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"content": "\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>People in the state’s health industry, from advocates to clinic directors, were left reeling by the new CBO report, which estimated the Senate Republican health plan would create an additional 22 million uninsured Americans by 2026.\u003c/p>\n\u003cp>“Nowhere are the dangers greater than in California, where our Medicaid program (Medi-Cal) covers more than one in three state residents,” said Sandra R. Hernández, president and CEO of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation.\u003c/a>\u003c/p>\n\u003cp>The Republican bill would radically cut federal funding for Medicaid, even more deeply than what was proposed in the House bill. It would also decrease subsidies for Americans who buy their own insurance on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>, but that’s a smaller group, about 1.7 million residents, compared to the 13.5 million residents covered by Medi-Cal.\u003c/p>\n\u003cp>“More Californians will likely delay or defer necessary care, and when they show up at clinics and emergency rooms, they will likely be sicker and costlier to treat,” Hernandez predicted.\u003c/p>\n\u003cp>“States, communities, and families will be forced to make unthinkable choices about providing necessary care for their loved ones,\" she added.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under the Senate plan, most consumers who shop for subsidized plans on Covered California would see their out-of-pocket costs rise, while also receiving less financial assistance to compensate. In San Francisco, a 60-year-old who earns $30,000 a year would be facing an out-of-pocket premium of $5,570 a year, more than double what she paid under the Affordable Care Act, according to an \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> by the Kaiser Family Foundation.\u003c/p>\n\u003cp>But a 27-year-old in San Francisco making $40,000 a year would see premiums decrease by 12 percent.\u003c/p>\n\u003cp>In general, older consumers would pay more under the Senate plan, because the bill allows insurers to charge them five times as much as younger people, but also because the subsidy they get decreases by almost $1,000 a year.\u003c/p>\n\u003cp>When it comes to the impacts on Medi-Cal, which covers the lower-income residents, people with disabilities, and many seniors, rural California would bear the brunt, said Doreen Bradshaw, executive director of a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of health clinics in northern California.\u003c/p>\n\u003cp>“If you look at a map, 44 out of 58 counties in California are rural,” she said. “We need to maintain [Medicaid] for rural America. This has the potential to be very devastating.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The state’s rural counties provide food, timber, and water for the rest of California and the rest of the country. Bradshaw said cutting health care for rural California workers would have a negative ripple effect on the national economy.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>People in the state’s health industry, from advocates to clinic directors, were left reeling by the new CBO report, which estimated the Senate Republican health plan would create an additional 22 million uninsured Americans by 2026.\u003c/p>\n\u003cp>“Nowhere are the dangers greater than in California, where our Medicaid program (Medi-Cal) covers more than one in three state residents,” said Sandra R. Hernández, president and CEO of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation.\u003c/a>\u003c/p>\n\u003cp>The Republican bill would radically cut federal funding for Medicaid, even more deeply than what was proposed in the House bill. It would also decrease subsidies for Americans who buy their own insurance on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>, but that’s a smaller group, about 1.7 million residents, compared to the 13.5 million residents covered by Medi-Cal.\u003c/p>\n\u003cp>“More Californians will likely delay or defer necessary care, and when they show up at clinics and emergency rooms, they will likely be sicker and costlier to treat,” Hernandez predicted.\u003c/p>\n\u003cp>“States, communities, and families will be forced to make unthinkable choices about providing necessary care for their loved ones,\" she added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under the Senate plan, most consumers who shop for subsidized plans on Covered California would see their out-of-pocket costs rise, while also receiving less financial assistance to compensate. In San Francisco, a 60-year-old who earns $30,000 a year would be facing an out-of-pocket premium of $5,570 a year, more than double what she paid under the Affordable Care Act, according to an \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> by the Kaiser Family Foundation.\u003c/p>\n\u003cp>But a 27-year-old in San Francisco making $40,000 a year would see premiums decrease by 12 percent.\u003c/p>\n\u003cp>In general, older consumers would pay more under the Senate plan, because the bill allows insurers to charge them five times as much as younger people, but also because the subsidy they get decreases by almost $1,000 a year.\u003c/p>\n\u003cp>When it comes to the impacts on Medi-Cal, which covers the lower-income residents, people with disabilities, and many seniors, rural California would bear the brunt, said Doreen Bradshaw, executive director of a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of health clinics in northern California.\u003c/p>\n\u003cp>“If you look at a map, 44 out of 58 counties in California are rural,” she said. “We need to maintain [Medicaid] for rural America. This has the potential to be very devastating.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The state’s rural counties provide food, timber, and water for the rest of California and the rest of the country. Bradshaw said cutting health care for rural California workers would have a negative ripple effect on the national economy.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Blaming 'Threat' of GOP Health Bill, California Hits Pause on Single Payer",
"title": "Blaming 'Threat' of GOP Health Bill, California Hits Pause on Single Payer",
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"content": "\u003cp>Single-payer health care, a longtime goal of progressive Democrats and the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">nurses' union\u003c/a>, is dead for now. No further legislative action will be taken in 2017.\u003c/p>\n\u003cp>A bill pushing a state-based single-payer system was brought to a halt late Friday when Assembly Speaker Anthony Rendon, D-Lakewood, declined to move it forward. The bill will not get a hearing by the Assembly Rules Committee before the July 14 deadline, though it could be taken up again in 2018. It passed the California Senate on June 1.\u003c/p>\n\u003cp>\"Single payer\" generally refers to health care systems in which the government pays doctors and other health providers using tax revenues, bypassing the use of private insurance companies as middlemen.\u003c/p>\n\u003cp>In some systems, the doctors work directly for the government, but the California bill proposes a variant in which doctors and hospitals remain private entities and establish contracts with the state to provide care.\u003c/p>\n\u003cp>Rendon described himself as a longtime supporter of a single-payer system, but said the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">current bill\u003c/a> was \"woefully incomplete\" and doesn't address the \"realities\" of both the Trump administration and voters.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Yesterday, Republicans in the U.S. Senate released a cynical plan to repeal the Affordable Care Act, posing a real and immediate threat to millions of Californians who only have health coverage because of the ACA,\" Rendon said in a statement.\u003c/p>\n\u003cp>“Preparing California to meet this threat must be the top health care priority for the Legislature, Governor Brown, and organizations that advocate for increasing access to health care.\"\u003c/p>\n\u003cfigure id=\"attachment_347195\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-347195\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Anthony-Rendon-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">California Assembly Speaker Anthony Rendon (right) confers with Assemblymember Cristina Garcia (left) in Sacramento on May 15, 2017. \u003ccite>(Bert Johnson/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In legislative slang, the \"Healthy California Act\" (SB 562) was a \"shell bill.\" It described a long list of covered services and claimed residents would not have to pay any premiums or copays. Based on the raw outline, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/01/single-payer-economics-one-health-plan-two-new-taxes-three-ways-to-save/\" target=\"_blank\" rel=\"noopener noreferrer\">two studies\u003c/a> tried to estimate the total cost: One came up with $400 billion a year, another said $330 billion.\u003c/p>\n\u003cp>\"This action does not mean SB 562 is dead,\" Rendon said later in the statement. He encouraged single-payer supporters in the Senate to use the time to \"fill the holes\" in the bill, and provide more information about financing, delivery of care and cost controls.\u003c/p>\n\u003cp>The two authors of the bill were disappointed by the move, but vowed to keep fighting for universal coverage in California.\u003c/p>\n\u003cp>State senators Ricardo Lara, D-Bell Gardens, and Toni G. Atkins, D-San Diego, released a joint statement.\u003c/p>\n\u003cp>“Continuing the push for universal healthcare has never been more critical, with Congress possibly days from voting on one of the cruelest bills in our nation’s history, which will lead to millions of the poorest Americans losing insurance, soaring costs for older and sicker people, and terrible budget choices for our state.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“California has the chance to lead our nation toward healthcare for all, and we will not turn our backs on this matter of life or death for families.”\u003c/p>\n\n",
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"excerpt": "Assembly leader says lawmakers must focus on stopping the 'real and immediate threat' posed by Republican health care legislation in Washington D.C.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Single-payer health care, a longtime goal of progressive Democrats and the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">nurses' union\u003c/a>, is dead for now. No further legislative action will be taken in 2017.\u003c/p>\n\u003cp>A bill pushing a state-based single-payer system was brought to a halt late Friday when Assembly Speaker Anthony Rendon, D-Lakewood, declined to move it forward. The bill will not get a hearing by the Assembly Rules Committee before the July 14 deadline, though it could be taken up again in 2018. It passed the California Senate on June 1.\u003c/p>\n\u003cp>\"Single payer\" generally refers to health care systems in which the government pays doctors and other health providers using tax revenues, bypassing the use of private insurance companies as middlemen.\u003c/p>\n\u003cp>In some systems, the doctors work directly for the government, but the California bill proposes a variant in which doctors and hospitals remain private entities and establish contracts with the state to provide care.\u003c/p>\n\u003cp>Rendon described himself as a longtime supporter of a single-payer system, but said the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">current bill\u003c/a> was \"woefully incomplete\" and doesn't address the \"realities\" of both the Trump administration and voters.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Yesterday, Republicans in the U.S. Senate released a cynical plan to repeal the Affordable Care Act, posing a real and immediate threat to millions of Californians who only have health coverage because of the ACA,\" Rendon said in a statement.\u003c/p>\n\u003cp>“Preparing California to meet this threat must be the top health care priority for the Legislature, Governor Brown, and organizations that advocate for increasing access to health care.\"\u003c/p>\n\u003cfigure id=\"attachment_347195\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-347195\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Anthony-Rendon-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/Anthony-Rendon-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">California Assembly Speaker Anthony Rendon (right) confers with Assemblymember Cristina Garcia (left) in Sacramento on May 15, 2017. \u003ccite>(Bert Johnson/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In legislative slang, the \"Healthy California Act\" (SB 562) was a \"shell bill.\" It described a long list of covered services and claimed residents would not have to pay any premiums or copays. Based on the raw outline, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/01/single-payer-economics-one-health-plan-two-new-taxes-three-ways-to-save/\" target=\"_blank\" rel=\"noopener noreferrer\">two studies\u003c/a> tried to estimate the total cost: One came up with $400 billion a year, another said $330 billion.\u003c/p>\n\u003cp>\"This action does not mean SB 562 is dead,\" Rendon said later in the statement. He encouraged single-payer supporters in the Senate to use the time to \"fill the holes\" in the bill, and provide more information about financing, delivery of care and cost controls.\u003c/p>\n\u003cp>The two authors of the bill were disappointed by the move, but vowed to keep fighting for universal coverage in California.\u003c/p>\n\u003cp>State senators Ricardo Lara, D-Bell Gardens, and Toni G. Atkins, D-San Diego, released a joint statement.\u003c/p>\n\u003cp>“Continuing the push for universal healthcare has never been more critical, with Congress possibly days from voting on one of the cruelest bills in our nation’s history, which will lead to millions of the poorest Americans losing insurance, soaring costs for older and sicker people, and terrible budget choices for our state.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“California has the chance to lead our nation toward healthcare for all, and we will not turn our backs on this matter of life or death for families.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "CHART: Who Wins, Who Loses With Senate Health Care Bill",
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"headTitle": "State of Health | KQED News",
"content": "\u003cp>Senate Republicans on Thursday \u003ca href=\"https://apps.npr.org/documents/document.html?id=3872487-SenateHCBill\">unveiled their plan\u003c/a> to repeal and replace the Affordable Care Act — also known as Obamacare. The long-awaited plan marks a big step toward achieving one of the Republican Party's major goals. (Story continues below chart.)\u003c/p>\n\u003cp>[ACACompare]\u003c/p>\n\u003cp>The Senate proposal is broadly similar to the bill passed by House Republicans last month, with a few notable differences. Senate Majority Leader Mitch McConnell, who has been criticized for drafting the bill in secret with just a dozen Republican Senate colleagues, says the proposal — which he calls a discussion draft — will stabilize insurance markets, strengthen Medicaid and cut costs to consumers.\u003c/p>\n\u003cp>\"We agreed on the need to free Americans from Obamacare's mandates. And policies contained in the discussion draft will repeal the individual mandates so Americans are no longer forced to buy insurance they don't need or can't afford,\" McConnell said.\u003c/p>\n\u003cp>Instead, the bill entices people to voluntarily buy a policy by offering them tax credits based on age and income to help pay premiums.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This bill is better designed than the House version, according to \u003ca href=\"https://medium.com/@avik\">Avik Roy\u003c/a>, founder of the Foundation for Research on Equal Opportunity, because it offers more help to older people who can't afford insurance while making coverage cheaper for young healthy people.\u003c/p>\n\u003cp>\"The bill will encourage a lot more of those individuals to buy health insurance,\" Roy says. \"That, in turn, will make the risk pool much healthier, which will also lower premiums. And the tax credits in the bill will also be better-designed.\"\u003c/p>\n\u003cp>But Caroline Pearson, a senior vice president at the consulting firm Avalere Health, says the bill bases its tax credits on lower-quality insurance.\"If you're paying a similar percentage of income, you're getting a less generous product under this new plan,\" she says.\u003c/p>\n\u003cp>The plan keeps some popular parts of Obamacare. It allows parents keep their children on their policies until age 26 and requires insurers to cover people with pre-existing conditions.\u003c/p>\n\u003cp>But it then allows states to opt out of that requirement.\u003c/p>\n\u003cp>\"The protections around pre-existing conditions are still in place in the Senate bill, but the waiver authority gives states options that could include limiting coverage for people with pre-existing conditions,\" says Pearson.\u003c/p>\n\u003cp>Those waivers would allow state to drop benefits \u003ca href=\"https://www.healthcare.gov/coverage/what-marketplace-plans-cover/\">required by Obamacare\u003c/a>, such as maternity coverage, mental health care and prescription drug coverage.\u003c/p>\n\u003cp>Both bills would eliminate most of the taxes imposed by the Affordable Care Act.\u003c/p>\n\u003cp>And they would bar people from using tax credits to buy policies that pay for abortion and also block Planned Parenthood from getting any money from Medicaid for a year.\u003c/p>\n\u003cp>Perhaps the most sweeping move, however, is that the Senate plan follows the House lead in completely changing how the government pays for health care for the poor and the disabled — and goes even further.\u003c/p>\n\u003cp>Today, Medicaid pays for all the care people need, and state and federal governments share the cost.\u003c/p>\n\u003cp>But Medicaid has been eating up an ever-larger share of federal spending. The Senate Republicans' plan puts a lid on that by rolling back the Obama-era expansion of the program and then granting states a set amount of money for each person enrolled. Republicans also want to change the way the federal government calculates payments to the states starting in 2025, reducing the federal government's contribution to the states.\u003c/p>\n\u003cp>\"The Medicaid cuts are even more draconian that the House bill was, though they take effect more gradually than the House bill did,\" Pearson says. \"So we're going to see very significant reductions in coverage in Medicaid and big cuts in federal funding that will result in significant budget gaps for states.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Several Republican senators have already said they oppose the bill, at least as of now. Senate leaders are aiming for a vote before July 4.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CHART%3A+Who+Wins%2C+Who+Loses+With+Senate+Health+Care+Bill&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Senate Republicans on Thursday \u003ca href=\"https://apps.npr.org/documents/document.html?id=3872487-SenateHCBill\">unveiled their plan\u003c/a> to repeal and replace the Affordable Care Act — also known as Obamacare. The long-awaited plan marks a big step toward achieving one of the Republican Party's major goals. (Story continues below chart.)\u003c/p>\n\u003cp>[ACACompare]\u003c/p>\n\u003cp>The Senate proposal is broadly similar to the bill passed by House Republicans last month, with a few notable differences. Senate Majority Leader Mitch McConnell, who has been criticized for drafting the bill in secret with just a dozen Republican Senate colleagues, says the proposal — which he calls a discussion draft — will stabilize insurance markets, strengthen Medicaid and cut costs to consumers.\u003c/p>\n\u003cp>\"We agreed on the need to free Americans from Obamacare's mandates. And policies contained in the discussion draft will repeal the individual mandates so Americans are no longer forced to buy insurance they don't need or can't afford,\" McConnell said.\u003c/p>\n\u003cp>Instead, the bill entices people to voluntarily buy a policy by offering them tax credits based on age and income to help pay premiums.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This bill is better designed than the House version, according to \u003ca href=\"https://medium.com/@avik\">Avik Roy\u003c/a>, founder of the Foundation for Research on Equal Opportunity, because it offers more help to older people who can't afford insurance while making coverage cheaper for young healthy people.\u003c/p>\n\u003cp>\"The bill will encourage a lot more of those individuals to buy health insurance,\" Roy says. \"That, in turn, will make the risk pool much healthier, which will also lower premiums. And the tax credits in the bill will also be better-designed.\"\u003c/p>\n\u003cp>But Caroline Pearson, a senior vice president at the consulting firm Avalere Health, says the bill bases its tax credits on lower-quality insurance.\"If you're paying a similar percentage of income, you're getting a less generous product under this new plan,\" she says.\u003c/p>\n\u003cp>The plan keeps some popular parts of Obamacare. It allows parents keep their children on their policies until age 26 and requires insurers to cover people with pre-existing conditions.\u003c/p>\n\u003cp>But it then allows states to opt out of that requirement.\u003c/p>\n\u003cp>\"The protections around pre-existing conditions are still in place in the Senate bill, but the waiver authority gives states options that could include limiting coverage for people with pre-existing conditions,\" says Pearson.\u003c/p>\n\u003cp>Those waivers would allow state to drop benefits \u003ca href=\"https://www.healthcare.gov/coverage/what-marketplace-plans-cover/\">required by Obamacare\u003c/a>, such as maternity coverage, mental health care and prescription drug coverage.\u003c/p>\n\u003cp>Both bills would eliminate most of the taxes imposed by the Affordable Care Act.\u003c/p>\n\u003cp>And they would bar people from using tax credits to buy policies that pay for abortion and also block Planned Parenthood from getting any money from Medicaid for a year.\u003c/p>\n\u003cp>Perhaps the most sweeping move, however, is that the Senate plan follows the House lead in completely changing how the government pays for health care for the poor and the disabled — and goes even further.\u003c/p>\n\u003cp>Today, Medicaid pays for all the care people need, and state and federal governments share the cost.\u003c/p>\n\u003cp>But Medicaid has been eating up an ever-larger share of federal spending. The Senate Republicans' plan puts a lid on that by rolling back the Obama-era expansion of the program and then granting states a set amount of money for each person enrolled. Republicans also want to change the way the federal government calculates payments to the states starting in 2025, reducing the federal government's contribution to the states.\u003c/p>\n\u003cp>\"The Medicaid cuts are even more draconian that the House bill was, though they take effect more gradually than the House bill did,\" Pearson says. \"So we're going to see very significant reductions in coverage in Medicaid and big cuts in federal funding that will result in significant budget gaps for states.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Several Republican senators have already said they oppose the bill, at least as of now. Senate leaders are aiming for a vote before July 4.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CHART%3A+Who+Wins%2C+Who+Loses+With+Senate+Health+Care+Bill&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Francisco Doctors and Nurses Rally Against Senate Health Care Bill",
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"content": "\u003cp>Roughly 200 San Francisco doctors and nurses rallied Thursday outside San Francisco General Hospital to protest the \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">recently released Senate health care bill\u003c/a>.\u003c/p>\n\u003cp>Crafted in secret by Republican leadership, the bill repeals major parts of the sweeping healthcare law implemented by President Obama, known as the Affordable Care Act or Obamacare. The Republican replacement bill would phase out Medicaid expansion, cap spending on Medicaid and eliminate many taxes that fund Obamacare.\u003c/p>\n\u003cp>“This is about public health,” said Sasha Cuttler, a nurse at the hospital. “This isn’t a partisan issue. ... We have a duty to speak up against this.”\u003c/p>\n\u003cfigure id=\"attachment_346861\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346861\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">A health care professional holding up a sign at a protest at the San Francisco General Hospital against the newly proposed health care bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Matthew Hickey, resident physician and one of the organizers of the rally, said that it’s time for medical professionals to get more politically active.\u003c/p>\n\u003cp>“With the new health care bill being revealed, we felt it’s the right moment for us doctors to do more in the political sphere,” he said. Together with a group of resident doctors, Hickey created the group \"Keep America Covered\" that has organized other rallies since the elections.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>During the rally, doctors, nurses and patients spoke to the crowd and led them in chants like, “Healthcare yes, denials no, profiteers have got to go.\" Organizers encouraged attendees to tweet about their opposition of the bill, as well as to ask their friends and family in other states to call their senators.\u003c/p>\n\u003cfigure id=\"attachment_346862\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346862\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Health care professionals at the San Francisco General Hospital protested against the proposed new health care bill which is intended to replace the Affordable Care Act. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Congressional Budget Office has yet to release its report on the bill, but their report on the House’s version of the bill concluded it would leave 23 million Americans uninsured.\u003c/p>\n\u003cp>“This is not simply a despicable effort to deny essential healthcare services to 23 million Americans,” said UCSF professor Kevin Grumbach. “It is fundamentally an attack on the poor and the most vulnerable in our society and a massive transfer of wealth to the richest part of our society.”\u003c/p>\n\u003cp>One of the speakers at the rally was Troy Brunét, a patient living with HIV. He fears for fellow patients living with the decease.\u003c/p>\n\u003cp>“We are reverting back to the 1980s when the AIDS crisis hit us,\" he said. \"And to be honest, this freaks me out. From now on, things are going to change for the worse.”\u003c/p>\n\u003cfigure id=\"attachment_346860\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346860\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Troy Brunét, a patient living with HIV, addressing the crowd at the San Francisco General Hospital. Health care professionals and some patients protested against the new Senate health care bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Brunét said he’ll continue to fight.\u003c/p>\n\u003cp>“I’m going call Scott Weiner and Senator Harris to tell them to continue the fight as well,\" he said. \"And I’m going to reach out to my family back in Louisiana to tell them to also call their representatives and voice their anger.”\u003c/p>\n\u003cp>Things changed pretty dramatically at San Francisco General with the passage of Obamacare in 2010. Before it passed, nearly 35 percent of the hospital’s patients were uninsured. After, that number dropped to 3 percent for inpatient care.\u003c/p>\n\u003cp>“It means that people are going to get sick and people are going to die,” Dr. Amy Whittle said. “As a pediatrician I’m worried about preventive care and not being able to provide all the care that we know saves us money down the line.”\u003c/p>\n\u003cp>Republican leaders hope to vote on the bill as soon as next week, despite some initial \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-health-care-bill-could-be-in-jeopardy-as-conservatives-announce-opposition/\" target=\"_blank\" rel=\"noopener noreferrer\">opposition from Conservative lawmakers\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_346863\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-346863 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Matthew Hickey, resident physician at the San Francisco General Hospital poses for a photo with a sign in protest of the newly proposed senate health bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>Earlier in the week, on Wednesday, the day before the Senate released their bill, another group of health care activists and senior citizens protested the proposed legislature, staging a \"die-in\" in front of the San Francisco Federal Building. The demonstration, organized by \u003ca href=\"https://t.co/Av5dcXIzXA\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Rising\u003c/a>, was briefly interrupted when a \u003ca href=\"http://hoodline.com/2017/06/motorcyclist-in-custody-after-allegedly-attempting-to-run-over-trumpcare-protestors\" target=\"_blank\" rel=\"noopener noreferrer\">motorcyclist rode during through the group\u003c/a>, narrowly missing some of the people lying in the middle of 7th Street. Police officers at the scene detained the man and he was taken into custody. No injuries were reported.\u003c/p>\n\u003cfigure id=\"attachment_346838\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-346838 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/GettyImages-699424552-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Healthcare activists hold signs as they stage a die-in while protesting the Trumpcare bill on June 21, 2017 in San Francisco. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\n",
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"excerpt": "As details of the Senate bill came out, several demonstrations in the city showed that many in S.F. were not happy with the latest bill. ",
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"description": "As details of the Senate bill came out, several demonstrations in the city showed that many in S.F. were not happy with the latest bill. ",
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"nprByline": "\u003cstrong>\u003ca href=\"https://ww2.kqed.org/news/author/shutson/\" target=\"_blank\">Sonja Hutson\u003c/a>\u003c/strong> and \u003cstrong>\u003ca href=\"https://twitter.com/sroosblad\" target=\"_blank\">Serginho Roosblad\u003c/a>\u003c/strong>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Roughly 200 San Francisco doctors and nurses rallied Thursday outside San Francisco General Hospital to protest the \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">recently released Senate health care bill\u003c/a>.\u003c/p>\n\u003cp>Crafted in secret by Republican leadership, the bill repeals major parts of the sweeping healthcare law implemented by President Obama, known as the Affordable Care Act or Obamacare. The Republican replacement bill would phase out Medicaid expansion, cap spending on Medicaid and eliminate many taxes that fund Obamacare.\u003c/p>\n\u003cp>“This is about public health,” said Sasha Cuttler, a nurse at the hospital. “This isn’t a partisan issue. ... We have a duty to speak up against this.”\u003c/p>\n\u003cfigure id=\"attachment_346861\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346861\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">A health care professional holding up a sign at a protest at the San Francisco General Hospital against the newly proposed health care bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Matthew Hickey, resident physician and one of the organizers of the rally, said that it’s time for medical professionals to get more politically active.\u003c/p>\n\u003cp>“With the new health care bill being revealed, we felt it’s the right moment for us doctors to do more in the political sphere,” he said. Together with a group of resident doctors, Hickey created the group \"Keep America Covered\" that has organized other rallies since the elections.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>During the rally, doctors, nurses and patients spoke to the crowd and led them in chants like, “Healthcare yes, denials no, profiteers have got to go.\" Organizers encouraged attendees to tweet about their opposition of the bill, as well as to ask their friends and family in other states to call their senators.\u003c/p>\n\u003cfigure id=\"attachment_346862\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346862\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Health care professionals at the San Francisco General Hospital protested against the proposed new health care bill which is intended to replace the Affordable Care Act. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Congressional Budget Office has yet to release its report on the bill, but their report on the House’s version of the bill concluded it would leave 23 million Americans uninsured.\u003c/p>\n\u003cp>“This is not simply a despicable effort to deny essential healthcare services to 23 million Americans,” said UCSF professor Kevin Grumbach. “It is fundamentally an attack on the poor and the most vulnerable in our society and a massive transfer of wealth to the richest part of our society.”\u003c/p>\n\u003cp>One of the speakers at the rally was Troy Brunét, a patient living with HIV. He fears for fellow patients living with the decease.\u003c/p>\n\u003cp>“We are reverting back to the 1980s when the AIDS crisis hit us,\" he said. \"And to be honest, this freaks me out. From now on, things are going to change for the worse.”\u003c/p>\n\u003cfigure id=\"attachment_346860\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346860\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Troy Brunét, a patient living with HIV, addressing the crowd at the San Francisco General Hospital. Health care professionals and some patients protested against the new Senate health care bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Brunét said he’ll continue to fight.\u003c/p>\n\u003cp>“I’m going call Scott Weiner and Senator Harris to tell them to continue the fight as well,\" he said. \"And I’m going to reach out to my family back in Louisiana to tell them to also call their representatives and voice their anger.”\u003c/p>\n\u003cp>Things changed pretty dramatically at San Francisco General with the passage of Obamacare in 2010. Before it passed, nearly 35 percent of the hospital’s patients were uninsured. After, that number dropped to 3 percent for inpatient care.\u003c/p>\n\u003cp>“It means that people are going to get sick and people are going to die,” Dr. Amy Whittle said. “As a pediatrician I’m worried about preventive care and not being able to provide all the care that we know saves us money down the line.”\u003c/p>\n\u003cp>Republican leaders hope to vote on the bill as soon as next week, despite some initial \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-health-care-bill-could-be-in-jeopardy-as-conservatives-announce-opposition/\" target=\"_blank\" rel=\"noopener noreferrer\">opposition from Conservative lawmakers\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_346863\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-346863 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Matthew Hickey, resident physician at the San Francisco General Hospital poses for a photo with a sign in protest of the newly proposed senate health bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>Earlier in the week, on Wednesday, the day before the Senate released their bill, another group of health care activists and senior citizens protested the proposed legislature, staging a \"die-in\" in front of the San Francisco Federal Building. The demonstration, organized by \u003ca href=\"https://t.co/Av5dcXIzXA\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Rising\u003c/a>, was briefly interrupted when a \u003ca href=\"http://hoodline.com/2017/06/motorcyclist-in-custody-after-allegedly-attempting-to-run-over-trumpcare-protestors\" target=\"_blank\" rel=\"noopener noreferrer\">motorcyclist rode during through the group\u003c/a>, narrowly missing some of the people lying in the middle of 7th Street. Police officers at the scene detained the man and he was taken into custody. No injuries were reported.\u003c/p>\n\u003cfigure id=\"attachment_346838\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-346838 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/GettyImages-699424552-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Healthcare activists hold signs as they stage a die-in while protesting the Trumpcare bill on June 21, 2017 in San Francisco. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Analysis: Why Senate Health Bill Is Even 'Meaner' for California",
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"content": "\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Medi-Cal Patients Flocking to ERs More Than Before ACA",
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"content": "\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Physician-Assisted Suicide Has Been Legal in California for a Year. How's it Going?",
"title": "Physician-Assisted Suicide Has Been Legal in California for a Year. How's it Going?",
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"content": "\u003cp>John Minor, a retired psychologist, epitomized the active Californian. A resident of Manhattan Beach, Minor ran long distances, bicycled, and hiked.\u003c/p>\n\u003cp>“He and my mom were both members of the Sierra Club,” said Jackie Minor of San Mateo, one of his daughters. \"They went on tons of backpacking trips, you know -- climbing mountains and trekking through the desert. He was just a very active person.”\u003c/p>\n\u003cp>But in the fall of 2014, Minor became ill with pulmonary fibrosis, a lung disease, and it was terminal. His family members said the disease slowly but surely eroded his quality of life. He became increasingly confined to his home, wracked by pain and violent fits of coughing, and suffered frightening episodes of choking and suffocation.\u003c/p>\n\u003cp>So two years after the diagnosis, on Sept. 15, 2016, John Minor sipped his last drink: apple juice laced with a lethal dose of medication his doctor had prescribed for him. He died surrounded by family members, at the age of 80.\u003c/p>\n\u003cp>“He laid down and went to sleep, and he was in a coma for about two hours and then he passed,” Jackie said. “It was very peaceful.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California’s \u003ca href=\"http://coalitionccc.org/tools-resources/end-of-life-option-act/\" target=\"_blank\" rel=\"noopener noreferrer\">End of Life Option Act\u003c/a> went into effect on June 9, 2016. The law created a process for dying patients to ask their doctors for a lethal prescription that the patients can then ingest privately, at home.\u003c/p>\n\u003cp>Since then, at least 500 Californians have received life-ending prescriptions, according to newly released data collected by \u003ca href=\"https://www.compassionandchoices.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Compassion and Choices\u003c/a>, an advocacy group that promotes aid-in-dying laws nationwide.\u003c/p>\n\u003cp>The organization also estimated that about 500 health systems and 100 hospice organizations now participate in the California law.\u003c/p>\n\u003cp>In addition, 80 percent of insurance companies in the state are paying claims involved in the process, such as doctor visits and the prescription itself.\u003c/p>\n\u003cp>“What the numbers are showing is that the law is working incredibly well,” said Matt Whitaker, the organization's director for California and Oregon. “It’s working as the lawmakers intended.”\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>But finding a doctor willing to prescribe the life-ending drugs isn’t always easy, in part because the state law allows doctors to opt out of prescribing -- even when the hospital where they work participates in the law.\u003c/p>\n\u003cp>The decision to prescribe does not come easily for many physicians.\u003c/p>\n\u003cp>“Even if they’re in support of aid-in-dying, they don’t necessarily want to be the person identified as the 'go-to' person for aid-in-dying. Because that’s a very different implication,” said Dr. Elizabeth Dzeng, an assistant professor of hospital medicine at the University of California, San Francisco.\u003c/p>\n\u003cp>About three dozen UCSF patients have requested such assistance since last June.\u003c/p>\n\u003cp>“There is a certain stigma for being known as a physician who writes these prescriptions,\" agreed Dr. Stephanie Harman, medical director of \u003ca href=\"https://stanfordhealthcare.org/medical-clinics/palliative-care.html\" target=\"_blank\" rel=\"noopener noreferrer\">palliative care services\u003c/a> at Stanford Health Care.\u003c/p>\n\u003cp>Harman decided to \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2628972\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> how the law was playing out in the Stanford system. She tracked 13 Stanford patients who received prescriptions for lethal drugs, and learned that half of them initially couldn’t get the drugs from their own doctor.\u003c/p>\n\u003cp>\"There is in the field, in medicine, a question of whether this is an ethical act for a physician,” she explained.\u003c/p>\n\u003cp>Other hospitals and health systems statewide are also trying to get a sense of what their terminal patients are experiencing. At the University of California, Los Angeles, about 20 patients have received prescriptions since the law went into effect — but only about half of them have gone on to take the meds, said Dr. Neil Wenger, a professor of medicine at UCLA and director of the \u003ca href=\"https://www.uclahealth.org/ethics-center/\" target=\"_blank\" rel=\"noopener noreferrer\">UCLA Health Ethics Center\u003c/a>.\u003c/p>\n\u003cp>Wenger helped develop a protocol for UCLA doctors, to guide them through the requirements of administering the medication to qualified terminally ill patients.\u003c/p>\n\u003cp>Among those he’s spoken with, there is a “whole range of preferences” regarding how and whether to participate in the law.\u003c/p>\n\u003cp>A “relatively small number” oppose the law outright, he said. Many others, however, believe patients should have access to aid-in-dying assistance, but don’t want to be involved in prescribing themselves, since it involves legal requirements, paperwork and conversations that can often be difficult.\u003c/p>\n\u003cp>“It raises a lot of feelings on the part of the doctor. It is something very, very different than what a doctor does -- which is saving people,\" Wenger explained. \"And it’s complicated. It takes a whole lot of time.”\u003c/p>\n\u003cp>Dr. Catherine S. Forest is one doctor who has committed herself to taking that time, and assisting patients who want the prescription.\u003c/p>\n\u003cp>Forest practices family medicine in the Stanford health system. Since the law passed, she’s assisted five patients who came to her practice after their own doctors refused.\u003c/p>\n\u003cp>Forest says what’s happening now in California is reminiscent of what happened in the 1970s, when abortion became legal. Even among doctors who agreed with the \u003cem>Roe v. Wade \u003c/em>decision, there was a reluctance to perform abortions.\u003c/p>\n\u003cp>“It takes awhile for people to train, to feel comfortable and to provide, and that was because it was not legal, and then it \u003cem>was\u003c/em> legal. And there are very few instances where we do that in medicine,” Forest says.\u003c/p>\n\u003cp>Aid-in-dying, she says, is one of those challenging moments for doctors. She expects it will take time for California to catch up with other states, like Oregon, that have well-established training resources to help doctors learn the process.\u003c/p>\n\u003cp>John Minor wasn't able to get a prescription at first. His doctors would not write the necessary prescription, so his family started scrambling.\u003c/p>\n\u003cp>“I started cold-calling just different hospitals and different departments within different hospitals,” Jackie said.\u003c/p>\n\u003cp>Ultimately, the family took the step of enrolling her father in a Kaiser Permanente insurance plan, and he received the prescription that he took last fall.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Mentally, he was ready,” said his widow, Sherry Minor. “It was an easy day for him.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>John Minor, a retired psychologist, epitomized the active Californian. A resident of Manhattan Beach, Minor ran long distances, bicycled, and hiked.\u003c/p>\n\u003cp>“He and my mom were both members of the Sierra Club,” said Jackie Minor of San Mateo, one of his daughters. \"They went on tons of backpacking trips, you know -- climbing mountains and trekking through the desert. He was just a very active person.”\u003c/p>\n\u003cp>But in the fall of 2014, Minor became ill with pulmonary fibrosis, a lung disease, and it was terminal. His family members said the disease slowly but surely eroded his quality of life. He became increasingly confined to his home, wracked by pain and violent fits of coughing, and suffered frightening episodes of choking and suffocation.\u003c/p>\n\u003cp>So two years after the diagnosis, on Sept. 15, 2016, John Minor sipped his last drink: apple juice laced with a lethal dose of medication his doctor had prescribed for him. He died surrounded by family members, at the age of 80.\u003c/p>\n\u003cp>“He laid down and went to sleep, and he was in a coma for about two hours and then he passed,” Jackie said. “It was very peaceful.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California’s \u003ca href=\"http://coalitionccc.org/tools-resources/end-of-life-option-act/\" target=\"_blank\" rel=\"noopener noreferrer\">End of Life Option Act\u003c/a> went into effect on June 9, 2016. The law created a process for dying patients to ask their doctors for a lethal prescription that the patients can then ingest privately, at home.\u003c/p>\n\u003cp>Since then, at least 500 Californians have received life-ending prescriptions, according to newly released data collected by \u003ca href=\"https://www.compassionandchoices.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Compassion and Choices\u003c/a>, an advocacy group that promotes aid-in-dying laws nationwide.\u003c/p>\n\u003cp>The organization also estimated that about 500 health systems and 100 hospice organizations now participate in the California law.\u003c/p>\n\u003cp>In addition, 80 percent of insurance companies in the state are paying claims involved in the process, such as doctor visits and the prescription itself.\u003c/p>\n\u003cp>“What the numbers are showing is that the law is working incredibly well,” said Matt Whitaker, the organization's director for California and Oregon. “It’s working as the lawmakers intended.”\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>But finding a doctor willing to prescribe the life-ending drugs isn’t always easy, in part because the state law allows doctors to opt out of prescribing -- even when the hospital where they work participates in the law.\u003c/p>\n\u003cp>The decision to prescribe does not come easily for many physicians.\u003c/p>\n\u003cp>“Even if they’re in support of aid-in-dying, they don’t necessarily want to be the person identified as the 'go-to' person for aid-in-dying. Because that’s a very different implication,” said Dr. Elizabeth Dzeng, an assistant professor of hospital medicine at the University of California, San Francisco.\u003c/p>\n\u003cp>About three dozen UCSF patients have requested such assistance since last June.\u003c/p>\n\u003cp>“There is a certain stigma for being known as a physician who writes these prescriptions,\" agreed Dr. Stephanie Harman, medical director of \u003ca href=\"https://stanfordhealthcare.org/medical-clinics/palliative-care.html\" target=\"_blank\" rel=\"noopener noreferrer\">palliative care services\u003c/a> at Stanford Health Care.\u003c/p>\n\u003cp>Harman decided to \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2628972\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> how the law was playing out in the Stanford system. She tracked 13 Stanford patients who received prescriptions for lethal drugs, and learned that half of them initially couldn’t get the drugs from their own doctor.\u003c/p>\n\u003cp>\"There is in the field, in medicine, a question of whether this is an ethical act for a physician,” she explained.\u003c/p>\n\u003cp>Other hospitals and health systems statewide are also trying to get a sense of what their terminal patients are experiencing. At the University of California, Los Angeles, about 20 patients have received prescriptions since the law went into effect — but only about half of them have gone on to take the meds, said Dr. Neil Wenger, a professor of medicine at UCLA and director of the \u003ca href=\"https://www.uclahealth.org/ethics-center/\" target=\"_blank\" rel=\"noopener noreferrer\">UCLA Health Ethics Center\u003c/a>.\u003c/p>\n\u003cp>Wenger helped develop a protocol for UCLA doctors, to guide them through the requirements of administering the medication to qualified terminally ill patients.\u003c/p>\n\u003cp>Among those he’s spoken with, there is a “whole range of preferences” regarding how and whether to participate in the law.\u003c/p>\n\u003cp>A “relatively small number” oppose the law outright, he said. Many others, however, believe patients should have access to aid-in-dying assistance, but don’t want to be involved in prescribing themselves, since it involves legal requirements, paperwork and conversations that can often be difficult.\u003c/p>\n\u003cp>“It raises a lot of feelings on the part of the doctor. It is something very, very different than what a doctor does -- which is saving people,\" Wenger explained. \"And it’s complicated. It takes a whole lot of time.”\u003c/p>\n\u003cp>Dr. Catherine S. Forest is one doctor who has committed herself to taking that time, and assisting patients who want the prescription.\u003c/p>\n\u003cp>Forest practices family medicine in the Stanford health system. Since the law passed, she’s assisted five patients who came to her practice after their own doctors refused.\u003c/p>\n\u003cp>Forest says what’s happening now in California is reminiscent of what happened in the 1970s, when abortion became legal. Even among doctors who agreed with the \u003cem>Roe v. Wade \u003c/em>decision, there was a reluctance to perform abortions.\u003c/p>\n\u003cp>“It takes awhile for people to train, to feel comfortable and to provide, and that was because it was not legal, and then it \u003cem>was\u003c/em> legal. And there are very few instances where we do that in medicine,” Forest says.\u003c/p>\n\u003cp>Aid-in-dying, she says, is one of those challenging moments for doctors. She expects it will take time for California to catch up with other states, like Oregon, that have well-established training resources to help doctors learn the process.\u003c/p>\n\u003cp>John Minor wasn't able to get a prescription at first. His doctors would not write the necessary prescription, so his family started scrambling.\u003c/p>\n\u003cp>“I started cold-calling just different hospitals and different departments within different hospitals,” Jackie said.\u003c/p>\n\u003cp>Ultimately, the family took the step of enrolling her father in a Kaiser Permanente insurance plan, and he received the prescription that he took last fall.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Mentally, he was ready,” said his widow, Sherry Minor. “It was an easy day for him.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
"title": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
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"content": "\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>State senators voted mostly along party lines, 23-14, to pass a bill that would create a state-managed health care system for all 39 million Californians – even though the bill was missing key details, namely, how to pay for it.\u003c/p>\n\u003cp>Opponents of the “Healthy California Act” repeatedly drew comparisons to the rushed Republican House bill to repeal and replace the Affordable Care Act in Washington, DC. They said state Democrats were guilty of the same tactics, pushing their bill on a single payer health system without a funding mechanism.\u003c/p>\n\u003cp>“It’s not cooked,” Sen. Jeff Stone, R-Temecula, said of the bill. “It’s raw meat.”\u003c/p>\n\u003cp>Senate Bill 596 would upend the state’s employer-based health insurance system and replace it with a “Medicare-for-all” single payer system run by the state.\u003c/p>\n\u003cp>Supporters admitted that the bill is a work in progress, but urged passage as a way to continue the debate, especially in light of uncertainty around billions of dollars in federal funding tied to the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The message to those people who say we’re irresponsible, I tell you, do not don’t judge us based upon a vote in a day,” said Sen. Bob Hertzberg, D-Los Angeles. “Judge us based upon our work at the end of the day.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz.\"\u003cbr>\n\u003ccite>Sen. John Moorlach, R-Costa Mesa\u003c/cite>\u003c/aside>\n\u003cp>How to pay for the new system – estimated to cost $400 billion a year – was the main point of contention, with several lawmakers arguing the state’s finances were already strapped.\u003c/p>\n\u003cp>\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz,\" said Sen. John Moorlach, R-Costa Mesa.\u003c/p>\n\u003cp>No specific funding plan was included in the bill, but an economic analysis by the University of Massachusetts-Amherst, commissioned by the bill’s sponsors, assumed two-thirds of the funding would come from existing federal and state funds that currently pay for Medicare and Medi-Cal, and the rest would come from either a payroll tax, or a combination of a 2.3 percent gross receipts tax on business revenue above $2 million and a 2.3 percent sales tax.\u003c/p>\n\u003cp>The health insurance industry criticized the financial assumptions in the report as “overly optimistic.\" Business groups called the taxes a “job killer” and lawmakers raised concerns on the Senate floor that the Trump administration would not allow the state, which has identified itself as a part of the Trump resistance, to re-apply those funds to a single payer system.\u003c/p>\n\u003cp>“We’re going to kick the crap out of Trump day in and day out on this floor, then we’re going to go beg him for a couple hundred billion dollars?” said Sen. Tom Berryhill, R-Twain Harte. “Should be an interesting ask.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“They are fighting to limit care and we’re fighting to expand it.”\u003cbr>\n\u003ccite>Sen. Ricardo Lara, D-Bell Gardens \u003c/cite>\u003c/aside>\n\u003cp>The bill’s primary author, Sen. Ricardo Lara, D-Bell Gardens, thanked his colleagues for a robust debate. He took copious notes, and even accepted critics’ comparison to him pushing his unfinished bill with the Republicans’ hasty passage of the repeal and replace Obamacare bill.\u003c/p>\n\u003cp>“But there is one fundamental difference,” Lara said. “They are fighting to limit care and we’re fighting to expand it.”\u003c/p>\n\u003cp>Because the bill is on a two-year legislative cycle, Lara has another year and half to work out the details of the funding plan. Getting it passed through the Senate gives him extra momentum to bring other stakeholders in on the debate, including, perhaps, Gov. Jerry Brown, who has indicated he would veto a single payer bill.\u003c/p>\n\u003cp>Lara vowed to work with lawmakers on both sides of the aisle going forward, and committed to having a transparent debate.\u003c/p>\n\u003cp>“For the countless people that still do not have access to care, and are still making the decision about putting food on their table or buying prescription drugs because they cannot afford them, we are going to put our minds together to ensure that we bring back a product that is fiscally prudent and sustainable.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>State senators voted mostly along party lines, 23-14, to pass a bill that would create a state-managed health care system for all 39 million Californians – even though the bill was missing key details, namely, how to pay for it.\u003c/p>\n\u003cp>Opponents of the “Healthy California Act” repeatedly drew comparisons to the rushed Republican House bill to repeal and replace the Affordable Care Act in Washington, DC. They said state Democrats were guilty of the same tactics, pushing their bill on a single payer health system without a funding mechanism.\u003c/p>\n\u003cp>“It’s not cooked,” Sen. Jeff Stone, R-Temecula, said of the bill. “It’s raw meat.”\u003c/p>\n\u003cp>Senate Bill 596 would upend the state’s employer-based health insurance system and replace it with a “Medicare-for-all” single payer system run by the state.\u003c/p>\n\u003cp>Supporters admitted that the bill is a work in progress, but urged passage as a way to continue the debate, especially in light of uncertainty around billions of dollars in federal funding tied to the Affordable Care Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The message to those people who say we’re irresponsible, I tell you, do not don’t judge us based upon a vote in a day,” said Sen. Bob Hertzberg, D-Los Angeles. “Judge us based upon our work at the end of the day.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz.\"\u003cbr>\n\u003ccite>Sen. John Moorlach, R-Costa Mesa\u003c/cite>\u003c/aside>\n\u003cp>How to pay for the new system – estimated to cost $400 billion a year – was the main point of contention, with several lawmakers arguing the state’s finances were already strapped.\u003c/p>\n\u003cp>\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz,\" said Sen. John Moorlach, R-Costa Mesa.\u003c/p>\n\u003cp>No specific funding plan was included in the bill, but an economic analysis by the University of Massachusetts-Amherst, commissioned by the bill’s sponsors, assumed two-thirds of the funding would come from existing federal and state funds that currently pay for Medicare and Medi-Cal, and the rest would come from either a payroll tax, or a combination of a 2.3 percent gross receipts tax on business revenue above $2 million and a 2.3 percent sales tax.\u003c/p>\n\u003cp>The health insurance industry criticized the financial assumptions in the report as “overly optimistic.\" Business groups called the taxes a “job killer” and lawmakers raised concerns on the Senate floor that the Trump administration would not allow the state, which has identified itself as a part of the Trump resistance, to re-apply those funds to a single payer system.\u003c/p>\n\u003cp>“We’re going to kick the crap out of Trump day in and day out on this floor, then we’re going to go beg him for a couple hundred billion dollars?” said Sen. Tom Berryhill, R-Twain Harte. “Should be an interesting ask.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“They are fighting to limit care and we’re fighting to expand it.”\u003cbr>\n\u003ccite>Sen. Ricardo Lara, D-Bell Gardens \u003c/cite>\u003c/aside>\n\u003cp>The bill’s primary author, Sen. Ricardo Lara, D-Bell Gardens, thanked his colleagues for a robust debate. He took copious notes, and even accepted critics’ comparison to him pushing his unfinished bill with the Republicans’ hasty passage of the repeal and replace Obamacare bill.\u003c/p>\n\u003cp>“But there is one fundamental difference,” Lara said. “They are fighting to limit care and we’re fighting to expand it.”\u003c/p>\n\u003cp>Because the bill is on a two-year legislative cycle, Lara has another year and half to work out the details of the funding plan. Getting it passed through the Senate gives him extra momentum to bring other stakeholders in on the debate, including, perhaps, Gov. Jerry Brown, who has indicated he would veto a single payer bill.\u003c/p>\n\u003cp>Lara vowed to work with lawmakers on both sides of the aisle going forward, and committed to having a transparent debate.\u003c/p>\n\u003cp>“For the countless people that still do not have access to care, and are still making the decision about putting food on their table or buying prescription drugs because they cannot afford them, we are going to put our minds together to ensure that we bring back a product that is fiscally prudent and sustainable.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Single Payer Economics: One Health Plan, Two New Taxes, Three Ways to Save",
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"content": "\u003cp>A new outside analysis claims a \"single payer\" health system for California would cost $330 billion a year, not $400 billion, the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\" target=\"_blank\" rel=\"noopener noreferrer\">initial price tag \u003c/a>announced last week in a legislative report.\u003c/p>\n\u003cp>The financial analysis also proposed two new taxes to pay for the system: an excise tax and a sales tax. That's in contrast to the 15 percent payroll tax proposed in last week's report.\u003c/p>\n\u003cp>The analysis was produced by a team of economists at the University of Massachusetts-Amherst, and paid for by the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">California Nurses Association\u003c/a>, a key leader in the movement to establish a universal health care system in California.\u003c/p>\n\u003cp>Supporters of a single-payer plan have promised these details for months, ever since two Democrats from southern California, state senators Ricardo Lara and Toni Atkins, introduced Senate Bill 562, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">\"The Healthy California Act.\" \u003c/a>The full Senate must vote on the bill by Friday for it to move forward in the legislative process.\u003c/p>\n\u003cp>Here's your takeaway:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>One Health Plan:\u003c/strong> Say goodbye to your employer-sponsored health plan, with its deductible, co-pays and co-insurance. Say goodbye to Medicare and its part B premium. Everyone would be moved into the still-unnamed, state-administered plan. The new plan would also completely absorb anyone now covered by Medi-Cal or Covered California. The seven percent of Californians who are still uninsured -- including undocumented residents -- would be brought into the fold as well.\u003c/p>\n\u003cp>The economists argue that a single payer plan, by eliminating private, for-profit insurers in California, and by pooling together public funds from Medicare and Medi-Cal, would create a stream-lined system with lots of bargaining power.\u003c/p>\n\u003cp>\"The good news is that California can get a lot more for our money,\" said State Senator Lara after unveiling the analysis on Wednesday at the state Capitol. \"When the legislature passes the Healthy California Act, we will actually spend less than we do now on health care.\"\u003c/p>\n\u003cp>\u003cstrong>Two New Taxes: \u003c/strong>The analysis assumes California would successfully obtain permission from the federal government -- not a given under a Trump administration -- to continue drawing down federal money for Medicare and Medi-Cal patients, but divert the funds into a single-payer system instead. That would take care of two-thirds of the annual cost.\u003c/p>\n\u003cp>Then, California could raise the remaining $106 billion by taxing consumers and business. Specifically, the analysis proposes:\u003c/p>\n\u003cul>\n\u003cli>A new 2.3 percent sales tax, except on basic living expenses such as housing, groceries, and utilities.\u003c/li>\n\u003cli>A new 2.3 percent excise tax on gross business receipts (the first $2 million in receipts are exempted).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Three Ways to Save:\u003c/strong> A single-payer plan would actually cost 10 percent less than the current system, the analysis claims. How would this savings of $38 billion be achieved?\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Overhead:\u003c/strong> Having only one insurer, California, eliminates the need to make a profit or spend money on marketing and sales. The health care \"providers\" (doctors, nurses, hospitals, nursing homes, etc.), would also save money because they wouldn't have to pay people to administer different insurance contracts and navigate multiple payment systems.\u003c/li>\n\u003cli>\u003cstrong>Medical Salaries and Drug Prices:\u003c/strong> As the only entity paying for healthcare, California could negotiate lower reimbursement rates for some services. The state plan could also pressure drug companies to lower prices as a condition of having their drugs included in the state-run \u003ca href=\"https://www.healthcare.gov/glossary/formulary/\" target=\"_blank\" rel=\"noopener noreferrer\">formulary.\u003c/a>\u003c/li>\n\u003cli>\u003cstrong>More Efficient Treatment from Cradle to Grave:\u003c/strong> In a single, streamlined system, doctors won't have to duplicate tests. A unified system of electronic health records could also help identify risk factors for illness, or prompt patients to get necessary vaccines and screenings.\u003c/li>\n\u003c/ul>\n\u003cp>The new report was received skeptically by Charles Bacchi, who leads the industry trade group for private insurers, the \u003ca href=\"http://California%20Association%20of%20Health%20Plans\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. Bacchi predicted the plan would be \"incredibly disruptive\" and \"unaffordable,\" and implied that doctors might leave the state.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They assume that every doctor is going to still be here in California providing coverage under this proposal,\" he said. \"And, you know, who knows? Something like this creates a lot of uncertainty.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new outside analysis claims a \"single payer\" health system for California would cost $330 billion a year, not $400 billion, the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\" target=\"_blank\" rel=\"noopener noreferrer\">initial price tag \u003c/a>announced last week in a legislative report.\u003c/p>\n\u003cp>The financial analysis also proposed two new taxes to pay for the system: an excise tax and a sales tax. That's in contrast to the 15 percent payroll tax proposed in last week's report.\u003c/p>\n\u003cp>The analysis was produced by a team of economists at the University of Massachusetts-Amherst, and paid for by the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">California Nurses Association\u003c/a>, a key leader in the movement to establish a universal health care system in California.\u003c/p>\n\u003cp>Supporters of a single-payer plan have promised these details for months, ever since two Democrats from southern California, state senators Ricardo Lara and Toni Atkins, introduced Senate Bill 562, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">\"The Healthy California Act.\" \u003c/a>The full Senate must vote on the bill by Friday for it to move forward in the legislative process.\u003c/p>\n\u003cp>Here's your takeaway:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>One Health Plan:\u003c/strong> Say goodbye to your employer-sponsored health plan, with its deductible, co-pays and co-insurance. Say goodbye to Medicare and its part B premium. Everyone would be moved into the still-unnamed, state-administered plan. The new plan would also completely absorb anyone now covered by Medi-Cal or Covered California. The seven percent of Californians who are still uninsured -- including undocumented residents -- would be brought into the fold as well.\u003c/p>\n\u003cp>The economists argue that a single payer plan, by eliminating private, for-profit insurers in California, and by pooling together public funds from Medicare and Medi-Cal, would create a stream-lined system with lots of bargaining power.\u003c/p>\n\u003cp>\"The good news is that California can get a lot more for our money,\" said State Senator Lara after unveiling the analysis on Wednesday at the state Capitol. \"When the legislature passes the Healthy California Act, we will actually spend less than we do now on health care.\"\u003c/p>\n\u003cp>\u003cstrong>Two New Taxes: \u003c/strong>The analysis assumes California would successfully obtain permission from the federal government -- not a given under a Trump administration -- to continue drawing down federal money for Medicare and Medi-Cal patients, but divert the funds into a single-payer system instead. That would take care of two-thirds of the annual cost.\u003c/p>\n\u003cp>Then, California could raise the remaining $106 billion by taxing consumers and business. Specifically, the analysis proposes:\u003c/p>\n\u003cul>\n\u003cli>A new 2.3 percent sales tax, except on basic living expenses such as housing, groceries, and utilities.\u003c/li>\n\u003cli>A new 2.3 percent excise tax on gross business receipts (the first $2 million in receipts are exempted).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Three Ways to Save:\u003c/strong> A single-payer plan would actually cost 10 percent less than the current system, the analysis claims. How would this savings of $38 billion be achieved?\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Overhead:\u003c/strong> Having only one insurer, California, eliminates the need to make a profit or spend money on marketing and sales. The health care \"providers\" (doctors, nurses, hospitals, nursing homes, etc.), would also save money because they wouldn't have to pay people to administer different insurance contracts and navigate multiple payment systems.\u003c/li>\n\u003cli>\u003cstrong>Medical Salaries and Drug Prices:\u003c/strong> As the only entity paying for healthcare, California could negotiate lower reimbursement rates for some services. The state plan could also pressure drug companies to lower prices as a condition of having their drugs included in the state-run \u003ca href=\"https://www.healthcare.gov/glossary/formulary/\" target=\"_blank\" rel=\"noopener noreferrer\">formulary.\u003c/a>\u003c/li>\n\u003cli>\u003cstrong>More Efficient Treatment from Cradle to Grave:\u003c/strong> In a single, streamlined system, doctors won't have to duplicate tests. A unified system of electronic health records could also help identify risk factors for illness, or prompt patients to get necessary vaccines and screenings.\u003c/li>\n\u003c/ul>\n\u003cp>The new report was received skeptically by Charles Bacchi, who leads the industry trade group for private insurers, the \u003ca href=\"http://California%20Association%20of%20Health%20Plans\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. Bacchi predicted the plan would be \"incredibly disruptive\" and \"unaffordable,\" and implied that doctors might leave the state.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They assume that every doctor is going to still be here in California providing coverage under this proposal,\" he said. \"And, you know, who knows? Something like this creates a lot of uncertainty.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The health overhaul bill passed by the House earlier this month accomplishes one major feat: It is even less popular than the not-very-popular Affordable Care Act it would largely replace, a new poll finds.\u003c/p>\n\u003cp>According to the \u003ca href=\"http://kff.org/health-reform/report/kaiser-health-tracking-poll-may-2017-the-ahcas-proposed-changes-to-health-care\">monthly tracking poll\u003c/a> from the Kaiser Family Foundation, 49 percent of respondents said they have a favorable view of the ACA, while 31 percent said they favored the GOP’s American Health Care Act, which narrowly \u003ca href=\"https://www.congress.gov/bill/115th-congress/house-bill/1628\">passed the House\u003c/a> on May 4. (Kaiser Health News is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>But in a mirror image of the ACA’s standing with the public, more than two-thirds of Republicans said they support their party’s health plan. Even more Democrats (78 percent) favored Obamacare.\u003c/p>\n\u003cp>The findings track those of other polls conducted since the Republican House passed the bill. A \u003ca href=\"https://poll.qu.edu/national/release-detail?ReleaseID=2461\">Quinnipiac University poll\u003c/a> released May 25 found 20 percent of Americans support the AHCA, compared with 57 percent opposition. \u003ca href=\"http://www.politico.com/story/2017/05/10/poll-gop-health-care-bill-support-238176\">A poll\u003c/a> from Morning Consult and Politico just after the bill passed found 38 percent supported the GOP measure and 44 percent opposed it.\u003c/p>\n\u003cp>Unlikely to boost the bill’s popularity is a report last week from the \u003ca href=\"https://www.cbo.gov/publication/52752\">Congressional Budget Office\u003c/a> that found after 10 years the legislation would result in 23 million fewer Americans with insurance and could make it harder for those with preexisting conditions to get and keep coverage.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Indeed, the KFF poll found that even Republicans show scant support for a change to some of the health law’s most popular provisions. Fewer than a fifth of Republicans favored changing the provision that limits how much more insurers can charge older people for insurance compared with younger people. And 22 percent of Republicans favored letting insurers charge sick people higher premiums if they have a break in their coverage.\u003c/p>\n\u003cp>A majority of Republicans supported the bill’s provisions that would allow states to establish work requirements for Medicaid enrollees and set up high-risk insurance pools for people with health problems.\u003c/p>\n\u003cp>More people said the GOP bill would hurt their personal health care than thought the same about a straight repeal of the ACA when asked about that issue in December.\u003c/p>\n\u003cp>Forty-five percent said the GOP bill would increase their own and their family’s costs for health care, compared with the December survey that found 28 percent thought that would be the result if the ACA were repealed. More than a third thought the GOP bill would make it harder to get and keep health insurance, compared with 21 percent who thought a repeal would have that consequence. And 34 percent said the GOP bill would likely make the quality of their health care worse, compared with 19 percent who said that about the ACA repeal.\u003c/p>\n\u003cp>Although about half of the public wants changes in the bill, nearly three-quarters of those surveyed said it was very or somewhat likely that Congress will pass and President Donald Trump will sign a bill to “repeal and replace” the ACA.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The survey of 1,205 adults, conducted May 16-22, has a margin of error of plus or minus 3 percentage points for the full sample.\u003c/p>\n\n",
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"excerpt": "Overall, respondents like the Republican bill even less than they like the bill it's trying to replace, the Affordable Care Act",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/julie-rovner/\">\u003cstrong>Julie Rovner\u003c/strong>\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The health overhaul bill passed by the House earlier this month accomplishes one major feat: It is even less popular than the not-very-popular Affordable Care Act it would largely replace, a new poll finds.\u003c/p>\n\u003cp>According to the \u003ca href=\"http://kff.org/health-reform/report/kaiser-health-tracking-poll-may-2017-the-ahcas-proposed-changes-to-health-care\">monthly tracking poll\u003c/a> from the Kaiser Family Foundation, 49 percent of respondents said they have a favorable view of the ACA, while 31 percent said they favored the GOP’s American Health Care Act, which narrowly \u003ca href=\"https://www.congress.gov/bill/115th-congress/house-bill/1628\">passed the House\u003c/a> on May 4. (Kaiser Health News is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>But in a mirror image of the ACA’s standing with the public, more than two-thirds of Republicans said they support their party’s health plan. Even more Democrats (78 percent) favored Obamacare.\u003c/p>\n\u003cp>The findings track those of other polls conducted since the Republican House passed the bill. A \u003ca href=\"https://poll.qu.edu/national/release-detail?ReleaseID=2461\">Quinnipiac University poll\u003c/a> released May 25 found 20 percent of Americans support the AHCA, compared with 57 percent opposition. \u003ca href=\"http://www.politico.com/story/2017/05/10/poll-gop-health-care-bill-support-238176\">A poll\u003c/a> from Morning Consult and Politico just after the bill passed found 38 percent supported the GOP measure and 44 percent opposed it.\u003c/p>\n\u003cp>Unlikely to boost the bill’s popularity is a report last week from the \u003ca href=\"https://www.cbo.gov/publication/52752\">Congressional Budget Office\u003c/a> that found after 10 years the legislation would result in 23 million fewer Americans with insurance and could make it harder for those with preexisting conditions to get and keep coverage.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Indeed, the KFF poll found that even Republicans show scant support for a change to some of the health law’s most popular provisions. Fewer than a fifth of Republicans favored changing the provision that limits how much more insurers can charge older people for insurance compared with younger people. And 22 percent of Republicans favored letting insurers charge sick people higher premiums if they have a break in their coverage.\u003c/p>\n\u003cp>A majority of Republicans supported the bill’s provisions that would allow states to establish work requirements for Medicaid enrollees and set up high-risk insurance pools for people with health problems.\u003c/p>\n\u003cp>More people said the GOP bill would hurt their personal health care than thought the same about a straight repeal of the ACA when asked about that issue in December.\u003c/p>\n\u003cp>Forty-five percent said the GOP bill would increase their own and their family’s costs for health care, compared with the December survey that found 28 percent thought that would be the result if the ACA were repealed. More than a third thought the GOP bill would make it harder to get and keep health insurance, compared with 21 percent who thought a repeal would have that consequence. And 34 percent said the GOP bill would likely make the quality of their health care worse, compared with 19 percent who said that about the ACA repeal.\u003c/p>\n\u003cp>Although about half of the public wants changes in the bill, nearly three-quarters of those surveyed said it was very or somewhat likely that Congress will pass and President Donald Trump will sign a bill to “repeal and replace” the ACA.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The survey of 1,205 adults, conducted May 16-22, has a margin of error of plus or minus 3 percentage points for the full sample.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
"site": "radio",
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},
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"rss": "https://feeds.npr.org/510312/podcast.xml"
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.commonwealthclub.org/podcasts",
"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
"tuneIn": "https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"
}
},
"forum": {
"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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},
"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
"airtime": "MON-FRI 7pm-8pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Fresh-Air-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/fresh-air/",
"meta": {
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"here-and-now": {
"id": "here-and-now",
"title": "Here & Now",
"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
"airtime": "MON-THU 11am-12pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Here-And-Now-Podcast-Tile-360x360-1.jpg",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
}
},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/hiddenbrain.jpg",
"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
"site": "news",
"source": "NPR"
},
"link": "/radio/program/hidden-brain",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/hidden-brain/id1028908750?mt=2",
"tuneIn": "https://tunein.com/podcasts/Science-Podcasts/Hidden-Brain-p787503/",
"rss": "https://feeds.npr.org/510308/podcast.xml"
}
},
"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"rss": "https://feeds.npr.org/510313/podcast.xml"
}
},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
"imageAlt": "KQED Hyphenación",
"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
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"source": "kqed",
"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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"amazon": "https://music.amazon.com/podcasts/6c3dd23c-93fb-4aab-97ba-1725fa6315f1/hyphenaci%C3%B3n",
"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Political Mind of Jerry Brown",
"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/xtTd",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
"meta": {
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},
"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"spotify": "https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x",
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"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
"site": "news",
"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
"meta": {
"site": "news",
"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
"imageAlt": "KQED Perspectives",
"officialWebsiteLink": "/perspectives/",
"meta": {
"site": "radio",
"source": "kqed",
"order": 14
},
"link": "/perspectives",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/id73801135",
"npr": "https://www.npr.org/podcasts/432309616/perspectives",
"rss": "https://ww2.kqed.org/perspectives/category/perspectives/feed/",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"
}
},
"planet-money": {
"id": "planet-money",
"title": "Planet Money",
"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
"officialWebsiteLink": "https://www.npr.org/sections/money/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/planet-money",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/M4f5",
"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
"tuneIn": "https://tunein.com/podcasts/Business--Economics-Podcasts/Planet-Money-p164680/",
"rss": "https://feeds.npr.org/510289/podcast.xml"
}
},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Political Breakdown",
"officialWebsiteLink": "/podcasts/politicalbreakdown",
"meta": {
"site": "radio",
"source": "kqed",
"order": 5
},
"link": "/podcasts/politicalbreakdown",
"subscribe": {
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"amazon": "https://music.amazon.com/podcasts/e0c2d153-ad36-4c8d-901d-f1da6a724824/political-breakdown",
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