Today is

Policy Updates for City/Local, State, and Federal.

Policy Updates: City/Local

1. KQED Documentary on the Bay Area’s Working Uninsured (Featuring SFCCC Clinics) to Air on October 27; 7:30 – 8 pm; Channel 9

With Robert Wood Johnson Foundation Sound Partners funding, SFCCC worked with KQED, other advocates and other providers to produce a documentary on the Bay Area’s working uninsured population. A key point of the documentary is that anyone can become uninsured with disastrous consequences for both health and finances. The half hour documentary features film footage in three SFCCC partner clinics. Dr. Ana Valdes (St. Anthony’s Free Medical Clinic) is extensively interviewed on camera.

The documentary will be previewed at the October 12 Board meeting.

2. California Pacific Medical Center (CPMC) Will Present a Check for $2 Million to SFCCC for Primary and Specialty Care Support to Health Disparities Communities in SF at An Event on November 17; 10 am – Noon; St. Anthony’s Foundation

The check presentation by Dr. Martin Brotman (CEO of CPMC) will be followed by a reception with finger foods. All SFCCC partner clinics staff are welcome and urged to attend this celebration of a new partnership for SF’s safety net. If you are planning to attend, please RSVP to the 415 355-2263.

Please contact Dick Hodgson at 415 355-2230 for further information.

3. The SFCCC/ DPH Referrals MOU Has Been Routed to SFGH Administration for Review and Comment; Revisions Based on Comments at the Last SFCCC Board Meeting Have Been Included in the Draft Sent Forward

The MOU was revised to clarify that SFGH will provide care to patients requiring urgent care and will not refer such patients to SFCCC partner health centers. The MOU was also revised to a call for SFGH to work with SFCCC to find ways to increase access to specialty care for SFCCC clinic patients – particularly those having a high-priority need for referral.

It has been suggested that the SFCCC Medical Directors Committee identify a roster of patient conditions that would preclude referral to SFCCC clinics (until the urgent care need is addressed and the patient stabilized for continuing primary care). This will be discussed at the October 12 Board meeting.

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Policy Updates: State

1. SFCCC Board Considering Revising Position on Prop 79; Summary of SFCCC Positions on Initiatives on Special Election Ballot Below

SFCCC believes that no City initiatives will have an impact on clinics and their clients. Four State initiatives could have an impact. The four initiatives (and SFCCC recommended positions) are:

• Prop 73 – Requirement for providers to notify parents of un-emancipated children seeking an abortion and to delay the procedure (OPPOSE)
• Prop 76 – “Live Within Our Means” Act; an initiative that would set caps on State spending and give the Governor authority to unilaterally cut spending in mid-year without the Legislature’s concurrence (OPPOSE);
• Prop 78 - An initiative that would ask drug makers to voluntarily provide discounts to Californians under 300% FPL (an industry plan similar to the Governor’s proposed California Rx program) (NEUTRAL);
• Prop 79 - A measure to require pharmaceutical manufacturers to provide discounts to Californians with incomes less than 400% FPL or face exclusion from Medi-Cal (Health Access backs this one) (STAFF RECOMMENDS SUPPORT)

Prop 73 - SFCCC recommends OPPOSE

Prop 76 – OPPOSE: If passed, the Governor could unilaterally reduce State health program funding and negatively impact clinics and their clients.

Prop 78 (NEUTRAL)/ Prop 79 (SUPPORT) - Both campaigns have contacted SFCCC seeking our support. CPCA has taken a neutral position because of the confusion presented by two such similar proposals on the ballot and the desire to focus pharmacy access efforts on maximizing 340b pricing for all safety net clinics in California. SFCCC staff recommends support of Prop 79 – pharmacy companies contracting with Medi-Cal for very large amounts of money should have an enforceable policy regarding providing discounted drugs to low-income Californians.

2. CPCA Will Carry Forward Proposal for $50 Million for Clinic Information Technology Development – the Funding to be Associated With $9.2 Billion Proposed Merger of United Health and Pacificare

Insurance Commissioner Garamendi asked CPCA to more fully document the clinics’ needs for inclusion of this funding in the merger discussion. This documentation is in process. As noted last month, new insurance company mergers are not currently being well received by the public because of concerns about increased premium costs resulting from reduced competition.

The bill releasing the $35 million for clinics from the last merger is on the Governor’s desk for signature. Hopefully, that funding – for capital projects – will soon be released through an RFP process similar to the Cedillo-Alarcon capital projects process.

3. CPCA To Submit Health Coverage Initiative Proposal to Tap in to $180 Million for New Health Coverage under California’s Medi-Cal Waiver Agreement with
Federal CMMS

At its October 17 meeting, the CPCA Board will consider options for submitting a health coverage proposal under the Governor’s agreement on Medi-Cal restructuring with CMMS. A large part of the agreement focuses on revising the way Disproportionate Share Hospitals (DSH) – hospitals with higher percentages of Medi-Cal and under-reimbursed patients – are paid by Medi-Cal. Another part of the agreement, however, requires the State to put forward an initiative to cover more uninsured Californians. The initiative does not require the provision of comprehensive services nor does it require all uninsured Californians to be covered. CPCA’s proposal will be one of several that is considered by the Administration and Legislature.

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Policy Updates: Federal

1. Despite Katrina and Rita Recovery Large Projected Medicaid Costs, Congess is Expected to Pursue Budget Reconciliation in October That Could Cut $10 Billion from Medicaid

The FY 2006 budget resolution calls for $35 billion in spending reductions. To achieve this, Congress began the budget reconciliation process, which involves crafting packages of tax and spending cuts, including reductions to Medicaid and other entitlement programs. The Senate Finance Committee was charged with finding $10 billion in reductions from the Medicaid program over five years. The tremendous impact of Hurricanes Katrina and Rita caused Congress to delay the reconciliation process in order to focus on disaster relief and recovery. However, all indications are that a reconciliation bill with cuts will be considered by Congress in October.

2. Republican Study Committee Proposes Freezing Community Health Centers Funding for Ten Years to Offset Hurricane Recovery Costs

The Republican Study Committee (made up of over 100 House Republicans) recently released a lengthy list of proposed government spending reductions to offset hurricane recovery costs. The document included proposals to block grant the Medicaid program and delay the implementation of the Medicare prescription drug benefit (Part D) for one year, among many others. Also included was a proposal to freeze federal health center funding for 10 years, suggesting that increases for community health centers should be funded by state and local governments.

Alternative Democratic proposals are being developed suggesting that costs for the war in Iraq could be cut to offset hurricane expenses. SFCCC will strenuously oppose the health center funding freeze proposals, block-granting or any other proposal that harms health center Medi-Cal clients. The needs of health center clients throughout the country will not be reduced because of the Katrina relief expenses. The federal government could look at reducing administrative and prescription pharmacy costs to offset Katrina expenses.

3. Medicare Prescription Drug Benefit to (Potentially) Go Into Effect January 2006

The new Medicare voluntary outpatient prescription drug benefit (Part D) will go into effect on January 1, 2006 (unless delayed per 2. above). All Medicare beneficiaries will be eligible for this new service, which is designed to lower the cost of prescription drugs for most senior and disabled beneficiaries. People on Medicare will have to sign up for a Medicare prescription drug plan to receive the benefit, and the various drug plans will provide a wide array of options. Low-income beneficiaries should sign up for the Low Income Subsidy (LIS). Beneficiaries can sign up for the drug benefit beginning Nov. 15. For more information, please see the California HealthCare Foundation (www.chcf.org) or the Centers for Medicare and Medicaid Services (www.medicare.gov.)

4. Health Center and Ryan White CARE Acts Up for Reauthorization in 2006

In 2002, Congress reauthorized the Federal Health Centers Program and most importantly, reauthorized and reconfirmed the core statutory requirements of the program (located in an underserved community, make services available without regard to ability to pay, provide comprehensive primary health care services, be governed by a board of directors a majority of whose members are patients of the health center). The Health Centers Authority expires on September 30, 2006 and, technically, will require reauthorization next year. The Ryan White CARE Act – which funds a broad range of services for HIV/ AIDS – is also up for reauthorization in 2006.

Congress, however, separates reauthorization from appropriations. It is possible for a program to continue for several years without reauthorization provided that appropriations are made to continue it. In some cases – where reauthorization might negatively change the program – it is advantageous to pursue appropriations as a higher priority than reauthorization. Because of other pressing Congressional priorities, both health center and Ryan White CARE reauthorization could be delayed.

Please call or email Dick Hodgson at (415) 355-2230 or rhodgson@sfccc.org -- if you have questions or need additional information.

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