On Wednesday at 2:00 pm PDT, the California Primary Care Association (CPCA) and the regional consortia will be kicking off an educational campaign highlighting the important and beneficial provisions of health care reform (HCR) that will make community clinic and health centers and their patients, better able to thrive.

The training is open to everyone interested in learning about the newly enacted law. However, they encourage staff that directly interact with patients on an ongoing basis -- clinicians, outreach workers, health educators, eligibility workers, front desk employees, etc. -- to participate.

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To join the training session
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1. Go to this site
2. Enter your name and email address.
3. Enter the session password: 72810HCWa
4. Click "Join Now".
5. Follow the instructions that appear on your screen.

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To join the session by phone only
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To receive a call back, provide your phone number when you join the training session, or call the number below and enter the access code.
Toll-free number: 866-469-3239
Access code: 925 392 727

If you have additional questions in advance of the webinar, please contact Aracely Navarro at anavarro @ cpca.org.

Herb Schultz, the new Regional Director of HHS Region IX, is adding stakeholders to his “CONTACT LIST" every day.

Region IX uses the Contact List to send information emails every few days with updates and announcements on reform implementation and other key HHS policies, programs, and initiatives.

If you would like to be added, please forward your contact information to the Regional Executive Officer, Michele Walker, at michele.walker @ hhs.gov. You can reach Mr. Schultz at herb.schultz @ hhs.gov.

Do you work for a community-based organization (CBO) that connects community members to prevention and wellness services, coordinates access to health services, and links individuals to coverage?

Did you know that health reform emphasizes local-level efforts aimed at wellness, health promotion, chronic disease prevention, and health care quality in a way that may provide new and enhanced opportunities for service organizations?

The Georgia Health Policy Center recently released an informative, easy-to-ready four page fact sheet that explains health reform's impact on CBO's and the myriad opportunities for CBO's in a post reform world.

In the fact sheet, you will find information on:
• Community Transformation Grants
• Grants to Promote Positive Behaviors and Outcomes
• Chronic Disease Prevention Incentives
• Maternal and Infant Visiting Programs
• Exchange Navigators and Coordinators
• Community Based Care Transition Program
• Community Health Teams
• Community Based Collaborative Care Network Program
• Primary Care Extension Program
• Health Professions Training Program
• Other funding and grant opportunities

If you are a county health administrator, a CBO executive director, a non-profit outreach worker, or anyone else who works "on the ground" to link members of your community to essential health services and programs, you definitely want to read this fact sheet.

... that approximately 
half 
of 
all 
fruits, 
nuts,
 and
 vegetables
 grown 
in 
the 
U.S.
 come 
from 
California
 farms?
... that farm workers in 
California
 consist
 mostly 
of 
young Latino 
males,
 with
 little
 education 
and 
low
 incomes?
... that most 
California
 farm workers 
are
 poor 
and 
have 
limited
 access 
to 
medical 
care
?
... that migrant 
workers 
face
 huge 
accessibility 
challenges
 due
 to
 geographic
 isolation 
and 
distance 
to 
health 
care
 providers?
... that since
 1996, 
legal 
immigrants have been 
excluded 
from 
full
 scope 
Medicaid
 for
 the 
first 
five 
years
 of 
living 
in 
the 
U.S.?
... and that health reform provides both opportunities and additional challenges for the migrant farm worker population?

Interested in learning more about the intersection between health care and California's agricultural workforce?

Read ITUP's newest fact sheet.

On Wednesday, the White House issued a press release announcing an Executive Order establishing the National Prevention, Health Promotion, and Public Health Council.

The Surgeon General will serve as the Chair of the Council, also shall be composed of:
(1) the Secretary of Agriculture;
(2) the Secretary of Labor;
(3) the Secretary of Health and Human Services;
(4) the Secretary of Transportation;
(5) the Secretary of Education;
(6) the Secretary of Homeland Security;
(7) the Administrator of the Environmental Protection Agency;
(8) the Chair of the Federal Trade Commission;
(9) the Director of National Drug Control Policy;
(10) the Assistant to the President and Director of the Domestic Policy Council;
(11) the Assistant Secretary of the Interior for Indian Affairs;
(12) the Chairman of the Corporation for National and Community Service; and
(13) the head of any other executive department or agency that the Chair may, from time to time, determine is appropriate.

The President will also be establishing an Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. The Advisory Group will have up to 25 non-federal members appointed by the President who will develop policy and program recommendations and advise the Council on lifestyle-based chronic disease prevention and management, integrative health care practices, and health promotion.

After obtaining ideas from relevant stakeholders and working closely with the Advisory Group, the Council will devise a National Prevention and Health Promotion Strategy that will:
* Set specific goals, measurable actions and timelines to carry out the strategy to reduce the incidence of preventable illness and disability in the U.S. and promote health and well-being, and;
* Make recommendations to improve federal efforts relating to prevention, health promotion, public health, and integrative health-care practices to ensure that federal efforts are consistent with available standards and evidence.

For more on federal promotion of prevention activities, see this fact sheet.

The word is spreading... more Americans are starting to agree that it does in fact make sense for more people to have health insurance, for the system to focus on prevention, to curb egregious insurance practices, and contain sky rocketing costs.

According to a new Kaiser Family Foundation poll, 48% of Americans now view health reform as "favorable," up from 41% in May.

More on the poll in Wednesday's Washington Post.

On Tuesday, the day after the California Senate passed Assembly Bill 1887 (Villines) and Senate Bill 227 (Alquist), the Governor signed the bills into law. The Governor's signature means that the state can now officially begin setting up the pool.

Yesterday, MRMIB announced that it will immediately start accepting names of people with pre-existing conditions who are interested in applying for the new high risk pool. On the MRMIB homepage, there's a link to send an email and request an application which should be ready in about a month.

California Healthline recently asked a group of experts and thinkers the following three questions:

(1) How can the Medi-Cal system be redesigned to not only deal with many more participants but to encourage a whole new portion of the state's population to consider Medi-Cal as an option?

(2) For many potential new participants, the thick red tape associated with government programs may be a serious detraction. How can California streamline the process?

(3) In addition to expanding Medi-Cal, California will be setting up a health insurance exchange offering discounted and subsidized coverage for those who don't qualify for Medi-Cal. Should the state create one screening process to handle both the exchange and Medi-Cal?

They got responses from:

* Alan Weil, Executive director, National Academy for State Health Policy

* Peter Cunningham, Senior fellow, Center for Studying Health System Change

* Lucien Wulsin and Cliff Sarkin, Director and Policy director, ITUP

* Micah Weinberg, Senior research fellow, New America Foundation

* Toby Douglas, Chief deputy director, California Dept. of Health Care Services

* Carmela Castellano-Garcia, President/CEO, California Primary Care Ass'n

* Jack Chou, President, California Academy of Family Physicians

Check out all of the responses, especially (Lucien's and mine)!

ITUP quoted today in a Contra Contra Times piece on the state's new high-risk pool.

The U.S. Department of Health and Human Services has launched what it is calling the Innovates Effort, an attempt to use technology and competition to actively engage HHS employees across the country to run the Department more effectively.

Below is a brief conversation between Todd Parks, the Chief Technology at HHS, and Craig Newmark, the founder of Craiglist.org and adviser to HHS's Innovates Effort.

With the state's new high risk pool -- providing coverage the those previously uninsurable due to preexisting medical conditions -- set to be operational on July 1, 2010, I would like to refer readers of our blog to a previous ITUP analysis of the high risk pool.

On March 26, 2010, Adam Dougherty and Mike Sloyan published Implementing Health Reform: Temporary High-Risk Pool, summarizing the provisions related to the program, reviewing the current high-risk pool in California, and making recommendations regarding next steps to implementation of the forthcoming expansion. Check it out!

You can read all of ITUP's previous reports, analyses, and white papers here.

This article came out today about some very large companies contemplating dropping coverage for their employees because, well to be honest, it would be significantly less expensive to just pay the fees. The article describes some of the "what if" scenarios but doesn't particularly explore the issue in full, but that's what keeps ITUP in business.

While the notion of employers dropping coverage and sending their employees to the exchanges is a possibility that certainly makes sense on paper for these large companies, this makes the company a less competitive place to work unless wages are increased in relation to the cost of exchange coverage.

But adding thousands of employees to the exchanges might not be a bad thing. For one, it would buffer the risk pools.

In any case, it'll be interesting to see what opponents of health reform will say about this considering many of these opponents championed the dismantling of employer-sponsored coverage.

It's a good article but read with caution, some of the employer analyses presented include old numbers (such as those listed on cadillac plan thresholds) and misleading wording (like implying that coverage for dependents up to age 26 could cost employers a substantial sum of money.) For the record, the threshold for determining a cadillac plan is annual premium of $10,200 for an individual and $27,500 for families and as for the coverage of dependents up to age 26, employers are not required to pay anything toward premiums for these dependents.

We recently compiled a county-by-county comparison on the effects of reform in California, estimating the extent of coverage expansion and subsidies at the county level. Below are the overview and spreadsheet describing our findings:

Before and After Reform: A County by County Comparison (pdf)
County Statistics (xls)

The House Committee on Energy and Commerce released similar district-level comparisons today, which you can scroll through on their website.

A recent UCLA Center for Health Policy Research report found that over 2 million Californians lost their health insurance since the beginning of the recession, an increase of 28% since 2007. According to the report, 8.2 million Californians, nearly one-quarter of the nonelderly, lacked health insurance for all or part of the year in 2009.

Head here and here for some useful tools exhibiting up-to-date whip counts in the House with sortable information on Representatives.

I've been touring the northern counties of California over the past few days for the annual ITUP regional workgroups, and we have met many inspiring individuals who are dedicated to the health of underserved communities in these rural areas. We were able to learn more about the unique needs, barriers, and solutions found in rural health care and I wanted to highlight a few programs that are particularly impressive.

We were able to tour one of the Open Door Community Health Centers in Eureka, which also houses the Telehealth and Visiting Specialist Center (TVSC). One of the biggest barriers in these areas is access to specialty medical care, from dermatology to cardiology and psychiatry. For some conditions, patients have traditionally been forced to travel as far as Sacramento and San Francisco to find these services. The TVSC utilizes state of the art video feeds and imaging to link patients to specialists all over the state without having to make the trek to a common location. For example, a patient at the Eureka clinic can receive an endoscopy from clinic staff, while an otolaryngologist at UCSF can diagnose abnormalities from a real-time video feed at his desk in San Francisco. Conversely, a psychiatrist at the TVSC can have regular video-sessions with a patient in the remote Siskiyou County clinic location who may not be able to travel the long distance to Eureka multiple times a week. In addition to advances in telemedicine, the Clinics act as a vital source of care for the safety net population who face additional financial barriers to care.

I am a major advocate of integrated health, and Shasta County's Hill Country Health and Wellness Center provides some impressive health services. From dental to preventive care and mental health, the Center is a one-stop-shop for a range of health needs. The newly expanded Center now also provides specialty care, a library of educational materials, and exercise/health promotion activities. This not only acts as a convenient way to address multiple health needs in one visit, but also instills a sense of personal health awareness for patients.

I've linked in the past to a top hat wearing/monocle doting/cigar smoking group called Billionaires for Wealthcare who bring a little lighthearted entertainment to the health reform universe. The insurance industry lobby AHIP held their annual conference in Washington, DC this week, which brought noticeable protest to the sidewalk outside the conference center.

This morning marked the conclusion of the conference, and a special operative faction of the Billionaires managed to infiltrate the event. I'll let the video speak for itself, which stars Bill McInturff (one of the "Harry and Louise" anti-reform ad masterminds). Have a good weekend, all.

Less a poke at the GOP, more a focus on the necessity.

As we watch the local town halls and listen to the countless soundbytes from various politicians and advocacy groups, it is incredibly important to discern the factual from the erroneous. August will continue to reveal legitimate concerns, but also less-accurate interpretations, with the proposals on the table.

The White House recently launched a Health Reform Reality Check website to counter some of the mainstream attacks, but other websites such as the non-partisan FactCheck delve into more specific policy items, as well.

Advocates as well as opponents use the Massachusetts reform in their arguments for how comprehensive reform will/won't work, and is an interesting experiment for what reform may look like on a national scale. Supporters say it has actually achieved universal coverage. Opponents argue that the measures are bankrupting the state.

Many pieces of the national proposals mirror what Mass. passed in 2006, including an individual and employer mandate, low-income subsidies, and a new public plan option. Today, the state boasts an insured rate of 98% but is indeed facing higher than expected costs and financing issues. (To be clear, some of the higher costs can be attributed to the fact that there were more uninsured people than originally believed, thus increasing overall enrollment costs. Costs per newly-enrolled individual are actually lower than expected.)

So what is the state doing to reign in costs, you ask? Are they vastly cutting benefits? Rationing care? Declaring bankruptcy and abandoning their pioneering reform effort? This week the Special Commission on the Health Care Payment System recommended that the state completely abandon the fee-for-service model (the biggest force in unchecked cost growth), and adopt coordinated care/pay-for-performance strategies around annual-adjusted fixed payments.

This is how health reform works; it is not one hail-mary pass but rather a playbook of options, constantly reassessing the situation and evolving. Its impossible to have an efficient system until you get everyone into it. Once coverage is universal and care is accessible, you can then cut costs through competitive bidding, payment reform, and system-wide efficiency.

Governor Arnold Schwarzenegger sent the following letter to congressional leadership on Capitol Hill to reiterate his vision and support for health care reform and to share concerns he has with some of the proposals:

July 31, 2009

Dear Senator Reid, Senator McConnell, Madam Speaker and Mr. Boehner,

I appreciate your commitment and hard work toward reforming the nation’s health care system. I think we can all agree that the current system is not working as it should, and I have long supported a significant overhaul. Costs continue to explode, while tens of millions remain uninsured or underinsured. Many families are one illness away from financial ruin – even if they do have insurance. We have the greatest medical technology in the world at our fingertips, yet Americans’ health status lags behind many countries that spend less than half what we do per capita. Any successful health care reform proposal must be comprehensive and built around the core principles of cost containment and affordability; prevention, wellness and health quality; and coverage for all.

Cost Containment and Affordability

Cost containment and affordability are essential not only for families, individuals and businesses, but also for state governments. Congress is proposing significant expansions of Medicaid to help reduce the number of uninsured and to increase provider reimbursement. Today, California administers one of the most efficient Medicaid programs in the country, and still the state cannot afford its Medicaid program as currently structured and governed by federal rules and regulations. The House originally proposed fully funding the expansion with federal dollars, but due to cost concerns, members decided to shift a portion of these expansion costs to states. I will be clear on this particular proposal: if Congress thinks the Medicaid expansion is too expensive for the federal government, it is absolutely unaffordable for states. Proposals in the Senate envision passing on more than $8 billion in new costs to California annually – crowding out other priority or constitutionally required state spending and presenting a false choice for all of us. I cannot and will not support federal health care reform proposals that impose billions of dollars in new costs on California each year.

The inclusion of maintenance of effort restrictions on existing state Medicaid programs only compounds any cost shift to states. We simply cannot be locked into a cost structure that is unsustainable. Governors have three primary ways to control Medicaid costs: they can adjust eligibility, benefits and/or reimbursement rates. Maintenance of effort requirements linked to existing Medicaid eligibility standards and procedures will effectively force state legislatures into autopilot spending and lead to chronic budget shortfalls.

The federal government must help states reduce their Medicaid financing burden, not increase it. A major fact or contributing to Medicaid’s fiscal instability, before any proposed expansion, is that the program effectively remains the sole source of financing for long-term care services. Therefore, I am encouraged by congressional proposals that create new financing models for long-term care services. Proposals that expand the availability and affordability of long-term care insurance are steps in the right direction, but they must be implemented in a fiscally sustainable way. More fundamentally, however, the federal government must take full responsibility for financing and coordinating the care of the dually eligible in order to appreciably reduce the cost trend for this group. This realignment of responsibilities is absolutely essential to controlling costs for this population, while ensuring that state governments will be better positioned to fill in any gaps that will undoubtedly arise from federal health care reform efforts.

I also encourage Congress to incorporate other strategies to help stabilize Medicaid costs for states. Delaying the scheduled phase-out of Medicaid managed care provider taxes pending enactment of new Medicaid rates, reimbursement for Medicaid claims owed to states associated with the federal government’s improper classification of certain permanent disability cases, and federal support for legal immigrant Medicaid costs are examples of federal efforts that could provide more stability to state Medicaid programs. Moreover, given the fiscal crisis that many stat es, including California, are experiencing, I strongly urge Congress to extend the temporary increase in the federal matching ratio to preserve the ability of state Medicaid programs to continue to provide essential services to low-income residents pending full implementation of national health reform.

Prevention, Wellness and Health Quality

Prevention, wellness and health promotion, along with chronic disease management, can help to lower the cost curve over the long run and improve health outcomes in the near term. This was one of the cornerstone pieces of my health care reform proposal in California, and I continue to believe it should be a key piece of the federal efforts. Prevention, wellness and chronic disease management programs should include both the individual and wider population levels.

At the individual level, proposals to provide refunds or other incentives to Medicare, Medicaid and private plan enrollees who successfully complete behavior modification programs, such as smoking cessation or weight loss, are critical reforms. To ensure they are widely used, individual prevention and wellness benefits should not be subject to beneficiary cost sharing.

Because individuals’ behaviors are influenced by their environments, health reform must place a high priority on promoting healthy communities that make it easier for people to make healthy choices. California has demonstrated through its nationally recognized tobacco control efforts that population-based strategies can be effective and dramatically change the way the people think and act about unhealthy behaviors, such as tobacco use. A similar model, community transformation grants, has been advanced in the Senate Committee on Health, Education, Labor, and Pension legislation, and it should be included to support policy, environmental, programmatic and infrastructure changes that address chronic disease risk factors, promote healthy living and decrease health disparities.

Quality improvement measures are also critical to health reform. The House proposal for a Center for Quality Improvement to improve patient safety, reduce healthcare-associated infections and improve patient outcomes and satisfaction is a positive step. Coordinated chronic disease management is necessary to improve outcomes for chronically ill people. Systematic use of health information technology and health information exchange, including access for public health agencies, is vital to providing the necessary tools to measure the success of quality improvement efforts. Finally, investments in core public health infrastructure can be facilitated through the creation of the proposed Prevention and Wellness Trust.

Coverage for All

Coverage for all is also an essential element of health care reform and I believe an enforceable and effective individual mandate, combined with guaranteed issuance of insurance, is the best way to accomplish this goal. The individual mandate must provide effective incentives to help prevent adverse selection that could occur if the mandate is too weak. Creating transparent and user-friendly health insurance exchanges to help consumers compare insurance options will also help facilitate participation. States should maintain a strong role in regulating the insurance market and have the ability to maintain and operate their own exchanges, with the understanding that some national standards will need to be established. California has a long history of protecting consumers through our two separate insurance regulators, one covering health maintenance organizations and the other monitoring all other insurance products. Maintaining a strong regulatory role at the state level is in the best interest of consumers, and I urge Congress to maintain this longstanding and effective relationship as you design these new market structures.

I hope our experience in California working toward comprehensive health care reform has informed the debate in Washington. There will be many short-term triumphs and seemingly insurmountable roadblocks for Congress and the nation on the road to comprehensive health care reform. We must all remain focused on the goal of fixing our health care system and remember that we all have something to gain from the reforms, and we all have a shared responsibility to achieve them. I look forward to working with you as you move forward on this desperately needed legislation.

Sincerely,

Arnold Schwarzenegger