Medi-Cal lawsuit on the horizon, a financial policy one

This past week, SFGate announced that San Francisco’s Mayor Gavin Newsom’s administration and coalition are outraged by the 10% Medi-Cal physician reimbursement implemented by Governor Schwarzenegger’s Medi-Cal wonks (article 1 and article 2). This desperate $600 million savings attempt by the State government is plan B after Governor Schwarzeneggar’s Medi-Cal reform failed to come to fruition.

Being in the Medicaid field, I have no idea how Mayor Newsom’s lawsuit can stand legal grounds. Burden of health care access? By cutting reimbursement, physicians who can forgo the slim Medi-Cal reimbursement margins will bar medical services to existing or new Medi-Cal patients. If this financial barrier to health care access can be shown, then the new decreased reimbursement is not actuarially sound. If this cut had to be approved by the Center for Medicare and Medicaid Services (CMS), then an actuary’s signature must have certified the rates to be sustainable for the current level of access or greater. Obstruction to access is difficult to prove because of the intangible definition for the highly fluid Medi-Cal population. In addition this is only arguable for managed care but not for the fee-for-service system. The testy lawsuit stands weak legal grounds.

Can anyone with more policy and legal field experience enlighten me on the legal argument of this lawsuit?

In my mind, if Mayor Newsom wants to become Governor Newsom, this lawsuit is more of a political platform building opportunity for the 2010 election. I really hate seeing charismatic politicians that have the power to do wonders but then become a disservice to the American public, and I think Mayor Newsom thinks so too. So I nailed my opportunity yesterday to put in a plug. I really did not want to seem like every other San Francisco business person in line to shamelessly plug their business and that is it. I wanted to tell him how I could be part of his A-team of civil servants to make his health care policy progressive, hospitable, and vastly improved. So what did I do?

I am very gracious that my firm participated in the city planning team for San Francisco Earth Hour. In exchange for volunteering for the event by handing out energy conservation incandescent light, I earned an invite to the kick-off event at MarketBar where I knew that the Mayor had a public appearance.

I sealed the deal by thinking of two main points to capture his coveted attention. Point one was to get him engaged: Do you recall a few months ago when you rode the N-Judah Muni Metro to work?

My witness to his N-Judah presence provoked his outrage on the city’s MUNI issues. His knowledge of the issues and detailed ridership numbers impressed my friend whose husband has a MUNI love and hate relationship. As he pointed out the electric MUNI car parked outside of MarketBar, I took a jab that Austin long had these buses, and the vehicles are cleaner, wider, and more comfortable. That comment sparked Mayor Newsom’s competitive sportsmanship. San Francisco can do much better than Austin!

Point two was to hit his health care policy interest dead-on. I had a little trouble plugging myself because I am very shy, too polite, and passive. So my friend helped me out by shouting that I had health care policy interests. That grabbed his attention and he asked, “Did you know that we are suing the governor for their Medi-Cal cuts?” I thought, “Duh!?” Which health care policy wonk did not. So I put in my plug for what my team did for the current Governor’s administration on Medi-Cal redesign. He asked for my business card, and I sincerely hope his administration follows up.

If Mayor Newsom is going to be the next Governor, I want my hand at health care reform done right the first time his administration proposes it. I am sick and tired of living through stale iterations of reform, issue attrition, and waning political momentum. I am also sick of complaining. While young and capable, I have the time, patience, and aptitude, and I hope I get in on the action.

On a separate note, the Governor learned from former First Lady’s Hillary Rodham Clinton’s political debacle at health care reform. Since 2004, the Governor had various task forces to gather genuine buy-in, extensive input, and productive discussions. PR wise, “redesign” appears to be a more salient policy term than “reform.” This was one of my first health care policy field work assignments. I will save this story for another day but feel free to browse through one sliver of the redesign planning at the California Health Care Foundation. I am just sad that with all the effort, blood, sweat, and tears, plan A failed, hence this slapped together Plan B to help salvage the State’s budget. Not surprising, a lawsuit abounds.

Part II of III: Shopping for Individual Health Insurance — How to shop for an individual health insurance carrier

Did you consider whether or not you qualify for public programs?

Medicaid is generally for low-income individuals and families with specific health condition(s) or family arrangement. Or Medicare is generally for 65+, some disabled, or all end stage renal disease persons.

In progressive locales, governments may have local health coverage for its residents. In San Francisco, Healthy San Francisco offers basic health needs to all residents by formalizing the fragmented safety net care.

If the aforementioned are not applicable and no insurance is out of the question, then shop for an individual health insurance plan.

Since the individual health insurance market is unregulated, comparison shopping sites like ehealthinsurance.com has not changed much in the last decade.

Part I of III: Shopping for Individual Health Insurance — You are leaving your job and concerned about health insurance coverage

After a company buy-out, my friend decided to take company severance and work as an independent contractor. The freedom and liberty to go as he please comes at a price, one being affordable health insurance.

Before delving into the individual health care market, first read Insure.com’s tips for buying individual health insurance.

Then, consider if these options are viable:

Spousal coverage
If your spouse is employed and has group health insurance, have him or her extend insurance to you.

No spouse, then no consideration. Rarely have I heard of marriages for health insurance, well except for U.S. citizens with Canadian citizens getting a piece of across the border health care. That is not likely to happen if you can not and do not frequent Canada.

COBRA coverage
Within a 63-day period, if your company is required to extend your current health insurance upon your departure, you can pay the full premium to maintain the same coverage. Depending on how lenient your company is, you may forgo the additional 2% administrative cost. In total, you pay up to 100%-102% of the full premium. You can be insured up to 18 continuous months. After that time period, if you are still in the individual health insurance market, then you are back to square one.

In the case of those who have been independent contractors for some time, COBRA coverage does not apply.

Group coverage through associations
Individual health insurance is priced differently from group insurance that one receives through employers, and oftentimes, the pricing can be much higher for the un-savvy shopper. Look for insurance offers from your alumni club or trade organizations, which sometimes, but rarely, have premiums set at group insurance levels.

If none of these apply, then read the next entry on selecting a health insurance plan suitable for you, the independent employee working for the company of one.

What more can we do?

“I don’t understand how children who are living poverty, who have nothing but the sandals that are three sizes too small on their feet, a T-shirt full of holes, and the three pieces of candy that they will try to sell on the street later that night for money, smile all day long. It doesn’t make sense how two siblings whose parents have both died from AIDS, who don’t have a place to go home at night, have the strength to hold each other’s hands and walk down the dirt road after school is over for the day. It blows my mind to watch 96 children who haven’t eaten for over 24 hours be so patient as to help the youngest children get their meal for the day before they get their own.” -Lindsay Cottrell, MHSA Candidate 2009; Assistant Direct of The Olevolos Project

Quote from Ah-Ha! in FINDINGS, Volume 23, Number 1 Fall/Winter 2007, a University of Michigan School of Public Health publication

 So what are you whining about in life? Channel that energy into projects that eliminate sad quotes and create a balance between the selfless and the selfish.