EVENT: Federal or State health care policy making 101

AcademyHealth is hosting their 2nd annual, three-and-a-half day “Health Policy Orientation” event from October 25th through the 28th at the Kaiser Family Foundation in Washington D.C.

The event starts by reflecting on health reform and the different executive, legislative, and judicial interactions. Panelists are expected from CMS, CRS, GAO, and MedPAC. The second day evolves around state health care program such as Medicaid, SCHIP, and health reform. The timing of the event could not have been better, with the Temporary High Risk Pool Program (THRPP) commencing this October for participating states. Hot topics that are bound to come up are the preparations and funds already spent for the appropriated $5 billion towards THRPP and the eventual insurance exchange occurring January 2014. The third day focuses on Medicare and communicating with policy leaders. The last day includes a Congressional site visit with possible Congressional member meetings.

If this orientation were around when I was a newly minted health care policy graduate, I would have jumped on this chance, with firm sponsorship of course. Registration ranges from $1,260 to $1,700.

Looking at last year’s participant list, the event appears to be geared towards consultants, policy advisors and analysts, academics and fellows, researchers and statisticians, think tanks, providers, and lawyers.

See agenda thus far. List of confirmed speakers.

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

Where did I leave this blog 2 years ago? Oh right, I was supposed to finish up the third part of the 3 part series on purchasing individual health insurance. Can you believe in 2 years, Massachusetts and San Francisco were able to ensure that all residents could receive a certain level of care without financial worries. *clap*cap* Oh and let us not forget the monumental health care reform under Obama’s second year of office. *standing ovation* Although not everyone agrees with the change, a huge change in health care is breath-taking. Instead of people like me getting burnt out from health care policy, there is renewed interest. So I am back. Part III is no longer relevant. Reviving U.S. Health Care Policy is back on the plate!

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.