A few weeks ago, we asked several Orange County insurance brokers, managed healthcare executives and others for their thoughts about health reform plans floating in Sacramento.
The competing plans from Gov. Arnold Schwarzenegger and the Democratic leaders of the Legislature prompted more comment than we were able to fit in our recent Healthcare special report.
Here are some of the other views we got.
Paul Keckley, executive director of the Deloitte Center for Healthcare Solutions, a unit of Deloitte & Touche, called Schwarzenegger’s proposal “among the most far-reaching of any plan offered in the U.S.”
Schwarzenegger’s plan could come to the Legislature once lawmakers finally sign off on a state budget. Provisions include a tax on physicians and hospitals “that benefit from payments by previously uninsured patients,” Keckley said.
There’s also a requirement that health insurance companies spend at least 85% of their premiums on health services. It also includes some elements of other plans, including an employer healthcare mandate for businesses with 10 or more workers.
It differs from the Democratic plan in one key point,the governor’s plan requires an individual mandate requiring all people to carry health coverage, either through an insurer or the state.
The notion of “shared responsibility” is a key one for businesses because they fear the costs of reform could be prohibitive if there’s not a large group of people to spread insurance risks among.
The governor’s Stay Healthy California reform effort is an opportunity and a threat to health insurers, according to Keckley.
The opportunity, he said, lies in expanding health services to an estimated additional 4 million Californians who might enroll in the plan, as well as potential for higher enrollment in individual and small-group health plans.
On the flip side, Keckley said Stay Healthy California includes a pair of possible threats,the 85% spending mandate, which he said “will inevitably reduce operating margins and profits for plans accustomed to administrative costs above 20%.”
Another threat comes from the doctor and hospital tax, which he said could add to “the already tense relationship with” plan operators.
Stay Healthy California still is in its infancy and changes are likely, Keckley said.
Denise Rodriguez, a Los Angeles-based Foley & Lardner partner who represents hospitals and other providers serving needy Californians, said there were some “critical issues” that need to be worked out if coverage expansion is going to work.
Those issues, according to Rodriguez:
– Improved access to treatment, including adequate payments for high-cost specialty services like trauma and burn care.
– Making sure premiums were affordable for families and individuals.
– Adequate funding to pay for healthcare services for those who remain uninsured.
– And “finally, in light of the state’s diverse population, a reformed healthcare system must assure the availability of linguistically competent and culturally sensitive services,” she said.
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Garden Grove Hospital: labor talks broke down early this month |
Tenet Shrugs Off Rally
Workers at Garden Grove Hospital and Medical Center, one of five local hospitals owned by Dallas-based Tenet Healthcare Corp., rallied earlier this month to call attention to claims of understaffing and a lack of supplies.
SEIU-United Healthcare Workers West and SEIU Local 121RN staged the rally.
The union and Tenet have been negotiating for a contract, but talks broke down at the start of August. The union represents about 7,000 California Tenet hospital employees who were unionized through a master deal covering 14 hospitals back in 2003.
Tenet dismissed the action. Through a spokesman, the company called the rally a negotiating tactic.
Bits and Pieces:
Valeant Pharmaceuticals International, the Aliso Viejo drug maker, made a $500,000 milestone payment to Ardea Biosciences Inc., a partner based in Carlsbad. Valeant and Ardea are working on compounds to treat neurological disorders Veterinary Pet Insurance Inc. of Brea named Kenneth Watkins, a former PacifiCare Behavioral Health official, as its chief financial officer. Separately, Veterinary Pet said it’s offering preventive care plans for its California customers. Veterinary Pet said the plans will roll out nationwide in the next 18 months Masimo Corp., an Irvine device maker, said it received Food and Drug Administration clearance for additional neonatal usage for its Rainbow SET oxygen measuring technology. Regulators cleared Masimo for measuring oxygen in newborn babies Hoag Memorial Presbyterian Hospital in Newport Beach said it received a grant from Irvine heart device maker Edwards Lifesciences Corp. that it will use to provide free heart valve screenings for seniors Nexgen Pharma Inc. of Irvine bought assets of Chemins Co. in Colorado Springs, Colo., including 250,000 square feet of manufacturing, laboratory and warehouse and distribution space.
