=\"_blank\">John Wesley Community Health Institute\u003c/a> in Los Angeles. Gregerson sees patients daily at the Institute’s \u003ca href=\"http://jwchinstitute.org/primary-medical-care/cch-downtown/\" target=\"_blank\">clinic in downtown LA’s Skid Row\u003c/a> neighborhood.\u003c/p>\n\u003cp>He sees Obamacare (and \u003ca href=\"http://centerforhealthreporting.org/article/%E2%80%98last-distraction%E2%80%99-removed-california-moves-ahead-health-reform1015\">California’s full-steam ahead movement on it\u003c/a>) as a way to increase quality health care to his patients. About 20 percent of them are currently enrolled in Medi-Cal. Come January 2014, when the president’s Affordable Care Act goes into full effect, about 80 percent will qualify, he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under the new law, the clinic will get reimbursed for more of the patients it already sees -- and for many of the new patients it expects to see. About a million more Angelenos are expected to get health insurance. Studies show that people visit the doctor more often when they’re insured. Community health centers have been planning for an explosion of new patients for several years.\u003c!--more-->\u003c/p>\n\u003cp>With more reimbursements for newly insured patients, Gregerson and his team will be able to hire more employees, which, in turn, will allow his clinic to serve more patients. He also expects clinics to deliver a higher level of service and higher quality of care because of increased competition for patients.\u003c/p>\n\u003cp>“For the health center, the things that we’ve already put in motion will continue to run the course,” he says. “The creating of new programs, money that’s been spent on remodeling and hiring new people, will move forward and will even accelerate.”\u003c/p>\n\u003cp>As I reported in a story for \u003ca href=\"http://centerforhealthreporting.org/article/community-health-centers-rise-california1011\">KPCC Southern California Public Radio\u003c/a>, Federally-Qualified Health Centers (FQHCs) like this one have already been ramping up their services and sites. They have become the darlings of the Affordable Care Act, with their \u003ca href=\"http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx\" target=\"_blank\">patient-centered medical home\u003c/a> team approach.\u003c/p>\n\u003cp>“It improves their attachment to the clinic because they’re not only attaching to a physician, they’re attaching to a whole team,” says Al Ballesteros, CEO at \u003ca href=\"http://jwchinstitute.org/about-us/\" target=\"_blank\">JWCH Institute\u003c/a>. “Their mental health, physical health, their nursing needs, their laboratory needs, their specialty referral needs, their needs for benefits, their needs for housing access, (are) all handled by a team.”\u003c/p>\n\u003cp>Ballesteros says community health centers help monitor chronic diseases, focus on preventive care and keep people away from expensive emergency room visits.\u003c/p>\n\u003cp>The JWCH Institute hasn’t been the only FQHC ramping up. Advocates say that the recession has introduced middle class Americans to community health centers.\u003c/p>\n\u003cp>In California, the number of patients seen at FQHCs rose from \u003ca href=\"http://www.nachc.com/client/documents/Primary_Care_Revolution_Final_8_16.pdf\" target=\"_blank\">2.7 million in 2009\u003c/a> to \u003ca href=\"http://www.nachc.com/client/2012%20Key%20data.pdf\" target=\"_blank\">3.1 million in 2011\u003c/a>.\u003c/p>\n\u003cp>Nationwide, patient numbers are expected to jump from the current \u003ca href=\"http://www.nachc.com/client/HCR_New_Patients_Final.pdf\" target=\"_blank\">20 million to 40 million by 2015\u003c/a>.\u003c/p>\n\u003cp>As for JWCH, its centers have been bombarded. In 2009, JWCH clinics provided 59 thousand primary care visits. They expect to have almost twice that number by year’s end.\u003c/p>\n\u003cp>“We started out here eight years ago with a clinic down here,” says Gregerson of the Skid Row location. “And just because of the demand, we’ve added a clinic in Bell Gardens, in Norwalk, in Lynwood. We just opened one in Bellflower about six or eight months ago.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We’re all human,” he says. “Everybody deserves to be taken care of.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "‘Last Distraction’ Removed as California Moves Ahead on Health Reform",
"title": "‘Last Distraction’ Removed as California Moves Ahead on Health Reform",
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"content": "\u003cp>By Emily Bazar and Lauren M. Whaley, \u003ca title=\"http://centerforhealthreporting.org/article/‘last-distraction’-removed-california-moves-ahead-health-reform1015?page=0,0\" href=\"http://centerforhealthreporting.org/article/%E2%80%98last-distraction%E2%80%99-removed-california-moves-ahead-health-reform1015?page=0,0\" target=\"_blank\">Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8836\" class=\"wp-caption alignleft\" style=\"max-width: 290px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/CoveredCalifornia1.png\">\u003cimg class=\"size-full wp-image-8836 \" title=\"California's insurance marketplace, Covered California, will open in October, 2013. People will be able to buy insurance, which will take effect January 1, 2014.\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/CoveredCalifornia1.png\" alt=\"Covered California, will open in October, 2013. It will be the primary individual insurance marketplace. People will be able to buy insurance, which will take effect January 1, 2014.\" width=\"290\" height=\"302\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/11/CoveredCalifornia1.png 290w, https://ww2.kqed.org/app/uploads/sites/27/2012/11/CoveredCalifornia1-32x32.png 32w\" sizes=\"(max-width: 290px) 100vw, 290px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">California's insurance marketplace, Covered California, will open in October, 2013 and is expected to be the primary individual health insurance market in California. People will be able to buy insurance, which will take effect January 1, 2014.\u003c/figcaption>\u003c/figure>\n\u003cp>First, there was uncertainty over a \u003ca href=\"http://centerforhealthreporting.org/article/california-faces-%E2%80%98cloud-uncertainty%E2%80%99-supreme-court-decision-health-care929\" target=\"_blank\">U.S. Supreme Court challenge\u003c/a>. Then came the race for the presidency.\u003c/p>\n\u003cp>Now, California lawmakers say the uncertainty is over and nothing can stop them from bringing health coverage to millions of uninsured Californians under President Obama’s signature health care law.\u003c/p>\n\u003cp>“This removes the last distraction and question from anyone’s mind that we won’t be launching a dramatic expansion in coverage in California,” said Peter Lee, executive director of \u003ca href=\"http://www.healthexchange.ca.gov/Pages/Default.aspx\" target=\"_blank\">California’s health insurance exchange\u003c/a>, a key piece of the expansion.\u003c/p>\n\u003cp>Last Wednesday, Lee and other California health leaders celebrated Obama’s re-election as a green light for fully implementing the Affordable Care Act. They also applauded the passage of Gov. Jerry Brown’s tax initiative, Proposition 30, saying its success may have prevented additional health cuts at the state level.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>More cuts would have complicated the state’s implementation of the federal law, whose major provisions debut in 2014 and include the health exchange and an expansion of Medi-Cal, the state’s version of Medicaid. More than 2 million people could gain coverage in the first year.\u003c/p>\n\u003caside class=\"pullquote alignright\">“Over the coming months, people will very much be looking to California as a model for how an exchange could work.”\u003c/aside>\n\u003cp>“Prop. 30 provides some breathing room (and) gives us the opportunity for a stable foundation from day one,” said \u003ca href=\"http://www.chhs.ca.gov/Documents/SecretaryDooleyBio2012.pdf\" target=\"_blank\">Diana Dooley\u003c/a>, secretary of the California Health and Human Services Agency.\u003c/p>\n\u003cp>The way ahead is not entirely clear of potential threats, however. Congressional Republicans have vowed to weaken the law, and upcoming budget negotiations could provide them an opportunity.\u003c!--more-->\u003c/p>\n\u003cp>California has the most uninsured residents in the country -- about 7 million -- and therefore potentially the most to gain.\u003c/p>\n\u003cp>“I am just so excited. For consumers, it means we really can have reform, and the millions of people without insurance can get it,” said Betsy Imholz, special projects director for \u003ca href=\"http://www.consumersunion.org/\" target=\"_blank\">Consumers Union\u003c/a>.\u003c/p>\n\u003cp>Some uninsured residents will be able to purchase federally subsidized insurance through the exchange, which will offer a marketplace of health plans. Individuals and families making between 138 and 400 percent of the federal poverty level, or up to $92,200 for a family of four in 2012, will be eligible for the subsidies.\u003c/p>\n\u003cp>The exchange plans to open in October 2013 with an open enrollment period, with coverage to commence in 2014.\u003c/p>\n\u003cp>By 2019, up to 2.1 million Californians could enroll in the subsidized coverage, according to a \u003ca href=\"http://www.healthpolicy.ucla.edu/pubs/files/calsim_Exchange1.pdf\" target=\"_blank\">joint analysis by UCLA and UC Berkeley\u003c/a>.\u003c/p>\n\u003cp>Exchange leaders didn’t wait for the Supreme Court or the election to get rolling. They already have awarded a $359 million contract for the development of the online portal and have begun soliciting health plans for the program, called “Covered California.”\u003c/p>\n\u003cp>“Over the coming months, people will very much be looking to California as a model for how an exchange could work,” said Larry Levitt, a senior vice president at the \u003ca href=\"http://www.kff.org/\" target=\"_blank\">Kaiser Family Foundation\u003c/a>. “Particularly as states that are somewhat more behind try and catch up, I have no doubt they’re going to be calling Sacramento to get some advice.”\u003c/p>\n\u003cp>The Medi-Cal expansion will broaden eligibility for the program by raising the qualifying income level and allowing those who were previously ineligible, such as single adults, to access coverage. Up to 1.6 million Californians could enroll in Medi-Cal under the expansion by 2019.\u003c/p>\n\u003cp>That process is already under way. About half a million low-income Californians are covered in the “Bridge to Reform,” the state’s precursor to the Medi-Cal expansion.\u003c/p>\n\u003cp>In Sacramento, state lawmakers are preparing for a special legislative session, called by Gov. Brown, to focus on the implementation of the health law. Bills approved during the special session take effect more quickly – 91 days after adjournment – than those in the regular legislative session.\u003c/p>\n\u003cp>Work will begin in earnest in January.\u003c/p>\n\u003cp>In part, California lawmakers have been waiting for direction from the federal government, which soon is expected to release a torrent of regulations and guidance to help states implement the law.\u003c/p>\n\u003cp>\u003ca href=\"http://sd24.senate.ca.gov/\" target=\"_blank\">Sen. Ed Hernandez\u003c/a>, Democratic chairman of the Senate Health Committee, has ambitious plans for legislation, including a measure that the governor vetoed this year. The bill would have, among other things, implemented a key piece of the federal law that requires health plans to cover anyone regardless of pre-existing medical conditions.\u003c/p>\n\u003cp>Both Hernandez and \u003ca href=\"http://asmdc.org/members/a05/\" target=\"_blank\">Democratic Assemblyman Richard Pan\u003c/a>, chairman of the Assembly Health Committee, acknowledge that challenges remain, both at the state and federal levels.\u003c/p>\n\u003cp>Even though the vast majority of funding for the law is from the federal government, Pan said he worries about the long-term financial impact on the state.\u003c/p>\n\u003cp>Hernandez pointed to marketing and outreach as a critical challenge, especially in a state with large and diverse ethnic populations. If Californians don’t know about the exchange, he said, they won’t be able to participate.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The key to success will be having as many people as we possibly can to spread the risk on the exchange,” he said.\u003c/p>\n\n",
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"excerpt": "First, there was uncertainty over a U.S. Supreme Court challenge. Then came the race for the presidency.\r\n\r\nNow, California lawmakers say the uncertainty is over and nothing can stop them from bringing health coverage to millions of uninsured Californians under President Obama’s signature health care law.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Emily Bazar and Lauren M. Whaley, \u003ca title=\"http://centerforhealthreporting.org/article/‘last-distraction’-removed-california-moves-ahead-health-reform1015?page=0,0\" href=\"http://centerforhealthreporting.org/article/%E2%80%98last-distraction%E2%80%99-removed-california-moves-ahead-health-reform1015?page=0,0\" target=\"_blank\">Center for Health Reporting\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_8836\" class=\"wp-caption alignleft\" style=\"max-width: 290px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/CoveredCalifornia1.png\">\u003cimg class=\"size-full wp-image-8836 \" title=\"California's insurance marketplace, Covered California, will open in October, 2013. People will be able to buy insurance, which will take effect January 1, 2014.\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/11/CoveredCalifornia1.png\" alt=\"Covered California, will open in October, 2013. It will be the primary individual insurance marketplace. People will be able to buy insurance, which will take effect January 1, 2014.\" width=\"290\" height=\"302\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/11/CoveredCalifornia1.png 290w, https://ww2.kqed.org/app/uploads/sites/27/2012/11/CoveredCalifornia1-32x32.png 32w\" sizes=\"(max-width: 290px) 100vw, 290px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">California's insurance marketplace, Covered California, will open in October, 2013 and is expected to be the primary individual health insurance market in California. People will be able to buy insurance, which will take effect January 1, 2014.\u003c/figcaption>\u003c/figure>\n\u003cp>First, there was uncertainty over a \u003ca href=\"http://centerforhealthreporting.org/article/california-faces-%E2%80%98cloud-uncertainty%E2%80%99-supreme-court-decision-health-care929\" target=\"_blank\">U.S. Supreme Court challenge\u003c/a>. Then came the race for the presidency.\u003c/p>\n\u003cp>Now, California lawmakers say the uncertainty is over and nothing can stop them from bringing health coverage to millions of uninsured Californians under President Obama’s signature health care law.\u003c/p>\n\u003cp>“This removes the last distraction and question from anyone’s mind that we won’t be launching a dramatic expansion in coverage in California,” said Peter Lee, executive director of \u003ca href=\"http://www.healthexchange.ca.gov/Pages/Default.aspx\" target=\"_blank\">California’s health insurance exchange\u003c/a>, a key piece of the expansion.\u003c/p>\n\u003cp>Last Wednesday, Lee and other California health leaders celebrated Obama’s re-election as a green light for fully implementing the Affordable Care Act. They also applauded the passage of Gov. Jerry Brown’s tax initiative, Proposition 30, saying its success may have prevented additional health cuts at the state level.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>More cuts would have complicated the state’s implementation of the federal law, whose major provisions debut in 2014 and include the health exchange and an expansion of Medi-Cal, the state’s version of Medicaid. More than 2 million people could gain coverage in the first year.\u003c/p>\n\u003caside class=\"pullquote alignright\">“Over the coming months, people will very much be looking to California as a model for how an exchange could work.”\u003c/aside>\n\u003cp>“Prop. 30 provides some breathing room (and) gives us the opportunity for a stable foundation from day one,” said \u003ca href=\"http://www.chhs.ca.gov/Documents/SecretaryDooleyBio2012.pdf\" target=\"_blank\">Diana Dooley\u003c/a>, secretary of the California Health and Human Services Agency.\u003c/p>\n\u003cp>The way ahead is not entirely clear of potential threats, however. Congressional Republicans have vowed to weaken the law, and upcoming budget negotiations could provide them an opportunity.\u003c!--more-->\u003c/p>\n\u003cp>California has the most uninsured residents in the country -- about 7 million -- and therefore potentially the most to gain.\u003c/p>\n\u003cp>“I am just so excited. For consumers, it means we really can have reform, and the millions of people without insurance can get it,” said Betsy Imholz, special projects director for \u003ca href=\"http://www.consumersunion.org/\" target=\"_blank\">Consumers Union\u003c/a>.\u003c/p>\n\u003cp>Some uninsured residents will be able to purchase federally subsidized insurance through the exchange, which will offer a marketplace of health plans. Individuals and families making between 138 and 400 percent of the federal poverty level, or up to $92,200 for a family of four in 2012, will be eligible for the subsidies.\u003c/p>\n\u003cp>The exchange plans to open in October 2013 with an open enrollment period, with coverage to commence in 2014.\u003c/p>\n\u003cp>By 2019, up to 2.1 million Californians could enroll in the subsidized coverage, according to a \u003ca href=\"http://www.healthpolicy.ucla.edu/pubs/files/calsim_Exchange1.pdf\" target=\"_blank\">joint analysis by UCLA and UC Berkeley\u003c/a>.\u003c/p>\n\u003cp>Exchange leaders didn’t wait for the Supreme Court or the election to get rolling. They already have awarded a $359 million contract for the development of the online portal and have begun soliciting health plans for the program, called “Covered California.”\u003c/p>\n\u003cp>“Over the coming months, people will very much be looking to California as a model for how an exchange could work,” said Larry Levitt, a senior vice president at the \u003ca href=\"http://www.kff.org/\" target=\"_blank\">Kaiser Family Foundation\u003c/a>. “Particularly as states that are somewhat more behind try and catch up, I have no doubt they’re going to be calling Sacramento to get some advice.”\u003c/p>\n\u003cp>The Medi-Cal expansion will broaden eligibility for the program by raising the qualifying income level and allowing those who were previously ineligible, such as single adults, to access coverage. Up to 1.6 million Californians could enroll in Medi-Cal under the expansion by 2019.\u003c/p>\n\u003cp>That process is already under way. About half a million low-income Californians are covered in the “Bridge to Reform,” the state’s precursor to the Medi-Cal expansion.\u003c/p>\n\u003cp>In Sacramento, state lawmakers are preparing for a special legislative session, called by Gov. Brown, to focus on the implementation of the health law. Bills approved during the special session take effect more quickly – 91 days after adjournment – than those in the regular legislative session.\u003c/p>\n\u003cp>Work will begin in earnest in January.\u003c/p>\n\u003cp>In part, California lawmakers have been waiting for direction from the federal government, which soon is expected to release a torrent of regulations and guidance to help states implement the law.\u003c/p>\n\u003cp>\u003ca href=\"http://sd24.senate.ca.gov/\" target=\"_blank\">Sen. Ed Hernandez\u003c/a>, Democratic chairman of the Senate Health Committee, has ambitious plans for legislation, including a measure that the governor vetoed this year. The bill would have, among other things, implemented a key piece of the federal law that requires health plans to cover anyone regardless of pre-existing medical conditions.\u003c/p>\n\u003cp>Both Hernandez and \u003ca href=\"http://asmdc.org/members/a05/\" target=\"_blank\">Democratic Assemblyman Richard Pan\u003c/a>, chairman of the Assembly Health Committee, acknowledge that challenges remain, both at the state and federal levels.\u003c/p>\n\u003cp>Even though the vast majority of funding for the law is from the federal government, Pan said he worries about the long-term financial impact on the state.\u003c/p>\n\u003cp>Hernandez pointed to marketing and outreach as a critical challenge, especially in a state with large and diverse ethnic populations. If Californians don’t know about the exchange, he said, they won’t be able to participate.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The key to success will be having as many people as we possibly can to spread the risk on the exchange,” he said.\u003c/p>\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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