Update on Congressional Joint Select Committee on Deficit Reduction
Posted on Thursday December 15, 2011

 On November 21, 2011, the Congressional Joint Select Committee on Deficit Reduction issued a statement indicating that it could not reach agreement on how to cut the Federal budget deficit.  The committee is comprised of 6 Democratic and 6 Republican lawmakers.  The Budget Control Act of 2011 established the group and authorized it to cut the deficit by at least $1.2 trillion by the end of November.

A contingency plan was built into the law in the event the committee failed.  The plan will begin on January 15, 2012 and automatically make $1.2 trillion in cuts to federal programs, cutting 50% from defense services and 50% from social and other services.  If Congress does not find a way to reduce spending without cutting these services, these cuts will be implemented in 2013 and in each year through 2021.  Programs exempted from the cuts include: Social Security, Medicaid, the Children’s Health Insurance Program and the Supplemental Nutrition Assistance Program.  While other programs, such as Medicare may only be cut by 2% in provider payments and Indian Health Service (IHS) may only be cut by 2% in any year.

The California Rural Indian Health Board and National Indian Health Board will continue to advocate that no cuts be made to IHS as this agency is already substantially underfunded.  The IHS needs $21 billion to adequately address the health care needs of all patients in its system, while the 2011 Administrative request was $4.4 billion.  Underfunding has resulted in many IHS programs running out of health care funds in the latter half of each fiscal year and scaling back the services that are provided.  Yet, American Indians/Alaska Natives (AIANs) continue to suffer from significant and severe health disparities, including high rates of diabetes, cardiovascular disease, pneumonia, mental health issues, influenza and injuries.

AIANs are more likely to die from alcoholism (770%), tuberculosis (650%), diabetes (420%), accidents (280%) and pneumonia/influenza (52%) than other Americans (IHS, 2003).  As a result of these substantially increased health problems and death rates, the life expectancy for AIANs is 71 years of age, approximately 5 years less than the rest of the US population (DHHS, 2000).  The Federal government must increase its partnership with Tribes and Indian health care clinics to reduce AIAN health disparities.  

Dear Supporters of California Indian Healthcare, 

This has been a very busy week for healthcare advocates working to have Governor Brown sign key health related legislation.  Earlier today I participated in a teleconference meeting with a representative of the governor’s office on the status of these bills.  It is clear that more organizational and citizen support of the legislation is necessary.  In light of this, would you please make a quick call to the governor’s office and urge him to sign these bills!  The number to dial is 916-445-2841.  The governor has 1 week left to decide the fate of the bills.

AB 415--Telehealth Advancement

AB415 updates the State practice of telehealth to clarify the consent and credentialing processes and assure access to appropriate reimbursement for telehealth services provided in both real time and through store and forward modes. 

AB1296--Streamlining Eligibility and Enrollment

AB1296 require California Health and Human Services Agency establish a standardized single application form and related renewal procedures for Medi-Cal, Healthy Families Program, the California Health Exchange and other programs. This bill is crucial as it sets a framework so that millions of Californians gain meaningful and easy access to coverage as the Affordable Care Act is implemented.

AB922--Improving Consumer Assistance

AB922 improves the Office of Patient Advocate to provide better assistance to California health care consumers by providing a central, enhanced center to handle questions and complaints and for them to be triaged to the appropriate agencies, whether regulatory or administrative, state or federal, etc.

SB222/AB210--Requires Maternity Coverage
SB222/AB210 requires that health plans sold in the individual and small group markets, respectively, stop discriminating against women and provide as a basic benefit, maternity care and maternity-related care, starting in July 2012.

SB51--Implements Medical Loss Ratio, Requiring Insurers to Devote 80-85% of Premium Dollars  on Patient Care

SB51 implements the Medical Loss Ratio provision of the Affordable Care Act that requires insurers in the large group market to spend 85% of premium dollars on health care and insurers in the small group and individual markets to spend 80% of health care dollars on actually providing health care rather than for administration or profit.

Mark LeBeau, MS
Health Policy Analyst
California Rural Indian Health Board, Inc.

Court rules Affordable Care Act’s ‘individual mandate’ unconstitutional, Medicaid expansion constitutional
Posted on Tuesday August 16, 2011

On August 12, 2011, the 11th Circuit Court of Appeals ruled that the Affordable Care Act’s ‘individual mandate’ provision, requiring U.S. citizens to maintain health insurance, is unconstitutional.  The case includes 26 states and involves two claims: (1) the individual mandate is illegal because it exceeds Congress’s Commerce Power and (2) the mandatory Medicaid expansion is unconstitutionally coercive upon states.

The court found that not buying health insurance is not commercial activity that can be regulated by Congress and therefore the mandate is unconstitutional.  In addition, the court found that the Medicaid expansion is constitutional.  This is important given that for the first three years of expansion, the Federal matching rate will be 100% and after this time period it will drop to 90%.  These rates are higher than any State currently receives and additional people will be able to receive the health care services that they need.

If this ruling stands and other legal challenges fall by the wayside, the vast majority of the Affordable Care Act would be implemented, including the provisions specific to Indian health care.

Federal officials propose reducing Medicaid program for people with low incomes 
Posted on Wednesday July 6, 2011

The Obama administration proposes to shrink the Medicaid health coverage program in an attempt to spend less on the program and protect it from other proposals that would drastically cut services.  The administration’s plan would reduce spending, shift costs to states, replace federal matching rates to states with a blended rate that would be less than currently exists and reduce the services that are covered under this program.  The plan was unveiled in April and projects a savings of $100 billion over ten years.

House Budget Committee Chairman Paul Ryan’s alternative proposal for Medicaid would change it to block grants for states and cut the funding by 35% in 2022 and nearly 50% in 2030.  Under the proposal, states could spend more of their own funds to keep the programs working as they traditionally have or cap enrollment, scale back eligibility and reduce services for the patients who rely on Medicaid.

The nation, states, tribes and Indian health programs cannot afford to have more people without access to the healthcare services that they need.  Medicaid is substantially more inexpensive than any other health insurance plan on the market.  Let’s stand together and fight to protect Medicaid, after all it is one of the good fights to be involved in.  The children, parents, people with disabilities, and elders that are participants in the Medicaid program and in our communities need a hero, be that advocate.