Ten categories of services must be covered by law: (1) ambulatory patient services, (2) emergency services (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance use disorder services, including behavioral health treatment, (6) prescription drugs, (7) rehabilitative and habilitative services and devices, (8) laboratory services, (9) preventive and wellness services and chronic disease management, and (10) pediatric services, including oral and vision care.

However the prospect of state variations is likely to leave consumers in
some locations with less adequate coverage. The full statement is at the link
below, which is followed by an excerpt: – Ellen Shaffer

Essential_Health_Benefits_Bulletin – HHS Dec. 16 2011

Intended Regulatory Approach
As noted in the introduction, the Affordable Care Act authorizes the Secretary to define EHB. In response to the research and recommendations described above, as a general matter, our goal is to pursue an approach that will:

• Encompass the 10 categories of services identified in the statute;

• Reflect typical employer health benefit plans;

• Reflect balance among the categories;

• Account for diverse health needs across many populations;

• Ensure there are no incentives for coverage decisions, cost sharing or reimbursement rates to discriminate impermissibly against individuals because of their age, disability, or expected length of life;

• Ensure compliance with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA);

• Provide States a role in defining EHB; and

• Balance comprehensiveness and affordability for those purchasing coverage.

As recommended by the IOM, HHSaims to balance comprehensiveness, affordability, and State flexibility while taking into account public input throughout the process of establishing and implementing EHB.23 Our intended approach to EHB incorporates plans typically offered by small employers and benefits that are covered across the current employer marketplace.

We intend to propose that EHB be defined by a benchmark plan selected by each State. The selected benchmark plan would serve as a reference plan, reflecting both the scope of services and any limits offered by a “typical employer plan” in that State as required by section 1302(b)(2)(A) of the Affordable Care Act. This approach is based on the approach established by Congress for the Children’s Health Insurance Program (CHIP), created in 1997, and for certain Medicaid populations. A major advantage of the benchmark approach is that it recognizes that issuers make a holistic decision in constructing a package of benefits and adopt packages they believe balance consumers’ needs for comprehensiveness and affordability. As described below, health insuranceissuers could adopt the scope of services and limits of the State benchmark, or vary it within the parameters described below.

Four Benchmark Plan Types

Our analysis of offerings that exist today suggests that the following four benchmark plan types for 2014 and 2015 best reflect the statutory standards for EHB in the Affordable Care Act:

(1) the largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market;

(2) any of the largest three State employee health benefit plans by enrollment;

(3) any of the largest three national FEHBP plan options by enrollment; or

(4) the largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the State.

HHSintends to assess the benchmark process for the year 2016 and beyond based on evaluation and feedback.

To reflect the State flexibility recommended by the IOM, under our intended approach, States are permitted to select a single benchmark to serve as the standard for qualified health plans inside the Exchange operating in their State and plans offered in the individual and small group markets in their State. To determine enrollment in plans for specifying the benchmark options, we intend to propose to use enrollment data from the first quarter two years prior to the coverage year and that States select a benchmark in the third quarter two years prior to the coverage year. For example, enrollment data from HealthCare.gov for the first quarter of calendar year 2012 could be used to determine which plans would be potential benchmarks for State selection and the benchmark plan specified during the third quarter of 2012 for coverage year 2014. If a State does not exercise the option to select a benchmark health plan, we intend to propose that the default benchmark plan for that State would be the largest plan by enrollment in the largest product in the State’s small group market.

Cathy Hurwit: Tax the Rich!  Julie Burkhart: Trust Women.  June 17, 2011

Cathy Hurwit, Chief of Staff to Rep. Jan Schakowsky, on Congressional Progressive Caucus campaign for an alternative budget.

Julie Burkhart, Trust Women PAC: Defending abortion care in the heartland.

Listen here, 12:05 – 12:30 p.m.:

http://www.kpfa.org/archive/id/70752

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

June 3, 2011: Take Action Now to Shift Realignment Funds from Prisons to Mental Health; Protecting Women’s Health

http://www.kpfa.org/archive/id/70332

Ernie Galvan (Rose, Bien & Galvan): Historic Supreme Court victory calls for fixing California prison overcrowding, and opens the doors for activists to get involved right now on county boards to shift realignment funding from jails to public health programs like community mental health/substance abuse treatment.

Kathy Spillar (Feminist Majority), Billye Avery (Avery Institute) and Ellen Shaffer (Silver Ribbon/Trust Women Campaign) on protecting access to family planning.

The California Public Health Association-North[1] and EQUAL Health Network[2], transmitted the following recommendations to the Institute of Medicine’s Committee on Preventive Services for Women for its consideration.  The recommendations strongly support preventive services that are necessary for women’s health and well-being and should be considered in the development of comprehensive guidelines for preventive services for women. These services address gaps that exist in recommended preventive services for USPSTF Grade A and B preventive services guidelines for women and in Bright Futures and USPSTF Grade A and B guidelines for adolescents. We highlight specific services and screenings that should supplement currently recommended preventive services for women. 

Recommendations for Preventive Services to Women and Girls

The U.S. Preventive Services Task Force recommendations fail to address any preventive reproductive health services for women, and critical gender‐specific preventive services that promote wellness, well‐being and healthy outcomes for women. We ask the Institute of Medicine Study Committee to include the following on its list of recommended preventive services for women:

1. Provide comprehensive family planning, preconception and interconception services.

a. The comprehensive range of family planning services (clinical assessment, education and counseling, method provision), prescriptions and devices are essential to health and reproductive health.

b. Preconception and interconception care are needed preventive services to ensure women are healthy when they become pregnant.

2. Provide comprehensive prenatal and post‐partum care to pregnant and parenting women.

a. Prenatal care services for all pregnant and postpartum women include case management, health education, nutrition and psychosocial risk assessments and referrals.

b. Integrate clinical activities from basic through subspecialty services as supported by The American Congress of Obstetricians and Gynecologists (ACOG).

3. Provide a comprehensive annual well‐woman visit.

a. A well‐woman visit provides preventive care and to manage gender‐based complex health needs. This would include sensitive and comprehensive preventive health counseling.

4. Routinely screen for intimate partner violence and conduct periodic assessments about violence.

a. Include an assessment of intimate partner violence (IPV), teen dating violence, reproductive coercion, IPV during pregnancy, sexual violence.

b. Screen for depression, substance abuse, and chronic illnesses.

5. Provide optimum nutrition screening and counseling along with support of physical activity.

a. Follow the Healthy People 2020: National Health Promotion and Disease Prevention Objectives13 for healthy eating and physical activity for women and adolescents

6. Routinely screen and treat eating disorders.

a. Include both nutrition counseling and behavioral health treatment to address eating disorders.

7. Promote a comprehensive range of breastfeeding and support services

a. Provide breastfeeding promotion, education and counseling services to women, by qualified individuals based on the level of intervention required, including information about breastfeeding related durable medical equipment, supplies and banked human milk.

b. Follow The Healthy People 2020: National Health Promotion and Disease Prevention Objectives for increasing breastfeeding initiation, exclusivity and duration rates.

Adapted from: Written testimony submitted to the Institute of Medicine Study Committee on preventive services for women. Sacramento: The Office of Women’s Health, Department of Public Health and the Department of Health Care Services (2011).

The California Public Health Association-North (CPHA-N) represents the diverse public health work force, community needs, and interests in Northern and Central California, provides leadership in public health in California, and initiates and supports action to meet needs or remedy problems including education and legislation. It provides opportunities for persons actively engaged or interested in the broad field of public health to share knowledge and experiences in order to achieve the primary goal of protecting and promoting public, environmental and personal health.

** EQUAL Health Network brings together partners from public health, women’s health and the public to advocate for Equitable, Quality, Universal, Affordable – EQUAL – health care. EQUAL is a project of the Center for Policy Analysis, an independent 501c3 organization working for a healthier world.

Government Shutdown Threatens Public Health

Women’s Health, Greenhouse Gas Emission Protection, Health Care Reform at Risk

The public’s health would be a collateral casualty of caustic ideological battles over the national budget. Republican demands to defund family planning and to stop EPA regulation of greenhouse gas emissions have brought the federal government to a standstill. Crippling the popular Planned Parenthood clinics and lowering air pollution standards would profoundly damage the health of the nation and of California.

Women and men in many of the poorest neighborhoods rely on Planned Parenthood facilities for basic health care services, family planning, HIV care and cancer screenings. The Planned Parenthood Affiliates of California, Inc., has been instrumental in public policy for the health of women and girls.

These ideologically-driven “social riders” to the proposed budget would also eliminate funds for implementation of the Affordable Care Act and the new consumer protection bureau, leaving hundreds of thousands of families struggling to afford medical care.

Cuts could also fall on the Center for Infectious Diseases & Emergency Readiness at the University of California Berkeley, the only research center in the United States on radiological and nuclear public health preparedness.

The proposed $60 billion in cuts that Congressional Republicans have demanded this year, and trillions to come, would devastate the very projects that could revitalize jobs and ensure prosperity. Millions of people’s livelihoods depend on publicly funded transportation, infrastructure, education, and health care.

In addition, the shutdown itself will weaken the fragile economy, immediately placing 800,000 federal workers on furlough, suspending paychecks for soldiers and delaying business loans. 

We need to develop a comprehensive solution that revitalizes federal revenues, while requiring those who benefit the most from our society’s infrastructure to pay the most to ensure its upkeep. Taxes for corporations and for wealthy individuals declined over the last decade, resulting in signficant income disparities between the rich and the poor in the U.S., and leading to health inequalities. Reversing tax giveaways to the super-rich and the nation’s largest corporations could raise $4 trillion within a decade.

 We stand in support of reproductive and public health and against the threat of climate change!  We urge our federal representatives to insist that these important programs continue!

 California Public Health Association-North  www.cphan.org 

EQUAL Health Network  www.equalhealth.info

California Pan-Ethnic Health Network www.cpehn.org

Government Shut-Down: Public’s Health at Risk

HR 676, Medicare for All; Feb 2011

But beyond the greater cost-savings, we believe that Option 3 is the most feasible because it is likely to be accepted by the broadest cross-section of stakeholders in Vermont. Through discussions with more than 100 stakeholders we gained a critical understanding of what various competing interests would tolerate, their issues, concerns and hopes, where they disagreed and where they landed on common ground. Political opposition to single payer systems is often rooted in concerns over transparency and accountability. We designed Option 3 to address those issues and to operate with the express input of a broad base of stakeholders. In sum, we believe that Option 3 provides benefits to patients, providers and the system at large, in keeping with both the equity, coverage and sustainability goals of Act 128.

MORE ON VERMONT: 
From: Rachel DeGolia, UHCAN

Once again, Vermont is proving to be a national leader in health care reform.  And, this time, it looks like they will create an entirely new health care system – a modified single payer system – that will provide “affordable, universal health care” for all Vermonters.
 
The whole country has a stake in their success in Vermont. If one state can make real progress on comprehensive health reform, that will help all of us no matter where we are in the struggle in our own states. 
 
The process, in a nutshell
Right now, legislators and advocates in Vermont are digesting the long-anticipated very dense “Health System Reform Design” draft report that Harvard economist Dr. William Hsiao issued on January 19th.  Of the three options Dr. Hsaio studied, he is urging the state to adopt a “modified single payer.”  There is key political support for a single payer approach – the new Governor, Peter Shumlin, many legislative leaders, and the entire congressional delegation, in addition to or, perhaps, as a result of (!) the tremendous grassroots movement that has been built over many years by health care advocacy groups in the state. 
 
After Hsaio’s final report is issued in mid-February, the legislators will have to get to work on crafting the actual legislation, a process that is expected to take until the end of the session in May.  The report provides a framework, but many details have to be worked out.  A guide developed by the Healthcare is a Human Right Campaign (run by the Vermont Workers Center) provides a means to assess how well any reform bill meets the principles of the Campaign: universality, equity, transparency, accountability and participation. See the “Detailed human Rights Standards for Healthcare Systems” here: http://r20.rs6.net/tn.jsp?llr=z858oyn6&et=1104304600328&s=5376&e=001uWaZGT4CgP4Kj9kewe7EpoAiEq-Pc_zYZezn3HKlAFgyaNq-z74sg5hzlDRo3i-_bKko0ShsfrkLIt1tKLMAxKQEVLnzQGMpaR8SYnKd5hfX_Z64djrE3mGlydnvshdqGB-aIY-nndc=.

In Congress, Vermont’s Senators Sanders and Leahy, and Rep. Welch, will soon introduce the “State Leadership in Healthcare Act,” a bill to move up the date from 2017 to 2014 when “state innovation” is allowed under the Affordable Care Act (ACA), thus allowing Vermont to move forward with a single payer system.  Careful consideration is being given to this step due to concerns about what states other than Vermont might do with the authority to waive provisions of the ACA.  
The opposition has not materialized quite yet, but everyone knows that the lobbyists for the insurance companies and others invested in maintaining the status quo – or twisting the reform for their own profit – will be pouring into the state very soon. Our colleagues in Vermont need and deserve our support!
 
Support Needed!
Grassroots health care justice groups are hard at work organizing key constituencies across the state. All the groups listed below have up-to-date information on the status of the campaign and links to the latest news coverage.
 
SEND DONATIONS to help pay for more organizers to Healthcare is a Human Right Campaign, www.workerscenter.org 
 
Contact James Haslam, Executive Director, Vermont Workers’ Center, james@workerscenter.org or 802/861-4892 to:
·  HOST A HOUSE PARTY and have a Campaign Organizer join you via Skype

·  Go to Vermont and VOLUNTEER in person for the campaign in the next few months
Other organizations in the lead:
Vermont Citizens Campaign for Health, www.universalhealthvt.org
Contact: Richard Davis, RN, Executive Director vcch@universalhealthvt.org or 802/251-0195
 
Vermont for Single Payer, a project of Vermont Health Care for All, the local affiliate of Physicians for a National Health Program, especially focused on mobilizing health providers, www.vermontforsinglepayer.org 
Contact: Deb Richter, MD, Executive Director hcforall@sover.net or 802/595-2820

Vermont Public Interest Research Group (VPIRG)
Contact: Cassandra Gekas, Health Care Advocate cgekas@vpirg.org  www.vpirg.org or 802/223-8421, x-4097

Health Care Reform:  ACA  and Medicare
What’s New, What did you Lose? What did you Gain?
General Meeting: Tuesday, January 18, 7:00 pm Cal State East Bay, Oak Room, Concord Campus,  Ygnacio Valley Blvd to Campus Drive, Concord, CA
Speakers:

Herb Schultz, Health and Human Services Director for Region 9 (western states), Medicare/CMS, former health policy consultant to the Schwarzenegger administration

Dr. Debbie LeVeen, health policy expert, former health policy professor, San Francisco State University

Dr. Lee Lawrence, Communications Director for the League of Women Voters of Diablo Valley
Health Policy Analyst, Unitarian Universalist Legislative Ministry (moderator)

Healthcare in the United States is facing unprecedented challenges and changes. Professor LeVeen and Director Schultz will give us an overview of the Affordable Care Act, the historic measure passed in March, 2010, and the process of implementing it which is now underway. How are access, cost, and quality issues being addressed as the new law settles in? What improvements does it offer? What shortcomings might plague it? And, we might add, how will this year’s midterm election results affect the new law? Tough questions, but our speakers will take them on.

Learn things that every health care consumer needs to know about health reform and its effects on Medicare, Medicaid, mandated insurance coverage, etc.  Ask those pressing questions about how the Presidential special commission on the deficit chaired by Alan Simpson and Erskine Bowles will affect health care access in the US for decades to come.  Don’t allow new health care options to baffle you and those you care about.

If you have no idea what your insurance premiums for Part A, B, or D will be as the Medicare/Medicaid rules shift and reform measures roll out, you need to be there. If you don’t have health coverage or a job with health benefits,
have chronic conditions or dependent children, parents, or grandparents, can’t afford COBRA premiums, you need to attend this important presentation and get your questions answered.

CSUEB Scholar-Olli and the League of Women Voters Diablo Valley are here to educate you about the future of the health-care in America.

At a gathering on November 21, 2010, a number of community partners who have been active with the EQUAL Health Network expressed our deep concerns regarding the future of health care reform and the political direction of the country more generally.  Our concerns included:

1. Misguided policies have widened social and economic inequality, eroding the middle class in the U.S. and shredding the financial security of millions.  A decade of the virtual abandonment of government oversight and accountability contributed significantly to the collapse of the financial sector, persistent high unemployment, record rates of home foreclosures and bankruptcies, and uncontrolled health care costs. Corporate-sponsored campaigns and corporate-dominated media attempt to falsely attribute responsibility for the economic crash to an overly intrusive government. This stands reality on its head and must be challenged.

2. Progress requires a political program that recognizes the central role of the government in generating an economic recovery.  Further tax breaks to wealthy individuals will not create jobs. Banks are now sitting on billions that they refuse to invest, while pursuing relentless and questionably legal home foreclosures. Substantial deficit spending is critical to regenerate demand and innovation. Demand will flow from employment in the public sector as well as programs such as extended unemployment benefits that provide cash to lower-income people who will spend it.  Public investment in education, health care and housing will help to renew innovation. It is vital to protect Medicare and Social Security from arbitrary cuts, both to protect people’s financial security and to reorient policy towards a more productive course.

3. The Obama Administration, elected on a wave of voter mobilization, has succeeded in enacting an historic health care reform law, as well as numerous other achievements. But it has yet to generate the momentum for an economic recovery, or the civic engagement that can achieve a political one.

We propose to organize our activities for the near future as follows: 

1. We call for leadership at every level- among elected officials. community leaders, and advocacy organizations – to reinvigorate our vision of social justice and to reconnect with and mobilize the American public in our own self-interest, for financial security and the opportunity to improve our lives and communities.

2. We will aim to act as catalysts for the change we believe is necessary, and seek to create alliances with organizations and individuals who ascribe to similar beliefs and goals.

3. In the realm of health care reform, we commit to the following. 

a. Oppose and resist calls to repeal, delay and otherwise undermine the implementation of the Affordable Care Act.

b. Educate the public about the substantial benefits ensuing from the ACA, particularly the expansion of publicly-financed coverage, greater controls over administrative waste and excessive costs, protection from insurance company abuses, and improvements in the quality of care.

c. Implement the law to the benefit of the public, through campaigns on regulations and state laws.

d. Address and improve the shortcomings of the law, most significantly:

• Cover abortion care and contraception the same as any other medical event.  Defuse the controversy over this issue and destigmatize the conversation.
• Cover undocumented residents and all individuals for the costs of health care, as a matter of human rights, reciprocal fairness for the treatment of Americans abroad, and good public health practice.
• Improve the affordability of health care.
• Recognize and aim to replicate the success of all other economically developed nations and many developing nations at controlling health care costs by invoking the authority of the government to negotiate prices with powerful health care industries including drug companies, hospitals and health care  professionals.  This includes expanding the role of local initiatives to provide publicly-financed and publicly-provided health care services, as well as broader initiatives to create state-based single payer systems.

The EQUAL Health Network’s listserve will continue to disseminate news and opinions consistent with these views, and provide a discussion blog for debate on how best to achieve them, at http://equalhealth.info/discuss/?pEQUAL =28