California farmers, ranchers struggle over health care costs

California’s farmers and ranchers are struggling with health care bills that, in some instances, threaten the viability of their family businesses, according to a report Wednesday by the Access Project and funded by the California Endowment.

The report finds that while almost all farm and ranch operators have health insurance, one in five says that California insurance premiums and other out-of-pocket health care costs are causing financial difficulties for themselves and their families.

These families report spending 37 percent of their income on health care coverage and medical costs.

“A better term for health insurance that leaves nearly one in five purchasers in financial jeopardy might be called ‘product failure’,” says Carol Pryor, a report author and policy director for the Access Project.

The survey also found that more than three in 10 farmers and ranchers (31 percent) are spending at least 10 percent of their annual income on health insurance premiums, prescriptions and other out-of-pocket medical costs. Spending this much on health care is a commonly used indicator of financially burdensome health care costs, the report’s authors say.

Farm and ranch operators are especially hard hit because they are often forced to buy insurance on the individual, non-group market, where insurance generally costs more and covers less, says the report.

The study shows that on average, those farmers and ranchers purchasing insurance in the non-group market spent almost twice as much on health care as those who got their health care coverage through off-farm or off-ranch employment. The median amount spent by farmers and ranchers who got insurance on the non-group market was $8,500 a year (including premiums and out-of-pocket costs), compared to $4,630 spent by people who got insurance through employment off the farm or ranch.

Three in 10 of the study’s respondents purchased health coverage directly on the open market. Nationally, only 8 percent of Americans obtain their health insurance this way.

“Right now farmers are faced with increasing costs for everything – fuel, feed, fertilizer. Adding exorbitant health care costs on top of these expenses is simply not sustainable and threatens the viability of family farm operations,” says Lynn McBride, director of the California Farmer’s Union.

One-fourth of those surveyed (26 percent) report having to draw on other financial resources to cover the costs of care. Of these respondents, 70 percent dipped into family savings and nearly one in three (29 percent) incurred credit card debt or increased existing debt. Others took out a loan, borrowed against their farm, withdrew money from a retirement account or turned to friends and family for help.

ABC's Dr. Tim Johnson, 15 Years of Shilling for Universal Health Care

ABC's liberal medical editor, Dr. Tim Johnson, appeared on Wednesday's "Good Morning America to boost Barack Obama's universal health care plan and critique the more market oriented proposals of John McCain. Co-host Robin Roberts began the segment by seriously asserting, "We're not endorsing one plan over the other. We're just showing the differences between the two."

But after she mentioned Obama's assertion during Tuesday's presidential debate that health care is a right, Johnson marveled, "But, I'm struck by the language of the right to life, liberty and the pursuit of happiness. Without good health, and that usually means without good health care, it's hard to have those other rights." Johnson, despite being a doctor, adopts the standard, liberal positions of most journalists and has a 15 year-plus history of advocating universal health care, including once asking if Republicans who opposed the policy were "immoral."

Regarding Senator McCain's idea to give people the opportunity to buy individual plans, even if they don't have an employer, Johnson criticized, "That's a difficult thing to do because there are so many different plans marketed." Accentuating the negative, he added, "So, you've got to do a lot of work on your own and read the fine print. It's a very difficult job for an individual."

Johnson found no such criticisms for Senator Obama's proposal. After describing the various health insurance plans the Democrat would offer, he approvingly observed, "But these plans will have been vetted by the government, just like they do for federal employees...But you know they've been vetted for basic care and coverage and that the cost is fair."

California Health Coverage Costs are a Bit Lower

Cost increases for California health insurance premiums are lower this year, and although California’s are higher than some other states, they are also still lower than in previous years.

The Kaiser Family Foundation and Health Research and Educational Trust confirm what news wires also are reporting: nationally, the rise in cost of health care premiums is about 5 percent. This continues a trend from 2007, when a similar small cost increase was instituted.

However, according to Randy Jones of Hometown Insurance Services in Solvang, in California premiums are somewhat higher: “Ours in California, the rate went up higher than that. We’re getting a 10 percent rise,” he said.

Although the national increases were reported at the end of September, California’s current insurance rates are more difficult to come by. Insurance industry and regulatory agency figures found on the Internet indicate the 10 percent rise is in the ballpark.

“If increases aren’t as bad this year, they were pretty horrendous last year,” Jones continued. One reason California’s premiums are not shooting up, he said: “We’re healthier.”

Another reason that California’s health insurance premiums have stayed relatively low, according to Jones, is the result of a ballot measure from about 15 years ago. That measure was approved by voters, capping punitive damage amounts. “So insurance companies don’t have to approve every little thing for fear of being sued,” Jones said. “But the quality of California health care hasn’t changed.”

The Kaiser study showed that not only insurance premiums have shown a steady increase. “Cost sharing for medical services has also increased in recent years. The percentage of employers sponsoring insurance and the percentage of workers covered by employer-sponsored insurance remained stable over the past year.”

California Legislature Drops Some Health Cuts From Budget

Early this morning, the California Legislature approved a budget proposal for fiscal year 2008-2009 that avoided some cuts to health care and other programs, the San Jose Mercury News reports. Democrats widely opposed the proposed cuts (Zapler, San Jose Mercury News, 9/16).

The proposal does not eliminate dental services for adult Medi-Cal beneficiaries or impose new restrictions on Medi-Cal services for undocumented immigrants. Medi-Cal is California's Medicaid program (Halper/Rau, Los Angeles Times, 9/16).

Beyond those already introduced by Senate Democrats, the budget agreement does not include cuts to California health care, human services or education programs, according to information Ventura County officials received from the California State Association of Counties (Biasotti, Ventura County Star, 9/16).
Healthy Families, Medi-Cal

The budget retains a provision to increase monthly premiums for Healthy Families, California's version of the State Children's Health Insurance Program (Los Angeles Times, 9/16).

The proposal would restore most of the 10% cut in Medi-Cal payments to health care providers beginning in March 2009 (Lin, AP/San Francisco Chronicle, 9/16). California's Medicaid reimbursement rates will remain the lowest in the U.S. even after the cuts are restored, according to the Los Angeles Times.

California Children at Risk of Losing Health Insurance Coverage

Thousands of California children could lose health insurance coverage in the coming months as a result of changes in Medi-Cal rules and decreased funding for local efforts that have provided coverage to children, the Los Angeles Times reports. Medi-Cal is California's Medicaid program.

State lawmakers will require parents of children enrolled in Medi-Cal to renew their enrollment every six months.

The administration of Gov. Arnold Schwarzenegger (R) projects that the requirement will contribute to a drop in Medi-Cal enrollment over the next two years of about 196,000 children.

State lawmakers also have increased monthly premiums for Healthy Families, California's version of the State Children's Health Insurance Program, by $2 to $3 per child.

As a result, the state estimates that the parents of 19,000 children no longer will receive coverage through the program by July 2009.

The changes to Medi-Cal and Healthy Families were approved as part of a larger effort to address the state budget deficit.
Local Efforts.

Beyond changes to Medi-Cal and Healthy Families rules, children also could lose coverage because of funding challenges faced by local initiatives operating in 30 counties. The efforts target children who are ineligible for Medi-Cal or Healthy Families because of income or citizenship requirements.

The initiatives are funded largely by private philanthropies and local First 5 commissions, which disburse funds from a state tobacco tax for early childhood health care and education efforts.

Wendy Lazarus, co-president of the advocacy group Children's Partnership, estimates that enrollment in the efforts has dropped by 8,000 over the past two years.

California health insurance ambition narrows

Seeking to salvage two years of efforts to completely remake California's health insurance system, Gov. Arnold Schwarzenegger and Democratic legislators are nearing deals intended to rein in costly, meager medical insurance policies sold directly to individuals.

In the final weeks of the legislative session, they are negotiating measures that would limit insurer profits on California individual insurance plans, require plans to provide a minimum set of benefits and restrict insurers' ability to cancel policies retroactively.

The new focus reflects how far Schwarzenegger remains from his original healthcare goal: to orchestrate medical insurance for the 5 million Californians who lack it. Despite a year of strenuous campaigning for his vision, which garnered attention nationwide, the state Senate rejected that $14.9-billion plan in January.

Many of the concepts now under discussion were included in that proposal. Although most California insurers supported the governor's broader effort because it would have created millions of new customers, the industry is uniformly resisting the current push to circumscribe some of its most lucrative products.

Three million Californians buy health insurance on their own rather than through employers. Insurers keep health insurance premiums low -- and profits high, their critics say -- on some individual policies by limiting the services they cover. Such plans may exclude prescription drugs and maternity services, for example; others may cover only hospital visits.

Many of the policies have big deductibles and require patients to pay large portions of their expenses, costing them much more than coverage obtained at workplaces.

California Takes Another Crack at Insurance Reform

After a failed attempt to pass a universal health plan early this year, California is now looking to rein in the notoriously consumer-unfriendly market for California individual health insurance.

States face a Catch 22 when it comes to health policies that people buy on their own. Require plans to provide certain benefits or bar them from rejecting individuals for health insurance coverage, and the result will be that the insurance gets more expensive. Give insurers lots of latitude about who and what to cover, and cheaper plans are available — but often not for the older and sicker patients who need coverage most.

So California is trying a balancing act. A proposal being considered in the legislature would require insurers to cover physician services, hospital care and preventive services, and would set a maximum amount patients would have to pay each year toward their bills, the Los Angeles Times reports. State regulators would sort policies into categories based on the health care benefits they offer and establish minimum benefits for each category, presumably making them easier to compare.

But Gov. Arnold Schwarzenegger wants to limit it to categorizing plans and not order insurers to offer specific benefits. Daniel Zingale, the governor’s senior advisor on health, told the Times that although “we need to make the insurance market more user-friendly,” too many benefit requirements could lead to price changes for people who already have coverage.

Sen. Darrell Steinberg, the bill’s Democratic author, told the Times he was “always willing to consider compromise” but that he also would like “the bill to be meaningful to consumers.”

Other ideas being negotiated include limiting limit insurer profits on individual insurance plans and restricting insurers’ ability to cancel policies retroactively.

California Governor Signs Health Care Protection Bill

California Governor Arnold Schwarzenegger signed AB 1150 by Assemblymember Ted Lieu (D-Torrance) which bans health insurance companies from rewarding their employees for canceling or limiting a patient's health insurance. While the Governor signed AB 1150 because of the urgent need to protect consumers from unfair health care rescissions, he continues to believe that health care reform must be comprehensive.

To that end, he has proposed legislation that would be the building blocks of comprehensive health care reform and is working with the legislature on a joint solution that will protect consumers, control costs and promote prevention.

"Until we achieve comprehensive health care reform, stopping unfair health care rescissions is an urgently needed consumer protection," Governor Schwarzenegger said. "This terrible practice further illustrates the erosion of the California health care system and the need for comprehensive health care reform. Today we are standing up for consumers by putting an end to a deplorable practice, and I will continue working with my partners in the legislature to stop unfair health care rescissions once and for all."

The Governor's goal of comprehensive health care reform would make health care rescissions a problem of the past. The Governor's AB x1 1, the Health Care Security and Reduction Act, would have required that all Californians take responsibility for their health coverage while guaranteeing that no Californian is turned away from buying Calfiornia health insurance based on their age or medical history.

Insurance Cancellation Questions Could Spread Beyond California

Today’s Health Blog jargon of the day is rescission, the California insurance industry’s practice of revoking individual insurance policies because of health-related mistakes or omissions on the application for coverage.

The companies say this is a key step for fighting fraud, but they’ve come under criticism in California by those who accuse them of going over applications with a fine-tooth comb after members who’ve been enrolled for a while get sick or injured and start submitting claims.

Now it looks like the push-back against rescission may be spreading. Henry Waxman, a Democratic California Congressman, held a hearing on the subject yesterday and said his oversight committee plans to investigate the issue nationally.

“I understand that California insurance companies need to protect themselves from fraud,” Waxman said in his opening statement. But “insurers are using technicalities or trumped-up ‘misrepresentations’ to rescind policies after individuals get sick and accumulate hundreds of thousands of dollars in medical bills.”

The health insurance industry supports third-party review, established by the states, for rescission decisions, Stephanie Kanwit, special counsel to the trade group America’s Health Insurance Plans, said at yesterday’s hearing.

Kanwit said the practice is very rare. And, she said, collecting accurate information on applicants’ health history is essential for the insurance market to function. “When individuals wait until they are ill before purchasing health insurance, costs are increased for other policyholders who pay into the system on a regular basis,” she said.

Meanwhile, back in California, the industry’s rescission problems are rolling on. The state’s Anthem Blue Cross and Blue Shield yesterday agreed to pay the state $13 million in fines and to offer new coverage to more than 2,200 Californians the companies dropped after they became ill, the Los Angeles Times reports. As part of the agreement the companies didn’t admit wrongdoing.

And earlier this week, Los Angeles’ city attorney announced a lawsuit against Blue Shield over the rescission issue. The city attorney launched an investigation into the issue earlier this year, and has already filed lawsuits against a few other insurers.