A nonprofit, nonpartisan media venture explaining California’s policies and politics

Trump v California

In this corner: Health

For basic background, start with The weigh-in: Health

issue
Family Planning
Medi-Cal
Obamacare
status
All talk, no action—yet
It's on!
Punch
Counter-punch
On the ropes
Draw!
California wins!
Trump wins!

State's single payer health bill set aside—now what?

published Jun 27, 2017

Proponents of single payer healthcare in California are strategizing about what do next after the speaker of the Assembly shelved the bill, saying it lacked critical details such as how it would be funded.

“It didn’t make any sense,” said Speaker Anthony Rendon, a Democrat from Paramount. “I hope the Senate takes this chance to take the bill more seriously than they did before.”

The single-payer effort had garnered a lot of attention. Supporters hailed it as an aggressive way for California to get proactive about health care before the federal government could repeal the Affordable Care Act, popularly known as Obamacare, and replace it with a less generous Trumpcare alternative. Today the GOP-dominated U.S. Senate announced it was delaying a vote on its version until after the July 4th holiday next week.

“It was downright silly for the California Senate to approve SB 562 without an explanation of how its estimated $400 billion annual price tag—triple the state’s general-fund budget—would be covered in a way that wouldn’t hammer taxpayers and the state economy,” the San Diego Union-Tribun” wrote in an editorial.

California senators had approved the single payer bill after assurances by its Democratic authors, Los Angeles Sen. Ricardo Lara and San Diego Sen. Toni Atkins, that they would come back to them with a funding plan. That wasn’t enough for Rendon, who called the bill more of a “values” move than real public policy.

Lara and Atkins have promised to unite with supporters, including the politically potent California Nurses Association, and “do whatever it takes to stop this assault on the American people.”

“We are disappointed that the robust debate about healthcare for all that started in the California Senate will not continue in the Assembly this year. This issue is not going away, and millions of Californians are counting on their elected leaders to protect the health of their families and communities,” they said in a joint statement.

Their bill would have pooled health care money, including Medicare and Medicaid dollars, into a state fund to cover health care for all Californians. It was intended to take the place of co-pays, deductible, and premiums.

Poll shows record support for Obamacare in California

published Jun 20, 2017

More than half of Californians worry they will lose health insurance if the Republican Congress and President Trump repeal what’s commonly known as Obamacare, according to a poll released today.

The findings show a widening gap between Californians and Washington D.C., with a record 65 percent saying they support the Affordable Care Act, compared to just 26 percent who oppose it. The statewide Berkeley IGS Poll administered by phone in May for the California Health Care Foundation.

Foundation President Sandra Hernández said in a statement that the findings show that Democrats, Republicans and Independents in California agree on the value of Medi-Cal, the state program that provides health coverage to low-income adults and children. “Policymakers in Washington may not understand how vital Medi-Cal is,” she said, “but Californians certainly do.”

In the survey, 69 percent of respondents described Medi-Cal as important to themselves and their families. When asked about Medi-Cal’s impact on the state overall, 88 percent described the program as important.

California Senate stands with Planned Parenthood

published May 31, 2017

Democrats in the state Senate have OK’d legislation that would give Californians the option to buy “pro-choice” license plates – a small but symbolic rebuke to GOP threats to cut federal funds to Planned Parenthood or any medical provider who performs abortions.

“California’s proudly a pro-choice state,” the bill’s author, Sen. Hannah-Beth Jackson (D-Santa Barbara), said in a brief debate on the matter. “We understand the importance of women being able to make their own reproductive decisions.”

Her bill, SB 309, would direct the Department of Motor Vehicles to offer a “California Trusts Women” specialty license plate if 7,500 orders are placed for one. More than 4,000 drivers have pledged to buy one, Jackson said.

Money raised from the sale of those plates would help fund the state’s Family Planning, Access, Care and Treatment program, which helps pay for services for $1.8 million low-income Californians.

President Donald Trump and Republicans in Congress have targeted abortion providers as part of their efforts to repeal and replace the Affordable Care Act. A health care bill narrowly approved by the House in May would gut federal funding to any provider, such as Planned Parenthood, that offers abortions as part of its family planning services.

That bill is now before the U.S. Senate, and Republicans there have said they will make substantial changes. If the abortion funding provision remains intact, the effect would be widespread in California, where Planned Parenthood is a key provider of basic family planning health services.

Just one Republican lawmaker in Sacramento spoke against the license plate bill. Sen. Joel Anderson of Alpine described the measure as a “racist bill” that “focuses abortion on the inner cities.”

The bill now goes to the Assembly.

Obamacare repeal passes the House: What will this mean for California?

published May 4, 2017

In a vote likely to upend both political fortunes and insurance markets across California, the House today passed a bill that would repeal and replace Obamacare by a slim 217-213 margin.

Though 21 Republicans did not support the controversial American Health Care Act, California’s GOP delegation voted as a bloc along with the GOP leadership. That includes vulnerable members such as Darrell Issa, who won his seat by only 1,621 votes last fall and whose district in Orange County went easily for Hillary Clinton. “Obamacare is doing real harm to California’s families and struggling businesses, and constituents are counting on me to deliver real relief,” Issa said in a press release. “Now is the time to make it right.”

The bill now moves onto the Senate, where it is likely to see considerable revisions before being passed back to the House. But even if the Republicans long-awaited repeal-and-replace plan does not become law, Democrats across the state are already singling out those lawmakers who voted for this unpopular bill.

“Kevin McCarthy and California Republicans in Congress chose Donald Trump and Paul Ryan over the needs of their own constituents,” Assembly Speaker Anthony Rendon said in a statement, calling out the House Majority Leader from Bakersfield by name. “They should be ashamed and they must be held accountable.”

Prior to the vote, Gov. Brown tried unsuccessfully to shame the California Republican delegation into breaking from their party’s leadership. “Just look at the districts of Representatives David Valadao (R-Hanford), Jeff Denham (R-Turlock) and Steve Knight (R-Lancaster) where 111,000, 109,000 and 76,000 Californians, respectively, are at risk of losing coverage because of this legislation,” the governor’s office said in an email blast two hours before the bill passed.

Though the bill was passed before the Congressional Budget Office had time to estimate its overall impact, an analysis of an earlier version of the Republican health plan by the non-partisan scorekeeper projected that 24 million more people nationwide would lose or opt out of coverage within ten years.

California, which invested heavily in the future of the Affordable Care Act nicknamed Obamacare, would be particularly affected if the bill becomes law. The UC Berkeley Center for Labor Research and Education estimates that the state would be forced to either spend an additional $10 billion annually or drop more than 3 million people from Medi-Cal, the state’s Medicaid program for poorer people, starting in 2020. That’s because the new health plan begins phasing out federal payments for Obamacare’s expansion of Medicaid at the end of the decade.

Californians who have purchased insurance through the Covered California health exchange could also see abrupt changes in coverage. While the new plan offers tax credits to those who buy insurance on their own, these credits are generally less generous than those offered by the Affordable Care Act, and are structured to increase with a person’s age. Exchange subsidies under Obamacare are tied to a person’s income, increasing as income declines.

Plus, as the Los Angeles Times has reported, the bill would also prohibit tax credits from being used for plans that cover abortion, which the vast majority of policies in the state do. If the bill becomes law, we can expect yet another lawsuit between California and the federal government.

 

Taking it to the streets: Senate panel approves "pro-choice" license plates

published Apr 27, 2017

A Senate panel this week approved legislation that would give Californians the option to buy “pro-choice” license plates—a direct response to Trump administration efforts to strip federal funding from any medical provider who performs an abortion.

The bill’s author, Democratic state Sen. Hannah-Beth Jackson of Santa Barbara, said SB 309 reaffirms California’s support for women’s health care and choice.

“California is energized, I believe, and ready to take on the out-right cruel attacks by a Congress and an administration who have no qualms about expressing their disdain for the health and choice of women and acting upon them to try to remove their opportunities to do so,” Jackson told the Senate Transportation and Housing Committee.

The bill would require the Department of Motor Vehicles to issue a specialized license plate with a “California Trusts Women” theme. Money raised from the sale of those license plates would help fund the state’s Family Planning, Access, Care and Treatment program, which provides services to $1.8 million low-income Californians.

Supporters of Planned Parenthood marching in Fresno parade. Photo by David Pradas.

Supporters of Planned Parenthood marching in Fresno parade. Photo by David Pradas.

Jackson said more than 3,000 Californians have pledged to buy the license plate so far.

The GOP’s failed effort earlier this year to repeal the Affordable Care Act included provisions to eliminate federal funding to any provider, such as Planned Parenthood, that offers abortions as part of their family planning services. President Trump and House Republican leaders are working to pass a revision in the House,  and yesterday it won the seal-of-approval from the Freedom Caucus of House conservatives. The new attempt still would gut federal funding for Planned Parenthood—a move that could affect a particularly broad array of health services in California.

Brian Johnston, executive director of the California ProLife Council, described the license plate bill as “intellectually dishonest,” saying “We know that calling this reproductive is in fact a code word for human abortion,” Johnston said. “There’s nothing reproductive in the act of human abortion.”

Lawmakers approved the bill by a 10-3 vote. It now goes to the Senate Appropriations Committee.

Paul Ryan pledges to keep trying to repeal Obamacare, while California Democrats cheer the House's failure

published Mar 27, 2017

Just days after House Speaker Paul Ryan admitted defeat in repealing the Affordable Care Act, he told party faithful that the effort is not over.

Late last week, House Republican leaders pulled the repeal bill because of a lack of votes. At that time Ryan said, “We’re going to be living with Obamacare for the foreseeable future.” But today, the Wisconsin Republican acknowledged his replacement legislation—dubbed Trumpcare or Ryancare, but officially called the American Health Care Act—was “flawed.” He also told donors the GOP intends to keep working on healthcare.

The Washington Post obtained a recording of the call and reported that Ryan said, “We’re not going to just all of a sudden abandon health care and move on to the rest. We are going to move on with rest of our agenda, keep that on track, while we work the health-care problem. . . . It’s just that valuable, that important.”

President Trump has publicly blamed Democrats for failure to repeal and replace the Affordable Care Act, and said his administration would try again within a year when “Obamacare explodes.” The health care plan enacted seven years ago requires that every American have health insurance, and offers subsidies for low-income families to make insurance more affordable. Critics of the program argue that it is not sustainable, is expensive, and does not provide enough options for consumers.

Democratic leaders in California, a state that embraced Obamacare, have been celebrating on social media all weekend long. Senate President Pro Tem Kevin de León tweeted: “Millions of Californians will keep their healthcare and our state budget just avoided a huge hit.”

“Americans saw on Day One that ripping care away from 24 million people in order to finance massive tax giveaways for people like Donald Trump was morally bankrupt and dangerous,” said Laphonza Butler, president of Service Employees International Union in California. “Day by day, the GOP made it clear that their so-called ‘health’ plan had nothing to do with health, as maternity services, children’s check-ups, and protections for people with pre-existing conditions were stripped from their proposal.”

Trumpcare reception: Gov. Brown calls it "harebrained," state Senate passes symbolic resolution against it

published Mar 14, 2017

As news hit that the Congressional Budget Office is estimating the GOP’s Trumpcare proposal would leave millions without health care, California Democrats denounced it in what is becoming a Sacramento reflex.

First up was the governor, who labeled it “harebrained:”


Then the state Senate, on a party-line vote, passed a non-binding resolution by Sen. Ed Hernandez (D-West Covina) demanding that Congress not repeal Obamacare unless its replacement guarantees Americans at least the same level of coverage. “A fraud is being perpetrated on the American people right now by this administration,” said state Sen. Scott Wiener (D-San Francisco.)

Fellow Democrats cited a fresh analysis from the nonpartisan Congressional Budget Office, which concluded that the GOP’s Trumpcare proposal would result in 14 million fewer Americans having health coverage in its first year—a number that over the next decade would grow to 24 million.

California’s Republican state senators countered that the current healthcare system isn’t working—that their constituents had seen their premiums and deductibles rise beyond affordability. Sen. Jeff Stone (R-Temecula) also derided his legislative colleagues for what he characterized as their “obsession with doing everything they can to poke this president in the eye.”

 

GOP health plan blocks tax credits to anyone whose insurance covers abortion—coverage California requires

published Mar 9, 2017

In their proposed repeal of the Affordable Care Act, the House GOP plan now being touted by President Trump includes an anti-abortion provision at odds with California law.

At issue is a restriction on the tax credits House Republicans want to offer people who buy their own health insurance. Their bill—which cleared its first committee hurdle in the wee hours of this morning on a party-line vote—would not allow individuals to use their tax credit to buy any health plan that includes abortion coverage.  But that’s is in direct conflict with California law, which requires health plans to provide abortion coverage.

“If federal law mandates this, it would likely lead to legal challenges because state law protects these services,” said Nancy Kincaid, spokeswoman for Insurance Commissioner Dave Jones, who has openly criticized GOP efforts to repeal President Obama’s signature health care law.

In an interview with the Los Angeles Times, Chuck Donovan, president of the Charlotte Lozier Institute, a think tank that opposes abortion, said the GOP plan would mean tax credits could not be used to purchase 98 percent of California’s current insurance offerings.

Drumroll, please...The Obamacare Replacement Plan has arrived

published Mar 7, 2017

We all knew this was coming.

House Republicans finally pulled back the curtain on their legislative effort to replace the Affordable Care Act. It’s a moment seven years in the making. Putting the kibosh on Obamacare was not only a central promise of both President Trump and the GOP’s 2016 campaign, it’s been a singular rallying point for the party since 2009. Now, at long last, the repeal and replace plan is ready for its close-up.

Or, as the President put it this morning:

“The American Health Care Act is a plan to drive down costs, encourage competition, and give every American access to quality, affordable health insurance,” House Speaker, Paul Ryan said in a statement.

Just how do House Republicans plan to do all of that? The incorrigibly wonkish can have a look at the full text of the legislation that emerged from two committees here and here, but these are the highlights:

  • Remove the ACA’s unpopular financial penalties on individuals and businesses who do not purchase health insurance—but replace them with a 30 percent premium surcharge applied to those who go without coverage for longer than two months
  • Phase out the Medicaid expansion (which currently covers over 3.5 million Californians) within three years
  • Replace the ACA’s insurance subsidies (which are higher for those who earn less) with individual tax credits (that rise with a person’s age)
  • Eliminate the ACA’s taxes on high-earners and costly medical devices
  • Prevents any health care service provider, including Planned Parenthood, from receiving federal funds through Medicaid if they perform abortions (a limit that would have particularly strong repercussions in California)

Though the House Republican bill takes a wrecking ball to the former President’s signature healthcare law, it does keep some of Obamacare’s most beloved goodies. It allows health insurance companies will still be barred from charging people more based on their pre-existing health conditions. Likewise, young Americans will still be able to stay on their parents’ healthcare plans until they turn 26.

How much all of this is going to cost (or save) the American taxpayer remains to be seen. According to the Washington Post, the Congressional Budget Office, the nonpartisan budgetary scorekeeper for all federal legislation, has not yet had time to estimate the bill’s price tag.

But the bill faces tough sledding ahead. In the House, a conservative uprising already is mounting against it, targeting among other features its use of tax credits—a.k.a. interference in the free market. One member of the Freedom Caucus dismissed it with a two-word tweet.

Earlier, four Republican senators—Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado, and Lisa Murkowski of Alaska—sent a letter to Senate Majority Leader Mitch McConnell vowing to vote against any bill “that does not include stability for Medicaid expansion populations or flexibility for states.”  Whether McConnell can win the confidence of those four lawmakers, while also attracting the necessary eight votes from the Democratic caucus to break a near-certain filibuster and keep conservative firebrands in line, will require a formidable act of political tightrope walking.

No matter the ideological and tactical divisions that run through the GOP, Republicans have always been able to agree on one thing: Obamacare has to go. Whether they can agree on anything else will determine if and how millions of Californians get their health insurance in the years to come.

If feds strip Planned Parenthood's funding, California would be especially hard hit

published Mar 2, 2017

If President Trump and conservative Republicans in Congress succeed in their effort to cut off Planned Parenthood from receiving any federal funds, the impact will be particularly strong in California—a state where legislators over the years have interpreted federal laws and rules in ways that have allowed more federal dollars to flow to Planned Parenthood clinics. Roughly half of the federal funding that Planned Parenthood receives nationwide now goes, mostly via Medicaid reimbursements, to cover health care and family planning services primarily low-income Californians.

And ironically, Planned Parenthood say if they were to lose all their federal funding, their California abortion clinics would remain open—those already are funded by private sources and by state reimbursements for poorer patients. Instead what would be at risk are all the non-surgical sites that provide other medical and contraception services.

Already the federal government prohibits any federal dollars from paying for abortions except in cases of rape, incest or to save the mother’s life. But this effort seeks to block federal funds from paying for any other kind of health care by providers who also perform abortions.

The state’s progressive state policies, put in place 30 years ago under Republican Gov. Pete Wilson, created a friendly environment for Planned Parenthood to expand and offer family planning services to low-income men and women above the federal poverty level. That’s in stark contrast to states such as Texas and Mississippi, which unsuccessfully sought to ban their state Medicaid healthcare programs for the poor from channeling any money to health care providers that perform abortions.

As a result, today Planned Parenthood is one of California’s major health care providers, operating 115 clinics that serve 850,000 mostly low-income patients a year who rely on Medicaid (in California, Medi-Cal) for health care. That’s nearly a third of the 2.5 million patients who visit Planned Parenthood clinics nationwide for basic health care and family planning services.

“Planned Parenthood is a major safety-net provider at a time of increased health care demand,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. “In a state like California with more Planned Parenthoods, the reliance would be that much greater.”

The Republican-controlled Congress, bolstered by President Trump’s election, is eyeing several strategies to stop the flow of federal funding to Planned Parenthood. That money—roughly $500 million a year nationwide, through Medicaid reimbursements, Title X family planning money and grants—pays for services such as cancer screening, breast exams, birth control, prenatal care and treating sexually transmitted diseases.

Although Trump has frequently acknowledged that Planned Parenthood helps millions of women, he also has said he would support congressional efforts to ban funding.

“I would defund it because of the abortion factor,” he said at the February 2016 GOP presidential debate. “I would defund it, because I’m pro-life.” Read the full CALmatters story:

 

State senators revive effort for California to go its own way via 'single-payer' healthcare

published Feb 22, 2017

Single-payer healthcare is once again up for debate in Sacramento, as two state senators push a bill to establish a plan before the federal government repeals the Affordable Care Act.

Los Angeles Sen. Ricardo Lara and San Diego Sen. Toni Atkins, both Democrats, have introduced SB 562, a very basic bill for universal health care that would require a simple majority to pass. Although more details will be filled in as the so-called Healthy California Act wends its way through the Legislature, Lara’s office said it would pool health care funds into a publicly-run fund.

Today hundreds of supporters joined a Sacramento rally organized by the California Nurses Association. They hope the bill’s sponsors are correctly calculating that  this bill may have a better chance of succeeding, given the anxiety created by the Trump administration’s pursuit of a “repeal and replace” strategy to dismantle the Affordable Care Act, also known as Obamacare.

“Healthy California gives everyone insurance because everyone has a right to health care,” said Lara in a statement.” Trump and the Republicans don’t get to pick the health care winners and losers and we’ll never get 100% health care in California unless we lead.”

It’s not the first time such a bill has been introduced in California. In 2006, when one of those efforts cleared the Legislature and landed on the desk of then- Gov. Arnold Schwarzenegger, he vetoed it—declaring “socialized medicine is not the solution to our state’s health care problems.”

Critics of universal coverage say it’s very costly and comes with a large tax increase. Other state have tried to pass similar laws, including Colorado, and failed. Vermont became the first state to attempt a single-payer system, but it tabled the plan after its Democratic governor released a report showing the program’s cost would nearly double the size of the state’s budget in the first year, and require big tax hikes.

It’s unclear yet what the newest single-payer proposal would cost California. The sponsors say it will be intended for everyone, regardless of immigration status—including those who are uninsured and those who get health insurance through their employers. It’s also not yet clear whether Gov. Brown, who has a mixed record of support for universal health care, would sign the bill.

In Washington D.C., GOP House Speaker Paul Ryan said Republicans will reveal their repeal and replacement plan after Presidents’ Day. That plan will aim to create a more competitive marketplace and provide tax credits to consumers to replace government subsidies.

State lawmakers pledge to protect Planned Parenthood from federal cuts

published Feb 8, 2017

President Trump’s first act regarding family planning involved reinstating a decades-old rule to prohibit foreign nonprofits that receive U.S. funds from teaching about abortions or providing them. He’s not the only president to do this: The restriction, nicknamed the Global Gag Rule, has been instituted by previous Republican presidents and overturned by Democratic ones.

Then GOP House Speaker Paul Ryan announced Congress would fast-track a provision to strip Planned Parenthood of hundreds of millions of dollars of federal funding, after a bitterly divided investigation panel recommended that the nation’s largest abortion provider lose its funding. Republicans on the panel suggested that some clinics and firms are illegally profiting from fetal-tissue transactions and that their business arrangements could create an incentive to perform more abortions—an allegation Democrats equated with McCarthy era smear tactics. “My hope is that this is going to provide the information that is necessary for action to be taken,” said Rep. Marsha Blackburn (R-Tenn.). “This will be a Congress and an administration that will be known for standing for the women, for the protection of unborn children, and the protection of life.”.

That’s why in California, Planned Parenthood is prepping for a battle. The organization, which has 115 centers in the Golden State and serves 850,000 people annually, receives Medi-Cal and Title X family planning funding and attributes about 40 percent of its funding to federal dollars. Executives say 97 percent of the organization’s services are non-abortion related, including contraception, breast exams and other preventative care.

Planned Parenthood Federation of America President Cecile Richards came to Sacramento to meet with state Senate Democrats in early February, afterward telling reporters that any federal funding cuts to Planned Parenthood would not affect abortions—the federal government already prohibits the use of federal funds for abortions. Instead, she said, it would jeopardize other health services such as providing birth control, and testing and treatment of sexually transmitted diseases.

Some abortion rights advocates warn that pro-choice states such as California—which have allowed Planned Parenthood to receive reimbursements for basic health care, including family planning services, to low-income patients—have, in effect, encouraged Planned Parenthood to become more dependent on federal funds here than in other states. In January, both houses of California’s Legislature passed resolutions pledging to protect Planned Parenthood and its services in the state.

Abortion rates are at a historic low in California—a development for which both sides of the debate are claiming credit.

California’s undocumented kids could be first to lose medical care under Trump

published Jan 25, 2017

The ability of some 164,000 poor undocumented California children to see a doctor for regular medical care hangs in the balance:  Several experts predict they could be among the first to lose health coverage if the Trump administration carries out its promise to end much of Obamacare, leaving California to try to make up the difference.

To be clear, the federal government does pay limited medical costs for kids in the country illegally under the restricted-scope Medi-Cal program, which is available to anyone regardless of immigration status for emergency and prenatal services only. Last May, however, California became one of a handful of states to provide state-funded full-scope Medi-Cal, California’s Medicaid program. About 71 percent of the program is funded by the state, according to the state Department of Health Care Services, with 29 percent paid for out of federal funds for emergency coverage. Also of note: Because the federal government funds emergency services, the state shares enrollee information with federal health officials.

In his most recent budget proposal, Gov. Jerry Brown allocated $279.5 million to cover approximately 185,000 kids in the coming year in what the state has dubbed its Health for All Kids program—double what the program was estimated to cost when it was approved.

With the election of Donald Trump, who took office last week, some health policy experts and advocates say the fledgling program is in danger. Assuming the new administration carries out plans to change how Medicaid is funded, health policy experts say California could stand to lose $17 billion the federal government currently provides for the Medi-Cal expansion the state adopted under the Affordable Care Act. Read the full CALmatters story:

 

In first executive order, Trump begins to dismantle Obamacare

published Jan 20, 2017

The President signed his first executive order to begin the repeal of the Affordable Care Act just hours after he was sworn into office. The broad order instructs federal agencies to roll back or waive provisions of the law within their purview. That means agencies can change, delay or bypass parts of the Act.

A week before Trump made this move, Gov. Jerry Brown sent a strident letter to House Majority Leader Kevin McCarthy—California’s highest ranking Republican in Congress—insisting that a repeal would create instability and send many Californians back to emergency room healthcare.

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