Tag Archive: Gov. Jerry Brown

Burgeoning enrollment in California’s Medicaid program raises tensions between administration, lawmakers over access to care, provider reimbursement rates

California Gov. Jerry Brown took a cautious approach on expanding Medicaid eligibility under the Patient Protection and Affordable Care Act. It was well into 2013 and not long before the start of the new fiscal year (July 1) and the October 1, 2013 launch of open enrollment in that state’s exchange marketplace, Covered California, before Brown approved legislation authorizing the Medicaid expansion. Even though the federal government would initially be covering most of the cost of the expansion, Brown was concerned about the overall growth of the state’s Medicaid program, Medi-Cal.

With good reason. Kim Belshé, who served as Health & Human Services Agency secretary in the previous administration of Gov. Arnold Schwarzenegger, warned in 2009 that even with a $10 billion infusion of supplemental federal cost share funding provided by the American Recovery and Reinvestment Act of 2009, “California cannot afford the Medicaid program as currently structured and governed by federal rules and requirements.” In other words, it’s a budget buster.

In 2013, Brown was at odds with his fellow Democrats in the Legislature who wanted to increase reimbursement rates paid to medical providers unhappy with low reimbursement rates. Since providers can opt not to accept Medi-Cal, they argued, it’s critical that they have sufficient incentive to do so to allow Medi-Cal enrollees adequate access to health care. Brown didn’t go along with boosting provider reimbursement rates that year, reasoning the state was still on the road to recovering its fiscal health after tax revenues were severely crimped in the 2008-09 recession.

Now two years later, Medi-Cal enrollment has jumped to more than 12 million, covering nearly 1 in 3 Californians and following the pattern seen in other states where Medicaid enrollments are outpacing by 2 to 1 sign ups for subsidized commercial health plans sold though state health benefit exchanges. The burgeoning enrollment has heightened the pre-existing tensions between Brown and legislative Democrats over increasing Medi-Cal provider reimbursement rates, as the Los Angeles Times reports in this story on two measures that would reverse the recession-era cuts in provider reimbursement rates.

As The Times reports, those tensions surfaced in this blunt exchange between the chair of the Senate Health Committee, Ed Hernandez (D-West Covina), and Jennifer Kent, director of the state Department of Health Care Services, at a hearing this week. Hernandez asked Kent to respond directly as to whether Medi-Cal patients have the same access to doctors as presumably more affluent Silicon Valley workers covered by commercial health plans.

“Yes or no?” he said.

“Yes,” Kent said.

“I don’t think so,” Hernandez replied.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

California readies strategies to address rising unfunded health care costs of retired state workers

The Los Angeles Times reports California Gov. Jerry Brown plans to address the growing unfunded liability of health care for retired state workers when he releases his 2015-16 fiscal year budget in January. That comes on the heels of a report by California State Controller John Chiang showing the unfunded liability of providing health and dental benefits for retired state workers is $71.8 billion, up $7.2 billion from $64.6 billion as of June 30, 2013. An actuarial study accompanying the report found retirees are living longer than expected, thereby imposing higher than expected liability on the state, which pays these costs as they are incurred.

State and local governments are concerned over burgeoning retiree health costs as they work to regain their financial footing following the sharp economic downturn of the previous decade. Two articles last year by Bloomberg and Governing magazine discuss a cost control strategy of directing retirees who don’t yet qualify for Medicare to state health benefit exchanges where many public pensioners would qualify for federal tax subsidies. This could represent a sizable portion of retirees since many public sector workers retire well before they turn 65 and become eligible for Medicare, often in their early 50s.

There is no indication that the strategy has widely caught on or that it is under consideration by Brown, a fiscal conservative who has been a strong supporter of California’s state-run exchange. If Brown were to propose the idea in his 2015 draft budget, it would likely generate strong resistance from California’s politically powerful state employee unions.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Jump in Medi-Cal enrollment will consume most of California’s tax windfall » Ventura County Star

Jump in Medi-Cal enrollment will consume most of state’s tax windfall » Ventura County Star.

The Ventura County Star’s Timm Herdt reports the majority of higher than projected tax receipts is being directed by the administration of Gov. Jerry Brown to cover also higher than expected enrollment in the state’s Medicaid program, Medi-Cal.

One year ago, Brown delayed approving legislation that expanded Medicaid eligibility under the Patient Protection and Affordable Care Act, concerned over the fiscal impact of a program the prior administration of Gov. Arnold Schwarzenegger deemed a budget buster during the recession.

With a staggering 3 in 10 Californians reliant on the public health insurance program, Medi-Cal continues to be a budget threat. Only this time, a revenue windfall staved off a shortfall for upcoming fiscal year that begins July 1.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Schedule control: Real cultural change toward achieving a healthier California

California, which once basked in the suntanned imagery of youthful vigor and health and fitness recognizes the shine has faded as its population grows older and more sedentary and obese, spawning an unprecedented increase in chronic, preventable disease.  Earlier this year, the administration of Gov. Jerry Brown formed a task force with the vision of restoring the Golden State to the healthiest in the nation by 2022.  This week, the Let’s Get Healthy California Task Force released a draft report outlining how the state will achieve that vision based on six goals and associated priorities and health indicators.

Brown and his Health and Human Services Agency Secretary Diana Dooley – who also chairs Covered California, the state’s health benefit exchange — are to be commended for initiating and championing this monumental project.  When it comes to something as big as improving the health status of the nation’s most populous state, one of the task force’s members, Dave Regan, president of Service Employees International Union – United Healthcare Workers West, clearly understands what’s needed to generate the enormous momentum to counter the sickly, sedentary status quo.  Here’s what he said with the release of the draft report as reported by the California HealthCare Foundation’s California Healthline:

There’s lots and lots of good stuff in here. What I’m thinking about is what’s not in here,” said Dave Regan, president of Service Employees International Union. “I keep going back to two things — 80% of what drives health care costs is behavioral, and only 20% of the cost of health care can be affected by what we do today.”

Regan said there needs to be a bigger change, a cultural change, to affect some of the root causes of rising health care costs and poor health of Californians.

“When you look at the goals and indicators in here, we may have a forest-and-trees effect. The behavioral culture is far more influential than all of us nibbling at the margins. … Unless we change the behaviors of millions of people, then we’re just tilting at windmills.”

Regan’s exactly right.  And he need look no further than the state workforce – a large portion represented by his union –  to see a glaring example of a subsection of the bigger California health problem.  These thousands of state employees need to get out of their offices and cubicles and exercise more.  Especially as they drive up the cost of providing them health care with one third driven by chronic conditions and raise serious questions as to whether the state will be able to afford to provide them health coverage in retirement.

But they are held prisoner by a rigid, outmoded Industrial Age work culture that requires them to be at the desks from 8 to 5, Monday through Friday.  Most could shift their work outside this fixed time frame and location, thanks to today’s information and communications technology — much of it innovated in California — that makes it easily possible for them to do their jobs in a home office or other locations where they can be productive.

This “work shifting” is an essential cultural change that Regan correctly says is needed because it affords people control over their daily schedules and frees up hours each week of wasted commuting time.  A 2011 University of Minnesota study found when people are afforded control over when and where they perform their jobs, they got more sleep and exercise.  Schedule control is thus a potentially powerful cultural shift because it enables healthy living – a goal identified in the task force report – and makes it easier for people to adopt healthier lifestyle choices.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Nearly one third of California state worker health care costs attributable to preventable chronic conditions

An Urban Institute Health Policy Center study released this week commissioned by the California State Controller’s Office found nearly 30 percent of health care expenditures for California state workers in 2008 were attributable to lifestyle-related chronic conditions such as diabetes, heart disease and hypertension. Ironically, the study determined, state entities with the highest percentages of employees with these preventable conditions staffed health-related departments including the Department of Health Care Services and the Department of Public Health. According to this Sacramento Bee story, the latter department will pilot a workplace wellness program that was kicked off in a ceremony emceed by television personality Dr. Mehmet Oz.  Later in the week, Gov. Jerry Brown, noting preventable and chronic health conditions account for 80 percent of the Golden State’s healthcare expenditures, ordered the state’s Health and Human Services Agency to create a task force to develop a 10-year plan for improving the health of Californians.

California is to be commended in recognizing that some form of intervention is required to bring down medical utilization costs among its workers where a degree of choice and control can be exercised. The California Public Employees Retirement System (CalPERS), is one of the nation’s biggest purchasers of health benefits, so whatever the state does to demonstrably bend the cost curve is likely to serve as a national model for public and private employers as well as payers and providers as an emerging accountable care paradigm begins to take root.

However, state officials should give thoughtful consideration to how this intervention is framed and executed if it is to have more than symbolic value and actually reduce medical expenditures.  “Workplace wellness” is a misnomer insofar as the lifestyle choices that can exacerbate — and prevent — chronic conditions are made mostly outside of the workplace and involve personal decisions concerning exercise, meals and sleep.  Moreover, a 2011 survey of employers found mixed results among those that adopted workplace wellness programs in terms of tangibly improving the health status of employees.

Instead of “workplace wellness,” the focus should be simply on wellness. It should treat employees like adults and give them the freedom to make the personal lifestyle choices they and their medical providers believe can best improve and preserve their health and fitness.  Confining employees to a cubicle for set work hours 40 hours a week and adding on more sedentary time spent commuting to and from that cubicle is hardly a health promoting activity. It robs workers of valuable time that could be spent on activities that enhance health, particularly sustained exercise. Nor is it necessary since Information and Communications Technology (ICT) has matured to the point state employees who are mostly knowledge and information workers can do their jobs from a home office or wherever else they can concentrate and be productive.

On this point, California’s pilot employee wellness program should incorporate a Results Only Work Environment (ROWE).  A ROWE values getting the work done over daily office attendance. Early indications are that workplaces that adopt ROWE can achieve better health status. A University of Minnesota study issued in December 2011 found workers in a ROWE realized increased health-related behaviors of more sleep and exercise — behaviors that can go a long way toward maintaining health and reducing medical utilization.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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