During a Senate subcommittee review of a number of state health care proposals yesterday, one theme seemed to stand out: People are unhappy with them.
The budget subcommittee on Health and Human Services heard proposals by the Department of Health Care Services to cut health plan rate reimbursement for Healthy Families' children by 25%. In addition, DHCS intends to move 900,000 children from that program into Medi-Cal managed care. The committee also heard from a long parade of people who opposed those proposals.
After all the testimony and acrimony, subcommittee chair Mark DeSaulnier (D-Concord) didn't quite know what to say.
"Well, Mr. Douglas," he finally said wryly to DHCS director Toby Douglas, "congratulations, at least, on your efforts to stimulate discussion."
Much of the controversy revolves around the state's effort to shift care for almost a million children in Healthy Families, California's federally subsidized Children's Health Insurance Program run by the Managed Risk Medical Insurance Board. DHCS wants to shift those children into Medi-Cal managed care, which has a lower reimbursement rate.
Most of the opposition centered on disruption in the continuity of care for those children, and the possibility that many of those children will have to find new providers.
"We oppose this proposal, and we're particularly concerned about those children in Kaiser care," according to Jessica Rothhaar of PICO California (the organization formerly known as Pacific Institute for Community Organizations). "Also in any areas currently without managed care, where children would have to change doctors."
Rothhaar said trying to transition 900,000 children all at once is problematic.
A different plan outlined by the Urban Institute won support in a recent report from the state legislative Analyst's Office. The Institute recommended more of a phased-in approach, with a smaller group of more-easily-transitioned children going first, what it called the Bright Line children.
"We are very concerned about continuity of care and access to care," Teresa Stark of Kaiser Permanente said. "When you look at this through the lens of health care reform, there are many options available. And Medi-Cal is only one of them."
"I would say that 900,000 kids is a big concern," Randy Perry of the California Children's Hospital Association said. "And care could be compromised for a lot of these kids."
Nick Louizos, representing the California Association of Health Plans, said he didn't know how health plans could continue to provide the same services with a 25% cut in rates.
"The rate cut is just massive in its scope," Louizos said. "It's not reasonable to think health plans could just absorb this."
The subcommittee left all the matters open without any kind of decision. DeSaulnier said discussion will continue through the spring.
"This [Healthy Families] program is one that's been very successful, so I have a great deal of apprehension about [changing] it," DeSaulnier said. "We will leave it open and take it up again in May."