San Diegans for Healthcare Coverage

Voices for Reform
Working Together Towards a Healthier Community

June 29, 2010


San Diegans for Healthcare Coverage (SDHCC) is a diverse coalition of community members committed to the common goal of advocating for affordable coverage and care for all through education, convening of the community and advocacy efforts. Voices for Reform is distributed weekly to inform and advocate for Health Reform.

Topic of the Month

SDHCC Raises Coalition Awareness and Understanding about Health
A Health Reform Sector Interchange was held on May 24th  to promote sharing and understanding across sectors, as well as to provide further input into local planning and strategy.  At that meeting, key coalition sectors (business, consumer, hospital, physician, clinics, County Health and Human Services Agency and health plans) prepared and presented both the top 3-5 benefits and top 3-5 issues and concerns with federal health reform.  Many common themes emerged regarding as yet undefined implementing regulations, short and long-term affordability, cost containment, health care capacity and sustainability and the local input and adjustments to meet local needs.  SDHCC has been invited to present the results of this session to the Regional Chamber Health Committee which had embarked on a similar effort.  The report and results will be posted to the new SDHCC website once it is activated this summer.

SDHCC Defines New Course of Action; Seeks Key Local Role in Health Reform Planning and Implementation

San Diegans for Healthcare Coverage held a special session, Strategic Planning– Plotting Our Course, on June 15th  to identify board and coalition member preferences for the future in light of the changing healthcare environment resulting from health reforms at the federal, state and local levels.  The structured working session helped to identify those functions and activities that are most valuable to coalition members, as well as secure input and consensus on SDHCC strategic direction in the future.  Activities related to convening stakeholders, providing education and advocacy and planning were identified as of most value.  For strategic direction, there was a clear consensus that coalition members want a role in how health reforms are implemented in the San Diego region.  A report summarizing the session will be prepared over the coming weeks.  The next steps will be to pursue feasibility of priority options identified for an expanded and more active SDHCC role in the future.


This Week in Healthcare

Health Reform Update
“If You Like Your Health Plan, You Can Keep It” – Clarification of the Rules
President Obama has said “If you like your health plan, you can keep it”.  However, there are rules that must be followed in order for this to remain accurate.  According to new regulations, health plans that existed on March 23, 2010 are allowed to make routine, but not major, changes in order to be “grandfathered” under the new law.  Plans will lose their grandfather status if they choose to significantly cut benefits or increase out-of-pocket spending for consumers.  According to the new regulations:
• You can keep the health plan you have in effect on September 23, 2010 if
o Benefits have not been significantly cut or reduced.  For example, a plan cannot decide to stop providing benefits to someone with diabetes or HIV.
o Co-Insurance has not been raised.  For example, a plan cannot decide to increase the percentage of costs that a consumer is responsible for.
o Co-payments have not been significantly raised.  For example, a plan cannot increase co-pays by more than $5 a year with adjustments for medical inflation.
o Deductibles have not been significantly raised.  For example, a plan cannot raise deductibles more than the rate of medical inflation plus 15 percentage points
o Employer contributions have not been significantly lowered.  For example, a plan cannot decrease the percentage paid by the employer by more than 5 percentage points.
o Annual limits paid by the insurer have not been added or tightened.  For example, a plan that already caps the amount it pays for services each year cannot change that cap. 
o Insurance companies have not been changed.  For example, if an employer chooses to buy insurance from a different insurance company, the new insurance company will not be considered a grandfathered plan.
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New High Risk Pool for Uninsurable Individuals Expected to Be Available by Late Summer
California Healthline, 6/29/10
On Monday, the California Senate passed two companion bills that would create a high-risk health insurance pool for residents who cannot obtain coverage because of pre-existing conditions, the Santa Rosa Press Democrat reports. The high-risk pool, which is a key component of the new health reform law, would cover such Californians until 2014, when a separate provision of the reform law will prohibit insurers from denying coverage to those with pre-existing conditions (Scott, Santa Rosa Press Democrat, 6/28).

The first bill (AB 1887), by Assembly member Mike Villines (R-Clovis), would create the high-risk pool, while the second bill (SB 227), by Sen. Elaine Alquist (D-Santa Clara), would authorize the state to set up the pool and contract with private insurers to provide coverage (California Healthline, 6/28).  The legislation would help the state draw down about $761 million in federal funding. Most Republican legislators voted against the measures because federal funding for the pool would run out in three years (Bussewitz, AP/San Diego Union-Tribune, 6/28).

The bills now go to Gov. Arnold Schwarzenegger (R), who has said he will sign them. Once the measures become law, California residents with pre-existing conditions are expected to be able to apply for the pool by the end of the summer.

Key Patient Protections Take Effect September 2010
A major goal of the Affordable Care Act is to put American consumers back in charge of their coverage and care.  On June 22, 2010, President Obama announced new regulations that will crack down on some of the most egregious practices of the insurance industry to help people with pre-existing conditions gain coverage and keep it when they need it, and protect Americans’ choice of doctors.

The new regulations include a set of protections that apply to health coverage starting on or after September 23, 2010, six months after the enactment of the Affordable Care Act.

•No Pre-Existing Condition Exclusions for Children Under Age 19.  Each year, thousands of children who were either born with or develop a costly medical condition are denied coverage by insurers.  The new regulations will prohibit insurance plans from limiting benefits for children and from refusing to sell children coverage at all based on the fact that a child has a pre-existing condition.  This policy applies to all types of insurance except for individual market plans that are “grandfathered.”  This critical policy will be broadened to Americans of all ages in 2014.
•No Unjustified Rescissions of Insurance Coverage.  Right now, insurance companies are able to retroactively cancel someone’s policy when they become sick, or if they or their employers made an unintentional mistake on their paperwork.  Under the regulations, insurers will be prohibited from rescinding coverage – for individuals or groups of people – except in cases involving fraud or an intentional misrepresentation of material facts.  There are no exceptions to this policy.
•No Lifetime Limits on Coverage.  Millions of Americans living with costly medical conditions are at risk of having their health insurance coverage disappear when their costs reach a lifetime limit set by their insurance company.  No plan issued or renewed after September 23, 2010 can use such a limit.
•Restricted Annual Limits on Coverage.  Even more binding than lifetime limits are annual dollar limits on what an insurance company will pay for health care.  The rules will phase out the use of annual limits over the next three years for most health plans before banning such limits entirely in 2014.
•Protecting Your Choice of Doctors.  Being able to choose your own doctor is a central principle in the Affordable Care Act that is highly valued by Americans.  The new rules make clear that health plan members are free to designate any available participating primary care provider as their primary care provider.
•Removing Insurance Company Barriers to Emergency Department Services.  Some insurers will pay only for health care provided by a limited number or network of providers – including emergency health care.  Others require prior approval before receiving emergency care at hospitals outside of their networks.  The new rules make emergency services more accessible for consumers.  Health insurers will not be able to charge higher cost-sharing (copayments or coinsurance) for emergency services obtained outside the plan’s network. 


Even With The ‘Grandfather Clause’ Protection, Change Is Coming To Most Health Plans
Jonathan Cohn, 6/21/2010
Now that Karl Rove doesn't have a Republican president to advise anymore, he's been picking up some new hobbies. One of them is health care policy. In a recent column for the Wall Street Journal editorial page, Rove made the latest in a series of attacks on the new reform law. Rove offered a number of familiar conservative allegations: Reform would bankrupt employers, stick people with lousy coverage, etc. But my personal favorite was his reaction to new regulations the Obama administration had issued just a few days before.
Read More >

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