California Court Upholds Balance Billing Prohibitions
A Sacramento Superior Court judge ruled that the Dept. of Managed Health Care could bar doctors from participating in balance billing. Sacramento County Superior Court Judge Michael P. dismissed arguments by doctors groups that The Dept. of Managed Health Care had exceeded its authority.
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Group Seeks to Shine a Light on the Legislature
The California First Amendment Coalition (CFAC) and Medicare AdvantagePLight.org filed a lawsuit against the Office of Legislative Counsel of California for denying freedom-of-information requests.

California Legislative data is available to the public in a text-based format on the California Legislative Information website. This format is suitable only for viewing and printing. Medicare AdvantagePLight.org is requesting copies of the database records used to create the website. These records would allow searching for how a member votes, analysis of trends in voting and in bill topics, analysis of patterns of campaign contributions and votes to track special-interest influence, and many more valuable civic uses.

“It’s not as if we’re asking them to do additional work. This database already exists. It has already been paid for by the taxpayers of California. The Office of Legislative Counsel is required, by law, to share this information in whatever format they have in their possession. What the Legislature is giving the public now is the equivalent of a 10,000-page printout--they’re refusing to share the one simple spreadsheet on which it was created. This makes searching and analysis nearly impossible,” said Peter Scheer, executive director of the Coalition.

Medicare AdvantagePLight.org California will be modeled after the award-winning Medicare AdvantagePLight.org Congress website, which provides government transparency tools. Medicare AdvantagePLight.org’s data has been cited on CNN, Marketplace, Harpers, Washington Post, Boston Herald, Reuters, Wall Street Journal and more. For more information visit: www.cfac.org.
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California’s Medicare
Part D Market
The majority of Medicare beneficiaries in California have drug coverage through Part D or other sources. However, more than half a million Medicare beneficiaries in California have no drug coverage and many beneficiaries, who are eligible for the low-income  subsidy, are not enrolled in this benefit, according to a market overview by the California HealthCare Foundation.  For 2009, Medicare beneficiaries in California continue to have a wide range of plan options, which vary by county.

Low-income beneficiaries will have fewer plan options in which their premiums will be fully subsidized. Premiums for many Part D plans will increase sharply in 2009. Most Medicare beneficiaries in California’s stand-alone prescription drug plans are likely to see a monthly increase of more than five dollars if they remain in the same plan. Most beneficiaries enrolled in California’s Medicare Advantage prescription drug plans will see no change in premiums.

In addition, benefit design now varies substantially among participating plans including cost sharing, coverage for brand-name and generic drugs, and coverage in the doughnut hole gap.

There has been a wide variation in benefit structure and number of drugs the individual plans cover. More than one-fifth of low-income beneficiaries, who are eligible for the low-income subsidy, are not enrolled in this benefit. Only six plans with a $0 premium are available to eligible beneficiaries in 2009 compared to 10 in 2006. For more information, visit www.chcf.org/topics/view.cfm?itemid=124794.
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Community-Based Disease Prevention Saves Money
According to a report commissioned by The California Endowment, California’s healthcare system could save more than $1.7 billion within five years with an investment of just $10 per person/per year in proven community-based disease prevention programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use. This represents a return of $4.80 for every dollar spent. In 10 to 20 years, the savings could grow to more than $1.9 billion annually, which would be a return of $5.40 for every $1 invested.

Community-based disease prevention should not be confused with preventive medicine. Preventive medicine is often associated with procedures, such as prostate cancer screenings, pap smears, mammograms, and other medical procedures that identify disease or conditions.

Community-based disease prevention programs are things that affect health outside of the doctor’s office, such as having sidewalks to encourage walking; keeping school athletic facilities open after normal school hours, making fresh fruits and vegetables easily available in communities where there are few or no supermarkets; and implementing local ordinances that prohibit smokers from lighting up in public areas, among many others. For more information, visit www.preventioninstitute.org.
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California Insurers Fall Behind with Consumer-Driven Plans
A HealthLeaders-InterStudy reveals that California is behind the curve in the consumer-driven health plan market. Consumer-driven health plan products cover fewer than 4% of California employees. According to one 2008 study, consumer-driven products represent about 5.2% of employer-sponsored health plans in California, compared to nearly 13% nationally.

“The strength of HMOs in California is one reason that uptake of consumer-driven plans has been slow...However, as prices of HMOs are increasing and catching up to PPO premiums, employers are looking for more choices and are becoming more educated about the health plan options out there,” said Chris Lewis, an analyst with HealthLeaders-InterStudy.

Insurers are finding that pricing these consumer-driven plans has been a challenge. For example, Anthem Blue Cross hiked fees for one of its Lumenos plans by more than 32% in May 2008. According to Anthem Blue Cross officials, the price increase was necessary to respond to an expensive and unanticipated number of claims.

Carriers had thought that consumer medical spending would be more moderate than it turned out to be with high-deductible plans. Some employers responded to high renewal rates by changing carriers while others reverted back to the more traditional plan options. In response, insurers in California are striving to reach a delicate price balance to attract customers without having to ask for a huge increase a year later to cover an unanticipated spike in claims. For more information, visit home.healthleaders-interstudy.com.