|January 10, 2007|
||California Takes A Positive Step|
||Go Beyond The Headlines|
||Coffee and Donuts Not Included|
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Earlier this week, California Gov. Arnold Schwarzenegger (R) unveiled a $12 billion proposal to extend health coverage to the 6.5 million Californians who currently have no insurance, including an estimated one million undocumented children. Under the proposal, all Californians must have insurance substantial enough to protect them from catastrophic health care costs, although the poorest will be subsidized. Those who go uncovered will be subject to tax penalties. “If you can’t afford it, the state will help you buy it. But you must be insured,” Schwarzenegger said on Monday. “That is number one.” In laying out his approach, the governor has worked to address the key questions of access to and affordability of health coverage, and shared responsibility for health costs. He has also responded to the demands of approximately 80 percent of California voters who have indicated they want the government to guarantee access to affordable health coverage for the state’s residents. While some aspects of Schwarzenegger’s proposal raise very serious concerns — particularly, whether health care will be truly affordable for lower-income Californians — as a whole, the proposal represents a positive and exciting step in the national debate on health care reform. “I look forward to everyone now having those debates,” Schwarzenegger said.
HOW IT WORKS: Under Schwarzenegger’s plan, low-income adults and children would be covered through the state’s insurance programs — Medi-Cal, the state’s Medicaid program, and Healthy Families. In an unprecedented step, all children would be provided access to the public programs if a family of four earns less than 300 percent of the $20,000 poverty level, regardless of immigration status. And in another major expansion, the proposal would provide Medi-Cal coverage to all adults with incomes below 100 percent poverty. The adults in families who earn above 100 percent and to 250 percent of the federal poverty level would become eligible for subsidized insurance rates on a sliding scale. The costs of providing such coverage would be shared by many. Employers with 10 or more employees could either offer coverage or contribute the equivalent of four percent of their payroll costs toward a statewide plan to be offered to employees. Hospitals would contribute four percent of their revenues while private physicians would have to pay two percent of their revenues. In return, Medi-Cal payments to doctors and hospitals would increase by $4 billion. The proposal would require insurers, health plans, and hospitals to spend 85 percent of all premiums and health spending on direct patient care, not administrative costs or profits. “He is taking steps to protect the most vulnerable: children and working adults,” said Irma Cota, chief executive officer for North County Health Services which annually serves about 55,000 clients.Supervisor Adrienne Tissier, a member of the county’s blue-ribbon task force on adult health care coverage expansion, added, “I do think it’s a step in the right direction, just in the fact that we’re addressing it.”
COVERING THE UNDOCUMENTED: Schwarzenegger’s proposal boldly proposes to extend coverage to all children, including those of undocumented children. It has engendered a great deal of criticism from the right. “Health coverage for illegal aliens is a nonstarter for us,” said Robert Huff, chairman of the Assembly’s Republican caucus. Acknowledging that covering undocumented immigrants is a controversial proposal, Schwarzenegger noted federal law already requires hospitals to accept everyone, regardless of immigration status, into their emergency rooms. Moreover, he explained that providing preventive care would help reduce expensive emergency room costs down the line. The average California family pays hundreds of dollars a year in “hidden taxes” through health insurance premiums to cover the uninsured. By covering undocumented immigrants, the Governor said that his plan would cut the hidden tax in half. “There is no debate about whether to provide medical care to people who are in California illegally,” Schwarzenegger said. “I know this is controversial, but federal law requires us to treat anyone who shows up at an emergency room in need of care. So, the decision for my team was, do we treat them in emergency rooms at the highest cost available or do we do it right and do it efficiently?” Bob Ross, president of the California Endowment, echoed the governor’s sentiments, “I sleep better at night knowing that all children have been afforded the opportunity for immunization. From a public health perspective, the state of California already pays for emergency room care and hospitalization for the children of illegal immigrants,” Ross said. “Why not spend the money more wisely and cheaply up front?“
CONCERNS OVER AFFORDABILITY: Schwarzenegger’s proposal raises questions — questions of nuance and technical detail, but also questions of ultimate results and underlying philosophy. Most importantly, it is unclear whether health care will truly be affordable to lower-income Californians if this plan were to become law. Emily Clayton, a health care advocate for the California Public Interest Research Group, said that policy wouldn’t provide much coverage and would require consumers to spend heavily before seeing any benefits. If the governor is really going to require people to have health insurance, any plan has to make sure there is affordable health insurance coverage available and make sure that the coverage provides some form of (real) insurance,” Clayton said. Thousands of working families may face unmanageable deductibles and other out-of-pocket costs — up to $10,000 per family per year — while families of four with incomes over $50,000 will be required to purchase coverage but will not receive any help with premium costs. It would be a terrible waste of effort and money if California’s uninsured families merely become California’s underinsured families. These questions and others will play out as the proposal works through the legislative process. At this point, we know that California is poised to advance the national debate on health system reform from a strong starting position.
ADMINISTRATION — SNOW FALSELY CLAIMS BUSH SAID ‘JUST THE OPPOSITE’ OF ‘MISSION ACCOMPLISHED’: In yesterday’s press briefing, White House Press Secretary Tony Snow tried to distance President Bush from his infamous “Mission Accomplished” speech, claiming that Bush said “just the opposite” of “Mission Accomplished”: “You know that the mission accomplished banner was put up by members of the USS Abraham Lincoln, and the president, on that very speech, said just the opposite, didn’t he?” But for that May 1, 2003 speech, Bush stood in front of a large banner that read, “Mission Accomplished.” In the opening of his speech, he declared, “Major combat operations in Iraq have ended. In the battle of Iraq, the United States and our allies have prevailed.” He called the “battle of Iraq” a “victory” In his radio address shortly after the speech, he boasted, “I delivered good news to the men and women who fought in the cause of freedom: their mission is complete and major combat operations in Iraq have ended.” Additionally, as Bob Woodward reported in October, then-Defense Secretary Donald Rumsfeld had to pressure the White House to take out of the speech the actual phrase “Mission Accomplished,” but he couldn’t “get the sign down.” In Oct. 2003, then-White House Press Secretary Scott McClellan admitted that the White House — not members of USS Lincoln — had “take[n] care of the production of the banner.”
ADMINISTRATION — MULTIPLE BUSH NOMINEES WITHDRAWN IN ‘CONCESSION TO POLITICAL REALITY’: “In an apparent effort to lower the temperature in the fierce battle over federal judges — and in a concession to political reality,” President Bush “won’t rename four controversial federal appeals court nominees whose confirmations were blocked last year.” “William Haynes, William G. Myers III and Michael Wallace all asked to have their appointments withdrawn, these officials said. Judge Terrence Boyle was informed of the White House’s decision.” “Haynes is the Pentagon’s top lawyer, and was an architect of the Bush’s now-abandoned policy toward treatment of detainees… He had been tapped for the 4th U.S. Circuit Court of Appeals.” “Myers, nominated to the 9th U.S. Circuit Court of Appeals, sparked opposition from environmentalist organizations.” Wallace drew opposition from “civil rights groups and the American Bar Association.” Boyle’s nomination to the 4th Circuit drew opposition because of “his rulings in civil rights and disability cases, as well as his higher-than-average reversal rate by higher courts.” In addition, Kenneth Tomlinson “has told the president that he would rather write a book about his experiences than undergo another confirmation process” to become chairman of the Broadcasting Board of Governors. Fox News reported. Tomlinson previously “headed the Corporation for Public Broadcasting, but was forced to step down from that organization after an inspector general’s report in 2005 found evidence that he had violated rules meant to insulate public television and radio from political influence.”
White House Press Secretary Tony Snow admitted yesterday that Congress had funding control over the Iraq war but said “the president could ultimately do what he wants.” Snow told reporters, “The President has the ability to exercise his own authority if he thinks Congress has voted the wrong way.”
“Last year was the warmest in the continental United States in the past 112 years — capping a nine-year warming streak ‘unprecedented in the historical record’ that was driven in part by the burning of fossil fuels, the government reported yesterday.”
“Democratic leaders said Tuesday that they intended to hold symbolic votes in the House and Senate on President Bush’s plan to send more troops to Baghdad,” the New York Times reports, “forcing Republicans to take a stand on the proposal and seeking to isolate the president politically over his handling of the war.”
Faculty members at Southern Methodist University, the “likely site” of Bush’s presidential library, “are raising sharp questions about the school’s identification with his presidency.” Yesterday, 150 faculty members voiced “a range of concerns, particularly on whether the school’s academic freedom and political independence might appear compromised by an association with not only the Bush library but also a museum that would accompany it.”
“Federal prosecutors have notified a former deputy secretary of the interior, J. Steven Griles, that he is a target in the public corruption investigation of Jack Abramoff’s lobbying activities.”
“Pentagon insiders say members of the Joint Chiefs of Staff have long opposed the increase in troops and are only grudgingly going along with the plan because they have been promised that the military escalation will be matched by renewed political and economic efforts in Iraq.”
“An Army private charged with the slaughter of an Iraqi family was diagnosed as a homicidal threat by a military mental health team three months before the attack.” The private was given medication and ordered to “get some sleep,” then returned to duty the next day “in the particularly violent stretch of desert in the southern Baghdad suburbs known as the ‘Triangle of Death.'”
Former senator Rick Santorum (R-PA) is now a senior fellow at the Ethics and Public Policy Center, where he “directs a program called ‘America’s Enemies,’” which will “focus on identifying, studying, and heightening awareness of the threats posed to America and the West.”
National taxpayer advocate Nina Olson told Congress yesterday to “repeal the authority it gave the Internal Revenue Service to use private debt collectors,” calling the program “inefficient, uneconomical and prone to abuse.”
And finally: Despite his “thin and slightly reedy” real voice, Rep. Dennis Kucinich (D-OH) can “steal the show” when he “really sings, deepening his voice and slowing the tempo to a working-in-the-fields, sharecropper cadence.” On Monday, Kucinich sang (and spoke) to an audience at Jesse Jackson’s 10th annual Rainbow/PUSH Coalition Wall Street Project Conference.