Saturday, July 8, 2023

CA Proposals Analysis from Kip Sullivan

Kip 5:05 AM (2 hours ago) to GreatNorthernHealth Thanks for posting this article, Craig. The split within the CA single-payer movement is serious. The damage done to relations between the parties could be long lasting, and the bill that split the movement -- SB 770 -- will (if it passes) inflict some harm on the CA Nurses Association's single-payer bill. With a little luck, the harm will consist only of a delay of one biennium (2023-2024) while the legislature discusses SB 770, enacts it, and awaits a report due June 1, 2024 before taking further action on CNA's single-payer bill. But it's possible SB 770 will inflict harm far greater than a mere delay. SB 770 could give Gov Newsom and legislators who oppose CNA's single-payer bill an excuse to oppose single-payer legislation indefinitely and to support multiple-payer legislation and/or incremental reforms that further entrench and further complicate the existing system (such as the retrograde Health Care Affordability Board which held its first meeting last March). I'll write a brief summary of SB 770 here and offer more details if readers on this list are interested. As you read my description of SB 770, ask yourself, Do you think it would be a good idea for single-payer groups in MN to introduce SB 770 in the next session of the MN legislature? To hear SB 770 proponents in CA tell it, the answer is yes, SB 770 "complements" CNA's single-payer bill and would definitely "complement" the MN Health Plan, the name of the single-payer bill we support here in MN. We will know in less than a year whether the claims made for SB 770 (some of which are extravagant) were true. Although SB 770 is a short bill (it's six pages long), it is difficult to explain it. It's difficult to explain because it is so abstract and opaque (the cryptic phrase "unified financing" is the leading example of opaque language), and because it requires the Secretary of CA's Health and Human Services Department (HHS) to accomplish something he probably can't accomplish until the CA legislature enacts CNA's single-payer bill. SB 770 is opaque SB 770 does two things: (1) It authorizes the CA HHS Secretary, Dr. Mark Ghaly, to "pursue waiver discussions with the federal government with the objective of a unified health care financing system...." and (2) it creates a "work group" the purpose of which is to "undertake a program of stakeholder engagement at sites across the state to address issues including, but not limited to, the specifics of the transition to a unified health care financing system...." SB770 | California 2023-2024 | Health care: unified health care financing. | TrackBill In just these two sentences (which are the most important because they contain the instructions to the executive branch) we encounter "waiver discussion," "unified financing," and "program of stakeholder engagement," and yet nowhere in the bill are these terms defined. The term "unified financing" is the most worrisome. It was concocted by a commission created by the CA legislature in 2019 called the Healthy CA for All Commission. For reasons the commission didn't explain, it adopted the squishy label "unified financing" to refer to both multiple-payer and single-payer systems. Can any of you give me a good reason why Health Care for All MN and MN PNHP should introduce a bill in the MN legislature that adopts the commission's squishy label? "Unified financing" appears 10 times in SB 770, "single payer" only once. Why? Dr. Ghaly probably cannot do what SB 770 asks him to do Federal law requires states that seek to enact single-payer legislation to apply to the federal government (the Centers for Medicare and Medicaid Services) for waivers from provisions in the Affordable Care Act (for example, the provision requiring Minnesota to run an "exchange" where people can buy health insurance from insurance companies), and before doing so, to enact the single-payer law for which they seek a waiver. CA, obviously, has not enacted a single-payer bill yet. When SB 770 proponents are asked why they are proposing that Dr. Ghaly talk to CMS about a waiver before CA enacts a single-payer bill, they reply that states can extract useful information from CMS even before states enact single-payer bills. This is such a novel proposition, and the laws governing waivers for state universal-coverage laws are so complex, that I'm reluctant to say it's completely bogus. CMS states on its website that states are welcome to approach CMS with "draft legislation" to discuss what to put in their waiver application. But SB 770 proponents can't even point to "draft legislation." I have asked several SB 770 proponents if they can name one question Dr. Ghaly could ask CMS during "waiver negotiations" that CMS can answer, in the absence of an enacted law or draft legislation, that isn't already available in federal law and regulations? I get no answers. SB 770 proponents have stated, for example, that Ghaly should be able to get CMS to tell him how much Medicare and Medicaid funds CA will get over an unspecified length of time for the never-defined "unified financing" system. Isn't it likely CMS will ask Ghaly to see a "draft" bill? Seems to me the answer is yes. If that happens, what will Ghaly do? Write up both a single-payer and a multiple-payer bill? Just a multiple-payer bill? It seems likely to me that Ghalys final report to the CA legislature 11 months from now will say something like, "CMS couldn't give us a firm estimate of the Medicare and Medicaid funds CA will get until we pass a single-payer bill. My best guess is x dollars." We shall see. SB 770 is rapidly approaching enactment. Ghaly will have to begin "negotiations" with CMS about one or more "unified financing" waivers soon, and complete his work by May 2024 in order to file a report with the CA legislature by June 1, 2024. We will know soon whether other states can accelerate the progress of single-payer legislation with a bill like SB 770, or whether bills like SB 770 merely pave the way for delay or worse. Kip Sullivan On 2023-07-06 10:15, Craig Brooks wrote: " Another main concern for the nurses union is the language used in the commission's report and Wiener's bill. "Unified financing does not equal single payer," Comsti said. She argued that if "unified financing" includes programs that leave room for health insurers or any middlemen to profit, then that essentially goes against the single-payer system they're seeking. " Craig

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