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WEEKENDS IN THE NOONER: Yes, it was beautiful outside. I wouldn't have been inside reading either...
Happy Monday! Last week was definitely What a Week so what do we do now? Well, we start anew...
And, Sacramentans from all perspectives were saddened of the death of Stephon Clark one year ago today, although we may have taken different ideological paths in the year following.
At this hour, the Reverend Al Sharpton and others are on the Capitol steps marking the anniversary, while Assemblymember Dr. Shirley Weber is with Clark's fiancé in front of the Citizen Hotel to talk about Weber's AB 392 (joint authored by Sacramento's Kevin McCarty). AB 392 is sponsored by social justice organizations and sets a new legal individual criminal liability standard for police use of deadly force, while law enforcement supports SB 230 (Caballero), which focuses on training and resources.
So you can plan accordingly, tonight there is a march from 6-8pm starting at the Meadowview Sac RT station. CapPubRad's Nick Miller gives a rundown on today's events.
HOW THE DIALYSIS DEBATE AND THE "RESISTANCE" COME TOGETHER: Following a support campaign totaling $39 million (cmte A, cmte B) and opposition campaign reaching $111 million showdown on last November's ballot over the failed Proposition 8, Dialysis Wars 2019 begins anew tomorrow at 1:30pm in Assembly Health where AB 290 (Wood) is on the agenda.
This is a Nooner summary. It's a before dawn Monday morning write up on only the second cup of coffee and certainly doesn't get in to the intricacies of the complex subject involved. That's what committee analysis is for, so if you want more, read the work of the committee staff, which includes arguments in support and opposition.
AB 290 is a different issue than voters faced in Prop. 8, which would have established a profit cap of 15% for dialysis clinic operations. AB 290 instead goes after the alleged practice of third-party premium assistance for health insurance that persuades patients to use private insurers with higher reimbursement rates to the provider rather than use non-premium Medicare or Medi-Cal for which the patients may otherwise qualify.
To start, the public health care plans (Medicare/Medicaid--Medi-Cal) have the ability to set their own service rates because large-scale providers simply can't exclude that part of the market, even though the public health care plans would be considered by providers to be reimbursing "below market." Meanwhile, private insurers negotiate reimbursement rates for large-scale providers, while small-scale providers (private doctors offices and clinics) often are reimbursed based on a standard set rate for each service. In both of the private (negotiated or set schedule) circumstances, the reimbursement is above that of the public health care plans and the third party providers thus far prefer serving patients with private insurance.
Under this model, the providers (i.e. dialysis, substance abuse clinics) rely on a balance of public health plan patients with privately insured patients. The more of the latter, the greater the profit. That's been the model since the Great Society health care plans were created in 1965.
Fast forward to today. Prior to the Affordable Care Act of 2020 (ACA or "Obamacare"), private health insurance was largely out of reach for individuals of lower-to-middle incomes. However, the Affordable Care Act primarily aimed at getting access to the private insurance market for individuals who were not eligible for the public health care plans, by providing a public subsidy for the plans with a balancer to those plans through an individual coverage mandate.
The practice of providers providing third-party (insurer) premium service directly or through nonprofit organizations to encourage patients to join the ACA exchanges where private insurance was made financially possible because of the public subsidy of exchange plans. This is true of both those who previously didn't have access through an employer, financially on the individual markets, or on the public health care plans.
Meanwhile, after the ACA was implemented, the Centers for Medicare and Medicaid Services (CMS) discovered the practice of financially interested parties providing premium assistance and found they posed certain risks to patients, such as short-term subsidies for a plan on a health care exchange when the ACA model is based on an annual premium "subscription." It thus promulgated regulations in December 2016 that would not prohibit the practice of premium subsidy, but rather require certain actions if such payments were made, such as the requirement of payment for a full plan or policy year and patient disclosures.
The dialysis companies filed suit against the Department of Health and Human Services/CMS alleging that the HHS/CMS violated the Administrative Procedures Act and the Medicare Act and a federal issued a preliminary injunction. Obviously, the federal Administration changed in the meantime and it is considered unlikely the current Administration will proceed with the federal rules.
AB 290 largely reflects a state-level version of the federal rules.
So, take the labor fights with dialysis from last session that culminated in a $150 million ballot measure fight in Prop. 10 and add to it the desire of the Legislature to fight back against the deregulation agenda of the Trump Administration. From my read, that's what we have with AB 290.
In favor of the bill are Health Access, labor, and the insurance companies. In opposition are providers including the dialysis companies, the California Medical Association and local medical societies, several business organizations, and some nonprofits that have also been intermediaries of the premium assistance programs.
Again, this is an oversimplification and is already too long. This is my attempt to write a Playbill summary, but don't assume you know the deets of the play until Act III concludes as Puck delivers a soliloquy. The curtain rises at 1:30 pm tomorrow in Room 4202. The bill is authored by the committee chair, Jim Wood (D-Healdsburg), so expect it to pass. However, the true fight on this bill won't be found in committee rooms but rather back rooms.
A similar bill--SB 1156 (Leyva)--was vetoed by Jerry Brown last year. The voters have said 40.1%-59.9% in November to slam down Prop. 8, but that was a very different concept than found in SB 1156 or AB 290. That said, the dialysis industry is using the same general ad campaign featuring dialysis patients and will cast votes for AB 290 as votes against those who rely on dialysis to live.
We saw last session that there were votes for it to pass (with a few GOP votes), Democrats have even bigger majorities, and there is a new sheriff in town. That said, like the death penalty issue I wrote about Friday, do voters understand nuances of the votes of their local legislators?
"GRANDILOQUENT" NEWSOM: Do you know what that word means? I certainly don't, but fortunately had parents that spend millions to get me in to USC. Not really, I went to community college, and have never found the need to use that word, but Dan Walters uses it in the first graf of today's column. Fortunately, we have Alexa.
Me: "Alexa, define grandiloquent."
We learn something new everyday. I think I could have figured that out on a multiple choice.
Anyway, Walters writes:
"Newsom has set himself apart from Brown on several high-profile issues, and this is another. His gay marriage gesture in 2004 turned out to be a political plus, especially after the U.S. Supreme Court agreed. Morality aside, this is another political gamble."
VOTER'S CHOICE ACT: In the Chron, John Wildermuth looks at the slow adoption of counties to the Voter's Choice Act system of mostly all-mail/drop-off voting. (One note, an additional county, Fresno, has added to those listed in the article.
More and #CAKEDAY after the jump . . .
PENSIONS: Ed Mendel takes a look at the dual pension-reform legal tales of San Diego and San José.
PRIVATE COMMUNITY LENDING: In the Los Angeles Times, Frank Shyong looks at how minority communities have created their own lending networks, a story that has long interested me, particularly how the doughnut shops in SoCal largely became Cambodian-owned and operated.
"The lending circles are especially prevalent in the Cambodian community, where many people don’t use banks because of language barriers and a distrust of institutions caused by genocide and economic instability in the aftermath of the Vietnam War.
In Los Angeles, diverse neighborhoods probably wouldn’t exist today without ROSCAs, which are most often run by women. When banks wouldn’t lend to minorities, the kye helped Koreatown business owners cluster in central Los Angeles. The hui helped finance Chinatown, and tanomoshis helped start some of Little Tokyo’s early businesses."
#CAKEDAY: Happy birthday to Assemblymember Ken Cooley, Senate Minority Leader Shannon Grove, and Joe Mathews!
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