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- Written by: Lake County News Reports
Savings from the months’ long deferral of medical care and treatment for ailments unrelated to COVID-19 has resulted in record net profits this year for health insurance companies and specialized health insurance companies, such as dental insurance plans.
“Health insurance companies are seeing record net profits this year due to lower policy benefit use, so I am urging they return some of those profits back to consumers, families, and businesses that they insure, many of whom are struggling financially due to COVID-19,” said Commissioner Lara. “As the regulator of the largest insurance market in the nation, it is my duty to make sure consumers are protected and insurance companies remain solvent.”
He added, “I am doing all within my authority to strike that delicate balance but, right now, the scales are not balanced for consumers and businesses with health insurance. With this notice, I am expecting health insurance companies to help contribute back to the recovery of services by businesses and get money back into the hands of consumers when they need it the most.”
The notice asks health insurance companies to provide premium refunds on either the November 2020 or December 2020 consumer statements in the form of a refund, credit, premium reduction or other adjustment.
Specialized health insurance policies, such as dental insurance, that have a maximum annual benefit may also comply with this request by increasing the 2021 annual benefit by a percentage equal to the period during which covered services were not available during 2020.
For example, as dental practices were essentially closed for a quarter of calendar year 2020, the 2021 maximum benefit would be increased by at least 25 percent.
The department has already worked with two health insurance companies who proactively sought to provide premium credits to their policy and certificate holders in the individual and group markets, returning between 5 percent and 15 percent of policyholders’ July 2020 premium.
Two other health insurance companies are currently working with the department in considering such credits as well.
This notice is the latest in a long list of consumer protection actions that Commissioner Lara has taken since the beginning of the COVID-19 pandemic, including previous orders similarly directing insurance companies to provide premium relief for automobile insurance and commercial liability policies to reflect the lower risk that policyholders are experiencing in the current COVID-19 landscape, which has thus far resulted in more than $1.2 billion in premium relief and reduced future premiums for California consumers and businesses.
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- Written by: Rural Association of Northern California Health Officers
In spite of the well-established safety and efficacy of the influenza (“flu”) vaccine, too few people get vaccinated each year. This is true even in challenging work environments such as face to face educational settings and healthcare facilities.
The evidence supporting universal influenza vaccination is overwhelming and in other parts of the world where vaccination is widely accepted by the populace, there are fewer influenza
cases, hospitalizations and deaths.
RANCHO feels it is important to bring to everyone’s attention the critical need for vaccination this fall among area residents and especially among healthcare workers and school staff. While we always recommend that all members of the public get flu vaccination annually, this fall in particular we are most concerned about these particular groups.
Since early reopening this summer and fall, schools and colleges around the nation have
seen significant transmission of coronavirus. Healthcare workers are at increased risk of acquiring and transmitting both influenza and coronavirus, and some of our most distressing coronavirus outbreaks have occurred in healthcare settings.
We recognize that these same settings are historically places where influenza is easily transmitted as well. We also recognize that with COVID-19 prevention measures in place, it is possible that we will see a reduction in influenza cases compared to previous years,” the group said.
The flu season in Australia this summer, for example, was mild but it is important to point out that this success was likely attributable to both a vigorous campaign to raise vaccination rates and implementation of COVID-19 prevention measures.
The combination of influenza and coronavirus circulating at the same time this year will not only make diagnosis challenging (since the two have similar symptoms) and increase demands on testing, but it will likely threaten our healthcare system’s capacity to provide care for everyone who needs it, when they need it.
Reducing flu cases as much as possible makes diagnosis easier, and preserves the ability to continue to care for all.
“With that in mind, we strongly recommend that all high risk work environments for influenza transmission, especially those in the health care and educational settings, strengthen workplace policies to ensure that staff are vaccinated for their own protection and the protection of members of the public,” the group said. “Some counties within our group have even written public health orders to this end.”
The traditional fallback of wearing a surgical mask for those who refuse vaccination is inadequate at a time when mask-wearing indoors is nearly universal, the group said.
“We are in agreement that the need for widespread influenza vaccination is critical this year, and we support both our joint and independent efforts to achieve that goal,” RANCHO members said.
Universal flu vaccination for everyone 6 months and older will make our communities safer for everyone this fall and winter, particularly those most vulnerable to serious complications of both influenza and coronavirus.
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- Written by: Lake County News Reports
The report, “Coverage When You Need It: Lessons From Insurance Coverage Transitions in California’s Individual Marketplace Pre- and Post- the COVID-19 Pandemic,” shows that as of June 2020, 1.53 million people were actively enrolled in Covered California, which represents the highest figure since the marketplace first opened its doors in 2014.
“This recession is the first test for the Affordable Care Act in a down economy, and while the economic toll has been grim, we are glad to see that Covered California is serving as the resource it is intended to be,” said Peter V. Lee, executive director of Covered California. “We do not celebrate higher enrollment, since it is evidence of too many people losing job-based coverage, but we are showing that when people need us most, Covered California is here to help.”
Covered California’s 1.53 million consumers represents an 8 percent increase over its previous high of 1.4 million in March of 2018.
The record enrollment has been driven by significant investments in marketing and outreach throughout its history, along with patient-first policies during the pandemic and recession.
Covered California established a COVID-19 special-enrollment period from March 20 to Aug. 31, which allowed any eligible uninsured individual to enroll. In addition, the exchange spent $9 million on an ad campaign to spread the word to those who needed coverage during the crisis.
A total of 289,460 people signed up for health care coverage during that time, which is more than twice the number who signed up during the same period last year.
“At a time when some are questioning the value of the Affordable Care Act, the COVID-19 pandemic underscores why health care for all is not only the right thing to do, but it is also sound public health policy,” said Lee. “Covered California should be seeing record enrollment because a safety net is of utmost importance during a health crisis and recession. However, for that safety net to work right, you need sound policies like a robust marketing and outreach plan, Medicaid expansion and protection from junk short-term plans. Now is the time to build on the Affordable Care Act, and not turn away from a law that has helped so many.”
In contrast to the enrollment growth seen in California, the federally facilitated marketplace saw only a 27 percent increase in the number of consumers signing up for coverage through the end of May.
The federal marketplace — which is operated by the Centers for Medicare and Medicaid Services and provides coverage to Americans in 38 states — has cut back on marketing and outreach and opted not to offer a special enrollment period specific to COVID-19.
Covered California’s analysis found an additional 500,000 Americans would have been insured during the pandemic if the federal marketplace had equaled California’s pace.
“The sad reality is that hundreds of thousands of Americans are facing the pandemic without insurance because of decisions made in Washington to undermine, rather than embrace, the Affordable Care Act,” said Lee. “Policies matter, and the goal of any exchange should be to promote enrollment and ensure that people have the coverage they need to protect themselves and their family.”
Since first offering coverage in 2014, Covered California has used all the tools of the Affordable Care Act to build a strong and sustainable individual market that helps keep health care premiums as low as possible. Covered California’s 11 contracted qualified health plans vie for consumers based on price and quality.
Significant investments in marketing and outreach have led to steady enrollment and a consumer pool that is consistently among the healthiest in the nation. In addition, California expanded its Medicaid program (known as Medi-Cal) and outlawed short-term plans that do not cover pre-existing conditions or provide essential health benefits.
As a result, the individual market in California has enjoyed two consecutive years of record-low rate changes with only a 0.8 percent rate change for the 2020 coverage year, and based on preliminary rates, an increase of only 0.6 percent for 2021.
Compared to the rest of the nation, California’s individual market health care premiums are estimated to be about 20 percent lower than what they would have been if the state’s enrollment looked more like that of the federally facilitated marketplace, which has enrolled fewer consumers who also have a less-healthy risk profile.
“The test of how marketplaces are serving Americans is the product of whether that marketplace has taken actions to implement and strengthen the Affordable Care Act or acted to undercut the availability of coverage,” Lee said. “What we are seeing now is a reflection of the past several years where California has leaned in to promote and build on the Affordable Care Act while the federal marketplace has gone in the opposite direction.”
Other major findings of the report are:
– More than half of new Covered California consumers (57 percent) who signed up during the COVID-19 special-enrollment period were previously enrolled in employer-sponsored insurance. This compares to 34 percent during open enrollment in 2018 and 39 percent during the 2019 open-enrollment period, which highlights the fragility of employer coverage during an economic downturn.
– While the majority of those enrolling during the COVID-19 special-enrollment period would have been eligible to sign up under normal rules, over one-fifth (21 percent) report having been previously uninsured. This means that more than 60,000 Californians benefited from getting insurance rather than being made to wait until the next open-enrollment period, resulting in not only peace of mind but also in consumers being able to get tested and, if needed, treated for COVID-19, helping keep the community at large safer.
– Among members who have recently left Covered California, only one in seven report leaving because they got a job that offered employer-sponsored insurance, compared to more than half of all disenrolling consumers in 2019. This is an indication that the weak economy means consumers are losing employer-sponsored insurance and that they are more likely to need the safety net of marketplace coverage longer because there are fewer employers hiring.
– In addition, about 24 percent reported they left the marketplace and became uninsured, compared to only 10 percent in 2018, an indication that insurance affordability challenges — even in the subsidized marketplace — may be even more pronounced during the economic crisis.
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- Written by: Lake County News Reports
“Nurse-midwives are the key to filling our statewide shortage of obstetrical care while increasing medical access for all women, especially those in rural or inner-city settings,” Sen. Dodd said. “By expanding their role, we address inequities and help close a gap that is only expected to worsen. I thank Gov. Newsom for recognizing the value of these dedicated women’s health practitioners and signing this bill into law.”
Senate Bill 1237 is sponsored by the California Nurse-Midwives Association and Black Women for Wellness. It expands access to care by authorizing nurse-midwives to conduct routine services without direct physician supervision, following the lead of 46 other states.
States that allow autonomous practice within a more integrated, collaborative model between physicians and midwives show significantly lower rates of cesarean, preterm birth, low birth-weight infants and neonatal death. Currently, nurse-midwives perform 50,000 deliveries or 10 percent of all births in California each year.
Sen. Dodd’s new law comes as experts from the California Maternal Quality Care Collaborative report Black women in California still die at a rate that is 3-4 times higher than white women during pregnancy, childbirth and postpartum.
Furthermore, babies born to Black women were more than three times as likely to die of a preterm, birth-related issue as babies born to white women in 2017. National and international organizations including the March of Dimes and the World Health Organization agree improved access to midwives is a necessary and innovative strategy to reduce and eventually eliminate racial disparities.
“We are thrilled that SB 1237 has made it across the finish line!” said Kathleen Belzer, president of the California Nurse-Midwives Association. “The restrictions on midwifery care that have been in place for decades have negatively impacted so many birthing people and nurse-midwives. Now, more individuals will be able to access the care they need and want. We thank Senator Dodd for his years of support and dedication.”
“Black Women for Wellness Action Project could not be more excited that starting next year, birthing people across California will have increased access to quality and safe maternal health services,” said Nourbese Flint, the group’s executive director. “In addition, this is an important step to closing the mortality gap between Black mothers and babies at a time where we know the stress on our health system is leading to deeper disparities among people of color.”
The bill was also sponsored by the United Nurses Association of California/Union of Health Care Professionals and NARAL Pro-Choice California.
The American College of Obstetricians and Gynecologists has stated that the obstetric workforce crisis cannot be abated without the help of nurse-midwives in a model of integrated, collaborative care.
In 2018, ACOG released a new version of their Joint Statement of Practice Relations which highlighted the critical shortages and misdistribution of maternity care providers, and called for autonomous practice for nurse-midwives under a model of team-based care.
SB 1237 being signed into law comes on the heels of recent statements by leading patient advocacy organizations, including the March of Dimes, California Health Care Foundation, and the Pacific Business Group on Health, calling for the immediate reduction in regulatory barriers to nurse-midwifery practice and greater investment in California’s nurse-midwifery workforce.
Dodd represents the Third Senate District, which includes all or portions of Napa, Yolo, Sonoma, Solano, Sacramento and Contra Costa counties.