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This is it.  We can't win the battle over AB 52 this afternoon, but we can lose it.  We can lose it if the bill doesn't come off of suspension so that it even gets to the full Senate Appropriations Committee so that we can see who the heroes and villains are.  That decision will probably be set in the minds of Senators in a few hours.

You may have seen serious diaries from jpmassar and quirkier ones from me asking you to call these six Democratic Senators and ask them to support AB52.

Senator Christine Kehoe (Chair) -- (916) 651-4039
Senator Elaine Alquist -- (916) 651-4013
Senator Ted W. Lieu -- (916) 651-4028
Senator Fran Pavley -- (916) 651-4023
Senator Curren Price -- (916) 651-4026
Senator Darrell Steinberg -- (916) 651-4006

Bear in mind: Constituents' Calls Matter Most!

Now I'm going to give you some insider details about the state of play and what we need to do now -- as in, before 4:00 p.m. PST if possible.  The takeaway is: if you are in the current 28th State Senate District or what will be the new 26th State Senate District, you should be calling Ted Lieu.  Now.  I'm not sending along instructions from anyone official; that's just my sense -- as someone who has been paying close attention -- of how things stand.

That is, specifically: Carson, El Segundo, Hermosa Beach, Lennox, Lomita, Manhattan Beach, Marina del Rey, Redondo Beach, Torrance, West Carson, and parts of Long Beach and Los Angeles) current district and , and/or his new District, SD 26, which includes Beverly Hills, Bel Air, Brentwood, Pacific Palisades and the Palos Verdes Peninsula.

Again: (916) 651-4028.

I made six calls this morning to the Democratic State Senators, aided tremendously by the previous spadework that others have done.  Here's what I found:

Chairwoman Kehoe:  This is the most important call that everyone can make.  She's a good Senator, but given the power and influence she has as Chair she is probably under enormous pressure.  We need her on our side.  My earlier update:

I just asked a smart and circumspect staffer in Kehoe's office if Kehoe's office could address the concern based on the comment from Lieu's office that the bill might not come off of the suspense calendar.  He was neither encouraging nor discouraging, explaining why a bill in general might remain on the suspense calendar (including the possibility of the sponsor changing it into a 2-year bill; someone more knowledgeable may want to explain that one) -- and I was left more discouraged than encouraged.

At this point, I'm neither encouraged nor discouraged by the response: I'm just activated.  Are you?

Alquist:  Her office has been telling people that she voted for the bill on the Health Committee and voted for it to be sent to Appropriations.  That's great.  CALL HER AND THANK HER!  But -- it's also not good enough.  A Senator can do all of that good stuff as a "freebie" if he or she knows that it will be scuttled -- privately (by not getting off suspension) or in a public vote (tomorrow) -- down the line.  The Appropriations version of the bill is in its final form.  We want her to make an unambiguous commitment.  But, even if she doesn't, I'm optimistic about her.

Lieu: I'm saving Lieu for last.

Pavley:  Exemplary!  She's for it.  Her office also said that if there's some meeting today to discuss what happens now, as I Kehoe's office at least implied would or could be the case (it wasn't entirely clear), she has not been asked to be part of it.  That's of some concern.

Price:  He represents a low-income area -- but so did two of the Assembly people who were the biggest problems for the bill on the Assembly Appropriations Committee, Jose Solorio and Charles Calderon.  He needs to get calls.  The staffer I spoke to "was just filling in"; we don't know what his position is.

Steinberg: Delightfully informed staffer.  Steinberg is for it.  She has not heard rumors of the bill not being likely to come off of suspension.  Steinberg has not supported any amendments to it.  I believe that we can count on him.

Now back to Lieu: I am not happy right now.  He should try to make us all happier.

Lieu's office, when asked whether the bill would be coming off of suspension, said that the author (Asmb. Feuer) would probably be the one to know, that legislators often don't take stands on bills until they see the final language, and that in many cases there are amendments that could change the bill, etc.

Well, guess what?  Bills can't be amended between now and tomorrow, so the bill is already in the form it will be in when he votes (or helps to kill it in secrecy) tomorrow.  So this is ... let's use the term "beside the point."   Sen. Lieu can take a stand now.  If he is wise, he'll do so.

I asked the staffer to pass on a message to Sen. Lieu.  I told him that if the bill doesn't go forward, that any contributions that Sen. Lieu gets from the health insurance industry between now and the SD 26 election in 2014 will hang like a millstone around his neck.  His new district contains Santa Monica, Hollywood, and Beverly Hills.  Democratic voters there will be attentive, aware, and unforgiving.  We'll keep track this very significant vote.  Blaming him if it doesn't make it out of suspension may be unfair -- for all I know, he might support it and Kehoe and Price or Alquist might be the ones to knock it down -- but frankly absent a firm commitment ahead of time to support the bill, that's what I'm going to do.  He's in a vulnerable position, moving into a new district, and he should know that his viability depends on the success of this bill.  (You get onto Appropriations and you have to take the heat.)

My conversation with Asmb. Feuer's office: I spoke to another wonderfully informed staffer in the office of Asmb. Feuer, the author of the bill.  She said that the Assemblyman appreciates our efforts to contact the members of the Senate Committee and that today is the crucial day to do so.  She says that the issue now is making sure that it gets off of the suspension calendar.  They are working hard, I get no sense of panic or pessimism, but they frankly don't know if it will come off suspension and they know that this is a critical hurdle.  You just don't know until it happens.  She is interested in knowing it anyone else hears rumors, more clear than the odd statement made to cooper888, about it possibly not coming out of suspension.  Right now, that doesn't really even rise to the level of being a real rumor; it could just have been a staff member giving a weird answer.  But we'd like to pin people down today on this point.

So, everyone: you want to be involved in politics?

Here and now, this afternoon, is your chance!

Originally posted to Doane Spills on Wed Aug 24, 2011 at 01:12 PM PDT.

Also republished by California politics.

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Comment Preferences

  •  Remember, Constituents' Calls Matter Most! (17+ / 0-)

    Do you know someone who is or will be represented by these Senators?

    They need to call.  You call, too, but they need to call.

    This afternoon.

    In my avatar, the blue bars show how many want Reps who COMPROMISE; the aqua bars show who wants Reps who STAND FAST no matter what. (Left=Overall; Center=Democrats; Right=Republicans.) And there's the problem!

    by Seneca Doane on Wed Aug 24, 2011 at 01:12:39 PM PDT

    •  so right now (5+ / 0-)

      it's stuck with the health committee due to a suspension?  is that the case?

      because if it's some committee holding it up, i say everyone is entitled to call members of said committee, even if his/her rep/senator isn't on the committee. because it is the legislature for all of california and so are any committees.

      My goal is to make the world safe for anarchy. - 4Freedom

      by Cedwyn on Wed Aug 24, 2011 at 01:19:27 PM PDT

      [ Parent ]

      •  It is currently on suspension in the Senate (5+ / 0-)

        Appropriations Committee, along with everything else that the Appropriations Committee may (or may not) vote on tomorrow.

        I think that everyone is entitled to call; focusing on constituents is simply recognizing which calls are most likely to be of greatest influence.  But everyone in state should call.  Out of Staters -- well, what we do will affect you, but that's still up to you.  As a rule, I don't call out of state legislators -- except if it's HUGE.

        In my avatar, the blue bars show how many want Reps who COMPROMISE; the aqua bars show who wants Reps who STAND FAST no matter what. (Left=Overall; Center=Democrats; Right=Republicans.) And there's the problem!

        by Seneca Doane on Wed Aug 24, 2011 at 01:25:50 PM PDT

        [ Parent ]

  •  Done acouple...with all the reminders it works (6+ / 0-)

    Price's office surprised but my info is that I am what I am...a small organization that provides benefits except that each year increases are killing us.

    Senator Kehoe's office delightful...

    Off to do more!

    Tiny Congress /ht peterboy/ This debt ceiling creation is not a 'Super Congress' it's a tiny one!!

    by SallyCat on Wed Aug 24, 2011 at 01:23:01 PM PDT

  •  Whom did you speak to in Asm. Feuer's office? (1+ / 0-)
    Recommended by:
    Plubius

    Arianna Smith?

  •  I called Senator Lieu's office. (3+ / 0-)

    Usual runaround about not taking a position and not being in a position to influence whether the bill gets out of committee.

    •  That does not sound factual, does it? (1+ / 0-)
      Recommended by:
      neroden

      There's no reason he can't take a position now -- the bill will not change overnight -- and he is certainly in a position to influence whether it comes out of suspension and whether it passes out of the committee.

      Did you get the sense that the staffer just thinks that we're dumb or oblivious?

      In my avatar, the blue bars show how many want Reps who COMPROMISE; the aqua bars show who wants Reps who STAND FAST no matter what. (Left=Overall; Center=Democrats; Right=Republicans.) And there's the problem!

      by Seneca Doane on Wed Aug 24, 2011 at 02:09:05 PM PDT

      [ Parent ]

      •  "Usually... (1+ / 0-)
        Recommended by:
        Seneca Doane

        Senator Lieu does not take a position until the bill comes up for a vote."  (Or maybe it was "comes up on the floor")

        I pointed out (reasonably politely) that this position is absurd, considering that he is on the committee that the bill has to get out of in order to be considered.  

        She then went into the spiel about his having no influence, at which point I said something like "whatever.  If the bill doesn't get out of committee I will be extremely disappointed in the Senator."

  •  The staffer in Lieu's office said the bill would (1+ / 0-)
    Recommended by:
    Plubius

    cost the state $50 million dollars.

    That seems like a ridiculous amount of money, but I don't really know anything about it.

    •  You just made some real news (2+ / 0-)
      Recommended by:
      Plubius, neroden

      I hope that you'll diary it both here and at Calitics.  I'd like to send the link to Dave Jones for comment.  That's the first real bit of news that I've heard.  Wow.

      Ted Lieu may be about to make a career-ending (though that will be delayed by three years) mistake.

      In my avatar, the blue bars show how many want Reps who COMPROMISE; the aqua bars show who wants Reps who STAND FAST no matter what. (Left=Overall; Center=Democrats; Right=Republicans.) And there's the problem!

      by Seneca Doane on Wed Aug 24, 2011 at 02:11:18 PM PDT

      [ Parent ]

      •  Not sure I follow. (1+ / 0-)
        Recommended by:
        Seneca Doane
        •  The $50 million figure is out there, I know, but (1+ / 0-)
          Recommended by:
          neroden

          that Lieu's office cites it as a potential reason to vote against AB-52 is news.  It's about $16 million per year.  Lay that against health insurance expenses for California households.

          Let's calculate: 37 million state population, probably about 2.6 per family, lots in group rather than individual coverage.  Let's be really conservative and say that one one million households  would be affected by this legislation.  Then we do the math.  Do we think that the prospect of discouraging unreasonable increases in health insurance premiums will not save them at least $16 for household?

          That, in effect is their implicit argument.   Don't spent $16 million per year to save Californians way more than $16 million per year.  Yeah, I'd call this "news."  (By this logic, imagine what we could save by getting rid of the justice system!)

          If Lieu blocks this, he's toast.

          In my avatar, the blue bars show how many want Reps who COMPROMISE; the aqua bars show who wants Reps who STAND FAST no matter what. (Left=Overall; Center=Democrats; Right=Republicans.) And there's the problem!

          by Seneca Doane on Wed Aug 24, 2011 at 03:45:19 PM PDT

          [ Parent ]

      •  I didn't get the name of the staffer. (1+ / 0-)
        Recommended by:
        Seneca Doane

        But presumably the cost estimate is a matter of public record somewhere.

  •  There really needs to be a special place for (4+ / 0-)
    Recommended by:
    jpmassar, Plubius, Seneca Doane, neroden

    diaries, articles or blogs like this that need lots of eyes for a limited amount of time.

    BTW, when I called I was told that my call would be logged in - whatever that means - by staffers from all offices.

  •  I called Steinberg (3+ / 0-)
    Recommended by:
    jpmassar, Seneca Doane, neroden

    "He is always in favor of rate regulation so I wouldn't worry about his vote, but how others will vote I couldn't tell ya."

    This is a bit disingenuous because he is going to be a key voice deciding what comes off suspense. Much bigger voice than Lieu or the other nonchair members.

  •  Seneca (2+ / 0-)
    Recommended by:
    jpmassar, Seneca Doane

    Thank you for doing this!

    T & R's

  •  The $50 million Ted Lieu's office is saying (0+ / 0-)

    that this bill will costing the state is presented in this document (h/t jpmassar).

    Markos's disk space is cheap, so I'll reproduce this whole govt doc here:

    BILL ANALYSIS

    Senate Appropriations Committee Fiscal Summary
    Senator Christine Kehoe, Chair

    AB 52 (Feuer)

    Hearing Date: 8/15/2011         Amended: 6/1/2011
    Consultant: Katie Johnson       Policy Vote: Health 5-3
              ________________

    BILL SUMMARY:  AB 52 would prohibit health care service plans and health insurers from implementing a rate for a new product or instituting a rate change unless it submits an application to the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI) and the application is approved.
              The Director of DMHC and the Insurance Commissioner would have the authority approve, deny, or modify any proposed rate or rate change.
              ________________

    Fiscal Impact (in thousands)

    Major Provisions  __ 2011-12 _ 2012-13 __ 2013-14 __ Fund

    CDI rate approval review,         $600        $1,000              $1,000  (Special hearings, appeals, regulations, and retroactive rate approval)

    DMHC rate approval     $6,500     $13,000     $13,000  
             Special*           review

    DMHC retroactive       at least $15,000 at least $15,000  
              $0Special**          rate approval

    DMHC regulations       $1,250     $1,250      $0                  Special** and one-time expenses

    DMHC hearings          likely in the millions of dollars annually                  Special**                              

              *Insurance Fund
              **Managed Care Fund
              ***Some expenses could be offset by approximately $1.4 million  federal funds annually for up to 3 years (actual fiscal years unknown) to be shared between the departments.

    STAFF COMMENTS: This bill meets the criteria for referral to the Suspense File.

    This bill would prohibit the approval of any rate that is found to be excessive, inadequate, or unfairly discriminatory or otherwise in violation of these provisions. These terms would be defined through the regulatory process since they are not defined in this bill. These provisions would apply to the individual, small group, and large group markets except for health plans contracted with the Department of Health Care Services for Medi-Cal managed care and with the Managed Risk Medical Insurance Board, Medicare supplement contracts, a health plan conversion contract, or a health plan offered to a federally eligible defined individual. This bill would require the departments in promulgating regulations to consider whether the rate is reasonable in comparison to coverage benefits.

    Individual and Small Group Markets

    This bill would require all health plans and insurers, for individual and small group health plan contracts and health
    insurance policies, to file with the departments a complete rate application, as specified, for any proposed rate change or rate for a new product that would become effective on or after January 1, 2012. The application would be required to be filed at least 60 days prior to the proposed effective date.

    This bill would prohibit the implementation of a rate change within one year of the date of implementation of the most recently approved rate change for each product and would require the plan or insurer to submit 18 specified data points, including those required by SB 1163 (Leno), Chapter 661, Statutes of 2010, as part of each application.

    According to CHBRP, DMHC regulates 67 percent and CDI regulates 33 percent of the small group market, which consists of about 3.4 million lives. DMHC regulates 35 percent and CDI regulates 65 percent of the individual market, which consists of about 2.1 million lives of the individual and small group markets respectively.

    Large Group Market

    This bill would require all health plans and insurers for large group health plan contracts and health insurance policies to file with the departments a complete rate application, as specified, for any proposed rate change or rate for a new product that would become effective on or after January 1, 2012.  The application would be required to be filed at least 60 days prior to the proposed effective date. This bill would prohibit the implementation of a rate change within one year of the date of implementation of the most recently approved rate change for each product and would require the plan or insurer to submit 43 specified information points, including those required by SB 1163 and federal law, as part of each application.

    According to the California Health Benefits Review Program, DMHC regulates 96.6 percent and CDI regulates 3.4 percent of the large group market, which consists of approximately 11.8 million lives, excluding Medi-Cal and Healthy Families enrollees.

    Requirements for All Applications

    All information submitted to the department would be required to be made publicly available by the departments, except that contracted rates between a health plan and a provider and a health plan and a large group subscriber would be deemed confidential. The departments would be required to issue a decision within 60 days on all rate applications, as specified.  This bill would permit the departments to notice a public hearing on a rate increase, in which case the departments would have 100 days in which to issue a decision.

    The departments would be required to hold hearings for any of the following reasons:

             1)   An enrollee, policy holder, or his/her representative, requests a hearing within 45 days of the date of the public notice and the department grants the request for a hearing; if the department denies the request, it would be required to issue written findings in support of that decision;

             2)   The departments determine for any reason to hold a hearing;

             3)   The proposed change would exceed 10 percent of the amount of the current rate under which the plan contracts, or would exceed 15 percent for any individual insured or enrollee subject to the rate increase, in which case the departments would be required to hold a hearing upon a timely request for a hearing.

    This bill would require the department to notify the public of any rate application by a health plan or insurer. Courts would have the final review over any department final finding, determination, rule, or order.

    An enrollee or policyholder would be permitted to intervene in any proceeding pursuant to these provisions and any advocate's, expert witness', or other reasonable costs would be paid compensated. The departments would also be able to make awards to the enrollee or insured as specified to be paid by the rate applicant.

    This bill would permit the departments to charge plans and insurers fees for the actual and reasonable costs related to filing and reviewing an application. This bill would establish the Department of Managed Health Care Health Rate Approval Fund and the Department of Insurance Health Rate Approval Fund into which the fees would be placed.

    This bill would permit the departments to issue guidance on or before July 1, 2012, related to the implementation of these provisions without being subject to the Administrative Procedures Act; regulations would be required to be adopted no later than January 1, 2013. This bill would permit the departments to suspend or revoke licenses for failure to comply with these provisions. The departments would be required to submit reports semiannually to the Legislature.

    Annual Review

    Under SB 1163, health insurers and health plans with products in the individual and small group markets are required to submit their rates for review by both CDI and DMHC 60 days prior to their effective date. This bill would also require the same carriers to submit a complete rate application, which would be required to include SB 1163 required information plus 17 other items. If the departments choose to review the rate application and conduct SB 1163 rate review concurrently, then the additional review costs associated with the extra data required by this bill would likely be minor.

    For the large group market, the rate application filings required by this bill would also be in addition to those required by SB 1163, which requires that health care service plans in the large group market submit to the departments any rates that would be unreasonable, as defined by federal law, at least 60 days prior to their taking effect. Although it is unknown how many SB 1163 rate filings would occur in the large group market, it is estimated that up to 15 percent would be unreasonable rates. Thus, CDI and DMHC would need to conduct reviews of rates submitted pursuant to this bill on about 85 percent of the rates in the large group market.

    Since CDI regulates less than 5 percent of the large group market, additional filing, review and approval of large group rate applications and approval of small group and individual market rates are not expected to exceed $1 million in Insurance Fund monies annually.

    Costs to DMHC to augment its review of SB 1163 small group and individual rate filings would likely be relatively minor.  However, since it regulates over 95 percent of the large group market, and it would review only approximately 15 percent of large group rate increases under SB 1163, there would be a significant increase in workload associated with the filing, review, and approval of the other 85 percent of large group market rate increases at a cost of approximately $13 million annually. It is estimated that DMHC would receive approximately 13,000 filings for the large group market. If DMHC were to discount the total filings by 25 percent for the self-funded market and 15 percent for the existing SB 1163 review process, there would be about 8,300 filings annually. Each filing review would take approximately 20 hours of DMHC staff time.

    Hearings and the Intervener

    Although it is unknown how many hearings would be conducted annually, costs to DMHC could be in the millions of dollars annually to pay for staff preparation time and administrative law judge services if at least 100 hearings were held. CDI does not expect significant costs due to hearings. Additionally, there could be costs to compensate an intervener in the hundreds of thousands to millions of dollars annually depending on the number of interveners and the number of hearings.

    Retrospective Rate Review and Approval

    This bill would require that any health plan or health insurer rate change that became effective for the period January 1, 2011, to December 31, 2011, would be subject to review and approval pursuant to these provisions. Costs to CDI would likely be minor and absorbable. Costs to DMHC could be at least $30 million, assuming at least half of the expected 8,300 large group rate filings were submitted and reviewed by the department. If this workload were expected to be completed within the 2012 calendar year, DMHC would likely need to contract out to complete the one-time workload.

    Additional Potential Fiscal Effects

    There could be a fiscal effect to the California Public Employees Retirement System (CalPERS) potentially in the tens of millions of dollars if this bill would necessitate it to begin its rate negotiation process earlier than it does now. If the rate negotiation process started earlier, CalPERS would use less actual data and more assumptions to calculate the rates, therefore the rates could be more uncertain and engender higher or lower rate increases. CalPERS is funded approximately 55 percent General Fund and 45 percent special and other funds.

    Costs to the California Health Benefit Exchange (Exchange) are unknown, but it would likely see a fiscal effect like CalPERS'.  Exchange administrative functions are expected to be funded by special funds through the California Health Trust Fund.  Additionally, premiums charged for health care coverage products within the Exchange are required to be the same for identical products offered outside of the Exchange. It is unknown how this would interact with this bill's rate approval.

    Federal Funding for Rate Review and Regulation

    The Patient Protection and Affordable Care Act (ACA) makes available funds for states conducting rate review and prior approval for up to 5 years. CDI and DMHC received a $1 million grant in FY 2010-2011. The departments are currently preparing to apply for a total grant of $4.3 million in federal funds to be spent over a three-year time period, or about $1.4 million annually that would be equally divided between the departments. If this bill were to pass, California could also be eligible for additional grant funding as a state that would conduct prior rate approval.

    (N.b.: I've done some reformatting for this space.)

    Of course, those costs are to be weighed against savings to consumers.  If opponents of the bill can't figure that out now, they'll figure it out by the next time that they face the voters.

    In my avatar, the blue bars show how many want Reps who COMPROMISE; the aqua bars show who wants Reps who STAND FAST no matter what. (Left=Overall; Center=Democrats; Right=Republicans.) And there's the problem!

    by Seneca Doane on Wed Aug 24, 2011 at 03:27:30 PM PDT

  •  Just got home and made the calls (1+ / 0-)
    Recommended by:
    Seneca Doane

    I doubt it's too late to call, as the phones were all answered by humans taking a running tally of phone calls. FWIW, the woman who answered Ted Lieu's line seemed pleased to add my call to the yes list, as she said, "excellent!" when I told her I am in favor of the bill.

    •  That's a very nice thing to hear! Thanks! (0+ / 0-)

      I have nothing against Ted Lieu -- yet.  ;7)

      In my avatar, the blue bars show how many want Reps who COMPROMISE; the aqua bars show who wants Reps who STAND FAST no matter what. (Left=Overall; Center=Democrats; Right=Republicans.) And there's the problem!

      by Seneca Doane on Wed Aug 24, 2011 at 04:41:38 PM PDT

      [ Parent ]

  •  Talked to Sen. Lieu's office (1+ / 0-)
    Recommended by:
    Seneca Doane

    Said he had no news to release but thought we would not be disappointed (we: family in Redondo Beach, Marina del Rey & environs, plus IE). Suggested not wasting time calling Democrats, call the Republicans on Approps.

    •  He did WHAT? (2+ / 0-)
      Recommended by:
      Villanova Rhodes, neroden

      Six of the nine votes on the Committee are Democratic and the three Republicans are all opposed.  We only need five votes.  Calling Republicans is the waste of time.

      That said: I'm glad for at least the hint of a good result and of his being on board.

      In my avatar, the blue bars show how many want Reps who COMPROMISE; the aqua bars show who wants Reps who STAND FAST no matter what. (Left=Overall; Center=Democrats; Right=Republicans.) And there's the problem!

      by Seneca Doane on Wed Aug 24, 2011 at 04:56:13 PM PDT

      [ Parent ]

  •  Made my calls! Thank you so much for keeping (1+ / 0-)
    Recommended by:
    Seneca Doane

    us up to date, and informed!

    I believe that banking institutions are more dangerous to our liberties than standing armies. Thomas Jefferson

    by Lucy2009 on Wed Aug 24, 2011 at 07:24:12 PM PDT

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